手術日期：1900/01/01 00:00 摘要__ 手術科部: 外科部 套用罐頭: Laminoplasty Pre-operative Diagnosis C2-C7 OPLL with spinal stenosis Post-operative Diagnosis Ditto Operative Method Posterior approach for C2 laminectomy,C3-C6 laminoplasty Pathology Nil Operative Findings Spinal cancal stenosis at C2-C7 The dural expanded after laminoplasty No change of SSEP Operative Procedures 1.ETGA,prone position 2.Vertical skin incision from C2-C7 3.Identify and dissect spinal process from paraspinal muscle 4.Partial C2 laminectomy 5.Make a groove at left lamina from C3to C6 by drill through complete separate 6.Make a groove at right lamina from C3to C6 by drill off the cortical bone 7.Elevation of the lamina to left side 8.Fix the lamina by 4 miniplate 9.Hemostasis,irrigation 10.Insert one hemovac below paraspinal muscle 11.Close the wound in layers Operators 賴達明 Assistants 陳元森,林欣穎 手術日期：1900/01/01 00:00 摘要__ 手術科部: 外科部 套用罐頭: HIVD Pre-operative Diagnosis L5-S1 HIVD Post-operative Diagnosis do Operative Method microsurgical disectomy Operative Findings Herniated disc of L5-S1, left side with ruptured annulus and left S1 decompression Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: prone 3.Skin preparation: the back was shaved and scrubbed with povidone-iodine detergent then painted with povidone-iodine tincture and followed by sterilized adhesive plastic sheet covering. 4.A spinal needle was inserted between spinous processes of L5-S1and a portable X-ray film was taken to locate the correct interspace. 5.Incision: 3-cm, between L5-S1 spinous processes, off-midiline at the L5S1 margin of spinous processes. The subcutaneous layer and lumbdorsal fascia were incised then. 6.The aponeurosis of the latissimus dorsi and ileocostalis lumborum muscles at spinous processes of L5S1 was incised, the muscles were detached from the interspinous ligament. The multifidus muscles were detached subperiosteally from L5-S1 laminae by a rasp. 7.The paravertebral muscles were retracted by a modified narrow Taylor retractor which was retained constantly by a rubbersling to the side rail of the operating table. 8.Under an operating microscope, the ligamentum flavum was cleaned and incised longitudinally at the lateral part with a No. 11 blade. The lateral portion of this ligament was removed with a small angle Kerrison rongeur, the lateral portion of the laminae and the medial border of the facets were removed too until the margin of the facets and a corridor to the disc that ran lateral to the root was reached. 9. The epidural fat was left undisturbed andpreserved. 10.The compressed S1 root and veins overlying the protruded discwere gently pushed away by placing 2 small cottonoid patties, one above and one below the disc at the floor of the epidural canal. 11.The compressed root was gently pushed further away temporarily by sucker tip in order to expose the herniated disc more clearly. The posterior longitudinal ligament and annulus were incised around the protruded disc with a No. 15 blade. The degenerated disc was removed with microdisc forceps until a substantial amount of the nucleus had been loosened with a cone curette and removed. 13.The lumbodorsal fascia was approximated by 3 interruped 2/0 silk stitches. 14.Thesubcutaneous layer was closed by running suture with 4/0 Dexon and skin by adhesive tape. 15.Course of the surgery: smooth. Operators 蔡瑞章 Assistants 楊士弘,王國川 手術日期：1900/01/01 00:00 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis bialteral SDE Post-operative Diagnosis do Operative Method SP shunt Operative Findings ourter membrane (+) xanthchromic fluid with low pressure Operative Procedures ETGA, supine liner incision, then create burr hole connect low pressure reservoir(1 CM H2O) close the wound Operators 王國川 手術日期：1900/01/01 00:00 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis lung cancer Post-operative Diagnosis ditto Operative Method port-A insertion Operative Findings blood drawing from port-A was smooth CxR showed good port-A catheter was in good position Operative Procedures 1. LA, supine 2. disinfection and drapping 3. port-A insertion by puncture method at l't subclavian vein 4. wound closure in layers Operators 李元麒 Assistants 陳克誠 手術日期：1900/01/01 00:00 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Gastric tumor Post-operative Diagnosis ditto Operative Method wedge resection Pathology pending Operative Findings A 6*5mm orange, soft mass noted at antrium near the pylorus. Operative Procedures 1. ETGA, supine position. 2. Upper midline mini-laparotomy. 3. Dissect omentum to expose antrium. 4. Wedge resection of the gastric tumor. 5. Close wounds after normal saline irrigation. Operators 李伯皇 Assistants 楊卿堯,賴宗賢 手術日期：1900/01/01 00:00 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis L3 neuroma Post-operative Diagnosis ditto Operative Method Total tumor excision Pathology nil Operative Findings After L3 and L4 partial laminectomy was done, a dumbell shape , soft and whitish tumor was noted on extradural space over L3 level. The tumor size was 2*2*2 cm. It compressed the thecal sac and the cauda equina was push to right postero-lateral aspect. Operative Procedures Under ETGA, the patient was at prone position. Low back midline incision was made. The paraspinal muscles wee all disected. Low L2,L3 and upper L4 partial lamiotomy, left side, was done. The extradural tuumor was identified. Partial debulking was performed first. Then dura was opened. The tumor protruded from outside was debulking by electrocoagulation. Then total tumor excision was done. L3 motor nerve was preserved. Then the dura was closed with 5-0 prolene. The extradural space was packed with gelformand surgicel. One epidural CWV drain was inserted and the wound was closed in layers. Remark: SSEP improved after operation. Operators 杜永光 Assistants 廖俊智 手術日期：1900/01/01 00:00 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT Pre-operative Diagnosis right frontal tumor Post-operative Diagnosis glioma Operative Method grossly total tumor excision Operative Findings 1. Mild brain swelling noted after open dura 2. cortical incision about 3x3 cm was mad over right frontal. The tumor lied 1 cm below normal brain tissue 3, The tumor is whitish, soft about 6x5 cm well demarcated at anterior and medial border. Border ofposterior aspect was not clear 4. Isular portion of MCA was seen after tumor excision Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated left. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: question mark incision over right F-T. Raney clips were applied to the scalp edge for temporary hemostasis. 5. Craniotomy window: 6x5cm, created by making 4 burr holes then cut by power saw. 6. Dural tenting:by 2/0 silk, 2 cm in interval, distributed along the edge of skull window. 7. Dural incision: curvilinear along the edge of skull window 8. Cortical incision about 3x3 cm via right frontal gyrus. The incision procede to tumor edge and was removedpiece by piece with bipolar and suction. 9. Hemostasis: The hemostasis during the resection ofthe tumor was obtained satisfactorily by bipolar coagulator and suction on the patties packing on the bleeders. The blood oozing point from several locations on the bare surface after lobectomy were packed with gelfoam for complete hemostasis. Finally, the cavity created after lobectomy was irrigated with NS several times and it was perfectly watery clear before the dural closure. 10.Dural closure: interruped 2/0 silk sutures for key stitches, then continuous suture with 4/0 Dexon to obtain water-tight closure 11.Closure of skull window: the skull plate was placed back to craniotomy window and fixed by 3 Gage 26 wires.The dura was tented to the center of the skull plate by a 2/0 stitch. The covering muscle was closed by interrupted 1/0 silk stitches. 12.Scalp closure: hemostasis was done withmonopolar coagulator touching on the sucker tip. Galea suturewas performed by continuous suture with 3/0 Dexon and skin by continuoussuture with 3/0 nylon. 13.Drain: one, epidural, Operators 林瑞明 Assistants 楊士弘,王國川 手術日期：1900/01/01 00:00 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) Pre-operative Diagnosis L4-5 stenosis Post-operative Diagnosis L4-5 stenosis Operative Method Lumbar Laminectomy of L4 ,L5, and partial L3 Pathology Nil Operative Findings 1.L4-5 stenosis of spinal canal due to hypertrophic ligmentum flavum and facet joint 2.L 4/5 disc of right side--minimal protrusion 3.Reexpansion of thecal sac after laminectomy Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: prone. 3. Skin preparation: the back was shaved and scrubbed with povidone-iodine detergent then painted with povidone-iodine tincture and followed by sterilized adhesive plastic sheet covering. 4. A spinal needle was inserted between spinous processes of L 4-5 and a portable X-ray film was taken to locate the correct interspace. 5. Incision: 10 cm, over spinous processes from L3 to S1. 6. The latissimus dorsi, ileocostalis lumborum muscles were detached from spinous processes of L3-S1 on both sides by Bovie, then multifidus muscles were dissected subperiosteally from the laminae with rasp. 7. The paravertebral muscles were retracted by self retaining retractorsto expose the spinous processes and laminae of L3-S1. The bleeding from the muscles were stopped by Bovie. 8. The spinous processes and laminae of L4,5and lower L3 were bitten off with rongeurs , Kerrison punch,and high speed air drill until theposterior half of the spinal canal was widely opened. The hypertrophic ligamenta flava including those at lateral recesses were excised.The epidural venous bleeding was stopped by gelfoam packing. 9. The right L4-5 disc of right side was checked as the MRI suggested protruding disc of it. 10.Theparavertebral muscles were closed by interrupted sutures with 2/0 silk, subcutaneous layer by continuous suture with 3/0 Dexon and skin by continuous suture with 3/0 nylon. 11.Drain:one, epilaminal, hemovac. Operators 蔡瑞章 Assistants 蕭輔仁,蘇雅俐 手術日期：1900/01/01 00:00 摘要__ 手術科部: 外科部 套用罐頭: AVF Pre-operative Diagnosis ESRD Post-operative Diagnosis ESRD Operative Method Arteriovenous fistula creation Pathology nil Operative Findings 1. The diameter of the artery was: 3mm; and the diameter of the vein was: 4mm . 2. The anastomosis opening diameter was: 8mm. 3. After the fistula created, a continuous thrill was felt over the fistula Operative Procedures The patient was put on supine position with left hand extended out of the operation table on the arm-board. The operation field was disinfected and draped as usual. Under local anesthsia, a longitudinal skin incision was made between the artery and the vein. The vein and then the artery were dissected out from the surrounding tissue. The vein was then transected and the distal end ligated. Heparin solution was used to flush the vein to test the patency and also to keep it from thrombosis. A bulldog was applied on the proximal end of the vein to prevent air emboli. After gaining distal and proximal control of the artery by bulldog, a longitudinal arteriotomy was performed. The end of the vein was then anastomosed to the arteriotomy with 7-0 prolene continuous suture. The bulldogs were released with the order of vein, distal artery, and proximal artery and the air expelled. After meticulous hemeostasis, the wound was closed in layers. Operators 王水深 Assistants 柯玉誠 手術日期：2001/02/19 00:00 摘要__ 手術科部: 外科部 套用罐頭: ATYPICAL Pre-operative Diagnosis hepatocellular carcinoma Post-operative Diagnosis hepatocellular carcinoma with hemangioma Operative Method Atypical hepatectomy S6, S7 Pathology pending Operative Findings 1. 0.7 cm in diameter yellowish encapsulated elastic tumor at seg. 6 2. 1.5 cm in diameter hemagioma at seg. 7 3. healthy liver, cirrhosis (-), ascites (-) 4. previous cholecystectomy Operative Procedures 1. ETGA with supine position 2. Right subcostal incision with xyphoid extension 3. Mobilization of right lobe and enterolysis 4. Intra-operative sona was applied for localizing the tumor 5. Atypical hepatectomy at S6 and S7 with CUSA and bipolar 6.Hemostasis and set 2 rubber draining tube to right subphrenic and subhepatic space. 7. Closed the wound in layers. Operators 李伯皇 Assistants 黃德佳,陳建華 手術日期：2001/03/07 12:27 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT Pre-operative Diagnosis brain tumor Post-operative Diagnosis falx meningioma Operative Method Craniotomy for falx tumor Pathology meningioma Operative Findings falx tumor, 5x5 cm, soft, yellowish and well-defined tumor Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet.4. Incision:curvilinear incision at frontal area. Raney clips were applied to the scalp edge for temporary hemostasis. Raney clips were applied to the edge of the scalp for temporary hemostasis. 5. Craniotomy window: 8x 4 cm, created by making 6 burr holes then cut by power saw. 6. Dural tenting: by 2/0 silk, 2 cm in interval, distributed along the edge of skull window. 7. Dural incision: crusade fashion (curvilinear along the edge of skull window) 8. Lobectomy: cerebral cortical incision was made by Greenwood bipolar forceps at frontal area. The procedure was then carried out deep into white mater until the tumor was exposed. The tumor was resected by bipolar forceps. The bleeding during the dissection was stopped by bipolar coagulator or by packing with conttonoid patties. 9. Hemostasis: The hemostasis during the resection ofthe tumor was obtained satisfactorily by bipolar coagulator and suction on the patties packing on the bleeders. The bleeding from artery was stopped by unipolar coagulator(or hemoclips). The blood oozing point from several locationsonthe bare surface after lobectomy were packed with gelfoam for complete hemostasis. Finally, the cavity created after lobectomy was irrigated with NS several times and it was perfectly watery clear before the dural closure. 10.Dural closure: interruped 2/0 silk sutures for key stitches, then continuous suture with 4/0 Dexon to obtain water-tight closure (Dural graft?) (A piece of lyodura ( x cm ) was used for a perfect dura repair. 11.Closure of skull window: the skull plate was placed back to craniotomy window and fixed by 3 Gage 26 wires. The dura was tented to the center of the skull plate by a 2/0 stitch. The covering muscle was closed by interrupted 1/0 silk stitches. 12.Scalp closure: hemostasis was done withmonopolar coagulator touching on the sucker tip. (The muscles were approximated by interrupted sutures with 2/0silk ) Galea suture was performed (the subcutaneous layer ) by continuous suture with 3/0 Dexon and skin by continuoussuture with 3/0 nylon. 13.Drain: one epidural drain was inserted prior to scalp closure Operators 曾勝弘 Assistants 楊士弘 手術日期：2001/03/09 13:30 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Subcutaneous tumor, right thigh Post-operative Diagnosis Ditto Operative Method Excision Pathology Pending Operative Findings A firm and fibrotic mass about 3x3x2 cm in size in semimembranosus muscle Operative Procedures 1.Spinal anesthesia, supine position 2.Disinfected with alcohol hibitane and drapped with surgical towels in sterile fashion 3.Incision along medial aspect of right thigh about 15 cm 4.Identify and excise tumor in semimembranosus muscle 5.Check bleeding 6.Set one CWV drain 7.Wound closure in layers 8.The patient tolerated the whole procedure well. Operators 湯月碧 Assistants 張瓊文,劉亮廷 手術日期：2001/03/16 18:00 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis CML S/P alloBMT, chronic GVHD, pancreatitis Post-operative Diagnosis Ditto Operative Method Port-A implantation Pathology Nil Operative Findings Port-A was inserted smoothly Operative Procedures 1. Local anesthsia 2. Left axillary oblique incision 3. Divide left cephalic vein 4. Insert port-A smoothly 5. Close the wound in layers Operators 林明燦 Assistants 李柏居簡穎瑄 手術日期：2001/05/03 18:11 摘要__ 手術科部: 外科部 套用罐頭: Cad Pre-operative Diagnosis CAD-2VD MR MS TR Post-operative Diagnosis ditto Operative Method CABG Pathology nil Operative Findings CAD: LAD mid 60% stenosis(2mm) LCX distak 80% stenosis(1.5mm) MSR Severe calcification of mitral annulus and P2 chordae. P3 prolapse. Thicking of motral leaflets. TR annulodilation. Operative Procedures 1. ETGA, supine 2. Median sternotomy 3. Ao RAA to SVC direct IVC cannulation 4. Moderate hypothermic CPB. 5. AXC antegrade cold blood cardioplegia 6. CABG: AO-SVG-OM1 LIMA-LAD(distal) 7. LA paraseptal atriotomy 8. Triangular resection ofP3. 9. Primary repare of the post mitral leaflet. 10. RA atriotomy. Wooler's annuloplasty to TV 11. Epicardial pacing wire. 12. Weaning off CPB 13. Wound closure. Operators 許榮彬 Assistants 吳毅暉,諶大中,賴宗賢,陳忠蔚 手術日期：2001/05/04 11:00 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Bilateral inguinal hernia Post-operative Diagnosis Ditto Operative Method GPRVS Pathology pending Operative Findings Bilateral direct hernia, abdominal wall defect, over inguinal area Operative Procedures 1. Under endotracheal general anesthesia, the patient was put at supine position. The operation field was disinfected and drapped as usual. 2. Low abdominal midline incision. The layers was deepened untill the pre-peritoneal fat. 3. Dissected the abdominal wall above the pre-peritoneal wall, bilaterally. Identified and looped the spermatic cord. 4. The mesh was applied in the layer between the pre-peritoneal fat and posterior layer of rectus sheeth. The spermatic cords were looped with mesh. 5. Check bleeding and hemostasis. 6. Closed the wound in layers. Operators 梁金銅 Assistants 黃慧夫 手術日期：2001/06/06 13:24 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis left parasellar cyst, r/o tumor Post-operative Diagnosis dotto Operative Method left temporal craniotomy for cyst fenestration and tumor excision Pathology pending Operative Findings 1.s/p left temporal craniotomy with marked temporalis muscle atrophy 2.some cystic component was noted over the middle fossa base with extension to parasellar region, the wall was thick 4.some soft yellowish necrotic tissue was noted over the parasellarregion. Operative Procedures 1.ETGA,supine with head turn to right 2.incision as previous wound 3.remove the previous skull plate 4.fenestration of the cyst 6.remove the necrotic tumor-like substance 7.hemostasis 8. set one CWV drain 9. close the wound Operators 高明見 Assistants 蕭輔仁,趙鴻丞 手術日期：2001/07/23 20:55 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Left upper lobe lung cancer with multiple surrounding nodule Post-operative Diagnosis Left upper lobe lung cancer with multiple surrounding nodule Operative Method Left upper lobe lobectomy and lymph node dissection Pathology Adenocarcinoma Operative Findings 1. One 3.5 x 3 x 2 cm pleural retracted mass located at left upper lobe. Cut surface : grayish 2. Several nodules (<1cm) located at left upper lobe. Cut surface:whitish. Hard in consistency. Operative Procedures 1. ETGA with double lumen 2. Right decubitus position 3. Thoracoscopic examination. 4. Left posterolateral thoracotomy via 4th ICS 5. Devide the LUL branch of superior pulmonary vein. Devide the LUL branch of pulmonary artery. Devide the LUL bronchuswith TA 30x4.8xI 6. Lymph node dissection : group 5,7,10,11 7. Check hemostasis and air leakage 8. Sent the pleural washing cytology 9. 28 Fr. chest tubes x II 10. Close the wound in layers. Operators 李元麒 Assistants 黃培銘 李 光 溫瓊容 手術日期：2001/09/10 13:26 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Carcinoid of rectum Post-operative Diagnosis Ditto Operative Method Transanal wide excision Pathology Pending Operative Findings A 1x1 cm polypectomy scar over 5 o'clock noted 6~7 cm from anal verge Operative Procedures 1.ETGA,lithotomy 2.identified the lesion position and expoures it. 3.removed the mass 4.check bleeding 5.RDx1 place in the anal canal 6.cover the anus by gauze Operators 游憲章 Assistants 吳建明,林致男 手術日期：2001/09/23 21:39 摘要__ 手術科部: 外科部 套用罐頭: Anterior Discectomy and Fusion, Cervical Spine Pre-operative Diagnosis C-HIVD Post-operative Diagnosis Ditto Operative Method Anterior Discectomy and Fusion, Cervical Spine Operative Findings 1.Relatively well-alignment of cervical spine 2.Spur formation over C3-4 3.Degenerative change of intervertebral disc of C3-4 4.Well-reexpansion of thecal sac after decompression. Operative Procedures 1. Anesthesia: endotracheal general 2.Position: supine with neck hyperextended by a air cuff placed beneath the shoulder. Rt side pelvis was elevated too. 3. Skin preparation: the anterior neck and rt iliac crest was shaved and scrubbed with povidone-iodinew detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4.Incision; 5 cm, transverse middle cervical, extended from anterior margin of sternocleidomastoid (SCM) muscle to thyroid cartilage. 5. The plastisma muscle was transected and mobilized from the underlying superficial cervical fascia which was then opened in vertical direction along the anterior margin of the SCM muscle. 6.The dissection was advanced at the loose plane between SCM muscle and strip muscles until the prevertebral fascia had been reached. The former structure was retracted to the lateral and the later structures with esophagus and trachea to the opposite side by Cloward cervical retractor. 7.The prevertebral fascia was opened vertically, the lesion intervertebral space was exposed and identified by intraoperative portable X-ray 8.The most medial portion of the longus coli muscles on both sides were detached from the vertebral bodies to providea wider exposure of the vertebral bodies. 9.The anterior longitudinal ligment was incised transversely at the margins of intervertebral space, the annulus fibrosus was cut too. 10.The degenerated disc and cartilage plate were removed by curette andthe anterior-inferior rim of C3-4 vertebral body was resected by Kerrison punch for easier approach to the posterior rim of the intervertebral space. 11.The intervertebral spac was widened by a Cloward interveetebral spreader. The sclerotic spondylotic bar at the posterior margin of C-3 bodies and the spur at foramen Luscka were removed by high speed air drill and fine curette. The posterior longitudinal ligament was cut from bony edge by curette and then removed. Consequently, the spinal dura expanded into the intervertebral space. 12.The surfaces of vertebral bodies at this intervertebral space was trimed by high speed air drill to creat a biconcave intervertebral space. 13.A 1.5x1.2 cm block of bone graft was taken from rt iliac crest,then trimed into a ovoid shape and size a little bit bigger than the intervertebral space. 14.The bone graft was packed into the intervertebral space tightly by a impactor. The intervertebral space was widened by pulling the patient's head whilethe impaction of the bone graft was doing. 15.The air cuff beneath the shoulder was deflated, the Cloward cervical retractor removed. 16.Wound closure: continuous suture with 4/0 Dexon for plastisma and continuous suture with 4/0 nylon on the skin. 17.Drain:1 x mini-hemovac 18.Blood transfusion:nil 19.Course of the surgery: smooth. Operators 賴達明 Assistants 廖俊智,徐光漢 手術日期：2001/09/28 08:25 摘要__ 手術科部: 外科部 套用罐頭: Biopsy 乳房 Pre-operative Diagnosis Left side advanced breast cancer Post-operative Diagnosis ditto Operative Method 1.Incisional biopsy, 2.Port-A implantation Pathology pending Operative Findings 5cm mass with overlying skin ulceration Operative Procedures ---Port-A implantation 1.Supine IVG 2.Incision along right deltopectoral groove 3.Insert artificial vessel through cephalic vein 4.Fix the port on pectoralis major muscle 5.Close the wound in layers ---Incisional biopsy 6.Curved incision at left breast 7.Take specimen for pathological examination 8.Hemostasis and close the wound Operators 張金堅 Assistants 黃凱文,陳哲伸 手術日期：2001/10/31 17:09 摘要__ 手術科部: 外科部 套用罐頭: AVF Pre-operative Diagnosis ESRD Post-operative Diagnosis ESRD Operative Method Arteriovenous fistula creation Pathology nil Operative Findings 1. The diameter of the artery was: 2mm ; and the diameter of the vein was: 2mm . 2. The anastomosis opening diameter was: 8mm . 3. After the fistula created, a continuous thrill was felt over the fistula Operative Procedures The patient was put on supine position with left hand extended out of the operation table on the arm-board. The operation field was disinfected and draped as usual. Under local anesthsia, a longitudinal skin incision was made between the artery and the vein. The vein and then the artery were dissected out from the surrounding tissue. The vein was then transected and the distal end ligated. Heparin solution was used to flush the vein to test the patency and also to keep it from thrombosis. A bulldog was applied on the proximal end of the vein to prevent air emboli. After gaining distal and proximal control of the artery by bulldog, a longitudinal arteriotomy was performed. The end of the vein was then anastomosed to the arteriotomy with 7-0 prolene continuous suture. The bulldogs were released with the order of vein, distal artery, and proximal artery and the air expelled. After meticulous hemeostasis, the wound was closed in layers. Operators 王水深 Assistants 紀乃新 手術日期：2001/11/09 16:20 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) Pre-operative Diagnosis lumbar spinal stenosis Post-operative Diagnosis 1. lumbar spinal stenosis 2.spinal neuroma Operative Method 1.Lumbar Laminectomy 2. spinal tumor excision Pathology pending Operative Findings Ligamentum flavum of L3-S1 was hypertrophic.Facet joints were not hypertrophic.Thecal sac of L3-S1(especially L4-5) was compressed by hypertrophic ligamentum flavum and it re-expanded well after decompressive laminectomy. An elastic tumor, about 0.6 cm indiameter , was noted in left L4-5 intraspinal extradural space. Operative Procedures Under endotracheal general anesthesia,the patient was lying on a prone position.Skin preparation was performed with povidone-iodine tincture and followed by sterilized adhesive plastic sheet covering. A spinal needle was inserted between spinous processes of L4-5 and a portable X-ray film was taken to locate the correct interspace. SKin Incision was made over spinous processes from L3 to S1. The latissimus dorsi, ileocostalis lumborum muscles were detached from spinous processes of L3-S1 on bothsides by Bovie, then multifidus muscles were dissected subperiosteally from the laminae with raspa. The paravertebral muscles were retracted by self retaining retractors to expose the spinous processes and laminae of L3-S1. The bleeding from the muscles were stopped by monopolar electrocautery. The spinous processes and laminae of total L4 and partial L3 and L5 were bitten off with rongeurs and Kerrison punch until the posterior half of the spinal canal was widely opened.(The spinous process and thelamina of L3-L5)was removed as a whole piece by cutting through the base of the lamina with Kerrison punch on both sides.) The hypertrophic ligamenta flava including those at lateral recesses were excised. The epidural venous bleeding was stopped by gelfoam packing. The interlaminal spaces of L3-L5 on both sides were widened by partial laminecotmy Kerrison punch until the space was large enough for the distraction hook. Theparavertebral muscles were closed by interrupted sutures with 2/0 silk, subcutaneous layer by continuous suture with 3/0 Dexon and skin by continuous suture with 3/0 nylon.One CWV drain was placed in epidural space. Operators 杜永光 Assistants 廖俊智,陳琬琳 手術日期：2001/11/16 09:00 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt Pre-operative Diagnosis VP shunt dysfunction with hydrocephalus Post-operative Diagnosis Ditto Operative Method VP shunting via left Kocher's point Pathology Nil Operative Findings 1. CSF: clear, colorless; pressure about 10 cm H2O 2. Ventricular catheter: 6.3 cm deep into the frontal horn of right lateral ventricle Reservoir: Medium-pressure type Peritoneal catheter: 25 cm deep into the peritonealcavity. Low- pressure type 3. Marked scarring at the operative field Operative Procedures 1. Anesthesia: Endotracheal general. 2. Position: Supine with head rotated to right and left shoulder elevated. 3. Skin preparation: Shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture; then covered with sterilizedadhesive plastic sheet. 4. Incision: 5 cm along previous scar, around right Kocher's point, corresponded to the location of left frontal horn. Raney clips were applied to the scalp edge for temporary hemostasis. 5.Afterthe scalp flap had been lifted and reflected anteriorly, a burr hole was made and the dura was tented by 2 stitches. 6. The dura was opened in cruciate fashion. Left lateral ventricle was tapped by a ventricular needle, and then a Nelaton tube was placed temporarily. 7. Minilaparotomy was done at LUQ of the abdomen, and then a trocar was inserted into peritoneal cavity. Subsequently, distal 25 cm segment of the peritoneal catheter was introduced into the peritoneal cavity through the outer tube of the trocar. The proximal end of this catheter was passed through subcutaneous tunnel at forechest, neck, right retroauricular area and connected with the reservoir and ventricular catheter. 8. The ventricular catheterwas inserted into left lateral ventricle after removing the Nelaton tube. The shunt system was checked to make sure its function was well. 9. The reservoir was fixed to the pericranium with 3 stitches. 10.Scalp closure: Hemostasis was done. Galea suture was performed by continuous suture with 3/0 Dexon and skin by continuous suture with 3/0 Nylon. 11.Course of the surgery: Smooth. Operators 高明見 Assistants 蕭輔仁,溫崇熙 手術日期：2001/11/30 10:09 摘要__ 手術科部: 外科部 套用罐頭: Hemorrhoidectomy Pre-operative Diagnosis hemorrhoid Post-operative Diagnosis Ditto Operative Method Hemorrhoidectomy Pathology Pending Operative Findings Multiple external and internal mixed hemorrhoids are noted at 1, 3, 5, 7 and 11 o'clock direction of anus. Operative Procedures 1. Under general anesthesia, the patient is placed in prone position. The perineal skin is carefully cleaned with alcohol better-iodine solution, and the anal canal is carefully swabbed with cotton-wool pledgets soaked in better-iodine solution until allfaecal materials have been removed. 2. The forceps are placed on the perianal skin just outside the mucocutaneous junction opposite each primary hemorrhoidal lesion (left lateral, right posterior and right anterior-3,7 and 11 o'clock direction. Gentle traction on the forceps brings each hemorrhoidal mass into view. 3. Incision along the edge of skin tag and exposure the subcutaneous space were performed. Dissection is continued in a coronal plane just close to the sphincter ani internus muscle and towards the pedicle of the hemorrhoid in the submucosal plane. 4. The pedicle is ligated with 2-0 silk suture. Then the pedicle can be cut through, and the whole hemorrhoid is removed. 5. The hemorrhoid over 1 and 5 direction of anus was removed by undermidedissection. 6. The edge of the anal mucosa skin tag is approximated with continuous 3-0 chromic catgut sutures. The anal canal is compressed by gauze and gelfoam. Operators 張金堅 Assistants 黃德佳,蔡青穎 手術日期：2001/12/25 10:16 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis GPRVS wound infection Post-operative Diagnosis ditto Operative Method Debridement Pathology Nil Operative Findings 1.A angle of mash noted just beneath the wound (subcutaneous) 2.Watery discharge was noted. 3.No pus 4.seroma(+) Operative Procedures 1.ETGA, supine position. 2.Skin well prepare. 3.Incision from the old wound. 4.Perform debridement. 5.set a penrose drain. 6.Left the wound opened. Operators 梁金銅 Assistants 黃德佳,吳典育 手術日期：2001/12/31 13:40 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis S/P GPRVS, wound infection Post-operative Diagnosis Ditto Operative Method Debridement and wound repair Operative Findings 1. A open wound at upper end of previous operative scar, 3X2.5X2.5 cm, with granulation tissue and a little necrotic fat tissue 2. A small piece of mesh could be seen at the bottom of the open wound. Pus accumulation below the mesh was also noted. Operative Procedures 1. ETGA,supine position 2. A skin incision along the previous operative scar was made. The dissection was carried down to expose the mash layer. 3. Pus was evacuated and most of the mash was removed. 4. The wound was irrigated with a large amount of normal saline and aquaous BI solution. 5. Close the anterior sheath with 1-0 vicryl. One CWV drain was placed under the anterior sheath. 6. Close the wound with matress nylon sutures. Operators 梁金銅 Assistants 游聖彬 手術日期：2002/02/22 17:37 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Nodular goiter. Post-operative Diagnosis Thyroid cancer. Operative Method Radical total thyroidectomy. Pathology Frozen : papillary carcinoma. Operative Findings 1. a 2 x 1.5 cm hard irregular mass at left lobe of thyroid near the left recurrent laryngeal nerve. 2. Regional LAP(+). 3. Pyramidal lobe(+). 4. Frozen section : papillary carcinoma. Operative Procedures 1. ETGA. supine position with neck hyperextension. 2. Transverse neck incision. 3. Mobilize bilateral thyroid lobe. 4. Radical total thyroidectomy. 5. Minihemovac x 2. 6. Wound closure. Operators 郭文宏 Assistants 吳建明,李　光 手術日期：2002/03/04 16:39 摘要__ 手術科部: 外科部 套用罐頭: LC Pre-operative Diagnosis Acute cholecystitis Post-operative Diagnosis Acute cholecystitis with empyema and perforation Operative Method Laparoscopic cholecystectomy Pathology pending Operative Findings 1.Turbid ascites 2.Severe adhesion around GB 3.Severe inflammation and distension of GB 4.GB wall thickening and rupture 5.Many small cholesterol stones Operative Procedures 1.ETGA, supine 2.Create one camera hole and three working holes by laparotomy(10-5-5) 3.Create CO2 pneumoperitoneum 4.Dissect and divide GB 5.Use endo-GIA to free gallbladder from liver bed 6.Remove gallbladder; check bleeding 7.Set one CWV drain 8.Close wounds in layers Operators 賴逸儒 Assistants 吳建明,王宗仁 手術日期：2002/03/08 11:34 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis CML; bilateral inguinal lymphadenopathy Post-operative Diagnosis Ditto Operative Method Excisional biopsy of left inguinal tumors Pathology Pending Operative Findings 1. A 1.5x1.0x1.0 cm yellowish lipoma-like mass over left inguinal area 2. A 1.0x1.0x1.0 cm yellowish lipoma-like mass over left upper anterior thigh Operative Procedures 1. IVG with laryngeal mask, supine position 2. Skin preparation 3. Linear incision over left inguinal area and left upper anterior thigh 4. Excisional biopsy of tumors 5. Close the wound in layers Operators 田郁文 Assistants 吳明勳,蔡青穎 手術日期：2002/03/11 10:00 摘要__ 手術科部: 外科部 套用罐頭: Hemorrhoidectomy Pre-operative Diagnosis Hemorrhoid Post-operative Diagnosis Hemorrhoid Operative Method Hemorrhoidectomy Pathology pending Operative Findings Multiple external and internal mixed hemorrhoids are noted at 3,5,7 and 11 o'clock direction of anus. Operators 王世名 Assistants 王宗仁 手術日期：2002/04/15 17:17 摘要__ 手術科部: 外科部 套用罐頭: C-P Angle Tumor Pre-operative Diagnosis left C-P angle tumor Post-operative Diagnosis r/o left vestibular schwannoma Operative Method total tumor excision Pathology pending Operative Findings 1.a 3.7 cm in diameter, yellowish , elastic-soft, well- defined, hypervascular tumor mass located at left side cerebellar-pontine angle. 2.the trigeminal nerve was deviated to anterio-media aspect; the facial nerve was compressed upward. The pons was pushed to right side. 3.mild IAC enlargement. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: 3/4 prone position 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: bow shape,--- retroauriculear. The sternocleidomastoideus, splenius capitis, oblique capitis superior and part of the trapezius muslces were devided until the posterior arch and transverse process of C1 waspalpable. 5.Craniectomy: 5x4 cm, left suboccipital retromastoid, to expose the margin of sigmoid sinus. 6. Dural incision: T shaped and reflected to sigmoid sinus. 7. CSF was drained via EVD (frazier point ), Consequently, the posteriorsurface of theC-P angle tumor was well exposed. 8. Under operating microscope, the tumor was first decompressed by tumor forcep and bipolar. 9.The vessels distributed on the posterior surface of the tumor were coagulated by bipoar coagulator and the branch of AICA adhered on the posterior-lower surface of the tumor was carefully separated. 10.The removal of the tumor was progressed by gutting the tumor parenchyma and by mobilization of the tumor capsule away from the surrounding vital structures in an alternate fashion. Great attention was paid to mobilize the tumor away from the brain stem and to identify the facial nerve. 11.After most part of the tumor except those of anterior superior part where the facial nerve hindon its anterior surface had been excised, the dura of petrous bone at posterior wall of the internal acoustic meatus was coagulated and stripped off. Then, the posterior wall of the internal acoustic meatus was fully opened by high speed air drill untilthe deepest part of intracanal tumor had been well exposed. The intracanal tumor was removed by small sucker and curette to expose the intracanal portion of the facial nerve . The last segment of the tumor left in the C-P angle was now resected with great precaution in order to preserve the nearly discernible facial nerve at this location (the nerve was identified and traced from both ends). 12.The blood oozing points on the cerebellar surface where compressed by the tumor previously were packed with gelfoam for hemostasis. The blood in the C-P angle cistern was washed out by NS irrigation. 13.Dural closure: interrupted 2/0 silk suture for key stitches, then continuous suture with 4/0 prolene to obtain water-tight closure (Dural graft was taken). 14.Wound closure: hemostasis was done with monopolar coagulator. The muscles were closed by interruped sutures with 1/0 silk, subcutaneous layer by continuous suture with 3/0 Dexon and skin by continuous suture with 3/0 nylon. 15.drain:one, epidural. 16.Blood transfusion:nil 17.Course of the surgery:smooth. Operators 曾漢民 Assistants 廖俊智,陳元森 手術日期：2002/05/01 12:17 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) Pre-operative Diagnosis Intraspinal tumor, L3,L4 Post-operative Diagnosis Intraspinal tumor, rule out neurofibroma, L3, L4 Operative Method Tumor excision, L3 laminectomy. Operative Findings 1.A 1.5cm in sized, encapsulated, soft, moderate vascularized, whitish intradural extramedullary tumor over left L4 dosal root was noted. A small tumor about 0.3 cm in size was noted 1.5cm proximal to the larger tumor over the same nerve root. The cauda equina was compressed and displaced to anterior aspect. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: prone. 3. Skin preparation: the back was shaved and scrubbed with povidone-iodine detergent then painted with povidone-iodine tincture and followed by sterilized adhesive plastic sheet covering. 4. A spinal needle was inserted between spinous processes of L3-4 and a portable X-ray film was taken to locate the correct interspace. 5. Incision: 10 cm, over spinous processes from L2 to L4. 6. The paraspinal muscles were detached from spinous processes of L2--4 on both sides by Bovie, then multifidus muscles were dissected subperiosteally from the laminae with rasp. 7. The paravertebral muscles were retracted by self retaining retractors to expose the spinous processes and laminae of L3--4. The bleeding from the muscles were stopped by Bovie. 8. The spinous processes and laminae of L3 were bitten off with rongeurs and Kerrison punch until the posterior half of the spinal canal was widely opened. (The spinous process and the lamina of L3 was removed as a whole piece by cutting through the base of the lamina with Kerrison punch on both sides.) The epidural venous bleeding was stopped by gelfoam packing. 9. The dura was opened under microscope, divided the tumor from the adjacent rootlet. Internal decompression was done. Clip the rootlet above and below the tumor. Close the dura with 4-0 prolene running suture after adequate hemostasis. A Hemovac was positioned over epidura space. 10.The paravertebral muscles were closed by interrupted sutures with 2/0 silk, subcutaneous layer by continuous suture with 3/0 Dexon and skin by continuous suture with 3/0 nylon. 11.Drain: one, epidura, hemovac. 12.Blood transfusion: nil 13.Courseofthe surgery: smooth. Remark: 1.Blood loss about 100cc. Operators 曾勝弘 Assistants 李定洲,吳益嘉 手術日期：2002/05/03 01:27 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis TGA,VSD,ASD,PDA Post-operative Diagnosis Ditto Operative Method 1.BSA 2.VSD repair 3. ASD repair 4. PDA ligation Operative Findings 1.Situs solitus, levocarida 2.VSD, perimembranous type 3.ASD 4.AV concordant, VA dsicordant,D-loop ventricle 5.Aorta is R't anterior to pulmonary trunk. Operative Procedures Under endotracheal intubated general inhalation anesthesia, the patient was placed in supine position.The patient was disinfected and drapped in the usual manner and a longitudinal skin incision median sternotomy used to enter the chest. The pericardium was incised in a inverted T direction and retracted laterally with stay sutures. Exposure of the mediastinum was obtained by sharp and blunt dissection . Tapes were passed around the superior and the inferior vena cava. The superior and inferior vena cava and the aorta were cannulated in the routine fashion. The patient was placed on cardiopulmonary bypass. Ligation of PDA was done. The aorta was crossclamped and transected over the root. In-situ make-up of the bilateral coronary artery flap was doneand transferred to PA root (neo-Ao).Make-up of pulmonary artery flap was done. Neo-aorta re-implantation was anastoomosed vai PA route. Spiral anastomosis of PA was done uwing partial wall of aorta. The anterior aspect of PA was constructed with pericardium. VSD repairt with Prolene interupted sutures with TV. ASD repari was done. De-ari, warm up and weaning of CPB. The heart beat was resumed spontaneously with normal sinus rhythm .Two chest tubes were placed into pericardial cavity. The sternum was closed with wire, and the wound was closed in layers. Operators 邱英世 Assistants 黃書健,紀乃新 手術日期：2002/05/09 17:43 摘要__ 手術科部: 外科部 套用罐頭: MRM Operative Findings Name: 洪瑞葉 Operation Date 91-04-10 Age & Gender: 45y/o female Operation Date 8:45-12:35 3hr50min Chart No. 4047147 Operator HP張金堅 VS戴浩治 Bed No. 9C07-1 Assistant R6王建興 R4王明暘 R2葉啟娟 Ri黃啟銘 Pre-OP diagnosis Left side advanced breastcancer with skin invasion s/p chemotherapy Post-OP diagnosis Left side advanced breast cancer with skin invasion s/p chemotherapy OP method Modified radical mastectomy with STSG, left side < OP Finding> A 5*5*6cm3 hard and whitish mass with overlyingerythematous change of skin and mild necrosis was found at 3-5 o'clock direction beneath left nipple. Enlarged axillary LAP was also noted. Level II LN dissection was done. Breast tissue felt severe fibrosis and skin defect about 15*15cm2 was also found.< OP Procedure > Under endotracheal intubated general anesthesia, patient was put on supine position with left arm 90 degree abducted. Skin was disinfected and draped as usual over left chest and thigh. A transverse elliptical incision about 25cm including the nipple-areolar complex and the skin from right parasternal to left axillary area was made superiolaterally. The incised skin was grasped and retracted upward with breast clamps for skin flap dissection. Electrocauterization was used for dissection of skin flaps. The dissection reached to the level 1 cm below clavicle superiorly, the costal margin inferiorly, and the parasternal area medially. Lateral dissection was extended to the border of latissimus dorsi. Theclavipectoral fascia was opened. The axillary vein was exposed and identified. The branches of the axillary vein were divided between ligatures. Axillary lymph node dissection was then performed for level I and II with identification and preserving of the long thoracic nerve and thoracodorsal nerve, breast tissue was removed en bloc with the axillary lymph nodes. The bleeders were checked meticulously. The operative field was irrigated with warm saline. Plasty surgeon was consulted for STGS harvest form left thigh (5*15cm2*III, 8/1000 inch thick) The lateral part of wound was closed. A CWV drains was left at left axillary area.The STGF was paste to the skin defect and fixed by Apose and 3-N strip. Tie-over dressing was put on the STSG and compressed by E-La bandage. The donor site of the left thigh was covered with Biofill. Estimated blood loss was minimal and the patient stood the whole procedure well. 手術者:________________ HP張金堅 記錄者:_______________R2葉啟娟 Operators 張金堅 Assistants 王明暘,葉啟娟 手術日期：2002/05/18 20:44 摘要__ 手術科部: 外科部 套用罐頭: Hernia Pre-operative Diagnosis Congenital heart disease; right inguinal hernia & hydrocele; left hydrocele; umbilical hernia. Post-operative Diagnosis Ditto Operative Method Herniorrhaphy for umbilical and bilateral inguinal hernia Pathology Pending Operative Findings Right indirect type inguinal hernia with hydrocele, no content in herniac sac; left hydrocele; umbilical hernia, small sac. Operative Procedures 1. Under endotracheal general anesthesia with the patient in supine position, prepping with Povidone iodine and draping was performed in the usual sterile fashion. 2. An transverse incision along skin crease was made in the bilateral inguinal area and subumbilical area. Incision was deepened through layers. The scarpa fascia was opened. The external oblique fascia was opened from external ring. 3. Spermatic cord was looped. Dissection was performed on the antero-medial aspect of the spermatic cord. An indirect herniac sac was noted and mobilized. The sac was opened and extended into distal and proximal ends, the latter was then high-ligated.. Adequate hemostasis was obtained. 4. Closure was proceeded with interrupted PDS on the scarpa fascia and the skinwas closed with PDS subcuticularly. Operators 許文明 Assistants 曾仁河 手術日期：2002/05/22 08:30 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Right lower leg laceration wound Post-operative Diagnosis Right lower leg laceration wound Operative Method Debridement and wound closure Pathology nil Operative Findings 1. Two laceration wound, about 6x1 cm, and 3x1 cm, with subcutaneous tract at right lower leg. 2. No pus accumulation. 3. No skin necrosis. 4. Mild erythematous change around the wound. Operative Procedures Under intra-venous injection, the patient received general anesthesia. The operation field was disinfected and drapped well. The wound was irrgigated with much normal saline. The non-viable tissue was removed. Adquate hemostasis was obtained. TwoMini-hemovac were inserted at each wound space. The wound was closed in two layers. Operators 簡雄飛 Assistants 賴幸光,黃慧夫 手術日期：2002/05/23 17:18 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis ditto Operative Method Ommaya insertion Pathology nil Operative Findings 1.The CSF was clear and light yellowish 2.The initial CSF pressure was 9-10 cmH2O 3.The ventricular catheter was inserted for 4.5 cm. Operative Procedures 1.ETGA,the patien was at supine position with head maintained for 45 degrees left rotation. 2.Incision was made around right Kocher point and the bone was cut by Rounger. 3.Set up the Ommaya and ventricular catheter was inserted for 4.5 cm via right Kocher point. 4.The wound was closed with 3-0 dexon and 4-0 nylon. Operators 郭夢菲 Assistants 李定洲,張源驛 手術日期：2002/05/28 14:00 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Right femoral artery aneurysm Post-operative Diagnosis Right FA to right femoral vein fistula Operative Method AV fistula division Pathology Nil Operative Findings 1. Right femoral artery was sized 12 mm; right femoral vein was sized 20 mm; 2. Femoral thrills were felt preop but no more felt postop; 3. AV fistula: right superficial femoral artery medial posterior aspect to right femoral vein, with diameter of 6 mm; 4. There was no pseudoaneurysm or capsule found. Operative Procedures Under ETGA, the patient was placed on supine position, followed by B-I disinfection and draping exposing right groin. At right femoral artery, longitudinal incision was made. CFA, DFA, SFA, and AV fistula were identified. The AV fistula was dividedand resected. SFA and FV orifices were directly closed with 6-0 prolene. After hemostasis, the wound was closed in layers. Operators 虞希禹 Assistants 吳毅暉,許　鈞,陳勁辰 手術日期：2002/06/14 20:21 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT Pre-operative Diagnosis Falx meningioma s/p TAE; basilar tip and right ICA siphon aneurysms. Post-operative Diagnosis Ditto Operative Method Frontal craniotomy-interhemispheric approach, Simpson II tumor excision for meningioma. Pathology Pending Operative Findings Bicoronal scalp incision was done, and then a wide frontal craniotomy was made. Dura incision was made over left frontal side in a inverted C shape, and which was reflected rightward to the border of superior saggital sinus. There was a small area of gliosis change over left frontal lobe resulted from pressure effect of the tumor. We then proceded the operation via left interhemispheric space. The tumor was pinkish to flesh in color, soft in consistency, 6x5x5cm in size, well-demarcated, bloody, and 2/3at left side, and 1/3 at right side. Bilateral pericallosal and callosomarginal arteries were encased by the tumor. We divided and dissected the tumor base off the falx to separate the tumor into a left and a right portion.Then tumor excision was performed by internal debulking with bipolar and tumor forceps for the left portion first. The left portion was finally totally removed. Right portion excision was then followed. However, left pericallosal artery was disrupted during procedures. Revascularizationwith end-to-end anastomosis was done with 10-0 prolene thread, and ischemic time during procedures was about one hour. The right portion was finally totally removed. After completing tumor excision, the tumor attachment on falx was treated with EMF. Operative Procedures 1. ETGA; supine; skull fixation with Mayfield skull clamp. 2. Bicoronal scalp incision--> frontal craniotomy--> inverted C shape dura incision over left frontal area--> reflected rightward. 3. Divide the tumor attachment on falx--> total excision of left portion of tumor with bipolar and tumor forceps. 4. Excise the right portion of the tumor--> revascularization of left pericallosal artery with end-to-end anastomosis with 10-0 prolene--> total excision of right portion of tumor with bipolar and tumorforceps. 5. Hemostasis with surgicele--> tumor attachment over falx treated with EMF--> dural closure--> seal the frontal sinus with Betadine-soaked gelform, bone wax, and pericranium. 6. Set one epidural CWV drain--> close the bone flap with miniplates--> close the scalp wound in layers. Operators 杜永光 Assistants 蕭輔仁,曾仁河 手術日期：2002/06/18 14:05 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt Pre-operative Diagnosis Hydrocephalus s/p Omaya reservoir insertion Post-operative Diagnosis Ditto Operative Method V-P Shunt Pathology Nil Operative Findings 1. Omaya: CSF clear; ventricular catheter: no fibrin debris. 2. CSF: clear and colorless; pressure: high, >15cmH2O. 3. VP shunt: low pressure setting peritoneal catheter; medium pressure setting Pudenz reservoir; ventricular catheter: 4.5cm; peritonealcatheter: 30cm. Operative Procedures 1.ETGA; supine position. 2.Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 3.Scalp incision: along previous OP scar (right Kocher). 4.Remove Omaya reservoir. 5.A mini-laparotomy was made over right side abdomen, just right side to the umbilicus-> insert the peritoneal catheter. 6.Make a subcutaneous tunnel from the abdominal wound, via right chest wall (lateral to right nipple), right neck, right retroauricular area, to the scalp wound-> connect to a Pudenz reservoir-> insert the ventricular catheter-> fix the reservoir onto the pericranium with silk threads. 7. Hemostasis-> close the scalp and abdominal wounds in layers. Operators 郭夢菲 Assistants 李定洲,曾仁河 手術日期：2002/06/19 00:00 摘要__ 手術科部: 外科部 套用罐頭: Cranioplasty Pre-operative Diagnosis right occipital skull tumor r/o osteoma Post-operative Diagnosis ditto Operative Method Cranioplasty Operative Findings 1.5*1.5*0.6 cm hard skull mass on right occipital area Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation:shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with a sterilized adhesive plastic sheet. 4. Incision: a 6cm linear incision above the mass. Raney clips were apllied to the scalp edge for temporary hemostasis. 5. The scalp was dissected away from skull. 6. The 2*2cm craniectomy around the mass. 7. carefully hemostasis. 8. Bone cement paste was applied to skull defect margin 9 The artificial skull plate was fixed to the skull with 3 wires. 10.Scalp closure: hemostasis was done with monopolar coagulator touching on the sucker tip. Galea suture was performed by continuous suture with 3/0 Dexon and skin by continuous suture with 3/0 nylon. . Operators 曾漢民 Assistants 蕭輔仁 手術日期：2002/06/26 12:55 摘要__ 手術科部: 外科部 套用罐頭: ATYPICAL Pre-operative Diagnosis HCC Post-operative Diagnosis HCC Operative Method S5 and partial S8 segmentectmy+microablation of the tumor at the margin of S7/S8+cholecystectomy Pathology Pending Operative Findings 1.There is a mass sized about 2X2 cm over segment 5, Its cut surface was yellowish. 2.There is a mass sized about 1X1 cm over segment 8. 3.There is a mass sized about 1X1 cm at the margin of S7/S8 4.Liver cirrhosis(-) 5.Portal vein thrombosis(-) 6.Ascites (-) 7.Blood loss:550c.c. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position and the whole abdominal skin was disinfected with painting of alcoholic povidon betaiodine. The operation field was then drapped with surgical towel as usual. Right subcostal incision was made with electronic tissue cauterizer. The upper operation field was then further pulled upwards and lateral-wards with Kent self-retractor. The ligamentum teres was ligated and divided for traction of the liver. Cystic duct and cystic arterywere ligated and divided and then the gallbladder was removed to expose the hilar structure of the liver. After dividing the falciform ligament to the level of IVC, the right triangular ligament and coronary ligament were divided with electrocauterizerand then the right lobe of the liver could be freely pulled out from behind the costal cage and could be approached easily. Intraoperative ultrasonography was performed to locate the tumors and to detect any unsuspected new lesions in the liver. Segmentectomy of S5 includung the hepatic tumor was performed with Ligasure and atypical hepatectomy of Segment 8 including the hepatic tumor was performed with microwave tissue coagulator. Then ablation of the hepatic tumopr at the margin of S7/S8 was performedwith microwave tissue coagulator. The exposed vascular structure and bile ducts in the resection plane were divided after ligation or clipping with vascular clip. When the resection was completed, detailed hemostasis of the raw surface was performed by electrocauterization and suture ligation of the bleeder. After this, the raw surface of the liver was covered with Surgicel and then the surgical wound was closed in three layers with two rubber drains left in the wound space. The muscular layer was closedwith two layers of continuous suture with one "O" Vicryl. The subcutaneous layer was closed with two "O" chromic catgut and then the epidermis approximated with interrupted suture with three "O" Nylon. Recorded by R1 謝宗宇 Operators 游憲章 Assistants 吳明勳 手術日期：2002/07/05 14:37 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) Pre-operative Diagnosis Lumbar stenosis, L3-4, L4-5 Post-operative Diagnosis Lumbar stenosis, L3-4, L4-5 Operative Method Lumbar Laminectomy, L3,4 and upper L5 Operative Findings 1.Scar tissue with adhesion of left paraspinal muscles, epidural space and left L4,5 roots 2.Hypertrophic facet joint and ligmentum flavum cause severe stenosis of lateral recess of of L3-4, L4-5 space 3.Dural sac exposed after procedure. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: prone with flexion of bilateral knees and hip. 3. Skin preparation: the back was shaved and scrubbed with povidone-iodine detergent 4. A spinal needle was inserted between spinous processes of L3and a portable X-ray film was taken to locate the correct interspace. 5. Incision: 7 cm vis privious scar 6. The latissimus dorsi, ileocostalis lumborum muscles were detached from spinous processes of L4 on both sides by Bovie, then multifidus muscles were dissected subperiosteally from the laminae with rasp. 7. The paravertebral muscles were retracted by self retaining retractors to expose the spinous processes and laminae of L3~L5 8. The spinous processes and laminae of L3,4 were bitten off with rongeurs and Kerrison punch until the posterior half of the spinal canal was widely opened. (The spinous process and the lamina of L3,4 was removed as a whole piece by cutting through the base of the lamina with Kerrison punch on both sides.) The hypertrophic ligamenta flava including those at lateral recesses were excised. The epidural venous bleeding was stopped by gelfoam packing. 9. The scar tissue adhering to L3,4 epidural space and left paraspinal muscles was removed by Kerrison punch. 10.The paravertebral muscles were closed by interrupted sutures with 2/0 silk, subcutaneous layer by continuous suture with 3/0 Dexon and skin by continuous suture with 3/0 nylon. 13.Drain: one, epilaminal, hemovac. 14.Course ofthe surgery: smooth. Operators 賴達明 Assistants 廖俊智,林洧呈 手術日期：2002/07/12 21:48 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT Pre-operative Diagnosis falx meningioma, frontal base, interhemispheric Post-operative Diagnosis falx meningioma, frontal base, interhemispheric Operative Method bifrontal approach, tumor excision, grade II Pathology pending Operative Findings 1. a whitish, elastic-firm well-encapsulated tumor at frontal base, interhemispheric, about 2x1.5x1.5cm in diameter, clear margin between tumor and normal brain tissue 2. brain well slack after tumor excision 3. frontal sinus opened, impacted with B-I gelfoam 4. prominent cortical vein just below the craniotomy window Operative Procedures The patient was put supine under ETGA, and head in neutral position. Scalp was disinfected as usual. Scalp incision was made for bifrontal approach, and scalp was reflected toward face. After one burrhole was drilled at midline, a 4x6cm craniotomy was performed at frontal area. Due to open of frontal sinus, Gelfoam rinsed with better-iodine was impacted into the sinus. After dura tenting, the dura was incised to expose the interhemiepheric space. Under microscope, bilateral hemisphere was gentlly retracted with self-retractor, and the tumor was carefully dissected from normal brain tissue with bipolar electrocauterization. During dissection, the tumor was intermittently under debulking with blade and tumor forcep until the residual tumor was only a thin layer. The residual tumor was finally removed totally with bipolar by dissection from peripheral normal brain. Meticulous hemostasis was done, and duroplasty was performed so that the dura was closed to water tight. Bone flap was fixed back with mini-plate, and bone cement was used for repair of the bone loss. One CWV drain was inserted into subgaleal space, and the wound was then closed in layers. Operators 林瑞明 Assistants 蕭輔仁,張　麟 手術日期：2002/08/09 18:48 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis 1.End stage renal disease; 2.Liver cirrhosis s/p renal transplantation Post-operative Diagnosis Ditto Operative Method A-V shunt creation(stretch graft, Gortex #6) Pathology Nil Operative Findings 1.Native cephalic vein sclerotic change with thrombosis over forearm 2.Post-Op. Thrill: strong 3.The patient is easy bleeding Operative Procedures 1.LA, left arm on the arm-board, well disinfecetd and draped. 2.Dissected the cephalic vein over forearm. Severe sclerotic change with thrombosis was noted and the vein was abandoned. 3.Dissected the brachial artery and concomittent vein. Made a bridge anastomosis with Gortex graft through subcutaneous tunnel. 4.Hemostasis was done well. Closed the wounds in layers. Operators 李伯皇 Assistants 黃書健,陳詠瑋 手術日期：2002/08/09 18:10 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Thoracoabdominal aneurysm. Post-operative Diagnosis Thoracoabdominal aneurysm. Operative Method Grafting. Pathology Nil. Operative Findings Tortuous thoracic aorta with aneurysmal formation from lower descending thoracic aorta to right common iliac artery with mural thrombosis. Operative Procedures 1. ETGA, right decubitus position, left thoracoabdominal incision since 10th ICS. 2. Retroperitoneal approach to identify aneurysm and major branches. 3. Grafting with 26 mm Hemashield by clamp and saw method with celiac trunk + SMA + right renal artery as an island flap and left renal artery as one isolated button -> reimplantation. 4. due to suspected left common iliac artery occlusion, we perform grafting with 10 mm Vascutek graft interposition. 5. Rubber drain x 1, Fr. 32 chest tube x 1. 6.Wound closure in layers. Operators 許榮彬 Assistants 李紹榕 李?光 手術日期：2002/09/06 11:52 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt Pre-operative Diagnosis Normal pressure hydrocephalus Post-operative Diagnosis Ditto Operative Method V-P Shunt (right Kocher) Pathology Nil Operative Findings 1. CSF: clear and colorless; pressure: 5cmH2O. 2. Pudenz reservoir: low pressure setting; ventricular catheter: 6cm; peritoneal catheter: 25cm, low pressure setting. Operative Procedures 1.ETGA; spine, head turn to left. 2.Incision: 5 cm curvilinear, right Kocher; Raney clips were applied to the scalp edge for temporary hemostasis. 3.After the scalp flap had been lifted and reflected anteriorly, a burr hole was made and the dura was tented by one stitch. 4.The dura was opened by a nib incision. Rt lateral ventricle was tapped by a ventricular needle, then a 6 cm segment of the ventricular catheter was introduced into the ventricle. The outer end of the catheter was connected to a Pudenz reservoir. 5.A nib incision was made at RUQ of the abdomen, then a trocar was pushed into peritoneal cavity. Subsequently, distal 25 cm segment of the peritoneal catheter (low pressure) was introduced into the peritoneal cavity through the outer tube of the trochar. The proximal end of this catheter was passed through subcutaneous tunnel at forechest, neck, rt retroauricular area and connected the reservoir. The shunt systemwas checked to make sure its function was working. 6.The reservoir was fixedto pericranium by 3 stitches. 7.Scalp closure: hemostasis was done with monopolar coagulator touching on the sucker tip. Galea suture was performed by continuous suture with 2/0. Dexon and skin by continuous suture with 3/0 nylon. 8.Course of the surgery: smooth. Operators 林瑞明 Assistants 蕭輔仁,曾仁河 手術日期：2002/09/11 08:27 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt Pre-operative Diagnosis V-P shunt dysfunction Post-operative Diagnosis ditto Operative Method V-P shunt revision Pathology nil Operative Findings 1.clear CSF, sent for culture and routine 2.severe adhesion of previous intraventricular catheter 3.new V-P shunt with medium pressure, 5.5cm intra-ventricular catheter Operative Procedures 1.ETGA, supine position 2.disinfected and drapped as usual 3.skin incision along previous wound, about 5cm curvilinear, right frontal 4.lifted scalp flap 5.remove previous V-P shunt system with prevervation of peritoneal and intraventricular catheters6.insert medium pressure V-P shunt, 5.5cm ventricular catheter 7.connect V-P shunt system 8.hemostasis 9.close wound in layers Operators 郭夢菲 Assistants 李定洲,張惠琇 手術日期：2002/09/27 00:00 摘要__ 手術科部: 外科部 套用罐頭: AVF Pre-operative Diagnosis AV shunt infection Post-operative Diagnosis Ditto Operative Method Debridement and removal of AV shunt Operative Findings Much pus was noted after opening the wound Operative Procedures 1. Local anesthesia, spine position 2. Skin disinfection 3. Remove previous infected AV shunt graft 4. Debridement Operators 虞希禹 Assistants 許　鈞,陳信安 手術日期：2002/10/04 09:00 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Severe MR Post-operative Diagnosis Severe MR Operative Method Mitral valve repair. Pathology pending Operative Findings Rupture of P2 chordae tendinae lead to severe MR. Operative Procedures Under endotracheal intubated general inhalation anesthesia, the patient was placed in supine position.The patient was disinfected and draped in the usual manner and a median sternotomy was used to enter the chest. The pericardium was incised in a cephalocaudaol direction and retracted laterally with stay sutures. Exposure of the mediastinum was obtained by sharp and blunt dissection. The superior and the inferior vena cava were looped. The superior and inferior vena cava and the aorta were cannulated. Then the patient was placed on cardiopulmonary bypass. The aorta was crossclamped. Cardioplegic solution was infused through aortic root. Right atriotomy and interatrial septum venting were done. Mitral valve repair with quadrangular resection and primaryclosure was done. The aortic crossclamp was released. Deairing was done. The right atriotomy and the interatrial septum incision were closed with 4-0 prolene continuous suture. The patient was placed back on partial CPB. The heart beat resumed normal sinus rhythm spontaneously. The rectal body temperature was rewarmed. The cardiopulmonary bypass was weaned after the patient's hemodynamics became stabilized. After protamine infused, the cannulae of SVC, IVC, and Aorta were removed. Two chest tubes ( 28# &32# ) were placed into pericardial cavity through two stabwounds inferior to the median sternotomy and fixed to the skin with stitches. The pericardium was closed. The muscular fascia and linea alba were closed with 2-0 vicryl continuous suture. The subcutaneous tissue was closed with 2-0 vicryl continuous suture and skin was closed with 4-0 vicryl subcutical continuous suture. Operators 林芳郁 Assistants 李紹榕,楊穎勤 手術日期：2002/10/16 14:54 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis AV shunt infection s/p debridement Post-operative Diagnosis as above Operative Method Debridement and split-thickness skin graft Pathology nil Operative Findings skin defect at left arm due to previous av shunt infection Operative Procedures under intravenous general anesthesia, the patient was prepared in usual fashion. After thorough debridement, the wound was closed with a split thickness skin graft harvested from the thigh Operators 謝孟祥 Assistants 陳右昇 手術日期：2002/10/18 08:42 摘要__ 手術科部: 外科部 套用罐頭: Hemorrhoidectomy Pre-operative Diagnosis Hemorrhoid Post-operative Diagnosis Hemorrhoid and anal fissure Operative Method Hemorrhoidectomy and internal sphincterotomy Pathology Pending Operative Findings 1. Mixed hemorrhoid over 3-, 7-, and 11-o'clock directions. 2. Anal fissures (+). Operative Procedures Under general anesthesia with endotracheal intubation, the patient was placed in prone position. The perineal area was disinfected and draped as usual. The forceps are placed on the perianal skin just outside the mucocutaneous junction opposite each primary hemorrhoidal lesion (3- ,7-, and 11-o'clock directions). Gentle traction on the forceps brings each hemorrhoidal mass into view. Incision along the edge of skin tag and exposure the subcutaneous space were performed. Dissection was continued in a coronal plane just close to the sphincter ani internus muscle and towards the pedicle of the hemorrhoid in the submucosal plane. The internus muscle was partially cut by electrocautery. The pedicle was ligated with 2-0 silk suture. Then the pedicle could be cut through, and the whole hemorrhoid was removed. The edge of the anal mucosa skin tag was approximated with continuous 3-0 chromic catgut sutures. The anal canal was compressed by gauze. The perineum wound was covered by a thick pad. Operators 梁金銅 Assistants 林正欣 手術日期：2002/11/01 10:30 摘要__ 手術科部: 外科部 套用罐頭: LC Pre-operative Diagnosis Gall stones with cholecystitis Post-operative Diagnosis Ditto Operative Method Laparoscopic Cholecystectomy Pathology Pending Operative Findings 1. 2 stones, one 1 cm in diameter, one 0.5 cm in diameter. pigmented 2. Severe liver cirrhosis 3. Minimal adhesion Operative Procedures 1. Operation Room Setup: Two video monitors, one on each side of the table, positioned toward the head of the table. The operator stood on the left side of the patient and the camera assistant stood next to the operator toward the foot of the table. To the patient's right side was the first assistant, opposite the operator and the surgical nurse stood next to the first assistant toward the foot of the table. The anesthesiologist and the monitoring equipment were at the head of the table. The laparoscopicinstrument tray was positioned at the foot of the table. Before the patient is placed under anesthesia, the camera, light source, scope, and insufflator should be checked to be certain that they are operational. The tank of carbon dioxide is also checkedto ensure that and adequate amount is available for the duration of the operation. 2. Anesthesia: General anesthesia with endotracheal intubation. 3. Position and catheterization: An intravenous infusion was started before operation. The patient ispositioned supine on the table. To facilitate laparoscopic exposure in the upper abdomen, a nasogastric tube is used to decompress the stomach. 4. Disinfection: The abdomen is prepared with Povidon-tincture solution that is applied and left for several minutes. Then the operation field was draped as usual. 5. Incision and establishing the ports: The patient was placed in 20° Trendelenburg position. A curvilinear wound about 1.5 cm in length was made at the sub-umbilical region, and the subcutaneous tissue was bluntly disscted to the fascia. Two towel-clamps were used to elevate the fascia in order to facilitate placing the Veress neddle into the abdomen cavity. To insure that the needle was in the peritoneum, a small syringe containing a few milliliters of normal saline was attached to the Veress needle to perform the drop-test. When the needle already entered the abdominal cavity, the relative negative pressure pulled the fluid through the needle and into the abdominal cavity. The needle was thenconnected to the insufflator and carbon dioxide was set at an initial flow of 1L/min. Then after the insufflated volume reached 1L the flow rate was set up to 6L/min. After the pneumoperitoneum with intra-abdominal pressure maintained at 14 mmHg was established, the 5-11mm Versaport (Camera port) was inserted through the sub-umbilical port and then the insufflator tubing was connected to the sheath. For patients who had received abdomen operation previously, mini-laparotomy was done to avoid inadvertenthollow organ injury. The fascia was opened and underlying peritoneum was explored digitally or by instrument. The adhesion was freed and the abdominal cavity beneath the fascia visualized. The trocar was removed from the sheath and the sheath was placedintothe abdominal cavity with care. In this condition, a purse string suture using a 2 "0" Dexon suture was done to seal the port. The laparoscope was then inserted through the sheath in the sub-umbilicus. A complete examination of all pelvic and intra-abdominal viscera was done. The table is then tiled with head up at least 20 to 30 degrees and rotated 15 degree to the left to expose the right upper quadrant properly. The secondary 5-11mm Versaport (working port) was placed through a transverse incision, 12 mm in length, located at the sub-xiphoid region. Then a 5mm port (fundic port, for grasping of the fundus) was inserted at the right anterior axillary line, at about one to one-half port length below the gallbladder. Another 5mm port (infundibularport,for grasping of the infundibulum) was inserted at the right mid-clavicular line about midway between the sub-xiphoid port and left axillary port. 6. Manipulation during the operation: A rachet clamp was utilized to grasp the fundus of the gallbladder through fundic port and the gallbladder was pushed up to the right diaphragm. Then another ratchet clamp was used to grasp the infundibulum through the infundibular port. 7. Dissection of the gallbladder: Dolphin dissector and hook dissector withan attached electric cautery was used to dissected the gallbladder through the operation port. The adhesion and areolar tissue around the cystic duct and cystic artery were dissected carefully to ensure inadvertent injury to the common bile duct and right hepaticartery. 8. Securing the cystic duct and cystic artery: Once the cystic duct was exposed and the relation with common bile duct was identified, the cystic duct is clipped by Endo-clipper and divided by the scissors. The cystic artery wasexposed by hookdissector, clipped by Endo-clipper, and divided by the scissors too. 9. Freeing the gallbladder: When cystic artery was secured and divided, traction was placed on the infundibulum of the gallbladder and the gallbladder was teased awayfromthe liver bed. The avascular interface was peeled away by cauterization with Dolphin or hood dissector. The position of the grasping clamps were changed as needed to provide the best exposure and to allow dissection of the gallbladder. Before the gallbladder was separated completely, visualization of the liver bed to check any bleeding point was done. Irrigation, suction and meticulous hemostasis were performed too. Then the gallbladder was separate completely from the liver bed. 10. Removing thegallbladder: The camera was shift to the sub-xiphoid working port and a clamp was inserted through the sub-umbilical port to grasp the cystic portion of the gallbladder. After decompression and extending the fascia incision, the resected gallbladder wasretrieved from the sub-umbilical wound. Fascia defect was closed to avoid incisional herniation and the wound was closed in layers and covered by sterile gauge. Operators 賴逸儒 Assistants 吳建明,洪基翔,王牧群 手術日期：2002/11/06 13:20 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Recurrent cerebellar hemangioblastoma Post-operative Diagnosis Ditto Operative Method Total tumor excision, suboccipital approach Pathology Pending Operative Findings 1. Severe distension of dura after craniotomy 2. A 4x3x4 cm cystic tumor with xanthochromic fluid at right hemisphere 3. Solid part was at posterior inferior vermix; the solid part was hypervascular, reddish with several feeding artery 4. Cortical veinat right hemisphere became dark after remove solid part Operative Procedures 1. ETGA; prone 2. Midline incision 3. Craniotomy 5x4 cm (cross-midline) 4. 3 cm cortical incision 5. Remove cystic tumor after aspiration for decompression 6. Remove solid part 7. Subgaleal drain 8. Close the wound Operators 賴達明 Assistants 王國川,王牧群 手術日期：2002/12/04 16:25 摘要__ 手術科部: 外科部 套用罐頭: OPCAB Pre-operative Diagnosis Coronary aterial disease(3-vessel disease) with recent MI Post-operative Diagnosis Ditto Operative Method Off-pump coronary artery bypass grafting Pathology Nil Operative Findings 1.Dilated and calcified ascending aorta 2.Proximal LAD aneurysm 3.Cardiac Cath. Findings: LAD: proximal, multiple plaques LCX: proximal, 95~99% stenosis RCA: small caliber PDA from LCX Operative Procedures 1.ETGA, supine position, well disinfected and draped. 2.Midline full sternotomy was done. Harvested left internal mammary artery. 3.Harvested left great saphenous vein with bridged skin incisions. 4.Infused Heparin. Set Octopus stabilizer. 5.CABG: LIMA---LAD SSVG--OM--PDA 6.Infused Protamine. 7.Hemostasis was done well. Set 2 chest tubes. Closed the wounds in layers. Operators 許榮彬 Assistants 許　鈞,陳詠瑋 手術日期：2003/01/10 15:58 摘要__ 手術科部: 外科部 套用罐頭: ATYPICAL Pre-operative Diagnosis HCC Post-operative Diagnosis Ditto Operative Method Atypical hepatectomy Pathology Pending Operative Findings 1. Cirrhosis ( ) , tumor number ( ), tumor size ( ) ×( )×( )cm 2. Location at segment ( ) color ( ) capsule ( ) 3. Satellite nodule ( ) rupture ( ) 4. Portal vein thrombosis() Hepatic vein thrombosis ( ) 5. Resection segment ( ) Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position and the whole abdominal skin was disinfected with painting of alcoholic povidon betaiodine. The operation field was then wrapped with surgical towel as usual. Right subcostal incision with cephalic extension was made with electronic tissue cauterizer. The upper operation field was then further pulled upwards and lateral-wards with Kent self-retractor. The ligamentum teres was ligated and divided for traction of the liver. After dividing the falciform ligament to the level of IVC, intraoperative ultrasonography was performed to locate the tumor and to detect any unsuspected new lesions in the liver. After this, the gall bladder was firstly removed to expose the hilar structure of the liver. The right hepatic artery and right portal vein was isolated firstly and was looped with different vascular tape for temporary vascular control during liver parenchymal resection. The right triangular ligament and coronary ligament were divided with electrocauterizer and then the right lobe of the liver could be freely pulled out from behind the costal cage and could be approached easily. By temporarily tightening of the vascular tapes, atypical hepatectomy of segment (Total S5 and Partial S6) including the hepatic tumor was performed with the aid microwave tissue coagulator. The exposed vascular structure and bile ducts in the resection plane were divided after ligation or clipping with vascular clip. When the resection was completed, detailed hemostasis of the raw surface was performed by electrocauterization and suture ligation of the bleeder. Identified S8 tumor mass by sonography and then echo-guided microwave tumor ablation was performed. After this, the raw surface of the liver was covered with Surgicel and then the surgical wound was closed in three layers with two rubber drains left in the wound space. The muscular layer was closed with two layers of continuous suture with one "O" Vicryl. The subcutaneous layer was closed with two "O" chromic catgut and then the epidermis approximated with interrupted suture with three "O" Nylon. Operators 游憲章 Assistants 洪基翔,顏俊銘 手術日期：2003/02/20 17:15 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis AVM s/p TAE with bleeding (SAH) Post-operative Diagnosis ditto Operative Method 1.EVD with ICP monitoring 2.subdural ICP monitoring Pathology nil Operative Findings Intracranial pressure 12 cm H2O. The dura was bulging mildly after burr hole creation.The CSF was slightly pinkish, not turbid Operative Procedures After general anesthesia , the patietn was put in supine position. The skin was disinfected and draped as usual. curvilinear skin incision was made over kocher point and a burr hole was created. After dural tenting with two stitches , the dura was incised. one ECD set was put after ventricular puncture. Another subdural ICP monitoring was also put in. After meticulous hemostasis , the wound was closed in layers. Operators 杜永光 Assistants 溫崇熙,陳元森 手術日期：2003/03/03 09:25 摘要__ 手術科部: 牙科部 套用罐頭: dentofacial deformityI--LeFort I+BVRO+genioplasty Pre-operative Diagnosis missing teeth Post-operative Diagnosis missing teeth Operative Method PSO;sinus left;illiac bone graft;miniplate miniscrew fixation Operative Findings Vertical dimension improve 5.0 mm s/p operation. Operative Procedures 1. The patient was put in a supine position. 2. Under ETGA , the disinfection and draping were done as usual. 3. The head of patient was elevated 10 degress. 4. 1:2000000 Bosmin was injection at vestibulae from #24 to #27 5. The oral incision inthe mucobuccal fold of from #24 to #27 6. The surgical saw was used to conduct the osteotomy of the lateral wall of the maxilla. 7. Separate the posterior segment of maxilla from the ptergoid plate by malleting an osteotome. 8.Remove of L't sinusmembrane and create a bone gap on lateral wall of L't maxillary sinus. 9.Take the illiac bone graft from L't illiac crest. 10.Put the illiac bone chip and cancellous bone into sinus cavity. 11.Fixation the graft with wiring and miniscrew 12.Put a bone chip on buccal aspect of #24--#27. 13.Fix a miniplate on buccal aspect of R't upper ridge. 14.Screw a miniscrew on upper R't palatal bone and two miniscrew fix the stent. 15.Two miniscrew was put in buccal side and lingual side between#44 and #45 16.One miniscrew fix on lower posterior edentulous ridge. 17.Fix a bone chip on L't lower buccal side with miniscrew 18.Closed the R't illiac incision line about 24 stitches with 3-0 Dexon and 4-0 Nylone 19. The patient stood the wholeprocedure well. Operators 郭生興 Assistants 董俊良,吳大維 韓昉疇 手術日期：2003/03/03 17:33 摘要__ 手術科部: 外科部 套用罐頭: ATYPICAL Pre-operative Diagnosis HCC Post-operative Diagnosis Ditto Operative Method Wedge resection Pathology Ditto Operative Findings 1.A3*3cm elastic protruding yellowish tumor was noted at S8 extent to S7 2.Capsule(-) 3.No satellite nodules 4.Ascites(-) 5.Liver cirrhosis(+) 6.Vascula invasion(-), macroscopic Operative Procedures 1.ETGA, supine porsition 2.Bilateral subcsotal incisoin and xyphoid extension 3.Adhesionlysis 4.Wedge resection of the tumor with safely margin 2.5cm by CUSA after microwave coagulation 5.Injury of MHV side wall and was suture with 4-0 prolene 6.Hemastasis and surgicel packing 7.One R-D was inserted and close the wound by layers Operators 何明志 Assistants 黃約翰,賴鵬升 手術日期：2001/04/09 11:20 摘要__ 手術科部: 外科部 套用罐頭: Carpal Tunnel Syndrome Pre-operative Diagnosis Carpal Tunnel Syndrome Post-operative Diagnosis Ditto Operative Method Carpal Tunnel Syndrome Pathology nil Operative Findings Transverse carpal ligament was calcified and hypertrophy. The median nerve compressed by the ligament was noted. Operative Procedures The patient was put in supine position. The hand and forearm were sterilized with povidone-iodine tincture, then covered with stockinet. We used 10 ml 1% Xylocaine solution at wrist area for regional block. Then, we made a longitudinal incision from vertical palmar crease to transverse wrist crease. The palmaris longus tendon was identified, then the plamar aponeurosis was cut longitidinally along the ulnar side of the palmaris longus tendon. The median nerve was identified beneath the palmars longus tendon. Under direct vision, the transverse carpal ligament was divided until no more pressure on the median nerve could be palpated. The skin was closed by continuous 3-0 Dexon and interrupted 4/0 nylon. The hand and wrist were draped with fluffy dressing and elastic bandage. The patient tolerated the whole procedure well. Operators 杜永光 Assistants 戴伯安,洪進昇 手術日期：2003/04/09 12:56 摘要__ 手術科部: 外科部 套用罐頭: HIVD Pre-operative Diagnosis L4-5 HIVD Post-operative Diagnosis ditto Operative Method L4-5 diskectomy Operative Findings Protruding L4-5 disc with compressing the right L4 nerve root. Operative Procedures Under endotracheal general anesthesia, the patient was placed in prone position with waist and knee flexion. The back was shaved and scrubbed with povidone-iodine detergent then painted with povidone-iodine tincture and followed by sterilized adhesive plastic sheet covering. A spinal needle was inserted between spinous processes of L4-5 and a portable X-ray film was taken to locate the correct interspace. Longitudinal skin incision was made 5cm in length, between L4-5 spinous processes, off-midiline atthe right margin of spinous processes. The subcutaneous layer and lumbdorsal fascia were also incised. The aponeurosis of the latissimus dorsi and ileocostalis lumborum muscles at spinous processes of L4-5 was incised, the muscles were detached from the interspinous ligament. The multifidus muscles were detached subperiosteally from L4 laminae by a rasp. The paravertebral muscles were retracted by a modified narrow Taylor retractor which was retained constantly by a rubber sling to the side rail ofthe operating table. Under an operating microscope, the ligamentum flavum was cleaned and removed longitudinally at the lateral part with Kerrison and disc clamp. The lateral portion of this ligament was removed with a small angle Kerrison rongeur, the inferior-lateral portion of the L4 laminae was removed with air-drill and Kerrison clamp, too. The compressed nerve root and veins overlying the bulging disc were gently pushed away by retractor. The posterior longitudinal ligament and annulus were incisedaround the bulging disc with a No. 15 blade. The degenerated disc was removed with microdisc forceps until a substantial amount of the nucleus had been loosened with a cone curette and removed. Meticulous hemostasis was performed. The lumbodorsal fasciawasapproximated by interruped silk stitches. The subcutaneous layer was closed by running suture with 4/0 Dexon and skin by adhesive tape. Operators 杜永光,賴達明 Assistants 蕭輔仁,王植賢 手術日期：2003/04/15 08:30 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Cervicothoracic syringomyelia Post-operative Diagnosis Ditto Operative Method Syringopleural shunt (T6 to right pleural cavity) Pathology Nil Operative Findings 1. The thoracic cord was slack when dura was opened, but clear and colorless fluid could be withdrawed from the syrinx by a syringe at midline. 2. T-tube: intramedullary portion: 1.5cm cephalad; 1.0cm caudad; pleural portion: 25cm. 3. Intra-op MEP of bilateral lower limbs: no change. Operative Procedures 1. ETGA; prone. 2. C-arm localization of the level of T5, T6 spinous processes. 3. Midline linear skin incision from T5~T7-> retract the paraspinous muscles to expose the spinous processes and laminae of T5~7. 4. Laminectomy: T5 (partial), T6, and T7 (partial). 5. Dura incision and dura opening. 6. Syrinx tapping with a syringe-> myelotomy: midline, T6 level, 0.5cm. 7. Insert the T-tube-> insert the pleural end to right pleural cavity under partial ventilator disconnection throught a subcutaneous tunnel (direct puncture). 8. Hemostasis-> close the wound in layers. Operators 林瑞明 Assistants 廖俊智,曾仁河 手術日期：2003/04/17 17:20 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Cervical cancer stage IIb Post-operative Diagnosis Cervical cancer stage IIb Operative Method Port-A implantation Pathology nil. Operative Findings Port-A was placed smoothly from right cephalic vein to SVC. Operative Procedures Under satisfactory intravenous general anesthesia with the patient in supine position, preparation and draping were performed in the usual sterile method. An incision was made in right cephalic vein region. After identification of the cephalic vein, Port-A catheter was inserted into the superior vena cava through the right cephalic vein under the fluoro-guidence and then the port was fixed on the pectoralis major muscle fascia. Adequate hemostasis was obtained. Then the wound was closed in layers. Thepatient tolerated the operation well and was sent to the recovery room in stable condition. Assistants R3 蔡伊達 手術日期：2003/04/30 09:54 摘要__ 手術科部: 外科部 套用罐頭: VATS bullectomy Pre-operative Diagnosis 1. Right pneumothorax 2. Left emohysema with bullous formation Post-operative Diagnosis ditto Operative Method Bullaectomy and mechanical pleurodesis via VATS. Operative Findings 1. A cluster of bulla at apex of RUL with rupture, ruptured bulla adhered to chest wall 2. Multiple bulla at LUL, some adhered to mediastinal pleura. Besides, emphysemaous change was also noed Operative Procedures 1. Anesthesia: General anesthesia using double-lumen endotracheal tube. 2. Supine wiht tow pneumatic calf at bilateral sides of back 3. Right side bullectomy via VATS Camera port: From the right sixth intercostal space in the mid-axillary line away from the lesion. 4. Working ports: First: From the 3rd intercostal space in the anterior axillary line. Second: From the 5th intercostal space in the posterior axillary line.. 5. The pleural adhesions are separated with grasping forceps and electrocautery. 6. The bulla is visualized and stabilized with the grasping forceps. 7. The Endo-GIA stapler is placed across its base. Wedge resection of the pulmonary lesion including the bulla is performed. 8. After meticulous homeostasis, one 28# chest tubesis placed via the camera port. The lung is ventilated under the direct vision. The skin is closed with 4-0 Nylon sutures. 9. Left bullecotmy Camera port: 7th ICS, AAL Working port: 3rd ICS, above nipple 5th ICS, MAL 10. Adhesionolysis and wedge resection of LUL by endo-GIA 45 x 4 m repair tear of lung 11. 28# x 1 and wound closure inl ayers Operators 黃培銘 Assistants 郭順文,曾宇鼎 手術日期：2003/07/13 12:27 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis L4-5 spondylolisthesis Post-operative Diagnosis L4-5 spondylolisthesis Operative Method TPS + autologus bone fusion Pathology pending Operative Findings Right L5 facet joint hypertrophy with granulation tissue infiltration right L5 root severe compression by granulation tissue Operative Procedures 1. ETGA Prone position 2. Incision alone previous wound 3. Partial L3 laminectomy to identify thecal sac 4. dissection of thecal sac from L3 level to L5 5. remove the granulation tissue 6. TPS set L4 4.5* 45mm * 2 L5 4.5 *45 m * 2 7. Rodfixation 8. Hemostasis 9. harvest bone graft form iliac crest 10 Autologous bone fusion 11. wound close in layer Operators 杜永光 Assistants 王國川,洪偉禎 手術日期：2003/07/16 22:00 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Neurofibromatosis, right thigh, left buttock and left flank mass Post-operative Diagnosis Ditto Operative Method 1. Excisional biopsy of right thigh and left buttock mass 2. Gross total excision outside the chest and abdominal cavity Pathology pending Operative Findings 1. 1x1x1 cm, well-defined, elastic, pink tumor at subcutaneous layer of lateral aspect of right thigh, arising from nerve fiber. 2. A similar tumor was located at left buttock. 3. A serial chains of multilobulated, pink, elastic tumor at subcutaneous layer of left flank, intermingled with small nerve fibers and vessels. Part of the tumor penetrates external oblique abdominis muscle into intercostal groove along the last intercostal nerve. It is possible arising from the intercostal nerve. The deeper part was amputated at the level of fascia. 4. Some of the tumor was noted to penetrate into the rectus abdominis muscle. This part was left because there was no s/s here. Operative Procedures 1. ETGA, left decubitus position. 2. Excisional biopsy of right thigh tumor. 3. Turn to right decubitus position. 4. Excisional biopsy of left buttock tumor. 5. Curvelinear incision over left flank for 12 cm 6. Total excision of tumor outside the fascia. 7. Hemostasis. 8. Set 1 CWV drain. 9. Close wound in layers. Operators 郭夢菲 Assistants 蔡翊新,黃修哲 手術日期：2003/07/16 19:40 摘要__ 手術科部: 外科部 套用罐頭: AVF Pre-operative Diagnosis ESRD Post-operative Diagnosis ESRD Operative Method Arteriovenous fistula creation Pathology nil Operative Findings 1.The diameter of the artery was 3mm and the diameter of the vein was 1.5mm. 2. The anastomosis opening diameter was 10mm . 3. After the fistula created, a continuous thrill was felt over the fistula Operative Procedures The patient was put on supine position with left hand extended out of the operation table on the arm-board. The operation field was disinfected and draped as usual. Under local anesthsia, a longitudinal skin incision was made between the artery and the vein. The vein and then the artery were dissected out from the surrounding tissue. The vein was then transected and the distal end ligated. Heparin solution was used to flush the vein to test the patency and also to keep it from thrombosis. A bulldog was applied on the proximal end of the vein to prevent air emboli. After gaining distal and proximal control of the artery by bulldog, a longitudinal arteriotomy was performed. The end of the vein was then anastomosed to the arteriotomy with 7-0 prolene continuous suture. The bulldogs were released with the order of vein, distal artery, and proximal artery and the air expelled. After meticulous hemeostasis, the wound was closed in layers. Operators 王水深 Assistants 劉亮廷,張兼華 手術日期：2003/07/25 15:40 摘要__ 手術科部: 外科部 套用罐頭: HIVD Pre-operative Diagnosis L4/5 HIVD Post-operative Diagnosis Ditto Operative Method L4/5 discectomy Pathology pending Operative Findings 1. Bulging left L4/5 disc causing posteriolateral displacement of left L5 root tightly 2. The thecal sac and L5 root become slack after discectomy Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: semiprone with a bolster beneath left side and flexed at the waist and knees. 3. Skin preparation: the back was shaved and scrubbed with povidone-iodine detergent then painted with povidone-iodine tincture and followed by sterilized adhesive plastic sheet covering. 4.A spinal needle was inserted between spinous processes of L 4-5 and a portable X-ray film was taken to locate the correct interspace. 5.Incision: 3-cm, between L4-5 spinous processes,off-midiline at the left margin of spinous processes. The subcutaneous layer and lumbdorsal fascia were incised then. 6.The aponeurosis of the latissimus dorsi and ileocostalis lumborum muscles at spinous processes of L 4, 5 was incised, the muscleswere detached from the interspinous ligament. The multifidus muscles were detached subperiosteally from L4, 5 laminae by a rasp. 7.The paravertebral muscles were retracted by a modified narrow Taylor retractor which was retained constantly by a rubbersling to the side rail of the operating table. 8.Under an operating microscope, the ligamentum flavum was cleaned and incised longitudinally at the lateral part with a No. 11 blade. The lateral portion of this ligament was removed with a small angleKerrison rongeur, the lateral portion of the laminae and the medial border of the facets were removed too until the margin of the facets and a corridor to the disc that ran lateral to the root was reached. 9. The epidural fat was left undisturbed andpreserved. 10.The compressed L-5 root and veins overlying the protruded disc were gently pushed away by placing 2 small cottonoid patties, one above and one below the disc at the floor of the epidural canal. 11.The compressed root was gently pushed further away temporarily by sucker tip in order to expose the herniated disc more clearly. The posterior longitudinal ligament and annulus were incised around the protruded disc with a No. 15 blade. The degenerated disc was removed with microdisc forceps until a substantial amount of the nucleus had been loosened with a cone curette and removed. 12.The lumbodorsal fascia was approximated by 3 interruped 2/0 silk stitches. 13.Thesubcutaneous layer was closed by running suture with 4/0 Dexon and skin by adhesive tape. 14.Course of the surgery: smooth. Operators 賴達明 Assistants 李定洲,張容蓉 手術日期：2003/07/28 12:03 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Granulation tissue of left elbow Post-operative Diagnosis Granulation tissue of left elbow Operative Method subcutaneous tumor excision Operative Findings 1.A 5X3 cm granulation tissue with pus discharge noted over left elbow Operative Procedures 1.IVG, supin position with left are abduction 2.fusiform skin incision with subcutaneous tumor excision 3.clean the wound with saline and close the dead space with 4-0 Dexon 4.STSG from left thigh due to large skin defect 5.long arm splint to maintainleft elbow in extesion Operators 李伯皇 Assistants 蘇彥豪 手術日期：2003/08/20 12:31 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Leukemia Post-operative Diagnosis Leukemia Operative Method Port-A removal Pathology Leukemia Operative Findings Port-A system intact Operative Procedures 1. ETGA, supine position with head mildly tilted and turned to the left 2. Skin preparation, disinfectionand drapping 3. Right transverse skin incision below the clavicle near the previous op scar 4. Dissection to expose port-A system. 5. Removal of port-A and compression of vessel 6. Wound closed in layers Operators 陳　芸 Assistants 黃博浩 手術日期：2003/08/20 00:17 摘要__ 手術科部: 外科部 套用罐頭: Head Injury Pre-operative Diagnosis head injury with bilateral contusion ICH, SDH and SAH Post-operative Diagnosis ditto Operative Method left F-T-P craniectomy for hematoma evacuation + subdural ICP monitoring+ duroplasty Pathology nil Operative Findings 1.Easy bleeding while performing craniectomy. 2.Tense dura, subdural hemaoma was noted 3.The pinkish, hyperemia brain tissue was bulged out after dura incision 4.ICP arou8nd 2 mmHg after wound closure Operative Procedures 1.ETGA, supine position 2.Skin preparation and draped as usual. ICP monitor insertion via a burr hole at frontal area 3.Question mark scalp incision 4.The scalp falp and temporalis muscle was dissected from the skull 5.four burr hole was then made and a 12x12 cm craniectomy plate was made. 6.Dura tenting was then performed. 7.Dura incision and hematoma evacuation 8.Duroplasty was made with artificial fura and fascia. 9.Set up ICP monitoring. 10.Two CWV drain was set up at supra and infra-muscular layer. 11.Close the wound in layers. 12.The skull plate was put at the abdomen above the facia layer. 13.Set one CWV drain and closed the wound Operators 黃勝堅 Assistants 蔡翊新,陳元森 手術日期：2003/08/21 00:00 摘要__ 手術科部: 外科部 套用罐頭: Head Injury Pre-operative Diagnosis Head injury with bilateral ICH, SAH and SDH s/p craniectomy Post-operative Diagnosis Ditto Operative Method Hematoma evacuation and duroplasty Operative Findings 1.Hematoma, about 15cc, found at temporal lobe, 4-5cm away from temporal tip 2.Tense brain tumor, ICP: 52mmHg, initially; it became slack after hematoma evacuation, ICP: 0-2 3.Thickened temporalis muscle, about 2.5cm in thickness Operative Procedures 1.ETGA and supine position 2.Skin was divided along the previous op line 3.Dura was opened and the artificial dura was removed 4.Identify the hematoma and evacuate it at temporal lobe, 4-5cm away from temporal tip 5.Hemastasis 6.Temporalis muscle resection 7.Duroplasty with temporalis fascia 8.CWV*I at subgaleal space 9.GM irrigation and close the wound in layers Operators 黃勝堅 Assistants 王國川,張　麟,陳振坤 手術日期：2003/08/25 12:04 摘要__ 手術科部: 外科部 套用罐頭: LAR Pre-operative Diagnosis Sigmoid colon cancer Post-operative Diagnosis Ditto Operative Method Low anterior resection (male) + incidental appendectomy Pathology Nil Operative Findings 1. A 20 x 2 cm, fungating annular mass was noted over anterior wall of rectum. 2. Regional lymph node enlargement (-), Serosa/pararectum involvement (+). Operative Procedures 1. Under general anesthesia, the patient was placed in lithotomy position, the skin was disinfected with alcohol better-iodine from the level of thigh to the nipple area. 2. The abdomen was opened and explored through a long median incision from the symphysis pubis to 3cm above the umbilicus. 3. Mobilization of the sigmoid colon by division of the white line of Toldt. 4. Identification of the left ureter and exposure of the inferior mesenteric vessels through incisions of the peritoneum at the base ofmesocolon. 5. The inferior mesenteric artery is then ligated and divided at its origin near the aorta, and the vein is tied separately at about the same level. 6. The bladder, seminal vesicles and prostate are separated from the front of the rectum bysharp and blunt dissection. Lateral ligaments are also divided. The mesorectum was divided with the consideration of adequate safety margin. Then the rectum is clamped and the tumor is removed after resection of the rectum. Two mass over anterior serosawall of the rectum were also resected. 7. The colon is then moved to come into apposition with the rectum. End-to-end anastomosis is performed. The peritoneal floor is closed with interrupted sutures and the mesenteric margin of sigmoid colon was approximated with the right peritoneal margin. 8. Indentified the appendix and ligated to removed it. 9. The pelvis is then irrigated with 2L normal saline and one rubber drain is placed at the left pelvic space. 10. The peritoneum and transverse abdominisfascia are closed with continueous 1-0 Vicryl suture. The subcutaneous layer with 3-0 chromic suture and the skin with 3-0 interrupted nylon sutures. Operators 梁金銅 Assistants 蔡明憲,蕭丞皓,徐光漢 手術日期：2003/09/02 03:24 摘要__ 手術科部: 外科部 套用罐頭: Aneurysm-frontotemporal approach Pre-operative Diagnosis SAH,Left MCA aneurysm rupture Post-operative Diagnosis SAH,Left MCA aneurysm rupture Operative Method Left MCA aneurysm clip-frontotemporal approach Pathology pending Operative Findings 1.Moderate bulging dura was found after craniotomy 2.Reddish with some blood clot-like SAH over subarachnoid was found after dura open 3.A 6*3*4 mm mushroom-shaped aneurysm over left MCA genu protruding antetosuperior-laterally was noted 4.Two sugita clips was applied to the aneurysm neck Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine head rotated to right.slightly extended then fixed by Mayfield skull clamp. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodinealcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision:left frontotemporal, curvilinear. The skin edge was clipped by Raney clips for temporary hemostasis. After scalp had been lifted, the temporalis muscle was incised and detached from temporal squama and reflected to lower temporal side. 5. Craniotomy window: 5x6 cm, frontotemporal, created by making 4 burr holes then cut by power saw. The lower temporal bone and pterionic ridge (esp. the inner table) were cut byrongeur as low as possible for easy approach to the anterior clinoid. 6. Dural tention: by 2/0 silk, distributed along the edge of skull window. 7. Dural incision: V shape, over-ridding Sylvian fissure and reflected to frontotemporal base. 8. Under operating microscope, the Sylvian fissure was opened, then the frontal and temporal opercula were retracted by self-retaining retractor inan opposite direction to expose the M-2 segment of rt MCA. When the dissectiom was carried out more proximally,the aneurysm soon came into view.The neck of the aneurysm was mobilized gently bya Gage 18 sucker and a fine tipbipolar forceps until itwas entirely free. 9.Two Sugita clip was applied to the neck of the aneurysm. 12.After successful clipping of the aneurysm, the patient's BP was brought back to normal, and the exposed field was irrigated with N.S. to make sure no any bleeding. 13.The brain retractors were removed. Thedura was closed water-tight by 2 2/0 silk for key stitches followed by running suture with 4/0 Dexon. 14.Closure of skull window: the skull plate was placed back to craniotomy window and fixed by 3 Gage 24 wires. The dura was tented to the center of the skull plate by a 2/0 stitch. The covering muscle was closed by interrupted stitches with 1/ 0 silk. 15.Scalp closure: hemostasis was done with monopolar coagulator touching on the sucker tip. Galea suture was performed by continuous suture with 3/0 Dexon and skin by continuous suture with 3/0 nylon. 16.Drain: one, epidural Operators 賴達明 Assistants 李定洲,李兆翔 手術日期：2003/09/17 16:00 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Parkinsonism stage III Post-operative Diagnosis Parkinsonism stage III, s/p left DBS implantation Operative Method Electrode implantation for Deep Brain Stimulation Pathology nil Operative Findings MER: Irregular hyperactive high frequency discharge at tract I between 25.7~28.0 mm tract II between 27.7~36.2 mm (but could be 31.8-36.2mm) tract II: move the calculated (12,4,4) traget 2.0 mm medially Operative Procedures 1. IVG with nasal O2 canula, supine position. 2. Burr hole at left frontal area. 3. Localize subthalamic nucleus by microelectrode recording. 4. Insert the electrode, confirmed by C-arm X-ray. 5. The electrode was burried at a subcutaneous pocket at left frontal area. 6. Close the wounds in layers. Operators 曾漢民 Assistants 蔡翊新 手術日期：2003/09/17 19:30 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt Pre-operative Diagnosis Fourth ventricle dilatation with aqueduct stenosis Post-operative Diagnosis Ditto Operative Method V-P shunt Pathology pending Operative Findings 1.Ventricular catheter: 5cm, peritoneal catheter: 25 cm. 2.CSF character: clear and colorless. 3.Reservoir was medium pressure system. Operative Procedures Under ETGA, one-quatrter prone position (right debucitus position) 1.Para-median skin incision 9 cm along posterior neck. 2.Soft tissue dissection with occipital craniotomy2x1.5 cm. 3.Dura tenting then cruciate dural incision to open dura. 4.Approach4th ventricle tela through sub-vermis route. 5.Ventricular and peritoneal catheter insertion to 4th ventricle and peritoneum respectively. 6.Create subcutaneous tunnel to connect the 2 catheters. 7.Wound closure in layers after hemostasis and saline irrigation. Operators 賴達明 Assistants 王國川,黃日新 手術日期：2003/09/24 10:10 摘要__ 手術科部: 外科部 套用罐頭: MRM Pre-operative Diagnosis Left breast Ca Post-operative Diagnosis Left breast Ca Operative Method MRM Operative Findings 1.A witish heterogeneous tumor about 3 cm and 2 cm around the nipple in 2 o`clock direction 2.Axilla level 1 lymph node (+) 3.Frozen : invasive carcinoma 4.Thoracodorsal nerve and lateral thoracic nerve were all intake Operative Procedures 1.Under the ETGA the patient placed in Supine position 2.The opeation field was disinfected and drapped with surgical towls 3.Mark the incision line and contained the nipple 4.Incision along the mark line, and then use eletrocauterizer for forming theupper and lower flaps to the pectoralis muscle and rectus sheath and to the sternum. 5.dissect the breast medially, elevated it sharply off the pectoralis major fascia, the perforation artery was ligated by 3-0 silk. 6.As the breast is elevated and theaxilla is approached, the clavicopectoral fascia is encountered. 7.Locate the axillary vein and its tributaries. Ligate in continuty with 3-0 silk all the branch to the breast. 8.Using a Scalpel or Metzen baum scissors, gently evacuate the axillary contents of fat and lymph nods. Long thoracic nerve and thoracodoral nerve were preserved. finally removed the specimen. 9.Set two VB one is drain the inferior flap and axilla the other is drain superior skin flap. 10.close the skin with 3-0 dexon and 4-0 Nylon Operators 張金堅 Assistants 蔡明憲,張東晟 手術日期：2003/09/24 10:00 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Recurrent left orbital and anterior temporal meningioma Post-operative Diagnosis ditto Operative Method left pterional approach for subtotal tumor excision. Pathology pending Operative Findings The tumor was found on soft tissue dissection, which mixed with the temporalis muscle. The border was ill-defined. After craniotomy, we noted tumor invasion to left temporal base and orbital fossa with optic nerve encasement. The overlying sphenoid ridgewas hyperosteotic, and the dura was thickened. We drilled off the anterior clinoid process for removal of the intraorbital tumor component. The cavernous sinus was not opened for tumor excision. Operative Procedures Under endotracheal anesthesia, the patient was positioned supine with head turned to right side horizontally. Skin incision was through previous scar, then dissect subcutaneous soft tissue and perform craniotomy along previously-made edge. The tumor at temporal base was excised after elevation of temporal lobe. After opening of the thickened dura, the left anterior clinoid process was drilled off and removed for further orbital fossa tumor excision using EMF system. After careful hemostasis, the dura wasclosed with DuraGen, and cranioplasty was performed with mini-plate. After insertion of 1 subgaleal drain, the wound was closed in layer. Operators 杜永光 Assistants 王國川,黃日新 手術日期：2003/10/04 09:20 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Parkinson disease s/p left DBS implantation. Post-operative Diagnosis Parkinson disease s/p bilateral DBS implantation. Operative Method Right side DBS and battery impalntation. Pathology Nil. Operative Findings 1.Position: (1) AP: -2 cm. (2) Lateral: +11.7 cm. (3) Vertical: -4.7 cm. 2.STN range: 24.8~30.6 mm. 3.DBS tip: 31.6 mm. 4.There was blood from tract during operation, and it was stopped by electrocoagulation and surgicel. Operative Procedures 1. Set up stereostatic frame. 2. Local anesthesia. 3. Vertical incision over right frontal region. 4. Make a burr hole. 5. Insert track and electric code to detect STN position. 5. Hemostasis with electrocoagulation and surgicel. 6. Insert DBS electric fiber. 7. Make a subgaleal tunnel to let right DBS fiber pass to left side. 8. GA with propofol. 9. Make a transverse incision over left chest region. 10. Make a subcutaneous tunnel for battery fibers. 11.Make connection of right DBS and No 6V; left DBS and No 5V, respectively. 12.Hemostasis. 13.Close the wound by layers. Operators 曾漢民 Assistants 張源驛,饒敦 手術日期：2003/10/31 08:52 摘要__ 手術科部: 外科部 套用罐頭: HIVD Pre-operative Diagnosis L3-4 HIVD Post-operative Diagnosis Ditto Operative Method Discectomy, left L3-4 Pathology Pending Operative Findings A bulging and ruptured disc at L3-4 protruded downward and compressed the thecal sac and root of left L4 Operative Procedures 1. ETGA, prone 2. Vertical incision at L3-4 with C arm guided 3. Deepen the incision to expose the L3 and L4 laminae 4. Laminotomy, lower L3 and upper L4 5. L3-4 microsurgical discectomy 6. Check bleeding and set a CWV drain 7. Close the wound in layers Operators 曾漢民 Assistants 溫崇熙,張金池 手術日期：2003/10/31 14:59 摘要__ 手術科部: 外科部 套用罐頭: mini LC Pre-operative Diagnosis GB stone with chronic cholecystitis Post-operative Diagnosis ditto Operative Method Mini-Laparoscopic Cholecystectomy Operative Findings 1.severe adhesion, swelling and thickening of GB wall 2.two cholesterol stones, 1.5x1.5x1.5cm and 1x1x1cm 3.one 0.2x0.2x0.2cm polyp like lesion over fundus Operative Procedures 1. Operation Room Setup: Two video monitors, one on each side of the table, positioned toward the head of the table. The operator stood on the left side of the patient and the camera assistant stood next to the operator toward the foot of the table. To the patient's right side was the first assistant, opposite the operator and the surgical nurse stood next to the first assistant toward the foot of the table. The anesthesiologist and the monitoring equipment were at the head of the table. The laparoscopicinstrument tray was positioned at the foot of the table. Before the patient is placed under anesthesia, the camera, light source, scope (including the 2-mm mini-laparoscope and 10-mm conventional laparoscope), and insufflator should be checked to be certain that they are operational. The tank of carbon dioxide is also checked to ensure that an adequate amount is available for the duration of the operation. 2. Anesthesia: General anesthesia with endotracheal intubation. 3. Position and catheterization: An intravenous infusion was started before operation. The patient is positioned supine on the table. To facilitate laparoscopic exposure in the upper abdomen, a nasogastric tube is used to decompress the stomach. 4. Disinfection: The abdomen is prepared with Povidon-tincture solution which is applied and left for several minutes. Then the operation field was draped as usual. 5. Incision and establishing the ports: The patient was placed in the 20° Trendelenburg position. A curvilinear wound about1.5 cm in length was made at the sub-umbilical region, and the subcutaneous tissue was bluntly dissected to the fascia. Two towel-clamps were used to elevate the fascia in order to facilitate placing the Veress needle into the abdomen cavity. To insure that the needle was in the peritoneum, a small syringe containing a few milliliters of normal saline was attached to the Veress needle to perform the drop-test. When the needle already entered the abdominal cavity, the relative negative pressure pulled thefluid through the needle and into the abdominal cavity. The needle was then connected to the insufflator and carbon dioxide was set at an initial flow of 1L/min. Then after the insufflated volume reached 1L the flow rate was set up to 6L/min. After thepneumoperitoneum with intra-abdominal pressure maintained at 14 mmHg was established, the 5-11mm Versaport (Camera port) was inserted through the sub-umbilical port and then the insufflator tubing was connected to the sheath. For patients who had received abdomen operation previously, mini-laparotomy was done to avoid inadvertent hollow organ injury. The fascia was opened and underlying peritoneum was explored digitally or by instrument. The adhesion was freed and the abdominal cavity beneath the fasciavisualized. The trocar was removed from the sheath and the sheath was placed into the abdominal cavity with care. In this condition, a purse string suture using a 2 "0" Dexon suture was done to seal the port for fear of air leakage. The 10-mm conventional laparoscope was then inserted through the sheath in the sub-umbilicus port. A complete examination of all pelvic and intra-abdominal viscera was done. The table is then tilted with head up at least 20 to 30 degrees and rotated 15 degree to the left to exposethe right upper quadrant properly. Then, under 10-mm laparoscope direct vision, three MiniSite disposable 2-mm introducer/Surgineedle instrument combinations were inserted at the sub-xiphoid, right mid-clavicular and right anterior axillary regionsjustalong the right subcostal margin. 6. Manipulation during the operation: Two 2-mm MiniSite Endo Grasp units were inserted through the right mid-clavicular and right anterior axillary ports for traction of the gallbladder. 7. Dissection of the gallbladder: A 2-mm MiniSite MiniShears (US Surgical Corporation) was operated through the sub-xiphoid port for dissection and cauterization for identifying the cystic duct and cystic artery. The adhesion and areolar tissue around the cystic duct and cystic artery were dissected carefully to prevent inadvertent injury to the common bile duct and right hepatic artery. 8. Securing the cystic duct and cystic artery: Once the cystic duct was exposed and the relation with common bile duct was identified, the2-mm mini-laparoscope was then inserted through the 2-mm sub-xiphoid port and the cystic duct and cystic artery were clipped and divided by conventional laparoscopic instruments through the sub-umbilical port. 9. Freeing the gallbladder: Soon afterwards, the10-mm conventional laparoscope was used again to dissect the gallbladder away from the liver bed using the 2-mm MiniSite MiniShears. Traction was placed on the fundic portion of the gallbladder and the gallbladder was teared away from the liver bed. The avascular interface was peeled away by cauterization with the 2-mm MiniSite MiniShears. The position of the grasping clamps were changed as needed to provide the best exposure and to allow dissection of the gallbladder. Before the gallbladder was separated completely, visualization of the liver bed to check any bleeding point was done. Irrigation, suction and meticulous hemostasis were performed, too. Then the gallbladder was separated completely from the liver bed. 10. Removing the gallbladder: The gallbladder was then retracted through the sub-umbilical port by a clamp inserted through the sub-umbilical port under visualization of the 2-mm mini-laparoscope. After decompression and extending the fascia incision, the resected gallbladder was retrieved fromthe sub-umbilical wound. The fascia defect of sub-umbilical wound was closed to prevent possible incisional hernia. Sterilized strips were applied on the three 2-mm wounds and the wounds were covered by sterile gauge. Operators 游憲章 Assistants 徐光漢,蘇彥豪 手術日期：2003/11/03 12:43 摘要__ 手術科部: 外科部 套用罐頭: 其他 Post-operative Diagnosis Left lower leg soft tissue defect with tibia exposure Operative Method Debridement and sequestrectomy of tibia Pathology Nil Operative Findings 1. A 13*7 cm necrotic wound over the medial side of left leg, granulation tissue (+), pus (+), oder (+/-), with grangrenous change over edge 2. The gastronemius muscle was intact. 3. 3*2 cm tibia exposure was noted, with periosteal necrosis Operative Procedures 1. SA, supine 2. Antiseptic 3. Debridement 4. Burred all the necrotic tissue of left tibia untill bleeding 5. Cover the tibial exposure area with Omiderm 6. Cover the wound with Beta-Iodine gauze Operators 簡雄飛 Assistants 吳名倫,楊博仁 手術日期：2003/11/12 10:28 摘要__ 手術科部: 外科部 套用罐頭: 其他 Post-operative Diagnosis Left lower leg soft tissue defect with tibia exposure Operative Method Debridement and osteotomy of tibia Pathology Nil Operative Findings 1. A 13*7 cm necrotic wound over the medial aspect of left lower leg, granulation tissue (+), pus (-), order (-) 2. Gastronemius muscle: intact 3. A 3*2 cm tibia exposure with tissue necrosis Operative Procedures 1. IVG, supine 2. Antiseptic 3. Debridement 4. Excised all the necrotic tissue of left tibia 5. Cover the wound with Hirudoid ointment and beta-Iodine gauze Operators 簡雄飛 Assistants 吳益嘉,楊博仁 手術日期：2003/11/17 15:00 摘要__ 手術科部: 外科部 套用罐頭: Cranioplasty Pre-operative Diagnosis skull defect,left frontal-temporal-parietal area Post-operative Diagnosis skul defect,left frontal-temporal-parietal area Operative Method cranioplasty Pathology nil Operative Findings 1.marked adhesion between scalp, dura, temporalis muscle, and fascia 2. previous craniotomy over left F-T-P region, previous skull plate at left side abdominal wall. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right. 3. Skin preparation:shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with a sterilized adhesive plastic sheet. 4. Incision: along the previous operation scar at left F-T-P area, Raney clips were apllied to the scalp edge for temporary hemostasis. 5. The scalp and temporalis muscle were dissected away from the underlying dura. 5. The scalp adtemporalis muscle flap were easily reflected from the underlying silastic sheet which was then removed. The dural surface and margin of skull defect were well exposed. 6. The bleeders on the dissected surfaces were coagulated with Bovie painstakingly. 7. The edge of the skull defect was exposed. 6. The original skull plate preserved at subcutanuous layer of abdomen was removed and placed back to the skull window then fixed by 5 wires and a dura tenting at the center of the skull plate. 8. A steinless steel wire mesh was molded to normal contour of right frontotemporal skull and then cut to fit the size and shape of the skull defect. 9. Bone cement paste was applied to the inner surface of the wire mesh and printed on the dura surface andskull defect margin, then removed for waiting the hardening of the cement. 10.Bone cement paste was spreaded on outer surface of the wire mesh. 11.Multiple drill holes were made on the skull plate made of bone cement. 12.The artificial skull plate wasfixed to the skull with 5 wires. 13.Scalp closure: hemostasis was done with monopolar coagulator touching on the sucker tip. Galea suture was performed by continuous suture with 3/0 Dexon and skin by continuous suture with 3/0 nylon. 14.Drain: one, epidural, collected in a surgeons glove. 15.Course of the surgery: smooth. Operators 黃勝堅 Assistants 溫崇熙,郭佩勳 手術日期：2003/11/19 09:53 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Left lower leg soft tissue defect with tibia exposure Post-operative Diagnosis Left lower leg soft tissue defect with tibia exposure Operative Method Debridement and STSG Pathology Nil Operative Findings 1. A 13*7 cm necrotic wound over the medial aspect of left lower leg, granulation tissue (+), pus (-) 2. A 3*2 cm tibia exposure with granulation tissue over the exposure wound 3. A STSG from the lateral aspect of left thigh was taken for the skin defect Operative Procedures 1. SA, supine 2. Antiseptic 3. Debridement 4. Harvest STSG from the lateral aspect of left thigh 5. Fix the STSG to the wound 6. Cover the donor site with Omiderm and beta-iodine gauze Operators 簡雄飛 Assistants 陳右昇,楊博仁 手術日期：2003/11/24 00:00 摘要__ 手術科部: 外科部 套用罐頭: Lobectomy Pre-operative Diagnosis LUL tumor, r/o malignancy Post-operative Diagnosis LUL adenocarcinoma Operative Method Wedge tumor resection convert to LUL lobectomy+mediastinal LNs dissection over group 5,7,9 Pathology pending Operative Findings A 1*1cm nodule over left lingual lobe; cut surface: hypercellular, whitish Operative Procedures 1. Under GA with double lumen ET, right lateral position 2. Camera port: 9th ICS, MAL working port: 5th ICS, AAL 7th ICS, PAL 3. Wedge esection via VATs was done 4. Minithorracotomy through 5th ICS 5. LUL lobectomy was done 6. Mediastinal LNs dissection was done 7. Bleeders and air leakage was checked 8. PLace 28Fr chest tube*2 then closure of wound in layers Operators 李元麒 Assistants 謝義山,曾宇鼎,張容蓉 手術日期：2004/01/14 13:00 摘要__ 手術科部: 外科部 套用罐頭: Cervical Laminectomy Pre-operative Diagnosis cervical spinal stenosis, C3-C6 Post-operative Diagnosis ditto Operative Method Cervical laminoplasty, C3-6 Pathology nil Operative Findings 1.cervical spinal cord compression, from C3-6. 2.spinal cord expands well after laminoplasty. Operative Procedures 1.Anesthesia: endotracheal general. 2. Position: prone with neck flexed and head fixed by a Mayfield skull clamp. 3.Incision: medline nape, from suboccipital to lower neck. 4.The paravertebral muscles were dissected to expose spinous processes. 5.Thespinous processes of C3-6 were cut at its base by high speed air drill and reserved for later use. 6. The right laminopedicle juction were cut through its whole thickness by high speed air drill. 7.The left laminopedicle juction was cut into a depthof it half thickness by high speed cutting burr. 8.The lamina was bent to the left side and fixed to facet joint capsule by 1-0 Nylon. 9.check bleeding and set one CWV drain. 10.closure of wound in layers. Operators 賴達明 Assistants 王國川,林昊諭 手術日期：2004/01/30 08:30 摘要__ 手術科部: 外科部 套用罐頭: Cervical Laminectomy Pre-operative Diagnosis cervical spine stenosis, C3-6 Post-operative Diagnosis ditto Operative Method C4,C5 corpectomy + C3-4, C4-5, C5-6 discectomy + anterior bone fusion + plate fixation Operative Findings 1. prominent osteophyte C3-4, C4-5, C5-6 with thecal sac compression 2. thecal sac re-expansion after C4, C5 corpectomy Operative Procedures 1. ETGA, supine position 2. right transverse cervical incision 3. seperate platysma muscle 4. hook carotid sheath laterally and trachea medially 5. check position with C-arm 6. C3-4, C4-5, C5-6 discectomy 7. C4, C5 corpectomy 8. harvest bone graftfrom right anterio-superior iliac crest 9. anterior bone fusion with iliac bone and plate fixation (C3, C6) 10. insert V/B over right iliac wound, mini H/V over right neck 11. close wound layer by layer Operators 賴達明 Assistants 蔡翊新,陳文彬 手術日期：2004/02/04 00:00 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) Pre-operative Diagnosis L4-5 Gr.I spondylolisthesis Post-operative Diagnosis ditto Operative Method posterior spinal fusion with instrumentation + L4 , L5 laminectomy Pathology nil Operative Findings 1.spontaneous reduction of spondylolisthesis at prone position as shown on C-arm 2.hypertrophy of facet joint and ligamentum flavum 3.loosening of L4-5 facet joint Operative Procedures 1.ETGA, prone position 2.C-arm localization of L4-5 disc space 3.Skin preparation and well draped 4.Longitudinal skin incision 5.Dissect paraspinal muscle and fascia to expose L4 and L5 lamina, transverse process 6.Perform L4 and L5 laminectomy7.Apply transpedical screws and check position with C-arm 8.Four screws and two plate was applied for posterior fusion(6.7 x 40) 9.Bone fragment taken from L4 and L5 spinous process was used for bone fusion 10.Wound irrigation with GM solution 11.Set one hemovac 12.Close the wound in layers. Operators 林瑞明 Assistants 王國川,陳元森 手術日期：2004/02/11 15:00 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT Pre-operative Diagnosis R't ventricular brain tumor, r/o neurocytoma Post-operative Diagnosis dittp Operative Method R't parieto-occipital craniotomy for total tumor excision, transcortical approach + Frazier point EVD & ICP monitoring Pathology frozen: compatible with neurocytoma Operative Findings 1. One 7.4x4.2x4.8 cm in size, intraventricular hypervascular, reddish-gray, soft, heterogenous tumor, causing compression of right ventricle and thalamus 2. The brain is slack after operation 3. Frozen section of the tumor: compatible with neurocytoma Operative Procedures 1. Under endotracheal general anesthesia, the patient was placed on prone position with Mayfield fixation. The operation field was disinfected and draped as usual. 2. One currilinear scalp incision was made on right parieto-occipital area reflect to temporal area 3. R't P-O crainotomy via 6 burr holes 4. Transcortical approach (2x1 cm, low parietal) for total tumor excision 5. Meticulous hemostasis 6. Inserted EVD into occipital horn for ICP monitor and CSF drainage 7. One CWV drain was placed at the subcutaneous layer 8. Closed the wound in layers Operators 賴達明 Assistants 李定洲,侯奕仲 手術日期：2004/02/18 00:32 摘要__ 手術科部: 外科部 套用罐頭: Hypophysectomy---Transphenoid Pre-operative Diagnosis Pituitary tumor, Acromegaly Post-operative Diagnosis Ditto Operative Method Hypophysectomy---Transphenoid Pathology Pending Operative Findings Whitish-grayish,soft,liquified tumor over right side of sellar turcica causing compression the normal gland to the upper and left side No CSF leakage was noted Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head tilted 30 degree to left. 3. Skin preparation: the face and anterior right thigh were prepared with povidone-iodine alcohol tincture, and the mucosa of oral and nasal cavity with aqueous povidone-iodine tincture. The former areas were covered by a sterilized adhesive plastic sheet. 4. The nasal submucosa at septum and floor and the subperiostium at upper alveola were infiltrated with 1:100 epinephrine solution. 5. Incision: at labial mucosa, 3 mm away from its gingival junction and corresponding to 4 upper incisors. 6. The inferior margin of the nasal septum and floor was exposed after the upper lip had been dissected subperiosteallly and lifted. 7. The mucosa of nasal septum and floor was dissected away from the septal cartilage and the bony floor on both sides from anterior to posterior and displaced laterally by a long nasal speculum. 8. The septal cartilage was cut at its basal juction by sepatal scissors and then displaced to one side. 9. A Hardy's nasal speculum was applied to displace the nasal mucosa laterally and keep the nasal cavity open constantly for the exposure of the vomer bone and the anterior wall of the sphenoid sinus. Before the sinus was opened, the position of the nasal speculum was adjusted under the radioimage intensifier to a direction which directly pointed to the sellar floor. 10.The exposed sinus mucosa was coagulated and resected. 11.Under the guide of radioimage intensifier, the sellar floor was penetrated by a osteotome, then widened by Kerrison punch. 12.The sellar floor dura was coagulated with bipolar forceps, then opened in cruciate fashion. 13.The soft tumor parenchyma was removed by curette and suction, then the capsule was mobilized away from the dura and normal pituitary gland and removed. The final piece of the tumor at suprasellar area sank into the sella spontaneously after the intrasellar tumor had been removed. This last piece of the tumor was carefully separated from the arachnoid by curette and fine sucker. The venous oozing from the dura was stopped by gelfoam packing. 14.The arachnoid and the opening of diaphragm sellae was enforced by a pieceof muscle fascia. The sellar cavity was packed with muscle strips removed from right rectus femoris. The sellar floor was reconstructed by supporting a piece of vomer bone between the dura and the margin of the sellar floor. The sphenoidsinus was packed with fat tissue. 15.The Hardy's nasal speculum was removed and the nasal mucosa returned to its normal position. Each side of the nasal cavities was tightly packed with a segment of IV tube surrounded by 3 gauze strips which had been soacked with Better-iodine ointment. 16.The labial wound was closed by interrupted stitches with 4/0 Dexon. 17.Blood transfusion: 18.Course of the operation:smooth. Operators 曾勝弘 Assistants 李定洲,黃詩浩 手術日期：2004/02/24 14:04 摘要__ 手術科部: 皮膚部 套用罐頭: Malignant tumor excision Pre-operative Diagnosis Basal cell carcinoma Post-operative Diagnosis Basal cell carcinoma Operative Method Tumor excision Operative Findings 1.There is a pea-sized hyperpigmented macule on the right nasolabial fold. Operative Procedures 1. The patient was put on supine position. 2. The operation field at the right nasolabial fold was well sterilized. 3. The operation field was marked as shown below. 4. Under local anesthesia,tumor was excised with 0.5 cm -1cm safety margin. 5. The defect was then sutured subcutaneously with 5-0 dexon and simple sutured with 5-0 nylon. 6. The wound was covered with gauze with compression. Operators 陳昭旭,廖怡華,許致榮 Assistants 陳怡如,柯玫如 手術日期：2004/02/25 00:00 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Dural AV fistula, feeding a from right PICA Post-operative Diagnosis ditto Operative Method Far lateral appraoch for feeding artery obliteration 2.Ventriculo-pleural shunt Pathology nil Operative Findings 1.two dura branch from right PICA was found and these two arteries were coagulased by bipolar 2.A granulation-like tissue was noted at the junction of right PICA and vertebral artery. It was also coagulased. 3.ICP> 30 cm H2O Operative Procedures 1.ETGA, prone position . Skull fixed with myfield clamp 2.Skin preparation 3.S shape sin incision 4.Ventriculostomy at right frazier point and insert negaton tube for CSF drainage 5.Soft tissue dissection 6.C1 laminectomy 7.Creat three burr holes and suboccipital craniotomy about 5x4 cm 8.Dura incision and identified PICA 9.Two feeding arteries penetrated into dura were sacrificed by bipolar 10.hemostasis and dura closed 11.Put back bone plate and fixed with three wires 12.Ventriculo-Pleural shunt creation 13.Set one CWV drain 14.Closed the wound in layers. Operators 林瑞明 Assistants 王國川,陳元森 手術日期：2004/02/27 08:22 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Sphenoid ridge meningioma, left side, huge with sellar involvementSphenoid ridge meningioma, left side, large with sellar involvement Post-operative Diagnosis Ditto Operative Method Subtotal excision via Pterional craniotomy with anterior clinoidectomySubtotal tumor excision via Pterional craniotomy + anterior clinoidectomy Pathology Pending Operative Findings 1.6x7x8 cm tumor,whitish,yellowish,graywish, elastic soft, moderate vascularity over left sphenoid ridge with parasellar involvement 2.Prominent ECA blood supply from anterior and middle fossa 3.The most frontal part of tumor was removed 4.Brain swelling and buldged out of the dural window1.6x7x8 cm tumor, whitish, yellowish, graywish, elastic, moderate vascularity over left sphenoid ridge with para-sellar involvement 2.Prominent bloodsupply from anterior and middle cranial fossa 3.The most front part of the tumor was removed Operative Procedures 1.ETGA,supine with tilted to right with Mayfield clamp fixation 2.Skin incision, left F-T 3.Pterional craniotomy and anterior clinoidectomy 4.Devascularization, extradural and intradural 5.Subtotal tumor excision 6.Hemostasis with fibrinogen coverage7.Closed through layers and mini-plate fixation1.ETGA, supine with head tilted to right with Mayfield clamo fixation 2.Skin incision, left F-T 3.Pterional craniotomy and anterior clinoidectomy 4.Devascularization extradurally and intradurally 5.Subtotal tumor excision 6.Hemostasis with fibrinogencoverage 7.Closed through layers Operators 杜永光 Assistants 李定洲,黃詩浩 手術日期：2004/02/28 16:00 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis 1. Myelomeningocele, T12-S area 2. Diastematomyelia, L3-4 3. F. T. lipoma, below L5 Post-operative Diagnosis Ditto Operative Method Remove the diastematomyelia + repair of the split cord and myelomeningocele Pathology Pending Operative Findings 1. A myelomeningocele measuring about 5x5 cm in size was noted at the thoracolumbar ares (T12 and below). There was not skin covering. The spinal cord was tethered here and and went down and back to the spinal cana. The spinal cord was open and the central canal here was widely opened and exposed. It was covered with a layer of granulation tissue. 2. A cartilageous spur (diastematomyelia) extended from the left side of the severe bifid lamine at the L3-4 level and going ventrally to the posterior surfaceof vertebral body. The cartilage made the spinal canal into two parts. The conus meddularis and left part of cauda equina went through the left side of the canal, while the right part of the cauda equina went throuhg the right side canal. 3. The conus medullaris level was at about L4-L5 level 4. Filum terminale lipoma is suspected by MRI study, but it is just below the operation field (maybe L5-S1). The diameter of it was less than 1 mm. It is left untouched this time. Operative Procedures Under ETGA, the patient was put in prone position. Skin disinfection with aqua. BI at the skin defect and alcoholic BI at other site were applied. Under microscopic view, the arachnoid membrane was dissected from the surrounding skin. The cord was then untethered. The granulation covering the exposed central canal was trimmed meticulously, then the pia was closed with 6-0 prolene to reconstruct the canal. The cartilage splitting the cord (diastematomyelia) was removed with rhongeur and kerrison punch. Theother tissue contributing to tethering was removed. The filum terminala was checked then the dura was repaired with a piece of fascia takeen from the left side paravertebral muscle for about 1x2.5 cm in size. Two layers of fascia was taken from both sides of the paravertebral muscle to reinforce to defect. The subcutaneous tissue was dissected widely till the midaxillary line to make a primary skin closure possible. A mini-hemovac was interted in the subcutaneous space. Operators 郭夢菲 Assistants 溫崇熙,張金池 手術日期：2004/03/15 09:00 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt Pre-operative Diagnosis Chiari malformation type II with hydrocephalus Post-operative Diagnosis ditto Operative Method VP shunt, right Kocher area Pathology nil Operative Findings 1. Preoperative frontal fontanelle was bulged and tense. 2. Shunt reservoir: medium pressure; ventricular catheter: 5.5 cm; peritoneal catheter: 30 cm. 3. CSF pressure: 12~15 cmH2O; CSF: clear and colorless. Operative Procedures 1. ETGA; supine with head tilted to left. 2. Curvilinear scalp incision and create the scalp flap-> dura opening was done over the frontal edge of right coronal suture about 2 cm off midline-> ventricular puncture. 3. Right abdominal mini-laparotomy andinsert the peritoneal catheter. 4. Pass the tube via a subcutaneous tunnel over right chest wall, right neck, right retroauricular area, to the ventricular puncture site. 5. Connect the tube to shunt reservoir, and then connect the ventricular catheterto the reservoir-> insert the ventricular catheter. 6. Hemostasis-> close the wound in layers. Operators 郭夢菲 Assistants 曾仁河 手術日期：2004/03/17 12:51 摘要__ 手術科部: 外科部 套用罐頭: Biopsy 乳房 Pre-operative Diagnosis right breast cancer Post-operative Diagnosis ditto Operative Method lumpectomy and LN dissection Pathology pending Operative Findings A yellowish firm tumor was found at 2 cm away from nipple over 10 o'clock position of the right breast. It measured 3x3x3 cm, and the margin was ill-defined. Axillary LN(+) Operative Procedures Patient was put on supine position with right arm 90 degree abducted. Under ETGA, skin was disinfected and draped as usual. A curvilinear incision was made from 7 to 1 o'clock position. Excisional biopsy of the tumor was performed. The specimens weresent for frozen section. The incised skin was grasped and retracted upward with breast clamps for skin flap dissection. Electrocauterization was used for dissection of skin flaps. Tumor was removed by dissection. Axillary lymph node dissection was then performed for level I and II with identification and preserving of the long thoracic and thoracodorsal nerves. The bleeders were checked meticulously. The operative field was irrigated with warm saline. The wound was closed layer by layers after one CWV drains were left. Blood loss was minimal and the patient stood the whole procedure well. Operators 郭文宏 Assistants 徐光漢 手術日期：2004/03/30 15:46 摘要__ 手術科部: 外科部 套用罐頭: VATS biopsy Pre-operative Diagnosis RLL cancer Post-operative Diagnosis Ditto+ LNs metx Operative Method VATS bullectomy+LNs dissection Pathology adenocarcinoma,metastatic Operative Findings 1.A small bulla at the apex of LUL. 2.Frozen section: group 5: negative 3: negative 7: positive Operative Procedures 1. Anesthesia: General anesthesia using double-lumen endotracheal tube. 2. Position: right decubitus position. An axillary roll is placed under the down side. The operative field is well disinfected and draped. 3. Camera port: From the seventh intercostal space in the mid-axillary line away from the lesion. 4. Working ports: First: From the fifth intercostal space in the anterior axillary line. Second: From the fifth intercostal space in the posterior axillary line. 5. The pleural adhesions are separated by grasping forceps and by electrocautery. 6. The pulmonary lesion is visualized and stabilized with the grasping forceps. 7. The Endo-GIA 75 stapler is placed across its base. Wedge resection of the pulmonary lesion is performed. 8. The specimen is sent for pathological examination and TB, fungus, and bacteria cultures. 9. LN excision of group 5, sent to frozen section. 10.After meticulous homeostasis, one 28# chest tubes is placed via the camera port. The lung is ventilated under the direct vision. The skin is closed with 4-0 Nylon sutures. 11.Left decubitus. 12.CATS: cameral port: 8th ICS MAL, Working ports: 5 th ICS AAL and PAL. 13.LNs excision of group 3 and 7, sent to frozen section. 14.After meticulous homeostasis, one 28# chest tubes is placed via the camera port. The lung is ventilated under the direct vision. The skin is closed with 4-0 Nylon sutures. Operators 李元麒 Assistants 郭順文,顏俊銘 手術日期：2004/04/21 08:30 摘要__ 手術科部: 外科部 套用罐頭: Aneurysm-frontotemporal approach Pre-operative Diagnosis Left sphenoid ridge meningioma s/p subtotal tumor excision via left pterion approach Post-operative Diagnosis Left sphenoid ridge meningioma s/p subtotal tumor excision via left pterion approach Operative Method Simpson Grade II tumor excision via left pterion approach Pathology pending Operative Findings 1. A whitish, firm, moderate to low vascularity, 5*5*5 cm residral tumor was found over left sphenoid ridge, encasing and pushing left ICA, ACA, MCA, A-COM, PCA, P-COM and choroid a. enccentrically and laterally 2. Left MCA M1 segment was severed duringdissection. It was coagulated for hemostasis 3. Severe adhesion around previous operation scar, esp. at dura and cortex 4. Left 3rd cranial nerve , tentorium dege, lateral aspect of cavernous wall and pontine surface were push away from the tumor. Operative Procedures The patient was in supine position with head tilt right and back elevated ,then fixed by Mayfield skull clamp. Endotracheal intubation with general anesthesia was given. The scalp preparation was started with shaving and scrubbing with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet.Scalp incision was made curvilinearly over left frontotemporal area and the skin edge was clipped by Raney clips for temporary hemostasis. After scalp had been lifted, the temporalis muscle was incised and detached from temporal squama and reflected to lower temporal side. Craniotomy window was a 5x6 cm, frontotemporal skull, created by making 4 burr holes and then cut by power saw. Thelower temporal bone and pterionic ridge (esp.the inner table) were cut by rongeur as low as possible for easy approach to the anterior clinoid. Dural tenting using 2-0 silk, was done and distributed along the edge of skull window.Dural incision was madetransversely over-ridding Sylvian fissure and reflected to frontotemporal base.Under operating microscope, the Sylvian fissure was dissected and then frontal lobe was retracted to well expose carotid-optic triangle. Fully exposed ACA, MCA ,PCA, optic chiasm and oculomotor nerve for residual tumor excision. Dura was then closed with 4-0 Prolene. Cranioplasty was done with miniplate and a CWV drain was placed below temporalis muscle for drainage. Her scalp was then close in two layers with 2-0 Vicryl and3-0 Nylon. Operators 杜永光 Assistants 陳偉華,李定洲 手術日期：2004/05/03 14:47 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis thyroid papillary carcinoma ,recurrent Post-operative Diagnosis thyroid papillary carcinoma ,recurrentthyroid papillary carcinoma,recurrent Operative Method LN dissectionNeck LN dissection Pathology metastatic thyroid papillary carcinomapapillary carcinoma,metastatic Operative Findings multiple lymph nodes about 1 cm in size were notedmultiple neck LN about 1 cm in size were found Operative Procedures 1. ETGA and on supine position 2. transverse skin incision about 5 cm 3. LN dissection 4. minihemovac insertion 5. close wound in layers Operators 黃實宏 Assistants 林鳳玲 手術日期：2004/05/21 17:47 摘要__ 手術科部: 外科部 套用罐頭: ATYPICAL Pre-operative Diagnosis Hepatoma Post-operative Diagnosis Ditto Operative Method Atypical hepatectomy (S5, S6 and partial S7) + cholecystectomy Pathology Pending Operative Findings 1Severe fatty liver 2.One well-encapsulated hepatic tumor was identified at junction of S5, S6, S7, and S8, with tumor-in-tumor pattern. Hypercellularity(+), yellowish, homogenous in cut surface. Size of tumor: 4x5x6cm. No central necrosis. 3.Liver cirrhosis(-). 4.Blood loss around 500 cc. 5. GB stone(+) Operative Procedures 1.ETGA, supine 2.Bilateral subcostal skin incision with extension to Xiphoid. 3.Mobilize right border of liver and cholecystectomy. 4.Remove tumor with atypical hepatectomy with CUSA and bipolar coagulation. 5.Check bleeding and bile leakage. 6.Set 2rubber drain tubes at right subhepatic and subphrenic area. 7.Wound closure in layer. Operators 何明志 Assistants 劉明松,黃日新 手術日期：2004/05/21 17:00 摘要__ 手術科部: 外科部 套用罐頭: HIVD Pre-operative Diagnosis C3/4, C4/5, C5/6 HIVD and C3~C5 OPLL Post-operative Diagnosis Ditto Operative Method C3/4,C4/5,C5/6 discectomy, C4&C5; corpectomy with autologous bone fusion + ALPS Operative Findings (1)Severe degenerative osteophytes were noted on anterior and posterior body edge of C3, C4, C5, C6. (2)Narrowing disc space of C3/4, C4/5, C5/6. (3)Hypertrophic and calcified post. longitudinal ligament and that compressed thecal sac severely. (4)Markable post. protrusion of C3/4, C5/6 disc that compressed the spinal cord. Operative Procedures (1)ETGA. supine position with neck mild extension. (2)Transverse incision at the level of superior border of thyroid cartilage. (3)Dissect through the space between trachea and right SCM muscle to expose vertebral body. (4)Identified C3/4 disc by C-arm. (5)C3/4, C4/5, C5/6 discectomy, C4 & C5 corpectomy. (6)Removal of calcified PLL. (7)Harvest one piece of iliac crest bone about 4 cm. (8)Put the autologous bone graft into the corpectomy space. (9)Plate fixation on C3 & C6 (5.8cm plate x 1, 14mm screw x 4). (10)Hemostasis. (11)Insert one drain to plate site. (12)Close the wound in layers. Operators 賴達明 Assistants 張源驛 手術日期：2004/06/18 11:00 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt Pre-operative Diagnosis Aqueduct and 4th ventricle dilatation s/p VP shunt; 4th ventricular shunt dysfunction Post-operative Diagnosis Ditto Operative Method Shunt revision, 4th ventricular shunt Pathology nil Operative Findings 1. Reservoir of 4th ventricular shunt: poor refilling before op. 2. Shortening of 4th ventricular catheter about 2 cm.-> good refilling of the reservoir after operation. Operative Procedures 1. ETGA; right decubitus park-bench position. 2. Posterior nape skin incision to explore the 4th ventricular reservoir and ventricular catheter. 3. Disconnect the ventricular catheter, and shorten the catheter about 2 cm, and then connect the catheter with the reservoir again. 4. Hemostasis-> close the wound in layers. Operators 賴達明 Assistants 曾仁河 手術日期：2004/06/19 09:00 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Port-A infection Post-operative Diagnosis Ditto Operative Method Port-A removal Pathology Nil Operative Findings Previous Port-A in left cephalic vein Operative Procedures 1. IVG and local anesthesia 2. Supine position 3. Disinfected and drapped 4. Skin incision along previous wound 5. Expose the Port-A 6. Remove the Port-A 7. Ligate previous insertion site with silk 8. Close the wound with 3-0 Vicryl and 4-0 Nylon Operators 田郁文 Assistants 周宗欣,王牧群 手術日期：2004/06/25 13:55 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Dizziness, r/o V-P shunt related Post-operative Diagnosis ditto Operative Method V-P shunt ligation Pathology nil Operative Findings No flow of V-P shunt after ligation Operative Procedures 1. supine position, disinfection, local anestehsia 2. a 1cm transverse incision was made at subclavicular area 3. Dissect and identify the catheter of V-P shunt 4. Ligation with Silk 5. Close the wound with 4-0 Nylon Operators 賴達明 Assistants 張源驛,周俊志 手術日期：2004/06/25 17:50 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Retroperitoneal neuroendocrine tumor Post-operative Diagnosis Retroperitoneal tumor, suspect pheochromocytoma Operative Method Retroperitoneal tumor excision + cholecystectomy Pathology pending Operative Findings 1. A 7*5*3 cm sized, goose-egg shaped, soft-elastic, reddish-yellowish, hypervascular mass was noted at right retroperitonium, just closed to the right renal vein 2. Unstable BP was noted when mobilizing the tumor Highest: 260/110 Lowest: 80/50 3.24hr VMA (urine): 11.21mg/24h 4. Regional lymph nodes (-). 5. GB: thick wall with moderate adhesion and 4 stones: yellowish, hard, 1*1cm Operative Procedures 1. Under general anesthesia, the patient was placed in supine position. The skin was disinfected with alcohol better-iodine from the level of symphysis pubis to nipple area. 2. The abdomen was opened and explored through a midline incision from epigastrium to 5 cm below the umbilicus. 3. Cholecystectomy was performed 4. The ascending colon was mobilized by dividing its peritoneal attachments upwards toward the hepatic flexure.(dissect white line) 5. The retroperitoneum cavity was opened after retracting the ascending colon to the left side 6. The retroperitoneum cavity was well exposed and identifed the tumor position. The adhesion between the tumor and surrounding tissue were divided and dissected piece by piece. 7. The right renal vein was well divided from the tumor. 8. The tumor was removed en bloc 9. One CWV drain was indwelled at the retroperotoneal cavity 10. Hemastasis and normal saline irrigation, then the wound was closed by layers. Operators 田郁文 Assistants 葉啟娟,林耿立 手術日期：2004/06/25 12:00 摘要__ 手術科部: 外科部 套用罐頭: HIVD Pre-operative Diagnosis L4-5 HIVD , right Post-operative Diagnosis ditto Operative Method Microsurgical discectomy of L4-5, right Pathology nil Operative Findings 1.ruptured disc was noted at L4-5 , right side with root compression 2.After discectomy , the root was free from compression Operative Procedures 1.ETGA, the patient was put in prone position 2.C-arm localization of L4-5 disc space 3.Skin preparation and well draped 4.Longitudinal skin incision 5.Soft tissue disscetion to expose L4-5 laminae 6.Perform L4-5 laminotomy with high speed drill and kerrison 7.Perform microscopic discectomy of L4-5 , right side 8.Hemostasis and local infiltration with rinderon solution 9.Close the wound in layers. Operators 林瑞明 Assistants 溫崇熙,陳元森 手術日期：2004/07/01 09:41 摘要__ 手術科部: 外科部 套用罐頭: Lobectomy Pre-operative Diagnosis right lower lobe adenocarcinoma s/p VATs LN dissection, s/p chemotherapy Post-operative Diagnosis ditto Operative Method Right middle and lower lobe bilobectomy Operative Findings 1. Previous VAts wounds at right chest wall 2. Mild adhesion of right lower lobe to previous op. wound 3. A 2x1.5cm firm, hypercellular tumor at right lower lobe 4. LN enlargement: Gr.7, 10, 11 5. Severe adhesion of Gr.7 LN to intermediate bronchus 6. Severe adhesion of previous Gr.3 LN biopsy site to right upper lobe. Operative Procedures 1. Anesthesia: General anesthesia using double-lumen endotracheal tube. An epidural anesthesia catheter is placed prior to the operation. 2. Position: Left decubitus position. An axillary roll is placed under the down side. The operative field is well disinfected and draped. 3. Wound incision was made at previous VATs wound and set camera port. The wound was estended to mini-thoracotomy through the fifth intercostal space. The pleural adhesions are separated using electrocautery. 4. The right lower lobe is retracted anteriorly. The inferior pulmonary ligment is divided.The inferior pulmonary vein is identified, doubly ligated, suture-ligated, and divided. 5. The fissure between the middle and lower lobes is separated and divided. And major fissure isalso separated and divided. 6. The pulmonary artery supplying the right middle and lower lobe are identified, doubly ligated, suture-ligated and divided. 7. The intermediate bronchus is identified, clamped with TA-30 stapler, and divided with a knife, leaving a 5-mm stump. The stump is disinfected with aqua-betadine. Interrupted 4-0 Ticron sutures are used for reinforcement of the stump. 8. The pleural cavity is irrigated with phosphate buffer solution and the fluid is sent for cytological examination. 9. Lymph node dissection is done at group 2, 3,8, 7, 8, 9,10, and 11. 12. After meticulous homeostasis and check-up of air leakage, two 28# chest tubes are placed at anterior and posterior aspect of pleural cavity respectively. The intercostal space is closed with interrupted 2# Chromic sutures. The muscle layer is closed with 1-0 Vicryl sutures and the subcutaneous layer is closed with 2-0 Vicryl sutures. Subcutical 3-0 Prolene sutures are used for closure of the skin. The endotracheal tubeis changed to single lumen tube and then the patient is sent to ICU for postoperative care. Operators 李元麒 Assistants 林洧呈 手術日期：2004/07/14 19:00 摘要__ 手術科部: 外科部 套用罐頭: Laminoplasty Pre-operative Diagnosis Cervical spine OPLL C3-6 Post-operative Diagnosis Ditto Operative Method Laminoplasty, left side open door, C3-6 Pathology Nil Operative Findings 1.Severe epidural venous plexus oozing, EBL: 600cc 2.Thecal sac expansion after decompression Operative Procedures 1.ETGA, prone 2.C2-7 skin incision 3.Paraspinal muscle splitting 4.Perform lamina dissection along the border of underlying thecal sac lateral wall 5.Perform laminoplasty 6.Set one CWV drain in epidura space 7.Close wounds in layers Operators 賴達明 Assistants 蔡翊新,曾仁河,李孟霖 手術日期：2004/07/19 14:30 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) Pre-operative Diagnosis Grade 1 spondylolisthesis of L4-5 Post-operative Diagnosis Ditto Operative Method Laminectomy of L4 and L4-5 TPS fixation with posterolateral bone fusion Pathology Nil Operative Findings 1.Bilateral side hypertrophied ligamentum flavum 2.L4-5 instability by Towel clamp 3.Thecal sac well expansion after decompression 4.Instrument: 6.5mm diameter x 45mm in length x 4 Rod: 5cm. left side 6cm. right side Operative Procedures 1.ETGA, prone position 2.L4-S1 midline incision 3.Dissect free paraspinal tissue 4.Laminectomy of L4 lamina 5.Transpedicle screw over L4.5 facet; confirmed by C-arm 6.Set one hemovac 7.Close wounds in layers Operators 曾漢民 Assistants 曾仁河,李孟霖 手術日期：2004/07/31 13:00 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt Pre-operative Diagnosis Hydrocephalus, right temporal horn Post-operative Diagnosis Ditto Operative Method V-P shunt Pathology Nil Operative Findings 1.CSF: clear, pressure: about 10cm H20 2.Medium pressure reservoir, 5cm depth ventricular catheter Operative Procedures 1.ETGA, supine, head turn to left 2.Right temporal dura burr hole 3.2.5cm depth insertion and CSF drain for culture 4.Right abdomen incision and shunt tip insertion 5.Subcutaneous tunnel connecting two loci 6.Medium pressure reservoir placement 7.Close wounds in layers Operators 賴達明 Assistants 蔡翊新,李孟霖 手術日期：2004/08/09 08:20 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Neurofibromatosis, type II, bilateral acoustic neuroma, multiple menigioma Post-operative Diagnosis Ditto Operative Method Simpson grade I tumor excision, meningioma, left frontaoparietal craniotomy Pathology Pending Operative Findings 1.Bulging dura after the craniotomy 2.A 8 cm multilobulated, dark-reddish, hypervascularity, soft, well-defined margin tumor over the left fronto-parietal lobe with dural attachment, the dura was thicker than normal Operative Procedures 1.ETGA, supine with head flexion tilting to the right side with Mayfield clamp fixation. Left shoulder elevated 2.U-shape skin incision 3.Open through layers 4.Craniotomy, left fronto-parietal 5.Dural tenting 6.Opened the dura 7.Simpson grade I tumor excision 8.Duroplasty 9.CWV x I 10.Closed through layers Operators 曾漢民 Assistants 溫崇熙,黃詩浩 手術日期：2004/08/11 00:00 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT Pre-operative Diagnosis Cerebellar ICH, Right IVH Post-operative Diagnosis Ditto Operative Method Suboccipital craniotomy and ICP monitor placement Pathology Nil Operative Findings 1. The cerebellum bulge out after opening the dura 2. Intra-OP echo for localization of the ICH 3. ICH about 3 x 3 x 2 cm over R't cerebellar hemisphere was noted 4. The cerebellum slag after hematoma was removed 5. EVD was set from Right Frazier's burr hole 10 cm into R't lateral ventricle Operative Procedures 1. ETGA, prone position with neck flexed and head fixed by Mayfield skull clamp 2. Skin prepare and draping 3. Skin incision from inion level to C2 4. Suboccital craniotomy: 3 x 5 cm 5. U-shaped dura incision 6. Hematoma evacuation 7. Hemostasis 8. EVD from R't Frazier's burr hole 9. Wound closed by layers Operators 賴達明 Assistants 溫崇熙,洪偉禎,古然文 手術日期：2004/08/14 00:00 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt Pre-operative Diagnosis Hydrocephalus with V-P shunt dysfunction Post-operative Diagnosis Hydrocephalus with V-P shunt dysfunction, occlusion of ventricular tip Operative Method Revision of V-P Shunt, proximal part Pathology Nil Operative Findings 1.CSF: clear and colorless. 2.Reservoir: medium. It was depressed before operation. 3.New ventricular catheter: set 5.3cm (previous catheter 5.5cm in length) Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: supine with head rotating to the left. 3.Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4.Incision: curvilinear along previous op scar, over right frontal area. 5.After the scalp flap had been lifted and reflected anteriorly, the old reservoir and ventricular catheter were replace by a set of new one. 8. The reservoirwas fixed to pericranium. 9. Wound closure: in layers 10.Course of the surgery: smooth. Operators 郭夢菲 Assistants 曾仁河,郭律廷 手術日期：2004/08/25 00:00 摘要__ 手術科部: 外科部 套用罐頭: HIVD Pre-operative Diagnosis HIVD, L4/5 Post-operative Diagnosis Ditto Operative Method Microscopic left Discectomy of L4/5 Pathology nil Operative Findings 1.Hypertrophic Ligmentum flavum 2.Degenerated and dehydrated disc of L4/5 protruded and compress the L5 root, which expanded well after discectomy 3.No significant compression of S1 root Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: prone 3.Skin preparation: the back was shaved and scrubbed with povidone-iodine detergent then painted with povidone-iodine tincture and followed by sterilized adhesive plastic sheet covering. 4.A spinal needle was inserted between spinous processes of L4/5 and a portable X-ray film was taken to locate the correct interspace. 5.Incision: 3-cm, between L4 and L5 spinous processes, off-midiline at the left margin of spinous processes. The subcutaneous layer and lumbdorsal fascia were incised then. 6.The aponeurosis of the latissimus dorsi and ileocostalis lumborum muscles at spinous processes of L4 and L5 was incised, the muscles were detached from the interspinous ligament. The multifidus muscles were detached subperiosteally from L 4/5 laminae by a rasp. 7.The paravertebral muscles were retracted 8.Under an operating microscope, the ligamentum flavum was cleaned and incised longitudinally at the lateral part with a No. 11 blade. The lateral portion of this ligament was removed with a small angle Kerrison rongeur, the lateral portion of the laminae and the medial border of the facets were removed too until the margin of the facets and a corridor to the disc that ran lateral to the root was reached. 9. The epidural fat was left undisturbed andpreserved. 10.The compressed L5 root and veins overlying the protruded disc were gently pushed away by placing 2 small cottonoid patties, one above and one below the disc at the floor of the epidural canal. 11.The compressed root was gently pushed further away temporarily by sucker tip in order to expose the herniated disc more clearly. The posterior longitudinal ligament and annulus were incisedaround the protruded disc with a No. 15 blade. The degenerated disc was removed with microdisc forceps until a substantial amount of the nucleus had been loosened with a cone curette and removed. 12.The lumbodorsal fascia was approximated by 3 interruped 2/0 silk stitches. 13.Thesubcutaneous layer was closed by running suture with 4/0 Dexon and skin by adhesive tape. 14.Course of the surgery: smooth. Operators 賴達明 Assistants 張　麟,陳盈志 手術日期：2004/09/25 00:07 摘要__ 手術科部: 外科部 套用罐頭: Chronic Subdural Hematoma Pre-operative Diagnosis Chronic Subdural Hematoma Post-operative Diagnosis Chronic Subdural Hematoma Operative Method Blurred hole drainage Pathology nil Operative Findings 1. Large amount of dark reddish homogenous fluid was drained out 2. Whitish outer membrane and brownish inner membrane were noted during procedure 3. The pressure inside the SDH was moderate 4. After drainage finished, no brain surface overextending noted Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesiveplastic sheet. 4. Incision: 3cm linar skin incision over right parietal area. Raney clips were applied to the scalp edge for temporary hemostasis. 5. A 1x1 cm blurred hole was created at right parietal area 6. Dural tenting: by 2/0 silk, and distributed along the edge of the trephine. 7. Dural incision, and the outer membrane of the hematoma was coagulated by Bovie along the edge of dural incision, then exicsed. 8. The liquified old blood and clot in the subdural space was irrigated with N.S. through a rubber tube until the return was clean. 9. Dural closure:interruped 2/0 silk sutures for key stitches, then continuous sutures with 4/0 Dexon to obtain water-tight closure. 10.Scalp closure:hemostasis was done with bipolar coagulator. Galea suture was performed by continuous sutures with 3/0 Dexon and skin by continuouss suture with 3/0 nylon. 11.Drain: one, subdural, collected in a collecting bag. Operators 曾勝弘 Assistants 陳元森,陳睿生 手術日期：2004/10/04 16:00 摘要__ 手術科部: 外科部 套用罐頭: C-P Angle Tumor Pre-operative Diagnosis Right cerebellopontine angle tumor Post-operative Diagnosis Right cerebellopontine angle vestibular schwannoma Operative Method Right retrosigmoid approach for tumor excision Pathology frozen: neurilemmoma Operative Findings 1.A 4.0x4.0x3.5cm elastic hard tumor over the right cerebellopontine angle.The superficial portion was elastic firm and whitish; the deep portion was soft and yellowish. 2.The cranial nerves were not visible 3.Some residuals were left near the IAC due to adhesion to one tortous vein 4.Intra-op frozen: neurilemmona Operative Procedures 1.ETGA, park-bench position exposing right occipital area 2.Disinfection and drapping 3.Post-auricular curvilinear incision, about 4.2 cm behind the EAC 4.Make a small(3.0x3.0cm) craniotomy via three blurr holes 5.Retrosigmoidal dural incision 6.Traction of cerebellar hemisphere to expose the tumor beneath 7.Tumor excision via bipolar 8.Hemostasis and irrigation 9.Dural tenting and cranioplasty 10.Placement of subgaleal CWV 11.Wound closed in layers Operators 曾漢民 Assistants 張　麟,黃博浩 手術日期：2004/10/11 10:10 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) Pre-operative Diagnosis T9-11, L3-5 stenosis Post-operative Diagnosis Ditto Operative Method Laminectomy T9-11, L3-5 Pathology Nil Operative Findings Hypertrophy of ligmentum flavum, L3-5 Cslcification of ligmentum flavum, T9-11 Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: prone. 3. Skin preparation: the back was shaved and scrubbed with povidone-iodine detergent then painted with povidone-iodine tincture and followed by sterilized adhesive plastic sheet covering. 4. A spinal needle was inserted between spinous processes of L4,T10 and a portable X-ray film was taken to locate the correct interspace. 5. Skin incision 6. The latissimus dorsi, ileocostalis lumborum muscles (trapezius, latissimus dorsi, ileocostalis lumborum, serratus posterior inferior and spinalis thoracis muscles --T-L; trapezius, latissimus dorsi, serratus posterior inferior and spinalis thoracis muscles-- lower T; trapezius, rhomboideus, serratus posterior superior,splenius cervicis, spinalis thoracis -- upper T) were detached from spinous processes of T9-11, L3-5 on both sides by Bovie, then multifidus muscles were dissected subperiosteally from the laminae with rasp. 7. The paravertebral muscleswere retracted by self retaining retractors to expose the spinous processes and laminae of --. The bleeding from the muscles were stopped by Bovie. 8. The spinous processes and laminae of T9-11, L3-5 were bitten off with rongeurs and Kerrison punch until the posterior half of the spinal canal was widely opened. The hypertrophic ligamenta flava including those at lateral recesses were excised. The epidural venous bleeding was stopped by gelfoam packing. 9. The interlaminal spaces of T9-11, L3-5 on both sides were widened by partial laminecotmy on T9-11, L3-5 with high speed air drill until the space was large enough for the distraction hook. The same procedure was done at T9-11, L3-5 interlaminal space. 10.The Harrington distractor was applied on the -- side to distract the fracture dislocation siteat -- until a good reduction had been obtained. A Harrington rod of -- cm long was bent 15 degree at its midpoint by a bender, then fixed tightly on the -- side laminae by one of its hooks on -- lamina at one end and the other on-- lamina on the other end. The same procedure was done on the -- side after the distractor had been removed. 11.The muscular attachment on the lateral aspect of the facets joint and the transverse processes of -- was detached by Bovie, then the lateral surface of each facets was decorticated with rongeurs. Posterior lateral fusion was done by onlay graft with the resected spinous process and lamina placed on the lateral aspect of the facets joints and pedicles of --. 12.Theparavertebral muscles were closed by interrupted sutures with 2/0 silk, subcutaneous layer by continuous suture with 3/0 Dexon and skin by continuous suturewith 3/0 nylon. 13.Drain: two, epilaminal, hemovac. 14.Blood transfusion: 15.Course ofthe surgery: smooth. Operators 杜永光 Assistants 溫崇熙,黃詩浩 手術日期：2004/10/11 09:11 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis olfactory groove/planum sphenoidale meningioma Post-operative Diagnosis ditto Operative Method Bifrontal craniotomy frontobasal approach for total excision. Pathology pending Operative Findings Intradural meningioma: elastic soft, whitish, hyprvascular and lobulated. Tightly adhere to frontal base. Olfactory nerves were preserved. Extradural meningioma:invasion into nasal cavity, ethemoid and sphenoid sinus. Right orbital wall erosion with a defect. Left orbital wall was intact Bilateral frontal sinus were opened and sealed with bone wax later covered by myogaleal flap. Operative Procedures ETGA, placement of lumbar drain, supine with head mildly flexed. Bicoronal incision Creation of the bone plate of sandwitch flap Bifrontal craniotomy via 4 blurr holes Divide and ligate SSS at the frontal base via microclip. Removal of intra and extra-dural tumor via piecemeal method with curette, bipolar and CUSA eXcel. Placement of 2 vaseline gauze over the left nasal cavity and 1 over the right. Iodofrom packing of the nasal cavity with the end placed over the right nostril.Myogaleal flap to covr frontal sinus. Sandwitch falp Reconstruction of cribiform plate Hemostasis and irrigation Placement of subgaleal CWV Wound closed in layers Placement of one merocel in each nostril Operators 曾漢民 Assistants 張　麟,黃博浩 手術日期：2004/10/18 13:30 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis C2-T6 syrinx Post-operative Diagnosis C2-T6 syrinx Operative Method Subocciptal craniectomy and duroplasty Pathology Nil Operative Findings 1.Thick and tight fibrous band at foramen magnum. 2.The dura expanded well after decompression. Operative Procedures 1.ETGA, prone position with head fixed in a skull clamp and neck mildly fixed. 2.Hockeysticky insertion. 3.Subocciptal craniotomy. 4.Duroplasty with a piece of fascia. 5.Wound close inlayers after hemostasis, placement of one epidural CWV drain. Operators 賴達明 Assistants 溫崇熙 手術日期：2004/10/20 08:45 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Lipoma over L't back Post-operative Diagnosis Ditto Operative Method Tumor excision Pathology (初步報告) lipoma Operative Findings A well-defined fatty-like tumor, 15x11x3 cm is noted over L't back. Operative Procedures 1. ETGA, prone 2. Skin disinfection 3. Tumor excision 4. Hemostasis and insert a CWV. 5. Close wound in layer Operators 簡雄飛 Assistants 鄭乃禎,張金池 手術日期：2004/10/27 13:12 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis R't thumb glomus tumor Post-operative Diagnosis Ditto Operative Method Excision Pathology (初步報告) glomus tumor Operative Findings A 0.5 cm in diameter firm tumor is noted over right thumb nail bed. Operative Procedures 1. Local anesthesia, supine 2. Skin disinfection 3. Longitudinal incision 4. Tumor excision 5. Hemostasis 6. Close wound in layer. Operators 簡雄飛 Assistants 鄭乃禎,張金池 手術日期：2004/11/01 17:20 摘要__ 手術科部: 外科部 套用罐頭: LC Pre-operative Diagnosis Acute cholecystitis Post-operative Diagnosis Ditto Operative Method Laparoscopic Cholecystectomy Pathology Pending Operative Findings Gallstone Characteristic: pigmemted Number: multiple The gallbladder wall: thickness The cystic duct: 1 The cystic artery: 1 Previous abdominal operation: nil Adhesion around the gallbladder: yes Others: bloody bile Operative Procedures 1. Operation Room Setup: Two video monitors, one on each side of the table, positioned toward the head of the table. The operator stood on the left side of the patient and the camera assistant stood next to the operator toward the foot of the table. To the patient's right side was the first assistant, opposite the operator and the surgical nurse stood next to the first assistant toward the foot of the table. The anesthesiologist and the monitoring equipment were at the head of the table. The laparoscopicinstrument tray was positioned at the foot of the table. Before the patient is placed under anesthesia, the camera, light source, scope, and insufflator should be checked to be certain that they are operational. The tank of carbon dioxide is also checkedto ensure that and adequate amount is available for the duration of the operation. 2. Anesthesia: General anesthesia with endotracheal intubation. 3. Position and catheterization: An intravenous infusion was started before operation. The patient ispositioned supine on the table. To facilitate laparoscopic exposure in the upper abdomen, a nasogastric tube is used to decompress the stomach. 4. Disinfection: The abdomen is prepared with Povidon-tincture solution that is applied and left for several minutes. Then the operation field was draped as usual. 5. Incision and establishing the ports: The patient was placed in 20° Trendelenburg position. A curvilinear wound about 1.5 cm in length was made at the sub-umbilical region, and the subcutaneous tissue was bluntly disscted to the fascia. Two towel-clamps were used to elevate the fascia in order to facilitate placing the Veress neddle into the abdomen cavity. To insure that the needle was in the peritoneum, a small syringe containing a few milliliters of normal saline was attached to the Veress needle to perform the drop-test. When the needle already entered the abdominal cavity, the relative negative pressure pulled the fluid through the needle and into the abdominal cavity. The needle was thenconnected to the insufflator and carbon dioxide was set at an initial flow of 1L/min. Then after the insufflated volume reached 1L the flow rate was set up to 6L/min. After the pneumoperitoneum with intra-abdominal pressure maintained at 14 mmHg was established, the 10mm Versaport (Camera port) was inserted through the sub-umbilical port and then the insufflator tubing was connected to the sheath. For patients who had received abdomen operation previously, mini-laparotomy was done to avoid inadvertent hollow organ injury. The fascia was opened and underlying peritoneum was explored digitally or by instrument. The adhesion was freed and the abdominal cavity beneath the fascia visualized. The trocar was removed from the sheath and the sheath was placedintothe abdominal cavity with care. In this condition, a purse string suture using a 2 "0" Dexon suture was done to seal the port. The laparoscope was then inserted through the sheath in the sub-umbilicus. A complete examination of all pelvic and intra-abdominal viscera was done. The table is then tiled with head up at least 20 to 30 degrees and rotated 15 degree to the left to expose the right upper quadrant properly. The secondary 10mm Versaport (working port) was placed through a transverse incision, 12mm in length, located at the sub-xiphoid region. Then a 5mm port (fundic port, for grasping of the fundus) was inserted at the right anterior axillary line, at about one to one-half port length below the gallbladder. Another 5mm port (infundibularport, for grasping of the infundibulum) was inserted at the right mid-clavicular line about midway between the sub-xiphoid port and left axillary port. 6. Manipulation during the operation: A rachet clamp was utilized to grasp the fundus of the gallbladder through fundic port and the gallbladder was pushed up to the right diaphragm. Then another ratchet clamp was used to grasp the infundibulum through the infundibular port. 7. Dissection of the gallbladder: Dolphin dissector and hook dissector withan attached electric cautery was used to dissected the gallbladder through the operation port. The adhesion and areolar tissue around the cystic duct and cystic artery were dissected carefully to ensure inadvertent injury to the common bile duct and right hepaticartery. 8. Securing the cystic duct and cystic artery: Once the cystic duct was exposed and the relation with common bile duct was identified, the cystic duct is clipped by Endo-clipper and divided by the scissors. The cystic artery wasexposedbyhook dissector, clipped by Endo-clipper, and divided by the scissors too. 9. Freeing the gallbladder: When cystic artery was secured and divided, traction was placed on the infundibulum of the gallbladder and the gallbladder was teased awayfrom theliver bed. The avascular interface was peeled away by cauterization with Dolphin or hood dissector. The position of the grasping clamps were changed as needed to provide the best exposure and to allow dissection of the gallbladder. Before the gallbladderwasseparated completely, visualization of the liver bed to check any bleeding point was done. Irrigation, suction and meticulous hemostasis were performed too. Then the gallbladder was separate completely from the liver bed. 10. Removing thegallbladder: The camera was shift to the sub-xiphoid working port and a clamp was inserted through the sub-umbilical port to grasp the cystic portion of the gallbladder. After decompression and extending the fascia incision, the resected gallbladder wasretrieved from the sub-umbilical wound. Fascia defect was closed to avoid incisional herniation and the wound was closed in layers and covered by sterile gauge. Operators 賴逸儒 Assistants 蔡明憲,張兼華 手術日期：2004/11/09 00:00 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis 1. Marfan syndrome 2. severe MR 3. ascending aortic aneurysm Post-operative Diagnosis 1. Marfan syndrome 2. severe MR 3. ascending aortic aneurysm Operative Method Bentall operation Pathology pending Operative Findings 1. Severe AR; dialted sortic annulus about 28-30mm in diameter; fusion of LCC and NCC with curling of leaflet edge; clear pericardial effusion; good LV contractility 2. Atherosclerotic change at RCA orifice; 2mm probe can be passed through it. 3. Ascending aortic aneurysm from the aortic root to the arch, with atherosclerotic change and maximal diateter of 10cm. The wall of aortic arch is relatively thin. Operative Procedures 1. ETGA, supine position 2. median sternostomy 3. right axillary artery, RA to SVC and RA to IVC cannulation 4. CPB 5. aorta crossclamp 6. transection of ascending aorta 7. antegrade and retrograde cardioplegia and deep hypothermia to 15 degree C 8. Bentall operation: a. 27mm St Jale HP mechanical valve and 30mm Hemashield vascular graft b. proximal anastomosis to the aortic annulus with interrupted plegetted prolene suture c. LCA and RCA coronary buttons anastomosis to the graft9. antegrade cerebral perfusion with balloon catheter obliterating innominate artery (100ml/min) 10. distal anastomosis of the graft to the aortic arch with double-layered suture 11. deair, warm-up, off CPB 12. place 2 chest tubes 13. close wound inlayers 14. dressing Operators 陳益祥 Assistants 許鈞,游聖彬,王瑋 手術日期：2004/11/16 11:40 摘要__ 手術科部: 外科部 套用罐頭: MRM Pre-operative Diagnosis Left breast cancer Post-operative Diagnosis Ditto Operative Method Modified radical mastectomy. left Pathology Pending Operative Findings 1.No obvious LAP. 2.Long thoracic nerve and thoracodorsal nerve were preserved. 3.Level I and Level II lymph nodes were excised for pathologic examination. Operative Procedures Patient was put on supine position with left arm 90 degree abducted. Under ETGA, skin was disinfected and draped as usual. An transverse elliptical incision, including the nipple-areolar complex and the skin over the biopsy wound, from left parasternalto left axillary area was made superiolaterally. The incised skin was grasped and retracted upward with breast clamps for skin flap dissection. Electrocauterization was used for dissection of skin flaps. The dissection reached to the level 1 cmbelow clavicle superiorly, the costal margin inferiorly and the parasternal area medially. Laterally dissecton was extended to the border of latissimus dorsi. The clavipectoral fascia was opened. The axillary vein was exposed and identified. The branches of the axillary vein were devided between ligatures. Axillary lymph node dissection was then performed for level I and II with identification and preserving of the long thoracic and thoracodorsal nerves. Breast tissue was removed en bloc with the axillary lymph nodes. The bleeders were checked meticulously. The operative field was irrigated with warm saline. The wound was closed layer by layers after two CWV drains were left. Blood loss was minimal and the patient stood the whole procedure well. Operators 黃俊升 Assistants 陳信安,陳克剛 手術日期：2004/12/04 08:45 摘要__ 手術科部: 外科部 套用罐頭: AVF Pre-operative Diagnosis ESRD. Post-operative Diagnosis ESRD. Operative Method Right elbow AVF. Pathology Nil. Operative Findings 1. Right brachial artery: 4mm. Right cephalic vein: 3mm. anastomosis length: 5mm. 2. post-op thrill: ok. Operative Procedures Under local anesethesia, right elbow incision was made and dissection of right brachial artery and cephalic vein were done. Then end-to-side anastomosis was performed. Wound was closed in layers. Operators 王水深 Assistants 李　光 手術日期：2004/12/06 16:30 摘要__ 手術科部: 外科部 套用罐頭: Port-A Pre-operative Diagnosis Breast cancer. Post-operative Diagnosis Breast cancer. Operative Method Port-A. Pathology Nil. Operative Findings Smooth blood flow in Port-A. Adequate position was confirmed by chest X ray. Operative Procedures Under local anesthesia, Port-A was inserted into right subclavian vein and then the wound was closed. Operators 黃書健 Assistants 李　光 手術日期：2004/12/29 13:44 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Pancreatic tail tumor Post-operative Diagnosis Gastric GIST Operative Method 1. Wedge resection of stomach, en bloc with tumor; 2. jejunostomy; 3. pylorus plasty Pathology pending Operative Findings 1. a 12x16cm gray-yellowish, elastic tumor was found with base arising from posterior wall of stomach. 2. Enlargement of Group 4 lymph nodes 3. no pancreatic invasio, adhesion only. Operative Procedures 1. ETGA, supine position 2. left subcostal incision with midline extension 3. adhesiolysis 4. wedge resection of stomach. with en bloc of the tumor 5. pyloroplasty 6. jejunostomy 7. close the wound in layer with 2 rubber drains insertion: right subhepatic and left subphrenic Operators 田郁文 Assistants 周俊志,趙鴻丞 手術日期：2005/02/18 17:10 摘要__ 手術科部: 外科部 套用罐頭: 肝右葉 Pre-operative Diagnosis Hepatocellular carcinoma, right Post-operative Diagnosis Ditto Operative Method Right hepatic lobectomy Pathology Pending Operative Findings 1. One huge 10x8x8 cm, solid, yellowish hepatic tumor with necrosis located at right superior segment(S7.8), Satellite nodule: nil. 2. Another tumor at S5, soft, whitish about 1.5x1.5x1.5cm. 3. No liver cirrhosis, No ascites. 4. No tumor thrombosis orregional invasion was noted. Operative Procedures 1. After the abdomen was opened through bilateral subcostal incision with a midline extension to the xyphoid, two self-retaining retractors of Kent type were used to retract the costal margins. 2. The liver was mobilized by dividing the falciform and triangular ligaments as well as freeing the liver from diaphragm. 3. The right hepatic lobe was rotated medially to expose the small hepatic veins communicating with the inferior vena cava, and these small vessels were ligated carefully. The hepatic tumor was palpated to identify its location and relation between major vessels. 4. The cystic artery and cystic duct were ligated, and the gallbladder was removed. 5. A clear exposure and ligated the right hepatic artery without interfere the bifurcation to the left hepatic artery was performed. The right portal vein and hepatic vein were also well exposed and ligated. The concave line of demarcation following the color change subsequent tolooping of the blood supply may be superficially outlined with a electrocautery. 6. Hepatic resection was started at the inferior border of the line of demarcation with aids of clamps and silk ligation. Larger branches of vessels and hepatic ducts were doubly ligated. 7. After the specimen was removed and copious warm normal saline irrigation, all bleeding and bile leakage on the section surface was rechecked and controlled with spreading function of electrocoagulator and surgicels overlain. 8. The abdomen was closed in layers after insertion of two rubber drain tubes inright subphrenic and left subhepatic space near the hepatic section surface. 9. Close the wound in layers. Operators 李伯皇,胡瑞恆 Assistants 洪基翔,李建勳 手術日期：2005/02/21 10:50 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Ditto Operative Method V-P Shunt Pathology nil Operative Findings 1.CSF clear, no debris 2.Open pressure about 20 cm H2O into right lateral ventricle 3.Medium pressure reservoir about 4.8 cm into right lateral ventricle 4.Peritonium catheter about 25 cm into abdominal cavity 5.Post OP V-P shunt function is good Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: supine with head rotated to left. 3.Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesiveplastic sheet. 4. Incision: 5 cm curvilinear, right frontal, corresponded to the location of right frontal horn. Raney clips were applied to the scalp edge for temporary hemostasis. 5.After the scalp flap had been lifted and reflected anteriorly, a small skull defect was made with bipolar and Rongeur. 6.The dura was opened by a nib incision. Rt lateral ventricle was tapped by a ventricular needle, then a 4.8 cm segment of the ventricular catheter was introduced into the ventricle. The outer endof the catheter was connected to a Pudenz reservoir. 7. A nib incision was made at RUQ of the abdomen , then distal 25 cm segment of the peritoneal catheter (medium pressure) was introduced into the peritoneal cavity after mini-laparotomy. The proximal end of this catheter was passed through subcutaneous tunnel at forechest, neck, right retroauricular area and connected the reservoir. The shunt system was checked to make sure its function was working. 8. The reservoir was fixed to pericranium by3 stitches. 9. Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 4/0. Dexon and skin by continuous suture with 4/0 nylon. 10.Course of the surgery: smooth. Operators 郭夢菲 Assistants 張　麟,魏書豪 手術日期：2005/03/12 00:00 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Meige's syndrome Post-operative Diagnosis Meige's syndrome s/p deep brain stimulator implantation Operative Method Bilateral GBS implantation to GPi Pathology nil Operative Findings 1. DBS electrode catheter was implanted smoothly to bilateral GPi nucleus under stereotactic technique and micro-electrophysiological monitoring. 2. DBS catheters were burried under galea for temporary stimulation test of effect. Operative Procedures 1. ETGA; stereotactic localization of AC, PC, bilateral GPi nuclei was done by MRI. 2. Bilateral frontal burr holes. 3. Microelectrophysiological monitoring to localize the tract and location of GPi nuclei. 4. Bury DBS catheters under galea. 5. Hemostasis. 6. Close wound in layers. Operators 曾勝弘 Assistants 曾仁河,R1 羅巧微 手術日期：2005/03/18 13:00 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Meige's syndrome s/p deep brain stimulator implantation Post-operative Diagnosis Meige's syndrome s/p deep brain stimulator implantation and generator implantation Operative Method Generator implantation Pathology nil Operative Findings Previous electrodes of DBS embedded at subgaleal layer at left parietal region. After connection to generator, the DBS functioned well by tester. Operative Procedures 1. ETGA, supine with head rotated to right. 2. Linear scalp incision at left parietal area. 3. Find the electrodes. 4. Skin incision at left subclavicular area. 5. Develop a subcutaneous pocket. 6. Connect the generator(Kinetra) to the electrodesvia a subcutaneous tunnel. Embed the generator at the pocket. 7. Close the wound in layers. Operators 曾勝弘 Assistants 蔡翊新,R1 羅巧微 手術日期：2005/03/26 08:50 摘要__ 手術科部: 婦產部 套用罐頭: VTH Pre-operative Diagnosis Uterine prolapse Post-operative Diagnosis ditto + rectocele Operative Method Vaginal total hysterectomy + BSO + P-repair Pathology pending Operative Findings 1. Uterus: prolapge Gr.II, grossly normal a 1x1 cm intramural myoma over fundus 2. Bilateral adnexa: atrophic change 3. Rectocele: Gr.I Operative Procedures 1. Put the patient on the lithotomy position. 2. Vaginal douching and skin disinfection. 3. Submucosal injection of diluted Pitressin (1:100) around the cervix and bladder base. 4. Make incision on the anterior vaginal mucosa and circumcision the cervix. 5. Enter the vescio-cervical space and utero-rectal space with long Kelly. 6. Clamp, cut and suture ligate bilateral vesico-cervical ligaments. 7. Clamp, cut and suture ligate bilateral utero-sacral ligaments. 8. Open the peritoneal cavity, anteriorly and posteriorly. 9. Clamp, cut and suture ligate bilateral cardinal ligaments and broad ligaments. 10. Clamp, cut and suture ligate bilateral tubo-ovarian ligaments and remove the uterus 11. Clamp, cut and suture ligate bilateral IP ligament and remove bil ovaries and tubes. 11. Reperitonization. 12. Approximate the vaginal stump. 13. Pack the vagina with gauze Operators 張道遠 Assistants 麥碧霞 手術日期：2005/03/27 10:00 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Left frontal tumor, low grade glioma Post-operative Diagnosis ditto Operative Method Craniotomy for total tumor excision Pathology pending Operative Findings 1.There was some adhesion between dura and brain surface near the central side of craniotomy 2.There was some fibrotic deposite on the vessel surface 3.The gyrus over the tumor becomes whiter and flattern than normal 4.The tumor was about 3x3x2.5cm andsurrounding with vessels. It was soft and fragile. The color was light gray-reddish. There was an edge between tumor and normal gyrus Operative Procedures 1.ETGA, supine, fixed by Mayfield fixor 2.Make an U shpaed flap 3.Make a craniotomy about 5x5cm 4.Open the tumor 5.Total tumor excsion through the edge of vessels 6.Hemostasis with surgicel and electrocoagulation 7.Close the dura with 4-0 prolene 8.The skull bone was fixed with 3 cores 9.Set an epidural CWV drain 10.Close the wound in layers Operators 曾漢民 Assistants 張源驛,陳衛洲 手術日期：2005/04/01 15:57 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Right axillary lymphadenopathy Post-operative Diagnosis Ditto Operative Method Excisional biopsy Pathology Pending Operative Findings 5 elastic, ovoid tumors were removed from right axilla. size: about 2x2cm Operative Procedures 1. Under ETGA, supine position 2. Well skin disinfection and draped 3. Excisional biopsy 4. Close the wound in layers with 3-0 Vicryl and 4-0 Vicryl after adequate hemostasis and setting 1 CWV over right axillary area. Operators 張金堅 Assistants 賴鵬升,陳賢典 手術日期：2005/04/08 11:23 摘要__ 手術科部: 外科部 套用罐頭: Right hemi Pre-operative Diagnosis A-colon ca Post-operative Diagnosis Cecum colon cancer with terminal ileum, bladder and abdominal wall invasion Operative Method 1.radical right hemicolecotomy+ LN dissection 2.partial resction of urinary bladder 3.segmental resection of terminal ileumx2 Pathology pending Operative Findings 1.one about 12x11x10cm3 cecum tumor located at low abdomen with direct abdominal wall, terminal ileum invasion and bladder dome invasion, cut surface: central necrosis(+), yellowish serosa invasion(+) 2.the tumor was so large that small intestine was obstructed 3.ascites: minimal 4.mesentery LNs: enlarged, multiple Operative Procedures 1.ETGA, supine 2.skin disinfection with B-I sol. 3.midline laparotomy 4.dissection ofA-colon from white line 5.ligate of ileocecal vessels, right colic vessels and middle colic vessels 6.dissection of tumor (with safety margin)from ant. abdominal wall and urinary blader(partial resection of bladder wall) 7.right hemicolectomy with LN dissection(with the aid of GIA) 8.repair the bladder dome and insertion of double J catheter by urologist 9.meticulous hemostasis 10.palcement of RD over L't douglaspouch Operators 梁金銅 Assistants 塗昭江,蘇彥豪 手術日期：2005/04/11 13:54 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Suspected right breast cancer; right axillary lymph node metastatid adenocarcinoma Post-operative Diagnosis Right breast cancer; right axillary lymph node metastatid adenocarcinoma Operative Method Simple mastectomy, right; Port-A insertion Pathology Pending Operative Findings 1. A 2cm in diameter, pink, firm tumor with multi-foci pinkish, firm nodules in right breastm lateral side 2. Status post right axillary lymph node dissection with fibrotic band 3. Forzen: carcinoma with multiple DCIS Operative Procedures 1. ETGA with supine position and right arm elevation 2. Skin incision along alveolar area 3. Partial mastectomy and sent for frozen 4. Left side Port-A insertion through puncture method 5. Right simple mastectomy 6. Set two CWV drain 7. Close the wound in layers Operators 張金堅 Assistants 賴鵬升,羅喬 手術日期：2005/04/13 10:10 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis C-P angle tumor s/p excision with wound infection Post-operative Diagnosis Ditto with dura defect and CSF leakage Operative Method Repair of dura defect with local fascia flap and lumbar drainage Pathology Pending Operative Findings 1. Small dura defect (2x2mm) at right retro-sigmoid area (previous op area). 2. GSF leakage (+) 3. Defect was reapaired by local fascia flap. 4. Lumbar drainagewas set from L4-5 smoothly. 5. Fistula extended to retro-auricular bone. Operative Procedures 1. under ETGA, prone position. 2. Skin incision along fistula opening and debridement. 3. Harvest a local retroauricular fascia flap to repair the dura defect. 4. Set lumbar drainage at L4-5 level. 5. Packing retro-auricular wound with gauze. Operators 賴達明 Assistants 洪偉禎,吳益嘉,李建勳 手術日期：2005/04/18 15:49 摘要__ 手術科部: 外科部 套用罐頭: HIVD Pre-operative Diagnosis HIVD, left L3/L4 and L4/L5 Post-operative Diagnosis ditto Operative Method microscopic diskectomy Pathology nil Operative Findings 1. Rupture disc compressing anterior portion of the thecan sac and L5 root 2. L3/L4, left buldging disc Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: semiprone with a bolster beneath and flexed at the waist and knees. 3. Skin preparation: the back was shaved and scrubbed with povidone-iodine detergent then painted with povidone-iodine tincture and followed by sterilized adhesive plastic sheet covering. 4.A spinal needle was inserted between spinous processes and a portable X-ray film was taken to locate the correct interspace. 5.Incision: 3-cm, between L 3-L5 spinous processes, off-midiline atthe -- margin of spinous processes. The subcutaneous layer and lumbdorsal fascia were incised then. 6.The aponeurosis of the latissimus dorsi and ileocostalis lumborum muscles at spinous processes was incised, the muscles were detached from the interspinous ligament. The multifidus muscles were detached subperiosteally from laminae by a rasp. 7.The paravertebral muscles were retracted by a modified narrow Taylor retractor which was retained constantly by a rubbersling to the side rail of the operating table. 8.Under an operating microscope, the ligamentum flavum was cleaned and incised longitudinally at the lateral part with a No. 11 blade. The lateral portion of this ligament was removed with a small angle Kerrison rongeur, the lateral portion of the laminae and the medial border of the facets were removed too until the margin of the facets and a corridor to the disc that ran lateral to the root was reached. 9. The epidural fat was left undisturbed andpreserved. 10.The compressed L5 root and veins overlying the protruded disc were gently pushed away by placing 2 small cottonoid patties, one above and one below the disc at the floor of the epidural canal. 11.The compressed root was gently pushed further away temporarily by sucker tip in order to expose the herniated disc more clearly. The posterior longitudinal ligament and annulus were incised around the protruded disc with a No. 15 blade. The degenerated disc was removed with microdisc forceps until a substantial amount of the nucleus had been loosened with a cone curette and removed. 13.The lumbodorsal fascia was approximated by 3 interruped 2/0 silk stitches. 14.Thesubcutaneous layer was closed by running suture with 4/0 Dexon and skin by adhesive tape. 15.Course of the surgery: smooth. Operators 賴達明 Assistants 曾仁河,黃博浩 手術日期：2005/04/20 18:37 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) Pre-operative Diagnosis L4-5 spondylolisthesis, grade I with unstable spine Post-operative Diagnosis Ditto Operative Method 1.Bilateral laminectomy & foraminotomy of L4-5, 2.Discectomy of L4-5 for interbody fusion with cage X 2, 3.TPS fixation on L4-5 Operative Findings 1.Hypertrophic and degenerated changed of bilateral L4-5 facets 2.No fracture of pars interarticularis of L4 3.Ligamentum flavum was also hypertrophic with thecal sac compression 4.Reduction was noted intraoperatively Operative Procedures 1.ETGA; prone 2.Midline skin incision from L3 to L5 3.Dissect and divide paraspinous muscles of L4-5 and then perform bilateral foraminotomy / laminectomy of L4-5 4.Discectomy of L4-5 5.Reduction of listhesis by TPS, and then insert cages for interbody fusion 6.Hemostasis and set one hemovac drain 8.Close wound in layers Operators 賴達明 Assistants 曾仁河,林志駿 手術日期：2005/04/20 09:45 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis C-P angle tumor s/p excision, with wound dishecence Post-operative Diagnosis Ditto Operative Method Local fascia flap Pathology Nil Operative Findings 1. Mastoid bone exposed defect 0.1x0.1 cm and previous defect 0.3x0.3cm under local flap covered. 2. Lumbar drainage through L4-5 space. Operative Procedures 1. Under ETGA, left decubitus position. 2. Skin antiseptic procedure and draped. 3. Scalp incision and creat local fascia flap. 4. Open previous flap wound to expose bone defect. 5. Close the bone defect with local fascia flap in two layers. 6. Set one CWV drainage at wound and close the scalp wound. 7. Lumbar drainage through L4-5 space. Operators 郭源松 Assistants 吳益嘉,陳元森,李建勳 手術日期：2005/05/16 18:38 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Right breast tumor rule out malignancy Post-operative Diagnosis Ditto Operative Method BCT ( Partial mastectomy with sentinal lymph node dissection) Pathology Pending Operative Findings 1. A 1.3*0.9cm tumor over right breast, 9.5 c'clock direction, 6cm away from nipple 2. Axillary lymph node enlargement (+) SLN 1 count 7250 SLN 2 count 1358 SLN 3 count 842 SLN 4 count 740 Operative Procedures 1. ETGA with supine position and right arm elevation 2. Elliptical skin incision 3. Partial mastectomy 4. Sentinal lymph node dissection 5. Hemostasis 6. Set one CWV 7. Close the wound in layers Operators 張金堅,郭文宏 Assistants 蔡明憲,羅喬 手術日期：2005/05/24 16:00 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Port A infection Post-operative Diagnosis ditto Operative Method remove port A Pathology nil Operative Findings 1.Hematoma around port A Operative Procedures 1.IVG and supine position 2.Disinfection and draped 3.Skin incision as previous wound 4.Remove port A 5.Hemostasis and irrigation 6.Close the wound in layers Operators 陳坤源 Assistants 陳衛洲 手術日期：2005/05/30 09:29 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis R't breast cancer s/p partial mastectomy + sentinel LND Post-operative Diagnosis Ditto Operative Method Axillary LN dissection, R't Pathology Infiltrating ductal carcinoma Operative Findings 1. Moderate adhesion noted at R't axillary region from previous sentinel LN dissection 2. Axillary LN dissection of level one and two lymph nodes, with preservation of thoracodorsal and long thoracic nn. Operative Procedures 1. ETGA, supine, R't arm abducted 2. Disinfected and draped 3. R't axillary incision 4. Axillary LN dissection 5. Irrigation and hemostasis 6. Set one CWV drain 7. Closed the wound in layers Operators 張金堅 Assistants 賴鵬升,古然文 手術日期：2005/06/02 08:30 摘要__ 手術科部: 婦產部 套用罐頭: Debulking Pre-operative Diagnosis pelvic tumor tumor, r/o malignancy. Post-operative Diagnosis rule out pseudomyxoma peritoni Operative Method ATH + BSO + omental biopsy + Appendectomy+ peritoneal biopsy Pathology nil Operative Findings 1. bialteral ovaries: enlarged, about 20*15*15 cm of ROV and 20*20*15cm of LOV. Both ovaries wre ruptured with mucin-like content inside; no solid part was seen We took thick septum for frozen section-> benign mucious tumor 2. Uterus: atrophic, uterine surface was coated with mucin-like substance 3. Appendix: enlarged, about 8*2*2cm s/p appendectomy 4. Diffuse mucin-like substance coatinf on omentum intestinal serosa, and peritoneum s/p omentum and peritoneal biopsy 5. Inset one ribber drain into CDS EBL: miminal, mucin-like ascites : 1000ml BT: nil Cx: nil Operative Procedures 1. Put the patient on the lithotomy position 2. Vaginal douching, on Foley, skin disinfection with beta-iodine, and skin draping. 3. Make midline vertical skin incision and open the abdominal wall layer by layer. 4. mucin-like ascites 1000 ml drain out 5. Apply auto-retractor and pack up the intestine to expose the uterus. 6. Dissect the bilateral ovarian tumors and send for frozen section: benign mucinous tumor 7. Clamp, ligate and cut left round ligament 8. Clamp, cut and ligate left infundibulo-pelvic ligament 9. Repeat step 8~10 at right side. 10. Dissect the densely adherent posterior leaf of broad ligaments overlying the uterosacral ligaments bilaterally. 11. Dissect and reflect the bladder downwards and off the uterus. 12. Clamp, cut and ligate the ascending branches of uterine arteries bilaterally at the level of isthmus of cervix. 13. Clamp, cut and ligate the paracervical vessels along lateral borders of cervix step by step downwards bilaterally till the level of lateral vaginalfornix. 14. Cut the uterus and grasp the vaginal stump 15. Suture the bilateral angles of vaginal stump with 1-0 Vicryl 16. Suture the vaginal stump with 1-0 Vicryl 17. Step by step clamp, cut and ligate the appendix 18. Excision one piece of omentum and peritoneum, send for pathology 19. Normal saline irrigatin of abdomen: 3000ml 20. Insert a rubber drain at the cul-de-sac. 21. Close the abdomen layer by layer. 22. Skin approximation with 4-0 Dexon. Recorded by R1周麗雲 Operators 謝長堯,鄭文芳 Assistants 李文瑞,黃家彥 手術日期：2005/06/02 08:30 摘要__ 手術科部: 婦產部 套用罐頭: TAH Pre-operative Diagnosis Myoma uteri Post-operative Diagnosis Myoma uteri Operative Method Total abdominal hysterectomy and bilateral salpingoophorectomy, appendectomy , omental biopsy and peritoneal biospy Pathology Pending Operative Findings 1. Uterus: vfl, hypertrophic and disfigured due to several myomata; M1: cm, type, at M2: cm, type, at 2. RAD: grossly normal 3. LAD: grossly normal 4. CDS: free of adhesion EBL: ml; BT: ; Complications: . Operative Procedures 1. Put the patient on the lithotomy position, vaginal douching, and on Foley. 2. Skin disinfection with beta-iodine and skin draping. 3. Make a Pfannenstiel skin incision and open the abdominal wall layer by layer. 4. Apply autoretractor and pack up the intestines to expose uterus. 5. Clamp, cut and ligate the bilateral round ligaments & open the broad ligaments anteriorly along the side of uterus downward to vesicouterine fold bilaterally. 6. Clamp, cut and ligate bilateral ovarian ligaments. 7. Dissect the densely adherent posterior leaf of broad ligaments overlying the uterosacral ligaments bilaterally. 8. Dissect and reflect the bladder downwards and off the uterus. 9. Clamp, cut and ligate the ascending branches of uterine arteries bilaterally at the level of isthmus of cervix. 10. Clamp, cut and ligate the paracervical vessels along lateral borders of cervix step by step downward bilaterally till the level of lateral vaginal fornix. 11. Cut the uterus and grasp the vaginal stump by Kockers. 12. Suture the vaginal stump with 1-0 vicryl sutures. 13. Fix the stumps of bilateral adnexa with the angles of vaginal stump. 14. Check bleeding and reperitonealization 15. Close the abdomen layer by layer. 16. Skin approximation with 4-0 Dexon. Operators 謝長堯,鄭文芳 手術日期：2005/06/03 15:27 摘要__ 手術科部: 外科部 套用罐頭: VATS biopsy Pre-operative Diagnosis Interstitial lung disease Post-operative Diagnosis ditto Operative Method Mini-VATS biopsy of LUL wedge resection Pathology emphysema Operative Findings No obvious lesion on the lung is noted grossly. Operative Procedures 1. Double-lumen ETGA, R't decubitus 2. VATS camera port: 7th ICS & MAL working port: 8th ICS & PAL, 5th ICS & MAL, 3 mm 3. LUL wedge resection via endo-GIA 60 x II 4. Set one chest tube, 24F, at post. thoracic cavity 5. Close wounds in layers Operators 陳晉興 Assistants 張金池 手術日期：2005/06/08 08:25 摘要__ 手術科部: 外科部 套用罐頭: C-P Angle Tumor Pre-operative Diagnosis Right CPA tumor, recurrence Post-operative Diagnosis Trigeminal neuroma Operative Method Retrosigmoid tumor excision, grossly total Pathology Pending Operative Findings The tumor was soft amd fragile, yellowish-whitish with about 3-4 cm in diameter and irregular shape. The medial dural layer of Meckel's cave was merged with tumor capsule pushed outward. The tumor invaded into Meckel's and the cave was distended. A large cyst located at the right cerebellar hemisphere was met first. After decompression, the brain was slack and the tumor was soon visible. The tumor was grossly totally removed and the SSEP didn't change during the operation. Operative Procedures Under ETGA, the patient was set in a 3/4 prone position with head fixed. After aseptic procedure, a retrosigmoid skin incision was done and the wound was extended in layers. Then the previous craniotomy was extended. After dural incision, the CSF of the cyst was drained out and the tumor was soon visible. The tumor was totally excised with debulky procedure and drilling off the Meckel's cave. The wound was then closed in layers. Operators 杜永光 Assistants 張　麟,黃詩浩 手術日期：2005/06/15 15:00 摘要__ 手術科部: 外科部 套用罐頭: MRM Pre-operative Diagnosis right breast ca Post-operative Diagnosis ditto Operative Method BCT--> MRM Pathology nil Operative Findings 1.one 1.5*2 cm firm tumor noted at 6 o'clock 2.axillary LAP(+) 3.SLN cytology: positive Operative Procedures 1.ETGA, supine 2.right axillary incision 3.SLN biopsy 4.right breast linear incision and wide excision of tumor performed 5.converted procedure to radical mastectomy due to tumor too close to nipple 6.check bleeding 7.2 J-P placed 8.close the wound Operators 黃俊升 Assistants 徐光漢 手術日期：2005/07/01 14:45 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Low grade glioma, left frontal basal, insular and mesial temporal Post-operative Diagnosis Ditto Operative Method Left pterion transsylvian approach for partial resection Pathology pending Operative Findings The frontal sinus was opened and sealed with bone wax After opening of the Sylvian fissure, the uncus, mesial temporal lobe, inula, frontal base were exposed. There was abnormal cerebral parenchyma noted over these regions. The tumor were ticky, whitishwith low vacularity. The frozen section showed probable low grade glioma or reactive gliosis. Operative Procedures ETGA, head fixed in Mayfield. Disinfection and drapping. Pterion inciision and craniotomy. Dural tenting followed by drilling of the sphenoid ridge. Dural inciison and tenting. Open the carotid and optic cistern. TransSylvian aproach with the Sylvian venleft on the temporal side. Removal of frontal base, mesial temporal and uncus. Hemostasis and dural closure. Wound closed inlayers after placement of CWV. Operators 杜永光 Assistants 曾仁河,黃博浩 手術日期：2005/07/06 12:02 摘要__ 手術科部: 外科部 套用罐頭: Hypophysectomy---Transphenoid Pre-operative Diagnosis Pituitary macroadenoma Post-operative Diagnosis Pituitary macroadenoma Operative Method Hypophysectomy---Transphenoid Operative Findings 1. The tumor was soft and fragile 2. Normal gland is not discernable 3. VEP during operation: no alterations Operative Procedures Under general anesthesia, place the patient in supine position with head tilted 30 degree to left. Prepared the face and left abdomen with povidone-iodine alcohol tincture, and the mucosa of oral and nasal cavity with aqueous povidone-iodine tincture.The former areas were covered by a sterilized adhesive plastic sheet. The nasal submucosa at septum and floorwere infiltrated with 1:100 epinephrine solution. Made an incision at right nasal submucosa. The mucosa of nasal septum and floor were dissected away from the septal cartilage, and it was then displaced laterally by a long nasal speculum. The septal cartilage was cut at its basal juction by sepatal scissors and then displaced to one side. Hardy's nasal speculum was applied to displace the nasal mucosa laterally and keep the nasal cavity open constantly for the exposure of the vomer bone and the anterior wall of the sphenoid sinus. The floor of the sinus was then removed. The exposed sinus mucosa was coagulated and resected. The sellar floor was opened. The dura was then coagulated with bipolar forceps, then opened in cruciate fashion. The tumor parenchyma was removed by curette and suction. The venous oozing from the dura was stopped by gelfoam packing.The sellar cavity was packed with a fat graft removed from left abdominal subcutaneous layer. The sellar floor was reconstructed by supporting a piece of vomer bone between the dura and the margin of the sellar floor. After returning the nasal mucosa to its normal position, each sideof the nasal cavities was tightly packed with a Merocel which had been soacked with better-iodine ointment. Operators 蔡瑞章 Assistants 張　麟,蘇亦昌 手術日期：2005/07/08 08:30 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Right breast cancer s/p MRM Post-operative Diagnosis Right breast cancer s/p MRM Operative Method Port-A insertion Operative Findings 1.Patent venous flow through port-A 2.Post-op proper Port-A location confirmed by intra-op CXR Operative Procedures 1. IVG, supine position 2. skin incision over left upper chest 3. Identify left cephalic vein 4. Port-A insertion through left cephalic vein 5. intra-op CXR 6. Close the wound in layers Operators 蔡孟昆 Assistants 羅喬,黃俊傑 手術日期：2005/07/08 15:00 摘要__ 手術科部: 外科部 套用罐頭: Right hemi Pre-operative Diagnosis Ascending colon cancer Post-operative Diagnosis ditto Operative Method Right hemicolectomy Pathology pending Operative Findings 1. An about 3*4 cm protruding tumor at 15 cm above the ileocecal valve in the ascending colon 2. No obvious serosal involvement Operative Procedures 1. ETGA, supine position 2. Make a midline incision from subxyphoid area to subumbilical area about 20 cm in length 3. Identify the ileocecal artery and vein and then ligate them 4. Identify the right colic a. & v. and the first branch of middle colica. & v. and then ligate them 5. Cut the transverse colon in midpoint bye GIA-50 6. Cut the ileum about 15 cm from ileocecal valve 7. Side-to-end colon to ileum anastomosis 8. Wash the abdominal cavity with normal saline 9. Adequate hemostasis and place a rubber drain at subhepatic area through LLQ of abdomen 10 Close the wound in layers Operators 林本仁 Assistants 周宗欣,陳建嘉 手術日期：2005/07/30 09:00 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT Pre-operative Diagnosis Cerebellar hemangioblastoma Post-operative Diagnosis Ditto Operative Method Suboccipital craniotomy for tumor excision Pathology Pending Operative Findings Traction between left cerebellum hemisphere adn tentorium, yellowish surface was noted different from normal cerebellum tissue. Cyst componenet was draned out. One 4*3 cm yellowish soft mass was taken out completely. It was located from left just close to vermis to deep portion of vermis. Operative Procedures Under endotracheal general anesthesia, patine was placed as prone with neck flexed and head fixed by Mayfield skull clamp. Scalp was shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. Skin incision was 10 cm, midline nape, from occiput to lower neck. Raney clips were applied to the edge of the scalp for temporary hemostasis. The trapezius, semispinalis capitis, splenius capitis muscleson both sides were splitted at its origin of ligamentum nuchae, then, together with rectus capitis posterior, obliqus capitis inferior were detached from suboccipital bone and the spinous processes of C-1,2 by Bovie and rasp, followed by sub- periosteal dissection on the posterior arch of C1. The paravertebral muscles were kept open by self retaining retractors to expose suboccipital bone and the posterior arch of the C1. The bleeding from the muscles was stopped by Bovie. Craniotomy window was 5x5cm created by making 5 burr holes. Dural incision was Y-fashion, and the dura flap was reflected to occiput. Intra-op sonography was performed for localization. Traction of the left hemisphere from tentorium. The lower half of the vermis was splitted forbetter exposure of the tumor. The mobilization of the tumor was started by dissecting the tumor free from the vermis at both lateral and the superior portion of the tumor with bipolar forceps. Hemostasis was followed by dural closure with interruped 2/0silk sutures for key stitches, then continuous suture with 4/0 Dexon to obtain water-tight closure. One CWV drain was set. Galea suture was performed by continuous suture with 2/0 Dexon and skin by continuoussuture with 3/0 nylon. Operators 曾漢民 Assistants 洪偉禎,陳佑群 手術日期：2005/08/03 17:59 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Left leg varicose vein Post-operative Diagnosis Left leg varicose vein Operative Method phlectomy Pathology pending Operative Findings Left thigh and calf varicose veins Operative Procedures 1. Spinal anesthesia, supine 2. Multiple skin incision for remove varicose veins 3. Wound closure Operators 王水深 Assistants 柯玉誠 手術日期：2005/08/08 22:30 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis lipomyelomeningocele Post-operative Diagnosis lipomyelomeningocele Operative Method Untethering by excision of lipomyelomeningocele Pathology Pending Operative Findings One yellow,soft,ill-defined lipoma connected with spinal cord over S2-S3 level,which was enlarged and rotaed counterclockwise from the caudal side Operative Procedures Under ETGA,the patient was put in prone position.Skin disinfection and drapping was done.Make a midline incision over sacrum area.Dissect and remove the lipoma.And dissect and untether between dura and spinal cord with the aid of microscope.Placement of asilastic sheet between the dura and placode.Insert one H/V over subcutaneous tissue.Close the wound in layers. Operators 郭夢菲 Assistants 洪偉禎,林欣穎 手術日期：2005/08/13 08:00 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Young-onset Parkinson disease, Stage III Post-operative Diagnosis ditto Operative Method DBS implantation, bilateral subthalamic nuclei (STN) Pathology nil Operative Findings Stereotactic procedures were done, and bilateral STN were localized by MRI scan. The coordinate of STN was calculated by a commercialized stereotactic computer, and then the patient was sent to OR. The patient and stereotactic frame were fixed onto the operative table. Under local-infiltrated anesthesia and after burr hole making at bilateral Kocher areas, STN was searched and localized by continuous electrophysiological monitoring. DBS electrodes were finally inserted to STN, and the wires were burried in a subgaleal pouch for subsequent surgery for battery implantation. Operative Procedures 1. Stereotactic frame was fixed onto the patient's head, and MRI scan was done. Coordinate of bilateral STN was calculated by a computer. 2. Fix the patient and frame onto the table, and perform local-infiltrated anesthesia. A transverse scalp incision over bilateral Kocher area was done, the burr holes were made. 3. Set up the microdrive and electrophysiological monitoring system, and localized STN by the monitor, and by intraop neurological test of limb rigidity performed by neurologist (戴春暉醫師).4. Insert the DBS electrodes, and bury the wires into a subgaleal pouch at left parietal area. 5. Hemostasis, and close the wound in layers. Operators 曾勝弘 Assistants 曾仁河 手術日期：2005/08/17 00:00 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt Pre-operative Diagnosis Parkinson disease Post-operative Diagnosis Ditto Operative Method IPG (implantable pulse generator) implantation Operative Findings Two wires were buried underneath the galea in left parietal area. Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: supine with head rotated to the right. 3.Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilizedadhesive plastic sheet. 4.Incision: one along previous op wound on the head, one transverse over left side chest wall. 5.After the scalp flap had been lifted and reflected anteriorly, a buried wires were identified. Then a subcutaneous tunnel was made from the chest wall upwards with one incision on the left side neck. 6.The wires were guided through the tunnel and connected to the IPG, which was placed in a subcutaneous pouch on the left chest wall. 7.Test the function of the IPG. 8.Closeall wounds. Operators 曾勝弘 Assistants 洪偉禎,郭律廷 手術日期：2005/09/03 15:04 摘要__ 手術科部: 外科部 套用罐頭: App Pre-operative Diagnosis acute appendicitis Post-operative Diagnosis acute appendicitis Operative Method laparoscopic appendectomy Pathology pending Operative Findings 1. dirty ascites: mild 2. inflammation appendix 3. no ruptre appendix Operative Procedures 1. IVGA, supine 2. aseptic, draped 3. incision a 10 mm carame port at subumbillcus, two 5mm working port at midline of suprapubic area 4. performed appendectomy 5. irrigation 6. check bleeding and hemostasis 7. close the wound in layers Operators 賴逸儒 Assistants 黃建逢,施懿玲 手術日期：2005/09/11 23:45 摘要__ 手術科部: 外科部 套用罐頭: Hypophysectomy---Transphenoid Pre-operative Diagnosis Recurrent pituitary tumor Post-operative Diagnosis Recurrent pituitary tumor Operative Method Transsphenoidal adenomectomy Operative Findings The sellar floor was absent and some fat graft was noted. The dura (or pseudocapsule) of tumor pituitary tumor was seen after vomer bone removal.The tumor appeared whitish, graysih, and soft. It extended above the diaphragnatic sella, and also extended into right cavernous sinys Operative Procedures Under ETGA, placed the patient in supine position with head tilted 30 degree to left. The nasal submucosa at septum was infiltrated with 1:100 epinephrine solution. Made an incision at right paranasal mucosa The inferior margin of the nasal septum and floor were then exposed and dissected away from the septal cartilage and the bony floor on both sides from anterior to posterior and displaced laterally by a long nasal speculum. The septal cartilage was cut at its basal juction by sepatal scissors andthen displaced to one side. A Hardy's nasal speculum was applied to displace the nasal mucosa laterally and keep the nasal cavity open constantly for the exposure of the vomer bone. After vomer removal, the dura (pseudocaosule of the tumor) was identied.Opened it in a cruciate fashion. The soft tumor parenchyma was removed by curette and suction, then the capsule was mobilized away from the dura and normal pituitary gland and removed. The final piece of the tumor at suprasellar area sank into the sella spontaneously after the intrasellar tumor had been removed. This last piece of the tumor was carefully separated from the arachnoid by curette and fine sucker. The venous oozing from the dura was stopped by gelfoam packing. The sellar floor was reconstructed by supporting a piece of vomer bone between the dura and the margin of the sellar floor. The Hardy's nasal speculum was removed and the nasal mucosa returned to its normal position. Each side of the nasal cavities was tightly packed with merocelsoacked with Better-iodine ointment. Operators 杜永光 Assistants 曾仁河,蘇亦昌 手術日期：2005/09/13 12:30 摘要__ 手術科部: 外科部 套用罐頭: Aneurysm-frontotemporal approach Pre-operative Diagnosis A-com aneurysm with SAH Post-operative Diagnosis ditto Operative Method aneurysm clipping, left pterion apporach Pathology nil Operative Findings 1.diffuse SAH, and brain swelling 2.IVH(+), because of bloody CSF from Pane's point EVD 3.A small aneurysm was noted at the junction of left ACA, A1, A-com. and left ACA A2, and directing anteriorly and cephalad 4.A localized hematoma was also noted above lamina terminalis and in frontal base parenchyma 5.The aneurysm was clipped with a bayonette type sugita clip 6.Fenestrated type A-com was noted 7.Left paine's point EVD for ICP monitoring Operative Procedures 1.ETGA, supine position, head turn to right Mayfield skull fixation 2.left pterional craniectomy 3.Retract frontal brain and dissect arachnoid plane of ICA and optic nerve 4.Dissect and identify the left ICA, left ACA A1 and then right ACA A1 5.A-comwas identify, and then left ACA A2 was also found 6.Identify the aneurysm 7.Aneurysm clipping 8.Hemostasis 9.Keep the paine's point EVD as ICP monitor 10.Dura closure 11.Close bone plate and set one subgaloal CWV 12.Close wound in layers Operators 陳敞牧 Assistants 曾仁河,柯柏瑞 手術日期：2005/09/21 12:07 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis A-com aneurysm s/p clipping, left Paine's EVD Post-operative Diagnosis Ditto Operative Method Right Kocher's EVD Pathology nil Operative Findings Opening pressure about 10cmH20 CSF bloody in colour Depth 6.5cm Paine's EVD adhere to the craniotomy bone plate Operative Procedures ETGA, supine disinfectiona nd drapping Removal of left paine's EVD after adhesiolysis Insertion of right Kocher's EVD Check funcyion Pullout and fixation wound closed in layers Operators 陳敞牧 Assistants 郭律廷,黃博浩 手術日期：2005/09/26 15:54 摘要__ 手術科部: 外科部 套用罐頭: ATYPICAL Pre-operative Diagnosis Recurrent hepatocellular carcinoma, S5 Post-operative Diagnosis Recurrent hepatocellular carcinoma, S5 Operative Method Atypical hepatectomy(S5+S6) Pathology NIL Operative Findings 1. A 2.5x2.0x2.0 cm, soft, yellowish tumor over S5 2. Adhesion between liver, daiphragm, and colon 3. Intra-op diaphragm rupture s/p repair 4. s/p cholecystectomy 5. Liver cirrhosis 6. Intra-op blood loss 2500ml Operative Procedures 1. ETGA, supine 2. Subcostal skin incision 3. Adhesionolysis between liver, diaphragm, and colon 4. Atypical hepatectomy (S5+6) with the aid of microwave 5. Hemostasis 6. Diaphragm repairment 7. Set 2 rubber drain over subphrenic area 8. Close thewound in layers Operators 游憲章 Assistants 羅喬,姜宜妮 手術日期：2005/09/26 15:13 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis RML and RLL nodules, r/o metastasis Post-operative Diagnosis ditto Operative Method VATS wedge resection, right side Operative Findings one 1x1cm, yellowish, fragile, ill-defined tumor at RLL the other dark, firm nodule about 0.3x0.3cm at RML Operative Procedures 1. ETGA with double lumen ET tube 2. left decubitus position 3. VATS: camera port: 9th ICS, MAL working port: 6th ICS, PAL mini-thoracotomy: 6th ICS, AAL 4. Wedge resection of RLL including the tumor by Endo-GIA 60 x III and 45 xI 5. Wedge resection of RML including the nodule by Endo-GIA 45 x I 6. check bleeding and air leakage 7. set one 28 Fr. chest tube 8. wound closure in layers Operators 李元麒 Assistants 林洧呈,周俊志 手術日期：2005/09/27 15:23 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Lung cancer Post-operative Diagnosis ditto Operative Method Port-A implantation Operative Findings Port-A catheter was inserted via right cephalic vein Operative Procedures 1. Supine, local anesthesia 2. incision at right deltopectoral area 3. Dissect and espose right cephalic vein 4. insert the port-A 5. Intra-operative CxR 6. Creat a subcutaneous pocket 7. put the port in the pocket and fix it 8. close the wound inlayers Operators 李元麒 Assistants 周俊志 手術日期：2005/09/28 18:04 摘要__ 手術科部: 外科部 套用罐頭: HIVD Pre-operative Diagnosis HIVD, L4/L5 Operative Method diskectomy Operative Findings 1.L4/5 protuding dicc, compression of nerve root 2.decompression after operation Operative Procedures 1.ETGA, prone 2.disinfection 3.mid-line incision, from L4-L5 4.paraspinal disection of the soft tissue, identify the L4, L5 transverse process by protable x-ray 5.identify the L5 nerve root 6.remove the soft tissue alone the nerve root 7.perform dickectomy, L4/L5 8.hemostasis, irrigation with N/S 9.close the wound in layers Operators 賴達明 Assistants 陳元森,吳正一 手術日期：2005/09/30 15:50 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt Pre-operative Diagnosis VP shunt dysfunction (Peritoneal catheter) Post-operative Diagnosis VP shunt dysfunction (Peritoneal catheter) Operative Method VP shunt revision Operative Findings Malposition of abdominal catheter. The VP shunt funcitoned well after revision. The peritoneal catheter was about 10cm inside the peritoneum. Operative Procedures Under ETGA, placed the patient in sup[ine position. Disinfected the abdomen with better iodine, and then made a skin incision at previous operative wound over the right flank. The catheter was identified at the subcutaneous layer, and wa then pulled out.MAde another skin incision at midline (3cm above the umbilicus), and the dissected depp until the linea alba was identidied. Punctured into the peritoneal cavity, and inserted the abdominal catheter into it. Closed the wound in layers after confirmation ofthe good function of VP shunt. Operators 杜永光 Assistants 曾仁河,蘇亦昌 手術日期：2005/10/08 10:00 摘要__ 手術科部: 外科部 套用罐頭: Port-A Pre-operative Diagnosis Non-Hodgkin's lymphoma Post-operative Diagnosis Ditto Operative Method Port-A insertion Pathology Nil Operative Findings Smooth blood flow via port-A catheter Operative Procedures Under local anesthesia, patient was placed in supine position and left subclavian vein was punctured. Guidewire was inserted, subclavicular pocket was created. Port-A was inserted and flushed with heparin. The wound was closed and the location was confirmed by CxR. Operators 王水深 Assistants 李孟霖 手術日期：2005/10/11 14:45 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis T7.T8 diskitis with epidural abscess Post-operative Diagnosis Ditto Operative Method T7.T8 diskitis with anterior autologous bone fusion Pathology Pending Operative Findings 1.Two pocket of paraspinal abscess (with hypervascular capsule) with flank pus. 2.T7.T8 disk space necrotic change with pus inside, some epidural abscess extending posteriorly with spinal cord compression. Operative Procedures Under general anesthesia with endotracheal tube insertion, the patient was put in Decubitus posture with left side up. The level of T8 vertebral body was localized by C-arm and then the skin was disinfected with povidine iodine painting. Transverse skin incision was made along the inferior border of scapula.The 7th rib was fractured and intercostal space was opened. Latissimus dorsi, intercostal muscle and anterior serratus muscle was cut. Disk between T7 and T8 was cut by osteofome and removed by disk clamp. The intervertebral space was cleared by straight and angled curettes until the dura was visible through posterior wall of disk space. Both endplates of T7 and T8 was curetted with curette. Bone graft was taken off by osteofome from anterior superioriliac crest. The bone graft was fixed into the space between T7 and T8 veterbral bodies. Hemostasis was achieved by gelform packing. One CWV drain was put in the extrapleural space inside the chest wall. The wound was closed in layers. Operators 賴達明 Assistants 張　麟,陳玫圻 手術日期：2005/10/13 16:38 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Ditto Operative Method V-P shunt Pathology Nil Operative Findings 1. Previous surgical wound healed well. 2. The CSF was clean and light yellowish. 3. The initial CSF pressure was 5-6 cmH2O 4. The ventricular catheter: 6.2cm The reservoir: medium pressure The peritoneal catheter: 30cm Operative Procedures After endotracheal general anesthesia, the patient was set on supine position with head turned to left side, for 15. The skin over right scalp, neck, chest, and abdomen was shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. A curvilinear incision via previous operative wound was created and extended 1cm to the right side over right parietal area. The scalp flap had been lifted and reflected anteriorly. The previous burr hole was exposed. Then a 6.2 cm segment of the ventricular catheter was introduced into the ventricle. The outer end of the catheter was connected to a Pudenz reservoir. A nib incision was made at RUQ of the abdomen, then a trocar was pushed into peritoneal cavity. Subsequently, distal 30 cm segment of the peritoneal catheter (medium pressure) was inserted to the peritoneal cavity through the outer tube of the trochar. The proximal end of this catheter was passedthrough subcutaneous tunnel at forechest, neck, L't retroauricular area and connected the reservoir. The shunt system was checked to make sure its functionwas working. The reservoir was fixed to pericranium. After proper hemostasis, Dexon and skin by continuous suture with 3/0 nylon. Operators 陳敞牧 Assistants 張源驛,蘇亦昌,陳玫圻 手術日期：2005/10/26 08:58 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Cranio-facial dystonia s/p DBS implantation Post-operative Diagnosis Ditto Operative Method DBS electrode adjustment Pathology Nil. Operative Findings 1. A pocket of abscess at subcutaneous of scalp 2. The DBS electrode was pulled out 2mm and then was fixed Operative Procedures 1. ETGA, supine position 2. Disinfecion and draped 3. Incision along previous DBS implantation wound 4. Identify the DBS wire with electrode 5. Pull out the DBS wire with electrode for 2 mm, and then fix the wire 6. Hemostasis and irrigation 7. Close the wound in layers Operators 曾勝弘 Assistants 陳元森,池岸軒 手術日期：2005/11/02 08:30 摘要__ 手術科部: 外科部 套用罐頭: mini LC Pre-operative Diagnosis GB STONE Post-operative Diagnosis GB STONE Operative Method MINI LC Operative Findings distend GB with multiple small stones, about 0.1cm Adhesion around the gallbladder: negative Operative Procedures 1. Operation Room Setup: Two video monitors, one on each side of the table, positioned toward the head of the table. The operator stood on the left side of the patient and the camera assistant stood next to the operator toward the foot of the table. To the patient's right side was the first assistant, opposite the operator and the surgical nurse stood next to the first assistant toward the foot of the table. The anesthesiologist and the monitoring equipment were at the head of the table. The laparoscopicinstrument tray was positioned at the foot of the table. Before the patient is placed under anesthesia, the camera, light source, scope (including the 2-mm mini-laparoscope and 10-mm conventional laparoscope), and insufflator should be checked to be certain that they are operational. The tank of carbon dioxide is also checked to ensure that an adequate amount is available for the duration of the operation. 2. Anesthesia: General anesthesia with endotracheal intubation. 3. Position and catheterization: An intravenous infusion was started before operation. The patient is positioned supine on the table. To facilitate laparoscopic exposure in the upper abdomen, a nasogastric tube is used to decompress the stomach. 4. Disinfection: The abdomen is prepared with Povidon-tincture solution which is applied and left for several minutes. Then the operation field was draped as usual. 5. Incision and establishing the ports: The patient was placed in the 20° Trendelenburg position. A curvilinear wound about1.5 cm in length was made at the sub-umbilical region, and the subcutaneous tissue was bluntly dissected to the fascia. Two towel-clamps were used to elevate the fascia in order to facilitate placing the Veress needle into the abdomen cavity. To insure that the needle was in the peritoneum, a small syringe containing a few milliliters of normal saline was attached to the Veress needle to perform the drop-test. When the needle already entered the abdominal cavity, the relative negative pressure pulled thefluid through the needle and into the abdominal cavity. The needle was then connected to the insufflator and carbon dioxide was set at an initial flow of 1L/min. Then after the insufflated volume reached 1L the flow rate was set up to 6L/min. After thepneumoperitoneum with intra-abdominal pressure maintained at 14 mmHg was established, the 5-11mm Versaport (Camera port) was inserted through the sub-umbilical port and then the insufflator tubing was connected to the sheath. For patients who had received abdomen operation previously, mini-laparotomy was done to avoid inadvertent hollow organ injury. The fascia was opened and underlying peritoneum was explored digitally or by instrument. The adhesion was freed and the abdominal cavity beneath the fasciavisualized. The trocar was removed from the sheath and the sheath was placed into the abdominal cavity with care. In this condition, a purse string suture using a 2 "0" Dexon suture was done to seal the port for fear of air leakage. The 10-mm conventional laparoscope was then inserted through the sheath in the sub-umbilicus port. A complete examination of all pelvic and intra-abdominal viscera was done. The table is then tilted with head up at least 20 to 30 degrees and rotated 15 degree to the left to exposethe right upper quadrant properly. Then, under 10-mm laparoscope direct vision, three MiniSite disposable 2-mm introducer/Surgineedle instrument combinations were inserted at the sub-xiphoid, right mid-clavicular and right anterior axillary regionsjustalong the right subcostal margin. 6. Manipulation during the operation: Two 2-mm MiniSite Endo Grasp units were inserted through the right mid-clavicular and right anterior axillary ports for traction of the gallbladder. 7. Dissection of the gallbladder: A 2-mm MiniSite MiniShears (US Surgical Corporation) was operated through the sub-xiphoid port for dissection and cauterization for identifying the cystic duct and cystic artery. The adhesion and areolar tissue around the cystic duct and cystic artery were dissected carefully to prevent inadvertent injury to the common bile duct and right hepatic artery. 8. Securing the cystic duct and cystic artery: Once the cystic duct was exposed and the relation with common bile duct was identified, the2-mm mini-laparoscope was then inserted through the 2-mm sub-xiphoid port and the cystic duct and cystic artery were clipped and divided by conventional laparoscopic instruments through the sub-umbilical port. 9. Freeing the gallbladder: Soon afterwards, the10-mm conventional laparoscope was used again to dissect the gallbladder away from the liver bed using the 2-mm MiniSite MiniShears. Traction was placed on the fundic portion of the gallbladder and the gallbladder was teared away from the liver bed. The avascular interface was peeled away by cauterization with the 2-mm MiniSite MiniShears. The position of the grasping clamps were changed as needed to provide the best exposure and to allow dissection of the gallbladder. Before the gallbladder was separated completely, visualization of the liver bed to check any bleeding point was done. Irrigation, suction and meticulous hemostasis were performed, too. Then the gallbladder was separated completely from the liver bed. 10. Removing the gallbladder: The gallbladder was then retracted through the sub-umbilical port by a clamp inserted through the sub-umbilical port under visualization of the 2-mm mini-laparoscope. After decompression and extending the fascia incision, the resected gallbladder was retrieved fromthe sub-umbilical wound. The fascia defect of sub-umbilical wound was closed to prevent possible incisional hernia. Sterilized strips were applied on the three 2-mm wounds and the wounds were covered by sterile gauge. Operators 游憲章 Assistants 張東晟,高佩琪 手術日期：2005/11/03 13:25 摘要__ 手術科部: 婦產部 套用罐頭: LSC myomectomy Pre-operative Diagnosis Myoma uteri Post-operative Diagnosis Myoma uteri Operative Method Laparoscopic myomectomy Pathology Pending Operative Findings see the pictures Operative Procedures 1. Put the patient on lithotomy position. 2. Vaginal douching, skin disinfection and skin draping 3. Insert uterine elevator and on Foley 4. Make a 1cm skin incision below the umbilicus 5. Insert Varess needle and make pneumoperitoneum 6. Insert 10mm trocar and laparoscope 7. Insert 2nd (12mm), 3rd (5mm) and 4th (5mm) trocars under laparoscopic inspection 8. Injection diluted Pitressin (1:50) into myoma uteri 9. Make incision on myoma via electrocauterization and enucleate the myoma 10. Suturerepair the uterine wound with 1-0 Vicryl. 11. Remove the myoma by morcellator. 12. Check bleeding and pack the uterine wound with a piece of Surgicell 13. Insert a CWV drain into cul-de-sac 14. Remove trocars and repair skin with 3-0 Vicryl EBL:100c.c BT;nil Cx:nil Operators 童寶玲 Assistants 陳甫仁 手術日期：2005/11/04 06:39 摘要__ 手術科部: 外科部 套用罐頭: Biopsy 乳房 Pre-operative Diagnosis Right breast tumor Post-operative Diagnosis Ditto Operative Method Biopsy of breast tumor Pathology Pending Operative Findings A yellowish firm tumor was found at 1 cm away from nipple over 5 o'clock position of the right breast. It measured 1.5x1x1 cm, and the margin was well-defined. Operative Procedures Under local anesthesia, the patient was put in supine position with her right arm elevated. The operation field including the whole right breast and axilla was disinfected with Povidon tincture and was properly draped. A curvilinear incision was made from3 to 6 o'clock position. Excisional biopsy of the tumor was performed. The specimens were sent for frozen section. The wound was closed with 3-0 Vicryl and 4-0 Dermalon sutures. The specimens for frozen section didn't show any evidence of malignancy. Operators 張金堅 Assistants 陳建良 手術日期：2005/11/10 08:11 摘要__ 手術科部: 外科部 套用罐頭: Biopsy 乳房 Pre-operative Diagnosis Left breast cancer with lymph node metastasis Post-operative Diagnosis Ditto Operative Method Incisional biopsy and Port-A implantation Pathology Pending Operative Findings 1.Tumor was located at 6 o'clock of left breast, hard inconsistency, 3~4 cm, oval shape with central necrosis 2.Port-A was inserted smoothly from left cephalic vein. CXR revealed no hemothorax and pneumothorax. Operative Procedures Under the endotracheal general anesthesia, the patient was placed in spuine position with right arm abducted at 90 degree. The operation filed was disinfected with alcoholic povidone iodine and draped as usual. A skin incision was made along margin of nipple-areola margin from 9 to 3 o' cock. Dissection was carried down to target site. Performed incisional biopsy of tumor, which was sent for examination. The wound was irrigated with water and hemostasis was obtained with electrocauterization. Another skin incision was made over right deltopectoral groove. Dissection was carried down to expose the left cephalic vein. Port-A suit was set up and then was inserted through right cephalic vein after venotomy(open method). Check the catheter position of Port-Aby portable CXR. Then the wound was closed in layer(two). Operators 張金堅,郭文宏 Assistants 陳建良 手術日期：2005/11/16 09:00 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis T7-8 TB osteomyelitis and discitis s/p anterolateral approach T7-8 corpectomy and autograft fusion; epidural abscess of T6-8 Post-operative Diagnosis Ditto Operative Method Posterolateral approach, T6-8 hemilaminectomy for abscess removal; TPS fixation of T5 and T9 + posteriolateral autograft fusion. Operative Findings 1.Epidural granulation accumulation in ventral side was noted from T6 to T8, which was soft and fragile in consistency, and was grayish to whitish in color. 2.TPS was done on T5 and T9, and posterolateral fusion was done by autograft from laminectomy bone 3.R't T7 root resection during operation Operative Procedures The patient was on endotracheatube with general anesthesia and put in prone position. The T8 level was localized by portable x-ray. A midline incision was made to expose T5 to T9. Right side paraspinal muscle was dissected and divided to expose T6-T8 laminae and transverse processes. Then hemilaminectomy of rigth T6 to T8 was done, the epidural ventral abscess was noted and removed. TPS and rod fixation at T5 and T9 were then performed. Posterolateral bone fusion was done, bleeding was checked and hemostasis with bipolar. Two hemovac drain was set at paraspinal and the wound was then closed in layers. Operators 賴達明 Assistants 曾仁河,丘基泰 手術日期：2005/11/23 09:03 摘要__ 手術科部: 外科部 套用罐頭: MRM Pre-operative Diagnosis Right breast cancer s/p exsional biopsy Post-operative Diagnosis Ditto Operative Method Modified radical mastectomy, right Pathology Infiltrating lobular carcinoma Operative Findings 1.Thirteen sentinel lymph nodes were sent for examination 2.Previous exsional biopsy scar Operative Procedures Patient was put on supine position with right arm 90 degree abducted. Under ETGA, skin was disinfected and draped as usual. An transverse elliptical incision, including the nipple-areolar complex and the skin over the biopsy wound, from right parasternalto right axillary area was made superiolaterally. The incised skin was grasped and retracted upward with breast clamps for skin flap dissection. Electrocauterization was used for dissection of skin flaps. The dissection reached to the level 1 cmbelow clavicle superiorly, the costal margin inferiorly and the parasternal area medially. Laterally dissecton was extended to the border of latissimus dorsi. The clavipectoral fascia was opened. The axillary vein was exposed and identified. The branches of the axillary vein were devided between ligatures. Axillary lymph node dissection was then performed for level I and II with identification and preserving of the long thoracic and thoracodorsal nerves. Breast tissue was removed en bloc with the axillary lymph nodes. The bleeders were checked meticulously. The operative field was irrigated with warm saline. The wound was closed layer by layers after two CWV drains were left. Blood loss was minimal and the patient stood the whole procedure well. Operators 張金堅 Assistants 陳建良 手術日期：2005/11/28 09:15 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT Pre-operative Diagnosis Right fontal glioma Post-operative Diagnosis Right fontal glioma Operative Method Grossly total tumor excision Operative Findings 2 characters of tumors were identified at the right frontal lobe. The first portion, which was stiff and grayish, was located more anteriorly. Another portion, which was sticky and gelanous was located posteriorly Operative Procedures After ETGA, the patient was put under supine position with head slight left tilt and fixed with Mayfield skull clamp. After proper shaving, the OP field over right frontoparietal area was well-disinfected. The scalp was incised in a linear shape with sagittal direction, 5cm in length. Then the scalp was temporary hemostasis with Raney clips. A 4x5cm craniotomy window was madewith 2 burred holes created.The dura was tented. Opened the dura, abd then incised into the cortical area via anteriomedial trans-sulcus approach. The tumor at frontal apex as well as frontal base were removed with bipolar diathermy tumor forceps. After proper hemostasis, the dura was closed after deair properly. The skull graft was recovered and fixed by 3 Gage 26 wires. A CWV drainwas set over the subgaleal space and the wound was then closed in layers. Operators 曾漢民 Assistants 曾仁河,蘇亦昌 手術日期：2005/12/02 09:10 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Right retroperitoneal schwannoma Post-operative Diagnosis Right retroperitoneal schwannoma Operative Method Retroperitoneal tumor excision + Neurolysis Pathology Schwannoma Operative Findings 1. One 3 x 3 cm, yellow-whitish, elastic, well-defined tumor with capsule between right psoas muscle and kidney 2. The tumor was inside perineum of right L2 nerve root 3. The L2 nerve root was preserved except origin of the tumor Operative Procedures Under endotracheal general anesthesia, the patient was put in left decubitus position. The operative field was scrubbed with povidone-iodine detergent then painted with povidone-iodine tincture and followed by sterilized adhesive plastic sheet covering.Curvilinear incision about 6cm long was made over right subcostal margin and anterior axillary line and deepened to external oblique fascia. The external oblique fascia was opened and external oblique muscle was split. The internal oblique fascia was then opened and the internal oblique and transversus abdominis muscles were split. The muscles and right kidney was retracted toward anterior aspect by Thompson retractor, then the tumor was identified. Under the operating microscope, the underlying fasciaand perineum were opened and internal decompression of the tumor was performed by curette, then the residual tumor was totally removed with capsule. The L2 nerve root was preserved. After hemostasis with bipolar electrocauterization and normal saline irrigation, one CWV drain tube was placed.Then the internal oblique, external oblique fascia and subcutaneous layer were approximated by continuous 2/0 Vicryl stitches. The subcuticular layer was closed by running suture with 4/0 Dexon and skin by adhesive tape. Operators 賴達明 Assistants 陳元森,黃俊傑 手術日期：2005/12/07 11:43 摘要__ 手術科部: 外科部 套用罐頭: Lobectomy Pre-operative Diagnosis HCC Post-operative Diagnosis Ditto Operative Method Right lobectomy and cholecystectomy Pathology pending Operative Findings 1. Minimal ascites 2. Scar formation over liver surface 3. A 10cm *5cm firm mass over resected liver S7 Operative Procedures 1. ETGA, supine 2. Disinfection and drapping 3. Subcostal skin incision and subxyphoid extention 4. Ligation of round ligament by silk tie 5. Dissect of R't and L't crus ligament and mobilized the liver 6. Perform Cholecystectomy 7. Indentify ofR't hepatic artery and portal vein, ligated by silk tie 8. R't lobectomy was done bu CUSA 9. Check bleeding and hemostasis 10. 2 R/D were placed over R't subphrenic area 11. Closure wound in layers Operators 胡瑞恆 Assistants 陳信安,張彥俊 手術日期：2005/12/15 00:31 摘要__ 手術科部: 外科部 套用罐頭: App Pre-operative Diagnosis acute appendicitis Post-operative Diagnosis ditto Operative Method open appendectomy Operative Findings 1.inflammed appendix, no fecalith, no significant ascites, appendix was not ruptured 2.sigmoid colon edematous 3.retro-cecal appendix Operative Procedures 1.ETGA, supine 2.disinfection 3.McBurney's incision 4.trace taenia to retrieve appendix 5.appendectomy with purse-string suture 6.one R/D inserted with its tip at Douglas pouch 7.close the wound in layers Operators 蔡孟昆 Assistants 周宗欣,黃建逢,陳思恆 手術日期：2005/12/19 09:20 摘要__ 手術科部: 外科部 套用罐頭: Lobectomy Pre-operative Diagnosis right upper lobe lung tumor Post-operative Diagnosis ditto Operative Method VATS lobectomy and lymph node dissection Pathology pending Operative Findings 1. a elastic, hypocellular tumor, sized about 3x3cm, located at LUL lung, with pleural retraction 2. no pleural effusion 3. group 5, 7 lymph node: frozen pathologic report revealed no malignant cell Operative Procedures 1. DL-ETGA, right decubitus position 2. skin disinfection 3. make three working ports 4. group 5, 7 lymph nodes dissection 5. sent for frozen: negative 6. extend one port to 8cm 7. dissect and seperate the fissure between left lower lobe and left upper lobe with Endo GIA 60x1 8. release the inferior pulmonary ligament 9. divided the superior pulmonary vein by suture ligation 10. divided pulmonary artery to left upper lobe by Endo GIA 45x1 and suture ligation 11. divided the left upper lobe bronchus by Endo GIA 45x2 12. remove the resected left upper lobe 13. hemostasis 14. place two chest tubes 15. check the air leakage by warm normal saline 16. close the wound in layers Operators 李元麒,郭順文 Assistants 陳克誠,林孟暐 手術日期：2006/01/05 14:30 摘要__ 手術科部: 外科部 套用罐頭: Lobectomy Pre-operative Diagnosis Lung squamous cell carcinoma at right lower lobe s/p neoadjuvent chemotherapy Post-operative Diagnosis Lung squamous cell carcinoma at right lower lobe s/p neoadjuvent chemotherapy Operative Method Right thoracotomy for right lower lobe lobectomy and lymph node dissection Operative Findings 1. One 1x0.5cm, yellowish, firm, hypercellular tumor at right lower lobe with pleural retraction 2. Lymph node enlargement: Gr. 3, 7, 11 with adhesion to surrounding structure Operative Procedures Under general anesthesia using double-lumen endotracheal tube. An epidural anesthesia catheter was placed prior to the operation. The patient was put in left decubitus position. An axillary roll was placed under the down side. The operative field was welldisinfected and draped. Right posterolateral thoracotomy was made through the fifth intercostal space. The inferior pulmonary ligment was divided. The inferior pulmonary vein was identified, doubly ligated, suture-ligated, and divided. The pulmonary artery supplying the right lower lobe was looped, doubly ligated, suture-ligated and divided. The bronchus to the lower lobe was identified, clamped with TA-30 stapler, and divided with a knife, leaving a 5-mm stump. The stump was disinfected with aqua-betadine. Interrupted 4-0 Ticron sutures were used for reinforcement of the stump. Lymph node dissection was done at group 3, 7 and 11. The pleural cavity was irrigated with phosphate buffer solution and the fluid was sent for cytological examination. After meticulous homeostasis and check-up of air leakage, two 28# chest tubes were placed at anterior and posterior aspect of pleural cavity respectively. The intercostal space was closed with interrupted 2# Chromic sutures. The muscle layer was closed with 1-0 Vicryl sutures and the subcutaneous layer was closed with 2-0 Vicryl sutures. Subcutical 3-0 Prolene sutures were used for closure of the skin. The endotracheal tube was changed to single lumen tube and then the patient was sent to ICU for postoperative care. Operators 李元麒 Assistants 林洧呈,陳克誠,黃俊傑 手術日期：2006/01/06 14:23 摘要__ 手術科部: 外科部 套用罐頭: ATYPICAL Pre-operative Diagnosis 1.Hepatic tumor 2.splenomegaly 3.GB stones Post-operative Diagnosis Ditto Operative Method Atypical hepatectomy,splenectomy,cholecystectomy Operative Findings 1.Splenomegaly 2.Liver cirrhosis with macronodularity change 3.A 1.5 cm in diameter yellowish tumor over S7 4.resection margin<1cm 5.capsule(-) 6.cirrhosis(+) Operative Procedures 1. Under endotracheal general anesthesia, the patient is placed in supine position. The operation field is disinfected and draped as usual. 2. Bilateral subcostal incision with cephalic extension 3. Splenectomy 4. Mobilize the liver by dividing falciform and triangular ligament 5. Cholecystectomy 6. Intra-OP echo examination for tumor localization 7. Atypical hepatectomy is performed by CUSA and bipolar coagulation and microwave 8. Meticulous hemostasis with Surgicel and check bile leakage 9. Two rubber drains are placed at right subphrenic and right subphrenic area 10. The wound is closed in layers Operators 胡瑞恆 Assistants 羅喬 手術日期：2006/01/09 11:02 摘要__ 手術科部: 外科部 套用罐頭: MRM Pre-operative Diagnosis Left breast cancer s/p C/T Post-operative Diagnosis ditto Operative Method Modified radical mastectomy. left Pathology pending Operative Findings A 2x3 cm soft brownish tumor located at 7 o'clock direction of left nipple.LAP(-). Operative Procedures Patient was put on supine position with left arm 90 degree abducted. Under ETGA, skin was disinfected and draped as usual. An transverse elliptical incision, including the nipple-areolar complex and the skin over the biopsy wound, from left parasternalto left axillary area was made superiolaterally. The incised skin was grasped and retracted upward with breast clamps for skin flap dissection. Electrocauterization was used for dissection of skin flaps. The dissection reached to the level 1 cm below clavicle superiorly, the costal margin inferiorly and the parasternal area medially. Laterally dissecton was extended to the border of latissimus dorsi. The clavipectoral fascia was opened. The axillary vein was exposed and identified. The branches of the axillary vein were devided between ligatures. Axillary lymph node dissection was then performed for level I and II with identification and preserving of the long thoracic and thoracodorsal nerves. Breast tissue was removed en bloc with the axillary lymph nodes. The bleeders were checked meticulously. The operative field was irrigated with warm saline. The wound was closed layer by layers after two CWV drains were left. Blood loss was minimal and the patient stood the whole procedure well. Operators 張金堅,郭文宏 Assistants 陳信安,江建勰 手術日期：2006/02/08 12:30 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Chronic renal failure with indication of peritoneal dialysis Post-operative Diagnosis ditto Operative Method Tenckhoff catheter implantation Pathology nil Operative Findings Peritoneal dialysis smoothly after operation Operative Procedures 1. Under IV general anethesia, local anesthesia was also performed, and the patient was put into supine position 2. SKin incision at left abdomen, then perform mini-laparotomy 3. Insert the Tenckhoff catheter and fix it with purstring suture, and extendit out from skin at LLQ. 4. After adquate hemostasis, the wound was closed in layers Operators 蔡孟昆 Assistants 賴鵬升,林耿立 手術日期：2006/02/10 17:50 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) Pre-operative Diagnosis Lumbar stenosis Post-operative Diagnosis Ditto Operative Method Hemilaminectomy ( partial L3&5, L4 total) for decompression Pathology nil Operative Findings 1. Hypertrophy of ligmentum flavum causing canal stenosis, especially at L3/4 and L4/5 2.Right inferior facet of L3 was removed due to fracture. Operative Procedures Under the general anesthesia with endotracheal tube inserted, the patient was set into prone position. The L3 to L5 level was identified by the C-arm. The back was scrubed and then disinfected with the povidine-iodine and then drapped well with sterile drapping. Midline back linear skin incision 5cm in length was done over the level of L3 to L5. The paravertebral soft tissue and muscle was dissected to expose the right side L4 laminae. Hemilamilectomy was done over L4 and partial L3&5. The hypertrophic ligmentum flavum was removed and then the bilateral L5 root was identified intact and fully decompressed. One epidural 1/8 H/V was set up and fixed with 2-0 silk. The muscle layer was closed with 2-0 silk interrrupt and then the skin layer with 3-0 Nylon interrupt. Operators 賴達明 Assistants 陳元森,陳盈志 手術日期：2006/02/13 20:00 摘要__ 手術科部: 外科部 套用罐頭: Kidney Post-operative Diagnosis ditto Operative Method Renal transplantation Operative Findings A: right renal artery with aortic patch-> left external iliac artery end-to-side anastomosis, diameter: 0.6cm V: Right renal vein with IVC patch-> left external iliac vein end-to-side anastomosis, diameter: 1.5cm Ureter: Right ureter -> Dome of bladder, left side with submuscular tunnel with stent (extravesicle anastomosis) (Recipient kidney: Right kidney) Reperfusion: 7:30pm Operative Procedures Under ETGA, supine position Disinfect skin, drapped well as usual Curvilliar skin incision at left inguinal area Divide external and internal oblique abdominis Expose left common iliac artery and vein Expose the dome of bladder Connect artery via end-to-side anastomosis Connect vein via ena-to-side anastomosis Connect ureter to dome of bladder via submuscular tunnel Hemostasis, irrigation Create cystostomy from recipient ureter, anastomotic site Set 1 R/D at iliac fossa Close the wound in layers 手術日期：2006/02/15 13:51 摘要__ 手術科部: 外科部 套用罐頭: LC Pre-operative Diagnosis Gall bladder polyps Post-operative Diagnosis Ditto Operative Method Laparoscopic cholecystectomy Pathology pending Operative Findings 1. A swelling gall bladder located at liver bed 2. Normal cystic duct & vessels 3. Cholesterol stone(+) multiple with bile salts Operative Procedures 1. ETGA, supine & skin disinfection, drapping 2. Set up the video-system & 4 working ports 10mm port at subumbilical area 10mm port at subxyphoid area 5mm port at subcostal/midclavicular line 5mm port at subcostal/ ant. axillary line 3. Dissection/ Identification of cystic duct and cystic vessels, ligated by endoclips 4. Free the GB from the liver bed alonger with the avascular margin 5. Pulled out the GB from the subumbilical port 6. Hemostasis with spread mode 7. Wounds closure in layers Operators 賴逸儒 Assistants 賴鵬升,侯奕仲,蔡孝恩 手術日期：2006/02/18 11:20 摘要__ 手術科部: 婦產部 套用罐頭: Cervial polypectomy Pre-operative Diagnosis 1.Myoma uteri 2.urinary retension Post-operative Diagnosis ditto, operated Operative Method transvaginal myomectomy Pathology pennding Operative Findings one huge myoma protruded from vagina about 8cm in size, the stalk was inserted at right low segment of uterus. total weight of myoma: 375gm. Operative Procedures 1.under ETGA 2.dorsal lithotomy position 3.vaginal douching and skin disinfection 4.reon foley 5.moceration and remove the huge myoma via cervix 6.hemostasis over the cervical stalk and the woozing cervix by suture and electrocaurization 7.check bleeding and insert vaginal sgauze x 3 pieces EBL: 1500gm Cx: nil BT: whole blood 2u, FFP 6U, PLT 6U Operators 童寶玲 Assistants 陳怡伶 手術日期：2006/03/03 10:40 摘要__ 手術科部: 外科部 套用罐頭: HIVD Pre-operative Diagnosis L3-4 HIVD Post-operative Diagnosis Ditto Operative Method L3-4 foramenotomy for discectomy Pathology nil Operative Findings 1. L3-4 central bulging disc with thecal sac compression 2. The thecal sac relief afterdisectomy 3. mild hypertrophic lig. flavum Operative Procedures 1. ETGA, prone position 2. C-arm for localization of L3-4 3. 4cm skin incision at L3-4 level 4. Dissect the paraspinal muscle from spinal process 5. L3-4 foramenotomy by air driller 6. L3-4 bukging disc was removed 7. Hemostasis 8. W'd close inlayers Operators 賴達明 Assistants 洪偉禎,張彥俊 手術日期：2006/03/08 20:25 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis fail back syndrome with left L5 root compression Post-operative Diagnosis ditto Operative Method RFA of bilateral L4~5 and S1 nerve roots Operative Findings IntraOP C-arm x-ray showed guiding needles at bilateral L4 L5 S1 facet joints Operative Procedures 1.disinfection under prone position 2.local anesthesia 3.insert guiding needle, confirm position with c-arm 4.RFA of bilateral L4 L5 S1 roots Operators 曾勝弘 Assistants 洪偉禎,陳思恆 手術日期：2006/03/16 08:27 摘要__ 手術科部: 婦產部 套用罐頭: RAH + BSO Pre-operative Diagnosis cervical cancer stage Ib1 Post-operative Diagnosis ditto Operative Method RAH +BSO + BPLND and SPD insertion Pathology pending Operative Findings 1.Uterus: avfl Cervix: one 3x3 cm necrotic lesion in posterior lip about 4 o'clock 2.RAD: grossly normal 3.LAD: grossly normal 4.CDS: free 5. Right parametrium: size : 2x2 cm, Induration (-); Left parametrium: size : 2x2 cm, Induration (-); 6. Vagina cuff: 2 cm , gross tumor (-), section margin free (+) 7. Bilateral pelvic lymphnodes: Normal Enlarged Induration Right external iliac (+) (-) (-) Right obturator(+) (-) (-) Left external iliac (+) (-) (-) Left obturator (+) (-) (-) 8. EBL: 1300 ml, BT: pRBC 4u + PLT 6u + FFP 3u Cx: nil Operative Procedures 1. Put the patient on the lithotomy position and prepare as usual. 2. Make and infraumbilical vertical skin incision and open the abdominal wall layer by layer. 3. Clamp, cut and suture ligate the right round ligament. 4. Enter into the right para-vesical space down to the pelvic floor. 5. Clamp, cut and suture ligate the right infundibulo-pelvic ligament. 6. Do the similar procedures as (3), (4), (5) over the left side. 7. En bloc dissection of the left external and internal iliac LN. 8. Explore the left obturator fossa, identify the left obturator nerve and remove the obturator LNs en bloc. 9. Stretch the left umbilical ligament and ligate the left uterine artery. 10. Free the left ureter from posterior sheath of the broad ligament. 11. Open the left para-rectal space. 12. Clamp, cut and ligate the left cardinal ligament. 13. Clamp, cut and ligate the posterior sheath of the broad ligament. 14. Do the similar procedures (7) to (13) over the right side. 15. Dissect the recto-vaginal septumto open the recto-vaginal space. 16. Cut the bilateral recto-vaginal fascia and clamp bilateral utero-sacral ligaments. 17. Dissect the vesico-uterine fascia and push urinary bladder downward to the upper third of vagina. 18. Open the bilateral ureteral tunnels by clamp and ligate anterior and posterior utero-vesical sheaths 19. Cut the bilateral utero-sacral ligaments. 20. Clamp and cut the upper third of vagina to remove the whole uterus and its appendages. 21. Suture the bilateral vaginal stumpangles. 22. Approximate the bilateral round ligament stump and its ipsilateral adnexal stump. 23. Insert two Hemovac into bilateral retroperitoneal space 24. Check bleeders, hemostasis and then close abdominal wall layer by layer. 25. SPD was insertedand fixed over supra-pubic area. 26. Approximate the skin wound with 4-0 Dexon subcataneously. Operators 黃思誠,童寶玲 Assistants 吳文毅,江盈澄 手術日期：2006/03/16 18:57 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis RLL tumor, suspect HCC metastasis Post-operative Diagnosis Ditto Operative Method Thoracotomy for RML + RLL bilobectomy and lymph node dissection Operative Findings 1. Adhesion between RLL, RML chest wall and diaphragm 2. One 1*1 cm firm, enlarged LN located near bifurcation of RML and RLL bronchus; cut surface: yellow-whitish, hypercellular 3. Other lymph nodes enlargement: Gr.3.7.10.11 Operative Procedures 1. ETGA: double lumen ET tube 2. Left decubitus position 3. Posterolateral thoracotomy 4. Adhesion lysis 5. Divide inf. pulmonary ligament 6. Loop divide anterior pulmonary vein by endo-GIA45*1 7. Loop double-ligate, suture ligate and divide superior pulmonary vein branch to RML 8. Open and divide minor tissue by GIA 75*1 9. Loop and divide pulmonary artery branch to RML and RLL 10.Transuit intermediate branches by TA 30*1 11. LN dissection 12. Set two 28Fr. chest tube 13. Wound closure in layers Operators 李元麒 Assistants 林洧呈,陳鍾岳 手術日期：2006/03/17 13:55 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) Pre-operative Diagnosis L4-5 spinal stenosis and spondylokithesis L4 on L5 Post-operative Diagnosis Ditto Operative Method L4-5 laminectomy + TPS +RF + cage fixation Pathology nil Operative Findings 1. L-45 canal stenosis with hypertrophic lig flavum and severe thecal sac compression 2. Thecal sa reexpanded well after laminectomy and remove of lig flavum 3. TPS: 6.5*4cm *4 Cage: 11mm *2 Operative Procedures 1. ETGA, prone position 2. Skin incision L3-5 3. L4 laminectomy 4. Removal of hypertrophic lig flavum 5. Identify of L3-4, L4-5 facet joint and L4-5 trasverse process 6. Cortocotomy at inferior lateral border of L3-4,L4-5 facet 7. Set TPS*4 at L4-5 8. Rod fixation 9. Removal L4-5 disc bilaterally 10. Set 11mm cage*2 at L4-5 disc space 11. Set H/V *2 12. Close w'd in layers Operators 賴達明 Assistants 洪偉禎,張彥俊 手術日期：2006/03/24 13:43 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis 4th ventricle ependymoma, recurrence Post-operative Diagnosis Ditto Operative Method 1. Suboccipital transvermis approach for total tumor excision Pathology pending Operative Findings 1. 3*3*4 cm, gray-pinkish tumor with cystic component located at the dorsal aspect of 4th ventricle 2. The cystic fluid was yellowish, the tumor capsule and brian surface was easily dissect but tumor showed infiltrated to brain parenchyma at base 3. Tumor character: elastic-soft and hypovascularity 4. Mild adhesion between dura and cerebellar surface Operative Procedures 1. ETGA , prone position 2. Longitudinal skin incision via previous wound 3. Soft tissue dissection to expose previous sunoccipital craniectomywindow 4. EVD insertion via right frazile point 5. V shape aural incision and adhesion lysis 6. Blunt dissection to reach tumor surface 7. Dissect the tumor capsule away from brain parenchyma with microdissector 8. Cystic fluid drainage for internal decompression 9. Remove the tumor and it's capsule totally 10. Hemostasis with surgicel packing 11. Set one CWV drain 12. Close wounfd in layers Operators 賴達明 Assistants 陳元森,張彥俊 手術日期：2006/03/25 17:50 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Parkinsonism Post-operative Diagnosis ditto Operative Method frameless deep brain stimulator implantation at subthalamic nucleus Operative Findings 1.depth from skull to right STN: 89.2 mm depth from skull to left STN: 90.4 mm 2.estimated STN location was at (12,4,4) true STN location was at 2mm anterior to (12,4,4) Operative Procedures 1.preop preparation a. set up five fiducial markers at scalp and send patient for head CT b. image fusion of CT and MRI by navigation system for surgical planing (set up entry point, target and 3D model) 2.in the OR a.supine, head fixed with Mayfield clamp and two piece neck collar b.using navigation system for set up entry point at patient's scalp c.local anesthesia at incision line and make a transverse linear scalp incision d.burred holes creation at entry point x 2 e.set upthe DBS tower over left burred hole f.connect the equipment step by step. registration of fiducials and define the entry point, trajectory and depth from the target g.insert the microelectrode for electrophysiological study to define the location of STN h.test for possible side effect with different voltages after implantation of deep brain stimulator i.fixation of the stimulator and undermine the battery j.hemostasis k.close the wound in layers Operators 曾勝弘 Assistants 陳元森,陳思恆 手術日期：2006/03/29 10:58 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt Pre-operative Diagnosis Parkinson's disease Post-operative Diagnosis ditto Operative Method generator implantation Operative Findings 1.generator implanted at left chest wall 2.electrode was retrieved at subgaleal space 3.generator function was tested during the procedure Operative Procedures 1.ETGA, supine, skin prepare 2.antiseptics applied, drapped 3.scalp incision and identify the electrodes 4.left chest wall horizontal incision 5.undermining and create subcutaneous pocket over the muscle layer 6.subcutaneous tunneling from scalp to chest wall 7.set up generator and electrodes 8.hemostasis 9.inset the generator, test function 10.gentamycin-saline irrigation 11.close the wound in layers Operators 曾勝弘 Assistants 陳元森,陳思恆 手術日期：2006/04/18 14:05 摘要__ 手術科部: 婦產部 套用罐頭: Conization Pre-operative Diagnosis Cervical intraepithelial neoplasm Post-operative Diagnosis Cervical intraepithelial neoplasm Operative Method Conization with LEEP Pathology Pending Operative Findings 1. A 1*1*1 cm specimen was resected. 2. Erosion over posterior lip of exocervix. Operative Procedures 1. Put the patient on lithotomy position. 2. Vaginal douching & skin disinfection. 3. Urinary catheterization and skin draping as usual. 4. Perform conization with LEEP. 5. Check bleeding and hemostasis by electrocauterization. 6. Suture the wound with 1-0 Vicryl. 7. On Foley and pack the vagina with 2 pieces of gauze. EBL: minimal; BT: nil; Cx: nil Recorded by R Operators 周松男 Assistants 蔡菀庭 手術日期：2006/05/03 09:30 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT Pre-operative Diagnosis Recurrent parasagittal meningioma over right pre-frontal area Post-operative Diagnosis Ditto Operative Method Simpson grade II tumor excision + Cranioplasty Pathology Pending Operative Findings 1. An about 2x2x3cm solid, firm, elastic and yellowish tumor was noted over the anterior parasagittal area, mainly over right side 2. The tumor invaded downward the frontal sinus, and anteriorly to the crest part of the frontal bone 3. Thesuperior sagittal sinus was also involved 4. The tumor was wide-based, and tightly attached to the falx 5. The dura was tightly attached to the skull due to past surgery 6. Intra-OP blood loss was about 150ml Operative Procedures After endotracheal general anesthesia, the patient was under supine with head rotated to right and head fixed by Mayfield skull clamp. The scalp was shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. After curvilinear incision via past OP scar, Raney clips were applied to the scalp edge for temporary hemostasis. Creat a extended craniotomy window (10x6 cm) via past craniotomy and three excess burred holes. Dural tenting was done by 2/0 silk, and distributed along the edge of skull window. Extend excision into the base of anterior fossa, the frontal sinus was opened, and a small part of skull over crest area was also excised due to invasion.The superior sagittal sinus was partial excised till venous return was noted and ligated. The bone defect was recreated with Bonesemen, and the sinus was filled with fascia graft from the temporalis m. Dura repair was done with fascia graft (base), and Duragene (anterior) tightly. A CWV drain was set over the epidura space and the skull plate was placed back to craniotomy window with miniplate. Galea suture was performed by continuous suture with 3/0 Dexon and skin by continuous suture with 3/0 nylon. Operators 曾勝弘 Assistants 張源驛,陳睿生 手術日期：2006/05/08 08:40 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Suprasellar brian tumor, R/O germinoma Post-operative Diagnosis Ditto Operative Method Partial tumor excision for biopsy Pathology Germinoma by frozen section. Operative Findings 1. One white-reddish, soft, fragile and hypovascular tumor located at base of 3rd ventricle. 2. Frozen section: germinoma. Operative Procedures Under ETGA, the patient was put in supine position with head fixed with Mayfield skull clump and turned to left. Skin antiseptic procedure was done with better-iodine tincture and then covered with drape. Create one burr hole at right frontal area. Ventricular catheter was inserted followed by endoscope. We located the tumor at base of 3rd ventricle. Partial tumor excision and send for frozen section was performed by endoscopic grasper. The wound was closed in layers after insert one EVD. Operators 曾漢民 Assistants 張源驛,李建勳 手術日期：2006/06/02 08:30 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT Pre-operative Diagnosis Left frontal tumor, R/O low grade astrocytoma, R/O oligodendroglioma Post-operative Diagnosis Ditto Operative Method Partial tumor excision Pathology Pending Operative Findings 1. Tumor character: somewhere firm, rubber like, whitish and too bright with hypervascularity, no clear margin with surrounding brain tissue. 2. Frozen section: normal brian tissue (could be low cellularuty). Operative Procedures Under ETGA, supine position, skin antiseptic procedure was done with BI detergent scrubbing and then tincture painting followed by draping. Bifrontal scalp incision was followed by left frontal craniotomy. Dura was incised after tenting. Tumor was localized by intra-op sonography. Partial tumor excision was performed at three different places and send for frozen section. After meticulous hemostasis, the wound was closed in layers. Operators 曾漢民 Assistants 洪偉禎,李建勳 手術日期：2006/06/14 18:30 摘要__ 手術科部: 外科部 套用罐頭: Chronic Subdural Hematoma Pre-operative Diagnosis Chronic subdural hematoma, bilateral Post-operative Diagnosis Ditto Operative Method Drainage of chronic subdural hematoma Pathology Nil Operative Findings Large amount of old blood and blood clot at bilateral subdural space, drainaged out after incision of dura and outter membrane of hematoma. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine position. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: vertical skin incision at parietal area. 5. Made one burr hole at each sides. 6. Dural tenting: by 2/0 silk, distributed along the edge of the trephine. 7. Dural incision: cross along the trephine margin. 8. The outer membrane of thehematoma was coagulated by Bovie along the edge of dural incision, then exicsed. 9. The liquified old blood and clot in the subdural space was evacuated by sucker, then thoroughly irrigated with N.S. through a rubber tube until the return was clean. 10. Dural closure: with C shape gelform. 11. Scalp closure:hemostasis was done with monopolar coagulator touching on the sucker tip. Galea suture was performed by continuous sutures with 2/0 Vicryl and skin by continuouss suture with 3/0 nylon. 13.Drain:one at each sides, subdural. Operators 黃勝堅 Assistants 洪偉禎,李建勳 手術日期：2006/06/16 16:00 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Left pleural effusion, right breast cancer, s/p BCT and chemotherapy Post-operative Diagnosis ditto Operative Method Left VATS decortication Pathology pending Operative Findings 1.Diffuse pleural adhesion of left lung 2.A peel layer over both LUL, LLL 3.Left apex and basal part loculated pleural effusion, total 350ml, yellow clear 4.LLL collapsed, color: pale Operative Procedures 1.DLETGA, right decubitus 2.Disinfection and drap 3.Camera port 6th ICS MAL by chest echo, working port: th ICS PAL 4.Adhesionolysis of left pleura cavity 5.Decortication of left lung 6.Check air leak, hemostasis 7.Set one 28Fr chest tube posteriorly 8.Close the wound in layers Operators 徐紹勛 Assistants 陳克誠,陳衛洲 手術日期：2006/06/24 08:40 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis PARKISONISM Post-operative Diagnosis DITTO Operative Method Deep brain stimulator implantation with frameless navigator Pathology NIL Operative Findings Eletrode was inserted to bilateral subthalamic neucleus, which was localized by electronic recording. Rigidity reduced from 2+ to +/- after electric stimulator Operative Procedures 1. IVGA + local anesthesia 2. By cronal scalp ski incision about 10cm 3. Burr hole at bilateral Kocher's point 4. Tower was seting at scalp 5. Localized the insertion tract by navigator system 6. Inserted the electrode to STN 7. Electric stimulationby inserted eletrode 8. Homeostasis 9. Closed the wound Operators 曾勝弘 Assistants 洪偉禎,蘇亦昌 手術日期：2006/06/28 16:12 摘要__ 手術科部: 外科部 套用罐頭: EC-IC Bypass Pre-operative Diagnosis MOYAMPOYA DISEASE Post-operative Diagnosis DITTO Operative Method EC-IC Bypass (LEFT SIDE) Pathology NIL Operative Findings The anterior and posterior branches of the STA were harvested. The MMA was preserved meticulously on craniotomy. After opening of the dura two cortical branches of the MCA were chosen as the recipient vessels. End-to-side anastomosis was done. Operative Procedures Anesthesia: endotracheal general. Position: supine with head rotated (tilted) to right. Skin preparation:shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture. The course of the superficial temporal artery was mapped out with methylene blue after identification by palpation, then the skin was covered with a sterilized adhesive plastic sheet. Isolation of the superficial temporal artery (STA): a segment ofthis artery together with its surrounding fat tissue was isolated by sharp dissection after the scalp incision along the arterial course had been made. The bleeding from scalp edge was stopped by bipolar coagulator. Scalp incision: the incision for arterial isolation was then extended backward to form a horse shoe shape temporal flap. Raney clips were applied to scalp edge for temporary hemostais. Craniotomy window: 4 cm trephine centered at angular gyrus (about 5above the external auditory canal) Dural tenting by 2/0 silk, 2cm in interval, distributed along the edge of skull window. Dural incision in crusade fashion (curlinear along the edge of skull window). Under operating microscope, a suitable cortical branch from the MCA was identified and the arachnoid around the vessel was removed by microscissors. A piece of plastic membrane was placed under the free segment of the artery. Two temporary microvascular clips were applied, 1 cm appart, to the isolated segment of the cortical vessel, which was then opened by cutting off a leaf-like patch of the vascular wall (same size as the diameter of the STA). Heparin solution was used to irrigate the vascular lumen. The STA was occluded by a temporary clip and divided at its distal end. The lumen was irrigated with heparin solution. The advantitia at the vascular stump was trimmed off. The STA was anastomosed end-to-side to the segment of cortical artery with 8 interrupted stitches of 10/0 monofilament nylon. The plastic membrane was folded back with a small patty to drape around theanastomosing site, then the vascular clips were released, the first one was on distal end of the cortical vessel, the2nd one was on the STA and the last one, on the proximal end of the cortical artery. The leakage from the anastomosis was successufully stopped by gentle pressure on the patty with a small sucker tip. Dural closure with interruped 2/0 silk sutures for key stitches, then continuous sutures with 4/0 Dexon to obtain water-tight closure except the corner where the STA went into subdural space.The loose space there was packed with gelfoam around the STA. The trephine button was simply placed back with wire fixation, The corner where STA passed through was bitten off for preventing undue pressure on the STA by the button. Scalp closure and hemostasis was done with monopolar coagulator touching on the sucker tip. Galea suture was performed by continuous suture with 3/0 Dexon and skin by continuous suture with 3/0 nylon. Operators 杜永光 Assistants 郭律廷,黃博浩 手術日期：2006/06/28 00:00 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt Pre-operative Diagnosis Parkinson's disease Post-operative Diagnosis Ditto Operative Method Generator implantation Pathology Nil Operative Findings After implantation of the generator, the electrods were tested to be working well. For future identification, the sheath covering the leads are: white on the right, and transparent on the left. Operative Procedures Under general anesthesia, the patient was placed in a supine position with head rotating to the right. Skin preparation was performed by shaving and scrubbing with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, thencovered with sterilized adhesive plastic sheet. Skin incision was made over right froto-parietal area, posterior to previous op wound. Another transverse skin incision was made on left chest wall and then a subcutenous pouch was created. A subcutaneous tunnel was made to connect the chest wound to the scalp wound with three 1 cm skin incisions on its way. The electrods were tested after connecting the leads to the generator through the tunnel. The wound was closed in layers. Operators 曾勝弘 Assistants 郭律廷 手術日期：2006/07/04 00:00 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Left breast cancer Post-operative Diagnosis Ditto Operative Method MRM+ levelI/II LND Pathology Pending Operative Findings 1. Two tumor were noted at left breast 2. Level I/II lymph nodes were dissected 3. SLND(+) Operative Procedures 1. ETGA 2. SUpine position and disinfection 3. Elliptical incision 4. Do MRM 5. Do level I/II lymph nodes dissection and SLND 6. Hemostasis 7. Insert two CWV 8. CLose wound in layers Operators 黃俊升 Assistants 吳經閔 手術日期：2006/07/05 17:07 摘要__ 手術科部: 外科部 套用罐頭: Biopsy 乳房 Pre-operative Diagnosis Left breast cancer Post-operative Diagnosis Ditto Operative Method Left breast excision biopsy + Port-A implantation to the right side Operative Findings Left breast tumor, suspected malignancy. Operative Procedures 1.ETGA, supine. 2.Disinfected the OP area and drapping as usual. 3.Skin incision of left breast. 4.Dissection to approach the breast tumor and biopsy was performed. 5.Close the wound of the breast. 6.Incision of the skin medial to right humerus. 7.Dissction to approach to right cephalic vein. 8.Port-A insertion to right cephalic vein was performed. 9.Close wound in layers. Operators 張金堅 Assistants 黃建逢,R1陳賢生 手術日期：2006/07/14 00:00 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Right breast cancer s/p BCT with poor Port-A position Post-operative Diagnosis Ditto Operative Method 1. Removal of Port-A 2. Port-A insertion Pathology Nil Operative Findings 1. One old Port-A was noted at LU chest 2. Good and patent Port-A position and function Operative Procedures 1. IVG 2. Supine position and disinfection 3. Skin incision, and remove old Port-A 4. Set new port-A system after identification of cephalic vein 5. Check CXR 6. Close wound in layers Operators 黃俊升 Assistants 吳經閔 手術日期：2006/07/21 12:25 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT Pre-operative Diagnosis Lung cancer with cerebellum metastasis Post-operative Diagnosis Ditto Operative Method Total tumor excisionvia suboccipital approach + EVD insertion for ICP monitor Pathology Pending Operative Findings 1. The tumor was about 4x2.5x3cm cystic llike tumor. The component inside was gelly-like yellowish one 2. EVD was inserted from right Frazier point and the set depth was about 8cm 3. The tumor was slight poor-margined from the peripheral brain tissue4. The ICP was moderate, and the initial pressure was 20cmH2O Operative Procedures AFter ETGA, the patinet was under prone position with head flexion, and fixed with Mayfield. An EVD was set from the right Frazier point, and the depth was about 8cm. Then midline incision into the scalp over the suboccipital area was done, and the lengthwas about 12cm. The supra-inion to the C2 level paraspinal muscle group was dissceted and a craniotomy was made around 4x4cm over the left suboccipital wiht 2 burr holes made. After proper dura tenting, the dura was opened in a cingulate pattern. The tumor was harvested via transcortical approach, and the inner gelly-like component was removed with tumor forceps. The outter solid component was dissected from the peripheral brain tissue. After proper hemostasis, the dura was tightly closed with one galealgraft and deair. A CWV drain was set over the spidural space, then the skull graft was recovered and fixed with 3 gages of thick Nylon. Then the wound was closed in layers. Operators 蔡瑞章 Assistants 洪偉禎,陳睿生 手術日期：2006/07/25 13:31 摘要__ 手術科部: 泌尿部 套用罐頭: herniorrhaphy, inguinal Pre-operative Diagnosis Left side inguinal hernia Post-operative Diagnosis Left side inguinal hernia,direct type Operative Method Left herniorrhaphy and posterior repair with Mesh Operative Findings 1. A large sac from posterior wall, direct sac. 2. Posterior wall weakness. Operative Procedures 1. Under satisfactory spinal anesthesia with the patient in supine position. 2. Prepping and draping was performed in the usual sterile fashion. 3. An inguinal oblique incision was made in the left inguinal area. 4. Deepened the wound through layers into inguinal canal. 5. The spermatic cord was mobilized, and an direct sac was noted. 6. The hernia sac was isolated from spermatic cord. 7. The sac was pushed back to the peritoneal cavity. 8. Posterior wall repair with Mesh. 9. After adequate hemostasis was obtained, the wound was closed in layers. 10. The patient tolerated the procedure very well, and was sent to the recovery room in satisfactory condition. Operators 劉詩彬 Assistants 陳億聲 手術日期：2006/07/28 00:00 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Left breast cancer s/p MRM Post-operative Diagnosis Ditto Operative Method Port-A insertion Pathology Nil Operative Findings 1. Patent and good Port-A position and function 2. Port-A tip at right subclavian vein Operative Procedures 1. IVG 2. Supine position and disinfection 3. Skin incision 4. Identify cephalic vein 5. Set Port-A system 6. Check CXR 7. Close wound in layers Operators 黃俊升 Assistants 吳經閔 手術日期：2006/07/28 08:35 摘要__ 手術科部: 外科部 套用罐頭: Carpal Tunnel Syndrome Pre-operative Diagnosis Right side carpal tunnel syndrome Post-operative Diagnosis Ditto Operative Method Neurolysis Pathology nil Operative Findings The transverse carpal ligament was thicken, which compressed the left median nerve. after decompression, the nerve was released Operative Procedures 1. supine position, skin disinfection, drapping and local anesthesia 2. Skin incision over the right palm crease 3. Divided the transverse carpal ligament, opened to exposure the median nerve 4. Wound closure Operators 曾漢民 Assistants 蘇亦昌,蔡孝恩 手術日期：2006/08/11 19:11 摘要__ 手術科部: 外科部 套用罐頭: LAR Pre-operative Diagnosis Lower rectal cancer Post-operative Diagnosis ditto Operative Method Laparoscopic LAR Operative Findings 1. A 2x 2cm, sessile polyp at lower rectum, 7cm above anal verge; grossly, no serosa invasion. 2. Regional lymph node enlargement(-). 3.Distal safe margin: 2cm, proximal safe margin: 5cm. Operative Procedures 1.ETGA, lithotomy position. 2.Setting of laparoscopy trochar: 10,10,5,5mm at peri-umbilical, RLQ, LLQ, lower abdomen. 3.Dissected sigmoid mesocolon, opened peritoneal reflection, ligation of superior rectal artery. 4.Divided lower rectum beyond tumor by endo-GIA x3, Hemoloc x1. 5.Extended lower abdominal wound, transected sigmoid colon above tumor. 6.End to end anastomosis by GIA # 31. 7.Set one CWV in Douglas pouch, hemostasis. 8.Wound closure in layers. Operators 賴逸儒 Assistants 林耿立,林昊諭 手術日期：2006/08/16 15:55 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis NF-II with C2-3 neurofibroma Post-operative Diagnosis NF-II with C2-3 neurofibroma Operative Method right C2-3 hemilaminectomy for total tumor excision Operative Findings 1.enlarge C3 root inside the spinal canal with cord compression. The C2-3 neuroforamen was enlarged and the tumor extend through neuroforamen to the psrs-spinal space. 2.the cord re-expand well after removal of tumor 3.intra-op SSEP:no change 4.blood loss:1000mL Operative Procedures 1.ETGA, prone position, head fixed with Mayfield clamp 2.skin incision from C1-C4 3.dissect right paraspinal muscle from spinal process 4.C2,3 hemilaminectomy by high speed air drills 5.open the dura of C3 root 6.the tumor(in spinal canal) was removed by piece meal 7.the paraspinal tumor was removed 8.hemostasis 9.set the CWV drain 10.wound close in layers Operators 賴達明 Assistants 洪偉禎,陳德遠 手術日期：2006/08/30 15:30 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis third ventricle tumor Post-operative Diagnosis third ventricle tumor R/O craniopharyngioma, R/O teratoma Operative Method endoscopic brain tumor biopy via left Kocher point approach Pathology frozen:R/O craniopharyngioma, R/O teratoma Operative Findings lobular, white-color, soft tumor. Frozen section was R/O craniopharyngioma, R/O teratoma. Operative Procedures 1.ETGA, supine position, head fixed with Mayfield clamp 2.linear incision at left Kocher point 3.set burr holex1 4.dura tenting with 1 stitch 5.dura incision 6.ventricle needle punch 7.dilated with Negaton tube(No.4, No.7) 8.insert Endoscopy 9.tumor biopsy 10.insert EVD 11.close wound in layers Operators 曾漢民 Assistants 洪偉禎,陳德遠 手術日期：2006/09/05 12:54 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis right breast tumor with local recurrance Post-operative Diagnosis ditto Operative Method right breast tumor excision Pathology pending Operative Findings a firm nodule, 2x1x1cm at right chest wall Operative Procedures 1. IVGA 2. The patient lies in the supine position with the left arm abducted to 115 degrees 3. The entire breast is prepped, and sterile drapes are placed. 4. A curvilinear incision is made directly over mass. 5. Breast flaps are created using sharp dissection. 6. The mass is found and sharply dissected circumferentially around the breast mass 7. hemostasis is achieved 8. Wound closure in layers with Penrose insertion. Operators 黃俊升 Assistants 張容蓉,林明賢 手術日期：2006/09/08 13:35 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Left breast tumor Post-operative Diagnosis Left breast tumor Operative Method Needle localization and partial masectomy Operative Findings 1. Needle localization of the clustered microcalcification at left UOQ was performed with QOG 7.5 cm neddle-wire system via CC approach. Operative Procedures 1. Mask anesthesia, supine position with left arm 90 degree abduction. 2. Needle localization of the clustered microcalcification at left UOQ. 3. Skin incision and identified tumor mass with needle localization guided. 4. Tumor excision, and confirmed with mammography. 5. Hemostasis 6. Wound closure layers by layers. Operators 郭文宏 Assistants 柯智群 手術日期：2006/09/09 00:26 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Craniopharyngioma Post-operative Diagnosis Ditto Operative Method Total tumor excision via transcortical and transventricular approach Pathology Frozen section: craniopharyngioma favored Operative Findings 1. A 4x4x5 cm well-defined tumor located at the suprasellar region. Main tumor within the 3rd ventricle. No extension into the lateral ventricles. 2. Lobulated cystic portion noted inside the tumor. Yellow-green, mucoid turbid fluid content.Elastic, yellow-pink soft solid portion over the base and ant portion. 3. Left fornix partially transected. Thalamostriate vein and septal vein preserved. Operative Procedures 1. ETGA, supine position; head fixed with Myfield skull clamp. 2. Head shaved, skin disinfected and draped. 3. U-shaped incision over the left scalp. 4. Harvested a fascial graft. 5. 4 Burr holes created and a 8x6 cm craniotomy window opened. 6.U-shaped dural incision made with base at SSS after dural tenting. 7. A 2.5 cm corticotomy created the previous EVD tract entry point. 8. Applied 2 brain retractors laterally and medially. 9. Partial transection of left fornix performed for more working space. 10. Internal decompression of tumor and removed tumor capsule in pieces. 11. Oozing from normal brain tissue noted. Hemostasis achieved with Surgicell packing. 12. One EVD tube was placed over the left lateral ventricle. 13. Dura closed with 4-0 Prolene continuous suture. Duroplasty performed with autologous fascial graft. 14. Bone plate replaced and fixed with 4 wires and 2 central tenting. 15. Subgaleal CWV drain inserted. 16. Closed wound in layers. Operators 曾漢民 Assistants 陳元森,吳拓 手術日期：2006/09/11 08:00 摘要__ 手術科部: 外科部 套用罐頭: MRM Pre-operative Diagnosis 1.Left breast cancer 2.Right breast tumor Post-operative Diagnosis ditto Operative Method 1. Left MRM 2. Incisional biopsy of right breast tumor Pathology pending Operative Findings 1. Right breast tumor 0.6*0.6cm, 3cm away from nipple, 11.5 clockwise, UOQ 2. Left breast tumor 3.1*0.5cm, 2cm away from nipple, 2 clockwise, UIQ 3. Level I LAP(+), Level II LAP(-), Rotter's LAP(-) Operative Procedures 1. ETGA, supine 2. Incisional biopsy of right breast tumor 3. Left modified radical mastectomy 4. Level I LN dissection 5. Level II LN dissection 6. Costobrachial nerve preservation 7. Rotter's LN dissection 8. Hemostasis 9. Normal saline irrigation 10. Wound closure in layers Operators 張金堅 Assistants 侯奕仲,李怡頡 手術日期：2006/09/13 13:49 摘要__ 手術科部: 外科部 套用罐頭: AVF Pre-operative Diagnosis ESRD Post-operative Diagnosis Ditto Operative Method Left wrist radio-cephalic AVF Pathology Nil Operative Findings 1. Radial a.: 4mm Cephalic v.: 5mm Anastomosis: 10mm 2. Post-op thrill: good Operators 王水深 Assistants 張兼華 手術日期：2006/09/18 13:36 摘要__ 手術科部: 外科部 套用罐頭: HIVD Pre-operative Diagnosis Herniated intervertebral disc disease at L4/L5 and spondylosis Post-operative Diagnosis Ditto Operative Method Diskectomy Pathology Pending Operative Findings 1. Ruptured disc at L4/L5 2. Severe adhesion around the thecal sac 3. The thecal sac was pushed medially by the fibrotic tissue 4. Adhesion around the L5 nerve root Operative Procedures 1. ETGA, supine position 2. Localization of spine level by fluoroscopy 3. Make an incision at the L4/L5 level 4. Dissect the paraspinal muscle 5. Perform laminotomy by high speed air drill 6. Adhesionlysis around the thecal sac 7. Perform diskectomy8. Dissect the fibrotic tissue 9. Hemostasis 10. Close the wound in layers Operators 賴達明 Assistants 郭律廷,陳建嘉 手術日期：2006/09/18 08:32 摘要__ 手術科部: 外科部 套用罐頭: ATYPICAL Pre-operative Diagnosis r/o HCC, seg 6-7 Post-operative Diagnosis Ditto Operative Method Atypical hepatectomy Pathology Pending Operative Findings 1. Cirrhosis ( - ) , tumor number ( 1 ), tumor size ( 5) ×(4 )×( 4 )cm 2. Location at segment ( S6 ) color ( yellowish ) capsule ( - ) 3. Satellite nodule ( - ) rupture ( - ) 4. Portal vein thrombosis( -) Hepatic vein thrombosis ( - ) 5. Resection segment ( S6-7 ) Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position and the whole abdominal skin was disinfected with painting of alcoholic povidon betaiodine. The operation field was then wrapped with surgical towel as usual. Right subcostal incision with cephalic extension was made with electronic tissue cauterizer. The upper operation field was then further pulled upwards and lateral-wards with Kent self-retractor. The ligamentum teres was ligated and divided for traction of the liver. After dividing the falciform ligament to the level of IVC, intraoperative ultrasonography was performed to locate the tumor and to detect any unsuspected new lesions in the liver. After this, the gall bladder was firstly removed to expose the hilar structure of the liver. The right hepatic artery and right portal vein was isolated firstly and was looped with different vascular tape for temporary vascular control during liver parenchymal resection. The right triangular ligament and coronary ligament were divided with electrocauterizer and then the right lobe of the liver could be freely pulled out from behind the costal cage and could be approached easily. By temporarily tightening of the vascular tapes, atypical hepatectomy of segment ( 6-7 ) including the hepatic tumor was performed with the aid of CUSA . The exposed vascular structure and bile ducts in the resection plane were divided after ligation or clipping with vascular clip. When the resection was completed, detailed hemostasis of the raw surface was performed by electrocauterization and suture ligation of the bleeder. After this, the raw surface of the liver was covered with Surgicel and then the surgical wound was closed in three layers with two rubber drains left in the wound space. The muscular layer was closed with two layers of continuous suture with one "1-O" Vicryl. The subcutaneous layer was closed with two "2-O" chromic catgut and then the epidermis approximated with interrupted suture with three "3-O" Nylon. Remarks: estimatedblood loss ( 650ml; ) Operators 李伯皇 Assistants 楊博仁,謝永,陳文發 手術日期：2006/09/26 00:00 摘要__ 手術科部: 泌尿部 套用罐頭: URS (biopsy) Pre-operative Diagnosis suspect left upper ureter tumor Post-operative Diagnosis left renal pelvic tumor Operative Method left URS Operative Findings 1.a whitish caudiflower like tumor at left ureter pelvic junction and was biopsied 2.mild trabeculation of bladder Operative Procedures Under satisfactory endotracheal general anesthesia with the patient in lithotomy position, preparation and draping were performed in the usual sterile fashion. A 21 Fr cystoscope was inserted and bladder wall was checked well. A 0.035 Fr. guide-wire wasinserted into LUO. A 6Fr Wolf ureterorenoscope was inserted into the left ureter under a guidewire guidance. Left UPJ tumor was noted and then was biopsied. Finally, a two way, 16 Fr. foley was placed and the procedure ended. The patient tolerated the operation well and was sent to the recovery room in a stable condition. Operators 余宏政 Assistants 王禎薇,翁文慶 手術日期：2006/09/27 14:21 摘要__ 手術科部: 外科部 套用罐頭: HIVD Pre-operative Diagnosis C4-5 HIVDL5-S1 HIVD Post-operative Diagnosis C4-5 HIVD S/P anterior cervical diskectomy with cage and cortical bone fusion Operative Method anterior diskectomy with cage and cortical bone fusion Operative Findings Anteriot spur formation over C3,C4,C6 was noted. The disc space of C4-C5 was narrow and the disc degenerated very severe. After disckectomy, posterior osteophyectomy and removal of the posterior longitudinal ligment, the theca sac expanded well. The artificial cage of 12mm x 6mm was inserted smoothly. Operative Procedures 1. under ETGA, the patient was in supine position. 2. transverse skin incision over the right aspect of the neck at C4-C5 level. 3. open skin and plattismus muscle, SCM muscle in layers and dissect to the pre-vertebral space. 4.sub-longus cut dissection. 5. applied the self retractor 6. diskectomy with disc clamp and high speerl-drill 7. remove the posterior osteophytes with 1mm, 2mm Kerrison pounch. 8. applied the cage and artificial cone graft. 9. close wounds in layers. Operators 曾勝弘 Assistants 黃詩浩,王士豪 手術日期：2006/10/03 13:56 摘要__ 手術科部: 泌尿部 套用罐頭: nephrectomy, radical Pre-operative Diagnosis Left ureteral Urothelial carcinoma Post-operative Diagnosis Left ureteral Urothelial carcinoma Operative Method 1. Hand-assisted laparoscopic bilateral radical nephroureterectomy and bladder cuff resection Pathology pending Operative Findings 1.Multiple cauliflower-like tumors in the left ureteropelvis junction Operative Procedures Under satisfactory endotracheal general anesthesia with the patient in a left flank position, prepping and draping were performed in the usual sterile method. A 7 cm midline longitudinal incision was carried out in the lower abdomen and it was deepened into peritoneum cavity. A Hand-port device was placed at the this wound. A 5-12 mm Versaport at mid calvicular was created under the assistance of the operator's hand. Pneumoperitoneum was created by inflation with CO2 to the pressure of 15 mmHg. The second 5-12 mm Versaport for working was created at mid axillary line under the optic assistance. After taking the descending colon down by Ultra shear, Geota's fascia was identified. After isolating the Geota's fascia, left renal pedicle was identified and controlled by Hemolocks. The adjacent tissue of left kidney was further divided. The left ureter was further isolated as low as possible. Removed Versaports one by one and closed the wound of ports with endoclosure device. The hand-port was removed and the left ureter and left kidney were identified. the left ureter was further isolated from the adjacent tissue till the V-U junction a. It was then divided at the V-U junction and the bldder wound was closed with 2-0 Monocryl. The left kidney andureter with bladder cuff was removed en bloc. One CWV drain was placed at the left retroperionteal cavity till the paravesical space. The wound was closed by layers. The patient tolerated the operation and was sent to POR for further management. Operators 余宏政,黃國皓 Assistants 沈恆立,黃曜暉 手術日期：2006/10/05 15:50 摘要__ 手術科部: 外科部 套用罐頭: Lobectomy Pre-operative Diagnosis Lung cancer, Left upper lobe Post-operative Diagnosis Lung cancer, Left upper lobe Operative Method Left upper lobe Lobectomy Pathology Adenocarcinoma Operative Findings 1. Some whitish small nodule was noted over posterior pleura, Pathology: non-malignant. 2. Severe adhession of left upper love to the pleura and arta, pulmonary vessels and broncus 3. A 4 x 3 cm tumor mass was noted in the left upper lobe, close/adhesed to antero-lateral chest wall 4. Several enlarged dark LNs was dissected and sent to pathology over 5 & 6 due to highly suspicious Operative Procedures 1. General anesthesia using double-lumen endotracheal tube. 2. Right decubitus position. An axillary roll is placed under the down side. The operative field is well disinfected and draped. 3. Skin incision to creat: Camera port: 8th ICS, MAL; Working port: 5th ICS, AAL & 6th ICS PAL. 4. Dissected suspicious posterior pleural tissue. 5. Thoracotomy at 6th ICS level, 15cm oblique-transverse, after negative frozen result of pleural seeding. 6. The pleural adhesions are separated using electrocautery. 7. The inferior pulmonary ligment is divided. The superior pulmonary vein is identified, suture-ligated, and divided. 8. The pulmonary artery supplying the left upper lobe is identified, suture-ligated and Endo-GIA 45x1, and divided.9. The bronchus to the upper lobe is identified, clamped and divided by TA 30x1, and reforce by Ticron 4-0. 10.Release inferior plumonary ligment. 11.Check bleeding and air-leak by N/S irrigation. 12.A Fr28 chest tube was placed. 13.Wound closurein layers. Operators 陳晉興 Assistants 陳克誠,柯智群 手術日期：2006/10/11 08:30 摘要__ 手術科部: 外科部 套用罐頭: LC Pre-operative Diagnosis Chronic cholecystitis with cholelithiasis Post-operative Diagnosis Ditto Operative Method Laparoscopic cholecystectomy Pathology Pending Operative Findings 1. Gallbladder distention with adhesion to liver parenchyma 2. Multiple small GB pigment stones Operative Procedures 1. ETGA, supine 2. Skin disinfected and draped 3. Subumbilical skin incision made and camera entry port created (5-11mm) 4. Peritoneal cavity distention with CO2 5. Working ports created under laparoscopic visualization: Subxiphoid (5-11mm)Right abdomen (5mm) x 2 6. Adhesionolysis and mobilization of gallbladder from hepatic parenchyma 7. Ligation and transection of cystic duct and artery branches 8. Retrieval of gallbladder via camera port 9. Checked for hemostasis and closed wounds in layers Operators 李伯皇 Assistants 周俊志,吳拓 手術日期：2006/10/13 21:29 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) Pre-operative Diagnosis Lumbar stenosis s/p L4 laminectomy with recurrence Post-operative Diagnosis Lumbar stenosis s/p L4 laminectomy with recurrence s/p L3 laminectomy Operative Method Laminectomy of L3 and sublamininal decompression of L3-4, L4-5 Pathology nil Operative Findings Severe stenosis of L3-L4 canal and L3-4, L4-5 lateral recess due to hypertrophy of ligamentum flavum and fibrosis. The L3 roots and theca sac was free after decompression. However, severe adhesion of the L4-5 lateral recess was noted and it was difficultto identify L4 roots Operative Procedures Under ETGA, the patient was set in prone position. Pre-operative fluoroscopic localization was done. Then skin was opened in layers and adhesional lysis was performed. L3 laminectomy and sublaminar decompression were done. L4-5 level adhesionolysis was done later for L4-5 decompression. After proper hemostasis, the wound was closed in layers with hemovac drain tube Operators 賴達明 Assistants 黃詩浩,朱智邦 手術日期：2006/10/28 18:33 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis lung cancer Post-operative Diagnosis ditto Operative Method port-a insertion Operative Findings port-A catheter was in good position shown by CxR Operative Procedures 1. LA, supine 2. disinfection and drapping 3. port-A insertion by puncture method at r't subclavin vein 4. wound closure in layers Operators 陳晉興 Assistants 陳克誠 手術日期：2006/11/11 08:03 摘要__ 手術科部: 泌尿部 套用罐頭: herniorrhaphy Pre-operative Diagnosis Bilateral inguinal hernia Post-operative Diagnosis Bilateral inguinal hernia Operative Method Laparoscopic herniorrhaphy Operative Findings 1. Bilateral weak Hasselback's triangle (direct hernia), right > left 2. Bilateral mesh was placed for posterior wall enforcement Operative Procedures Under satisfactory endotracheal general anesthesia with the patient in a supine position, prepping and draping were performed. A 16 Fr Foley was inserted with sterile method. A balloon trocar was placed at periumbilical area. The wound was deepened into pre-peritoneum. The balloon was inflated and a pre-peritoneal space was created. The camera was inserted. Two 5 mm ports were placed at subumbilicus. The right direct hernia sac was identified and was pulled inside the right internal ring. For posteriorwall repair, mesh was attached to the abdominal wall around the bilateral internal ring and along the inguinal canal. The wound was closed in layers. The patient tolerated the operation well and was sented to POR under a stable condition. Operators 闕士傑 Assistants 王俊凱,姜宜妮 手術日期：2006/11/21 01:10 摘要__ 手術科部: 婦產部 套用罐頭: BSO Pre-operative Diagnosis Pelvic tumor Post-operative Diagnosis Left ovarian tumor with torsion Operative Method Left salpingo-oophorectomy Pathology pending Operative Findings 1. Uterus: avfl, grossly normal 2. LAD: Tumor 1:10x8x8 cm whitish, solid tumor, firm consistancy, connected to LOV Tumor 2:10x9x9 cm congested, solid tumor, firm consistancy, with pedicle to LOV, torsion 1 round 3. RAD: atrophy 4. CDS: ascites: 50 ml, no adhesion. Estimated blood loss: minimal. Blood transfusion: nil. Complications: nil. Operative Procedures 1. Put patient on the lithotomy position. 2. Vaginal douching and insert Foley catheter. 3. Skin disinfection with betadine. 4. Skin drapping as usual. 5. Vertical skin incision was made to open the abdominal wall layer by layer. 6. Ligate thepedicle of left adnexa and cut it. 7. Checking bleeding and hemostasis. 8. Close the abdominal wall layer by layer with 1-0 Vicryl 9. Approximation of skin with 4-0 Dexon Operators 陳思原 Assistants 黃家彥,江盈澄 手術日期：2006/11/22 12:30 摘要__ 手術科部: 外科部 套用罐頭: 肝左葉 Pre-operative Diagnosis HCC,lateral seg Post-operative Diagnosis Ditto Operative Method Lateral segmentectomy Pathology Pending Operative Findings 1. A 6*5*5 cm, yellow~reddish, elastic~firm hypercellular tumor over lateral segment 2. Modereate liver cirrhosis 3. Mild dark~reddish ascites noted after laparotomy Operative Procedures 1. ETGA, supine 2. Disinfection and draped 3. Uppere midlinelaparotomy 4. Mobilize the lateral segment 5. Lateral segmentectom with CUSA,Bipolar 6. Place one R/D: left subphrenic 7. Close wound in layers Operators 李伯皇 Assistants 楊博仁,吳孟哲 手術日期：2006/11/24 18:05 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Mastitis, right Post-operative Diagnosis Ditto Operative Method debridement Pathology NIL Operative Findings pus formation over the right breast Operative Procedures 1. GA, supine position, right arm abduction 2. skin disinfection and drapped 3. skin incision 4. normal saline 8000ml irrigation 5. debridement 6. wet-dressing with 5 gauze 7. packing Operators 郭文宏 Assistants 施惠雯 手術日期：2006/11/29 00:00 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt Pre-operative Diagnosis hydrocephalus Post-operative Diagnosis Ditto Operative Method V-P shunt via right kocher point Pathology nil Operative Findings the opening pressure was about 10 mmHg. The depth of the ventricular catheter was 4 cm in length Operative Procedures 1.ETGA, supine position with head rotate to left 2.Transverse skin incision 3.Right Kocher burr hole was made for ventricular tapping 4.RUQ minilaparotomy for insertion of peritoneal catheter 5.subcutaneous tunnel was made to the scalp wound for placement of catheter. 6.Insertion of ventricular catheter into right frontal horn, 4cm 7.Connection of both catheters with a reservoir ( medium pressure) 8.wound closure in layer Operators 楊士弘 Assistants 陳盈志 手術日期：2006/11/30 16:14 摘要__ 手術科部: 泌尿部 套用罐頭: TUR-P Pre-operative Diagnosis benign prostate hyperplasia Post-operative Diagnosis benign prostate hyperplasia Operative Method Transurethral resection of the prostate Operative Findings 1. 38 g of prostatic tissue was resected 2. bilateral lobes of the prostate kiss together 2. bladder trabeculation(+) Operative Procedures Under satisfactory spinal anesthesia, the patient was placed in the lithotomy position. Prepping and draping were performed in the usual sterile method. Urethral meatus stricture was noted and dilated by Sounding to 30 Fr. A 27 Fr. Olympus resectoscope sheath was inserted into the urethra with adequate lubrication. Then the resectoscope was inserted. Bulbar urethral stricture was noted. The bilateral lobes of his prostate were resected by a wire loop electrocautery. The chips was washed out with a Ellik evacuator. Hemostasis was done. A 22 Fr. 3-way Foley catheter was inserted and its balloon was inflated to 50c.c. Continuous N/S irrigation started. The patient tolerated the operation well and was sent to the recovery room with stable condition. Operators 闕士傑 Assistants 王俊凱 手術日期：2006/12/02 21:54 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis right masitis Post-operative Diagnosis right masitis Operative Method debridement and wound closure Operative Findings no more pus formation and necrotic tissue Operative Procedures 1.IVIG 2.supine position 3.remove dressing 4.disinfection 5.debridment 6.clsoe wound 7.send skin+breast tissue to pathology Operators 郭文宏 Assistants 朱俊霖 手術日期：2006/12/06 12:24 摘要__ 手術科部: 外科部 套用罐頭: Laminoplasty Pre-operative Diagnosis spinal stenosis, ossification of posterior longitude ligament over C3-C5 Post-operative Diagnosis ditto Operative Method C3-C5 OPEN-DOOR laminoplasty, Pathology nil Operative Findings 1.Hypertrophic ligamentum flavum and multiple spurs resulted in spinal stenosis (dural sac compression) at C3-5. 2.Good expansion of dural sac was confirmed after laminoplasty. 3.Stable fixation of lamina over C3-5 with miniplates was found afterprocedures Operative Procedures 1.ETGA, prone with neck flexed, head fixed by Mayfiled skull clamp 2.medline nape incision, from suboccipital to lower neck 3.splitted paraspinal muscle and soft tissue 4.drilling with high air-driller; performed simple layer of right laminal archescortex of C3-C5 and left laminal arches cortex bone of C3-C5 were removed 5.harvest C3 spinal process serve as bone graft. 6.perform C3-5 open-door laminoplasty(open left side lamina and shift to right side, fix with miniplate and bone graft) 7.hemostasis 8.insert hemovac x1 over paraspinal muscle 9.irrigation by N/S 10.close wound in layers Operators 賴達明 Assistants 洪偉禎,吳正一 手術日期：2006/12/07 14:38 摘要__ 手術科部: 婦產部 套用罐頭: TAH Pre-operative Diagnosis CIS with vaginal invasion Post-operative Diagnosis CIS with vaginal invasion Operative Method Total abdominal hysterectomy, partial vaginectomy Pathology Pending Operative Findings 1. Uterus: avfl, grossly normal Cervix: eroded and uneven surface over 2 ~ 6 o'clock direction Vaginal wall: eroded ans uneven lesion. Ant. wall: 2cm and post. wall 1.5cm was resected. 2. RAD: grossly normal 3. LAD: grossly normal 4. CDS: free of adhesion EBL: ml; BT: ; Complications: . Operative Procedures 1. Put the patient on the lithotomy position, vaginal douching, and on Foley. 2. Skin disinfection with beta-iodine and skin draping. 3. Make a Pfannenstiel skin incision and open the abdominal wall layer by layer. 4. Apply autoretractor and pack up the intestines to expose uterus. 5. Clamp, cut and ligate the bilateral round ligaments & open the broad ligaments anteriorly along the side of uterus downward to vesicouterine fold bilaterally. 6. Clamp, cut and ligate bilateral ovarian ligaments. 7. Dissect the densely adherent posterior leaf of broad ligaments overlying the uterosacral ligaments bilaterally. 8. Dissect and reflect the bladder downwards and off the uterus. 9. Clamp, cut and ligate the ascending branches of uterine arteries bilaterally at the level of isthmus of cervix. 10. Clamp, cut and ligate the paracervical vessels along lateral borders of cervix step by step downward bilaterally till the level of lateral vaginal fornix. 11. Cut the uterus and grasp the vaginal stump by Kockers. 12. Suture the vaginal stump with 1-0 vicryl sutures. 13. Fix the stumps of bilateral adnexa with the angles of vaginal stump. 14. Check bleeding and reperitonealization 15. Close the abdomen layer by layer. 16. Skin approximation with 4-0 Dexon. Operators 陳祈安 Assistants 黃婉儀,陳宜慧 手術日期：2006/12/18 12:01 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis L2-3 Sspinal tumor, susp. neuroma Post-operative Diagnosis ditto Operative Method right L2 hemi-laminectomy + tumor excision Pathology pending Operative Findings 1. a 2*2*2 cm, well defined, capsuled tumor, with yellowish, soft, low-vascularity content was noted extending from L2-3 nneural foramen laterally 2. tumor capsule was intact after excision 3. CSF leakage was noted and sealed after packing with gelfoamin the capsule Operative Procedures ETGA, prone position. Perform C-arm x-ray for intra-op localization of L1-5 spine. Midline skin incision and split the paraspinal muscles laterally for expose the lamina of L2-3 Perform right hemi-laminectomy and identify the tumor located over neural foramen Incision of tumor capsule and perform tumor excision by piecemeal fashion with tumor focep. CSF leakage was noted Compress with gelfoam in the capsule for hemostasis and CSF sealing. Close the capsule by suture. Hemostasis and irrigation with N./S. Insert a hemovac and close the wound in layers Operators 杜永光 Assistants 郭律廷,吳正一 手術日期：2006/12/20 11:30 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis left inguinal hernia Post-operative Diagnosis ditto Operative Method Herniorrhaphy + Bassini Pathology pending Operative Findings 1. indirect type sliding hernia is noted at left inguinal area 2. weak posterior wall 3. much adipose tissue Operative Procedures 1. SA, supine 2. left inguinal area incision 3. loop spermatic cord 4. dissection for hernia sac 5. purse-string suture and high ligation 6. Bassini procedure 7. hemostasis 8. wound closure in layers Operators 陳炯年 Assistants 侯奕仲 手術日期：2006/12/21 14:52 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis TRIGEMINAL NEURALGIA Post-operative Diagnosis DITTO Operative Method RADIOFREQUENCY COAGULATION Operative Findings TEMP:80 CENTIGRADE DURATION:90 SEC Operative Procedures 1.IVG,SUPINE 2.PROCEDURE:PUNCTURE AT LEFT MOUTH ANGLE TO THE FORAMEN OVALE UNDER THE C-ARM GUIDE 3.THERMOCOAGULATION WITH RF AFTER IDENTIFICATION OF THE TERMOTRY 4.PACKED THE WOUND Operators 曾勝弘 Assistants 黃詩浩 手術日期：2007/01/04 00:00 摘要__ 手術科部: 外科部 套用罐頭: App Pre-operative Diagnosis acute appendicitis Post-operative Diagnosis ruptured acute appendicitis with tumor formation Operative Method appendidectomy Operative Findings 1.retrocecal appendix 2.swelling of appendix with tumor formation with perforation at base of apendix 3.no fecalith Operative Procedures 1. Under endotracheal general anesthesia, the patient was placed in supine position. The operation field including the abdomen and the lower chest was disinfected with alcohol-Povidon tincture and dressed properly. 2. A McBurney transverse incision was made. The incision was deepened to the aponeurosis of the external oblique. The aponeurosis of the external oblique muscle was incised from the edge of the rectus sheath outward the flank parallel to the direction of fibers. With the external oblique aponeurosis held aside by mosquitos hemostats, the internal oblique and transversus muscle were split. 3. The transversalis fascia and peritoneum were picked up between forceps and opened with knife. 4. The appendix was found by tracing the taeniae coli. 5.The appendix was ligated at the junction between the cecum and appendix after a minor crush with a clamp. Then the appendix was cut at 0.5 cm distal to the ligature after the clump by a Kelly. 6. The adhesion between the appendix and the ascending colonwas divided by electrocauterization and ligatures. Once the appendix was delivered its mesentery near the tip was seized with a clamp. The mesentery of the appendix was ligated and divided. 7. A purse -string suture was laid in the wall of the cecum atthe base of the appendix. The suture on the base of the appendix was cut and pushed inward with the clamp to invaginate the stump. 8. Check bleeding and possible pus accumulations over paracolic gutter and Douglas pouch with pads. 9. Drain insertion: over right Dulgluse puch 10. The wound was closed by layers. Operators 黃凱文 Assistants 黃彥鈞,翁文慶 手術日期：2007/01/05 13:00 摘要__ 手術科部: 外科部 套用罐頭: OpenGB Pre-operative Diagnosis acute cholecystitis Post-operative Diagnosis GB & CBD stone & cholecystitis with impending rupture of GB Operative Method open cholecystectomy & choledocholithotomy with T-tube insertion Pathology pending Operative Findings 1. Multiple GB stones & CBD stone. range from 0.5cm ~ 1.4 cm in diameter, pigmented, blackish in appearance, ovoid in shape 2. Enlarged & disteneded GB (12cm in diameter)with extreme inflammation, thick wall, white bile in side (pus-like appearance) Operative Procedures 1. ETGA, supine, skin disinfection, drapping 2. subcostal incision in layers 3. mobilized the GB after adhesiolysis and decompression the bile first 4. Removal of the GB after ligation of the cystic duct and vessels 5. open the CBD, removed the stonefrom the distal/proximal CBD by stone forcep and irrigation, intra-OP choledochoscopic exploration; T-tube insertion and closure of the CBD interruptedly 6. Hemostasis at GB fossa, compression by Gelfoam 7. One rubber drain insertion at subhepatic area8. wound closure in layers in layers, penrose drains insertion into the cutaneous wound Operators 黃凱文 Assistants 林耿立,蔡孝恩 手術日期：2007/01/08 13:45 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) Pre-operative Diagnosis Lumbar stenosis, L3/4, L4/5 Post-operative Diagnosis Ditto Operative Method L4 laminectomy and lateral recess removal of L3/4, L4/5 Pathology nil Operative Findings Marked hypertrophic facet over L3/4 and L4/5 which caused the canal stenosis and compression of L4, L5 root. Scar formation and adhesion was noted over the right L5 root. Thecal sac expanded well after decompression. Operative Procedures Under the general anesthesia with endotracheal tube intubated, the patient was set into prone position. The operation field was scrubbed and disinfected with povidine-iodine and then drapped well with sterile drapping. Midline back incision was done along previous wound. The paravertebral muscle was dissected to expose the L3 and L4 laminae. Laminectomy was done to L4, then the Karrison was used to remove the hypertrophic facet till the thecal sac expanded well. Hemostasis was done with gelform packing.Rinderon injection was done over right L5 root. One CWV drain was set for drainage. The muscle layer was approximated. The subcutaneous layer was closed with 2-0 Vicryl and the skin layer with 3-0 Nylon Operators 杜永光 Assistants 陳元森,陳盈志 手術日期：2007/02/05 08:07 摘要__ 手術科部: 外科部 套用罐頭: esophagectomy,staple Pre-operative Diagnosis NSCLC , stage IIIA Post-operative Diagnosis Ditto Operative Method VATS mediastinal LN dissection Operative Findings Group 5 LNs enlargement , character : firm , whitish , hypercellular Gr : 7 LNs : not enlargement , black , soft Operative Procedures 1. Anesthesia: General anesthesia using double-lumen endotracheal tube. 2. Position: left decubitus position. An axillary roll is placed under the down side. The operative field is well disinfected and draped. 3. Camera port: From the seventh intercostal space in the mid-axillary line away from the lesion. 4. Working ports: First: From the fifth intercostal space in the anterior axillary line. Second: From the fifth intercostal space in the posterior axillary line. 5. LN dissection Gr : 5 , 7 6.After homeostasis, one 28# chest tubes is placed via the camera port. The lung is ventilated under the direct vision. The skin is closed with in layers Operators 李元麒 Assistants 陳克誠,林洧呈,方建豐 手術日期：2007/02/06 15:10 摘要__ 手術科部: 婦產部 套用罐頭: LAVH Pre-operative Diagnosis adenomyosis Post-operative Diagnosis ditto Operative Method Laparoscopic assisted vaginal hysterectomy Pathology pending Operative Findings 1. Uterus: AVFL, adenomyosis change 2. Left adnexae: grossly normal; RAD: absent 3. pelvic adhesion at pelvic side wall and CDS 4. Total weight of uterus: 314gm EBL: minimal; BT: nil; Cx: nil. Operative Procedures 1. Put the patient on lithotomy position and vaginal douching. 2. Skin disinfection and draping 3. Insert uterine elevator and on Foley 4. Make a 1cm skin incision below the umbilicus 5. Insert Varess needle and make pneumoperitoneum 6. Insert 10 mmtrocar and laparoscopy 7. Insert 2nd (10mm) and 3rd (5mm) trocar under laparoscopic inspection 8. Injection diluted Pitressin (1:100) into utero-vesical fold and bilateral broad ligament 9. Cut off bilateral round ligaments via electrocauterization 10.Cut off bilateral ovarian ligaments and fallopian tubes via electrocauterization 11. Dissect and ligate bilateral uterine artery with 1-0 Vicryl 12. Dissect and cut off serosa over utero-vesical and utero-rectal fold 13. Submucosal injection of diluted Pitressin (1:100) around the cervix 14. Make incision on the anterior vaginal mucosa and circumcision the cervix. 15. Enter the vesico-cervical space and utero-rectal space with long Kelly. 16. Clamp, cut and suture ligate bilateral utero-sacral ligaments with 1-0 Vicryl 17. Open the peritoneal cavity, anteriorly and posteriorly. 18. Clamp, cut and suture ligate bilateral cardinal ligaments with 1-0 Vicryl 19. Cut the uterus through midline with scissors 20. Morceration of the uterus 21. Clamp,cut and suture ligate bilateral ovarian ligaments and remove the uterus 22. Reperitonealization and approximate the vaginal stump. 23. Check bleeding and hemostasis under laparoscopy. Insert one surgicel and one CWV. 24. Remove trocar and repair skinwith 3-0 Vicryl Recorded by R Operators 黃思誠 Assistants 林芯予 手術日期：2007/02/08 16:00 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Right breast tumor,. with malignant pleural effusion Post-operative Diagnosis Right breast tumor,. with malignant pleural effusion Operative Method Port-A implantation Pathology Nil Operative Findings One Port-A inserted into left subclavian vein Operative Procedures After satisfactory intravenous anethesia and supine position, the prepping and drapping were performed in usual sterile method. An oblique incision was created at left subclavian area, and the left Cepalic vein was identified after wound deepening. Due to small diameter of left Cephalic vein, needle puncture into left subclavian vein was performed. After guide wire inserted, the Port-A was inserted into left subclavian vein smoothly. Portable X ray showed appropriate site. After wound closure, the patient was sent to recovery room under stable condition. Operators 張金堅 Assistants 張容蓉 手術日期：2007/02/09 15:00 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis right frontal lobe tumor Post-operative Diagnosis ditto Operative Method craniectomy for grossly total tumor excision Pathology pending Operative Findings 1. a 2x2x4cm solid part tumor, soft, low-vascularity, ill-defined, whitish 2. cystic part, 7cm in diameter, septum(+), with yellowish fluid contains 3. right lateral ventricle was expose while tumor excision 4. granulation like change was noted aroundcaudate nucleus Operative Procedures The patient has been in supine position and under ETGA during the whole procedure. His head was fixed with Mayfield clamp. After disinfection and clean drapping, the J shaped skin incision was made. A craniectomy via 5 burr holes was performed. The dura incision was in U shape. The tumor was removed by trans-cortical approach method. Grossly total tumor excision was performed. Following tumor excision, we performed hemostasis carefully, and the dura mater was closed. Bone plate was fixed by mini-plate. One epidura drain tube was placed. In the end, the wound was closed in layers. Operators 曾漢民 Assistants 洪偉禎,林孟暐 手術日期：2007/02/27 10:22 摘要__ 手術科部: 泌尿部 套用罐頭: TUR-BT Pre-operative Diagnosis Bladder tumor Post-operative Diagnosis Bladder tumor Operative Method TURBT(Transurethral resection of bladder tumor) Operative Findings Cauliflower-like tumors mass at the prostatic urethera, the bilateral wall of the posterior and dome of the urinary bladder Operative Procedures Under spinal anesthenia with the patient in the lithotomy position, prepped and draping were performed in the usual sterile method. Resectoscope was inserted into the urethra and bladder, and the whole bladder was checked. The tumor was resected by resectoscopy, piece by piece.The resected tissue was removed with Ellik evacuator. Adequate hemostasis was then obtained. A 22Fr. 3-way Foley catheter was inserted and continuous bladder irrigation with normal saline started. The balloon was inflated to 10cc. The patient was then sent to the recovery room in a stable condition. Operators 余宏政 Assistants 張尚仁,翁文慶 手術日期：2007/03/06 15:42 摘要__ 手術科部: 婦產部 套用罐頭: VTH Pre-operative Diagnosis 1. Uterine prolapse grade II 2. cystocele grade III 3.rectocele, grade 2 4.enterocele Post-operative Diagnosis ditto Operative Method Vaginal total hysterectomy+A-P repair Pathology pending Operative Findings 1. Uterus: prolapge Gr.II, 5*3*2cm, atrophic change 2. Bilateral adnexa: atrophic change 3. Cystocele: Gr.II 4. Rectocele: Gr.I1. Operative Procedures 1. Put the patient on the lithotomy position. 2. Vaginal douching and skin disinfection. 3. Submucosal injection of diluted Pitressin (1:100) around the cervix and bladder base. 4. Make incision on the anterior vaginal mucosa and circumcision the cervix. 5. Enter the vescio-cervical space and utero-rectal space with long Kelly. 6. Clamp, cut and suture ligate bilateral vesico-cervical ligaments. 7. Clamp, cut and suture ligate bilateral utero-sacral ligaments. 8. Open the peritoneal cavity, anteriorly and posteriorly. 9. Clamp, cut and suture ligate bilateral cardinal ligaments and broad ligaments. 10. Clamp, cut and suture ligate bilateral tubo-ovarian ligaments and remove the uterus 11. Reperitonization. 12. Approximate the vaginal stump. 13. Submucosal injection of diluted Pitressin (1:100) into anterior vaginal wall. 14. Make incision on the anterior vaginal mucosa. 15. Dissectthe vesico-vaginal space. 16. Push the bladder upward. 17. Remove partial anterior vaginal mucosa 18. Repairthe anterior vaginal wall with 1-0 Vicryl continuously. 19. Inject diluted Pitressin (1:100) into posterior vaginal wall. 20. Make posterior vaginal incision and dissect the utero-rectal space 21. Remove partial posterior vaginal mucosa 22. Suture the incision wound as episiotomy wound with 3-0 Vicryl 13. Insert two pieces of vaginal gauze in one chain and Foley catheter. Estimated blood loss: 50ml Blood transfusion: nil Complication: nil Operators 張廷禎 Assistants 陳怡伶 手術日期：2007/04/12 15:29 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis CAD, 3-V-D Post-operative Diagnosis CAD, 3-V-D Operative Method OPCAB Pathology pending Operative Findings 1.Fair heart contractility 2. CAD, 3-V-D LM 50% stenosis LAD total occlusion LCx proximal 80% stenosis, distal 80% stenosis RCA proximal 70% stenosis, middle 70% stenosis, diatal 60% stenosis Operative Procedures ETGA, supine, sternotomy Harvest LIMA, left thigh GSV OPCAB: LIMA to LAD, SVG: Ao to PDA, Ao to OM Chest tube x2 insertion, right pleura opened Wound closure Operators 許榮彬 Assistants 柯玉誠 手術日期：2007/04/15 01:13 摘要__ 手術科部: 外科部 套用罐頭: AVM Pre-operative Diagnosis Right temporal-parietal AVM with massive ICH Post-operative Diagnosis Ditto Operative Method AVM excision and ICH evacuation via right F-T-P craniotomy Pathology Pending Operative Findings Bulging brain after craniotomy was performed. An ecchymosis with ruptured cortex at right temporal lobe near the angular gyrus was noted. About 60ml ICH occupied the right temporal lobe with extension to the temporal tip. A 4cm X 2cm X 2cm tortuous niduswith multiple feeders from MCA and PCA occupied at the tempor-parietal junction. Its main drainage vein drained to the deep brain. The brain was slack after ICH evacuation. Operative Procedures 1.ETGA, 3/4 supine with head tilting to left 2.Traumatic flap at right F-T-P area 3.Open in layers 4.Right F-T-P craniotomy 5.Dural incision after tenting 6.Craniotomy at angular gyrus 7.ICH evacuation 8.AVM excision 9.Hemostasis 10.Set a CVW andclose wound in layers Operators 王國川 Assistants 黃詩浩,周韋翰 手術日期：2007/04/15 10:47 摘要__ 手術科部: 外科部 套用罐頭: MRM Pre-operative Diagnosis Right breast cancer Post-operative Diagnosis Right breast cancer Operative Method Modified radical mastectomy Pathology Pending Operative Findings One 3.0 cm hard tumor at R12/4 Operative Procedures 1.Under ETGA, supine position 2.Fish-mouth skin incision 3.Right simple mastectomy 4.Right axillary lymph node dissection 5.Insert 2 CWV drain 6.Close wound layer by layer Operators 黃俊升 Assistants 林欣穎,王昭閎 手術日期：2007/04/18 08:50 摘要__ 手術科部: 外科部 套用罐頭: Cervical Laminectomy Pre-operative Diagnosis Neurofibromstosis II with neuroma over C2-4 and cord compression Post-operative Diagnosis Ditto Operative Method Left hemilaminectomy for subtotal tumor excision Pathology Frozen section: schwannoma Operative Findings 1. The tumor was well encapsulated, white-greyish, elastic-firm, size: 4.5X2 X1.5 cm3 at C2-4 level, with the origin from left C4 and C5 nerves. The tumor was located in the extradural space with extraforaminal extension. The foramen for left C4 was widely dilated due to tumor extension. The foramen for C5 nerve was dilated, too. but not that much. The spinal cord was markedly pushed to right side and over the midline. 2. Profound bleeding was noted around the foramen (stump of the tumor). 3. Frozen section: schwannoma. Malignant change was not mentioned 4. Two transinet episodes of SSEP changes over left upper extremity were noted during operation. They recovered soon after next stimulation. 5. Dura tear for a long segment from C2 to C4 at the exitzone of left side nerves were noted. It was primarily repaired with 5-0 prolene and covered with Duraform. Operative Procedures Under general anesthesia and prone position, the head was fixed in Mayfield skull clump. The skin was scrubbed, antiseptic with alcohol B-I then draped. Midline skin incision was made from C2-5 spinous process. The paravetebral muscle and soft tissue weredissected. Left hemilaminectomy with air-drill and Kerisson punch were made right to the spinous processes. Under miscoscopic view, the capsule of the extradural tumor was coagulated with bipolar forceps, then it was opened with knife. Internal decompression with micro-dissector and tumor forceps under the assisstance of operative microscope was performed till the tumor capsule was left. The capsule was divided at the lateral side with the medial ventral part left in situ. The tumor was then dissected atthe foraminal part. Profound bleeding was noted, so residual of the tumor at the extraforaminal part wass removed till it was out of the field. The residula of the tumor still caused marked bleeding, so direct compression was applied firmly for 20 minutes to get complete hemostasis. The same procedure was applited to the left C4-5 level. The long segment of the dura tear was repaired with 5-0 prolene then covered with Duraform. The wound was then closed in layers after one CWV drain was set up at the subcutaneous (extradural) level. Operators 郭夢菲 Assistants 郭律廷,李建勳 手術日期：2007/04/28 00:00 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Cranio-facial dystonia s/p DBS , out of battery Post-operative Diagnosis Ditto Operative Method DBS, revision of left Gpi; 2.Change battery Pathology nil Operative Findings The new DBS was inserted via the tract 2mm lateral to previous one Operative Procedures IVG supine position head fixed with Mayfield. Skin preparation. Linear transverse incision along previous wound indentify the wire, remove it. Set up the set of Navigator identify the left GPi then reinsert new stimulator. Reconnect. Hemostasisclose wound in layers. Left subclavicular incision along previous wound. Identify old battery and change a new one, fixed with 2 stiches. Hemostasis close wound subcutaneously. The function of the DBS system were checked to be OK. Operators 曾勝弘 Assistants 陳盈志 手術日期：2007/05/01 16:10 摘要__ 手術科部: 外科部 套用罐頭: Lobectomy Pre-operative Diagnosis lung cancer s/p C/T Post-operative Diagnosis ditto Operative Method LUL lobectomy via minithoracotomy Operative Findings 1. A 1.5 cm whitish hypercellular mass was noted at LUL 2. Gr.5 LN: fibrotic, Gr.7 LN: soft, no LAP 3. moderate adhesion was noted at AP window Operative Procedures 1.ETGA with double lumen, right lateral position 2.Disinfection and drapping 3.VATS setting at previous wounds 4.Divide superior pulmonary vein by endo GIA 45 *1 5.Divide pulmonary artery, lingual and posterior ascending by suture ligation 6.DivideLUL main pulmonary artery by endo GIA45 7.Divide bronchus of LUL by endo GIA45 8.Lymph node dissection 9.Check bleeding and air leakage 10.28 Fr. chest tube * 2 11.Close the wound in layers Operators 李元麒 Assistants 林洧呈,陳克誠,廖斌志 手術日期：2007/05/08 14:15 摘要__ 手術科部: 婦產部 套用罐頭: TAH Pre-operative Diagnosis CIN3 Post-operative Diagnosis Ditto Operative Method TAH + BSO Pathology Pending Operative Findings 1. Uterus: 5*2*1cm, with a 1*1cm, intramural myoma at anterior wall 2. Adnexae: atrophy, grossly normal 3. Cul-de-sac: free of adhesion 4. Exocervix: smooth EBL: 50ml; BT: nil; Complications: nil. Operative Procedures 1. Put the patient on the lithotomy position, vaginal douching, and on Foley. 2. Skin disinfection with beta-iodine and skin draping. 3. Make a Pfannenstiel skin incision and open the abdominal wall layer by layer. 4. Apply autoretractor and pack up the intestines to expose uterus. 5. Clamp, cut and ligate the bilateral round ligaments & open the broad ligaments anteriorly along the side of uterus downward to vesicouterine fold bilaterally. 6. Clamp, cut and ligate bilateral infundibulo-pelvic ligaments. 7. Dissect the densely adherent posterior leaf of broad ligaments overlying the uterosacral ligaments bilaterally. 8. Dissect and reflect the bladder downwards and off the uterus. 9. Clamp, cut and ligate the ascending branches of uterine arteriesbilaterally at the level of isthmus of cervix. 10. Clamp, cut and ligate the paracervical vessels along lateral borders of cervix step by step downward bilaterally till the level of lateral vaginal fornix. 11. Cut the uterus and grasp the vaginal stumpby Kockers. 12. Suture the vaginal stump with 1-0 vicryl sutures. 13. Fix the stumps of bilateral adnexa with the angles of vaginal stump. 14. Check bleeding and reperitonealization 15. Close the abdomen layer by layer. 16. Skin approximation with 4-0 Dexon. Operators 李鎡堯 Assistants 何積泓 手術日期：2007/05/10 13:00 摘要__ 手術科部: 外科部 套用罐頭: Lobectomy Pre-operative Diagnosis bilateral lung tumors, r/o HCC lung metastasis Post-operative Diagnosis bilateral lung tumors, r/o HCC lung metastasis Operative Method bilateral wedge resection via VATS Operative Findings 1.LLL a 2 cm hepatoma-like mass 2.RUL a 1cm and a 1.2 cm hepatoma-like mass 3.RLL B6 a 1.2 cm buldging hepatoma-like mass Operative Procedures 1.ETGA with DL, R't then L't lateral position 2.disinfection and drapping 3.bilateral VATS setting as usual 4.bilateral VATS wedge resection by endo-GIA 60 and 45 5.check air leakage 6.set 28 Fr. chest tube at both side respectively 7.close the wound by layers Operators 李元麒 Assistants 陳克誠,李奕辰 手術日期：2007/05/29 09:40 摘要__ 手術科部: 婦產部 套用罐頭: Conization Pre-operative Diagnosis Cervical intraepithelial neoplasm III Post-operative Diagnosis Cervical intraepithelial neoplasm III Operative Method Conization Pathology Pending Operative Findings 1. A 2.0*2.0*1.0 cm specimen was resected. 2. Erosion over exocervix and one erythematous lesion at cervical os Operative Procedures 1. Put the patient on lithotomy position. 2. Vaginal douching & skin disinfection. 3. Urinary catheterization and skin draping as usual. 4. Perform conization with electrocauterization. 5. Check bleeding and hemostasis by electrocauterization. 6. Suture the wound with 1-0 Vicryl. 7. On Foley and pack the vagina with 1 pieces of gauze. EBL: minimal; BT: nil; Cx: nil Operators 許博欽 Assistants 陳思宇 手術日期：2007/06/04 13:36 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis RAI, ECD, DORV, PA, s/p RBTs, divided, s/p Bilateral BDG, cystic mass left to the ascending aorta Post-operative Diagnosis Mediastinum abscess formation Operative Method Adhesiolysis and pericardiectomy & pus drainage & debridement Pathology pending Operative Findings One abscess (about 10cc) was noted with yellowish sticky fluid conent over the anterior aspect of aorta. One piece of surgical membrane(? might be Gore-Tex membrane) was noted in the abscess Dextrocardia Operative Procedures 1. ETGA, supine, aseptic method as usual 2. Median sternotomy 3. Adhesiolysis 4. Debridment, pus drainage, obtained swab culture, removal of the foreign body, irrigation by GM solution 5. 2 chest tubes insertion at left/right mediastinum 6. wound closure in layers Operators 張重義 Assistants 陳偉華,張兼華,蔡孝恩 手術日期：2007/06/06 08:30 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt Pre-operative Diagnosis L't DBS electrode fracture Post-operative Diagnosis L't DBS electrode fracture Operative Method L't DBS electrode revision Operative Findings left electrode dysfunction (R't side was intact) left electrode dislocation with downward migration which was revised by pulling it upward and fixed in one subcutaneous pocket 6 sensors were placed for subsequencial stereotaxy Operative Procedures 1.ETGA, supine, head turn to the right side 2.sterialize the skin 3.skin incision at post-auricular area and expose the electrode 4.revision and fixation in subcutaneous pocket 5.hemastasis and wound closure 6.fix 6 sensors for subsequencial stereotaxy Operators 曾勝弘 Assistants 黃博浩,李奕辰 手術日期：2007/06/08 11:37 摘要__ 手術科部: 外科部 套用罐頭: Laminoplasty Pre-operative Diagnosis C spine stenosis with myelopathy Post-operative Diagnosis C spine stenosis with myelopathy Operative Method Laminoplasty Pathology nil Operative Findings The thecal sac expanded posteriorly after laminoplasty Operative Procedures 1. Under ETGA, placed the patient in prone with 3-point skeletal fixation. 2. Performed midline skin incision from C2 to C7 level. Disected deeply and incised along the midline. 3. Detached the paravertebral muscle subperiosteally to the medial facet.4. Used high speed to drill a groove on the left side first (junction between lamina and facet) 5. Made another groove on the right side 6. Reflected the laminae toward the left side. Placed one bony graft (retrieved from spinous process) on each level of laminoplasty level. Fixed the graft with miniplate. 7. Set one CWV drain. Closed the fascia and muscle in layers Operators 賴達明 Assistants 蘇亦昌,余奇樺 手術日期：2007/06/09 08:00 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis 1. Parkinsonism s/p bilateral DBS at STN 2. Left DBS dysfunction Post-operative Diagnosis 1. Parkinsonism s/p bilateral DBS at STN 2. Left DBS dysfunction Operative Method Left DBS revision, framless navigator guide Operative Findings 1. Three trials of trajectories were performed to identify the left STN using intraop electrophysiological monitoring 2. Target of left electrode: left STN (x:14 y:4 z:11.18) 3. Rigidity markedly decreased after electrical generator was turned on Operative Procedures The patient was placed in supine, and the scalp was cleaned with povidone iodine. Under general anersthesia, we made a skin incision along the old wound A new bur hole was then made at left frontal bone, which was estimated preoperatively by navigator system. We then opened the dura and inserted the electrode to the expected target. Intraoperative electrophysiological monitoring was used to confirm the precision of the target. Three trials of trajectories were performed. We confirmed the proper position.After the procedure, we connected to the generator, and the patient's rigidity improved. Operators 曾勝弘 Assistants 蘇亦昌,余奇樺 手術日期：2007/06/09 08:00 摘要__ 手術科部: 外科部 套用罐頭: ATYPICAL Pre-operative Diagnosis Hepatocellular carcinoma, S5-8 junction Post-operative Diagnosis ditto Operative Method Bisegmentectomy, S5-8 Operative Findings 1.a 4x4x3cm tumor at S8, lobulated, well-defined, yellowish, no central necrosis. 2.tumor location was near right hepatic vein. 3.gross macronodular cirrhosis, mild ascites. Operative Procedures 1. ETGA, supine position. 2. right subcostal laparotomy with cephalic extension. 3. Mobilize the liver. 4. Perform cholecystectomy and looping right hepatic artery, portal vein. 5. Intra-op sonography for localization of tumor. 6. Perform hepatectomywith the aid of CUSA and bipolar electrocauterizer. 7. Hemostasis, cover raw surface of the liver with gelfoam. 8. Place two rubber drains: S5-8 raw surface, right subphrenic area. 9. Close the wound in layers. Operators 李伯皇,胡瑞恆 Assistants 蘇彥豪,林昊諭 手術日期：2007/06/14 00:00 摘要__ 手術科部: 婦產部 套用罐頭: AP repair Pre-operative Diagnosis Cystocele, stage III Post-operative Diagnosis Ditto Operative Method Cystoplasty (Purse-string method and Gynemesh placement) Pathology Pending Operative Findings 1. Uterine prolapse, stage I 2. Cystocele, stage III Operative Procedures 1. Put the patient on lithotomy position. 2. Vaginal douching and skin disinfection. Urinary cathterization. 3. Submucosal injection of diluted Pitressin (1:100) into anterior vaginal wall. 4. Make incision on the anterior vaginal mucosa. 5. Dissectthe vesico-vaginal space. 6. Push the bladder upward. Purse-string method was used to plicate the bladder base. Place a piece of Gynemesh underbeneath the bladder base 7. Remove partial anterior vaginal mucosa 8. Insert two pieces of vaginal gauze in one chain and Foley catheter. Estimated blood loss: minimal Blood transfusion: nil Complication: nil Operators 林鶴雄 Assistants 蕭聖謀 手術日期：2007/06/21 10:52 摘要__ 手術科部: 婦產部 套用罐頭: VTH Pre-operative Diagnosis 1. Uterine prolapse 2. Cystocele 3. Rectocele Post-operative Diagnosis Ditto, operated Operative Method Vaginal total hysterectomy and A-P repair Pathology Pending Operative Findings 1. Uterus: prolapge Gr.II-III, atrophic change 2. Bilateral adnexa: atrophic change 3. Cystocele: Gr.III-IV 4. Rectocele: Gr.III Operative Procedures 1. Put the patient on the lithotomy position. 2. Vaginal douching and skin disinfection. 3. Submucosal injection of diluted Pitressin (1:100) around the cervix and bladder base. 4. Make incision on the anterior vaginal mucosa and circumcision the cervix. 5. Enter the vescio-cervical space and utero-rectal space with long Kelly. 6. Clamp, cut and suture ligate bilateral vesico-cervical ligaments. 7. Clamp, cut and suture ligate bilateral utero-sacral ligaments. 8. Open the peritoneal cavity, anteriorly and posteriorly. 9. Clamp, cut and suture ligate bilateral cardinal ligaments and broad ligaments. 10. Clamp, cut and suture ligate bilateral tubo-ovarian ligaments and remove the uterus 11. Reperitonization. 12. Approximate the vaginal stump. 13. Pack the vagina with gauze Operators 童寶玲 Assistants 陳宇立 手術日期：2007/07/11 08:50 摘要__ 手術科部: 外科部 套用罐頭: HIVD Pre-operative Diagnosis L4/5 HIVD with radiculopathy Post-operative Diagnosis Ditto Operative Method Microscope left side L4/5 laminotomy + diskectomy and bilateral sublaminal decompression Pathology Nil Operative Findings 1. The L4/5 disk was noted to be extroded into the space between PLL and body. especially over left side 2. The thecal sac and nerve root was noted to be well expanded after decompression 3. PLL and annus calcification was noted, and a small rupture ofPLL was found Operative Procedures After ETGA, the patient was under prone position with flexion. C-arm localization, and midline incision into the L4/5 level. The paraspinal muscle was splitted and the lamina over L4, 5 was exposed. Left side laminotomy was done over L4 & L5 with Kerrison and tne flavum ligamentum was excised with knife and grasp. Then the dural sac and the nerve root were identified and splitted medially with nerve hook. We incised into the PLL with knife and the rupture disk was noted over the space between PLL andbody. The disk was removed with currette and disk clump. After hemostasis, a piece of subcutaneous fatty tissue was covered between nerve root and thecal sac. The wound was finally closed in layers. Operators 蔡瑞章 Assistants 黃詩浩,陳睿生 手術日期：2007/07/23 08:30 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT Pre-operative Diagnosis Right frontal tumor susp. meningioma Post-operative Diagnosis Right frontal tumor susp. meningioma Operative Method Craniotomy for tumor excision Pathology Pending Operative Findings 1. The tumor was located at bilateral middle frontal lobe, and mainly over right side. 2. The tumor was grayish reddish, solid, fragile was well-vascularized one. 3. The SSS was involoved and opened for tumor remove intra-OP. 4. A nip open of the left frontal dura was done for left side tumor remove. 5. The right ACA was noted intra-OP and the tumor feeding brench was noted and ligated. 6. Hyperosteosis was noted with well veins supplied Operative Procedures After ETGA, the patient was under prone position with head neutral position and fixed with Mayfield. We incised into the scalp in a H shape via frontal area (2cm behind the coronal suture). After six burr holes made over the margin of the scalp wound,craniotomy was made about 8x12cm. The dura over right frontal was opened in a curvillinear shape after proper tenting (the dura base toward the midline). The tumor was grayish reddish, solid, fragile was well-vascularized one over the medial side. The tumor was devascularized with bipolar, and totally removed with dissector and tumor forceps. The right ACA was noted intra-OP and the tumor feeding brench was noted and ligated. The SSS was involoved and then opened for tumor remove intra-OP. The dura overSSS was repaired with 9-0 Prolene. A nip open of the left frontal dura was done for left side tumor remove. After proper hemostasis with gelfoam and surgicel, dura repair and tenting was done properly after deair. The skull was covered back and fixed withwires X6. One subgaleal CWV drain was set. The scalp wound was closed in layers. Operators 曾漢民 Assistants 黃博浩,陳睿生 手術日期：2007/07/27 08:00 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis right breast microcalcification Post-operative Diagnosis right breast microcalcification Operative Method partial mastectomy under needle localization Operative Findings microcalcification of right breast Operative Procedures 1.ETGA, supine, sterialize the skin 2.skin incision at right breast 3.do the partial mastectomy 4.hemostasis and close the wound Operators 張金堅,王明暘 Assistants 羅喬,李奕辰 手術日期：2007/07/30 19:35 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Parkinson disease Post-operative Diagnosis Parkinson disease Operative Method bilateral DBS Operative Findings Target : bilateral subthalamic nucleus. Bilateral extremities rigidty improved after DBS stimulation Operative Procedures IVG supine Transverse skin incision cross previous localized entry point Bilateral burn holes Awake patient Localization of SDN by navigation Set frameless DBS electrode instrument Electrode insertion Test STN thickness DBS insertion Repeat sameprocedure at right entry point Hemostasis and closed the wound Operators 曾勝弘 Assistants 黃詩浩,陳景中 手術日期：2007/07/31 08:30 摘要__ 手術科部: 牙科部 套用罐頭: ORN------sequestrectomy Pre-operative Diagnosis Osteomyelitis Post-operative Diagnosis Ditto Operative Method 1.Sequestrectomy & debridement 2. Teruplug (S) insertion Pathology Nil Operative Findings #44 local osteomyelitis pus(+) Operative Procedures 1. The patient was put in a supine position. 2. Under ETGA, on foley, disinfection and draping were done as usual. 3. A 1x1 cm sequestrum at R't posterior mandibular region with irregular surface. 4. Buccal incision with flap reflection was done. 5. Sequestrectomy and debridement with Rongeur & curettage was done. 6. Teruplug (S) insertion was done. 7. Sutured with 4 stitches of 3-0 silk. 8. The patient stood the whole procedure well. Recorded by TR 蔡孝誠 Operators 郭英雄 Assistants 蔡孝誠曾建福楊方瑜 手術日期：2007/08/01 15:30 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Failed back syndrome Post-operative Diagnosis Failed back syndrome Operative Method TPS + L4 foraminotomy Pathology nil Operative Findings s/p laminectomy from L3 to L5. The left nerve root was compressed tightly. Operative Procedures After ETGA, the patient was placed prone position. We made a skin incision along the old scar of previous lumbar spine operation. Then we dissected deep along the midline. The superior facet joint at L4 and L5 level was identified. Then the transpedicular screwwas inserted at L4 and L5. After that, left L4 foraminotomy was performed. Then we closed the wounds in layers. Operators 賴達明 Assistants 蘇亦昌,游欣樺 手術日期：2007/08/04 19:29 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis C4/5 C7/T1 HIVD Post-operative Diagnosis C4/5 C7/T1 HIVD Operative Method MICROSURGICAL DISCECTOMY AND CAGE IMPLANT Pathology NIL Operative Findings The cord was decompressed after discetomy and removal of posterior spur. Intra-OP C-arm confirmed proper location of cage. Operative Procedures THE PATIENT WAS ANESTHESED BY ETGA. HE WAS PUT IN SUPINE POSITION. TWO NECK TRANSVERSE INCISIONS WERE DONE TO EXPOSE C4/5 AND C7/T1. DISCECTOMY AND CAGE IMPLANTATION WERE DONE. AFTER HEMOSTASIS, 2 MINI-HEMOVAC WERE PLACED. WOUNDS WERE CLOSED IN LAYERS. Operators 賴達明,蕭輔仁 Assistants 黃博浩 手術日期：2007/08/04 21:50 摘要__ 手術科部: 外科部 套用罐頭: Head Injury Pre-operative Diagnosis Left traumatic SDH, ICH over frontotemporal area Post-operative Diagnosis Ditto Operative Method ICP monitor insertion and craniectomy for hematoma evacuation and decompression Pathology nil Operative Findings 1. ICP after burr hole craniectomy: 31 cmH2O 2. Tense dura after craniectomy. The largest SDH located at left temporal area with traumatic ICH. 3. ICP after closing wound: 10 cmH2O. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position with head turned to right. The scalp was shaved, scrubbed and antiseptic with B-I then draped. One burr hole was made at left temporal area followed by ICP insertion. The craniectomy was extended after sclp falp made. The dura was opened after tenting. The SDH was removed by suction and hemostasis with gelform packing and bipolar coagulator. Duroplasty with Duraform. After set 2 CWV drain at epidural space, the wound was closed in layers. Operators 蕭輔仁 Assistants 黃博浩,李建勳 手術日期：2007/08/06 20:22 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Parkinsonism Post-operative Diagnosis Parkinsonism Operative Method IPG inplantation Pathology nil Operative Findings After implantation, we checked impedence which ranged from 1000 ~ 2000. Operative Procedures After ETGA, we made a skin incision at left parietal region and identified the electrode which was implanted in the previous operation. We made another skin incision 2 cm below left clavicle. We then implanted the IPG at subcutaneous pocket.We made a subcutaneous tunnel from scalp to the fore-chest. Then we passed through the electrode and connected to the IPG. Then we closed the wound in layers. Operators 曾勝弘 Assistants 蘇亦昌,游欣樺 手術日期：2007/08/06 07:30 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Left temporalis muscle hypertrophic change with brain compression Post-operative Diagnosis Ditto Operative Method Temporalis muscle resection Pathology Pending Operative Findings 1. The right temporalis muscle (measured as 88mL, 98g) is edematous and thick (about 2.3 cm). Epidural hematoma was scanty. 2. ICP level before op: 40 mmHg; after op:14 mmHg. Operative Procedures Under ETGA and supine position, the scalp was antiseptic with alcohol-BI tincture and draped. The wound was opened along previous incision line. After identified the temporalis muscle, it was resected and hemostasis with bipolar coagulator at zygomatic level. 2 CWV drains were set up before close the wound in layers. Operators 蕭輔仁 Assistants 蘇亦昌,李建勳 手術日期：2007/08/10 21:47 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Right frontal brain tumor Post-operative Diagnosis r/o GBM Operative Method Right frontal craniotomy for tumor excision Pathology pending Operative Findings One 8.0x7.5x6.0cm3 greyish-yellowish tumor located in the right frontal region. The cystic portion was on the lateral portion and the majority of the solid part was in the medial part. There was yellowish and elastic firm cystic wall, of which margin withbrain was not very clear. Operative Procedures Under endotracheal general anesthesia, patient was set in supine with head rotated to left and fixed by Mayfield skull clamp. Skin was shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. Incision over right pterion area, and Raney clips were applied to the scalp edge for temporary hemostasis. Craniotomy wascreated by making 3 burr holes and then cut by power saw. Dural tenting was set by 2/0 silk, 2 cm in interval, distributed along the edge of skull window. Dura was incised in U shape. Tumor was identified and removed by tumor forcep, ring curette, and suctino. Hemostasis was check, cranioplasty with minipate, and one subgaleal CWV was inserted. Wound was closed in layers. Operators 賴達明 Assistants 黃博浩,曾峰毅 手術日期：2007/08/13 09:18 摘要__ 手術科部: 外科部 套用罐頭: LC Pre-operative Diagnosis Gall stone Post-operative Diagnosis Gall stone Operative Method Laparoscopic Cholecystectomy Pathology Pending Operative Findings Gallstone and/or Gallbladder polyps Operative Procedures 1. ETGA, on supine position, disinfected with alcoholic B-I and draped as usual 2. Supraumbilical mini-laparotomy about 20mm in length, inflatted with pneumoperitoneum setting at 12mmHg 3. Created three more port over subxyphoid, mid-clavicular and anterior axillary area about 5mm in length 4. Divided cystic duct and artery, then ligated and transected them 5. Dissected GB from peripheral tissue 6. Remove GB with plastic glove 7. Hemostasis and NS irrigation 8. Closed wound in layers Operators 胡瑞恆 Assistants 潘為元,蔡東明,方鳳吟 手術日期：2007/08/13 14:10 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis chest wall tumor Post-operative Diagnosis chest wall tumor Operative Method tumor excision Pathology pending Operative Findings a 1x1 cm tumor, clear, yellowish Operative Procedures 1. IVG, supine 2. skin prepare and drapping 3. skin incision avove tumor location 4. remove tumor 5. close OP wound in layers Operators 李元麒 Assistants 陳克誠 手術日期：2007/08/22 12:02 摘要__ 手術科部: 外科部 套用罐頭: Hypophysectomy---Transphenoid Pre-operative Diagnosis Pituitary macroadenoma Post-operative Diagnosis ditto Operative Method Transphenoid adenectomy Operative Findings 1.One elastic, firm tumor around 2.5x4 cm with thickened wall at pituitary area. Cystic content was noted after dura opening. After tumor was retracted out, one defect of arachnoid membrane was noted with CSF leakage and also, brain parenchyma was visualized. But we didn't see optic chiasm. 2.Intra-op frozen: sclerotic tissue with little cell, suspect adenoma Operative Procedures Under endotracheal general anesthesia, patient was put in supine position with head tilted 30 degree to left. The face and abdomen were prepared with povidone-iodine alcohol tincture, and the mucosa of oral and nasal cavity with aqueous povidone-iodinetincture. The former areas were covered by a sterilized adhesive plastic sheet. We incised the perpendicular plate mucosa to exposed the periosteum layer. We fracture the sphenoid floor to enter the sphenoid sinus. the mucosa inside the sinus was then resected. Sella floor was fractured and exposed dura layer, the tumor was also exposed. After dura incision, cystic content was then draained out. We dissect the tumor margin to devided it from adjacent tissue. The tumor was retracted out from the sella turcica. The defect of arachnoid membrane and brain parenchyma were noted and covered with surgicel and gelform. We harvest one piece of abdominal fat tisse to cover the defect. And then we put the bone graft back and inserted merosel. After that, we inserted one lubar drain at L4~5 level. Operators 蔡瑞章 Assistants 郭律廷,胡朝凱 手術日期：2007/08/30 08:25 摘要__ 手術科部: 婦產部 套用罐頭: Vaginectomy Pre-operative Diagnosis Recurrent HSIL Post-operative Diagnosis ditto Operative Method transabdominal partial vaginectomy Pathology pending Operative Findings 1.1*1cm necrotic tissue was found at left anterior wall of vaginal stump 2.one 4*3*3cm vagina stump was resection, free margine(+) EBL: 350mL, BT:nil, Cx:nil Operative Procedures 1. Put the patient on the lithotomy position and prepare as usual. 2. Make and infraumbilical vertical skin incision and open the abdominal wall layer by layer. 3. Clamp, cut and suture ligate the right round ligament. 4. Enter into the right para-vesical space down to the pelvic floor. 5. Stretch the left umbilical ligament and ligate the left uterine artery. 6. Free the left ureter from posterior sheath of the broad ligament. 7. Open the left para-rectal space. 8. Do the similar procedures over the right side. 9. open the recto-vaginal space. 10. Dissect the vesico-stump fascia and push urinary bladder downward 11. Open the bilateral ureteral tunnels by clamp and ligate anterior and posterior utero-vesical sheaths 12. Clamp and cut the upper third of vagina to remove partial vagina 13. Suture the bilateral vaginal stump angles. 14. Check bleeders, hemostasis and then close abdominal wall layer by layer. 15. Approximate the skin wound with 4-0 Dexon subcataneously. Operators 陳祈安 Assistants 陳宇立,黃佩慎 手術日期：2007/09/05 14:30 摘要__ 手術科部: 外科部 套用罐頭: 肝右葉 Pre-operative Diagnosis Hepatic tumor, S7 segment Post-operative Diagnosis Ditto Operative Method S6,S7 hepatectomy + chelecystectomy Pathology Nil Operative Findings 1. A 3*3*3cm lobulated tumor located at S7 segment of liver, no capsule was noted, margin >1cm from portal vein 2. Mild liver cirrhosis Operative Procedures 1.ETGA, supine position 2.Skin disinfection and drapping 3.Right subcostal skin incision with cephalic exension 4.Identify round ligment and cut it 5.Cholecystectomy 6.Identify and label right hepatic artery and right portal vein 7.Perform S6,S7 hepatectomy 8.Check bleeding, hemostasis, and normal saline irrigation 9.Put a ruber drain ar right subphrenic space 10.Close the wound in layers Operators 吳耀銘 Assistants 張容蓉,陳彥宇 手術日期：2007/09/10 08:35 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Chronic pancreatitis.Gastric varies bleeding. Post-operative Diagnosis ditto. Operative Method 1.Spleenectomy.2.Devascularization. Pathology Pending. Operative Findings 1.Spleno-megaly. 2.Gastric varies with engorges veins. 3.Pancreas hardness after palpation. Operative Procedures 1.Under ETGA,drapping and disinfection as usual. 2.Midline laparotomy. 3.Devascularization of gastric vessels around greater curvature. 4.Spleenectomy. 5.Rubber drain inserted at L't subphrenic area. 6.Close the W'd in layers. Operators 田郁文 Assistants 羅喬,蔡尚節 手術日期：2007/09/12 22:09 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis NeuroblastomaRight lung apex tumor with T1-3 epidural and paravertebral extension, suspect neuroblastoma Post-operative Diagnosis NeuroblastomaRight lung apex tumor with T1-3 epidural and paravertebral extension, suspect neuroblastoma Operative Method Debulking and port-A insertionGrossly total tumor excision via lower C7-T3 laminectomy and right T1-2 foraminectomy Pathology Pending Operative Findings 1. A 4cm in diameter, sphere, heterogeneous, hard mass over posterior mediastinum at the level of T1-2, adhesive to apical lobe of right lungThe tumor was weel encapsulated, grayish, soft, fragile and hypervascular. Two portions of the tumor can be identified. One infiltrated into the paravertebral muscles over the T2 and T3 levels. The other part distributed over dorsal and right aspect of the epidural spaces from lower C7 to T3 levels. This portion of tumor also extended through the enlarged right T1-2 intervertebral foramen into the thoracic cavity. The right T1 nerve root was entrapped and encased by the tumor, but could be preserved. TheT2 nerve was partially encased and could be preserved, too. The frozen pathology was "small blue round cell, suspect neuroblastoma or lymphoma". The estimated blood loss was 1,300ml. Operative Procedures 1. ETGA with one lung ventilation, right decubitus position, antiseptic applied 2. Right thoracotomy to approach pleural cavity 3. One lung ventilation 4. Seperate the tumor from right lung 5. Excision of the tumor piece-by-piece and send specimen topathological examination 6. Chest tube insertion 7. Close the wound in layers 8. Port-A insertion on left subclavian veinUnder ETGA, the patient was positioned prone on chest rolls with the arms on either side. After disinfection with povidone iodine, the skin incision extended in the midline from C7 to T4 level. The skin and subcutaneous tissue were then incised down to the deep fascia until the exposure of the spinous processes. The paraspinal muscles were then separated subperiosteally from the spinous processes on either side using electrocautery and guaze dissection. The muscle was detached until the exposure of facetjoints. Gelpi-type retractors were used for exposure. The tumor infiltrating at right deep paraspinal muscle was excised first. Then the spinous process and the laminae from lower C7 to T3 were removed using Leksell rongeurs and Kerrison punches. The whole spinal canal was well exposed now. The dorsal aspect of the tumor was removed piecemeally first using tumor forceps and alligator forceps. The right lateral portion of epidural tumor was further excised under microscopic view. At this moment, the bleeding mainly from epidural spaces (possible raw surface of tumor and the engorged venous plexuses) was profound, but it was soon stopped by further removal of the tumor and gelfoam packing or bipolar electrocauterization. Further resection of pars interarticularis over the T1-T2 was performed to gain access to the tumor part inside the enlarged T1-2 intervertebral neural faramen and lateral thoracic spinal canal. The tumor surrounding around the T1 nerve root was removed, and the remaining cavity was thenfilled with two pieces of gelfoam soaked with cresyl violet for further identification by the pediatric surgeon. Hemostasis was ensured. An epidural CWV drainage tube was then placed from a separate stabbing wound on left side. The paravertebral muscle and fascia were approximated with interrupted silk sutures in a 1-cm interval. The subcutaneous layer was closed in two layers with continuous 2-0 vicryl sutures. The skin was then closed with continuous 3-0 nylon sutures. Operators 許文明郭夢菲 Assistants 蔡明憲,周恒文蘇亦昌 手術日期：2007/09/18 17:55 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Chronic subdural effusion Post-operative Diagnosis Ditto Operative Method Subdural-peritoneal shunt Pathology Nil Operative Findings Subdural effusion pressure high, clear Shunt pressure 10mm H2O Operative Procedures 1. ETGA, supine with head tilt to right 2. 3cm incision at left peritoneal area 3. Scalp dissect to expose skull 4. Made a burr hole 5. Open abd wound over left abd area to enter the peritoneal cavity 6. Make a subcutaneous tunnel 7. Insert abd drain 8. Open dura and insert drain 9. Connect both and close wound in layers Operators 王國川 Assistants 胡朝凱 手術日期：2007/09/21 00:00 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Interstitial lung disease; colon caner, with liver metastasis Post-operative Diagnosis ditto Operative Method VATs wedge resectin and pleurectomy Pathology pending Operative Findings general irregular lung surface Operative Procedures 1. DLETGA, left decubitus position 2. Disinfection and drap 3. VATS port: camera port: 8th ICS MAL Working port 4th ICS AAL 6th ICS PAL 4. Wedge resection by EndoGIA 5. Pleurectomy 6. Hemostasis and irrigation 7. close wound in layers Operators 徐紹勛 Assistants 張彥俊,陳勇璋 手術日期：2007/09/23 15:22 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis RAI, DORV, TAPVR, PS Post-operative Diagnosis RAI, DORV, TAPVR, PS Operative Method Bitaleral BDG shunt creation + MPA ligation Pathology None Operative Findings 1. Situs ambihuus levocardiac, right arch, Ao is left anterior to MPA 2. Bilateral SVC, diameter of SVC about 5mm, RPA diameter= 8 mm, LPA diameter = 6mm 3. Per-op PAP= 24/20, SBP = 96/67, CVP = 13, SpO2 = 80%, after BDG and MPA ligation, CVP = 14, SpO2= 93% 4.Right azygous vein was identified and ligation, left side azygous vein was not forund Operative Procedures After ETGA, the patient was in supine position and receive full sternotomy. Bilateral SVC, RPA and LPA was dissected, and respective anastomosis of SVC to RPA and LPA were done in an end-to-side fusion with 7.0 Maxon sutures. Then MPA was ligated with silk suture. Surgical membrane was used in wrapping of AsAo, MPA, bilateral SVC, and couverge of pericardial space. Then 3 chest tube was set-up on bilateral pleural space and median sternum. Finally, the wound was closed in layers and wrapped. Operators 張重義 Assistants 黃日新,蔡東明 手術日期：2007/09/28 00:00 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Left frontal-temporal epidural hematoma Post-operative Diagnosis Ditto Operative Method Craniotomy for hematoma evacuation Pathology nil Operative Findings some oozing from MMA branch were cauterized, some venous oozing from midline was packed for hemostasis. No SDH. The brain expanded after hematoma evacuation Operative Procedures Under ETGA, the patient was set into supine position with head rotated to right side. The operation field was disinfected and drapped with sterile drapping. U-shape scalp incision was done over the swelling area. Burr hole was made for decompression. Craniotomy was done. The bleeder was identified and cauterized. Dura tenting was done. After hemostasis, one epidural CWV drain was set for drainage. The bone was fixed with wire. The wound was closed in layers Operators 陳敞牧 Assistants 黃博浩,陳盈志 手術日期：2007/10/01 08:50 摘要__ 手術科部: 外科部 套用罐頭: Cervical Laminectomy Pre-operative Diagnosis Cervical HIVD with canal stenosis Post-operative Diagnosis Ditto Operative Method C3-6 laminectomy Pathology Nil Operative Findings The canal was severe stenosis. The cord was compressed tightly which re-expansion well after laminectomy. Operative Procedures Under general anesthesia and intubation, the skull was fixed with Mayfield skull clump. Put the patient in prone position and the skin was scrubbed, antiseptic with alcohol-BI then draped. The skin incision was made in midline from C2-7 spinous process and dissected underlying tissue and separated the paraspinal muscle to expose the lamina. C3-6 laminectomy was then performed with rounger. After hemostasis, the wound was closed in layers with one CWV drain at wound site. Operators 曾漢民 Assistants 黃詩浩,李建勳 手術日期：2007/10/01 11:23 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis colon cancer Post-operative Diagnosis ditto Operative Method right hemicolectomy Pathology pending Operative Findings 1. A cauliflower tumor about 5x5 cm in proximal T-colon 2. Serosa invasion(+) 3. Lymph node enlargement at ileocolic vessels 4. No peritonium seeding 5. No liver metastasis 6. Surgical staging T3N2M0 Operative Procedures 1. ETGA, supine position 2. Sterilize, drapping 3. Midline laparotomy 4. Morbilize right colon 5. Ligate ileocolic vessels, rigth colic vessels, and middle colic vessels right branch 6. Right hemicolectomy by GIA x 2 7. Ileocolectomy side to side anastomosis 8. One rubber drain at right subhepatic area 9. Close wound in layers Operators 張金堅 Assistants 張東晟,陳勇璋 手術日期：2007/10/02 21:02 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Kidney tumor, left Post-operative Diagnosis Malignant mesenchymal tumor, left Operative Method Retroperitoneal malignant tumor excision and Port-A catheter implantation Pathology Mesenchymal tumor Operative Findings 1.A 12*15*10cm, well-defined, round, solid tumor at left retroperitoneal cavity, ruputre with Gerota fasia involvement, without descending colon involvement 2.A pediatric port-A catheter was inserted at right jugular vein Operative Procedures 1.ETGA, supine position 2.Skin disinfection and drapped 3.Midline incision: from subxyphoid to umbilicus 4.Explore intraabdominal cavity 5.A 12*15*10 cm well defined, round, solid tumor was noted at retroperitoneum below descending colon. 6.The tumorwas ruptured when we were dissectinf ti form retorpertonium. 7.Intr*operative frozen biopsy from tumor showed mesenchymal malignant tumor. 8.Repai the rupture site with suture 9.Remove whole tumor from retroperitonium 10.CHeck right side retroperitoneum: no palpable mass was found 11.Hemostasis and perform normal saline irrigation at abdominal cavity 12.Close wound in layers and packing after Hemovac inserted at left subsplenic 13.Skin disinfection and drapped again 14.Transverse skin incision atright neck and right middle sternum border 15.Dissected external jugular vein and inserted pediatric Port-A catheter form external jugular vein to SVC 16.Close wound in layers Operators 許文明 Assistants 蔡明憲陳建嘉蔡東明周祐威 手術日期：2007/10/02 12:00 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis right mediastinal tumor, r/o neurogenic tumor Post-operative Diagnosis ditto Operative Method VATS tumor excision Pathology pending Operative Findings a 4x4cm, well-capsulated, well-defined, yellowish, elastic to firm tumor, located at apex of right chest cavity, suspect neurogenic tumor Operative Procedures 1. DLETGA, left decubitus position 2. skin was disinfected and drapped 3. make three VATS working ports: 7th ICS, MAL(2cm), 5th ICS, AAL(4cm), 4th ICS, PAL(4cm) 4. dissect the parietal pleura around the tumor with electrocoagulator 5. dissect and seperate the tumor from chest wall, ligate the feeding vessel with endo-clips 6. hemostasis, check air leakage 7. place one Fr. 28 chest tube 8. close the wound in layers Operators 李元麒 Assistants 陳克誠,林孟暐 手術日期：2007/10/08 13:02 摘要__ 手術科部: 麻醉部 套用罐頭: Port-A removal Pre-operative Diagnosis CML Post-operative Diagnosis ditto Operative Method Port-A removal Pathology nil Operative Procedures 1. Under general anesthesia, put the patient on supine position 2. The skin of right precordial area was disinfected with beta-iodine 3. Open the Port-A wound 4. Remove the Port-A catheter 5. Wound debridement 6. Close the skin layer by layer 7. Dressing with B-I gauze and compression Recorded by R2 朱俊霖 Operators 林至芃 Assistants 朱俊霖 手術日期：2007/10/13 17:00 摘要__ 手術科部: 外科部 套用罐頭: Port-A Pre-operative Diagnosis Esophageal cancer Post-operative Diagnosis Ditto Operative Method Port-A catheter implantation, right subclavian vein Pathology Nil Operative Findings The venous blood flow freely in the Port-A catheter after implantation. Operative Procedures The patient was put on supine position. The operation field was disinfected and draped as usual. Under local anesthesia, the Port-A catheter was implanted on right side upper chest with puncture method. Operators 吳毅暉 Assistants 陳佑群 手術日期：2007/10/14 13:55 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis ditto Operative Method VP shunt Operative Findings 1.Low opening pressure:0 cmH2O 2.Codman reservior, programmable, now set: 8 cmH2O 3.Subdural effusion (+) 4.Clear CSF 5.Intraventricular catheter: 6 cm Intra-abdominal catheter: 30 cm Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: supine with head rotated to left 3.Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 5 cm curvilinear, right Kocher point 5.After the scalp flap had been lifted and reflected anteriorly, a burr hole was made and the dura was tented by 2 stitches. 6.The dura was opened by a nib incision. Rt lateral ventriclewas tapped by a ventricular needle, then a 6 cm segment of the ventricular catheter was introduced into the ventricle. The outer end of the catheter was connected to a Codman reservoir. 7. A nib incision was made at RUQ of the abdomen, open into peritoneal cavity. 8.The proximal end of catheter was passed through subcutaneous tunnel at forechest, neck, rt retroauricular area and connected the reservoir and anti-siphone. The shunt system was checked to make sure its functionwas working. 9.Insertabdominal catheter 10. Scalp closure: hemostasis was done with monopolar coagulator touching on the sucker tip. Galea suture was performed by continuous suture with 3/0. Dexon and skin by continuous suture with 3/0 nylon. Operators 王國川 Assistants 胡朝凱 手術日期：2007/10/15 19:52 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Left breast cancer Post-operative Diagnosis Ditto Operative Method Port-A implantation; Left neck lymph node dissection Operative Findings 1. Port-A inserted via right subclavian vein by puncture method. Fixed at 18cm, test smoothly. X ray: OK 2. Left neck lymph node (+) grossly. Firm to hard, non movable, whitish. Operative Procedures 1. ETGA with supine 2. Aseptic and drapped 3. Right side port A insertion through subclavian vein by ouncture method 4. Wound closure after hemostasis 5. Left neck transverse incision 6. Lymph node dissection 7. Hemostasis 8. Wound closure in layers. Operators 張金堅,郭文宏 Assistants 莊育權 林政頤 手術日期：2007/10/15 08:30 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis RAI, DORV, ECD, PA, s/p right BTs, devided, s/p bilateral BDG, patent Post-operative Diagnosis Ditto Operative Method 1. AV valve plasty 2. PA patch augmentation 3. right internal mammary vein ligation Pathology Nil Operative Findings 1. Situs ambigous, detrocardia 2. ECD, common AV valve with mild to moderate regurgitation 3. DORV, dominent RV, pulmonary atresia 4. RPA and LPA interruption 5. multiple pus-like substance at mediastinum, we do AFS, negative finding 6. one right internal mammary vein to RLPV fistula 7. circulatory arrest under 19C: 26minutes + 6 minutes Operative Procedures Under endotracheal general anesthesia, patient was placed as supine position. Median sternotomy was performed then AsAo, IVC cannulation. Patient was set to cardiopulmonary bypass. Aortic cross-clamp with antegrade cardioplegia was performed. Left side RA atriotomy was performed, then AV valvuloplasty was performed with DeVegus annuloplasty. RA was locsed then added left RAA cannulation. LPA to RPA incision was performed. PA patch augmentation under DHCA was performed. The patient was placed backon partial CPB. The heart beat resumed normal sinus rhythm spontaneously. The rectal body temperature was rewarmed and the cardiopulmonary bypass was weaned off after the patient's hemodynamics became stabilized. Four chest tubes were placed into pericardial cavity. Surgical membrane was covered mediastinum. The sternum was closed with wire stitches. The subcutaneous tissue was closed in layers. Operators 張重義 Assistants 陳映澄,陳佑群 手術日期：2007/10/16 13:18 摘要__ 手術科部: 骨科部 套用罐頭: Endoscopic carpal tunnel release Pre-operative Diagnosis Bilateral carpal tunnel syndrome Post-operative Diagnosis Ditto Operative Method Decompression of median nerve at wrist, bilateral Pathology Nil Operative Findings Bilateral flexor retinaculum hypertrophy with median nerve entrapment Operative Procedures 1. Under ETGA, the patient was put in supine position with hand board use 2. Skin was disinfected and draped as ususal 3. Transverse skin incision at left wrist and dissect to the level of flexor retinaculum 4. Incise the retinaculum to release median nerve 5. Irrigate the operation field with normal saline 6. Close the wound in layers 7. Perform same procedure (steps 3~6) to the right side Operators 孫瑞昇 Assistants 李忠謙,黃哲南 手術日期：2007/10/17 11:31 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT Pre-operative Diagnosis Lung cancer with cerebellar metastasis s/p tumor excision, with recurrence Post-operative Diagnosis ditto Operative Method Gross total tumor excision Pathology pending Operative Findings There's a 1cm in diameter, reddish, soft tumor with low vascularity located beneath the upper end of previous craniotomy window. The tumor adhered to the dura. Operative Procedures The patient was under ETGA, on prone position. Skin preparation was done, then skin incision along previous OP scar was made. Previous craniotomy window was exposed, then the bone plate was removed. The dura was opened based on the left transverse sinus.Under loupe, the tumor was removed totally with bipolar cauterization, tumor forceps and dissector. Duroplasty was performed with Duraform. The wound was closed in layers after fixing the bone plate with one stitch of Nylon and placing a CWV drain betweenbone and muscle layers. Operators 蔡瑞章 Assistants 郭律廷,張允亮 手術日期：2007/10/19 15:00 摘要__ 手術科部: 外科部 套用罐頭: Port-A Pre-operative Diagnosis CML Post-operative Diagnosis Ditto Operative Method Port-A catheter implantation, left internal jugular vein Pathology Nil Operative Findings The venous blood flow freely in the Port-A catheter after implantation. Operative Procedures The patient was put on supine position. The operation field was disinfected and draped as usual. Under local anesthesia, the Port-A catheter was implanted on left side upper chest. Operators 吳毅暉 Assistants 陳佑群 手術日期：2007/10/20 23:36 摘要__ 手術科部: 外科部 套用罐頭: Chronic Subdural Hematoma Pre-operative Diagnosis Chronic subdural hematoma, right frontal-temporal-parietal Post-operative Diagnosis Chronic subdural hematoma, right frontal-temporal-parietal Operative Method trephination over right frontal-temporal Pathology nil Operative Findings A ruber drain was set for drainage. Dark-red sanguinous fluid was drained out with some blood clot over right frontal-temporal-parietal while opening the outer membrane. Operative Procedures The patient received ETGA and was put in supine position with head tile to left. A linear incision 3 cm was done over right temporal area and a burr hole was made. After proper hemostasis, dura tenting was done and nip incision into dura was performed. The outer membranewas then openedand hemolysis fluid gushed out. Aruber drain was inserted. N/S irrigation for blood clot and hematoma was done. Finally the rubber drain was fixed and deair was done. THe wound was closed in layer. Operators 郭夢菲 Assistants 陳睿生,顏君霖 手術日期：2007/10/22 16:17 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) Pre-operative Diagnosis Lumbar stenosis Post-operative Diagnosis Lumbar stenosis Operative Method Lower L3 and total L4&L5; laminectomy Pathology nil Operative Findings The thecal sac was tightly compressed by the hypertrophic ligament flavum from lower L3-L5 levels Operative Procedures Under ETGA, prone position, we made skin preparation and C-arm X-ray to localize the level of L3-L5. We made midline incision and deepen the wound to expose spinous process and lamia of L3-L5. Under microscopy, we made laminectomy on lower L3-L5 and removed lig. flavum. Then we check bleeder and hemostasis. Epidural CWV was set. THen we closed the wound in layers. Operators 杜永光 Assistants 郭律廷,姜秉均 手術日期：2007/10/23 11:32 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis T5 ~ T7 epidural metastatic lesion and T6 pathologic fracture Post-operative Diagnosis Ditto Operative Method Posterolateral approach for tumor excision(T6~T7) TPS, for fixation (T4T5T6) Pathology Pending Operative Findings 1. Epidural metastatic tumor mainly occupied at ventral side of T5~T7 spinal cord, which compressed the cord. The cord bulged posteriorly. 2. T4, T5 TPS: 5.0*35mm * 4 T8 TPS: 5.5*40mm * 2 Rod *2 Cross link *1 3. Left T6 root was clipped and divided for better exposure Operative Procedures 1. ETGA, prone position 2. Skin disinfection and drapping 3. Linear incision from T3~T8 level, and dissect along the mid-fascia 4. The paravertebral muscles was detached subperiosteally(T3~T8) 5. Screwed the pedicle and fixation at T4 T5 T8 bilaterally 6. Laminatectomy was then performed at T5~T7 level. 7. The lateral margin of laminae was removed further to expose the ventral side of metastatic lesion and remove it 8. Set one rod at both sides and set one cross-link 9. Set two epidural hemovac 10.Close the wound in layers Operators 陳敞牧 Assistants 蘇亦昌,林哲安 手術日期：2007/10/26 17:00 摘要__ 手術科部: 外科部 套用罐頭: ATYPICAL Pre-operative Diagnosis colon cancer with liver metastasis Post-operative Diagnosis colon cancer with liver metastasis Operative Method segmentectomy (S7) Pathology pending Operative Findings Two whitish lesions (3cm and 5cm in diameter respective) over right posterior lobe were noted and resected. Operative Procedures Under ETGA, the patient was placed in supine position with dis-infection performed. Benz incision was made first. After self-retractor (Kent) used and entering peritoneal cavity, two whitish-yellowish lesions over right posterior lobes were mentioned. Wedge resection was then performed with CUSA and bipolar used. After careful hemostasis and copious warm N/S irregation, one RD was inserted. The wound was then closed in layers. Operators 黃凱文 Assistants 楊雅雯,洪浩雲 手術日期：2007/10/28 09:04 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis esophageal cancer Post-operative Diagnosis ditto Operative Method port A implantation Pathology nil Operative Findings tip of Port-A is in the correct branch of SVC, confirmation by CXR Operative Procedures 1.Supine, disinfection and draping 2.local anesthesia 3.Identification of left subclavian vein by puncture method. 4.Insertion of Port-A catheter 5.Closure of wound in layers Operators 李元麒 Assistants 林孟暐 手術日期：2007/10/29 19:22 摘要__ 手術科部: 外科部 套用罐頭: AVM Pre-operative Diagnosis Left frontal AVM Post-operative Diagnosis ditto Operative Method AVM excision via Bicoronal incision Operative Findings One 6x4 cm AVM nidus at left frontal lobe with the feeding artery of left ACA that was embolized by pre-op TAE. The feeder became slight hard and dark in color. One 1x1.2 cm aneurysm was noted proximal on ipsilateral ACA. Many engorged cortical draining veins were noted after dura opening. No deep drainage was found. Operative Procedures Under ETGA, patient was put in supine position with head tilt to right and fixed with Mayfield skull clamp. Skin preparation was completed with shaving and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture,then covered with sterilized adhesive plastic sheet. Bicoronal incision was then made. Bilateral facial nerve preservation procedure was performed by dissecting the layer between temporalis fascia and muscle layer. Craniotomy window was made as 10x8 cm at left frontal area. After dural tenting, dural was incised by crusade fahion with the base left at midline. The nidus was approached via left frontal pole. The embolized feeding artery was exposed by dissection. By tracing the feeding artery, the nidus was isolated and devided via the interface of arachnoid membrane. The feeder was finally cauterized and devided. After the entire mass of the nidus had been dissected free, the drainage vein was occluded by hemoclips and divided. The blood oozing point from several laocations on the bare surface of the hematoma cavity were packed with surgicel for complete hemostasis. Dural was closed. A piece of pericranium was used for covering the defect of frontal sinus.After one CWV drain insertion, the bone graft was put back and the skin was closed in layers. Operators 杜永光 Assistants 黃詩浩,胡朝凱 手術日期：2007/10/30 14:46 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Ditto Operative Method Tracheostomy Pathology Nil Operative Findings Fr. 8 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with 2% xylocain to the subcutaneous layer. A longitudinal skin incision approximately 2 cm is made just 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and platysma muscle. The strap muscles are splitted longitudinnally and the pre-tracheal fascia is identified. The thyroid isthmus is also splitted. Tracheostomy is made at the level of 2ndring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheostomy tube inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tube is fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheostomy tube. At last, we check bleeding and dress the wound with Beta-iodine gauze. Operators 徐紹勛 Assistants 官振翔 手術日期：2007/11/01 11:36 摘要__ 手術科部: 泌尿部 套用罐頭: URS-SM Pre-operative Diagnosis Left ureteral stricture Post-operative Diagnosis Left ureteral stricture Operative Method Left URS Operative Findings Left lower ureteral stricture, severe Operative Procedures Under satisfactory intravenous general anesthesia with the patient in the lithotomy position, skin preparation was performed. A cystoscope was inserted into the bladder and a guidewire was then introduced into the ureteral orifice. A 6 Fr. ureteroscope was introduced into the ureter. A Fr.7-24cm DBJ catheter was inserted. A 20 Fr. Foley catheter was placed in the urinary bladder. The patient tolerated the operation well and was sent to the recovery room in stable condition. Operators 黃國皓 Assistants 姜宜妮 手術日期：2007/11/02 13:11 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis colon cancer Post-operative Diagnosis colon cancer Operative Method port-A implantation, cut down Pathology nil Operative Findings 1.the tip of port-A catheter at the junction of SVC and right antrium 2.back flow:smooth Operative Procedures 1.IVGA 2.skin incision at left anterior chest wall 3.identify the cephalic vein and insert Port-A catheter 4.check the position of port-A catheter position 5.make a pocket for port-A 6.wound closure in layers Operators 張金堅 Assistants 林明賢 手術日期：2007/11/03 13:37 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Colon ca with liver meta, s/p op Post-operative Diagnosis Ditto Operative Method Port-A imlantation Pathology Pending Operative Findings The tip at SVC Operative Procedures 1. Supine 2. Disinfection and draped 3. Left chest incision 4. Identify cephalic vein 5. Convert to punctuate method due to small cephalic vein 6. Check position with portable X ray 7. Close wound in layers Operators 黃凱文 Assistants 吳孟哲 手術日期：2007/11/05 17:21 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Bilateral lung tumors, RUL and LUL, rule out HCC metastasis Post-operative Diagnosis Ditto Operative Method Bilateral VATS for LUL and RUL wedge resection Pathology Pending Operative Findings 1.A1.2cm soft hypercellular necrotic tumor at apex of LUL 2.A0.7cm soft hypercellular necrotic tumor at apex of RUL 3.Multiple bullous change at apex of RUL Operative Procedures 1.DLETGA, right decubitus 2.Skin disinfection and draping 3.VATS ports: 7th ICS-MAL, 7th ICS-PAL, 5th ICS-AAL 4.Create rubber tunnel membrane with finger parts of gloves to cover the port wounds 5.LUL wedge resection with Endo-GIA 60*II+45*I 6.Checkair leak and bleeding 7.Fr.24 chest tube*I 8.Close wound in layers 9.Shift to left decubitus 10.VATS ports: 8th ICS-MAL, 7th ICS-PAL, 5th ICS-AAL 11.Create rubber tunnel membrane with finger parts of gloves to cover the port wounds 12.RUL wedge resection with Endo-GIA 60*III+45*I 13.Check air leak and bleeding 14.Fr.24 chest tube*I 15.Close wound in layers Operators 李元麒 Assistants 張金池,陳衛洲,姜志勇 手術日期：2007/11/06 19:15 摘要__ 手術科部: 泌尿部 套用罐頭: herniorrhaphy, inguinal Pre-operative Diagnosis Left side inguinal hernia Post-operative Diagnosis Left side inguinal hernia Operative Method Left herniorrhaphy and posterior repair with Mesh Operative Findings 1. Sac from internal inguinal ring, indirect sac 2. Posterior wall weakness. Operative Procedures 1. Under satisfactory spinal anesthesia with the patient in supine position. 2. Prepping and draping was performed in the usual sterile fashion. 3. An inguinal oblique incision was made in the left inguinal area. 4. The wound was deepened through layers into inguinal canal. 5. The spermatic cord was mobilized, and an indirect sac was noted. 6. The hernia sac was isolated from spermatic cord. 7. Ligation and transection of the hernia sac near the the internal inguinal ring was performed. 8. Posterior wall repair with Mesh, and interrupted 1-O nylon was performed to approximate the conjoin ligment, transverse abdominal fascia and the shelfing portion of the inguinal ligament. 9. After adequate hemostasis was obtained, the wound was closed in layers with 3-O silk on the external oblique fascia and 3-O chromic on the Scarpa's fascia. Skin was closed with interrupted 3-O nylon mattress stitches. 10. The patient tolerated the procedure very well, and was sent to the recoveryroom in satisfactory condition. The sponge count was correct and blood loss was minimal. Operators 余宏政 Assistants 沈恆立,柯智群 手術日期：2007/11/10 21:49 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Left PCA infarction + left chronic subdural effusion Post-operative Diagnosis ditto Operative Method Left craniectomy decompression Operative Findings 1.Pre-OP GCS: E1M2Vt Pupil: 5/5 mm without light reflex Post-OP pupil: R't/L't: 5/3 mm without light reflex 2.No pulsatile brain 3.Black motor oil like chronic subdural effusion around 1 cm in thick over left F-T-P area 4.Frontal lobe contusion Operative Procedures Under ETGA, patient was put in supine position with head tilt to right. After well antisepsis and drapping procedure, left trauma flap skin incision was performed from pre-auricular area upward to 1 cm above ear then turn backward and pass the curvature of skull, followed by another turn upward to 1 cm away from midline and went anterior to 1 cm behind hair line and then crossed the midline with a curvature incision. The subcutaneous soft tissue was then opened by blunt dissection. Periosteum was then incised by elctrocauterization and dissected to open. After 6 burr holes drilled, craniectomy was performed with Midas air drill. Dural tenting was then performed and was followed with curvature dura incision 1 cm away from edge. Fascia flap was utilized tore-union with the dura during dura opening with 4-0 prolene. Chronic subdural effusion was removed. After 2 CWV drains and ICP monitor insertion, wound was closed in layers. Operators 王國川 Assistants 胡朝凱 手術日期：2007/11/11 13:20 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT Pre-operative Diagnosis Convexity meningioma, right fronto-temporal region Post-operative Diagnosis Ditto Operative Method Simpson grade I tumor excision via right pterional craniotomy Pathology Pending Operative Findings A 4cm in diameter yellowish-whitish, elastic firm, well-demarcated, moderate vascularity, dural basal meningioma occupied at the right fronto-parietal regioncausing compression to the frontal and temporal lobe. The tumor grew through the dural and the dura was thickening and the dura vessels engorged very much. Some pial vessels from frontal surface grew into the tumor. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head tilted left and head fixed by Mayfield skull clamp. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcoholtincture, then covered with sterilized adhesive plastic sheet. 4. Incision: Curvillinear skin incision at right fronto-temporal region was made. Raney clips were applied to the scalp edge for temporary hemostasis. The wound was opened in layers.Facial nerve preservation was performed. 5. Craniotomy window:13x9 cm, fronto-temporal, created by making four burr holes then cut by power saw. 6. Dural tenting: by 2/0 silk, 2 cm in interval, distributed along the edge of skull window. 7.Dural incision: curvilinear along the edge of skull window. 8. The tumor was resected by bipolar forceps along its vague discernible junction with normal white mater as en-block of 4 x 6 cm size(Simpson grade I tumor excision). 9. Hemostasis: The hemostasis during the resection ofthe tumor was obtained satisfactorily by bipolar coagulator and suction on the patties packing on the bleeders. The blood oozing point from several locationsonthe bare surface after lobectomy were packed with Surgicel for complete hemostasis. Finally, the cavity created after tumor excision was irrigated with NS several times and it was perfectly watery clear before the dural closure. 10.Duroplasty was performed with Gortex artificial graft andthe fascia of temporalis muscle. 11.Closure of skull window: the skull plate was placed back to craniotomy window and fixed by four miniplates. The dura was tented to the center of the skull plate by a 2-0 stitches. The covering muscle was closed by interrupted 2-0 silk stitches. 12.Scalp closure: hemostasis was done with bipolar coagulator touching on the sucker tip. Galea suture was performed (the subcutaneous layer) by continuous suture with 3-0 Dexon and skin by Appose staples. 13.Drain: one CWV drain was placed at epidural space. 14.Blood transfusion:4U pRBC 15.Course of the surgery: smooth Operators 曾漢民 Assistants 黃詩浩,李振豪 手術日期：2007/11/14 20:52 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Lumbar spondylolisthesis, L3~4 Post-operative Diagnosis ditto Operative Method TPS with cage fusion, posteriorly Operative Findings 1.Spondylosis (+), hypertrophic facet joint 2.Screw: 45x2, 40x2, rod: 5 3.Thecal sac expanded well after surgery Operative Procedures 1.ETGA, prone 2.Pre-op localization with C-arm 3.Mid-line incision 4.Dissect muscle layers and pushed away 5.Dissect facet joint and then expose transverse process 6.Partial removal of facet joint and made pedicle tunnel 7.After C-arm confirm, TPSwas locked into the tunnel 8.Laminectomy and tehn discectomy of L3~4 disc 9.Insert artificial disc 10.Close wound in layers after one hemovac insertion Operators 賴達明 Assistants 郭律廷,胡朝凱 手術日期：2007/11/14 15:45 摘要__ 手術科部: 外科部 套用罐頭: Cranioplasty Pre-operative Diagnosis Traumatic ICH status post left craniectomy Post-operative Diagnosis Ditto Operative Method Cranioplasty Pathology Nil Operative Findings Mild brain swelling. Wire mesh with bone cement was used. Operative Procedures 1. ETGA, supine with head turning to the right 2. Skin shaved, scrubbed and disinfected with alcohol B-I, then draped 3. Scalp incision along previous OP scar and dissected dura from scalp 4. Create artificial skull plate with wire mesh and bone cement5. Tent the dura, and fix the skull plate with miniplates 6. Insert one CWV drain at subgaleal space, and then close the wound in layers Operators 王國川 Assistants 李建勳,R1黃哲南 手術日期：2007/11/15 18:14 摘要__ 手術科部: 骨科部 套用罐頭: Proximal humerus fracture-plating Pre-operative Diagnosis osteogenic imperfecta; right humeral shaft fracture, s/p ORIF x 4 times Post-operative Diagnosis ditto Operative Method removal of implant Pathology nil Operative Findings 1. implant in situ 2. bony union Operative Procedures 1. ETGA, left decubitus position 2. Skin infected and draped 3. Scar incision 4. Dissect soft tissue to expose wire 5. Cut wire node 6. Hemostasis and irrigation 7. Set hemovac x 1 8. Close wound in layers Operators 林晉 Assistants 吳鴻康,陳勇璋 手術日期：2007/11/19 15:19 摘要__ 手術科部: 外科部 套用罐頭: Lobectomy Pre-operative Diagnosis Lung tumor, LLL Post-operative Diagnosis Bronchogenic carcinoma Operative Method VATS LLL lobectomy + LN dissection Pathology Pending Operative Findings 1.One small papable nodule (1.1cm in diameter) was noted at LLL. Frozen biopsy showed BCA. 2.Several enlarged LN at gilum and paraaortic region Operative Procedures 1.DLETGA, right debuticus position 2.Skin disinfection and drapping 3.VATS setting: 7th ICS (MAL+PAL), 4th ICS AAL 4.Identify LLL and perform wedge resection with endoGIA45 for papable nodule in LLL 5.Intraoperative frozen showed BCA 6.After dividingand transection of lung vessels, LLL was removed with endoGIA45. 7.Dissect left hilum and paraaortic LNs 8.Set one 28Fr chest tube at left chest cavity 9.Hemostasis and close wound in layers Operators 郭順文 Assistants 張金池,蔡東明 林佩縈 手術日期：2007/11/20 18:34 摘要__ 手術科部: 外科部 套用罐頭: Lobectomy Pre-operative Diagnosis Lung tumor Post-operative Diagnosis Lung cancer, adenocarcinoma Operative Method VATS lobectomy, LUL + LN dissection Pathology Frozen: adenocarcinoma Operative Findings 1.Veseral pleural retraction at LUL 2.Intra-operative frozen biopsy showed adenocarcinoma, 2cm in diameter in LUL Operative Procedures 1.DLETGA, right debuticus 2.Skin disinfection and drapping 3.Set VATS working prots*3 4.After dissection of peural adhesion, LUL wedge resection was dissected and send for frozen 5.Frozen showed adenocarcinoma 6.Remove LUL with endoGIA 7.NOrmal saline irrigation and hemostasis with surgicel 8.Set one 28Fr chest tube at left chest 9.CLose wound in layers Operators 陳晉興 Assistants 張金池,蔡東明,張碩得 手術日期：2007/11/28 09:00 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT Pre-operative Diagnosis Pectroclival meningioma, left, recurrent Post-operative Diagnosis Ditto Operative Method Partial tumor excision via left retroauricular, retrosigmoid approach Pathology Pending Operative Findings The tumor was whitish, soft, fragile, one with some necrotic tissue inside. It was noted to be firmly attached to the cerebellum, pons, and was also occupied the left CP angle fully. The VII, VIII cranial nerves were encased in the tumor, but we were failed to harvest these two nerves. We also drilled into the posterior pectrous region, and the presigmoid space was also filled with tumor mass, but we didn't remove it due to highly risk. Operative Procedures After ETGA, the patient was under supine position with left side slight elevation. The head was right tilt and fixed with Mayfield. The right retrosigmoid area was well-disinfected, and the OP area was covered with OP site. Curvillicular incision intothe scalp over right retrosigmoid area via previous wound, and the length was about 10cm. The previous craniotomy window was extended till the sigmoid and transverse sinus were noted. We also performed the posterior pectroectomy to extend the presigmoidspace. Curvillinear incision into the dura over the retrosigmoid space. A huge whitish, solid, fragile tumor occupied at the right C-P angle. The cerebellum and pons were compressed by the tumor. Central debulking was done gradually, and the CN VIII and the CN VII encased in the tumor was unable to be identified even use facial EP monitor. After deompression of the CP angle, we stopped tumor removal due to highly risk. Proper hemostasis was done, and the dura was covered with Durafoam after deair. The small skull graft was covered back and fixation with miniplate. The scalp was finally closed in layers. Operators 杜永光 Assistants 郭律廷,陳睿生 手術日期：2007/11/28 17:50 摘要__ 手術科部: 外科部 套用罐頭: Port-A Pre-operative Diagnosis Lung cancer Post-operative Diagnosis Ditto Operative Method Port A insertion Pathology Nil Operative Findings Port A catheter was insert over the right IJV. Operative Procedures Under LA and supine position, the skin was prepared. Right IJV cut down and right front chest subcutaneous pocked were performed and te port A catheter was insert over the right IJV smoothly , after jhemostasis, the wound was closed in layers. Operators 吳毅暉 Assistants 李千慧 手術日期：2007/12/05 18:08 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) Pre-operative Diagnosis Lumbar stenosis(L3-5), grade I spondylolithesis Post-operative Diagnosis Lumbar stenosis(L3-5), grade I spondylolithesis Operative Method L3-L5 laminectomy and autology bone fusion. Operative Findings Severe facet joint hypertrophy and ligamnetum flavum hypertrophy. The thecal sac was decompressed after this procedure. Dural tear was repaired. Mild bleeding tendency. Operative Procedures ETGA prone C-arm localization. Linear incision. Expose L3-5 lamina. L3-5 laminectomy. Posteriolateral fusion with autologous bone graft. Placement of hemovac 1/8 x2. Wound closed in layers. Operators 曾勝弘 Assistants 黃博浩,繆璇 手術日期：2007/12/05 12:16 摘要__ 手術科部: 外科部 套用罐頭: perianal abscess Pre-operative Diagnosis Perianal abscess Post-operative Diagnosis Perianal abscess Operative Method Incision and drainage Pathology Nil Operative Findings No fistula found Operative Procedures 1.Under spinal anesthesia, trendelenburg position 2.Disinfect and drape 3.Incision and drainage 4.Put in iodoform gauze Operators 黃凱文 Assistants 張得一 手術日期：2007/12/06 09:40 摘要__ 手術科部: 泌尿部 套用罐頭: TRUS-P-biopsy Pre-operative Diagnosis probable prostate cancer Post-operative Diagnosis probable prostate cancer Operative Method TRUS-P biopsy Pathology pending Operative Findings 1. Prostate size about 23 gm 2. 12 cores of prostate tissue removed under TRUS guide Operative Procedures Under satisfactory intravenous general anesthesia with the patient in a decubitus position, prepping and drapping were performed in the usual sterile method. 12 cores of biopsy were taken at the bilateral peripheral and paramedial areas of his prostate under a transrectal ultrasonography assistance. Thereafter, local compression with operator’s fingers was done for 5 minutes. The patient tolerated the operation well and was sent to the recovery room in a stable condition. Operators 陳　淳 Assistants 何承勳,陳弘生 手術日期：2007/12/07 08:00 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Recurrent pituitary macroadenoma Post-operative Diagnosis Ditto Operative Method Transnasal transsphenoid tumor excision Pathology Pending Operative Findings The tumor mass was mainly in the sphenoid sinus. It was a whitish solid one with severe peripheral adhesion. The dura wasn't noted inside the operation. No obvious CSF leakage was found. Operative Procedures After ETGA, the patient was under supine postion with head mild left tilt. Well-disinfected over bilateral nasal cavity was done and then we incised into the mucosal septum via right nasal cavity. After hemostasis, the sphenoid sinus was opened, the tumormass was mainly in the sphenoid sinus. It was a whitish solid one with severe peripheral adhesion. The dura wasn't noted inside the operation. No obvious CSF leakage was found. After recheck of the tumor, hemostasis was done over the sellar cavity and the mucosa was covered back with gelfoam. The vomer bone graft was also covered back, and bilateral nasal cavities were filled with mirocels. Operators 杜永光 Assistants 黃詩浩,陳睿生 手術日期：2007/12/12 19:15 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Mediastenal mass, r/o lymphoma Post-operative Diagnosis Ditto Operative Method Port A implantation Pathology none Operative Findings 1.Good flow of port A 2.Tip of port A : SVC and RA junction Operative Procedures 1.LA, supine, skin disinfected 2.Puncture of left subclavian vein, insert port A with Seldinger's maneuver 3.Fix the port A, check location of port A with CXR, hemostasis, close the wound in layers Operators 李元麒 Assistants 謝永 手術日期：2007/12/14 09:07 摘要__ 手術科部: 外科部 套用罐頭: Hernia Pre-operative Diagnosis 1.Indirect inguinal hernia, bilateral 2.Tongue tie Post-operative Diagnosis ditto Operative Method 1.Herniorrhaphy and high ligation 2. Z-plasty Pathology pending Operative Findings 1.Bilateral indirect type inguinal hernia, no content in herniac sac 2.Tongue tie Operative Procedures 1. Under endotracheal general anesthesia with the patient in supine position, prepping with Povidone iodine and draping was performed in the usual sterile fashion. 2. An transverse incision along skin crease was made in the bilateral inguinal area. Incision was deepened through layers. The scarpa fascia was opened. The external oblique fascia was opened from external ring. 3. Spermatic cord was looped. Dissection was performed on the antero-medial aspect of the spermatic cord. An indirect herniac sacwas noted and mobilized. The sac was opened and extended into distal and proximal ends, the latter was then high-ligated.. Adequate hemostasis was obtained. 4. Closure was proceeded with interrupted catgut on the scarpa fascia and the skin was closed with catgut subcuticularly. 5.Z-plasty over inferior tongue 6.Suture the wound by catgut Operators 許文明 Assistants 官振翔,蔡明憲 吳正一 洪千惠 手術日期：2007/12/17 09:00 摘要__ 手術科部: 外科部 套用罐頭: Microvascular Decompression Pre-operative Diagnosis Left trigeminal neuralgia Post-operative Diagnosis Ditto Operative Method Microvascular decompression Pathology Nil Operative Findings The SCA main trunk ran nearby the CN V and a loop branch was noted to compressed the CN V-III in the deep side. We departed these two from the nerve entry zone, and the space between them was filled with Teflon fiber. A varient vein was noted over superficial area. Operative Procedures After ETGA, the patient was under supine position. The head was right turn and fixed with Mayfield. The left retrosigmoid area was well-disinfected, and the OP area was covered with OP site. Curvillicular incision into the scalp over right retroauricular area. An ovoid craniotomy window was made and extended inferiorly. Curvillinear incision into the dura over the retrosigmoid space and then we expanded into inverse K shape. We extended into the foramen Magnum and CSF was drined for deompression. Thenthe AICA, CN VII and VIII were harvested. A varient vein was noted over superficial area and the superior petrosal vein was ligated. We traced upward and the CN V and SCA were noted below the tentorium. The SCA main trunk ran nearby the CN V and a loop branch was noted to compressed the CN V-III in the deep side. We departed these two from the nerve entry zone, and the space between them was filled with Teflon fiber. Then proper hemostasis was done, and the dura was closed tightly with fascia by 4-o Prolene. The muscle layer and the scalp were finally closed in layers. Operators 杜永光 Assistants 黃詩浩,陳睿生 手術日期：2007/12/17 14:26 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis GE reflux Post-operative Diagnosis ditto Operative Method Laparoscopic gastrostomy Pathology nil Operative Findings 1. Mild amount of ascites, clear 2. Dilated colon Operative Procedures 1. GA with tracheostomy, supine 2. Disinfect and drape as usual 3. Set camera port at periumbilical area by mini-laparotomy 4. Gastrostomy 5. Wound closure Operators 許文明 Assistants 吳正一 曾峰毅 手術日期：2007/12/24 13:00 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) Pre-operative Diagnosis Right L3/4 pars fracture, L3-5 lumbar stenosis, L3-5 left lateral recess syndrome Post-operative Diagnosis Ditto Operative Method L2 laminectomy + L3-5 posterior fusion with TPS Pathology Nil Operative Findings The screws over L4,5 were preserved and two new screws (6.7x45mm) were set over L3. Bilateral 6.0mm in diameter rods were set over L3-5 with "Hua-An" brand. L3/4 pars fracture was noted over right side with spondylolithesis. Severe adhesive granulation wasnoted over L3-5 thecal sac. Operative Procedures After ETGA, the patient was under prone position. We incised into the orevious wound. The L2 lamina was harvested and total laminectomy was done. The thecal sac was noted and we dissected the plane between the granulation tissue and the thecal sac from L3-L5. The previous TPS was harvested amd we removed the rods. New TPS with 6.7x45mm screwss were set over L3. The new 6.0mm rods were set. Then hemostasis, and twp 1/8 hemovac were set. The wound was closed in layers. Operators 杜永光,賴達明 Assistants 黃詩浩,陳睿生 手術日期：2007/12/24 00:00 摘要__ 手術科部: 骨科部 套用罐頭: Total knee replacement-Medial, standard Pre-operative Diagnosis osteoarthritis, left knee Post-operative Diagnosis same Operative Method total knee replacement with Zimmer prostheses Operative Findings 1. Marginal osteophyte formation, 2. joint space narrowing, especially in the medial compartment, resulting in varus knee deformity 3. cartilage wearing with subchondral bone exposure 4. Diffuse synovitis 4. Zimmer prostheses,left knee (femoral: E ,tibial: 4, insert: 14 mm, patellar: 26 mm) Operative Procedures 1. Under spinal anesthesia, the patient was placed in supine position. The operative field was scrubbed, disinfected and draped as usual. After exsanguination, the pneumatic tourniquet was inflated to 350mmHg. A longitudinal incision was made in the midline of the anterior aspect of the knee joint. Medial parapatellar arthrotomy was done. The patella was reflected laterally, and the knee was flexed. The synovium, lateral and medial menisci, ACL and PCL were excised. 2. A hole parallel to the femoral shaft and approximately 1 cm anterior to the origin of the PCL was drilled in the center of the patellar sulcus. The IM femoral sizing guide was inserted into the hole until it contacted the distal femur, with its anterior boom contacting anterior cortex andboth feet resting on the cartilage of the posterior condyles. The medial and lateral reference holes for 3-degree external rotation were drilled. The femoral AP sizing guide was then replaced by the IM alignment guide, which was placed flush against the medial femoral condyle. Two pins were inserted into the reference holes to achieve 3-degree femoral component external rotation. 3. The anterior femoral cutting guide was attached to the IM alignment guide, with its boom contacting the anterior cortex just distal to the anterior condyles. The anterior femoral cut was made, and the anterior femoral cutting guide was removed. 4. The distal femoral cutting guide was attached to the IM alignment guide. The pivot pin was dropped into the pivot hole in the IMalignment guide. The holding pins were placed to further secure the guide to the femur. The IM alignment guide was then removed. The distal cut was made completely flat. 5. The AP dimension of the femur was determined by placing the femoral AP measurement guide flat onto the smoothly cut distal femur, with its feet resting on the cartilage of the posterior condyles and the gauge resting on the anterior femoral surface. With its top ledge set on the cut surface of the anterior femur, the correct-size femoral finishing guide was centered mediolaterally. Two spring pins were inserted, followed by placement of two holding pegs. The final femoral cuts were then made in the following sequence: posterior condyles, posterior chamfers, anterior condyles, anterior chamfers, trochlear recess. The two slots on the anterior face of the guide were used to make reference marks of the sides of the trochlear recess. The guide was then removed, and the 5-in-1 femoral finish guide was then placed onto the femur and secured with two pins. The sides of the intercondylar notch were cut. 6. The knee was placed in maximal flexion and the tibia was levered anteriorly using the PCL retractor. A Hohmann retractor was used to retract the patella laterally. The extramedullary tibial cutting guide was positioned with its foot pointing to the center of the ankle. The body of the guide was then adjusted to parallel the anterior tibial shaft, while the center of the guide lied just medial to the mid-portion of the tibial tubercle. The guide was then secured with pins. A10 mm tibial depth resection gauge was placed into the cutting slot, and the cutting platform was adjusted until the arm of the gauge rested on the cartilage of the lateral tibial condyle. A tibial resection gauge wasthen used to check the location of the cut on the posterior tibia. A hanging extramedullary rod was then placed after removal of the extramedullary guide to confirm the longitudinal axis of the prosthetic tibial component. The cutting platform was then secured with fixation pins. The tibial cut was then performed. 7. A provisional tibial sizing plate and a femoral provisional component were selected. A trial reduction was performed. The knee was flexed and extended to check the range of motion and ligamentous stability. 8. A modular handle was attached to the selected tibial sizing plate. With the handle aligned with the anterior aspect of the tibia, the sizing plate was rotated so the handle pointed at the tibial tubercle. The alignment rod was used to double check varus/valgus alignment. The plate was then pinned in place with two holding pins. With the stem tibial drill guide in place, the tibia was drilled until the engraved line on the drill was in line with the top of the drill sleeve. The broachwas impacted to the proper depth indicated by the etched groove on the impactor aligning with the impactor handle. The broach impactor assembly and the tibial sizing plate were then removed. 9. The caliper was used to measure the thickness of patella.The appropriate size patellar reamer surfacing guide was inserted into the patella reamer clamp. The clamp was applied at a 90 degree angle to the longitudinal axis, with the surfacing guide encompassing the articulating surface of the patella. The clampwing was turned to the proper indication for the correct amount of bone that was to remain after reaming. The patella was reamed until the step on the reamed bottomed out on the clamp wing. The patellar drill guide was placed over the patella with the handle on the medial side and perpendicular to the tendon. An expander was used to finish the holes. 10. The prosthetic components were cemented into place in the order of patella, femur, and tibia. The articular surface inserter was applied to aid in insertion of the articular liner. 11. After meticulous hemostasis and normal saline irrigation, the wound was closed in layers. Operators 劉華昌 Assistants 余曉筌,吳凱文,林蔚鑫 手術日期：2007/12/28 13:12 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Arachnoid cyst, quadrigeminal and convexity, s/p craniotomy, CP thenVP shunt with cyst recurrence Post-operative Diagnosis Arachnoid cyst, quadrigeminal and convexity, s/p craniotomy, CP thenVP shunt with cyst recurrence Operative Method 1.Fenestration of the arachnoid cyst. 2.conversion of VP shunt into CP shunt Pathology nil. Operative Findings There is a huge arachnoid cyst extending from the quadrigeminal cistern to left temporal region, both in the supra- and infra-tentorial space. There was septation in between the cyst. A previous fenetration at the septum medial to the tentorium at posterior-superior part of the cyst was seen. Opening pressure 8 cmH2O and above. Intra-cyst catheter: 5.5cm length , without pressure setting Operative Procedures Under ETGA , the patient was put in supine position and head rotated to right in 90 degree. We made a linear skin incision over left temporal area and created a burr hole. After dura tenting, a ventricular needle was used to puncture through the left temporal lobe. The cortex was only 1 cm in thickness. Gradual dilatation of the puncture hole with various sizes of nelaton tubes then the disposable peel-away sheath was inserted instead. The neuroendoscope was inserted to inspect first and identified the cystic membrane at parasellar cistern. A fenestration about 4 mm was then done. The left oculomotor nerve and ICA could be identified and preserved. The scope was reorientaed toward the medio-posterior septum and another fenestration was done . After that aprevious fenestration hole was seen posterior to it. It was still patent. The previous VP shunt was disconnected between the ventricular catheter and the reservoir. The reservoir and antisiphon device was removed. The peritoneal catheter was left and itwas proved to be patent with saline irrigation. We implanted a new shunt into the cyst for 5.5 cm, pointing anteriorly and connecting to the peritoneal catheter by a straight cinnector. All Three wounds were closed by 3-0 vicryl and 4-0 nylon. Operators 郭夢菲 Assistants 郭律廷,李佳穎 手術日期：2007/12/31 11:30 摘要__ 手術科部: 骨科部 套用罐頭: Olecranon fracture-TBW Pre-operative Diagnosis Left olecranon fracture Post-operative Diagnosis Left olecranon fracture Operative Method ORIF with Leibinger plate and screws Pathology nil Operative Findings Left olecranon fracture, displaced Operative Procedures 1. ETGA, supine position, air torniquet 250mmHg 2. Posterior longitudinal skin incision over L't elbow 3. ORIF with Leibinger plate and screws 3.0mm screw x1 2.7mm screw x1 6-hole plate x1 2.3mm screw x5 4. Close the wound by layers 5.Apply long arm splint and sling Operators 張志豪 Assistants 藍宗裕 手術日期：2008/01/02 20:00 摘要__ 手術科部: 牙科部 套用罐頭: cellulitis--I & D Pre-operative Diagnosis L't face cellulitis, NPC s/p CCRT, R/O tumor recurrence Post-operative Diagnosis L't face cellulitis, NPC s/p CCRT, R/O tumor recurrence, s/p op Operative Method Extraoral I&D; (submandibular space - pterygomandibular space; preauricular- infratemporal space) + #38 complicated extraction Pathology Pending Operative Findings 1.#38 mobility GII and sequestrum was noted over retromolar area. 2.Buccal space and parapharyngeal space aspiration (-) Operative Procedures 1. Patient was put in a supine position. 2. Under GA, disinfection and draping were done as usual. 3. Incision was made at L't submandibular about 4cm in length. 4. Dissect involved space with pean and irrigate with aqua-s-iodine and N/S. 5. Put drainage from submandibular space to pterygomandibular space; from preauricular to infratemporal space and then fixed with 3-0 Nylon. 6. #38 complicated extraction was done and irrigate with aqua-s-iodine and N/S over the wound. 7. The patient tolerated thewhole procedure well. Recorded by G1周佳璇 Operators 章浩宏 Assistants 林倩伶周佳璇蘇瑜涵 手術日期：2008/01/07 08:30 摘要__ 手術科部: 外科部 套用罐頭: ATYPICAL Pre-operative Diagnosis 1.HCC, S6, s/p microwave cogulation, recurrence, s/p TAE 2. Liver cirrhosis, 3.GB stones Post-operative Diagnosis Ditto Operative Method Atypical hepatic lobectomy, S6 + cholecystectomy Pathology S6 Operative Findings 1.Liver cirrhosis, moderate 2. No ascites 3.MOderate adhesion around GB 4.2 hard, 1x1 cm stones, in GB 5.A 1x1 cm, yellowish, fibrotic ara, over surface of S6 Operative Procedures 1.ETGA, supine, skin disinfected. 2.Right subcoastal incision 3.MOblize right hepatic lobe by dissection of right coronary ligament and falciform ligament 4.Cholecystectomy 5.Echo for localization of the tumor 6.Atypical lobectomy with CUSA 7.Checkbleeding, bile leak, hsmostasis, set 2 x Rubber drains, 1 at right subhepatic space, 1 at right subphrenic space, wound closure in layers Operators 李伯皇 Assistants 黃彥鈞,謝永,鄧庶杭 手術日期：2008/01/07 16:48 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Left petroclival meningioma, recurrent Post-operative Diagnosis ditto Operative Method Pterion approach, Simpson grade IV tumor excision for optic nerve decompression Operative Findings 1.Adhesion was noted between skull bone and dura, also between dura and brain surface. 2.A whitish, elastic to firm tumor was found beneath optic nerves extended to sphenoid ridge and clival area that encased the cavernous sinus and pituitary stalk. 3.The cavernous sinus and pituitary stalk were intact 4.The optic nerves were free after decompression Operative Procedures Under ETGA, patient was put in supine position with head tilt to right and fixed with Mayfield skull clamp. The incision was made via previous wound fron pre-auricular area to midline. After dissection to expose previous burr holes, craniotomy was made asa 9x7 cm bone window. Curvillinear dura incision was performed. Frontal lobe was gently retracted to exposed optic nerve and right ICA. The lamina terminalis was opened a small hole to drain CSF. so that the brain became slack. The tumor was identified by slightly pushing the optic nerves, ICA away and then excised by CUSA and tumor forceps. The optic nerves were free from tumor after decompression. Then, the retactor was shift to temporal area to exposed the cavernous sinus and left oculomotor nerve. Tumor here was then debulked. The retractor shift to temporal tip and the tumor beneath and clival area was excised. Hemostasis was performed with surgicel. The dura was closed. And the bone graft was put back and fixed with miniplate. The skin was closedin layers after one CWV drain insertion. Operators 杜永光 Assistants 郭律廷,胡朝凱 手術日期：2008/01/07 08:50 摘要__ 手術科部: 骨科部 套用罐頭: Total knee replacement-Medial, standard Pre-operative Diagnosis Post-traumatic osteoarthritis, right knee Post-operative Diagnosis Ditto Operative Method TKR, right knee with Zimmer prosthesis Operative Findings 1.Right knee joint contracture with limited ROM 0~90 degrees 2.Malunion of previous tibial plateau 3.Chondral erosion with subcondral bone expose 4.Narrowing joint space 5.Numberous fibrosis tissue in proximal tibia Operative Procedures 1.SA with epidural anesthesia, supine, skin disinfection, draping, On pneumotornique 2.Skin incision along previous operation scar with medial parapatellar approach 3.Dissect to knee joint cavity, saw off patellar insertion site with bone 4.Perform TKRby steps with Femur:C#, Tibia:2# Insert:12mm, Patella:26mm 5.Insert autogenic bone graft between patellar tendon and bone and internal fixation with two 16# wires 6.Normal saline irrigation, set up one 1/8# hemovac 7.Close the wound in layers Operators 王至弘 Assistants 陳致宇,黃興耀 手術日期：2008/01/09 12:30 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Left inguinal hernia, indirect Post-operative Diagnosis Ditto Operative Method Left herniorrhaphy + Bassini procedure Pathology Hernia sac Operative Findings 1.A 3x3 cm hernia sac, with severe adhesion around spermatic cord was noted over left inguinal area. 2.No content in the sac. Operative Procedures 1.SA, supine, skin disinfected. 2.Left inguinal incision 3.Incise external oblique fascia, moblize hernia sac from spermatic cord, high-ligation of the sac 4.Perform Bassini's procedure by approximating inguinal ligament and inferior margin of internaloblique muscle with 1-0 nylon sutures 5.Hemostasis, close the wound in layers. Operators 林明燦,楊卿堯 Assistants 陳賢典,謝永,朱建銘 手術日期：2008/01/10 08:00 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Esophageal CA s/p CCRT Post-operative Diagnosis Esophageal CA s/p CCRT Operative Method VATS subtotal esophagectomy with LN dissection, Retrosternal gastric tube reconstruction, cervial esophagogastrostomy, jejunostomy Pathology PENDING Operative Findings 1. Fibrotic, 2.0cm segmental stricture with irreular surface,and severe adhesion of upper third esophagus, thicken mediastina pleura 2. Firm, enlarged Gr 105, 107 LNS 3. A 2 cm upper third, esophageal tumor with luminal stricture 4. Cervical esophagogastostomy with all hand suture Operative Procedures 1. DLETGA, left decubitus 2. Disinfection and drap 3. Right VATS: working ports 7th ICS PAL, 5th ICS AAL 8th ICS MAL camera port 7th ICS AAL 4. Open pleura, dissect inferior pulmonary ligament 5. Loop esophagus,divide withEndoGIA at lower third 6. Dissect esophagus upward 7. Dissect Gr 105,106,107 LNS 8. Insert two 24 Fr. chest tube 9. Close the chest wound, shift to supine 10.Redrap, midlaparotomy 11.Dissect gastric tube with Ligsure 12. Cervical incison, dissectesophagus 13. Retrosternal gastric tube bypass, manubricumosteotomy 14. Cervical esophagogastrostomy with all hand suture 15. Irrigation, insert two penrose drains, close the wound 16. Insert 2 rubber drains(left subphrenic, right subhepatic , mediastinal chest tube ) 17. Jejunostomy 18. Close the wound in layers Operators 李元麒 Assistants 張金池,陳衛洲,方耀德 手術日期：2008/01/12 10:05 摘要__ 手術科部: 婦產部 套用罐頭: LAVH Pre-operative Diagnosis Myoma uteri Post-operative Diagnosis Myoma uteri Operative Method Laparoscopic assisted vaginal hysterectomy+bilateral salpingo-oophorectomy Pathology pending Operative Findings 1. Uterus: Avfl , 7x7x6 cm , one 5x5x6cm intramural myoma at posterior wall 2. Adnexae: atrophic 3. Cul-de-sac: free 4. Total weight of uterus: 205gm EBL:minimal; BT: nil; Cx: nil. Operative Procedures 1. Put the patient on lithotomy position and vaginal douching. 2. Skin disinfection and draping 3. Insert uterine elevator and on Foley 4. Make a 1cm skin incision below the umbilicus 5. Insert Varess needle and make pneumoperitoneum 6. Insert 10 mmtrocar and laparoscopy 7. Insert 2nd (10mm) and 3rd (5mm) trocar under laparoscopic inspection 8. Injection diluted Pitressin (1:100) into utero-vesical fold and bilateral broad ligament 9. Cut off bilateral round ligaments via electrocauterization 10.Cut off bilateral I-P ligments via electrocauterization 11. Dissect and ligate bilateral uterine artery with 1-0 Vicryl 12. Dissect and cut off serosa over utero-vesical and utero-rectal fold 13. Submucosal injection of diluted Pitressin (1:100) around the cervix 14. Make incision on the anterior vaginal mucosa and circumcision the cervix. 15. Enter the vesico-cervical space and utero-rectal space with long Kelly. 16. Clamp, cut and suture ligate bilateral utero-sacral ligaments with 1-0 Vicryl 17. Open the peritoneal cavity, anteriorly and posteriorly. 18. Clamp, cut and suture ligate bilateral cardinal ligaments with 1-0 Vicryl 19. Cut the uterus through midline with scissors 20. Morceration of the uterus 21. Clamp, cut and suture ligate bilateral ovarian ligaments and remove the uterus 22. Reperitonealization and approximate the vaginal stump. 23. Check bleeding and hemostasis under laparoscopy 24. Remove trocar and repair skin with 3-0 Vicryl Operators 黃思誠 Assistants 陳思宇,林冠宏 手術日期：2008/01/12 13:25 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis PNET s/p Saint Jude Post-operative Diagnosis PNET s/p Saint Jude Operative Method Bilateral wedge resection Pathology Pending Operative Findings 1. Two nodules, firm and whitish, were found in RLL, one of them was adhered to the pleura 2. One nodule, firm and whitish, was noted in LLL Operative Procedures 1. DLETGA, right decubitus 2. Disinfection and drapping 3. VATS setting: the 7th ICS-MAL, the 4th ICS-AAL, the 7th ICS-PAL 4. Identified the tumor 5. Wedge resection by endo GIA-45 x II 6. Chest tube Fr.24 x 1 7. DLETGA, left decubitus 8. VATS setting as before 9. Identified the two lesions 10.Wedge resection x 2 by endo GIA-45 11.Chest tube Fr.24 x 1 12.Closed the wound in layers Operators 陳晉興 Assistants 梁嘉儀,徐綱宏 手術日期：2008/01/16 20:07 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Glioma, rught frontal lobe, s/p OP, recurrent Post-operative Diagnosis ditto Operative Method Total tumor excision via right frontal area Pathology pending Operative Findings Bulging brain after dural incision was noted. Previous corticotomy at the right frontal lobe was found. A 3.6cm x 2.3cm x 4.4cm greywish reedish, elastic soft cystic tumor occupied at the right frontal periventricular area. Another 1.4cm cystic tumor at the septum pellucium was also excision. Operative Procedures Under ETGA, supine positionwas placed with head tilting to left with Mryfield clamp fixed. The left frontal incision was made alon the previous scar. The scalp was opened by layers. After four original burr holes with two new burr holes were made, the Right frontal caniotomy was performed. Dura was opened from right side and the tumor was removed totally. The tumor of septum was also removed by Bipolar. The hemostasis was performed and the wound was closed by layers with one CWV inserted. Operators 曾漢民 Assistants 黃詩浩,黃凱傑 手術日期：2008/01/16 08:30 摘要__ 手術科部: 骨科部 套用罐頭: Open Reduction of clavicle fracture Pre-operative Diagnosis Right clavicle fracture s/p ORIF Post-operative Diagnosis Ditto Operative Method Removal of implants Pathology Nil Operative Findings 1. Bone solid union 2. Implants in situ (reconstruction plate 8H7S and 3 interfragmental screws) Operative Procedures 1. ETGA, semisitting position 2. Skin disinfection 3. Skin incision 4. Removal of implants 5. Irrigation with normal saline 6. Closure of wound in layers Operators 王至弘 Assistants 李忠謙,許駿毅,廖翊廷 手術日期：2008/01/18 00:00 摘要__ 手術科部: 外科部 套用罐頭: Port-A Pre-operative Diagnosis ESRD Post-operative Diagnosis Ditto Operative Method Perm Cath implantation Pathology Nil Operative Findings 1. Intra-op ultrasound localized right IJV. 2. Post-op CXR showed no hemothorax or pneumothorax. The tip position is well. Operative Procedures 1. IVG+supine 2. Intra-op ultrasound localized right IJV 3. Right IJV cut-down 4. Implantate Perm Cath Operators 王植賢 Assistants 李官燁 手術日期：2008/01/19 12:38 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Pituitary macroadenoma Post-operative Diagnosis Ditto Operative Method Sublabial transsphenoidal adenomectomy Pathology Pending Operative Findings A 2.7*2.0*2.0cm tumor occupying the sella, right suprasella, right ethmoid sinus and sphenoid sinus. Grossly it is mildly yellowish whitish resembling pituitary adenoma. Navigator was used to identify the posterior margin which was compatible with the dura identified intra-operatively. After removal of the suprasella part, the arachinoid membrane descended. No CSF leakage. The venous bleeding from cavernous sinus was packed. Operative Procedures ETGA, supine with head fixed in Mayfield. Navigator registeration. Sublabial incision and expose the sublabial route. Transsphenoidal tumor remove, Hemostasis and nasal packing. Operators 曾漢民 Assistants 黃博浩,姜志勇 手術日期：2008/01/21 12:53 摘要__ 手術科部: 骨科部 套用罐頭: Open reduction for fracture of radius,ulna Pre-operative Diagnosis Left olecranon fracture s/p ORIF with Leibinger plate with implant failure Post-operative Diagnosis Ditto Operative Method revision ORIF with TBW Pathology Nil Operative Findings Left olecranon fracture s/p ORIF with Leibinger plate with implant failure Nonunion of previous fracture Operative Procedures ETGA, supine, disinfection, drap, on air tournique Skin incision via previous op scar Dissect to fx site ROI of previous implants and debridement revision ORIF with TBW (1.8 k-pin x2, 16# wire x1) NS irrigation Close wound in layers on long arm cast Operators 張志豪 Assistants 廖翊廷 手術日期：2008/01/21 12:20 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis T12 & L1 compression fracture with cord compression Post-operative Diagnosis Ditto Operative Method T12 & L2 TPS with posteriolateral fusion, reduction of retropulsion; Healed L1-2 osteomyelitis Pathology Nil Operative Findings TPS were inserted into T12 & L2 under C-arm guide. After left L1 laminectomy, the dura and root were seen. Bulging backwarded L1 posterior body was reduced. The retropulsion was reduced. Operative Procedures ETGA, prone and C-arm localization. Skin disinfection and draping. Make midline skin incision. Expose T11-L3 lamina and facet joint. Insert TPS under C-arm guide. Perform left L1 laminectomy than reduction of retropulsion. Rod fixation through posteriolateral. Do fusion. Hemostasis and put a Hemovac. Close wound in layers. Operators 賴達明 Assistants 黃博浩,姜志勇 手術日期：2008/01/23 10:24 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Pituitary macroadenoma Post-operative Diagnosis ditto Operative Method Transsphenoid Adenomectomy Operative Findings 1.One 1.7x1.5 cm whitish, mild jelly like tumor at the post part of sella turcica. The normal gland was just beneath the sella floor, in front of the tumor. 2.After tumor removal, arachnoid membrane exposed 3.CSF leakage was noted, sealed with tissuecolduo 4.There was no motor oil like content Operative Procedures After ETGA, the patient was under supine position with head mild left tilt. The nasal cavity was well-disinfective, and then we incised into the nasal septum. However, it was firmly adhesive. After remove of the soft tissue and the granulation, we extended into the sphenoidal sinus, and the whitish, solid and soft tumor was filled with the sinus. The lower border of the sinus was drilled out to fully exposed the tumor. The tumor was removed with ring-currette. CSF leakage was noted during operation and was sealed with tissuecol duo. After hemostasis, the sinus was filled with gelfoam, and bilateral nasal cavity was filled with mirocels. Operators 杜永光 Assistants 郭律廷,胡朝凱 手術日期：2008/01/23 17:33 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Pituitary macroadenoma Post-operative Diagnosis ditto Operative Method Trans-sphenoid tumor excision Operative Findings 1.A snowman shape about 6 cm in size tumor located at sella turcica and extended upward passing through diaphragm sella. The tumor was soft and mild reddish 2.The sellar floor became thin due to tumor compression. 3.There is mild CSF leak during operation but sealed with Tissucol Duo 4.The tumor extended into right cavernous sinus and mild bleeding was noted. 5.A vascular branch, suspect meningohypophyseal trunk was cauterized. Operative Procedures Under ETGA, patient was put in supine position with mild head extension. After well anti-septic procedure and drapping, left nasal septum mucosa was incised. Dissection was performed along with the periosteum, after fracture vomer, sphenoid sinus anteriorwall was exposed. It was then fractured and sphenoid sinus was entered. The mucosa of shpenoid sinus was excised and then the sellar floor was fractured. Dura was opened as a cruciate form. Tumor was exposed and excised piece by piece with currette and tumor forceps. The dorsum sella was reached and was drilled off partially, so that we can removed further posterior part of tumor. The suprasellar part of tumor was removed by passing through the tunnel restricted by diaphragm sella until a thin capsule was visualized. During the procedure, a small arachnoid defect was noted and sealed with tissucol duo. Bone graft was put back. Merosel was used to pack the nostril. Operators 杜永光 Assistants 郭律廷,胡朝凱 手術日期：2008/01/24 08:30 摘要__ 手術科部: 外科部 套用罐頭: LC Pre-operative Diagnosis GB stones Post-operative Diagnosis Ditte Operative Method L.C. Pathology GB Operative Findings 1.Moderate adhesion around umbilicus 2.No adhesion around GB 3.Multiple 0.5 cm, pigmented stones in GB Operative Procedures 1.ETGA, supine, skin disinfected 2.Set L.C ports Camera port: 1.0 cm, supraumbilicus Working ports: 1.0 cm, epigastrium 0.5 cm x 2, RUQ 3.Expose cystic duct and a. ligate them 4.REmove GB from liver bed 5.Hemostasis, wound closure Operators 吳耀銘 Assistants 吳正一,謝永 手術日期：2008/01/28 14:20 摘要__ 手術科部: 外科部 套用罐頭: MRM Pre-operative Diagnosis 1. Right breast DCIS s/p excisional biopsy 2. RUL cancer s/p VATS LN dissection Post-operative Diagnosis 1. Right breast DCIS s/p excisional biopsy 2. RUL cancer s/p VATS LN dissection Operative Method Right simple mastectomy Pathology Pending Operative Findings No grossly residual tumor was noted Operative Procedures Under endotracheal general anesthesia, the patient was put on supine position with right arm elevated. The skin was disinfected and draped as usual. An elliptical incision including the nipple-areolar complex was performed, then skin flap was made. The dissection reached to clavicle superiorly, the costal margin inferiorly and the parasternal area medially. Laterally dissecton was extended to the border of latissimus dorsi. Breast tissue was removed. The bleeders were checked meticulously. The operative field was irrigated with warm saline. The wound was closed layer by layers after two CWV drains were left. Operators 張金堅,郭文宏 Assistants 黃俊傑,郭博彥,張聖暉 手術日期：2008/01/28 17:30 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis 1. RUL lung cancer s/p VATS LN dissection 2. Rigth breast DCIS s/p simple mastectomy Post-operative Diagnosis 1. RUL lung cancer s/p VATS LN dissection 2. Rigth breast DCIS s/p simple mastectomy Operative Method Port-A implantation Pathology Nil Operative Findings 1. Right subclavian vein venous blood flow freely in the Port-A catheter after implantation 2. CXR examination: catheter tip at tortuous right subclavian vein Operative Procedures The patient was put on supine position. The operation field was disinfected and draped as usual. Under local anesthesia, the Port-A catheter was implanted on right side via right suclavian vein with puncture method. The port-A implantation was performed smoothly. After hemostasis, the wound was closed in layers. Operators 李元麒 Assistants 黃俊傑,郭博彥 手術日期：2008/01/28 11:30 摘要__ 手術科部: 外科部 套用罐頭: VATS biopsy Pre-operative Diagnosis 1. RUL lung nodule 2. Right breast ductal carcinoma in situ s/p excisional biopsy Post-operative Diagnosis 1. RUL lung cancer, with mediastinal lymph node metastasis 2.Right breast ductal carcinoma in situ s/p excisional biopsy Operative Method Right VATS group 3,4,7 lymph node dissection Pathology Pending Operative Findings 1. Lymphadenopathy was noted at Group 3 and 4, size larger than 1cm 2. A huge tumor noted at RUL with plerual retraction Operative Procedures 1. DLETGA, left decubitus position 2. Skin was disinfected and drapped 3. Make three VATS ports: 8th ICS at MAL; 5th ICS at AAL; 6th ICS at PAL 4. Group 3,4,7 lymph nodes were dissected out 5. Hemostasis 6. Insert one 24Fr. chest tube 7. Close the wounds in layers Operators 李元麒 Assistants 陳克誠,陳衛洲,郭博彥 手術日期：2008/02/01 20:14 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Megacolon Post-operative Diagnosis ditto Operative Method Laparoscopic assisted hemicolectomy with pull-through Pathology pending Operative Findings 1. Segmental distension of colon were noted 2. Pull through was made from mid T-colon to anus 3. s/p VP shunt 4. s/p gastrostomy 5. Adhesion (+) Operative Procedures 1. ETGA, supine, disinfect and drap as usual 2. Create 3 ports, explore abdominal cavity with laparoscope 3. Adhesiolysis, dissect mesorectum and mesocolon up to hepatic flexure, mobilize rectum, sigmoid, colon up to A-colon 4. Dissect anus area abovedentate line, mobilize distal rectum 5. Transverse incision along port wound over right subcostal area 6. Pull-through of T-colon to anus, transect mid T-colon and mucosa-to-mucosa anastomosis was made between proximal end of T-colon and anus mucosa 7.NS irrigation, close wound in layers Operators 許文明 Assistants 吳孟哲,張允亮 手術日期：2008/02/04 14:54 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis HCC with left occipital lobe metastasis and tumor bleeding Post-operative Diagnosis Ditto Operative Method Craniotomy for tumor excision and hematoma evacuation Pathology Pending Operative Findings A soft and fragile tumor was found in the left occipital lobe, about 2.5cm in diameter. It resulted in 25~30ml of hematoma, which extended toward the parietal lobe. Operative Procedures Under ETGA, patient was put in prone position with head fixed with mayfield skull clamp after head shaved and scrubbed with povidone-iodine detergent. The skin was disinfected and whole operation field was drapped as usual. A 15 cm inverted-U incision wasmade on left occipital region. After the scalp flap had been lifted and reflected posteriorly, temporal hemostasis was achieved by bipolar coagulator and Raney clips. Three burr holes were made and then created a 4x4cm craniotomy window by power saw. Dural tenting with 4 stitches along the edge was done with silk. We made a cruciate dural incision to expose the brain tissue. Soft tumor part was removed by suction and the rest was dissected from the brain tissue. The intracerebral hematoma was removed easily by a sucker and packed the bare surface of the hematoma cavity with surgicels for complete hemostasis. We closed the dura with 4-0 prolene suture. After we injected N/S into previous hematoma cavity, the dura was closed completely. The dura was tentedwith silk and we packed the epidural space with gelfoam. We set one epidural CWV and then placed the bony graft back and fixed it with three wires. After hemostasis was done, galea suture was performed by continuous suture with 3-0 Dexon and skin was closed by continuous suture with 3-0 nylon. Operators 陳敞牧 Assistants 蘇亦昌,洪浩雲 手術日期：2008/02/14 21:05 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT Pre-operative Diagnosis Left temporal cystic lesion, suspect radiation necrosis, suspect metastatic brain tumor Post-operative Diagnosis ditto Operative Method Left temporal craniotomy for aspiration of cyst and excisional biopsy Pathology pending Operative Findings The cyst content was yellow-reddish, mild turbid in character. The brain was slack after aspiration. No communication with ventricle was noted during operation. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position with left shoulder elevated and head turned to right. The scalp was shaved, scrubbed and disinfected with alcoholic B-I then draped. Linear scalp incision at left temporal region followed by 8x5cm craniotomy. The dura was opened in cruciate fashion. Performed corticotomy for aspiration of the cyst via middle temporal gyrus. One 0.8x0.8cm temporal cortex was excised for pathology exam. The epidural bleeding was packing with gelform and dural tenting. Duroplasty with 4-0 prolene sutures and temporalis fascia graft. The skull plate was fixed with wires and the wound closed in layers. Operators 陳敞牧 Assistants 李建勳,張允亮 手術日期：2008/02/14 14:11 摘要__ 手術科部: 泌尿部 套用罐頭: Laparoscopic radical prostatectomy Pre-operative Diagnosis prostate cancer, T1aN0M0 Post-operative Diagnosis prostate cancer, T1aN0M0 Operative Method Extraperitoneal laparoscopic radical prostatectomy + bilateral pelvic LN dissection Pathology pending Operative Findings 1.Resected prostate:4x3.5x3 cm with bilateral seminal vesicle 2.Two CWV drain at bilateral perivesical space Operative Procedures Under satisfactory endotracheal general anesthesia with the patient in a supine position, prepping and draping was performed. A 16 Fr Foley was inserted with sterile method. A balloon trocar was placed at periumbilical area. The wound was deepened intopre-peritoneum. The balloon was inflated and a pre-peritoneal space was created. One 5-12 mm & three 5 mm port were placed at bilateral lower abdomen. Dissection were perfomed at bilateral endopelvic fascia first. Endopelvic fascia was opened and pubo-prostatic ligaments were identified. Superficial dorsal vein was ligated and the Santorini's plexus and deep dorsal vein complex was ligated with 1-0 Vicryl suture. The puboprostatic ligament was partially transected. A transverse incision was done overthe anterior wall of the bladder neck. The bladder was entered and bilateral ureteral orifices were identified. This incision was done along the bladder neck posteriorly and sharp dissection over full thickness of bladder was done until seminal vesicles was exposed. The seminal vesicles were identified and vas deference were divided. The prostate was freed from the rectum over Denonvilliers' layer with Ultrashear. Bilateral iliac and obturator lymph node were dissected by Ultrashear, and the resected lymph node was delivered from the periumbilical wound after placement in the retrieval bag. The resected prostate specimen was placed into a retrieval bag and delivered from the wound at periumbilical area. Twelve sutures of 3-0 RB-1 monovicryl were placedinto the urethral stump and the margin of the bladder neck. A 20 Fr nephrostomy tube was inserted into the urethra and bladder with balloon inflated to 5 ml after the anastomosis was completed. Two CWV drain tubes were placed near the area of anastomosis. We closed the 5-12 mm port wound with 1-0 Vicryl and skin with 3-0 Nylon. The patient tolerated the procedure very well, and was sent to the recovery room in satisfactory condition. Operators 闕士傑 Assistants 王禎薇,翁文慶 手術日期：2008/02/14 08:40 摘要__ 手術科部: 骨科部 套用罐頭: Total knee replacement-Medial, standard Pre-operative Diagnosis Osteoarthritis, bilateral knees Post-operative Diagnosis Ditto Operative Method Left TKR with Zimmer prosthesis (F:"C", T:#3, P: 26mm, I: 10mm) Pathology Pending Operative Findings 1. Cartilage wearing and subcondral bone exposure 2. Osteophyte formation 3. Varus deformity Operative Procedures Under spinal anesthesia, the patient was placed in supine position. The operation field was disinfected and draped as usual. After inflate air tourniquet at 300 mmHg, skin incision was done along midline of knee and approach the knee via medial approach.Bony preparation of femur, tibia and patella were performed with "Zimmer" jigs subsequently. Applied total knee prosthesis with cement, Tibia: #3, Femur: "C", Patella: 26 mm, Insert: 10 mm. Then deflate air tourniquet and check bleeding. After clean surgical wound with normal saline irrigation, finally close the wound in layers. Operators 江清泉 Assistants 黃裕閔,許建文,吳拓 手術日期：2008/02/15 12:30 摘要__ 手術科部: 外科部 套用罐頭: Port-A Pre-operative Diagnosis CML Post-operative Diagnosis Ditto Operative Method Port-A catheter implantation, right internal jugular vein Pathology nil Operative Findings The venous blood flow freely in the Port-A catheter after implantation. Operative Procedures The patient was put on supine position. The operation field was disinfected and draped as usual. Under local anesthesia, the Port-A catheter was implanted on right side upper chest. Operators 吳毅暉 Assistants 陳佑群 手術日期：2008/02/17 02:38 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Acute Massive pulmonary embolism, s/p ECMO-CPR Post-operative Diagnosis Ditto Operative Method Pulmonary embolectomy + TVP Pathology Pending Operative Findings 1. Cardiac arrest, PEA s/p CPR and Pre-op ECMO support fair heart contractility 2. Fresh dark reddish thrombus in bilateral pulmonary arteries with total occlusion of right pulmonary artery, left upper lobe, and partial occlusion of left lower lobe pulmonary artery 3. Tricuspid annular dilatation with TR, s/p TVP with DeVega's annuloplasty 4. Post-op hemodynamics relatively stable, so ECMO was removed Operative Procedures 1. ETGA, supine position 2. Skin disinfection and drapped 3. Full sternotmoy 4. AsAo, RAA --> SVC, IVC cannulation, on CPB, cooling to 25 degrees AXC, antegrade cardioplegia, venting through IAS MPA - LPA incision, remove the thrombus en blocRPA incision longitudinally, remove the thrombus, as well Repair pulmonary artery 5. TVP with DeVega's annuloplasty. Close PFO and RA 6. Rewarm, dearr, wean off CPB 7. Hemostasis, set 4 C/T with bilateral pleura opened 8. Sternal wound closure in layers 9. ECMO cannula removed, repair of inguinal wound Operators 陳益祥,黃書健 Assistants 黃日新,張兼華,阮廷倫 手術日期：2008/02/21 16:50 摘要__ 手術科部: 外科部 套用罐頭: esophagectomy,staple Pre-operative Diagnosis Esophageal squamous cell carcinoma s/p CCRT. T3N1, middle third Post-operative Diagnosis Ditto Operative Method 1.Right VATS subtotal esophagectomy and retrosternal gastric tube reconstruction 2. Jejunostomy Pathology Pending Operative Findings 1. Some soft, Gr.107 LNs; many soft Gr. 106 LNs. 2. Mild adhesion noted in RUL to chest wall and upper third mediastinum. 3. Esophageal mucosala irregularity and ulceration, mildly noted at upper third and anterior part of middle third. 4. Mild adhesion of spleen, gastric cardia portion and T-colon Operative Procedures 1. DLETGA, left decubitus. 2. disinfection and drap. 3. VATS setting 4. Open mediastinal pleura. 5. Loop and divide, lower third esophagus with Endo GIA. 6. Dissect along esophagus, divide azygos vein with EndoGIA. 7. Gr.106 LNs dissection. 8. Insert two Fr.24 chest tube. 9.Close the chest wound. Shift to supine. 10. Mid laparotomy, make gastric tube with ligasure. 11. Open crus muscle; divide left gastric vessels. 12. Make substernal tunnel. 13. Cervical skin incision. Loop esophagus. 14. Endo GIA 45 staple applied, another hand-suture with Maxon. 15. Insert two neck penrose drain. 16. Insert two abdominal rubber drains, mediastinal Fr.24 chest tube and jejunostomy. 17. Close the wound in layers. Operators 李元麒 Assistants 黃培銘,張金池,陳衛洲,陳郁惟 手術日期：2008/02/21 10:00 摘要__ 手術科部: 骨科部 套用罐頭: Total knee replacement-Medial, standard Pre-operative Diagnosis Osteoarthritis, right knee Post-operative Diagnosis Ditto Operative Method Right TKR with Zimmer prosthesis (Tibia: #3, Femur: "C", Patella: 26mm, Insert: 10mm) Pathology Pending Operative Findings 1. Cartilage wearing and subcondral bone exposure 2. Osteophyte formation 3. Varus deformity Operative Procedures Under spinal anesthesia, the patient was placed in supine position. The operation field was disinfected and draped as usual. After inflate air tourniquet at 300 mmHg, skin incision was done along midline of knee and approach the knee via medial approach.Bony preparation of femur, tibia and patella were performed with "Zimmer" jigs subsequently. Applied total knee prosthesis with cement, Tibia: #3, Femur: "C", Patella: 26mm, Insert: 10mm. Then deflate air tourniquet and check bleeding. After clean surgical wound with normal saline irrigation, finally close the wound in layers. Operators 江清泉 Assistants 蔣建中,許建文,薛永德 手術日期：2008/02/23 17:26 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis pulmonary embolism s/p embolectomy, post-op sternal dehiscence Post-operative Diagnosis ditto Operative Method sternal rewiring and debridement Pathology nil Operative Findings 1.Multiple sternal bone fracture with wires cut-through and sternal bone instability 2.Large amount of serous pericardial and pleural effusion, no pus or necrotic tissue or evidence of active infection was found at mediastinal space 3.Fair heart contractility, no active bleeder Operative Procedures Under ETGA and supine position, redo full sternotomy was performed. The wires were removed. After copious saline irrigation, the debridement was performed in the pericardial space. Sternal rewiring was performed firmly. The wound was closed in layers. Operators 陳益祥,黃書健 Assistants 黃日新 手術日期：2008/02/25 10:00 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Grade II astrocytoma s/p OP with CSF leakage(subgleal effusion) Post-operative Diagnosis Ditto Operative Method Dural repair Pathology Nil Operative Findings There's a 0.5cm in diameter and a 1 cm in diameter dural defect on the ant-medial side and posterior side of craniotomy window. The dural defect was repaired by temporalis fascia and tissue Coduo. Operative Procedures 1. ETGA, supine position 2. Skin preparation 3. Skin incisionalong previous op scar 4. Remove the skull plate 5. Repair the dural defects 6. Central tenting of the dura layer 7. Fix the skull plate by miniplates 8. Set a subgleal CWV drain 9. Closed wound in layers Operators 曾漢民 Assistants 郭律廷,徐綱宏 手術日期：2008/02/28 09:00 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Pituitary macroadenoma s/p TSA, recurrence Post-operative Diagnosis Pituitary macroadenoma s/p TSA, recurrence Operative Method Endonasal trans-sphenoidal tumor biopsy under navigation Pathology pending Operative Findings 1. The septal mucosa were thickening due to previous surgery. Severe adhesion over the posterior wall of the sphenoidal sinus and sellar floor was found. It was difficult to identify the normal structure over the sellar floor and the tumor. So we just took several pieces of the surrounding tissues for pathologic study. 2. Intra-op CSF leakage(+) 3. Suck the cystic compartment of the mass Operative Procedures 1. ETGA, supine with Meyfield clamp fixed 2. Applied the cranial frame of the navigation and registration 3. Aseptic preparation 4. Bosmin injection of the nasal mucosa and mucosal incision 5. Subperiosteal dissection to the rostrum of the sphenoidalsinus 6. Adhesiolysis 7. Partial tumor excision 8. Repair the dura defect with Duroform and fat pad 9. Close the wound and septum reconstruction Operators 蔡瑞章 Assistants 黃詩浩,林哲安 手術日期：2008/03/03 14:10 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT Pre-operative Diagnosis Epilepsy, tuberous sclerosis Post-operative Diagnosis Ditto Operative Method Right amygdalohippocampectomy, partial right temporal lobectomy (Inferior gyrus and partial middle temporal gyrus) Pathology pending Operative Findings ECOG showed the focus located at right middle temporal gyrus. Inferior temporal gyrus and anterior middle temporal gyrus ( 4cm) was resected. Then ECOG revealed no spike. One soft, fragile greyish mass-like was found at hippocampus. Multiple nodule wasnoted when the brain was palpated. Temporal horn was identified. Operative Procedures Under the general anesthesia with endotracheal tube intubation, the patient was set into supine position with head tilt to left. The operation field was scrubbed and disinfected with povidine-iodine and then drapped with sterile drapping. Right frontal-temporal curvilinear scalp incision was done.The temporalis muscle was divided. After burr hole x 4, craniectomy was done 7x5cm by the saw. The sphenoid ridge was flattened with rhonger. U-sahpe dura incision was made with its base at frontal side. The ECOG was applied to identify the focus. Partial temporal lobectomy was done with sucker and hemostasis was made with bipolar and surgicel. ECOG was applied again to identify the focus. Amygdalohippocampectomy was done under microscope and one mass-like lesion was dissected and removed. Hemostasis was done with bipolarl and surgicel. Duroplasty was done with fascia and 4-0 prolene. The boneplate was fixed with 4 wires and central tenting x 2. One epidural CWV drain was set for drainage. The galea was closedwith 3-0 Vicryl and the skin with 4-0 Nylon. Operators 曾勝弘,楊士弘 Assistants 陳盈志 手術日期：2008/03/03 16:02 摘要__ 手術科部: 外科部 套用罐頭: Cranioplasty Pre-operative Diagnosis Left PCA infarction s/p craniectomy Post-operative Diagnosis ditto Operative Method Cranioplasty Operative Findings 1.Left 15x14 cm skull defect 2.Dura was intact 3.Mild buldging brain was noted during operation Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotatedto right. 3. Skin preparation:shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with a sterilized adhesive plastic sheet. 4. Incision: along the previous operation scar, Raney clips were apllied to the scalp edge for temporary hemostasis. 5. The scalp was dissected away from the underlying dura. It was easily reflected from the underlying silastic sheet which was then removed. The dural surface and margin of skull defect were well exposed. 6. The original skull plate was placed back to the skull window then fixed by miniplate and a dura tenting at the center of the skull plate. 7. Bone cement pastewas applied at skull defect margin 8.Drain: one, epidural, collected in a surgeons glove. 9.Then close the wound Operators 王國川 Assistants 蘇亦昌,胡朝凱 手術日期：2008/03/04 16:39 摘要__ 手術科部: 外科部 套用罐頭: AVR Pre-operative Diagnosis aortic valve regurgitation Post-operative Diagnosis ditto Operative Method aortic valve replacement with 21mm St. Jude mechanical valve Pathology pending Operative Findings 1.AOrtive valve: degenerative change, annulodilation, causing severe AR 2.CAD, 3VD, s/p CABG, patetnt 2 SVG 3.Dilated LA, LV, good LV contractility Operative Procedures Under supine position, the patient was intubated with general anesthesia. Right parasternotomy was performed. 3-6 rib was resected. CPB was performed by cannulating left CFA, RA appendige. Aortic crossclamping was done. Transverse aortomy was performed, followed by direct antegrade cardioplegia infusion. After resecting aortic valve, AVR was performed with 23 mm St. Jude mechanicla valve. Aorta was closed. After re-warming, de-air, CPB was weaned off. Left CFA was repaired. Complete hemostasiswas performed. 2 chest tubes were set in right pleural cavity and the wound was closed in layers. Operators 許榮彬 Assistants 陳映澄,陳建璋 手術日期：2008/03/06 13:00 摘要__ 手術科部: 泌尿部 套用罐頭: URS (biopsy) Pre-operative Diagnosis left lower ureteral stricture Post-operative Diagnosis left lower ureteral stricture Operative Method right URS Operative Findings 1.severe stricture was noted in left lower ureter and URS can't be passed by 2.polyposis was also noted. Operative Procedures Under satisfactory intravenous general anesthesia with the patient in the lithotomy position, skin preparation was performed. A cystoscope was inserted into the bladder and a guidewire was then introduced into the ureteral orifice. A 6 Fr. ureteroscope was introduced into the ureter. Severe stricture was noted at left lower ureter and URS can't be passed. A 16 Fr. Foley catheter was placed in the urinary bladder. The patient tolerated the operation well and was sent to the recovery room in stable condition. Operators 黃國皓 Assistants 洪順發 手術日期：2008/03/07 09:30 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Pituitary tumor s/p TSA, hydrocephalus Post-operative Diagnosis ditto Operative Method EVD insertion wia right kocher's point Pathology Nil Operative Findings Xanthrochronie CSF gushed out while ventriular puncture. The opening pressure was above 12cm H2O. Ventricular catheter was 6cm in depth. Operative Procedures 1. ETGA, supine 2. Skin incision at right frontal area 3. opening in layers and Burrhole at right kocher's point 4. Dural incision after tenting 5. Ventricular puncture 6. Inserted the EVD 7. Closure the wound in layers Operators 蔡瑞章 Assistants 黃詩浩,鄒冠全 手術日期：2008/03/08 11:13 摘要__ 手術科部: 泌尿部 套用罐頭: TUR-BN Pre-operative Diagnosis 1.AUR 2.r/o right renal tumor Post-operative Diagnosis 1.AUR 2.r/o right renal tumor Operative Method TUIBN and URS Pathology Nil Operative Findings 1.Bladder neck contracture 2.Bulbar urethra stricture 3.Multiple blood clot at bladder and right renal pelvis Operative Procedures Under the satisfactory intravenous general anesthesia with the patient in a lithotomy position, prepping and draping were performed in the usual sterile method. Resectoscope was inserted into the urethra with well lubrication. Fibrous tissue at the bulbar urethra was noted. Incision at the 5 and 7 o'clock position by TUR was performed. Then URS was inserted after guidewire. Ureteral catheter was placed in right ureter. A 3-way 22Fr. Foley catheter was placed for stenting the urethra. Then he was sent tothe recovery room with a stable condition. Operators 闕士傑 Assistants 王禎薇,曾任偉 手術日期：2008/03/17 16:38 摘要__ 手術科部: 外科部 套用罐頭: Burn- debridement and STSG Pre-operative Diagnosis Bilateral lower leg contact burn Post-operative Diagnosis Bilateral lower leg contact burn Operative Method 1) Debridement, 2) STSG Operative Findings 1. one 5*5cm yellowish eschar over left lower posterior leg 2. diffused dark red necrotic tissue over bilateral lower leg 3. STSG, 240cm2, from left anterior thigh, 8/1000 Operative Procedures 1. ETGA, supine 2. Disinfection and drapping 3. Debride bilateral lower leg burn injury wounds 4. Hemostasis, saline irrigation 5. Harvest STSG from left anterior thigh 6. Apply STSG to bilateral lower leg wounds 7. Set bilateral long leg splint Operators 楊永健 Assistants 陳建良,莊民楷 手術日期：2008/03/24 09:45 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Hyperthyroidism, respiratory failure Post-operative Diagnosis ditto Operative Method Left total and right subtotal thyroidectomy and tracheostomy Operative Findings Bilateral larygneal recurrent nerve are preserved Tracheostomy was created at C2 cartilidge Fr7.low presure tube was inserted smoothly Operative Procedures Under ETGA, supine with neck hyperextension Disinfect skin and drapped as usual Transverse skin incision above the sternal notch Dissect and expose bilateral lobe of thyroid gland Ligate supplying vessels Idntify the recurrent laryngeal nerves Horizontal incision at trachea Dilate the tracheostomy Insert low pressure tube Hemostasis Set 2 CWV at paratracheal gutter Close the wound in layers Operators 吳明勳 Assistants 周俊志,潘為元 手術日期：2008/03/26 10:00 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Left shoulder mass, r/o lipoma Post-operative Diagnosis ditto Operative Method tumor excision Pathology pending Operative Findings 1. One 7cm soft, yellowish mass over left shoulder, intramuscular of pectoralis major Operative Procedures 1. ETGA, supine 2. Antiseptic and drapping 3. Skin incision 4. Tumor excision 5. Set one CWV drain 6. Close the wound in layers Operators 謝榮賢 Assistants 李兆翔,林哲安 手術日期：2008/03/31 18:25 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Conexity meningioma, left, parietal area Post-operative Diagnosis ditto Operative Method Simpson grade I tumor excision via left parietal craniotomy Pathology Pending Operative Findings Bulging dura after craniotmy was noted. A 5cmx4cmx7cm greyish, whitish, reddish, elastic-firm at left parietal area. The tumor was supplied by ECA and some Pia vessels formMCA and PCA. Operative Procedures Under ETGA, prone with Mayfield clamp fixation, we made currillinear skin incision at left P-O area and opened in layers, then we did left parietal craniotomy and did dural incision after tenting. Then we detached the dural-base, devascularization and total tumor excision via debulking maneuver. After Hemostaiss, we closed the wound in layers with duroplasty with Gortex artificial dural graft. Operators 曾漢民 Assistants 黃詩浩,鄒冠全 手術日期：2008/04/02 09:00 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Varicose vein, right lower limbs Post-operative Diagnosis Ditto Operative Method 1. EVRF 2. Muller's phlembectomy Pathology Pending Operative Findings 1. EVRF: 96J, 15W, 18cm, 3'48" 2. tortused and engorged vein of right lower limb Operative Procedures Under general anesthesia, patient was placed as supine position. Lower limbs was disinfected and well drapped. Right great saphenous vein was puncture at just above knee level under sonography-guide. Radiofrequency cathter was inserted upto the femoral veinjunction. Tumison solution was injected around the great saphenous vein. Radiofrequency ablation was performed. Tortused veins was stripped. Operators 王水深 Assistants 陳佑群 手術日期：2008/04/09 00:00 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis ESRD Post-operative Diagnosis ESRD Operative Method Tenckhoff insertion Pathology Nil Operative Findings 1. Patent tube function; burided at low abdominal wall Operative Procedures 1. On IVG 2. Supine position and disinfection 3. Skin iniciosn 4. Set Tube 5. Bury the tube at low abdominal wall 6. Close wound in layers Operators 蔡孟昆 Assistants 吳經閔 手術日期：2008/04/09 16:10 摘要__ 手術科部: 外科部 套用罐頭: Laminoplasty Pre-operative Diagnosis Cervical stenosis Post-operative Diagnosis Ditto Operative Method Laminoplasty Operative Findings The dura sac seemed tightly compressed before laminoplasty Operative Procedures Under ETGA and prone position, middle skin incision was performed. The paraspinal muscle were detached from low C2 to upper C7 spinous process. With Midas air drill, open-door-style laminoplasty was performed with hinge on the right side from C3-C6. Hemostasis was performed and a epidural CWV drain was set. The wound was then closed by layers. Operators 曾漢民 Assistants 郭律廷,林哲光 手術日期：2008/04/14 22:08 摘要__ 手術科部: 骨科部 套用罐頭: HIVD-disectomy Pre-operative Diagnosis C3~C7 spinal stenosis with myelopathy Post-operative Diagnosis C3~C7 spinal stenosis with myelopathy Operative Method C3~C6 Kurukawa laminoplasty with allo bone graft + C7 partial laminectomy Operative Findings 1. spinal stenosis over C3~C7 level 2. good pulsation of the dura after decompression Operative Procedures 1. ETGA, prone on R-H frame, fix the head 2. check level under C-arm 3. sterialize the skin 4. skin incision at nuchal region, split the soft tissue 5. do the C3~C6 spinous proscess midline osteotomy and expose the cord 6. do the Kurukawa laminoplasty by allo graft at C3~C6 level 7. do the C7 partial laminectomy 8. chesk stability, set 1/8# H-V x2 9. close the wound Operators 楊曙華 Assistants 許家豪,陳致宇,李奕辰 手術日期：2008/04/18 16:00 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis C3-7 cervical stenosis Post-operative Diagnosis Ditto Operative Method C3-7 laminoplasty. Open-door type hinge on left side Pathology Nil Operative Findings After laminoplasty, the cord appeared explored. Operative Procedures ETGA, Prone with skeletal fixation. After disinfection, midline incision from C2 to C7. Performed subperiosteal muscle dissection. Created a groove from C3 to C7 as the hinge side. Created the groove on the right side. Used retractor to fracture theright groove. Used miniplate with bony graft to fixed the laminae. Set one CWV drain. Closed the wound in layers. Operators 賴達明 Assistants 蘇亦昌,羅健洺 手術日期：2008/04/26 11:00 摘要__ 手術科部: 骨科部 套用罐頭: Open reduction for fracture of femoral neck Pre-operative Diagnosis Left femoral periprosthetic fracture Post-operative Diagnosis Ditto Operative Method ORIF with DCP, 9H8S and cerclage wire x 4 Pathology Nil Operative Findings 1. Left femoral periprosthetic fracture, Vancouver type B. 2. Long spiral fracture, 2-3mm displacement. 3. Severe osteoporosis. Operative Procedures 1. Induction of anesthesia, lateral decubitus position. 2. Skin prepped and draped. 3. Left lateral thigh incision, dissect to femur bone. 4. ORIF with DCP, 9H8S and cerclage wire x 4. 5. N/S irrigation, checked hemostasis. 6. Closed wound in layers. Operators 孫瑞昇 Assistants 林蔚鑫,陳致宇,吳拓 手術日期：2008/04/29 17:30 摘要__ 手術科部: 外科部 套用罐頭: Biopsy 乳房 Pre-operative Diagnosis Breast cancer Post-operative Diagnosis ditto Operative Method Old tumor margin excision+ALDN level I and II+SLND Pathology pending Operative Findings No visible tumor noted Operative Procedures 1.ETGA 2.Carefully clean and disinfect the surgical area skin 3.Skin incision along the inferior line of right areola. Remove and sample the old tumor site. 4.Skin incision at axilla. ALND level I and II as well as SLND was performed. 5.Clip at four coner of the spce of old tumor. 6.Wound closure Operators 黃俊升 Assistants 柯柏瑞,錢穎群 洪子文 手術日期：2008/05/01 11:18 摘要__ 手術科部: 婦產部 套用罐頭: Staging surgery Pre-operative Diagnosis Ovarian tumor Post-operative Diagnosis Ovarian cancer Operative Method Staging surgery (RSO, right pelvic lymph nodes dissection, partial omentectomy, appendectomy, ascites cytology) Pathology Frozen: metastatic or primary adenocarcinoma Operative Findings 1. Uterus: avfl, normal size. 2. Right ovary: a 15 * 15 * 15 cm solid tumor with mucinous cysts in it. Capsule remained intaqct during operation. 3. Left ovary: grossly normal. 4. Bilateral Fallopian tubes: grossly normal. 5. Cul-de-sac: serous ascitie, about 500 ml. No adhesion bands. 6. Omentum: grossly normal Appendix: grossly normal 7. Extrauterine spread(-); 8. Bilateral pelvic lymph nodes: Normal Enlarged Indurated Right iliac nodes + -- Right obturator node + - - 9. No residual tumor, no intraoperative tumor rupture. EBL: 150ml, BT: nil, Complication: nil Operative Procedures 1. Put the patient on the lithotomy position. 2. Vaginal douching, on Foley, skin disinfection with beta-iodine, and skin draping. 3. Make midline vertical skin incision and open the abdominal wall layer by layer. 4. Apply auto-retractor and pack up the intestine to expose the uterus. 5. Moderate ascities, send for cytology. 6. Clamp, cut and ligate right infundibulo-pelvic and ovarian ligament to remove right ovary and tube. 8. Open the posterior peritoneum to expose the right external iliac artery. 9. Dissection of the right external iliac lymph nodes and obturator lymph nodes. 10. Step by step, clamp, cut and ligate the infracolic omentum. Appendectomy was also performed. 11. Close the retroperitoneal space interruptedly with 2-0 vicryl. 12. Check bleeding and hemostasis. 13. Close the abdomen layer by layer. 14. Skin approximation with 4-0 Dexon. Operators 林鶴雄 Assistants 蕭聖謀 手術日期：2008/05/08 12:39 摘要__ 手術科部: 外科部 套用罐頭: OPCAB Pre-operative Diagnosis 1) CAD, 2-V-D, 2) CHF Post-operative Diagnosis 1) CAD, 2-V-D, 2) CHF Operative Method 1) OPCAB (LIMA to LAD, SVG: AsAo to RCA), 2) LV pacemaker wire implantation Pathology Nil Operative Findings 1. poor contractility 2. LAD, RCA mid total occlusion Operative Procedures Under endotracheal general anesthesia, the patient was placed on supine position. The skin over chest, abdomen, and both thigh were sterilized with beta-iodine, and draped in usual way. The chest was opened by midline sternotomy. The pericardium was opened by inverted-T incision. The left internal mammary artery was dissected from its origin down to the sixth rib. The saphenous vein was harvested from the left thigh with multiple incisions. The bleeding of branches was checked with heparinized autologousblood. Under the add of Octopus stablizer, the LIMA was anastomosed with LAD. The SVG was anastomosed with RCA by using 7-0 prolene in that order. The distal end of SVG was anastomosed to ascending aorta with continuous suture using 5-0 prolene under partialaorta clamp. After meticulous hemostasistwo chest tubes were inserted, both in pericardium space. The sternum was closed with steel wire in interrupted stictches. The rest of wound was closed in anatomic layers. The wound over thigh was closed in three anatomic layers. Operators 許榮彬 Assistants 陳佑群,莊民楷 手術日期：2008/05/09 09:11 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Left inguInal hernia, indirect type Post-operative Diagnosis ditto Operative Method Left herniorrhaphy by Halsted operation Pathology Pending Operative Findings 1. Large hernia sac with thickened wall 2. Weak posterior wall Operative Procedures 1. GA with LMA, supine position 2. Make a left inguinal incision 3. Dissect out the hernia sac 4. Perform high ligation of the sac 5. Repair the posterior wall with conjoint tendent and inguinal ligament 6. Reinforce the repair with external obliqueaponeurosis 7. Close the wound in layers Operators 胡瑞恆 Assistants 陳建嘉,鄒冠全 手術日期：2008/05/12 12:59 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis C5 spinal metastasis with prevertebral and epidural involvement Post-operative Diagnosis C5 spinal metastasis with prevertebral and epidural involvement Operative Method C5 corpectomy; C4/5,C5/6 disectomy; tumor excision Operative Findings C5 spinal tumor with prevertebral, paravertebral (more on the right), and epidural involvement. The tumor was fragile, yellowish, soft and hypervascular. After corpectomy, diskectomy, and removal of epidural componint, the cord and roots were seen. The roots were decompressed. No significant intra OP SSEP change. Operative Procedures ETGA supine R't cervical incision C4/5, C5/6 diskectomy Expose C4-6 C5 corpectomy, C4/5 C5/6 diskectomy, and tumor reveal Bone cement and wire mesh reconstruction. Plate fixation Hernnis and placement of mini-HV Wound closed in layers Hemostasis Operators 賴達明 Assistants 黃博浩,黃立偉 手術日期：2008/05/13 10:21 摘要__ 手術科部: 泌尿部 套用罐頭: TUR-BT Pre-operative Diagnosis Recurrent bladder cancer Post-operative Diagnosis Recurrent bladder cancer Operative Method TURBT(Transurethral resection of bladder tumor) Operative Findings Broad base cauliflower-like tumor at right lateral wall, near RUO. Operative Procedures Under satisfactory anesthesia with the patient in the lithotomy position, prepping and draping were performed in the usual sterile method. A Fr 22 Olympus Resectoscope was inserted into the urethra and bladder, and the whole bladder was inspected carefully. This revealed presence of tumor located at right lateral wall. Trigone and bilateral orifices were identified and inspected carefully. The tumor was resected with resectoscope, piece by piece. The resected tissues were removed with Ellik evacuator. Adequate hemostasis was then obtained. A 22Fr. 3-way Foley catheter was inserted and continuous bladder irrigation with normal saline started. The balloon was inflated to 10 cc. The patient was then sent to the recovery room in a stable condition. Operators 余宏政 Assistants 何承勳,柯智群 手術日期：2008/05/16 21:00 摘要__ 手術科部: 外科部 套用罐頭: ATYPICAL Pre-operative Diagnosis HCC Post-operative Diagnosis HCC Operative Method Central lobectomy, S5, S7, S8 Pathology Pending Operative Findings Liver cirrhosis without ascites One 9cm tumor at S5+8, one 1.9cm tumor at S7 Bile sand in GB Operative Procedures 1.ETGA, supine 2.Inverted Y incision 3.Cholecystectomy 4.S5,8 + Partial S4,7 segmentectomy by CUSA and bipolar 5.Close the wound in layers Operators 何明志 Assistants 陳賢典,張得一 手術日期：2008/05/16 15:58 摘要__ 手術科部: 外科部 套用罐頭: MRM Pre-operative Diagnosis L't breast CA Post-operative Diagnosis L't breast CA Operative Method Modified radical mastectomy. left Pathology invacive ductal carcinoma Operative Findings a mass, with size 1.7 x 1.1 Operative Procedures Patient was put on supine position with left arm 90 degree abducted. Under ETGA, skin was disinfected and draped as usual. An transverse elliptical incision, including the nipple-areolar complex and the skin over the biopsy wound, from left parasternalto left axillary area was made superiolaterally. The incised skin was grasped and retracted upward with breast clamps for skin flap dissection. Electrocauterization was used for dissection of skin flaps. The dissection reached to the level 1 cmbelow clavicle superiorly, the costal margin inferiorly and the parasternal area medially. Laterally dissecton was extended to the border of latissimus dorsi. The clavipectoral fascia was opened. The axillary vein was exposed and identified. The branches of the axillary vein were devided between ligatures. Axillary lymph node dissection was then performed for level I and II with identification and preserving of the long thoracic and thoracodorsal nerves. Breast tissue was removed en bloc with the axillary lymph nodes. The bleeders were checked meticulously. The operative field was irrigated with warm saline. The wound was closed layer by layers after two CWV drains were left. Blood loss was minimal and the patient stood the whole procedure well. Operators 張金堅 Assistants 黃彥鈞 手術日期：2008/05/16 12:20 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis right breast cancer s/p BCT + SLND Post-operative Diagnosis right breast cancer s/p BCT + SLND Operative Method re-excision Operative Findings Previous OP scaring over right breast was observed. Operative Procedures Under IVGA and supine position, dis-infection was performed. Skin incision was made along previous scaring. The breast tissue over 12-3 o'clock direction was resected and sent to pathology exam. After careful hemostasis performed, the wound was closed. Operators 黃俊升 Assistants 楊雅雯 手術日期：2008/05/16 12:16 摘要__ 手術科部: 外科部 套用罐頭: Port-A Pre-operative Diagnosis breast cancer Post-operative Diagnosis breast cancer s/p port-A implantation Operative Method port-A implantation Pathology nil Operative Findings one catheter of Port-A was inserted through left subclavian vein post-op CXR: good position, no pneumothorax, no hemothorax Blood withdraw: ++, complication: nil Operative Procedures 1.IVG, supine, skin disinfection and drapping 2.Localize left subclavian vein 3.Placement of guidewire into left subclavian vein 4.Linear incision at left chest and make a subcutaneous pocket, then make a tunnel 5.Insertion of Port-A 6.Intra-op CXR to check position: no pneumothorax or hemothorax, the tip position is well 7.Close wound in layers Operators 王植賢 Assistants 廖敏村 手術日期：2008/05/21 00:18 摘要__ 手術科部: 骨科部 套用罐頭: Total elbow replacement Pre-operative Diagnosis Neglected proximal humeral fracture-dislocation, right Post-operative Diagnosis Neglected proximal humeral fracture-dislocation, right Operative Method Total shoulder replacement (Zimmer) Pathology nil Operative Findings 1. Proximal humeral fracture 2. Osteolytic change of proximal fragment 3. Complete rupture long head of bicep muscle Operative Procedures 1. General anesthesia, semi-sitting position 2. Skin disinfected and draped 3. Skin incision at right shoulder and delto-pectoral approach 4. Remove fracture fragment 5. Set TSR prosthesis, including humeral head, humeral stem, and glenoid cap 6. Hemostasis and irrigation 7. Close wound Operators 蔡清霖 Assistants 毛贊智,薛永德,陳勇璋 手術日期：2008/05/21 19:50 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Left frontal tumor, r/o low-grade astrocytoma Post-operative Diagnosis Left frontal tumor, r/o low-grade astrocytoma Operative Method Total tumor excision via left frontal craniotomy Pathology Pending Operative Findings About 2.5cm x 2.5cm x 2.0cm whitish, yellowish, elastic soft and jelly-like tumor located at the left superior frontal gyrus. The margin was not clear. Operative Procedures Under ETGA, the patient was put in supine position with head fixed with Mayfield clamp. Bicoronal skin incision was done and we opened in layers and did left frontal craniotomy. And dural incision after tenting, total tumor excision was performed after localization with echo guidiance. Finally hemostasis and closed the wound in layers with subgaleal CWV xI left. Operators 曾漢民 Assistants 黃詩浩,廖御佐 手術日期：2008/05/22 08:15 摘要__ 手術科部: 婦產部 套用罐頭: Conization Pre-operative Diagnosis Vaginal intraepithelial neoplasm III Post-operative Diagnosis Vaginal intraepithelial neoplasm III Operative Method Partial vaginectomy Pathology Pending Operative Findings 1. A 0.5*0.5cm erosive lesion 9'oclock dirrection near vaginal stump. Operative Procedures 1. Put the patient on lithotomy position. 2. Vaginal douching & skin disinfection. 3. Urinary catheterization and skin draping as usual. 4. Perform partial vaginectomy with electrocauterization. 5. Check bleeding and hemostasis by electrocauterization. 6. Suture the wound with 3-0 monocryl. 7. On Foley and pack the vagina with 1 piece of gauze. EBL: minimal; BT: nil; Cx: nil Operators 張道遠 Assistants 林思宏 手術日期：2008/05/23 09:10 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Myelomeningocele Post-operative Diagnosis Myelomeningocele and Filum terminale lipoma Operative Method Repair of myelomeningocele and excision of filum terminale lipoma Pathology pending Operative Findings One buldging mass with intact skin at sacrum area was found. Dura sac was intact. The conus was tethered to the dura sac with one herniated filum terminale lipoma found Operative Procedures Under the general anesthesia with endotracheal tube intubation, the patient was set into prone position. The operation field was scrubbed and disinfected with povidine-iodine. Fusiform skin incision was done over the skin of the bulding mass longitudinally. The dura plane was dissected with microdissecter and small scissors. Then the lipoma of filum terminale and the tethered cord was identified. The cord was detethered and mobilized. The filum terminale lipoma was excised with microdissector and microscissors. The dura was closed in 2 layers (infolding) with 4-0 prolene. The fascia and subcutaneous layer was dissected. The wound edge was modified. The subcutaneous layer was closed with 3-0 dexon and the skin with 4-0 Nylone. Operators 郭夢菲 Assistants 黃詩浩,陳盈志 手術日期：2008/05/29 14:48 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis A-com aneurysm with SAH Post-operative Diagnosis A-com aneurysm with SAH Operative Method 1. Aneurysm clipping 2. EVD insertion Pathology Pending Operative Findings 1. CSF: xanthrochromic CSF. Theopening pressure was about 15cmH2O. Ventricular catheter was 6.5cm in depth. 2. Aneurysm: The brain surface was swelling after opening the dura. The aneurysm protrude from A-com and toward anterior - inferiorly, laterallymild vasospasm of left A1 was noted. Operative Procedures ETGA. Supine head fixed with Mayfield and head tilt to right 30 degree. Skin preparation. Right frontal. Right frontal curvilinear incision. Burr hole at right Kocher point. Ventricular tapping then inset EVD. Left frontal-temporal curvilinear incision with connection to EVD wound. Dissect temporalis muscle. Burr holes including key hhole. Craniotomy under 7*4 cm. Dura tenting, flatten sphenoid ridge. U-shape dura incision. Apply brain retracter to frontal side. Dissect the neck of aneurysm, bilateral A1and A2. Proximal control of left A1. Apply aneurysm clip to the neck of aneurysm. Check floor of bilateral A2. Hemostasis. Dura closure. Fix bone plate. CWV drain for one set. Close the wound in layers. Operators 王國川 Assistants 郭律廷,郭書瑞 手術日期：2008/05/30 16:00 摘要__ 手術科部: 外科部 套用罐頭: Hypophysectomy---Transphenoid Pre-operative Diagnosis Pituitary tumor, suspect macroadenoma Post-operative Diagnosis Ditto Operative Method Transnasal trans-sphenoid tumor excision Pathology Pending Operative Findings The tumor was about 3cm in diameter. It was a gray-whitish one. The tumor was a soft, fragile one. Arachnoid membrane was noted an fell intra-OP. Reddish normal gland was noyrf to be pulled aside. Intra-OP CSF leakage was noted and Tissu co-dul was applied. Operative Procedures After ETGA, the patient was under supine postion with head left tilt and mild extension. After bosmin rinsed of the bilateral nasal cavities was done. Well-disinfected over bilateral nasal cavity was done and then we incised into the mucosal septum via right nasal cavity. The bony septum was harvested andleft side pulled. The rosterum of the bony anterior sinus with vomer bone was removed. After hemostasis, the sphenoid sinus was opened, the mucosa layer were splitted. The sellar floor and the upper clivus were noted to be erosed by the tumor. It was soft, gray-whitish and fragile. Arachnoid membrane was noted intra-OP and rupturewas found. CSF leakage was noted and Tissu co-dul was applied. Normal gland was pulled aside by the tumor. After recheck of the tumor, hemostasis was done over the sellar cavity and the mucosa was covered back with gelfoam. The vomer bone graft was also covered back, and bilateral nasal cavities were filled with mirocels. Operators 杜永光 Assistants 郭律廷,陳睿生 手術日期：2008/05/31 14:56 摘要__ 手術科部: 骨科部 套用罐頭: Arthroscopic surgery Pre-operative Diagnosis Both knees internal derangement Post-operative Diagnosis Left knee ACL partial tear Operative Method Arthroscopy Pathology nil Operative Findings 1. Intact PF joint, PCL, medial meniscus and lateral meniscus, both knees. 2. Left knee ACL partial tear with laxity. 3. Mild synovitis, both knees. Operative Procedures 1. SA, supine, on pneumatic torniquet. 2. Arthroscopy. 3. Close the wound. Operators 王至弘 Assistants 陳俊和 手術日期：2008/06/04 21:46 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Right breast cancer s/p, port-A infection Post-operative Diagnosis Right breast cancer s/p, port-A infection Operative Method Removal of Port-A Pathology Nil Operative Findings Port-A catheter at left upper chest Operative Procedures 1.Under local anesthesia, skin disinfection 2.Left upper chest oblique skin incision along previous operation scar 3.Identified the port-A catheter 4.Removal of Port-A 5.Check bleeding and hemostasis 6.Closed the wound in layers Operators 張金堅 Assistants 陳賢典 手術日期：2008/06/05 18:31 摘要__ 手術科部: 外科部 套用罐頭: Lobectomy Pre-operative Diagnosis RUL adenocarcinoma , T2N2M0 s/p chemotherapy. Post-operative Diagnosis ditto. Operative Method VATS RUL lobectomy Pathology pending. Operative Findings 1.Mild adhesion of RUL apex. 2.Fibrotic scaring change was noted over mediastinum. 3.A 3x3cm yellowish-white,firm tumor with plerual retraction at RUL. 4.A enlarged firm lobar LN with adhesion to anterior branch of PA and bronchus. Operative Procedures 1.DLETGA with left decubitus. 2.Disinfection and drapping. 3.VATS setting: 7th PAL , 8th MAL , 4th AAL. 4.RUL adhesionlysis. 5.Divide interlobar fissure with endo-GIA. 6,open mediastinal pleura 7.Loop and divide RUL vein with endo-GIA. 8.Divide posterior asending A. with Suture liagtion and clips. 9.divide anterior branch of P.A with endo-GIA. 10.Divide bronchus with endo-GIA. 11.Insert 2 Fr.24 C/T , check bleeding and air-leak , wound closure. Operators 李元麒 Assistants 陳衛洲,梁嘉儀,李佳穎 手術日期：2008/06/05 11:50 摘要__ 手術科部: 泌尿部 套用罐頭: URS (biopsy) Pre-operative Diagnosis Left obstructive uropathy Post-operative Diagnosis R/O left ureteral tumor Operative Method Left URS biopsy + DBJ insertion Pathology left URS biopsy Operative Findings 1. Uneven mucosa at left low ureter, r/o urothelial carcinoma 2. Left low ureteral stricture Operative Procedures After satisfactory intravenous anesthesia and lithotomy position, the prepping and drapping were performed in usual sterile method. Left URS was inserted via guidewire, and we performed left URS biopsy. Then, we set left DBJ and Foley catheter. Understable condition, the patient was sent to recovery room for further care. Operators 黃國皓 Assistants 賴建榮 手術日期：2008/06/06 16:34 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Craniopharyngioma Post-operative Diagnosis ditto Operative Method Right subfrontal approach for tumor excision Operative Findings 1.One yellowish, hard with some calcified and cystic component tumor, around 2.1 x 2.0 cm, beneath the optic chiasm and compressed the optic nerves upward. It extended into 3rd ventricle and to the mamillary body area. 2.The optic nerves and olfactory nerve were visualized and preserved. 3.There was a capsule and the tumor was well defined. 4.Severe adhesion was noted in operative area. 5.Pituitary stalk was noticed and was pushed away by the tumor. Also, mamillary body and PCA were noticed. 6.Theposterior part of the tumor penetrated interdigitally into brain parenchyma. Operative Procedures Under ETGA, patient was put in supine position with his head fixed with Mayfield skull clamp. After well anti-septic procedure and drapping, skin inciion was made via previous wound and extended. After opening of skin flap, craniotomy that cross the midline was made. Dura was opened with the base left at midline. Frontal lobe was retracted downward. Olfactory nerve was identified then followed by visualizing optic nerves. The cystic part of tumor was drained out initially. And lamina terminalis was opend.Then, the solid part of tumor was debulked with CUSA. The posterior part capsule was reached. And dissection was performed between the capsule and arachnoid layer. Finally, it was completely removed. The mamillary body was exposed. PCA, SCA, BA and thirdnerves were exposed. After hemostasis, dura was closed with one piece of fascia. Frontal sinus was packed with gelfoam and was covered with fascia. Bone was put back and fixed with miniplate. Then wound was closed in layers. Operators 杜永光 Assistants 黃博浩,胡朝凱 手術日期：2008/06/10 13:24 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Severe AR Post-operative Diagnosis Ditto Operative Method AVR(23mm, Edward SAV tissue valve) Pathology Pending Operative Findings Tricuspid aortic valve. Prolapse of LCC and downward displacement of RCC causing severe AR. Annular calcification was not severe. Operative Procedures Under ETGA, supine position, the skin was prepared. Full sternotomy was then performed. The pericardium was tent, the AsAo, RAA--SVC and IVC were cannulated. CPB was initiated. The LUPV was vent after AXC. After transverse aortotomy, antegrade cardioplegia infusion was given through RCA and LCA orifice. The diseased aortic valve was resect. After sizing, 23mm, Edward tissue valve was used for AVR with interrupt, plegitted,horizontal mattress suture. The aorta was repair, the heart was diair, rewarm. The LUPV incision was closed. The patient was weaning off CPB. 2 chest tubes were set over pericardial space. After hemostasis, the wound was closed in layers. Operators 許榮彬 Assistants 李千慧 手術日期：2008/06/10 09:00 摘要__ 手術科部: 外科部 套用罐頭: AVR Pre-operative Diagnosis AR Post-operative Diagnosis Ditto Operative Method AVR Pathology None Operative Findings LCC prolapse, RCC downward displacement due to retraction Aortic annulus: no severe calcification Operative Procedures Under supine position, the patient was intubated with general anesthesia. After skin disinfection, full median sternotomy was performed. CPB was set by cannulation of AsAo, RAA -> SVC, IVC, with cooling to 28C. Aortic crossclamping was performed, followedby RUPV venting. Transverse aortomy was done, followed by direct antegrade cardioplegia infusion. Aortic valve was resected. AVR was performed with 23mm Edward S.A.V. tissure valve. Aortomy was closed. RUPV was closed. Afetr rewarming and de-air, CPB wasweaned off. Hemostasis was achived. 2 x chest tubes were set in medianstenum. Pericardium was closed. THe wound was closed in layers. Operators 許榮彬 Assistants 李千慧 手術日期：2008/06/11 20:00 摘要__ 手術科部: 外科部 套用罐頭: Aneurysm-frontotemporal approach Pre-operative Diagnosis A com aneurysm ruptured with ICH Post-operative Diagnosis Ditto Operative Method Right Kocher's point EVD insertion + left petrional approach for aneurysm clipping Pathology Nil Operative Findings The left previous EVD was removed with a new one replaced. Teh aneurysm dome was adherent to right A2. Teh neck was dissected and clipped. The rectus gyrus was removed for exposure of the aneurysm. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position with head fixed with Mayfield skull clump. The scalp was scrubbed, disinfected with alcohol B-I then draped. The frontotemporal scalp flap was created for pterional approach.The previous EVD was removed and replaced with one new EVD catheter. The dura was opened after tenting. The rectus gyrus was removed for aneurysm neck dissection and clipping. The aneurysmal neck was clipped. After hemostasis, the dura was closed and theskull was fixed with miniplates and screws. One CWV drain was set up before closed the wound in layers. Operators 王國川 Assistants 黃博浩,李建勳 手術日期：2008/06/12 16:18 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Breast cancer Post-operative Diagnosis Ditto Operative Method Port-A catheter implantation Operative Findings Port-A catheter was inserted via right subclavian vein smoothly, tip at SVC/RA junction Operative Procedures 1.Supine, LA 2.Oblique skin incision over right deltopectoral groove 3.Identifed right cephalic vein 4.Inserted port-A catheter but failed due to acute angle 5.Pucher the right subclavian vein, inserted catheter 6.Portable c-arm for localization 7.Fixed the port 8.Closed the wound Operators 張金堅 Assistants 丘基泰 手術日期：2008/06/13 00:00 摘要__ 手術科部: 牙科部 套用罐頭: impaction-------odontectomy Pre-operative Diagnosis Oropharyngeal cancer T2N0Mx, periodontitis Post-operative Diagnosis Oropharyngeal cancer T2N0Mx, periodontitis s/p op Operative Method Complicated extraction of #16#17#18#26#27#28#32#36#37#38#42#46#47#48 combine alveoloplasty Operative Findings several lacerative wound in bilateral buccal mucosa Operative Procedures 1.ETGA suspine position 2.Disinfection and draping were done as usual. 3.Complicated odontectomy of #16#17#18#36#37#38#46#47#48 was achieved 4.Alveolar plasty by stryker's dril 5.Irrigation was performed with N/S 6.Primary closure with 4-0 dexon 7. A piece of gauze was packed 8.The patient stood the whole procedure well. recorded by R3蔡尚節 Operators 李正 Assistants 蔡尚節蔡晴予 手術日期：2008/06/16 20:33 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis RUL adenocarcinoma Post-operative Diagnosis RUL adenocarcinoma with mediastinal LN metastasis Operative Method VATS mediastinal LN dissection and port-A insertion Pathology Pending Operative Findings 1. Soft but enlarged LNs in the Gr.3,4,7 2. A RLL tumor with viseral pleural retraction Operative Procedures 1. DLETGA, left decubitus 2. Disinfection and drapping 3. VATS, the 8th ICS-MAL, the 5th ICS-AAL, the 7th ICS-PAL 4. Mediastinal LNs dissection (Gr.3,4,7)-> frozen: focal metastasis in the Gr.3,4 LNs 5. Check bleeding and hemostasis 6. Chest tube Fr.24 x 1 7. Closed the wound in layers 8. Port-A placement via puncture into right subclavian vein Operators 李元麒 Assistants 張金池,梁嘉儀 手術日期：2008/06/16 17:40 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis RUL adenocarcinoma. Post-operative Diagnosis ditto. Operative Method Right VATS Gr. 3,4,7 LN dissection +Ｐｏｒｔ－Ａ　ｉｍｐｌｎａｔａｔｉｏｎ Pathology pending. Operative Findings 1.A 4.5x3.5x3 cm firm tumor at RUL with pleura retraction. 2.Enlarged and firm Gr.3,4 LNs , small soft Gr.7 LNs. Frozen:postive for malignancy. Operative Procedures 1.DLETGA with left decubitus. 2.Disinfection and drapping. 3.VATS setting as usual. 4.Open mediastinal pleura. 5.Gr.3,4,7 LNs dissection. 6.Check bleeding and insert 1 Fr 24 C/T. 7.Wound closure by layers. 8.Change position ti supine. 9.Port-A wasimplanted and intra-op CxR check-up. 10.Wound closure. Operators 李元麒 Assistants 陳衛洲,李佳穎 手術日期：2008/06/17 17:10 摘要__ 手術科部: 婦產部 套用罐頭: Staging surgery Pre-operative Diagnosis Pelvic tumor Post-operative Diagnosis Ovarian cancer, stage Ic, endometrioid adenocarcinoma Operative Method Staging surgery (Total abdominal hysterectomy, bilateral salpingo-oophorectomy, bilateral pelvic lymph nodes dissection, omental bipsy and peritoneal washing cytology) Pathology Frozen section: endometrioid adenocarcinoma Operative Findings 1. Uterus: Avfl, posterior wall adhesion with ROV tumor. Cervix: smooth, no gross tumor invasion. 2. ROV: one 10*10*10cm ovarianc tumor with brownish content and some dark red necrotic tissue, intraop rupture: (+). 3. LOV: grossly normal. 4. Bilateralallopian tubes: grossly normal. 5. Cul-de-sac: tumor obligated. 6. Omentum: grossly normal, infracolic omentectomy was done. 7. Extrauterine spread:(-) 8. Right pelvic lymph nodes: Normal EBL: 500ml, BT: nil, Complication: nil Operative Procedures 1. Put the patient on the lithotomy position. 2. Vaginal douching, on Foley, skin disinfection with beta-iodine, and skin draping. 3. Make midline vertical skin incision and open the abdominal wall layer by layer. 4. Apply auto-retractor and pack up the intestine to expose the uterus. 5. Little ascities, send for cytology. 6. Clamp, ligate and cut left round ligament 7. Clamp, cut and ligate left infundibulo-pelvic ligament 8. Repeat step 6~7 at right side. 9. Dissect the densely adherent posterior leaf of broad ligaments overlying the uterosacral ligaments bilaterally. 10. Dissect and reflect the bladder downwards and off the uterus. 11. Clamp, cut and ligate the ascending branches of uterine arteries bilaterally at the level of isthmus ofcervix. 12. Clamp, cut and ligate the paracervical vessels along lateral borders of cervix step by step downwards bilaterally till the level of lateral vaginal fornix. 13. Cut the uterus and grasp the vaginal stump 14. Suture the bilateral angles of vaginal stump with 1-0 Vicryl 15. Suture the vaginal stump with 1-0 Vicryl 16. Open the posterior peritoneum to expose the external iliac artery. 17. Sampling of the external iliac lymph nodes and obturator lymph nodes. 18. Step by step, clamp, cut andligate the infracolic omentum. 19. Close the retroperitoneal space interruptedly with 2-0 vicryl. 20. Insert one rubber drain at CDS 20. Check bleeding and hemostasis. 21. Close the abdomen layer by layer. 22. Skin approximation with Appose. Operators 鄭文芳 Assistants 陳宇立,林思宏 手術日期：2008/06/17 22:44 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis RML lung adenocarcinoma Post-operative Diagnosis RML lung adenocarcinoma Operative Method RML lobectomy and LN dissection, VATS Pathology Pending Operative Findings 1. 3cm x 4cm, irregular shape mass, hypercellular and yellowish, with pleural retraction 2. Gr.3,4,7: frozen: negative Operative Procedures 1. DLETGA, left decubitus 2. Disinfection and drapping 3. VATS, the 7th ICS-MAL, the 7th ICS-PAL, the 4th ICS-AAL 4. Gr. 3,4,7 LN dissection 5. Identified the lesion 6. Transect pulmonary artery by hand ligation and clips pulmonary veinby endo GIA-30 bronchus by endo GIA-45 7. Check bleeding and air-leak 8. Chest tube Fr.24 x II 9. Closed the wound in layers Operators 李元麒 Assistants 陳衛洲,梁嘉儀,許祟善 手術日期：2008/06/20 13:55 摘要__ 手術科部: 皮膚部 套用罐頭: Melanoma excision and sentinal lymph node biospy Pre-operative Diagnosis A. Melanoma B. Nevocellular nevus Post-operative Diagnosis Ditto Operative Method A. Wide excision and SLN biopsy B. excision Pathology A. Wide excision x 1, SLN x 1 B. excision x 1 Operative Findings 1. There is one 3cm surgical scar over the right upper arm. 2. There is one 0.8cm round regular brownish to blackish macule on the right upper arm. 3. There are several small (<1cm) lymph nodes in the right axillary area below the pectoralis major muscle. Operative Procedures 1. Under ETGA,the patient lied in supine position. 2. Disinfected the surgical fields at right upper arm, and right axilla 3. Injected methylene blue to the lesion site (right upper arm). 4. Marked the surgical field with 2 cm safety margin. 5. We excised the skin along the safety margin deep to the muscular fascia. Close the wound in layers with 4-0 Nylon and 3-0 Dexon. 6. We detected the highest signal (Tc99 intensity 950) at right axillary by gamma probe. We exposed the right axillary lymph nodes, and excised the sentinel lymph node. The signal intensity of the sentinel lymph nodes were 1900 and 11. 7. Adequate hemostasis was done. 8. Inserted one CWV drain at right axillary area. 9. Closed the wound in layers with 4-0 Dexon and 4-0 Nylon atright axillary area. 10. Covered the wound with BI gauze, gauze and wrapped them with tapes. 11. Excise the nevocellular nevus. Operators 陳昭旭,廖怡華,許致榮 Assistants 沈宜萱 手術日期：2008/06/25 18:00 摘要__ 手術科部: 麻醉部 套用罐頭: Port-A implantation Pre-operative Diagnosis Ovarian cancer Post-operative Diagnosis ditto Operative Method Port-A implantation Operative Procedures Under IVG anesthesia, put the patient on supine position.18G IV catheter was inserted via the internal jugular vein incision and negatively aspirated until venous blood attainable. J-wire was inserted smoothly via the needle in rostral direction.12G internal jugular catheter with dilator was inserted through the J-wire. Dilator was then removed. IV catheter was threaded into 12G catheter until mark 19cm on the catheter. Skin tunnel between internal jugular and pre-cordial incision was made by the blunt dissection with Kelly clamp. Catheter was then threaded. Port was inserted into the pouch of precordial incision. Catheter was adapted into the port and locked with restrictor. Skin was closed layer by layer. Both catheter and port were perfused with heparin solution after implantation. Site: right internal jugular approach, port-A at right subclavicle Operators 黃啟祥 Assistants 鄭孝良 手術日期：2008/06/25 11:00 摘要__ 手術科部: 麻醉部 套用罐頭: Port-A implantation Pre-operative Diagnosis Ovarain cancer Post-operative Diagnosis ditto Operative Method Port-A implantation Operative Procedures Under IVG anesthesia, put the patient on supine position.18G IV catheter was inserted via the internal jugular vein incision and negatively aspirated until venous blood attainable. J-wire was inserted smoothly via the needle in rostral direction.12G internal jugular catheter with dilator was inserted through the J-wire. Dilator was then removed. IV catheter was threaded into 12G catheter until mark 22cm on the catheter. Skin tunnel between internal jugular and pre-cordial incision was made by the blunt dissection with Kelly clamp. Catheter was then threaded. Port was inserted into the pouch of precordial incision. Catheter was adapted into the port and locked with restrictor. Skin was closed layer by layer. Both catheter and port were perfused with heparin solution after implantation. Site: right internal jugular approach, port-A at right subclavicle Operators 黃啟祥 Assistants 鄭孝良 手術日期：2008/06/30 00:00 摘要__ 手術科部: 外科部 套用罐頭: MRM Pre-operative Diagnosis Right breast cancer Post-operative Diagnosis Right breast cancer Operative Method MRM + ALND Pathology pending Operative Findings 1. Right breast tumor, 2.3x1.6cm, 9.5 o'clock, 5.5cm to nipple 2. Right ALND performed, including Level I+II 3. Thoracodorsal and long thoracic nerves were perserved Operative Procedures 1.ETGA, supine position 2.Skin disinfection and drapped as usual 3.Right breast elliptical incision 4.Right mastectomy was done 4.Identified long thoracic and thoracodorsal nerve 5.Dessected level I, II LN 6.N/S irrigation and hemostasis 7.Closed the wound in layers and Set two CWV drains Operators 張金堅 Assistants 陳賢典,曾昱超, 游彥麟 手術日期：2008/06/30 20:33 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) Pre-operative Diagnosis Lumbar spondylotic stenosis, L4-5 Post-operative Diagnosis Ditto Operative Method Bilateral L4-5 laminotomy and sublaminar decompression Operative Findings The spinous processes, lamina, and facet joints of L4-5 were thickened. The ligamentum flavum was thick also. The thecal was compressed tightly and became slack after decompression. Operative Procedures 1. ETGA, prone. 2. Low back midline incision. 3. Dissection of left paraspinal muscle from the spinous process and lamina bilaterally. 4. Removal of lower L4 and upper L5 lamina, as well as medial facet joint by high speed air drill and Kerrison punches. 5. Removal ligamentum flavum. 6. Hemostasis. 7. Repeat 3-7 over right side. 8. Two mini-HV drains in the epilaminal space. 9. Wound closure. Operators 楊士弘 Assistants 李建勳 手術日期：2008/07/01 00:00 摘要__ 手術科部: 骨科部 套用罐頭: Scoliosis-PIPF Pre-operative Diagnosis Spodylolisthesis, L3 on L4 (Gr I) and L4 on L5 (Gr II) with Spinal stenosis, L3~4 and L4~5 status post PDPIPF Post-operative Diagnosis Spodylolisthesis, L3 on L4 (Gr I) and L4 on L5 (Gr II) with Spinal stenosis, L3~4 and L4~5 status post PDPIPF Operative Method Removal of implants Operative Findings Spodylolisthesis, L3 on L4 (Gr I) and L4 on L5 (Gr II) with Spinal stenosis, L3~4 and L4~5 status post PDPIPF, implant in situ Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position on Relton-Hall frame. The operative field was scrubbed, disinfected and draped as usual. Posterior approach with midline skin incision; Deepen the incision to the level of spinous processes. Posterior approach to the L3~L5 with exposure the implants of was done. Remove the implants was then carried out.(PS x 6, rods x 2, crosslink x 1). After irrigation with N/S and hemostasis were achieved, the wound was closed in layers. Operators 陳博光,徐錫靖 Assistants 洪立維,黃興耀 手術日期：2008/07/07 00:00 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt Pre-operative Diagnosis A-com aneurysm s/p clipping with hydrocephalus Post-operative Diagnosis ditto Operative Method V-P shunting Operative Findings 1.the tract of intracranial cath was along the previous EVD 2.opening pressure was about 130mm-H2O 3.the intraperitoneal cath was about 25cm in length Operative Procedures Under ETGA, supine position. The head was tilted to left side. OP field was disinfected and draped as usual. Incision along previous OP scar on the right scalp followed by disseting the scalp till skull layer. Exposure the previous burr hole followed by opening the dura. Then find the tract to the right ventricle by ventricular probe. Minilaparotomy followed by creating the right subcutaneous turnel between right scalp and abdominal wall. Set abdominal drainage tube and implant the medium pressure valve,Stryker. Do hemostasis and fix the valve. Close the scalp and abdominal wound in layers. Operators 王國川 Assistants 黃博浩,陳德福 手術日期：2008/07/09 14:17 摘要__ 手術科部: 麻醉部 套用罐頭: Port-A implantation Pre-operative Diagnosis Disseminated malignant neoplasm Post-operative Diagnosis ditto Operative Method port-A implantation Operative Procedures Under IVG anesthesia, put the patient on supine position.18G IV catheter was inserted via the internal jugular vein incision and negatively aspirated until venous blood attainable. J-wire was inserted smoothly via the needle in rostral direction.12G internal jugular catheter with dilator was inserted through the J-wire. Dilator was then removed. IV catheter was threaded into 12G catheter until mark 20cm on the catheter. Skin tunnel between internal jugular and pre-cordial incision was made by the blunt dissection with Kelly clamp. Catheter was then threaded. Port was inserted into the pouch of precordial incision. Catheter was adapted into the port and locked with restrictor. Skin was closed layer by layer. Both catheter and port were perfused with heparin solution after implantation. Site: right internal jugular approach, port-A at right subclavicle Operators 黃啟祥 Assistants 陳世鴻 手術日期：2008/07/16 19:10 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis L4~5 spondylolisthesis with HIVD Post-operative Diagnosis ditto Operative Method Diskectomy and posterior fusion with Dynesys Operative Findings 1.Screw length: 40mm x 4 2.Buldging disc over left L4~5 disc space that compress the nerve root 3.Spondylolisthesis L4 on L5 Operative Procedures 1.ETGA, prone 2.Midline skin incision from L3~S1 3.Dissect bilateral paraspinous muscle group about 3.5 cm away from mid-line 4.Dissect to expose pedicle that lateral to facet joint 5.Insert Dynesys screws and confirmed with intra-op fluoroscopy 6.insert wires and fixed it bilaterally 7.Left laminotomy 8.Retract thecal sac and nerve root medially 9.Diskectomy 10.Insert two hemovac drain 11.Close wound in layers Operators 賴達明 Assistants 胡朝凱 手術日期：2008/07/17 15:39 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis BREAST CA Post-operative Diagnosis DITTO Operative Method PORT-A INSERTION Pathology NIL Operative Findings PATENT VENOUS FLOW AND PROPER LOCATION OF PORT-A Operative Procedures 1.Supine, LA 2.Inserted port-A catheter VIA PUNCTURE METHOD 3.Fixed the port.Closed the wound Operators 張金堅 Assistants 吳正一 手術日期：2008/07/17 21:14 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis r/o ischimic bowel Post-operative Diagnosis ischimic bowel Operative Method segmental resection of small bowel Pathology pending Operative Findings 1. a lot of turbid acsites 2. cysnotic change of small bowel about 40 cm; others pink 3. mesentary vessel palsation: weak Operative Procedures 1. ETGA , supine position 2. skin disinfection and drapped as usual 3. midline incision 4. adhesiolysis, then identified bowel condition 5. segmental resection of small bowel about 70 cm, then create an ileostomy 6. normal saline irrigation and set one rubber drain to Douglus pouch 7. Closure of the wound by layers Operators 胡瑞恆 Assistants 吳經閔,楊惠馨 手術日期：2008/07/18 04:17 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis r/o teratoma Post-operative Diagnosis r/o teratoma Operative Method Intra-abdominal tumor excision Pathology pending Operative Findings 1. One 5 cm diameter tumor. Multiconpoment with cystic-like tissue. R/O L't ovary origin 2. R't ovary: No obvious lesion Operative Procedures 1. ETGA, with supine position 2. Transverse skin incision over lower abdominal area 3. Mobileiae abdominal tumor and ligation feeding vessel-->Dossect along tumor by laters 4. Remove specimen 5. Wound closure by layers Operators 許文明 Assistants 李佳穎,蔡明憲 手術日期：2008/07/19 11:00 摘要__ 手術科部: 外科部 套用罐頭: ATYPICAL Pre-operative Diagnosis 1.Hepatocellular carcinoma (S6) 2.HBV carrier with liver cirrhosis Post-operative Diagnosis ditto Operative Method Laparocopic hepatectomy (S6 + partial S7) Operative Findings 1.gross macronodular liver cirrhosis. 2.a 2x2cm lobulated, yellowish tumor at S6. 3.minimal ascites. Operative Procedures 1.ETGA, left ducubitus position. 2.Mini-laparotomy for subumbilical camera port. 3.Set another 3 working ports (10-10-5) at right subcostal area. 4.Perform bi-subsegmentectomy by Harmonic saclpel and bi-polar electrocauterizer. 5.Tissue-culdo for liver raw surface hemostasis and then surgicel coverage. 6.Set one CWV drain in right subhepatic area. 7.Remove specimen from subumbilical wound. 8.Wound closure in layers. Operators 吳耀銘 Assistants 林昊諭,許閔彥 手術日期：2008/07/21 12:45 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT Pre-operative Diagnosis Suprasellar tumor, suspected craniopharyngioma Post-operative Diagnosis Suprasellar tumor, suspected craniopharyngioma Operative Method Subfrontal approach for total tumor excision Operative Findings The tumor located at the suprasellar lesion and compressed the optic nerves and pituitary stalk. The tumor was a cystic lesion with some solid part located at the left side. The fluid inside the tumor was yellowish and clear, and the solid part was yellowish, soft, and lipid-rich. The capsule was totally removed via the margin of arachnoid membrane. It was well supplied from the superior hypophyseal trunk. Operative Procedures Under ETGA, we put her in supine position with head fixed by Mayfield. Disinfection and drapping were done as routine. Bicoronal scalp incision, 15cm in length, was made. After three Burr holes were created, a craniotomy window, about 8x6cm, was made atright frontal area. Dura was opened via the margin after dura tenting. Right frontal lobe was retracted upward, and bilateral optic nerves and right olfactory nerve were identified. The tumor was located at the suprasellar area, and we approach it via post-chiasmatic region. The tumor capsule was carefully dissected from the plane between arachnoid membrane. The cystic fluid was drained, and the tumor capsule was totally removed. After hemostasis was done, dura was tightly closed with a fascia graft. Theskull was recovered and fixed with Miniplates after central tenting. After setting one subgaleal CWV drain, we closed the wound in layers. Operators 曾漢民 Assistants 陳睿生,莊民楷 手術日期：2008/07/22 00:00 摘要__ 手術科部: 泌尿部 套用罐頭: TUR-BT Pre-operative Diagnosis r/o prostate cancer,Bladder tumor Post-operative Diagnosis r/o prostate cancer; bladder neck tumor, r/o prostate cancer invasion Operative Method TURBT(Transurethral resection of bladder tumor) and TRUSP biopsy Pathology pending Operative Findings 1. polypoid tumor around the bladder neck 2. 12+3 cores TRUSP biopsy was performed Operative Procedures 1. Under satisfactory anesthesia with the patient in lithotomy position, prepping and draping was performed in the usual sterile fashion. 2. TRUSP was performed and echo-guided prostate biopsies were performed smoothly with Biopty gun. The cores of tissue specimen were obtained. 3.The biosy area was compressed for several minutes to ensure adequate hemostasis. 4. A Fr 22 Olympus Resectoscope was inserted into the urethra and bladder, and the whole bladder was inspected carefully. This revealed presence of fungating tumors located at bladder neck. Trigone and bilateral orifices were identified and inspected carefully. 5. The tumors were resected with resectoscope, piece by piece. 6. The resected tissues were removed with Ellik evacuator. 7. Adequate hemostasis was then obtained. 8. A 22Fr. 3-way Foley catheter was inserted and continuous bladder irrigation with normal saline started. 9. The balloon was inflated to 40 cc. 10. The patient was then sent to the recovery room in a stable condition. Operators 賴明坤 Assistants 洪順發 手術日期：2008/07/29 11:00 摘要__ 手術科部: 骨科部 套用罐頭: Excision of soft tissue tumor, benign, large or deep Pre-operative Diagnosis Left upper back tumor Post-operative Diagnosis Left upper back tumor Operative Method Tumor excision Pathology pending Operative Findings one 2x2x1 cm, yellowish, elastic well-defined tumor over left upper back Operative Procedures 1. Anesthetic inducion, on right lateral decubitus position. 2. Skin disinfected and draped. 3. Longitudinal skin incision over tumor. 4. Dissected tumor margin; then removed. 5. Irrigated with normal saline and hemostasis. 6. Closed wound by layers. Operators 楊榮森 Assistants 薛永德,王政為 手術日期：2008/07/31 14:48 摘要__ 手術科部: 泌尿部 套用罐頭: nephroureterectomy + bladder cuff resection Pre-operative Diagnosis R/O left ureter tumor Post-operative Diagnosis R/O left ureter tumor Operative Method Hand-assisted laparoscopic nephroureterectomy and bladder cuff resection,left side Pathology Pending Operative Findings 1.No obvious tumor visible at left kidney and proximal ureter 2.Severe adhision of left urter near internal ilac artery 3.Left internal ilac artery injury when dissecting ureter, s/p ligated 4.EBL 400ml Operative Procedures Under satisfactory endotracheal general anesthesia with the patient in a right flank position,prepping and draping was performed. A 7 cm left low oblique abdominal skin incision was carried out and it was deepened into peritoneal cavity. The ureter wasidentified and marked with a stay suture. A Hand-port device (Gelport) was placed at this wound. A 5-12 mm Versaport was inserted at LLQ of abdomen. Pneumoperitoneum was created by inflation with CO2 to the pressure of 15 mmHg. The second 5-12 mm Versaport for working was placed subcostally under the optic assistance. After taking the ascending colon down with Ultrashear, Geota's fascia was identified. After isolating the Geota's fascia, The Lt renal pedicle was identified. The gonal and adrenal veinswere clipped with Hemolocks and divided. The renal artery and renal vein were also identified, separaated from surrounding tissue. These were doubly clipped with Hemolocks and divided. The adjacent tissue of the Lt kidney was further mobilized, divided. The Gelport and trocars were removed. Wound exposure was obtained with retractors. The ureter was further dissected till near common iliac artery, severe adhision was noted. We tried dessected left ureter but it was still very difficult. However, internaliliac artery was injured and hemostasis was performed by ligation internal iliac artery. Left kidney and proximal ureter were removed. Two #7 CW drain was placed through renal fossa and left ureter stump. We closed the wound of ports with endoclosure device after placing a patch of surgicel at the right renal fossa and adequet hemostasis.The wound was closed by layers with 1-O vicryl on the peritoneum and 1-O silk, figure-of-eight sutures on the fascia. The skin was closed with 3-O nylon stitches. The patient tolerated theoperation well and was sent to the recovery room with stable condition. The blood loss was estimated to be 400 c.c. Operators 黃國皓 Assistants 翁文慶,陳聖復 手術日期：2008/08/05 19:00 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis left breast tumor Post-operative Diagnosis ditto Operative Method Needle localization+partial mastectomy Pathology pending Operative Findings 1.2 previous needle localization sites over left breast 2.tumor excision with safe margin Operative Procedures 1.IVG+mask, supine with left arm abduction 2.Disinfect and drap 3.Make skin incision over upper pole of left aveola and 2/10 tumor site 4.Partial mastectomy with safe margin 5.Menticular hemostasis 6.Place a penrose drain on the axilla side wound 7.Close in layers Operators 黃俊升 Assistants 潘為元,趙崧筌 手術日期：2008/08/05 13:32 摘要__ 手術科部: 外科部 套用罐頭: OPCAB Pre-operative Diagnosis CAD, 3VD Post-operative Diagnosis ditto Operative Method OPCAB Pathology nil Operative Findings 1.Fair LV contracitlity 2.CAD, 3VD: LM: patent LAD: heavy calcification, proximal to middle seg. 80-90% stenosis LCx: Mid 80% stenosis RCA: distal 70% stenosis and heavy calcification Operative Procedures 1.Under supine position, the patient was intubated with generel anesthesia. 2.After skin disinfection, full median sternotomy was performed. 3.Left GSV was harvested with open method. LIMA was harvested. OPCAB was performed in sequence: LIMA -> LAD,GSV1: AsAO-> PDA, GSV2: AsAO -> OM2. 4.After hemostasis, 2 x chest tubes were set.(left pleura open) 5.The wound was closed in layers. Operators 許榮彬 Assistants 李孟霖,林明賢,林哲安 手術日期：2008/08/05 11:20 摘要__ 手術科部: 骨科部 套用罐頭: Total knee replacement-Medial, standard Pre-operative Diagnosis bilateral knee osterarthritis Post-operative Diagnosis bilateral knee osterarthritis s/p left TKR Operative Method left TKR,zimmer (F:E# ,T:5# ,P:32# ,I:10mm) Pathology pending Operative Findings 1. Cartilage wearing and subcondral bone exposure 2. Osteophyte formation 3. Varus deformity Operative Procedures Under spinal anesthesia, the patient was placed in supine position. The operation field was disinfected and draped as usual. After inflate air tourniquet at 300 mmHg, skin incision was done along midline of knee and approach the knee via medial approach.Bony preparation of femur, tibia and patella were performed with "Zimmer" jigs subsequently. Applied total knee prosthesis with cement, Tibia: #5, Femur: "E", Patella: 32#, Insert: 10mm. Then deflate air tourniquet and check bleeding.Lateral release wasperformed and after clean surgical wound with normal saline irrigation, a 1/4" H/V drain was inserted, and finally the wound was closed in layers. Operators 江清泉 Assistants 陳致宇,陳勇璋,黃偉程 手術日期：2008/08/05 12:23 摘要__ 手術科部: 泌尿部 套用罐頭: cystoscopy（biopsy ) Pre-operative Diagnosis Urethral tumor Post-operative Diagnosis Ditto Operative Method Cystoscope + biopsy Pathology pending Operative Findings Mutiple, small tumor like leision at urethra Operative Procedures 1. IVG and lithotomy position 2. Disinfection and drapping 3. Cystoscope was inserted into urethra and biopsy 4. TUR-P instrument was inserted in urethra 5. Electrocoagulation 6. Placed 20 Fr 3 way foley with 1 cc balloon 7. Operation finished Operators 闕士傑 Assistants 陳億聲,許崇善 手術日期：2008/08/07 08:57 摘要__ 手術科部: 婦產部 套用罐頭: TVT Pre-operative Diagnosis USI Post-operative Diagnosis ditto Operative Method Tension free vaginal tape suspension(TVT) Pathology Nil Operative Findings 1. cystocele Operative Procedures 1. Put the patient on lithotomy position 2. Douching, urine catheterization, disinfecting with beta-iodine and skin draping as usual 3. Inject dilute pitressin (1:100) into anterior vaginal submucosa and paravesicle space. 4. Make a vertical skin incision 1cm below the urethral orifice 5. Make a blind tunnel from the incision wound to reach retropubic space bilaterally 6. Apple catheter guide foley to avoid injury of urethra 7. Insert TVT into the blind tunnel to retropubic space bilaterally 8. Make two small skin incisions of 0.5 cm on lower abdominal area 9. Perform cystoscopy to check if any bladder injury. 9. Adjust the tension of the TVT according the urine leakage. 10. Remove the sheath of the TVT and cut the end of the TVT. 11. Repairthe vaginal wall and lower abdominal wall. 12. Pack the vagina with one piece of gauze and on Foley Estimated blood loss：minimal Blood transfusion：nil Complication：nil Operators 張道遠 Assistants 陳芊 手術日期：2008/08/07 10:33 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Lung canacer with percardium effusion Post-operative Diagnosis ditto Operative Method pericardiotomy Pathology pending Operative Findings 1. yellowish effusion gush out from percardium space 2. effusion collected for study Operative Procedures 1. ETGA, supine 2. subxyphoid skin incision 3. dissect of pericardial tissue and fat 4. identify of pericardium and perform pericardiotomy 5. insertion of 28Fr L-shape chest tube into pericardium 6. close wound Operators 李元麒,黃培銘 Assistants 張彥俊,陳劭芊 手術日期：2008/08/09 09:00 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT Pre-operative Diagnosis Right frontal low grade glioma Post-operative Diagnosis Ditto Operative Method Tumor excision via right F-T craniotomy Pathology Pending Operative Findings The residual tumor was removed til the posterior inferior margin reached the sylvian fissure. The anterior medial portion almost reached the lateral ventricle(about 3~5mm according to intraoperative sonography). After hemostasis, the tumor bed was clear. Operative Procedures Under endotracheal tube general anesthesia, the patient was put at supine position with head tilt to left side. Skin incision was made via previous wound and the craniotomy bone plate was removed. The dural was opened after removed old sutures. Intra-operative sonography was used for localization of the residual tumor. The residual tumor was removed under microscope assistance. After hemostasis, the dura was closed with prolene and the craniotomy bone plate put back. Miniplate was applied for fixation of craniotomy bone plate. One subgaleal CWV drain was placed and the wound was closed in layers. Operators 王國川 Assistants 黃博浩,李振豪 手術日期：2008/08/12 15:08 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Left UTCC, s/p laparoscopic nephrectomy Post-operative Diagnosis Ditto Operative Method Segmental resection of small bowel and anastomosis Pathology Pending Operative Findings 1. Severe adhesion between sigmoid colon to the abdominal wall and pelvic wall. Fibrosis or tumor related? 2. Terminal ileum, ~10 cm and ~30 cm above ileocecal valve, adhered to the pelvic wall. Fibrosis or tumor related? 3. Firm mass around sigmoid colon, pelvic wall, left iliac vessel and terminal ilum Operative Procedures 1. F/U Urologist 2. Adheionlysis 3. Serosa tear was noted at terminal ilum 4. Segmental resection of small bowel 5. End-to-end anastomosis of small bowel 6. -->Urologist Operators 林本仁 Assistants 吳孟哲,陳建嘉 手術日期：2008/08/12 18:48 摘要__ 手術科部: 泌尿部 套用罐頭: 其他 Pre-operative Diagnosis Left distal ureter tumor Post-operative Diagnosis Left distal ureter tumor Operative Method Left distal ureterectomy and bladder cuff resection Operative Findings 1. Severe adhesion of left distal ureter and bladder cuff 2. R/o Tumor invasion to pelvic wall and external iliac vessels 3. Blood loss 650ml 4. Severe adhession between sigmoid colon to abdominal wall, pelvic wall fibrosis or tumor related was suspected 5. Terminal ileum ~10cm above ileocecal valve adhesion to the pelvic wall, pelvic wall fibrosis or tumor related was suspected 6. Firm mass around sigmoid colon, pelvic wall, left iliac vessel, termial ileum Operative Procedures After general anesthesia, an midline incision was made at lower abdomen and it was deepened into the peritoneal cavity. The severe adhesion of bowel was identified. We consult GS for adhesialysis and segmental resection of ileum due to severe adhesion ofintestine. Besides,Severe adhession between sigmoid colon to abdominal wall, pelvic wall fibrosis or tumor related was suspected. We sent some tissue to frozen section of pathology. It revealed fibrovascular tisuue without malignancy. The ureter and gonadal vein was first identified, and the ureter was controlled with1-0 silk ligation. Then the ureter was dissected toward the uretero-vesical junction and the bladder cuff was divided and closed with 2-0 Vicryl sutures. The ureteral stump was ligated with a1-0 silk ligation and covered with gauze. After adequate hemostasis and recheck bleeder and removal all the gauze, CWV was put near the bladder cuff. Then the patient was sent to 4FI for further care. Operators 黃國皓 Assistants 賴明志,姜秉均 手術日期：2008/08/13 15:30 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Ditto Operative Method Right Kocher's point VP shunt Pathology Nil Operative Findings 1. CSF opening pressure: 16cmH2O 2. Ventricular catheter: 6.5 cm,peritoneal catheter: 25cm. Medium pressure, Medtronic burr-hole type reservoir was used. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position with shoulder elevated and head turned to left. The scalp was shaved, scrubbed, antiseptic with alcohol B-I then draped. A curvilinear skin incision was made at right frontal region followed by burr hole craniotomy. The dura was incised after tenting. A ventricular puncture needle was used to puncture then shifted to nelaton tube. Minilaparotomy was made at right upper abdomen and the peritoneal catheter was inserted and test function. The shunt cather was then passed through subcutaneous layer of abdomen, anterior chest wall, neck, retroauricular area then connected to the reservoir. The nelaton tube was then changed to ventricular catheter and connected to the reservoir. After testing the shunt function, the wounds were closed in layers. Operators 蔡瑞章 Assistants 李建勳,李佳舫 手術日期：2008/08/13 17:05 摘要__ 手術科部: 外科部 套用罐頭: Cad Pre-operative Diagnosis CAD, 3VD Post-operative Diagnosis ditto Operative Method CABG Pathology nil Operative Findings 1.Fair LV contractiltiy 2.CAD, 3VD LAD: proximal long seg severe stenosis > 90% LCx: proximal 90% stenosis RCA: proximal 90% stenosis Operative Procedures 1.ETGA, supine position, median sternotomy 2.Hearvest bilateral GSV 3.AsAo, RAA cannulation, on CPB, partial bypass 4.CABG was performed in sequence: SVG:1.AsAo-> OM1->PDA -> LAD 5.rewarm, deair, weaning off CPB 6.After hemostasis, 2 chest tubes were set in pericardium cavity 7.The wound was the closed in layers. Operators 陳益祥 Assistants 李千慧,林明賢 手術日期：2008/08/13 08:10 摘要__ 手術科部: 泌尿部 套用罐頭: adrenalectomy, left Pre-operative Diagnosis Left adrenal tumor Post-operative Diagnosis Left adrenal tumor Operative Method Left partial laparoscopic adrenalectomy Pathology cortical adenoma Operative Findings 2 Cm-sized yellowish tumor in upper pole of adrenal gland Operative Procedures Under satisfactory anesthesia with the patient in left flank position, prepping and draping were performed in the usual sterile fashion. A 16Fr. Foley was inserted into the bladder before the positioning. A 5-12 mm visiport was created at paraumbilical area with CO2 inflation up to 15 mmHg. Two 2-mm miniports were furtherly placed at LUQ along mid-clavicular line and anterior axillary line. The descending colon was taken down, and the Gerota's fascia was opened. The left adrenal gland was exposed after careful dissection. The left adrenal tumor was delivered and removed after being entrapped into the finger of surgical glove as retrieval bag. Adequate hemostasis was obtained. The wound was closed with 5/8 dexon and skin was closed with 3-0 nylon. The patient tolerated the procedure well and was sent to post-operative room in stable condition. Operators 闕士傑 Assistants 柯智群 手術日期：2008/08/15 11:28 摘要__ 手術科部: 外科部 套用罐頭: HIVD Pre-operative Diagnosis HIVD, L4-5 Post-operative Diagnosis ditto Operative Method Microscopic diskectomy Pathology nil Operative Findings The L4/5 intervertebral disk protruded posteriorly. No ruptured disk was found. After removing of the buldging disk, the thecal sac was well-decompressed. Operative Procedures Under ETGA and prone position with trunk-flexion. C-arm was used to localize the L4 and L5. Posterior low back skin incision was done and followed by splitting the left paraspinal muscles. Left L4 laminectomy was done. Removal of ligmentum flavum and epidural fat was done. Split the thecal sac and root medially and harvest the intervertebral disk. Remove the buldging disck with disk clap and currette. Hemostasis and close the wound in layers. Operators 賴達明 Assistants 陳睿生,高明蔚,賴佐庭 手術日期：2008/08/15 19:49 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Coccygeal tumor, suspect chordoma Post-operative Diagnosis ditto, tumor type undetermined Operative Method Posterior approach for toal tumor excision Pathology pending Operative Findings The tumor was noted at the anterioinfecior aspect of the coccyx. The tumor size was about 3.5cm in diameter and it was firmly attached to the coccyx abd oerioheral tissue. The tumor occupied mainly at the retroperitoneal space. Rectum was noted anteriorlyand intact. The low part of the coccyx was removed and the end part of filum terminale was noted and electroligated. Operative Procedures Under ETGA and prone position, the patient was mildly flexed. Curvillinear incision at the upper part of the buttock. The tumor was noted attached to the coccyx and it was also extended anteriorly. It was carefully dissected from the peripheral connectivetissue. The lower part of the coccyx was removed. Hemostasis and the fascia was closed tightly. We set a CWV drain and the wound was closed in layers. Operators 賴達明 Assistants 陳睿生,高明蔚 手術日期：2008/08/16 08:45 摘要__ 手術科部: 骨科部 套用罐頭: Reconstruction of cruciate ligament-arthroscope Pre-operative Diagnosis ACL rupture, right knee Post-operative Diagnosis 1. ACL rupture, right knee 2. Medial and lateral meniscus posterior horn tear, right knee Operative Method 1. Arthroscopic double-bundle reconstruction of right knee ACL 2. Partial meniscectomy, right knee med and lat meniscii Pathology Pending Operative Findings 1. ACL rupture, right knee 2. Medial and lateral meniscus posterior horn tears, right knee Operative Procedures 1. ETGA, supine, on tourniquet 2. Disinfection and draping 3. Created right knee arthroscopy ports 4. Partial meniscectomy of right knee medial and lateral posterior horn tears 5. Harvested right semitendinosis and gracilis autografts 6. Drilled tibial and femoral tunnels for AM and PL bundles with arthroscopic jig guides 7. Passed grafts from tibial to femoral tunnels 8. Fixed femoral ends with Endobuttons, tibial ends with Bioscrews 9. Stapled residual graft ends to tibial bone 10. N/S irrigation, closed wounds in layers Operators 王至弘 Assistants 陳致宇,吳拓 手術日期：2008/08/18 09:30 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Pituitary adenoma s/o transsphenoidal adenomectmoy with CSF rhinorrhea Post-operative Diagnosis Ditto Operative Method Sphenoid sinus packing with autologus fat pad Pathology Nil Operative Findings CSF rhinorrhea severely over left side without definite leakage site. Minimal residual adenoma was noted and removed during operation. No appearent CSF leakage after fat pad packing. Operative Procedures Under endotracheal tube general anesthesia, the patient was put at supine position. The skin and nasal, oral mucosa were disinfected with B-I then draped. Mucosal incision was made at left nasal cavity followed by deviation of nasal septum. The vomer bone was removed to expose the sphenoid sinus. The residual tumor was removed by suction. Harvested the fat pad from right abdomen via previous operative site. Packing the sphenoid sinus with fat pad. The vomer bone was put back and nostril packing was doneafter reposition of nasal mucosa. Lumbar puncture was performed for lumbar drain setting. Operators 曾漢民 Assistants 李建勳,李振豪 手術日期：2008/08/19 19:21 摘要__ 手術科部: 外科部 套用罐頭: MRM Pre-operative Diagnosis Left breast ductal carcinoma in situ, status post needle localization Post-operative Diagnosis Left breast ductal carcinoma in situ, status post needle localization Operative Method Modified radical mastectomy and sentinel lymph node dissection Pathology Pending Operative Findings 1. No grossly palpale breast tumor 2. Sentinel lymph nodes were located with Navigator at left axilla 3. Imprint cytology of sentinel lymph node 1&2 : negative Operative Procedures 1. Under ETGA, supine position with left arm 105 degrees abducted 2. Skin disinfection and draping 3. Make an elliptical skin incision including the nipple-areolar complex 4. Dissect the skin flaps with electrocauterization, superiorly to the clavicle,medially to the midline, laterally to the border of latissimus dorsi, and inferiorly to the rectal sheath 5. Remove the left breast tissue 6. Identify the sentinel lymph nodes with Navigator 7. Sentinel lymph node dissection and sent for imprint cytology 8. Hemostasis 9. Wound irrigation with normal saline 10. Set 2 CWV drains 11. Wound closure in layers Operators 黃俊升 Assistants 潘為元,古恬音 手術日期：2008/08/22 08:38 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt Pre-operative Diagnosis Hydropcephalus s/p VP shunt Post-operative Diagnosis ditto, s/p VP shunt revision Operative Method VP shunt revision Pathology nil Operative Findings The CSF was clear. THe VP shunt was patent. Operative Procedures Under ETGA and supine position, skin disinfection and draping was underwent. Skin incision along the previous op scar. Expose the VP shunt. Skin incision 3cm below the previous op scar. Shunt elongation by using a straight connector in between the old andnew catheters and insertion into the peritonium. Hemostasis and wound closure in layers. Operators 郭夢菲 Assistants 陳睿生,高明蔚,許君豪 手術日期：2008/08/24 15:00 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Liver cirhosis Post-operative Diagnosis ditto Operative Method Cadaver liver transplant Pathology pending Operative Findings 1. Severe cirhosis of liver, weight 580gm, right lobe atrophy, no tumor 2. Large amount of ascites 3. Portal vein, 12mm(Rt) and 15mm(Lt) in diameter 4. Hepatic artery, 2mm in diameter with lumen dissection. A suspected artery branch was noted at rightside of liver but without strong flow (1mm) 5. CBD: 9mm in diameter 6. Hepatic vein: 10mm (Rt), 6mm and 4mm (Mid*2), 16mm (Lt) 7. Donor hepatic artery: 3mm; donor portal vein: 7mm Operative Procedures 1.ETGA, with supine position. 2.Disinfection then draping. 3.Make bilateral subcostal laparotomic skin incisions, with extension to xyphoud. 4.Adhesiolysis and ascites drainage 5.Mobilize the liver 6.Hilum dissection then divide the CBD & hepatic artery. 7.Total hepatectomy: divide the portal vein --> short hepatic vein --> hepatic vein --> remove specimen. 8.Cross clamp the IVC --> IVC anastomosis (donor IVC-recipient hepatic vein). 9.Portal vein anastomosis --> stop cross clamp the IVC. 10.Hepatic artery anastomosis by platic surgeon via microscope. 11.CBD anastomosis with T-tube (bile duct tube) as stent, cholecystectomy 12.Irrigation with copious warm normal saline & hemostasis. 13.Place 2 J-P drains at right subhepatic area and subphrenicarea. 14.Close the wound in layers. Operators 李伯皇,胡瑞恆,何明志 Assistants 林耿立,蔡東明 手術日期：2008/08/25 10:20 摘要__ 手術科部: 外科部 套用罐頭: App Pre-operative Diagnosis Appendicitis Post-operative Diagnosis Appendicitis Operative Method Appendectomy Pathology Pending Operative Findings 1. Erythematous cahnge of the appendix. The diameter of appendix is ~1cm, the length of the appendix is ~7cm long. 2. Mild clear ascites. 3. Fragile tissue. Operative Procedures 1. ETGA, supine 2. Disinfection and draped 3. Right paramedian incision 4. Identify the appendix 5. Ligate and resect mesoappendix 6. Ligate and resect the appendix at the base 7. Cover the appendix with soft tissue. 8. Irrigation with wet gauze 9. Place a CWV drain at Dogulas pouch 10. Close the wound in layers Operators 王明暘 Assistants 吳孟哲,陳姿君.張鈺斌 手術日期：2008/08/27 07:30 摘要__ 手術科部: 麻醉部 套用罐頭: Port-A implantation Pre-operative Diagnosis lung cancer Post-operative Diagnosis ditto Operative Method port-A insertion Pathology nil Operative Findings NP Operative Procedures Under IVG anesthesia, put the patient on supine position.18G IV catheter was inserted via the internal jugular vein incision and negatively aspirated until venous blood attainable. J-wire was inserted smoothly via the needle in rostral direction.12G internal jugular catheter with dilator was inserted through the J-wire. Dilator was then removed. IV catheter was threaded into 12G catheter until mark cm on the catheter. Skin tunnel between internal jugular and pre-cordial incision was made by the bluntdissection with Kelly clamp. Catheter was then threaded. Port was inserted into the pouch of precordial incision. Catheter was adapted into the port and locked with restrictor. Skin was closed layer by layer. Both catheter and port were perfused with heparinsolution after implantation. Site: right internal jugular approach, port-A at right subclavicle Operators 黃啟祥 手術日期：2008/08/30 16:38 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Liver cirrhosis, liver recipient, post-op intraabdominal bleeding Post-operative Diagnosis Ditto Operative Method Exploratory Laparotomy Pathology Pending Operative Findings Massive blood clot and hematoma over peri-liver space, volumn: 1500ml. Operative Procedures 1. ETGA, supine. 2. Skin disinfection then drapped. 3. Pre-op wound re-open. 4. Irrigation blood colt and hematoma over peri-liver space with normal saline. 5. Liver biopsy. 6. Close wound in layers. Operators 何明志 Assistants 吳正一,廖先啟 手術日期：2008/09/02 14:54 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Right frontal low grade glioma Post-operative Diagnosis Right frontal low grade glioma Operative Method Tumor excision via right F-T craniotomy Operative Findings The residual tumor was removed til the posterior inferior margin reached the sylvian fissure. The anterior medial portion almost reached the lateral ventricle(about 3~5mm according to intraoperative sonography). After hemostasis, the tumor bed was clear. Operative Procedures Under endotracheal tube general anesthesia, the patient was put at supine position with head tilt to left side. Skin incision was made via previous wound and the craniotomy bone plate was removed. The dural was opened after removed old sutures. Intra-operative sonography was used for localization of the residual tumor. The residual tumor was removed under microscope assistance. After hemostasis, the dura was closed with prolene and the craniotomy bone plate put back. Miniplate was applied for fixation of craniotomy bone plate. One subgaleal CWV drain was placed and the wound was closed in layers. Operators 王國川 Assistants 黃博浩 手術日期：2008/09/03 13:58 摘要__ 手術科部: 外科部 套用罐頭: 肝右葉 Pre-operative Diagnosis HCC of right lobe Post-operative Diagnosis HCC of right lobe Operative Method Right hepatic lobectomy + partial S4 resection+ T tube insertion with exploratory of biliary tract Operative Findings 1. Tumor location: SegmentS4,S5,S8 ___________ 2. Tumor size: solitary: 10X8X8cm. Multiple: _________________ 3. Color: Gray. 4. Consistence: Solid 5. Ascites: No Splenomegaly: No( ) 6. Liver cirrhosis: No; 7. Tumor thrombosis: No 8. Capsule:Yes;well-defined 9. Regional invasion: No Operative Procedures After the abdomen was opened through a long right subcostal incision with a midline extension to the xyphoid, two self-retaining retractors of Kent type were used to retract the costal margins. The liver was mobilized by dividingthe falciform and triangular ligaments as well as freeing the liver from diaphragm. The right hepatic lobe was rotated medially to expose the small hepatic veins communicating with the inferior vena cava, and these small vessels were ligated carefully. The hepatic tumor was palpated, and examined with intraoperative sonography to identify its location and relation between major vessels. The cystic artery and cystic duct were ligated, and the gallbladder was removed. A clear exposure and looping with one red elastic band of the right hepatic artery without interfere the bifurcation to the left hepatic artery was performed. ((Angiogram was reviewed. The right hepatic artery, arising from the superior mesenteric artery, was identified.)) The right portal vein was also well exposed and looped with blue elastic band. The right hepatic vein was looped and divided with vascular clamps, and vascular sutures were used to secure the stumps. The concave line of demarcation following the color change subsequent tolooping of the blood supply may be superficially outlined with a electrocautery. Hepatic resection was started at the inferior border of the line of demarcation with aids of (1) CUSA and bipolar coagulator,(2) silk sutures on both section sides, (3) microwave coagulator tocontrol bleeding. Larger branches of vessels and hepatic ducts were doubly ligated. After the specimen was removed we also explorered the biliary tract . placed a T tube then copious warm normal saline irrigation, all bleeding and bile leakage on the section surface was rechecked and controlled with spreading function of electrocoagulator and surgicels overlain. The abdomen was closed in layers after insertion of two rubber drain tubes in right subphrenic and subhepatic space near the hepatic sectionsurface. Remarks: blood loss:100 c.c. operation time: transfusion: 手術日期：2008/09/04 16:20 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Sacral fistula Post-operative Diagnosis Sacral fistula Operative Method Debridement and tumor excision Pathology Pending Operative Findings A deep tumor was noted while performing fistulectomy and debridement. The tumor was irregular and yellowish, size was about 4*3*1 cm3. Operative Procedures ETGA. Prone. Antiseptics. Fistulectomy and debridement Tumor excision Irrigation BI gauze packing Operators 楊永健 Assistants 陳思恆,陳姿君 手術日期：2008/09/11 18:15 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Scaral fistula Post-operative Diagnosis Scaral fistula Operative Method Debridement and vac insertion Pathology Nil Operative Findings A /p wound about 2 cm was noted in sacral area. Wound condition: clean Operative Procedures ETGA. Prone. Antiseptics Debridement Inset vac Operators 楊永健 Assistants 陳思恆,陳姿君 手術日期：2008/09/12 16:45 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Ischemic bowel, suspect SMA dissection Post-operative Diagnosis Ischemic bowel Operative Method Bowel segmental resection Pathology Pending Operative Findings 1. Mottling and ischemic change from Triez's ligament to terminal ileum, most severe at proximal 60 cm jejunum 2. SMA was examed by intra-operative echo, and it showed small dissection flap Operative Procedures 1. ETGA with supine position, disinfection 2. Midline abdominal incision 3. Exam all length of small bowel, ischemic change was noted at nearly all small intestine below Triez's ligament. 4. Table consult with CVS for bypass. Large diameter of SMA wasdissected out, pulsation(+), no obvious dissection was noted by echo 5. Resection of proximal 60 cm jejunum from Triez's ligament by GIA, side-to-side anastomosis 6. Hemostasis, close wound with layers 7. POR Operators 陳炯年 Assistants 黃彥鈞,蘇彥榮 手術日期：2008/09/19 14:13 摘要__ 手術科部: 外科部 套用罐頭: HIVD Pre-operative Diagnosis Cervical spondylotic radiculopathy, left C7 & C8 Post-operative Diagnosis Ditto Operative Method Anterior cervical diskectomy of C6-7, C7-T1, and interbody cage fusion Operative Findings 1. Bony spur over anterior vertebral bodies of C6-T1. 2. Relatively healthy intervertebral discs. 3. Hypertrophic PLL and uncinate process over the left C6-7 & C7-T1 disc levels, causing compression of the nerve roots. 4. The left C7 and T1 neuroforamen was free from tension after decompression. Operative Procedures 1. ETGA, supine, neck extended. 2. Right anterior neck incision. 3. Dissection between the SCM and strap muscles to reach the prevertebral fascia. 4. Intra-op. C-arm localization of C6-7 & C7-T1 levels. 5. Anterior microsurgical diskectomy of C7-T1.6. Removal of posterior spurs and PLL with currete, Kerrison punches, and nerve hook. 7. Insertion of interbody cages filled with hydroxyappatite particles. C6-7 cage size: 12 mm deep, 6 mm high; C7-T1 cage size: 12 mm deep, 5 mm high 8. One CWVdrain left in neck wound. 9. Wound closure in layers. Operators 楊士弘 Assistants 蘇亦昌,陳凱翔 手術日期：2008/09/24 21:20 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Parkinson's disease s/p DBS insertion with low battery Post-operative Diagnosis Ditto Operative Method DBS generator replacement Operative Findings DBS generator normally function after replacement Operative Procedures Under ETGA. Supine position with left shoulder elevated. The skin was scrubbed and disinfected with alcohol B-I then draped. The skin incision was made along previous OP scar. The previous generator was dissected from surrounding soft tissue. The newgenerator was inserted and tested. After irrigation the wound with gentamicin solution, the wound was closed in layers. Operators 曾勝弘 Assistants 李建勳,陳凱翔 手術日期：2008/09/25 21:39 摘要__ 手術科部: 外科部 套用罐頭: Lobectomy Pre-operative Diagnosis Adenocarcinoma, right upper lobe, status post VATS LND and chemotherapy Post-operative Diagnosis Ditto Operative Method VATS right upper lobe lobectomy Pathology Pending Operative Findings 1. 4x3 cm firm whitish hypercellular mass with pleural retraction over RUL 2. Adhesion of chest cavity especially in RUL apex extrapleural approach for adhesiolysis 3. No obvious group 3,4 LN were noted group 10 LN enlargement Operative Procedures 1. DLETGA, left decubitus position 2. VATS port setting 3. Adesiolysis 4. Identify pulmonary vein to RUL and divide by Endo-GIA 5. Complete fissure with Endo-GIA 6. Dissect RUL pulmonary artery and divide with double ligation and suture ligation andEndo-GIA 7. Dissect RUL bronchus and divide with Endo-GIA 8. Check bleeding and air-leak 9. Set Fr.28 chest tube x II 10.Close wound in layers Operators 李元麒 Assistants 張金池,張彥俊,游健生 手術日期：2008/09/25 14:15 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Sacral fistula Post-operative Diagnosis Ditto Operative Method Debridement and fasiocutaneous flap. Pathology Nil Operative Findings A 2cm wound /o was noed, with healthy granulation. No pus formation. Contact dermatitis in peripheral area. Operative Procedures 1. ETGA. Prone. Antiseptics applied. 2. Debridement. 3. N/S irrigation. 4. Make a fasiocutaneous flap. 5. Woudn closure. Operators 楊永健 Assistants 阮廷倫,陳姿君.李宜家 手術日期：2008/09/26 17:03 摘要__ 手術科部: 外科部 套用罐頭: HIVD Pre-operative Diagnosis C5/6 HIVD Post-operative Diagnosis Ditto Operative Method C5/6 disckectomy with cage insertion Pathology nil Operative Findings Buldging disc compress the cord . The cord decompression well. Cage 4mm. Operative Procedures Under ETGA , with supine neck extention , right neck transverse incision was done . We dissect to expose paravertebral space. Dissectomy with curray then drill and karrison. Insert cage into C5/6 space. After meticulous hemostasis , a minihemovac was set then we closed the wound in layers. Operators 賴達明 Assistants 陳盈志,張政傑 手術日期：2008/09/30 17:53 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Right breast cancer ,suspect chest wall metastasis Post-operative Diagnosis Right breast cancer,suspect chest wall metastasis Operative Method Soft tissue tumor wide excision Pathology pending Operative Findings 1.one palpable tumor at right chest wall, superficial Operative Procedures 1.ETGA,supine position 2.Skin disinfection and draped 3.Create one transverse 8cm ellipitical incision on anterior chest wall. 4.Dissect soft tissue around the soft tumor. 5.Draw out the tumor 6.Hemostasis 7.Undermining the skin flap 8.Close the wound in layers Operators 黃俊升 Assistants 黃俊傑,許閔彥 手術日期：2008/09/30 08:30 摘要__ 手術科部: 骨科部 套用罐頭: Total knee replacement-Medial, standard Pre-operative Diagnosis Osteoarthritis, left knee Post-operative Diagnosis Osteoarthritis, left knee Operative Method Left total knee arthroplasty with Zimmer prostheses( femur: C; tibia: 3#; patella: 26mm; insert: 10mm) Operative Findings 1.Cartilage wearing with subchondral bone exposure 2.Joint space narrowing with varus deformity 3.Marginal osteophyte formation 4.Hypertrophic synovitis Operative Procedures 1.Under anesthesia, in supine position. The operative field was dis-infected and draped in usual fashion. On pneumotourniquet 300 mmHg. 2.Midline skin incision was made with medial parapatellar approach to reach the knee joint 3.Medial meniscectomy wasperformed with the knee in flexion. Cut ACL. Remove infrapatellar fat and perform lateral meniscectomy. 4.Bring the knee into extension. A stay suture was placed to mark the joint line. Mark whiteside line and transcondylar axis. Create femoral canal. Apply intramedullary alignment guide to make anterior femoral cut. 5.Apply extramedullary alignment guide rod to check mechanical axis with the knee in extension 6.Mark extension gap on the tibia using the gap measuring jig 7.Perform distal femoral cutwith the knee in flexion and mark flexion gap in the posterior femoral condyles 8.Apply extrameduallry tibial alignment guide and perform tibial cut 9.Apply femoral sizing jig. Use appropriate cutting jig to perform femoral posterior, chamfer cuts andboxcut. 10.Remove posterior osteophytes and perform posterior capsular release 11.Apply tibial plate sizer. Confirm proper axis with guide rod. 12.Fix the tibial plate with 3 pins. Create tibial canal with reamer and broach. 13.Perform trial reductionwith provisional prosthetic components 14.Prepare patellar surface with cutting guide and bone saw 15.The prosthetic components were cemented into place in the order of tibia, femur, and patella. The articular surface inserter was applied to aid in insertion of the articular liner. 16.Meticulously achieve hemostasis, followed by normal saline irrigation 17.Place 1/4 inch hemovac x 1. Close the wound in layers. Operators 江清泉 Assistants 洪立維,黃興耀,陳怡孜 手術日期：2008/10/01 16:20 摘要__ 手術科部: 外科部 套用罐頭: Closure stomy Pre-operative Diagnosis Ischemic bowel s/p segmental resection of small bowel and ileostomy closure Post-operative Diagnosis ditto Operative Method Ileostomy closure Pathology nil Operative Findings 1. Purulent greenish pus discharge from lower third laparotomy wound 2. Take-down of ileostomy and re-anastomose in side-to-side fashion Operative Procedures 1. ETGA, supine 2. Antiseptic and drapping 3. Para-median laparotomy 4. Take-down of ileostomy and re-anastomose in side-to-side fashion 5. Hemostasis 6. Set one rubber drain to anastomotic side Operators 胡瑞恆 Assistants 丘基泰,林哲安 手術日期：2008/10/03 13:50 摘要__ 手術科部: 泌尿部 套用罐頭: TUR-P Pre-operative Diagnosis 1.benign prostate hyperplasia2.suspect prostate cancer Post-operative Diagnosis 1.benign prostate hyperplasia2.suspect prostate cancer Operative Method 1.Transurethral resection of the prostate2.TRUS-P biopsy Operative Findings 1. 7 g of prostatic tissue was resected 2. bilateral lobes of the prostate kiss together 3. bulbar urethra stricture s/p bugination, to 28Fr 4. prostate biopsy, 6-core Operative Procedures Under satisfactory intravenous anesthesia, the patient was placed in lithotomy position. Prepping and draping were performed in the usual sterile method. TRUS-P biopsy wiht 6-core was done smoothly. Bulbar urethral stricture was noted and was dilated with Sounding to Fr 28. A Fr 22.5. Olympus resectoscope sheath was inserted into the urethra with adequate lubrication. Then the resectoscope was inserted. Bilateral lobes of prostate were resected with cutting loop piece after piece. The chips were washed out with a Ellik evacuator. Hemostasis was done. A 20 Fr. 3-way Foley catheter was inserted and its balloon was inflated to 25c.c. Continuous N/S irrigation started. The patient tolerated the operation well and was sent to the recovery room with stablecondition. Operators 劉詩彬 Assistants 翁文慶 手術日期：2008/10/04 14:59 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Parkinson's disease Post-operative Diagnosis ditto Operative Method Right DBS implantation, failed Operative Findings After drilling of two burr holes. We attempt to insert DBS electrode through the right burr hole. However, due to decrease of baseline signal and bleeding from the insertion site, ICH was suspected. Head CT showed only minimal ICH. Operative Procedures supine with head placed in headholder. Bicoronal incision and place two burr holes. Set up DBS system. Tissucol duoplacement before dural incision. Dural incision and insert electrode. Wound closed in layers. Operators 曾勝弘 Assistants 黃博浩 手術日期：2008/10/04 08:40 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Ventriculomegaly and hydrocephalus status post VP shunt Post-operative Diagnosis Ventriculomegaly and hydrocephalus status post VP shunt post ligation Operative Method VP shunt ligation Pathology Nil Operative Findings 1. Preveious VP shunt at rught side 2. VP shunt ligation at right clavicle Operative Procedures 1. ETGA. Supine position 2. Skin prepare, disinfection and draped as sterile 3. Skin incision for 2 cm at right chest wall below clavicle 4. VP shunt ligation with silk 5. Hemostasis and irrigation with N/S 6. closed wound in layers Operators 楊士弘 Assistants 蘇亦昌 手術日期：2008/10/06 17:30 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Hydrocephalus s/p VP shunt s/p ligation with recurrent hydrocephalus Post-operative Diagnosis Ditto Operative Method Release of VP shunt ligation Pathology Nil Operative Findings The shunt was smooth after remove the stitch of the shunt. VP shunt reservoir function was well after release the ligation. Operative Procedures Under general anesthesia, the patient was put in supine position. The skin was disinfected with alcohol B-I then draped. Opened the previous op wound and removed the underlying stitiches. Located the ligation of the shunt and removed the stitch. Check theshunt function and closed the wound with 3-0 Vicryl and 4-0 Nylon interrupted stitches. Operators 楊士弘 Assistants 李建勳 手術日期：2008/10/07 11:30 摘要__ 手術科部: 外科部 套用罐頭: Port-A Pre-operative Diagnosis Metastatic cervical spine tumors of unknown origin, portA infection Post-operative Diagnosis ditto Operative Method Removal of portA from right subclavicular area Pathology nil Operative Findings The portA catheter was removed from the right subclavicular smoothly in whole length, sent tip culture and wound swab culture Operative Procedures The patient was posed in supine position with skin disinfection and drapping. Incision via previous op scar, removal of the catheter from the tunnel smoothly then mobilized the port from the subcutaneous pouch. Adequate hemostasis, wound closure in layers. Operators 吳毅暉 Assistants 蔡孝恩 手術日期：2008/10/08 00:00 摘要__ 手術科部: 外科部 套用罐頭: HIVD Pre-operative Diagnosis C6-7 HIVD Post-operative Diagnosis Ditto Operative Method Discectomy with cage insertion Pathology nil Operative Findings Buldging disc and ruptured disc compress the cord. The thecal sac expanded well after decompression. 7mm cage was inserted into C6-7 intervertebral space. Operative Procedures Under the general anesthesia with endotracheal tube intubated, the patient was set into supine position and neck was hyperextended with one pillow beneath the back. The operation field was disinfected and drapped. Transverse incision along the skin cris was done over right neck. Prevertebral muscle was dissected to expose the prevertebral space and the body of C6,7. C-arm was used to identify the location of C6/7. Apply the self-retracter with 2 screw at C6&C7.; Incise the disc of C6/7, then remove with disclamp. Use Curay and Karrison to remove the disc and hypertrophic PLL till exposure of cord. Use the drill to drill off the spur. The cage was placed into the interbody space of C6/7. Hemostasis was done with Bipolar. One minihemovac was placed for drainage. The wound was closed in layers. Operators 賴達明 Assistants 陳盈志 手術日期：2008/10/11 19:20 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis suspected over-drainage of VP shunt Post-operative Diagnosis ditto Operative Method VP shunt ligation Pathology nil Operative Findings patent 4th ventricular VP shunt Operative Procedures Local anaesthesia lidocaine 1% (5ml). Left cervical incision for ligation of the 4th ventricle shunt. VP shunt ligation. Close wound in layers. Operators 賴達明 Assistants 黃博浩,沈士雄 手術日期：2008/10/14 19:29 摘要__ 手術科部: 牙科部 套用罐頭: tongue ca.--wide excision+RND Pre-operative Diagnosis Squamous cell carcinoma, L't tongue s/p op (cT2N0M0) Post-operative Diagnosis Squamous cell carcinoma, L't tongue s/p op (cT3N2M0) Operative Method 1. Wide excision 2. Radical neck dissection 3. tongue flap repairing 4. complicated extraction 5. tracheostomy Pathology pending Operative Findings Two enlarged jugular-digastric lymph node over level II and level III were found and dissected. Operative Procedures 1. The patient was put in supine position. 2. Under ETGA, on Foley, disinfection and draping were done as usual. 3. The L't radical neck dissection was performed as following (1) Marking the mandibular border, clavicle, sternal bone, facial artery, SCMmuscle and incision lines with marking pen was done. (2) The submandibular and vertical incision over the L't neck was made with #15 scalpel and electrocautery. (3) Sharp dissection of platysma was done to expose the SCM and omohyoid muscle. (4) The several enlarge lymph nodes were noted during dissection. (5) The external & anterior jugular vein and facial artery were identified and ligated. (6) The ligated vessels and SCM muscle were cut at their proximal end and reflected to expose the underlyinginternal jugular vein. (7) The internal jugular vein was isolated and preserved. (8) The SCM, external jugular vein, and surrounding lymph nodes and tissue were reflected en bloc to separate them from the common carotid artery, vagus nerve, phrenic nerve and other underlying tissues. 4. Massive irrigation was done with diluted B-I & N/S. 5. Drain tubes were inserted via skin incision of the lower neck and fixed with silk followed by connected with CWV. 6. Primary closure of the incision wound was achieved layer by layer with 4-0 dexon & 4-0 Nylon 7. Marked the tumor by gentian violet with safety margin 2 cm. 8.Wide excision of the tumor(Partial glossectomy) was accomplished with electrocautery along the marking shadow. 9.The muscle layer wassutured in horizontal matrix with 3-0 dexon. 10.Primary closure was performed with 3-0 silk 11. Repairing the intraoral wound with tongue flap 12. Extraction of the tooth #33 13. Tracheostomy was performedRecorded by G1唐宗凡 Operators 李正 Assistants R4蔡尚節G1唐宗凡Ri賴威任 手術日期：2008/10/15 15:00 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Pineal tumor and third ventricular tumor Post-operative Diagnosis ditto Operative Method endoscopic tumor biopsy and 3rd ventriculostomy and EVD insertion via right kocher point Pathology pending Operative Findings The tumor was sof, fragile, whitish and hypervascular. It located at 3rd ventricle floor near outlet with aqueduct obstruction. The 3rd ventriculostomy was done at the ventricular floor near the bottom of tumor. The tumor descend through the stomy withpartial stomy obliteration. CSF: intial pressure was about >15 cmH2O. Ventricular catheter was 8cm in length Operative Procedures 1. ETGA. supine 2. Right frontal incision then burr hole at kocher 3. ventricular tapping then insert sheath and scope 4. tumor biopsy then ventriculostomy 5. hemostasis with N/S irrigation 6. EVD insertion 7. Close wound in layer Remark: 2 timesof hypotension with near shock status was noted, which resumed after Bosmin injection Operators 王國川 Assistants 陳盈志,謝忠佑 手術日期：2008/10/16 13:58 摘要__ 手術科部: 泌尿部 套用罐頭: PCNSL Pre-operative Diagnosis right staghorn stone Post-operative Diagnosis right staghorn stone Operative Method Percutaneous nephrolithotripsy, right / left side Pathology nil Operative Findings 1. a yellowish stones in the right renal calyces Operative Procedures Under satisfactory intubated general anesthesia with the patient in a lithotomy position, prepping and draping were carried out. A 5 Fr. ureteral catheter was inserted into the right ureter smoothly through the 21Fr cystoscope. A 16 Fr. Foley catheter wasindwelled. The patient was changed to a prone position. Skin preparation was done. A puncture needle with a hub was inserted into right renal lower calyx under fluoroscope guidence. A 0.035-inch flexible tip guidewire was indwelled through the puncture needle. The tract was dilated with fascial dilators, which was facilitated by passing them over the guidewire, up to 12 Fr. A follower was indwelled by passing it over the guidewire. The tract was further dilated with the following Amplatz dilators by passing them over the follower, up to 30 Fr. A 30 Fr. Amplatz sheath was indwelled and a nephroscope was inserted under adequate visualization at all times. Normal saline was used for irrigation. The instrument was passed to the level of the stone. The stonein the calyx was fragmented with pneumatic device and the stone fragement were removed. A DBJ catheter was inserted from the renal pelvis to the urinary bladder. It was checked by the fluoroscopy. At the same time the previous ureteral catheter was removed. A 20 Fr. percutaneous nephrostomy tube was left in place. The patient tolerated the procedure very well and was sent to the recovery room in satisfactory condition. Operators 李苑如 Assistants 賴明志,李勇毅 手術日期：2008/10/16 11:18 摘要__ 手術科部: 骨科部 套用罐頭: Total knee replacement-Medial, standard Pre-operative Diagnosis Right knee osteoarthritis Post-operative Diagnosis Right knee osteoarthritis Operative Method Total knee arthroplasty with Zimmer prosthesis Pathology Nil Operative Findings 1.Cartilage wearing and subcondral bone exposure 2.Osteophytes formation 3.Varus deformity Operative Procedures 1.Spinal anesthesia, supine position 2.Skin disinfection, draping, on tourniquet 300mmHg 3.Skin midline incision, medial para-patellar approach 4.Dissect to MCL and protect it 5.Bony preparation with femur, tibial and patella with Zimmer jigs subsequently 6.Insert Zimmer prosthesis: F:#E, T:#5 , P:size 32, 8.5mm, I:10mm 7.Check the mobility and stability of new joint 8.Off the tourniquet, hemostasis 9.Normal saline irrigation and set drainage with 1/4" hemovac 10.Close wound in layers Operators 江清泉 Assistants 簡裕明,曾渥然,黃哲南 手術日期：2008/10/16 17:29 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Left posterior chest wall tumor, suspected HCC metastasis Post-operative Diagnosis Ditto Operative Method Wide excision of chest wall tumor with ribs Pathology Pending Operative Findings 1.A 12cm*5cm*4cm fusiform, heterogenous, hypercellular, soft tumor is noted over the left posterior 9th rib with muscular invasion. 2.No pleural effusion. pleural invasion. gross 8th and 10th rib involvement. skin involvement. 3.Safetymargin: at least 1cm. 4.Blood loss: 700mL. Operative Procedures 1.General anesthesia using single-lumen endotracheal tube. 2.The patient is placed in a prone position. 3.The operative field is well disinfected and well draped. 4.Make a oblique skin incision along the 9th rib from PAL posteriorly. 5.Identify the chest wall tumor. 6.Cut off the left posterior 8th, 9th, and 10th rib with a safety margin at least 1cm from the tumor grossly. 7.Resect the chest wall tumor and cut-downed ribs with 1cm safety margin at least. 8.Reconstruction the chest wall defect withTitanic Mesh designed for the defect and fixed with steel-wire is done. 9.Meticulous hemostasis was done. 10.The pleural cavity is irrigated with wram normal saline. 11.Check-up of air leakage was done. 12.Close the wound in layers. 13.A Fr.28 chesttubes is indwelled at the left pleural cavity respectively. 14.The patient is sent to 3A2 ICU for postoperative care. Operators 李元麒 Assistants 張金池,李佳穎,郭庭均 手術日期：2008/10/17 11:30 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis ESRD Post-operative Diagnosis ditto Operative Method SMAP activation Pathology nil Operative Findings Patent SMAP catheter Operative Procedures Identify the SMPA catheter and activation Close the wound Operators 蔡孟昆 Assistants 丘基泰,潘為元 手術日期：2008/10/17 15:50 摘要__ 手術科部: 外科部 套用罐頭: Closure stomy Pre-operative Diagnosis Rectal cancer, s/p LAR with ileostomy Post-operative Diagnosis Rectal cancer, s/p LAR with ileostomy Operative Method Ileostomy closure, with method of side-to- side anastomosis Operative Findings 1. pink color of ileum after anastomosis Operative Procedures 1. ETGA, supine 2. Disinfection and drapping 3. Transverse elliptical skin incision, along ileostomy-skin junction with 0.3cm distance away from 4. Dissect to expose part of ileum, 5cm proxmial and distal to ileostomy 5. Transect ileum, proximal and distal to ileostomy site, with GIA 6. Side-to-side anastomosis of ileum 7. Hemostasis, saline irrigation 8. Set one Penrose drain 9. Close the wound in layers, with three subcutaneous Penrose Operators 梁金銅 Assistants 林昊諭,莊民楷 手術日期：2008/10/22 09:48 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt Pre-operative Diagnosis VP shunt over drainage4th ventricle dilatation after posterior fossa VP shunt ligation Post-operative Diagnosis Dittoditto Operative Method Anti-sephon implantation via left neckAnti-siphone insertion Pathology Nil Operative Findings Clear CSF, pressure low, previous ligation was removed1.Posterior fossa VP shunt patent after removal of ligation stitch 2.Clear CSF Operative Procedures 1. ETGA 2. Left neck incision 3. Identify catheter, cut down then connect to anti-sephon 4. Hemostasis 5. Closed wound in layers1.ETGA, supine 2.Left neck previous wound incision 3.Exposed posterior fossa VP shunt which was ligated before 4.Remove stitch 5.Devide the catheter and re-connect to Anti-siphone 6.Close wound in layers Operators 賴達明 Assistants 陳盈志,胡朝凱 手術日期：2008/10/22 23:55 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt Pre-operative Diagnosis Third ventricular tumor with hydrocephalus Post-operative Diagnosis Ditto Operative Method Left Kocher's point V-P shunt insertion Pathology Nil Operative Findings Low CSF opening pressure: 5cm H2O. Clear CSF drained out. Metronic burr hole type high pressure V-P shunt was used. Ventricular catheter 6.5 cm peritoneal catheter : 25cm Operative Procedures Under general anesthesia and intubation. The patient was put in supine position with shoulder elevated. The scalp was shared screubbed, disinfected with alcohol B-I then drapped. Removed the previous right side EVD and sutured with 3-0 Nylon. Curvilinear scalp incision was made at right frontal area followed by burr hole. The dura was opened after tenting. Ventricle puncture was made by ventricular puncture needel. Minilaparotomy was made at left abdomen. The shunt tube was passed via abdomen, anterior chest wall, neck to retroauricular area. The shunt was connected to the high pressure reservior and tested for patency. The wounds were closed in layers. Operators 王國川 Assistants 李建勳,羅健洺 手術日期：2008/10/28 16:46 摘要__ 手術科部: 骨科部 套用罐頭: Open reduction for fracture of femoral ITC-CHS Pre-operative Diagnosis Left femoral intertrochanteric fractur Post-operative Diagnosis Ditto Operative Method ORIF with Compression hip screw (Richard), 135 degree, 4Holes, 4screws Pathology nil Operative Findings as diagnosis Operative Procedures 1. Under spinal anesthesia, the patient was placed on fracture table with supine position. 2. Close reduction under C-arm guided. 3. Skin prep and drapping as usual. 4. Skin incision along lateral thigh. 5. ORIF with CHS 6. Release the traction and screw the compression screw. 7. Normal saline irrigation and close the wound in layers Operators 林繼昌 Assistants 藍宗裕,陳俊和 手術日期：2008/10/29 12:53 摘要__ 手術科部: 麻醉部 套用罐頭: Port-A implantation Pre-operative Diagnosis Cervical cancer Post-operative Diagnosis Ditto Operative Method port-A implantation Pathology Nil Operative Findings Nil Operative Procedures Under IVG anesthesia, put the patient on supine position. The operation field was disinfected and draped as usual. 18G IV catheter was inserted via the internal jugular vein with cut down method under echo-guided procedure. J-wire was inserted smoothly via the needle in rostral direction.12G internal jugular sheath with dilator was inserted through the J-wire. Dilator was then removed. IV catheter was threaded into 12G sheath until mark 21cm on the catheter. Sheath was then threaded. Skin tunnel between internal jugular and pre-cordial incision was made. Port was inserted into the pouch of precordial incision. Catheter was adapted into the port and locked with restrictor. Skin was closed layer by layer. Both catheter and port were perfused with heparinsolution after implantation. Site: right internal jugular approach, port-A at right subclavicle Operators 黃啟祥 Assistants 劉玉蘭 手術日期：2008/11/07 23:34 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT Pre-operative Diagnosis cerebellar tumor, medulloblastoma or astrocytoma Post-operative Diagnosis ditto Operative Method 1.Craniotomy for tumor excision;2.Right Frazier's EVD insertion for ICP monitoring Pathology pending Operative Findings 1.One 3cm in diameter, lobulated tumor over the roof of the 4th ventricle(from the vermis). It was greyish-yellow moderately hypervascular resembling glioma. The margin of it was unable to be dissected from the roof of 4th ventricle and bilateral cerebellum. The lower part of the tumor had a morgin from the 4th ventricular roof. 2.High intra-ventricular pressure,>30 cmH2O. The cerebellum was mildly slack after CSF drainage 3. The fourth ventricle floor was seen after tumor removal. No BAEP change durign operation Operative Procedures Under endotracheal general anesthesia,the patient was put in the prone position with head fixed by Mayfield head holder. One 2cm linear incision was made over the right Frazier's point and Burr hole was created. Dural tenting and ventricular puncture were done for EVD insertion for 8 cm in length. After the insertion of the EVD, one 15cm midline incision was made. We explored the suboccipital and C1 region. We made several Burr holes and then performed craniotomy. The dura was then incised in inverted Ushape. Under microscopic view, we removed the tumor mass piecemeally with CUSA by transvermian incision. After careful hemostasis, the dura mater was closed with a fascial graft. Cranioplasty with 4 wires was perfomed. We set one subcutaneous CWV drain and then closed the wound in layers. Operators 郭夢菲 Assistants 黃博浩,陳建璋 手術日期：2008/11/10 10:20 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Left breast tumor Post-operative Diagnosis ditto Operative Method Breast conservative therapy + axillary lymph node dissection Pathology pending Operative Findings 1.One 2x2 cm firm mass over left lateral breast 2.Axillary lymph node enlargement(+) Operative Procedures 1.ETGA, supine position 2.Skin disinfection and drapping 3.Make a curvillinear skin incision above left nipple 4.Dissect the breast tissue and remove the tumor 5.Expose the axillary area and identify the pectoralis major, minor m. 6.Identify and preserve long thoracic and thoracodorsal nerve 7.Perform axillary lymph node dissection 8.Hemostasis and wound irrigation with normal saline 9.Set one CWV drain at left lower thorax 10.Wound closure in layers Operators 張金堅 Assistants 吳孟哲 手術日期：2008/11/12 08:55 摘要__ 手術科部: 骨科部 套用罐頭: Arthroscopic surgery Pre-operative Diagnosis Right knee osteonecrosis with cartilage defect over medial condyle of right femur Post-operative Diagnosis Right knee osteonecrosis with cartilage defect over medial condyle of right femur Operative Method 1. Arthroscopic examination and debridement, 2. Bone marrow aspiration Pathology Nil Operative Findings 1. Arthroscopy: PF joint: mild OA change Med. / Lat. menisci: intact ACL / PCL: intact Mild synovitis 2. Two cartilage defects over medial condyle of right femur, about 1 x 1 cm2 Operative Procedures 1. SA, supine position. 2. Skin disinfected and draped. 3. Exsanguinated with rubber bandage; on pneumatic tourniquet 350 mmHg. 4. Created camera port and working port. 5. Performed arthroscopic examination and debridement with shaver.6. Bone marrow aspiration from left iliac crest. 7. Irrigated with normal saline and closed wound by Nylon suture. Operators 劉華昌,王至弘 Assistants 謝瑞洋,陳志偉 手術日期：2008/11/13 13:32 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis RUL adenocarcinoma s/p chemotherapy Post-operative Diagnosis RUL adenocarcinoma s/p chemotherapy s/p VATS lobectomy Operative Method VATS lobectomy Pathology pending Operative Findings 1.A 1cm whitish~gray nodule in RUL, no pleural retraction Operative Procedures 1.DLETGA, left decubitus position 2.Skin disinfection and draped 3.Create VATS setting: 4th ICS, AAL 7th ICS, MAL 4th ICS, PAL 4.Identify the lesion 5.Transect pulmonary vein by endo-GIA 30 pulmonary artery by endo-GIA 30branch of vessels by hand ligation bronchus by endo_GIA 45 fissure by endo_GIA 60 6.RUL lobectomy 7.Check bleeding and hemostasis 8.CHest tube 28 Fr. X 2 9.Close the wound in layers. Operators 李元麒 Assistants 梁嘉儀,許閔彥 手術日期：2008/11/19 16:00 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) Pre-operative Diagnosis L4/L5, L5/S1 spondylolisthesis and lumbar stenosis Post-operative Diagnosis ditto Operative Method 1. Trans-pedicle screws, L4~S1 2. Laminectomy, L4~S1 3. posterolateral fusion Pathology nil Operative Findings 1. The dura was severely compressed by distorted spinal canal (esp at L5~S1) as well as thick ligmentum flavum and osteophytes 2. TPS: L4: 6.5x40mm x 2 L5: 6.5x40mm x 2 S1: 6.5x40mm x 2 rod x 2, no cross link 3. Dura tear (+),mild s/p prolene repair Operative Procedures ETGA, prone, midline incision Paravertebral muscle detachment Inserted TPS as usual fasion first Laminectomy was then performed Applied rods Close the wound Operators 賴達明 Assistants 蘇亦昌,王政為 手術日期：2008/11/20 16:53 摘要__ 手術科部: 婦產部 套用罐頭: Debulking Pre-operative Diagnosis Pelvic tumor, r/o ovarian malignancy. Post-operative Diagnosis Ovarian cancer with cancerous peritonitis Operative Method Debulking surgery (Right oophorectomy + Cytoreduction surgery + infracolic omentectomy + Appendectomy) Pathology Frozen: Operative Findings 1.Supraumbilical midline vertical skin incision 2.Uterus: s/p hysterectomy. 3.Adnexa: LOV: cannot be seen due to S-colon adhesion ROV: 6x6x6 cm , capsule not intact , papillary tumor grow out from surface and invasion to appendix , intra-op rupture(-) Fallopian tube: cannot be seen due to tumor occupied 4.CDS: invisible due to tumor mass occupied 5.Ascites: yellowish, serous , about 4300 ml 6.Bilateral pelvic lymph nodes: not checked 7.Omentum: one 10x6x2cm omentum cake, multiple hard,variablesized nodules (5~20 mm in diameter) infracolic omentectomy was done. 8.Liver: grossly normal & smooth Subdiaphragmatic surface: miliary tumor seeding(+), bean sized 9.Appendix: invasion by ROV tumor, appendectomy was done 10.Multiple tumor seedings over peritoneum and mesentery, size: 0.2~3cm, the 3cm nodule over S-colon seemed to make partial obstruction by palpation 10.After the operation, suboptimal debulking surgery was achieved. 11.Residue tumor: multiple tumors, maximal diameter about 3 cm, over S-colon, D-colon, bowel mesentery and peritoneum EBL: 5100 ml (blood loss 800ml+ ascites 4300 ml) BT: PRBC 2 U Cx: nil Operative Procedures 1. Put the patient on the lithotomy position 2. Vaginal douching, on Foley, skin disinfection with beta-iodine, and skin draping. 3. Make midline vertical skin incision and open the abdominal wall layer by layer. 4. Serous ascites 4300 ml, send for cytology 5. Step by step clamp, cut and ligate the omentum 6. Excision the tumor seeding on small intestine, mesentery and peritoneum. 7. Excision the ROV tumor 8. Perform appendectomy 9. Insert a rubber drain at the cul-de-sac. 10. Close the abdomenlayer by layer. 11. Skin approximation with 4-0 Nylon. Operators 魏凌鴻 Assistants 陳宇立,朱凌慧 手術日期：2008/11/21 11:55 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Left temporal tumor, r/o GBM Post-operative Diagnosis Ditto Operative Method Craniotomy for tumor excision Pathology Send brain tumor for pathology Operative Findings The tumor consisted of two cystic components (at posterior part) and soilid tumor at anterior part. The whole mass was in the left temporal lobe, which expanded the brain, pushed sylvian fissure upward, and flattened the sulci. Frozen: GBM Operative Procedures On ETGA, supine, traumatic flap craniectomy. Opened the dura. Aspirated the cystic fluid first. The tumor was then removed along it's border. Placed back the bone. Set one cwv drain. Closed the wound. Operators 蔡瑞章 Assistants 蘇亦昌,劉威廷 手術日期：2008/11/21 08:33 摘要__ 手術科部: 骨科部 套用罐頭: Bipolar hemiarthroplasty Pre-operative Diagnosis right femoral neck fracture Post-operative Diagnosis Ditto Operative Method Bipolar hemi-arthroplasty with United prosthesis Pathology nil Operative Findings posterior approach Stem: 3# proximal, 12mm dia.Cap:43mm Head : 26+0 Liner:26mm I.D., 43mm O.D. OP finding : 1. Subcapital displaced fracture 2. osteophyte formation Operative Procedures 1.SA, lateral decubitus. 2.Skin disinfection and draping. 3.Longitudinal skin incision over left hip, Posterior approach. 4.Reverse T-Capsulotomy to dislocate the head and remove it. 5.Reaming femoral canal to 12 mm. 6.Broaching the femoral canal. 7.Insertion of United prosthesis 8.Reduction of the hip with traction. 9.Irrigated with normal saline and hemostasis. 10.Capsule repair . Wound closure. Operators 林晉 Assistants 陳致宇,方建豐 手術日期：2008/11/22 11:20 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Left frontal tumor, r/o GBM Post-operative Diagnosis Ditto Operative Method Left frontal craniotomy for tumor excision Pathology Pending result Operative Findings Left fromtal tumor reach the surface on left superior temporal gyrus. The tumor was grayish, yellowish, resembling GBM. It was hypervascular measuring about 5.0x4.5x3.5cm in sixe. The lower portion abuts the lateral ventrical (CSF egress on resection). The protion involving the SMA was kept intact. No ACA injury. The brain was slash after tumor resection. Operative Procedures ETGA, supine Bicoronal incision, Burr hole x1 than craniotomy. Dural incision and tumor removal. Hemostasis. Dural closure with prolene. Cranioplasty with miniplate. Subgaleal CWV drain. Wound closed in layers. Operators 曾勝弘 Assistants 黃博浩,劉威廷 手術日期：2008/11/25 00:00 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Ditto Operative Method 3rd ventriculostomy Pathology nil Operative Findings CSF was clear, the opening pressure was about 15cmH2O. Ventriculostomy was done at 3rd ventricle floor. Operative Procedures Under the general anesthesia with endotracheal tube intubation, the patient was set into supine position. The operation field was scrubbed and disinfected with povidine-iodine and then drapped with sterile drappings. Right frontal linear incision was done and burr hole was made with drill. Dura was opened after tenting with 2 stitches. Ventricular tapping was done and then the scope was inserted into the lateral ventricle then to 3rd ventricle. The 3rd ventricular floor was identified and penetrated with monopolar. Then the hole was dilated by frugatti. The scope was removed and EVD was inserted. Hemostasis was done and the wound was closed in layers. Operators 郭夢菲 Assistants 陳盈志 手術日期：2008/11/26 09:38 摘要__ 手術科部: 麻醉部 套用罐頭: Port-A implantation Pre-operative Diagnosis LUNG CANCER Post-operative Diagnosis DITTO Operative Method PORT-A IMPLANTATION Pathology NIL Operative Findings NIL Operative Procedures Under IVG anesthesia, put the patient on supine position. The operation field was disinfected and draped as usual. 18G IV catheter was inserted via the internal jugular vein with cut down method under echo-guided procedure. J-wire was inserted smoothly via the needle in rostral direction.12G internal jugular sheath with dilator was inserted through the J-wire. Dilator was then removed. IV catheter was threaded into 12G sheath until mark 22 cm on the catheter. Sheath was then threaded. Skin tunnel betweeninternal jugular and pre-cordial incision was made. Port was inserted into the pouch of precordial incision. Catheter was adapted into the port and locked with restrictor. Skin was closed layer by layer. Both catheter and port were perfused with heparinsolution after implantation. Site: RIGHT internal jugular approach, port-A at right subclavicle Operators 黃啟祥 手術日期：2008/11/27 10:30 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis R/O tibia osteomyelitis Post-operative Diagnosis Ditto Operative Method Sequestrectomy Pathology Pending Operative Findings Much debris & necrotic tissue were noted at the tract of fistula, which leads to the necrotic bone cavity. Sequestrum was also noted. No pus accumulation was seen during debridement. Operative Procedures Under nerve block and intravenous general anesthesia, the patient was put at supine position. The skin was disinfected and draped as usual. The wound was extended longitudinally. Debridement and sequestrectomy was performed. After hemostasis and normalsaline irrigation, normal saline gauze wet dressing was applied. Operators 謝榮賢 Assistants 陳思恆,李振豪 手術日期：2008/11/27 16:59 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Left breast cancer s/p op Post-operative Diagnosis Ditto Operative Method Port-A implantation Pathology Nil Operative Findings 1. Good right cephalic vein. Operative Procedures 1. Under LA and supine position. 2. Skin disinfection and drape as usual. 3. Oblique incision about 3 cm along right deltoid groove. 4. Identify right cephalic vein and implant port-A catheter. 5. Wound closure in layers. Operators 張金堅 Assistants R3張義佳 手術日期：2008/11/29 11:40 摘要__ 手術科部: 泌尿部 套用罐頭: TUR-P Pre-operative Diagnosis benign prostate hyperplasia Post-operative Diagnosis benign prostate hyperplasia Operative Method Transurethral resection of the prostate Operative Findings 1. 42 g of prostatic tissue was resected 2. bilateral lobes of the prostate kiss together 3. bladder trabeculations 4. marked intravesical growth of medial lobe of the prostate 5. 40cc balloon Operative Procedures Under satisfactory spinal anesthesia, the patient was placed in lithotomy position. Prepping and draping were performed in the usual sterile method. A Fr 27. Olympus resectoscope sheath was inserted into the urethra with adequate lubrication. Then the resectoscope was inserted. Bulbar urethral stricture was noted. Bilateral lobes of prostate were resected with cutting loop piece after piece. The chips were washed out with a Ellik evacuator. Hemostasis was done. A 22 Fr. 3-way Foley catheter was insertedand its balloon was inflated to 50c.c. Continuous N/S irrigation started. The patient tolerated the operation well and was sent to the recovery room with stable condition. Operators 王碩盟 Assistants 姜秉均 手術日期：2008/12/02 15:30 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt Pre-operative Diagnosis Cerebellar medulloblastoma s/p excision with hydrocephalus Post-operative Diagnosis Ditto Operative Method Right Kocher's point VP shunt insertion Pathology Nil Operative Findings CSF opening pressure: 20cmH2O with clear CSF drained out. Ventricular catheter: 6.5cm, peritoneal catheter: 32cm. Medtronic, burr hole type reservoir was used. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position with head turned to left. The scalp was shaved, scrubbed, antiseptic with alcohol B-I then draped. The previous right frontal scalp wound was opened. The nelaton tube was inserted via previous tract into ventricle. Minilaparotomy was made at right abdomen and the peritoneal catheter was inserted and test function. The shunt cather was then passed through subcutaneous layer of abdomen, anterior chest wall, neck, retroauriculararea then connected to the reservoir. The nelaton tube was then changed to ventricular catheter and connected to the reservoir. After tested the function, the wounds were all closed in layers. Operators 郭夢菲 Assistants 李建勳,周恒文 手術日期：2008/12/02 17:29 摘要__ 手術科部: 外科部 套用罐頭: Port-A Pre-operative Diagnosis Cerebellar medulloblastoma s/p excision with hydrocephalus Post-operative Diagnosis Ditto Operative Method Port-A implantation Pathology Nil Operative Findings Port-A was inserted from internal jugular vein through cutdown method Operative Procedures 1. Under endotracheal general anesthesia with the patient in supine position, prepped and draping were performed in the usual sterile method. 2. An incision was made in left side neck and subclavical area. After identification of the internal jegular vein, Port-A catheter was inserted. Adequate hemostasis was obtained. Then the wound was closed in layers. Post-operative portable X-ray showed catheter tip in correct venous branch to SVC. Operators 許文明 Assistants 潘為元 手術日期：2008/12/08 14:00 摘要__ 手術科部: 外科部 套用罐頭: Cervical Laminectomy Pre-operative Diagnosis Cervical OPLL with spinal stenosis, C3-6 Post-operative Diagnosis ditto Operative Method C3-6 laminoplasty, open door miniplate with hinge on the right Pathology nil Operative Findings The cord expanded well after laminoplasty. No dural injury or SSEP change. Operative Procedures Under ETGA and prone position, the operation field was disinfected and draped as usual. Midline incision was made followed by exposure the C3-6 lamina. The lamina was fracture by drill. Laminoplasty was performed with miniplates. After hemostasis, one CWVwas left in situ. The wound was closed in layers. Operators 杜永光 Assistants 黃博浩,陳德福 手術日期：2008/12/09 14:10 摘要__ 手術科部: 泌尿部 套用罐頭: Laparoscopic radical prostatectomy Pre-operative Diagnosis prostate cancer Post-operative Diagnosis prostate cancer Operative Method Extraperitoneal laparoscopic radical prostatectomy + bilateral pelvic LN dissection Pathology pending Operative Findings 1.Resected prostate:4x3x5 cm with bilateral seminal vesicle 2.severe adhesion over periprostatic space 3.Two CWV drain at bilateral perivesical space 4.bilateral neurovascular bundle was not preserved Operative Procedures Under satisfactory endotracheal general anesthesia with the patient in a supine position, prepping and draping was performed. A 16 Fr Foley was inserted with sterile method. A balloon trocar was placed at periumbilical area. The wound was deepened into pre-peritoneum. The balloon was inflated and a pre-peritoneal space was created. One 5-12 mm & three 5 mm port were placed at bilateral lower abdomen. Dissection were perfomed at bilateral endopelvic fascia first. Endopelvic fascia was opened and pubo-prostatic ligaments were identified. Superficial dorsal vein was ligated and the Santorini's plexus and deep dorsal vein complex was ligated with 1-0 Vicryl suture. The puboprostatic ligament was partially transected. A transverse incision was done overthe anterior wall of the bladder neck. The bladder was entered and bilateral ureteral orifices were identified. This incision was done along the bladder neck posteriorly and sharp dissection over full thickness of bladder was done until seminal vesicles was exposed. The seminal vesicles were identified and vas deference were divided. The prostate was freed from the rectum over Denonvilliers' layer with Ultrashear. Bilateral iliac and obturator lymph node were dissected by Ultrashear, and the resected lymphnode was delivered from the periumbilical wound after placement in the retrieval bag. The resected prostate specimen was placed into a retrieval bag and delivered from the wound at periumbilical area. Twelve sutures of 3-0 RB-1 monovicryl were placed into the urethral stump and the margin of the bladder neck. A 20 Fr nephrostomy tube was inserted into the urethra and bladder with balloon inflated to 5 ml after the anastomosis was completed. Two CWV drain tubes were placed near the area of anastomosis.We closed the 5-12 mm port wound with 1-0 Vicryl and skin with 3-0 Nylon. The patient tolerated the procedure very well, and was sent to the recovery room in satisfactory condition. Operators 闕士傑 Assistants 賴明志,伍嘉偉 手術日期：2008/12/09 14:30 摘要__ 手術科部: 泌尿部 套用罐頭: 其他 Pre-operative Diagnosis Bladder UC, r/o urethral recurrence Post-operative Diagnosis Bladder UC, r/o urethral recurrence Operative Method Distal urethrectomy Pathology Pending Operative Findings 1.Severe adhesion over the bulbar urethra. 2.The whole urethra was removed. 3.Two Penrose were inserted. Operative Procedures 1.ETGA with lithotomy position. 2.Perineum skin incision was made and the wound was deepened. 3.Identified the urethra and dissected it ti the distal side. 4.Made incision over the glans and dissected the urethra to the proximal side. 5.Isolated the whole urethra and removed it en-bloc. 6.Adequate hemostasis. 7.Inserted two Penrose for drainage. 8.Clsoed the wound in layers. 9.Send the patient to POR under the stable condition. Operators 闕士傑 Assistants 何承勳,張宇鳴 手術日期：2008/12/10 09:38 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Bilateral lung nodules, ruled out colon cancer metastasis Post-operative Diagnosis Ditto Operative Method VATS partial resection of LUL, LLL, RUL and RLL Pathology Pending Operative Findings 1. A scar formation was noted at LUL 2. An palpable nodule with umbilical surface located at B6 of left lung 3. Two palpable nodules and three ones located at RUL and RLL, respective 4. Several calcification plaques were noted on the surface of bilateral lungs 5. No adhesion or anthrocosis were noted Operative Procedures 1. DLETGA, right decubitus position 2. Skin disinfection and draping 3. Set VATS ports: 5th ICS AAL, 7th ICS MAL and 5th ICS PAL 4. Localize scar formation and nodule via finger-touch 5. Resect the scar and nodule with Endo-GIA 6. Normal saline irrigation then check air leakage 7. Set Fr. 28 chest tube x 1 8. Inject Xylocaine and Rinderon around operation wounds 9. Close wounds in layers 10. Change to left decubitus position 11. Skin disinfection and draping 12. Set VATS ports: 5th ICS AAL, 7thICS MAL and 5th ICS PAL 13. Localize nodules via finger-touch 14. Resect the nodules with Endo-GIA 15. Normal saline irrigation then check air leakage 16. Set Fr. 28 chest tube x 1 17. Inject Xylocaine and Rinderon around operation wounds 18. Closewounds in layers Operators 李章銘 Assistants 梁嘉儀,林子超 手術日期：2008/12/12 20:51 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Synovial cyst, L4-5 Post-operative Diagnosis Nil Operative Method Laminotomy for decompression Pathology Pending Operative Findings 1. Synovial cyst at L4-5 area. right and compressed the root 2. Hypertrophic ligament Operative Procedures 1. ETGA, supine 2. Midline incision at L4-5 area 3. Dissect muscle layer to expose L4-5 lamina 4. Laminotomy 5. Removal of hypertrophic connective tissue and cyst 6. Close the wound in layers Operators 賴達明 Assistants 胡朝凱,周恒文 手術日期：2008/12/12 19:20 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt Pre-operative Diagnosis Subdural effusion Post-operative Diagnosis Subdural effusion Operative Method Left side S-P shunt Pathology Nil Operative Findings The opening pressure of subdural effusion was about 10-13cmH2O. Yellowish subdural effusion was noted. Arachnoid membrane expand after effusion drainage. Subdural catheter 5cm and peritoneal catheter 20cm and no reservoir. Operative Procedures 1. ETGA supine head tilt to right 2. Left frontal-temporal linear incision 3. Burr hole 4. Dura openingafter tenting, insert Nelaton 5. LUQ minilaparotomy, insert peritoneal catheter. 6. Subcutaneous tunnel 7. Connect peritoneal and subdural catheter via connector 8. Insert subdural catheter, frontal direction fixed. 9. Hemostasis 10. Close wound in layers Operators 郭夢菲 Assistants 陳盈志,李昱儀 手術日期：2008/12/13 08:30 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Parkinson's disease Post-operative Diagnosis Ditto Operative Method Bilateral GPi DBS electrodes insertion Pathology Nil Operative Findings 1. The rigidity decreased after wire inserted at stimulation "on". 2. The optic tract was located with microelectrode before localizing GPi. The final targets were 2mm lateral to the planned targets bilatearlly. Operative Procedures Under IV general anesthesia, the patient was put in supine position. The scalp was shaved, scrubbed and antiseptic with alcohol B-I. Registered the preset localization point to navigator. Bicoronal scalp incision was made to located previous DBS wire ports. Localization of globus pallidus interna (GPi) with microelectrode assistance. Inserted the DBS wire and fixed with the port. Waked the patient from the anesthesia and started stimulation from low voltage. Checked the clinical responses while usingdifferent voltage for stimulation. Performed the same procedure at left side. After hemostasis and set the wires at subgaleal pocket, closed the wound in layers. Operators 曾勝弘 Assistants 李建勳 手術日期：2008/12/17 10:17 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Parkinsonism s/p DBS electrode insertion Post-operative Diagnosis Ditto Operative Method Neurostimulator implantation and electrodes connection Pathology Nil Operative Findings 1. The neurostimulator was implanted on the space between submucosa ans fascia of PM over the left chest 2. Intro-op test of current and impedance was within acceptable range Operative Procedures 1. ETGA, supine with head turned to right, disinfection and draped 2. Make a curvilinear incision over left parietal scalp and draw the electrodes inserted at the previous surgery out 3. Make a pouch for neurostimulator on left chest 4. Create the subcutaneous tunnel from the scalp wound, left retroauricular, left neck to the neurostimulator 5. Connect the electrodes and test the impedance 6. Close the wound in layers Operators 曾勝弘 Assistants 陳睿生,周恒文 手術日期：2008/12/19 16:10 摘要__ 手術科部: 外科部 套用罐頭: VATS biopsy Pre-operative Diagnosis Multiple lung tumors, ruled out metastasis Post-operative Diagnosis Ditto Operative Method VATS RML wedge resection Pathology Pending Operative Findings Multiple tumor located at right lung, their sizes ranged from 0.5 cm to 4 cm. Several of them were with pleural retraction Operative Procedures 1. DLETGA, left decubitus position 2. VATS ports setting: 5th ICS AAL and PAL, 7th ICS MAL 3. Identify one tumor at RML and perform wedge resection via Endo-GIA 4. Set one Fr. 28 chest tube 5. Close wound in layers Operators 陳晉興 Assistants 李佳穎,林子超 手術日期：2008/12/19 14:00 摘要__ 手術科部: 骨科部 套用罐頭: Bone or osteochondral graft Pre-operative Diagnosis Osteochondronecrosis, right knee Post-operative Diagnosis Ditto Operative Method Osteochondral graft Pathology Pending Operative Findings Osteochondral necrosis noticed at medial condyle of right distal femur Operative Procedures 1.Anesthesia induction, supine position 2.Perform skin scrubbing, disinfection, and draping 3.Apply pneumotoniquet 330mmHg on right proximal thigh 4.Make longitudinal skin incision via midline of right knee 5.Harvest periosteum from anteromedial aspect of proximal tibia 6.Revise the site of osteochondronecrosis with curretage 7.Impact the cartilage defect with cultured stem cell matrix 8.Cover the defect with perioseum graft and fixation with resorptable suture 9.Irrigate the operation field withcopious normal saline 10.Close the wound in layers 11.Apply a long leg splint Operators 劉華昌 Assistants 謝瑞洋,陳彥宇 手術日期：2008/12/22 20:21 摘要__ 手術科部: 外科部 套用罐頭: CVA Pre-operative Diagnosis left parietal AVM with ICH Post-operative Diagnosis ditto Operative Method left parietal-temporal craniectomy for hematoma evacuation Operative Findings There was one about 40-45ml hematoma occupying at left parietal-frontal area. After craniectomy, brain swelling was noted. There was engorged arterialized vein drainage to vein of Labe. One engorged feeding artery was noted superficial to the hematoma.The size of pupil (pre-op and post-op) was (R/L 5.5/5.5 and 3.5/3.0) ICP after skin closure was 7-8mmHg Operative Procedures 1.ETGA and kept supione position with head tilt to right 2.skin preparation and sterilization were done 3.we performed left frontal-temporal curilinear incision (trauma flap, modified) 4.we did Burr hole x2 and craniectomy 5.U-shape dura incision wasperformed 6.corticotomy behind motor cortex and hematoma evvacuation were performed 7.we did hemostasis with bipolar then surgical packing 8.we performed duroplasty with duroform and 4-0 prolene 9.ICP montior to temporal side and epidural CWV drain were set. 10.Finally we close wound in layers Operators 杜永光 Assistants 蘇亦昌,陳盈志,李彥儀 手術日期：2008/12/23 17:36 摘要__ 手術科部: 骨科部 套用罐頭: Open reduction for closed or open humeral fracture; tuberosity, shaft or coudyles Pre-operative Diagnosis Left humeral greater tuberasity avulsion fracture Post-operative Diagnosis Ditto Operative Method ORIF with Ticron suture Pathology Nil Operative Findings as pre-op dx Operative Procedures ETGA, semisitting, disinfection, drap Skin incision, transdeltoid approach Dissect to fx site ORIF with #5 Ticron NS irrigation Close wound in layers Operators 林繼昌 Assistants 簡裕明,廖翊廷 手術日期：2008/12/24 16:36 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT Pre-operative Diagnosis left brain AVM with ICH and IICP Post-operative Diagnosis ditto Operative Method craniectomy and ICP monitoring Pathology nil Operative Findings Severe brain swelling was noticed during decompressive craniectomy. The brain became slacky after decompression and remarkable engorged vennous drainage of the AVM was also noted. One subdural ICP monitor inserted. Operative Procedures Under ETGA and supine position, the scalp was disinfected and draped as usual. The previous incision wsa extended to the midline and occipital area followed by performing left F-T-P-O craniectomy. The dura was opened in curvilinear fasion followed by performing duraplasty. Insert the subdural ICP monitor. After hemostasis, 2 subgaleal draiange CWV were left in situ. The wound was closed in layers. Operators 杜永光 Assistants 黃博浩,陳德福 手術日期：2008/12/26 16:00 摘要__ 手術科部: 骨科部 套用罐頭: Spinal stenosis-PDPIPF Pre-operative Diagnosis L2,3,4,5 spinal stenosis with L2/3 HIVD Post-operative Diagnosis L2,3,4,5 spinal stenosis with L2/3 HIVD Operative Method PD PI PF and L2/3 diskectomy Pathology pending Operative Findings Spinal sac compression st L 2,3,4,5 Right L2/3 HIVD with root compression PD: L3,4,5 total laminectomy, L2 partial laminectomy PI: L2,3,4,5 pedical screw x 8, Rod x 2, cross link: 1 PF: autologous and allogenous bone grafting Operative Procedures 1.ETGA ,prone position ,on R-H frame 2.localize the level under C-arm check 3.sterilize the skin and drap as usual 4.skin incision ,medline longitudinal approach 5.dissect paraspinal muscle to spine 6.perforem posterior instrumentation with pedicle screw X8 ,rod X2 ,cross link X1 7.performe posterior decompression :L3,4,5 total laminectomy ,L2 partial laminectomy 9.Do the posterior fusion with autologous and allogenous bone graft 10.irrigaiton of the wound with N/S and set 1/8 H-V 11.close the wound in layers Operators 楊曙華 Assistants 簡裕明,陳明峰 手術日期：2008/12/27 12:38 摘要__ 手術科部: 外科部 套用罐頭: DM foot-debridement and STSG Pre-operative Diagnosis Right tibia open fracture, s/p ORIF, osteomyelitis s/p debridement and VAC Post-operative Diagnosis ditto Operative Method Rotation flap and STSG Pathology Pending Operative Findings 1. One (1x3) cm open wound at pretibial side of right leg with tibia bone exposure 2. Granulation tissue growth (+) 3. 5x1 cm2 STSG harvested from right thigh Operative Procedures 1. Under spinal anesthesia, patient lied at supine position. 2. We excised the devitalized tissue. 3. Rotate adjacent skin flap and close the dead space 4. We harvested the 8/1000-inch in thickness STSG from right thigh with air-drive Zimmer dermatome.5. We applied the STSG on theskin defect and then tie-over 6. We applied short leg splint for immobilization. 7. Patient tolerated this procedure well. Operators 謝榮賢 Assistants 黃傑慧,蔡易臻 手術日期：2008/12/31 18:07 摘要__ 手術科部: 麻醉部 套用罐頭: Port-A implantation Pre-operative Diagnosis Cervical cancer Post-operative Diagnosis Ditto Operative Method Port-A implantation, echo-guided Pathology Nil Operative Findings 1.Site: left subclavian vein, with echo-guided procedure 2.Patent flow after implantation Operative Procedures Under general anesthesia, the patient was set on supine position and bilateral subclavian veins were checked by echo. After local anesthesia applied, transverse skin incision for 3cm was made at pre-cordial area. Undermine the skin at the layer betweensubcutaneous tissue and deep fascia in lateral direction. An IV catheter was inserted via the subclavian incision and negatively aspirated until venous blood attainable. J-wire was inserted smoothly via the needle in rostral direction. A subclavian catheter with dilator was inserted through the J-wire. Dilator was then removed. The IV catheter for Port-a was threaded into the subclavian catheter until mark 24cm. Skin tunnel between subclavian and pre-cordial incision was made by the blunt dissection withKelly clamp. Catheter was then threaded. Port was inserted into the pouch of pre-cordial incision. Catheter was adapted into the port and locked with restrictor. Skin was closed layer by layer. Both catheter and port were perfused with heparin solution after implantation. Operators 林至芃 Assistants 周韋翰 手術日期：2009/01/02 14:55 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Right parasagital meningioma , recurrent s/p gamma- knife Post-operative Diagnosis Ditto Operative Method Right F-P craniotomy for tumor excision Pathology pending Operative Findings Epidural meningioma buldging through parietal bure hole. After removal of the plate , the tumor was seen. Dissection through the interhemisphrum firm was done , some recurrent of the falx was seen and the callosumaryial aetery was preserved. The tumor was relatively hypocascular with ill-defined margin. The tumor also invaded into the SSS. Operative Procedures ETGA , supine with head fixed in Mayfield. Incision along previous incision. Removed of epidural component. Removal of bone plate. Remova; of turn and hemostasis with flostal and bipolar cautheation. Duraform coreage was cranoplate with miniplate. Placed a CWV and closed the wound in layers. Operators 曾漢民 Assistants 黃博浩,張政傑 手術日期：2009/01/07 10:15 摘要__ 手術科部: 外科部 套用罐頭: VATS biopsy Pre-operative Diagnosis left upper lobe lung tumor, r/o SCLC Post-operative Diagnosis left upper lobe lung tumor, small cell lung cancer Operative Method 1. Left VATS mediastinal lymph node biopsy 2.Port-A implantation via left subclavian vein Operative Findings 1. a 5X3 firm tumor at left hilum, with LUL consolidation; with mild pleural adhesion 2. moderate amount pleural effusion 3. no pleural lesions Operative Procedures 1. DLETGA, right decubitus position 2. Skin disinfection 4. Set VATS ports 5. dissect pleural adhesion 6. pleural effusion sampling 7. identify and do the biopsy of the mass at left hilum 8. hemostasis 9. place a 28 Fr chest tube 10. close wound in layers Operators 李元麒 Assistants 陳衛洲,梁嘉儀,R1李捷琦 手術日期：2009/01/12 16:49 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Lymphoma with suspect CNS relapse Post-operative Diagnosis ditto Operative Method Omaya implantation Pathology nil Operative Findings CSF opening pressure is about 8cmH20 with clear CSF drained out. Ventricular catheter is about 6.5cm with once ventricular puncture. Operative Procedures Under ETGA, the patient was put in supine position. The scalp was shaved, disinfected, and then draped. Curvilinear scalp incision was made at right frontal region, followed by a burr hole. The dura was opened after tenting. We punctured the ventricle with ventricular puncture needle, and then inserted the Omaya resorvoir and ventricular catheter. We tested the omaya reservoir function, and it is satisfactory. We closed the wound in layers. Operators 王國川 Assistants 李建勳,曾峰毅 手術日期：2009/01/14 15:00 摘要__ 手術科部: 外科部 套用罐頭: OPCAB Pre-operative Diagnosis CAD, 2VD Post-operative Diagnosis Ditto Operative Method OPCAB Pathology Nil Operative Findings 1. Fair heart contractility 2. LAD: long segment 90% stenosis RCA: mid 80% stenosis Patent LM and LCX Operative Procedures Under endotracheal general anesthesia, the patient was placed on supine position. The skin over chest, abdomen, and both thigh were sterilized with beta-iodine, and draped in usual way. The chest was opened by midline sternotomy. The pericardium was opened by inverted-T incision. The left internal mammary artery was dissected from its origin down to the sixth rib. The saphenous vein was harvested from the left thigh with multiple incisions. The bleeding of branches was checked with heparinized autologousblood. Under the add of Octopus stablizer, the LIMA was anastomosed with LAD. The SVG was anastomosed with Dx-PDA by using 7-0 prolene in that order. The distal end of SVG was anastomosed to ascending aorta with continuous suture using 6-0 prolene under partialaorta clamp. After meticulous hemostasis, the pericardium was left open without suture. 4 chest tubes were inserted, both in pericardium space. The sternum was closed with steel wire in interrupted stictches. The rest of wound was closed in anatomic layers. The wound over thigh was closed in three anatomic layers. Operators 陳益祥,王植賢 Assistants 李千慧,徐綱宏 手術日期：2009/01/17 18:45 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT Pre-operative Diagnosis Right intraventricular choroid plexus papilloma, with hydrocephalus Post-operative Diagnosis Right intraventricular choroid plexus papilloma, with hydrocephalus Operative Method total excision of the tumor via right parietal craniotomy and EVD placement for ICP monitoring Pathology pending Operative Findings 1. The IICP was so severe that the cerebral mantle was thin to 2 mm in thickness. The CSF was clear and tranparent. 2. A tumor measuring about 4x4x4 cm was located in right trigon with its feeder coming from right choroid arter. The tumor was hypervascular and weel-encapsulated. Some septum formation around the tumor was noted. Operative Procedures 1. The patient was anesthesized under ETGA in supine position with head turned to the very left side. 2. The skin was shaved, disinfected and prepped in the usual sterile fashtion. 3. curvilinear incision of the scalp and craniotomy was performed with right parietal approach. 4. Open the dura under miscroscopic view in cruciate shape after tenting the dura. 5. Dissect into the right ventricle via transcortical incision 6. Identify and remove the intraventricular tumor by cauterization of the hypervascular capsule and then traced the feeder till the choroid plexus was exposed. The feeding artery was cauterized and divided then the tumor was removed en bloc. 7. Homeostasis and irrigation of the ventricle 8. Place one EVD to the right lateral ventricle. 9. Fixed back the skull plate with silk after dura closure 10. Close the wound in layers. Operators 郭夢菲 Assistants 陳盈志,李勇毅 手術日期：2009/01/18 19:32 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis 4th ventricular tumor suspect ependymoma, with hydrocepahlus Post-operative Diagnosis Ditto Operative Method Nearly toal excision of the tumor via craniotomy and EVD for ICP monitoring Pathology Pending Operative Findings The tumor was pinkich greyish, fragile, moderately vascular, size about 3.7cm X 3.6 cm X 3.1cm, located vermis with extension to 4th ventricle, which was fully occupied. The feeding vessels was a branch of right PICA. It became enlarged than normal size.The origin of the tumor was on the right dorsal surface of the pons and it was adhered tightly to the cerebellar peduncle at right side that it was unable to make a complete excision here. The opening pressure of the CSF was very high (>20cm). The SCF was clear and transparent. Ventricular catheter: 9cm in length. Operative Procedures Under general anesthesia and intubation, the patient was put in prone position with head fixed with Mayfield skull clump. The scalp was shaved, scrubbed, disinfected with alcohol B-I then draped. Linear scalp incision was made at right parietal region followed by burr hole. The dura was opened after tenting. The ventricle was punctured with puncture needle under intraoperative sonography guidance then shifted to the ventricular catheter for 9 cm in length. Then the wound was closed. Another midlind scalpincision was made from 2 cm above inion to C2 spinous process level and incised the muscles. The craniotomy was made with high speed air drill and the dura was opened in inverted U-shaped after tenting. The tumor was located after retracted the cerebellartonsils and vermis. The tumor excision was performed under surgical microscope with bipolar coagulation, tumor forceps and suction. The aqueduct was fully opened after excision of the tumor. At the most adhesion site at right doral pons, one layer of tumor, maybe about 2-3 mm in thickness, was left intact to avoid brain stem injury. The hemostasis was achieved with surgicel lining of the tumor bed. The skull plate was fixed back with 4 wires after central tenting. The wound was closed in layers after onesubgaleal CWV drain set up. The EVD drain was connected to the drainage system for ICP monitoring. Operators 郭夢菲 Assistants 李建勳,楊惠馨 手術日期：2009/01/30 16:28 摘要__ 手術科部: 外科部 套用罐頭: Laminoplasty Pre-operative Diagnosis Cervical stenosis, C3-6 Post-operative Diagnosis ditto Operative Method Laminoplasty C3-6 Pathology nil Operative Findings Severe setnosis with hypertrophic ligmentum flavum was noted at C3-6. The spinal cord was decompressed after laminoplasty. Laminoplasty was performed with 2 5-hole mini-plates and 2 6-hole mini-plates, screws, and autologous bone graft for fusion. Operation time was 2 hours, and blood loss was about 300ml. Operative Procedures Under ETGA, the patient was put in prone posistion with Mayfield head clump fixation. Midline skin incision was made to expose C3-6 laminae. Bilateral laminae of C3-6 were dilled for two grooves. Open-door laminoplasty with hinge on the left was performedwith mini-plates, screws, and autologous bone graft for fusion. After placing one CWV, we closed the wound in layers. Operators 陳敞牧 Assistants 蘇亦昌,曾峰毅 手術日期：2009/02/04 14:12 摘要__ 手術科部: 泌尿部 套用罐頭: TUR-BT Pre-operative Diagnosis r/o Bladder tumor Post-operative Diagnosis Chronic cystits, r/o Neurogenic bladder Operative Method TURBT(Transurethral resection of bladder tumor) Operative Findings 1. No gross bladder tumor was noted 2. Moderate bladder trabeculation 3. Erythematous change at trigone and dome Operative Procedures Under satisfactory anesthesia with the patient in the lithotomy position, prepping and draping were performed in the usual sterile method. A Fr 22 Olympus Resectoscope was inserted into the urethra and bladder, and the whole bladder was inspected carefully. Trigone and bilateral orifices were identified and inspected carefully. The suspicious lesions were resected with resectoscope, piece by piece. The resected tissues were removed with Ellik evacuator. Adequate hemostasis was then obtained. A 22Fr. 3-way Foley catheter was inserted and continuous bladder irrigation with normal saline started. The balloon was inflated to 10 cc. The patient was then sent to the recovery room in a stable condition. Operators 王碩盟 Assistants 柯智群 手術日期：2009/02/05 15:17 摘要__ 手術科部: 骨科部 套用罐頭: Endoscopic carpal tunnel release Pre-operative Diagnosis Carpal tunnel syndrome, right wrist Post-operative Diagnosis Carpal tunnel syndrome, right wrist Operative Method Endoscopic carpal tunnel release Pathology nil Operative Findings Hypertrophy of transcarpal ligament Median nerve was compressed Operative Procedures 1. Under anethesia, supine position 2. Skin disinfected and draped 3. On tourniquet 4. Transverse skin incision at volar side of the wrist 5. Dilate the carpal tunnel 6. Curet the synovium 7. Transect the transcarpal ligament with Agee type endoscopic release 8. Hemostasis and irrigation 9. Close the wound Operators 侯勝茂 Assistants 洪立維,陳致宇,陳勇璋 手術日期：2009/02/05 20:03 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) Pre-operative Diagnosis metastatic spinal tumor, C7 Post-operative Diagnosis ditto Operative Method C7 hemilaminectomy and tumor remove Pathology pending Operative Findings 1. A well vasculized lesion occupied on C7 left side lamina and pedicle. The tumor was dark reddish in shape and soft, fragile in texture. Easy oozing was also noted during identified the tumor. 2. The adjacent tissue was fibrotic change. Bamboo like spine was also noted. Operative Procedures 1.Under ETGA, the patient was put in prone position. Skin disinfection and draped was performed porperly. 2.Fix the head with mayfield clamp. 3.Make a midleine posterior neck incision about 10 cm in length 4.Spilt the paraspinal muscle by layers. 5.Expose the C7 spinous process 6.Removed C7 spinous process and perform C7 left side hemi-laminectomy 7.After C7 hemilaminectomy, the tumor was found below the lamina and infiltrated into pedicle. It was easy oozing during exposure. 8.Excised the tumor with currette and tumor forceps 9.Hemostasis 10.Palced a CWV drain 11.Closed the wound in layers Operators 曾漢民 Assistants 陳睿生,林珂如 手術日期：2009/02/07 16:13 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt Pre-operative Diagnosis Bilateral subdural effusion Post-operative Diagnosis ditto Operative Method right SP shunt Operative Findings 1.Clear , yellowish effusion was drained out 2.Subdural catheter: 5 cm 3.Intraabdominal catheter: > 30 cm 4.Codman 40 mmHg pressure reservior was used. 5.ICP high Operative Procedures 1.ETGA, supine 2.Right temporal area vertical incision 3.Dissect skin flap 4.Cruciate form periosteum incision 5.Burr hole drill 6.RUQ abdominal transverse incision 7.Dissect to enter peritoneum 8.Insert abdominal catheter 9.Made a subcutaneous tunnel 10.Pass the catheter through subcutaneous tunnel 11.Open dura then insert catheter 12.Close wound in layers Operators 郭夢菲 Assistants 胡朝凱 手術日期：2009/02/07 11:55 摘要__ 手術科部: 泌尿部 套用罐頭: TRUS-P-biopsy Pre-operative Diagnosis r/o prostate cancer Post-operative Diagnosis r/o prostate cancer Operative Method TRUSP biopsy Pathology pending Operative Findings systemic 12 cores TRUSP biopsy was performed Operative Procedures Under satisfactory anesthesia with the patient in right flank position, prepping and draping was performed in the usual sterile fashion. TRUSP was performed and echo-guided prostate biopsies were performed smoothly with Biopty gun. The cores of tissue specimen were obtained. The biosy area was compressed for several minutes to ensure adequate hemostasis. The patient tolerated the operation well and was sent to the floor in satisfactory condition. Operators 蒲永孝 Assistants 姜宜妮 手術日期：2009/02/09 14:32 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis ditto Operative Method VP shunt insertion Operative Findings 1.Opening pressure: more than 20 cmH2O, clear CSF 2.Intraventricular catheter: 5.5 cm 3.Intra-abdominal catheter: 30 cm 4.Medtronic medium pressure reservior was used. 5.The anterior fontanell was stony hard. The coronal suture was widely opened. Operative Procedures Under ETGA, patient was put in supine with head rotated to left. Skin was shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 5 cm curvilinearskin incision was made at right Kocher point. After the scalp flap had been lifted and reflected anteriorly, a burr hole was made with karrison punch. The dura was then opened by a nib incision. Rt lateral ventricle was tapped by a ventricular needle, then a 5.5 cm segment of the ventricular catheter was introduced into the ventricle. The outerend of the catheter was connected to a Medtronic reservoir. A nib incision was made at RUQ of the abdomen , then minilaparotomy was performed to enter peritonealcavity. Subsequently, distal 30 cm segment of the peritoneal catheter (medium pressure) was introduced into the peritoneal cavity. The proximal end of this catheter was passed through subcutaneous tunnel at forechest, neck, rt retroauricular area and connected the reservoir. The shunt systemwas checked to make sure its function was working. The reservoir was fixed to pericranium by 3 stitches. Scalp closure after hemostasis. Operators 郭夢菲 Assistants 胡朝凱 手術日期：2009/02/12 00:00 摘要__ 手術科部: 婦產部 套用罐頭: LSC myomectomy Pre-operative Diagnosis Myoma uteri Post-operative Diagnosis Myoma uteri Operative Method Laparoscopic myomectomy Pathology Pending Operative Findings 1. Uterus: Avfl, hypertrophic and disfigured by one myoma; total weight of myoma:163 gm. M1:7 x8x cm,intramural type, at posterior wall 2. RAD: grossly normal. 3. LAD: grossly normal. 4. CDS: free of ascites and adhesion. EBL:minimal;BT: nil; Cx: nil Operative Procedures 1. Put the patient on lithotomy position. 2. Vaginal douching, skin disinfection and skin draping 3. Insert uterine elevator and on Foley 4. Make a 1cm skin incision above the umbilicus 5. Insert Varess needle and make pneumoperitoneum 6. Insert 10mm trocar and laparoscope 7. Insert 2nd (12mm), 3rd (5mm) trocars under laparoscopic inspection 8. Injection diluted Pitressin (1:50) into myoma uteri 9. Make incision on myoma via electrocauterization and enucleate the myoma 10. Suturerepair the uterine wound with 1-0 Vicryl. 11. Remove the myoma by morcellator. 12. Check bleeding and pack the uterine wound with a piece of Interceed 13. Insert a CWV drain into cul-de-sac 14. Remove trocars and repair skin with 3-0 Vicryl Recorded by R1林美邑 Operators 黃思誠 Assistants 陳思宇,周麗雲,林美邑 手術日期：2009/02/13 12:05 摘要__ 手術科部: 外科部 套用罐頭: Thymectomy Pre-operative Diagnosis Anteriror mediastinal tumor Post-operative Diagnosis Anteriror mediastinal tumor, r/o thymoma Operative Method 1.Sternotomy with tumor excision 2.total thymectomy Pathology pending Operative Findings A 5X4 cm well-capsulated, hypercellularity tumor with cystic degeneration, located at anterior mediatsinum r/o thymoma Operative Procedures 1.ETGA, supine position 2.Skin preparation, disinfection and draping 3.Skin incision, midline above the sternum 4.Sternotomy was done and dissection to the tumor was done 5.Tumor excision was done with total thymectomy 6.Hemostasis, irrigation and closure of wounds Operators 李章銘 Assistants 林孟暐,PGY 董正仁 手術日期：2009/02/13 13:19 摘要__ 手術科部: 骨科部 套用罐頭: Open reduction for closed or open humeral fracture; tuberosity, shaft or coudyles Pre-operative Diagnosis Left shoulder dislocation, left humeral greater tuberosity avulsion fracture Post-operative Diagnosis ditto Operative Method ORIF with Mitec anchor suture x 3 and Ticron Pathology nil Operative Findings as diagnosis, fragile bone fragment Operative Procedures 1.anesthesics induction, in semi-sitting position 2. skin disinfection, draped 3. skin incision over the lateral side of left upper arm 4. trans-deltoid approach, exposed the fracture site 5. ORIF with Mitec anchor suture x 3 and Ticron 6. repair thedeltoid muscle 7. irrigation, hemostasis 8. close the wound Operators 林繼昌 Assistants 方建豐,王政為 手術日期：2009/02/19 17:00 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt Pre-operative Diagnosis Posterior fossa arachnoid cyst, midline and left cerebellar Post-operative Diagnosis Ditto Operative Method Left cystoperitoneal shunt Pathology Nil Operative Findings The ICP was moderately increased and the CSF was clear. Intracystic catheter length was about 3cm; the intra-abdominal catheter was about 22 cm in length. No reservior was implanted. Operative Procedures 1. ETGA, supine with head right turn 2. 3cm linear incision at left occipital area, 2 cm from the midline 3. Creat a burr hole, dural tenting 4. Minilaparotomy at LUQ 5. Penetrate the sub-Q tunnel from LUQ to left suboccipital wound 6. Open dura, andinserted the intra-cystic catheter for 3-3.5cm 7. Insert the abdominal side for 22 cm after withdrawing of 10 cc CSF for studies 8. Hemostasis, and close the wound in layers Operators 郭夢菲 Assistants 陳睿生 手術日期：2009/02/20 08:20 摘要__ 手術科部: 外科部 套用罐頭: Port-A Pre-operative Diagnosis Lung cancer Post-operative Diagnosis Ditto Operative Method Port A insertion Pathology None Operative Findings The venous blood flow freely in the Port-A catheter after implantation. Operative Procedures The patient was put on supine position. The operation field was disinfected and draped as usual. Under local anesthesia, the Port-A catheter was implanted on right side upper chest with puncture method via right IJV. Operators 詹志洋 Assistants 謝永 手術日期：2009/02/24 00:00 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Parkinson disease Post-operative Diagnosis Ditto Operative Method DBS implantation, bilateral Pathology nil Operative Findings DBS electrode was inserted to bilateral STN as planned target.STN and SNR was identified under electrophyiology moniter. Operative Procedures supine with head placed in headholder. Bicoronal incision and place two burr holes. Set up DBS system. Tissucol duroplacement after dural incision. Dural incision and insert electrode under electrophysiology monitor. Wound closed in layers. Operators 曾勝弘 Assistants 陳盈志 手術日期：2009/02/25 12:41 摘要__ 手術科部: 外科部 套用罐頭: HIVD Pre-operative Diagnosis L5~S1 HIVD and L4~L5 stenosis Post-operative Diagnosis ditto Operative Method Right L5~S1 diskectomy and right L4/5 foraminectomy Operative Findings 1.Protuding disc was noted at L5/S1 that compressed the right S1 root tightly. 2.After decompression, root was loosened and expanded 3.Laminar stenosis of Right L4/L5 Operative Procedures Under endotracheal general anesthesia, patient was put in prone position. Pre-Op fluoroscopic localization was performed. The back was shaved and scrubbed with povidone-iodine detergent then painted with povidone-iodine tincture and followed by sterilizedadhesive plastic sheet covering. Incision was made as 3-cm, between L5~S1 spinous processes. The subcutaneous layer and lumbdorsal fascia were incised then the aponeurosis of the latissimus dorsi and ileocostalis lumborum muscles at spinous processes ofL 5~S1 was incised, the muscles were detached from the interspinous ligament. The multifidus muscles were detached subperiosteally from L5~S1 laminae by a rasp. The paravertebral muscles were retracted by a modified narrow Taylor retractor which was retained constantly by a rubbersling to the side rail of the operating table. under an operating microscope, the ligamentum flavum was cleaned and incised longitudinally at the lateral part.The lateral portion of this ligament was removed with a small angle Kerrison rongeur, the lateral portion of the laminae and the medial border of the facets were removed too until the margin of the facets and a corridor to the disc that ran lateral to the root was reached. The epidural fat was left undisturbed andpreserved. The compressed S1 root and veins overlying the protruded disc were gently pushed away by placing 2 small cottonoid patties, one above and one below the disc at the floor of the epidural canal. The compressed root was gently pushed further away temporarily by sucker tip in order to expose the herniated disc more clearly. The posterior longitudinal ligament and annulus were incised around the protruded disc with a No. 15 blade. The degenerated disc was removed with microdisc forceps until a substantial amount of the nucleus had been loosened with a cone curette and removed. L4/L5 laminotomy was performed for removal of hypertrophic ligmentum flavum. The lumbodorsal fascia was approximated by 3 interruped 2/0 silk stitches. Thesubcutaneous layer wasclosed by running suture with 4/0 Dexon and skin by adhesive tape. Operators 賴達明 Assistants 黃博浩,胡朝凱 手術日期：2009/02/27 14:52 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis cerebellar tumor, r/o metastasis Post-operative Diagnosis cerebellar tumor, r/o metastasis Operative Method suboccipital approach for total tumor excision Operative Findings After dural opening and corticotomy, the tumor was seen in the right cerebellar hemisphere, measuring about 3.5x3.5x3.0cm. It is a hypervascular tumor with well-defined border. it was excised totally. The superior portion seems to have invasion into the sinus. Operative Procedures ETGA, Mayfield headholder fixation and prone position with head flexion. Midline incision and expose suboccipital area. burr hole and craniotomy. Dural opening and tumor excision with bipolar, suction, and tumor forcep. Hemostasis, dural closure with fascia graft. Cranioplasty with wire. wound closed in layers after placement of CWV. Operators 曾漢民 Assistants 黃博浩 手術日期：2009/03/02 15:53 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt Pre-operative Diagnosis Shunt wound infection Post-operative Diagnosis Shunt wound infection Operative Method Wound debridement Pathology nil Operative Findings Pus discharge from wound; the shunt was intact, no CSF leakage Operative Procedures 1.ETGA supine, head to left 2.Fusiform wound incision 3.Debride with curette 4. Close wound with 2.0 Nylon Operators 王國川 Assistants 陳盈志,林祥源 手術日期：2009/03/03 08:20 摘要__ 手術科部: 泌尿部 套用罐頭: 其他 Pre-operative Diagnosis Parkinson disease s/p DBS Post-operative Diagnosis Parkinson disease s/p DBS Operative Method generator implantation Pathology nil Operative Findings good function of the system after generator implant Operative Procedures 1.ETGA supine 2.Left parietal-occopital skin incision 3.Pull out previous lead (L and R) 4.Left subcutaneous pocket creation 5.Tunneling and assemble lead with generator 6.Check function 7.Hemostasis 8.Wound closed in layers Assistants 伍嘉偉,黃博浩 手術日期：2009/03/04 10:34 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis LLL nodule, suspected primitive neuroectodermal tumor, metastasis Post-operative Diagnosis Ditto Operative Method VATs wedge resection of LLL Pathology Pending Operative Findings A 0.7 cm, soft, well-defined lesion, yellowish in LLL, near fissure Operative Procedures 1.DLETGA, hight decutbitus 2.Disinfection and drapping 3.VATs: the 7th ICS-MAL, the 5th ICS-MAL, the 9thICS-PAL 4.Identified the lesion after adhesiolysis 5.Wedge resection of LLL 6.Check bleeding and hemostasis 7.Chest tube Fr.24*1 8.Closed the wound in layers Operators 陳晉興 Assistants 梁嘉儀 手術日期：2009/03/04 20:33 摘要__ 手術科部: 骨科部 套用罐頭: Open reduction for bimalleolare fracture 開立醫師: 陳勇璋 開立時間: 2009/03/04 20:33 Pre-operative Diagnosis Bimalleolar fracture, right ankle Post-operative Diagnosis Bimalleolar fracture, right ankle Operative Method ORIF with a STP and a malleolar screw Pathology nil Operative Findings bimalleolar fracture Operative Procedures 5. Reduction and fixation of lateral malleolar fracture with a semitubular plate (6H6S) 1. Under anesthesia, supine position 2. Skin disinfected and draped 3. On pneumatic tourniquet 4. Skin incision at lateral aspect of right ankle 6. Skin incision at medial aspect of right ankle 7. Reduction and fixation with a malleolar screw 8. Hemosatasis and irrigation 9. Close the wound and apply a short leg splint Operators 王至弘, Assistants 陳勇璋, 吳拓, 陳致宇, 手術日期：2009/03/04 08:46 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis left DM foot Post-operative Diagnosis ditto Operative Method Debridement Operative Findings A 0.5 x 0.8 cm ulcer was noted at the tibial side of left great toe. Operative Procedures IVG, supine, antisepitcs applied Debridement Wet dressing Operators 郭源松 Assistants 陳思恆 手術日期：2009/03/05 11:00 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt Pre-operative Diagnosis VP shunt wound infection with abscess formation Post-operative Diagnosis Ditto Operative Method Debridement Pathology nil Operative Findings Granulation tissue with some discharge noted at right neck Operative Procedures 1.Skin disinfection & draped 2.Local anesthesia 3.Spindle shape skin incision, including the wound 4.Debridement with curette 5.Hemostasis and closed the wound with 3-0 Nylone. Operators 王國川 Assistants 李建勳 手術日期：2009/03/09 08:38 摘要__ 手術科部: 骨科部 套用罐頭: Total hip replacement-Anterior 開立醫師: 陳彥宇 開立時間: 2009/03/09 08:38 Pre-operative Diagnosis Osteoarthritis of hip, right Post-operative Diagnosis Ditto Operative Method Total hip arthroplasty, right with Wright large-head metal-on-metal prosthesis (shell:52mm, femur stem:13.5mm head:48mm neck:-3.5mm) Total hip arthroplasty, right with Wright large-head metal-on-metal prosthesis (shell:52mm, femur stem:__mm head:48mm+0) Total hip arthroplasty, right with Wright large-head metal-on-metal prosthesis (shell:52mm, femur stem:13.5mm head:48mm+0) Total hip arthroplasty, right with Wright ceramic prosthesis (shell:__mm, femur stem:__mm head:__mm+0) Pathology nil Operative Findings 3. Hypertrophy of joint capsule and synovium 1. OsteophyteS over medial wall of acetabulum, femoral neck and head. 2. Cartilage wearing and subchondral bone exposure Operative Procedures 1.Under spinal anesthesia, the patient was placed in lateral decubitus position. 2. The skin dis-infection was performed and scrubbed with beta-iodine detergent and alcoholic solution. 3. Longitudinal skin incision and anterior-lateral approach were done to dissect the gluteal medium muscle fiber and to dissect the joint capsule. 4. Osteotomy with bone saw at the femoral neck and remain 1cm of calcar. 5. Removal of femoral head was performed as following after dissecting the ligamentum teris. 6. Exposed the acetabulum rimand reamed the acetabulaum size by size to fit the proper size of acetabular shield. 7. Insert was set to shield as following. 8. Then intra-medullar reaming of the femoral medullar canal with rigid reamer was done size by size. 9. Enlarged the inlet of femoral bone canal by broach was performed to fit the femoral stem. 10. Set the femoral stem prosthesis into femoral canal and put the neck and head onto the stem. 11. Reduced the femoral head component into acetabular prosthesis and checked the stability of new joint. 12. Then irrigated the wound with normal saline and hemostasis was carried carefully. 13. Finally, close the wound layer by layer. 2. The skin dis-infection was performed and scrubbed with beta-iodine detergent and alcoholic solution. (MIS, anterolateral approach) Operators 侯勝茂, Assistants 陳彥宇, 李忠謙, 許家豪, 潘敬軒 手術日期：2009/03/09 11:21 摘要__ 手術科部: 骨科部 套用罐頭: Revision total knee replacement Pre-operative Diagnosis S/P right TKR with tibia mal-aligment Post-operative Diagnosis ditto Operative Method Revisional TKR with Tibia re-alignment Pathology nil Operative Findings 1. osteolysis of proximal tibia 2. Tibia bone mal-alignment 3. Severe adhesion and fibrosis of knee joint 4. prothesis in situ without wearing Operative Procedures 1. Spinal anesthesia, supine on pneumatic torniquet. 2. Skin incision along previous OP scar. 3. Medial approach and release, Synovectomy. Removal of original tibia insert and prothesis 4. Re-alignment of tibia bone and tibia osteotomy 5. Revision TKR with original tibia insert and prothesis 6. Put allograft bone and cement inbetween the tibia bone, insert, and prothesis 7. Two K-wire was placed around the realigned tibia bone 8. N/S irrigation, lateral release of knee joint 9. Hemastasis, close the wound in layers. Operators 王至弘 Assistants 陳俊和,徐鎮平 手術日期：2009/03/16 14:16 摘要__ 手術科部: 骨科部 套用罐頭: Other Pre-operative Diagnosis Bilateral carpal tunnel syndrome Post-operative Diagnosis ditto Operative Method Bilateral carpal tunnel release Pathology nil Operative Findings hypertrophic flexor retinaculum Operative Procedures 1. anesthesics induction, in supine position 2. skin disinfection, draped, on tourniquet 3. skin incision over the right wrist, volar side 4. dissected, released the flexor retinaculum 5. irrigation, close the wound 6. skin incision over the left wrist, volar side 7. dissected, released the flexor retinaculum 8. irrigation, close the wound Operators 孫瑞昇 Assistants 陳俊和,王政為 手術日期：2009/03/16 14:11 摘要__ 手術科部: 骨科部 套用罐頭: Bilateral carpal tunnel release 開立醫師: 陳致宇 開立時間: 2009/03/16 14:11 Pre-operative Diagnosis Bilateral capral tunnel syndrome Post-operative Diagnosis ditto Operative Method Bilateral carpal tunnel release Pathology nil Operative Findings Bilareral hypertrophic flexor retinaculum Operative Procedures 2. skin disinfection, draped, on tourniquet 3. slin incision at the right wrist, volar side 4. dissected, exposed the flexor reti 1. anesthesics induction, in supine position Operators 孫昇 Assistants 王政為,陳俊和 手術日期：2009/03/19 09:29 摘要__ 手術科部: 外科部 套用罐頭: DM foot-debridement and STSG 開立醫師: 林子超 開立時間: 2009/03/19 09:29 Pre-operative Diagnosis Ulceration and cellulitis over left calf Post-operative Diagnosis Ditto Operative Method Debridement Pathology Nil Operative Findings 1. An oval shaped ulceration, 3x2cm in size, at anterior aspect of left calf with intact periostium 2. Mild erythematous change along the edge of wound Operative Procedures 1. Under spinal anesthesia, patient lied at supine position. 2. We excised the devitalized tissue. 3. We irrigated the wound with normal saline. 4. We applied beta-iodine ointment on the wound and covered with gauze. 5. We wrapped elastic bandage over left foot and calf 6. Patient tolerated this procedure well. Operators 楊永健 Assistants 黃傑慧,林子超 手術日期：2009/03/21 20:07 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for tumor excision 開立醫師: 林子超 開立時間: 2009/03/21 20:07 Pre-operative Diagnosis Brain metastasis, multiple involve supratentorium and infratentorium Post-operative Diagnosis Ditto Operative Method Suboccipital craniotomy tumor excision of cerebellar tumor Pathology Pending Operative Findings The tumor was soft elastic with mucinous content in character. One 2.5 cm at left lateral cerebellar hemisphere, one 2.3 cm at right cerebellum and one 1.5 cm at left median side. Operative Procedures 1. Under endotracheal general anesthesia 2. The patient lay in prone position with Mayfield fixation 3. Midline skin incision 4. Made three Burr holes for craniotomy 5. Bilateral U-shape dura incision 6. Echo-guided corticotomy: identified tumor, dissected along border then removed with tumor forceps 7. Hemostasis and surgical packing 8. Closed the dura with 4-0 prolene 9. Fixed bone plate with 3 wires 10. Set one subgaleal CWV drain 11. Close the wound in layers Operators 蔡瑞章 Assistants 陳盈志,林子超 手術日期：2009/03/22 01:00 摘要__ 手術科部: 外科部 套用罐頭: VATS biopsy Pre-operative Diagnosis anterior mediastinal tumor with pleural effusion, suspect malignanct germ cell tumor Post-operative Diagnosis ditto Operative Method 1.VATS tumor biopsy, right side approach 2.Port-A implantation Pathology pending Operative Findings 1.Two huge, firm mediastinal tumors with cystic component, easy bleeding, adhesion to RML and RLL 2.Moderate amount pleural effusion 3.Port A position: good, blood withdrawal: smoothly Operative Procedures 1.DLETGA, left decubitus position 2.Disinfection and drapped 3.VATS setting 4.Do pleural effusion collection 5.Tumor biopsy 6.Hemostasis and set Fr.28 chest tube *1 7.Close wound in layers 8.Supine position and perform port-A implant via left subclavicular vein by puncture method. Operators 張金池 Assistants 張彥俊,趙崧筌 手術日期：2009/03/26 08:00 摘要__ 手術科部: 泌尿部 套用罐頭: URS (biopsy) Pre-operative Diagnosis Left ureteral stricture Post-operative Diagnosis Left ureteral stricture Operative Method Left URS and ureteral catheter placement Pathology nil Operative Findings 1. Left middle ureteral severe stricture, and it is failed to pass throught stricture site 2. No specific bladder lesion Operative Procedures Under satisfactory intravenous anesthesia and lithotomy position, the prepping and drapping were performed in usual sterile method. Left URS was performed via guide wire, but it was failed to pass the stricture site. We inserted 7Fr. ureteral catheterthrough guidewire, and set 16Fr. Foley catheter. Under stable condition, the patient was sent to recovery room for further care. Operators 黃國皓 Assistants 洪順發,賴建榮 手術日期：2009/03/26 09:35 摘要__ 手術科部: 外科部 套用罐頭: Debridement and STSG 開立醫師: 林子超 開立時間: 2009/03/26 09:35 Pre-operative Diagnosis Ulceration over left tibial region Post-operative Diagnosis Ditto Operative Method Debridement and STSG Pathology Nil Operative Findings One 2x3 cm ulceration at left tibial region with a small defect with exposure of periostium Harvest STSG: 5x4 cm in area Operative Procedures 1. Under spinal anesthesia, patient lied at supine position. 2. We excised the devitalized tissue. 3. We harvested the 8/1000-inch in thickness STSG from left thigh with air-drive Zimmer dermatome. 4. We suture one stitch with 2-0 Nylon for covering the defect of granulation 5. We applied the STSG on the skin defect and then tie-over 6. We applied short leg splint for immobilization. Operators 楊永健 Assistants 黃傑慧 手術日期：2009/03/26 13:11 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt Pre-operative Diagnosis V-P shunt infection Post-operative Diagnosis ditto Operative Method V-P shunt removal with abscess debridement Pathology pending Operative Findings Occult V-P shunt Pus infiltrated inside ventricular catheter and reservoir Two abscess was noted along shunt pathway, right posterior auricular scalp. Operative Procedures 1. IVGA, supine position, skin parepared 2. Linear incision along shunt 3. Dissect, identify ventricular catheter and reservoir, then remove 4. Debride of abscesses 5. Close wounds Operators 王國川 Assistants 李建勳,陳柏達 手術日期：2009/03/27 09:30 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT Pre-operative Diagnosis Left parietal meningioma, recurrence Post-operative Diagnosis Left parietal meningioma, recurrence Operative Method Left parietal craniotomy for tumor excision Pathology pending Operative Findings Left parietal meningioma recured on the inferior lateral edge of previous resection site. The margin was not well defined. It was about 4.2x4.0x3.5cm yellow pinkish and hypervascular. Moderate brain swellingon dural close. The dura was resected with Gortex used for duraplasty. Operative Procedures 1.ETGA, prone with head fixed in Mayfield. 2.Redo previous craniotomy with extended craniotomy in the inferior lateral part. 3.Echo identification of the tumor. 4.Excision of previous Gortex. 5.Tumor excision. Hemostasis. 6.Duraplasty with Gortex, cranioplasty with wires. 7.Wound close in layers with a subgaleal CWV drain. Operators 曾漢民 Assistants 黃博浩,伍嘉偉 手術日期：2009/03/31 13:30 摘要__ 手術科部: 外科部 套用罐頭: HIVD Pre-operative Diagnosis C3/4, 4/5 OPLL Post-operative Diagnosis ditto Operative Method C4 corpectomy, C3/4, 4/5 discectomy, anterior fusion with autologous bone graft + plate fixation Pathology nil Operative Findings severe marginal spur formation, narrowed disc space C3/4 4/5 PLL became calcified and adhesion to dura was noted. Plate 34mm screw 16mmx4 Operative Procedures ETGA, supine, skin prepared Right neck incision expose C3-C4 Carm localization Corpectomy of C4 with C3/4, 4/5 discectomy till cord expanded Harvest right iliac crest bone graft, and insert interbody space Plate fixation with screw Hemostasis, CWVx1Close wound in layers Operators 賴達明 Assistants 陳盈志,陳柏達 手術日期：2009/04/01 16:40 摘要__ 手術科部: 泌尿部 套用罐頭: TUR-BT Pre-operative Diagnosis Bladder tumor Post-operative Diagnosis Bladder tumor Operative Method TURBT(Transurethral resection of bladder tumor) Operative Findings Cauliflower-like tumors at right lateral wall Operative Procedures Under satisfactory anesthesia with the patient in the lithotomy position, prepping and draping were performed in the usual sterile method. A Fr 22 Olympus Resectoscope was inserted into the urethra and bladder, and the whole bladder was inspected carefully. This revealed presence of sessile tumors located at right lateral wall. Trigone and bilateral orifices were identified and inspected carefully. The tumor(s) was(were)resected with resectoscope, piece by piece. The resected tissues were removed with Ellik evacuator. Adequate hemostasis was then obtained. A 22Fr. 3-way Foley catheter was inserted and continuous bladder irrigation with normal saline started. The balloon was inflated to 10 cc. The patient was then sent to the recovery room in a stable condition. Operators 黃昭淵 Assistants 翁文慶 手術日期：2009/04/01 13:36 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) Pre-operative Diagnosis Spondylolisthesis, L4 on L5 Post-operative Diagnosis Spondylolisthesis, L4 on L5 Operative Method 1) sublaminar decompression, 2) posterior instrumentation with TPS, L4-5, 3) TLIF with banana cage Pathology Nil Operative Findings 1. TPS: four 6.5x40mm screw over L4&L5; 2. cage: 11mm in height, banana cage Operative Procedures 1. ETGA, prone 2. Disinfection and drapping 3. Midline skin incision over L3-5 region 4. Detach paravertebral muscles subperiostealy 5. Insert TPS to T4&T5; from juction between transverse process and facet joint 6. Remove right lamina and L4-5 facetjoint 7. Sublaminar decompression of contralateral lamina 8. Remove L4-5 intervertibral disc 9. Insert the cage into L4-5 disc space 10. Hemostasis, saline irrigation 11. Set two hemovac drainage tubes 12. Close the wound in layers Operators 賴達明 Assistants 蘇亦昌,莊民楷 手術日期：2009/04/06 12:00 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt Pre-operative Diagnosis Arachnoid cyst, left posterior fossa, s/p cystoperitoneal shunt with dysfunction Post-operative Diagnosis Ditto Operative Method Cystoperitoneal shunt revision Pathology Nil Operative Findings A new burr hole was made about 1cm medial and 1.5 cm below the previous one. An about 3cm in length new intracystic catheter was inserted from the new burr hole. The old one was successfully removed. The CSF in the cyst was clear and mild pressure was noted. Operative Procedures After ETGA, the patinet was under supine position with head turned to the right side. We opened the previous wound over left suboccipital region and exposed the previous shunt. A new burr hole was made about 1cm medial and 1.5 cm below the previous one. The cystic side of the old shunt was removed and an about 3cm in length new intracystic catheter was inserted from the new burr hole after it was connected to the previous peritoneal catheter with a straight connector. After hemostasis, the wound was closed in layers. Operators 郭夢菲 Assistants 陳睿生蘇亦昌,陳睿生 手術日期：2009/04/08 08:50 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt Pre-operative Diagnosis Bilateral retrocerebellar arachnoid cyst Post-operative Diagnosis Ditto Operative Method Left cystoperitoneal shunt with Codman fixed pressure 40 mmH2O shunt Pathology Nil Operative Findings The skull thickness was thin and down to 1mm. The fluid gashed out after opened the arachnoid cyst. The CSF was clear and transparent. Codman Hakim cylindrical valve, pressure 40mm +/-10 mm was used. Cystal part: 4cm, peritoneal part: 25cm. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position with head turned to right. The scalp was shaved, scrubbed, disinfected with alcohol B-I then draped. The linear scalp incision was made 3 cm away from midline and at the inferior occipitl bone. A burr hole was made with high speed drill. Minilaparotomy was made at left upper abdomen and inserted the peritoneal catheter for 25 cm. Passed the shunt via subcutaneous tunnel through anterior chest wall, neck to the occipital woundand connected to the cylindrical valve. Opened the dura after tenting and inserted the cystal catheter for 4 cm. Connected the cystal catheter to the reservoir and check function. Closed the wounds in layers. Operators 郭夢菲 Assistants 李建勳,古恬音 手術日期：2009/04/10 12:01 摘要__ 手術科部: 外科部 套用罐頭: Lobectomy Pre-operative Diagnosis RLL tumor Post-operative Diagnosis Ditto Operative Method VATS RLL lobectomy and LN dissection Pathology pending Operative Findings A 5*4cm greyish tumor with necrosis tissue. irregular shape Operative Procedures 1. DLETGA, ledt decubitus 2. VATS port setting 3. Dissection of inf. pulmonary ligament 4. Transet RLL pulmonary vain , artery and bronchus by endo-GIA 5. RLL lobectomy 6. G3 3,7 Ln dessection 7. Set 28Fr chest tube *1 8. Close wound Operators 李章銘 Assistants 張彥俊,梁嘉儀 手術日期：2009/04/10 05:30 摘要__ 手術科部: 外科部 套用罐頭: Kidney Pre-operative Diagnosis ESRD Post-operative Diagnosis Ditto Operative Method Cadaver-related kidney transplantation Pathology Nil Operative Findings 1. One hematoma area around 3x3cm at donor kidney cortex 2. Cold ischemic time till reperfusion was 4hr 40min. 3. After reperfusion, kidney was warm, pink, but no ecchymosis was noted 4. After reperfusion, hematuria was noted Operative Procedures 1.ETGA, supine position 2.Gilbson incision, expose R't ext.iliac artery and vein. 3.Perform kidney transplantation: Graft renal a.-->R't external iliac a. (diameter:0.8cm, contineous suture with 5.0 prolene) Graft IVC-->R't external iliac v. (diameter=2cm, contineous suture wuth 5-0 prolene) 4.Reperfusion. 5.Perform extravesicle neouretero cystostomy with double -J as stent 6.Hemostasis. 7.Place a R-D around the graft. 8.close wound in layers. Operators 蔡孟昆,葉啟娟 Assistants 羅健洺 手術日期：2009/04/12 21:20 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Acute SDH at right F-T-P area Post-operative Diagnosis ditto Operative Method Decompressive craniectomy with hematoma evacuation, parital lobectomy of right frontal base and temporal tip, and ICP monitor insertion Pathology nil Operative Findings Before the operation, the patient's right pupil was dilated, and returned to normal size after the operation. About 1.5cm thick acute SDH was noted at right F-T-P area with underlying brain parenchyma contusion. Post-op ICP was 3mmHg. The brain regained pulsation after decompression. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head tilted to left. Linear skin incision was made at right temporal area first, and one burr hole was done for decompression. We completed question-mark skin incision andmade trauma flap. We harvested the fascia of right temporalis muscle, and achieved craniectomy after making another 4 burr holes. Dura was incised for hematoma evacuation and hemostasis after dural tenting. Necrotic brain parechyma at right frontal base and right temporal tip was incised for hemostasis and decompression. Duroplasty was done with autologous fascia graft. We inserted one subdural ICP monitor and two epidural CWV drains. The wound was closed in layers. Operators 王國川 Assistants 陳睿生,曾峰毅 手術日期：2009/04/14 15:27 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) Pre-operative Diagnosis L2-5 stenosis Post-operative Diagnosis L2-5 stenosis Operative Method L3-5 laminectomy with posterolateral fusion Pathology nil Operative Findings Marked hypertrophy of facet joint L2/3, L3/4, L4/5 with narrowed spinal space. The dura adhere to ligament tightly. Two places of dura tear was noted while manipulation, which primary repaired. No further CSF leak was noted. The root of L3, L4, L5 was identified bilaterally. Operative Procedures 1.ETGA, prone , C-arm localization 2.Midline back incision 3.Expose L2-5 laminae 4.Laminectomy L3-5 with Ronger and then kerrison 5.Repair dura tear 6.Posterolateral fusion L2/3, L3/4, L4/5 7.Hemostasis, H/V X1 8.closure of wounds in layers Operators 曾勝弘 Assistants 陳盈志,PGY董正仁 手術日期：2009/04/15 18:11 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Right SDH, s/p craniectomy; Left EDH Post-operative Diagnosis ditto Operative Method Left parietal craniotomy for hematoma evacuation Pathology nil Operative Findings One transverse fracture line was noted at left parietal area. About 1.5 to 2cm thick epidural hematoma was found at left parietal. There was minimal subdural hematoma. The brain was decompressed after hematoma removal. Operative Procedures Under endotracheal general anaesthesia, the patient was put in supine position with head tilted to right. U-shaped skin incision was made, an three burr holes were drilled. 4x5cm craniotomy was made. Dural tenting was done, and then hematoma was removed.After achieving hemostasis, cranioplasty was done with wire fixation and central tenting. One subgaleal drain was put. The wound was closed in layers. Operators 王國川 Assistants 曾峰毅 手術日期：2009/04/17 16:30 摘要__ 手術科部: 外科部 套用罐頭: VATS biopsy Pre-operative Diagnosis Bilateral multiple lung nodules Post-operative Diagnosis ditto Operative Method port-A implantation + VATS LLL wedge resection Pathology pending Operative Findings 1. One 1.5cm whitish firm tumor over LLL 2. port-A tip over SVC Operative Procedures 1. DLETGA, supine, skin prepared 2. Puncture to right subclavicular vein 3. Port-A was inserted 4. Wound closure and change position to right decubitus 5. VATS setting as usual 6. Identify tumor and wedge resection by EndoGIA 7. Set one Fr 28 C/T 8. Wound closure Operators 陳晉興 Assistants 李佳穎,陳柏達 手術日期：2009/04/20 14:20 摘要__ 手術科部: 骨科部 套用罐頭: Endoscopic carpal tunnel release Pre-operative Diagnosis Bilateral carpal tunnel syndrome Post-operative Diagnosis ditto Operative Method Bilateral carpal tunnel release Pathology nil Operative Findings 1. hypertrophic flexor retinaculum 2. hyperremic and artophic median nerve Operative Procedures 1. aneshtesics induuction, in supine position 2. skin disinfection, draped, on tourniquet 3. curved skin incinio over bilateral wrist 4. release the flexor retinaculum 5. irrigation, hemostasis 6. close the wound Operators 孫瑞昇 Assistants 陳勇璋,王政為 手術日期：2009/04/23 16:47 摘要__ 手術科部: 外科部 套用罐頭: Port-A insertion 開立醫師: 徐綱宏 開立時間: 2009/04/23 16:47 Pre-operative Diagnosis Lung cancer Post-operative Diagnosis Ditto Operative Method port-A implantation via right internal jugular vein Pathology nil Operative Findings 1. The port-A catheter was inserted via right internal jugular vein by puncture & echo-guided procedure 2. Patent flow after implantation Operative Procedures -Anesthesia: local, the patient was put on supine position. The operation field was disinfected and draped as usual. -Port-A catheter was implanted on rightside upper chest with cut down/puncture method under echo-guided procedure. -Port-A: After skin disinfection and drapping & local anesthesia, echo-guided RIJV puncture and catheterization was performed. Creation of the subcutaneous pocket at right subclavicular area. Tunneliztion, advanced the catheter into the RIJV via the peel-away sheath smoothly. Wound closure in layers after adequate hemostasis. Operators 吳毅暉 Assistants 徐綱宏 楊美慎 (F,1939/11/10,72y4m) 手術日期 2009/04/23 手術主治醫師 王國川 手術區域 兒醫 066房 01號 診斷 Transient ischemic attack (TIA) 器械術式 EC-IC by-pass 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 3 紀錄醫師 李建勳, 時間資訊 16:21 臨時手術NPO 07:51 報到 08:25 進入手術室 08:30 麻醉開始 08:50 誘導結束 09:50 抗生素給藥 10:05 手術開始 12:45 開始輸血 12:50 抗生素給藥 15:55 麻醉結束 15:55 手術結束 16:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 7 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 顱內外血管吻合術 1 1 R 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 R 摘要__ 手術科部: 外科部 套用罐頭: EC-IC Bypass Pre-operative Diagnosis Right internal carotid artery stenosis Post-operative Diagnosis Ditto Operative Method Right EC-IC bypass (STA anterior branch-M4 branch: end-to-side anastomosis, posterior branch: indirect bypass) Specimen Count And Types Pathology Nil Operative Findings The frontal branch of right STA was more prominent than posterior branch and was used for anastomosis. The end-to-side anastomosis was made at right M4 branch. The post-anastomosis flow: up to 22 mL/min. The posterior branch of STA was put on the surfaceof sylvian fissure for indirect bypass. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position with head fixed with Mayfield skull clump then draped. The STA was located with duplex and marked. The scalp was shaved, scrubbed, disinfected with alcohol B-I then draped. The scalp incision was made along posterior branch of STA and dissected the both branches of STA together with one layer of fascia under surgical microscope. Incision over the temporalis muscles followed by craniotomy at right temporal area. The dura was opened after tenting along the craniotomy window. Opened the sylvian fissue and located one M4 branch. End-to-side anastomosis of anterior branch of STA and M4 was performed under surgical microscope with 10-0 Nylon sutures after temporal cliping. The minorleakage was stopped by the surgicel lining and cotton pad packing. Checked the post-anastomosis flow with Transonic Flow-QC flowmeter. The posterior branch of STA was clipped at distal end and put on the sylvian surface. The dura was approximated with 4-0 Prolene sutures and then covered with DuraForm artificial dura. The temporalis muscle was approximated with 2-0 silk sutures after fixed the skull plate back with miniplates and screws. One CWV drain was set up before closed the wound in layers. Operators 王國川 Assistants 李建勳 手術日期：2009/04/23 09:30 摘要__ 手術科部: 外科部 套用罐頭: EC-IC Bypass Pre-operative Diagnosis Right internal carotid artery stenosis Post-operative Diagnosis Ditto Operative Method Right EC-IC bypass (STA anterior branch-M4 branch: end-to-side anastomosis, posterior branch: indirect bypass) Pathology Nil Operative Findings The frontal branch of right STA was more prominent than posterior branch and was used for anastomosis. The end-to-side anastomosis was made at right M4 branch. The post-anastomosis flow: up to 22 mL/min. The posterior branch of STA was put on the surfaceof sylvian fissure for indirect bypass. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position with head fixed with Mayfield skull clump then draped. The STA was located with duplex and marked. The scalp was shaved, scrubbed, disinfected with alcohol B-I then draped. The scalp incision was made along posterior branch of STA and dissected the both branches of STA together with one layer of fascia under surgical microscope. Incision over the temporalis muscles followed by craniotomy at right temporal area. The dura was opened after tenting along the craniotomy window. Opened the sylvian fissue and located one M4 branch. End-to-side anastomosis of anterior branch of STA and M4 was performed under surgical microscope with 10-0 Nylon sutures after temporal cliping. The minorleakage was stopped by the surgicel lining and cotton pad packing. Checked the post-anastomosis flow with Transonic Flow-QC flowmeter. The posterior branch of STA was clipped at distal end and put on the sylvian surface. The dura was approximated with 4-0 Prolene sutures and then covered with DuraForm artificial dura. The temporalis muscle was approximated with 2-0 silk sutures after fixed the skull plate back with miniplates and screws. One CWV drain was set up before closed the wound in layers. Operators 王國川 Assistants 李建勳 手術日期：2009/04/23 20:57 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis respiratory failure Post-operative Diagnosis ditto Operative Method tracheostomy Pathology nil Operative Findings 1.Fr.8 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly Operative Procedures 1.ETGA, supine 2.Neck skin disinfection and drapping 3.Localize the cricothyroid membrance and midline skin incision over 2nd tracheal ring 4.Separate the strap muscle and identify the trachea 5.Tracheostomy and insert low pressure tube 6.One stitch suture over stoma Operators 張金池 Assistants 張彥俊 手術日期：2009/05/01 13:54 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) Pre-operative Diagnosis L3-S1 spinal stenosis Post-operative Diagnosis ditto Operative Method L3-4 and L4-5 right hemilaminectomy and left sublaminal decompression Pathology nil Operative Findings Hypertrophic ligamentum flavum and facet joints over L3-L5 was noticed and the theca sca was compressed tightly. The sac was decompressed after microscopic hemilaminectomy and sublaminal decompression. Operative Procedures 1.Under ETGA and prone position 2.skin disinfection and draping 3.localize the lumbar spine under flouroscopy 4.linear incision and displace the paraspinanous muscle laterally from the right side 5.perform L3-4 and L4-5 hemilaminectomy and removal ofthe hypertrophic ligamentum flavum 6.sublaminal decompression of left side 7.check bleeder and close the wound in layers Operators 賴達明 Assistants 蘇亦昌,陳德福 手術日期：2009/05/02 15:14 摘要__ 手術科部: 外科部 套用罐頭: OpenGB Pre-operative Diagnosis Chronic cholecystitis with gall bladder stones Post-operative Diagnosis Ditto Operative Method Open cholecystectomy Pathology Pending Operative Findings 1. Chronic inflammation and thickened GB wall were noted 2. There were several pigmented stones 3. Marked adhesion between GB and omentun was noted Operative Procedures After the abdomen was opened through a right oblique subcostal incision, a self-retaining retractor was used on the right side to retract the costal margin. Adhesion between the undersurface of the gallbladder (GB)and adjacent structures was divided.Adequate exposure was maintained by downward retraction with moist sponges over the duodenum andbowels to get better defining the region of hepatoduodenal ligament. With surgeon's thumb and index finger, thoroughly palpated the region for evidence of calculi in the common bile duct, as well as for thickening of the head of the pancreas. The enucleation of the GB was started by dividing the peritoneum on the inferior aspect of the GB and extending it downward to the region of the ampulla. With traction maintain on the ampulla, the cystic duct was defined by means of blunt dissection. A long right-angle clamp was then passed behind the cystic duct which was isolated from the common duct. The cystic duct was ligated with a transfixing suture. The cystic artery was likewise isolated and divided with great care to avoid injury to the possible anomaloushepatic artery. After the cystic duct and artery had been tied, removal of the GB was begun. The peritoneal incision, initially made on the inferior surfaceof the GB, was extended upward around the fundus. With careful scissors dissection and electrocoagulator, the loose areolar tissue between the GB and its liver bed was divided, and the final peritoneal attachment between the GB and liver was severed.The abdomen was closed in layers after irrigation with copious warm normal saline solution. Operators 吳耀銘 Assistants 吳經閔,古恬音 手術日期：2009/05/05 09:00 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT Pre-operative Diagnosis Right frontal oligoastrocytoma, WHO grade III, s/p excision, recurrence Post-operative Diagnosis Ditto Operative Method Right frontal craniotomy for tumor excision Pathology Pending Operative Findings The dura was adhered to the brain surface over craniotomy site. The tumor was located at right frontal lobe posterior to previous operation site. The tumor was greyish, soft, without definite margin from peripheral brain parenchyma. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position with head turned to left. The scalp was shaved, scrubbed, disinfected with alcohol B-I then draped. The scalp incision was made along previuos op scar and dissected to exposethe previous craniotomy skull plate. We removed the skull plate with elevator and tented the dura along anterior frontal site. The dura was opened along the craniotomy window. Tumor excision was made with bipolar coagulation and tumor forceps. The falx wascleared after tumor excision. Hemostasis was performed with bipolar coagulation and surgicel lining of the tumor bed. The dura was closed with 4-0 Prolene in continuous sutures and water-tight fashion, and the skull plate was fixed back with miniplates.The wound was closed in layers after one CWV drain set at subgaleal layer. Operators 賴達明 Assistants 李建勳,曾峰毅 手術日期：2009/05/13 09:03 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT Pre-operative Diagnosis left parietal parasagittal meninoma Post-operative Diagnosis left parietal falx meingioma Operative Method Left parietal craniotomy for tumor excision Pathology Pending Operative Findings The tumor was elastic soft and fragile with moderate vascularity. It attached to falx. Some remanents near the superior sagittal sinus was left. The others were resected totally. No hyperosteosis or bony invasion. There is cystic portion in the inferior part of the tumor (cystic degerneration of meningioma). The tumor penetrated the dura near the midline. The plane was not well-defined on the lateral surface of the tumor. No intra-operative SSEP change was noted. Operative Procedures ETGA. Maxfield headholder fixation in prone position. U shape scalp incision. Burrholes then craniotomy. Dural incision and dissect tumor plane along arachoniod space. Devascularization and debulking. Tumor exicision and hemostasis. Duroplasty with fasical graft. Cranioplasty with wire. Placment of subgaleal CWV. Wound closed in layers. Operators 蔡瑞章 Assistants 黃博浩,游健生 手術日期：2009/05/18 22:30 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Yolk sac tumor, stage III, s/p C/T Post-operative Diagnosis Ditto Operative Method Sternotomy and 4th ICS thoracotomy, for tumor debulking Pathology Pending Operative Findings 1. A firm, irregular shape of tumor in anterior mediastinal area, with yellowish ~ whitish fragile tissue. 2. Tumor severe adhesion between lung and pericardium. 3. Innominate vein was encased by the tumor. Operative Procedures 1. ETGA, supine position. 2. Skin disinfection then drapped. 3. Sternotomy. 4. Adhesionlysis between the tumor and surrounding tissue / organ. 5. Debulking the main tumor. 6. Check bleeding and hemostasis. 7. Two Fr.28 chest tubes insertion: right chest and mediastinum. 8. Closed the wound in layers. Operators 張金池 Assistants 梁嘉儀,廖先啟 手術日期：2009/05/20 08:41 摘要__ 手術科部: 外科部 套用罐頭: Chronic Subdural Hematoma Pre-operative Diagnosis Left chronic SDH Post-operative Diagnosis ditto Operative Method Left burr hole drainage Operative Findings 1.Motor oil like liquified old blood gushed out while the dura was opened. We irrigate the subdrual space till it becamd pinkish in color. 2.EVD, sized 3.5 mm in diameter, was set toward frontal area subdurally as a drain tube Operative Procedures 1. ETGA, supine position with head rotate to the right 2. Linear incision over left frontotemporal region 3. dissect to open skin flap 4. open periosteum 5. Creat a burr hole with high speed drill bur 6. Dura opening after proper tenting 7. Insert EVD and irrigation with normal saline till the subdrual fluid became pinkish 8. Close the wound in layers after the drainage tube was passed via a subcutaneous tunnel 9. De-air Operators 郭夢菲 Assistants 胡朝凱 手術日期：2009/05/21 09:00 摘要__ 手術科部: 泌尿部 套用罐頭: DBJ stent insertion Pre-operative Diagnosis Left hydronephrosis Post-operative Diagnosis Left hydronephrosis Operative Method cystoscopy and DBJ change Pathology nil Operative Findings A Cook 6-22 DBJ was insertion Dirty urine Operative Procedures Under satisfactory anesthesia with the patient in lithotomy position, prepping and drapping was performed in the usual sterile fashion. A Fr 21 Olympus cystoscope was introduced into the bladder cavity under direct vision. Careful inspection was done andprevious DBJ was pull out. A new Cook 6-22 DBJ was insertion. Patient tolerated the procedure very well and was sent to recovery room in satisfactory condition. Operators 黃國皓 Assistants 洪佳宏,伍嘉偉 手術日期：2009/05/22 22:56 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis left thalamic ICH with IVH and acute hydrocephalus Post-operative Diagnosis ditto Operative Method left Kocher EVD Pathology nil Operative Findings The CSF was pinkish with opening pressure of 12-13 cm-H2O. EVD was inserted at left Kocher point. Operative Procedures 1.ETGA and supine position 2.skin disinfection and draping 3.linear incision on left Kocher point 4.Burr creation 5.dura opening and insert the ventricular cath 6.hemostasis and close the wound in layers. Operators 王國川 Assistants 陳德福 手術日期：2009/05/22 12:15 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Falx meningioma Post-operative Diagnosis ditto Operative Method Simpson grade V partial tumor excision Pathology pending Operative Findings We approach the tumor right side interhemispheric method. There is a 5.5*4.5*6 cm tumor arising from the falx with bilateral extension. The tumor is whitish, hardish, capsulated, calcified, mild vascularized and encasing the bilateral ACA-callosamarginalbranch. The normal vasculature was all preserved. The tumor was removed partially. Operative Procedures Under ETGA, head mildly rotated to left side and Mayfield fixation, the scalp was disinfected and draped as usual. One coronal curvilinear incision and craniotomy across the midline were done. After dura tenting, the bleeders from the superior sagittal sinus were all packed with surgicelle . We coagulized the arterial feeder to the tumor on the dura. The dura was opened in C shape from right side and the reflected to the medline. The tumor came into view after we retract the right brain laterally. The ACAencased by the tumor was identified. We perform tumor removal along the arachnoid plane and the falx was incised to exposure the tumor on the left side. The tumor was removed in central debulking method followed by peice by peice removal with forceps, scisor, CUSA and biploar coagulator assisted. The bilateral ACA with branches were preserved and the tumor was removed partially. Hemostasis was done followed by closurethe dura in water-tight fasion. The skull was fixed with miniplates and we left one epidural CWV in situ. The wound was closed in layers. Operators 杜永光 Assistants 蘇亦昌,陳德福 邱伯仁 (M,1943/10/05,68y5m) 手術日期 2009/05/27 手術主治醫師 王碩盟 手術區域 西址 039房 03號 診斷 Prostate cancer 器械術式 Herniorrhaphy , Hydrocelectomy 手術類別 預定手術 手術部位 腹 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林珍榮 ASA 2 紀錄醫師 柯智群, 時間資訊 15:05 進入手術室 15:10 麻醉開始 15:15 誘導結束 15:20 抗生素給藥 15:30 手術開始 16:55 手術結束 16:55 麻醉結束 17:05 進入恢復室 19:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 鼠蹊疝氣修補術－無腸切除 1 1 R 摘要__ 手術科部: 泌尿部 套用罐頭: herniorrhaphy, inguinal Pre-operative Diagnosis Right side inguinal hernia Post-operative Diagnosis Right side inguinal hernia Operative Method Right herniorrhaphy and posterior repair with Mesh Specimen Count And Types Pathology Operative Findings 1. Sac from right internal inguinal ring, indirect sac. 2. Posterior wall weakness. Operative Procedures Under satisfactory spinal anesthesia with the patient in supine position. Prepping and draping was performed in the usual sterile fashion. An inguinal oblique incision was made in the right inguinal area. The wound was deepened through layers into inguinal canal. The spermatic cord was mobilized, and an indirect sac was noted. The hernia sac was isolated from spermatic cord. Ligation and transection of the hernia sac near the the internal inguinal ring was performed. Posterior wall repair with Mesh. After adequate hemostasis was obtained, the wound was closed in layers with 3-O silk on the external oblique fascia and 3-O chromic on the Scarpas fascia. Skin was closed with interrupted 3-O nylon mattress stitches. The patient tolerated the procedure very well, and was sent to the recovery room in satisfactory condition. The sponge count was correct and blood loss was minimal. Operators 王碩盟 Assistants 柯智群 手術日期：2009/05/27 17:11 摘要__ 手術科部: 泌尿部 套用罐頭: herniorrhaphy, inguinal Pre-operative Diagnosis Right side inguinal hernia Post-operative Diagnosis Right side inguinal hernia Operative Method Right herniorrhaphy and posterior repair with Mesh Operative Findings 1. Sac from right internal inguinal ring, indirect sac. 2. Posterior wall weakness. Operative Procedures Under satisfactory spinal anesthesia with the patient in supine position. Prepping and draping was performed in the usual sterile fashion. An inguinal oblique incision was made in the right inguinal area. The wound was deepened through layers into inguinal canal. The spermatic cord was mobilized, and an indirect sac was noted. The hernia sac was isolated from spermatic cord. Ligation and transection of the hernia sac near the the internal inguinal ring was performed. Posterior wall repair with Mesh. After adequate hemostasis was obtained, the wound was closed in layers with 3-O silk on the external oblique fascia and 3-O chromic on the Scarpas fascia. Skin was closed with interrupted 3-O nylon mattress stitches. The patient tolerated the procedure very well, and was sent to the recovery room in satisfactory condition. The sponge count was correct and blood loss was minimal. Operators 王碩盟 Assistants 柯智群 手術日期：2009/05/27 13:00 摘要__ 手術科部: 麻醉部 套用罐頭: Port-A implantation Pre-operative Diagnosis Intranasal tumor Post-operative Diagnosis Ditto Operative Method Port-A implantation Pathology Nil Operative Findings 1. Site: right subclavian vein, with echo-guided procedure 2. Patent flow after implantation Operative Procedures Under general anesthesia, the patient was set on supine position and bilateral subclavian veins were checked by echo. After local anesthesia applied, transverse skin incision for 3cm was made at pre-cordial area. Undermine the skin at the layer between subcutaneous tissue and deep fascia in lateral direction. An IV catheter was inserted via the subclavian incision and negatively aspirated until venous blood attainable. J-wire was inserted smoothly via the needle in rostral direction. A subclavian catheterwith dilator was inserted through the J-wire. Dilator was then removed. The IV catheter for Port-a-Cath was threaded into the subclavian catheter until mark 20 cm. Skin tunnel between subclavian and pre-cordial incision was made by the blunt dissection with Kelly clamp. Catheter was then threaded. Port was inserted into the pouch of pre-cordial incision. Catheter was adapted into the port and locked with restrictor. Skin was closed layer by layer. Both catheter and port were perfused with heparin solution after implantation. Operators 林峰盛 Assistants 劉婉琪 手術日期：2009/05/30 19:27 摘要__ 手術科部: 外科部 套用罐頭: port-A 開立醫師: 林明賢 開立時間: 2009/05/30 19:27 Pre-operative Diagnosis lung cancer Post-operative Diagnosis s/p port-A insertion Operative Method port-A implantation via right internal jugular vein Pathology nil Operative Findings 1. The port-A catheter was inserted via right internal jugular vein by puncture & echo-guided procedure 2. Patent flow after implantation Operative Procedures -Port-A: After skin disinfection and drapping & local anesthesia, echo-guided RIJV puncture and catheterization was performed. Creation of the subcutaneous pocket at right subclavicular area. Tunneliztion, advanced the catheter into the RIJV via the peel-away sheath smoothly. Wound closure in layers after adequate hemostasis. Operators 詹志洋 Assistants 林明賢 手術日期：2009/06/03 18:30 摘要__ 手術科部: 外科部 套用罐頭: C-P Angle Tumor Pre-operative Diagnosis Left petroclival meningioma Post-operative Diagnosis Ditto Operative Method EVD insertion for ICP monitor and retrosigmoid approach for tumor debulking, S-M Gr. IV Pathology Pending Operative Findings The tumor was soft, fragile and well-capsuled. Multiple lobulation was noted. It was fed from the base at petrous region. The CN 7,8 complex and low cranial nerves were compressed laterioinferiorly. The CN 5,6 wasn't seen intra-OP. The superior petrosal vein was well preserved. BAEP decreased intra-OP. The CSF was clear, and the intraventricular catheter was 10cm in depth, the ICP was moderate. Operative Procedures After ETGA, the patient was under right side park-bench position. The head was fixed with Mayfield. We incised inot the left parietal region, and a burr hole was made at frazier^s point. The dura was opened and we inserted an EVD about 10cm in depth. Theleft retrosigmoid area was well-disinfected, and the OP area was covered with OP site. Curvillicular incision into the scalp over left retrosigmoid area, and the length was about 10cm. After two burr holes made at the asterion and sigmoid junction, an ovoid craniotomy window was created and extended with K8 drill till the sigmoid-transverse junction was exposed. Then we incised into the dura "K" shape. We opened the arachnoid membrane from caudal portion and released the CSF inside cistern magnum for decompression. The cerebellum was retracted posteriorly. The tumor was soft, fragile and well-capsuled. Multiple lobulation was noted. It was fed from the base at petrous region. The CN 7,8 complex and low cranial nerves were compressed laterioinferiorly. TheCN 5,6 wasn't seen intra-OP. The superior petrosal vein was well preserved. BAEP decreased intra-OP. Proper hemostasis was done with surgicel adn gelfoam, and the dura was tightly closed with fascia after deair. Skull graft was covered back and fixationwith wires after dura tightly closing with fascia graft. The skull defect was filled with bone cement. A subgaleal CWV drain was set. The scalp was finally closed in layers. Operators 王國川 Assistants 陳睿生 手術日期：2009/06/04 19:00 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Cervical cancer with T12 metastasis, intramedullary Post-operative Diagnosis Ditto Operative Method T12 laminectomy tumor excision Pathology Pending Operative Findings The tumor was intradural intramedullary. It is soft, fragile in character, with mucinous content. The cord was expanded by tumor. Operative Procedures Under ETGA, the patient was placed in prone position. C-arm was used for localization of the T12 spinous process. A midline back skin incision was made over T12 spinous process, the incision was then deepened to expose paravertebral muscles. The muscles were dissected, T12 laminectomy and partial T11 + L1 laminectomy were then performed. A midline dural opening was made, the arachnoid was then opened. The expanded cord was identified, electrocauterized and opened. The tumor was pulled out piece by piece with tumor forceps, and dissection with ring curret. Bleeding was checked and hemostasis achieved under Surgical packing. An epidural CWV was placed, the wound was closed in layers. Operators 蔡瑞章 Assistants 陳盈志,王奐之 手術日期：2009/06/04 16:48 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Right lung nodules, suspected HCC metastasis Post-operative Diagnosis ditto Operative Method VATS wedge resection, RUL*1, RML*1, RLL*1 Pathology pending Operative Findings 1.A 0.6 cm, elastic to firm, well defiened nodule in RUL 2.A 1.2 cm, elastic to firm, well defiened nodule in RLL 3.A 2 cm, elastic to firm, well defiened nodule in RML 4.All the tumor cutting face revealed bile-like color Operative Procedures 1. DLETGA with left decubitus position, skin disinfection and drapped 2. VATS setting: the 4th ICS-AAL, the 7th ICS-MAL, the 7th ICS-PAL 3. Identified the lesion 4. Wedge rescetion of RUL, RML,RLL by endo GIA 60 5. Check bleeding and hemostasis 6. Chest tube Fr28*1 7. Close the wound in layers Operators 陳晉興 Assistants 梁嘉儀,林珂如 手術日期：2009/06/08 17:25 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT Pre-operative Diagnosis Brain tumor, cerebellar vermis, r/o medulloblastoma Post-operative Diagnosis Ditto Operative Method Suboccipital craniotomy for transvermian tumor excision Operative Findings The tonsil was seen just below the foramen magnum after dural opening. The tumor can be barely seen throught the varicula after lateral retraction of the tonsils. Therefore, a transvermian approach was adopted. A 1.5 cm long vertical cortical incision wasmade in the cerebellar vermis after bipolar coagulation. The white mater was removed by suction until the tumor was exposed at a depth of 1 cm below the cortical surface. The tumor arose from the vermis, was greyish red, soft fragile, and moderately vascularized. It could be removed by No. 8 sucker. The tumor slightly attached to the right inferior cerebellar peduncle only. The 4th ventricular floor was free from tumor invasion. No SSEP change occurred during the course of surgery. Operative Procedures 1. ETGA, prone, head fixed by a Mayfield clamp, with neck in hyperflexed position. 2. Posterior midline incision, 2 cm above inion to C2. 3. Suboccipital craniotomy, 6 cm x 4 cm. 4. Y shaped dural incision; the occipital sinus occluded by hemoclips then divied. 5. Vertical corticotomy in the vermis. 6. Tumor excision under microscopy by bipolar cautery, suction, and tumor forceps. 7. Hemostasis by bipolar cautery, surgicel and gelfoam packing. 8. Dural closure, with the aid of a piece of pericranium. 9. Fixation of the skull plate back to the craniotomy window by 4 wires. 10. One subgaleal drain tube. 11. Wound closure in layers. Operators 楊士弘 Assistants 陳盈志 手術日期：2009/06/09 17:00 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) Pre-operative Diagnosis L5-S1 spondylolithesis Post-operative Diagnosis Ditto Operative Method L5 laminectomy, L5-S1 disckectomy, L5-S1 TPS fixation, cage and posteriolateral fusion Pathology Nil Operative Findings The L5-S1 disc space was narrowing. TPS fusion with Synthes screws: 6.2mm X 4mm x3, 7mmX4mmX1, Rod: 5cmX2. Cage: 11mm X 2. Operative Procedures Under general anesthesia and intubation, the patient was put in prone position. Located the L5-S1 space with portable C-arm X-ray. Skin scrubbed, disinfected with alcohol B-I then draped. Midline skin incision from L4-S1 spinous processes and seperated the paraspinal muscles to expose the laminae. Inserted the TPS screws under intraop fluoroscope guidace. The L5 laminectomy was performed with rongeur and Kerrison punch. The L5-S1 disckectomy was performed with currete and disc clump. The cages were inserted at bilateral side of L5-S1 disc space and checked with intraop X-ray. The rods were set up and one epidural hemovac drain tube was set up before close the wound in layers. Operators 賴達明 Assistants 黃博浩,李建勳,王奐之 手術日期：2009/06/10 19:05 摘要__ 手術科部: 外科部 套用罐頭: C-P Angle Tumor Pre-operative Diagnosis Right cerebellopontine angle tumor, suspect vestibular schwannoma Post-operative Diagnosis Ditto Operative Method Right retrosigmoid approach for tumor excision Pathology Pending Operative Findings Hypervascular right cerebellopontine angle tumor resembling vestibular schwannoma. The internal acoustic canal was drilled open and the tumor was removed to identify the facial nerve (which was pushed anterior inferiorly). The tumor was 3.2*3.0*2.8cm in size with well-demarcated margin. Operative Procedures After ETGA, the patient was put in supine position with head fixed in Mayfield head holder and turned to left. A retroauricular curved skin incision was then made. The suboccipital region was exposed after fascial graft harvesting. 2 burr holes were madefollowed by a circular craniotomy. A K-shaped dural incision was performed with subsequent CSF drainage. Brain retractor was then applied to hold back the cerebellum. Tumor was debulked and the internal acoustic canal was drilled open to identify the facial nerve, the intracanalicular tumor was removed. The lower and upper poles of the tumor were then dissected, followed by dissection of the brainstem side. Bleeding was checked and hemostasis was achieved after tumor removal. Tissucol Duo was used for reinforcement of bleeding site. The dura was closed and covered with formerly harvested fascial graft. The skull bone was put back and fixed with wires. After placing a subgaleal CWV, the wound was closed in layers. Operators 蔡瑞章 Assistants 黃博浩,陳盈志,王奐之 手術日期：2009/06/11 10:20 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt Pre-operative Diagnosis Left CPA tumor status post, hydrocephalus Post-operative Diagnosis Ditto Operative Method VP shunt via right Kocher^s point Pathology Nil Operative Findings The CSF was xanthochromic and ICP was moderate. The intra-ventricular catheter was about 6.5cm in length. Operative Procedures 1. ETGA, supine with head left turn 2. Curvillinear scalp incision over right frontal 3. Make a burr hole over right Kocher^s point 4. Minilaparotomy was made over RUQ 5. Set up subcutaneous tunnel from RUQ to right Kocher with one connective incision 6.Insert the abdominial catheter and connect the catheter with reservior and intraventricular one (6.5cm) 7. Insert the intraventricular catheter 8. Hemostasis, and close the wounuds in lyaers Operators 王國川 Assistants 陳睿生 手術日期：2009/06/12 13:05 摘要__ 手術科部: 外科部 套用罐頭: 甲狀腺 Pre-operative Diagnosis Thyroid goiter, bilateral Post-operative Diagnosis Ditto Operative Method Bilateral total thyroidectomy Pathology Pending Operative Findings 1. There was one 5cm mass at the right lobe of thyroid gland, and another 1.5cm nodule at the junction of the left lobe and isthmus 2. There was one 0.5 cm calcified nodule at the middle part of the left lobe 3. Bilateral recurrent laryngeal nerves were identified and preserved Operative Procedures 1. ETGA, supine position 2. Skin disinfection and draping 3. Make a transverse skin incision at mid neck 4. Divide the platysma muscles 5. Remove the thyroid gland with Ligasure 6. Identify the recurrent laryngeal nerves and preserve them 7. Hemostasis, Surgicel lining of the raw surface 8. Set two minihemovacs 9. Wound closure in layers Operators 吳明勳 Assistants 吳經閔,洪浩雲,古恬音 手術日期：2009/06/15 14:58 摘要__ 手術科部: 外科部 套用罐頭: 肝右葉 Pre-operative Diagnosis HCC, right lobe Post-operative Diagnosis HCC, right lobe with suspect retroperitoneal seeding Operative Method 1.Right lobectomy 2.Cholecystectomy 3.Retroperitoneal tumor excision 4.Diaphragm repair Operative Findings 1.One huge 8x8x6cm hypervascular, elastic, and darkness tumor was noted at right lobe with proturding posterior with severe adhesion to retroperitoneal fascia and diaphragm 2.One 2x1cm reddish firm tumor was noted at right retroperitoneal was biopsy 3.One 3x2cm Diaphragm rupture was noted and repared 4.Blood loss about 2000ml Operative Procedures 1. ETGA, supine position 2. Make bilateral subcostal skin incision with cephalic extension 3. Transect the round ligament the divide the falciform ligament 4. Perform cholecystectomy 5. Mobilize the liver 6. Identify the right hepatic artery, rightportal vein, and right hepatic duct, hilum control 7. Perform right lobectomy with CUSA and bipolar electrocauterization 8. Ligate the hepatic duct, right hepatic artery, and right portal vein 9. Excisional biopsy of retroperitoneal seeding 10. Repairof diaphragm by interrupt silk suture 11. Hemostasis was achieved by electrocauterization and Surgicel lining of the raw surface 12. Normal saline irrigation 13. Set two rubbers drain at right subphrenic area 12. Wound closure in layers Operators 李伯皇 Assistants 黃俊傑,黃凱傑 手術日期：2009/06/16 15:37 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis esophageal cancer Post-operative Diagnosis ditto Operative Method port-A insertion Pathology nil Operative Findings small cephalic vein was noted Operative Procedures port-A insertion via subclavian vein, left failed due to patient incoorperate Operators 李章銘,張金池 Assistants 林珂如,謝永? 手術日期：2009/06/16 13:07 摘要__ 手術科部: 外科部 套用罐頭: Chronic Subdural Hematoma Pre-operative Diagnosis LEFT Chronic Subdural Hematoma Post-operative Diagnosis LEFT Chronic Subdural Hematoma Operative Method Burred hole drainage Operative Findings about 40ml CSDH was evacuated. Inner and outer membrane were evident. The brain expanded a little. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated (tilted) to right. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered withsterilized adhesive plastic sheet. 4. Incision: horse shoe shape at --parietal area. Raney clips were applied to the scalp edge for temporary hemostasis. 5. Left parietal burr hole 6. Dural tenting 7. Dural incision: 3/4 circle along the trephine margin. 8. The outer membrane of the hematoma was coagulated by Bovie along the edge of dural incision, then exicsed. 9. The liquified old blood and clot in the subdural space was evacuated by sucker, then thoroughly irrigated with N.S. through a rubber tube until the return was clean. The inner membrane of the hematoma was opened by a nib incision when the membrane had beenlifted away from its underlying arachnoid by a sucker, then the membrane was cut in 4 different directionsas far as possible under direct vision with head light for subdural illumination. 10.Dural closure:interruped 2/0 silk sutures for key stitches, then continuous sutures with 4/0 Dexon to obtain water-tight closure (Dural graft?) 11.Closure of skull window: the trephine button was placed back simply after one coner of its edge had been rongeured out for the drain. 12.Scalp closure:hemostasis was done with monopolar coagulator touching on the sucker tip. Galea suture was performed by continuous sutures with 3/0 Dexon and skin by continuouss suture with 3/0 nylon. 13.Drain: one, subdural Operators 陳敞牧 Assistants 黃博浩,蘇亦昌 手術日期：2009/06/17 17:15 摘要__ 手術科部: 外科部 套用罐頭: Chronic Subdural Hematoma Pre-operative Diagnosis Right parietotemporal chronic subdural hematoma Post-operative Diagnosis Ditto, resolved Operative Method Right temporal parietal craniectomy Pathology Nil Operative Findings Outer membrane was noted at right temporal-parietal area, no significant suubdural hematoma was found. Operative Procedures After ETGA, the patient was put in supine position with head tilted to left. A right frontal linear incision was made, followed by a burr hole creation. No subdural hematoma was identified after dural opening, the wound was then extended to a U-shape incision. Another burr hole at temporal area was created, followed by craniotomy. A small C-shape dural incision was performed. The outer membrane was electrocauterized then. The dura was closed the 4-0 Prolene continuous sutures. The bone plate was fixed with 3 wires, followed by wound closure. Operators 曾漢民 Assistants 陳盈志,王奐之 手術日期：2009/06/17 15:30 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Esophageal cancer Post-operative Diagnosis ditto Operative Method Port-A insertion Pathology nil Operative Findings port-A insertion via right subclavian vein Operative Procedures 1.IVG, supine 2.Skin disinfection and drapped 3.port-A insertion via puncture method 4.intra-op CXR: port-A tip at SVC-RV junction 5.close the wound in layers Operators 李章銘 Assistants 蔡東明,林珂如 手術日期：2009/06/17 09:00 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT Pre-operative Diagnosis Falx manigioma s/p partial tumor excision Post-operative Diagnosis Ditto Operative Method Simpson grade IV tumor excision + EVD insertion Pathology Pending Operative Findings The tumor was elastic-firm, whitish with moderate-highly vasculization. The right pericallosal, both sides callosomarginal arteries and internal cerebral veins were encased by the tumor and unable to seperate. So one central part of the tumor was left in situ due to major vessel encasement. The tumor also extended into the lateral ventricles. The left callosomarginal artery was transected during tumor excision and was anastomosis with 10-0 Nylon. The SSEP, MEP was transient flattened and returned to normal after anastomosis. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position with head fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, disinfected with alcohol B-I then draped. The scalp incision was made along previous op wound. Thecraniotomy was opened and the dura was tented after opening. Tumor excision was perforemd under surgical microscope with SONOPET, CUSA, bipolar cautary and tumor forceps. The left callosomarginal artery was anastomosis with 10-0 Nylon. The central part ofthe tumor was left in situ with the falx. One EVD was inserted into the lateral ventricle after removed the tumor. Hemostasis was achieved with Surgicel lining of the tumor bed. The skull was fixed back with Miniplates. One subgaleal CWV drain was set and the wound was closed in layers. Operators 杜永光 Assistants 李建勳,李振豪 手術日期：2009/06/19 14:30 摘要__ 手術科部: 外科部 套用罐頭: Port-A Pre-operative Diagnosis Cerebellar tumor, medulloblastoma Post-operative Diagnosis Ditto Operative Method Port-A insertion Pathology Nil Operative Findings Post-operative portable X-ray showed Port-A catheter tip in correct venous branch to SVC. Port-A catheter was set in the right inguinal jugular vein by cut-down method. Blood flow: ++ Operative Procedures 1. Under endotracheal general anesthesia with the patient in supine position, prepped and draping were performed in the usual sterile method. 2. An incision was made in right side neck and subclavical area. After identification of the internal jegular vein, Port-A catheter was inserted. Adequate hemostasis was obtained. Post-operative portable X-ray showed catheter tip in correct venous branch to SVC. Then the wound was closed in layers. Operators 林文熙 Assistants 陳姿君 手術日期：2009/06/23 17:49 摘要__ 手術科部: 泌尿部 套用罐頭: cystoscopy（biopsy ) Pre-operative Diagnosis bladder tumor S/P TURBT Post-operative Diagnosis same Operative Method cystoscopy Pathology nil Operative Findings right lateral old OP scar no obvious tumor recurrence Operative Procedures Under satisfactory anesthesia with the patient in lithotomy position, prepping and drapping was performed in the usual sterile fashion. A Fr 21 Olympus cystoscope was introduced into the bladder cavity under direct vision. Careful inspection revealed theLt hemitrigone and Lt ureteral orifice was normal. Patient tolerated the procedure very well and was sent to recovery room in satisfactory condition. Operators 黃昭淵 Assistants 賴明志,伍嘉偉 施怡森 (M,1940/06/07,71y9m) 手術日期 2009/06/23 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Lumbar spondylosis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉育彰 ASA 2 紀錄醫師 焉保元, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:00 進入手術室 08:05 麻醉開始 08:35 誘導結束 08:50 抗生素給藥 09:41 手術開始 12:10 抗生素給藥 15:10 抗生素給藥 15:30 開始輸血 16:35 手術結束 16:35 麻醉結束 16:55 送出病患 16:57 進入恢復室 18:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 9 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 手術 椎間盤切除術－腰椎 1 2 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) Pre-operative Diagnosis 1. L3/4 HIVD with recurrance 2. L4/5 spondylolithesis Post-operative Diagnosis Ditto Operative Method L3/4 decompression with posterior fusion by paramedian app. Specimen Count And Types Pathology Nil Operative Findings Severe fibrosis was noted at the L3/4 epidural space. A synthes 11mm banana cage was inserted from left side. The left side lower facet of L3 was removed for decompression. Severe osteoprosis was noted. Posterior fixation of L3~5 synthes 6.7x 4.5 mm screws x6 and 7cm rods x 2 Operative Procedures 1. ETGA, prone, C-arm localization. 2. Reopen and expend previous operation site. 3. Incise into left prarspinal muscle (3cm apart from spinous process) 4. Identigy L3~5 transverse process 5. Set left side L3~5 TPS. 6. Remove left L3 lower facet joint and do sublaminar decompression foward contralateral side. 7. Set the L3/4 banana cage from left side after L3/4 epidural adhesion lysis. 8. Set the Left side rods and fix. 9. Incision into the right side paraspinal muscle 10. Do TPS over L3~L5 as previous method. 11. Hemostasis, set two 1/8 hemovac. 12. Irrigation, close the wound in layers. Operators 賴達明 Assistants 陳睿生,焉保元 手術日期：2009/06/23 09:00 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) Pre-operative Diagnosis 1. L3/4 HIVD with recurrance 2. L4/5 spondylolithesis Post-operative Diagnosis Ditto Operative Method L3/4 decompression with posterior fusion by paramedian app. Pathology Nil Operative Findings Severe fibrosis was noted at the L3/4 epidural space. A synthes 11mm banana cage was inserted from left side. The left side lower facet of L3 was removed for decompression. Severe osteoprosis was noted. Posterior fixation of L3~5 synthes 6.7x 4.5 mm screws x6 and 7cm rods x 2 Operative Procedures 1. ETGA, prone, C-arm localization. 2. Reopen and expend previous operation site. 3. Incise into left prarspinal muscle (3cm apart from spinous process) 4. Identigy L3~5 transverse process 5. Set left side L3~5 TPS. 6. Remove left L3 lower facet joint and do sublaminar decompression foward contralateral side. 7. Set the L3/4 banana cage from left side after L3/4 epidural adhesion lysis. 8. Set the Left side rods and fix. 9. Incision into the right side paraspinal muscle 10. Do TPS over L3~L5 as previous method. 11. Hemostasis, set two 1/8 hemovac. 12. Irrigation, close the wound in layers. Operators 賴達明 Assistants 陳睿生,焉保元 手術日期：2009/06/23 22:09 摘要__ 手術科部: 外科部 套用罐頭: 1. PA tumor excision 2.RML lung wedge resection 3.TVP 開立醫師: 林明賢 開立時間: 2009/06/23 22:09 Pre-operative Diagnosis PA tumor. lung tumor, TR Post-operative Diagnosis ditto Operative Method 1. PA tumor excision 2.RML lung wedge resection 3.TVP Pathology pending Operative Findings 1.fungating soft and fragible tumor was noted at MPA, RPA, LPA and RVOT septum with severe adhesion to RPA 2.tumor invade intima of PAs, especially the MPA anterior wall 3.multiple small nodules over thr right lung surface 4.pericardial effusion and pleural effusion: clean 5.frozen section: malignant Operative Procedures 1.ETGA, supine position, median sternotomy 2.On CPB: A:ascendning aorta; V:RAA & IVC, cooling to 25 degree celsius 3.MPA incision and tumor excision was performed deep to LPA and RPA bifurcation 4.excised anterior wall of MPA 5.repair MPA and incised distal RPA for tumor excision 6.RA incision and tricuspid valve repair was performed using 2-0 Ticron x one stitch for plication 7.repair RA and RPA 8.wedge resection of RML lung was performed 9.rewarm, deair, wean off CPB 10.hemostasis, set two chest tubes and close wound in layers Operators 黃書健，徐紹勛 Assistants 林明賢 手術日期：2009/06/25 16:39 摘要__ 手術科部: 骨科部 套用罐頭: Total hip replacement-Anterior 開立醫師: 陳彥宇 開立時間: 2009/06/25 16:39 Pre-operative Diagnosis 2.Avascular necrosis of femoral head, left, Ficat stage III 1.Avascular necrosis of femoral head, right, Ficat stage II Post-operative Diagnosis Ditto Operative Method 1.Cord decompression, right 2.Left total hip arthroplasty with Wright large head metal-on-metal prosthesis (shell:54mm, femur stem:12.7mm, head:48mm, neck:short) Pathology Pending Operative Findings 1. Osteophyte over medial wall of left acetabulum, femoral neck and head. 2. Cartilage fragmentation and subchondral bone collapse, left femoral head Operative Procedures 1.Under endotracheal tube general anesthesia, the patient was placed in supine position on fracture table. The skin dis-infection was performed and scrubbed with beta-iodine detergent and alcoholic solution. 2.Longitudinal skin incision was made on lateral aspect of right thigh. Drill 4.0 k-wire multiply on right femoral head under fluoroscope. 3.Irrigate the operation field with copious normal saline, then close the wound in layers. 4.Reposition the patient to right decubitus position. Make longitudinal skin incision on left thigh and anterior-lateral approach to dissect the gluteal medius muscle fiber and to dissect the joint capsule. 5.Osteotomy with bone saw at the femoral neck and remain 1cm of calcar. Then remove the femoral head after dissecting the ligamentum teres. 6.Expose the acetabulum rima nd ream the acetabulaum size by size to fit the proper size of acetabular shield. Then intra-medullar reaming of the femoral medullar canal with rigid reamer was done size by size. Enlarged the inlet of femoral bone canal by broach was performed to fit the femoral stem. 7.Set the femoral stem prosthesis into femoral canal and put the neck and head onto the stem. Reduce the femoral head component into acetabular prosthesis and checked the stability of new joint. 8.Then irrigate the wound with normal saline and check bleeding. Finally, close the wound layer by layer. Operators 侯勝茂 Assistants 陳彥宇,侯咸仰 手術日期：2009/06/25 15:32 摘要__ 手術科部: 外科部 套用罐頭: Port-A 開立醫師: 謝永 開立時間: 2009/06/25 15:32 Pre-operative Diagnosis Lung cancer Post-operative Diagnosis Ditto Operative Method Port-A catheter implantation Pathology nil Operative Findings The venous blood flow freely in the Port-A catheter after implantation. Operative Procedures The patient was put on supine position. The operation field was disinfected and draped as usual. Under local anesthesia, the Port-A catheter was implanted on right side upper chest with puncture method via RIJV Operators 王水深 Assistants 謝永？ 手術日期：2009/06/26 13:00 摘要__ 手術科部: 外科部 套用罐頭: Anterior Discectomy and Fusion, Cervical Spine Pre-operative Diagnosis Cervical spine C5~C6 HIVD Post-operative Diagnosis Cervical spine C5~C6 HIVD Operative Method Diskectomy+ Autologous bone fusion Operative Findings 1.Narrow C5~C6 disc space 2.Hypertrophic PLL 3.One ruptured disc was noted at left side disc space Operative Procedures 1.ETGA position 2.Right neck transverse incision 3.Dissect muscle layer to expose pre-vertebral space 4.Detach paravertebral muscle 5.Diskectomy 6.Harrvest bone graft from right ant. sup. iliac crest 7.Inserted bone into disc space 8.Set one hemovac then close wound Operators 賴達明 Assistants 胡朝凱,曾杏榕 手術日期：2009/06/27 20:59 摘要__ 手術科部: 泌尿部 套用罐頭: herniorrhaphy, inguinal Pre-operative Diagnosis Right side inguinal hernia Post-operative Diagnosis Right side inguinal hernia Operative Method Right herniorrhaphy and posterior repair with Mesh Operative Findings 1. Sac from posterior wall, direct sac. 2. Posterior wall weakness. Operative Procedures Under satisfactory spinal anesthesia with the patient in supine position. Prepping and draping was performed in the usual sterile fashion. An inguinal oblique incision was made in the right inguinal area. The wound was deepened through layers into inguinal canal. The spermatic cord was mobilized, and an direct sac was noted. The hernia sac was isolated from spermatic cord. Posterior wall repair with interrupted 1-O nylon was performed to approximate the conjoin ligment, transverse abdominal fascia and the shelfing portion of the inguinal ligament. Mesh repair. After adequate hemostasis was obtained, the wound was closed in layers with 3-O silk on the external oblique fascia and 3-O chromic on the Scarpas fascia. Skin was closed with interrupted 3-O nylon mattress stitches. The patient tolerated the procedure very well, and was sent to the recovery room in satisfactory condition. The sponge count was correct and blood loss was minimal. Operators 黃國皓 Assistants 柯智群 手術日期：2009/06/27 15:01 摘要__ 手術科部: 外科部 套用罐頭: Trans-sphenoid adenomectomy 開立醫師: 王奐之 開立時間: 2009/06/27 15:01 Pre-operative Diagnosis Pituitary macroadenoma Post-operative Diagnosis Ditto Operative Method Endonasal trans-sphenoid subtotal pituitary tumor excision Pathology Pending Operative Findings The tumor was soft and fragile in character, white-reddish in color, normal gland was seen in left portion of sella after tumor removal. Operative Procedures After ETGA, the patient was put in supine position with head mildly tilted to left. The nasal mucosa was dissected, followed by identification of sphenoid outlet. The sphenoid floor was fractured and removed, the sellar floor was seen eroded by the tumor, fractured and removed. The tumor popped out after dural opening. Some of the tumorous tissue was removed with tumor forceps and ring curret, and the residual was removed with suction. The suprasellar portion of tumor was also subtotally removed. Hemostasis and reconstruction of the sellar floor was achieved with Gelfoam, some of the bony fragments were put back; reinforced with Tissucol Duo. The operative procedure ends with bilateral nasal cavities packing with Marocel. Operators 王國川 Assistants 王奐之 手術日期：2009/06/30 15:49 摘要__ 手術科部: 外科部 套用罐頭: Anterior Discectomy and Fusion, Cervical Spine Pre-operative Diagnosis C4~C5 HIVD Post-operative Diagnosis C4~C5 HIVD Operative Method Microscopic diskectomy+anterior fusion with cage Operative Findings Marginal spur formation and bulging disc at C4~C5 with lateral recess stenosis. Cord expanded well after diskectomy. Cage 5mm Operative Procedures 1.ETGA supine neck extension 2.Right neck incision 3.Dissect prevertebral space 4.C arm localization C4~C5 5.Diskectomy with curretage then use drill to drill off spur then karrision to remove PLL till cord decompression 6.Cage insertion 7.Hemostasis, minihemovac X1 8.Close wound in layers Operators 賴達明 Assistants 陳盈志,曾杏榕 手術日期：2009/07/02 11:17 摘要__ 手術科部: 外科部 套用罐頭: Cranioplasty Pre-operative Diagnosis Skull defect of right frontal-parietal-temporal regions. Post-operative Diagnosis Skull defect of right frontal-parietal-temporal regions. Operative Method Right frontal-parietal-temporal cranioplasty. Pathology Nil. Operative Findings - Brief history: Traumatic acute SDH at right frontal-parietal-temporal regions with severe brain swelling, s/p emergent craniectomy and hematoma removal on 04-12. - Current GCS: E4VtM5, ventilator dependence. - Operative findings: - well- delineated galea and meningeal planes. - Blood loss: 150ml. Operative Procedures Under general anesthesia, the patient was put in supine position with the head flex in 15 degrees. The head was tilted to the left side. After skin preparation wih shaving of the hair , scrubbing with povidone iodine detergent, and followed by painting with povidone-iodine alcohol tincture, scalp was covered with sterilized clothes. Later, we incised along the previous operation scar and applied Raney clips to the scalp edge for hemostasis. The scalp and temporalis muscle were dissected bluntly tothe edge of skull bone. We reflexed the scalp and temporalis muscle for exposure of operative field. The bleeders on the dissected surfaces were coagulated with Bipolar coagulator. The edge of the skull defect was exposed. Dura tenting was made by 2-0 silk and through the newly-made holes. We inserted CWV drain between the meninges and skull bone for drainage. Then, we repaired the skull defect with bone cement meticulously after fixing the skull bone with plates and screws. The scalp wasclose with 2-0 polysorb and 3-0 Vicryl with continous simple and matress sutures. The patient was sent to POR for post-operative monitoring. Operators 王國川 Assistants 鍾文桂 佘上翊 (M,1994/12/08,17y3m) 手術日期 2009/07/07 手術主治醫師 郭夢菲 手術區域 兒醫 067房 02號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 2 紀錄醫師 陳德福, 時間資訊 10:35 報到 10:45 進入手術室 10:50 麻醉開始 11:15 誘導結束 11:20 抗生素給藥 12:05 手術開始 14:30 抗生素給藥 17:33 抗生素給藥 19:05 麻醉結束 19:05 手術結束 19:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 9 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除－手術時間在４～８小時 1 1 L 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 L 手術 超音波診查機–腦神經外科術中特殊儀器使用費 1 0 L 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis left temporal tumor, suspect low grade glioma Post-operative Diagnosis ditto Operative Method Nearly total excision of the tumor via trans-sulcus approach by left temporal craniotomy Specimen Count And Types Pathology pending Operative Findings There is a 7*3*4cm in size tumor over the left temporal lobe, mainly occupying the wholein left inferior temporal gyrus. The tumor was fragile, soft, and some were elastic firm. It was hypovascular to moderate hypervascular. It was gray-yellowish and infiltrative in characters without margin. Some normal-looking brain tissue was noted inside the tumor. The system of vein of Labbe had three branches. One was underneath the left temporal base, and the other two were distributed at the posterior temporal region. The anterior one crossed over the tumor and all of them were well preserved after removal of the tumor. The tumor extended to the ipisilateral temporal horn and part of the parietal and occipital lobes. The ventricle wall was visible after removal ofthe tumor. Intraoperative echo was used to help identify the tumor margin. Operative Procedures Under ETGA, supine and head rotated to right side position with pin-type Mayfield head holder fixation, the scalp was disinfected and draped as usual. One horse-shoes shape incision from pre-auricular to post-auricular area was made followed by creating a4*7 cm craniotomy window. We localized the tumor with intra-op ultrasound. Dura tenting and dura opening were done in cruciate incision. The tumor came into view at the left temporal base. Under micoscopic surgery, we approached the tumor via the sulcusbetween the left middle and inferior temporal gyri. The tumor was removed meticulously under forceps, bipolar coagulator and sucker assisted. After the lateral ventricle was reached we performed intra-OP sonography again to identify the residual tumor. They were then removed in the same manners. Hemostasis was done and the rough surface was covered with Surgicelle. The dura was closed in water tight fasion and the skull was fixed back with miniplates. One epidural J-P was left in situ and the wound was closed in layers. Operators 郭夢菲 Assistants 陳德福 手術日期：2009/07/07 19:26 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis left temporal tumor, suspect low grade glioma Post-operative Diagnosis ditto Operative Method Nearly total excision of the tumor via trans-sulcus approach by left temporal craniotomy Pathology pending Operative Findings There is a 7*3*4cm in size tumor over the left temporal lobe, mainly occupying the wholein left inferior temporal gyrus. The tumor was fragile, soft, and some were elastic firm. It was hypovascular to moderate hypervascular. It was gray-yellowish and infiltrative in characters without margin. Some normal-looking brain tissue was noted inside the tumor. The system of vein of Labbe had three branches. One was underneath the left temporal base, and the other two were distributed at the posterior temporal region. The anterior one crossed over the tumor and all of them were well preserved after removal of the tumor. The tumor extended to the ipisilateral temporal horn and part of the parietal and occipital lobes. The ventricle wall was visible after removal ofthe tumor. Intraoperative echo was used to help identify the tumor margin. Operative Procedures Under ETGA, supine and head rotated to right side position with pin-type Mayfield head holder fixation, the scalp was disinfected and draped as usual. One horse-shoes shape incision from pre-auricular to post-auricular area was made followed by creating a4*7 cm craniotomy window. We localized the tumor with intra-op ultrasound. Dura tenting and dura opening were done in cruciate incision. The tumor came into view at the left temporal base. Under micoscopic surgery, we approached the tumor via the sulcusbetween the left middle and inferior temporal gyri. The tumor was removed meticulously under forceps, bipolar coagulator and sucker assisted. After the lateral ventricle was reached we performed intra-OP sonography again to identify the residual tumor. They were then removed in the same manners. Hemostasis was done and the rough surface was covered with Surgicelle. The dura was closed in water tight fasion and the skull was fixed back with miniplates. One epidural J-P was left in situ and the wound was closed in layers. Operators 郭夢菲 Assistants 陳德福 手術日期：2009/07/08 11:47 摘要__ 手術科部: 外科部 套用罐頭: varicose vein 開立醫師: 謝永 開立時間: 2009/07/08 11:47 Pre-operative Diagnosis Lower limbs varicose vein (Left) Post-operative Diagnosis Lower limbs varicose vein (Left) s/p EVRF Operative Method EVRF + Muller’s phlebectomy Pathology pending Operative Findings 1. engorged varicose vein over lower legs, telangiectasia (+) 2. Data: time: 1min40 sec, temperature: 120''C, energe: 12W, length:28 cm, 5 cycles Operative Procedures -Under IVG, the patient was posed in supine position with. adequate skin disinfection and drapping. -EVRF: Echo-guided left GSV catheterization and sheath insertion. EVLT from 2cm distal to GSV/CFV junction to the distal of GSV near to the knee. -Hemostasis, wounds closure. Compression by bandage. Operators 王水深 Assistants 謝永？ 手術日期：2009/07/08 09:30 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Right side fronto-temporal and meddle fossa arachnoid cyst Post-operative Diagnosis Ditto Operative Method Right side cystoperitoneal shunt, 40mm H2O Codman flat bottomed type Pathology Nil Operative Findings A Codmann 40mmH2O shunt was inserted to the cyst. The length was about 5cm. The abdominal site was over RUQ and the peritoneal catheter was about 40 cm in length. The fluid inside the cyst was clear and the initial pressure was high. Operative Procedures 1. ETGA, supine position with right side elevation 2. Linear incision above the auricular region 3. Make a burr hole and dural tenting 4. Minilaparotomy at RUQ 5. Insert the intra-abdominal shunt aboue 30cm 6. Create a subcutaneous tunnel from RUQ toright auricular,and then pass the shunt 7. Connect the reservior (40mm H2O Codman typed fixed pressure) and 5cm intracystal shunt with a right angle bottom 8. Dura opening, and then insert the intracystal catheter. fix the catheter at the burr hole margin 9. Hemosatsis, and close the wound in layers Operators 郭夢菲 Assistants 陳睿生 手術日期：2009/07/10 13:04 摘要__ 手術科部: 骨科部 套用罐頭: Open reduction for fracture of radius,ulna Pre-operative Diagnosis Right distal radioulnar fracture Post-operative Diagnosis Right distal radioulnar fracture Operative Method ORIF with Zimmer volar locking plate (4H8S) Pathology Nil Operative Findings 1. Right distal radioulnar fracture, with radial height shortening Operative Procedures 1. Anesthesia induction, supine position 2. Skin disinfected, draped, on tourniquet 3. Made one logitudinal incision medial to FCR tendon, Henry's approach 4. Dissected and exposed the fracture site 5. Reduced and fixed with Zimmer voalr lockingplate (4H8S) 6. Irrigation with N/S and hemostasis 7. Closed the wound in layers 8. Applied one short arm splint Operators 孫瑞昇 Assistants 吳拓,姜志勇,賴昆鴻 手術日期：2009/07/13 09:33 摘要__ 手術科部: 外科部 套用罐頭: Laparoscopic cholecystectomy 開立醫師: 陳建嘉 開立時間: 2009/07/13 09:33 Pre-operative Diagnosis Gallbladder stone Post-operative Diagnosis Ditto Operative Method Laparoscopic cholecystectomy Pathology Pending Operative Findings 1. Mild adhesion around the gallbladder 2. One about 2cm in diameter stone noted Operative Procedures 1. ETGA, supine position 2. Make 10-10-5-5 ports 3. Adhesionlysis 4. Dissect the Calot triangle 5. Ligate the cystic vessel with Endoclips 6. Ligate the cystic duct with Endoclips 7. Dissect the gallbladder from the liver bed 8. Hemostasis 9. Close the wounds in layers Operators 賴逸儒 Assistants 陳建嘉, 郭彥志 手術日期：2009/07/13 10:30 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT Pre-operative Diagnosis Brain tumor at right frontal area Post-operative Diagnosis Ditto Operative Method Craniotomy for brain tumor excision Pathology Frozen section: metastatic carcinoma Operative Findings The motor area was 2cm posterior to the tumor. The tumor was elastic, yellowish, size 1.8cm in diameter, located at right frontal area. Operative Procedures Under endotracheal general anaesthesia, the patient was put in supine position with neck flexed. After shaved, disinfected, and draped, curvilinear skin incision was made at right parietal area. We made four burr holes, and then created craniotomy. U-shape dura incision was made, and we located the tumor with sonography. Intra-operative electrophysiological mapping located the motor area 2cm posterior to the tumor, and we avoided damaging that area. Tumor excision was perfomred with dissection of the tumor and bipolar coaulation for hemostasis. The tumor was removed with tumor forceps and sent for fronzen section. The hemostasis was achieved with surgicel lining of the tumor bed. The duroplasty was done with Duroform and the skull was closed with wires and miniplate. The wound was then closed in layers after one subgaleal CWV drain tube placed. Operators 曾漢民 Assistants 李建勳,曾峰毅 手術日期：2009/07/14 18:45 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Suspect Port-A infection Post-operative Diagnosis Ditto Operative Method Port-A catheter remove Pathology None Operative Findings 1.One Port-A catheter was removed from left chest Operative Procedures 1.Supine position 2.Skin disinfection and drapping as usual 3.Skin incision under local anesthesia 4.Remove Port-A catheter 5.Close woundi n layers Operators 黃培銘 Assistants 蔡東明 手術日期：2009/07/15 11:38 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Falx meningioma status post tumor excision twice; Bilateral subdural effusion Post-operative Diagnosis Ditto Operative Method S-P shunt, bilateral, without reservior Pathology Nil Operative Findings 1. Much celar subgaleal effusions noted after skin incision over the previous operative wound, two incisions over bilateral frontal area 2. Bilateral yellowish, clear subdural effusions were noted with left side relatively high pressure 3. Subdural catheter 5cm long; peritoneal catheter 20 cm long Operative Procedures Under ETGA and supine position, skin disinfected and drapped were performed as usual. Skin incision was done over the previous operative wound, bilateral frontal area. The previous cone-shaped bone graft over right frontal area was removed and another burr hole was created over left frontal area. Dura was opened after dura tenting and bipolar cauterization. Skin incision was done over the right abdomen. Subcutaneous tunnel created with sylate. Subdural drains x2 connected with Y-shaped connecter and connected to peritoneal catheter. Hemostasis was done with Gelfoam packing over the burr holes. The wounds were closed in layers. Operators 杜永光 Assistants 陳盈志,林哲光 手術日期：2009/07/17 20:02 摘要__ 手術科部: 外科部 套用罐頭: Port-A 開立醫師: 郭庭均 開立時間: 2009/07/17 20:02 Pre-operative Diagnosis Invasive nasal lymphoepithelioid carcinoma with intracranial invasion (T4N0Mx) Invasive Post-operative Diagnosis Ditto Operative Method Port-A catheter implantation Pathology nil Operative Findings The venous blood flow freely in the Port-A catheter after implantation. Operative Procedures The patient was put on supine position. The operation field was disinfected and draped as usual. Under local anesthesia, the Port-A catheter was implanted on left side upper chest with dissection method. A subcutaneos pocket was made using blunt dissection over the right deltopectoral area. After meticuous hemostasis, check-up of the venous flow, and check-up of position via postable CXR, the wound was closed using 3-0 Dexon and 4-0 Nylon sutures. Then the patient was sent to general ward for post-operative care. The patient was put on supine position. The operation field was disinfected and draped as usual. Under local anesthesia, the Port-A catheter was implanted on left side upper chest with puncture method. Operators 楊士弘 Assistants R5陳德福,R2郭庭均,R1陳志軒 手術日期：2009/07/17 13:51 摘要__ 手術科部: 外科部 套用罐頭: 1. Partial L4 + L5 laminectomy for decompress... 開立醫師: 陳睿生 開立時間: 2009/07/17 13:51 Pre-operative Diagnosis L4/5 spondylolithesis, grade. I with stenosis Post-operative Diagnosis Ditto Operative Method 1. Partial L4 + L5 laminectomy for decompression; 2. L4/5 posterior fixation with lateral fusion Pathology Nil Operative Findings The thecal sac was tightly compressed at L4/5 level, and well-decompressed after laminectomy. L4/5fixation with A-spine screws (6.5x45mm) x4, and 5cm rods x2 Operative Procedures 1. ETGA, prone, C-arm localized 2. Posterior midline incision, and split paraspinal muscle bilaterally 3. Identify L4/5 facets, and L4, L5 transverse processes 4. Partial L4, and L5 laminectomy till thecal sac expansion 5. Insert transpedicular screws over bilateral L4, L5 6. Set the rods, and do autologus bone graft fusion 7. Hemostasis, set a hemovac 8. Close the wound in layers Operators 王國川 Assistants 陳睿生 手術日期：2009/07/20 13:12 摘要__ 手術科部: 外科部 套用罐頭: Laparoscopic cholecystectomy 開立醫師: 陳建嘉 開立時間: 2009/07/20 13:12 Pre-operative Diagnosis Gallbladder stone Post-operative Diagnosis Gallbladder stone with cholecystitis Operative Method Laparoscopic cholecystectomy Pathology Pending Operative Findings 1. Several pigmented stones about 1.5-2cm in diameter 2. Edematous gallbladder wall Operative Procedures 1. ETGA, supine position 2. Make 10-10-5-5 ports 3. Dissect the Calot triangle 4. Ligate the cystic vessel and duct with Endoclips 5. Dissect the gallbladder from the liver bed 6. Hemostasis 7. Take out the specimen 8. Close the wounds in layers Operators 賴逸儒 Assistants 陳建嘉, 楊惟鈞 手術日期：2009/07/20 18:04 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT Pre-operative Diagnosis Multiple metastatic brain tumor Post-operative Diagnosis dittop Operative Method Right frontal craniotomy for tumor excision Pathology pending Operative Findings One 4.8x4.5x4.2cm cystic tumor, containing clear fluid and some debris, was noted at right frontal lobe. Operative Procedures Under endotracheal general anaesthesia, the patient was put in supine position with neck flexed and head fixed with Mayfield head clump. After skin scrubbed, disinfected, and drapped, one curvilinear skin incision was made. We created one 6x8cm craniotomywindow after 5 burr holes. After dura tented, we made one C-shape dura incision. Tumor was located with sonography, and tumor excision was done with bipolar cauterization and suction. After hemostasis, duroplasty was done with 4-0 prolene and autologousfascia graft. Bone graft was put back and fixed with mini-plate. We set on subgaleal CWV, and closed the wound in layers. Operators 曾漢民 Assistants 李建勳,曾峰毅 手術日期：2009/07/21 09:52 摘要__ 手術科部: 外科部 套用罐頭: LC Pre-operative Diagnosis Gallbladder stone Post-operative Diagnosis Ditto Operative Method Laparoscopic cholecystectomy Pathology pending Operative Findings 1.multiple pigment/cholesterol gallstones in the gallbladder. 2.Adhesion around the gallbladder. Gallbladder wall thickening(+), inflammatory change of GB Operative Procedures 1.ETGA , supine position. 2.sterilization and draping. 3.created pneumoperitoneum via Camera port (10mm) at subumbilical area. 4.created working port (10mm) at subxiphoid area ; one another working ports(5mm) at right subcostal area. 5. dissection ofgallbladder from liver bed. 6. identification of cystic duct and cystic artery, respectively. 7. Division after clipping. 8. Removed the gallbladder via subumbilical wound. 7. Checking bleeding, wound closure. Operators 黃凱文 Assistants 劉士宏 手術日期：2009/07/24 15:44 摘要__ 手術科部: 外科部 套用罐頭: Partial L4/5 laminectomy + posterior fixation... 開立醫師: 陳盈志 開立時間: 2009/07/24 15:44 Pre-operative Diagnosis L4/5 HIVD with stenosis Post-operative Diagnosis L4/5 HIVD with stenosis Operative Method Partial L4/5 laminectomy + posterior fixation + fusion Pathology nil Operative Findings The thecal sac was well-expanded after decompresssion. TPS: Synthes screws 6.2x40mmx4 rods 50mmx2 Suspected left L5 root fraction intra-operation. After fixation, posteriolateral fusion was done with autologus bone graft. Operative Procedures 1. ETGA, prone position, C-arm localization of L4-5 2. Posterior medline incision 3. Split bilateral paraspinal muscle 4. Identify L4/5 transverse process 5. Perform L4/5 TPS with synthes screws x4 (6.2x40) 6. Partial lower L4 upper L5 laminectomy + foraminotomy 7. Set the rods 8. Hemostasis, set 1/8 H/V 9. Close the wound in layers Operators VS賴達明 Assistants R5陳睿生 R1陳志軒 手術日期：2009/07/24 09:30 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) Pre-operative Diagnosis L5-S1 spondylolisthesis with spinal stenosis Post-operative Diagnosis Ditto Operative Method L5-S1 TPS and laminectomy Pathology Nil Operative Findings The height of L5 vertebral body was shortened. Pseudoarthrosis with L5-S1 spondylolisthesis was noted. The lumbar stenosis and lateral recess stenosis was caused by hypertrophic ligmentum flavum. Spinal bifida was noted after sacrum exposed. Two 45mm x6.2mm screws were applied at L5 body. The sacral screws were 40mm x 6.2mm. Two rods was applied for posterior fixation. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in prone position. The skin was disinfected and draped as usual. C-arm portable X-ray was used for localization. The Midline skin incision was made at L4-S2 level. The muscular layers was dissected to expose the facets and partial transverse processes of L5-S1. Trans-pedicular screws fixation was done followed by L5 laminectomy. Two rods was applied for TPS setting. One Hemovac drain was left and the wound was closed in layers. Operators 賴達明 Assistants 胡朝凱,李振豪 手術日期：2009/07/24 16:00 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Lung cancer Post-operative Diagnosis Ditto Operative Method Port-A implantation at left subclavian vein Pathology Nil Operative Findings Venous blood returned smoothly after Port-A implantation. Operative Procedures Skin disinfected with alcohol b-I then draped. Under local anesthesia, left subclavian vein was punctured and inserted guide wire. Created subcutaneous pocket. Inserted Port-A device and fixed at subcutaneous pocket. Checked tip position with portable X-ray. Checked venous blood return and closed the wound in layers. Operators 曾漢民 Assistants 李建勳,曾峰毅 手術日期：2009/07/29 11:07 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT 開立醫師: 郭庭均 開立時間: 2009/07/29 11:07 Pre-operative Diagnosis Meningiomas, left parieta-parasagital falx and right posterior frontal recurrence; left posterior parietal subcutaneous tumor Post-operative Diagnosis Ditto Operative Method Craniotomy for Simpsons Gr.II (left parietal); Gr.III (right posterior frontal) tumor removal Pathology Pending Operative Findings The tumors were soft, fragile, and purple in color. It was well-capsuled. Several fibrotic portions were noted, especially over the right posterior frontal area. The portion adhered to the SSS were preserved. Moderate adhesion of the right posterior frontal one was found. Operative Procedures Under endotracheal general anesthesia, the patient was placed in a supine position with head fixed by Mayfield skull clamp. Then we shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet for skin preparation. We opened the previous scalp wound at bicoronal region adn extended to the left parietal region.Raney clips were applied to the scalp edge for temporary hemostasis. Then we excised the left parietal subcutaneous neuroma. We created a 6cm*6cm craniotomy window by making five burr holes then cut by power saw. Dural tenting qas done by 2/0 silk, 2 cm in interval, distributed along the edge of skull window. Then we opened the dura by crusade fashion (curvilinear along the edge of skull window). The tumor was tightly adhered to the dura and nearly total removed after dissection with dissector and brain cottons. The dura was tightly closed with fascia. The skull bone graft was placed back to craniotomy window and fixed by 3 Gage 26 wires. Then we created another 6cm*6cm craniotomy window by making five burr holes which crossed the medline then cut by power saw. The dura was founc to be teared. Then we performed hemostasis using bipolar electrocautezation and brain cottons. The intra-OP ECHO was used to recheck of the tumor. After split the frontal lobe, the tumor was noted. The tumor was carefully removed partially, and the arteries passed were preserved. We performed hemostasis using bipolar electrocautezation touching. The dura was repaired with fascia. The skull bone graft was placed back to craniotomy window and fixed by 3 Gage 26 wires. The muscles were approximated by interrupted sutures with 2/0 silk. The galea suture was performed in the subcutaneous layer by continuous suture with 3/0 Dexon and the skin by continuoussuture with 3/0 Nylon sutures in layers. Operators 曾勝弘 Assistants R5陳睿生,R2郭庭均 陳寰穎 (M,2003/07/05,8y8m) 手術日期 2009/08/03 手術主治醫師 廖漢文 手術區域 東址 000房 號 診斷 Moyamoya disease 器械術式 Common Carotid Angiography 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 時間資訊 08:15 麻醉開始 08:30 誘導結束 10:15 麻醉結束 10:20 進入恢復室 11:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術日期：2009/08/04 16:12 摘要__ 手術科部: 麻醉部 套用罐頭: Port-A implantation, internal jugular 開立醫師: 蔡靜影 開立時間: 2009/08/04 16:12 Pre-operative Diagnosis AML Post-operative Diagnosis Ditto Operative Method Port-A implantation, echo-guided Pathology Nil Operative Findings 1.The port-A catheter was inserted via right internal jugular vein by cut down & echo-guided procedure 2.Patent flow after implantation 3.Others: nil Operative Procedures 1.The patient was set on supine position and bilateral internal jugular veins were checked by echo. 2.After IVGA and local anesthesia applied, direct cut down method was performed. Then identify internal jugular vein andan IV catheter was advanced at neck wound with negatively aspiration until venous blood attainable. 4.J-wire was inserted smoothly via the needle in rostral direction. An internal jugular catheter with dilator was inserted through the J-wire, and the dilator was then removed. 6.IV catheter for Port-a was threaded into the internal jugular catheter until mark 25 cm. Skin tunnel between internal jugular and pre-cordial incision was made by the blunt dissection with Kellyclamp. The catheter was then threaded. 7.The catheter was adapted into the port and locked with restrictor. The port was inserted into the pouch of pre-cordial incision. 8.Skin was closed layer by layer. Both catheter and the portwere perfused with heparin solutionafter implantation. Operators 林至芃 Assistants 鄭孝良 手術日期：2009/08/05 09:00 摘要__ 手術科部: 外科部 套用罐頭: Hypophysectomy---Transphenoid Pre-operative Diagnosis Pituitary macroadenoma s/p transsphenoid adenomectomy with recurrence Post-operative Diagnosis Ditto Operative Method Transsphenoid adenomectomy Pathology Pituitary adenoma Operative Findings The sphenoid mucosa showed fibrotic change. Some fibrotic tissue over previous operation site dura. The tumor was white-yellowish, and soft-elastic. The normal pituitary gland was preserved during the procedure. CSF leakage was sealed with Tissucol Duo and surgicel. Operative Procedures Under endotracheal general anaesthesia, the patient was put in supine position with neck extended and tilted 30 degress to left. After disinfection and draping, the local anaesthesia was injected submucosally at right norstril. The nasal mucosa was incised at previous op scar, and we seperated the mucosa to expose vomer bone. After removal of vomer bone by osteotome and remocal of mucosa by alligator, we knocked out the sellar floor with osteotome. The dura was opened, and the tumor was removed by tumor forcepsand ring curette. The CSF leakage was sealed with Tissucol Duo and surgicel. We achieved hemostasis with gelform packing, and we covered back the sphenoid sinus floor and vomer bone. We packed the norstrils with Merocel after reduction of the mucosa. Operators 杜永光,楊士弘 Assistants 李建勳,鍾文桂 陳寰穎 (M,2003/07/05,8y8m) 手術日期 2009/08/05 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Moyamoya disease 器械術式 Moyamoya P-DUH 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 范守仁 ASA 2 紀錄醫師 陳德福, 時間資訊 00:00 臨時手術NPO 07:55 報到 08:05 進入手術室 08:15 麻醉開始 09:00 誘導結束 09:20 抗生素給藥 09:45 手術開始 12:25 抗生素給藥 12:30 麻醉結束 12:30 手術結束 12:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱內外血管吻合術 1 1 R 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Right encephaloduroangiosynangiosis 開立醫師: 陳德福 開立時間: 2009/08/05 12:58 Pre-operative Diagnosis Moyamoya disease Post-operative Diagnosis ditto Operative Method Right encephaloduroangiosynangiosis Right encephaloduroarteriosynangiosis Specimen Count And Types Pathology nil Operative Findings The right posterior branch of STA was harvested along with its galeal flap. The dura was incised with meticulous preservation of MMA. The collateral circulation was profound on the dural surface. The cortical vessel was exposed by opening the arachnoid. Operative Procedures 1.ETGA, supine with head turne to left 2.Dopler identification of STA 3.Curved incision, harvest the posterior branch of the right STA posterior branch 4.linear incision of the temporalis muscle 5.Burr hole X2 then craniotomy 6.Dural tenting and incision under microscope. Anchoring suture of the flap and the dural edges at 4 cornors. 7.Open the arachnoid of cortical surface, place the STA graft on the cortical surface to contact with the cortical vessels after a piece of gelfoam was place anterior to the graft (to push the graft to contact the vessel) 8.Close the dura with prolene 9.Cranioplasty with wires 10.Wound closure in layers Operators 郭夢菲 Assistants R4陳德福 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Moyamoya disease Post-operative Diagnosis ditto Operative Method Right encephaloduroangiosynangiosis Specimen Count And Types Pathology nil Operative Findings The right posterior branch of STA was harvested along with its galeal flap. The dura was incised with meticulous preservation of MMA. The collateral circulation was profound on the dural surface. The cortical vessel was exposed by opening the arachnoid./ Operative Procedures 1.ETGA, supine with head turne to left 2.Dopler identification of STA 3.Curved incision, harvest the posterior branch of the right STA posterior branch 4.linear incision of the temporalis muscle 5.Burr hole X2 then craniotomy 6.Dural tenting and incisionunder microscope. Anchoring sutures of the flap and the dural edges at 4 cornors. 7.Open the arachnoid of cortical surface, place the STA graft on the cortical surface to contact with the cortical vessels after a piece of gelfoam was place anterior to thegraft (to push the graft to contact the vessel) 8.Close the dura with prolene 9.Cranioplasty with wires 10.Wound closure in layers/ Operators 郭夢菲 Assistants R4陳德福 手術日期：2009/08/06 11:20 摘要__ 手術科部: 外科部 套用罐頭: Wound debridement 開立醫師: 陳睿生 開立時間: 2009/08/06 11:20 Pre-operative Diagnosis Parkinsonism status post bilateral DBS with wound infection Post-operative Diagnosis Ditto Operative Method Wound debridement Pathology Pending Operative Findings Yellowish pus was noted to be accumulated at both left chest wound and left retroauricular wound. Some necrotic tissue with granulation formation were also noted and removed. Post-OP the generator function was fair. Operative Procedures 1. ETGA, supine position with head right turn 2. Transverse skin incision at left upper chest 3. Expose the generator and wires 4. Wound debridement and excise of necrotic tissue 5. Incision into the left retroauricular region via previous wound 6. Wound debridement 7. Hemostasis, and close the wound in layers Operators VS 曾勝弘 曾勝弘 Assistants 陳睿生 R5 陳睿生 手術日期：2009/08/06 16:45 摘要__ 手術科部: 外科部 套用罐頭: Ventriculo-peritoneal shunt implantation. 開立醫師: 鍾文桂 開立時間: 2009/08/06 16:45 Pre-operative Diagnosis Hydrocephalus. Post-operative Diagnosis Hydrocephalus. Operative Method Ventriculo-peritoneal shunt implantation. Pathology Nil. Operative Findings - Clear colorless CSF fluid was collected for routine study. - Medtronic medium pressure with delta chamber, ventricular site: 4.7cm, peritonral site: 20(30) cm. Operative Procedures Under ETGA, the patient was put in supine position and the head tilted to left and extended. - After well drapping and disinfection, the planned shunt tract was marked out. An reverse C-shape incision was made at After well drapping and disinfection, the planned shunt tract was marked out. An reverse C-shape incision was made at Kochers point, and a transverse 2-cm long incision was made at right lower quadrant of abdomen. The peritoneal cavity was reached after dissection. We inserted periotneal portion of the V-P shunt and made a purstring along the shunt tube. The shunt passed through subcutaneous larger from abdomen to head. The scalp was dissected along periosteum layer. The skull along the right anterior margin of anterior frontanelle was removed piece by piece with Rongeur and left a 1 cm bur hole. Ventricular needle was inserted at Kochers point, then the ventricular portion was inserted at 4.7 cm level. With the connected reservior and Delta chamber, the whole shunt system was implanted smoothly. The wounds were close in layers as usual. The patient was sent to ICU without events. Operators Dr. 郭夢菲 Assistants R4鍾文桂, Intern 李時偉 手術日期：2009/08/06 14:46 摘要__ 手術科部: 外科部 套用罐頭: Lobectomy Pre-operative Diagnosis RML adencarcinoma Post-operative Diagnosis Ditto Operative Method VATS RML lobectomy + RUL wedge resection +Gr.3,4,7,11 LND Pathology Pending Operative Findings 1.One 2*2*2cm, yellowish, elastic and frim mass was noted at RML with invasion to partial RUL and bronchus. Pleural retraction (+) 2.Several soft, blackish LNs were noted at Gr. 3,4,7. Frozen biopsy showed negative in malignancy 3.Enlarged and hardish intralobar LNs were noted at RML and RLL 4.Post*op air leakage (+) 5.Blood loss: 200ml Operative Procedures 1.DLETGA, left decubitus 2.Skin disinfection and rapping 3.VATS setting 4.LND at Gr.3,4,7 with harmonic scaple 5.Divided minor and major fissure with endoGIA60 6.Divided and transect Right PV by endoGIA30 7.Divided and transect Right PA by endoGIA308.Wedge resection for RUL with endoGIA60 9.Dissect major fissure with elactroscaple 10.Transect RML bronchus with endoGIA60 11.Repair of rough surface with Prolene 4-0 12.Set-up one chest tube Fr.28 13.Close wound in layers Operators 陳晉興 Assistants 蔡東明,徐紹勛,孫偉哲 手術日期：2009/08/08 15:18 摘要__ 手術科部: 骨科部 套用罐頭: Total knee arthroplasty with Zimmer prosthesis 開立醫師: 曾渥然 開立時間: 2009/08/08 15:18 Pre-operative Diagnosis Knee osteoarthritis, right Post-operative Diagnosis Ditto Operative Method Total knee arthroplasty with Zimmer prosthesis Pathology Nil Operative Findings 1.Osteophytes formation 2.Cartilage wearing over medial compartment with joint space narrowing 3.Severe synovitis 4.New prosthesis: femur D# tibia 2# insert 12mm patella 26# 7.5mm 5.Vancomycin-mixed cementing Operative Procedures 1.Spninal anesthesia, supine 2.Skin disinfection and well draped 3.Midline incision, mid-vastus approach 4.Bony preparation of femur, tibia and patella subsequently 5.Insert the prosthesis step by step, check the stability of new joint 6.Normal saline irrigation, on 1/8" hemovac 7.Close the wound in layers Operators VS王至弘 Assistants R4吳拓;R2曾渥然;R2江毅彥 手術日期：2009/08/11 17:31 摘要__ 手術科部: 外科部 套用罐頭: Removal of L3/4 TPS with TPS on L3-L5(extend ... 開立醫師: 吳晉睿 開立時間: 2009/08/11 17:31 Pre-operative Diagnosis s/p L3/4 TPS with L4 on 5 spondylolisthesis Post-operative Diagnosis Ditto Operative Method Removal of L3/4 TPS with TPS on L3-L5(extend TPS) with posterolateral fusion on L4/5 Pathology Nil Operative Findings Brokened point between L4/5 with unstable condition was noted Previous TPS on L3/4 was 6.5mm*45mm*4. New TPS on L3-L5 was 6.5mm*45mm*6 Listhesis of L4 on L5 was reduced on C-arm after TPS Dura tear over L5 was noted which was OP procedure repaired. Operative Procedures 1.ETGA prone 2.Midline back incision 3.Dissect paraspinal muscle to expose previous TPS 4.TPS on L5 5.Removal of previous TPS on L3/4 then insert near one along previous tract 6.Rod fixation, posterolateral fusion on L4/5 7.Hemostasis 8.Close wound in layers Operators 賴達明 Assistants R6陳盈志, R1吳晉睿 手術日期：2009/08/11 16:14 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Left upper lung nodule Post-operative Diagnosis Left upper lung adenocarcinoma Operative Method VATS lobectomy and lymph node dissection Pathology Adenocarcinoma Operative Findings 1. A 1.5*1.5cm, soft to elastic, irregular shape tumor, hypercellulcity, located at left upper lung 2. Group 5, 7 Lymph node: blackish, anthracosis change 3. Mild adhesion at lingual lobe and left lower lung Operative Procedures 1. DLETGA, Right decusitus position 2. Skin disinfection 3. VATS port set as usual 4. Left upper lung resection. Frozen: Adenocarcinoma 5. Extended the AAL wound to 6 cm 6. Identify and loop the left upper lung Pulmonary vein 7. Seperate the fissurewith EndoGIA 8. Loop the lingual PA and 4 LUL PA branches 9. Ligate them with EndoGIA 10. Ligate the LUL PV with EndoGIA 11. Resect the LUL bronchus with EndoGIA 12. Group 5.7 lymph node dissection 13. Repair the air-leakage site. 14. Place 1 Fr 28 chest tube 15. Close the wound in layer. Operators 李章銘 Assistants 林孟暐 手術日期：2009/08/14 12:57 摘要__ 手術科部: 外科部 套用罐頭: Laminoplasty 開立醫師: 林哲光 開立時間: 2009/08/14 12:57 Pre-operative Diagnosis C3-6 central stenosis Post-operative Diagnosis Ditto Operative Method Laminoplasty of C3-6 open door with axis left on the right side Operative Findings Dura rexpansion well was noted after laminoplasty Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: prone with neck flexed and head fixed by a Mayfield skull clamp 3. Skin preparation: occipital and neck areas were shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: medline nape, from suboccipital to lower neck. 5. The trapezius, semispinalis capitis, splenius capitis muscles on both sides were splitted at its origin of ligamentum nuchae, then, together with serratus posterior superior, rectus capitis posterior, obliqus capitis inferior and multifidus were detached from the spinous processes of C3-6 by Bovie, followed by subperiosteal dissection on the laminae. 6. The paravertebral muscles were kept open by self retaining retractors to expose spinous processes and laminae of C3-6. The bleeding from the muscles was stopped by Bovie. 7. The spinous processes of C3-6 were cut at its base by bone cutter. 8. The left side laminal arches were cut through its whole thickness at its midline by a high speed air drill. The base of the right side laminae at its laminopedicle juction was cut into a depth of it half thickness by a high speed air drill. 9. The left side lamina was bent to the lateral side by opening a book like action of a Cloward intervertebral spreader. Consequently, the posterior half of the spinal canal was enlarged. 10.The hypertrophic ligmenta flava, esp. at posterior central region were resected. 11. Gap newly created between the lt and rt leminae at C3-6 after splitting was bridged by the reserved spinous process which was fixed to the laminae by miniplate bending as Z-shaped. (only C3 level had the aoutologus bone graft) 12. The new epidural empty space was loosely packed with subcutaneous fatty tissue. 13. The paravertebral muscles were closed by interrupted sutures with 2/0 silk, subcutaneous layer by continuous suture with 3/0 Dexon and skin by continuous suture with 3/0 nylon. 14. Drain: one, epilaminal, hemovac. 15. Course of the surgery:smooth. Operators 賴達明, Assistants 林哲光, 胡朝凱, 胡朝凱,林哲光 手術日期：2009/08/21 14:00 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT Pre-operative Diagnosis Left parietal recurrent anaplastic meningioma Post-operative Diagnosis Ditto Operative Method Left parietal craniotomy for tumor excision Pathology Pending Operative Findings The tumor was red-yellowish in color, elastic to firm in character, 3.8x4.3x3.3 in size. The margin between brain parenchyma and the tumor was not clear. Peripheral gliosis of the brain was noted. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in prone position. The head was fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. Left parietal scalp incision was made along previous wound and thescalp flap was elevated. The wires for fixation of skull plate was cutting off the and bone plate was elevated. Gortex for duroplasty was removed and the tumor was identified. The plane at gliosis surrounding the tumor was dissected with bipolar and thenpushed by cottonoid. Enbloc tumor resection was done. Hemostasis was achieved with bipolar cautery and Surgicel. Duroplasty with new Gortex dura was done. The skull plate was replaced with 8 #26 wires. After placing one subgaleal CWV drain, the wound wasclosed in layers. Operators 曾漢民 Assistants 陳盈志,李振豪 手術日期：2009/08/22 15:47 摘要__ 手術科部: 外科部 套用罐頭: Right pterion approach, total tumor excision 開立醫師: 陳盈志 開立時間: 2009/08/22 15:47 Pre-operative Diagnosis Right frontaltemporal GBM Post-operative Diagnosis Ditto Operative Method Right pterion approach, total tumor excision Specimen Source and Count Brain tumor Pathology Pending Operative Findings The tumor was soft, gragile in character; greyish, reddish in color. The margin was not clear. The vascularity was high. A cystic content with hematoma was noted at inferior lateral part of the tumor. The central part of the tumor was necrotic and the peripheral part of the tumor was relative elastic. MCA and its branches was encased by the tumor. Operative Procedures 1. ETGA, supine, head tilt to left, head fixed; Mayfield 2. Right F-T curvilinear incision. 3. Divide temporalis muscle, burr hole X4 craniotomy 4. Dura tenting C shape, dura incision 5. Echo localization 6. open sylvian fissure, identify tumor border 7. corticotomy, inferior frontal gyrus dissect along tumor border, central debulking; suction and tumor forceps then circumferentially dissect tumor border 8. Hemostasis, surgical packing 9. Dura closure, 4-0 prolene 10. Epidural CWVx1 11. Fix bone plate; miniplate 12. Close wound in layers Operators 王國川 Assistants 陳盈志 手術日期：2009/08/27 23:19 摘要__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 郝政鴻 開立時間: 2009/08/27 23:19 Pre-operative Diagnosis Remove left temporal epidural hematoma (300 ml) Left temporal epidural hematoma (300 ml) Post-operative Diagnosis Ditto Operative Method Bilateral thoracoscopic T2 sympathectomy Remove left temporal epidural hematoma (300 ml) Specimen Source and Count Nil Pathology Nil Operative Findings Large amount of epidural hematoma was removed after opened the scalp flap, contineous oozing was slack down after remove the EDH Operative Procedures Under ETGA, Supine position with head turned to right. The scalp was scrubbed, disinfected then draped. Opened the scalp flap and removed the epidural hematoma. Hemostasis with bipolar coagulation. Set up 2 CWV drain at epidural space and closed the wound in layers Operators 王國川 Assistants 李建勳, 郝政鴻 手術日期：2009/09/02 12:27 摘要__ 手術科部: 外科部 套用罐頭: Vsd Pre-operative Diagnosis VSD, pulmonary hypertension, ASD II, infundibular PS Post-operative Diagnosis Ditto Operative Method VSD patch repair, ASD closure, infundibulectomy Pathology Nil Operative Findings 1. Distended RV and MPV 2. Perimembranous inlet to trabecular type, VSD (7mm in diameter) 3. ASD: secundum type (3mm in diameter) 4. Infundibulectomy at perietal band 5. transient AV block during rewarm: temporary pacemaker implant 6. Bil. pleura intact; pericardium approximated Operative Procedures Supine, ETGA, midline sternotomy CPB: A:AsAo, V: bicaval; partial CPB, hypothermia to 28 degrees AXC, antegrade cardioplegia, total CPB RA atriotomy, venting from ASD Detachment of tricuspid (partial) ant septal annulus VSD repair, 7 x 6-0 pledgettedprolene suture with Dacron patch Re-attachment of the tricuspid ant. leaflet with 6-0 prolene, saline test: compatent Closure of ASD with 5-0 prolene, rewarm, deair Release AXC, venting from Bungus, closure RA Resume partial CPB, wean off CPB gradually Hemostasis, 2 C/T inserted, Wound closure After 2 temporary pacemaker inserted Operators 張重義 Assistants 蔡孝恩,羅健洺 手術日期：2009/09/03 12:30 摘要__ 手術科部: 外科部 套用罐頭: Transnasal transshenoidal tumor removal 開立醫師: 趙崧筌 開立時間: 2009/09/03 12:30 Pre-operative Diagnosis Pituitary macroadenoma Post-operative Diagnosis Ditto Operative Method Transnasal transshenoidal tumor removal Specimen Source and Count *1 for pathology Pathology Pending Operative Findings Severe granulation change was noted due to previous operation. The sphenoid sinus was filled with debris. The tumor was semisolid, soft and whitish. Apoplexy was also impressed with hematoma drained. CSF leakage was noted intraoperatively. Operative Procedures 1.ETGA, supine with head extension 2.Incision and extend the space between bony septum 3.Removal of the bony chip 4.Removal of granulation tissue 5.C-arm localization and then harvest the tumor 6.CSF leakage was found and the dura tear was repaired with tissue-co dul 7.Hemostasis, pack the space with Gelform 8.Close the wound with pack plastic gloves Operators 王國川 Assistants 陳睿生 趙崧筌 手術日期：2009/09/04 14:01 摘要__ 手術科部: 外科部 套用罐頭: Laminoplasty 開立醫師: 廖先啟 開立時間: 2009/09/04 14:01 Pre-operative Diagnosis L4, L5 stenosis Post-operative Diagnosis Ditto Operative Method Lumbar Laminectomy L4 for decompression Specimen Source and Count Nil Pathology Nil Operative Findings Hypertrophic ligmentum flavum at L4/L5 Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: prone. 3. Skin preparation: the back was shaved and scrubbed with povidone-iodine detergent then painted with povidone-iodine tincture and followed by sterilized adhesive plastic sheet covering. 4. A spinal needle was inserted between spinous processes of L4 and a portable X-ray film was taken to locate the correct interspace. 5. Incision: 5 cm, over spinous processes from L4 to L5. 6. Split L4 spinous process with saw. 7. Sublaminar decompression, remove hypertropic ligmentum flavum. 8. Hemostasis 8. Theparavertebral muscles were closed by interrupted sutures with 2/0 Vicril, subcutaneous layer by continuous suture with 2/0 Vicril and skin by continuous suture. Operators VS賴達明 Assistants R6陳盈志,R2廖先啟 手術日期：2009/09/07 12:47 摘要__ 手術科部: 套用罐頭: PDA division + PA banding 開立醫師: 黃俊銘 開立時間: 2009/09/07 12:47 Pre-operative Diagnosis DORV, subpulmonary VSD(Taussig-Bing anomaly), large PDA, with pulmonary HTN and CHF Post-operative Diagnosis Ditto Operative Method PDA division + PA banding Pathology Nil Operative Findings 1. Situs slolitus, levocardia, left arch 2. DsAo~7mm, no CoA, Arch~5mm, Large PDA~5mm 3. PLSVC(+) 4. Pre-PDA division BP 29/19 mmHg Post-PDA division BP 59/30mmHg 5. Enlarged MPA~6mm PA banding to around 5mm Pre-banding SpO2 98%(FiO2 0.6) Post-Banding SpO2 85~87% (FiO2 0.6) 6. Pericardial effusion(+), large amount Operative Procedures ETGA, right decubitus, skin disinfected Left thoracotomy via 4th ICS Incision of parietal pleura, expose PDA, DsAo PDA division with 6-0 Prolene and 3# silk sutures Incision of pericardium, expose MPA PA banding with 6mm Gortex vascular graft stripe and 5-0 Prolene sutures Fix the banding to MPA Close pericardium and parietal pleura Hemostasis, set C/T*1 Wound close Operators 張重義 Assistants 謝永？ 黃俊銘 手術日期：2009/09/08 11:17 摘要__ 手術科部: 外科部 套用罐頭: Debridement 開立醫師: 覃紹殷 開立時間: 2009/09/08 11:17 Pre-operative Diagnosis Parkinson disease s/p DBS with left neck wire exposure Post-operative Diagnosis Ditto Operative Method Debridement 1.Revision of connecting wire; 2.Debridement Specimen Source and Count 1 specimen: subcutaneous tissue of left neck wound Pathology Pending Operative Findings There is a 0.5*3cm skin defect at the connector of wires. The nearby soft tissue was debrided and the wires to the IPG were exchanged. We created a new subcutaneous tunnel for the wires. The neck wound was finally closed with Vicryl and Nylon in layers Operative Procedures 3.Incision was made along previous op scar on left chest. The IPG and wires were exposed 4.We performed debridement of the left neck wound 1.ETGA, supine position 2.Skin disinfection and draping 3.Incision along previous op scar on left chest followed by exposure of the IPG and wires 4.Debridement of neck wound 5.Exchanged lines to the IPG 6.Closed the wound after fixing the IPG and wires 7.Closed the neck wound in layers 5.Removed old connecting wires and replaced with new one and connected them with IPG 1. Under ETGA, the patient was placed in supine position 2.The skin was disinfected and drapped 5.The old connecting wires were removed and replaced with new one. The connecting wires were then connected with IPG 6.The wounds were closed inlayers after fixing the IPG and wires Operators 曾勝弘 Assistants R4陳德福,R1覃紹殷 手術日期：2009/09/09 14:27 摘要__ 手術科部: 麻醉部 套用罐頭: Port-A implantation, subclavian 開立醫師: 林文瑛 開立時間: 2009/09/09 14:27 Pre-operative Diagnosis Cervical cancer Post-operative Diagnosis Ditto Operative Method Port-A implantation, echo-guided Pathology Nil Operative Findings 1.Site: right subclavian vein, with echo-guided procedure 2.Patent flow after implantation 3.Others: nil Operative Procedures 1.The patient was set on supine position and bilateral subclavian veins were checked by echo. 2.After IVGA and local anesthesia applied, transverse skin incision for 3cm was made at pre-cordial area. 3.Undermine the skin at the layer between subcutaneous tissue and deep fascia in lateral direction. 4.An IV catheter was inserted via the subclavian incision and negatively aspirated until venous blood attainable. 5.J-wire was inserted smoothly in rostral direction. A subclavian catheter with dilator was inserted through the J-wire, and the dilator was then removed. 6.The catheter of Port-A was threaded into the subclavian vein until mark 20 cm. The catheter was adapted into the port and locked with restrictor.The Port was inserted into the pouch of pre-cordial incision. 7.Skin was closed layer by layer. Both catheter and port were perfused with heparin solution after implantation. Operators 林至芃, Assistants 林文瑛, 手術日期：2009/09/09 20:53 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT 開立醫師: 曾峰毅 開立時間: 2009/09/09 20:53 Pre-operative Diagnosis Left middle fossa base tumor Post-operative Diagnosis ditto Operative Method Left pterional approach for tumor excision Pathology pending Operative Findings One intradural mass lesion, up to 4.6cm in its greatest diameter, was located at left middle fosaa, soft to elastic in character, with extradural extension, about 1.5cm, into foramen ovale. Foramen ovale was enlarged. Dura thickening was noted at temporal base, the border between the tumor and the normal brain parenchyma was not clear. Operative Procedures Under endotracheal general anaesthesia, tha patient was put in supine position with head rotated to right and fixed by Mayfield skull clamp. After skin preparation, we made one curvilinear skin incision at left frontal area. One 6x8cm craniotomy window as then created after 3 burr holes. We incised the dura, and retracted the temporal lobe away from the skull base. Tumor was removed with bipolar cauterization and tumor forceps, and the tumor extended to extradural into foramen ovale. That part of tumor was removed as well. After hemostasis, duroplasty was done with Duroform and 3-0 prolene suture in water-tight fashion. Bone graft was put back and fixed with mini-plates after central tenting and one epidural CWV set. The wound was closed in layers. Operators 蔡瑞章 Assistants 曾峰毅, 陳盈志 手術日期：2009/09/10 10:49 摘要__ 手術科部: 外科部 套用罐頭: Permcath/port-A 開立醫師: 謝永 開立時間: 2009/09/10 10:49 Pre-operative Diagnosis PA tumor Post-operative Diagnosis s/p port-A insertion Operative Method port-A implantation via right internal jugular vein Specimen Source and Count nil Pathology nil Operative Findings 1. The port-A catheter was inserted via right internal jugular vein by echo-guided procedure 2. Patent flow after implantation 3. Tip position located at RA/SVC junction Operative Procedures -Anesthesia: local anesthesia, the patient was put on supine position. The operation field was disinfected and draped as usual. -Port-A: After skin disinfection and drapping & local anesthesia, echo-guided RIJV catheterization was performed. Creation of the subcutaneous pocket at right subclavicular area. Tunneliztion, advanced the catheter into the RIJV via the peel-away sheath smoothly. Ensure the catheter tip position by portable CXR. Wound closure in layers after adequate hemostasis. Operators 王水深, Assistants 謝永, 手術日期：2009/09/18 10:02 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Esophageal cancer. Post-operative Diagnosis ditto. Operative Method port-A insertion Pathology nil. Operative Findings Port-A tip over SVC. Operative Procedures 1.LA. 2.Cut down over Rt shoulder and identify cephalic vein. 3.Port-A was inserted and CxR check-up. 4.Wound closure. Operators 李元麒 Assistants 李佳穎 手術日期：2009/09/19 23:49 摘要__ 手術科部: 外科部 套用罐頭: Right frontal keyhole craniotomy for excision... 開立醫師: 鍾文桂 開立時間: 2009/09/19 23:49 Pre-operative Diagnosis Right frontal tumor, suspect lymphoma. Post-operative Diagnosis Right frontal tumor, suspect lymphoma. Operative Method Right frontal keyhole craniotomy for excisional biopsy. Pathology Frozen pathology: inflammatory change with lymphocytic infiltration. Operative Findings Some yellowish gray abnomal brain tissue were removed and sent for frozen pathology three times. Steroid was used for one week before holding it 3 days prior to operation. Operative Procedures Under ETGA, the patient was put in supine position and the head was tilted 10 degrees to the left. A linear 8-cm incision was done just above the right eyebrow. Two burr holes were done at right keyhole and its opposite position. After making a 3x3 cm craniotomy, the dura was tented and incised. A small corticotomy was done at the measured tumor location. Biopsy of the grossly abnormal brain tissue was done with tumor forceps. Frozen pathology revealed either normal brain tissue( the first two attemps. Due to negative findings, another corticotomy was made. Frozen biopsy revealed inflammatory changes with lymphocytic infiltration. Then, the corticotomy surface was covered by surgicel. After tenting the dura in water-tight fashion, the bone plate was fixed with screws and plates. After wound closure, the patient was sent to ICU smoothly. Operators V.S. 賴達明 Assistants R6李建勳R4鍾文桂 手術日期：2009/09/19 22:43 摘要__ 手術科部: 外科部 套用罐頭: Craniectomy and debridement. 開立醫師: 鍾文桂 開立時間: 2009/09/19 22:43 Pre-operative Diagnosis Skull bone osteomyelitis and scalp abscess formation at left frontal-parietal-temporal areas. Head injury with left F-T-P acute SDH s/p craniotomy. Post-operative Diagnosis Ditto. Operative Method Craniectomy and debridement. Pathology Nil. Operative Findings Fragments of bone plates due to infective erosion were removed totally. Operative Procedures Under general anesthesia, the patient was put in supine position and the head was tilted to the right side. After well disinfection and draping, the previous operative wound was reopened. The plates and screws for skull fixation were removed one by one. Some granulation tissues were noted around the fragmented bone plates. After lysis of the adhesion, the fragments were removed totally. Aggressive irrigation and debridement were done for the infected area. The dura mater remained intact during the procedure. After placing two CWV drains and hemostasis, the wound was closed in layers. The patient was sent to ICU smoothly. Operators V.S. 王國川 Assistants R6李建勳R4鍾文桂 手術日期：2009/09/20 06:26 摘要__ 手術科部: 外科部 套用罐頭: Permcath/port-A 開立醫師: 謝永 開立時間: 2009/09/20 06:26 Pre-operative Diagnosis Lung cancer Post-operative Diagnosis s/p port-A insertion Operative Method Port-A implantation via right internal jugular vein Specimen Source and Count nil Pathology nil Operative Findings 1. The port-A catheter was inserted via right internal jugular vein by puncture procedure 2. Patent flow after implantation 3. Tip position located at RA/SVC junction Operative Procedures -Anesthesia: local anesthesia, the patient was put on supine position. The operation field was disinfected and draped as usual. -Port-A: After skin disinfection and drapping & local anesthesia, RIJV puncture and catheterization was performed. Creation of the subcutaneous pocket at right subclavicular area. Tunneliztion, advanced the catheter into the RIJV via the peel-away sheath smoothly. Ensure the catheter tip position by portable CXR. Wound closure in layers after adequate hemostasis. Operators 王水深, Assistants 謝永, 手術日期：2009/09/22 10:58 摘要__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 陳政維 開立時間: 2009/09/22 10:58 Pre-operative Diagnosis Acute subdural hemorrhage Post-operative Diagnosis Ditto Operative Method Craniectomy and ICP monitor insertion Specimen Source and Count Nil Pathology Nil Operative Findings 1. Brain swelling, machine oil like blood was draining from subdural space. 2. The post operative ICP was around 1-2mmHg. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 4 cm at anterior-lower temporal area, the skin edge was clipped by Raney clips for temporary hemostasis. The temporalis muscles was incised down to the tempoal squama which was exposed then by applying a self retaining retractor on the muscle. 5. A burr hole was made and the dura was incised for evacuating part of the subdural hematoma, therefore the IICP could be relieved earlier. 6. The incision was extended to a temporal horseshoe, and the temporalis muscle was detached from temporal squama by rasp subsequently. 7. Craniotomy window: 10x10 cm, created by making 4 burr holes then cut by power saw. 8. Dural tenting: by 2/0 silk, 4cm in interval, distributed along the edge of skull window. 9. Dural incision: crusade fahion (curvilinear along the edge of skull window) 10.The subdural clot was removed by sucker and those located beyound the cranial window was washed out by saline irrigation through a Nelaton tube introduced into subdural space. (Because of severe brain swelling, once the dura had been opened for an 1 inch distance and subdural clot cleaned, it was immediatedly covered by anchoring the dural graft on the opening to prevent the fungating of the brain through the dural opening. The procedure of opening the dura and dural graft was advanced in an alternate fashion until the horese shoe shaped dura incision had been completedly closed.) 11.Hemosatasis: the bleeders was stopped by Bovie and oozing surface was covered with gelfoam. 12.Place ICP monitor at subdural space 13.Dural closure:was closed with a piece of dural graft taking from temporalis fascia.(crescent shape 15 cm long, 15 cm wide) along the whole length of the duralincision in order to create an additional space for the swollen brain. 14.Scalp closure: hemostasis was done with monopolar coagulatortouching on the sucker tip. Galea suture was performed by continuous suture with 3/0 Dexon and skin by continuous suture with 3/0 nylon. 15.Drain: one, epidural, collected in a surgeons glove. 16.Blood transfusion: 1U pRBC 17.Course of the surgery: smooth. Operators VS.郭夢菲 Assistants R5 胡朝凱 R2 陳政維 手術日期：2009/09/24 11:50 摘要__ 手術科部: 泌尿部 套用罐頭: Laparoscopic pyeloplasty 開立醫師: 蔡博超 開立時間: 2009/09/24 11:50 Pre-operative Diagnosis Left UPJ obstruction Post-operative Diagnosis Left UPJ stricture Operative Method Laparoscopic ureterolysis and left ureterorenoscopy with double J catheter insertion Specimen Source and Count nil Pathology nil Operative Findings Grossly no obstruction of left UPJ after peri-ureteral tissue dissection; Left UPJ stricture on ureterorenoscopy; Left DBJ insertion under optic guidance Operative Procedures Under satisfactory endotracheal anesthesia with right decubitus position. Disinfection and pepped as usual. Creat cemera port(10mm)on left periumbilical region with aid of Visiport and pneumoperitoneum. Creat 5mm and 10mm working port on midclavicular line with aid of optic guidance and Versastep. Mobilized the descending colon and identified the low pole of left kidney. Identified the renal pelvis and left upper ureter. Dissection of the periureteral tissue. Grossly no obstruction of left UPJ was noted after complete and mobilized the left upper ureter and renal pelvis. After discussion with family, pyeloplasty was held. Adequate hemostasis was achieved and closed the wound in layers. Change patient position to lithotomy Disinfection and pepped. Cystoscopy with left ureter guidewire cannulization was performed. Left ureteroscopy was performed and left UPJ stricture was noted. Direct dilation of left UPJ was performed. A Fr7 22cm DBJ was inserted and a Fr16 Foley was inserted. Patient tolerated the procedure and was sent to POR. The estimated blood loss was minimal. The count of gauze and needle was correct. There was no specimen. Operators 黃國皓, Assistants 蔡博超, 洪佳宏, 手術日期：2009/09/28 17:45 摘要__ 手術科部: 外科部 套用罐頭: Cadaveric RTx 開立醫師: 吳經閔 開立時間: 2009/09/28 17:45 Pre-operative Diagnosis CRI Post-operative Diagnosis Ditto Operative Method Cadaveric RTx Specimen Source and Count 1 Pathology 1 pending Operative Findings 1. Warm ischemic time : till 16:05 2. One renal artery and one renal vein of graft Operative Procedures 1. ETGA 2. Supine position and disinfection 3. RLQ curved skin incision 4. Identify peritoneum 5. Explore iliac vessels 6. Do end-to-end anastomosis between renal artery and internal iliac artery after ligation of distal iliac artery; do end-to-side anastomosis between renal vein and ext iliac vein 7. N/S irrigation and insert one R/D 8. Close wound in layers Operators 蔡孟昆 Assistants 吳經閔 手術日期：2009/09/28 11:48 摘要__ 手術科部: 外科部 套用罐頭: Htx Pre-operative Diagnosis Dilated cardiomyopathy with end-stage renal disease Post-operative Diagnosis Ditto Operative Method Orthotopic cardiac transplantation Pathology Pending Operative Findings 1. Poor heart contractility(recipient heart): EF by TEE: 10% 2. Dilated four chamber 3. Ischemic time: 78mins Operative Procedures Under ETGA, the patient was put in supine position. Perform midline sternotomy. Cannulation: V: IVC and RA, A: AsAo, on CPB, cooling to 30 degree Celsus. AXC, antegrade cardioplegia. Incise the patient heart. Anastomosis of LA cuff and PA, then rewarm. Anastomosis of AsAo, deair from Bungus needle. Anastomosis of RA cuff. Wean off CPB. Hemostasis and set pacemaker wire. Set 2 chest tube. Close the pericardium and then the wound in layers. The patient was proceeded to renal transplantation. Operators 王水深,紀乃新 Assistants 林明賢,周恒文 手術日期：2009/09/29 19:09 摘要__ 手術科部: 外科部 套用罐頭: C4-6 laminoplasty (open door) 開立醫師: 覃紹殷 開立時間: 2009/09/29 19:09 Pre-operative Diagnosis C4-6 stenosis Post-operative Diagnosis Ditto Operative Method C4-6 laminoplasty (open door) Specimen Source and Count nil Pathology nil Operative Findings The right side lamina was opened for decompression. The thecal sac was well expanded. C5-6 spinous processes were used as graft. Calcified ligamentum was also noted. Operative Procedures Under ETGA, the patient was placed in prone position and head fixed with Mayfield. A midline incision, about 12cm in length, was made at posterior neck. The incision was made deep into nuchal ligament and bilateral paraspinal muscles were splited. C3-6 spinous processes and laminae were exposed. High speed drill was used over bilateral lamina over C4-6. Left lamina was used as greenstick to elevate right side lamina. Spur and ligamentum flavum were removed using Kerrison. C5-6 spinous processes were cut down and used as graft. We fixed the graft with lamina and right lateral mass with miniplates*3. After hemostasis, a CWV drain was set. The wound was then closed in layers. Operators 陳敞牧 Assistants R5陳睿生,R1覃紹殷 手術日期：2009/09/30 12:42 摘要__ 手術科部: 外科部 套用罐頭: Left partial mastectomy 開立醫師: 雷秋文 開立時間: 2009/09/30 12:42 Pre-operative Diagnosis Left breast microcalcification Post-operative Diagnosis Ditto Operative Method Left partial mastectomy Pathology pending Operative Findings a needle locate at 3 oclock, 1 cm away from left nipple Operative Procedures 1. IVIG and supine position 2. Skin disinfection and skin incision 3. Do partial mastectomy, send specimen to x-ray room 4. Check bleeder, hemostasis and close wound in layers Operators 張金堅，郭文宏 Assistants 雷秋文 手術日期：2009/09/30 13:30 摘要__ 手術科部: 泌尿部 套用罐頭: cystoscopy（biopsy ) Pre-operative Diagnosis R/O bladder tumor Post-operative Diagnosis same Operative Method cystoscopy and biopsy Pathology pending Operative Findings 1.No gross tumor was noted 2.2 uneven mucosa was noted over left lat. wall r/o recurrence 3.erythematous engorged vein over trigone 4.trabeculation, moderate Operative Procedures Under satisfactory anesthesia with the patient in lithotomy position, prepping and drapping was performed in the usual sterile fashion. A Fr 21 Olympus cystoscope was introduced into the bladder cavity under direct vision. Careful inspection revealed theLt hemitrigone and Lt ureteral orifice was normal. Cup biopsies were obtained from some suspicious areas. A Fr 16 Foley catheter was inserted. Patient tolerated the procedure very well and was sent to recovery room in satisfactory condition. Operators 黃昭淵 Assistants 伍嘉偉 手術日期：2009/10/02 17:41 摘要__ 手術科部: 外科部 套用罐頭: VATs LLL wedge resection + VATs RUL wedge res... 開立醫師: 曾偉倫 開立時間: 2009/10/02 17:41 Pre-operative Diagnosis Colon cancer with bilateral lung metastasis Post-operative Diagnosis Colon cancer with bilateral lung metastasis Operative Method VATs LLL wedge resection + VATs RUL wedge resection+ VATs RML lobectomy Specimen Source and Count 4 pieces About size:2x1xx1 Source:RUL wedge resection About size:2x1xx1 Source:RUL Margin About size:3x2xx2 Source:LLL wedge resection About size:8x6x3 Source:RML Pathology Pending Operative Findings 1. A 1cm soft irregular shape hypercellularity tumor at LLL 2. A 2cm irregular shape whitish hypercellularity tumor, located at RML with pleural retraction 3. A 1cm, irregular, whitish, soft, hypercellularity tumor, located at RUL 4. The right chest cavity was adhesive Operative Procedures 1. DLETGA, patient put on right decubitus position then skin disinfection 2. VATs ports set as previous port setting 3. LLL wedge resection x1 4. Place one 28 fr. C/T then close wound layer by layer 5. Left decubitus position, skin disinfection 6. VATs ports set as previous port setting 7. Adhesionlysis 8. RUL wedge resection 9. Seperate the fissure with endo-GIA 10. Loop the RML PV, divided it with double ligation, suture ligation and endo-clips 11. Loop the RML bronchus then divide it with endo-GIA 12. Loop the RML PA (2 branches) the divide it with endo-GIA 13. VATs RML lobectomy with endo-GIA (divide the right minor fissure) 14. Hemostasis, repair the air leakage site with prolene 3-0 continous suture 15. Place once 28 fr. C/T 16. Close wound layer by layer Operators VS 李章銘 Assistants R林孟暐、R曾偉倫 手術日期：2009/10/04 11:45 摘要__ 手術科部: 外科部 套用罐頭: Stripe craniectomy and skull remodeling for c... 開立醫師: 鍾文桂 開立時間: 2009/10/04 11:45 Pre-operative Diagnosis Craniosynostosis. Post-operative Diagnosis Craniosynostosis. Operative Method Stripe craniectomy and skull remodeling for craniosynostosis. Pathology Nil. Operative Findings Fused sagital suture and narrowed labdoid suture. Moderate dural adhesion with skull bone at inion. The shape of the skull was less longitudial and more rounded after the operation. Operative Procedures Under general anesthesia, the patient was put in supine position and the head was put in horseshoe-shape headset. After shaving,disinfection, and draping, the anterior and posterior fontanelles were marked out with bicoronal zigzag incision. After dissection of the subgaleal plane, a 6 x 10 cm rectangular -shape craniectomy was done with high speed drills. The borders are 3 cm lateral to sagital suture bilaterally, posterior margin of anterior fontanelle, and anterior margin of posterior fontanelle. Additional craniectomy was done by Karrison punch at inion and proximal part of labdoid suture. Then, additional three triangular 手術日期：2009/10/05 01:31 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis lung cancer Post-operative Diagnosis ditto. Operative Method Port-A removal. Pathology nil. Operative Findings Port-A over Rt shoulder. Operative Procedures 1.LA. 2.Skin incision along old wound. 3.Remove port-A and wound cloure. Operators 張金池 Assistants 李佳穎 手術日期：2009/10/05 17:45 摘要__ 手術科部: 外科部 套用罐頭: Right hemi 開立醫師: 林昊諭 開立時間: 2009/10/05 17:45 Pre-operative Diagnosis Colon tumor Post-operative Diagnosis Colon tumor Operative Method Right hemicolectomy Pathology pending Operative Findings 1. A 2cm, fungating tumor was noted at proximal T-colon 2. Serosa involvement (-). 3. Ascites (-). 4. Regional lymph nodes (+). Operative Procedures 1. Under general anesthesia, the patient was placed in supine position. The skin was disinfected with alcohol better-iodine from the level of symphysis pubis to nipple area. 2. Port-site set up as shown 3. The ascending colon was mobilized by dividing its peritoneal attachments upwards toward the hepatic flexure. 4. The underlying right ureter and gonadal vessels were kept posteriorly in the retroperitoneum. 5. By applying gently anterior retraction on the mobilized right colon, the surgeon exposes the duodenum, which was left unharmed in the retroperitoneum by dividing any remaining tissue tethering the colon to the retroperitoneum. 6. Adhesion between colon and gallbladder were divided under direct view. 7. The gastrocolic ligaments were divided between clamps with preservation of the gastroepiploic vessels along the greater curvature of the stomach. 8. The right branch of middle colic artery was identified and ligated. 9. The right colic artery and ileocolic vessels were identified and ligated. 10. The mesentery of right half of the T-colon, ascending colon and terminal ileum were incised piece by piece. 11. The terminal ileum was transected at 10 cm proximal to the ileocecal junction. 12. Ileocolic end-to-end anastomosis was done byautosuture13. One rubber drain was indwelled at subhepatic area. 14. The wound was closed by layers. Operators 梁金銅, Assistants 黃彥鈞, 手術日期：2009/10/07 17:56 摘要__ 手術科部: 外科部 套用罐頭: Open cholecystitis 開立醫師: 楊惠馨 開立時間: 2009/10/07 17:56 Pre-operative Diagnosis Gallbladder stone with acute cholecystits and Mirrizzi syndrome Post-operative Diagnosis Gallbladder stone with acute cholecystits and Mirrizzi syndrome Operative Method Open cholecystitis Specimen Source and Count 1. gallbladder Pathology pending Operative Findings 1. Severely inflammatory change of gallbladder wall with gangrene change 2. One about 1cm indiameter atone in Hartmann pouch with compression to common bile duct was noted Operative Procedures 1. ETGA, supine 2. Make a right subcostal incision 3. Adhesiolysis 4. Dissect the gallbladder from liver bed 5. Transect the cystic duct and vessel 6. Hemostasis 7. Set one R/D in right subhepatic area 8. Close the wound in layers Operators VS田郁文 Assistants R5陳建嘉 R2楊惠馨 手術日期：2009/10/07 16:10 摘要__ 手術科部: 外科部 套用罐頭: perianal abscess 開立醫師: 陳柏誠 開立時間: 2009/10/07 16:10 Pre-operative Diagnosis anal cancer Post-operative Diagnosis anal cancer Operative Method tumor excision Specimen Source and Count 1.anal cancer Operative Findings 1.anal cancer at posterior anal internal spincter s/p tumor wide excision Operative Procedures 1.spinal anethesia,prepping and drapping,prone postion. 2.dilate the anus and see the tumor at posterior side near internal spincter (6 oclcok). 3.tumor excision was done 4.hemostasis 5.plug iodine guaze in anus 6.por Operators 梁金銅 Assistants 陳柏誠 郭金琳 (F,1963/08/27,48y6m) 手術日期 2009/10/08 手術主治醫師 廖漢文 手術區域 東址 000房 號 診斷 CVD (Cerebrovascular Diseases) 器械術式 Other RAD exam/intervention 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 3 時間資訊 00:00 臨時手術NPO 08:30 麻醉開始 08:40 誘導結束 11:15 麻醉結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 許輪 (M,1956/04/25,55y10m) 手術日期 2009/10/09 手術主治醫師 何子昌 手術區域 東址 010房 04號 診斷 Proliferative diabetic retinopathy (PDR) 器械術式 P.P.V.- simple 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 劉耀臨, 時間資訊 12:10 報到 12:30 進入手術室 12:50 手術開始 14:00 手術結束 14:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 矽油排除術 1 2 L 手術 眼前房血塊清除 1 1 L 手術日期：2009/10/12 15:34 摘要__ 手術科部: 外科部 套用罐頭: debridement 開立醫師: 李維棠 開立時間: 2009/10/12 15:34 Pre-operative Diagnosis suspected epidural abscess Post-operative Diagnosis suspected epidural abscess Operative Method debridement Specimen Source and Count nil Pathology nil Operative Findings Some clear yellowish fluid was noted while wound opening. The OP scar was thicken. Operative Procedures 1. ETGA, supine position 2. Open previous operation wound at parietal region about 10 cm 3. Dissect the plain between dura and galeal 4. N/S irrigation 5. Set a CWV and close the wound Operators 王國川 Assistants 陳睿生 李維棠 手術日期：2009/10/15 17:17 摘要__ 手術科部: 婦產部 套用罐頭: LAVH 開立醫師: 陳芊 開立時間: 2009/10/15 17:17 Pre-operative Diagnosis Myoma uteri Post-operative Diagnosis Myoma uteri Operative Method Laparoscopic assisted vaginal hysterectomy Specimen Source and Count 1 piece Source:Uterus Pathology pending Operative Findings 1. Uterus: hypertrophic and disfigured due to multiple uterine myomata. M1= 6x6x6cm, intramural typr, at fundus. M2= 4x4x4cm, subserosal type, at posterior uterine wall. M3= 3x3x3cm, intraligamental type, at left broad ligament. M4= 2x2x2cm, intramural type, at anterior uterine wall. M5= 2x2x2cm, intramural type, at posterioe uterine wall. There are still several myoma aroudn 1-2cm. 2. Adnexae: grossly normal 3. Cul-de-sac: free 4. Total weight of uterus: 1012gm EBL: 800 ml; BT: pRBC:4U; Cx: nil. Operative Procedures 1. Put the patient on lithotomy position and vaginal douching. 2. Skin disinfection and draping 3. Insert uterine elevator and on Foley 4. Make a 1cm skin incision below the umbilicus 5. Insert Varess needle and make pneumoperitoneum 6. Insert 10 mmtrocar and laparoscopy 7. Insert 2nd (10mm), 3rd (5mm), and 4th (5mm) trocar under laparoscopic inspection 8. Injection diluted Pitressin (1:100) into utero-vesical fold and bilateral broad ligament 9. Cut off bilateral round ligaments via electrocauterization 10.Cut off bilateral ovarian ligaments and fallopian tubes via electrocauterization 11. Dissect and ligate bilateral uterine artery with 1-0 Vicryl 12. Dissect and cut off serosa over utero-vesical and utero-rectal fold 13. Submucosal injection of diluted Pitressin (1:100) around the cervix 14. Make incision on the anterior vaginal mucosa and circumcision the cervix. 15. Enter the vesico-cervical space and utero-rectal space with long Kelly. 16. Clamp, cut and suture ligate bilateral utero-sacral ligaments with 1-0 Vicryl 17. Open the peritoneal cavity, anteriorly and posteriorly. 18. Clamp, cut and suture ligate bilateral cardinal ligaments with 1-0 Vicryl 19. Cut the uterus through midline with scissors 20. Morceration of the uterus 21. Clamp,cut and suture ligate bilateral ovarian ligaments and remove the uterus 22. Reperitonealization and approximate the vaginal stump. 23. Check bleeding and hemostasis under laparoscopy 24. Remove trocar and repair skin with 3-0 Vicryl. Operators 許博欽, Assistants 陳芊, 手術日期：2009/10/15 23:19 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for tumor removal 開立醫師: 楊惠馨 開立時間: 2009/10/15 23:19 Pre-operative Diagnosis Right frontal tumor with diffuse swelling Post-operative Diagnosis Right frontal tumor with diffuse swelling Operative Method Craniotomy for tumor removal Specimen Source and Count 1 piece, brain tumor Pathology pending Operative Findings The tumor located at posteior frintal gyrus and it was whitish, translucent in appearance. Gliotic change was noted and poor margined tumor was impressed. Some cystic component was noted inside and high grade glioma was first impression. Diffuse brain swelling was noted and the sylvian fissue was pushed downward by the tumor. Operative Procedures 1.ETGA, supine with head left turn 2.Right F-T curvillinear scalp incision 3.Create 5 burr holes and an about 15*15 cm craniotomy window was made. 4.Dura tenting via the window margin 5.The tumor margin was dissected from normal brain parenchyma and then the tumor was removed under microscope assist 6.Hemostasis with surgicel 7.Tightly dura repair with fascia graft 8.Fix back skull graft with miniplates*3 and central tenting 9.Set a subgaleal CWV 10.Close the wound in layers Operators VS王國川 Assistants R5陳睿生 R2楊惠馨 手術日期：2009/10/15 14:38 摘要__ 手術科部: 麻醉部 套用罐頭: Port-A remove, GA 開立醫師: 王憶嘉 開立時間: 2009/10/15 14:38 Pre-operative Diagnosis COLON CA Post-operative Diagnosis Ditto Operative Method Removal of Port-A Pathology Nil Operative Findings Tip culture x 1 Operative Procedures 1.Under IVGA and local anesthesia, skin incision was made along the previous incision site. 2.Uncovered the Port-A, and then removed it. 3.Wash the pouch with normal saline. 4.Subcutaneous and skin suture. Operators 林峰盛, Assistants 王憶嘉, 手術日期：2009/10/18 17:54 摘要__ 手術科部: 骨科部 套用罐頭: Other 開立醫師: 陳勇璋 開立時間: 2009/10/18 17:54 Pre-operative Diagnosis bone tumor, left femoral neck Post-operative Diagnosis bone tumor, left femoral neck Operative Method incision biopsy Specimen Source and Count 1 piece About size:0.2*0.2 cm Source:bone tumor Pathology pending Operative Findings a regional fragile cortex at the subcapital area meal-colored tissue in the femroal neck Operative Procedures 1. Spinal anesthesia, right lateral decubitus position 2. Skin disinfected and draped 3. SKin incision at left hip 4. Anteriorly approach the hip joint 5. Create a window the femoral subcapital area 6. Collect tumor tissue 7. Hemostasis and irrigation 8. Close the wound Operators 楊榮森, Assistants 陳勇璋, 簡裕明, 手術日期：2009/10/18 08:36 摘要__ 手術科部: 外科部 套用罐頭: mediastinal LN biopsy 開立醫師: 郝政鴻 開立時間: 2009/10/18 08:36 Pre-operative Diagnosis RUL NSCLC Post-operative Diagnosis Ditto Operative Method mediastinal LN biopsy Specimen Source and Count 2 piece About size:1 cm Source:group 2, 3 LN Pathology Pending Operative Findings mediastinal LN(+) at pretrachea and paratrachea area. Easily touch bleeding Operative Procedures ETGA Make a 3 cm circular skin incision at neck Mediastinal biopsy Hemostasis and wound closed in layers Operators 陳晉興 Assistants 林孟暐 郝政鴻 手術日期：2009/10/21 21:00 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Left frontotemporal ICH Post-operative Diagnosis Ditto Operative Method Craniectomy, ICH evacuation and duroplasty Pathology Pending Operative Findings The brain was swelling and tense before hematoma evacuation. The hematoma was about 30 c.c. reddish, dense with one suspecious bleeder, which was coagulated. The duroplasty was done with pericranium and the skull plate was preserved in NS bone bank. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position with head turned to right. The scalp was scrubbed, disinfected with alcohol B-I then draped. The sclap was opened along previuos wound and removed the skull plate. The durawas opened and the hematoma was located with intraoperative sonography. Hematoma evacuation was perforemd via corticotomy with tumor forceps and suction. One suspected beeder was coagulated with bipolar cauterizer. The duroplasty was performed with pericranium and 4-0 Prolene sutures. The skull plate was preserved in NS bone bank. The wound was closed in layers after one subgaleal CWV set. Operators 杜永光 Assistants 李建勳,李振豪 手術日期：2009/10/21 09:30 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT Pre-operative Diagnosis Left temporal tumor suspect low grade glioma Post-operative Diagnosis Ditto, suspect high grade glioma Operative Method Left pterional approach craniotomy for tumor excision Pathology Pending Operative Findings The patient was irritable at the time wake up from the general anesthesia and unable to cooperated with language testing, so the awake surgery was aborted. The tumor was red-yellowish, elastic, located at left superior temporal and inferior frontal gyrus,with Sylvian fissure pushed upward. The tumor was highly vasculized. The brain was bulging during closure of the dura. Operative Procedures Under general anesthesia and mask oxygenation, the patient was put in supine position with head fixed with Mayfield skull clump. The stereostatic device was set up before draping. The scalp was shaved, scrubbed, disinfected with alcohol B-I then draped. The scalp incision was made in traumatic flap fashion after local anesthesia with Xylocaine. The frontotemporal craniotomy was made as usual pterional approach with occipital extension. The dura was opened after tenting along the craniotomy window. The general anesthesia was stopped to awake the patient. However, the patient showed irritable motion and unable to cooperate. The general anesthesia was started again. The tumor excision was made with bipolar coagulation, CUSA and tumor forceps. The hemostasiswas coagulated, soaked with H2O2 and packing with surgicel lining. The dura was closed with 4-0 Prolene sutures. The skull plate was fixed back with miniplates and screws. The wound was closed in layers after one epidural CWV drain set up. Operators 杜永光 Assistants 李建勳,李振豪 手術日期：2009/10/21 23:04 摘要__ 手術科部: 外科部 套用罐頭: EC-IC bypass, right superficial temporal arte... 開立醫師: 鍾文桂 開立時間: 2009/10/21 23:04 Pre-operative Diagnosis Moyamoya disease. Post-operative Diagnosis Moyamoya disease. Operative Method EC-IC bypass, right superficial temporal artery- MCA. Specimen Source and Count 1 piece About size: Source: Pathology Nil. Operative Findings Right frontal branch of superficial temporal artery to right M4 branch of middle cerebral artery. Patent bypass. Operative Procedures Under ETGA, the patient was put in supine position. The head was tilted to the left and fixed with Mayfield. The superficial temporal artery pathway was marked out by Duplex ultrasound. Then, the operative area was disinfected and draped. A 10-cm linear incision was made at pre-auricular area. The frontal branch of right superficial temporal artery was dissected from the surrounding soft tissue meticulously. The galea flap remained attaching to the vessel. Then, the dissected artery was resected from its distal part and clipped with a tempoary clip after vessel heparinization. The temporalis muscle was dissected. A 3-cm craniotomy was made. After dural tenting and incision, the arachnoid mater was incised to exposed the underlying vessels. The right M4 branch of middle cerebral artery was applied with temporary clips. The two arteries were prepared for anastomosis. End-to-side anastomosis was done smoothly. The patency was checked with temporary occlusion at each end. The bone plate was trimed to allow smooth flow of the anastomosis. The bone plate was fixed with plates and screws. The wound was closed in layers. The patient was sent to ICU smoothly. Operators V.S. 王國川 Assistants R4 鍾文桂 R4 鍾文桂 ,R1 李維棠 手術日期：2009/10/22 14:12 摘要__ 手術科部: 外科部 套用罐頭: VATS RUL lobectomy 開立醫師: 李佳穎 開立時間: 2009/10/22 14:12 Pre-operative Diagnosis Bladder ca. with lung mets Post-operative Diagnosis Bladder ca. with lung mets Operative Method VATS RUL lobectomy Specimen Source and Count 2 pieces About size:RUL about 15*8cm Source:RUL of lung About size:0.5*0.5cm *2 Source:LN, Gr.11 Pathology nil Operative Findings 1. 2*1.3cm, 1*0.8cm whitish hypercellular tumors over RUL 2.Two blackish nodules over RUL r/o anthracotic LN 3.Enlarged of interlobar LN and adhesive to pulmonary artery. Operative Procedures 7.Dissect of inferior pulmonary ligment 1.ETGA with blocker, left decubitus 2.VATS port setting 3.Identify of RUL pulmonary vein and devide by endo GIA 4.Identify of RUL pulmonary artery and devide by endo GIA 5.Identify of RUL bronchus and devide by endo GIA 6.Gr11 LN dissection 7.Dissect of inferior pulmonary 8.Check airleak and bleeding 9.Set 28Fr chest tube*1 10.Close wound Operators VS陳晉興,VS徐紹勳 Assistants R5張彥俊,Ri方怡婷 手術日期：2009/10/26 08:24 摘要__ 手術科部: 外科部 套用罐頭: IPG implantation 開立醫師: 李維棠 開立時間: 2009/10/26 08:24 Pre-operative Diagnosis Parkinsonism Post-operative Diagnosis Parkinsonism Operative Method IPG implantation Specimen Source and Count Nil Pathology Nil Operative Findings IPG was implanted and test function was intact Operative Procedures 1. ETGA and supine position 2. Left pariental incision identify previously placed electrode 3. Subcutaneous tunnel performed 4. Left subclavian pocket performed then insert IPG 5. Test function: OK 6. Close wound in layers Operators V.S. 曾勝弘 Assistants R6陳盈志, R1李維棠 手術日期：2009/10/26 11:32 摘要__ 手術科部: 麻醉部 套用罐頭: Port-A implantation, subclavian 開立醫師: 陳逸加 開立時間: 2009/10/26 11:32 Pre-operative Diagnosis LUNG CA Post-operative Diagnosis Ditto Operative Method Port-A implantation, echo-guided Specimen Source and Count nil Pathology Nil Operative Findings 1.Site: right subclavian vein, with echo-guided procedure 2.Patent flow after implantation 3.Others: nil Operative Procedures 1.The patient was set on supine position and bilateral subclavian veins were checked by echo. 2.After IVGA and local anesthesia applied, transverse skin incision for 3cm was made at pre-cordial area. 3.Undermine the skin at the layer between subcutaneous tissue and deep fascia in lateral direction. 4.An IV catheter was inserted via the subclavian incision and negatively aspirated until venous blood attainable. 5.J-wire was inserted smoothly in rostral direction. A subclavian catheter with dilator was inserted through the J-wire, and the dilator was then removed. 6.The catheter of Port-A was threaded into the right subclavian vein until mark 21 cm. The catheter was adapted into the port and locked with restrictor.The Port was inserted into the pouch of pre-cordial incision. 7.Skin was closed layer by layer. Both catheter and port were perfused with heparin solution after implantation. Operators 詹偉弘, Assistants 王憶嘉, 手術日期：2009/10/27 10:16 摘要__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 梁嘉儀 開立時間: 2009/10/27 10:16 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Ditto Operative Method Tracheostomy Specimen Source and Count nil Pathology None Operative Findings Fr . 7 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators VS張金池 Assistants R4李佳穎,Int陳傑賀 手術日期：2009/10/27 16:44 摘要__ 手術科部: 外科部 套用罐頭: Cranioplasty 開立醫師: 楊士弘 開立時間: 2009/10/27 16:44 Pre-operative Diagnosis Craniosynostosis due to Crouzon syndrome Post-operative Diagnosis Craniosynostosis due to Crouzon syndrome Operative Method Cranioplasty Specimen Source and Count nil Pathology Nil Operative Findings After reconstruction of the parieto-occipital skull bone, there was a large epidural space (about 1 cm between dura and occipital bone) for future brain expansion. Decreased AP diameter of the skull was noted. The anterior fontanell was tense and wide opened. The sagittal and lambdoid sutures were fused. The parietal and occipital bone had many bony perforation, about 0.5 to 1.0 cm in diameter. The inner surface of the skull had many bony ridges. The dura mater was multi-nodular in appearance. The brain (covered with dura) gradually expanded posteriorly after removal of the skull plate. After reconstruction of the parieto-occipital skull bone, there was a large subdural space (about 1 cm between dura and occipital bone) for future brain expansion. Operative Procedures Under ETGA, the patient was placed in prone position with his frontal region supported by a gel pad. Bicoronal scalp incision was made, and the scalp flap was reflected posteroinferiorly until the inion was reached. The pericranium was dissected inferiorly as a separate layer. Four burr holes was made to facilitate craniotomy of the parietal and occipital skull as a whole piece, about 10 cm x 10 cm in diameter. The parietal bone was fasioned with a modified barrel stave technique to create a space posteriorly for the brain to expand. The skull flap was fixed to the craniotomy edges with silk stitches, with a bone wedge between the superior end of skull flap and the anterior craniotomy edge. A subgaleal drain was placed, and the wound closed in layers. Operators 楊士弘,郭夢菲 Assistants 陳德福 手術日期：2009/10/28 14:43 摘要__ 手術科部: 外科部 套用罐頭: cranioplasty 開立醫師: 陳德福 開立時間: 2009/10/28 14:43 Pre-operative Diagnosis Right traumatic SDH s/p decompressive craniectomy, right F-T-P cranial defect Right traumatic SDH s/p decompressive craniectomy, right F-T-P skull bone defect Post-operative Diagnosis ditto Operative Method cranioplasty Specimen Source and Count nil Pathology pending Operative Findings 4.New bone formation with bone island was found. 1.There is cranial vault defect over right frontal -temporal- parietal area and the craniectomy window was soft &mild; depressed before surgery. 2.There are several burr holes at right skull and 3 of them were at frontal and key holes area. 3.The skull was fixed with 2 wires and 4 microplates. 1.There is cranial vault defect over right frontal-temporal-parietal area and the craniectomy window was soft & mild depressed before surgery. 3.The skull was fixed with 2 wires and 4 sets of microplates. 4.New bone formation with bone island was found at right lower frotnal region. Operative Procedures Under ETGA and supine position, the scalp was disinfected and draped as usual. Incision along previous operation scar and exposure the epidural plane were done. The edege of cranil defect was identified followed by seperating the temporalis muscle. 3 cental dura tenting were done and the skull was fixed with miroplates and wires. One subgaleal CWV was left in situ and the wound was closed in layers. Under ETGA and supine position, the scalp was disinfected and draped as usual. Incision along previous operation scar and exposure the epidural plane were done. The edege of cranil defect was identified followed by seperating the temporalis muscle. Threee cental dural tenting were done and the skull was fixed with miroplates and wires. a piece of bone measuring about 1.5x1.5 cm in diameter was used to fiile the gap at the posterior margin of the skull plate. One subgaleal CWV was left in situ and the wound was closed in layers. Operators AP 郭夢菲 Assistants R4 陳德福 手術日期：2009/10/28 14:13 摘要__ 手術科部: 麻醉部 套用罐頭: Port-A implantation, subclavian 開立醫師: 王憶嘉 開立時間: 2009/10/28 14:13 Pre-operative Diagnosis lung ca Post-operative Diagnosis Ditto Operative Method Port-A implantation, echo-guided Pathology Nil Operative Findings 1.Site: right subclavian vein, with echo-guided procedure 2.Patent flow after implantation 3.Others: nil Operative Procedures 1.The patient was set on supine position and bilateral subclavian veins were checked by echo. 2.After IVGA and local anesthesia applied, transverse skin incision for 3cm was made at pre-cordial area. 3.Undermine the skin at the layer between subcutaneous tissue and deep fascia in lateral direction. 4.An IV catheter was inserted via the subclavian incision and negatively aspirated until venous blood attainable. 5.J-wire was inserted smoothly in rostral direction. A subclavian catheter with dilator was inserted through the J-wire, and the dilator was then removed. 6.The catheter of Port-A was threaded into the subclavian vein until mark 21 cm. The catheter was adapted into the port and locked with restrictor.The Port was inserted into the pouch of pre-cordial incision. 7.Skin was closed layer by layer. Both catheter and port were perfused with heparin solution after implantation. Operators 林至芃, Assistants 王憶嘉, 手術日期：2009/10/30 11:57 摘要__ 手術科部: 外科部 套用罐頭: VATs lymphnode dissection Gr 3,4,7 開立醫師: 曾偉倫 開立時間: 2009/10/30 11:57 Pre-operative Diagnosis Mediastinal LN enlargment, suspect lymphma Post-operative Diagnosis Mediastinal LN enlargment, suspect lymphma Operative Method VATs lymphnode dissection Gr 3,4,7 Specimen Source and Count 2 pieces About size:1x1x0.5 cm Source:Gr. 3,4 LN About size:0.5x0.5x0.3 cm Source:Gr. 7 LN Pathology Pending Operative Findings 1. Soft, blackish, lymphnode over Gr. 3,4,7 area Operative Procedures 4. Locate Gr. 3,4 LN the do dissection 5. Locate Gr. 7 LN then do dissection 6. Check bleeding 7. Place one 28 fr. chest tube 8. Close wound in layers 1. Under ETGA, patient was put on left decubitus position 2. Disinfected and drapped as usual 3. create 3 ports as VATs setting Operators VS 李章銘 Assistants R 張彥俊、 R 曾偉倫 手術日期：2009/11/03 12:06 摘要__ 手術科部: 外科部 套用罐頭: Anterior diskectomy and fusion with cage 開立醫師: 陳睿生 開立時間: 2009/11/03 12:06 Pre-operative Diagnosis Cervical HIVD, C4/5, 5/6 Post-operative Diagnosis Ditto Operative Method Anterior diskectomy and fusion with cage Specimen Source and Count nil Pathology Nil Operative Findings The C5/6 disk space was narrowing. After total diskectomy, the thecal sac was well-expanded. A 5mm Synthes cage was implanted. Operative Procedures 1. ETGA, spine with head extension 2. Right neck transverse incision, and incise into the plastyma muscle 3. Split the plane between SCM, trachea, and esophagus 4. Expose pre-vertebral space and C-arm localized C5/6 level 5. Set self-retractor and microdiskectomy was done with aligator, high speed drill and currette 6. Remove of PLL, spurs 7. Insert the cage for fusion 8. Hemostasis, set a mini-hemovac, and close the wound in layers Operators VS 賴達明 Assistants R5 陳睿生 手術日期：2009/11/04 17:45 摘要__ 手術科部: 外科部 套用罐頭: Head Injury Pre-operative Diagnosis Right frontotemporal traumatic SDH and SAH Post-operative Diagnosis Ditto Operative Method Craniectomy + subdural hematoma evacuation + duroplasty + ICP monitor insertion Pathology Nil Operative Findings The SAH gushed out while dura opening. The brain parenchyma was soft but decrease in pulsatile. Two bleeder was found during the operation. One was at frontal base and the other one was at temporal lobe. Duroplasty was done with fascia graft. The ICP monitor was at subdural space and the ICP after skin closure was 4-5mmHg. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine position with head turned to left. Traumatic flap scalp inciaion was made at right F-T-P area. The scalp flap was elevated and the temporalis muscle was dissected. Five burr holeswere created and one 15x20cm craniectomy was performed with high-speed drills. Dura tenting was performed along craniectomy window. The dura was opened in C-shape and subdural hematoma was removed. Right frontal base contusion was noted and partial frontal lobe lobectomy was performed for decompression. After hemostasis with Surgicel and bipolar electrocautery, duroplasty with fascia graft was done with subdural ICP monitor placement. The temporalis muscle was cut down for decompression. One CWV drain was set up and the wound was closed in layers. Operators 王國川 Assistants 陳睿生,李振豪 手術日期：2009/11/05 07:43 摘要__ 手術科部: 外科部 套用罐頭: EDH evacuation 開立醫師: 陳德福 開立時間: 2009/11/05 07:43 Pre-operative Diagnosis Traumatic brain injury with SDH and EDH Post-operative Diagnosis ditto Operative Method EDH evacuation Specimen Source and Count NIL Pathology nil Operative Findings The ICP before surgery was 28-30mmHg. There is 2.0cm in thickness EDH over craniecotmy window. Blood oozing from temporal skull base and temporalis muscle was noticed. We packed surgicelles into the skull base and cauterized the rough surface of temporalis muscle. Bone wax covering the skull edege was performed. After the procedure, the ICP was 6mmHg and 2 epidural CWV were left in situ. Operative Procedures Under ETGA and supine position, the scalp was disinfected and draped as usual. We opened the previous right scalp trauma flap and exposure the epidural space. The EDH was evacuated and some oozings were identified. We packed surgicelles into the temporal skull base and cauterized the temporalis muscle. Bone wax was used for bone oozing. After hemostasis, 2 epidural CWV were left in situ. The wound was closed in layers. Operators VS 王國川 Assistants R4 陳德福 R5陳睿生 手術日期：2009/11/09 15:13 摘要__ 手術科部: 外科部 套用罐頭: 1. Exploring Laparotomy 開立醫師: 陳建銘 開立時間: 2009/11/09 15:13 Pre-operative Diagnosis Gastric cancer Post-operative Diagnosis Gastric cancer Operative Method 1. Exploring Laparotomy 2. Feeding jejunostomy Specimen Source and Count 2 pieces About size:5x6 cm Source:Omentum About size:0.2cm Source:mesentary nodule r/o tumor seeding Pathology nil Operative Findings 1. Frozen abdomen 2. Omentum cake, multiple omentum and mesentary seeding, multiple lymph nodes over hepatoduodenal ligament 3. Severe adhesion from stomach body to pancreatic head Operative Procedures 1. ETGA, Supine position, skin sterilize 2. Midline Skin incision above umbilicus 3. Dissect through peritoneum and identify the stomach and omentum. 4. Transect one part of omentum for pathology 5. Mesentaric nodule dissection for pathology 6. Perform feeding jejunostomy 7. Hemostasis and wound closure in layers Operators VS林明燦 VS李柏居 Assistants CR柯柏瑞 Ri施清元 手術日期：2009/11/10 06:55 摘要__ 手術科部: 外科部 套用罐頭: DBS implantation 開立醫師: 陳盈志 開立時間: 2009/11/10 06:55 Pre-operative Diagnosis Parkinson disease Post-operative Diagnosis Ditto Operative Method DBS implantation Specimen Source and Count nil Pathology nil Operative Findings The DBS electrode was inserted to planned target. Right side 3 tracts was tested (2mm anterior and lateral to the planned tarted). Rigidity improved after stimulation. Head CT showed no significant hematoma Operative Procedures Under the general anesthesia with endotracheal tube intubation, the patient was set into supine position. Skin preparation was done and drapped with sterile drapping Entry point was identified by the navitation and marked with drill Transverse linear incision was done and Burr hole was made at marked entry point bilaterally Set up electrophysiology moniter system and the STN was identified bilaterally. The electrode was inserted to the target and then fixed. Hemostasis was done with bipolar The wound was closed in layer Operators 曾勝弘 Assistants 陳盈志 手術日期：2009/11/10 18:01 摘要__ 手術科部: 婦產部 套用罐頭: TVT 開立醫師: 張奕凱 開立時間: 2009/11/10 18:01 Pre-operative Diagnosis stress incontinence Post-operative Diagnosis ditto Operative Method Tension free vaginal tape suspension(TVT) Specimen Source and Count nil Pathology Nil Operative Findings cystocele Operative Procedures 1. Put the patient on lithotomy position 2. Douching, urine catheterization, disinfecting with beta-iodine and skin draping as usual 3. Inject normal saline into anterior vaginal submucosa and paravesicle space. 4. Make a vertical skin incision 1cm below the urethral orifice 5. Make a blind tunnel from the incision wound to reach retropubic space bilaterally 6. Apple catheter guide foley to avoid injury of urethra 7. Insert TVT into the blind tunnel to retropubic space bilaterally 8. Make two small skin incisions of 0.5 cm on lower abdominal area 9. Perform cystoscopy to check if any bladder injury. 9. Adjust the tension of the TVT according the urine leakage. 10. Remove the sheath of the TVT and cut the end of the TVT. 11. Repair the vaginal wall and lower abdominal wall. 12. Pack the vagina with two pieces of gauze and on Foley Operators 余宏政 Assistants 姜宜妮 手術日期：2009/11/10 07:04 摘要__ 手術科部: 外科部 套用罐頭: sublaminar decompression 開立醫師: 陳盈志 開立時間: 2009/11/10 07:04 Pre-operative Diagnosis L2-3 stenosis Post-operative Diagnosis Ditto Operative Method sublaminar decompression Specimen Source and Count nil Pathology nil Operative Findings Hypertrophic ligmentum flavum cause canal stenosis, previous L3 TPS was found Operative Procedures 1.ETGA, prone position and C-arm localize 2.Midline back incision 3.detach right paraspinal muscle expose L2,3 and previous TPS 4.L2 laminotomy with drill and then karrison punch 5.remove bilateral ligmentum flavum till root decompression 6.hemostasis 7.close wound in layers Operators 賴達明 Assistants 陳盈志 手術日期：2009/11/11 17:39 摘要__ 手術科部: 外科部 套用罐頭: Simpsons grade III tumor remove and skull bas... 開立醫師: 曾峰毅 開立時間: 2009/11/11 17:39 Pre-operative Diagnosis Frontal convexity meningioma, recurrent Post-operative Diagnosis Ditto Operative Method Simpsons grade III tumor remove and skull base reconstrcution Specimen Source and Count 1 piece About size: Source: Pathology Pending Operative Findings 1. The tumor occupied at bilateral frontal sunus and left side orbital ring was invased, too. We remove the tumor at ethmoid sinus, and the frontal base was reconstructed by plasty surgeon. 2. The tumor was whitish with some fibrotic portions. Some tumors adhered to the periorbital and intraorbital muscles Operative Procedures 1. ETGA, supine and head under neutral position 2. Scalp incision at bi-coronal pattern 3. Dissect the subcutaneous plane and remove of previous craniotomy bone graft. 4. Expose the tumor at bilateral frontal sinus, and remove the tumor with tumor forceps 5. Remove of residual left upper orbital ring 6.The intraorbitalportion of the tumor was removed. 7. The glabella and orbital ring were reconstructed with plates*2 by plasty surgeon 8. Hemostasis, central tented 9. Fix back the skull graft and cranioplasty with bone cement 10. Set a subgaleal CWV 11. Close the wound in layers Operators 曾勝弘 Assistants R5陳睿生 R1黃愉真 手術日期：2009/11/11 19:35 摘要__ 手術科部: 腫瘤醫學部 套用罐頭: Ommaya implantation, left kocher 開立醫師: 陳盈志 開立時間: 2009/11/11 19:35 Pre-operative Diagnosis Brain metastasis with CSF seeding Post-operative Diagnosis Ditto Operative Method Ommaya implantation, left kocher Specimen Source and Count nil Pathology nil Operative Findings The opening pressure was < 10cmH2o, 6.2cm ventricular reservoir Operative Procedures 1.ETGA, supine 2.left frontal curvilinear incision 3.Burr hole 4.ventricular tapping 5.Insert Ommaya reservoir 6.Hemostasis 7.close wound in layers Operators 蕭輔仁 Assistants 陳盈志 手術日期：2009/11/12 14:52 摘要__ 手術科部: 外科部 套用罐頭: 1. partial excision of the arachnoid cyst for... 開立醫師: 郭夢菲 開立時間: 2009/11/12 14:52 Pre-operative Diagnosis quadrigeminal cyst and poor brain compliance Quadrigeminal arachnoid cyst and poor brain compliance. Post-operative Diagnosis quadrigeminal cyst and poor brain compliance Quadrigeminal arachnoid cyst and poor brain compliance. Operative Method 1. partial excision of the arachnoid cyst for fenestration 2. cranioplasty to expand the intracranial volume Specimen Source and Count 1 piece About size:1X1 cm in diameter Source:arachnoid membrane Pathology nil Operative Findings 1. The occipital skull bone was markedly thickened and up to 1.5 to 2 cm in thickness. 2. The arachnoid membrane of the quadrigeminal cyst was very thick and surrounded by many small vessels. There were many veins on its posterior wall, but could be dissected away from the arachnoid cyst under microscopic view. 3. There was a mambrane or septum on the left side of the main arachnoid cyst, it was fenestrated to communicate the main quadrigeminal cyst and the small residual left temporal one. 1. The occipital skull bone was markedly thickened and up to 1.5 to 2 cm in thiskness. 2. The arachnoid membrane of the quadrigeminal cyst was very thick and surrounded by many small vessels. There were many veins on its posterior wall, but could be dissected away from the arachnoid cyst under microscopic view. Operative Procedures After shaving, disinfection, and draping, a 10-cm midline incision was made from 2-cm above the inion to 1.5 cm above the foramen magnum. A 5x5cm craniotomy was created acrossing the bilateral transverse sinus and superior sagittal sinus after dissection of the scalp. Under microscopic view, dissection of the arachnoid membrane and the surrounding vessels by microscissors and dissectors were done via supracerebellar infratentorial approach until the arachnoid cyst wall was reached. Cranioplasty was performed by removing the inner table of the craniotomy bone plate by high speed drill to futher expand the intracranial volume. The scalp wound was closed in layers after placing a CWV drian in the subgaleal space. Under ETGA, the patient was put in prone position. The head was put in the midline position and fixed with Mayfield head pins. After shaving, disinfection, and draping, a 10-cm midline incision was made from 2-cm above the inion. A 5-cm craniotomy was created acrossing the transverse sinus after dissection of the scalp. After well hemostasis and dural tenting, durotomy was made based on transverse sinus. Dissection of the arachnoid membrane and the surrounding vessels by microscissors and dissectors were done via supracerebellar/ infratentorial approach until the arachnoid cyst wall was reached. A 1-cm2 fenestration of the arachnoid cyst wall was created. Clear colorless CSF drained out from the cyst cavity. Inside the cavity, another two septems were seen. One was located at the anterior side of the cyst, and the other was located at the left side of the cyst. We made another fenestration at the left septum to connect the quadrigeminal and temporal cyst. The anterior one which connects to third ventricle was left intact. The inner table of the craniotomy bone plate was removed by high speed drill for decompression. Finally, the bone plate was fixed with plates and screws. The scalp wound was closed in layers after placing a CWV drian. The patient was sent to ICU smoothly. Operators Dr. 郭夢菲 Assistants R4 鍾文桂 手術日期：2009/11/12 22:07 摘要__ 手術科部: 外科部 套用罐頭: Suboccipital craniectomy for tumor excision 開立醫師: 陳德福 開立時間: 2009/11/12 22:07 Pre-operative Diagnosis posterior fossa cystic tumor with acute bleeding with hydrocephalus, nature ? Post-operative Diagnosis ditto suspect cerebellar glioma with acute bleeding and obstructive hydrocephalus Operative Method Suboccipital craniectomy for tumor excision Suboccipital craniectomy for tumor excision, hematoma evacuation, and decompression. Specimen Source and Count 1 piece About size:3*3*5CM Source:Cerebellum 2.Surgical site culture 1. 4-5 pieces of tumor about size:3*3*5CM were sent to pathology. Source:Cerebellum 2.Surgical site was sent for culture, too. Pathology pending Operative Findings 1.The dura was tense after we perform suboccipital craniectomy. 2.The cerebellum tissue gushed out spontaneously after dura opening and the brain parenchyma was fragile and easy bleeding with ICH. 3.There was a 3*5*3cm in sized multi-cystic lesion occupying the posterior cranial fossa. The tumor compressed the 4th ventricle from dorsal side; extended upward to the quadrigeminal cistern and down ward to the cerebellar tonsils which stands for tonsil herniation. 4.The tumor had well capsulated cysts with yellowish fluid in contents. 5.After the tumor and hematoma were removed, the brain became slacky and we performed duroplasty with Gortex and Duragen. 6.PT and aPTT before the surgery was 30/50 seconds; we continued components therapy during the whole procedure. 1.The anterior fontanel was stony hard and the sutures were widely separated just before operation. The dura was markedly tense and the cerebellum tended to bulge out after we removed the suboccipital bone and opened the dudra. 2.There was some subdural hematoma on the surface of both cerebellar hemisphere. The necrotic cerebellar tissue gushed out spontaneously after dura opening and the brain parenchyma was fragile due to previous hematoma and tumor compression, and was easy bleeding, but stopped bleeding after decompression. Engorged vessels were also remarkable on the cerebellar surface and surrounding the tumor and hematoma. 3.There was a 3*5*3cm in sized multi-cystic lesion occupying the posterior cranial fossa, manily in the vermis posterior to the 4th ventricular roof. The tumor compressed the 4th ventricle from dorsal side; and extended upward to the tentoriaum and quadrigeminal cistern and down ward to the medullary-cervical junction. 4.The tumor was cystic, well-encapsulated and filled with yellowish fluid. Some solid tumor was inside and mixed the necrotic cerebellar tissue. 5.After the tumor and hematoma were removed, the CSF gushed out from the 4th ventricle, and the brain became slacky and we performed duroplasty with Gortex on right side and Duragen under the dura. 6.PT and aPTT before the surgery was 30/50 seconds; we continued component therapy during the whole procedure. The blood loss during operation was about 30 cc and was not herd to control. 2.The cerebellum tissue gushed out spontaneously after dura opening and the brain parenchyma was fragile and easy bleeding with ICH. Engorged vessels were also remarkable. Operative Procedures Under ETGA and prone position, the scalp and posterior neck were disinfected and draped as usual. Linear incision from inion to the middle of the neck was done and the cranial vault was exposed. 3*4cm in sized suboccipital craniectomy was done followed by performing dura opening in V shape. The fragile and easy bleeding brain tissue gushed out and we protected the parenchyma by pads. The tumor than came into view. The tumor and ICH were removed by suckers, forceps and bipolar coagulators. While the brain tissue encountered, we stopped the tumor excision procedure and performed hemostasis. The rough surface was covered with Surgicelles and the dura was closed in water tight fasion with Gortex and Durogen assisted. One epidural minihemovac was left in situ and we closed the wound in layers. Under ETGA and prone position, the scalp and posterior neck were disinfected and draped as usual. Linear incision from 2 cm above inion to the middle of the neck was done and the cranial vault was exposed. A 3*4cm in sized suboccipital craniectomy was done by Kerrison pounches followed by performing dura opening in curved V-shape step by step to prevent downward herniation under miocroscope. The fragile and easy bleeding cerebellar tissue tended to bulge out due to marked IICP. We protected the brain with cottonoid patties and release the subdural hematoma first. We also transiently decreased the PaCO2 to 27 mmHg and gave mannitol to the patient to decrease the ICP. The tumor accompanying the ICH came into view, then they were removed by suckers, tumor forceps and bipolar coagulators. While the relative normal though necrotic brain tissue encountered, we stopped the tumor excision procedure and performed hemostasis. Finally we could reach the tentorium, and cervicomeddulary junction. The rough surface was covered with Surgiceles and the dura was closed in water tight fasion with a piece of Gortex at the middle and right side of the dural defect and put a piece of Durogen under the drua. One epidural minihemovac was left in situ and we then closed the wound in layers. Operators AP 郭夢菲 Assistants R4 陳德福 手術日期：2009/11/12 17:18 摘要__ 手術科部: 外科部 套用罐頭: Port-A implantation, left subclavian vein 開立醫師: 莊民楷 開立時間: 2009/11/12 17:18 Pre-operative Diagnosis Rectal cancer, s/p neoadjuvant chemotherapy, s/p LAR, with lung metastasis Post-operative Diagnosis Rectal cancer, s/p neoadjuvant chemotherapy, s/p LAR, with lung metastasis Operative Method Port-A implantation, left subclavian vein Specimen Source and Count nil Pathology Nil Operative Findings 1. blood return smooth after port-A implantation 2. intraoperative portable CXR shoed port-A tip over SVC Operative Procedures 1. LA, supine 2. Disinfection and drapping 3. Transverse skin incision over left subclavian area 4. Port-A catheter insertion into left subclavian vein through puncture method 5. Create subcutaneous pouch; fix port-A 6. Hemostasis 7. Close the wound in layers Operators VS 梁金銅 Assistants R2 莊民楷 陳佑嘉 (M,2009/10/28,2y4m) 手術日期 2009/11/14 手術主治醫師 張重義 手術區域 兒醫 067房 01號 診斷 Tetralogy of Fallot 器械術式 Repair TF, V.S.D., E.C.D.,TC 手術類別 緊急手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 4E 紀錄醫師 黃俊銘, 時間資訊 08:15 臨時手術NPO 08:15 開始NPO 11:15 通知急診手術 12:20 報到 12:20 進入手術室 12:25 麻醉開始 12:55 誘導結束 13:45 手術開始 14:35 抗生素給藥 17:00 抗生素給藥 20:00 麻醉結束 20:00 手術結束 20:10 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 7 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 4 0 麻醉 Hemoglobin (Hb) 4 0 麻醉 測血糖 4 0 麻醉 Ca (Calcium) 4 0 麻醉 Na (Sodium) 4 0 麻醉 K (Potassium) 4 0 麻醉 Cl (Chloride) 4 0 麻醉 Blood gas analysis 4 0 手術 四合群症之修補（Ｔ．Ｆ） 1 1 手術 二尖瓣擴張術 1 2 手術 Ａ．Ｓ．Ｄ　修補 1 4 手術 體外心肺循環 1 1 摘要__ 手術科部: 外科部 套用罐頭: Total correction(VSD patch repair, ASD closur... 開立醫師: 黃俊銘 開立時間: 2009/12/15 19:38 Pre-operative Diagnosis Absent pulmonary valve syndrome; TOF, ASD, airway compression with CO2 retension Post-operative Diagnosis Ditto Operative Method Total correction(VSD patch repair, ASD closure, infundibulectomy, RVOT patch reconstruction, LPA/RPA reduction) Specimen Count And Types PA wall Pathology PA wall Operative Findings 1. situs, solitus, levocardia, left arch 2. enlarged MPA, LPA/RPA (MPA 10mm, LPA 12mm, RPA 10mm), hypoplastic pulmonary valve 3. VSD(+): 10mm, cono-ventricular type 4. ASD: seccundum, 3mm; one 1 mm left after ASD repair 5. Hegar 6# could pass RVOT reconstruction and repaired LPA/RPA; reconstructed RVOT around 10mm 6. Post-OP bilateral pleura opened; sternum unapproximated Operative Procedures 1. Supine, ETGA, midline sternotomy 2. CPB: A: AsAo; V: bicaval-> hypothermia to 28C, partail CPB 3. AXC, antegrade cardioplegia, RA atriotomy, LA venting via ASD 4. RV ventriculotomy at RVOT longitudinally 5. Infundibulectomy by releasing of parietal band with resected 6. VSD patch repair: 10* 5-0 pledgetted Prolene 7. LPA/RPA incision transversly; resection of redundent anterior wall of PA; LPA posterior wall plicated with continuous Prolene suture until MPA/LPA junction. Re-approximated of PA anterior wall (LPA/RPA: Hegar 6# could pass) after transected AsAo 8. Re-approximated pf AsAo, RVOT patch formation by glutaraldehyde-treated autologus pericardial patch (monocuspid) 9. Transannular patch reconstructed at RVOT 10. Rewarm, deair, closure of partial ASD (1mm residual ASD left), venting from Bungus needle 11. Closure of RA atriotomy, 12. Hemostasis, partial CPB (shift IVC V-cannula to RAA site), wean-off CPB 13. Open bilateral pleura, set C/T*3 14. Wound left unapproximated Operators 張重義 Assistants 蔡孝恩 黃俊銘 Indication Of Emergent Operation 手術日期：2009/11/17 10:39 摘要__ 手術科部: 牙科部 套用罐頭: cyst------enucleation 開立醫師: 李正 開立時間: 2009/11/17 10:39 Pre-operative Diagnosis Maxillary bone tumor, right Post-operative Diagnosis Ditto Operative Method Bone tumor excision 1. Bone tumor excision 2. Complicated extraction, #14,#15 Specimen Source and Count 1 piece; About size:20*15*10 mm (devided into many segments); Source:bone chips and bone tumor like tissue form post extraction socket of #15,#14 1 piece; About size:20*15*10 mm (deveded into many segments); Source:bone chips and bone tumor like tissue form post extraction socket of #15,#14 Pathology Pending Operative Findings 1. EBL: 50ml 2. #14, #15 root external resorption 3. bone tumor like soft tissue was noted in posted extraction socket of #14,#15; also suspect the scar tissue Operative Procedures 1. The patient was put in a supine position. 2. Under ETGA, disinfection and draping were done as usual. 3. Section of #15x#17 metal bridge of done. 4. A bucccal full thickness flap was elevated and reflected in maxillary labial and buccal gingivae from the distal of #13 to mesial of #17. 5. Bony perforation was noted in labial aspect. The perforated bony chips were removed by Rongeur, and bone tumor excision was performed. 5. Interrupted suture with 2-0 silk was performed. 8. The patient stood the whole procedure well. Operators VS李正 Assistants CR陳玟秀 G1高端佑 Ri盧育成 手術日期：2009/11/18 20:57 摘要__ 手術科部: 外科部 套用罐頭: 肝右葉 開立醫師: 洪浩雲 開立時間: 2009/11/18 20:57 Pre-operative Diagnosis HCC recurrence Post-operative Diagnosis HCC recurrence, s/p right hepatic lobectomy Operative Method Right hepatic lobectomy Specimen Source and Count 1 piece About size:10x8x6cm Source:liver, right lobe Pathology pending, liver, 1 Operative Findings 1. Tumor location: Segment_s6 2. Tumor size: solitary:6x7x8cm, fragile 3. Hemangioma at S4 and left lateral lobe 4. Suspect diaphragm injury 5. Tumor rupture 6. severe adhesion at duodenum, T-colon, stomach, and liver 7. two R/Ds Operative Procedures ETGA, supine skin prepare, draping. After the abdomen was opened through a long right subcostal incision with a midline extension to the xyphoid, two self-retaining retractors of Kent type were used to retract the costal margins. The liver was mobilized by freeing the liver from diaphragm and severe adhesion to other organs. The right hepatic artery and right portal vein was ligated, and right hepatic lobectomy was done with the use of (1) CUSA and bipolar coagulator,(2) silk sutures on both section sides, (3) microwave coagulator to control bleeding. Larger branches of vessels and hepatic ducts were doubly ligated. After the specimen was removed and copious warm normal saline irrigation, all bleeding and bile leakage on the section surface was rechecked and controlled with spreading function of electrocoagulator and gelfoam overlain. The abdomen was closed in layers after insertion of two rubber drain tubes in right subphrenic and subhepatic space near the hepatic section surface. blood loss:800ml Operators 黃凱文 Assistants 黃凱傑 郭正雅 手術日期：2009/11/18 23:55 摘要__ 手術科部: 外科部 套用罐頭: Decompressive craniectomy, ICH evacuation, an... 開立醫師: 曾峰毅 開立時間: 2009/11/18 23:55 Pre-operative Diagnosis Right MCA territory infarction Post-operative Diagnosis Right MCA territory infarction with hemorrhagic transformation Operative Method Decompressive craniectomy, ICH evacuation, and ICP monitor insertion Pathology nil Operative Findings Tense dura was noted after craniectomy. After dura opened, severe brain swelling with ICH at temporal and frontal lobe. Tense dura was noted after craniectomy. After dura opened, severe brain swelling was noted. We performed intra-operative sonography to confirm ICH at temporal and frontal lobe. Operative Procedures Under endotracheal general anaesthesia, the patient was put in supine position with head rotated to left. After scalp shaved, scrubbed, disinfected, and then draped, we made a question-mark skin incision at right site, and reflected the scalp flap inferiorly. We drilled 4 burr holes, and then performed 6x10cm craniectomy. We tented the dura along the craniectomy window, and harvested the temporalis fascia. We incised the dura in U-shape, and evacuated the ICH at right temporal and frontal lobe. After hemostasis and inserting the ICP monitor subdurally, we closed the dura with autologous fascia in water-tight fashion. We closed the wound in layers after 2 CWV insertion. Operators VS 王國川 Assistants R3 曾峰毅 R2 古恬音 手術日期：2009/11/19 15:28 摘要__ 手術科部: 外科部 套用罐頭: Tumor incision 開立醫師: 張皓鈞 開立時間: 2009/11/19 15:28 Pre-operative Diagnosis Left Buttock soft tissue tumor Post-operative Diagnosis Ditto Operative Method Tumor incision Specimen Source and Count 1 piece About size:6*8 cm Source:left buttock soft tissue tumor Pathology Pending Operative Findings 1.Cytic like tumor with hematoa inside and solid base over left buttock Operative Procedures 1.Spinal anesthesia , prone 2.Incision over left buttock 3.Identified the tumor 4.Dissection for the tumor 5.Incision the tumor 6.Hemostasis 7.Set one drains 8.Primary closure in layers Operators 黃約翰 王國川 Assistants 張皓鈞 手術日期：2009/11/22 13:18 摘要__ 手術科部: 套用罐頭: Left Kocher VP shunt insertion 開立醫師: 陳睿生 開立時間: 2009/11/22 13:18 Pre-operative Diagnosis Post-ICH hydrocephalus Hydrocephalus after severe intravermian hemorrhage Hydrocephalus after severe intravermian hemorhage Post-operative Diagnosis Ditto Operative Method Left Kocher VP shunt insertion Specimen Source and Count 3 pieces About size: Source:CSF 2ML About size: Source:CSF 2ML About size: Source:CSF 2ML 3 tubes of CSF were collected for studies Pathology Nil Operative Findings The ICP was above 10 cmH2O and the CSF was mild yellowish. High protein content was noted. A medium pressure Metronic VP shunt was inserted and the intra-ventricular catheter was about 4.8 cm. The ICP was above 10 cmH2O and the CSF was mild yellowish. High protein content was noted. A medium pressure Metronic VP shunt was inserted and the intra-ventricular catheter was about 4.8 cm. The length of the intraperitoneal catheter was about 25-30 cm in length. Operative Procedures After ETGA, the patient was under supine position and head right tilt. Then right frontal curvillinear scalp incision was done. The left lateral margin of anterior fontanelle was identified and expanded with rounger. The dura was opened, and then the frontal horn of lateral ventricle was punched. We made a linear incision at RMQ, and minilaparotomy was done. A subcutaneous tunnel from RMQ to right frontal region with one connecting wound was done. The intra-abdominal catheter was set, then the reservior and insert intra-ventricular catheter (4.8cm in depth) were set. After Hemostasis, the wound was closed the wound in layers. Left side shunt was planned due to previous CVP insertion at right neck. After ETGA, the patient was under supine position and head right tilt. Then right frontal curvillinear scalp incision was done. The left anterior margin of anterior fontanelle was identified and extended with rhonger. The dura was opened, and then the frontal horn of lateral ventricle was punched. We made a linear incision at RMQ, and minilaparotomy was done. A subcutaneous tunnel from RMQ to right frontal region with one connecting wound was done. The intra-abdominal catheter was set for 25 to 30 cm, then the reservior of medium pressure was connectoed to the ventricular catheter (4.8cm in depth) and the peritoneal catheter. After Hemostasis, the wounds were closed in layers. Operators AP. 郭夢菲 Assistants R5 陳睿生 手術日期：2009/11/22 18:30 摘要__ 手術科部: 外科部 套用罐頭: Microscopic diskectomy 開立醫師: 古恬音 開立時間: 2009/11/22 18:30 Pre-operative Diagnosis L3-4, L4-5 HIVD Post-operative Diagnosis Ditto Operative Method Microscopic diskectomy Specimen Source and Count nil Pathology Nil Operative Findings 1. Bulging disc at L3-4, L4-5 level that compressed the nerve roots tightly 2. The discs became loose and dehydrated Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position. The L3-4, L4-5 level were localized with intraoperative fluoroscopy. A midline skin incision was made at L3-5 level followed by detachment of right paravertebral muscles. The lower border of L3 and L4 laminae were open with drill. The thickened ligamentum flavum was resected with Kerrison punch. After retracting the roots medially, diskectomy of L3-4 and L4-5 was performed under surgical microscope. Hemostasis was achieved, and the wound was closed in layers Operators VS賴達明 Assistants R5陳睿生, R2古恬音 手術日期：2009/11/23 20:16 摘要__ 手術科部: 骨科部 套用罐頭: Arthroscopic surgery 開立醫師: 陳明峰 開立時間: 2009/11/23 20:16 Pre-operative Diagnosis Left knee lateral meniscus tear Post-operative Diagnosis Left knee lateral meniscus tear Operative Method 1.Arthroscopic shaving 2.Lateral meniscus repair Specimen Source and Count nil Pathology nil Operative Findings 1.LM bucket handle tear. Lataral plateua subchondral bone exposure with OA change. 2.Intack ACL, MM and PF joint Operative Procedures 1.SA. 2.Arhroscopic examination and shaving. 3.Insite-out method to repair LM. 4.Close wound. Operators 江清泉 Assistants 陳致宇 陳明峰 陳彥豪 手術日期：2009/11/23 21:08 摘要__ 手術科部: 外科部 套用罐頭: Port-A implantation 開立醫師: 張得一 開立時間: 2009/11/23 21:08 Pre-operative Diagnosis Gastric cancer Operative Method Port-A implantation Operative Findings Patent venous flow and adequate position checked by intraop CXR Operative Procedures Under local anesthesia, the Port-A was inserted via left cephalic vein by cut-down method. The wound was close in layers Operators 林明燦 Assistants 張得一 手術日期：2009/11/24 14:17 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for tumor excision 開立醫師: 王奐之 開立時間: 2009/11/24 14:17 Pre-operative Diagnosis Right parietal low grade glioma Post-operative Diagnosis Ditto Operative Method Craniotomy for tumor excision Specimen Source and Count 1 piece About size:2*2*2cm Source:right parietal brain tumor Pathology Frozen: grade II astrocytoma Operative Findings The tumor was yellow-whitish and was elastic, ill-defined in gross appearance. Intra-operative frozen section showed grade II astrocytoma. The tumor involved the gyrus beneath to the sensory cortex. A huge cortical vein was noted across and well preserved. Operative Procedures After ETGA, the patient was placed in prone position with neck slightly extended and head fixed with Mayfield clamp. An U-shaped posterior scalp incision was made and 5 burr holes were made. A 6*6cm craniotomy window was made, followed by dural tenting. Intra-operative echo was used to localize the tumor besides navigation system. The arachnoid membrane and cortical veins were dissected from the lesion. Total removal of the involved gyrus was carried out. Hemostasis was achieved with Surgicel, the dura was closed with pericranium graft. After deair, the skull graft was fixed back with #24 wires and centrally tented. A subgaleal CWV was set, the operative procedure ended with wound closure in layers. Operators 曾漢民 Assistants 陳睿生,王奐之 手術日期：2009/11/24 16:01 摘要__ 手術科部: 外科部 套用罐頭: TPS L3, 4, 5 & cross-link, cage fusion L3/4, ... 開立醫師: 王奐之 開立時間: 2009/11/24 16:01 Pre-operative Diagnosis L4 compression fracture with L3/4, L4/5 stenosis Post-operative Diagnosis Ditto Operative Method TPS L3, 4, 5 & cross-link, cage fusion L3/4, posterolateral fusion Specimen Source and Count 1 piece About size:1cm Source:r/o metastasis Pathology Pending Operative Findings Compression fracture at L4 and bone was osteoporotic, hypertrophic ligamentum flavum at L3/4, L4/5, tumor was less likely. TPS: 6.2*45mm*6, rod: 8cm, cross-link*1, cage: 13mm*2 Operative Procedures After ETGA, the patient was placed in prone position. A midline back incision was made, followed by detachment of paraspinal muscles. TPS over L3, 4, 5 was then performed. L3/4 laminectomy with decompression was done, followed by cage fusion over L3/4, After ETGA, the patient was placed in prone position. A midline back incision was made, followed by detachment of paraspinal muscles. TPS over L3, 4, 5 was then performed. L3/4 laminectomy with decompression was done, followed by cage fusion over L3/4, part of the L4 body was removed with shaver. Rod fixation and cross-link was then added. Hemostasis was achieved, followed by setting a hemovac. The operative procedure ended with wound closure in layers. Operators 賴達明 Assistants 陳盈志,王奐之 手術日期：2009/11/25 17:17 摘要__ 手術科部: 外科部 套用罐頭: tumor excision 開立醫師: 胡朝凱 開立時間: 2009/11/25 17:17 Pre-operative Diagnosis Scalp tumor Post-operative Diagnosis ditto Operative Method tumor excision Operative Findings 1.One about 1.8 cm tumor, which is yellowish and soft with capsule, located at subcutaneous layer of left frontal area 2.Adhesion between tumor and periosteum Operative Procedures 1.Local anesthesia 2.Transverse skin incision 3.Subcutaneous dissection 4.Tumor excision after central debulky 5.Hemostasis 6.Close wound in layers Operators 曾勝弘 Assistants 胡朝凱 手術日期：2009/11/25 12:15 摘要__ 手術科部: 骨科部 套用罐頭: Total hip replacement-Posterior 開立醫師: 黃哲南 開立時間: 2009/11/25 12:15 Pre-operative Diagnosis Right acetabular bone tumor, suspect metastatic tumor Post-operative Diagnosis Right acetabular bone tumor, suspect metastatic tumor Operative Method 1. Excision of acetabular bone tumor 2. Total hip replacement with United hip prosthesis, right Specimen Source and Count 1 piece Source:bone, right acetabulum Pathology Pending Operative Findings Much fragile tumor tissue at periacetabular region; medial cortex of acetabulum was destructed Operative Procedures 1. Spinal anesthesia, left decubitus position 2. Skin prepped and draped; posterolateral approach 3. Osteotomize femoral neck and remove femoral head and neck 4. Excise and curet acetabular bone tumor, then irrigate with alcohol and N/S 5. Place autogenous bone graft (femoral head) into acetabular bony defect 6. Impact bone graft and ream in sizes to 48mm 7. Place cup (48mm OD, screws x3) and liner (28mm OD) 8. Ream femoral canal to 10mm and broach to 1# 9. Insert stem (prox. 1#, dist. 9mm) and heat (28mm OD, -3 neck) 10.Reduce hip and check stability, hemostasis, set 1/8" Hemovac x1 11.Repair external rotators, then close wound in layers Operators 楊榮森 Assistants 黃哲南, 李忠謙 手術日期：2009/11/25 18:40 摘要__ 手術科部: 外科部 套用罐頭: Laminoplasty 開立醫師: 胡朝凱 開立時間: 2009/11/25 18:40 Pre-operative Diagnosis C-spinal stenosis Post-operative Diagnosis ditto Operative Method Laminoplasty Operative Findings 1.Hypertrophic PLL that compressed the thecal sac tightly 2.After laminoplasty, thecal sac expanded well Operative Procedures 1.Anesthesia: endotracheal general. 2. Position: prone with neck flexed and head fixed by a Mayfield skull clamp 3.Skin preparation: occipital and neck areas were shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: medline nape, from suboccipital to lower neck. 5.The trapezius, semispinalis capitis, splenius capitis muscles on both sides were splitted at its origin of ligamentum nuchae, then, together with serratus posterior superior, rectus capitis posterior, obliqus capitis inferior and multifidus were detached from the spinous processes of C 3-6, followed by subperiosteal dissection on the laminae. 6.bleeding from the muscles was stopped by Bovie. 7.The spinous processes of C 3~6 were cut at its base by high speed air drill andreserved for later use. 8. The left laminal arches were cut through its whole thickness. The right side laminae at its laminopedicle juction was cut into a depth of it half thickness by a 1mm head size high speed cutting burr. 9.The lamina was bent to the right side by opening a door like action of a Cloward intervertebral spreader. Consequently, the posterior half of the spinal canal was enlarged. 10.The hypertrophic ligmenta flava, esp. at posterior central region were resected. 11.Each gap newly created after splitting was bridged by the reserved spinous process which was fixed to the laminae by a miniplate on each end. 12.A 3 mm width partial laminectomy was done with Kerrison punch at the outer margin of C2 lamina and the upper margin of C7 lamina. 13.The paravertebral muscles were closed by interrupted sutures with 2/0 silk, subcutaneous layer by continuous suture with 3/0 Dexon and skin by continuous suture with 3/0 nylon. 14.Drain: one, epilaminal, hemovac. Operators 陳敞牧 陳昶牧 Assistants 胡朝凱 手術日期：2009/11/27 12:46 摘要__ 手術科部: 外科部 套用罐頭: 1) Incisional biopsy, 2)Port-A implantation, ... 開立醫師: 莊民楷 開立時間: 2009/11/27 12:46 Pre-operative Diagnosis Left advanced breast cancer Post-operative Diagnosis Left advanced breast cancer Operative Method 1) Incisional biopsy, 2)Port-A implantation, right subclavian vein Specimen Source and Count 1 piece About size:2x2cm Source:left breast tumor Pathology pending Operative Findings 1. one huge solid tumor occupying whole left breast 2. blood return smooth after port-A implantation 3. intraoperative portable CXR showed port-A tip over SVC Operative Procedures 1. ETGA, supine 2. Disinfection and drapping 3. Transverse skin incision over right subclavicular area, 3cm 4. Port-A catheter insertion into right subclavian vein through puncture method 5. Create subcutaneous pouch; fix port-A 6. Hemostasis 7. Close the wound in layers 8. Curvature skin incision over left subclavicular area, 5cm 10. Incisional biopsy of left breast tumor 11. Apply Surgicel 12. Close the wound in layers Operators VS 張金堅 Assistants R2 莊民楷 手術日期：2009/11/30 21:08 摘要__ 手術科部: 骨科部 套用罐頭: Total knee replacement-Medial, standard 開立醫師: 陳明峰 開立時間: 2009/11/30 21:08 Pre-operative Diagnosis Left knee osteoarthritis Post-operative Diagnosis Left knee osteoarthritis Operative Method Total knee arthroplasty, left, Zimmer NexGen LPS-Flex with cement, Specimen Source and Count 1 piece About size:a piece of bone Source:femur Pathology 1 piece About size:1x1x0.3cm Source:bone, distal femur Operative Findings 1. Cartilage wearing and subcondral bone exposure 2. Osteophyte formation 3. Varus deformity 4. Femur: C, Tibia: 3, Patella: 26mm, Insert: 10mm. Operative Procedures 1.SA. supine. 2.On tourniqeut 300 mmHg. 3.Midline incision. 4.Medial para-patella approach. 5.Medial release 6.Femoral cut and tibia cut. 7.Posterior release. 8.Prosthesis fixation with cementing. 9.Normal saline irrigation. Hemostasis.1/4 HV. 10.Close wound in layers. Operators 江清泉 Assistants 陳致宇 陳明峰 陳彥豪 蘇惠卿 (F,1948/04/25,63y10m) 手術日期 2009/11/30 手術主治醫師 賴達明 手術區域 東址 005房 01號 診斷 Spondylolisthesis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 王奐之, 時間資訊 07:45 報到 08:05 進入手術室 08:20 麻醉開始 08:50 誘導結束 09:10 抗生素給藥 09:25 手術開始 12:07 手術結束 12:07 麻醉結束 12:10 抗生素給藥 12:22 送出病患 12:23 進入恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 術後止痛 1 0 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 手術 椎弓切除術（特壓）－二節以內 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: L4-5 transpedical screws, diskectomy, cage in... 開立醫師: 王奐之 開立時間: 2009/12/02 20:19 Pre-operative Diagnosis L4-5 spondylolisthesis with HIVD Post-operative Diagnosis Ditto Operative Method L4-5 transpedical screws, diskectomy, cage insertion and L4 laminectomy Specimen Count And Types nil Pathology Nil Operative Findings 1. Floating L4 on L5 2. Osteoporosis (+) 3. Protrusion of L4-5 disk 4. Stenotic lateral recess 5. Cage: 11# Operative Procedures After ETGA, the patient was placed in prone position. A midline incision was made from L4 to S1. The paravertebral muscle groups were then detached, followed by exposure of facet joints and transverse processes. TPS screws were inserted, L4 laminectomy and L4-5 diskectomy were then done. A 11# cage was inserted into the intervetebral space, and the rods were fixed in place. After setting a hemovac drain and achieving hemostasis, the operative procedure ended with wound closure in layers. Operators 賴達明 Assistants 胡朝凱,王奐之 郭義雄 (M,1938/02/14,74y1m) 手術日期 2009/11/30 手術主治醫師 王國川 手術區域 東址 002房 04號 診斷 Cerebellar hemorrhage 器械術式 Craniotomy (A.V.M.) VS-TZENG 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3 紀錄醫師 李振豪, 時間資訊 13:28 通知急診手術 13:50 報到 13:55 進入手術室 14:00 麻醉開始 14:20 誘導結束 15:00 抗生素給藥 15:03 手術開始 18:10 麻醉結束 18:10 手術結束 18:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 摘要__ 手術科部: 外科部 套用罐頭: CVA Pre-operative Diagnosis Right frontal ICH and SDH Post-operative Diagnosis Ditto Operative Method Craniotomy for hematoma evacuation Specimen Count And Types Pathology Nil Operative Findings About 70-80 ml hematoma was noted mainly at frontal region. A hardish hematoma was found at the brain surface. No active bleeder was found at the brain surface. No active bleeder was found in side SDH was noted and removed. Post-op brain pulsation was poor. The brain was slack and atrophy with tense bridging vein after hematoma removal. The lateral ventricle was not opened during the operation. Operative Procedures Under ETGA and supine position, the scalp was shaved, scrubbed, and disinfected as usual. Bicoronal scalp incision was made and the scalp flap was elevated. Three burr holes were created followed by right frontal craniotomy with 8x6cm in size. After dural tenting, the dura was opened based on superior sagittal sinus. corticotomy was performed from the anterior middle frontal lobe. hematoma evacuation was performed with sucker and assisted with brain retractor. Hemostasis was achieved with bipolar cautery and Surgicel. The dura was closed with 4-0 prolene and fascia graft repair. The skull plate was replaced with Miniplates and a subgaleal CWV drain was set up. The wound was then closed in layers. Operators 王國川 Assistants 陳睿生,李振豪 Indication Of Emergent Operation 手術日期：2009/11/30 16:37 摘要__ 手術科部: 外科部 套用罐頭: CVA Pre-operative Diagnosis Right frontal ICH and SDH Post-operative Diagnosis Ditto Operative Method Craniotomy for hematoma evacuation Pathology Nil Operative Findings About 70-80 ml hematoma was noted mainly at frontal region. A hardish hematoma was found at the brain surface. No active bleeder was found at the brain surface. No active bleeder was found in side SDH was noted and removed. Post-op brain pulsation was poor. The brain was slack and atrophy with tense bridging vein after hematoma removal. The lateral ventricle was not opened during the operation. Operative Procedures Under ETGA and supine position, the scalp was shaved, scrubbed, and disinfected as usual. Bicoronal scalp incision was made and the scalp flap was elevated. Three burr holes were created followed by right frontal craniotomy with 8x6cm in size. After dural tenting, the dura was opened based on superior sagittal sinus. corticotomy was performed from the anterior middle frontal lobe. hematoma evacuation was performed with sucker and assisted with brain retractor. Hemostasis was achieved with bipolar cautery and Surgicel. The dura was closed with 4-0 prolene and fascia graft repair. The skull plate was replaced with Miniplates and a subgaleal CWV drain was set up. The wound was then closed in layers. Operators 王國川 Assistants 陳睿生,李振豪 手術日期：2009/12/01 20:27 摘要__ 手術科部: 外科部 套用罐頭: Permcath 開立醫師: 林明賢 開立時間: 2009/12/01 20:27 Pre-operative Diagnosis ESRD Post-operative Diagnosis s/p Permcath insertion Operative Method permcath implantation via right internal jugular vein Pathology nil Operative Findings 1. The permcath catheter was inserted via right internal jugular vein by puncture & echo-guided procedure 2. Patent flow after implantation Operative Procedures -Anesthesia: local, the patient was put on supine position. The operation field was disinfected and draped as usual. -Permcath catheter was implanted on right side upper chest with puncture method under echo-guided procedure. The catheter was advenced via the peel-away sheath smoothly after tunnelization. -The flow was checked and flushed with heparin solution. The wounds were closure by 2-0 Nylon. Local compression for hemostasis. Operators 詹志洋 Assistants 林明賢 手術日期：2009/12/01 12:30 摘要__ 手術科部: 外科部 套用罐頭: Tenckhoff implantation 開立醫師: 陳志軒 開立時間: 2009/12/01 12:30 Pre-operative Diagnosis Subcutaneous orifice of peritoneal dialysis infection Post-operative Diagnosis Subcutaneous orifice of peritoneal dialysis infection Operative Method Remove half Tenckhoff catheter and reconstruction Specimen Source and Count Nil Pathology nil Operative Findings Peritoneal dialysis smoothly after operation Operative Procedures 1. Under IV general anethesia, local anesthesia was also performed, and the patient was put into supine position 2. SKin incision at peri-umbilicus area 3. Identify the internal orifice of Tenchkhoff catheter. 4. Transect the catheter, and reconstruction with new one 5. Remove the previous residual catheter 6. After adquate hemostasis, the wound was closed in layers Operators VS蔡孟昆 Assistants R1陳志軒 Ri林義傑 手術日期：2009/12/01 16:29 摘要__ 手術科部: 外科部 套用罐頭: RFA 開立醫師: 陳柏誠 開立時間: 2009/12/01 16:29 Pre-operative Diagnosis Colon cancer with liver metastasis Post-operative Diagnosis ditto Operative Method RFA Pathology Nil Operative Findings 1. A 6x6 cm tumor at S7, ablation time:22+16 minutes, by 3cm probes x3 2. A 5 cm tumor at S6, albation time: 25+8 minutes, by 3 cm probe 3. A 4 cm tumor at S2, albation time:25 minutes, by 3 cm probes x 2 Operative Procedures 1. IVGA with mask, supine 2. Skin disinfection and draping 3. Performed RFA with echo guided 4. POR Operators 黃凱文 Assistants R1陳柏誠 手術日期：2009/12/01 15:47 摘要__ 手術科部: 套用罐頭: BMA+B 開立醫師: 劉郁文 開立時間: 2009/12/01 15:47 Pre-operative Diagnosis yolk sac tumor Post-operative Diagnosis yolk sac tumor Operative Method Bone marrow aspiration and biopsy Specimen Source and Count 1 piece About size: Source: Pathology Pending Operative Findings Approximately 20 mL of BM aspirate was obtained. BM smear showed the presence of BM particles. Operative Procedures 1. IVGA. 2. On prone position. 3. Skin prepped and draping. 4. BM aspiration via the left posterior superior iliac spine. 5. Using a 8-G trephine needle, BM biopsy was then performed. 6. Needle withdrawn and wound compressed with sterile dressing. 7. Patient on supine and sent to the 6PE. Operators VS楊永立 Assistants R3劉郁文/R5李孟如 手術日期：2009/12/02 12:43 摘要__ 手術科部: 套用罐頭: Gross total tumor excision via left frontal a... 開立醫師: 鍾文桂 開立時間: 2009/12/02 12:43 Pre-operative Diagnosis Left frontal metastatic tumor, from mediastinal yolk sac tumor. Post-operative Diagnosis Left frontal metastatic tumor, from mediastinal yolk sac tumor. Operative Method Gross total tumor excision via bicoronal left frontal craniotomy Gross total tumor excision via left frontal approach. Specimen Source and Count 1 piece About size: Source:Left frontal tumor. many pieces (piecemeal) of necrotic tumor was sent for pathology. Source:Left frontal tumor. Pathology Pending. Operative Findings The tumor was ill-defined, moderate vascular, necrotic in nature. There was no clear margin between the tumor and the normal brain tissue. The tumor was composed of a cystic portion that 20 cc dark yellowish liquid was aspirated. Intraoperative ultrasound was used to localize the tumor and was used to document a total excision of the lesion. The fluid was sent for cytology, routine, and bacterial culture. Dark brown soft, elastic, non-encapsulated tumor with intralesional liquified hemorrhage. Moderate adhesion to normal brain tissue. Aspiration of liquified hematoma(20 cc) under intraoperative ultrasound guidance.It was sent for cytology, CSF routine, and bacterial culture. Easy oozing operative field. Operative Procedures Under ETGA, the patient was put in supine position and the head was slightly extended. After shaving, disinfection and draping, a 20 cm curvilinear bicoronal incision was made. After dissection of the scalp, a 3x6 cm craniotomy was made by high speed drill. The dura was tented and opened to exposed the underlying tumor. An area of more yellowish brain surface was noted. Under the guidance of ultrasonography, aspiration of the liqufied hematoma was done at the mentioned area. Later, a small cortocotomy was created for tumor excision. The tumor was removed in piecemeal fashion by tumor forceps, suction, and its surface was seperated from the normal brain tissue by dissectors. Gross total tumor excision was achieved with a emptied cavity left. After well hemostatsis and covering of surgical on the cavity surface, the dura was closed in watertight fashion. The dural defects were repaired with DuraGen.A CWV drain was placed in subgaleal space. Finally, the wound was closed in layers. The patient was sent to ICU smoothly. After shaving, disinfection and draping, a 20 cm curvilinear bicoronal incision was made. After dissection of the scalp, a 3x6 cm craniotomy was made just left to the medline on left frontal bone. An area of more yellowish brain surface was noted. Intraoperative ultrasound was used to localize the tumor. We aspirated the intratumorla fluid to get a relaxed brain. Later, a small cortocotomy was created for tumor excision. The tumor was removed in piecemeal fashion by tumor forceps, suction, and its margin was dissected from the normal brain by dissectors. Gross total tumor excision was achieved with ultrasound document. After well hemostatsis and covering of surgicel on the cavity surface, the dura was closed in watertight fashion. The dural defects were repaired with DuraGen. The skull bone plate was fixed back with miniplates. A CWV drain was placed in subgaleal space after a central tenting. Operators V.S. 郭夢菲 Assistants R4 陳德福,鍾文桂,Intern 薛雅元. 手術日期：2009/12/02 18:17 摘要__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 曾峰毅 開立時間: 2009/12/02 18:17 Pre-operative Diagnosis Brain contusion at right with left SDH, status post operation; acute SDH at right frontoparietal area. Post-operative Diagnosis ditto Operative Method Right craniectomy and ICP monitor insertion Pathology nil Operative Findings About 2 cm thick SDH was noted at right frontoparietal area. One linear nondepressed skull fracture was noted at right temporal area with one bleeding bridge vein. Adhesion betwwen brain parenchyma with dura was noted at right temporoparietal area. About 2 cm thick SDH was noted at right frontoparietal area. One linear nondepressed skull fracture was noted at right temporal area with one bleeding bridge vein. Adhesion betwwen brain parenchyma with dura was noted at right temporoparietal area. Post-op ICP: 1mmHg. Operative Procedures 1. ETGA, supine, head rotated to left 2. Scalp shaved, scrubbed, disinfected, and then draped 3. Question mark skin incision 4. Craniectomy after four burr holes drilled 5. Dura tenting along the craniectomy window 6. Dur incision and hematoma evacaution 7. Hemostasis 8. Place one subdural ICP monitor 9. Duroplasty with Durofoam 10. Place two subgaleal CWV 11. Wound closure Operators VS 蔡翊新 Assistants R5 胡朝凱 R3 曾峰毅 張麗娟 (F,1967/05/24,44y9m) 手術日期 2009/12/07 手術主治醫師 王國川 手術區域 東址 002房 03號 診斷 CVA 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 4E 紀錄醫師 蕭惠壬, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 11:00 通知急診手術 12:20 進入手術室 12:22 麻醉開始 12:40 誘導結束 13:30 開始輸血 13:45 手術開始 17:05 手術結束 17:05 麻醉結束 17:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 顱骨切除術，包括異物移除或減壓或神經切斷 1 1 L 手術 顱內壓監視置入 1 2 L 摘要__ 手術科部: 神經部 套用罐頭: Left craniectomy for decompression 開立醫師: 蕭惠壬 開立時間: 2010/01/08 21:35 Pre-operative Diagnosis Left MCA infarction Post-operative Diagnosis Ditto Operative Method Left craniectomy for decompression Specimen Count And Types nil Pathology nil Operative Findings 1. Pulseless and swellling brain was noted at left temporal to pareital lobe 2. ICP after closure, 7~8 cmH2O 3. Dura was closure with one piece of fascia Operative Procedures 1. ETGA, supine with head rotate to right side 2. Left trauma flap skin incinsion was made 3. Reflect skin flap downward with facial nerve preservation 4. Resect temporalis muscle 5. Burr hole drill 6. Craniotomy 7. Dural incision after dural tenting 8. Duroplasty with one piece of fascia 9. set CWV drains and ICP monitor 10. Close wound in layers Operators VS王國川 Assistants R5胡朝凱 R4鐘文桂 R1蕭惠壬 Indication Of Emergent Operation 手術日期：2009/12/08 14:00 摘要__ 手術科部: 外科部 套用罐頭: Neurolysis 開立醫師: 曾峰毅 開立時間: 2009/12/08 14:00 Pre-operative Diagnosis Tardy ulnar plasy, left Post-operative Diagnosis ditto Operative Method Neurolysis Operative Findings Tight fibrotic band was noted at left elbow area, compressing ulnar nerve. Ulnar nerve was decompressed after neurolysis. Operative Procedures Under ETGA, the paient was put in supine position. Longitudinal linear skin incision was made at left elbow, and dissection was made to expose between olecranon and medial epicondyle. Fibrotic band was release. After hemostasis, the wound was closed in layers. Operators VS 賴達明 Assistants R4 陳德福 R3 曾峰毅 手術日期：2009/12/08 16:40 摘要__ 手術科部: 外科部 套用罐頭: RFA 開立醫師: 陳志軒 開立時間: 2009/12/08 16:40 Pre-operative Diagnosis Colon cancer with liver mets and lung mets s/p liver segmentectomy of S7 Post-operative Diagnosis Colon cancer with liver mets and lung mets s/p liver segmentectomy of S7 Operative Method RFA Specimen Source and Count Nil Pathology Nil Operative Findings One hypoechoic tumor at S5: 6x5cm, ablation time 25+16min, by three probes Operative Procedures After IVGA with mask, she was put on supine position. Skin disinfection and draping as usual. Performed Cool-tip RFA 2 cm tip *3 under echo guided. Operators VS黃凱文 Assistants R1陳志軒 手術日期：2009/12/09 20:47 摘要__ 手術科部: 外科部 套用罐頭: VATS right decortication and mechanical pleur... 開立醫師: 蔡東明 開立時間: 2009/12/09 20:47 Pre-operative Diagnosis 1.Malignant pleural effusion, right 2.Breast cancer s/p MRM, right and chemotherapy Post-operative Diagnosis 1.Malignant pleural effusion, right 2.right empyema 3.Breast cancer s/p Op and chemotherapy Operative Method VATS right decortication and mechanical pleurodesis Specimen Source and Count 1 piece About size: Source:Right pleura Pathology Pending Operative Findings 1.Much adhesion bands and lobulated pleural effusion was noted at right thoracic cavity. jelly like formation (+) 2.Post-op air-leakage (+). Repair with endoclips is done. Expansion: well Operative Procedures 1.DLETGA< left decubitus 2.Skin disinfection and drapped 3.VATS setting 4.Adhesionlysis and remove parietal pleura 5.Hemostasis and check air-leakage 6.Normal saline irrigation 7.Mechanical pleurodesis 8.Set-up two chest tube, Fr.32 9.Close wound in layers Operators VS李章銘 Assistants R3蔡東明 R2陳柏達 Ri黃旭輝 手術日期：2009/12/11 21:34 摘要__ 手術科部: 外科部 套用罐頭: L5-S1 microdiskectomy 開立醫師: 王奐之 開立時間: 2009/12/11 21:34 Pre-operative Diagnosis L5-S1 HIVD Post-operative Diagnosis Ditto Operative Method L5-S1 microdiskectomy Specimen Source and Count nil Pathology Nil Operative Findings 1. Easy oozing during the operation was noted. TPS insertion was attempted initially but L5 transverse process & lateral body fracture was noted, resulting in inability of screw insertion. Artificial bones were used to allow lateral fusion. 2. L5-S1 bulging disc was noted. 3. EBL: 800ml Operative Procedures After ETGA, the patient was placed in prone position. The skin was disinfected and draped in usual sterile fashion. A midline linear skin incision was made at lower back, and the incision was further extended into fascial layer. 2 parallel fascial incisions at bilateral paramedian position were made, followed by dissection to expose the L5 & S1 transverse processes. Markers were inserted and the locations confirmed with intra-operative C-arm fluoroscopy. TPS screw insertion was then attempted, but failed. L5-S1 diskectomy was performed currette and alligator under microscope after a left L5 laminotomy. After achieving hemostasis, 2 CWV drains were set. The operative procedure ended with wound closure in layers Operators 賴達明 Assistants 陳睿生,王奐之 手術日期：2009/12/11 22:11 摘要__ 手術科部: 外科部 套用罐頭: Port-A insertion 開立醫師: 黃世銘 開立時間: 2009/12/11 22:11 Pre-operative Diagnosis Lung cancer Post-operative Diagnosis Lung cancer Operative Method Port-A insertion Specimen Source and Count nil Pathology nil Operative Findings Good flow of Port-A Operative Procedures 1.Under local anesthesia with supine position 2. Disinfected and drapped as usual 3. Echo-guided puncture of right internal jugular vein 4. The Port-A catheter was implanted on left side upper chest 5. Wound closure in layers Operators P. 王水深 Assistants R4謝永, R1黃世銘 魏陳秀鑾 (F,1938/12/17,73y2m) 手術日期 2009/12/14 手術主治醫師 郭生興 手術區域 西址 038房 01號 診斷 Radicular cyst 器械術式 Antrostomy for maxillary sinus 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 林至芃 ASA 2 紀錄醫師 陳玟秀, 時間資訊 07:50 報到 07:58 進入手術室 08:10 麻醉開始 08:15 誘導結束 08:26 抗生素給藥 08:50 手術開始 10:35 手術結束 10:35 麻醉結束 10:45 送出病患 10:50 進入恢復室 12:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 骨瘤切除術（＞２公分） 1 0 L 手術 島狀根帶蒂皮瓣移植 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 牙科部 套用罐頭: cyst------enucleation 開立醫師: 郭生興 開立時間: 2009/12/14 11:02 Pre-operative Diagnosis Post-operation maxillary cyst Post-operative Diagnosis Post-operation maxillary cyst, s/p op Operative Method 1.Cyst enucleation 2.Buccal fat pad repair Specimen Count And Types 1 piece About size:2 cm x 1 cm Source:soft tissue, excision from upper left maxilla Pathology Pending Operative Findings 1.Buccal bone plate perforation Operative Procedures 1.The patient was put in a supine position. 2.Under ETGA, disinfection and draping were done as usual. 3.A full-thickness flap was elevated and reflected in maxillary buccal gingiva from the distal of #24 to distal of #27. 4.Bony perforation was noted in labial aspect. The perforated bony chips were removed by stryker, and enucleation was performed. 5.Buccal fat pad repair, and suture with 3-0 Dexon. 6.Interrupted suturewith 3-0 silk was performed. 7.The patient stood the whole procedure well. Operators VS郭生興 Assistants CR陳玟秀 G1張玲瑜 Ri錢之琳 手術日期：2009/12/16 09:33 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Left trigeminal V3 neuralgia Post-operative Diagnosis Ditto Operative Method Left V3 radiofrequency thermorhizotomy Pathology Nil Operative Findings Sensory stimulation: 0.1V 50Hz 1msec. RF albation: 80 degrees for 90 sec at left V3. Specimen: nil Operative Procedures Under IVG and nasal cannula oxygenation, the patient was put in supine position. The skin was disinected with hibitan and draped. The skin was incised with 18G needle followed by troca insertion. The position of radiofrequency needle was checked with intraoperative fluoroscope. Awaked the patient from the anesthesia and check the needle position by testing sensation. The ablation was then performed with 80 degrees for 90 sec. The needle was then removed and covered the wound with bandage. Operators 曾勝弘 Assistants 李建勳,王奐之 手術日期：2009/12/16 12:36 摘要__ 手術科部: 外科部 套用罐頭: 1.Revision of ventriculoperitoneal shunt with... 開立醫師: 鍾文桂 開立時間: 2009/12/16 12:36 Pre-operative Diagnosis 1. Hydrocephalus. 2. Arachnoid cyst in posterior fossa. 1.Arachnoid cyst, posterior fossa, S/P CP shunt with shunt dysdunction.2.Hydrocephalus, S/P VP shunt with slit ventricle Post-operative Diagnosis 1. Hydrocephalus. 2. Arachnoid cyst in posterior fossa. 1.Arachnoid cyst, posterior fossa, S/P CP shunt with shunt dysdunction.2.Hydrocephalus, S/P VP shunt with slit ventricle Operative Method 1.Revision of ventriculoperitoneal shunt with Codman programmable valve(30-200mmH20, set 40 mmH2O. 2. Revision of cystoperitoneal shunt. 1.Revision of ventriculoperitoneal shunt with adding Codman programmable valve(30-200mmH20, set at 40 mmH2O). Pathology Nil. Operative Findings The catheter of the CP shunt could be removed smoothly, and the intracranial pressure was moderately increased. The CSF was clear and tranparent in color. The distal catheter was confirmed to be patent by injection of some normal saline. The VP shunt was still patent when the programmable reserboir was inserted in between the distal catheter. Codman programmable valve(30-200mmH20, set 40 mmH2O, the previous reservoir was left intact. The catheter to the arachnoid cyst was repositioned more inferiorly to drain the left sided arachnoid cyst in posterior fossa.( tip 3.5 cm long) Operative Procedures After identifying the shunt tube, it was connected with the programmable shunt. The patency of the shunt was checked. After wound closure in layers, the patient was sent to POR smoothly. A small burr hole was done by high speed drill 1.5 cm caudal to the previous burr hole at the left occipital region. A proximal cathter, 3.5 in length was connected with previous distal shunt tube with a right-angle connector after the distal catheter was confirmed to patent by injection with normal saline. After opening the dura and arachnoid membrane, the cyst catheter was inserted and the right-angle connector was fixed to the subcutaneous tissue to let the shunt tip projecting to the left side. Under ETGA, the patient was put in prone position. After shaving, disinfection and draping, the previous wound for cystoperitoneal shunt was incised and the shunt was exposed. A small burr hole was done by high speed drill. The cyst catheter( tip 3.5 cm long) was connected with the shunt tube via a right-angle connector. After opening the dura and arachnoid membrane, the cyst catheter was inserted more to the left side for better drainage. Another two 1-cm scalp incisions were made along the ventriculoperitoneal shunt. The patency of the C-P shunt was checked. After opening the dura and arachnoid membrane, the cyst catheter was inserted more to the left side for better drainage.The catheter to the arachnoid cyst was repositioned more inferiorly to drain the left sided arachnoid cyst in posterior fossa.( tip 3.5 cm long) After identifying the shunt tube, it was connected with the programmable shunt. The patency of the shunt was checked.Codman programmable valve(30-200mmH20, set 40 mmH2O, the previous reservoir was left intact. Another two 1-cm scalp incisions were made along the ventriculoperitoneal shunt at the right postauricular region. After identifying the shunt tube, it was divided and a Codman programmable reservoir was inserted in between the shunt. The pressure was set at 40 mmH2O, the previous reservoir of Metronic medium pressure was left in right frontal region. Operators V.S. 郭夢菲 Assistants R4 鍾文桂,Intern薛雅元. 手術日期：2009/12/17 17:45 摘要__ 手術科部: 外科部 套用罐頭: VATS RML wedge resection + LLL lobectomy 開立醫師: 蔡東明 開立時間: 2009/12/17 17:45 Pre-operative Diagnosis 1.Cecum adenocarcinoma with liver metastasis s/p right hemicolectomy+hepatic resection and chemotherapy 2.RML and LLL lung tumors, suspect metastasis Post-operative Diagnosis Ditto Operative Method VATS RML wedge resection + LLL lobectomy Specimen Source and Count 1.RML wedge 2.LLL lung, 3.Gr.10 LN Pathology Pending Operative Findings 1.One 1.6*1.5cm yellowish-whitish nodule was noted at RML, pleural retraction (+) 2.One 4.3*3cm yellowish-whitish mass was noted at LLL, near B6 bronchus 3.One 0.8*0.5cm blackish firm LN was noted at RUL/RML fissure 4.Post-op air-leakage at right thoracic cavity Operative Procedures 1.DLETGA, left decubitus 2.Skin disinfection and drapping 3.VATS setting 4.Wedge resection for RML tumor 5.Dissect RML/RUL fissure to locate the LN 6.Set-up one Fr.24 chest tube 7.Close the wound in layers 8.Shift position to right decubitus 9.VATS setting 10.Dissect for pulmonary vessels 11.Transect inf. pulmonary vein by endoGIA 12.Transect pulmonary artery to LLL 13.Transect LLL branchus and remove LLL 14.Normal saline irrigation and check air-leakage and bleeding 15.Set-up one Fr.28 chest tube 16.Close the wound in layers Operators VS陳晉興 Assistants R3蔡東明 R2黃柏誠 手術日期：2009/12/18 15:37 摘要__ 手術科部: 泌尿部 套用罐頭: TUR-BT 開立醫師: 柯智群 開立時間: 2009/12/18 15:37 Pre-operative Diagnosis Bladder tumor, hematuria Post-operative Diagnosis Bladder tumor, hematuria Operative Method TURBT(Transurethral resection of bladder tumor) Pathology pending Operative Findings 1. Multiple small necrotic tumors at posteior wall, superficial. 2. Engorged vessels with general bladder wall oozing Operative Procedures 1. Under satisfactory anesthesia with the patient in the lithotomy position, prepping and draping were performed in the usual sterile method. 2. A Fr 22 Olympus Resectoscope was inserted into the urethra and bladder, and the whole bladder was inspected carefully. This revealed presence of tumors located at posterior wall. Trigone and bilateral orifices were identified and inspected carefully. 3. The tumors wereresected with resectoscope, piece by piece. 4. The resected tissues were removed. 5. Adequate hemostasis was then obtained. 6. A 22Fr. 3-way Foley catheter was inserted and continuous bladder irrigation with normal saline started. 7. The balloon was inflated to 10 cc. 8. The patient was then sent to the recovery room in a stable condition. Operators 劉詩彬, Assistants 柯智群, 手術日期：2009/12/18 18:45 摘要__ 手術科部: 外科部 套用罐頭: Permcath/port-A 開立醫師: 謝永 開立時間: 2009/12/18 18:45 Pre-operative Diagnosis Soft tissue tumor Post-operative Diagnosis s/p port-A insertion Operative Method port-A implantation via right internal jugular vein Specimen Source and Count nil Pathology nil Operative Findings 1. The port-A catheter was inserted via right internal jugular vein by echo-guided procedure 2. Patent flow after implantation 3. Tip position located at RA/SVC junction Operative Procedures -Anesthesia: local anesthesia, the patient was put on supine position. The operation field was disinfected and draped as usual. -Port-A: After skin disinfection and drapping & local anesthesia, echo-guided RIJV catheterization was performed. Creation of the subcutaneous pocket at right subclavicular area. Tunneliztion, advanced the catheter into the RIJV via the peel-away sheath smoothly. Ensure the catheter tip position by portable CXR. Wound closure in layers after adequate hemostasis. Operators 王水深, Assistants 謝永, 手術日期：2009/12/21 20:19 摘要__ 手術科部: 外科部 套用罐頭: Right parietal burr hole for hematoma removal` 開立醫師: 曾峰毅 開立時間: 2009/12/21 20:19 Pre-operative Diagnosis Acute subdural hematoma Post-operative Diagnosis ditto Operative Method Right parietal burr hole for hematoma removal` Right parietal burr hole for hematoma removal Pathology nil Operative Findings About 1cm thick hematoma was noted at subdural space. Brain expanded after hematoma removal. Operative Procedures Under endotracheal general anaesthesia, the patient was put in supine position with head rotated to left. After scalp shaved, scrubbed, disinfected, and then draped, we made one linear incision about 4cm posterior to previous operation wound. One burr hole was made with air-drill, and dura was incised in X-shape. Hematoma was removed, and subdural normal saline irrigation was done. Hemostasis was achieved by Gelfoam packin. The wound was closed in layers. Operators VS 曾漢民 Assistants R6 李建勳 R3 曾峰毅 手術日期：2009/12/21 13:30 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT Pre-operative Diagnosis Craniopharyngioma Post-operative Diagnosis Ditto Operative Method Right frontal craniectomy Pathology Nil Operative Findings The brain protruded outward even under Mannitol and hyperventilation. Right frontal lobe laceration was noted during protruding. Tumor excision was canceled due to severe brain swelling. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position. The scalp was shaved, scrubbed, disinfected with alcohol B-I then draped. The right frontal craniectomy was performed with high speed air drill. The dura was opened after tenting. The brain parenchyma protruding and laceration were noted after opened the dura. Tumor excision was canceled due to severe brain swelling. The skull plate was not put back for decompression and the skin was closed with interrupted 2-0 silk sutures. Operators 曾漢民 Assistants 李建勳,朱峻緯 手術日期：2009/12/22 14:35 摘要__ 手術科部: 外科部 套用罐頭: C5 corpectomy + anterior fusion with autologu... 開立醫師: 陳睿生 開立時間: 2009/12/22 14:35 Pre-operative Diagnosis C4/5, 5/6 stenosis with OPLL Post-operative Diagnosis C4/5, 5/6 stenosis with OPLL Operative Method C5 corpectomy + anterior fusion with autologus bone graft and fixation with plate Specimen Source and Count nil Pathology Nil Operative Findings Degenerative spondylosis was noted with narrowing disc spce at C4/5, 5/6. PLL calcification with narrowing spinal canal was found after C5 corpectomy. The PLL was adhered to the dura. An iliac bone graft was extracted from left side and used for fusion. A 37mm Synthes cervical plate was used and fixed at C4, graft, C6 by 6 screws. Operative Procedures 1. ETGA, supine with head mild extension 2. Right neck transverse incision 3. Split between SCM and trachea, esophagus 4. Expose the pre-vertebral space, and C-arm localize C5 level 5. Set self retractor between C4/5 and C5/6 6. Microdiskectomy over C4/5, and C5/6 disk 7. C5 corpectomy was performed with Midas drill 8. Remove of calcified PLL for decompression 9. Transversely incise into LLQ region and expose the left side iliac crest 10.Extract a piece of iliac bone as graft 11.Insert the bone graft into the C5 space 12.Set the plate and fix with screws over C4, graft, and C6 (x2 separately) 13.Hemostasis, set a minihemovac 14.Close the wound in layers Operators VS 賴達明 Assistants R5 陳睿生; Ri 手術日期：2009/12/22 09:38 摘要__ 手術科部: 外科部 套用罐頭: MRM 開立醫師: 李雅萍 開立時間: 2009/12/22 09:38 Pre-operative Diagnosis left breast tumor Post-operative Diagnosis left breast tumor Operative Method Left breast tumor excision Specimen Source and Count 1 piece About size:2x2cm Source:left breast Pathology pending Operative Findings A 2x2cm left breast firm tumor at 3 o''clock to the nipple. Operative Procedures 1. IVG, supine position, skin disinfection 2. Make a linear incision near the nipple-areolar complex. 3. Perform tumor excision 4. Check bleeding and wound closure 1. IVGA, supine position, skin disinfection Operators 黃俊升 Assistants 鄭宗杰 李雅萍 廖思涵 手術日期：2009/12/22 16:15 摘要__ 手術科部: 套用罐頭: 1. Spinal tumor excisional biopsy, 2. Adhesio... 開立醫師: 鍾文桂 開立時間: 2009/12/22 16:15 Pre-operative Diagnosis Primitive neuroectodermal tumor status post C7-T3 laminectomy and right T1-2 foraminotomy(2007/09/12) with suspected tumor recurrence at right T1-2 levels. Primitive neuroectodermal tumor status post C7-T3 laminectomy and right T1-2 foraminotomy(2007/09/12) with tumor recurrence at T1-2 levels. Post-operative Diagnosis Primitive neuroectodermal tumor status post C7-T3 laminectomy and right T1-2 foraminotomy(2007/09/12) with suspect fibrotic change, R/O recurrence at T1-2 levels. Primitive neuroectodermal tumor status post C7-T3 laminectomy and right T1-2 foraminotomy(2007/09/12) with postoperative fibrotic change and adhesions and suspected tumor recurrence at T1-2 levels. Operative Method 1. Spinal tumor excisional biopsy of epidural mass, bone, and paravertebral muscle 1. Spinal tumor excisional biopsy, 2. Adhesiolysis for spinal cord decompression. Specimen Source and Count 2 pieces About size: Source:T 1-2 epidural tissue and paraspinal muscle. About size: Source:T2 lamina. 3 pieces About size: Source: T1-2 epidural tissue, paraspinal muscle, and right pedicle and lamina. Pathology Pending. Operative Findings 1. Severe adhesion and fibrotic change at the previous operative site. No obvious tumor tissue was noted in the right epidural, bone, and paravertebral muscle. 2. Dura mater: intact after decompression, no CSF leakage. 3. Intraoperative sonography to locate the thecal sac because of severe fibrotic change, and the obscure tissue plane. 1. Severe adhesion and fibrotic change at the previous operative site. 2. Dura mater: intact after decompression, no obvious CSF leakage. 3. Intraoperative sonography to locate possible tumor site and spinal cord throuogh the severe fibrotic change, and the obscure tissue plane. Several biopsies in possibe tumor recurrence sites at epidural space(with fibrotic change), right paraspinal muscle( with gross change of tissue character, more yellowish), and T1 pedicle were done . No gross tumor lesion was noted. 4. Several biopsies in possibe tumor recurrence sites at epidural space(with fibrotic change), right paraspinal muscle( with gross change of tissue character, more yellowish), and T1 pedicle were done . 5. No gross tumor lesion was noted. Operative Procedures Incision was along the previous operative site and according to the preoperative metal marking and X-ray localization on skin. Meticulous dissection was done along the midline. Due to obscure operative plane with much fibrotic change, intraoperative sonography was performed to locate the spinal cord. The fibrotic tissue surrounding the thecal sac on right side from C7 to T3 was lysed and sent for pathology. The remaining lamina and pedicle was removed for pathology. The paravertebral muscle was dissected from the T1-2 foramen and then from the lateral margin of the muscle about 2.5 cm lateral to the midline to the medial part. No obvious tumor could be found. One grossly more yellowish spot at right paraspinal muscle was also biopsied. After well hemostasis and one epidural CWV drain placement, the wound was closed in layers. The patient was sent to POR smoothly. Under ETGA, the patient was put in prone position and her head was turned to the right side. Incision was along the previous operative site. Meticulous dissection was done along the midline. Due to obscure operative plane with much fibrotic change, intraoperative sonography was performed to locate the spinal cord and possible tumor(not seen in sonography). The fibrotic tissue surrounding the spinal cord was lysed to free the cord. The fibrotic tissue anterior to the cord at T1-2 level was biopsied. One grossly more yellowish spot at right paraspinal muscle and part of the right T2 pedicle were also biopsied. After well hemostasis and one epidural CWV drain placement, the wound was closed in layers. The patient was sent to POR smoothly. Operators V.S. 郭夢菲. Assistants R4 鍾文桂 Ri薛雅元. 手術日期：2009/12/23 22:04 摘要__ 手術科部: 外科部 套用罐頭: Permcath/port-A 開立醫師: 謝永 開立時間: 2009/12/23 22:04 Pre-operative Diagnosis Leukemia Post-operative Diagnosis s/p port-A insertion Operative Method port-A implantation via right internal jugular vein Specimen Source and Count nil Pathology nil Operative Findings 1. The port-A catheter was inserted via right internal jugular vein by echo-guided procedure 2. Patent flow after implantation 3. Tip position located at RA/SVC junction Operative Procedures -Anesthesia: local anesthesia, the patient was put on supine position. The operation field was disinfected. -Port-A: After skin disinfection and drapping & local anesthesia, echo-guided RIJV catheterization was performed. Creation of the subcutaneous pocket at right subclavicular area. Tunneliztion, advanced the catheter into the RIJV via the peel-away sheath smoothly. Ensure the catheter tip position by portable CXR. Wound closure in layers after adequate hemostasis. Operators 王水深, Assistants 謝永, 手術日期：2009/12/24 03:42 摘要__ 手術科部: 外科部 套用罐頭: right parietal craniotomy with total tumor ex... 開立醫師: 林哲光 開立時間: 2009/12/24 03:42 Pre-operative Diagnosis Esophageal cancer with right parietal metastasis Post-operative Diagnosis Ditto Operative Method right parietal craniotomy with total tumor excision Pathology Pending Operative Findings The tumor was elastic to firm in character 6.2cm in size. It is located at right parietal lobe with the border was clear. Vascularity was low. Operative Procedures Under ETGA and prone position with head fixed with Mayfield head clump, skin disinfected and drapped were performed as usual. U shape skin incision was performed and right parietal craniotomy was performed after 5 burr holes were created wtih 3 of them created near the midline. Central debulking of the tumor was done and then dissected along the border of tumor with bipolar and sucker. Hemostasis with surgcells was done. Dura closure and duroplasty with pericranium were performed. The bone graft was fixed with wire. The wound was closed in layers after subgaleal drain inserted. Operators 曾漢民 Assistants 陳盈志, 林哲光 手術日期：2009/12/24 11:12 摘要__ 手術科部: 外科部 套用罐頭: VATS subtotal esophagectomy + laparotomy for ... 開立醫師: 李佳穎 開立時間: 2009/12/24 11:12 Pre-operative Diagnosis Esophageal squamous cell carcinoma, T3N1M0, s/p CCRT Post-operative Diagnosis Esophageal squamous cell carcinoma, T3N1M0, s/p CCRT Operative Method VATS subtotal esophagectomy + laparotomy for gastric tube reconstruction via posterior mediastinal route with cervical esophago-gastrostomy + feeding jejunostomy and pylomyoplasty Specimen Source and Count 1.Esophagus*1, 10-20cm length 2.Stomach*1, around 3cm length 3.Esophago-gastric ring*1, around 2cm 4.Gr.106,107,110 LN*1 Pathology pending Operative Findings 1.Around 5cm length, fibrotic area with wall thickening in 32-37cm below the incisor, no mass or ulcerative area was found 2. Gr. 106, 107, 110 LN were dissected 3. Severe adhesion between stomach, diaphragm and omentum 4. Jejunostomy was created and fixed at 55cm Operative Procedures 1.DLETGA, left decubitus 2.Disinfection and drapping 3.VATS as usual setting 4.Transect Azygos vein by endo GIA-30 5.Dissect and mobilize esophagus 6.Gr. 106,107,110 LN dissection 7.Check bleeding and air-leak 8.Chest tube Fr.28*1 9.Closed the wound in layers 10.ETGA, supine position 11.Chest tube Fr.28*1 at left side 12.Laparotomy 13.Adhesiolysis of abdomen, identified the esophagus 14.Gastric tube shaping by endo GIA-45 15.Pyloplasty 16.Gastric tube reconstruction via posterior mediastinal route with cervical esophago-gastrostomy anastomosis 17.N/S irrigation of abdomen and neck after NG fixation 18.R/D*2 at subhepatic and subphrenic area Penrose*2 at neck 19.Jejunostomy creation 20.Closed the wound in layers(abdomen) Partial closure of neck wound(wet dressing Q8H) Operators VS李章銘 Assistants R5梁嘉儀,Ri許雅睿,Ri陳以幸 許麗昭 (F,1962/08/15,49y6m) 手術日期 2009/12/24 手術主治醫師 廖漢文 手術區域 東址 000房 號 診斷 Subarachnoid hemorrhage 器械術式 NEURO T.A.E 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 3 時間資訊 08:00 臨時手術NPO 08:00 開始NPO 15:35 麻醉開始 16:00 誘導結束 18:15 麻醉結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術日期：2009/12/25 01:38 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for tumor excision 開立醫師: 朱峻緯 開立時間: 2009/12/25 01:38 Pre-operative Diagnosis Left parietal lobe tumor Post-operative Diagnosis Left parietal lobe tumor Operative Method Craniotomy for tumor excision Specimen Source and Count Left parietal lobe tumor Pathology pending Operative Findings One 1.5 cm3 grayish, soft tumor at left parietal area with a well defined border. The tumor was hypervascular. Operative Procedures 1.ETGA, supine with head fixed. 2.Left parietal reverse U shape skin incision 3.Reflect skin flap 4.Craniotomy 5.Dural opening with the base left at midline 6.Tumor excision with forceps and suction 7.Hemostasis 8.Fixed bone back with wire 9.Set CWV drain then close the wound in layers Operators VS曾漢民 Assistants R5胡朝凱 R1朱峻緯 手術日期：2009/12/25 01:32 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for tumor excision 開立醫師: 朱峻緯 開立時間: 2009/12/25 01:32 Pre-operative Diagnosis Right parietal lobe tumor Post-operative Diagnosis Right parietal lobe tumor Operative Method Craniotomy for tumor excision Specimen Source and Count 1 piece, About size: 3.5x3.0x3.6 cm, Source:Right parietal lobe tumor 1 piece About size: Source: Pathology pending Operative Findings 2. A cystic portion was also noted at the bottom of the tumor 1. One 3.5x3.0x3.6 cm grayish, soft,easy suckable tumor located beneath right sensory cortex with a relative ill defined margin. Operative Procedures 1.ETGA, supine with head fixed. 2.Right reverse U shape skin incision 3.Reflect skin and periosteal layer 4.Craniotomy 5.Navigation localization 6.Dural opening with the base left at midline 7.Transsulcus approach and tumor excision 8.Hemostasis 9.Fixed bone back with wire after dural closure 9.Set CWV drain then close the wound in layers Operators VS曾漢民 Assistants R5胡朝凱 R1朱峻緯 手術日期：2009/12/25 16:20 摘要__ 手術科部: 外科部 套用罐頭: Open reduction and internal fixation 開立醫師: 陳思恆 開立時間: 2009/12/25 16:20 Pre-operative Diagnosis Left orbital rim and zygomatico-maxillary complex fracture Post-operative Diagnosis Ditto Operative Method Open reduction and internal fixation Operative Findings 1. Left maxillary fracture at lateral buttress and medial buttress with minimal displacement; but the entire maxilla was depressed compared to the midline structure. 2. Left zygoma fracture at the inferior orbital rim and between the lateral buttress; the frontozygomatic junction was intact. 3. The inferior orbital rim was displaced, and the medial orbital floor was also fractured; but there was no herniation of orbital content or incarceration of EOM. 4. The lateral buttress and the inferior orbital rim were fixed with miniplates. Operative Procedures ETGA, supine, antiseptics applied. Incision along lateral orbit laceration wound and transconjunctiva and superior gingival sulcus to explore the fracture sites. Dingman reduction. Fixation with miniplates. Wound closure in layers. Operators 謝孟祥 Assistants 陳思恆, 高明蔚, 徐吉全 許麗昭 (F,1962/08/15,49y6m) 手術日期 2009/12/25 手術主治醫師 廖漢文 手術區域 東址 000房 號 診斷 Subarachnoid hemorrhage 器械術式 NEURO T.A.E 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 4E 時間資訊 08:00 臨時手術NPO 18:20 麻醉開始 18:25 誘導結束 19:15 麻醉結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術日期：2009/12/26 16:30 摘要__ 手術科部: 外科部 套用罐頭: Wide excision of malignant soft tissue tumor 開立醫師: 陳思恆 開立時間: 2009/12/26 16:30 Pre-operative Diagnosis Suspect epithelioid sarcoma recurrence Post-operative Diagnosis Ditto, with hematoma formation Operative Method Wide excision of malignant soft tissue tumor Operative Findings A 8 x 6 x 6 cm tumor with hematoma component (at the superficial side) was noted at left buttock, which extended from the subcutaneous layer to the ischial tuberosity and along the ischial bone to the lateral side of the anal canal. The tumor was medial to the piriformis muscle. The hematoma was about more than 50 ml. The base of the tumor was adhesed to the ischial bone and was more firm and solid in character. Operative Procedures ETGA, prone, antiseptics applied. Fusiform incision of skin. Wide excision of the tumor along the subcutaneous fat and elevate the tumor at the level of gluteus fascia and the periosteum of the ishium. Hemostasis. Marking of the tumor location for the oncoradiologists with hemoclips (x 5). Two CWV inserted. Wound closure in layers. Operators 戴浩志 Assistants 陳思恆, 官振翔 手術日期：2009/12/28 19:41 摘要__ 手術科部: 外科部 套用罐頭: Left pterional approach tumor excision, Simps... 開立醫師: 林哲光 開立時間: 2009/12/28 19:41 Pre-operative Diagnosis Recurrent left sphenoidal ridge meningioma Post-operative Diagnosis Ditto Operative Method Left pterional approach tumor excision, Simpson grade III Specimen Source and Count Tumor Pathology Pending Operative Findings One 7cm sized, elastic-hard, ill-defined mass over left temporal lobe, sphenoidal ridge in origin, with extension to sellar, suprasellar area and middle fossa and compressing brainstem. It directly invaded into left cavernous sinus with left ICA included. Left optic nerve atrophic change was also noted. One cyst was noted with clear CSF content and connected to the lateral ventricle was noted. Operative Procedures Under ETGA and supine position with head rotated to right side and fixed with Mayfield head clump, skin disinfected and drapped were performed as usual. Skin incision was done along the previous operative wound. The previous craniotomy window was opened after removal of mini-plates. The sphenoidal ridge was removed with air-drill with medial part of left untouch. The dura was then opened after dura tenting. The cyst was opened and clear fluid was drained out. Central debulking of the tumor was done with Cusa over left temporal area. The tumor over middle fossa and cavernous sinus were also removed. The distal ICA and branches were identified and the tumor detached from these structures carefully and preserved. Hemostasis with Surgecells packing was done and the dura was closed in water-tie method. EVD was inserted into lateral ventricle and fixed over the scalp. The wound was then closed in layers after subgaleal drain inserted. Operators P 杜永光 Assistants CR 陳盈志, R3 林哲光 手術日期：2009/12/28 15:30 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT Pre-operative Diagnosis Left tentorial meningioma Post-operative Diagnosis Ditto Operative Method Left parietal craniotomy for transcortical tumor excision Pathology Pending Operative Findings The tumor was white-greyish, some part was soft and other parts were elastic with high vascularity. The part encased normal brian vessels were left in situ. 35mm EVD was inserted at tumor cavity after opened the lateral ventricle. Operative Procedures Under general anesthesia and intubation, the patient was put in prone position with head fixed with Mayfield skull clump. The scalp was shaved, scrubbed, disinfected with alcohol B-I then draepd. The hocky-stick scalp incision was made at the left parietal area and performed the craniotomy. The dura was opened along the craniotomy edge after located the tumor with intraoperative sonography. The tumor excision was started with central debulky with tumor forceps via transcortical approach. The hemostasis was achieved with bipolar coagulation, surgicel packing and Floseal. Tumor excision was performed with bipolar coagulation and tumor forceps piece by piece. The final pieces of the tumor which encased the normal brain vessels were left in situ. 35mm EVD wasinserted at tumor cavity after opened the lateral ventricle. The dura was closed with 4-0 Prolene sutures. The skull plate was fixed back with wires with central tenting. The wound was closed in layers after one epidural CWV drain set up. Operators 曾漢民 Assistants 李建勳,朱峻緯 手術日期：2009/12/28 11:40 摘要__ 手術科部: 外科部 套用罐頭: VATS RML wedge resection and pleural biopsy 開立醫師: 雷秋文 開立時間: 2009/12/28 11:40 Pre-operative Diagnosis Right multiple nodules, r/o malignancy, s/p port-A insertion Post-operative Diagnosis Right lung adenocarcinoma Operative Method VATS RML wedge resection and pleural biopsy Specimen Source and Count 2 pieces About size:2 CM Source:RML lung tumor About size:4 cm Source:pleura Pathology pending Operative Findings 1. Around 2 cm, whitish, elastic to firm mass was noted in RML, frozen: adenocarcinoma 2. Several whitish, firm plaques were found in pleura Operative Procedures 1. DLETGA, left decubitus 2. disinfection and drapping 3. VATS as usual 4. Identified the mass 5. Pleural biopsy 6. RML wedge resection by endo GIA-60, 45 7. Send to frozen 8. Check bleeding and hemostasis 9. chest tube Fr. 28x1 10. Closed the wound in layers Operators P 李元麒，VS 徐紹勛 Assistants R5 梁嘉儀，R5 張彥俊，R1 雷秋文 手術日期：2009/12/31 19:31 摘要__ 手術科部: 外科部 套用罐頭: Thoracotomy for tumor excision 開立醫師: 雷秋文 開立時間: 2009/12/31 19:31 Pre-operative Diagnosis Left chest wall tumor, r/o neuroectodermal tumor, recurrence Post-operative Diagnosis Ditto Operative Method Thoracotomy for tumor excision Specimen Source and Count 1 piece About size:5 x 3.5 cm Source:paraspinal tumor Pathology pending Operative Findings 1. Around 5cm x 3.5cm, at the 9th, 10th rib elastic to firm mass 2. the 9th, 10th rib, partial resection Operative Procedures 1. ETGA, right decubitus 2. Disinfection and drapping 3. Thoracotomy, the 9th ICS 4. Resection of anterior side of the 9th, 10th rib 5. Dissect along the 8th ICS and 10th ICS 6. Resection of posterior side of the 9th, 10th rib 7. Tumor with 9th, 10th partial rib resection 8. Check bleeding and hemostasis 9. chest tube Fr. 28 x 1 10. closed the wound in layers Operators VS 陳晉興 Assistants R5 梁嘉儀，R1 雷秋文 林秋和 (M,1945/10/10,66y5m) 手術日期 2009/12/31 手術主治醫師 陳敞牧 手術區域 東址 005房 03號 診斷 Patients requiring long-term use of a respirator due to respiratory failure, use respirator 6 hours per day continue 30 days 器械術式 Brain tumor Crainotomy(Others) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 5E 紀錄醫師 郝政鴻, 時間資訊 18:05 進入手術室 18:10 麻醉開始 18:20 誘導結束 18:30 開始輸血 18:40 抗生素給藥 18:45 手術開始 21:55 抗生素給藥 23:20 手術結束 23:20 麻醉結束 23:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 1 L 手術 顱內壓監視置入 1 2 L 手術 頸動脈結紮術－急性結紮 1 4 L 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 記錄__ 手術科部: 外科部 套用罐頭: Left F-T-P cranioectomy hematoma evacuation +... 開立醫師: 郝政鴻 開立時間: 2010/01/01 07:26 Pre-operative Diagnosis DIFFUSE SAH WITH SEVERE BRAIN SWELLING, F-T ICH Post-operative Diagnosis Ditto Operative Method Left F-T-P cranioectomy hematoma evacuation + Duroplasty + ICP monitor insertion + left cervical ICA ligation Specimen Count And Types nil Pathology Nil Operative Findings The brain was severe swelling. Diffuse SAH was noted. After dura opening the brain buldging out and blood jet out from sylvian fissure. Due to severe swelling. Temporal tip resection was done. Hematoma was noted at F-T lobe under sonography, which was evacuated. The ICP after skin closure was 15~18 mmHg. Pospoperation pupil size R/L: 2/4 mm Operative Procedures ETGA Supine head tilt to right Left F-T-P trauma flap Burr hole x 5 craniotomy U-shape dura opening The brain swelling was noted then blood jet out from Sylvian fissure corticotomy hematoma evacuation then due to severe brain swelling temproal tip resection then cauterize MCA. Expose neck ICA then ligation for hemostasis Duroplaasty with Duraform ICP monitor to temporal base Hemostasis, epidurl CWV x2 Closed wound in layers Operators 陳敞牧 Assistants 陳盈志 郝政鴻 Indication Of Emergent Operation 手術日期：2009/12/31 13:56 摘要__ 手術科部: 外科部 套用罐頭: Graft removed and abscess drainage iwth debri... 開立醫師: 蕭惠壬 開立時間: 2009/12/31 13:56 Pre-operative Diagnosis Head injury with s/p craniectomy s/p cranioplasty;with artificial graft extrusion Post-operative Diagnosis Ditto Operative Method Graft removed and abscess drainage with debridement Graft removed and abscess drainage iwth debridement Specimen Source and Count 1 piece sent for culture ; Source:epidural abscess Pathology nil Operative Findings The artificial graft was noted to extrude at temporal side. Granulation tissue with old abscess were noted at both subgaleal and epidural side. The artificial graft was noted to extrude at temporal side. Granulation tissue with old abscess were noted at both subgaleal and wpidural side. Operative Procedures 1. ETGA. Supine with head left turn 2. Open the wound at frontal portion 3. Dissect the plane between granulation tissue and artificial plate 4. Remove of the plate with wire *5 cutting down 5. Debridement with curette 6. Set a CWV, close the wound interruptly Operators VS 王國川 Assistants R5 陳睿生 R1 蕭惠壬 張慶進 (M,1966/07/10,45y8m) 手術日期 2010/01/01 手術主治醫師 蔡瑞章 手術區域 東址 002房 01號 診斷 Nasopharynx cancer ( NPC ) 器械術式 Ommaya reservoir implantation 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 3E 紀錄醫師 許松鈺, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 09:20 進入手術室 09:20 麻醉開始 09:25 誘導結束 10:10 手術開始 10:50 手術結束 10:55 麻醉結束 11:00 送出病患 11:25 進入恢復室 12:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 歐氏貯囊置放手術 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Left Kocher point omaya reservoir implantation 開立醫師: 李建勳 開立時間: 2010/01/01 11:56 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Ditto Operative Method Left Kocher point omaya reservoir implantation Left Kocher point ommaya reservoir implantation Specimen Count And Types nil Pathology Nil Operative Findings CSF opening pressure: 15 cmH2O. Set drainage pressure: 15cmH2O Operative Procedures Under general anesthesia and tracheostomy ventilation, the patient was put in supine position. The scalp was shaved, scrubbed, disinfected with alcohol B-I then draped. Curvilinear scalp incision was made at left frontal region followed by burr hole creation. The dura was incised after tenting with 3-0 silks. A ventricular puncture needle was used to puncture then shifted to ventricular catheter of omaya reservoir. Fixed the omaya reservoir at scalp and checked the function. The wound was closed in layers and inserted needle to the reservoir and connected to the drainage system. Operators P蔡瑞章 Assistants R6李建勳R1許松鈺 Indication Of Emergent Operation 林秋和 (M,1945/10/10,66y5m) 手術日期 2010/01/01 手術主治醫師 陳敞牧 手術區域 東址 027房 03號 診斷 Patients requiring long-term use of a respirator due to respiratory failure, use respirator 6 hours per day continue 30 days 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 4E 紀錄醫師 許松鈺, 時間資訊 20:22 臨時手術NPO 20:22 開始NPO 20:23 通知急診手術 21:30 進入手術室 21:35 麻醉開始 21:40 誘導結束 22:18 手術開始 23:00 抗生素給藥 00:45 手術結束 00:45 麻醉結束 00:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 內科部 套用罐頭: Right termporal craniectomy for hematoma evac... 開立醫師: 李建勳 開立時間: 2010/01/02 01:12 Pre-operative Diagnosis Bilateral frontotemporal ICH s/p right craniectomy Bilateral frontotemporal ICH s/p left craniectomy Post-operative Diagnosis Bilateral frontotemporal ICH s/p right craniectomy Bilateral frontotemporal ICH s/p left craniectomy Operative Method Right termporal craniectomy for hematoma evacuation Right temporal craniectomy for hematoma evacuation Specimen Count And Types nil Pathology Nil Operative Findings The hematoma was dense over right Sylvian fissure. About 50 mL blood clot was evacuation. The ICP after wound closure was 12mmHg. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position with head turned to left. The scalp was shaved, scrubbed, disinfected with alcohol B-I then draped. The linear scalp incision was made at left temporal area followed by craniectomy with high speed air drill. The dura was opened in cruciated fashion. The hematoma evacuation was performed with suction, tumor forcpes and bipolar coagulation to achieve hemostasis. The hemostasis was futher done with surgicel lining of the hematoma bed. The wound was closed in layers after one epidural CWV drain set up. Under general anesthesia and intubation, the patient was put in supine position with head turned to left. The scalp was shaved, scrubbed, disinfected with alcohol B-I then draped. The linear scalp incision was made at right temporal area followed by craniectomy with high speed air drill. The dura was opened in cruciated fashion. The hematoma evacuation was performed with suction, tumor forcpes and bipolar coagulation to achieve hemostasis. The hemostasis was futher done with surgicel lining of the hematoma bed. The wound was closed in layers after one epidural CWV drain set up. Operators vs陳敞牧 Assistants R6李建勳 R1許松鈺 Indication Of Emergent Operation 手術日期：2010/01/04 12:54 摘要__ 手術科部: 外科部 套用罐頭: Laparoscopic subtotal gastrectomy, with B-II ... 開立醫師: 莊民楷 開立時間: 2010/01/04 12:54 Pre-operative Diagnosis Gastric tumor, suspected GIST Post-operative Diagnosis Gastric tumor, suspected GIST Operative Method Laparoscopic subtotal gastrectomy, with B-II reconstruction Specimen Source and Count 1 piece About size:6X8cm Source:stomach Pathology pending Operative Findings 1. one lobulated submucosal solid tumor, 6.5cm, over anteiror wall to greater curvature site of antrum; no direct invasion to surrounding tissue 2. several LAPs around 1.5~2cm in group 1, 3, 5, 6 LNs, which were excised 1. one whitish ulcerative solid tumor, 2.5x1cm, over anteiror wall to greater curvature site of antrum to pylorus; no direct invasion to surrounding tissue noted 2. no obvious LAPs noted, group 5, 6 LNs were excised 3. minimal clear ascites Operative Procedures 1. ETGA, supine with lithotomy position 2. Disinfection and drapping 3. Set one 10mm camera port subumbilically; set three 10-10-2mm working ports over right mid-abdomen, left mid-abdomen, and subxyphoid area 4. Posterior wall dissection 5. Dissect along hepatoduodenal ligament 6. Divide proximal duodenum with endo-GIA 7. Dissect along greater and lesser curvature till upper body 8. Transect stomach over upper body with endo-GIA 9. Perform B-II reconstruction with gastrojejunostomy form 45cm below Treiz ligament 10. Hemostasis 11. Set one CWV drain over right subhepatic area 12. Minimal lower midline laparotomy; harvest the specimen 13. Close the wound in layers Operators VS 林明燦 Assistants R5 丘基泰, R5 楊雅雯, R2 莊民楷 楊昀庭 (M,1984/09/06,27y6m) 手術日期 2010/01/04 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Intracerebral hemorrhage 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 4E 紀錄醫師 李振豪, 時間資訊 06:00 臨時手術NPO 06:00 開始NPO 14:38 通知急診手術 15:02 進入手術室 15:07 麻醉開始 15:20 抗生素給藥 15:30 誘導結束 16:08 手術開始 18:50 抗生素給藥 21:50 抗生素給藥 22:45 手術結束 22:45 麻醉結束 22:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 開顱術摘除血管病變－動靜脈畸型－小型－深部 1 1 手術 腦室體外引流 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 7 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: (1)Suboccipital craniectomy for AVM resection... 開立醫師: 李建勳 開立時間: 2010/01/04 23:13 Pre-operative Diagnosis Cereberllar hemorrhage with IVH suspect AVM bleeding Post-operative Diagnosis Cereberllar hemorrhage with IVH suspect AVM bleeding Operative Method (1)Suboccipital craniectomy for AVM resection and hematoma evacuation (2)Right Frazier EVD insertion Specimen Count And Types 1 piece About size:1g Source:AVM resection Pathology Pending Operative Findings CSF openeing pressure: 25cm H2O. The hematoma was located at upper cerebellum near AVM. Several feeding arteries and two main drainage veins were found and coagulated. Operative Procedures Under general anesthesia and intubation, the patient was put in prone position with head fixed with Mayfield skull clump. The scalp was shaved, scrubbed, disinfected with alcohol B-I then draped. The right Frazier point EVD was inserted for releasing the CSF. The midline scalp incision was made 2cm above inoin down to the C2 spinous process. Seperated the nuchal muscles and paraspinal muscles to perform the suboccipital craniectomy. The dura was opened in V-shaped. The hematoma evacuation was performed with bipolar coagulation via transcortical approach. The feeding arteries were bipolar coagulated and the drainage veins were temporal clipped before coagulation. The hemostasis was achieved with surgicel lining of the AVM cavity. The duroplasty was performed with fascia graft and 4-0 PRolene sutures. The wound was then closed in layers after one epidural CWV drain set up. Under general anesthesia and intubation, the patient was put in prone position with head fixed with Mayfield skull clump. The scalp was shaved, scrubbed, disinfected with alcohol B-I then draped. The right Frazier point EVD was inserted for releasing the CSF. The midline scalp incision was made 2cm above inion down to the C2 spinous process. Seperated the nuchal muscles and paraspinal muscles to perform the suboccipital craniectomy. The dura was opened in V-shaped. The hematoma evacuation was performed with bipolar coagulation via transcortical approach. The feeding arteries were bipolar coagulated and the drainage veins were temporal clipped before coagulation. The hemostasis was achieved with Surgicel lining of the AVM cavity. The duroplasty was performed with fascia graft and 4-0 Prolene sutures. The wound was then closed in layers after one epidural CWV drain set up. Operators 賴達明 Assistants 李建勳 李振豪 Indication Of Emergent Operation 手術日期：2010/01/05 18:21 摘要__ 手術科部: 套用罐頭: Implantation of ventricular-peritonral shunt ... 開立醫師: 鍾文桂 開立時間: 2010/01/05 18:21 Pre-operative Diagnosis Hydrocephalus. Post-operative Diagnosis Hydrocephalus. Operative Method Implantation of ventricular-peritonral shunt via right Kocher point. Specimen Source and Count nil Pathology Nil. Operative Findings 1. Clear colorless high-pressure CSF gushed out from ventriculostomy tube. 2. Medtronic meduim pressure reservoir was implanted. Operative Procedures Under ETGA, the patient was put in supine position and the head was slightly tilted to the left. The operative area was disinfected and draped. A lunar incision was made at right Kocher point and a transverse incision was made at right upper quadrant of abdomen. After making a burr hole and durotomy, ventriculostomy was made. Subcutaneous tunnel was made from abdomen to head with passage of the shunt. The distal end of the shunt was inserted to the Douglas pouch and the proxomal end was inserted at the ventriculostomy tract after connecting the reservoir. The wounds were closed in layers. The patient was sent to POR smoothly. Operators V.S. 楊士弘. Assistants R4鍾文桂,Ri 薛涵中. 手術日期：2010/01/05 14:19 摘要__ 手術科部: 外科部 套用罐頭: Tumor excision 開立醫師: 吳經閔 開立時間: 2010/01/05 14:19 Pre-operative Diagnosis left thorax lipoma Post-operative Diagnosis Ditto Operative Method Tumor excision Specimen Source and Count 1 piece About size:15*12 Source:lipoma Pathology Pending Operative Findings 1. One 15/12 cm elastic yellowish lipoma was noted at left upper thorax Operative Procedures 1. ETGA 2. Supine position and disinfection 3. Ski inicison 4. Do tumor excision 5. Insert one CWV 6. Close wound in layers Operators 陳炯年 Assistants Wu jin-Ming 許春進 (M,1933/10/12,78y5m) 手術日期 2010/01/05 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Radiculopathy 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 許松鈺, 時間資訊 00:00 臨時手術NPO 07:37 報到 08:05 進入手術室 08:15 麻醉開始 08:25 誘導結束 09:00 抗生素給藥 09:08 手術開始 12:05 手術結束 12:05 麻醉結束 12:15 送出病患 12:15 進入恢復室 13:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 手術 椎弓切除術（特壓）－超過二節 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 摘要__ 手術科部: 外科部 套用罐頭: L3-5 laminectomy and foraminotomy 開立醫師: 陳德福 開立時間: 2010/01/05 14:16 Pre-operative Diagnosis Lumbar stenosis, L3-5 Post-operative Diagnosis ditto Operative Method L3-5 laminectomy and foraminotomy Specimen Count And Types nil Pathology nil Operative Findings 1.The lumbar thecal sac was compressed tightly over L3-5 by the hypertrophic ligamentum flavum and facet joints. The lateral recess was filled with osteophytes. 2.One calcified disc with right L4 root compression was noticed and the calcification was removed under microscopic surgery 3.L3-5 laminectomy and foraminotomy were performed smoothly and the theca sac was decompressed after the procedure 4.One epidural drainage was left in situ Operative Procedures Under ETGA and prone position, the skin was disinfected and draped as usual. Under C-arm flouroscope guided, we identify the L3-5 and make a linear incision in the midline. The paraspinous muscles were displaced laterally. The spinous process of L3-5 was exposed and removed followed by laminectomy. The ligamentum flavum and epidural fat were removed and the osteophytes in the lateral recess was removed as well. The bilateral nerve roots from L4-S1 were identified without injury and the theca sac was decompressed after laminectomy. The nerve root was mobile without limitation after foraminotomy. Hemostais was done and one epidural CWV was left in situ. The wound was closed in layers. Operators 曾勝弘 Assistants R4陳德福 R1許松鈺 相關圖片 手術日期：2009/12/21 07:35 摘要__ 手術科部: 外科部 套用罐頭: 1. fixation of the bone pieces; 2. debridemen... 開立醫師: 陳建璋 開立時間: 2009/12/21 07:35 Pre-operative Diagnosis 1.frontal bone depressed fracture with contralateral ICH; multiple facial laceration wounds Post-operative Diagnosis ditto Operative Method 1. fixation of the bone pieces; 2. debridement and wound repair Specimen Source and Count nil Pathology nil Operative Findings 1. Communicated frontal bone fracture into 8 pieces; they were reducted and fixed with microplates 2. One 15cm laceration wound; another 10cm laceration wound and a preauricular 15cm laceration wound were noted. The perfusion was good Operative Procedures 1. After the neural surgeon taking out the bone pieces, we ressembled them and restored them to normal contour followed by fixation with microplates. 2. The neural surgeon completed their duroplasty and cranioplasty 3. Local debridement over the wounds were performed. The necrotic/ devitalized tissue was removed piecemeally. After careful hemostasis and irrigation with large wmount of normal saline, the wounds were closed in layers, Operators 謝榮賢 Assistants 陳建璋 手術日期：2010/01/05 18:02 摘要__ 手術科部: 外科部 套用罐頭: Cranioplasty and debridement. 開立醫師: 鍾文桂 開立時間: 2010/01/05 18:02 Pre-operative Diagnosis Head injury with left frontal communicated frontal bone fracture. Post-operative Diagnosis Head injury with left frontal communicated frontal bone fracture with dural defect and intracerebeal hemorrhage. Operative Method Cranioplasty and debridement. Pathology Nil. Operative Findings Fragments of frontal and nasal bones were fixed by Plastic Surgeons. Duroplasty was done for the bony defect. A small intracerebral hematoma was noted beneath the dural defect. Operative Procedures Under ETGA, the patient was put in supine position and the head was slightly tilted to the right side. The scalp was incised along the laceration wound to expose left frontal bone. The bone plate was taken out with high speed drill and the fractured bone plates were removed for reconstruction by plastic surgeon on duty. The dural defect was repaired with 3-0 silk after removal of the intracerebral hematoma with well coagulation. The bone plate was fixed with plates and screws. The laceration was was debrided and irrigated with normal saline. The wound was closed and repiared by plastic surgeon on duty. The patient was sent to ICU smoothly. Operators V.S. 蕭輔仁 Assistants R5 胡朝凱,R4 鍾文桂 施怡森 (M,1940/06/07,71y9m) 手術日期 2010/01/05 手術主治醫師 劉宏輝 手術區域 東址 003房 01號 診斷 Spondylosis with myelopathy, cervical 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 08:15 報到 08:20 進入手術室 08:25 麻醉開始 08:30 誘導結束 08:55 抗生素給藥 09:20 手術開始 11:20 手術結束 11:20 麻醉結束 11:30 送出病患 11:32 進入恢復室 12:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 摘要__ 手術科部: 外科部 套用罐頭: Programmable V-P shunt implantation 開立醫師: 李振豪 開立時間: 2010/01/05 11:26 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Ditto Operative Method Programmable V-P shunt implantation Specimen Count And Types Nil Pathology Nil Operative Findings 10cmH2O pressure programmable V-P shunt was implanted via left Kochers point, left retroauricular, left forechest, and left upper abdomen. Antisyphon device was placed at left forechest. The CSF was clear and 20ml CSF was sampled for CSF study. Ventricular catheter: 6.5cm, Peritoneal catheter: 20cm Operative Procedures Under endotracheal tube general anesthesia, the patient was put at supine position with head turned to right. The scalp was shaved, scrubbed, and disinfected. The left forechest and left upper abdomen was also disinfected as usual. One linear scalp incision was made at left Kochers point followed by one burr hole. After dura opening, ventricular puncture was performed and the ventricular catheter was placed. One linear skin incision was made over left upper abdomen. A subcutaneous tunnel was created and the shunt was passed. The other two scalp wound was made over left retro-auricular area for placement of programmable device. Left forechest skin incision was performed and antisyphon device was assembled. The function of the shunt was tested and hemostasis was achieved. The wound was then closed in layers. Operators 賴達明 Assistants 陳睿生, 李振豪 相關圖片 黃永富 (M,1950/10/10,61y5m) 手術日期 2010/01/06 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Brain Tumor 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾峰毅, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:05 進入手術室 08:10 麻醉開始 08:30 誘導結束 09:10 抗生素給藥 09:30 手術開始 12:10 抗生素給藥 15:10 抗生素給藥 16:25 麻醉結束 16:25 手術結束 16:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 9 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 開顱術摘除血管病變－腦血管瘤－無徵的 1 2 R 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT 開立醫師: 曾峰毅 開立時間: 2010/01/06 16:53 Pre-operative Diagnosis Right cavernous sinus meningioma and anterior communicating artery aneurysm Post-operative Diagnosis Right cavernous sinus meningioma and anterior communicating artery aneurysm Operative Method Right pterional approach for tumor excision and aneurysm clipping Specimen Count And Types Several fargment of one tumor was sent for pathology. Several fragments of one tumor was sent for pathology. Pathology pending Operative Findings The tumor located at right cavernous sinus, extending intradurally through arachniod membrane, encaing right ICA causing segmental occluded, push third nerve upward with severe adhesion to the nerve. The tumor was soft, hyper to normovascular, but contained some part hard to elastic. One aneurysm, 2.86mm in diameter, 1.8mm wide in neck, arised from A-com, pointing to right, anteriorly, and inferiorly. One straight Sugita clip was applied to the aneurysm. The tumor was removed subtoally, and blood loss was about 450ml. Operative Procedures Under endotracheal general anaesthesia, the patient was put in supine posiiton with right shoulder elevated, head rotated to left, and fixed with Mayfield head clamp. Scalp shaved, scrubbed, disinfected, and then draped, we made one curvilinear skin incision at right. Scalp falp was dissected with facial nerve preservation, and reflected caudally. Temporalis muscle was transected along supierior temporal line, with muscle cuff left on the bone graft. We made three burr holes, and then created one 5x10cm craniotomy window. Dura was tented along craniotomy edge, and bone edge was extended inferiorly to expose frontal base and temporal base extradurally. Sphenoid ridge was drilled off with diamond drill to perform anterior clinoidecotmy. Optic nerve decompression was achieved. the dura of frontal base was electrocauterized for tumor devacularization. Frontal base was flattened, and superior orbital fissure was opened. U-shape dura incision was made. Sylvian fissure was opened via the anterior border of Sylvian vein. We dived the tumor from right optic nerve, right ICA, right oculomotor nerve, and removed it in piecemeal fashion. Dura base was cauterized. A-com aneurysm was dissected, and exposed well. One straight Sugita clip was applied for clipping. Temporalis muscle was transected along supierior temporal line, with muscle cuff left on the bone graft. We made three burr holes, and then created one 5x10cm craniotomy window. Dura was tented along craniotomy edge, and bone edge was extended inferiorly to expose frontal base and temporal base extradurally. Sphenoid ridge was drilled off with diamond drill to perform anterior clinoidecotmy. Duroplasty was done in water-tight fashion. Bone graft was fixed back with miniplates after epidural CWV set. The wound was closed in layers. Optic nerve decompression was achieved. the dura of frontal base was electrocauterized for tumor devacularization. Frontal base was flattened, and superior orbital fissure was opened. U-shape dura incision was made. Sylvian fissure was opened via the anterior border of Sylvian vein. We dived the tumor from right optic nerve, right ICA, right oculomotor nerve, and removed it in piecemeal fashion. Dura base was cauterized. A-com aneurysm was dissected, and exposed well. One straight Sugita clip was applied for clipping.Duroplasty was done in water-tight fashion. Bone graft was fixed back with miniplates after epidural CWV set. The wound was closed in layers. Operators P 杜永光 Assistants R6 李建勳 R3 曾峰毅 管蔡素貞 (F,1936/11/23,75y3m) 手術日期 2010/01/06 手術主治醫師 賴達明 手術區域 東址 005房 03號 診斷 Subarachnoid hemorrhage 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林至芃 ASA 3E 紀錄醫師 鍾文桂, 時間資訊 19:18 通知急診手術 19:30 報到 19:30 進入手術室 19:35 麻醉開始 19:40 誘導結束 19:50 抗生素給藥 20:15 手術開始 20:55 麻醉結束 20:55 手術結束 21:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室體外引流 1 1 摘要__ 手術科部: 外科部 套用罐頭: Insertion of external ventricular drainage vi... 開立醫師: 鍾文桂 開立時間: 2010/01/08 13:25 Pre-operative Diagnosis Anterior communicating artert aneurysm, ruptured with acute hydrocephalus. Post-operative Diagnosis Anterior communicating artert aneurysm, ruptured with acute hydrocephalus. Operative Method Insertion of external ventricular drainage via right Kocher point. Specimen Count And Types nil Pathology Nil. Operative Findings Pinkish CSF, with high pressure, gushed out from ventriculostomy tube. Medtronic EVD, 5.5cm was inserted. Operative Procedures ETGA, head in midline, supine position. Shaving, disinfection, and draping. Linear scalp incision at right frontal area. Drill a burr hole. Dural tenting, durotomy. Insert ventriculostomy puncture needle at right Kocher point. Insert EVD along the same tract. Fixation of drainage tube. Close wound in layers. Send patient to ICU smoothly. Operators V.S. 賴達明. Assistants R5 陳睿生 R4 鍾文桂. Indication Of Emergent Operation 唐彰甫 (M,1938/10/04,73y5m) 手術日期 2010/01/07 手術主治醫師 王國川 手術區域 東址 002房 02號 診斷 Traumatic subdural hemorrhage 器械術式 V-P shunt 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 陳德福, 時間資訊 10:00 報到 10:05 麻醉開始 10:10 進入手術室 10:15 誘導結束 10:40 手術開始 12:15 麻醉結束 12:15 手術結束 12:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: VPS, left frontal 開立醫師: 陳德福 開立時間: 2010/01/07 12:28 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis ditto Operative Method VPS, left frontal Specimen Count And Types 1 piece About size:3ML Source:CSF Pathology nil Operative Findings 1.The ventricular opening pressure:12cmH2O, CSF: clear, mild yellowish 2.Intraventricular cath:6.2cm; Intraperitoneal cath: 20cm 3.One medium pressure, Metronic, valve type shunt was implantated at left Kocher point Operative Procedures 1.Under ETGA and supine position 2.Skin disinfection and draping 3.Curvilinear incision at left frontal and burr hole creation 4.Dura tenting and dura opening followed by insert ventricular taping needle 5.Left upper abdomen minilaparotomy 6.Subcutaneous tunneling and connect the tube 7.Insert the valve and check the shunt function 8.Hemostasis and close the wound in layers Operators VS 王國川 Assistants r6 陳盈志 r4 陳德福 Indication Of Emergent Operation 手術日期：2010/01/08 16:28 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT 開立醫師: 曾峰毅 開立時間: 2010/01/08 16:28 Pre-operative Diagnosis Parasellar chondrosarcoma, status post trans-sphenoidal resection, recurrence Post-operative Diagnosis Parasellar chondrosarcoma, status post trans-sphenoidal resection, recurrence Operative Method Left petrional approach for tumor excision Specimen Source and Count Several fragments of one tumor was sent for pathology. Pathology Pending Operative Findings One 1.6x1.2x0.7cm, greysih, soft, fragile, capsuled tumor with some elastic to hard portion, was noted in the parasellar region, more at left. The tumor pushed left optic nerve to the superior-medial direction. Tumor capsule was adhesived to left optic nerve, left hypophyseal artery, left ICA tightly, and thus was left in situ after cauterization. Operative Procedures Under endotracheal general anaesthesia, the patient was put in supine position with left shoulder elevated, head roated to right, and fixed with Mayfield head clamp. the scalp shaved, scrubbed, disinfected, and then draped, we made on ecurvilinear skin incision at left. Scalp flap was dissected with facial nerve preservation, and reflectd inferiorly. tmporalis muscle was transected along superior temporal line, and reflected inferiorly. After 3 burr holes drilled, we created one 5x10cm craniotomy window. The dura was tented along craniotomy window, and epidural bleeding was stopped by Gelfoam packing. Sphenoid ridge was drilled off, and anterior clinoidectomy was performed. Sphenoid sinus was openedwith intact mucosa, and was packed with beta-iodine Gelfoam. Optic canal was opened as well. Dura was opened in U-shape. Tumor was centrally debulked, and posterior cliniod was drilled off. Tumor capsule was cauterized and left in situ due to severe adhesion to optic nerve and hypophyseal artery. Autologous fascia was packed, and Tissucol-Duo was sealed at the tumor site. Duroplasty was done in water-tight fashion with 3-0 prolene. Bone graft was fixed back with mini-plates after one epidural CWv set. The wound was closed in layers. Operators P 杜永光 Assistants R6 李建勳 R3 曾峰毅 許春嬌 (F,1949/06/27,62y8m) 手術日期 2010/01/08 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Cervical Spondylosis 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 13:30 進入手術室 13:35 麻醉開始 13:50 誘導結束 14:00 抗生素給藥 14:20 手術開始 15:55 手術結束 15:55 麻醉結束 16:05 送出病患 16:10 進入恢復室 17:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術－頸椎 1 1 手術 脊椎融合術－前融合，無固定物（每增加＜＝四節） 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: ACDF C5-6 開立醫師: 曾偉倫 開立時間: 2010/01/08 15:58 Pre-operative Diagnosis C5-6 HIVD Post-operative Diagnosis C5-6 HIVD Operative Method ACDF C5-6 Specimen Count And Types nil Pathology Nil. Operative Findings Bulging disc over C5-6, with marginal spur formation, causing cord compression. The cord expand well after then disc was resected. Cage 5mm Operative Procedures 1. ETGA, patient was put on supine position 2. Disinfected as usual, then right neck horizontal skin incision 3. Dissect pre-vetebral disc pace then expose C5-6 disc with C-ame localization 4. discectomy with scissor, surratage then drill marginal spur 5. Remove disc with karison punch then hemostasis with gelform packing 6. Cage 5mm insertion at c5-6 7. Close wound in layers Operators VS 曾漢民 Assistants R 陳盈志、R 曾偉倫 手術日期：2010/01/08 16:30 摘要__ 手術科部: 外科部 套用罐頭: 1. L4-5 TPS revision with L3 extension, 2. L3... 開立醫師: 李振豪 開立時間: 2010/01/08 16:30 Pre-operative Diagnosis 1. L3 on L4 spondylolisthesis, 2. L3/4 HIVD, 3. status post L4-5 TPS 1. L3 on L4 spondylolisthesis, 2. L3/4 ruptured disc, 3. status post L4-5 TPS Post-operative Diagnosis 1. L3 on L4 spondylolisthesis, 2. L3/4 HIVD, 3. status post L4-5 TPS 1. L3 on L4 spondylolisthesis, 2. L3/4 ruptured disc, 3. status post L4-5 TPS Operative Method 1. L4-5 TPS revision with L3 extension, 2. L3/4 microdiskectomy Specimen Source and Count Nil Pathology Nil Operative Findings 1. Screws: 6.2x45mm x V and 7x45mm x I Rod x II 2. L3 on L4 anterior listhesis with instability and narrowing of the disc space. 3. Right L3/4 protruded disc with nerve root compression 4. Severe adhesion and scar formation but dura was intact after the operation. 1. Screws: 6.2x45mm x 5 and 7x45mm x 1 Operative Procedures Under endotracheal tube general anesthesia, the patient was put on prone position. C-arm portable X-ray was applied for localization. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision from L3-L5 along previous scar was made. The subcutaneous soft tissue, paravertebral muscle groups, and scar tissue was dissected and detached for exposure of the previous transpedicular screws and L3 facet joint. L4-5 TPS revision with L3 extension was performed. The adhesionlysis was performed after inserted the all six transpedicular screws. The dura was identified and microdiskectomy was performed for L3/4 HIVD. After hemostasis and gentamicin solutions irrigation, the TPS was set up. One epilaminal CWV drain was placed and the wound was closed in layers. Under endotracheal tube general anesthesia, the patient was put on prone position. C-arm portable X-ray was applied for localization. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision from L3-L5 along previous scar was made. The subcutaneous soft tissue, paravertebral muscle groups, and scar tissue was dissected and detached for exposure of the previous transpedicular screws and L3 facet joint. L4-5 TPS revision with L3 extension was performed. The adhesionlysis was performed after inserted the all six transpedicular screws. The dura was identified and microdiskectomy was performed for L3/4 ruptured disc. After hemostasis and gentamicin solutions irrigation, the TPS was set up. One epilaminal CWV drain was placed and the wound was closed in layers. Operators 賴達明 Assistants 胡朝凱, 李振豪 許麗昭 (F,1962/08/15,49y6m) 手術日期 2010/01/08 手術主治醫師 詹志洋 手術區域 東址 016房 03號 診斷 Subarachnoid hemorrhage 器械術式 Permcath 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 徐綱宏, 時間資訊 10:52 臨時手術NPO 12:43 報到 12:43 進入手術室 13:00 麻醉開始 13:02 誘導結束 13:05 手術開始 13:20 麻醉結束 13:20 手術結束 13:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 內頸靜脈切開，永久導管放置術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Permcath/port-A 開立醫師: 徐綱宏 開立時間: 2010/01/08 13:29 Pre-operative Diagnosis ESRD Post-operative Diagnosis s/p Permcath Operative Method permcath implantation via right internal jugular vein Specimen Count And Types Nil Pathology nil Operative Findings 1. The permcath catheter was inserted via right internal jugular vein by Cut down & echo-guided procedure 2. Patent flow after implantation 3. Tip position located at RA/SVC junction Operative Procedures -Anesthesia: ETGA, the patient was put on supine position. The operation field was disinfected and draped as usual. -Permcath catheter was implanted on right side upper chest with cut down/puncture method under echo-guided procedure. The catheter was advenced via the peel-away sheath smoothly after tunnelization. -The flow was checked and flushed with heparin solution. The wounds were closure by 2-0 Nylon. Local compression for hemostasis. Operators 詹志洋 Assistants 徐綱宏 管蔡素貞 (F,1936/11/23,75y3m) 手術日期 2010/01/11 手術主治醫師 王堯弘 手術區域 東址 000房 號 診斷 Subarachnoid hemorrhage 器械術式 NEURO T.A.E 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 王永彬 ASA 3 時間資訊 13:20 麻醉開始 13:25 誘導結束 16:30 麻醉結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 高進財 (M,1932/09/18,79y5m) 手術日期 2010/01/11 手術主治醫師 賴達明 手術區域 東址 002房 01號 診斷 Subdural hemorrhage or effusion 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3E 紀錄醫師 許松鈺, 時間資訊 23:55 開始NPO 23:55 臨時手術NPO 06:55 通知急診手術 08:55 報到 09:10 進入手術室 09:15 麻醉開始 09:20 誘導結束 09:50 抗生素給藥 10:00 手術開始 11:05 手術結束 11:05 麻醉結束 11:15 送出病患 11:15 進入恢復室 12:47 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 慢性硬腦膜下血腫清除術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Burr hole for hematoma drainage 開立醫師: 許松鈺 開立時間: 2010/01/11 11:32 Pre-operative Diagnosis Chronic subdural hematoma, left frontal-temporal-parietal region Post-operative Diagnosis Chronic subdural hematoma, left frontal-temporal-parietal region Operative Method Burr hole for hematoma drainage Specimen Count And Types Nil Pathology Nil Operative Findings 1. Oil like fluid drained out while opening outer membrane was noted and no old clot was found 2. Fair drain pulsation was noted after hematoma evacuation Operative Procedures 1. ETGA, supine position with head tilt to the right side, skin disinfection 2. Left frontal linear incision about 3cm 3. Make a burr hole 4. Dura tenting followed with outer membrane opening 5. Drain out hematoma and N/S irrigation 6. Set a subdural R/D 7. De-air and close the wound in layers Operators 賴達明 Assistants 陳睿生,許松鈺 Indication Of Emergent Operation 陳佑嘉 (M,2009/10/28,2y4m) 手術日期 2010/01/11 手術主治醫師 張重義 手術區域 兒醫 067房 01號 診斷 Tetralogy of Fallot 器械術式 Repair TF, V.S.D., E.C.D.,TC 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 4 紀錄醫師 周恒文, 時間資訊 09:10 報到 09:10 進入手術室 09:15 麻醉開始 09:25 誘導結束 10:25 手術開始 11:00 抗生素給藥 17:00 抗生素給藥 17:15 開始輸血 18:35 麻醉結束 18:35 手術結束 18:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 11 0 麻醉 T.E.E 1 0 麻醉 Peripheral arterial line inserti 1 0 手術 Ａ．Ｓ．Ｄ　修補 1 4 麻醉 Lactic Acid (lactate) 4 0 麻醉 動脈血液檢查全套 4 0 麻醉 Hemoglobin (Hb) 4 0 麻醉 測血糖 4 0 麻醉 Ca (Calcium) 4 0 麻醉 Na (Sodium) 4 0 麻醉 K (Potassium) 4 0 麻醉 Cl (Chloride) 4 0 麻醉 Blood gas analysis 4 0 手術 瓣膜成形術 1 1 手術 二尖瓣擴張術 1 2 手術 體外心肺循環 1 1 摘要__ 手術科部: 外科部 套用罐頭: PA plasty, RVOT reconstruction, TVP, ASD redu... 開立醫師: 黃柏誠 開立時間: 2010/01/13 22:44 Pre-operative Diagnosis Abscent pulmonary valve syndrome with TOF s/p total correction; MPA with bifurcation stenosis; right side bronchus compression; residual ASD Post-operative Diagnosis Abscent pulmonary valve syndrome with TOF s/p total correction; MPA with bifurcation stenosis; right bronchus external compression by RPA Operative Method PA plasty, RVOT reconstruction, TVP, ASD reduction, and intra-op bronchoscopy Specimen Count And Types nil Pathology Nil Operative Findings 1. Situs solitus, levocardia, left arch 2. Preop TEE: 4mm ASD with bidirectional shunt and mild PR 3. Bilateral intrapulmonary dilated PA with early branching of PAs. They all were difficult to reducing the size. 4. PA plasty: resection of partial anterior wall of RPA proximal to first branch orifice(before PA plasty, #6 Hegar could pass). RVOT(surgical membrane monocuspid valve) to cover previous RVOT(#12 Hegar could pass proximal ventriculotomy). 5. TVP: posterior annular plication 6. Intra-op bronchoscopy: bilateral bronchomalasia(especially right middle bronchus) without obvious stenosis 7. Post-op bilateral pleura opened, sternal unapproximated 8. No SVC stenosis(Fr16 V-cannula could pass) 9. Post-op RVP 36/11 mmHg(ABP: 67/42) Operative Procedures Supine, ETGA, resternotomy, adhesionolysis. CPB: AsAo; RAA(to SVC) and IVC, partial CPB and hypothermia to 20 degree Celsius. AXC, antegrade cardioplegia. RA atriotomy and venting via ASD. Longitudinal RVOT incision and removal of previous patch and pericardial monocuspid valve. TVP with posterior annular plicaiton. RPA transverse incision, resection of small piece of distal RPA anterior wall. Intra-op bronchoscopy: difficult passage through scope after right main bronchus(malacia instead of stenosis). Closure of RPA incision. Extension of LPA incision to distal RVOT cuspid attach to previous pulmonary annulus(edge to pericardium) then along the RVOT margin. Gortex patch was attached to the RVOT-LPA as augmentation. Rewarm, deair, via ASD after ASD reduction. Closure of RA atriotomy. Deair via Bungus needle. Release AXC. Hemostasis, open bialteral pleura, set up PD, set C.T*3. Sternal unapproximated. Operators 張重義 Assistants 蔡孝恩,周恒文 許麗昭 (F,1962/08/15,49y6m) 手術日期 2010/01/11 手術主治醫師 王國川 手術區域 東址 001房 06號 診斷 Subarachnoid hemorrhage 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 污染 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3E 紀錄醫師 高明蔚, 時間資訊 00:00 臨時手術NPO 15:53 進入手術室 16:05 麻醉開始 16:08 誘導結束 16:25 手術開始 17:00 手術結束 17:00 麻醉結束 17:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 氣管切開造口術 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 高明蔚 開立時間: 2010/01/11 17:14 Pre-operative Diagnosis SAH, with respiratory failure Post-operative Diagnosis SAH, with respiratory failure, statust post trachestomy Operative Method Trachestomy Specimen Count And Types NA Pathology NA Operative Findings #7 tracheostomy tube was placed Operative Procedures Under ETGA, the patient was placed supine with head mildly extended. We performed skin disinfection with alcoholic betaiodine and draping as usual. We indentified the location and performed longitidinal skin incision and disseted the tissue in layers. After approaching to the pre-tracheal fasia, we disseted it and performed circular incision over the trachea. Under well exploration and indentification, #7 tracheostomy tube was inserted smoothly and confirmed with EtCO2. We then performed hemostasis and closed the wound with 3-0 Nylon. The wound was covered with BI gauze. Operators 王國川 Assistants 胡朝凱、高明蔚 手術日期：2010/01/12 14:18 摘要__ 手術科部: 外科部 套用罐頭: Left L4~5 laminotomy for decompression 開立醫師: 胡朝凱 開立時間: 2010/01/12 14:18 Pre-operative Diagnosis Left L4~5 neural foramne stenosis Post-operative Diagnosis Left L4~5 neural foramne stenosis Operative Method Left L4~5 laminotomy for decompression Specimen Source and Count Nil Pathology Nil Operative Findings 1.Severe hypertrophy of left L4~5 fact and ligment that compressed the nerve root tightly. And after decompression, nerve root became loose. Operative Procedures 1.ETGA, prone 2.Midline incision at L4~5 level 3.Detach paravertebral muscle 4.Drill of left L4 lamina and partial L5 5.Remove lamina and facet ligment 6.Expose nerve root 7.Close wound in layers. Operators 賴達明 Assistants 胡朝凱, 高明蔚 手術日期：2010/01/12 14:35 摘要__ 手術科部: 外科部 套用罐頭: Permcath/port-A 開立醫師: 羅健洺 開立時間: 2010/01/12 14:35 Pre-operative Diagnosis ESRD Post-operative Diagnosis ESRD s/p Permcath insertion s/p Permcath, port-A insertion Operative Method permcath implantation via right internal jugular vein permcath/port-A implantation via right internal jugular vein Specimen Source and Count Nil Pathology nil Operative Findings Cut down & echo-guided procedure 2. Patent flow after implantation 3. Tip position located at RA/SVC junction 1. The permcath catheter was inserted via right internal jugular vein by echo-guided procedure 1. The permcath/port-A catheter was inserted via right internal jugular vein by Operative Procedures -Anesthesia: local/IVG/ETGA, the patient was put on supine position. The operation field was disinfected and draped as usual. -Permcath catheter was implanted on right/left side upper chest with cut down/puncture method under echo-guided procedure. The catheter was advenced via the peel-away sheath smoothly after tunnelization. -The flow was checked and flushed with heparin solution. The wounds were closure by 2-0 Nylon. Local compression for hemostasis. -Port-A: After skin disinfection and drapping & local anesthesia, echo-guided RIJV cut down and catheterization was performed. Creation of the subcutaneous pocket at right subclavicular area. Tunneliztion, advanced the catheter into the RIJV via the peel-away sheath smoothly. Ensure the catheter tip position by portable CXR. Wound closure in layers after adequate hemostasis. -Anesthesia: IVG, the patient was put on supine position. The operation field was disinfected and draped as usual. -Permcath catheter was implanted on right side upper chest with puncture method under echo-guided procedure. The catheter was advenced via the peel-away sheath smoothly after tunnelization. Wound closure in layers after adequate hemostasis. Operators 詹志洋 Assistants 羅健洺 林祐生 (M,1957/02/13,55y1m) 手術日期 2010/01/13 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Glioma 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 曾峰毅, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:07 進入手術室 08:10 麻醉開始 08:45 誘導結束 09:20 抗生素給藥 09:37 手術開始 12:30 抗生素給藥 15:30 麻醉結束 15:30 手術結束 15:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４～８小時 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 7 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT 開立醫師: 曾峰毅 開立時間: 2010/01/13 16:00 Pre-operative Diagnosis Right frontal glioma, status post biopsy, grade II-III Post-operative Diagnosis Right frontal glioma, status post biopsy, grade II-III Operative Method Right frontal craniotomy for tumor excision Specimen Count And Types Surgical specimens of brain tumor was sent for pathology. Pathology Nil Operative Findings Well-defined tumor, about 3x7x4cm, noted at superior frontal gyrus, with greyish soft portion and yellowish to whitish firm portion. Right lateral ventricle was exposed during the tumor excision. Operative Procedures Under endotracheal general anaesthesia, the patient was put in supine position. Scalp was shaved, scrubbed, disinfected, and then draped, and falp was reflected inferiorly after bicoronal skin incision made. We drilled 4 burr holes, and then created one 6x6cm craniotomy window. Dura was tented along the craniotomy edge, and was incised in U-shape with base a medial side. Tumor was excised along the gyrus edge, and hemostasis was done. EVD was inserted into right lateral ventricle. Duroplasty was done in water-tight fashion with 3-0 prolene. Bone graft was fixed back with mini-plates, and one subgaleal CWV was set. The wound was closed in layers. Operators P 杜永光 Assistants R6 李建勳 R3 曾峰毅 趙蘭花 (F,1908/11/29,103y3m) 手術日期 2010/01/13 手術主治醫師 蔡翊新 手術區域 東址 001房 03號 診斷 Intracerebral hemorrhage 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 11:44 通知急診手術 12:10 進入手術室 12:15 麻醉開始 12:50 誘導結束 13:00 抗生素給藥 13:08 手術開始 14:10 手術結束 14:10 麻醉結束 14:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 顱內壓監視置入 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 蔡翊新 開立時間: 2010/01/13 14:05 Pre-operative Diagnosis Head injury with right F-T-P acute SDH, bilateral frontal contusions Post-operative Diagnosis Head injury with right F-T-P acute SDH, bilateral frontal contusions Operative Method ICP monitoring Specimen Count And Types Nil. Pathology Nil. Operative Findings Bleeding tendency was noted. The blood oozed easily from subcutaneous layer and epidural space. After burr hole creation and dural opening, some subdural blood was removed. The brain was not swollen. ICP was 3 mmHg. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 5 cm at right frontal area, the skin edge was clipped by Raney clips for temporary hemostasis. 5. A burr hole was made at right Kocher point and the dura was incised for evacuating part of the subdural hematoma. 6. Hemosatasis: the bleeders was stopped by Bovie and oozing surface was covered with gelfoam. 7. A subdural ICP monitor was inserted to right frontal region. 8. Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 9. Drain: nil. 10.Blood transfusion: Platelet 24U before operation. 11.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R4鍾文桂Ri陳以幸 Indication Of Emergent Operation 管蔡素貞 (F,1936/11/23,75y3m) 手術日期 2010/01/15 手術主治醫師 賴達明 手術區域 東址 001房 03號 診斷 Subarachnoid hemorrhage 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 3 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 14:15 進入手術室 14:30 麻醉開始 14:45 誘導結束 15:09 手術開始 16:35 手術結束 16:35 麻醉結束 16:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱內壓監視置入 1 1 R 手術 氣管切開造口術 1 0 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Tracheosotmy. 開立醫師: 鍾文桂 開立時間: 2010/01/21 17:54 Pre-operative Diagnosis Respiratory failure. 1.Hydrocephalus 2.Respiratory failure. Post-operative Diagnosis Respiratory failure. 1.Hydrocephalus 2.Respiratory failure. Operative Method Tracheosotmy. 1.Revision of external ventricular drainage. 2.Tracheosotmy. Specimen Count And Types 1 piece About size: Source: Pathology Nil. Operative Findings 7.0 Fr. tracheotomy tube was inserted at 2nd/3rd tracheal ring. Medtronic EVD tube was inserted at 5.5 cm depth. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: head in midline. 3. Shaving, disinfection, and draping. 4. Outline right Kocher point. 5. Linear scalp incision at right Kocher point. Drill a burr hole. 6. Dural tenting, durotomy. 7. Insert ventricular needle with CSF drainage. 8. Fix and insert EVD. Connect EVD with close drainage system. 8. Fix and insert EVD. Connect EVD with close drainage system. Close wound in layers. Second operation: 1. Remove draping for EVD insertion. 2. Position: head in midline, neck in extension position to expose trachea. 3. Skin preparation: alcohol povidone beta-iodine. 4. Incision: linear 2-cm longitudinal incision 2 cm below cricoid catilage. 5. Midline incision and dissection until tracheal rings were exposed. 6. Incise tracheal rings. Retraction at tracheal lumen. 7. Insertion of tracheostomy tube. Check patency of airway. 8. Primary wound closure. Fixation of tracheostomy tube. Operators V.S. 賴達明 Assistants R6 李建勳 R4 鍾文桂. 林秋和 (M,1945/10/10,66y5m) 手術日期 2010/01/15 手術主治醫師 張金池 手術區域 東址 003房 02號 診斷 Patients requiring long-term use of a respirator due to respiratory failure, use respirator 6 hours per day continue 30 days 器械術式 Tracheostomy 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3E 紀錄醫師 張金池, 時間資訊 00:00 開始NPO 00:00 臨時手術NPO 11:41 通知急診手術 15:19 報到 15:20 進入手術室 15:55 麻醉開始 15:57 誘導結束 16:05 手術開始 16:55 麻醉結束 16:55 手術結束 17:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 氣管切開造口術 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 張金池 開立時間: 2010/01/18 14:30 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Ditto Operative Method Tracheostomy Specimen Count And Types nil Pathology None Operative Findings Fr . 8 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators 張金池 Assistants Ri 陳以幸 Indication Of Emergent Operation 手術日期：2010/01/15 18:40 摘要__ 手術科部: 外科部 套用罐頭: AVF 開立醫師: 徐綱宏 開立時間: 2010/01/15 18:40 Pre-operative Diagnosis ESRD with AVG failure Post-operative Diagnosis ESRD s/p AVG creation Operative Method Arteriovenous graft creation, Left Specimen Source and Count nil Pathology nil Operative Findings 1. The diameter of the artery was: 3 mm; and the diameter of the vein was: 2 mm 2. The anastomosis opening diameter was:10 mm. 3. Site: brachio-deep AVG 4. After the fistula created, a continuous thrill was felt over the fistula, bruit (+) Operative Procedures The patient was put on supine position with left hand extended out of the operation table on the arm-board. The operation field was disinfected and draped as usual. Under IVG, a transverse skin incision was made above the elbow crease. The brachial artery then the concomitant deep vein and were dissected out from the surrounding tissue. The graft was imbeded over the anterioir surface of the upper arm. The vein was then opened. The graft was anastomosed to the vein in end-to-side fashion. After gaining distal and proximal control of the artery by ductus clamps, a longitudinal arteriotomy was performed. The end of the graft was then anastomosed to the arteriotomy with 7-0 prolene continuous suture. After meticulous hemeostasis, the wound was closed in layers. Operators 詹志洋, Assistants 徐綱宏, 王韋筑 手術日期：2010/01/18 08:24 摘要__ 手術科部: 外科部 套用罐頭: Right partial mastectomy & axillary lymph nod... 開立醫師: 王奐之 開立時間: 2010/01/18 08:24 Pre-operative Diagnosis Right breast cancer Post-operative Diagnosis Ditto Operative Method 1. Right partial mastectomy & axillary lymph node dissection 2. Left subclavian Port-A implantation Right partial mastectomy & axillary lymph node dissection Specimen Source and Count 3. Rotter node *1, 0.5*0.5cm 4. Breast tissue *1, 7*8*3cm 5. Breast resection margin *1, 2*3cm 1. Level 1 ALN *1, 5*6cm 2. Level 2 ALN *1, 2*3cm Pathology Pending Operative Findings A tumor about 1.8cm in diameter located at 10:00/4cm. Level 1 & 2 axillary lymph node were dissected, 2 intercostal nerves preserved. Port-A inserted through left subclavian vein via puncture method, blood flow from catheter fluent (in & out). Catheter tip at RA & SVC junction, confirmed with CXR and left side SVC was noted. A tumor about 1.8cm in diameter located at 10:00/4cm. Level 1 & 2 axillary lymph node were dissected, intercostal nerves preserved. Operative Procedures 8. Close the wound in layers. 9. Puncture into left subclavian vein. 10. Make a skin incision at left deltopectoral groove. 11. Insert Port-A and secure base. 12. Check location. 13. Close the wound in layers. 1. ETGA, supine with righ arm elevated. 2. Skin disinfection & draping in sterile fashion. 3. Make a fusiform skin incision at UOQ of right breast. 4. Perform partial mastectomy around tumor. 5. Perform axillary lymph node dissection. 6. Hemostasis. 7. Set 1 CWV drain. Operators 張金堅,郭文宏 Assistants 王奐之,許雅睿 王奐之 手術日期：2010/01/19 20:44 摘要__ 手術科部: 外科部 套用罐頭: VATS LND dissection (Gr.5) 開立醫師: 蔡東明 開立時間: 2010/01/19 20:44 Pre-operative Diagnosis LUL adenocarcinoma Post-operative Diagnosis Ditto Operative Method VATS LND dissection (Gr.5) Specimen Source and Count 1 piece About size:2*2cm Source:Gr.5 LNs Pathology Frozen showed metastatic adenocarcinoma noted at Gr.5 LN Operative Findings 1.One 2*2cm yellowish, hardish tumor noted at LUL with invasion to B6 and pleural retraction. 2.Several enlarged, blackish LNs were noted at Gr.5. Frozen biospy showed metastatic adenocarcinoma 3.There was no detectable LNs at Gr.7 4.One Port-A catheter was inserted at left subclavian vein by puncture method. The intra-operative CXR showed the catheter tip was in SVC and the blood flow is smooth. Operative Procedures 1.DLETGA, right decubitus 2.Skin disinfection and drapping 3.VATS setting 4.Dissection for Gr.5 LN 5.Frozen biopsy showed metastatic adenocarcinoma noted at Gr.5 LNs 6.Normal saline irrigation and hemostasis 7.Set-up one Fr.28 chest tube to left thoracic cavity 8.Close the wound in layers and shift the position to supine 9.Insertion of Port-A catheter at left subclavian vein by puncture method 10.After confirmation by CXR, the wound was closed in layers Operators VS李章銘 Assistants R3蔡東明 Ri李馨 施怡森 (M,1940/06/07,71y9m) 手術日期 2010/01/19 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Spondylosis with myelopathy, cervical 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 07:35 報到 08:03 進入手術室 08:15 麻醉開始 08:35 誘導結束 08:52 抗生素給藥 09:15 手術開始 11:52 抗生素給藥 13:45 麻醉結束 13:45 手術結束 13:55 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 手術 椎間盤切除術－頸椎 1 1 R 手術 脊椎融合術－前融合，有固定物（＜＝四節） 1 2 R 摘要__ 手術科部: 外科部 套用罐頭: C3-4, C4-5 anterior diskectomy with cage fusion 開立醫師: 李振豪 開立時間: 2010/01/19 14:22 Pre-operative Diagnosis C3-4, C4-5 HIVD and C3-4 retrolisthesis Post-operative Diagnosis C3-4, C4-5 HIVD and C3-4 retrolisthesis Operative Method C3-4, C4-5 anterior diskectomy with cage fusion Specimen Count And Types Nil Pathology Nil Operative Findings The C3-4 intervertebral space was narrowed with marginal spur formation and disc protrusion. 5mm and 8mm cage was placed at C3-4, and C4-5 intervertebral space for anterior fusion. The thecal sac was well expanded after anterior diskectomy. No EP change was noted during the whole procedure. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine position. The skin was scrubbed, disinfected, and draped as usual. One transverse skin incision with 5cm in length was made at right middle neck. The plastisma muscle was transected and mobilized from the underlying superficial cervical fascia which was then opened in vertical direction along the anterior margin of the SCM muscle. The dissection was advanced at the loose plane between SCM muscle and strip muscles until the prevertebral fascia had been reached. The former structure was retracted to the lateral and the later structures with esophagus and trachea to the opposite side by cervical retractor. The prevertebral fascia was opened vertically, the C3-4 intervertebral space was exposed and identified by intraoperative portable X-ray. The most medial portion of the longus coli muscles on both sides were detached from the vertebral bodies to providea wider exposure of the vertebral bodies. The anterior longitudinal ligment was incised transversely at the margins of intervertebral space, the annulus fibrosus was cut too. The degenerated disc and cartilage plate were removed by high speed air-drilled, Kerrison punch, and curette. The same procedure was done at C4-5 intervertebral space. The 5mm and 8mm cages were placed into the C3-4 and C4-5 for anterior fusion. Portal X-ray was used for confirmed the location of the cages. After hemostasis, one MiniHemovac was placed and the wound was closed in layers. Operators 賴達明 Assistants 陳睿生, 李振豪, 許淞鈺 手術日期：2010/01/19 17:21 摘要__ 手術科部: 外科部 套用罐頭: Microdiskectomy 開立醫師: 李振豪 開立時間: 2010/01/19 17:21 Pre-operative Diagnosis L5-S1 HIVD, right Post-operative Diagnosis L5-S1 HIVD, right Operative Method Microdiskectomy Specimen Source and Count Nil Pathology Nil Operative Findings The right S1 root was compressed tightly by the buldging intervertebral disc which degenerative change was noted. The disc was protruded downward. After the operation, the nerve root was well decompressed. Operative Procedures Under endotracheal tube general anesthesia, the patient was put at prone position . C-arm portable X-ray was used for localization. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made and the subcutaneous soft tissue was dissected. Right side paravertebral muscle groups was detached for exposure of right side laminae with modified narrow Taylor retractor. Under operating microscope, laminotomy was performed with Kerrison punch and the thecal sac was identified. The compressed nerve root and the thecal sac was gently pushed away temporarily in order to expose the herniated disc more clearly. Microdiskectomy was performed. After hemostasis, the wound was closed in layers. Operators 賴達明 Assistants 陳睿生, 李振豪 吳克良 (M,1980/03/01,32y0m) 手術日期 2010/01/20 手術主治醫師 蔡翊新 手術區域 東址 001房 07號 診斷 Head Injury 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 污染 麻醉方式 全身麻醉 麻醉主治醫師 蕭柏妮 ASA 4E 紀錄醫師 楊惠馨, 時間資訊 22:42 開始NPO 22:42 通知急診手術 23:45 進入手術室 23:50 麻醉開始 00:00 誘導結束 00:27 手術開始 00:30 開始輸血 03:20 手術結束 03:20 麻醉結束 03:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 1 R 手術 顱內壓監視置入 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 蔡翊新 開立時間: 2010/01/20 03:16 Pre-operative Diagnosis Skull fracture of right temporal squama and petrous bone with dural tear and right temporal lobe laceration, contusion, SDH and EDH. Post-operative Diagnosis Skull fracture of right temporal squama and petrous bone with dural tear and right temporal lobe laceration, contusional ICH, SDH and EDH. Operative Method Right temporo-occipital craniectomy for removal of ICH, SDH and EDH + ICP monitoring. Specimen Count And Types nil Pathology Nil. Operative Findings 1. A 2 cm laceration of right auricle just above the external acoustic canal came from the skull base fracture, with debris of brain tissue and hematoma oozing intermittently. 2. Thick subgaleal hematoma with swelling of right temporal muscle was noted. Comminuted skull fracture at right temporal squama and petrous bone led to the skull base. Laceration of underlying dura and brain was noted, with small amount of EDH and SDH. The right temporal lobe was contused at the base and the ICH was removed. The dural tear was impossible to repair because of its skull base location. After skin closure, the ICP was 10 mmHg. 1. Thick subgaleal hematoma with swelling of right temporal muscle was noted. Comminuted skull fracture at right temporal squama and petrous bone led to the skull base. Laceration of underlying dura and brain was noted, with small amount of EDH and SDH. The right temporal lobe was contused at the base and the ICH was removed. The dural tear was impossible to repair because of its skull base location. After skin closure, the ICP was 10 mmHg. Thick subgaleal hematoma with swelling of right temporal muscle was noted. Comminuted skull fracture at right temporal squama and petrous bone led to the skull base. Laceration of underlying dura and brain was noted, with small amount of EDH and SDH. The right temporal lobe was contused at the base and the ICH was removed. The dural tear was impossible to repair because of its skull base location. After skin closure, the ICP was 10 mmHg. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: inverted U-shaped incision, 12 x 12 cm at right frontotemporo- occipital area, the skin edge was clipped by Raney clips for temporary hemostasis. 5. Craniectomy window: 12 x 10 cm, right F-T-O, created by making 4 burr holes then cut by power saw. The EDH was removed. 6. Dural tenting: by 2/0 silk, 2 cm in interval, distributed along the edge of skull window. 7. Dural incision: curvilinear along the edge of skull window. 8. The subdural clot and right temporal base contusional ICH were removed by sucker. 10.Hemosatasis: the bleeding from the skull base fracture was stopped by bone wax. Those bleeders at epidural space and parenchyma were stopped by Bovie and oozing surface was covered with gelfoam. 11.Dural closure: with a piece of dural graft taking from temporalis fascia. 12.The skull plate was removed and placed in bone bank for preservation. 13.Right temporal muscle was excised to obtain more space for brain swelling. 14.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 1/0 Vicryl and skin by continuous suture with 3/0 nylon. 15.Drain: one, epidural, CWV. 16.Blood transfusion: PRBC 4U, FFP3U; blood loss: 2300 ml. 17.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R4陳德福R2楊惠馨 Indication Of Emergent Operation 王梅子 (F,1941/11/04,70y4m) 手術日期 2010/01/22 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Osteoporosis 器械術式 Neurolysis of the uluar neuve 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 面罩麻醉 麻醉主治醫師 黃慧薰 ASA 2 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 11:55 進入手術室 11:55 麻醉開始 12:00 抗生素給藥 12:05 誘導結束 12:10 手術開始 13:00 手術結束 13:00 麻醉結束 13:10 送出病患 13:10 進入恢復室 14:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Semi-opened mask inhalation anes 1 0 手術 神經分離術－手．足之神經 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Neurolysis 開立醫師: 陳盈志 開立時間: 2010/01/22 12:56 Pre-operative Diagnosis Tardy Ulnar palsy, right side Post-operative Diagnosis Tardy Ulnar palsy, right side Operative Method Neurolysis Specimen Count And Types nil Pathology nil Operative Findings fibous band was noted encasing the ulnar nerve tightly at elbow groove. Operative Procedures 1.IVG, supine, right arm elevated 2.Skin preparation 3.Right elbow curvilinear incision 4.Dissect soft tissue to expose the fibrous band encasing the ulnar naerve 5.Open the fibrous band to release ulnar nerve. 6.hemostasis 7.close wound in layers Operators VS曾漢民 Assistants R6陳盈志 R1曾偉倫 林松茂 (M,1954/08/12,57y7m) 手術日期 2010/01/22 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Intracerebral hemorrhage 器械術式 Crainotomy Brain Tumor(P-LIN) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 4E 紀錄醫師 蔡立威, 時間資訊 00:53 開始NPO 00:53 臨時手術NPO 00:53 通知急診手術 01:35 報到 01:40 進入手術室 01:45 麻醉開始 02:10 誘導結束 02:10 抗生素給藥 02:30 手術開始 03:45 開始輸血 05:45 麻醉結束 05:45 手術結束 05:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: craniotomy for hematoma evacuation 開立醫師: 蔡立威 開立時間: 2010/01/26 07:47 Pre-operative Diagnosis right putaminal ICH with uncal herniation Post-operative Diagnosis ditto Operative Method craniotomy for hematoma evacuation Specimen Count And Types nil Pathology nil Operative Findings the hematoma was more than 100mL and soft, fragile. The ventricle was not seen intra-op. Corticotomy was done at posterior frontal lobe, and the brain surface shrinked after decompression. Some small arterial bleeding was found at the deep side. Operative Procedures 1.ETGA, supine with head left turn 2.right F-T scalp curvillinear incision 3.split temporalis muscle 4.create 2 burr holes and an about 6*8cm craniotomy was done 5.dura tacking, and then opening 6.corticotomy from posterior frontal 7.hematoma evacuation with sucker 8.hemostasis with surgical 9.Repair and dura closed with fascia graft 10.fix back skull graft with wires*4, central tacking 11.set a cwv drain below temporalis muscle 12.close the wound in layers Operators VS賴達明 Assistants R5陳睿生,R1蔡立威 Indication Of Emergent Operation 手術日期：2010/01/22 18:25 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for tumor excision 開立醫師: 賴碩倫 開立時間: 2010/01/22 18:25 Pre-operative Diagnosis Right parietal lobe GBM Post-operative Diagnosis Right parietal lobe GBM Operative Method Craniotomy for tumor excision Specimen Source and Count Ttumor x 1 Pathology Tumor Operative Findings 1.One about 5 cm grayish, soft tumor located at right parietal lobe about 1 cm distant to cortex 2.The surrounding brain was also swelling and necrotic 3.MCA branch was noted and encased by the tumor 4.During mapping, tumor was 2 cm away from sensory cortex Operative Procedures 1.ETGA, supine, head rotate to left and fixed with skull clamp 2.Right reverse U shape skin incision 3.Skin reflection 4.Incise open fascia and muscle 5.Craniotomy 6.Dural tenting 7.Dural opening with the base left at temporal area 8.Transcortical approach 9.Tumor dissection along with the plane between tumor and gliotic brain 10.Tumor excision 11.Hemostasis 12.Close dura with prolene 13.Fix bone back with wire after CWV drain setting 14.Close wound in layers. Operators 王國川 Assistants 胡朝凱 手術日期：2010/01/23 18:20 摘要__ 手術科部: 創傷醫學部 套用罐頭: VATS LN dissection + RUL lobectomy 開立醫師: 楊惠馨 開立時間: 2010/01/23 18:20 Pre-operative Diagnosis RUL adenocarcinoma Post-operative Diagnosis RUL adenocarcinoma Operative Method VATS LN dissection + RUL lobectomy Specimen Source and Count 3 piece About (1)size:15*5*2 cm Source:RUL (2)size:3*2*2 cm Source:Gr.3+4 LN -> sent to frozen (3)size:2*2*2 cm Source:Gr.7 LN -> sent to frozen Pathology 1. LNs Gr3+4, Gr.7: frozen: no malignancy 2. RUL: pending Operative Findings 1. Around 2cm, whitish, elastic to firm mass was noted in RUL, with mild pleural retraction 2. Gr3&4 + 7 LN dissection: frozen: no malignancy Operative Procedures 1. DLETGA, left decubitus 2. Disinfection and drapping 3. VATS as usual setting 4. Gr. 3,4,7 LN dissection 5. Send to frozen 6. Transect pulmonary vein by endo-GIA-45(white), fissure by endo-GIA-45(green), pulmonary artery by endo-GIA-45(white), bronchus by endo-GIA-45(green) 7. RUL lobectomy 8. Check bleeding and hemostasis, check air-leak 9. Chest tube Fr. 28 *1 10. Closed the wound in layers Operators VS張金池 Assistants R5梁嘉儀 R2楊惠馨 杜俊男 (M,1964/09/24,47y5m) 手術日期 2010/01/24 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 CVA 器械術式 Brain tumor Crainotomy(Others) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3E 紀錄醫師 吳晉睿, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 11:22 通知急診手術 12:05 進入手術室 12:10 麻醉開始 12:30 誘導結束 12:50 抗生素給藥 13:08 手術開始 13:15 開始輸血 15:50 抗生素給藥 17:05 手術結束 17:05 麻醉結束 17:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 手術 顱骨切除術，包括異物移除或減壓或神經切斷 1 1 手術 顱內壓監視置入 1 2 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Suboccipital craniectomy with duroplasty, EVD... 開立醫師: 陳盈志 開立時間: 2010/01/24 17:41 Pre-operative Diagnosis PICA infarction with cerebellar swelling and obstructive hydrocephalus Post-operative Diagnosis PICA infarction with cerebellar swelling and obstructive hydrocephalus Operative Method Suboccipital craniectomy with duroplasty, EVD via right Frazier as ICP moniter Specimen Count And Types nil Pathology nil Operative Findings CSF was clear, the opening pressure was very high > 20cmH2O. Ventricular catheter was 10cm in depth. After decompression, ICP was about 2~3cmH2O. Right side cerebellum was very swelling, which spontanous buldging out after dura incision. Operative Procedures 1.ETGA, prone with neck flexion and head fixation with Mayfield 2.Right Frazier EVD insertion as ICP moniter 3.Midline incision 4.Detach muscle to expose inion to C1 posterior arch 5.Burr hole x 6 then craniectomy with saw 6.Y shape dura incision 7.removal of partial swelling brain 8.Duroplasty with duraform 9.Hemostasis 10.Epidural CWV drain x 1 11.close wound in layers. Operators VS賴達明 Assistants R6陳盈志 R1吳晉睿 Indication Of Emergent Operation 李秀容 (F,1966/09/20,45y5m) 手術日期 2010/01/25 手術主治醫師 蔡瑞章 手術區域 東址 001房 02號 診斷 Ependymoma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3E 紀錄醫師 賴碩倫, 時間資訊 06:43 臨時手術NPO 06:43 開始NPO 09:41 通知急診手術 12:30 報到 12:50 進入手術室 12:55 麻醉開始 13:15 誘導結束 13:24 抗生素給藥 13:50 手術開始 16:24 抗生素給藥 17:00 開始輸血 19:40 抗生素給藥 20:20 麻醉結束 20:20 手術結束 20:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４～８小時 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 7 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: Interhemispheric transcallosal tumor removal 開立醫師: 賴碩倫 開立時間: 2010/01/31 11:12 Pre-operative Diagnosis 3rd ventricular tumor, susp. glioma, susp. ependymoma Post-operative Diagnosis 3rd ventricular tumor, susp. glioma, susp. ependymoma Operative Method Interhemispheric transcallosal tumor removal Specimen Count And Types 1 specimen: brain tumor 2x2cm, CSF x5 Pathology pending Operative Findings The tumor aws grayish, soft and fragile. Gilotic change was suspected. The tumor firmly attached to 3rd ventricular roof and right thalamus was able to be identified. Hematoma was noted inside the tumor and lateral 3rd ventricular space and old blood clots in tumor was suspected. We approached the tumor via left lateral ventricle. The septum pallucidum was intact and opened intra-op. EVD was inserted via right kocher, and depth was around 7cm Operative Procedures 1. ETGA, spine with head fixed by Mayfield and elevated. 2. Curvillinear scalp incision at bilateral coronal suture. 3. Create 6 bur holes(2 across midline) and an about 10x10cm craniotomy, set a right kocher EVD was made, then dura tented. 4. Right frontal dura opened toward the sinus 5. Dissect and protect of bridging vein 6. Retract the right middle frontal to expose the cigulate gyrus and find out bilateral pericallosal artery. 7. Linear incision into the corpus callosum about 2cm 8. Drain out the hematoma at lateral ventricle and the tumor was debulked. 9. Remove of tumor and send frozen section 10. Expose the margin between tumor and ventricular wall 11. Opernseptum pallucidum and remove the tumor and hematomaat right foramen monro to 3rd ventricle 12. Hemostasis the deep feeding artery from 3rd ventricular floor 13. Hemostasis tightily close the dura with duraform graft clearly 14. Repair the sinus leakage 15. Fix back skull graft with wire x5 16. Set a subgaleal CWV 17. Close the wound in layers Operators P蔡瑞章 VS王國川 Assistants R5陳睿生 R2高明蔚 R1賴碩倫 Indication Of Emergent Operation 廖義崑 (M,1951/02/28,61y0m) 手術日期 2010/01/25 手術主治醫師 賴達明 手術區域 東址 019房 05號 診斷 Brain abscess 器械術式 Removal of epidural hematoma 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 4E 紀錄醫師 賴碩倫, 時間資訊 00:00 臨時手術NPO 21:08 進入手術室 21:15 麻醉開始 21:20 誘導結束 21:53 手術開始 21:55 開始輸血 22:50 手術結束 22:50 麻醉結束 23:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 硬腦膜外血腫清除術 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Hematoma evacuation 開立醫師: 陳莉芳 開立時間: 2010/01/25 23:09 Pre-operative Diagnosis Left temporal abscess s/p open drainage with epidural hematoma Post-operative Diagnosis Left temporal abscess s/p open drainage with epidural hematoma Operative Method Hematoma evacuation Specimen Count And Types nil Pathology Nil Operative Findings Large amount (50mL) of epidural hematoma with dura compression. One suspected galeal vessles bleeding was coagulated with bipolar coagulation. The brain was relaxed after hematoma evacuation. One subdural and one epidural CWV drains were set up. The ICP tip was put in subdural space. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position with head turned to right. The scalp was disinfected with alcohol B-I then draped. The wound was opened along previous wound and removed the stitiches. The epidural hematoma was removed. One suspected galeal vessles bleeding was coagulated with bipolar coagulation. The brain was relaxed after hematoma evacuation. Irrigated the wound with gentamycin solution. One subdural and one epidural CWV drains were set up. The ICP tip was put in subdural space. The wound was then closed in layers. Operators VS賴達明 Assistants R6李建勳 R1賴碩倫 廖義崑 (M,1951/02/28,61y0m) 手術日期 2010/01/25 手術主治醫師 賴達明 手術區域 東址 002房 01號 診斷 Brain abscess 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 污染 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 4E 紀錄醫師 許松鈺, 時間資訊 04:49 通知急診手術 04:49 臨時手術NPO 04:49 開始NPO 13:45 進入手術室 13:50 麻醉開始 14:15 誘導結束 14:30 抗生素給藥 14:43 開始輸血 14:48 手術開始 18:20 手術結束 18:20 麻醉結束 18:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱內壓監視置入 1 4 L 手術 腦內血腫清除術 1 1 L 手術 顱骨切除術，包括異物移除或減壓或神經切斷 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 內科部 套用罐頭: Craniectomy and Abscess drainage and ICP inse... 開立醫師: 胡朝凱 開立時間: 2010/01/25 18:55 Pre-operative Diagnosis Left temporal brain abscess and severe brain swelling Post-operative Diagnosis Left temporal brain abscess and severe brain swelling Operative Method Craniectomy and Abscess drainage and ICP insertion Specimen Count And Types Pus culture x 3 Pathology Nil Operative Findings 1.The brain surface was intact after dural opening 2.Corticotomy was performed at left middle temporal gyrus 3.Frank pus, whitish to yellowish, gush out from left temporal lobe and the brain became slack after drainage. 4.Thick abscess capsule Operative Procedures 1.ETGA, supine 2.Left trauma flap skin incision 3.Reflect skin flap 4.detach muscle flap 5.Burr hole drainage 6.Craniectomy 7.Hemostasis 8.Dural opening 9.corticotomy at left middle temporal gyrus 10.drain pus 11.Hemostasis 12.Set one subdural drain and ICP monitor 13.Close dura with fascia flap 14.Set one CWV drain then close wound in layers Operators 賴達明 Assistants 胡朝凱,許松鈺 Indication Of Emergent Operation 趙蘭花 (F,1908/11/29,103y3m) 手術日期 2010/01/25 手術主治醫師 蔡翊新 手術區域 東址 018房 002號 診斷 Intracerebral hemorrhage 器械術式 Tracheostomy 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 趙安怡 ASA 3 紀錄醫師 李佳穎, 時間資訊 10:25 報到 10:25 進入手術室 10:26 麻醉開始 10:27 誘導結束 10:35 手術開始 10:50 麻醉結束 10:50 手術結束 10:55 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 氣管切開造口術 1 0 摘要__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 李佳穎 開立時間: 2010/01/25 10:53 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Ditto Operative Method Tracheostomy Specimen Count And Types nil Pathology None Operative Findings Fr . 7 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators VS張金池 Assistants R4李佳穎 Indication Of Emergent Operation 手術日期：2010/01/26 12:44 摘要__ 手術科部: 外科部 套用罐頭: L3-L5 laminectomy for decompression 開立醫師: 高明蔚 開立時間: 2010/01/26 12:44 Pre-operative Diagnosis L3-S1 lumbar stenosis wih L3/L4, L5/S1 HIVD Post-operative Diagnosis L3-S1 lumbar stenosis wih L3/L4, L5/S1 HIVD Operative Method L3-L5 laminectomy for decompression Specimen Source and Count NA Pathology NA Operative Findings Thickening ligmentum flavum was noted especially at L3/L4, L4/L5 junction. Calcified herniated disc was found at L5/S1. After laminectomy, the thecal sac was well-decompressed. Operative Procedures 2.Posterior back incision 3.Split bilateral paraspinal muscles to expose laminae and spinous processes of L3-5 4.L3-5 laminectomy with bone cutter and rongeur 5.Remove ligamentum flavum 6.Foraminal decompression with Kerrison ponch 7.Hemostasis, set 1/8 hemovac x1 8.Close the wound in layers 1.ETGA, prone, localized L3-5 with C-arm Operators 曾勝弘 Assistants R5陳睿生,R2高明蔚 連正義 (M,1938/11/09,73y4m) 手術日期 2010/01/26 手術主治醫師 賴達明 手術區域 東址 001房 02號 診斷 Intracerebral hemorrhage 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 4E 紀錄醫師 陳盈志, 時間資訊 00:00 開始NPO 08:58 通知急診手術 09:25 進入手術室 09:30 麻醉開始 09:40 誘導結束 10:00 抗生素給藥 10:20 手術開始 11:00 開始輸血 13:00 抗生素給藥 14:45 手術結束 14:45 麻醉結束 14:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Suboccipital craniectomy hematoma evacuation 開立醫師: 陳盈志 開立時間: 2010/01/26 15:09 Pre-operative Diagnosis Cerebellar ICH with IVH Post-operative Diagnosis Cerebellar ICH with IVH Operative Method Suboccipital craniectomy hematoma evacuation Specimen Count And Types nil Pathology nil Operative Findings about 40mL hematoma was found at left hemisphere extend to vermis. IVH was also noted. The brain was slake after hematoma evacuation Operative Procedures 1.ETGA, prone with neck flexion and head fixation with Mayfield 2.Midline incision 3.Detach muscle to expose inion to C1 posterior arch 4.Burr hole x 5 then craniectomy with saw 5.Y shape dura incision 6.hematoma evacuation with sucker 7.Hemostasis with surgicel packing 8.Duroplasty with duraform and fascia graft 9.Epidural CWV drain x 1 10.close wound in layers. Operators VS賴達明 Assistants R6陳盈志 Ri歐陽霓 Indication Of Emergent Operation 卓有亮 (M,1936/10/15,75y4m) 手術日期 2010/01/26 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Lumbar Spondylosis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 許松鈺, 時間資訊 00:00 臨時手術NPO 14:25 報到 14:40 進入手術室 14:50 麻醉開始 15:00 誘導結束 15:00 抗生素給藥 15:20 手術開始 18:00 抗生素給藥 18:41 開始輸血 19:10 手術結束 19:10 麻醉結束 19:20 送出病患 19:23 進入恢復室 20:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 椎間盤切除術－腰椎 1 2 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 摘要__ 手術科部: 外科部 套用罐頭: L3/4, L4/5 TPS + laminectomy 開立醫師: 許松鈺 開立時間: 2010/01/26 17:33 Pre-operative Diagnosis L3/4, L4/5 HIVD L3/4, L4/5 SPNDYLOLISTHESIS AND HIVD Post-operative Diagnosis L3/4, L4/5 HIVD L3/4, L4/5 SPNDYLOLISTHESIS AND HIVD Operative Method L3/4, L4/5 TPS + laminectomy L3~5 TPS + L4 laminectomy and L3~4~5 diskectomy Specimen Count And Types Nil Pathology Nil Operative Findings 1. Bulged intervertebral disc of L3/4 and L4/5 with tight compression of the thecal sac 1.Severe stenosis of lateral recess at L3~5 level 2.Bulged intervertebral disc of L3/4 and L4/5 with tight compression of the thecal sac 3.scoliosis at lumbar spine Operative Procedures 1. ETGA, prone position 2. Check L3-L5 by C-arm, skin disinfection 3. Make a midline skin incision from L3-L5 4. Extend to the muscular fascia plane and advance bilaterally to para-median place 5. Blunt dissection of the para-spinal muscle for identification bilateral transverse process of L3-L5 5. Blunt dissection of the para-spinal muscle for identification bilateral transverse process of L3-L5 6. Place trans-pedicular screw over L3-L5 6. Place trans-pedicular screw over L3-L5 7. Identify spinous process of L3-L5 and perform laminectomy for decompression 7. Identify spinous process of L3-L5 and perform laminectomy for decompression 7. Identify spinous process of L4 and perform laminectomy 8. extend to upper and lower L3~4 and L4~5 root and release 9. L3~5 partial diskectomy 10. set hemovac drain then close wound in layers Operators 賴達明, 蕭輔仁 Assistants 胡朝凱, 許松鈺 林芳瑜 (F,1993/11/12,18y4m) 手術日期 2010/01/27 手術主治醫師 楊士弘 手術區域 兒醫 067房 01號 診斷 Primitive neuroectodermal tumor 器械術式 Spinal fusion posterior 手術類別 臨時手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 2 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 08:00 報到 08:07 進入手術室 08:10 麻醉開始 08:50 誘導結束 09:55 抗生素給藥 10:20 手術開始 12:55 抗生素給藥 15:25 開始輸血 15:55 抗生素給藥 18:55 抗生素給藥 19:00 麻醉結束 19:00 手術結束 19:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 2 手術 惡性病髓腫瘤切除術 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 14 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 3 0 麻醉 Hemoglobin (Hb) 3 0 麻醉 測血糖 3 0 麻醉 Ca (Calcium) 3 0 麻醉 Na (Sodium) 3 0 麻醉 K (Potassium) 3 0 麻醉 Cl (Chloride) 3 0 麻醉 Blood gas analysis 3 0 摘要__ 手術科部: 套用罐頭: Tumor excision + posterior fixation and fusio... 開立醫師: 楊士弘 開立時間: 2010/01/27 19:58 Pre-operative Diagnosis (1) Recurrent spinal metastasis, T1-T2, with spinal cord compression; (2)primitive neuroectodermal tumor s/p op. + chemotherapy + radiotherapay Post-operative Diagnosis (1) Recurrent spinal metastasis, T1-T2, with spinal cord compression; (2)primitive neuroectodermal tumor s/p op. + chemotherapy + radiotherapay Operative Method Tumor excision + posterior fixation and fusion from C6,7 to T3,4 Tumor excision + posterior spinal fixation and fusion from C6,7 to T3,4 Specimen Count And Types 1 piece About size:小 Source:T1, T2 vertebral tumor Pathology Pending Operative Findings 1. Thick epidural scar was found over the previous laminectomy site from T1 to T3 vertebrae. 2. Soft fragile, greyish red, moderately vascularized tumor was found in the right lateral and anterior epidural space of T1 and T2, with destruction of the T2 pedicle, transverse process, and rib head. The right half vertebral bodies of T1 and T2 were also destructed and ivaded by the tumor. 3. The right T1 root was circumferentially compressed by the tumor, and became free of tension after tumor excision. 4. Instrumentation: C6 lateral mass screws: 18 mm x 3.5 mm right C7 transfacet screw: 14 mm x 3.5 mm left C7 transfacet screw: 12 mm x 3.5 mm bilateral T3, T4 screws: 30 mm x 4.35 mm Screws of each side were connected with one rod One cross-link to bridge both rods Operative Procedures 1. ETGA, prone, head fixed with radiolucent Mayfield skull clamp 2. Posterior midline incision, C5 to T5 3. Dissection and removal of epidural scar from T1 to T3 4. Tumor excision over T1, T2 vertebral bodies, right T2 pedicle, T1-2 & T2-3 facets, and T2 transverse process 4. Tumor excision over T1, T2 vertebral bodies, right T2 pedicle, T1-2 & T2-3 facets, and T2 transverse process. 5. Hemostasis. 6. Insertion of c6 lateral mass screws, C7 transfacet screws, and T3-4 pedicle screws, which were connected with rods and a cross link 6. Insertion of c6 lateral mass screws, C7 transfacet screws, and T3-4 pedicle screws, which were connected with rods and a cross link. Onlay posterior bone fusion was done with ydroxyappaptite bone substitutes from C6-T4. 7. One epidural CWV drain 8. Wound closure in layers Operators 郭夢菲, 楊士弘 Assistants 鍾文桂 吳穎龍 (M,1962/12/05,49y3m) 手術日期 2010/01/28 手術主治醫師 杜永光 手術區域 東址 001房 02號 診斷 Intracerebral hemorrhage 器械術式 Brain tumor Crainotomy(Others) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 4E 紀錄醫師 許松鈺, 時間資訊 11:20 報到 11:25 進入手術室 11:32 麻醉開始 11:55 誘導結束 13:00 抗生素給藥 13:04 手術開始 16:00 抗生素給藥 16:10 抗生素給藥 17:10 開始輸血 19:10 麻醉結束 19:10 手術結束 19:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 7 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 開顱術摘除血管病變－動靜脈畸型－小型－表淺 1 1 B 手術 腦內血腫清除術 1 2 B 手術 腦室體外引流 1 4 B 摘要__ 手術科部: 外科部 套用罐頭: suboccipital craniotomy for dural AVF excisio... 開立醫師: 陳盈志 開立時間: 2010/01/28 19:49 Pre-operative Diagnosis right frontal dural AVF with ICH and IVH Post-operative Diagnosis right frontal dural AVF with ICH and IVH Operative Method suboccipital craniotomy for dural AVF excision and hematoma evacuation and left kocher EVD insertion Frontal craniotomy for dural AVF excision and hematoma evacuation and left kocher EVD insertion Specimen Count And Types 1 piece About size:one 1.5cm engorged AV fistula Source:dural a\AV fistula Pathology pending Operative Findings multiple feeding artery come from pia of right frontal tip and base connecting with engorged drainage vein. 50mL hematoma was noted at right frontal and frontal was severe swelling. CSF was xanthochromic. The opening pressure was 15cmH2O. ventricular catheter was 6.2cm in length Operative Procedures Under ETGA, the patient was set into supine position with neck extension and head fixed with Mayfield Skin preparation. Bicoronal scalp incision and pericranium was divided. Burr hole x 3 were made and craniotomy window was done cross the midline. Remove frontal sinus mucosa and packing with gelform and bone wax. Linear dural incision was done and hematoma was evacuated with suction. The feeding artery from pia of frontal tip and base was cauterized. Then the veinous drainage was cauterized. Hemostasis was done with bipolar and surgicel packing. Duroplasty was done with fascia graft and 4-0 prolene. Frontal sinus was covered with fascia. Left frontal kocher point EVD was inserted Bone plate was fixed with miniplate after central tenting One subgaleal CWV drain was set and the wound was closed in layers. Operators P杜永光 Assistants R6陳盈志 R1許松鈺 Indication Of Emergent Operation 趙蘭花 (F,1908/11/29,103y3m) 手術日期 2010/01/28 手術主治醫師 蔡翊新 手術區域 東址 002房 05號 診斷 Intracerebral hemorrhage 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林峰盛 ASA 4E 紀錄醫師 李振豪, 時間資訊 12:30 開始NPO 12:30 臨時手術NPO 18:42 報到 18:44 進入手術室 18:55 麻醉開始 18:58 誘導結束 19:15 手術開始 20:10 麻醉結束 20:10 手術結束 20:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Burr hole drainage 開立醫師: 李振豪 開立時間: 2010/01/28 20:29 Pre-operative Diagnosis Right fronto-temporal-parietal chronic subdural hematoma Post-operative Diagnosis Right fronto-temporal-parietal chronic subdural hematoma Operative Method Burr hole drainage Specimen Count And Types Nil Pathology Nil Operative Findings 1. Much motor oil-like fluid gushed out after opening outer membrane. 2. The brain parenchyma was slack after evacuation of chronic subdural hematoma Operative Procedures Under tracheostomy tube general anesthesia, the patient was put at supine position. Wound sutures were removed. The skin was shaved, scrubbed, and disinfected as usual. The previous scalp wound was extended laterally and a small scalp flap was elevated. One burr hole was made. The dura was opened after tenting. The outer membrane was opened and the edge of opening was coagulated by bipolar cautery. One rubber drain was placed into subdural space and normal saline irrigation was performed toward occipital, temporal, and frontal area till clear drainage. The rubber drain was placed toward frontal area and externalization was done. After hemostasis, the wound was closed in layers. Deair was done after wound closure. Operators 蔡翊新 Assistants 李振豪 Indication Of Emergent Operation 相關圖片 何進富 (M,1957/02/26,55y0m) 手術日期 2010/01/29 手術主治醫師 曾漢民 手術區域 東址 019房 01號 診斷 Meningitis 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 污染 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 2 紀錄醫師 高明蔚, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:08 進入手術室 08:15 麻醉開始 09:10 誘導結束 09:50 抗生素給藥 10:10 手術開始 10:50 開始輸血 13:00 抗生素給藥 13:20 麻醉結束 13:20 手術結束 13:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Craniectomy and abscess evauation 開立醫師: 高明蔚 開立時間: 2010/01/29 14:16 Pre-operative Diagnosis Left parieto-occipital junction abscess Post-operative Diagnosis Left parieto-occipital junction abscess and epidural abscess Operative Method Craniectomy and abscess evauation Specimen Count And Types 1 piece About size:Multiple segments Source:Brain abscess Pathology PENDING Operative Findings 1.Frank pus gush out after dural opening 2.Epidural pus and granulation tissue(+) 3.Organized hematima was also noted in side the abscess cavity 4.The cavity connect to ventricle Operative Procedures 1.ETGA, prone and head fixed with skull clamp 2.Skin incision via previous wound 3.Dissect to open skin flap 4.Craniectomy 5.Open dura 6.Corticotomy and pus evacuation 7.Orgranized hematoma evacuation 8.Hemostasis 9.EVD insertion 10.Irrigation with normal saline 11.Close dura with fascia flap 12.Set CWV drain then close wound in layers Operators 曾漢民 Assistants R5胡朝凱,R2高明蔚 林芳瑜 (F,1993/11/12,18y4m) 手術日期 2010/01/29 手術主治醫師 許文明 手術區域 兒醫 062房 03號 診斷 Primitive neuroectodermal tumor 器械術式 Lobecomy & thoracoplasty or br 手術類別 緊急手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 蕭柏妮 ASA 3 紀錄醫師 蔡立威, 時間資訊 00:00 開始NPO 00:00 臨時手術NPO 09:49 通知急診手術 13:10 進入手術室 13:10 報到 13:30 麻醉開始 14:00 誘導結束 15:22 手術開始 16:15 開始輸血 17:00 抗生素給藥 20:05 麻醉結束 20:05 手術結束 20:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 惡性縱隔腔腫瘤切除 1 1 R 手術 肺單元切除術 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 套用罐頭: RUL lung partial lobectomy for tumor debulking 開立醫師: 蔡立威 開立時間: 2010/01/29 21:02 Pre-operative Diagnosis Primitive neuroectodermal tumor, with spine and lung metastasis Post-operative Diagnosis Primitive neuroectodermal tumor, with spine and lung metastasis Operative Method RUL lung partial lobectomy for tumor debulking RUL lung apical segmentectomy 2.tumor debulking Specimen Count And Types 1 piece About size:5*5cm Source:right upper lobe lung Pathology pending Operative Findings 1. a ill-marginated, firm, with yellowish content, main tumor was noted at right upper lobe lung 2. multiple metastatic 0.5~1cm nodules was noted at the surface of RUL and RML Operative Procedures 1.ETGA, left decubitus 2.skin disinfection and drapping 3.thoracotomy with transverse skin incision over old scar 4.identify main tumor and dissect it from normal lung tissue, SVC 5.carefully ligate the bronchus and vessels 6.resect main tumor 7.hemostasis 8.N/S irrigation and check air-leak 9.repair lung surface by prolene continuous suture 10.recheck air-leak 11.insert a 28Fr. chest tube 12.close wound in layers Operators VS許文明 Assistants R1蔡立威,Ri郭百曾 Indication Of Emergent Operation 手術日期：2010/01/31 15:03 摘要__ 手術科部: 外科部 套用罐頭: Total tumor excision 開立醫師: 高明蔚 開立時間: 2010/01/31 15:03 Pre-operative Diagnosis Right retroauricular subcutaneous tumor Post-operative Diagnosis Right retroauricular subcutaneous tumor Operative Method Total tumor excision Specimen Source and Count 1 piece About size:2*1.5cm Source:right scalp Pathology Pending Operative Findings The tumor was soft grayish and lobulated. The size was about 2*1.5cm Operative Procedures Local anesthesia, prone position Retriauricular linar incision Dissect the tumor from peripheral tissue Total removal of the tumor Hematostasis, close the wound Operators 曾勝弘 Assistants R5陳睿生 唐碧霞 (F,1931/11/26,80y3m) 手術日期 2010/01/31 手術主治醫師 杜永光 手術區域 東址 005房 01號 診斷 Subarachnoid hemorrhage 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 4E 紀錄醫師 鍾文桂, 時間資訊 08:00 開始NPO 13:15 通知急診手術 16:24 進入手術室 16:25 麻醉開始 16:45 誘導結束 17:00 抗生素給藥 17:05 手術開始 17:45 手術結束 17:45 麻醉結束 17:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱內壓監視置入 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: EVD insertion via right kocher point as ICP m... 開立醫師: 鍾文桂 開立時間: 2010/01/31 17:41 Pre-operative Diagnosis SAH with IVH and hydrocephalus Post-operative Diagnosis SAH with IVH and hydrocephalus Operative Method EVD insertion via right kocher point as ICP monitor Specimen Count And Types nil Pathology nil Operative Findings CSF was reddish. the opening pressure was about 10~13cmH2O. ventricular catheter was 6cm in depth Operative Procedures Under general anesthesia with endotracheal tube intubation. The patient was set into supine position. The operation field was scrubbed and drapped. Right frontal linear incision was done and one burr hole was made with air drill at right kocher point. Dura tenting was done with one stitch. Ventricular tapping was done and EVD was inserted and then fixed. Hemostasis was done and the wound was closed in layers. Operators P杜永光 Assistants R6陳盈志R4鍾文桂 Indication Of Emergent Operation 唐碧霞 (F,1931/11/26,80y3m) 手術日期 2010/02/01 手術主治醫師 廖漢文 手術區域 東址 000房 號 診斷 Subarachnoid hemorrhage 器械術式 NEURO T.A.E 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 4E 時間資訊 15:30 麻醉開始 15:40 誘導結束 17:10 麻醉結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 郭陳寶惜 (F,1952/01/06,60y2m) 手術日期 2010/02/01 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Lymphoma 器械術式 Stereotaxic procedure for biop 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:05 進入手術室 08:20 麻醉開始 08:30 誘導結束 09:15 抗生素給藥 09:20 手術開始 13:10 麻醉結束 13:10 手術結束 13:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 手術 立體定位術－切片 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Stereotactic biopsy of brain tumor 開立醫師: 李振豪 開立時間: 2010/02/01 13:03 Pre-operative Diagnosis Right thalamus and midbrain tumor, suspect malignancy Post-operative Diagnosis Right thalamus and midbrain tumor, suspect malignancy Operative Method Stereotactic biopsy of brain tumor Specimen Count And Types 1 piece About size:0.05g, multiple pieces Source:Right thalamus and midbrain tumor Pathology Frozen section: pleomorphic appearance, suspect malignancy Operative Findings The brain is atrophic. Blood clot is noted during stereotactic biopsy but no active bleeding from tract is noted. The specimen is grayish in color. Left side MEP is absent before the operation. The right side MEP, bilateral BAEP, and SSEP are all within normal limit and no significant change after the operation. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine position with head fixed with Mayfield skull clamp. Navigator registration was done and the biopsy tract was planned. The scalp was shaved, scrubbed, and disinfected as usual. One linear scalp incision was made at right Kochers point followed by one burr hole creation. Dural tenting was done and the dura was opened with cruciform in fashion. The fram of stereotactic biopsy was set up and biopsy of right thalamic and midbrain tumor was performed. The specimen was sent for frozen section. Stereotactic biopsy was done in all four directions. The biopsy needle was removed and hemostasis was checked. The wound was then closed in layers. The vital signs were stable during whole procedure. Operators 杜永光 Assistants 李建勳, 李振豪 相關圖片 林春 (F,1944/09/03,67y6m) 手術日期 2010/02/01 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 古恬音, 時間資訊 00:00 臨時手術NPO 12:37 報到 14:50 進入手術室 14:55 麻醉開始 15:25 誘導結束 15:30 抗生素給藥 15:35 手術開始 18:30 抗生素給藥 18:45 麻醉結束 18:45 手術結束 18:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除－手術時間在４小時以內 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 摘要__ 手術科部: 外科部 套用罐頭: Right frontal craniotomy total tumor excision 開立醫師: 陳盈志 開立時間: 2010/02/01 19:18 Pre-operative Diagnosis Falx meningioma right side Post-operative Diagnosis Falx meningioma right side Operative Method Right frontal craniotomy total tumor excision Specimen Count And Types 1 piece About size:4x3x3cm Source:falx meningioma Pathology pending Operative Findings The tumor was soft to elastic in character. There was dura base noted at falx. The margin was clear. Operative Procedures Under general anesthesia with endotracheal tube intubation, the patient was set into supine position with head fixed with mayfield. The operation field was scrubbed and disinfected with povidine iodine and then drapped well with sterile drapping. Bicoronal scalp incision was done. Burr hole was made with air drill and then craniotomy was done with saw. U-shape dura incision was done with SSS as its base. The tumor at the falx was identified. Devascularization was done along the dura base at falx. Central debulking was done with sucker and scissors. Then the border of the tumor was dissected circumferentially with bipolar and dissector and then removed. Hemostasis was done with bipolar and then surgicel packing. Duroplasty was done with pericranium and 4-0 prolene. Bone was fixed back with miniplate x 3 (3-3-2). One subgaleal drain was set then the wound was closed in layers Operators VS曾漢民 Assistants R6陳盈志R2古恬音 許麗昭 (F,1962/08/15,49y6m) 手術日期 2010/02/01 手術主治醫師 王國川 手術區域 東址 012房 4號 診斷 Subarachnoid hemorrhage 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 陳德福, 時間資訊 00:00 臨時手術NPO 12:43 報到 13:05 進入手術室 13:15 麻醉開始 13:20 誘導結束 14:18 手術開始 15:05 手術結束 15:05 麻醉結束 15:08 進入恢復室 15:15 送出病患 16:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: VPS, left frontal 開立醫師: 陳德福 開立時間: 2010/02/01 15:15 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis DITTO Operative Method VPS, left frontal Specimen Count And Types 1 piece About size:3ML Source:CSF Pathology NIL Operative Findings 1.The ventricular opening pressure:12cmH2O, CSF: clear and colorless 2.Intraventricular cath:6.7cm; Intraperitoneal cath: 25cm 3.One medium pressure, 長安, valve type shunt was implantated at left Kocher point Operative Procedures 1.Under ETGA and supine position 2.Skin disinfection and draping 3.Curvilinear incision at left frontal and burr hole creation 4.Dura tenting and dura opening followed by insert ventricular taping needle 5.Left upper abdomen minilaparotomy 6.Subcutaneous tunneling and connect the tube 7.Insert the valve and check the shunt function 8.Hemostasis and close the wound in layers Operators vs 王國川 Assistants r4 陳德福 相關圖片 毛國龍 (M,1936/09/08,75y6m) 手術日期 2010/02/03 手術主治醫師 賴達明 手術區域 東址 005房 01號 診斷 Chronic osteomyelitis 器械術式 Diskectomy thoracic 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 楊博智, 時間資訊 00:00 臨時手術NPO 08:00 報到 08:10 進入手術室 08:15 麻醉開始 09:05 誘導結束 09:20 抗生素給藥 10:10 手術開始 12:30 開始輸血 13:55 麻醉結束 13:55 手術結束 14:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 脊椎融合術－前融合，無固定物（＜＝四節） 1 2 手術 椎間盤切除術－脊椎 1 1 摘要__ 手術科部: 內科部 套用罐頭: Posteriolateral approach for diskectomy and a... 開立醫師: 陳睿生 開立時間: 2010/02/03 14:29 Pre-operative Diagnosis Osteomyelitis with spondylodiskitis over T7-8 Post-operative Diagnosis Ditto Operative Method Posteriolateral approach for diskectomy and anterior fusion Specimen Count And Types 1 piece About size:pieces Source:granulation tissue and abscess Pathology Pending Operative Findings The T7-8 vertebral bodies were noted to be collapsed. Abscess with granulation tissue were noted at intervertebral sapce. Left side T7 rib was cut and inserted into the intervertebral space as autologus bone graft. Intra-op moderate bleeding was noted due to right segmental artery rupture. Operative Procedures 1. ETGA, right side decubitus position, and C-arm localized T7-8 level 2. Left chest wall transverse incision at posteriolateral aspect 3. Incise into the muscle and harvest the T7, 8 ribs 4. Cut down T7 rib at posteriolateral side, and identify pleura 5. Dissect the pleural space after setting retractor, and split the left lung and aorta anteriorly 6. Incise into the right side vertebra-rib junction, and then perform T7-8 diskectomy 7. Remove the abscess and necrotic tissue 8. Hemostasis, and saline irrigation 9. Insert the cut rib into the T7-8 intervertebral space as fusion graft 10.Insert a retropleural CWV drain, and close the wound in layers Operators VS 賴達明 Assistants R5 陳睿生, R1 楊博智 管蔡素貞 (F,1936/11/23,75y3m) 手術日期 2010/02/04 手術主治醫師 杜永光 手術區域 東址 003房 02號 診斷 Subarachnoid hemorrhage 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 4 紀錄醫師 張得一, 時間資訊 10:20 報到 10:25 進入手術室 10:30 麻醉開始 10:40 誘導結束 11:15 手術開始 12:10 麻醉結束 12:10 手術結束 12:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 曾峰毅 開立時間: 2010/02/04 12:30 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Fixed medium-pressure ventriculoperitoneal shunt via left Kocher point Specimen Count And Types 6ml CSF was sent for routine, BCS, and culture Pathology nil Operative Findings Clear CSF drained out while ventriculostomy. Opening pressure was about 10cmH20. Ventricular catheter is about 6.5cm, while peritoneal catheter was about 30cm long. Fixed Medtronic medium-pressure VPS was inserted via left Kocher point. Operative Procedures Under endotracheal general anaesthesia, the patient was put in supine position with head rotated to right. After skin shaved, scrubbed, disinfected, and then draped, we made one transverse skin incision at left upper abdomen. Peritoneal catheter was inserteted via mini-laparotomy, and was put through via subcutaneous tunnel at left occipital scalp. We made one curvilinear skin incision at left frontal, and drilled one burr hole. We made one dura incision in X-shape. Ventircular catheter was inserted after ventricular puncture. We connected shunt system altogether, and checked it worked fine. The wound was closed in layers. Operators P 杜永光 Assistants R6 陳盈志 R3 曾峰毅 R3 張得一 李允翔 (M,1986/01/09,26y2m) 手術日期 2010/02/04 手術主治醫師 賴達明 手術區域 東址 005房 01號 診斷 Tardy ulnar palsy 器械術式 Neurolysis of the uluar neuve 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:05 進入手術室 08:10 麻醉開始 08:15 誘導結束 08:36 抗生素給藥 09:20 手術開始 11:30 手術結束 11:30 麻醉結束 11:40 送出病患 11:40 進入恢復室 13:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 神經分離術–肩，臀關節以上，包括臂神經叢，坐骨神經 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 摘要__ 手術科部: 外科部 套用罐頭: Neurolysis of ulnar nerve. 開立醫師: 鍾文桂 開立時間: 2010/02/04 11:51 Pre-operative Diagnosis Left tardy ulnar palsy. Post-operative Diagnosis Left tardy ulnar palsy. Operative Method Neurolysis of ulnar nerve. Neurolysis of ulnar nerve. Specimen Count And Types nil Pathology Nil. Operative Findings Malposition of the ulnear nerve. The ulnar nerve is not located in the cubital tunnel. Instead, it located in medial condyle. The ulnar nerve was free after lysis of the fibrotic bands. Operative Procedures Anesthesia: general, laryngeal mask. Position: supine. Incision: Curvilinear incision just at the left cubital tunnel.10 cm long. Dissection: along the cubital tunnel. Lysis of the fibrotic bands around the ulnar nerve and tranlocation of th fascia for more lysis. Wound closure in layers. Send patient to POR smoothly. Operators V.S. 賴達明 Assistants R6 陳盈志,R4 鍾文桂. 林瑞元 (M,1937/11/24,74y3m) 手術日期 2010/02/06 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Spinal tumor 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 3 紀錄醫師 陳睿生, 時間資訊 00:00 臨時手術NPO 07:42 報到 08:00 進入手術室 08:15 麻醉開始 09:00 抗生素給藥 09:15 誘導結束 09:40 手術開始 09:50 開始輸血 12:00 抗生素給藥 12:45 手術結束 12:45 麻醉結束 13:00 送出病患 13:05 進入恢復室 15:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術－腰椎 1 1 手術 椎弓切除術（特壓）－二節以內 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 麻醉 術後止痛 1 0 摘要__ 手術科部: 外科部 套用罐頭: Lower L2 tp L3 right side hemilaminectomy and... 開立醫師: 陳睿生 開立時間: 2010/02/06 13:16 Pre-operative Diagnosis L2/3, 3/4 epidural and paraspinal mass Post-operative Diagnosis L2/3 epidural mass, suspect inflammation tissue, and L3/4 ruptured disk Operative Method Lower L2 tp L3 right side hemilaminectomy and remove of L3/4 ruptured disk Lower L2 tO L3 right side hemilaminectomy and remove of L3/4 ruptured disk Specimen Count And Types 1 piece About size:pieces Source:disk, suspect inflammation tissue Pathology Pending Operative Findings L3/4 ruptured disk with thecal sac and right L4 root compression was noted. L2/3 epidural fatty tissue with necrotic portion was noted and removed. The previous TPS was fair with granulation tissue formation. Operative Procedures 1. ETGA, prone position and C-arm localized L3 level 2. Low back incision along previous wound 3. Split right side paraspinal muscle and expose L2/3, 3/4 interlaminal space and previous rod 4. Lower L2 to L3 hemilaminectomy was performed under microscope 5. Split thecal sac at L3/4 level and remove of ruptured disk 6. Harvest L2/3 epidural mass and remove 7. Hemostasis, set a 1/8 hemovac 8. Close the wound in layers Operators VS 賴達明 Assistants R5 陳睿生, Ri 黃文賢 (M,1967/01/31,45y1m) 手術日期 2010/02/07 手術主治醫師 王國川 手術區域 東址 018房 01號 診斷 CVA 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 4E 紀錄醫師 陳姿君, 時間資訊 10:00 臨時手術NPO 10:00 開始NPO 13:20 通知急診手術 14:50 進入手術室 15:00 麻醉開始 15:20 抗生素給藥 15:30 誘導結束 15:49 手術開始 16:00 開始輸血 18:20 抗生素給藥 20:20 手術結束 20:20 麻醉結束 20:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 1 R 手術 顱內壓監視置入 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Right F-T-P craniectomy with hematoma evacuat... 開立醫師: 陳姿君 開立時間: 2010/02/07 20:34 Pre-operative Diagnosis Right MCA infarct with hemorhagic transformation Post-operative Diagnosis Right MCA infarct with hemorhagic transformation Operative Method Right F-T-P craniectomy with hematoma evacuation and ICP monitor insertion Specimen Count And Types nil Pathology nil Operative Findings The brain was very swelling. SAH and ICH was noted diffusely at left frontal temporal area. ICP was 6~8mmHg after skin closure. Easy oozing was noted which may be related to coagulopathy. The brain was very swelling. SAH and ICH was noted diffusely at right parietotemporal area. ICP was 6~8mmHg after skin closure. Easy oozing was noted which may be related to coagulopathy. Operative Procedures 1.ETGA, supine with head tilt to left 2.Skin preparation 3.Right frontal-temporal trauma flap scalp incision 4.Resect temporalis muscle and harvest fascia graft 5.Burr hole x 6 then craniectomy 15x8cm was done 6.Dura tenting was done and then C-shape dura incision was done 7.Temporal tip resection for hematoma evacuation and decompression 7.Partial resection at parietotemporal lobe for hematoma evacuation and decompression 8.Hemostasis with bipolar and surgicel packing 9.Duroplasty with fascia graft and 4-0 prolene 10.One ICP monitor was inserted to temporal direction 11.Two epidural CWV drain was set 12.close wound in layers Operators VS王國川 Assistants R3曾峰毅R2陳姿君 Indication Of Emergent Operation 吳穎龍 (M,1962/12/05,49y3m) 手術日期 2010/02/08 手術主治醫師 杜永光 手術區域 東址 003房 02號 診斷 Intracerebral hemorrhage 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 4E 紀錄醫師 鍾文桂, 時間資訊 00:03 臨時手術NPO 00:03 開始NPO 12:00 進入手術室 12:05 麻醉開始 12:15 誘導結束 13:00 抗生素給藥 13:15 手術開始 15:55 手術結束 15:55 麻醉結束 16:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 手術 腦室腹腔分流手術 1 2 L 手術 氣管切開造口術 1 0 L 摘要__ 手術科部: 外科部 套用罐頭: 1. Implantation of ventriculoperitoneal shunt... 開立醫師: 鍾文桂 開立時間: 2010/02/08 16:30 Pre-operative Diagnosis 1. Hydrocephalus. 2. Respiratory failure. Post-operative Diagnosis 1. Hydrocephalus. 2. Respiratory failure. Operative Method 1. Implantation of ventriculoperitoneal shunt via left Kocher point. 2. Tracheosotmy. Specimen Count And Types 1 piece About size:2 CC. Source:CSF CULTURE. Pathology Nil. Operative Findings Codman medium pressure ventriculoperitoneal shunt, ventricular: 6.5cm, peritoneal: 30 cm. ( Two sets were used due to valve obstruction in the first one.) 8.0 Fr. tracheosotmy tube for tracheostomy. Operative Procedures Anesthesia: endotracheal, general. Position: supine, head tilted to right. Removal of the EVD. Collect tip culture. Shaving, disinfection, and draping. Opening of the previous operative wound at right Kocher point. Normal saline irrigation of the burr hole. 5-cm incision at right upper quadrant of abdomen. Dissection to peritoneal cavity. Subcutaneous passage of shunt tube. Connect ventricular tube with valve. Insert ventricular catheter. Check shunt patency. Change a new valve due to valve obstruction. Re-insertion of ventricular catheter at left Kocher point. Check shunt patency. Wound closure in layers. Second operation: disinfection, draping of anterior neck. Longitudinal 2 cm incision at 2nd/3rd tracheal ring position. Midline dissection. Incision of 2nd/3rd tracheal ring. Insertion of tracheosotmy tube. Check patency of ventilation status. Primary suture of wound. Send patient to ICU smoothly. Operators Prof. 杜永光. Assistants R6 李建勳,R4 鍾文桂. Indication Of Emergent Operation 林芷妍 (F,2009/08/17,2y6m) 手術日期 2010/02/08 手術主治醫師 張重義 手術區域 兒醫 068房 01號 診斷 Congenital heart disease 器械術式 TCPC,JATENE,TAPVR,NORWOOD 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 4 紀錄醫師 黃俊銘, 時間資訊 00:32 臨時手術NPO 07:44 報到 08:10 進入手術室 08:15 麻醉開始 09:15 誘導結束 09:20 抗生素給藥 09:40 手術開始 12:20 抗生素給藥 15:00 開始輸血 15:20 抗生素給藥 15:42 麻醉結束 15:42 手術結束 16:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 心房–肺動脈迴路成形術 1 1 手術 肺動脈瓣狹窄擴張術 1 2 手術 肺動脈結紮 1 4 手術 體外心肺循環 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 7 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 T.E.E 1 0 麻醉 動脈血液檢查全套 4 0 麻醉 Hemoglobin (Hb) 4 0 麻醉 測血糖 4 0 麻醉 Ca (Calcium) 4 0 麻醉 Na (Sodium) 4 0 麻醉 K (Potassium) 4 0 麻醉 Cl (Chloride) 4 0 麻醉 Blood gas analysis 4 0 摘要__ 手術科部: 外科部 套用罐頭: 1. PA plasty 2. Bilateral BDG shunt creation ... 開立醫師: 黃俊銘 開立時間: 2010/07/05 13:36 Pre-operative Diagnosis DORV, remote VSD, s/p PA banding + PDA division with PA bifurcation stenosis Post-operative Diagnosis DORV, remote VSD, s/p PA banding + PDA division with PA bifurcation stenosis Operative Method 1. PA plasty 2. Bilateral BDG shunt creation 3. MPA division Specimen Count And Types nil Pathology Nil Operative Findings 1. Situs solitus, d-looped ventricle, levocardia, left arch, AsAo is right anterior to MPA 2. s/p PA banding, ~3mm in diameter with severe fibrosis around distal MPA, PA bifurcation, proximal bilateral PAs, leading to bilateral proximal PA stenosis 3. No innominate v. Right SVC:6mm, PLSVC: 5mm, RPA:5mm, LPA:5mm Right BDG shunt anastmosis:8mm Left BDG shunt anastomosis:8mm 4. Central PA after patch augmentation:6mm 5. Pulmonary hypertension, (PAP 25~30) with bloody sputum during operation 6. No ASD 7. Post-OP PAP 33/26(30), CVP 12, BP 75/47, SpO2 45% Operative Procedures ETGA, supine, skin disinfected Midline sternotomy harvest pericardium, treated with glutaraldehyde CPB with AsAo, RAA, PLSVC cannulation, cooling to 25C AXC, antegrade cardioplegia infusion LAA venting MPA amputation, with division of proximal MPA stump Central PA augmentation with glutaraldehyde treated pericardium patch PLSVC transection, division of LA side LPA incision, left BDG shunt creation with end-to-side anastomosis from PLSVC to left PA with 7-0 Maxon Right SVC transection, add right SVC cannulation RA side SVC division RPA incision, right DBG shunt creation with end-to-side anastomosis from eight SVC to right PA with 7-0 prolene Rewarm, deair, wean-off CPB Hemostasis, set 4 C/Ts in mediastinum(2), bilateral pleural cavities Sternum unapproximated, covered with silicon membrane Operators 張重義 Assistants 謝永 黃俊銘 侯秀溱 (F,1949/12/13,62y3m) 手術日期 2010/02/09 手術主治醫師 陳坤源 手術區域 東址 012房 03號 診斷 Multinodular goiter nontoxic 器械術式 Total thyroidectomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林子富 ASA 2 紀錄醫師 廖御佐, 時間資訊 13:30 進入手術室 13:35 麻醉開始 13:40 抗生素給藥 13:45 誘導結束 13:53 手術開始 15:47 手術結束 15:47 麻醉結束 15:55 送出病患 16:02 進入恢復室 18:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 雙側甲狀腺全葉切除術 1 1 B 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Bilateral total thyroidectomy 開立醫師: 廖御佐 開立時間: 2010/02/09 16:04 Pre-operative Diagnosis Bilateral nodular goiter Post-operative Diagnosis Bilateral nodular goiter Operative Method Bilateral total thyroidectomy Specimen Count And Types bilateral thyroid gland Pathology Pending Operative Findings 1.One enlarged 8.0*6.0 cm left thyroid gland; One 1.5*2.0 cm right thyroid gland with multinodular goiter Operative Procedures 1.ETGA, neck extention 2.Disinfection and drapped 3.Linear incision 4.Identify left recurrent laryngeal nerve 5.Left thyroidectomy 6.Identify right recurrent laryngeal nerve 5.Right thyroidectomy 6.Set two CWV drain 7.Close the wound in layers Operators 陳坤源 Assistants 廖御佐 李冠儀 何進富 (M,1957/02/26,55y0m) 手術日期 2010/02/09 手術主治醫師 曾漢民 手術區域 東址 005房 04號 診斷 Meningitis 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 髒 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 郝政鴻, 時間資訊 12:00 臨時手術NPO 12:00 開始NPO 18:00 通知急診手術 19:00 報到 19:20 進入手術室 19:25 麻醉開始 19:30 誘導結束 19:58 手術開始 21:00 抗生素給藥 21:55 麻醉結束 21:55 手術結束 22:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 腦內血腫清除術 1 1 手術 腦室體外引流 1 2 記錄__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT 開立醫師: 郝政鴻 開立時間: 2010/02/09 22:40 Pre-operative Diagnosis Brain abscess Post-operative Diagnosis Ditto Operative Method Brain abscess debridement and EVD insertion Specimen Count And Types 1 piece About size:3 ml Source:Brain abscess adn dura tissue Pathology Nil Operative Findings The cavity about 6 cm in diameter with abscess formation and wall granulation was noted. The abscess cavity was near tentorium. EVD was insertedd into the brain abscess cavity. One CWV was inserted under scalp. Operative Procedures After endotracheal intubation and general anesthesia, the patient was put on supine position. Incision over the previous operation scar. Apply the scalp clips. Intraoperation sonography check the abscess cavity. Cruciate incision over the dura. Drain out the brain abscess and collect culture. Irrigation with Vancomycin in 500 ml N/S. Set EVD into the brain abscess cavity. Closed dura. Set one CWV under the scalp. Closed scalp with vicryl 1-0 and Appose. 2. Position: supine with head tilted to right Operators 曾漢民, Assistants 陳睿生, 郝政鴻 Indication Of Emergent Operation 吳穎龍 (M,1962/12/05,49y3m) 手術日期 2010/02/10 手術主治醫師 杜永光 手術區域 東址 003房 03號 診斷 Intracerebral hemorrhage 器械術式 Removal of chronic subdural 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 4E 紀錄醫師 李建勳, 時間資訊 11:40 臨時手術NPO 14:25 報到 14:25 進入手術室 14:35 麻醉開始 14:45 誘導結束 15:00 手術開始 16:20 麻醉結束 16:20 手術結束 16:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 2 R 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Right frontal burr hole for hematoma evacuation 開立醫師: 李建勳 開立時間: 2010/02/10 16:42 Pre-operative Diagnosis 1. Right frontal AVF with ICH s/p evacuation 2. Subdural hematoma Post-operative Diagnosis 1. Right frontal AVF with ICH s/p evacuation 2. Subdural hematoma Operative Method Right frontal burr hole for hematoma evacuation Specimen Count And Types nil Pathology Nil Operative Findings Dark-reddish hematoma (30mL) drained out from the subdural space after opened the dura. The outter membrane was found after opened the dura. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position. The scalp was shaved, scrubbed and antiseptic with alcohol B-I then draped. The right frontal op wound was opened and extended with one linear scalp incision. One burr hole was created. The dura was tenting with 3-0 silk before opening. After opened the outter membrane of hematoma and N/S irrigation at four direction, one rubber drain with side holes was left in the subdural space. The wound was closed in layers and performed de-air procedure with the rubber drain then connected to the drainage bag. Operators P 杜永光 Assistants R6 李建勳 相關圖片 黃李蕙米 (F,1945/09/05,66y6m) 手術日期 2010/02/10 手術主治醫師 曾漢民 手術區域 東址 005房 03號 診斷 Lumbar Spondylosis 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 2 紀錄醫師 古恬音, 時間資訊 00:00 臨時手術NPO 14:15 報到 14:21 進入手術室 14:25 麻醉開始 14:35 誘導結束 15:05 抗生素給藥 15:14 手術開始 17:55 手術結束 17:55 麻醉結束 18:00 送出病患 19:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 椎弓切除術（特壓）－二節以內 1 1 摘要__ 手術科部: 套用罐頭: L5 laminectomy for decompression 開立醫師: 陳盈志 開立時間: 2010/02/10 18:08 Pre-operative Diagnosis L4/5 L5/S1 stenosis Post-operative Diagnosis L4/5 L5/S1 stenosis Operative Method L5 laminectomy for decompression Specimen Count And Types nil Pathology nil Operative Findings Hypertrophic ligmentum flavum at L4/5 L5/S1 causing canal stenosis. Root expanded well after laminectomy. Buldging disc at L4/5 was noted but root was decompressed well. Operative Procedures 1.ETGA, prone Carm localization 2.Skin preparation 3.Midline back incision, then detach paraspinal muscle to expose lower L4 to upper S1 lamina 4.laminectomy L5 with rongeur and karrison punch till decompression of L5 and S1 root. Foraminotomy was also done with karrison 5.Hemostasis, gelform packing 6.close wound in layers Operators VS曾漢民 Assistants R6陳盈志R2古恬音 郭世元 (M,1933/01/06,79y2m) 手術日期 2010/02/11 手術主治醫師 王國川 手術區域 東址 018房 05號 診斷 Subarachnoid hemorrhage (SAH) 器械術式 Craniotomy(Aneurysms) P-DUH 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 4E 紀錄醫師 陳盈志, 時間資訊 23:06 通知急診手術 23:15 報到 23:15 進入手術室 23:20 麻醉開始 23:40 誘導結束 00:00 抗生素給藥 00:20 手術開始 03:15 抗生素給藥 04:55 麻醉結束 04:55 手術結束 05:10 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 開顱術摘除血管病變－腦血管瘤－有徵的 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Right pterion craniotomy aneurysm clipping 開立醫師: 陳盈志 開立時間: 2010/02/11 05:29 Pre-operative Diagnosis SAH with right temporal ICH, suspect aneurysm bleeding Post-operative Diagnosis SAH with right temporal ICH, suspect mycotic aneurysm bleeding Operative Method Right pterion craniotomy aneurysm clipping Specimen Count And Types nil Pathology nil Operative Findings 40mL hematoma was noted at right temporal lobe with brain swelling. SAH was noted mostly at sylvian fissure. One irregular shape aneurysm was noted at the bottom of hematoma at tmporal tip . One straight clip was applied Operative Procedures Under ETGA and supine position with head rotated to left side, vortex down, and fixed with Mayfield head clump, skin disinfected and drapped were performed as usual. Curvilinear skin incision over right F-T area was done. Dura was opened after dura tetning. The sylvian fissure was opened from distal to proximal. Hematoma evacuation was done with sucker. Aneurysm was exposed and clip was applied to aneurysm neck. Hemostasis with surgecell and Gelfoam were done. Dura closure in water-tie and the skull plate was fixed with mini-plates. The wound was then closed in layers after subgaleal drain inserted. Operators VS王國川 Assistants R6陳盈志 Indication Of Emergent Operation 許文勇 (M,1960/01/08,52y2m) 手術日期 2010/02/10 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 Malignant neoplasm of trachea 器械術式 Ommaya reservoir implantation 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 3 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 11:30 報到 11:43 進入手術室 11:50 麻醉開始 12:00 誘導結束 12:22 手術開始 13:00 手術結束 13:00 抗生素給藥 13:00 麻醉結束 13:05 送出病患 13:10 進入恢復室 14:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 歐氏貯囊置放手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Right Kocher point ommaya reservoir implantateion 開立醫師: 李建勳 開立時間: 2010/02/10 13:09 Pre-operative Diagnosis Lung cancer with brain metastasis Post-operative Diagnosis Lung cancer with brain metastasis Operative Method Right Kocher point ommaya reservoir implantateion Specimen Count And Types nil Pathology Nil Operative Findings Clear CSF drained out after ventricular puncture. Ventricular catheter: 6.5cm. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position. The scalp was shaved, scrubbed, disinfected with alcohol B-I then draped. Curvilinear scalp incision was made at right frontal Kocher point followed by burr hole. The dura was opened after tenting with 3-0 silk sutures. The ventricle was punctured with ventricular puncture needle then shifted to Ommaya reservoir. After checked the reservoir function, the wound was closed in layser. Operators VS 王國川 Assistants R6 李建勳 R4 鍾文桂 管蔡素貞 (F,1936/11/23,75y3m) 手術日期 2010/02/12 手術主治醫師 楊士弘 手術區域 東址 001房 02號 診斷 Subarachnoid hemorrhage 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 王永彬 ASA 3E 紀錄醫師 張得一, 時間資訊 12:00 臨時手術NPO 12:00 開始NPO 14:52 通知急診手術 15:33 進入手術室 15:35 麻醉開始 15:40 誘導結束 16:29 手術開始 18:00 手術結束 18:00 麻醉結束 18:10 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 慢性硬腦膜下血腫清除術 1 2 L 手術 腦脊髓液分流管重置 1 2 L 摘要__ 手術科部: 內科部 套用罐頭: 1. Left burr hole for subdural drainage with ... 開立醫師: 李建勳 開立時間: 2010/02/12 18:29 Pre-operative Diagnosis 1. A-com aneurysm with SAH, hydrocephalus s/p VP shunt. 2. Left chronic subdural hematoma Post-operative Diagnosis 1. A-com aneurysm with SAH, hydrocephalus s/p VP shunt. 2. Left subdural effusion Operative Method 1. Left burr hole for subdural drainage with EVD catheter 2. VP shunt revision to programmable valve with antisiphon device Specimen Count And Types Nil Pathology Nil Operative Findings Some clear-yellowish CSF drained out from subdral space after opened the dura. Medtronic programmable valve with delta chamber were implanted, set vulve value: 2.5. Operative Procedures Under general anethesia and tracheotomy ventilator support, the patient was put in supine position. The scalp was shaved, scrubbed, disinfected with alcohol B-I then draped. The abdominal wound was also prepared. Linear scalp incision was made at left temporal area followed by burr hole creation. The dura was opened after tenting. The subdral effusion was drained out and set the EVD catheter at the subdrual space. Irrigated the subdural space with N/S and fixed the EVD via subcutaneous tunnel. The previous VP shunt wound was opened and replaced the valve with programmable valve with delta chamber. Retracted the shunt to smooth the course of the shunt via the abdominal wound. After hemostasis and irrigated the wounds with gentamycin solution, the wounds were closed in layers. Operators VS 楊士弘 Assistants R6 李建勳 R2 張得一 Indication Of Emergent Operation 相關圖片 李沛蓉 (F,2010/02/09,2y1m) 手術日期 2010/02/12 手術主治醫師 楊士弘 手術區域 兒醫 067房 01號 診斷 Hypotonia 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 4E 紀錄醫師 吳晉睿, 時間資訊 18:10 進入手術室 18:40 麻醉開始 20:20 開始輸血 21:00 抗生素給藥 21:45 誘導結束 22:45 手術開始 01:52 抗生素給藥 02:50 手術結束 02:50 麻醉結束 03:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 1 手術 顱內壓監視置入 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 8 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 套用罐頭: (1) Right Frazier EVD for ICP monitor; (2) Su... 開立醫師: 楊士弘 開立時間: 2010/02/13 03:06 Pre-operative Diagnosis Cerebellar hemorrhage with obstructive hydrocephalus Post-operative Diagnosis Cerebellar hemorrhage with obstructive hydrocephalus Operative Method (1) Right Frazier EVD for ICP monitor; (2) Suboccipital craniotomy for hematoma evacuation Specimen Count And Types nil Pathology Nil Operative Findings 1. Blood tinged CSF with high opening pressure was noted upon ventricular puncture. 2. The posterior fossa dura was rather tense after removal of skull plate. 3. Subdural blood clot was noted in the posterior and superior cerebellar surface. 4. Spontaneous drainage of intracerebal blood clot througth 4. Spontaneous drainage of intracerebal blood clot through vermis 5. Some blood clot in the cerebellum with some small vessels intervened inside. 6. The brain was slack after hematoma evacuation. Operative Procedures 1. ETGA, prone. 2. Right parietal scalp incision. 3. Right Frazier burr hole for ventricular tapping. 4. Insertion of a ventricular catheter into right lateral ventricle, 7.5 cm inside the brain. 5. Wound closure. 6. Midline scalp incision, 1 cm above inino to C1. 7. Suboccipital craniotomy, 4 cm x 3 cm. 8. U-shaped dural incision. 9. Evacuation of subdural and intracerebellar blood clot with suckers and bipolar forceps. 10. Hemostasis with bipolar coagulation, surgicel and Gelfoam. 11. Wound closure in layers. Operators 楊士弘 Assistants R5陳睿生, R1吳晉睿 Indication Of Emergent Operation 練林梅妹 (F,1929/03/10,83y0m) 手術日期 2010/02/13 手術主治醫師 王國川 手術區域 東址 005房 01號 診斷 Intracerebral hemorrhage 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 王永彬 ASA 4E 紀錄醫師 張得一, 時間資訊 02:30 通知急診手術 03:20 進入手術室 03:25 麻醉開始 03:35 開始輸血 03:50 誘導結束 04:05 抗生素給藥 04:25 手術開始 07:05 抗生素給藥 08:20 手術結束 08:20 麻醉結束 08:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Right parieto-occipital craniotomy for hemato... 開立醫師: 楊士弘 開立時間: 2010/02/13 08:22 Pre-operative Diagnosis Intracerebral hemorrhage, right parietal and occipital lobes Post-operative Diagnosis Intracerebral hemorrhage, right parietal and occipital lobes Operative Method Right parieto-occipital craniotomy for hematoma evacuation Specimen Count And Types nil Pathology Nil Operative Findings 1. Diffuse wound oozing was noted. 2. The brain bulged out after craniotomy and dural opening. 3. Subpial hematoma was evident in the right parietal and occipital lobes. 4. About 60 c.c. blood clot was removed. Some clot was soft, some more tough and hypervascular. 5. The hematoma bed also easily oozed. 6. The brain became less swelling after hematoma evacuation. Operative Procedures 1. ETGA, prone. 2. Inverted U shaped incision over right parieto-occipital scalp. 3. Right parieto-occipital craniotomy, 5 cm x 5 cm. 4. X-shaped dural incision. 5. Cortical incision over right occipital lobe, 1.5 cm long, for removal of subcortical blood clot. 6.Cortical incision over right parietal lobe, 1 cm long, for removal of subcortical blood clot. 7. Hemostasis of white matter bleeders with bipolar coagulation, surgicel, and gelfoam. 8. Dural closure with a piece of pericranium as dural graft. 9. Fixation of skull plate to craniotomy window with four wires (gauge 26) and two central tenting stitches. 10. One subgaleal CWV drain. 11. Wound closure in layers. Operators 楊士弘 Assistants 李建勳, 陳睿生, 張得一 Indication Of Emergent Operation 相關圖片 徐瑞月 (F,1958/01/01,54y2m) 手術日期 2010/02/14 手術主治醫師 陳敞牧 手術區域 東址 001房 01號 診斷 Brain tumors, malignant 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 3E 紀錄醫師 陳建銘, 時間資訊 02:00 開始NPO 02:00 臨時手術NPO 09:41 通知急診手術 10:20 報到 10:30 進入手術室 10:35 麻醉開始 11:20 誘導結束 11:30 手術開始 11:50 抗生素給藥 13:40 開始輸血 15:05 麻醉結束 15:05 手術結束 15:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除－手術時間在４小時以內 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Right side suboccipital cranitomy tumor excision 開立醫師: 陳盈志 開立時間: 2010/02/14 15:26 Pre-operative Diagnosis Cerebellar metastatic tumor, right hemisphere Post-operative Diagnosis Cerebellar metastatic tumor, right hemisphere Operative Method Right side suboccipital cranitomy tumor excision Specimen Count And Types 1 piece About size:3x2.5x2.5cm Source:cerebellar cystic tumor Pathology pending Operative Findings The tumor was about 3x2.5x2.5cm in size and elastic in character. There are two large cystic component inside the tumor. It located at right upper cerebellar hemiphere. Operative Procedures 1.ETGA, prone with neck flexion and head fixation with Mayfield 2.Right side hockystick incision 3.Detach muscle to expose inion to C1 posterior arch 4.Burr hole x 3 then craniotomy with saw 5.U shape dura incision sinus based 6.tumor excision with dissecter circumferentially and then tumor forceps removal. 7.Hemostasis with bipolar and surgicel packing 8.Duroplasty with duraform 9.Fix bone plate with wire x 3 10.subgaleal CWV drain x 1 11.close wound in layers. Operators VS陳敞牧 Assistants R6陳盈志R1陳建銘 Indication Of Emergent Operation 林忠益 (M,1943/07/01,68y8m) 手術日期 2010/02/16 手術主治醫師 陳敞牧 手術區域 東址 002房 1號 診斷 Malignant neoplasm of trachea 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 陳國瑋, 時間資訊 22:26 臨時手術NPO 22:26 開始NPO 07:30 通知急診手術 08:40 進入手術室 08:50 麻醉開始 09:20 開始輸血 10:00 誘導結束 10:50 手術開始 11:00 抗生素給藥 14:55 手術結束 14:55 麻醉結束 15:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除－手術時間在４～８小時 1 1 R 摘要__ 手術科部: 腫瘤醫學部 套用罐頭: RIght occipitoparietal craniotomy for tumor e... 開立醫師: 李建勳 開立時間: 2010/02/16 15:17 Pre-operative Diagnosis Right occipitoparietal metastatic tumor with ICH Post-operative Diagnosis Right occipitoparietal metastatic tumor with ICH Operative Method RIght occipitoparietal craniotomy for tumor excision Specimen Count And Types 1 piece About size:3g Source:Right occipitoparietal tumor excision Pathology Pending Operative Findings The tumor was elastic, red-greyish, size 4cm in diameter, located at right occipitoparietal lobe. The tumor was seperable from normal brain parenchyma at the margin. The ICH was found anterior to the tumor. Operative Procedures Under general anesthesia and intubation, the patient was put in prone position with head fixed with Mayfield skull clump then draped. The scalp was shaved, scrubbed, disinfected with alcohol B-I then draped. The inverted-U shaped scalp incision was made at right occipitoparietal area followed by craniotomy. The dura was opened along the craniotomy window after tenting with 3-0 silks. The tumor was located with intra-operative sonography. Tumor excision was performed with bipolar coagulation and tumor forceps. The hemostasis was achieved with surgicel lining of the tumor bed and bipolar coagulation. The skull plate was fixed back with wires and the wound was closed in layers after one CWV drain set up. Operators VS 陳敞牧 Assistants R6 李建勳 R1 陳國瑋 Indication Of Emergent Operation 相關圖片 張書豪 (M,1987/07/17,24y7m) 手術日期 2010/02/16 手術主治醫師 陳敞牧 手術區域 東址 001房 02號 診斷 Subarachnoid hemorrhage (SAH) 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 4E 紀錄醫師 陳國瑋, 時間資訊 14:05 通知急診手術 14:40 報到 14:40 進入手術室 14:56 麻醉開始 15:05 誘導結束 15:30 抗生素給藥 15:58 手術開始 16:35 麻醉結束 16:35 手術結束 16:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 顱內壓監視置入 1 1 摘要__ 手術科部: 外科部 套用罐頭: Right Kocher point EVD insertion 開立醫師: 李建勳 開立時間: 2010/02/16 16:49 Pre-operative Diagnosis Diffuse SAH with hydrocephalus Post-operative Diagnosis Diffuse SAH with hydrocephalus Operative Method Right Kocher point EVD insertion Specimen Count And Types nil Pathology Nil Operative Findings CSF opening pressure 50cmH2O with clear-pinkish CSF drain out. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position. The scalp was shaved, scrubbed, disinfected with alcohol B-I then draped. Curvilinear scalp incision was made at right frontal area followed by burr hole creation. Inserted Ventricular puncture needle then shifted to EVD catheter. Fixed the EVD and tested patency. Closed the wound in layers and connected the EVD to drainage system. Operators VS 陳敞牧 Assistants R6 李建勳 R1 陳國瑋 Indication Of Emergent Operation 相關圖片 伍家旺 (M,1972/03/26,39y11m) 手術日期 2010/02/17 手術主治醫師 陳敞牧 手術區域 東址 001房 01號 診斷 Intracerebral hemorrhage 器械術式 Craniotomy(Aneurysms) P-DUH 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3E 紀錄醫師 陳志軒, 時間資訊 22:00 開始NPO 03:25 通知急診手術 04:49 報到 04:50 麻醉開始 04:50 進入手術室 05:15 誘導結束 05:35 抗生素給藥 05:50 手術開始 11:30 開始輸血 14:50 麻醉結束 14:50 手術結束 15:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 開顱術摘除血管病變－腦血管瘤－有徵的 1 1 R 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 12 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 摘要__ 手術科部: 外科部 套用罐頭: ICH evacuation and aneurysm clipping 開立醫師: 胡朝凱 開立時間: 2010/02/17 15:20 Pre-operative Diagnosis A-com aneurysm and right frontal ICH Post-operative Diagnosis A-com aneurysm and right frontal ICH Operative Method ICH evacuation and aneurysm clipping Specimen Count And Types NIL Pathology Nil Operative Findings 1.About 40 ml hematoma located insided the right frontal lobe with adhesion of brain tissue 2.One wide based A-com aneurysm measured about 6 mm with a daughter aneurysm protruded toward anteriorly and upward. 3.Intra-op rupture (+) and hemostasis with packing and coagulation 4.Craniectomy was done due to brain swelling 5.One Sugita straight clip was used Operative Procedures 1.ETGA, supine, head fixed with Mayfield skull clamp 2.right frontal curvillinear skin incision was done 3.reflect skin flap 4.devided muscle 5.Craniectomy 6.Open dura with the base left at midline 7.Corticotomy for hematoma evacuation 8.interhemispheric approach for exposing the A-com and aneurysm by tracing A2 downward. 9.Aneurysmal clipping with straight clip 10.Hemostasis 11.duroplasty with durofoam 12.close wound in layers Operators 陳敞牧 Assistants 李建勳,胡朝凱,李振豪,陳志軒 Indication Of Emergent Operation 吳惠澄 (M,1931/09/08,80y6m) 手術日期 2010/02/18 手術主治醫師 陳敞牧 手術區域 東址 003房 01號 診斷 Intracerebral hemorrhage 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 4E 紀錄醫師 蕭惠壬, 時間資訊 10:36 通知急診手術 10:36 開始NPO 10:36 臨時手術NPO 12:15 報到 12:30 進入手術室 12:35 麻醉開始 13:00 誘導結束 13:27 手術開始 17:15 麻醉結束 17:15 手術結束 17:25 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 顱骨切除術，包括異物移除或減壓或神經切斷 1 1 手術 顱內壓監視置入 1 2 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT 開立醫師: 蕭惠壬 開立時間: 2010/02/18 18:03 Pre-operative Diagnosis Right pontine and cerebellar infarction with hemorrhagic transformation Post-operative Diagnosis Ditto Operative Method 1. Suboccipital craniectomy 2. EVD form left Frazier Specimen Count And Types nil Pathology Nil Operative Findings 1. EVD: metronic, ICP: 5~10 cmH20, CSF: clear; deepth: 8cm 2. Right pontine and cerebellar infarction with hemorrhagic transformation. Massive effect: small 3. Duraplasty with facia graft Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: prone. head fixed by Mayfield skull clamp 3. Skin preparation and drap as usual. 4. EVD implatation from left Frazier 5. Incision: linear incision from occiput to upper neck. Raney clips were applied to the scalp edge for temporary hemostasis. Muscles was splitted to ligamentum nuchae, suboccipital bone and the spinous processes of C-1. 6. Craniectomy window: 5 x 4 cm,created by making 4 burr holes, then cut by power saw. 7. Dural tenting and dural incision with crusade fashion 8. Remove hematoma and necrotic brain tissue, then hemostasis with sugicel and gelfoam 9. dural plasty with facia graft. 10.Closure of skull window: 12.Scalp closure: hemostasis. Galea suture was performed by continuous suture with 2-0 Vicryl and skin by continuous suture with 3/0 nylon. 13.Drain: one, epidural Operators VS 陳敞牧 Assistants R5 陳睿生 R4 陳德福 R1 蕭惠壬 Indication Of Emergent Operation 林在情 (M,1948/07/10,63y8m) 手術日期 2010/02/19 手術主治醫師 楊士弘 手術區域 東址 003房 1號 診斷 Spine bone metastasis 器械術式 Laminectomy for decompression 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 4E 紀錄醫師 楊博智, 時間資訊 12:48 開始NPO 12:48 臨時手術NPO 12:48 通知急診手術 04:48 報到 05:05 進入手術室 05:15 麻醉開始 06:00 誘導結束 06:10 抗生素給藥 06:40 手術開始 07:35 開始輸血 09:10 抗生素給藥 10:35 手術結束 10:35 麻醉結束 10:45 送出病患 10:52 進入恢復室 11:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 惡性病髓腫瘤切除術 1 1 摘要__ 手術科部: 外科部 套用罐頭: Tumor excision for spinal cord decompression 開立醫師: 楊士弘 開立時間: 2010/02/19 10:52 Pre-operative Diagnosis Recurrent spinal metastasis, T2-5, with spinal cord compression Post-operative Diagnosis Recurrent spinal metastasis, T2-5, with spinal cord compression Operative Method Tumor excision for spinal cord decompression Specimen Count And Types 1 piece About size:小 Source:vertebral tumor Pathology Pending Operative Findings Wound scar was found over upper back, from T1 to T6 level. Posterior spinal fixation system (Epidural scar tissue was found over previous laminectomy site from T2 to T5. Soft fragile, greyish white tumor was found between the scar and dura. After tumor removal the thecal sac reexpanded well. Operative Procedures 1. ETGA, prone, head fixed with Mayfield skull clamp. 2. Upper back midline incision along previous wound scar, T1 to T6. 3. Dissection of paraspinal muscles off lamina and TPS screws-rods-cross links. 3. Dissection of paraspinal muscles off lamina and TPS screws-rods-cross links. Removal of cross links for exposure of epidural scar and tumor. 4. Dissection and removal of epidural scar tissue. 5. Removal of tumor with tumor forceps, currets, dissectors, and suckers. 6. Partial corpectomy of posterior T2 vertebral body, along with excision of posterior longitudinal ligament. 7. Hemostasis. 8. Replacement of cross links over rods. 9. One HV drain and one CWV drain. 10. Wound closure in layers. Operators 楊士弘 Assistants 陳睿生,楊博智 Indication Of Emergent Operation 范發興 (M,1955/05/24,56y9m) 手術日期 2010/02/18 手術主治醫師 王國川 手術區域 東址 001房 01號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 3E 紀錄醫師 蕭惠壬, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 07:20 通知急診手術 08:20 進入手術室 08:25 麻醉開始 08:50 誘導結束 09:30 抗生素給藥 09:50 手術開始 12:30 抗生素給藥 13:40 開始輸血 15:35 抗生素給藥 19:40 抗生素給藥 21:40 手術結束 21:40 麻醉結束 21:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 19 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除－手術時間在８小時以上 1 1 手術 顱內壓監視置入 1 2 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT 開立醫師: 蕭惠壬 開立時間: 2010/02/18 22:33 Pre-operative Diagnosis Brain tumor, suspect intraventricular meningioma Post-operative Diagnosis Ditto Operative Method Craniotomy for ICT Specimen Count And Types 1 piece About size:7cm Source:brain Pathology Pending Operative Findings 1. A firm, well-defined, whitish tumor located at left ventricle. Its size was around 7 cm in diameter. 2. Some cyst with yellowish clear fluid accumulation and some soft whitish necrotic tissue was found in the center of the tumor. 3. Old hemorrhage was noticed. 4. Feeding arteries were from the inferior medial side of ventricle. Multiple drainage veins were engorged. 5. EVD implatation in the right ventricle, around 5cm in depth. 6. One CWV drain was set at subgaleal space. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: prone with neck flexed and head fixed by Mayfield skull clamp. 3. Skin preparated and draped as usual. 4. Incision: A inverted U shage incision line was designed at left occipital area. Raney clips were applied to the scalp edge for temporary hemostasis. 5. Craniotomy window:7 x 5 cm, created by making 4 burr holes thencut by power saw. 6. Dural tenting: by 2/0 silk, 2 cm in interval, distributed along the edge of skull window. 7. Dural incision: curvilinear along the edge of skull window 8. Intraoperation echo was used to identify the location of the tumor. Linear Cortectomy was done about 4 cm. The tumot was noticed subcortical level about 2cm. Central debulking was performed with CUSA and scisor. The residual tumor was dissected from the ventricle. 9. The hemostasis was obtained by bipolar coagulator. The blood oozing point from several locations on the bare surface were packed with gelfoam for complete hemostasis. Irrigation with NS several times and it was perfectly watery clear before the dural closure. 10 EVD was set in the ventricle. 11.Dural closure with fascia graft. 12.Closure of skull window and scalp 13.Drain: one, subgaleal space 14.Blood loss: 1000 mL 15.Course of the surgery: smooth. Operators vs 王國川 Assistants R5 陳睿生 R1 蕭惠壬 Indication Of Emergent Operation 陳乾龍 (M,1960/07/23,51y7m) 手術日期 2010/02/19 手術主治醫師 楊士弘 手術區域 東址 005房 02號 診斷 Lumbar spondylosis 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 2 紀錄醫師 張得一, 時間資訊 00:00 臨時手術NPO 12:55 報到 13:27 麻醉開始 13:35 進入手術室 13:35 誘導結束 14:00 抗生素給藥 14:12 手術開始 17:30 手術結束 17:30 麻醉結束 17:35 進入恢復室 17:40 送出病患 18:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術－腰椎 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 摘要__ 手術科部: 外科部 套用罐頭: Bilateral L5 laminotomy for microsurgical dis... 開立醫師: 楊士弘 開立時間: 2010/02/19 17:33 Pre-operative Diagnosis Herniated intervertebral disk, L5-S1, bilateral Post-operative Diagnosis Herniated intervertebral disk, L5-S1, bilateral Operative Method Bilateral L5 laminotomy for microsurgical diskectomy Specimen Count And Types 1 piece About size:小 Source:L5-S1 disk Pathology Pending Operative Findings The thecal sac and S1 roots were compressed tightly by a posteriorly bulging L5-S1 disc. There is no ruptured disc fragement. The herniated disc was rather tough and adhered strongly with the L5 vertebral end plates. The thecal sac and roots became slack after removal of the central and both lateral portions of the herniated disc. The thecal sac and S1 roots were compressed tightly by a posteriorly bulging L5-S1 disc. There is no ruptured disc fragement. The herniated disc was rather tough and adhered strongly with the L5 vertebral end plates. Therefore, bilateral approaches for diskectomy were needed for adequate decompression. The thecal sac and roots became slack after removal of the central and both lateral portions of the herniated disc. Operative Procedures 1. ETGA, prone. 2. C-arm localization of L5-S1 level. 3. Low back midline incision. 4. Dissection of left paravertebral muscles off the L5-S1 spinous processes and lamina. 5. Laminotomy of lower two thirds of left L5 lamina with high speed air drill and kerrison punches under microscope. 6. Excision of PLL with Kerrison punches. 6. Excision of yellow ligament with Kerrison punches. 7. Microsurgical diskectomy with knife, currets, disc forceps, and kerrison punches. 8. Repeat the procedure of 4-7 over the right side. 9. Epidural irrigation of Rinderon solution. 10. Wound closure in layers. 5. Operators 楊士弘 Assistants 李建勳,張得一 相關圖片 林國安 (M,1955/12/09,56y3m) 手術日期 2010/02/20 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 CVA 器械術式 Craniotomy(Aneurysms) Others 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林子富 ASA 4E 紀錄醫師 陳建銘, 時間資訊 19:17 進入手術室 19:17 報到 19:25 麻醉開始 19:40 誘導結束 20:00 開始輸血 20:40 抗生素給藥 21:06 手術開始 23:40 抗生素給藥 01:25 麻醉結束 01:25 手術結束 醫令資訊 類別 名稱 量 刀 側 手術 顱骨切除術，包括異物移除或減壓或神經切斷 1 1 手術 顱內壓監視置入 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 神經部 套用罐頭: 1. Right Frazier EVD insertion; 2. Suboccipit... 開立醫師: 陳睿生 開立時間: 2010/02/21 02:07 Pre-operative Diagnosis Left cerebellar infarction with brainstem compression Post-operative Diagnosis Ditto Operative Method 1. Right Frazier EVD insertion; 2. Suboccipital craniectomy + duroplasty Specimen Count And Types nil Pathology Nil Operative Findings A Metronic EVD was inserted at right Frazier point about 8cm in depth, and the initial ICP was above 10cmH2O, and CSF was clear. Suboccipital craniectomy was performed and the cerebellum protruded after dura opening. Duroplasty was performed with fascia graft. Operative Procedures After ETGA, the patient was under prone position and fixed with Mayfield clump. About 3cm linear incision was made at right parietal region , and a burr hole was made. After dura tacking, the dura was opened and we punched the right lateral ventricle. Then a Metronic EVD was inserted about 8cm in depth. After hemostasis, the woudn was closed in layers. About 12cm linear incision was made from 3cm above inion to C2 level. Fascia graft was extracted from occipital region. Then bilateral paraspinal muscle was splitted from nuchal ligament. The muscle was also detached from suboccipital region. The C1 arch was exposed and the posterior rim of foramen magnum was also noted. Then 4 burr holes were made at inion, 1cm above foramen magnum, and bilateral suboccipital regions. Then about 8x6 cm craniectomy was made. The craniectomy was extended with rounger and kerrison pouch. The posterior ring of the foramen magnum was opened. Then the dura was opened along the lower region of the craniectomy window. Occipital sinus was opened and ligated with Wake clump. Duroplasty was then performed with fascia graft. After hemostasis, an epidural CWV was inserted and the paraspinal muscles were closed in layers. The wound was closed in layers. Operators P 杜永光 Assistants R5 陳睿生, R1 陳建銘 Indication Of Emergent Operation 林忠益 (M,1943/07/01,68y8m) 手術日期 2010/02/20 手術主治醫師 陳敞牧 手術區域 東址 001房 02號 診斷 Malignant neoplasm of trachea 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林子富 ASA 3E 紀錄醫師 鍾文桂, 時間資訊 17:35 進入手術室 17:40 麻醉開始 17:42 誘導結束 18:49 手術開始 18:56 開始輸血 21:00 抗生素給藥 21:15 手術結束 21:15 麻醉結束 21:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 急性硬腦膜下血腫清除術 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 摘要__ 手術科部: 外科部 套用罐頭: Evacuation of acute subdural and intracerebra... 開立醫師: 鍾文桂 開立時間: 2010/02/20 22:03 Pre-operative Diagnosis Right parietal-occipital acute subdural and intracerebral hemorrhage. Post-operative Diagnosis Right parietal-occipital acute subdural and intracerebral hemorrhage. Operative Method Evacuation of acute subdural and intracerebral hemorrhage. Specimen Count And Types nil Pathology Nil. Operative Findings About 20 cc organized hematoma at subdural space. Moderate oozing. Some intracerebral hemorrhage was removed. Hemostasis was checked well. Moderate oozing. Some intracerebral hemorrhage was removed. Hemostasis was well-checked. Operative Procedures Anesthesia: endotracheal, general. Position: prone, head tilted to left and fixed with Mayfield headholder. Incision: along previous operative wound, ㄇ shape. Removal of previous craniotomy plate. Release previous duroplasty. Evacuation of subdural and intracerebral hemorrhage. Well hemostasis of the brain surface of the emptied cavity with bipolar coagulator and surgicel. Dura closure in watertight fashion. Fixation of craniotomy bone plate with wires and tenting of dural mater. Wound closure in layers. Send the patient to ICU smoothly. Operators V.S. 陳敞牧. Assistants R5 陳睿生,R4 鍾文桂,R1 許松鈺. Indication Of Emergent Operation 范發興 (M,1955/05/24,56y9m) 手術日期 2010/02/20 手術主治醫師 王國川 手術區域 東址 002房 01號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林子富 ASA 3E 紀錄醫師 陳建銘, 時間資訊 05:39 開始NPO 05:39 臨時手術NPO 05:39 通知急診手術 07:50 進入手術室 07:55 麻醉開始 08:05 誘導結束 09:00 手術開始 09:10 開始輸血 11:25 手術結束 11:25 麻醉結束 11:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: hematoma evacuation 開立醫師: 陳建銘 開立時間: 2010/02/20 11:52 Pre-operative Diagnosis 1.Brain tumor,suspect intraventricular meningioma 2.ICH at previous op site Post-operative Diagnosis DITTO Operative Method hematoma evacuation Specimen Count And Types nil Pathology nil Operative Findings 1.minor panrynchemal oozing was noted but huge hemotoma was found over previous op site 2.severe oozing over epidual and subcutaneous layer 3.Pulsation of the brain was intact 4.Metornic EVD was inserted inside at previous op side(5cm), the color of CSF:xanthochromic Operative Procedures 1.ETGA, 2.Skin disinfection and drapped 2.Skin disinfection and supine with head rotated tilted to left 3. 3. incision over previous suture line 4. open the previos skin graft and skull 5. hematoma evacuation 6. insert the EVD and one CWV drain tube over subcutaneous layer 7. hemostasis 8. closed the wound by layer Operators vs王國川 Assistants R5陳睿生 R1陳建銘 Indication Of Emergent Operation 鮑正鋼 (M,1956/03/08,56y0m) 手術日期 2010/02/21 手術主治醫師 王國川 手術區域 東址 002房 02號 診斷 Intracerebral hemorrhage 器械術式 Brain tumor Crainotomy(Others) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林子富 ASA 4E 紀錄醫師 吳晉睿, 時間資訊 11:08 通知急診手術 11:35 進入手術室 11:40 麻醉開始 12:10 誘導結束 12:20 抗生素給藥 12:39 手術開始 13:12 開始輸血 15:45 手術結束 15:45 麻醉結束 15:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 腦內血腫清除術 1 1 L 手術 顱內壓監視置入 1 2 L 摘要__ 手術科部: 外科部 套用罐頭: 1. Craniotomy for hematoma evacuation; 2. ICP... 開立醫師: 吳晉睿 開立時間: 2010/02/21 16:10 Pre-operative Diagnosis Left putaminal ICH with IVH; uncal herniation Post-operative Diagnosis Ditto Operative Method 1. Craniotomy for hematoma evacuation; 2. ICP monitor insertion Specimen Count And Types nil Pathology Nil Operative Findings Organized huge hematoma was noted and the volume was about 100ml. Minor IVH was also noted intra-op. No obvious bleeder was found but some fixed hematom was noted at deep site. Parychemal ICP monitor was inserted and post-op ICP was about 3mmHg. Operative Procedures 1. ETGA, supine position with head right turn 2. Left frontotemporal curvillinear incision 3. Temporalis muscle was splitted, and then 5x6cm craniotomy window was created with 2 burr holes done 4. Dura tacking, and then opened 5. Corticotomy was done at inferior posterior frontal about 2cm 6. Hematoma was evacuated with suction and tissue forceps 7. Ventricle was noted intra-op, and we tried to inserted EVD but failed 8. Hemostasis, set an ICP monitor at parychema 9. Dura close with fascia graft 10.Fix back skull graft and central tacking 11.Set a subcutaneous CWV drain 12.Close the wound in layers Operators VS 王國川 Assistants R5 陳睿生, R1 吳晉睿 Indication Of Emergent Operation 潘蔡金鶴 (F,1944/05/12,67y10m) 手術日期 2010/02/22 手術主治醫師 杜永光 手術區域 東址 005房 02號 診斷 Compression fracture, pathological, spontaneous 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 張得一, 時間資訊 00:00 臨時手術NPO 12:30 報到 12:57 進入手術室 13:50 抗生素給藥 14:05 麻醉開始 14:06 手術開始 14:30 誘導結束 17:00 抗生素給藥 18:30 手術結束 18:30 麻醉結束 18:35 進入恢復室 18:40 送出病患 20:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 椎弓切除術（特壓）－二節以內 1 2 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 記錄__ 手術科部: 外科部 套用罐頭: 1. Right L4 hemilaminectomy and foraminal dec... 開立醫師: 胡朝凱 開立時間: 2010/02/22 18:33 Pre-operative Diagnosis L3-4 compression fracture with L4 spondylolithesis L3-4 compression fracture with lateral spondylolithesis of L3-5 Post-operative Diagnosis L3-4 compression fracture with L4 spondylolithesis L3-4 compression fracture with lateral spondylolithesis of L3-5 Operative Method L3-L5 transpedicle screw fixation 1. Right L4 hemilaminectomy and foraminal decompression, 2.Transpedicle screw fixation and posterolateral bone fusion, L3-5 L3-L5 transpedicle screw fixation with left L4 laminectomy Specimen Count And Types Nil Nil Pathology Nil Nil Operative Findings 1.Severe spondylolithesis of L4 to the left 1.Scoliospondylosis and osteopenia of the lower lumbar spine was noted. The facet joints were loose over L3-4 and L4-5 levels. The right L4 foramen was crowded due to hypertrophic L3-4 facet and ligamentum flavum, which caused compression of the right L4 root. 2.TPS rods: "syntheo" right L3, left L5 screws: 40mm long, 6.2mm diameter 2.Screw position checked by C-arm intraoperatively Right L5, left L3-4 screws: 40mm long, 5.5mm diameter, rod 7cm each, one cross-link Operative Procedures Under ETGA, patient was put in prone position. A spinal needle was inserted Under ETGA, patient was put in prone position. A spinal needle was placed between spinous processes of L4~5 and a portable X-ray film was taken to between spinous processes of L2~5 and a portable X-ray film was taken to between spinous processes of L2~5 and a portable X-ray film was taken to locate the correct interspace.The back was shaved and scrubbed with locate the correct interspace. The back was shaved and scrubbed with povidone-iodine detergent then painted with povidone-iodine tincture and followed by sterilized adhesive plastic sheet covering. Incision was made povidone-iodine detergent then painted with povidone-iodine tincture and 7 cm, over spinous processes from L3 to L5. The latissimus dorsi, 7 cm, over spinous processes from L2 to L5. The latissimus dorsi, followed by sterilized adhesive plastic sheet covering. Incision was made ileocostalis lumborum muscles were detached from spinous processes on both sides by Bovie, then multifidus muscles were dissected subperiosteally 14 cm, over spinous processes from L2 to L5. The latissimus dorsi, from the laminae with rasp. The paravertebral muscles were retracted by ileocostalis lumborum muscles were detached from spinous processes on both self retaining retractors to expose the spinous processes and laminae. The bleeding from the muscles were stopped by Bovie. The muscular attachment sides by Bovie, then multifidus muscles were dissected subperiosteally on the lateral aspect of the facets joint and the transverse processes from the laminae with rasp. The paravertebral muscles were retracted by of L4 and L5 were detached by Bovie, then the lateral surface of each of L3~L5 were detached by Bovie, then the lateral surface of each self retaining retractors to expose the spinous processes and laminae. The facets was decorticated with rongeurs. Posterior lateral fusion was done by inserting the TPS screws at L4 and L5 pedicles and checked by C-arm bleeding from the muscles were stopped by Bovie. The muscular attachment by inserting the TPS screws at right L3 and L5 and left L3~5 pedicles and checked by C-arm intraoperatively. The spinous processes and laminae of L4 was bitten off intraoperatively. The left side laminae of L4 was bitten off on the lateral aspect of the facets joint and the transverse processes with rongeurs and Kerrison punch until the posterior half of the spinal canal was widely opened. The hypertrophic ligamenta flava including those of L3~L5 were detached by Bovie, then the lateral surface of each at lateral recesses were excised. The epidural venous bleeding was stopped facets was decorticated with rongeurs. Posterior fixation was done by gelfoam packing. After laminectomy, the rods were inserted and fixed with the screws. After one hemovac drain insertion, the paravertebral by inserting the TPS screws at right L3 and L5 and left L3~5 pedicles and the position checked by C-arm intraoperatively. The right side laminae of L4 and right L3-4 facet were bitten off with rongeurs and Kerrison punch until the posterior half of the spinal canal was widely decompressed. The hypertrophic ligamenta flava including those at lateral recesses and foramen were excised. The epidural venous bleeding was stopped by gelfoam packing. After laminectomy, two rods were inserted and fixed with the screws. One cross-link was used to bridge both rods after one hemovac drain insertion, the wound was closed in layers. with the screws. After one hemovac drain insertion, the wound was closed in layers. Operators 杜永光 楊士弘 杜永光 楊士弘 Assistants 胡朝凱 張得一 胡朝凱 張得一 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: 1. Right L4 hemilaminectomy and foraminal dec... 開立醫師: 張得一 開立時間: 2010/02/22 19:48 Pre-operative Diagnosis L3-4 compression fracture with lateral spondylolithesis of L3-5 Post-operative Diagnosis L3-4 compression fracture with lateral spondylolithesis of L3-5 Operative Method 1. Right L4 hemilaminectomy and foraminal decompression, 2.Transpedicle screw fixation and posterolateral bone fusion, L3-5 Specimen Count And Types Nil Pathology Nil Operative Findings 1.Scoliospondylosis and osteopenia of the lower lumbar spine was noted. The facet joints were loose over L3-4 and L4-5 levels. The right L4 foramen was crowded due to hypertrophic L3-4 facet and ligamentum flavum, which caused compression of the right L4 root. 2.TPS rods: "syntheo" right L3, left L5 screws: 40mm long, 6.2mm diameter Right L5, left L3-4 screws: 40mm long, 5.5mm diameter, rod 7cm each, one cross-link Operative Procedures Under ETGA, patient was put in prone position. A spinal needle was placed between spinous processes of L2~5 and a portable X-ray film was taken to locate the correct interspace. The back was shaved and scrubbed with povidone-iodine detergent then painted with povidone-iodine tincture and followed by sterilized adhesive plastic sheet covering. Incision was made 14cm over spinous processes from L2 to L5. The latissimus dorsi, ileocostalis lumborum muscles were detached from spinous processes on both sides by Bovie, then multifidus muscles were dissected subperiosteally from the laminae with rasp. The paravertebral muscles were retracted by self-retaining retractors to expose the spinous processes and laminae. The bleeding from the muscles were stopped by Bovie. The muscular attachment on the lateral aspect of the facets joints and the transverse processes of L3-L5 were detached by Bovie, then the lateral surface of each facets was decorticated with rongeurs. Posterior fixation was done by inserting the TPS screws at right L3 and L5 and left L3-5 pedicles and the position checked by C-arm intraoperatively. The right side laminae of L4 and right L3-4 facet were bitten off with rongeurs and Kerrison punch until the right L4 foramen was widely decompressed. The hypertrophic ligamenta flava including those at lateral recesses and foramen were excised. The epidural venous bleeding was stopped by gelfoam packing. After laminectomy, 2 rods were put on each side with the screws. One cross link was used to bridge both rods. After one hemovac drain insertion, the wound was closed in layers. Operators 杜永光 楊士弘 Assistants 胡朝凱 張得一 相關圖片 練林梅妹 (F,1929/03/10,83y0m) 手術日期 2010/02/22 手術主治醫師 楊士弘 手術區域 東址 002房 03號 診斷 Intracerebral hemorrhage 器械術式 Tracheostomy 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 4E 紀錄醫師 鍾文桂, 時間資訊 08:00 開始NPO 08:00 臨時手術NPO 12:40 通知急診手術 13:50 報到 13:55 進入手術室 14:00 麻醉開始 14:05 誘導結束 14:23 手術開始 14:50 麻醉結束 14:50 手術結束 14:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 氣管切開造口術 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Tracheostomy. 開立醫師: 鍾文桂 開立時間: 2010/02/22 15:37 Pre-operative Diagnosis Respiratory failure. Post-operative Diagnosis Respiratory failure. Operative Method Tracheostomy. Specimen Count And Types nil Pathology Nil. Operative Findings 7.0 Fr tracheostomy tube was inserted at the 2nd trracheal ring. Operative Procedures Under ETGA, the patient was put in supine position. The neck was extended to expose the trachea more superficially. A linear 3-cm incision was made in the midline below cricoid cartilage. Midline dissection was done to reach the tracheal ring. A tracheostomy was done by excise a piece of the tracheal ring.(0.2cm2) The 7.0 Fr tracheostomy tube was inserted smoothly. The wound was closed primarily by 3-0 Nylon. The patient was sent back to ICU smoothly. Operators V.S. 楊士弘. Assistants R4 鍾文桂. Indication Of Emergent Operation 何東鏘 (M,1935/10/20,76y4m) 手術日期 2010/02/23 手術主治醫師 詹志洋 手術區域 東址 016房 01號 診斷 Atherosclerosis of the extremities with intermittent claudication 器械術式 PAOD stent insertion 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 蕭柏妮 ASA 3 紀錄醫師 楊惠馨, 時間資訊 07:58 報到 08:15 進入手術室 08:50 麻醉開始 09:20 誘導結束 09:54 抗生素給藥 10:10 手術開始 12:10 手術結束 12:10 麻醉結束 12:35 送出病患 12:52 進入恢復室 14:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 血管整形術 1 0 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: SFA stents 開立醫師: 楊惠馨 開立時間: 2010/02/23 13:04 Pre-operative Diagnosis SFA total occlusion SFA total occlusion, right side Post-operative Diagnosis SFA total occlusion SFA total occlusion, right side Operative Method SFA stents Specimen Count And Types nil Pathology NIL Operative Findings 1. Right SFA total recannulation at popliteal a. 2. After stenting, dissection was noted at distal end. Using 6cm stent to repair dissection Operative Procedures 1. ETGA, supine 2. Puncture left CFA and insert wire and 8Fr. sheath 2. Puncture left CFA and insert wire and 8Fr. sheath to right SFA 3. PTA using 3mm balloon 4. Insert 6mm-17cm and 6mm-15cm stents 5. Dissection was noted at distal end of stent 6. Insert 6mm-6cm stent to repair distal dissection 7. Using Angio-seal to hemostasis, but failed, then hemostasis by finger pressure Operators VS詹志洋 Assistants R4林明賢 R2楊惠馨 彭月雲 (F,1957/04/12,54y11m) 手術日期 2010/02/23 手術主治醫師 曾勝弘 手術區域 東址 005房 02號 診斷 Herniation of intervertebral disc, lumbar (HIVD) 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 張得一, 時間資訊 00:00 臨時手術NPO 09:23 報到 09:35 進入手術室 09:40 麻醉開始 09:45 誘導結束 10:15 抗生素給藥 10:22 手術開始 11:45 手術結束 11:45 麻醉結束 11:55 送出病患 11:55 進入恢復室 13:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 椎間盤切除術－腰椎 1 1 記錄__ 手術科部: 外科部 套用罐頭: L5-S1 Disectomy 開立醫師: 張得一 開立時間: 2010/02/23 12:01 Pre-operative Diagnosis L5-S1 HIVD Post-operative Diagnosis L5-S1 HIVD Operative Method L5-S1 Disectomy Specimen Count And Types Nil Pathology Nil Operative Findings 1.Bulging disc was noted at left L5-S1 with narrowed intervertebral space 2.Degenerative change of the IVD Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: semiprone with a bolster beneath both side and flexed at the waist and knees. 3. Skin preparation: the back was shaved and scrubbed with 3.A needle was put on the back between spinous processes of L5-S1 and c-arm was checked to locate the correct interspace. povidone-iodine detergent then painted with povidone-iodine tincture and followed by sterilized adhesive plastic sheet covering. 4.A spinal needle was inserted between spinous processes of L5-S1 4.Skin preparation: the back was shaved and scrubbed with povidone-iodine detergent then painted with povidone-iodine tincture and followed by sterilized adhesive plastic sheet covering. and c-arm was checked to locate the correct interspace. 5.Incision: 3-cm, between L5-S1-spinous processes. The subcutaneous layer and lumbdorsal fascia were incised. 6.The aponeurosis of the latissimus dorsi and ileocostalis lumborum muscles at spinous processes of left L5-S1 was incised, the muscles were detached from the interspinous ligament. The multifidus muscles were detached subperiosteally from L5-S1 laminae by a rasp. 7.The paravertebral muscles were retracted by a modified narrow Taylor retractor which was retained constantly by a rubbersling to the side rail of the operating table. 8.Under an operating microscope, the ligamentum flavum was cleaned and incised longitudinally at the lateral part with a No. 11 blade. The lateral portion of this ligament was removed with a small angle Kerrison rongeur, the lateral portion of the laminae and the medial border of the facets were removed too until the margin of the facets and a corridor to the disc that ran lateral to the root was reached. 9. The epidural fat was left undisturbed andpreserved. 10.The compressed L4 root and veins overlying the protruded disc were gently pushed away by placing 2 small cottonoid patties, one above and one below the disc at the floor of the epidural canal. 11.The compressed root was gently pushed further away temporarily by sucker tip in order to expose the herniated disc more clearly. The posterior longitudinal ligament and annulus were incised around the protruded disc with a No. 15 blade. The degenerated disc was removed with microdisc forceps until a substantial amount of the nucleus had been loosened with a cone curette and removed. 12.The lumbodorsal fascia was approximated by 3 interruped 2/0 silk stitches. 13.Thesubcutaneous layer was closed by running suture with 4/0 Dexon and skin by adhesive tape. 14.Course of the surgery: smooth. Operators 曾勝弘 Assistants 陳睿生 張得一 相關圖片 吳秉洋 (M,2009/07/01,2y8m) 手術日期 2010/02/23 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Spina bifida, lumbar 器械術式 Cord untethering -KUO 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 2 紀錄醫師 陳德福, 時間資訊 00:00 臨時手術NPO 07:55 報到 08:00 進入手術室 08:10 麻醉開始 08:30 誘導結束 08:50 抗生素給藥 09:20 手術開始 11:50 抗生素給藥 12:25 手術結束 12:25 麻醉結束 12:35 送出病患 12:40 進入恢復室 14:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 手術 脊椎內脊髓內腫瘤切除術 1 1 手術 椎弓整形術 1 2 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 摘要__ 手術科部: 外科部 套用罐頭: 1.Intradural lipomatous tumor removal[partial... 開立醫師: 陳德福 開立時間: 2010/02/23 12:31 Pre-operative Diagnosis Tethered cord syndrome, dermal sinus tract with lipomatous band Tethered spinal cord due to extradural lipomatous band and intradural lipoma Post-operative Diagnosis ditto Operative Method 1.Intradural lipomatous tumor removal[partial] and detethering 2.laminoplasty 1.Intradural lipomatous tumor removal[partial] and detethering 2.Cutting of filum terminalis 3.laminoplasty L2-4 1.untethering by subtotal excision of intradural lipoma and extradural lipomatous band 2.Cutting of filum terminalis 3.laminoplasty L1-4 Specimen Count And Types 2 pieces About size:2*2*1CM Source:intrathecal lipomatous tumor About size:1*0.3*0.3cm Source:dermal sinus tract Pathology pending Operative Findings 1.There is a closed dermal sinus tract over the lumbosacral area with one tiny skin dimpleing. The consistency of the tract was hard and elastic. 1.There is a closed dermal sinus tract over the lumbosacral area with one tiny skin dimpleing. The consistency of the tract was hard and elastic. There is deformity of the lamina of L4 and 5 with cartilegous change. 1.There is shallow skin dilple over the lumbosacral region without skin defect. 2. the lamina of L5 was deformed that it was dorsally reflected to toward the subcutaneous region. 3. There is an extradural lipomatous band extended upward from under the deformed L5 lamine to the L3-4 level. It is about 1 mm in diameter and penetrated through the dural into the intradural space and continuously upward to the dorsal lipoma at the L1 to L3 levels. 1.There is shallow skin dilple over the lumbosacral region without skin defect. 2. the lamina of L5 was deformed that it was dorsally reflected to toward the subcutaneous region. 3. There is an extradural lipomatous band extended upward from under the deformed L5 lamine to the L3-4 level. It is about 1 mm in diameter and penetrated through the dura into the intradural space and continuously upward to the dorsal lipoma at the L1 to L3 levels. This extradural and intradural connenction cdauses the tethering effect to the spinal cord. 2.The tract pass through the interlamina space of L4-5 into the subarachnoid plane of the spinal canal with one 4*1.5*1.5cm in sized lipomatous tumor which contributes to the tethering effect. The tract was cut off and the tumor was partially removed. The cord was detethered and the procedure and we repaired the surface of the residual tumor with prolene. 3.The intradural lipoma was 4*1.5*1.5cm in size. The tract was cut off and the tumor was partially removed. The cord was detethered and the procedure and we repaired the surface of the residual tumor with prolene. 4.The intradural lipoma was 4*1.5*1.5cm in size. 3.The filum terminalis was infiltrated with mild fatty tissue. We cut it for detethering at the lower L4 level. 5. the filum terminale was not thick but was mildly infiltrated by lipomatous tissue, so it was cut for preventing future tethering at the lower L4 level. 5. the filum terminale was not thick but was mildly infiltrated by lipomatous tissue, so it was cut for preventing future tethering at the lower L4 level. 6. Primary duroplasty and laminoplasty were done 4.Duroplasty and laminoplasty was done 4.Duroplasty and laminoplasty was done Operative Procedures Under ETGA and prone position, the skin was disinfected and draped as usual. Under ETGA and prone position, the skin was disinfected and draped as usual. One midline linear incision was done and the deformed dorsiflected lamina was removed. dermoid sinus tract was identified carefully. The L2-5 paraspinal muscle was dissected laterally. Under microscopic surgery, the L4-5 epidural space was identified, then the L2-4 laminotomy was done. The dura was opened along the midline and the tract pass through the dura into the sub-arachonid plane with one lipomatous tumor was identified. The tract of the dermal sinus was exposed and cut later on. Partial tumor excision was done and we repaired the surface of residual tumor with Prolene. The filum terminalis was identified later and we cut it off after coagulating it.The adhesiolysis was done and copious normal saline irrigation was performed. Hemostasis and dura closure were performed. L2-4 laminoplasty was performed with multiple silk sutures. The wound was closed in layers. One midline linear incision was done and the deformed dorsiflected lamina was removed. dermoid sinus tract was identified carefully. The L2-5 paraspinal muscle was dissected laterally. Under microscopic surgery, the L4-5 epidural space was identified, then the L2-4 hhhhkjhkhkhlaminotomy was done. The dura was opened along the midline and the tract pass through the dura into the sub-arachonid plane with one lipomatous tumor was identified. The tract of the dermal sinus was exposed and cut later on. Partial tumor excision was done and we repaired the surface of residual tumor with Prolene. The filum terminalis was identified later and we cut it off after coagulating ihkhkjhkjhkjht.The adhesiolysis was done and copious normal saline irrigation was performed. Hemostasis and dura closure were performed. L2-4 laminoplasty was performed with multiple silk sutures. The wound was closed in layers. One midline linear incision was done and the deformed dorsiflected lamina was removed. dermoid sinus tract was identified carefully. The L1-5 paraspinal muscle was dissected laterally. Under microscopic surgery, the deformed lamina was removed then the L1-4 laminotomy was done. The dura was opened along the midline and the lipomatous band pass through the dura into the sub-arachonid plane with one lipomatous tumor was identified. The band was cut. Partial tumor excision was done and we repaired the surface of residual tumor and the placode with Prolene. The filum terminalis was identified later and we cut it off after coagulating. The adhesiolysis was done and copious normal saline irrigation was performed. Hemostasis and dura closure were performed. L1-4 laminoplasty was performed with multiple silk sutures. The wound was closed in layers. Under ETGA and prone position, the skin was disinfected and draped as usual. One midline linear incision was done and the dermoid sinus tract was identified carefully. The L2-5 paraspinal muscle was dissected laterally. Under microscopic surgery, the L4-5 epidural space was identified, then the L2-4 laminotomy was done. The dura was opened along the midline and the tract pass through the dura into the sub-arachonid plane with one lipomatous tumor was identified. The tract of the dermal sinus was exposed and cut later on. Partial tumor excision was done and we repaired the surface of residual tumor with Prolene. The filum terminalis was identified later and we cut it off after coagulating it.The adhesiolysis was done and copious normal saline irrigation was performed. Hemostasis and dura closure were performed. L2-4 laminoplasty was performed with multiple silk sutures. The wound was closed in layers. Operators AP 郭夢菲 AP 郭夢菲 Assistants R4 陳德福 相關圖片 簡維鴻 (M,2001/08/28,10y6m) 手術日期 2010/02/23 手術主治醫師 郭夢菲 手術區域 兒醫 067房 02號 診斷 Arachnoid cyst 器械術式 Brain tumor Crainotomy(Others) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 陳德福, 時間資訊 00:00 臨時手術NPO 12:15 報到 12:45 進入手術室 12:55 麻醉開始 13:30 誘導結束 15:30 抗生素給藥 15:45 手術開始 18:30 抗生素給藥 18:35 麻醉結束 18:35 手術結束 18:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４～８小時 1 1 R 手術 立體定位術－抽吸 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Endoscopic fenestration, Nevigator system guided 開立醫師: 陳德福 開立時間: 2010/02/23 14:51 Pre-operative Diagnosis Intraventricular arachnoid cyst, right trigone area Intraventricular arachnoid cyst, right trigon Intraventricular arachnoid cyst, right trigonwith focal hydrocephalus Intraventricular arachnoid cyst, right trigon with focal hydrocephalus Post-operative Diagnosis ditto ditto Operative Method Endoscopic fenestration and shrinkage of the arachnoid cyst by Nevigator system guided Endoscopic fenestration and shrinkage of the arachnoid cyst via right occipital horn by Nevigator system guided Endoscopic fenestration, Nevigator system guided Specimen Count And Types CSF Pathology nil Operative Findings 1.There is a 4*6*3cm in sized cystic tumor at the trigone of right ventricle. The capsule of the cyst was whitish and the content inside the 1.There is a 4*6*3cm in sized cystic tumor at the trigone of right ventricle. The capsule of the cyst was whitish and the content inside the cyst was clear and colorless. cyst was clear and colorless. 2.Multiple fenestrations on the cyst wall were performed and we coagulized the cyst capsule for shrinking the size of the cyst. 2.Multiple fenestrations on the cyst wall were performed till the anterior and posterior capsule was communicated with the right frontal horn and we coagulate the cyst capsule for shrinking the size of the cyst till the medial wall of right ventricular body was seen. 1.There is a 4*6*3cm in sized cystic tumor at the trigone of right ventricle. The capsule of the cyst was whitish and the content inside the cyst was clear and colorless. 2.Multiple fenestrations on the cyst wall were performed and we coagulized the cyst capsule for shrinking the size of the cyst. 3.One EVD was left in situ. Operative Procedures Under ETGA and supine with head rotated to the left side position, Nevigator system was registered and the trajectory of endoscopic appraoch was simulated. The scap was disinfected and draped as usual. One linear incision was done at right Frazier point and one 1.4cm burr hole was created. The dura was opened and the endoscopic system was inserted under Nevigator system guided. The cyst was encountered and we inspect the capsule of the cyst via endoscope. The lateral ventricle wall, choroid plexus, foramen of Morro, and vascular structure were observed after we made multiple fenestrations on the cyst. After hemostasis, we left on EVD in the lateral ventricle and the wound was closed in layers. Under ETGA and supine with head rotated to the left side position, Nevigator system was registered and the trajectory of endoscopic appraoch was simulated. The scap was disinfected and draped as usual. One linear incision was done at right Frazier point and one 1.4cm burr hole was created. The dura was opened after dural tenting and the endoscopic system was inserted under Nevigator system guided. The posterior cystic wall was encountered and we then proceeded the scope to the anterior cystic wall. After fenestration with scope, scissors, and fogarty catheter, the right frontal horn was reached. since the communication was not large enough, we then coagulated the whole cystic wall over the medial and posterior sides till the cyst shrank and the medial ventricular wall could communicate freely to the frontal and posterior horns. The lateral ventricle wall, choroid plexus, foramen of Monro, and vascular structure were observed. After hemostasis, we left on EVD in the lateral ventricle and the wound was closed in layers. Under ETGA and supine with head rotated to the left side position, Nevigator system was registered. The trajectory of endoscopic appraoch was simulated. The scap was disinfected and draped as usual. One linear incision was done at right Frazier point and one 1.4cm burr hole was created. The dura was opened and the endoscopic system was inserted under Nevigator system guided. The cyst was encountered and we inspect the capsule of the cyst via endoscope. The frontal horn was reached after we made one 1cm in sized fenestration. After hemostasis, the wound was closed in layers. Under ETGA and supine with head rotated to the left side position, Nevigator system was registered and the trajectory of endoscopic appraoch was simulated. The scap was disinfected and draped as usual. One linear incision was done at right Frazier point and one 1.4cm burr hole was created. The dura was opened and the endoscopic system was inserted under Nevigator system guided. The cyst was encountered and we inspect the capsule of the cyst via endoscope. The lateral ventricle wall, choroid plexus, foramen of Morro, and vascular structure were observed after we made multiple fenestrations on the cyst. After hemostasis, we left on EVD in the lateral ventricle and the wound was closed in layers. Operators AP 郭夢菲 Assistants R4 陳德福 陳麗真 (F,1950/03/25,61y11m) 手術日期 2010/02/23 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Pituitary tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 楊博智, 時間資訊 00:00 臨時手術NPO 07:30 報到 08:05 進入手術室 08:15 麻醉開始 08:40 誘導結束 09:03 抗生素給藥 09:55 手術開始 12:00 麻醉結束 12:00 手術結束 12:10 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 手術 經由蝶竇之腦下垂體瘤切除 1 1 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Transnasal trans-sphenoidal approach for tumo... 開立醫師: 潘為元 開立時間: 2010/02/23 12:15 Pre-operative Diagnosis pituitary macroadenoma Post-operative Diagnosis pituitary macroadenoma Operative Method Transnasal trans-sphenoidal approach for tumor excision Specimen Count And Types tumorx1 Pathology pituitary tumor Operative Findings The tumor was whitish, and soft one, and the predominant part located at the right side sella turcica. Unintended arachnoid membrane rupture was noted and sealed with tissuco-dul. The buldging lateral wall nearby the ICA was suspect. Pseudomembrane was noted after tumor excision. Operative Procedures After ETGA, the patient was put in supine position with head mild left tilt. The nasal cavity was well-disinfective, and then we incised into the nasal septum. Dissection was performed along with the periosteum to expose sphenoid sinus anterior wall and sphenoid ostia. After fracture of vomer, sphenoid sinus anterior wall was also fractured. The mucosa was removed. The sella floor was exposed and removed with kerrison. After cruciate form incision, tumor buldged out. And it was further removed with tumor forceps and ring currette. During operation, cavernous sinus ruptured was noted, but it was stopped immediately by gelfoam packing. After total excision of tumor was made, arachnoid defect was sealed with tissuco-dul. And the bony graft was put back and followed by compaction of merosel. Operators 賴達明 Assistants 胡朝凱,楊博智 黃阿秀 (F,1942/10/11,69y5m) 手術日期 2010/02/23 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Spondylolisthesis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 楊博智, 時間資訊 00:00 臨時手術NPO 12:30 進入手術室 12:35 麻醉開始 12:45 誘導結束 13:10 抗生素給藥 13:30 手術開始 16:10 抗生素給藥 19:10 抗生素給藥 19:30 開始輸血 21:00 手術結束 21:00 麻醉結束 21:10 送出病患 21:13 進入恢復室 22:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 9 0 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 手術 椎間盤切除術－腰椎 1 2 摘要__ 手術科部: 外科部 套用罐頭: L4 and L5 sublaminal decompression, L4/5 disc... 開立醫師: 李建勳 開立時間: 2010/02/23 21:13 Pre-operative Diagnosis L4/5 spondylolithesis with HIVD,L4/5 and L5/S1 stenosis Post-operative Diagnosis L4/5 spondylolithesis with HIVD,L4/5 and L5/S1 stenosis Operative Method L4 and L5 sublaminal decompression, L4/5 disckectomy with cage fusion and L4/5 TPS fixation Specimen Count And Types nil Pathology Nil Operative Findings The L4/5 and L5/S1 were found stenosis with thickened ligmentum flavum. Synthes TPS 6.25mmX40mmX3 and 6.25mmX40mmX1, rod 45mmX2 with one 12mm cage were inserted. Operative Procedures Under general anesthesia and intubation, the patient was put in prone position. Located the L4/5 and L5/S1 space with portable X-ray. The skin was scrubbed, disinfected with alcohol B-I then draped. Midline skin incision with seperated the fascia parasaggitally. Bilateral paramedian fascia incision and seperated the muscle to located the transverse process. Inserted L4/5 TPS with the position checked with portable X-ray. L4 and L5 sublaminal decompression was performed after splitted the spinous processes. removed the ligmentum flavum with Kerrison punch. L4/5 bilateral discectomy was then performed with surgical blade incision of the PLL. Inserted the disc cage bilaterally and checked the position with portable X-ray. Set up the rods and the hemovac drains at the wound. Closed the wound in layers. Operators VS 賴達明 Assistants R6 陳盈志 R6 李建勳 R1 楊博智 相關圖片 趙卿珍 (F,1962/04/28,49y10m) 手術日期 2010/02/24 手術主治醫師 王碩盟 手術區域 東址 009房 6號 診斷 Wound infection postoperative 器械術式 Debridment-- >10cm 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 靜脈麻醉 麻醉主治醫師 葉惠敏 ASA 3 紀錄醫師 林威佑, 時間資訊 16:40 報到 16:45 進入手術室 16:55 麻醉開始 16:56 誘導結束 16:57 手術開始 17:20 手術結束 17:20 麻醉結束 17:30 送出病患 17:33 進入恢復室 18:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 膀胱鏡檢查 1 0 手術 切開排膿 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 摘要__ 手術科部: 泌尿部 套用罐頭: cystoscopy（biopsy ) 開立醫師: 賴建榮 開立時間: 2010/02/24 17:45 Pre-operative Diagnosis R/O bladder rupture Post-operative Diagnosis severe bladder trabeculation, suspect neurogenic bladder Operative Method cystoscopy, incision and debridement Specimen Count And Types 1 piece About size: Source:Culture Pathology pending Operative Findings 1. Severe trabeculation 2. Bilateral ureteral orifice intact 3. Large amount abscess was drained from suprapubic wound 4. No grossly definite rupture of bladder Operative Procedures Under satisfactory anesthesia with the patient in lithotomy position, prepping and drapping was performed in the usual sterile fashion. A Fr 21 Olympus cystoscope was introduced into the bladder cavity under direct vision. Careful inspection revealed theLt hemitrigone and bilateral ureteral orifice was normal. Severe trabeculation was noted. No grossly significant rupture was noted. A Fr 16 Foley catheter was inserted. A nelaton was inserted into suprapubic wound and large amount abscess was drained from the wound. A 10 Fr. silicon Foley catheter was inserted for drainage. Patient tolerated the procedure very well and was sent to recovery room in satisfactory condition. Operators 王碩盟, Assistants 林威佑, 陳春貴 (M,1951/07/01,60y8m) 手術日期 2010/02/24 手術主治醫師 杜永光 手術區域 東址 002房 01號 診斷 Subarachnoid hemorrhage (SAH) 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 陳睿生, 時間資訊 07:30 通知急診手術 08:20 報到 08:25 進入手術室 08:35 麻醉開始 08:45 誘導結束 09:30 抗生素給藥 10:45 手術開始 12:30 開始輸血 13:00 抗生素給藥 15:55 麻醉結束 15:55 手術結束 16:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 開顱術摘除血管病變－腦血管瘤－有徵的 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 7 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Aneurysmal clipping via right pterion approach 開立醫師: 陳睿生 開立時間: 2010/02/24 16:48 Pre-operative Diagnosis A-com aneurysm with rupture and diffuse SAH Post-operative Diagnosis Ditto Operative Method Aneurysmal clipping via right pterion approach Specimen Count And Types nil Pathology Nil Operative Findings The aneurysm located at the junction between right side A1 and A-com. It was longitudinal with inferior protrusion and the height was about 6mm. Peripheral SAH was noted and the aneurysm was tightly attached to the optic chiasma. We used a right tilt Sugita clip for clipping and the pulsation of bilateral ACA and A-com were fair post-operatively. The frontal sinus was opened intra-operatively, and packed with fascia graft after disinfection. Operative Procedures After ETGA, the patient was under supine position and head left turn with fixation by Mayfield clump. Right frontotemporal curvillinear incision and we dissected the fascia and temporalis muscle with facial nerve preservation. Three burr holes made and an about 8x6 cm craniotomy window was created. Dura tacking was done and the outer 1/2 sphenoid ridge was drilled out till lateral superior orbital fissure exposure. The dura was opened in a curvelinear shape. We retracted frontal lobe upward under microscope. The optic nerve and ICA were identified. After decompression with CSF drainage from cistern, the rectal gyrus between optic nerve and olfactory nerve was removed about 1cm in length. The aneurysm was harvested and the neck was dissected with adhesionlysis. The bilateral A2 and A-com were also exposed. We applied a right tile Sugita clip and the aneurysmal sac was opened. The dura was tightly closed with deair. The exposed frontal sinus was packed with fascia graft. The skull graft was fixed back with miniplates x3 with central tacking. An epidural CWV drain was set, and the wound was closed in layers. Operators P 杜永光 Assistants R5 陳睿生, Ri Indication Of Emergent Operation 高信謙 (M,1955/03/15,56y11m) 手術日期 2010/02/24 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Astrocytoma 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 08:10 進入手術室 08:25 麻醉開始 09:05 誘導結束 09:30 抗生素給藥 10:05 手術開始 11:04 開始輸血 12:30 抗生素給藥 12:55 手術結束 12:55 麻醉結束 13:23 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除－手術時間在４小時以內 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Right frontal craniotomy for tumor biopsy and... 開立醫師: 李建勳 開立時間: 2010/02/24 12:59 Pre-operative Diagnosis Multiple brian tumor suspect high grade glioma Post-operative Diagnosis Multiple brian tumor suspect high grade glioma Operative Method Right frontal craniotomy for tumor biopsy and cyst drainage Specimen Count And Types 1 piece About size:1g Source:craniotomy for tumor biopsy Pathology Frozen section: high grade glioma. Pathology: pending Operative Findings The cyst was found under the falx and the tumor was located medial to the cyst. The tumor was greyish, soft with moderate vascularity. One arachnoid granule with massive bleeding was sutured with 5-0 Prolene. The cyst was found under the falx and the tumor was located medial to the cyst. The tumor was greyish, soft with moderate vascularity. One arachnoid granule with massive bleeding was sutured with 5-0 Prolene. The left side MEP decreased in amplitude and recovered spontaneously. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position with head fixed with Mayfield skull clump and turned to left. The scalp was shaved, scrubbed, disinfected with alcohol B-I then draped. The curvilinear scalp incision was made across the midline followed by crnaiotomy created by high speed air drill. The dura was opened after tenting around the craniotomy window. The smaller cortical drainage vein was bipolar coagulated and cut to enter the interhemispheric space. Trace the falx to located the cyst and drained the content. Tumor biopsy was perforemd with tumor forceps and hemostasis with bipolar coagulation and surgicel lining of the tumor bed. The dura was closed with 4-0 Prolene sutures and the skull plate was fixed back with miniplates and screws. The wound was closed in layers after one subgaleal CWV drain set up. Operators P 杜永光 Assistants R6 李建勳 R3 李振豪 相關圖片 林紫湲 (F,1976/02/12,36y1m) 手術日期 2010/02/24 手術主治醫師 杜永光 手術區域 東址 003房 02號 診斷 Subdural and cerebral hemorrhage 器械術式 Craniotomy (A.V.M.) P-DUH 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 13:30 報到 13:40 進入手術室 13:45 麻醉開始 14:00 誘導結束 15:00 抗生素給藥 15:12 手術開始 18:00 抗生素給藥 19:00 麻醉結束 19:00 手術結束 19:10 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 開顱術摘除血管病變－動靜脈畸型－小型－深部 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Right Frazier point EVD insertion and craniot... 開立醫師: 李建勳 開立時間: 2010/02/24 19:21 Pre-operative Diagnosis Right trigone AVM Post-operative Diagnosis Right trigone AVM Operative Method Right Frazier point EVD insertion and craniotomy for AVM resection Specimen Count And Types 1 piece About size:0.5g Source:craniotomy for AVM resection Pathology PEnding Operative Findings Low CSF opening pressure (< cmH2O). The AVM located inside the right choroid plexus with drainage vein ran lateral posteriorly. The right trigone choroid plexus was removed with the AVM. Low CSF opening pressure (< 5cmH2O). The AVM located inside the right choroid plexus with drainage vein ran lateral posteriorly. The right trigone choroid plexus was removed with the AVM. Operative Procedures Under general anesthesia and intubation, the patient was put in prone position with head fixed with Mayfield skull clump. The scalp was shaved, scrubbed, disinfected with alcohol B-I then draped. Linear scalp incision was made at right Frazier point followed by craniotomy for 4cm in diameter. The dura was opened in cruciate fashion after tenting around the craniotomy window. Inserted the EVD under the guidance of intraoperative sonography. Corticotomy along the EVD tract into the right lateral ventricle. Resected the AVM with the choroid plexus and the venous drainage. Hemostasis with bipolar coagulator and surgicel lining. Closed the dura with the EVD left in the ventricle. The skull plate was fixed back with wires. The wound was then closed in layers. Operators P 杜永光 Assistants R6 李建勳 R3 李振豪 相關圖片 周惠雅 (F,1971/12/24,40y2m) 手術日期 2010/02/24 手術主治醫師 蔡瑞章 手術區域 東址 005房 01號 診斷 Secondary malignant neoplasm of lung 器械術式 Brain tumor Crainotomy(Others) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 古恬音, 時間資訊 00:00 臨時手術NPO 07:48 報到 08:05 進入手術室 08:20 麻醉開始 08:50 誘導結束 08:55 抗生素給藥 09:25 手術開始 11:55 抗生素給藥 13:00 麻醉結束 13:00 手術結束 13:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４小時以內 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 摘要__ 手術科部: 外科部 套用罐頭: Right parietal craniotomy total tumor excision 開立醫師: 陳盈志 開立時間: 2010/02/24 13:26 Pre-operative Diagnosis Right parietal tumor, r/o metastasis Post-operative Diagnosis Right parietal tumor, r/o metastasis Operative Method Right parietal craniotomy total tumor excision Specimen Count And Types 1 piece About size:multiple fragments total 3cm diameter Source:right parietal tumor Pathology pending Operative Findings The tumor was soft fragile in character. There is one cystic component with yellowish fluid content and necrotic tissue. The solid portion of the tumor is soft, greyish yellowish in color. The margin was clear. Operative Procedures Under general anesthesia and intubation, the patient was put in prone position with head fixed with Mayfield skull clump. The scalp was shaved, scrubbed, disinfected with alcohol B-I then draepd. The hocky-stick scalp incision was made at the right parietal area and performed the craniotomy. The U-shape dura was opened along the craniotomy edge after located the tumor with intraoperative sonography. The tumor excision was started with central debulky with cystic portion drainage with syringe. Tumor excision was performed with bipolar coagulation and tumor forceps piece by piece. Hemostasis was done with bipolar and surgicel packing. The dura was closed with 4-0 Prolene sutures. The skull plate was fixed back with wires with central tenting. The wound was closed in layers after one subgaleal CWV drain set up. Operators P蔡瑞章 Assistants R6陳盈志R2古恬音 王梓仲 (M,2000/07/20,11y7m) 手術日期 2010/02/24 手術主治醫師 楊士弘 手術區域 兒醫 067房 號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(Others) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 2E 紀錄醫師 陳德福, 時間資訊 09:22 臨時手術NPO 09:22 開始NPO 11:24 通知急診手術 15:20 報到 15:55 進入手術室 16:00 麻醉開始 16:20 誘導結束 16:30 抗生素給藥 16:45 手術開始 17:20 麻醉結束 17:20 手術結束 17:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱內壓監視置入 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 套用罐頭: right frontal EVD insertion 開立醫師: 陳德福 開立時間: 2010/02/24 17:23 Pre-operative Diagnosis posterior fossa tumor with acute hydrocephalus Post-operative Diagnosis ditto Operative Method right frontal EVD insertion Specimen Count And Types 1 piece About size:10ML Source:CSF Pathology pending Operative Findings 1.The ventricle opening pressure: >30cmH2O 2.CSF: clear and colorless 3.One EVD was inserted via right Kocher point Operative Procedures Under ETGA and supine position, the scalp was disinfected and draped as usual. One linear incision on right frontal scalp was done and burr hole was created. The dura was opened and we insert the ventricular tapping needle. The CSF gushed out spontaneously and we insert the EVD. The wound was then closed in layers. Operators VS 楊士弘 Assistants R4 陳德福 Indication Of Emergent Operation 唐碧霞 (F,1931/11/26,80y3m) 手術日期 2010/02/25 手術主治醫師 杜永光 手術區域 東址 002房 02號 診斷 Subarachnoid hemorrhage 器械術式 Tracheostomy 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3 紀錄醫師 李建勳, 時間資訊 21:47 通知急診手術 00:00 開始NPO 00:00 臨時手術NPO 13:30 進入手術室 13:30 報到 13:35 麻醉開始 13:40 誘導結束 15:02 手術開始 17:30 麻醉結束 17:30 手術結束 17:35 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 手術 腦室腹腔分流手術 1 1 摘要__ 手術科部: 外科部 套用罐頭: 1. Left Kocher point VP shunt insertion 2. Tr... 開立醫師: 李建勳 開立時間: 2010/02/25 17:48 Pre-operative Diagnosis Hyhdrocephalus and respiratory failure Post-operative Diagnosis Hyhdrocephalus and respiratory failure Operative Method 1. Left Kocher point VP shunt insertion 2. Tracheostomy Specimen Count And Types 3 pieces About size:1mL Source:CSF About size:1mL Source:CSF About size:1mL Source:CSF Pathology Nil Operative Findings CSF opening pressure 8 cmH2O with clear CSF drained out. Medtronic medium pressure reservoir was used. Ventricular catheter length: 6.7cm, peritoneal catheter:25cm. Fr 7 tracheostomy tube was inserted via 2nd trachea ring. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position with head turned to right. The sclap was shaved, scrubbed, disinefected with alcohol B-I then draped. A curvilinear skin incision was made at left frontal region followed by burr hole. The dura was incised after tenting. A ventricular puncture needle was used to puncture then shifted to nelaton tube. Minilaparotomy was made at left upper abdomen and the peritoneal catheter was inserted and test function. The shunt cather was then passed through subcutaneous layer of abdomen, anterior chest wall, neck, retroauricular area then connected to the reservoir. The nelaton tube was then changed to ventricular catheter and connected to the reservoir. After testing the function, the wounds were all closed in layers. Operators P 杜永光 Assistants R6 李建勳 Indication Of Emergent Operation 相關圖片 許楊素珠 (F,1956/09/12,55y6m) 手術日期 2010/02/25 手術主治醫師 賴達明 手術區域 東址 002房 03號 診斷 Subarachnoid hemorrhage 器械術式 Craniotomy(Aneurysms) P-DUH 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 蕭柏妮 ASA 4E 紀錄醫師 張皓鈞, 時間資訊 10:30 開始NPO 17:18 通知急診手術 18:30 報到 18:45 進入手術室 18:50 麻醉開始 19:10 誘導結束 19:45 抗生素給藥 19:55 手術開始 23:05 開始輸血 23:40 抗生素給藥 01:00 麻醉結束 01:00 手術結束 01:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 開顱術摘除血管病變－腦血管瘤－有徵的 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Left side Pterion approach aneurysm clipping 開立醫師: 陳盈志 開立時間: 2010/02/26 01:38 Pre-operative Diagnosis Left MCA bifurcation aneurysm with SAH Post-operative Diagnosis Left MCA bifurcation aneurysm with SAH Operative Method Left side Pterion approach aneurysm clipping Specimen Count And Types nil Pathology nil Operative Findings Diffuse SAH and the brain was severe swelling was noted after dura opening. The sylvian fissure was opened and one aneurysm from MCA bifurcation was noted protruding upward laterally. The dome was about 8mm. Much clot was noted with adhesion near the aneurysm. One 135 degree angled clip was applied. Three perforator nearby and 2 branches was identified and preserved. Operative Procedures 1.ETGA, supine with head tilt to right and fixed with Mayfield 2.Skin preparation 3.Left F-T curvilinear scalp incision 4.Detach temporalis muscle with muscle cuff then burr hole x 3 and craniotomy 5.Flatten sphenoid ridge then C-shape dura opening 6.open sylvian fissure with bipolar and dissecter till well exposure of M1 and bifurcation 7.Applied one 135 degree angled clip for clipping and then apply template clip to M1, then cauterize the aneurysm till shrinkage then remove template clip 8.Hemostasis with bipolar and surgicel packing 9.Dura closure with 4-0 prolene 10.Fix bone plate with miniplate 11.Close wound with subgaleal CWV drain x 1 Operators vs賴達明 Assistants r6陳盈志r1張皓鈞 Indication Of Emergent Operation 廖鼎晨 (M,1966/07/17,45y7m) 手術日期 2010/02/25 手術主治醫師 陳敞牧 手術區域 東址 005房 03號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(Others) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 張得一, 時間資訊 00:00 臨時手術NPO 13:10 報到 14:05 進入手術室 14:10 麻醉開始 14:40 誘導結束 14:40 抗生素給藥 15:05 手術開始 15:40 開始輸血 17:40 抗生素給藥 20:40 抗生素給藥 22:10 麻醉結束 22:10 手術結束 22:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４～８小時 1 1 L 手術 頭顱成形術 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 8 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Tumor resection with left craniectomy and cra... 開立醫師: 張得一 開立時間: 2010/02/25 22:45 Pre-operative Diagnosis Left fronto-parieto-temporal meningioma Post-operative Diagnosis Left fronto-parieto-temporal meningioma Operative Method Tumor resection with left craniectomy and cranioplasty Specimen Count And Types Bone, fascia, tumor Pathology Frozen: meningioma Operative Findings 1. Thickened left skull up to 5cm with irregular indentation of skull surface. Craniectomy area: 15x15cm. 2. One greyish, soft, vascularized parasagittal tumor around 7x6x4cm occupying left fronto-parietal region, with compression of brain surface. The tumor occupied superior sagittal sinus totally. 3.The margin was not clear 4.The tumor extended both epidurally and intradurally with invasion to fascia and bone 5.Cranioplasty was done with wiremesh and bone cement 6.Blood loss : 4000 ml Operative Procedures 1.ETGA, supine with head rotate to right 2.Reverse U shape skin incision 3.Reflect skin flap 4.Detach fascia layer 5.Craniectomy 6.Tumor excision with suction piece by piece 7.Superior sagital sinus was partially resect 8.Hemostasis 9.Duroplasty with durofoam 10.Cranioplasty with wiremesh and bonecement and fixed with miniplate 11.Set CWV drain and close wound in layers Operators 陳敞牧 Assistants 胡朝凱,張得一 王梓仲 (M,2000/07/20,11y7m) 手術日期 2010/02/25 手術主治醫師 廖漢文 手術區域 東址 000房 號 診斷 Brain tumor 器械術式 NEURO T.A.E 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 2 時間資訊 12:30 麻醉開始 12:45 誘導結束 14:30 麻醉結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 杜福泉 (M,1950/07/23,61y7m) 手術日期 2010/02/25 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 鍾文桂, 時間資訊 23:55 臨時手術NPO 10:45 報到 11:25 進入手術室 11:30 麻醉開始 11:55 誘導結束 11:55 抗生素給藥 12:31 手術開始 14:50 抗生素給藥 15:00 麻醉結束 15:00 手術結束 15:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４小時以內 1 1 L 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 摘要__ 手術科部: 外科部 套用罐頭: Excision of brain tumor, left frontal approach. 開立醫師: 鍾文桂 開立時間: 2010/02/25 15:44 Pre-operative Diagnosis Left frontal metastatic tumor, originated from adenocarcinoma of colon. Post-operative Diagnosis Left frontal metastatic tumor, originated from adenocarcinoma of colon.. Operative Method Excision of brain tumor, left frontal approach. Specimen Count And Types 1 piece About size:About 30 cc. Source:Left frontal brain tumor. Pathology Pending. Operative Findings Fairly delineated tumor margin. Gross total tumor excision. Presence of old tumor bleeding at cortical surface. The tumor invaded the dura. Frontal base was exposed after tumor removal. Tumor characters: grayish, soft, chesse like tumor, moderate oozing. Two cortical vein were electrocoagulated by bipolar. Operative Procedures Anesthesia: general, endotracheal. Preparation: head in midline, position: supine. Disinfection, draping. Incision: bicoronal. Craniotomy: left frontal 3x5 cm, 1 cm lateral to midline, frontal sinus: intact. Dural tenting, durotomy ( medial side as base). Tumor was noted right after durotomy. Incision of arachnoid membrane. Tumor excision along tumor margin. Gross total tumor excision. Well hemostasis via Surgicel and bipolar electrocoagulator. Duroplasty with fascia graft. Fixation of craniotomy plate with plates and screws. Wound closure in layers. Send the patient to ICU smoothly. Operators V.S. 王國川. Assistants R4 鍾文桂. 趙蘭花 (F,1908/11/29,103y3m) 手術日期 2010/02/25 手術主治醫師 蔡翊新 手術區域 東址 005房 01號 診斷 Intracerebral hemorrhage 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 5 紀錄醫師 張得一, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:07 進入手術室 08:22 麻醉開始 08:30 誘導結束 08:36 抗生素給藥 09:10 手術開始 10:15 手術結束 10:15 麻醉結束 10:25 送出病患 10:28 進入恢復室 12:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 手術 腦室腹腔分流手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 林杰欣 開立時間: 2010/02/25 10:23 Pre-operative Diagnosis Hydorcephalus Post-operative Diagnosis Hydorcephalus Operative Method V-P Shunt Specimen Count And Types CSF Pathology Nil Operative Findings 1.Opening pressure was about 12 cmH2O 2.Clear CSF 3.Programmable Codman reservior was use, initial setting: 120 mmH2O Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: supine with head rotated left. 3.Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 5 cm curvilinear via right frontal previous wound 5.A nib incision was made at RUQ of the abdomen , and mini-laparotomy was done. 6.The proximal end of this catheter was passed through subcutaneous tunnel at forechest, neck, rt retroauricular area and connected the reservoir. 7.Ventricular puncture 8.Insert ventricular catheter then abdominal catheter 9.Subsequently, distal 30 cm segment of the peritoneal catheter was introduced into the peritoneal cavity through the outer tube of the trochar. 10. The reservoir was fixed to pericranium by 3 stitches. 9. wound closure Operators 蔡翊新 Assistants 胡朝凱,張得一 周棟一 (M,1928/12/31,83y2m) 手術日期 2010/02/25 手術主治醫師 蔡翊新 手術區域 東址 001房 01號 診斷 Subdural hemorrhage following injury, with brief (less than one hour) loss of consciousness 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林子富 ASA 3E 紀錄醫師 陳德福, 時間資訊 00:38 開始NPO 05:38 通知急診手術 06:00 報到 06:10 進入手術室 06:20 麻醉開始 06:45 抗生素給藥 06:45 誘導結束 06:50 手術開始 08:30 開始輸血 09:55 抗生素給藥 10:10 麻醉結束 10:10 手術結束 10:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 急性硬腦膜下血腫清除術 1 1 L 手術 顱內壓監視置入 1 2 L 摘要__ 手術科部: 外科部 套用罐頭: Left frontal-temporal-parietal craniotomy hem... 開立醫師: 陳盈志 開立時間: 2010/02/25 10:40 Pre-operative Diagnosis Acute traumatic SDH, left side Post-operative Diagnosis Acute traumatic SDH, left side Operative Method Left frontal-temporal-parietal craniotomy hematoma evacuation and duroplasty and ICP monitor insertion Specimen Count And Types nil Pathology nil Operative Findings About 1.5cm thickness hematoma acumulated at subdural space with brain parenchyma compression. The brain was slake after hematoma evacuation. One bleeding point from bridging vein was noted. ICP was 0mmHg after skin closure. Operative Procedures 1.ETGA, supine with head tilt to right side 2.Skin preparation 3.Left F-T-P trauma flap scalp incision 4.Detach temporalis muscle. Burr hole x 4 then craniotomy 5.C-shape dural opening was done and hematoma was evacuated. 6.The bleeder from bridging vein was cauterized with bipolar then surgicel packing 7.Duroplasty with fascia graft and 4-0 prolene 8.Insert ICP monitor and fix bone plate with miniplate after central tenting 9.Close wound in layers with one subgaleal CWV drain Operators VS蔡翊新 Assistants R6陳盈志R4陳德福 Indication Of Emergent Operation 鄭印庫 (M,1953/12/20,58y2m) 手術日期 2010/02/25 手術主治醫師 蔡翊新 手術區域 東址 005房 02號 診斷 Injury (severeity score >=16) 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 張得一, 時間資訊 00:00 臨時手術NPO 10:43 進入手術室 10:47 麻醉開始 10:55 誘導結束 10:58 抗生素給藥 11:25 手術開始 13:40 手術結束 13:40 麻醉結束 13:50 送出病患 13:50 進入恢復室 15:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Glucose 1 0 手術 頭顱成形術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Cranioplasty 開立醫師: 蔡翊新 開立時間: 2010/02/25 13:01 Pre-operative Diagnosis Right frontotemporoparietal skull defect. Post-operative Diagnosis Right frontotemporoparietal skull defect. Operative Method Cranioplasty with autologous bone graft. Specimen Count And Types nil Pathology Nil. Operative Findings A 14 x 12 cm skull defect at right frontotemporoparietal region. The right temporal muscle has been excised during previous operation. The dura was slack and there was no subdural fluid collection. The skull defect was repaired with autologous bone graft placed in the bone bank and fixed with mini-plates and screws. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right (left). 3. Skin preparation:shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with a sterilized adhesive plastic sheet. 4. Incision: along the previous operation scar at right F-T-P area, Raney clips were apllied to the scalp edge for temporary hemostasis. 5. The right F-T-P scalp was dissected away from the underlying dura. 6. The bleeders on the dissected surfaces were coagulated with Bovie painstakingly. 7. The edge of the skull defect was exposed. 8. The original skull plate preserved at bone bank was placed back to the skull window then fixed by 3 mini-plates and 6 screws. Two dural tenting were placed at the center of the skull plate. A piece of bone cement was attached to replace the bulk of right temporal muscle for better cosmetics. 9. Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 1/0 Vicryl and skin by continuous suture with 3/0 nylon. 10.Drain: one epidural and one subgaleal CWVs. 11.Blood transfusion: nil. 12.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5胡朝凱R2張得一 相關圖片 何東鏘 (M,1935/10/20,76y4m) 手術日期 2010/02/26 手術主治醫師 詹志洋 手術區域 兒醫 067房 01號 診斷 Atherosclerosis of the extremities with intermittent claudication 器械術式 Embolectomy, Thrombectomy 手術類別 緊急手術 手術部位 腹 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 王永彬 ASA 3 紀錄醫師 周恒文, 時間資訊 01:50 報到 02:00 進入手術室 02:10 麻醉開始 02:30 誘導結束 02:35 抗生素給藥 02:50 手術開始 03:00 開始輸血 04:50 麻醉結束 04:50 手術結束 05:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 血管探查 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 記錄__ 手術科部: 外科部 套用罐頭: explore 開立醫師: 詹志洋 開立時間: 2010/02/26 05:14 Pre-operative Diagnosis retroperitoneal hematoma r/o right external iliac artery rupture. Post-operative Diagnosis retroperitoneal hematoma, spontaenous Operative Method exploration, vascular Specimen Count And Types 1 piece About size:A LOT Source:retroperitoneal hematoma Pathology hematoma Operative Findings large right retroperitoneal hematoma with bladder compression. Intact iliac artery and veins. Diffuse oozing of retroperitoneal beds. Operative Procedures With general anethesia and supine position. Iodine paint and drape. Right lower quadrant incision around 4 fb above right femoral crease. Retroperitoneally approached iliac vessels and hematoma. Evacuation. Checked bleeding. Where no vessel had been injured. Irrigation. Placed a few surgicel strips and two drains. Closed in layers. Operators 詹志洋 Assistants 林明賢 周恆文 Indication Of Emergent Operation 楊凱富 (M,1991/10/15,20y4m) 手術日期 2010/02/26 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Pituitary Tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 2 紀錄醫師 陳盈志, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:09 進入手術室 08:20 麻醉開始 09:00 誘導結束 09:05 抗生素給藥 09:20 手術開始 12:20 抗生素給藥 12:35 麻醉結束 12:35 手術結束 12:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經由蝶竇之腦下垂體瘤切除 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 摘要__ 手術科部: 外科部 套用罐頭: Transsphenoid adenomectomy 開立醫師: 陳盈志 開立時間: 2010/02/26 13:16 Pre-operative Diagnosis Pituitary tumor Post-operative Diagnosis Pituitary tumor Operative Method Transsphenoid adenomectomy Specimen Count And Types 1 piece About size:Multiple fragments Source:pituitary tumor Pathology pending Operative Findings The tumor was soft elastic in character, whitish in color. The tumor capsule was thick and the tumor did not drop even after CO2 retension. It is also difficult to be pulled out. CSF leak was noted while manipulation, which was repaired with gelform and tissue codul. No VEP change was noted during the procefure Operative Procedures After ETGA, the patient was put in supine position with head mild left tilt. The nasal cavity was well-disinfective, and then we incised nasal mucosa near osteum and then drill off nasal septum under endoscope. Dissection was performed along with the periosteum to expose sphenoid sinus anterior wall and sphenoid ostia then into sphenoid sinus. The sella floor was exposed and removed with kerrison. Under microscope, cruciate form dura incision was done, and tumor buldged out. It was further removed with tumor forceps and ring currette. CO2 retension was done and due to difficult drop of tumor, eligater was used to pull the tumor out. CSF leak was noted, but it was stopped by gelfoam packing and tissue co dul. Nasal cavity was packed with gloves finger with cotton. Operators VS曾漢民 Assistants R6陳盈志 簡博文 (M,1941/09/24,70y5m) 手術日期 2010/02/26 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Brain cancer 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 2 紀錄醫師 陳盈志, 時間資訊 00:00 臨時手術NPO 12:38 報到 13:15 進入手術室 13:25 麻醉開始 13:50 誘導結束 14:10 抗生素給藥 14:35 手術開始 17:26 抗生素給藥 19:15 麻醉結束 19:15 手術結束 19:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４～８小時 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 摘要__ 手術科部: 外科部 套用罐頭: Left occipital craniotomy tumor excision 開立醫師: 陳盈志 開立時間: 2010/02/26 20:05 Pre-operative Diagnosis Left occipital-parietal-frontal GBM Post-operative Diagnosis Left occipital-parietal-frontal GBM Operative Method Left occipital craniotomy tumor excision Specimen Count And Types 2 pieces About size:Multiple fragments Source:suspect necrotic portion of tumor About size:Multiple fragments Source:solid portion of tumor Pathology pending Operative Findings The tumor was soft fragile in character. There are necrotic portion in the deep lateral part. Solid portion was more in medial part. The tumor involve the lateral wall of occipital horn. The margin was not clear and vascularity was high. Operative Procedures Under general anesthesia with endotracheal tube intubation, the patient was set into prone position with head fixed with Mayfield. The operation field was disinfected and drapped with sterile drapping. U-shape scalp incision was done. After 5 burr hole made, craniotomy was done with saw. Dura tenting was done with silk 2-0 interruptedly. U-shape dura incision was done with SSS as base. After echo guide identification, occpital transsulci corticotomy was done and the tumor was exposed. The tumor border was dissected with bipolar circumferentially and the tumor was removed piece by piece with tumor forceps. Hemostasis was done with bipolar and surgicel packing. Duroplasty was done with fascia and 4-0 prolene. The bone plate was fixed with 4 wires after central tenting. The wound was closed in layers after one subgaleal CWV drain. Operators VS曾漢民 Assistants R6陳盈志 連正義 (M,1938/11/09,73y4m) 手術日期 2010/02/26 手術主治醫師 賴達明 手術區域 東址 001房 01號 診斷 Intracerebral hemorrhage 器械術式 Tracheostomy 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3E 紀錄醫師 曾峰毅, 時間資訊 00:39 臨時手術NPO 00:39 開始NPO 08:25 進入手術室 08:30 麻醉開始 08:39 通知急診手術 08:40 誘導結束 08:52 手術開始 09:15 手術結束 09:15 麻醉結束 09:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 氣管切開造口術 1 0 摘要__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 曾峰毅 開立時間: 2010/02/26 09:29 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Ditto Operative Method Tracheostomy Specimen Count And Types Nil Pathology Nil Operative Findings Fr. 8 tracheostomy tube was inserted. Operative Procedures Under intravenous general anaesthesia, the patient was put in supine position with neck extended. Midline skin incision was made at neck 1cm above the sternal notch. Dissection was made layer by layer to expose 2nd to 4th trachea ring, and trachestomy was made followed by tube insertion. Operators VS 賴達明 Assistants R3 曾峰毅 Indication Of Emergent Operation 毛國龍 (M,1936/09/08,75y6m) 手術日期 2010/02/26 手術主治醫師 賴達明 手術區域 東址 001房 04號 診斷 Chronic osteomyelitis 器械術式 Tracheostomy 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 3E 紀錄醫師 張得一, 時間資訊 00:45 開始NPO 00:45 臨時手術NPO 09:45 通知急診手術 15:18 進入手術室 15:18 報到 15:25 麻醉開始 15:30 誘導結束 15:37 手術開始 15:52 麻醉結束 15:52 手術結束 15:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 氣管切開造口術 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 曾峰毅 開立時間: 2010/02/26 15:50 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Ditto Operative Method Tracheostomy Specimen Count And Types Nil Pathology Nil Operative Findings Fr.8 trahceostomy tube was inserted via 2nd to 4th tracheal ring. Operative Procedures Under intravenous general anaesthesia, the patient was put in supine position with neck extended. Midline skin incision was made at neck 1cm above the sternal notch. Dissection was made layer by layer to expose 2nd to 4th trachea ring, and trachestomy was made followed by tube insertion. Operators VS 賴達明 Assistants R3 曾峰毅 R3 張得一 Indication Of Emergent Operation 許楊素珠 (F,1956/09/12,55y6m) 手術日期 2010/02/26 手術主治醫師 賴達明 手術區域 東址 002房 02號 診斷 Subarachnoid hemorrhage 器械術式 Brain tumor Crainotomy(Others) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 3E 紀錄醫師 鍾文桂, 時間資訊 10:20 通知急診手術 11:25 報到 11:25 進入手術室 11:30 手術開始 11:30 麻醉開始 11:35 誘導結束 13:00 抗生素給藥 14:40 麻醉結束 14:40 手術結束 14:55 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 顱骨切除術，包括異物移除或減壓或神經切斷 1 2 摘要__ 手術科部: 創傷醫學部 套用罐頭: 1. Craniectomy of left frontal-temporal-parie... 開立醫師: 鍾文桂 開立時間: 2010/02/26 15:24 Pre-operative Diagnosis Left MCA aneurysm, status post aneurysmal clipping, with severe brain swelling. Post-operative Diagnosis Left MCA aneurysm, status post aneurysmal clipping, with severe brain swelling. Operative Method 1. Craniectomy of left frontal-temporal-parietal regions. 2. Evacuation of subdural hemorrhage. 3. ICP monitor implantation. Specimen Count And Types nil Craniectomy bone plate in refrigirator. Pathology Nil. Operative Findings Codman ICP monitor: 1-2 mmHg intraoperatively. Fair brain pulsation after durotomy. One large cortical vein bleed actively. ceased with Surgicel packing. Operative Procedures Anesthesia: general, endotracheal. Position: supine, head tilted to right. Disinfection, draping. Extension of scalp wound posteriorly in reverse L shape. Release of temporalis muscle sutures, craniotomy bone fixation plates and screws, and dural tenting. Extension of craniotomy to parietal-temporal regions. Curvilinear durotomy, evacuation of subdural hematoma. Dural augmentation with DuraFoam. Set of ICP monitor, two CWV drains. Close wound in layers. Send the patient to ICU smoothly. Operators V.S. 賴達明. Assistants R5 胡朝凱, R4 鍾文桂. Indication Of Emergent Operation 江文耀 (M,1930/11/14,81y4m) 手術日期 2010/02/26 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Lumbar spondylosis 器械術式 Laminectomy for decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:05 進入手術室 08:20 麻醉開始 08:30 誘導結束 09:33 抗生素給藥 09:49 手術開始 12:00 手術結束 12:00 麻醉結束 12:10 送出病患 12:10 進入恢復室 13:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 手術 椎弓切除術（特壓）－二節以內 1 1 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: L4 laminectomy and right L5 hemilaminectomy f... 開立醫師: 李建勳 開立時間: 2010/02/26 11:55 Pre-operative Diagnosis L4/5 L5/S1 stenosis Post-operative Diagnosis L4/5 L5/S1 stenosis Operative Method L4 laminectomy and right L5 hemilaminectomy for decompression Specimen Count And Types nil Pathology Nil Operative Findings The L4/5 and L5/S1 were sereve stenosis with theca sac compressed by the thick ligmentum flavum. The bilateral L4 roots and right L5 root were relaxed after decompression. Operative Procedures Under generl anesthesia and intubation, the patient was put in prone position. The L4/5 spinous processes were located with portable X-ray. Midline skin incision was made followed by spinous process spliting with oscillating saw. The L4 and right L5 hemilaminectomy was performed with rongeur and Kerrison punch. The thick ligmentum flavum was removed for decompression. Hemostasis was achieved with gelform packing and one minihemovac was inserted. The spinous process was fixed back with 1-0 Vicryl suture. The wound was then closed in layers. Operators VS 賴達明 VS 蕭輔仁 Assistants R6 李建勳 R3 李振豪 相關圖片 何有義 (M,1931/10/10,80y5m) 手術日期 2010/02/26 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Spondylolisthesis 器械術式 Laminectomy for decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 11:30 報到 12:35 進入手術室 12:40 麻醉開始 12:55 誘導結束 13:05 抗生素給藥 13:20 手術開始 16:05 抗生素給藥 16:25 手術結束 16:25 麻醉結束 16:42 送出病患 16:44 進入恢復室 18:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 椎弓切除術（特壓）－二節以內 1 1 摘要__ 手術科部: 外科部 套用罐頭: L4 and partial L3,5 laminectomy for decompression 開立醫師: 李建勳 開立時間: 2010/02/26 16:16 Pre-operative Diagnosis L3/4 and 4/5 stenosis Post-operative Diagnosis L3/4 and 4/5 stenosis Operative Method L4 and partial L3,5 laminectomy for decompression Specimen Count And Types nil Pathology Nil Operative Findings The L3/4 and 4/5 level was stenosis with thick ligmentum flavum. The theca sac and L4 roots were relaxed after decompression. Operative Procedures Under generl anesthesia and intubation, the patient was put in prone position. The L3/4,4/5 spinous processes were located with portable X-ray. Midline skin incision was made followed by L3,4 spinous process spliting with oscillating saw. The L4 and partial L3, L5 hemilaminectomy was performed with rongeur and Kerrison punch. The thick ligmentum flavum was removed for decompression. Unintended durotomy was sutured with 5-0 Prolene. Hemostasis was achieved with gelform packing and one CWV was inserted. The spinous process was fixed back with 1-0 Vicryl suture. The wound was then closed in layers. Operators VS 賴達明 Assistants R6 李建勳 R3 李振豪 相關圖片 陳金玉 (F,1957/10/11,54y5m) 手術日期 2010/02/26 手術主治醫師 賴達明 手術區域 東址 003房 03號 診斷 Spondylolisthesis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 16:10 報到 17:00 進入手術室 17:10 麻醉開始 17:30 誘導結束 17:43 抗生素給藥 17:56 手術開始 20:45 手術結束 20:45 麻醉結束 21:00 送出病患 22:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 手術 椎弓切除術（特壓）－二節以內 1 2 麻醉 術後止痛 1 0 摘要__ 手術科部: 外科部 套用罐頭: L4/5 TPS with Dynesys system and L4 partial l... 開立醫師: 李建勳 開立時間: 2010/02/26 20:40 Pre-operative Diagnosis L4/5 spondylolithesis and stenosis Post-operative Diagnosis L4/5 spondylolithesis and stenosis Operative Method L4/5 TPS with Dynesys system and L4 partial laminectomy for decompression Specimen Count And Types nil Pathology Nil Operative Findings The Zimmer Dynesys screws 6.4mmX45mmX4, spacer and stablizing rod: right 21mm, left 20mm were used. The L4/5 stenosis was relaxed after decompression. Operative Procedures under general anesthesia and intubation, the patient was put in prone position. The L4 and L5 transverse processes were located with portable X-ray. Midline skin incision and dissected the fascia plan. The fascia was incised 2 fb off midline bilaterally. Inserted the TPS screws under portable C-arm X-ray. Set up Dynesys stabilizing rods and spacers. Lower L4 partial laminectomy was performed with rongeur. The thick ligmentum flavum was removed with Kerrison punch. After hemostasis, the wound was closed in layers after two minihemovac drains set at subcutaneous space and laminectomy site. Operators VS 賴達明 Assistants R6 李建勳 R3 李振豪 相關圖片 李建明 (M,1929/10/15,82y4m) 手術日期 2010/02/26 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Lumbar spondylosis 器械術式 Laminectomy for decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 2 紀錄醫師 楊博智, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:05 進入手術室 08:15 麻醉開始 08:45 誘導結束 09:10 抗生素給藥 09:34 手術開始 11:05 手術結束 11:05 麻醉結束 11:10 送出病患 11:13 進入恢復室 12:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術（特壓）－二節以內 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 摘要__ 手術科部: 外科部 套用罐頭: Left side L4/5 laminotomy for cyst removal 開立醫師: 楊博智 開立時間: 2010/02/26 11:09 Pre-operative Diagnosis L4/5 extradural cyst, suspect synovial cyst Post-operative Diagnosis Ditto Operative Method Left side L4/5 laminotomy for cyst removal Specimen Count And Types 1 piece About size:pieces Source:synovial cyst Pathology Pending Operative Findings Whitish, fragile cyst was noted at the left L4/5 junction, and it seems to be origined from facet joint. After cyst removal, the thecal sac was well expanded. Operative Procedures 1. ETGA, prone position and C-arm localized L4/5 level 2. Low back midline incision about 5cm 3. Split left side paraspinal muscle wtih subperiosteal dissection 4. Left L4/5 laminotomy was performed with high speed drill under microscope 5. Remove of ligamentum flavum, and the cyst was also removed under Kerrison punch 6. Hemostasis, close the wound in layers Operators VS. 賴達明 Assistants R5 陳睿生, R1 楊博智 相關圖片 王國榮 (M,1950/11/24,61y3m) 手術日期 2010/02/26 手術主治醫師 賴達明 手術區域 東址 019房 02號 診斷 Ependymoma 器械術式 Malignant intraspinal tumor, e 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 2 紀錄醫師 楊博智, 時間資訊 00:00 臨時手術NPO 11:03 報到 11:25 進入手術室 11:30 麻醉開始 11:50 誘導結束 12:10 抗生素給藥 12:29 手術開始 15:10 抗生素給藥 18:10 抗生素給藥 19:25 手術結束 19:25 麻醉結束 19:45 送出病患 21:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 惡性病髓腫瘤切除術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 8 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: L1, 2 laminectomy for tumor remove 開立醫師: 陳睿生 開立時間: 2010/02/26 19:32 Pre-operative Diagnosis L1-2 intramedullary tumor, suspect ependymoma Post-operative Diagnosis Ditto Operative Method L1, 2 laminectomy for tumor remove Specimen Count And Types 1 piece About size:pieces Source:tumor Pathology Pending Operative Findings The tumro was whiltish with some dark reddish and blueish portions. It was hardish and firmly attached to the conus and peripheral roots. Several small hematoma was noted and repeated intra-tumor bleeding was suspected. Yellowish thin fragments were also noted. The roots, conus, and dura were tightly compressed by the tumor and decompressed after tumor remove. Operative Procedures 1. ETGA, prone position, and C-arm localized L1, 2 level 2. Back midline incision 3. Split bilateral paraspinal muscle and expose the L1, 2 spinous process and lamina 4. Drill the L1, 2 lamina at lamina, facet junction, and then remove the lamina 5. Open the dura, and tacking 6. Split the roots and harvest the tumor inside the conus 7. Dissect the tumor from periopheral roots 8. Remove the tumor with CUSA, tumor forceps, and ring curettte 9. Hemostasis, close the dura tightly with Durafoam graft 10.Set an epidural CWV drain 11.Close the wound in layers Operators VS. 賴達明 Assistants R5 陳睿生, R1 楊博智 王淑蘭 (F,1960/04/11,51y11m) 手術日期 2010/02/26 手術主治醫師 賴達明 手術區域 東址 002房 05號 診斷 Degeneration of intervertebral disc, lumbar or lumbosacral 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 2 紀錄醫師 陳睿生, 時間資訊 00:00 臨時手術NPO 19:20 進入手術室 19:30 麻醉開始 19:35 誘導結束 20:00 抗生素給藥 20:20 手術開始 23:00 抗生素給藥 23:10 手術結束 23:10 麻醉結束 23:20 送出病患 23:25 進入恢復室 00:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術－腰椎 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 摘要__ 手術科部: 外科部 套用罐頭: Microdiskectomy 開立醫師: 陳睿生 開立時間: 2010/02/26 23:19 Pre-operative Diagnosis Left side L4/5 ruptured disk Post-operative Diagnosis Ditto Operative Method Microdiskectomy Specimen Count And Types nil Pathology Nil Operative Findings The L4/5 intervertebral disk was noted to be ruptured from left side intervertebral space. It protruded posterioinferiorly and compressed the L5 root tightly. The root and thecal sac was well decompressed after the procedure. Operative Procedures 1. ETGA, prone position, and C-arm localized L4/5 level 2. Low back midline incision 3. Split left side paraspinal muscle and expose L4/5 interlaminal space 4. L4/5 left side laminotomy with high-speed drill and Kerrison 5. Remove of ligamentum flavum, and split thecal sac medially to identify the ruptured disk 6. Incise into PLL and remove the ruptured disk with aligator 7. Remove residual disk with curette and disk clump 8. Hemostasis, close the wound in layers Operators VS 賴達明 Assistants R5 陳睿生, R4 鍾文桂 吳惠澄 (M,1931/09/08,80y6m) 手術日期 2010/02/26 手術主治醫師 張金池 手術區域 東址 002房 003號 診斷 Intracerebral hemorrhage 器械術式 Tracheostomy 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 梁嘉儀, 時間資訊 15:20 報到 15:20 進入手術室 15:25 麻醉開始 15:30 誘導結束 15:45 手術開始 15:50 麻醉結束 15:50 手術結束 16:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 氣管切開造口術 1 0 摘要__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 陳柏達 開立時間: 2010/02/26 16:01 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types nil Pathology None Operative Findings Fr.8 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators VS 張金池 Assistants R5 梁嘉儀 Ri 鍾政樺 Indication Of Emergent Operation 王梓仲 (M,2000/07/20,11y7m) 手術日期 2010/02/26 手術主治醫師 楊士弘 手術區域 兒醫 067房 02號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(Others) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 蕭柏妮 ASA 3 紀錄醫師 陳德福, 時間資訊 00:30 開始NPO 00:30 臨時手術NPO 07:31 通知急診手術 11:50 進入手術室 11:50 報到 12:00 麻醉開始 12:30 誘導結束 13:35 手術開始 16:40 開始輸血 17:00 抗生素給藥 20:50 麻醉結束 20:50 手術結束 21:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 10 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 麻醉 Lactic Acid (lactate) 2 0 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 腦瘤切除－手術時間在４～８小時 1 1 摘要__ 手術科部: 外科部 套用罐頭: tumor excision 開立醫師: 陳德福 開立時間: 2010/02/26 21:14 Pre-operative Diagnosis posterior fossa hemangioblastoma with brain stem compression Post-operative Diagnosis ditto Operative Method tumor excision Specimen Count And Types 1 piece About size:2*1*1CM Source:posterior fossa tumor Pathology pedning Operative Findings 1.There is a 3.5*3*3cm in sized cystic tumor with a 2*1*1cm solid part at the lower part of the 4th ventricle. The obex was distended and the brain stem was compressed tightly. The solid part tumor was reddish, sponge-like, easy bleeding and filled up with arterial feeders and venous drainages. 2.There are 2 major arterial feeders from the branches of PICA and 2 venous draiange to the medullary vein. The feeders and drainages were coagulized circumferentially. 3.The solid tumor was totally removed [some tufts was found on the floor of the 4th ventricle] and we left part of the cyst in situ. 4.The PICA and its branches were preserved well. 5.The Tissuco Duo was dressed on the epidural space. Operative Procedures Under ETGA and prone positin with Mayfield pediatric pin type head fixator, the scalp was disinfected and draped as usual. One midline incision to expose 2cm above the inion to the C1 was done. The suboccipital craniotomy was performed and the dura was opened in Y shape. The bilateral cerebellar tonsils were retracted superiorly with self retractor and the tumor came into view. The arachnoid membrane was opened and we coagulize the arterial feeders and venous drainage circumfrentially. The cystic part of the tumor was exposed and the clear fluid gushed out after we open the cyst. After the tumor was totally removed, the floor of 4th ventricle, dorsum medulla and the central canal of the high cervial spinal cord were well visulized. Some small tufts of suspected anormaly on the floor of 4th ventricle were removed. After hemostasis, the dura was closed in water tight fasion with autologous periosteum fascia. Tissuco Duo was dressed on the epidural space. The skull was fixed with miniplates and one CWV was left in situ. The wound was closed in layers. Operators VS 楊士弘 Assistants R4 陳德福 Indication Of Emergent Operation 相關圖片 鄭魏玉 (F,1952/04/15,59y10m) 手術日期 2010/02/26 手術主治醫師 王國川 手術區域 東址 023房 04號 診斷 Herniation of intervertebral disc without myelopathy, lumbar (HIVD) 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 2 紀錄醫師 胡朝凱, 時間資訊 00:00 臨時手術NPO 15:10 報到 15:30 進入手術室 15:35 麻醉開始 15:55 誘導結束 16:30 抗生素給藥 16:39 手術開始 17:20 開始輸血 19:30 抗生素給藥 21:30 麻醉結束 21:30 手術結束 21:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 手術 椎間盤切除術－腰椎 1 2 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 摘要__ 手術科部: 外科部 套用罐頭: L2~4 TPS and L2~3,3~4 diskectomy and cage ins... 開立醫師: 胡朝凱 開立時間: 2010/02/26 21:51 Pre-operative Diagnosis L2~3, 3~4 spondylolisthesis with HIVD and spinal stenosis Post-operative Diagnosis L2~3, 3~4 spondylolisthesis with HIVD and spinal stenosis Operative Method L2~4 TPS and L2~3,3~4 diskectomy and cage insertion Specimen Count And Types Nil Pathology Nil Operative Findings 1.Movable L3 on L4 2.Severe adhesion of L3~5 3.The herniated disc compressed the thecal sac tightly, but after decompression, it expanded well 4.Fibrotic tissue that made the lateral recess stenosis Operative Procedures 1.ETGA, prone 2.Midline incision at L2~5 level 3.Detach paravertebral muscle 4.Laminectomy of L2~4 5.Screw insertion 6.diskectomy 7.cage insertion 8.Rod and cross link fixation 9.hemovac drain insertion then close wound in layers Operators 王國川 Assistants 胡朝凱,鍾文桂 王玟淇 (F,2005/11/25,6y3m) 手術日期 2010/02/27 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Aromatic L-amino acid decarboxylase deficiency 器械術式 Stereotaxic procedure for impl 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林至芃 ASA 3 紀錄醫師 李建勳, 時間資訊 00:00 臨時手術NPO 07:48 報到 08:10 進入手術室 08:30 麻醉開始 09:10 誘導結束 09:59 抗生素給藥 10:00 手術開始 12:59 抗生素給藥 13:45 開始輸血 15:59 抗生素給藥 18:00 麻醉結束 18:00 手術結束 18:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 立體定位術－功能性失調 1 1 B 手術 立體定位術－功能性失調 1 2 B 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 11 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Stereotatic injection of AV vector at bilater... 開立醫師: 李建勳 開立時間: 2010/02/27 18:56 Pre-operative Diagnosis Aromatic L-amino acid decarboxylase deficiency Post-operative Diagnosis Aromatic L-amino acid decarboxylase deficiency Operative Method Stereotatic injection of AV vector at bilateral putamen Specimen Count And Types nil Pathology Nil Operative Findings 80 microliter of adeno-associated virus loaded with AADC gene (AV vector) was injected at two different sites (middle and lateral) of putamen (total:320microliter).Immediate follow up head CT showed no ICH. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position. The scalp was shaved, scrubbed, disinfected with alcohol B-I then draped. Two burr holes were made with perforator followed by tenting with 3-0 silk sutures. Set up the navigator with registeration of pre-fixed skull screws. Fixed the DBS tower at the burr hole and inserted the catheter as planned. Injected the adeno-associated virus loaded with AADC gene (AV vector) was injected at two different sites (middle and lateral lower third) of putamen (total:320microliter). Sealed the burr hole with gelform packing and Tissucol Duo. Closed the wound in layers after hemostasis. Operators VS 曾勝弘 Assistants R6 李建勳 R6 陳盈志 相關圖片 陳影泉 (M,1937/10/21,74y4m) 手術日期 2010/02/27 手術主治醫師 楊士弘 手術區域 東址 003房 01號 診斷 Canal stenosis 器械術式 Laminectomy for decompression 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林至芃 ASA 3 紀錄醫師 李建勳, 時間資訊 00:00 臨時手術NPO 07:37 報到 07:50 進入手術室 08:00 麻醉開始 08:20 誘導結束 08:45 抗生素給藥 09:06 手術開始 12:05 手術結束 12:05 麻醉結束 12:15 抗生素給藥 12:17 送出病患 12:18 進入恢復室 15:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術－腰椎 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Microsurgical diskectomy and decompression of... 開立醫師: 楊士弘 開立時間: 2010/02/27 12:00 Pre-operative Diagnosis L4-5 vertebral lateral recess stenosis; L4-5 herniated intervertebral disc Post-operative Diagnosis L4-5 vertebral lateral recess stenosis; L4-5 herniated intervertebral disc Operative Method Microsurgical diskectomy and decompression of lateral recess, right L4-5 Specimen Count And Types nil Pathology Nil Operative Findings 1. Wound scar over previous laminotomoy site at right L4-5. 2. Partial regrowth of previously resected right L4-5 facet. 3. Bulging of right L4-5 intervertebral disc. Operative Procedures 1. ETGA, prone. 2. Low back midline incision through previous op. scar. 3. Dissection of wound scar from right L4-5 lamina and facet. 4. Resection of inferior right L4 articular process and medial upper right L5 articular process with currets, kerrison punches. 5. Microsurgical diskectomy with knife, currets, and disk forceps. 6. Irrigation of wound with Rinderon solution. 7. One CWV drain in the epilaminal space. 8. Wound closure in layers. Operators 楊士弘 Assistants 李建勳 相關圖片 王耀良 (M,1974/10/22,37y4m) 手術日期 2010/02/27 手術主治醫師 王國川 手術區域 東址 003房 1號 診斷 Herniation of intervertebral disc without myelopathy, lumbar (HIVD) 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林至芃 ASA 2 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 09:22 報到 09:32 進入手術室 09:45 麻醉開始 09:53 誘導結束 10:30 抗生素給藥 10:38 手術開始 13:10 手術結束 13:10 麻醉結束 13:18 送出病患 13:25 進入恢復室 14:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 手術 椎間盤切除術－腰椎 1 1 B 手術 椎弓切除術（特壓）－二節以內 1 2 B 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 B 摘要__ 手術科部: 外科部 套用罐頭: L5 laminectomy and L5/S1 microdiskectomy. 開立醫師: 鍾文桂 開立時間: 2010/02/27 13:53 Pre-operative Diagnosis Herniated intervertebral disc, L5/S1 level. Post-operative Diagnosis Herniated intervertebral disc, L5/S1 level. Operative Method L5 laminectomy and L5/S1 microdiskectomy. Specimen Count And Types nil Pathology Nil. Operative Findings A big ruptured disc at L5/S1 level compressed the thecal sac and bilateral S1 root severely, more on right S1 root. Decompressive laminectomy was done due to difficult exposure of the disc space. Narrow L5/S1 disc space. Slack bilateral S1 root after diskectomy. Operative Procedures Anesthesia: general, endotracheal. Position: prone. Intraoperative fluoroscopy for checking L5/S1 disc level. 3-cm incision at the marked area after disinfection and draping. Midline dissection. Left side approach first. Laminotomy of L5 level. Difficulty in approaching disc level. Right side dissection. Removal of L5 spinous process, and decompressive L5 laminectomy by Rongeur, Kerrison punch. Removal of ligamentum flavum. Removal of ruptured disc at right axilla. Removal of ruptured disc. Well hemostasis. Wound closure in layers. Send the patient to POR smoothly. Operators V.S. 王國川. Assistants R 4 鍾文桂. 張芳瑜 (F,1988/06/01,23y9m) 手術日期 2010/03/01 手術主治醫師 廖漢文 手術區域 東址 000房 號 診斷 Intracerebral hemorrhage 器械術式 NEURO T.A.E 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 王永彬 ASA 1 時間資訊 00:00 臨時手術NPO 13:55 麻醉開始 14:10 誘導結束 17:05 麻醉結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 呂玉珍 (F,1971/04/21,40y10m) 手術日期 2010/03/01 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Glioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 陳建銘, 時間資訊 07:38 報到 07:55 進入手術室 08:00 麻醉開始 08:25 誘導結束 08:55 抗生素給藥 09:35 手術開始 11:55 抗生素給藥 15:05 麻醉結束 15:05 手術結束 15:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４～８小時 1 1 R 手術 顱內壓監視置入 1 2 R 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 摘要__ 手術科部: 外科部 套用罐頭: 1.Craniotomy and brain tumor excision 開立醫師: 陳建銘 開立時間: 2010/03/01 12:46 Pre-operative Diagnosis Right thalamus tumor Post-operative Diagnosis Right thalamus tumor,glioma gradeII Operative Method 1.Craniotomy and brain tumor excision Right frontal craniotomy for tumor excision and right Kocher point EVD insertion 2. Specimen Count And Types 2 pieces About size: Source: About size: Source: Pathology Frozen section: gradeII glioma. Pathology: pending Operative Findings 1.Frozen:glioma,gradeII The CSF opening pressure was 10cmH2O with clear CSF drained out. The right thalamic tumor was elastic, yellow-greyish, located anterior to the choroid plexus with many blood supplies from posterior side. The anterior part of the tumor was more greyish and reddish. The inner ventricle wall was intact. Operative Procedures Under general anestheis and intubation, the patient was put in supine posiion with head fixed with Mayfield skull clump. The scalp was shaved, scrubbed, disinfected with alcohol B-I then draped. The curvilinear scalp incision was made at right frontal area followed by craniotomy. The tumor was located with intraoperative sonography. The ventricle was punctured with puncture needle then shifted to nelaton tube. Corticotomy was made with bipolar coagulation of the pia mater then incision medial to the frontal drainage vein. The tumor excision was performed with bipolar coagulation and tumor forceps. The feeding vessels were coagulated with bipolar coagulation. Hemostasis was achieved with surgicel linging of the tumor bed and Tissucol Duo on surgicel for easily oozing site. The dura was closed and the skull plate was fixed back with miniplates and screws. The wound was closed in layers after one epidural CWV set up. Operators VS曾漢民 Assistants R6李建勳,R1陳建銘 相關圖片 莊秀珍 (F,1955/10/30,56y4m) 手術日期 2010/03/01 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 2 紀錄醫師 陳建銘, 時間資訊 14:40 報到 15:40 進入手術室 15:45 麻醉開始 16:10 誘導結束 16:15 抗生素給藥 16:40 手術開始 19:15 抗生素給藥 20:15 麻醉結束 20:15 手術結束 20:25 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除－手術時間在４～８小時 1 1 摘要__ 手術科部: 外科部 套用罐頭: Right frontal craniotomy for subfrontal appro... 開立醫師: 李建勳 開立時間: 2010/03/01 20:44 Pre-operative Diagnosis Tuberculum sellar meningioma Post-operative Diagnosis Tuberculum sellar meningioma Operative Method Right frontal craniotomy for subfrontal approach Simpson grade II tumor excision Specimen Count And Types 1 piece About size:1G Source:Craniotomy for tumor exicsion Pathology Pending Operative Findings The tumor was soft, size 2X1cm, located at tuberculum sella with sand-like microcalcification. The olfactory nerve was found transected during the procedure. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position with head fixed with Mayfield skull clump. The scalp was shaved, scrubbed, disinfected with alcohol B-I then draped. The bicoronal scalp incision was made followed by right frontal craniotomy. The frontal base was smoothened by high speed air drill. The dura was opened after tenting along the craniotomy window. Retracted the right frontal lobe to expose the olfactory nerve and optic nerve. The tumor was found and dissected from surrounding parenchyma with microdissector under microscope assitance. The tumor excision was performed with tumor forceps and suction. The dural base was bipolar coagulated. Hemostasis was achieved with surgicel lining of the tumor bed. The skull plate was fixed back with miniplates and screws after one epidural CWV drain set up and central tenting. The wound was then closed in layers. Operators VS 曾漢民 Assistants R6 李建勳 R1 陳建銘 相關圖片 駱罔腰 (F,1933/06/07,78y9m) 手術日期 2010/03/02 手術主治醫師 賴達明 手術區域 東址 003房 03號 診斷 Subarachnoid hemorrhage 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 4E 紀錄醫師 王奐之, 時間資訊 22:10 通知急診手術 23:06 進入手術室 23:06 報到 23:10 麻醉開始 23:40 誘導結束 00:03 手術開始 00:45 手術結束 00:45 麻醉結束 00:55 送出病患 23:50 抗生素給藥 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 腦室體外引流 1 1 摘要__ 手術科部: 外科部 套用罐頭: Ommaya reservoir implantation 開立醫師: 王奐之 開立時間: 2010/03/02 01:18 Pre-operative Diagnosis Acute SAH with hydrocephalus Post-operative Diagnosis Ditto Operative Method Right Kocher point EVD insertion. Specimen Count And Types nil Pathology Nil Operative Findings Reddish CSF drained out after ventricular puncture. CSF open pressure 5-8cmH2O. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position. The scalp was shaved, scrubbed, antiseptic with alcohol B-I then draped. A linear skin incision was made at right frontal region followed by right Kocher point burr hole creation. The dura was incised after tenting with 3-0 silk. A ventricular puncture needle was used to puncture then shifted to the EVD catheter. EVD was then set through a subcutaneous tunnel. After checking EVD function, the wound was closed in layers. Operators VS賴達明 Assistants R5陳睿生,R2王奐之 Indication Of Emergent Operation 張書豪 (M,1987/07/17,24y7m) 手術日期 2010/03/01 手術主治醫師 陳敞牧 手術區域 東址 001房 05號 診斷 Subarachnoid hemorrhage (SAH) 器械術式 Tracheostomy 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 4E 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 11:00 通知急診手術 13:20 進入手術室 14:25 麻醉開始 14:30 誘導結束 15:10 手術開始 16:45 手術結束 16:45 麻醉結束 16:55 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 腦室體外引流 1 1 L 手術 氣管切開造口術 1 0 L 摘要__ 手術科部: 外科部 套用罐頭: 1. EVD revision via left Kocher point. 2. Tra... 開立醫師: 鍾文桂 開立時間: 2010/03/01 17:18 Pre-operative Diagnosis 1. Hydrocephalus, 2. Respiratory failure. Post-operative Diagnosis 1. Hydrocephalus, 2. Respiratory failure. Operative Method 1. EVD revision via left Kocher point. 2. Tracheostomy. Specimen Count And Types nil Pathology Nil. Operative Findings EVD revision via left Kocher point, CSF: serosanginous, clear. Set 6 cm. Tracheostomy: 8.0 Fr. Operative Procedures Anesthesia: endotracheal, general. Position: supine, head in midline. Removal of the previous right Kocher EVD and collect tip culture. Shaving, disinfection, and draping. Curvilinear scalp incision at left Kocher. Burr hole by high speed drill. Dural tenting& durotomy. Ventriculosotomy via ventricular puncture needle via left Kocher point to left frontal horn of lateral ventricle. Insertion of EVD at the same point, EVD fixation. Wound closure in layers. Tracheosomy: midline supine position, neck: hyper-extended. Midline incision, 2 cm. Midline dissection to 2nd/3rd tracheal ring. Incision of 2nd& 3rd tracheal ring. Insertion of 8.0 Fr tracheotomy tube, and removal of endotracheal tube. Check ventilation status. Wound closure primarily. Send the patient to ICU smoothly. Operators V.S. 陳敞牧. Assistants R5 胡朝凱,R4 鍾文桂. Indication Of Emergent Operation 陳億如 (F,1976/07/07,35y8m) 手術日期 2010/03/01 手術主治醫師 陳敞牧 手術區域 東址 003房 02號 診斷 Oligodendroglioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 曾峰毅, 時間資訊 00:00 臨時手術NPO 14:45 報到 15:23 進入手術室 15:25 麻醉開始 15:45 誘導結束 16:00 手術開始 16:45 抗生素給藥 19:45 抗生素給藥 20:15 麻醉結束 20:15 手術結束 20:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除－手術時間在４～８小時 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT 開立醫師: 曾峰毅 開立時間: 2010/03/01 20:31 Pre-operative Diagnosis Left frontal tumor Post-operative Diagnosis Left frontal tumor, suspected low-grade glioma Operative Method Left frontal craniotomy for tumor excision Specimen Count And Types Several fragments of one tumor was sent for pathology. Pathology Nil Operative Findings 3.5x3x3.2cm soft to elastic tumor, greyith, well defined, grows along the gyrus. Operative Procedures With endotracheal general anaesthesia, the tient was put in supine position with head rotated to right and fixed with Mayfield head clamp. Under navigation, we delineated the incision on the sclap. After scalp shaved, scrubbed, and disinfection, we made one inverted U-shaped skin incision at left frontal, and drilled four burr holes to created one 6x5cm craniotomy window. Dura tenting was done along the craniotomy window. U-shape dura incision was done, and tumor excision was done along the gyrus and with the navigation guided. Duroplasty was done in water tight fashion with Durofoam and autologous fascia graft. Bone graft was fixed back with mini-plates, and one subgaleal CWV was placed. The wound was closed in layers. Operators VS 陳敞牧 Assistants R6 陳盈志 R3 曾峰毅 朱璽恩 (F,2010/02/19,2y0m) 手術日期 2010/03/01 手術主治醫師 張重義 手術區域 兒醫 067房 01號 診斷 Interruption of aortic arch 器械術式 C.O.A. (Aortaplasty) 手術類別 緊急手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 4E 紀錄醫師 林哲安, 時間資訊 18:22 通知急診手術 00:21 開始NPO 00:21 臨時手術NPO 12:27 進入手術室 12:27 報到 12:30 麻醉開始 13:20 誘導結束 13:30 抗生素給藥 13:50 手術開始 16:50 抗生素給藥 18:30 開始輸血 20:10 抗生素給藥 23:10 抗生素給藥 03:10 抗生素給藥 03:20 麻醉結束 03:20 手術結束 03:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 22 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 4 0 麻醉 動脈血液檢查全套 4 0 麻醉 Hemoglobin (Hb) 4 0 麻醉 測血糖 4 0 麻醉 Ca (Calcium) 4 0 麻醉 Na (Sodium) 4 0 麻醉 K (Potassium) 4 0 麻醉 Cl (Chloride) 4 0 麻醉 Blood gas analysis 4 0 手術 主動脈－肺動脈開窗之修補手術 1 2 手術 室中隔缺損（ＶＳＤ）修補手術 1 1 手術 體外心肺循環 1 1 手術 Ａ．Ｓ．Ｄ　修補 1 4 記錄__ 手術科部: 套用罐頭: 1. Aortoplasty, ASD direct closure, VSD patch... 開立醫師: 蔡孝恩 開立時間: 2010/05/30 16:53 Pre-operative Diagnosis IAA, Type A, ASD, VSD, PDA Post-operative Diagnosis IAA, Type A, ASD, VSD, PDA Operative Method 1. Aortoplasty, ASD direct closure, VSD patch repair and PDA division 2. AsAo to arch patch augmentation 3. ECMO support Specimen Count And Types nil Pathology Operative Findings 1. Situs solitus, levocardia 2. IAA Type A with interruption AsAo: diameter:4mm, MPA:10mm, PDA:5MM VSD: conoventricular type with posterior malalignment, diameter:4mm ASD: secundum type, 3mm 3. Due to relative small AsAo and pressure gradient about 30mmHg between right upper and lower limbs, aortoplasty was performed with pericardial patch Operative Procedures 1. Supine, ETGA, skin incision 2. Midline sternotomy 3. Loop AsAo, innominate artery, RCCA, RSCA, LPA, RPA and PDA 4. Cannulate via AsAo/MPA(to DsAo)/RAA 5. Initiation of partial CPB and hypothermia to 18 Celsius 6. Snare RPA and LPA, Aortic cross clamp, antegrade cardioplegia, total CPB 7. Transverse RV ventriculotomy and repair VSD with Dacron patch and 7-o pledgetted sutures 8. Ligate and transect PDA, mobilize DsAo, 9. Circulatory arrest and selective antegrade cerebral perfusion at 80ml/min 10.Snare innominate a. RCCA and LSCA 11.Opne AsAo with one longitudinal incision and extend into LSCA 12.Performed end-to-side anastomosis 13.Deair, rewarm, direct closure of ASD 14.Closed RA, RV and weaned off CPB 15.Set four chest tubes, peritoneal dialysis tube and epicardial pacemaker wires Remarks: Due to elevated lactic acid and pressure gradient post anastomosis, we re-start CPB and hypothermia to 18 Celsius( A-cannulae via innominate artery) Aortic cross clamp, antegrade cardioplegia, circulatory arrest Aortoplasty with autologus glutaraldehyde-treated pericardial patch Rewarm, deair, hemostasis Under ECMO suppot and sternum unapproximated. Operators VS張重義 Assistants R4徐綱宏 R3林哲安 Indication Of Emergent Operation 蔣麗珠 (F,1949/04/22,62y10m) 手術日期 2010/03/01 手術主治醫師 蕭輔仁 手術區域 東址 002房 04號 診斷 Compression fracture 器械術式 Laminectomy for decompression 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3E 紀錄醫師 張皓鈞, 時間資訊 13:50 通知急診手術 15:10 報到 15:30 進入手術室 15:35 麻醉開始 16:00 誘導結束 16:04 抗生素給藥 17:05 手術開始 19:04 抗生素給藥 20:45 手術結束 20:45 麻醉結束 20:55 送出病患 21:00 進入恢復室 22:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 脊椎融合術－前融合，有固定物（＜＝四節） 1 1 L 手術 椎間盤切除術－腰椎 1 2 摘要__ 手術科部: 外科部 套用罐頭: L2 corpectomy and posteriolateral fusion and ... 開立醫師: 陳睿生 開立時間: 2010/03/01 21:17 Pre-operative Diagnosis L2 compression fracture with roots compression Post-operative Diagnosis L2 compression fracture with roots compression Operative Method L2 corpectomy and posteriolateral fusion and fixation with artificial grafts Specimen Count And Types nil Pathology Nil Operative Findings The L2 body was tightly compressed and severe osteoporosis was noted. After removing of the L2 body and L1/2, 2/3 disks, the thecal sac was well expanded. United 40x19mm body cage with autologus bone graft was used for fusion. United 5cm Z plate with 40mm screws x4 at L1, L3 were set. Operative Procedures 1. ETGA, right side decubitus position, and C-arm localized L2 level 2. Left RUQ curvillinear incision about 12cm 3. Incise into external and internal abdominalis and oblique muscles 4. Extend the retroperitoneal space to identify the psoas muscle and anterior aspect of the spine 5. Split the psoas muscle posteriorly and identify L2 body under C-arm 6. Perform L2 corpectomy and L1/2, 2/3 diskectomy with curette, Kerrison, and rounger 7. Insert the 40mm body cage 8. Set the Z plate with 40mm screws x2 at L1, 3 level separately 9. Hemostasis, set a CWV drain 10.Close the wound in layers Operators VS 蕭輔仁 Assistants R5 陳睿生, R1 張浩鈞 Indication Of Emergent Operation 陳錫徵 (M,1954/06/05,57y9m) 手術日期 2010/03/01 手術主治醫師 王國川 手術區域 東址 001房 6號 診斷 CVA 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 4E 紀錄醫師 李振豪, 時間資訊 10:00 開始NPO 17:44 通知急診手術 18:35 進入手術室 18:45 麻醉開始 19:10 誘導結束 19:35 手術開始 23:20 手術結束 23:20 麻醉結束 23:25 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 顱骨切除術，包括異物移除或減壓或神經切斷 1 1 手術 顱內壓監視置入 1 2 摘要__ 手術科部: 外科部 套用罐頭: Right fronto-temporo-parietal craniectomy, du... 開立醫師: 李振豪 開立時間: 2010/03/01 23:40 Pre-operative Diagnosis Right MCA infarction with brainstem compression Post-operative Diagnosis Right MCA infarction with brainstem compression Operative Method Right fronto-temporo-parietal craniectomy, duroplasty, and ICP monitor insertion Specimen Count And Types Nil Pathology Nil Operative Findings The brain surface became whitish without pulsation at right MCA territory. The brain became swelling gradually during the operation. The ICP after wound closure is 7mmHg. The reference of ICP monitor: 503. Operative Procedures Under endotracheal tube general anesthesia, the patient was put at supine position with head turned to left. The scalp was shaved, scrubbed, and disinfected as usual. Traumatic flap scalp incision was made at right fronto-temporo-parietal area and the scalp flap was elevated. Facial nerve preservation was performed. The periosteum and the temporalis muscle was elevated and the periosteum and part of the fascia of temporalis muscle was harvested for autologus duroplasty. Four burr holes were created followed by one 16x12cm craniectomy window. After dural tenting, the dura was opened. Partial temporal lobectomy was performed for decompression and autologus duroplasty was done. After hemostasis, the ICP monitor was placed at subdural space. One epidural CWV was set and the wound was closed in layers. Operators VS王國川 Assistants R5胡朝凱, R3李振豪 Indication Of Emergent Operation 相關圖片 陳可麗 (F,1953/10/20,58y4m) 手術日期 2010/03/01 手術主治醫師 蔡翊新 手術區域 東址 003房 01號 診斷 Brain tumors, malignant 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 曾峰毅, 時間資訊 07:30 報到 08:05 進入手術室 08:15 麻醉開始 08:30 誘導結束 09:00 抗生素給藥 09:10 手術開始 12:00 抗生素給藥 13:30 開始輸血 15:05 麻醉結束 15:05 手術結束 15:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４～８小時 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Left frontotemporal craniotomy for tumor excision 開立醫師: 曾峰毅 開立時間: 2010/03/01 15:20 Pre-operative Diagnosis Left frontal tumor, suspected glioma Post-operative Diagnosis Left frontal glioma, high grade Operative Method Left frontotemporal craniotomy for tumor excision Specimen Count And Types Several fragments of one tumor was sent for final pathology. Pathology Frozen: high grade glioma Operative Findings One greyish, hypervascular, soft to fragile, ill-defined tumor was noted at left frontotemporal lobe with Broca area involved. Broca area was spared during tumor resection. Operative Procedures With endotracheal general anesthesia, the patient was put in supine position with head rotated to right and fixed with Myafield head clamp. After scalp shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then the sclap was covered with sterilized adhesive plastic sheet. One curvilinear skin incision was made at left. Craniotomy window 8x10cm was created by 5 burr holes drilled. Dura was tented along the craniotomy window. Dural was incised in curvilinear fashion along the edge of skull window. Tumor exicision was done with partial frontal lobectomy. Tumor cavity was paved with Surgicels. Dura was closed in water-tight fashion with 3-0 prolene. After one epidura CWV set, we fixed the bone graft back with mini-plates. The wound was closed in layers. Operators VS 蔡翊新 Assistants R3 陳盈志 R3 曾峰毅 黃桂淼 (F,1954/05/15,57y9m) 手術日期 2010/03/01 手術主治醫師 林至芃 手術區域 西址 035房 3號 診斷 Lung cancer 器械術式 Insertion of hichman or port a 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 林至芃 ASA 3 時間資訊 11:00 報到 11:30 進入手術室 11:35 麻醉開始 11:40 誘導結束 11:45 抗生素給藥 11:50 手術開始 12:05 麻醉結束 12:05 手術結束 12:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 ｐｏｒｔ–Ａ導管植入術–治療性導管植入術 1 0 蕭輔然 (M,1949/08/25,62y6m) 手術日期 2010/03/02 手術主治醫師 蔡瑞章 手術區域 東址 001房 02號 診斷 Herniated Intervertebral Disc ( HIVD ) 器械術式 Diskectomy lumbar 手術類別 臨時手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 李建勳, 時間資訊 00:00 臨時手術NPO 10:15 報到 10:50 進入手術室 11:00 麻醉開始 11:15 誘導結束 12:02 抗生素給藥 12:03 手術開始 14:06 手術結束 14:06 麻醉結束 14:10 送出病患 14:18 進入恢復室 15:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 手術 椎間盤切除術－腰椎 1 1 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: L4/5 hemilaminectomy for microscopic disckectomy 開立醫師: 李建勳 開立時間: 2010/03/02 14:15 Pre-operative Diagnosis L4/5 HIVD Post-operative Diagnosis L4/5 HIVD Operative Method L4/5 hemilaminectomy for microscopic disckectomy Specimen Count And Types Nil Pathology Nil Operative Findings The left side L4/5 root was compressed tightly by the herniated disc. After the procedure, the root and theca sac were relaxed. Operative Procedures Under general anesthesia and intubation, the patient was put in prone position. The L4/5 space was located with portable C-arm X-ray. The skin was scrubbed, disinfected with alcohol B-I then draped. Midline skin incision was made from L4-L5 spinous processess. The paraspinal muscles were seperated and retracted with Taylor retractor. Under surgical microscope assistance, the left hemilaminectomy was performed with curette and Kerrison punch. The ligmentum flavum was removed by Kerrison punch to expose the dura. The protruded disc was removed and the PLL was incised with No. 15 surgical blade and the disc was further removed after curetage by disc clumps. After hemostasis, the wound was closed in layers. Operators P 蔡瑞章 Assistants R6 李建勳 Ri 相關圖片 張耀騰 (M,1946/01/15,66y1m) 手術日期 2010/03/02 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Spinal stenosis, lumbar 器械術式 Benign intraspinal tumor, exci 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 李振豪, 時間資訊 07:30 報到 08:00 進入手術室 08:10 麻醉開始 08:20 誘導結束 08:29 抗生素給藥 08:50 手術開始 11:29 抗生素給藥 12:25 手術結束 12:25 麻醉結束 12:35 送出病患 12:36 進入恢復室 13:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 手術 良性病髓腫瘤切除術 1 1 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Partial tumor excision 開立醫師: 胡朝凱 開立時間: 2010/03/02 12:32 Pre-operative Diagnosis L4 intradural tumor L4 intradural tumor, suspect benign tumor Post-operative Diagnosis L4 intradural tumor L4 intradural tumor, suspect stitch granulation Operative Method Partial tumor excision Specimen Count And Types 1 small pieces Pathology Tumor Forzen section: stitch granulation Operative Findings 1.Severe adhesion of wound was noted 2.The hypertrophic scar tissue compressed the thecal sac. 3.During the dural opening, One grayish, hard tumor that adhesion to the dura and encase the cauda eqina was noted. And it was not easy to be resected. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in prone position. The skin was scrubbed, disinfected, and drap as usual. Midline skin incision at L2~L5 level along previous op scar was made. The soft tissue and scar tissue was dissected in order to expose the dura. One small incidental durotomy was noted during the dissection. After the thecal sac was well exposed, the dura was opened with 2cm in length. Adhesionalysis of dura and the tumor was tried but failed due to encasement of the cauda equina. Intra-operative frozen section was sent and the result showed stitch granulation. Decompression and neurolysis was tried. After hemostasis, the dura was closed with 4-0 Prolene. One epidural CWV drain was placed and the wound was closed in layers. Operators VS 曾勝弘 Assistants R5 胡朝凱, R3 李振豪 林玉華 (F,1937/12/20,74y2m) 手術日期 2010/03/02 手術主治醫師 曾勝弘 手術區域 東址 005房 02號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 12:25 報到 12:43 進入手術室 12:55 麻醉開始 13:20 誘導結束 13:40 抗生素給藥 13:58 手術開始 16:53 抗生素給藥 17:10 麻醉結束 17:10 手術結束 17:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除－手術時間在４小時以內 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Simpson I tumor excision 開立醫師: 胡朝凱 開立時間: 2010/03/02 17:03 Pre-operative Diagnosis Left frontal convexity meningioma Post-operative Diagnosis Left frontal convexity meningioma Operative Method Simpson I tumor excision Specimen Count And Types tumor Multiple pieces of brain tumor and dura with about 15g in weight Pathology Tumor Pending Operative Findings 1.Hyperosteosis was noted at inner table of bone 2.One grayish to yellowish, elastic tumor was noted which measured about 4.7x4.5 cm at left fontal convexity area with dura tail. 3.The tumor margin was clear with feeding vessels from base. 4.The dura defect was closed with periosteum. Operative Procedures Under ETGA, patient was put in supine position with head rotate to right and fixed with Mayfield skull clamp. U shape skin incision was done at left frontal to parietal area. Skin flap was dissected and opened. After four burr holes drilled, craniotomy was performed as a 7x7 bone window one cm away from midline, followed by dural tenting. U shape dural incision was made with the base left at midline. The tumor was excised by gently dissection through the interface between tumor and brain tissue. Vascular perforation was cauterized. Hemostasis was then performed. After then, dura was closed with one piece of periosteum and prolene. Bone graft was fixed back with wire. After one CWV drain insertion, wound was closed in layers. Operators 曾勝弘 Assistants 胡朝凱, 李振豪 黃奕堯 (M,1980/05/02,31y10m) 手術日期 2010/03/02 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Acoustic neuroma 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 張皓鈞, 時間資訊 07:30 報到 08:07 進入手術室 08:10 麻醉開始 08:35 誘導結束 09:20 抗生素給藥 09:39 手術開始 12:20 抗生素給藥 15:20 抗生素給藥 17:55 麻醉結束 17:55 手術結束 18:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 12 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Retrosigmoid approach for tumor excision 開立醫師: 張皓鈞 開立時間: 2010/03/02 18:38 Pre-operative Diagnosis Right side C-P angle tumor, suspect acoutic neuroma Post-operative Diagnosis Right side C-P angle tumor, suspect acoutic neuroma Operative Method Retrosigmoid approach for tumor excision Specimen Count And Types pieces, tumor Pathology Pending Operative Findings The tumor was whitish-yellowish, firm and soft one. It was well capsulted and the size was about 4 cm in diameter. The cerebellum was severely swelling while dura opening. However, it shrinked after tumor debulking. The tumor was removed inside the capsule by CUSA for decompression. CN VII and VIII was not found through the procedure. SSEP and BAEP showed no obvious interval change. Operative Procedures 1. ETGA, and the patient was under right side park-ebnch position 1. ETGA, and the patient was under right side park-bench position 2. Retroauricular curvillinear incision about 12cm 3. Find out the astron and creat three bur holes above the mastoid process 4. An about 4cm in diameter craniotomy window was created with K8 drill 5. The dura was opened in an inverse K shape, and tacking 6. The right side cerebellum was retracted posteriorly with self retractor 7. Cerebellar decompression by CSF drainage from cistern magnum 8. The tumor was found in front of the cerebellum 9. We opened the tumor capsule and central debulking was performed with CUSA, and tumor forceps till the tumor mass was all removed grossly 10.Hemostasis, close the dura with fascia graft 11.Fix back the skull graft with miniplates x3 12.Set a CWV drain, and close the wound in layers Operators VS賴達明 Assistants R5陳睿生 R1張皓鈞 李承典 (M,1978/06/25,33y8m) 手術日期 2010/03/02 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 HIVD 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 張皓鈞, 時間資訊 18:35 進入手術室 18:45 麻醉開始 18:50 誘導結束 19:08 抗生素給藥 19:18 手術開始 20:25 手術結束 20:25 麻醉結束 20:35 送出病患 21:34 進入恢復室 21:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術－腰椎 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Microdiskectomy 開立醫師: 陳睿生 開立時間: 2010/03/02 20:40 Pre-operative Diagnosis L5/S1 HIVD Post-operative Diagnosis L5/S1 HIVD Operative Method Microdiskectomy Specimen Count And Types nil Pathology Nil Operative Findings Disk protrusion was noted at right side L5/S1 level. The disk was noted to be degenerative change. After diskectomy, the thecal sac and root were well decompressed. Operative Procedures 1. ETGA, prone position, and C-arm localized L5/S1 level 2. Low back midline incision 3. Split right side paraspinal muscle at L5/S1 junction 4. L5/S1 laminotomy with Kerrison 5. Split thecal sac, and find out the protruding disk 6. Diskectomy was performed with aligator and disk clump 7. Hemostasis, close the wound in layers Operators VS 賴達明 Assistants R5 陳睿生, R1 張皓鈞 楊振霆 (M,1977/03/14,35y0m) 手術日期 2010/03/02 手術主治醫師 賴達明 手術區域 東址 005房 04號 診斷 Benign neoplasm of connective and other soft tissue,site unspecified 器械術式 Benign intraspinal tumor, exci 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 黃愉真, 時間資訊 19:10 報到 19:15 進入手術室 19:20 麻醉開始 19:30 誘導結束 19:56 抗生素給藥 20:28 手術開始 01:50 手術結束 01:50 麻醉結束 02:00 送出病患 02:05 進入恢復室 03:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 手術 良性病髓腫瘤切除術 1 1 摘要__ 手術科部: 外科部 套用罐頭: T1-3 and left T4 laminectomy for tumor excision 開立醫師: 李建勳 開立時間: 2010/03/03 02:04 Pre-operative Diagnosis T1/2 and left T3/4 tumor, suspect neuroma Post-operative Diagnosis T1/2 and left T3/4 tumor, suspect neuroma Operative Method T1-3 and left T4 laminectomy for tumor excision Specimen Count And Types 1 piece About size:2G Source:Laminectomy for spine tumor exicsion Pathology Pending Operative Findings The T1/2 tumor was located at right ventral side of the cord. The tumor was elastic-firm, greyish, size 2X2X4 cm, with extension to the right T2 root. The tumor margin was clear from the nerve root. The other tumor at left T4 root distal to the neural foramen. Operative Procedures Under general anesthesia and intubation, the patient was put in prone position. The T1 level was located with portable C-arm X-ray. The skin incision was made from C7 to T5 spinous process and seperated the paraspinal muscles. T1-3 laminectomy was performed with rongeur, Kerrison punches and high speed air drill. The dura was opened with surgical blade incision. The cord was retracted slightly to expose the tumor at ventral side. Ring curattage and dissector were used to seperated the tumor from the cord. The tumor excision was performed with CUSA begun with central debulky method. The tumor extension to the root was removed after drill opened the right T2 neural foramen. The left T4 lamina and neural foramen were drilled off in order to expose the tumor. The tumor exicsion was performed with CUSA and tumor forceps. The T1-3 dura was sutured with 5-0 Prolene and the left T4 opening was covered with DURAFORM. The wound was closed in layers after one epidural CWV drain set up. Operators VS 賴達明 Assistants R6 李建勳 R1 黃愉真 相關圖片 朱璽恩 (F,2010/02/19,2y0m) 手術日期 2010/03/02 手術主治醫師 張重義 手術區域 兒醫 068房 02號 診斷 Interruption of aortic arch 器械術式 TCPC,JATENE,TAPVR,NORWOOD 手術類別 緊急手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 4 紀錄醫師 羅健洺, 時間資訊 04:00 臨時手術NPO 04:00 開始NPO 12:55 通知急診手術 14:29 報到 14:30 進入手術室 14:30 開始輸血 14:31 麻醉開始 14:55 手術開始 15:40 誘導結束 16:35 麻醉結束 16:35 手術結束 16:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 探查性心包膜切開術 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Hemostasis 開立醫師: 羅健洺 開立時間: 2010/03/04 17:39 Pre-operative Diagnosis Mediastinal bleeding Post-operative Diagnosis Ditto Operative Method Hemostasis Specimen Count And Types Nil Pathology Nil Operative Findings One active bleeder was noted at the aortoplasty patch and repaired with multiple pledgetted 6-0 prolene sutures One active bleeder at the lateral side of innominate artery Operative Procedures Supine, ETGA, skin preparation. Hematoma evacuation. Hemostasis with multiple pledgetted to prolene. Pack the para aortic region with Surgicel. Covered sternal wound with silicone membrane. Operators 張重義 Assistants 徐綱宏,羅健洺 Indication Of Emergent Operation 柯素蘭 (F,1964/12/30,47y2m) 手術日期 2010/03/02 手術主治醫師 黃俊升 手術區域 東址 051房 02號 診斷 Breast cancer, female 器械術式 Partial mastectomy 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 蔡立威, 時間資訊 11:30 報到 11:35 進入手術室 11:50 手術開始 11:50 抗生素給藥 12:15 手術結束 12:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 部份乳房切除術－單側 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: partial mastectomy, right breast 開立醫師: 吳孟哲 開立時間: 2010/03/02 12:20 Pre-operative Diagnosis right breast cancer Post-operative Diagnosis right breast cancer Operative Method partial mastectomy, right breast Specimen Count And Types 1 piece About size:1*1*2cm Source:right breast Pathology pending Operative Findings A huge, 15*15*10cm, mass was noted over right breast, with ulcerative lesion in its central area Operative Procedures 1.local anesthesia 1.local anesthesia, supine 2.fusiform skin incision, about 3cm in length, 2.fusiform skin incision, about 3cm in length, over lateral side of right breast 3.do incisional biopsy 4.hemostasis 5.close wound in layers Operators VS黃俊升 Assistants R5吳經閔,R1蔡立威,Ri何天民 張再勝 (M,1952/09/07,59y6m) 手術日期 2010/03/02 手術主治醫師 蕭輔仁 手術區域 東址 005房 03號 診斷 Low back pain 器械術式 Radiofrequency coagulation 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 李振豪, 時間資訊 16:45 報到 17:35 進入手術室 17:55 麻醉開始 17:59 誘導結束 18:00 手術開始 18:30 麻醉結束 18:30 手術結束 18:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 高頻熱凝療法 1 1 B 摘要__ 手術科部: 外科部 套用罐頭: L2 bilateral pulse radiofrequency 開立醫師: 李振豪 開立時間: 2010/03/02 18:39 Pre-operative Diagnosis Facet pain Post-operative Diagnosis Facet pain Operative Method L2 bilateral pulse radiofrequency Specimen Count And Types NIl Pathology Nil Operative Findings 1.Bilateral neural foramen were inserted to ablate DRG. And the muscle twiching was noted during procedure. 2.Twice course radiofrequency were performed with 42 celcius degree and 180 secs. Operative Procedures 1.confirm location with C-arm 2.Needle insertion to L2 neural foramen 3.re-confirmed with C-arm 4.42 celcius degree and 180 secs ablation 5.Repeat same procedure at left side 6.Inject rinderon at L4~5 interspinous space Operators 蕭輔仁 Assistants 張麟,胡朝凱 許力平 (M,1968/08/18,43y6m) 手術日期 2010/03/02 手術主治醫師 林峰盛 手術區域 西址 035房 08號 診斷 Spinal cord injury 器械術式 Nerve block / PC 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 硬肌麻醉 麻醉主治醫師 林峰盛 ASA 3 紀錄醫師 林峰盛, 時間資訊 00:00 臨時手術NPO 18:50 進入手術室 18:55 麻醉開始 19:00 誘導結束 19:00 手術開始 19:30 手術結束 19:30 麻醉結束 19:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Epidural anesthesia 1 0 摘要__ 手術科部: 麻醉部 套用罐頭: LENB 開立醫師: 林峰盛 開立時間: 2010/03/02 19:35 Pre-operative Diagnosis 1.spinal cord injury 2. radiculopathy Post-operative Diagnosis 1. spinal cord injury 2. radiculopathy Operative Method Root block and transforaminal epidural block Specimen Count And Types nil Pathology Nil Operative Findings Operative Procedures LA with 1% xylocaine 5 ml pt in prone position Under fluoroscopic-guiddance, dianostic root block and transforaminal epidural block was done to left T12-L2 level with 23G spinal needle, 0.5% Marcaine 10mg+Kenaocrt 5mg were injected per root after contrast media was given Operators 林峰盛 Assistants 陳心言 王秀如 (F,1976/05/11,35y10m) 手術日期 2010/03/03 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Moyamoya disease 器械術式 Moyamoya P-DUH 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾峰毅, 時間資訊 07:38 報到 08:03 進入手術室 08:05 麻醉開始 08:35 誘導結束 09:30 抗生素給藥 10:05 手術開始 12:30 抗生素給藥 15:30 抗生素給藥 16:50 麻醉結束 16:50 手術結束 17:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱內外血管吻合術 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 10 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Left STA to MCA bypass 開立醫師: 曾峰毅 開立時間: 2010/03/03 16:55 Pre-operative Diagnosis Moyamoya Disease Post-operative Diagnosis Ditto Operative Method Left STA to MCA bypass Specimen Count And Types Nil Pathology Nil Operative Findings 1.Total [cortical artery] ischemic time: 62 mins 2.The posterior branch of STA was anastomosed with cortical branch of MCA [EC-IC] bypass in end to side fashion 3.Patent flow after the anastemosis Operative Procedures Under endotracheal general anaesthesia, the patient was put in supine position with head rotated to right. Scalp was shaved and scrubbed, and the course of the superficial temporal artery was mapped out with methylene blue after identification by Doppler. We made one S-shap skin incision along the STA course and dissected to isolate anterior and posterior branch of STA. Temporalis muscle was incised and reflected inferiorly. One 4x4cm craniotomy window was made and dura tenting was done along the craniectomy window. X-shape dura incision was done. Under operating microscope, a suitable cortical branch from the MCA was identified and the arachnoid around the vessel was removed by microscissors. Two temporary microvascular clips were applied, 1 cm appart, to the isolated segment of the cortical vessel, which was then opened by cutting off a leaf-like patch of the vascular wall. Heparin solution was used to irrigate the vascular lumen. The STA was occluded by a temporary clip and divided at its distal end. The lumen was irrigated with heparin solution. The advantitia at the vascular stump was trimmed off. The STA was anastomosed end-to-side to the segment of cortical artery interrupted stitches of 10/0 prolene. The vascular clips were released, and the leakage from the anastomosis was successufully stopped by gentle pressure on the patty with a small sucker tip. The dural plasty was performed by contineous prolene suture with muscular fascia .The loose space there was packed with gelfoam around the STA. The corner where STA passed through was bitten off for preventing undue pressure on the STA by the button. After checking bleeder and doing hemostasis, the wound was closed in layers. Operators P 杜永光 Assistants R6 陳盈志 R3 曾峰毅 何明玉 (F,1960/07/15,51y7m) 手術日期 2010/03/03 手術主治醫師 曾漢民 手術區域 東址 003房 02號 診斷 Pituitary Tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾漢民, 時間資訊 17:00 報到 17:25 進入手術室 17:30 麻醉開始 17:50 誘導結束 17:59 抗生素給藥 18:10 手術開始 19:30 麻醉結束 19:30 手術結束 19:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 經由蝶竇之腦下垂體瘤切除 1 1 摘要__ 手術科部: 外科部 套用罐頭: Hypophysectomy---Transphenoid 開立醫師: 陳盈志 開立時間: 2010/03/03 20:07 Pre-operative Diagnosis pituitary tumor Post-operative Diagnosis Pituitary tumor Operative Method transsphenoid adenomectomy Specimen Count And Types 1 piece About size:multiple fragments Source:pituitary tumor Pathology pending Operative Findings The tumor was soft fragile in character, yellowish reddish in color. The vascularity was high. The tumor located near left side and the attachment to cavornous sinus was noted. Operative Procedures After ETGA, the patient was put in supine position with head mild left tilt. The nasal cavity was well-disinfective, and then we incised nasal mucosa near osteum and then drill off nasal septum under endoscope. Dissection was performed along with the periosteum to expose sphenoid sinus anterior wall with osteotone then into sphenoid sinus. The sella floor was exposed and removed with kerrison. Under microscope, cruciate form dura incision was done, and tumor buldged out. It was further removed with tumor forceps and ring currette. Ring currete was used to pulled tumor out and the tumor was removed with tumor forceps piece by piece. CSF leak was noted, but it was stopped by gelfoam packing and tissue co dul. Nasal cavity was packed with gloves finger with cotton. Operators VS曾漢民 Assistants R6陳盈志R3曾峰毅 王萬守 (M,1936/12/28,75y2m) 手術日期 2010/03/03 手術主治醫師 蔡瑞章 手術區域 東址 002房 01號 診斷 硬腦膜下出血 器械術式 Removal of chronic subdural 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2E 紀錄醫師 陳睿生, 時間資訊 22:41 臨時手術NPO 08:32 報到 08:50 進入手術室 08:55 麻醉開始 09:00 誘導結束 09:40 抗生素給藥 09:44 手術開始 10:40 手術結束 10:40 麻醉結束 10:45 送出病患 10:47 進入恢復室 12:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 手術 慢性硬腦膜下血腫清除術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Bur hole for drainage 開立醫師: 陳睿生 開立時間: 2010/03/03 11:00 Pre-operative Diagnosis Left frontotemporoparietal chronic SDH Post-operative Diagnosis Left frontotemporoparietal chronic SDH Operative Method Bur hole for drainage Specimen Count And Types 5 pieces About size:3ML Source:SDH About size:3ML Source:SDH About size:3ML Source:SDH About size:3ML Source:SDH About size:3ML Source:SDH Pathology Nil Operative Findings About 100ml motor oil like hemolytic fluid was drained. Outer membrane was found, and fair brain pulsation and expansion were noted after drainage. Few old blood clots were found. Operative Procedures 1. ETGA, supine position with head right turn 2. Linear incision at left temporal about 3cm 3. Creat a bur hole and dura tacking 4. Open the dura and outer membrane 5. Drain out the fluid inside 6. Normal saline irrigation of the subdural space 7. Set a rubber drain 8. Close the wound in layers Operators P 蔡瑞章 Assistants R5 陳睿生, R3 曾峰毅 相關圖片 蔡宗宏 (M,1963/05/26,48y9m) 手術日期 2010/03/03 手術主治醫師 蔡瑞章 手術區域 東址 005房 01號 診斷 Benign neoplasm of cranial nerves 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳建銘, 時間資訊 07:55 報到 08:03 進入手術室 08:10 麻醉開始 08:50 誘導結束 09:20 抗生素給藥 09:45 手術開始 12:20 抗生素給藥 14:15 開始輸血 15:20 抗生素給藥 18:20 抗生素給藥 20:05 麻醉結束 20:05 手術結束 20:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 16 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Retrosigmoid approach for tumor excision 開立醫師: 李建勳 開立時間: 2010/03/03 13:01 Pre-operative Diagnosis Right cerebellopotine neuroma Post-operative Diagnosis Right cerebellopotine neuroma Operative Method Retrosigmoid approach for tumor excision Specimen Count And Types 1 piece About size:2g Source:CPA tumor by craniotomy Pathology Pending Operative Findings The cerebellum was adhered to the dura at the previous operation site. The tumor was greyish, elastic-firm, hypervascular , located at right cerebellopotine angle, with CNVII and CNVIII encasement. The tumor was unable to seperate from the brain stem so one thin layer of the tumor was left in situ to prevent damage of the brain stem. The cerebellum was adhered to the dura at the previous operation site. The tumor was greyish, elastic-firm, located at right cerebellopotine angle, with CNVII and CNVIII encasement. Operative Procedures Under general anesthesia and intubation, the patient was put in park-bench position with his head fixed with Mayfield skull clups. The scalp incision was made partially along the previous wound and exteded. The previous burr hole was located and removed. widened the craniotomy window. The tumor was exposed after retraction of the cerebellum, The tumor excision was performed with CUSA internal decomperssion first. The facial nerve nereve was checked by intraoperative bipolar stimulator but could not be found. The tumor was unable to seperate from the brain stem so one thin layer of the tumor was left in situ to prevent damage of the brain stem. Hemostasis was achieve with surgicel lining of the tumor bed. The duroplasty was performed with fascia graft and 4-0 Prolene sutures. The skull plates were fixed back with wires and the bony defect was filled with bone cemen. The wound was then closed in layers after one subgaleal CWV drain set up. Under general anesthesia and intubation, the patient was put in Parkbench position with his head fixed with Mayfield skull clups. The scalp incision was made partially along the previous wound and exteded. The previous burr hole was located and removed. widened the craniotomy window. The tumor was exposed after retraction of the cerebellum, The tumor excision was performed with CUSA internal decomperssion first. The facial nerve and acoustic nereve were checked by intraoperative bipolar stimulator. The tumor capsule Operators P 蔡瑞章 Assistants R6 李建勳 R1 陳建銘 相關圖片 林秋和 (M,1945/10/10,66y5m) 手術日期 2010/03/03 手術主治醫師 陳敞牧 手術區域 東址 001房 01號 診斷 Patients requiring long-term use of a respirator due to respiratory failure, use respirator 6 hours per day continue 30 days 器械術式 Cranioplasty 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 胡朝凱, 時間資訊 07:40 通知急診手術 08:14 報到 08:15 進入手術室 08:20 麻醉開始 08:23 誘導結束 09:46 手術開始 11:00 抗生素給藥 13:15 開始輸血 15:20 麻醉結束 15:20 手術結束 15:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 頭顱成形術 1 1 L 手術 腦室腹腔分流手術 1 4 B 手術 頭顱成形術 1 2 R 摘要__ 手術科部: 外科部 套用罐頭: Bilateral cranioplasty and left VP shunt 開立醫師: 胡朝凱 開立時間: 2010/03/03 15:58 Pre-operative Diagnosis bilateral Skull defect and hydrocephalus Post-operative Diagnosis bilateral Skull defect and hydrocephalus Operative Method Bilateral cranioplasty and left VP shunt Specimen Count And Types NIl Pathology Nil Operative Findings 1.Bilateral skull defects were noted 2.A dural defect was also noted at left parietal lobe posterior area. And the brain became necrotic and liquified. 3.The dural defect was covered with durofoam 4.Left Medtronic VP shunt was inserted with medium pressure reservior. 5.Opening pressure: about 15 cmH2O, clear CSF. Intraventricular catheter: 6.3 cm Operative Procedures 1.ETGA, supine 2.Left skin incision via previous wound was done 3.reflect skin flap along the interface between dura and galea 4.LUQ area transverse skin incision 5.minilaparotomy was done 6.Made a subcutaneous tunnel 7.Pass the catheter 8.Ventricular puncture 9.Fixed bone back with miniplate 10.Connect the catheter to reservior and insert 11.close wound in layers 12.right cranioplasty was also done and fixed with wire. Operators 陳敞牧 Assistants 胡朝凱 Indication Of Emergent Operation 林釆憶 (F,1998/04/23,13y10m) 手術日期 2010/03/03 手術主治醫師 楊士弘 手術區域 兒醫 067房 01號 診斷 Moyamoya disease 器械術式 Moyamoya P-DUH 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 4 紀錄醫師 鍾文桂, 時間資訊 07:39 報到 08:10 進入手術室 08:20 麻醉開始 09:40 誘導結束 10:00 抗生素給藥 10:29 手術開始 13:00 抗生素給藥 14:35 麻醉結束 14:35 手術結束 14:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱內外血管吻合術 1 1 R 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 R 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 摘要__ 手術科部: 外科部 套用罐頭: Encephaloduroarteriosynangiosis, right. 開立醫師: 鍾文桂 開立時間: 2010/03/03 15:18 Pre-operative Diagnosis Moyamoya syndrome. Post-operative Diagnosis Moyamoya syndrome. Operative Method Encephaloduroarteriosynangiosis, right. Specimen Count And Types nil Pathology Nil. Operative Findings The parietal branch of the superficial temporal artery was chosen for the synangiosis. Operative Procedures Under ETGA, the patient was put in supine position. The head was tilted to the left. After shaving, the tract of the superficial temporal artery and its branches were outlined by tracing througth Doppler. After disinfection and draping, the S-shape scalp incision was done. The parietal branch of the left superficial temporal artery and its pedicle graft were lysed from the surrounding soft tissue under microscope. The temporalis muscle below was dissected. A 4-cm craniotomy was created with high speed drill. After dural tenting the dura was opened, lysis of the arachnoid membrane surrounding the branch of MCA was done. The arterial pedicle was anchored to the four cornors of the dural opening to let the pedicle lying loosely on the brain surface. The pedicle had good contact with the exposed MCA branches. Later, the SMA pedicle was sutured to the dural edges by 5-0 prolene. A piece of DuraFoam was placed above the dura mater. The bone plate was fixed with 3 wires. The wound was closed in layers. Operators V.S. 楊士弘 Assistants R4鍾文桂 吳秋慧 (F,1965/09/18,46y5m) 手術日期 2010/03/04 手術主治醫師 陳晉興 手術區域 東址 019房 02號 診斷 Lung cancer 器械術式 Thoracoscopy+Open Chest 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 陳晉興, 時間資訊 11:10 報到 12:05 進入手術室 12:10 麻醉開始 13:05 誘導結束 13:10 抗生素給藥 13:25 手術開始 15:33 開始輸血 16:20 抗生素給藥 16:40 麻醉結束 16:40 手術結束 16:51 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 術後止痛 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 一葉肺葉切除 1 1 摘要__ 手術科部: 外科部 套用罐頭: Lobectomy 開立醫師: 蕭惠壬 開立時間: 2010/03/04 17:15 Pre-operative Diagnosis Lung adenocarcinoma, RLL, s/p chemotherpy Post-operative Diagnosis Lung adenocarcinoma, RLL, s/p chemotherpy Operative Method Right middle and lower lobe Lobectomy Specimen Count And Types 3 pieces About size:20*10*5 cm Source:Lung: RML + RLL About size:0.5*0.5 cm Source:LN, Group 3 About size:0.5*0.5 cm Source:LN, group 7 Pathology Adenocarcinoma Operative Findings 1. Tumor size: 2.5cm in diameter 2. Tumor location: RLL 3. Tumor invasion (-) 4. Lymph nodes enlargement: +, an lymph node adhesion to intermedial bronchus (B6) closely with external compression to bronchus Operative Procedures 1. Anesthesia: General anesthesia using double-lumen endotracheal tube. An epidural anesthesia catheter is placed prior to the operation. 2. Position: Left decubitus position. An axillary roll is placed under the down side. The operative field is well disinfected and draped. 3. Right posterolateral thoracotomy is made through the fifth intercostal space. The pleural adhesions are separated using electrocautery. 4. The right middle and lower lobes are retracted anteriorly. The inferior pulmonary ligment is divided.The inferior pulmonary vein is identified, doubly ligated, suture-ligated, and divided. 5. The pulmonary artery supplying the right middle and lower lobe is identified, doubly ligated, suture-ligated and divided. 6. The bronchus to the midlle and lower lobe is identified, clamped with TA-30 stapler, and divided with a knife, leaving a 5-mm stump. Interrupted 4-0 Ticron sutures are used for reinforcement of the stump. 7. The pleural cavity is irrigated. 8. Lymph node dissection is done at group 3,and 7. After meticulous homeostasis and check-up of air leakage, one 28# chest tubes are placed at posterior aspect of pleural cavity. 9. The intercostal space is closed with interrupted 2# Chromic sutures. The muscle layer is closed with 1-0 Vicryl sutures and the subcutaneous layer is closed with 2-0 Vicryl sutures. Subcutical 3-0 Prolene sutures are used for closure of the skin. The endotracheal tube is changed to single lumen tube and then the patient is sent to ICU for postoperative care. Operators VS 陳晉興 Assistants R5 張彥俊 R1 蕭惠壬 張寶瑜 (F,1962/05/12,49y10m) 手術日期 2010/03/04 手術主治醫師 蕭輔仁 手術區域 東址 005房 01號 診斷 Cervical Spondylosis 器械術式 OPLL-Anterior Corpectomy VSLai 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 李振豪, 時間資訊 07:55 報到 08:00 進入手術室 08:05 麻醉開始 08:15 誘導結束 08:50 抗生素給藥 09:15 手術開始 11:50 抗生素給藥 13:45 手術結束 13:45 麻醉結束 13:50 送出病患 13:55 進入恢復室 14:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術－前融合，有固定物（＜＝四節） 1 2 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 椎間盤切除術－頸椎 1 1 摘要__ 手術科部: 外科部 套用罐頭: C6 corpectomy and anterior fusion, fixation w... 開立醫師: 陳睿生 開立時間: 2010/03/04 13:35 Pre-operative Diagnosis C5/6, 6/7 HIVD with cervical stenosis Post-operative Diagnosis C5/6, 6/7 HIVD with cervical stenosis Operative Method C6 corpectomy and anterior fusion, fixation with body cage and plate Specimen Count And Types nil Pathology Nil Operative Findings C6 corpectomy was performed with C5/6, 6/7 diskectomy. The cord and C5,6 roots were well decompressed after corpectomy. An about 2cm United body cage was implanted, and 38mm A-spine cervical plate was fixed at C5, 7 level with 14mm screws x4. Operative Procedures Under endotracheal tube general anesthesia, the patient was put at supine positio. The skin was scrubbed, disinfected, and draped as usual. One transverse skin incision was made at left lower neck. The platysma muslce was transected and the subcutaneous tissue was dissected along the fascia. The carotid sheath was left at outer part. The pre-vertebral muscle group was identified and detached from Under endotracheal tube general anesthesia, the patient was put at supine positio. The skin was scrubbed, disinfected, and draped as usual. One transverse skin incision was made at left lower neck. The platysma muslce was transected and the subcutaneous tissue was dissected along the fascia. The carotid sheath was left at outer part. The pre-vertebral muscle group was identified and detached from the vertebral body. The intervertebral disc was identified and confirmed by C-arm portable X-ray. C5-6, C6-7 diskectomy and C6 corpectomy was performed with high-speed air-drived drill, Karrison, and curatte. After decompression, the thecal sac was well expanded. After hemostasis, the united body cage was implanted for anterior fusion. A-spine cervical plate was fixed at C5 and C7 level with 4 screws. The location of body cage and cervical plate were confirmed by C-arm portable X-ray. One epidural CWV drain was placed and the wound was closed in layers. Operators VS 蕭輔仁 Assistants R5 陳睿生, R3 李振豪 陳貴昌 (M,1979/08/08,32y7m) 手術日期 2010/03/04 手術主治醫師 曾漢民 手術區域 東址 002房 03號 診斷 Glioma 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3 紀錄醫師 陳德福, 時間資訊 00:00 臨時手術NPO 14:35 進入手術室 14:40 麻醉開始 14:50 誘導結束 15:00 抗生素給藥 15:35 手術開始 17:15 手術結束 17:15 麻醉結束 17:20 送出病患 18:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 腦室腹腔分流手術 1 1 B 手術 深部複雜創傷處理－傷口長１０公分以上者 1 0 B 摘要__ 手術科部: 外科部 套用罐頭: 1.Right frontal VPS 開立醫師: 陳德福 開立時間: 2010/03/04 17:34 Pre-operative Diagnosis Hydrocephalus with CSF leakage from the left scalp wound Post-operative Diagnosis ditto Operative Method 1.Right frontal VPS 2.Left scalp wound debridement and primary repair Specimen Count And Types 2 pieces About size:swab Source:left scalp wound About size:swab Source:left scalp wound Pathology nil Operative Findings 1.The CSF was clear and colorless with ventricular opening pressure of 15cm-H2O 2.One Metronic medium pressure shunt valve was implantated at right Kocher point 3.The intraventricular cath: 6.2cm and intraperitoneal cath: 20cm 4.The left scalp wound had poor healing with one 0.7*0.7cm scalp defect Operative Procedures Under ETGA and supine position, the scalp and abdomen was disinfected and draped as usual. One curvilinear incision on the right frontal scalp was done and burr hole was created. The dura was opened followed by inserting the ventricular needle. One minilaparotomy was done on the right upper abdomen and the subcutaneous tunnel was created. The intraventricular cath and intraperitoneal cath was connected and the wound was closed in layers. Then, the left scalp was disinfected and draped. The wound debridement and irrgation with copious normal saline were performed. The cultrue swebs were done and the wound was closed. Operators VS 曾漢民 Assistants r6陳盈志 r4陳德福 江美滿 (F,1959/10/17,52y4m) 手術日期 2010/03/04 手術主治醫師 李苑如 手術區域 東址 008房 04號 診斷 Urethral caruncle 器械術式 Biopsy lymphnode /WOR 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 靜脈麻醉 麻醉主治醫師 劉治民 ASA 2 紀錄醫師 陳柏誠, 時間資訊 10:30 報到 10:40 進入手術室 10:50 麻醉開始 10:55 誘導結束 11:00 抗生素給藥 11:05 手術開始 11:25 手術結束 11:25 麻醉結束 11:30 送出病患 11:33 進入恢復室 12:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 尿道腫瘤切除術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 摘要__ 手術科部: 泌尿部 套用罐頭: tumor excision 開立醫師: 賴建榮 開立時間: 2010/03/04 11:38 Pre-operative Diagnosis urethral meatus tumor suspect caruncle Post-operative Diagnosis urethral meatus tumor suspect caruncle Operative Method tumor excision Specimen Count And Types 1.a 7mmx7mm tumor at urethral meatus suspect caruncle Pathology pending Operative Findings 1.a 7mmx7mm tumor at urethral meatus suspect caruncle Operative Procedures 1.use cystoscope to find the border of the urethral meatus tumor 2.do tumor excision and suture hemostasis with 3 0 chromic 3.16 fr. foley insertion 4.POR Operators 李苑如 Assistants 賴建榮 陳柏誠 黃南容 (M,1954/11/24,57y3m) 手術日期 2010/03/04 手術主治醫師 賴達明 手術區域 東址 012房 03號 診斷 Radiculopathy 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 鍾文桂, 時間資訊 14:25 報到 14:50 麻醉開始 14:55 誘導結束 14:57 進入手術室 15:25 抗生素給藥 16:15 手術開始 17:55 手術結束 17:55 麻醉結束 18:05 送出病患 18:10 進入恢復室 19:18 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 椎間盤切除術－腰椎 1 1 摘要__ 手術科部: 外科部 套用罐頭: Microdiskectomy 開立醫師: 陳睿生 開立時間: 2010/03/04 18:07 Pre-operative Diagnosis L5/S1 ruptured disk over right side Post-operative Diagnosis L5/S1 ruptured disk over right side Operative Method Microdiskectomy Specimen Count And Types nil Pathology Nil Operative Findings Ruptured disk was noted at right side spinal cannal and compressed the thecal sac and root tightly. After PLL incision, the ruptured disk protruded out and was removed smoothly. After diskectomy, the thecal sac and root were well decompressed. Operative Procedures 1. ETGA, prone position and C-arm localized L5/S1 level 2. Low back midline incision about 4cm 3. Split right side L5/S1 paraspinal muscle 4. Identify the interlaminal space and do laminotomy over L5/S1 junction 5. Split the thecal sac and root, and the ruptured disk was noted 6. Incise into the PLL and the rupture disk was removed 7. Diskectomy was performed with curette, aligator, and disk clump 8. Hemostasis, close the wound in layers Operators VS 賴達明 Assistants R5 陳睿生, R4 鍾文桂, Ri 張書豪 陳佳念 (F,1952/07/29,59y7m) 手術日期 2010/03/04 手術主治醫師 陳敞牧 手術區域 東址 005房 02號 診斷 Herniation of intervertebral disc (HIVD) 器械術式 Diskectomy lumbar 手術類別 臨時手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 李振豪, 時間資訊 14:06 進入手術室 14:10 麻醉開始 14:20 誘導結束 14:30 抗生素給藥 14:53 手術開始 16:30 手術結束 16:30 麻醉結束 16:40 送出病患 16:50 進入恢復室 18:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 椎間盤切除術－腰椎 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 外科部 套用罐頭: L5-S1 microdiskectomy, left 開立醫師: 李振豪 開立時間: 2010/03/04 15:39 Pre-operative Diagnosis L5-S1 HIVD, left Post-operative Diagnosis L5-S1 HIVD, left Operative Method L5-S1 microdiskectomy, left Specimen Count And Types Nil Pathology Nil Operative Findings L5/S1 disk protrusion was noted manily over left side. The left side S1 root was reddish and swelling. A piece of rupture disk was noted at the S1 axiallary region. After diskectomy, the root and thecal sac were well decompressed. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in prone position. The L5-S1 intervertebral space was localized by C-arm portable X-ray. The skin was scrubbed, disinfected, and draped as usual. One midlie skin incision with 4cm in length was made at L5-S1 level. The subcutaneous soft tissue was dissected and the spinous process of L5 was identified. Left side paravertebral muscle groups were detached and retracted by a modified narrow Taylor retractor. Under operating microsope, laminotomy was performed ad the thecal sac was well preserved. The buldgig disc was noted after gently pushed the thecal sac away. Microdiskectomy was done. Hemostasis was achieved with bipolar cautery and Gelform packing. The wound was then closed in layers. Operators VS陳敞牧 Assistants R5陳睿生, R3李振豪 郭淑芳 (F,1957/12/11,54y3m) 手術日期 2010/03/04 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 李建勳, 時間資訊 07:45 報到 08:05 進入手術室 08:10 麻醉開始 08:45 誘導結束 08:55 抗生素給藥 09:10 手術開始 11:55 抗生素給藥 15:00 抗生素給藥 18:00 抗生素給藥 19:48 開始輸血 20:55 麻醉結束 20:55 手術結束 21:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 18 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除－手術時間在８小時以上 1 1 摘要__ 手術科部: 外科部 套用罐頭: Right pterional approach for tumor excision 開立醫師: 李建勳 開立時間: 2010/03/04 19:11 Pre-operative Diagnosis Planium sphenoidale meningioma Post-operative Diagnosis Planium sphenoidale meningioma Operative Method Right pterional approach for tumor excision Right pterional approach for Simpson grade III tumor excision Specimen Count And Types 1 piece About size:2g Source:craniotomy for tumor excision Pathology Pending Operative Findings The tumor was elastic-firm, with sereve compressed the bilateral optic nerve. The hyperosis was also servere. The right optic nerve was found with severe compressed by the tumor and the tumor was removed partially to decompression. Bilateral ACA branches were also found tightly encased by the tumor. The brain was mild swelling after craniotomy and still mild swelling after closure of the dura. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position with head fixed with Mayfield skull clump. The scalp was shaved, scrubbed, disinfected with alcohol B-I then draped. The scalp incision was made at right frontotemporal area followed by craniotomy created as usual pterional approach. The dura was opened after tenting around the craniotomy window. The Sylvian fissure was opened under surgical microscope after anterior clinoidectomy. Central debulky was performed after located the CN III and internal carotid artery. The ACA branches and right optic nerve were found after partial tumor excision. Further tumor removal was difficult due to unable to identified the left optic nerve and elstic-firm of the tumor. After hemostasis with surgicel lining of the tumor bed, the duroplasty was performed with 4-0 Prolene sutures. The skull plate was fixed back with miniplates and screws. The wound was closed in layers after one subgaleal CWV drain set up. Operators P 瑞章 vs 王國川 Assistants R6 李建勳 R1 賴碩倫 相關圖片 林煌英 (F,1956/09/11,55y6m) 手術日期 2010/03/05 手術主治醫師 李章銘 手術區域 東址 056房 03號 診斷 Breast cancer, female 器械術式 Thoracoscopy 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 3 紀錄醫師 蕭惠壬, 時間資訊 15:20 報到 15:20 進入手術室 16:10 麻醉開始 16:25 誘導結束 16:40 抗生素給藥 16:55 手術開始 17:55 手術結束 17:55 麻醉結束 18:05 送出病患 19:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 胸腔鏡肋膜黏合術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: VATS bullectomy 開立醫師: 蕭惠壬 開立時間: 2010/03/05 18:38 Pre-operative Diagnosis Breast cancer with malignancy pleural effusion Post-operative Diagnosis Breast cancer with malignancy pleural effusion Operative Method Mechanical pleurodesis via VATS. Specimen Count And Types 2 pieces About size:15cc * 6 tube Source:plerual effusion About size:0.3*0.3 cm 2 piece Source:pleura Pathology invasive ductal carcinoma with lymph node metastasis Operative Findings 1. Pleural adhesions and multlple tumor seeding over plerua and diaphragm were noitced 2. Bloody pleural effusion, large amount Operative Procedures 1. Anesthesia: General anesthesia using double-lumen endotracheal tube. 2. Position: left decubitus position. An axillary roll is placed under the down side. The operative field is well disinfected and draped. 3. Camera port: From the right sixth intercostal space in the mid-axillary line away from the lesion. 4. Working ports: First: From the fourth intercostal space in the anterior axillary line. Second: From the fourth intercostal space in the posterior axillary line.. 5. The pleural adhesions are separated with electrocautery. 6. pleural biopsy was done for pathalogic examination. 7. Apical pleurodesis is performed by dry gauze abrasion of the parietal pleura. 8. After meticulous homeostasis, two 28# chest tubes was placed. The skin is closed with 4-0 Nylon sutures. Operators VS李章銘 Assistants CR林孟暐 R1蕭惠壬 邵坤成 (M,1951/09/16,60y5m) 手術日期 2010/03/05 手術主治醫師 李苑如 手術區域 西址 039房 7號 診斷 Hydronephrosis 器械術式 Removal of double-J 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 10:45 進入手術室 10:48 麻醉開始 10:52 手術開始 10:54 手術結束 10:54 麻醉結束 10:56 送出病患 吳秀鳳 (F,1945/04/08,66y11m) 手術日期 2010/03/05 手術主治醫師 曾漢民 手術區域 東址 003房 01號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 3 紀錄醫師 曾峰毅, 時間資訊 08:05 進入手術室 08:10 麻醉開始 08:20 誘導結束 08:30 抗生素給藥 08:30 手術開始 10:33 手術結束 10:33 麻醉結束 10:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４小時以內 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 摘要__ 手術科部: 外科部 套用罐頭: Right frontal craniotomy tumor excision 開立醫師: 陳盈志 開立時間: 2010/03/05 10:57 Pre-operative Diagnosis Right frontal convexity meningioma Post-operative Diagnosis Right frontal convexity meningioma Operative Method Right frontal craniotomy tumor excision Specimen Count And Types 1 piece About size:3X3X3CM Source:RIGHT FRONTAL TUMOR Pathology pending Operative Findings The tumor was elastic hard in character. It located at right frontal with dura base and hyperostosis was noted. The hyperostosis portion was drilled. Operative Procedures Under RTGA, the patient was set into supine position with head fixed with Mayfield. The operation field was disinfected and drapped with sterile drapping. Right frontal curvilinear incision was done 2 Burr hole was made and then cranitomy was done 7x6cm. Dura tenting was done. Circumferential dura incision was made around the tumor. The tumor was dissected along its arachnoid plane and the tumor was removed en bloc with its dura base Duroplasty was done with fascia graft. The bone plate was fixed with miniplate. The wound was closed in layers after subgaleal CWV drain x 1. Operators VS曾漢民 Assistants R6陳盈志R3曾峰毅 林淑霞 (F,1953/03/16,58y11m) 手術日期 2010/03/05 手術主治醫師 曾漢民 手術區域 東址 003房 02號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 2 紀錄醫師 曾峰毅, 時間資訊 11:05 進入手術室 11:07 麻醉開始 11:30 誘導結束 11:30 抗生素給藥 11:40 手術開始 14:15 手術結束 14:15 麻醉結束 14:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４小時以內 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 摘要__ 手術科部: 外科部 套用罐頭: Right frontal craniotomy tumor excision 開立醫師: 陳盈志 開立時間: 2010/03/05 14:40 Pre-operative Diagnosis Falx meningioma Post-operative Diagnosis Falx meningioma Operative Method Right frontal craniotomy tumor excision Specimen Count And Types 1 piece About size:multiple fragment Source:falx meningioma Pathology pending Operative Findings The tumor was soft fragile in character. The margin was clear with arachnoid plane. The falx became thickened, which was cauterized and incised Operative Procedures Under RTGA, the patient was set into supine position with head fixed with Mayfield. The operation field was disinfected and drapped with sterile drapping. Right frontal U shape incision was done. 4 Burr hole was made and then cranitomy was done 8x6cm. Dura tenting was done. U-shape dura incision was made. The tumor was debulked with sucker and the border was dissected along its arachnoid plane. Its dura base on falx was cauterized and then excised. Duroplasty was done with fascia graft. The bone plate was fixed with miniplate. The wound was closed in layers after subgaleal CWV drain x 1. Operators VS曾漢民 Assistants R6陳盈志R3曾峰毅 袁玉英 (F,1959/01/05,53y2m) 手術日期 2010/03/05 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 2 紀錄醫師 陳建銘, 時間資訊 07:32 報到 08:04 進入手術室 08:10 麻醉開始 08:20 誘導結束 08:25 抗生素給藥 09:05 手術開始 11:20 麻醉結束 11:20 手術結束 11:25 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除－手術時間在４小時以內 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 摘要__ 手術科部: 外科部 套用罐頭: Right frontal craniotomy for Simpson grade I ... 開立醫師: 李建勳 開立時間: 2010/03/05 11:39 Pre-operative Diagnosis Right frontal tumor, suspect meningioma Post-operative Diagnosis Right frontal tumor, suspect meningioma Operative Method Right frontal craniotomy for Simpson grade I tumor exicison Specimen Count And Types 1 piece About size:1.5g Source:craniotomy for tumor exicison Pathology Pending Operative Findings The tumor was yellowish, elastic, size: 2.5x2.5x2cm, located at right frontal convexity with clear arachnoid plan from the surrounding brain. The brain was slack after removing the tumor. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position. The scalp was shaved, scrubbed, disinfected with alcohol B-I then draepd. The scalp was incised bicoronally and followed by craniotomy creation. The dura was opened along the tumor attachment after tenting around the craniotomy window. The tumor was dissected away from the normal brain at the arachnoid membrane plan. The tumor vessels were bipolar coagulated and the hemostasis was further achieved with surgicel lining of the tumor bed. The duroplasty was performed with pericranium and 4-0 Prolene sutures. The skull plates was fixed back with miniplates and screws. The wound was then closed in layers with one subgaleal drain set up. Operators VS 曾漢民 Assistants R6 李建勳 R1 陳建銘 相關圖片 鮑正鋼 (M,1956/03/08,56y0m) 手術日期 2010/03/05 手術主治醫師 張金池 手術區域 東址 057房 04號 診斷 Intracerebral hemorrhage 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 3 紀錄醫師 李佳穎, 時間資訊 14:20 進入手術室 14:25 麻醉開始 14:30 誘導結束 14:33 手術開始 14:45 手術結束 14:45 麻醉結束 14:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 氣管切開造口術 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 李佳穎 開立時間: 2010/03/05 14:25 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Ditto Operative Method Tracheostomy Specimen Count And Types nil Pathology None Operative Findings Fr .8 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators 郭順文 Assistants 李佳穎 侯明利 (M,1942/05/02,69y10m) 手術日期 2010/03/05 手術主治醫師 王國川 手術區域 東址 005房 02號 診斷 Traumatic brain injury 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 2 紀錄醫師 鍾文桂, 時間資訊 11:58 報到 12:10 進入手術室 12:15 麻醉開始 12:25 誘導結束 12:50 抗生素給藥 13:15 手術開始 14:45 手術結束 14:45 麻醉結束 14:50 進入恢復室 14:50 送出病患 16:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 腦室腹腔分流手術 1 1 L 手術 氣管切開造口術 1 0 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 賴碩倫 開立時間: 2010/03/05 15:04 Pre-operative Diagnosis 1. Hydrocephalus. 2. Repiratory failure. Post-operative Diagnosis 1. Hydrocephalus. 2. Repiratory failure. Operative Method 1. Implantation of ventricular-peritoneal shunt, left Kocher; 2. Tracheosotmy. Specimen Count And Types Nil Pathology Nil. Operative Findings 1. 長安 Medium pressure reservoir, Ventricular catheter: 6cm. 2. Tracheostomy tube: 8.0 Fr.; calcified tracheal ring. Operative Procedures Operation I: Anesthesia: endotracheal, general. Position: supine, head tilted to right. Shaving, disinfection, and draping. Scalp: Curvilinear incision at right Kocher point. Abdomen: 5 cm linear incision at left upper quadrant of abdomen. Burr hole at left Kocher. Dural tenting, durotomy. Insertion of ventricular puncture needle at left Kocher point. Dissection of abdominal wound until reaching peritoneal cavity. Subcutaneous dissection by tunnel passage, and insertion of shunt catheter. Connect ventricular catheter and shunt catheter to reservoir. Insert ventricular catheter into left Kocher point. Check shunt patency. Insert shunt catheter to peritoneal cavity. Wound closure in layers. Operation II: Position: midline, neck in extended position. Incision: 2 cm linear incision two finger breath above the sternal notch. Midline dissection. Tracheostomy at 2nd/3rd tracheal rings. Insert tracheostomy tube. Check EtCO2 and O2 saturation. Fixation of tracheostomy tube. Wound closure primarily. Operators V.S. 王國川. Assistants R4鍾文桂,R1賴碩倫. 陳龍福 (M,1945/12/17,66y2m) 手術日期 2010/03/05 手術主治醫師 蔡翊新 手術區域 東址 019房 01號 診斷 Hepatic cancer 器械術式 Malignant intraspinal tumor, e 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 2 紀錄醫師 張皓鈞, 時間資訊 07:40 報到 08:10 進入手術室 08:20 麻醉開始 08:35 誘導結束 08:50 抗生素給藥 09:15 手術開始 10:30 開始輸血 12:10 手術結束 12:10 麻醉結束 12:25 抗生素給藥 12:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 惡性病髓腫瘤切除術 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Cervical Laminectomy 開立醫師: 蔡翊新 開立時間: 2010/03/05 12:17 Pre-operative Diagnosis Hepatocellular carcinoma with T2-5 metastasis and epidural compression of cord; left T3,4,5 rhizotomy. Post-operative Diagnosis Hepatocellular carcinoma with T2-5 metastasis and epidural compression of cord. Operative Method Lower T2 to T5 laminectomy with epidural tumor excision. Specimen Count And Types 1 piece About size:10 x 6 x 4 cm Source:T2-5 laminae and epidural mass Pathology Pending. Operative Findings 10 x 6 x 4 cm grey-red-yellowish, hypervascular tumor located at lower T2 to T5 laminae and epidural space. The thecal sac was compressed by the tumor and expanded well after tumor excision. The tumor extended through left T4 pedical to left side of T4 vertebral body. The tumor was grossly totally excised. Left T3,4,5 roots were encased and infiltrated by the tumor and they were clipped at the origin and excised distally. Massive bleeding was encountered during tumor excision. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: prone. 3. Skin preparation: upper back region was scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: midline, 12 cm in length, from T2 to T6 spinous process. 5. The paraspinal muscles were splitted and detached from the spinous processes of lower T2 to T5 by Bovie, followed by subperiosteal dissection on the laminae. 6. The paravertebral muscles were kept open by self retaining retractors to expose spinous processes and laminae of lower T2 to T5. The bleeding from the muscles was stopped by Bovie. 7. The spinous processes and laminae of lower T2 to T5 were bitten off by different type of rongeurs and Kerrison punch until posterior half of the spinal canal was widely opened and the cord had been well decompressed. The tumor was removed by Rongeur and currettes. The epidural venous bleeding was stopped by Gelfoam packing. The oozing from the bone was packed by bone wax. 8. The paravertebral muscles were closed by interrupted sutures with 1/0 Vicryl, subcutaneous layer by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 9. Drain: one, epilaminal, hemovac. 10.Blood loss: 3000ml; Blood transfusion: PRBC 4U, Whole blood 4U. 11.Course of surgery: transient hypotension (BP down to 43/35 mmHg) while closing the wound, but BP resumed soon after inotropic agents and fluid supplement were given. Operators VS蔡翊新 Assistants R5胡朝凱R1張皓鈞 黃金嬌 (F,1942/09/06,69y6m) 手術日期 2010/03/06 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Parkinsonism (F02.3) 器械術式 Stereotaxic procedure for func 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 面罩麻醉 麻醉主治醫師 詹光政 ASA 3 紀錄醫師 陳建銘, 時間資訊 07:45 報到 07:53 進入手術室 08:00 麻醉開始 08:10 誘導結束 08:40 抗生素給藥 08:51 手術開始 11:40 抗生素給藥 15:35 麻醉結束 15:35 手術結束 15:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 深部腦核電生理定位 1 0 B 手術 立體定位術－功能性失調 1 1 L 手術 立體定位術－功能性失調 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Semi-opened mask inhalation anes 1 0 麻醉 Semi-opened INHALATION GENERAL A 4 0 麻醉 SENI-OPENED INHALATION GENERAL A 7 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: Insertion of DBS wire at bilateral subthalamus nucleas 開立醫師: 李建勳 開立時間: 2010/03/06 15:50 Pre-operative Diagnosis Parkison disease Post-operative Diagnosis Parkison disease Operative Method Insertion of DBS wire at bilateral subthalamus nucleas Specimen Count And Types Nil Pathology Nil Operative Findings 1. The identified subthalamic nucleus at left side: 4.6mm in length, right side: 5.1mm in length. 2. The rigidity decreased after wire inserted at stimulation "on". 3. Left eye with left-ward gaze limitation when stimulation "on" over leftsubthalamic nucleus. 4. The final target was 2mm anterior to the planned target. Operative Procedures Under IV general anesthesia, the patient was put in supine position. The scalp was shaved, scrubbed and antiseptic with alcohol B-I. Registered the preset localization point to navigator. Bicoronal scalp incision was made with burr hole made at entery point of left frontal region as navigator guided. The DBS wire port was set up and localization of subthalamus nucleus with microelectrode assistance. Inserted the DBS wire and fixed with the port. Waked the patient from the anesthesia and started stimulation from low voltage. Checked the clinical responses while using different voltage for stimulation. Performed the same procedure at right side. After hemostasis, closed the wound in layers. Operators VS 曾勝弘 Assistants R6 李建勳 R1 陳建銘 相關圖片 朱璽恩 (F,2010/02/19,2y0m) 手術日期 2010/03/06 手術主治醫師 黃書健 手術區域 兒醫 068房 1號 診斷 Interruption of aortic arch 器械術式 TCPC,JATENE,TAPVR,NORWOOD 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 4E 紀錄醫師 羅健洺, 時間資訊 15:06 開始NPO 15:06 臨時手術NPO 15:06 通知急診手術 09:15 進入手術室 09:17 麻醉開始 09:20 誘導結束 09:35 手術開始 10:45 手術結束 10:45 麻醉結束 11:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 探查性心包膜切開術 1 2 摘要__ 手術科部: 外科部 套用罐頭: Sternal approximation with skin closure 開立醫師: 羅健洺 開立時間: 2010/03/08 17:11 Pre-operative Diagnosis IAA, type A with VSD s/p total correction Post-operative Diagnosis Ditto Operative Method Sternal approximation with skin closure Specimen Count And Types Nil Pathology Nil Operative Findings The BP will drop to 40-50 mmHg without obvious wave form when sternum closed. thus we used a chorter syringe to approximate the sternum and closed the skin Operative Procedures Supine, ETGA, skin preparation, Hematoma evacuation. Try sternum closure, but failed. Sternum approximate with 1.5cm syringe bridege. skin approximated. Operators 黃書健 Assistants 徐綱宏,羅健洺 Indication Of Emergent Operation 賴建元 (M,1981/02/11,31y1m) 手術日期 2010/03/07 手術主治醫師 曾漢民 手術區域 東址 002房 01號 診斷 Secondary cancer of Brain and spinal cord 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2E 紀錄醫師 曾漢民, 時間資訊 09:26 通知急診手術 09:31 開始NPO 17:55 進入手術室 17:55 報到 18:00 麻醉開始 18:10 誘導結束 18:16 手術開始 20:15 手術結束 20:15 麻醉結束 20:25 進入恢復室 20:25 送出病患 21:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 手術 顱骨切除術，包括異物移除或減壓或神經切斷 1 1 摘要__ 手術科部: 外科部 套用罐頭: Craniectomy for debridement 開立醫師: 陳盈志 開立時間: 2010/03/07 20:36 Pre-operative Diagnosis Epidural abscess Post-operative Diagnosis Epidural abscess Operative Method Craniectomy for debridement Specimen Count And Types nil Pathology nil Operative Findings A thin layer of yellowish abscess and necrotic tissue was noted beneath the bone plate. Water irrigation system, left side in and right side out Operative Procedures 1.ETGA, supine 2.Disinfection and drapping 3.Open previous wound with blade and scissors 4.Remove miniplate and then remove bone plate. 5.Debridement was done and irrigation with N/S 6.Hemostasis 7.Set two epidural R/D as irrigation system 8.close wound in layers Operators VS曾漢民 Assistants R6陳盈志R2黃博誠 Indication Of Emergent Operation 姜陳素梅 (F,1955/07/17,56y7m) 手術日期 2010/03/07 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Subarachnoid hemorrhage 器械術式 EC-IC by-pass 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3E 紀錄醫師 賴碩倫, 時間資訊 01:57 臨時手術NPO 01:57 開始NPO 15:57 通知急診手術 16:30 進入手術室 16:35 麻醉開始 16:40 誘導結束 17:00 手術開始 17:30 抗生素給藥 20:30 抗生素給藥 00:30 抗生素給藥 01:50 手術結束 01:50 麻醉結束 02:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 11 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 開顱術摘除血管病變－腦血管瘤－有徵的 1 1 L 手術 開顱術摘除血管病變－腦血管瘤－有徵的 1 2 L 手術 顱內壓監視置入 1 4 記錄__ 手術科部: 外科部 套用罐頭: Left pterional approach for aneurysm clipping... 開立醫師: 李建勳 開立時間: 2010/03/08 02:27 Pre-operative Diagnosis Left ICA and Acom aneurysm Post-operative Diagnosis Left ICA and Acom aneurysm Operative Method Left pterional approach for aneurysm clipping and left Pannies point EVD insertion. Specimen Count And Types nil Pathology Nil Operative Findings The CSF opening pressure was around 20 cmH2O. The left ICA aneurysm was located distal to Pcom and proximal to ophthalamic artery, pointed upwards and was clipped with one Sugita aneurysm clip. The Acom aneurysm neck was about 3mm and was also clipped with one Sugita aneurysm clip. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position with head fixed with Mayfield skull clump. The scalp was shaved, scrubbed, disinfected with alcohol B-I then draped. Left frontotemporal scalp incision was made as usual pterional approach followed by craniotomy. The medial sphenoid ridge was further drill off by high speed air drill for wider operation field. Insertion of the EVD from left Kocher point was failed. Opened the dura in fish-mouth fasion after tenting around the craniotomy window. Inserted the Left Pannies point EVD. Skin incision over left neck 2 fb below the manduble angle and dissected to located the CCA, ICA and ECA. Prepaared the ICA for proximal control. Opened the sylvian fissure and relaxed the brain by releasing the CSF. Dissected the arachnoid to exspose the MCA, ICA and CN III. Followed the ICA to locate the aneurysm. Clipped the aneurysm with Sugita aneurysm clip. Traced the left A1 to the Acom and dissected the right A1 and A2. Isolated the Acom aneurysm and clipped the cneurysm with Sugita aneurysm clip. The dura was sutured with 4-0 Prolene. The skull plate was fixed back with miniplates and screws after central tenting and one subgaleal CWV drian set up. The temporalis fascia was sutured back and the wounds were closed in layers. Operators VS 王國川 Assistants R6 李建勳 R1 賴碩倫 Indication Of Emergent Operation 相關圖片 耿杰 (M,1976/09/04,35y6m) 手術日期 2010/03/08 手術主治醫師 陳沛裕 手術區域 東址 027房 04號 診斷 Clavicle fracture 器械術式 Remove of implant-Knowle's pin 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉漢平 ASA 3 紀錄醫師 姜志勇, 時間資訊 13:12 報到 13:35 進入手術室 13:40 麻醉開始 13:50 誘導結束 13:53 抗生素給藥 14:05 手術開始 15:25 手術結束 15:25 麻醉結束 15:45 送出病患 15:50 進入恢復室 17:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 骨內固定物拔除術－其他部位 2 1 L 摘要__ 手術科部: 骨科部 套用罐頭: Removal of implants (Knoles pin*1 + wire*1 fr... 開立醫師: 姜志勇 開立時間: 2010/03/08 15:21 Pre-operative Diagnosis 1.Left clavicle fracture s/p ORIF with Knowles pin + wire 2.Left foot fracture s/p ORIF with K-wire*7 Post-operative Diagnosis 1.Left clavicle fracture s/p ORIF with Knowles pin + wire 2.Left foot fracture s/p ORIF with K-wire*7 Operative Method Removal of implants (Knoles pin*1 + wire*1 from left clavicle; K-wire*7 from left foot) 3.The distal part of the broken K-wire was left in situ Specimen Count And Types nil Pathology Nil Operative Findings 1.Left clavicle fracture s/p ORIF with Knowles pin + wire 2.Left foot fracture s/p ORIF with K-wire*7 (including one broken K-wire) Operative Procedures 1. Anesthetic induction, supine position. 2. Skin disinfected and draped. 3. Skin incision over previous operation scar. 4. Dissected and exposed old implants; then removed. (Knoles pin*1 + wire*1 from left clavicle; K-wire*7 from left foot) 5. The distal part of the broken K-wire was left in situ 6. Irrigated with normal saline and hemostasis. 7. Closed wound by layers. Operators 陳沛裕, Assistants 姜志勇, 陳彥宇, 何進富 (M,1957/02/26,55y0m) 手術日期 2010/03/08 手術主治醫師 曾漢民 手術區域 東址 002房 02號 診斷 Meningitis 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 陳睿生, 時間資訊 11:33 報到 11:40 麻醉開始 11:45 誘導結束 11:45 進入手術室 12:17 手術開始 12:38 手術結束 12:38 麻醉結束 12:45 進入恢復室 12:45 送出病患 14:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 氣管切開造口術 1 0 摘要__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 陳睿生 開立時間: 2010/03/08 12:50 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Ditto Respiratory failure Operative Method Tracheostomy Specimen Count And Types nil Pathology None Operative Findings Fr.8 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After ETGA, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a Fr.8 low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators VS 曾漢民 Assistants R5 陳睿生, Ri 張穎環 (F,1951/05/01,60y10m) 手術日期 2010/03/08 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 陳建銘, 時間資訊 07:45 報到 08:05 進入手術室 08:20 麻醉開始 09:05 抗生素給藥 09:05 誘導結束 09:14 手術開始 11:30 麻醉結束 11:30 手術結束 11:35 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 腦瘤切除－手術時間在４小時以內 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: LEft frontal craniotomy for Simpson grade I t... 開立醫師: 李建勳 開立時間: 2010/03/08 11:46 Pre-operative Diagnosis Left frontal tumor suspect meningioma Post-operative Diagnosis Left frontal tumor suspect meningioma Operative Method LEft frontal craniotomy for Simpson grade I tumor excision Specimen Count And Types 1 piece About size:1.8x1.8x1.5cm Source:craniotomy tumor excision Pathology Pending Operative Findings The tumor was white-yellowish, elastic, size 1.8x1.8x1.5 cm, located at left frontal area with seperable margin from the surrounding brain parenchyma. Operative Procedures Under general anestheisa and intubation, the patient was put in supine position with head turned to right. The scalp was shaved, scrubbed, disinfected with alcohol b-I then draepd. The skin incision was made as pterioanl approach and followed by craniotomy over the tumor. The opened frontal sinus was sealed with bone wax after filled with B-I gelform. The dura was opened around the tumor after tenting around the craniotomy window. The tumor was dissected from the surrounding brain parenchyma with dissector and bipolar coagulated the feeder. Hemostasis was achieved with surgicel lining of the tumor bed. The duroplasty was performed with pericranium and 4-0 Prelene sutures. The opened frontal sinus was further sealed with pericranium flap. The skull plate was fixed back with miniplates and the wound was closed in layers after one subgaleal CWV drain set up. Operators VS 曾漢民 Assistants R6 李建勳 R1 陳建銘 相關圖片 陳佩如 (F,1982/11/20,29y3m) 手術日期 2010/03/08 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Astrocytoma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 2 紀錄醫師 陳建銘, 時間資訊 11:05 報到 11:52 進入手術室 12:00 麻醉開始 12:30 誘導結束 12:30 抗生素給藥 13:15 手術開始 15:30 抗生素給藥 17:05 麻醉結束 17:05 手術結束 17:12 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４～８小時 1 1 L 手術 顱內壓監視置入 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 摘要__ 手術科部: 外科部 套用罐頭: Left parietal craniotomy for tumor excision a... 開立醫師: 李建勳 開立時間: 2010/03/08 17:37 Pre-operative Diagnosis Left lateral ventricular tumor with hydrocephalus Post-operative Diagnosis Left lateral ventricular tumor with hydrocephalus Operative Method Left parietal craniotomy for tumor excision and EVD insertion Specimen Count And Types 1 piece About size:2g Source:craniotomy for tumor excision Pathology Frozen section: subependymal giant cell astrocytoma, pathology: pending Operative Findings The CSF gashed out after punctured into the ventricle with clear CSF drained out. The tumor was white-yellowish, elastic with moderate vascularity. Some of the blood supply was from the choroid plexus and coagulated during tumor excision. The cystic wall showed whitening change. The brain was slack down after released the CSF and tumor excision. Operative Procedures Under general anesthesia and intubation, the patient was put in prone position with head fixed with Mayfield skull clump. The scalp was shaved, scrubbed, disinfected with alcohol B-I then draped. Inverted U-shaped scalp incision was made at left parietal area followed by craniotomy. Transcortical incision was made after puncture into the ventricle and released the CSF for brain relaxation. The cystic wall was opened and bipolar coagulated. The tumor was coagulated and dissected from surrounding brain parenchyma. The choroid plexus with blood supply to the tumor was coagulated and cut. The tumor was send for frozen section. After total removed the tumor, the hemostasis was achieved with surgicel lining of the tumor bed. The EVD was set in the left lateral ventricle and fixed at the scalp. The duroplasty was performed with one fascia graft and 4-0 Prolene sutures. The skull plate was fixed back with wires and the wound was closed in layers after one subgaleal CWV set up. Operators VS 曾漢民 Assistants R6 李建勳 R1 陳建銘 相關圖片 吳龍夫 (M,1944/07/09,67y8m) 手術日期 2010/03/08 手術主治醫師 賴達明 手術區域 東址 002房 03號 診斷 顱內出血(ICH) 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3E 紀錄醫師 陳睿生, 時間資訊 11:38 通知急診手術 12:47 報到 13:10 進入手術室 13:15 麻醉開始 13:45 誘導結束 14:10 抗生素給藥 14:32 手術開始 17:10 抗生素給藥 18:00 麻醉結束 18:00 手術結束 18:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for hematoma evacuation 開立醫師: 陳睿生 開立時間: 2010/03/08 18:29 Pre-operative Diagnosis Left tempoparietal ICH Post-operative Diagnosis Left tempoparietal ICH Operative Method Craniotomy for hematoma evacuation Specimen Count And Types nil Pathology Nil Operative Findings Severe brain swelling was noted while dura opening. Mild SAH was also noted. The hematoma was about 60ml in amount. It was longitudinal shpae and extended from superior temporal region to parietal region. After hematoma removal, the brain was shrinked, and the pulsation was fair. No active bleeder was noted intra-op. Operative Procedures 1. ETGA, supine position with head right turn 2. Curvillinear scalp incision at tempoparietoccipital region 3. Creat three bur holes and an about 6x8cm craniotomy window was made 4. Dura tacking, and the dura was opened via the craniotomy margin 5. 3cm corticotomy was made at the lower part of parietal lobe 6. Find out the hematoma and evecuated with Fr.8 sucker 7. Nearly total remove of the hematoma, and hemostasis with surgicel 8. Dura closed tightly after deair 9. Fix back the skull graft with 4 gages of wires, and central tacking 10.Set a subgaleal CWV drain 11.Close the wound in layers Operators VS 賴達明 Assistants R5 陳睿生, Ri Indication Of Emergent Operation 花秋華 (F,1943/10/26,68y4m) 手術日期 2010/03/08 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Pathologic fracture of vertebrae 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 2 紀錄醫師 張皓鈞, 時間資訊 07:45 報到 08:00 進入手術室 08:10 麻醉開始 08:45 誘導結束 09:10 抗生素給藥 09:30 手術開始 12:10 抗生素給藥 14:45 手術結束 14:45 麻醉結束 14:55 送出病患 15:00 進入恢復室 17:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 手術 脊椎融合術－前融合，無固定物（＜＝四節） 1 2 摘要__ 手術科部: 外科部 套用罐頭: Posterior lateral internal fixation with tran... 開立醫師: 張皓鈞 開立時間: 2010/03/08 15:26 Pre-operative Diagnosis L4-5 Spondylolisthesis Post-operative Diagnosis L4-5 Spondylolisthesis Operative Method Posterior lateral internal fixation with transpedicle screw*4 (Right side L3,L5, Left side L4-L5)Rods *2 , and bony fusion with Cage No 11 *2 Specimen Count And Types nil Pathology Nil Operative Findings 1.Gr II spondylolisthesis over L4-5 with spinal stenosis 2.Servere oseteoporosis 2.Servere oseteoporosis with right side pedicle fracture Operative Procedures 1.ETGA prone position 2.Sterile with ALC BI over surgical field 3.Localized the L4-5 spine level under C arm guided 4.Incision at midline over lower back 5.Performed paraspinal spliting and Indentified the facet joint and transverse process 6.Applied the Transpedicle Screws over left side L4 L5 and right side L3 L5. 7.Applied Rods and fixation with the TPS 7.Applied Rods and fixation with the TPS ,and performed laminotomy and interbody fusion with cage and autologus bone graft 8.Hemostatsis 9.Applied Hemovac 10.Gentamicin N/S irrigation over the wound 11.Primary closure wound in layers Operators VS賴達明 Assistants R6 陳盈志 R1張皓鈞 朱璽恩 (F,2010/02/19,2y0m) 手術日期 2010/03/08 手術主治醫師 黃書健 手術區域 兒醫 068房 02號 診斷 Interruption of aortic arch 器械術式 C.O.A. (Aortaplasty) 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 4 紀錄醫師 羅健洺, 時間資訊 13:22 臨時手術NPO 14:05 進入手術室 14:10 麻醉開始 14:12 誘導結束 14:20 手術開始 15:10 手術結束 15:10 麻醉結束 15:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 探查性心包膜切開術 1 2 摘要__ 手術科部: 外科部 套用罐頭: Sternum closure 開立醫師: 羅健洺 開立時間: 2010/03/08 17:13 Pre-operative Diagnosis IAA type A with VSD s/p total correction Post-operative Diagnosis Ditto Operative Method Sternum closure Specimen Count And Types Nil Pathology Nil Operative Findings No blood clot noted. Post op BP: 88/55mmHg, CVP 14-16mmHg, No surgical membrane used. Operative Procedures Supine, ETGA, skin preparation. Irrigate mediastinum with diluted Vancomycin, G.M. and B-I solution. hemostasis. Closed wound in layers. Operators 陳益祥 Assistants 徐綱宏,羅健洺 許力平 (M,1968/08/18,43y6m) 手術日期 2010/03/08 手術主治醫師 蕭輔仁 手術區域 東址 003房 02號 診斷 Spinal cord injury 器械術式 Laminectomy for decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 張皓鈞, 時間資訊 15:10 進入手術室 15:15 麻醉開始 15:25 誘導結束 15:50 抗生素給藥 16:04 手術開始 18:20 手術結束 18:20 麻醉結束 18:35 送出病患 18:35 進入恢復室 20:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術（特壓）－超過二節 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 復健部 套用罐頭: T11-L1 Laminectomy 開立醫師: 張皓鈞 開立時間: 2010/03/08 18:40 Pre-operative Diagnosis T12-L1 fracture dislocation status post TPS fixation with canal stenosis Post-operative Diagnosis T12-L1 fracture dislocation status post TPS fixation with canal stenosis Operative Method T11-L1 Laminectomy Specimen Count And Types nil Pathology Nil Operative Findings 1.Severe adhesion 2.TPS from T11 to L1 3.mild spinal stnosis over T12 L1 4.Suspected Dura avulsion and T12 L1 rootlet exposure Operative Procedures 1.ETGA prone 2.Sterile with ALC BI over surgical field 3.Incision over previous scar 4.Dissected in layers and exposure the previous TPS and the lamina 5.Performed laminectomy 6.Hemostasis and pack with Geoform 7.Set one CWV 8.N/S irrigation 9.Primary clsoure wound in layers Operators VS蕭輔仁 Assistants R6陳盈志 R1張皓鈞 錢嘉明 (M,1951/09/14,60y6m) 手術日期 2010/03/08 手術主治醫師 王國川 手術區域 東址 016房 04號 診斷 Unspecified cerebral artery occlusion 器械術式 Brain tumor Crainotomy(Others) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 4E 紀錄醫師 鍾文桂, 時間資訊 13:25 進入手術室 13:30 麻醉開始 13:45 誘導結束 14:15 抗生素給藥 14:43 手術開始 15:00 報到 17:15 抗生素給藥 18:15 麻醉結束 18:15 手術結束 18:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 1 手術 顱內壓監視置入 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 摘要__ 手術科部: 神經部 套用罐頭: 1. External ventricular drainage tube inserti... 開立醫師: 鍾文桂 開立時間: 2010/03/08 19:39 Pre-operative Diagnosis Right cerebellar ischemic infart with brain swelling and brainstem compression. Post-operative Diagnosis Right cerebellar ischemic infart with brain swelling and brainstem compression. Operative Method 1. External ventricular drainage tube insertion via right Frazier. 2. Decompressive craniecomty, and partial resection of right cerebellar hemisphere. Specimen Count And Types 1 piece About size:5 CC Source:CSF. Pathology Nil. Operative Findings 1. Infarted right cerebellar hemisphere with brain swelling. 2. Right Frazier EVD: insert 9 cm;low ICP intraoperatively, below 10 cmH2O. Operative Procedures Anesthesia: endotracheal, general. Position: head in midline, fixed by Mayfield, prone position. Shaving, disinfection, Draping. Right Frazier EVD insertion after burr hole,then wound closure in layers. Midline incision at suboccipital area. 1 cm above inion, up to C2 level. Craniectomy to expose bilateral cerebellar hemisphere. Clipping of occipital sinus and durotomy accross occipital sinus. Partial resection of infarcted right cerebellar hemisphere including tonsil. Well hemostasis with bipolar coagulator and Sugicel. Dural augmentation with fascia graft. Placement of one CWV drain at epidural space. Wound closure in layers. Operators V.S. 王國川. Assistants R4鍾文桂,Ri 曾育昇. Indication Of Emergent Operation 歐張玉霞 (F,1933/08/11,78y7m) 手術日期 2010/03/09 手術主治醫師 蔡瑞章 手術區域 東址 003房 02號 診斷 Subdural hemorrhage 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 曾峰毅, 時間資訊 11:01 通知急診手術 14:35 報到 14:45 進入手術室 14:50 麻醉開始 14:55 誘導結束 15:05 抗生素給藥 15:20 手術開始 16:25 麻醉結束 16:25 手術結束 16:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Chronic Subdural Hematoma 開立醫師: 曾峰毅 開立時間: 2010/03/09 16:26 Pre-operative Diagnosis Right chronic subdural hematoma Post-operative Diagnosis Right chronic subdural hematoma Operative Method Burr hole for drainage Specimen Count And Types Nil Pathology Nil Operative Findings Dark-brownish subdural effusion was drained at right. Outer membrane(+) Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to left. After scalp scrubbed, disinfected, and then draped, we made on linear skin incision at right frontal. We drilled one burr hole, and tented the dura. Dura was opened, and one subdural rubber drain was inserted for drainage. Normal saline irrigation was done at subdural space. The wound was closed in layers after hemostasis. We deair the subdural space with normal saline. Operators P 蔡瑞章 Assistants R5 陳睿生 R3 曾峰毅 Indication Of Emergent Operation 黃金嬌 (F,1942/09/06,69y6m) 手術日期 2010/03/09 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Parkinsonism (F02.3) 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 胡朝凱, 時間資訊 07:50 報到 08:03 麻醉開始 08:03 進入手術室 08:10 誘導結束 08:38 抗生素給藥 09:01 手術開始 10:12 手術結束 10:12 麻醉結束 10:22 送出病患 10:23 進入恢復室 11:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Left battery insertion 開立醫師: 胡朝凱 開立時間: 2010/03/09 10:19 Pre-operative Diagnosis Parkinson disease Post-operative Diagnosis Parkinson disease Operative Method Left battery insertion Specimen Count And Types Nil Pathology Nil Operative Findings Battery was inserted at left subclavicular area Operative Procedures 1.ETGA, supine 2.Left post-auricular area skin incision 3.Identified electric wire 4.Made a transverse skin incision at left subclavicular area 5.Made a pouch 6.Made a subcutanneous tunnel 7.pass the catheter 8.Connect to the battery and electric wire 9.Insertion and close wound in layers Operators 曾勝弘 Assistants 胡朝凱 張菫宸 (M,1997/11/12,14y4m) 手術日期 2010/03/09 手術主治醫師 曾勝弘 手術區域 東址 005房 02號 診斷 Spine compression, sequelae 器械術式 OPLL-Anterior Corpectomy VSLai 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 胡朝凱, 時間資訊 10:30 報到 10:45 進入手術室 10:50 麻醉開始 11:10 誘導結束 11:30 抗生素給藥 11:45 手術開始 14:30 抗生素給藥 15:17 手術結束 15:17 麻醉結束 15:30 送出病患 15:35 進入恢復室 16:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術－前融合，有固定物（＜＝四節） 1 2 手術 椎間盤切除術－頸椎 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: T1 corpectomy with cage insertion plus plate ... 開立醫師: 胡朝凱 開立時間: 2010/03/09 15:29 Pre-operative Diagnosis T1 compression fracture Post-operative Diagnosis T1 compression fracture Operative Method T1 corpectomy with cage insertion plus plate fixation Specimen Count And Types some piece of bone chips Pathology T1 bone chips Operative Findings 1.Compression fracture of T1 and peripheral adhesion lesion was noted. 2.The bone became loosened and fibrotic. 3.The PLL became thick and adhere to dura with fibrotic tissue 4.After decompression, the thecal sac expanded Operative Procedures 1.ETGA, supine 2.Right supraclavicular area transverse skin incision 3. 3.dissect along the anterior border of SCM muscle to expose pre-vertebral space 4.detach longus coli muscle 5.C7~T1 and T1~2 diskectomy 6.T1 corpectomy 7.Remove PLL 8.Cage insertion with artificial bone 9.plate fixation 10.set hemovac drain 11.close wound inlayers Operators 曾勝弘 Assistants 胡朝凱 黃瑞川 (M,1965/01/14,47y2m) 手術日期 2010/03/09 手術主治醫師 曾勝弘 手術區域 西址 033房 1號 診斷 Lipoma 器械術式 Scalp tumor 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 09:30 報到 09:50 進入手術室 10:22 麻醉開始 10:27 手術開始 10:27 誘導結束 10:50 麻醉結束 10:50 手術結束 11:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 頭皮腫瘤 1 2 L 手術 頭皮腫瘤 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: bilateral scalp tumor excision 開立醫師: 陳德福 開立時間: 2010/03/09 11:10 Pre-operative Diagnosis sccalp tumor,right nevus and left lipoma Post-operative Diagnosis ditto Operative Method bilateral scalp tumor excision Specimen Count And Types 2 pieces About size:0.5*0.5*0.5cm Source:scalp nevus About size:2*2*3cm Source:scalp tumor Pathology pending Operative Findings 1.There is a 0.5*0.5*0.5cm fungative mass lesion at the right occipital scalp without local inflammation or discharge. 2.There is a subcutanousl, soft, yellowish, elastic and well capsulated tumor over the left occipital scalp. The tumor is 2*2*3cm in size and we removed it totally. Operative Procedures Under LA, the paitent had prone position. The scalp was disinfected and draped as usual. One fusiform scalp incision around the nevus was done and the tumor was removed followed by primary clousure. Another linear incision was done one the left occipital scalp and the subcutaneous lipomatous tumor was removed. The wound was closed in layers. Operators VS 曾勝弘 Assistants r4 陳德福 葉光政 (M,1950/03/10,62y0m) 手術日期 2010/03/09 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Lumbar spondylosis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳睿生, 時間資訊 07:50 報到 08:05 進入手術室 08:10 麻醉開始 08:20 誘導結束 09:05 抗生素給藥 09:30 手術開始 12:14 抗生素給藥 13:20 手術結束 13:20 麻醉結束 13:30 送出病患 13:33 進入恢復室 14:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 手術 椎弓切除術（特壓）－二節以內 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: L3/4, 4/5 sublaminar decompression and L4/5 T... 開立醫師: 陳睿生 開立時間: 2010/03/09 13:52 Pre-operative Diagnosis L4/5 spondylolithesis with lumbar stenosis Post-operative Diagnosis L4/5 spondylolithesis with lumbar stenosis Operative Method L3/4, 4/5 sublaminar decompression and L4/5 TPS with Dynesys Specimen Count And Types nil Pathology Nil Operative Findings Narrowing canal space were noted over L3/4, 4/5, and the thecal sac was well decompressed after removal of ligamentum flvum and spur. Dynesys transpedicular screws were implanted at L4, 5 level. The screws were 6.4 x 45mm and the flexible rods were 2.25cm at left side and 1.75cm at right side. Operative Procedures 1. ETGA, prone position, and C-arm localized L4/5 level 2. Low back midline incision, and expose the fascia 3. Bilateral paraspinal muscular incision about 3cm, and the muscle was splitted to find out the L4, L5 transverse processs and facets 4. Dynesys screws were implanted at L4, 5 level, and C-arm recheck the position of the screws 5. Set the flexible rods 6. Split the L4 spinous process with sew 7. Remove of the L4 lamina for decompression 8. Remove of ligamentum flavum and spurs for decompression 9. Hemostasis, set 1/8 hemovac x2 inside bilateral muscular layers and CWV x1 at epidural space 10.Close the wound in layers Operators VS 賴達明 Assistants R5 陳睿生, Ri 蔡玉成 (M,1939/08/09,72y7m) 手術日期 2010/03/09 手術主治醫師 林峰盛 手術區域 西址 035房 3號 診斷 Spinal stenosis 器械術式 Nerve block / PC 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 林峰盛 ASA 3 時間資訊 13:30 報到 14:10 進入手術室 14:15 麻醉開始 14:17 誘導結束 14:20 手術開始 14:55 麻醉結束 14:55 手術結束 15:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 末稍神經阻斷術 6 0 B 摘要__ 手術科部: 麻醉部 套用罐頭: LENB 開立醫師: 林峰盛 開立時間: 2010/03/09 15:01 Pre-operative Diagnosis 1.spinal stenosis 2. radiculopathy Post-operative Diagnosis 1. spinal stenosis 2. radiculopathy Operative Method 1.lumbar epidural steroid inection 2. diagnostic facet block Specimen Count And Types nil Pathology Nil Operative Findings L3-4 filling defect of contrast media Operative Procedures LA with 1% xylocaine 5 ml pt in prone position 3. Under fluoroscopic-guiddance, LENB was done to L3-4 level with 16G Tuohy needle, 60mg Kenaocrt in 0.5% xylocaine 10ml was given after contrast media injection 4. Bil L3-5 daignostic block facet with kenacort 3 mg in 0.5 Marcine 1 ml Operators 林峰盛 Assistants 陳心言 徐瑞月 (F,1958/01/01,54y2m) 手術日期 2010/03/09 手術主治醫師 黃國皓 手術區域 東址 015房 05號 診斷 Brain tumors, malignant 器械術式 Double-J ureteral stent insert 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 面罩麻醉 麻醉主治醫師 葉惠敏 ASA 4 紀錄醫師 周淇業, 時間資訊 14:30 進入手術室 14:35 麻醉開始 14:40 誘導結束 14:45 抗生素給藥 15:07 手術開始 15:30 手術結束 15:30 麻醉結束 15:35 送出病患 15:37 進入恢復室 17:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Semi-opened mask inhalation anes 1 0 手術 雙丁輸尿管導管置入術 1 0 B 摘要__ 手術科部: 泌尿部 套用罐頭: DBJ stent insertion 開立醫師: 周淇業 開立時間: 2010/03/09 14:34 Pre-operative Diagnosis Bilateral obstructive uropathy Post-operative Diagnosis bilateral obstructive uropathy Operative Method cystoscopy and DBJ insertion cystoscopy and DBJ insertion (Right: 6-24 cm tumorstent, Left: 6-22 cm DBJ) Specimen Count And Types Nil. Pathology nil Operative Findings Right: 6-24 cm tumorstent, Left: 6-22 cm DBJ were inserted smoothly Operative Procedures Under satisfactory anesthesia with the patient in lithotomy position, prepping and drapping was performed in the usual sterile fashion. A Fr 21 Olympus cystoscope was introduced into the bladder cavity under direct vision. Careful inspection was done andDBJ was inserted. Patient tolerated the procedure very well and was sent to recovery room in satisfactory condition. Under satisfactory anesthesia with the patient in lithotomy position, prepping and drapping was performed in the usual sterile fashion. A Fr 21 Olympus cystoscope was introduced into the bladder cavity under direct vision. Careful inspection was done and left DBJ was inserted. Right previous DBJ was retrieved by grasp and introduced by guidewire. Right 6-24 cm tumorstent was inserted through guidewire under fluoroscopy guidance. 16Fr. Foley catheter was indwelled smoothly. Patient tolerated the procedure very well and was sent to recovery room in satisfactory condition. Operators 黃國皓 Assistants 周淇業,葉庭豪 華靜芬 (F,1969/01/27,43y1m) 手術日期 2010/03/09 手術主治醫師 陳敞牧 手術區域 東址 016房 01號 診斷 Sprain, back 器械術式 Benign intraspinal tumor, exci 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 李建勳, 時間資訊 09:15 報到 09:30 進入手術室 09:35 麻醉開始 10:00 誘導結束 10:15 抗生素給藥 11:15 手術開始 14:10 抗生素給藥 14:35 手術結束 14:35 麻醉結束 14:45 送出病患 14:50 進入恢復室 16:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 手術 惡性病髓腫瘤切除術 1 1 手術 椎間盤切除術－頸椎 1 2 摘要__ 手術科部: 外科部 套用罐頭: C5 corpectomy, C4/5,5/6 disckectomy and body ... 開立醫師: 李建勳 開立時間: 2010/03/09 15:03 Pre-operative Diagnosis Multiple cervical spine tumor with C5 cord compression Post-operative Diagnosis Multiple cervical spine tumor with C5 cord compression Operative Method C5 corpectomy, C4/5,5/6 disckectomy and body cage insertion Specimen Count And Types 1 piece About size:0.5g Source:C5 body tumor Pathology Pending Operative Findings The C5 vetebral body was collapsed. The dura expansion well after C5 corpectomy and disckectomy. ADD plus CS22511217 (A spine) body cage with four 14mm screws were used. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position with neck extension. The C5/6 space was located with portable C-arm X-ray. The skin over anterior neck was scrubbed, disinfected with alcohol b-I then draped. Transverse skin incision was made at right neck and dissected to expose the anterior vetebral body. The C5/6 space was further checked with portable X-ray. The C4/5, 5/6 disckectomy and C5 corpectomy were performed with curetage, disc clump and high speed air drill. The endplate was smoothen before cage insertion. The position and the screws were checked with C-arm X-ray after insertion. One minihemovac was inserted at wound before the wound closed in layers. Operators VS 陳敞牧 Assistants R6 李建勳 Indication Of Emergent Operation 相關圖片 徐金龍 (M,1947/11/20,64y3m) 手術日期 2010/03/09 手術主治醫師 周介仁 手術區域 東址 026房 2號 診斷 Cataract 器械術式 Phaco+PCIOL 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 09:10 報到 09:35 進入手術室 09:40 麻醉開始 09:44 麻醉結束 10:02 手術開始 10:33 手術結束 10:35 送出病患 摘要__ 手術科部: 眼科部 套用罐頭: Phaco-Temporal (周介仁) 開立醫師: 黃宇軒 開立時間: 2010/03/09 10:33 Pre-operative Diagnosis Cataract (os) Post-operative Diagnosis Pseudophakia (os) Operative Method Phacoemulsification and PCIOL implantation (os) Specimen Count And Types nil Pathology Nil Operative Findings Cataract (os) Operative Procedures 1. Under peribulbar anesthesia 2. Disinfection, irrigation and draping. 3. Application of an eyelid speculum. 4. Made a clear corneal incision and penetrate into AC with 2.5mm cresent knife at 10 oclock position . 5. Inject Viscoat into the anterior chamber. 6. Continuous circular capsulorrhexis was done with capsular forceps. 7. Made a sideport at 5 oclock position with the MVR blade. 8. Hydrodissection and hydrodelineation were done with BSS. 9. Phacoemulsification of the nucleus by standard divide-and-conquer technique. 10. Aspiration of the residual cortical material with I/A cannula. 11. One-piece PCIOL was implanted into the bag after injection of Viscoat. 12. The residual Viscoat was washedout by Simcoe I/A cannula. 13. Inject BSS into AC and check leakage. 14. Subconjunctival injection of Rinderon and Gentamicin. 15. Maxitrol patching Operators VS周介仁 Assistants R3黃宇軒 陳沛沅 (M,2009/03/14,3y0m) 手術日期 2010/03/09 手術主治醫師 楊士弘 手術區域 兒醫 067房 01號 診斷 Anomalies of skull and face bones 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 鍾文桂, 時間資訊 07:55 報到 08:04 進入手術室 08:30 麻醉開始 09:35 誘導結束 09:55 抗生素給藥 10:32 手術開始 10:45 開始輸血 12:55 抗生素給藥 16:00 抗生素給藥 18:20 麻醉結束 18:20 手術結束 18:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱骨切除術，包括異物移除或減壓或神經切斷 1 1 手術 腦室體外引流 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 12 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 4 0 麻醉 Hemoglobin (Hb) 4 0 麻醉 測血糖 4 0 麻醉 Ca (Calcium) 4 0 麻醉 Na (Sodium) 4 0 麻醉 K (Potassium) 4 0 麻醉 Cl (Chloride) 4 0 麻醉 Blood gas analysis 4 0 手術 顱顏合併手術 1 1 摘要__ 手術科部: 外科部 套用罐頭: Fronto-orbital craniectomy for reconstruction... 開立醫師: 鍾文桂 開立時間: 2010/03/09 17:58 Pre-operative Diagnosis Craniosynostosis due to Crouzon syndrome. Post-operative Diagnosis Craniosynostosis due to Crouzon syndrome. Operative Method Fronto-orbital craniectomy for reconstruction of cranial vault. EVD at right Kocher point. Specimen Count And Types nil Pathology Nil. Operative Findings Bicoronal wound scar was seen. After reflexion of scalp flap, craniotomy edges from the previous operation was seen. Tight adhesion of the dura mater with skull bone was noted especially around the previous craniotomy edges and anterior fontanelle. Temporary EVD was inserted for CSF drainage to decompress the swollen brain. The brain became less tense after CSF drainage. The coronal suture was fused, but not the metopic suture. Operative Procedures Anesthesia: general, endotracheal. Position: supine, head in midline, fixed on horse shoes head rest. Shaving, disinfection, and draping. Incision: along the previous operative bicoronal wound. Subgaleal dissection down to roof of the orbital cavity. Periosteum dissection from the skull bone. Bilateral superior orbital nerve were released. Two burr holes were made at bilateral keyhole. Two burr holes were made at forehead due to severe adhesion of the dura mater to skull bone. Dissection of the anterior fontanelle from the skull bone. Craniectomy down to anterior skull base, lateral to squamous bone, and posterior to the previous craniotomy edge. Dural repair of the dura tear with primary suture and DuraGen. A durotomy at right Kocher point. Insert Negaton tube for CSF drainage. Cranial valut reconstruction was done by Plastic surgeons. Set up one CWV drain. Remove Negaton tube. Close wound in layers.Send the patient to ICU smoothly. Operators V.S. 楊士弘 Assistants R4 鍾文桂. 張愷恩 (M,1985/05/05,26y10m) 手術日期 2010/03/10 手術主治醫師 蔡瑞章 手術區域 東址 005房 01號 診斷 Pituitary tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳建銘, 時間資訊 07:55 報到 08:02 進入手術室 08:10 麻醉開始 08:35 誘導結束 08:50 抗生素給藥 09:25 手術開始 11:50 抗生素給藥 13:25 麻醉結束 13:25 手術結束 13:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經由蝶竇之腦下垂體瘤切除 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 摘要__ 手術科部: 外科部 套用罐頭: Endoscopic transsphenoid adenomectomy 開立醫師: 李建勳 開立時間: 2010/03/10 13:56 Pre-operative Diagnosis Pituitary adenocarcinoma, suspect apoplexy Pituitary adenoma, suspect apoplexy Post-operative Diagnosis Pituitary adenocarcinoma Pituitary adenoma Operative Method Endoscopic transsphenoid adenomectomy Specimen Count And Types 1 piece About size:0.5g Source:Pituitary tumor Pathology Pending Operative Findings The tumor was about 1cm in diameter, with some yellowish, gelatin-like content inside the tumor. The CSF leakage was sealed with gelform and Tissucol Duo. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position. The skin over face was disinfected with alcohol B-I and the nasal mucosa was disinfected with aqueous B-I then draped. Set up the Endoscope system with arm-support. The nasal mucosa was coagulated and the spenoid sinus was drilled opened then widened with Kerrison punch. The mucosa inside the spenoid sinus was removed with aligator. The posterior sphenoid sinus floor was removed to expose the dura. The dura was bipolar coagulated and incised in cruciate fashion. The tumor was removed with ring curette and aligator. The CSF leakage was sealed with gelform and Tissucol Duo. The sphenoid flood was recontructed with bone fragments. The nasal mucosa was packing with one finger of gloove filled with vasline gauze soaked in B-I ointment. Operators P 蔡瑞章 VS 楊士弘 Assistants R6 李建勳 R1 陳建銘 相關圖片 黃毓婷 (F,1977/12/17,34y2m) 手術日期 2010/03/10 手術主治醫師 蔡瑞章 手術區域 東址 005房 02號 診斷 Oligodendroglioma 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳建銘, 時間資訊 13:03 報到 13:50 進入手術室 13:58 麻醉開始 14:25 誘導結束 14:50 抗生素給藥 15:25 手術開始 17:50 抗生素給藥 18:25 麻醉結束 18:25 手術結束 18:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４小時以內 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 摘要__ 手術科部: 外科部 套用罐頭: Right parietal craniotomy for tumor excision ... 開立醫師: 李建勳 開立時間: 2010/03/10 18:57 Pre-operative Diagnosis Right parietal ICH, suspect tumor bleeding Post-operative Diagnosis Right parietal ICH, suspect tumor bleeding Operative Method Right parietal craniotomy for tumor excision and hematoma evacuation Specimen Count And Types 2 pieces About size:3g Source:hematoma About size:1g Source:perihematoma brain tissue Pathology Pending Operative Findings The hematoma was located at right parietal with dark reddish blood aspirated out for 30mL. Some blood clot was found with perihematoma necrotic brain tissue and gliosis tissue. Operative Procedures Under general anesthesia and intubation, the patient was put in prone position with head fixed with Mayfield skull clump. The scalp was shaved, scrubbed, disinfected with alcohol B-I then draped. The inverted U-shaped scalp incision was made at right parietal area followed by craniotomy. The tumor was located with intraoperative sonography. The dura was opened after tenting. The liquified hematoma was aspirated by 14G catheter for decompression first. The hematoma and perihematoma tissue were removed via transcortical approach. Hemostasis was achieved with surgicel lining of the hematoma cavity. The dura was closed with 4-0 Prolene sutures and the skull plate was fixed back with wires. The wound was closed in layers after one subgaleal CWV drain set up. Operators P 蔡瑞章 Assistants R6 李建勳 R1 陳建銘 相關圖片 劉昌壽 (M,1941/12/15,70y2m) 手術日期 2010/03/10 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Cerebral aneurysm 器械術式 Craniotomy(Aneurysms) P-DUH 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 賴碩倫, 時間資訊 07:52 報到 08:05 進入手術室 08:25 麻醉開始 09:05 誘導結束 09:20 抗生素給藥 09:40 手術開始 12:22 抗生素給藥 13:30 開始輸血 14:30 麻醉結束 14:30 手術結束 14:35 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 開顱術摘除血管病變－腦血管瘤－無徵的 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Left Pterion approach aneurysm clipping 開立醫師: 陳盈志 開立時間: 2010/03/10 14:53 Pre-operative Diagnosis Left MCA bifurcation aneurysm Post-operative Diagnosis Left MCA bifurcation aneurysm Operative Method Left Pterion approach aneurysm clipping Specimen Count And Types nil Pathology nil Operative Findings The sylvian fissure was opened and one aneurysm from MCA bifurcation was noted protruding upward laterally. The dome was about 6mm. One straight clip was applied. 2 branches was identified and preserved. Operative Procedures Under the general anesthesia with endotracheal tube intubation, the patient was set into supine position with head tilt to right and fixed with Mayfield Skin preparation was done with alcohal-betaiodine and then drapped. Left F-T curvilinear scalp incision was done and then detach temporalis muscle with muscle cuff. 3 burr hole was made and then craniotomy was done Flatten sphenoid ridge then C-shape dura opening was done Open sylvian fissure with microscissor and dissecter till well exposure of M1 and bifurcation. Applied one template clip to M1 then straight clip for clipping. Then cauterize the aneurysm till shrinkage and remove template clip Hemostasis was done with bipolar and surgicel packing .Dura closure with 4-0 prolene and fix bone plate with miniplate. Close wound with subgaleal CWV drain x 1 Operators VS賴達明 Assistants R6陳盈志R1賴碩倫 陳豐麥 (M,1981/09/14,30y6m) 手術日期 2010/03/10 手術主治醫師 王國川 手術區域 東址 001房 04號 診斷 Epidural hemorrhage 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 3 紀錄醫師 張皓鈞, 時間資訊 21:27 臨時手術NPO 21:27 開始NPO 23:28 通知急診手術 00:25 報到 00:31 進入手術室 00:35 麻醉開始 01:10 誘導結束 01:15 抗生素給藥 01:21 手術開始 03:30 麻醉結束 03:30 手術結束 03:35 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 硬腦膜外血腫清除術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for hematoma remove 開立醫師: 陳睿生 開立時間: 2010/03/10 03:22 Pre-operative Diagnosis Right frontotemporal epidural hematoma Post-operative Diagnosis Right frontotemporal epidural hematoma Operative Method Craniotomy for hematoma remove Specimen Count And Types nil Pathology Nil Operative Findings Organized hematoma was noted at right frontal region. The thickness was about 3cm. A linear skull fracture was noted at temporal region. Middle meningeal arteral bleeding was also noted. After hematoma removal, the brain was decompressed and under well pulsation. Operative Procedures 1. ETGA, supine position with head left turn 2. Right fronrtotemporal curvillinear scalp incision 3. Dissect the temporalis muscle, and well preserved the frontalis br. of facial nerve 4. Make two bur holes, and create a craniotomy window about 6x6cm 5. Hematoma evacuation, and electric ligation of the middle meningeal artery 6. Hemostasis, and well dura tacking 7. Fix back the skull graft with 2 gages of wires, and miniplate x3 after central tacking 8. Set a subgaleal CWV drain, and suture back the temporalis muscle 9. Close the wound in layers Operators VS 王國川 Assistants R5 陳睿生, R3 曾峰毅, R1 張皓鈞 Indication Of Emergent Operation 劉昇展 (M,1974/01/06,38y2m) 手術日期 2010/03/11 手術主治醫師 黃國皓 手術區域 東址 053房 07號 診斷 Colon cancer of sigmoid colon 器械術式 Double-J ureteral insert/WOR 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 面罩麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 蔡博超, 時間資訊 15:30 報到 15:36 進入手術室 15:40 麻醉開始 15:50 誘導結束 16:05 手術開始 16:15 手術結束 16:15 麻醉結束 16:20 送出病患 16:23 進入恢復室 17:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Semi-opened mask inhalation anes 1 0 手術 雙丁輸尿管導管置入術 1 0 L 摘要__ 手術科部: 泌尿部 套用罐頭: DBJ stent replacement 開立醫師: 蔡博超 開立時間: 2010/03/11 16:27 Pre-operative Diagnosis Left obstructive uropathy Post-operative Diagnosis Left obstructive uropathy Operative Method cystoscopy and DBJ insertion Specimen Count And Types nil Pathology nil Operative Findings 1. Encrustation of previous DBJ 2. Turbid urine in urinary bladder Operative Procedures Under satisfactory anesthesia with the patient in lithotomy position, prepping and drapping was performed in the usual sterile fashion. A Fr 21 Olympus cystoscope was introduced into the bladder cavity under direct vision. Careful inspection was done and the previous left DBJ was removed. The new DBJ was inserted. Patient tolerated the procedure very well and was sent to recovery room in satisfactory condition. Operators 黃國皓, Assistants 蔡博超, 翁文慶, 周慶 (M,1954/03/22,57y11m) 手術日期 2010/03/11 手術主治醫師 曾漢民 手術區域 東址 003房 02號 診斷 Brain cancer 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 污染 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3 紀錄醫師 賴碩倫, 時間資訊 10:55 報到 11:25 麻醉開始 11:25 進入手術室 11:35 誘導結束 11:50 抗生素給藥 11:55 手術開始 14:00 手術結束 14:00 麻醉結束 14:10 進入恢復室 14:10 送出病患 15:23 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 深部複雜創傷處理－傷口長５－１０公分者 1 0 L 記錄__ 手術科部: 外科部 套用罐頭: 1. Wound debridement 開立醫師: 賴碩倫 開立時間: 2010/03/11 14:31 Pre-operative Diagnosis 1. Atypical meningioma s/p operation 2. Skull wound infection 3. CSF leakage from previous burr hole Post-operative Diagnosis 1. Atypical meningioma s/p operation 2. Skull wound infection 3. CSF leakage from previous burr hole Operative Method 1. Wound debridement 2. Lumbar drain insertion Specimen Count And Types nil Pathology nil Operative Findings 1. Unhealing wound with granulation tissue but good blood supply over parietal region 2. CSF leakage from previous burr hole 3. CSF : clear Operative Procedures 1. ETGA, right decubitus, well draped 2. Perform lumbar drain insertion from L4-L5 3. Skin incision from previous surgical scar at parietal region of skull. 4. Perform curette and debridement 5. N/S irrigation 6. Close wound with Nylon by continuous mattrex suture. Operators VS曾漢民 Assistants R5陳睿生 R1賴碩倫 曾碧霜 (F,1932/02/25,80y0m) 手術日期 2010/03/12 手術主治醫師 詹志洋 手術區域 東址 001房 05號 診斷 Atherosclerosis of the extremities with gangrene 器械術式 Embolectomy, Thrombectomy 手術類別 緊急手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 3E 紀錄醫師 謝永, 時間資訊 00:00 開始NPO 15:44 通知急診手術 23:00 報到 23:07 進入手術室 00:00 麻醉開始 00:10 誘導結束 00:55 抗生素給藥 01:00 手術開始 02:40 麻醉結束 02:40 手術結束 02:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 動脈內膜切除術 1 1 L 手術 血管整形術 1 0 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Thrombectomy to left popliteal a. + PTA to le... 開立醫師: 謝永 開立時間: 2010/03/12 03:26 Pre-operative Diagnosis PAOD, left leg, with left leg gangrenous change Post-operative Diagnosis Ditto Operative Method Thrombectomy to left popliteal a. + PTA to left popliteal a. + intra-arterial sheath implantation Specimen Count And Types 1 piece About size:Intima Source:Intima Pathology Intima Operative Findings Severe atherosclerotic change over left CFA, SFA and popliteal a. Hard, calcified thrombus over left popliteal a. => Failed with Fogaty catheter thrombectomy Total occlusion below distal L. SFA, with much collaterals downward Both wet and dry gangrenous change over left lower legs Operative Procedures Under supine position, the patient was intubated with general anesthesia. After skin disinfection, left inguinal incision was made, with exposure to left CFA. Thrombectomy with 4 Fr and 5.5 Fr Fogaty catheter was performed to left popliteal a, but failed. PTA was performed to left popliteal a. with Wanda 5.0 mm. Repeated thrombectomy failed. The L. CFA was repaired after endarectomy, with set-up of intra-arterial sheath into left popliteal a. The wound was then closed in layers. Operators 詹志洋 Assistants 謝永？,覃紹殷 Indication Of Emergent Operation 黃佩雯 (F,1969/01/20,43y1m) 手術日期 2010/03/11 手術主治醫師 陳敞牧 手術區域 東址 005房 01號 診斷 Spinal tumor 器械術式 Benign intraspinal tumor, exci 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 李振豪, 時間資訊 07:38 報到 08:03 進入手術室 08:15 麻醉開始 08:40 誘導結束 09:12 抗生素給藥 09:25 手術開始 12:10 抗生素給藥 13:10 手術結束 13:10 麻醉結束 13:20 送出病患 13:25 進入恢復室 14:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 良性病髓腫瘤切除術 1 1 手術 椎弓切除術（特壓）－二節以內 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 摘要__ 手術科部: 外科部 套用罐頭: 1. L3 and 4 laminectomy for total tumor excis... 開立醫師: 李建勳 開立時間: 2010/03/11 13:04 Pre-operative Diagnosis L4/5 intraspinal tumor suspect neuroma Post-operative Diagnosis L4/5 intraspinal tumor suspect neuroma Operative Method 1. L3 and 4 laminectomy for total tumor excision 2. Posteriolateral fusion Specimen Count And Types 1 piece About size:1.5g Source:intraspinal tumor Pathology Pending Operative Findings The tumor was soft-elastic, size 4x3x2.5cm, located at L4/5 level with the root fanning over the tumor. There was no margin between the tumor ahd the root was transected and anastomosis with 8-0 Eithion. Operative Procedures Under general anesthesia and intubation, the patient was put in prone position. The L4/5 spinous process werec checked with poratble C-arm X-ray. The midline skin incision was made from L3 to L5 spinous processes and seperated the paraspinal muscle to expose the laminae. L3 and L4 laminectomy was performed with rongeur and Kerrison punch. The dura was opened in midline and tened with 3-0 silk. The arachnoid membrane was opened under surgicel microscope. The tumor was dissected from the surrounding nerve roots. Internal decompression was tried before seperated the tumor from the root but failed. The root was transected and anastomosis with 8-0 Eithion. The dura was closed with 5-0 Prolene sutures. The posteriolateral fusion was performed with autologous bone graft. The wound was closed in layers after one epidural CWV drain set up. Operators VS 陳敞牧 Assistants R6 李建勳 R3 李振豪 相關圖片 鄭慧英 (F,1959/09/06,52y6m) 手術日期 2010/03/11 手術主治醫師 陳敞牧 手術區域 東址 005房 02號 診斷 Other tuberculosis of intestines, peritoneum, and mesenteric glands, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture 器械術式 Spinal fusion anterior spinal 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 賴碩倫, 時間資訊 00:00 臨時手術NPO 13:05 報到 13:37 進入手術室 13:50 麻醉開始 14:20 誘導結束 14:30 抗生素給藥 15:04 手術開始 17:30 抗生素給藥 18:00 開始輸血 20:30 手術結束 20:30 抗生素給藥 20:30 麻醉結束 20:40 送出病患 22:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 脊椎融合術－前融合，無固定物（＜＝四節） 1 2 L 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 手術 椎間盤切除術－腰椎 1 4 L 摘要__ 手術科部: 外科部 套用罐頭: LEft posteriolateral approach for granulation... 開立醫師: 陳睿生 開立時間: 2010/03/11 21:10 Pre-operative Diagnosis Left retroperitoneal granulation tissue with T11-L2 prevertebral abscess, and L1/2 spondylodiskitis Post-operative Diagnosis Left retroperitoneal granulation tissue with T11-L2 prevertebral abscess, and L1/2 spondylodiskitis Operative Method LEft posteriolateral approach for granulation removal and L1/2 diskectomy with autologus bone fusion, posterial approach for L1/2 fixation with transpedicular screws Specimen Count And Types 5 pieces About size:pieces Source:granulation tissue, for pathological study About size:0.5cm Source:granulation tissue, for bacterial culture About size:0.5cm Source:granulation tissue, for bacterial culture About size:0.5cm Source:granulation tissue, for fungal culture About size:0.5cm Source:granulation tissue, for TB culture Pathology Pending Operative Findings Dark blueish granulation tissue was noted over left side retroperitoneal space, and severe psoas muscle swelling was also noted. L1/2 bony erosion was also found, and the disk with erosive tissue was removed. Left T12 rib was cut down for anterior fusion. L1/2 paramedian approach for transpedicular screws and rods fixation were done. A-spine 6.0x40mm screws x4 were used, and the rods were 5cm in length. Operative Procedures 1. ETGA, right side decubitus position with left side expansion 2. C-arm localized L1/2 level 3. LUQ curvillinear skin incision about 12cm 4. Incise into the external, internal oblique, and transverse abdominalis muscle; cut down the T12 floatting rib 5. Expose the retroperitoneal space, and swelling psoas muscle with granulation tissue were noted 6. Remove of granulation tissue, and we split the psoas muscle to expose the L1/2 intervertebral space 7. Diskectomy with removal of erosive body were performed with curette 8. Insert the rib sections into the L1/2 space as fusion graft 9. Hemostasis, set a cwv drain, and close the wound in layers 10.Change position into prone, and C-arm localized L1/2 level 11.Back midline incision to expose the fascia 12.Bilateral paramedian fascia incision, and split the latissmus muscle to find out the bilateral L1/2 transverse process and facets 13.Transpedicular screws were implanted and C-arm recheck of the TPS position 14.Set the rods and hemostasis 15.Set 1/8 hemovac drains bilaterally 16.Close the wound in layers Operators VS 陳敞牧 Assistants R5 陳睿生, R1 賴碩倫 陳駿瑋 (M,1982/05/24,29y9m) 手術日期 2010/03/11 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Brain contusion 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 3E 紀錄醫師 蔡立威, 時間資訊 08:00 臨時手術NPO 08:00 開始NPO 03:08 通知急診手術 03:40 麻醉開始 03:45 進入手術室 03:45 報到 03:45 誘導結束 04:39 手術開始 05:00 抗生素給藥 07:00 麻醉結束 07:00 手術結束 07:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱骨切除術，包括異物移除或減壓或神經切斷 1 1 L 手術 顱內壓監視置入 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Left frontotemporoparietal craniectomy for de... 開立醫師: 李建勳 開立時間: 2010/03/11 07:10 Pre-operative Diagnosis Traumatic brian injury with severe brain swelling Post-operative Diagnosis Traumatic brian injury Operative Method Left frontotemporoparietal craniectomy for decompression and ICP monitor insertion Specimen Count And Types nil Pathology Nil Operative Findings The temporalis muscle was removed for further decompression. The brain bulging out mildly after opened the dura. Some contusion over brain surface was noted. The reference of ICP was 504 and the ICP after wound closure: 6mmHg. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position with head turned to right. The scalp was shaved, scrubbed, disinfected with alcohol B-I then draped. The left frontotemporoparietal carniectomy was performed. The dura was tenting along the craniectomy window then opened. The temporalis muscle was removed for further decompression. The ICP monitor was inserted at subdural space and fixed at the scalp. The wound was closed in layers after two CWV drain set up. Operators VS 王國川 Assistants R6李建勳R3李振豪R1蔡立威 Indication Of Emergent Operation 相關圖片 郭義雄 (M,1938/02/14,74y1m) 手術日期 2010/03/11 手術主治醫師 王國川 手術區域 東址 003房 1號 診斷 Cerebellar hemorrhage 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3 紀錄醫師 賴碩倫, 時間資訊 00:00 臨時手術NPO 07:15 報到 08:08 進入手術室 08:20 麻醉開始 08:40 誘導結束 09:20 抗生素給藥 09:46 手術開始 10:35 手術結束 10:35 麻醉結束 10:58 送出病患 11:01 進入恢復室 13:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 手術 腦室腹腔分流手術 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 賴碩倫 開立時間: 2010/03/11 10:58 Pre-operative Diagnosis Right frontal ICH Post-operative Diagnosis Right frontal ICH Operative Method V-P Shunt Specimen Count And Types nil Pathology nil Operative Findings 1. Metronic programmable shunt over left kichers point 2. Shunt intraventricular :7 cm 3. ICP=5 cmH2O, CSF: clear Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: supine with head rotated to right. 3.Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 3 cm linear, left frontal incision of sculp. 5.After the scalp flap had been lifted and reflected anteriorly, a burr hole was made at kochers point and the dura was tented by 2 stitches. 6.The dura was opened by a nib incision. Lt lateral ventricle was tapped by a ventricular needle, then a 7 cm segment of the ventricular catheter was introduced into the ventricle. The outer end of the catheter was connected to a Metronic programmable reservoir. 7. 2 nib incision was made at LUQ of the abdomen and left parietal region, then a trocar was pushed into peritoneal cavity. Subsequently, distal 20 cm segment of the peritoneal catheter was introduced into the peritoneal cavity through the outer tube of the trochar. The proximal end of this catheter was passed through subcutaneous tunnel at forechest, neck, Lt retroauricular area and connected the reservoir. The shunt system was checked to make sure its function was working. 8. The reservoir was fixed to pericranium by 2 stitches. 9. Scalp closure: hemostasis was done with monopolar coagulator touching on the sucker tip. Galea suture was performed by continuous suture with 3/0. Dexon and skin by continuous suture with 3/0 nylon. 10.Course of the surgery: smooth. Operators VS王國川 Assistants R5陳睿生 R1賴碩倫 黃源鑑 (M,1937/08/03,74y7m) 手術日期 2010/03/12 手術主治醫師 杜永光 手術區域 東址 003房 2號 診斷 Pituitary Tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 2 紀錄醫師 曾峰毅, 時間資訊 12:50 報到 13:30 進入手術室 13:35 麻醉開始 14:00 誘導結束 14:10 抗生素給藥 14:25 手術開始 17:10 抗生素給藥 18:15 麻醉結束 18:15 手術結束 18:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經由蝶竇之腦下垂體瘤切除 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Hypophysectomy---Transphenoid 開立醫師: 曾峰毅 開立時間: 2010/03/12 17:53 Pre-operative Diagnosis Pituitary macroadenoma, non-functional Post-operative Diagnosis Pituitary macroadenoma, non-functional Operative Method Endonasal trans-sphenoidal adenomectomy Specimen Count And Types Several fragments of one tumor was sent for pathology. Pathology Pending Operative Findings About one 2.1x2.3x1.5cm, yellowish-pinkish, hypervascular, soft, fragile tumor was noted in the sella. CSF leakage(+) Operative Procedures With general anesthesia and intubation, the patient was put in supine position. The skin over face was disinfected with alcohol B-I and the nasal mucosa was disinfected with aqueous B-I then draped. We set up the Endoscope system with arm-support. The nasal mucosa was coagulated and the spenoid sinus was drilled opened then widened with Kerrison punch. The mucosa inside the spenoid sinus was removed with aligator. The posterior sphenoid sinus floor was removed to expose the dura. The dura was bipolar coagulated and incised in cruciate fashion. The tumor was removed with ring curette and aligator. The CSF leakage was sealed with gelform. The sphenoid flood was recontructed with bone fragments. The nasal mucosa was packing with one finger of gloove filled with vasline gauze soaked in B-I ointment. Operators P 杜永光 VS 楊士弘 Assistants R6 陳盈志 R6 黃建智 R3 曾峰毅 洪進德 (M,1969/08/14,42y7m) 手術日期 2010/03/12 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Acromegaly 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 2 紀錄醫師 陳建銘, 時間資訊 07:35 報到 08:04 進入手術室 08:15 麻醉開始 08:45 誘導結束 08:48 抗生素給藥 09:17 手術開始 10:15 麻醉結束 10:15 手術結束 10:25 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 經由蝶竇之腦下垂體瘤切除 1 1 摘要__ 手術科部: 外科部 套用罐頭: Transsphnoid adenomectomy 開立醫師: 李建勳 開立時間: 2010/03/12 10:39 Pre-operative Diagnosis Pituitary macroadenoma Post-operative Diagnosis Pituitary macroadenoma Operative Method Transsphnoid adenomectomy Specimen Count And Types 1 piece About size:0.5g Source:adenomectomy Pathology Pending Operative Findings The tumor was yellowish, soft, size 1.2cm in diameter. The normal gland was found after tumor excision. CSF leakage was sealed with Tissuecol Duo nad gelform packing. Operative Procedures Under general anethesia and intubation, the patient was put in supine position with head tilted 30 degree to left. The facial skin was antiseptic with alcohol B-I tincture, and the mucosa of oral and nasal cavity with aqueous B-I. The former areas were covered by sterilized adhesive plastic sheets then draped. The nasal mucosa incision was made after local anesthesia injection at right submucosal layer. A nasal speculum was applied to displace the nasal mucosa laterally and keep the nasal cavity open constantly for the exposure of the vomer bone and the anterior wall of the sphenoid sinus. Dissection was made under surgical microscope assistance to remove the anterior sphenoid wall and vomer by osteotome. The mucosa was removed by clumps. The posterior sphenoid wall was penetrated by osteotome and Kerrison punch. The sellar floor dura was coagulated with bipolar forceps, then opened in cruciate fashion. The soft tumor parenchyma was removed by curette and suction. The CSF leakage was sealed with Tissuecol Duo nad gelform packing. The arachnoid and the opening of diaphragm sellae was enforced by packing with gelform as in the sellar cavity. The sellar floor was reconstructed by supporting a piece of vomer bone between the dura and the margin of the sellar floor. The nasal speculum was removed and the nasal mucosa returned to its normal position. Each side of the nasal cavities was tightly packed with a segment of rubber glove finger filled with vaseline gauze strips which had been soaked with better-iodine ointment. Operators VS曾漢民 Assistants R6李建勳R1陳建銘 相關圖片 江綠媚 (F,1960/10/22,51y4m) 手術日期 2010/03/12 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 2 紀錄醫師 陳建銘, 時間資訊 10:55 報到 11:05 進入手術室 11:10 麻醉開始 11:35 誘導結束 11:36 抗生素給藥 12:12 手術開始 15:50 抗生素給藥 18:10 麻醉結束 18:10 手術結束 18:25 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 手術 顱底瘤手術 1 1 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Bifrontal craniotomy for tumor excision 開立醫師: 李建勳 開立時間: 2010/03/12 18:48 Pre-operative Diagnosis Planium sphenoidale meningioma Post-operative Diagnosis Planium sphenoidale meningioma Operative Method Bifrontal craniotomy for tumor excision Specimen Count And Types 1 piece About size:15g Source:brain tumor Pathology Pending Operative Findings The tumor is white-yellowish, elastic-firm, size 7x6x6cm, with seperable arachnoid space from the surrounding brain parenchyma. The planium sphenoidale showed hyperosis change. The ACA branches were encased by the tumor and unable to seperate completely. One piece of tumor (2X1.7x1cm) was left in situ to prevent further damage of the normal vessels. The optic chiasm was seened with no compression after tumor excision. Operative Procedures Under general anesthesia and intubaion, the patient was put in supine position with head fixed with Mayfield skull clump. The scalp was shaved, scrubbed, disinected with alcohol B-I then draped. The bicoronal scalp incision was made followed by bifrontal craniotomy. The dura was opened bilaterally after tenting over the craniotomy window. The anterior falx was transected after applied the weck. The tumor was located by tracing along the falx. The tumor excision was started from central debulky with bipolar coagulation and removed the tumor with scissors. The feeders were bipolar coagulated. One piece of tumor (2X1.7x1cm) was left in situ to prevent further damage of the normal vessels. The duroplasty was performed with periostium and 4-0 Prolene sutures. The skull plate was fixed back with miniplates and screws. The wound was closed in layers after one subgaleal CWV drain set up. Operators VS 曾漢民 Assistants R6 李建勳 R1 陳建銘 相關圖片 許秀珍 (F,1966/02/07,46y1m) 手術日期 2010/03/12 手術主治醫師 蔡瑞章 手術區域 東址 019房 02號 診斷 Malignant neoplasm of cardia of stomach 器械術式 Ommaya reservoir implantation 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 2 紀錄醫師 張皓鈞, 時間資訊 00:05 臨時手術NPO 00:05 開始NPO 08:05 通知急診手術 10:05 報到 10:45 進入手術室 10:50 麻醉開始 11:00 誘導結束 11:15 抗生素給藥 11:30 手術開始 12:05 手術結束 12:05 麻醉結束 12:15 送出病患 12:20 進入恢復室 13:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 歐氏貯囊置放手術 1 1 R 摘要__ 手術科部: 腫瘤醫學部 套用罐頭: Right Omaya reservior insertion 開立醫師: 胡朝凱 開立時間: 2010/03/12 12:14 Pre-operative Diagnosis hydrocephalus Post-operative Diagnosis hydrocephalus Operative Method Right Omaya reservior insertion Specimen Count And Types CSF study for 3 tubes Pathology Nil Operative Findings 1.Clear CSF 2.Opening pressure: about 15 cmH20 3.intraventricular catheter: 6.3 cm Operative Procedures 1.ETGA, supine 2.Right Kocher point curvature skin incision 3.Reflect skin flap 4.open periosteum 5.Burr hole drill 6.Dural tenting 7.Open dura, then ventricular puncture 8.Omaya reservior insertion 9.Close wound in layers Operators 蔡瑞章 Assistants 胡朝凱,張皓鈞 Indication Of Emergent Operation 吳華 (M,1933/02/10,79y1m) 手術日期 2010/03/13 手術主治醫師 蔡瑞章 手術區域 東址 019房 04號 診斷 Subdural hemorrhage following injury without mention of open intracranial wound,with no loss of consciousness 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 3E 紀錄醫師 陳建銘, 時間資訊 01:03 報到 01:03 進入手術室 01:15 麻醉開始 01:20 誘導結束 01:43 抗生素給藥 02:00 手術開始 02:40 手術結束 02:40 麻醉結束 02:55 送出病患 03:00 進入恢復室 04:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Removal of SDH with Burr hole drainage 開立醫師: 胡朝凱 開立時間: 2010/03/13 02:50 Pre-operative Diagnosis Right chronic SDH Post-operative Diagnosis right chronic SDH Operative Method Removal of SDH with Burr hole drainage Specimen Count And Types NIL Pathology Nil Operative Findings 1.Motor oil like hematoma drained out from right SDH area 2.The brain was slack 3.Outer membrane was noted Operative Procedures 1.ETGA, supine 2.Right parietal area transverse skin incision 3.Open periosteum 4.Burr hole drill 5.Dural tenting 6.open dura 7.Rubbe drain insertion 8.water irrigation 9.Fix rubber drain 10.close wound in layers 11.De-air Operators 蔡瑞章 Assistants 胡朝凱,陳建銘 Indication Of Emergent Operation 黃阿秀 (F,1942/10/11,69y5m) 手術日期 2010/03/12 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Spondylolisthesis 器械術式 Debridment-- 5-10cm 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 2 紀錄醫師 張皓鈞, 時間資訊 07:58 報到 08:05 進入手術室 08:10 麻醉開始 08:45 誘導結束 08:56 手術開始 10:10 手術結束 10:10 麻醉結束 10:25 送出病患 10:30 進入恢復室 11:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 深部複雜創傷處理－傷口長１０公分以上者 1 0 摘要__ 手術科部: 外科部 套用罐頭: Wound debridemehnt 開立醫師: 胡朝凱 開立時間: 2010/03/12 10:19 Pre-operative Diagnosis L4-5 spondylolisthesis status post Transpedicle screw fixation with wound infection Post-operative Diagnosis L4-5 spondylolisthesis status post Transpedicle screw fixation with wound infection Operative Method Wound debridemehnt Specimen Count And Types nil Pathology Nil Operative Findings Granulation tissue and Granulation tissue and necrotic tissue was noted . Intact of fascia layer without infection sign Operative Procedures 1.ETGA , prone position 2.Sterile with Aq BI 3.Remove stiches 4.Gentamicin with normal saline water irrigation 1000ml 5.Remove necrotic tissue and irrigation 6.Set one CWV and one Hemovac drain 7.Primary closure wound Operators 賴達明 Assistants R5胡朝凱 R1張皓鈞 曾碧霜 (F,1932/02/25,80y0m) 手術日期 2010/03/12 手術主治醫師 詹志洋 手術區域 東址 001房 01號 診斷 Atherosclerosis of the extremities with gangrene 器械術式 Embolectomy, Thrombectomy 手術類別 緊急手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 謝永, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 03:19 通知急診手術 08:55 進入手術室 09:00 麻醉開始 09:10 誘導結束 09:30 手術開始 11:00 手術結束 11:00 麻醉結束 11:10 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 血管整形術 1 0 L 手術 經動脈導管之栓塞物切除術 1 2 L 摘要__ 手術科部: 外科部 套用罐頭: SFA stenting 開立醫師: 詹志洋 開立時間: 2010/03/12 11:16 Pre-operative Diagnosis critical limb ischemia, left popliteal calcified occlusion and thrombosis, left leg. s/p catheter directed thrombolysis 6 hours. Post-operative Diagnosis critical limb ischemia, left popliteal calcified occlusion and thrombosis, left leg. s/p catheter directed thrombolysis 6 hours, residual thrombosis. Operative Method femoro-popliteal stenting and continuing catheter thrombolysis. Specimen Count And Types nil Pathology calcified atherosis and thrombosis Operative Findings calcified popliteal artery occlusion with thrombosis. Operative Procedures With general anesthesia. We explored the Operators Assistants Indication Of Emergent Operation 記錄__ 手術科部: 外科部 套用罐頭: SFA stenting 開立醫師: 謝永 開立時間: 2010/03/14 00:28 Pre-operative Diagnosis critical limb ischemia, left popliteal calcified occlusion and thrombosis, left leg. s/p catheter directed thrombolysis 6 hours. Post-operative Diagnosis critical limb ischemia, left popliteal calcified occlusion and thrombosis, left leg. s/p catheter directed thrombolysis 6 hours, residual thrombosis. Operative Method femoro-popliteal stenting and continuing catheter thrombolysis. Specimen Count And Types nil Pathology calcified atherosis and thrombosis Operative Findings calcified popliteal artery occlusion with thrombosis. Operative Procedures With general anesthesia. We re-explored the left CFA with L. CFA antegrade catheterization. Thrombectomy was performed. Left poplteal a. was stented with 6 x 150 mm Bard Lifestent stent. The wound was closed and intra-arterial sheath was kept. Operators 詹志洋 Assistants Ri黃繼正 Indication Of Emergent Operation 邱逢琪 (M,1950/08/20,61y6m) 手術日期 2010/03/13 手術主治醫師 張金池 手術區域 東址 018房 02號 診斷 Lung cancer 器械術式 Thoracoscopy+Open Chest 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林峰盛 ASA 2 紀錄醫師 張彥俊, 時間資訊 11:35 進入手術室 11:40 麻醉開始 12:05 誘導結束 12:15 抗生素給藥 12:37 手術開始 14:50 手術結束 14:50 麻醉結束 14:55 送出病患 16:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 縱隔腔或胸腔內淋巴根除術 1 1 L 手術 ｐｏｒｔ–Ａ導管植入術–治療性導管植入術 1 0 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 摘要__ 手術科部: 外科部 套用罐頭: VATS mediastinal LN dissection and port-A ins... 開立醫師: 林威佑 開立時間: 2010/03/13 15:15 Pre-operative Diagnosis LLL tumor Post-operative Diagnosis LLL adenocarcinoma with mediastinal LN metastasis Operative Method VATS mediastinal LN dissection and port-A insertion Specimen Count And Types 2 pieces About size:1*1cm Source:Gr5 LN About size:0.5*0.5cm Source:Gr6 LN Pathology pending Operative Findings 1. Pleura retracted tumor over LLL and adhesion to LUL 2. Gr 5,6 LN was dissected but not enlarge 3. Gr5 LN frozen showed adenocarcinoma metastasis Operative Procedures 1. ETGA with blocker, right decubitus 2. VATS port setting 3. Gr 5,6 LN dissection 4. Check bleeding and set 28Fr chest tube*1 5. Close wound 6. Change to supine position 7. Port-A was inserted via subclavian vein by puncture method Operators VS張金池 Assistants R5張彥俊 Ri蘇軏 曾惠雀 (F,1961/04/21,50y10m) 手術日期 2010/03/13 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Intracranial hemorrhage 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 4E 紀錄醫師 蕭惠壬, 時間資訊 12:02 通知急診手術 12:45 進入手術室 12:50 麻醉開始 12:55 抗生素給藥 13:00 誘導結束 13:33 手術開始 14:00 開始輸血 16:45 手術結束 16:45 麻醉結束 17:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 1 手術 急性硬腦膜下血腫清除術 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Craniectomy for hematoma evacuation and SDH r... 開立醫師: 陳睿生 開立時間: 2010/03/13 17:31 Pre-operative Diagnosis Right parietoccipital ICH with SDH Post-operative Diagnosis Right parietoccipital ICH with SDH Operative Method Craniectomy for hematoma evacuation and SDH removal Specimen Count And Types 1 piece About size:5ML Source:HEMATOMA Pathology Pending Operative Findings About 30ml organized hematoma was noted at the parietoccipital region. The brain parychema was severe swelling pre-OP. Thin SDH layer was noted at F-T-P region and was removed. No obvious vascular lesion nor organic lesion was noted inside the hematoma. Operative Procedures 1. ETGA, prone position with head right turn and fix with Mayfield clump 2. Right O-P-T curvillinear scalp incision 3. Five bur holes were made and an about 8x8 cm craniectomy window was created 4. Dura tacking and then opened via the craniectomy margin 5. Evacuate of the thin SDH 6. About 3cm corticotomy was created at parietal region 7. The hematoma was harvested with suction 8. Hemostasis and the ventricle was also noted 9. The parychema raw surface was covered with surgicel 10.Dura was closed with Durafoam graft 11.Set a epidural CWV drain 12.Close the wound in layers Operators VS 賴達明 Assistants R5 陳睿生; R1 蕭惠壬 Indication Of Emergent Operation 曾碧霜 (F,1932/02/25,80y0m) 手術日期 2010/03/13 手術主治醫師 賴達明 手術區域 東址 002房 05號 診斷 Atherosclerosis of the extremities with gangrene 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 4E 紀錄醫師 陳建銘, 時間資訊 03:17 報到 03:20 進入手術室 03:25 麻醉開始 03:30 誘導結束 03:53 開始輸血 04:10 手術開始 06:00 抗生素給藥 07:05 麻醉結束 07:05 手術結束 07:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for hematoma evacuation 開立醫師: 胡朝凱 開立時間: 2010/03/13 07:30 Pre-operative Diagnosis Left temporal about 40 ml ICH Post-operative Diagnosis Left temporal about 40 ml ICH Operative Method Craniotomy for hematoma evacuation Specimen Count And Types Nil Pathology Nil Operative Findings 1.About 40 ml hematoma was noted at left temporal lobe. 2.No obvious bleeder was noted 3.After hematoma evacuation, the brain became slack Operative Procedures 1.ETGA, supine 2.Left temporal area U shape skin incision 3.Reflect skin flap 4.Detach temporal muscle 5.Craniotomy 6.dural tenting then dural opening 7.Corticotomy and then identified hematoma 8.Hematoma evacuation 9.Hemostasis with surgicel 10.Close dura with durofoam cover defect 11.Fix bone back wih wire 12.Close wound in layers Operators 賴達明 Assistants 胡朝凱,鐘文桂,陳建銘 Indication Of Emergent Operation 陳魏嘉英 (F,1935/12/04,76y3m) 手術日期 2010/03/13 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Compression fracture 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 3 紀錄醫師 賴碩倫, 時間資訊 07:44 報到 08:05 進入手術室 08:10 麻醉開始 08:40 誘導結束 08:50 手術開始 09:02 抗生素給藥 12:02 抗生素給藥 14:25 手術結束 14:40 送出病患 14:40 麻醉結束 18:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 手術 椎弓切除術（特壓）－二節以內 1 2 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 摘要__ 手術科部: 外科部 套用罐頭: L1 laminectomy and osteotomy, fixation with t... 開立醫師: 曾峰毅 開立時間: 2010/03/13 14:38 Pre-operative Diagnosis L1 compression fracture with posterior protusion of bone chip Post-operative Diagnosis L1 compression fracture with posterior protusion of bone chip Operative Method L1 laminectomy and osteotomy, fixation with transpedicular screws at T11, T12, L2, and L3, and posterolateral fusion with autologous bone graft Specimen Count And Types Nil Pathology Nil Operative Findings L1 compression fracture with bone chip posterior protuding and thecal sac compression. Thecal sac was relaxed after osteotomy. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. With C-arm localization, we made one midline skin incision and dissected to expose bilateral laminae from T11 to L2. Transpedicular screws was inserted into bilateral laminae of T11, T12, L2, and L3. L1 laminectomy was done, and bone chip was removed. L1 osteotomy was done as well. We set up the rod and cross links. After hemostasis, we placed two hemovac drainage, and closed the wound in layers. Operators VS 賴達民 Assistants R5 陳睿生 R3 曾峰毅 R1 賴碩倫 梁梅蘭 (F,1950/04/12,61y11m) 手術日期 2010/03/14 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 3E 紀錄醫師 陳建銘, 時間資訊 00:11 臨時手術NPO 00:11 開始NPO 07:11 通知急診手術 08:25 報到 08:50 進入手術室 09:00 麻醉開始 09:30 抗生素給藥 09:30 誘導結束 09:40 手術開始 12:30 抗生素給藥 14:25 麻醉結束 14:25 手術結束 14:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４～８小時 1 1 R 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 摘要__ 手術科部: 外科部 套用罐頭: Right frontal craniotomy for Simpson grade II... 開立醫師: 李建勳 開立時間: 2010/03/14 14:49 Pre-operative Diagnosis Right frontal falx meningioma Right frontal parasaggital meningioma Post-operative Diagnosis Right frontal falx meningioma Right frontal parasaggital meningioma Operative Method Right frontal craniotomy for Simpson grade II tumor excision Specimen Count And Types 1 piece About size:15g Source:craniotomy for tumor excision Pathology Pending Operative Findings The tumor is yellowish, elastic-firm, size 7x6x5cm, attached to the falx with extension to left frontal area. The tumor margin was unable to seperate clearly from the normal brain parenchyma at arachnoid plane. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position with head fixed with Mayfield skull clump. The scalp was shaved, scrubbed, disinfected with alcohol B-I then draped. The bicoronal scalp incision was made followed by right frontal craniotomy. The dura was opened around the tumor after tenting along the craniotomy window. The tumor was dissected from the surrounding normal brain tissue with dissector and bipolar coagulator. The tumor was detached from the falx. Central debulky method was applied before further dissection of the tumor. The midline attachment was dissected under the surgicel microscope assistance. The falx was incised with surgical blade and removed the left frontal tumor. The duroplasty was performed with 4-0 Prolene sutures and periostium. The skull plate was fixed back with miniplates and screws after one epidural CWV drain set up. The wound was then closed in layers. Operators VS 曾漢民 Assistants R6 李建勳 R1 陳建銘 Indication Of Emergent Operation 相關圖片 何東鏘 (M,1935/10/20,76y4m) 手術日期 2010/03/15 手術主治醫師 戴浩志 手術區域 東址 009房 4號 診斷 Atherosclerosis of the extremities with intermittent claudication 器械術式 Debridment-- >10cm 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 3 紀錄醫師 陳建璋, 時間資訊 15:00 報到 15:00 進入手術室 15:05 麻醉開始 15:10 誘導結束 15:11 手術開始 15:30 手術結束 15:35 麻醉結束 15:40 進入恢復室 15:40 送出病患 16:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 深部複雜創傷處理－傷口長１０公分以上者 1 0 R 摘要__ 手術科部: 外科部 套用罐頭: debridement 開立醫師: 黃愉真 開立時間: 2010/03/15 15:44 Pre-operative Diagnosis status post SFA stenting with wound infection and dehiscence Post-operative Diagnosis ditto Operative Method debridement Specimen Count And Types nil Pathology nil Operative Findings 1. One 11cm wound over the right hypogastric area with dehiscence and moderate amount of necrotic tissue. 2. Pus accumulation over the previous drain hole. 3. NO exposure of the main vessels and nerves Operative Procedures Under endotracheal general anesthesia, the patient was put in the supine position. The operative field was disinfected and draped as usual. We dissected and removed the necrotic tissue piecemeally with the scissors and curretage. After careful hemostasis and irrigation with large amount of normal saline. The wound was paccked with wet dressing Operators 戴浩志 Assistants 陳建璋 張芳瑜 (F,1988/06/01,23y9m) 手術日期 2010/03/15 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Arteriovenous malformation, brain 器械術式 Craniotomy (A.V.M.) P-DUH 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 曾峰毅, 時間資訊 07:40 報到 08:03 進入手術室 08:10 麻醉開始 08:35 誘導結束 08:40 抗生素給藥 08:46 手術開始 11:40 抗生素給藥 14:55 抗生素給藥 15:35 麻醉結束 15:35 手術結束 15:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 7 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 開顱術摘除血管病變－動靜脈畸型－小型－深部 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Interhemispheric approach for total excision ... 開立醫師: 陳盈志 開立時間: 2010/03/15 16:00 Pre-operative Diagnosis Right frontal arteriovenous malformation Post-operative Diagnosis Right frontal arteriovenous malformation Operative Method Interhemispheric approach for total excision of arteriovenous malformation Specimen Count And Types 1 piece About size:3X3X2cm Source:right frontal AVM Pathology pending Operative Findings Multiple feeders came from callosomarginal arteries. Some feeders was thrombosed due to previous embolization. Engorged arterialized drainage was noted, and turned to be dark purple after AVM removed. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head extended and fixed with Mayfield head clamp. After scalp scrubbed, shaved, disinfected, and then draped, we made one bicoronal skin incision. We reflected the scalp flap inferiorly. We drilled three burr holes, one at right keyhole, one at right side of SSS, and one at left side of SSS. Craniotomy was done, and dura incision was made in C-shape with base at SSS. We retracted the falx away from the right frontal lobe, and approach the lesion via interhemispheric route. We identified the arterial feeders from callosomarginal arteries and coagulated, and transected them. We dissected the AVM from superficial to deeper part, and transected the drainage vein. AVM was removed, and hemostasis was done. We closed the dura with 4-0 prolene in water-tight fashion. Bone graft was fixed back with mini-plates. After set one subgaleal CWV drainage, the wound was closed in layers. Operators P 杜永光 Assistants R6 陳盈志 R3 曾峰毅 陳阿黎 (F,1942/01/02,70y2m) 手術日期 2010/03/15 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Hydrocephalus 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 4 紀錄醫師 陳建銘, 時間資訊 07:55 報到 08:09 進入手術室 08:15 麻醉開始 08:25 誘導結束 08:45 抗生素給藥 09:18 手術開始 11:05 手術結束 11:05 麻醉結束 11:15 送出病患 11:17 進入恢復室 12:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 腦室腹腔分流手術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Right Kocher point VP shunt insertion with an... 開立醫師: 李建勳 開立時間: 2010/03/15 11:16 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Right Kocher point VP shunt insertion with antisiphon device Specimen Count And Types nil Pathology Nil Operative Findings The CSF opening pressure 8cmH2O with clear CSF drained out. Programmable Codman Hakim shunt with antisiphon device were inserted. Intial pressure set 8cmH2O. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position with head turned to left. The scalp was shaved, scrubbed, antiseptic with alcohol B-I then draped. A curvilinear skin incision was made at right frontal region followed by burr hole. The dura was incised after tenting. A ventricular puncture needle was used to puncture then shifted to nelaton tube. Minilaparotomy was made at right upper abdomen and the peritoneal catheter was inserted and test function. The shunt cather was then passed through subcutaneous layer of abdomen, anterior chest wall, neck, retroauricular area then connected to the reservoir. The nelaton tube was then changed to ventricular catheter and connected to the reservoir. The antisiphon device was inserted below the reservoir. After testing the function, the wounds were all closed in layers. Operators VS 曾漢民 Assistants R6 李建勳 R1 陳建銘 相關圖片 黃銀貞 (F,1943/12/02,68y3m) 手術日期 2010/03/15 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Cushing syndrome 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 陳建銘, 時間資訊 11:05 報到 11:26 進入手術室 11:35 麻醉開始 12:15 誘導結束 12:19 抗生素給藥 12:40 手術開始 14:10 麻醉結束 14:10 手術結束 14:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 經由蝶竇之腦下垂體瘤切除 1 1 摘要__ 手術科部: 外科部 套用罐頭: Endoscopic transsphenoid adenomectomy 開立醫師: 李建勳 開立時間: 2010/03/15 14:25 Pre-operative Diagnosis Pituitary macroadenoma with Cushing syndrome Pituitary microadenoma with Cushing syndrome Post-operative Diagnosis Pituitary macroadenoma with Cushing syndrome Pituitary microadenoma with Cushing syndrome Operative Method Endoscopic transsphenoid adenomectomy Specimen Count And Types 1 piece About size:0.3g Source:transsphenoid adenomaectomy Pathology Pending Operative Findings The tumor was yellowish, elastic, size 1.2cmX0.5cmX1cm. CSF leakage was noted during the procedure and was sealed with Tissucol Duo. Operative Procedures Under general anethesia and intubation, the patient was put in supine position with head tilted 30 degree to left. The facial skin was antiseptic with alcohol B-I tincture, and the mucosa of oral and nasal cavity with aqueous B-I. The former areas were covered by sterilized adhesive plastic sheets then draped. Under endoscope, the nasal mucosa was coagulated at right norstril. A nasal speculum was applied to displace the nasal mucosa laterally and keep the nasal cavity open constantly for the exposure of the vomer bone and the anterior wall of the sphenoid sinus. The anterior sphenoid wall and posterior sphenoid wall was remove by high speed air drill and Kerrison punch. The sellar floor dura was coagulated then opened in cruciate fashion. The soft tumor parenchyma was removed by curette and aligator. The CSF leakage was sealed with Tissuecol Duo nad gelform packing. The arachnoid and the opening of diaphragm sellae was enforced by packing with gelform as in the sellar cavity. The nasal mucosa returned to its normal position. Right side of the nasal cavities was tightly packed with a segment of rubber glove finger filled with vaseline gauze strips which had been soaked with better-iodine ointment. Operators VS 曾漢民 Assistants R6 李建勳 R1 陳建銘 相關圖片 陳麗雲 (F,1952/11/02,59y4m) 手術日期 2010/03/15 手術主治醫師 賴達明 手術區域 東址 005房 03號 診斷 Benign neoplasm of spinal cord 器械術式 Benign intraspinal tumor, exci 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 陳建銘, 時間資訊 14:30 報到 15:00 進入手術室 15:10 麻醉開始 15:20 抗生素給藥 15:20 誘導結束 16:20 手術開始 18:20 抗生素給藥 19:05 手術結束 19:05 麻醉結束 19:15 送出病患 21:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 手術 良性病髓腫瘤切除術 1 1 摘要__ 手術科部: 外科部 套用罐頭: Right L1 laminectomy for tumor excision 開立醫師: 李建勳 開立時間: 2010/03/15 19:18 Pre-operative Diagnosis L1 intraspinal extramedullary tumor, suspect neuroma Post-operative Diagnosis L1 intraspinal extramedullary tumor, suspect neuroma Operative Method Right L1 laminectomy for tumor excision Specimen Count And Types 1 piece About size:1g Source:laminectomy for tumor excision Pathology Pending Operative Findings The tumor was yellowish, soft, size 3X2X1.5cm , located at right L1 level, Suspected from the right L1 root. The attached root was not able to preserve. Operative Procedures Under general anesthesia and intubation, the patient was put in prone position. Located the L1 spinous process with portable X-ray. Midline skin incision was made and seperated the right paraspinal muscles to expose the T12-L1 laminae. Right L1 laminectomy was performed with high speed air drill and Kerrison punch. The dura was opened and temporally tenting with 3-0 silk sutures. The tumor was found after opened the arachnoid membrane. Central debulky was applied first. The attempt to seperate the root and the tumor was failed. The tumor was totally removed and the attached root was bipolar coagulated. The dura was closed with 5-0 Prolene sutures. The wound was closed in layers after one epidural CWV drain set up. Operators VS賴達明 Assistants R6李建勳 R1陳建銘 相關圖片 簡民杰 (M,1947/12/08,64y3m) 手術日期 2010/03/15 手術主治醫師 陳敞牧 手術區域 東址 001房 04號 診斷 Malignant neoplasm of rectum 器械術式 Spinal fusion posterior 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3E 紀錄醫師 楊博智, 時間資訊 09:30 開始NPO 11:07 通知急診手術 17:00 報到 17:30 進入手術室 17:33 麻醉開始 18:00 抗生素給藥 18:00 誘導結束 18:35 手術開始 20:30 開始輸血 21:00 抗生素給藥 21:50 手術結束 21:50 麻醉結束 22:05 送出病患 22:05 進入恢復室 23:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 手術 惡性病髓腫瘤切除術 1 1 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 2 摘要__ 手術科部: 外科部 套用罐頭: T4-8 laminectomy tumor excision and T4&T8; TPS... 開立醫師: 陳盈志 開立時間: 2010/03/15 21:45 Pre-operative Diagnosis T5-7 spinal metastasis Post-operative Diagnosis T5-7 spinal metastasis Operative Method T4-8 laminectomy tumor excision and T4&T8; TPS fixation Specimen Count And Types 1 piece About size:multiple fragments Source:T5-7 tumor Pathology pending Operative Findings The tumor was elastic in character, whitish yellowish in color. It involve T5-7 spinous process, T5 6lamina and T5 body and the bone became fragile. Epidural tumor was noted from T4-8 dorsal to the cord. right T5 root was sacrificed. TPS 5.5x35mm at T5, 5.5x40mm at T8 Operative Procedures 1.ETGA, prone 2.Midline back incision 3.detach paraspinal muscle expose T4-8 lamina 4.TPS at T4&T8; 5.Laminectomy T4-8 was done with rongeur and karrison punch. Epidural tumor was removed by dissector and kerrison till full expansion of cord. 6.T5 body tumor was curreted with currete 7.Hemostasis. Rod fixation then cross link x 1 8.H/V x 1 then close wound in layers Operators VS陳敞牧 Assistants R6陳盈志R1楊博智 Indication Of Emergent Operation 姜陳素梅 (F,1955/07/17,56y7m) 手術日期 2010/03/15 手術主治醫師 廖漢文 手術區域 東址 000房 號 診斷 Subarachnoid hemorrhage 器械術式 NEURO T.A.E 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 王永彬 ASA 3 時間資訊 13:20 麻醉開始 13:30 誘導結束 16:15 麻醉結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 蔡秀鳳 (F,1932/04/09,79y11m) 手術日期 2010/03/15 手術主治醫師 蔡翊新 手術區域 東址 001房 03號 診斷 Head Injury 器械術式 V-P shunt 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3 紀錄醫師 賴碩倫, 時間資訊 13:35 報到 14:10 進入手術室 14:15 麻醉開始 14:25 誘導結束 14:35 抗生素給藥 14:55 手術開始 16:03 手術結束 16:03 麻醉結束 16:10 送出病患 16:20 進入恢復室 17:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 蔡翊新 開立時間: 2010/03/15 16:01 Pre-operative Diagnosis Bilateral frontotemporal subdural effusion. Post-operative Diagnosis Bilateral frontotemporal subdural effusion. Operative Method Left subduroperitoneal shunt Specimen Count And Types nil Pathology Nil. Operative Findings After opening the dura and outer membrane at left temporal area, clear, colorless fluid gushed out. The pressure was low, so the resevoir of the S-P shunt was chosen as very low pressure (10 mmH2O). The intradural length was 5 cm. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 5 cm linear, left temporal, with the center of the incision located 7 cm above the external ear canal. 5. After the scalp flap had been retracted, a burr hole was made and the dura was tented by 2 stitches. 6. The dura and outer membrane were opened by a nib incision. The subdural effusion was drained for 2 seconds, then the opening was covered temporarily with a piece of Gelfoam to prevent overdrainage. 7. A minilaparotomy was made at LUQ of the abdomen , then a trocar was pushed into peritoneal cavity. Subsequently, distal 25 cm segment of the peritoneal catheter (open end) was introduced into the peritoneal cavity through the outer tube of the trochar. The proximal end of this catheter was passed through subcutaneous tunnel at forechest, neck, left retroauricular area and connected the reservoir. The subdural catheter was inserted and connected to the reservoir. The shunt system was checked to make sure its function was working. 8. The reservoir was fixed to pericranium by 1 stitch. 9. Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 10.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5胡朝凱R1賴碩倫 Indication Of Emergent Operation 黃榮秋 (F,1950/11/19,61y3m) 手術日期 2010/03/16 手術主治醫師 賴達明 手術區域 東址 016房 02號 診斷 Lumbar spondylosis 器械術式 Spinal fusion posterior 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 陳建銘, 時間資訊 09:32 通知急診手術 14:18 進入手術室 14:25 麻醉開始 14:35 誘導結束 14:40 抗生素給藥 15:27 手術開始 17:40 抗生素給藥 18:45 手術結束 18:45 麻醉結束 19:00 送出病患 19:03 進入恢復室 20:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 摘要__ 手術科部: 外科部 套用罐頭: L4/5 posterior fixation with Dynasis 開立醫師: 陳盈志 開立時間: 2010/03/16 19:06 Pre-operative Diagnosis L4/5 spondylosis Post-operative Diagnosis L4/5 spondylosis Operative Method L4/5 posterior fixation with Dynasis Specimen Count And Types nil Pathology nil Operative Findings TPS at L4 and L5 6.4x45mm, right side 21mm, left side 24.5mm Operative Procedures 1.ETGA, prone 2.Midline back incision, paramedian approach 3.identify bilateral facet and transverse process at L4/L5, then TPS was set under C-arm to L4 and L5 4.set up dynamic rod 5.Hemostasis,H/V x 2 at bilateral paraspinal muscle 6.close wound in layers Operators VS 賴達明 Assistants R6陳盈志R1陳建銘 Indication Of Emergent Operation 李詩賢 (M,1954/05/01,57y10m) 手術日期 2010/03/16 手術主治醫師 蔡瑞章 手術區域 東址 001房 01號 診斷 顱內出血(ICH) 器械術式 Brain tumor Crainotomy(Others) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3E 紀錄醫師 張皓鈞, 時間資訊 01:41 通知急診手術 01:41 臨時手術NPO 01:41 開始NPO 02:40 進入手術室 02:45 麻醉開始 03:20 抗生素給藥 03:30 誘導結束 03:47 手術開始 06:20 抗生素給藥 07:00 手術結束 07:00 麻醉結束 07:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 腦內血腫清除術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Right temporal parietal craniotomy hematoma e... 開立醫師: 張皓鈞 開立時間: 2010/03/16 07:30 Pre-operative Diagnosis Right temporal parietal ICH, suspect tumor Post-operative Diagnosis Right temporal parietal ICH, suspect tumor Operative Method Right temporal parietal craniotomy hematoma evacuation and tumor excision Specimen Count And Types 1 piece About size:1.5x1x1cm Source:hematoma suspect tumor Pathology pending Operative Findings about 50~60mL hematoma was evacuated from temporal lobe to parietal lobe. hematoma connected to ventricle was noted. one soft elastic mass was noted inside the blood clot. The brain was slake after hematoma evacuation. ICP was 2mmHg after skin closure Operative Procedures 1.ETGA, supine head tilt to left 2.Skin preparation 3.Right temporal parietal U shape skin incision 4.detach temporalis muscle 5.Burr hole x 4 then craniotomy 6.Dura tenting, then U shape dura incision 7.ultrasound localization. 8.Corticotomy 1cm at frontal-parietal Operators 蔡瑞章 Assistants R6陳盈志 R1張皓鈞 Indication Of Emergent Operation 摘要__ 手術科部: 外科部 套用罐頭: Right temporal parietal craniotomy hematoma e... 開立醫師: 陳盈志 開立時間: 2010/03/16 11:26 Pre-operative Diagnosis Right temporal parietal ICH, suspect tumor Post-operative Diagnosis Right temporal parietal ICH, suspect tumor Operative Method Right temporal parietal craniotomy hematoma evacuation and tumor excision Specimen Count And Types 1 piece About size:1.5x1x1cm Source:hematoma suspect tumor Pathology pending Operative Findings about 50~60mL hematoma was evacuated from temporal lobe to parietal lobe. hematoma connected to ventricle was noted. one soft elastic mass was noted inside the blood clot at posterior side. The brain was slake after hematoma evacuation. ICP was 2mmHg after skin closure Operative Procedures 1.ETGA, supine head tilt to left 2.Skin preparation 3.Right temporal parietal U shape skin incision 4.detach temporalis muscle 5.Burr hole x 4 then craniotomy 6.Dura tenting, then U shape dura incision 7.ultrasound localization. 8.Corticotomy 1cm at parietal area, then hematoma evacuation was done under microscope. 9.One soft mass was noted at posterior portion of the hematoma, which was also be removed with bipolar 10.Hemostasis was done with surgicel packing and bipolar 11.Dura closure with 4-0 prolene 12.Fix bone plate with 4 wires 13.Close wound in layers after one subgaleal CWV drain Operators P蔡瑞章 Assistants R6陳盈志R1張皓鈞 Indication Of Emergent Operation 張玉貞 (F,1930/11/21,81y3m) 手術日期 2010/03/16 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Cervical Spondylosis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 07:50 報到 08:03 進入手術室 08:10 麻醉開始 08:30 誘導結束 09:15 抗生素給藥 09:36 手術開始 12:30 抗生素給藥 13:20 麻醉結束 13:20 手術結束 13:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 椎弓切除術（特壓）－超過二節 1 2 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 摘要__ 手術科部: 外科部 套用罐頭: C1 laminectomy and C0 to C2~C3 posterior wire... 開立醫師: 胡朝凱 開立時間: 2010/03/16 13:12 Pre-operative Diagnosis C2 dens fracture and C1~2 subluxation Post-operative Diagnosis C2 dens fracture and C1~2 subluxation Operative Method C1 laminectomy and C0 to C2~C3 posterior wire fixation Specimen Count And Types NIL Pathology Nil Operative Findings 1.After prone position, the C spine reduction was approve and confirmed by C-arm 2.C1~2 floating was noted. 3.K-pin was used for C0~C2,3 fixation 4.Lateral fusion was done with artificial bone and sutologous bone Operative Procedures 1.ETGA, prone 2.Midline incision at inion to C5 level 3.Detach paravertebral muscle groups to expose C21 posterior arch, C2~5 spinous process 4.C1 laminectomy 5.Use K-pin to model the loop that fit the posterior curve 6.Drill 4 burr holes at ossipital bone 7.Insert wires at occipital bone, C2, C3 sublaminar area 8.Fix K-pin with wires 9.lateral fusion 10.Set one menihemovac drain then close wound in layres Operators 曾勝弘 Assistants 胡朝凱,李振豪 牛以幼 (F,1939/01/20,73y1m) 手術日期 2010/03/16 手術主治醫師 曾勝弘 手術區域 東址 005房 02號 診斷 Herniation of intervertebral disc 器械術式 Lamino plasty 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 張皓鈞, 時間資訊 12:45 報到 13:48 進入手術室 13:55 麻醉開始 14:06 抗生素給藥 14:10 誘導結束 14:44 手術開始 16:45 手術結束 16:45 麻醉結束 16:55 送出病患 17:00 進入恢復室 19:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術（特壓）－超過二節 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 摘要__ 手術科部: 外科部 套用罐頭: C3~7 laminectomy 開立醫師: 胡朝凱 開立時間: 2010/03/16 16:55 Pre-operative Diagnosis C3~7 spinal stenosis Post-operative Diagnosis C3~7 spinal stenosis Operative Method C3~7 laminectomy Specimen Count And Types Nil Pathology Nil Operative Findings 1.Hypertrophic flavum ligment that compressed the spinal cord tightly 2.After decompression, the thecal sac expanded well Operative Procedures 1.ETGA, prone 2.Midline incision at C2~T1 level 3.Detach paravertebral muscle group 4.Expose C3~7 spinous process then lamina 5.Remove spinous process and partial lamina with Ronguer 6.further removal of lamina with kerrison punch 7.Hemostasis 8.Set one CWV drain 9.Close wound in layers Operators 曾勝弘 Assistants 胡朝凱,張皓鈞 丁吳留 (F,1934/10/21,77y4m) 手術日期 2010/03/16 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 顱內出血(ICH) 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 4E 紀錄醫師 李振豪, 時間資訊 12:10 通知急診手術 12:35 報到 12:35 進入手術室 12:40 麻醉開始 12:50 誘導結束 13:00 開始輸血 13:10 抗生素給藥 13:25 手術開始 16:10 抗生素給藥 18:50 麻醉結束 18:50 手術結束 19:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 腦內血腫清除術 1 1 R 手術 顱內壓監視置入 1 2 R 摘要__ 手術科部: 外科部 套用罐頭: 1. Right frontotemporal craniectomy for hemat... 開立醫師: 李建勳 開立時間: 2010/03/16 20:15 Pre-operative Diagnosis Right putaminal intracerebral hemorrhage Post-operative Diagnosis Right putaminal intracerebral hemorrhage Operative Method 1. Right frontotemporal craniectomy for hematoma evacuation and decompression 2.ICP monitor insertion Specimen Count And Types 1 piece About size:5g Source:hematoma evacuation Pathology Pending Operative Findings Large amount of hematoma was evacuated from left frontal and temporal lobe (about 80mL). Generalized oozing was noted during the procedure. The brain was temporally slack down after hematoma evacuation, but bulding again while closing the wound. The ICP after wound closure: 36mmHg. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position with head turn to left. The scalp was shaved, scrubbed, disinfected with alcohol B-I then draped. The question mark scalp incision was made at left frontotemporal area followed by craniectomy. The dura was opened after tenting along the craniectomy window. The temporal base was further removed by rongeur. The hematoma was located with intraoperaive sonography. The hematoma evacuation was performed via corticotomy at temporal and frontal site. The oozing was packing with surigcel lining of the hematoma cavities. The ICP monitor was set up at right temporal subdurally. The duroplasty was performed with temporalis fascia graft and 4-0 Prolene sutures. The wound was closed in layers after one subcutaenous CWV set up. Operators VS 賴達明 Assistants R6 李建勳 R3 李振豪 Indication Of Emergent Operation 相關圖片 郭良雄 (M,1938/11/17,73y3m) 手術日期 2010/03/16 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 HIVD 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 張皓鈞, 時間資訊 07:45 報到 08:05 進入手術室 08:15 麻醉開始 08:30 誘導結束 08:40 抗生素給藥 09:15 手術開始 11:40 抗生素給藥 12:10 手術結束 12:10 麻醉結束 12:20 送出病患 12:25 進入恢復室 13:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術－前融合，有固定物（＜＝四節） 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 摘要__ 手術科部: 外科部 套用罐頭: Microdiskectomy with cage anterior fusion 開立醫師: 陳睿生 開立時間: 2010/03/16 12:33 Pre-operative Diagnosis C3/4 HIVD with myelopathy Post-operative Diagnosis Ditto Operative Method Microdiskectomy with cage anterior fusion Specimen Count And Types nil Pathology Nil Operative Findings Calcified ALL was noted at C3/4 level. The C3/4 disk was degenerative change with disk space narrowing. The cord was tightly compressed by the herniated disk, spurs, and well expanded after diskectomy. A 6mm Synthes cage was implanted. Operative Procedures 1. ETGA, supine position with head extension 2. Right neck transverse incision 3. Incise into the plastyma muscle, and then dissect the plane between SCM and trachea, esophagus 4. Expose the prevertebral space and C-arm localized C3/4 level 5. Set Koros and Casper self retractor under microscope 6. Diskectomy was performed with curette 7. The endplate and posterior spurs were removed with high speed drill 8. The PLL was removed to deompress the cord 9. Hemostasis, set the 6mm Synthes cage 10.Set a 1/8 hemovac, and close the wound in layers Operators VS 賴達明 Assistants R5 陳睿生, R1 張皓鈞 相關圖片 蕭博文 (M,1979/08/01,32y7m) 手術日期 2010/03/16 手術主治醫師 賴達明 手術區域 東址 001房 02號 診斷 Herniation of intervertebral disc (HIVD) 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 陳睿生, 時間資訊 12:15 報到 13:04 進入手術室 13:07 麻醉開始 13:15 誘導結束 13:30 抗生素給藥 14:01 手術開始 15:58 手術結束 15:58 麻醉結束 16:10 送出病患 16:12 進入恢復室 17:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術－頸椎 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 摘要__ 手術科部: 外科部 套用罐頭: Right side foraminotomy for decompression 開立醫師: 陳睿生 開立時間: 2010/03/16 16:30 Pre-operative Diagnosis Right side C6/7 ruptured disk with radiculopathy Post-operative Diagnosis Right side C6/7 ruptured disk with radiculopathy Operative Method Right side foraminotomy for decompression Specimen Count And Types nil Pathology Nil Operative Findings The right side C6/7 disk and upper C7 body were drilled out for decompression. A piece of ruptured disk was removed after foraminotomy, and the PLL was also opened for decompression. Operative Procedures 1. ETGA, supine position with head extension 2. Right lower neck transverse incision, and incise into the plastyma muscle 3. Dissect the plane between SCM and trachea, esophagus 4. Expose the pre-vertebral space and C-arm localize the C6/7 disk 5. Set Koros self-retractor, and foraminotomy was performed at right C6/7 disk space with high speed drill 6. Remove of ruptured disk and PLL 7. Hemostasis, close the wound in layers Operators VS 賴達明 Assistants R5 陳睿生, Ri 相關圖片 陳松 (M,1938/10/25,73y4m) 手術日期 2010/03/16 手術主治醫師 賴達明 手術區域 東址 001房 04號 診斷 Spinal tumor 器械術式 Benign intraspinal tumor, exci 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳睿生, 時間資訊 16:05 報到 16:23 進入手術室 16:30 麻醉開始 16:35 誘導結束 16:55 抗生素給藥 17:15 手術開始 19:25 手術結束 19:25 麻醉結束 19:35 送出病患 19:40 進入恢復室 20:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 良性病髓腫瘤切除術 1 1 摘要__ 手術科部: 外科部 套用罐頭: Left side hemilaminectomy for tumor remove 開立醫師: 陳睿生 開立時間: 2010/03/16 20:03 Pre-operative Diagnosis L2 intraspinal extramedullary tumor, suspect neuroma Post-operative Diagnosis L2 intraspinal extramedullary tumor, suspect neuroma Operative Method Left side hemilaminectomy for tumor remove Specimen Count And Types 1 piece About size:PIECES Source:TUMOR Pathology Pending Operative Findings The tumor was whitish, solid with capsule, and some yellowish portion was noted inside the tumor. The tumor located at the ventral side of the thecal sac, and it was noted to be origined from one root. The root was left after tumor remove. Operative Procedures 1. ETGA, prone position 2. Low back midline incision, and split the L2 spinous process with sew 3. After traction of the spinous process, the right side L2 lamina was exposed 4. Right L2 hemilaminectomy was performed with rounger, kerrison pounch and high speed drill 5. Dura opening and tacking 6. After opening of the arachnoid membrane, the tumor was noted by splitting of the roots 7. Detach the tumor from peripheral roots, and central debulking of the tumor was performed 8. Then the tumor capsule was removed with preservation of the adhered roots 9. Hemostasis, and close the dura tightly 10.Set an epidural CWV drain, and close the wound in layers Operators VS 賴達明 Assistants R5 陳睿生, Ri 相關圖片 林陳桂偕 (F,1934/04/25,77y10m) 手術日期 2010/03/16 手術主治醫師 陳敞牧 手術區域 東址 005房 03號 診斷 Lumbar spondylosis 器械術式 Laminectomy for decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 胡朝凱, 時間資訊 17:00 報到 17:20 進入手術室 17:30 麻醉開始 17:40 誘導結束 17:50 抗生素給藥 18:15 手術開始 20:50 手術結束 20:50 抗生素給藥 20:50 麻醉結束 21:05 送出病患 21:10 進入恢復室 22:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 手術 椎間盤切除術－腰椎 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Right side L3~5 sublaminar decompression 開立醫師: 胡朝凱 開立時間: 2010/03/16 21:05 Pre-operative Diagnosis L3~4, 4~5 lateral recess syndrome Post-operative Diagnosis L3~4, 4~5 lateral recess syndrome Operative Method Right side L3~5 sublaminar decompression Specimen Count And Types NIL Pathology Nil Operative Findings 1.Severe hypertrophic flavum ligment at L3~5 area. 1.Severe hypertrophic flavum ligment at L3~5 area. 2.The ligment compressed the thecal sac and root tightly. 3.The root was injected, but after decompression, it became loose Operative Procedures 1.ETGA, prone 2.Midline incision at L3~5 level 3.Rdetach right para-vertebral muscle group 4.Expose L3, L4 lamina 5.Laminotomy 6.Excised flavum ligment by kerrison 7.Further excision flavum ligment from right side to left by tilting table 8.Hemostasis 9.Close wound in layers Operators 陳敞牧 Assistants 胡朝凱,張皓鈞 蘇靖淳 (F,1998/03/15,13y11m) 手術日期 2010/03/16 手術主治醫師 楊士弘 手術區域 兒醫 067房 01號 診斷 Anomalies of spine, unspecified 器械術式 Diskectomy cervical (Posterie 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 2 紀錄醫師 鍾文桂, 時間資訊 07:50 報到 08:08 進入手術室 08:15 麻醉開始 08:50 誘導結束 10:00 抗生素給藥 10:58 手術開始 13:00 抗生素給藥 14:20 開始輸血 16:14 抗生素給藥 19:15 麻醉結束 19:15 手術結束 19:25 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 14 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 3 0 麻醉 Hemoglobin (Hb) 3 0 麻醉 測血糖 3 0 麻醉 Ca (Calcium) 3 0 麻醉 Na (Sodium) 3 0 麻醉 K (Potassium) 3 0 麻醉 Cl (Chloride) 3 0 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 手術 椎弓切除術（特壓）－二節以內 1 2 手術 骨或軟骨移植術 1 1 麻醉 Blood gas analysis 3 0 摘要__ 手術科部: 外科部 套用罐頭: (1) C1 laminectomy for posterior decompressio... 開立醫師: 楊士弘 開立時間: 2010/03/16 19:26 Pre-operative Diagnosis Os odontoideum with atlantoaxial subluxation Post-operative Diagnosis Os odontoideum with atlantoaxial subluxation, not reducible Operative Method (1) C1 laminectomy for posterior decompression (2) Occipitocervical fixation from occiput to C3 (3) Occipitocervical fusion from occiput to C2 Specimen Count And Types nil Pathology Operative Findings Operative Procedures Operators 楊士弘 Assistants 鍾文桂 摘要__ 手術科部: 外科部 套用罐頭: (1) C1 laminectomy for posterior decompressio... 開立醫師: 古恬音 開立時間: 2010/03/16 20:20 Pre-operative Diagnosis Os odontoideum with atlantoaxial subluxation Post-operative Diagnosis Os odontoideum with atlantoaxial subluxation, not reducible Operative Method (1) C1 laminectomy for posterior decompression (2) Occipitocervical fixation from occiput to C3 (3) Occipitocervical fusion from occiput to C2 Specimen Count And Types nil Pathology Nil. Operative Findings Severe fibrotic adhesions around C1 level. Lysis of the adhesion bands for releasing spinal cord. T shape occipital plate, fixed with two occipital screws(4mm) Two lateral mass screws at C3 level. (16mm,left;18mm,right); Two rods for fixation. A 8-cm rib was collected at left side as autograft. It was divided into half for bilateral occipitocervical fusion. Four wire fixation sites: bilateral rib autograft to occipital bone and C2 spinous process; bilateral C2 lamina to rod of internal fixation. Operative Procedures Anesthesia: general, endotracheal. Position: prone, head fixed with Mayfield 3-pin head-holder. Incision: midline from inion to C4 level; 5-cm incision at left upper back for harvesting rib autograft. Midline dissection until inion and C4 spinous process were exposed. Lateral dissection was done until bilateral C3 laminae were fully exposed. C1 laminectomy for posterior decompression. C3 lateal mass screws, bilateral. T-shape occipital plate, with two occipital screws. Placement of two longitudinal rods. Harvest a segment of rib as autograft and divide the graft into half. Decortication of fusion surface. Fixation of bone grafts with wires over occipital bone and C2 spinous process, bilateral. Bilateral C2 facet wiring for fixation of rods, . Wound closure in layers after placing one CWV drain. Send the patient to ICU smoothly. Operators 楊士弘 Assistants 鍾文桂 摘要__ 手術科部: 外科部 套用罐頭: (1) C1 laminectomy for posterior decompressio... 開立醫師: 鍾文桂 開立時間: 2010/03/19 10:37 Pre-operative Diagnosis Os odontoideum with atlantoaxial subluxation Post-operative Diagnosis Os odontoideum with atlantoaxial subluxation, not reducible Operative Method (1) C1 laminectomy for posterior decompression (2) Occipitocervical fixation from occiput to C3 (3) Occipitocervical fusion from occiput to C2 Specimen Count And Types nil Pathology Nil. Operative Findings Severe fibrotic adhesions around C1 level. Lysis of the adhesion bands for releasing spinal cord. T shape occipital plate, fixed with two occipital screws(4mm) Two lateral mass screws at C3 level. (16mm,left;18mm,right); Two rods for fixation. A 8-cm rib was collected at left side as autograft. It was divided into half for bilateral occipitocervical fusion. Four wire fixation sites: bilateral rib autograft to occipital bone and C2 spinous process; bilateral C2 lamina to rod of internal fixation. CSF leakage, repaired with DuraGen. Operative Procedures Anesthesia: general, endotracheal. Position: prone, head fixed with Mayfield 3-pin head-holder. Incision: midline from inion to C4 level; 5-cm incision at left upper back for harvesting rib autograft. Midline dissection until inion and C4 spinous process were exposed. Lateral dissection was done until bilateral C3 laminae were fully exposed. C1 laminectomy for posterior decompression. C3 lateal mass screws, bilateral. T-shape occipital plate, with two occipital screws. Placement of two longitudinal rods. Harvest a segment of rib as autograft and divide the graft into half. Decortication of fusion surface. Fixation of bone grafts with wires over occipital bone and C2 spinous process, bilateral. Bilateral C2 facet wiring for fixation of rods, . Wound closure in layers after placing one CWV drain. Send the patient to ICU smoothly. Operators 楊士弘 Assistants 鍾文桂 林國安 (M,1955/12/09,56y3m) 手術日期 2010/03/17 手術主治醫師 郭順文 手術區域 東址 005房 03號 診斷 CVA 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林峰盛 ASA 3 紀錄醫師 許松鈺, 時間資訊 16:12 報到 16:12 進入手術室 16:15 麻醉開始 16:20 誘導結束 16:25 手術開始 16:35 麻醉結束 16:35 手術結束 16:44 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 氣管切開造口術 1 0 摘要__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 許松鈺 開立時間: 2010/03/17 16:53 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types nil Pathology None Operative Findings Fr.8 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators 郭順文 Assistants 林孟暐, 許松鈺 相關圖片 林謝玉蘭 (F,1945/04/14,66y11m) 手術日期 2010/03/17 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾峰毅, 時間資訊 07:52 報到 08:05 進入手術室 08:10 麻醉開始 08:55 誘導結束 09:13 抗生素給藥 09:15 手術開始 12:13 抗生素給藥 15:05 麻醉結束 15:05 手術結束 15:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 手術 腦瘤切除－手術時間在４～８小時 1 1 L 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Occipital craniotomy for tumor excision 開立醫師: 曾峰毅 開立時間: 2010/03/17 15:18 Pre-operative Diagnosis Left falcotentorial meningioma Post-operative Diagnosis Left falcotentorial meningioma Operative Method Occipital craniotomy for tumor excision Specimen Count And Types Several fragments of one tumor Pathology pending Operative Findings One well-defined, soft, normovascular, extra-axial, whitish, extra-axial, tumor with dura attachment to falx was noted at left. Operative Procedures With endotracheal general anaestheisa, the patient was put in prone position with neck flexed and head fixed with head clamp. After sclap shaved, scrubbed, disinfected, and then drapde, we made one U-shape skin incision at occipital area. We drilled 6 burr holes, and then created one craniotomy window. Dura was tented around the craniotomy, and sinus bleeding was stopped by Gelfoam pressing. Dura incisino was made in C-shape with base along the superior saggital sinus. Tumor was dissected, and tumor base at falx was coagulated. Central debulking was done first, and remaining part of the tumor was removed with capsule. Dura was closed in water-tight fashion with 4-0 prolene. Bone graft was fixed back with. After one subgaleal CWV inserted, we closed the wound in layers. Operators P 杜永光 Assistants R6 陳盈志 R6 黃建智 R3 曾峰毅 李光男 (M,1944/04/29,67y10m) 手術日期 2010/03/17 手術主治醫師 蔡瑞章 手術區域 東址 005房 01號 診斷 Lumbar stenosis 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳建銘, 時間資訊 07:50 報到 08:05 進入手術室 08:10 麻醉開始 08:30 誘導結束 09:30 抗生素給藥 09:35 手術開始 12:30 抗生素給藥 13:35 手術結束 13:35 麻醉結束 13:40 送出病患 13:45 進入恢復室 14:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 手術 椎間盤切除術－腰椎 1 1 R 手術 椎弓切除術（特壓）－二節以內 1 2 R 摘要__ 手術科部: 外科部 套用罐頭: 1. L3 and L4 laminectomy for decompression 2.... 開立醫師: 李建勳 開立時間: 2010/03/17 13:54 Pre-operative Diagnosis 1. Lumbar stenosis, L3 and L4 2. Herniated disc at left L5/S1 1. Lumbar stenosis, L3 and L4 2. Herniated disc at right L5/S1 Post-operative Diagnosis 1. Lumbar stenosis, L3 and L4 2. Herniated disc at left L5/S1 1. Lumbar stenosis, L3 and L4 2. Herniated disc at right L5/S1 Operative Method 1. L3 and L4 laminectomy for decompression 2. Left L5 hemilaminectomy for microscopic disckectomy 1. L3 and L4 laminectomy for decompression 2. right L5 hemilaminectomy for microscopic disckectomy Specimen Count And Types 1 piece About size:1G Source:Disckectomy Pathology Pending Operative Findings 1. The theca sac was compressed tightly by the thickened ligmentum flavum. After the procedure, the theca sac was relaxed. The unintended durotomy was sutured with 5-0 Prolene. 2. The left L5/S1 herniated disc with S1 root mild compression. The root was relaxed after disckectomy. Operative Procedures Under general anesthesia and intubation, the patient was put in prone position with L3,4,5 spinous processes located with portable C-arm X-ray. The skin was scrubbed, disinfected with alcohol B-I then draepd. The midlin skin incision was made from L2 to S1 spinous process and dissected the paraspinal muscle to expose the laminae. The left L5/S1 hemilaminectomy was performed before disckectomy under microscope was done. The L3 and L4 laminectomy was performed with rongeur and Kerrison punch. The unintended durotomy was sutured with 5-0 Prolene. After hemostasis with gelform packing, the wound was closed in layers after one epidural CWV drain set up. Operators p 蔡瑞章 Assistants R6 李建勳 R1 陳建銘 相關圖片 陳麗雲 (F,1952/11/02,59y4m) 手術日期 2010/03/17 手術主治醫師 陳炯年 手術區域 東址 002房 01號 診斷 Benign neoplasm of spinal cord 器械術式 Exploratory laparatomy 手術類別 緊急手術 手術部位 腹 傷口分類 污染 麻醉方式 全身麻醉 麻醉主治醫師 王永彬 ASA 4E 紀錄醫師 王奐之, 時間資訊 02:16 通知急診手術 03:10 進入手術室 03:15 麻醉開始 03:25 誘導結束 03:35 手術開始 04:25 開始輸血 05:20 手術結束 05:20 麻醉結束 05:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 良性腸減灶切除術 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Segmental resection of small bowels 開立醫師: 陳建嘉 開立時間: 2010/03/17 05:15 Pre-operative Diagnosis Ischemic bowels Post-operative Diagnosis Ischemic bowels due to strangulation Operative Method Segmental resection of small bowels Specimen Count And Types 1 piece About size:25*25*25cm Source:small bowels Pathology pending Operative Findings 1. Massive bloody ascites 2. Strangualation of small bowels from about 130cm below Treitz ligament and the ischemic change of small bowels extended to about 80cm before ileocecal valve 3. Residual small bowels about 210cm in length Operative Procedures 1. ETGA, supine position 2. Make a midline incision 3. Identify the region of ischemic bowels 4. Perform segmental resection 5. Perform end-to-end anastamosis 6. Set one rubber drain in cul-de-sac 7. Close the wound in layers Operators 陳炯年 Assistants 陳建嘉, 王奐之 Indication Of Emergent Operation 相關圖片 陳佑嘉 (M,2009/10/28,2y4m) 手術日期 2010/03/17 手術主治醫師 張重義 手術區域 兒醫 067房 01號 診斷 Tetralogy of Fallot 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 4 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 08:20 進入手術室 08:25 麻醉開始 08:30 誘導結束 09:25 手術開始 11:00 手術結束 11:00 麻醉結束 11:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 外科部 套用罐頭: Ventricular-peritoneal shunt implantation via... 開立醫師: 鍾文桂 開立時間: 2010/03/17 11:29 Pre-operative Diagnosis Hydrocephalus. Post-operative Diagnosis Hydrocephalus. Operative Method Ventricular-peritoneal shunt implantation via left Kocher. Specimen Count And Types 1 piece About size:3 cc CSF for CSF routine, culture, glucose and total protein. Source: Pathology Nil. Operative Findings Low intracranial pressure, clear colorless CSF. Medtronic medium pressure reservoir. Ventricular catheter: 5.5cm, peritoneal catheter: 40 cm. Operative Procedures Anesthesia: endotracheal, general. Position: supine, head slightly tilted to right side. Incision: semicircular at left Kocher, linear longitudinal at left upper quadrant of abdomen. Dissection of left anterior margin of anterior fontanelle. Removal of some bony edge of anterior fontanelle. Dural incision. Insertion of ventricular puncture needle over left Kocher. Abdominal incision and dissection until reaching peritoneal cavity. Subcutaneous diessection from abdomen to head. Insertion of peritoneal and ventricular catheters after connecting with reservoir. Wound closure in layers. Send the patient to ICU smoothly. Operators V.S. 楊士弘. Assistants R4 鍾文桂. 蔡楓玲 (F,1974/07/18,37y7m) 手術日期 2010/03/18 手術主治醫師 曾勝弘 手術區域 東址 005房 03號 診斷 Malignant neoplasm of cranial nerves 器械術式 Stereotaxic procedure for biop 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 陳德福, 時間資訊 11:38 報到 12:40 進入手術室 12:45 麻醉開始 12:55 誘導結束 13:00 抗生素給藥 13:45 手術開始 16:00 抗生素給藥 16:30 麻醉結束 16:30 手術結束 16:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 手術 立體定位術－切片 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Stereotaxic tumor biopsy, right frontal entery 開立醫師: 陳德福 開立時間: 2010/03/18 17:01 Pre-operative Diagnosis left brain tumor right basal ganglion brain tumor Post-operative Diagnosis ditto Operative Method Stereotaxic tumor biopsy, right frontal entery Specimen Count And Types 1 piece About size:0.3*0.5*0.3CM Source:brain tumor Pathology pending Operative Findings Under Nevigator system guided, we performed stereotaxic tumor via right frontal lobe and the procedure was done smoothly. The tumor was greyish to reddish with soft in consistency. Under Nevigator system guided, we performed stereotaxic tumor biopsy with entery point as right frontal area and the procedure was done smoothly. The tumor was greyish to reddish and it is soft in consistency. Operative Procedures Under ETGA and supine position, the Navigator system was registered. The entery point was decided under Navigator planning from right fontal lobe. The ventricles was spared and we inserted the biopsy needle followed by performing the tumor biopsy. The scalp was then closed in layers. Under ETGA and supine position, the Navigator system was registered. The entery point was decided under Navigator planning from right fontal area. The ventricles was spared and we inserted the biopsy needle to performe tumor biopsy. The scalp was then closed in layers. Operators VS 曾勝弘 Assistants R6 陳盈志 R4 陳德福 范健民 (M,1927/08/08,84y7m) 手術日期 2010/03/18 手術主治醫師 林晉 手術區域 東址 001房 01號 診斷 Patella fracture, closed 器械術式 ORIF - Patellar Fr(K-pin,wire 手術類別 緊急手術 手術部位 四肢 傷口分類 清潔 麻醉方式 脊髓麻醉 麻醉主治醫師 林子富 ASA 3 紀錄醫師 曾渥然, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 08:20 報到 09:10 進入手術室 09:12 麻醉開始 09:15 誘導結束 09:30 抗生素給藥 09:38 手術開始 10:40 手術結束 10:40 麻醉結束 10:45 進入恢復室 10:45 送出病患 12:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Spinal anesthesia 1 0 手術 石膏切開，開窗 1 0 R 手術 膝蓋骨骨折開放性復位術 1 1 R 記錄__ 手術科部: 骨科部 套用罐頭: ORIF with tension-band wiring 開立醫師: 曾渥然 開立時間: 2010/03/18 10:52 Pre-operative Diagnosis Patella fracture, right Post-operative Diagnosis Patella fracture, right Operative Method ORIF with tension-band wiring Specimen Count And Types nil Pathology Nil Operative Findings 1.Patella fracture, transverse 2.Implants: two 2.0mm K-pins and one 16# double-strand wire Operative Procedures 1.Spinal anesthesia, supine 2.Skin disinfection and well draped 3.Midline incision over right knee, approach to fracture site 4.Remove the hematoma, reduce the fracture with two towel clips 5.Apply tension-band wiring technique step by step 6.Check the articular surface 7.Normal saline irrigation, close the wound in layers Operators 林晉 Assistants CR陳俊和;R4陳彥宇;R3曾渥然 Indication Of Emergent Operation 趙立飛 (M,1950/05/30,61y9m) 手術日期 2010/03/18 手術主治醫師 陳敞牧 手術區域 東址 012房 03號 診斷 Spondyloisthesis, acquired 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 李建勳, 時間資訊 12:30 報到 12:56 進入手術室 13:00 麻醉開始 13:15 誘導結束 14:00 抗生素給藥 14:13 手術開始 17:00 抗生素給藥 18:50 開始輸血 21:10 手術結束 21:10 麻醉結束 21:18 送出病患 21:20 進入恢復室 22:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 手術 椎間盤切除術－腰椎 1 2 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 8 0 摘要__ 手術科部: 外科部 套用罐頭: L4/5 trasnpedicular screws (TPS) fixation, L3... 開立醫師: 李建勳 開立時間: 2010/03/18 21:21 Pre-operative Diagnosis L3/4, 4/5 herniated lumbar disc with spondylolithesis Post-operative Diagnosis L4/5 herniated lumbar disc with spondylolithesis Operative Method L4/5 trasnpedicular screws (TPS) fixation, L3 and L4 laminectomy and disckectomy with disc cage fusion Specimen Count And Types nil Pathology Nil Operative Findings The L3/4, 4/5 stenosis with herniated disc more severe at L4/5. The Vigor disc cage 11mm and 10mm were inserted at L3/4, 4/5 disc space after disckectomy. Aspine TPS screws 6.5mmX45mm X4 and rods X2 (50mm, 60mm). Operative Procedures Under general anesthesia and intubation, the patient was put in prone position. The L4 and L5 transverse processes were located with portable X-ray. The skin was scrubbed, disinfected with alcohol B-I then draped. Midline skin incision was made from L2 to S1 spinous process and seperated at the fascia layer. Paramedian fascia incision was made 4cm away from midline bilaterally. The transverse processes were located and the paraspinal muscles were retracted by tubal retractor. The TPS were inserted and checked position with portable X-ray. The L4 and L5 laminectomy were performed with bone cutter, rongeur and Kerrison punch. The disckectomy was performed with surgicel blade incision of the posterior longitudinal ligment followed by aligator removal of the disc. The disc cages were inserted and checked position with portable X-ray. After set up the rods, hemovac and CWV drains, the wound was closed in layers. Under general anesthesia and intubation, the patient was put in prone position. The L4/5transverse processes were located with portable X-ray. The skin was scrubbed, disinfected with alcohol B-I then draped. Midline skin incision was made from L2 to S1 spinous process and seperated at the fascia layer. Paramedian fascia incision was made 4cm away from midline. The paraspinal muscles were retracted by tubal retractor. The TPS were inserted and checked position with portable X-ray. The L4 and L5 laminectomy were performed with bone cutter, rongeur and Kerrison punch. The disckectomy was performed with surgicel blade incision of the posterior longitudinal ligment followed by aligator removal of the disc. The disc cages were inserted and checked position with portable X-ray. The unintended durotomy was covered with gelform. After set up the rods, hemovac and CWV drains, the wound was closed in layers. Operators VS 陳敞牧 Assistants R6 李建勳 相關圖片 林在情 (M,1948/07/10,63y8m) 手術日期 2010/03/18 手術主治醫師 楊士弘 手術區域 東址 005房 02號 診斷 Spine bone metastasis 器械術式 Debridment-- 5-10cm 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3 紀錄醫師 鍾文桂, 時間資訊 10:00 報到 10:07 進入手術室 10:10 麻醉開始 10:20 誘導結束 10:28 抗生素給藥 10:49 手術開始 12:15 手術結束 12:15 麻醉結束 12:20 送出病患 12:35 進入恢復室 13:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 深部複雜創傷處理－傷口長５－１０公分者 1 0 手術 深部複雜創傷處理－傷口長５公分以下者 1 0 摘要__ 手術科部: 外科部 套用罐頭: T spine wound debridement 開立醫師: 李建勳 開立時間: 2010/03/18 11:47 Pre-operative Diagnosis T spine metastatic tumor s/p op with wound dehiscence Post-operative Diagnosis T spine metastatic tumor s/p op with wound dehiscence Operative Method T spine wound debridement Specimen Count And Types 2 pieces About size:X1 Source:Wound swab culture About size:X1 Source:Wound swab culture Pathology Nil Operative Findings The wound was curreted and the granulation tissue was removed. The lower T spine wound was side open, about 8 cm x 3 cm in size, with granulation tissue in the wound beds. Some avascular fascial bands and pseudocapsule were noted as well. The wound bled healthly after wound debridement. Another 0.8 cm diametered wound defect was noted in the previous right hemovac drain site. Some epithelial defect was present. Operative Procedures Under general anesthesia and intubation, the patient was put in prone position. The skin was scrubbed, disinfected with alcohol B-I then draped. The wound was curreted and the granulation tissue was removed. The wound was irrigated with noraml saline. The wound was closed with 1-0 Vicryl and 3-0 Nylon after one CWV drain set up. Operators vs 楊士弘 Assistants R6 李建勳 R4 鍾文桂 相關圖片 張天林 (M,1985/08/08,26y7m) 手術日期 2010/03/18 手術主治醫師 楊士弘 手術區域 東址 005房 01號 診斷 Hyperhidrosis 器械術式 Endoscopic T2 sympathectomy 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 鍾文桂, 時間資訊 07:39 報到 08:05 進入手術室 08:10 麻醉開始 08:15 誘導結束 08:35 抗生素給藥 08:50 手術開始 09:28 手術結束 09:28 麻醉結束 09:40 送出病患 09:42 進入恢復室 11:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 經內視鏡胸交感神經切斷術 1 1 摘要__ 手術科部: 外科部 套用罐頭: Video thoracoscopic T2 sympathectomy, bilateral 開立醫師: 李建勳 開立時間: 2010/03/18 09:37 Pre-operative Diagnosis Hyperhidrosis Post-operative Diagnosis Hyperhidrosis Operative Method Video thoracoscopic T2 sympathectomy, bilateral Specimen Count And Types nil Pathology Nil Operative Findings Both hands temperature increased after ablation of T2 sympathetic trunk. Right side: 29.1->31.1 ℃ ; left side: 28.1->30.5 ℃. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position with bilateral upper limbs adduction. The skin over chest and bilateral axillary area were disinfected with alcohol Better-iodine then draped. Transverse skin incision for 1 cm was made crossed the right anterior axillary line at T3 level. Dissected the underlyning soft tissue before inserted the video thoracoscope and the port. Located the sympathetic trunk at the posterior 2nd rib after holding the ventilation. Sympathectomy of the T2 trunk was performed with monopolar coagulation. Deair procedure was performed before closed the wound with 3-0 Nylone stiches. Performed the same prcedure at left side. Operators VS 楊士弘 Assistants R6 李建勳 R4 鍾文桂 相關圖片 陳阿市 (F,1951/12/20,60y2m) 手術日期 2010/03/18 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3 紀錄醫師 陳睿生, 時間資訊 07:49 報到 08:10 進入手術室 08:15 麻醉開始 08:55 誘導結束 09:25 抗生素給藥 09:32 手術開始 12:25 抗生素給藥 15:20 麻醉結束 15:20 手術結束 15:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 L 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 摘要__ 手術科部: 外科部 套用罐頭: Left side retrosigmoid approach for simpson^s... 開立醫師: 陳睿生 開立時間: 2010/03/18 16:05 Pre-operative Diagnosis Left petroclival meningioma with recurrence Post-operative Diagnosis Left petroclival meningioma with recurrence Operative Method Left side retrosigmoid approach for simpson^s gradeIV tumor remove Specimen Count And Types 1 piece About size:pieces Source:tumor Pathology Pending Operative Findings The tumor occupied left petroclival region. Severe adhesion was noted at cerebellum and petrosal region, and it might be caused by previous surgery. The tumor was whitish blueish, soft and well vascularized. It was also well capsuled. The tumor extended to the tentorial edge, and adhered to the tentorium and petrosal region tightly. After tumor remove, the CN V was noted at the medial side of the tumor. The CN VII, VIII were encapsuled in the tumor, and the tumor adhered to the cranial nerves were left. Operative Procedures 1. ETGA, rigth side 3/4 prone position and head fixed with Mayfield 2. Left retrosigmoid curvillinear scalp incision via previous wound 3. Remove of previous bone cement and skull graft 4. Dura opening, and tenting 5. Adhesionlysis, and cerebellar decompression was done with CSF drainage from cistern Magnum 6. The tumor was exposed by cerebellar retraction 7. Open the tumor capsule, and central debulking was performed with electric cauterization and tumor forceps 8. The tumor capsule was carefully dissected from petrosal region, peripheral cranial nerves, and brain stem 9. The tumor adhered to the CN VII and VIII was left undo 10.Hemostasis, close the dura with Durafoam 11.Fix back the skull with wires x2, and remoduling with bone cement 12.Set a subgaleal CWV drain, and close the wound in layers Operators VS 王國川 Assistants R5 陳睿生, R1 賴碩倫 陳洪絹 (F,1941/02/10,71y1m) 手術日期 2010/03/19 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 2 紀錄醫師 曾峰毅, 時間資訊 07:45 報到 08:05 進入手術室 08:20 麻醉開始 08:40 抗生素給藥 09:00 誘導結束 09:10 手術開始 11:40 抗生素給藥 12:00 麻醉結束 12:00 手術結束 12:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４小時以內 1 1 L 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 摘要__ 手術科部: 外科部 套用罐頭: Left frontal craniotomy tumor excision 開立醫師: 陳盈志 開立時間: 2010/03/19 12:20 Pre-operative Diagnosis Left frontal convexity meningioma Post-operative Diagnosis Left frontal convexity meningioma Operative Method Left frontal craniotomy tumor excision Specimen Count And Types 1 piece About size:3.3x3.2x2cm Source:dura based mass Pathology pending Operative Findings The tumor was dura based with dura tail noted. The margin was well defined. Dura thickening was noted. Tumor was elastic in character. Operative Procedures Under the genral anesthesia with endotracheal tube intubation, the patient was set into supine position with head tilt to right and fixed with Mayfield. The operation field was disinfected and drapped with sterile drapping. Left frontal-temporal curvilinear scalp incision was done. 2 Burr hole was made and then craniotomy was done. Cnetral tenting was done with silk interruptedly. Circumferential dura incision was done and the tumor was dissected with dissecter along its arachnoid plane. Then the tumor was removed en bloc with dura. Hemostasis was done with bipolar. Duroplasty was done with pericranium and 4-0 prolene. Bone plate was fixed with miniplate(3-3-2) after central tenting. One subgaleal CWV drain was set and the wound was closed in layers. Operators P杜永光 Assistants R6陳盈志R3曾峰毅 陳新政 (M,1935/05/01,76y10m) 手術日期 2010/03/19 手術主治醫師 杜永光 手術區域 東址 003房 02號 診斷 Lumbar spondylosis 器械術式 Laminectomy for decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 2 紀錄醫師 曾峰毅, 時間資訊 12:40 進入手術室 12:45 麻醉開始 12:55 誘導結束 13:00 抗生素給藥 13:25 手術開始 16:00 抗生素給藥 16:05 手術結束 16:05 麻醉結束 16:15 送出病患 16:20 進入恢復室 19:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術（特壓）－超過二節 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 曾峰毅 開立時間: 2010/03/19 16:13 Pre-operative Diagnosis Lumbar stenosis L3-5 Post-operative Diagnosis Lumbar stenosis L3-5 Operative Method Lower L3 to L5 laminectomy, bilateral foraminotomy from L3 to L5. Specimen Count And Types Nil Pathology Nil Operative Findings Hypertrophic ligamentum flavum compressed the thecal sac tightly. Thecal sac was relaxed after decompression. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After skin scrubbed, disinfected, and then draped, we made one midline skin incision with C-arm localization. We dissected to exposed the bilateral laminae of L3-5. Laminectomy was done with Kerrison punch and Rongeur. Bilateral foraminotmoy was done at L3-5. We closed the wound in layers after set one hemovac. Operators P 杜永光 Assistants R6 陳盈志 R3 曾峰毅 陳阿黎 (F,1942/01/02,70y2m) 手術日期 2010/03/19 手術主治醫師 詹志洋 手術區域 東址 016房 01號 診斷 Hydrocephalus 器械術式 A-V Shunt 手術類別 臨時手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 4 紀錄醫師 謝永, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:20 進入手術室 08:30 麻醉開始 08:35 誘導結束 09:00 抗生素給藥 09:10 手術開始 10:02 手術結束 10:02 麻醉結束 10:15 送出病患 10:17 進入恢復室 11:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 血管整形術 1 0 R 記錄__ 手術科部: 外科部 套用罐頭: PTA 開立醫師: 謝永 開立時間: 2010/03/19 10:27 Pre-operative Diagnosis AVG thrombosis Post-operative Diagnosis Ditto Operative Method PTA Specimen Count And Types nil Pathology None Operative Findings Thrombus in AVG A critical stenosis over A anastomosis, up to 90% Another stenosis over V anastomosis, up to 70% Post-op thrills (+) Operative Procedures Under masked IVG, the patient was in supine position. The skin was disinfected. AVG was catheterized. Thrombus was crashed with 4 Fr# Fogaty catheter. PTA to both A and V anastomosis with Wanda 6 mm balloon was performed. Urokinase was infused. The wound was then closed in layers. Operators 詹志洋 Assistants 謝永 記錄__ 手術科部: 外科部 套用罐頭: crossing catheter thrombolysis and angioplasty 開立醫師: 謝永 開立時間: 2010/03/19 10:28 Pre-operative Diagnosis right arm arteriovenous graft thrombosis Post-operative Diagnosis right arm arteriovenous graft thrombosis and stenosis Operative Method crossing catheter thrombolysis and angioplasty. Specimen Count And Types nil Pathology thrombosis of the multiple stenotic graft. Operative Findings thrombosis within the multiple puncture site-related stenotic graft. With throbmolysis and angioplasty, graft flow resumed and improved a lot. Bruit presented. Operative Procedures With general anesthesia and supine position. Right arm was positioned, prepared, and draped. With C-ARM setup, we catheterised the thrombosed graft using two 6F sheaths in a crossing fashion and towarded both ends. Using a 4F thru-lumen Fogarty, we negotiated the inflow junction and withrew a segment and cleared the inflow thrombus. With urokinase solution infusion, we achieved pharmacomechanical thrombolysis. A 6mm*8cm balloon was used to dilated the multiple stenotic lesions subsequently. Completion angio revealed a patent graft. With stick method, we closed the two sheathing site with purse-string sutures. The patient stood the procedure well. Postop bruit were present. The stick-sutures should be removed 1 hour postop. Operators 詹志洋 謝永 Assistants 陳錫勳 (M,1965/07/25,46y7m) 手術日期 2010/03/19 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 2 紀錄醫師 陳建銘, 時間資訊 07:45 報到 08:05 進入手術室 08:10 麻醉開始 08:30 誘導結束 08:50 抗生素給藥 09:35 手術開始 10:45 開始輸血 11:50 抗生素給藥 13:20 麻醉結束 13:20 手術結束 13:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４～８小時 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: frontal craniotomy for Simpson grade II tumor excision 開立醫師: 李建勳 開立時間: 2010/03/19 13:46 Pre-operative Diagnosis Right frontal parasaggital meinigioma Post-operative Diagnosis Right frontal parasaggital meinigioma Operative Method Right frontal craniotomy for Simpson grade I tumor excision Specimen Count And Types 2 pieces About size:2x2cm Source:dura About size:10g Source:craniotomy for tumor excision Pathology Pending Operative Findings The tumor was yellowish, elastic, size 6 cm in diameter, with high vascularity. The tumor was able to seperated from the surrounding brain parenchyma by the aracndhound plan. The brain was slghtly bulging at the beginning of the excision, and was slack down after tumor excision. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position with head fixed with Mayfield skull clump. The scalp was shaved, scrubbed, disinfected with alcohol B-I then draped. The inverted U-shaped scalp incision was made followed by right frontal craniotomy. The dura was opened around the tumor after tenting along the craniotomy window. The highly vasculized tumor carefully detached from the surrounding brain parenchyma with dissector and bipolar coagulator. The duroplasty was performed with 4-0 Prolene sutures and periostium. The skull plate was fixed back with miniplates and screws after one subcutaenous CWV drain set up. The wound was then closed in layers. Operators VS 曾漢民 Assistants R6 李建勳 R1 陳建銘 相關圖片 孫正怡 (F,1986/06/06,25y9m) 手術日期 2010/03/19 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Brain tumors, malignant 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 3 紀錄醫師 陳建銘, 時間資訊 13:25 報到 13:45 進入手術室 13:50 麻醉開始 14:20 誘導結束 14:30 抗生素給藥 14:45 手術開始 17:10 麻醉結束 17:10 手術結束 17:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 頭顱成形術 1 1 摘要__ 手術科部: 外科部 套用罐頭: Drainage of subcutaneous effusion, duroplasty... 開立醫師: 李建勳 開立時間: 2010/03/19 17:33 Pre-operative Diagnosis Craniopharyngioma s/p craniectomy Post-operative Diagnosis Craniopharyngioma s/p craniectomy Operative Method Drainage of subcutaneous effusion, duroplasty and cranioplasty Specimen Count And Types Subcutaneous effusion, 10mL Pathology Nil Operative Findings The subcutaneous effusion was drained out with 18G catheter with some debris. The brain was slack down after drainage of the effusion. Operative Procedures Under general anestheis and intubation, the patient was put in supine position with head turned to left. The scalp was shaved, scrubbed, disinfected with alcohol B-I then draped. The sonography was made before tapping the subcutaneous effusion with 18G catheter. The scalp incision was made along previous op scar and dissected the dura from the scar tissue. The Gortex artificial dura was used for duroplasty. The skull plate was taken out from refrigerator and fixed back with miniplates and screws. The scalp was closed in layers after one subcutaenous CWV drain set up. Operators VS 曾漢民 Assistants R6 李建勳 R1 陳建銘 相關圖片 駱罔腰 (F,1933/06/07,78y9m) 手術日期 2010/03/19 手術主治醫師 賴達明 手術區域 東址 019房 02號 診斷 Subarachnoid hemorrhage 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 3 紀錄醫師 張皓鈞, 時間資訊 13:05 報到 13:05 進入手術室 13:10 麻醉開始 13:12 誘導結束 13:18 手術開始 13:40 麻醉結束 13:40 手術結束 13:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 氣管切開造口術 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 張皓鈞 開立時間: 2010/03/19 14:14 Pre-operative Diagnosis Subarachnoid hemorrhage with Respiratory failure Post-operative Diagnosis Subarachnoid hemorrhage with Respiratory failure Operative Method Tracheostomy Specimen Count And Types nil Pathology None Operative Findings Fr7,low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators VS賴達明 Assistants R5 陳睿生 R1張皓鈞 相關圖片 黨啟秀 (F,1944/06/12,67y9m) 手術日期 2010/03/19 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Spondylosis,lumbar&myelopathy; 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 2 紀錄醫師 張皓鈞, 時間資訊 07:45 報到 08:05 進入手術室 08:10 麻醉開始 08:30 誘導結束 09:10 抗生素給藥 09:21 手術開始 12:20 手術結束 12:20 麻醉結束 12:25 送出病患 12:32 進入恢復室 14:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 椎弓切除術（特壓）－二節以內 1 1 摘要__ 手術科部: 外科部 套用罐頭: L4, 5 laminectomy for adhesionlysis and decom... 開立醫師: 陳睿生 開立時間: 2010/03/19 12:42 Pre-operative Diagnosis L4/5 HIVD with spondylolithesis s/p with stenosis Post-operative Diagnosis L4/5 HIVD with spondylolithesis s/p with stenosis Operative Method L4, 5 laminectomy for adhesionlysis and decompression Specimen Count And Types nil Pathology Nil Operative Findings Minor herniated disk was noted at L5/S1, and the disk was left undo. Adhesion was noted at left L4/5 level and adhesionlysis with remove of residual ligamentum flavum was performed. After L4, 5 laminectomy, the thecal sac was well expanded. Operative Procedures 1. ETGA, prone position, C-arm localized the L4/5 level 2. Low back midline incision along the previous wound 3. Split the L4, 5 spinous process with sew 4. Perform laminectomy over L4, 5 level 5. Adhesionlysis was performed at left L4/5 under microscope 6. Remove of ligamentum flavum over L3/4, L4/5 level for decompression 7. Hemostasis, set a CWV drain and close the wound in layers Operators VS 賴達明 Assistants R5 陳睿生, R1 張皓鈞 相關圖片 李穎信 (M,1977/01/30,35y1m) 手術日期 2010/03/20 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林峰盛 ASA 3 紀錄醫師 陳盈志, 時間資訊 07:35 報到 07:52 進入手術室 08:01 麻醉開始 08:25 抗生素給藥 08:30 手術開始 08:30 誘導結束 11:36 抗生素給藥 12:31 麻醉結束 12:31 手術結束 12:35 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除－手術時間在４～８小時 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Left frontal craniotomy tumor excision 開立醫師: 陳盈志 開立時間: 2010/03/20 12:52 Pre-operative Diagnosis Left frontal convexity meningioma Post-operative Diagnosis Left frontal convexity meningioma Operative Method Left frontal craniotomy tumor excision Specimen Count And Types 2 pieces About size:7x5x4cm mass Source:left frontal convexity meningiom About size:6x5x1cm Source:bone with tumor Pathology pending Operative Findings The tumor was elastic to firm in character. The margin is clear except slight adhesion at medial anterior side with some cortical vein. The tumor eroded the bone and hyperostosis was noted. Operative Procedures Under the genral anesthesia with endotracheal tube intubation, the patient was set into supine position with head tilt to right and fixed with Mayfield. The operation field was disinfected and drapped with sterile drapping. Left frontal-temporal curvilinear scalp incision was done cross midline. 5 Burr hole was made and then craniotomy was done. Dura tenting was done with silk interruptedly. Circumferential dura incision was done and the tumor was dissected with dissecter along its arachnoid plane. Mild adhesion was separated and cauterized at the anterior medial side. Then the tumor was removed en bloc with dura. Dura tail was cauterized and curreted. Hemostasis was done with bipolar. Duroplasty was done with pericranium and 4-0 prolene. Hyperostosis portion of the bone was removed with saw and then cranioplasty was done with wired mesh and bone cement. Bone plate was fixed with miniplate(3-3-2) after central tenting. One subgaleal CWV drain was set and the wound was closed in layers. Operators VS曾漢民 Assistants R6陳盈志Ri莊淳戎 翁金福 (M,1955/07/17,56y7m) 手術日期 2010/03/20 手術主治醫師 賴達明 手術區域 東址 002房 02號 診斷 Cerebral aneurysm 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林峰盛 ASA 3E 紀錄醫師 鍾文桂, 時間資訊 08:00 臨時手術NPO 08:00 開始NPO 13:05 進入手術室 13:15 麻醉開始 13:35 誘導結束 13:40 抗生素給藥 14:00 手術開始 14:35 手術結束 14:35 麻醉結束 14:40 抗生素給藥 14:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱內壓監視置入 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 摘要__ 手術科部: 外科部 套用罐頭: Insertion of external ventriclar drainage tub... 開立醫師: 鍾文桂 開立時間: 2010/03/20 16:04 Pre-operative Diagnosis 1. Acute obstructive hydrocephalus. 2. A-Com aneurysm status post embolization, with re-rupture and intraventricular hemorrhage. Post-operative Diagnosis 1. Acute obstructive hydrocephalus. 2. A-Com aneurysm status post embolization, with re-rupture and intraventricular hemorrhage. Operative Method Insertion of external ventriclar drainage tube via left Kocher point for ICP monitoring and CSF drainage. Specimen Count And Types 1 piece About size:CSF evaluation. 5 cc. Source:CSF. Pathology Nil. Operative Findings Clear pinkish CSF gushed out from ventriculostomy tube. High ICP. Left Kocher EVD, insertion, 6 cm. Operative Procedures Anesthesia: general, tracheostomy. Position: supine, head in midline. Shaving, disinfection, draping. Incision: 3 cm linear incision at left Kocher point. One burr hole by high speed drill. Dura tenting, durotomy. Insert ventricular puncture needle at left Kocher point. Insert EVD tube over the same tract. Wound closure in layers after fixation of EVD tube & checking presence of CSF drainage. Send the patient to ICU smoothly. Operators V.S. 賴達明. Assistants R4 鍾文桂 Indication Of Emergent Operation 沈永村 (M,1961/11/28,50y3m) 手術日期 2010/03/20 手術主治醫師 楊士弘 手術區域 東址 003房 01號 診斷 Lung cancer 器械術式 Spinal fusion anterior spinal 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林峰盛 ASA 3 紀錄醫師 張皓鈞, 時間資訊 07:40 報到 08:04 進入手術室 08:10 麻醉開始 09:00 誘導結束 09:05 抗生素給藥 09:30 手術開始 12:05 抗生素給藥 13:30 開始輸血 15:05 抗生素給藥 17:15 麻醉結束 17:15 手術結束 17:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 惡性病髓腫瘤切除術 1 1 L 手術 脊椎融合術－前融合，有固定物（＜＝四節） 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 10 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: (1) Anterior paramedian retroperitoneal appro... 開立醫師: 楊士弘 開立時間: 2010/03/20 17:23 Pre-operative Diagnosis (1) Spinal metastasis, L4; (2) Small cell lung cancer Post-operative Diagnosis (1) Spinal metastasis, L4; (2) Small cell lung cancer Operative Method (1) Anterior paramedian retroperitoneal approach for subtotal excision of spinal tumor; (2) K-pin and methyl methacrylate graft between L3 and L5 vertebral bodies Specimen Count And Types 1 piece About size:small Source:L4 vertebral tumor Pathology Pending Operative Findings (1) The left L4 vertebral body became elastic due to destruction by tumor tissue which is greyish red, fragile and elastic, hypervascular. The thecal sac and left L4 root were tightly compressed and became tension free after debulking of the tumor. (2) The position of methylacrylate graft was confirmed by C-arm fluoroscopy. (3) Profuse bleeding of tumor during dissection and excision of the tumor. Operative Procedures 1. ETGA, supine. 2. Left paramedian incision over anterior abdominal wall, L3 to L5. 3. Opening of anterior and posterior rectal sheaths. 4. Dissection along retroperitoneal space to reach the anterior surface of lumbar spine. 5. Medial retraction of the peritoneal sac by Book-Water retractor system. 6. Coagulation and division of segmental vessels and iliolumbar vein. 7. L3 and L5 anterior diskectomy. 8. Excision of L4 vertebral tumor with knife, currets, disk forceps, tumor forceps, and bipolar cautery. 9. Hemostasis. 10. Insertion of a 2.0 mm diametered k-pin through the end plates into the L3 and L5 vertebral bodies. 11. Insertion of a wire mesh cage for filling of methyl methacrylate between the L3 and L5 vertebral bodies. 12. Two CWV drains: one in retroperitoneal space, one in subcutaneous space. 13. Wound closure in layers Operators 楊士弘 Assistants 胡朝凱,張皓鈞 相關圖片 葉海雄 (M,1959/04/05,52y11m) 手術日期 2010/03/20 手術主治醫師 王國川 手術區域 東址 001房 01號 診斷 Unspecified site of spinal cord injury without evidence of spinal bone injury 器械術式 Diskectomy cervical(Anterier) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林峰盛 ASA 3E 紀錄醫師 曾峰毅, 時間資訊 00:01 臨時手術NPO 00:01 開始NPO 08:01 通知急診手術 09:10 報到 09:10 進入手術室 09:15 麻醉開始 09:45 誘導結束 10:20 抗生素給藥 10:25 手術開始 13:10 麻醉結束 13:10 手術結束 13:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術－頸椎 1 1 手術 脊椎融合術－前融合，有固定物（＜＝四節） 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 摘要__ 手術科部: 外科部 套用罐頭: Anterior Discectomy and Fusion, Cervical Spine 開立醫師: 曾峰毅 開立時間: 2010/03/20 13:20 Pre-operative Diagnosis C3-4 transdiscal fracture with cord compression Post-operative Diagnosis C3-4 transdiscal fracture with cord compression Operative Method Anterior Discectomy, Fusion with Bone Cage and Artificial Bone Graft, and Fixation with Plates Specimen Count And Types Nil Pathology Nil Operative Findings Transdiscal fracture was noted at C3/4 with instability and cord compression. Fusion was done with Synthesis cervial cage, 8mm in height. Fixation was then done with Synthesis plate, 20mm in length. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with neck extended. After skin scrubbed, disinfected, and then draped, we made one transverse skin incison at right side of neck. We dissected via medial side of SCM, and exposed vertebral body of C3/4. Anterior diskectomy was done with Currette and Kerrison punch. Fusion was done with Synthesis cervial cage, 8mm in height. Fixation was then done with Synthesis plate, 20mm in length. After set one CWV, we closed the wound in layers. Operators VS 王國川 Assistants R3 曾峰毅 Indication Of Emergent Operation 呂玉珍 (F,1971/04/21,40y10m) 手術日期 2010/03/21 手術主治醫師 曾漢民 手術區域 東址 003房 02號 診斷 Glioma 器械術式 V-P shunt 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林峰盛 ASA 3E 紀錄醫師 鄭孟伯, 時間資訊 09:00 臨時手術NPO 09:00 開始NPO 09:02 通知急診手術 15:10 報到 15:25 進入手術室 15:35 麻醉開始 15:40 誘導結束 16:00 抗生素給藥 16:20 手術開始 18:05 手術結束 18:05 麻醉結束 18:10 送出病患 18:13 進入恢復室 19:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 鄭孟伯 開立時間: 2010/03/21 18:34 Pre-operative Diagnosis oligodendroglioma s/p, with acute hydrocephalus Post-operative Diagnosis oligodendroglioma s/p, with acute hydrocephalus Operative Method V-P Shunt via left kocher^s point Specimen Count And Types nil Pathology nil Operative Findings 1.v-p shunt was placed from left kocher^s point to LUQ abdomen with two connecting wounds 2. intra-ventriclar catheter was 6 cm in length 3. intra-abdominal catheter was 15 cm in length 4. ICP was 10~15 cmH2O and CSF was mild turbid Operative Procedures 1.Anesthesia: endotracheal general. 1. Anesthesia: endotracheal general. 2.Position: supine with head rotated to right. 2. Position: supine with head rotated to right. 3.Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 5 cm curvilinear, left frontal. Raney clips were applied to the 4. Incision: 5 cm curvilinear, left frontal. Raney clips were applied to the scalp edge for temporary hemostasis. scalp edge for temporary hemostasis. 5.After the scalp flap had been lifted and reflected anteriorly, a burr hole was made and the dura was tented by 2 stitches. 5. After the scalp flap had been lifted and reflected anteriorly, a burr hole was made and the dura was tented by 2 stitches. 6.The dura was opened by a nib incision. Left lateral ventricle was tapped by a ventricular needle, then a 6 cm segment of the ventricular catheter was introduced into the ventricle. The outer end of the catheter was connected to a Pudenz reservoir. 6. The dura was opened by a nib incision. Left lateral ventricle was tapped by a ventricular needle, then a 6 cm segment of the ventricular catheter was introduced into the ventricle. The outer end of the catheter was connected to a Pudenz reservoir. 7. A mini laparotomy was made at LUQ of the abdomen, then a 15-cm segment of the peritoneal catheter (medium pressure) was introduced into the peritoneal cavity through the outer tube of the trochar. The proximal end of this catheter was passed through subcutaneous tunnel at forechest, neck, etroauricular area and connected the reservoir. The shunt systemwas checked to make sure its function was working. 8. The proximal end of this catheter was passed through subcutaneous tunnel at forechest, neck, etroauricular area and connected the reservoir. The shunt systemwas checked to make sure its function was working. The reservoir was fixed to pericranium by 3 stitches. 8. The reservoir was fixed to pericranium by 3 stitches. 9. Scalp closure: hemostasis was done with monopolar coagulator touching on the sucker tip. Galea suture was performed by continuous suture with 3/0. Dexon and skin by continuous suture with 3/0 nylon. 10.Course of the surgery: smooth. Operators VS 曾漢民 Assistants R5 陳睿生, R1 鄭孟伯 Indication Of Emergent Operation 陳阿黎 (F,1942/01/02,70y2m) 手術日期 2010/03/21 手術主治醫師 詹志洋 手術區域 東址 005房 01號 診斷 Hydrocephalus 器械術式 Permcath 手術類別 臨時手術 手術部位 胸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 謝永, 時間資訊 13:25 報到 13:30 進入手術室 13:35 麻醉開始 13:40 誘導結束 13:45 手術開始 14:05 手術結束 14:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 內頸靜脈切開，永久導管放置術 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Permcath/port-A 開立醫師: 謝永 開立時間: 2010/03/21 15:33 Pre-operative Diagnosis ESRD Post-operative Diagnosis Ditto Operative Method permcath implantation via left internal jugular vein Specimen Count And Types nil Pathology nil Operative Findings 1. The permcathcatheter was inserted via left internal jugular vein 2. Patent flow after implantation 3. Tip position located at RA/SVC junction 4.S/P V-P shunt creation over right neck Operative Procedures -Anesthesia: local anesthesia, the patient was put on supine position. The operation field was disinfected and draped as usual. -Permcath catheter was implanted on left side upper chest with puncture method. The catheter was advenced via the peel-away sheath smoothly after tunnelization. -The flow was checked and flushed with heparin solution. The wounds were closure by 2-0 Nylon. Local compression for hemostasis. Post-op care plan: 1.wound CD QD+PRN 2.pain control with tinten 3.prophylatic antibiotics use Operators 詹志洋, Assistants 謝永, 顏文隆 (M,1940/01/10,72y2m) 手術日期 2010/03/21 手術主治醫師 曾漢民 手術區域 東址 002房 01號 診斷 CAD,post PTCA 器械術式 Brain tumor Crainotomy(Others) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林峰盛 ASA 3E 紀錄醫師 鄭孟伯, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 08:45 報到 09:00 進入手術室 09:05 麻醉開始 09:35 誘導結束 09:40 抗生素給藥 10:02 手術開始 12:40 手術結束 12:40 抗生素給藥 12:40 麻醉結束 12:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 內科部 套用罐頭: Craniotomy for hematoma evacuation 開立醫師: 陳睿生 開立時間: 2010/03/21 13:26 Pre-operative Diagnosis Left side F-T-P chronic and subacute SDH Post-operative Diagnosis Left side F-T-P chronic and subacute SDH Operative Method Craniotomy for hematoma evacuation Specimen Count And Types 1 piece About size:pieces Source:c-SDH outer membrane Pathology Nil Operative Findings Segmentation of the chronic SDH was noted and multiple outer menbrane was noted. The fluid inside the outer compartment was dark reddish, and the fluid inside the inner one was yellowish clear. After removal of the outter membranes, we inserted a rubber drain at the subdural space, and the brain expanded mildly. Operative Procedures 1. ETGA, supine position with head right turn 2. Left frontotemporal curvillinear incision 3. Split the temporalis muscle, and a 5cm craniotomy was performed with 4 burr holes made 4. Dura tacking, and we opened the dura via the window margin 5. After electric cauterization, the outer membrane was removed 6. The subdural fluid was drained and the space was irrigated with normal saline 7. Close the dura tightly after set a rubber drain at subdural space 8. Fix back the skull graft with miniplate x3 after central tacking 9. Set a subgaleal CWV drain, and close the wound in layers Operators VS 曾漢民 Assistants R5 陳睿生, R1 鄭孟伯 Indication Of Emergent Operation 何東鏘 (M,1935/10/20,76y4m) 手術日期 2010/03/22 手術主治醫師 戴浩志 手術區域 東址 000房 號 診斷 Atherosclerosis of the extremities with intermittent claudication 器械術式 Debridment-- >10cm 手術類別 緊急手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 3 紀錄醫師 陳建璋, 時間資訊 08:00 臨時手術NPO 08:00 開始NPO 09:56 通知急診手術 14:15 進入手術室 14:20 麻醉開始 14:25 誘導結束 14:26 手術開始 14:50 麻醉結束 14:50 手術結束 15:00 送出病患 15:03 進入恢復室 16:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 深部複雜創傷處理－傷口長１０公分以上者 1 0 R 摘要__ 手術科部: 外科部 套用罐頭: debridement 開立醫師: 陳建璋 開立時間: 2010/03/22 14:53 Pre-operative Diagnosis status post SFA stenting with wound infection Post-operative Diagnosis ditto Operative Method debridement Specimen Count And Types nil Pathology nil Operative Findings 1. Much hematoma and necrotic tissue over the retroperitoneal space with extension to the previous drain hole. 2. No exposure of major vessels Operative Procedures Under endotracheal general anesthesia, the patient was put in the supine position. The operative field was disinfected and draped as usual. we dissected and removed the necrotic tissue piecemeally with curretage and scissors. After irrigation wiht large amount of normal saline(>3000ml) and careful hemostasis, the wound was packed with Bosmine gauze. Operators 戴浩志 Assistants 黃傑慧; 陳建璋 Indication Of Emergent Operation 江美絨 (F,1955/06/29,56y8m) 手術日期 2010/03/22 手術主治醫師 翁碧茹 手術區域 西址 033房 4號 診斷 Neck mass 器械術式 Benign neck mass excision (sim 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 10:20 報到 10:45 進入手術室 11:02 麻醉開始 11:04 手術開始 11:04 誘導結束 11:55 麻醉結束 11:55 手術結束 11:58 送出病患 高信謙 (M,1955/03/15,56y11m) 手術日期 2010/03/22 手術主治醫師 杜永光 手術區域 東址 003房 02號 診斷 腦惡性腫瘤 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3 紀錄醫師 李振豪, 時間資訊 13:30 進入手術室 13:40 麻醉開始 14:07 誘導結束 14:15 抗生素給藥 14:45 手術開始 17:15 抗生素給藥 19:30 手術結束 19:40 送出病患 19:40 麻醉結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除－手術時間在４～８小時 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Right frontal craniotomy tumor excision 開立醫師: 陳盈志 開立時間: 2010/03/22 19:56 Pre-operative Diagnosis Right frontal glioma Post-operative Diagnosis Right frontal glioma Operative Method Right frontal craniotomy tumor excision Specimen Count And Types 1 piece About size:multiple fragments 4x4x3cm Source:right frontal mass Pathology pending Operative Findings The tumor was soft fraigile in character. Greyish reddish in color. There was cystic portion with turbid fluid inside. The margin was not clear. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position. The scalp was shaved, scrubbed, disinfected with alcohol B-I then draped. The bicoronal scalp incision was made along previous op scar followed by right frontal craniotomy extended from frevious craniotomy window. The dura was opened after located the tumor with intraoperative sonography. The tumor excision was done with central debulking and drainage of cystic portion. Then dissect along tumor border with dissector and bipolar and remove tumor piece by piece. Hemostasis with surgicel was done. The duroplasty was performed with pericranium and 4-0 Prolene sutures. The skull plate was fixed back with miniplates and screws after one subgaleal CWV drain set up. The wound was then closed in layers. Operators P杜永光 Assistants R6陳盈志R3李振豪 林秋花 (F,1952/05/20,59y9m) 手術日期 2010/03/22 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 李振豪, 時間資訊 07:45 報到 08:05 進入手術室 08:14 麻醉開始 08:30 誘導結束 09:00 抗生素給藥 09:05 手術開始 12:10 抗生素給藥 13:00 麻醉結束 13:00 手術結束 13:10 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 手術 腦瘤切除－手術時間在４小時以內 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Right subfrontal approach tumor excision 開立醫師: 陳盈志 開立時間: 2010/03/22 13:28 Pre-operative Diagnosis Tubercullum sella meningioma Post-operative Diagnosis Tubercullum sella meningioma Operative Method Right subfrontal approach tumor excision Specimen Count And Types 1 piece About size:1.3x1.2x1cm Source:tuberculum sella meningioma Pathology pending Operative Findings The tumor was elastic to firm in character. Its dura base at tuberculum sella was noted. The margin was very clear. No tumor extended into optic canal was noted. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head extended and fixed with Mayfield head clamp. After scalp scrubbed, shaved, disinfected, and then draped, we made one bicoronal skin incision. We reflected the scalp flap inferiorly. We drilled three burr holes, one at right keyhole, one at right side of SSS, and one at left side of SSS. Craniotomy was done, and dura incision was made in U-shape with base at SSS. We drill off the anterior frontal base, release the olfactory nerve and approach the lesion via subfrontal approach. The tumor base was devascularized with bipolar and then the tumor was detached from its base with dissector. The arachnoid plane was also dissected and then remove the tumor en bloc. We closed the dura with 4-0 prolene in water-tight fashion. The frontal sinus was packed with beta-iodinized gelform then covered with pericranium graft. Bone graft was fixed back with mini-plates. After set one subgaleal CWV drainage, the wound was closed in layers. Operators P杜永光 Assistants R6陳盈志R3李振豪 顏承莘 (M,1961/09/29,50y5m) 手術日期 2010/03/22 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Astrocytoma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 陳建銘, 時間資訊 07:50 報到 08:02 進入手術室 08:10 麻醉開始 08:40 誘導結束 08:50 抗生素給藥 09:05 手術開始 11:20 麻醉結束 11:20 手術結束 11:25 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除－手術時間在４小時以內 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: frontal craniotomy for Simpson grade II tumor excision 開立醫師: 李建勳 開立時間: 2010/03/22 11:38 Pre-operative Diagnosis Left frontal recurrent low grade astrocytoma Post-operative Diagnosis Left frontal recurrent low grade astrocytoma Operative Method Left frontal craniotomy for tumor excision Specimen Count And Types 1 piece About size:1gm Source:craniotomy for tumor exicison Pathology Frozen section: low cellularity, no malignancy cell could be identified. Pathology: pending Operative Findings The tumor showed high echogenicity. The tumor is grey-yellowish, soft-elastic, size 4X1X1 cm, without definite border from the normal brain parenchyma. The left frontal lateral ventricle was opened after tumor excision and sealed with Tissuecol Duo. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position. The scalp was shaved, scrubbed, disinfected with alcohol B-I then draped. The bicoronal scalp incision was made along previous op scar followed by left frontal craniotomy. The dura was opened after located the tumor with intraoperative sonography. The tumor excision was done by excision of the gyrus. The suspected tumor was sent for frozen section. The left frontal lateral ventricle was opened after tumor excision and sealed with Tissuecol Duo. The duroplasty was performed with pericranium and 4-0 Prolene sutures. The skull plate was fixed back with miniplates and screws after one subgaleal CWV drain set up. The wound was then closed in layers. Operators VS 曾漢民 Assistants R6 李建勳 R1 陳建銘 相關圖片 葉志麟 (M,1964/12/28,47y2m) 手術日期 2010/03/22 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Acoustic neuroma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 陳建銘, 時間資訊 11:15 報到 11:44 進入手術室 11:50 麻醉開始 12:20 誘導結束 13:10 抗生素給藥 13:18 手術開始 16:10 抗生素給藥 17:20 麻醉結束 17:20 手術結束 17:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 顱底瘤手術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Right retrosigmoid approach tumor excision 開立醫師: 李建勳 開立時間: 2010/03/22 17:45 Pre-operative Diagnosis Right cerebellopotine angle (CPA) tumor suspect acoustic neuroma Post-operative Diagnosis Right cerebellopotine angle (CPA) tumor suspect acoustic neuroma Operative Method Right retrosigmoid approach tumor excision Specimen Count And Types 1 piece About size:0.5gm Source:craniotomy for tumor excision Pathology Pending Operative Findings The tumor was yellowish, elastic, size 3cm in diameter and pushed the CNVII posterioinferiorly. One piece of the tumor (1cm X0.5cm) was left in situ in order not to damage the CNVII. The CN VII was identified with bipolar stimulator. Operative Procedures Under general anestheis and intubation, the patient was put in Park bench position. The scalp was shaved, scrubbed, disinfected with alcohol B-I then draped. Linear scalp incisin was made at right retroauricular area followed by craniotomy to expose the transverse-sigmoid junction. The dura was opened after tenting along the craniotomy window. The CSF was released for relax the cerebellum. The retractor was applied to retained the cerebellum. The tumor was dissected from the surrounding cerebellum and excised with bipolar coagulator and tumor forceps. One piece of the tumor (1cm X0.5cm) was left in situ in order not to damage the CNVII after identified with bipolar stimulator. Hemostasis was achieved with surgicel lining of the tumor bed. The duroplasty was performed with fascia graft and 4-0 Prolene sutuers. The skull plates was fixed back with miniplates and screws. The wound was closed in layers after one subgaleal CWV drain set up. Operators VS 曾漢民 Assistants R6 李建勳 R1 陳建銘 相關圖片 黃光石 (M,1943/08/10,68y7m) 手術日期 2010/03/22 手術主治醫師 蔡瑞章 手術區域 東址 001房 01號 診斷 Subdural hematoma 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3E 紀錄醫師 陳睿生, 時間資訊 22:00 臨時手術NPO 22:00 開始NPO 06:37 通知急診手術 08:48 報到 09:00 進入手術室 09:05 麻醉開始 09:10 誘導結束 09:40 抗生素給藥 09:50 手術開始 11:00 手術結束 11:00 麻醉結束 11:10 送出病患 11:15 進入恢復室 12:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 慢性硬腦膜下血腫清除術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Right side bur hole for hematoma evacuation 開立醫師: 陳睿生 開立時間: 2010/03/22 11:27 Pre-operative Diagnosis Bilateral chronic SDH Post-operative Diagnosis Bilateral chronic SDH Operative Method Right side bur hole for hematoma evacuation Specimen Count And Types 3 pieces About size:3ml Source:hematoma About size:3ml Source:hematoma About size:3ml Source:hematoma Pathology Nil Operative Findings Motor oil like hemolytic fluid was drained from right subdural space. No obvious blood clot was noted, and brain pulsation was fair after decompression. No obvious outer membrane was noted. Operative Procedures 1. ETGA, supine position with head left turn 2. Linear incision at frontal region 3. Create a bur hole 4. Dura tacking, and then the dura was opened 5. Drain out the old hematoma, and then the subdural space was irrigated with normal saline 6. Set a subdural rubber drain 7. Close the wound in layers, and deair Operators P 蔡瑞章 Assistants R5 陳睿生 Indication Of Emergent Operation 相關圖片 王淑珍 (F,1960/04/27,51y10m) 手術日期 2010/03/22 手術主治醫師 李苑如 手術區域 西址 038房 9號 診斷 Cervical cancer 器械術式 Fiberocystoscopy /WOR 手術類別 臨時手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 無麻醉 麻醉主治醫師 ASA 1 紀錄醫師 周淇業, 時間資訊 14:20 進入手術室 14:22 手術開始 14:25 手術結束 14:27 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 膀胱鏡檢查 1 0 朱璽恩 (F,2010/02/19,2y0m) 手術日期 2010/03/22 手術主治醫師 張重義 手術區域 兒醫 067房 01號 診斷 Interruption of aortic arch 器械術式 C.O.A. (Aortaplasty) 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 4 紀錄醫師 張得一, 時間資訊 00:00 臨時手術NPO 12:48 進入手術室 12:48 報到 12:50 麻醉開始 13:15 誘導結束 13:20 抗生素給藥 13:38 手術開始 14:18 開始輸血 16:15 麻醉結束 16:15 手術結束 16:25 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 手術 主動脈狹窄之修補 1 2 記錄__ 手術科部: 外科部 套用罐頭: Aortopexy 開立醫師: 張得一 開立時間: 2010/03/22 16:44 Pre-operative Diagnosis IAA type A with VSD s/p TC with left main bronchus stenosis Post-operative Diagnosis IAA type A with VSD s/p TC with left main bronchus stenosis Operative Method Aortopexy Specimen Count And Types nil Pathology nil Operative Findings Sever LMB stenosis with poor air entry. Severe adhesion at left pleural space. Post op bronchoscope: LMB patent, with improved air entry by auscultation Operative Procedures 1.ETGA, right decubitus position 2.Posterolateral thoracotomy 3.Adhesiolysis of pleural cavity 4.Dissect the DsAo from the surrounding soft tissue 5.Aortopexy to the apex of parietal caviy with 5-0 pledgetted prolene. 6.Set one chest tube, close the wound in layers Operators 張重義 Assistants 徐綱宏(recorder) 張得一 周棟一 (M,1928/12/31,83y2m) 手術日期 2010/03/22 手術主治醫師 郭順文 手術區域 東址 007房 01號 診斷 Subdural hemorrhage following injury, with brief (less than one hour) loss of consciousness 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 趙安怡 ASA 4 紀錄醫師 蔡東明, 時間資訊 00:00 臨時手術NPO 08:10 報到 08:10 進入手術室 08:15 麻醉開始 08:20 誘導結束 08:38 手術開始 08:50 麻醉結束 08:50 手術結束 08:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 氣管切開造口術 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 蔡東明 開立時間: 2010/03/22 09:06 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Ditto Operative Method Tracheostomy Specimen Count And Types nil Pathology None Operative Findings Fr .8 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators VS郭順文 Assistants R3蔡東明 Ri沈宜華 唐美蓉 (F,1951/01/01,61y2m) 手術日期 2010/03/23 手術主治醫師 曾勝弘 手術區域 東址 005房 02號 診斷 Cellulitis 器械術式 Debridment-- 5-10cm 手術類別 預定手術 手術部位 頭、頸 傷口分類 污染 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 10:10 報到 10:43 進入手術室 10:55 麻醉開始 11:00 誘導結束 11:20 手術開始 13:05 手術結束 13:05 麻醉結束 13:15 進入恢復室 13:15 送出病患 14:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 深部複雜創傷處理－傷口長１０公分以上者 1 0 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Wound debridement and bursectomy 開立醫師: 胡朝凱 開立時間: 2010/03/23 13:09 Pre-operative Diagnosis Left neck wound infection Post-operative Diagnosis Left neck wound infection Operative Method Wound debridement and bursectomy Specimen Count And Types wound granulation tissue x1 and culture tube x 3 Pathology Wound granulation tissue Operative Findings 1.Pus and granulation tissue were noted arround the wires 2.Mild necrotic tissue was also noted Operative Procedures 1.ETGA, supine 2.Left wound skin incision via previous wound 3.dissect to expose wires 4.Removed granulation tissue 5.Vancomycin water irrigation 6.close wound i two layers Operators 曾勝弘 Assistants 胡朝凱,李振豪 陳秋蘭 (F,1965/06/26,46y8m) 手術日期 2010/03/23 手術主治醫師 曾漢民 手術區域 西址 033房 01號 診斷 Carpal tunnel syndrome 器械術式 Neurolysis of the uluar neuve 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 10:15 報到 10:30 進入手術室 10:48 手術開始 11:55 手術結束 12:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 正中神經或尺神經腕部減壓術–單側 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Left median nerve decompression 開立醫師: 李建勳 開立時間: 2010/03/23 13:22 Pre-operative Diagnosis Left carpal tunnel syndrome Post-operative Diagnosis Left carpal tunnel syndrome Operative Method Left median nerve decompression Specimen Count And Types nil Pathology Nil Operative Findings The left median nerve was compressed tightly by the fibrous band acrossed. The median nerve was relaxed after incision over the fibrous band and the tightness sensation over the fingers were relived. Operative Procedures The skin was disinfected with alcohol B-I and draped. Under local anesthesia with 1% Xylocain, the incision was made at middle palm and dissected the tissue and muscle to expose the median nerve. The fibrous band was incised with scissors to release the compression. Hemostasis was achieved with bipolar coagulation and the wound was closed in layers. Operators VS 曾漢民 Assistants R6 李建勳 R1 賴碩倫 相關圖片 王明德 (M,1922/10/20,89y4m) 手術日期 2010/03/23 手術主治醫師 蔡瑞章 手術區域 東址 007房 03號 診斷 Subdural hemorrhage or effusion 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林峰盛 ASA 3E 紀錄醫師 張皓鈞, 時間資訊 14:04 開始NPO 14:04 臨時手術NPO 16:44 通知急診手術 22:15 報到 22:15 進入手術室 22:20 麻醉開始 22:30 誘導結束 22:45 抗生素給藥 22:55 手術開始 23:20 開始輸血 23:55 手術結束 23:55 麻醉結束 00:15 送出病患 00:15 進入恢復室 01:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 麻醉 Peripheral arterial line inserti 1 0 手術 慢性硬腦膜下血腫清除術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Left frontal burr hole for hematoma evacuation 開立醫師: 陳盈志 開立時間: 2010/03/24 00:01 Pre-operative Diagnosis Left frontal parietal chronic SDH Post-operative Diagnosis Left frontal parietal chronic SDH Operative Method Left frontal burr hole for hematoma evacuation Specimen Count And Types nil Pathology nil Operative Findings 1.The outer and inner membrane: intact 2.There is 70-80ml darkish and liquified subdural hematoma gushed out spontaneously after opening the outer membrane. 3.The brain not expanded well after drainage and one subdural rubber drainage was left in situ. Operative Procedures 1.under ETGA and supine positon 2.skin disinfection and draping 3.linear incision and burr hole creation 4.dura tenting and dura opening 5.drainage of the subdural hematoma and irrigation with copious normal saline 6.left one subdural rubber draiange in situ 7.drain out the air inside the cranium 8.close the wound in layers Operators P蔡瑞章 Assistants R6陳盈志R1張皓鈞 Indication Of Emergent Operation 蔡楓玲 (F,1974/07/18,37y7m) 手術日期 2010/03/23 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Malignant neoplasm of cranial nerves 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 07:44 報到 08:00 進入手術室 08:10 麻醉開始 08:15 誘導結束 08:45 抗生素給藥 09:12 手術開始 10:16 手術結束 10:16 麻醉結束 10:25 送出病患 10:30 進入恢復室 11:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室腹腔分流手術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: VP shunt insertion via Left Kocher point 開立醫師: 胡朝凱 開立時間: 2010/03/23 10:25 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method VP shunt insertion via Left Kocher point Specimen Count And Types CSF Cytology, culture, routine, BCS Pathology Nil Operative Findings 1.Opening pressure: above 15 cmH2O, and mild turbid whitish CSF 2.High pressure Medtronic reservior was used 3.Ventricular cathe: 5.5 cm 4.peritoneal catheter: 25 cm Operative Procedures Under ETGA, patient was put in supine with head rotated to right. Skin was shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 5 cm curvilinear skin incision was made at left Kocher point. After the scalp flap had been lifted and reflected anteriorly, a burr hole was made and the dura was tented by 2 stitches. The dura was then opened by a nib incision. Rt lateral ventricle was tapped by a ventricular needle, then a 5.5 cm segment of the ventricular catheter was introduced into the ventricle. The outer Under ETGA, patient was put in supine with head rotated to right. Skin was shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 5 cm curvilinear skin incision was made at left Kocher point. After the scalp flap had been lifted and reflected anteriorly, a burr hole was made and the dura was tented by 2 stitches. The dura was then opened by a nib incision. Lt lateral ventricle was tapped by a ventricular needle, then a 5.5 cm segment of the ventricular catheter was introduced into the ventricle. end of the catheter was connected to a Medtronic reservoir. A nib incision The outer end of the catheter was connected to a Medtronic reservoir. A nib incision was made at LUQ of the abdomen , then minilaparotomy was performed to The outer end of the catheter was connected to a Medtronic reservoir. A nib incision was made at LUQ of the abdomen , then minilaparotomy was performed was made at RUQ of the abdomen , then minilaparotomy was performed to then minilaparotomy was performed to enter peritoneal cavity. Subsequently, distal 20 cm segment of the peritoneal catheter (medium pressure) was introduced into the peritoneal cavity. The proximal end of this catheter was passed through subcutaneous tunnel at forechest, neck, rt retroauricular area and connected the tunnel at forechest, neck, Lt retroauricular area and connected the reservoir. The shunt systemwas checked to make sure its function was working. The reservoir was fixed to pericranium by 3 stitches. Scalp closure after hemostasis. Operators 曾勝弘 Assistants 胡朝凱,李振豪 相關圖片 蔡豐翳 (M,2009/05/30,2y9m) 手術日期 2010/03/23 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Anomalies of spinal cord 器械術式 Cord untethering -KUO 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 2 紀錄醫師 鍾文桂, 時間資訊 08:00 報到 08:08 進入手術室 08:15 麻醉開始 08:40 誘導結束 08:55 抗生素給藥 09:17 手術開始 10:50 手術結束 10:50 麻醉結束 11:15 送出病患 11:20 進入恢復室 12:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 脊椎內脊髓內腫瘤切除術 1 1 手術 椎弓整形術 1 2 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 記錄__ 手術科部: 外科部 套用罐頭: 1.Untether of filum terminalis and total remo... 開立醫師: 鍾文桂 開立時間: 2010/03/23 11:49 Pre-operative Diagnosis Tethered cord syndrome. Tethered spinal cord due to filum terminale lipoma Post-operative Diagnosis Tethered cord syndrome. Tethered spinal cord due to filum terminale lipoma Operative Method 1.Untether of filum terminalis and total removal of fibrolipoma. 1.Untether of filum terminalis by segmental resection of of filum terminalefibrolipoma. 2.Laminoplasty of L5 level. Specimen Count And Types 1 piece About size:1 cm. Source:thickened filum terminale with lipoma. 1 piece About size:1 cm. Source:filum terminale with lipomatous infiltration. Pathology Pending. Operative Findings Thickened filum terminalis(1.5 mm in thickness)partly attached to dura mater. The diameter of filum terminalis was 1.5 mm, not enlarged by definition, but it was infiltrated by lipomatous tissue and was partly attached to dura by possibly mild previous arachnoiditis. A thin film of fibrolipoma which attached to filum terminalis was removed totally. Operative Procedures Under general anesthesia, the patient was put in prone position. After disinfection and draping, a 5 cm linear longitudinal incision was made at L4-5 level. Dissection of paraspinal muscle with exposure of inferior margin of L4 lamina, and L5 lamina was done. Dissection of paraspinal muscle with exposure of L4/L5 laminae. The sspace of one level exposure is enough so we performed grooving with 1 mm Kerrison punches at both side of the L5 and reflected L5 lamina upward to expose the epidural space. We achieved L5 laminoplasty with 1-mm Kerrison punch. After seperating the ligamentum flavum from the dura mater, the dura mater was incised in linear fashion. Under microscope, we remove part of the epidural fat and the dura mater was incised in linear fashion. The underneath filum terminalis was identified and isolated from the surrounding nerve roots. The filum terminalis was transsected by bipolar electrocoagulator and microscissor. The overlying fibrolipoma was removed with a piece of filum terminale. The filum terminalis was transsected by bipolar electrocoagulator and microscissor. After water-tight closure of the dura mater, the wound was closed in layers. After water-tight closure of the dura mater, the wound was closed in layers after laminoplasty of L5 was performed with fixation with 6 stitches of silk at the ligmentum flavum. The patient was sent to POR smoothly. Operators A.P. 郭夢菲. Assistants R4 鍾文桂. 林基次 (M,1926/10/25,85y4m) 手術日期 2010/03/23 手術主治醫師 賴達明 手術區域 東址 001房 01號 診斷 Cerebrovascular accident 器械術式 Burr hole (trephination) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 陳德福, 時間資訊 16:59 通知急診手術 00:00 開始NPO 00:00 臨時手術NPO 09:10 報到 09:25 進入手術室 09:26 麻醉開始 09:31 誘導結束 09:38 抗生素給藥 10:21 手術開始 11:20 手術結束 11:20 麻醉結束 11:30 送出病患 11:35 進入恢復室 13:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: burr hole drainage 開立醫師: 陳德福 開立時間: 2010/03/23 11:28 Pre-operative Diagnosis recurrent CSDH, left Post-operative Diagnosis ditto Operative Method burr hole drainage Specimen Count And Types 1 piece About size:50ML Source:subdural hematoma Pathology nil Operative Findings 1.The outer and inner membrane: intact 2.There is 70-80ml darkish and liquified subdural hematoma gushed out spontaneously after opening the outer membrane. 3.The brain expanded well after drainage and one subdural rubber drainage was left in situ. Operative Procedures 1.under ETGA and supine positon 2.skin disinfection andn draping 3.linear incision and burr hole creation 4.dura tenting and dura opening 5.drainage of the subdural hematoma and irrigation with copious normal saline 6.left one subdural rubber draiange in situ 7.drain out the air inside the cranium 8.close the wound in layers Operators VS 賴達明 Assistants R4 陳德福 Indication Of Emergent Operation 相關圖片 李朝陽 (M,1940/08/16,71y6m) 手術日期 2010/03/23 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Hydrocephalus 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 張皓鈞, 時間資訊 07:47 報到 08:05 進入手術室 08:10 麻醉開始 08:20 誘導結束 08:51 抗生素給藥 09:23 手術開始 10:55 手術結束 10:55 麻醉結束 11:02 送出病患 11:07 進入恢復室 12:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 張皓鈞 開立時間: 2010/03/23 11:15 Pre-operative Diagnosis Normal pressure hydrocephalus Post-operative Diagnosis Normal pressure hydrocephalus Operative Method V-P Shunt implantation ,via right Kocher Specimen Count And Types nil Pathology Nil Operative Findings 1.Codman programmable shunt 2.Initial setting 80mmHg 2.Initial setting 80mmH2O 3.Intraventricular cath 6 cm 4.Intra-abdominal cath 20cm 5.CSF clear , pressure around 10 cm H2O Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: supine with head rotated (tilted) to right (left). 3.Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 3cm linear incision via right side frontal 5.After the scalp flap had been lifted , a burr hole was made and the dura was tented by 2 stitches. 6.The dura was opened by a nib incision. Rt lateral ventricle was tapped by a ventricular needle, then a 6 cm segment of the ventricular catheter was introduced into the ventricle. The outer end of the catheter was connected to a Codman programmable reservoir. 7. A minillaparotomy incision was made at RUQ of the abdomen Subsequently, distal 20 cm segment of the peritoneal catheter was introduced into the peritoneal cavity through the outer tube of the trochar. The proximal end of this catheter was passed through subcutaneous tunnel at forechest, neck, rt retroauricular area and connected the reservoir. The shunt system was checked to make sure its function was working. 8. The reservoir was fixed to parietal region . 9. Scalp closure: hemostasis was done with monopolar coagulator touching on the sucker tip. Galea suture was performed by continuous suture with 2/0. Dexon and skin by continuous suture with 3/0 nylon. 10.Course of the surgery: smooth. Operators 賴達明 Assistants R5陳睿生 R1張皓鈞 高惠美 (F,1954/08/18,57y6m) 手術日期 2010/03/23 手術主治醫師 賴達明 手術區域 東址 003房 2號 診斷 Ossification of posterior longitudinal ligament (OPLL) 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳睿生, 時間資訊 10:45 報到 11:12 進入手術室 11:20 麻醉開始 12:10 誘導結束 12:21 抗生素給藥 12:55 手術開始 15:31 抗生素給藥 16:00 麻醉結束 16:00 手術結束 16:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術（特壓）－超過二節 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: C1 laminectomy and lower C2 to C6 laminoplast... 開立醫師: 陳睿生 開立時間: 2010/03/23 16:45 Pre-operative Diagnosis Cervical stenosis with rheumatoid srthritis and OPLL over C1-C6 Post-operative Diagnosis Cervical stenosis with rheumatoid srthritis and OPLL over C1-C6 Operative Method C1 laminectomy and lower C2 to C6 laminoplasty (open door) Specimen Count And Types nil Pathology Nil Operative Findings Severe stenosis at C1-2 junction was noted and the cord with thecal sac was well decompressed after C1 laminectomy. Laminoplasty was performed at C3-6 level, and the hindge side was over right. The lamina was fixed with miniplates x4 (4 holes at C3, 5 holes at C4, 5, and 6 holes at C6) Operative Procedures 1. ETGA, prone position and head flexion with fixation by Mayfield clump 2. Posterior neck midline incision 3. Incise into the nuchal ligament and split trapzius, paraspinal muscle bilaterally 4. Expose the C1 posterior arch and C2 to C6 spinous process, lamina 5. Flattern the C1 posterior arch with high speed drill and then remove the arch with curette and aligator 6. Remove of the lower part of C2 spinous process, lamina 7. Drill two groves at bilateral side of the C3 to C6 lamina; the right side drilled into the outer cortex, and the left side drilled through bi-cortexs 8. Elevated the C3-6 lamina with splitter from left side 9. Fix the lamina with left side lateral mass with miniplates x4 10.Hemostasis, set an epidural CWV drain 11.Close the wound in layers Operators VS 賴達明 Assistants R5 陳睿生, Ri 王奕淳 (M,1986/05/03,25y10m) 手術日期 2010/03/23 手術主治醫師 賴達明 手術區域 東址 003房 03號 診斷 Spine tumor 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 張皓鈞, 時間資訊 15:55 報到 16:30 進入手術室 16:45 麻醉開始 16:55 誘導結束 17:50 抗生素給藥 17:53 手術開始 19:50 開始輸血 21:35 手術結束 21:35 麻醉結束 21:53 送出病患 23:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 惡性病髓腫瘤切除術 1 1 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 摘要__ 手術科部: 外科部 套用罐頭: Total tumor remove and posterior fixation ove... 開立醫師: 陳睿生 開立時間: 2010/03/23 22:08 Pre-operative Diagnosis T2-3 extraspinal metastatic tumor T2-3 extraspinal metastatic tumor ,suspected Giant cell tumor Post-operative Diagnosis T2-3 extraspinal metastatic tumor T2-3 extraspinal metastatic tumor ,suspected Giant cell tumor Operative Method Total tumor remove and posterior fixation over T2-T4 Specimen Count And Types 1 piece About size:3x3cm Source:tumor Pathology Pending Operative Findings The tumor invased left side T2, 3 lamina and pedicles. It was whitish, soft and fragile. The tumor was well margined and compressed the cord at T3 level tightly. Total tumor remove was performed with remove of left side T2, 3 lamina and pedicles. The vertebral bodies left wass relatively healthy. Synthes transpedicular screws were inserted at bilateral T2, T4 level, and the length was about 30mm with 3.5mm in diameter. The rods were 5cm and a 3cm crosslink was inserted. Operative Procedures 1. ETGA, prone position, and C-arm localized T3 level 2. Posterior midline incision, and split paraspinal muscle from lower T1 to upper T4 level 3. Carefully dissect the plane between the tumor and the health bony tissue 4. After ligation of the supply vessels, the tumor was removed enbloc 5. Insert transpedicular screws x4 at T2, 4 levels, and C-arm localization 6. Set bilateral rods, and the crosslink 7. Hemostasis, perform posteriolateral fusion with autologus and artifical bone grafts 8. Set an epidural CWV drain, and close the wound in layers Operators VS 賴達明 Assistants R5 陳睿生, R1 張皓鈞 相關圖片 高秀治 (F,1961/10/30,50y4m) 手術日期 2010/03/23 手術主治醫師 賴達明 手術區域 東址 022房 03號 診斷 Cervical spondylosis 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李建勳, 時間資訊 15:20 進入手術室 15:25 麻醉開始 15:35 誘導結束 15:35 抗生素給藥 16:05 手術開始 18:15 手術結束 18:15 麻醉結束 18:25 送出病患 18:30 進入恢復室 19:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術－頸椎 1 1 手術 脊椎融合術－前融合，有固定物（＜＝四節） 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 摘要__ 手術科部: 外科部 套用罐頭: Anterior approach for disckectomy and autolog... 開立醫師: 李建勳 開立時間: 2010/03/23 18:38 Pre-operative Diagnosis C5-6 herniated intervetebral disc (HIVD) with cord compression Post-operative Diagnosis C5-6 herniated intervetebral disc (HIVD) with cord compression Operative Method Anterior approach for disckectomy and autologous bone fusion Specimen Count And Types nil Pathology Nil Operative Findings The C5/6 HIVD with spur formation was noted. The right anteriosuperior iliac crest bone graft was harvested for bone fusion. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position with head extension. The skin over right anterior neck was scrubedd, disinfected with alcohol B-I then draped. The transverse skin incision was made at right anterior neck anddivided the platysma muscle. The incision was made over SCM muscle and dissectede along between the fascia plane. The carotid sheath was retracted laterally and the trachea was retrated medially. The longus colli muscles were bipolar coagulated and divided. Localization of C5/6 was performed with portable C-arm X-ray. The cervical retractor was inserted. The prevetebral fascia was incised with No. 15 surgical blade into the disc space. The disckectomy was performed with Kerrison punch, disc clumps and curette under surgical microscope assistance. The spur was removed wtih high-speed air-drill. The posterior longitudinal ligment was removed with Kerrison punch to expose the dura. The herniated disc was check for upward and downward heniation with nerve hook. The right anteriosuperior iliac crest bone graft was harvested for bone fusion. Before wound closure, one minihemovac was set up at wound site. Operators VS 賴達明 Assistants R6 李建勳 相關圖片 沈永村 (M,1961/11/28,50y3m) 手術日期 2010/03/23 手術主治醫師 楊士弘 手術區域 東址 005房 03號 診斷 Lung cancer 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 李振豪, 時間資訊 13:00 報到 13:30 進入手術室 13:35 麻醉開始 13:55 誘導結束 14:45 開始輸血 14:46 手術開始 18:04 抗生素給藥 18:20 手術結束 18:20 麻醉結束 18:35 送出病患 18:35 進入恢復室 21:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 手術 椎弓切除術（特壓）－二節以內 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: (1) Left L4 hemilaminectomy (2)Transpedicle s... 開立醫師: 楊士弘 開立時間: 2010/03/23 18:21 Pre-operative Diagnosis L4 spinal metastasis s/p tumor excision and interbody methylmethacrylate graft and k-pin fixation Post-operative Diagnosis L4 spinal metastasis s/p tumor excision and interbody methylmethacrylate graft and k-pin fixation Operative Method (1) Left L4 hemilaminectomy (2)Transpedicle screws and rods fixation of L2, L4, and L5 with SinBoneHT bone replacement graft Specimen Count And Types nil Pathology Nil Operative Findings The left L4 inferior facet was destructed by the tumor. The thecal sac expanded well after decompression. Screw size: 6.5 mm x 45 mm, inserted into bilateral L2, L3, L5 pedicles. Rod size: 13 cm long each, over both sides of screws. One cross link to bridge both sides of rods. Operative Procedures 1. ETGA, prone. 2. C-arm localization of L2, L3, and L5. 3. Posterior midline incision, L2 to L5. 4. Left L4 hemilaminectomy with air drill and kerrison punches. 5. Insertion of screws into bilateral L2, L3, L5 screws. 6. Fixation of screws on each side with a rod. 7. One cross link to bridge both rods. 8. Decortication of right L3,4,5 lamina for placement of SinBone graft. 9. Two 1/8 inch HV drains in the epilaminal space. 10. Wound closure in layers. Operators 楊士弘 Assistants 胡朝凱,李振豪 相關圖片 鄭豐達 (M,1932/03/03,80y0m) 手術日期 2010/03/23 手術主治醫師 王國川 手術區域 東址 007房 02號 診斷 CVA 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林峰盛 ASA 3E 紀錄醫師 蔡立威, 時間資訊 16:26 開始NPO 16:26 臨時手術NPO 16:26 通知急診手術 17:25 報到 17:45 進入手術室 17:50 麻醉開始 18:15 誘導結束 18:18 抗生素給藥 18:40 手術開始 21:45 麻醉結束 21:45 手術結束 21:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 1 R 手術 顱內壓監視置入 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 神經部 套用罐頭: Right craniectomy for hematoma evacuation and... 開立醫師: 陳盈志 開立時間: 2010/03/23 21:05 Pre-operative Diagnosis Right MCA infarction with hemorrhagic transformation Post-operative Diagnosis Right MCA infarction with hemorrhagic transformation Operative Method Right craniectomy for hematoma evacuation and duroplast + ICP monitor insertion Specimen Count And Types nil Pathology nil Operative Findings The brain was swelling and hematoma was found at frontal lobe about 30~40 mL The brain was swelling and hematoma was found at frontal lobe about 30~40 mL The brain was pulsless. ICP after skin closure was mmHg The brain was pulsless. ICP after skin closure was 0-1mmHg Operative Procedures 1.ETGA, supine with head tilt to left 2.Right frontal-temporal-parietal trauma flap scalp incision 3.Detach temporalis muscle then resect it 4.Burr hole then craniectomy was done with saw 5.Dura tenting and then C-shape open the dura 6.Use ultrasound to identify the hematoma, then frontal tip resection with bipolar and then hematoma evacuation 7.Hemostasis with bipolar and surgicel packing 8.Duroplasty with fascia graft and 4-0 prolene 9.subdural ICP monitor insertion to temporal base 10.Epidural CWV drain x 2 11.close wound in layers Operators VS王國川 Assistants R6陳盈志R3曾峰毅R1蔡立威 Indication Of Emergent Operation 畢台興 (M,1959/02/07,53y1m) 手術日期 2010/03/24 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Glioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 賴碩倫, 時間資訊 14:47 進入手術室 14:50 麻醉開始 15:15 誘導結束 15:30 手術開始 15:40 抗生素給藥 18:35 手術結束 18:35 麻醉結束 18:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４～８小時 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: frontal craniotomy for Simpson grade II tumor excision 開立醫師: 李建勳 開立時間: 2010/03/24 18:57 Pre-operative Diagnosis Infiltrative brain tumor susepct gliomatosis cerebri Post-operative Diagnosis Infiltrative brain tumor susepct gliomatosis cerebri Operative Method Right frontal craniotomy for tumor excision Specimen Count And Types 1 piece About size:2g Source:craniotomy for brain tumor Pathology Pending Operative Findings The tumor is reddish, soft-elastic, located at right frontal lobe withour definite border from normal brain parenchyma. The tumor, which showed high signal on T2WI, within one of the frontal gyrus was removed under stereotatic navigator guidance. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position with head fixed with Mayfield skull clump. Set up the stereotatic navigator and registed with pre-op MRI. The scalp was shaved, scrubbed, disinfected with alcohol B-I then draped. The U-shaped scalp incision was made followed by right frontal craniotomy. The tumor was located with navigator. The dura was opened around the tumor after tenting along the craniotomy window. The tumor excision was performed with bipolar coagulator and suction along the gyrus border. Hemostasis was achieved with bipolar coagulation and surgicel lining of the tumor bed. The dura was closed with 4-0 Prolene sutures. The skull plate was fixed back with miniplates and screws after one epidural CWV drain set up. The wound was then closed in layers. Operators VS 曾漢民 Assistants R6 李建勳 R1 賴碩倫 相關圖片 郭月雲 (F,1956/04/13,55y11m) 手術日期 2010/03/24 手術主治醫師 杜永光 手術區域 東址 003房 1號 診斷 Cerebral aneurysm, nonruptured 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾峰毅, 時間資訊 07:35 報到 08:06 進入手術室 08:15 麻醉開始 08:39 誘導結束 09:20 抗生素給藥 09:30 手術開始 14:20 麻醉結束 14:20 手術結束 14:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Suboccipital craniotomy for brain tumor excision 開立醫師: 曾峰毅 開立時間: 2010/03/24 14:37 Pre-operative Diagnosis Cerebellar cystic tumor, suspected hemangioblastoma Post-operative Diagnosis Cerebellar cystic tumor, suspected hemangioblastoma Operative Method Suboccipital craniotomy for brain tumor excision Specimen Count And Types One 0.5x0.5x0.5cm tumor was sent for pathology. Pathology Pending Operative Findings One cystic tumor, with xanthochromic fluid contents and hypervascular muronodular component was located at cerebellar more at right. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position with head fixed by Mayfield skull clamp. After scalp shaved, scrubbed, disinfected, and then draped, we made one midline skin incision from 5cm above inion to C2 level. We harvested the fascia, and drilled 4 burr holes. Suboccpital craniotomy was done. We use ventricular needle to puncture the cystic tumor to drain its contents. Dura incision wade at right cerebellar hemisphere in C-shape. Corticotomy was made near the junction of right hemiphere and tonsil. Solid tumor part was resected. Dura was closed in water-tight fashion. Bone graft was fixed back with mini-plates, and after one subgaleal CWV, the wound was closed in layers. Operators P 杜永光 Assistants R6 陳盈志 R3 曾峰毅 林洪月枝 (F,1942/01/20,70y1m) 手術日期 2010/03/24 手術主治醫師 杜永光 手術區域 東址 005房 01號 診斷 Brain Tumor 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 賴碩倫, 時間資訊 07:40 報到 08:05 進入手術室 08:15 麻醉開始 08:30 誘導結束 08:40 手術開始 08:50 抗生素給藥 14:15 麻醉結束 14:15 手術結束 14:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除－手術時間在４～８小時 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 摘要__ 手術科部: 外科部 套用罐頭: Right pterional approach for Simpson grde II ... 開立醫師: 李建勳 開立時間: 2010/03/24 14:32 Pre-operative Diagnosis Right inner third sphenoid ridge meningioma Post-operative Diagnosis Right inner third sphenoid ridge meningioma Operative Method Right pterional approach for Simpson grde II tumor excision Specimen Count And Types 1 piece About size:5g Source:craniotomy for tumor excision Pathology Pending Operative Findings The tumor was witish, elastic, size 2.5 cm in diameter with dura attachment at right inner third sphenoid ridge with seperable arachnoid plane from the normal brain parenchyma. The main tumor vessles were from the sphenoid ridge. The right olfactory nerve was found transected after tumor excision. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position with head fixed with Mayfield skull clump. The scalp was shaved, scrubbed, disinfected with alcohol B-I then draped. The scalp incision was made at right frontotemporal area as usual pterional approach followed by craniotomy. The sphenoid ridge was further drilled off by high speed air drill under surgicel microsope. The anterior clinoidectomy was performed with diamond drill. The dura was opened in fish-mouth fashion. The main tumor feeder was bipolar coagulated and the tumor was dissected from the surrounding normal brain tissue with bipolar coagulator in one piece. The attached dura was further bipolar coagulated. The duroplasty was performed with 4-0 Prolene sutures and periostium. The skull plate was fixed back with wires and miniplates after one epidural CWV drain and central tenting set up. The wound was then closed in layers. Operators P 杜永光 Assistants R6 李建勳 R1 賴碩倫 相關圖片 周慶 (M,1954/03/22,57y11m) 手術日期 2010/03/24 手術主治醫師 曾漢民 手術區域 東址 003房 02號 診斷 Brain cancer 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾峰毅, 時間資訊 14:46 進入手術室 14:50 麻醉開始 14:50 抗生素給藥 15:00 誘導結束 15:38 手術開始 17:10 手術結束 17:10 麻醉結束 17:20 送出病患 17:20 進入恢復室 18:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 腦室腹腔分流手術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 曾峰毅 開立時間: 2010/03/24 17:19 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Codman programmable VPS with anti-siphon device inserted via right Kocher point, 10cmH20 Specimen Count And Types CSF was sent for CSF routine, BCS, and culture. Pathology Nil Operative Findings Ventricular cather length is 6cm, and Codman programmable VPS with anti-siphon device is inserted via right Kocher point, 10cmH20. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to left. After skin scrubbed, disinfected, and then draped, we made one transverse skin incision at right upper abdomen, and mini-laparotomy was done. Peritoneal catheter was inserted, and pulled out via subcutaneous tunnel at right occpital scalp. Another skin incision was made at right frontal area, and one burr hole was drilled. We inserted ventricular cathter, and connected it to programmable valve and anti-siphon device. We checked the shunt function, and closed the wound in layers. Operators VS 曾漢民 Assistants R6 陳盈志 R6 黃建智 R3 曾峰毅 相關圖片 曾碧霜 (F,1932/02/25,80y0m) 手術日期 2010/03/24 手術主治醫師 詹志洋 手術區域 東址 026房 03號 診斷 Atherosclerosis of the extremities with gangrene 器械術式 Embolectomy, Thrombectomy 手術類別 預定手術 手術部位 四肢 傷口分類 污染 麻醉方式 靜脈麻醉 麻醉主治醫師 黃啟祥 ASA 1 紀錄醫師 謝永, 時間資訊 00:00 臨時手術NPO 15:13 報到 15:30 進入手術室 15:30 麻醉開始 15:35 誘導結束 15:43 手術開始 16:10 手術結束 16:10 麻醉結束 16:15 送出病患 16:25 進入恢復室 16:41 抗生素給藥 17:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 手術 深部複雜創傷處理－傷口長５－１０公分者 1 0 L 記錄__ 手術科部: 外科部 套用罐頭: debridement 開立醫師: 詹志洋 開立時間: 2010/03/24 16:50 Pre-operative Diagnosis left femoral wound hematoma Post-operative Diagnosis left femoral wound hematoma Operative Method debridement and repair Specimen Count And Types nil Pathology soft tissue hematoma and skin edge necrosis Operative Findings left femoral wound subcutaenous hematoma 30 ml, and soft tissue necrosis, skin edge necrosis. Operative Procedures With iv sedation and local 30 ml xylocain infiltration, we opened left femoral wound, evacuated the hematoma, did wound cultures, debrided necrotic fat, and irrigated the wound with a lot of NS (500 ml). The necrotic skin edge was excised. With one penrose drain, we closed the wound with 2-0 Nylone big sutures. The patient stood the procedure well. Operators 王水深 Assistants 徐羽宜 張良幸 (F,1964/10/12,47y5m) 手術日期 2010/03/24 手術主治醫師 賴達明 手術區域 東址 001房 1號 診斷 Intracerebral hemorrhage 器械術式 Craniotomy(Aneurysms) P-DUH 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 胡朝凱, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 06:45 通知急診手術 08:20 進入手術室 08:30 麻醉開始 08:50 誘導結束 09:45 手術開始 11:00 抗生素給藥 16:00 開始輸血 16:40 手術結束 16:40 麻醉結束 16:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 8 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 開顱術摘除血管病變－腦血管瘤－有徵的 1 1 L 手術 腦室體外引流 1 2 L 摘要__ 手術科部: 外科部 套用罐頭: Left craniectomy for aneurysmal clipping and ... 開立醫師: 胡朝凱 開立時間: 2010/03/24 17:15 Pre-operative Diagnosis A-COM ANEURYSM RUPTURE Post-operative Diagnosis A-COM ANEURYSM RUPTURE Operative Method Left craniectomy for aneurysmal clipping and EVD insertion Specimen Count And Types CSF routine, BCS, culture tubes Pathology Nil Operative Findings 1.One about 3 x 3 mm aneurysm protruded toward right and upward with a daughter aneurysm noted at A-com behind the left A1 2.Much adhesion surround the a-com area 3.Brain was swelling and EVD was performed with the opening pressure higher then 15 cmH2O. Yellowish SCF was noted 4.prominent left A1 and bilateral A2 were noted. And recurrent artery of Hubner were preserved 5.One curved Sugita clip was used. 6.Twice temporary clipping was performed, each took less then 3 minutes Operative Procedures 1.ETGA, supine with head rotate to right and extension and fixed with skull clamp 2.Curvature skin incision 3.Reflect the skin flap with facial nerve preservation procedure 4.reflect temporalis muscle flap 5.Burr hole drill then craniectomy 6.EVD insertion 7.Curvature dural opening 8.Retract the frontal lobe 9.Open sylvian fissure 10.Expose optic nerve, ICA then A1 11.Trace A1 to identify A2 12.Dissect aneurysmal neck 13.clipping 14.Hemostasis 15.Dural plasty with muscle fascia 16.Set CWV drain then close wound in layers Operators 賴達明 Assistants 胡朝凱, Ri Indication Of Emergent Operation 呂碧雲 (F,1948/03/12,64y0m) 手術日期 2010/03/24 手術主治醫師 賴達明 手術區域 兒醫 067房 01號 診斷 Herniation intervertebral disc without myelopathy, thoracic (HIVD) 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 鍾文桂, 時間資訊 07:55 報到 08:08 進入手術室 08:10 麻醉開始 08:19 誘導結束 08:40 抗生素給藥 09:06 手術開始 12:06 手術結束 12:06 麻醉結束 12:15 進入恢復室 12:15 送出病患 14:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 手術 椎間盤切除術－腰椎 1 1 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 摘要__ 手術科部: 外科部 套用罐頭: 1. Microsurgical diskectomy, right side appro... 開立醫師: 鍾文桂 開立時間: 2010/03/24 12:39 Pre-operative Diagnosis L4-5 herniated intervertebral disc. Post-operative Diagnosis L4-5 herniated intervertebral disc. Operative Method 1. Microsurgical diskectomy, right side approach. 2. Posterior stabilization of L4,5 spinous process by Wallis. Specimen Count And Types nil Pathology Nil. Operative Findings 1. Much scar tissue formation around right L5 root. 2. Ruptured disc at L4-5 level. After decompression, the root was slack. Intact thecal sac and root along decompression. 3. Zimmer Wallis 10 mm placed at L4/5 inter-spinous process space. The supraspinous ligament was preserved. Operative Procedures Anesthesia: general,endotracheal. Position: prone position. Preparation: disinfection, draping. Incision: along the previous operative wound and 1 cm extension superiorly and inferiorly. Dissection along the previous operative area. Resection of scar tissue for root and thecal sac decompression. Diskeectomy for root decompression. Exposure of L4&5 spinous process with preservation of supraspinous process. Placement of posterior stabilization prosthesis. Well hemostasis and placement of one hemovac drain. Wound closure in layers. Send the patient to POR smoothly. Operators V.S. 賴達明. Assistants R4 鍾文桂,Ri 劉旅安. 黃洋 (M,1957/11/01,54y4m) 手術日期 2010/03/25 手術主治醫師 陳敞牧 手術區域 東址 003房 01號 診斷 Brain metastasis 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 賴碩倫, 時間資訊 08:30 報到 08:52 進入手術室 09:00 麻醉開始 09:15 誘導結束 09:50 抗生素給藥 10:10 手術開始 13:13 抗生素給藥 13:50 麻醉結束 13:50 手術結束 14:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除－手術時間在４小時以內 1 1 摘要__ 手術科部: 內科部 套用罐頭: Craniotomy for total tumor remove 開立醫師: 陳睿生 開立時間: 2010/03/25 14:23 Pre-operative Diagnosis Right frontal tumor, suspect metastasis Post-operative Diagnosis Right frontal tumor, suspect metastasis Operative Method Craniotomy for total tumor remove Specimen Count And Types 1 piece About size:4x3cm Source:tumor Pathology Pending Operative Findings The tumor was yellowish, elastic and moderate margined with the peripheral brain tissue. It was about 3x4x4cm in size and was noted to adhered to the dura at medial side. The involved dura was then removed. Peripheral brain tissue hardish change was noted and post-radiation change was suspect. After totally remove of the tumor, the right frontal horn was exposed and packed with gelfoam. Operative Procedures 1. ETGA, supine position and head fixed with Mayfield clump 2. Bicoronal scalp incision, and the pericranium was preserved. 3. After one bur hole made, an about 5x6cm craniotomy window was created at right frontal region 4. Dura tacking, ECHO localized the tumor and then the dura was opened via the window margin 5. Adhesionlysis between the dura and tumor 6. The plane between the tumor and peripheral brain tissue was carefully dissected 7. The tumor was totally removed, and then the hardish change brain tissue was also removed 8. Hemostasis, excise the involved dura, and the dura was tightly closed with fascia graft after deair 9. Fix back the skull graft with miniplates x4 10.Set a subgaleal CWV drain, and close the wound in layers Operators VS 陳敞牧 Assistants R5 陳睿生, R1 賴碩倫 陳彥云 (F,1966/06/02,45y9m) 手術日期 2010/03/25 手術主治醫師 楊士弘 手術區域 東址 005房 01號 診斷 Hyperhidrosis 器械術式 Endoscopic T2 sympathectomy 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 鍾文桂, 時間資訊 07:46 報到 08:04 進入手術室 08:08 麻醉開始 08:13 誘導結束 08:45 抗生素給藥 08:55 手術開始 09:30 手術結束 09:30 麻醉結束 09:45 送出病患 09:55 進入恢復室 10:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 經內視鏡胸交感神經切斷術 1 1 B 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Video thoracoscopic sympathectomy 開立醫師: 楊士弘 開立時間: 2010/03/25 09:38 Pre-operative Diagnosis Hyperhidrosis Post-operative Diagnosis Hyperhidrosis Operative Method Video thoracoscopic sympathectomy Specimen Count And Types nil Pathology Nil Operative Findings Right hand temp: 31.3 degress (pre-op.) -> 32.6 degrees (post-op.) Left hand temp: 27.4 degress (pre-op.) -> 32.6 degrees (post-op.) Operative Procedures 1. ETGA, supine. 2. Incision at right anterior axillary line over 4th intercostal space. 3. Insertion of Trocar into the pleural space after disconnection of ventilator from endotracheal tube, for introduction of thoracoscope. 4. Electrocoagulation of the T2 sympathetic trunk on the 2nd rib. 5. Removal of thoracoscope and trocar after reexpansion of lung. 6. Wound closure. 7. Repeat procedures 2-6 over the left side. Operators 楊士弘 Assistants 李建勳,鍾文桂 相關圖片 李凱欣 (F,1989/12/15,22y2m) 手術日期 2010/03/25 手術主治醫師 王國川 手術區域 東址 002房 05號 診斷 SDH, trauma 器械術式 Brain tumor Crainotomy(Others) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3E 紀錄醫師 鍾文桂, 時間資訊 08:00 臨時手術NPO 08:00 開始NPO 21:18 報到 21:18 進入手術室 21:20 麻醉開始 21:50 誘導結束 22:56 手術開始 00:00 開始輸血 03:15 麻醉結束 03:15 手術結束 03:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱內壓監視置入 1 4 手術 急性硬腦膜下血腫清除術 1 1 L 手術 眼窩減壓術 1 2 L 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Dolenc^s approach for anterior clinoidectomy;... 開立醫師: 陳睿生 開立時間: 2010/03/26 02:56 Pre-operative Diagnosis Depressed fracture with left optic nerve compression; acute EDH at middle fossa base Post-operative Diagnosis Depressed fracture with left optic nerve compression; acute EDH at middle fossa base Operative Method Dolenc^s approach for anterior clinoidectomy; EDH removal; ICP monitor insertion Specimen Count And Types nil Pathology Nil Operative Findings Multiple left temporal bone fracture was noted. EDH was noted at the middle fossa base and temporal tip. Left orbital roof fracture was noted and the optic nerve was compressed tightly by the bone chip. After clioidectomy, the optic nerve was well decompressed. Parychemal ICP monitor was inserted at left frontal. The initial ICP was about 10mmHg post-op. Operative Procedures 1. ETGA, supine position and head right turn with Mayfield clump fixation 2. Left frontotemporal curvillinear incision, and perform facial nerve preservation 3.Incise and split the temporalis muscle 4. Create 3 bur holes at keyhole, posterior zygomatic region, and posterior superior temporal line, and then an about 8x8 cm craniotomy window was made 5. Dura tacking, and then the sphenoid ridge was drilled flattern 6. Remove the EDH, and the fractured anterior clinoid process was noted under microscope 7. Drill out and remove the anterior clinoid process 8. Nip dura opening and then a parychemal ICP monitor was inserted at the left frontal region 9. Fix back the fractured temproal bone with wires x2 10.Fix back the skull graft with miniplates x3, and central tacking 11.Hemostasis, set a subgaleal CWV drain 12.Close the wound in layers Operators VS 王國川 Assistants R5 陳睿生, R4 鍾文桂, R1 吳晉睿 Indication Of Emergent Operation 賴文英 (F,1976/10/29,35y4m) 手術日期 2010/03/25 手術主治醫師 王國川 手術區域 東址 000房 號 診斷 Subacute sclerosing panencephalitis 器械術式 Brain biopsy (TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 鍾文桂, 時間資訊 09:50 報到 09:50 進入手術室 09:55 麻醉開始 10:00 誘導結束 10:44 手術開始 11:56 麻醉結束 11:56 手術結束 12:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 腦組織活體切片 1 1 R 手術 歐氏貯囊置放手術 1 2 R 摘要__ 手術科部: 神經部 套用罐頭: Right Kocher point omaya reservoir implantati... 開立醫師: 李建勳 開立時間: 2010/03/25 11:54 Pre-operative Diagnosis Encephalitis Post-operative Diagnosis Encephalitis Operative Method Right Kocher point omaya reservoir implantationa and brain biopsy Specimen Count And Types 1 piece About size:0.1gm Source:open brain biopsy Pathology Pending Operative Findings The brain was more elastic than usual. The inserted ventricular catheter: 6.5cm, wtih clear CSF draien out. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position. The scalp was shaved, scrubbed, disinfected with alcohol B-I then draepd. Curvilinear scalp incision was made at right frontal area followed by burr hole creation. The dura was opened in cruciated fashion after tenting with 3-0 silk. The ventricle catheter of omaya was inserted after ventricular puncture. The brain biopsy was performed with aligator at brain surface. The omaya was fixed at galeal layer and the wound was closed in layers. Operators VS 王國川 Assistants R6 李建勳 R4 鍾文桂 相關圖片 張翠芳 (F,1974/02/19,38y0m) 手術日期 2010/03/26 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾峰毅, 時間資訊 08:00 報到 08:10 進入手術室 08:15 麻醉開始 08:40 誘導結束 08:50 抗生素給藥 10:09 手術開始 11:50 抗生素給藥 14:50 抗生素給藥 17:05 麻醉結束 17:05 手術結束 17:10 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 10 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 顱底瘤手術 1 1 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT 開立醫師: 曾峰毅 開立時間: 2010/03/26 15:59 Pre-operative Diagnosis Pontine cavernoma Post-operative Diagnosis Pontine cavernoma Operative Method Craniotomy for ICT Suboccipital craniotomy, telovelar approach, for pontine cavernoma Specimen Count And Types Two fragments of one tumor was sent for pathology. Pathology Pending Operative Findings One 0.5x0.5x0.5cm tortuous vessels was noted in the pons, with hemosidrin deposition and old hemorrhage in different stages. Facial colliculus stimulation was well localized. There was no change of intra-operative SSEP and MEP. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position with head fixed with Mayfield head clamp and neck flexed. After scalp shaved, scrubbed, disinfected, and then draped, we made one midline skin incision from 5cm above the inion to C2 level. We harvest autoloug fascia graft, and detached paraspinal muscles from their insertion. We drilled two burr holes, and the created suboccpital craniotomy followed by C1 laminectomy. Dura incision was made in Y-shape. We entered fourth ventricle via telovelar approach. Tumor location could be visualized on the floor of fourth ventricle. Tumor was dissected meticulously. Tumor cavity was paved with Surgicels for hemostasis. Dura was closed in water-tight fashion with 4-0 prolene and autologous fascia graft. Bone graft was fixed back with mini-plates. After one subgaleal CWV set, we closed the wound in layers. Operators P 杜永光 Assistants R6 陳盈志 R3 曾峰毅 江清菊 (F,1966/03/17,45y11m) 手術日期 2010/03/26 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Bacterial meningitis 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 賴碩倫, 時間資訊 07:48 報到 08:05 進入手術室 08:10 麻醉開始 08:20 誘導結束 08:50 手術開始 08:50 抗生素給藥 09:50 手術結束 09:58 送出病患 10:02 進入恢復室 11:35 離開恢復室 14:25 麻醉結束 醫令資訊 類別 名稱 量 刀 側 手術 肌肉或深部組織腫瘤切除術及異物取出術 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 內視鏡功能鼻竇手術－單側 1 1 摘要__ 手術科部: 外科部 套用罐頭: Repair of CSF leakage with autologous fat gra... 開立醫師: 李建勳 開立時間: 2010/03/26 10:00 Pre-operative Diagnosis CSF leakage after transsphenoid adenomectomy Post-operative Diagnosis CSF leakage after transsphenoid adenomectomy Operative Method Repair of CSF leakage with autologous fat graft and Tissucol Duo Specimen Count And Types Nil Pathology Nil Operative Findings One prominent CSF leakage was noted medial to right middle tuebina and was repaired with autologous fat graft and Tissucol Duo. One prominent and two minor CSF leakage was noted medial to both middle turbinae and was repaired with autologous fat graft and Tissucol Duo. Operative Procedures Under general anestheis and intubation, the patient was put in supine position. The skin over face and right abdomen were disinfected with alcohol better iodine then draped. The Under general anestheis and intubation, the patient was put in supine position. The skin over face and right abdomen were disinfected with alcohol better iodine then draped. Set up the endoscope system. The CSF leakage sites were located with endoscope. Harvested fat graft from previous right abdomen scar. The CSF leakage sites were repaired with autologous fat graft and Tissucol Duo. Closed the abdominal wound in layers. Operators VS 曾漢民 Assistants R6 李建勳 R1 賴碩倫 相關圖片 謝承翰 (M,2005/10/12,6y5m) 手術日期 2010/03/26 手術主治醫師 曾勝弘 手術區域 兒醫 065房 04號 診斷 Other disturbances of aromatic amino-acid metabolism 器械術式 Stereotaxic procedure for impl 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 蕭柏妮 ASA 3 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 14:50 報到 15:10 進入手術室 15:15 麻醉開始 15:35 誘導結束 15:40 手術開始 16:25 手術結束 16:25 麻醉結束 16:35 送出病患 17:00 進入恢復室 18:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 頭皮腫瘤 1 1 B 摘要__ 手術科部: 套用罐頭: Implantation of fiducials for stereotatic gen... 開立醫師: 鍾文桂 開立時間: 2010/03/26 17:37 Pre-operative Diagnosis Aromatic L-amino acid decarboxylase deficiency. Post-operative Diagnosis Aromatic L-amino acid decarboxylase deficiency. Operative Method Implantation of fiducials for stereotatic gene therapy. Specimen Count And Types nil Pathology Nil. Operative Findings Total of 10 fiducials were implanted over the head. Follow-up brain CT was done immediately after fiducial implantation. Operative Procedures Anesthesia: laryngeal mask, general anesthesia. Preparation: alcohol- povidone iodine disinfection, well-draping. mark the planned implantation sites. Scalp incision and then implantation of fiducials. Primary suture of scalp wounds. Well fixation of fiducials. Send the patient to CT room for imaging stereotasis, then to POR for observation. Operators V.S 曾勝弘. Assistants R4 鍾文桂. 劉吳欗 (F,1939/09/30,72y5m) 手術日期 2010/03/26 手術主治醫師 賴達明 手術區域 東址 005房 02號 診斷 Thoracic myelopathy 器械術式 Syringomyelia - Shunting 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 陳建銘, 時間資訊 09:52 報到 10:10 進入手術室 10:30 麻醉開始 10:42 抗生素給藥 10:45 誘導結束 11:12 手術開始 14:25 手術結束 14:25 麻醉結束 14:35 送出病患 14:45 進入恢復室 16:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 手術 椎弓切除術（特壓）－二節以內 1 1 手術 腰椎腦脊髓液池體外引流 1 2 摘要__ 手術科部: 外科部 套用罐頭: T7 laminectomy for cystopleural shunt insertion 開立醫師: 李建勳 開立時間: 2010/03/26 14:25 Pre-operative Diagnosis Thoracic arachnoid cyst with cord compression Post-operative Diagnosis Thoracic arachnoid cyst with cord compression Operative Method T7 laminectomy for cystopleural shunt insertion Specimen Count And Types nil Pathology Nil Operative Findings The arachnoid cyst was found anterior to the T7 level of spinal cord with cord compressed posteriorly. The T-tube was inserted after opened the arachnoid cyst. The SSEP was not changed during the whole procedure. Operative Procedures Under general anesthesia and intubation, the patient was put in prone position. The skin was scrubbed, disinfected with alcohol better-iodine then draped. Midline skin incision was made from T6-8 spinous processes and seperated the paraspinal muscle to expose the T7 lamina. Laminectomy was performed with rongeur and Kerrison punch. The dura was opened and temporal tenting with 2-0 silk. The arachnoid cyst was found after mild retraction of the cord. Opened the cyst with microscissors and inserted the T-tube. Passed the tube via subcutaneous tunnel and inserted via intercostal space to the right pleural cavity. Heomstasis was achieved with gelform packing. Closed the wounds after one epidrual CWV drain set up. Operators VS 賴達明 Assistants R6 李建勳 R1 陳建銘 相關圖片 吳碧霞 (F,1950/08/29,61y6m) 手術日期 2010/03/26 手術主治醫師 賴達明 手術區域 東址 005房 03號 診斷 HIVD 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳建銘, 時間資訊 14:15 報到 14:50 進入手術室 14:55 麻醉開始 15:05 誘導結束 15:20 抗生素給藥 15:42 手術開始 17:20 手術結束 17:20 麻醉結束 17:30 進入恢復室 17:30 送出病患 19:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 椎間盤切除術－腰椎 1 1 摘要__ 手術科部: 外科部 套用罐頭: Right hemilaminectomy for microscopic disckectomy 開立醫師: 李建勳 開立時間: 2010/03/26 17:26 Pre-operative Diagnosis Right L4/5 herniated intervetebral disc (HIVD) Post-operative Diagnosis Right L4/5 herniated intervetebral disc (HIVD) Operative Method Right hemilaminectomy for microscopic disckectomy Specimen Count And Types nil Pathology Nil Operative Findings The right L4/5 HIVD cause L5 root compression. The theca sac and the L5 root were relaxed after disckectomy. Operative Procedures Under general anesthesia and intubation, the patient was put in prone position. The skin was scrubbed, disinfected with alcohol better-iodine then draped. Midline skin incision was made from L4-5 spinous processess followed by seperation of the right paraspinal muscles and retracted with Taylor retractor. Under surgical microscope assistance, the rigth L4 hemilaminectomy was performed with curette and Kerrison punch. The ligmentum flavum was removed by Kerrison punch to expose the dura. The herniated disc was removed after the PLL was incised with No. 15 surgical blade and the disc was further removed after curetage by disc clumps. After hemostasis, the wound was closed in layers. Operators VS 賴達明 Assistants R6 李建勳 R1 陳建銘 相關圖片 蔡仁根 (M,1936/04/30,75y10m) 手術日期 2010/03/26 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Lumbar spondylosis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 3 紀錄醫師 張皓鈞, 時間資訊 07:45 報到 08:10 進入手術室 08:15 麻醉開始 08:20 誘導結束 08:55 抗生素給藥 09:20 手術開始 11:55 抗生素給藥 14:25 手術結束 14:25 麻醉結束 14:35 送出病患 14:37 進入恢復室 16:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 手術 椎弓切除術（特壓）－二節以內 1 4 手術 椎間盤切除術－腰椎 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: L3-4 L5-S1 LAMINOTOMY FOR decompression , TPS... 開立醫師: 胡朝凱 開立時間: 2010/03/26 14:26 Pre-operative Diagnosis Lumbar stenosis over L3-4, 4-5, L5-S1 ,Spondylolisthesis L4-5 Post-operative Diagnosis Lumbar stenosis over L3-4, 4-5, L5-S1 ,Spondylolisthesis L4-5 Operative Method L3-4 L5-S1 LAMINOTOMY FOR decompression , TPS at L4~5 and anterior bony fusion with cage *2 Specimen Count And Types nil Pathology NIL Operative Findings 1.benign prostate hypertrophy status post operation with stricture ,table consulted for Uroglogist with 18Fr three -way -foley insertion . 2.Facet hypertrophy was noted 3.L4 on L5 listhesis 4.hypertrophic flavum ligment beneath the L3~5 level that compressed the thecal sac tightly Operative Procedures 1.ETGA , prone position 2.Located the L3-4-5-S1 under C arm and sterile with ALC BI 3.Incision over midline and dissection until facet joint and transverse process was identified 4.Applied the transpedicle screw over L4-5 and fixation and recheck with C arm 5.Microscopic dikectomy and bony fusion with cage and allograft 6.L3-4 and L5-S1 laminotomy for decompression 7.Applied Rods 8.Hemostasis and set one Hemo-vac 9.Primary closure wound in layers Operators 賴達明 Assistants R5 胡朝凱 R1 張皓鈞 徐海陵 (F,1947/07/17,64y7m) 手術日期 2010/03/26 手術主治醫師 賴達明 手術區域 東址 019房 02號 診斷 Cervical spondylosis 器械術式 Lamino plasty 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 張皓鈞, 時間資訊 14:13 報到 14:55 進入手術室 15:00 麻醉開始 15:10 誘導結束 15:15 抗生素給藥 16:07 手術開始 18:05 手術結束 18:05 麻醉結束 18:15 送出病患 18:20 進入恢復室 19:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 椎弓整形術 1 1 摘要__ 手術科部: 外科部 套用罐頭: Laminoplasty over C3-6 (open door) 開立醫師: 陳睿生 開立時間: 2010/03/26 18:28 Pre-operative Diagnosis Cervical stenosis with OPLL over C3-6 Post-operative Diagnosis Cervical stenosis with OPLL over C3-6 Operative Method Laminoplasty over C3-6 (open door) Specimen Count And Types nil Pathology Nil Operative Findings The left side lamina was used as hindge side, and we elevated rigth side C3-6 lamina for decompression. Miniplates x4 were used for fixation. The thecal sac was well expanded after decompression. Peri-op no obvious evoke potential change was noted. Operative Procedures 1. ETGA, prone position, head fixed with Mayfield clump and hyperflexion 2. Posterior neck midline incision, and split paraspinal muscles via nuchal ligament 3. Expose C3-6 spinous process and lamina 4. Drill out outer cortex of left side lamina and bicortex at right side lamina 5. Split the C3-6 lamina with splitter from right side 6. Fix the lamina with lateral mass by miniplates x4 7. Hemostasis, set one CWV drain 8. Close the paraspinal muscle and wound in layers Operators 賴達明 Assistants R5陳睿生 R1張皓鈞 相關圖片 徐瑞月 (F,1958/01/01,54y2m) 手術日期 2010/03/26 手術主治醫師 黃國皓 手術區域 東址 015房 07號 診斷 Brain tumors, malignant 器械術式 Double-J insertion (bil)/WOR 手術類別 預定手術 手術部位 腹 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 葉惠敏 ASA 3 紀錄醫師 林威佑, 時間資訊 15:15 進入手術室 15:30 麻醉開始 15:40 誘導結束 15:57 手術開始 16:25 手術結束 16:25 麻醉結束 16:30 送出病患 16:35 進入恢復室 18:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 雙丁輸尿管導管置入術 1 0 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 摘要__ 手術科部: 泌尿部 套用罐頭: DBJ stent insertion 開立醫師: 林威佑 開立時間: 2010/03/26 16:41 Pre-operative Diagnosis Bilateral obstructive uropathy Post-operative Diagnosis Bilateral obstructive uropathy Operative Method cystoscopy and metallic tumorstent insertion Specimen Count And Types nil Pathology nil Operative Findings Fr. 6-24 cm metallic tumorstent was inserted into left ureter smoothly Operative Procedures Under satisfactory anesthesia with the patient in lithotomy position, prepping and drapping was performed in the usual sterile fashion. A Fr 21 Olympus cystoscope was introduced into the bladder cavity under direct vision and previous DBJ was removed. Careful inspection was done and guidewire was inserted via previous DBJ. Adequate postition was identified under fluoroscopy. Fr.6-24cm Metallic tumorstent was inserted smoothly under fluoroscopy guided. Patient tolerated the procedure very well and was sent to recovery room in satisfactory condition. Operators 黃國皓, Assistants 林威佑, 張宇鳴, 謝承翰 (M,2005/10/12,6y5m) 手術日期 2010/03/27 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Other disturbances of aromatic amino-acid metabolism 器械術式 Stereotaxic procedure for func 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 李建勳, 時間資訊 07:55 報到 08:05 進入手術室 08:15 麻醉開始 09:00 誘導結束 09:13 抗生素給藥 09:30 手術開始 12:13 抗生素給藥 14:10 麻醉結束 14:10 手術結束 14:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 立體定位術－功能性失調 1 1 L 手術 立體定位術－功能性失調 1 1 R 摘要__ 手術科部: 套用罐頭: Stereotatic injection of adeno-associated vir... 開立醫師: 李建勳 開立時間: 2010/03/27 15:05 Pre-operative Diagnosis Aromatic L-amino acid decarboxylase (AADC) deficiency Post-operative Diagnosis Aromatic L-amino acid decarboxylase deficiency Operative Method Stereotatic injection of adeno-associated virus vector at bilateral putamen Specimen Count And Types nil Pathology Nil Operative Findings 80 microliter of adeno-associated virus vector loaded with AADC gene was injected at two different sites (middle and lateral) of putamen (total:320microliter).Immediate follow up head CT showed no ICH. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position. The scalp was shaved, scrubbed, disinfected with alcohol better-iodine then draped. Two burr holes were made with perforator followed by tenting with 3-0 silk sutures. Set up the navigator with registeration of pre-fixed skull screws. Fixed the stereotactic tower at the burr hole and inserted the catheter as planned. Injected the adeno-associated virus vector loaded with AADC gene was injected at two different sites (middle and lateral lower third) of putamen (total:320microliter). Sealed the burr hole with gelform packing and Tissucol Duo. Closed the wound in layers after hemostasis. Operators VS 曾勝弘 Assistants R6 李建勳 相關圖片 吳武堤 (M,1932/11/28,79y3m) 手術日期 2010/03/27 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Hydrocephalus 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 賴碩倫, 時間資訊 07:55 報到 08:10 進入手術室 08:15 麻醉開始 08:20 誘導結束 08:46 抗生素給藥 09:17 手術開始 10:05 手術結束 10:05 麻醉結束 10:10 送出病患 10:20 進入恢復室 11:33 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室腹腔分流手術 1 1 記錄__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 賴碩倫 開立時間: 2010/03/27 10:10 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method V-P Shunt Specimen Count And Types 3 bottles of CSF Pathology nil Operative Findings 1. 7cm programmable shunt catheter in to frontal horn of ventricle; set pressure 10cmH2O 2. Clear CSF with 10cmH2O intracerebral pressure Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: supine with head rotated to left. 3.Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 5 cm curvilinear, right frontal, corresponded to the location of right frontal horn. Raney clips were applied to the scalp edge for temporary hemostasis. 5.After the scalp flap had been lifted and reflected anteriorly, a burr hole was made and the dura was tented by 2 stitches. 6.The dura was opened by a nib incision. Rt lateral ventricle was tapped by a ventricular needle, then a 7 cm segment of the ventricular catheter was introduced into the ventricle. The outer end of the catheter was connected to a Pudenz reservoir. 7. A nib incision was made at RUQ of the abdomen , then a trocar was pushed into peritoneal cavity. Subsequently, distal 25 cm segment of the peritoneal catheter (10cmH2O pressure) was introduced into the peritoneal cavity through the outer tube of the trochar. The proximal end of this catheter was passed through subcutaneous tunnel at forechest, neck, rt retroauricular area and connected the reservoir. The shunt systemwas checked to make sure its function was working. 8. The reservoir was fixed to pericranium by 3 stitches. 9. Scalp closure: hemostasis was done with monopolar coagulator touching on the sucker tip. Galea suture was performed by continuous suture with 3/0. Dexon and skin by continuous suture with 3/0 nylon. 10.Course of the surgery: smooth. Operators VS王國川 Assistants R4胡朝凱 R1賴碩倫 林雅筠 (F,1985/04/03,26y11m) 手術日期 2010/03/27 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 Hydrocephalus 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 賴碩倫, 時間資訊 10:10 報到 10:17 進入手術室 10:35 麻醉開始 10:40 誘導結束 10:44 抗生素給藥 11:00 手術開始 11:25 手術結束 11:25 麻醉結束 11:35 送出病患 11:40 進入恢復室 13:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦脊髓液分流管重置 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Ventriculo-peritoneal shunt revision 開立醫師: 賴碩倫 開立時間: 2010/03/27 11:37 Pre-operative Diagnosis Hydrocephalus, status post ventriculo-peritoneal shunt insertion Post-operative Diagnosis Hydrocephalus, status post ventriculo-peritoneal shunt insertion Operative Method Ventriculo-peritoneal shunt revision Specimen Count And Types 3 bottles of CSF Pathology nil Operative Findings 1. patent ventriculo-peritoneal shunt 2. CSF: clear, pressure 15cmH2O Operative Procedures The patient was put in supine position, with ETGA. The skin of abdomen was well-draped. Perform skin incision from previous scar at left sideabdomen. The we dissected through preperitoneal layer and identified the tube. Check the lumen and confirm its patency. Perform skin incision from right side abdomen and dissect to preperitoneal layer. Open peritoneum and set the shunt tube into peritoneal cavity. N/S irrigation of the wound and close wound in layers Operators VS王國川 Assistants R4胡朝凱 R1賴碩倫 吳思穎 (F,1981/05/23,30y9m) 手術日期 2010/03/29 手術主治醫師 王至弘 手術區域 東址 021房 02號 診斷 Ankle fracture 器械術式 Remove of Implant(L,S,AO) 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 面罩麻醉 麻醉主治醫師 劉漢平 ASA 3 紀錄醫師 張允亮, 時間資訊 10:40 報到 11:03 進入手術室 11:15 麻醉開始 11:35 誘導結束 11:42 抗生素給藥 11:49 手術開始 12:15 手術結束 12:15 麻醉結束 12:20 進入恢復室 12:20 送出病患 13:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Semi-opened mask inhalation anes 1 0 手術 骨內固定物拔除術－其他部位 1 1 R 記錄__ 手術科部: 骨科部 套用罐頭: Removal of implant 開立醫師: 張允亮 開立時間: 2010/03/29 11:08 Pre-operative Diagnosis Right bimalleolar fracture s/p ORIF, bony union Post-operative Diagnosis Right bimalleolar fracture s/p ORIF, bony union Operative Method Removal of implants Specimen Count And Types nil Pathology Nil Operative Findings 1.Right bimalleolar fracture s/p ORIF, bony union 2.Implants in situ Operative Procedures 1. Anesthetic induction, supine position. 2. Skin disinfected and draped. 3. Skin incision over previous operation scar. 4. Dissected and exposed old implants; then removed. 5. Irrigated with normal saline and hemostasis. 6. Closed wound by layers. Operators 王至弘, Assistants 張允亮, 陳明峰, 徐特生 (M,1947/03/14,65y0m) 手術日期 2010/03/29 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Brain Tumor 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 曾峰毅, 時間資訊 07:40 報到 08:01 進入手術室 08:10 麻醉開始 08:50 誘導結束 09:02 抗生素給藥 09:30 手術開始 12:30 抗生素給藥 15:30 開始輸血 15:45 抗生素給藥 16:50 抗生素給藥 18:40 麻醉結束 18:40 手術結束 18:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 13 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 顱底瘤手術 1 1 R 手術 開顱術摘除血管病變－腦血管瘤－無徵的 1 2 R 摘要__ 手術科部: 外科部 套用罐頭: Right subfrontal, trans-lamina terminalis- fo... 開立醫師: 曾峰毅 開立時間: 2010/03/29 18:46 Pre-operative Diagnosis Third ventricular tumor, suspected colloid cyst Post-operative Diagnosis Third ventricular craniopharyngioma, and right superior hypophyseal artery aneurysm, unruptured, complicated with intra-operative rupture Operative Method Right subfrontal, trans-lamina terminalis- for thrid ventricular tumor, and right hypophyseal aneurysm clipping. Specimen Count And Types Several fragments of one tumor was sent for pathology. Pathology Pending Operative Findings One cystic tumor, with yellowish, firm to elastic muronodular portion, and motor-oil-like content was noted in the third ventricle with uncler border between nearby hypothalamus, and thin pseduocapsule. One wide base, 5.5mm in neck width, and 5mm in diameter, aneurysm arised right internal carotid artery, pointing laterally and superiorly. Intra-operative rupture at aneurysm neck occurred, and hemostasis was achieved by clipping and sealing with Floseal. Blood loss was about 4500ml. Operative Procedures With endotracheal general anesthesia, the patient was put in supine with head fixed by Mayfield skull clamp. After scalp shaved, scrubbed, disinfected, and then draped, we made one bicoronal skin incision and reflected the scalp flap inferiorly. We drilled one burr hole at each side of ansterior part of superior saggital sinus, and one burr hole at right keyhole. We made one right frontal craniotomy, and tented the dura along the craniotomy edge, and removed mucosa of exposed frontal sinus. Frontal sinus was further packed with Gelfoam and beta-iodine, and sealed with bone wax. Dura incision was made in C-shape with base at medial side. Arachnoid membrane of interhemispheric fissure, and Sylvian fisure was released. right olfactory nerve was preserved, and released. Brain was retracted from the frontal base. Lamina terminalis was opened, and tumor excision was performed after drainage of the cystic content. Dura over right anterior clinoid process was opened, and partial clinoidectomy was done. Distral dura ring was opened, and aneurysm clipping was performed. Intra-operative rupture of aneurysm was stopped by common carotid artery compression, multiple clipping, and sealing with Floseal. Diffuse subarachnoid hematoma was irrigated with normal saline and washed out. Dura was closed in water-tight fasion with 4-0 prolene. Bone graft was fixed back with mini-plates, and one sub galeal CWv was inserted. We closed the wound in layers. Operators P 杜永光 Assistants R6 陳盈志 R3 曾峰毅 吳秋月 (F,1958/02/09,54y1m) 手術日期 2010/03/29 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Pituitary Tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3 紀錄醫師 賴碩倫, 時間資訊 07:45 報到 08:05 進入手術室 08:10 麻醉開始 08:40 誘導結束 09:00 抗生素給藥 09:13 手術開始 10:28 麻醉結束 10:28 手術結束 10:35 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 粘膜下中隔矯正術 1 2 手術 經由蝶竇之腦下垂體瘤切除 1 1 摘要__ 手術科部: 外科部 套用罐頭: Endoscopic transsphenoid adenomectomy 開立醫師: 李建勳 開立時間: 2010/03/29 10:44 Pre-operative Diagnosis Pituitary macroadenoma Post-operative Diagnosis Pituitary macroadenoma Operative Method Endoscopic transsphenoid adenomectomy Specimen Count And Types 1 specimen: 0.1x0.2cm pituitary tumor Pathology pending Operative Findings 1. The sellar floor was penetrated by the tumor. The cystic rupture was suspect due to empty cytic cavity was found. 2. Small amount of whitish, soft tumor was found. The normal gland was found after adenomectomy. 3. No CSF leakage noted during the procedure. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head tilted 30 degree to left. 3. Skin preparation: the face and anterior right thigh were prepared with povidone-iodine alcohol tincture, and the mucosa of oral and nasal cavity with aqueous povidone-iodine tincture. The former areas were covered by a sterilized adhesive plastic sheet. Set up the endocscope system. 4. The nasal submucosa at septum and floor were infiltrated with 1:100 epinephrine solution. 5. The nasal mucosa was coagulated to expose the vomer bone. 6. the nasal speculum was applied to displace the nasal mucosa laterally and keep the nasal cavity open constantly for the exposure of the vomer bone and the anterior wall of the sphenoid sinus. 7. The sellar floor was penetrated by a osteotome, then widened by Kerrison punch. 8. The sellar floor dura was coagulated with bipolar forceps, then opened in cruciate fashion. 9.The soft tumor parenchyma was removed by curette and suction 10. The venous oozing from the dura was stopped by gelfoam packing. 11. The arachnoid and the opening of diaphragm sellae was packing with gelform and selaed with Tissucol Duo. 12. The sellar floor was reconstructed by bone plate at the margin of the sellar floor. 13. The vomer bone was put back in position. 14. The nasal speculum was removed and the nasal mucosa returned to its normal position. Right side of the nasal cavities was tightly packed with a segment of plastic glove finger packed with vasline gauze strips which had been soacked with Better-iodine ointment. Operators VS曾漢民 Assistants R6李建勳 R1賴碩倫 相關圖片 陳清文 (M,1950/08/23,61y6m) 手術日期 2010/03/29 手術主治醫師 蔡瑞章 手術區域 東址 005房 02號 診斷 Infection and inflammatory reaction due to nervous system device, implant, and graft 器械術式 Revision of CSF shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 4 紀錄醫師 賴碩倫, 時間資訊 00:00 臨時手術NPO 11:20 報到 11:20 進入手術室 11:25 麻醉開始 11:30 誘導結束 12:03 手術開始 12:55 麻醉結束 13:03 送出病患 15:55 手術結束 醫令資訊 類別 名稱 量 刀 側 手術 腦脊髓液分流管重置 1 1 手術 顱內壓監視置入 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 內科部 套用罐頭: Removal of right VP shunt and inserted left K... 開立醫師: 李建勳 開立時間: 2010/03/29 13:18 Pre-operative Diagnosis Hydrocephalus status post ventriculoperitoneal(VP) shunt with infection Post-operative Diagnosis Hydrocephalus status post ventriculoperitoneal shunt with infection Operative Method Removal of right VP shunt and inserted left Kocher point ommaya reservoir Specimen Count And Types 5 pieces About size:5cm Source:ventricular catheter About size:5cm Source:peritoneal catheter About size:1mL Source:CSF About size:1mL Source:CSF About size:4mL Source:CSF Pathology Nil Operative Findings The CSF was staw-colored and was drained out smoothly after insertion of the ommaya reservoir. The ventricular catheter: 6.5cm in length. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position. The scalp was shaved, scrubbed, disinfected with better-iodine then draped. The right scalp incision was made along previous op scar and removed the peritoneal catheter, programmable shunt and the ventricular catheter. Closed the wound in layers. Left scalp incision was made over left Kocher point followed by creation of the burr hole. The dura was opened after tenting with 3-0 silk. The ventricle was punctured by puncture needle then shifted to ommaya reservoir. The reservoir was checked for function and fixed to the galea. Closed the wound in layers and connected the ommaya reservoir to the drainage system with scalp needle. Operators P 蔡瑞章 Assistants R6 李建勳 R1 賴碩倫 相關圖片 郭子睿 (M,1996/09/25,15y5m) 手術日期 2010/03/29 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Brain tumors, malignant 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 09:45 報到 10:16 進入手術室 10:25 麻醉開始 10:52 誘導結束 11:10 抗生素給藥 11:50 手術開始 13:45 開始輸血 14:10 抗生素給藥 16:50 麻醉結束 16:50 手術結束 17:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除－手術時間在４～８小時 1 1 手術 顱內壓監視置入 1 4 手術 顱骨切除術，包括異物移除或減壓或神經切斷 1 2 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 摘要__ 手術科部: 套用罐頭: 1. Insertion of EVD at right Frizier for ICP ... 開立醫師: 鍾文桂 開立時間: 2010/03/29 18:23 Pre-operative Diagnosis 1. Cerebellar / pineal gland tumor. 2. Obstructive hydrocephalus. Pineal germ cell tumor or cerebellar medullobalstoma 2. Obstructive hydrocephalus. Post-operative Diagnosis 1. Cerebellar / pineal gland tumor, suspect medulloblastoma. 1. Pineal or cerebellar medullobalstoma, rule out germ cell tumor. 2. Obstructive hydrocephalus. Operative Method 1. Insertion of EVD at right Frizier for ICP monitoring and CSF drainage. 2. Subtotal tumor excision, supracerebellar- intratentorial approach. 2. Partial tumor excision, supracerebellar-intratentorial approach. 3. Craniectomy, suboccipital. 3. Craniectomy, suboccipital, for decompression. Specimen Count And Types 1 piece About size:many small pieces Source:brain tumor. Pathology Frozen section: small round blue cells, medulloblastoma is favored. Frozen section: small round blue cells, medulloblastoma or lymphoma is favored Operative Findings Easy oozing operative field. Tumor characters: fragile, red- yellowish, partially encapsulated, high vascularity. Tumor characters: fragile (almost necrotic), red-grey, partially encapsulated, high vascularity. Third ventricle, vein of Galen,and internal cerebral veins were not reached intraoperatively. Low intraoperative intracranial pressure. < 10 cmH2O. Low intraoperative intracranial pressure (< 10 cmH2O.) after surgery Operative Procedures Position: prone; head fixed with 3-pin head holder, slightly flexed. Anesthesia: endotracheal with non-kinking ET tube, general Preparation: shaving, disinfection, draping. Procedure I: Right Frazier EVD. Procedure I: Right Frazier EVD, 10 cm in length. 1. Linear longitudinal incision at right Frazier point. 2. Burr hole, dura tenting, and durotomy. 3. Insertion of ventriculostomy needle. 4. Insertion and fixation of EVD tube throught the same ventriculostomy track. Procedure II & III: subtotal tumor excision & craniectomy. Procedure II & III: partial tumor excision & occipital/suboccipitalcraniectomy. 1. Midline incision from 1 cm above inion to C2 level. 1. Midline incision from 3 cm above inion to C2 level. 2. Suboccipital craniectomy with partial exposure of bilateral transverse sinus. 2. Suboccipital craniectomy with partial exposure of bilateral transverse sinus. 3. Curvilinear durotomy, electrocoagulation and transsection of occipital sinus. 3. Curvilinear durotomy, electrocoagulation and transsection of occipital sinus. 4. Intratentorial- supracerebellar approach to reach tumor mass. 4. Reflected the dural flap upward and infratentorial-supracerebellar approach to reach tumor mass. 5. Tumor excision by tumor forceps, suction tube, and bipolar electrocoagulator. 6. Well hemostasis with Surgicel and bipolar electrocoagulator. 7. Dural augmentation with DuraFoam and seal with TissueColDuo. 8. Placement of one intramuscular CWV drain. 9. Wound closure in layers 10. Send the patient to ICU smoothly. Operators A.P. 郭夢菲. Assistants R4. 鍾文桂. Indication Of Emergent Operation 蘇宛君 (F,1985/10/23,26y4m) 手術日期 2010/03/29 手術主治醫師 陳敞牧 手術區域 東址 005房 03號 診斷 Malignant neoplasm of nasal cavities 器械術式 OPLL- Anterior Corpectomy 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3 紀錄醫師 賴碩倫, 時間資訊 00:00 臨時手術NPO 13:28 進入手術室 13:35 麻醉開始 14:00 誘導結束 14:00 抗生素給藥 14:30 手術開始 17:00 抗生素給藥 20:00 抗生素給藥 20:00 開始輸血 21:35 手術結束 21:35 麻醉結束 21:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 8 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 椎間盤切除術－頸椎 1 2 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 4 手術 惡性病髓腫瘤切除術 1 1 摘要__ 手術科部: 外科部 套用罐頭: 1. C5 corpectomy, anterior fusion with body c... 開立醫師: 李建勳 開立時間: 2010/03/29 21:42 Pre-operative Diagnosis Multiple spine metastatic tumors with C5 and T9 cord compression Post-operative Diagnosis Multiple spine metastatic tumors with C5 and T9 cord compression Operative Method 1. C5 corpectomy, anterior fusion with body cage and plate 2. T9 laminectomy for tumor excision and T8, T12 transpedicle screw (TPS) fixation 1. C5 corpectomy, C4/5 5/6 disckectomy, anterior fusion with body cage and plate 2. T9 laminectomy for tumor excision and T8, T12 transpedicle screw (TPS) fixation Specimen Count And Types 2 pieces About size:2g Source:C5 tumor About size:3g Source:T9 tumor Pathology Pending Operative Findings 1. The C5 vetebral body was collapsed with yellowish tumor. Medtronic body cage with 34mm Synthes cervical plate were used for anterior fusion. 1. The C5 vetebral body was collapsed with yellowish tumor. Medtronic body cage with 34mm Synthes cervical plate were used for anterior fusion. 2. The T9 vetebral body was filled with soft,hypervascular, yellowish tumor. Synthes TPS 5.5mmX35mmX2 at T8 level and 6.5mmX40mmX2 at T12 level with 130mm rod X2 and one cross-link were used. 2. The T9 vetebral body was filled with soft,hypervascular, yellowish tumor. Synthes TPS 5.5mmX35mmX2 at T8 level and 6.5mmX40mmX2 at T12 level with 130mm rod X2 and one cross-link were used. The both T9 roots were transected after clipping. The both T9 roots were transected after clipping. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position with head extension. The skin over anterior neck was scrubbd, disinfected with alcohol better-iodine then draped. The transverse skin incision was made at right neck with incision over the platysma muscle. The carotid sheath was retracted laterally while the trachea and esophagus were retracted medially. Blunt dissection between the muscle groups to located the collapsed C5 vetebral body. Tumor excision with disckectomy were performed with surgical blade incision over the ALL and removed the tumor with curette and Kerrison punch. The hemostasis was achieved with bipolar coagulation and gelform packing. The body cage was talored for size after corpectomy and disckectomy. The plate was inserted after the body cage and checked both implantation with portable C-arm X-ray. After one minihemovac set up, the wound was closed in layers. Replace the patient in prone position. Checked the T8-12 vetebral body with portable X-ray. Scrubbed and disinfected the back skin with alcohol better-iodine then draped. Midline skin incision over T7-L1 spinous processes and seperated the paraspinal muscles to expose the laminae. Inserted the T8 and T12 TPS then checked position with portable X-ray. T9 laminectomy followed by tumor excision with Kerrison punch and curette. The both T9 roots were transected after clipping. Hemostasis was achieved with gelform packing. Set up the rods, cross-link and hemovac drains. Closed the wound in layers. Operators VS 陳敞牧 Assistants R6 李建勳 R1 賴碩倫 相關圖片 梁碧春 (F,1955/02/01,57y1m) 手術日期 2010/03/30 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 07:40 報到 08:03 進入手術室 08:05 麻醉開始 08:30 誘導結束 08:50 抗生素給藥 09:00 手術開始 12:00 麻醉結束 12:00 手術結束 12:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４小時以內 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 摘要__ 手術科部: 外科部 套用罐頭: Simpson grade II tumor excision 開立醫師: 胡朝凱 開立時間: 2010/03/30 12:03 Pre-operative Diagnosis Right tentorial meningioma Post-operative Diagnosis Right tentorial meningioma Operative Method Simpson grade II tumor excision Specimen Count And Types several piece of brain tumor Pathology pending Operative Findings 1.One about 2.5 cm whitish, firm tumor was noted that attache to the right transverse sinus and tentorium 2.The tumor margin was clear 3.No obvious hyperosteosis 4.No obvious dural tail Operative Procedures 1.ETGA, supine with right side elevation and the head was fixed with skull clamp 2.Right postauricuilar curve incision was done 3.Devided the muscle group 4.Craniotomy 5.cruciate form dural opening 6.retract the inferior temporal gyrus to identify the tumor 7.Dissect around the tumor border 8.The attachment was devided with cauterization 9.central debulky was also performed 10.tumor was resected piece by piece 11.hemostasis 12.close dura with prolene and one piece of fascia 13.fixed bone back with miniplate 14.close wound in layers Operators 曾勝弘 Assistants 胡朝凱,李振豪 陳賽珠 (F,1952/06/26,59y8m) 手術日期 2010/03/30 手術主治醫師 曾勝弘 手術區域 東址 005房 02號 診斷 Spinal tumor 器械術式 Benign intraspinal tumor, exci 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 11:40 報到 12:40 進入手術室 12:45 麻醉開始 13:00 誘導結束 13:30 抗生素給藥 13:46 手術開始 17:05 麻醉結束 17:05 手術結束 17:18 送出病患 17:23 進入恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 手術 良性病髓腫瘤切除術 1 1 摘要__ 手術科部: 外科部 套用罐頭: Laminectomy for Simpson grade II tumor excision 開立醫師: 李振豪 開立時間: 2010/03/30 17:16 Pre-operative Diagnosis T2~3 intradural extramedullary meningioma Post-operative Diagnosis T2~3 intradural extramedullary meningioma Operative Method Laminectomy for Simpson grade II tumor excision Specimen Count And Types Multiple small pieces of intraspinal tumor with about 5gram in weight Pathology Frozen : meningioma Operative Findings 1.One whitish, firm tumor located at T2~3 level in front of spinal cord and compressed the cord tightly posteriorly and right laterally. 2.During operation, SSEP and MEP persisted, the left lower leg MEP imporved after tumor excision 3. 3.CSF leakage was noted after closure of dura and Gelform packing was performed. Operative Procedures Under endotracheal tube general anesthesia, the patient was put on prone position with head fixed wity Mayfield skull clamp. C-arm portable X-ray was applied for localization of T2-T3 space. The skin was disinfected and draped as usual. Midline skin incision at T1~T3 level was performed and the subcutaneous soft tissue was dissected. the T1~T3 laminae were exposed after detachment of paravertebral muscle group. T2 and partial T1, T3 laminectomy was performed and the thecal sac was exposed. The dura was opened and the tumor was identified. The tumor was detached from dural base by bipolar cautery. The specimen was sent for Forzen section. Due to hardish and adhere of the tumor with spinal cord, the tumor was removed piece by piece with bipolar cautery and tumor forceps. SSEP and MEP monitor was applied during whole procedure. After tumor removal, the left lower leg MEP improved. Hemostasis was achieved and the dura was closed with water-tight sutures. CSF leakage was noted after closure of dura and Gelform packing was applied. One epidural CWV drain was set and the wound was closed in layers. Operators VS曾勝弘 Assistants R5胡朝凱, R3李振豪 王右辰 (M,2009/01/24,3y1m) 手術日期 2010/03/30 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Craniosynostosis 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 2 紀錄醫師 鍾文桂, 時間資訊 07:50 報到 08:10 麻醉開始 08:10 進入手術室 08:50 誘導結束 09:00 抗生素給藥 09:50 手術開始 10:00 開始輸血 12:12 抗生素給藥 14:40 麻醉結束 14:40 手術結束 14:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 顱骨縫線早期封閉症手術－顱骨分割法 1 2 手術 顱骨切除術，包括異物移除或減壓或神經切斷 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 摘要__ 手術科部: 外科部 套用罐頭: Strip craniectomy and cranial vault remodeling. 開立醫師: 鍾文桂 開立時間: 2010/03/30 19:29 Pre-operative Diagnosis Craniosynostosis, scaphocephaly. Post-operative Diagnosis Craniosynostosis, scaphocephaly. Operative Method Strip craniectomy and cranial vault remodeling. Pi cranioplasty and cranial vault remodeling. Anterior Pi craniectomy then cranioplasty and cranial vault remodeling. Specimen Count And Types nil Pathology Nil. Operative Findings Premature closure of meitopic and sagital sutures. No anterior fontanelle. Premature closure of meitopic and sagital sutures. No anterior fontanelle. there was ridge formation over the sagittal suture. Intact superior sagital sinus. No CSF leakage. Decreased anterior-posterior diameter and increased biparietal diameter postoperatively. Before correction, the anterior-posterior diameter was elogated and the biparietal diameter was narrow. There was marked indentation over the bone posterior to the coronal suture and marked frontal bossing. Deepening of middle meningeal artery groove, bilateral. Deepening of middle meningeal artery groove, bilateral. It may be due to increased intracranial pressure. Mild tense brain. Blood loss: 150 cc, transfusion 100 cc packed RBC. Operative Procedures Anesthesia: endotracheal, general. Position: supine, head in midline. Preparation: shaving, disinfection, and draping. Incision: Bicoronal zig-zag incision. Strip craniectomy with sparing of superior sagital sinus region. Craniectomy of the parietal bone on both side with sparing of superior sagital sinus region. Barrel-stave remodeling of the two harvested bone plates with 3-0 Vicry to decreased anterior-posterior diameter and increased biparietal diameter. Barrel-stave remodeling of the two harvested bone plates with 3-0 Vicry to decreased anterior-posterior diameter and increased biparietal diameter. Barrel-stave remodelling was also undertaken to temporal bone and the bone was bended gently toward lateral side to increase the bitemporal distance. Craniectomy and remodeling of bone strip over superior sagital sinus. Dural tenting; fixation of bone plates with 3-0 Vicryl. Placement of one CWV drain. Placement of one CWV drain at the subgaleal space after the periosteum was closed back. Wound clsoure in layers. Wound closure in layers. Send the patient to ICU smoothly. Operators V.S. 郭夢菲 Assistants R4 鍾文桂 李宜臻 (F,1978/10/01,33y5m) 手術日期 2010/03/30 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Spinal tumor 器械術式 Benign intraspinal tumor, exci 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 張皓鈞, 時間資訊 07:30 報到 08:10 進入手術室 08:12 麻醉開始 08:25 誘導結束 09:10 抗生素給藥 09:31 手術開始 12:10 抗生素給藥 13:50 麻醉結束 13:50 手術結束 14:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 脊椎內脊髓內腫瘤切除術 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: C1 Laminectomy for tumor excision 開立醫師: 陳睿生 開立時間: 2010/03/30 14:32 Pre-operative Diagnosis C1-C2 intramedullary tumor, cavernoma Post-operative Diagnosis C1-C2 intramedullary tumor, cavernoma Operative Method C1 Laminectomy for tumor excision Specimen Count And Types 1 piece About size:1.8 cm Source:C1 intramedullary tumor Pathology pending Operative Findings The tumor located at the C1-2 level of the cord. It was dark reddish and lobulated. The margin between the tumor and medulla was clear. Peripheral hemosiderin deposition was also noted. The tumor was well vascularized but no obvious supply vessel found. We approached the tumor from the posterior midline of the cord. No SSEP change was noted. Peri-op left side MEP change was noted, and it returned after the procedure. Operative Procedures 1. ETGA, prone position, head fixed with Mayfield clump and hyperflexion 2. Posterior neck midline incision, and split paraspinal muscles via nuchal ligament 3. Expose Occipital bone to upper C2 spinous process and lamina 4. Drill to remove the C1 posterior arch 5. The dura was opened and temporally tenting with 3-0 silk sutures 6. Corticotomy was done between bilateral fasciculus, and the tumor was found inside the cord 7. The plane between the tumor and cord was carefully dissected with ring forceps, and dissector 8. The tumor was then totally removed under EP monitoring 9. Primary closure of the dura was done with 5-0 prolene 10.Hemostasis, set a epidural CWV drain 11.Close the wound in layers Operators 賴達明 Assistants R5 陳睿生 R1 張皓鈞 洪秀蘭 (F,1943/05/06,68y10m) 手術日期 2010/03/30 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Lumbar spondylosis 器械術式 Laminectomy for decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 張皓鈞, 時間資訊 13:35 報到 14:30 進入手術室 14:35 麻醉開始 14:45 誘導結束 15:15 抗生素給藥 15:23 手術開始 17:05 手術結束 17:05 麻醉結束 17:15 送出病患 17:20 進入恢復室 18:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 椎弓切除術（特壓）－二節以內 1 1 摘要__ 手術科部: 外科部 套用罐頭: Left side laminotomy for adhesionlysis and su... 開立醫師: 陳睿生 開立時間: 2010/03/30 17:30 Pre-operative Diagnosis Lumbar stenosis s/p with lateral recess syndrome over left L4/5 Post-operative Diagnosis Lumbar stenosis s/p with lateral recess syndrome over left L4/5 Operative Method Left side laminotomy for adhesionlysis and sublaminar decompression Specimen Count And Types nil Pathology Nil Operative Findings Post-operative change with ever adhesion was noted atepidural space. The left L5 root was compressed by the granulation tissue and ligamentum flavum. After adhesionlysis and remove of residual ligamentum flavum, the root was well deompressed. Operative Procedures 1. ETGA, prone position and C-amr localized L4/5 level 2. Incise into the previous wound 3. Split left side paraspinal muscle, and identify and L4/5 interlaminal space 4. Set self retractor, and laminotomy was performed under microscope 5. Adhesionlysis, and remove of residual ligamentum flavum 6. Find out the left L5 root and incise into the L4/5 disk space for deompression 7. Hemostasis, close the wound in layers Operators VS 賴達明 Assistants R5 陳睿生, R1 張皓鈞 郭麗枝 (F,1951/07/15,60y7m) 手術日期 2010/03/30 手術主治醫師 賴達明 手術區域 東址 002房 03號 診斷 Intracerebral hemorrhage (ICH) 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 李建勳, 時間資訊 11:45 報到 12:25 進入手術室 12:30 麻醉開始 12:35 誘導結束 13:20 抗生素給藥 13:26 手術開始 15:45 手術結束 15:45 麻醉結束 15:56 送出病患 16:00 進入恢復室 17:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 手術 腦室腹腔分流手術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Right Kocher point ventriculoperitoneal (VP) ... 開立醫師: 李建勳 開立時間: 2010/03/30 15:56 Pre-operative Diagnosis Hydrocephalus after intracerebral hemorrhage with intraventricular hemorrhage Post-operative Diagnosis Hydrocephalus after intracerebral hemorrhage with intraventricular hemorrhage Operative Method Right Kocher point ventriculoperitoneal (VP) shunt insertion with antisiphon device Specimen Count And Types 3 pieces About size:1mL Source:CSF About size:1mL Source:CSF About size:1mL Source:CSF Pathology Nil Operative Findings CSF opening pressure: 8cmH2O with clear CSF drained out. Metronic medium pressure valve with Codman antisiphon device were implanted. Ventricular catheter: 6.5cm; peritoneal catheter: 25cm. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position with head turned to left. The scalp was shaved, scrubbed, antiseptic with alcohol better-iodine then draped. A curvilinear skin incision was made at right frontal region followed by burr hole. The dura was incised after tenting. A ventricular puncture needle was used to puncture then shifted to nelaton tube. Minilaparotomy was made at right upper abdomen and the peritoneal catheter was inserted and test function. The shunt cather was then passed through subcutaneous layer of abdomen, anterior chest wall, neck, retroauricular area then connected to the reservoir. The nelaton tube was then changed to ventricular catheter and connected to the reservoir. The antisiphon device was implanted at right anterior chest below the clavicle. After testing the function, the wounds were all closed in layers. Operators VS 賴達明 Assistants R6 李建勳 相關圖片 陳佑嘉 (M,2009/10/28,2y4m) 手術日期 2010/03/30 手術主治醫師 許巍鐘 手術區域 兒醫 062房 01號 診斷 Tetralogy of Fallot 器械術式 BRONCHOSCOPY-COMPLICATED 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 4 紀錄醫師 曾怡凡, 時間資訊 08:15 報到 08:15 進入手術室 08:25 麻醉開始 08:26 誘導結束 08:34 手術開始 08:42 麻醉結束 08:42 手術結束 08:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 管、支氣管、細支氣管異物除去術－氣管鏡 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 耳鼻喉部 套用罐頭: Rigid bronchoscopy 開立醫師: 曾怡凡 開立時間: 2010/03/30 08:13 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Rigid bronchoscope Specimen Count And Types Nil Pathology Nil Operative Findings Pharynx: Nasopharynx_______________________________ Tongue base_______________________________ Vallecula_________________________________ Hypopharynx_______________________________ Larynx: Epiglottis__________________________________ Aryepiglottic fold__________________________ Arytenoid cartilage_________________________ Accesory cartilage___________________________ True vocal fold______________________________ False vocal folds___________________________ Subglotttis____________________________________ Trachea:_______________________________________ Carina: _____________________________________ Right main bronchus:_________________________ Left main bronchus___________________________ Others:______________________________________ Operative Procedures The patient was in supine position. Jet ventilation was used for impending airway obstruction. Rigid bronchoscopy was set and larynx, subglottis, trachea, carina, bilateral main bronchus, and right upper, middle, lower; left upper and lowerbronchus were checked. Operators Asp許巍鐘 Assistants R3曾怡凡 莊蔥 (F,1955/04/08,56y11m) 手術日期 2010/03/31 手術主治醫師 黃約翰 手術區域 東址 053房 03號 診斷 Other lymphomas, lymph nodes of multiple sites 器械術式 Neck lymph node dissection/WOR 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 廖御佐, 時間資訊 14:20 報到 14:39 進入手術室 14:45 麻醉開始 14:50 誘導結束 15:00 抗生素給藥 15:04 手術開始 15:23 手術結束 15:23 麻醉結束 15:26 送出病患 15:30 進入恢復室 16:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 淋巴腺活體切片 1 1 R 摘要__ 手術科部: 內科部 套用罐頭: Lymph node biopsy 開立醫師: 廖御佐 開立時間: 2010/03/31 15:33 Pre-operative Diagnosis Lymphoma, right inguinal lymph node enlargement Post-operative Diagnosis Lymphoma, right inguinal lymph node enlargement Operative Method Lymph node biopsy Specimen Count And Types 1 piece About size:0.4*0.6cm Source:right inguinal lymph node Pathology Pending Operative Findings Several enlarged lymph nodes were palpable. Operative Procedures 1.GA< supine 2.Lymph node biopsy 3.Close the wound Operators 黃約翰 Assistants 廖御佐 徐千婷 相關圖片 王武雄 (M,1942/11/02,69y4m) 手術日期 2010/03/31 手術主治醫師 杜永光 手術區域 東址 002房 01號 診斷 Hydrocephalus 器械術式 Revision of CSF shunt 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2E 紀錄醫師 胡朝凱, 時間資訊 07:33 臨時手術NPO 07:33 開始NPO 08:33 通知急診手術 09:05 報到 09:20 進入手術室 09:30 麻醉開始 09:35 誘導結束 10:05 抗生素給藥 10:19 手術開始 11:20 手術結束 11:20 麻醉結束 11:50 送出病患 11:55 進入恢復室 14:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Right subdural peritoneal shunt 開立醫師: 胡朝凱 開立時間: 2010/03/31 11:43 Pre-operative Diagnosis Right frontal to temporal subdural effusion Post-operative Diagnosis Right frontal to temporal subdural effusion Operative Method Right subdural peritoneal shunt Specimen Count And Types Nil Pathology Nil Operative Findings 1.Outer membrane was noted 2.yellowish fluid was noted after the membrane opening 3.Opening pressure was about 10cmH2O Operative Procedures Under ETGA, patient was supine with his head rotate to left. The wound incision was done via previous wound and extended. Dissect to expose the previous catheter and connector. A new burr hole was done at right frontal area. After dural tenting, the dura was opened as cruciate form. And the catheter was inserted. And the catheter was connect to abdominal catheter. The wound was then closed in layers. Operators 杜永光 Assistants 胡朝凱 Indication Of Emergent Operation 鍾銀貞 (F,1951/01/11,61y2m) 手術日期 2010/03/31 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾峰毅, 時間資訊 07:15 報到 08:02 進入手術室 08:05 麻醉開始 08:30 誘導結束 09:03 抗生素給藥 09:36 手術開始 12:03 抗生素給藥 14:35 麻醉結束 14:35 手術結束 14:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４～８小時 1 1 R 麻醉 Glucose 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Right retrosigmoid approach for tentorial men... 開立醫師: 曾峰毅 開立時間: 2010/03/31 15:02 Pre-operative Diagnosis Meningioma at right transverse-sigmoid sinus junction Post-operative Diagnosis Meningioma at right transverse-sigmoid sinus junction Operative Method Right retrosigmoid approach for tentorial meningioma Specimen Count And Types Several fragments of one tumor was sent for pathology. Pathology Pending Operative Findings One 2.9x2.6x.2.5cm well defined, extra-axial, soft, capsulsed, round-shaped tumor was noted at right transverse-sigmoid sinus with dura-based on tentorium. Right transverse sinus was partially occluded by tumor, and occpital sinus draiange was prominent for compensation. Vein of Labbe drains to right transverse-sigmoid sinus still. Operative Procedures With endotracheal general anesthesia, the patient was put in supine position with head roated to left, and fixed with Mayfield head clamp. After scalp shaved, scrubbed, disinfected, and then draped, we made one curvilinear skin incision at right post-auricular area. We harvested the fascia. We drilled one burr hole at right asterion, and created one craniotomy about 4x6cm. Craniotomy was extende a little to expose sinus well. Curvilinear dura incision was done, and tumor-cerebellum border was dissected. Tumor was removed with central debulking first and then removed totally by bipolar cauterizaiton and CUSA. Dura attachment of this tumor was cauterized as well. Hemoastasis was done with cauterization and Surgicels. Dura was closed in water-tight fashion with 4-0 porlene and autologous fascia. Bone graft was fixed back with mini-plates, and the wound was closed in layers. Operators P 杜永光 Assistants R6 陳盈志 R3 曾峰毅 陳里美 (F,1955/10/25,56y4m) 手術日期 2010/03/31 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Acromegaly 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳建銘, 時間資訊 15:25 報到 15:25 進入手術室 15:30 麻醉開始 15:45 抗生素給藥 15:45 誘導結束 16:00 手術開始 18:00 麻醉結束 18:00 手術結束 18:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經由蝶竇之腦下垂體瘤切除 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 摘要__ 手術科部: 外科部 套用罐頭: Endoscopic transsphenoid adenomectomy 開立醫師: 李建勳 開立時間: 2010/03/31 18:31 Pre-operative Diagnosis Pituitary macroadenoma Post-operative Diagnosis Pituitary macroadenoma Operative Method Microscopic transsphnoid adenomectomy Specimen Count And Types 1 piece About size:0.5g Source:transsphenoid adenomectomy Pathology Pending Operative Findings The tumor was yellowish, soft, size 1cm in diameter. The normal gland was found at right side to the tumor. Minimal CSF leakage was sealed with Tissuecol Duo and gelform packing. Operative Procedures Under general anethesia and intubation, the patient was put in supine position with head tilted 30 degree to left. The facial skin was antiseptic with alcohol better-iodine tincture, and the mucosa of oral and nasal cavity with aqueous better-iodine . The former areas were covered by sterilized adhesive plastic sheets then draped. Under endoscope, the nasal mucosa was coagulated at right norstril. A nasal speculum was applied to displace the nasal mucosa laterally and keep thenasal cavity open constantly for the exposure of the vomer bone and the anterior wall of the sphenoid sinus. The anterior sphenoid wall and posterior sphenoid wall was remove by osteotome and Kerrison punch. Microscope was applied due to unable to manipulate under endoscope. The dura was coagulated then opened in cruciate fashion. The soft tumor parenchyma was removed by curette and aligator. The CSF leakage was sealed with Tissuecol Duo nad gelform packing. The arachnoid and the opening of diaphragm sellae was enforced by packing with gelform as in the sellar cavity. The nasal mucosa returned to its normal position. Both sides of the nasal cavities was tightly packed with a segment of rubber glove finger which had been soaked with better-iodine ointment. Operators VS 曾漢民 Assistants R6 李建勳 R1 陳建銘 相關圖片 朱國民 (M,1929/09/16,82y5m) 手術日期 2010/03/31 手術主治醫師 黃昭淵 手術區域 東址 015房 4號 診斷 Malignant neoplasm of trigone of urinary bladder 器械術式 Double-J ureteral insert/WOR 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 面罩麻醉 麻醉主治醫師 葉惠敏 ASA 3 紀錄醫師 洪順發, 時間資訊 12:40 報到 12:40 進入手術室 12:50 麻醉開始 12:55 誘導結束 13:00 抗生素給藥 13:10 手術開始 13:45 手術結束 13:45 麻醉結束 13:50 送出病患 13:55 進入恢復室 15:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 膀胱腫瘤之切除－內視鏡下 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Semi-opened mask inhalation anes 1 0 摘要__ 手術科部: 泌尿部 套用罐頭: TUR-BT 開立醫師: 洪順發 開立時間: 2010/03/31 14:03 Pre-operative Diagnosis Bladder tumor Post-operative Diagnosis Bladder tumor Operative Method TURBT(Transurethral resection of bladder tumor) Specimen Count And Types 1 piece About size:1x1mmx3 Source:bladder tumor Pathology pending Operative Findings 1. tumors at left lateral wall. Operative Procedures 1. Under satisfactory anesthesia with the patient in the lithotomy position, prepping and draping were performed in the usual sterile method. 2. A Fr 22 Olympus Resectoscope was inserted into the urethra and bladder, and the whole bladder was inspected carefully. This revealed presence of sessile tumors located at Lt lateral wall. Trigone and bilateral orifices were identified and inspected carefully. 3. The tumors were resected with resectoscope, piece by piece. 4. The resected tissues were removed with Ellik evacuator. 5. Adequate hemostasis was then obtained. 6. A 22Fr. 3-way Foley catheter was inserted and continuous bladder irrigation with normal saline started.7. The balloon was inflated to 10 cc. 8. The patient was then sent to the recovery room in a stable condition. Operators 黃昭淵, Assistants 洪順發, 王葭家 (F,2009/06/19,2y8m) 手術日期 2010/03/31 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Epidermoid cyst 器械術式 Scalp tumor Suture 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 2 紀錄醫師 鍾文桂, 時間資訊 07:48 報到 08:20 進入手術室 08:28 麻醉開始 08:35 誘導結束 08:40 抗生素給藥 09:01 手術開始 09:37 手術結束 09:37 麻醉結束 09:50 進入恢復室 09:50 送出病患 11:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 骨瘤切除術１–２公分 1 0 R 摘要__ 手術科部: 外科部 套用罐頭: Total excision of intraosseous epidermoid cyst. 開立醫師: 鍾文桂 開立時間: 2010/03/31 10:03 Pre-operative Diagnosis Right frontal intraosseous tumor. Right frontal dermoid or epidermoid cyst. Post-operative Diagnosis Right frontal intraosseous epidermoid cyst. Right frontal intraosseous dermoid or epidermoid cyst. Operative Method Total excision of intraosseous epidermoid cyst. Specimen Count And Types 1 piece About size:1X1 CM Source:SKULL TUMOR. 1 piece About size:1X1 CM Source:dermoid or epidermoid cyst in the SKULL Pathology Pending. Operative Findings Eroded outer table of skull bone overlying the cyst. After cyst removal, inner table of the skull bone was exposed. Eroded outer table of skull bone overlying the cyst. The periosteum was intact and covered the epidermoid cyst. After cyst removal, inner table of the skull bone was exposed which was intact. Epidermoid cyst: intact whitish cyst capsule;white- yellowish content. Epidermoid cyst: intact whitish cyst capsule; white-yellowish content. Operative Procedures Anesthesia: endotracheal, general. Position: supine, head slightly tilted to left. Incision: linear 1.5 cm over the cyst. Dissection over the mass lesion. Seperation of the cyst from the eroded skull bone. Seperation of the cyst from the eroded skull bone to get a total excision. Total excision of the skull bone. Trimming the bone edges with 2mm Kerrison punch. Wound closure in layers. Send the patient to POR smoothly. Operators A.P. 郭夢菲. Assistants R4 鍾文桂. 賴溦欣 (F,2006/05/06,5y10m) 手術日期 2010/03/31 手術主治醫師 郭夢菲 手術區域 兒醫 067房 02號 診斷 Epilepsy 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 鍾文桂, 時間資訊 09:44 報到 10:05 進入手術室 10:10 麻醉開始 10:25 誘導結束 10:40 抗生素給藥 10:57 手術開始 13:10 麻醉結束 13:10 手術結束 13:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 手術 神經分離術–肩，臀關節以上，包括臂神經叢，坐骨神經 1 2 L 手術 腦室腹腔分流手術 1 1 L 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 記錄__ 手術科部: 外科部 套用罐頭: 1. Neurolysis of left vagus nerve. 開立醫師: 鍾文桂 開立時間: 2010/03/31 14:06 Pre-operative Diagnosis Intractable epilepsy Refractory epilepsy Post-operative Diagnosis Refractory epilepsy Operative Method 1. Neurolysis of left vagus nerve. 2. Implantation of vagus nerve stimulator. 2. Implantation of vagus nerve stimulator (Cyberonic Model 103). Specimen Count And Types nil Pathology Nil. Operative Findings Isolation of left vagus nerve from carotid sheath. Generator was placed in left upper chest wall. Generator was placed in left upper anterior chest wall. Impantation devices for vagus nerve stimulation therapy: Implantation devices for vagus nerve stimulation therapy: - Cyberonics Model 302 Lead, single pin, 2.0mm inner diameter. - Cyberonics Demipulse Model 103 Generator. Operative Procedures 1. Anesthesia: endotracheal, general. 2. Position: supine, head placed in midline with neck in extension position. 2. Position: supine, head placed in midline with neck in mild extension position. 3. Preparation: disinfection, draping, outlining of opereative incisions. 4. Incisions: transverse linear 3-cm incision at left neck and chest. 5. Dissection through anterior margin of sternocledomastoid muscle after 5. Dissection through anterior margin of sternocledomastoid muscle after incising platysma muscle. incising platysma muscle. 6. Isolation of vagus nerve after exposing carotid sheath. 6. Isolation of left vagus nerve after exposing carotid sheath. 7. Create subcutaneous pocket over left upper chest wall. 7. Create subcutaneous pocket over left upper chest wall. 8. Create subcutaneous tunnel by tunneler. 9. Application of three spiral electrodes over left vagus nerve. 10.Connect the lead with generator. 11.Check functioning of the generator with Model 201 Programming Wand and Model 250 Programming Software. 12.Implantation of generator and lead over subcutaneous spaces in two wounds. 12.Implantation of generator and lead over subcutaneous spaces in two wounds after three anchoring suture were made at the neck site. 13.Wound closure in layers. Operators A.P. 郭夢菲. Assistants R4 鍾文桂. 劉吳欗 (F,1939/09/30,72y5m) 手術日期 2010/03/31 手術主治醫師 賴達明 手術區域 東址 002房 02號 診斷 Thoracic myelopathy 器械術式 Syringomyelia - Shunting 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2E 紀錄醫師 胡朝凱, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 09:46 通知急診手術 11:45 報到 12:10 進入手術室 12:15 麻醉開始 12:20 誘導結束 12:55 抗生素給藥 13:12 手術開始 15:00 手術結束 15:00 麻醉結束 15:10 送出病患 15:15 進入恢復室 17:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 腰椎腦脊髓液池體外引流 1 1 摘要__ 手術科部: 外科部 套用罐頭: Re-position of shunt catheter 開立醫師: 胡朝凱 開立時間: 2010/03/31 15:11 Pre-operative Diagnosis sYRINGOMYELO-PLEURAL SHUNT COMPRESSION Post-operative Diagnosis sYRINGOMYELO-PLEURAL SHUNT COMPRESSION Operative Method Re-position of shunt catheter Specimen Count And Types Nil Pathology nil Operative Findings 1.The shunt cathter come out from the midline of dural that push the spinal cord to the left side. 2.The tube was re-position to right side Operative Procedures 1.ETGA, prone position 2.Wound incision via previous wound 3. 3.Dissect to exposethe shunt catheter 4.transverse cut open dura 5.place the catheter to the right side 6.Reunion dura with prolene 7.Hemostasis then close wound in layers Operators 賴達明 Assistants 蕭輔仁,胡朝凱,Ri Indication Of Emergent Operation 鄭重輝 (M,1944/10/05,67y5m) 手術日期 2010/03/31 手術主治醫師 賴達明 手術區域 東址 005房 01號 診斷 Spinal injury & complication 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 陳建銘, 時間資訊 07:50 報到 08:05 進入手術室 08:20 麻醉開始 08:35 誘導結束 09:05 抗生素給藥 09:50 手術開始 12:45 手術結束 13:00 送出病患 13:00 麻醉結束 醫令資訊 類別 名稱 量 刀 側 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 手術 脊椎融合術－前融合，無固定物（＜＝四節） 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Removal of cervical cage and anterior fusion ... 開立醫師: 李建勳 開立時間: 2010/03/31 13:17 Pre-operative Diagnosis Ankylosing spondylitis with cervical fracture with implanted cage dislodge Post-operative Diagnosis Ankylosing spondylitis with cervical fracture with implanted cage dislodge Operative Method Removal of cervical cage and anterior fusion with autologous bone graft Specimen Count And Types nil Pathology Nil Operative Findings The previous implated cage and plate were dialodge. Some granulation tissue formation around the implants. The aligment was smooth during intraoperative portable C-arm X-ray check-up. Autologous bone graft for 3.5cm were harvested from right anteriosuperior iliac crest. Operative Procedures Under general aneshesia and intubation, the patient was put in supine position with halovest in position. The skin over anterior neck and right iliac crest were scrubbed, disinfected with alcohol better-iodine then draped. The right neck incision was made along previous op scar and adhesionolysis to expose the implants. Removed the implants and the granulation tissue. Checked the aligment of the cervical spine with intraoperative C-arm X-ray. Autologous bone graft for 3.5cm were harvested from right anteriosuperior iliac crest and packing into the previous corpectomy site. Set up two CWV drain and closed the wounds in layers. Operators VS 賴達明 Assistants R6 李建勳 R1 陳建銘 相關圖片 李宗德 (M,1953/08/24,58y6m) 手術日期 2010/03/31 手術主治醫師 蒲永孝 手術區域 西址 039房 14號 診斷 Kidney transplant 器械術式 Removal of double-J 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 林威佑, 時間資訊 16:38 進入手術室 16:42 麻醉開始 16:45 手術開始 17:00 手術結束 17:00 麻醉結束 17:08 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 膀胱鏡檢查 1 0 姜陳素梅 (F,1955/07/17,56y7m) 手術日期 2010/03/31 手術主治醫師 王國川 手術區域 東址 005房 02號 診斷 Subarachnoid hemorrhage 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳建銘, 時間資訊 13:30 進入手術室 13:40 麻醉開始 13:50 誘導結束 13:50 抗生素給藥 14:05 手術開始 14:45 手術結束 14:45 麻醉結束 15:00 送出病患 15:00 進入恢復室 16:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室腹腔分流手術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Right Kocher point ventriculoperitoneal (VP) ... 開立醫師: 李建勳 開立時間: 2010/03/31 15:01 Pre-operative Diagnosis Aneurysm rupture with subarachnoid hemorrhage and hydrocephalus Post-operative Diagnosis Aneurysm rupture with subarachnoid hemorrhage and hydrocephalus Operative Method Right Kocher point ventriculoperitoneal (VP) shunt insertion Specimen Count And Types 3 pieces About size:1mL Source:CSF About size:1mL Source:CSF About size:1mL Source:CSF Pathology nil Operative Findings CSF opening pressure: 10cmH2O with clear CSF drained out. Codman programmable shunt, set 100mmH2O. The ventricular catheter: 7cm; peritoneal shunt: 25cm. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position with head turned to left. The scalp and abdomen were scrubbed, disinfected with better-iodine then draped. Transverse scalp incision was made at right frontal Kocher point followed by creation of burr hole. The dura was opened afte tenting. The ventrile was punchered with puncher needle. Minilaparotomy at right abdomen in to peritonum. Passed the shunt through subcutaneous tunnel from abdomen, anterior chest wall, neck to retroauricular area. Inserted the ventricular catheter and connected to the programmable valve and peritoneal shunt. Tested the shunt function and closed the wound in layers. Operators VS 王國川 Assistants R6 李建勳 R1 陳建銘 相關圖片 張紘彬 (M,2010/02/07,2y1m) 手術日期 2010/04/01 手術主治醫師 郭夢菲 手術區域 兒醫 066房 01號 診斷 Bacterial meningitis 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 3E 紀錄醫師 陳德福, 時間資訊 02:00 臨時手術NPO 02:00 開始NPO 13:00 進入手術室 13:10 麻醉開始 13:25 誘導結束 14:15 手術開始 14:50 手術結束 14:50 麻醉結束 15:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 記錄__ 手術科部: 套用罐頭: burr hole drainage of the left subdural fluid 開立醫師: 陳德福 開立時間: 2010/04/01 15:00 Pre-operative Diagnosis bilateral subdural fluid collection with masss effect, left predominent Post-operative Diagnosis ditto Operative Method burr hole drainage of the left subdural fluid Specimen Count And Types 1 piece About size:10ML Source:Left subdural fluid Pathology pending Operative Findings 1.The outter membrane: + 1.outer membrane formation: + 2.There is 51ml clear yellowish fluid gushed out spontaneously after opening the outter membrane. 2.There is 51ml clear yellowish fluid gushed out spontaneously after opening the outer membrane. 3.The brain expanded partially after drainage and one subdural drainage was left in situ. Operative Procedures 1.under ETGA and supine positon 2.skin disinfection andn draping 3.linear incision and burr hole creation 3.linear incision and burr hole creation over left temporoparietal region 4.dura tenting and dura opening 5.drainage of the subdural fluid 6.left one subdural draiange in situ 7.drain out the air inside the cranium 8.close the wound in layers Operators VS 郭夢菲 Assistants R4 陳德福 Indication Of Emergent Operation 相關圖片 杜俊男 (M,1964/09/24,47y5m) 手術日期 2010/04/01 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 CVA 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3 紀錄醫師 陳柏達, 時間資訊 11:00 報到 11:51 進入手術室 12:00 麻醉開始 12:10 誘導結束 12:17 抗生素給藥 12:33 手術開始 13:20 手術結束 13:20 麻醉結束 13:45 進入恢復室 13:45 送出病患 14:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 胡朝凱 開立時間: 2010/04/01 13:36 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method V-P Shunt Specimen Count And Types NIl Pathology nil Operative Findings 1.Clear CSF 2.Opening pressure was about 10 cmH2O 3.Medtronic programmable shunt was used 4.Intraventricular catheter: 6.5 cm Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: supine with head rotated left. 3.Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 5 cm curvilinear, right Kocher 5.After the scalp flap had been lifted and reflected anteriorly, a burr hole was made and the dura was tented by 2 stitches. 6.RUQ minilaparotomy 7.Pass subcutaneous tunnel and catheter 8.The dura was opened by a nib incision. Rt lateral ventricle was tapped by a ventricular needle, then a 6.5 cm segment of the ventricular catheter was introduced into the ventricle. The outer end of the catheter was connected to a Medtronic programmable reservoir. 9. The reservoir was fixed to pericranium by 3 stitches. 10. Scalp closure: hemostasis was done with monopolar coagulator touching on the sucker tip. Galea suture was performed by continuous suture with 3/0. Dexon and skin by continuous suture with 3/0 nylon. 11.Course of the surgery: smooth. Operators 王國川 Assistants 胡朝凱, 陳柏達 李宗德 (M,1953/08/24,58y6m) 手術日期 2010/04/01 手術主治醫師 蒲永孝 手術區域 東址 001房 01號 診斷 Kidney transplant 器械術式 Removal of double-J 手術類別 緊急手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 靜脈麻醉 麻醉主治醫師 劉治民 ASA 3 紀錄醫師 林威佑, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 07:53 通知急診手術 08:40 報到 08:50 進入手術室 08:55 麻醉開始 09:00 誘導結束 09:00 抗生素給藥 09:11 手術開始 09:25 手術結束 09:25 麻醉結束 09:32 送出病患 09:35 進入恢復室 10:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 經膀胱鏡逆行尿管導管 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 摘要__ 手術科部: 泌尿部 套用罐頭: DBJ stent removal 開立醫師: 賴建榮 開立時間: 2010/04/01 09:46 Pre-operative Diagnosis s/p renal transplantation Post-operative Diagnosis s/p renal transplantation Operative Method cystoscopy, URS, and removal of DBJ Specimen Count And Types nil Pathology nil Operative Findings 1. DBJ of graft kidney was removed smoothly via 11Fr. URS 2. DBJ encrustration 3. High bladder neck Operative Procedures Under satisfactory anesthesia with the patient in lithotomy position, prepping and drapping was performed in the usual sterile fashion. A Fr 21 Olympus cystoscope was introduced into the bladder cavity under direct vision. Careful inspection was done and DBJ of graft kidney was tried to remove but it failed. An 11 Fr. URS was introduced into bladder and the DBJ was removed smoothly. A 16 Fr. Foley catehter was inserted. Patient tolerated the procedure very well and was sent to recovery room in satisfactory condition. Operators 蒲永孝, Assistants 林威佑, 姜秉均, Indication Of Emergent Operation 彭永豐 (M,1946/05/10,65y10m) 手術日期 2010/04/01 手術主治醫師 陳敞牧 手術區域 東址 005房 01號 診斷 Spine tumor 器械術式 Benign intraspinal tumor, exci 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 李振豪, 時間資訊 07:30 報到 08:07 進入手術室 08:15 麻醉開始 08:50 誘導結束 09:30 抗生素給藥 09:51 手術開始 12:21 抗生素給藥 14:10 麻醉結束 14:10 手術結束 14:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 良性病髓腫瘤切除術 1 1 手術 椎弓切除術（特壓）－二節以內 1 2 摘要__ 手術科部: 外科部 套用罐頭: C1 and partial C2 laminectomy for intradural ... 開立醫師: 李振豪 開立時間: 2010/04/01 14:49 Pre-operative Diagnosis C1 intraspinal tumor, suspect neuroma Post-operative Diagnosis C1 intraspinal tumor, suspect neuroma Operative Method C1 and partial C2 laminectomy for intradural tumor excision Specimen Count And Types multiple small pieces of intraspinal tumor Pathology Pending Operative Findings The tumor is well encapsulated, moderate vascularized, yellowish, elastic in character with right C1 neural foramen extension. Distended spinal accessory nerve was noted at the capsule of the tumor. The spinal accessory nerve is sacrificed during the manipulation. The cord is pushed to left side with compression by the tumor. No obvious SSEP change noted after whole procedure. Operative Procedures Under endotracheal tube general anesthesia, the patient was put at prone position with head fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. Midline skin incision was made from inion to C3 level. The subcutaneous soft tissue was dissected and the paravertebral muscle groups were detached. C1 and partial C2 laminectomy was done and the thecal sac was exposed. The foramen magnum was opened also for exposure of upper part of the tumor. Linear incision was made for dural opening. The tumor was identified and the tumor was removed with bipolar cautery and tumor forceps. Right spinal accessory nerve was sacrificed during manipulation. Hemostasis was achieved after tumor removal. The drua was closed with water tight suture. One epidural CWV drain was set and the wound was closed in layers. Operators VS陳敞牧 Assistants R6陳盈志, R3李振豪 賴文英 (F,1976/10/29,35y4m) 手術日期 2010/04/01 手術主治醫師 王國川 手術區域 東址 019房 03號 診斷 Subacute sclerosing panencephalitis 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 4E 紀錄醫師 陳盈志, 時間資訊 21:37 開始NPO 21:37 臨時手術NPO 21:37 通知急診手術 22:17 進入手術室 22:30 麻醉開始 22:40 誘導結束 22:45 開始輸血 22:45 手術開始 23:26 手術結束 23:26 麻醉結束 23:35 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 顱內壓監視置入 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Left kocher EVD insertion as ICP monitor 開立醫師: 陳盈志 開立時間: 2010/04/01 23:49 Pre-operative Diagnosis IVH with acute hydrocephalus Post-operative Diagnosis IVH with acute hydrocephalus Operative Method Left kocher EVD insertion as ICP monitor Specimen Count And Types nil Pathology nil Operative Findings The opening pressure was very high (>30cmH2O). CSF was pinkish. ventricular catheter set 6cm in depth Operative Procedures Under general anesthesia and intubation, the patient was put in supine position. The scalp was shaved, scrubbed, disinfected with alcohol B-I then draepd. Linear scalp incision was made at left frontal area followed by burr hole creation. The dura was opened in cruciated fashion after tenting with 3-0 silk. The ventricle catheter of EVD was inserted after ventricular puncture. The EVD was fixed and the wound was closed in layers Operators VS王國川 Assistants R6陳盈志 Indication Of Emergent Operation 朱邦豪 (M,1984/08/31,27y6m) 手術日期 2010/04/01 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Subdural hemorrhage (SDH) 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 陳柏達, 時間資訊 07:45 報到 08:05 進入手術室 08:10 麻醉開始 08:20 誘導結束 09:10 抗生素給藥 09:25 手術開始 11:30 手術結束 11:30 麻醉結束 11:35 送出病患 11:40 進入恢復室 14:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 頭顱成形術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 摘要__ 手術科部: 外科部 套用罐頭: Cranioplasty 開立醫師: 胡朝凱 開立時間: 2010/04/01 11:04 Pre-operative Diagnosis Right skull defect Right skull defect Post-operative Diagnosis Right skull defect Operative Method Cranioplasty Specimen Count And Types nil Pathology nil Operative Findings right skull defect abut 20x25 cm Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left 3. Skin preparation:shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with a sterilized adhesive plastic sheet. 4. Incision: along the previous operation scar. Raney clips were apllied to the scalp edge for temporary hemostasis. 5. The scalp and temporalis muscle were dissected away from the underlying dura. 5. The scalp was easily reflected from the underlying silastic sheet which was then removed. The dural surface and margin of skull defect were well exposed. 6. The bleeders on the dissected surfaces were coagulated with Bovie painstakingly. 7. The edge of the skull defect was exposed. 6. The original skull plate preserved was placed back to the skull window then fixed by miniplate and a dura tenting at the center of the skull plate. Then use bone cement to perform further plasty. 8. Scalp closure: hemostasis was done with monopolar coagulator touching on the sucker tip. Galea suture was performed by continuous suture with 3/0 Dexon and skin by continuous suture with 3/0 nylon. 14.Drain: three, epidural, collected in a surgeons glove. Operators 王國川 Assistants 胡朝凱,陳柏達 陳鄭美仔 (F,1942/05/22,69y9m) 手術日期 2010/04/02 手術主治醫師 杜永光 手術區域 東址 003房 02號 診斷 Aneurysm 器械術式 Craniotomy(Aneurysms) P-DUH 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 林哲光, 時間資訊 07:40 報到 08:07 進入手術室 08:15 麻醉開始 09:15 誘導結束 09:25 抗生素給藥 09:45 手術開始 12:25 抗生素給藥 13:50 開始輸血 15:25 抗生素給藥 17:00 麻醉結束 17:00 手術結束 17:10 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 10 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 開顱術摘除血管病變－腦血管瘤－無徵的 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Aneurysm-frontotemporal approach 開立醫師: 林哲光 開立時間: 2010/04/02 15:19 Pre-operative Diagnosis Left Pcom large aneurysm, unruptured Left posterior communicating artery (P-com) large aneurysm, unruptured Post-operative Diagnosis Ditto Left P-com large aneurysm, unruptured Operative Method Left pterional approach Pcom large aneurysm clipping Left Dolenc approach for aneurysm clipping Specimen Count And Types nil Pathology Pending Operative Findings Thin layer of frontotemporal skull bone plate was noted and severe osteoporosis was impressed. Left anterior clinoidal process was removed via Dolenc approach. Intraoperative increased tension of dura was noted after craniotomy and dural tenting. The frontal sinus was opened during craniotomy and sealed with bone wax and sutured with pericranium fascia flap. Intraoperative increased tension of dura was noted after craniotomy and dural tenting. Right frontal sinus exposure was noted after craniectomy and mucosa removal and B-I gelfoam packing were done. The sinus was then sealed with bone wax and covered with fascia. Subdural hematoma was noted after dural opening mainly over the left frontal area. Severe artherosclerotic change of ICA was noted. Aneurysmal sac tearing was noted when clip applying. EP of right limbs diminshed after template clipping for ICA proximal control but no recovery of motor and sensory of right lower limb. Evoked potential of right limbs diminshed after template clipping for ICA proximal control and no recovery of motor and sensory of right lower limb. Total four clips were applied to the neck of the aneurysm and another clip was applied to the tearing site of the aneurysmal sac. Total four fenestrated clips were applied to the neck of the aneurysm and another curved clip was applied to the tearing site of the aneurysmal sac. Operative Procedures Under general anesthesia with supine position with left back elevated and head rotated to right side, the head was fixed by Mayfield skull clump. Skin disinfected and drapped were then performed as usual. A curvilinear skin incision over left frontotemporal area was then done. The Under general anesthesia with supine position with left back elevated and head rotated to right side, the head was fixed by Mayfield skull clump. Skin disinfected and drapped were then performed as usual. A curvilinear skin incision over left frontotemporal area was then done. The temporalis muscle was then deflected to the base of zygomatic arch. The F-T craniectomy was then performed after 3 burr holes created with air drill. The lower temporal bone and pterionic ridge were cut by rongeur as low as possible. Left anterior clinoidal process was then removed via Dolenc approach. The dura was then opened after dural tenting. Under general anesthesia with supine position with left back elevated and head rotated to right side, the head was fixed by Mayfield skull clump. Skin disinfected and drapped were then performed as usual. A curvilinear skin incision over left frontotemporal area was then done. The temporalis muscle was then deflected to the base of zygomatic arch. The F-T craniotomy was then performed after 3 burr holes created with air drill. The lower temporal bone and sphenoid ridge were removed by rongeur as low as possible. Left anterior clinoidal process was then removed via Dolenc approach. The dura was then opened after dural tenting. Proximal side of left sylvian fissure was then opened and the left optic nerve was then identified. The anterior loop of ICA and the aneurysm were then identified. The template clip was applied to the distal end of left ICA. Proximal side of left sylvian fissure was then opened and the left optic nerve was then identified. The anterior loop of ICA and the aneurysm were then identified. The template clip was applied to the distal part of anterior loop of left ICA. Fenestrated clip was applied to the aneurysmal neck with anterior choroidal artery left untouch. Residual aneurysmal neck was noted and another 2 fenestrated clip were applied. However, tearing of aneurysmal sac was noted when the 4th clip applying. The tear was then approximated with a curve clip. The anterior choroidal artery, MCA, ACA were checked and good patency were confirmed after template clip removal. The dura was then closed after Tissucol-Duo applying around the clips. Proximal side of left sylvian fissure was then opened and the left optic nerve was then identified. The anterior loop of ICA and the aneurysm were then identified. The template clip was applied to the distal part of anterior loop of left ICA. Fenestrated clip was applied to the aneurysmal neck with anterior choroidal artery left untouch. Residual aneurysmal neck was noted and another 2 fenestrated clip were applied. However, tearing of aneurysmal sac was noted when the 4th clip applying. The tear was then approximated with a curve clip. The anterior choroidal artery, MCA, ACA were checked and good patency were confirmed after template clip removal. The dura was then closed in water-tie method after Tissucol-Duo applying around the clips. The central tenting of the dura was done. The skull bone was then put back and fixed with miniplates and screws. The wound was then closed in layers after epidural CWV drain inserted. 5. Craniotomy window: 5x6 cm, frontotemporal, created by making 4 burr holes then cut by power saw. The lower temporalbone and pterionic ridge (esp. the inner table) were cut by rongeur as low as possible for easy approach to the anterior clinoid. 6. Dural tention: by 2/0 silk, ---cm in interval, distributed along the edge of skull window. 7. Dural incision: V shape, over-ridding Sylvian fissure and reflected to frontotemporal base. 8. Ventricular tapping and drainage of CSF was made to slacken down the brain for easy approach to anterior clinoid without undue traction on the brain. 8. A 0.7 cmcortical incision was made with a Scarff bipolar forceps at the anterior location of the rt superior temporal gyrus, then the intracerebral hematoma was sucked out until the brain was slack enough for a easy approach to the insula where the aneurysm located. 9. Under operating microscope, the Sylvian fissure was opened, then the frontal and temporal opercula were retracted by self-retaining retractor inan opposite direction to expose the M-2 segment of rt MCA. When the dissectiomwas carried out more proximally, the aneurysm soon came into view. From that moment on, the patinet''s blood pressure was brought down to 80 mHg by Nitroprussid. The neck of the aneurysm was mobilized gently bya Gage 18 sucker and a fine tipbipolar forceps until itwas entirely free. 9. The Sylvian vein was coagulated and divided from sphenoparietal sinus, then the temporal tip and the adjacent frontal lobe base were retracted by 2 self retaining retractors. 10.Under operating microscope, the suprasellar cistern was opened, meanwhile, the patinet''s blood pressure was brought down to-- mHg by-- . The right optic nerve and ICA came into view. The arachnoid trabeculi and the fibrin (or blood clot) were cleaned out to expose the neck of the aneurysm which located just beneath the edge of tentorial hiatus. The neck of the aneurysm was mobilized gently by a Gage 18 sucker and a fine tip bipolar forceps until it was entirely free. l1.A-- Sugita clip was applied to the neck of the aneurysm. 12.After successful clipping of the aneurysm, the patient''s BP was brought back to normal, and the exposed field was irrigated with N.S. to make sure no any bleeding. 13.The brain retractors were removed. Thedura was closed water-tight by 2 2/0 silk for key stitches followed by running suture with 4/0 Dexon. 14.Closure of skull window: the skull plate was placed back to craniotomy window and fixed by 3 Gage 24 wires. The dura was tented to the centerof the skull plate by a 2/0 stitch. The covering muscle was closed by interrupted stitches with 1/ 0 silk. 15.Scalp closure: hemostasis was done with monopolar coagulator touching on the sucker tip. Galea suture was performed by continuous suture with 3/0 Dexon and skin by continuous suture with 3/0 nylon. 16.Drain: one, epidural, collected in a surgeon''s glove. 17.Blood transfusion: 18.Course of the surgery: smooth. Operators 杜永光, P 杜永光 Assistants 林哲光, 李建勳, R3 林哲光, R6 李建勳 相關圖片 陳志傑 (M,1957/04/28,54y10m) 手術日期 2010/04/02 手術主治醫師 杜永光 手術區域 東址 002房 03號 診斷 Compressive optic neuropathy (cranial nerve II) 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 15:55 報到 16:20 進入手術室 16:25 麻醉開始 16:40 誘導結束 17:20 抗生素給藥 17:35 手術開始 19:05 麻醉結束 19:05 手術結束 19:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經由蝶竇之腦下垂體瘤切除 1 1 手術 鼻中膈造形術 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Hypophysectomy---Transphenoid 開立醫師: 林哲光 開立時間: 2010/04/02 19:05 Pre-operative Diagnosis Pituitary macoradenoma Post-operative Diagnosis Ditto Pituitary macoradenoma Operative Method Endonasal transsphenoidal hypophysectomy Endonasal transsphenoidal adenomectomy Specimen Count And Types 1 piece About size:2 x2 cm Source:pituitary macroadenoma Pathology Pending Operative Findings Nasal septum deviation was noted. Around 2cm sized soft-elasitc, well-demarcated mass lesion was noted over the pituitary gland with upward invasion and compressing to optic chiasm. Left cavernous sinus bleeding was noted during the operation and gelfoam packing was done. Nasal septum deviation was noted. Around 2cm sized yellowish, soft-elasitc, well-demarcated mass lesion was noted over the pituitary gland. Left cavernous sinus bleeding was noted during the operation and stopped by gelfoam packing. No cerebrospinal fluid leakage was noted. Operative Procedures Under general anesthesia with supine position with head mild extension 4. The nasal submucosa at septum and floor and the subperiostium at upper ,the nasal submucosa at septum and floor was infiltrated with 1:100 epinephrine solution. alveola were infiltrated with 1:100 epinephrine solution. 5. Incision: at labial mucosa, 3 mm away from its gingival junction and The nasal mucosa incision was made after local anesthesia injection at right submucosal layer. A nasal speculum was applied to displace the nasal mucosa laterally and keep the nasal cavity open constantly for the exposure of the vomer bone and the anterior wall of the sphenoid sinus. Before the sinus was opened, the position of the nasal speculum was adjusted under the radioimage intensifier to a direction which directly pointed to the sellar floor. Dissection was made under surgical microscope assistance to remove the anterior sphenoid wall and vomer by osteotome. The mucosa was removed by clumps. The posterior sphenoid wall was penestrated by osteotome and Kerrison punch. The sellar floor dura was coagulated with bipolar forceps, then opened in cruciate fashion. The soft tumor parenchyma was removed by ring curette and suction. The venous oozing from the left cavernous sinus was stopped by gelfoam packing. The arachnoid and the opening of diaphragm sellae was enforced by packing with gelform as in the sellar cavity. The sellar floor was reconstructed by supporting a piece of vomer bone between the dura and the margin of the sellar floor. The nasal speculum was removed and the nasal mucosa returned to its normal position. Each side of the nasal cavities was tightly packed with a segment of rubber glove finger filled with vaseline gauze strips which had been soaked with better-iodine ointment. nasal cavities was tightly packed with a Merocel which had been soaked with better-iodine ointment. corresponding to 4 upper incisors. 6. The inferior margin of the nasal septum and floor was exposed after the upper lip had been dissected subperiosteallly and lifted. 7. The mucosa of nasal septum and floor was dissected away from the septal cartilage and the bony floor on both sides from anterior to posterior and displaced laterally by a long nasal speculum. 8. The septal cartilage was cut at its basal juction by sepatal scissors and then displaced to one side. 9. A Hardys nasal speculum was applied to displace the nasal mucosa laterally and keep the nasal cavity open constantly for the exposure of the vomer bone and the anterior wall of the sphenoid sinus. Before the sinus was opened, the position of the nasal speculum was adjusted under the radioimage intensifier to a direction which directly pointed to the sellar floor. 10.The exposed sinus mucosa was coagulated and resected. 11.Under the guide of radioimage intensifier, the sellar floor was penetrated by a osteotome, then widened by Kerrison punch. 12.The sellar floor dura was coagulated with bipolar forceps, then opened in cruciate fashion. 13.The soft tumor parenchyma was removed by curette and suction, then the capsule was mobilized away from the dura and normal pituitary gland and removed. The final piece of the tumor at suprasellar area sank into the sella spontaneously after the intrasellar tumor had been removed. This last piece of the tumor was carefully separated from the arachnoid by curette and fine sucker. The venous oozing from the dura was stopped by gelfoam packing. 14.The arachnoid and the opening of diaphragm sellae was enforced by a pieceof muscle fascia. The sellar cavity was packed with muscle strips removed from right rectus femoris. The sellar floor was reconstructed by supporting a piece of vomer bone between the dura and the margin of the sellar floor. The sphenoidsinus was packed with fat tissue. 15.The Hardys nasal speculum was removed and the nasal mucosa returned to its normal position. Each side of the nasal cavities was tightly packed with a segment of IV tube surrounded by 3 gauze strips which had been soacked with Better-iodine ointment. 16.The labial wound was closed by interrupted stitches with 4/0 Dexon. 17.Blood transfusion: 18.Course of the operation:smooth. Operators 杜永光, P 杜永光 Assistants 林哲光, 李建勳, R3 林哲光 R6 李建勳 相關圖片 林麗玉 (F,1965/05/17,46y9m) 手術日期 2010/04/02 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Lumbar Spondylosis 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 古恬音, 時間資訊 00:00 臨時手術NPO 08:06 進入手術室 08:10 麻醉開始 08:20 誘導結束 08:30 抗生素給藥 08:53 手術開始 10:40 手術結束 10:40 麻醉結束 10:45 送出病患 10:47 進入恢復室 12:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術－腰椎 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 外科部 套用罐頭: microscopic discectomy L5/S1 開立醫師: 陳盈志 開立時間: 2010/04/02 10:37 Pre-operative Diagnosis L5/S1 HIVD,left side Post-operative Diagnosis L5/S1 HIVD,left side Operative Method microscopic discectomy L5/S1 Specimen Count And Types nil Pathology nil Operative Findings one large dehydrated buldging disc at L5/S1 left side with root compression Operative Procedures 1.ETGA,prone with C-arm localization 2.Skin preparation 3.Midline back incision with detach of left side paraspinal muscle to expose L5 and S1 lamina 4.Laminotomy L5 with karriso punch to expose S1 root 5.Retract dura with root to identify L5/S1 disc 6.Incise the disc then curretage and romove the disc with eligator 7.Hemostasis with gelform packing 8.local rideron injection 9.close wound in layers Operators VS曾漢民 Assistants R6陳盈志R2古恬音 陳美燕 (F,1944/11/01,67y4m) 手術日期 2010/04/02 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 古恬音, 時間資訊 00:00 臨時手術NPO 11:00 麻醉開始 11:00 進入手術室 11:40 抗生素給藥 11:45 誘導結束 12:05 手術開始 14:40 抗生素給藥 16:05 開始輸血 16:20 手術結束 16:20 麻醉結束 16:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT 開立醫師: 陳盈志 開立時間: 2010/04/02 17:06 Pre-operative Diagnosis Left tentorial meningioma Post-operative Diagnosis Left tentorial meningioma Operative Method Left temporal craniotomy subtemporal approach for subtotal tumor excision Specimen Count And Types 1 piece About size:3x2.5x2cm with multiple pieces Source:left tentorial meningioma Pathology pending Operative Findings The tumor was elastic in character. Tumor has dura base at tentorium. The margin was clear and one small pieces was left due to adhesion to suspect PCA branches.CNIV was identified behind the tumor Operative Procedures Under general anesthesia with endotracheal intubation The patient was set into supine with head rotated to left and head fixed by Mayfield skull clamp. The skin was shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. Scalp incision with U-shape was done and Raney clips were applied to the scalp edge for temporary hemostasis. Craniotomy window 7 x 6 cm, created by making 3 burr holes then cut by power saw. Dural tenting was done by 2/0 silk, 2 cm in interval, distributed along the edge of skull window. Dural incision was linear along the edge of temporal The tumor was cauterized by bipolar forceps along its tenrorial base. Then the tumor was dissected with bipolar and removed piece by piece and then gradually roll the tumor out. The bleeding during the dissection was stopped by bipolar coagulator or by packing with conttonoid patties. The hemostasis during the resection of the tumor was obtained by bipolar coagulator The blood oozing were packed with gelfoam and surgicel for complete hemostasis. Dural closure was done with continuous suture with 4/0 prolene to obtain water-tight closure the skull plate was placed back to craniotomy window and fixed by miniplate. The dura was tented to the center of the skull plate by a 2/0 stitch. The covering muscle was closed by interrupted 1/0 silk stitches. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. One epidural CWV drain was. Operators VS曾漢民 Assistants R6陳盈志R2古恬音 張林鈺錚 (F,1943/11/25,68y3m) 手術日期 2010/04/02 手術主治醫師 王碩盟 手術區域 東址 008房 03號 診斷 Renal tumor 器械術式 Nephrectomy / supine 手術類別 預定手術 手術部位 腹 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 3 紀錄醫師 林威佑, 時間資訊 10:20 報到 10:30 進入手術室 10:40 麻醉開始 11:25 誘導結束 11:30 抗生素給藥 11:41 手術開始 11:50 開始輸血 15:00 抗生素給藥 15:12 麻醉結束 15:12 手術結束 15:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 腹腔鏡腎切除術 1 1 R 摘要__ 手術科部: 泌尿部 套用罐頭: nephrectomy, radical 開立醫師: 賴建榮 開立時間: 2010/04/02 16:04 Pre-operative Diagnosis Right renal tumor, Suspect AML Post-operative Diagnosis Right renal tumor, Suspect AML Operative Method Right laparoscopic radical nephrectomy Specimen Count And Types 1 piece About size:About 12*6 cm Source:Right kidney Pathology Pending Operative Findings 1. A 4*5 cm tumor at right middle pole. 2. Estimated blood loss was 900 ml 3. Rubber drain was placed at right renal fossa Operative Procedures Under satisfactory endotracheal general anesthesia with the patient in left decubitus position, prepping and draping was performed. A 5-12 mm Visiport was inserted at axillary line under direct vision. Retroperitoneal space was created by inflation with 700 ml water to the glove. The second 5-12 mm Versaport for working was placed at posterior axillary line under the optic assistance and another 5 mm at anterior axillary line. Geotas fascia was identified. The lower pole and right renal pedicle were identified. Careful dissection was carried out along the renal vein was identified. The Right adrenal vein was clipped with small Hemo-o-lockand divided. The accessary lumbal veins were also clipped and divided. The renal vein and artery were dissected from the surrounding tissue. The renal artery and renal vein were doubly clipped with Hemo-o-lock and divided. The entire bundle including vessels, and ureter were isolated from the surrounding tissue. The entire kidney with the Gerota intact was totally mobilized. The renal bed was inspected with adequate hemostasis while the pressure of pneumo-retropaeritoneum was decreased to 5 mmHg. Surgicels were pasted on the adrenal and renal pedicle areas. Wound was opened between two 5-12 mm port and the kidney was delivered from the Wound. Rubber drain was inserted into the renal bed through 5mm working port. The wound was closed with continuous 1-O vicryl on the muscle layer and 2-O chromic on the fascia. The skin was closed with interrupted 3-O nylon stitches. The patient tolerated the procedure well and was send to ICU for intensive care. The blood loss was estimated to be 900 C.C. The sponge cout was correct. Operators 王碩盟, Assistants 林威佑, 黃旭澤 林錦華 (F,1954/12/26,57y2m) 手術日期 2010/04/02 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Cervical spondylosis 器械術式 Spinal fusion post (Halifax) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 07:44 報到 08:08 進入手術室 08:15 麻醉開始 08:30 誘導結束 09:50 抗生素給藥 09:56 手術開始 13:00 抗生素給藥 13:50 麻醉結束 13:50 手術結束 14:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術－前融合，有固定物（＜＝四節） 1 1 手術 臉部以外皮膚及皮下腫瘤摘除術　２公分至４公分 1 2 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 摘要__ 手術科部: 外科部 套用罐頭: C1-2 transarticular screw fixation + C1 poste... 開立醫師: 游健生 開立時間: 2010/04/02 14:32 Pre-operative Diagnosis C1-2 sublaxation Post-operative Diagnosis C1-2 sublaxation Operative Method C1-2 transarticular screw fixation + C1 posterior arch removal + posterior fusion with autologous bone grafts Specimen Count And Types nil Pathology Nil Operative Findings 1. Transarticular screws (4.5 x 40mm) were inserted through medial side of C2 lateral mass to C1 anterior arch under C-arm guidance 2. After removal of C1 posterior arch, the thecal sac was well expanded. 3. Autologous bone grafts were harvested from right posterior iliac crest. 4. One bone graft was fixed to C2 lamina with mini-plate on each side. 5. No change of SSEP or MEP during operation. Operative Procedures 1. Under ETGA, patient was put into prone position and head fixed with Mayfield head holder 2. A midline incision was made from the lower part of suboccipital region to C4 level 3. Dissected in layers and identified the spinous process of C2 4. Separated the neck muscle and exposed the foramen magum and C1 posterior arch 5. Inserted transarticular screw under C-arm guidance 6. Removal of C1 posterior arch 7. Harvested autologous bone grafts from outer cortex of posterior iliac crest 8. Fixed one bone graft to C2 lamina with mini-plate on each side 9. Hemostasis, N/S, and Gentamicin solution irrigation 10. Set one epidural CWV drain and closed the wounds in layers Operators VS賴達明 Assistants R5陳睿生, R2游健生 葉清吉 (M,1940/03/04,72y0m) 手術日期 2010/04/02 手術主治醫師 楊士弘 手術區域 東址 019房 02號 診斷 Spine bone metastasis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 13:50 報到 14:50 進入手術室 14:58 麻醉開始 15:20 誘導結束 15:40 抗生素給藥 15:50 手術開始 17:18 開始輸血 18:40 抗生素給藥 20:40 手術結束 20:40 麻醉結束 20:45 送出病患 20:55 進入恢復室 22:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 惡性病髓腫瘤切除術 1 1 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Vertebral body (L3) Paraspinal tumor excision 開立醫師: 楊士弘 開立時間: 2010/04/02 20:48 Pre-operative Diagnosis Paraspinal tumor with extension to vertebral body (L3), suspect metastatic adenocarcinoma of lung (1) Spinal metastasis of left L3 vertebrae with paraspinal extension (2) lung cancer Post-operative Diagnosis Ditto (1) Spinal metastasis of left L3 vertebrae with paraspinal extension s/p tumor excision and internal fixation from L1, L2, to L4 (2) lung cancer Operative Method Vertebral body (L3) Paraspinal tumor excision (1) Vertebral and paravertebral tumor excision (2) Posterior spinal fixation from L1, L2, to L4 by transpedicle screws and rods fixation Specimen Count And Types 1 piece About size:4x7x3 cm Source:Paraspinal muscle tumor with vertebral body involvement Pathology Pending Operative Findings The outer cortical layer of left L4 lamina was intact. The inner cortical layer and cancellous bone was destructed by the tumor. The left L4 pedicle and articular facets was also destructed and infiltrated by the tumor, which also eroded the left L3 vertebral body. The tumor was greyish red, soft fragile, and hypervascular. The thecal sac and left L3 root was free from tension after tumor excision. After removal of the vertebral tumor, the paraspinal tumor was exposed by splitting of the longissmus and multifidus muscles. The tumor was encapsulated and severely adhered to the psoas muslces. The internal content was soft elastic and hypervascular. Some old blood clot was found in the lower part of the tumor. Operative Procedures (1) ETGA, prone. (2) C-arm localization of L3 vertebrae. (3) Low back midline incision from L1 to L4. (4) Dissection of paravertebral muscles off the spinous processes and lamina from L1 to L4. (5) Left L4 hemilaminectomy and facectomy for removal of tumor in the left lamina, articular facets, pedicle, and posterior vertebral body. (6) Hemostasis with gelfoam and bipolar cautery. (7) Left paraspinal fascia incision and muscle splitting for exposure of paraspinal tumor. (8) Intracapsular tumor debulking followed by excision of the tumor capsule. (9) Internal fixation of transpedicle screws and rods (A-spine system): L1, L2 screws: 6.0 mm x 40 mm right L4 screw: 6.0 mm x 45 mm left L4 screw: 6.5 mm x 45 mm rods: 13 cm each on both sides one cross link (10) One CWV drain in left paraspinal wound; two HV drains in the epilaminal space. (11) Wound closure in layers. Operators VS楊士弘 Assistants R5陳睿生, R2游健生 相關圖片 簡振仁 (M,1963/11/09,48y4m) 手術日期 2010/04/03 手術主治醫師 楊士弘 手術區域 東址 003房 01號 診斷 Liver cancer 器械術式 OPLL- Anterior Corpectomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3 紀錄醫師 陳盈志, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:05 進入手術室 08:20 麻醉開始 08:30 誘導結束 09:00 抗生素給藥 09:12 手術開始 12:40 抗生素給藥 14:05 手術結束 14:05 麻醉結束 14:35 送出病患 14:37 進入恢復室 16:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 惡性病髓腫瘤切除術 1 1 手術 脊椎融合術－前融合，有固定物（＜＝四節） 1 2 摘要__ 手術科部: 外科部 套用罐頭: (1)vertebral tumor excision by C6 corpectomy ... 開立醫師: 楊士弘 開立時間: 2010/04/03 14:19 Pre-operative Diagnosis Metastatic spinal tumor, C6, with bilateral C6 roots and spinal cord compression Post-operative Diagnosis Metastatic spinal tumor, C6, with bilateral C6 roots and spinal cord compression Operative Method (1)vertebral tumor excision by C6 corpectomy and C5-6/C6-7 diskectomy (2)methyl methacrylate interbody graft in C6 corpectomy site and anterior locking plate fixation from C5 to C7 Specimen Count And Types 1 piece About size:大 Source:C6 vertebral tumor Pathology Pending Operative Findings The C6 vertebral body was infiltrated by greyish red, soft fragile tumor. The vascularity of tumor was moderate. The thecal sac and bilateral C6 roots was compressed by the tumor and became slack after decompression. Operative Procedures 1. ETGA, supine, neck extended. 2. Right anterior neck incision. 3. Dissection along anterior SCM to reach the prevertebral space. 4. C-arm localization of the C6 vertebral body. 5. Diskectomy of the C5-6 and C6-7 under microscope. 6. Corpectomy and tumor excision of C6 vertebral body by rongeur, currets, kerrison punches, and disk forceps. 7. Hemostasis with gelfoam. 8. Interbody graft by a custom made wiremesh cage filled with methyl methacrylate. 9. Fixation of anterior locking plate (40 mm long, A-spine system by 冠亞) with four screws into the C5 body (3.5 mm x 14 mm, left; 3.5 mm x 16 mm, right) and C7 body (3.5 mm x 16 mm on both sides). 10. One miniHV drain in the wound. 11. Wound closure in layers. Operators 楊士弘 Assistants 陳盈志 相關圖片 陳鄭美仔 (F,1942/05/22,69y9m) 手術日期 2010/04/04 手術主治醫師 杜永光 手術區域 東址 001房 05號 診斷 Aneurysm 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3E 紀錄醫師 曾峰毅, 時間資訊 18:36 通知急診手術 19:10 報到 19:10 進入手術室 19:15 麻醉開始 19:20 誘導結束 19:40 手術開始 20:50 開始輸血 21:00 抗生素給藥 22:10 麻醉結束 22:10 手術結束 22:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱骨切除術，包括異物移除或減壓或神經切斷 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Left decompressive craniectomy 開立醫師: 曾峰毅 開立時間: 2010/04/04 21:35 Pre-operative Diagnosis Post-operative brain swelling with mass effect Post-operative Diagnosis Post-operative brain swelling with mass effect Operative Method Left decompressive craniectomy Specimen Count And Types Removed bone graft will be stored at bone bank. Pathology Nil Operative Findings About 0.5 to 1cm thick epidurla hematoma was noted at left frontal area. Brain pulsation was good. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to right. We removed previous inserted CWV, and shaved, scrubbed, disinfected, and then draped the scalp. We removed the skin stapples of previous operation wound, and dissected and refelxed previous petrional curvilinear-incised scalp flap inferiorly. We removed the mini-plates, and then bone graft. Epidural hematoma was removed. We made one another skin incision perpendicular to previous operation wound, and harvested fascia from left temporalis muscle. temporalis muscle was detached from its insertion and was reflected inferioryly as well. Another burr hole was drilled at left high posterior frontal area. Craniectmoy was done. Duroplasty was performed with autologous fascia. After inserting two epidural CWV, we closed the wound in layers. Operators P 杜永光 Assistants R6 李建勳 R5 胡朝凱 R3 曾峰毅 Indication Of Emergent Operation 張遜鐘 (M,1937/12/21,74y2m) 手術日期 2010/04/04 手術主治醫師 杜永光 手術區域 東址 002房 04號 診斷 Brain metastasis 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3E 紀錄醫師 陳志軒, 時間資訊 00:11 開始NPO 00:11 臨時手術NPO 00:11 通知急診手術 00:45 進入手術室 00:45 報到 00:55 麻醉開始 01:30 誘導結束 01:31 開始輸血 01:32 抗生素給藥 01:58 手術開始 05:15 麻醉結束 05:15 手術結束 05:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４小時以內 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Right frontal-temporal-parietal craniotomy fo... 開立醫師: 陳盈志 開立時間: 2010/04/04 06:15 Pre-operative Diagnosis Right frontal metastasis with tumor bleeding Post-operative Diagnosis Right frontal metastasis with tumor bleeding Operative Method Right frontal-temporal-parietal craniotomy for hematoma evacuation and tumor excision. Specimen Count And Types 1 piece About size:multiple pieces of tumor Source:Right frontal tumor Pathology pending Operative Findings The tumor was soft elastic in character. The margin was not clear. Hematoma about 30mL was noted surrounding the tumor. The brain was slake after the tumor excision. Operative Procedures Under the general anesthesia with endotracheal tube intubation, the patient was set into supine position iwth head tilt to left and shoulder elevated. The operation field was scrubbed and disinfected and then drapped. Right frontal-temporal-parietal scalp trauma flap incision was done. Temporalis muscle was detached and 5 burr hole was made then craniotomy was done. Dura tenting was done with 3-0 silk. C-shape dura incision was done and the tumor with hematoma was identified at frontal area. Corticotomy was done and then hematoma was evacuated. We dissect the tumor along the border created by the hematoma, then the tumor was removed in several pieces by tumor forceps. Hemostasis was done with bipolar and surgicel packing. Dura was closed in 4-0 prolene. The bone was fixed with miniplate. One subgaleal CWV drain was set and the wound was closed in layers. Operators VS陳敞牧 Assistants R6陳盈志R1陳志軒 Indication Of Emergent Operation 張遜鐘 (M,1937/12/21,74y2m) 手術日期 2010/04/06 手術主治醫師 陳敞牧 手術區域 東址 002房 05號 診斷 Brain metastasis 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 4E 紀錄醫師 陳睿生, 時間資訊 16:00 臨時手術NPO 16:00 開始NPO 23:15 報到 23:15 進入手術室 23:20 麻醉開始 23:25 誘導結束 23:53 開始輸血 00:08 手術開始 02:10 麻醉結束 02:10 手術結束 02:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱骨切除術，包括異物移除或減壓或神經切斷 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 摘要__ 手術科部: 外科部 套用罐頭: Craniectomy and duroplasty; ICP monitor insertion 開立醫師: 陳睿生 開立時間: 2010/04/06 02:53 Pre-operative Diagnosis Right frontal metastasis s/p with brain swelling and transfalcine herniation Post-operative Diagnosis Right frontal metastasis s/p with brain swelling and transfalcine herniation Operative Method Craniectomy and duroplasty; ICP monitor insertion Specimen Count And Types nil Pathology Nil Operative Findings After skull graft remove, EDH was noted and removed. After dura opening, the brian was moderate swelling. An intraparychemal ICP monitor was inserted and the initial ICP was about 7-8 mmHg. Fascia was used as duroplasty graft. Reference: 496 Operative Procedures 1. ETGA, supine position with head left turn 2. Reopen the previous scalp wound 3. Loosing the miniplates and elevate the skull graft; EDH removal 4. Open the dura wound and duroplasty was performed with fascia graft 5. Insert an intraparychemal ICP and set an epidural CWV drain 6. Close the wound in layers Operators VS 陳敞牧 Assistants R5 陳睿生; Ri Indication Of Emergent Operation 邱伯仁 (M,1943/10/05,68y5m) 手術日期 2010/04/05 手術主治醫師 曾勝弘 手術區域 東址 001房 03號 診斷 Prostate cancer 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 曾偉倫, 時間資訊 08:07 開始NPO 08:07 臨時手術NPO 10:07 通知急診手術 13:30 報到 13:35 進入手術室 13:40 麻醉開始 13:50 誘導結束 14:30 手術開始 15:45 開始輸血 16:00 抗生素給藥 18:30 麻醉結束 18:30 手術結束 18:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４～８小時 1 1 L 手術 頭顱成形術 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT 開立醫師: 曾峰毅 開立時間: 2010/04/05 18:59 Pre-operative Diagnosis Subdural effusion with skull osteolytic lesion with dura based-mass Post-operative Diagnosis Suspected prostate cancer with skull bone and dura metastasis complicated with subacute subdural hemorrhage. Cranioplasty was done with mesh and bone cement. Operative Method Left craniecotmy wtih duroplasty for skull and dura tumor excision; cranioplasty Specimen Count And Types Left temporalis muscle, left frontal skull bone, and dura-based tumor were resected, and sent for pathology. 10ml pinkish, clear, subdural effusion was sent for cytology. Pathology Pending Operative Findings One osteolytic tumor noted at left frontal skull bone with invasion to overriding temoralis muscle. Skull tumor was remvoed totally with surrounding skull and temoralis muscle. One hypervascualr, soft, fragile, whitish to greyish, dura-based tumor was noted at left frontotemporal dura with surrounding dura thickening. Dura-based tumor was resected, but resection margin is not clear. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to right. After skin shaved, scrubbed, disinfected, and then draped, one curvilinear skin incision was made at left frontal area, and scalp flap was reflectd inferiorly. We dissected the temoporalis muscle with invased tumor totally, and drilled 5 burr holes. Craniectomy was done surrounding protuding osteolytic bone tumor. Dura was opened, and dura-based tumor was resected after dura tenting. Hemostasis was done, and duroplasty was performed with Gore-tex artificial dura graft and 4-0 prolene water-tight fashion. Frontal part of bone graft was fixed back with mini-plates, and cranioplasty was done with wire mesh and bone cement after dura central tenting. After placing one subgaleal CWV, we closed the wound in layers. Operators VS 曾勝弘 Assistants R3 曾峰毅 R1 曾偉倫 Indication Of Emergent Operation 郭陳寶惜 (F,1952/01/06,60y2m) 手術日期 2010/04/06 手術主治醫師 詹光政 手術區域 西址 036房 02號 診斷 Other lymphoma 器械術式 Insertion of hichman or port a 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 詹光政 ASA 3 時間資訊 08:00 報到 10:40 進入手術室 11:00 麻醉開始 11:05 抗生素給藥 11:08 誘導結束 11:45 手術開始 13:00 麻醉結束 13:00 手術結束 13:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 ｐｏｒｔ–Ａ導管植入術–治療性導管植入術 1 0 R 李曉青 (F,1977/09/23,34y5m) 手術日期 2010/04/06 手術主治醫師 曾漢民 手術區域 東址 001房 4號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2E 紀錄醫師 李建勳, 時間資訊 08:00 臨時手術NPO 08:00 開始NPO 14:35 進入手術室 14:45 麻醉開始 15:30 抗生素給藥 15:30 誘導結束 15:35 手術開始 16:30 開始輸血 18:45 手術結束 18:45 麻醉結束 19:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４小時以內 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: frontal craniotomy for Simpson grade II tumor excision 開立醫師: 李建勳 開立時間: 2010/04/06 19:26 Pre-operative Diagnosis Right frontal parasaggital meningioma Post-operative Diagnosis Right frontal parasaggital meningioma Operative Method Right frontal craniotomy for Simpson grade II tumor excision Specimen Count And Types 1 piece About size:10g Source:Right frontal craniotomy for tumor excision Pathology Pending Operative Findings The tumor is yellowish, elastic-firm, size 5x5x4cm loblated, attached to the falx. Some feeders from the flax and frontal lobe inferior to the tumor were coagulated with bipolar cauterizer. The margin was seperable from the normal brain parenchyma at arachnoid plane. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position with head fixed with Mayfield skull clump. The scalp was shaved, scrubbed, disinfected with alcohol better-iodine then draped. The L-shaped scalp incision was made followed by right frontal craniotomy. The dura was opened around the tumor after tenting along the craniotomy window. Some feeders from the flax and frontal lobe inferior to the tumor were coagulated with bipolar cauterizer. The tumor was detached from the falx. The tumor was dissected from the surrounding normal brain tissue with dissector and bipolar coagulator then excised in one piece. The attached falx and dura were coagulated with bipolar caurterizer. The duroplasty was performed with 4-0 Prolene sutures and periostium. The skull plate was fixed back with miniplates and screws after one subgaleal CWV drain set up. The wound was then closed in layers. Operators VS 曾漢民 Assistants R6 李建勳 Indication Of Emergent Operation 相關圖片 唐春松 (M,1941/03/26,70y11m) 手術日期 2010/04/06 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Cervical Spondylosis 器械術式 Laminectomy C-Spinal(Posterier 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳睿生, 時間資訊 00:00 臨時手術NPO 07:30 報到 08:05 進入手術室 08:10 麻醉開始 08:40 誘導結束 09:00 抗生素給藥 09:06 手術開始 11:20 手術結束 11:20 麻醉結束 11:30 送出病患 11:40 進入恢復室 13:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術（特壓）－超過二節 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: C3-7 laminectomy for decompression 開立醫師: 陳睿生 開立時間: 2010/04/06 11:43 Pre-operative Diagnosis Cervical stenosis over C3-7 Post-operative Diagnosis Cervical stenosis over C3-7 Operative Method C3-7 laminectomy for decompression Specimen Count And Types nil Pathology Nil Operative Findings The thecal sac was tightly compressed at C3-7 level. After laminectomy, the thecal sac was well expanded. Pre-op poor right side SSEP was noted, and no SSEP change peri-op. Operative Procedures 1. ETGA, prone position and head fixed with Mayfield clump 2. Posterior neck midline incision 3. Incise into the nuchal ligament 4. Expose the C2-7 spinous process, and the soft tissue above lamina was also dissected 5. Remove spinous process with rounger 6. Laminectomy was done with rounger and kerrison pounch under SSEP monitor 7. Hemostasis, set an epidural CWV drain 8. Close the wound in layers Operators VS 曾勝弘 Assistants R5 陳睿生 宋瓊華 (F,1956/10/05,55y5m) 手術日期 2010/04/06 手術主治醫師 曾勝弘 手術區域 東址 005房 02號 診斷 Spine tumor 器械術式 Benign intraspinal tumor, exci 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳睿生, 時間資訊 00:00 臨時手術NPO 11:48 進入手術室 12:05 麻醉開始 12:10 誘導結束 12:50 抗生素給藥 13:00 手術開始 15:25 手術結束 15:25 麻醉結束 15:40 送出病患 15:48 進入恢復室 17:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 良性病髓腫瘤切除術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 摘要__ 手術科部: 外科部 套用罐頭: L1,2 laminectomy for total tumor remove 開立醫師: 陳睿生 開立時間: 2010/04/06 16:02 Pre-operative Diagnosis L1 intraspinal extramedullary tumor, suspect neuroma Post-operative Diagnosis L1 intraspinal extramedullary tumor, suspect neuroma Operative Method L1,2 laminectomy for total tumor remove Specimen Count And Types pieces, tumor Pathology Pending Operative Findings The tumor was soft, whitish, and well capsuled. It was about 12cm in diameter, and was noted to be origined from one root. Cystic component was noted inside the tumor, and the fluid was yellowish. The root was ligated after tumor remove. Operative Procedures 1. ETGA, prone position, and C-arm localized the L1 level 2. Posterior midline insicion 3. Split bilateral paraspinal muscle to expose the L1,2 spinous process and lamina 4. Remove of L1, 2 spinous process, and do L1, 2 laminectomy 5. Incise into the dura and proper tacking 6. Find out the tumor mass, and central debulking was performed 7. The tumor was carefully detached from the adhered root 8. Totally remove of the tumor and ligate the root 9. Hemostasis, close the dura tightly 10.Set an epidural CWV drain 11. Close the wound in layers Operators VS 曾勝弘 Assistants R5 陳睿生 黃子丞 (M,2007/08/06,4y7m) 手術日期 2010/04/06 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Diplegic infantile cerebral palsy 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 陳德福, 時間資訊 00:00 臨時手術NPO 07:54 報到 08:09 進入手術室 08:15 麻醉開始 08:50 誘導結束 09:00 抗生素給藥 09:40 手術開始 10:55 開始輸血 12:00 抗生素給藥 13:30 麻醉結束 13:30 手術結束 13:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 2 B 手術 慢性硬腦膜下血腫清除術 1 1 B 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: 1.removal of bilateral subdural hematoma 開立醫師: 陳德福 開立時間: 2010/04/06 14:29 Pre-operative Diagnosis bilateral chronic subdural hematoma 1. bilateral chronic subdural hematoma 2. S/P VP shunt insertion Post-operative Diagnosis ditto 1. Left chronic subdural hematoma and right subdural effusion 2. S/P VP shunt insertion Operative Method 1.removal of bilateral subdural hematoma 1.removal of bilateral subdural hematoma via bilateral frontotemporoparietal craniotomy 2. Removal of outer and inner membrane of the subdural hematoma 2.remvoal of VPS Specimen Count And Types 3 pieces About size:10ml Source:subdural hematoma, right About size:3*4cm Source:outer membrane of subdural hematoma About size:10ml Source:subdural hematoma, left 3 pieces. A. outer membrane of right side. B. inner membrane of right side. C. outer membrane of left side. subdrual hematoma and effeusion were sent for studies with total of 6 tubes. Pathology Pending Operative Findings 1.There are intact bilateral outer and inner membrane of the subdural hematoma. The outer membrane over left side is reddish, easy bleeding and hypervascularized. The inner membrane is transparent over left side while the right side inner membrane is whitish with fibrotic change. 1.There are intact bilateral outer and inner membrane of the subdural hematoma. The outer membrane over left side is reddish, easy bleeding and hypervascularized. The inner membrane is transparent over left side while the right side inner membrane is whitish with fibrotic change. The outer membrane over the right side was not that vascularized. There were some septum formation over the left subdural space, but not very fibrotic. 2.There is 50ml darkish, reddish and partial-liquified subdural hematoma gushed out spontaneously after opening the left side outer membrane and; while the there is clear and yellowish fluid gushed out spontaneously after opening the right side outer membrane. 2.There is 50ml darkish, reddish and partial-liquified subdural hematoma gushed out spontaneously after opening the left side outer membrane and; while the there is clear and yellowish fluid gushed out spontaneously after opening the right side outer membrane. 3.The brain expanded partially after drainage and one subdural drainage are left in situ bilaterally. 4.The right inner membrane is opened and tented to the dura with outer membrane. 5.The VPS is removed. 6.The left temporal vein [vein of Labbe] penetrate trough the inner and outer membrane of the subdural hematoma. This vein is well preserved. Operative Procedures 1.under ETGA and supine positon 2.skin disinfection andn draping 3.Curvilinear bicoronal incision and identify the cath & valve of the VPS 3.Curvilinear bicoronal incision and identify the diatal catheter of the programmable shunt & valve of the VPS 4.Removal of the shunt system was done 4.Removal of the whole shunt system was done smoothly 5.one 4*4cm craniotomy was done on the right side followed by dura tenting 6.The dura and outer membrane were opened 7.drainage of the subdural hematoma and irrigation with copious normal saline 8.the inner membrane was opened 9.left one subdural draiange in situ 10.perform the same procedure on the left side [step 5~9] 10.perform the same procedure on the left side [step 5~9] and the skull is fixed with microplates and wires 11.close the wound in layers Operators AP 郭夢菲 Assistants R4 陳德福 相關圖片 林錦華 (F,1954/12/26,57y2m) 手術日期 2010/04/06 手術主治醫師 賴達明 手術區域 東址 009房 04號 診斷 Cervical spondylosis 器械術式 Laminectomy C-Spinal(Posterier 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2E 紀錄醫師 李建勳, 時間資訊 13:08 進入手術室 13:30 麻醉開始 13:40 誘導結束 13:45 抗生素給藥 13:57 手術開始 14:20 手術結束 14:20 麻醉結束 14:40 進入恢復室 16:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 肌肉或深部組織腫瘤切除術及異物取出術 1 2 摘要__ 手術科部: 外科部 套用罐頭: Removal of epidrual close wound vacuum (CWV) ... 開立醫師: 李建勳 開立時間: 2010/04/06 14:36 Pre-operative Diagnosis C1-2 sublaxation status post operation with drain tube rupture Post-operative Diagnosis C1-2 sublaxation status post operation with drain tube rupture Operative Method Removal of epidrual close wound vacuum (CWV) drain tube Specimen Count And Types 1 piece About size:4CM Source:CWV drain Pathology Nil Operative Findings 4cm CWV drain tube was removed after opened the wound. Operative Procedures Under general anesthesia and intubation, the patient was put in prone position. The skin was scrubbed, disinfected with alcohol better-iodine and draped. Opened the previous operation wound and removed stitches. Located the CWV drain tube and removed. Closed the wound in layers. Operators VS 賴達明 Assistants R6 李建勳 Indication Of Emergent Operation 相關圖片 林昇華 (M,1963/01/26,49y1m) 手術日期 2010/04/06 手術主治醫師 賴達明 手術區域 東址 002房 01號 診斷 Anomalies of cerebrovascular system 器械術式 Tracheostomy 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 陳盈志, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 08:20 進入手術室 08:20 報到 08:30 麻醉開始 09:00 誘導結束 10:45 手術開始 11:00 抗生素給藥 14:01 開始輸血 16:10 麻醉結束 16:10 手術結束 16:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 7 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 3 0 麻醉 動脈血液檢查全套 3 0 麻醉 Hemoglobin (Hb) 3 0 麻醉 測血糖 3 0 麻醉 Ca (Calcium) 3 0 麻醉 Na (Sodium) 3 0 麻醉 K (Potassium) 3 0 麻醉 Cl (Chloride) 3 0 麻醉 Blood gas analysis 3 0 手術 開顱術摘除血管病變－動靜脈畸型－中型－表淺 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Right frontal craniotomy AVM total excision, ... 開立醫師: 陳盈志 開立時間: 2010/04/06 16:41 Pre-operative Diagnosis Right frontal AVM, respiratoery failure Post-operative Diagnosis Right frontal AVM, respiratoery failure Operative Method Right frontal craniotomy AVM total excision, tracheostomy Specimen Count And Types 1 piece About size:3x2.5x2cm Source:right frontal AVM Pathology pending Operative Findings The feeder came from MCA and ACA branches. The nidus was about 3x2.5x2cm in size. The drainage vein drain into SSS. Fr.8 tracheostomy tube was inserted Operative Procedures 1.ETGA, supine with head fixed with Mayfield 2.Skin preparation 3.Open previous craniotomy, extend to left side as bicoronal incision 4.Remove previous craniotomy bone plate, then extend craniotomy window to right subfrontal. 5.U-shape dura incision with SSS as base 6.Identify the feeders of the AVM and cauterized, then dissect along the border of the nidus, finally cauterize and cut down the drainage vein. 7.Hemostasis wiht bipolar and surgicel packing 8.Duroplasty with fascia graft 9.Fix bone plate with miniplate 10.setsubgaleal CWV drain x1 then close wound in layers 11.Reposition 12.Tracheostomy via 2nd to 3rd tracheal ring. Operators VS賴達明 Assistants R6陳盈志Ri Indication Of Emergent Operation 蕭玉臻 (F,1938/11/01,73y4m) 手術日期 2010/04/06 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(Others) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳柏達, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:13 麻醉開始 08:45 報到 09:00 誘導結束 09:00 抗生素給藥 09:43 手術開始 12:00 抗生素給藥 12:10 麻醉結束 12:10 手術結束 12:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除－手術時間在４小時以內 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Simpson grade I tumor excision 開立醫師: 黃柏誠 開立時間: 2010/04/06 12:32 Pre-operative Diagnosis Left temporal to parietal meningioma Post-operative Diagnosis Left temporal to parietal meningioma Operative Method Simpson grade I tumor excision Specimen Count And Types Pieces of tumor Pathology pending Operative Findings 1.One about 3.7x4.3 cm firm, whitish to yellowish tumor with medium cascularity located at left temporal to parietal area that compressed the motor area. 2.Hyperostosis was noted. 3.Some feeding vessels from MMA was noted 4.Duroplasty with temporalis fascia Operative Procedures 1.ETGA, supine with head rotate to right and fixed with Mayfield skull clamp 2.Reverse U shape skin incision at left temporal to parietal area 3.Reflect skin flap then muscular flap 4.Craniotomy 5.Dural tenting 6.Open dura along the edge of tumor 7.Central debulking 8.Dissect tumor margin 9.Total tumor excision 10.Duroplasty with temopralis fascia 11.fix bone back with miniplate 12.Close wound in layers Operators 賴達明 Assistants 胡朝凱,陳柏達 王聖 (M,1964/03/11,48y0m) 手術日期 2010/04/06 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Cervical spondylosis 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 胡朝凱, 時間資訊 00:00 臨時手術NPO 12:25 報到 12:48 進入手術室 12:55 麻醉開始 13:15 誘導結束 13:30 抗生素給藥 13:32 手術開始 16:50 手術結束 16:50 麻醉結束 17:00 送出病患 17:05 進入恢復室 19:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術－頸椎 1 1 手術 脊椎融合術－前融合，無固定物（＜＝四節） 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 摘要__ 手術科部: 外科部 套用罐頭: Anterior approach for diskectomy and artifici... 開立醫師: 胡朝凱 開立時間: 2010/04/06 17:01 Pre-operative Diagnosis C4~5 HIVD Post-operative Diagnosis C4~5 HIVD Operative Method Anterior approach for diskectomy and artificial disc insertion Specimen Count And Types NIL Pathology Nil Operative Findings 1.Posterior protrusion of disc that compressed the spinal cord tightly 2.No obvious marginal spur 3.Freely movable uncal joint 4.6# artificial disc was inserted Operative Procedures 1.ETGA, supine 2.Right neck transverse skin incision 3.Dissect along the anterior border of SCM to the prevertebral space 4.Detach longus colli muscle 5.Diskectomy 6.Identify midline with C-arm 7.Artificial disc insertion 8.Hemostasis 9.Close wound in layers Operators 賴達明 Assistants 胡朝凱 林錫麒 (M,1963/10/01,48y5m) 手術日期 2010/04/06 手術主治醫師 賴達明 手術區域 東址 009房 5號 診斷 Herniation of intervertebral disc 器械術式 Diskectomy lumbar 手術類別 臨時手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳德福, 時間資訊 19:00 臨時手術NPO 14:30 報到 14:50 麻醉開始 14:50 進入手術室 15:00 誘導結束 15:05 抗生素給藥 16:35 手術開始 17:30 手術結束 17:30 麻醉結束 17:40 送出病患 17:45 進入恢復室 18:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術－腰椎 1 1 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 復健部 套用罐頭: Microscopic diskectomy, lumbar 開立醫師: 陳德福 開立時間: 2010/04/06 17:53 Pre-operative Diagnosis L4-5 HIVD with ruptured disc, left predominent Post-operative Diagnosis ditto Operative Method Microscopic diskectomy, lumbar Specimen Count And Types nil Pathology nil Operative Findings There is a whitish, hard and calcified ruptured disc at the L4-5 level over left side with L5 root compression. The ruptured disc is downward migrating. The root is compressed with local inflammatory change. After removal of the disc, the nerve root became mobile and decompressed. Operative Procedures Under ETGA and prone position, the skin was disinfected and draped as usual. C-arm localization was done followed by linear incision at midline. The left paraspinaous muscle was displaced laterally and partial laminectomy between L4-5 was done. Under microscoipic surgery, the ligmentum flavum and epidural fat were removed to exposure the nerve root and thecal sac. The herniated disc was then identified and removed with Alligator, Rounger, Currettes and Disc clamps assisted. The disc is nearly total removed and hemostasis is done. The wound was closed in layers finally. Operators VS 賴達明 Assistants R4 陳德福 相關圖片 廖輝鳳 (F,1964/07/30,47y7m) 手術日期 2010/04/07 手術主治醫師 王國川 手術區域 東址 001房 07號 診斷 顱內出血(ICH) 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 4E 紀錄醫師 古恬音, 時間資訊 22:38 通知急診手術 22:38 臨時手術NPO 22:38 開始NPO 23:45 進入手術室 23:45 開始輸血 23:50 麻醉開始 00:05 抗生素給藥 00:15 誘導結束 00:34 手術開始 02:40 手術結束 02:40 麻醉結束 02:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 腦瘤切除－手術時間在４小時以內 1 1 L 手術 顱內壓監視置入 1 2 L 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Left F-T-P craniotomy for hematoma evacuation... 開立醫師: 陳盈志 開立時間: 2010/04/07 02:21 Pre-operative Diagnosis Left parietal skull bone metastasis with bleeding as EDH Post-operative Diagnosis Left parietal skull bone metastasis with bleeding as EDH Operative Method Left F-T-P craniotomy for hematoma evacuation and ICP monitor insertion Specimen Count And Types 1 piece About size:multiple fragments Source:left parietal skull bone Pathology pending Operative Findings Soft fragile tumor at left parietal bone with bone erosion was noted. Tumor bleeding was noted, which cause epidural hematoma. The vascularity was high. ICP monitor was inserted to subdura space and ICP after skin closure was 8 mmHg Operative Procedures 1.ETGA, supine with head tilt to right 2.Skin preparation 3.Left frontal-temporal-parietal trauma flap scalp incision 4.Burr hole x 4 then craniotomy 8x7cm 5.hematoma evacuation and then dura tenting was done with 3-0 silk in 1cm distance. 6.The tumor at left parietal bone was curreted till hard bone edge reached. 7.Hemostasis with bipolar and gelform 8.Insert ICP monitor to temporal tip. 9.Fix bone plate with miniplate after epidural CWV drain x 1 10.close wound in layers Operators VS王國川 Assistants R6陳盈志R4陳德福R2陳盈志 R6陳盈志R4陳德福R2古恬音 Indication Of Emergent Operation 吳璨瑛 (F,1963/09/30,48y5m) 手術日期 2010/04/06 手術主治醫師 田郁文 手術區域 東址 006房 05號 診斷 Pancreatic tumor 器械術式 Exploratory laparatomy 手術類別 預定手術 手術部位 腹 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉育彰 ASA 2 紀錄醫師 黃俊傑, 時間資訊 13:42 報到 13:46 進入手術室 14:00 麻醉開始 14:10 誘導結束 14:18 抗生素給藥 14:22 手術開始 16:35 手術結束 16:35 麻醉結束 16:45 送出病患 16:50 進入恢復室 17:52 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 胰臟尾端部分切除術–脾臟保留 1 1 手術 ｐｏｒｔ–Ａ導管植入術–治療性導管植入術 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 記錄__ 手術科部: 外科部 套用罐頭: 1. Distal Pancreatectomy with spleen preserva... 開立醫師: 黃俊傑 開立時間: 2010/04/06 16:56 Pre-operative Diagnosis 1. Pancreatic body neuroendocrine tumor 2. left breast cancer s/p MRM Post-operative Diagnosis 1. Pancreatic body neuroendocrine tumor 2. left breast cancer s/p MRM Operative Method 1. Distal Pancreatectomy with spleen preservation 2. Port-A insertion Specimen Count And Types 1 piece About size:8x4cm Source:pancreatic tail with tumor Pathology Pending Operative Findings 1. one 1x1cm, hard, whitish mass over pancreatic body, with hematoma and inflammatory change beside 2. Patent venous flow from Port-A in right subclavian vein. The place of catheter tip was confirmed by CXR. Operative Procedures 1. Under endotracheal general anesthesia, the patient was put in supine position. The operative field was disinfected and draped as usual method. 2. After the abdomen was opened through a upper midline incision, the resectability of the tumor was determined by dividing the gastrocolic ligament and mobilizing the distal pancreas from the retroperitoneum. 3. The splenic vein was transected at level of pancreatic tail and body. The pancreas was transected at its body portion. The pancreatic stump was closed by interrupted mattress silk sutures and continuous Prolene suture. 4. The abdomen was closed in layers after insertion of two rubber drain tubes in peripancreatic area. 5. Short oblique incision was made over right upper abdomen. 6. The right subclavian vein was identified by puncture method, then the Port-A catheter was inserted. 7. The Port was set in right upper chest, after intraoperative CXR, the wound was closed in layers. Operators AP田郁文 Assistants R5黃俊傑, Ri 相關圖片 張貴美 (F,1953/06/16,58y8m) 手術日期 2010/04/07 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Brain Tumor 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 07:48 報到 08:05 進入手術室 08:10 麻醉開始 08:45 誘導結束 08:53 抗生素給藥 09:03 手術開始 11:53 抗生素給藥 14:55 麻醉結束 14:55 手術結束 15:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４～８小時 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT 開立醫師: 林哲光 開立時間: 2010/04/07 13:11 Pre-operative Diagnosis Recurrent left temporal meningioma Post-operative Diagnosis Recurrent left temporal meningioma with cavernous sinus invasion Operative Method Left pterional approach tumor excision Left pterional approach subtotal tumor excision and duroplasty with Duraform Left pterional approach Simpson IV tumor excision and duroplasty with Duraform Specimen Count And Types 1 piece About size: Source:left temporal meningioma Pathology Pending Operative Findings About 3cm sized well-demarcated elastic-firm greyish mass lesion was noted over left temporal lobe with dura, left orbital cavity and left cavernous sinus invasion. Some tumor invaded along the suprachiasmatic recess with right side optic nerve invasion. About 3cm sized well-demarcated elastic-firm greyish mass lesion was noted over left temporal lobe with dura, left orbital cavity and left cavernous sinus invasion. Some tumor invaded along the suprachiasmatic recess with right side optic nerve invasion. Left optic nerve sheath was cutted and no obvious tumor compression. Atrophic change of left optic nerve was noted compared to right side. The tumor inside the left cavernous sinus was left untouched with intact dura. About 3cm sized well-demarcated elastic-firm greyish mass lesion was noted over left temporal lobe with dura, left orbital cavity and left cavernous sinus invasion. Some tumor invaded along the suprachiasmatic recess with right side optic nerve compression. Left optic nerve sheath was cutted and no obvious tumor invasion. Atrophic change of left optic nerve was noted compared to right side. The tumor inside the left cavernous sinus was left untouched with intact dura. Operative Procedures Under ETGA and supine position with left back elevated, skin disinfected and drapped were performed as usual. Skin incision was done along the previous operative wound. The previous craniotomy window, F-T area, was identfied and the bone graft was removed. The dura was then opened after dural tenting. Under general anesthesia and intubation, the patient was put in supine position with left back elevated, skin disinfected and drapped were performed as usual. Skin incision was done along the previous operative wound. The previous craniotomy window, F-T area, was identfied and the bone graft was removed. The dura was then opened after dural tenting. The left optic nerve and left ICA were identified. The optic chiasm was then exposed well and some of the tumor along the suprachiasmatic recess were removed. Subtotal removal of the tumor mass was performed over the from temporal area through the lateral part of the left cavernous sinus to the middle fossa with bioplar cauterization over the dura of the base of the tumor. Hemostasis was then performed with surgecells and the dura defect was reconstructed with Duraform. The wound was then closed in layers after CWV drain inserted. The left optic nerve and left ICA were identified. The optic chiasm was then exposed well and some of the tumor along the suprachiasmatic recess were removed. Subtotal removal of the tumor mass was performed over the from temporal area through the lateral part of the left cavernous sinus to the middle fossa with bioplar cauterization over the dura of the base of the tumor and CUSA. Hemostasis was then performed with surgecells and the dura defect was reconstructed with Duraform. The wound was then closed in layers after CWV drain inserted. Operators P 杜永光, Assistants R3 林哲光, R6 李建勳 黃銀貞 (F,1943/12/02,68y3m) 手術日期 2010/04/07 手術主治醫師 曾漢民 手術區域 東址 005房 03號 診斷 Benign neoplasm of pituitary gland and craniopharyngeal duct (pouch) 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 古恬音, 時間資訊 00:00 臨時手術NPO 14:35 報到 14:45 進入手術室 14:50 麻醉開始 15:00 誘導結束 15:40 手術開始 16:50 手術結束 16:50 麻醉結束 17:00 送出病患 17:05 進入恢復室 18:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 內視鏡功能鼻竇手術－單側 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Repair CSF leak 開立醫師: 陳盈志 開立時間: 2010/04/07 17:27 Pre-operative Diagnosis CSF leak Post-operative Diagnosis CSF leak Operative Method Repair CSF leak Specimen Count And Types nil Pathology nil Operative Findings There is CSF leak noted at sellar floor. After packing with fat and tissue codul, No further leak was noted. Operative Procedures 1.ETGA, supine 2.Under endscope guide, identify the leak point 3.Harvest fat and fascia from LLQ, packing to the leak site, then apply tissue codul 4.packing nasal cavity Operators VS曾漢民 Assistants R6陳盈志R2古恬音 林千鶴 (F,1941/06/06,70y9m) 手術日期 2010/04/07 手術主治醫師 蔡瑞章 手術區域 東址 005房 01號 診斷 Spinal stenosis, lumbar 器械術式 Laminectomy for decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 古恬音, 時間資訊 00:00 臨時手術NPO 07:48 報到 08:05 進入手術室 08:15 麻醉開始 08:25 誘導結束 08:45 抗生素給藥 09:10 手術開始 11:45 抗生素給藥 12:00 手術結束 12:00 麻醉結束 12:10 送出病患 12:15 進入恢復室 13:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術（特壓）－二節以內 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 摘要__ 手術科部: 外科部 套用罐頭: Sublaminar decompression L3/4, 4/5 開立醫師: 陳盈志 開立時間: 2010/04/07 11:58 Pre-operative Diagnosis L3/4,4/5 stenosis Post-operative Diagnosis L3/4,4/5 stenosis Operative Method Sublaminar decompression L3/4, 4/5 Specimen Count And Types nil Pathology nil Operative Findings Hypertrophic ligmentum flavum at l3/4, 4/5 cause canal stenosis, the dura expanded well after sublaminar decompression Operative Procedures 1.ETGA, prone with C-arm localization 2.Skin preparation 3.Midline back incision 4.Split l3/4, 4/5 spinous process with saw 5.laminectomy L3/4 4/5, then remove hypertrophic ligmentum flavum till well decompression of foramen. 6.Hemostaasis with gelform packing 7.close wound in layers Operators P蔡瑞章 Assistants R6陳盈志R2古恬音 邱伯仁 (M,1943/10/05,68y5m) 手術日期 2010/04/07 手術主治醫師 曾勝弘 手術區域 東址 001房 01號 診斷 Prostate cancer 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 曾峰毅, 時間資訊 08:00 通知急診手術 09:00 進入手術室 09:05 麻醉開始 09:34 誘導結束 09:35 抗生素給藥 09:40 開始輸血 09:51 手術開始 12:25 手術結束 12:25 麻醉結束 12:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 急性硬腦膜下血腫清除術 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 曾峰毅 開立時間: 2010/04/07 12:30 Pre-operative Diagnosis Left subdural hemorrhage and epidural hemorrhage Post-operative Diagnosis Left subdural hemorrhage and epidural hemorrhage Operative Method Craniotomy for hematoma evacuation Specimen Count And Types Nil Pathology Nil Operative Findings Bleeding tendency was noted. There is epidural hematoma, about 1cm, and acute subdural hematoma at left frontal lobe. Diffuse oozes came from rough surface of temporalis muscle and dura edge. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to right. After skin scrubbed, disinfected, and then draped, we made the skin incision along the previous operation wound. Bone graft was removed, and epidural hematoma was removed. Dura graft was opened in Y-shape, and subdural hemorrhage was evacuated. After hemostasis, was closed the dura in water-tight fashion with 4-0 prolene. Bone graft was fixed back with mini-plates, after two central tentings and one epidural CWV set. After put one subgaleal CWV, we closed the wound in layers. Operators VS 曾勝弘 Assistants R5 陳睿生 R3 曾峰毅 Indication Of Emergent Operation 鄭佑任 (M,1995/10/23,16y4m) 手術日期 2010/04/07 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Arteriovenous malformation, brain 器械術式 Crainotomy Brain Tumor(P-LIN) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 陳德福, 時間資訊 00:00 臨時手術NPO 08:45 報到 08:52 進入手術室 09:00 麻醉開始 09:40 誘導結束 10:00 抗生素給藥 10:53 手術開始 13:20 抗生素給藥 16:30 抗生素給藥 16:45 麻醉結束 16:45 手術結束 16:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱內壓監視置入 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 8 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 開顱術摘除血管病變－動靜脈畸型－小型－深部 1 1 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 摘要__ 手術科部: 外科部 套用罐頭: craniotomy cavernoma excision 開立醫師: 陳德福 開立時間: 2010/04/07 17:32 Pre-operative Diagnosis left temporal lobe cavernoma with bleeding, recurrent left temporal lobe cavernoma with intracerebral bleeding, recurrent Post-operative Diagnosis ditto Operative Method craniotomy cavernoma excision cavernoma excision and hematoma removal via left temporal craniotomy under navigation. Specimen Count And Types 2 pieces About size:2*2*1.5CM Source:cavernoma About size:1*1*1cm Source:choroid plexus or cavernoma Pathology pending Operative Findings 1.There is cyst over the left inferior-posterior temporal lobe, which is contributed from previous surgery. 1.There is a porencephalic cyst formation over the left inferior-posterior temporal lobe, which resulted from previous surgery. 2.One multi-lobulated, grape like, purple, partially calcified, easy bleeds and 2*2*3cm in sized vascular lesion was removed from the left middle temporal lobe. Some liquified hematoma beneth the vascular lesion was noticed. The lesion is lateral and superior to the cyst. 2.One multi-lobulated, grape like, purple, partially calcified, easy bleeds and 2*2*3cm in sized vascular lesion was removed from the left middle temporal lobe. Some liquified hematoma beneath the vascular lesion was noticed and removed. The lesion is lateral and superior to the cyst. 3.Another smaller lesion removed from the area nearby the choroid plexus of the leftl ateral ventricle. 3.Another smaller lesion removed from the area nearby the choroid plexus of the left lateral ventricle. 4.We perform corticotomy along the inferior temporal sulcus. 5.Nevigator system assisted appraoch is performed. Operative Procedures Under ETGA and supine position, the scalp was fixed with Mayfield pin type head fixator. The scalp was disinfected and draped as usual. One incision along previous operation scar was done [reverse U shpae, left temporal area]. The craniotomy and dura tenting were performed adn the dura was opened in C shape. Adhesiolysis and nevigator guided appraoch were done. One 2.5cm corticotmy was created over inferior temporal gyrus and the cavernoma was encountered. The cavernoma was removed meticulously with circumferential dissection. Another lesion nearby the left choroid plexus was removed as well. Hemostasis was done and we left one EVD in situ. The dura was closed in water tight fasion and the skull was fixed with wires. One subgaleal CWV was left and the wound was closed in layers. Under ETGA and supine position, the scalp was fixed with Mayfield pin type head fixator. The scalp was disinfected and draped as usual. Navigation system was set up for intraoperative use. One incision along previous operation scar was done [reverse U shpae, left temporal area]. The craniotomy and dura tenting were performed and the dura was opened in C shape. Adhesiolysis and nevigator guided appraoch were done via the porencephalic cyst, then a 2.5cm corticotmy was created anteriorly over inferior temporal gyrus and the cavernoma was encountered. Under microscopic view, the cavernoma was removed meticulously with circumferential dissection from outer wall of the ventricle to the medial wall. Under the guidance of navigation system, another suspicious lesion nearby the left choroid plexus was removed as well. Hemostasis was done and we left one EVD in situ. The dura was closed in water tight fasion and the skull was fixed with wires. One subgaleal CWV was left and the wound was closed in layers. Operators AP 郭夢菲 Assistants R4 陳德福 相關圖片 黃勝吉 (M,1933/12/10,78y3m) 手術日期 2010/04/07 手術主治醫師 王國川 手術區域 東址 001房 04號 診斷 Head Injury 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 4E 紀錄醫師 莊民楷, 時間資訊 19:13 通知急診手術 19:50 報到 19:50 進入手術室 20:00 麻醉開始 20:15 誘導結束 20:20 抗生素給藥 20:30 手術開始 20:55 開始輸血 23:25 抗生素給藥 23:40 麻醉結束 23:40 手術結束 23:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 1 R 手術 顱內壓監視置入 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Craniectomy 開立醫師: 胡朝凱 開立時間: 2010/04/08 00:23 Pre-operative Diagnosis tRAUMATIC RIGHT ACUTE sdh Acute traumatic right F-T-P SDH Post-operative Diagnosis tRAUMATIC RIGHT ACUTE sdh Acute traumatic right F-T-P SDH Operative Method Craniectomy Right F-T-P craniectomy + hematoma evacuation Specimen Count And Types nil Pathology Nil Operative Findings 1.Pre OP GCS: E1M4Vt 2.2 cm in thick hematoma was noted at right frontal, parietal, to temporal area that compressed the brain tightly. 3.One fracture line was noted at frontal area 4.One ruptured and bleeding bridging vein was noted at right frontal lobe that drain to SSS. 5.After decompression, the ICP was about 5 mmHg 6.Frontal lobe contusion Operative Procedures Under ETGA, patient was put in supine position with head tilt to left. After well antisepsis and drapping procedure, right trauma flap skin incision was performed from pre-auricular area upward to 1 cm above ear then turn backward and pass the curvature of skull, followed by another turn upward to 1 cm away from midline and went anterior to 1 cm behind hair line and then crossed the midline with a curvature incision. Under ETGA, patient was put in supine position with head tilt to left. After well antisepsis and drapping procedure, right trauma flap skin incision was performed from pre-auricular area upward to 1 cm above ear then turn backward and pass the curvature of skull, followed by another turn upward to 1 cm away from midline and went anterior to 1 cm behind hair line and then crossed the midline with a curvature incision. The subcutaneous soft tissue was then opened by blunt dissection. Periosteum was then incised by elctrocauterization and dissected to open. After 4 burr holes drilled, craniectomy was performed with Midas air drill. Dural tenting was then performed and was followed with curvature dura incision 1 cm away from edge. The hematoma was removed. And the bleeder was hemostasis. Fascia flap was utilized to re-union with the dura during dura opening with 4-0 prolene. After 2 CWV drains and ICP monitor insertion, wound was closed in layers. The subcutaneous soft tissue was then opened by blunt dissection. Periosteum was then incised by elctrocauterization and dissected to open. After 4 burr holes drilled, craniectomy was performed with Midas air drill. Dural tenting was then performed and was followed with curvature dura incision 1 cm away from edge. The hematoma was removed. And the bleeder was hemostasis. Fascia flap was utilized to re-union with the dura during dura opening with 4-0 prolene. After 2 CWV drains and ICP monitor insertion, wound was closed in layers. The subcutaneous soft tissue was then opened by blunt dissection. Periosteum was then incised by elctrocauterization and dissected to open. After 4 burr holes drilled, craniectomy was performed with Midas air drill. Dural tenting was then performed and was followed with curvature dura incision 1 cm away from edge. The hematoma was removed. And the bleeder was hemostasis. Fascia flap was utilized to re-union with the dura during dura opening with 4-0 prolene. After 2 CWV drains and ICP monitor insertion, wound was closed in layers. Operators 王國川 VS 王國川 Assistants 胡朝凱,莊民楷 R5 胡朝凱, R2 莊民楷 Indication Of Emergent Operation 劉家豪 (M,1996/12/27,15y2m) 手術日期 2010/04/08 手術主治醫師 廖漢文 手術區域 東址 000房 號 診斷 Brain tumor 器械術式 NEURO T.A.E 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 2 時間資訊 12:00 麻醉開始 12:05 誘導結束 13:35 麻醉結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 何進富 (M,1957/02/26,55y0m) 手術日期 2010/04/08 手術主治醫師 曾漢民 手術區域 東址 001房 2號 診斷 Meningitis 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3 紀錄醫師 陳盈志, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 10:29 通知急診手術 11:45 報到 12:20 進入手術室 12:25 麻醉開始 12:30 誘導結束 12:47 手術開始 13:15 抗生素給藥 13:30 手術結束 13:30 麻醉結束 13:35 送出病患 13:44 進入恢復室 14:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 顱內壓監視置入 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Right kocher EVD as ICP monitor 開立醫師: 陳盈志 開立時間: 2010/04/08 13:47 Pre-operative Diagnosis isolated right side ventriculomegaly Post-operative Diagnosis isolated right side ventriculomegaly Operative Method Right kocher EVD as ICP monitor Specimen Count And Types nil Pathology nil Operative Findings CSF was clear. the opening pressure was low (5cmH2O) ventricular catheter was 6.5cm in langth Operative Procedures 1.ETGA, supine 2.Skin preparation 3.Right frontal linear incision 4.Burr hole then ventricular tapping 5.insert EVD then fixed 6.Hemostasis the close wound Operators VS曾漢民 Assistants R6陳盈志 Indication Of Emergent Operation 吳柏承 (M,1992/09/11,19y6m) 手術日期 2010/04/08 手術主治醫師 郭夢菲 手術區域 東址 005房 01號 診斷 Scoliosis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 陳德福, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:10 進入手術室 08:15 麻醉開始 08:50 誘導結束 09:20 抗生素給藥 09:41 手術開始 12:20 抗生素給藥 15:20 抗生素給藥 18:20 抗生素給藥 19:20 開始輸血 21:20 抗生素給藥 00:30 麻醉結束 00:30 手術結束 00:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術－後融合，無固定物 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 25 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 良性病髓腫瘤切除術 1 1 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 摘要__ 手術科部: 外科部 套用罐頭: 1.Intraspinal tumor excision 2.posterior fusi... 開立醫師: 陳德福 開立時間: 2010/04/08 17:52 Pre-operative Diagnosis Lumbar spine neurofibroma[left] with extradural extension and scoliosis Huge intraspinal extradural neurofibroma, lumbar spine, L1-5, with extraforaminal extension into left psoas muscle Post-operative Diagnosis ditto Operative Method 1.Intraspinal tumor excision 2.posterior fusion of lumbar spine with bone graft 1.Intraspinal tumor excision 2.posterior fusion of lumbar spine with bone graft 3.Laminoplasty 1.Intraspinal tumor excision by L1-4 laminotomy and upper L5 laminectomy 2.posterior fusion of lumbar spine with bone graft, L1 to L5 1.Intraspinal tumor excision by L1-4 laminotomy and upper L5 laminectomy 2.Posterolateral fusion of lumbar spine with allogenic bone graft, L1 to L5 Specimen Count And Types 1 piece About size:2*2*1CM Source:Intraspinal tumor Pathology pending; frozen section pathology: neurofibroma is most likely Operative Findings 1.There is scoliotic change over the T-L spine 1.There is scoliotic change over the lumbar spine 2.The theca saca was compressed tightly to the right side by the intraspinal tumor. 2.The thecal sac was compressed tightly to the right side by the intraspinal tumor. The thecal sal containing the conus medullaris and the cauda equina below was compressed even into the right spinal reccess in one level. 3.There is a yellowish-whitish, soft-elastic, well capsulated, multilobulated and originated from the left L2-4 nerve roots tumor identified afte the laminectomy. The intraspinal tumor is removed subtotally with CUSA assisted in subcapsular debulking method. 3.There is a yellowish-whitish, soft-elastic, well capsulated, multilobulated and originated from the left L2-4 nerve roots tumor identified afte the laminectomy. The tumor has rish blood supply and is easy bleeding. The intraspinal tumor is removed subtotally with CUSA assisted in subcapsular debulking method. 3.There is a yellowish-whitish, soft-elastic, well capsulated, multilobulated and originated from the left L2-4 nerve roots tumor identified afte the laminectomy [exact origin could not be clearly identified due to the tortous structure]. The tumor has rish blood supply and is easy bleeding. The intraspinal tumor is removed subtotally with CUSA assisted in subcapsular debulking method. 3.There is a yellowish-whitish, soft-elastic, well capsulated, multilobulated and originated from the left L2-4 nerve roots tumor identified afte the laminectomy. The tumor has rish blood supply and is easy bleeding. The intraspinal tumor is removed near-totally with CUSA assisted in subcapsular debulking method. 3.There is a yellowish-whitish, soft-elastic, well capsulated, multilobulated tumor which originated from the left L3-4 nerve roots and identified afte the laminectomy [exact origin could not be clearly identified due to the poor defined tumor-nerve junction]. The tumor has rich blood supply and is easily bleeding. The intraspinal tumor is removed subtotally with CUSA, bipolar, currets, and microscissors. 3.The tumor was yellowish-whitish, soft-elastic, well capsulated, and multilobulated, which originated from the left L3-4 nerve roots and was identified after laminectomy [the exact origin could not be clearly identified due to the poor defined tumor-nerve junction]. The tumor has rich blood supply and was easily bleeding. The intraspinal tumor is removed nearly totally with CUSA, bipolar, currets, and microscissors. 4.The theca sac was decompressed and reexpanded after the procedure. 4.The theca sac was decompressed and reexpanded after the procedure. There is a bony defect on the posterior vertebral body of the L3-4, which is resulted from the tumor compression. 4.The theca sac was decompressed and reexpanded after the procedure. There is a bony defect on the posterior vertebral body of the L3and L4, which resulted from tumor compression. 4.The thecal sac was decompressed and reexpanded after removal of the tumor. There is a bony defect on the posterior vertebral body of the L3 and L4, which was compatible with the severe scalloping change shown on MRI due to chronic tumor compression. 5.Posterior lateral fusion with bone graft was done. 5.Posterolateral fusion with allogenic bone graft was done from L1 to L5 levels. Operative Procedures Under ETGA and prone position, C-arm fluoroscope was done. The skin disinfection and draping were done as usual. One 15cm linear incision was done for exposure the lower T12 to the L5 area. The paraspinous muscles was displaced laterally with self-retractors. The L1 to upper L5 laminectomy was done and the tumor came into view. Under microscpic surgery, the tumor was removed by CUSA with subcapsular central debulking method. The upper and lower margin between the tumor and the thecal sca was identified and the tumor was removed subtotally. There are some nerve roots identified and hemostasis was done. The autologous bone was used for posterior lateral fusion of lumbar spine. The wound was then closed in layers. Under ETGA and prone position, C-arm fluoroscope was done. The skin disinfection and draping were done as usual. One 15cm linear incision was done for exposure the lower T12 to the L5 area. The paraspinous muscles was displaced laterally with self-retractors. The L1 to upper L5 laminectomy was done and the tumor came into view. Under microscpic surgery, the tumor was removed by CUSA with subcapsular central debulking method. The upper and lower margins between the tumor and the thecal sca was identified and the intraspinal tumor was removed near-totally. There are some nerve roots identified and hemostasis was done. The autologous bone was used for posterior lateral fusion of lumbar spine. Miniplates were used for laminoplasty. Hemovac drainaged were left in situ. The wound was then closed in layers. Under ETGA and prone position, C-arm fluoroscope was done. The skin disinfection and draping were done as usual. One 15cm linear incision was done for exposure the lower T12 to the L5 area. The paraspinous muscles was displaced laterally with self-retractors. The L1 to upper L5 laminectomy was done and the tumor came into view. Under microscpic surgery, the tumor was removed by CUSA with subcapsular central debulking method. The upper and lower margins between the tumor and the thecal sca was identified and the intraspinal tumor was removed near-totally. There are some nerve roots identified and hemostasis was done. Under ETGA and prone position, C-arm fluoroscope was done. The skin disinfection and draping were done as usual. One 15cm linear incision was done for exposure the lower T12 to the L5 area. The paraspinous muscles was displaced laterally with self-retractors. The L1 to upper L5 laminectomy was done and the tumor came into view. Under microscpic surgery, the tumor was removed by CUSA with subcapsular central debulking method. The upper and lower margins between the tumor and the thecal sac was identified and the intraspinal tumor was removed near-totally. The left L3 and L4 could not be preserved because they were blended with the tumor. We sutured the possible dural defect over the left L3 and L4 nerve origin, then covered the dural suture region with Durofoam to prevent CSF leakage. Allograft bone was used for posterior lateral fusion of lumbar spine. Miniplates and screws were used for laminoplasty. One CWV drain was left in situ. The wound was then closed in layers. We decorticated the transverse process from L1 to L5, then allograft bone was used for posterior lateral fusion of lumbar spine. Miniplates and screws were used for laminoplasty from L1 to L4. One CWV drain was left in situ. The wound was then closed in layers. Operators AP 郭夢扉 VS 楊士弘 AP 郭夢菲 VS 楊士弘 Assistants R4 陳德福 相關圖片 洪敏夫 (M,1943/12/07,68y3m) 手術日期 2010/04/08 手術主治醫師 陳敞牧 手術區域 東址 003房 03號 診斷 Spondylosis with myelopathy, cervical 器械術式 Decompression of mediun nerve 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 1 紀錄醫師 陳柏達, 時間資訊 00:00 臨時手術NPO 14:20 報到 14:35 麻醉開始 14:35 進入手術室 14:40 誘導結束 14:55 抗生素給藥 15:12 手術開始 16:05 手術結束 16:05 麻醉結束 16:10 送出病患 17:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 神經分離術－手．足之神經 1 1 R 手術 正中神經或尺神經腕部減壓術–單側 1 2 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Carpal Tunnel Syndrome 開立醫師: 胡朝凱 開立時間: 2010/04/08 16:19 Pre-operative Diagnosis Right Tardive ulnar palsy and Carpal Tunnel Syndrome Post-operative Diagnosis Right Tardive ulnar palsy and Carpal Tunnel Syndrome Operative Method Neurolysis Specimen Count And Types nil Pathology nil Operative Findings 1.Hypertrophic apponeurosis taht compressed the median nerve tightly. 2.Fibrotic tissue that compressed the ulnar nerve Operative Procedures 1.ETGA, supine 2.Right elbow one curvature skin incision 3.Dissect to expose ulnar nerve 4.Release the nerve by excising peripheral connective tissue 5.Close wound in layers 6.Right palm longitudinal skin incision 7.open aponeurosis 8.Close wound in layers Operators 陳昶牧 Assistants 胡朝凱,陳柏達 蘇芷誼 (F,1984/11/01,27y4m) 手術日期 2010/04/08 手術主治醫師 林東燦 手術區域 兒醫 069房 02號 診斷 Polyneuropathy 器械術式 BMA 手術類別 臨時手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 黃啟祥 ASA 2 紀錄醫師 劉士嶢, 時間資訊 11:40 報到 11:42 進入手術室 12:00 麻醉開始 12:02 誘導結束 12:05 手術開始 12:45 手術結束 12:45 麻醉結束 12:50 送出病患 12:55 進入恢復室 14:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎穿刺 1 0 L 手術 骨髓穿刺 1 0 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 記錄__ 手術科部: 套用罐頭: TIT+BMA 開立醫師: 劉彥麟 開立時間: 2010/04/08 12:58 Pre-operative Diagnosis Acute lymphoblastic leukemia, polyneuropathy Post-operative Diagnosis Acute lymphoblastic leukemia, polyneuropathy Operative Method 1. Lumbar puncture. 2. Bone marrow aspiration Specimen Count And Types 2 pieces About size:5.5 mL Source:CSF About size:30 mL Source:BMA Pathology Pending CSF cytology and BMA cytogenetics Operative Findings CSF appearance: Straw-colored, slowly dripped. BM smear showed (+) BM particles. Operative Procedures Under IVGA, patient was held in knee-chest decubitus position, with the lumbar area skin prepped and draped. A 22-G spinal needle was introduced into the L3-L4 intervertebral space and advanced slowly until the dura was penetrated. Total 5.5 mL of CSF was tapped without trauma. Then the needle was withdrawn completely, and the wound was covered with sterile dressing. The patient was changed to prone position, with pelvic area skin prepped and draped properly. BM aspiration via the left posterior superior iliac spine was performed with a 15-G needle smoothly. Then the needle was withdrawn and the wound was compressed with sterile dressing. Operators R5劉彥麟/VS林東燦 Assistants R2劉士嶢 陳玉婷 (F,1974/01/06,38y2m) 手術日期 2010/04/08 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Cervical spondylosis 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 陳柏達, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:08 進入手術室 08:15 麻醉開始 08:30 誘導結束 09:08 抗生素給藥 09:27 手術開始 11:20 手術結束 11:20 麻醉結束 11:30 送出病患 11:32 進入恢復室 12:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術－頸椎 1 1 手術 脊椎融合術－前融合，有固定物（每增加＜＝四節） 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: Anterior approach for discectomy and Cage ins... 開立醫師: 胡朝凱 開立時間: 2010/04/08 11:35 Pre-operative Diagnosis C5~6 HIVD Post-operative Diagnosis C5~6 HIVD Operative Method Anterior approach for discectomy and Cage insertion Specimen Count And Types NIL Pathology nil Operative Findings 1.One reuptured disc protruded backward and compressed the spinal cord. 2.After decompression, the spinal cord expanded well 3.No spur od OPLL formation Operative Procedures 1.ETGA,supine 2.Right neck transverse skin incision 3.Dissect to exposed pre-vertebral space 4.Detach paravertebral muscle 5.Discectomy 6.Cage 6# insertion 7.set one minihemovac drain 8.Close wound in layers Operators 王國川 Assistants 胡朝凱,陳柏達 陳秀卿 (F,1944/11/01,67y4m) 手術日期 2010/04/08 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 Cerebral infarction 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 1 紀錄醫師 陳柏達, 時間資訊 00:00 臨時手術NPO 11:20 報到 11:37 麻醉開始 11:37 進入手術室 11:45 誘導結束 12:25 抗生素給藥 12:42 手術開始 14:15 手術結束 14:15 麻醉結束 14:25 送出病患 14:27 進入恢復室 16:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 手術 頭顱成形術 1 1 手術 腦室腹腔分流手術 1 2 摘要__ 手術科部: 外科部 套用罐頭: Right Frazier Medtronic VP shunt insertion an... 開立醫師: 柯柏瑞 開立時間: 2010/04/08 14:31 Pre-operative Diagnosis Right skull bone defect and hydrocephalus Post-operative Diagnosis Right skull bone defect and hydrocephalus Operative Method Right Frazier Medtronic VP shunt insertion and right cranioplasty Specimen Count And Types CSF routine, BCS, culture tubes Pathology nil Operative Findings 1.Clear CSF 2.Opening pressure about 15 cmH2O 3.After CSF drainage, the craniotomy window became slack 4.Intraventricualr catheter: 9 cm Operative Procedures 1.ETGA, supine with head rotate to left 2.Right Frazier point curvature skin incision 3.Dissect skin flap 4.Burr hole drill 5.RUQ minilaparotomy 6.Made a subcutaneous tunnel 7.Pass catheter 8.Ventricular puncture then insert catheter 9.Connect to reservior and abdominal catheter then close wound in layers 10.Right skin incision via previous wound 11.Reflect skin flap 12.cauterized the bony edge 13.Fix bone back with miniplate 14.Set CVW drain then close wound in layers Operators 王國川 Assistants 胡朝凱,陳柏達 管萬富 (M,1951/10/27,60y4m) 手術日期 2010/04/08 手術主治醫師 黃正賢 手術區域 東址 010房 08號 診斷 Retinal detachment (RD) 器械術式 P.P.V. + S.B - 1 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 陳達慶, 時間資訊 19:30 報到 20:00 進入手術室 20:24 手術開始 22:17 手術結束 22:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 眼坦部玻璃體切除術－複雜 1 1 R 手術 鞏膜切除併植入或扣壓 1 2 R 手術 光線凝固治療－複雜 1 4 R 摘要__ 手術科部: 眼科部 套用罐頭: PPV (RD全套) 開立醫師: 陳達慶 開立時間: 2010/04/08 22:18 Pre-operative Diagnosis Rhegmatogenous retinal detachment (od) Post-operative Diagnosis Rhegmatogenous retinal detachment (od) Operative Method Complicated PPV + Encircling buckle + retinal reposition with D-K line + endolaser + Intravitreous injection of C3F8 0.7 ml (od) Specimen Count And Types nil Pathology NIL Operative Findings retinal dialysis from 10 to 12 oclock Operative Procedures 1. Under retrobulbar anesthesia 2. Disinfection and draping as usual, apply an eyelid speculum. 3. 360-degree peritomy and hemostasis with cautery. 4. Identify SR,IR,MR and LR 5. Encircling Scleral buckle with Goretex was done 6. Three sclerotomy were made then apply light probe, microvit, and infusion line through the sclerotomy wounds. 7. Vitrectomy was performed with Microvit 8. Retinal reposition with D-K line 9. Air-fluid exchange with Charle’s needle and air pump 10. Endolaser was applied around upper peripheral retina 11. Apply cryotherapy around upper peripheral retina 12. Intravitreal injection of C3F8 0.7 ml 13. Close sclerotomy wound with 9-0 Nylon 14. Close conjunctival wound with 6-0 Vicryl. 15. Subconjunctival injection of Rinderon and Gentamicin. 16. Atropine and Latycin patching. Operators 黃正賢 Assistants R4 朱筱桑 R3 陳達慶 李姿穎 (F,1985/12/20,26y2m) 手術日期 2010/04/09 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Facial spasm 器械術式 Microvascular decompression 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 07:55 報到 08:07 進入手術室 08:15 麻醉開始 08:45 誘導結束 09:00 抗生素給藥 09:02 手術開始 12:00 抗生素給藥 13:20 麻醉結束 13:20 手術結束 13:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 手術 腦微血管減壓術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Left retrosigmoid craniotomy for microvascula... 開立醫師: 李建勳 開立時間: 2010/04/09 13:59 Pre-operative Diagnosis Left hemifacial spasm Post-operative Diagnosis Left hemifacial spasm Operative Method Left retrosigmoid craniotomy for microvascular decompression Specimen Count And Types Nil Pathology Nil Operative Findings One branch of anterioinferior cerebellar artery (AICA) passed through the space between CN VII and VIII with compression to the root exiting zone of CN VII. After dissection and Teflon packing, the AICA was away from the root exiting zone. The brainstem auditory evoke potential was intact during the procedure. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position with head turned to right. The scalp was shaved, scrubbed, disinfected with alcohol better-iodine then draped. The S-shaped scalp incision was made at left retroauricular area. Harvested the fascia graft before 2 cm X 2 cm craniotomy. The dura was opened after tenting. The cerebellum was relaxed by draining the CSF from the potomedulla and cerebellopontine cistern. Located the CVII, VIII and dissected to seperate the AICA branches. Inserted the Teflon patches between the cranial nerves and vessels. Duroplasty with autologous fascia graft and 4-0 Prolene sutures. The skull plate was put back with gelform packing. Closed the wound in layers. Operators P 杜永光 Assistants R6 李建勳 R3 林哲光 相關圖片 江清菊 (F,1966/03/17,45y11m) 手術日期 2010/04/09 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Bacterial meningitis 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 古恬音, 時間資訊 11:05 報到 11:52 進入手術室 12:15 麻醉開始 12:25 誘導結束 12:30 抗生素給藥 12:46 手術開始 15:10 手術結束 15:10 麻醉結束 15:20 送出病患 15:23 進入恢復室 16:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 內視鏡功能鼻竇手術－單側 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 摘要__ 手術科部: 外科部 套用罐頭: Repair with autologous graft and Tissucol Duo 開立醫師: 古恬音 開立時間: 2010/04/09 15:03 Pre-operative Diagnosis CSF rhinorrhea Post-operative Diagnosis CSF rhinorrhea s/p repair with autologous fat graft Operative Method Repair with autologous graft and Tissucol Duo Specimen Count And Types nil Pathology Nil Operative Findings There was one leakage hole at previous repair site of sella floor. The other sphenoid sinus mucosa was intact. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position. The facial skin and left abdomen were disinfected with better iodin then covered with sterile adhesive. After setting up the endoscope system, the sella floor was explored. The leakage hole was identified and packed with autologous abdominal fat then sealed with Tissucol Duo Operators VS曾漢民 Assistants R6陳盈志 柯堯彬 (M,1965/03/30,46y11m) 手術日期 2010/04/09 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Spine tumor 器械術式 Benign intraspinal tumor, exci 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 古恬音, 時間資訊 00:00 臨時手術NPO 08:07 進入手術室 08:15 麻醉開始 08:20 誘導結束 08:40 抗生素給藥 09:00 手術開始 11:25 手術結束 11:25 麻醉結束 11:30 送出病患 11:32 進入恢復室 13:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 良性病髓腫瘤切除術 1 1 摘要__ 手術科部: 外科部 套用罐頭: L1-2 laminoplasty for intraspinal tumor excision 開立醫師: 古恬音 開立時間: 2010/04/09 11:34 Pre-operative Diagnosis L1-2 intraspinal tumor, suspected neuroma Post-operative Diagnosis L1-2 intraspinal tumor, suspected neuroma Operative Method L1-2 laminoplasty for intraspinal tumor excision Specimen Count And Types 1 piece About size:0.5*0.5cm Source:intraspinal meningioma Pathology Pending Operative Findings One 0.8cm soft, yellowish, well-defined tumor was noted at L1-2 level, pushing the spinal cord slighly forward. adhesion to L1 rootlet was noted Operative Procedures Under ndotracheal general anesthesia, the patient was put in prone position. The skin scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. Midline skin incision was made form L1 to L2 level. The paravertebral muscles were detached until the exposure of bilateral laminae. The laminal arches were cut through its whole thickness at its midline by high speed air drill then removed. The dura was opened in a linear fashion and the tumor was identified. The tumor was removed after circumferential dissection, and the arachnoid defect was repaired with 7-o prolene. After close the dura with 5-o prolene, lamina was fixed back with miniplates and screws. After placing one CWV drain, the wound was closed in layers Operators VS曾漢民 Assistants R6陳盈志,R2古恬音 郭錦鐘 (M,1928/10/10,83y5m) 手術日期 2010/04/09 手術主治醫師 曾勝弘 手術區域 東址 002房 01號 診斷 Hepatocellular carcinoma 器械術式 Laminectomy for decompression 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 胡朝凱, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 06:59 通知急診手術 08:55 進入手術室 09:00 麻醉開始 09:15 誘導結束 09:35 抗生素給藥 09:55 手術開始 11:35 麻醉結束 11:35 手術結束 11:40 送出病患 11:45 進入恢復室 13:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術（特壓）－二節以內 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Laminectomy for decompression 開立醫師: 古恬音 開立時間: 2010/04/09 11:49 Pre-operative Diagnosis Suspect HCC metastasis, L4~5 level Post-operative Diagnosis Suspect HCC metastasis, L4~5 level Operative Method Laminectomy for decompression Specimen Count And Types several pieces of bony fragment, ligments and suspected tumor Pathology yellowish soft tissue at epidural space, L4~5 level Operative Findings 1.yellowish, soft tissue at epidural space, L4~5 level, that compressed the thecal sac tightly 2.Hypertrophic flavum ligment compressed the nerve roots was also noted. 3.After decompression, the thecal sac expanded well Operative Procedures 1.ETGA, prone 2.Midline skin incision at L4~5 level 3.Detach paravertebral muscle group 4.Lower border of L4 lamina and upper border of L5 lamina was removed 5.Further removal of flavum ligment 6.Identified L4, 5 nerve roots 7.Hemostasis 8.Close wound in layers Operators 曾勝弘 Assistants 胡朝凱, Ri Indication Of Emergent Operation 文慶順 (M,1934/03/05,78y0m) 手術日期 2010/04/09 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Lumbar fracture 器械術式 Laminectomy for decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 13:13 報到 14:02 進入手術室 14:10 麻醉開始 14:20 誘導結束 15:20 抗生素給藥 16:00 手術開始 19:50 抗生素給藥 20:20 手術結束 20:20 麻醉結束 20:30 送出病患 20:31 進入恢復室 23:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 椎弓切除術（特壓）－二節以內 1 1 摘要__ 手術科部: 外科部 套用罐頭: L3/4 laminotomy and sublaminal decompression 開立醫師: 李建勳 開立時間: 2010/04/09 20:28 Pre-operative Diagnosis Lumbar stenosis over L3-5 level Post-operative Diagnosis Lumbar stenosis over L3-5 level Operative Method L3/4 laminotomy and sublaminal decompression Specimen Count And Types nil Pathology Nil Operative Findings Severe stenosis over L3/4 and L4/5 with thickened ligmentum flavum. The unintended durotomy was closed with 5-0 Prolene sutures. Operative Procedures Under general anesthesia and intubation, the patient was put in prone position. The L3-5 spinous processes were located with portable C-arm X-ray. The skin was scrubbed, disinfected with alcohol better-iodine then draped. Midline skin incision was made from L3 to L5 spinous process. The L4 spinous process was splitted with oscillation saw. The lamina was further opened with osteotone. Sublaminal decompression was performed with Kerrison punches. The unintended durotomy was closed with 5-0 Prolene sutures. Hemostasis was achieved with gelform packing. After one epidural CWV drain set up, the wound was closed in layers. Operators VS 賴達明 Assistants R3 林哲光 R6 李建勳 相關圖片 劉麗英 (F,1924/12/28,87y2m) 手術日期 2010/04/09 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Osteosarcoma 器械術式 Neurolysis 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 07:55 報到 08:18 進入手術室 08:30 麻醉開始 09:00 誘導結束 09:40 抗生素給藥 09:50 手術開始 11:30 麻醉結束 11:30 手術結束 11:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 良性病髓腫瘤切除術 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Tumor debulking for root decompression 開立醫師: 陳睿生 開立時間: 2010/04/09 11:27 Pre-operative Diagnosis Sacral tumor over S1 level, suspect osteogenic tumor, suspect neuroma Post-operative Diagnosis Sacral tumor over S1 level, suspect osteogenic tumor, suspect neuroma Operative Method Tumor debulking for root decompression Specimen Count And Types 1 piece About size:PIECES Source:SACRAL TUMOR Pathology Pending Operative Findings The tumor was soft, yellowish, and fragile. Some jelly like and cystic components were also noted. The right side sacral was invaded by the tumor, and it seemed to firmly attached to the S1 root. After decompression, the thecal sac and root were well expanded. Operative Procedures 1. ETGA, patient was put into prone position 2. Disinfected and draped the operation field as usual 3. Midline incision from L5 to S1 and dissected in layers 4. Exposed the right lamina of L5 and S1 5. Performed partial S1 laminectomy (right side) and expose the tumor 6. Removed the tumor in piecemeal fashion intracapsulely with identification of thecal sac and right S1 nerve root 7. Hemostasis and normal saline irrigation 8. Set one CWV drain in tumor cavity and fixed it at skin 9. Closed wound in layers Operators VS 賴達明 Assistants R5 陳睿生; R2 游健生 廖林淑花 (F,1948/07/12,63y8m) 手術日期 2010/04/09 手術主治醫師 賴達明 手術區域 東址 019房 02號 診斷 Herniation of intervertebral disc with myelopathy, cervical (HIVD) 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 12:00 報到 12:15 進入手術室 12:20 麻醉開始 12:30 誘導結束 12:40 抗生素給藥 13:52 手術開始 15:40 抗生素給藥 17:50 手術結束 17:50 麻醉結束 18:00 送出病患 18:03 進入恢復室 20:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 手術 椎間盤切除術－腰椎 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 摘要__ 手術科部: 外科部 套用罐頭: L5 laminectomy + L5-S1 diskectomy + L5-S1 per... 開立醫師: 游健生 開立時間: 2010/04/09 17:55 Pre-operative Diagnosis L5-S1 herniated intervertebral disc Post-operative Diagnosis L5-S1 herniated intervertebral disc Operative Method L5 laminectomy + L5-S1 diskectomy + L5-S1 percutaneous traspedicle screw fixation L5 laminectomy for L5-S1 diskectomy + fusion with autologous bone grafts + L5-S1 percutaneous transpedicle screw fixation Specimen Count And Types nil Pathology Nil Operative Findings 1. L5-S1 ruptured disc with thecal sac compression 2. Well decompression of thecal sac after diskectomy 3. Autologous bone grafts were extracted from L5 spinous process 4. Percutaneous transpedicle screws (Depuy: Viper system) L5: 40x6.0 mm S1: 35x6.0 mm Rod: left: 45mm right: 50mm Operative Procedures 1. ETGA, patient was put into prone position 2. Locate L5 and S1 spinous processes and pedicles by C-arm 3. Disinfection and draping the operation field as usual 4. Midline incision from L5 to S1 level and dissected in layers 5. Exposed the spinous process and laminae of L5 6. Performed L5 laminectomy 7. Performed L5-S1 diskectomy under microscope 8. Put autologous bone grafts into L5-S1 intervertebral space for fusion 9. Closed wound in layers after hemostasis and normal saline/Gentamycin solution irrigation 10. Paramedian incisions over L5, S1 pedicles 11. Blunt dissection of paraspinal muscles and locate L5 and S1 12. Set percutaneous transpedicle screws at L5 and S1 under C-arm guidance 13. Connected percutaneous TPS by a rod on each side 14. Hemostasis, normal saline and Gentamycin solution irrigation 15. Close wounds in layers Operators VS 賴達明 Assistants R5 陳睿生, R2 游健生 楊翁順 (M,1967/12/07,44y3m) 手術日期 2010/04/09 手術主治醫師 賴達明 手術區域 東址 005房 03號 診斷 Lumbar Spondylosis 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳柏達, 時間資訊 00:00 臨時手術NPO 15:28 報到 15:45 進入手術室 15:50 麻醉開始 15:55 誘導結束 16:50 抗生素給藥 17:05 手術開始 19:37 手術結束 19:37 麻醉結束 19:42 送出病患 19:47 進入恢復室 20:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術－腰椎 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 摘要__ 手術科部: 外科部 套用罐頭: Discectomy and Coflex insertion 開立醫師: 胡朝凱 開立時間: 2010/04/09 19:52 Pre-operative Diagnosis Left L4~5 HIVD Post-operative Diagnosis Left L4~5 HIVD Operative Method Discectomy and Coflex insertion Specimen Count And Types nil Pathology Ruptured disc Operative Findings 1.Huge ruptured disc was noted from L4~5 disc space that compressed the right L5 root tightly. 2.After decompression, thecal sac expanded well 3.12# Coflex was inserted Operative Procedures 1.ETGA, prone 2.midline skin incision 3.detach right pavavertebral muscle 4.remove flavum ligment 5.discectomy 6.drill spinous process 7.Coflex insertion 8.hemostasis 9.close wound in layers Operators 賴達明 Assistants 胡朝凱, 陳柏達 邱慶煌 (M,1938/03/19,73y11m) 手術日期 2010/04/09 手術主治醫師 李章銘 手術區域 東址 057房 2號 診斷 Lung cancer 器械術式 Port-A catheter implatation 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 蔡東明, 時間資訊 11:20 報到 11:50 進入手術室 12:20 手術開始 14:55 手術結束 15:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 ｐｏｒｔ–Ａ導管植入術–治療性導管植入術 1 0 L 摘要__ 手術科部: 外科部 套用罐頭: Port-A implantation 開立醫師: 蔡東明 開立時間: 2010/04/09 15:07 Pre-operative Diagnosis Lung cancer, right lower lobe Post-operative Diagnosis Lung cancer, right lower lobe Operative Method Port-A implantation Specimen Count And Types nil Pathology None Operative Findings One Port-A catheter was inserted at left subclavian vein by puncture method. The CXR showed that the catheter was in SVC and the blood return is smooth. Operative Procedures 1.Under local anesthesia, the patient was put in supine position. 2.Skin disinfecton and drapping 3.Puncture for right subclavian vein. However, the vein could not be located by puncture or cut-down method. 3.Skin disinfection for left chest and drapping again 4.Puncture for left subclavian vein by puncture method. 5.The CXR showed that the catheter tip was in SVC and the blood return is smooth. The ABG showed that the blood sample is vein 6.Close the wound in layers Operators VS李章銘 Assistants R5梁嘉儀 R3蔡東明 何進富 (M,1957/02/26,55y0m) 手術日期 2010/04/10 手術主治醫師 曾漢民 手術區域 東址 001房 01號 診斷 Meningitis 器械術式 V-P shunt 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 蕭柏妮 ASA 3E 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 07:04 通知急診手術 09:13 報到 09:20 進入手術室 09:35 麻醉開始 09:40 誘導結束 10:39 手術開始 12:20 手術結束 12:20 麻醉結束 12:30 送出病患 12:40 進入恢復室 14:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 摘要__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt implantation 開立醫師: 李振豪 開立時間: 2010/04/10 12:59 Pre-operative Diagnosis Hydrocephalus, status post EVD insertion Post-operative Diagnosis Hydrocephalus, status post EVD insertion Operative Method Ventriculoperitoneal shunt implantation Specimen Count And Types 3cm CSF for bacterial culture, routine, and biochemistry study Pathology Nil Operative Findings Clear CSF was noted. The CSF was sampled for bacterial culture, routine, and biochemistry study. The opening pressure was 5cmH2O. The Metronic median pressure reservoir was implanted. The ventricular catheter was 6.5cm in length and the peritoneal catheter was 35cm in length. Operative Procedures Under tracheostomy tube general anesthesia, the patient was put in supine position with head rotated to left. The EVD was removed and the scalp wound stitches were also removed. The skin was shaved, scrubbed, and disinfected as usual. The previous wound was opened the the Burr hole was identified. One 4cm skin incision was made at right upper abdomen. The subcutaneous soft tissue was dissected and the fascia was noted. The fascia was incised and the muscle was splitted. The peritoneum was identified, the peritoneum was opened. A trocar was pushed into peritoneal cavity under direct vision. One subcutaneous tunnel was created from right upper abdomen via right forechest, right neck, right retroauricular area, to right temporal area. Two small scalp incision was made and the tube was passed through the subcutaneous tunnel. The V-P shunt was set up and the function was checked. 6.5cm ventricular catheter with Metronic median pressure reservoir was placed and 35cm peritoneal catheter was placed into peritoneal cavity under trocar guided. The function of V-P shunt was checked again. After hemostasis, the reservoir was fixed to pericranium by 3 stitches. The wound was then closed in layers. Operators VS曾漢民 Assistants R3李振豪 Indication Of Emergent Operation 相關圖片 王明德 (M,1922/10/20,89y4m) 手術日期 2010/04/10 手術主治醫師 蔡瑞章 手術區域 東址 001房 02號 診斷 Subdural hemorrhage 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 蕭柏妮 ASA 3E 紀錄醫師 李振豪, 時間資訊 07:30 臨時手術NPO 07:30 開始NPO 13:44 通知急診手術 14:41 進入手術室 14:45 麻醉開始 14:50 開始輸血 15:00 誘導結束 15:45 抗生素給藥 16:04 手術開始 17:30 手術結束 17:30 麻醉結束 17:35 送出病患 17:40 進入恢復室 19:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Burr hole for chronic subdural hematoma drainage 開立醫師: 李振豪 開立時間: 2010/04/10 17:48 Pre-operative Diagnosis Left frontotemporoparietal chronic subdural hematoma, recurrence Post-operative Diagnosis Left frontotemporoparietal chronic subdural hematoma, recurrence Operative Method Burr hole for chronic subdural hematoma drainage Specimen Count And Types nil Pathology Nil Operative Findings About 120ml motor oil-like fluid was drained out. The brain was slack after hematoma evacuation. The outer membrane was cauterized and the inner membrane was left in situ. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine position with head rotated to right. The scalp was shaved, scrubbed, and disinfected as usual. The scalp incision was made along previous wound and the previous burr hole was identified. The motor oil-like fluid gushed out from the burr hole and about 120ml chronic subdural hematoma was drained out. The outer membrane was cauterized with bipolar cautery. The rubber drain was placed into four direction and irrigation with normal saline was done for evacuation of chronic subdural hematoma. The brain surface was noted after hematoma evacuation. The brain was slack after the operation. The rubber drain was placed toward frontal area and the wound was closed in layers after hemostasis. Deair was done after wound closure. Operators P蔡瑞章 Assistants R3 李振豪 Indication Of Emergent Operation 相關圖片 簡振仁 (M,1963/11/09,48y4m) 手術日期 2010/04/10 手術主治醫師 楊士弘 手術區域 東址 003房 01號 診斷 Liver cancer 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 蕭柏妮 ASA 3 紀錄醫師 李建勳, 時間資訊 07:40 報到 08:03 進入手術室 08:10 麻醉開始 08:45 誘導結束 09:15 抗生素給藥 09:43 手術開始 12:15 抗生素給藥 15:15 抗生素給藥 18:15 抗生素給藥 19:40 麻醉結束 19:40 手術結束 19:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 惡性病髓腫瘤切除術 1 1 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 15 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Right lateral parascapular approach for excis... 開立醫師: 楊士弘 開立時間: 2010/04/10 20:15 Pre-operative Diagnosis Vertebral metastasis, T3; Hepatoma Post-operative Diagnosis Vertebral metastasis, T3; Hepatoma Operative Method Right lateral parascapular approach for excision of T3 vertebral tumor; posterior fixation with transpedicle screws and rods Specimen Count And Types 1 piece About size:小 Source:T3 vertebral tumor Pathology Pending Operative Findings The T3 vertebral body was infiltrated by greyish red, soft elastic, moderately vasculared tumor. The anterior longitudinal ligament was infiltrated by the tumor. The tumor indented the posterior longitudinal ligament. The thecal sac re-expanded well after tumor excision. Operative Procedures 1. ETGA, prone, head fixed with Mayfield skull clamp. 2. L-shaped incision, with a vertical limb from C6 to T6 and the horizontal limb curved below the right scapula. 3. Detachment of the right trapezius, rhomboid, serratus posterior superior muscles from the spinous processes and retracted laterally. 4. Detachment of right paraspinal muscles from the spinous processes, lamina, and transverse processes, and retracted superiorly. 5. Removal of a segment of 5 cm long 3rd and 4th ribs from the costotransverse joint laterally. 6. Costotransversectomy, right T3 and T4. 7. Diskectomy, right T2-3 and T3-4. 8. Corpectomy of the T3 vertebral body and tumor excision. 9. Insertion of a 12 mm diametered expandable body cage into the T3 corpectomy site. 10. Adjustment of the cage position and height with C-arm fluoroscopy. 11. Insertion of transpedicle screws system (A-spine)under C-arm guide: left T1, 5.0 mm x 35 mm right T1, left T2, 4.5 mm x 25 mm bilateral T4, T5, 4.5 mm x 30 mm rods: 13 cm long on each side cross links x 2 12. Hemostasis 13. Two hemovac drain in the epilaminal space; one CWV drain in the corpectomy site. 14. Wound closure in layers. Operators 楊士弘 Assistants 李建勳 相關圖片 鄭竹田 (M,1937/11/30,74y3m) 手術日期 2010/04/10 手術主治醫師 謝榮賢 手術區域 東址 006房 02號 診斷 ICH, trauma 器械術式 Reduction of mandible;simple 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 蕭柏妮 ASA 3 紀錄醫師 游彥辰, 時間資訊 23:31 臨時手術NPO 09:42 報到 10:00 進入手術室 10:05 麻醉開始 10:30 誘導結束 10:40 手術開始 12:33 手術結束 12:33 麻醉結束 12:52 送出病患 12:55 進入恢復室 15:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 深部複雜臉部創傷處理–小　５公分以內 1 0 L 手術 下顎骨骨折開放性復位（簡單） 1 1 B 摘要__ 手術科部: 外科部 套用罐頭: 1. Open reduction internal fixation to mandib... 開立醫師: 游彥辰 開立時間: 2010/04/10 13:19 Pre-operative Diagnosis 1. Bilateral mandible ramus fracture; 2. Facial laceration Post-operative Diagnosis 1. Bilateral mandible ramus fracture; 2. Facial laceration Operative Method 1. Open reduction internal fixation to mandible fracture; 2. Wound repair to facial laceration Specimen Count And Types nil Pathology Nil Operative Findings Bilateral mandible ramus fracture was noted. The right side fracture was located at mandible ramus with minimal displacement and was stable. A linear mini-plate was fixed to the fracture line with 4 screws. The left side fracture was at mandible ramus near angle, with severe displacement (anterior part fractured inward). After reduction, the fracture line was fixed with a linear mini-plate with 4 screws. There was one through-through laceration wound at left upper lip. Wound repair was performed in layers. Another laceration wound was found at left cheek and was sutured. Operative Procedures After nasal ETGA, the patient was placed in supine position. Anti-septic preparation was done. Two linear incision was made at lower gingiva. Dissection was performed deep to mandible bone and the periosteum was elevated with protection of mental nerve. The fracture was reduced and linear mini-plate was applied to fix the fracture with 4 screws for each side of fracture. After adequate irrigation, the wound was closed in layers. The left upper lip and left cheek laceration wounds were repaired then. Operators VS謝榮賢 Assistants R5陳思恒, R3游欣樺, R1黃世銘 相關圖片 黃輝明 (M,1953/07/22,58y7m) 手術日期 2010/04/11 手術主治醫師 曾勝弘 手術區域 東址 001房 01號 診斷 Subdural hemorrhage 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 蕭柏妮 ASA 3E 紀錄醫師 李振豪, 時間資訊 22:00 開始NPO 02:24 通知急診手術 03:00 報到 03:05 進入手術室 03:10 麻醉開始 03:20 誘導結束 03:45 抗生素給藥 03:56 手術開始 05:00 手術結束 05:00 麻醉結束 05:10 進入恢復室 05:10 送出病患 06:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 手術 慢性硬腦膜下血腫清除術 1 1 摘要__ 手術科部: 外科部 套用罐頭: Burr hole drainage of chronic subdural hematoma 開立醫師: 李建勳 開立時間: 2010/04/11 05:10 Pre-operative Diagnosis Left chronic subdural hematoma Post-operative Diagnosis Left chronic subdural hematoma Operative Method Burr hole drainage of chronic subdural hematoma Specimen Count And Types 1 piece About size:10ml Source:chronic subdural hematoma Pathology Nil Operative Findings 1. Large amount (about 70mL) of darkreddish liquified hematoma drainaged out from subdural space after open the thickened outter membrane. 2. The brain parenchyma was not expand well while closing the wound. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position. The scalp was shaved, scrubbed and antiseptic with alcohol better-iodine then draped. One linear scalp incision was made at left posterior frontal area followed by burr hole creation. The dura was tenting with 3-0 silk before opening. After opened the outter membrane of hematoma and normal saline irrigation at four direction, one rubber drain with side holes was left in the subdural space. The wound was closed in layers and performed de-air procedure with the rubber drain then connected to the drainage bag. Operators VS 曾勝弘 Assistants R3 李振豪 R6 李建勳 Indication Of Emergent Operation 相關圖片 張山龍 (M,1957/02/04,55y1m) 手術日期 2010/04/11 手術主治醫師 賴達明 手術區域 東址 002房 02號 診斷 Intracerebral hemorrhage 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 蕭柏妮 ASA 3E 紀錄醫師 張得一, 時間資訊 16:40 開始NPO 16:40 臨時手術NPO 16:40 通知急診手術 17:10 報到 17:15 麻醉開始 17:42 進入手術室 18:00 抗生素給藥 18:05 誘導結束 18:15 手術開始 21:25 麻醉結束 21:25 手術結束 21:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 摘要__ 手術科部: 外科部 套用罐頭: Left craniotomy for ICH evacuation 開立醫師: 胡朝凱 開立時間: 2010/04/11 21:49 Pre-operative Diagnosis Left putaminal ICH Post-operative Diagnosis Left putaminal ICH Operative Method Left craniotomy for ICH evacuation Specimen Count And Types NIL Pathology Hematoma Operative Findings 1.About 30 ml hematoma located at left putaminal area\ 2.A small bleeder was noted at the base of the hematoma 3.Peripheral brain tissue became fragile and easy touch bleeding 4.After hematoma removal, brain became slack Operative Procedures 1.ETGA, supine with head rotate to right 2.Left Curvature skin incision was made at temporal to frontal area 3.Dissect to reflect skin flap 4.Split temoparis muscle 5.Craniotomy 6.Dural tenting 7.Cruciate form dural opening 8.Corticotomy at Left inferior frontal gyrus 9.ICH evacuation 10.hemostasis 11.Close dura with prolene 12.Fixed bone back with miniplate 13.Close wound in layers Operators 賴達明 Assistants 胡朝凱,張得一 Indication Of Emergent Operation 戴淑麗 (F,1950/01/06,62y2m) 手術日期 2010/04/12 手術主治醫師 曾漢民 手術區域 東址 005房 03號 診斷 Brain cancer 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 陳睿生, 時間資訊 00:00 臨時手術NPO 14:30 報到 15:50 進入手術室 15:55 麻醉開始 16:15 誘導結束 16:24 抗生素給藥 16:55 手術開始 19:45 麻醉結束 19:45 手術結束 19:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４小時以內 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for total tumor remove 開立醫師: 陳睿生 開立時間: 2010/04/12 20:26 Pre-operative Diagnosis Right occipitoparietal tumor, suspect high grade astrocytoma Post-operative Diagnosis Right occipitoparietal tumor, suspect high grade astrocytoma Operative Method Craniotomy for total tumor remove Specimen Count And Types 1 piece About size:2X2X2CM Source:TUMOR Pathology Pending Operative Findings The tumor was soft, fragile, and multiple cystic component was also noted. It extended to the surface of the cortex, and the solid mass size was about 2x2x2cm after cystic drainage. The tumor was poor defined from peripheral brain tissue, and was well vascularized from peripheral brain tissue. Operative Procedures 1. ETGA, prone position and head fix with Mayfield clump 2. Inverse U scalp incision over right occipital region 1. ETGA, prone position and head fix with Mayfield clump 2. Inverse U scalp incision over right occipital region 3. Create four bur holes and an about 8x8cm craniotomy window was made 4. Dura tacking, and intra-op ECHO was performed for survey 5. Open the dura along the craniotomy window, and the tumor was noted at the cortex surface 6. Drain out the cystic component 7. Carefully dissect the tumor from peripheral tissue with bipolar and scissors 8. En bloc removal of the tumor 9. Hemostasis, close the dura tightly with fascia graft 10.Set a subgaleal CWV drain 11.Close the wound in layers Operators VS 曾漢民 Assistants R5 陳睿生, Ri 沈賢圳 (M,1956/11/10,55y4m) 手術日期 2010/04/12 手術主治醫師 李章銘 手術區域 東址 007房 03號 診斷 Esophagus cancer 器械術式 Port-A catheter implatation 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 趙安怡 ASA 3 紀錄醫師 李佳穎, 時間資訊 23:59 臨時手術NPO 15:10 報到 15:22 進入手術室 15:27 麻醉開始 15:35 誘導結束 15:40 抗生素給藥 15:50 手術開始 17:25 手術結束 17:25 麻醉結束 17:34 送出病患 17:40 進入恢復室 19:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腹腔鏡空腸造廔術 1 1 L 手術 ｐｏｒｔ–Ａ導管植入術–治療性導管植入術 1 0 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Gasless jejunostomy + Port-A insertion. 開立醫師: 李佳穎 開立時間: 2010/04/12 17:29 Pre-operative Diagnosis esophageal cancer Post-operative Diagnosis ditto. Operative Method Gasless jejunostomy + Port-A insertion. Specimen Count And Types nil Pathology nil. Operative Findings 1.Jejunostomy was inserted 40cm below Treitz ligament. 2.port-A tip over SVC. Operative Procedures 1.ETGA with supine position. 2.Gasless setting and jejunostomy creation. 3.Wound closure by layers . 4.Puncture to Lt subclavian vein and port-A was inserted. 5.CxR check-up and wound closure. Operators VS李章銘 Assistants r4李佳穎 劉家豪 (M,1996/12/27,15y2m) 手術日期 2010/04/12 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:06 進入手術室 08:20 麻醉開始 08:45 誘導結束 09:45 抗生素給藥 10:00 手術開始 11:40 開始輸血 12:50 抗生素給藥 15:45 抗生素給藥 19:07 抗生素給藥 20:50 麻醉結束 20:50 手術結束 21:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在８小時以上 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 17 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Left pterional approach for tumor excision an... 開立醫師: 李建勳 開立時間: 2010/04/12 21:20 Pre-operative Diagnosis Left sphenoidal ridge meningioma Post-operative Diagnosis Left sphenoidal ridge meningioma Operative Method Left pterional approach for tumor excision and cranioplasty Specimen Count And Types Multipe pieces About size:6x4x3cm Source:Left sphenoidal ridge meningioma Pathology Pending Operative Findings Hyperostosis of frontal skull bone was noted with pinikish color; thin skull bone formation was noted over the previous Duragen coverage of F-T craniectomy window; Mild brain swelling was noted after dural opening; severe adhesion over left sylvian fissure was noted. The tumor was whitish-to-yellowish, well-demarcated, hypervascularized, elastic-firm in consistency, about 6x4x3cm in size, with encasemet of left MCA and its branchs, direct impressing left optic nerve to right side, and direct invading into left cavernous sinus to pituitary fossa and left middle fossa. The left lateral ventricular wall was noted medial to the tumor. Operative Procedures Under ETGA and supine position with head rotated to right side, the scalp was disinfected and drapped as usual after head fixed with Mayfield head clump. Skin incision was made along the previous operative wound and dissected temporalis muscle from the dura and the craniectomy window was extended to expose the left frontal lobe as pterional approach. Tumor excision over left temporal base was done in piecemeal with cavitron ultrasonic surgical aspirator (CUSA), bipolar cauterization and tumor forceps. Severe adhesion of left sylvian fissure was noted and central debulking of left temporal base tumor was performed at first until left optic nerve was exposed. The tumor near the ophthalmic segment of ICA was excised with some bleeding was noted and template clips were applied and removed after hemostasis with Surgicel. The remaining tumor was removed piece by piece after bipolar cautery. Hemostasis was achieved with Surgicel lining of the tumor bed. The dura was closed with 4-0 Prolene sutures. The skull plate was fixed back with miniplates and screws. The wound was closed in layers after one subgaleal closed wound vacuum(CWV) drain set up. Operators P 杜永光 Assistants R3 林哲光/ R6 李建勳 相關圖片 施冠聿 (M,1973/06/01,38y9m) 手術日期 2010/04/12 手術主治醫師 廖漢文 手術區域 東址 000房 號 診斷 Carotid body tumor 器械術式 NEURO T.A.E 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 王永彬 ASA 3 時間資訊 11:30 麻醉開始 11:50 誘導結束 14:10 麻醉結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 林彥伶 (F,1966/08/17,45y6m) 手術日期 2010/04/12 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Secondary cancer of brain and spinal cord 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 古恬音, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:00 進入手術室 08:12 麻醉開始 09:00 誘導結束 09:05 抗生素給藥 09:11 手術開始 11:40 麻醉結束 11:40 手術結束 11:53 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除－手術時間在４小時以內 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT 開立醫師: 古恬音 開立時間: 2010/04/12 12:16 Pre-operative Diagnosis Left frontoperiatal tumor, suspected high-grade glioma Post-operative Diagnosis Left frontoperiatal tumor, suspected high-grade glioma Operative Method Left frontoparietal craniotomy for tumor excision Specimen Count And Types 1 piece About size:1*1 Source: Pathology Frozen section: high-grade malignancy, suspected GBM or metastatic Operative Findings One hypervascular, whitish tumor was noted at left frontoparietal region, about 3.5cm in size. Cystic component was noted within the tumor, and the content was clear. The tumor was located beneath and immediately posterior to the sensory cortex according to intraoperative mapping. Frozen section revealed high-grade malignancy, suspected GBM or metastatic lesion. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with the head rotated to right and fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected with better iodine. Then draping was done in usual fashion. One U-shaped scalp incision was made at left fronto-parietal region. 8*6cm craniotomy window was made after for 4 Burr holes. The dura was opened in after peripheral tenting. Tumor excision was performed with bipolar coagulation and tumor forceps after corticotomy. Hemastasis was achieved with bipolar coagulation and Surgicel lining of tumor bed. After tumor removal, the dura was closed with 5-o prolene. The bone plate with fixed back with miniplates after setting on CWV drain, then the wound was closed in layers. Operators VS曾漢民 Assistants R5陳睿生, R2古恬音 謝秉倫 (M,1982/05/02,29y10m) 手術日期 2010/04/12 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Astrocytoma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 陳睿生, 時間資訊 00:00 臨時手術NPO 11:40 報到 12:16 麻醉開始 12:45 誘導結束 13:00 抗生素給藥 13:16 手術開始 13:16 進入手術室 15:10 麻醉結束 15:10 手術結束 15:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４小時以內 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for tumor total removal 開立醫師: 陳睿生 開立時間: 2010/04/12 15:46 Pre-operative Diagnosis Right frontal astrocytoma status post with recurrence Post-operative Diagnosis Right frontal astrocytoma status post with recurrence Operative Method Craniotomy for tumor total removal Specimen Count And Types 1 piece About size:pieces Source:tumor Pathology Pending Operative Findings The tumor was hardish, elastic and well margined from peripheral normal brain tissue. It was about 2cm in diameter, and located in front of the sylvian fissure. Operative Procedures 1. ETGA, supine position and head fix with Mayfield clump 2. Right frontal scalp incision along previous wound 3. Incise into temporalis muscle, and remove previous skull graft with sew 4. Localize the tumor with ECHO and navigation, and the dura was opened curvillinearly 5. Identify the tumor at the posterior frontal region and dissect the margin between the tumor and normal brain 6. Totally remove the tumor under navigation guided 7. Hemostasis, and the dura was tightly closed with fascia anf Durafoam graft 8. Fix back skull graft with miniplates x3 9. Set a subgaleal CWV drain 10.Close the wound in layers Operators VS 曾漢民 Assistants R5 陳睿生;R2 古恬音 江李梅鳳 (F,1942/11/04,69y4m) 手術日期 2010/04/12 手術主治醫師 王水深 手術區域 兒醫 068房 03號 診斷 Acute leukemia 器械術式 Port-A Implatation /WOR 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 徐綱宏, 時間資訊 19:21 報到 19:30 進入手術室 19:35 抗生素給藥 19:38 麻醉開始 19:40 誘導結束 19:41 手術開始 20:07 麻醉結束 20:07 手術結束 20:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 內頸靜脈切開，永久導管放置術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Port-A 開立醫師: 徐綱宏 開立時間: 2010/04/12 20:13 Pre-operative Diagnosis AML Post-operative Diagnosis AML Operative Method Port-A catheter implantation Specimen Count And Types nil Pathology nil Operative Findings The venous blood flow freely in the Port-A catheter after implantation. Operative Procedures The patient was put on supine position. The operation field was disinfected and draped as usual. Under local anesthesia, the Port-A catheter was implanted on right side upper chest with puncture method via RIJV under echo guide Post-op care plan: 1.wound CD QD+PRN2.pain control with tinten 3.prophylatic antibiotics use Operators 王水深 Assistants 徐綱宏 許文勇 (M,1960/01/08,52y2m) 手術日期 2010/04/12 手術主治醫師 劉嘉銘 手術區域 西址 035房 04號 診斷 Malignant neoplasm of trachea 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林至芃 ASA 3 紀錄醫師 林彥翰, 時間資訊 15:10 報到 15:10 進入手術室 15:12 麻醉開始 15:13 誘導結束 15:30 手術開始 15:50 麻醉結束 15:50 手術結束 15:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 氣管切開造口術 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 耳鼻喉部 套用罐頭: tracheostomy 開立醫師: 林彥翰 開立時間: 2010/04/12 20:33 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure,operated Operative Method Tracheostomy Specimen Count And Types Nil Pathology Nil Operative Findings A No. 8 Low-Pressure cuffed tracheostomy tube was inserted Operative Procedures (1)The patient was in supine position with neck hyperextended. ETGA was performed. (2)Skin was disinfected and draped as usual. Local anesthesia with Bosmin-rinsed Xylocaine was injected into the subcutaneous tissue and the pretracheal area. (3)A vertical skin incision was made in the midline of lower neck. (4)Subcutaneous tissue, fascia and strap muscles were seperated, then the thyroid gland was seen and hooked upwards with thyroid hooks. (5)The tracheal rings were cut in longitudinal direction. A oval-shaped window was made at the 2 nd to 3 rd tracheal rings. (6)A No.8 Low-Pressure cuffed tracheostomy tube was inserted. (7)The patient tolerated the above procedure well. Operators AP 劉嘉銘 Assistants R2 林彥翰/ R4 林哲儀 廖輝鳳 (F,1964/07/30,47y7m) 手術日期 2010/04/12 手術主治醫師 王國川 手術區域 東址 001房 02號 診斷 顱內出血(ICH) 器械術式 Tracheostomy 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 4E 紀錄醫師 胡朝凱, 時間資訊 00:00 開始NPO 00:00 臨時手術NPO 12:08 報到 12:08 進入手術室 12:10 麻醉開始 12:12 誘導結束 12:35 手術開始 13:00 抗生素給藥 13:10 麻醉結束 13:10 手術結束 13:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 手術 氣管切開造口術 1 0 摘要__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 胡朝凱 開立時間: 2010/04/12 13:14 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Ditto Operative Method Tracheostomy Specimen Count And Types nil Pathology None Operative Findings Fr . 7, low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. After endotracheal tube general anesthesia, supine position is made with shoulder elevation. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators 王國川 Assistants 胡朝凱, Ri Indication Of Emergent Operation 賴上錦 (F,1952/03/01,60y0m) 手術日期 2010/04/13 手術主治醫師 李章銘 手術區域 東址 018房 02號 診斷 Lung cancer 器械術式 Thoracoscopy+Open Chest 手術類別 預定手術 手術部位 胸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 梁嘉儀, 時間資訊 12:50 進入手術室 12:55 麻醉開始 13:20 誘導結束 13:38 抗生素給藥 13:57 手術開始 18:00 抗生素給藥 20:30 手術結束 20:30 麻醉結束 20:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 胸腔鏡肺葉切除術 1 1 L 手術 根除性淋巴切除術（肺葉切除或全肺切除時） 1 2 L 麻醉 術後止痛 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 7 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: 1. VATS right LN dissection and right lower l... 開立醫師: 梁嘉儀 開立時間: 2010/04/13 20:31 Pre-operative Diagnosis 1. Left upper lobe adenocarcinoma with LN metastasis status post port-A insertion and chemothoerapy 2. Right lower lobe nodule Post-operative Diagnosis Left upper lobe adenocarcinoma with LN metastasis status post port-A insertion and chemothoerapy 2. Right lower lobe nodule, fibrosis Operative Method 1. VATS right LN dissection and right lower lobe wedge resection 2. VATS left upper lobe lobectomy and LN dissection 2. VATS left upper lobe lobectomy with B6 wedge resection and LN dissection 3. Port-A removal Specimen Count And Types 5 pieces About size:12cm Source:LUL About size:3cm Source:RLL About size:0.3cm Source:Gr.3,4 About size:0.4cm Source:Gr.7 About size:0.3cm Source:Gr.10 Pathology Pending Operative Findings 1. Around 0.2cm small nodule, greyish, at right lower lobe, Frozen: fibrosis 2. Around 2.5cm with cavity, yellowish mass was noted at left upper lobe 2. Around 2.5cm with cavity, yellowish mass was noted at left upper lobe, near fissure 3. No enlargement was seen in Gr.3,4,7,10 LN 4. Incomplete fissure (+) 5. Port-A was removed smoothly Operative Procedures 1. DLETGA, left decubitus 2. Disinfection and drapping 3. VATS setting 4. Gr.3,4,7 LN dissection 5. RLL wedge resection by endo GIA-60 6. Send to Frozen 7. Check bleeding and hemostasis 8. Chest tube Fr. 28 x 1 9. Closed the wound in layers 10.DLETGA, right decubitus 11.Disinfection and drapping 12.VATS setting 13.Dissect and transect fissure by endo GIA-60 14.Transect pulmonary artery by endo GIA-30 pulmonary vein by endo GIA-45 bronchus by endo GIA-45 15.Gr.10,11,3 LN dissection 16.Check bleeding and hemostasis 17.Chest tube Fr.28 x 1 18.Closed the wound in layers 19.DLETGA, supine position 20.Left port-A was removed Operators VS 李章銘 Assistants R5 張彥俊 R5 梁嘉儀 Ri 曾文萱 林麗娟 (F,1969/04/21,42y10m) 手術日期 2010/04/13 手術主治醫師 吳明勳 手術區域 東址 012房 03號 診斷 Goiter nodular 器械術式 Total thyroidectomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉育彰 ASA 2 紀錄醫師 丘基泰, 時間資訊 11:40 報到 12:20 進入手術室 12:25 麻醉開始 12:30 誘導結束 12:30 抗生素給藥 12:46 手術開始 13:50 手術結束 13:50 麻醉結束 14:00 送出病患 14:05 進入恢復室 15:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 單側甲狀腺全葉切除術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Right total thyroidectomy 開立醫師: 丘基泰 開立時間: 2010/04/13 13:54 Pre-operative Diagnosis Multiple nodular goiter, right predominant Post-operative Diagnosis Multiple nodular goiter, right predominant Operative Method Right total thyroidectomy Specimen Count And Types 1 piece About size:6x5cm Source:Right lobe of thyroid Pathology Pending Operative Findings 1.Multiple nodular goiter,right lobe predominant, the largest one about 2.5cm 2.Recurrent laryngeal nerve was preserved Operative Procedures 1.ETGA, supine, neck hyperextension 2.Curviture skin incision 3.Mobilized right lobe of thyroid, identified right recurrent laryngeal nerve 4.Right total thyroidectomy by ligasure 5.Surgicel packing, a mini-hemovac was set 6.Closed the wound Operators 吳明勳 Assistants 丘基泰 孔維寧 (M,1947/11/05,64y4m) 手術日期 2010/04/13 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Hydrocephalus 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳柏達, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:06 進入手術室 08:12 麻醉開始 08:25 誘導結束 09:00 抗生素給藥 09:05 手術開始 10:10 手術結束 10:10 麻醉結束 10:20 送出病患 10:25 進入恢復室 11:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室腹腔分流手術 1 1 摘要__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt via right Kocher^s... 開立醫師: 陳睿生 開立時間: 2010/04/13 10:27 Pre-operative Diagnosis Normal pressure hydrocephalus Post-operative Diagnosis Normal pressure hydrocephalus Operative Method Ventriculoperitoneal shunt via right Kocher^s point Specimen Count And Types 3 pieces About size:2ml Source:CSF About size:2ml Source:CSF About size:2ml Source:CSF Pathology Nil Operative Findings The CSF was clear, and the ICP was about 5-10cmH2O. A medium pressure Metronic shunt set was inserted. The intraventricular shunt was 6.2cm in length, and the intra-abdominal shunt was about 20cm in length. Operative Procedures Operators Assistants 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 陳柏達 開立時間: 2010/04/13 10:29 Pre-operative Diagnosis Normal pressure hydrocephalus Post-operative Diagnosis Normal pressure hydrocephalus Operative Method Ventriculoperitoneal shunt via right Kocher^s point Specimen Count And Types 3 pieces About size:2ml Source:CSF About size:2ml Source:CSF About size:2ml Source:CSF Pathology nil Operative Findings The CSF was clear, and the ICP was about 5-10cmH2O. A medium pressure Metronic shunt set was inserted. The intraventricular shunt was 6.2cm in length, and the intra-abdominal shunt was about 20cm in length. 3 pieces About size:2ml Source:CSF About size:2ml Source:CSF About size:2ml Source:CSFNormal pressure hydrocephalus Ventriculoperitoneal shunt via right Kocher^s point The CSF was clear, and the ICP was about 5-10cmH2O. A medium pressure Metronic shunt set was inserted. The intraventricular shunt was 6.2cm in length, and the intra-abdominal shunt was about 20cm in length. Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: supine with head rotated (tilted) to left. 3.Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 5 cm curvilinear, right parietal, corresponded to the location of anterior horn. Raney clips were applied to the scalp edge for temporary hemostasis. 5.After the scalp flap had been lifted and reflected anteriorly, a burr hole was made and the dura was tented by 2 stitches. 6.The dura was opened by a nib incision. Rt lateral ventricle was tapped by a ventricular needle, then a 6.2 cm segment of the ventricular catheter was introduced into the ventricle. The outer end of the catheter was connected to a Pudenz reservoir. 7. A nib incision was made at RUQ of the abdomen , then a trocar was pushed into peritoneal cavity. Subsequently, distal 20 cm segment of the peritoneal catheter (medium pressure) was introduced into the peritoneal cavity through the outer tube of the trochar. The proximal end of this catheter was passed through subcutaneous tunnel at forechest, neck, rt retroauricular area and connected the reservoir. The shunt systemwas checked to make sure its function was working. 8. The reservoir was fixed to pericranium by 3 stitches. 9. Scalp closure: hemostasis was done with monopolar coagulator touching on the sucker tip. Galea suture was performed by continuous suture with 3/0. Dexon and skin by continuous suture with 3/0 nylon. 10.Course of the surgery: smooth. Operators VS曾勝弘 Assistants R5陳睿生 R2陳柏達 李文金 (M,1954/10/31,57y4m) 手術日期 2010/04/13 手術主治醫師 曾勝弘 手術區域 東址 005房 02號 診斷 Carpal tunnel syndrome 器械術式 Decompression of mediun nerve 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 陳柏達, 時間資訊 00:00 臨時手術NPO 10:40 報到 10:50 進入手術室 11:00 抗生素給藥 11:10 麻醉開始 11:11 誘導結束 11:12 手術開始 11:12 麻醉結束 12:25 手術結束 12:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 正中神經或尺神經腕部減壓術–單側 1 2 R 手術 神經分離術–肩，臀關節以上，包括臂神經叢，坐骨神經 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Carpal Tunnel Syndrome 開立醫師: 陳柏達 開立時間: 2010/04/13 13:55 Pre-operative Diagnosis Carpal tunnel syndrome and ulnar nerve compression Post-operative Diagnosis Carpal tunnel syndrome and ulnar nerve compression Operative Method Median nerve release and ulnar nerve neurolysis Specimen Count And Types nil Pathology nil Operative Findings 1. Median nerve was entraped in trasverse carpal ligament and relased after dissection. 2. Ulnar nerve was entraped distally in Cubital tunnel and relased after dissection Operative Procedures 1.The hand and forearm were sterilized with povidone-iodine tincture, then covered with stockinet. 2.Anesthesia: tourniquet was applied at distal upper arm, then regional block with 15 ml 1% Xylocaine solution was infused through cephalic vein catheter at wrist area. 3. Incision: S shape from vertical palmar crease to transverse wrist crease. 4.The palmaris longus tendon was identified, then the plamar aponeurosis was cut longitidinally along the ulnar side of the palmaris longus tendon. 5. Themedian nerve was identified beneath the palmars longus tendon. Under direct vision, the transverse carpal ligament was divided until no more pressure on the median nerve could be palpated. 6. The skin was closed by interrupted suture with 4/0 nylon.7.The tourniquet was released. The hand and wrist were draped with fluffy dressing and elastic bandage. Operators VS曾勝弘 Assistants R5陳睿生 R2陳柏達 李翊豪 (M,2009/06/02,2y9m) 手術日期 2010/04/13 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Encephalocele 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 游彥辰, 時間資訊 00:00 臨時手術NPO 07:57 報到 08:05 進入手術室 08:20 麻醉開始 09:00 誘導結束 09:25 抗生素給藥 09:56 手術開始 10:00 開始輸血 12:25 抗生素給藥 15:25 抗生素給藥 18:25 麻醉結束 18:25 手術結束 18:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顏面皮膚及皮下腫瘤切除術１～２公分 1 2 手術 眼窩成形術 1 1 手術 顱顏合併手術 1 1 B 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 12 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 3 0 麻醉 Hemoglobin (Hb) 3 0 麻醉 測血糖 3 0 麻醉 Ca (Calcium) 3 0 麻醉 Na (Sodium) 3 0 麻醉 K (Potassium) 3 0 麻醉 Cl (Chloride) 3 0 麻醉 Blood gas analysis 3 0 手術 頭顱成形術 1 2 摘要__ 手術科部: 外科部 套用罐頭: cranioplasty 開立醫師: 陳思恆 開立時間: 2010/04/13 18:59 Pre-operative Diagnosis plagiocephaly, early fusion of the left part of coronal suture Post-operative Diagnosis plagiocephaly, early fusion of the left part of coronal suture Operative Method cranioplasty Specimen Count And Types Pathology nil Operative Findings Plagiocephaly, early fusion of the left part of the coronal suture, with relative depression of the left frontal area and left supraorbital bar, and compensative bulging of the left temporal region. Cranioplasty was performed with take down of the frontal bone and supraorbital bar and reshaping with bending and combination of the bone segments of the bone grafts. The bone grafts were fixed with absorbable plates. A 0.5 x 0.5 cm firm tumor was noted at right upper eyelid lateral side with severe adhesion to its overlying lid skin. Operative Procedures ETGA, supine, antiseptics applied. Elevate scalp flap via bicoronal incision. Elevate the galeal flap with bilateral superficial temporal fascia. Take down of the frontal bone by neurosurgeons. Take down the supraorbital bar. Bending of the supraorbital bar to make protrusion of the left side supraorbital region and increase the orbital volume. Cut the frontal bone into 4 pieces and reshape the frontal area to increase intracranial volume. Fixation with absorbable plates. One CWV inserted. Wound closure in layers. Removal of right upper eyelid tumor and wound closure. Operators 謝孟祥, 郭夢菲 Assistants 陳思恆, 陳德福, 游欣樺 周淑芬 (F,1939/05/31,72y9m) 手術日期 2010/04/13 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Lumbar spondylosis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:07 進入手術室 08:20 麻醉開始 08:30 誘導結束 09:00 抗生素給藥 09:40 手術開始 12:00 抗生素給藥 14:05 手術結束 14:05 麻醉結束 14:14 送出病患 14:17 進入恢復室 15:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 手術 椎間盤切除術－腰椎 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 摘要__ 手術科部: 外科部 套用罐頭: Right L4~5 hemilaminectomy for discectomy, ba... 開立醫師: 游健生 開立時間: 2010/04/13 14:13 Pre-operative Diagnosis L4~5 spondylolisthesis and spinal stenosis Post-operative Diagnosis L4~5 spondylolisthesis and spinal stenosis Operative Method Right L4~5 hemilaminectomy for discectomy, banana cage insertion, and percutaneous TPS insertion at L4~5 Specimen Count And Types Nil Pathology Nil Operative Findings 1.Hypertrophic flavum ligment was noted. 2.L4~5 protruding disc theat compressed teh thecal sac and roots tightly 3.10# banana cage was used 4. 4.L4~5 percutaneous TPS was done Operative Procedures 1.ETGA, prone 2.Midline incision at L4~5 level 3.Detache right paravertebral muscle 4.Right L5 hemilaminectomy 5.Remove right L4~5 facet 6.Resect flavum ligment 7.Discectomy 8.Cage insertion 9.Close wound after one hemovac drain insertion 10.Paramedian 4 skin incision 11.Biopsy needle insertion to localization 12.Insert K-pin as a guide 13.Screws insertion 14.Rod fixation 15.Close wound in layers Operators 賴達明 Assistants 胡朝凱, 游健生 梁鄭照 (F,1937/11/26,74y3m) 手術日期 2010/04/13 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Spondylolisthesis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 14:05 報到 14:34 進入手術室 14:40 麻醉開始 14:50 誘導結束 15:15 抗生素給藥 15:31 手術開始 18:20 手術結束 18:20 麻醉結束 18:30 送出病患 18:38 進入恢復室 20:08 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 手術 椎間盤切除術－腰椎 1 2 摘要__ 手術科部: 外科部 套用罐頭: L4~5 TPS and discectomy for cage insertion 開立醫師: 胡朝凱 開立時間: 2010/04/13 18:32 Pre-operative Diagnosis l4~5 spondylolisthesis and spinal stenosis Post-operative Diagnosis l4~5 spondylolisthesis and spinal stenosis Operative Method L4~5 TPS and discectomy for cage insertion Specimen Count And Types Nil Pathology nil Operative Findings 1.Hypertrophic flavum ligment and protruding disc that compressed the thecal sac tightly 2.Anterior listhesis of L4 on L5 3.11# cages were inserted into L4~5 disc space Operative Procedures 1.ETGA, prone 2.Midline incision at L4~5 level 3.Detach paravertebral muscle group 4.Expose transverse process and facet 5.Screws insertion 6.L4~5 laminotomy 7.resected flavum ligment 8.Discectomy 9.Cage insertion 10.Fix rods 11.Close wound in layers after one hemovac drain inseriton Operators 賴達明 Assistants 胡朝凱,游健生 林佑聲 (M,1974/07/18,37y7m) 手術日期 2010/04/13 手術主治醫師 賴達明 手術區域 東址 005房 03號 診斷 Spinal tumor 器械術式 Benign intraspinal tumor, exci 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 陳柏達, 時間資訊 00:00 臨時手術NPO 12:30 報到 13:00 進入手術室 13:05 麻醉開始 13:10 誘導結束 13:40 抗生素給藥 14:17 手術開始 16:16 手術結束 16:19 麻醉結束 16:30 送出病患 16:35 進入恢復室 17:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 良性病髓腫瘤切除術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 陳睿生 開立時間: 2010/04/13 16:38 Pre-operative Diagnosis T7-8 extraspinal tumor, suspect hemangioma Post-operative Diagnosis T7-8 extraspinal tumor, suspect hemangioma Operative Method T7 hemilaminectomy for total tumor remove Specimen Count And Types 1 piece About size:1.5 X1.5CM Source:TUMOR Pathology Pending Operative Findings The tumor located at right T7-8 epidural space. It compressed the cord to the left side. The tumor was soft, reddish, and well capsuled. It also extended to the right T7 foramen. The tumor was easily dissected from peripheral tissue, and was totally removed. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: prone. 3. Skin preparation: the back was shaved and scrubbed with povidone-iodine detergent then painted with povidone-iodine tincture and followed by sterilized adhesive plastic sheet covering. 4. A spinal needle was inserted between spinous processes of T9-T10 and a portable X-ray film was taken, andestimated location was calculated with image for T7-T8 approach 5. Incision: 6 cm, over spinous processes from T7/T8 6. The latissimus dorsi, trapezius,serratus posterior inferior and spinalis thoracis muscles were detached from spinous processes of T7 on both sides by Bovie 7. The bleeding from the muscles were stopped by Bovie 8. The spinous processes and of T7 were bitten off with rongeurs and Kerrison punch until the posterior half of the spinal canal was widely opened. (The spinous process was removed as a whole piece by cutting with Kerrison punch ) 9. The tumor was exposed after removal of spinous process. With gross vision and then microscopic dissection, the tumor was removed en bloc. 10. After placement of one submuscular CWV and hemostasis, paravertebral muscles were closed by interrupted sutures, with 1/0 vicryl, subcutaneous layer by continuous suture with 3/0 vicryy, and skin by continuous suture with 3/0 nylon. Operators VS 賴達明 Assistants R5陳睿生 R2陳柏達 楊長壽 (M,1947/07/20,64y7m) 手術日期 2010/04/13 手術主治醫師 黃凱文 手術區域 東址 013房 04號 診斷 Hepatic cancer 器械術式 R.F.A 手術類別 預定手術 手術部位 腹 傷口分類 清潔 麻醉方式 面罩麻醉 麻醉主治醫師 葉育彰 ASA 3 紀錄醫師 朱峻緯, 時間資訊 14:28 報到 14:54 進入手術室 15:00 麻醉開始 15:03 抗生素給藥 15:05 誘導結束 15:20 手術開始 16:00 手術結束 16:00 麻醉結束 16:05 送出病患 16:10 進入恢復室 17:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 肝腫瘤無線頻率電熱療法－小於３公分 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Semi-opened mask inhalation anes 1 0 記錄__ 手術科部: 外科部 套用罐頭: Radiofrequency Ablation(RFA) 開立醫師: 朱峻緯 開立時間: 2010/04/13 15:17 Pre-operative Diagnosis Hepatocellular carcinoma Hepatocellular carcinoma s/p TAE, s/p RFA, with recurrence Post-operative Diagnosis Ditto Operative Method Radiofrequency Ablation(RFA) Specimen Count And Types nil Pathology nil Operative Findings One 1.2cm tumor at S6, One 1.2cm tumor at S6, SWCT with 3cm tip needles x 3, ablation time: 12min. One 1.2cm tumor at S6, RFA with 3cm tip needles, ablation time: 12+12min. One 1.2cm tumor at S6, RFA with 3cm tip needle, ablation time: 12+12min. Operative Procedures 1. IVGA, supine position 2. Skin disinfection with B-I. 3. Local anesthesia with Xylocaine. 4. Identify the tumor with intra-operation echo. 5. Perform RFA/SWCT with 3 cm tip needles x 3, ablation time: 12min. 5. Perform RFA with 3 cm tip needles x 3, ablation time: 12min. 5. Perform RFA with 3 cm tip needle, ablation time: 12+12min. 6. Cover the wound with gauze. Operators VS黃凱文 Assistants R1朱峻緯 蘇芷誼 (F,1984/11/01,27y4m) 手術日期 2010/04/13 手術主治醫師 楊士弘 手術區域 東址 001房 04號 診斷 Polyneuropathy 器械術式 Excision of neuroma 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2E 紀錄醫師 李建勳, 時間資訊 13:12 開始NPO 13:12 臨時手術NPO 13:12 通知急診手術 15:15 進入手術室 15:20 麻醉開始 15:30 誘導結束 16:10 抗生素給藥 16:20 手術開始 19:32 手術結束 19:32 麻醉結束 19:45 送出病患 19:45 進入恢復室 20:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 手術 惡性病髓腫瘤切除術 1 1 摘要__ 手術科部: 套用罐頭: Partial excision of leptomeningeal tumor 開立醫師: 楊士弘 開立時間: 2010/04/13 20:00 Pre-operative Diagnosis Intraspinal leptomeningeal lesion, r/o recurrence of lymphoblastic leukemia Post-operative Diagnosis Intraspinal leptomeningeal lesion, r/o recurrence of lymphoblastic leukemia Operative Method Partial excision of leptomeningeal tumor Specimen Count And Types 3 pieces About size:小, 0.5 cm x 0.3 cm Source:arachnoid membrane About size:小, 0.5 cm x 0.5 cm Source:thickened pia mater coating on nerve roots About size:小. 0.8 cm x 0.8 cm Source:bone Pathology Frozen pathology: small round blue cells (+) Operative Findings Yellowish CSF drained out after opening the dura and arachnoid membrane. The arachnoid membrane was thickened and redundant, with some adhesion of the pia mater. The pia mater of roots was coated with a thin layer of greyish, soft fragile, moderately vascularized tumor. Operative Procedures 1. ETGA, prone. 2. C-arm localization of L2 spinous process. 3. Midline incision from L1 to L3. 4. Laminectomy of L2 and lower L1. 5. Longitudinal pening of dural mater. 6. Dissection and excision of arachnoid membrane to expose the nerve roots. 7. Microdissection of tumor from pia surface with dissectors, jewlery forceps, and microscissors under surgical microscope. 8. Partial tumor excision. 9. Dural closure with 5-0 prolene continuous suture. 10. Fixation of L2 lamina with miniplates and screws. 11. One epilaminal CWV drain. 12. Wound closure in layers. Operators 楊士弘 Assistants 陳盈志,李建勳 Indication Of Emergent Operation 相關圖片 陳佑嘉 (M,2009/10/28,2y4m) 手術日期 2010/04/13 手術主治醫師 許巍鐘 手術區域 兒醫 062房 02號 診斷 Tetralogy of Fallot 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 孟繁宇, 時間資訊 10:18 報到 10:18 進入手術室 10:20 麻醉開始 10:23 誘導結束 10:36 手術開始 11:50 麻醉結束 11:50 手術結束 11:57 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 氣管切開造口術 1 0 手術 支氣管鏡檢查 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 耳鼻喉部 套用罐頭: tracheostomy 開立醫師: 孟繁宇 開立時間: 2010/04/13 12:14 Pre-operative Diagnosis Resipratory failure Post-operative Diagnosis Resipratory failure,operated Operative Method Tracheostomy Specimen Count And Types 1 piece About size:0.5X0.5 Source:Trahceal ring Pathology Pending Operative Findings A No.4.5 shiley tracheostomy tube was inserted Operative Procedures (1)The patient was in supine position with neck hyperextended. (2)Skin was disinfected and draped as usual. Local anesthesia with Bosmin-rinsed Xylocaine was injected into the subcutaneous tissue and the pretracheal area. (3)A horizontal skin incision was made in the midline of lower neck. (4)Subcutaneous tissue, fascia and strap muscles were seperated, then the thyroid gland was seen and hooked upwards with thyroid hooks. (5)The tracheal rings were cut off in round shape. A round window was made at the 2 nd to 3 rd tracheal rings. (6) Trachea was reflected upward and forward and sutured to the surounding soft tissue and skin with 4-0 Nylon. (6)A No.4.5 shiley tracheostomy tube was inserted. (7)The patient tolerated the above procedure well. Operators Asp 許巍鐘 Assistants R4 林哲儀 R3 孟繁宇 摘要__ 手術科部: 耳鼻喉部 套用罐頭: Rigid bronchoscopy 開立醫師: 孟繁宇 開立時間: 2010/04/13 12:18 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Rigid bronchoscope Specimen Count And Types Nil Pathology Nil Operative Findings Pharynx: Nasopharynx_________No check____________ Tongue base__________Patent_____________ Vallecula____________Patent_______________ Hypopharynx___________Patent_____________ Larynx: Epiglottis______________Patent_____________ Aryepiglottic fold________Patent____________ Arytenoid cartilage_______Patent___________ Accesory cartilage_________Patent____________ True vocal fold_________Contact granulation____ False vocal folds__________Patent____________ Subglotttis__________________Patent___________ Trachea:___________________Patent____________ Carina: ___________Contact granulation_________ Right main bronchus:___Upper branch Corllapse__ Left main bronchus________Patent _________ Others:______________Nil_____________ Operative Procedures The patient was in supine position. Jet ventilation was used for impending airway obstruction. Rigid bronchoscopy was set and larynx, subglottis, trachea, carina, bilateral main bronchus, and right upper, middle, lower; left upper and lowerbronchus were checked. Bilateral lung irrigation with bosmin and xylocain effusion was done. Operators Asp 許巍鐘 Assistants R4 林哲儀 R3 孟繁宇 龔黃梨香 (F,1948/08/25,63y6m) 手術日期 2010/04/13 手術主治醫師 王國川 手術區域 西址 033房 1號 診斷 Carpal tunnel syndrome 器械術式 Excision of neuroma 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 09:30 進入手術室 09:35 麻醉開始 09:40 手術開始 10:30 手術結束 10:30 麻醉結束 10:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 神經分離術－上臂．前臂．大腿．小腿處之神經 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 曾峰毅 開立時間: 2010/04/13 10:39 Pre-operative Diagnosis Carpal tunnel syndrom, right Post-operative Diagnosis Carpal tunnel syndrom, right Operative Method Median nerve decompression Specimen Count And Types Nil Pathology Nil Operative Findings Median nerve was compressed tightly by fibrotic band. Nerve was relaxed after decompression. Operative Procedures With local anasethesia, the patient was put in supine postion with right arm in supination. Cruvilinear skin incision was made at right wrist, and dissected to release median nerve. The wound was closed in layers. Operators VS 王國川 Assistants R3 曾峰毅 陳庭輝 (M,1936/12/10,75y3m) 手術日期 2010/04/13 手術主治醫師 王國川 手術區域 西址 033房 2號 診斷 Carpal tunnel syndrome 器械術式 Decompression of mediun nerve 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 09:20 報到 10:45 進入手術室 11:00 麻醉開始 11:05 手術開始 11:45 手術結束 11:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 神經分離術－上臂．前臂．大腿．小腿處之神經 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 曾峰毅 開立時間: 2010/04/13 11:51 Pre-operative Diagnosis Carpal tunnel syndrome, right Post-operative Diagnosis Carpal tunnel syndrome, right Operative Method Median nerve decompression at right Specimen Count And Types Nil Pathology Nil Operative Findings Right median nerve was compressed by fibrotic band tightly. Median nerved was relieved well after decompression. Operative Procedures With local anaesthesia, the patient was put in supine position. Curvilinear skin incision was done at right wrist, and dissection was done to relieve median nerve. The wound was closed in layers. Operators VS 王國川 Assistants R3 曾峰毅 林玲珍 (F,1951/02/28,61y0m) 手術日期 2010/04/14 手術主治醫師 蔡瑞章 手術區域 東址 005房 01號 診斷 Benign neoplasm of pituitary gland 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 古恬音, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:00 進入手術室 08:05 麻醉開始 08:45 誘導結束 08:55 抗生素給藥 09:27 手術開始 11:50 開始輸血 11:50 抗生素給藥 12:50 麻醉結束 13:00 手術結束 13:10 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 經由蝶竇之腦下垂體瘤切除 1 1 摘要__ 手術科部: 外科部 套用罐頭: Endoscopic transsphenoid adenomectomy 開立醫師: 陳盈志 開立時間: 2010/04/14 13:24 Pre-operative Diagnosis Pituitary macroadenoma Post-operative Diagnosis Pituitary macroadenoma Operative Method Endoscopic transsphnoid adenomectomy Specimen Count And Types 1 piece About size:multiple small fragments Source:pituitary tumor Pathology Pending Operative Findings The tumor was yellowish, elastic, size 4.5cm in diameter snowman shape. No CSF leakage was noted. Operative Procedures Under general anethesia and intubation, the patient was put in supine position with head tilted 30 degree to left. The facial skin was antiseptic with alcohol better-iodine tincture, and the mucosa of oral and nasal cavity with aqueous better-iodine . The formerareas were covered by sterilized adhesive plastic sheets then draped. Under endoscope, the nasal mucosa was coagulated at right norstril. A nasal speculum was applied to displace the nasal mucosa laterally and keep thenasal cavity open constantly for the exposure of the vomer bone and the anterior wall of the sphenoid sinus. The anterior sphenoid wall and posterior sphenoid wall was remove by high speed air drill and Kerrison punch. The sellar floor durawas coagulated then opened in cruciate fashion. The soft tumor parenchyma was removed by curette and aligator. The arachnoid and the opening of diaphragm sellae was enforcedby packing with gelform as in the sellar cavity. The nasal mucosa returned to its normal position. Right side of the nasal cavities was tightly packed with a segment of rubber glove finger filled with vaseline gauze strips which had been soaked with better-iodine ointment. Operators P蔡瑞章 Assistants R6陳盈志R2古恬音 莊蔥 (F,1955/04/08,56y11m) 手術日期 2010/04/14 手術主治醫師 林子富 手術區域 西址 035房 4號 診斷 Other lymphomas, lymph nodes of multiple sites 器械術式 Port-A Implatation /WOR 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 陳世鴻, 時間資訊 16:20 進入手術室 16:25 麻醉開始 16:30 手術開始 17:00 手術結束 17:10 進入恢復室 17:10 送出病患 18:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 血管探查 1 1 R 摘要__ 手術科部: 麻醉部 套用罐頭: Port-A rivision, subclavian 開立醫師: 陳世鴻 開立時間: 2010/04/14 17:03 Pre-operative Diagnosis Large B cell lymphoma Post-operative Diagnosis Ditto Operative Method Port-A rivision Specimen Count And Types nil Pathology Nil Operative Findings 1.Site: right subclavian vein 2.Patent flow after implantation 3.Others: nil Operative Procedures 1.The patient was set on supine position 2.Local anesthesia applied, cutting previous skin and subcutaneous suture. 5.Port- A base disconection from catheter, then J-wire was inserted smoothly through catheter. Then adjust the catheter position. 6.The catheter of Port-A was threaded into the subclavian vein until mark 22 cm. The catheter was adapted into the port and locked with restrictor.The Port was inserted into the pouch of pre-cordial incision. 7.Skin was closed layer by layer. Both catheter and port were perfused with heparin solution after implantation. Operators 林子富 Assistants 陳世鴻, Indication Of Emergent Operation 莊蔥 (F,1955/04/08,56y11m) 手術日期 2010/04/14 手術主治醫師 林子富 手術區域 西址 036房 03號 診斷 Other lymphomas, lymph nodes of multiple sites 器械術式 Port-A Implatation /WOR 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 林子富 ASA 3 紀錄醫師 陳世鴻, 時間資訊 00:00 臨時手術NPO 13:20 進入手術室 13:25 麻醉開始 13:30 誘導結束 13:39 抗生素給藥 13:50 手術開始 14:35 手術結束 14:35 麻醉結束 14:45 送出病患 14:47 進入恢復室 16:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 ｐｏｒｔ–Ａ導管植入術–治療性導管植入術 1 0 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 摘要__ 手術科部: 麻醉部 套用罐頭: Port-A implantation, subclavian 開立醫師: 陳世鴻 開立時間: 2010/04/14 14:39 Pre-operative Diagnosis Large B-cell lymphoma Post-operative Diagnosis Ditto Operative Method Port-A implantation, echo-guided Specimen Count And Types nil Pathology Nil Operative Findings 1.Site: right subclavian vein, with echo-guided procedure 2.Patent flow after implantation 3.Others: nil Operative Procedures 1.The patient was set on supine position and bilateral subclavian veins were checked by echo. 2.After IVGA and local anesthesia applied, transverse skin incision for 3cm was made at pre-cordial area. 3.Undermine the skin at the layer between subcutaneous tissue and deep fascia in lateral direction. 4.An IV catheter was inserted via the subclavian incision and negatively aspirated until venous blood attainable. 5.J-wire was inserted smoothly in rostral direction. A subclavian catheter with dilator was inserted through the J-wire, and the dilator was then removed. 6.The catheter of Port-A was threaded into the subclavian vein until mark 22 cm. The catheter was adapted into the port and locked with restrictor.The Port was inserted into the pouch of pre-cordial incision. 7.Skin was closed layer by layer. Both catheter and port were perfused with heparin solution after implantation. Operators 林子富 Assistants 陳世鴻, 施冠聿 (M,1973/06/01,38y9m) 手術日期 2010/04/14 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Carotid body tumor 器械術式 EC-IC by-pass 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:05 進入手術室 08:15 麻醉開始 09:00 抗生素給藥 09:00 誘導結束 09:25 手術開始 12:00 抗生素給藥 15:30 抗生素給藥 18:40 抗生素給藥 19:55 麻醉結束 19:55 手術結束 20:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 血管探查 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 15 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: harvest of right radial artery 開立醫師: 陳思恆 開立時間: 2010/04/14 10:33 Pre-operative Diagnosis right carotid body tumor Right carotid body tumor Post-operative Diagnosis right carotid body tumor Right carotid body tumor Operative Method harvest of right radial artery Harvest of right radial artery Specimen Count And Types Pathology nil Operative Findings A 20 cm long radial artery graft was harvested from right forearm. The perfusion of ulnar artery was checked intraoperatively. Operative Procedures ETGA, supine, antiseptics applied. S shape incision of forearm. Elevate radial artery. Clump of radial artery to check the perfusion of ulnar artery. Take down radial artery and check leakage. One CWV inserted. Wound closure in layers. Operators 戴浩志 Assistants 陳思恆, 林哲光 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: harvest of right radial artery 開立醫師: 李建勳 開立時間: 2010/04/14 21:14 Pre-operative Diagnosis Right carotid body tumor Post-operative Diagnosis Right carotid body tumor Operative Method Partial tumor excision and dissection of the carotid body tumor Specimen Count And Types 1 piece About size: Source:right carotid body tumor 2 pieces About size:0.5x0.5cm Source:tumor About size:0.5x0.5cm Source:tumor Pathology Pending Operative Findings A hypervascular mass lesion orginated from the wall of the birfucation of right common carotid artery. The right internal jugular vein was also involved with venous wall thickening. The right common carotid artery was encased by the tumor, tightly adhered to the vascular wall but was seperable. The ansa cervicalis distal to the first branch was resected for dissecting the tumor. Variant of external carotid artery (ECA) was noted with one proximal ECA branch ran anteriorly. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position with head fixed with Mayfield skull clump and rotated to left side. The scalp was shaved, scrubbed, disinfected with alcohol better-iodine then draped. The right neck was exposed for dissection and tumor excision. The frontotemporal scalp incision was made in usual pterional approach followed by craniotomy. The sphenoid ridge was further drilled off in order to open the Sylvian fissure. The incision of the neck was made 2 cm below the mandible angle. Dissecting the muscle and soft tissue to expose the tumor and the common carotid artery. The tumor was dissected with bipolar coagulation then cut with surgical scissors. The early branch of ECA and the bification of common carotid artery were dissected from the tumor. The neck wound was closed in layers with one minihemovac set up. The skull plate was fixed back with one epidural close wound vaccum drain tube set up. The scalp wound was then closed in layers. Operators P 杜永光 Assistants R3 林哲光 R6 李建勳 相關圖片 吳信豐 (M,1955/03/26,56y11m) 手術日期 2010/04/14 手術主治醫師 蔡瑞章 手術區域 東址 005房 02號 診斷 Brain tumors, malignant 器械術式 Brain tumor Crainotomy(Others) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 古恬音, 時間資訊 00:00 臨時手術NPO 12:30 報到 13:43 進入手術室 13:55 麻醉開始 14:15 誘導結束 14:46 手術開始 17:08 抗生素給藥 20:10 麻醉結束 20:10 手術結束 20:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除－手術時間在４～８小時 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Right frontal craniotomy for tumor excision 開立醫師: 古恬音 開立時間: 2010/04/16 07:22 Pre-operative Diagnosis Right frontal base tumor with corpus callosum extension, suspected high-grade glioma Post-operative Diagnosis Right frontal base tumor with corpus callosum extension, suspected high-grade glioma Operative Method Right frontal craniotomy for tumor excision Specimen Count And Types 2 pieces About size:about 5gm Source:right frontal lobe About size:about 1gm Source:right frontal lobe tumor Pathology Pending Operative Findings The tumor at right frontal base was ill-defined, fragile, and gray-reddish in color. The vascularity was high. Extenstion through corpus callosum to the left hemisphere was noted and partially removed. Another smaller tumor was noted near midline and above the lateral ventricle, which was also fragile and hypervascular. Cystic component was noted within both tumors. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with the head fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected with better iodine, then draping was done in the usual sterile fashion. Bicoronal scalp incision was made behind the coronal suture. After drilling two burr holes, one 10*6cm craniotomy window was made at right frontal area. Then dura was opened in a U-shaped fashion after peripheral tenting. Intraoperative ultrasound was used to identified the tumor. The frontal base tumor was removed with bipolar coagulation and tumor forceps, including the part extending throught corpus callosum. The other smaller tumor was also removed. Hemostasis was achieved with Surgicel lining of the tumor bed and bipolar coagulation. Then the dura was closed with 5-o prolene. The bone plate was fixed back with miniplates and screw. After setting one CWV drain, the wound was closed in layers Operators P蔡瑞章 Assistants R6陳盈志,R5胡朝凱,R2古恬音 陳美惠 (F,1963/04/28,48y10m) 手術日期 2010/04/14 手術主治醫師 許榮彬 手術區域 兒醫 068房 1號 診斷 Infective endocarditis 器械術式 M.V.R. 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 陳志軒, 時間資訊 07:50 報到 08:09 進入手術室 08:10 麻醉開始 08:48 誘導結束 09:05 抗生素給藥 09:47 手術開始 10:35 抗生素給藥 12:05 抗生素給藥 13:23 手術結束 13:35 送出病患 13:35 麻醉結束 醫令資訊 類別 名稱 量 刀 側 手術 體外心肺循環 1 1 手術 主動脈瓣或二尖瓣或三尖瓣之置換手術 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 放置肺動脈導管術 1 0 麻醉 Cardiac out-put 1 0 麻醉 Swan-gang catheterization 1 0 麻醉 動脈血液檢查全套 4 0 麻醉 Hemoglobin (Hb) 4 0 麻醉 測血糖 4 0 麻醉 Ca (Calcium) 4 0 麻醉 Na (Sodium) 4 0 麻醉 K (Potassium) 4 0 麻醉 Cl (Chloride) 4 0 麻醉 Blood gas analysis 4 0 麻醉 T.E.E 1 0 記錄__ 手術科部: 內科部 套用罐頭: Mitral valve replacement(St. Jade tissue valv... 開立醫師: 陳志軒 開立時間: 2010/04/15 12:00 Pre-operative Diagnosis Infective endocarditis, severe mitral regurgitation with pulmonary edema Post-operative Diagnosis Infective endocarditis, severe mitral regurgitation with pulmonary edema Operative Method Mitral valve replacement(St. Jade tissue valve EPIC) Specimen Count And Types 2 pieces About size:3x1cm Source:mitral valve About size:0.5cm Source:MV culture Pathology Pending Operative Findings 1. Good heart contratility 2. Mitral valve: post and anterior a. vegetation on mitral leaflet b. a 1cm perforation at P3 c. IE cause chordal tenanes rupture(A3,A2,P3,P2; A1,P1 no involve) d.resect AML, PML, Preserve basal chordal Operative Procedures 1. ETGA, supine position 2. median sternotomy 3. AsAo, RAA-SVC, IVC cannulation, on CPB, cooling to 28 degree 4. Aorta cross clamp, antegrade cardioplegia infusion, LA incision 5. Check pathology, mitral valve replacement was performed using 29mm St. Jade Epic tissue valve, using 2-0 interrrupted pledgetted suture 6. Aortotomy to check LVOT and aorta valve 7. Close aortatomy , close LA 8. Deair from AsAo, rewarm, weanning from CPB 9. Hemostasis, set two chest tubes, close wound in layers Operators 許榮彬 Assistants 林明賢 陳志軒 許文勇 (M,1960/01/08,52y2m) 手術日期 2010/04/14 手術主治醫師 王國川 手術區域 東址 002房 02號 診斷 Malignant neoplasm of trachea 器械術式 Ommaya reservoir implantation 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 06:35 通知急診手術 12:00 進入手術室 12:07 麻醉開始 12:10 誘導結束 12:35 手術開始 12:43 抗生素給藥 13:10 手術結束 13:10 麻醉結束 13:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 頭皮腫瘤 1 1 摘要__ 手術科部: 外科部 套用罐頭: Removal of Ommaya reservoir 開立醫師: 李振豪 開立時間: 2010/04/14 13:40 Pre-operative Diagnosis 1. CNS infection, 2. s/p Ommaya reservoir implantation Post-operative Diagnosis 1. CNS infection, 2. s/p Ommaya reservoir implantation Operative Method Removal of Ommaya reservoir Specimen Count And Types Three culture swab for bacteria, fungus, and mycobacteria culture. One Ommaya reservoir tip for bacteria culture. Pathology Nil Operative Findings Subgaleal clear effusion is noted after skin incision and swab x III was performed for bacteria, fungus, and mycobacteria culture. Tip culture of Ommaya reservior is also done. The opening pressure after removal of Ommaya reservoir is more than 20cmH2O. The CSF is clear in character. Operative Procedures Under tracheostomy tube general anesthesia, the patient was put in supine position with head rotated to left. The scalp was shaved, scrubbed, and disinfected as usual. The scalp incision was made via previous op scar. The culture was performed after scalp incision. The Ommaya reservoir was identified and removal of Ommaya reservoir was done. The wound was irrigated with Gentamicin solution and the burr hole was packing with Gelform. After hemostasis, the wound was closed in layers. Operators VS王國川 Assistants R3李振豪, R2游健生 Indication Of Emergent Operation 相關圖片 施冠聿 (M,1973/06/01,38y9m) 手術日期 2010/04/15 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Carotid body tumor 器械術式 EC-IC by-pass 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 08:10 進入手術室 08:10 報到 08:12 麻醉開始 08:15 誘導結束 10:10 手術開始 13:00 抗生素給藥 13:39 開始輸血 20:10 麻醉結束 20:10 手術結束 20:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 16 0 手術 顱內外血管吻合術 1 1 R 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: External carotid to internal carotid artery(E... 開立醫師: 李建勳 開立時間: 2010/04/15 21:14 Pre-operative Diagnosis Right carotid body tumor Post-operative Diagnosis Right carotid body tumor Operative Method External carotid to internal carotid artery(EC-IC) bypass, right external carotid artery (ECA) to M2 segment of right middle cerebral artery (MCA) Specimen Count And Types Nil Pathology Pending Operative Findings The harvested right radial artery was 20cm long. Heparin 1ml, 5000U/ml, was given before template clips were applied to the M2 segment, the template clip was removed after 100 minutes and good patency of graft was noted after bypass from right ECA to M2 segment of right MCA. The right ECA and internal carotid artery (ICA) were ligated after bypass. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position with head fixed with Mayfield skull clump and rotated to left side. The skin was disinfected and drapped were performed as usual over right scalp and right neck. Skin incision was made over the previous operative wound and the skull bone was also removed after screw of miniplates were removed. Right sylvian fissure was opened and the M2 and M3 segment of right MCA was identified. Harvested right radial artery were introduced into the subcutaneous tunnel which was created wtih stylate from crainotomy window to the previous neck wound over the right common carotid artery. Two temporary microvascular clips were applied to the M2 segment of right MCA. The end-to-side anastomosis with harvested graft to M2 segment of right MCA was performed with 9-0 ethilon nylon suture after 1ml Heparin intravenous injection. The temporary clips were then removed after anastmosis complete. The previous dissected variant branch of enlarged ECA was then transected and end-to-end anastomosis with harvested graft artery and ECA was then performed with 8-0 ethilon nylon suture. Heparin solution was used to irrigate the vascular lumen. Temporary clip was applied to the distal site of anastomosis site of ECA. The distal end was then cauterized with bioplar and cut off with reinforcement with 7-0 Prolene. The ICA was also ligated distal to bification of common carotid artery. The dura was closed with 4-0 Prolene sutures and the skull plate was remoduled to form a corridor for the bypass vessel. The scalp and neck wounds were then closed in layers with one closed wound vacuum and one minihemovac set up seperately. Operators P 杜永光 Assistants R3 林哲光, R6 李建勳 相關圖片 李順情 (M,1966/12/12,45y3m) 手術日期 2010/04/15 手術主治醫師 賴達明 手術區域 東址 019房 19號 診斷 Cerebral hemorrhage 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林峰盛 ASA 4E 紀錄醫師 林哲光, 時間資訊 20:40 通知急診手術 20:54 報到 20:54 進入手術室 20:58 麻醉開始 21:10 誘導結束 21:15 手術開始 21:46 抗生素給藥 22:02 開始輸血 01:15 麻醉結束 01:15 手術結束 01:25 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 腦內血腫清除術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Left frontal-temporal craniotomy hematoma eva... 開立醫師: 陳盈志 開立時間: 2010/04/16 01:07 Pre-operative Diagnosis Left putamen ICH Post-operative Diagnosis Left putamen ICH Operative Method Left frontal-temporal craniotomy hematoma evacuation Specimen Count And Types 1 piece About size:4x3x2mm Source:hematoma Pathology pending Operative Findings Lerge hematoma located from inferior frontal to middle temporal. The brain was slake after hematoma evacuation. A small piece connecting with several feeding arteries was noted. Operative Procedures 1.ETGA, supine with head tilt to right 2.skin preparation 3.Left frontal temporal curvilinear incision 4.Detach temporalis muscle, Burr hole x 4 then craniotomy 5.C-shape open the dura, identify hematoma with ultrasound 6.Coticotomy via middle frontal then hematoma evacuation 7.Hemostasis with bipolar and surgicel packing 8.Dura closure with 4-0 prolene 9.Fix bone with miniplate then set subgaleal CWV drain x 1 10.close wound in layers Operators VS賴達明 Assistants R6陳盈志R3林哲光 Indication Of Emergent Operation 陳美惠 (F,1963/04/28,48y10m) 手術日期 2010/04/15 手術主治醫師 賴達明 手術區域 兒醫 066房 02號 診斷 Infective endocarditis 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 4E 紀錄醫師 陳盈志, 時間資訊 14:28 通知急診手術 15:25 進入手術室 15:25 報到 15:25 麻醉開始 15:40 誘導結束 16:05 手術開始 16:55 麻醉結束 16:55 手術結束 17:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱內壓監視置入 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: left kocher point EVD insertion and ICP monit... 開立醫師: 陳盈志 開立時間: 2010/04/15 17:32 Pre-operative Diagnosis ICH with IVH with acute hydrocephalus Post-operative Diagnosis ICH with IVH with acute hydrocephalus Operative Method left kocher point EVD insertion and ICP moniter insertion Specimen Count And Types nil Pathology nil Operative Findings CSf was xanthochromic and the opening pressure was high >25cmH2O. ventricular catheter was 6.5cm in depth. ICP initially was 22mmHg, which became 15mmHg after skin closure. ICP tip was inserted to left frontal ventricle (6.5cm along EVD tract) Operative Procedures 1.ETGA, supine 2.Skin preparation 3.Left frontal linear incision 4.Burr hole then dura tenting 5.Cruiciformly open the dura then ventricular tapping 6.Insert EVD and ICP monitor to ventricle 7.Hemostasis then close wound in layers. Operators Vs賴達明 Assistants R6陳盈志Ri Indication Of Emergent Operation 魏麗珍 (F,1959/03/05,53y0m) 手術日期 2010/04/15 手術主治醫師 王水深 手術區域 兒醫 067房 06號 診斷 Coccyx malignant neoplasm 器械術式 Port-A Implatation /WOR 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 徐綱宏, 時間資訊 18:37 報到 19:00 進入手術室 19:02 抗生素給藥 19:05 麻醉開始 19:07 手術開始 19:07 誘導結束 19:07 麻醉結束 19:25 手術結束 19:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 內頸靜脈切開，永久導管放置術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Port-A 開立醫師: 徐綱宏 開立時間: 2010/04/15 19:31 Pre-operative Diagnosis Chondroma Post-operative Diagnosis Chondroma Operative Method Port-A catheter implantation Specimen Count And Types nil Pathology nil Operative Findings The venous blood flow freely in the Port-A catheter after implantation. Operative Procedures The patient was put on supine position. The operation field was disinfected and draped as usual. Under local anesthesia, the Port-A catheter was implanted on right side upper chest with puncture method via RIJV under echo guide Post-op care plan: 1.wound CD QD+PRN2.pain control with tinten 3.prophylatic antibiotics use Operators 王水深 Assistants 徐綱宏 林翊宸 (M,2000/06/15,11y8m) 手術日期 2010/04/15 手術主治醫師 楊士弘 手術區域 兒醫 066房 01號 診斷 Malignant neoplasm of cerebrum, except lobes and ventricles 器械術式 Brain tumor Crainotomy(Others) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 3 紀錄醫師 陳德福, 時間資訊 00:00 臨時手術NPO 08:00 報到 08:06 進入手術室 08:20 麻醉開始 09:15 誘導結束 09:30 抗生素給藥 09:55 手術開始 12:30 抗生素給藥 14:30 麻醉結束 14:30 手術結束 14:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４～８小時 1 1 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 摘要__ 手術科部: 外科部 套用罐頭: craniotomy for tumor excision 開立醫師: 陳德福 開立時間: 2010/04/15 14:50 Pre-operative Diagnosis medulloblastoma, recurrence Post-operative Diagnosis ditto Operative Method craniotomy for tumor excision Specimen Count And Types 1 piece About size:2*1*2CM Source:cerebellar tumor Pathology pending Operative Findings 1.There is a 2*1*2cm in sized tumor at the right dorsal part of the 4th ventricle. The tumor is soft, whitish, and somehow capsulated. 2.The solid tumor was totally removed under microscopic surgery. 3.Adhesion over previous surgery field is remarkable. Operative Procedures Under ETGA and prone positin with Mayfield pediatric pin type head fixator, the scalp was disinfected and draped as usual. One midline incision to expose 2cm above the inion to the C1 was done. The suboccipital craniotomy was performed and the dura was opened in Y shape. The bilateral cerebellar tonsils were retracted laterally with self retractor and the tumor came into view. We removed the tumor with tumor forceps and sucker meticulously. The feeders were all coagulated.After the tumor was totally removed, the floor of 4th ventricle, dorsum medulla and the central canal of the high cervial spinal cord were well visulized. After hemostasis, the dura was closed in water tight fasion with Duragene. The skull was fixed with wires and one CWV was left in situ. The wound was closed in layers. Operators vs 楊士弘 Assistants R4 陳德福 相關圖片 李昱昕 (M,1982/06/04,29y9m) 手術日期 2010/04/15 手術主治醫師 王國川 手術區域 東址 005房 02號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(Others) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 陳柏達, 時間資訊 00:00 臨時手術NPO 11:00 進入手術室 11:15 麻醉開始 11:40 誘導結束 12:00 抗生素給藥 12:22 手術開始 15:00 抗生素給藥 17:20 手術結束 17:20 麻醉結束 17:35 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 顱底瘤手術 1 1 記錄__ 手術科部: 外科部 套用罐頭: Tumor excision 開立醫師: 胡朝凱 開立時間: 2010/04/15 14:46 Pre-operative Diagnosis Left CP angle tumor Post-operative Diagnosis Left CP angle tumor Operative Method Tumor excision Specimen Count And Types pieces of tumor in one bottle Pathology yellowish, soft tumor Operative Findings One 3.6x1.8 cm soft, yellowish, tumor located at left CP angle with a well defined margin and capsule. A large cyst located at the upper part of the tumor and compressed the tirgeminal nerve. The tumor arised from inferior vestibular nerve and pushed cochlear nerve caudally and facial nerve anteriorly. After operation, fascial nerve and cochlear nerve were preserved. Operative Procedures Under endotracheal general anesthesia, patient was put in park-bench position with head fixed by Mayfield skull clamp. Skin was shaved and scrubbed with povidone-iodine detergent, then covered with sterilized adhesive plastic sheet. Left post-auricular (retrosigmoid) curvillinear incision was made. The sternocleidomastoideus, splenius capitis, oblique capitis superior and part of the trapezius muslces were devided down to C1 level. Craniotomy was then performed as a 5x4 cm bone window to expose the margin of sigmoid sinus. Dural incision was made like "K" shape and reflected to sigmoid sinus. CSF was drained first at magnum cistern until the cerebellum was slack enough for gentle retraction downward. Consequently, the posterior surface of the C-P angle tumor was well exposed. Under operating microscope, the vessels distributed on the posterior surface of the tumor were coagulated by bipoar coagulator. Then central debulky was performed to made the tumor be loosen. The dura of petrous bone at posterior wall of the internal acoustic meatuswas coagulated and stripped off. Then, the posterior wall of the internal acoustic meatus was fully opened by high speed air drill until the deepest part of intracanal tumor had been well exposed. The intracanal tumor was removed to expose the intracanal portion of the facial nerve. The last segment of the tumor left in the C-P angle was now resected along with the margin between brain parnechyme and capsule with great precaution. AEP and SSEP were performed to identified fascial and cochlear nerve. Dural was closed with a fascia graft The muscles were closed by interruped sutures. Then the wound was closed in layers. Operators P 蔡瑞章, VS 王國川 Assistants 胡朝凱,陳柏達 張麗娟 (F,1967/05/24,44y9m) 手術日期 2010/04/15 手術主治醫師 王國川 手術區域 東址 005房 01號 診斷 CVA 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3 紀錄醫師 陳柏達, 時間資訊 00:00 臨時手術NPO 07:54 報到 08:17 進入手術室 08:20 麻醉開始 08:30 誘導結束 08:50 抗生素給藥 09:10 手術開始 10:40 手術結束 10:40 麻醉結束 10:50 送出病患 10:52 進入恢復室 11:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 手術 頭顱成形術 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Left cranioplasty 開立醫師: 胡朝凱 開立時間: 2010/04/15 10:49 Pre-operative Diagnosis Left cranial defect Post-operative Diagnosis Left cranial defect Operative Method Left cranioplasty Specimen Count And Types Nil Pathology Nil Operative Findings Left skull defect abut 20x25 cm Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right 3. Skin preparation:shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with a sterilized adhesive plastic sheet. 4. Incision: along the previous operation scar. Raney clips were apllied to the scalp edge for temporary hemostasis. 5. The scalp was dissected away from the underlying dura. 5. The scalp was easily reflected from the underlying silastic sheet which was then removed. The dural surface and margin of skull defect were well exposed. 6. The bleeders on the dissected surfaces were coagulated with Bovie painstakingly. 7. The edge of the skull defect was exposed. 8. The original skull plate preserved was placed back to the skull window then fixed by miniplate and a dura tenting at the center of the skull plate. 9. Further cranioplasty was done with bone cement 10. Scalp closure: hemostasis was done with monopolar coagulator touching on the sucker tip. Galea suture was performed by continuous suture with 3/0 Dexon and skin by continuous suture with 3/0 nylon. 11.Drain: one, epidural Operators 王國川 Assistants 胡朝凱,陳柏達 黃銀貞 (F,1943/12/02,68y3m) 手術日期 2010/04/16 手術主治醫師 曾漢民 手術區域 東址 027房 04號 診斷 Benign neoplasm of pituitary gland and craniopharyngeal duct (pouch) 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 邱義霖, 時間資訊 00:00 臨時手術NPO 15:55 進入手術室 16:05 麻醉開始 16:10 誘導結束 16:47 手術開始 17:15 抗生素給藥 17:55 手術結束 17:55 麻醉結束 18:05 送出病患 18:08 進入恢復室 19:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 內視鏡功能鼻竇手術－單側 1 2 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Repair CSF leak with abdominal fat 開立醫師: 邱義霖 開立時間: 2010/04/17 13:53 Pre-operative Diagnosis CSF leak, status post repair Post-operative Diagnosis CSF leak, status post repair, status post revised repair Operative Method Repair CSF leak with abdominal fat Specimen Count And Types nil Pathology nil Operative Findings There is CSF leak noted at sellar floor. After packing with fat and tissue codul, No further leak was noted. Operative Procedures 1.ETGA, supine 2.Under endscope guide, identify the leak point 3.Harvest fat and fascia from LLQ, packing to the leak site layer by layer, then apply tissue codul 4.No any artificial material packing nasal cavity Operators P曾漢民 Asp吳振吉 Assistants R2 邱義霖 蘇珮菁 (F,1978/07/12,33y8m) 手術日期 2010/04/16 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Pituitary Tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 古恬音, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:20 麻醉開始 08:45 誘導結束 09:00 抗生素給藥 09:34 手術開始 11:35 手術結束 11:35 麻醉結束 11:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經由蝶竇之腦下垂體瘤切除 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 記錄__ 手術科部: 外科部 套用罐頭: Transnasal trans-sphenoidal approach for tumo... 開立醫師: 胡朝凱 開立時間: 2010/04/16 11:41 Pre-operative Diagnosis pituitary macroadenoma Post-operative Diagnosis pituitary macroadenoma Operative Method Transnasal trans-sphenoidal approach for tumor excision Specimen Count And Types pieces of tumor Pathology pending Operative Findings Atrophic nasal mucosa. Narrow meatus. The tumor was whitish, soft one with apoplexy. Post-OP dura and arachnopid membrane was noted. Severe adhesion and granulation were noted perinasally. Operative Procedures After ETGA, the patient was put in supine position with head mild left tilt. The nasal cavity was well-disinfective, and then we incised into the nasal septum. Dissection was performed along with the periosteum to expose sphenoid sinus anterior wall and sphenoid ostia. After fracture of vomer, sphenoid sinus anterior wall was also fractured. The mucosa was removed. The sella floor was exposed and removed with kerrison. After cruciate form incision, tumor buldged out. And it was further removed with tumor forceps and ring currette. During operation, cavernous sinus ruptured was noted, but it was stopped immediately by gelfoam packing. After total excision of tumor was made, the bony graft was put back and followed by compaction of merosel. Operators 曾漢民 Assistants 胡朝凱 李清海 (M,1965/04/30,46y10m) 手術日期 2010/04/16 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 古恬音, 時間資訊 00:00 臨時手術NPO 12:00 報到 12:20 進入手術室 12:25 麻醉開始 12:55 誘導結束 13:05 抗生素給藥 13:10 手術開始 16:05 抗生素給藥 16:10 麻醉結束 16:10 手術結束 16:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除－手術時間在４小時以內 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 記錄__ 手術科部: 外科部 套用罐頭: Simpson I tumor excision 開立醫師: 吳經閔 開立時間: 2010/04/16 16:36 Pre-operative Diagnosis Left parietal convexity meningioma Post-operative Diagnosis Left parietal convexity meningioma Operative Method Simpson I tumor excision Specimen Count And Types pieces of tumor and dura Pathology pending Operative Findings No obvious hyperosteosis was noted. The tumor was well defined within 1.5 cm in depth from cortex. But after then, it invaded ino brain parenchyma without a well defined margin. It was hypervascular, measuring 5.2x4.3x4 cm. It was totally excised under microscopy. The dura was closed with Gortex artificial dura. Operative Procedures Under ETGA, patient was put in supine position with head rotate to right and fixed with Mayfield skull clamp. Curvature skin incision was done at left temporal to parietal area. Skin flap was dissected and opened. After three burr holes drilled, craniotomy was performed as a 7x7 bone window one cm away from midline, followed by dural tenting. Dural incision was made along with the edge of tumor. The tumor was excised by gently dissection through the interface between tumor and brain tissue piece by piece. Vascular perforation was cauterized. Hemostasis was then performed. After then, dura was closed with prolene. After one CWV drain insertion, wound was closed in layers. Operators 曾漢民 Assistants 胡朝凱,古恬音 周潔明 (F,1966/10/13,45y5m) 手術日期 2010/04/16 手術主治醫師 蔡瑞章 手術區域 東址 003房 03號 診斷 Arteriovenous malformation, brain 器械術式 Crainotomy Brain Tumor(P-LIN) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林至芃 ASA 4E 紀錄醫師 陳建銘, 時間資訊 10:19 臨時手術NPO 10:19 開始NPO 17:19 通知急診手術 20:25 報到 20:25 進入手術室 20:30 麻醉開始 20:45 抗生素給藥 20:45 誘導結束 21:20 手術開始 00:35 麻醉結束 00:35 手術結束 00:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 手術 腦內血腫清除術 1 1 記錄__ 手術科部: 外科部 套用罐頭: Trans-vermian hematoma evacuation 開立醫師: 胡朝凱 開立時間: 2010/04/17 00:57 Pre-operative Diagnosis Cerebellar ICH Post-operative Diagnosis Cerebellar ICH Operative Method Trans-vermian hematoma evacuation Specimen Count And Types nil Pathology nil Operative Findings 1.About 6 ml ICH at left vermis and ruptured into forth ventricle 2.After hematoma evacuation, clear CSF drained from aquaduct fluently. 3.No obvious vascular malformation structure or tumor was noted during operation Operative Procedures 1.ETGA, prone 2.Midline skin incision from 5 cm above inion dow to C1 level 2.Midline skin incision from 5 cm above inion down to C1 level 3.Detach caput splenium muscle 4.Craniectomy down to foramen magnum 5.Y shape dural opening 6.Cortocotomy at vermis 7.Hematoma evacuation 8.Hemostasis 9.Duroplasty with fascia 10.Set one CWV drain then close wound in layers Operators 蔡瑞章,王國川 Assistants 胡朝凱,陳建銘 Indication Of Emergent Operation 李麒郎 (M,1941/01/08,71y2m) 手術日期 2010/04/16 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Spondyloisthesis, acquired 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 游健生, 姜秉均, 時間資訊 00:00 臨時手術NPO 08:03 報到 08:10 進入手術室 08:30 麻醉開始 08:50 誘導結束 09:25 抗生素給藥 09:30 手術開始 12:40 抗生素給藥 13:50 手術結束 13:50 麻醉結束 14:05 送出病患 14:06 進入恢復室 15:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 直視下尿道切開術 1 1 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 手術 椎間盤切除術－腰椎 1 3 摘要__ 手術科部: 外科部 套用罐頭: Posteriolateral interbody fusion and fixation... 開立醫師: 陳睿生 開立時間: 2010/04/16 13:50 Pre-operative Diagnosis Lumbar stenosis with lithesis (grade.I) over L4/5 Post-operative Diagnosis Lumbar stenosis with lithesis (grade.I) over L4/5 Operative Method Posteriolateral interbody fusion and fixation with transpedicular screws Specimen Count And Types nil Pathology Nil Operative Findings The thecal sac was tightly compressed and well expanded after L4/5 laminotomy. Hypertrophic facets were noted over L4/5 joints, and thicken ligamentum flavum with narrowing lateral recess were also found. Screws: Synthes 6.2x45mm X4 over L4, 5; rods: 5cm x2; PEEK cage: Synthes 11mm x2. Operative Procedures 1. Follow Urologist"s procedure 2. Patient was put into prone position 3. Locate L4, 5 transverse process level C-arm 4. Disinfection and draped operation field as usual 4. Midline incision over lower part of L3 to L5 level 5. Detach paraspinal muscle and expose L4, 5 transverse process 6. Insert transpedicle screws under C-arm guidance 7. Perform L4, L5 laminotomy, L5 superior facetectomy, then L4/5 diskectomy 8. Set one rod on each side to connect TPS 9. Hemostasis and irrigation with normal saline and Gentamycin solution 10.Set one epidural Hemovac 11.Close wound in layers Operators VS 賴達明 Assistants R5 陳睿生; R2 游健生 記錄__ 手術科部: 外科部 套用罐頭: Posteriolateral interbody fusion and fixation... 開立醫師: 姜秉均 開立時間: 2010/04/30 18:08 Pre-operative Diagnosis bladder neck contracture Post-operative Diagnosis bladder neck contracture Operative Method transurethral incision of bladder neck Specimen Count And Types nil Pathology nil Operative Findings bladder neck contracture Operative Procedures Under satisfactory spinal anesthesia, the patient was placed in lithotomy position. Prepping and draping were performed in the usual sterile method. Then the resectoscope was inserted. Bladder neck contracture was noted. TUI-BN was done. Hemostasis was done. A 22 Fr. 3-way Foley catheter was inserted and its balloon was inflated to 10c.c. Continuous N/S irrigation started. The patient tolerated the operation well and was sent to the recovery room with stable condition. Operators 劉濕彬 劉詩彬 Assistants 姜秉均 林玉瑱 (F,1968/08/08,43y7m) 手術日期 2010/04/16 手術主治醫師 賴達明 手術區域 東址 019房 02號 診斷 Lumbar Spondylosis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 14:00 報到 14:20 進入手術室 14:25 麻醉開始 14:40 誘導結束 14:50 抗生素給藥 15:10 手術開始 17:50 抗生素給藥 19:05 手術結束 19:05 麻醉結束 19:15 送出病患 19:18 進入恢復室 20:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 手術 椎間盤切除術－腰椎 1 2 摘要__ 手術科部: 外科部 套用罐頭: L4-5 posterior fixation with Dynesys system +... 開立醫師: 游健生 開立時間: 2010/04/16 19:36 Pre-operative Diagnosis L4-5 ruptured intervertebral disk, right Post-operative Diagnosis L4-5 ruptured intervertebral disk, right Operative Method L4-5 posterior fixation with Dynesys system + Right L4-5 laminotomy for diskectomy Specimen Count And Types nil Pathology Nil Operative Findings 1. Large ruptured intervertebral disc from right side of intervertebral space compressing thecal sac and right L5 nerve root tightly 2. Intervertebral disc was noted with severe degenerative change 3. Dynesys system was applied: TPS: 6.2x45mm x4 at L4 and L5 Dynamic rod: right: 17.5mm left: 22.5mm Operative Procedures 1. Under ETGA, patient was put into prone position 2. Located L4, L5 pedicle level by C-arm 3. Disinfected and draped the operation field as usual 4. Midline incision from lower L3 to L5 level deep 5. Dissected to fasica level and performed undermine laterally 6. Made paramedian incision at fascia 3cm away from midline on each side 7. Separated the paraspinal muscle along its fiber bluntly and exposed L4, L5 transverse processes 8. Inserted transpedicle screws at L4 & L5 under C-arm guidance 9. Midline incision at fascia and detached right side paraspinal muscle from lamina 10.Performed right L4 & L5 laminotomy, then microscopic diskectomy 11.Set Dynamic rod on each side connecting TPS 12.Hemostasis and irrigation with normal saline and Gentamycin solution 13.Set one epidural-subcutaneous hemovac and one subcutaneous hemovac 14.Closed wounds in layers Operators VS賴達明 Assistants R5陳睿生, R2游健生 吳秀玲 (F,1959/02/08,53y1m) 手術日期 2010/04/16 手術主治醫師 賴達明 手術區域 東址 027房 03號 診斷 Spondylolisthesis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 13:18 報到 13:38 進入手術室 13:42 麻醉開始 13:50 誘導結束 14:15 抗生素給藥 14:26 手術開始 15:15 手術結束 15:15 麻醉結束 15:30 進入恢復室 17:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 骨內固定物拔除術－脊椎 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Removal of right L5-S1 transpedicular screws 開立醫師: 李振豪 開立時間: 2010/04/16 15:44 Pre-operative Diagnosis Malposition of right L5-S1 transpedicular screws Post-operative Diagnosis Malposition of right L5-S1 transpedicular screws Operative Method Removal of right L5-S1 transpedicular screws Specimen Count And Types Nil Pathology Nil Operative Findings The direction of right L5-S1 screws are pointed laterally. The screws and rod are removed smoothly. Well bony fusion is noted during the operation. Operative Procedures Under endotracheal tube general anesthesia, the potient was put at prone position. The skin was scrubbed, disinfected, and draped as usual. The skin incision was made along previous operative scar. The subcutaneous tissue was dissected and the right L5-S1 transpedicular screws were identified. The soft tissue around the screws and rod were dissected. The instrument was removed and hemostasis was achieved. After irrigation with normal saline, the wound was then closed in layers. Operators VS賴達明 Assistants R3李振豪 許瓊花 (F,1945/11/02,66y4m) 手術日期 2010/04/16 手術主治醫師 杜永光 手術區域 東址 000房 號 診斷 Spinal metastasis 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 07:58 報到 08:05 進入手術室 08:20 麻醉開始 08:50 誘導結束 09:15 抗生素給藥 09:20 手術開始 12:32 抗生素給藥 15:45 麻醉結束 15:45 手術結束 15:55 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 7 0 手術 腦瘤切除－手術時間在４～８小時 1 1 L 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Left frontoparietal craniotomy for Simpson gr... 開立醫師: 李建勳 開立時間: 2010/04/16 16:21 Pre-operative Diagnosis Falx meningioma, left frontoparietal area Post-operative Diagnosis Falx meningioma, left frontoparietal area Operative Method Left frontoparietal craniotomy for Simpson grade III tumor exicision Specimen Count And Types 1 piece About size:7cm sized Source:falx meningioma, left parietal area Pathology Pending Operative Findings No hyperostosis was noted on the skull over the tumor. Dura thickening over the tumor near the superior saggital sinus was noted and relatively hard palpation was noted compared to surrounding parenchyma. The motor cortex was pushed anteriorly by the tumor according to the motor cortex mapping. The tumor was soft, whitish-yellowish, size 7 cm in diameter seperated in to two lobes. The superior saggital sinus was involved by the tumor. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position with neck flexion and head fixed with Mayfield skull clump. The scalp was shaved, scrubbed, and disinfected then drapped Left frontoparietal craniotomy was performed and the superior saggital sinus were also exposed well. Located the tumor with intraoperative sonography. The drua was then opened along the craniotomy window after dural tenting. Motor cortex mapping was done before the tumor excisionh. The tumor excision started from detached the tumor from the convexity dura and falx. The tumor was seperated from the normal parenchyma along the arachnoid plane. Central debulky method was applied first and the tumor was removed piece by piece. The superior saggital sinus was involved by the tumor and was not able to remove totally. Hemostaiss was achieved with surgicel lining of the tumor bed. The dura was closed with 4-0 Prolene sutures and the skull plates was fixed back with wires with one epidrual closed wound vaccum drain set up. The wound was then closed in layers. Operators P 杜永光, Assistants R3 林哲光, R6 李建勳, 相關圖片 沈永村 (M,1961/11/28,50y3m) 手術日期 2010/04/16 手術主治醫師 黃培銘 手術區域 東址 021房 04號 診斷 Lung cancer 器械術式 Tracheostomy 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 4E 紀錄醫師 張彥俊, 時間資訊 15:30 進入手術室 15:40 麻醉開始 15:45 誘導結束 15:50 抗生素給藥 15:54 手術開始 16:05 手術結束 16:05 麻醉結束 16:12 送出病患 16:20 進入恢復室 17:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 氣管切開造口術 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 張彥俊 開立時間: 2010/04/16 16:08 Pre-operative Diagnosis Vocal cord palsy Post-operative Diagnosis Vocal cord palsy Operative Method Tracheostomy Specimen Count And Types nil Pathology nil Operative Findings Fr . 8 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tube is fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators VS黃培銘 Assistants R5張彥俊 Indication Of Emergent Operation 林淑芬 (F,1959/03/15,52y11m) 手術日期 2010/04/16 手術主治醫師 楊士弘 手術區域 東址 001房 01號 診斷 Thoracic myelopathy 器械術式 Excision of intraspinal AVM < 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2E 紀錄醫師 陳盈志, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 08:59 通知急診手術 10:55 報到 11:00 進入手術室 11:10 麻醉開始 11:20 誘導結束 12:10 抗生素給藥 12:23 手術開始 15:05 手術結束 15:05 麻醉結束 15:15 送出病患 15:17 進入恢復室 16:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 手術 脊椎腔內動靜脈畸型切除術－二節以內 1 1 摘要__ 手術科部: 神經部 套用罐頭: Transection of fistula 開立醫師: 楊士弘 開立時間: 2010/04/16 15:12 Pre-operative Diagnosis Spinal dural arteriovenous fistula (type I), right L1 Post-operative Diagnosis Spinal dural arteriovenous fistula (type I), right L1 Operative Method Transection of fistula Specimen Count And Types nil Pathology Nil Operative Findings After dural openiing, some engorged veins werer seen in the surface of cauda equina. A 1 mm diametered thick walled vessel (arterialized vein) was found entering the subarachnoid space along with a nerve root from the right L1 foramen. Operative Procedures 1. ETGA, prone. 2. C-arm localization of the right T12-L1 interspace. 3. Posterior midline incision, T12-L2, 6 cm long. 4. Laminotomy, L1, with air drill and kerrison punch. 5. Longitudinal opening of dura mater. 6. Lysis of arachnoid membrane around the fistula vessel (arterialized vein). 7. Ligation of the fistula with 3 hemoclips. 8. Bipolar coagulation and division of the fistula. 9. Dural closure with continous 5-0 prolene suture. 10. Fixation of the L1 lamina back with miniplates and screws. 11. Wound closure in layers. Operators 楊士弘 Assistants 陳盈志 Indication Of Emergent Operation 藍玉輝 (M,1937/01/24,75y1m) 手術日期 2010/04/17 手術主治醫師 賴達明 手術區域 東址 001房 4號 診斷 顱內出血(ICH) 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 4E 紀錄醫師 李維棠, 時間資訊 16:35 通知急診手術 17:20 進入手術室 17:22 麻醉開始 17:50 誘導結束 18:00 抗生素給藥 18:27 手術開始 22:00 手術結束 22:00 麻醉結束 22:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 腦內血腫清除術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for hematoma evacutaion 開立醫師: 陳睿生 開立時間: 2010/04/17 22:29 Pre-operative Diagnosis Left side putaminal ICH Post-operative Diagnosis Left side putaminal ICH Operative Method Craniotomy for hematoma evacutaion Specimen Count And Types nil Pathology Nil Operative Findings Organized hematoma with clear fluid was found via corticotomy. No active bleeder was found, and after evacuation, the brain surface shrinked. Operative Procedures 1. ETGA, supine position with head right turn 2. Curvillinear scalp incision at left frontotemporal region 3. Dissect temporalis muscle 4. Make two bur holes, and an about 6x5cm craniotomy window was created 5. Dura tacking, and the ICH was identified under intra-op ECHO 6. Dura opening, and 3cm corticotomy was made at middle frontal lobe 7. Identify the hematoma, and it was evacuated under microscope 8. Hemostasis with surgicel 9. Tightly dura close with fascia graft after deair 10.Fix back skull graft with wires x4, and central tacking 11.Close the wound in layers Operators VS 賴達明 Assistants R5 陳睿生, R3 曾峰毅, R1 李維棠 Indication Of Emergent Operation 廖鼎晨 (M,1966/07/17,45y7m) 手術日期 2010/04/17 手術主治醫師 陳敞牧 手術區域 東址 005房 01號 診斷 Meningioma 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 2 紀錄醫師 李建勳, 時間資訊 00:00 臨時手術NPO 07:20 抗生素給藥 07:30 報到 08:12 進入手術室 08:15 麻醉開始 08:25 誘導結束 09:37 手術開始 12:45 手術結束 12:45 麻醉結束 13:00 送出病患 13:07 進入恢復室 14:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 頭顱成形術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Cranioplasty and repair of cerebrospinal flui... 開立醫師: 李建勳 開立時間: 2010/04/17 13:03 Pre-operative Diagnosis Meningioma s/p excision with subgaleal effusion Post-operative Diagnosis Meningioma s/p excision with subgaleal effusion Operative Method Cranioplasty and repair of cerebrospinal fluid (CSF)leakage Specimen Count And Types 3 pieces About size:3ML Source:CSF About size:3ML Source:CSF About size:3ML Source:CSF Pathology Nil Operative Findings The minor CSF leakage was noted from the cover site of Duraform. The leakage was covered by Gelform filled with blood patch. New artificial skull plate was made with wire mesh and bone cemen for cranioplasty. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position with head turned to right. The scalp was shaved, scrubbed, disinfected with alcohol better-iodine then draped. The scalp incision was made along previous op scar. Removed the skull plated and repaired the CSF leakage with Gelform filled with blood patch. Cover the area with another DuraGen. A new atificial skull plate was made with wire mesh and bone cemen for cranioplasty. After hemostasis and two closed wound drain set up at subgaleal space, the wound was closed in layers. Operators VS 陳敞牧 Assistants R6 李建勳 相關圖片 郭陳玉英 (F,1937/09/21,74y5m) 手術日期 2010/04/17 手術主治醫師 楊士弘 手術區域 東址 003房 01號 診斷 Lumbar spondylosis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 2 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 07:35 報到 08:02 進入手術室 08:40 麻醉開始 09:15 誘導結束 09:30 抗生素給藥 09:52 手術開始 12:30 抗生素給藥 14:12 開始輸血 14:45 手術結束 14:45 麻醉結束 15:00 送出病患 15:05 進入恢復室 19:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 手術 椎間盤切除術－腰椎 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: (1) L4-5 diskectomy and lower L4-upper L5 lam... 開立醫師: 楊士弘 開立時間: 2010/04/17 15:02 Pre-operative Diagnosis Lumbar spondylolisthesis and herniated intervertebral disc, L4-5 Post-operative Diagnosis Lumbar spondylolisthesis and herniated intervertebral disc, L4-5 Operative Method (1) L4-5 diskectomy and lower L4-upper L5 laminectomy for spinal canal decompression; (2) Transpedicle screws and rods fixation of L4-5 (3) Posterior interbody fusion with 2 interbody cages filled with autologous bone grafts Specimen Count And Types nil Pathology Nil Operative Findings The L4-5 facet joints and ligamentum flavum were hypertrophic, and compressed the thecal sac. The L4 was anteriorly subluxed over L5 mildly. The thecal sac re-expanded well after decompression. Hardware used: L4, L5 pedicle screws: 6.2 mm x 45 mm each rods: one for each side, 5 cm each PLIF cage: one for each side, 11 mm high Operative Procedures 1. ETGA, prone. 2. C-arm localization of L4, L5 3. Posterior midline incision from L3-S1. 4. Posterior decompression of spinal canal by laminectomy (lower L4, upper L5), diskectomy (L4-5). 5. Insertion of transpedicle screws into L4, L5 levels. 6. Diskectomy and endplates preparation. 7. Insertion of PLIF cages. 8. Two 1/8 inch HV drains 9. Wound closure in layers. Operators 楊士弘 Assistants 陳睿生,游健生 朱璽恩 (F,2010/02/19,2y0m) 手術日期 2010/04/17 手術主治醫師 楊士弘 手術區域 兒醫 067房 1號 診斷 Interruption of aortic arch 器械術式 V-P shunt 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 游健生, 時間資訊 08:26 開始NPO 08:26 臨時手術NPO 08:26 通知急診手術 15:40 進入手術室 15:40 報到 15:55 麻醉開始 16:00 誘導結束 16:43 手術開始 18:10 麻醉結束 18:10 手術結束 18:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 外科部 套用罐頭: Ventriculo-peritoneal shunt 開立醫師: 游健生 開立時間: 2010/04/17 18:53 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculo-peritoneal shunt Specimen Count And Types 1 piece About size:5ml Source:CSF Pathology Pending Operative Findings 1. Ventricle opening pressure was about 8cmH2O 2. Ventricle catheter length: 5cm Peritoneal catheter length: 50cm 3. Codman programmable valve set at 80mmH2O was used Operative Procedures 1. Under ETGA, patient was put into supine position with head turned to right and left shoulder mildly elevated 2. Disinfected and draped the operation field as usual 3. Made a transverse scalp incision at left Kocker"s region 4. Dissected in layers and exposed the border between cranium and anterior fontanelle 5. Separated the periosteum and removed some cranium by Kerrison 6. Exposed and coagulated the dura by bipolar electrocautery 7. Durotomy in cruciate fashion 8. Performed ventriculostomy and inserted ventricle catheter into frontal horn of left lateral ventricle 9. Made a transverse incision at left lower abdomen 10. Dissected in layers and opened peritoneum 11. Inserted peritoneal catheter and created subcutaneous tunnel from the abdominal wound to scalp wound 12. Passed the catheter through the tunnel and connected it to Codman programmable valve and ventricle catheter 13. Hemostasis and normal saline irrigation 14. Close wounds in layers Operators VS楊士弘 Assistants R5陳睿生, R2游健生 Indication Of Emergent Operation 李凱欣 (F,1989/12/15,22y2m) 手術日期 2010/04/17 手術主治醫師 謝榮賢 手術區域 東址 009房 01號 診斷 SDH, trauma 器械術式 Zygoma; Gillies reduction 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 3 紀錄醫師 阮廷倫, 時間資訊 08:00 進入手術室 08:30 麻醉開始 08:35 誘導結束 09:00 抗生素給藥 09:12 手術開始 11:00 手術結束 11:00 麻醉結束 11:10 送出病患 11:14 進入恢復室 14:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 顴骨－開放性復位－複雜 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Open reduction and internal fixation 開立醫師: 阮廷倫 開立時間: 2010/04/17 11:17 Pre-operative Diagnosis Left zygoma tripod + arch fracture Post-operative Diagnosis Left zygoma tripod + arch fracture Operative Method Open reduction and internal fixation Specimen Count And Types Nil Pathology Nil Operative Findings 1. Left zygoma tripod and arch frature with displacement was noticed 2. Fracture line approach: sub-eyebrow and upper gingival sulcus 3. Fracture fixation: right fronto-zygomatic junction and right lateral batress Operative Procedures Under general anesthesia, the patient was put in supine position. The skin was disinfected and draped as usual. Sub-eyebrow incision and upper gingival sulcus incision was done to approach the fracture lines. The zygoma fracture was reducted by using Dingman and the fracture sites were fixed by miniplates * 2. The wounds were closed with 4-0, 5-0 Dexon, 6-0 Nylon. Operators VS謝榮賢 Assistants R4阮廷倫 楊賴寶鳳 (F,1950/11/20,61y3m) 手術日期 2010/04/17 手術主治醫師 王國川 手術區域 東址 003房 2號 診斷 Cerebral aneurysm 器械術式 Craniotomy(Aneurysms) P-DUH 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 4E 紀錄醫師 游健生, 時間資訊 19:03 通知急診手術 19:03 臨時手術NPO 19:03 開始NPO 19:55 報到 20:00 進入手術室 20:10 麻醉開始 21:00 誘導結束 21:05 抗生素給藥 21:30 手術開始 02:55 抗生素給藥 04:55 手術結束 04:55 麻醉結束 05:05 送出病患 23:55 抗生素給藥 醫令資訊 類別 名稱 量 刀 側 手術 開顱術摘除血管病變－腦血管瘤－有徵的 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 10 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: (1)Left pterional approach for aneurysm clipp... 開立醫師: 李建勳 開立時間: 2010/04/18 05:16 Pre-operative Diagnosis Anterior communicating artery (A-com) aneurysm rupture with subarachnoid hemorrhage Post-operative Diagnosis Anterior communicating artery (A-com) aneurysm rupture with subarachnoid hemorrhage Operative Method (1)Left pterional approach for aneurysm clipping (2)Left Kocher point external ventricular drainage (EVD) insertion Specimen Count And Types nil Pathology Nil Operative Findings The opening pressure was not high (around 10-15 cmH2O). The A-com aneurysm was found with one lobe protruded anteriorly and another lobe protruded superiorly. The aneurysm was clipped by two fenestrated Sugita aneurysm clips. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position with head fixed with Mayfield skull clump. The scalp was shaved, scrubbed, disinfected with alcohol better-iodine then draped. The burr hole was made at left Kocher point for insertion of the EVD. Fixed the EVD tube after passing through subcutaneous tunnel at the scalp. Left frontotemporal scalp incision was made as usual pterional approach followed by craniotomy. The medial sphenoid ridge was further drill off by high speed air drill for wider operation field. Opened the dura in fish-mouth fasion after tenting around the craniotomy window. Opened the sylvian fissure and relaxed the brain by releasing the cerebrospinal fluid(CSF). Dissected the arachnoid to exspose the internal cerebral artery(ICA) and CN II. Followed the ICA to locate the anerior cerebral artery(ACA) and the aneurysm. Clipped the two aneurysms with fenestrated Sugita aneurysm clips and packing the aneurysm neck with temporalis fascia. The dura was sutured with 4-0 Prolene. The skull plate was fixed back with miniplates and screws after central tenting and one epidural closed wound vaccum drian set up. The temporalis muscle and fascia were sutured back and the wound was closed in layers. Operators P 蔡瑞章 VS 王國川 Assistants R2 游健生 R3 曾峰毅 R6 李建勳 Indication Of Emergent Operation 王明德 (M,1922/10/20,89y4m) 手術日期 2010/04/18 手術主治醫師 蔡瑞章 手術區域 東址 019房 01號 診斷 Subdural hemorrhage 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 3E 紀錄醫師 古恬音, 時間資訊 07:01 臨時手術NPO 07:01 開始NPO 17:48 報到 17:55 進入手術室 18:05 麻醉開始 18:30 誘導結束 18:50 抗生素給藥 19:16 手術開始 20:45 開始輸血 22:50 手術結束 22:50 抗生素給藥 22:50 麻醉結束 23:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 2 0 手術 慢性硬腦膜下血腫清除術 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 記錄__ 手術科部: 外科部 套用罐頭: Craniotomy for hematoma evacuation 開立醫師: 胡朝凱 開立時間: 2010/04/18 23:19 Pre-operative Diagnosis Left acute on chronic SDH Post-operative Diagnosis Left acute on chronic SDH Operative Method Craniotomy for hematoma evacuation Specimen Count And Types outer membrane and inner membrane Pathology pending Operative Findings 1.Acute hematoma was noted at left parietal to temporal area 2.Outer and inner membrane were thick 3.The brain was slack, but after removal of inner membrane, it expanded mildly Operative Procedures 1.ETGA, supine 2.Left reverse U shape skin incision 3.Reflect skin flap downward 4.Open temporalis muscle 5.Craniotomy 6.dural tenting 7.Open dura 8.Excised outer membrane 9.Evacuate hematoma 10.remove inner membrane 11.Hemostasis 12.Dura closure after setting one rubber drain 13.Fixed bone back with miniplate 14.Set one CWV drain then close wound in layers Operators 蔡瑞章 Assistants 胡朝凱,古恬音 Indication Of Emergent Operation 謝國威 (M,2005/11/21,6y3m) 手術日期 2010/04/18 手術主治醫師 楊士弘 手術區域 兒醫 067房 02號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 2E 紀錄醫師 朱峻緯, 時間資訊 00:37 臨時手術NPO 00:37 開始NPO 08:38 通知急診手術 11:16 進入手術室 11:16 報到 11:30 麻醉開始 11:50 誘導結束 12:30 抗生素給藥 12:45 手術開始 15:15 開始輸血 15:45 抗生素給藥 18:30 抗生素給藥 21:00 麻醉結束 21:00 手術結束 21:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 11 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 3 0 麻醉 Hemoglobin (Hb) 3 0 麻醉 測血糖 3 0 麻醉 Ca (Calcium) 3 0 麻醉 Na (Sodium) 3 0 麻醉 K (Potassium) 3 0 麻醉 Cl (Chloride) 3 0 麻醉 Blood gas analysis 3 0 手術 腦瘤切除－手術時間在８小時以上 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Right frontotemporal craniotomy for total tum... 開立醫師: 楊士弘 開立時間: 2010/04/18 21:07 Pre-operative Diagnosis Brain tumor, right frontal lobe Brain tumor, left frontal lobe Post-operative Diagnosis Brain tumor, right frontal lobe Brain tumor, left frontal lobe Operative Method Right frontotemporal craniotomy for total tumor excision Left frontotemporal craniotomy for total tumor excision Specimen Count And Types 1 piece About size:小: Source:brain tumor Pathology pending Operative Findings The brain bulged out after dural opening. Intra-op. sonar revealed a heterogenous subcortical tumor in the right frontal lobe. A small portion of tumor surface was seen under the pia mater near the skull base. The tumor was heterogenous in character. Most part of the tumor was greyish red, soft fragile, and hypervascular, while some part was yellowish red, brittle with some calcification. About 30 c.c. liquified old blood was found in the center of the tumor. The tumor was adherent to the pia mater. It did not encase the MCA or other major vessels. The deepest part of tumor was adherent with the ependymal layer of the lateral ventricular wall. Clear CSF was found inside the lateral ventricle. The brain bulged out after dural opening. Intra-op. sonar revealed a heterogenous subcortical tumor in left frontal lobe. A small portion of tumor surface was seen under the pia mater near the skull base. The tumor was heterogenous in character. Most part of the tumor was greyish red, soft fragile, and hypervascular, while some part was yellowish red, brittle with some calcification. About 30 c.c. liquified old blood was found in the center of the tumor. The tumor was adherent to the pia mater. It did not encase the MCA or other major vessels. The deepest part of tumor was adherent with the ependymal layer of the lateral ventricular wall. Clear CSF was found inside the lateral ventricle. The brain became slack after tumor excision. Operative Procedures 1. ETGA, supine, head fixed with Mayfield skull clamp then rotated to right. 2. Right frontotemporal curvilinear incision. 2. Left frontotemporal curvilinear incision. 3. Right frontotemporal craniotomy, 8 cm x 7 cm. 3. Left frontotemporal craniotomy, 8 cm x 7 cm. 4. U-shaped dural incision. 5. Intra-op. sonography. 6. Coagulation and incision of pia mater in the right frontal lobe overlying the tumor. 7. Central debulking of tumor with bipolar forceps, tumor forceps, and suckers. 8. Dissection and removal of tumor shell from the brain parenchyma with bipolar, dissector, and cottonoids. 9. Surgicel packing of the white mater surface after tumor removal. 10. One epidural drain. 11. Fixation of skull bone flap back to the craniotomy window. 12. Wound closure in layers. Operators 楊士弘 Assistants 胡朝凱,朱峻緯 Indication Of Emergent Operation 相關圖片 陳賢端 (M,1956/06/13,55y9m) 手術日期 2010/04/19 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 08:00 報到 08:08 進入手術室 08:15 麻醉開始 08:50 誘導結束 09:10 抗生素給藥 09:55 手術開始 11:06 開始輸血 12:10 抗生素給藥 17:00 麻醉結束 17:00 手術結束 19:10 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 10 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除－手術時間在４～８小時 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: frontal craniotomy for Simpson grade II tumor excision 開立醫師: 李建勳 開立時間: 2010/04/19 17:52 Pre-operative Diagnosis Right frontal convexity meningioma Post-operative Diagnosis Right frontal convexity meningioma Operative Method Right frontal craniotomy for Simpson grade II tumor excision Specimen Count And Types 1 piece About size:10g Source:craniotomy for tumor excision Pathology Pending Operative Findings The tumor is yellowish, soft-elastic, size 6 cm in diameter. The tumor margin was seperate clearly from the normal brain parenchyma at arachnoid plane. Some necrotic tumor with fluid was noted at inferior part of the tumor. One artery was encased tightly by the tumor and unable to seperated the tumor completely. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position with head fixed with Mayfield skull clump. The scalp was shaved, scrubbed, disinfected with alcohol better-iodine then draped. The inverted U-shaped scalp incision was made connected to previous op scar followed by right frontal craniotomy. The dura was opened around the tumor after tenting along the craniotomy window. The tumor was dissected from the surrounding normal brain tissue with dissector and bipolar coagulator. Two silk sutures was used for traction of the tumor. The tumor was resected in one piece after dissection. One artery was encased tightly by the tumor and unable to seperated the tumor completely. Hemostasis was achieved with Surgicel lining of the tumor bed. The dura was sutured with 4-0 Prolene sutures. The skull plate was fixed back with wires, miniplates and screws after one epidural CWV drain set up. The wound was then closed in layers. Operators P 杜永光 Assistants R3林哲光 R6李建勳 相關圖片 李士君 (M,1970/04/26,41y10m) 手術日期 2010/04/19 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Glioblastoma multiforma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 古恬音, 時間資訊 00:00 臨時手術NPO 08:00 報到 08:05 進入手術室 08:15 麻醉開始 08:40 抗生素給藥 08:45 誘導結束 09:08 手術開始 11:40 抗生素給藥 14:10 麻醉結束 14:10 手術結束 14:23 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４～８小時 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for total tumor remove 開立醫師: 陳睿生 開立時間: 2010/04/19 14:53 Pre-operative Diagnosis Left temporal GBM with recurrence Post-operative Diagnosis Left temporal GBM with recurrence Operative Method Craniotomy for total tumor remove Specimen Count And Types 1 piece About size:5x5cm Source:tumor Pathology Pending Operative Findings The tumor was about 5x5cm in size. It was whitish, yellowish, and firm one. Radiation related tumor fibrotic change was impressed. The tumor was well vascularized from deep side. After total remove of the firm tumor, some soft abnormal brain tissue was noted peripherally. The abnormal tissue was also removed. Operative Procedures 1. ETGA, supine position; head right turn and fix with Mayfield clump 2. Incise into the scalp as previous wound and extend inferiorly at temporal side 3. The skull graft was removed after removing plate 4. Craniotomy was extended with sew anteriorly, and then find out the tumor with intra-op ECHO 5. The previous artificial dura graft was removed, and the dura was opened widely 6. The tumor was dissected from peripheral brain tissue with suction and electrocauterization of the supply vessels 7. The tumor was totally removed after dissection 8. Remove of peripheral abnormal brain tissue 9. Hemostasis, the dura was closed with Gortex graft 10.Set an epidural CWV drain 11.Fix back skull graft with wires x3 and miniplates x3 12.Close the wound in layers Operators VS 曾漢民 Assistants R5 陳睿生; R2 古恬音 江李梅鳳 (F,1942/11/04,69y4m) 手術日期 2010/04/19 手術主治醫師 曾勝弘 手術區域 東址 002房 01號 診斷 Acute leukemia 器械術式 Ommaya reservoir implantation 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 09:35 報到 09:43 進入手術室 09:45 麻醉開始 09:50 抗生素給藥 10:10 誘導結束 10:38 手術開始 11:40 手術結束 11:40 麻醉結束 11:50 送出病患 11:57 進入恢復室 13:17 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 歐氏貯囊置放手術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Omaya implantation via right Kocher point 開立醫師: 曾峰毅 開立時間: 2010/04/19 11:43 Pre-operative Diagnosis Acute leukemia with CNS involvement Post-operative Diagnosis Acute leukemia with CNS involvement Operative Method Omaya implantation via right Kocher point Specimen Count And Types 3ml CSf was sent for cytology. Pathology Nil Operative Findings Opening pressure is about negative 5cmH20. Clear, colorless CSF was noted. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position. After sclap shaved, scrubbed, disinfected, and the draped, we made one cruvilinear skin incision at right frontal area. We drilled one burr hole, tented the dura, and made durotomy. Ventriculostomy was done by venntricular puncture. Omaya was inserted, and CSF was sampled via the Omaya reservoir. We fixed the Omaya by suture, and closed the wound by layers after hemostasis. Operators vs 曾勝弘 Assistants R3 曾峰毅 R2 游健生 邱貳定 (M,1936/01/30,76y1m) 手術日期 2010/04/20 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Cervical Spondylosis 器械術式 Laminectomy C-Spinal(Posterier 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 07:57 報到 08:08 進入手術室 08:15 麻醉開始 08:25 誘導結束 08:47 抗生素給藥 09:07 手術開始 11:05 手術結束 11:05 麻醉結束 11:17 送出病患 11:20 進入恢復室 12:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 椎弓整形術 1 1 記錄__ 手術科部: 外科部 套用罐頭: C3~5 laminoplasty 開立醫師: 胡朝凱 開立時間: 2010/04/20 11:28 Pre-operative Diagnosis C3~5 spinal stenosis Post-operative Diagnosis C3~5 spinal stenosis Operative Method C3~5 laminoplasty Specimen Count And Types Nil Pathology nil Operative Findings 1.Hypertrophic PLL that compressed the thecal sac tightly 2.After laminoplasty, thecal sac expanded well Operative Procedures 1.Anesthesia: endotracheal general. 2. Position: prone with neck flexed and head fixed by a Mayfield skull clamp 3.Skin preparation: occipital and neck areas were shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: medline nape, from suboccipital to lower neck. 5.The trapezius, semispinalis capitis, splenius capitis muscles on both sides were splitted at its origin of ligamentum nuchae, then, together with serratus posterior superior, rectus capitis posterior, obliqus capitis inferior and multifidus were detached from the spinous processes of C 3-5, followed by subperiosteal dissection on the laminae. 6.bleeding from the muscles was stopped by Bovie. 7.The spinous processes of C 3~5 were cut at its base by high speed air drill andreserved for later use. 8. The right laminal arches were cut through its whole thickness. The left side laminae at its laminopedicle juction was cut into a depth of it half thickness by a 1mm head size high speed cutting burr. 9.The lamina was bent to the left side by opening a door like action of a Cloward intervertebral spreader. Consequently, the posterior half of the spinal canal was enlarged. 10.The hypertrophic ligmenta flava, esp. at posterior central region were resected. 11.Each gap newly created after splitting was bridged by the reserved spinous process which was fixed to the laminae by a miniplate on each end. 12.The paravertebral muscles were closed by interrupted sutures with 2/0 silk, subcutaneous layer by continuous suture with 3/0 Dexon and skin by continuous suture with 3/0 nylon. 14.Drain: one, epilaminal, hemovac. Operators 賴達明 Assistants 胡朝凱,游健生 黃鈺翔 (M,1997/11/30,14y3m) 手術日期 2010/04/20 手術主治醫師 楊士弘 手術區域 兒醫 067房 01號 診斷 Primitive neuroectodermal tumor 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 07:30 報到 08:08 進入手術室 08:27 麻醉開始 08:50 抗生素給藥 08:51 誘導結束 09:43 手術開始 11:50 抗生素給藥 14:50 抗生素給藥 17:50 麻醉結束 17:50 手術結束 17:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 惡性病髓腫瘤切除術 1 1 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 手術 脊椎融合術－前融合，有固定物（＜＝四節） 1 3 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 11 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 記錄__ 手術科部: 外科部 套用罐頭: 1. C3 corpectomy and anterior fusion with wir... 開立醫師: 李振豪 開立時間: 2010/04/20 18:28 Pre-operative Diagnosis Primitive neuroectodermal tumor with C3 metastasis and pathologic compression fracture Post-operative Diagnosis Primitive neuroectodermal tumor with C3 metastasis and pathologic compression fracture Operative Method 1. C3 corpectomy and anterior fusion with wire mesh, bone cement, and plate 2. C2 translaminar screws, C4 and C5 lateral mass screws for posterior fixation and fusion Specimen Count And Types Multiple small pieces of spinal tumor Pathology Pending Operative Findings 1, The tumor is hypervascular, easily bleeding, soft, fragile, and ill-demarcated in characters. The C3 spinous process and lamina are all destructed by the tumor. 2. Plates: 28mm, four 12mm screws 3. C2 translaminar screws: 20mm x 2 C4 lateral mass screws: 18mm x 2 C5 lateral mass screws: R/L 18mm/16mm Rods: 6cm x 2 Cross link x 1 with 4cm rod Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine position with head extension. C-arm portable X-ray was used for localization of C3 body. The skin was scrubbed, disinfected, and draped as usual. One curvilinear, transverse skin incision was made at right submandibular area. The subcutaneous soft tissue was dissected and the carotid sheath was identified. The prevertebral fascia was identified after dissected along the fascia interface. The longus coli muscle was dissected in order to expose the vertebral body. The C3 body was identified again by C-arm portable X-ray. C3 corpectomy, C3-4, C4-5 diskectomy was done with currette and Karrison punch. The dura was well expanded after the procedure. After hemostasis, the Gelform was placed at epidural space. Wire mesh was placed and the bone cement was used for anterior fusion. The plate was applied with four screws fixation. Hemostasis was achieved and one Minihemovac was placed. The wound was then closed in layers after normal saline irrigation. The position of the patient was changed to prone position with head fixed with Mayfield skull clamp. The skin was shaved, scrubbed, disinfected, and draped as usual. One midline skin incision was made from suboccipital to C6 level. The C2, C4, and C5 spinous process was exposed. The paravertebral muscle group was detached and the C2~C5 laminae was exposed. The tumor was excised and hemostasis was achieved with Gelform packing. C3 laminectomy for tumor excision was done. C2 translaminar screws, C4, C5 lateral mass screws were applied for posterior fixation. One cross-link was used. The location of instrument was checked with C-arm portable X-ray. After normal saline irrigation, the wound was closed in layers with one epilaminar CWV drain. The position of the patient was changed to prone position with head fixed with Mayfield skull clamp. The skin was shaved, scrubbed, disinfected, and draped as usual. One midline skin incision was made from suboccipital to C6 level. The C2, C4, and C5 spinous process was exposed. The paravertebral muscle group was detached and the C2~C5 laminae was exposed. The tumor was excised and hemostasis was achieved with Gelform packing. C3 laminectomy for tumor excision was done. C2 translaminar screws, C4, C5 lateral mass screws were applied for posterior fixation. One cross-link was used. The location of instrument was checked with C-arm portable X-ray. Decortication was performed with high-speed air-drilled and posterio fusion was done with Sinbone. After normal saline irrigation, the wound was closed in layers with one epilaminar CWV drain. Operators VS楊士弘 Assistants R3李振豪 徐惟菁 (F,1968/11/05,43y4m) 手術日期 2010/04/20 手術主治醫師 黃俊升 手術區域 東址 026房 01號 診斷 Female breast cancer 器械術式 Port-A catheter Implatation 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 王永彬 ASA 2 紀錄醫師 黃凱傑, 時間資訊 07:55 報到 08:10 進入手術室 08:20 麻醉開始 08:25 誘導結束 08:31 抗生素給藥 08:45 手術開始 09:35 手術結束 09:35 麻醉結束 09:41 送出病患 09:43 進入恢復室 10:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 ｐｏｒｔ–Ａ導管植入術–治療性導管植入術 1 0 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 摘要__ 手術科部: 外科部 套用罐頭: Port-A insertion, Right 開立醫師: 黃凱傑 開立時間: 2010/04/20 09:49 Pre-operative Diagnosis Breast cancer, left Post-operative Diagnosis Breast cancer, left Operative Method Port-A insertion, Right Specimen Count And Types nil Pathology nil Operative Findings Post-operative portable X-ray showed Port-A catheter tip in correct venous branch to SVC. Operative Procedures 1. Under endotracheal general anesthesia with the patient in supine position, prepped and draping were performed in the usual sterile method. 2. An incision was made in right side neck and subclavical area. After identification of the cephalic vein, Port-A catheter was inserted. Adequate hemostasis was obtained. Then the wound was closed in layers. Post-operative portable X-ray showed catheter tip in correct venous branch to SVC. Then the wound Operators 黃俊升 Assistants 黃凱傑 Ri羅名宇 江聰仁 (M,1965/10/08,46y5m) 手術日期 2010/04/20 手術主治醫師 陳敞牧 手術區域 東址 005房 01號 診斷 Acoustic tumor 器械術式 Brain tumor Crainotomy(Others) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳柏達, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:09 進入手術室 08:16 麻醉開始 08:50 誘導結束 09:20 抗生素給藥 09:36 手術開始 12:20 抗生素給藥 15:20 抗生素給藥 17:00 麻醉結束 17:00 手術結束 17:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 R 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 9 0 摘要__ 手術科部: 外科部 套用罐頭: Right side retrosigmoid appro00ach for subtot... 開立醫師: 陳睿生 開立時間: 2010/04/20 17:41 Pre-operative Diagnosis Right CPA tumor, suspect acoustic neuroma Post-operative Diagnosis Right CPA tumor, suspect acoustic neuroma Operative Method Right side retrosigmoid appro00ach for subtotal tumor remove Specimen Count And Types 1 piece About size:pieces Source:tumor Pathology Pending Operative Findings The tumor was about 3.5cm in diameter. It was whitish, soft, and fragile. The tumor was well capsuled and compressed the pons, right side cerebellum tightly. The CN V, VII, & VIII were not found intra-op. A piece of tumor capsule was left at the deepest side due to pons adhesion. Operative Procedures 1. ETGA, 3/4 prone position, head right turn and fix with Mayfield clump 2. Right side retrosigmoid curvillinear scalp incision 3. Identify the astron point and make two bur holes at right astron and occipital 4. Creat a craniotomy about 5x5cm to expose the transverse and sigmoid sinus 5. Inverse K dura incision for opening 6. Drain out CSF from cistern magnum for decompression 7. Retract cerebellum posteriorly with self retractor 8. Expose the lateral aspect of the tumor capsule 9. Central tumor debulking with tumor forceps and electricaugerization 10.After central decompression, the tumor capsule was dissect from peirpheral brain parychema 11.Partially remove of the tumor capsule 12.Hemostasis, and the cavity was deair 13.The dura was tightly closed with fascia graft 14.Fix back skull graft with wires, and central tacking 15.Set a subgaleal CWV drain, and close the wound in layers Operators VS 陳敞牧 Assistants R5 陳睿生, R2 陳柏達 羅信泰 (M,1966/11/29,45y3m) 手術日期 2010/04/21 手術主治醫師 杜永光 手術區域 東址 002房 02號 診斷 Respiratory failure, with long-term ventilator use 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 4E 紀錄醫師 胡朝凱, 時間資訊 09:40 通知急診手術 10:35 報到 10:35 進入手術室 10:40 麻醉開始 11:00 誘導結束 11:36 手術開始 13:00 抗生素給藥 14:55 麻醉結束 14:55 手術結束 15:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 顱骨切除術，包括異物移除或減壓或神經切斷 1 1 B 手術 腦室體外引流 1 2 B 記錄__ 手術科部: 外科部 套用罐頭: Right craniectomy and EVD replacement 開立醫師: 胡朝凱 開立時間: 2010/04/21 15:22 Pre-operative Diagnosis Right MCA aneurysm rupture with brain swelling Post-operative Diagnosis Right MCA aneurysm rupture with brain swelling Operative Method Right craniectomy and EVD replacement Specimen Count And Types CSF routine, BCS, culture x 3 tubes. EVD tip culture x 1 tube Pathology nil Operative Findings 1.Severe brain swelling and subarachnoid blood clot were noted. 2.Initial Opening pressure: more then 20 cmH2O, CSF clean 3.Brain pulsation: positive Operative Procedures 1.ETGA, supine 2.Left previous skin incision 3.EVD replacement 4.Right previous wound skin incision 5.Reflect skin flap downward 6.Open periosteum 7.Craniectomy 8.Duroplasty with durofoam 9.Resect muscle flap 10.wound in layers Operators P 杜永光 Assistants 胡朝凱, Ri Indication Of Emergent Operation 郭文禮 (M,1955/03/24,56y11m) 手術日期 2010/04/21 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Trigeminal neuralgia (Cranial nerve V) 器械術式 Microvascular decompression 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 07:45 報到 07:55 進入手術室 08:25 麻醉開始 08:55 誘導結束 08:58 抗生素給藥 10:13 手術開始 13:10 麻醉結束 13:10 手術結束 13:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦微血管減壓術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Microvascular Decompression 開立醫師: 李建勳 開立時間: 2010/04/21 14:00 Pre-operative Diagnosis Left trigeminal neuralgia Post-operative Diagnosis Left trigeminal neuralgia Operative Method Microvascular Decompression Specimen Count And Types nil Pathology Nil Operative Findings The left trigeminal nerve was found compressed laterally by the superior cerebellar arteries. The trigeminal nerve was free of compression after Teflon patch insertion. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position with head turned to right. The scalp was shaved, scrubbed, disinfected with alcohol better-iodine then draped. The S-shaped scalp incision was made at left retroauricular area. Harvested the fascia graft before 2 cm X 2 cm craniotomy. The dura was opened after tenting. The cerebellum was relaxed by draining the CSF. The petrosal vein was identified and the fifth nerve was also identified. The arachnoid membrane around the CVII, VIII complex were dissected to the base of flocuulus. The superior cerebellar arteries were then pushed away from the trigeminal nerve with Teflon. The trigeminal nerve seemed free of compression after Teflon inserted. Duroplasty with autologous fascia graft and 4-0 Prolene sutures. The skull plate was put back with gelform packing. Closed the wound in layers. Operators P 杜永光 Assistants R3 林哲光 R6 李建勳 劉家芳 (M,1966/03/10,46y0m) 手術日期 2010/04/21 手術主治醫師 蔡瑞章 手術區域 東址 005房 01號 診斷 Glioma 器械術式 Brain tumor Crainotomy(Others) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 07:47 報到 08:01 進入手術室 08:30 麻醉開始 08:55 誘導結束 09:05 抗生素給藥 09:37 手術開始 13:15 麻醉結束 13:15 手術結束 13:25 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除－手術時間在４小時以內 1 1 L 摘要__ 手術科部: 內科部 套用罐頭: Craniotomy for tumor remove 開立醫師: 陳睿生 開立時間: 2010/04/21 13:46 Pre-operative Diagnosis Left posterior frontal tumor, suspect low grade glioma Post-operative Diagnosis Left posterior frontal tumor, suspect high grade glioma Operative Method Craniotomy for tumor remove Specimen Count And Types 1 piece About size:pieces Source:tumor Pathology Pending Operative Findings The tumor located at posterioinferior frontal lobe. It was grayish whitish, and soft, fragile. Severe gliotic change was noted at the central part and poor margined was noted between the tumor and normal brain tissue. The tumor size was about 4x4 cm. The tumor protruded at the subdural space and subdural effusion was noted. Operative Procedures 1. ETGA, supine position, head right turn and fix with Mayfield clump 2. Left frontotemporal curvillinear scalp incision 3. Dissect the temporalis muscle, and 4 bur holes were made 4. An about 10x10 cm craniotomy window was created, and intra-op ECHO recheck the tumor 5. Dura tacking, and the dura was opened via the window margin 6. Adhesionlysis between the tumor and arachnoid membrane, brain tissue 7. Identify the tumor margin and dissect the tumor from brain parychema 8. Nearly total remove of the tumor 9. Close the dura tightly 10.Fix back the skull graft with miniplates x3 11.Set a subgaleal CWV drain, and close the wound in layers Operators P 蔡瑞章 Assistants R5 陳睿生；R2 游健生 溫鏡清 (M,1951/10/19,60y4m) 手術日期 2010/04/21 手術主治醫師 蔡瑞章 手術區域 東址 019房 02號 診斷 Lymphoma 器械術式 Brain tumor Crainotomy(Others) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 11:05 報到 11:27 進入手術室 11:30 麻醉開始 11:30 抗生素給藥 11:35 誘導結束 12:20 手術開始 15:00 麻醉結束 15:00 手術結束 15:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 手術 立體定位術－切片 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Stereotactic biopsy for right insula tumor 開立醫師: 李振豪 開立時間: 2010/04/21 15:47 Pre-operative Diagnosis Multiple brain tumor, suspect lymphoma Post-operative Diagnosis Multiple brain tumor, suspect lymphoma Operative Method Stereotactic biopsy for right insula tumor Specimen Count And Types 1 piece About size:3 pieces of brain tissue Source:Stereotactic biopsy Pathology Frozen section: small blue cell, favor lymphoma Operative Findings Stereotactic biopsy was performed under Metronic Navigator-guided. The gross pathology showed graish, gelly-like brain tumor with clear margin between normal brain tissue. Small oozing was noted at 3rd time biopsy. Total four small pieces specimen was sampled for pathology and frozen section. Operative Procedures Under endotracheal tube general anesthesia, the patient was put at supine position with head fixed with Mayfield skull clamp. Registration for Metronic Navigator was done. The scalp was shaved, scrubbed, and disinfected as usual. The entry point was decided over left frontal area, near Kocher point under Navigator-guided. One linear scalp incision was made followed by one burr hole creation. After dural tenting, cruciform dural opening was performed. Stereotactic biopsy was done with four small pieces specimen sampled. The frozen section was sent and result showed suspect lymphoma. After hemostasis, the wound was then closed in layers. The patient stood whole procedure well and the pupil was isocornic with bilateral prompt light reflex. Operators Prof. 蔡瑞章 Assistants R3 李振豪 相關圖片 陳碧嬌 (F,1966/10/06,45y5m) 手術日期 2010/04/21 手術主治醫師 蔡瑞章 手術區域 東址 005房 02號 診斷 Spinal tumor 器械術式 Malignant intraspinal tumor, e 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 13:42 進入手術室 13:50 麻醉開始 14:00 誘導結束 14:13 抗生素給藥 14:46 手術開始 17:15 抗生素給藥 17:20 手術結束 17:20 麻醉結束 17:30 送出病患 17:35 進入恢復室 18:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 手術 良性病髓腫瘤切除術 1 1 摘要__ 手術科部: 外科部 套用罐頭: Partial T6, 8, and total T7 laminectomy for t... 開立醫師: 陳睿生 開立時間: 2010/04/21 17:44 Pre-operative Diagnosis T7 intraspinal extramedullary tumor, suspect neuroma Post-operative Diagnosis T7 intraspinal extramedullary tumor, suspect neuroma Operative Method Partial T6, 8, and total T7 laminectomy for total tumor remove Specimen Count And Types 1 piece About size:2x2cm Source:tumor Pathology Pending Operative Findings The tumor was about 2x2x2cm in size. It was whitish, solid and well capsuled. The tumor was noted to be origined from right T8 root. After total remove of the tumor, the root was preserved. Operative Procedures 1. ETGA, prone position 2. Back midline incision, and the bilateral trapzius muscle and paraspinal muscle were dissected to expose the T6-8 spinous process and lamina 3. Lower T6, total T7, and upper T8 laminectomy with rounger and kerrison pounch 4. Midline dura incision and then dura tacking 5. The arachnoid membrane was dissected and the tumor was identified 6. The tumor capsule was dissected from cord, peripheral roots, and arachnoid membrane 7. Totally remove of the tumor, and the root was preserved 8. Hemostasis, close the dura tightly 9. Set an epidural 1/8 hemovac 10.Close the wound in layers Operators P. 蔡瑞章 Assistants R5 陳睿生, R2 游健生 張紘彬 (M,2010/02/07,2y1m) 手術日期 2010/04/21 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Bacterial meningitis 器械術式 Removal of chronic subdural 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 陳德福, 時間資訊 00:00 臨時手術NPO 08:00 報到 08:10 進入手術室 08:28 麻醉開始 08:35 誘導結束 09:12 手術開始 10:05 麻醉結束 10:05 手術結束 10:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 套用罐頭: right burr hole drainage of subdural fluid 開立醫師: 陳德福 開立時間: 2010/04/21 10:22 Pre-operative Diagnosis bilateral subdural fluid collection bilateral subdural fluid collection Post-operative Diagnosis ditto Operative Method right burr hole drainage of subdural fluid Specimen Count And Types 1 piece About size:3ML Source:right subdural fluid Pathology pending Operative Findings 1.outer membrane formation: + 2.There is 10ml clear yellowish fluid gushed out spontaneously after opening the outer membrane. 3.The brain expanded partially after drainage and one subdural drainage was left in situ. 3.The brain expanded partially after drainage and one subdural drainage was left in situ for about 3.5 cm. Operative Procedures 1.under ETGA and supine positon 2.skin disinfection andn draping 3.linear incision and burr hole creation over left temporoparietal region 4.dura tenting and dura opening 5.drainage of the subdural fluid 6.left one subdural draiange in situ 7.drain out the air inside the cranium 8.close the wound in layers Operators AP 郭夢菲 Assistants R4 陳德福 相關圖片 蘇芷誼 (F,1984/11/01,27y4m) 手術日期 2010/04/21 手術主治醫師 許文明 手術區域 兒醫 066房 04號 診斷 Polyneuropathy 器械術式 Port-A catheter implatation 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 廖御佐, 時間資訊 12:35 報到 12:50 進入手術室 12:55 麻醉開始 13:05 誘導結束 13:14 手術開始 13:15 抗生素給藥 13:45 手術結束 13:45 麻醉結束 13:50 送出病患 13:55 進入恢復室 15:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 內頸靜脈切開，永久導管放置術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 套用罐頭: Port-A implantation, puncture 開立醫師: 廖御佐 開立時間: 2010/04/21 14:01 Pre-operative Diagnosis ALL, relapse 1.ALL 2.B-cell lymphoma Post-operative Diagnosis ALL, relapse 1.ALL 2.B-cell lymphoma Operative Method Port-A implantation, puncture Specimen Count And Types 1 piece About size:Nil Source:Nil Pathology Nil Operative Findings The port-A tip was at the junction of RA and SVC. The blood flow was patent. Operative Procedures ETGA, supine Disinfection and drapped Puncture over right subclavian vein Port-A implantation Check position by portable CXR Close the wound Operators 許文明 Assistants 廖御佐 陳佳瑟 (F,1973/07/23,38y7m) 手術日期 2010/04/22 手術主治醫師 陳敞牧 手術區域 東址 005房 01號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(Others) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 陳柏達, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:00 進入手術室 08:10 麻醉開始 08:55 誘導結束 09:20 抗生素給藥 09:47 手術開始 12:20 抗生素給藥 15:00 麻醉結束 15:00 手術結束 15:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: Retro-sigmoid approach tumor excision 開立醫師: 陳柏達 開立時間: 2010/04/22 11:15 Pre-operative Diagnosis Left acoustic neuroma Post-operative Diagnosis ditto Operative Method Retro-sigmoid approach tumor excision Specimen Count And Types x1 Pathology pending Operative Findings One 3x2 cm soft, yellowish, tumor located at left CP angle with a well defined margin and capsule. The tumor arised from inferior vestibular nerve and pushed cochlear nerve caudally and facial nerve anteriorly. After operation, fascial nerve and cochlear nerve were preserved. One 3x2 cm soft, yellowish, tumor located at left CP angle with a well defined margin and capsule. The tumor arised from inferior vestibular nerve and pushed cochlear nerve caudally and facial nerve anteriorly. After operation, fascial nerve and cochlear nerve were not visualized. The lower cranial nerve preserved well. Operative Procedures Under endotracheal general anesthesia, patient was put inthree-quarter prone position with head tilt to right and was fixed by Mayfield skull clamp. Skin was shaved and scrubbed with povidone-iodine detergent, then covered with sterilized adhesive plastic sheet. Left post-auricular (retrosigmoid) curvillinear incision was made. The sternocleidomastoideus, splenius capitis, oblique capitis superior and part of the trapezius muslces were devided down to C1 level. Craniotomy was then performed as a 5x4 cm bone window to expose the margin of sigmoid sinus. Dural incision was made like "K" shape and reflected to sigmoid sinus. CSF was drained first at foramen magnum cistern until the cerebellum was slack enough for gentle retraction downward. Consequently, the posterior surface of the C-P angle tumor was well exposed. Under operating microscope, the vessels distributed on the posterior surface of the tumor were coagulated by bipoar coagulator and the branch of AICA adhered on the posterior-lower surface of the tumor was carefully separated. Then central debulky was performed to made the tumor be loosen. The vessels that supplied the tumor which came from pontal area were again devascularized. Under operating microscope, the vessels distributed on the posterior surface of the tumor were coagulated by bipoar coagulator and the branch of AICA adhered on the posterior-lower surface of the tumor was carefully separated. Then central debulky was performed to made the tumor be loosen. The vessels that supplied the tumor which came from pontal area were again devascularized. the tumor that attached to brain stem was left in situ. then dura was closed with fascia and wound was closed in layers. The dura of petrous bone at posterior wall of the internal acoustic meatuswas coagulated and stripped off. Then, the posterior wall of the internal acoustic meatus was fully opened by high speed air drill until the deepest part of intracanal tumor had been well exposed. The intracanal tumor was removed to expose the intracanal portion of the facial nerve. The last segment of the tumor left in the C-P angle was now resected along with the margin between brain parnechyme and capsule with great precaution. Dural was closed with a fascia graft The muscles were closed by interruped sutures. Then the wound was closed in layers. Operators VS陳敞牧 Assistants R5胡朝凱 R2陳柏達 黃文賢 (M,1967/01/31,45y1m) 手術日期 2010/04/22 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Intracerebral hemorrhage 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:00 進入手術室 08:05 麻醉開始 08:10 誘導結束 08:41 抗生素給藥 09:18 手術開始 11:10 手術結束 11:13 麻醉結束 11:17 送出病患 11:20 進入恢復室 12:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 頭顱成形術 1 2 R 手術 腦室腹腔分流手術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: 1. Right cranioplasty for skull defect, 2. V-... 開立醫師: 李振豪 開立時間: 2010/04/22 11:44 Pre-operative Diagnosis 1. Right MCA territory infarction status post right fronto-temporo-parietal craniectomy, 2. Hydrocephalus Post-operative Diagnosis 1. Right MCA territory infarction status post right fronto-temporo-parietal craniectomy, 2. Hydrocephalus Operative Method 1. Right cranioplasty for skull defect, 2. V-P shunt implantation via right Kocher"s points Specimen Count And Types 3 tube CSF with total 45ml in volume for routine, biochemistry, and bacterial culture Pathology Nil Operative Findings 1. The opening pressure was about 10cm H2O and about 100ml CSF was drained out after ventricular puncture. The brain was slacked after ventricular drainage. The CSF was clear in appearance and sampled for CSF routine, biochemistry, and bacterial culture. Autologous skull plate was applied for cranioplasty. 2. V-P shunt: Metronic median pressure reservoir was used for Ventricular catheter: 6.5cm in length Peritoneal catheter: 30cm in length Peritoneal catheter: 25cm in length Operative Procedures Under endotracheal tube general anesthesia, the patient was put at supine position with head rotated to left. The scalp was shaved, scrubbed, and disinfected as usual. The scalp incision was made along previous operative scar and the scalp flap was dissected and elevated. The bone edge was identified and skeletonized with electronic cautery. Ventricular puncture was performed and CSF was sampled and released for cranioplasty. One transverse skin incision was made at right upper quadrant abdomen and the subcutaneous soft tissue, rectus abdomen muscle was dissected for exposure of peritoneum. Minilaparotomy was done and the peritoneal cavity was opened under direct vision. One subcutaneous tunnel was created form right upper abdomen, right forechest, right neck, and retroauricular area and connected with craniectomy window. The autologus skull plate was fixed back with Miniplates and the wound was irrigated with Gentamicin solutions. After hemostasis, the V-P shunt was set up and the function was rechecked. One CWV drain was set up and the wound was then closed in layers. Operators VS王國川 Assistants R3李振豪 相關圖片 鄭竹田 (M,1937/11/30,74y3m) 手術日期 2010/04/22 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 ICH, trauma 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3 紀錄醫師 曾峰毅, 時間資訊 00:00 臨時手術NPO 11:00 報到 11:35 進入手術室 11:39 麻醉開始 11:45 誘導結束 11:55 抗生素給藥 12:14 手術開始 13:00 手術結束 13:00 麻醉結束 13:08 送出病患 13:14 進入恢復室 14:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室腹腔分流手術 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Subdro-peritoenal shunt via left frontal burr... 開立醫師: 曾峰毅 開立時間: 2010/04/22 13:16 Pre-operative Diagnosis External hydrocephalus Post-operative Diagnosis External hydrocephalus Operative Method Subdro-peritoenal shunt via left frontal burr hole Specimen Count And Types 10ml xanthochromic clear CSF was sent for CSF routine, biochemistry profile, and lactic acid level study. Pathology Nil Operative Findings Clear, xanthrochromic CSF was drained out while durotomy made. Codman, fixed-pressure, very low range (10mmH20 +- 10mmH20), shunt was inserted via left frontal burr hole. Operative Procedures Under endotracheal general anaesthesia, the patient was put in supine position with head rotated to right. After skin shaved, scrubbed, disinfected, and then draped, we made one transverse skin incision and created laparotomy at left upper abdomen. We created subcutaneous tunnel from left upper abdoemn to left scalp. One transverse skin incision was done at left frontal, and one burr hole was done. Dura was opened, and subdural effusion was drained. Shunt catheter was pulled through from left upper abdomen to left scalp, and connected with valve. Ventricular catheter was inserted into subdural space after irrigation. Peritoneal catheter was inserted into peritoneal cavity after good function checked. The wound was closed in layers. Operators VS 王國川 Assistants R3 曾峰毅 樂敏婉 (F,1958/03/28,53y11m) 手術日期 2010/04/23 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Pituitary tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 07:39 報到 07:55 進入手術室 08:15 麻醉開始 09:30 抗生素給藥 09:35 誘導結束 09:55 手術開始 13:00 抗生素給藥 14:30 麻醉結束 14:30 手術結束 14:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經由蝶竇之腦下垂體瘤切除 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 記錄__ 手術科部: 外科部 套用罐頭: Endoscopic transsphenoid adenomectomy 開立醫師: 林哲光 開立時間: 2010/04/23 15:03 Pre-operative Diagnosis Pituitary tumor Post-operative Diagnosis Pituitary tumor Operative Method Endoscopic transsphenoid adenomectomy Specimen Count And Types Multiple pieces, Source:transsphenoid adenomectomy Pathology Pending Operative Findings Some yellowish, soft-elastic, mass lesion was noted inside the pituitary fossa. Easily touch bleeding was noted during the operation inside the pituitary fossa. CSF leakage was noted during the operation and Tissuecol Duo and gelform packing. Lumbar drain was also inserted for CSF leakage. Operative Procedures Under general anethesia and intubation, the patient was put in supine position with head tilted 30 degree to left. The facial skin was antiseptic with alcohol better-iodine tincture, and the mucosa of oral and nasal cavity with aqueous better-iodine . The formerareas were covered by sterilized adhesive plastic sheets then draped. Under endoscope, the nasal mucosa was coagulated at right norstril. A nasal speculum was applied to displace the nasal mucosa laterally and keep thenasal cavity open constantly for the exposure of the vomer bone and the anterior wall of the sphenoid sinus. The anterior sphenoid wall and posterior sphenoid wall was remove by high speed air drill and Kerrison punch. The sellar floor durawas coagulated then opened in cruciate fashion. The soft tumor parenchyma was removed by curette and aligator. The CSF leakage was sealed with Tissuecol Duo nad gelform packing. The arachnoid and the opening of diaphragm sellae was enforced by packing with gelform as in the sellar cavity. The nasal mucosa returned to its normal position. Right side of the nasal cavities was tightly packed with a segment of rubber glove finger filled with vaseline gauze strips which had been soaked with better-iodine ointment. Lumbar drain was inserted over L4-5 level in left decubitus position after skin disinfection. Operators VS 楊士弘 P 杜永光 Assistants R3 林哲光 R6 李建勳 相關圖片 沈賢圳 (M,1956/11/10,55y4m) 手術日期 2010/04/23 手術主治醫師 李章銘 手術區域 東址 057房 01號 診斷 Esophagus cancer 器械術式 Stent insertion 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 3 紀錄醫師 張彥俊, 時間資訊 07:58 報到 08:07 進入手術室 08:20 麻醉開始 08:30 誘導結束 08:40 手術開始 09:15 手術結束 09:15 麻醉結束 09:25 送出病患 09:30 進入恢復室 10:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 氣管支架置放術 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Trachea stent insertion 開立醫師: 張彥俊 開立時間: 2010/04/23 09:48 Pre-operative Diagnosis Esophgeal cancer with trachea invasion Post-operative Diagnosis Esophgeal cancer with trachea invasion Operative Method Trachea stent insertion Specimen Count And Types nil Pathology nil Operative Findings multiple nodular lesion over traceha cause lumen narrowing Upper trachea external compressed by esophageal tumor 6cm long , OD 1.8cm diameter covered stent was inserted Operative Procedures ETGA, supine bronchosopic guided trachea stent insertion was done Operators VS李章銘 Assistants R5張彥俊 Ri吳元宏 周慶 (M,1954/03/22,57y11m) 手術日期 2010/04/23 手術主治醫師 曾漢民 手術區域 東址 019房 01號 診斷 Meningitis, unspecified 器械術式 Debridment-- >10cm 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 古恬音, 時間資訊 00:00 臨時手術NPO 07:35 報到 08:05 進入手術室 08:15 麻醉開始 08:20 誘導結束 09:00 抗生素給藥 09:20 手術開始 11:35 手術結束 11:35 麻醉結束 11:50 送出病患 11:55 進入恢復室 15:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 手術 移前皮瓣移植術 1 1 手術 頭顱成形術 1 1 記錄__ 手術科部: 外科部 套用罐頭: Duroplasty and advanced flap 開立醫師: 胡朝凱 開立時間: 2010/04/23 11:51 Pre-operative Diagnosis Wound dehiscence, and dural leakage Post-operative Diagnosis Wound dehiscence, and dural leakage Operative Method Duroplasty and advanced flap Specimen Count And Types one piece of granulation tissue Pathology nil Operative Findings 1.Small dural leak point at the edge of Gortex and dura. Prolene continuous suture was done.3 2.Subdural air trapping was also noted. 3.Undermined scalp was done for advanced flap Operative Procedures 1.ETGA, prone with head fixed with Mayfield skull clamp 2.Previous skin incision 3.Reflect skin flap 4.Remove the bone graft 5.Repair the dural leakage 6.Fixed bone back 7.Advanced skin flap 8.Close wound in layers after one CWV drain insertion Operators 曾漢民,謝榮賢 Assistants 胡朝凱,古恬音 林施秀玉 (F,1949/08/16,62y6m) 手術日期 2010/04/23 手術主治醫師 曾漢民 手術區域 東址 019房 02號 診斷 Pituitary Tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 古恬音, 時間資訊 00:00 臨時手術NPO 11:33 報到 12:18 進入手術室 12:35 麻醉開始 12:55 誘導結束 13:00 抗生素給藥 13:22 手術開始 14:30 麻醉結束 14:30 手術結束 14:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 經由蝶竇之腦下垂體瘤切除 1 1 記錄__ 手術科部: 外科部 套用罐頭: Transnasal trans-sphenoidal approach for tumo... 開立醫師: 周俊志 開立時間: 2010/04/23 14:53 Pre-operative Diagnosis PITUITARY MACROADENOMA WITH APOPLEXY Post-operative Diagnosis PITUITARY MACROADENOMA WITH APOPLEXY Operative Method Transnasal trans-sphenoidal approach for tumor excision Specimen Count And Types pieces of tumor Pathology pending Operative Findings The tumor was yellowish, soft one. Dark motor oil like blood was drained out after open tumor. Post-OP the normal gland was seen. The arachnopid membrane was intact. Operative Procedures After ETGA, the patient was put in supine position with head mild left tilt. The nasal cavity was well-disinfective, and then we incised into the nasal septum. Dissection was performed along with the periosteum to expose sphenoid sinus anterior wall and sphenoid ostia. After fracture of vomer, sphenoid sinus anterior wall was also fractured. The mucosa was removed. The sella floor was exposed and removed with kerrison. After cruciate form incision, tumor buldged out. And it was further removed with tumor forceps and ring currette. After total excision of tumor was made, the bony graft was put back and followed by compaction of merosel. Operators 曾漢民 Assistants 胡朝凱 張素芳 (F,1946/12/21,65y2m) 手術日期 2010/04/23 手術主治醫師 蔡瑞章 手術區域 東址 019房 01號 診斷 Intracerebral hemorrhage (ICH) 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3E 紀錄醫師 陳志軒, 時間資訊 18:56 臨時手術NPO 18:56 開始NPO 23:56 通知急診手術 00:55 報到 00:55 進入手術室 01:00 麻醉開始 01:10 誘導結束 02:00 抗生素給藥 02:17 手術開始 06:15 麻醉結束 06:15 手術結束 06:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 手術 腦內血腫清除術 1 1 L 手術 顱內壓監視置入 1 2 L 摘要__ 手術科部: 外科部 套用罐頭: (1) Left frontotemporal craniotomy for hemato... 開立醫師: 李建勳 開立時間: 2010/04/23 06:46 Pre-operative Diagnosis Left putaminal intracerebral hemorrhage with intraventricular hemorrahge Post-operative Diagnosis Left putaminal intracerebral hemorrhage with intraventricular hemorrahge Operative Method (1) Left frontotemporal craniotomy for hematoma evacuation (2) Right Kocher point extraventricular drainage(EVD) for intracranial peessure(ICP) monitoring Specimen Count And Types 4 pieces About size:5mL Source:craniotomy for hematoma evacuation About size:1mL Source:CSF About size:1mL Source:CSF About size:1mL Source:CSF Pathology Pending Operative Findings The CSF opening pressure was high (>30mmH2O). Large amount of hematoma about 60mL was noted at left frontal and temporal lobes. The brain was slack down afer hematoma evacuation. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position with head turned to right. The scalp was shaved, scrubbed, disinfected with alcohol better iodine then draped. The right EVD was inserted at Kocher opoint. The question mark scalp incision was made at left frontotemporal area followed by craniotomy. The dura was opened along the craniotomy window after tenting with 3-0 silk sutures. The ICH was located with intraoperative sonography. The frontal corticotomy was made to evacuate the hematoma. The hemostasis was achieved with bipolar coagulation and surgicel lining of the hematoma bed. The dura was closed with 4-0 Prolene sutures and DURAFORM cover the defect. The skull plate was fixed back with minipaltes and screws. The wound was then closed in layers after one epidural closed wound vaccum drain set up. Operators P 蔡瑞章 Assistants R1 陳志軒 R6 李建勳 Indication Of Emergent Operation 相關圖片 邱慶煌 (M,1938/03/19,73y11m) 手術日期 2010/04/23 手術主治醫師 賴達明 手術區域 東址 005房 01號 診斷 Lung cancer 器械術式 Malignant intraspinal tumor, e 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 08:01 進入手術室 08:10 麻醉開始 08:45 誘導結束 09:07 手術開始 09:07 抗生素給藥 11:25 手術結束 11:25 麻醉結束 11:52 送出病患 11:56 進入恢復室 13:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 惡性病髓腫瘤切除術 1 1 L 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: T5 laminectomy for total remove, and cord dec... 開立醫師: 陳睿生 開立時間: 2010/04/23 11:41 Pre-operative Diagnosis Lung cancer with T5 metastasis Post-operative Diagnosis Lung cancer with T5 metastasis Operative Method T5 laminectomy for total remove, and cord decompression Specimen Count And Types 1 piece About size:pieces Source:tumor Pathology Pending Operative Findings The tumor occupied the T5 left side lamina and pedicle. It was whitish, mild hardish, and well capsuled. Some soft portion was noted inside it. The cord was compressed to the right side, and the ligamentum flavum was adhered to the dura. After total remove of the tumor, the left T5 root was exposed, and the cord was well expanded. Operative Procedures 1. ETGA, prone position 2. Midline incision over upper back about 10cm 3. Dissect bilateral trapzius and paraspinal muscles to expose the T4-6 spinous process and lamina 4. Remove of lower T4 to total T5 spinous process 5. Identify the tumor over left T5 lamina 6. Partial T4 and total T5 laminectomy, and dissect the tumor from the cord and peripheral muscle 7. Remove of left side T5 pedicle for totally remove of the tumor 8. Hemostasis, expose the left T5 root 9. Set an epidural 1/8 hemovac, and close the wound in layers Operators VS 賴達明 Assistants R5 陳睿生; R2 王奐之 相關圖片 吳銀樹 (M,1962/01/07,50y2m) 手術日期 2010/04/23 手術主治醫師 賴達明 手術區域 東址 005房 02號 診斷 Cervical Spondylosis 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 11:18 報到 12:12 進入手術室 12:20 麻醉開始 12:25 誘導結束 12:30 抗生素給藥 13:05 手術開始 15:10 手術結束 15:10 麻醉結束 15:20 送出病患 15:20 進入恢復室 16:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術－頸椎 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 摘要__ 手術科部: 外科部 套用罐頭: Right side C4/5 foraminotomy 開立醫師: 陳睿生 開立時間: 2010/04/23 15:16 Pre-operative Diagnosis Right C4/5 foraminal stenosis Post-operative Diagnosis Right C4/5 foraminal stenosis Operative Method Right side C4/5 foraminotomy Specimen Count And Types nil Pathology Nil Operative Findings After removal of right side lower C4, and upper C5 spurs, the root was decompressed and well expanded. After removal of right side lower C4, and upper C5 spurs, the C5 root was decompressed and well expanded. Operative Procedures 1. ETGA, supine position with head mild extension 2. Right neck skin oblique incision 3. Incise into the plastyma muscle, and dissect the plane between the SCM and trachea, esophagus 4. Expose the prevertebral space, and C-arm localized the C4/5 space 5. Set a self retractor, and we drill into the right side C4/5 disk space with high speed drill under microscope 6. Drill out and remove of the lower C4, and upper C5 spurs 7. Hemostasis, and set a 1/8 hemovac 8. Close the wound in layers Operators VS 賴達明 Assistants R5 陳睿生; R2 王奐之 相關圖片 謝淑真 (F,1961/03/19,50y11m) 手術日期 2010/04/23 手術主治醫師 賴達明 手術區域 東址 005房 03號 診斷 Lumbar Spondylosis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 14:55 報到 15:36 進入手術室 15:45 麻醉開始 15:50 誘導結束 16:00 抗生素給藥 16:30 手術開始 19:00 抗生素給藥 19:17 開始輸血 20:50 手術結束 20:50 麻醉結束 21:00 送出病患 21:03 進入恢復室 22:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 手術 椎間盤切除術－腰椎 1 2 摘要__ 手術科部: 外科部 套用罐頭: L3/4, 4/5 laminotomy for sublaminar decompres... 開立醫師: 陳睿生 開立時間: 2010/04/23 21:13 Pre-operative Diagnosis L3/4, 4/5 HIVD with lumbar stenosis and spondylolithesis, status post L3/4 diskcetomy Post-operative Diagnosis L3/4, 4/5 HIVD with lumbar stenosis and spondylolithesis, status post L3/4 diskcetomy Operative Method L3/4, 4/5 laminotomy for sublaminar decompression + L3-5 posterioalteral fixation with TPS and L3/4 interbody fusion with PEEK cage Specimen Count And Types nil Pathology Nil Operative Findings Severe adhesion was noted at L3/4 level especially over right side. The thecal sac was adhered to the ligamentum flavum and scar tightly. After laminotomy and adhesionlysis, the thecal sac was well decompressed over L3/4, 4/5 level. The L3/4 disk was mild to moderate herniated and compressed the sac. Synthes instructmentation: Screws: 6.2 x 40 mm at L3, 4, 5 (total 6 screws) Rods: 80mm x2 PEEK cage: 11mm x2 at L3/4 level Operative Procedures 1. ETGA, prone position and C-arm localized L3, 4, 5 pedicles 2. Low back midline incision about 15cm 3. Split bilateral paraspinal muscles to expose L3-5 spnious processes and lamina 4. Identify L3, 4, 5 transverse processes and transpedicular screws were inserted under C-arm guide 5. L3/4, 4/5 laminotomy and remove of ligamentum flavum 6. Adhesionlysis was performed especially over right L3/4 level 7. Split thecal and L3/4 diskectomy was performed 8. Inserted bilateral PEEK cages under C-arm guide 9. Set bilateal rods and tightly fix the transpedicular screws system 10.Hemostasis, set two epidural 1/8 hemovac 11.Close the wound in layers Operators VS 賴達明 Assistants R5 陳睿生; R2 王奐之 相關圖片 柯素蘭 (F,1964/12/30,47y2m) 手術日期 2010/04/23 手術主治醫師 楊士弘 手術區域 東址 002房 03號 診斷 Malignant neoplasm of female breast, unspecified 器械術式 Malignant intraspinal tumor, e 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 李振豪, 時間資訊 00:55 臨時手術NPO 00:55 開始NPO 08:55 通知急診手術 12:05 報到 12:26 進入手術室 12:30 麻醉開始 12:40 誘導結束 13:25 抗生素給藥 13:54 手術開始 16:30 開始輸血 17:25 抗生素給藥 18:10 手術結束 18:10 麻醉結束 18:20 送出病患 18:25 進入恢復室 19:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 惡性病髓腫瘤切除術 1 1 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 2 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: T3-4 laminectomy for spinal tumor excision an... 開立醫師: 李振豪 開立時間: 2010/04/23 18:28 Pre-operative Diagnosis T3-4 spinal tumor with cord compression, suspect metastatic tumor Post-operative Diagnosis T3-4 spinal tumor with cord compression, suspect metastatic tumor Operative Method T3-4 laminectomy for spinal tumor excision and cord decompression + posterior fixation with transpedicular screws T3-4 laminectomy and pediculectomy(both T4)for spinal tumor excision and cord decompression + posterior fixation with transpedicular screws and rods Specimen Count And Types 1 piece About size:multiple small pieces of tumor Source:Spinal tumor Pathology Pending Operative Findings 1. The tumor was white-reddish, firm, hypovascular in character. The border between dura and the tumor was clear but the bony structure and the posterior longitudinal ligment was infiltrated by the tumor. The cord was tightly compressed at T3-4 level. After debulking of the tumor, the cord was well expanded. 2. Transpedicular screws 2. Transpedicular screws(Stryker, Xia) T2: 4.5 x 25mm x II T3: left side: 4.5 x 30mm x I T5: 4.5 x 30mm x II Rod: 9cm x II Operative Procedures Under endotracheal tube general anesthesia, the patient was put at prone position. The location of T3 and T4 was identified by C-arm portable X-ray. The skin was scrubbed, disinfected and draped as usual. The midline skin incision from T1 to T6 level was made. The subcutaneous soft tissue was dissected. The paravertebral muscle group was detached. The T2 to T5 lamina was exposed. T3 and T4 laminectomy was performed for tumor excision and decompression. The pedicle of T4 were also removed for tumor excision. The dura was not opened during the operation. The transpedicular screws at T2, T3, and T5 was performed under C-arm portable X-ray guided. After confirmed the location of the screws, the rods was set up. Hemostasis was achieved and two Hemovac drain was placed. The wound was irrigated and then closed in layers. Operators VS楊士弘 Assistants R3李振豪, Ri Indication Of Emergent Operation 王惠文 (F,1963/12/17,48y2m) 手術日期 2010/04/23 手術主治醫師 楊士弘 手術區域 東址 003房 02號 診斷 Herniated intervertebral disc (HIVD) 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 14:25 報到 14:55 進入手術室 15:05 麻醉開始 15:15 誘導結束 15:56 抗生素給藥 16:08 手術開始 18:30 手術結束 18:30 麻醉結束 18:35 送出病患 18:40 進入恢復室 19:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術－腰椎 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 摘要__ 手術科部: 外科部 套用罐頭: Right L5 hemilaminectomy for microscope disck... 開立醫師: 李建勳 開立時間: 2010/04/23 18:29 Pre-operative Diagnosis Right L5/S1 herniated intervetebral disc (HIVD) with root compression Post-operative Diagnosis Right L5/S1 herniated intervetebral disc (HIVD) with root compression Right L5/S1 ruptured intervetebral disc (HIVD) with root compression Operative Method Right L5 hemilaminectomy for microscope disckectomy Specimen Count And Types 1 piece About size:3g Source:Herniated disc Pathology Pending Operative Findings The bulging disc was found compressed the right S1 root tightly with posterior displacement. The root was free from compression after disckectomy. The ruptured disc was found compressing the right S1 root tightly with posterior displacement. The root was free from compression after disckectomy. Operative Procedures Under general anesthesia and intubation, the patient was put in prone position. The L5 and S1 spinous processes were located with portable C-arm X-ray. The skin was scrubbed, disinfected with alcohol better-iodine then draped. Midline skin incision was made from L5-S1 spinous processess. The paraspinal muscles were seperated and retracted with Taylor retractor. Under surgical microscope assistance, the rigth L5 hemilaminectomy was performed with high speed air drill, curette and Kerrison punch. The ligmentum flavum was removed by Kerrison punch to expose the dura. The herniated disc was removed with aligator and the PLL was incised with No. 15 surgical blade. After hemostasis, the wound was closed in layers. Operators VS 楊士弘 Assistants R2 游健生 R6 李建勳 相關圖片 吳文忠 (M,1932/12/26,79y2m) 手術日期 2010/04/23 手術主治醫師 王國川 手術區域 東址 001房 3號 診斷 Subdural hemorrhage 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 陳德福, 時間資訊 01:21 臨時手術NPO 01:21 開始NPO 12:21 通知急診手術 14:40 報到 15:00 進入手術室 15:10 麻醉開始 15:15 抗生素給藥 15:20 誘導結束 15:51 手術開始 17:20 手術結束 17:20 麻醉結束 17:30 送出病患 17:33 進入恢復室 18:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 慢性硬腦膜下血腫清除術 1 1 B 手術 慢性硬腦膜下血腫清除術 1 2 B 摘要__ 手術科部: 外科部 套用罐頭: bilateral burr hole drainage 開立醫師: 陳德福 開立時間: 2010/04/23 17:41 Pre-operative Diagnosis bilateral chronic subdural hematoma Post-operative Diagnosis ditto Operative Method bilateral burr hole drainage Specimen Count And Types 1 piece About size:50ml Source:subdural hematoma Pathology nil Operative Findings 1.outer membrane inner membrane formation: + 2.There is motor-oil like fluid [right:50ml; left: 20] gushed out spontaneously after opening the outer membrane. 3.The brain expanded partially after drainage and one subdural drainage was left in situ for about 3.5 cm bilaterally. Operative Procedures 1.under ETGA and supine positon 2.skin disinfection andn draping 3.linear incision and burr hole creation over left temporoparietal region 4.dura tenting and dura opening 5.drainage of the subdural fluid 6.left one subdural draiange in situ 7.drain out the air inside the cranium 8.repeat the procedure from 3-7 on the right side 9.close the wound in layers Operators VS 王國川 Assistants R4 陳德福 R3 林哲光 Indication Of Emergent Operation 相關圖片 張碧 (F,1937/06/10,74y9m) 手術日期 2010/04/24 手術主治醫師 王國川 手術區域 東址 003房 03號 診斷 Cerebrovascular accident (CVA) 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 3E 紀錄醫師 朱峻緯, 時間資訊 21:58 通知急診手術 23:39 報到 23:39 進入手術室 23:40 麻醉開始 00:10 誘導結束 00:15 抗生素給藥 00:46 手術開始 02:00 開始輸血 03:40 手術結束 03:40 抗生素給藥 03:40 麻醉結束 03:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 腦內血腫清除術 1 1 手術 顱內壓監視置入 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 記錄__ 手術科部: 外科部 套用罐頭: Craniectomy + ICP monitor insertion + partial... 開立醫師: 朱峻緯 開立時間: 2010/04/24 04:27 Pre-operative Diagnosis Right MCA infarction with severe brain swelling Post-operative Diagnosis Right MCA infarction with severe brain swelling Operative Method Craniectomy + ICP monitor insertion + partial right frontal lobectomy Specimen Count And Types nil Pathology nil Operative Findings 1.Rhe right side frontal lobe ischemic change with mild to moderate swelling 2.The brain parenchima is whitish and fragile and poor-pulsatile 1.Right side frontal lobe ischemic change with mild-to-moderate swelling 2.The brain parenchima is whitish and fragile and poor-pulsatile 1.Right side frontal lobe ischemic change with mild-to-moderate swelling 2.The brain parenchyma is whitish and fragile and poor-pulsatile 3.Codmen ICP monitor was inserted subdurally 4.The initial post-op ICP is about 2 4.The initial post-op ICP is about 2 mmHg Operative Procedures 1.ETGA, supine position with head turned to left side 2.Skin disinfection and drapping 3.Right side fronto-temporal scalp incision as trauma flap 4.Dissect temporalis muscle to expose kea hole 4.Dissect temporalis muscle to expose key hole 5.Create four burr holes and make a craniectomy window about 12x15 cm 6.Cut down sphenoid ridge and perform dura tenting 7.Extract a fascia graft from temporalis muscle and cut down temporalis muscle 8.Dura opening along the craniectomy window 9.Partial right frontal lobectomy with bipolar and suction 10.Hemostasis 11.Duraplasty with fascia graft 12.Inset a subdural ICP monitor 12.Insert a subdural ICP monitor 13.Set an epidural CWV drain and close the wounds in layers Operators VS王國川 Assistants R5陳睿生 R1朱峻緯 Indication Of Emergent Operation 陳文明 (M,1959/03/15,52y11m) 手術日期 2010/04/24 手術主治醫師 陳晉興 手術區域 東址 018房 01號 診斷 Hepatic cancer 器械術式 Mediastinoscope 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 3 紀錄醫師 莊民楷, 時間資訊 07:50 報到 08:00 進入手術室 08:25 麻醉開始 08:45 誘導結束 08:50 抗生素給藥 09:00 手術開始 10:00 手術結束 10:00 麻醉結束 10:10 進入恢復室 10:10 送出病患 11:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 縱膈腔鏡檢查合併切片 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: Mediastinoscopic lymph node biopsy 開立醫師: 莊民楷 開立時間: 2010/04/24 10:28 Pre-operative Diagnosis Mediastinum lymph node adenopathy, suspected HCC metastases Post-operative Diagnosis Mediastinum lymph node adenopathy, suspected HCC metastases Operative Method Mediastinoscopic lymph node biopsy Specimen Count And Types 1 piece About size:0.5x0.3cm Source:Mediastinum LAPs Pathology pending Operative Findings 1. several enlarged lymph node was noted over subcarnal and sub-aortic-arch area 2. two lymph nodes below the junction of aortic arch and innominant artery were dissected for biopsy and culture 3. cross section of dissected lymph node was whitish and fragile, highly suspected HCC metastases Operative Procedures 1. ETGA, supine with neck hyperextension 2. Disinfection and drapping 3. Transverse skin incision, 3cm in length, 5cm above sternal nutch 4. Dissect to expose trachea and along pretracheal plane 5. Set mediastinoscopy 6. Dissect to expose LAPs, perform excisional biopsy of two 7. Hemostasis, Surgicel packing 8. Close the wound in layers Operators VS 陳晉興 Assistants R5 張彥俊, R2 莊民楷 陳葉碧珠 (F,1936/09/30,75y5m) 手術日期 2010/04/24 手術主治醫師 楊士弘 手術區域 東址 005房 01號 診斷 Spondylitis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 3 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:05 進入手術室 08:30 麻醉開始 08:57 誘導結束 09:08 抗生素給藥 09:38 手術開始 12:10 抗生素給藥 13:30 開始輸血 15:08 抗生素給藥 18:08 抗生素給藥 21:25 麻醉結束 21:25 手術結束 21:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 18 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 脊椎融合術－前融合，無固定物（＜＝四節） 1 2 摘要__ 手術科部: 內科部 套用罐頭: (1) Lateral extrtacavitary approach for T10 a... 開立醫師: 楊士弘 開立時間: 2010/04/24 21:25 Pre-operative Diagnosis Thoracic spinal lesion with spinal cord compression, T10-11 Post-operative Diagnosis Thoracic spinal lesion with spinal cord compression, T10-11, r/o tuberculotic spondylodiskitis Operative Method (1) Lateral extrtacavitary approach for T10 and T11 corpectomy and anterior instrumented fusion by titanium body cage filled with autologous bone graft; (2) Posterior fixation with transpedicle screws and rods from T8, T9 to T12, L1 Specimen Count And Types 2 pieces About size:小 Source:vertebral body and disc About size:小 Source:granulation tissue inside T10-11 disc Pathology Pending Operative Findings There was whitish fibrotic tissue around the T10-11 disc space, which adhered tightly with the PLL, disc and periosteum. The fibrotic tissue became thickened in the anterior epidural space and caused spinal cord compression. The disc was partially destroyed by greyish red, soft fragile, moderately vascularized, granulation tissue. The T11 vertebral body was partially collapsed. The vertebral body of T10 and T11 was sclerotic. The thecal sac became free from tension after decompression. Operative Procedures 1. ETGA, prone. 2. C-arm localization of T10 and T11. 3. Hocky stick incision from T8 to L1. 4. Dissection of paravertebral muscle from spinous procesess, lamina and transverse processes. Hemilaminectomy of lower T10 and upper T11, with preservation of spinous processes. 5. Resection of right 9th, 10th, and 11 th ribs from rib head outward for a distance of 6 cm. 6. Diskectomy of T9-10, T10-11, and T11-12 with knife, disc forceps, and currets. 7. Corpectomy, T10, T11, with air drills, rongeurs and kerrisons. 8. Dissection 8. Dissection of PLL from thecal sac, followed by removal of PLL and adherent fibrotic tissue. 9. Insertion of a 6 cm long, 14 mm diameterd titanium body cage filled with bone chips prepared from ribs, into the corpectomy site 10. Insertion of transpedicle screws: T8,9 screws: 5.0 mm x 35 mm T12, L1 screws: 5.0 mm x 40 mm rods: 15 cm on each side one cross link 11. Two HV drains in the epilaminal space; one CWV drain in the corpectomy site. 12. Wound closure in layers. Operators 楊士弘 Assistants 李建勳,王奐之 相關圖片 傅慧屏 (F,1963/10/30,48y4m) 手術日期 2010/04/26 手術主治醫師 華筱玲 手術區域 產房 090房 3號 診斷 Endometrial hyperplasia 器械術式 D & C for diagnostic /WOR 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 靜脈麻醉 麻醉主治醫師 ASA 1 時間資訊 08:00 報到 10:10 進入手術室 10:25 抗生素給藥 10:30 手術開始 10:42 手術結束 10:50 送出病患 10:55 進入恢復室 12:35 離開恢復室 記錄__ 手術科部: 婦產部 套用罐頭: Fractional D&C; 開立醫師: 陳麒年 開立時間: 2010/04/26 10:53 Pre-operative Diagnosis dysfunctional uterine bleeding Post-operative Diagnosis dysfunctional uterine bleeding Operative Method Fractional dilatation and curettage Specimen Count And Types 2 pieces About size: Source:endocervix About size: Source:endometrium Pathology Pending Operative Findings 1. Uterus: Anteversion, 9cm 2. Scanty endocervical and some endometrial tissue and much old blood clot were curetted out 3. Estimated blood loss:30ml Blood transfusion:nil Complication:nil Operative Procedures 1. Put the patient on lithotomy position 2. Douching, skin disinfection and skin draping as usual 3. Sounding: Anteversion, 9cm 4. Cervical dilatation to Hegar no.8 5. Curette endocervical canal and uterine cavity. 6. Pack the vagina with a piece of gauze Operators 華筱玲, Assistants 林明緯, 鄭顯文 (M,1982/11/01,29y4m) 手術日期 2010/04/26 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Astrocytoma 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 1 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 07:48 報到 08:10 進入手術室 08:20 麻醉開始 08:40 誘導結束 09:50 抗生素給藥 10:23 手術開始 13:03 抗生素給藥 16:05 抗生素給藥 17:30 麻醉結束 17:30 手術結束 17:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 10 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 手術 顱底瘤手術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Right combined far-lateral and retrosigmoid a... 開立醫師: 李建勳 開立時間: 2010/04/26 18:00 Pre-operative Diagnosis Epidermoid cyst, prepontine area Post-operative Diagnosis Low cranial nerve neuroma, prepontine area Operative Method Right combined far-lateral and retrosigmoid approach tumor excision Specimen Count And Types 1 piece About size: Source:tumor Pathology Fronzen showed neurilemmoma Operative Findings Around 4cm sized, greysih to yellowish, soft to elastic, well demarcated mass lesion was noted over the prepontine area, covered with extended dentate ligament, which is directly compressing the pons and medulla oblongata. The C1 root and basilar artery were identfied and preserved. The brainstem evoked potential (BAEP) was slow down during the procedure, bur recovered spontaneously. One small piece of tumor over medulla left in situ to avoid further damage of the brain stem. Operative Procedures Under general anestheis and intubation,the patient was put in supine position with head rotated to left side, the head was fixed with head clumped with mastoid process as the top and vertex down. A revised hocky-stick skin incision was performed along the midline below the inion to the C2 level and included the asterion. The scalp flap was reflected and the posterior nuchal muscles were dissected along the fascia including the semipinalis muscle, rectu capitis muscles. The forament magnum and C1 posterior arch were identified. The vertebral artery was also identified and was preserved. The craniotomy was then performed after creating a burr hole over the asterion to the foramen magnum. Partial laminectomy of C1 posterior arch was also performed. The occipital condyle was identified and the inner third joint was removed for surgical field exposure. The dura was then opened over the connection between the periosteum and dura reflection. The CSF drainage was then performed at cistern magnum. The dura was then opened well to exposed the cerebellum and medulla. The tumor was then identfied over the angle between the cerebellum and medulla. The 1st dendate ligament was extended by the tumor and tumor excision was done after incision over dentated ligament. The tumor removal was performed with CUSA , tumor forceps and bipolar coagulation. Hemostasis was achieved with surgicel lining of the tumor bed. One small piece of tumor over medulla left in situ to avoid further damage of the brain stem. The dura was closed with 4-0 Prolene suture and fascia graft. The skull plate was closed with miniplates and screws with one subgaleal closed wound vaccum drain. THe wound was then closed in layers. Operators P 杜永光 Assistants R3 林哲光, R6 李建勳 莊靜怡 (F,1970/12/24,41y2m) 手術日期 2010/04/26 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 古恬音, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:06 進入手術室 08:10 麻醉開始 08:35 誘導結束 09:00 抗生素給藥 09:06 手術開始 12:00 抗生素給藥 12:33 開始輸血 14:10 麻醉結束 14:10 手術結束 14:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 顱底瘤手術 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Simpson grade III tumor excision 開立醫師: 胡朝凱 開立時間: 2010/04/26 14:32 Pre-operative Diagnosis Left anterior clinoid meningioma Post-operative Diagnosis Left anterior clinoid meningioma Operative Method Simpson grade III tumor excision Specimen Count And Types pieces of tumor in one bottle Pathology pending Operative Findings 1.One 3 cm yellowish, and hypervascular tumor which the base attached to the anterior clinoid. 2.Left MCA was partially encased in the tumor 3.One small piece of tumor was left in situ for preventing damage to lenticulostriate vessels. 4.The margin was well defined. Operative Procedures 1.ETGA, supine and the head was fixed with Mayfield skull clamp 2.Left OZ craniotomy was done with preservation of V1 branch and orbital fat 3.Dural opening after dural tenting 4.Retract brain downward 5.cauterization at the tumor base to devascularize 6.Disect tumor along with the plane between tumor and brain 7.Resect tumor piece by piece 8.Identify MCA and kept it intact 9.Hemostasis 10.Close dura with prolene and one piece of periosteum 11.Set one CWV drain then fixed bone back with miniplate 12.Close wound in layers Operators 曾漢民 Assistants 胡朝凱,古恬音 張山龍 (M,1957/02/04,55y1m) 手術日期 2010/04/26 手術主治醫師 郭順文 手術區域 東址 005房 02號 診斷 Intracerebral hemorrhage 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 趙安怡 ASA 4 紀錄醫師 蔡東明, 時間資訊 23:41 臨時手術NPO 15:07 進入手術室 15:12 麻醉開始 15:14 誘導結束 15:30 手術開始 15:50 手術結束 15:50 麻醉結束 15:55 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 氣管切開造口術 1 0 記錄__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 蔡東明 開立時間: 2010/04/26 16:02 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Ditto Operative Method Tracheostomy Specimen Count And Types nil Pathology None Operative Findings Fr . 8 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators VS郭順文 Assistants R3蔡東明 R1李維棠 林立峰 (M,1953/10/01,58y5m) 手術日期 2010/04/26 手術主治醫師 王國川 手術區域 東址 001房 05號 診斷 Major trauma rated 16 or above on the severeity scale ( Injury severeity score >=16 ) 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 3E 紀錄醫師 胡朝凱, 時間資訊 16:10 開始NPO 16:10 臨時手術NPO 16:10 通知急診手術 17:15 報到 17:15 進入手術室 17:20 麻醉開始 17:30 誘導結束 18:05 抗生素給藥 18:10 開始輸血 18:30 手術開始 19:05 麻醉結束 19:05 手術結束 19:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 顱內壓監視置入 1 1 R 手術 頭皮腫瘤 1 2 L 記錄__ 手術科部: 外科部 套用罐頭: Right frontal ICP monitor insertion 開立醫師: 蘇彥榮 開立時間: 2010/04/26 19:32 Pre-operative Diagnosis Traumatic SDH, SAH, ICH Post-operative Diagnosis Traumatic SDH, SAH, ICH Operative Method Right frontal ICP monitor insertion Specimen Count And Types nil Pathology nil Operative Findings 1.Mild brain swelling 2.Immediate post op ICP around 14~16 mmHg Operative Procedures 1.ETGA, supine 2.Right frontal vertical skin incision 3.Dissect to open periosteum 4.Burr hole drill 5.Dural tenting 6.Open dura 7.ICP insertion 8.Close wound in layers Operators 蔡翊新 Assistants 胡朝凱 Indication Of Emergent Operation 朱益賦 (M,1976/02/16,36y0m) 手術日期 2010/04/27 手術主治醫師 李章銘 手術區域 東址 018房 4號 診斷 Lung Tumor 器械術式 Thoracoscopy 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 李章銘, 時間資訊 18:55 進入手術室 18:57 麻醉開始 19:10 誘導結束 19:37 抗生素給藥 19:40 手術開始 21:20 手術結束 21:20 麻醉結束 21:25 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 胸腔鏡肺楔狀或部分切除術 1 1 摘要__ 手術科部: 外科部 套用罐頭: VATS LUL wedge resection *3, LLL wedge resect... 開立醫師: 張彥俊 開立時間: 2010/04/27 21:52 Pre-operative Diagnosis Left lung tumors suspect colon cancer metastasis Post-operative Diagnosis Left lung tumors suspect colon cancer metastasis Operative Method VATS LUL wedge resection *3, LLL wedge resection *1 Specimen Count And Types 4 pieces About size:1*1cm Source:LUL About size:1.2*1.2cm Source:LUL About size:0.5*0.3cm Source:LUL About size:2*2cm Source:LLL Pathology PEnding Operative Findings 1. 1*1cm, 1.2*1.2cm, 0.5*0.3cm elastic firm whitish tumor over LUL. 2*2cm elastic firm whitish tumor over LLL Operative Procedures 1. ETGA with blocker, right decubitus 2. VATS port setting 3. Identify of lesion and perform wedge resection 4. Check bleeding and air leak 5. Set 28Fr chest tube *1 6. Close wound Operators VS李章銘 Assistants R5張彥俊 李宜純 (F,1976/05/17,35y9m) 手術日期 2010/04/27 手術主治醫師 黃俊升 手術區域 東址 051房 02號 診斷 Breast cancer, female 器械術式 BCT+SLND or ALND 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 王永彬 ASA 2 紀錄醫師 羅婉育, 時間資訊 07:21 臨時手術NPO 13:30 進入手術室 13:35 麻醉開始 13:45 誘導結束 13:50 抗生素給藥 14:15 手術開始 16:37 手術結束 16:37 麻醉結束 16:45 送出病患 16:55 進入恢復室 18:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腋窩淋巴腺清除術 1 1 R 手術 部份乳房切除術－單側 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 摘要__ 手術科部: 外科部 套用罐頭: Partial masectomy+SLND 開立醫師: 羅婉育 開立時間: 2010/04/27 17:02 Pre-operative Diagnosis Right breast cancer Post-operative Diagnosis Right breast cancer Operative Method Partial mastectomy+ALND Specimen Count And Types 6 pieces About size:2*3cm Source:level 1 ALN About size:2*2cm Source:level 2 ALN About size:1.5cm Source:sentinel LN About size:1.5cm Source:sentinel LN About size:1.5cm Source:normal LN About size:5*6cm Source:right breast Pathology ALND and breast tumor Operative Findings 1. SLND1: ;SLND2: ; imprint cytology: positive 2. Non-SLND 3. The breast tumor: 5x6 cm, at 2.5 cm from nipple, 12 oclock Operative Procedures 1. ETGA, supine 2. Skin disinfection and draping 3. Axillary skin incision 4. Performed SLND, send for imprint cytology. The result was positive 5. Performed partial masectomy via wound near tumor. 6. Performed ALND at right axilla, level 1 and level 2 ALN were removed. 6. Hemostasis, normal saline irrigation 7. Set CWVx1 and Close wound in layers Operators 黃俊升, Assistants 黃凱傑　羅婉育　劉旅安 張明和 (M,1939/04/02,72y11m) 手術日期 2010/04/27 手術主治醫師 蔡瑞章 手術區域 東址 002房 05號 診斷 Lung cancer, non-small cell 器械術式 V-P shunt 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 王永彬 ASA 3E 紀錄醫師 陳建銘, 時間資訊 09:30 臨時手術NPO 12:08 開始NPO 12:09 通知急診手術 18:39 報到 18:40 進入手術室 18:44 麻醉開始 18:50 誘導結束 18:50 抗生素給藥 19:27 手術開始 20:15 手術結束 20:15 麻醉結束 20:20 送出病患 20:28 進入恢復室 21:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室腹腔分流手術 1 1 R 摘要__ 手術科部: 內科部 套用罐頭: Right ventriculoperitoneal(VP) shunt insertio... 開立醫師: 李建勳 開立時間: 2010/04/27 20:12 Pre-operative Diagnosis (1)Lung cancer (2)Suspect normal pressure hydrocephalus Post-operative Diagnosis (1)Lung cancer (2)Suspect normal pressure hydrocephalus Operative Method Right ventriculoperitoneal(VP) shunt insertion via right Kocher point Specimen Count And Types 4 pieces About size:1mL Source:CSF About size:1mL Source:CSF About size:1mL Source:CSF About size:5mL Source:CSF Pathology Nil Operative Findings The dura was thickened with hypervascular change. The CSF opening pressure: 10 cmH2O, ventricular shunt: 6.7 cm, peritoneal shunt: 25cm. Medtronic medium pressure(10cm H2O) burr hole type vlave was used. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position with head turned to left. The scalp was shaved, scrubbed, antiseptic with alcohol better-iodine then draped. A curvilinear skin incision wasmade at right frontal region followed by burr hole. The dura was incised after tenting. A ventricular puncture needle was used to puncture then shifted to nelaton tube. Minilaparotomy was made at right upper abdomen and the peritoneal catheter was inserted and test function. The shunt cather was then passed through subcutaneous layer of abdomen, anterior chest wall, neck, retroauricular area then connected to the reservoir. The nelaton tube was then changed to ventricular catheter and connected to the reservoir. After testing the function, the wounds were all closed in layers. Operators P 蔡瑞章 Assistants R1 陳建銘 R3 曾峰毅 R6 李建勳 Indication Of Emergent Operation 相關圖片 趙金拴 (M,1941/12/16,70y2m) 手術日期 2010/04/27 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Lumbar Spondylosis 器械術式 Laminectomy for decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳柏達, 時間資訊 00:00 臨時手術NPO 07:43 報到 08:06 進入手術室 08:17 麻醉開始 08:25 誘導結束 08:55 抗生素給藥 09:06 手術開始 11:05 手術結束 11:05 麻醉結束 11:11 送出病患 11:15 進入恢復室 12:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 椎弓切除術（特壓）－二節以內 1 1 摘要__ 手術科部: 外科部 套用罐頭: L4, 5 laminectomy for decompression 開立醫師: 陳睿生 開立時間: 2010/04/27 11:25 Pre-operative Diagnosis Lumbar stenosis over L3/4, 4/5 Post-operative Diagnosis Lumbar stenosis over L3/4, 4/5 Operative Method L4, 5 laminectomy for decompression Specimen Count And Types nil Pathology Nil Operative Findings Thicking ligamentum flavum was noted especially over L4/5 level. Narrowing lumbar canal was also noted. The thecal sac was well expanded after decompression. Lateral recess stenosis was noted over L3/4, 4/5, L5/S1 level, and the nerve was well decompressed after removal of ligamentum and foraminotomy. Operative Procedures Anesthesia: endotracheal general. Position: prone. Skin preparation: the back was scrubbed with povidone-iodine detergent. A spinal needle was inserted between spinous processes of L4/5 and a portable X-ray film was taken to locate the correct interspace, then painted with povidone-iodine tincture and followed by sterilized adhesive plastic sheet covering. Incision: 10 cm, over spinous processes from L3 to L5. The latissimus dorsi, ileocostalis lumborum muscles (trapezius, latissimus dorsi, ileocostalis lumborum) were detached from spinous processes of L3 on both sides by Bovie, then multifidus muscles were dissected subperiosteally from the laminae with rasp. The paravertebral muscles were retracted by self retaining retractors to expose the spinous processes and laminae of L4 and L5. The bleeding from the muscles were stopped by Bovie. The spinous processes and laminae of L4/5 were bitten off with rongeurs and Kerrison punch until the posterior half of the spinal canal was widely opened. The hypertrophic ligamenta flava including those at lateral recesses were excised. The epidural venous bleeding was stopped by gelfoam packing. The interlaminal spaces of L3-5 on both sides were widened by partial laminecotmy on-- with high speed air drill until the space was large enough for the distraction hook. The same procedure was done at interlaminal space.The Harrington distractor was applied on the both side to distract the fracture dislocation site. The same procedure was done on the other side after the distractor had been removed. The paravertebral muscles were closed by interrupted sutures with 906 vicryl, and skin by continuous suture with 3/0 nylon. Drain: two in one, epilaminal, hemovac. Course ofthesurgery: smooth. Operators VS 曾勝弘 Assistants R5 陳睿生; R2 陳柏達 林玉霞 (F,1945/11/08,66y4m) 手術日期 2010/04/27 手術主治醫師 曾勝弘 手術區域 東址 005房 02號 診斷 Trigeminal neuralgia (Cranial nerve V) 器械術式 Radiofrequency coagulation 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳柏達, 時間資訊 00:00 臨時手術NPO 10:55 報到 11:20 進入手術室 11:55 麻醉開始 11:58 誘導結束 12:00 抗生素給藥 12:08 手術開始 12:45 手術結束 12:45 麻醉結束 12:50 送出病患 12:55 進入恢復室 14:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 手術 高頻熱凝療法 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Radiofrequency ablation 開立醫師: 陳睿生 開立時間: 2010/04/27 12:59 Pre-operative Diagnosis Right side trigeminal neuralgia over V-II territory Post-operative Diagnosis Right side trigeminal neuralgia over V-II territory Operative Method Radiofrequency ablation Specimen Count And Types nil Pathology Nil Operative Findings The foramen ovale was localized under C-arm guided. RF ablation was done under the setting of 80oC 90seconds. Operative Procedures Under IV general anethesia, the patient lied at supine position. After disinfected as usual, Right maxilliary nerve was approached by 18.Gauze needle puncture. The tip of the needle was confirmed with C-arm at the location of foramen ovale. We awaked the patient, and confirmed the numbness and pain of right cheek region. Radiofrequency was performed after anethesia. The wound was covered after the procedure without bleeding or CSF leakage. Operators VS 曾勝弘 Assistants R5 陳睿生; R2 陳柏達 張峻森 (M,1986/07/19,25y7m) 手術日期 2010/04/27 手術主治醫師 曾勝弘 手術區域 東址 005房 03號 診斷 Brachial plexus injury 器械術式 Neurolysis of the uluar neuve 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 陳柏達, 時間資訊 00:00 臨時手術NPO 12:50 報到 13:00 進入手術室 13:08 麻醉開始 13:15 誘導結束 13:15 抗生素給藥 13:48 手術開始 16:15 抗生素給藥 17:40 手術結束 17:40 麻醉結束 17:45 送出病患 18:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 顯微鏡神經移植或轉移 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Right side ulnar nerve transplantation 開立醫師: 陳睿生 開立時間: 2010/04/27 17:56 Pre-operative Diagnosis Right side brachial plexus injury with muscle atrophy Post-operative Diagnosis Right side brachial plexus injury with muscle atrophy Operative Method Right side ulnar nerve transplantation Right side partial ulnar nerve transplantation Specimen Count And Types nil Pathology Nil Operative Findings The musculocutaneous nerve was noted and reddish, atrophic change. Intra-op nerve stimulation showed negative finding. We harvested the ulnar nerve and extracted the anteriolateral fibers for anastomosis. The anastomosis was done with 6 stitiches 10-0 prolene. The musculocutaneous nerve was noted and reddish, atrophic change. Intra-op nerve stimulation showed negative finding. We harvested the ulnar nerve and extracted the anteriolateral fascicles for anastomosis. The anastomosis was done with 6 stitiches 10-0 prolene. Operative Procedures Under general ET anethesia, the patient lied at supine position with right arm abducted. Longitudinal linear incision was performed at middle right arm. Median nerve, ulnar nerve, and musculocutaneous nerve were dissected and identified. Ligation of musculocutaneous nerve was performed 1cm proximal to muscle insertion. One fascicle of ulnar nerve was dissected and tranplanted to stump of musculocutaneous nerve under microscopy. The wound was closed in layers after hemostasis. Operators VS 曾勝弘 Assistants R5 陳睿生; R2 陳柏達 陳竑諺 (M,2008/09/22,3y5m) 手術日期 2010/04/27 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Encephalocele 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 07:53 報到 08:05 進入手術室 08:10 麻醉開始 09:00 誘導結束 09:38 抗生素給藥 09:39 手術開始 11:20 手術結束 11:20 麻醉結束 11:25 送出病患 11:30 進入恢復室 12:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦脊髓液分流管重置 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 記錄__ 手術科部: 外科部 套用罐頭: Cystoperitoneal shunt revision 開立醫師: 李振豪 開立時間: 2010/04/27 11:42 Pre-operative Diagnosis Posterior fossa arachnoid cyst, s/p left cystoperitoneal shunt with shunt dysfunction Post-operative Diagnosis Posterior fossa arachnoid cyst, s/p left cystoperitoneal shunt with shunt dysfunction Operative Method Cystoperitoneal shunt revision Specimen Count And Types nil Pathology Nil Operative Findings The previous proximal catheter that placed into posterior fossa arachnoid cyst was adhered tightly. So we left the catheter in situ. Some fibrin deposition was noted after removal of the connector. No obstruction of distal catheter that placed into peritoneal cavity was noted. The CSF drained from the arachnoid cyst was clear. The new proximal catheter length was 5cm with one right-angled connector connecting with previous distal catheter. The previous proximal catheter that placed into posterior fossa arachnoid cyst was adhered tightly. So we left the catheter in situ. Some fibrin deposition was noted after removal of the connector. No obstruction of distal catheter that placed into peritoneal cavity was noted. The CSF drained from the arachnoid cyst was clear. The new proximal catheter length was 4.5cm with one right-angled connector connecting with previous distal catheter. Operative Procedures Under endotracheal tube general anesthesia, the patient was put at prone position. The scalp was shaved, scrubbed, and disinfected as usual. Midline scalp incision from suboccipital to C1 level was made and the subcutaneous tissue was dissected within the midline. The skull, posterior ring of C1, and cisterna magna were identified. The other scalp incision was made along previous wound and the cystoperitoneal shunt was exposed. The proximal catheter was tried to remove but failed due to adhesion. The connector was removed and the distal catheter was passed via a subcutaneous tunnel to midline wound. The new proximal catheter was connected with the distal catheter with one right angled connector. The length of the proximal catheter was about 5cm. The cisterna magna was opened and the proximal catheter was placed via the opening into the arachnoid cyst. Three anchoring suture was done for fixation of the catheter. After hemostasis, the wound was then closed with 4-0 Vicryl and 4-0 Nylon. The proximal catheter was tried to remove but failed due to adhesion. The connector was removed and the distal catheter was passed via a subcutaneous tunnel to midline wound. The new proximal catheter was connected with the distal catheter with one right-angled connector. The length of the proximal catheter was about 4.5cm. The cisterna magna was opened and the proximal catheter was placed via the opening into the arachnoid cyst. Three anchoring suture was done for fixation of the catheter. After hemostasis, the wounds were then closed with 4-0 Vicryl and 4-0 Nylon. Operators VS郭夢菲 Assistants R3李振豪 相關圖片 賴建甫 (M,2009/03/05,3y0m) 手術日期 2010/04/27 手術主治醫師 郭夢菲 手術區域 兒醫 067房 02號 診斷 Foreign body, magnetic, in other or multiple sites 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 李振豪, 時間資訊 12:09 臨時手術NPO 11:35 報到 11:41 進入手術室 11:45 麻醉開始 12:20 誘導結束 12:30 抗生素給藥 12:50 手術開始 15:30 抗生素給藥 15:45 開始輸血 16:45 麻醉結束 16:45 手術結束 16:52 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除－手術時間在４小時以內 1 1 L 手術 超音波診查機–腦神經外科術中特殊儀器使用費 1 0 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 記錄__ 手術科部: 外科部 套用罐頭: Left frontal craniotomy for foreign body remove. 開立醫師: 李振豪 開立時間: 2010/04/27 17:26 Pre-operative Diagnosis Foreign body(three needles) in brain parenchyma Post-operative Diagnosis Foreign body(three needles) in brain parenchyma Operative Method Left frontal craniotomy for foreign body remove. Specimen Count And Types 1 piece About size:Multiple pieces of foreign body Source:Foreign body, sent to bacterial culture Pathology Nil Operative Findings Three rusty needles are noted at left frontal, falx, and right frontal area with about 3.5cm in length in longest one. The needle was easily fractured and covered by granulation and gliosis tissue. The major vessels between hemisphere was spared from the needle injury. 1. When the scalp was opened, only one entry hole was found just left to the superior sagittal sinus. The neelde could not be found at this stage. Three rusty needles are noted in the left frontal lobe, falx, and right frontal area with the needle length 2.3, 2.5, and 3.0 cm in length, respectively. The outer end of the needles was easily fractured due to rust and covered by granulation and gliosis tissue. The major vessels between hemisphere was spared from the needle injury and preserved during operation. Three rusty needles are noted in the left frontal lobe, falx, and right frontal area with the needle length 1.3, 1.5, and 2.0 cm in length, respectively. The outer end of the needles was easily fractured due to rust and covered by granulation and gliosis tissue. The major vessels between hemisphere was spared from the needle injury and preserved during operation. Operative Procedures Under endotracheal tube general anesthesia, the patient was put at supine position with head rotated to left. The scalp was shaved, scrubbed, and disinfected as usual. Bicoronal scalp incision was made and the periosteum was preserved. The anterior fontanelle was identified. Granulation, gliosis, and adhesion were noted at dura and brain surface. Under endotracheal tube general anesthesia, the patient was put at supine position with head rotated to left. The scalp was shaved, scrubbed, and disinfected as usual. Bicoronal scalp incision was made and the periosteum was preserved. The anterior fontanelle was identified. We tried to identify the needle along the entry hole, however, it has migrated inside the dura. Granulation, gliosis, and adhesion were noted at dura and brain surface. Left frontal craniotomy window with 4x6cm in size was performed after creation of two burr hole. The dura was opened with C-shaped based on superior saggital sinus. One large cortical vein was found during dura opening and preserved by modification of dura opening. Intra-operative echo was used for localization of the needles. The needles were removed under operation microscopic assisted. Hemostasis was achieved and the dura was closed with 4-0 prolene. The skull plate was fixed back with three wires and one subgaleal CWV drain was placed. The wound was then closed with 3-0 Vicryl and 4-0 Nylon. We rhongeured off some of the skull around the entry point then left frontal craniotomy crossing the medline with bony window of 4x6cm in size was performed after creation of two burr hole. The dura was opened with C-shaped based on superior saggital sinus under operation microscopic assisted.. One large cortical vein was found during dura opening and preserved by modification of dura opening at the posterior part of the dura. Intra-operative echo was used for localization of the first needle, which pointed anteriorly. We then reflected the dura along the falx to find the second needle, which entried the falx just beneath the lower margin of the SSS, and went down along the falx. At the tip of it, the third one could be found. We then incised the falx and traced along the third needle downward till the tip reached the opposite side of the flax. The tip was located just beside the ACA. The needle was then removed. Hemostasis was achieved and the dura was closed with 4-0 prolene. The skull plate was fixed back with three wires and one subgaleal CWV drain was placed. The wound was then closed with 3-0 Vicryl and 4-0 Nylon. Operators VS郭夢菲 Assistants R3李振豪 相關圖片 蔡尊五 (M,1934/06/03,77y9m) 手術日期 2010/04/27 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Spondylolisthesis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 07:21 報到 08:03 進入手術室 08:10 麻醉開始 08:20 誘導結束 08:48 抗生素給藥 09:10 手術開始 11:48 抗生素給藥 12:30 手術結束 12:30 麻醉結束 12:40 送出病患 12:43 進入恢復室 14:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 手術 脊椎融合術－前融合，無固定物（＜＝四節） 1 2 記錄__ 手術科部: 外科部 套用罐頭: L3~4 TPS and discectomy for cage insertion 開立醫師: 胡朝凱 開立時間: 2010/04/27 12:39 Pre-operative Diagnosis L3~4 spondylolisthesis and stenosis Post-operative Diagnosis L3~4 spondylolisthesis and stenosis Operative Method L3~4 TPS and discectomy for cage insertion Specimen Count And Types nil Pathology nil Operative Findings 1.Floating L3 on L4 2.Hypertrophic flavum ligment that make the spinal canal stenotic 3.Protrusion disc was also noted 4.Two 11# cages were used Operative Procedures 1.ETGA, prone 2.Midline incision at L3~4 level 3.Detach paravertebral muscle 4.Expose facet and transverse process 5.TPS screws insertion 6.L3~4 laminectomy 7.Remove flavum ligment 8.Discectomy 9.Cage insertion 10.Rods fixation 11.posterior-lateral fusion 12.Set one hemovac drain 13.Close wound in layers Operators 賴達明 Assistants 胡朝凱,游健生 張敏川 (M,1954/07/09,57y8m) 手術日期 2010/04/27 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Lumbar Spondylosis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 12:25 報到 12:55 進入手術室 13:00 麻醉開始 13:10 誘導結束 13:45 抗生素給藥 14:00 手術開始 15:50 手術結束 15:50 麻醉結束 15:58 進入恢復室 15:59 送出病患 17:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術（特壓）－二節以內 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 記錄__ 手術科部: 外科部 套用罐頭: L5 laminectomy and roots decompression 開立醫師: 胡朝凱 開立時間: 2010/04/27 15:56 Pre-operative Diagnosis L4~5, L5~S1 spinal stenosis Post-operative Diagnosis L4~5, L5~S1 spinal stenosis Operative Method L5 laminectomy and roots decompression Specimen Count And Types nil Pathology nil Operative Findings 1.Stenosis of L4~5, L5~S1 due to hypertrophic flavum ligment 2.The nerve roots was compressed tightly 3.After removal of ligment, the roots became expanded and the neural foramen became loose Operative Procedures 1.ETGA, prone 2.midline incision at L4~ S1 level 3.Split L5 spinous process 4.Detach paravertebral muscle 5. 5.Laminectomy of L5 and partial L4 6.Remove flavum ligment until the roots were exposed 7.Hemostasis 8.Set one hemovac drain then close wound in layers Operators 賴達明 Assistants 胡朝凱,游健生 唐李桂英 (F,1937/03/07,75y0m) 手術日期 2010/04/27 手術主治醫師 賴達明 手術區域 東址 003房 03號 診斷 Spinal stenosis, cervical 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 15:45 報到 16:05 進入手術室 16:15 麻醉開始 16:20 誘導結束 16:25 抗生素給藥 16:43 手術開始 18:50 手術結束 18:50 麻醉結束 19:00 送出病患 20:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 椎間盤切除術－頸椎 1 1 記錄__ 手術科部: 外科部 套用罐頭: Anterior approach for microscopic discectomy 開立醫師: 胡朝凱 開立時間: 2010/04/27 18:50 Pre-operative Diagnosis C3~4 HIVD Post-operative Diagnosis C3~4 HIVD Operative Method Anterior approach for microscopic discectomy Specimen Count And Types nil Pathology nil Operative Findings 1.protruding disc at C3~4 level that compressed the spinal cord tightly 2.After removal of PLL, the thecal sac expanded 3.6# cage was inserted Operative Procedures 1.ETGA, supine 2.Right neck transverse skin incision 3.Dissect along with the anterior border of SCM to expose prevertebral space 4.localization 5.Detach longus colli muscle 6.Discectomy under microscopy 7.Resect PLL 8.Cage insertion 9.Set one hemovac drain 10.Close wound in layers Operators 賴達明 Assistants 胡朝凱,游健生 林榮彬 (M,1961/11/10,50y4m) 手術日期 2010/04/27 手術主治醫師 陳敞牧 手術區域 西址 033房 01號 診斷 Lipoma 器械術式 Excision of neuroma 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 09:00 報到 09:10 進入手術室 09:18 麻醉開始 09:28 手術開始 10:32 手術結束 10:35 送出病患 摘要__ 手術科部: 外科部 套用罐頭: Lipoma excision 開立醫師: 李建勳 開立時間: 2010/04/27 10:46 Pre-operative Diagnosis Right back intramuscular lipoma Post-operative Diagnosis Right back intramuscular lipoma Operative Method Lipoma excision Specimen Count And Types 1 piece About size:3g Source:lipoma excision Pathology Pending Operative Findings The tumor was soft, yellowish, located at right low back intramuscularly with clear borer from the muscle. Total tumor excision was achieved. Operative Procedures Disinfected the skin with alcohol better-iodine then draped. Under local anestheisa, transverse skin incision was made over the tumor and dissected the tumor. The muscle was seperated and the tumor was retracted out from the muscle. Hemostasis then closed the wound in layers. Operators VS 陳敞牧 Assistants R6李建勳 相關圖片 朱璽恩 (F,2010/02/19,2y0m) 手術日期 2010/04/27 手術主治醫師 許巍鐘 手術區域 兒醫 062房 04號 診斷 Interruption of aortic arch 器械術式 BRONCHOSCOPY-COMPLICATED 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 孟繁宇, 時間資訊 10:23 報到 10:25 進入手術室 10:30 麻醉開始 10:33 誘導結束 10:35 手術開始 10:53 麻醉結束 10:53 手術結束 10:57 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 管、支氣管、細支氣管異物除去術－氣管鏡 1 1 手術 支氣管鏡檢查 1 0 記錄__ 手術科部: 耳鼻喉部 套用罐頭: Rigid bronchoscope + selective bronchial lava... 開立醫師: 孟繁宇 開立時間: 2010/04/27 12:57 Pre-operative Diagnosis Left pulmonary atelectasis Post-operative Diagnosis Left pulmonary atelectasis Operative Method Rigid bronchoscope + selective bronchial lavage with Jet ventilator Specimen Count And Types nil Pathology Nil Operative Findings Pharynx: Nasopharynx________No check________________ Tongue base________Patent_______________ Vallecula__________Patent_________________ Hypopharynx__________Patent_______________ Larynx: Epiglottis_____________Patent_____________ Aryepiglottic fold______Patent_____________ Arytenoid cartilage______Patent____________ Accesory cartilage________Patent____________ True vocal fold____Left side vocal palsy____ False vocal folds___Left side vocal palsy__ Subglotttis_____________Patent________________ Trachea:________________Patent________________ Carina: __________________Patent_____________ Right main bronchus:_______Patent____________ Left main bronchus: corlapse, left side main bronchus inferior part 1. External compression 2. Fibrosis 3. granulation Others:__________________Nil________________ Operative Procedures The patient was in supine position. Jet ventilation was used for impending airway obstruction. Rigid bronchoscopy was set and larynx, subglottis, trachea, carina, bilateral main bronchus, and right upper, middle, lower; left upper and lowerbronchus were checked. Jet ventilation was used under 20 psi 20 times (maneuver control). Left side bronchial lavage was used with bosmin and xylocain (1:100) mixture 15c.c. Patient tolerated well during the procedure. The patient was in supine position. Jet ventilation was used for impending airway obstruction. Rigid bronchoscopy was set and larynx, subglottis, trachea, carina, bilateral main bronchus, and right upper, middle, lower; left upper and lowerbronchus were checked. Jet ventilation was used under 20 psi 20 times (maneuver control). Left side bronchial lavage was used with bosmin and xylocain (1:100) mixture solution 15c.c. Patient tolerated well during the procedure. Operators Asp 許巍鐘 Assistants R3 孟繁宇 陳佑嘉 (M,2009/10/28,2y4m) 手術日期 2010/04/27 手術主治醫師 許巍鐘 手術區域 兒醫 062房 02號 診斷 Tetralogy of Fallot 器械術式 BRONCHOSCOPY-COMPLICATED 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 孟繁宇, 時間資訊 09:20 報到 09:23 進入手術室 09:24 麻醉開始 09:25 誘導結束 09:26 手術開始 09:35 麻醉結束 09:35 手術結束 09:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 氣管造口整形術 1 1 手術 換造口器 1 0 手術 管、支氣管、細支氣管異物除去術－氣管鏡 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 耳鼻喉部 套用罐頭: Rigid bronchoscopy 開立醫師: 孟繁宇 開立時間: 2010/04/27 09:56 Pre-operative Diagnosis Respiratory failure, status post tracheotomy Post-operative Diagnosis Respiratory failure, status post tracheotomy Operative Method Rigid bronchoscope + stoma plasty + change tracheal tube 4.5# (shiley) Specimen Count And Types nil Pathology Nil Operative Findings Pharynx: Nasopharynx__________No check__________ Tongue base___________patent___________ Vallecula_____________patent______________ Hypopharynx____________patent_____________ Larynx: Epiglottis_____________patent_____________ Aryepiglottic fold______patent_____________ Arytenoid cartilage_______patent___________ Accesory cartilage_______patent____________ True vocal fold____right side residual granulation__ False vocal folds________patent____________ Subglotttis_____________patent_______________ Trachea:___tracheal tube tip contact granuloma____ Carina: _____________patent ________________ Right main bronchus:_____granulation_________ Left main bronchus_______patent___________ Others:_______________Nil______________ Operative Procedures The patient was in supine position. Jet ventilation was used for impending airway obstruction. Rigid bronchoscopy was set and larynx, subglottis, trachea, carina, bilateral main bronchus, and right upper, middle, lower; left upper and lowerbronchus were checked. Stomaplasty was performed after rigid bronchoscope. Tracheal tube 4.5# shiley tube was changed smoothly. Operators Asp 許巍鐘 Assistants R3 孟繁宇 郭義雄 (M,1938/02/14,74y1m) 手術日期 2010/04/27 手術主治醫師 許榮彬 手術區域 東址 016房 01號 診斷 Pulmonary tuberculosis, unspecified 器械術式 TAA(AAA) stent insertion 手術類別 預定手術 手術部位 腹 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 徐綱宏, 時間資訊 07:47 報到 08:10 進入手術室 08:15 麻醉開始 08:51 誘導結束 09:00 抗生素給藥 09:24 手術開始 12:20 麻醉結束 12:20 手術結束 12:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 胸（腹）部動靜廔管之切除移植及直接修補手術–升主動脈 1 1 手術 主動脈造影 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: EVAR 開立醫師: 徐綱宏 開立時間: 2010/05/28 16:20 Pre-operative Diagnosis AAA, infrarenal type Post-operative Diagnosis AAA, infrarenal type Operative Method EVAR Specimen Count And Types nil Pathology Nil Operative Findings 1. One huge infrarenal type AAA with Max diameter about 9cm 2. Main body: AX1-2-36-127 Left limb: TFLE-12-54 Right limb: TFLE-12-54 3. Post op angiography: no endoleak Operative Procedures Under supine position and ETGA, bilateral CFA was dissected and looped. Retrograde puncture of the angiosheath was done and angiography was performed to examine the pathology and the position of bilateral renal artery. The mainbody stent was then deployed from the left CFA. Extention limb to both bilateral CIA was done smoothly. Angiography was done to check for endoleak. After removal of the sheath, bilateral CFA was repaired with 6-0 Prolene sutures. The wound was closed in layers Operators 許榮彬 Assistants 詹志洋　徐綱宏 詹喻媗 (F,2005/01/12,7y2m) 手術日期 2010/04/28 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Hydrocephalus 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 陳德福, 時間資訊 14:49 臨時手術NPO 07:55 報到 08:05 進入手術室 08:10 麻醉開始 08:20 誘導結束 08:42 抗生素給藥 09:00 手術開始 09:36 手術結束 09:36 麻醉結束 10:00 送出病患 10:00 進入恢復室 11:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: elongation of peritoneal catheter 開立醫師: 陳德福 開立時間: 2010/04/28 09:40 Pre-operative Diagnosis hydrocephalus s/p VPS, short catheter Post-operative Diagnosis ditto Operative Method elongation of peritoneal catheter VP shunt revision by elongation of peritoneal catheter Specimen Count And Types previous intraperitoneal catheter tip: for culture Pathology nil Operative Findings 1.Shortage of intraperitoneal shunt catheter is noted and elongation procedure is done. The new intraperitoneal catheter is about 25ml. 1.Shortage of intraperitoneal shunt catheter is noted. The tip of peritoneal catheter was just located at the peritoneal membrane. Elongation procedure is done. The new intraperitoneal catheter is about 25ml. 2.Spontanous clear CSF dripping from the proximal catheter is noticed 2.Spontanous clear CSF dripping from the proximal catheter is noticed that indicates the patency of previous shunt Operative Procedures Under ETGA and supine position, the abdomen is disinfected and draped as usual. One incision along previous abdominal wound is done and we dissect the soft tissue for exposure the shunt catheter. The fistula to the intraperitoneal cavity is found and we insert another new intraperitoneal catheter followed by connecting the new catheter with the old one by plastic connector. Hemostasis is done and the wound is closed in layers. Under ETGA and supine position, the abdomen is disinfected and draped as usual. One incision along previous abdominal wound is done and we dissect the soft tissue for exposure the shunt catheter. The fistula to the intraperitoneal cavity is found and we insert another new intraperitoneal catheter after removing out the short peritoneal catheter and then connected the new catheter with the old one by a straight connector. Hemostasis is done and the wound is closed in layers. Operators AP 郭夢菲 Assistants R4 陳德福 任士平 (M,1964/11/14,47y4m) 手術日期 2010/04/28 手術主治醫師 王水深 手術區域 東址 018房 02號 診斷 Lung cancer 器械術式 Port-A Implatation /WOR 手術類別 臨時手術 手術部位 胸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 周恒文, 時間資訊 10:55 報到 11:10 進入手術室 11:15 抗生素給藥 11:20 麻醉開始 11:22 誘導結束 11:25 手術開始 11:55 手術結束 12:00 麻醉結束 12:08 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 內頸靜脈切開，永久導管放置術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Permcath/port-A 開立醫師: 周恒文 開立時間: 2010/04/28 12:02 Pre-operative Diagnosis Lung cancer Post-operative Diagnosis Lung cancer s/p port-A insertion Operative Method port-A implantation via right internal jugular vein Specimen Count And Types nil Pathology nil Operative Findings 1. The port-A catheter was inserted via right internal jugular vein by echo-guided procedure 2. Patent flow after implantation 3. Tip position located at RA/SVC junction Operative Procedures After skin disinfection and drapping & local anesthesia, echo-guided RIJV cut down and catheterization was performed. Creation of the subcutaneous pocket at right subclavicular area. Tunneliztion, advanced the catheter into the RIJV via the peel-away sheath smoothly. Ensure the catheter tip position by portable CXR. Wound closure in layers after adequate hemostasis. Ensure the catheter tip position by portable CXR. Wound closure in layers after adequate hemostasis. Remark: The patient has foreign body sensation and severe cough after catheter implant. Bilateral breathing sound is clear and not decreased. Give O2 supplement and keep head up position. Operators 王水深 Assistants 徐綱宏,周恒文 陳鄭美仔 (F,1942/05/22,69y9m) 手術日期 2010/04/28 手術主治醫師 許巍鐘 手術區域 東址 023房 03號 診斷 Aneurysm 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 4E 紀錄醫師 邱義霖, 時間資訊 11:17 報到 11:19 進入手術室 11:20 麻醉開始 11:25 誘導結束 11:26 抗生素給藥 11:32 手術開始 11:58 手術結束 12:00 麻醉結束 12:02 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 氣管切開造口術 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 耳鼻喉部 套用罐頭: tracheostomy 開立醫師: 邱義霖 開立時間: 2010/04/28 12:25 Pre-operative Diagnosis cerebral aneurysm s/p endotracheal tube intubation Post-operative Diagnosis cerebral aneurysm s/p endotracheal tube intubation,operated Operative Method Tracheostomy Specimen Count And Types nil Pathology Nil Operative Findings A No. 7 Low-Pressure cuffed tracheostomy tube was inserted Operative Procedures (1)The patient was in supine position with neck hyperextended. (2)Skin was disinfected and draped as usual. Local anesthesia with Bosmin-rinsed Xylocaine was injected into the subcutaneous tissue and the pretracheal area. (3)A vertical skin incision was made in the midline of lower neck. (4)Subcutaneous tissue, fascia and strap muscles were seperated, then the thyroid gland was seen and hooked upwards with thyroid hooks. (5)The tracheal rings were cut in longitudinal direction. A oval-shaped window was made at the 2 nd to 3 rd tracheal rings. (6)A No._7__ Low-Pressure cuffed tracheostomy tube was inserted. (7)The patient tolerated the above procedure well. Operators 許巍鐘, Assistants R4王士豪R2邱義霖 黃雅芬 (F,1967/06/25,44y8m) 手術日期 2010/04/28 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Facial spasm 器械術式 Microvascular decompression 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 07:35 報到 08:01 進入手術室 08:10 麻醉開始 08:50 誘導結束 09:03 抗生素給藥 10:02 手術開始 12:03 抗生素給藥 13:50 麻醉結束 13:50 手術結束 13:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦微血管減壓術 1 1 L 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 摘要__ 手術科部: 外科部 套用罐頭: Left retrosigmoid approach for microvascular ... 開立醫師: 李建勳 開立時間: 2010/04/28 14:01 Pre-operative Diagnosis Left hemifacial spasm Post-operative Diagnosis Left hemifacial spasm Operative Method Left retrosigmoid approach for microvascular decompression Specimen Count And Types nil Pathology Nil Operative Findings One branch of anterioinferior cerebellar artery (AICA) compressed the root exiting zone of cranial nerve (CN) VII. The vessel was mobilized away from the CN VII with the compression site packing with Teflon patch. The brain stem evoked potential (BAEP) showed no change during the procedure. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position nad head fixed with Mayfield skull clump then turned to right. The scalp was shaved, scrubbed, disinfected with alcohol better-iodine then draped. The S-shaped scalp incision was made at retroauricular area followed by craniotomy creation. The dura was opened in K-shaped and tented to expose the cerebellum. The CSF was released from the cerebellopotine cistern and cerebellomedullar cistern for relaxation of the cerebellum. The offending vessel was mobilized away from the CN VII and VIII complex, then packing with Teflon patch. The duroplasty was perfomred with fascia graft and 4-0 Rrolene sutures. The skull plate was put back in craniotomy window. The wound was closed in layers after one subgaleal closed wound vaccum drain set up. Operators P 杜永光 Assistants R3 林哲光 R6 李建勳 相關圖片 楊茲涵 (F,1984/04/06,27y11m) 手術日期 2010/04/28 手術主治醫師 曾漢民 手術區域 東址 003房 02號 診斷 Glioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 14:23 報到 14:32 進入手術室 14:35 麻醉開始 15:10 誘導結束 15:45 抗生素給藥 16:58 手術開始 18:45 抗生素給藥 18:55 麻醉結束 18:55 手術結束 19:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 腦瘤切除－手術時間在４小時以內 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: frontal craniotomy for Simpson grade II tumor excision 開立醫師: 李建勳 開立時間: 2010/04/28 18:58 Pre-operative Diagnosis Left frontal tumor Post-operative Diagnosis Left frontal tumor Operative Method Right frontal craniotomy for total tumor excision under navigation guidance Left frontal craniotomy for total tumor excision under navigation guidance Specimen Count And Types 1 piece About size:0.5g Source:craniotomy for tumor excision Pathology Pending Operative Findings The tumor was greyish, soft, size 1.2cm in diameter, located at surface of left frontal lobe with seperable margin from the normal brain parenchyma. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position with head fixed with Mayfield skull clump. Registered the navigation machine. The scalp was shaved, scrubbed, disinfected with alcohol better-iodine then draped. The curved scalp incision was made followed by left frontal craniotomy. The dura was opened around the tumor after tenting along the craniotomy window. The tumor was dissected from the surrounding normal brain tissue with dissector and bipolar coagulator. The tumor was removed with tumor forceps and suction. Comfirmed total tumor resection with navigator. Hemostasis was achieved with Surgicel lining of the tumor bed. The duroplasty was performed with 4-0 Prolene sutures and fascia graft. The skull plate was fixed back with miniplates and screws and the wound was closed in layers. Operators VS 曾漢民 Assistants R3 林哲光 R6 李建勳 相關圖片 藍林芙蓉 (F,1940/01/04,72y2m) 手術日期 2010/04/28 手術主治醫師 蔡瑞章 手術區域 東址 005房 02號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(Others) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳柏達, 時間資訊 00:00 臨時手術NPO 12:10 報到 12:39 進入手術室 12:45 麻醉開始 13:05 誘導結束 13:10 抗生素給藥 13:31 手術開始 15:35 麻醉結束 15:35 手術結束 15:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４小時以內 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for total tumor remove 開立醫師: 陳睿生 開立時間: 2010/04/28 16:12 Pre-operative Diagnosis Left temporal tumor, suspect glioma Post-operative Diagnosis Left temporal tumor, suspect glioma Operative Method Craniotomy for total tumor remove Specimen Count And Types 1. piece about size of 0.3cm: frozen: high grade glioma 2. one 3x4cm tumor Pathology Pending Operative Findings The tumor was about 4cm in diameter. It was soft, fragile, and poor defined from peripheral brain parychema. Exophytic pattern with dura attachment was also noted. Old hematoma was noted inside the tumor, and tumor bleeding was impressed. The tumor located at the middle temporal gyrus, and was totally removed. Intra-op frozen section showed high-grade glioma. Operative Procedures Under general anethesia, the patient lied at supine position and faced to right. After disinfected an drapped as usual, inverse U-shape incision at left temporal region above ear was performed. 5 burr hole and following crainotomy was performed. Dura was opened with tenting after we identify the tumor with intra-op sonography. The tumor was dissected and sent for frozen, and excised totally. After hemostasis, duroplasty was performed with scalp flap, and crainotomy bone fraft was covered back with wire fixation and central tenting. Sclap wound was closed in layers after placement of one subgaleal drain. Operators P蔡瑞章 VS王國川 Assistants R5陳睿生R2陳柏達 張紘彬 (M,2010/02/07,2y1m) 手術日期 2010/04/28 手術主治醫師 郭夢菲 手術區域 兒醫 067房 02號 診斷 Bacterial meningitis 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 陳德福, 時間資訊 00:43 臨時手術NPO 10:15 報到 10:20 進入手術室 10:25 麻醉開始 10:35 誘導結束 10:40 抗生素給藥 11:08 手術開始 12:15 麻醉結束 12:15 手術結束 12:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 套用罐頭: left subdural peritoneal shunt 開立醫師: 陳德福 開立時間: 2010/04/28 12:19 Pre-operative Diagnosis left subdural effusion Post-operative Diagnosis ditto Operative Method left subdural peritoneal shunt Specimen Count And Types 1 piece About size:2ml Source:subdural effusion. left Pathology nil Operative Findings 1.Clear and colorless subdural fluid gushed out spontanously after we opened the dura and the outer membrane. 2.The subdural catheter: 3cm and the intraperitoneal catheter: 25cm Operative Procedures Under ETGA and supine position, the scalp and abdomen were disinfected and draped as usual. Incision on left scalp and left upper abdomen ware done and we identified the subdural space. Minilapatomy was performed smoothly. The subcutaneous tunnel was perfromed as well. The subdural catheter was inserted and we inserted the intraperitoneal catheter. We fixed the catheter with silks. Hemostasis is done and the wound is closed in layers. Under ETGA and supine position, the scalp and abdomen were disinfected and draped as usual. Incision on left scalp and left upper abdomen ware done and we identified the subdural space. Minilapatomy was performed smoothly. The subcutaneous tunnel was perfromed as well. The subdural catheter was connected to the peritoneal catheter with a straight connector, then the subdural catheter was inserted into the subdural space. We fixed the catheter with three silks. Hemostasis is done and the wounds were closed in layers. Operators AP 郭夢菲 Assistants R4 陳德福 相關圖片 藍良男 (M,1942/04/26,69y10m) 手術日期 2010/04/28 手術主治醫師 蔡瑞章 手術區域 東址 000房 號 診斷 Brain metastasis 器械術式 Brain tumor Crainotomy(Others) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳柏達, 時間資訊 00:00 臨時手術NPO 07:37 報到 08:06 進入手術室 08:20 麻醉開始 08:55 誘導結束 09:15 抗生素給藥 09:21 手術開始 12:15 抗生素給藥 12:20 麻醉結束 12:20 手術結束 12:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４小時以內 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 摘要__ 手術科部: 外科部 套用罐頭: Interhemispheric approach for total tumor remove 開立醫師: 陳睿生 開立時間: 2010/04/28 12:50 Pre-operative Diagnosis Left posterior frontal tumor, suspect metastasis Post-operative Diagnosis Left posterior frontal tumor, suspect metastasis Operative Method Interhemispheric approach for total tumor remove Specimen Count And Types 1 piece About size:1.5X1.5CM Source:TUMOR Pathology Pending Operative Findings The tumor located at pre-motor gyrus. It is about 1.5x1.5x1.5 cm in size, whitish, firm and solid one. The margin between the tumor and brain parychema was relative clear. A small artery was encased in the tumor, and was carefully dissected and preserved. Operative Procedures 1. ETGA, supine position and head fixed with Mayfield clump 2. Bilateral frontal curvillinear incision 3. 6 burr holes was made and craniotomy along the burr hole border 4. Perform dura tenting, and identify tumor with sonography 5. Open dura, retract left posterior frontal lobe from middle side 6. Dissect and excise the tumor en bloc. 7. Close dura with central tenting, fix craniotomy bone back with wires x4 8 Set one subgaleal drain, and close scalp wound in layers. Operators P 蔡瑞章; VS 王國川 Assistants R5 陳睿生; R2 陳柏達 吳志行 (M,1964/03/09,48y0m) 手術日期 2010/04/29 手術主治醫師 陳晉興 手術區域 東址 019房 01號 診斷 Lung cancer 器械術式 Thoracoscopy+Open Chest 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 硬肌麻醉 麻醉主治醫師 陳李魁 ASA 2 紀錄醫師 張彥俊, 時間資訊 07:55 報到 08:06 進入手術室 08:10 麻醉開始 08:40 誘導結束 09:00 抗生素給藥 09:05 手術開始 12:00 抗生素給藥 12:30 麻醉結束 12:30 手術結束 12:35 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 術後止痛 1 0 手術 胸腔鏡肺葉切除術 1 1 R 手術 根除性淋巴切除術（肺葉切除或全肺切除時） 1 4 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Epidural anesthesia 1 0 麻醉 EPIDURAL ANESTHESIA 5 0 手術 胸腔鏡肺楔狀或部分切除術 1 2 摘要__ 手術科部: 外科部 套用罐頭: VATS RUL lobectomy, RML wedge resection and L... 開立醫師: 張彥俊 開立時間: 2010/04/29 13:18 Pre-operative Diagnosis RUL lung cancer Post-operative Diagnosis RUL lung cancer Operative Method VATS RUL lobectomy, RML wedge resection and LN dissection Specimen Count And Types 5 pieces About size:15*13cm Source:RUL About size:3*2cm Source:RML About size:5*5cm Source:Gr3,4LN About size:1*1cm Source:Gr 7LN About size:0.5*0.5cm Source:GR 11LN Pathology pending Operative Findings 3.5*2.5cm whitish elastic firm tumor over RUL near the minor fissure and grossly invasion to RML, RML wedge resection was done for safe margin. Small blackish nodule over RML Interlobar LAP(+) Operative Procedures 1. Anesthesia: IVG with epidural anesthesia catheter is placed prior to the operation. 2. Position: Left decubitus position. An axillary roll is placed under the down side. The operative field is well disinfected and draped. 3. VATS port was set up as usual: camera port at 8th ICS mid-axillary line, two working port at 5th ICS anterior axillary line and 7th ICS posterior axillary line. 4. The RUL pulmonary vein is identified, ligated and divided by endo-GIA. 5. The fissure is separated and divided. 6. The pulmonary artery supplying the right upper lobe is identified, doubly ligated and divided by endo GIA 7. The bronchus to the upper lobe is identified, divided with endo GIA 8. The inferior pulmonary ligment is divided 9. Lymph node dissection is done at group 3, 4, 7, and 11. 12. After meticulous homeostasis and check-up of air leakage, one 28# chest tubes are placed . The muscle layer and the subcutaneous layer are closed with 2-0 Vicryl sutures. 3-0 nylone sutures are used for closure of the skin. Operators VS陳晉興 Assistants R5張彥俊 R1鄭孟伯 鄭重輝 (M,1944/10/05,67y5m) 手術日期 2010/04/29 手術主治醫師 郭順文 手術區域 東址 009房 8號 診斷 Spinal injury & complication 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 4 紀錄醫師 李維棠, 時間資訊 15:52 臨時手術NPO 16:15 進入手術室 16:15 報到 16:16 麻醉開始 16:20 誘導結束 17:00 抗生素給藥 17:03 手術開始 17:25 麻醉結束 17:25 手術結束 17:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 氣管切開造口術 1 0 L 記錄__ 手術科部: 外科部 套用罐頭: Tracheotomy 開立醫師: 李維棠 開立時間: 2010/04/29 17:55 Pre-operative Diagnosis Respiratory failure s/p intubation Post-operative Diagnosis ditto Operative Method Tracheotomy Specimen Count And Types nil Pathology nil Operative Findings Fr.7 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. A 14-gauge needle is inserted between the first and second or the second and third tracheal rings until air was aspirated into the syringe. Inserted the guidewire and introduced the tube exchanger. Removed the guidewire and the tracheostomy tube is then introduced along the dilator with an inner cannula in place. The inner cannula is removed and the tube is fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Operators VS 郭順文 Assistants R1 李維棠 廖瑞蓮 (F,1954/07/02,57y8m) 手術日期 2010/04/29 手術主治醫師 陳敞牧 手術區域 東址 005房 02號 診斷 Spondyloisthesis, acquired 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 13:50 報到 13:55 進入手術室 14:00 麻醉開始 14:15 誘導結束 14:35 抗生素給藥 14:55 手術開始 17:59 抗生素給藥 19:00 手術結束 19:00 麻醉結束 19:07 送出病患 19:10 進入恢復室 21:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 手術 脊椎融合術－前融合，無固定物（＜＝四節） 1 2 記錄__ 手術科部: 外科部 套用罐頭: Paramedian approach for TPS and discectomy fo... 開立醫師: 胡朝凱 開立時間: 2010/04/29 19:07 Pre-operative Diagnosis L3~4 spondylolisthesis and spinal stenosis L4~5 spondylolisthesis and spinal stenosis Post-operative Diagnosis L3~4 spondylolisthesis and spinal stenosis L4~5 spondylolisthesis and spinal stenosis Operative Method Paramedian approach for TPS and discectomy for cage insertion Specimen Count And Types Nil Pathology nil Operative Findings 1.Hypertrophic flavum ligment 2.Listhesis L4 on L5 3.bulgind disc at L4~5 level Operative Procedures 1.ETGA, prone 2.Midline skin incision at L3~5 level 3.Dissect to muscular fascia layers 4.Paramedian approach to expose L4~5 transverse process 5.TPS screws insertion 6.Midline detach paravertebral muscle groups 7.L4 laminectomy 8.Discectomy 9.Cage insertion 10.Rods fixation 11.Set one CWV drain then close wound in layers Operators 陳敞牧 Assistants 胡朝凱,王奐之 簡振仁 (M,1963/11/09,48y4m) 手術日期 2010/04/29 手術主治醫師 楊士弘 手術區域 東址 053房 01號 診斷 Liver cancer 器械術式 Port-A catheter implatation 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 陳德福, 時間資訊 00:00 臨時手術NPO 09:25 進入手術室 09:40 抗生素給藥 09:50 麻醉開始 09:51 誘導結束 09:52 手術開始 10:35 手術結束 10:35 麻醉結束 10:38 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 ｐｏｒｔ–Ａ導管植入術–治療性導管植入術 1 0 L 摘要__ 手術科部: 外科部 套用罐頭: Port-A implantation 開立醫師: 陳德福 開立時間: 2010/04/29 11:00 Pre-operative Diagnosis metastatic HCC Post-operative Diagnosis ditto Operative Method Port-A implantation Specimen Count And Types NIL Pathology nil Operative Findings 1.One Chemosite port-A is inserted via left cephalic vein, 18cm in length. 2.Portable CXR is done for checking the position of catheter tip. Operative Procedures Under LA and supine position, the left anterior chest is disinfected and draped as usual. One linear incision at left subclavicle area is done followed by dissecting the soft tissue till exposure the left cephalic vein. The phelotomy is done and we insert the Port-A catheter. The patency is checked and the injection site is fixed at the subcutaneous pocket. Hemostasis is done and the wound is closed in layers. Operators VS 楊士弘 Assistants R4 陳德福 李國正 (M,1947/01/20,65y1m) 手術日期 2010/04/29 手術主治醫師 楊士弘 手術區域 東址 001房 04號 診斷 Other specified bone tuberculosis 器械術式 Diskectomy thoracic 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 4E 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 14:00 報到 14:00 進入手術室 14:05 麻醉開始 14:10 誘導結束 15:36 開始輸血 16:02 手術開始 19:35 麻醉結束 19:35 手術結束 19:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 手術 椎間盤切除術－脊椎 1 1 L 手術 脊椎融合術－前融合，無固定物（＜＝四節） 1 2 L 摘要__ 手術科部: 外科部 套用罐頭: T5-6 diskectomy + autologous bone fusion with rib 開立醫師: 楊士弘 開立時間: 2010/04/29 19:29 Pre-operative Diagnosis T5-6 spondylodiskitis Post-operative Diagnosis T5-6 spondylodiskitis Operative Method T5-6 diskectomy + autologous bone fusion with rib Specimen Count And Types 1 piece About size:小 Source:T5-6 disc Pathology pending Operative Findings The perivertebral soft tissue around T5-6 disc was thickened and fibrotic. The T5-6 disc was filled with soft fragile, reddish granulation tissue. The PLL was thick and compressed the thecal sac. The thecal sac was free from tension after removal of PLL. Operative Procedures 1. ETGA, left lateral decubitus position. 2. C-arm localization of right 6th rib. 3. Curvilinear incision under the right scapula and along the 6th rib, from the posterior axillary line medially to 4 cm from the midline. 4. Removal of the right 6th rib, from posterior axillary line to the rib head. 5. Retraction of the 5th and 7 th ribs with a retractor. 6. Diskectomy with a knife, currets, and Kerrisons. 7. Preparation of a bone trough in the lower T5 and upper T6 end plates. 8. Insertion of a 1.2 cm long rib segment to the T5-6 disk space. 9. One epidural drain . 10. Wound closure in layers. Operators 楊士弘 Assistants 陳德福,游健生 Indication Of Emergent Operation 相關圖片 詹群英 (F,1953/04/27,58y10m) 手術日期 2010/04/29 手術主治醫師 楊士弘 手術區域 東址 003房 02號 診斷 Malignant neoplasm of brain, unspecified 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 13:40 報到 14:15 進入手術室 14:20 麻醉開始 14:25 誘導結束 15:27 手術開始 17:10 手術結束 17:10 麻醉結束 17:20 送出病患 17:22 進入恢復室 18:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 腦室腹腔分流手術 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Left Frazier"s ventriculoperitoneal shunt 開立醫師: 李振豪 開立時間: 2010/04/29 17:36 Pre-operative Diagnosis Lung cancer with leptomeningeal carcinomatosis and hydrocephalus, s/p Ommaya reservoir implantation Post-operative Diagnosis Lung cancer with leptomeningeal carcinomatosis and hydrocephalus, s/p Ommaya reservoir implantation Operative Method Left Frazier"s ventriculoperitoneal shunt Specimen Count And Types 1 piece About size:total 15ml CSF Source:CSF sent for routine, BCS, and bacterial culture Pathology Nil Operative Findings 1. Ventricular catheter: 10cm in length Peritoneal catheter: 30cm in length Reservoir: Codman 10cmH2O pressure reservoir 2. The opening pressure is about 10cmH2O with clear CSF drained out. The CSF was sent for routine, CSF, and bacterial culture 3. The reservoir was placed at left retroauricular area. Operative Procedures Under endotracheal tube general anesthesia, the patient was put at supine position with head rotated to right. The scalp was shaved, scrubbed, and disinfected as usual. One linear scalp incision was made at left Frazier"s point. A burr hole was made and the dura was tented. The dura was opened with cruciform in fashion and left lateral ventricle was tapped by a ventricular needle. CSF was sampled after ventricular puncture. 10 cm ventricular catheter was inserted and connected to a Codman 10cmH2O pressure reservoir. One transverse skin incision was made at left upper abdomen. The subcutaneous soft tissue was dissected and the rectus abdomen muscle was splitted. The peritoneum was opened under direct vision. One subcutaneous tunnel was created from left upper abdomen, left forechest, left neck, left retroauricular area to Frazier"s point. The catheter was passed through subcutaneous tunnel and connected to the reservoir. The function of the shunt was checked. The trochar was introduced into peritoneal cavity. And the peritoneal catheter was placed with 30cm in length. After hemostasis, the wound was closed in layers. Operators VS楊士弘 Assistants R3李振豪, Ri 相關圖片 楊世琛 (M,1965/01/09,47y2m) 手術日期 2010/04/29 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Moyamoya disease 器械術式 Moyamoya P-DUH 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 07:37 報到 08:02 進入手術室 08:10 麻醉開始 08:40 誘導結束 09:10 抗生素給藥 09:42 手術開始 12:10 抗生素給藥 13:45 麻醉結束 13:45 手術結束 13:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 手術 顱內外血管吻合術 1 1 R 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Extracranial-intracranial bypass surgery 開立醫師: 李振豪 開立時間: 2010/04/29 14:19 Pre-operative Diagnosis Moyamoya disease Post-operative Diagnosis Moyamoya disease Operative Method Extracranial-intracranial bypass surgery Specimen Count And Types Nil Pathology Nil Operative Findings The anterior branch of superficial temporal artery was isolated with 8cm in length. The end-to-side, fish-mouth fashion anastomosis between superficial temporal artery and M4 frontal branch was performed with interrupted sutures. The brain parenchyma became much reddish after anastomosis. The pulsation of both superficial temporal artery and frontal branch were good. No SSEP change was noted during the operation. Operative Procedures Under endotracheal tube general anesthesia, the patient was put at supine position with head rotated to left and fixed with Mayfield skull clamp. The anterior and posterior branches of superficial temporal artery were identified by duplex. The scalp was shaved, scrubbed, and disinfected as usual. One curvilinear scalp incision was made at right frontotemporal area for pterional approach. Under operative microscope assisted, the anterior branches of superficial temporal artery was exposed and isolated with total 8cm in length and divided with one temporal clip. The posterior branches of superficial temporal artery was divided after hemoclip clipping. Heparin infusion was applied from distal end of the graft. One T-shaped incision was made at the fascia and temporalis muscle. The temporalis muscle was detached from the skull. Three burr holes were made followed by one 6x4cm craniotomy window. Dura was opened with star-shaped after dura tenting. The M4 frontal branch arising from sylvian fissure was identified. One tiny branche was sacrificed. The opening of graft was tailed to enlarge the opening. One linear incision at the frontal branch was made along the axis of the artery. Two anchoring suture was done and the interruptted suture was performed for end-to-side, fish-mouth fashion anastomosis with 10-0 Nylon. Hemostasis was achieved with bipolar cautery and Surgicel. Dura was closed with 4-0 prolene and Duraform. The skull plate was fixed back with four wires. The wound was then closed in layers after placing one CWV drain. Operators VS王國川 Assistants R3李振豪 相關圖片 顏陳金鳳 (F,1950/02/10,62y1m) 手術日期 2010/04/29 手術主治醫師 蔡翊新 手術區域 東址 005房 01號 診斷 Malignant neoplasm of female breast, nipple and areola 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 07:55 報到 08:08 進入手術室 08:20 麻醉開始 09:10 誘導結束 09:20 抗生素給藥 09:42 手術開始 12:20 抗生素給藥 13:30 麻醉結束 13:30 手術結束 13:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４～８小時 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT 開立醫師: 蔡翊新 開立時間: 2010/04/29 13:06 Pre-operative Diagnosis Breast cancer with right occipital bone metastasis and right occipital lobe brain metastasis. Post-operative Diagnosis Breast cancer with right occipital bone and epidural metastasis and right occipital lobe brain metastasis. Operative Method Right occipital craniotomy for brain tumor excision. Specimen Count And Types 3 pieces About size:2 x 2 x 0.1 cm Source:epidural mass About size:5 x 4 x 3 cm in 2 pieces Source:right superior occipital lobe About size:4 x 2 x 3 cm Source:right occipital lobe Pathology Pending. Operative Findings There were multiple bony erosion with pinkish, soft mass in occipital bone. A thin layer (1 mm) of epidural tumor was noted. The cortex of right occipital lobe was whitish and adherent to the dura and the abnormal change extended about 10 x 6 cm. Intraoperative ultrasound showed a hyperechoic lesion, 5 x 4 x 3 cm, located superiorly, and the other hyperechoic lesion with two cystic components, located inferiorly, in the right occipital lobe. The mass was grey-yellowish in color, soft in character, without obvious margin. The cystic fluid was clear and yellowish. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: prone with neck flexed and head fixed by Mayfield skull clamp. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: reversed U-shaped, 12 x 10 cm, at right occipital region with 2 cm across midline. Raney clips were applied to the scalp edge for temporary hemostasis. 5. Craniotomy window: 10 x 8 cm, right occipital, created by making 6 burr holes then cut by power saw. 6. Dural tenting: by 2/0 silk, 2 cm in interval, distributed along the edge of skull window. 7. Dural incision: curvilinear along the edge of skull window 8. Lobectomy: two corticotomy, 6 x 5 cm superiorly and 4 x 4 cm inferiorly, were made by Greenwood bipolar forceps at right occipital region. The tumor was resected by bipolar forceps along its vague discernible junction with normal white mater as en-block of 5 x 4 x 3 cm in size superiorly, and 4 x 2 x 3 cm in size inferiorly. 9. Hemostasis: The hemostasis during the resection of the tumor was obtained satisfactorily by bipolar coagulator and suction on the patties packing on the bleeders. The bleeding from artery was stopped by bipolar coagulator. The blood oozing point from several locations on the bare surface after lobectomy were packed with gelfoam for complete hemostasis. Finally, the cavity created after lobectomy was irrigated with NS several times and it was perfectly watery clear before the dural closure. 10.Dural closure: interruped 2/0 silk sutures for key stitches, then continuous suture with 4/0 Prolene to obtain water-tight closure. 11.Closure of skull window: The metastatic lesions on the skull plate were removed by currettage. The skull plate was placed back to craniotomy window and fixed by 3 miniplates and 6 screws. The dura was tented to the center of the skull plate by a 2/0 stitch. The covering muscle was closed by interrupted 1/0 silk stitches. 12.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 13.Drain: one, epidural, CWV. 14.Blood transfusion: Nil. 15.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5胡朝凱R2王奐之 陳姿佑 (F,2007/05/07,4y10m) 手術日期 2010/04/30 手術主治醫師 王廷明 手術區域 東址 027房 01號 診斷 Club foot, acquired 器械術式 Club foot+AL Split trans'/ WOR 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉漢平 ASA 3 紀錄醫師 曾渥然, 時間資訊 07:45 報到 08:08 進入手術室 08:30 麻醉開始 08:30 抗生素給藥 08:40 誘導結束 08:56 手術開始 09:40 麻醉結束 09:45 手術結束 09:50 送出病患 09:52 進入恢復室 10:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 踝關節固定術 1 1 L 手術 肌腱轉移或移位 1 2 L 手術 石膏固定－長腿 1 0 L 記錄__ 手術科部: 骨科部 套用罐頭: 1.Anterior tibialis tendon transfer; 2.Talo-n... 開立醫師: 曾渥然 開立時間: 2010/04/30 10:07 Pre-operative Diagnosis Club foot, left Post-operative Diagnosis Club foot, left Operative Method 1.Anterior tibialis tendon transfer; 2.Talo-navicular joint reduction and internal fixation Specimen Count And Types nil Pathology Nil Operative Findings 1.Talo-navicular joint subluxation 2.Full anterior tibialis tendon transfer to lateral cuneiform Operative Procedures 1.ETGA, supine position 2.Skin disinfection and well draped 3.Skin incision overlying the talo-navicular joint, perform anterior, posterior and spring ligament release 4.Identify anterior tibialis tendon and dissect it at insertion site, transfer it to lateral cuneiform and fix it with one button by proper tension 5.Reduce the talo-navicular joint and internal fixation with two 1.5mm K-wires 6.Close the woune in layers, on long-leg cast for further protection and keep the foot at everted and dorsiflexed position Operators 王廷明,郭耿南 Assistants CR李奕辰;R3曾渥然 黃惠萱 (F,1958/03/01,54y0m) 手術日期 2010/04/30 手術主治醫師 楊士弘 手術區域 東址 003房 02號 診斷 Major depressive disorder, recurrent episode, moderate (F33.1) 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 10:50 報到 11:50 進入手術室 12:00 麻醉開始 12:15 誘導結束 12:25 抗生素給藥 12:45 手術開始 15:25 手術結束 15:25 麻醉結束 15:35 送出病患 15:40 進入恢復室 16:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 手術 椎間盤切除術－頸椎 1 1 手術 脊椎融合術－前融合，無固定物（＜＝四節） 1 2 摘要__ 手術科部: 精神部 套用罐頭: Anterior microsurgical diskectomy + interbody... 開立醫師: 楊士弘 開立時間: 2010/04/30 15:26 Pre-operative Diagnosis Cervical herniated intervertebral disc, C5-6 Post-operative Diagnosis Cervical herniated intervertebral disc, C5-6 Operative Method Anterior microsurgical diskectomy + interbody fusion Specimen Count And Types nil Pathology Nil Operative Findings The C5-6 disc space was narrow. The disc material became dehydrated. The posterior marginal spur of C5-6 was thick and fused in the middle and left side over anterior epidural space, causing significant compression of the thecal sac. The disk also bulged posteriorly. The thecal sac became free from tension afer decompression. Operative Procedures 1. ETGA, supine. 2. Transverse incision over right anterior neck. 3. Dissection along the right medial SCM to reach the prevertebral space. 4. C-arm localization of the C5-6 disk space. 5. Detachment of longus colli muscle for insertion of retractors. 6. Diskectomy and osteophysectomy by a knife, currets, air drill, and kerrison punches under surgical microscope. 7. Insertion of a 11 mm deep, 5 mm high PEEK cage into the C5-6 disc space. 8. Verification of the cage position with C-arm. 9. One mini-HV drain in the neck wound. 10. Wound closure in layers. Operators 楊士弘 Assistants 李建勳,王奐之 沈遜讓 (M,1929/04/28,82y10m) 手術日期 2010/04/30 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Lumbar stenosis 器械術式 Laminectomy for decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 陳睿生, 時間資訊 00:00 臨時手術NPO 07:35 報到 08:02 進入手術室 08:10 麻醉開始 08:20 誘導結束 08:50 抗生素給藥 09:02 手術開始 11:50 抗生素給藥 12:06 開始輸血 12:25 手術結束 12:25 麻醉結束 12:38 送出病患 12:40 進入恢復室 14:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術（特壓）－二節以內 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: L3,4 laminectomy for decompression 開立醫師: 陳睿生 開立時間: 2010/04/30 12:36 Pre-operative Diagnosis Lumbar stenosis over L2-5 Post-operative Diagnosis Lumbar stenosis over L2-5 Operative Method L3,4 laminectomy for decompression Specimen Count And Types nil Pathology Nil Operative Findings Spinal canal narrowing was noted and the thecal sac was tightly compressed. Thicken ligamentum flavum was also noted with severe lateral recess compression. Dura tear was noted while laminectomy and was tightly repaired. Operative Procedures 1. ETGA, prone position and C-arm localize L3/4, 4/5 level 2. Low back midline incision 3. Split bilateral paraspinal muscles 4. Expose the L2 to L5 lamina 5. Perform L3, 4 laminectomy with rounger and kerrison pounch 6. Remove of ligamentum flavum especially over L2/3, 3/4, 4/5 lateral recess 7. Repair dura tear with 4-0 prolene 8. Hemostasis, and pack the thecal sac with Durafoam 9. Set 1/8 hemovac x2 10.Close the wound in layers Operators VS 曾漢民 Assistants R5 陳睿生, R2 古恬音 吳佩臻 (F,2005/10/15,6y4m) 手術日期 2010/04/30 手術主治醫師 曾勝弘 手術區域 兒醫 068房 03號 診斷 Aromatic L-amino acid decarboxylase deficiency 器械術式 Stereotaxic procedure for impl 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 蕭柏妮 ASA 3 紀錄醫師 林哲光, 時間資訊 14:10 報到 14:26 進入手術室 14:35 麻醉開始 14:45 誘導結束 15:08 手術開始 15:38 手術結束 15:38 麻醉結束 16:10 送出病患 17:54 離開恢復室 17:54 進入恢復室 醫令資訊 類別 名稱 量 刀 側 手術 頭皮腫瘤 1 1 B 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 記錄__ 手術科部: 外科部 套用罐頭: Moyamoya disease 開立醫師: 林哲光 開立時間: 2010/04/30 16:05 Pre-operative Diagnosis Aromatic amion acid decarboxylase deficiency Aromatic amino acid decarboxylase deficiency Post-operative Diagnosis Aromatic amion acid decarboxylase deficiency Aromatic amino acid decarboxylase deficiency Operative Method Implantation of fiducial markers Specimen Count And Types nil Pathology Operative Findings total 8 fiducial markers over bilateral frontal area , parietal area Operative Procedures Under ETGA and supine position, skin disinfected over scalp was performed with alcoholic B-I solution. Total 8 fiducial markers were implanted over bilateral frontal area and parietal area, covered with better iodine and guaze. They were fixed with purse string and plastic cup. Operators 曾勝弘, Assistants 林哲光, 林松茂 (M,1954/08/12,57y7m) 手術日期 2010/04/30 手術主治醫師 郭順文 手術區域 西址 033房 01號 診斷 DM 器械術式 Tracheostomy 手術類別 預定手術 手術部位 胸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 林子富 ASA 3 紀錄醫師 蔡東明, 時間資訊 08:55 報到 08:55 進入手術室 09:00 麻醉開始 09:05 誘導結束 09:20 手術開始 09:35 麻醉結束 09:35 手術結束 09:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 氣管切開造口術 1 0 記錄__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 蔡東明 開立時間: 2010/04/30 09:59 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Ditto Operative Method Tracheostomy Specimen Count And Types nil Pathology None Operative Findings Fr . 8 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators VS郭順文 Assistants R3蔡東明 R1鄭孟伯 徐海陵 (F,1947/07/17,64y7m) 手術日期 2010/04/30 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Cervical spondylosis 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:06 進入手術室 08:30 麻醉開始 08:40 誘導結束 09:00 抗生素給藥 09:10 手術開始 11:40 手術結束 11:40 麻醉結束 11:45 送出病患 11:50 進入恢復室 13:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術－前融合，有固定物（＜＝四節） 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 記錄__ 手術科部: 外科部 套用罐頭: Anterior approach for discectomy and cage, pl... 開立醫師: 胡朝凱 開立時間: 2010/04/30 11:53 Pre-operative Diagnosis C4~5 OPLL and HIVD Post-operative Diagnosis C4~5 OPLL and HIVD Operative Method Anterior approach for discectomy and cage, plate fixation Specimen Count And Types nil Pathology nil Operative Findings 1.Hypertrophic PLL that compress the spinal cord tightly 2.6# cage was inserted 3.No instability was noted Operative Procedures 1.ETGA, supine 2.Right neck transverse skin incision 3.Dissect to expose prevertebral space 4.Localization 5.Detach longus colli muscle 6.Discectomy 7.Cage insertion 8.Plate fixation 9.Set hemovac drain then close wound in layers Operators 賴達明 Assistants 胡朝凱,游健生 吳梅桃 (F,1954/03/23,57y11m) 手術日期 2010/04/30 手術主治醫師 賴達明 手術區域 東址 005房 02號 診斷 Radiculopathy 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳睿生, 時間資訊 00:00 臨時手術NPO 12:10 報到 13:01 進入手術室 13:05 麻醉開始 13:10 誘導結束 13:56 抗生素給藥 14:13 手術開始 16:56 抗生素給藥 17:40 手術結束 17:40 麻醉結束 17:45 送出病患 17:50 進入恢復室 20:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 手術 椎弓切除術（特壓）－二節以內 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: T9, 10 laminectomy for decompression and T8, ... 開立醫師: 陳睿生 開立時間: 2010/04/30 18:06 Pre-operative Diagnosis Spinal stenosis over T9/10, 10/11 Post-operative Diagnosis Spinal stenosis over T9/10, 10/11 Operative Method T9, 10 laminectomy for decompression and T8, 9, 11 posteriolateral fusion with fixation Specimen Count And Types nil Pathology Nil Operative Findings The thecal sac was quite narrowing especially over T9/10, 10/11 level. Calcified ligamentum flavum with dura adhesion was also noted. Minor dura tear was noted intra-op, but no obvious CSF leakage. Posterior fixation with Synthes system: Screws: 5.0x 35mm at T8, 9 (4 screws); 6.2x 35mm at T11 (2 screws) Rods: 11cm x2 Operative Procedures 1. ETGA, prone position with trunk flexion 2. Posterior midline skin incision about 15cm 3. Split bilateral paraspinal muscle to expose the T8-11 spinous process and lamina 4. Remove of T8-10 spinous process and T9, 10 laminectomy with rounger and high speed drill 5. Remove of calcified ligamentum flavum, and lateral recess decompression with Kerrison pounch 6. Set transpedicular screws over T8, 9, 11 7. Insert bilateral rods and fixation 8. Hemostasis, set 1/8 hemovac x2 9. Close the wound in layers Operators VS 賴達明 Assistants R5 陳睿生, Ri 鄭智元 (M,1958/11/10,53y4m) 手術日期 2010/04/30 手術主治醫師 賴達明 手術區域 東址 019房 02號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(Others) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 11:20 報到 12:05 進入手術室 12:05 麻醉開始 12:35 誘導結束 12:45 抗生素給藥 12:50 手術開始 15:45 抗生素給藥 16:20 麻醉結束 16:20 手術結束 16:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４小時以內 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Craniotomy for tumor excision 開立醫師: 胡朝凱 開立時間: 2010/04/30 16:40 Pre-operative Diagnosis Left frontal convexity meningioma Post-operative Diagnosis Left frontal convexity meningioma Operative Method Craniotomy for tumor excision Specimen Count And Types Nil Pathology pending Operative Findings 1.One reddish, soft, well defined tumor with dural base was noted at left frontal convexity area. 2.The arachnoid membrane was intact 2.The arachnoid membrane was intact 3.Simpson grade I tumor excision was performed Operative Procedures 1.ETGA, supine 2.Left frontal curvature skin incision 3.Reflect ksin flap anteriorly 4.Harvest one piece of fascia 5.Craniotomy 6.Dural excision with tumor excision 7.Hemostasis 8.Fiz bone back with miniplate and bone cement for cranioplasty 9.Close wound in layers Operators 賴達明 Assistants 胡朝凱,游健生 江麗華 (F,1963/05/27,48y9m) 手術日期 2010/04/30 手術主治醫師 楊士弘 手術區域 東址 002房 06號 診斷 Malignant neoplasm of female breast, nipple and areola 器械術式 OPLL- Anterior Corpectomy 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 鄭孟伯, 時間資訊 11:30 臨時手術NPO 11:30 開始NPO 18:55 通知急診手術 20:03 進入手術室 20:15 麻醉開始 21:00 抗生素給藥 21:05 誘導結束 22:15 手術開始 22:15 報到 23:45 開始輸血 00:07 抗生素給藥 01:00 手術結束 01:00 麻醉結束 01:05 送出病患 01:15 進入恢復室 02:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 手術 惡性病髓腫瘤切除術 1 1 手術 脊椎融合術－前融合，有固定物（＜＝四節） 1 2 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Anterior approach for C7 corpectomy, cage ins... 開立醫師: 胡朝凱 開立時間: 2010/05/01 01:16 Pre-operative Diagnosis C7 breast cancer meta with pathological fracture C7 vertebral metastasis with pathological compression fracture; breast cancer Post-operative Diagnosis C7 breast cancer meta with pathological fracture C7 vertebral metastasis with pathological compression fracture; breast cancer Operative Method Anterior approach for C7 corpectomy, cage insertion, and plate fixation Anterior approach for C7 corpectomy and tumor excision, body cage insertion, and plate + screws fixation Specimen Count And Types pieces of tumor and bone fragment Pathology pending Operative Findings 1.Yellowish, mild hypervascularity tumor located at C7 vertebral body to pedicle that compressed the spinal cord tightly 1.Yellowish, mild hypervascularity tumor located at C7 vertebral body and lateral masses which compressed the spinal cord tightly 2.The C7 height decreased severely 2.The C7 height decreased markedly 3.After decompression, thecal sac expanded well Operative Procedures 1.ETGA, supine 2.Right neck transverse skin incision 3.Dissect along with the anterior border of SCM muscle 4.Expose prevertebral space 5.Detach longus colli muscle 6.Corpectomy and tumor excision lateral to the border of spinal cord 6.C7 Corpectomy, C6-7 and C7-T1 diskectomy, and tumor excision with knife, currets, and kerrison punches 7.Cage insertion 7.Body cage insertion into the corpectomy space, 12 mm in diameter, 2 cm in height 8.Plate fixation 8.Plate (36 mm long), and 4 screws (16 mm long, 3.5 mm in diameter) for C6 to T1 fixation 9.Set one CWV drain then close wound in layers Operators 楊士弘 Assistants 胡朝凱,鄭孟伯 Indication Of Emergent Operation 相關圖片 謝國棟 (M,1937/04/08,74y11m) 手術日期 2010/04/30 手術主治醫師 楊士弘 手術區域 東址 003房 01號 診斷 Cervical spondylosis 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:08 進入手術室 08:15 麻醉開始 08:25 誘導結束 09:03 手術開始 11:05 手術結束 11:05 麻醉結束 11:38 送出病患 11:40 進入恢復室 13:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術－頸椎 1 1 手術 脊椎融合術－前融合，無固定物（＜＝四節） 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: Anterior microsurgical diskectomy + interbody... 開立醫師: 楊士弘 開立時間: 2010/04/30 10:44 Pre-operative Diagnosis Cervical herniated intervertebral disk, C3-4 Post-operative Diagnosis Cervical herniated intervertebral disk, C3-4 Operative Method Anterior microsurgical diskectomy + interbody cage fusion Specimen Count And Types nil Pathology Nil Operative Findings The C3-4 disk was dehydrated and easily detached from the vertebral end plates. The posterior marginal spur was prominent. The disc material bulged out posteriorly and compressed the thecal sac. The PLL became thin. The thecal sac reexpanded well after decompression. Operative Procedures 1. ETGA, supine. 2. Transverse skin incision along right anterior neck. 3. Dissection along the right medial SCM to reach the prevertebral space. 4. C-arm localization of C3-4 disk. 5. Detachment of longus collis muscles from anterior vertebrae for insertion of cervical retractors. 6. Diskectomy with knife, disk forceps, currets under microscope. 7. Partial decortication of vertebral end plates. 8. Insertion of a interbody cage filled with hydroxyappatite particles. Cage size: 6 mm high, 11 mm deep. 9. C-arm verification of cage position. 10. Wound closure in layers. Operators 楊士弘 Assistants 李建勳,王奐之 相關圖片 王盈晴 (F,1986/11/11,25y4m) 手術日期 2010/04/30 手術主治醫師 王國川 手術區域 東址 003房 04號 診斷 Pituitary tumor 器械術式 T.S.H. 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2E 紀錄醫師 陳建銘, 時間資訊 16:06 通知急診手術 16:07 開始NPO 16:07 臨時手術NPO 22:42 進入手術室 22:45 麻醉開始 23:00 誘導結束 23:05 抗生素給藥 23:37 手術開始 01:45 手術結束 01:45 麻醉結束 01:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經由蝶竇之腦下垂體瘤切除 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 記錄__ 手術科部: 外科部 套用罐頭: Hypophysectomy---Transphenoid 開立醫師: 胡朝凱 開立時間: 2010/05/01 01:45 Pre-operative Diagnosis Pituitary macroadenoma with apoplexy Post-operative Diagnosis Pituitary macroadenoma with apoplexy Operative Method Transphenoid adenomectomy Specimen Count And Types pieces of tumor Pathology pending Operative Findings 1.Hard tumor was noted 2.Motor oil like blood was also noted Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head tilted 30 degree to left. 3. Skin preparation: the face and anterior right thigh were prepared with povidone-iodine alcohol tincture, and the mucosa of oral and nasal cavity with aqueous povidone-iodine tincture. The former areas were covered by a sterilized adhesive plastic sheet. 4. The nasal submucosa at septum and floor and the subperiostium at upper alveola were infiltrated with 1:100 epinephrine solution. 5. Incision: at labial mucosa, 3 mm away from its gingival junction and corresponding to 4 upper incisors. 6. The inferior margin of the nasal septum and floor was exposed 7. The mucosa of nasal septum and floor was dissected away from the septal cartilage and the bony floor on both sides from anterior to posterior and displaced laterally by a long nasal speculum. 8. The septal cartilage was cut at its basal juction by sepatal scissors and then displaced to one side. 9. A Hardy's nasal speculum was applied to displace the nasal mucosa laterally and keep the nasal cavity open constantly for the exposure of the vomer bone and the anterior wall of the sphenoid sinus. Before the sinus was opened, the position of the nasal speculum was adjusted under the radioimage intensifier to a direction which directly pointed to the sellar floor. 10.The exposed sinus mucosa was coagulated and resected. 11.Under the guide of radioimage intensifier, the sellar floor was penetrated by a osteotome, then widened by Kerrison punch. 12.The sellar floor dura was coagulated with bipolar forceps, then opened in cruciate fashion. 13.The soft tumor parenchyma was removed by curette and suction, then the capsule was mobilized away from the dura and normal pituitary gland and removed. The final piece of the tumor at suprasellar area sank into the sella spontaneously after the intrasellar tumor had been removed. This last piece of the tumor was carefully separated from the arachnoid by curette and fine sucker. The venous oozing from the dura was stopped by gelfoam packing. 14.The arachnoid and the opening of diaphragm sellae was enforced by a pieceof muscle fascia. The sellar cavity was packed with muscle strips removed from right rectus femoris. The sellar floor was reconstructed by supporting a piece of vomer bone between the dura and the margin of the sellar floor. The sphenoidsinus was packed with fat tissue. 15.The Hardy's nasal speculum was removed and the nasal mucosa returned to its normal position. Each side of the nasal cavities was tightly packed with a segment of IV tube surrounded by 3 gauze strips which had been soacked with Better-iodine ointment. 16.The labial wound was closed by interrupted stitches with 4/0 Dexon. 17.Blood transfusion: 18.Course of the operation:smooth. Operators 王國川 Assistants 陳建銘 Indication Of Emergent Operation 吳佩臻 (F,2005/10/15,6y4m) 手術日期 2010/05/01 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Aromatic L-amino acid decarboxylase deficiency 器械術式 Stereotaxic procedure for func 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 3 紀錄醫師 李建勳, 時間資訊 16:25 進入恢復室 17:30 離開恢復室 00:00 臨時手術NPO 07:58 報到 08:15 進入手術室 08:25 麻醉開始 09:30 抗生素給藥 09:35 誘導結束 09:54 手術開始 12:30 抗生素給藥 14:35 麻醉結束 14:35 手術結束 14:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 立體定位術－功能性失調 1 1 B 手術 立體定位術－功能性失調 1 2 B 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Glucose 1 0 摘要__ 手術科部: 套用罐頭: Stereotatic injection of AV vector at bilater... 開立醫師: 李建勳 開立時間: 2010/05/01 15:40 Pre-operative Diagnosis Aromatic L-amino acid decarboxylase deficiency Post-operative Diagnosis Aromatic L-amino acid decarboxylase deficiency Operative Method Stereotatic injection of AV vector at bilateral putamen Specimen Count And Types nil Pathology Nil Operative Findings 80 microliter of adeno-associated virus loaded with AADC gene (AV vector) was injected at two different sites (middle and lateral) of putamen (total:320microliter).Immediate follow up head CT showed no ICH. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position. The scalp was shaved, scrubbed, disinfected with alcohol B-I then draped. Two burr holes were made with perforator followed by tenting with 3-0 silk sutures. Set up the navigator with registeration of pre-fixed skull screws. Fixed the DBS tower at the burr hole and inserted the catheter as planned. Injected the adeno-associated virus loaded with AADC gene (AV vector) was injected at two different sites (middle and lateral lower third) of putamen (total:320microliter). Sealed the burr hole with gelform packing and Tissucol Duo. Closed the wound in layers after hemostasis. Operators VS 曾勝弘 Assistants R6 李建勳 相關圖片 李順情 (M,1966/12/12,45y3m) 手術日期 2010/05/01 手術主治醫師 郭順文 手術區域 東址 002房 02號 診斷 Cerebral hemorrhage 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 2 紀錄醫師 蔡東明, 時間資訊 12:13 進入手術室 12:15 麻醉開始 12:20 誘導結束 12:25 抗生素給藥 12:32 手術開始 12:50 手術結束 12:50 麻醉結束 12:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 氣管切開造口術 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 蔡東明 開立時間: 2010/05/01 12:16 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Ditto Operative Method Tracheostomy Specimen Count And Types nil Pathology None Operative Findings Fr . 8 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators VS郭順文 Assistants R3蔡東明 Ri鍾一瑋 李國正 (M,1947/01/20,65y1m) 手術日期 2010/05/01 手術主治醫師 楊士弘 手術區域 東址 003房 2號 診斷 Other specified bone tuberculosis 器械術式 Laminectomy for decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 3 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 13:45 進入手術室 13:45 報到 13:50 麻醉開始 13:55 誘導結束 14:45 手術開始 16:40 開始輸血 17:33 麻醉結束 17:33 手術結束 17:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 手術 椎弓切除術（特壓）－二節以內 1 1 摘要__ 手術科部: 外科部 套用罐頭: lower T4, T5, and upper T6 laminotomy for re... 開立醫師: 楊士弘 開立時間: 2010/05/01 18:13 Pre-operative Diagnosis T5-6 epidural abscess with spinal cord compression Post-operative Diagnosis T5-6 epidural abscess with spinal cord compression Operative Method lower T4, T5, and upper T6 laminotomy for removal of epidural abscess Specimen Count And Types 1 piece About size:小 Source:T5-6 epidural granulation tissue Pathology pending Operative Findings The posterior epidural space at T5-6 level was occupied by soft fragile, yellowish grey, hypovascular granulation tissue. The spinal cord was compressed and reexpanded well after removal of granulatio tissue. Operative Procedures 1. ETGA, prone. 2. C-arm localization of T5-6 level. 3. Midline incision over upper back. 4. Dissection and retraction of paraspinal muscles bilaterally off spinous processes and lamina. 5. Laminotomy of bilateral T5, upper T6, and lower T4 by air drill, and kerrison punches. 6. Dissection of removal of epidural granulation tissue with tumor forceps, currets, and alligator forceps. 7. Hemostasis. 8. One epidural CWV drain. 9. Wound closure in layers. Operators 楊士弘 Assistants 陳國瑋 相關圖片 林立峰 (M,1953/10/01,58y5m) 手術日期 2010/05/01 手術主治醫師 林晉 手術區域 東址 001房 4號 診斷 Major trauma rated 16 or above on the severeity scale ( Injury severeity score >=16 ) 器械術式 ORIF - Large ""A-O"" plate 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 3E 紀錄醫師 董正仁, 時間資訊 14:35 臨時手術NPO 14:35 開始NPO 14:42 通知急診手術 19:25 報到 19:25 進入手術室 19:30 麻醉開始 19:32 誘導結束 20:00 抗生素給藥 20:08 手術開始 20:45 開始輸血 21:00 抗生素給藥 21:37 麻醉結束 21:37 手術結束 21:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 脛骨骨折開放性復位術 1 1 R 手術 石膏副木固定－長腿 1 0 R 記錄__ 手術科部: 骨科部 套用罐頭: ORIF with Buttress plate (7H7S) 開立醫師: 董正仁 開立時間: 2010/05/01 21:58 Pre-operative Diagnosis Right tibial plateau fracture, comminuted Post-operative Diagnosis Right tibial plateau fracture, comminuted Operative Method ORIF with Buttress plate (7H7S) Specimen Count And Types nil Pathology nil Operative Findings as diagnosis Operative Procedures 1.ETGA, supine position 2.Skin preparation, disinfection and draping 3.Skin incision over the lateral aspect of right knee 4.Dissect to expose the fracture site 5.ORIF with buttress plate under the C-arm guide 6.Set 1/8# hemovac 7.Hemostasis, irrigation and closure of wound Operators 林晉, Assistants 董正仁, 吳拓, Indication Of Emergent Operation 黃金泉 (M,1955/04/20,56y10m) 手術日期 2010/05/01 手術主治醫師 王國川 手術區域 東址 006房 01號 診斷 Subdural hemorrhage 器械術式 Brain tumor Crainotomy(Others) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 3E 紀錄醫師 黃世銘, 時間資訊 00:00 開始NPO 00:00 臨時手術NPO 12:30 通知急診手術 14:04 報到 14:10 麻醉開始 14:20 進入手術室 14:28 抗生素給藥 14:40 誘導結束 15:20 手術開始 17:15 麻醉結束 17:15 手術結束 17:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 急性硬腦膜下血腫清除術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Left frontal-temporal craniotomy for evacuati... 開立醫師: 鍾文桂 開立時間: 2010/05/01 17:59 Pre-operative Diagnosis Left frontal-parietal-temporal acute subdural hemorrhage. Post-operative Diagnosis Left frontal-parietal-temporal acute subdural hemorrhage. Operative Method Left frontal-temporal craniotomy for evacuation of acute subdural hemorrhage. Dural augmentation for brain swelling. Specimen Count And Types nil Pathology Nil. Operative Findings Mild brain swelling; easy ozing operative field. One active oozing cortical vein was noted and electrocoagulated. Operative Procedures Under general anesthesia, the head was tilted to the right side. After shaving, disinfection, and well-draping, a 30-cm question-mark incision was made at left frontal-temporal region. After application of Raney scalp clips for hemostasis, dissection of the temporalis muscle from the skull bone was done with monopolar electrocoagulation. With well exposure of the underlying skull bone, four burr holes were drilled. Then, a 5-cm craniotomy was created. Curvilinear durotomy was done after dural tenting. The underlying acute subdural hemorrhage was removed by suction. The active oozing cortical vein was noted in the frontal region. It was electrocoagulated by bipolar forceps. After well hemostasis and ensurance of no active oozing, the dura mater was closed in water-tight fashion and augmented by temporalis fascia. The craniotomy bone plate was fixed with wires. Finally, the wound was closed in layers. The patient was sent to ICU smoothly. Operators V.S. 王國川. Assistants R4 鍾文桂,R1 黃世銘. Indication Of Emergent Operation 張春武 (M,1967/07/27,44y7m) 手術日期 2010/05/01 手術主治醫師 王國川 手術區域 東址 003房 1號 診斷 Malignant neoplasm of cerebrum, except lobes and ventricles 器械術式 Brain tumor Crainotomy(Others) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 3 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:05 進入手術室 08:12 麻醉開始 08:30 誘導結束 09:15 抗生素給藥 09:20 手術開始 12:15 抗生素給藥 12:40 麻醉結束 12:40 手術結束 12:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４小時以內 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 記錄__ 手術科部: 外科部 套用罐頭: Grossly total tumor excision 開立醫師: 胡朝凱 開立時間: 2010/05/01 12:29 Pre-operative Diagnosis Recurrent right fronto-temopral GBM Post-operative Diagnosis Recurrent right fronto-temopral GBM Operative Method Grossly total tumor excision Specimen Count And Types One piece of tumor Pathology pending Operative Findings 1.Grayish, elastic tumor located at the right fronto-temporal area with a relative clear margin. Some cytic part was also noted. 2.right MCA was partial encased by tumor, but we preserved the MCA 3.Peripheral brain tissue was swelling and dark yellowish. Operative Procedures 1.ETGA, supine with head fixed with skull clamp 2.Previous wound skin incision 3.Reflect skin flap downward 4.Remove previous miniplate 5.Open craniotomy bone graft 6.Dural tenting 7.open dura 8.tumor excision 9.hemodtasis 10.close dura with durofoam 11.Fix bone back 12.Close wound in layers after one CWV drain was inserted Operators 王國川 Assistants 胡朝凱,陳國瑋 李銘偉 (M,1982/11/12,29y4m) 手術日期 2010/05/02 手術主治醫師 蔡翊新 手術區域 東址 002房 02號 診斷 Subdural hemorrhage following injury, with loss of consciousness of unspecified duration 器械術式 ICP monitoring 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 3E 紀錄醫師 陳國瑋, 時間資訊 00:52 臨時手術NPO 00:52 開始NPO 12:53 通知急診手術 13:50 開始輸血 13:50 麻醉開始 13:55 誘導結束 14:05 進入手術室 14:25 手術開始 14:40 抗生素給藥 17:20 手術結束 17:20 麻醉結束 17:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 急性硬腦膜下血腫清除術 1 1 L 手術 顱內壓監視置入 1 2 R 記錄__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 蔡翊新 開立時間: 2010/05/02 17:27 Pre-operative Diagnosis 1. Head injury with occipital skull fracture, bilateral frontotemporal SDH, SAH and brain edema. 2. Right facial and frontal laceration with subgaleal hematoma. Post-operative Diagnosis 1. Head injury with occipital skull fracture, bilateral frontotemporal SDH, SAH and brain edema. 2. Right facial and frontal laceration with subgaleal hematoma. Operative Method 1. Left frontotemporoparietal craniectomy for duroplasty and subdural hematoma evacuation plus right frontal intraparenchymal ICP monitoring. 2. Repair of right frontal scalp laceration. Specimen Count And Types nil Pathology Nil. Operative Findings 1. Initial ICP upon right frontal burr hole creation was 30 mmHg. 2. Tight dura was noted after left F-T-P craniectomy. SDH abut 0.8 cm in thickness was noted at left F-T-P area and scattered SAH at left frontal lobe. The cerebral vessels were congested and the brain was bulging out rapidly after dural opening. 3. ICP was 22 mmHg after craniectomy, 9 mmHg after duroplasty, and 26 mmHg after skin closure. 4. Right frontal scalp laceration s/p Apose approximation, with continuous oozing from the middle part. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 4 cm at right frontal area, the skin edge was clipped by Raney clips for temporary hemostasis. 5. A burr hole was made and the dura was incised to insert the ICP monitor. 6. The incision was extended to a left frontotemporoparietal horseshoe, and the temporalis muscle was detached from temporal squama by rasp subsequently. 7. Craniotomy window: 14 x 12 cm, left F-T-P, created by making 5 burr holes then cut by power saw. 8. Dural tenting: by 2/0 silk, 3 cm in interval, distributed along the edge of skull window. 9. Dural incision: curvilinear along the edge of skull window 10.The subdural clot was removed by sucker. Duroplasty was performed with DuroForm, 12 x 10 cm cutting into 3 pieces. 11.The skull plate was removed and stored at bone bank for preservation. 11.The skull plate was removed and stored at bone bank for preservation. The left temporal muscle was excised to obtain more intracranial space. 12.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 1/0 Vicryl and skin by continuous suture with 2/0 nylon. 13.Drain: two, epidural, CWV. 14.Blood transfusion: PRBC 8U, WB 2U, FFP 6U, PLT 12U 15.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R3曾峰毅R1陳國瑋 Indication Of Emergent Operation 張寶瑜 (F,1962/05/12,49y10m) 手術日期 2010/05/03 手術主治醫師 童寶玲 手術區域 兒醫 065房 3號 診斷 Uterine myoma 器械術式 L.A.V.H Dr- P Huang 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 2 紀錄醫師 蔡可欣, 時間資訊 11:12 報到 11:25 進入手術室 11:30 麻醉開始 11:40 誘導結束 11:41 抗生素給藥 12:00 手術開始 14:20 手術結束 14:20 麻醉結束 14:25 送出病患 14:30 進入恢復室 15:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 腹腔鏡全子宮切除術 1 1 摘要__ 手術科部: 婦產部 套用罐頭: LAVH 開立醫師: 蔡可欣 開立時間: 2010/05/03 14:39 Pre-operative Diagnosis 1.Myoma uteri Post-operative Diagnosis 1.Myoma uteri 2.Pelvic adhesion Operative Method Laparoscopic assisted vaginal hysterectomy Specimen Count And Types 1 piece About size:447g Source:uterus Pathology pending Operative Findings 1. Uterus: multiple uterine myomata 2. Adnexae: grossly normal 3. Cul-de-sac: free 4. Total weight of uterus: 447gm 5. Estimated blood loss: 100ml Blood transfusion:nil Complication:nil Operative Procedures 1. Put the patient on lithotomy position and vaginal douching. 2. Skin disinfection and draping 3. Insert uterine elevator and on Foley 4. Make a 1cm skin incision below the umbilicus 5. Insert Varess needle and make pneumoperitoneum 6.Insert 10 mmtrocar and laparoscopy 7. Insert 2nd (10mm) and 3rd (5mm) trocar under laparoscopic inspection 8. Injection diluted Pitressin (1:100) into utero-vesical fold and bilateral broad ligament 9. Cut off bilateral round ligaments via electrocauterization 10.Cut off bilateral ovarian ligaments and fallopian tubes via electrocauterization 11. Dissect and ligate bilateral uterine artery with 1-0 Vicryl 12. Dissect and cut off serosa over utero-vesical and utero-rectal fold 13. Submucosal injection of diluted Pitressin (1:100) around the cervix 14. Make incision on the anterior vaginal mucosa and circumcision the cervix. 15. Enter the vesico-cervical space and utero-rectal space with long Kelly. 16.Clamp, cut and suture ligate bilateral utero-sacral ligaments with 1-0 Vicryl 17. Open the peritoneal cavity, anteriorly and posteriorly. 18. Clamp, cut and suture ligate bilateral cardinal ligaments with 1-0 Vicryl 19. Cut the uterus through midline with scissors 20. Morceration of the uterus 21. Clamp,cut and suture ligate bilateral ovarian ligaments and remove the uterus 22. Reperitonealization and approximate the vaginal stump. 23. Check bleeding and hemostasis underlaparoscopy 24. Remove trocar and repair skin with 3-0 Vicryl Operators 童寶玲, Assistants 朱凌慧, 蔡可欣, 張淑 (F,1999/07/27,12y7m) 手術日期 2010/05/03 手術主治醫師 廖漢文 手術區域 東址 000房 號 診斷 Epilepsy 器械術式 Common Carotid Angiography 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 王永彬 ASA 3 時間資訊 08:50 麻醉開始 09:00 誘導結束 10:45 麻醉結束 10:50 進入恢復室 12:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 江麗華 (F,1963/05/27,48y9m) 手術日期 2010/05/03 手術主治醫師 楊士弘 手術區域 東址 003房 02號 診斷 Malignant neoplasm of female breast, nipple and areola 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 11:55 報到 12:08 進入手術室 12:10 麻醉開始 12:25 誘導結束 12:35 抗生素給藥 13:10 手術開始 14:06 開始輸血 15:55 抗生素給藥 16:55 手術結束 16:55 麻醉結束 17:15 送出病患 17:20 進入恢復室 19:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 惡性病髓腫瘤切除術 1 1 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 2 摘要__ 手術科部: 外科部 套用罐頭: C7 laminectomy for tumor excision; posterior ... 開立醫師: 楊士弘 開立時間: 2010/05/03 16:50 Pre-operative Diagnosis C7 vertebral metastasis with spinal cord compression; breast cancer Post-operative Diagnosis C7 vertebral metastasis with spinal cord compression; breast cancer Operative Method C7 laminectomy for tumor excision; posterior fixation from C7 to T1 Specimen Count And Types 1 piece About size:小 Source:C7 vertebral tumor Pathology C7 laminectomy for tumor excision; posterior fixation from C7 to T1 Operative Findings The C7 lamina and spinous process were partially destroyed by soft fragile, greyish red, hypervascular tumor. The thecal sac was compressed by the tumor and reexpanded well after decompression. polyaxial screws and rods were used for posterior fixation from C6 to T1: both C6 lateral mass screws: 16 mm long, 3.5 mm in diameter right T1 pedicle screw: 20 mm long, 4 mm in diameter left T1 pedicle screw: 22 mm long, 4 mm in diameter rods: 4 cm long on each side Operative Procedures 1. ETGA, prone, head fixed with skull clamp and flexed. 2. Midline incision from C5 to T2. 3. Dissection and retraction of bilateral paraspinal muscles from the spinous processes and lamina. 4. C7 laminectomy with rongeurs, kerrison punches, and currets. 5. Tumor excision with tumor forceps, bipolar, kerrison punches, and currets. 6. Hemostasis with gelfoam strips. 7. Insertion of C6 lateral mass screws and T1 pedilce screws, which were linked with a 4 cm long rod on each side. 8. One epilaminal drain. 9. Wound closure in layers. Operators 楊士弘 Assistants 陳盈志,陳國瑋 相關圖片 曾俊銘 (M,1986/10/13,25y5m) 手術日期 2010/05/04 手術主治醫師 王國川 手術區域 東址 002房 01號 診斷 Other and unspecified intracranial hemorrhage following injury, unspecified state of consciousness 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 污染 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3E 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 23:45 通知急診手術 00:10 進入手術室 00:15 麻醉開始 00:20 誘導結束 00:30 抗生素給藥 01:00 手術開始 02:10 手術結束 02:10 麻醉結束 02:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 顱內壓監視置入 1 1 記錄__ 手術科部: 外科部 套用罐頭: 1. Placement of Codman ICP monitor at right f... 開立醫師: 鍾文桂 開立時間: 2010/05/04 02:59 Pre-operative Diagnosis 1. Severe head injury with brain swelling, subarachnoid hemorrhage, intracerebral hemorrhage, and epidural hemorrhage. 2. Scalp laceration wound. Post-operative Diagnosis 1. Severe head injury with brain swelling, subarachnoid hemorrhage, intracerebral hemorrhage, and epidural hemorrhage. 2. Scalp laceration wound. Operative Method 1. Placement of Codman ICP monitor at right frontal region. 2. Debridement and primary suture of left parietal scal wound. 2. Debridement and primary suture of left parietal scalp wound. Specimen Count And Types nil Pathology Nil. Operative Findings 1. Codman ICP monitor, zero point:488, ICP at OR: 5mmHg. 2. 5 cm laceration wound at left parietal region. 2. 5 cm laceration wound at scalp,left parietal region. Operative Procedures Under ETGA, the patient was put in supine position and head in placed at midline. 1st operation: After shaving, disinfection, and draping, a linear incision was made at right frontal region. A burr hole was drilled until dura mater was reached. After durotomy, the ICP monitor was inserted at brain parenchyma. Then, the wound was closed in layers. 2nd operation: The previous surgiclips were removed over the scalp laceration wound. After normal saline irrigation and debridement, the wound was closed primarily. Operators V.S. 王國川. Assistants R5 陳睿生,R4 鍾文桂. Indication Of Emergent Operation 賴恩瑩 (F,1974/11/29,37y3m) 手術日期 2010/05/03 手術主治醫師 王國川 手術區域 東址 005房 01號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 曾峰毅, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:05 進入手術室 08:10 麻醉開始 08:30 誘導結束 08:33 抗生素給藥 09:14 手術開始 11:00 開始輸血 11:40 抗生素給藥 13:25 麻醉結束 13:25 手術結束 13:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４～８小時 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT 開立醫師: 曾峰毅 開立時間: 2010/05/03 11:35 Pre-operative Diagnosis Right frontal tumor, suspected high-grade glioma Post-operative Diagnosis Right frontal tumor, suspected high-grade glioma Operative Method Right frontal crainotomy for tumor excision Specimen Count And Types Several fragments of one tumor was sent for pathology. Pathology Frozen: glioma, poor differentiated is likely, grading to be determined. Operative Findings One ill-defined, greyish, soft, fragile, hypervascular tumor was noted at right frontal lobe. Frozen biopsy sugguested glioma is the most likely diagnosis. Frontal sinus was not exposed. Operative Procedures With endotracheal general anaesthesia, the patient was putin supine position with head in neurtral position. After scalp shaved, scrubbed, disinfected, and then draped, we made one bicoronal skin incision and reflected the flap inferiorly. Right frontal periosteum was dissected and reflected inferiorly. We drilled 3 burr holes and created one 6x8cm right frontal cranitomy, whoch did not cross midline. Dura was tented along the craniotmoy window. After ultrasound localization, we made dura incision in C-shape with base along the midline. Tumor was removed in piecemeal fahsion with biopolar, suction, and tumor forceps. Hemostasis was performed with Surgiel packing over the tumor cavity. Dura was closed in water-tight fahsion with 3-0 prolene. Bone graft was fixed back with mini-plates. After setting two subgaleal CWV drains, we closed the wound in layers. With endotracheal general anaesthesia, the patient was putin supine position with head in neurtral position. After scalp shaved, scrubbed, disinfected, and then draped, we made one bicoronal skin incision and reflected the flap inferiorly. Right frontal periosteum was dissected and reflected inferiorly. We drilled 3 burr holes and created one 6x8cm right frontal cranitomy, whoch did not cross midline. Dura was tented along the craniotmoy window. After ultrasound localization, we made dura incision in C-shape with base along the midline. Tumor was removed in piecemeal fahsion with biopolar, suction, and tumor forceps. Hemostasis was performed with Surgiel packing over the tumor cavity. Dura was closed in water-tight fahsion with 3-0 prolene. Bone graft was fixed back with mini-plates. After setting one subgaleal CWV drains, we closed the wound in layers. Operators VS 王國川 Assistants R6 李建勳 R3 曾峰毅 羅信泰 (M,1966/11/29,45y3m) 手術日期 2010/05/04 手術主治醫師 郭順文 手術區域 東址 019房 02號 診斷 Respiratory failure, with long-term ventilator use 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 鄒冠全, 時間資訊 10:15 進入手術室 10:20 麻醉開始 10:25 誘導結束 10:30 手術開始 10:45 手術結束 10:45 麻醉結束 10:55 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 氣管切開造口術 1 0 記錄__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 鄒冠全 開立時間: 2010/05/04 10:58 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Ditto Operative Method Tracheostomy Specimen Count And Types nil Pathology None Operative Findings Fr . 8 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators 張金池 Assistants R3蔡東明, R2鄒冠全 王文棋 (M,1932/02/11,80y1m) 手術日期 2010/05/04 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Neuropathy 器械術式 Malignant intraspinal tumor, e 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 許松鈺, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:07 進入手術室 08:20 麻醉開始 08:50 誘導結束 09:20 抗生素給藥 09:24 手術開始 12:20 抗生素給藥 13:45 麻醉結束 13:45 手術結束 13:50 開始輸血 14:02 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 良性病髓腫瘤切除術 1 1 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 記錄__ 手術科部: 外科部 套用罐頭: Laminectomy for tumor excision 開立醫師: 胡朝凱 開立時間: 2010/05/04 14:00 Pre-operative Diagnosis c3~4 RIGHT NEUROMA c4~5 RIGHT NEUROMA Post-operative Diagnosis c3~4 RIGHT NEUROMA c4~5 RIGHT NEUROMA Operative Method Laminectomy for tumor excision Specimen Count And Types pieces of tumor Pathology pending Operative Findings 1.One elastic firm, yellowish tumor measured about 3 cm in length located at the anterior side of C3~4 level spinal cord wich extended toward right neural foramen. 1.One elastic firm, yellowish tumor measured about 3 cm in length located at the anterior side of C4~5 level spinal cord wich extended toward right neural foramen. 1.One elastic firm, yellowish tumor measured about 3 cm in length located at the anterior side of C4~5 level spinal cord wich extended toward right neural foramenof right C5 root. 2.The tumor was well defined and hypervascularity with some cystic portion inside the tumor. 3.some dorsal sensory fibers were sacrificed. 3.Right C5 dorsal root were sacrificed. 4.The tumor attached to right C5 nerve root. And the root was preserved. 4.The tumor attached to right C5 nerve root. And the C5 motor root was preserved. 5.Bleeding tendency was noted Operative Procedures 1.ETGA, prone with head fixed with skull clamp 2.Midline incision from C2 to C6 level 3.Detach paravertebral muscle 4.Laminectomy of lower C2, C3 and c4 4.Laminectomy of lower C2, C3 and c4 and upper C5 5.Midline dural incision 6.open arachnoid space 7.dissect tumor border 8.Piece by piece tumor excision 9.Hemostasis 10.Close dura with prolene 11.Set one CWV drain then close wound in layers Operators 曾勝弘 Assistants 胡朝凱 相關圖片 鄧式諒 (M,1932/05/16,79y9m) 手術日期 2010/05/04 手術主治醫師 侯育致 手術區域 東址 026房 06號 診斷 Cataract 器械術式 Phaco+PCIOL 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 13:50 報到 15:20 進入手術室 15:25 麻醉開始 15:30 麻醉結束 15:35 手術開始 16:00 手術結束 16:05 送出病患 記錄__ 手術科部: 眼科部 套用罐頭: Phacoemulsification and PCIOL implantation (od) 開立醫師: 吳郁芊 開立時間: 2010/05/04 08:36 Pre-operative Diagnosis Cataract (od) Post-operative Diagnosis Cataract (od) Operative Method Phacoemulsification and PCIOL implantation (od) Specimen Count And Types nil Pathology Nil Operative Findings Cataract (od) Operative Procedures 1. Under topical anesthesia. 2. Disinfection, irrigation and draping. 3. Application of an eyelid speculum. 4. Made a clear corneal incision and penetrate into AC with 2.5mm trapezoid knife at 10 oclock position. 5. Inject Healon into the anterior chamber. 6. Continuous circular capsulorrhexis was done with bent needle and capsular forceps. 7. Made a sideport at 2 oclock position with the MVR blade. 8. Hydrodissection and hydrodelineation were done with BSS. 9. Phacoemulsification of the nucleus by standard divide-and-conquer technique. 10. Aspiration of the residual cortical material with I/A tube. 11. Foldable PCIOL was implanted into the bag after injection of Viscoat. 12. The residual Healon was washed out by I/A device. 13. Inject BSS into AC and check leakage 14. Stromal hydration of the wound with BSS 16. Topical irrigation of Rinderon and Gentamycin. 17. Maxitrol patching. Operators VS 侯育致 Assistants R4 朱筱桑 R3 吳郁芊 黃耀明 (M,1944/09/02,67y6m) 手術日期 2010/05/04 手術主治醫師 陳炯年 手術區域 東址 012房 01號 診斷 Parkinsonism (F02.3) 器械術式 Exploratory laparatomy 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 靜脈麻醉 麻醉主治醫師 葉育彰 ASA 3 紀錄醫師 陳韋廷, 時間資訊 23:59 臨時手術NPO 07:35 報到 08:10 進入手術室 08:20 麻醉開始 08:30 誘導結束 08:44 手術開始 09:30 手術結束 09:30 麻醉結束 09:40 送出病患 09:45 進入恢復室 10:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 胃管插入 1 0 手術 上消化道汎內視鏡檢查 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 記錄__ 手術科部: 神經部 套用罐頭: Nasoduodenal tube insertion by panendoscopy 開立醫師: 吳經閔 開立時間: 2010/05/04 09:32 Pre-operative Diagnosis Parkinsonism Post-operative Diagnosis Parkinsonism Operative Method Nasoduodenal tube insertion by panendoscopy Specimen Count And Types nil Pathology Nil Operative Findings Patent and good tube position and function 2. Several tiny gastric polyps Operative Procedures 1. IVG 2. left decubitus position 3. Set tube by PES 4. Check CXR Operators 陳炯年 Assistants Wu Jin-Ming 吳柏承 (M,1992/09/11,19y6m) 手術日期 2010/05/04 手術主治醫師 許文明 手術區域 兒醫 066房 02號 診斷 Retroperitoneal tumor 器械術式 Exploratory laparatomy 手術類別 預定手術 手術部位 腹 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 2 紀錄醫師 曾偉倫, 時間資訊 11:50 報到 12:00 進入手術室 12:05 麻醉開始 12:35 誘導結束 12:40 抗生素給藥 13:15 手術開始 15:40 抗生素給藥 17:00 開始輸血 18:35 麻醉結束 18:35 手術結束 18:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腹腔惡性腫瘤切除術 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Tumor excision 開立醫師: 曾偉倫 開立時間: 2010/05/04 18:54 Pre-operative Diagnosis Ganglioneuroma, lumbar spine, L1-5, with extraforaminal extension into left psoas muscle status post intraspinal tumor excision and posterolateral fusion via L1-4 laminoplasty Post-operative Diagnosis Ganglioneuroma, lumbar spine, L1-5, with extraforaminal extension into left psoas muscle status post intraspinal tumor excision and posterolateral fusion via L1-4 laminoplasty Operative Method Tumor excision Laparotomy with tumor excision Specimen Count And Types A 5x4x4 cm para-spinal tumor Pathology Retroperitonium tumor, near spine Operative Findings 1. The left kidney was pushed upwards by the buldging left psoas muscle 1. The left kidney was pushed upwards by the tumor, and the psoas muscle was pushed lateraly 2. The tumor inside the psoas muscle was yellowish, elastic with irregular border, tumor necrosis was also noted 3. Rich blood supply around the tumor 4. Some tumor feeding vessels came from aorta Operative Procedures 1. Under ETGA, patient was put on supine position 2. Disinfected and drapped as usual 3. Mid-line skin incsion from sternum to supra-pubic area, then open wound layer by layer 4. Mobilize the left colon and push the intestine to right side 5. Identify the gonadal vessels and left ureter, well preserved 6. Mobilized the tumor gradually by dividing the surrounding vessels 7. Do tumor resection 8. Check bleeding and set one CWV drain 9. Close wound in layers Operators VS 許文明 Assistants R 林昊諭 R 劉旅安 R 曾偉倫 張淑 (F,1999/07/27,12y7m) 手術日期 2010/05/04 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Epilepsy 器械術式 Moyamoya P-DUH 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 3 紀錄醫師 胡朝凱, 時間資訊 07:45 報到 08:08 進入手術室 08:30 麻醉開始 09:05 誘導結束 09:20 抗生素給藥 09:50 手術開始 13:05 麻醉結束 13:05 手術結束 13:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱內外血管吻合術 1 1 R 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 手術 朴卜勒氏血流測定（週邊血管） 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 林芷妍 (F,2009/08/17,2y6m) 手術日期 2010/05/04 手術主治醫師 楊士弘 手術區域 兒醫 067房 號 診斷 Congenital heart disease 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 3 紀錄醫師 胡朝凱, 時間資訊 00:00 臨時手術NPO 13:36 進入手術室 13:36 報到 13:42 麻醉開始 13:47 誘導結束 14:35 抗生素給藥 14:47 手術開始 16:05 麻醉結束 16:05 手術結束 16:12 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 記錄__ 手術科部: 外科部 套用罐頭: Chronic Subdural Hematoma 開立醫師: 楊士弘 開立時間: 2010/05/04 16:17 Pre-operative Diagnosis Chronic subdural effusion, bilateral Subdural effusion, bilateral Post-operative Diagnosis Chronic Subdural Hematoma, bilateral Operative Method Craniostomy with subdural drain placement Specimen Count And Types Subdural fluid were collected in 2 test tubes Pathology Nil Operative Findings Dark engine-oil-like fluid gushed out after incision of outer membrane Brain expanded well after drainage of SDH Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated (tilted) to right (left). 2. Position: supine with head rotated to the left. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: horse shoe shape at --parietal area. Raney clips were applied to 4. Incision: linear -- right frontal. the scalp edge for temporary hemostasis. 5. Craniotomy: 4 cm trephine at --parietal area. 5. Burr-hole: 0.5 cm 6. Dural tenting: by 2/0 silk at --cm interval, distributed along the edge of the trephine. 7. Dural incision: 3/4 circle along the trephine margin. 6. Dural incision: 3/4 circle along the burr hole. 8. The outer membrane of the hematoma was coagulated by Bovie along the edge of 7. The outer membrane of the hematoma was coagulated by Bovie along the edge of dural incision, then exicsed. 9. The liquified old blood and clot in the subdural space was evacuated by sucker, then thoroughly irrigated with N.S. through a rubber tube until the sucker, then thoroughly irrigated with N.S. through a rubber tube until the return was clean. The inner membrane of the hematoma was opened by a nib return was clean. incision when the membrane had beenlifted away from its underlying arachnoid 10. Subdural drain was placed with the tip directed toward right frontal area. 11. The wound was closed in layers after hemostasis and fixation of the subdural drain. by a sucker, then the membrane was cut in 4 different directions as far as possible under direct vision with head light for subdural illumination. 10.Dural closure:interruped 2/0 silk sutures for key stitches, then continuous sutures with 4/0 Dexon to obtain water-tight closure (Dural graft?) 11.Closure of skull window: the trephine button was placed back simply after one coner of its edge had been rongeured out for the drain. 12.Scalp closure:hemostasis was done with monopolar coagulator touching on the sucker tip. Galea suture was performed by continuous sutures with 3/0 Dexon and skin by continuouss suture with 3/0 nylon. 13.Drain: one, subdural, collected in a surgeons glove. 14.Blood transfusion: 15.Course of the surgery: smooth. Operators 楊士弘 Assistants 蔡宗良 傅繼瑩 (F,1972/12/06,39y3m) 手術日期 2010/05/04 手術主治醫師 賴達明 手術區域 東址 001房 01號 診斷 Subarachnoid hemorrhage 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2E 紀錄醫師 李建勳, 時間資訊 00:00 開始NPO 00:00 臨時手術NPO 08:35 報到 08:35 進入手術室 08:50 麻醉開始 09:05 誘導結束 10:00 抗生素給藥 10:25 手術開始 17:00 麻醉結束 17:00 手術結束 17:18 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 開顱術摘除血管病變－腦血管瘤－有徵的 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 8 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Left petironal approach for aneurysm clipping 開立醫師: 李建勳 開立時間: 2010/05/04 17:42 Pre-operative Diagnosis Left middle cerebral artery(MCA) aneurysm rupture with subarachnoid hemorrhage(SAH) Post-operative Diagnosis Left MCA aneurysm rupture with SAH Operative Method Left petironal approach for aneurysm clipping Specimen Count And Types nil Pathology Nil Operative Findings The aneurysm was located at M1/2 junction with 1 cm neck, with protruding medially. The aneurysm clipping was performed with one belnet Sugita aneurysm clip. The brain was swelling after opened the dura with severe SAH. The aneurysm was located at M1/2 junction with 1 cm neck, with protruding medially. The aneurysm clipping was performed with one belnet Sugita aneurysm clip. One temporal branch of MCA was perserved after aneurysm clipping. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position with head fixed with Mayfield skull clump. The scalp was shaved, scrubbed, disinfected with alcohol better-iodine then draped. Left frontotemporal scalp incision was made as usual pterional approach followed by craniotomy. The medial sphenoid ridge was further drill off by high speed air drill for wider operation field. Opened the dura in fish-mouth fasion after tenting around the craniotomy window. Opened the sylvian fissure from distal to proximal MCA. Dissected the arachnoid to exspose the ICA and remove partial lower temporal lobe to expose the internal carotid artery(ICA) and MCA. Followed the MCA to locate the aneurysm. Clipped the aneurysm with belnet Sugita aneurysm clip. Bipolar coagulated the aneurysm dome. The duroplasty was performed with 4-0 Prolene sutuers and fascia graft. The skull plate was fixed back with miniplates and screws after central tenting and one epidural CWV drian set up. The temporalis fascia was sutured back and the wound was closed in layers. Operators VS 賴達明 Assistants R6 李建勳 Indication Of Emergent Operation 相關圖片 鄭進貴 (M,1951/10/03,60y5m) 手術日期 2010/05/04 手術主治醫師 賴達明 手術區域 東址 003房 03號 診斷 Cerebrovascular accident (CVA) 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 3E 紀錄醫師 黃柏誠, 時間資訊 19:42 臨時手術NPO 19:42 開始NPO 19:43 通知急診手術 20:53 報到 20:53 進入手術室 20:55 麻醉開始 21:30 誘導結束 21:45 抗生素給藥 22:16 手術開始 00:25 麻醉結束 00:25 手術結束 00:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Right frontal craniotomy hematoma evacuation 開立醫師: 陳盈志 開立時間: 2010/05/05 00:20 Pre-operative Diagnosis Right frontal ICH Post-operative Diagnosis Right frontal ICH Operative Method Right frontal craniotomy hematoma evacuation Specimen Count And Types nil Pathology nil Operative Findings About 40mL hematoma was found at right frontal near motor cortex, no active bleeder was found. Operative Procedures 1.ETGA, supine 2.Skin preparation 3.Right frontal linear incision 4.Burr hole x1 then craniotomy 5x5cm 5.C-shape dura incision 6.Echo guide hematoma localization 7.corticotomy 8mm then hematoma evacuation 8.Hemostasis with surgicel packing 9.Dura closure with 4-0 prolene 10.Fix bone plate with wire x 3 11.close wound in layers Operators VS賴達明 Assistants R6陳盈志R2黃柏誠 Indication Of Emergent Operation 張銓滿 (M,1938/10/24,73y4m) 手術日期 2010/05/04 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 鄭孟伯, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:09 進入手術室 08:15 麻醉開始 08:40 誘導結束 08:55 抗生素給藥 09:45 手術開始 12:00 抗生素給藥 13:10 麻醉結束 13:10 手術結束 13:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４小時以內 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for Simpson^s grade II tumor remove 開立醫師: 陳睿生 開立時間: 2010/05/04 13:44 Pre-operative Diagnosis Right temporoparietal tumor, suspect meningioma Post-operative Diagnosis Right temporoparietal tumor, suspect meningioma Operative Method Craniotomy for Simpson^s grade II tumor remove Specimen Count And Types nil a meningioma of 7cm in diameter, and 2 cm in thickness, with the dura attached to it Pathology Pending Operative Findings The tumor was about 4x10cm in size. It was well margined and soft, solid tumor. The tumor was tightly attached to the dura, and the margin between the tip of the tumor and the brain parychema was not very clear. The tumor was almost totally removed and the residual part was electrocauterized. Operative Procedures 1. ETGA, supine position with head left turn adn fixed with Mayfield clump 2. Right temporoparietal curvillinear scalp incision 3. Dissect the temporalis muscle 4. Create 3 bur holes, and an about 8x12cm craniotomy window was done 5. Dura tacking, and the tumor was identified under intra-op ECHO 6. Dura opening along the craniotomy margin, and the tumor was firmly attached to the dura 7. The tumor was carefully dissected from the brain parychema 8. Hemostasis, and the brain surface was covered with surgicel and gelfoam 9. The dura was repaired with fascia graft, and artificial dura graft 10.Central tacking, and the skull graft was fixed with miniplates x5 11.Suture back temporalis muscle, a subgaleal CWV drain was set 12.Close the wound in layers Operators VS 賴達明 Assistants R5 陳睿生, R1 鄭孟伯 白榮富 (M,1952/01/15,60y1m) 手術日期 2010/05/04 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Acute osteomyelitis 器械術式 Anterior Spinal fusion (Others) 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鄭孟伯, 時間資訊 00:00 臨時手術NPO 13:20 報到 13:40 進入手術室 13:45 麻醉開始 14:05 誘導結束 15:20 手術開始 18:00 抗生素給藥 18:50 手術結束 18:50 麻醉結束 19:00 送出病患 19:05 進入恢復室 20:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術－脊椎 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Glucose 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 摘要__ 手術科部: 外科部 套用罐頭: Anterior approach for diskectomy at T8, 9 level 開立醫師: 陳睿生 開立時間: 2010/05/04 19:25 Pre-operative Diagnosis T8, 9 osteomyelitis with spondylodiskitis Post-operative Diagnosis T8, 9 osteomyelitis with spondylodiskitis Operative Method Anterior approach for diskectomy at T8, 9 level Specimen Count And Types 1 piece About size:pieces Source:necrotic tissue Pathology Pending Operative Findings Some necrotic tissue was noted at T8, 9 intervertebral space. Partial T8, 9 fusion was also noted, and no more bone graft was inserted. The T8, 9 disk space was narrowing, and peripheral tissue swalling was also found. Operative Procedures 1. ETGA, one lung ventilation, right decubitus, and mild left side trunk extension 2. Transverse incision was made at the 7th intercostal space of left lateral chest wall 3. Dissect the chest wall to expose the lateral side of 6-8 ribs, and the 8th rib was cut 4. The intercostal space was extended with self-retractor 5. The left lung, heart, and aorta were identified and retracted anteriorly under well protection 6. The 8th rib head was exposed and partially removed to expose the T8, 9 intervertebral space with C-arm guided 7. Remove of necrotic tissue and residual disk 8. Hemostasis, set a #32 chest tube and a CWV drain at left pleural space 9. Fix back 8th rib with 1-o Ticon 10.Suture close the muscle of chest wall, and close the wound in layers Operators VS 賴達明 Assistants R5 陳睿生, R1 鄭孟伯 陳吉永 (M,1944/09/28,67y5m) 手術日期 2010/05/04 手術主治醫師 黃凱文 手術區域 東址 013房 04號 診斷 Hepatic cancer 器械術式 R.F.A 手術類別 預定手術 手術部位 腹 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 葉育彰 ASA 3 紀錄醫師 陳乃涓, 時間資訊 12:30 報到 13:10 進入手術室 13:11 麻醉開始 13:15 誘導結束 13:25 抗生素給藥 13:27 手術開始 14:08 手術結束 14:08 麻醉結束 14:15 送出病患 14:20 進入恢復室 15:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 肝腫瘤無線頻率電熱療法－小於３公分 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 記錄__ 手術科部: 外科部 套用罐頭: RFA 開立醫師: 陳乃涓 開立時間: 2010/05/04 14:32 Pre-operative Diagnosis Hepatocellular carcinoma Post-operative Diagnosis Hepatocellular carcinoma Operative Method RFA Specimen Count And Types nil Pathology Nil Operative Findings 1. A 1 cm tumor, at S3, ablation time: 14 minutes 2. Another 2 cm tumor at right superior liver, ablation time: 12 minutes Operative Procedures 1. IVGA with mask, supine 2. Skin disinfection and draping 3. Performed RFA (SWCT threshold-control 3-cm tip x2) with echo guidance, to a 1 cm tumor, at S3, ablation time: 14 minutes, and to another 2 cm tumor at right superior liver, ablation time: 12 minutes. 3. Performed RFA (SWCT threshold-control 3-cm tip x2) with echo guidance, to a 1 cm tumor, at S3 near IVC, ablation time: 14 minutes, and to another 2 cm tumor at right superior liver, ablation time: 12 minutes. Operators 黃凱文 Assistants 陳乃涓 趙卿珍 (F,1962/04/28,49y10m) 手術日期 2010/05/05 手術主治醫師 王碩盟 手術區域 東址 016房 02號 診斷 Breast cancer, female 器械術式 Debridment-- >10cm 手術類別 緊急手術 手術部位 腹 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 翁文慶, 時間資訊 09:33 通知急診手術 13:45 進入手術室 14:03 麻醉開始 14:04 誘導結束 14:05 手術開始 14:06 手術結束 14:06 麻醉結束 14:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 導管引流–手術創傷處置及換藥 1 0 摘要__ 手術科部: 泌尿部 套用罐頭: surgical drainage 開立醫師: 翁文慶 開立時間: 2010/05/05 14:38 Pre-operative Diagnosis 1.Vesicocutaneous fistula 2.Extraperitoneal urinoma Post-operative Diagnosis 1.Vesicocutaneous fistula 2.Extraperitoneal urinoma Operative Method surgical drainage Specimen Count And Types nil Pathology nil Operative Findings 1.wound: fair without pus formation 2.pink fluid from extraperitoneal space Operative Procedures 1.disinfection and drapping, supine position 2.local anesthesiae with xylocaine 3.dissect the old tract 4.insert the drain tube(16Fr. Silicon Foley) into extraperitoneam 5.wound care Operators 王碩盟 Assistants 翁文慶 Indication Of Emergent Operation 張友鼎 (M,1930/10/13,81y5m) 手術日期 2010/05/05 手術主治醫師 謝榮賢 手術區域 東址 012房 5號 診斷 Malignant melanoma of skin 器械術式 Port-A catheter implatation 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 面罩麻醉 麻醉主治醫師 葉惠敏 ASA 3 紀錄醫師 官振翔, 時間資訊 14:45 報到 15:05 進入手術室 15:10 麻醉開始 15:15 誘導結束 15:25 抗生素給藥 15:35 手術開始 17:05 手術結束 17:08 麻醉結束 17:15 送出病患 17:20 進入恢復室 18:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 臉部以外皮膚及皮下腫瘤摘除術　小於２公分 1 1 手術 內頸靜脈切開，永久導管放置術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Semi-opened mask inhalation anes 1 0 摘要__ 手術科部: 外科部 套用罐頭: Tumor excision 開立醫師: 官振翔 開立時間: 2010/05/05 16:06 Pre-operative Diagnosis Lymphoma with left inguinal LN Post-operative Diagnosis Lymphoma with left inguinal LN Operative Method LN incision biopsy Specimen Count And Types Patho*1 Pathology Pending Operative Findings 1. One 4x4cm, firm, black, nonmovable, nonpulsatile LN noted over left inguinal area Operative Procedures Under general anesthesia, the patient lied in supine position. Antiseptics applied and drapped as usual. Linear skin incision over right inguinal area. Dissection to exposed tumor. Tumor incision biopsy performed and normal saline irrigation. Wound closure in layers Operators 謝榮賢 Assistants 官振翔 張書豪 朱芯誼 (F,2008/09/27,3y5m) 手術日期 2010/05/05 手術主治醫師 郭夢菲 手術區域 兒醫 065房 01號 診斷 Hypotony 器械術式 Cord untethering -KUO 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 2 紀錄醫師 胡朝凱, 時間資訊 07:40 報到 08:03 進入手術室 08:10 麻醉開始 08:50 誘導結束 09:00 抗生素給藥 09:24 手術開始 11:10 手術結束 11:10 麻醉結束 11:30 送出病患 11:35 進入恢復室 12:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓整形術 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 脊椎內脊髓內腫瘤切除術 1 1 記錄__ 手術科部: 外科部 套用罐頭: Untethering of spinal cord with tumor exision 開立醫師: 胡朝凱 開立時間: 2010/05/05 11:35 Pre-operative Diagnosis Tethered cord syndrome Tethered spinal cord due to dorsal intradural lipoma, T11-L1,2 junction 1. Tethered spinal cord due to dorsal intradural lipoma, T11-L1,2 junction 2. Deformed L2 spincous process and subcutaneous lipoma Post-operative Diagnosis Tethered cord syndrome Tethered spinal cord due to dorsal intradural lipoma, T11-L1,2 junction Tethered spinal cord due to dorsal intradural lipoma, T11-L1,2 junction 2. Deformed L2 spincous process and subcutaneous lipoma Operative Method Untethering of spinal cord with tumor exision 1. Untethering of spinal cord with partial excision lipoma and lysis of lipoduroneural junction via L1 laminoplasty 2. excision of subcutaneous deformed spinous process, L1 1. Untethering of spinal cord with partial excision lipoma and lysis of lipoduroneural junction via L1 laminoplasty 2. excision of subcutaneous lipoma and deformed spinous process, L1 1. Untethering of spinal cord with partial excision lipoma and lysis of lipoduroneural junction via L1 laminoplasty 2. excision of subcutaneous lipoma and deformed spinous process of L2 Specimen Count And Types 3 pieces: 1. Lipoma intradural, 2. Lipoma subcutaneous, 3. Spinous process Pathology Report pending Operative Findings 1. Lipoma adhered firmly to the dura opening at T12 area and can be tracked into the dural rostrally to approximately T9 area, which was not explored. 1. A subcutaneous lipoma measuring approximately 5 cm in diameter and 2.5 cm in thickness wraping a deformed spinous process of L1. The spinous process extended from right lamina to the left side and went horizontally. The L1 lamina had bifid change. The subcutaneous lipoma penetrated through the bifid lamina into the extradural space then going into the intradual compartment. 1. A subcutaneous lipoma measuring approximately 5 cm in diameter and 2.5 cm in thickness wraping the deformed spinous process of L2. The spinous process extended from right lamina to the left side and went horizontally. The L2 lamina thus had bifid change. The subcutaneous lipoma penetrated through the bifid lamina into the extradural space then going into the intradual compartment. 2. Subcutaneous lipoma measuring approximately 5 cm in diameter and 2.5 cm in thickness. 2. The intradural lipoma was dorsal in type. It adhered firmly to the dura opening at L1-2 junction area and can be pulled down and divided. The upper end of the lipoma at the T11 level was left untouched to prevent future tethering. There was a tiny rudimentary root at the right side of lipoma. It went out from the intradural compartment to the lipodural junction. It was resected to get a complete untethering. Operative Procedures Patient was placed in prone position after general anesthesia has begun. Skin was prepped and drapped in the usual manner. Under ETGA, the patient was placed in prone position. Skin was prepped and drapped in the usual manner. Linear skin incision was applied. Periosteal dissection was carried out. Linear skin incision was applied. Periosteal dissection was carried out at the subcutaneous lipoma and deformed spinous process till the L2 lamina was exposed. We cut off the deformed spinous process with rhongeur and excision of the subcutaneous lipoma. Then surgical microscope was brought into view. Laminotomy was done to T12 and T11. The tumor was detached circumferentially and the linear durotomy was done to expose the further until T10 area. Laminotomy was done to L1 with 1mm Kerrison punches, then the L1 lamina was relfected upward to expose the dura. The epidural fat was coagulated and removed. The dura was opened upward from the penetration part at L1-2 junction. The dura was tented at four cornors. The lipoma was detached circumferentially from the dura and the comus medullaris under. After complete untethering of the lipoma, it was pulled down gently, then it was transected after coaglulation. After removal of the tumor, the dura was closed with 5-0 Prolene. After removal of the lipoma, the dura was closed with 5-0 Prolene. The surface of dura was covered with several piece of gelfoam. Laminoplasty was done by suturing it back to its original position with silk at ligamentum flavum. After meticulous hemostasis, the wound was closed in layers. Laminoplasty was done to T11 and T12. After meticulous hemostasis, the wound was closed in layers. Operators 郭夢菲 Assistants 蔡宗良 劉戎琪 (F,1947/07/10,64y8m) 手術日期 2010/05/05 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Meningioma 器械術式 Benign intraspinal tumor, exci 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鄭孟伯, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:05 進入手術室 08:10 麻醉開始 08:40 誘導結束 09:00 抗生素給藥 09:39 手術開始 12:00 抗生素給藥 12:55 麻醉結束 12:55 手術結束 13:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 良性病髓腫瘤切除術 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 摘要__ 手術科部: 外科部 套用罐頭: Tumor excision 開立醫師: 陳盈志 開立時間: 2010/05/05 13:27 Pre-operative Diagnosis Right C2 neuroma Post-operative Diagnosis Right C2 neuroma Operative Method Tumor excision Specimen Count And Types 1 piece About size:2x1.5x1.5cm Source:right C2 neuroma Pathology pending Operative Findings 1.The tumor was yellowish elastic to firm in character. It is capsulated and the venous plexus cross over the tumor. The tumor was mainly at epidural space. The tumor originated from C2 root. Operative Procedures 1.ETGA, prone with head fixed with Mayfield 2.Skin preparation 3.Midline back incision 4.Detach paraspinal muscle, expose C1 and C2 lamina, then the tumor was identified at left C1 epidural space 5.open the capsule then intracapsular dissect the tumor circumferentially, pull out the tumor totally. 6.Cauterize and remove residual tumor with capsule 7.Hemostasis 8.CWV drain x 1 9.close wound in layers. Operators VS賴達明 Assistants R6陳盈志R1鄭孟伯 陳許寶雲 (F,1935/07/18,76y7m) 手術日期 2010/05/05 手術主治醫師 賴達明 手術區域 東址 027房 03號 診斷 Lumbar spondylosis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳睿生, 時間資訊 00:00 臨時手術NPO 13:40 報到 14:20 進入手術室 14:30 麻醉開始 14:50 誘導結束 14:55 抗生素給藥 15:23 手術開始 17:08 手術結束 17:08 麻醉結束 17:15 送出病患 17:20 進入恢復室 19:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 骨內固定物拔除術－其他部位 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 外科部 套用罐頭: Remove implants 開立醫師: 陳睿生 開立時間: 2010/05/05 17:33 Pre-operative Diagnosis L3-5 spondylolithesis status post TPS with radiculopathy Post-operative Diagnosis L3-5 spondylolithesis status post TPS with radiculopathy Operative Method Remove implants Specimen Count And Types nil Pathology Nil Operative Findings The implants were removed smoothly. Operative Procedures 1. ETGA, prone position 2. Incise into previous wound 3. Dissect bilateral paraspinal muscles 4. Expose the implants, and remove totally 5. Hemostasis, set two 1/8 hemovac drains 6. Close the wound in layers Operators VS 賴達明 Assistants R5 陳睿生; Ri 黃玟菱 (F,1971/01/28,41y1m) 手術日期 2010/05/05 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Neurofibromatosis 器械術式 Intraspinal intramedullary tum 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 鄭孟伯, 時間資訊 00:00 臨時手術NPO 12:40 報到 13:25 進入手術室 13:30 麻醉開始 13:35 誘導結束 13:45 抗生素給藥 14:10 手術開始 17:00 手術結束 17:00 抗生素給藥 17:00 麻醉結束 17:10 送出病患 17:15 進入恢復室 18:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 良性病髓腫瘤切除術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 摘要__ 手術科部: 外科部 套用罐頭: Right S1 laminotomy tumor debulking 開立醫師: 陳盈志 開立時間: 2010/05/05 17:17 Pre-operative Diagnosis Right S1 neuroma Post-operative Diagnosis Right S1 neuroma Operative Method Right S1 laminotomy tumor debulking Specimen Count And Types 1 piece About size:multiple fragments Source:right S1 neuroma Pathology pending Operative Findings 1.The tumor was soft elastic in character and was capsulated. it originated from S1 root. The capsule is difficult to be differented from root. Operative Procedures 1.ETGA, prone position 2.Skin preparation 3.Midline back incision 4.Detach right paraspinal muscle, expose L5 and S1 lamina, 5.S1 laminotomy then the tumor was identified 6.open the capsule then intracapsular dissect the tumor circumferentially. 7.Hemostasis 8.CWV drain x 1 9.close wound in layers. Operators VS賴達明 Assistants R6陳盈志R1鄭孟伯 蘇芷誼 (F,1984/11/01,27y4m) 手術日期 2010/05/05 手術主治醫師 楊士弘 手術區域 兒醫 062房 01號 診斷 Polyneuropathy 器械術式 Debridment-- 5-10cm 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 林峰盛 ASA 2 紀錄醫師 胡朝凱, 李孟如, 時間資訊 00:00 臨時手術NPO 12:10 報到 12:15 進入手術室 12:20 麻醉開始 12:25 誘導結束 12:37 手術開始 13:30 抗生素給藥 14:00 手術結束 14:00 麻醉結束 14:10 送出病患 14:10 進入恢復室 15:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 深部複雜創傷處理－傷口長５－１０公分者 1 0 手術 腦室內注射留置器或脊髓腔內化學藥物注射 1 0 記錄__ 手術科部: 套用罐頭: TIT 開立醫師: 李孟如 開立時間: 2010/05/05 14:07 Pre-operative Diagnosis Acute lymphoblastic leukemia; CNS lymphoma Post-operative Diagnosis Acute lymphoblastic leukemia; CNS lymphoma Operative Method Intrathecal chemotherapy Specimen Count And Types 1 piece About size:10ml Source:CSF Pathology CSF routine and cytology Operative Findings CSF appearance: Clear, slowly dripped Operative Procedures Under IVGA, patient was held in knee-chest decubitus position, with the lumbar area skin prepped and draped. A 22-G needle was introduced into the L3-L4 intervertebral space and advanced slowly until the dura was penetrated. Total 10 mL of CSF was tapped without trauma. Chemotherapy with methotrexate 15 mg, hydrocortisone 25 mg, and ara-c 40 mg in normal saline to 10 mL was injected into the subarachnoid space smoothly. Then the needle was withdrawn completely,and the wound was covered with sterile dressing. Operators R5李孟如/VS林東燦 Assistants R2劉士嶢 記錄__ 手術科部: 外科部 套用罐頭: Wound debridement 開立醫師: 胡朝凱 開立時間: 2010/05/05 14:55 Pre-operative Diagnosis Surgical site infection, lumbar, posterior Post-operative Diagnosis Surgical site infection, superficial, lumbar, posterior Operative Method Wound debridement Specimen Count And Types 2 pieces About size:Culture tubes Source:Surgical site discharges About size:Culture tubes Source:Surgical site discharges Pathology nil Operative Findings 1. serosanginous pus discharges approximately 10 mL 2. Necrotic tissue surrounds the wound 3. Infection was limited at the superfical layer Operative Procedures Under ETGA, the patient was placed in a supine position. The skin was prepped and drapped in the usual manner. Wound incision was made on the previous wound. All suture visible were removed except the deep fascia layer. Necrotic wounds were currettaged and irrigated with 1000 mL isotonic saline. A 7 mm Jackson-Pratt drain was placed in the superficial layer. The wound was closed in layers. Operators VS楊士弘 Assistants R4蔡宗良 謝國威 (M,2005/11/21,6y3m) 手術日期 2010/05/05 手術主治醫師 周獻堂 手術區域 兒醫 062房 3號 診斷 Brain tumor 器械術式 Lumbar puncture 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 林峰盛 ASA 3 紀錄醫師 李孟如, 時間資訊 00:00 臨時手術NPO 14:54 進入手術室 14:55 麻醉開始 14:57 誘導結束 15:03 手術開始 15:04 手術結束 15:04 麻醉結束 15:10 送出病患 15:10 進入恢復室 16:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎穿刺 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 記錄__ 手術科部: 套用罐頭: Lumbar 開立醫師: 李孟如 開立時間: 2010/05/05 15:13 Pre-operative Diagnosis Brain tumor Post-operative Diagnosis Brain tumor Operative Method Lumbar puncture Specimen Count And Types 5 pieces About size:1.2ml Source:CSF, sent to cytology (hema) About size:1.2ml Source:CSF, sent to cytology About size:1.2ml Source:CSF, sent to routine About size:1.2ml Source:CSF, sent to alfa-fetoprotein About size:1.2ml Source:CSF, sent to beta-HCG Pathology CSF studies Operative Findings CSF appearance: Clear, slowly dripped. Operative Procedures After intravenous general anesthesia, the patient was placed in knee-chest decubitus position. The skin overlying the lumbar area was applied with aseptic procedures and draping. A 22-G needle was introduced into the L3-L4 intervertebral space and advanced slowly until the dura was penetrated. Total 6 mL of CSF was collected into 5 sterile test tubes and labeled. Then the needle was withdrawn completely, and the wound was covered with sterile dressing. Operators R5李孟如/VS周獻堂 Assistants R2劉士嶢 張阿香 (F,1931/08/05,80y7m) 手術日期 2010/05/05 手術主治醫師 王國川 手術區域 東址 005房 01號 診斷 Cerebral hemorrhage 器械術式 Craniotomy(Aneurysms) P-DUH 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 07:30 報到 08:10 進入手術室 08:20 麻醉開始 09:00 抗生素給藥 09:00 誘導結束 09:17 手術開始 11:45 開始輸血 12:00 抗生素給藥 14:15 手術結束 14:18 送出病患 16:15 麻醉結束 醫令資訊 類別 名稱 量 刀 側 手術 開顱術摘除血管病變－腦血管瘤－有徵的 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 8 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Right pterional approach for aneurysm wrapping 開立醫師: 李建勳 開立時間: 2010/05/05 14:07 Pre-operative Diagnosis Right posterior communicating artery(Pcom) aneurysm with oculomotor nerve compression Post-operative Diagnosis Right posterior communicating artery(Pcom) aneurysm with oculomotor nerve compression Operative Method Right pterional approach for aneurysm wrapping Specimen Count And Types nil Pathology Nil Operative Findings The internal carotid artery(ICA) showed artherosclerotic change with clacification and unable to performed the proximal control. The aneurysm neck was ruptured while clipping. The rupture site was sealed with Surgicel lining and Tissucol Duo. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position with head fixed with Mayfield skull clump. The scalp was shaved, scrubbed, disinfected with alcohol better-iodine then draped. Right frontotemporal scalp incision was made as usual pterional approach followed by craniotomy. The medial sphenoid ridge was further drill off by high speed air drill for wider operation field. Opened the dura in fish-mouth fasion after tenting around the craniotomy window. CSF was drained out for relaxation of the brain. Opened the sylvian fissure from distal to proximal to expose the ICA. Clipped the aneurysm with stright Sugita aneurysm clip. The aneurysm neck was ruptured while clipping. The rupture site was sealed with Surgicel lining and Tissucol Duo. The dura was closed with 4-0 Prolene sutuers. The skull plate was fixed back with miniplates and screws after central tenting and one subgaleal CWV drian set up. The temporalis fascia was sutured back and the wound was closed in layers. Operators VS 王國川 Assistants R6 李建勳 R1 陳國偉 溫鏡清 (M,1951/10/19,60y4m) 手術日期 2010/05/06 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 Lymphoma 器械術式 Port-A catheter implatation 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 許松鈺, 時間資訊 00:00 臨時手術NPO 10:45 報到 11:15 進入手術室 11:25 抗生素給藥 11:40 手術開始 12:50 手術結束 12:57 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 ｐｏｒｔ–Ａ導管植入術–治療性導管植入術 1 0 L 摘要__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 曾峰毅 開立時間: 2010/05/06 12:56 Pre-operative Diagnosis Lymphoma Post-operative Diagnosis Lymphoma Operative Method Port-A insertion Specimen Count And Types Nil Pathology Nil Operative Findings Intra-operative C-arm showed proper position of catheter tip, and blood drawing via port-A was smooth. Operative Procedures Under local anaesthesia, the patient was put in supine position. We failed subclavian vein puncture, and then made skin incision at left upper chest. We dissected to exposed left cephalic vein, and inserted the port-A catheter. We fixed the port with suture, and closed the wound in layer. Port-A catheter position was checked by C-arm. Operators VS 王國川 Assistants R3 曾峰毅 R1 許松鈺 李然堯 (M,1953/01/27,59y1m) 手術日期 2010/05/06 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Trigeminal neuralgia 器械術式 Radiofrequency coagulation 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 劉治民 ASA 3 紀錄醫師 陳睿生, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:05 進入手術室 08:15 麻醉開始 08:20 誘導結束 08:36 抗生素給藥 08:45 手術開始 09:25 手術結束 09:25 麻醉結束 09:30 送出病患 09:32 進入恢復室 10:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 高頻熱凝療法 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 摘要__ 手術科部: 外科部 套用罐頭: Radiofrequency ablation 開立醫師: 陳睿生 開立時間: 2010/05/06 09:47 Pre-operative Diagnosis Trigeminal neuralgia over CN V-III Post-operative Diagnosis Trigeminal neuralgia over CN V-III Operative Method Radiofrequency ablation Specimen Count And Types nil Pathology Nil Operative Findings Radiofrequency setting: 80 celsius degree for 90 seconds. Operative Procedures 1. IVGA, supine position 2. Insert the needle at 3cm from the right mouth corner 3. Identify the needle tip at the foramen ovale by intra-op C-arm, and insert the ablation needle 4. Motor (2Hz) and sensory (50Hz) stimulation to localize the sensory portion of the V-III branch 5. Radiofrequency ablation with setting of 80 celsius for 90seconds 6. Remove the needles Operators VS 曾勝弘 Assistants R5 陳睿生 蔡玉成 (M,1939/08/09,72y7m) 手術日期 2010/05/06 手術主治醫師 林峰盛 手術區域 西址 035房 05號 診斷 Spinal stenosis, lumbar 器械術式 Nerve block / PC 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 硬肌麻醉 麻醉主治醫師 林峰盛 ASA 3 時間資訊 14:30 報到 14:35 進入手術室 14:40 麻醉開始 14:42 誘導結束 14:50 手術開始 15:15 麻醉結束 15:15 手術結束 15:20 送出病患 摘要__ 手術科部: 麻醉部 套用罐頭: Pulsed RF 開立醫師: 林峰盛 開立時間: 2010/05/06 15:19 Pre-operative Diagnosis Radiculopathy spinal stenosis Post-operative Diagnosis Radiculopathy spinal stenosis Operative Method pulsed RF caudal epidural Specimen Count And Types nil Pathology Nil Operative Findings Operative Procedures 1. IV sedation with midazolam and LA with 1% xylocaine 2. pt in prone position 3. Under fluoroscopic-guidance, insert 22 G SMK RF meedle into right L3-5 neuroforamen 4. Neurostimulation with 50 HZ and 2 Hz 0.1-0.5 mV current with positive result 60-80V 2 Hz, 20 ms, 120sec *2 pulsed RF was delivered 5. caudal epidural block with echo-guidance, kenacort 40mg in 0.5%xylocaine 10 ml Operators 林峰盛, Assistants 賴佳欣, 周耀東 (M,1963/07/11,48y8m) 手術日期 2010/05/06 手術主治醫師 陳敞牧 手術區域 東址 005房 02號 診斷 Herniation of intervertebral disc 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 3 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 10:00 報到 10:05 進入手術室 10:05 麻醉開始 10:15 誘導結束 10:30 抗生素給藥 10:55 手術開始 13:30 抗生素給藥 14:20 手術結束 14:20 麻醉結束 14:30 送出病患 14:35 進入恢復室 16:28 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 手術 脊椎融合術－前融合，無固定物（＜＝四節） 1 2 手術 椎間盤切除術－頸椎 1 1 記錄__ 手術科部: 外科部 套用罐頭: Anterior approach for diskectomy, C4-5 and C4... 開立醫師: 鍾文桂 開立時間: 2010/05/06 14:51 Pre-operative Diagnosis Herniated intervertebral disc,C4-5 with cord compression. Post-operative Diagnosis Herniated intervertebral disc,C4-5 with cord compression. Operative Method Anterior approach for diskectomy, C4-5 and C4-5 interbody fusion with PEEK disc spacer. Specimen Count And Types nil Pathology Nil. Operative Findings A big ruptured disc over right side of C4-5 disc level. Stimulan allograft bone material and 7mm Vigor PEEK disc spacer for interbody fusion. Slack cord after decompression. Thickened posterior longitudinal ligament. Operative Procedures 1. Anesthesia: ETGA. 2. Position: supine, head in midline, neck in extension position. 3. Incision: right neck 5 cm incision, anterior approach. 4. Transection of platysma muscle; dissection along anterior border of sternocledomastoid muscle until reaching longus collis muscle. 5. Splinting midline of longus collis muscle with exposure of cervical spine. 6. Check C4-5 disc level with needle by C-arm. 7. Set up retractor system with protection of esophagus,and carotid sheath. 8. Incision of anterior longitudinal ligament. 9. Diskectomy by curretes, alligator, and Kerrison punch. 10.Removal of posterior longitudinal ligament. 11.Implantation of disc spacer for interbody fusion. 12.Well hemostasis. 13.Wound closure in layers. Operators V.S. 陳敞牧. Assistants R5陳睿生,R4鍾文桂. 廖浩誠 (M,1982/09/11,29y6m) 手術日期 2010/05/06 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Subdural hemorrhage following injury without mention of open intracranial wound,with no loss of consciousness 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林珍榮 ASA 2 紀錄醫師 許松鈺, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:22 進入手術室 08:25 麻醉開始 08:30 誘導結束 08:35 抗生素給藥 09:19 手術開始 10:45 手術結束 10:45 麻醉結束 10:53 送出病患 10:58 進入恢復室 12:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 頭顱成形術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 記錄__ 手術科部: 外科部 套用罐頭: Cranioplasty 開立醫師: 曾峰毅 開立時間: 2010/05/06 10:55 Pre-operative Diagnosis Status post craniectomy Post-operative Diagnosis Status post craniectomy Operative Method Cranioplasty Specimen Count And Types Nil Pathology Nil Operative Findings Skull defect are located at left fronto-tempero-parietal area. Hypertrophic sclap was noted near frontopaireal area. Operative Procedures Under endotracheal general anaesthesia, the patient was put in supine position with head rotated to right. After scalp shaved, scrubbed, disinfected, and then draped, we made the skin incision along the previous wound. We reflected the scalp flap inferiorly, the exposed the crainectomy edge. We fixed the artificial bone graft with screws and plates. After central tenting and subgaleal CWV set, we closed the wound in layers. Operators VS 王國川 Assistants R3 曾峰毅 R1 許松鈺 相關圖片 黃鈺翔 (M,1997/11/30,14y3m) 手術日期 2010/05/07 手術主治醫師 楊永立 手術區域 兒醫 062房 12號 診斷 Primitive neuroectodermal tumor 器械術式 BMA+B 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 面罩麻醉 麻醉主治醫師 蕭柏妮 ASA 3 紀錄醫師 李孟如, 時間資訊 00:00 臨時手術NPO 15:40 報到 15:56 進入手術室 16:00 麻醉開始 16:03 誘導結束 16:05 手術開始 16:20 手術結束 16:20 麻醉結束 16:25 進入恢復室 16:25 送出病患 17:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Semi-opened mask inhalation anes 1 0 手術 骨髓穿刺併骨髓切片 1 0 L 記錄__ 手術科部: 套用罐頭: BMA+B 開立醫師: 李孟如 開立時間: 2010/05/07 16:27 Pre-operative Diagnosis PNET Post-operative Diagnosis PNET Operative Method Bone marrow aspiration and biopsy Specimen Count And Types 2 pieces About size:20ml Source:BM aspiration About size:2cm Source:BM biopsy Pathology Pending Operative Findings Approximately 20 mL of BM aspirate was obtained. BM smear showed the presence of BM particles. Operative Procedures 1. IVGA. 2. On prone position. 3. Skin prepped and draping. 4. BM aspiration via the left posterior superior iliac spine. 5. Using a 11-G trephine needle, BM biopsy was then performed. 6. Needle withdrawn and wound compressed with sterile dressing. 7. Patient on supine and sent to the PAR. Operators R5李孟如/VS楊永立 Assistants R2劉士嶢 黃耀明 (M,1944/09/02,67y6m) 手術日期 2010/05/07 手術主治醫師 陳炯年 手術區域 東址 007房 01號 診斷 Parkinsonism (F02.3) 器械術式 Percutaneous Endoscopic Jejunostomy 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 2 紀錄醫師 柯柏瑞, 時間資訊 23:59 臨時手術NPO 08:10 進入手術室 08:15 麻醉開始 08:20 誘導結束 08:39 抗生素給藥 08:55 手術開始 11:30 手術結束 11:30 麻醉結束 11:40 送出病患 11:43 進入恢復室 12:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 胃造口術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 記錄__ 手術科部: 外科部 套用罐頭: Percutaneous gastrostomy and jejunostomy 開立醫師: 柯柏瑞 開立時間: 2010/05/07 10:00 Pre-operative Diagnosis Parkinson disease Post-operative Diagnosis Parkinson disease Operative Method Percutaneous gastrostomy and jejunostomy Percutaneous panendoscopic assisted gastrostomy and gastro-intestinal tube into 3rd portion of duodenum Specimen Count And Types nil Pathology nil Operative Findings J-stomy tube located at jejunum Operative Procedures 1.ETGA, supine position, skin disinfection 2.Intra-OP penendoscope exam 3.Skin incision at LUQ and introduce the needle, catheter and guide wire into the stomach 4.Pull out the guide wire by the scope and setup the gastrostomy tube 5.Put the j-stomy guide wire into gastrostomy 6.Guide the guide wire into jejunum and setup the jejunostomy tube from the gastrostomy 7.Intra-Op confirm the location by portable X ray Operators 陳炯年 葉啟娟 Assistants 柯柏瑞 許楊素珠 (F,1956/09/12,55y6m) 手術日期 2010/05/07 手術主治醫師 賴達明 手術區域 東址 019房 02號 診斷 Subarachnoid hemorrhage 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 胡朝凱, 時間資訊 00:00 臨時手術NPO 11:35 報到 11:55 進入手術室 12:05 麻醉開始 12:10 誘導結束 13:08 手術開始 13:10 抗生素給藥 15:45 手術結束 15:45 麻醉結束 15:55 送出病患 16:00 進入恢復室 17:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 頭顱成形術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 記錄__ 手術科部: 外科部 套用罐頭: Cranioplasty 開立醫師: 賴昆鴻 開立時間: 2010/05/07 16:09 Pre-operative Diagnosis Left skull defect Post-operative Diagnosis Left skull defect Operative Method Cranioplasty Specimen Count And Types nil Pathology nil Operative Findings 1.Left skull defect abut 20x25 cm 2.Thin skin Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right 3. Skin preparation:shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with a sterilized adhesive plastic sheet. 4. Incision: along the previous operation scar. Raney clips were apllied to the scalp edge for temporary hemostasis. 5. The scalp and temporalis muscle were dissected away from the underlying dura. 5. The scalp was easily reflected from the underlying silastic sheet which was then removed. The dural surface and margin of skull defect were well exposed. 6. The bleeders on the dissected surfaces were coagulated with Bovie painstakingly. 7. The edge of the skull defect was exposed. 6. The original skull plate preserved was placed back to the skull window then fixed by miniplate and a dura tenting at the center of the skull plate. 8. Scalp closure: hemostasis was done with monopolar coagulator touching on the sucker tip. Galea suture was performed by continuous suture with 3/0 Dexon and skin by continuous suture with 3/0 nylon. 14.one CWV drain was inserted Operators 賴達明 Assistants 胡朝凱,Ri 翁芷香 (F,1932/12/11,79y3m) 手術日期 2010/05/07 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Lumbar stenosis 器械術式 Laminectomy for decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:05 進入手術室 08:20 麻醉開始 08:30 誘導結束 08:45 抗生素給藥 09:07 手術開始 10:26 手術結束 10:26 麻醉結束 10:36 送出病患 10:38 進入恢復室 12:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術（特壓）－二節以內 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Sublaminar decompression 開立醫師: 陳盈志 開立時間: 2010/05/07 10:25 Pre-operative Diagnosis L3/4 stenosis Post-operative Diagnosis L3/4 stenosis Operative Method Sublaminar decompression Specimen Count And Types nil Pathology nil Operative Findings Hypertrophic ligmentum flavum at L3/4 cause canal stenosis. Severe adhesion was noted. Dura tear was noted with CSF leak at right side, which was packed with gelform Operative Procedures 1.ETGA, prone with C-arm localization 2.Skin preparation 3.Midline back incision 4.detach paraspinal muscle left side 5.fracture spinous process with osteotone 6.remove ligmentum flavum with karrison punch 7.Hemostasis, CWV drain x 1 8.close wound in layers. Operators VS賴達明 Assistants R6陳盈志R1陳國瑋 許瓊花 (F,1945/11/02,66y4m) 手術日期 2010/05/07 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Spinal metastasis 器械術式 Laminectomy for decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 10:35 報到 10:50 進入手術室 10:53 麻醉開始 11:20 誘導結束 11:45 抗生素給藥 13:00 手術開始 14:45 抗生素給藥 17:45 抗生素給藥 20:03 手術結束 20:03 麻醉結束 20:08 送出病患 20:10 進入恢復室 21:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 10 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 惡性病髓腫瘤切除術 1 1 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 2 手術 ｐｏｒｔ–Ａ導管植入術–治療性導管植入術 1 0 摘要__ 手術科部: 外科部 套用罐頭: 1.T12 laminectomy tumor excision and TPS at T... 開立醫師: 陳盈志 開立時間: 2010/05/07 18:18 Pre-operative Diagnosis T12 metastatic tumor Post-operative Diagnosis T12 metastatic tumor Operative Method 1.T12 laminectomy tumor excision and TPS at T10,11,L1; 2.Port-A insertion Specimen Count And Types 1 piece About size:Multiple fragments Source:T12 metastatic tumor Pathology pending Operative Findings 1.The tumor was elastic in character. It involve T12 body, right pedicle and rib and the bone was eroded and became fragile. The vascularity was moderate. 2.TPS 35x5.5 x4 at T10,T11; 35x6.2x2 at L1. Rod 10cm x2, cross link x1 3.Port-A inserted to adequate position via left subclavian vein Operative Procedures 1.ETGA, prone position with C-arm localization 2.Skin preparation 3.Midline back incision 4.Detach paraspinal muscle to expose bilateral laminae T10~L1 5.TPS at T10,11,L1 6.T12 laminectomy with rongeur and then the tumor was removed piece by piece 7.Curretage of the tumor with curved currete along its edge till healthy bone edge. Rhizotomy of right T12 was done. 8.packing the body space with bone cement. 9.Hemostasis with bipolar and gelform packing 10.Rod fixation and crosslink 11.close wound in layers after H/V x 2 12.Reposition to supine position 13.Left subclavian incision 14.Identify cephalic vein and cut down to insert port-A catheter. 14.subclavian vein punture then insert port-A catheter. 15.Confirm tip position then fix the port-A pocket. 16.Close wound in layers. Operators VS賴達明 Assistants R6陳盈志R1陳國瑋 相關圖片 徐黃娥 (F,1933/04/20,78y10m) 手術日期 2010/05/07 手術主治醫師 賴達明 手術區域 東址 005房 01號 診斷 Lumbar spondylosis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 許松鈺, 時間資訊 16:52 臨時手術NPO 10:10 報到 10:15 進入手術室 10:20 麻醉開始 10:30 誘導結束 11:00 手術開始 14:00 抗生素給藥 15:00 手術結束 15:00 麻醉結束 15:07 送出病患 15:10 進入恢復室 16:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 手術 椎弓切除術（特壓）－二節以內 1 2 摘要__ 手術科部: 外科部 套用罐頭: 1. L4/5 percutaneous transpedicle screw (TPS)... 開立醫師: 李建勳 開立時間: 2010/05/07 15:23 Pre-operative Diagnosis L3-5 lumbar stenosis and L4/5 spondylolisthesis Post-operative Diagnosis L3-5 lumbar stenosis and L4/5 spondylolisthesis Operative Method 1. L4/5 percutaneous transpedicle screw (TPS) fixation and posteriolateral fusion 2.L3/4 4/5 hemilaminectomy for decompression and left L4/5 disckectomy Specimen Count And Types nil Pathology Nil Operative Findings The Depuy percutaneous TPS system was used. The left L4/5 disc was bulging and disckectomy was performed with autologous bone graft packing. Operative Procedures Under general anestheis and intubation, the patient was put in prone position. The back and previous inserted guide needles were disinfected with alcohol better iodine and draped. The incision was made over the guide needle and set up the percutaneous TPS then checked with portable C-arm X-ray. The midline skin incision was then made from L3-L5 spinous processes. L3/4,4/5 hemilaminectomy were performed with rongeur and Kerrison punch. The theca sac was decompressed and the left L4/5 disckectomy was performed. Posteriolateral fusion and disc space packing were done with autologous bone graft. After one CWV drain set up, the wounds were closed in layers. Operators VS 賴達明 Assistants R1 許松鈺 R6 李建勳 相關圖片 高正基 (M,1942/02/19,70y0m) 手術日期 2010/05/07 手術主治醫師 賴達明 手術區域 東址 005房 02號 診斷 Lumbar spondylosis 器械術式 Laminectomy for decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 許松鈺, 時間資訊 00:00 臨時手術NPO 15:00 報到 15:22 進入手術室 15:25 麻醉開始 15:35 誘導結束 16:00 抗生素給藥 16:10 手術開始 17:30 手術結束 17:30 麻醉結束 17:35 送出病患 17:45 進入恢復室 19:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術（特壓）－二節以內 1 1 B 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: L4/5 laminotomy for sublaminal decompression ... 開立醫師: 李建勳 開立時間: 2010/05/07 17:36 Pre-operative Diagnosis L4/5 stenosis with right synovial cyst Post-operative Diagnosis L4/5 stenosis with right synovial cyst Operative Method L4/5 laminotomy for sublaminal decompression and cystectomy Specimen Count And Types nil Pathology Nil Operative Findings The thickened ligmentum flavum compressed the theca sac tightly. The theca sac was relaxed after the procedure. Operative Procedures Under general anesthesia and intubation, the patient was put in prone position. The skin was scrubbed, disinfected with alcohol better-iodine then draped. Midline skin incision was made from L4-5 spinous processes. The spinous process was divided in midline with oscillation saw. The laminotomy and removal of the ligmentum flavum were performed with Kerrison punches. The thickened synovial cyst was also removed. After hemostasis with Gelform packing, the wound was closed in layers. Operators VS賴達明 Assistants R1 許松鈺 R6 李建勳 相關圖片 陳碧麗 (F,1941/09/13,70y6m) 手術日期 2010/05/07 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Lumbar stenosis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 胡朝凱, 時間資訊 00:00 臨時手術NPO 07:35 報到 08:05 進入手術室 08:10 麻醉開始 08:15 誘導結束 09:00 抗生素給藥 09:03 手術開始 11:30 手術結束 11:30 麻醉結束 11:40 送出病患 11:43 進入恢復室 13:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 手術 骨內固定物拔除術－脊椎 1 1 記錄__ 手術科部: 外科部 套用罐頭: Remove TPS 開立醫師: 胡朝凱 開立時間: 2010/05/07 11:37 Pre-operative Diagnosis Screws compromise Post-operative Diagnosis Screws compromise Operative Method Remove TPS Specimen Count And Types Nil Pathology Nil Operative Findings 1.No CSF leakage after screws removal. 2.Screws was all removed Operative Procedures 1.ETGA, prone 2.Midline incision 3.Lateral extension to expose screws 4.Remove screws 5.Hemostasis 6.set one CWV drain then close wound in layers Operators 賴達明 Assistants 胡朝凱, Ri 郭義雄 (M,1938/02/14,74y1m) 手術日期 2010/05/07 手術主治醫師 戴浩志 手術區域 東址 009房 03號 診斷 Pulmonary tuberculosis, unspecified 器械術式 Hematoma evacuation, right inguinal wound Debridment 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 4 紀錄醫師 官振翔, 時間資訊 12:40 報到 12:50 進入手術室 12:55 麻醉開始 13:30 抗生素給藥 13:30 誘導結束 13:40 手術開始 14:35 麻醉結束 14:35 手術結束 14:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 深部複雜創傷處理－傷口長１０公分以上者 1 0 R 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Debridement 開立醫師: 官振翔 開立時間: 2010/05/07 14:54 Pre-operative Diagnosis RIght inguinal area poor healing wound Post-operative Diagnosis RIght inguinal area poor healing wound Operative Method Debridement and hematoma evacuation Specimen Count And Types Culture *2 Pathology Nil Operative Findings 1. Much hematoma accumulation noted over right inguinal area wound with some fatty necrosis Operative Procedures Under general anesthesia, the patient lied in supine position. Antiseptics applied and drapped as usual. debridement performed. Normal saline irrigation. Wound closure with 2-0 Nylon and one CWV drain Operators 戴浩志, Assistants 官振翔, 羅名宇 黃菊妹 (F,1940/01/03,72y2m) 手術日期 2010/05/08 手術主治醫師 黃昭淵 手術區域 東址 015房 02號 診斷 Bladder cancer 器械術式 Cystoscopy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 詹偉弘 ASA 1 紀錄醫師 張宇鳴, 時間資訊 08:45 報到 08:50 進入手術室 08:58 麻醉開始 09:00 誘導結束 09:02 抗生素給藥 09:10 手術開始 09:23 手術結束 09:23 麻醉結束 09:30 進入恢復室 09:30 送出病患 10:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 手術 膀胱鏡檢查 1 0 手術 經內視鏡切片（每一診次） 1 0 記錄__ 手術科部: 泌尿部 套用罐頭: cystoscopy（biopsy ) 開立醫師: 張宇鳴 開立時間: 2010/05/08 09:37 Pre-operative Diagnosis Bladder UC s/p TUR-BT Post-operative Diagnosis R/O bladder tumor Operative Method cystoscopy and biopsy Specimen Count And Types 1 piece About size:0.1cm*0.1cm Source:bladder biopsy Pathology pending Operative Findings A small papule at right ureteral orifice, r/o bladder tumor Operative Procedures Under satisfactory anesthesia with the patient in lithotomy position, prepping and drapping was performed in the usual sterile fashion. A Fr 21 Olympus cystoscope was introduced into the bladder cavity under direct vision. Careful inspection was done. There was necrotic tissue covering the scar near the left ureteral orifice due to previous resection. Cup biopsies were obtained from some suspicious areas. A Fr 16 Foley catheter was inserted. Patient tolerated the procedure very well and was sent to recovery room in satisfactory condition. Operators 黃昭淵, Assistants 張宇鳴, 高朝輝 (M,1968/07/14,43y8m) 手術日期 2010/05/08 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 鄭孟伯, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:00 進入手術室 08:05 麻醉開始 08:45 誘導結束 09:00 抗生素給藥 09:30 手術開始 12:00 開始輸血 12:00 抗生素給藥 14:50 麻醉結束 21:40 手術結束 21:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４～８小時 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Left pterional approach for Simpson grade II ... 開立醫師: 陳睿生 開立時間: 2010/05/08 15:29 Pre-operative Diagnosis Left fronto-temporal meningioma Post-operative Diagnosis Left fronto-temporal meningioma Operative Method Left pterional approach for Simpson grade II tumor excision Specimen Count And Types 1 piece About size:7x8x10cm Source:brain tumor, suspected menigioma Pathology Pending Operative Findings The tumor was whitish, soft with some semisolid portion at the middle fossa base. It was about 10 x 6 x 6cm in size, and was firmly attached to the dura at middle fossa base. It was a well capsuled one and could be dissected from peripheral brain parychema with a subarachnoid space. Several feeding arteries and two drainage veins were noted at the capsule and was moderately bleeding due to previous embolization. The skull was thin change and mild finger groove pattern. Operative Procedures 1. ETGA, supine position and head right turn, fixed with Mayfield clump 2. Left frontotemporal curvillinear scalp incision 3. Dissect the temporalis muscle 4. Make 4 burr holes and create a craniotomy window about 10x 12cm 5. Drill flattern the sphenoid ridge, and dura tacking 6. Open the dura along craniotomy window 7. Dissect the tumor from the dura 8. Dissect the tumor from peripheral brain tissue and electric ligate the vessels 9. Central tumor debulking, and remove the tumro with capsule piece by piece 10.Dissect the tumor and remove totally 11.Hemostasis, close the dura tightly with fascia graft 12.Set an epidural CWV drain, and fix back the skull graft with miniplates x3, central tacking 13.Close the wound in layers Operators VS 曾勝弘 Assistants R5 陳睿生, R1 鄭孟伯 高朝輝 (M,1968/07/14,43y8m) 手術日期 2010/05/08 手術主治醫師 曾勝弘 手術區域 東址 002房 03號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 4E 紀錄醫師 陳德福, 時間資訊 16:58 進入手術室 17:00 麻醉開始 17:05 通知急診手術 17:05 開始NPO 17:05 誘導結束 17:05 臨時手術NPO 17:20 抗生素給藥 17:35 手術開始 18:00 開始輸血 20:20 抗生素給藥 21:40 手術結束 21:40 麻醉結束 21:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 急性硬腦膜下血腫清除術 1 2 B 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy ICH and EDH evacuation 開立醫師: 陳德福 開立時間: 2010/05/08 22:25 Pre-operative Diagnosis left meningioma s/p craniotomy tumor excision, post-OP ICH and EDH Post-operative Diagnosis ditto Operative Method Craniotomy ICH and EDH evacuation Specimen Count And Types NIL Pathology nil Operative Findings 1.There is EDH aross the midline at the anterior third frontal area. Multiple venous bleeders noticed from the superior saggital sinus and we tented the dura after craniotomy. 2.Hematoma at the tumor bed is noticed and the brain remains slacky after the hamatoma is totally removed. 3.No residual tumor is found. Operative Procedures Under ETGA and supine position, the scalp was disinfected as draped as usual. The left scalp surgical wound is opened and we made extended incision to the right frontal area. One 10*8cm in sized cranitomy is done at the anterior third midline frontal area. The bleeders are identified and we perform hemostasis and dura tenting. The skull is fixed with wires. The left F-T-P cranitomy is done and the dura is opened. The hematoma inside the tumor fossa is removed and we identified one possible bleeder. The bleeder is coagulized. The dura is closed in water tight fasion and one epidural CWV is left in situ. The wound is closed in layers. Operators AP 曾勝弘 Assistants R4 陳德福 R2楊惠馨 Indication Of Emergent Operation 黃金泉 (M,1955/04/20,56y10m) 手術日期 2010/05/08 手術主治醫師 王國川 手術區域 東址 002房 02號 診斷 Subdural hemorrhage 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3E 紀錄醫師 鄭孟伯, 時間資訊 07:40 臨時手術NPO 07:40 開始NPO 08:18 通知急診手術 09:00 報到 09:20 進入手術室 09:30 麻醉開始 09:40 抗生素給藥 09:40 誘導結束 10:00 手術開始 10:00 開始輸血 11:50 麻醉結束 11:50 手術結束 12:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 急性硬腦膜下血腫清除術 1 2 L 記錄__ 手術科部: 外科部 套用罐頭: Craniectomy and subdural hematoma evacuation 開立醫師: 陳德福 開立時間: 2010/05/08 12:18 Pre-operative Diagnosis Left acute-subacute subdural hematoma with mass effect Post-operative Diagnosis ditto Operative Method Craniectomy and subdural hematoma evacuation Specimen Count And Types 20ml subdural hematoma, acute and subacute Pathology nil Operative Findings 1.There is acute-subacute subdural hematoma[around 20ml] over left fronto-temporo-parietal area and the brain is swelling remarkably. After the removal of hematoma, the brain became slacky partially. 2.There is outer membrane formation over the left frontal area and some clear fluid gushed out after opening the outer membrane. 3.The craniectomy window is 10*8cm in sized and we perform duroplasty with Durafoam. Operative Procedures Under ETGA and supine position, the scalp was disinfected as usual. The stitches for the previous operation were removed and we exposed the skull from previous operation wound with anterior extension. The wires were removed and extended craiectomy was done. The dura tenting and dura opening were performed and the brain gushed out. The subdural hematoma was removed step by step followed by performing duroplasty. One epidural CWV was left in situ and the wound was closed in layers. Operators VS 王國川 Assistants R4 陳德福 R1鄭孟伯 Indication Of Emergent Operation 藍良男 (M,1942/04/26,69y10m) 手術日期 2010/05/09 手術主治醫師 王國川 手術區域 東址 005房 01號 診斷 Brain metastasis 器械術式 Port-A catheter Removal 手術類別 緊急手術 手術部位 胸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 蔡宗良, 時間資訊 08:39 通知急診手術 15:20 進入手術室 15:55 麻醉開始 15:57 誘導結束 15:58 手術開始 16:40 手術結束 16:40 麻醉結束 16:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 肌肉或深部組織腫瘤切除術及異物取出術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: removal of Port-A/Permcath 開立醫師: 蔡宗良 開立時間: 2010/05/09 22:14 Pre-operative Diagnosis fever Post-operative Diagnosis ditto Operative Method removal of Port-A Specimen Count And Types 1 piece About size:Port-A tip Source Pathology nil Operative Findings the catheter was removed totally and the course was smooth Operative Procedures The patient was put on supine position. The operation field was disinfected and draped as usual. Under local anesthesia, the Port-A catheter was removed from previous wound smoothly. The wound was irrigated and closed in layers. Operators VS王國川 Assistants R4蔡宗良 Indication Of Emergent Operation 高朝輝 (M,1968/07/14,43y8m) 手術日期 2010/05/09 手術主治醫師 曾勝弘 手術區域 東址 002房 04號 診斷 Brain tumor 器械術式 Removal of epidural hematoma 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3E 紀錄醫師 許松鈺, 時間資訊 18:00 臨時手術NPO 21:42 進入手術室 21:42 報到 21:42 麻醉開始 21:45 誘導結束 22:00 開始輸血 22:20 手術開始 00:05 麻醉結束 00:05 手術結束 00:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 硬腦膜外血腫清除術 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: Left side craniotomy for hematoma evacuation 開立醫師: 王奐之 開立時間: 2010/05/10 00:26 Pre-operative Diagnosis Left frontal temporal EDH Left fronto-temporal EDH Post-operative Diagnosis Left frontal temporal EDH Left fronto-temporal EDH Operative Method Left side craniotomy for hematoma evacuation Specimen Count And Types nil Pathology nil Operative Findings One acteive bleeder from STA was noted. Oozing from temporal base epidural space was noted. No significant dubdural hematoma was noted. One acteive bleeder from STA was noted. Oozing from temporal base epidural space was noted. No significant subdural hematoma was noted. Operative Procedures 1.ETGA, spuine with head tilt to right 2.Skin preparation. 3.Open previous wound and removed craniotomy window after miniplate removal 4.Remove epidural hematoma. Hemostasis with bipolar and dura tenting with gelform packing 5.Opne the dura to check if any bleeding then close 5.Open the dura to check if any bleeding then close 6.central tenting x4. then fix bone plate with miniplate after epidural CWVx1 7.close wound in layers Operators VS曾勝弘 Assistants R6陳盈志R1許松鈺 相關圖片 張阿香 (F,1931/08/05,80y7m) 手術日期 2010/05/09 手術主治醫師 王國川 手術區域 東址 002房 03號 診斷 Cerebral hemorrhage 器械術式 Brain tumor Crainotomy(Others) 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 4E 紀錄醫師 許松鈺, 時間資訊 09:00 臨時手術NPO 15:35 報到 15:40 進入手術室 15:45 麻醉開始 15:50 抗生素給藥 15:50 誘導結束 16:15 手術開始 19:20 麻醉結束 19:20 手術結束 19:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: CVA 開立醫師: 蔡翊新 開立時間: 2010/05/09 18:25 Pre-operative Diagnosis Right p-com artery aneurysm s/p right frontotemporal craniotomy with EDH, s/p TAE, with right temporal ICH due to bleeding tendency. Post-operative Diagnosis Right p-com artery aneurysm s/p right frontotemporal craniotomy with EDH, s/p TAE, with right temporal ICH due to bleeding tendency.. Operative Method Right frontotemporal craniotomy with extension to posterior temporal for removal of EDH and right temporal ICH. Specimen Count And Types 1 piece About size:4 x 2 x 1 cm Source:ICH, suspected vascular lesion Pathology Pending. Operative Findings 1. EDH, about 1.5 cm in thickness, was encoutered upon reopening the previous right frontotemporal craniotomy bone, without active bleeder. When the dura was opened at right posterior temporal area, thin subdural hematoma was noted, possibly coming from spontaneous rupture of the ICH into subdural space. About 5.5 x 5 x 4.5 cm blood clots was removed with the assistance of intraoperative ultrasound. Some vascular tufts were encountered inside the ICH. The brain tissue surrounding the hematoma was fragile and easily suckable. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: along previous wound at right frontotemporal, curvilinear, with an extending limb to right posterior temporal area. The skin edge was clipped by Raney clips for temporary hemostasis. After scalp had been lifted, the temporalis muscle was reflected to lower temporal side. 5. Craniotomy: previous craniotomy plate was removed and extended to right posterior temporal area. 6. Dural tenting: by 2/0 silk, 2 cm in interval, distributed along the edge of skull window. 7. Dural incision: Cruciate at right posterior temporal area, away from previous dural incision. 8. A 2 cm cortical incision was made at posterior temporal gyrus and the intracerebral hematoma was exposed. The hematoma was sucked out carefully. Those tough clot was removed by forceps and the vascular tufts were coagulated before their excision. The cavity was irrigated with NS and the blood oozing was stopped by Surgicel packing. Before closure of the dura, the hematoma caivty was clean and the brain once bulging was slightly slack. 9. Dural closure: interrupted 2/0 silk sutures for key stitches, then continous sutures with 4/0 Prolene to obtain water-tight closure. 10.The craniotomy bone plates were assembled with wires and fixed back to the craniotomy window. 11.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 12.Drain: two, epidural, CWV. 13.Blood transfusion: Nil. 14.Course of the surgery: smooth. Operators VS蔡翊新VS王國川 Assistants R6陳盈志R1許松鈺 相關圖片 王梨玲 (F,1958/12/23,53y2m) 手術日期 2010/05/10 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Brain metastasis 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:03 進入手術室 08:10 麻醉開始 08:35 誘導結束 08:45 抗生素給藥 08:50 手術開始 11:45 手術結束 11:45 抗生素給藥 11:45 麻醉結束 11:53 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 腦瘤切除－手術時間在４小時以內 1 1 摘要__ 手術科部: 外科部 套用罐頭: frontal craniotomy for Simpson grade II tumor excision 開立醫師: 李建勳 開立時間: 2010/05/10 12:10 Pre-operative Diagnosis Left frontal tumor suspect metastasis Post-operative Diagnosis Left frontal radiation necrosis Operative Method Left frontal craniotomy for tumor excision Specimen Count And Types 1 piece About size:0.5g Source:craniotomy for tumor excision Pathology Frozen section: necrotic tissue. Pathology: pending Operative Findings The tumor is yellowish, elastic-firm, size 1.2 cm in diameter, located between motor and pre-motor cortex. The margin was seperable from the normal brain parenchyma. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position with head fixed with Mayfield skull clump. The scalp was shaved, scrubbed, disinfected with alcohol better-iodine then draped. The left frotnal scalp U-shpaed incision was made followed by left frontal craniotomy. The tumor was located with intra-operative sonography. The dura was opened around the tumor after tenting along the craniotomy window. The tumor excision was was performed via trans-sulcus approach with bipolar cautery. The frozen section was send and the total tumor excision was performed. The dura was closed with 4-0 Prolene sutures. The skull plate was fixed back with wires after one subgaleal close wound vaccum drain set up. The wound was then closed in layers. Under general anesthesia and intubation, the patient was put in supine position with head fixed with Mayfield skull clump. The scalp was shaved, scrubbed, disinfected with alcohol better-iodine then draped. The left frotnal scalp U-shpaed incision was made followed by left frontal craniotomy. The tumor was located with intra-operative sonography. The dura was opened around the tumor after tenting along the craniotomy window. The tumor excision was was performed via trans-sulcus approach with bipolar cautery. The frozen section was send and the total tumor excision was performed. The dura was closed with 4-0 Prolene sutures. The skull plate was fixed back with wires after one subgaleal close wound vaccum drain set up. The wound was then closed in layers. Operators VS 曾漢民 Assistants R1 陳國偉 R6 李建勳 R1 陳國瑋 R6 李建勳 相關圖片 余智凱 (M,1981/12/14,30y3m) 手術日期 2010/05/10 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Brain Tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 10:45 報到 12:08 進入手術室 12:10 麻醉開始 12:50 抗生素給藥 12:50 誘導結束 13:20 手術開始 15:15 麻醉結束 15:15 手術結束 15:25 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 經由蝶竇之腦下垂體瘤切除 1 1 手術 粘膜下中隔矯正術 1 2 摘要__ 手術科部: 外科部 套用罐頭: Sublabial transsphenoid adenomectomy 開立醫師: 李建勳 開立時間: 2010/05/10 15:44 Pre-operative Diagnosis Pituitary macroadenoma Post-operative Diagnosis Pituitary macroadenoma Operative Method Sublabial transsphenoid adenomectomy Specimen Count And Types 2 pieces About size:0.5g Source:Pituitary About size:0.5g Source:Pituitary Pathology Pending Operative Findings The tumor extended into spenoid sinus and was grey-reddish, soft, filled the sphenoid sinus. The tumor superior to the sphenoid sinus posterior wall is more yellowish, also soft in character. The normal pituitary gland was found after tumor excision. No cerebrospinal fluid was noted after tumor excision. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position. The skin over the face was disinfected with alcohol better-iodine and the nasal, oral mucosa was disinfected with aqeous better-iodine then draepd. The nasal and oral mucosa was infiltrated with epinephrin solution. The oral mucosa was incised above the incisors and dissected the mucosa to expose the vomer bone. Used the osteotome to remove the vomer bone. Tumor excision was performed with ring curette under microscope assistance. The sphenoid sinus posterior wall was removed with Kerrison punches. The dura was opened with scissors. The tumor was removed with ring curette and suction. Checked the op field with endoscope. Hemostasis was achieved with Gelform packing. Reconstructed the sphenoid sinus wall and vomer bone with bone chips. The middle turbinates were reducted and packing with gauze wrapped with finger of gloves soaked with better-iodine ointment. Operators VS 曾漢民 Assistants R1 陳國瑋 R6 李建勳 相關圖片 林正雄 (M,1938/01/10,74y2m) 手術日期 2010/05/10 手術主治醫師 曾漢民 手術區域 東址 005房 03號 診斷 Spine tumor 器械術式 Anterior Spinal fusion(TZENG) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 15:20 報到 15:40 進入手術室 16:30 誘導結束 16:38 抗生素給藥 16:50 麻醉開始 16:55 手術開始 17:25 開始輸血 20:20 手術結束 20:20 麻醉結束 20:30 送出病患 20:30 進入恢復室 21:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 惡性病髓腫瘤切除術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Right retroperitoneal approach for tumor excision 開立醫師: 李建勳 開立時間: 2010/05/10 20:25 Pre-operative Diagnosis Adrenal tumor with L3 metastasis Post-operative Diagnosis Adrenal tumor with L3 metastasis Operative Method Right retroperitoneal approach for tumor excision Specimen Count And Types 1 piece About size:5g Source:Spine tumor excision Pathology Pending Operative Findings The peritonium was adhesion to the retroperitoneal structure and was incidentally opened during dissection and repaired with 3-0 silke sutures. The tumor was elastic-firm, white-yellowish, hypervascularized, size 4X2X2 cm, located at right side of L3 vetebral body. Operative Procedures under general anethesia and intubation, the patient was put in supine position. Located the L3 vetebral body with portable C-arm X-ray. The skin over abdomen was scrubbed, disinfected with alcohol better iodine and draped. Linear skin incision was made over located marker and seperated the muscle and fascia through the retroperitoneal space to the vetebral body. The opened peritonium was repaired with 3-0 silk sutures. Set up retractors to keep the operation field opened. The tumor excision was performed with bipolar coagulation, scissors, and disc clump. Hemostasis was achieved with bipolar cautery and Surgicel lining of the tumor bed. Two hemovac drain tubes were set up at tumor bed and the wound was closed in layers. Operators VS 曾漢民 Assistants R1 陳國瑋 R6 李建勳 相關圖片 高麗容 (F,1941/12/20,70y2m) 手術日期 2010/05/10 手術主治醫師 廖漢文 手術區域 東址 000房 號 診斷 Subarachnoid hemorrhage 器械術式 NEURO T.A.E 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 4 時間資訊 14:10 麻醉開始 14:20 誘導結束 16:00 麻醉結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Aneurysmal SAH with acute hydrocephalus Post-operative Diagnosis Aneurysmal SAH with acute hydrocephalus Operative Method EVD via right Kocher^s point Specimen Count And Types 4 pieces About size:2ml Source:CSF About size:2ml Source:CSF About size:2ml Source:CSF About size:2ml Source:CSF Pathology Nil Operative Findings The CSF was xanthochromic, and the ICP was about10-15cm H2O. EVD was inserted via rigth Kocher^s point, and the depth was about 6.3cm./ Operative Procedures 1. ETGA, supine position2. Right frontal curvillinear scalp incision3. Create a bur hole at right Kocher^ point4. Dura tacking, and opening5. Corticotomy, and punch the right lateral ventricle6. Insert the EVD, and fix it7. Hemostasis, and close the wod in layers/ Operators VS 賴達明 Assistants R5 陳睿生 高麗容 (F,1941/12/20,70y2m) 手術日期 2010/05/10 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Subarachnoid hemorrhage 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3 紀錄醫師 陳睿生, 時間資訊 08:36 通知急診手術 19:29 報到 19:30 進入手術室 19:40 麻醉開始 19:43 抗生素給藥 19:45 誘導結束 20:23 手術開始 21:10 麻醉結束 21:10 手術結束 21:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室體外引流 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: EVD via right Kocher^s point 開立醫師: 陳睿生 開立時間: 2010/05/10 21:36 Pre-operative Diagnosis Aneurysmal SAH with acute hydrocephalus Post-operative Diagnosis Aneurysmal SAH with acute hydrocephalus Operative Method EVD via right Kocher^s point Specimen Count And Types 4 pieces About size:2ml Source:CSF About size:2ml Source:CSF About size:2ml Source:CSF About size:2ml Source:CSF Pathology Nil Operative Findings The CSF was xanthochromic, and the ICP was about10-15cm H2O. EVD was inserted via rigth Kocher^s point, and the depth was about 6.3cm. Operative Procedures 1. ETGA, supine position 2. Right frontal curvillinear scalp incision 3. Create a bur hole at right Kocher^ point 4. Dura tacking, and opening 5. Corticotomy, and punch the right lateral ventricle 6. Insert the EVD, and fix it 7. Hemostasis, and close the wound in layers Operators VS 賴達明 Assistants R5 陳睿生 Indication Of Emergent Operation 張陳富美 (F,1940/11/20,71y3m) 手術日期 2010/05/10 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Rheumatoid arthritis 器械術式 OPLL-Anterior Corpectomy VSLai 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3 紀錄醫師 鄭孟伯, 時間資訊 00:00 臨時手術NPO 07:31 報到 08:02 進入手術室 08:25 麻醉開始 09:15 誘導結束 09:30 抗生素給藥 09:55 手術開始 12:30 抗生素給藥 15:30 抗生素給藥 16:05 麻醉結束 16:05 手術結束 16:10 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 7 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 脊椎骨全部切除術 1 1 摘要__ 手術科部: 外科部 套用罐頭: Retropharyngeal approach odontoidectomy 開立醫師: 陳盈志 開立時間: 2010/05/10 16:39 Pre-operative Diagnosis RA with odontoid basilar invagination Post-operative Diagnosis RA with odontoid basilar invagination Operative Method Retropharyngeal approach odontoidectomy Specimen Count And Types nil Pathology nil Operative Findings hypertrophic periodontoid ligment and dysmorphic odontoid cause C1-2 subluxation. Canal stenosis was noted. Basilar invagination was noted. Operative Procedures under ETGA, the patient was set into supine position with neck extension and rotated to left. The operation field was disinfected and then drapped. Right neck submandibular curvilinear incision was done. Dissect to expose hypoglossal nerve, supralaryngeal nerve and preserve it then expose prevertebral area. Set up Tompson retracter and C2/3 disc was identified by the C-arm. Drill the odontoid till egg-shape and then remove the tip piece by piece with karrison punch till exposure of the dura. Hemostasis with bipolar and gelform packing. Set up one CWV drain and then close wound in layers Operators VS賴達明 Assistants R6陳盈志R1鄭孟伯 柯水金 (M,1948/08/25,63y6m) 手術日期 2010/05/10 手術主治醫師 蕭輔仁 手術區域 東址 003房 03號 診斷 Other conditions of brain 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3E 紀錄醫師 陳政維, 時間資訊 08:30 臨時手術NPO 21:30 報到 21:38 進入手術室 21:45 麻醉開始 22:05 抗生素給藥 22:10 誘導結束 22:15 開始輸血 23:15 手術開始 00:40 麻醉結束 00:40 手術結束 00:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 立體定位術－切片 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: Trephination for brain biopsy 開立醫師: 陳睿生 開立時間: 2010/05/11 01:02 Pre-operative Diagnosis Left frontal mass lesion Post-operative Diagnosis Left frontal mass lesion Operative Method Trephination for brain biopsy Specimen Count And Types 2 piece About size:pieces Source:brain cortex, dura Pathology Pending Operative Findings The arachnoid membrane was thicken and swelling. The brain cortex was mild gliotic change. We extracted a piece of brain cortex from the posterior frontal gyrus, and the size was about 1x1x1.5 cm. Operative Procedures 1. ETGA, supine position with head right turn and fix with Mayfield clump 2. Set navigation system to identify the left posterior frontal gyrus 3. Left frontal linear scalp incision about 10cm 4. A bur hole was made and then trephination was created 5. Dura tacking, and the dura was then opened 6. Incise into the arachnoid membrane, and a nip corticotomy was done 7. Extract brain cortex 8. Hemostasis, and close the dura with Durafoam graft 9. Central tacking, and the skull graft was covered back 10.Set a subgaleal CWV drain, and close the wound in layers Operators VS 蕭輔仁 Assistants R5 陳睿生, R2 陳政維 黃慧忠 (M,1955/08/22,56y6m) 手術日期 2010/05/11 手術主治醫師 蕭輔仁 手術區域 東址 001房 02號 診斷 Spinal metastasis 器械術式 Spinal fusion posterior 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 陳盈志, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 08:25 通知急診手術 10:58 報到 11:20 進入手術室 11:35 麻醉開始 12:00 抗生素給藥 12:20 誘導結束 13:15 手術開始 14:00 開始輸血 15:00 抗生素給藥 15:15 麻醉結束 15:15 手術結束 15:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 惡性病髓腫瘤切除術 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Tumor excision 開立醫師: 陳盈志 開立時間: 2010/05/11 15:39 Pre-operative Diagnosis T2 metastatic tumor suspect thyroid origin Post-operative Diagnosis T2 metastatic tumor suspect thyroid origin Operative Method Tumor excision Specimen Count And Types 1 piece About size:multiple fragments Source:T2 metastatic tumor Pathology pending Operative Findings The tumor was doft fragile in character and vascularity was high. Tumor eroded the right T2 and T3 lamina also 3rd rib was involved. Pleura was intact. Right T3 root was encased by the tumor. Operative Procedures 1.ETGA, prone with head fixed with mayfield. 2.Skin preparation 3.Midline back incision 4.Detach right side paraspinal muscle 5.Tumor debulking with currete and remove tumor piece by piece till total tumor removed. 6.Hemostasis with surgicel and gelform packing 7.CWV drain x 1 8.close wound in layers. Operators VS蕭輔仁 Assistants R6陳盈志Ri曾 Indication Of Emergent Operation 鄧式諒 (M,1932/05/16,79y9m) 手術日期 2010/05/11 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Brain tumors, malignant 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 胡朝凱, 時間資訊 07:46 報到 08:05 麻醉開始 08:06 進入手術室 08:42 誘導結束 08:50 抗生素給藥 08:56 手術開始 12:05 抗生素給藥 13:00 抗生素給藥 13:20 麻醉結束 13:20 手術結束 13:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４～８小時 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Left occipital tumor excision 開立醫師: 王奐之 開立時間: 2010/05/11 13:53 Pre-operative Diagnosis Left occipital tumor Post-operative Diagnosis Left occipital tumor Operative Method Left occipital tumor excision Specimen Count And Types pieces of tumor Pathology Frozen:high grade glioma Operative Findings The tumor was ill-defined and was hypervascular, grayish to reddish, measuring 5x6 cm. It was totally excised. The peripheral brain tissue showed gliosis like appearance. The tumor attach to dura and tentorium. Operative Procedures Under ETGA, patient was put in prone position with head fixed with Mayfield skull clamp. U shape skin incision was done at left occipital area. Skin flap was dissected and opened. After four burr holes drilled, craniotomy was performed as a 7x8 bone window one cm away from midline, followed by dural tenting. U shape dural incision was made with the base left at midline. The tumor was excised by gently dissection through the interface between tumor and brain tissue. Vascular perforation was cauterized. Hemostasis was then performed. After then, dura was closed with prolene. Wound was closed in layers. Operators 曾勝弘 Assistants 胡朝凱, Ri 滕瑋光 (F,1950/01/31,62y1m) 手術日期 2010/05/11 手術主治醫師 曾勝弘 手術區域 東址 005房 02號 診斷 Lumbar spondylosis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 胡朝凱, 時間資訊 13:05 報到 14:06 進入手術室 14:20 麻醉開始 14:30 誘導結束 14:40 抗生素給藥 14:55 手術開始 17:30 手術結束 17:30 麻醉結束 17:36 送出病患 17:40 進入恢復室 18:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術－後融合，無固定物 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 記錄__ 手術科部: 外科部 套用罐頭: L3~5 laminectomy and posterior lateral fusion 開立醫師: 胡朝凱 開立時間: 2010/05/11 17:43 Pre-operative Diagnosis L3~5 spondylolisthesis and spinal stenosis Post-operative Diagnosis L3~5 spondylolisthesis and spinal stenosis Operative Method L3~5 laminectomy and posterior lateral fusion Specimen Count And Types NIL Pathology nil Operative Findings 1.Grade II anterior listhesis of L3~5 with neural foramen stenosis 2.Instability was found on L3~4 level 3.The thecal sac expanded well after laminectomy Operative Procedures 1.ETGA, prone 2.Midline skin incision 3.Detach paravertebral muscle to expose lamina and transverse process of L3~5 4.Laminectomy of L3~5 5.Further widening for exposing L3~5 roots 6.Decortication of L3~5 facet and transeverse p0rocess 7.Put bone chips and artificial bone graft to the space 8.Set one hemovac drain then close wound in layers. Operators 曾勝弘 Assistants 胡朝凱, Ri 江宗庚 (M,1931/02/18,81y0m) 手術日期 2010/05/11 手術主治醫師 曾勝弘 手術區域 西址 033房 01號 診斷 Carpal tunnel syndrome 器械術式 Decompression of mediun nerve 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 09:03 進入手術室 09:12 麻醉開始 09:15 手術開始 09:45 麻醉結束 09:46 手術結束 09:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 神經分離術－手．足之神經 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 曾峰毅 開立時間: 2010/05/11 09:52 Pre-operative Diagnosis Carpal tunnel syndrome Post-operative Diagnosis Carpal tunnel syndrome Operative Method Median nerve decompression at right Specimen Count And Types Nil Pathology Nil Operative Findings Hyertrophic flexor retinaculum compressed the median nerve tightly, and nerve was decompressed after flexr retinaculum released. Thumb function was well after the surgery. Operative Procedures Patient was put in supine position with right arm abduction. After local anaesthesia with lidocaine infiltration around the wrist crease, linear skin incision was made at right wrist. We dissected to expose flexor retinaculum, which was released to decompress the median nerve. After hemostasis achieved, we closed the wound in layers. Operators VS 曾勝弘 Assistants R3 曾峰毅 陳塏仁 (M,2006/02/14,6y1m) 手術日期 2010/05/11 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Vomiting 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 2 紀錄醫師 蔡宗良, 時間資訊 07:45 報到 08:10 進入手術室 08:15 麻醉開始 08:50 誘導結束 09:30 抗生素給藥 09:52 手術開始 12:30 抗生素給藥 15:45 麻醉結束 15:45 手術結束 15:55 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 7 0 手術 腦瘤切除－手術時間在４～８小時 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: C-P Angle Tumor 開立醫師: 蔡宗良 開立時間: 2010/05/12 09:51 Pre-operative Diagnosis Cerebellar tumor, left-sided Cerebellar tumor, left cerebellar hemisphere with brainstem extension, suspect glioma Post-operative Diagnosis Cerebellar glioma, left-sided Cerebellar tumor, left cerebellar hemisphere with brainstem extension, suspect glioma Operative Method Craniotomy for the removal of cerebellar tumor Left suboccipital craniotomy (crossing midline) for the subtotal removal of tumor Specimen Count And Types 1 piece About size: Source: Cerebellum Pathology Probably low grade glioma. Fianl pathology report pending. Operative Findings 1. Cerebellar edema was presence before tumor resection. 1. Merked brain swelling was noted before tumor resection. The tumor was ill-defined, greyish, soft, and hypovascular. It contained a few clear fluid inside. The anterior margin of the tumor could not be separated from the normal brain. 2. The fluid in the cystic lesion returned clear colorless upon fenestration. 3. The tumor was grey in color and consistency was much dense than normal brain parenchyma. Tumor was poorly demarcated. Operative Procedures General anesthesia was employed under general anesthesia. Head was fixed by Mayfield head clamp and the patient was put in a prone position with the head flexed 30 degrees and elevated against the floor. General anesthesia was employed under general anesthesia. Head was fixed by Mayfield head clamp and the patient was put in a prone position with the neck flexed. An approximately 9 cm linear wound incision was made from 2 cm above the inion towards spinous process of C2. Suboccipital muscles were dissected and left-sided skull were exposed. Burr-holes and craniotomy were made as depicted. Dura was opened in a inverse U-shaped basing of the transverse sinus above. Suboccipital muscles were dissected and left-sided skull were exposed. Burr-holes were made on both side of the occipital sinus and just below the transverse sinus. Left suboccipital craniectomy with extension across the midline was made. Dura was opened in a inverse U-shaped basing of the transverse sinus above. It was then reflected upward. The occipital sinus was divided after bipolar coagulation. The tumor was identified by ultrasonography. An approximately 1.5 cm Corticotomy was made. We tried to use ultrasound to identify the tumor, but only one cystic portion was found. The other lesion looked to be solid and ill-defined. An approximately 1.5 cm corticotomy was made 1 cm below the left transverse sinus. We deepened the incision tract to 2.5 to 3 cm beneath the cortical surface to expose the tumor. The tumor was removed in a piecemeal meathod by bipolar cautery, tumor forceps, and suction. Some specimen were sent for pathological investigation. The skull was fixed to the craniotomy window. A 7mm Jackson-Pratt drain was placed in the epidural space. The wound was closed in layers. The tumor was removed in a piecemeal meathod by bipolar cautery, tumor forceps, and suction. Some specimen were sent for pathological investigation. We removed the tumor as much as possible till a depth of 4.5 to 5 cm. There was still a layer of tumor at the anterior margin of the tumor cavity, but we left that part since the preoperative MRI demontrated that this depth was at the junction between the left cerebellum and braistem. The skull plate was trimmed at its lower margin, and it was fixed to the craniotomy window with three wires. A 8 mm Jackson-Pratt drain was placed in the epidural space. The wound was closed in layers. Operators VS郭夢菲 Assistants R4蔡宗良 嚴啟安 (M,2008/08/20,3y6m) 手術日期 2010/05/11 手術主治醫師 郭夢菲 手術區域 兒醫 066房 03號 診斷 Subdural hemorrhage 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 2 紀錄醫師 蔡宗良, 時間資訊 14:45 報到 15:27 進入手術室 15:35 麻醉開始 16:10 誘導結束 16:30 抗生素給藥 16:46 手術開始 17:20 開始輸血 20:12 麻醉結束 20:12 手術結束 20:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 頭顱成形術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Cranioplasty 開立醫師: 蔡宗良 開立時間: 2010/05/12 10:18 Pre-operative Diagnosis Skull autograft adsoption, s/p cranioplasty, vault, right-sided Floating skull due to skull autograft adsoption, right frontotemporal Post-operative Diagnosis Skull autograft adsoption, s/p cranioplasty, vault, right-sided Floating skull due to skull autograft adsoption, right frontotemporal Operative Method Cranioplasty Specimen Count And Types None Pathology Nil Operative Findings There was fibrotic changes to the borders of skull autograft bone. The whole autograft was also separted into several segments with dense fibrotic tissues in between. There was fibrotic changes to the borders of previous skull autograft bone. The microplates were loosened due to adsorption of the bone plate. The whole autograft was also separted into several segments with dense fibrotic tissues in between due to adsorption. Operative Procedures General anesthesia was employed under endotracheal intubation. The patient was placed in supine position with head rotated 60 degrees to the left. General anesthesia was employed under endotracheal intubation. The patient was placed in supine position with head rotated to the left. The scalp was prepped and drapped in the usual manner. Skin incision was made along the previous wound. The scalp was prepped and drapped in the usual manner. Skin incision was made along the previous wound. The galea apponeurotica was dissected from the skull. Multiple burr-holes were made accrossthe craniotomy window as depicted. Multiple burr-holes were made at the margin of the intact skull window as depicted. Methyl methacrylate was paved at the surface of skull encompass the previous craniotomy window to reinforce the skull plate. Methyl methacrylate was paved at the surface of adsorpted skull plate encompassing the gap between the adsorpted bone plate and previous craniotomy window to reinforce the skull plate. Multiple holes were made by K8 drill. An epidural drain was placed. The wound was closed in layers. Multiple holes were made by K8 drill on the bone cement plate. We then put back the artificial bone plate after three stitches of dural tenting. An epidural drain was placed. The wound was closed in layers. Operators Kuo Meng Fei, MD, PhD. VS 郭夢菲 Assistants Chai Chung Liang, MD. R4 蔡宗良 吳龍夫 (M,1944/07/09,67y8m) 手術日期 2010/05/11 手術主治醫師 張宏江 手術區域 東址 015房 04號 診斷 Renal stone 器械術式 U.R.S.-S.M. + Meatotomy,URS 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 靜脈麻醉 麻醉主治醫師 葉惠敏 ASA 3 紀錄醫師 曾任偉, 時間資訊 12:42 報到 12:54 進入手術室 12:55 麻醉開始 13:00 誘導結束 13:03 抗生素給藥 13:10 手術開始 13:40 手術結束 13:40 麻醉結束 13:45 送出病患 13:50 進入恢復室 14:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 手術 診斷性輸尿管鏡檢，包括輸尿管膀胱接合處，擴張術及膀胱鏡術 1 0 R 記錄__ 手術科部: 泌尿部 套用罐頭: URS-SM 開立醫師: 曾任偉 開立時間: 2010/05/11 13:58 Pre-operative Diagnosis Right renal stone Post-operative Diagnosis Right renal stone Operative Method URS-SM Specimen Count And Types nil Pathology nil Operative Findings 1.Angulation of right upper ureter 2.Fail to approach to the renal pelvis Operative Procedures Under satisfactory anesthesia with the patient in the lithotomy position, skin preparation was performed. A cystoscope was inserted into the bladder and a guidewire was then introduced into the ureteral orifice. A 6 Fr. ureteroscope was introduced into the ureter. Angulation of right upper ureter was note , so the scope and guidewire can not pass. A 16 Fr. Foley catheter was placed in the urinary bladder. The patient tolerated the operation well and was sent to the recovery room in stable condition. Operators 張宏江 Assistants 曾任偉 陳文陽 (M,1962/01/31,50y1m) 手術日期 2010/05/11 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 許松鈺, 時間資訊 07:40 報到 08:05 進入手術室 08:10 麻醉開始 08:40 誘導結束 09:30 抗生素給藥 10:01 手術開始 12:30 抗生素給藥 13:40 麻醉結束 13:40 手術結束 13:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 顱底瘤手術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Retrosigmoid approach for tumor remove 開立醫師: 陳睿生 開立時間: 2010/05/11 13:53 Pre-operative Diagnosis Left cerebellopontine angle epidermoid cyst Post-operative Diagnosis Left cerebellopontine angle epidermoid cyst Operative Method Retrosigmoid approach for tumor remove Specimen Count And Types 1 piece About size:pieces Source:tumor Pathology Pending Operative Findings The tumor was soft, whitish, and fragile. Solid mass with some cystic portion inside was found. The cyst was opened and fluid inside was clear. The tumor capsule was firmly attached to the CN VII, VIII and V. The tumor capsule was dissect but some portion was left due to adhesion. Operative Procedures 1. ETGA, park-bench and the head was fixed with Mayfield clump and right turn 2. Left retrosigmoid scalp curvillinear incision, and extract fascia graft 3. Make burr holes at asterion and posterior fossa base 4. Create a craniotomy window about 6x6 cm with high speed drill and sew 5. The dura was opened in a reverse "K" shape 6. Retract the cerebellum hemisphere posteriorly, and drain CSF from cistern magnum for decompression 7. Retract the cerebellum with self retractor, and identify the CN VII, and VIII 8. Open the tumor capsule and the cyst was drained 9. The whitish tumor mass was removed 10.Dissect the tumor capsule from the peripheral nerves, and partially removed 11.Hemostasis, close the dura with fascia graft 12.Fix back skull graft with wires x5 13.Close the wound in layers Operators VS 賴達明 Assistants R5 陳睿生, R1 許松鈺 相關圖片 廖添勝 (M,1958/08/02,53y7m) 手術日期 2010/05/11 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Cervical myelopathy 器械術式 Diskectomy cervical (Posterie 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 許松鈺, 時間資訊 13:20 報到 14:10 進入手術室 14:15 麻醉開始 14:30 誘導結束 14:50 抗生素給藥 15:27 手術開始 17:47 手術結束 17:47 麻醉結束 18:00 送出病患 18:05 進入恢復室 19:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 手術 椎弓整形術 1 1 摘要__ 手術科部: 外科部 套用罐頭: Laminoplasty over C3-6 (open door) 開立醫師: 陳睿生 開立時間: 2010/05/11 18:19 Pre-operative Diagnosis Cervical stenosis over C3-6 Post-operative Diagnosis Cervical stenosis over C3-6 Operative Method Laminoplasty over C3-6 (open door) Specimen Count And Types nil Pathology Nil Operative Findings Thecal sac was well expanded after lamina elevation. The lamina was elevated from left side. Four pieces of miniplates were used for laminoplasty (C3: prolonged 4 holes; C4,5: 5 holes; C6: 6 holes). Intra-op no obvious SSEP change. Operative Procedures 1. ETGA, prone position and head fixed with Mayfield clump 2. Posterior midline skin incision 3. Incise into the trapzius and paraspinal muscle and dissect bilaterally to expose the lower C2 to C7 spinous process 4. Expose the C3-6 lamina totally 5. Drill out the outer cortex of right side C3-6 lamina and bi-cortex at left side C3-6 lamina 6. Elevate the lamina from left side with splitter 7. Remove the ligamentum flavum for decompression 8. Fix the elevated lamina with facets with miniplates x4 and screws (5mm at facet side and 7mm at lamina side) 9. Hemostasis, set an epidural CWV drain 10.Close the muscle and skin in layers Operators VS 賴達明 Assistants R5 陳睿生; R1 許松鈺 相關圖片 劉壬葵 (M,1946/08/03,65y7m) 手術日期 2010/05/11 手術主治醫師 賴達明 手術區域 東址 003房 03號 診斷 Lumbar spondylosis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 許松鈺, 時間資訊 17:40 報到 18:10 進入手術室 18:15 麻醉開始 18:35 誘導結束 18:35 抗生素給藥 19:29 手術開始 21:35 抗生素給藥 22:50 手術結束 22:50 麻醉結束 23:00 送出病患 23:05 進入恢復室 00:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 手術 椎弓切除術（特壓）－二節以內 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: L4/5 transpedicle screw (TPS) fixation and L4... 開立醫師: 李建勳 開立時間: 2010/05/11 22:54 Pre-operative Diagnosis Lumbar stenosis L4/5 s/p L4 laminotomy with lateral recess syndrome Post-operative Diagnosis Lumbar stenosis L4/5 s/p L4 laminotomy with lateral recess syndrome Operative Method L4/5 transpedicle screw (TPS) fixation and L4 laminectomy for decompression L4/5 transpedicle screw (TPS) fixation, posteriolateral autologous bone fusion and L4 laminectomy for decompression Specimen Count And Types nil Pathology Nil Operative Findings TPS with Synthes screws: 6.2mmX45mmX3 and 7.0mmX45mmX1. Rods:50mmX2. Lumbar stenosis with thickened ligmentum flavum and scar tissue formation, which were removed after laminectomy. Operative Procedures Under genral anesthesia and intubation, the patient was put in prone position. The L4 and L5 pedicles were located with portable C-arm X-ray. The skin was scrubbed, disinfected with alcohol better-iodine then draped. Midline skin incision was made along previous op scar and dissected to expose the L4/5 facet joints. Transpedicle screws were inserted under portable C-arm X-ray guidance. The L4 laminectomy was performed with rongeur and Kerrison punches. The thickened ligmentum flavum and scar tissue were removed with Kerrison punch. The rods were set up and two hemovac drains were set up at wound. The wound was then closed in layers. Under genral anesthesia and intubation, the patient was put in prone position. The L4 and L5 pedicles were located with portable C-arm X-ray. The skin was scrubbed, disinfected with alcohol better-iodine then draped. Midline skin incision was made along previous op scar and dissected to expose the L4/5 facet joints. Transpedicle screws were inserted under portable C-arm X-ray guidance. The L4 laminectomy was performed with rongeur and Kerrison punches. The thickened ligmentum flavum and scar tissue were removed with Kerrison punch. Posteriorlateral fusion with autologous bone graft was performed. The rods were set up and two hemovac drains were set up at wound. The wound was then closed in layers. Operators VS 賴達明 Assistants R1 許松鈺 R6李建勳 相關圖片 王淑珍 (F,1960/04/27,51y10m) 手術日期 2010/05/11 手術主治醫師 鄭文芳 手術區域 兒醫 065房 01號 診斷 Cervical cancer 器械術式 Radical hysterectomy 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 蔡可欣, 時間資訊 07:45 報到 08:02 進入手術室 08:05 麻醉開始 08:30 誘導結束 08:35 抗生素給藥 08:42 手術開始 11:10 開始輸血 11:35 抗生素給藥 12:20 手術結束 12:20 麻醉結束 12:25 送出病患 12:30 進入恢復室 14:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 子宮頸癌全子宮根除術 1 1 手術 骨盆腔淋巴腺切除術 1 2 手術 膀胱造口術 1 4 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 婦產部 套用罐頭: RAH + BSO 開立醫師: 蔡可欣 開立時間: 2010/05/11 11:45 Pre-operative Diagnosis cervical camncer, stage IB2 Post-operative Diagnosis ditto Operative Method RAH +BSO + BPLND and SPD insertion Specimen Count And Types 5 pieces About size:10g Source:left iliac LN About size:10g Source:left obturator LN About size:10g Source:right iliac LN About size:10g Source:right obturator LN About size:12x10x8cm Source:uterus Pathology pending Operative Findings 1. Uterus: Avfl, 12x10x8cm, a 6x6x6cm submucosal myoma was found 2.RAD:atrophy 3.LAD:atrophy 4.CDS:free 5. Right parametrium size : 2x1cm, Induration (-; Left parametrium size : 2x1cm, Induration (-) 6. Vagina cuff: 1 cm , cacerous lesion about 5x3x2 cm in size, section margin free (+) 7. Bilateralpelvic lymph nodes: Right external iliac :grossly normal Right obturator and hypogastric: grossly normal Right obturator and hypogastric: indurated Left external iliac: grossly normal Left obturator and hypogastric: grossly normal Left obturator and hypogastric: indurated and enlarged 8. Estimated blood loss: 8. Estimated blood loss:600ml Blood transfusion:PRBC2u Blood transfusion:PRBC2u Complication:nil Operative Procedures 1. Under ETGA, put the patient on the lithotomy position and prepare as usual. 2. Make and infraumbilical vertical skin incision and open the abdominal wall layer by layer. 3. Clamp, cut and suture ligate the right round ligament. 4. Enter into the right para-vesical space down to the pelvic floor. 5. Clamp, cut and suture ligate the right infundibulo-pelvic ligament. 6. Do the similar procedures as (3), (4), (5) over the left side. 7. En bloc dissection of the left external and internal iliac LN. 8. Explore the left obturator fossa, identify the left obturator nerve and remove the obturator LN en bloc. 9. Stretch the left umbilical ligament and ligate the left uterine artery. 10. Free the left ureter from posterior sheath of the broad ligament. 11. Open the left para-rectal space. 12. Clamp, cut and ligate the left cardinal ligament. 13. Clamp, cut and ligate the posterior sheath of the broad ligament. 14. Do the similar procedures (7) to (13) over the right side. 15. Dissect the recto-vaginal septum to open the recto-vaginal space. 16. Cut the bilateral recto-vaginal fascia and clamp bilateral utero-sacral ligaments. 17. Dissect the vesico-uterine fascia and push urinary bladder downward to the upper third of vagina. 18. Open the bilateral ureteral tunnels by clamp and ligate anterior and posterior utero-vesical sheaths 19. Cut the bilateral utero-sacral ligaments. 20. Clamp and cut the upper thirdof vagina to remove the whole uterus and its appendages. 21. Suture the bilateralvaginal stump angles. 22. Place and fix the bilateral vaginal drains at the retroperitoneal space. 23. Approximate the bilateral round ligament stump and its ipsilateral adnexal stump. 24. Insert two Hemovac into bilateral retroperitoneal space and reperitonealization 25. Check bleeders, hemostasis and then close abdominal wall layer by layer. 26. SPD was inserted and fixed over supra-pubicarea. 27. Approximate the skin wound with 4-0 Dexon subcataneously. Operators 鄭文芳, 謝長堯, Assistants 劉惠珊, 陳宜慧, 徐瑞月 (F,1958/01/01,54y2m) 手術日期 2010/05/11 手術主治醫師 黃國皓 手術區域 東址 001房 02號 診斷 Acute renal failure, unspecified 器械術式 P.C.N. pig tail 手術類別 緊急手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 靜脈麻醉 麻醉主治醫師 葉惠敏 ASA 3E 紀錄醫師 張宇鳴, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 07:36 通知急診手術 09:40 進入手術室 10:10 麻醉開始 10:13 誘導結束 10:14 手術開始 10:25 麻醉結束 10:25 手術結束 10:30 送出病患 10:35 進入恢復室 11:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 尿道擴張 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 麻醉 Glucose 1 0 記錄__ 手術科部: 泌尿部 套用罐頭: Urethral sounding and on Foley 開立醫師: 張宇鳴 開立時間: 2010/05/11 10:40 Pre-operative Diagnosis R/o bilateral obstructive uropathy Post-operative Diagnosis R/o acute urinary retention Operative Method Urethral sounding and on Foley Specimen Count And Types nil Pathology Nil Operative Findings 1.Adhesion over urethral orifice. 2.Failed bilateral pigtail PCN due to minimal hydronephrosis. Operative Procedures 1.IVGA with flank position. 2.Skin was prepped and drapped. 3.Tried to inserted left pigtail PCN but failed. 4.On 18 Fr. silicon Foley. 5.POR. Operators 黃國皓 Assistants 張宇鳴, Indication Of Emergent Operation 許清配 (F,1962/06/12,49y9m) 手術日期 2010/05/11 手術主治醫師 陳敞牧 手術區域 東址 005房 03號 診斷 Spinal stenosis, cervical 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 胡朝凱, 時間資訊 17:40 報到 18:00 進入手術室 18:05 麻醉開始 18:09 誘導結束 18:15 抗生素給藥 18:45 手術開始 20:50 手術結束 20:50 麻醉結束 21:00 進入恢復室 21:00 送出病患 22:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術－前融合，無固定物（＜＝四節） 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 椎間盤切除術－頸椎 1 1 記錄__ 手術科部: 外科部 套用罐頭: Anterior approach discectomy and cage insertion 開立醫師: 胡朝凱 開立時間: 2010/05/11 21:14 Pre-operative Diagnosis C4~5 HIVD Post-operative Diagnosis C4~5 HIVD Operative Method Anterior approach discectomy and cage insertion Specimen Count And Types Nil Pathology Nil Operative Findings 1.Disc protrusion that compressed the thecal sac tightly. 2.OPLL was noted and adhesion to the dura tightly 3.After decompression, the dura expanded well Operative Procedures 1.ETGA, supine 2.Right neck transverse skin incision 3.Dissect along the anterior border of SCM muscle 4.Exposed the prevertebral space 5.localization of C4~5 disc 6.Discectomy 7.Remove OPLL 8.Cage inseriton 9.Set one hemovac drain then close wound in layers Operators 陳敞牧 Assistants 胡朝凱, Ri 李謙希 (F,1970/07/30,41y7m) 手術日期 2010/05/11 手術主治醫師 蔡翊新 手術區域 西址 033房 02號 診斷 Carpal tunnel syndrome 器械術式 Neurolysis of the uluar neuve 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 10:00 進入手術室 10:13 麻醉開始 10:15 手術開始 11:00 手術結束 11:00 麻醉結束 11:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 正中神經或尺神經腕部減壓術–單側 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 曾峰毅 開立時間: 2010/05/11 11:07 Pre-operative Diagnosis Carpal tunnel syndrome, left Post-operative Diagnosis Carpal tunnel syndrome, left Operative Method Median nerve decompression, left Specimen Count And Types Nil Pathology Nil Operative Findings Flexor retinaculum compressed the median nerve tightly, and nerve was decompressed after flexr retinaculum released. Thumb function was well after the surgery. Operative Procedures Patient was put in supine position with left arm abduction. After local anaesthesia with lidocaine infiltration around the wrist crease, linear skin incision was made at left wrist. We dissected to expose flexor retinaculum, which was released to decompress the median nerve. After hemostasis achieved, we closed the wound in layers. Operators VS 蔡翊新 Assistants R3 曾峰毅 林許瑞蘭 (F,1950/04/20,61y10m) 手術日期 2010/05/11 手術主治醫師 蔡翊新 手術區域 西址 033房 03號 診斷 Carpal tunnel syndrome 器械術式 Neurolysis of the uluar neuve 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 11:30 進入手術室 11:35 麻醉開始 11:40 手術開始 12:25 手術結束 12:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 正中神經或尺神經腕部減壓術–單側 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Neurolysis 開立醫師: 蔡翊新 開立時間: 2010/05/11 12:16 Pre-operative Diagnosis Right carpal tunnel syndrome Post-operative Diagnosis Right carpal tunnel syndrome Operative Method Neurolysis (right median nerve decompression Specimen Count And Types nil Pathology Nil. Operative Findings Hypertrophic flexor retinaculum compressed the median nerve tightly, and nerve was decompressed after flexr retinaculum released. Thumb function was well after the surgery. Operative Procedures Patient was put in supine position with right arm abduction. After local anaesthesia with lidocaine infiltration around the wrist crease, linear skin incision was made at wrist. We dissected to expose flexor retinaculum, which was released to decompress the median nerve. After hemostasis achieved, we closed the wound in layers. Operators VS蔡翊新 Assistants R3曾峰毅 NGLIANG FIE (M,1940/02/06,72y1m) 手術日期 2010/05/12 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Acoustic tumor 器械術式 retrosigmoid 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 07:40 報到 08:10 進入手術室 08:15 麻醉開始 08:50 誘導結束 09:40 抗生素給藥 10:01 手術開始 12:30 抗生素給藥 15:40 抗生素給藥 16:15 麻醉結束 16:15 手術結束 16:23 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 8 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Retrosigmoid approach total tumor excision 開立醫師: 鍾文桂 開立時間: 2010/05/12 16:08 Pre-operative Diagnosis Left side acoustic neuroma Post-operative Diagnosis Left side acoustic neuroma Operative Method Retrosigmoid approach total tumor excision Specimen Count And Types 1 piece About size:3.5x2.5x3cm Source:left side acoustic neuroma Pathology pending Operative Findings The tumor was elastic soft in character and yellowish in color. The tumor is capsulated and originated from the inferior vestibular nerve. Cochlear nerve and facial nerve was expanded and became thin band separately. Trigeminal nerve and low cranial nerve was also mild compressed. Facial nerve stimulation showed intact facial nerve. Operative Procedures Under the general anesthesia with endotracheal tube intubation, the patient was set into supine position with head rotated to right and flexion. The operation wound was scrubbed and disinfected then drapped with sterile drapping. Retroauricular elongated S-shape incision was done. One piece of fascia was harvested. Detach muscle to expose Asterion, stylomastoid groove. Burr hole was made at asterion and then widened till exposure of transverse and sigmoid sinus. Craniotomy was made with saw. Dura was opened as reverse-pie shape. CSF was drained from foramen magnum. Apply retracter on cerebellum then identify the tumor. Cauterized the surface of the tumor then central debulking was done with currete and then tumor forceps. Dissect the tumor away from pontine side and then cochlear nerve. Use facial nerve stimulation to identify the tract of facial nerve. Drill open the IAC and then CNVII and VIII was identified. The tumor was dissected away from facial nerve from the distal to proximal then the tumor was totally removed. Hemostasis was done with bipolar and surgicel packing. IAC was packed with sugicel, tissue-codul and then fat-fascia graft. Duroplasty was done with fascia graft and 4-0 prolene. The bone plate was fixed with miniplate. One CWV drain was set and the wound was closed in layers. Operators P杜永光 Assistants R6陳盈志R4鍾文桂 相關圖片 林文海 (M,1919/01/07,93y2m) 手術日期 2010/05/12 手術主治醫師 杜永光 手術區域 東址 003房 02號 診斷 Hydrocephalus 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 鍾文桂, 時間資訊 14:10 報到 16:55 進入手術室 17:00 麻醉開始 17:10 誘導結束 17:30 抗生素給藥 17:48 手術開始 19:05 手術結束 19:05 麻醉結束 19:10 送出病患 19:15 進入恢復室 20:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: V-P shunt via right kocher point 開立醫師: 陳盈志 開立時間: 2010/05/12 18:47 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method V-P shunt via right kocher point Specimen Count And Types nil Pathology nil Operative Findings CSF was clear, the opening pressure was about 7~8cmH2O. The ventricular catheter was 6.3cm in depth. Median pressure reservoir was set. Operative Procedures Under the general anesthesia with endotracheal tube intubation, the patient was set into supine position with head tilt to left. Skin preparation was done with povidine-iodine and then drapped. Right frontal curvilinear incision was done. Burr hole was made and dura tenting was done. Dura was opened cruciformly and then ventricular tapping was done. RUQ minilaparotomy was done and then subcutaneous tunnel was made. The catheter was pulled through and connected to the catheter and then insert into ventricle and peritoneum. Hemostasis was done and the wound was closed in layers. Operators P杜永光 Assistants R6陳盈志R4鍾文桂 蔡張雪珠 (F,1949/12/28,62y2m) 手術日期 2010/05/12 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳國瑋, 時間資訊 11:40 報到 12:48 進入手術室 12:55 麻醉開始 13:30 誘導結束 13:40 抗生素給藥 13:50 手術開始 16:40 抗生素給藥 18:25 麻醉結束 18:25 手術結束 18:35 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除－手術時間在４～８小時 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: frontal craniotomy for Simpson grade II tumor excision 開立醫師: 李建勳 開立時間: 2010/05/12 18:47 Pre-operative Diagnosis Right frontal convexity meningioma Post-operative Diagnosis Right frontal convexity meningioma Operative Method Right frontal craniotomy for Simpson grade I tumor excision Specimen Count And Types 1 piece About size:5g Source:brain tumor excision Pathology Pending Operative Findings The right frontal skull showed hyperosis change. The tumor is yellowish, soft-elastic, size 7x4x1cm, wide base at frontal area. The tumor margin was seperable from the normal brain parenchyma at arachnoid plane. One feeding artery was found at base of the tumor and coagulated after tumor excision. The dura covered the tumor was removed. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position with head fixed with Mayfield skull clump. The scalp was shaved, scrubbed, disinfected with alcohol better-iodine then draped. The bicoronal scalp incision was made followed by right frontal craniotomy. The dura was opened around the tumor after tenting along the craniotomy window. The tumor was dissected from the surrounding normal brain tissue with dissector and bipolar coagulator. The tumor was transected near the base for hemostasis of the feeding artery of the tumor. The residual tumor was removed with suction. The duroplasty was performed with 4-0 Prolene sutures and periostium. The skull plate was fixed back with miniplates and screws after one subgaleal closed wound vaccum drain set up. The wound was then closed in layers. Operators VS 曾漢民 Assistants R1 陳國瑋 R6 李建勳 相關圖片 羅慧君 (F,1980/01/01,32y2m) 手術日期 2010/05/12 手術主治醫師 曾漢民 手術區域 東址 005房 03號 診斷 Pituitary Tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 曾漢民, 時間資訊 18:05 報到 19:00 進入手術室 19:05 麻醉開始 19:30 誘導結束 19:35 抗生素給藥 19:40 手術開始 20:50 麻醉結束 20:50 手術結束 21:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經由蝶竇之腦下垂體瘤切除 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 摘要__ 手術科部: 外科部 套用罐頭: Endoscopic transsphenoid adenomectomy 開立醫師: 李建勳 開立時間: 2010/05/12 21:17 Pre-operative Diagnosis Pituitary microadenoma Post-operative Diagnosis Pituitary microadenoma Operative Method Microscopic transsphnoid adenomectomy Specimen Count And Types 1 piece About size:0.5G Source:pituitary tumor Pathology Pending Operative Findings The tumor was yellowish, elastic-firm, size 0.8cm in diameter, located more at left side. CSF leakage was sealed with Tissuecol Duo nad gelform packing. Operative Procedures Under general anethesia and intubation, the patient was put in supine position with head tilted 30 degree to left. The facial skin was antiseptic with alcohol better-iodine tincture, and the mucosa of oral and nasal cavity with aqueous better-iodine . The formerareas were covered by sterilized adhesive plastic sheets then draped. Under microscope, the nasal mucosa was ingeted with local anestheisa and epinephrine at right norstril then incision was made. A nasal speculum was applied to displace the nasal mucosa laterally and keep the nasal cavity open constantly for the exposure of the vomer bone and the anterior wall of the sphenoid sinus. The vomer bone was removed by osteotome and aligator. The posterior sphenoid wall was remove by Kerrison punch. The sellar floor dura was coagulated then opened in cruciate fashion. The tumor parenchyma was removed by aligator after seperated with curette. The CSF leakage was sealed with Tissuecol Duo nad gelform packing. The posterior sphenoid wall was recontructed with bone clip. The sphenoid sinus was packing with gelform as in the sellar cavity. The vomer bone was put back in place. The nasal mucosa returned to its normal position. Right side of the nasal cavities was tightly packed with a segment of rubber glove finger filled with vaseline gauze strips which had been soaked with better-iodine ointment. Operators VS 曾漢民 Assistants R1 陳國瑋 R6 李建勳 相關圖片 邱慶瑞 (M,1965/12/26,46y2m) 手術日期 2010/05/12 手術主治醫師 蔡瑞章 手術區域 東址 005房 01號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳國瑋, 時間資訊 07:44 報到 08:05 進入手術室 08:10 麻醉開始 08:45 誘導結束 09:00 抗生素給藥 09:14 手術開始 12:00 抗生素給藥 12:20 麻醉結束 12:20 手術結束 12:28 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除－手術時間在４小時以內 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: frontal craniotomy for Simpson grade II tumor excision 開立醫師: 李建勳 開立時間: 2010/05/12 12:15 Pre-operative Diagnosis Right frontal convexity meningioma Post-operative Diagnosis Right frontal convexity meningioma Operative Method Right frontal craniotomy for Simpson grade I tumor excision Specimen Count And Types 1 piece About size:5g Source:brain tumor excision Pathology Pending Operative Findings The frontal skull with hyperosis change and one piece of the tumor was protruded through the dura. The tumor is yellowish, soft-elastic, size 5cm in dameter, attached to the dura. The tumor margin was seperable from the normal brain parenchyma at arachnoid plane except the base of the tumor, which was more difficult to seperate from the brain parenchyma. The superior saggital sinus opening was sutured with 4-0 Prolnene. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position. The scalp was shaved, scrubbed, disinfected with alcohol better-iodine then draped. The curvilinear scalp incision was made followed by right frontal craniotomy. The dura was opened around the tumor after tenting along the craniotomy window. The superior saggital sinus opening was sutured with 4-0 Prolnene. The tumor was dissected from the surrounding normal brain tissue with dissector and bipolar coagulator. The tumor was detached from the brain parenchyma in one piece. The base of the tumor was seperated with dissector and bipolar coagulation. Hemostasis was achieved with Surgicel lining of the tumor bed. The duroplasty was performed with 4-0 Prolene sutures and periostium. The skull plate was fixed back with miniplates and screws after one epidural close wound vaccum drain set up. The wound was then closed in layers. Operators P 蔡瑞章 Assistants R1 陳國瑋 R6 李建勳 相關圖片 吳阿財 (M,1947/02/21,65y0m) 手術日期 2010/05/12 手術主治醫師 梁金銅 手術區域 東址 056房 02號 診斷 Chronic renal failure 器械術式 Open AR 手術類別 預定手術 手術部位 腹 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 羅婉育, 時間資訊 10:40 報到 11:00 進入手術室 11:10 麻醉開始 11:30 誘導結束 11:55 手術開始 14:30 麻醉結束 14:30 手術結束 14:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 降結腸或乙狀結腸切除術併行吻合術及淋巴節清掃 1 1 手術 腹腔內異物卻除術 1 2 摘要__ 手術科部: 外科部 套用罐頭: LAR 開立醫師: 羅婉育 開立時間: 2010/05/12 15:04 Pre-operative Diagnosis sigmoid colon cancer Post-operative Diagnosis sigmoid colon cancer Operative Method Low anterior resection (male) Specimen Count And Types 4 pieces About size:2cm Source:LN About size:2.5cm Source:LN About size:2.5cm Source:LN About size:15*10cm Source:rectum and sigmoid colon Pathology nil Operative Findings 1. A 2.5*2 cm, fungating, ulcerative mass was noted sigmid colon 2. Regional lymph node enlargement (+), 3. Ascites (+) 4. Dissection to D2 LN. Operative Procedures 1. Under general anesthesia, the patient was placed in supine position, the skin was disinfected with alcohol better-iodine from the level of thigh to the nipple area. 2. The peritoneal dialysis tube was removed first. The abdomen was opened and explored through a long median incision from the symphysis pubis to 3cm above the umbilicus. 3. Mobilization of the sigmoid colon by division of the white line of Toldt. 4. Identification of the left ureter and exposure of the inferior mesenteric vessels through incisions of the peritoneum at the base of mesocolon. 5. The inferior mesenteric artery is then ligated and divided at its origin near the aorta, and the vein is tied separately at about the same level. 6. The sigmoid colon and upper 1/2 of rectum was removed. 7. The colon is then moved to come into apposition with the rectum. End-to-end anastomosis is performed by CEA. 8. ileostomy was performed at the right side of abdomen. 9. The pelvis is then irrigated with 2L normal saline and one rubber drain was set near the anastomosis site. 10. The peritoneum and transverse abdominis fascia are closed with continueous 1-0 Vicryl suture. The subcutaneous layer with 3-0 chromic suture and the skin with 3-0 interrupted nylon sutures. Remark: Blood loss: 100c.c Transfusion: nil Operators 梁金銅, Assistants 黃彥鈞 洪皓雲 羅婉育 洪瑞葉 (F,1956/09/22,55y5m) 手術日期 2010/05/13 手術主治醫師 陳晉興 手術區域 東址 017房 02號 診斷 Lung cancer 器械術式 Thoracoscopy+Open Chest 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 硬肌麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 林孟暐, 時間資訊 12:25 報到 12:55 進入手術室 13:10 麻醉開始 13:50 誘導結束 14:00 抗生素給藥 14:15 手術開始 17:17 抗生素給藥 18:35 麻醉結束 18:35 手術結束 18:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 術後止痛 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Epidural anesthesia 1 0 麻醉 EPIDURAL ANESTHESIA 7 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 胸腔鏡肺葉切除術 1 1 B 手術 胸腔鏡肺楔狀或部分切除術 1 2 B 手術 根除性淋巴切除術（肺葉切除或全肺切除時） 1 4 B 記錄__ 手術科部: 外科部 套用罐頭: VATS RML wedge resection + VATS LUL lobectomy... 開立醫師: 林孟暐 開立時間: 2010/05/13 19:02 Pre-operative Diagnosis 1. RML lung tumor, LUL lung tumor 2. breast cancer status post MRM Post-operative Diagnosis 1. RML adenocarcinoma 2. LUL lung tumor 3. breast cancer status post MRM Operative Method VATS RML wedge resection + VATS LUL lobectomy + group 5, 7 LND Specimen Count And Types 4 pieces About size:4x3x3 Source:RML wedge resection About size:12x12x8 Source:RUL About size:5x2x2 Source:group 5 LNs About size:0.5x0.5 Source:group 7 LNs Pathology 1. frozen section revealed RML adenocarcinoma 2. other patho reports were pending Operative Findings 1. a 1x1cm, greyish, hypercellularity, irregular shape, elastic to firm tumor, located at RML near minor fissure, with pleural retraction, the frozen section revealed adenocarcinoma 2. a 4x4cm, greyish, hypercellularity, irregular shape, firm tumor, located at apex of LUL, with pleural retraction 3. The interlobar lymph nodes were enlarged 4. The group 5 LN was firm, moderately adhesive to the aorta, PA main trunk and the phrenic nerve. The left phrenic nerve was preserved. Operative Procedures 1. DLETGA, left decubitus position 2. skin disinfection 3. VATS ports set as usual 4. RML wedge resection 5. hemostasis, check air leakage, place one Fr. 28 chest tube 6. close the wound in layers 7. right decubitus position 8. skin disinfection 9. VATS ports set as usual with AAL wound extended to 6cm 10. loop the lingual PA and proper PA branches (5 branches), then divide them with endo-GIA 11. loop the superior pulmonary vein then divide it with endo-GIA 12. loop then divide the LUL bronchus with endo-GIA 13. group 5 LND, group 7 LND, inferior pulmonary ligament dissection 14. check air leakage, irrigate with normal saline 15. place one Fr. 28 chest tube 16. close the wound in layers Operators VS 陳晉興 Assistants R5 林孟暐 Ri 林佩璇 蕭素花 (F,1957/04/03,54y11m) 手術日期 2010/05/13 手術主治醫師 李苑如 手術區域 東址 008房 07號 診斷 Neurogenic bladder 器械術式 Cystoscopy 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 靜脈麻醉 麻醉主治醫師 劉治民 ASA 2 紀錄醫師 蘇彥榮, 時間資訊 14:10 報到 14:28 進入手術室 14:30 麻醉開始 14:38 誘導結束 14:40 抗生素給藥 14:49 手術開始 15:06 手術結束 15:06 麻醉結束 15:10 送出病患 15:12 進入恢復室 16:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 間質性膀胱炎膀胱尿道鏡擴張術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 記錄__ 手術科部: 泌尿部 套用罐頭: hydrodilatation,for intersitial cystitis 開立醫師: 蘇彥榮 開立時間: 2010/05/13 15:23 Pre-operative Diagnosis Interstitial cystitis Post-operative Diagnosis Interstitial cystitis Operative Method Hydrodilatation Specimen Count And Types nil Pathology Nil Operative Findings 1. Many engorged vessels on urinary bladder wall 2. Spots of bleeding noted during and after the procedure 3. Urinary bladder capacity: 600 mL 4. Hydrodilatation persisted for 10 minutes Operative Procedures Under satisfactory anesthesia with the patient in lithotomy position, prepping and drapping was performed in the usual sterile fashion. A Fr 21 Olympus cystoscope was introduced into the bladder cavity under direct vision. Careful inspection revealed many engorged vessels on bladder wall. Hydrodilatation persisted for 10 minutes. Spots of bleeding noted during and after the procedure. A Fr 16 Foley catheter was inserted. Patient tolerated the procedure very well and was sent to recovery room in satisfactory condition. Operators 李苑如, Assistants 蘇彥榮, 賴建榮, 張宏隆 (M,1958/08/22,53y6m) 手術日期 2010/05/13 手術主治醫師 陳敞牧 手術區域 東址 003房 04號 診斷 Traumatic subdural hemorrhage 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 蕭柏妮 ASA 3E 紀錄醫師 李建勳, 時間資訊 10:00 臨時手術NPO 10:00 開始NPO 11:12 通知急診手術 19:45 報到 19:50 進入手術室 19:55 麻醉開始 20:05 誘導結束 20:15 抗生素給藥 20:45 手術開始 22:00 手術結束 22:00 麻醉結束 22:10 送出病患 22:15 進入恢復室 23:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Right burr hole drainage of chronic subdural ... 開立醫師: 李建勳 開立時間: 2010/05/13 22:36 Pre-operative Diagnosis Right chronic subdural hematoma Post-operative Diagnosis Right chronic subdural hematoma Operative Method Right burr hole drainage of chronic subdural hematoma Specimen Count And Types nil Pathology Nil Operative Findings 1. Dark reddish liquified hematoma drainaged out from subdural space after open the thickened outter membrane. Septations were noted during irrigation. 2. The brain parenchyma did not expand well while closing the wound. Subgaleal hemorrahge was noted during closing the wound and hemostasis was achieved with gelform packing. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position. The scalp was shaved, scrubbed and antiseptic with alcohol better-iodine then draped. One linear scalp incision was made at right frontal area followed by burr hole creation. The dura was tenting with 3-0 silk before opening. After opened the outter membrane of hematoma and normal saline irrigation at four direction, one rubber drain with side holes was left in the subdural space. Subgaleal hemorrahge was noted during closing the wound and hemostasis was achieved with gelform packing. The wound was closed in layers and performed de-air procedure with the rubber drain then connected to the drainage bag. Operators VS 陳敞牧 Assistants R6 李建勳 Indication Of Emergent Operation 相關圖片 林龍雄 (M,1942/08/08,69y7m) 手術日期 2010/05/13 手術主治醫師 蕭輔仁 手術區域 東址 005房 01號 診斷 Cerebrovascular accident (CVA) 器械術式 Laminectomy for decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 4 紀錄醫師 許松鈺, 時間資訊 07:42 報到 08:14 進入手術室 08:25 麻醉開始 09:00 誘導結束 09:10 抗生素給藥 09:20 手術開始 11:50 手術結束 11:50 麻醉結束 12:05 送出病患 12:10 進入恢復室 13:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 椎弓切除術（特壓）－超過二節 1 1 記錄__ 手術科部: 外科部 套用罐頭: C2~5 laminectomy 開立醫師: 胡朝凱 開立時間: 2010/05/13 11:57 Pre-operative Diagnosis c3~5 Stenosis Post-operative Diagnosis c3~5 Stenosis Operative Method C2~5 laminectomy Specimen Count And Types nil Pathology Nil Operative Findings 1.Sever stenosis at C3~5 level, especially C3~4 level 2.After decompression, the thecal sac expanded well 3.Hypertrophic flavum ligment Operative Procedures 1.ETGA, prone 2.Midline incision at C2~6 level 3.Detach paravertebral muscle group 4.Expose C2~5 lamina 5.Laminectomy with Ronguer and kerrison 6.Further widening of laminectomy 7.Set one CWV drain 8.Close wound in layers Operators 蕭輔仁 Assistants 胡朝凱,許松鈺 相關圖片 蘇惠玲 (F,1951/11/01,60y4m) 手術日期 2010/05/13 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Brain cancer 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林珍榮 ASA 3 紀錄醫師 陳睿生, 時間資訊 07:47 報到 08:05 進入手術室 08:20 麻醉開始 08:45 誘導結束 09:00 抗生素給藥 09:47 手術開始 12:10 麻醉結束 12:10 手術結束 12:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除－手術時間在４小時以內 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for tumor remove 開立醫師: 陳睿生 開立時間: 2010/05/13 12:50 Pre-operative Diagnosis Rigth posterior frontal GBM wtih recurrence Right posterior frontal GBM wtih recurrence Right posterior frontal GBM with recurrence Post-operative Diagnosis Rigth posterior frontal GBM wtih recurrence Right posterior frontal GBM wtih recurrence Right posterior frontal GBM with recurrence Operative Method Craniotomy for tumor remove Specimen Count And Types 2 pieces About size:PIECES Source:DURA WITH GRANULATION About size:PIECES Source:TUMOR Pathology Pending Operative Findings A huge cystic portion was noted and the fluid inside was yellowish, turbid. The solid lesion was noted at the cyst margin, and mainly at the anterior side. The tumor was removed as possible, and the margin between the tumor and peripheral brain tissue was unclear. Intra-op frozen section showed high grade glioma. Operative Procedures 1. ETGA, supine position and head left turn, fix with Mayfield clump 2. Scalp incision via the previous wound at rigth frontotemporal region 2. Scalp incision via the previous wound at right frontotemporal region 3. Cut down wires, and remove the skull graft, intra-op ECHO evaluation of the tumor 4. Open the dura in a cross shape 5. Drain out the fluid inside the cyst 6. The solid portion of the tumor was dissected from the brain parychema 7. The tumor was totally removed under MEP, SSEP monitor 8. Close the dura with fascia graft 9. Fix back the skull graft with wires x5, and central tacking 10.Set a subgaleal CWV drain, and close the wound in layers Operators VS 王國川 Assistants R5 陳睿生, Ri 曾碧清 (F,1963/09/25,48y5m) 手術日期 2010/05/14 手術主治醫師 楊榮森 手術區域 東址 022房 03號 診斷 Osteonecrosis 器械術式 THR 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 3 紀錄醫師 謝忠佑, 時間資訊 14:00 進入手術室 14:05 麻醉開始 14:15 誘導結束 14:15 手術開始 14:20 抗生素給藥 15:05 開始輸血 16:35 手術結束 16:35 麻醉結束 17:12 送出病患 17:15 進入恢復室 18:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 手術 股關節全置換術 1 1 R 摘要__ 手術科部: 骨科部 套用罐頭: 1. removal of the implants 2. THR, UNited pro... 開立醫師: 謝忠佑 開立時間: 2010/05/14 16:30 Pre-operative Diagnosis bilateral femoral head avascular necrosis Post-operative Diagnosis bilateral femoral head avascular necrosis Operative Method 1. removal of the implants 2. THR, UNited prosthesis Specimen Count And Types 1 piece About size: Source:cytology x 1 pathology x 1 Pathology femoral head, IM canal debris Operative Findings bilateral femoral head avascular necrosis Operative Procedures 1. Under anesthesia, in lateral decubitus position 2. disinfection and draped 3. longitudinal incision, posteriolateral approach ,perform THR step with step with United proshtesis Stem 1# 9mm Cup 48mm head 28mm+0mm liner 28mm 4. check alignment and stability, copious normal saline irrigation 5. close wound in layers after setting 1/8 h/v x 1 Operators 楊榮森, Assistants 陳致宇 謝忠佑 方建豐 陳昭益 (M,1940/11/05,71y4m) 手術日期 2010/05/14 手術主治醫師 何子昌 手術區域 東址 010房 07號 診斷 Cataract 器械術式 P.P.V.- complicated 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 陳達慶, 時間資訊 13:10 報到 13:20 進入手術室 13:40 麻醉開始 13:45 麻醉結束 13:50 手術開始 14:55 手術結束 15:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 移位晶體摘除合併玻璃體切除術 1 1 L 記錄__ 手術科部: 眼科部 套用罐頭: PPV (RD全套) 開立醫師: 陳達慶 開立時間: 2010/05/14 14:52 Pre-operative Diagnosis Retained lens meterial (os) Post-operative Diagnosis Retained lens meterial (os) Operative Method PPLV (os) Specimen Count And Types Pathology NIL Operative Findings Retained lens meterial (os) in vitreous cavity Operative Procedures 1. Under retrobulbar anesthesia 2. Disinfection and draping as usual, apply an eyelid speculum. 3. peritomy and hemostasis with cautery. 4. suture of previous cataract wound with 10-0 mylon and form AC with viscoat 5. Three sclerotomy were made then apply light probe, microvit, and infusion line through the sclerotomy wounds. 6. Vitrectomy was performed with Microvit 7. remove of retained lens (nucleus) with fragmentone 8. reposition of dislocated IOL to AC with microforceps 9. made a PI with vitretor 10. Close sclerotomy wound with 9-0 Nylon 11. Close conjunctival wound with 8-0 Vicryl. 12. Subconjunctival injection of Rinderon and Gentamicin. 13. Latycin patching. Operators 何子昌, Assistants R4 陳芳婷 R3 陳達慶 陳王勉 (F,1939/04/12,72y11m) 手術日期 2010/05/14 手術主治醫師 何子昌 手術區域 東址 010房 04號 診斷 Cataract 器械術式 Phaco+PCIOL 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 11:12 進入手術室 11:29 手術開始 11:52 手術結束 11:58 送出病患 記錄__ 手術科部: 眼科部 套用罐頭: Phaco-Superior (何子昌) 開立醫師: 陳達慶 開立時間: 2010/05/14 08:18 Pre-operative Diagnosis Cataract (o ) Post-operative Diagnosis Cataract (o ) Operative Method Phacoemulsification and PCIOL implantation (o ) Specimen Count And Types Pathology Nil Operative Findings Cataract (o ) Operative Procedures 1. Under peribulbar anesthesia 2. Disinfection, irrigation and draping 3. Application of eyelid speculum 4. Made a clear corneal incision and penetrate into AC with 2.5mm trapezoid knife at 11 oclock position 5. Inject Viscoat into the anterior chamber 6. Continuous circular capsulorrhexis was done with bent needle and capsular forceps 7. Made a sideport at 3 oclock position with the MVR blade 8. Hydrodissection and hydrodelineation were done with BSS 9. Phacoemulsification of the nucleus by standard divide-and-conquer technique 10. Aspiration of the residual cortical material with I/A tube 11. Foldable PCIOL was implanted into the bag after injection of Viscoat 12. The residual Viscoat was washed outby Simcoe I/A cannula 13. Inject BSS into AC and check leakage, and inject Miostat to AC to constrict the pupil 14. Stromal hydration of the wound with BSS 16. Subconjunctival injection of Rinderon and Gentamycin 17. Lactycin patching Operators 何子昌, Assistants R4 陳芳婷 R3 陳達慶 劉家豪 (M,1996/12/27,15y2m) 手術日期 2010/05/14 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Cerebral aneurysm 器械術式 Craniotomy(Aneurysms) P-DUH 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 07:43 報到 08:25 進入手術室 08:30 麻醉開始 08:50 誘導結束 09:15 抗生素給藥 09:35 手術開始 12:28 抗生素給藥 13:55 麻醉結束 13:55 手術結束 14:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 開顱術摘除血管病變－腦血管瘤－有徵的 1 1 L 手術 顱內壓監視置入 1 4 L 手術 腦內血腫清除術 1 2 L 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: 1. Aneurysmal wrapping. 2. Evacuation of intr... 開立醫師: 陳盈志 開立時間: 2010/05/14 14:34 Pre-operative Diagnosis Ruptured middle cerebral artery pseudoaneurysm,left with intracerebral hemorrhage and acute hydrocephalus. Post-operative Diagnosis Ruptured middle cerebral artery pseudoaneurysm,left with intracerebral hemorrhage and acute hydrocephalus. Operative Method 1. Aneurysmal wrapping. 2. Evacuation of intracerebral hemorrhage. 3. Insertion of external ventricular drainage. Specimen Count And Types nil Pathology Nil. Operative Findings One wide based pseudoaneurysm was noted at left side M1 segment. The wall was fragile in character. The neck tear was noted and the true lumen wall was sutured continuously and then packed with fascia graft and tissue codul. Ischemia time was about 20 minutes. Operative Procedures Under the general anesthesia with endotracheal tube intubation, the patient was set into supine position with head tilt to right and vertex down and fixed with Mayfield. The operation field was scrubbed and disinfected with povidine-iodine and then drapped. Left side frontal-temporal scalp incision along previous wound was done. Remove previous miniplate screw and then the craniotomy window was removed. Curvilinear dura incision. Apply retractor to frontal lobe and hematoma evacuation was done. During hematoma evacuation, ruptured pseudoaneurysm was noted. We packed with cottonoid and sucker to expose the hole. Continuous suture closure was done with 10-0 prolene. Then we packed with surgicel till hemostasis. Then fascia graft and tissue codul was apllied alternatived to cover it. Hemostasis was done with bipolar and surgicel packing. EVD was inserted via Dandy point. Bone plate was fixed back with miniplate and silk. One subgaleal CWV drain was set. The wound was closed in layers. Operators P杜永光 Assistants R6陳盈志R4鍾文桂 林賴麗蓉 (F,1970/11/03,41y4m) 手術日期 2010/05/14 手術主治醫師 杜永光 手術區域 東址 003房 02號 診斷 Glioma 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 蔡宗良, 時間資訊 13:50 報到 14:34 進入手術室 14:35 麻醉開始 15:00 誘導結束 15:30 抗生素給藥 15:39 手術開始 18:30 抗生素給藥 19:05 手術結束 19:05 麻醉結束 19:12 抗生素給藥 19:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４～８小時 1 1 R 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Left side Pterion approach tumor excision 開立醫師: 蔡宗良 開立時間: 2010/05/14 19:01 Pre-operative Diagnosis Left uncus tumor suspect glioma Post-operative Diagnosis Left uncus tumor suspect glioma Operative Method Left side Pterion approach tumor excision Specimen Count And Types 1 piece About size:3x2.5x2 Source:left uncal tumor Pathology pending Operative Findings The tumor was soft whitish int character. It located at left side uncus. The margin is note clear. Focal swelling was noted. Operative Procedures Under ETGA, the patient was set into supine position with head tilt to left and fixed with Mayfield. The operation field was disinfected and drapped. Left frontal temporal curvilinear incision was done. Temporalis muscle was detached till temporal base expose with muscle cuff left along superior temporal line. Burr hole was made at key hole and then craniotomy window was done with saw. Dura tenting was done. The skull base was drilled to be flattened and spheoid ridge was drill till superior orbital fissure exposure. Linear dura incision was done and the dura was reflected as fish-mouth shape. Open the sylvian fissure with microscissor dissection. Apply retracter to temporal lobe and the tumor was identified at the medial side at uncus. Surface cauterization was done with bipolar and then the tumor central dubulking was done with tumor forceps. Then the sucker and bipolar was used to remove the tumor border till normal brain exposed. Arachnoid membrane was kept intact. Hemostasis was done with bipolar and surgicel packing. Dura was closed with 4-0 prolene and bone plate was fixed back with miniplate. One subgaleal CWV drain was set and the wound was closed in layers. Operators P杜永光 Assistants R6陳盈志R4蔡宗良 胡后欣 (F,1979/07/22,32y7m) 手術日期 2010/05/14 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Acromegaly 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳國瑋, 時間資訊 07:43 報到 08:08 進入手術室 08:25 麻醉開始 08:50 抗生素給藥 08:50 誘導結束 09:40 手術開始 11:25 麻醉結束 11:25 手術結束 11:31 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 經由蝶竇之腦下垂體瘤切除 1 1 手術 粘膜下中隔矯正術 1 2 摘要__ 手術科部: 外科部 套用罐頭: Endoscopic transsphenoid adenomectomy 開立醫師: 李建勳 開立時間: 2010/05/14 11:45 Pre-operative Diagnosis Pituitary macroadenoma Post-operative Diagnosis Pituitary macroadenoma Operative Method Microscopic transsphenoid adenomectomy Specimen Count And Types 1 piece About size:0.3g Source:transsphenoid adenomectomy Pathology Pending Operative Findings The tumor was yellowish, soft, size 1.8 cm in diameter, penetrated the anterior sella wall. The normal gland was found during tumor excision. The cerebrospinal fluid (CSF) leakage was sealed with Tissucol Duo. Some CSF leakage anterior to the dura was also sealed off. Operative Procedures Under general anethesia and intubation, the patient was put in supine position with head tilted 30 degree to left. The facial skin was antiseptic with alcohol better-iodine tincture, and the mucosa of oral and nasal cavity with aqueous better-iodine . The formerareas were covered by sterilized adhesive plastic sheets then draped. Under microscope, the nasal mucosa was infiltrated with Lidocine and Epidephrin then incised with surgical blade. Submucosal dissection and applied the nasal speculum to displace the nasal septum laterally and keep thenasal cavity open constantly for the exposure of the vomer bone and the anterior wall of the sphenoid sinus. The vomer bone and the anterior sphenoid wall was remove by osteotome and Kerrison punch. Under general anethesia and intubation, the patient was put in supine position with head tilted 30 degree to left. The facial skin was antiseptic with alcohol better-iodine tincture, and the mucosa of oral and nasal cavity with aqueous better-iodine . The formerareas were covered by sterilized adhesive plastic sheets then draped. Under microscope, the nasal mucosa was infiltrated with Lidocine and Epidephrin then incised with surgical blade. Submucosal dissection and applied the nasal speculum to displace the nasal septum laterally and keep thenasal cavity open constantly for the exposure of the vomer bone. The vomer bone and the anterior sphenoid wall was remove by osteotome and Kerrison punch. The residual posterior sphenoid wall was removed with Kerrison punch. The sellar floor dura was coagulated then opened in cruciate fashion. The soft tumor parenchyma was removed by curette and aligator. Checked the tumor cavity with endoscope. The arachnoid and the opening of diaphragm sellae was enforcedby packing with gelform and Tissuecol Duo as in the sellar cavity. The vomer bone was placed back and the nasal mucosa returned to its normal position. Right side of the nasal cavities was tightly packed with two segment of rubber glove finger filled with vaseline gauze strips which had been soaked with better-iodine ointment. The residual posterior sphenoid wall was removed with Kerrison punch. The sellar floor dura was coagulated then opened in cruciate fashion. The soft tumor parenchyma was removed by curette and aligator. Checked the tumor cavity with endoscope. The arachnoid and the opening of diaphragm sellae was enforcedby packing with gelform and Tissuecol Duo as in the sphenoid cavity. The vomer bone was placed back and the nasal mucosa returned to its normal position. Right side of the nasal cavities was tightly packed with two segment of rubber glove finger filled with vaseline gauze strips which had been soaked with better-iodine ointment. Operators VS 曾漢民 Assistants R1 陳國瑋 R6 李建勳 相關圖片 劉新堯 (M,1950/03/24,61y11m) 手術日期 2010/05/14 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Pituitary tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳國瑋, 時間資訊 11:05 報到 11:50 進入手術室 11:56 麻醉開始 12:25 誘導結束 12:35 抗生素給藥 12:43 手術開始 14:00 麻醉結束 14:00 手術結束 14:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經由蝶竇之腦下垂體瘤切除 1 1 手術 粘膜下中隔矯正術 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 摘要__ 手術科部: 內科部 套用罐頭: Microscopic transsphenoid adenomectomy 開立醫師: 李建勳 開立時間: 2010/05/14 14:24 Pre-operative Diagnosis Pituitary macroadenoma Post-operative Diagnosis Pituitary macroadenoma Operative Method Microscopic transsphenoid adenomectomy Specimen Count And Types 1 piece About size:0.2g Source:transsphenoid adenomectomy Pathology Pending Operative Findings The tumor was yellowish, soft, size 1.2 cm in diameter. The normal gland was found during tumor excision. The cerebrospinal fluid (CSF) leakage was sealed with Tissucol Duo. Operative Procedures Under general anethesia and intubation, the patient was put in supine position with head tilted 30 degree to left. The facial skin was antiseptic with alcohol Hibitan, and the mucosa of oral and nasal cavity with aqueous better-iodine . The former areas were covered by sterilized adhesive plastic sheets then draped. Under microscope, the nasal mucosa was infiltrated with Lidocine and Epidephrin then incised with surgical blade. Submucosal dissection and applied the nasal speculum to displace the nasal septum laterally and keep the nasal cavity open constantly for the exposure of the vomer bone. The vomer bone and the anterior sphenoid wall was remove by osteotome and Kerrison punch. The residual posterior sphenoid wall was removed with Kerrison punch. The sellar floor dura was coagulated then opened in cruciate fashion. The soft tumor parenchyma was removed by curette, aligator and suction. The arachnoid and the opening of diaphragm sellae was enforced by packing with gelform and Tissuecol Duo as in the sphenoid cavity. The vomer bone was placed back and the nasal mucosa returned to its normal position. Right side of the nasal cavities was tightly packed with two segment of rubber glove finger filled with vaseline gauze strips which had been soaked with better-iodine ointment. Operators VS 曾漢民 Assistants R1 陳國瑋 R6 李建勳 相關圖片 林原震 (M,1965/08/16,46y6m) 手術日期 2010/05/14 手術主治醫師 曾漢民 手術區域 東址 005房 03號 診斷 Lumbar stenosis 器械術式 Laminectomy for decompression 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳國瑋, 時間資訊 14:08 報到 14:30 進入手術室 14:35 麻醉開始 14:45 誘導結束 15:25 抗生素給藥 16:01 手術開始 18:25 抗生素給藥 18:45 手術結束 18:45 麻醉結束 19:00 送出病患 19:00 進入恢復室 21:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 手術 椎間盤切除術－腰椎 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 摘要__ 手術科部: 外科部 套用罐頭: Left L4/5 hemilaminectomy for bilateral decom... 開立醫師: 李建勳 開立時間: 2010/05/14 18:40 Pre-operative Diagnosis L4/5 herniated disc with stenosis Post-operative Diagnosis L4/5 herniated disc with stenosis Operative Method Left L4/5 hemilaminectomy for bilateral decompression and disckectomy Specimen Count And Types 1 piece About size:1g Source:Herniated disc Pathology Pending Operative Findings The left L4/5 protruding disc compressed the left L5 root. Thickened ligmentum flavum caused stenosis. Unintended durotomy was packing with fat tissue. The theca sac was relaxed after bilateral decompression and disckectomy. Operative Procedures Under general anesthesia and intubation, the patient was put in prone position. The L4 and L5 spinous processes were located with portable C-arm X-ray. The skin was scrubbed, disinfected with alcohol better iodine then draped. Midline skin incision was made and divided the left paraspinal muscle to expose the L4 and L5 laminae. Hemilaminectomy was performed with high speed air drill under surgical microscope. The ligmentum flavum was removed with Kerison punches. Disckectomy was performed with surgical blade and disc clumps while the theca sac protected with love retractor. The ligmentum flavum over midline and right side was removed to relax the theca sac. The unintended durotomy was packing with fat tissue. The dura was soaked with Rinderon solution. The dermis and fascia were infiltrated with Marcaine. The wound was then closed in layers. Operators VS 曾漢民 Assistants R1 陳國瑋 R6 李建勳 相關圖片 劉光傑 (M,1941/08/10,70y7m) 手術日期 2010/05/14 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Cervical myelopathy 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鄭孟伯, 時間資訊 07:38 報到 08:10 進入手術室 08:15 麻醉開始 08:20 誘導結束 09:00 抗生素給藥 09:05 手術開始 11:40 手術結束 11:40 麻醉結束 11:45 送出病患 11:47 進入恢復室 12:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術－頸椎 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 記錄__ 手術科部: 外科部 套用罐頭: HIVD 開立醫師: 胡朝凱 開立時間: 2010/05/14 11:50 Pre-operative Diagnosis Herniation of Intervertebral disk, C3/C4 Post-operative Diagnosis Herniation of Intervertebral disk, C3/C4 Operative Method HIVD Specimen Count And Types nil Pathology nil Operative Findings 1.Protrusion disc at C3~4 level that compressed the spinal cord tightly 2.After decompression, the cord expanded well 3.Mild OPLL was also noted. Operative Procedures 1. Supine, ETGA, skin-disinfection, drapped as usual 2. 5cm transverse incision made on the right side of neck at the postion infront of C3 and C4. 4. A spinal needle was inserted between spinous processes of C3 and C4, and a portable X-ray film was taken to locate the correct interspace. 3. Incision: 3-cm, to reach the intervetebral disk of C3/C4. 4. The paravertebral muscles were retracted 5. Under an operating microscope, the intervetebral disk of C3/C4 was removed by curator with suction. 6. After the complete removal of the C3/C4 disk, a intervertebral cage was inserted into the space previously occupied by C3/C4 intervertebral disk. 7. hemostasis by gelform with the aide of electrocouagulation knife. 8. A mini hemovac was placed 9. wound closure in layers Operators 賴達明 Assistants 胡朝凱, 鄭孟伯 記錄__ 手術科部: 外科部 套用罐頭: HIVD 開立醫師: 胡朝凱 開立時間: 2010/05/14 11:50 Pre-operative Diagnosis Herniation of Intervertebral disk, C3/C4 Post-operative Diagnosis Herniation of Intervertebral disk, C3/C4 Operative Method HIVD Specimen Count And Types nil Pathology nil Operative Findings 1.Protrusion disc at C3~4 level that compressed the spinal cord tightly 2.After decompression, the cord expanded well 3.Mild OPLL was also noted. Operative Procedures 1. Supine, ETGA, skin-disinfection, drapped as usual 2. 5cm transverse incision made on the right side of neck at the postion infront of C3 and C4. 4. A spinal needle was inserted between spinous processes of C3 and C4, and a portable X-ray film was taken to locate the correct interspace. 3. Incision: 3-cm, to reach the intervetebral disk of C3/C4. 4. The paravertebral muscles were retracted 5. Under an operating microscope, the intervetebral disk of C3/C4 was removed by curator with suction. 6. After the complete removal of the C3/C4 disk, a intervertebral cage was inserted into the space previously occupied by C3/C4 intervertebral disk. 7. hemostasis by gelform with the aide of electrocouagulation knife. 8. A mini hemovac was placed 9. wound closure in layers Operators 賴達明 Assistants 胡朝凱, 鄭孟伯 嚴小平 (F,1964/01/10,48y2m) 手術日期 2010/05/14 手術主治醫師 蕭輔仁 手術區域 東址 019房 02號 診斷 Back pain 器械術式 Malignant intraspinal tumor, e 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鄭孟伯, 時間資訊 12:30 報到 12:35 進入手術室 12:40 麻醉開始 13:00 誘導結束 13:30 抗生素給藥 13:45 手術開始 16:45 抗生素給藥 17:37 開始輸血 18:55 手術結束 18:55 麻醉結束 19:05 送出病患 19:10 進入恢復室 21:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 惡性病髓腫瘤切除術 1 1 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 麻醉 Lactic Acid (lactate) 2 0 記錄__ 手術科部: 創傷醫學部 套用罐頭: posterior approach for tumor excision and T11... 開立醫師: 胡朝凱 開立時間: 2010/05/14 19:03 Pre-operative Diagnosis T12, L2 malignant tumor metastasis Post-operative Diagnosis T12, L2 malignant tumor metastasis Operative Method posterior approach for tumor excision and T11, L1, L3~4 TPS Specimen Count And Types Pieces of tumors Pathology pending Operative Findings 1.yellowish and elastic tumor located at the left side of T12 and L2 pedicle and vertebral body. The tumor was hypervascular. 2.The nerve roots was compressed tightly. Operative Procedures 1.ETGA, prone 2.Midline incision at T11 to L4 level 3.Detach paravertebral muscle groups 4.TPS screws insertion 5.Laminectomy of T12 to L2 6.Further tumor excision was done 7.Hemostasis 8.Rods and cross link fixation 9.Set two hemovac drain then clsoe wound in layers Operators 蕭輔仁 Assistants 胡朝凱,鄭孟伯 黃金泉 (M,1955/04/20,56y10m) 手術日期 2010/05/14 手術主治醫師 王國川 手術區域 東址 002房 04號 診斷 Subdural hemorrhage 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 陳睿生, 時間資訊 09:39 通知急診手術 09:39 臨時手術NPO 09:39 開始NPO 12:25 進入手術室 12:30 麻醉開始 12:40 誘導結束 13:20 抗生素給藥 13:50 手術開始 14:40 開始輸血 16:20 抗生素給藥 16:30 手術結束 16:30 麻醉結束 16:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 顱骨切除術，包括異物移除或減壓或神經切斷 1 2 L 摘要__ 手術科部: 外科部 套用罐頭: Craniectomy, and duroplasty 開立醫師: 陳睿生 開立時間: 2010/05/14 16:55 Pre-operative Diagnosis Chronic subdural hemorrhage with brain swelling Post-operative Diagnosis Chronic subdural hemorrhage with brain swelling Operative Method Craniectomy, and duroplasty Decompressive craniectomy, and duroplasty Specimen Count And Types 3 pieces About size:1ml Source:C-SDH fluid, for CSF routine About size:1ml Source:C-SDH fluid, for CSF BCS About size:1ml Source:C-SDH fluid, for CSF lactic acid Pathology Nil Operative Findings The brain was moderate swelling, and palsated. Thicken outer membrane was noted and some dark brownish fluid was found inside. The outer membrane was removed and the dura was augmentated with fascia graft. Operative Procedures 1. ETGA, supine position with head right turn 2. Reopen the previous scalp wound and extend to the temporal and parietal side as a trauma flap 3. Dissect the temporalis muscle to expose the previous skull defect 4. Make two bur holes at key hole and temporal side, and extend the craniectomy window to about 12x12 cm 5. Proper dura tacking, and the dura was opened in a curvillinear shape 6. Remove of the outer membrane of the subdural hemorrhage and drain out the fluid inside 7. Excise the temporalis muscle and extract the fascia 8. Duroplasty with fascia graft and Durafoam graft 9. Hemostasis, set an epidural CWV drain 10.Close the wound in layers Operators VS 王國川 Assistants R5 陳睿生; Ri Indication Of Emergent Operation 惲煒立 (M,1936/01/09,76y2m) 手術日期 2010/05/15 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 胡朝凱, 時間資訊 07:40 報到 08:00 進入手術室 08:10 麻醉開始 08:35 誘導結束 08:45 抗生素給藥 09:15 手術開始 11:15 麻醉結束 11:15 手術結束 11:25 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 腦瘤切除－手術時間在４小時以內 1 1 記錄__ 手術科部: 外科部 套用罐頭: Craniotomy for tumor excision 開立醫師: 胡朝凱 開立時間: 2010/05/15 11:48 Pre-operative Diagnosis Right occipital tumor Post-operative Diagnosis Right occipital tumor Operative Method Craniotomy for tumor excision Specimen Count And Types one piece of tumor Pathology pending Operative Findings 1.One whitish elastic firm tumor around 2.5 cm located at right occipital area. The margin was relative clear. 2.Peripheral brain became swelling Operative Procedures 1.ETGA, prone with head fixed with skull clamp 2.Reverse U shape skin incision at right occipital area 3.Craniotomy 4.Open dura with the base left at midline 5.Identify tumor with echo 6.Dissect tumor along with the border between tumor and brain 7.Hemostasis 8.Close dura with one piece of fascia 9.Fix bone back with miniplate 10.Close wound in layers Operators 曾漢民 Assistants 胡朝凱,Ri 張友鼎 (M,1930/10/13,81y5m) 手術日期 2010/05/15 手術主治醫師 曾勝弘 手術區域 東址 003房 01號 診斷 Malignant melanoma of skin 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 陳國瑋, 時間資訊 07:42 報到 08:00 進入手術室 08:15 麻醉開始 08:50 誘導結束 09:00 抗生素給藥 09:47 手術開始 12:00 抗生素給藥 14:50 麻醉結束 14:50 手術結束 15:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４～８小時 1 1 L 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 摘要__ 手術科部: 外科部 套用罐頭: suboccipital craniotomy tumor excision 開立醫師: 陳盈志 開立時間: 2010/05/15 14:43 Pre-operative Diagnosis Left cerebellum tumor suspect melanoma Post-operative Diagnosis Left cerebellum tumor suspect melanoma Operative Method suboccipital craniotomy tumor excision Specimen Count And Types 1 piece About size:multiple fragments Source:left cerebellum tumor Pathology pending Operative Findings The tumor was black sandish in character. It located at left cerebellum and the border was clear. Operative Procedures 1.ETGA, prone with head fixed with Mayfield 2.Skin preparation 3.T shape dura incision 4.Detach muscle to expose foramen magnum to C2 5.Burr hole x 5 then craniotomy was done with saw 6.C-shape dura incision after echo localization 7.Corticotomy 2cm then retract brain to expose the lesion 8.Remove tumor piece by piece with tumor forceps. 9.Hemostasis with surgicel and bipolar 10.close dura with fascia graft and 4-0 prolene 11.Fix bone plate with wire 12.subgaleal CWV drain x 1 13.close wound in layers. Operators VS曾勝弘 Assistants R6陳盈志R1陳國瑋 閔戩 (M,1988/04/09,23y11m) 手術日期 2010/05/15 手術主治醫師 蔡翊新 手術區域 東址 002房 02號 診斷 Other and unqualified skull fracture, closed with cerebral laceration and contusion, with concussion 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 污染 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 1 紀錄醫師 黃柏誠, 時間資訊 12:34 通知急診手術 13:50 報到 14:00 進入手術室 14:20 麻醉開始 14:30 誘導結束 14:44 抗生素給藥 15:09 手術開始 17:40 麻醉結束 17:40 手術結束 17:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 硬腦膜外血腫清除術 1 1 R 手術 顱內壓監視置入 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 蔡翊新 開立時間: 2010/05/15 17:40 Pre-operative Diagnosis Right frontal open depressed skull fracture with epidural hemorrhage and right frontal lobe contusion. Post-operative Diagnosis Right frontal open depressed skull fracture with epidural hemorrhage and right frontal lobe contusion. Operative Method Right frontal craniectomy for removal of epidrual hematoma and debridement. Right frontal intraparenchymal ICP monitoring. Specimen Count And Types 1.for pathology, About size:2 x 2 cm, several pieces in one jar Source:right frontal bone 2.for culture, About size:2 x 1 cm, two pieces, Source:right frontal bone Pathology Pending. Operative Findings 1. A 7 cm irregular skin laceration s/p stapling at right forehead, extended from right eyebrow upward. 2. Initial ICP: 12 mmHg. 3. Comminuted, depressed skull fracture, about 6 x 3 cm, at right frontal bone, extended from orbital rim. The inner table of right frontal sinus was also fractured and the mucosal lining was exposed. There was EDH about 1 cm in thickness, mixed with fracture skull bone chips and some blue foreign bodies, possibly paint on helmet. There was a tiny dural tear, about 0.3 cm in length, without evident subdural entry of bone or foreign body. 4. ICP after skin closure was about 15 mmHg. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 4 cm at right frontal area, the skin edge was clipped by Raney clips for temporary hemostasis. 5. A burr hole was made at right frontal area for ICP monitor insertion at right frontal lobe. The wound was closed before opening the right forehead wound. 6. Right forehead wound staples were removed and the wound was extended superiorly about 1 cm in length (whole length about 8 cm). 7. The debris of fractured skull and EDH were removed carefully. The final craniectomy window was about 6 x 3 cm in size. The mucosa of frontal sinus was removed and the frontal sinus was packed with Gelfoam soaking in aquaous better-iodine solution. 8. Dural tenting: by 2/0 silk, 1.5 cm in interval, distributed along the edge of skull window. 9. Dural closure: using 4-0 Prolene to close the dural tear. 10.Hemosatasis: the epidural bleeders were stopped packing with gelfoam and oozing from the bone marrow was packed with bone wax. 11.Scalp closure: Galea suture was performed by interrupted suture with 2/0 Vicryl and skin by interrupted suture with 5/0 nylon. 12.Drain: one, epidural, CWV. 13.Blood transfusion: nil. 14.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R3曾峰毅R2黃柏誠 Indication Of Emergent Operation 李瑞廣 (M,1925/06/23,86y8m) 手術日期 2010/05/15 手術主治醫師 蔡翊新 手術區域 東址 001房 05號 診斷 Other and unspecified intracranial hemorrhage following injury, unspecified state of consciousness 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3E 紀錄醫師 陳建銘, 時間資訊 00:26 臨時手術NPO 00:26 開始NPO 19:26 通知急診手術 21:15 報到 21:15 進入手術室 21:20 麻醉開始 21:40 抗生素給藥 21:45 誘導結束 22:15 手術開始 00:40 抗生素給藥 01:40 麻醉結束 01:40 手術結束 01:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 腦內血腫清除術 1 1 R 手術 顱內壓監視置入 1 2 R 摘要__ 手術科部: 外科部 套用罐頭: CVA 開立醫師: 蔡翊新 開立時間: 2010/05/16 00:53 Pre-operative Diagnosis Head injury with left occipital skull fracture, bilateral frontal contusion ICH, more at right side. Post-operative Diagnosis Head injury with left occipital skull fracture, bilateral frontal contusion ICH, more at right side. Operative Method Right frontotemporal craniotomy for ICH evacuation and subdural ICP monitoring. Specimen Count And Types nil Pathology Nil. Operative Findings Subdural hematoma, about 0.5 cm in thickness, was noted upon opening the dura at right frontal area. Contusional ICH, about 6 x 4.7 x 4.5 cm (60 ml, measured from CT scan), was evacuated from anterior part of right frontal lobe. The adjacent brain tissue was fragile and easy touch-bleeding. After hematoma evacuation, the brain was slack and ICP was around 2 mmHg. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: right frontotemporal, curvilinear, extended across midline. The skin edge was clipped by Raney clips for temporary hemostasis. 5. Craniotomy: A 8 x 6 cm craniotomy was made at right frontotemporal area, with the medial border 1 cm away from midline and inferior border 1.5 cm above frontal base. 6. Dural tenting: by 2/0 silk, 1.5 cm in interval, distributed along the edge of skull window. 7. Dural incision: curvilinear along the craniotomy window and another limb leading to medioinferior border. 8. A 5 cm cortical incision was made at 5 cm posterior to right frontal tip. The hematoma and contused brain were sucked out carefully. Those taugh clot was removed by forceps. The cavity was irrigated with NS and the blood oozing was stopped by bipolar coagulation and Surgicel packing. Before closure of the dura, the hematoma caivty was clean and the brain once bulging was very slack. 9. A Codman ICP monitor was placed at subdural space. 10.Dural closure: interrupted 2/0 silk sutures for key stitches, then continous sutures with 4/0 Prolene to obtain water-tight closure. 11.The craniotomy bone plate was fixed back with miniplates and screws. 12.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 13.Drain: one epidural and one subgaleal CWV drains. 14.Blood transfusion: nil. 15.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R3曾峰毅R1陳建銘 Indication Of Emergent Operation 連正義 (M,1938/11/09,73y4m) 手術日期 2010/05/16 手術主治醫師 賴達明 手術區域 東址 002房 03號 診斷 Bacterial meningitis 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 4E 紀錄醫師 陳睿生, 時間資訊 00:01 開始NPO 12:01 臨時手術NPO 21:17 通知急診手術 22:23 報到 22:23 進入手術室 22:25 麻醉開始 22:30 誘導結束 22:55 手術開始 23:00 抗生素給藥 23:20 麻醉結束 23:20 手術結束 23:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 手術 腦室體外引流 1 1 R 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: EVD via right Kocher^s point 開立醫師: 陳睿生 開立時間: 2010/05/16 23:43 Pre-operative Diagnosis Meningitis with acute hydrocephalus Post-operative Diagnosis Meningitis with acute hydrocephalus Operative Method EVD via right Kocher^s point Specimen Count And Types 6 pieces About size:2.5ml Source:CSF About size:2.5ml Source:CSF About size:2.5ml Source:CSF About size:2.5ml Source:CSF About size:2.5ml Source:CSF About size:2.5ml Source:CSF Pathology Nil Operative Findings The CSF was clear but the ICP was extremely high. The EVD was about 6.5cm in depth. Operative Procedures 1. ETGA, supine position 2. Linear incision at right frontal region 3. Create a bur hole at Kocher^s point 4. Dura tacking, and open the dura 5. Punch the ventricle, and insert the EVD about 6.5cm in depth 6. Hemostasis, close the wound in layers Operators VS 賴達明 Assistants R5 陳睿生 Indication Of Emergent Operation 陳寬邦 (M,1946/05/12,65y10m) 手術日期 2010/05/16 手術主治醫師 賴達明 手術區域 東址 002房 02號 診斷 Subdural hemorrhage following injury and with unspecified concussion 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 4E 紀錄醫師 鍾文桂, 時間資訊 08:00 開始NPO 13:30 通知急診手術 17:10 報到 17:10 進入手術室 17:13 麻醉開始 17:20 誘導結束 17:55 抗生素給藥 18:10 手術開始 19:25 麻醉結束 19:25 手術結束 19:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 B 手術 慢性硬腦膜下血腫清除術 1 2 B 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Burr holes for drainage of chronic subdural h... 開立醫師: 鍾文桂 開立時間: 2010/05/16 19:48 Pre-operative Diagnosis Bilateral chronic subdural hemorrhage. Post-operative Diagnosis Bilateral chronic subdural hemorrhage. Operative Method Burr holes for drainage of chronic subdural hemorrhage. Specimen Count And Types nil Pathology Nil. Operative Findings Motor-oil like liquified hematoma drained out from rubber drains. Poor brain expansion. Operative Procedures 1.Under ETGA, the patient was put in supine position and head was placed in the midline. 2. After shaving, disinfection, and draping, one linear 3-cm scalp incision and a following burr hole were made at each side. 3. Dura tenting was done after well hemostasis of the scalp incision. 4. After durotomy, the liquified hematoma was drained from the rubber drains. 5. Then, the wound was closed in layers after fixation of the rubber drains. 6. We irrigated the subdural space with normal saline and further evacuated the subdural air. 7. Finally, the closed drainage system was set. 8. The patient was sent to ICU smoothly. Operators V.S. 賴達明. Assistants R5陳睿生,R4 鍾文桂,R1陳乃涓. Indication Of Emergent Operation 李正勇 (M,1939/02/23,73y0m) 手術日期 2010/05/17 手術主治醫師 何子昌 手術區域 西址 032房 04號 診斷 Central retinal vein occlusion 器械術式 Aspiration of vitreous 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 13:25 進入手術室 13:28 麻醉開始 13:30 手術開始 13:33 手術結束 13:33 麻醉結束 13:35 送出病患 摘要__ 手術科部: 眼科部 套用罐頭: IVIA 開立醫師: 何子昌 開立時間: 2010/05/17 13:30 Pre-operative Diagnosis macular edema Post-operative Diagnosis Ditto Operative Method Intravitreal Injection Of Avastin(OS) Specimen Count And Types nil Pathology nil Operative Findings nil Operative Procedures 1.Under topical anesthesia. 2.Disinfection and draping as usual. 3.Apply an eyelid speculum. 4.Intravitreal injection of Avastin 0.05ml 5.Check leakage 6.Iop measurement by digit 7.Check bare VA>ND100cm Operators 何子昌, Assistants 李毅安, 盧翁素珠 (F,1947/06/29,64y8m) 手術日期 2010/05/17 手術主治醫師 住院醫師 手術區域 西址 032房 12號 診斷 Breast cancer, female 器械術式 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 14:50 進入手術室 15:00 麻醉開始 15:05 手術開始 醫令資訊 類別 名稱 量 刀 側 手術 肌肉或深部組織腫瘤切除術及異物取出術 1 1 R 記錄__ 手術科部: 套用罐頭: removal of Port-A/Permcath 開立醫師: 吳晉睿 開立時間: 2010/05/17 15:40 Pre-operative Diagnosis Breast cancer s/p chemotherapy Post-operative Diagnosis Breast cancer s/p chemotherapy Operative Method Removal of Port-A catheter, right side Specimen Count And Types nil Pathology nil Operative Findings Port-A catheter was removed totally and the course was smooth Operative Procedures The patient was put on supine position. The operation field was disinfected and draped as usual. Under local anesthesia, the right side Port-A catheter was removed from previous wound smoothly. The wound was irrigated and closed in layers. Post-op care plan: 1.wound CD QD+PRN 2.pain control with Tinten 3.prophylatic antibiotics use Operators VS黃約翰 Assistants R2廖先啟 張圳 (M,1928/01/15,84y1m) 手術日期 2010/05/17 手術主治醫師 蕭輔仁 手術區域 東址 001房 02號 診斷 Prostate cancer 器械術式 Laminectomy for decompression，Malignant intraspinal tumor, e 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3E 紀錄醫師 胡朝凱, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 07:00 通知急診手術 09:55 報到 10:37 進入手術室 10:40 麻醉開始 11:15 誘導結束 12:00 抗生素給藥 12:03 手術開始 13:55 麻醉結束 13:55 手術結束 14:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 惡性病髓腫瘤切除術 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: T1~3 laminectomy and T2 partial tumor excision 開立醫師: 胡朝凱 開立時間: 2010/05/17 14:22 Pre-operative Diagnosis Tumor T2 metastasis Post-operative Diagnosis Tumor T2 metastasis Operative Method T1~3 laminectomy and T2 partial tumor excision Specimen Count And Types pieces of tumor Pathology pending Operative Findings 1.Fragile and yellowish tumor at T2 area that compressed the spinal cord tightly was noted. 2.After decompression, spinal cord expanded well Operative Procedures 1.ETGA, rpone 2.Midline incision at T1~3 level 3.Detach paravertebral muscle group 4.Expose T1~3 lamina 5.Laminectomy 6.Tumor excision 7.Hemostasis 8.Set hemovac drain 9.Close wound in layers Operators 蕭輔仁 Assistants 胡朝凱, Ri Indication Of Emergent Operation 施冠聿 (M,1973/06/01,38y9m) 手術日期 2010/05/17 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Carotid body tumor 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3 紀錄醫師 鍾文桂, 時間資訊 07:38 報到 08:00 進入手術室 08:10 麻醉開始 09:10 誘導結束 10:00 抗生素給藥 10:14 手術開始 13:00 抗生素給藥 15:50 麻醉結束 15:50 手術結束 16:10 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 7 0 手術 頸動脈體瘤切除術 1 1 R 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Anterior approach subtotal tumor excision 開立醫師: 鍾文桂 開立時間: 2010/05/17 15:52 Pre-operative Diagnosis Right side carotid body tumor Post-operative Diagnosis Right side carotid body tumor Operative Method Anterior approach subtotal tumor excision Specimen Count And Types 1 piece About size:4x3x3cm Source:right side carotid body tumor Pathology pending Operative Findings The tumor was hard elastic in character. It was capsulated and severe adhesion between the tumor and the carotid artery was noted, which may because of previous operation. Due to severe adhesion and easy bleeding, subtotal tumor excision was done. Operative Procedures Under the general anesthesia with endotracheal tube intubation, the patient was set into supine position with neck extension and rotated to left and head fixed with Mayfield. The operation field was scrubbed and disinfected with povidine iodine and then drapped well. Right neck incision was done along previous wound under microscope. Platysma was opened and dissect to expose previous anastomosis and carotid artery and hypoglossal nerve. Identify the tumor behind the carotid artery. The plane between tumor wall and artery wall was identified. The tumor was sutured with silk as retraction and then dissection was made along the tumor wall with bipolar cauterize the surface. Dissection was made circumferentially then pull the tumor out. Hemostasis with Flocil and bipolar. The wound was closed in layers. Operators P杜永光 Assistants R6陳盈志R4鍾文桂 闕心彤 (F,1950/10/02,61y5m) 手術日期 2010/05/17 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Hemangioma of intracranial structures 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3 紀錄醫師 陳國瑋, 時間資訊 07:35 報到 08:02 進入手術室 08:08 麻醉開始 08:50 誘導結束 09:00 抗生素給藥 09:32 手術開始 12:00 抗生素給藥 12:08 麻醉結束 12:08 手術結束 12:13 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: frontal craniotomy for Simpson grade II tumor excision 開立醫師: 李建勳 開立時間: 2010/05/17 12:05 Pre-operative Diagnosis Right intraorbital tumor suspect hemangioma Post-operative Diagnosis Right intraorbital hemangioma Operative Method Right frontal craniotomy for total tumor excision Specimen Count And Types 1 piece About size:1g Source:craniotomy for tumor excision Pathology Pending Operative Findings The tumor was reddish, size 1.5cm in diameter, located inferior to superior rectus muscle of right eye. The margin was clear and the tumor was dissected in one piece. The cranial nerve (CN) III was perserved well. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position with head fixed with Mayfield skull clump. The scalp was shaved, scrubbed, disinfected with alcohol better-iodine then draped. The bicoronal scalp incision was made followed by right frontal craniotomy. The dura tenting was made along the craniotomy window. The orbital roof was drilled opened with high speed air drill. The tumor was found after opened the periorbital fat and dissected from the surrounding normal musles with dissector. The vessel at pedicle was coagulated wtih bipolar cautery. Hemostasis was achieved with Sirgicel lining of the tumor bed. The periorbital fat was cloased with 6-0 Nylon sutures and the orbital roof was put back in place. The dura was tenting to the orbital bone. The skull plate was fixed back with miniplates and screws after one subgaleal close wound vaccum drain set up. The wound was then closed in layers. Operators VS 曾漢民 Assistants R1 陳國瑋 R6 李建勳 相關圖片 羅海萍 (F,1959/10/06,52y5m) 手術日期 2010/05/17 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Acoustic neuroma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 陳國瑋, 時間資訊 11:50 報到 12:30 進入手術室 12:35 麻醉開始 12:55 誘導結束 13:00 抗生素給藥 13:33 手術開始 14:35 開始輸血 16:00 抗生素給藥 18:30 麻醉結束 18:30 手術結束 18:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 顱底瘤手術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Retrosigmoid approach for near total tumor ex... 開立醫師: 李建勳 開立時間: 2010/05/17 19:06 Pre-operative Diagnosis Left cerebellopotine angle(CPA) tumor Post-operative Diagnosis Left cerebellopotine angle(CPA) tumor Operative Method Retrosigmoid approach for near total tumor exicision Specimen Count And Types 1 piece About size:1g Source:CPA tumor excision Pathology Pending Operative Findings The cerebellum was swelling while opening the dura. The tumor was soft-elastic, size 2cm in diameter with cystic formation. The tumor was adhered to the brain stem and was not able to completely seperated from the brain stem. One thin piece of the tumor was left in situ to prevent futher brain stem damage. The distal part of facial nerve was detected with bipolar stimulator but the proximal end was not definitly found. Operative Procedures Under general anesthesia and intubation, the patient was put in Park-Bench position with head fixed with Mayfield skull clump. The scalp was shaved, scrubbed, disinfected with alcohol better-iodine then draped. The curvilinear scalp incision was made at left retroauricular area followed by craniotomy. The dura was opened along the posterior craniotomy window after tenting. The cerebrospinal fluid (CSF) was drained out for relaxation of the cerebellum. The tumor was found after retraction of the cerebellum. Tumor excision was performed with bipolar coagulator and tumor forceps. The border was seperated with dissector under surgical microscope. The cranial nerves were detected with bipolar stimulator. The last piece of the tumor was left in situ to prevent further brain stem damage. The duroplasty was performed with fascia graft and 4-0 Prolene sutures. The skull plate was fixed back with miniplates and screws. The wound was then closed in layers after one subgaleal close wound vaccum drain set up. Operators VS 曾漢民 Assistants R1 陳國瑋 R6 李建勳 相關圖片 鞏台興 (M,1965/08/07,46y7m) 手術日期 2010/05/17 手術主治醫師 賴達明 手術區域 東址 002房 01號 診斷 Intracerebral hemorrhage 器械術式 External ventricular drainage，Craniotomy(Aneurysms) VS-TZENG 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3E 紀錄醫師 陳睿生, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 07:00 通知急診手術 08:25 進入手術室 08:28 麻醉開始 08:30 誘導結束 09:15 抗生素給藥 10:09 手術開始 12:10 抗生素給藥 12:10 開始輸血 15:10 抗生素給藥 16:35 手術結束 16:35 麻醉結束 16:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 8 0 手術 開顱術摘除血管病變－腦血管瘤－有徵的 1 1 R 手術 顱內壓監視置入 1 2 R 摘要__ 手術科部: 外科部 套用罐頭: Right pterion approach for aneurysm clipping,... 開立醫師: 陳睿生 開立時間: 2010/05/17 17:27 Pre-operative Diagnosis Right A-com aneurysm rupture with diffuse SAH Post-operative Diagnosis Right A-com aneurysm rupture with diffuse SAH Operative Method Right pterion approach for aneurysm clipping, EVD insertion via right King^s point Specimen Count And Types nil Pathology Nil Operative Findings Diffuse SAH was noted while dura opening. The sneurysm was noted at right side A-com, A1-A2 junction. It was about 8mm in diameter, and was clipped with a beyonet shape Sugita clip. Post-op bilateral A1-2 flow were fair. Suspect a right side recurrent artery from right A1 was ligated intra-op. The EVD was inserted from right side King^s point and the depth was about 6.5cm. The initial ICP was about 15cm H2O, and the CSF was xanthochromic pattern. Diffuse SAH was noted while dura opening. The aneurysm was noted at right side A-com, A1-A2 junction. It was about 8mm in diameter, and was clipped with a beyonet shape Sugita clip. Post-op bilateral A1-2 flow were fair. Suspect a right side recurrent artery from right A1 was ligated intra-op. The EVD was inserted from right side King^s point and the depth was about 6.5cm. The initial ICP was about 15cm H2O, and the CSF was xanthochromic pattern. Operative Procedures 1. ETGA, supine position and head left turn, fixed with Mayfield clump 2. Rigth frontotemporal curvillinear scalp incision 3. Dissect the temporalis muscle, and create three burr holes at key hole, right temporal region 4. An about 6x8 cm craniotomy window was made 5. Dura tacking, and repair the rigth frontal sinus 6. Dura opening, and a King^s point EVD was inserted about 6.5cm in depth for decompression 7. Open the sylvian fissure, and retract the right frontal lobe upward 8. Identify the right side ICA and optic nerve 9. Suck out the rigth side rectal gyrus, and trace the right A1 to localize the A-com 10.Adhesionlysis to expose the aneurysm, and dissect the neck carefully 11.Clip the aneurysm with a beyonet shape Sugita clip with right A1 temporary clipping about 6 minutes 11.Clip the aneurysm with a beyonet shape Sugita clip with right A1 temporary clipping about 6 minutes, the aneurysm was fenestrated after clipping 12.Hemostasis with surgicel, and close the dura tightly after proper deair 13.Fix the EVD and set an epidural CWV drain 14.Central tacking, and fix the skull graft with miniplates x3 15.Close the temporalis muscle and scalp in layers Operators VS 賴達明 Assistants R5 陳睿生, Ri Indication Of Emergent Operation 顏王阿續 (F,1933/08/27,78y6m) 手術日期 2010/05/17 手術主治醫師 王國川 手術區域 東址 019房 03號 診斷 Major trauma rated 16 or above on the severeity scale ( Injury severeity score >=16 ) 器械術式 Subtemporal decompression -bil 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 3E 紀錄醫師 李建勳, 時間資訊 20:36 通知急診手術 21:00 進入手術室 21:05 麻醉開始 21:25 誘導結束 21:38 抗生素給藥 21:42 手術開始 00:38 抗生素給藥 01:21 開始輸血 03:25 手術結束 03:25 麻醉結束 03:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 腦內血腫清除術 1 1 B 手術 顱內壓監視置入 1 2 B 摘要__ 手術科部: 外科部 套用罐頭: (1)Left craniectomy for hematoma evacuation a... 開立醫師: 李建勳 開立時間: 2010/05/18 04:13 Pre-operative Diagnosis Bilateral traumatic acute subdural hematoma(SDH) and intracerebral hematoma(ICH) Post-operative Diagnosis Bilateral traumatic acute SDH and ICH Operative Method (1)Left craniectomy for hematoma evacuation and ICP monitor insertion. (2)Right craniotomy for hematoma evacuation. Specimen Count And Types nil Pathology Nil Operative Findings The brain was not bulging out after opened the dura. The acute subdural hematoma was noted at left temporal and forntal area for about 1.5 cm. Left frontal partial lobectomy was performed for hemostasis. The left temporalis muscle was resected for decompression. The reference of intracranial pressure (ICP) monitor: 502. Right temporal skull fracture was noted after refletion of the scalp. The right subdural hematoma was also noted for 1.5 cm after opened the dura. The ICP was 2 mmHg after both side operations. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position with head turned to right. The scalp was shaved, scrubbed, disinfected with alcohol better-iodine then draped. Traumatic scalp flap was created followed by craniectomy by high speed air dril. The dura was tenting along the craniectomy window then opened the dura. The subdural and intracerebral hematoma were removed. The left frontal lobe was partially removed for achieve hemostasis. The duroplasty was performed with fascia graft with 4-0 Prolene sutures. The left temporalis muscle was resected for decompression. ICP monitor was inserted and tested for funtion. Two subgaleal closed wound vaccums were set up before closed the wound in layers. Reposition the patient with head turned to left. The scalp was shaved, scrubbed, disinfected with alcohol better-iodine then draped. The right craniotomy was made after traumatic scalp incision. The dura was tenting along the craniotomy window then opened. Subdural hematoma was removed with suction and hemostasis with Surgicel lining of the bridging veins. The skull plate was put back with wires. The wound was closed in layers after one subgaleal CWV drain set up. Operators VS 王國川 Assistants R2 楊惠馨 R4 蔡宗良 R6 李建勳 Indication Of Emergent Operation 相關圖片 李銘偉 (M,1982/11/12,29y4m) 手術日期 2010/05/17 手術主治醫師 黃培銘 手術區域 東址 000房 號 診斷 Subdural hemorrhage following injury, with loss of consciousness of unspecified duration 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 趙安怡 ASA 4 紀錄醫師 鄒冠全, 時間資訊 23:59 臨時手術NPO 13:33 報到 13:33 進入手術室 13:45 麻醉開始 13:47 誘導結束 13:50 手術開始 14:08 麻醉結束 14:08 手術結束 14:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 氣管切開造口術 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 鄒冠全 開立時間: 2010/05/17 14:23 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Ditto Operative Method Tracheostomy Specimen Count And Types nil Pathology None Operative Findings Fr . 8 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators 黃培銘 Assistants R2鄒冠全 唐美蓉 (F,1951/01/01,61y2m) 手術日期 2010/05/18 手術主治醫師 曾勝弘 手術區域 東址 005房 02號 診斷 Infection and inflammatory reaction due to nervous system device, implant, and graft 器械術式 Debridment-- 5-10cm 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 胡朝凱, 時間資訊 12:50 報到 13:40 進入手術室 13:50 麻醉開始 13:55 誘導結束 14:16 手術開始 15:22 麻醉結束 15:23 手術結束 15:25 送出病患 15:30 進入恢復室 16:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 深部複雜創傷處理－傷口長５－１０公分者 1 0 L 記錄__ 手術科部: 外科部 套用罐頭: Left wound debridement 開立醫師: 胡朝凱 開立時間: 2010/05/18 15:36 Pre-operative Diagnosis Left neck DBS wound infection Post-operative Diagnosis Left neck DBS wound infection Operative Method Left wound debridement Specimen Count And Types granulation tissue Pathology pending Operative Findings 1.Yellowish and necrotic tissue was noted at the wound area 2.Granulation tissue was also noted surround the wires 3.Thin skin Operative Procedures 1.ETGA, supine 2.Left wound incision 3.Open wound then dissect the granulation tissue 4.bursectomy 5.Further debridement 6.Close wound in layers Operators 曾勝弘 Assistants 胡朝凱 賴玉香 (F,1962/07/18,49y7m) 手術日期 2010/05/18 手術主治醫師 曾勝弘 手術區域 東址 001房 02號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 陳盈志, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 08:33 通知急診手術 11:05 報到 11:35 進入手術室 11:45 麻醉開始 12:10 誘導結束 12:55 手術開始 13:00 抗生素給藥 16:00 抗生素給藥 19:00 麻醉結束 19:00 手術結束 19:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 7 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 顱底瘤手術 1 1 摘要__ 手術科部: 外科部 套用罐頭: Subfrontal approach total tumor excision Simp... 開立醫師: 陳盈志 開立時間: 2010/05/18 19:31 Pre-operative Diagnosis Olfactory groove meningioma Post-operative Diagnosis Olfactory groove meningioma Operative Method Subfrontal approach total tumor excision Simpson grade II Specimen Count And Types 1 piece About size:4x4x3.5 Source:olfactory groove meningioma Pathology pending Operative Findings The tumor was elastic hard in character. It has attachment at olfactory groove and the arachnoid plane was clear. The brain was swelling. The tumor was bilobulated and divided by the falx. Operative Procedures 1.ETGA, supine with head extension 2.Disinfection and drapping 3.Bicoronal scalp incision 4.Burr hole x 3 then right frontal craniotomy 5.U shape dura incision after dura tenting 6.Right subfrontal approach retract frontal lobe, partial frontal tip resection was done due to swelling brain. 7.Meningioma was identified and devascularization was done with bipolar along olfactory groove which was attached by the tumor. 8.Central debulking of the tumor with bipolar and scissors then gradually pull the tumor out alternatively. 9.Remomove the tumor along the arachnoid plane. 10.hemostasis with bipolar and surgicel packing. 11.Dura closure with fascia graft and 4-0 prolene 12.Fix bone plate with miniplate 13.close wound in layers. Operators VS曾勝弘 Assistants R6陳盈志Ri Indication Of Emergent Operation 陳燦桐 (M,1948/12/02,63y3m) 手術日期 2010/05/18 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Glioblastoma 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 胡朝凱, 時間資訊 07:40 報到 08:03 進入手術室 08:10 麻醉開始 08:40 誘導結束 08:45 抗生素給藥 09:13 手術開始 11:40 開始輸血 11:45 抗生素給藥 13:23 麻醉結束 13:23 手術結束 13:25 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除－手術時間在４～８小時 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Craniotomy for tumor excision 開立醫師: 胡朝凱 開立時間: 2010/05/18 13:24 Pre-operative Diagnosis right temporal glioma Post-operative Diagnosis right temporal glioma Operative Method Craniotomy for tumor excision Specimen Count And Types pieces of tumor Pathology Frozen: GBM Operative Findings 1.One grayish, soft, and irregular shape tumor located at right temporal area with invasion behavior. 2.The tumor was hypervascular. 3.The peripheral brain tissue was gliotic appearance Operative Procedures 1.ETGA, supine 2.Right temporal reverse U shape skin incision 3.Reflect skin downward 4.Open temporalis muscle and 4.Open temporalis muscle andPeriosteum 5.Craniotomy 6.Dural tenting 7.Open dura with the base at temporal area 8.Corticotomy then remove tumor piece by piece along the interface between the tumor and normal brain 9.Hemostasis 10.close dura 11.Fix bone back with wire 12.Close wound in layers Operators 曾勝弘 Assistants 胡朝凱, Ri 張品品 (F,1947/03/20,64y11m) 手術日期 2010/05/18 手術主治醫師 曾勝弘 手術區域 東址 005房 03號 診斷 Brain metastasis 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 胡朝凱, 時間資訊 15:02 報到 15:36 進入手術室 15:45 麻醉開始 16:20 抗生素給藥 16:20 誘導結束 16:45 手術開始 19:40 麻醉結束 19:40 手術結束 19:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４小時以內 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 記錄__ 手術科部: 外科部 套用罐頭: Subfrontal tumor excision 開立醫師: 胡朝凱 開立時間: 2010/05/18 20:01 Pre-operative Diagnosis Left frontal tumor Post-operative Diagnosis Left frontal tumor Operative Method Subfrontal tumor excision Specimen Count And Types Pieces of tumor Pathology pending Operative Findings 1.One firm 2 cm whitish tumor with dural tail located at the left frontal base that attach to the frontal base an falx. 2.The tumor is hypovascular 3.The margin between tumor and brain was clear Operative Procedures 1.ETGA, supine 2.Bicoronal skin incision 3.Reflect skin flap downward 4.Open periosteum 5.Craniotomy with the midline left on SSS 6.Dural opening with the base left on midline 7.Retract frontal brain 8.Devascularized of tumor base 9.Dissect between tumor and brain 10.Remove tumor 11.Hemostasis 12.Fix bone back with miniplate 13.Close wound in layers Operators 曾勝弘 Assistants 胡朝凱, Ri 李政庭 (M,2005/03/31,6y11m) 手術日期 2010/05/18 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Development delay, other 器械術式 Revision of CSF shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 2 紀錄醫師 陳德福, 時間資訊 07:40 報到 08:05 進入手術室 08:10 麻醉開始 08:20 誘導結束 08:32 抗生素給藥 09:18 手術開始 10:00 手術結束 10:00 麻醉結束 10:10 進入恢復室 10:10 送出病患 11:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: remvoal of the shunt reservior 開立醫師: 陳德福 開立時間: 2010/05/18 10:13 Pre-operative Diagnosis arachnoid cyst s/p cystoperitoneal shunt with malfunction arachnoid cyst s/p cystoperitoneal shunt with shunt function insufficiency (interposition of pressure setting valve) Post-operative Diagnosis ditto Operative Method remvoal of the shunt reservior shunt revision by remvoal of the shunt reservior Specimen Count And Types 1 piece About size:3ML Source:CSF Pathology nil Operative Findings There is clear and colorless CSF drained out after the transection of proximal part of the previous shunt reservior. We removed the shunt reservior and connect the catheter with a metal connector. There is clear and colorless CSF drained out after the transection of proximal part of the previous shunt reservior. It indicated the patency of the shunt. We removed the shunt reservior and connect a straight metal catheter betweent he cystic and the peritoneal catheters. Operative Procedures Under ETGA and supine position, the scalp was disinfected and draped as usual. We made incision along previous operation wound and the catheter was identified. We protect the proximal part of the catheter and retract the distal catheter including the shunt reservior. The reservior is removed and we connect the catheter with one metal connector. The catheter is fixed with silks and the wound is closed in layers. Under ETGA and supine position, the scalp was disinfected and draped as usual. We made incision along previous operation wound at the left suboccipital region and the catheter was identified. We protect the proximal part of the catheter and retract the distal catheter including the shunt reservior. The reservior (Codman 40 mm H2O) is removed and we connect the catheter with one metal connector. The catheter is fixed with silks to surrounding tissue for three stitches, and the wound is closed in layers. Operators AP 郭夢菲 Assistants ｒ４　陳德福 相關圖片 游丰叡 (M,1998/06/26,13y8m) 手術日期 2010/05/18 手術主治醫師 郭夢菲 手術區域 兒醫 067房 02號 診斷 Scalp tumor 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 1 紀錄醫師 陳德福, 時間資訊 10:00 報到 10:15 進入手術室 10:20 麻醉開始 10:30 抗生素給藥 10:30 誘導結束 11:15 手術開始 13:30 麻醉結束 13:30 手術結束 13:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４～８小時 1 1 L 手術 頭顱成形術 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 記錄__ 手術科部: 外科部 套用罐頭: 1.Craniotomy tumor excision; 2.Cranioplasty 開立醫師: 陳德福 開立時間: 2010/05/18 14:03 Pre-operative Diagnosis skull tumor with hemorrhage, left posterior-superior auricular area Post-operative Diagnosis ditto Operative Method 1.Craniotomy tumor excision; 2.Cranioplasty 1.Craniotomy tumor excision; 2.Autogenous bone graft for cranioplasty Specimen Count And Types 1 piece About size:3*2*3CM Source:skull tumor Pathology pending; intraoperative frozen section: chronic inflammation Operative Findings 1.There is a 3*3*2cm in sized tumor originated from the left posterior-superior auricular skull. The tumor is infiltrative, soft, cystic and bi-cortex involved. 1.There is a 3*3*2cm in sized tumor originated from the left posterior-superior auricular skull. The tumor is infiltrative, soft, cystic and bi-cortex involved. The tumor extended to the dura but the dura was intact. The tumor expanded very tense laterally to the subgaleal level. 2.There is old hematoma inside the tumor and the cystic lesion is tense before draining out the fluid content. 3.Fibrotic change over the epidural-inner skull cortex plane is noticed and we remove the infiltrative tumor totally, grossly. 4.There is a 4*3cm in sized skull defect after we removed the tumor. The skull defects is repaired with autologous bone graft from the nearby skull [1/2 slice reconstruction fassion]. Operative Procedures Under ETGA and supine position, the scalp is disinfected and draped as usual. One curvilinear incision posterior to the lesion is made and we expose the tumor under meticulous dissection. The margin and border to the skull of cystic lesion is identified. We drain out the fluid content and the tumor is removed step by step. The possible infiltrative lesion is removed furthermore and one 3*4cm in sized skull graft is harvested. The skull graft is devided in 1/2 slice fasion and the cranioplasty is done with miniplates and autologous bone graft. Hemostasis is done and one subgaleal drainage is left in situ. The wound is closed in layers. Under ETGA and supine position, the scalp is disinfected and draped as usual. One curvilinear incision posterior to the lesion is made and we expose the tumor under meticulous dissection. The margin and border to the skull of cystic lesion is identified. We drain out the fluid content and the tumor is removed step by step. The possible infiltrative lesion is removed furthermore and one 3*4cm in sized skull graft is harvested from the skull above the tumor. The skull graft is bivalved into 2 slices and the outer table was placed back to the donor site, and the inner table was place to the bony defect of the tumor site. The bone plates were fixed with miniplates and screws. Hemostasis is done and one subgaleal drainage is left in situ. The wound is closed in layers. Operators AP 郭夢菲 Assistants r4 陳德福 相關圖片 曾惠雀 (F,1961/04/21,50y10m) 手術日期 2010/05/18 手術主治醫師 林峰盛 手術區域 西址 035房 06號 診斷 Radiculopathy 器械術式 Nerve block / PC 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 硬肌麻醉 麻醉主治醫師 林峰盛 ASA 3 時間資訊 15:35 進入手術室 15:36 麻醉開始 15:37 誘導結束 15:40 手術開始 15:55 手術結束 15:55 麻醉結束 16:00 送出病患 記錄__ 手術科部: 麻醉部 套用罐頭: Pulsed RF 開立醫師: 林峰盛 開立時間: 2010/05/18 15:57 Pre-operative Diagnosis Radiculopathy Post-operative Diagnosis radiculopathy Operative Method L5-S1 transforaminal epidural block Pulsed RF Specimen Count And Types nil Pathology Nil Operative Findings Operative Procedures 1. LA with 1% xylocaine 2. pt in prone position 3. Under fluoroscopic-guidance, insert 22 G SMK RF meedle into left L5-S1 neuroforamen 4. Neurostimulation with 50 HZ and 2 Hz 0.1-0.5 mV current with positive result 60-80V 2 Hz, 20 ms, 120sec *2 pulsed RF was delivered 5. transforaminal epidural block with kenacort 40 mg 6. diagnostic facet block left L4/5 and L5/S1 with kenacort 10mg send pt to POR Operators 林峰盛, Assistants 劉玉蘭, 張陳富美 (F,1940/11/20,71y3m) 手術日期 2010/05/18 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Rheumatoid arthritis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 鄭孟伯, 時間資訊 07:35 報到 08:05 進入手術室 08:15 麻醉開始 08:30 誘導結束 09:00 抗生素給藥 09:40 手術開始 11:05 開始輸血 12:00 抗生素給藥 14:30 麻醉結束 14:30 手術結束 14:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 手術 椎弓切除術（特壓）－二節以內 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Posterior Fusion for Cervical Spine 開立醫師: 鄭孟伯 開立時間: 2010/05/18 15:01 Pre-operative Diagnosis Rheumatoid arthritis with odontoid basilar invagination Post-operative Diagnosis Rheumatoid arthritis with odontoid basilar invagination Operative Method 1. Occipitocervical fixation with lateral mass screws at C3,4 and occipital plate 2. C3,4 laminectomy for decompression, and cervical posteriolateral fusion Specimen Count And Types nil Pathology nil Operative Findings The C1 posterior arch was abscent and split C2 spinous process was noted. After C3,4 laminectomy, the thecal sac was well expanded and the lamina was used as graft for posteriolateral fusion. The bony grafts were fixed with miniplates x2. Occipitocervical fixation was done with Synthes implants. Occipital plate: 12mm(superior) and 10mm(inferior) screws Screws: 10mm x2 at C3, and 12mm x2 at C4 Rods: 9cm Operative Procedures 1. ETGA, prone position and head hyperflexion, fixed with Mayfield clump 2. Posterior neck linear incision about 18cm 3. Dissect the trapzius muscle and paraspinal muscle to expose the suboccipital region and C1-4 lamina and spinous process 4. Expose the C3-4 lateral mass, and insert the screws toward superiolateral aspect at C3,4 level 5. Fix the occipital plate at suboccipital region with screws x2 at midline 6. C3,4 laminectomy and the bone was used as graft 7. Set the rods after bending and fix them with screws tightly 8. Occipital, C2 lamina and C3,4 lateral mass decortication for fusion 9. Fix the bone graft at C2 lamina with miniplates x2 10.Hemostasis, set an epidural CWV drain 11.Close the wound in layers Operators VS 賴達明 Assistants R5 陳睿生; R1 鄭孟伯 曹秀緩 (F,1954/12/03,57y3m) 手術日期 2010/05/18 手術主治醫師 賴達明 手術區域 東址 002房 02號 診斷 Cerebral aneurysm, nonruptured 器械術式 Craniotomy(Aneurysms) P-DUH 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2E 紀錄醫師 李建勳, 時間資訊 07:59 臨時手術NPO 07:59 開始NPO 07:59 通知急診手術 09:15 進入手術室 09:30 麻醉開始 09:55 誘導結束 10:03 抗生素給藥 11:00 手術開始 13:03 抗生素給藥 16:03 抗生素給藥 18:05 手術結束 18:05 麻醉結束 18:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 開顱術摘除血管病變－腦血管瘤－有徵的 1 1 R 手術 顱內壓監視置入 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 9 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Right pterional approach for aneurysm clippin... 開立醫師: 李建勳 開立時間: 2010/05/18 19:03 Pre-operative Diagnosis Right posterior cerebral artery(PCA) aneruysm rupture with subarachnoid hemorrhage (SAH) Post-operative Diagnosis Right posterior cerebral artery(PCA) aneruysm rupture with subarachnoid hemorrhage (SAH) Operative Method Right pterional approach for aneurysm clipping and extraventricular drainage insertion for intracranial pressure (ICP) monitoring Specimen Count And Types nil Pathology Nil Operative Findings The brain was mild swellig after opened the dura. The PCA aneurysm was found at P1-2 junction and was clipped with one angled and one fenestrated Sugita aneurysm clips. The brain was mild swellig after opened the dura. The PCA aneurysm was found at P3-4 junction and was clipped with one angled and one fenestrated Sugita aneurysm clips. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position with head fixed with Mayfield skull clump. The scalp was shaved, scrubbed, disinfected with alcohol better-iodine then draped. Right frontotemporal scalp incision was made as usual pterional approach followed by craniotomy. The medial sphenoid ridge was further drill off by high speed air drill for wider operation field. Opened the dura in fish-mouth fasion after tenting around the craniotomy window. EVD was insered via right Pannies point. Fixed the EVD tube after passing through subcutaneous tunnel at the scalp. Opened the sylvian fissure and relaxed the brain by releasing the CSF. Dissected the arachnoid to exspose the ICA and CN III. Retracted the temporal lobe to located the PCA. Partial temporal lobe was removed for better expose the aneurysm. Clipped the aneurysm with one angled Sugita aneurysm clip and another fenestrated clip. The aneurysm dome was opened to checked the clipping. The dura was sutured with 4-0 Prolene and covered the defect with Duraform. The skull plate was fixed back with miniplates and screws after central tenting and one subgaleal CWV drian set up. The temporalis fascia was sutured back and the wound was closed in layers. at the scalp. Opened the sylvian fissure and relaxed the brain by releasing the CSF. Dissected the arachnoid to exspose the ICA and CN III. Retracted the temporal lobe and trace along the tentorial edge to located the PCA. Partial temporal lobe was removed for better expose the aneurysm. Clipped the aneurysm with one angled Sugita aneurysm clip and another fenestrated clip. The aneurysm dome was opened to checked the clipping. The dura was sutured with 4-0 Prolene and covered the defect with Duraform. The skull plate was fixed back with miniplates and screws after central tenting and one subgaleal CWV drian set up. The temporalis fascia was sutured back and the wound was closed in layers. Operators VS 賴達明 Assistants R6 李建勳 Indication Of Emergent Operation 相關圖片 劉月裡 (F,1953/12/16,58y2m) 手術日期 2010/05/18 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Lumbar spondylosis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 鄭孟伯, 時間資訊 13:53 報到 15:00 進入手術室 15:05 麻醉開始 15:35 誘導結束 15:40 抗生素給藥 16:12 手術開始 19:30 手術結束 19:30 麻醉結束 19:40 進入恢復室 19:40 送出病患 21:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 手術 椎間盤切除術－腰椎 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: L4/5 posteriolateral fusion and fixation, L3/... 開立醫師: 陳睿生 開立時間: 2010/05/18 19:52 Pre-operative Diagnosis Lumbar stenosis over L3-5 and L4/5 spondylolithesis, Grade. I Post-operative Diagnosis Lumbar stenosis over L3-5 and L4/5 spondylolithesis, Grade. I Operative Method L4/5 posteriolateral fusion and fixation, L3/4 sublaminar decompression Specimen Count And Types nil Pathology Nil Operative Findings The thecal sac was well expanded after laminectomy. Thicken ligamentum flavum was noted intra-op. Mild osteoporosis was found intra-op. Mild disk protrusion was noted at L4/5, and total diskectomy with cage fusion was done. TPS: Synthes screws: 6.2 x 40 mm at L4, 5 Rods: 5cm x2 Cage: Synthes PEEK cage, 11mm x2 Operative Procedures 1. ETGA, prone position, and C-arm localize the L3-5 level 2. Low back midline skin incision about 15cm 3. Split bilateral paraspinal muscle to expose the L3-5 lamina and spinous process 4. Identify L4, 5 transverse process and insert transpedicular screws under C-arm guided 5. Lower L4 and L5 laminectomy and remove of ligamentum flavum for decompression 6. Total diskectomy was done with curette and kerrison 7. Insert bilateral PEEK cages and C-arm localized the position 8. Bilateral L3/4 laminotomy, and remove of ligamentum flavum for decompression 9. Fix the rods with screws 10.Hemostasis, set a 1/8 hemovac, and close the wound in layers Operators VS 賴達明 Assistants R5 陳睿生, R1 鄭孟伯 吳徽燦 (M,1935/10/10,76y5m) 手術日期 2010/05/18 手術主治醫師 陳敞牧 手術區域 東址 027房 04號 診斷 Lumbar spondylosis 器械術式 Laminectomy for decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳國瑋, 時間資訊 14:45 報到 15:00 進入手術室 15:17 麻醉開始 15:27 誘導結束 15:47 抗生素給藥 15:57 手術開始 18:25 手術結束 18:25 麻醉結束 18:30 送出病患 18:35 進入恢復室 19:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術（特壓）－二節以內 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 曾峰毅 開立時間: 2010/05/18 18:21 Pre-operative Diagnosis Lumbar stenosis, L2 to L5 Post-operative Diagnosis Lumbar stenosis, L2 to L5 Operative Method Central-split laminoplasty for decompression, L3 and L4 Specimen Count And Types Nil Pathology Nil Operative Findings Hypertrophic ligamentum flavum was noted from L2 to L5. Blood loss is about 1000ml. Operative Procedures With endotracheal general anesthesia, the patient was put in prone position. After skin scrubbed, disinfected, and draped, we made one midline skin incision after C-arm localization to expose the spinous process tip of L3 and L4. We used air-drill to drill the L3-4 spinous process from the tip, and splitted the spinous process away. Decompression was done from L2/3 junction to L4/5 junction. We closed the wound in layers after hemostasis and setting one hemovac. Operators VS 陳敞牧 Assistants R3 曾峰毅 R1 陳國瑋 李宜純 (F,1976/05/17,35y9m) 手術日期 2010/05/19 手術主治醫師 黃俊升 手術區域 東址 052房 04號 診斷 Breast cancer, female 器械術式 Port-A catheter Implatation 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 周博敏, 時間資訊 15:52 報到 16:05 進入手術室 16:27 抗生素給藥 16:35 麻醉開始 16:40 誘導結束 16:41 手術開始 18:50 手術結束 19:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 ｐｏｒｔ–Ａ導管植入術–治療性導管植入術 1 0 L 摘要__ 手術科部: 外科部 套用罐頭: Port-A 開立醫師: 黃凱傑 開立時間: 2010/05/19 18:30 Pre-operative Diagnosis Right breast cancer Post-operative Diagnosis Right breast cancer Operative Method Port-A insertion Specimen Count And Types nil Pathology nil Operative Findings Post-operative portable X-ray showed Port-A catheter tip in correct venous branch to SVC. Operative Procedures 1. Under endotracheal general anesthesia with the patient in supine position, prepped and draping were performed in the usual sterile method. 2. An incision was made in left side neck and subclavical area. After identification of the cephalic vein, Port-A catheter was inserted. Adequate hemostasis was obtained. Then the wound was closed in layers. Post-operative portable X-ray showed catheter tip in correct venous branch to SVC. Then the wound Operators 黃俊升 Assistants 周博敏 劉家豪 (M,1996/12/27,15y2m) 手術日期 2010/05/19 手術主治醫師 杜永光 手術區域 東址 001房 05號 診斷 Cerebral aneurysm 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2E 紀錄醫師 陳德福, 時間資訊 11:00 臨時手術NPO 11:00 開始NPO 11:58 通知急診手術 16:45 進入手術室 17:00 麻醉開始 17:10 誘導結束 17:57 手術開始 18:30 手術結束 18:30 麻醉結束 18:55 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室體外引流 1 2 R 摘要__ 手術科部: 外科部 套用罐頭: right Kocher point EVD revision 開立醫師: 陳德福 開立時間: 2010/05/19 18:43 Pre-operative Diagnosis Hydrocephalus s/p EVD insertion with EVD obstruction Post-operative Diagnosis ditto Operative Method right Kocher point EVD revision Specimen Count And Types 1 piece About size:5ML Source:CSF Pathology nil Operative Findings 1.The previous left forntal EVD was obstructed by blood clots. 2.One antibiotics coating EVD tube was inserted at right Kocher point 3.The ventricular opening pressure is around 28 cmH2O and the intraventricular catheter is 6cm. Operative Procedures Under ETGA and supine position, the scalp was disinfected and draped as usual. One curvilinear incision on right frontal scalp was done and one burr hole was created. The dura tenting and durotomy were done. The ventricular tapping needle was inserted and the CSF gushed out spontaneously. One EVD catheter was inserted thereafter. The function of the catheter was fair and the wound was closed in layers. Operators P 杜永光 Assistants R4 陳德福 Indication Of Emergent Operation 陳雲屏 (F,1959/11/14,52y4m) 手術日期 2010/05/19 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Cushing syndrome 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 陳盈志, 時間資訊 07:39 報到 08:03 進入手術室 08:10 麻醉開始 08:40 誘導結束 08:50 抗生素給藥 09:36 手術開始 11:50 抗生素給藥 12:35 麻醉結束 12:35 手術結束 12:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經由蝶竇之腦下垂體瘤切除 1 1 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Transsphenoid adenomectomy 開立醫師: 陳盈志 開立時間: 2010/05/19 12:58 Pre-operative Diagnosis Cushing disease Post-operative Diagnosis Cushing disease Operative Method Transsphenoid adenomectomy Specimen Count And Types 1 piece About size:multiple fragments Source:pituitary tumor Pathology pending Operative Findings The tumor was yellowish elastic in character. It located inside the gland and the margin was not clear. CSF leak was noted which was repaired with gelform and tissue codul Operative Procedures Under general anethesia and intubation, the patient was put in supine position with head tilted 30 degree to left. The facial skin was antiseptic with alcohol better-iodine tincture, and the mucosa of oral and nasal cavity with aqueous better-iodine. The former areas were covered by sterilized adhesive plastic sheets then draped. The nasal mucosa incision was made after local anesthesia injection at right submucosal layer. A nasal speculum was applied to displace the nasal mucosa laterally and keep the nasal cavity open constantly for the exposure of the vomer bone and the anterior wall of the sphenoid sinus.Dissection was made under surgical microscope assistance to remove the anterior sphenoid wall and vomer by osteotome. The mucosa was removed by aligators. Before the posteriorsphenoid wall was opened, the position of the nasal speculum was adjusted under the radioimage intensifier to a direction which directly pointed to the sellar floor.The posterior sphenoid wall was penestrated by osteotome and widened by Kerrison punch. The sellar floor dura was coagulated with bipolar forceps, then opened in cruciate fashion. The soft tumor parenchyma was removed by curette and tumor forceps. The venous oozing from the dura was stopped by gelfoam packing. The arachnoid and the opening of diaphragm sellae was enforced by packing with gelform as in the sellar cavity. The sellar floor was reconstructed by supporting a piece of bone chip etween the dura and the margin of the sellar floor. The sphenoid sinus was packed with Gelform. The vomer bone was put back in place. The nasal speculum was removed and the nasal mucosa returned to its normal position. Each side of the nasal cavities was tightly packed with Merocil which had been soaked with better-iodine ointment Lumbar drain was set. Operators P杜永光 Assistants R6陳盈志R4鍾文桂 鄭孝忠 (M,1960/11/16,51y3m) 手術日期 2010/05/19 手術主治醫師 杜永光 手術區域 東址 003房 02號 診斷 Head Injury 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 12:35 報到 13:00 進入手術室 13:10 麻醉開始 13:25 誘導結束 14:00 手術開始 17:00 手術結束 17:00 抗生素給藥 17:00 麻醉結束 17:20 送出病患 17:22 進入恢復室 18:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 手術 頭顱成形術 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Cranioplasty 開立醫師: 陳盈志 開立時間: 2010/05/19 17:21 Pre-operative Diagnosis lEFT SIDE SKULL DEFECT Skull defect, left. Post-operative Diagnosis lEFT SIDE SKULL DEFECT Skull defect, left. Operative Method Cranioplasty Specimen Count And Types nil Pathology nil Operative Findings Severe adhesion between galea and dura was noted. The brain was mild slake. The wound overpassed the anterior hair line. Operative Procedures Under the general anesthesia with endotracheal tube intubation, the patient was set into supine position with head tilt into right. The wound was disinfected and drapped. The wound was opened along previous wound. Dissect to expose the plane between galea and dura. Repair dura defect with prolene. The bone edge was dissected to be exposed. Made the artificial plate with wired mesh and bone cement at inner and outer table. Fix the plate to the bone edge with miniplate. Hemostasis was done. One subgaleal CWV drain was set and the wound was closed in layers Operators P杜永光 Assistants R6陳盈志R4鍾文桂 胡林錦秀 (F,1937/09/08,74y6m) 手術日期 2010/05/19 手術主治醫師 杜永光 手術區域 東址 027房 03號 診斷 Infarction 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 胡朝凱, 時間資訊 15:03 報到 15:35 進入手術室 15:49 麻醉開始 15:55 誘導結束 16:10 抗生素給藥 16:35 手術開始 19:10 抗生素給藥 20:15 手術結束 20:15 麻醉結束 20:30 送出病患 20:35 進入恢復室 22:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 頭顱成形術 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Cranioplasty 開立醫師: 胡朝凱 開立時間: 2010/05/19 20:30 Pre-operative Diagnosis Left craniectomy Post-operative Diagnosis Left craniectomy Operative Method Cranioplasty Specimen Count And Types nil Pathology nil Operative Findings 1.Left skull defect abut 20x25 cm 2.The craniotomy window was slack Operative Procedures Under ETGA, patient was put in supine position with head rotated to right Incision was made along the previous operation scar. Raney clips were apllied to the scalp edge for temporary hemostasis. The scalp and temporalis muscle were dissected away from the underlying dura. The scalp was easily reflected from the underlying silastic sheet which was then removed. The dural surface and margin of skull defect were well exposed. The bleeders on the dissected surfaces were coagulated with Bovie painstakingly. The edge of the skull defect was exposed. The cranioplasty was further made by wiremesh and bone cement then fixed by miniplate and a dura tenting at the center of the skull plate. Hemostasis was done with monopolar coagulator touching on the sucker tip. Galea suture was performed by continuous suture with 3/0 Dexon and skin by continuous suture with 3/0 nylon. Drain: one, epidural. Operators 杜永光 Assistants 陳盈志,胡朝凱,Ri 賴麗菁 (F,1974/12/04,37y3m) 手術日期 2010/05/19 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳國瑋, 時間資訊 12:50 報到 12:57 進入手術室 13:00 麻醉開始 13:35 誘導結束 13:40 抗生素給藥 13:50 手術開始 16:40 抗生素給藥 18:50 麻醉結束 18:50 手術結束 19:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４～８小時 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: frontal craniotomy for Simpson grade II tumor excision 開立醫師: 李建勳 開立時間: 2010/05/19 19:14 Pre-operative Diagnosis Right parietal convexity meningioma Post-operative Diagnosis Right parietal convexity meningioma Operative Method Right parietal craniotomy for Simpson grade I tumor excision Specimen Count And Types 1 piece About size:5g Source:craniotomy for brain tumor exision Pathology Pending Operative Findings The tumor is yellowish, soft-elastic, size 6x6x5cm, with two lobulation, located posterior to right motor cortex. The tumor margin was seperable from the normal brain parenchyma at arachnoid plane. The overlying dura was removed for Simpson grade I tumor excision. The overlying skull showed mild hyperosis change. Operative Procedures Under general anesthesia and intubation, the patient was put in prone position with head fixed with Mayfield skull clump. The scalp was shaved, scrubbed, disinfected with alcohol better-iodine then draped. The U-shaped scalp incision was made followed by right parietal craniotomy. The dura was opened around the tumor after tenting along the craniotomy window. The tumor was dissected from the surrounding normal brain tissue with dissector and bipolar coagulator. Central debulky method was applied before further dissection of the tumor. The final pieces of the tumor was dissected under surgical microscope and hemostasis was achieved by Sugicel lining of the tumor bed. Motor cortex was checked after total tumor excision. The duroplasty was performed with 4-0 Prolene sutures and periostium. The skull plate was fixed back with wires after central tenting. One subgalearl CWV drain set up before the wound was closed in layers. Operators VS 曾漢民 Assistants R1陳國瑋 R6 李建勳 相關圖片 溫鏡清 (M,1951/10/19,60y4m) 手術日期 2010/05/19 手術主治醫師 王國川 手術區域 東址 005房 03號 診斷 Lymphoma 器械術式 Port-A catheter Removal/WOR 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 胡朝凱, 時間資訊 20:14 開始NPO 20:14 通知急診手術 20:14 臨時手術NPO 21:00 報到 21:10 進入手術室 21:23 手術開始 21:45 手術結束 21:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 肌肉或深部組織腫瘤切除術及異物取出術 1 1 L 記錄__ 手術科部: 腫瘤醫學部 套用罐頭: Remove port-A catheter 開立醫師: 胡朝凱 開立時間: 2010/05/19 21:50 Pre-operative Diagnosis Port-A infection Post-operative Diagnosis Port-A infection Operative Method Remove port-A catheter Specimen Count And Types pora-a catheter tip culture Pathology nil Operative Findings 1.Mild wound discharge 2.No obvious pus was noted Operative Procedures 1.Local anesthesia. 2.Previous wound incision 3.Identify Port-A catheter 4.Remove catheter 5.hemostasis 6.Close wound in layers Operators 王國川 Assistants 胡朝凱 Indication Of Emergent Operation 蕭明玉 (F,1984/08/05,27y7m) 手術日期 2010/05/19 手術主治醫師 蔡瑞章 手術區域 東址 005房 01號 診斷 Pituitary tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳國瑋, 時間資訊 07:40 報到 08:05 進入手術室 08:10 麻醉開始 08:40 誘導結束 08:56 抗生素給藥 09:24 手術開始 12:00 抗生素給藥 12:12 麻醉結束 12:12 手術結束 12:23 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 經由蝶竇之腦下垂體瘤切除 1 1 摘要__ 手術科部: 外科部 套用罐頭: Microscopic transsphenoid adenomectomy 開立醫師: 李建勳 開立時間: 2010/05/19 12:41 Pre-operative Diagnosis Pituitary macroadenoma Post-operative Diagnosis Pituitary macroadenoma Operative Method Microscopic transsphenoid adenomectomy Specimen Count And Types 1 piece About size:0.3g Source:transsphenoid adenoectomy Pathology Pending Operative Findings The tumor was elastic, yellow-whitish, size 1 cm in size, located more at left side, with some soft part. The normal gland was seen and preserved during the operation. No CSF leakage was noted. Operative Procedures Under general anethesia and intubation, the patient was put in supine position with head tilted 30 degree to left. The facial skin was antiseptic with alcohol better-iodine tincture, and the mucosa of oral and nasal cavity with aqueous better-iodine. The former areas were covered by sterilized adhesive plastic sheets then draped. The nasal mucosa incision was made after local anesthesia injection at right submucosal layer. A nasal speculum was applied to displace the nasal mucosa laterally and keep the nasal cavity open constantly for the exposure of the vomer bone and the anterior wall of the sphenoid sinus.Dissection was made under surgical microscope assistance to remove the anterior sphenoid wall and vomer by osteotome. The mucosa was removed by aligators. Before the posteriorsphenoid wall was opened, the position of the nasal speculum was adjusted under the radioimage intensifier to a direction which directly pointed to the sellar floor.The posterior sphenoid wall was penestrated by osteotome and widened by Kerrison punch. The sellar floor dura was coagulated with bipolar forceps, then opened in cruciate fashion. The soft tumor parenchyma was removed by curette and suction. The venous oozing from the dura was stopped by gelfoam packing. The arachnoid and the opening of diaphragm sellae was enforced by packing with gelform as in the sellar cavity. The sellar floor was reconstructed by supporting a piece of bone chip etween the dura and the margin of the sellar floor. The sphenoid sinus was packed with Gelform. The vomer bone was put back in place. The nasal speculum was removed and the nasal mucosa returned to its normal position. Each side of the nasal cavities was tightly packed with Merocil which had been soaked with better-iodine ointment. Operators P 蔡瑞章 Assistants R1 陳國瑋 R6 李建勳 相關圖片 陳美惠 (F,1963/04/28,48y10m) 手術日期 2010/05/19 手術主治醫師 黃培銘 手術區域 兒醫 063房 02號 診斷 Infective endocarditis 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 鄒冠全, 時間資訊 01:00 臨時手術NPO 08:39 報到 08:40 進入手術室 08:45 麻醉開始 08:50 誘導結束 08:51 手術開始 09:00 手術結束 09:05 送出病患 09:05 麻醉結束 醫令資訊 類別 名稱 量 刀 側 手術 氣管切開造口術 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 鄒冠全 開立時間: 2010/05/19 09:04 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Ditto Operative Method Tracheostomy Specimen Count And Types nil Pathology None Operative Findings Fr . 7 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators 黃培銘 Assistants R2鄒冠全 陳佑嘉 (M,2009/10/28,2y4m) 手術日期 2010/05/19 手術主治醫師 楊士弘 手術區域 兒醫 067房 號 診斷 Tetralogy of Fallot 器械術式 Revision of CSF shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 4 紀錄醫師 蔡宗良, 時間資訊 08:23 進入手術室 08:25 麻醉開始 08:27 誘導結束 09:08 抗生素給藥 09:30 手術開始 10:35 手術結束 10:35 麻醉結束 10:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦脊髓液分流管重置 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Revision of ventriculoperitoneal shunting, le... 開立醫師: 蔡宗良 開立時間: 2010/05/19 11:08 Pre-operative Diagnosis Overdrainage, hydrocephalus s/p ventriculoperitoneal shunting, left-sided Kocher Post-operative Diagnosis Overdrainage, hydrocephalus s/p ventriculoperitoneal shunting, left-sided Kocher Operative Method Revision of ventriculoperitoneal shunting, left-sided Kocher Specimen Count And Types CSF obtained was sent for culture Pathology NIL Operative Findings Codman programmable, valve set at 12 cm H2O, ventricular catheter 5 cm at previous Kocher point. Operative Procedures General anesthesia was applied under connection through tracheostomy. Skin was drapped and prepped in the usual manner. The wound to the head was incised on his previous wound. The medium-pressure reservoir was dissected and removed. The abdominal catheter was minimally dissected through previous wound. A Codman programmable reservoir with anti-siphon valve was connected to his previous abdominal catheter. The catheter was fixed by 3-0 silk at galea. Wound was closed in layers. Operators VS 楊士弘 Assistants R4 蔡宗良 管萬富 (M,1951/10/27,60y4m) 手術日期 2010/05/19 手術主治醫師 黃正賢 手術區域 東址 010房 07號 診斷 Retinal detachment 器械術式 Pars plana lensectomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 陳達慶, 時間資訊 16:30 報到 16:50 進入手術室 17:04 麻醉開始 17:08 麻醉結束 17:29 手術開始 19:35 手術結束 19:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 晶體切除術合併玻璃體切除術 1 1 R 手術 光線凝固治療－複雜 1 2 R 手術 人工水晶體植入術－第二次植入 1 4 R 記錄__ 手術科部: 眼科部 套用罐頭: PPV (RD全套) 開立醫師: 陳達慶 開立時間: 2010/05/19 18:59 Pre-operative Diagnosis Rhegmatogenous retinal detachment + cataract (od) Post-operative Diagnosis Rhegmatogenous retinal detachment + cataract (od) Operative Method PPLV + endolaser + Intravitreous injection of silicone oil 5 ml (od) Specimen Count And Types Pathology NIL Operative Findings Rhegmatogenous retinal detachment from 2 to 6 oclock, retinal break at 2 oclock Operative Procedures 1. Under retrobulbar anesthesia 2. Disinfection and draping as usual, apply an eyelid speculum. 3. peritomy and hemostasis with cautery. 4. Two sclerotomy were made then apply microvit and infusion line through the sclerotomy wounds. 5. lensectomy was performed with fragmentome 6. the third sclerotomy were made then apply light through the sclerotomy wound. 7. Vitrectomy was performed with Microvit 8. clear corneal wound was done at 12 o clock and then PCIOL was implanted into sulcus 9. two stitches was sutured to the corneal wound with 9-0 nylon 10. Air-fluid exchange with Charle’s needle and air pump 11. Endolaser was applied around the breaks and peripheral retina 12. Intravitreal injection of silicone oil 5 ml 13. Close sclerotomy wound with 9-0 Nylon 14. Close conjunctival wound with 6-0 Vicryl. 15. Subconjunctival injection of Rinderon and Gentamicin. 16. Atropine and Latycin patching. Operators 黃正賢, Assistants R4 許祺鑫 R3 陳達慶 黃慧忠 (M,1955/08/22,56y6m) 手術日期 2010/05/20 手術主治醫師 陳坤源 手術區域 東址 006房 02號 診斷 Spinal metastasis 器械術式 Total thyroidectomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林珍榮 ASA 2 紀錄醫師 梁高議, 時間資訊 12:25 報到 13:18 進入手術室 13:19 麻醉開始 13:25 誘導結束 13:30 抗生素給藥 13:53 手術開始 16:30 抗生素給藥 16:55 手術結束 16:55 麻醉結束 17:10 送出病患 17:15 進入恢復室 17:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 雙側甲狀腺全葉切除術 1 1 B 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 摘要__ 手術科部: 外科部 套用罐頭: TOTAL THYROIDECTOMY 開立醫師: 梁高議 開立時間: 2010/05/20 17:25 Pre-operative Diagnosis Thyroid cancer Post-operative Diagnosis Ditto Operative Method TOTAL THYROIDECTOMY Specimen Count And Types 2 pieces About size:Large Source:Right thyroid gland About size:small Source:Left thyroid gland Pathology Pending Operative Findings 1. One large soft and elastic right thyroid tumor with easy bleeding was noted. 2. Paratracheal lymph node involvement: negative 3. Upper mediastinal lymph node involvement: negative Operative Procedures 1. After induction of general anesthesia, the patient was put on supine position with a pillow placed between the scapula. The neck was hyperextended and with chin nose pointed directing anteriorly, the head was stabilized. Using a thyroid drape, the endotracheal tube and the patient`s face were separated from the operation field. 2. A slight curved skin incision was performed about two-finger breadth above sternal notch 10 cm in length. The incision was carried down to the platysma muscle to reach the avascular plane, then the superior flap was developed with a combination of electrocautery and blunt dissection and was carried to level above the cartilage. The inferior flap was developed 1 cm in the midline. 3. The self-retaining retractor was inserted with retraction superiorly and inferiorly. The muscle with the avascular fascia was identified and divided with electrocautery. After the thyroid isthmus has been identified, the strap muscles were elevated by forceps, the thyroid lobe was noted by a finger placed ona sponge. Exposing the right thyroid lobe was done by dissecting the strap muscle from the surface of the thyroid gland. By placing clamps on the thyroid substance, the thyroid lobe was elevated anteriorly. The middle thyroid veins were individually controlled and divided. 4. Then inferior parathyroid gland was identified and dissected carefully without disruption of the blood supply from the inferior thyroid artery The branches of inferior thyroid artery were individually divided. The recurrent laryngealnerve was exposed in tracheoesophageal groove at the medial aspect of inferior thyroid artery. It was gently dissected for some distance along tracheoesophageal groove with bipolar electrocautery. 5. After inferior and lateral traction on sup. aspect of the thyroid lobe, the space between the thyroid and larynx was opened. Identification of the sup. thyroid vessel was done. 6. The sup. thyroid artery and vein were controlled and divided individually with double ligation. 7. Then the sup. parathyroid gland was identified at post. aspect of thyroid gland with gradually ant. displacement of sup. thyroid pole. It was gently dissected and preserved in situ. 8. The recurrent laryngeal nerve was seen and gently dissected with bipolar electrocautery through entire lengthto the point, it was penetrating the cricothyroid membrane. The entire thyroid lobe was dissected from trachea from the suspensory ligament, and it was removed from left lobe by division in thymus. 9. The procedure was performed in the left side in the sameway. 10. One CWV was inserted in the paratracheal space follow by meticulous hemostasis. Wound was closely in three layers. The superficial fascia was approximately loosely with 4-0 vicryl interrupted sutures. The skin flap was closed with 4-0 vicryland 5-0 vicryl interruptedly. The patient stands the operation well. Recorded by R Operators 陳坤源 Assistants 梁高議、阮齡儀 賴綢妹 (F,1929/03/04,83y0m) 手術日期 2010/05/20 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 Hydrocephalus 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 許松鈺, 時間資訊 12:25 報到 12:45 進入手術室 12:50 麻醉開始 13:00 誘導結束 13:10 抗生素給藥 13:23 手術開始 14:10 手術結束 14:10 麻醉結束 14:20 進入恢復室 14:20 送出病患 15:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室腹腔分流手術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt via right Kocher^ ... 開立醫師: 許松鈺 開立時間: 2010/05/20 14:29 Pre-operative Diagnosis Normal pressure hydrocephalus Post-operative Diagnosis Normal pressure hydrocephalus Operative Method Ventriculoperitoneal shunt via right Kocher^ point Specimen Count And Types nil Pathology Nil Operative Findings The Codman programmable VP shunt was inserted to the right lateral ventricle via right Kocher^s point. The initial setting was 100mmH2O. The intraventricular cathether was 7cm in depth, and the intra-abdominal shunt at RUQ was about 20cm in length. Operative Procedures 1.ETGA, supine with head tilted to the left side, skin disinfection 2.Incision: 5 cm curvilinear, right occipital, corresponded to the 2.Incision: 5 cm curvilinear, right frontal, corresponded to the location of right occipital horn. Raney clips were applied to the location of right frontal horn. Raney clips were applied to the scalp edge for temporary hemostasis. 3.After the scalp flap had been lifted and reflected anteriorly, a burr hole was made and the dura was tented by 2 stitches. 4.The dura was opened by a nib incision. Rt lateral ventricle was tapped by a ventricular needle, then a 7 cm segment of the ventricular catheter was introduced into the ventricle. The outer end of the catheter was connected to a Codman programmable VP shunt. 5. A nib incision was made at RUQ of the abdomen , then a trocar was pushed into peritoneal cavity. Subsequently, distal 20 cm segment of the peritoneal catheter was introduced into the peritoneal cavity through the outer tube of the trochar. The proximal end of this catheter was passed through subcutaneous tunnel at forechest, neck, rt retroauricular area and connected the reservoir. The shunt system was checked to make sure its function was working. 6. Scalp closure: hemostasis was done with monopolar coagulator touching on the sucker tip. Close the wound in layers. Operators 王國川 Assistants 陳睿生, 許松鈺 相關圖片 張東龍 (M,1937/04/20,74y10m) 手術日期 2010/05/20 手術主治醫師 陳敞牧 手術區域 東址 005房 02號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李建勳, 時間資訊 11:10 報到 11:42 進入手術室 11:47 麻醉開始 12:50 誘導結束 12:55 抗生素給藥 13:00 手術開始 16:05 開始輸血 16:10 抗生素給藥 18:15 麻醉結束 18:15 手術結束 18:25 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 手術 腦瘤切除－手術時間在４～８小時 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Left suboccipital craniotomy for tumor excision 開立醫師: 李建勳 開立時間: 2010/05/20 19:04 Pre-operative Diagnosis Hepatocellular carcinoma with multiple brain and cerebellar metastasis Post-operative Diagnosis Hepatocellular carcinoma with multiple brain and cerebellar metastasis Operative Method Left suboccipital craniotomy for tumor excision Specimen Count And Types 1 piece About size:2g Source:craniotomy for tumor excision Pathology Pending Operative Findings The tumor was soft, greyish, size 1.5cm in diameter with seperable margin from the normal cerebellar tissue. The cerebellum was swelling after tumor excision but relaxed after CSF drainage. Operative Procedures Under general anesthesia and intubation, the patient was put in prone position with head fixed with Mayfield skull clump. The scalp was shaved, scrubbed, disinfected with alcohol better-iodine then draped. The hocky-stick scalp incision was made at left suboccipital area followed by craniotomy with high speed air drill. The tumor excision was performed via transcortical approach. Central debulky was applied first and the tumor was dissected with dissector from the normal cerebellar tissue. The hemostasis was achieved with Surgicel lining of the tumor bed. The duroplasty was performed with fascia graft and 4-0 Prolene sutures. The skull plate was fixed back with wires. The wound was closed in layers after one subgaleal CWV drain set up. Operators VS 陳敞牧 Assistants R6 李建勳 相關圖片 簡振仁 (M,1963/11/09,48y4m) 手術日期 2010/05/20 手術主治醫師 楊榮森 手術區域 東址 002房 01號 診斷 Liver cancer 器械術式 Tumor excision + ORIF 手術類別 緊急手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 3 紀錄醫師 謝忠佑, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 08:35 進入手術室 08:39 麻醉開始 08:44 誘導結束 09:00 抗生素給藥 09:13 手術開始 10:55 麻醉結束 10:55 手術結束 11:00 送出病患 11:03 進入恢復室 12:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 惡性骨瘤廣泛切除（一次） 1 1 R 手術 開放性或閉鎖性肱骨粗隆或骨幹或踝部骨折，開放性復位術 1 2 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 骨科部 套用罐頭: 1. tumor excision 開立醫師: 謝忠佑 開立時間: 2010/05/20 11:15 Pre-operative Diagnosis HCC, bone metastasis, with pathologic fracture Post-operative Diagnosis HCC, bone metastasis, with pathologic fracture Operative Method 1. tumor excision 2. ORIF with clover leaf plate Specimen Count And Types 1 piece About size: Source:pathology x 1 Pathology pending Operative Findings whitish, fragile tumor tissue over the proximal humerus, protruding from the medullary canal and broke the cortex Operative Procedures 1. ETGA, in semitting position 2. disinfection and draped 3. longitudinal sigmoid shaped incision, later to the deltopectoral groove, split the deltoid muscle and biceps muslces, identify the axillary neuro-vascular bundle 4. curetted the tumor tissue after injection of 95% alcohol about 33 cc, excised the tumor from the IM canal, supplement with cement (embedded with Vancomycin) 5. fixation with 4.5 clover leaf plate and 3.5 screws x 9, irrigation with 95% alcohol, irrigation with normal saline 6. set 1/8 h/v x 1, close wound in layers, apply arm sling Operators 楊榮森, Assistants 謝忠佑, 方建豐, 陳致宇, Indication Of Emergent Operation 馬吳富枝 (F,1941/03/30,70y11m) 手術日期 2010/05/20 手術主治醫師 楊士弘 手術區域 東址 005房 01號 診斷 Herniation of intervertebral disc without myelopathy, cervical 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李建勳, 時間資訊 07:45 報到 08:05 進入手術室 08:16 麻醉開始 08:20 誘導結束 09:05 抗生素給藥 09:16 手術開始 11:18 手術結束 11:18 麻醉結束 11:25 送出病患 11:35 進入恢復室 12:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術－頸椎 1 1 R 手術 脊椎融合術－前融合，無固定物（＜＝四節） 1 2 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 摘要__ 手術科部: 外科部 套用罐頭: Anterior diskectomy + interbody cage fusion 開立醫師: 楊士弘 開立時間: 2010/05/20 11:26 Pre-operative Diagnosis Cervical herniated intervertebral disc, C4-5 Post-operative Diagnosis Cervical herniated intervertebral disc, C4-5 Operative Method Anterior diskectomy + interbody cage fusion Specimen Count And Types nil Pathology Nil Operative Findings The cervical disc was mildly dehydrated, and easily scraped off the vertebral end plates. A piece of posteriorly ruptured disc was found in the central part of disc, causing indentation of the thecal sac and posterior longitudinal ligament. The thecal sac reexpanded well after decompression. Operative Procedures 1. ETGA, supine, neck extended. 2. Right anterior neck incision. 3. Dissection along the medial edge of SCM muscle to reach the prevertebral space. 4. C-arm localization of the C4-5 disk space. 5. Microsurgical diskectomy with knife, currets, disk forceps, and kerrison punches. 6. Excision of the PLL with currets, nerve hook, and kerrison punches. 7. Insertion of a 6 mm high, 11 mm deep cage, which was filled with calcium phosphate particles. 8. Wound closure in layers after insertion of a mini-HV drain. Operators 楊士弘 Assistants 李建勳 相關圖片 涂崟嘉 (F,1957/01/20,55y1m) 手術日期 2010/05/20 手術主治醫師 蕭輔仁 手術區域 東址 003房 03號 診斷 Herniation of intervertebral disc (HIVD) 器械術式 Radiofrequency coagulation(P-G 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 許松鈺, 時間資訊 14:18 報到 14:35 進入手術室 15:09 麻醉開始 15:15 麻醉結束 15:16 手術開始 16:10 手術結束 16:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 高頻熱凝療法 1 1 B 記錄__ 手術科部: 外科部 套用罐頭: L2 DRG radiofrequency coagulation and shoulde... 開立醫師: 胡朝凱 開立時間: 2010/05/20 16:20 Pre-operative Diagnosis L2 radiculopathy and shoulder tendon calcification Post-operative Diagnosis L2 radiculopathy and shoulder tendon calcification Operative Method L2 DRG radiofrequency coagulation and shoulder tender point de-calcification L2 DRG pulsed radiofrequency coagulation and shoulder tender point de-calcification Specimen Count And Types nil Pathology nil Operative Findings 1.Bilateral L2 dermatone soreness 2.Calcified lesion at bilateral shoulder Operative Procedures 1.Local anesthesia 2.Bilateral L2 DRG locaqlization 3.42 celcius degree adn 120 secs radifrequency coagulation 4.Localize bilateral shouder tender point 5.Use needle to de-calcification Operators 蕭輔仁 Assistants 胡朝凱 黃久雄 (M,1944/12/10,67y3m) 手術日期 2010/05/20 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Cervical cord lesion, others 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 許松鈺, 時間資訊 07:50 報到 08:05 進入手術室 08:10 麻醉開始 08:30 誘導結束 09:00 抗生素給藥 09:30 手術開始 11:00 抗生素給藥 12:15 手術結束 12:15 麻醉結束 12:25 送出病患 12:26 進入恢復室 13:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術－頸椎 1 1 手術 脊椎融合術－前融合，無固定物（＜＝四節） 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 記錄__ 手術科部: 外科部 套用罐頭: HIVD 開立醫師: 許松鈺 開立時間: 2010/05/20 12:48 Pre-operative Diagnosis Central cord syndrome Post-operative Diagnosis Central cord syndrome Operative Method Anterior approach C4-C5, C5-C6 diskectomy + cage placement Specimen Count And Types Nil Pathology Nil Operative Findings 1. Calcified, degenerative disc and decreased interspace of C4-5, C5-6 was noted Operative Procedures 1.ETGA, supine postion, locate the correct interspace of C4-5, C5-6by C-arm 2. Skin preparation and disinfection 3. Make a transverse skin incision over right neck besides the thyroid cartilage 4.The subcutaneous layer and platysma muscle were dissected to expose the C4-C6 spine 5.The paravertebral muscles were retracted 6.Under an operating microscope, the degenerated disc and ligment of C4-5, C5-6 were cleaned 7. Place one 6mm cage into C4-5, one 7mm cage into C5-6 8. Place one drain tube and close the wound in layers Operators 王國川 Assistants 陳睿生, 許松鈺 相關圖片 黃鴻明 (M,1973/10/23,38y4m) 手術日期 2010/05/21 手術主治醫師 杜永光 手術區域 東址 003房 02號 診斷 Cavernous angioma 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 08:55 報到 09:00 進入手術室 09:10 麻醉開始 09:40 誘導結束 10:05 抗生素給藥 10:30 手術開始 13:05 抗生素給藥 16:05 抗生素給藥 19:00 抗生素給藥 19:05 麻醉結束 19:05 手術結束 19:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 顱底瘤手術 1 1 L 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 12 0 記錄__ 手術科部: 外科部 套用罐頭: Subtemporal approach tumor excision 開立醫師: 陳盈志 開立時間: 2010/05/21 18:42 Pre-operative Diagnosis Midbrain cavernoma with hemorrhage Post-operative Diagnosis Midbrain cavernoma with hemorrhage Operative Method Subtemporal approach tumor excision Specimen Count And Types 1 piece About size:multiple fragments <1cm Source:midbrain cavernoma Pathology pending Operative Findings The tumor located at midbrain and peripheral old blot was noted. The most surface site was near anteral lateral pons. Multiple small feeders was found the lesion was compatible with cavernoma. Left side Trochlea nerve severance was noted during manipulation. Operative Procedures Under the general anesthesia with endotracheal tube in tubation, the patient was set into supine position with head tilt to right and extension with head fixed with Mayfield. Navigation was set up for guide. The operation field was disinfected with povidine-iodine and then drapped. Left side frontal-temporal curvilinear scalp incision was done. The temporalis muscle was detached with facial nerve preservation. 3 burr hole was made and then craniotomy was done. Zygoma was removed with osteotone then temporalis was reflected downward. Flatten till temporal base exposed. Dura tenting was done and open the dura as fishmouth shape. The temporal lobe was retracted and the membrane of lilicrest was opened. Tentorium was cut and brainstem was identified. One hemosiderin deposition site was found near the trochlea nerve and SCA. Corticotomy was done at the point and old hematoma was evacuated. The cavernoma was identified and dissection was made with bipolar circumferentially till all small feeders cauterized. The cavernoma was removed piece by piece. Hemostasis was done with bipolar and then surgicel. Dura closure was done with 4-0 prolene. Frontal sinus was sealed off with bone wax and then fascia covering. Fix bone plate with miniplate after central tenting and one subgaleal CWV drain was set. The wound was closed in layers. Operators P杜永光 Assistants R6陳盈志R4鍾文桂 相關圖片 周明賢 (M,1955/02/12,57y1m) 手術日期 2010/05/21 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳國瑋, 時間資訊 07:39 報到 08:06 進入手術室 08:20 麻醉開始 08:45 誘導結束 08:58 抗生素給藥 09:00 手術開始 11:58 抗生素給藥 13:45 抗生素給藥 14:50 麻醉結束 14:50 手術結束 15:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 顱底瘤手術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Left pterional approach craniotomy for Simpso... 開立醫師: 李建勳 開立時間: 2010/05/21 15:10 Pre-operative Diagnosis Left temporal sphenoid ridge meningioma Post-operative Diagnosis Left temporal sphenoid ridge meningioma Operative Method Left pterional approach craniotomy for Simpson grade II tumor excision Specimen Count And Types 1 piece about 1g source: invaded skull 1 piece About size:15g Source:tumor excision 1 piece about 1g source: tumor outside dura Pathology Pending Operative Findings The temporal base skull was fragile and one piece of tumor was found outside of the dura. The tumor was white-yellowish, soft-elastic, size 6.5cm X6cm X 5cm, located at right outter third sphenoid ridge. The temporal base dura was involved by the tumor and removed with one defect. The dural defect was covered with Duraform. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position with head fixed with Mayfield skull clump and turned to right. The scalp was shaved, scrubbed, disinfected with alcohol better-iodine then draped. The left pterional approach with left frontotemporal scalp incision followed by craniotomy with posterior extension. The dura was opened around the tumor after tenting along the craniotomy window. The feeder of the tumor was bipolar coagulated at the attached dura. The tumor was then dissected from the surrounding normal brain tissue with dissector and bipolar coagulator. The feeder from the base was coagulated after removed the tumor in one piece. Hemostasis was achieved with Surgicel lining of the tumor bed. The dura was closed with 4-0 Prolene sutures and the defect was covered with Duraform. The skull plate was fixed back with miniplates and screws after one epidural closed wound vaccum drain set up. The wound was then closed in layers. Operators VS 曾漢民 Assistants R1 陳國瑋 R6 李建勳 相關圖片 潘坤福 (M,1944/02/15,68y0m) 手術日期 2010/05/21 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Carotid stenosis 器械術式 EC-IC by-pass 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 鄭孟伯, 時間資訊 07:35 報到 08:10 進入手術室 08:15 麻醉開始 08:50 誘導結束 09:00 抗生素給藥 09:10 手術開始 12:00 抗生素給藥 13:40 開始輸血 15:10 抗生素給藥 17:05 麻醉結束 17:05 手術結束 17:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 10 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 顱內外血管吻合術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Left side STA-MCA end to side anastomosis (lo... 開立醫師: 陳睿生 開立時間: 2010/05/21 17:46 Pre-operative Diagnosis Left side ICA stenosis Post-operative Diagnosis Left side ICA stenosis Operative Method Left side STA-MCA end to side anastomosis (low flow) Specimen Count And Types nil Pathology Nil Operative Findings The anterior branch of the left side STA was extracted for anastomosis. A distal M3 in the sylvian fissure was harvested for bypass. After anastomosis, the graft pulsation was patent. The skull bone was well vascularized and enrich colateral flow was suspect. Operative Procedures 1. ETGA, supine position and head right turn, fix with Mayfield clump 2. Identify the left side STA with sono guide intra-op 3. Left frontotemporal curvillinear scalp incision 4. Harvest the anterior branch of the STA, and heparinzation for anastomosis graft 5. Incise and dissect the temporalis muscle, and make four bur holes at temporal region 6. Create an about 6x8 cm craniotomy window 7. Dura tacking and open the dura in a curvillinear shape 8. Dissect the sylvian fissure, and expose to harvest a M3 branch 9. Temporal clipping, and STA to MCA end to side anastomosis was performed with 10-0 Nylon stitiches x8 10.Hemostasis, close the dura with Durafoam 11.Fix back the skull graft with miniplates x3 12.Set a subgaleal CWV drain, and close the wound in layers Operators VS 賴達明 Assistants R5 陳睿生; R1 鄭孟伯 蔡金幣 (F,1956/01/12,56y2m) 手術日期 2010/05/21 手術主治醫師 賴達明 手術區域 東址 005房 02號 診斷 HIVD 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳國瑋, 時間資訊 14:15 報到 15:15 進入手術室 15:23 麻醉開始 15:35 誘導結束 16:00 抗生素給藥 16:11 手術開始 18:05 手術結束 18:05 麻醉結束 18:15 送出病患 18:25 進入恢復室 19:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術－頸椎 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 外科部 套用罐頭: Anterior approach for disckectomy and fusion ... 開立醫師: 李建勳 開立時間: 2010/05/21 18:11 Pre-operative Diagnosis C5/6 HIVD Post-operative Diagnosis C5/6 HIVD Operative Method Anterior approach for disckectomy and fusion with cage Specimen Count And Types nil Pathology Nil Operative Findings The c5/6 disc was herniated with spur formation to compromised the dura. One 12mmX 6mm disc cages was inserted with artificial bone graft packing. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position with head extended. The skin over right anterior neck was scrubedd, disinfected with alcohol better-iodine then draped. The transverse skin incision was made at right anterior neck anddivided the platysma muscle. The incision was made over SCM muscle and dissectede along between the fascia plane. The carotid sheath was retracted laterally and the trachea was retrated medially. The longus colli muscles were bipolar coagulated and divided. Localization of C5/6 was performed with portable C-arm X-ray. The cervical retractor was inserted. The prevetebral fascia was incised with No. 15 surgical blade into the disc space. The disckectomy was performed with Kerrison punch and curette under surgicalmicroscope assistance. The spur was removed wtih high-speed air-drill. The posterior longitudinal ligment was removed with Kerrison punch to expose the dura. The herniated disc was check for upward and downward heniation with nerve hook. The disc cage was inserted after hemostasis. The wound was closed and one minihemovac set up at wound site. Operators VS 賴達明 Assistants R1 陳國瑋 R6 李建勳 相關圖片 林龍雄 (M,1942/08/08,69y7m) 手術日期 2010/05/21 手術主治醫師 徐錫靖 手術區域 東址 027房 03號 診斷 Cerebrovascular accident (CVA) 器械術式 PD+PI+PF DR-CHEN P 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 3 紀錄醫師 董正仁, 時間資訊 13:50 報到 14:10 進入手術室 14:13 麻醉開始 14:45 誘導結束 14:50 抗生素給藥 15:33 手術開始 17:50 抗生素給藥 18:15 開始輸血 20:30 麻醉結束 20:30 手術結束 20:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 手術 脊椎融合術－前融合，有固定物（＜＝四節） 1 2 手術 椎弓切除術（特壓）－超過二節 1 4 手術 骨或軟骨移植術 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 記錄__ 手術科部: 骨科部 套用罐頭: Spinal stenosis-PDPIPF + PLIF 開立醫師: 董正仁 開立時間: 2010/05/21 20:21 Pre-operative Diagnosis Multiple spinal stenosis, T11-L5 Post-operative Diagnosis Ditto Operative Method 1) total laminectomy at T11~L4; 2) Posterial spinal fusion with vertebral screw x 8 + Rod x2 , L1~L4; 3) PLIF with 4 cages, L2/3, L3/4; 4) Postero-lateral fusion with allograft,L1~L4 Specimen Count And Types 2 pieces About size:culture Source:allograft About size:disc Source:L2/3, L3/4 Pathology pending Operative Findings 1.Ligamentum flavum hypertrophy and fact degenerative change with hypertrophy 2.Multiple budging discs 3.Good dural pulsaltion after decompression Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position on Relton-Hall frame. The operative field was scrubbed, disinfected and draped as usual. Posterior approach with midline skin incision; Deepen the incision to the level of spinous processes.. Posterior approach to the T11~L5 were done. Extend laminectomy area to T11~L4. The hypertrophied ligamentum flavum was removed. The compressed dural sac expanded after decompressoin. Posterior instrumentation with of L1~L4. was carried out. (1) Pedicle screws *8: bilateral L1-L4 (2) Rods x 2, Cross link x 2 Diskectomy of L2/3, L3/4 intervertebral disc were then performed for releasing the root compression. Some blocks of bone graft + cages *4 were inserted into the inter-body space (PLIF) bilaterally(over L2/3, L3/4). Posterior lateral fusion with allogenic, autograft bone graft with sinbone was performed. 1/8"" HV drain tube was inserted. After irrigation with N/S and hemostasis was achieved, the wound was closed in layers. Operators 徐錫靖, Assistants 賴昆鴻, 范垂嘉, 董正仁, 陳志偉, 陳勇璋, 李奕辰, 吳阿財 (M,1947/02/21,65y0m) 手術日期 2010/05/21 手術主治醫師 紀乃新 手術區域 東址 016房 05號 診斷 Chronic renal failure 器械術式 A-V Shunt 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 林哲安, 時間資訊 14:10 報到 14:38 進入手術室 14:52 麻醉開始 14:53 誘導結束 14:55 手術開始 17:56 麻醉結束 17:56 手術結束 18:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 動靜脈造廔術合併人工血管使用（兩處吻合） 1 1 記錄__ 手術科部: 外科部 套用罐頭: AVF 開立醫師: 林哲安 開立時間: 2010/06/07 17:04 Pre-operative Diagnosis ESRD under P/D Post-operative Diagnosis ESRD under P/D Operative Method Arteriovenous fistula creation, Left Perm cath insertion, Right Specimen Count And Types nil Pathology nil Operative Findings 1. The diameter of the artery was: 3 mm; and the diameter of the vein was: 2 mm 2. The anastomosis opening diameter was: 10 mm. 3. Site: radiocephalic, 4. After the fistula created, a continuous thrill was felt over the fistula, bruit (+) Operative Procedures -- The patient was put on supine position with left hand extended out of the operation table on the arm-board. The operation field was disinfected and draped as usual. Under local anesthesia, a longitudinal skin incision was made between the artery and the vein. The vein and then the artery were dissected out from the surrounding tissue. The vein was then transected and the distal end ligated. Heparin solution was used to flush the vein to test the patency and alsoto keep it from thrombosis.A bulldog was applied on the proximal end of the vein to prevent air emboli. After gaining distal and proximal control of the artery by bulldogs, a longitudinal arteriotomy was performed. The end of the vein was then anastomosed to the arteriotomy with 7-0 prolene continuous suture. The bulldogs were released with the order of vein, distal artery, and proximal artery and the air expelled. After meticulous hemeostasis, the wound was closed in layers. -- Perm cath was inserted via cannulation of right IJV under echo-guidance Operators VS詹志洋 Assistants R3林哲安 傅忠強 (M,1948/08/01,63y7m) 手術日期 2010/05/22 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Pituitary tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 2 紀錄醫師 胡朝凱, 時間資訊 07:35 報到 08:02 進入手術室 08:10 麻醉開始 08:50 誘導結束 09:10 抗生素給藥 09:20 手術開始 12:20 麻醉結束 12:20 手術結束 12:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Peripheral arterial line inserti 1 0 手術 經由蝶竇之腦下垂體瘤切除 1 1 記錄__ 手術科部: 外科部 套用罐頭: Hypophysectomy---Transphenoid 開立醫師: 胡朝凱 開立時間: 2010/05/22 12:53 Pre-operative Diagnosis Pituitary macroadenoma Post-operative Diagnosis Pituitary macroadenoma Operative Method Transphenoid adenomectomy Specimen Count And Types pieces of tumor Pathology pending Operative Findings 1.One yellowish, firm tumor located inside sella turcina which was measured about 3x2 cm. 2.After operation, arachnoid membrane was seen. The buldging lateral wall nearby the ICA was noted 3.Some adhesion and granulation were noted Operative Procedures After ETGA, the patient was put in supine position with head mild left tilt. The nasal cavity was well-disinfective, and then we incised into the nasal septum. Dissection was performed along with the periosteum to expose sphenoid sinus anterior wall and sphenoid ostia. After fracture of vomer, sphenoid sinus anterior wall was also fractured. The mucosa was removed. The sella floor was exposed and removed with kerrison. After cruciate form incision, tumor buldged out. And it was further removed with tumor forceps and ring currette. During operation, cavernous sinus ruptured was noted, but it was stopped immediately by gelfoam packing. After total excision of tumor was made, the bony graft was put back and followed by compaction of merosel. Operators 曾漢民 Assistants 胡朝凱 吳志行 (M,1964/03/09,48y0m) 手術日期 2010/05/22 手術主治醫師 曾漢民 手術區域 東址 003房 02號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 3 紀錄醫師 許松鈺, 時間資訊 10:40 報到 11:18 進入手術室 11:20 麻醉開始 11:40 誘導結束 12:15 抗生素給藥 12:58 手術開始 14:15 麻醉結束 14:15 手術結束 14:25 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 腦瘤切除－手術時間在４小時以內 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Trephination for total tumor remove 開立醫師: 陳睿生 開立時間: 2010/05/22 14:34 Pre-operative Diagnosis Right posterior temporal tumor, suspect metastasis Right posterior temporal tumor, suspect lung adenocarcinoma metastasis Post-operative Diagnosis Right posterior temporal tumor, suspect metastasis Right posterior temporal tumor, suspect lung adenocarcinoma metastasis Operative Method Trephination for total tumor remove Trephination for total tumor removal Specimen Count And Types 1 piece About size:5x3mm Source:tumor with brain tissue Pathology Pending Operative Findings The tumor located at the surface of the posterior aspect of middle temporal gyrus. It was about 4x3x2mm in size. The gross pattern was light whitish, and solid one. The tumor located at the surface of the posterior aspect of middle temporal gyrus. It was about 4x3x2mm in size. The gross pattern was light whitish, and mild solid one. Operative Procedures 1. ETGA, supine position and head left turn 2. Preauricular scalp incision in a curvillinear pattern about 12cm in length 3. Incise into the temporalis muscle and then an about 5x5cm craniotomy window was create with two bur holes made 3. Incise into the temporalis muscle and then an about 5x5cm craniotomy window was create with two burr holes made 4. Dura tacking, and the dura was closed along the window margin 5. Identify the tumor mass at the surface of middle temporal gyrus 6. Totally remove the lesion with peripheral electrocauterization 7. Hemostasis, close the dura tightly after deair 8. Central tacking, and the skull graft was fix back with #26 wires x3 9. Close the temporalis muscle and wound in layers Operators VS 曾漢民 Assistants R5 陳睿生, R1 許松鈺 相關圖片 劉壬葵 (M,1946/08/03,65y7m) 手術日期 2010/05/22 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Lumbar spondylosis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 3 紀錄醫師 許松鈺, 時間資訊 07:40 報到 07:53 進入手術室 08:10 麻醉開始 08:58 抗生素給藥 09:00 誘導結束 09:25 手術開始 10:46 手術結束 10:46 麻醉結束 10:58 送出病患 11:03 進入恢復室 12:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 記錄__ 手術科部: 外科部 套用罐頭: Transpedicular screw revision 開立醫師: 陳睿生 開立時間: 2010/05/22 11:09 Pre-operative Diagnosis Lumbar stenosis with L4/5 lithesis, status post Lumbar stenosis, L4/5, status post L4/5 transpedicular screw fixation and L4 laminectomy Post-operative Diagnosis Lumbar stenosis with L4/5 lithesis, status post Lumbar stenosis, L4/5, status post L4/5 transpedicular screw fixation and L4 laminectomy Operative Method Transpedicular screw revision Specimen Count And Types nil Pathology Nil Operative Findings The screw at left L5 pedicle was re-implanted under C-arm guided. Serous secretion with suspect wound infection at superficial L5 level. Operative Procedures 1. ETGA, prone position with trunk mild flexion 2. Reopen of previous wound and identify the TPS system 3. Remove of the previous screw at left L5 pedicle 4. Re-tapping the transpedicular tunnel 5. Re-insert the screw and C-arm confirm the screw position 6. Close the wound in layers Operators VS 賴達明 Assistants R5 陳睿生; R1 許松鈺 相關圖片 劉壬葵 (M,1946/08/03,65y7m) 手術日期 2010/05/23 手術主治醫師 徐錫靖 手術區域 東址 000房 號 診斷 Lumbar spondylosis 器械術式 CLOSE REDUCTION. RIGHT HIP 手術類別 緊急手術 手術部位 四肢 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 劉治民 ASA 2E 紀錄醫師 謝忠佑, 時間資訊 07:00 臨時手術NPO 07:00 開始NPO 01:42 進入手術室 01:45 麻醉開始 01:50 誘導結束 01:52 手術開始 02:00 手術結束 02:00 麻醉結束 02:05 送出病患 02:10 進入恢復室 03:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 手術 股關節脫位開放性復位術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Lumbar stenosis, L4/5, status post L4/5 transpedicular screw fixation and L4 laminectomy Post-operative Diagnosis Lumbar stenosis, L4/5, status post L4/5 transpedicular screw fixation and L4 laminectomy Operative Method Transpedicular screw revision Specimen Count And Types nil Pathology Nil Operative Findings The screw at left L5 pedicle was re-implanted under C-arm guided. Serous secretion with suspect wound infection at superficial L5 level./ Operative Procedures 1. ETGA, prone position with trunk mild flexion2. Reopen of previous wound and identify the TPS system3. Remove of the previous screw at left L5 pedicle4. Re-tapping the transpedicular tunnel5. Re-insert the screw and C-arm confirm the screw position6.lose the wound in layers/ Operators VS 賴達明 Assistants R5 陳睿生; R1 許松鈺 Indication Of Emergent Operation 摘要__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 謝忠佑 開立時間: 2010/05/23 10:08 Pre-operative Diagnosis right hip, post THR, dislocation Post-operative Diagnosis right hip, post THR, dislocation Operative Method closed reduction Specimen Count And Types nil Pathology nil Operative Findings dislocated hip joint Operative Procedures 1. IVGA, in supine position 2. closed reduction under fluoroscopy Operators 徐錫靖, Assistants 謝忠佑, 陳明峰, Indication Of Emergent Operation 記錄__ 手術科部: 骨科部 套用罐頭: closed reduction 開立醫師: 謝忠佑 開立時間: 2010/05/23 10:50 Pre-operative Diagnosis right hip, post THR, dislocation Post-operative Diagnosis right hip, post THR, dislocation Operative Method closed reduction Specimen Count And Types nil Pathology nil Operative Findings dislocated hip joint Operative Procedures 1. IVGA, in supine position 2. closed reduction under fluoroscopy Operators 徐錫靖, Assistants 謝忠佑, 陳明峰, Indication Of Emergent Operation 摘要__ 手術科部: 外科部 套用罐頭: closed reduction 開立醫師: 謝忠佑 開立時間: 2010/05/24 17:53 Pre-operative Diagnosis right hip, post THR, dislocation Post-operative Diagnosis right hip, post THR, dislocation Operative Method closed reduction Specimen Count And Types nil Pathology nil Operative Findings dislocated hip joint Operative Procedures 1. IVGA, in supine position 2. closed reduction under fluoroscopy Operators 徐錫靖, Assistants 謝忠佑, 陳明峰, Indication Of Emergent Operation 徐廖碧蓮 (F,1952/12/20,59y2m) 手術日期 2010/05/22 手術主治醫師 王國川 手術區域 東址 005房 02號 診斷 Subdural hemorrhage (SDH) 器械術式 Craniotomy(Aneurysms) P-DUH 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 3E 紀錄醫師 鄭孟伯, 時間資訊 12:38 通知急診手術 13:20 報到 13:20 進入手術室 13:45 抗生素給藥 14:30 麻醉開始 14:40 誘導結束 14:50 手術開始 16:45 抗生素給藥 19:45 抗生素給藥 20:10 麻醉結束 20:10 手術結束 20:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱內壓監視置入 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 開顱術摘除血管病變－腦血管瘤－有徵的 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Right frontal approach for aneurysmal clipping 開立醫師: 胡朝凱 開立時間: 2010/05/22 20:46 Pre-operative Diagnosis Right A2 aneurysm rupture Post-operative Diagnosis Right A2 aneurysm rupture Operative Method Right frontal approach for aneurysmal clipping Specimen Count And Types nil Pathology nil Operative Findings 1.One saccular aneurysm arised from A2 protruded toward to left and anteriorly that adhesed to left A2. 2.Peripheral blood clot and adhesion was also noted. 3.Stright Sugita aneurysm clip was used to complete clipping Operative Procedures 1.ETGA, supine with head fixed with skull clamp 2.Bicoronal skin incision 3.Reflect skin flap downward 4.open periosteum 5.craniotomy 6.Dural tenting 7.Open dura with the base left at midline 8.Retract right frontal lobe to identify distal A2 9.Trace back to proximal A2 10.Expose aneurysm and its neck 11.Aneurysmal clipping 12.Hemostasis 13.Close dura with durofoam 14.fix bone back with miniplate and bone cement 15.Close wound in layers. Operators 王國川 Assistants 胡朝凱,鄭孟伯 Indication Of Emergent Operation 葛煥彰 (M,1955/11/03,56y4m) 手術日期 2010/05/23 手術主治醫師 賴達明 手術區域 東址 001房 02號 診斷 Fracture of multiple cervical vertebra, closed 器械術式 Diskectomy cervical(Anterier) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 3 紀錄醫師 張政傑, 時間資訊 07:45 開始NPO 07:45 臨時手術NPO 10:45 通知急診手術 14:35 報到 14:50 進入手術室 15:00 麻醉開始 15:20 誘導結束 15:42 抗生素給藥 16:03 手術開始 18:20 手術結束 18:20 麻醉結束 18:30 送出病患 18:30 進入恢復室 19:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 手術 脊椎融合術－前融合，有固定物（＜＝四節） 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Anterior Discectomy and Fusion, Cervical Spine 開立醫師: 張政傑 開立時間: 2010/05/23 18:53 Pre-operative Diagnosis Cervical spine fracture and dislocation , C4-5 Post-operative Diagnosis Cervical spine fracture and dislocation , C4-5 Operative Method Anterior discectomy and fusion, cervical Spine C4-5 Specimen Count And Types nil Pathology nil Operative Findings 1. Rupture of disk , C4-5 2. Suspected fracture of posterior spine , C4 and C5 3. Swelling of paraspinal tissue 4. Artificial disk , SYNTHES 6mm was implanted 5. Metal plate : 18*4 mm ; Screws : 16 mm * IV Operative Procedures 1. Anesthesia: endotracheal general 2. Position: supine with neck hyperextended 3. Skin preparation 4. Incision; 5 cm, transverse right neck 5. Transect the plastisma muscle 6. Dissect the loose plane between SCM muscle and strip muscles until the prevertebral fascia had been reached.Cloward cervical retractor was used 7. The prevertebral fascia was opened vertically, the lesion intervertebral space was exposed and identified by intraoperative portable X-ray 8. Exposure of the vertebral bodies.The anterior longitudinal ligment was incised transversely at the margins of intervertebral space, the annulus fibrosus was cut too. 9. The ruptured disc and cartilage plate were removed by curette 10. Implant the artificial disk with bone graft 11. Fixed C4-5 with metal plate 12. Hemostasis and place a minihemovac drainage 13. Wound closure is layers Operators 賴達明, Assistants 陳睿生, 張政傑 Indication Of Emergent Operation 相關圖片 伍惇 (M,1940/06/07,71y9m) 手術日期 2010/05/24 手術主治醫師 黃信豪 手術區域 西址 034房 03號 診斷 直腸乙狀結腸連接部惡性腫瘤 器械術式 Port-A Implatation /WOR 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 賴佳欣, 時間資訊 00:00 臨時手術NPO 11:30 進入手術室 11:35 麻醉開始 11:40 誘導結束 11:45 抗生素給藥 11:52 手術開始 12:35 手術結束 12:35 麻醉結束 12:40 送出病患 12:45 進入恢復室 14:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 ｐｏｒｔ–Ａ導管植入術–治療性導管植入術 1 0 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 記錄__ 手術科部: 麻醉部 套用罐頭: Port-A implantation, subclavian 開立醫師: 賴佳欣 開立時間: 2010/05/24 12:36 Pre-operative Diagnosis colon cancer Post-operative Diagnosis Ditto Operative Method Port-A implantation, echo-guided Specimen Count And Types nil Pathology Nil Operative Findings 1.Site: right subclavian vein, with echo-guided procedure 2.Patent flow after implantation 3.Others: nil Operative Procedures 1.The patient was set on supine position and bilateral subclavian veins were checked by echo. 2.After IVGA and local anesthesia applied, transverse skin incision for 3cm was made at pre-cordial area. 3.Undermine the skin at the layer between subcutaneous tissue and deep fascia in lateral direction. 4.An IV catheter was inserted via the subclavian incision and negatively aspirated until venous blood attainable. 5.J-wire was inserted smoothly in rostral direction. A subclavian catheter with dilator was inserted through the J-wire, and the dilator was then removed. 6.The catheter of Port-A was threaded into the subclavian vein until mark 22 cm. The catheter was adapted into the port and locked with restrictor.The Port was inserted into the pouch of pre-cordial incision. 7.Skin was closed layer by layer. Both catheter and port were perfused with heparin solution after implantation. Operators 黃信豪, Assistants 賴佳欣, 張圳 (M,1928/01/15,84y1m) 手術日期 2010/05/24 手術主治醫師 王碩盟 手術區域 東址 007房 04號 診斷 Prostate cancer 器械術式 TRUS-Biobsy 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 靜脈麻醉 麻醉主治醫師 黃慧薰 ASA 3 紀錄醫師 曾任偉, 時間資訊 00:00 臨時手術NPO 14:00 進入手術室 14:10 手術開始 14:10 麻醉開始 14:12 誘導結束 14:22 手術結束 14:22 麻醉結束 14:25 送出病患 15:30 離開恢復室 15:44 進入恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 手術 前列腺切片－控取式 1 1 記錄__ 手術科部: 泌尿部 套用罐頭: TRUS-P-biopsy 開立醫師: 曾任偉 開立時間: 2010/05/24 14:31 Pre-operative Diagnosis r/o prostate cancer Post-operative Diagnosis r/o prostate cancer Operative Method TRUSP biopsy Specimen Count And Types 12 core Pathology pending Operative Findings systemic 12 cores TRUSP biopsy was performed Operative Procedures Under satisfactory anesthesia with the patient in right flank position, prepping and draping was performed in the usual sterile fashion. TRUSP was performed and echo-guided prostate biopsies were performed smoothly with Biopty gun. The cores of tissue specimen were obtained. The biosy area was compressed for several minutes to ensure adequate hemostasis. The patient tolerated the operation well and was sent to the floor in satisfactory condition. Operators 王碩盟 Assistants 曾任偉 李明潔 (F,1974/08/14,37y7m) 手術日期 2010/05/24 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 鍾文桂, 時間資訊 07:45 報到 08:03 進入手術室 08:05 麻醉開始 08:40 誘導結束 09:00 抗生素給藥 09:34 手術開始 12:00 抗生素給藥 15:00 抗生素給藥 18:00 抗生素給藥 19:15 麻醉結束 19:15 手術結束 19:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 R 手術 眼窩減壓術 1 2 R 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 R 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 14 0 記錄__ 手術科部: 外科部 套用罐頭: Simpson grade I tumor excsion via Dolenc appr... 開立醫師: 鍾文桂 開立時間: 2010/05/24 20:10 Pre-operative Diagnosis Optic nerve sheath meningioma,right, with intracranial extension. Post-operative Diagnosis Optic nerve sheath meningioma,right, with intracranial extension. Operative Method Simpson grade I tumor excsion via Dolenc approach,right and unroofing of orbital rim. Specimen Count And Types 1 piece About size:2cm Source:optic nerve sheath meningioma. Pathology Pending. Operative Findings 1. Encasement of right ophthalmic artery by the tumor. Mild stricture of the artery is noted. 1. Encasement of right ophthalmic artery, middle cerebral artery, and anterior cerebral artery by the tumor. Mild stricture of the artery is noted. 2. Intact optic chiasm. 2. Intact optic chiasm and pituitary stalk. 3. Ophthalmic artery and optic nerve,right were sacrafized for total tumor excision. 4. No intraoperative left VEP change. 5. Opening of the frontal, and ethmoid sinuses. 5. Opening of the ethmoid sinus. Operative Procedures Under ETGA, the patient was placed in supine position and the head was tilted to the left. After shaving, disinfection, and well-draping, the operative wound was incised along the previous operative wound with temporal extension over the preauricular area. With careful dissection of the scar tissue, the skull bone was exposed. Craniotomy was made with temporal extension for preparation of Dolenc approach. After tenting, the sphnoid ridge was flattened with rongeur and high speed drill and anterior clinoid process was removed with exposure of the frontal and ethmoidmal sinuses. Later, the roof and lateral wall of the orbital rim were also removed After finishing the bony removal and durotomy,proximal part of slyvian fissure was opened for exposure of the frontal skull base. The frontal&temporal; lobes were retacted. By tracing the middle cerebral artery, we found ophthalmic artery which was encased by the meningioma. The tumor was removed by CUSA and tumor forceps. Then, we checked the optic chiasm,oculomotor nerve, and perforators of P-com artery. They were all intact. Later, the dural mater was pulled back to expose the orbit. The ring of Zenn was excised and the ophthalmic artery was sacrafised together with optic nerve,right. The periorbita was incised to reach the tumor mass. With mild retraction of the orbital fat, the tumor was exposed. We removed the tumor by pull through method. The tumor was excised totally. Finally, we closed the wound in layers after duroplasty, closure of periorbita, and cranioplasty with bone cement. The patient was sent to ICU smoothly. Operators Prof. 杜永光 Assistants R6 陳盈志, R4 鍾文桂. 相關圖片 黃育綸 (F,1972/04/03,39y11m) 手術日期 2010/05/24 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 陳國瑋, 時間資訊 07:35 報到 08:00 進入手術室 08:10 麻醉開始 08:50 誘導結束 09:10 抗生素給藥 09:20 手術開始 12:10 抗生素給藥 14:00 麻醉結束 14:00 手術結束 14:10 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 顱底瘤手術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Retrosigmoid approach for near total tumor ex... 開立醫師: 李建勳 開立時間: 2010/05/24 14:20 Pre-operative Diagnosis Left cerebellopotine angle(CPA) tumor Post-operative Diagnosis Left cerebellopotine angle(CPA) tumor Operative Method Retrosigmoid approach for near total tumor exicision Specimen Count And Types 1 piece About size: Source:CP angle tumor fragment Pathology Pending Operative Findings The cerebellum was swelling while opening the dura. The tumor was yellowish, soft-elastic, size 3 cm in diameter. The tumor was adhered to the brain stem and was not able to completely seperated from the brain stem. One thin piece of the tumor was left in situ to prevent futher brain stem damage. Operative Procedures Under general anesthesia and intubation, the patient was put in 3/4 prone position with head fixed with Mayfield skull clump. The scalp was shaved, scrubbed, disinfected with alcohol better-iodine then draped. The curvilinear scalp incision was made at left retroauricular area followed by craniotomy. The dura was opened along the posterior craniotomy window after tenting. The cerebrospinal fluid (CSF) was drained out for relaxation of the cerebellum. The tumor was found after retraction of the cerebellum. Tumor excision was performed with bipolar coagulator and tumor forceps. The border was seperated with dissector under surgical microscope. The cranial nerves were detected with bipolar stimulator. The last piece of the tumor was left in situ to prevent further brain stem damage. The duroplasty was performed with fascia graft and 4-0 Prolene sutures. The skull plate was fixed back with wires. The wound was then closed in layers after one subgaleal close wound vaccum drain set up. Operators VS 曾漢民 Assistants R1 陳國瑋 R6 李建勳 相關圖片 張祐禎 (F,1972/08/10,39y7m) 手術日期 2010/05/24 手術主治醫師 曾漢民 手術區域 東址 005房 號 診斷 Cushing syndrome 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 陳國瑋, 時間資訊 13:25 報到 14:35 麻醉開始 14:50 誘導結束 15:00 抗生素給藥 15:15 手術開始 15:30 進入手術室 16:50 麻醉結束 16:50 手術結束 17:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 經由蝶竇之腦下垂體瘤切除 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 外科部 套用罐頭: Microscopic transsphenoid adenomectomy 開立醫師: 李建勳 開立時間: 2010/05/24 17:24 Pre-operative Diagnosis Cushing syndrome Post-operative Diagnosis Cushing syndrome Operative Method Microscopic transsphenoid adenomectomy Specimen Count And Types 1 piece About size:0.1g Source:transsphenoid adenomectomy Pathology Pending Operative Findings The tumor was whitish, elastic, hypervascularized, size 1 cm in diameter, located more at left side. No CSF leakage was noted after tumor excision. The tumor was whitish, elastic, hypervascularized, size 1 cm in diameter, located more at left side. One suspected tumor vessel, which was oozing after opened the dura, was bipolar coagulated. No CSF leakage was noted after tumor excision. Operative Procedures Under general anethesia and intubation, the patient was put in supine position with head tilted 30 degree to left. The facial skin was antiseptic with alcohol hibitan tincture, and the mucosa of oral and nasal cavity with aqueous better-iodine. The former areas were covered by sterilized adhesive plastic sheets then draped. The nasal mucosa incision was made after local anesthesia injection at right submucosal layer. A nasal speculum was applied to displace the nasal mucosa laterally and keep the nasal cavity open constantly for the exposure of the vomer bone and the anterior wall of the sphenoid sinus.Dissection was made under surgical microscope assistance to remove the anterior sphenoid wall and vomer by osteotome. The mucosa was removed by aligators. The posterior sphenoid wall was penestrated by osteotome and widened by Kerrison punch. The sellar floor dura and venous bleeding were coagulated with bipolar forceps and stopped by gelfoam packing., then opened in cruciate fashion. The soft tumor parenchyma was removed by curette and suction. The arachnoid and the opening of diaphragm sellae was enforced by packing with gelform as in the sellar cavity. The sphenoid sinus was packed with Gelform. The vomer bone was put back in place. The nasal speculum was removed and the nasal mucosa returned to its normal position. Right side of the nasal cavities was tightly packed with two gauze in the finger of glove which had been soaked with better-iodine ointment. Operators VS 曾漢民 Assistants R1 陳國瑋 R6 李建勳 相關圖片 吳欣潔 (F,2008/10/23,3y4m) 手術日期 2010/05/24 手術主治醫師 廖漢文 手術區域 東址 000房 號 診斷 Moyamoya disease 器械術式 Common Carotid Angiography 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 王永彬 ASA 3 時間資訊 08:40 麻醉開始 08:50 誘導結束 10:10 麻醉結束 10:40 進入恢復室 11:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 高冏淯 (M,1931/03/12,81y0m) 手術日期 2010/05/24 手術主治醫師 賴達明 手術區域 東址 002房 03號 診斷 Depressive disorder (F33.9) 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2E 紀錄醫師 曾峰毅, 時間資訊 07:00 臨時手術NPO 07:00 開始NPO 09:06 通知急診手術 14:10 報到 14:30 進入手術室 14:35 麻醉開始 14:44 誘導結束 14:55 抗生素給藥 15:14 手術開始 16:20 手術結束 16:20 麻醉結束 16:25 送出病患 16:40 進入恢復室 17:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 手術 慢性硬腦膜下血腫清除術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Left burr hole for subdural drainage 開立醫師: 曾峰毅 開立時間: 2010/05/24 16:13 Pre-operative Diagnosis Left chronic subdural hematoma Post-operative Diagnosis Left chronic subdura hematoma Operative Method Left burr hole for subdural drainage Specimen Count And Types nil Pathology Nil Operative Findings There were outer and inner membrane, and dark-browinsh subdural effusion was drained out. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to right. After scalpshaved, scrubbed, and disinfeted, we made one linear skin incision at left frontal. We drilled one burr hole, and inserted one rubbder drain into subdural space for irrigation and drinaege. We closed the wound in layers after de-air and hemostasis. Operators VS 賴達明 Assistants R3 曾峰毅 Ri 林自華 Indication Of Emergent Operation 李瑞廣 (M,1925/06/23,86y8m) 手術日期 2010/05/24 手術主治醫師 蔡翊新 手術區域 東址 002房 02號 診斷 Other and unspecified intracranial hemorrhage following injury, unspecified state of consciousness 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 4E 紀錄醫師 曾峰毅, 時間資訊 20:19 臨時手術NPO 20:19 開始NPO 08:19 通知急診手術 11:15 報到 11:50 進入手術室 11:55 麻醉開始 12:00 誘導結束 12:35 手術開始 14:00 手術結束 14:00 麻醉結束 14:05 送出病患 14:10 進入恢復室 16:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 慢性硬腦膜下血腫清除術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Chronic Subdural Hematoma 開立醫師: 蔡翊新 開立時間: 2010/05/24 13:38 Pre-operative Diagnosis Left frontotemporal chronic subdural hematoma or subdural effusion. Post-operative Diagnosis Left frontotepmoral subdural effusion, suspected external hydrocephalus. Operative Method Left frontal burr hole drainage. Specimen Count And Types nil Pathology Nil. Operative Findings Thick dura was noted at left frontal area. There was no outer membrane noted. After opening the dura, clear, light yellowish subdural effusion gushed out. The brain remained slack after drainage of the effusion. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: linear, at left frontal area. Raney clips were applied to the scalp edge for temporary hemostasis. 5. A burr hole was made at left frontal area. 6. Dural tenting: by 2/0 silk at 1 cm interval, distributed along the edge of the trephine. 7. Dural incision: cruciate at middle of the burr hole. 8. The clear effusion in the subdural space was drained via a rubber tube. 9. Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous sutures with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 10.Drain: one subdural rubber drain connecting to a closed drainage bag. 11.Blood transfusion: nil. 12.Course of the surgery: transient blood pressure drop to 56/31 mmHg immediately after opening the dura, and recovered soon after given inotropic agents. Operators VS蔡翊新 Assistants R3曾峰毅Ri林自華 Indication Of Emergent Operation 許致軒 (M,1978/03/07,34y0m) 手術日期 2010/05/25 手術主治醫師 賴達明 手術區域 東址 001房 02號 診斷 Subarachnoid hemorrhage (SAH) 器械術式 Craniotomy(Aneurysms) P-DUH 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 李建勳, 時間資訊 00:33 臨時手術NPO 00:33 開始NPO 06:33 通知急診手術 08:35 進入手術室 08:35 報到 08:45 麻醉開始 08:55 抗生素給藥 08:55 誘導結束 10:55 手術開始 12:30 抗生素給藥 13:45 開始輸血 15:30 抗生素給藥 17:55 麻醉結束 17:55 手術結束 18:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 開顱術摘除血管病變－腦血管瘤－有徵的 1 1 L 手術 顱內壓監視置入 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 10 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Left pterional approach for aneurysm clipping... 開立醫師: 李建勳 開立時間: 2010/05/25 18:34 Pre-operative Diagnosis Multiple aneurysms with left MCA aneurysm rupture Post-operative Diagnosis Multiple aneurysms with left MCA aneurysm rupture Operative Method Left pterional approach for aneurysm clipping and Pannies point EVD insertion for ICP monitoring Specimen Count And Types nil Pathology Nil Operative Findings The aneurysm was irregular in shape and three Sugita aneurysm clips were applied to clip the aneursymal neck. The brain was swelling after opened the dura and mild swelling while closing the dura. The anterior and posterior branches of left superficial temporal artery were preserved. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position with head fixed with Mayfield skull clump. The scalp was shaved, scrubbed, disinfected with alcohol better-iodine then draped. Left frontotemporal scalp incision was made as usual pterional approach followed by craniotomy. The medial sphenoid ridge was further drill off by high speed air drill for wider operation field. Opened the dura in fish-mouth fasion after tenting around the craniotomy window. Pannies point EVD was inserted and fixed the EVD at scalp. Opened the sylvian fissure and relaxed the brain by releasing the CSF. Dissected the arachnoid to exspose the ICA and MCA. Followed the MCA to locate the aneurysm. Dissected the aneruysm neck with microdissector. Clipped the aneurysm with Sugita aneurysm clips after proximal control of the MCA. The dura was sutured with 4-0 Prolene sutures. The skull plate was fixed back with miniplates and screws after central tenting and one subgaleal CWV drian set up. The temporalis fascia was sutured back and the wound was closed in layers. Operators VS 賴達明 Assistants R6 李建勳 Indication Of Emergent Operation 相關圖片 李有利 (M,1959/12/04,52y3m) 手術日期 2010/05/25 手術主治醫師 林晉 手術區域 西址 035房 01號 診斷 Pain in joint, pelvic region and thigh 器械術式 Remove of inplant/ L ""O,AO""備困難拔釘包 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 脊髓麻醉 麻醉主治醫師 林至芃 ASA 3 紀錄醫師 葉炳君, 時間資訊 08:05 進入手術室 08:15 麻醉開始 08:20 誘導結束 08:30 抗生素給藥 08:40 手術開始 08:50 手術結束 08:50 麻醉結束 09:00 進入恢復室 10:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 Spinal anesthesia 1 0 手術 骨內固定物拔除術－骨盆，髖骨，肱骨，股骨，尺骨，橈骨，脛骨 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 摘要__ 手術科部: 骨科部 套用罐頭: Removal of implant 開立醫師: 葉炳君 開立時間: 2010/05/25 08:50 Pre-operative Diagnosis Left femoral intertrochanteric fracture, bony malunion Post-operative Diagnosis Left femoral intertrochanteric fracture, bony malunion Operative Method Removal of implants Specimen Count And Types nil Pathology Nil Operative Findings 1. Left ITC fracture, bony malunion 2. Implants in situ Operative Procedures 1. Anesthetic induction(SA), lateral decuibitus position. 2. Skin disinfected and draped. 3. Skin incision over the implant eminence 4. Dissected and exposed old implants; then removed.(one Smith-Peterson nail) 5. Irrigated with normal saline and hemostasis. 6. Closed the wound by layers. Operators 林晉, Assistants 葉炳君, 陳明峰, 簡士承 (M,1985/05/31,26y9m) 手術日期 2010/05/26 手術主治醫師 曾勝弘 手術區域 東址 001房 03號 診斷 Malignant neoplasm of liver, primary 器械術式 Crainotomy Brain Tumor(P-LIN)，External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3E 紀錄醫師 陳建銘, 時間資訊 00:00 開始NPO 10:50 通知急診手術 02:13 進入手術室 02:15 麻醉開始 02:40 誘導結束 03:30 抗生素給藥 03:42 手術開始 07:10 手術結束 07:10 麻醉結束 07:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除－手術時間在４～８小時 1 1 摘要__ 手術科部: 外科部 套用罐頭: Left cerebellar craniotomy for tumor excision 開立醫師: 李建勳 開立時間: 2010/05/26 07:36 Pre-operative Diagnosis Left cerebellar tumor with suspected bleeding Post-operative Diagnosis Left cerebellar tumor with suspected bleeding Operative Method Left cerebellar craniotomy for tumor excision Specimen Count And Types 1 piece About size:3g Source:craniotomy for tumor excision Pathology Pending Operative Findings The cerebellum was mild swelling after craniotomy. The tumor was grey-reddish, hypervascular, size 3cm in diameter with seperable margin from the peripheral normal brain parenchyma. The tumor bed was easily oozing and packing wit Surgicel lining. Operative Procedures Under general anesthesia and intubation, the patient was put in prone position with head fixed with Mayfield skull clump. The scalp was shaved, scrubbed, disinfected with alcohol better iodine then draped. Hocky stick scalp incision was made from midline to left cerebellum followed by craniotomy. The dura was opened in cruciate fashion and tumor excision was performed with bipolar coagulator via transcortical approach. The tumor bed was easily oozing and packing wit Surgicel lining. The dura was closed with 4-0 Prolene sutures. The craniotomy window was tenting with 3-0 silk sutures. The skull plate was fixed back with wires. The wound was closed in layers after 1 subgaleal CWV drain set up. Operators VS 曾勝弘 Assistants R1 陳建銘 R6 李建勳 Indication Of Emergent Operation 相關圖片 何開敏 (F,1929/04/08,82y11m) 手術日期 2010/05/25 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Seizures 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 胡朝凱, 時間資訊 07:35 報到 08:07 進入手術室 08:10 麻醉開始 08:35 誘導結束 09:10 抗生素給藥 09:20 手術開始 12:10 抗生素給藥 13:40 開始輸血 13:55 麻醉結束 13:55 手術結束 14:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除－手術時間在４～８小時 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Right subfrontal tumor excision 開立醫師: 胡朝凱 開立時間: 2010/05/25 14:29 Pre-operative Diagnosis Planum sphenoidale meningioma Post-operative Diagnosis Planum sphenoidale meningioma Operative Method Right subfrontal tumor excision Specimen Count And Types pieces of tumor Pathology Pending Operative Findings 1.One whitish, firm, tumor located at frontal base that arised from planum sphenoidale was noted. 2.The vascular supply comed from tumor base. 3.Dural base was noted. 4.The margin between tumor and brain surface was clear. Operative Procedures 1.ETGA, supine 2.Bicoronal skin incision 3.Reflect skin downward 4.Craniotomy 5.Dural tenting 6.Open dura as the base left on midline 7.Resect partial right frontal lobe 8.devascularized 9.Central debulky 10.Remove tumor totally 11.Close dura with durofoam 12.Fixed bone back with miniplate and bone cement 13.Close wound in layers Operators 曾勝弘 Assistants 胡朝凱, Ri 何開敏 (F,1929/04/08,82y11m) 手術日期 2010/05/25 手術主治醫師 曾勝弘 手術區域 東址 022房 03號 診斷 Seizures 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 4E 紀錄醫師 胡朝凱, 時間資訊 15:27 通知急診手術 15:35 進入手術室 15:38 麻醉開始 15:40 誘導結束 15:48 手術開始 17:20 開始輸血 18:15 手術結束 18:15 麻醉結束 18:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 腦內血腫清除術 1 2 R 記錄__ 手術科部: 外科部 套用罐頭: Right craniotomy for hematoma evacuation 開立醫師: 胡朝凱 開立時間: 2010/05/25 18:38 Pre-operative Diagnosis Right frontal hematoma Post-operative Diagnosis Right frontal hematoma Operative Method Right craniotomy for hematoma evacuation Specimen Count And Types Nil Pathology nil Operative Findings 1.About 100 ml blood clot was noted in the right frontal lobe 2.The blood extended into ventricle 3.Diffuse woozing was noted on brain rough surface 4.The brain became slack after hematoma evacuation Operative Procedures 1.ETGA, supine 2.skin incision at previous wound 3.Reflect skin 4.Craniotomy 5.Open dura 6.Hematoma evacuation 7.Hemostasis 8.Insert EVD 9.Close dura and fix bone back 10.Close wound in layers Operators 曾勝弘 Assistants 胡朝凱 Indication Of Emergent Operation 李游玉梅 (F,1952/04/25,59y10m) 手術日期 2010/05/25 手術主治醫師 曾勝弘 手術區域 西址 033房 01號 診斷 Carpal tunnel syndrome 器械術式 Neurolysis of the uluar neuve 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 08:20 進入手術室 08:25 麻醉開始 08:32 手術開始 08:55 手術結束 09:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 神經分離術－手．足之神經 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: medium nerve decompression 開立醫師: 陳德福 開立時間: 2010/05/25 09:04 Pre-operative Diagnosis right capal tunnel syndrome Post-operative Diagnosis ditto Operative Method medium nerve decompression Specimen Count And Types NIL Pathology NIL Operative Findings The transverse ligament is hypertrophic with compression to the medium nerve. 2.The medium nerve is decompressed after release the hypertrophic ligament. Operative Procedures Under LA and supine position, the right forearm and hand is disinfected and draped. One linear incision at the palm is made and the transverse ligament is exposed. The ligament is released by knife and the medium nerve is exposed. Hemostasis, the wound is closed in layers. Operators AP 曾勝弘 Assistants r4 陳德福 李韋文 (M,2004/02/28,8y0m) 手術日期 2010/05/25 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Diastematomyelia 器械術式 Cord untethering -KUO 手術類別 臨時手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 2 紀錄醫師 蔡宗良, 時間資訊 00:01 臨時手術NPO 07:48 報到 08:06 進入手術室 08:15 麻醉開始 08:25 誘導結束 09:07 抗生素給藥 09:27 手術開始 12:07 抗生素給藥 15:07 抗生素給藥 17:00 手術結束 17:00 麻醉結束 17:05 送出病患 17:05 進入恢復室 18:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 10 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 動脈血液檢查全套 1 0 手術 脊椎內脊髓內腫瘤切除術 1 1 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Untethering of spinal cord 開立醫師: 蔡宗良 開立時間: 2010/05/25 18:06 Pre-operative Diagnosis Tethered cord syndrome Retethered cord syndrome due to diastematomyelia and myelomeningocele, S/P, and tight filum terminale Post-operative Diagnosis Tethered cord syndrome Retethered cord syndrome due to diastematomyelia and myelomeningocele, S/P Operative Method Untethering of spinal cord Untethering of spinal cord from duroneurla junction and excision of the fibrous septum between the split cords Specimen Count And Types 1 piece, Source:septum separating the spinal bifida Pathology The septum separating the spinal bifida was excised The septum separating the split cord malformation. Operative Findings 1. Severe adhesion of intradural nerve roots on the wall of dura at the lateral wall of dura bilaterally at from L3 to L5 area, resulting tethering of spinal cord. 1. Severe adhesion of the duroneural junction at the dorsal side of the spinal cord and the split cord. from T12 to sacral end. The bilateral dorsal nerve roots were tightly adhered to the dura, especially from L3 to L5 area, where the split cord was located. 2. A septum separating the spinal bifida was removed 2. Some arachnoid fibrosis were noted in the operative field due to previous operation. There was an arachnoid septum at the left side of the cord that tethered the left ventral roots to the dorsal side. A fibrous septum separating the spinal cord into two (split cord malformation) and extended to the cauda equina. It was not connected with the ventral thecal sac, so it was not causing severe tethering effect. We then removed it. 3. No visible filum terminale was found. 3. No visible filum terminale was found. 4. The paravertebral muscle over the op field disapperaed dut to previous myelominingocele, so the skin under was the dura and some fibrous tissue. The patient had scoliosis. Operative Procedures General anesthesia was applied under endotracheal intubation. Patient was placed in a prone position. Sterilization was carried out in the usual manner. Skin incision was made on his previous scar. Microscope was brought into the surgical field. We begun durotomy from the cephalad end. General anesthesia was applied under endotracheal intubation. Patient was placed in a prone position. Sterilization was carried out in the usual manner. Skin incision was made on his previous scar. Microscope was brought into the surgical field. We begun durotomy from the cephalad end. Adhesiolysis of spinal cord and nerve roots were performed accordingly. The septum separating the spinal bifida was removed. All visble adhesions were separated until L5 level. The dura was closed by 5-0 Prolene and sealed by fibrin glue (Tissuecol Duo, Baxter). The wound was closed in layers. Adhesiolysis of spinal cord and nerve roots were performed accordingly from side to side. The fibrous septum separating the split cord was removed meticulously till the anterior margin disclose contacting with the ventral roots instead of the anterior thecal sac. All visble adhesions were separated from T12 to the end of thecal sac. We checked the caudal part of the spinal cord and confirmed that there was no filum terminale. The dura was closed by 5-0 Prolene and sealed by fibrin glue (Tissuecol Duo, Baxter). The wound was closed in layers. Operators VS 郭夢菲 Assistants R4 蔡宗良 張陳富美 (F,1940/11/20,71y3m) 手術日期 2010/05/25 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Rheumatoid arthritis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 鄭孟伯, 時間資訊 08:18 進入手術室 08:20 麻醉開始 08:21 誘導結束 09:50 手術開始 11:35 手術結束 11:35 麻醉結束 11:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 手術 深部複雜創傷處理－傷口長１０公分以上者 1 0 摘要__ 手術科部: 外科部 套用罐頭: Occipitocervical fusion revision 開立醫師: 王奐之 開立時間: 2010/05/25 12:19 Pre-operative Diagnosis Rheumatoid arthritis with odontoid basilar invagination Post-operative Diagnosis Rheumatoid arthritis with odontoid basilar invagination Operative Method Occipitocervical fusion revision Specimen Count And Types nil Pathology Nil Operative Findings 1. The bilateral rods of the cervicooccipital fusion system were released, their curvatures were adjusted, and they were re-installed back to their previous locations when the neck was put in the neutral position 2. Each of the rods was cut short by about 1 cm Operative Procedures 1. prone position, ETGA, skin disinfection, drapped as usual 2. re-open the wound in the posterior neck created made in the previous surgery 3. released the bilateral rods, took them out 4. re-adjusted the neck of the patient in the neutral position 5. adjusted the curvatures of the rods by tools, to let them fit the curvature of the neutral position of the neck 6. re-installed the rods back to their previous locations 7. place one CWV drainage tube 8. wound closure in layers Operators VS賴達明 Assistants R5陳睿生, R1鄭孟伯 林暖 (F,1961/06/10,50y9m) 手術日期 2010/05/25 手術主治醫師 賴達明 手術區域 東址 001房 02號 診斷 Subarachnoid hemorrhage 器械術式 Craniotomy(Aneurysms) VS-TZENG 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 4E 紀錄醫師 陳建銘, 時間資訊 00:35 臨時手術NPO 00:35 開始NPO 08:00 通知急診手術 19:15 報到 19:15 進入手術室 19:20 麻醉開始 19:30 誘導結束 19:40 抗生素給藥 20:33 手術開始 22:35 抗生素給藥 01:15 麻醉結束 01:15 手術結束 01:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 開顱術摘除血管病變－腦血管瘤－有徵的 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Right petrional approach for aneurysm clipping 開立醫師: 李建勳 開立時間: 2010/05/26 01:42 Pre-operative Diagnosis Right P-com aneurysm rupture with SAH Post-operative Diagnosis Right P-com aneurysm rupture with SAH Operative Method Right petrional approach for aneurysm clipping Specimen Count And Types nil Pathology Nil Operative Findings The frontal sinus was opened during craniotomy and sealed off with gelform soaked in better-iodine. The right P-com aneurysm was protruded laterally and inferiorly. One belnet shaped Sugita aneurysm clip was applied to clip the aneursymal neck. The brain was mild swelling while closing the dura. The right anterior choroidal artery was preserved. The EVD was removed after fixed back the skull plate due to tightly compressed by the skull plate. Operative Procedures Under general anesthesia and intubation, the patient was put in supineposition with head fixed with Mayfield skull clump. The scalp was shaved,scrubbed, disinfected with alcohol better-iodine then draped. Left frontotemporal scalp incision was made as usual pterional approach followed by craniotomy. The frontal sinus was opened during craniotomy and sealed off with gelform soaked in better-iodine. The medial sphenoid ridge was further drill off by highspeed air drill for wider operation field. Opened the dura in fish-mouth fasion after tenting around the craniotomy window. Pannies point EVD was inserted and fixed the EVD at scalp. Opened the sylvian fissure and relaxed the brain by releasing the CSF. Dissected the arachnoid to exspose the CN III and ICA. Followed the ICA to locate the aneurysm. Dissected the ICA and aneruysm neck with microdissector. Clipped the aneurysm with one Belnet Sugita aneurysm clip after proximal control of the MCA. The dura was sutured with 4-0 Prolene sutures. The skull plate was fixed back with miniplates and screws after central tenting and one subgaleal CWV drian set up. The temporalis fascia was sutured back and the wound was closed in layers. Operators VS 賴達明 Assistants R1 陳建銘 R3 曾峰毅 R6 李建勳 Indication Of Emergent Operation 相關圖片 游張金蝦 (F,1935/01/15,77y1m) 手術日期 2010/05/25 手術主治醫師 賴達明 手術區域 東址 009房 05號 診斷 Cerebrovascular accident (CVA) 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 陳盈志, 時間資訊 07:00 臨時手術NPO 07:00 開始NPO 14:12 報到 14:35 進入手術室 14:40 麻醉開始 14:50 誘導結束 15:06 抗生素給藥 15:20 手術開始 16:15 手術結束 16:15 麻醉結束 16:25 送出病患 16:28 進入恢復室 18:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Burr hole for hematoma evacuation 開立醫師: 陳盈志 開立時間: 2010/05/25 16:39 Pre-operative Diagnosis chronic SDH right side Post-operative Diagnosis chronic SDH right side Operative Method Burr hole for hematoma evacuation Specimen Count And Types nil Pathology nil Operative Findings Subdural dark brownish hematoma, about 1.2 cm in thickness, was noted upon opening the dura at right frontal temporal area. After hematoma evacuation, the brain was slack. Outer membrane was noted. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: linear, at right frontal area. 5. A burr hole was made at right frontal area. 6. Dural tenting: by 2/0 silk one stitch 7. Dural incision: cruciate at middle of the burr hole. 8. The dark brownish SDH was drained via a rubber tube. 9. Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous sutures with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 10.Drain: one subdural rubber drain connecting to a closed drainage bag. Operators VS賴達明 Assistants R6陳盈志 Indication Of Emergent Operation 詹倩萍 (F,1967/08/29,44y6m) 手術日期 2010/05/25 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Spinal neuroma 器械術式 Benign intraspinal tumor, exci 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 許松鈺, 時間資訊 10:50 報到 12:03 進入手術室 12:15 麻醉開始 12:20 誘導結束 12:48 抗生素給藥 13:06 手術開始 15:48 抗生素給藥 16:17 手術結束 16:17 麻醉結束 16:28 送出病患 16:30 進入恢復室 17:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 良性病髓腫瘤切除術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 記錄__ 手術科部: 外科部 套用罐頭: T9, 10 laminectomy for total tumor remove 開立醫師: 陳睿生 開立時間: 2010/05/25 16:41 Pre-operative Diagnosis T9 intraspinal extramedullary tumor, suspect neuroma Post-operative Diagnosis T9 intraspinal extramedullary tumor, suspect neuroma Operative Method T9, 10 laminectomy for total tumor remove T9, 10 laminectomy for total tumor removal Specimen Count And Types 1 piece About size:1.5 X1.5 CM Source:TUMOR Pathology Pending Operative Findings The tumor was an intra-spinal one. It was whitish, well capsuled and the size was about 1.5cm in diameter. The cord was compressed to the rigth ventral side. A nerve root was tightly adhered to the tumor and was carefully preserved. The tumor attached to the dura at the left lateral side, and was detached. The tumor was an intra-spinal one. It was whitish, well capsulated and the size was about 1.5cm in diameter. The cord was compressed to the right ventral side. A nerve root was tightly adhered to the tumor and was carefully preserved. The tumor attached to the dura at the left lateral side, and was detached. Operative Procedures 1. ETGA, prone position 2. Posterior back midline incision about 10cm 3. Split the bilateral paraspinal muscle and expose the T9-10 lamina 4. T9, 10 laminectomy with rounger and high speed drill to expose the dura 5. Linear dura incision, and the dura was temporary tacked 6. Identify the tumor, and dissect the arachnoid membran between the tumor and roots, cord 7. Detach the tumor from the attached root, and dura; then totally remove the tumor 8. Hemostasis, close the dura tightly 9. Set an epidural CWV drain 10.Close the wound in layers Operators VS 賴達明 Assistants R5 陳睿生, R1 許松鈺, R1鄭孟伯 相關圖片 范健民 (M,1927/08/08,84y7m) 手術日期 2010/05/25 手術主治醫師 賴達明 手術區域 東址 003房 03號 診斷 Back pain 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鄭孟伯, 時間資訊 00:00 臨時手術NPO 16:15 報到 16:35 進入手術室 16:48 麻醉開始 17:00 誘導結束 17:15 抗生素給藥 17:40 手術開始 20:04 開始輸血 20:10 抗生素給藥 21:20 手術結束 21:20 麻醉結束 21:30 送出病患 21:35 進入恢復室 23:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 摘要__ 手術科部: 外科部 套用罐頭: L3/4 posterior fixation with TPS and remove o... 開立醫師: 陳睿生 開立時間: 2010/05/25 21:39 Pre-operative Diagnosis Lumbar stenosis with spondylolithesis over L3/4 Post-operative Diagnosis Lumbar stenosis with spondylolithesis over L3/4 Operative Method L3/4 posterior fixation with TPS and remove of bilateral L3/4 facet joints for decompression Specimen Count And Types nil Pathology Nil Operative Findings Severe adhesion was noted over previous wound, and the spinous process and lamina over L3/4 were removed during previous procedure. The L4 transverse process was not found intra-op, and the facet joints over L3/4 were severe hypertrophic change. After remove of facet joints, the thecal sac and roots were well-decompressed. Synthes transpedicular screws: screws: 45x 6.5mm x4 rods: 5cm x2 Operative Procedures 1. ETGA, prone position, and C-arm localize the L3-4 level 2. Lower back midline incision 3. Split bilateral paraspinal muscle to expose the L3-4 lamina 4. Remove of granulation tissue 5. Identify the L3, 4 transverse process, and transpedicular screws were implanted 6. Remove of bilateral L3/4 facet joints with rounger and Kerrison pounch 7. Hemostasis, set bilateral rods 8. Set a 1/8 hemovac, and close the wound in layers Operators VS 賴達明 Assistants R5 陳睿生; R1 鄭孟伯 施王樨珍 (F,1932/04/24,79y10m) 手術日期 2010/05/25 手術主治醫師 賴達明 手術區域 東址 005房 02號 診斷 Lumbar Spondylosis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳德福, 時間資訊 14:20 進入手術室 14:25 麻醉開始 14:45 誘導結束 15:00 抗生素給藥 16:06 手術開始 18:00 抗生素給藥 19:45 手術結束 19:45 麻醉結束 19:50 送出病患 19:55 進入恢復室 21:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 手術 椎間盤切除術－腰椎 1 2 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 摘要__ 手術科部: 外科部 套用罐頭: PLIF with cages, L4-5 開立醫師: 陳德福 開立時間: 2010/05/25 20:03 Pre-operative Diagnosis L4-5 spondylolisthesis and spondylosis with spinal stenosis Post-operative Diagnosis ditto Operative Method PLIF with cages, L4-5 Specimen Count And Types NIL Pathology NIL Operative Findings 1.Hypertrophic ligamentum flavum and protruding disc at L4-5 space is noticed. The thecal sac was compressed tightly. There is grade I spondylolisthesis over L4-5. 2.4 TPS[6.2*40mm] with 2 rods and 2 cages [No.11,synthes] were implanted over L4-5. Operative Procedures Under ETGA and prone position, the skin is disinfected and draped as usual. The location of incision was decided by C-arm flouroscope. The paraspinous muscle was displaced laterally to expose the L3-4 & L4-5 facet joints. TPS was done under flouroscope guided and L4-5 laminecotmy was also performed. The nerve roots were identified and we performed discectomy. While the L4-5 disc is almost removed totoally, 2 cages were inserted with pusher. The location of TPS and cages was checked under flouroscope and one epidural drainage was left in situ. The wound was closed in layers. Operators vs 賴達明 vs蕭輔仁 Assistants r4 陳德福 r4鍾文桂 劉耘彤 (F,1982/12/06,29y3m) 手術日期 2010/05/25 手術主治醫師 蔡翊新 手術區域 西址 033房 02號 診斷 Epidermoid cyst 器械術式 Scalp tumor 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 10:40 進入手術室 11:00 麻醉開始 11:04 手術開始 11:20 手術結束 11:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 頭皮腫瘤 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: scalp tumor excision 開立醫師: 陳德福 開立時間: 2010/05/25 11:25 Pre-operative Diagnosis Scalp tumor Post-operative Diagnosis Scalp atheroma Operative Method scalp tumor excision Specimen Count And Types 1*1*1 CM, SCALP TUMOR Pathology pending Operative Findings 1.There is a 1*1*1cm firm and capsulated tumor at the frontal-midline scalp. 2.The content is whitish and tooth paste like. 3.The tumor is totally removed with the capsule Operative Procedures Under LA and supine position, the scalp is disinfected and draped as usual. One linear incision is made and the tumor is exposed. We removed the tumor along the calpusle plane. Hemostasis is done and the wound is closed in layers. Operators VS 蔡翊新 Assistants R4 陳德福 張貴英 (F,1949/11/04,62y4m) 手術日期 2010/05/26 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳國瑋, 時間資訊 14:00 報到 14:30 進入手術室 14:35 麻醉開始 15:20 誘導結束 15:30 抗生素給藥 15:45 手術開始 18:30 抗生素給藥 18:50 麻醉結束 18:50 手術結束 19:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除－手術時間在４小時以內 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: frontal craniotomy for Simpson grade II tumor excision 開立醫師: 李建勳 開立時間: 2010/05/26 18:40 Pre-operative Diagnosis Left middle fossa meningioma Post-operative Diagnosis Left middle fossa meningioma Operative Method Right fontotemporal craniotomy for Simpson grade I tumor excision Specimen Count And Types 1 piece About size:5g Source:craniotomy for tumor exicison Pathology Pending Operative Findings The tumor is grey-yellowish, elastic, size 3cmin diameter, with clear arachnoid plane from the normal brain parenchyma. The attached dura was removed for Simpson grade I tumor excision and duroplasty with PRECLUDE DURA-SUBSTITUUT (aritfitial gortex dura). Operative Procedures Under general anesthesia and intubation, the patient was put in supine position with head fixed with Mayfield skull clump. The scalp was shaved, scrubbed, disinfected with alcohol better-iodine then draped. The left frontotemporal scalp incision was made followed by right temporal craniotomy. The dura was opened around the tumor after tenting along the craniotomy window. The tumor was dissected from the surrounding normal brain tissue with dissector and bipolar coagulator at the arachnoid plane in one piece. Hemostasis was achieved with Surgicel lining of the tumor bed. The attached dura was removed for Simpson grade I tumor excision and duroplasty with PRECLUDE DURA-SUBSTITUUT (aritfitial gortex dura). The skull plate was fixed back with miniplates and screws after one subgaleal CWV drain set up. The wound was then closed in layers. Operators VS 曾漢民 Assistants R1 陳國瑋 R6 李建勳 相關圖片 呂駿 (M,2010/04/10,1y11m) 手術日期 2010/05/26 手術主治醫師 郭夢菲 手術區域 兒醫 062房 07號 診斷 Subdural hemorrhage 器械術式 S-P shunt, left-sided 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 4E 紀錄醫師 胡朝凱, 時間資訊 15:30 通知急診手術 17:53 報到 17:55 進入手術室 17:55 麻醉開始 18:05 誘導結束 18:35 抗生素給藥 18:46 手術開始 19:35 麻醉結束 19:35 手術結束 19:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 套用罐頭: Left SP shunt 開立醫師: 胡朝凱 開立時間: 2010/05/26 19:51 Pre-operative Diagnosis Bilateral subdural effusion Post-operative Diagnosis Bilateral subdural effusion Operative Method Left SP shunt Specimen Count And Types CSF for 5 tubes Pathology nil Operative Findings 1.Yellowish effusion was drained out 1.Yellowish pinkish effusion was drained out, the pressure was mildly to moderately increased. 2.Brain was slack 2.Brain was slack after decompression. There was outer membrane formation. The presence of inner membrane or not could not be confirmed dur to small burr hole. 3.Intraperitoneal catheter was 25 cm 4.Intraventricular catheter was about 4 cm Operative Procedures 1.ETGA, supine 2.Left temporal vertical skin incision 3.Open periosteum and made a burr hole 4.Dural tenting 5.LUQ transverse skin incision 6.minilaparotomy 6.minilaparotomy and insertion of peritoneal catheter. 7.Pass the catheter via subcutaneous tunnel 8.connect catheter 8.connect catheters with a straight connector. 9.Open dura 10.Insert ventricualr then peritoneal catheter 10.Insert ventricualr catheter 11.Close woun in layers Operators 郭夢菲 Assistants 胡朝凱 Indication Of Emergent Operation 李宛蓉 (F,1991/12/19,20y2m) 手術日期 2010/05/26 手術主治醫師 郭夢菲 手術區域 兒醫 067房 號 診斷 Diplegic infantile cerebral palsy 器械術式 Excision of soft tissue tumor, 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 07:45 報到 08:45 進入手術室 09:00 麻醉開始 09:02 誘導結束 09:03 手術開始 09:50 手術結束 10:00 送出病患 19:50 麻醉結束 醫令資訊 類別 名稱 量 刀 側 手術 神經切斷術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Removal of keloid with partial removal of neu... 開立醫師: 蔡宗良 開立時間: 2010/05/26 10:27 Pre-operative Diagnosis Neurofibromatosis, with keloid scar formation Post-operative Diagnosis Neurofibromatosis, with keloid scar formation Operative Method Removal of keloid with partial removal of neurofibroma Specimen Count And Types 1 piece About size:0.4 cm in diameter, branches Source:nerve, forearm Pathology pending Operative Findings Serial chains of multilobulated, branched, pink, elastic tumor at subcutaneous layer. The visible part over the wound exposed were amputated with the remaining branches stay intact. Operative Procedures Under disinfection, preparation and local anesthesia, an ellipse wound incision was applied to include the keloid scar. The keloid was removed. Combination of sharp and blunt dissection, branches of the neuroma was visible. The visible part over the wound exposed were amputated with the remaining branches stay intact. After hemostasis, the wound was closed in layers. Operators VS 郭夢菲 Assistants R4 蔡宗良 林梁悅 (F,1939/09/22,72y5m) 手術日期 2010/05/26 手術主治醫師 黃勝堅 手術區域 東址 002房 02號 診斷 Head Injury 器械術式 Craniectomy 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 4E 紀錄醫師 胡朝凱, 時間資訊 05:53 通知急診手術 05:53 開始NPO 06:55 進入手術室 07:00 麻醉開始 07:30 誘導結束 07:32 手術開始 09:17 手術結束 09:17 麻醉結束 09:25 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 顱骨切除術，包括異物移除或減壓或神經切斷 1 1 R 手術 顱內壓監視置入 1 2 R 記錄__ 手術科部: 外科部 套用罐頭: Right craniectomy and ICP monitor insertion 開立醫師: 胡朝凱 開立時間: 2010/05/26 09:43 Pre-operative Diagnosis Traumatic bifrontal and right temporal contusional ICH and right SDH Post-operative Diagnosis Traumatic bifrontal and right temporal contusional ICH and right SDH Operative Method Right craniectomy and ICP monitor insertion Specimen Count And Types nil Pathology nil Operative Findings 1.Pre-OP GCS: E1M4Vt Pupil: R/L: 6/3 mm without light reflex 2.mild pulsatile brain and swelling brain 3.Black motor oil like chronic subdural effusion around 1 cm in thick over left F-T-P area 4.Frontal lobe and temporal lobe contusion Operative Procedures Under ETGA, patient was put in supine position with head tilt to left. After well antisepsis and drapping procedure, right trauma flap skin incision was performed from pre-auricular area upward to 1 cm above ear then turn backward and pass the curvature of skull, followed by another turn upward to 1 cm away from midline and went anterior to 1 cm behind hair line and then crossed the midline with a curvature incision. The subcutaneous soft tissue was then opened by blunt dissection. Periosteum was then incised by elctrocauterization and dissected to open. After 4 burr holes drilled, craniectomy was performed with Midas air drill. Dural tenting was then performed and was followed with curvature dura incision 1 cm away from edge. Fascia flap was utilized to re-union with the dura during dura opening with 4-0 prolene. Chronic subdural effusion was removed. After 2 CWV drains and ICP monitor insertion, wound was closed in layers. Operators 黃勝堅 Assistants 胡朝凱, Ri Indication Of Emergent Operation 黃詩彥 (M,1972/11/22,39y3m) 手術日期 2010/05/26 手術主治醫師 蕭輔仁 手術區域 東址 005房 01號 診斷 Fracture, cervical-spine 器械術式 OPLL-Anterior Corpectomy VSLai 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳國瑋, 時間資訊 07:40 報到 08:00 進入手術室 08:05 麻醉開始 08:35 誘導結束 09:10 抗生素給藥 09:13 手術開始 12:15 抗生素給藥 14:05 手術結束 14:05 麻醉結束 14:15 送出病患 14:20 進入恢復室 15:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術－頸椎 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 手術 脊椎融合術－前融合，有固定物（＜＝四節） 1 2 記錄__ 手術科部: 外科部 套用罐頭: C4 corpectomy and fusion with artificial body... 開立醫師: 陳國瑋 開立時間: 2010/05/26 14:43 Pre-operative Diagnosis C4 vertebral body fracture Post-operative Diagnosis C4 vertebral body fracture Operative Method C4 corpectomy and fusion with artificial body cage Specimen Count And Types nil Pathology Nil Operative Findings The anterior aspect of the C4 body was noted to be fractured and mobilized. Total C4 corpectomy and C3/4, 4/5 total diskectomy were performed. An Ulrich ADD plus cage was implanted, and the size was about 5cm. The cage was fixed with C3, 5 bodies with 14mm screws x4. Autologus bone graft was inserted into the cage for further fusion. No obvious thicken PLL nor spondylosis was noted. Intra-op no obvious SSEP change. Operative Procedures 1. ETGA, supine, localized the C4 level and checked with C-arm 2. Skin disinfection with betadine and then draped with the anterior neck exposed 3. Transverse skin incision along right anterior neck, resection of platysma 4. Pull aside the trachea and esophagus 5. Identified the C4 vertebral body through the space between right SCM and trachea 6. Total C4 corpectomy with air-driven drill and Karrison 7. Total discetomy of C34 and C45 8. Anterior fusion with artificial body cage and autologus bone graft 9. Check the position of cage with C-arm 10. Set One CWV at pervertebral space 11. Wound closure in layers with Vicryl and Nylon Operators VS 蕭輔仁 Assistants R5 陳睿生, R1 陳國瑋 顏王阿續 (F,1933/08/27,78y6m) 手術日期 2010/05/26 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 Major trauma rated 16 or above on the severeity scale ( Injury severeity score >=16 ) 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 鍾文桂, 時間資訊 10:51 進入手術室 10:55 麻醉開始 10:58 誘導結束 11:04 手術開始 11:30 手術結束 11:30 麻醉結束 11:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 氣管切開造口術 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 神經部 套用罐頭: Tracheostomy. 開立醫師: 鍾文桂 開立時間: 2010/05/26 11:55 Pre-operative Diagnosis Respiratory failure. Post-operative Diagnosis Respiratory failure. Operative Method Tracheostomy. Specimen Count And Types nil Pathology Nil. Operative Findings Short, thick neck. Difficulty in finding the midline plane. Operative Procedures Under ETGA, the patient was placed in supine position. The neck was extended. A 2-cm midline incision was made at below the cricoid cartilage. Until reaching the trachea, a 5-mm hole wasmade at the first tracheal ring. Then, the endotracheal tube was pulled outward and the tracheostomy tube was inserted. After ensuring the well ventilation status, the wound was closed primarily and the tracheostomy tube was fixed with the skin. Operators V.S. 王國川 Assistants R6 陳盈志, R4 鍾文桂. 洪根樹 (M,1930/03/01,82y0m) 手術日期 2010/05/26 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Brain abscess 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 鍾文桂, 時間資訊 07:43 報到 08:05 進入手術室 08:10 麻醉開始 08:20 誘導結束 09:00 抗生素給藥 09:10 手術開始 10:16 手術結束 10:16 麻醉結束 10:30 送出病患 10:35 進入恢復室 11:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Implantation of ventriculoperiotneal shunt, p... 開立醫師: 鍾文桂 開立時間: 2010/05/26 12:01 Pre-operative Diagnosis Communicating hydrocephalus. Post-operative Diagnosis Communicating hydrocephalus. Operative Method Implantation of ventriculoperiotneal shunt, programmable. Specimen Count And Types nil Pathology Nil. Operative Findings Codman Hakim programmable shunt, 30mmH2O~200mmH2O. Clear colorless CSF gushed out. Hard septae in intraventricular space. Difficult in ventricular puncture. Operative Procedures Under ETGA, the patient was put in supine position. The head was tilted to the left. After shaving, disinfection, and draping, two linear operative wounds were incised at right frontal scalp and right upper quadrant of abdomen. A burr hole was drilled at right Kocher point. The abdominal wound was dissected until peritoneal cavity was reached. The tunnel passer penetrated through the subcutaneous space from abdomen to head. The shunt catheter was passed from abdomen to head. It was connected with the programmable valve. The ventricular catheter was inserted at right Kocher point after durotomy. After ensuring the patency of the shunt system, the wounds were closed in layers. The patient was sent to POR smoothly. Operators V.S. 王國川. Assistants R4鍾文桂Ri徐千婷. 洪佑仁 (M,1982/08/25,29y6m) 手術日期 2010/05/26 手術主治醫師 王國川 手術區域 東址 003房 03號 診斷 Malignant neoplasm of temporal lobe 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 許松鈺, 時間資訊 11:35 報到 11:50 進入手術室 11:55 麻醉開始 12:06 抗生素給藥 12:10 誘導結束 12:36 手術開始 15:05 手術結束 15:05 抗生素給藥 15:05 麻醉結束 15:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 開顱術摘除血管病變－腦血管瘤－有徵的 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Left temporal craniotomy total tumor removal 開立醫師: 陳盈志 開立時間: 2010/05/26 15:07 Pre-operative Diagnosis Left temporal cavernoma Post-operative Diagnosis Left temporal cavernoma Operative Method Left temporal craniotomy total tumor removal Specimen Count And Types 1 piece About size:0.8cm Source:Left temporal cavernoma Pathology pending Operative Findings The tumor was 0.8cm in size with elastic whitish portion with some small feeders. Peripheral hemosiderin change was also noted. Operative Procedures 1.ETGA, supine with head tilt to right 2.Disinfection and drapping 3.Left temporal U shape scalp incision detach temporalis muscle. 4.Burr hole x 3 then craniotomy 6x5cm 5.Dura tenting then U shape dura incision after echo localization 6.Corticotomy 6mm then identify the lesion 7.Remove peripheral hemosiderin part then pull the tumor and dissect along the border then remove tumor totally. 8.Hemostasis with bipolar and surgicel packing 9.Duroplasty with duraform 10.Fix bone plate with wirex3 then subgaleal CWV drain x 1 11.close wound in layers Operators VS王國川 Assistants R6陳盈志R1許松鈺 相關圖片 林彥伶 (F,1966/08/17,45y6m) 手術日期 2010/05/27 手術主治醫師 陳晉興 手術區域 東址 018房 02號 診斷 Secondary malignant neoplasm of brain and spinal cord 器械術式 Thoracoscopy 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 蔡東明, 時間資訊 12:30 進入手術室 12:32 麻醉開始 12:50 誘導結束 13:15 抗生素給藥 13:30 手術開始 16:15 抗生素給藥 17:15 手術結束 17:15 麻醉結束 17:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 胸腔鏡肺葉切除術 1 1 R 手術 根除性淋巴切除術（肺葉切除或全肺切除時） 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: VATS right lower lobe lobectomy + lymphnode d... 開立醫師: 蔡東明 開立時間: 2010/05/27 17:39 Pre-operative Diagnosis Lung adenocarcinoma with brain metastasis s/p crainiotomy for tumor excision Post-operative Diagnosis Lung adenocarcinoma with brain metastasis s/p crainiotomy for tumor excision Operative Method VATS right lower lobe lobectomy + lymphnode dissection Specimen Count And Types 2 pieces About size:20*20*18cm Source:right lower lobe About size:2*2cm Source:lymphnodes, Gr.3,4,7,10,11 Pathology Pending Operative Findings 1.One 5*3.5cm, yellowish, elastic and firm, hypercellular mass was noted at right lower lobe, posterior basal segment, near right inferior pulmonary vein. 2.Multiple hardish, enlarged lymphnode were noted at Gr.3,4,7,10,11. 3.Blood loss: 200ml 4.After pulmonary repair with Prolene, there is no air-leakage Operative Procedures 1. Anesthesia: General anesthesia using double-lumen endotracheal tube. An epidural anesthesia catheter is placed prior to the operation. 2. Position: Left decubitus position. An axillary roll is placed under the down side. The operative field is well disinfected and draped. 3. VATS setting. The pleural adhesions are separated using electrocautery. 4. The fissure between the middle and lower lobes is separated and divided by endoGIA. 5. The right lower lobe is retracted anteriorly. The inferior pulmonary ligment is divided.The inferior pulmonary vein is identified and divided by endoGIA. 6. The pulmonary artery supplying the right lower lobe is identified and divided by endoGIA. 7. The bronchus to the lower lobe is identified and divided by endoGIA. 8. The pleural cavity is irrigated with normal saline solution and well hematostasis. The plmonary laceration was repaired by Prolene 4-0. 9. Lymph node dissection is done at group 3, 4, 7, 8, 9,10, and 11. 10. After meticulous homeostasis and check-up of air leakage, one 28# chest tubes are placed at posterior aspect of pleural cavity respectively. The wound is closed in layers Operators VS陳晉興 Assistants R3蔡東明 Ri王麗君 相關圖片 曾惠雀 (F,1961/04/21,50y10m) 手術日期 2010/05/27 手術主治醫師 林峰盛 手術區域 西址 035房 06號 診斷 Radiculopathy 器械術式 Nerve block / PC 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 林峰盛 ASA 2 時間資訊 16:42 進入手術室 16:43 麻醉開始 16:45 誘導結束 16:47 手術開始 17:20 手術結束 17:20 麻醉結束 17:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 高頻熱凝療法 1 1 L 記錄__ 手術科部: 麻醉部 套用罐頭: RF lesioning 開立醫師: 劉玉蘭 開立時間: 2010/05/27 17:19 Pre-operative Diagnosis Radiculopathy Post-operative Diagnosis Radiculopathy Operative Method 1.LA with 1%xylocaine. 2.patient in prone position 3. Under fluoroscopic-guidance, left L4-S1 nerve root was identified 4. RFA was done to left L4-S1 nerve root with 42 degree 120 sec twice 5. Transforaminal epidural block to L4 and S1 with 40mg kenacort in 0.5% lidocaine 3ml 6. sent patient to POR Specimen Count And Types nil Pathology Nil Operative Findings nil Operative Procedures RFA Operators 林峰盛, Assistants 劉玉蘭, 胡王香蓮 (F,1923/04/10,88y11m) 手術日期 2010/05/27 手術主治醫師 賴達明 手術區域 東址 002房 05號 診斷 Intracerebral hemorrhage 器械術式 Removal of ICH, right temporal 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林子富 ASA 3E 紀錄醫師 陳國瑋, 時間資訊 17:27 開始NPO 17:27 臨時手術NPO 17:27 通知急診手術 18:15 進入手術室 18:15 報到 18:30 麻醉開始 18:50 誘導結束 19:20 抗生素給藥 19:36 手術開始 22:20 麻醉結束 22:20 手術結束 22:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Right frontotemporoparietal carniectomy for h... 開立醫師: 李建勳 開立時間: 2010/05/27 22:17 Pre-operative Diagnosis Right temporoparietal spontaneous ICH Post-operative Diagnosis Right temporoparietal spontaneous ICH Operative Method Right frontotemporoparietal carniectomy for hematoma evacuation and decompression Specimen Count And Types nil Pathology nil Operative Findings The brain was not swelling after opened the dura. Large amount of hematoma was noted (about 40mL) at right temporoparietal lobe. No acute bleeder was noted. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position with head turned to left. The scalp was shaved, scrubbe, disinfected with alcohol better iodine then draped. Traumatic scalp flap was created followed by frontotemporoparietal craniectomy. The dura was opened after tenting along the craniectomy window. The hematoma was located with intra-operaive sonography. Hematoma evacuation was perforemd with suction via transcortical approach. The hemostasis was achieved with bipolar coagulation and Surgicel lining of the hematoma bed. The dura was closed with DURAFORM cover the dura incision site. The wound was closed in layers after two subgaleal CWV drains set up. Operators VS 蕭輔仁 Assistants R1 陳國瑋 R4 鍾文桂 R6 李建勳 Indication Of Emergent Operation 相關圖片 彭忠信 (M,1939/08/29,72y6m) 手術日期 2010/05/27 手術主治醫師 蕭輔仁 手術區域 東址 005房 01號 診斷 C5-C7 level with unspecified spinal cord injury 器械術式 OPLL-Anterior Corpectomy VSLai 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 許松鈺, 時間資訊 07:38 報到 08:05 進入手術室 08:15 麻醉開始 08:40 誘導結束 09:15 抗生素給藥 09:25 手術開始 12:15 抗生素給藥 14:00 手術結束 14:00 麻醉結束 14:10 送出病患 14:12 進入恢復室 15:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術－前融合，有固定物（＜＝四節） 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 手術 椎間盤切除術－頸椎 1 1 記錄__ 手術科部: 外科部 套用罐頭: Anterior approach for disckectomy and fusion ... 開立醫師: 李建勳 開立時間: 2010/05/27 14:01 Pre-operative Diagnosis Traumatic C6/7 transdiscla fracture dislocation Traumatic C6/7 transdisc fracture dislocation Post-operative Diagnosis Traumatic C6/7 transdiscla fracture dislocation Traumatic C6/7 transdisc fracture dislocation Operative Method Anterior approach for disckectomy and fusion with disc cage and plate Anterior approach for diskectomy and fusion with disc cage and plate Specimen Count And Types nil Pathology Nil Operative Findings The C6/7 disc was ruptured anteriorly with C6/7 dislocation. Aspine Disc cage 8mmX12mm was inserted with 32mm plate. The C6/7 disc was ruptured anteriorly with C6/7 dislocation. A spine Disc cage 8X12mm was inserted with 32mm plate. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position with head extension. The skin over right anteiror neck was scrubbed, disinfected with alcohol better iodine then draped. Transverse skin incision was made at right neck and extended through fasica plane to expose the vetebral body. Checked the positio with portable X-ray. Disckectomy was performed with curette and aligator under surgicel microscope. The PLL was opened and removed. Inserted the artificial disc with artifical bone. Inserted the plate and checked position with portable X-ray. The wound was closed in layers after one CWV drain set up at wound. Under general anesthesia and intubation, the patient was put in supine position with head extension. The skin over right anteiror neck was scrubbed, disinfected with alcohol better iodine then draped. Transverse skin incision was made at right neck and extended through fasica plane to expose the vetebral body. Checked the position with portable X-ray. Diskectomy was performed with curette and aligator under surgicel microscope. The PLL was opened and removed. Inserted the artificial disc with artifical bone. Inserted the plate and checked position with portable X-ray. The wound was closed in layers after one CWV drain set up at wound. Operators VS 蕭輔仁 Assistants R1 許松鈺 R6 李建勳 相關圖片 陳盛宏 (M,1938/01/20,74y1m) 手術日期 2010/05/27 手術主治醫師 蕭輔仁 手術區域 東址 005房 02號 診斷 Spinal stenosis, lumbar 器械術式 Radiofrequency coagulation 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 許松鈺, 時間資訊 14:00 報到 14:35 進入手術室 15:13 麻醉開始 15:15 誘導結束 15:16 手術開始 16:09 麻醉結束 16:09 手術結束 16:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 高頻熱凝療法 1 1 B 記錄__ 手術科部: 外科部 套用罐頭: Pulsed radiofrequency coagulation 開立醫師: 許松鈺 開立時間: 2010/05/27 16:04 Pre-operative Diagnosis Lumbar stenosis Post-operative Diagnosis Lumbar stenosis Operative Method Pulsed radiofrequency coagulation Specimen Count And Types Nil Pathology Nil Operative Findings PRF with 42 Celsius, 180secx2 over bilateral L2 dorsal root ganglion and left S2 tender point Operative Procedures 1. Prone position, skin disinfection, local anesthesia 2. Localize bilateral L2 dorsal root ganglion with C-arm 3. Set PRF equipment and perform PRF 4. Localize the tender point over left S2 with C-arm 5. Set PRF equipment and perform PRF Operators 蕭輔仁 Assistants 李建勳, 胡朝凱, 許松鈺 相關圖片 李國禎 (M,1973/09/30,38y5m) 手術日期 2010/05/27 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Stroke 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 陳睿生, 時間資訊 07:40 報到 08:05 進入手術室 08:10 麻醉開始 08:50 誘導結束 09:50 手術開始 13:30 抗生素給藥 16:15 麻醉結束 16:15 手術結束 16:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 L 手術 顱內外血管吻合術 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 8 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Left STA-MCA bypass, Simpsons^ grade IV tumor... 開立醫師: 陳睿生 開立時間: 2010/05/27 17:02 Pre-operative Diagnosis Left side intra-carvenous portion meningioma with ICA stenosis Left side intra-cavenous portion meningioma with ICA stenosis Post-operative Diagnosis Left side intra-carvenous portion meningioma with ICA stenosis Left side intra-cavenous portion meningioma with ICA stenosis Operative Method Left STA-MCA bypass, Simpsons^ grade IV tumor remove via pterional approach Specimen Count And Types 1 piece About size:pieces Source:tumor Pathology Pending Operative Findings The left side STA anterior branch was extracted as the bypass graft. It was end to side anastomosed to the temporal M4. Post- OP the re-perfusion was fair. The tumor was hardish, whitish, and well capsuled in the cavernous sinus. Due to the hardish properity of the tumor, tumor debulking for decompression was done. The optic nerve was tightly adhered with the tumor, and the margin between them was unclear. Operative Procedures 1. ETGA, supine position and head right turn, fixed with Mayfield clump 2. Identify the left STA, and then left frontotemporal curvillinear scalp incision was done 3. The anterior and posterior branches of the superficial temporal artery was dissected and extracted as graft, and heparinization 4. Creat three burr holes and an about 8x6cm craniotomy was made 5. The dura was tented and then it was opened along the craniotomy window 6. Open the sylvian fissue and harvest a temporal M4 portion 7. End- to side anastomosis was performed with 10-0 Nylon under microscope and temporary clipping 8. Hemostasis, and expose the sylvian fissure widely 9. Identify the optic nerve, and the tumor was found just behind the optic nerve 10.Open the cavernous sinus, and the tumor was debulked for decompression with electrocauterization 11.Hemostasis, close the dura with Durafoam 12.Fix back skull graft with miniplates x3, and central tacking 13.Set a subgaleal CWV drain, and close the wound in layers Operators VS 王國川 Assistants R5 陳睿生, Ri 廖述邦 (M,1957/08/19,54y6m) 手術日期 2010/05/28 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Glioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳國瑋, 時間資訊 08:45 報到 09:00 進入手術室 09:10 麻醉開始 09:40 誘導結束 09:45 抗生素給藥 09:50 手術開始 12:45 抗生素給藥 13:35 麻醉結束 13:35 手術結束 13:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除－手術時間在４～８小時 1 1 摘要__ 手術科部: 外科部 套用罐頭: frontal craniotomy for Simpson grade II tumor excision 開立醫師: 李建勳 開立時間: 2010/05/28 13:32 Pre-operative Diagnosis Left frontal tumor suspect high grade glioma Post-operative Diagnosis Left frontal tumor suspect high grade glioma Operative Method Awake surgyer with left frontal craniotomy for tumor excision Specimen Count And Types 1 piece About size:1g Source:craniotomy tumor exicsion Pathology Frozen section: astrocytoma; pathology: pending Operative Findings The tumor is not appearant after opened the dura. Digital counting stopped after bipolar stimulation of the brain surface inferior to the tumor. General tonic-clonic seizure was noted once during the stimulation, lasted for 2 minutes and stopped after cold lactate-ringer solution irrigation with propofol injection. The tumor was soft, greyish, size 1.5 cm in diameter, with seperable margin from normal brain parenchyma. The tumor is not appearant after opened the dura. Digital counting stopped after bipolar stimulation of the brain surface inferior to the tumor. General tonic-clonic seizure was noted once during the stimulation, lasted for 2 minutes and stopped after cold lactate-ringer solution irrigation with propofol injection. The tumor was soft, greyish, size 1.5 cm in diameter, with seperable margin from normal brain parenchyma. One i cm surface ICH was noted after craniotomy without progression during the procedure. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position with head fixed with Mayfield skull clump. Registered the stereotatic navigator. The scalp was shaved, scrubbed, disinfected with alcohol better-iodine then draped. The left frontal scalp curved incision was made after stereotatic location of the tumor and followed by left frontal craniotomy. The dura was opened around the tumor after tenting along the craniotomy window. The tumor was dissected from the surrounding normal brain tissue with dissector along the craniotomy window. The patient was awaken from IV general anesthesia and checked speech function. One epidosde of GTC was noted during bipolar stimulation and stopped by cold lactate ringer solution irrigation. IV general anesthesia was given again after located the speech area. and bipolar coagulator. The tumorwas detached from the falx. Central debulky method was applied before further The tumor excision was performed with bipolar coagulator and tumor forceps in one piece. The hemostasis was achieved with Surgicel lining of the tumor bed. dissection of the tumor. The midline attachment was dissected under the surgicel microscope assistance. The falx was incised with surgical bladeand removed the left frontal tumor. The duroplasty was performed with 4-0 The dura was closed with with 4-0 Prolene sutures and periostium. The skull plate was fixed back with miniplates and screws after one epidural Prolene sutures and periostium. The skull plate was fixed back with miniplates and screws after one subgaleal CWV drain set up. The wound was then closed in layers. Operators VS 曾漢民 Assistants R1 陳國瑋 R6 李建勳 相關圖片 黃素秋 (F,1960/02/14,52y1m) 手術日期 2010/05/28 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 HIVD 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 陳國瑋, 時間資訊 13:40 報到 14:05 進入手術室 14:20 麻醉開始 14:30 誘導結束 14:40 抗生素給藥 14:58 手術開始 18:30 手術結束 18:30 麻醉結束 18:40 送出病患 18:50 進入恢復室 19:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術－頸椎 1 1 R 手術 脊椎融合術－前融合，有固定物（＜＝四節） 1 2 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 摘要__ 手術科部: 外科部 套用罐頭: Anterior approach for disckectomy, fusion wit... 開立醫師: 李建勳 開立時間: 2010/05/28 18:34 Pre-operative Diagnosis C5/6 6/7 HIVD with cervical stenosis Post-operative Diagnosis C5/6 6/7 HIVD with cervical stenosis Operative Method Anterior approach for disckectomy, fusion with cage and plate insertion Specimen Count And Types nil Pathology Nil Operative Findings The C5/6/7 stenosis was caused by HIVD. Medtronic cornerstone peek cage 4mmX11mmX14mm at C5/6, 5mmX11mmX14mm at C6/7; 37mm plate with 14mm screws X4 were used. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position with head extended. The skin over right anterior neck was scrubedd, disinfected with alcohol better-iodine then draped. The transverse skin incision was made at right anterior neck anddivided the platysma muscle. The incision was made over SCM muscle and dissectede along between the fascia plane. The carotid sheath was retracted laterally and the trachea was retrated medially. The longus colli muscles were bipolar coagulated and divided. Localization of C5/6 was performed with portable C-arm X-ray. The cervical retractor was inserted. The prevetebral fascia was incised with No. 15 surgical blade into the disc space. The disckectomy was performed with Kerrison punch, disc clumps and curette under surgical microscope assistance. The spur was removed wtih high-speed air-drill. The posterior longitudinal ligment was removed with Kerrison punch to expose the dura. The herniated disc was check for upward and downward heniation with nerve hook. The Bone cage was inserted after hemostasis. The same procedure was performed over C6/7 disc. The plate was fixed with four 4mmX14mm screws. The instrument position was check with portable X-ray before wound closure and one minihemovac set up at wound site. Operators VS 蔡翊新 VS 曾漢民 Assistants R1 陳國瑋 R6 李建勳 相關圖片 陳正培 (M,1979/07/30,32y7m) 手術日期 2010/05/28 手術主治醫師 曾漢民 手術區域 東址 019房 01號 診斷 Brain cancer 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 胡朝凱, 時間資訊 07:33 報到 08:07 進入手術室 08:20 麻醉開始 08:45 誘導結束 09:10 抗生素給藥 09:41 手術開始 12:40 抗生素給藥 15:05 麻醉結束 15:05 手術結束 15:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 顱底瘤手術 1 1 記錄__ 手術科部: 外科部 套用罐頭: Infratentorial approach for total tumor excision 開立醫師: 趙崧筌 開立時間: 2010/05/28 15:36 Pre-operative Diagnosis Pineal gland tumor Post-operative Diagnosis Pineal gland tumor Operative Method Infratentorial approach for total tumor excision Specimen Count And Types Pieces of tumor Pathology Frozen: pineocytoma Operative Findings 1.One reddish, elastic firm tumor located at pineal gland beneath the great vein of galen with clear margin. Some vessels attached to the brain surface but was all preserved after fine dissection. The tumor was moderate vascularity. 2.After tumor removal, the third ventricle was clearly seen. And CSF drained out from aqueat duct. Operative Procedures 1.ETGA, prone with head fixed with skull clamp 2.Midline incision from 5 cm above inion to C1 level 3.Detach the splenium coli muscle until the C1 arch was exposed 4.Craniotomy 5.dural tenting 6.V shape dural incision 7.Retract dura upward 8.Retract vermis downward 9.expose great vein of Galen then tumor 10.Dissect tumor edge and excised piece by piece 11.Total tumor excision 12.Hemostasis 13.Duroplasty with one piece of fascia 14.Set one CWV drain then close wiound in layers Operators 曾漢民 Assistants VS蔡翊新, R5 胡朝凱, Ri 陳正培 (M,1979/07/30,32y7m) 手術日期 2010/05/28 手術主治醫師 蔡翊新 手術區域 東址 005房 03號 診斷 Brain cancer 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 4E 紀錄醫師 曾峰毅, 時間資訊 19:51 通知急診手術 20:15 報到 20:15 進入手術室 20:20 麻醉開始 20:25 誘導結束 20:50 手術開始 21:00 抗生素給藥 22:35 麻醉結束 22:35 手術結束 22:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 硬腦膜外血腫清除術 1 2 B 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 曾峰毅 開立時間: 2010/05/28 23:01 Pre-operative Diagnosis Bilateral epidural hematoma Post-operative Diagnosis Bilateral epidural hematoma Operative Method 1. Bilateral craniotomy for epidural hematoma removal 2. Ligation of ventriculoperitoneal shunt Specimen Count And Types Nil Pathology Nil Operative Findings About 2-3cm thick epidural hematoma was noted at bialteral frontoparieal area. ICP was about 2mmHg after the hematoma removal. Operative Procedures With endotracheal general anesthesia, the patient was put in supine position with neck flexed and head fixed with Mayfield head clamp. After scalp scrubbed, shaved, disinfected, and then draped, we made one reverse-U-shaped skin incision at each side of parietal area. One burr hole was made at each side, and then followed by cranitomy. Dura tenting was done along each craniotomy window. Hematoma was removed, and hemostasis was done. We ligated the VPS, and inserted ICP monitor into left subdural space. We fixed back bone graft with mini-plates. After setting one subgaleal CWV, we closed the wound in layers. Operators VS 曾漢民 VS 蔡翊新 Assistants R5 胡朝凱 R3 曾峰毅 Indication Of Emergent Operation 陳德仁 (M,1947/07/17,64y7m) 手術日期 2010/05/28 手術主治醫師 蔡瑞章 手術區域 東址 003房 01號 診斷 Brain metastasis 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 蔡宗良, 時間資訊 07:40 報到 08:04 進入手術室 08:10 麻醉開始 08:50 誘導結束 09:07 抗生素給藥 09:32 手術開始 12:50 麻醉結束 12:50 手術結束 13:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除－手術時間在４小時以內 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Right parietal craniotomy tumor excision 開立醫師: 陳盈志 開立時間: 2010/05/28 13:11 Pre-operative Diagnosis Right parietal metastatic tumor Post-operative Diagnosis Right parietal metastatic tumor Operative Method Right parietal craniotomy tumor excision Right parietal craniotomy and gross total tumor excision Specimen Count And Types 1 piece About size:5X5X4cm Source:Right parietal metastatic tumor Pathology pending Operative Findings The tumor was elastic in character. Central necrosis with some mucinous content was noted. The margin was well defined. The brain was swelling. Vascularity was low. The tumor was elastic firm in consistency and yellowish grayish in color, well demarcated with peritumoral gliosis. Central necrosis with some mucinous content was noted. The margin was well defined. The brain was swelling. Vascularity was moderate to low. Operative Procedures Under ETGA, the patient was set into prone position with head fixed with Mayfield. The operation field was disinfected and then drapped well. Under ETGA, the patient was placed in a prone position with head fixed with Mayfield. The operation field was disinfected and then drapped as ususal. Right parietal U shape scalp incision was done. Detach occipital muscle and then 4 burr hole was made. Craniotomy window 8x7cm was made. Right parietal U shape scalp incision was done. Detach occipital muscle and then 4 burr holes were made. Craniotomy window 8x7cm was made after sawing with high speed air drill. Under echo localization, U shape dura incision was done. The tumor bled and ruptured to surface. Corticotomy was made and the tumor was pulled out with tumor forceps and dissect along its border. Remove the tumor piece by piece then en bloc removal was done. Under echo localization, U shape dura incision was done. The tumor bled and ruptured to surface. Corticotomy was made at the thinnest part of cortex covering the tumor and the tumor was extirpated piece by piece with tumor forceps after central debulking and dissected along its border. Remove the tumor piece by piece at the begining and finally the last piece of tumor was removed en bloc. Hemostasis was done with bipolar and then surgicel packing. Dura was closed with 4-0 prolene. The bone was fixed with wire and central tenting. One subgaleal CWV drain was set. The wound was closed in layers. Meticulous hemostasis was then done with bipolar cauterization and packed with surgicel and gelfoam. Dura was closed with 4-0 prolene. The bone was fixed with wire and central tenting. One subgaleal CWV drain was set. The wound was closed in layers. Operators P蔡瑞章 Assistants R6陳盈志R4蔡宗良 蔡俊茂 (M,1957/11/20,54y3m) 手術日期 2010/05/28 手術主治醫師 賴達明 手術區域 東址 001房 02號 診斷 Head Injury 器械術式 Removal of chronic subdural hematoma, right-sided 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2E 紀錄醫師 曾峰毅, 時間資訊 20:00 臨時手術NPO 20:00 開始NPO 08:42 通知急診手術 11:35 報到 11:49 進入手術室 12:00 麻醉開始 12:10 誘導結束 12:30 抗生素給藥 12:52 手術開始 14:00 手術結束 14:00 麻醉結束 14:10 送出病患 14:15 進入恢復室 15:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: Chronic Subdural Hematoma 開立醫師: 曾峰毅 開立時間: 2010/05/28 14:03 Pre-operative Diagnosis Chronic subdural hemorrhage Post-operative Diagnosis Chronic subdural hemorrahge Operative Method Right frontal burr hole for subdural drainage Specimen Count And Types nil Pathology nil Operative Findings Drak-brownish subdural effusion was drained out. There was outer and inner membrane. Brain expanded after decompression. Operative Procedures With endotracheal general anasethesia, the patient was put in supine position with head roated to left. After scalp shaved, scrubbed, disinfected, and then draped, we made one linear skin incision at right frontal area. We drilled one burr hole, and created durotomy. Rubber drain was inserted for drainage and saline irrigation. We closed the wound, and de-ari the subdural space. Operators VS 蕭輔仁 Assistants R3 曾峰毅 Ri 周嘉俞 Indication Of Emergent Operation 何冠毅 (M,2009/10/09,2y5m) 手術日期 2010/05/28 手術主治醫師 謝孟祥 手術區域 東址 000房 01號 診斷 Acrocephlosyndactyly 器械術式 nailbed reconstruction 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 2 紀錄醫師 朱峻緯, 時間資訊 07:50 報到 08:05 進入手術室 08:40 麻醉開始 09:00 誘導結束 09:15 手術開始 10:03 麻醉結束 10:03 手術結束 10:25 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 甲床與手指重建術 1 1 L 手術 甲床與手指重建術 1 2 R 手術 甲床與手指重建術 1 4 L 記錄__ 手術科部: 外科部 套用罐頭: Others 開立醫師: 朱峻緯 開立時間: 2010/05/28 10:24 Pre-operative Diagnosis Syndactyly with paronychia of bilateral hands and left foot Post-operative Diagnosis Syndactyly with paronychia of bilateral hands and left foot Operative Method Nail bed reconstruction Specimen Count And Types nil Pathology nil Operative Findings Syndactyly with paronychia of bilateral hands and left foot 1. Syndactyly of bilateral hands and feet 2. Paronychia of bilateral hands and left foot Operative Procedures 1. ETGA, supine position 2. Skin preparation and draping 3. Nail bed reconstruction of bilateral hands and left foot 4. Cover the wounds with B-I gauze Operators VS謝孟祥 Assistants R5黃傑慧 R1朱峻緯 Ri葉恩琪 林麗凰 (F,1951/05/05,60y10m) 手術日期 2010/05/28 手術主治醫師 蕭輔仁 手術區域 東址 003房 04號 診斷 Subdural hematoma 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 4E 紀錄醫師 陳盈志, 時間資訊 08:33 開始NPO 14:33 通知急診手術 18:15 報到 18:20 進入手術室 18:25 麻醉開始 18:40 抗生素給藥 18:50 誘導結束 19:04 手術開始 21:30 手術結束 21:30 麻醉結束 21:40 送出病患 21:40 抗生素給藥 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 腦瘤切除－手術時間在４小時以內 1 1 L 手術 慢性硬腦膜下血腫清除術 1 2 L 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Left frontal crniotomy for hematoma evacuatio... 開立醫師: 陳盈志 開立時間: 2010/05/28 21:59 Pre-operative Diagnosis Left side frontal convexity meningioma and chronic SDH Post-operative Diagnosis Left side frontal convexity meningioma and chronic SDH Operative Method Left frontal crniotomy for hematoma evacuation and tumor excision Specimen Count And Types 1 piece About size:2x1.5x1cm Source:Left frontal meningioma Pathology pending Operative Findings Subacute hematoma at subdura space was noted with outer membrane, but no inner membrane was found. One elastic whitish tumor with dura base was noted. Some adhesion was found with tumor ans outer membrane of chronic SDH. The brain was slake after hematoma evacuation. Operative Procedures 1.ETGA, supine with head tilt to right 2.Skin preparation 3.Left frontal-temporal curvilinear incision 4.Burr hole x 2 then craniotomy at frontal 8x4cm 5.Dura tenting then U-shape dura incision 6.Cauterize outer membrane and then remove it, cauterize along its edge. 7.Dissect the tumor along its border then remove it totally with its dura base. 8.Hemostasis with bipolar and surgicel packing 9.Insert subdural rubber drain for irrigation then fixed as subdural drain. 10.close dura closure with duraform and fascia graft 11.fix bone with miniplate 12.One subgaleal CWV drain was set then close wound in layers. Operators VS蕭輔仁 Assistants R6陳盈志Ri Indication Of Emergent Operation 柯聰明 (M,1958/10/11,53y5m) 手術日期 2010/05/28 手術主治醫師 蕭輔仁 手術區域 東址 003房 02號 診斷 Low back pain 器械術式 Radiofrequency coagulation 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 蔡宗良, 時間資訊 12:45 報到 13:30 進入手術室 13:43 抗生素給藥 13:52 麻醉開始 13:54 手術開始 14:15 手術結束 14:26 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 高頻熱凝療法 1 1 L 記錄__ 手術科部: 套用罐頭: Dorsal root ganglion radiofrequency gangliono... 開立醫師: 蔡宗良 開立時間: 2010/05/28 14:47 Pre-operative Diagnosis Low back pain Post-operative Diagnosis Low back pain Operative Method Dorsal root ganglion radiofrequency ganglionotomy, bilateral Specimen Count And Types nil Pathology None Operative Findings Fluoroscopy confirmed the tip of RF needle in appropriate position. Operative Procedures After localization of L2 disc space, the proposed working field were disinfected and drapped as usual. After application of local anesthesia, the ganglionotomy needle was applied to reach the dorsal root ganglion of L2. After fluoroscopic confirmation, sensory and motor stimulation were tested. Pulsed frequency was applied for 180 seconds. Identical procedure was done to the contralateral side Operators VS 蕭輔仁 Assistants CR 陳盈志, R4 蔡宗良 趙卿珍 (F,1962/04/28,49y10m) 手術日期 2010/05/29 手術主治醫師 詹志洋 手術區域 東址 001房 04號 診斷 Breast cancer, female 器械術式 Port-A catheter Removal/WOR 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 林哲安, 時間資訊 18:30 報到 18:35 進入手術室 18:50 麻醉開始 18:52 誘導結束 18:54 手術開始 19:05 麻醉結束 19:05 手術結束 19:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 肌肉或深部組織腫瘤切除術及異物取出術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: removal of Port-A/Permcath 開立醫師: 蔡孝恩 開立時間: 2010/06/01 10:53 Pre-operative Diagnosis fever of Port-A Post-operative Diagnosis ditto Operative Method removal of Port-A catheter Specimen Count And Types nil Pathology nil Operative Findings the catheter was removed totally and the course was smooth Operative Procedures The patient was put on supine position. The operation field was disinfected and draped as usual. Under local anesthesia, the Port-A catheter was removed from previous wound smoothly. The wound was irrigated and closed in layers. Operators VS詹志洋 Assistants R3林哲安 徐惠珠 (F,1941/09/18,70y5m) 手術日期 2010/05/29 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Acromegaly 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 王永彬 ASA 2 紀錄醫師 鄭孟伯, 時間資訊 07:55 進入手術室 08:00 麻醉開始 08:40 誘導結束 09:00 抗生素給藥 09:05 手術開始 09:45 報到 10:35 麻醉結束 10:35 手術結束 10:42 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經由蝶竇之腦下垂體瘤切除 1 1 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 外科部 套用罐頭: Endoscopic transsphenoid adenomectomy 開立醫師: 李建勳 開立時間: 2010/05/29 11:00 Pre-operative Diagnosis Pituitary macroadenoma Post-operative Diagnosis Pituitary macroadenoma Operative Method Transsphnoid adenomectomy Specimen Count And Types 1 piece About size:0.3g Source:transshpenoid adenomectomy Pathology Pending Operative Findings One part of tumor was white-yellowish, soft, size 1cmx1cmx0.8cm. The other part of the tumor was yellowish, elastic, size 1.5cm X0.5cm X0.5cm, mild adhered to the arachnoid membrane. The normal gland was found after tumor excision. CSF leakage was sealed with Tissuecol Duo nad gelform packing. Operative Procedures Under general anethesia and intubation, the patient was put in supine position with head tilted 30 degree to left. The facial skin was antiseptic with alcohol better-iodine tincture, and the mucosa of oral and nasal cavity with aqueous better-iodine . The formerareas were covered by sterilized adhesive plastic sheets then draped. Under microscope, the nasal mucosa was ingected with local anestheisa and epinephrin then made incision at left norstril. A nasal speculum was applied to displace the nasal mucosa laterally and keep the nasal cavity open constantly for the exposure of the vomer bone and the anterior wall of the sphenoid sinus. The anterior sphenoid wall and posterior sphenoid wall was remove by osteotome and Kerrison punch. The mucosa in the sphenoid sins was removed with aligator. The sellar floor dura was coagulated then opened in cruciate fashion. The soft tumor parenchyma was removed by curette, aligator and tumor forceps. The other part of the tumor was removed with aligator. The CSF leakage was sealed with Tissuecol Duo nad gelform packing. The arachnoid and the opening of diaphragm sellae was enforcedby packing with gelform as in the sellar cavity. The nasal mucosa returned to its normal position. Both sides of the nasal cavities was tightly packed with a segment of rubber glove finger filled with vaseline gauze strips which had been soaked with better-iodine ointment. Operators VS 曾漢民 Assistants R1 鄭孟伯 R6 李建勳 相關圖片 陳阿市 (F,1951/12/20,60y2m) 手術日期 2010/05/29 手術主治醫師 林晉 手術區域 東址 021房 01號 診斷 Fracture, femoral intertrochanteric 器械術式 Hemi..Bipolar 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 脊髓麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 賴昆鴻, 時間資訊 08:08 進入手術室 08:30 麻醉開始 08:45 誘導結束 08:50 抗生素給藥 09:00 手術開始 10:05 手術結束 10:05 麻醉結束 10:10 送出病患 10:12 進入恢復室 11:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Spinal anesthesia 1 0 手術 部份關節置換術併整形術–只置換髖臼或股骨或半股關節或半肩關節 1 1 R 摘要__ 手術科部: 骨科部 套用罐頭: Right hip bipolar hemiarthroplasty with Unite... 開立醫師: 賴昆鴻 開立時間: 2010/05/29 10:02 Pre-operative Diagnosis Right femoral neck fracture Post-operative Diagnosis Right femoral neck fracture Operative Method Right hip bipolar hemiarthroplasty with United prothesis Specimen Count And Types nil Pathology nil Operative Findings Right femoral neck fracture, subcapital, neglected Operative Procedures 1. Spinal anesthesia, left decubitus position. 2. Skin disinfection, draped. 3. Skin incision over lateral thigh, dissected to the hip joint with posterolateral approach. 4. Removed the femoral head and prepared the femoral component with jigs, reamer and broach. 5. Applied the prothesis (Cap: 40mm, neck: standard, stem: 2#, 10mm) 6. Checked the ROM, stability and alignmnet. 7. Irrigation, hemostasis, closed in layers. Operators 林晉, Assistants 賴昆鴻, 許駿毅, 楊俊彩 (M,1953/01/01,59y2m) 手術日期 2010/05/30 手術主治醫師 蔡翊新 手術區域 東址 001房 02號 診斷 Arteriovenous malformation, brain 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 王永彬 ASA 3E 紀錄醫師 胡朝凱, 時間資訊 10:15 開始NPO 10:15 臨時手術NPO 10:15 通知急診手術 11:18 進入手術室 11:18 報到 11:30 麻醉開始 11:40 誘導結束 12:08 手術開始 16:00 麻醉結束 16:00 手術結束 16:10 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 開顱術摘除血管病變－動靜脈畸型－小型－表淺 1 1 L 手術 顱內壓監視置入 1 2 L 摘要__ 手術科部: 外科部 套用罐頭: AVM 開立醫師: 蔡翊新 開立時間: 2010/05/30 16:03 Pre-operative Diagnosis Left frontal dural arteriovenous fistula rupture with left frontal intracerebral hematoma and left frontotemporal subdural hematoma. Post-operative Diagnosis Left frontal arteriovenous malformation rupture with left frontal intracerebral hematoma and left frontotemporal subdural hematoma. Operative Method Left frontotemporal craniectomy for evacuation of subdural and intracerebral hematoma and excision of AVM. Left frontotemporal craniectomy for evacuation of subdural and intracerebral hematoma and excision of AVM + ICP monitoring. Specimen Count And Types 1 piece About size:2 X 0.8 x 0.3 cm Source:left frontal AVM Pathology Pending. Operative Findings Tense dura was noted after craniectomy. Subdural hematoma, organized, with dark reddish liquified blood, about 1 cm in thickness, was noted at left frontotemporal region. The brain remained slack after SDH removal. An arteriovenous malformation was encountered at left frontal tip, with feeding artery coming from left ophthalmic artery and draining vein to cortical vein and superior sagittal sinus. The nidus was about 2 x 1 x 0.3 cm. About 40 ml intracerebral hematoma was evacuated at left frontal lobe, just beneath the AVM. ICP after duroplasty was 2 mmHg and after skin closure was also 2 mmHg. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right (lt) 2. Position: supine with head rotated to right. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: horse shoe shape, lt fronto-parietal,with its mid-portion at 4. Incision: curvilinear, left fronto-temporal, Raney clips were applied to the scalp edge for temporary hemostasis. sagittal line. Raney clips were applied to the scalp edge for temporary hemostasis. 5. Craniotomy window: x cm, lt fronto-parietal, created by making - burr holes 5. Craniotomy window: 12 x 10 cm, left fronto-temporal, created by making 3 burr holes, then cut by power saw. then cut by power saw. 6. Dural tenting: by 2/0 silk, 2.5 cm in interval, distributed along the edge 6. Dural tenting: by 2/0 silk, 2 cm in interval, distributed along the edge of skull window. of skull window. 7. Dural incision: crusade fahion. 7. Dural incision: curvilinear fashion. 8. The parietal cortex at parasagittal region was incised by bipolar 8. The subdural hematoma was evacuated by sucker. Left frontal tip AVM was excised by coagulating and dividing the arterial feeder first, dissecting along the plane between brain tissue and the nidus, then coagulating and dividing the venous drainage. The intraparenchymal hematoma just beneath the AVM was evacuated. coagulator. The soft clot of the huge intracerebral hematoma was removed easily by a sucker until the lt lateral ventricle came into view. The tough clot was then removed which resulted in active bleeding from the nidus of AVM. Theabnormal vessels including the feeding artery, nidus and the drainage vein were then resected by a bipolar coagulator. 8. Under operating microscope, the arachnoid membrane of sulcus was opened and the adjacent gyri were separated to expose the feeding artery of AVM from . The feeding artery was traced to the nidus then divided. The nidus of the AVM was isolated from the surrounding brain tissue by microbipolar coagulator with great precaution to minimize the chance of rupture. Afterthe entire mass of the nidus had been dissected free, the drainage vein was occluded by hemoclips and divided. 9. Hemostasis: The blood oozing point from several laocations on the bare 9. Hemostasis: The blood oozing point from several locations on the bare surface of the hematoma cavity were packed with gelfoamfor complete surface of the hematoma cavity were packed with Surgicel for complete hemostasis. Finally, the cavity was irrigated with NS several times and it was perfectly water clear before the dural closure. 10.Dural closure: interruped 2/0 silk sutures for key stitches, then continuous 10.Dural closure: interruped 2/0 silk sutures for key stitches, a fascial flap was used for duroplasty, and dura was closed by continuous suture with 4/0 Prolene to obtain water-tight closure. suture with 4/0 Dexon to obtain water-tight closure. A piece of pericranium (5x1 cm) was used for a perfect dural closure. 11.Closure of skull window: the skull plate was placed back to craniotomy 11.The craniectomy bone plate was stored at bone bank. window and fixed by 3 Gage 22 wires. The dura was tented to thecenter of the skull plate by a 2/0 stitch. 12.Scalp closure: hemostasis was done with monopolar coagulator touching on the 12.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. sucker tip. Galea suture was performed by continuous suture with 3/0 Dexon and skin by continuous suture with 3/0 nylon. 13.Drain: one, epidural, which was collected in a surgeon's glove. 13.Drain: two, epidural, CWV. ICP monitor was inserted to left temporal subdural space. 14.Blood transfusion: none 14.Blood transfusion: PRBC 2U. Blood loss: 500 ml. 15.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5胡朝凱 Indication Of Emergent Operation 林麗凰 (F,1951/05/05,60y10m) 手術日期 2010/05/30 手術主治醫師 蕭輔仁 手術區域 東址 003房 01號 診斷 Subdural hematoma 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 王永彬 ASA 4E 紀錄醫師 高明蔚, 時間資訊 06:00 開始NPO 06:00 臨時手術NPO 13:00 報到 13:05 進入手術室 13:05 麻醉開始 13:10 誘導結束 13:30 手術開始 14:35 麻醉結束 14:35 手術結束 14:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Chronic Subdural Hematoma 開立醫師: 曾峰毅 開立時間: 2010/05/30 14:35 Pre-operative Diagnosis Chronic subdural hematoma Post-operative Diagnosis Chronic subdural hematoma Operative Method Left frontal burr hole for subdural drainage Specimen Count And Types Nil Pathology Nil Operative Findings Dark-yellowish subdural effusion gushed out while durotomy. Brain expanded a little after decompression. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to right. After scalp shaved, scrubbed, disinfected, and then draped, we made one linear skin incision at left frontal area. We drilled one burr hole, and put one subdural drain for drainage and saline irrigation. We closed the wound in layers and de-air the subdural space. Operators VS 蕭輔仁 Assistants R3 曾峰毅 R2 高明蔚 Indication Of Emergent Operation 相關圖片 吳盛坤 (M,1947/12/01,64y3m) 手術日期 2010/05/30 手術主治醫師 蕭輔仁 手術區域 東址 001房 04號 診斷 Subdural hematoma 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 王永彬 ASA 3E 紀錄醫師 曾峰毅, 時間資訊 15:00 臨時手術NPO 15:00 開始NPO 17:23 通知急診手術 21:55 報到 21:59 進入手術室 22:03 麻醉開始 22:10 誘導結束 22:20 抗生素給藥 22:37 手術開始 23:35 手術結束 23:35 麻醉結束 23:43 送出病患 23:45 進入恢復室 00:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Chronic Subdural Hematoma 開立醫師: 曾峰毅 開立時間: 2010/05/30 23:38 Pre-operative Diagnosis Left chronic subdural hematoma Post-operative Diagnosis Left chronic subdural hematoma Left subacute subdural hematoma Operative Method Left frontal burr hole for subdural drainage Specimen Count And Types Nil Pathology Nil Operative Findings Drak-brownish, motor-oil-like, old blood gushed out after durotomy. 1. Drak-brownish, motor-oil-like, old blood gushed out after durotomy. 2. Outer membrane(+), inner membrane(-) Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to right. After scalp shaved, scrubbed, disinfected, and then draped, we made one linear skin incision at left frontal area. We drilled one burr hole, and created durotomy. We inserted subdural rubbder drain for drainage and saline irrigation. We closed the wound in layers after de-air subdural space. Operators VS 蕭輔仁 Assistants R3 曾峰毅 R1 許松鈺 Indication Of Emergent Operation 相關圖片 劉家豪 (M,1996/12/27,15y2m) 手術日期 2010/05/31 手術主治醫師 杜永光 手術區域 東址 005房 02號 診斷 Cerebral aneurysm 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3 紀錄醫師 陳國瑋, 時間資訊 13:10 報到 13:48 進入手術室 14:00 麻醉開始 14:10 誘導結束 15:07 手術開始 16:13 手術結束 16:13 麻醉結束 16:27 送出病患 16:34 進入恢復室 17:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室腹腔分流手術 1 2 R 記錄__ 手術科部: 外科部 套用罐頭: Right VP shunt insertion 開立醫師: 胡朝凱 開立時間: 2010/05/31 16:34 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Right VP shunt insertion Specimen Count And Types Tip culture Pathology nil Operative Findings 1.Opening pressure: around 15 cmH2O 2.Codman Median pressure was used 3.Ventricular cathe: 6.2 cm 4.peritoneal catheter: 30 cm Operative Procedures Under ETGA, patient was put in supine with head rotated to left. Skin was shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. Previous skin incision was made at right Kocher point. After the scalp flap had been lifted and reflected anteriorly, a 6 cm segment of the ventricular catheter was introduced into the ventricle to replace the previous EVD. The outer end of the catheter was connected to a Codman reservoir. A nib incision was made at RUQ of the abdomen , then minilaparotomy was performed to enter peritoneal cavity. Subsequently, distal 20 cm segment of the peritoneal catheter (medium pressure) was introduced into the peritoneal cavity. The proximal end of this catheter was passed through subcutaneous tunnel at forechest, neck, rt retroauricular area and connected the reservoir. The shunt systemwas checked to make sure its function was working. The reservoir was fixed to pericranium by 3 stitches. Scalp closure after hemostasis. Operators P 杜永光, VS 賴達明 Assistants R5胡朝凱, R1 陳國瑋 吳富強 (M,1974/11/27,37y3m) 手術日期 2010/05/31 手術主治醫師 曾漢民 手術區域 東址 003房 01號 診斷 Pituitary Tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 陳盈志, 時間資訊 07:30 報到 08:04 進入手術室 08:15 麻醉開始 08:45 誘導結束 09:03 抗生素給藥 09:18 手術開始 10:55 麻醉結束 10:55 手術結束 11:03 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經由蝶竇之腦下垂體瘤切除 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 摘要__ 手術科部: 外科部 套用罐頭: Transsphenoid adenomectomy 開立醫師: 陳盈志 開立時間: 2010/05/31 11:22 Pre-operative Diagnosis Pituitary tumor Post-operative Diagnosis pituitary tumor Operative Method Transsphenoid adenomectomy Specimen Count And Types 1 piece About size:small multiple fragments Source:pituitary tumor Pathology pending Operative Findings The tumor was soft fragile in character. Sellar floor has been eroded. Previous apoplexy was suspected. CSF leak was noted during the procedure, which was packed with fat and tissue codul. Operative Procedures After ETGA, the patient was put in supine position with head mild left tilt. The nasal cavity was well-disinfective, and then we incised into the nasal septum. Dissection was performed along with the periosteum to expose sphenoid sinus anterior wall and sphenoid ostia. After fracture of vomer, sphenoid sinus anterior wall was also fractured. The mucosa was removed. The sella floor was exposed and removed with kerrison. After cruciate form incision, tumor buldged out. And it was further removed with tumor forceps and ring currette. During operation, CSF leak was noted, but it was stopped by gelfoam, fat and tissue codul packing. After total excision of tumor was made, the bony graft was put back and followed by compaction of merosel. Operators VS曾漢民 Assistants R6陳盈志 駱美怡 (F,1981/06/18,30y8m) 手術日期 2010/05/31 手術主治醫師 曾漢民 手術區域 東址 003房 02號 診斷 Pituitary Tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 陳盈志, 時間資訊 10:55 報到 11:28 進入手術室 11:30 麻醉開始 12:05 誘導結束 12:20 手術開始 12:20 抗生素給藥 13:40 麻醉結束 13:40 手術結束 13:55 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 經由蝶竇之腦下垂體瘤切除 1 1 摘要__ 手術科部: 外科部 套用罐頭: Transsphenoidal adenomectomy 開立醫師: 陳盈志 開立時間: 2010/05/31 14:25 Pre-operative Diagnosis Pituitary tumor Post-operative Diagnosis Pituitary tumor Operative Method Transsphenoidal adenomectomy Specimen Count And Types 1 piece About size:Multiple fragments Source:pituitary tumor Pathology pending Operative Findings The tumor was soft fragile in character. CSF leak was noted during the procedure, which was repaired with gelform and tissue codul. Operative Procedures After ETGA, the patient was put in supine position with head mild left tilt. The nasal cavity was well-disinfective, and then we incised into the nasal septum. Dissection was performed along with the periosteum to expose sphenoid sinus anterior wall and sphenoid ostia. After fracture of vomer, sphenoid sinus anterior wall was also fractured. The mucosa was removed. The sella floor was exposed and removed with kerrison. After cruciate form incision, tumor buldged out. And it was further removed with tumor forceps and ring currette. During operation, CSF leak was noted, but it was stopped by gelfoam and tissue codul packing. After total excision of tumor was made, the bony graft was put back and followed by compaction of merosel. Operators VS 曾漢民 Assistants R6陳盈志 葉李玉梅 (F,1961/12/23,50y2m) 手術日期 2010/05/31 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 許松鈺, 時間資訊 07:30 報到 08:00 進入手術室 08:05 麻醉開始 08:50 誘導結束 09:05 抗生素給藥 09:31 手術開始 12:05 抗生素給藥 13:12 麻醉結束 13:12 手術結束 13:28 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４小時以內 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 記錄__ 手術科部: 外科部 套用罐頭: Craniotomy for Simpson^s grade.II tumor remove 開立醫師: 陳睿生 開立時間: 2010/05/31 13:51 Pre-operative Diagnosis Right posterior frontal parasagittal meningioma Post-operative Diagnosis Right posterior frontal parasagittal meningioma Operative Method Craniotomy for Simpson^s grade.II tumor remove Specimen Count And Types 2 pieces About size:pieces Source:tumor About size:1x2cm Source:dura Pathology Pending Operative Findings The tumor located at the medial side of posterior frontal region. It was about 3.5x4x4 cm in size. It was a whitish, solid, and well-capsuled one. The tumor was hardish with partial necrotic poritions. It was tightly attached to the dura and falx. The tumor base was electrocauterized and curetted. Operative Procedures 1. ETGA, supine position and head hyperflexion, fixed with Mayfield clump 2. Right posterior frontal curvillinear scalp incision about 20cm 3. Six bur holes made, and an about 8x10cm, cross midline craniotomy window was created 4. Dura tacking, and the tumor was identified with intra-op ECHO 5. Open the dura toward the sinus, and along the craniotomy window 6. The arachnoid membrane between the normal brain tissue and tumor was carefully dissected 7. Central debulking of the tumor for decompression 8. Ligate the supply vessels, and the arachnoid plane was totally dissected 9. After the tumor adhered to the falx was curetted removed, the tumor was totally removed 10.Hemostasis, close the dura tightly with fascia graft 11.Fix back the skull graft with wires x4, and central tacking 12.Set a subgaleal CWV drain, and close the wound in layers Operators VS 曾漢民 Assistants R5 陳睿生, R1 許松鈺 相關圖片 李仕漢 (M,1964/11/25,47y3m) 手術日期 2010/05/31 手術主治醫師 廖漢文 手術區域 東址 000房 號 診斷 Aneurysm 器械術式 TAE aneurysm, left P-com 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 王永彬 ASA 4E 時間資訊 09:53 通知急診手術 09:53 臨時手術NPO 09:53 開始NPO 13:40 麻醉開始 13:46 誘導結束 14:40 麻醉結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Left P-com aneurysm with ruptured Post-operative Diagnosis Left P-com aneurysm with ruptured Operative Method Left craniectomy and EVD insertion Specimen Count And Types nil Pathology nil Operative Findings 1.Brain was swelling after dural opening2.Blood clot was drain out after EVD insertion3.Initial ICP was about 20 cmH2O4.During wound closure, the craniectomy window buldged again and became tense. The intra-op echo showed massive IVH/ Operative Procedures 1.ETGA, supine2.Left kocher point skin incision3.Burr hole drill4.EVD insertion5.Left trauma flap skin incision6.Reflect skin and muscle flap downward7.Craniectomy after burr hole drill8.Dural tenting9.Duroplasty with one piece of muscle fascia10.Set tCWV drain then clsoe wound in layers/ Operators 賴達明 Assistants VS. 蕭輔仁, R5胡朝凱, R 許松鈺 Indication Of Emergent Operation 李仕漢 (M,1964/11/25,47y3m) 手術日期 2010/05/31 手術主治醫師 賴達明 手術區域 東址 001房 號 診斷 Aneurysm 器械術式 Craniotomy(Aneurysms) P-DUH 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 王永彬 ASA 4E 紀錄醫師 許松鈺, 時間資訊 00:21 通知急診手術 00:50 進入手術室 00:55 麻醉開始 01:00 誘導結束 01:30 手術開始 01:55 抗生素給藥 04:55 抗生素給藥 05:12 手術結束 05:12 麻醉結束 05:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 顱骨切除術，包括異物移除或減壓或神經切斷 1 1 L 手術 顱內壓監視置入 1 2 L 記錄__ 手術科部: 外科部 套用罐頭: Left craniectomy and EVD insertion 開立醫師: 胡朝凱 開立時間: 2010/05/31 05:48 Pre-operative Diagnosis Left P-com aneurysm with ruptured Post-operative Diagnosis Left P-com aneurysm with ruptured Operative Method Left craniectomy and EVD insertion Specimen Count And Types nil Pathology nil Operative Findings 1.Brain was swelling after dural opening 2.Blood clot was drain out after EVD insertion 3.Initial ICP was about 20 cmH2O 4.During wound closure, the craniectomy window buldged again and became tense. The intra-op echo showed massive IVH Operative Procedures 1.ETGA, supine 2.Left kocher point skin incision 3.Burr hole drill 4.EVD insertion 5.Left trauma flap skin incision 6.Reflect skin and muscle flap downward 7.Craniectomy after burr hole drill 8.Dural tenting 9.Duroplasty with one piece of muscle fascia 10.Set two CWV drain then clsoe wound in layers Operators 賴達明 Assistants VS. 蕭輔仁, R5胡朝凱, R 許松鈺 Indication Of Emergent Operation 相關圖片 謝忠鋃 (M,1955/01/02,57y2m) 手術日期 2010/05/31 手術主治醫師 黃培銘 手術區域 東址 001房 03號 診斷 Malignant neoplasm of cervical esophagus 器械術式 Tracheostomy 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 蔡東明, 時間資訊 17:44 通知急診手術 22:30 報到 22:45 進入手術室 23:08 抗生素給藥 23:10 手術開始 23:16 手術結束 23:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 氣管切開造口術 1 0 記錄__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 蔡東明 開立時間: 2010/06/01 06:46 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Ditto Operative Method Tracheostomy Specimen Count And Types nil Pathology None Operative Findings Fr. 8 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators VS黃培銘 Assistants R3蔡東明 Indication Of Emergent Operation 呂鳳明 (M,1926/08/12,85y7m) 手術日期 2010/05/31 手術主治醫師 陳敞牧 手術區域 東址 006房 04號 診斷 Subdural hemorrhage 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3E 紀錄醫師 陳德福, 時間資訊 11:00 通知急診手術 16:05 報到 17:15 進入手術室 17:25 麻醉開始 17:35 誘導結束 18:21 抗生素給藥 18:47 手術開始 20:40 手術結束 20:40 麻醉結束 20:50 送出病患 22:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: craniotomy partial tumor excision and subdura... 開立醫師: 陳德福 開立時間: 2010/05/31 21:09 Pre-operative Diagnosis left subdural hematoma Post-operative Diagnosis HCC, highly suspect metatasis to left subdural with subdural hematoma Operative Method craniotomy partial tumor excision and subdural drainage Specimen Count And Types 1 piece About size:1*1*0.5CM Source:SUBDURAL OUTER MEMBRANE Pathology pending Operative Findings 1.There is thickened and hypervascularized outer membrane at the left subdural space. 2.The darkish with small clots subdural hematoma drained out after opening the outer membrane. We irrigate the space with copious normal saline. 3.One 3*3 cm in sized craniotomy was done for tumor excision and one subdural drainage is left in situ. Operative Procedures Under ETGA and supine position, the scalp was disinfected and draped as usual. One curvilinear incision was done on the left scalp with 3*3cm craniotomy. The dura tenting and opening were done. While the tumor like outer membrane exposed, we try to open it and some darkish hematoma gushed out. We sampled one piece of outer membrane for pathology. One subdural drain was left in situ. The skull was fixed with wires and the wound was closed in layers. Operators VS 陳敞牧 Assistants r4 陳德福 Indication Of Emergent Operation 蘇芷誼 (F,1984/11/01,27y4m) 手術日期 2010/05/31 手術主治醫師 林東燦 手術區域 兒醫 062房 07號 診斷 Acute lymphoid leukemia ( ALL ) 器械術式 IT 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 面罩麻醉 麻醉主治醫師 黃啟祥 ASA 3 紀錄醫師 李孟如, 時間資訊 01:00 臨時手術NPO 11:55 報到 12:02 進入手術室 12:07 麻醉開始 12:09 誘導結束 12:15 手術開始 12:30 麻醉結束 12:30 手術結束 12:33 送出病患 12:35 進入恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Semi-opened mask inhalation anes 1 0 手術 腦室內注射留置器或脊髓腔內化學藥物注射 1 0 記錄__ 手術科部: 套用罐頭: TIT 開立醫師: 李孟如 開立時間: 2010/05/31 12:35 Pre-operative Diagnosis CNS lymphoma Post-operative Diagnosis CNS lymphoma Operative Method Intrathecal chemotherapy Specimen Count And Types 1 piece About size:9ml Source:CSF Pathology CSF routine and cytology Operative Findings CSF appearance: Clear, slowly dripped Operative Procedures Under IVGA, patient was held in knee-chest decubitus position, with the lumbar area skin prepped and draped. A 22-G needle was introduced into the L3-L4 intervertebral space and advanced slowly until the dura was penetrated. Total 9 mL of CSF was tapped without trauma. Chemotherapy with methotrexate 15 mg, hydrocortisone 25 mg, and ara-c 40 mg in normal saline to 9 mL was injected into the subarachnoid space smoothly. Then the needle was withdrawn completely,and the wound was covered with sterile dressing. Operators R5李孟如/VS林東燦 Assistants R1賴韻光 郭信達 (M,1978/02/14,34y1m) 手術日期 2010/05/31 手術主治醫師 蔡翊新 手術區域 東址 003房 04號 診斷 Fracture of vault of skull, open with subarachnoid, subdural, and extradural hemorrhage, with prolonged (more than 24 hours)loss of consciousness and return to pre-existing conscious level 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 4E 紀錄醫師 陳睿生, 時間資訊 18:02 開始NPO 18:02 臨時手術NPO 18:02 通知急診手術 18:32 報到 18:32 進入手術室 18:45 麻醉開始 18:58 抗生素給藥 19:05 誘導結束 19:10 手術開始 21:20 麻醉結束 21:20 手術結束 21:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 硬腦膜外血腫清除術 1 1 L 手術 顱內壓監視置入 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Craniectomy for hematoma evacuation, ICP moni... 開立醫師: 陳睿生 開立時間: 2010/05/31 21:53 Pre-operative Diagnosis Left temporoparietal epidural hematoma, traumatic Post-operative Diagnosis Left temporoparietal epidural hematoma, traumatic Operative Method Craniectomy for hematoma evacuation, ICP monitoring Specimen Count And Types nil Pathology Nil Operative Findings Open wound was noted at the left parietal region about 5cm, and linear skull bone fracture was noted. The EDH was more than 60ml, and the thickness was about 3.5cm. After hematoma remove, oozing was noted at branches of middle meningeal artery. The brain was shrinked, and proper tacked. Subdural ICP monitor was set, and the initial ICP was -3mmHg. Reference: 496 Operative Procedures 1. ETGA, supine position and head right turn 2. Extend the parietal wound curvillinearly 3. Incise into the temporalis muscle 4. Create a bur hole at temporal region, and then drain out the hematoma for decompression 5. Create another bur hole at parietal region, and then an about 8x8cm craniotomy window was made 6. Totally remove of the hematoma, electrocauterize the oozing MMA branch at the temporal region 7. Normal saline irrigation to the subdural space for expansion 8. Dura tacking, and then ICP monitor was inserted subdurally 9. Set an epidural CWV drain, and fix back the skull graft with wires x6 10.Close the muscle and wound in layers Operators VS 蔡翊新 Assistants R5 陳睿生 Indication Of Emergent Operation 王再雲 (F,1956/11/10,55y4m) 手術日期 2010/06/01 手術主治醫師 王國川 手術區域 東址 001房 02號 診斷 Intracranial abscess 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 胡朝凱, 時間資訊 09:00 開始NPO 09:00 臨時手術NPO 12:00 通知急診手術 12:46 報到 12:46 進入手術室 12:48 麻醉開始 13:10 抗生素給藥 13:15 誘導結束 13:50 手術開始 15:40 麻醉結束 15:40 手術結束 15:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 腦內血腫清除術 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Left craniectomy and abscess evacuation 開立醫師: 胡朝凱 開立時間: 2010/06/01 16:01 Pre-operative Diagnosis Left frontal brain abscess Post-operative Diagnosis Left frontal brain abscess Operative Method Left craniectomy and abscess evacuation Specimen Count And Types pus for 4 tubes Pathology pending Operative Findings 1.Mild turbid fluid accumulate beneath the bone graft and epidural space. 2.Frontal sinus exposure was noted st previous surgery 3.Frank pus about 45 ml was noted after mild craniotomy 4.Thick abscess capsule was noted and left in situ Operative Procedures 1.ETGA, supine 2.Left previous wound skin incision 3.Reflect skin flap downward 4.Previous bone graft removal 5.Echo localization 6.corticotomy 7.Pus drainage 8.Set one EVD 9.Close dura with one piece of fascia 10.Set one CWV drain then close wound in layers. Operators 王國川 Assistants 胡朝凱 Indication Of Emergent Operation 陳瑞美 (F,1960/05/27,51y9m) 手術日期 2010/06/01 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Benign neoplasm of cerebral meninges 器械術式 Crainotomy Brain Tumor(P-LIN) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 07:37 報到 08:05 進入手術室 08:15 麻醉開始 08:40 誘導結束 09:10 抗生素給藥 09:14 手術開始 12:10 抗生素給藥 12:55 麻醉結束 12:55 手術結束 13:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除－手術時間在４～８小時 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Simpson grade II tumor excision. 開立醫師: 鍾文桂 開立時間: 2010/06/01 13:33 Pre-operative Diagnosis Right parietal convexity meningioma. Post-operative Diagnosis Right parietal convexity meningioma. Operative Method Simpson grade II tumor excision. Specimen Count And Types 2 pieces About size:7 cm Source:tumor About size:6 cm Source:dura Pathology Pending. Operative Findings 1. Moderate oozing operative field. Blood loss: 150cc. 2. Inner cortical bone, and dura mater are invaded by the tumor. 3. A small piece of tumor capsule was left in place due to proximity to motor cortex. 4. Slack brain after tumor excision. fair brain expansion. 6. The invaded dura was electrocoagulated at posterior inferior part of the craniotomy window. 6. The invaded dura was electrocoagulated at posterior inferior part of the craniotomy window. The invaded dura was excised at the center of the craniotomy window. 5. The invaded dura was electrocoagulated at posterior inferior part of the craniotomy window. The invaded dura was excised at the center of the craniotomy window. Operative Procedures Under ETGA, the patient was put in supine position, the head was tilted to the left side. A ㄇ- shape incision was made at right parietal-occipital region after well disinfection and draping. A square craniotomy about 10 cm in diameter was made by high speed drills. The dura mater was incised in ㄇ-shape using the inferior part of the craniotomy as its base. While elevating the dura mater, the tumor invaded through the dura mater. We seperated the dura mater with the tumor mass by Patty and bipolar electrocoagulator. After central debulking, we resect the tumor along its arachnoid plane. Some severe adhesion of the tumor capsule and its arachonoid plane was noted near the motor cortex and superficial cortical veins. Those parts were left in place. With well hemostasis and covering the exposed brain surface with Surgicel, the tumor-invaded dura mater was excised. The dura defect was reparied by fascia graft. Finally, the wounds was closed in layers. No drain was inserted. The patient was sent ot ICU smoothly. Operators V.S. 曾勝弘 Assistants R4　鍾文桂 相關圖片 吳欣潔 (F,2008/10/23,3y4m) 手術日期 2010/06/01 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Moyamoya disease 器械術式 BILATERAL MOYAMOYA, EDAS 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 蔡宗良, 時間資訊 00:00 臨時手術NPO 08:00 報到 08:05 進入手術室 08:20 麻醉開始 08:50 誘導結束 09:50 抗生素給藥 09:50 手術開始 12:30 開始輸血 12:50 抗生素給藥 16:00 麻醉結束 16:00 手術結束 16:10 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 7 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Glucose 1 0 麻醉 動脈血液檢查全套 3 0 麻醉 Hemoglobin (Hb) 3 0 麻醉 測血糖 3 0 麻醉 Ca (Calcium) 3 0 麻醉 Na (Sodium) 3 0 麻醉 K (Potassium) 3 0 麻醉 Cl (Chloride) 3 0 麻醉 Blood gas analysis 3 0 手術 顱內外血管吻合術 1 1 B 手術 顱內外血管吻合術 1 2 B 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 B 記錄__ 手術科部: 外科部 套用罐頭: Moyamoya disease 開立醫師: 蔡宗良 開立時間: 2010/06/01 16:55 Pre-operative Diagnosis Moyamoya syndrome, bilateral Moyamoya syndrome, bilateral, may be due to protein C and S deficiency Post-operative Diagnosis Moyamoya syndrome, bilateral Moyamoya syndrome, bilateral, may be due to protein C and S deficiency Operative Method Encephaloduroarteriosynangiosis, bilateral Encephaloduroarteriosynangiosis (EDAS, STA-MCA indirect bypass), bilateral Specimen Count And Types nil Pathology None Operative Findings The brain parenchyma is atrophic and more pale comparing to those of normal one. The brain parenchyma is mildly atrophic and more pale comparing to those of normal one. When the dura was opened, much CSF flew out and the brain became slackened. Multiple collaterals were noted at dura mater and brain surface. The parietal branch of the superficial temporal artery was chosen for the synangiosis. The parietal branch of both superficial temporal arteries were chosen for the synangiosis. Operative Procedures Under ETGA, the patient was put in supine position. The head was tilted to the right. After shaving, the tract of the superficial temporal artery and its branches were outlined by tracing througth Doppler. After disinfection and draping, the L-shape scalp incision was done with avoidance of exposing the proposed position of middle meningeal artery. Microscope was brought into the surgical field. The parietal branch of the right superficial temporal artery and its pedicle graft were lysed from the surroundong soft tissue under microscope. The temporalis muscle below was dissected. A 4-cm craniotomy was created with high speed drill. Under ETGA, the patient was put in supine position. The head was tilted to the right. After shaving, the tract of the left superficial temporal artery and its branches were outlined by tracing througth Doppler. After disinfection and draping, An L-shape scalp (hockey-stick) incision was done along with the parietal branch of left STA. Microscope was brought into the surgical field. The parietal branch of the right superficial temporal artery and its pedicle galeal graft were lysed from the surroundong soft tissue under microscope. Monopolar was used to dissected the STA graft and the galea 4 mm on both sides of the STA. The temporalis muscle below was dissected longitudinally along the graft. A 4-cm ovoid shape craniotomy was created with high speed drill. After dural tenting the dura was opened, lysis of the arachnoid membrane was done. The arterial pedicle was anchored to the four cornorsof the sural opening to let the pedicle lying loosely on the brain surface. The pedicle had good contact with the exposed MCA branches. Later, the SMA pedicle was sutured to the dural edges by 5-0 prolene. To gain more close contact of the artery with brain surface, several pieces of gelfoam were placed above the artery and a piece of DuraGen was placed above the dura mater.With several dural tenting and central tenting, the bone plate was fixed with 3 wires. The wound was closed in layers. After dural tenting the dura was opened, lysis of the arachnoid membrane was done. The arterial pedicle was anchored to the four cornorsof the sural opening to let the pedicle lying loosely on the brain surface. The pedicle had good contact with the exposed MCA branches. Later, the SMA pedicle was sutured to the dural edges by 5-0 prolene. To gain more close contact of the artery with brain surface, several pieces of gelfoam were placed above the artery and a piece of DuraGen was placed above the dura mater.With several dural tenting and central tenting, the bone plate was fixed with 3 wires. The wound was closed in layers. Similar procedure was performed to the right-side. After dural tenting the dura was opened, lysis of the arachnoid membrane was done. The arterial pedicle was anchored to the four cornors of the dural opening to let the pedicle lying loosely on the brain surface. The pedicle had good contact with the exposed MCA branches on both frontal and temporal lobes. Later, the dura was closed primaruily with by 5-0 prolene with placement a piece of Durogen under the dura to prevent CSF leakage. With central tenting, the bone plate was fixed back with 3 wires. The wound was closed in layers. Similar procedure was performed to the right-side. Operators VS 郭夢菲 Assistants R4 蔡宗良 祝王雲玉 (F,1929/05/10,82y10m) 手術日期 2010/06/01 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Cervical Spondylosis 器械術式 Anterior Spinal fusion (Others) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 黃世銘, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:05 進入手術室 08:15 麻醉開始 08:30 誘導結束 09:20 抗生素給藥 09:30 手術開始 12:18 抗生素給藥 12:55 麻醉結束 12:56 手術結束 13:05 送出病患 13:10 進入恢復室 14:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術－頸椎 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 脊椎融合術－前融合，有固定物（＜＝四節） 1 2 摘要__ 手術科部: 外科部 套用罐頭: Anterior Discectomy and Fusion, Cervical Spin... 開立醫師: 陳德福 開立時間: 2010/06/01 13:16 Pre-operative Diagnosis Cervical spondylosis with spinal stenosis and myelopathy, C3/4 and C6/7 Post-operative Diagnosis ditto Operative Method Anterior Discectomy and Fusion, Cervical Spine C3/4, C6/7 Specimen Count And Types nil Pathology nil Operative Findings 1.There is severe spondylosis with spinal stenosis at C3-4 and C6-7. The thecal sac was compressed tighly before decompression and after the discectomy, the thecal sac was decompressed. 2.6mm in sized Synthes cervical cages were implanted at C3/4 and C6/7 space. Operative Procedures 1. Anesthesia: endotracheal general 2. Position: supine with neck hyperextended by a air cuff placed beneath the shoulder. 3. Skin preparation: the anterior neck was scrubbed with povidone-iodinew detergent followed by painting with povidone-iodine alcohol tincture, then drapped as usrual. Place 25G needles over the neck skin for guilding of incision and checked by C-Arm 4. Incision; 5 cm, transverse middle cervical, extended from anterior margin of right sternocleidomastoid (SCM) muscle to thyroid cartilage. 5. The plastisma muscle was transected and mobilized from the underlying superficial cervical fascia which was then opened in vertical direction along the anterior margin of the SCM muscle. 6. The dissection was advanced at the loose plane between SCM muscle and strip muscles until the prevertebral fascia had been reached. The former structure was retracted to the lateral and the later structures with esophagus and trachea to the opposite side. 7. The prevertebral fascia was opened vertically, the lesion intervertebral space of C3/4 was exposed and identified by C-Arm. 8. The anterior longitudinal ligment was incised transversely at the margins of intervertebral space, the annulus fibrosus was cut too. 9. The degenerated disc and cartilage plate were removed by curette. 10. The intervertebral space was widened by a Cloward interveetebral spreader. The posterior longitudinal ligament was cut from bony edge by curette and then removed. Consequently, the spinal dura expanded into the intervertebral space. 11. The cervical cage was packed into the intervertebral space tightly by a impactor. The intervertebral space was widened by pulling the patients head whilethe impaction of the bone graft was doing. 12. Repeat the procedure from procedure No 4 to No 11 at lower neck for the C6/7 cervical stenosis. 13. Wound closure: continuous suture with 3/0 Dexon for plastisma and continuous suture with 4/0 Dexon on the skin. Remarks 1. Drain: 1 Mini-HemoVAC 2. Blood transfusion:nil 3. Course of the surgery: smooth. Operators VS 賴達明 Assistants r4 陳德福 r1 黃世銘 相關圖片 高建元 (M,1961/11/11,50y4m) 手術日期 2010/06/01 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Headache 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 黃世銘, 時間資訊 00:00 臨時手術NPO 13:00 報到 13:20 進入手術室 13:25 麻醉開始 13:50 誘導結束 14:00 抗生素給藥 14:31 手術開始 17:00 抗生素給藥 18:10 麻醉結束 18:10 手術結束 18:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４～８小時 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 摘要__ 手術科部: 外科部 套用罐頭: right suboccipital craniotomy for tumor excision 開立醫師: 陳德福 開立時間: 2010/06/01 18:34 Pre-operative Diagnosis cerebellar hemangioblastoma s/p tumor excision, recurrence Post-operative Diagnosis ditto Operative Method right suboccipital craniotomy for tumor excision Specimen Count And Types 1 piece About size:0.5*0.5*0.3CM Source:Cerebellar tumor Pathology pending Operative Findings 1.There is a 5cm in sized cystic tumor with mural nodule noted at the right cerebellum. The cystic content is yellowish and clear fluid. 2.We found a reddish lesion with mutilpe vascular tufts accumulation at the medial part of the right cerebellum. The lesion was removed and sent for pathology diagnosis. Operative Procedures Under ETGA and prone position with Mayfield pin type head fixator fixation, the scalp was disinfected as usual. One incision along previous wound was done and right suboccipital craniotomy was performed. The dura was opened in K shpae in order to expose the cystic tumor. The mragin between the tumor and normal brain tissue was identified. After the cystic content was drained out, we explore the medial side of the tumor for finding the mural nodule. The solid part of the tumor was remvoed and we performed duroplasty with autologous muscel fascia graft. The skull was fixed with miniplates and the wound was closed in layers with one subcutaneous CWV in situ. Operators VS 賴達明 Assistants R4 陳德福 R1黃世銘 林正治 (M,1944/03/24,67y11m) 手術日期 2010/06/01 手術主治醫師 賴達明 手術區域 東址 005房 02號 診斷 Spondyloisthesis, acquired 器械術式 Lumbar spondylolithesis 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 12:40 報到 13:23 進入手術室 13:25 麻醉開始 13:40 誘導結束 14:30 抗生素給藥 14:50 手術開始 17:30 抗生素給藥 20:30 抗生素給藥 20:40 麻醉結束 20:45 手術結束 20:50 送出病患 20:55 進入恢復室 22:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術－腰椎 1 2 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 7 0 記錄__ 手術科部: 外科部 套用罐頭: L3/4 discectomy left side and posterior fixat... 開立醫師: 陳盈志 開立時間: 2010/06/01 20:53 Pre-operative Diagnosis recurrent L3/4 HIVD, left side with L4/5 stenosis Post-operative Diagnosis recurrent L3/4 HIVD, left side with L4/5 stenosis Operative Method L3/4 discectomy left side and posterior fixation with TPS; L4/5 sublaminar decompression Specimen Count And Types nil Pathology nil Operative Findings Left L3/4 buldging disc with severe scar formation was noted. The root was decompressed well after discectomy and adhesionalysis. Hypertrophic ligmentum flavum was noted at L4/5. TPS 6.5x45mm x4 at L3,4. Operative Procedures 1.ETGA, prone C-arm localization 2.Skin preparation 3.Midline back incision, detach paraspinal muscle 4.TPS at L3,4 under C-arm guide 5.L3/4 left side laminotomy with adhesionalysis to identify root and disc 6.Discectomy with currete and disclamp under microscope 7.Bilateral L4/5 laminotomy for sublaminar decompression with karrison 8.Rod fixation 9.Hemostasis, H/V x 1 10.close wound in layers Operators VS賴達明 Assistants R6陳盈志R4鍾文桂 相關圖片 藍開奎 (M,1929/01/28,83y1m) 手術日期 2010/06/02 手術主治醫師 陳敞牧 手術區域 東址 002房 05號 診斷 Subdural hematoma 器械術式 Burr hole (trephination) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林至芃 ASA 3E 紀錄醫師 鍾文桂, 時間資訊 13:00 開始NPO 17:22 通知急診手術 23:50 進入手術室 23:55 麻醉開始 00:15 誘導結束 00:33 抗生素給藥 00:54 手術開始 01:50 麻醉結束 01:50 手術結束 02:10 送出病患 02:20 進入恢復室 03:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 慢性硬腦膜下血腫清除術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Burr hole for hematoma evacuation 開立醫師: 陳盈志 開立時間: 2010/06/02 01:56 Pre-operative Diagnosis Left side chronic SDH Post-operative Diagnosis Left side chronic SDH Operative Method Burr hole for hematoma evacuation Specimen Count And Types nil Pathology nil Operative Findings dark brownish fluid gushed out after opening the outer membrane. The brain was slake after hematoma evacuation. About 60mL hematoma was drained. Operative Procedures 1.ETGA, supine 2.Skin preparation 3.Left frontal skin incision 4.Burr hole then dura tenting x 2 5.Insert R/D with N/S irrigation then left drain to frontal direction as subdural drain. 6.Hemostasis 7.close wound in layers Operators VS陳敞牧 Assistants R6陳盈志R4鍾文桂 Indication Of Emergent Operation 沈永村 (M,1961/11/28,50y3m) 手術日期 2010/06/01 手術主治醫師 王水深 手術區域 東址 016房 03號 診斷 Spinal metastasis 器械術式 Port-A catheter Removal/WOR 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 黃俊銘, 時間資訊 14:35 報到 14:45 進入手術室 14:59 麻醉開始 15:03 誘導結束 15:05 手術開始 15:25 麻醉結束 15:25 手術結束 15:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 內頸靜脈切開，永久導管放置術 1 1 摘要__ 手術科部: 外科部 套用罐頭: Remove Port-A 開立醫師: 黃俊銘 開立時間: 2010/07/21 17:19 Pre-operative Diagnosis Small cell lung cancer Post-operative Diagnosis Small cell lung cancer Operative Method Remove Port-A Specimen Count And Types nil Pathology Nil Operative Findings Intact catheter tip Operative Procedures Skin disinfect, draping LA Incision along previous scar Remove Port-A Wound close Operators 王水深 Assistants 黃俊銘 莊朝宗 (M,1938/09/22,73y5m) 手術日期 2010/06/02 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Occlusion and stenosis of carotid artery 器械術式 EC-IC bypass 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 蔡宗良, 時間資訊 00:00 臨時手術NPO 07:48 報到 08:05 進入手術室 08:15 麻醉開始 08:35 誘導結束 09:15 抗生素給藥 10:10 手術開始 12:15 抗生素給藥 14:00 手術結束 15:15 抗生素給藥 16:00 麻醉結束 16:10 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 8 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 手術 顱內外血管吻合術 1 1 R 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 手術 誘發電位手術監視機–腦神經外科術中特殊儀器使用費 1 0 記錄__ 手術科部: 外科部 套用罐頭: EC-IC Bypass, STA, right-sided, parietal bran... 開立醫師: 蔡宗良 開立時間: 2010/06/02 16:50 Pre-operative Diagnosis Internal carotid artery stenosis, old infarction, right-sided Post-operative Diagnosis Internal carotid artery stenosis, old infarction, right-sided Operative Method EC-IC Bypass, STA, right-sided, parietal branch, to MCA M3 branch Specimen Count And Types None Pathology None Operative Findings Parietal branch of right-sided STA appears to possess a better flow. Operative Procedures Under endotracheal intubation, general anesthesia was applied. Patient was positioned in a supine position with head rotated to the left. Skin was prepped as usual. The course of the superficial temporal artery was mapped out with methylene blue after identification by palpation, then the skin was covered with a sterilized adhesive plastic sheet. Isolation of the superficial temporal artery (STA): a 5 cm segment of this artery together with its surrounding fat tissue was isolated by sharp dissection after the scalp incision along the arterial course had been made. The bleeding from scalp edge was stopped by bipolar coagulator. Scalp was incised for arterial isolation was then extended backward to form a horse shoe shape temporal flap. Craniotomy window was made with 4 cm trephine centered at angular gyrus. Dural tented by 2/0 silk, 1 cm in interval, distributed along the edge of skull window. Dura was incised in a crusade fashion (curlinear along the edge of skull window). Under operating microscope, a suitable cortical branch from the MCA was identified and the arachnoid around the vessel was removed by microscissors. A piece of plastic membrane was placed under the free segment of the artery. Two temporary microvascular clips were applied, 1 cm appart, to the isolated segment of the cortical vessel, which was then opened by cutting off a leaf-like patch of the vascular wall (same size as the diameter of the STA). Heparin solution was used to irrigate the vascular lumen. The STA was occluded by a temporary clip and divided at its distal end. The lumen was irrigated with heparin solution. The adventitia at the vascular stump was trimmed off. The STA was anastomosed end-to-side to the segment of cortical artery with 2 angular stich each pole, 3 to the frontal side, 4 to the parietal side, with interrupted stitches of 10/0 monofilament nylon. The plastic membrane was folded back with a small patty to drape around the anastomosing site, then the vascular clips were released, the first one was on distal end of the cortical vessel, the 2nd one was on the STA and the last one, on the proximal end of the cortical artery. The leakage from the anastomosis was successufully stopped by gentle pressure on the patty with a small sucker tip. Dura was closed with interruped 2/0 silk sutures for key stitches, then continuous sutures with 4/0 Dexon to obtain water-tight closure except the corner where the STA went into subdural space. The loose space there was packed with gelfoam around the STA. The trephine button wassimplyplaced back without fixation. The corner where STA passed through was bitten off for preventing undue pressure on the STA by the button. Scalp was closed after hemostasis was done with monopolar coagulator touching on the sucker tip. Galea suture was performed by continuous suture with 3/0 Dexon and skin by continuous suture with 3/0 nylon. A 7 mm CWV drain was placed at the epidural space. Operators VS 賴達明 Assistants R5 陳睿生, R4 蔡宗良 葉文燕 (F,1963/10/20,48y4m) 手術日期 2010/06/02 手術主治醫師 曾漢民 手術區域 東址 005房 03號 診斷 Pituitary Tumor 器械術式 TSH 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 14:08 報到 14:20 進入手術室 14:25 麻醉開始 14:40 誘導結束 15:00 抗生素給藥 15:10 手術開始 16:30 麻醉結束 16:30 手術結束 16:35 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 經由蝶竇之腦下垂體瘤切除 1 1 記錄__ 手術科部: 外科部 套用罐頭: Transnasal trans-sphenoidal approach for drainage 開立醫師: 胡朝凱 開立時間: 2010/06/02 16:49 Pre-operative Diagnosis pituitary macroadenoma Post-operative Diagnosis Ratheke cleft cyst Operative Method Transnasal trans-sphenoidal approach for drainage Specimen Count And Types nil Pathology nil Operative Findings The cyst content was whitish, milky with a thick wall. Post-OP arachnoid membrane was seen. The buldging lateral wall nearby the ICA was noted. Tissuco-dul was use. Operative Procedures After ETGA, the patient was put in supine position with head mild left tilt. The nasal cavity was well-disinfective, and then we incised into the nasal septum. Dissection was performed along with the periosteum to expose sphenoid sinus anterior wall and sphenoid ostia. After fracture of vomer, sphenoid sinus anterior wall was also fractured. The mucosa was removed. The sella floor was exposed and removed with kerrison. After cruciate form incision, cyst content buldged out. And it was further removed with suction. After cyst opening, the bony graft was put back and followed by compaction of merosel. Operators 曾漢民 Assistants 胡朝凱,游健生 胡逸然 (F,1976/02/22,36y0m) 手術日期 2010/06/02 手術主治醫師 賴達明 手術區域 東址 001房 03號 診斷 Breast cancer, female 器械術式 OPLL-Anterior Corpectomy VSLai 手術類別 緊急手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 3E 紀錄醫師 朱峻緯, 時間資訊 08:36 開始NPO 08:36 臨時手術NPO 11:36 通知急診手術 15:50 報到 16:10 進入手術室 16:15 麻醉開始 16:35 誘導結束 16:40 抗生素給藥 17:19 手術開始 19:00 開始輸血 21:40 麻醉結束 21:40 手術結束 21:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術－前融合，有固定物（＜＝四節） 1 2 手術 惡性病髓腫瘤切除術 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 乳房腫瘤組織檢查切片術 1 4 R 記錄__ 手術科部: 神經部 套用罐頭: Breast tumor, right 開立醫師: 廖御佐 開立時間: 2010/06/02 19:13 Pre-operative Diagnosis Post-operative Diagnosis Breast tumor, right Operative Method Breast tumor, right Specimen Count And Types 1 piece About size:1*1cm Source:Right breast tumor Pathology Pending Operative Findings One 8.0*10.0 hard tumor beneath the nipple over right breast Operative Procedures ETGA, table consultation Curvilinear incision Tumor biopsy Hemostasis Set one penrose Close the wound Operators 黃俊升 Assistants 廖御佐 Indication Of Emergent Operation 摘要__ 手術科部: 神經部 套用罐頭: C7 corpectomy wtih autologus iliac graft fusi... 開立醫師: 陳睿生 開立時間: 2010/06/02 22:35 Pre-operative Diagnosis C7 pathological compression fracture, suspect breast cancer with metastasis Post-operative Diagnosis C7 pathological compression fracture, suspect breast cancer with metastasis Operative Method C7 corpectomy wtih autologus iliac graft fusion, Anterior fixation with plate over C6-T2 Specimen Count And Types nil Pathology Nil Operative Findings Compressed fracture was noted over T7 level, and whitish, solid tumor was noted inside the body. The tumor was also noted to be adhered to the PLL, and nearly total removed. A piece of iliac bone graft was extracted from right anterior iliac surface. 37mm Synthes cervical plate was used for fixation. 18mm screws x4 were used at C6, T2 level, and 16mm screws x2 were used to fix the plate and bone graft. Operative Procedures 1. ETGA, supine position, and left side lower neck curvillinear skin incision 2. Split the plane between the SCM and trachea, esophagus to expose the prevertebral space 3. C-arm localized C7 level, and self-retractor was set for widely exposure 4. The C7 body was removed with disk clump and Kerrison pounch, and C6/7, C7/T1 disks were also removed 5. Expose the PLL, and remove of residual tumor at lateral side 6. Right iliac skin incision about 6cm, and dissect the anterioriliac aspect 7. Cut down a piece of iliac graft about 4.5x2x2cm 8. Insert the iliac graft into the C7 space 9. Fix the Synthes cervical plate at C6, T2 level 10.Fix the plate to the bone graft 11.Hemostasis, set a CWV drain at prevertebral space, and a 1/8 hemovac at iliac wound 12.Close the wound in layers Operators VS 賴達明 Assistants R6 李建勳, R5 陳睿生, R4 陳德福, R1 朱峻維 Indication Of Emergent Operation 蔡林玲麗 (F,1943/12/26,68y2m) 手術日期 2010/06/02 手術主治醫師 賴達明 手術區域 東址 005房 01號 診斷 Cervical spondylosis 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 胡朝凱, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:02 進入手術室 08:10 麻醉開始 08:20 誘導結束 08:48 抗生素給藥 09:11 手術開始 11:48 抗生素給藥 12:20 手術結束 12:20 麻醉結束 12:30 送出病患 12:33 進入恢復室 14:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 椎間盤切除術－頸椎 1 1 手術 脊椎融合術－前融合，有固定物（＜＝四節） 1 2 記錄__ 手術科部: 外科部 套用罐頭: C4~6 discectomy and cage insertion 開立醫師: 胡朝凱 開立時間: 2010/06/02 12:37 Pre-operative Diagnosis C4~6 HIVD Post-operative Diagnosis C4~6 HIVD Operative Method C4~6 discectomy and cage insertion Specimen Count And Types nil Pathology nil Operative Findings 1.The ruptured disc that compressed the C4~5 level spinal cord tightly. Also, the C5~6 disc protruded and compressed the cord. 2.The disc was dehydrated 3.Thickend PLL Operative Procedures 1.ETGA, supine 2.right transverse neck skin incision 3.Dissect slong with the anterior border of SCM muscle 4.Expose prevertebral space 5.Discectomy 6.Cage insertion 7.Set one minihemovac drain 8.Close wound in layers Operators 賴達明 Assistants 胡朝凱, Ri 劉誠展 (M,1959/03/28,52y11m) 手術日期 2010/06/02 手術主治醫師 蕭輔仁 手術區域 東址 005房 02號 診斷 Lumbar Spondylosis 器械術式 radiofrequency albation 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 胡朝凱, 時間資訊 12:15 報到 12:50 進入手術室 13:12 抗生素給藥 13:25 麻醉開始 13:28 手術開始 14:00 麻醉結束 14:00 手術結束 14:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 高頻熱凝療法 1 1 B 記錄__ 手術科部: 外科部 套用罐頭: Bilateral L2 DRG radiofreqency caoagulation 開立醫師: 胡朝凱 開立時間: 2010/06/02 14:10 Pre-operative Diagnosis Lower back pain Post-operative Diagnosis Lower back pain Operative Method Bilateral L2 DRG radiofreqency caoagulation Specimen Count And Types nil Pathology nil Operative Findings 1.Bilateral L2 DRG 42 celcius degree 180 secs Operative Procedures 1.Local anesthesia 2.Needle insertion at L2 level to reach the transverse foramen outlet 3.confirmation with C-arm 4.Coagulation 5.Perform same procedure at left side Operators 蕭輔仁 Assistants 胡朝凱 曾惠雀 (F,1961/04/21,50y10m) 手術日期 2010/06/03 手術主治醫師 賴達明 手術區域 東址 003房 號 診斷 Intracranial hemorrhage 器械術式 cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:05 進入手術室 08:10 麻醉開始 08:15 誘導結束 08:53 抗生素給藥 09:11 手術開始 11:40 手術結束 11:40 麻醉結束 11:50 送出病患 11:55 進入恢復室 13:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 頭顱成形術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 記錄__ 手術科部: 外科部 套用罐頭: Cranioplasty 開立醫師: 鍾文桂 開立時間: 2010/06/03 11:59 Pre-operative Diagnosis 1. Right occipital ICH and IVH status post craniretomy Post-operative Diagnosis 1. Right occipital ICH and IVH status post craniretomy Operative Method Cranioplasty Specimen Count And Types nil Pathology Nil Operative Findings 1. A skull defect over right P-O area about 6x4 cm. 2. Intact dura mater. 3. Blood loss: 300cc. Operative Procedures 1.Under ETGA, the patient was placed in supine position and the head was tilted to the left side. 2. After shaving, disinfection, and well draping, the previous operative wound was incised. 3. By dissecting along the subgaleal space, the scalp was elevated from the dura mater. 4. Then,the gentamicin-rinsed autograft bone plate was placed on the bone defect and fixed with mini-plates and screws. 5. After placing a CWV drain, the wound was closed in layers. 6. The patient was sent to POR smoothly. Operators VS 賴達明 Assistants R4 鍾文桂,R1曾偉倫 吳連金 (F,1945/05/26,66y9m) 手術日期 2010/06/03 手術主治醫師 陳敞牧 手術區域 東址 005房 01號 診斷 Acoustic tumor 器械術式 retrosigmoid app for tumor remove 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 胡朝凱, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:05 進入手術室 08:10 麻醉開始 09:30 誘導結束 10:20 抗生素給藥 10:30 手術開始 13:30 抗生素給藥 15:00 麻醉結束 15:00 手術結束 15:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Retrosigmoid approach for Simpson grade I tum... 開立醫師: 胡朝凱 開立時間: 2010/06/03 15:36 Pre-operative Diagnosis Left CP angle tumor Post-operative Diagnosis Left CP angle tumor, suspect meningioma Operative Method Retrosigmoid approach for Simpson grade I tumor excision Specimen Count And Types pieces of tumor Pathology Pieces of tumor Operative Findings 1.One 3.5 cm whitish to yellowish elastic firm tumor attached to clival dura was noted at left CP angle area. 2.The tumor compressed the brain stem and Cranial nerves 7~10. but after operation, the nerves were all preserved. 3.The border of tumor was well defined Operative Procedures 1.ETGA, 3/4 prone with head fixed with skull clamp 2.Left post-auricular curve skin incision 3.Reflect skin flap anteriorly 4.Craniotomy after burr hole drill at Asterion 5.Curvature dural incision 6.Retract cerebellum downward 7.coagulate tumor surface 8.Central debulky 9.dissect tumor from brain and cranial nerves with dissector 10.Complete tumor excision 11.Hemostasis 12.Duroplasty with one piece of fascia 13.Fixed bone back with wires 14.Close wound in layers Operators 陳敞牧 Assistants 胡朝凱,Ri 甘秋雄 (M,1941/09/25,70y5m) 手術日期 2010/06/03 手術主治醫師 陳敞牧 手術區域 東址 003房 02號 診斷 Lumbar spondylosis 器械術式 sublaminar decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 11:30 報到 12:06 進入手術室 12:10 麻醉開始 12:30 誘導結束 13:00 抗生素給藥 13:13 手術開始 16:05 抗生素給藥 17:10 手術結束 17:10 麻醉結束 17:17 送出病患 17:20 進入恢復室 18:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術－腰椎 1 2 手術 椎弓整形術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: L4/5 right hemilaminectomy for bilateral subl... 開立醫師: 李建勳 開立時間: 2010/06/03 17:04 Pre-operative Diagnosis L4/5 HIVD with stenosis Post-operative Diagnosis L4/5 HIVD with stenosis Operative Method L4/5 right hemilaminectomy for bilateral sublaminal decompression Specimen Count And Types nil Pathology Nil Operative Findings Hypertrophic ligmentum flavum and HIVD with servere stenosis of L4/5. The theca sac was distended well and free of compression after disckectomy and removal of the ligmentum flavum. Operative Procedures Under general anesthesia and intubation, the patient was put in prone position. The L4/5 was located with portable c-arm X-ray. The skin was scrubbed, disinfected with alcohol better iodine then draped. The midline skin incision was made over L4-5 spinous processes and seperated the paraspinal muscle to expose the laminae. The right hemilaminectomy was performed with high speed air drill and Kerrison punches. The ligmentum flavum was removed by Kerrison punches. The disckectomy was started with No.15 surgical blade incision of the posterior longitudinal ligment and removal of the disc with aligator and disc clump. The L4 lamina was further dilled off to expose the left side ligmentum flavum. Removed the left side ligmentum flavum and performed disckectomy for further decompression. Hemostasis was achieved with Gelform packing of the epidural space and bipolar coagulation. The wound was then closed in layers after one minihemovac set up at wound. Operators VS 陳敞牧 Assistants R1 曾偉倫 R4 鍾文桂 R6 李建勳 相關圖片 黃道民 (M,1978/11/07,33y4m) 手術日期 2010/06/04 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 腦內出血 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 蔡宗良, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:05 進入手術室 08:10 麻醉開始 08:35 誘導結束 09:30 抗生素給藥 10:17 手術開始 12:30 抗生素給藥 15:30 抗生素給藥 16:00 麻醉結束 16:00 手術結束 16:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４～８小時 1 1 L 手術 腦室體外引流 1 2 L 手術 誘發電位手術監視機–腦神經外科術中特殊儀器使用費 1 0 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 8 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Interhemispheric transcallosal approach for r... 開立醫師: 蔡宗良 開立時間: 2010/06/04 17:21 Pre-operative Diagnosis Intraventricular tumor, left-sided Post-operative Diagnosis Suspect ependymoma or central neurocytoma, lateral ventricle Operative Method Interhemispheric transcallosal approach for removal of intraventricular tumor, lateral ventricle, left-sided Specimen Count And Types Two specimen from the tumor were collected and sent for frozen section and definite pathology Pathology Frozen section: suspect ependymoma or central neurocytoma, lateral ventricle Operative Findings 1. Dural sinus in the posterior frontal dura. 2. The tumor extended laterally and posteriorly in the left lateral ventricle. Tumor was soft in consistency, grey in color, cystic components and surface is irregular and poor margin 3. Old hematoma was found and removed. 4. Feeding vessel of the tumor (suspect posterior medial and lateral choroidal artery) was identified from the posterior medial side of the ventricle. Operative Procedures General anesthesia was applied under endotracheal intubation. SSEP was set. Mayfield head-clamp was applied with head 45 degrees facing to the left with 30 flexion. Partial bicoronal scalp incision. Craniotomy was made as depicted. Dura tenting was done at an interval of 1 cm. Microscope was brought into the surgical field. Dura open in inverted U shape, basing at frontal side of the craniotomy window. Entrance into the interhemispheric fissure is made. Brain retractor was used to retract the falx. CSF was released from opening of sulcal cistern and callosal cistern to allow relaxation of the brain. Soft cotton balls were placed at the anterior and posterior extent of the dissection to provide working space. Corpus callosum was identified with two pericallosal arteries lying above it. A callosotomy of approximately 1.2 cm was made. Tumor was enucleated and followed external ventricular drain was plced through the callosotomy into the lateral ventricle. Dura was closed by 4-0 Prolene. Skull was fixed back to the craniotomy window with miniplates. A CWV drain was placed at the epidural space. The wound was closed in layers. Operators VS 杜永光 Assistants CR 陳睿生, R4 蔡宗良 黃道民 (M,1978/11/07,33y4m) 手術日期 2010/06/04 手術主治醫師 杜永光 手術區域 東址 003房 02號 診斷 腦內出血 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 4E 紀錄醫師 王樹聲, 時間資訊 21:12 報到 21:12 進入手術室 21:15 麻醉開始 21:30 誘導結束 21:55 手術開始 00:10 抗生素給藥 02:40 麻醉結束 02:40 手術結束 02:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除－手術時間在４～８小時 1 2 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis Intraventricular tumor, left-sided Post-operative Diagnosis Suspect ependymoma or central neurocytoma, lateral ventricle Operative Method Interhemispheric transcallosal approach for removal of intraventricular tumor, lateral ventricle, left-sided Specimen Count And Types Two specimen from the tumor were collected and sent for frozen section and definite pathology Pathology Frozen section: suspect ependymoma or central neurocytoma, lateral ventricle Operative Findings 1. Dural sinus in the posterior frontal dura.2. The tumor extended laterally and posteriorly in the left lateral ventricle. Tumor was soft in consistency, grey in color, cystic components and surface is irregular and poor margin3. Old hematoma was founand removed.4. Feeding vessel of the tumor (suspect posterior medial and lateral choroidal artery) was identified from the posterior medial side of the ventricle./ Operative Procedures General anesthesia was applied under endotracheal intubation. SSEP was set. Mayfield head-clamp was applied with head 45 degrees facing to the left with 30 flexion. Partial bicoronal scalp incision. Craniotomy was made as depicted. Dura tenting wadone at an interval of 1 cm. Microscope was brought into the surgical field. Dura open in inverted U shape, basing at frontal side of the craniotomy window. Entrance into the interhemispheric fissure is made. Brain retractor was used to retract thealx. CSF was released from opening of sulcal cistern and callosal cistern to allow relaxation of the brain.Soft cotton balls were placed at the anterior and posterior extent of the dissection to provide working space. Corpus callosum was identified wh two pericallosal arteries lying above it. A callosotomy of approximately 1.2 cm was made. Tumor was enucleated and followed external ventricular drain was plced through the callosotomy into the lateral ventricle.Dura was closed by 4-0 Prolene. Skuwas fixed back to the craniotomy window with miniplates. A CWV drain was placed at the epidural space. The wound was closed in layers./ Operators VS 杜永光 Assistants CR 陳睿生, R4 蔡宗良 摘要__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 陳睿生 開立時間: 2010/06/05 03:28 Pre-operative Diagnosis Left lateral ventricle tumor with ICH, IVH and acute hydrocephalus Post-operative Diagnosis Left lateral ventricle tumor with ICH, IVH and acute hydrocephalus Operative Method Parietal craniotomy for tumor remove and hematoma evacuation Specimen Count And Types 1 piece About size:pieces Source:tumor Pathology Pending Operative Findings Tumor and hematoma were noted after parietal corticotomy. The tumor was soft, whitish, and well vascularized at the posterior portion, and some calcified spots were also noted. The anterior portion was grayish, and mild necrotic change. The tumor was tightly adhered with the choroid plexus, and was dissected intra-op. The initial ICP was about 15-20 cmH2O, and a EVD was inserted via the Frazier^s point. Operative Procedures After ETGA, the patient was under prone position, and head was fixed with Mayfield clump under mild flexion. Left parietal region linear scalp incision was made about 12cm. A craniotomy window was made about 10x6 cm. After proper dura tacking, the dura was opened toward the sinus. A tiny corticotomy was made at the left Frazier^s point. Nelaton tube was inserted into the lateral ventricle for decompression. Then the corticotomy was extended with a 10ml syrinage lumen. The CSF with old hematoma was drained out. The tumor was hemostated, and was removed piece by piece with electrocauterization and CUSA. The margin between the choroid plexus and the tumor was dissected. After nearly total removal of the tumor, hemostasis was done with surgicel. An EVD was inserted into the ventricle. The dura was tightly closed with fascia and Duragene graft. The skull graft was fixed back with miniplates x3 after central tacking. A subgaleal CWV was set, and the wound was closed in layers. Operators P 杜永光, VS 黃博浩 Assistants R5 陳睿生, R1 王樹聲 簡晉裕 (M,1947/12/15,64y2m) 手術日期 2010/06/04 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Pituitary Tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:01 進入手術室 08:10 麻醉開始 08:40 誘導結束 08:52 抗生素給藥 09:25 手術開始 10:29 麻醉結束 10:29 手術結束 10:35 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 經由蝶竇之腦下垂體瘤切除 1 1 記錄__ 手術科部: 外科部 套用罐頭: T.S.A 開立醫師: 許立民 開立時間: 2010/06/04 10:42 Pre-operative Diagnosis Pituitary macroadenoma Post-operative Diagnosis Pituitary macroadenoma Operative Method T.S.A Specimen Count And Types pieces of tumor Pathology pieces of tumor Operative Findings 1.One soft, yellowish to whitish tumor located in sella turcica 2.After tumor excision, arachnoid membrane exposed and intact Operative Procedures After ETGA, the patient was put in supine position with head mild left tilt. The nasal cavity was well-disinfective, and then we incised into the nasal septum. Dissection was performed along with the periosteum to expose sphenoid sinus anterior wall and sphenoid ostia. After fracture of vomer, sphenoid sinus anterior wall was also fractured. The mucosa was removed. The sella floor was exposed and removed with kerrison. After cruciate form incision, tumor buldged out. And it was further removed with tumor forceps and ring currette. After total excision of tumor was made, the bony graft was put back and followed by compaction of merosel. Operators 曾漢民 Assistants 胡朝凱,游健生 高俊雄 (M,1941/10/01,70y5m) 手術日期 2010/06/04 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 10:30 報到 10:45 進入手術室 10:50 麻醉開始 11:30 誘導結束 11:55 抗生素給藥 12:03 手術開始 14:10 麻醉結束 14:10 手術結束 14:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４小時以內 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Craniotomy for Simpson grade I tumor excision 開立醫師: 胡朝凱 開立時間: 2010/06/04 14:24 Pre-operative Diagnosis Occipital falx meningioma Post-operative Diagnosis Occipital falx meningioma Operative Method Craniotomy for Simpson grade I tumor excision Specimen Count And Types pieces of tumor Pathology pending Operative Findings The tumor was hyperechoic on sonography. It was well defined and was hypervascular, measuring 3 cm. It was totally excised under microscopy. The tumor extended beyong falx to right side and was also excised. The margin was clear. Operative Procedures Under ETGA, patient was put in prone position with head fixed with Mayfield skull clamp. U shape skin incision was done at left occipital area. Skin flap was dissected and opened. After four burr holes drilled, craniotomy was performed as a 7x7 bone window one cm away from midline, followed by dural tenting. U shape dural incision was made with the base left at midline. The tumor was excised by gently dissection through the interface between tumor and brain tissue. Vascular perforation was cauterized. Hemostasis was then performed. After then, dura was closed with prolene. After one CWV drain insertion, wound was closed in layers. Operators 曾漢民 Assistants 胡朝凱, 游健生 邱淑琴 (F,1962/04/28,49y10m) 手術日期 2010/06/04 手術主治醫師 曾漢民 手術區域 東址 005房 03號 診斷 Meningioma 器械術式 SUBFRONTAL APPROACH FOR TUMOR REMOVE 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 13:50 報到 14:27 進入手術室 14:30 麻醉開始 14:55 誘導結束 15:15 抗生素給藥 15:25 手術開始 17:15 麻醉結束 17:15 手術結束 17:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４小時以內 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 記錄__ 手術科部: 外科部 套用罐頭: Subfrontal Simpson Grade I tumor excision 開立醫師: 胡朝凱 開立時間: 2010/06/04 17:35 Pre-operative Diagnosis tuberculum sella MENINGIOMA Post-operative Diagnosis tuberculum sella MENINGIOMA Operative Method Subfrontal Simpson Grade I tumor excision Subfrontal Simpson Grade II tumor excision Specimen Count And Types tumor Pathology pending Operative Findings 1.One reddish elastic tumor located at tuberculum sella measured as 1 cm that compressed the optic nerve 2.The tumor margin was clear. After tumor excision, stalk was noted Operative Procedures 1.ETGA, supine with head fixed with skull clamp 2.Right curvature skin incision 3.Reflect skin flap downward 4.Craniotomy after key hole burr hole drill 5.Dural tenting 6.Open dura 7.Subfrontal brain retraction 8.Devascularization 9.Dissect tumor border 10.En-bloc tumor excision 11.Hemostasis 12.Close dura 13.Fix bone back 14.Set one CWV drain then close wound in layers Operators 曾漢民 Assistants 胡朝凱,游健生 周裕欽 (M,1970/12/14,41y3m) 手術日期 2010/06/04 手術主治醫師 謝孟祥 手術區域 東址 001房 02號 診斷 Cerebral palsy 器械術式 Pressure sore Debridment 手術類別 預定手術 手術部位 四肢 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 3 紀錄醫師 陳建璋, 時間資訊 10:45 報到 11:10 進入手術室 11:20 麻醉開始 11:25 誘導結束 11:35 抗生素給藥 11:38 手術開始 12:10 手術結束 12:10 麻醉結束 12:20 送出病患 12:25 進入恢復室 14:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 深部複雜創傷處理－傷口長５－１０公分者 1 0 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: debridement and wound repair 開立醫師: 陳建璋 開立時間: 2010/06/04 12:29 Pre-operative Diagnosis pressure sore over the left hip Post-operative Diagnosis pressure sore over the left hip Operative Method debridement and wound repair Specimen Count And Types nil Pathology nil Operative Findings One 3cm in diameter chronic wound with 5cm subcutaneous pocket and moderate amount of necrotic tissue over the lateral side of the left hip was noted. No pus and no abscess was detected. Operative Procedures Under LMA general anesthesia, the patient wans put in the supine position. The operative field was disinfected and draped as usual. Incision along the wound margin was made. We dissected and removed the entire capsule with coating of normal tissue. After careful hemostasis and irrigation with large amount of normal saline, local flap was elevated and the aound was closed in layers. Operators 謝孟祥 Assistants 陳建璋 邵國平 (M,1953/08/03,58y7m) 手術日期 2010/06/04 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Cervical spondylosis 器械術式 FORAMINOTOMY 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 黃世銘, 時間資訊 00:00 臨時手術NPO 07:55 報到 08:07 進入手術室 08:15 麻醉開始 08:25 誘導結束 09:00 抗生素給藥 09:18 手術開始 12:00 抗生素給藥 12:10 手術結束 12:10 麻醉結束 12:20 送出病患 12:20 進入恢復室 13:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 手術 椎間盤切除術－頸椎 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Anterior approach for foraminotomy, C5-6 &C6-7; 開立醫師: 陳德福 開立時間: 2010/06/04 12:31 Pre-operative Diagnosis Cervical spondylosis status post anterior microdisectomy C5-6-7 with interbody fusion(Zebra plate 42mm and screws 21mm x6 fixation Post-operative Diagnosis ditto Operative Method Anterior approach for foraminotomy, C5-6 &C6-7; Specimen Count And Types nil Pathology Nil Operative Findings 1.There is hypertrophic osteophytes at the nerve foramen of right C5-6 and C6-7 space with nerve root compression. 2.The nerve roots was decompressed after the formanimotomy. Operative Procedures 1. Anesthesia: endotracheal general 2. Position: supine with neck hyperextended by a air cuff placed beneath the shoulder. 3. Skin preparation: the anterior neck was rubbed with povidone-iodinew detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4.Incision: From previous surgical scar, 5 cm, transverse middle cervical 5. The plastisma muscle was transected and mobilized from the underlying superficial cervical fascia which was then opened in vertical direction along the anterior margin of the SCM muscle. 6.The dissection was advanced at the loose plane between SCM muscle and strip muscles until the Zebra plate had been seen. The former structure was retracted to the lateral and the later structures with esophagus and trachea to the opposite side by Cloward cervical retractor. 7.The most medial portion of the longus coli muscles on right side were detached from the vertebral bodies to providea wider exposure of the vertebral bodies. 9.The right C5-6 and C6-7 osteophytes were removed by drills and the nerve roots were decompressed. 10.Wound closure: continuous suture with 3/0 Dexon for plastisma and continuous suture with 4/0 nylon on the skin. 11.Drain:one 12.Blood transfusion:nil 13.Course of the surgery: smooth. Operators VS 賴達明 Assistants r4 陳德福 r1 黃世銘 相關圖片 楊美容 (F,1940/02/22,72y0m) 手術日期 2010/06/04 手術主治醫師 賴達明 手術區域 東址 019房 02號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(Others) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 黃世銘, 時間資訊 00:00 臨時手術NPO 12:05 報到 12:30 進入手術室 12:35 麻醉開始 12:55 誘導結束 13:20 抗生素給藥 13:46 手術開始 16:20 抗生素給藥 19:55 麻醉結束 19:55 手術結束 20:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 7 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 顱底瘤手術 1 1 L 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 L 摘要__ 手術科部: 外科部 套用罐頭: left Ptrional approach with Simpson grage III... 開立醫師: 陳德福 開立時間: 2010/06/04 20:37 Pre-operative Diagnosis Left brain tumor, inner third sphenoid ridge, suspected meningioma Post-operative Diagnosis Left brain tumor, inner third sphenoid ridge, suspected meningioma Operative Method left Ptrional approach with Simpson grage III tumor excision Specimen Count And Types 1 piece Source:Left brain tumor, inner third sphenoid ridge Pathology Pending Operative Findings 1.The is a 3.5 cm in sized well capsulated, dura base, hypervascularized, elastic, yellowish-greyish and multi-lobulated tumor arising from the left inner third sphenoid ridge. 2.The tumor extends into sellar cavity, infratentorium and the peripeduncular cistern with compression to the left optic nerve and oculomotor nerve. The ICA and its branches were encased by the tumor and after the nearly total tumor removal, the vasculature was well preserved. 3.The patient has left pupil dilatation to 3mm while the right pupil size was 2mm. Operative Procedures Under ETGA and supine position with pin type Mayfield head fixator fixation, the scalp was disinfected and draped as usual. One curvilinear incision over the left scalp was made and we performed pterional approach with a 8*10cm in sized caniotomy. The dura tenting was done and we dilled off the out part of the sphenoid ridge to make it flat. The dura was opened in fish mouth fasion and the left sylvian fissure was opened. The tumor came into view while we retract the brain with brain retractor. We open the arachonoid membrane nearby the optic nerve with CSF drainage. The dura base attachment was devascularized and we identify the tumor margin with retractor assisted. The tumr then was removed with CUSA, bipolar and tumor forceps in central debulking method. The anterior and posterior margin of the tumor was identified and we detached the tumor. The small part of the tumor extends into the left sellar cavity and infratentorium were removed as much as possible. While the normal ICA with perforators, ACA, MCA, optic nerve and oculomotor nerve were clearly seem, we closed the dura in water right fasion. The skull was fixed with miniplates and one subgaleal CWV was left in situ. The wound was closed in layers. Operators VS賴達明 Assistants r4 陳德福 r1 黃世銘 簡豪逸 (M,1972/07/02,39y8m) 手術日期 2010/06/04 手術主治醫師 蕭輔仁 手術區域 東址 005房 04號 診斷 Skin tumor 器械術式 scalp tumor remove 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 李建勳, 時間資訊 00:00 臨時手術NPO 18:53 報到 18:55 進入手術室 19:05 抗生素給藥 19:18 麻醉開始 19:19 麻醉結束 19:20 手術開始 19:50 手術結束 20:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 頭皮腫瘤 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Scalp tumor excision 開立醫師: 李建勳 開立時間: 2010/06/04 20:01 Pre-operative Diagnosis Left occipital scalp tumor Post-operative Diagnosis Left occipital scalp tumor Operative Method Scalp tumor excision Specimen Count And Types 1 piece About size:0.5g Source:scalp tumor Pathology Pending Operative Findings One elastic, whitish tumor size 0.5cmX0.5cmX1cm, located at left occipital area. Operative Procedures Scalp shaving, disinfected with alcohol better-iodine then draped. Scalp incision over the tumor. Tumor excision after dissection. Hemostasis and closed the wound in layers. Operators VS 蕭輔仁 Assistants R6 李建勳 相關圖片 李銘偉 (M,1982/11/12,29y4m) 手術日期 2010/06/04 手術主治醫師 黃培銘 手術區域 東址 057房 02號 診斷 Subdural hemorrhage following injury, with loss of consciousness of unspecified duration 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 4 紀錄醫師 林孟暐, 時間資訊 10:10 報到 10:10 進入手術室 10:15 麻醉開始 10:20 誘導結束 10:25 手術開始 10:35 麻醉結束 10:35 手術結束 10:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 氣管切開造口術 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 內科部 套用罐頭: tracheostomy revision 開立醫師: 林孟暐 開立時間: 2010/06/04 10:52 Pre-operative Diagnosis respiratory failure, status post tracheostomy, with stoma bleeding and reintubation Post-operative Diagnosis respiratory failure, status post tracheostomy, with stoma bleeding and reintubation Operative Method tracheostomy revision Specimen Count And Types nil Pathology nil Operative Findings some easily touch-bleeding granulation tissue was noted at previous stoma site Operative Procedures 1. ETGA, supine 2. skin disinfecion 3. hemostasis at previous stoma site 4. Fr. 8.0 tracheostomy tube was inserted via previous stoma Operators VS 黃培銘 Assistants R5 林孟暐 劉聖芬 (F,1964/10/07,47y5m) 手術日期 2010/06/05 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Hemangioma of intracranial structures 器械術式 craniotomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 黃世銘, 時間資訊 00:00 臨時手術NPO 08:10 進入手術室 08:15 麻醉開始 08:40 誘導結束 08:40 抗生素給藥 09:42 手術開始 11:50 手術結束 11:50 麻醉結束 12:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 開顱術摘除血管病變－動靜脈畸型－小型－表淺 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Right frontal craniotomy tumor excision 開立醫師: 陳盈志 開立時間: 2010/06/05 12:18 Pre-operative Diagnosis Right frontal cavernoma Post-operative Diagnosis Right frontal cavernoma Operative Method Right frontal craniotomy tumor excision Specimen Count And Types 1 piece About size:small piece 0.5cm Source:right frontal cavernoma Pathology pending Operative Findings The lesion was found near premotor cortex (after mapping)and perifocal hemosiderin change was noted. Cavernoma was suspected and multiple small vessel was noted. Operative Procedures 1.ETGA, supine with neck flexion 2.Skin preparation 3.Right frontal C shape scalp incision 4.Burr hole x 4 then craniotomy 5.Dura tenting then U shape dura opening 6.Mapping to identify motor cortex. transsulci approach 7.dissect along its border circumferentially and then remove the tumor totally 8.Hemostasis with bipolar and surgicel packing 9.Dura closure and fix bone with miniplate 10.close wound in layers Operators VS曾漢民 Assistants R6陳盈志R1黃世銘 邱李嘉代 (F,1944/12/18,67y2m) 手術日期 2010/06/05 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Acromegaly 器械術式 TSH 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 黃世銘, 時間資訊 00:00 臨時手術NPO 11:10 報到 12:30 進入手術室 12:35 麻醉開始 12:50 誘導結束 13:00 抗生素給藥 13:15 手術開始 14:40 麻醉結束 14:40 手術結束 14:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 經由蝶竇之腦下垂體瘤切除 1 1 摘要__ 手術科部: 外科部 套用罐頭: transsphenoid adenomectomy 開立醫師: 陳盈志 開立時間: 2010/06/05 15:00 Pre-operative Diagnosis pituitary tumor Post-operative Diagnosis pituitary tumor Operative Method transsphenoid adenomectomy Specimen Count And Types 1 piece About size:multiple small fragments Source:pituitary tumor Pathology pending Operative Findings The tumor was yellowish in character. The central part of tumor was fragile, but the margin was elstic and adhere to arachnoid membrane tightly. CSF leak was noted during manipulation, which was repaired with gelform and tissue codul. Operative Procedures After ETGA, the patient was put in supine position with head mild left tilt. The nasal cavity was well-disinfective, and then we incised into the nasal septum. Dissection was performed along with the periosteum to expose sphenoid sinus anterior wall and sphenoid ostia. After fracture of vomer, sphenoid sinus anterior wall was also fractured. The mucosa was removed. The sella floor was exposed and removed with kerrison. After cruciate form incision, tumor buldged out. And it was further removed with tumor forceps and ring currette. During operation, CSF leak was noted, but it was stopped by gelfoam packing and tissu codul. After total excision of tumor was made, the bony graft was put back and followed by compaction of merosel. Operators VS曾漢民 Assistants R6陳盈志R1黃世銘 張翊 (M,1918/10/08,93y5m) 手術日期 2010/06/05 手術主治醫師 陳敞牧 手術區域 東址 003房 號 診斷 Subdural hematoma 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3E 紀錄醫師 鍾文桂, 時間資訊 12:00 臨時手術NPO 12:00 開始NPO 19:50 報到 20:04 進入手術室 20:10 麻醉開始 20:20 誘導結束 20:50 抗生素給藥 21:11 手術開始 22:35 手術結束 22:35 麻醉結束 22:47 進入恢復室 23:45 離開恢復室 22:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 記錄__ 手術科部: 外科部 套用罐頭: Burr hole for evacuation of chronic subdural ... 開立醫師: 鍾文桂 開立時間: 2010/06/05 23:12 Pre-operative Diagnosis Right frontal-parietal-temporal chronic subdural hemorrhage. Post-operative Diagnosis Right frontal-parietal-temporal chronic subdural hemorrhage. Operative Method Burr hole for evacuation of chronic subdural hemorrhage. Specimen Count And Types nil Pathology Nil. Operative Findings Dark liquified subdural hemorrhage drained out from the burr hole. Mild brain expansion. Easy ozzing, Blood loss: 20 cc. Operative Procedures Under ETGA, the patient was placed in supine position, and the head was placed in the midline. After shaving, disinfection, and draping, a linear 3 cm incision was made at right frontal area. A burr hole was made with high speed drill. After dural tenting and durotomy, dark liquified hematoma drained out. After normal saline irrigation with more clear subdural fluid, the wound was closed in layers and a rubber drain was placed in subdural space. Air evacuation was achieved with normal saline irrigation through the subdural drain. Until the subdural drain was clear and most of the air had been evacuated, a closed drainage system was set. Finally the patient was sent to POR smoothly. Operators V.S. 陳敞牧 Assistants R4 鍾文桂 Indication Of Emergent Operation 相關圖片 陳國松 (M,1941/03/12,71y0m) 手術日期 2010/06/05 手術主治醫師 蔡翊新 手術區域 東址 002房 01號 診斷 Subdural hemorrhage 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 4E 紀錄醫師 王樹聲, 時間資訊 04:41 通知急診手術 04:48 開始NPO 05:30 進入手術室 05:30 報到 05:35 麻醉開始 05:45 誘導結束 06:00 抗生素給藥 06:10 手術開始 07:17 開始輸血 09:00 抗生素給藥 09:45 麻醉結束 09:45 手術結束 09:47 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 手術 腦內血腫清除術 1 1 手術 顱內壓監視置入 1 2 摘要__ 手術科部: 外科部 套用罐頭: 1.ICH and SDH evacuation 2.Craniectomty with ... 開立醫師: 陳德福 開立時間: 2010/06/05 10:22 Pre-operative Diagnosis traumatic left skull frature with SDH, ICH and SAH Post-operative Diagnosis ditto Operative Method 1.ICH and SDH evacuation 2.Craniectomty with duroplasty 3.ICP monitoring Specimen Count And Types 1 piece About size:12*10CM Source:left skull bone Pathology nil Operative Findings 1.There is a linear skull fracture with massive subgaleal hematoma noticed from left parietal to the key hole. 2.The SDH was about 2cm in thickness and the brain was compressed tightly. 3.Contussion ICH over left parietal lobe and frontal lobe was noticed and the frontal lobe was partially removed. There is blood oozing from the interhemispheric area and skull base. 4.Duroplasty was done with autologous muscle fascia and Durafoam. 5.The brain remained swelling after the procedure and the ICP at the end of skin closure is around 18mmHg. 6.Pre-OP pupils R/L: 2.5/2.0mm and post OP pupils R/L: 2.0/2.0 Operative Procedures Under ETGA and supine position, the scalp was disinfected and draped as usual. One traumatic flap was done over the left scalp. The craniectomy was performed for decompressing the temporal area. Dura tenting was done and the dura opened in C shaped after the muscle fascia was harvested. The left temporalis muscle was removed. We evacuated the SDH and ICH . After hemostasis, the duroplasty was done and we insert one subdural ICP monitor wire. 2 CWV was left in the epidural space and the wound was closed in layers. Operators VS 王國川 Assistants r4 陳德福 r1 王樹聲 Indication Of Emergent Operation 莊永川 (M,1934/07/01,77y8m) 手術日期 2010/06/07 手術主治醫師 陳偉勵 手術區域 東址 011房 02號 診斷 Cataract 器械術式 Phaco+PCIOL 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 10:48 進入手術室 10:49 麻醉開始 10:50 誘導結束 11:10 手術開始 11:45 手術結束 11:50 送出病患 記錄__ 手術科部: 眼科部 套用罐頭: Phaco-Temporal (陳偉勵) 開立醫師: 黃宇軒 開立時間: 2010/06/07 08:37 Pre-operative Diagnosis Cataract (os) Post-operative Diagnosis Cataract (os) Operative Method Phacoemulsification and PCIOL implantation (os) Specimen Count And Types nil Pathology Nil Operative Findings Cataract (os) Operative Procedures 1. Under topical anesthesia 2. Disinfection, irrigation and draping. 3. Application of an eyelid speculum. 4. Made a clear corneal incision and penetrate into AC with 2.5mm cresent knife at 2 oclock position . 5. InjectViscoat into the anterior chamber. 6. Continuous circular capsulorrhexis was done with capsular forceps. 7. Made a sideport at 5 oclock position with the MVR blade. 8. Hydrodissection and hydrodelineation were done with BSS. 9. Phacoemulsification of the nucleus by standard divide-and-conquer technique. 10. Aspiration of the residual cortical material with I/A cannula. 11. One-piece PCIOL was implanted into the bag after injection of Viscoat. 12. The residual Viscoatwas washed out by I/A cannula. 13. Inject BSS into AC and check leakage. 14. Subconjunctival injection of Rinderon and Gentamicin. 15. Maxitrol patching. Operators VS陳偉勵 Assistants R4朱筱桑, R3黃宇軒 廖建義 (M,1954/06/22,57y8m) 手術日期 2010/06/07 手術主治醫師 杜永光 手術區域 東址 003房 號 診斷 Brain Tumor 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 蔡宗良, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:06 進入手術室 08:15 麻醉開始 08:40 誘導結束 09:30 抗生素給藥 09:58 手術開始 12:48 抗生素給藥 15:55 抗生素給藥 17:20 麻醉結束 17:20 手術結束 17:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 10 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 顱底瘤手術 1 1 B 摘要__ 手術科部: 外科部 套用罐頭: Right subfrontal approach for Simpson grade I... 開立醫師: 陳睿生 開立時間: 2010/06/07 17:51 Pre-operative Diagnosis Olfactory groove meningioma Post-operative Diagnosis Olfactory groove meningioma Operative Method Right subfrontal approach for Simpson grade II tumor excision Specimen Count And Types 1 piece About size:大 Source:Brain Pathology Pending Operative Findings The tumor is whitish-yellowish, elastic-firm, size 7x6x5cm, attached to the falx with extension to left frontal area. The fronal lobe was compressed upward, and a thin layer was covered in front of the tumor. The vascular supply of the tumor comes from anterior branch of MMA, falx base, and ethmoidal arteries of the olfactory groove. Another deep feeding artery was noted from the ACAs and was ligated intra-op. The tumor was noted to extend into bilateral optic canal, and more severe at left side. The left side optic nerve was compressed tightly. The tumor bed at the olfactory groove and planum sphenoidale were curetted with CUSA. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position with head fixed with Mayfield skull clump. The scalp was shaved, scrubbed, disinfected with alcohol better-iodine then draped. The bicoronal scalp incision was made followed by right frontal craniotomy with left side estension, and surpassing the superior saggital sinus. The dura was opened in a inverted U shape basing on the superior sagittal sinus. The surface of the tumor was devascularized by bipolar cautery. Multiple wedge shape resection was done with the aid of CUSA. Cotton pads were used to separate the surrounding normal brain tissue from the brain tumor. The tumor was detached from the olfactory groove, planum sphenoidale, and prechiasmatic cistern, decompressing the right-sided optic nerve. The midline attachment was dissected under the surgicel microscope assistance. The duroplasty was performed with 4-0 Prolene sutures and periostium. The skull plate was fixed back with miniplates and screws after one epidural CWV drain set up. The wound was then closed in layers. Operators P 杜永光 Assistants R5 陳睿生, R4 蔡宗良 施張阿月 (F,1936/08/18,75y6m) 手術日期 2010/06/07 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Lumbar Spondylosis 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 08:01 進入手術室 08:05 麻醉開始 08:15 誘導結束 09:00 抗生素給藥 09:13 手術開始 10:35 手術結束 10:35 麻醉結束 10:45 送出病患 10:48 進入恢復室 12:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術－腰椎 1 1 B 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 外科部 套用罐頭: L4-5 sublaminar decompression and right foram... 開立醫師: 游健生 開立時間: 2010/06/07 10:43 Pre-operative Diagnosis L4-5 spondylosis Post-operative Diagnosis L4-5 spondylosis Operative Method L4-5 sublaminar decompression and right foraminotomy Specimen Count And Types nil Pathology Nil Operative Findings L4-5 hypertrophic ligamentum flavum. The dural sac was well decompressed after the procedure. L5 nerve roots were visualized, well preserved, and decompressed. Operative Procedures 1. Under ETGA, patient was put into prone position 2. Disinfection and draping as usual after locating L4-5 intervertebral disc space by C-arm 3. Midline incision over L4-5 level 4. Detached right para-spinal muscle and exposed right L4 lamina 5. Performed L4 right laminotomy by drilling 6. Removed ligamentum flavum 7. Performed foraminotomy, right L4-5 intervertebral foramen 8. Closed wound in layers Operators VS 曾漢民 Assistants R5 胡朝凱 R2 游健生 鄧文榮 (M,1969/08/18,42y6m) 手術日期 2010/06/07 手術主治醫師 柯政郁 手術區域 西址 033房 10號 診斷 Neck mass 器械術式 Benign neck mass excision (sim 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 15:50 報到 16:00 進入手術室 16:08 麻醉開始 16:10 手術開始 16:45 麻醉結束 16:45 手術結束 16:50 送出病患 記錄__ 手術科部: 耳鼻喉部 套用罐頭: Incisional biopsy of neck mass, right 開立醫師: 林彥翰 開立時間: 2010/06/07 16:03 Pre-operative Diagnosis Neck mass, right Post-operative Diagnosis Neck mass, right ,operated Operative Method Incisional biopsy of neck mass, right Specimen Count And Types x1, neck mass, right, 1x1x1 cm in size Pathology x1, neck mass, right, 1x1x1 cm in size. Operative Findings Right neck mass,firm and fixed, 8x10 cm in size, s/p incisional biopsy Operative Procedures 1.The patient was in supine position with neck hyperextended and turned to the left side. 2.Skin was disinfected and draped as usual. 3.Local anesthesia with Bosmin-rinsed Xylocaine was injected into the subcutaneous tissue around the neck mass after marking. 4.A 1 cm horizontal incision parallel to the skin crease was made. 5.The subcutaneous tissue was cut through. 6.One 10 x 8 cm right neck mass was found s/p incisional biopsy. 7.The specimen was sent to pathology. 8.After hemostasis, the wound was closed and the patient tolerated the procedure well. Operators P 柯政郁 Assistants R2 林彥翰/ R3 李亭逸 嚴蓬萊 (M,1936/01/23,76y1m) 手術日期 2010/06/07 手術主治醫師 蕭輔仁 手術區域 東址 019房 03號 診斷 Lung tumor 器械術式 Spinal fusion posterior 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3E 紀錄醫師 陳柏達, 時間資訊 11:17 開始NPO 11:17 臨時手術NPO 15:17 通知急診手術 21:30 報到 21:40 進入手術室 21:45 麻醉開始 21:50 誘導結束 22:35 抗生素給藥 22:35 手術開始 00:15 開始輸血 01:45 抗生素給藥 03:35 麻醉結束 03:35 手術結束 03:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 惡性病髓腫瘤切除術 1 1 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: T7-9 laminectomy tumor excision and TPS T5,6,9,10 開立醫師: 陳盈志 開立時間: 2010/06/08 03:57 Pre-operative Diagnosis T7,8 metastatic tumor Post-operative Diagnosis T7,8 metastatic tumor Operative Method T7-9 laminectomy tumor excision and TPS T5,6,9,10 Specimen Count And Types 1 piece About size:multiple fragments Source:T7,8 metastatic tumor Pathology pending Operative Findings The tumor was whitish elastic in character. It involve T8 lamina pedicle and bitateral costcotransverse junction and body. Vascularity was moderate to high.TPS 5.5x35mm x 3; 6.0x40mm x 5 crosslink x 1 Operative Procedures 1.ETGA, prone 2.Skin preparation C-arm localize 3.Midline back incision, detach paraspinal muscle expose Lamina T5/6,9,10 4.Laminectomy T7-9 then tumor excision with curretage and tumor forceps along the bone edge. 5.Hemostasis gelform packing 6.TPS on T5,6,9,10 confirm by C-arm 7.H-V x 1 then close wound in layers Operators VS蕭輔仁 Assistants R6陳盈志R2陳柏達 Indication Of Emergent Operation 陳國松 (M,1941/03/12,71y0m) 手術日期 2010/06/07 手術主治醫師 王國川 手術區域 東址 018房 03號 診斷 Subdural hemorrhage 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 4E 紀錄醫師 李振豪, 時間資訊 20:48 通知急診手術 21:09 進入手術室 21:12 麻醉開始 21:45 手術開始 22:20 誘導結束 22:25 開始輸血 22:45 送出病患 22:45 麻醉結束 22:45 手術結束 醫令資訊 類別 名稱 量 刀 側 手術 急性硬腦膜下血腫清除術 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Epidural and subdural hematoma evacuation 開立醫師: 李振豪 開立時間: 2010/06/07 23:11 Pre-operative Diagnosis Left fronto-temporo-parietal epidural and subdural hematoma Post-operative Diagnosis Left fronto-temporo-parietal epidural and subdural hematoma + duroplasty Left fronto-temporo-parietal epidural and subdural hematoma Operative Method Epidural and subdural hematoma evacuation Epidural and subdural hematoma evacuation + duroplasty Specimen Count And Types Nil Pathology Nil Operative Findings About 60ml epidural hematoma and 20ml subdural hematoma was evacuated. No active bleeder was noted during the operation. The brain was not severe swelling after hematoma evacuation. Duroplasty with 2x2cm Duraform was done after evacuation of subdrual hematoma. ICP was 4~5mmHg after scalp closure. Operative Procedures Under endotracheal tube general anesthesia, the patient was put at supine position with head rotated to right. The previous CWV drains were removed. The scalp was scrubbed and previous stitches were removed. The scalp was disinfected and draped as usual. The skin incision was made alon previous wound and the scalp flap was elevated. The epidural hematoma was removed. The dura was opened with cruciform. The subdural hematoma was evacuated and duroplasty with 2x2cm Duraform was used. Hemostasis was achieved and the wound was irrigated with Gentamicin solution. Two subgaleal CWV drain was placed and the wound was closed in layers. Operators VS王國川 Assistants R3李振豪 Indication Of Emergent Operation 相關圖片 馮元 (M,2001/05/11,10y10m) 手術日期 2010/06/08 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Brain tumor 器械術式 Crainotomy Brain Tumor(P-LIN) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 曾峰毅, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:19 進入手術室 08:30 麻醉開始 08:50 誘導結束 09:45 抗生素給藥 09:55 手術開始 12:42 抗生素給藥 15:05 開始輸血 15:41 抗生素給藥 17:15 麻醉結束 17:15 手術結束 17:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 超音波診查機–腦神經外科術中特殊儀器使用費 1 0 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 手術 慢性硬腦膜下血腫清除術 1 2 L 手術 顱底瘤手術 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 10 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 3 0 麻醉 Hemoglobin (Hb) 3 0 麻醉 測血糖 3 0 麻醉 Ca (Calcium) 3 0 麻醉 Na (Sodium) 3 0 麻醉 K (Potassium) 3 0 麻醉 Cl (Chloride) 3 0 麻醉 Blood gas analysis 3 0 記錄__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT 開立醫師: 曾峰毅 開立時間: 2010/06/08 17:47 Pre-operative Diagnosis Pineal region tumor with obstructive hydrocephalus, status post ventriculoperitoneal shunt insertion at right, complicated with shunt overdrainagae and left chronic subdural hematoma Pineal region tumor with obstructive hydrocephalus, status post ventriculoperitoneal shunt insertion at right, complicated with shunt overdrainage and left chronic subdural hematoma Post-operative Diagnosis Pineal region tumor with obstructive hydrocephalus, status post ventriculoperitoneal shunt insertion at right, complicated with shunt overdrainagae and left chronic subdural hematoma Pineal region tumor with obstructive hydrocephalus, status post ventriculoperitoneal shunt insertion at right, complicated with shunt overdrainage and left chronic subdural hematoma Operative Method 1. Left parietal burr hole for subdural drianage. 2. Suboccpital craniotomy, infratentorial supracerebellar approach for tumor excision. 3. Cyst drainage by trans-cerebellar puncture 1. Left parietal burr hole for subdural drianage. 2. Suboccpital craniotomy, infratentorial supracerebellar approach for tumor excision. 3. Echo-guide cyst drainage by trans-cerebellar puncture Specimen Count And Types Several fragments of tumor was sent for pathology. Sudural effusion was sent for cytology. CSF sampled and cyst part of tumor was sent for tumor markers, cytology, and biocehmistry study. Pathology Frozen biopsy: no neoplasm identified Frozen biopsy: fibromyxoid tissue Operative Findings Chronic subdural hematoma with inner and outer membrane was noted at left fronto-pairetal junction. One capsuled, heterogenous-contained, elastic, pinkish, normo to hypervascular tumor was noted at pineal region with extension to left thalamus. Partial tumor excision was done. Cyst part of the tumor was drained, and the character of fluid was clear and yellowish. Operation course was smooth, and blood loss was about 250ml. 1. Chronic subdural hematoma with inner and outer membrane was noted at left fronto-pairetal junction. 2. One encapsuled, multiple cystic and solid (heterogenous-contained), elastic, pinkish, normo- to hypervascular tumor was noted at pineal region with extension to left thalamus and fourth ventricle. Partial tumor excision was done. A huge cyst measuring about 3X3 cm in diameter was noted over the right ceregellar hemisphere. The cystic tumor was drained with echo-guide puncture. Its capsule was very thick that it needed a sharp needle to get punctured throuhg, and the character of fluid was clear and yellowish. Operation course was smooth, and blood loss was about 250ml. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position with neck flexed and head fixed with Mayfield head clamp. We shaved, scrubbed, disinfected, and then draped the scalp, and made one linear skin incision at left fronto-parietal area. With endotracheal general anaesthesia, the patient was put in prone position with neck flexed and head fixed with Mayfield head clamp. We shaved, scrubbed, disinfected, and then draped the scalp, and made one linear skin incision at left fronto-parietal area. We drilled one burr hole and then inserted one subdural CWV for drainage. We closed the wound in layers. We drilled one burr hole and then inserted one subdural CWV for drainage after dural tenting. We closed the wound in layers. We made one midline linear skin incision at occipital area, and applied the Raney clips to sclap incision. We drilled four burr holes, and then created suboccipital craniotomy with Karrisons and saw. Y-shape dura incision was made after epidural and sinus bleeding was stopped. We retrated tentorium upward, and got the access to tumor via the infratentorial supracerebellar approach. Tumor excision was done in piecemeal fashion. We made one midline linear skin incision at occipital area, and applied the Raney clips to sclap incision. We drilled four burr holes, and then created suboccipital craniotomy with Karrisons and saw. Y-shape dura incision was made after epidural and sinus bleeding was stopped. We reflected the dural falp and retracted tentorium upward, and got the access to tumor via the infratentorial supracerebellar approach. Tumor excision was done in piecemeal fashion. The tumor was elastic, cutting with microscissors following bipolar coagulation were undertaken. Forzen section was sent, but only fibromyxoid tissue was noted. We kept on removing the tumor till vein of Galen and one cm before the tentorial edge were reached. We then removed the tumor downward toward the fourth ventricular part. We made one midline linear skin incision at occipital area, and applied the Raney clips to sclap incision. We drilled four burr holes, and then created suboccipital craniotomy with Karrisons and saw. Y-shape dura incision was made after epidural and sinus bleeding was stopped. Under microscopic aid, we reflected the dural falp and retracted tentorium upward, and got the access to tumor via the infratentorial supracerebellar approach. Tumor excision was done in piecemeal fashion. The tumor was elastic, cutting with microscissors following bipolar coagulation were undertaken. Forzen section was sent, but only fibromyxoid tissue was noted. We kept on removing the tumor till vein of Galen and one cm before the tentorial edge were reached. We then removed the tumor downward toward the fourth ventricular part. We puncutured the cystic part of the tumor via right cerebellar with sonography guide. Hemostasis was done, and water-tight suture was done for dura closure with autologous fascia graft and Tissucol-Duo. Bone graft was fixed back with mini-plates. After setting one subgaleal CWV, achieving hemostasis, and removing Raney clips, we closed the wound in layers. We puncutured the cystic part of the tumor located over the right cerebellar hemisphere with 18 gauge needle (ventricular puncture deenle could not puncture through because the wall was too thick) under sonography guide. Hemostasis was done, and water-tight suture was done for dura closure with autologous fascia graft and Tissucol-Duo. Bone graft was fixed back with 4 pairs of mini-plates and screws. After setting one subgaleal CWV, achieving hemostasis, and removing Raney clips, we closed the wound in layers. Operators VS 郭夢菲 Assistants R3 曾峰毅 蔡篤宗 (M,1938/08/24,73y6m) 手術日期 2010/06/08 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Spondylolisthesis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳德福, 時間資訊 00:00 臨時手術NPO 07:25 報到 08:05 進入手術室 08:15 麻醉開始 08:45 誘導結束 09:00 抗生素給藥 09:30 手術開始 12:24 開始輸血 12:40 抗生素給藥 14:55 手術結束 14:55 麻醉結束 15:05 送出病患 15:07 進入恢復室 16:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 椎間盤切除術－腰椎 1 2 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 摘要__ 手術科部: 外科部 套用罐頭: 1.PLIF with cages implantation 2.Lumbar disce... 開立醫師: 陳德福 開立時間: 2010/06/08 15:28 Pre-operative Diagnosis Lumbar spondylosis and spondylolisthesis with radiculopathy, L4-5 Post-operative Diagnosis ditto Operative Method 1.PLIF with cages implantation 2.Lumbar discectomy and laminectomy Specimen Count And Types NIL Pathology NIL Operative Findings 1.Grade I spondylolisthesis with instability, L4-5 2.Hypertrophic facet and ligamentum flavum were noted with thecal sac compression 3.2 cages [Synthese No 11] and 4 TPS [6.2x45mm] were implantated over L4-5. Operative Procedures Under ETGA and prone position, the skin is disinfected and draped as usual. The location of incision was decided by C-arm flouroscope. The paraspinous muscle was displaced laterally to expose the L3-4 & L4-5 facet joints. TPS was done under flouroscope guided and L4-5 laminecotmy was also performed. The nerve roots were identified and we performed discectomy. While the L4-5 disc is almost removed totoally, 2 cages were inserted with pusher. The location of TPS and cages was checked under flouroscope and one epidural drainage was left in situ. The wound was closed in layers. Operators vs 賴達明 VS 瀟輔仁 Assistants R4 陳德福 施詹京華 (F,1944/05/10,67y10m) 手術日期 2010/06/08 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Spondyloisthesis, acquired 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳德福, 時間資訊 00:00 臨時手術NPO 14:40 報到 15:20 進入手術室 15:23 麻醉開始 15:35 抗生素給藥 15:35 誘導結束 16:08 手術開始 18:08 手術結束 18:08 麻醉結束 18:18 送出病患 18:20 進入恢復室 20:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術（特壓）－二節以內 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 摘要__ 手術科部: 外科部 套用罐頭: 1.TPS fusion with Dyneses L4/5 2.Lumabr lamin... 開立醫師: 陳德福 開立時間: 2010/06/08 18:31 Pre-operative Diagnosis Lumbar spndylolisthesis with radiculopathy, L4-5 Post-operative Diagnosis ditto Operative Method 1.TPS fusion with Dyneses L4/5 2.Lumabr laminectomy 1.TPS fusion with Dynesys L4/5 2.Lumabr laminectomy Specimen Count And Types nil Pathology nil Operative Findings 1.Hypertrophic ligametum flavum over L4-5 was noted with moderate thecal sac compression. 3.Dyneses was implanted at L4/5 3.Dynesys was implanted at L4/5 Operative Procedures Under ETGA and prone position, the skin is disinfected and draped as usual. The location of incision was decided by C-arm flouroscope. We penetrated the paraspinous muscle at subcutaneous layer and the transverse process and lateral aspect of facet joint were exposed. Bilateral TPS was done under flouroscope guided and the Dyneses was set up. L4-5 laminectomy was also performed. The nerve roots were identified and we performed foraminotomy. The location of TPS was checked under flouroscope and one subcutaneous drainage was left in situ. The wound was closed in layers. Operators vs 賴達明 Assistants R4 陳德福 古黃素月 (F,1951/07/19,60y7m) 手術日期 2010/06/08 手術主治醫師 賴達明 手術區域 東址 006房 01號 診斷 Meningioma 器械術式 left side craniotomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 胡朝凱, 時間資訊 00:00 臨時手術NPO 07:43 報到 08:05 進入手術室 08:15 麻醉開始 08:35 誘導結束 08:50 抗生素給藥 09:19 手術開始 11:50 抗生素給藥 14:16 麻醉結束 14:16 手術結束 14:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除－手術時間在４～８小時 1 1 記錄__ 手術科部: 外科部 套用罐頭: Interhemispheric approach for Simpson grade I... 開立醫師: 胡朝凱 開立時間: 2010/06/08 14:33 Pre-operative Diagnosis Left Falx meningioma Post-operative Diagnosis Left Falx meningioma Operative Method Interhemispheric approach for Simpson grade II tumor excision Specimen Count And Types pieces of tumor Pathology pending Operative Findings 1.One yellowish, soft tumor located beneath left motor cortex that arised from left falx. The tumor contain some soft and some solid part. 2.The tumor border bwtween brain was clear but adhesed. 3.The capsule was all removed. 4. No brain or SSS invasion was noted. Operative Procedures 1.ETGA, supine with head fixed with skull clamp 2.Left U shap skin incision that cross midline 3.Reflect skin flap downward 4.Reflect periosteum 5.Craniotomy 6.Dural opening as the base left at midline 7.Midline approach to expose tumor 8.Devascularization and central debulky 9.Dissect tumor from brain via the interface 10.Left vessel in situ 11.Complete tumor excision 12.Hemostasis 13.close dura with prolene 14.Fix bone back with miniplate 15.Set one CWV drain then close wound in layers Operators 賴達明 Assistants 胡朝凱,黃世銘 范光錦 (M,1935/02/12,77y1m) 手術日期 2010/06/08 手術主治醫師 賴達明 手術區域 東址 005房 02號 診斷 Ossification of posterior longitudinal ligament (OPLL) 器械術式 Lamino plasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 黃世銘, 時間資訊 00:00 臨時手術NPO 14:10 報到 14:35 進入手術室 14:45 麻醉開始 14:55 誘導結束 15:00 抗生素給藥 15:29 手術開始 17:45 手術結束 17:45 麻醉結束 17:50 送出病患 17:55 進入恢復室 20:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓整形術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 記錄__ 手術科部: 外科部 套用罐頭: C3~6 laminoplasty 開立醫師: 周博敏 開立時間: 2010/06/08 17:56 Pre-operative Diagnosis OPLL ,cervical Post-operative Diagnosis OPLL ,cervical Operative Method C3~6 laminoplasty Specimen Count And Types nil Pathology nil Operative Findings 1.Hypertrophic PLL that compressed the thecal sac tightly 2.After laminoplasty, thecal sac expanded well Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: prone with neck flexed and head fixed by a Mayfield skull clamp 3.Skin preparation: occipital and neck areas were shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: medline nape, from suboccipital to lower neck. 5.The trapezius, semispinalis capitis, splenius capitis muscles on both sides were splitted at its origin of ligamentum nuchae, then, together with serratus posterior superior, rectus capitis posterior, obliqus capitis inferior and multifidus were detached from the spinous processes of C 3-6, followed by subperiosteal dissection on the laminae. 6.bleeding from the muscles was stopped by Bovie. 7.The spinous processes of C 3~6 were cut at its base by high speed air drill andreserved for later use. 8. The left laminal arches were cut through its whole thickness. The right side laminae at its laminopedicle juction was cut into a depth of it half thickness by a 1mm head size high speed cutting burr. 9.The lamina was bent to the right side by opening a door like action of a Cloward intervertebral spreader. Consequently, the posterior half of the spinal canal was enlarged. 10.The hypertrophic ligmenta flava, esp. at posterior central region were resected. 11.Each gap newly created after splitting was bridged by the reserved spinous process which was fixed to the laminae by a miniplate on each end. 12.A 3 mm width partial laminectomy was done with Kerrison punch at the lower margin of C2 lamina and the upper margin of C7 lamina. 13.The paravertebral muscles were closed by interrupted sutures with 2/0 silk, subcutaneous layer by continuous suture with 2/0 Dexon and skin by continuous suture with 3/0 nylon. 14.Drain: one, epilaminal, CWV Operators 賴達明 Assistants vs 蕭輔仁, R 胡朝凱, 黃世銘 顏王阿續 (F,1933/08/27,78y6m) 手術日期 2010/06/08 手術主治醫師 黃國皓 手術區域 東址 000房 號 診斷 Major trauma rated 16 or above on the severeity scale ( Injury severeity score >=16 ) 器械術式 Double-J ureteral stent insert 手術類別 預定手術 手術部位 腹 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 4 紀錄醫師 楊智凱, 時間資訊 14:00 報到 14:00 進入手術室 14:15 麻醉開始 14:18 誘導結束 14:20 抗生素給藥 14:25 手術開始 14:30 麻醉結束 14:30 手術結束 14:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 雙丁輸尿管導管置入術 1 0 L 記錄__ 手術科部: 泌尿部 套用罐頭: DBJ stent insertion 開立醫師: 楊智凱 開立時間: 2010/06/08 14:46 Pre-operative Diagnosis left hydronephrosis Post-operative Diagnosis left hydronephrosis Operative Method cystoscopy and DBJ insertion Specimen Count And Types nil Pathology nil Operative Findings 7Fr. 22cm DBJ(BARD) was replaced Operative Procedures Under satisfactory anesthesia with the patient in lithotomy position, prepping and drapping was performed in the usual sterile fashion. A Fr 21 Olympus cystoscope was introduced into the bladder cavity under direct vision. Careful inspection was done and DBJ was replaced. Patient tolerated the procedure very well and was sent to recovery room in satisfactory condition. Operators 黃國皓 Assistants 曾任偉,楊智凱 蔡淑慈 (F,1953/03/26,58y11m) 手術日期 2010/06/08 手術主治醫師 王國川 手術區域 西址 033房 01號 診斷 Atheroma skin 器械術式 Scalp tumor 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 09:50 進入手術室 09:58 麻醉開始 09:59 手術開始 10:15 手術結束 10:15 麻醉結束 10:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 臉部以外皮膚及皮下腫瘤摘除術　小於２公分 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Tumor excision 開立醫師: 游健生 開立時間: 2010/06/08 10:33 Pre-operative Diagnosis Scalp atheroma Post-operative Diagnosis Scalp atheroma Operative Method Tumor excision Specimen Count And Types 1 piece About size:1.5x1.5cm Source:scalp tumor Pathology Pending Operative Findings A yellowish, soft, well-encapsulated tumor at subcutaneous layer Operative Procedures 1. Patient was put into supine position 2. We shaved the operation field (the tumor as centre with a 2cm diameter) 3. Disinfected and draped the area as usual 4. Under local anesthesia, we incised the scalp over the tumor about 2cm in length 5. Separated the tumor from surrounding subcutaneous tissue preserving the integrity of capsule 6. Excised the tumor and irrigated the wound with normal saline 7. Closed wound in layers Operators VS 王國川 Assistants R2 游健生 沈惠婷 (F,1972/08/03,39y7m) 手術日期 2010/06/09 手術主治醫師 杜永光 手術區域 東址 003房 號 診斷 Brain Tumor 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 蔡宗良, 時間資訊 00:00 臨時手術NPO 08:12 報到 09:10 進入手術室 09:15 麻醉開始 09:45 誘導結束 10:20 抗生素給藥 10:28 手術開始 13:20 抗生素給藥 16:20 抗生素給藥 17:20 麻醉結束 17:20 手術結束 17:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 開顱術摘除血管病變－動靜脈畸型－中型－深部 1 1 L 手術 腦室體外引流 1 2 L 手術 誘發電位手術監視機–腦神經外科術中特殊儀器使用費 1 0 L 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 8 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 記錄__ 手術科部: 外科部 套用罐頭: Anterior interhemispheric transcallosal trans... 開立醫師: 蔡宗良 開立時間: 2010/06/09 18:22 Pre-operative Diagnosis Carvernoma, thalamus, left-sided Post-operative Diagnosis Carvernoma, thalamus, left-sided Operative Method Anterior interhemispheric transcallosal transchoroidal approach for vascular lesion removal at thalamus, left-sided. Specimen Count And Types One, brain tumor Pathology Report pending Operative Findings A small dark-reddish tumor with structures resembling vascular harmatoma was found at the medial side of the left-sided thalamus. Left side transcallosal approach was made, and the callostomy was 1.2cm. We exposed the third ventricle via tinea choroidea, and the opening was about 1cm. After total remove of the tumor, a left lateral ventricle EVD was inserted for monitoring. Dural sinus was noted at the left posterior frontal region, and was protected. Operative Procedures General anesthesia was applied under endotracheal intubation. SSEP was set. Mayfield head-clamp was applied with head 45 degrees facing to the left with 30 flexion. Partial bicoronal scalp incision. Craniotomy was made as depicted. Dura tenting was done at an interval of 1 cm. Microscope was brought into the surgical field. Dura open in inverted U shape, basing at superior sagittal sinus. Entrance into the interhemispheric fissure is made by placeing a brain retractor to retract the falx and CSF was released from opening of sulcal cistern and callosal cistern to allow relaxation of the brain. Soft cotton balls were placed at the anterior and posterior extent of the dissection to provide working space. Corpus callosum was identified with two pericallosal arteries lying above it. A callosotomy of approximately 1.2 cm was made and we entered the left-sided lateral ventricle. Choroid plexus and tenia choroidea was identified. Entrance to the 3rd ventricle was performed by dissecting the tenia choroidea and the tela choroidea below it. Tumor was enucleated and followed external ventricular drain was placed through the callosotomy into the lateral ventricle. Dura was closed by 4-0 Prolene. Skull was fixed back to the craniotomy window with miniplates. A CWV drain was placed at the epidural space. The wound was closed in layers. Operators P 杜永光 Assistants R5 陳睿生, R4 蔡宗良 胡嘉龍 (M,1955/05/15,56y9m) 手術日期 2010/06/09 手術主治醫師 蔡瑞章 手術區域 東址 005房 01號 診斷 Brain metastasis 器械術式 Crainotomy Brain Tumor(P-LIN) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:02 進入手術室 08:07 麻醉開始 08:40 誘導結束 08:50 抗生素給藥 09:16 手術開始 11:50 麻醉結束 11:50 手術結束 11:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４小時以內 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Right frontal craniotomy for total tumor excision 開立醫師: 胡朝凱 開立時間: 2010/06/09 11:35 Pre-operative Diagnosis Right frontal metastatic tumor Post-operative Diagnosis Right frontal metastatic tumor Operative Method Right frontal craniotomy for total tumor excision Specimen Count And Types pieces of tumor, and peripheral brain tissue Pathology pending Operative Findings The tumor located at right frontal gyrus with cystic component. The peripheral brain tissue became gliotic and whitish. The tumor margin was not well defined. One solid part beneath the cyst was noted and excised. The tumor located at right frontal gyrus with cystic component. The peripheral brain tissue became gliotic and whitish. The tumor margin was not well defined. One solid part beneath the cyst was noted and excised. The tumor was yellowish greyish, elastic in consistence. The cystic content was in staw color and was clear. Operative Procedures Under ETGA, patient was put in supine position. Bicoronal skin incision was done. Skin flap was dissected and opened. After two burr holes drilled, craniotomy was performed as a 7x7 bone window one cm away from midline down to supraorbital area, followed by dural tenting. U shape dural incision was made with the base left at frontal area. The tumor and gyrus were excised by gently dissection through the interface between tumor and brain tissue. Vascular perforation was cauterized. Hemostasis was then performed. After then, dura was closed with prolene. After one CWV drain insertion, wound was closed in layers. Under ETGA, patient was put in supine position. Bicoronal skin incision was done. Skin flap was dissected and opened. After two burr holes drilled, craniotomy was performed as a 7x7 bone window one cm away from midline down to supraorbital area, followed by dural tenting. U shape dural incision was made with the base left at frontal area. The tumor and gyrus were excised by gently dissection through the interface between tumor and brain tissue. Vascular perforation was cauterized. Hemostasis was then performed. After then, dura was closed with prolene. After one CWV drain insertion, the bone plate was replaced and fixed with miniplate and screws. The wound was then closed in layers. Operators 蔡瑞章 Assistants 胡朝凱,游健生 葉中森 (M,1956/12/17,55y2m) 手術日期 2010/06/09 手術主治醫師 蔡瑞章 手術區域 東址 005房 02號 診斷 Spinal metastasis 器械術式 Intraspinal intramedullary tum,TPS 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 11:40 報到 12:05 進入手術室 12:10 麻醉開始 12:50 誘導結束 13:30 抗生素給藥 13:40 手術開始 16:30 抗生素給藥 17:35 手術結束 17:35 麻醉結束 17:45 送出病患 17:45 進入恢復室 19:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 惡性病髓腫瘤切除術 1 1 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: T12 tumor excision and T11, L1~2 TPS 開立醫師: 胡朝凱 開立時間: 2010/06/09 17:24 Pre-operative Diagnosis T12 metastatic tumor Post-operative Diagnosis T12 metastatic tumor Operative Method T12 tumor excision and T11, L1~2 TPS Specimen Count And Types pieces of tumor Pathology pending Operative Findings 1. One reddish, elastic firm tumor located at T12 epidural space that compressed the spinal cord tightly. Part of tumor extended via left T12 nerve root as a dumbell shape. After laminectomy and tumor excision, Thecal sac expanded well. Operative Procedures 1.ETGA, prone 2.Midline incision from T11 to L2 3.Detach paravertebral muscle groups 4.Expose facet and transverse process 5.TPS screws insertion at T11, L1, L2 6.T12 laminectomy 7.Tumor excision 8.Exposed left T12 nerve root and preserved 9.Fix rods and cross links 10.Hemostasis 11.Set one hemovac then close wound in layers Operators 蔡瑞章 Assistants 胡朝凱, 游健生 陳富子 (F,1943/01/31,69y1m) 手術日期 2010/06/09 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Normal pressure hydrocephalus 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 曾峰毅, 時間資訊 00:00 臨時手術NPO 07:47 報到 08:05 進入手術室 08:10 麻醉開始 08:30 誘導結束 08:50 抗生素給藥 09:19 手術開始 10:50 手術結束 10:50 麻醉結束 11:00 送出病患 11:15 進入恢復室 13:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 腦室腹腔分流手術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Ventriculoperitoenal shunt was inserted via r... 開立醫師: 曾峰毅 開立時間: 2010/06/09 11:20 Pre-operative Diagnosis Normal pressure hydrocephalus Post-operative Diagnosis Normal pressure hydrocephalus Operative Method Ventriculoperitoenal shunt was inserted via right Kocher point Specimen Count And Types CSF was sent for routine, BCS, and culture. Pathology Nil Operative Findings Ventricular pucuture was done once, and clear, colorless CSF was drained. Codman Hakin programmable shunt was inserted, and initial valve pressure was set at 18cmH20. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to left. After scalp shaved, scrubbed, disinfected, and then draped, we made one linear skin incision at right frontal area. We drilled one burr hole, and created durotomy. Ventricular puncutre was done once, and inserted ventricular catheter. We made one transverse skin incision at right upper abdomen, and created mini-laparotomy. Peritoneal catheter was inserted. We created subcutaneous tunnel, and pull the peritoneal catheter through. We assemble the shunt system, and checked the function. The wound was closed in layers. With endotracheal general anaesthesia, the patient was put in supine position with head rotated to left. After scalp shaved, scrubbed, disinfected, and then draped, we made one linear skin incision at right frontal area. We drilled one burr hole, and created durotomy. Ventricular puncutre was done once, and inserted ventricular catheter for 6.5 cm. We made one transverse skin incision at right upper abdomen, and created mini-laparotomy. Peritoneal catheter was inserted for about 35 cm. We created subcutaneous tunnel, and pull the peritoneal catheter through. We assemble the shunt system, and checked the function. The wound was closed in layers. Operators VS 郭夢飛 Assistants R3 曾峰毅 相關圖片 蕭興周 (M,1921/11/10,90y4m) 手術日期 2010/06/09 手術主治醫師 蕭輔仁 手術區域 西址 034房 05號 診斷 Carpal tunnel syndrome 器械術式 Excision of soft tissue tumor, 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 13:00 報到 14:50 進入手術室 15:05 麻醉開始 15:10 手術開始 16:15 麻醉結束 16:15 手術結束 16:20 送出病患 記錄__ 手術科部: 外科部 套用罐頭: Tumor excision 開立醫師: 黃愉真 開立時間: 2010/06/09 10:04 Pre-operative Diagnosis Post-operative Diagnosis Ditto Operative Method Excision of subcutaneous tumor Specimen Count And Types 1 piece About size: Source:tumor Pathology pending Operative Findings 1. A　x cm well-capsulated, round, soft tumor over was remvoed. Operative Procedures 1. Local anesthesia, supine position 2. Skin disinfection. 3. Skin incision at tumor site. 4. Tumor excision was done with electrocautery knife. 5. Wound irrigation, hemostasis. 6. Close wounds in layers with 3-0 Vicryl, 4-0 Nylon. Operators 塗昭江 Assistants 黃愉真 許智逢 (M,1978/11/26,33y3m) 手術日期 2010/06/09 手術主治醫師 王國川 手術區域 東址 002房 02號 診斷 Subarachnoid hemorrhage (SAH) 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 4E 紀錄醫師 鍾文桂, 時間資訊 11:24 開始NPO 11:24 臨時手術NPO 11:24 通知急診手術 12:13 報到 12:13 進入手術室 12:15 麻醉開始 12:35 誘導結束 12:50 抗生素給藥 13:05 手術開始 15:53 開始輸血 16:50 麻醉結束 16:50 手術結束 17:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 1 手術 顱內壓監視置入 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 創傷醫學部 套用罐頭: (1) Left frontotemporoparietal craniectomy fo... 開立醫師: 李建勳 開立時間: 2010/06/09 16:56 Pre-operative Diagnosis Traumatic ICH, SDH at bilateral frontal and left temporal lobe Post-operative Diagnosis Traumatic ICH, SDH at bilateral frontal and left temporal lobe Operative Method (1) Left frontotemporoparietal craniectomy for hematoma evacuation and decompression (2) ICP monitor insertion Specimen Count And Types 1 piece About size:x1 Source:Bone smear culture Pathology Nil Operative Findings The ICP monitor was inserted into left frontal parenchyma .The ICP before opened the dura: 35mmHg. The traumatic ICH mainly located at left temporal and frontal base. After hematoma evacuation together with some contusional brain parenchyma, the ICP decreased to 3mmHg. The ICP elevated to 9mmHg after scalp closure. The temporalis muscle was removed for further decompression. The craniectomy skull plate was stored at bone bank. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position with head turned to right. The scalp was shaved, scrubbed, disinfected with alcohol better iodine then draped. Traumatic scalp flap was created followed by frontotemporoparietal craniectomy. The ICP monitor was inserted into left frontal parenchyma before opened the dura. The dura was opened along the craniectomy window. Hematoma evacuation was performed with bipolar coagulator and suction. The contusional brain parenchyma was removed with suction. Hemostasis was achieved with Surgicel lining of the brain parenchyma surface and bipolar coagulation of the arachnoid memebrane. The dura plasty was performed with temporalis fascia and 4-0 Prolene sutures. The temporalis muscle was removed for further decompression. The wound was closed in layers after two subgaleal CWV drains set up. Operators VS 王國川 Assistants R4 鍾文桂 R6 李建勳 Indication Of Emergent Operation 相關圖片 林月英 (F,1934/06/06,77y9m) 手術日期 2010/06/10 手術主治醫師 黃正賢 手術區域 東址 010房 01號 診斷 Cataract 器械術式 ECCE+PCIOL 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3 紀錄醫師 麥珮怡, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:05 進入手術室 08:09 麻醉開始 08:15 誘導結束 09:03 手術開始 09:55 手術結束 09:55 麻醉結束 10:05 送出病患 10:10 進入恢復室 11:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 白內障囊外摘出術併植入人工水晶體 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 記錄__ 手術科部: 眼科部 套用罐頭: ECCE ( 楊長豪) 開立醫師: 麥珮怡 開立時間: 2010/06/10 09:51 Pre-operative Diagnosis Cataract (od) Post-operative Diagnosis Cataract (od) Operative Method ECCE and PCIOL implantation Specimen Count And Types nil Pathology Nil Operative Findings Cataract (od ) Operative Procedures 1.Under general anesthesia 2.Disinfection, irrigation and draping. 3.Apply an eyelid speculum. 4.Bridle suture over SRM. 5.Superior 150-degree peritomy and hemostasis with cautery. 6.1st and 2nd planes of limbal incision with a No.64 blade. 7.Penetrate into the anterior chamber inject Healon into the anterior chamber. 8.Anterior capsulotomy with can-opening technique. 9.Extend limbal wound with scissors. 10.Two 10-0 Nylon preplace limbal sutures were made. 11.Hydrodissection with BSS solution. 12.Deliver the nucleus. 13.Tighten the preplaced suture. 14.Irrigation and aspiration of cortical material with Simcoe I/A cannula. 15.PCIOL was implanted. 16.Close limbal wound with 10-0 Nylon ( stitches). 17.Wash out residual Healon with Simcoe I/A cannula. 18.Inject Miostat into AC. 19.Subconjunctival injection of Gentamicin & Rinderon. 20.Maxitrol patching. Operators 黃正賢, Assistants R4陳韻如R2麥珮怡 羅更隆 (M,1932/11/26,79y3m) 手術日期 2010/06/10 手術主治醫師 陳敞牧 手術區域 東址 002房 03號 診斷 Head injury, unspecified 器械術式 Burr hole, subdural drain, bilateral NURO83038C0000 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3E 紀錄醫師 蔡宗良, 時間資訊 00:04 臨時手術NPO 00:04 開始NPO 09:14 通知急診手術 12:10 報到 12:40 進入手術室 12:45 麻醉開始 12:50 誘導結束 13:00 抗生素給藥 13:28 手術開始 15:00 手術結束 15:00 麻醉結束 15:08 進入恢復室 15:10 送出病患 16:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 慢性硬腦膜下血腫清除術 1 1 B 手術 慢性硬腦膜下血腫清除術 1 2 B 記錄__ 手術科部: 外科部 套用罐頭: Chronic Subdural Hematoma 開立醫師: 蔡宗良 開立時間: 2010/06/10 15:40 Pre-operative Diagnosis Chronic subdural hematoma, bilateral Post-operative Diagnosis Chronic subdural hematoma, bilateral Operative Method Craniostomy with subdural drain placement, bilateral Specimen Count And Types nil Pathology None Operative Findings Motor-oil like fluid gushed out when the outer membrane was incised. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head in neutral position 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized OP site. 4. Incision: linear, with Raney clips applied to the scalp edge for temporary hemostasis. 5. Craniostomy: burr hole immediately below skin incision 6. Dural tenting: by two 3/0 silk 7. Dural incision: cruciate. 8. The outer membrane of the hematoma was coagulated by Bovie along the edge of dural incision, then exicsed. 9. The liquified old blood and clot in the subdural space was evacuated by sucker, then thoroughly irrigated with isotonic saline through a rubber tube until the return was clean. 10. Dural closure: Gel-foam packing 11. Scalp closure: 2-0 Vicryl 12. Identical procedure was performed to the contralateral side 13. Drain: two, bilateral, subdural, collected in bag. 14. Blood transfusion: none 15. Course of the surgery: smooth. Operators VS 陳敞牧 Assistants CR 陳睿生, R4 蔡宗良 Indication Of Emergent Operation 林來福 (M,1951/12/15,60y2m) 手術日期 2010/06/10 手術主治醫師 陳敞牧 手術區域 東址 019房 04號 診斷 Subdural hemorrhage 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2E 紀錄醫師 許松鈺, 時間資訊 12:00 臨時手術NPO 12:00 開始NPO 22:30 報到 22:40 進入手術室 22:43 麻醉開始 22:50 誘導結束 23:12 抗生素給藥 23:34 手術開始 00:30 手術結束 00:30 麻醉結束 00:40 送出病患 00:45 進入恢復室 01:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Left burr hole for hematoma evacuation 開立醫師: 李建勳 開立時間: 2010/06/11 00:11 Pre-operative Diagnosis Left chronic subdural hematoma Post-operative Diagnosis Left chronic subdural hematoma Operative Method Left burr hole for hematoma evacuation Specimen Count And Types nil Pathology Nil Operative Findings Large amount (about 50mL) of sbudrual hematoma was drained out after opened the dura. The brain parenchyma did not expanded well after hematoma evacuation. Operative Procedures under general anesthesia and intubation, the patient was put in supine position. The scalp was shaved, scrubbed, disinfected with alcohol better iodine then draepd. Linear scalp incision was made at left frontal region over the chronic subdural hematoma. The burr hole was then created followed by dural tenting with 3-0 silk. The dura and outter membrane were bipolar coaulated. After opened the dura, irrigated the subdural space with saline in rubber drain tube in all four directions. After hematoma evacuation, the drain tube was left in sudural space and fixed at scalp . The wound was closed in layers and de-air procedure was performed. under general anesthesia and intubation, the patient was put in supine position. The scalp was shaved, scrubbed, disinfected with alcohol better iodine then draepd. Linear scalp incision was made at left frontal region over the chronic subdural hematoma. The burr hole was then created followed by dural tenting with 3-0 silk. The dura and outer membrane were bipolar coaulated. After opened the dura, irrigated the subdural space with saline in rubber drain tube in all four directions. After hematoma evacuation, the drain tube was left in sudural space and fixed at scalp . The wound was closed in layers and de-air procedure was performed. Operators VS 陳敞牧 Assistants R1 許松鈺 R4 鍾文桂 R6 李建勳 Indication Of Emergent Operation 相關圖片 許貴滿 (F,1960/09/06,51y6m) 手術日期 2010/06/10 手術主治醫師 陳敞牧 手術區域 東址 003房 03號 診斷 Carpal tunnal syndrome 器械術式 Neurolysis of the uluar neuve 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 鍾文桂, 時間資訊 14:10 報到 14:15 進入手術室 14:30 抗生素給藥 14:40 麻醉開始 14:45 誘導結束 14:48 手術開始 15:25 手術結束 15:46 16:35 16:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 正中神經腕部減壓術－雙側 1 1 記錄__ 手術科部: 外科部 套用罐頭: Neurolysis of bilateral median nerves. 開立醫師: 鍾文桂 開立時間: 2010/06/11 01:06 Pre-operative Diagnosis Carpal tunnel syndrome, bilateral. Post-operative Diagnosis Carpal tunnel syndrome, bilateral. Operative Method Neurolysis of bilateral median nerves. Specimen Count And Types Nil. Pathology Nil. Operative Findings Severely compressed median nerves by the thickened transverse retinaculum. Left median nerve is more severely compressed. Operative Procedures Under local anesthesia, the patient was placed in supine position and bilateral upper extrimities were abducted. After disinfection and draping, a linear longitudinal incision was made at the transverse retinaculum level at bilateral palmar area. Through dissection of the whole retinaculum longitudinally, the median nerve was exposed and released. The wounds were closed primarily. Operators V.S. 陳敞牧 Assistants R4 鍾文桂 李達生 (M,1972/09/09,39y6m) 手術日期 2010/06/10 手術主治醫師 陳敞牧 手術區域 東址 005房 01號 診斷 Herniation of intervertebral disc (HIVD) 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 胡朝凱, 時間資訊 00:00 臨時手術NPO 07:56 報到 08:06 進入手術室 08:15 麻醉開始 08:35 誘導結束 08:45 抗生素給藥 09:29 手術開始 11:40 手術結束 11:40 麻醉結束 11:50 送出病患 11:55 進入恢復室 12:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術－腰椎 1 1 麻醉 Peripheral arterial line inserti 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 記錄__ 手術科部: 外科部 套用罐頭: Left discectomy 開立醫師: 胡朝凱 開立時間: 2010/06/10 11:50 Pre-operative Diagnosis L4~5 ruptured disc, left Post-operative Diagnosis L4~5 ruptured disc, left Operative Method Left discectomy Specimen Count And Types nil Pathology nil Operative Findings 1.Protruding disc at L4~5 level that comrpessed the thecal sac tightly. 2.One small piece of ruptured disc downward protrusion at L5 body 3.After decompression, the root became loose. Operative Procedures 1.ETGA, prone 2.Midline skin incision at L4~5 level 3.Detach left paravertebral muscle 4.Expose lamina and drill 5.Loaminotomy 6.Resect flavum ligment with Kerrison 7.Identify disc and protrusion one 8.remove disc 9.Hemostasis 10.Close wound in layers Operators 陳敞牧 Assistants 胡朝凱, Ri 吳翠英 (F,1955/07/22,56y7m) 手術日期 2010/06/10 手術主治醫師 陳敞牧 手術區域 東址 005房 02號 診斷 Brain tumor 器械術式 Brain biopsy -Stereotaxic 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 胡朝凱, 時間資訊 00:00 臨時手術NPO 11:40 報到 12:18 進入手術室 12:23 麻醉開始 12:30 誘導結束 12:44 抗生素給藥 13:15 手術開始 15:44 抗生素給藥 17:20 麻醉結束 17:30 手術結束 17:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 立體定位術－切片 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 內科部 套用罐頭: Right fromtal stereotatic biopsy 開立醫師: 胡朝凱 開立時間: 2010/06/10 17:39 Pre-operative Diagnosis Multiple cystic brain lesion Post-operative Diagnosis Multiple cystic brain lesion Operative Method Right fromtal stereotatic biopsy Specimen Count And Types pieces of tumor Pathology frozen: degenerated brain Operative Findings 1.pieces of grayish brain tissue was taken Operative Procedures 1.ETGA, supine 2.Right frontal transverse skin incision 3.Dissect and burr hole drill 4.Localization with navigator 5.open dura 6.take biopsy 7.hemstasis 8.Close wound in layers Operators 陳敞牧 Assistants 胡朝凱 彭彩雲 (F,1952/06/28,59y8m) 手術日期 2010/06/10 手術主治醫師 陳敞牧 手術區域 東址 020房 05號 診斷 Carpal tunnel syndrome 器械術式 Neurolysis 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 陳德福, 時間資訊 14:55 報到 15:05 進入手術室 15:13 抗生素給藥 15:25 麻醉開始 15:28 誘導結束 15:30 手術開始 16:10 麻醉結束 16:10 手術結束 16:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 神經分離術－手．足之神經 1 1 摘要__ 手術科部: 外科部 套用罐頭: nerve decompression 開立醫師: 陳德福 開立時間: 2010/06/18 00:42 Pre-operative Diagnosis capal tunnel syndrome, right Post-operative Diagnosis capal tunnel syndrome, right Operative Method nerve decompression Specimen Count And Types nil Pathology nil Operative Findings The right median nerve is compressed by the hypertropic transverse ligement tightly. Operative Procedures Under LA, the skin is disinfected as usual. One linear incision on the right palm and exposure the ligament. The ligament is incised to expose the median nerve and we cut the fibrous tissue distal and proximal to the wrist untill the nerve is well decompressed. The wound is closed in layers. Operators VS 陳敞牧 Assistants r4 陳德福 吳阿財 (M,1947/02/21,65y0m) 手術日期 2010/06/10 手術主治醫師 蕭輔仁 手術區域 東址 003房 02號 診斷 Back pain 器械術式 Radiofrequency coagulation(Hun 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 鍾文桂, 時間資訊 12:35 進入手術室 13:00 麻醉開始 13:00 抗生素給藥 13:05 麻醉結束 13:06 手術開始 13:45 手術結束 13:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 高頻熱凝療法 1 1 B 記錄__ 手術科部: 套用罐頭: Radiofrequency ablation of bilateral L2 doral... 開立醫師: 鍾文桂 開立時間: 2010/06/11 00:58 Pre-operative Diagnosis Sciatica Post-operative Diagnosis Sciatica Operative Method Radiofrequency ablation of bilateral L2 doral root ganglion. Specimen Count And Types nil Pathology Nil. Operative Findings Radiofrequency ablation at bilateral L2 dorsal root ganglion for 180 seconds in two fractions. Operative Procedures Under local anesthesia, we located the bilateral L2 dorsal root ganglion with the spinal needle by intraoperative fluoroscope. After ensuring the location, radiofrequency ablation at bilateral L2 doral root ganglion was done smoothly. The patient tolerated the whole procedure well. Operators V.S. 蕭輔仁 Assistants R4 鍾文桂 陳清標 (M,1930/09/09,81y6m) 手術日期 2010/06/10 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Cerebrovascular Diseases 器械術式 endarterectomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 07:35 報到 08:08 進入手術室 08:10 麻醉開始 08:50 誘導結束 09:00 抗生素給藥 09:18 手術開始 12:00 麻醉結束 12:00 手術結束 12:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 動脈內膜切除術 1 1 R 手術 臉部以外皮膚及皮下腫瘤摘除術　小於２公分 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: 1. Eversion endarterectomy over right ICA, EC... 開立醫師: 鍾文桂 開立時間: 2010/06/10 12:33 Pre-operative Diagnosis 1. Right internal-carotid artery stenosis 2. Right neck nevus Post-operative Diagnosis 1. Right internal-carotid artery stenosis 2. Right neck nevus Operative Method 1. Eversion endarterectomy over right ICA, ECA and CCA 2. Skin tumor excision Specimen Count And Types 2 pieces About size:3x1x1 cm Source:Endothelium of right CCA, ICA and ECA About size:0.5x0.5x0.3 cm Source:Nevus over right neck Pathology Pending Operative Findings 1. Severe arthrosclerosis over right CCA, ICA and ECA with stenosis 2. The blood low after the endarterectomy was fair 3. CCA clamping time: 33 mins 4. No significant EEG or SSEP change during the operation 5. A black nevus over his right neck Operative Procedures 1. Under ETGA, patient was put on supine position with head face to left side 2. Skin incision above the right SCM 3. Open wound in layers then identify the commom carotic artery 4. Perform adhesionlysis around the CCA, ICA and ECA 5. Clamp the superior thyroid artery, common carotid artery, external carotid artery and internal carotid artery respectedly 6. Incision over the conncetion between ICA and CCA 7. Perform endarterectomy over ICA, CCA and ECA 8. Re-anastomosis over the ICA and CCA 9. Check blood flow over the ICA, ECA and CCA. The flow was good 10. Check bleeding then place one CWV drain 11. Resect the skin nevus 12. Close wound in layers Operators VS 王國川 Assistants R4 鍾文桂 R1 曾偉倫 邱逢琪 (M,1950/08/20,61y6m) 手術日期 2010/06/11 手術主治醫師 張金池 手術區域 東址 057房 03號 診斷 Lung cancer 器械術式 Thoracoscopy+Open Chest 手術類別 預定手術 手術部位 胸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 3 紀錄醫師 高明蔚, 時間資訊 14:52 報到 15:00 進入手術室 15:05 麻醉開始 15:45 誘導結束 15:55 抗生素給藥 16:05 手術開始 18:55 抗生素給藥 20:10 麻醉結束 20:10 手術結束 20:25 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 光動力療法 1 0 手術 一葉肺葉切除 1 1 L 手術 肺楔狀或部份切除術 1 2 L 摘要__ 手術科部: 外科部 套用罐頭: Thoracotomy for LLL lobectomy, lymph node dis... 開立醫師: 高明蔚 開立時間: 2010/06/11 20:51 Pre-operative Diagnosis Left lower lobe adenocarcinoma, status post VATS lymph node dissection and chemotherapy, susp pleural metastasis Post-operative Diagnosis Left lower lobe adenocarcinoma, status post VATS lymph node dissection and chemotherapy, susp pleural metastasis, susp. LUL invasion Operative Method Thoracotomy for LLL lobectomy, lymph node dissection, pleural tumor wide excision, partial wedge resection of LUL, and photodynamic therapy Specimen Count And Types 5 pieces About size:15cm Source:LLL About size:5cm Source:LUL wedge About size:3cm Source:Pleural tumor About size:Multiple Source:Gr.5 About size:Multiple Source:Gr.10 Pathology Pending. Previous LN: adenocarcinoma Operative Findings One 4cm yellowish necrotic tumor at LLL, pleural traction(+). Partial LUL was severely adhesed to the LLL, susp. local invasion, wedge resection was made. Tiny (2mm) defect of left upper bronchus noted, s/p primary closure and intercostal muscle flap coverage. Gr.5 and Gr.10 LNs enlargement noted. One 1.3cm pleural tumor at posterior chest wall. PDT profiles: 7 points: apex->anterior chest wall->pericardium->anterios sulcus->posterior sulcus->posterior chest wall->lateral chest wall (-> wound), 630nm, 75sec/point, 30J/point Operative Procedures DLETGA, right decubitus, skin disinfection and draping as usual. Throacotomy setting. Divide LLL from LUL between major fissure, transect PV -> PA -> bronchus. Wedge resection of LUL. Harvest intercostal muscle flap to cover left upper bronchus defect after primary closure. Partial pleurodectomy for wide excision of pleural tumor. Perform PDT. Hemostasis, warm saline irrigation, set Fr.28 chest tube x2. Wound closure in layers. Operators 張金池 Assistants R5林孟暐 R2高明蔚 陳昭益 (M,1940/11/05,71y4m) 手術日期 2010/06/11 手術主治醫師 何子昌 手術區域 東址 011房 11號 診斷 Aphakia 器械術式 IOL implantation--secondary 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 劉耀臨, 時間資訊 18:35 報到 19:15 進入手術室 19:45 手術開始 20:25 手術結束 20:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 人工水晶體植入術－第二次植入 1 1 L 記錄__ 手術科部: 眼科部 套用罐頭: ECCE 開立醫師: 劉耀臨 開立時間: 2010/06/11 20:35 Pre-operative Diagnosis Pseudophakia (os) Post-operative Diagnosis Pseudophakia (change IOL) (os) Operative Method Removal of IOL + ACIOL implantation (os) Specimen Count And Types nil Pathology Nil Operative Findings pseudophakia (os) 3-piece in anterior chamber Operative Procedures 1. Under retrobulbar anesthesia 2. Disinfection, irrigation and draping. 3. Apply an eyelid speculum. 4. Bridle suture over SRM. 5. Superior 150-degree peritomy and hemostasis with cautery. 6. 1st and 2nd planes of limbal incision witha No. 64 blade. 7. Penetrate into the anterior chamber inject Viscoat into the anterior chamber. 8. Removed the IOL in anterior chamber 9. Inject Miostat into AC. 10. ACIOL was implanted. 11. Closed limbal wound with 10-0 Nylon. 12. Irrigation and aspiration of Viscoat with Simcoe I/A cannula. 13. Subconjunctival injection of Gentamicin and Rinderon. 14. Latycin patching. Operators 何子昌, Assistants 劉耀臨, 陳昱瑋 (M,1991/06/02,20y9m) 手術日期 2010/06/11 手術主治醫師 蔡瑞章 手術區域 東址 005房 03號 診斷 Brain tumor 器械術式 V-P shunt 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 1E 紀錄醫師 游健生, 時間資訊 08:00 臨時手術NPO 08:00 開始NPO 18:51 通知急診手術 19:55 報到 20:00 進入手術室 20:10 麻醉開始 20:15 誘導結束 20:45 抗生素給藥 20:59 手術開始 22:15 手術結束 22:15 麻醉結束 22:20 送出病患 22:25 進入恢復室 23:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 游健生 開立時間: 2010/06/11 22:48 Pre-operative Diagnosis 3rd ventricle tumor with obstructive hydrocephalus Post-operative Diagnosis 3rd ventricle tumor with obstructive hydrocephalus Operative Method V-P Shunt, right Kocher"s Specimen Count And Types 1 piece About size:13cc Source:CSF Pathology nil Operative Findings 1. Opening pressure: >15cmH2O 2. Ventricle catheter: 6.7cm, Peritoneal catheter: 25cm 3. CSF was clear 4. Reservoir: medium pressure Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: supine with head rotated and tilted to left. 3.Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 5 cm curvilinear, at right Kocher"s point, corresponded to the location of right frontal horn. Raney clips were applied to the scalp edge for temporary hemostasis. 5.After the scalp flap had been lifted and reflected anteriorly, a burr hole was made and the dura was tented by 1 stitch. 6.The dura was opened by a nib incision. Rt lateral ventricle was tapped by a ventricular needle, then a 6.7 cm segment of the ventricular catheter was introduced into the ventricle. The outer end of the catheter was connected to a Pudenz reservoir. 7. A transverse incision was made at RUQ of the abdomen and dissected in layers. After opening the peritonium, a trocar was pushed into peritoneal cavity. Subsequently, distal 25 cm segment of the peritoneal catheter (medium pressure) was introduced into the peritoneal cavity through the outer tube of the trochar. The proximal end of this catheter was passed through subcutaneous tunnel at forechest, neck, rt retroauricular area and connected the reservoir. The shunt system was checked to make sure its function was normal. 8. The reservoir was fixed to pericranium by 3 stitches. 9. Scalp closure: hemostasis was done with monopolar coagulator touching on the sucker tip. Galea suture was performed by continuous suture with 3/0. Dexon and skin by continuous suture with 3/0 nylon. 10.Course of the surgery: smooth. Operators VS 蔡瑞章 Assistants R6 陳盈志 R2 游健生 Indication Of Emergent Operation 何開敏 (F,1929/04/08,82y11m) 手術日期 2010/06/11 手術主治醫師 曾勝弘 手術區域 東址 019房 03號 診斷 Seizures 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 14:20 報到 14:20 進入手術室 14:25 麻醉開始 14:30 誘導結束 14:40 手術開始 15:15 麻醉結束 15:15 手術結束 15:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 氣管切開造口術 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 游健生 開立時間: 2010/06/11 15:28 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types nil Pathology None Operative Findings Fr. 7 low pressure cuffed tube inserted via 3rd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide above the sternal notch. It carries through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. Tracheotomy is made by a T-shaped incision with transverse incision at the level of C2-3 inter-ring membrane. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tube is fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators VS 曾勝弘 Assistants R4 陳德福 R2 游健生 高正基 (M,1942/02/19,70y0m) 手術日期 2010/06/11 手術主治醫師 楊永健 手術區域 西址 031房 03號 診斷 Back wound 器械術式 Wide excision - soft tissue tu 手術類別 預定手術 手術部位 脊椎 傷口分類 污染 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 11:05 進入手術室 11:20 麻醉開始 11:22 手術開始 11:30 手術結束 11:30 麻醉結束 11:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 淺部創傷處理－傷口長５公分以下者 1 0 記錄__ 手術科部: 外科部 套用罐頭: debridement and primary closure 開立醫師: 黃柏誠 開立時間: 2010/06/11 11:53 Pre-operative Diagnosis post spine surgery and poor wound healing Post-operative Diagnosis post spine surgery and poor wound healing Operative Method debridement and primary closure Specimen Count And Types nil Pathology nil Operative Findings 1.a 2x0.5 cm linear poor healing wound was noted at previous operation site Operative Procedures 1.prone position 2.disinfection and drapping 3.Local anesthesia 4.incision from poor healing wound margin 5.N/S irrigation 6.primary closeure wound by 4-0 Nylon Operators VS楊永健 Assistants R2黃柏誠 李文雄 (M,1960/07/14,51y8m) 手術日期 2010/06/11 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Neurofibroma 器械術式 Intraspinal intramedullary tum 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 蔡宗良, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:06 進入手術室 08:10 麻醉開始 08:20 誘導結束 09:30 抗生素給藥 09:42 手術開始 12:30 抗生素給藥 13:50 手術結束 13:50 麻醉結束 14:00 送出病患 14:05 進入恢復室 15:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎內脊髓內腫瘤切除術 1 1 L 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 L 手術 誘發電位手術監視機–腦神經外科術中特殊儀器使用費 1 0 L 手術 神經分離術－手．足之神經 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 記錄__ 手術科部: 外科部 套用罐頭: 1. Posterior hemilaminectomy approach for int... 開立醫師: 蔡宗良 開立時間: 2010/06/11 14:31 Pre-operative Diagnosis 1. Intradural extramedullary neurogenic tumor, L1 root, right-sided 2. Paraspinal neurogenic tumor, right-sided Post-operative Diagnosis 1. Intradural extramedullary neurogenic tumor, L1 root, right-sided 2. Paraspinal neurogenic tumor, right-sided Operative Method 1. Posterior hemilaminectomy approach for intradural extramedullary tumor excision 2. Paramedian paraspinal tumor excision Specimen Count And Types 2 pieces About size:小 Source:L1 About size:小 Source:L4 Pathology Report pending Operative Findings 1. Intradural extramedullary tumor was rounded in shape, smooth in surface and soft in consistency. 2. Paraspinal tumor was large, jelly-like content, rounded in shape, smooth in surface and soft in consistency. The spinal nerves are identified below the tumor after tumor excision. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: prone. 3. Skin preparation: the back was shaved and scrubbed with povidone-iodine detergent then painted with povidone-iodine tincture and followed by sterilized adhesive plastic sheet covering. 4. A spinal needle was inserted between spinous processes of L1 and a portable X-ray film was taken to locate the correct interspace. 5. Incision: 6 cm, over spinous processes from T12 to L2. 6. The spinal process was split by high-speed pneumatic saw. 7. The right laminae of L1 were bitten off with rongeurs and Kerrison punch to perform right-sided hemilaminectomy. 9. Dura was opened and the tumor was excised. 11. A transverse wound was made at right-sided L2 level 5 centimeter away from the midline. 12. The paravertebral muscles were split and the transverse process of L4 was removed. 13. The tumor was centrally debulked and with the remaining sheath removed. 14. Both wound were closed by Dexon and skin by continuous suture with 3/0 nylon. 13.Drain: one each, epilaminal, CWV. 14.Blood transfusion: none 15.Course ofthesurgery: smooth. Operators VS 賴達明 Assistants CR 陳睿生 R4 蔡宗良 郭倉華 (M,1985/08/26,26y6m) 手術日期 2010/06/11 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Spondylolysis, lumbar-sacral(L-S) 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 蔡宗良, 時間資訊 00:00 臨時手術NPO 14:20 進入手術室 14:23 麻醉開始 14:30 誘導結束 15:00 抗生素給藥 15:10 手術開始 16:40 手術結束 16:40 麻醉結束 16:55 送出病患 16:55 進入恢復室 18:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術－腰椎 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 記錄__ 手術科部: 外科部 套用罐頭: HIVD 開立醫師: 蔡宗良 開立時間: 2010/06/11 16:51 Pre-operative Diagnosis Herniated lumbar disc, L5-S1, left-sided Post-operative Diagnosis Herniated lumbar disc, L5-S1, left-sided Operative Method Microdiscectomy Specimen Count And Types nil Pathology None Operative Findings Herniated lumbar disc, bulging, compresing the S1 root Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: prone with a bolster beneath -- side and flexed at the waist and knees. 3. Skin preparation: the back was shaved and scrubbed with povidone-iodine detergent then painted with povidone-iodine tincture and followed by sterilized adhesive plastic sheet covering. 4.A spinal needle was inserted between spinous processes of L5 and a portable X-ray film was taken to locate the correct interspace. 5.Incision: 3-cm, between L5-S1 spinous processes. The subcutaneous layer and lumbdorsal fascia were incised then. 6.The aponeurosis of the latissimus dorsi and ileocostalis lumborum muscles at spinous processes of L5 was incised, the muscles were detached from the interspinous ligament. The multifidus muscles were detached subperiosteally from L5-S1 laminae by a rasp. 7.The paravertebral muscles were retracted by a modified narrow Taylor retractor which was retained constantly by a rubbersling to the side rail of the operating table. 8.Under an operating microscope, the ligamentum flavum was cleaned and incised longitudinally at the lateral part with a No. 11 blade. The lateral portion of this ligament was removed with a small angle Kerrison rongeur, the lateral portion of the laminae and the medial border of the facets were removed too until the margin of the facets and a corridor to the disc that ran lateral to the root was reached. 9. The epidural fat was left undisturbed andpreserved. 10.The compressed L- root and veins overlying the protruded disc were gently pushed away by placing 2 small cottonoid patties, one above and one below the disc at the floor of the epidural canal. 11.The compressed root was gently pushed further away temporarily by sucker tip in order to expose the herniated disc more clearly. The posterior longitudinal ligament and annulus were incised around the protruded disc with a No. 15 blade. The degenerated disc was removed with microdisc forcepsuntil a substantial amount of the nucleus had been loosened with a cone curette and removed. 12.A piece of subcutaneous fat was resected and covered on -- root. 13.The lumbodorsal fascia was approximated by 3 interruped 2/0 silk stitches. 14.Thesubcutaneous layer was closed by running suture with 4/0 Dexon and skin by adhesive tape. 15.Course of the surgery: smooth. Operators VS 賴達明 Assistants CR 陳睿生 R4 蔡宗良 莊文達 (M,1958/12/30,53y2m) 手術日期 2010/06/11 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 HIVD 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳德福, 時間資訊 00:00 臨時手術NPO 07:35 報到 08:08 進入手術室 08:10 麻醉開始 08:15 誘導結束 08:50 抗生素給藥 09:07 手術開始 11:25 手術結束 11:25 麻醉結束 11:35 送出病患 11:40 進入恢復室 12:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 手術 椎間盤切除術－腰椎 1 1 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 摘要__ 手術科部: 外科部 套用罐頭: 1.Lumbar diskectomy, microscopic 2.interspino... 開立醫師: 陳德福 開立時間: 2010/06/11 11:52 Pre-operative Diagnosis L4-5 HIVD, central disc Post-operative Diagnosis ditto Operative Method 1.Lumbar diskectomy, microscopic 2.interspinous device implantation 1.Lumbar diskectomy, microscopic 2.interspinous process device implantation Specimen Count And Types nil Pathology nil Operative Findings 1.There is a central protruding disc at the L4-5 space with thecal sac compression. 2.The diskectomy was performed via left laminotomy window. 3.Corflex interspinous device was implantated at the L4-5 spinous process, No. 10. Operative Procedures Under ETGA and prone position, the skin was disinfected and draped as usual. The location of L4-5 was identified by C-arm fluoroscope and we made a linear incision. The paraspinous muscle was displaced laterally via the left side and one laminotomy window was done. The ligamentum flavum was removed and the nerve root was found. We retract the nerve root medially and start to remove the disc by currettage, aligator, and disc clamp. The nerve was fully decompressed and we insert the interspinous device with the preservation of supraspinous ligament. Hemostasis is done and the wound was closed in layers. Operators VS 賴達明 Assistants R4 陳德福 R1黃世銘 相關圖片 翁春長 (M,1927/09/24,84y5m) 手術日期 2010/06/11 手術主治醫師 陳敞牧 手術區域 東址 002房 03號 診斷 Subdural hemorrhage 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 14:15 報到 14:33 進入手術室 14:40 麻醉開始 14:50 誘導結束 14:55 抗生素給藥 15:20 手術開始 16:05 手術結束 16:05 麻醉結束 16:16 送出病患 16:22 進入恢復室 18:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: Chronic Subdural Hematoma 開立醫師: 曾峰毅 開立時間: 2010/06/11 16:14 Pre-operative Diagnosis Right chronic subdural hematoma Post-operative Diagnosis Right chronic subdural hematoma Operative Method Right frontal burr hole for subdural drainage Specimen Count And Types Subdural effusion was sent for cytology. Pathology Nil Operative Findings Dark-brownish subdural fluid was drained. Blood loss was minimal. Course was smooth. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head roated to left. After scalp shaved, scrubbed, disinfected, and then draped, we made one right frontal linear skin incision. We drilled one burr hole, and created durotomy. One rubbder drained inserted into subdural space for drainage and irrigation. We closed the wound in layers after subdural space de-air. Operators VS 陳敞牧 Assistants R3 曾峰毅 Ri 劉欣瑜 Indication Of Emergent Operation 蔡郭清盆 (F,1939/02/15,73y0m) 手術日期 2010/06/11 手術主治醫師 蕭輔仁 手術區域 東址 005房 01號 診斷 Brain abscess 器械術式 Crainotomy Brain Tumor(P-LIN) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:06 進入手術室 08:16 麻醉開始 08:28 誘導結束 09:34 手術開始 11:20 麻醉結束 11:20 手術結束 11:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 頭顱穿洞術（止血引流、穿刺檢查） 1 2 L 手術 歐氏貯囊置放手術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: 1.Debridement of brain abscess cavity through... 開立醫師: 鍾文桂 開立時間: 2010/06/11 11:49 Pre-operative Diagnosis Right frontal-parietal brain abscess with obstructive hydrocephalus. Post-operative Diagnosis Right frontal-parietal brain abscess with obstructive hydrocephalus. Operative Method 1.Debridement of brain abscess cavity through drainage. 2.Ommaya reservoir insertion via left Kocher point. Specimen Count And Types 3 pieces About size:EVD Source:EVD tip culture About size:Abscess cavity Source:Abscess cavity About size:abscess Source:abscess cavity. Pathology Nil. Operative Findings Some fibrotic and necrotic tissues came out from the abscess cavity. Yellow-green purulent discharge came out from the abscess cavity. Clear colorless CSF. Slack brain. A necrotic area noted at right frontal brain surface. Aspiration and irrigation of abscess cavity was done through this necrotic brain. Intraoperative echo-guided puncture to the abscess cavity. Operative Procedures Under ETGA, the patient was put in supine position. The head was slightly tilted to the left. After shaving, disinfection, and well draping, the previous EVD wound was opened. The EVD tip was cut and removed for culture. The new Ommaya reservoir was inserted through the same tract. Later, under intraoperative echogram, we located the abscess. Part of the previous craniotomy wound was opened. We located the abscess cavity again with direct contact to the brain surface. A ventriculostomy needle was inserted through the necrotic tissue to reach the abscess. Thick purulent discharge was noted. We irrigated the cavity with normal saline through a negaton tube. Later, we removed the negaton tube. The wound was closed in layers. No drainge tube was inserted. The rest of the EVD tube was removed. The patient was sent to ICU smoothly. Operators V.S. 蕭輔仁. Assistants R4 鍾文桂. 相關圖片 吳有諒 (M,1964/03/12,48y0m) 手術日期 2010/06/11 手術主治醫師 蕭輔仁 手術區域 東址 005房 02號 診斷 Gastrointestinal bleeding 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 11:25 報到 11:42 進入手術室 11:50 麻醉開始 12:10 誘導結束 12:10 抗生素給藥 12:58 手術開始 15:14 抗生素給藥 17:37 手術結束 17:37 麻醉結束 17:47 送出病患 17:50 進入恢復室 19:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 頭顱成形術 1 1 L 手術 肌肉或深部組織腫瘤切除術及異物取出術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 記錄__ 手術科部: 外科部 套用罐頭: 1. Harvesting of autograft skull bone at subc... 開立醫師: 鍾文桂 開立時間: 2010/06/11 18:14 Pre-operative Diagnosis Left skull bone defect. Post-operative Diagnosis Left skull bone defect. Operative Method 1. Harvesting of autograft skull bone at subcutaneous area of abdomen. 2. Cranioplasty with autograft bone plates and bone cements. Specimen Count And Types nil Pathology Nil. Operative Findings 1. 3 pieces for bone plates, two from left side, one from right side. Only two bone plates were used for cranioplasty. The left one was given to his wife. 2. Atrophic temporalis muscle. The defect was filled with bone cement. 3. Moderate adhesion. Intact brain parenchyma. Operative Procedures 1. Under ETGA, the patient was put in supine position and the head was tilted to the right. 2. After shaving, disinfection and well draping, the abdminal wound was opened. We dissected along the edges of the bone plates. Three bone plates were collected. The wound was closed in layers. 3. We incised along the previous craniectomy wound. Dissection was made along the subgaleal space. The temporalis muscle was seperated. 4. The two bone plates were fixed with plates and screws. The defected area was filled up the bone cements. The temporalis muscle was attached to the artificial bone plate. 5. After placing one CWV drain, the wound was closed in layers. Operators V.S. 蕭輔仁 Assistants R4 鍾文桂. 許新土 (M,1956/11/14,55y4m) 手術日期 2010/06/11 手術主治醫師 王國川 手術區域 東址 019房 02號 診斷 Hydrocephalus 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 黃世銘, 時間資訊 00:00 臨時手術NPO 11:40 報到 12:00 進入手術室 12:10 麻醉開始 12:20 抗生素給藥 12:30 誘導結束 13:00 手術開始 13:45 手術結束 13:45 麻醉結束 13:55 送出病患 14:00 進入恢復室 15:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: VPS revision 開立醫師: 陳德福 開立時間: 2010/06/11 14:05 Pre-operative Diagnosis Hydrocephalus [s/p VPS] Post-operative Diagnosis ditto Operative Method VPS revision Specimen Count And Types nil Pathology nil Operative Findings 1.The intraperitoneal catheter is patent 2.One medium-low pressure valve, Metronic programmable valve, was inserted at the right frontal area Operative Procedures Under ETGA and supine position, the right scalp and abdomen was disinfected and draped as usual. Linear incision along previous right frontal scar and the posterior auricular area were done. The shunt valve and catheter were identified and the patency of the intraperitoneal catheter was checked. We removed the shunt valve and re-insert a new medium-low pressure valve in situ. The function of the valve was fair and the wound was closed in layers. Operators vs 王國川 Assistants R4 陳德福 r1 黃世銘 相關圖片 林明德 (M,1960/12/10,51y3m) 手術日期 2010/06/12 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Parkinsonism 器械術式 Stereotaxic procedure for func 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 胡朝凱, 時間資訊 00:00 臨時手術NPO 07:51 報到 08:00 進入手術室 08:20 麻醉開始 08:25 誘導結束 09:05 抗生素給藥 09:10 手術開始 09:50 開始輸血 12:05 抗生素給藥 15:05 抗生素給藥 15:35 麻醉結束 15:35 手術結束 15:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 深部腦核電生理定位 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 7 0 手術 立體定位術－功能性失調 1 1 手術 立體定位術－功能性失調 1 2 記錄__ 手術科部: 套用罐頭: Bilateral subthalamic nucleus DBS insertion 開立醫師: 胡朝凱 開立時間: 2010/06/12 15:50 Pre-operative Diagnosis Parkinson disease Post-operative Diagnosis Parkinson disease Operative Method Bilateral subthalamic nucleus DBS insertion Specimen Count And Types nil Pathology nil Operative Findings 1.After DBS insertion, the rigidity decreased from 2+ to less then 1+. 2.No neurologic deficit during whole procedure. 3.Bilateral two trajectory were test Operative Procedures 1.Under IVGA, supine 2.Navigation setting 3.localization of entry point 4.made a bony mark by bony drill 5.Transverse skin incision 6.Dissect periosteum 7.Burr hole drill 8.dural tenting 9.probe tower setting 10.open dura and insert probe 11.localization of nucleus 12.Insert stimulation probe and fixation. 13.Do the same procedure at right side 14.Close wound in layers Operators 曾勝弘 Assistants 胡朝凱 林梁悅 (F,1939/09/22,72y5m) 手術日期 2010/06/12 手術主治醫師 黃勝堅 手術區域 東址 002房 01號 診斷 Head Injury 器械術式 Tracheostomy 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3E 紀錄醫師 林孟暐, 時間資訊 20:14 開始NPO 20:14 臨時手術NPO 20:14 通知急診手術 09:14 進入手術室 09:14 報到 09:15 麻醉開始 09:17 誘導結束 09:21 手術開始 09:30 麻醉結束 09:30 手術結束 09:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 氣管切開造口術 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 林孟暐 開立時間: 2010/06/12 09:43 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types nil Pathology None Operative Findings Fr . 7 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators VS 李章銘 Assistants R5 林孟暐 Indication Of Emergent Operation 官宇原 (M,1954/12/21,57y2m) 手術日期 2010/06/12 手術主治醫師 蕭輔仁 手術區域 東址 005房 01號 診斷 Prostate cancer 器械術式 Spinal fusion posterior 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 3E 紀錄醫師 趙崧筌, 時間資訊 19:31 臨時手術NPO 19:31 開始NPO 23:31 通知急診手術 03:45 報到 03:50 麻醉開始 03:50 進入手術室 04:30 誘導結束 04:45 抗生素給藥 04:55 手術開始 07:05 麻醉結束 07:05 手術結束 07:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 惡性病髓腫瘤切除術 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: C3-5 laminectomy tumor excision 開立醫師: 陳盈志 開立時間: 2010/06/12 07:27 Pre-operative Diagnosis C3-4 metastatic tumor Post-operative Diagnosis C3-4 metastatic tumor Operative Method C3-5 laminectomy tumor excision Specimen Count And Types 1 piece About size:multiple small fragments Source:C3-4 metastatic tumor Pathology pending Operative Findings The tumor was soft, elastic and reddish in character. Tumor mainly located at C4 and lower C3 epidural space. Some bony involvement at C4 was noted, and C4 lamina became mild fragile. Operative Procedures 1.ETGA, prone with head fixed with Mayfield 2.Skin preparation 3.Midline skin incision, detach paraspinal muscle to see C2-6 lamina 4.Laminectomy C3-5 with rongeur and karrison punch. 5.Epidural mass was dissected with curved curette and then removed with karrison piece by piece. 6.Hemostasis with gelform packing 7.One CWV drain was set for drainage 8.close wound in layer Operators VS蕭輔仁 Assistants R6陳盈志R2趙崧筌 Indication Of Emergent Operation 周映輝 (M,1931/12/05,80y3m) 手術日期 2010/06/12 手術主治醫師 王國川 手術區域 東址 002房 03號 診斷 Cerebrovascular accident (CVA) 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 4E 紀錄醫師 李振豪, 時間資訊 09:13 通知急診手術 10:50 報到 10:50 進入手術室 10:55 麻醉開始 11:30 誘導結束 11:43 手術開始 13:00 抗生素給藥 14:55 麻醉結束 14:55 手術結束 15:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 1 R 手術 顱內壓監視置入 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Right fronto-temporo-parietal craniectomy + D... 開立醫師: 李振豪 開立時間: 2010/06/12 15:43 Pre-operative Diagnosis Right MCA territory infarction with hemorrhagic transformation Post-operative Diagnosis Right MCA territory infarction with hemorrhagic transformation Operative Method Right fronto-temporo-parietal craniectomy + Duroplasty + ICP monitor insertion Specimen Count And Types Nil Pathology Nil Operative Findings The brain was swelling after dura opening. The infarcted brain tissue was fragile, edematous, soft, and whitish. The temporal hemorragic transformation was evacuated with partial temporal lobectomy. The ICP was 2mmHg after wound closure. The brain was swelling after dura opening. The infarcted brain tissue was fragile, edematous, soft, and whitish. The temporal hemorragic transformation was evacuated with partial temporal lobectomy. The ICP was 2mmHg after wound closure. ICP reference: 480 Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine position with head rotated to left. The scalp was shaved, scrubbed, and disinfected as usual. Traumatic scalp incision was made and the scalp flap was elevated. The temporalis muscle flap was elevated. 5 Burr holes were created followed by right fronto-temporo-parietal craniectomy. Dural tenting was performed and the Dura was opened with C-shaped. Right temporal ICH was removed with partial temporal lobe lobectomy. Hemostasis was achieved with bipolar cautery and Surgicel lining. The fascia of temporalis muscle was harvested and duroplasty was done. ICP monitor was inserted to subdural space with the tip at right temporal fossa. Two epidural CWV drains were placed and the wound was closed in layers. Operators VS王國川 Assistants R3李振豪, R1曾偉倫 Indication Of Emergent Operation 相關圖片 許績淵 (M,1954/08/16,57y6m) 手術日期 2010/06/14 手術主治醫師 蔡瑞章 手術區域 東址 005房 02號 診斷 Brain tumors, malignant 器械術式 Crainotomy Brain Tumor(P-LIN) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 12:45 報到 13:25 進入手術室 13:30 麻醉開始 13:50 誘導結束 14:15 抗生素給藥 14:40 手術開始 17:15 抗生素給藥 17:30 麻醉結束 17:30 手術結束 17:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 腦瘤切除－手術時間在４小時以內 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: left craniotomy for tumor excision 開立醫師: 胡朝凱 開立時間: 2010/06/14 17:33 Pre-operative Diagnosis Left temporal to parietal tumor Post-operative Diagnosis Left temporal to parietal tumor, suspect GBM Operative Method left craniotomy for tumor excision Specimen Count And Types pieces of tumor Pathology Frozen: GBM Operative Findings 1.One irregular shape, reddish, soft tumor located at left parietal lobe to partial temporal lobe with invasive margin. 2.Complete tumor excision was done. 2.Gross total tumor excision was done for the biggest tumor. 3.The tumor was greyish inside with hemorrhagic cavity. The lowest border was not clear. 3.The tumor was grey-reddish inside with hemorrhagic cavity. The lowest border was not clear. Operative Procedures 1.ETGA, supine 2.Left reverse U shape skin incision was done 3.Open periosteum 4.Craniotomy 4.Craniotomy and dura tenting 5.Open dura 6.dissect tumor arround the border initially 7.Further resect tumor with suction 8.hemostasis 9.close dura with prolene 10.Fix bone back with miniplate 11.Set CWV drain then clsoe wound in layers Operators 蔡瑞章 Assistants 王國川,胡朝凱,游健生 葉檉淦 (F,1956/09/18,55y5m) 手術日期 2010/06/14 手術主治醫師 王水深 手術區域 東址 002房 03號 診斷 Hypertension 器械術式 Axilo-bifemoral Bypass 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 黃俊銘, 時間資訊 14:29 麻醉開始 15:28 進入手術室 15:42 誘導結束 16:20 抗生素給藥 16:33 手術開始 19:15 開始輸血 19:20 抗生素給藥 20:25 手術結束 20:25 麻醉結束 20:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 頸（肢體）動靜廔管之切除移植及直接修補，右繞道手術 1 1 B 手術 頸（肢體）動靜廔管之切除移植及直接修補，右繞道手術 1 2 B 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Left axillo-femoral bypass + femoro-femoral b... 開立醫師: 黃俊銘 開立時間: 2010/07/04 16:59 Pre-operative Diagnosis Takayasu arteritis with infra-renal aorta stenosis s/p stenting, with suprarenal aorta stenosis Post-operative Diagnosis Takayasu arteritis with infra-renal aorta stenosis s/p stenting, with suprarenal aorta stenosis Operative Method Left axillo-femoral bypass + femoro-femoral bypass Specimen Count And Types nil Pathology Nil Operative Findings Pre-OP PG(suprarenal-infra-renal):~110mmHg Nearly total occlusion of supra-renal aorta Graft: axillo-femoral: 8mm ringed Impra ePTFE FF-bypass: 8mm ringed Impra ePTFE Post-OP femoral pulsation: R ++, L++ Operative Procedures Supine with left arm abducted, ETGA Skin disinfect, draping Identify and control left axillary artery, bilateral femoral arteries Create subcutaneous tunnel from left inguinal to left subclavian area, posterior to pectoralis major muscle, along AAL, then pass Impra vascular End-to-side anastomosis of graft to axillary artery with 6-0 Prolene End-to-side anastomosis of graft to left CFA with 6-0 Prolene End-to-side anastomosis of graft to right CFA with 6-0 Prolene End-to-side anastomosis of graft to graft with 5-0 Prolene Deair, hemostasis Wound close in layers Operators 王水深 吳毅暉 Assistants 徐綱宏 黃俊銘 陳鄭美仔 (F,1942/05/22,69y9m) 手術日期 2010/06/14 手術主治醫師 杜永光 手術區域 東址 003房 02號 診斷 Aneurysm 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 4 紀錄醫師 蔡宗良, 時間資訊 00:00 臨時手術NPO 15:00 進入手術室 15:10 麻醉開始 15:20 誘導結束 15:50 抗生素給藥 16:00 手術開始 18:45 手術結束 18:45 麻醉結束 19:00 送出病患 19:05 進入恢復室 20:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 頭顱成形術 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Cranioplasty, fronto-temporo-parie, left-sided 開立醫師: 蔡宗良 開立時間: 2010/06/14 19:09 Pre-operative Diagnosis Cranial vault defect, fronto-temporo-parietal, left-sided, s/p craniectomy Post-operative Diagnosis Cranial vault defect, fronto-temporo-parietal, s/p cranioplasty Operative Method Cranioplasty, fronto-temporo-parie, left-sided Specimen Count And Types nil Pathology None Operative Findings Brain slackened. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right. 3. Skin preparation:shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: along the previous operation scar, Raney clips were apllied to the scalp edge for temporary hemostasis. 5. The scalp and temporalis muscle were dissected away from the underlying dura. 5. The scalp ad temporalis muscle flap were reflected. The dural surface and margin of skull defect were well exposed. 6. The bleeders on the dissected surfaces were coagulated with Bovie painstakingly. 7. The edge of the skull defect was exposed. 6. The original skull plate preserved at subcutanuous layer of rt anterior thigh was removed and placed back to the skull window then fixed by 3 wires and a dura tenting at the center of the skull plate. 8. A stainless steel wire mesh was molded to normal contour of right frontotemporal skull and then cut to fit the size and shape of the skull defect. 9. Bone cement paste was applied to the inner surface ofthe wire mesh and printed on the dura surface and skull defect margin, then removed for waiting the hardening of the cement. 10.Bone cement paste was spreaded on outer surface of the wire mesh. 11.Multiple drill holes were made on the skull plate made of bone cement. 12.The artificial skull plate was fixed to the skull with 3 wires. 13.Scalp closure: hemostasis was done with monopolar coagulator touching on the sucker tip. Galea suture was performed by continuous suture with 3/0 Dexon and skin by continuous suture with 3/0 nylon. 14.Drain: one, epidural, collected in a surgeons glove. 15.Blood transfusion: 16.Course of the surgery: smooth. Operators VS 杜永光 Assistants CR 陳睿生, R4 蔡宗良 洪性榮 (M,1940/05/13,71y10m) 手術日期 2010/06/14 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3 紀錄醫師 蔡宗良, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:06 進入手術室 08:12 麻醉開始 08:30 誘導結束 09:00 抗生素給藥 09:32 手術開始 12:00 抗生素給藥 14:20 麻醉結束 14:20 手術結束 14:33 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４～８小時 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Frontal craniotomy for removal of brain tumor 開立醫師: 蔡宗良 開立時間: 2010/06/14 14:48 Pre-operative Diagnosis Brain tumor, frontal lobe, right-sided Post-operative Diagnosis Anaplastic astrocytoma, right frontal Operative Method Frontal craniotomy for removal of brain tumor Specimen Count And Types 1 piece About size:小 Source:Brain, frontal lobe, right-sided Pathology Frozen section: anaplastic astrocytoma Operative Findings 1. Greyish in color, soft in tissue consistency, and poorly demarcated brain tumor over frontal lobe. 2. The tumor protruded below the falx to the contralateral side, resulting an indentation over contralateral brain surface. 3. Bilateral callosomarginal artery was identified, and preserved. Operative Procedures Endotracheal intubation with general anesthesia was performed and the patient is positioned in supine with head rotated 10 degrees to the left. Mayfield headclamp was applied and a bicoronal skin incision behind the hairline was done. Craniotomy was done as depicted. Dura was opened in a inverted-U shape basing on the superior sagittal sinus. Brain retractor was used to retract the fronta lobe to the right. The tumor was found at the right-sided surface in the interhemispheric space. Tumor was sent for frozen section and the remaining part was removed by tumor forceps and bipolar cautery. Hydrogen peroxide was used for hemostasis. The dura was closed and the skull plate was fixed back to the craniotomy window. The wound was closed in layers. Operators VS 杜永光 Assistants CR 陳睿生, R4 蔡宗良 楊淑雯 (F,1949/03/09,63y0m) 手術日期 2010/06/14 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:05 進入手術室 08:15 麻醉開始 08:45 誘導結束 08:50 抗生素給藥 08:50 手術開始 11:50 抗生素給藥 13:00 麻醉結束 13:00 手術結束 13:12 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４～８小時 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Left occipital craniotomy for simpson grade I... 開立醫師: 胡朝凱 開立時間: 2010/06/14 13:25 Pre-operative Diagnosis Left occipital falx meningioma Post-operative Diagnosis Left occipital falx meningioma Operative Method Left occipital craniotomy for simpson grade I tumor excision Specimen Count And Types pieces of tumor Pathology pending Operative Findings 1.One 4x5x4.5 firm, whitish tumor located at left occipital area that arised from falx with bilateral protrusion. 2.The tumor border was clear 3.The dura was excised Operative Procedures 1.ETGA, prone with head fixed with skull clamp 2.Reverse U shape skin incision at left occipital area. 3.reflect skin and periosteum 4.Craniotomy 5.Dural tenting 6.dura opening with the base left at midline 7.dissect to exopse tumor 8.Devascularization at falcine blood supply 9.Dissect along the interface of tumor and brain 10.Resect tumor piece by piece 11.resect the contralateral tumor by dissection 12.Hemostasis 13.Close dura 14.Fix bone back with miniplate 15.Close wound in layers after CWV drain insertion Operators 曾漢民 Assistants 胡朝凱,游健生 陳國松 (M,1941/03/12,71y0m) 手術日期 2010/06/14 手術主治醫師 張金池 手術區域 東址 002房 01號 診斷 Subdural hemorrhage 器械術式 Tracheostomy 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 4E 紀錄醫師 廖先啟, 時間資訊 23:59 臨時手術NPO 23:59 開始NPO 08:00 通知急診手術 08:52 進入手術室 08:55 麻醉開始 09:00 誘導結束 09:15 手術開始 09:35 手術結束 09:35 麻醉結束 09:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 氣管切開造口術 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 廖先啟 開立時間: 2010/06/14 09:37 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types Nil Pathology None Operative Findings Fr. 8 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators VS李章銘 VS張金池 Assistants R2廖先啟 Indication Of Emergent Operation 秦既明 (M,1926/03/07,86y0m) 手術日期 2010/06/14 手術主治醫師 王國川 手術區域 東址 005房 03號 診斷 Dementia senile 器械術式 V-P shunt 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 胡朝凱, 時間資訊 08:00 臨時手術NPO 08:00 開始NPO 12:56 通知急診手術 18:00 進入手術室 18:05 麻醉開始 18:15 誘導結束 18:30 抗生素給藥 18:45 手術開始 19:15 手術結束 19:15 麻醉結束 19:38 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Right programmable Codman VP shunt insertion 開立醫師: 游健生 開立時間: 2010/06/14 19:22 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Right programmable Codman VP shunt insertion Specimen Count And Types nil Pathology nil Operative Findings 1.Opening pressure about less then 10 cmH2O 2.Intraventricular catheter: 6.5 cm Operative Procedures 1.ETGA, supine 2.Right kocher point transverse skin incision 3.open periosteum 4.Burr hole drill 5.OPen dura 6.RUQ minilaparotomy 7.Pass catheter via subcutaneous tunnel 8.Ventricular puncture then insert ventricular catheter 9.Connect to reservior then abdominal catheter 10.Insert abdominal catheter then close wound in layers Operators 王國川 Assistants 胡朝凱 Indication Of Emergent Operation 曾碧清 (F,1963/09/25,48y5m) 手術日期 2010/06/15 手術主治醫師 楊榮森 手術區域 東址 020房 01號 診斷 Bone metastasis 器械術式 THR 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉漢平 ASA 3 紀錄醫師 徐鎮平, 時間資訊 08:05 進入手術室 08:10 麻醉開始 08:35 抗生素給藥 09:00 誘導結束 09:00 手術開始 09:30 開始輸血 10:50 手術結束 10:50 麻醉結束 11:00 送出病患 11:05 進入恢復室 12:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 股關節全置換術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 記錄__ 手術科部: 骨科部 套用罐頭: Total hip replacement-Posterior 開立醫師: 徐鎮平 開立時間: 2010/06/15 10:33 Pre-operative Diagnosis Osteonecrosis of hip, left Post-operative Diagnosis Osteonecrosis of hip, left Operative Method Total hip arthroplasty with United prosthesis (shell 48__mm; head _28_mm; femur stem 11__mm ) Specimen Count And Types 1 piece About size:1 Source:LEFT FEMORAL HEAD Pathology left femoral head Operative Findings 1. Osteophyte over medial wall of acetabulum, femoral neck and head. 2. Cartilage wearing and subchondral bone exposure Operative Procedures Under ET spinal anesthesia, the patient was placed in decubitus position. The skin was dis-infected and scrubbed with beta-iodine detergent and alcoholic solution. Longitudinal skin incision over previous scar and removal of CHS first Posterior approach were done to dissect the joint capsule. Debridement was done with reamer and rongeur. The wound was irrigated with massive normal-saline. The acetabulum rim was exposed. Acetabulum was reamed size by size to fit the proper size of acetabular shield. Trans-acetabular screws x 2 were use to fix the shield Insert was set to shield. Then intra-medullar reaming of the femoral medullar canal with rigid reamer was done size by size. Enlarged the inlet of femoral bone canal by broach to fit the femoral stem. The femoral stem prosthesis was set into femoral canal and head were put onto the stem. The femoral head component was reduced into acetabular prosthesis and the stability of new joint was checked. Then the wound was irrigated with 1000ml normal saline and hemostasis was performed carefully. Finally, the wound was closed layer by layer after Appling one 1/4 hemovac. Operators 楊榮森 Assistants 薛永德,方建豐,徐鎮平 李白菊 (F,1958/03/10,54y0m) 手術日期 2010/06/15 手術主治醫師 楊士弘 手術區域 西址 033房 01號 診斷 Carpal tunnel syndrome 器械術式 Excision of neuroma 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 08:45 報到 09:13 進入手術室 09:32 麻醉開始 09:35 手術開始 10:25 麻醉結束 10:25 手術結束 10:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 正中神經或尺神經腕部減壓術–單側 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 曾峰毅 開立時間: 2010/06/15 10:34 Pre-operative Diagnosis Bilateral carpal tunnel syndrome Post-operative Diagnosis Bilateral carpal tunnel syndrome Operative Method Right median nerve decompression Specimen Count And Types Nil Pathology Nil Operative Findings The hypertrophic fibrotic band compressed the right median nerve tightly. The nerve was decompressed well after the surgery. Operative Procedures With local anaesthesia, the patient was put in supine position with right ar abducted. We made one linear skin incision at right wrist, and dissected to release the flexor reticulum. The wound was closed in layers. Operators VS 蔡翊新 Assistants R3 曾峰毅 林千鶴 (F,1941/06/06,70y9m) 手術日期 2010/06/15 手術主治醫師 蔡瑞章 手術區域 西址 033房 02號 診斷 Carpal tunnel syndrome 器械術式 Decompression of mediun nerve 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 09:00 報到 10:50 進入手術室 11:00 麻醉開始 11:03 手術開始 11:35 手術結束 11:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 正中神經或尺神經腕部減壓術–單側 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 蔡翊新 開立時間: 2010/06/15 11:44 Pre-operative Diagnosis Bilateral carpal tunnel syndrome, status post endoscopic right median nerve decompression Post-operative Diagnosis Bilateral carpal tunnel syndrome, status post endoscopic right median nerve decompression Operative Method Right median nerve decompressin, re-do Specimen Count And Types Nil Pathology Nil Operative Findings Median nerve was compressed by fibrotic band and scarring tissue tightly. The nerve was decompressed after the surgery. Operative Procedures With local anaesthesia, the patient was put in supine position with right arm abduected. We made one linear skin incision at right wrist, and dissected to expose the flexor reticulum. We release the fibrotic band and scarring tissue. The wound was closed in layers. Operators VS 蔡翊新 Assistants R3 曾峰毅 葉中森 (M,1956/12/17,55y2m) 手術日期 2010/06/15 手術主治醫師 蒲永孝 手術區域 東址 001房 03號 診斷 Spinal metastasis 器械術式 TRUS-P biopsy 手術類別 緊急手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 靜脈麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 蘇彥榮, 時間資訊 08:15 臨時手術NPO 08:15 開始NPO 08:41 通知急診手術 17:50 進入手術室 17:53 麻醉開始 17:55 誘導結束 17:58 手術開始 18:06 麻醉結束 18:06 手術結束 18:10 送出病患 18:12 進入恢復室 19:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 前列腺切片－控取式 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 記錄__ 手術科部: 泌尿部 套用罐頭: TRUS-P-biopsy 開立醫師: 蘇彥榮 開立時間: 2010/06/15 17:46 Pre-operative Diagnosis r/o prostate cancer Post-operative Diagnosis r/o prostate cancer Operative Method TRUSP biopsy Specimen Count And Types 4 pieces About size:3 core biopsy Source:right medial About size:3 core biopsy Source:right lateral About size:3 core biopsy Source:left medial About size:3 core biopsy Source:left lateral Pathology pending Operative Findings systemic 12 cores TRUSP biopsy was performed Operative Procedures Under satisfactory anesthesia with the patient in right flank position, prepping and draping was performed in the usual sterile fashion. TRUSP was performed and echo-guided prostate biopsies were performed smoothly with Biopsy gun. The cores of tissue specimen were obtained. The biopsy area was compressed for several minutes to ensure adequate hemostasis. The patient tolerated the operation well and was sent to the floor in satisfactory condition. Operators 蒲永孝, Assistants 楊智凱, 蘇彥榮, 姜秉均, Indication Of Emergent Operation 何開敏 (F,1929/04/08,82y11m) 手術日期 2010/06/15 手術主治醫師 曾勝弘 手術區域 東址 003房 02號 診斷 Seizures 器械術式 V-P shunt 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 黃世銘, 時間資訊 14:00 臨時手術NPO 14:00 開始NPO 16:29 通知急診手術 17:20 進入手術室 17:25 麻醉開始 17:28 誘導結束 18:50 手術開始 21:18 抗生素給藥 22:00 手術結束 22:00 麻醉結束 22:10 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室腹腔分流手術 1 2 R 摘要__ 手術科部: 外科部 套用罐頭: Right Frazier point and right paramedian tran... 開立醫師: 李建勳 開立時間: 2010/06/15 22:33 Pre-operative Diagnosis Hydrocephalus with dilated 4th ventricle Post-operative Diagnosis Hydrocephalus with dilated 4th ventricle Operative Method Right Frazier point and right paramedian transcerebellar ventriculoperitoneal shunts insertion Specimen Count And Types nil Pathology Nil Operative Findings 1. CSF opening pressure: around 10cmH2O 2. Ventricular catheter: right Frazier: 10 cm, right cerebellar: 5cm, peritoneal catheters: 20cm X 2. Medtronic burr-hole type medium pressaure reservoir X2 were used. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position with head fixed with Mayfield skull clump and turned to left. The scalp was shaved, scrubbed, antiseptic with alcohol better-iodine then draped. A linear scslp incision was made at right paramedian followed by two burr holes, one at right Frzier another at 2 cm below inion. The dura was incised after tenting. A ventricular puncture needle was used to puncture the cerebellar trajectory but failed. Use intraoperative sonography to guide the puncture needle then shifted to nelaton tube. The right Frazier point catheter was inserted by the same method. The nelaton tubes were then changed to ventricular catheters and connected to the reservoirs. Minilaparotomy was made at right upper abdomen and the peritoneal catheter was inserted and test function. The two seperated shunt cathers were then passed through subcutaneous layer of abdomen, anterior chest wall, neck, retroauricular area then connected to the reservoirs. After testing the function, the wounds were all closed in layers. Operators VS 曾勝弘 Assistants R1 黃世銘 R6 李建勳 Indication Of Emergent Operation 相關圖片 林明德 (M,1960/12/10,51y3m) 手術日期 2010/06/15 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Parkinsonism 器械術式 Debridment-- 5-10cm 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 07:30 報到 08:07 進入手術室 08:15 麻醉開始 08:20 誘導結束 08:34 抗生素給藥 08:58 手術開始 10:32 手術結束 10:32 麻醉結束 10:40 送出病患 10:42 進入恢復室 12:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 2 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 記錄__ 手術科部: 外科部 套用罐頭: Implantation of neurostimulator for deep brai... 開立醫師: 鍾文桂 開立時間: 2010/06/15 11:01 Pre-operative Diagnosis Parkinsons disease. Post-operative Diagnosis Parkinsons disease. Operative Method Implantation of neurostimulator for deep brain stimulation. Specimen Count And Types nil Pathology Nil. Operative Findings Medtronic Kinetra Neurostimulator, Model 7428. Medtronic Access Therapy Controller Model 7436. Operative Procedures 1. Under ETGA, the patient was placed in supine position and the head was tilted to the right. 2. After shaving, disinfection, and draping, the location of the stimulator was identified. We incised a 5-cm incision and pulled out the electrodes. 3. We also made another incision below the left clavicle. A subcutaneous pocket was made for the stimulator. 4. A subcutaneous tunnel was made from head to chest. The leads were connected together. 5. We used NVision Clinician Programmer Model 8840 for ensuring the connections. 6. Finally the wounds were closed in layers. The patient was sent to POR smoothly. Operators A.P. 曾勝弘. Assistants R4 鍾文桂. 相關圖片 戴基謀 (M,1949/03/04,63y0m) 手術日期 2010/06/15 手術主治醫師 曾勝弘 手術區域 東址 005房 02號 診斷 Spinal stenosis, lumbar 器械術式 Laminectomy for decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 10:10 報到 10:46 進入手術室 10:55 麻醉開始 11:20 誘導結束 11:23 抗生素給藥 12:01 手術開始 14:15 手術結束 14:15 麻醉結束 14:25 送出病患 14:30 進入恢復室 15:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 手術 椎弓切除術（特壓）－二節以內 1 1 記錄__ 手術科部: 外科部 套用罐頭: Decompressive laminectomy at L4,L5 and half o... 開立醫師: 鍾文桂 開立時間: 2010/06/15 14:50 Pre-operative Diagnosis L4/5 lumbar stenosis. Post-operative Diagnosis L4/5 lumbar stenosis. Operative Method Decompressive laminectomy at L4,L5 and half of L3. Specimen Count And Types nil Pathology Nil. Operative Findings Hypertrophic ligamentum flavum. Slack bilateral L4,L5,S1 roots after decompression. Operative Procedures 1. Under ETGA, the patient was placed in prone position. 2. A 10-cm incision was made after ensuring L3/4 and L4/5 levels with C-arm fluoroscope, and disinfection, and draping. 3. The paraspinal muscles were splinted from the spinous process and the laminae by monopolar electrocoagulator. 4. The L4, L5 and part of L3 lamina were removed by Rongeur, and Kerrison punch. The hypertrophied ligamentum flavum were also removed in the same manner. 5. After seeing the slack roots and well hemostasis, we placed a hemovac drain. 6. The wound was closed in layers. Operators V.S. 曾勝弘 Assistants R4 鍾文桂 胡逸然 (F,1976/02/22,36y0m) 手術日期 2010/06/15 手術主治醫師 王水深 手術區域 東址 016房 03號 診斷 Breast cancer, female 器械術式 Port-A Implatation /WOR (C-arm) 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 黃俊銘, 時間資訊 16:08 進入手術室 16:20 抗生素給藥 16:56 麻醉開始 16:57 誘導結束 16:59 手術開始 17:55 手術結束 18:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 內頸靜脈切開，永久導管放置術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Port-A insertion, echo guided 開立醫師: 黃俊銘 開立時間: 2010/06/15 18:25 Pre-operative Diagnosis Breast cancer with bone metastasis Post-operative Diagnosis Breast cancer with bone metastasis Operative Method Port-A insertion, echo guided Specimen Count And Types nil Pathology Nil Operative Findings Puncture to left IJV under echo guidance Good blood return Catheter tip position checked by C-arm Operative Procedures Skin disinfect, draping LA Puncture to left IJV under echo guidance Create subcutaneous pocket Insert catheter via peel away sheath Check guidewire and catheter position by C-arm WOund close Operators 王水深 Assistants 黃俊銘 Ri洪健華 陳林春菊 (F,1938/01/26,74y1m) 手術日期 2010/06/15 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Cervical Spondylosis 器械術式 OPLL- Anterior Corpectomy 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 黃世銘, 時間資訊 00:00 臨時手術NPO 07:33 報到 08:05 進入手術室 08:10 麻醉開始 08:30 誘導結束 09:00 抗生素給藥 10:05 手術開始 12:00 抗生素給藥 13:50 麻醉結束 13:50 手術結束 13:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 手術 椎弓切除術（特壓）－二節以內 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 摘要__ 手術科部: 外科部 套用罐頭: C1-2 transarticular screw and C1 laminectomy ... 開立醫師: 陳盈志 開立時間: 2010/06/15 14:07 Pre-operative Diagnosis C1-2 subluxation with C1 stenosis Post-operative Diagnosis C1-2 subluxation with C1 stenosis Operative Method C1-2 transarticular screw and C1 laminectomy with posterior fusion Specimen Count And Types nil Pathology nil Operative Findings TAS left 38mm, right 32m; no SSEP change was noted during the procedure Posterolateral fusion was done with autologous bone graft from C1 posterior arch Operative Procedures 1.ETGA, prone with Mayfield fixation 2.Skin preparation 3.Midline back incision, detach muscle to expose C1~3 lamina 4.Under C-arm guide, insert guide pin from C2 medial facet to C1 anterior arch, then replace with cannulating screw, perform the procedure bilaterally 5.C1 laminectomy was done with cutting bird drill then 1-0 karrison. 6.Split C1 lamina to 2 piece then perform posterolateral fusion between C1-2 with bone graft and miniplate fixation 7.hemostasis, CWV drain x1 8.close wound in layers Operators VS賴達明 Assistants R6陳盈志R1黃世銘 林春梅 (F,1938/06/04,73y9m) 手術日期 2010/06/15 手術主治醫師 蔡翊新 手術區域 東址 053房 01號 診斷 Subdural hemorrhage following injury, with loss of consciousness of unspecified duration 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 4E 紀錄醫師 李振豪, 時間資訊 13:22 通知急診手術 13:40 報到 13:48 進入手術室 13:50 麻醉開始 13:55 誘導結束 13:58 抗生素給藥 14:13 手術開始 16:58 抗生素給藥 17:10 麻醉結束 17:20 手術結束 17:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 急性硬腦膜下血腫清除術 1 1 R 手術 顱內壓監視置入 1 2 R 記錄__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 蔡翊新 開立時間: 2010/06/15 15:58 Pre-operative Diagnosis Right frontotemporoparietal acute subdural hemorrhage (SDH) Post-operative Diagnosis Right frontotemporoparietal acute subdural hemorrhage (SDH) Operative Method Right frontotemporoparietal craniotomy for SDH removal, duroplasty and ICP monitoring Specimen Count And Types nil Pathology Nil. Operative Findings Tense dura was noted and dark reddish liquified blood gushed out upon first burr hole creation. There were massive blood clots in the subdural space at right F-T-P region, 2 cm in thickness and 14 x 12 cm in area. There were two active bleeders from cortical arteries at right temporal region. No definite contusion or SAH over cortical surface was noted. After SDH removal, the brain was slightly slack. ICP was low after wound closure. Tense dura was noted and dark reddish liquified blood gushed out upon first burr hole creation. There were massive blood clots in the subdural space at right F-T-P region, 2 cm in thickness and 14 x 12 cm in area. There were two active bleeders from cortical arteries at right temporal region. No definite contusion or SAH over cortical surface was noted. After SDH removal, the brain was slightly slack. ICP was low after wound closure. Reference of Codman ICP monitor: 487. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 4 cm at right anterior-lower temporal area, the skin edge was clipped by Raney clips for temporary hemostasis. The temporalis muscle was incised down to the tempoal squama which was exposed then by applying a self retaining retractor on the muscle. 5. A burr hole was made and the dura was incised for evacuating part of the subdural hematoma, therefore the IICP could be relieved earlier. 6. The incision was extended to a temporal horseshoe, and the temporalis muscle was detached from temporal squama by rasp subsequently. 7. Craniotomy window: 12 x 10 cm, right F-T-P, created by making 4 burr holes then cut by power saw. 8. Dural tenting: by 2/0 silk, 2 cm in interval, distributed along the edge of skull window. 9. Dural incision: curvilinear along the edge of skull window. 10.The subdural clot was removed by sucker and those located beyond the cranial window was washed out by saline irrigation. 11.Hemosatasis: the bleeders was stopped by Bovie and oozing surface was covered with gelfoam. 12.Dural closure: with a piece of dural graft taking from temporalis fascia, (crescent shape 12 cm long, 2 cm wide) along the whole length of the dural incision. dural incision. ICP monitor was inserted to subdural space of right temporal region. 13.The skull plate was fixed back by mini-plates and screws. 14.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 15.Drain: two, epidural, CWV. 15.Drain: one epidural and one subgaleal CWV. 16.Blood transfusion: nil. 17.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5胡朝凱R3李振豪 Indication Of Emergent Operation 曾子嫣 (F,2010/06/10,1y9m) 手術日期 2010/06/16 手術主治醫師 許文明 手術區域 兒醫 066房 01號 診斷 Single liveborn, born in hospital, delivered without mention of cesarean delivery 器械術式 exploratory laparotomy 手術類別 緊急手術 手術部位 腹 傷口分類 污染 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 郭庭均, 時間資訊 22:54 臨時手術NPO 22:54 開始NPO 07:30 通知急診手術 08:34 報到 08:35 進入手術室 08:40 麻醉開始 09:30 誘導結束 10:15 抗生素給藥 10:25 手術開始 10:45 開始輸血 12:05 手術結束 12:05 麻醉結束 12:10 送出病患 12:15 抗生素給藥 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 新生兒壞死性腸炎手術，含腸造口 1 1 記錄__ 手術科部: 外科部 套用罐頭: NEC with bowel perforation 開立醫師: 郭庭均 開立時間: 2010/06/16 12:53 Pre-operative Diagnosis NEC with suspected bowel perforation Post-operative Diagnosis NEC with bowel perforation Operative Method Wxplore laparotomy for bowel resection + intra-abdominal abscess drainage + ileostomy Specimen Count And Types 1 piece About size:8-9cm Source:necrotic ilrum Pathology Pending. Operative Findings 1.NEC with bowel perforation, proximal 5-10cm to ileo-cecal junction, necrotic segment around 8cm in length. 2.Turbid ascites. 3.Multiple fibris coating over the intestines. 4.Blood loss: < 10mL. Operative Procedures Under endotracheal general anesthesia, the patient was placed in a supine position. The operation field including the abdomen and the lower chest was disinfected with alcohol-Povidon tincture and dressed properly. A 6cm transverse incision, 2cm in distance from the umbilicus, over the right lower quadrant was made. The incision was deepened to the aponeurosis of the external oblique. The aponeurosis of the external oblique muscle was incised from the edge of the rectus sheath outward the flank parallel to the direction of fibers. With the external oblique aponeurosis held aside by mosquitos hemostats, the internal oblique and transversus muscle were split. The transversalis fascia and peritoneum were picked up between forceps and opened with knife. The intra-abdominal abscess was drained out. The overlying fibrin coating was removed using forceps. We resected the completely necrotic parts of ileum after its blood supply from mesentary divided by electrocauterization and suture ligatures. . A 2cm transverse incision, 4cm below the laparotomy wound, over the right lower quadrant was made. We extracted the ileum using ring forceps. Ileotomy was made. Check bleeding and possible pus accumulations over paracolic gutter and Douglas pouch. We indwelled three Penrose drainages over subhepatic area, Douglas pouch, and subsplenic area. The wound was closed in layers. (Recorded by R2郭庭均) Operators VS許文明 Assistants R5丘基泰,R2郭庭均 Indication Of Emergent Operation 相關圖片 沈惠婷 (F,1972/08/03,39y7m) 手術日期 2010/06/16 手術主治醫師 杜永光 手術區域 東址 026房 號 診斷 Brain Tumor 器械術式 V-P shunt 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3E 紀錄醫師 許松鈺, 時間資訊 00:42 開始NPO 00:42 臨時手術NPO 08:43 通知急診手術 13:04 報到 13:05 進入手術室 13:10 麻醉開始 13:12 誘導結束 14:25 手術開始 16:20 麻醉結束 16:20 手術結束 16:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 記錄__ 手術科部: 外科部 套用罐頭: V-P Shunt, right Kocher point 開立醫師: 許松鈺 開立時間: 2010/06/16 16:46 Pre-operative Diagnosis Cavernous hemangioma, left, status post vascular lesion removal Post-operative Diagnosis Cavernous hemangioma, left, status post vascular lesion removal Operative Method V-P Shunt, right Kocher point Specimen Count And Types EVD tip culture Pathology Nil Operative Findings 1. Severe bradycardia(~30-40bpm)was noted during operation and recovered after VP shunt was placed successfully 2. Codman fixed pressure reservoir 100mmH2O was used Operative Procedures ETGA, supine position with head tilt to left side, skin disinfection. We made skin incision along previous operative wound and mild extend to the right side. A burr hole was made and the dura was tented by two stitches. The dura was opened by a nib incision. Rt lateral ventricle was tapped by a ventricular needle, then a ventricular catheter was introduced into the ventricle. A nib incision was made at RUQ of the abdomen , then a trocar was pushed into peritoneal cavity. The proximal end of this catheter was passed through subcutaneous tunnel at forechest, neck, rt retroauricular area and connected the reservoir. The shunt system was checked to make sure its function was working. Distal 25 cm segment of the peritoneal catheter was introduced into the peritoneal cavity through the outer tube of the trochar. We closed the wound over head and abdomen layer by layer. Operators p杜永光 Assistants 陳睿生, 許松鈺 Indication Of Emergent Operation 相關圖片 張金寶 (M,1945/07/04,66y8m) 手術日期 2010/06/17 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Hydrocephalus 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3 紀錄醫師 蔡宗良, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:10 進入手術室 08:15 麻醉開始 08:30 誘導結束 09:22 抗生素給藥 09:40 手術開始 10:48 手術結束 10:48 麻醉結束 10:56 送出病患 11:00 進入恢復室 13:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 記錄__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 蔡宗良 開立時間: 2010/06/17 11:06 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunting, right-sided Specimen Count And Types 3 tube, CSF, for routine lab Pathology none Operative Findings 1. Ventriculostomy succeeded in one attempt. 2. CSF: clear 3. Intraventricular pressure: 10 cmH2O Operative Procedures General anesthesia applied with endotracheal intubation. Patient was positioned in supine with head rotated to 60 degrees to the left. Skin was prepped and drapped as usual. Incision was done with 5 cm curvilinear to the right Kocher point. Raney clips were applied to the scalp edge for temporary hemostasis. After the scalp flap had been lifted and reflected anteriorly, a burr hole was made and the dura was tented by 1 stitches. The dura was opened by a nib incision. Right lateral ventricle was tapped by a ventricular needle, then a 6.5 cm segment of the ventricular catheter was introduced into the ventricle. The outer end of the catheter was connected to a medium-pressure reservoir. A linear incision was made at RUQ of the abdomen , then a trocar was pushed into peritoneal cavity. Subsequently, distal 20 cm segment of the peritoneal catheter was introduced into the peritoneal cavity through the outer tube of the trochar. The proximal end of this catheter was passed through subcutaneous tunnel at forechest, neck, rt retroauricular area and connected the reservoir. The shunt system was checked to make sure its function was working. The reservoir was fixed to pericranium by 3 stitches. Wounds were closed in layers. Operators VS 杜永光 Assistants R4 蔡宗良, R4 陳德福 朱文敏 (F,1960/04/08,51y11m) 手術日期 2010/06/17 手術主治醫師 蔡瑞章 手術區域 東址 002房 01號 診斷 Brain abscess 器械術式 Brain abscess drainage/evacuation 手術類別 緊急手術 手術部位 頭、頸 傷口分類 髒 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2E 紀錄醫師 曾峰毅, 時間資訊 00:00 開始NPO 00:00 臨時手術NPO 07:00 通知急診手術 08:32 報到 08:45 進入手術室 09:00 麻醉開始 09:30 抗生素給藥 09:40 誘導結束 10:02 手術開始 11:25 麻醉結束 11:25 手術結束 11:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦組織活體切片 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Right parietal craniotomy for abscess drainage 開立醫師: 李建勳 開立時間: 2010/06/17 11:26 Pre-operative Diagnosis Right parietal abscess Post-operative Diagnosis Right parietal abscess Operative Method Right parietal craniotomy for abscess drainage Specimen Count And Types 1 piece About size:7 Source:3xswab culture, 4X pus tube Pathology Nil Operative Findings Yellowish, sticky abscess for 10 c.c. was aspirated from the lesion. Operative Procedures Under general anesthesia and intubation, the patient was put in prone position with head fixed with Mayfield skull clump. The scalp was shaved, scrubbed, disinfected with alcohol better iodine then draped. Linear scalp incision was made 2 cm paramedian for 8cm followed by craniotomy 4X4cm. The dura incision was made after tenting along the craniotomy window. The abscess was punctured with ventricular puncture needle after intraoperative sonography localization. The abscess was aspirated and the cavity was irrigated with normal saline. The dura was closed with 3-0 silk sutures and the skull plate was fixed back with wires. The wound was closed in layers after one subcutanesous CWV drain set up. Operators P 蔡瑞章 Assistants R3 曾峰毅 R6 李建勳 Indication Of Emergent Operation 相關圖片 黃進福 (M,1945/01/28,67y1m) 手術日期 2010/06/17 手術主治醫師 陳敞牧 手術區域 東址 005房 01號 診斷 Spinal stenosis, lumbar 器械術式 Laminectomy for decompression 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:05 進入手術室 08:10 麻醉開始 08:25 誘導結束 09:10 抗生素給藥 09:18 手術開始 12:10 抗生素給藥 12:40 開始輸血 12:50 手術結束 12:50 麻醉結束 13:00 送出病患 13:05 進入恢復室 14:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術（特壓）－二節以內 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: Sublaminar decompression of L4 and part of L5. 開立醫師: 鍾文桂 開立時間: 2010/06/17 13:07 Pre-operative Diagnosis L4/5 lumbar stenosis. Post-operative Diagnosis L4/5 lumbar stenosis. Operative Method Sublaminar decompression of L4 and part of L5. Specimen Count And Types nil Pathology Nil. Operative Findings Hypertrophic ligamentum flavum. The roots and thecal sac were slack after decompression. Dura tear with exposure of right L4 rootlet. Repair with Gelfoam packing. Dura tear with exposure of right L5 rootlet. Repair with Gelfoam packing. Operative Procedures 1. ETGA, prone position. 2. Disinfection, draping, and localization of L4/5 with fluoroscopy. 3. Midline incision and paraspinal dissection. 4. Splitting of spinous process with high speed drill. 5. Sublaminar decompression with Rongeur and Kerrison punch. 5. Repair of dura mater with Gelfoam packing. 6. Placement of one epidural CWV drain. 7. Wound closure in layers. 8. Send the patient to POR smoothly. Operators V.S. 陳敞牧. Assistants R4 鍾文桂, R1 曾偉倫. 彭忠信 (M,1939/08/29,72y6m) 手術日期 2010/06/17 手術主治醫師 蕭輔仁 手術區域 東址 003房 02號 診斷 C5-C7 level with unspecified spinal cord injury 器械術式 Spinal fusion post (Halifax) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 胡朝凱, 時間資訊 00:00 臨時手術NPO 10:48 報到 11:19 進入手術室 11:20 麻醉開始 11:45 誘導結束 12:40 抗生素給藥 13:00 手術開始 16:10 抗生素給藥 17:05 手術結束 17:05 麻醉結束 17:20 送出病患 17:30 進入恢復室 18:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 手術 椎弓切除術（特壓）－超過二節 1 2 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: C5~T1 laminectomy with C5,6,T1 lateral mass s... 開立醫師: 胡朝凱 開立時間: 2010/06/17 17:22 Pre-operative Diagnosis C6~7 traumatic spinal cord injury Post-operative Diagnosis C6~7 traumatic spinal cord injury Operative Method C5~T1 laminectomy with C5,6,T1 lateral mass screws insertion C5~T1 laminectomy with C5,6 lateral mass screws and T1 TPS insertion Specimen Count And Types nil Pathology nil Operative Findings 1.One piece of bony fragment was noted that inpinge at C5~6 level that compressed the spinal cord tightly. 2.Much adhesion tissue and fibrosis was noted since wound opening and epidural area. 3.After decompression, the cord expanded well Operative Procedures 1.ETGA, prone with head fixed with skull clamp 2.Midline incision at C2 to T1 level 3.Detach paravertebral muscle and fibrotic tissue to expose lamina and lateral mass. 4.Laminectomy at C5~T1 5.Remove bone chip at C5~6 level 6.Lateral mass screws insertion 7.T1 TPS insertion 8.Fix rods 9.Fix cross link 10.Set hemovac drain then close wound in layers Operators 蕭輔仁 Assistants 胡朝凱, Ri 徐水火 (M,1954/07/30,57y7m) 手術日期 2010/06/17 手術主治醫師 蕭輔仁 手術區域 東址 053房 01號 診斷 頸部退化性脊椎炎(Cervical spondylosis) 器械術式 Laminectomy C-Spinal(Posterier 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3 紀錄醫師 陳盈志, 時間資訊 00:00 臨時手術NPO 09:10 報到 09:15 進入手術室 09:20 麻醉開始 09:30 誘導結束 10:00 抗生素給藥 10:18 手術開始 13:00 抗生素給藥 13:25 手術結束 13:25 麻醉結束 13:30 送出病患 13:35 進入恢復室 14:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 良性病髓腫瘤切除術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: cord tumor biopsy 開立醫師: 陳盈志 開立時間: 2010/06/17 13:43 Pre-operative Diagnosis Cervical cord intramedullary tumor s/p laminoplasty Post-operative Diagnosis Cervical cord intramedullary tumor s/p laminoplasty Operative Method cord tumor biopsy Specimen Count And Types 1 piece About size:Small piece Source:Cervical cord intramedullary tumor Pathology pending Operative Findings The tumor was soft elastic yellowish in character and its margin was not clear. Tumor extend beyond the C6-7. Previous duroplasty was noted and biopsy site at C7 was also found. This time biopsy site was upper then previous one at about C6-7 level. Cord was slightly enlarged and 1mm thick cord was noted. There is multiple minimal whitish spot noted in the tumor. Frozen showed suspect sarcoidosis or inflammation Operative Procedures 1.ETGA, prone with Mayfield fixation 2.Skin preparation 3.Midline back incision along previous wound 4.Detach paraspinal muscle till T1 lamina expose then upward dissection till dura exposure. 5.Midline dura incision (previous incision along right side) then retracted 6.Cordotomy then tumor biopsy with miniscalpel and ring forceps 7.Hemostasis with durgicel and N/S irrigation 8.Close dura in layers 9.epidural CWV x1 then close wound in layers Operators VS蕭輔仁 Assistants R6陳盈志Ri 楊吉 (M,1950/06/20,61y8m) 手術日期 2010/06/17 手術主治醫師 王國川 手術區域 東址 005房 02號 診斷 Stroke 器械術式 Craniotomy for tumor remove 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 4 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 13:13 進入手術室 13:25 麻醉開始 14:15 誘導結束 14:30 抗生素給藥 14:55 手術開始 18:35 抗生素給藥 18:45 手術結束 18:45 麻醉結束 18:55 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 顱內外血管吻合術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: EC-IC bypass, right. 開立醫師: 鍾文桂 開立時間: 2010/06/17 19:19 Pre-operative Diagnosis 1. Carotid stenosis. 2. Multiple lacunar infarcts in ACA, MCA territories. Post-operative Diagnosis 1. Carotid stenosis. 2. Multiple lacunar infarcts in ACA, MCA territories. Operative Method EC-IC bypass, right. Specimen Count And Types nil Pathology Nil. Operative Findings 1. Frontal branch of superficial temporal artery was anastomosed with M4 branch of MCA in end to side fashion. 2. A small anastomosis leakage was sealed with Surgicel. 3. Ischemic time: 30 minutes. 4. Good flow and pulsation of both arteries after anastomosis. Operative Procedures 1. ETGA, supine position, head tilted to left. 2. Outline the superficial temporal artery with Doppler on scalp. 3. Shaving, disinfection, and draping. 4. Incision and dissection to expose STA. 5. Excision of STA from its distal part and clip it with tempoary clip. 6. Dissection of temporalis muscle; A 5 cm craniotomy. 7. Durotomy and dural tenting. 8. Dissection of arachnoid membrane and exposure of M4 branch of MCA. 9. Placement of temporary clips at each end of MCA. Incision of MCA wall. 10.Anastomosis of MCA and STA with 10-0 Prolene. 11.Ensurance of patency of anastomosis and seal of possible leakage. 12.Duraplasty with DuraGen. Fixation of bone plates with plates and screws. 13.Wound closure in layers after placing one CWV drain. Operators V.S. 王國川 Assistants R4 鍾文桂 R1 曾偉倫 林素秋 (F,1956/01/20,56y1m) 手術日期 2010/06/18 手術主治醫師 黃鶴翔 手術區域 西址 039房 11號 診斷 Hematuria 器械術式 Fiberocystoscopy /WOR 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 11:50 進入手術室 11:52 手術開始 11:54 手術結束 11:56 送出病患 游秀琴 (F,1942/05/15,69y9m) 手術日期 2010/06/18 手術主治醫師 曾漢民 手術區域 東址 002房 03號 診斷 Subdural hemorrhage or effusion 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 鍾文桂, 時間資訊 08:00 臨時手術NPO 08:00 開始NPO 11:59 通知急診手術 13:48 報到 13:56 進入手術室 14:00 麻醉開始 14:15 誘導結束 14:35 抗生素給藥 15:00 手術開始 17:30 抗生素給藥 17:30 手術結束 17:40 麻醉結束 17:40 送出病患 17:42 進入恢復室 18:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 手術 慢性硬腦膜下血腫清除術 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Craniotomy for evauation of subdural hemorrhage. 開立醫師: 鍾文桂 開立時間: 2010/06/18 18:14 Pre-operative Diagnosis Subacute and chronic subdural hemorrhage at left frontal-temporal-parietal regions. Post-operative Diagnosis Subacute and chronic subdural hemorrhage at left frontal-temporal-parietal regions. Operative Method Craniotomy for evauation of subdural hemorrhage. Specimen Count And Types nil Pathology Nil. Operative Findings 1. Presence of inner and outer membranes. 2. Several bridging veins were noted and left intact. No active bleeder was noted. 3. Blood clot was dark red-brown in color,and gel like consistency. Some liquified hematoma was also noted. Operative Procedures 1. ETGA, supine position, head tilted to the right. 2. Shaving, disinfection, and draping. 3. Curvilinear incision at left frontal region. 4. Scalp incision and dissection. 5. A 5-cm craniotomy. 6. ㄇ- shape durotomy and dural tenting. 7. Evacuation of subacute and chronic hematoma by suction. 8. Electrocoagulation of outer membrane at durotomy edges. 9. Water-tight duraplasty. 10.Placement of one subdural drain. 11.Fixation of skull bone plate with plates and screws. 12.Wound closure in layers. 13.Evacuation of subdural air. 14.Send the patient to POR smoothly. Operators V.S. 曾漢民 Assistants R6 陳盈志 R4鍾文桂 Indication Of Emergent Operation 張子強 (M,1979/11/19,32y3m) 手術日期 2010/06/18 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Pituitary tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 胡朝凱, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:03 進入手術室 08:10 麻醉開始 08:25 誘導結束 09:10 抗生素給藥 09:30 手術開始 11:15 麻醉結束 11:15 手術結束 11:25 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 經由蝶竇之腦下垂體瘤切除 1 1 記錄__ 手術科部: 外科部 套用罐頭: Transnasal trans-sphenoidal approach for tumo... 開立醫師: 胡朝凱 開立時間: 2010/06/18 11:34 Pre-operative Diagnosis pituitary macroadenoma Post-operative Diagnosis pituitary macroadenoma Operative Method Transnasal trans-sphenoidal approach for tumor excision Specimen Count And Types pieces of tumor Pathology PENDING Operative Findings The tumor was yellowish, soft one located inside the sella turcica. Post-OP, the normal gland and arachnoid membrane was seen. One small CSF leak at olfactory nerve area was noted. Operative Procedures After ETGA, the patient was put in supine position with head mild left tilt. The nasal cavity was well-disinfective, and then we incised into the nasal septum. Dissection was performed along with the periosteum to expose sphenoid sinus anterior wall and sphenoid ostia. After fracture of vomer, sphenoid sinus anterior wall was also fractured. The mucosa was removed. The sella floor was exposed and removed with kerrison. After cruciate form incision, tumor buldged out. And it was further removed with tumor forceps and ring currette. After total excision of tumor was made, the bony graft was put back and followed by compaction of merosel. Operators 曾漢民 Assistants 胡朝凱 黃素珠 (F,1960/12/10,51y3m) 手術日期 2010/06/18 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Acoustic tumor 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 11:10 報到 11:50 進入手術室 11:55 麻醉開始 12:29 抗生素給藥 12:45 誘導結束 13:19 手術開始 15:29 抗生素給藥 16:55 麻醉結束 16:55 手術結束 17:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 顱底瘤手術 1 1 摘要__ 手術科部: 外科部 套用罐頭: Left retrosigmoid approach for tumor excision 開立醫師: 游健生 開立時間: 2010/06/18 17:59 Pre-operative Diagnosis Left acoustic neuroma Post-operative Diagnosis Left acoustic neuroma Operative Method Left retrosigmoid approach for tumor excision Specimen Count And Types 1 piece About size:0.5x0.5cm Source:left acoustic nerve tumor Pathology pending Operative Findings The tumor arised from CN VII spreading it into a thin layer. Part of the tumor extended into internal acoustic canal, which was left in situ after surgery, expanding the internal acoustic meatus. It was yellowish and elastic and has cystic component. It was well-encapsulated and clearly separated from brain by arachnoid. CN V, VII, IX and branches from basliar artery and AICA were identified and preserved. The tumor arised from CN VIII spreading it into a thin layer. Part of the tumor extended into internal acoustic canal, which was left in situ after surgery, expanding the internal acoustic meatus. It was yellowish and elastic and has cystic component. It was well-encapsulated and clearly separated from brain by arachnoid. CN V, VII, IX and branches from basliar artery and AICA were identified and preserved. Operative Procedures Under ETGA, patient was put into 3/4 prone position with head turning to right and fixed by Mayfield headholder. After shaving of hair, we disinfected and draped the operation field with plastic adhesive sheet. A linear incison was made at posterior border of mastoid process. We dissected in layers and harvested fasica grafts. After exposing the skull, craniotomy was done with anterior border at sigmoid sinus and superior border at transverse sinus. We packed the mastoid air cells by beta-ioidine soaked gelfoam, Tissucol-duo, and finally covered with fasica graft. A curvilinear durotomy was done and dura falp was reflected toward sigmiod sinus with silk sutures. Cerebellum was gentlely retracted and detached from adhesion sites by bipolar electrocautery. After well-exposure of the tumor, facial nerve stimulation was done to confirm it was not at the tumor surface. Then, we incised the tumor capsule and central debulking was performed initially. After central debulking in piece-meal and draining out cystic content, the tumor capsule was retracted and dissected from brain along the arachnoid plane. Before removal of the tumor, we identified the facial nerve by stimulation and presevred it. The tumor part inside internal acoustic canal was left in situ. After tumor removal, we identified CN V, VII, IX, and branches from basilar artery and AICA. We performed dura plasty with fasica graft and sutured with water-tight continuous Prolene after hemostasis and expelling the air by normal saline. We fixed the bone flap back after packing gel-foam at epidural space. Finally, closed the wound in layers. Operators VS 曾漢民 Assistants R5 胡朝凱 R2 游健生 馮元 (M,2001/05/11,10y10m) 手術日期 2010/06/18 手術主治醫師 許文明 手術區域 兒醫 063房 01號 診斷 Brain tumor 器械術式 Port-A catheter implatation 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 柯柏瑞, 時間資訊 07:40 報到 08:05 進入手術室 08:10 麻醉開始 08:20 誘導結束 08:40 抗生素給藥 08:45 手術開始 09:30 手術結束 09:30 麻醉結束 09:33 送出病患 09:35 進入恢復室 10:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 ｐｏｒｔ–Ａ導管植入術–治療性導管植入術 1 0 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Port-A 開立醫師: 柯柏瑞 開立時間: 2010/06/18 09:39 Pre-operative Diagnosis Brain tumor Post-operative Diagnosis Brain tumor Operative Method Port-A insertion Port-A insertion, right subclavian vein Specimen Count And Types nil Pathology nil Operative Findings Post-operative portable X-ray showed Port-A catheter tip in RA Operative Procedures 1.General anesthesia, LMA intubation, supine position, skin disinfection 2.Port-A implant into right subclavian vein by puncture method 3.Intra-OP CXR confirm the location 4.Close the wound by layers Operators 許文明, Assistants 柯柏瑞 林弘造 (M,1945/07/28,66y7m) 手術日期 2010/06/18 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Dislocations of first cervical vertebra, closed 器械術式 Spinal fusion post (Halifax) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 蔡宗良, 時間資訊 00:00 臨時手術NPO 07:30 報到 08:05 進入手術室 08:15 麻醉開始 08:35 誘導結束 10:10 抗生素給藥 10:26 手術開始 13:15 抗生素給藥 13:50 麻醉結束 13:50 手術結束 14:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 手術 椎弓切除術（特壓）－二節以內 1 2 手術 誘發電位手術監視機–腦神經外科術中特殊儀器使用費 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: 1. Posterior transarticular screw fixation, b... 開立醫師: 蔡宗良 開立時間: 2010/06/18 14:22 Pre-operative Diagnosis Subluxation C1-2 Post-operative Diagnosis Subluxation C1-2 Operative Method 1. Posterior transarticular screw fixation, bilateral 2. C1 laminectomy Specimen Count And Types None Pathology None Operative Findings The tip of the bilateral TA screws were slightly above C1. Operative Procedures General anesthesia was applied through endotracheal intubation. Patient was positioned in prone position with head fixed by Mayfield head-clamp. Operation field was prepped and drapped routinely. Skin incision began from inion to C6 level. Periosteal dissection was performed to exposed the spinous process until bilateral facet joints of C2-3 were seen. Inner aspects of spinal cord at C1-2 level were dissected. Bilateral transarticular screw were fixed under fluoroscopic guidance. C1 arch were removed and bone fragments were fixed by mini-plates. The wound was closed in layers after placing a CWV drain at the epidural space. Operators VS 賴達明 Assistants CR 陳睿生, R4 蔡宗良 黃正德 (M,1938/11/11,73y4m) 手術日期 2010/06/18 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Cervical Spondylosis 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 蔡宗良, 時間資訊 00:00 臨時手術NPO 08:35 進入恢復室 13:30 報到 14:10 進入手術室 14:20 麻醉開始 14:45 誘導結束 15:05 抗生素給藥 15:21 手術開始 18:05 抗生素給藥 18:15 手術結束 18:15 麻醉結束 18:25 送出病患 19:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術－頸椎 1 1 手術 脊椎融合術－前融合，無固定物（＜＝四節） 1 2 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 麻醉 Glucose 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 記錄__ 手術科部: 外科部 套用罐頭: Anterior Discectomy and Fusion, Cervical Spine 開立醫師: 蔡宗良 開立時間: 2010/06/18 18:44 Pre-operative Diagnosis Herniated cervical disc, C3-4 Post-operative Diagnosis Herniated cervical disc, C3-4 Operative Method Anterior Discectomy and Fusion, Cervical Spine Specimen Count And Types nil Pathology None Operative Findings 1. Redundant OPLL 2. Herniated cervical disc towards thecal sac Operative Procedures 1. Anesthesia: endotracheal general 2.Position: supine with neck hyperextended by a air cuff placed beneath the shoulder. Rt side pelvis was elevated too. 3. Skin preparation: the anterior neck and rt iliac crest was shaved and scrubbed with povidone-iodinew detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4.Incision; 5 cm, transverse middle cervical, extended from anterior margin of sternocleidomastoid (SCM) muscle to thyroid cartilage. 5. The plastisma muscle was transected and mobilized from the underlying superficial cervical fascia which was then opened in vertical direction along the anterior margin of the SCM muscle. 6.The dissection was advanced at the loose plane between SCM muscle and strip muscles until the prevertebral fascia had been reached. The former structure was retracted to the lateral and the later structures with esophagus and trachea to the opposite side by Cloward cervical retractor. 7.The prevertebral fascia was opened vertically, the lesion intervertebral space was exposed and identified by intraoperative portable X-ray 8.The most medial portion of the longus coli muscles on both sides were detached from the vertebral bodies to providea wider exposure of the vertebral bodies. 9.The anterior longitudinal ligment was incised transversely at the margins of intervertebral space, the annulus fibrosus was cut too. 10.The degenerated disc and cartilage plate were removed by curette andthe anterior-inferior rim of vertebral body was resected by Kerrison punch for easier approach to the posterior rim of the intervertebral space. 11.The intervertebral spac was widened by a Cloward interveetebral spreader. The posterior longitudinal ligament was cut from bony edge by curette and then removed. Consequently, the spinal dura expanded into the intervertebral space. 12.The surfaces of vertebral bodies at this intervertebral space was trimed by high speed air drill to creat a biconcave intervertebral space. 13.A 6 mm PEEK cage was impacted into the intervertebral space. 14.The bone graft was packed into the intervertebral space tightly by a impactor. The intervertebral space was widened by pulling the patients head whilethe impaction of the bone graft was doing. 15.The air cuff beneath the shoulder was deflated, the Cloward cervical retractor removed. 16.Wound closure: continuous suture with 4/0 Dexon for plastisma and continuous suture with 4/0 nylon on the skin. Operators VS 賴達明 Assistants CR 陳睿生, R4 蔡宗良 蔡添財 (M,1935/07/26,76y7m) 手術日期 2010/06/18 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Lumbar Spondylosis 器械術式 Laminectomy for decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 黃世銘, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:10 進入手術室 08:15 麻醉開始 08:20 誘導結束 09:00 抗生素給藥 09:24 手術開始 11:35 手術結束 11:35 麻醉結束 11:45 送出病患 11:45 進入恢復室 12:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術（特壓）－二節以內 1 2 手術 脊椎融合術－後融合，無固定物 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 摘要__ 手術科部: 外科部 套用罐頭: L2-3 decompressive laminectomy 開立醫師: 陳德福 開立時間: 2010/06/18 11:54 Pre-operative Diagnosis Lumbar stenosis with radiculopathy, L2-3 Post-operative Diagnosis Lumbar stenosis with radiculopathy, L2-3 Operative Method L2-3 decompressive laminectomy Specimen Count And Types NIL Pathology NIL Operative Findings 1.The hypertrophic ligamentum flavum over L2-3 was noticed and the thecal sac was decompressed after the laminectomy. 2.Bilateral foraminotomy of L3 root is performed 3.Posteral lateral fusion with autologous bone was done Operative Procedures Under ETGA and prone position, the skin was disinfected and draped as usual. One linear incision at midline is done and the paraspinous muscle was displaced laterally. The lamina of L2 and L3 was exposed and laminectomy for decompression is done. The hypertropic ligamentum flavum was removed. Foraminotomy was performed and the thecal sac expanded well. One epidural drainage was left in situ. Posteral lateral fusion with autologous bone was done. The wound was closed in layers. Operators VS 賴達明 Assistants r4 陳德福 r1黃世銘 林來有 (F,1948/02/25,64y0m) 手術日期 2010/06/18 手術主治醫師 賴達明 手術區域 東址 019房 02號 診斷 Herniation of intervertebral disc 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 黃世銘, 時間資訊 00:00 臨時手術NPO 11:37 報到 12:00 進入手術室 12:10 麻醉開始 12:20 誘導結束 12:30 抗生素給藥 13:05 手術開始 15:30 手術結束 15:30 抗生素給藥 15:35 麻醉結束 15:55 進入恢復室 16:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 B 手術 椎弓切除術（特壓）－二節以內 1 2 B 摘要__ 手術科部: 外科部 套用罐頭: 1.L4-5 TPS fusion 2.L4 laminotomy 開立醫師: 陳德福 開立時間: 2010/06/18 16:02 Pre-operative Diagnosis L4-5 protruding disc and spondylolisthesis with neurogenic claudication Post-operative Diagnosis L4-5 protruding disc and spondylolisthesis with neurogenic claudication Operative Method 1.L4-5 TPS fusion 2.L4 laminotomy Specimen Count And Types nil Pathology nil Operative Findings 1.The spinal stenosis is noticed at L4-5 and 4 TPS with rod was implantated via lateral approach route 2.Laminotomy window was done for decompression at the lower L4 Operative Procedures Under ETGA and prone position, the skin disinfection and draping was done. Linear incision at midline and the subcutaneous tissue was displaced laterally in order to make a opening of the fascia of the paraspinous muscle . The junction of transverse process and facet joint of L4 and L5 was identified. The TPS was then implantated under flouroscopic guided bilaterally. 2 rods was inserted as well. Lower L4 laminotomy was done and the hypertrophic ligamentum flavum was remvoed. One epidural and subcutaneous draiange was left in situ and the wound was closed in layers. Operators VS 賴達明 Assistants R4 陳德福 R1 黃世銘 游輝強 (M,1956/03/18,55y11m) 手術日期 2010/06/18 手術主治醫師 賴達明 手術區域 東址 019房 03號 診斷 HIVD 器械術式 Diskectomy lumbar(Others) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 黃世銘, 時間資訊 00:00 臨時手術NPO 15:45 報到 16:10 進入手術室 16:15 麻醉開始 16:25 誘導結束 16:35 抗生素給藥 17:06 手術開始 19:10 手術結束 19:10 麻醉結束 19:20 送出病患 20:47 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 椎弓切除術（特壓）－二節以內 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: left L3-4 laminotomy 開立醫師: 陳德福 開立時間: 2010/06/18 19:29 Pre-operative Diagnosis Lumbar spine HIVS with stenosis, L3-5 Lumbar spine HIVD with stenosis, L3-5 Post-operative Diagnosis Lumbar spine HIVS with stenosis, L3-5 Lumbar spine HIVD with stenosis, L3-5 Operative Method left L3-4 laminotomy Specimen Count And Types nil Pathology nil Operative Findings The hypertrophic ligamentum flavum and protruding herniated disc was noticed at the L3-4 and L4-5. After laminotomy, the nerve root was well decomprssed and clear identified. One minor dura tear with CSF leakage developed during this procedure and the CSF leakage stopped after packing. Operative Procedures Under ETGA and prone position, the skin was disinfected and draped as usual. One 4cm linear incision was done in the midline and the left paraspinous muscle was displaced laterally to expose the L3-4 lamina. Laminotomy was done and the ligamentum flavum was removed as well. The nerve root was decompressed and the wound was closed in layers. Operators VS賴達明 Assistants R4陳德福 R1黃世銘 江麗華 (F,1963/05/27,48y9m) 手術日期 2010/06/18 手術主治醫師 張金堅 手術區域 東址 056房 04號 診斷 Female breast cancer 器械術式 Port-A catheter Implatation 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 陳政維, 時間資訊 14:00 進入手術室 14:14 抗生素給藥 14:35 手術開始 15:45 手術結束 15:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 ｐｏｒｔ–Ａ導管植入術–治療性導管植入術 1 0 R 記錄__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 陳政維 開立時間: 2010/06/18 16:05 Pre-operative Diagnosis Breast cancer, s/p operation Post-operative Diagnosis Ditto Operative Method Port-A catheter implantation Specimen Count And Types Nil Pathology Nil Operative Findings 1. Port-A catheter indwelled via right IJV to SVC smoothly 2. Old port-A wound over right deltopectralis groove, cervical vertebral metastasis s/p operation Operative Procedures 1. LA, supine position 2. Skin disinfection and well draped 3. Puncture IJV then indwelled guide wire 4. Make subcutaneous tunnel to right chest wall, make right chest wall pocket 5. Indwelled cather, set port-A, flow patent 6. Check CXR, well localization 7. Close the wound in layers Operators P 張金堅 Assistants R2 陳政維 黃呈烈 (M,1949/04/10,62y11m) 手術日期 2010/06/19 手術主治醫師 陳敞牧 手術區域 東址 019房 01號 診斷 Subarachnoid hemorrhage 器械術式 External ventricular drainage，Craniotomy(Aneurysms) VS-TZENG 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林子富 ASA 3E 紀錄醫師 胡朝凱, 時間資訊 03:58 報到 04:00 進入手術室 04:05 麻醉開始 04:25 誘導結束 05:10 抗生素給藥 05:13 手術開始 08:10 抗生素給藥 09:45 開始輸血 11:16 抗生素給藥 11:35 手術結束 11:35 麻醉結束 11:45 送出病患 20:00 開始NPO 20:00 臨時手術NPO 醫令資訊 類別 名稱 量 刀 側 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 開顱術摘除血管病變－腦血管瘤－有徵的 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 7 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 腦內血腫清除術 1 2 記錄__ 手術科部: 外科部 套用罐頭: Right pterional approach for aneurysm clipping 開立醫師: 胡朝凱 開立時間: 2010/06/19 12:17 Pre-operative Diagnosis A-com aneurysm rupture with ICH and SAH Post-operative Diagnosis A-com aneurysm rupture with ICH and SAH Operative Method Right pterional approach for aneurysm clipping Specimen Count And Types nil Pathology nil Operative Findings 1.One about 8x3 mm saccular aneurysm arise from A-com and protruded toward right upper area. And about 40 ml ICH was also noted at right frontal lobe. 2.Intra-op aneurysm rupture was noted. and s small rupture at the base was wrapped. Operative Procedures 1.ETGA, supine with head fixation with skull clamp 2.Right frontal curvature skin incision 3. reflect skin downward 4.detach temporalis muscle 5.Craniotomy 6.ICH evacuation via a corticotomy 7.Retract right frontal lobe downward 8.Identify right optic nerve and right ICA 9.Trace to identify A-com 10.proximal control 11.Aneurysm clipping 12.Close dura with durofoam 13.Fix bone back 14.close wound in layers after one CWV insertion Operators 陳敞牧 Assistants 陳盈志, 胡朝凱 Indication Of Emergent Operation 郭世元 (M,1933/01/06,79y2m) 手術日期 2010/06/19 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 Intracerebral hemorrhage (ICH) 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林子富 ASA 4E 紀錄醫師 胡朝凱, 時間資訊 21:40 臨時手術NPO 21:40 開始NPO 21:40 通知急診手術 22:25 進入手術室 22:27 麻醉開始 22:30 誘導結束 22:50 手術開始 00:20 手術結束 00:20 麻醉結束 00:25 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦內血腫清除術 1 1 手術 腦室體外引流 1 2 記錄__ 手術科部: 外科部 套用罐頭: Right ICH and IVH evacuation and right tempor... 開立醫師: 胡朝凱 開立時間: 2010/06/20 00:51 Pre-operative Diagnosis Right temporal ICH and IVH Post-operative Diagnosis Right temporal ICH and IVH Operative Method Right ICH and IVH evacuation and right temporal EVD insertion Specimen Count And Types nil Pathology nil Operative Findings 1.About 45 ml ICH in right temporal lobe and extended into ventricle. 2.The brain became gliosis and fragile without pulsation. 3.No obvious vascular lesion was noted during operation. Operative Procedures 1.ETGA, supine with head rotate to left 2.Right previous wound incision 3.craniotomy via previous wound 4.dural opening at right temporal area 5.Corticotomy at right temporal lobe 6.Hematoma evacuation 7.IVH evacuation 8.EVD insertion 9.Duroplasty with durofoam 10.Fix bone back with miniplate 11.Set one CWV drain then close wound in layers Operators 王國川 Assistants 胡朝凱, 蕭惠壬 Indication Of Emergent Operation 郭世元 (M,1933/01/06,79y2m) 手術日期 2010/06/19 手術主治醫師 王國川 手術區域 東址 006房 02號 診斷 Intracerebral hemorrhage (ICH) 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林子富 ASA 4E 紀錄醫師 曾峰毅, 時間資訊 16:04 開始NPO 16:04 臨時手術NPO 16:04 通知急診手術 17:05 進入手術室 17:10 麻醉開始 17:20 誘導結束 17:21 抗生素給藥 17:25 手術開始 18:05 手術結束 18:05 麻醉結束 18:10 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 顱內壓監視置入 1 1 摘要__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 曾峰毅 開立時間: 2010/06/19 18:00 Pre-operative Diagnosis Intraventricular hemorrhage, complicated with acute hydrocephalus Post-operative Diagnosis Intraventricular hemorrhage, complicated with acute hydrocephalus Operative Method External ventricular draiange via right frontal burr hole. Specimen Count And Types Nil Pathology Nil Operative Findings Bloody CSF drained out via the external ventricular drain. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine postiion. After scalp shaved, scrubbed, disinfected, and then draped, we made skin incision along previous surgical wound. We created durotomy via previuos burr hole, and inserted ventricular catheter after ventricular puncture. The wound was closed in layers. Operators VS 王國川 Assistants R5 胡朝凱 R3 曾峰毅 Indication Of Emergent Operation 劉陳幸子 (F,1944/08/28,67y6m) 手術日期 2010/06/21 手術主治醫師 王國川 手術區域 東址 000房 號 診斷 Cerebral aneurysm 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 4E 時間資訊 15:27 通知急診手術 16:40 麻醉開始 17:25 誘導結束 21:00 麻醉結束 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 曾傑昇 (M,1985/07/31,26y7m) 手術日期 2010/06/21 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Arteriovenous malformation, brain 器械術式 Craniotomy (A.V.M.) P-DUH 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 蔡宗良, 時間資訊 07:45 報到 08:05 進入手術室 08:15 麻醉開始 08:35 誘導結束 09:20 抗生素給藥 09:57 手術開始 12:20 抗生素給藥 15:20 抗生素給藥 16:20 麻醉結束 16:20 手術結束 16:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 開顱術摘除血管病變－動靜脈畸型－小型－表淺 1 1 R 手術 誘發電位手術監視機–腦神經外科術中特殊儀器使用費 1 0 手術 超音波診查機–腦神經外科術中特殊儀器使用費 1 0 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 8 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Removal of arteriovenous malformation 開立醫師: 陳睿生 開立時間: 2010/06/21 17:17 Pre-operative Diagnosis Arteriovenous malformation, occipital lobe, right-sided Post-operative Diagnosis Arteriovenous malformation, occipital lobe, right-sided Operative Method Removal of arteriovenous malformation Specimen Count And Types 1 piece About size:小 Source:Brain Pathology Report pending Operative Findings Motor-oil like cystic lesion resembling an old intracerebral hematoma was noticed. Superficial AV shunting was noted around the calcine gyrus. An about 1x2x2cm AVM was found at inferior parietal gyrus, and inferior to the hematoma. Several deep feeding arteries were noted and drainage veins were also found. The feeding arteries with nidus were electracauterized and then removed. Operative Procedures General anesthesia was done under endotracheal intubation. Head of the patient was fixed by Mayfield headclamp and positioned in prone with head rotated 60 degrees to the left. Skin was shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. Skin was incised in a horse-shoe shape with its mid-portion at sagittal line. Raney clips were applied to the scalp edge for temporary hemostasis. A craniotomy window of 6 x 6 cm was created by making - burr holes and then cut by power saw. Dura was tented by 2/0 silk, 2.5 cm in interval, distributed along the edge of skull window. Dura was incised in a inverted U fashion, basing on the superior saggital sinus. The cortex at parasagittal region was incised by bipolar coagulator. The soft clot of the huge intracerebral hematoma was removed easily by a sucker until the lt lateral ventricle came into view. The tough clot was then removed which resulted in active bleeding from the nidus of AVM. The abnormal vessels including the feeding artery, nidus and the drainage vein were then resected by a bipolar coagulator. Under operating microscope, the arachnoid membrane of sulcus was opened and the adjacent gyri were separated to expose the feeding artery of AVM. The feeding artery was traced to the nidus then divided. The nidus of the AVM was isolated from the surrounding brain tissue by microbipolar coagulator with great precaution to minimize the chance of rupture. Afterthe entire mass of the nidus had been dissected free, the drainage vein was occluded by hemoclips and divided. The blood oozing point from several laocations on the bareurface of the hematoma cavity were packed with gelfoamfor complete hemostasis. Finally, the cavity was irrigated with NS several times and it was perfectly water clear before the dural closure. Dura was closed by continuous suture with 4/0 Dexon to obtain water-tight closure. The skull plate was placed back to craniotomy window and fixed by 3 Gauge 22 wires. The dura was tented to the center of the skull plate by a 2/0 stitch. Wound was closed in layers. Operators P 杜永光 Assistants R5 陳睿生, R4 蔡宗良 柯魏美枝 (F,1943/04/30,68y10m) 手術日期 2010/06/21 手術主治醫師 曾漢民 手術區域 東址 005房 號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3 紀錄醫師 游健生, 時間資訊 07:45 報到 08:03 進入手術室 08:13 麻醉開始 08:25 誘導結束 08:55 抗生素給藥 09:19 手術開始 11:05 麻醉結束 11:05 手術結束 11:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４小時以內 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 套用罐頭: Partial tumor excision 開立醫師: 胡朝凱 開立時間: 2010/06/21 11:20 Pre-operative Diagnosis recurrent atypical meningioma Post-operative Diagnosis recurrent atypical meningioma Operative Method Partial tumor excision Specimen Count And Types pieces of tumor Pathology pending Operative Findings 1.multiple yellowish to whitish firm tumor extended from intracranial to extracranial that make the skin became thin. 2.Part of bone was also eroded Operative Procedures 1.ETGA, supine with head fixed with skull clamp 2.Previous U shape skin incision was done 3.Reflect skin flap along the interface of dermis and tumor 4.Tumor excision 5.Further fixation of artificial bone plate 6.Hemostasis 7.Close wound with Vicryl and appose skin staple Operators 曾漢民 Assistants 胡朝凱, 游健生 李永蘋 (F,1949/11/20,62y3m) 手術日期 2010/06/21 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Pituitary adenoma : GHoma PRLoma 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 游健生, 時間資訊 11:30 報到 11:40 進入手術室 11:45 麻醉開始 12:00 誘導結束 12:26 抗生素給藥 12:55 手術開始 14:30 麻醉結束 14:30 手術結束 14:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 手術 經由蝶竇之腦下垂體瘤切除 1 1 記錄__ 手術科部: 外科部 套用罐頭: T.S.A 開立醫師: 胡朝凱 開立時間: 2010/06/21 14:49 Pre-operative Diagnosis pituitary microadenoma, growth hormone tumor Post-operative Diagnosis pituitary microadenoma, growth hormone tumor Operative Method T.S.A Specimen Count And Types pieces of tumor Pathology pending Operative Findings The tumor was whitish to yellowish, soft one located at right side of sella turcica. The border was clear. Post-OP arachnopid membrane was seen. The tumor was complete excision. A small CSF leakage was noted and sealed with Tissucol-duo. Operative Procedures After ETGA, the patient was put in supine position with head mild left tilt. The nasal cavity was well-disinfective, and then we incised into the nasal septum. Dissection was performed along with the periosteum to expose sphenoid sinus anterior wall and sphenoid ostia. After fracture of vomer, sphenoid sinus anterior wall was also fractured. The mucosa was removed. The sella floor was exposed and removed with kerrison. After cruciate form incision, tumor buldged out. And it was further removed with tumor forceps and ring currette. After total excision of tumor was made, the bony graft was put back and followed by compaction of merosel. Operators 曾漢民 Assistants 胡朝凱, 游健生 白彩雪 (F,1939/01/30,73y1m) 手術日期 2010/06/21 手術主治醫師 蔡瑞章 手術區域 東址 002房 04號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(Others) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2E 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 13:35 報到 13:58 進入手術室 14:00 麻醉開始 14:25 誘導結束 15:00 抗生素給藥 15:19 手術開始 17:55 開始輸血 18:00 抗生素給藥 21:26 麻醉結束 21:26 手術結束 21:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４～８小時 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 7 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: Simpson grade II tumor excision for left fron... 開立醫師: 鍾文桂 開立時間: 2010/06/21 22:06 Pre-operative Diagnosis Left frontal-temporal meningioma. Post-operative Diagnosis Left frontal-temporal meningioma. Operative Method Simpson grade II tumor excision for left frontal-temporal meningioma via left pterional approach. Specimen Count And Types 1 piece About size: Source:left F-T menigioma. Pathology Gross: soft, elastic, red-brownish, well demarcated,and easy oozing tumor. Gross: soft, red-brownish, well demarcated,and easy oozing tumor. Operative Findings 1. Main blood supply from middle meningeal artery. Many dimplings on inner table of skull bone due to engorged arteries. 2. No obvious arachnoid plane intraoperatively. Obvious arachnoid plane in MRI findings. 3. Slack brain after tumor excision. Sylvian veins lie on the medial wall of the tumor. 4. The tumor-invaded dura was excised. The dural defect was repaired with DuraGen. 4. The tumor-attached dura was excised. The dural defect was repaired with DuraGen. Operative Procedures Under ETGA, the patient was placed in supine position, and the head was tilted to the right and fixed with Mayfield 3-pin head holder. After shaving, disinfection, and draping, a question mark shape incision was made at left frontal-temporal region. A 15x10 cm craniotomy was done by high speed drills after dissection. After durotomy and dural tenting, the tumor was excised by tumor forceps and suction in piece meal fashion. After dural tenting and durotomy, the tumor was seperated first from surrounding brain and was then excised by tumor forceps and suction in piece meal fashion. The tumor was sucted out gradually until normal brain cortex appeared. After total tumor excision, the cavity was covered with surgicel for hemostasis. After total tumor excision, meticulous hemostatis was performed mainly with gelfoam and surgicel packing, and with bipolar coagulator when necessary. After ensuring no active bleeder, the tumor invaded dura mater was excised and repaired with DuraGen. After ensuring no active bleeder, the tumor-attached dura mater was excised and repaired with DuraGen in a water tight manner. The craniotomy bone plate was fixed with plates and screws. The craniotomy bone plates were fixed together with wires first and then replaced and fixed with plates and screws. With an epidural drain, the wound was closed in layers. Operators Prof. 蔡瑞章 Assistants R4 鍾文桂 Ri周岩毅 Indication Of Emergent Operation 相關圖片 許致軒 (M,1978/03/07,34y0m) 手術日期 2010/06/22 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Subarachnoid hemorrhage (SAH) 器械術式 Craniotomy(Aneurysms) P-DUH 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 胡朝凱, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:05 進入手術室 08:10 麻醉開始 08:35 誘導結束 09:10 抗生素給藥 09:32 手術開始 12:10 抗生素給藥 15:10 抗生素給藥 16:10 麻醉結束 16:10 手術結束 16:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 開顱術摘除血管病變－腦血管瘤－無徵的 1 1 R 手術 開顱術摘除血管病變－腦血管瘤－無徵的 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 8 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 麻醉 C.V.P. catheter in ubation 1 0 記錄__ 手術科部: 套用罐頭: Right pterional approach for aneurysmal clipping 開立醫師: 胡朝凱 開立時間: 2010/06/22 16:38 Pre-operative Diagnosis A-com and right MCA aneurysm Post-operative Diagnosis A-com and right MCA aneurysm Operative Method Right pterional approach for aneurysmal clipping Specimen Count And Types nil Pathology nil Operative Findings 1.One saccular aneurysm about 5.5x4 mm located at right MCA trifurcation and clipped with curved sugita clip 2.One saccular aneurysm located at A-com about 5x3 mm that arised from right A1 and protuded anteriorly without surround adhesion. It was clipped with two sugita clips. 3.The bilateral A1 came below optic nerve that cross optic chiasm Operative Procedures 1.ETGA, supine with head fixed with skull clamp 2.Right curvature skin incision 3.Reflect skin flap with facial nerve preservation procedure 4.Craniotomy 5.Dural opening after dural tenting 6.Open sylvian fissue to expose the MCA aneurysm 7.aneurysmal clipping with one right angled clip 8.Retract right frontal lobe downward to expose optic nerve 9.Identify right ICA 10.trace optic nerve to identify right A1 then A2 11.Expose aneurysmal neck 12.Clipping 13.HEmostasis 14.Dural closure 15.Set one CWV drain then close wound in layers Operators 賴達明 Assistants 胡朝凱, Ri 林承德 (M,1966/07/31,45y7m) 手術日期 2010/06/22 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Brachial plexus injury 器械術式 Neurolysis of the uluar neuve 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 黃世銘, 鍾文桂, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:03 進入手術室 08:09 麻醉開始 08:15 誘導結束 08:28 抗生素給藥 08:52 手術開始 11:30 抗生素給藥 13:08 手術結束 13:08 麻醉結束 13:15 送出病患 13:20 進入恢復室 14:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 手術 神經移植－上臂．前臂．大腿．小腿處之神經 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Nerve transplantation from left partial ulnar... 開立醫師: 鍾文桂 開立時間: 2010/06/22 13:34 Pre-operative Diagnosis Left brachial plexus injury. Post-operative Diagnosis Left brachial plexus injury. Operative Method Nerve transplantation from left partial ulnar nerve to motor branch of nerve to biceps muscle. Specimen Count And Types Pathology Nil. Operative Findings Two nerve roots of motor branch of nerve to biceps muscle were anastomosed with left partial ulnar nerve in end to end fasion. One of the roots was very small(0.5mm in diameter.) Operative Procedures 1. ETGA, supine position, left upper extrimity in abduction position. 2. 15cm incision at medial side of left arm. 3. Dissection through intermuscular bundles to reach the ulnar nerve and nerves to biceps muscle. 4. Intraoperative MEP to ensure the nerves. 5. End to end anastomosis of the nerves with 10-0 Prolene. 6. Wound closure in layers. Operators V.S. 曾勝弘 Assistants R4鍾文桂 R1黃世銘 陳怡儒 (F,1959/09/17,52y5m) 手術日期 2010/06/22 手術主治醫師 曾勝弘 手術區域 東址 005房 02號 診斷 HIVD 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 黃世銘, 時間資訊 00:00 臨時手術NPO 13:18 報到 13:35 進入手術室 13:45 麻醉開始 13:50 誘導結束 14:40 抗生素給藥 14:50 手術開始 16:25 手術結束 16:25 麻醉結束 16:30 送出病患 16:35 進入恢復室 17:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 椎間盤切除術－腰椎 1 1 記錄__ 手術科部: 外科部 套用罐頭: Microsurgical diskectomy,right side approach. 開立醫師: 鍾文桂 開立時間: 2010/06/22 16:42 Pre-operative Diagnosis L5/S1 herniated intervertebral disc. Post-operative Diagnosis L5/S1 herniated intervertebral disc. Operative Method Microsurgical diskectomy,right side approach. Specimen Count And Types nil Pathology Nil. Operative Findings Herniated and calcified intervertebral disc. Slack root after decompression. Operative Procedures 1. ETGA, prone position. 2. Localization of L5/S1 level with intraoperative fluoroscopy. 3. Disinfection, draping. 4. 2-cm skin incision and midline subperiosteal dissection. 5. Removal of inferior margin of L5 lamina, right and superior margin of S1 lamina, and medial portion of the facet joint. 6. Retract S1 root. Incision of posterior longitudinal ligament. 7. Diskectomy by alligator, curretes, and Kerrison punch. 8. Well hemostasis. 9. Wound closure in layers. Operators V.S. 曾勝弘 Assistants R4 鍾文桂 R1黃世銘 胡王香蓮 (F,1923/04/10,88y11m) 手術日期 2010/06/22 手術主治醫師 蕭輔仁 手術區域 東址 005房 03號 診斷 Intracerebral hemorrhage 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 16:15 報到 16:55 進入手術室 17:00 麻醉開始 17:05 誘導結束 17:20 抗生素給藥 17:38 手術開始 20:00 手術結束 20:00 麻醉結束 20:10 送出病患 20:15 進入恢復室 21:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 頭顱成形術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Glucose 1 0 記錄__ 手術科部: 外科部 套用罐頭: Cranioplasty. 開立醫師: 鍾文桂 開立時間: 2010/06/22 20:21 Pre-operative Diagnosis Skull bone defect, right. Post-operative Diagnosis Skull bone defect, right. Operative Method Cranioplasty. Specimen Count And Types nil Pathology Nil. Operative Findings Slack brain. Intact dura during dissection. Autologous skull bone plate for cranioplasty. Operative Procedures 1. ETGA, supine position, head tilted to left. 2. Shaving, disinfection, and draping. 3. Incision along the previous operative wound. 4. Subgaleal dissection. 5. Fixation of bone graft with plates and screws. 6. Dural tenting. 7. Wound closure in layers after placement of one CWV drain. Operators V.S. 蕭輔仁 Assistants R4 鍾文桂 R1 黃世銘 陳朝土 (M,1948/09/30,63y5m) 手術日期 2010/06/22 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Lumbar Spondylosis 器械術式 Diskectomy lumbar(Others) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 胡朝凱, 時間資訊 00:00 臨時手術NPO 15:50 報到 16:40 進入手術室 16:45 麻醉開始 16:50 誘導結束 17:15 抗生素給藥 17:42 手術開始 19:25 手術結束 19:25 麻醉結束 19:35 送出病患 19:35 進入恢復室 21:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 椎間盤切除術－腰椎 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: L4~5 discectomy 開立醫師: 胡朝凱 開立時間: 2010/06/22 19:35 Pre-operative Diagnosis L4~5 HIVD, right Post-operative Diagnosis L4~5 HIVD, right Operative Method L4~5 discectomy Specimen Count And Types nil Pathology nil Operative Findings 1.Protruding disc at L4~5 level that compressed the right L5 nerve root tightly. 2.The disc became dehydrated and loose 3.Hypertrophic flavum ligment was also noted. Operative Procedures 1.ETGA, prone 2.Midline skin incision 3.Detach paravertebral muscle at right L4~5 level 4.Laminotomy at L4 to L5 5.Resect flavum ligment to ecpose L5 nerve 6.Discectomy 7.Hemostasis 8.Close wound in layers Operators 賴達明 Assistants 胡朝凱, Ri 鍾晴雄 (M,1944/04/28,67y10m) 手術日期 2010/06/23 手術主治醫師 陳敞牧 手術區域 東址 019房 05號 診斷 Subdural hemorrhage 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林峰盛 ASA 3E 紀錄醫師 胡朝凱, 時間資訊 18:00 臨時手術NPO 18:00 開始NPO 23:25 報到 23:35 進入手術室 23:40 麻醉開始 00:00 誘導結束 00:10 抗生素給藥 00:26 手術開始 01:00 手術結束 01:00 麻醉結束 01:45 送出病患 01:50 進入恢復室 02:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 手術 慢性硬腦膜下血腫清除術 1 1 R 記錄__ 手術科部: 復健部 套用罐頭: Right burr hole drainage 開立醫師: 胡朝凱 開立時間: 2010/06/23 01:08 Pre-operative Diagnosis Right chronic SDH Post-operative Diagnosis Right chronic SDH Operative Method Right burr hole drainage Specimen Count And Types nil Pathology nil Operative Findings 1.Motor oil like hematoma was drained out from right frontal. temporal, to parietal area. 2.Outer membrane was noted 3.Brain was still slack after hematoma drainage. Operative Procedures 1.ETGA, supine 2.Right frontal area transverse skin incision 3.Dissect skin flap 4.open periosteum 5.Burr hole drill 6.Dural tenting 7.dural opening 8.Insert one rubber drain and irrigation 9.Fix rubber drain then close wound in layers 10.De-air Operators 陳敞牧 Assistants 胡朝凱 Indication Of Emergent Operation 劉俊甫 (M,1951/03/18,60y11m) 手術日期 2010/06/22 手術主治醫師 蕭輔仁 手術區域 東址 027房 02號 診斷 Fracture, lumbar-spine 器械術式 Spinal fusion posterior 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾峰毅, 時間資訊 08:46 通知急診手術 12:00 報到 12:30 進入手術室 12:35 麻醉開始 12:40 誘導結束 12:50 抗生素給藥 13:22 手術開始 15:50 抗生素給藥 16:20 開始輸血 17:10 手術結束 17:10 麻醉結束 17:20 送出病患 17:20 進入恢復室 18:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 手術 椎弓切除術（特壓）－超過二節 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 曾峰毅 開立時間: 2010/06/22 17:13 Pre-operative Diagnosis L2 chance fracture Post-operative Diagnosis L2 change fracture Operative Method L1 to L3 laminectomy, reduction of L2 chance fracture, and posterior fixation with TPS at T12, L1, L3, and L4, posterolateral fusion with autologous bone graft. Specimen Count And Types Nil Pathology Nil Operative Findings Spinal canal was decompressed well after laminectomy. Posterior deplaced part of L2 chance fracture was reduced after impaction. A-spine 45x6.5mm TPSs were inserted at both pedicles at L1, L3, and L4. 45x6.0mm TPS were inserted into both pedicles of T12. Two 17cm rods and one cross-link were set. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. We idenfied spine level with C-arm. After back skin scrubbed and disinfected, we made one linear skin incision from T11 to L5. We dissected paraspinal muscle via subosteal route from T12 to L4. We created laminectomy from L1 to L3, and reduced posterio protruding part of L2 facture with impactor. We inserted transpedicuarl screws at both pedicles at T12, L1, L3, and L4. We connected the TPS with rods and one cross link. Posterolateral fusion with autologous bone graft was done. After hemostasis and two hemovac set, we closed the wound in layers. Operators VS 蕭輔仁 Assistants R4 陳德福 R3 曾峰毅 Indication Of Emergent Operation 楊瑞德 (M,1954/06/28,57y8m) 手術日期 2010/06/22 手術主治醫師 謝敦理 手術區域 東址 027房 07號 診斷 Fever 器械術式 Tracheostomy 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 4E 紀錄醫師 李建賢, 時間資訊 21:00 開始NPO 02:27 通知急診手術 03:00 報到 03:05 進入手術室 03:20 麻醉開始 03:30 誘導結束 03:40 手術開始 04:00 手術結束 04:00 麻醉結束 04:10 送出病患 04:20 進入恢復室 05:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 手術 氣管切開造口術 1 0 記錄__ 手術科部: 耳鼻喉部 套用罐頭: Tracheostomy 開立醫師: 李建賢 開立時間: 2010/06/22 03:22 Pre-operative Diagnosis Respiratory distress Post-operative Diagnosis Respiratory distress, operated Operative Method Tracheostomy Specimen Count And Types nil Pathology Nil Operative Findings tracheostomy done Operative Procedures The patient was in supine position with neck hyperextended. Skin was disinfected and draped as usual. Local anesthesia with Bosmin-rinsed Xylocaine was injected into the subcutaneous tissue and the pretracheal area layer by layer. A verticalskin incision was made in the midline of lower neck. Subcutaneous tissue, fascia and strap muscles were separated, then the thyroid gland was seen and hooked upwards with thyroid hooks. The tracheal rings were cut in longitudinal direction.An oval-shaped window was made at the 2 nd to 3 rd rings. A low pressure no. 8 tracheostomy tube was inserted. The patient tolerated the above procedure well. Operators vs 謝敦理 Assistants R4 陳景中 R3孟繁宇 R2李建賢 R1林玫君 Indication Of Emergent Operation 陳吉永 (M,1944/09/28,67y5m) 手術日期 2010/06/22 手術主治醫師 黃凱文 手術區域 東址 013房 03號 診斷 Hepatic cancer 器械術式 R.F.A 手術類別 預定手術 手術部位 腹 傷口分類 清潔 麻醉方式 面罩麻醉 麻醉主治醫師 葉育彰 ASA 3 紀錄醫師 洪浩雲, 時間資訊 11:55 報到 12:35 進入手術室 12:50 麻醉開始 12:55 誘導結束 13:00 抗生素給藥 14:15 手術開始 15:05 手術結束 15:05 麻醉結束 15:10 進入恢復室 15:10 送出病患 16:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 肝腫瘤無線頻率電熱療法－大於３公分（含）小於５公分 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Semi-opened mask inhalation anes 1 0 麻醉 Semi-opened INHALATION GENERAL A 1 0 記錄__ 手術科部: 外科部 套用罐頭: RFA 開立醫師: 王樹聲 開立時間: 2010/06/22 14:58 Pre-operative Diagnosis HEPATOCELLULAR CARCINOMA Post-operative Diagnosis HEPATOCELLULAR CARCINOMA Operative Method RFA Specimen Count And Types nil Pathology Nil Operative Findings A 3.1cm tumor at S3, ablation time:12min Operative Procedures 1. IVGA with mask, supine 2. Skin disinfection and draping 3. Performed RFA with echo guided, a 3.1cm tumor at S3 with ablation time of 12min 4. Patient was sent to POR for recovery Operators 黃凱文 Assistants 李政霆 洪林伸 (F,1932/11/22,79y3m) 手術日期 2010/06/22 手術主治醫師 王國川 手術區域 東址 002房 04號 診斷 Ischemic stroke 器械術式 Suboccipital craniectomy with EVD and C1 laminectomy 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林峰盛 ASA 4E 紀錄醫師 游健生, 時間資訊 07:13 臨時手術NPO 07:13 開始NPO 15:14 通知急診手術 16:45 報到 16:45 進入手術室 17:35 麻醉開始 18:30 誘導結束 18:49 手術開始 21:00 抗生素給藥 22:10 手術結束 22:20 送出病患 22:20 麻醉結束 醫令資訊 類別 名稱 量 刀 側 麻醉 C.V.P. catheter in ubation 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 手術 顱骨切除術，包括異物移除或減壓或神經切斷 1 1 手術 顱內壓監視置入 1 2 摘要__ 手術科部: 外科部 套用罐頭: Suboccipital craniectomy and EVD insertion vi... 開立醫師: 陳睿生 開立時間: 2010/06/22 22:05 Pre-operative Diagnosis Left cerebellar infarction with acute hydrocephalus Post-operative Diagnosis Left cerebellar infarction with acute hydrocephalus Operative Method Suboccipital craniectomy and EVD insertion via right Frazier Specimen Count And Types nil Pathology Nil Operative Findings The initial ICP was about 5-10cmH2O. A Metronic EVD was inserted via right Frazier^s point. The EVD depth was about 10cm, and CSF was clear. The medial side of left cerebellar hemisphere was whitish, and swelling. Necrotic change with central hemorrhagic change was noted. The hemisphere and left tonsilar lobe were removed for decompression. A fascia was used for duroplasty. Operative Procedures 1. ETGA, prone position, and head fixed with Maydield clump 2. Linear incision was made at right Frazier^s point about 3cm 3. Create a bur hole, and punch the ventricle 4. Insert the EVD and fix 5. Close the wound in layers 6. Midline scalp incision at suboccipital region about 15cm 7. Extract a piece of fascia at occipital region 8. Incise into the nuchal ligamentum and dissect the trapzius muscle bilaterally 9. Expose the suboccipital region of the skull and C1 posterior ring 10.Create four bur holes at inion, and suboccipital region 11.Make a craniectomy window about 8x8cm 12.Remove the posterior rim of the foramen Magnum 13.Dura opening, and ligate the occipital sinus 14.Expose the cerebellar hemisphere 15.Electrocauterize the cortical veins and suck remove the necrotic brain tissue 16.Hemostasis, and duroplasty was done with fascia graft after deair 17.Set an epidural CWV drain, and close the wound in layers Operators VS 王國川 Assistants R5 陳睿生, R2 游健生 Indication Of Emergent Operation 陳玫玲 (F,1958/05/29,53y9m) 手術日期 2010/06/23 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Brain Tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 蔡宗良, 時間資訊 00:00 臨時手術NPO 07:33 報到 08:05 進入手術室 08:10 麻醉開始 08:30 誘導結束 09:15 抗生素給藥 09:45 手術開始 12:20 抗生素給藥 13:15 麻醉結束 13:15 手術結束 13:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經由蝶竇之腦下垂體瘤切除 1 1 手術 誘發電位手術監視機–腦神經外科術中特殊儀器使用費 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 記錄__ 手術科部: 外科部 套用罐頭: Hypophysectomy---Transphenoid 開立醫師: 蔡宗良 開立時間: 2010/06/23 12:37 Pre-operative Diagnosis Pituitary macroadenoma Post-operative Diagnosis Pituitary macroadenoma Operative Method Endoscopic endonasal transphenoidal hypophysectomy Endoscopic endonasal transphenoidal adenomectomy Specimen Count And Types 1 piece About size:小 Source:Sella Pathology Report pending Operative Findings 1. The tumor has protruded through the sellar floor where the bony part was absent. 1. The sellar turcica bulged downward. The bony part became paper thin, with a small part eroded with dura exposed. 2. The tumor has two part, the first part was whitish in color and soft in consistency and easily suckable. The second part is similar except the color is more yellowish. 3. The suprasellar cistern collapsed downward after tumor excision. No CSF was noted. Operative Procedures General anesthesia was applied under endotracheal intubation. Patient was positioned in supine with head tilted 30 degree to left. The face and anterior right thigh were prepared with povidone-iodine alcohol tincture, and the mucosa of oral and nasal cavity with aqueous povidone-iodine tincture. The former areas were covered by a sterilized adhesive plastic sheet. The exposed sinus mucosa was coagulated and resected. The sellar floor was penetrated by an osteotome, then widened by Kerrison punch. The sellar floor dura was coagulated with bipolar forceps, then opened in cruciate fashion. General anesthesia was applied under endotracheal intubation. Patient was positioned in supine with head tilted 10 degrees to left. The face was prepared with povidone-iodine alcohol tincture, and the mucosa of oral and nasal cavity with aqueous povidone-iodine tincture. The former areas were covered by a sterilized adhesive plastic sheet. The exposed sinus mucosa was coagulated and resected. The anterior wall of sphenoid sinus was penetrated by a high speed diamond burr, then widened by Kerrison punches. The sellar bony sellar floor was also opened with a diamond burr and then kerrison punches. The dura of sellar turcica was coagulated with bipolar forceps, then opened in cruciate fashion. The soft tumor parenchyma was removed by curette and suction, then the capsule was mobilized away from the dura and normal pituitary gland and removed. The final piece of the tumor at suprasellar area sank into the sella spontaneously after the intrasellar tumor had been removed. This last piece of the tumor was carefully separated from the arachnoid by curette and fine sucker. The venous oozing from the dura was stopped by gelfoam packing. The sellar floor was reconstructed by supporting a piece of vomer bone between the dura and the margin of the sellar floor. Each side of the nasal cavities was tightly packed with soaked iodine ointment. The soft tumor parenchyma was removed by curette and suction, then the capsule was mobilized away from the dura and normal pituitary gland and removed. The final piece of the tumor at suprasellar area sank into the sella spontaneously after the intrasellar tumor had been removed. This last piece of the tumor was carefully separated from the arachnoid by curette and fine sucker. The venous oozing from the dura was stopped by gelfoam packing. The sellar floor was reconstructed by supporting a piece of vomer bone between the dura and the margin of the sellar floor. Each side of the nasal cavities was tightly packed with soaked vaseline ointment. The soft tumor parenchyma was removed by curette and suction, then the capsule was mobilized away from the dura and further tumor removal was done. The final piece of the tumor at suprasellar area sank into the sella spontaneously after the intrasellar tumor had been removed. This last piece of the tumor was carefully separated from the arachnoid by curette and fine sucker. The venous oozing from the dura was stopped by gelfoam packing. The sellar floor was reconstructed by supporting gelfoam strips and a piece of vomer bone between the dura and the margin of the sellar floor. Each side of the nasal cavities was tightly packed with vaseline ointment soaked rubber finger gloves. Operators P 杜永光, VS 楊士弘 Assistants CR 陳睿生 R4 蔡宗良 記錄__ 手術科部: 外科部 套用罐頭: Hypophysectomy---Transphenoid 開立醫師: 蔡宗良 開立時間: 2010/06/29 21:15 Pre-operative Diagnosis Pituitary macroadenoma Post-operative Diagnosis Pituitary macroadenoma Operative Method Endoscopic endonasal transphenoidal hypophysectomy Endoscopic endonasal transphenoidal adenomectomy Specimen Count And Types 1 piece About size:小 Source:Sella Pathology Report pending Operative Findings 1. The tumor has protruded through the sellar floor where the bony part was absent. 1. The sellar turcica bulged downward. The bony part became paper thin, with a small part eroded with dura exposed. 2. The tumor has two part, the first part was whitish in color and soft in consistency and easily suckable. The second part is similar except the color is more yellowish. 3. The suprasellar cistern collapsed downward after tumor excision. No CSF was noted. Operative Procedures General anesthesia was applied under endotracheal intubation. Patient was positioned in supine with head tilted 10 degrees to left. The face was prepared with povidone-iodine alcohol tincture, and the mucosa of oral and nasal cavity with aqueous povidone-iodine tincture. The former areas were covered by a sterilized adhesive plastic sheet. The exposed sinus mucosa was coagulated and resected. The anterior wall of sphenoid sinus was penetrated by a high speed diamond burr, then widened by Kerrison punches. The sellar bony sellar floor was also opened with a diamond burr and then kerrison punches. The dura of sellar turcica was coagulated with bipolar forceps, then opened in cruciate fashion. The soft tumor parenchyma was removed by curette and suction, then the capsule was mobilized away from the dura and further tumor removal was done. The final piece of the tumor at suprasellar area sank into the sella spontaneously after the intrasellar tumor had been removed. This last piece of the tumor was carefully separated from the arachnoid by curette and fine sucker. The venous oozing from the dura was stopped by gelfoam packing. The sellar floor was reconstructed by supporting gelfoam strips and a piece of vomer bone between the dura and the margin of the sellar floor. Each side of the nasal cavities was tightly packed with vaseline ointment soaked rubber finger gloves. Operators P 杜永光, VS 楊士弘 Assistants CR 陳睿生 R4 蔡宗良 邵麗英 (F,1958/05/03,53y10m) 手術日期 2010/06/23 手術主治醫師 杜永光 手術區域 東址 003房 02號 診斷 Brain Tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 蔡宗良, 時間資訊 00:00 臨時手術NPO 13:25 報到 14:00 進入手術室 14:05 麻醉開始 14:15 誘導結束 14:20 抗生素給藥 14:25 手術開始 17:20 抗生素給藥 18:05 麻醉結束 18:05 手術結束 18:10 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 手術 經由蝶竇之腦下垂體瘤切除 1 1 手術 誘發電位手術監視機–腦神經外科術中特殊儀器使用費 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Endoscopic endonasal transphenoidal hypophyse... 開立醫師: 蔡宗良 開立時間: 2010/06/23 17:15 Pre-operative Diagnosis Pituitary macroadenoma Post-operative Diagnosis Pituitary macroadenoma Operative Method Endoscopic endonasal transphenoidal hypophysectomy Endoscopic endonasal transphenoidal adenomectomy Specimen Count And Types 1 piece About size:小 Source:Pituitary Pathology Report pending Operative Findings 1. The tumor was whitish in color and soft in consistency and easily suckable. 1. The tumor was yellowish white in color and soft fragile in consistency and easily suckable. 2. CSF leakage during the currettage of tumor 2. CSF leakage occurred during the end of tumor removal from the right side corner near the cavernous sinus. Operative Procedures General anesthesia was applied under endotracheal intubation. Patient was positioned in supine with head tilted 30 degree to left. The face and anterior right thigh were prepared with povidone-iodine alcohol tincture, and the mucosa of oral and nasal cavity with aqueous povidone-iodine tincture. The former areas were covered by a sterilized adhesive plastic sheet. The exposed sinus mucosa was coagulated and resected. The sellar floor was penetrated by an osteotome, then widened by Kerrison punch. The sellar floor dura was coagulated with bipolar forceps, then opened in cruciate fashion. General anesthesia was applied under endotracheal intubation. Patient was positioned in supine with head tilted 10 degree to left. The face was prepared with povidone-iodine alcohol tincture, and the mucosa of oral and nasal cavity with aqueous povidone-iodine tincture. The former areas were covered by a sterilized adhesive plastic sheet. The nasal mucosa in the sphenoido-ethmoid recess was coagulated and removed for exposure of the junction of nasal septum and sphenoidal rostrum, which was resected by a high speed diamond burr and kerrison punches. The sellar floor was penetrated by a diamond drill, then widened by Kerrison punch. The sellar floor dura was coagulated with bipolar forceps, then opened in cruciate fashion. The soft tumor parenchyma was removed by curette and suction, then the capsule was mobilized away from the dura and normal pituitary gland and removed. The final piece of the tumor at suprasellar area sank into the sella spontaneously after the intrasellar tumor had been removed. This last piece of the tumor was carefully separated from the arachnoid by curette and fine sucker. The CSF leakage from the dura was stopped by Gelfoam and Surgical packing, with further laying of Tissue-Col Duo. The sellar floor was reconstructed by supporting a piece of vomer bone between the dura and the margin of the sellar floor. Each side of the nasal cavities was tightly packed with soaked vaseline ointment. The soft tumor parenchyma was removed by curette and suction, then the capsule was mobilized away from the dura and tumor was further removed. The final piece of the tumor at suprasellar area sank into the sella spontaneously after the intrasellar tumor had been removed. This last piece of the tumor was carefully separated from the arachnoid by curette and fine sucker. The CSF leakage from the dura was stopped by Gelfoam and Surgical packing, with further laying of Tissue-Col Duo. The sellar floor was reconstructed by supporting a piece of vomer bone between the dura and the margin of the sellar floor. Each side of the nasal cavities was tightly packed with vaseline ointment soaked rubber gloves. The soft tumor parenchyma was removed by curette and suction, then the capsule was mobilized away from the dura and tumor was further removed. The final piece of the tumor at suprasellar area sank into the sella spontaneously after the intrasellar tumor had been removed. This last piece of the tumor was carefully separated from the arachnoid by curette and fine sucker. The CSF leakage from the dura was stopped by Gelfoam and Surgical packing, with further laying of Tissue-Col Duo. The sellar floor was reconstructed by supporting a piece of vomer bone between the dura and the margin of the sellar floor. Each side of the nasal cavities was tightly packed with vaseline ointment soaked rubber gloves. Operators P 杜永光, VS 楊士弘 Assistants CR 陳睿生 R4 蔡宗良 邱子瑀 (F,1981/09/09,30y6m) 手術日期 2010/06/23 手術主治醫師 杜永光 手術區域 東址 003房 03號 診斷 Brain Tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 蔡宗良, 時間資訊 00:00 臨時手術NPO 18:30 進入手術室 18:40 麻醉開始 18:55 誘導結束 19:20 抗生素給藥 19:30 手術開始 22:20 抗生素給藥 22:50 手術結束 22:50 麻醉結束 23:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 經由蝶竇之腦下垂體瘤切除 1 1 手術 誘發電位手術監視機–腦神經外科術中特殊儀器使用費 1 0 摘要__ 手術科部: 外科部 套用罐頭: Endoscopic endonasal transphenoidal adenomectomy 開立醫師: 蔡宗良 開立時間: 2010/06/23 22:14 Pre-operative Diagnosis Pituitary macroadenoma Post-operative Diagnosis Pituitary macroadenoma Operative Method Endoscopic endonasal transphenoidal adenomectomy Lumbar drain Specimen Count And Types 2 pieces About size:小 Source:Suspect adenoma About size:小 Source:Suspect normal pituitary gland Pathology Report pending Operative Findings 1. The tumor has was whitish in color and mucous and mild elastic in consistency but not easily suckable. 1. The tumor was whitish in color and mild elastic in consistency but not easily suckable. 2. CSF fluid oozing was noticed after tumor removal Operative Procedures General anesthesia was applied under endotracheal intubation. Patient was positioned in supine with head tilted 30 degree to left. The face and anterior right thigh were prepared with povidone-iodine alcohol tincture, and the mucosa of oral and nasal cavity with aqueous povidone-iodine tincture. The former areas were covered by a sterilized adhesive plastic sheet. The exposed sinus mucosa was coagulated and resected. The sellar floor was penetrated by an osteotome, then widened by Kerrison punch. The sellar floor dura was coagulated with bipolar forceps, then opened in cruciate fashion. The soft tumor parenchyma was removed by curette and suction, then the capsule was mobilized away from the dura and further tumor removal was done. The final piece of the tumor at suprasellar area sank into the sella spontaneously after the intrasellar tumor had been removed. This last piece of the tumor was carefully separated from the arachnoid by curette and fine sucker. The venous oozing from the dura was stopped by gelfoam packing. The sellar floor was reconstructed by supporting gelfoam strips and a piece of vomer bone between the dura and the margin of the sellar floor. Each side of the nasal cavities was tightly packed with vaseline ointment soaked rubber finger gloves. Lumbar drain was placed after the surgery has completed. The soft tumor parenchyma was removed by curette and suction, then the capsule was mobilized away from the dura and further tumor removal was done. The final piece of the tumor at suprasellar area sank into the sella spontaneously after the intrasellar tumor had been removed. This last piece of the tumor was carefully separated from the arachnoid by curette and fine sucker. The venous and CSF oozing from the dura was stopped by gelfoam packing and Tissue-Col Duo. The sellar floor was reconstructed by supporting gelfoam strips and a piece of vomer bone between the dura and the margin of the sellar floor. Each side of the nasal cavities was tightly packed with vaseline ointment soaked rubber finger gloves. Lumbar drain was placed after the surgery has completed. Operators P 杜永光, VS 楊士弘 Assistants CR 陳睿生 R4 蔡宗良 許重義 (M,1944/07/27,67y7m) 手術日期 2010/06/23 手術主治醫師 曾漢民 手術區域 東址 020房 03號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 15:00 報到 15:10 進入手術室 15:15 麻醉開始 15:40 誘導結束 15:55 抗生素給藥 16:20 手術開始 19:20 抗生素給藥 19:55 麻醉結束 19:55 手術結束 20:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Right frontal craniotomy for Simpson grade II... 開立醫師: 鍾文桂 開立時間: 2010/06/23 20:30 Pre-operative Diagnosis Tuberculum sellar meningioma Post-operative Diagnosis Tuberculum sellar meningioma Operative Method Right frontal craniotomy for Simpson grade II tumor excision Specimen Count And Types 1 piece About size:5g Source:tumor excision Pathology Pending Operative Findings The tumor is yellowish, elastic-firm, size 7x6x5cm, attached to the falx with extension to left frontal area. The tumor margin was unable to seperate clearly from the normal brain parenchyma at arachnoid plane. Intact pituitary stalk and bilateral optic nerve. Disruption of right olfactory nerve. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position with head fixed with Mayfield skull clump. The scalp was shaved, scrubbed, disinfected with alcohol better-iodine then draped. The bicoronal scalp incision was made followed by right frontal craniotomy. The dura was opened around the tumor after tenting along the craniotomy window. The tumor was dissected from the surrounding normal brain tissue with dissector and bipolar coagulator. The tumorwas detached from the falx. Central debulky method was applied before further dissection of the tumor. The midline attachment was dissected under the surgicel microscope assistance. The falx was incised with surgical bladeand removed the left frontal tumor. The duroplasty was performed with 4-0 Prolene sutures and periostium. The skull plate was fixed back with miniplates and screws after one epidural CWV drain set up. The wound was then closed in layers. Operators V.S. 曾漢民 Assistants R6 R4 . R6 陳盈志 R4 鍾文桂 . 相關圖片 陳昱瑋 (M,1991/06/02,20y9m) 手術日期 2010/06/23 手術主治醫師 蔡瑞章 手術區域 東址 005房 號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(Others) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 胡朝凱, 時間資訊 00:00 臨時手術NPO 07:33 報到 08:08 進入手術室 08:15 麻醉開始 09:00 誘導結束 09:50 抗生素給藥 10:08 手術開始 12:50 抗生素給藥 15:50 抗生素給藥 17:20 麻醉結束 17:20 手術結束 17:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除－手術時間在４～８小時 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 10 0 記錄__ 手術科部: 外科部 套用罐頭: Transcallosal partial tumor excision 開立醫師: 胡朝凱 開立時間: 2010/07/20 14:56 Pre-operative Diagnosis Third ventricular tumor Post-operative Diagnosis Third ventricular tumor Operative Method Transcallosal tumor partial excision Specimen Count And Types pieces of tumor Pathology pending Operative Findings 1.One elastic, grayish tumor with moderate vascularity was noted inside the third ventricle. The attachment to the thalamus could not be seen clearly. 2.Bilateral chronic subdural hematoma were also noted. 3.tumor was partially excised. Some necrotic tissue was noted inside the tumor. Operative Procedures Under ETGA, patient was put in supine position with head fixed with mayfield skull clamp. Bicoronal skin incision was done. Reflect skin flap anteriorly was followed by periosteum opening. Bilateral bur hole drilling was done to drain the chronic SDH. Craniotomy was performed cross the midline . Dural was opened as the base left on midline after dural tenting. Navigation was performed to identify the tumor location. Interhemispheric approach was done to expose the corpus callosum. One small corticortomy was done. Dissect corpus callosum from left side to enter left lateral ventricle. The septum pelucidum was then opened to identify bilateral choroid plexus. Left tenia choroidea was cut open. And the third ventricle was entered after further dissection between bilateral ICVs. The tumor was exposed. Partial tumor excision was then done with dissection and tumor forceps grasping. After hemostasis, the dura was closed with fascia graft. The previous VP shunt reservior was then change to high pressure. The rubber drain was also fixed. After bone fixation with miniplate, The wound was closed in layers. Operators P. 蔡瑞章 Assistants vs.王國川 R5胡朝凱 R2游建生 黃藍玉秀 (F,1949/02/20,63y0m) 手術日期 2010/06/23 手術主治醫師 曾勝弘 手術區域 東址 002房 01號 診斷 Brain metastasis 器械術式 Brain tumor Crainotomy(Others) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 陳德福, 時間資訊 00:09 臨時手術NPO 00:09 開始NPO 07:09 通知急診手術 08:45 報到 09:00 進入手術室 09:05 麻醉開始 09:25 誘導結束 10:00 抗生素給藥 10:20 手術開始 12:55 麻醉結束 12:55 手術結束 13:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４小時以內 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: left suboccipital craniotomy for tumor excision 開立醫師: 陳德福 開立時間: 2010/06/23 13:22 Pre-operative Diagnosis Left cerebellar tumor, nature to be determinated Post-operative Diagnosis Left cerebellar tumor, nature to be determinated Operative Method left suboccipital craniotomy for tumor excision Specimen Count And Types 1 piece About size:3*3*3CM Source:left cerebellar tumor Pathology pending Operative Findings 1.There is a 3*3*3cm in sized cystic tumor with mass effect at the left cerebellum. The tumor is superficial, reddish, soft, elastic and well demarcated. 2.The tumor was totally removed Operative Procedures Under ETGA and prone position, the cranial vault was fixed with 3 pinged pin type head fixator. The scalp was disinfected and draped as usual. One Hocky-stick incision over left occipital area was done and one 5*4cm in sized craniotomy at left suboccipital area was created. The transvers sinus and part of the sigmoid sinus were identified and the dura was opened in cruciate fasion. One corticotomy was done and the tumor came in to view. We removed the tumor in debulking fasion. Hemostasis is done and the dura was closed in water tight fasion with Prolene. The skull was fixed with wires and one subgaleal draiange was left in situ. The wound was closed in layers. Operators AP 曾勝弘 Assistants R4 陳德福 Indication Of Emergent Operation 呂張寶蓮 (F,1937/12/22,74y2m) 手術日期 2010/06/23 手術主治醫師 曾勝弘 手術區域 東址 002房 02號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(Others) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 陳德福, 時間資訊 00:11 臨時手術NPO 00:11 開始NPO 07:11 通知急診手術 13:40 進入手術室 13:45 麻醉開始 14:10 誘導結束 14:20 抗生素給藥 14:55 手術開始 17:20 抗生素給藥 19:55 手術結束 19:55 麻醉結束 20:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 腦瘤切除－手術時間在４～８小時 1 1 R 手術 頭顱成形術 1 2 R 摘要__ 手術科部: 外科部 套用罐頭: 1.Craniotomy tumor excision, Simpson grade II... 開立醫師: 陳德福 開立時間: 2010/06/23 20:24 Pre-operative Diagnosis right outer third sphenoid ridge meningioma s/p TAE Post-operative Diagnosis right outer third sphenoid ridge meningioma s/p TAE Operative Method 1.Craniotomy tumor excision, Simpson grade III 2.Cranioplasty Specimen Count And Types 1 piece About size:8*6*5CM Source:dura based tumor, brain Pathology pending Operative Findings 1.There is a 8*6*5cm in sized tumor arising from the right outer third sphenoid ridge with wide dura base. The tumor is greyish to whitish, soft, fragile, easy bleeding, and multiple nodulated with cental necrosis. 2.The tumor extends into adjacent skull and right temporalis muscle through one 2.5*3cm in sized skull defect. The skull was removed for the majority of the craniotomy was filled with tumor. 3.Cranioplasty with wire mesh and bone semen was done; Duroplasty with autologous temporalis fascia was done. Operative Procedures Under ETGA and supine position, the skull was fixed with Mayfield head fixator with 3 pins. The scalp was disinfected and draped as usual. One curvilinear incision was done on right scalp and we performed cranoitomy as Pterional approach. After dura tenting, the dura was opened in circle fasion. The tumor came into view and we removed the tumor with sucker, bipolar, tumor forceps, and scisor assisted. We removed the tumor in central debulking fasion. The dura base was coagulated and hemostasis was done. Duroplasty was done with autologous temporalis fascia. The cranioplasty with done with wire mesh and bone semen. One subgaleal CWV was left in situ. The wound was closed in layers. Operators AP 曾勝弘 Assistants R4 陳德福 Indication Of Emergent Operation 蘇芷誼 (F,1984/11/01,27y4m) 手術日期 2010/06/23 手術主治醫師 林東燦 手術區域 兒醫 062房 03號 診斷 Spinal cord lesion 器械術式 IT, BMB+A 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 面罩麻醉 麻醉主治醫師 林峰盛 ASA 3 紀錄醫師 李孟如, 時間資訊 10:04 報到 10:34 進入手術室 10:42 麻醉開始 10:45 誘導結束 10:50 手術開始 11:33 手術結束 11:33 麻醉結束 11:35 送出病患 11:40 進入恢復室 12:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室內注射留置器或脊髓腔內化學藥物注射 1 0 B 手術 骨髓穿刺併骨髓切片 1 0 B 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Semi-opened mask inhalation anes 1 0 記錄__ 手術科部: 套用罐頭: TIT+BMA 開立醫師: 李孟如 開立時間: 2010/06/23 11:47 Pre-operative Diagnosis CNS lymphoma Post-operative Diagnosis CNS lymphoma Operative Method 1. Intrathecal chemotherapy. 2. Bone marrow aspiration and biopsy Specimen Count And Types 4 pieces About size:10ml Source:CSF About size:10ml Source:BM aspiration, sent to cytogenetics About size:40ml Source:BM aspiration, sent o immunophenotype About size:3cm Source:BM biopsy Pathology Pending CSF cytology and BMA cytogenetics Operative Findings CSF appearance: Clear, slowly dripped. BM smear showed + BM particles. Operative Procedures Under IVGA, patient was held in knee-chest decubitus position, with the lumbar area skin prepped and draped. A 22-G needle was introduced into the L3-L4 intervertebral space and advanced slowly until the dura was penetrated. Total 10 mL of CSF was tapped without trauma. Chemotherapy with methotrexate 15 mg, hydrocortisone 25 mg, and ara-c 40 mg in normal saline to 10 mL was injected into the subarachnoid space smoothly. After IT chemotherapy, the patient was changed to prone position, with pelvic area skin prepped and draped properly. BM aspiration via the left posterior superior iliac spine was performed with a 15-G needle smoothly. BM biopsy with 8-G trephine needle via the right posterior superior iliac spine was then performed. Then the needle was withdrawn and the wound was compressed with sterile dressing. Patient on supine and sent to the PAR. Operators R5李孟如/VS林東燦 Assistants R3顏玎安 吳裕賢 (M,1968/02/20,44y0m) 手術日期 2010/06/23 手術主治醫師 戴浩志 手術區域 東址 026房 03號 診斷 Spinal injury with complication, sequelae 器械術式 eyelid repair 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 4E 紀錄醫師 陳建璋, 時間資訊 00:54 開始NPO 00:54 臨時手術NPO 08:54 通知急診手術 13:09 報到 13:10 進入手術室 13:15 麻醉開始 13:20 誘導結束 14:00 手術開始 16:50 麻醉結束 16:50 手術結束 17:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 局部皮瓣（２公分以上） 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 摘要__ 手術科部: 外科部 套用罐頭: Debridement + wund repair and local flaps 開立醫師: 陳建璋 開立時間: 2010/06/23 17:30 Pre-operative Diagnosis Comminuted lateration wound over the right upper and lower eyelids Post-operative Diagnosis Comminuted lateration wound over the right upper and lower eyelids Operative Method Debridement + wund repair and local flaps Specimen Count And Types nil Pathology nil Operative Findings 1. Comminuted laceration wounds over the right upper and lower eyelid with anterior 1/2 eyeball exposue. No eyeball rupture and intact EOM was noted. The wound was deep to the lateral orbital rim. 2. The orbicularis muscle was injured and seperated into several small segments. Large amount of foreign bodies was also noted. Operative Procedures Under endotracheal general anesthesia, the patient was put in the supine position. The operative field was disinfected and draped as usual. We dissected and removed the necrotic tissue. After careful hemostasis, and irrigation with large amount of normal saline, the orbicularis muscle was repaired and the wounds were repaired in layers.. Operators 戴浩志 Assistants 陳建璋 Indication Of Emergent Operation 白彩雪 (F,1939/01/30,73y1m) 手術日期 2010/06/24 手術主治醫師 蔡瑞章 手術區域 東址 002房 01號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 4E 紀錄醫師 鍾文桂, 時間資訊 00:20 臨時手術NPO 00:20 開始NPO 07:20 通知急診手術 07:42 進入手術室 07:50 麻醉開始 07:55 誘導結束 08:15 開始輸血 08:33 手術開始 09:10 抗生素給藥 11:25 手術結束 11:25 麻醉結束 11:35 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 急性硬腦膜下血腫清除術 1 2 L 記錄__ 手術科部: 外科部 套用罐頭: Left frontotemporal craniotomy for hematoma e... 開立醫師: 李建勳 開立時間: 2010/06/24 11:23 Pre-operative Diagnosis Left frontotemporal convexity meningioma s/p exision with subdural hematoma Post-operative Diagnosis Left frontotemporal convexity meningioma s/p exision with subdural hematoma Operative Method Left frontotemporal craniotomy for hematoma evacuation and subdural drain insertion Specimen Count And Types 2 pieces About size:1 Source:swab culture About size:1 Source:DURAFORM (implanted) Pathology Nil Operative Findings Subdural effusion was noted besides hematoma. The brain expansion well after removing the effusion and hematoma. Gortex artificial dura (GORE PRECLUDE PDX) was used for duroplasty. One subdural rubber drain was set up at previous tumor cavity. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position with head turned to right. The scalp was scrubbed, disinfected with alcohol better-iodine then draped. The scalp incision was made along previous wound followed by removing the skull plate. Previously implanted DURAFORM was removed and the subdural effusion and hematoma were removed with suction. The Gortex artificial dura was used for duroplasty. One rubber drain tube was set up at previous tumor cavity. The skull plate was fixed back with miniplates and one subgaleal CWV drain was set up before closed the wound in layers. Operators P 蔡瑞章 Assistants R4 鍾文桂 R6 李建勳 Indication Of Emergent Operation 相關圖片 詹雅慧 (F,1969/01/24,43y1m) 手術日期 2010/06/24 手術主治醫師 蕭輔仁 手術區域 東址 002房 02號 診斷 Female breast cancer 器械術式 Spinal fusion posterior 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2E 紀錄醫師 曾偉倫, 時間資訊 00:55 臨時手術NPO 00:55 開始NPO 07:55 通知急診手術 12:40 進入手術室 12:45 麻醉開始 12:55 誘導結束 13:30 抗生素給藥 13:30 開始輸血 14:00 手術開始 15:30 抗生素給藥 17:40 手術結束 17:40 麻醉結束 18:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 惡性病髓腫瘤切除術 1 1 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 曾偉倫 開立時間: 2010/06/24 18:17 Pre-operative Diagnosis Metastastic epidural spinal cord compression, T9-L1 Post-operative Diagnosis Metastastic epidural spinal cord compression, T9-L1 Operative Method Removal of metastastic epidural spinal cord compression, T9-L1 Specimen Count And Types 1 piece About size:小 Source:Epidural mass Pathology Report pending Operative Findings 1. Epidural mass with spinal cord compression mostly from the posterior 2. Tumor involvement was extensive, including poor bone quality of spinous process and lamina. Vascularity of the tumor and adjacent involved tissues were very high and hemostasis is very difficult. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: prone. 3. The level of surgery was confirmed fluroscopically. 4. Longitudinal skin incision from T9 level to L1 level was made. 5. Periosteal dissection to expose spinous process and lamina. 6. Rongeur and Kerrison were used for laminectomy. 7. Epidural mass lesion was removed by tumor forceps, disc clamps. 8. Hemostasis with Gelfoam packing 9. Two HemoVac were placed epidurally 10. Skin was closed in layers. Operators VS 蕭輔仁 Assistants R4 蔡宗良, R1 曾偉倫 Indication Of Emergent Operation 許新春 (M,1947/03/03,65y0m) 手術日期 2010/06/24 手術主治醫師 蕭輔仁 手術區域 東址 005房 01號 診斷 Cervical spondylosis 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 曾峰毅, 時間資訊 00:00 臨時手術NPO 07:32 報到 08:05 進入手術室 08:10 麻醉開始 08:28 抗生素給藥 08:30 誘導結束 09:02 手術開始 11:25 手術結束 11:25 麻醉結束 11:35 送出病患 11:35 進入恢復室 13:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術（特壓）－二節以內 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 曾峰毅 開立時間: 2010/06/24 11:32 Pre-operative Diagnosis L4/5 spinal stenosis Post-operative Diagnosis L4/5 spinal stenosis Operative Method Sublaminar decompressio at L4 Specimen Count And Types Nil Pathology Nil Operative Findings Bilateral L4 roots was identified well after decomrpession. Thecal sac was decompressed as well. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. With C-arm localization, we made one midline skin incision from L3 to L5. We dissected the paraspinal muscle and created laminotomy at both sides of L4. Sublaminar decompression was done. After normal saline irrigation and hemostasis, we closed the wound in layers. Operators VS 蕭輔仁 Assistants R3 曾峰毅 Ri 鄭宇軒 許新土 (M,1956/11/14,55y4m) 手術日期 2010/06/24 手術主治醫師 王國川 手術區域 東址 005房 02號 診斷 Hydrocephalus 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3 紀錄醫師 曾峰毅, 時間資訊 11:55 進入手術室 11:57 麻醉開始 12:00 誘導結束 12:10 手術開始 12:35 手術結束 12:35 麻醉結束 12:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 氣管切開造口術 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 曾峰毅 開立時間: 2010/06/24 12:35 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Ditto Operative Method Tracheostomy Specimen Count And Types Nil Pathology None Operative Findings Fr.8 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators VS 王國川 Assistants R3 曾峰毅 R1 曾偉倫 葉陳火國 (M,1949/04/08,62y11m) 手術日期 2010/06/24 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Cerebrovascular Diseases 器械術式 EC-IC by-pass 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:10 麻醉開始 08:53 誘導結束 09:30 抗生素給藥 10:04 手術開始 12:30 抗生素給藥 14:30 手術結束 14:30 麻醉結束 14:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱內外血管吻合術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Right EC-IC bypass 開立醫師: 胡朝凱 開立時間: 2010/06/24 14:57 Pre-operative Diagnosis right MCA stenosis Post-operative Diagnosis right MCA stenosis Operative Method Right EC-IC bypass Specimen Count And Types Nil Pathology nil Operative Findings 1.Right posterior branch of STA was occluded 2.Anterior branch of STA was harvest to anastomosis to right frontal M3 branch 3.After Anastomosis, the flow patent Operative Procedures 1.ETGA, supine with haed rotate to left and fixed with skull clamp 2.Right temporal to parietal curvature skin incision 3.Dissect subcutaneous fascia layer to exopse right STA 4.Harvest right anterior branch of STA 5.Cut open temporalis muscle 6.Craniotomy 7.Identify one M3 branch that is toward frontal lobe 8.End to side anastomosis 9.Hemostasis 10.Close dura with durofoam 11.Fix bone back with miniplate 12.Close wound in layers after one CWV drain insertion Operators 王國川 Assistants 胡朝凱,曾偉倫 林來發 (M,1944/12/06,67y3m) 手術日期 2010/06/24 手術主治醫師 王國川 手術區域 東址 005房 03號 診斷 Cerebrovascular accident 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 12:35 報到 12:55 進入手術室 13:00 麻醉開始 13:10 誘導結束 13:20 抗生素給藥 13:58 手術開始 15:26 手術結束 15:26 麻醉結束 15:36 送出病患 15:37 進入恢復室 16:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 頭顱成形術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 記錄__ 手術科部: 外科部 套用罐頭: Cranioplasty. 開立醫師: 鍾文桂 開立時間: 2010/06/25 18:14 Pre-operative Diagnosis Right skull bone defect. Post-operative Diagnosis Right skull bone defect status post cranioplasty. Operative Method Cranioplasty. Specimen Count And Types nil Pathology Nil. Operative Findings 1. Atrophic temporalis muscle. Intact dura mater after dissection. 2. Severe adhesion of fascia with dura mater. 3. Tight skin during closure, extensive subgaleal dissection for good wound closure. 4. Cranioplasty with computer recontruction bone plate which is made of bone cement. Operative Procedures 1. ETGA, supine position, head tilted to the left. 2. Shaving, disinfection, and draping. 3. Incision along the previous operation wound. 4. Subgaleal dissection. 5. Clear out of bone margins. 6. Fixation of artificial bone plate with plates and screws. 7. Dural tenting. 8. Wound closure in layers. Operators V.S. 王國川 Assistants R4 鍾文桂 唐堅平 (F,1957/09/18,54y5m) 手術日期 2010/06/25 手術主治醫師 王水深 手術區域 東址 026房 04號 診斷 Lung cancer 器械術式 Port-A Implatation /WOR 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 周恒文, 時間資訊 15:35 進入手術室 15:40 抗生素給藥 16:00 手術開始 16:35 手術結束 16:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 內頸靜脈切開，永久導管放置術 1 1 記錄__ 手術科部: 外科部 套用罐頭: Permcath/port-A 開立醫師: 周恒文 開立時間: 2010/06/25 16:25 Pre-operative Diagnosis Lung cancer Post-operative Diagnosis Lung cancer s/p port-A insertion Operative Method port-A implantation via right internal jugular vein Specimen Count And Types nil Pathology nil Operative Findings 1. The port-A catheter was inserted via right internal jugular vein by Cut down & echo-guided procedure 2. Patent flow after implantation 3. Tip position located at RA/SVC junction Operative Procedures -Port-A: After skin disinfection and drapping & local anesthesia, echo-guided RIJV cut down and catheterization was performed. Creation of the subcutaneous pocket at right subclavicular area. Tunneliztion, advanced the catheter into the RIJV via the peel-away sheath smoothly. Ensure the catheter tip position by portable CXR. Wound closure in layers after adequate hemostasis. Post-op care plan: 1.wound CD QD+PRN 2.pain control with tinten 3.prophylatic antibiotics use Operators 王水深 Assistants 周恒文,李維棠 張圳 (M,1928/01/15,84y1m) 手術日期 2010/06/25 手術主治醫師 劉詩彬 手術區域 東址 008房 01號 診斷 Prostate cancer 器械術式 Bilateral Orchiedectomy 手術類別 預定手術 手術部位 腹 傷口分類 清潔 麻醉方式 面罩麻醉 麻醉主治醫師 葉惠敏 ASA 3 紀錄醫師 張奕凱, 時間資訊 07:45 報到 08:05 進入手術室 08:29 麻醉開始 08:31 誘導結束 08:35 抗生素給藥 08:43 手術開始 09:50 手術結束 09:50 麻醉結束 09:55 送出病患 10:03 進入恢復室 11:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Semi-opened mask inhalation anes 1 0 手術 睪丸切除術－雙側 1 1 B 摘要__ 手術科部: 泌尿部 套用罐頭: orchiectomy, simple, bilateral 開立醫師: 張奕凱 開立時間: 2010/06/25 08:10 Pre-operative Diagnosis Prostate cancer Post-operative Diagnosis Prostate cancer Operative Method Bilateral orchiectomy, simple Specimen Count And Types 1 piece About size: Source:bilateral testis Pathology pending Operative Findings Bilateral testes:Normal color, size and axis Operative Procedures Under satisfactory intravenous genearal anesthesia with the patient in a supine position, prepping and draping were performed in the usual sterile method. A vertical midline incision was made in the scrotum, and it was extended through the parietal and visceral layers of the tunica vaginalis over left testis. The testis was delivered through the incision. The left testis was first manipulated with the vas deferens, along with the vasculature, and was isolated, divided, and ligated with several 4# silk ties. Adequate hemostasis was obtained. The right testis was then removed in similar method. The incision wound was closed with interrupted 2-0 chromic cat-gut suture. The patient tolerated the operation well and was sent to the recovery room in stable condition. Operators 劉詩彬, Assistants 張奕凱, 蔡碧霞 (F,1941/10/04,70y5m) 手術日期 2010/06/25 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Brain Tumor 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 蔡宗良, 時間資訊 00:00 臨時手術NPO 07:48 報到 08:05 進入手術室 08:10 麻醉開始 08:30 誘導結束 09:30 抗生素給藥 10:15 手術開始 12:47 抗生素給藥 15:53 抗生素給藥 16:20 麻醉結束 16:20 手術結束 16:25 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 8 0 手術 腦瘤切除－手術時間在４～８小時 1 1 記錄__ 手術科部: 外科部 套用罐頭: 1. Subfrontal approach craniotomy for tumor r... 開立醫師: 蔡宗良 開立時間: 2010/06/25 16:33 Pre-operative Diagnosis 1. Meningioma, planum sphenoidale 2. Aneurysm, non-ruptured, anterior communicating artery, right-sided Post-operative Diagnosis 1. Meningioma, planum sphenoidale, Simpson grade II removal 2. Aneurysm, non-ruptured, anterior communicating artery, right-sided Operative Method 1. Subfrontal approach craniotomy for tumor removal, right-sided 2. Clipping of aneurysm Specimen Count And Types Frozen section and the remaining for final pathological investigation. Pathology Frozen section: WHO Grade I meningioma Operative Findings 1. The tumor was whitish-yellowish and elastic-firm, measuring about 3cm in diameter and located in the midline frontal base, based on the sphenoid planum and tuberculum sella with extension into posterior ethmoid and sphenoid sinus with bony erosion. 2. The vascular supply of the tumor comes from ethmoidal arteries of the olfactory groove. 3. The pituitary gland is pushed posteriorly. The anterior aspect of optic chiasm and optic nerves are displaced upward. Inferior hypophyseal artery can be seen. 4. An aneurysm measuring 6.8 mm in height with neck of 2 mm, arising from right-sided ACoA, pointing anteriorly upward. There are two A2 segment after ACoA. 5.Ischemia time for temporary clip: 3mins 12 secs, and 2 mins 42 sec Operative Procedures Under general anesthesia and intubation, the patient was put in supine position with head fixed with Mayfield skull clump. The scalp was shaved, scrubbed, disinfected with alcohol better-iodine then draped. The bicoronal scalp incision was made followed by right frontal craniotomy with left side estension, and surpassing the superior saggital sinus. The dura was detached from the skull throught the frontal skull base. The crista-galli was exposed and removed. The tumor was reached and specimen was obtained for frozen section. Part of the superior wall of ethmoid sinus and sphenoid sinus were removed to expose the tumor. The tumor was grossly removed. The dura was opened in a inverted U shape basing on the frontal base. The surface of the tumor was devascularized by bipolar cautery. Resection was done with the aid of CUSA. Cotton pads were used to separate the surrounding normal brain tissue from the brain tumor. The tumor was detached from the olfactory groove, planum sphenoidale, and prechiasmatic cistern, decompressing the right-sided optic nerve. Bilateral A1 segment of ACA were identified, followed by anterior communicating artery and bilateral A2 segment. Proximal control was obtained by cliping the bilateral A1 segment. The aneurysm was clipped by a 45 degrees clip. The midline attachment was dissected under the surgicel microscope assistance. The duroplasty was performed with 4-0 Prolene sutures and periostium. The skull plate was fixed back with miniplates and screws after one epidural CWV drain set up. The wound was then closed in layers. Operators P 杜永光 Assistants CR 陳睿生 R4 蔡宗良 謝玉琇 (F,1982/01/10,30y2m) 手術日期 2010/06/25 手術主治醫師 曾漢民 手術區域 東址 005房 號 診斷 Astrocytoma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 08:05 報到 08:10 進入手術室 08:20 麻醉開始 09:00 誘導結束 09:05 手術開始 09:46 抗生素給藥 12:50 抗生素給藥 13:10 麻醉結束 13:10 手術結束 13:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４～８小時 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 記錄__ 手術科部: 外科部 套用罐頭: Total tumor excision 開立醫師: 胡朝凱 開立時間: 2010/06/25 13:30 Pre-operative Diagnosis Right frontal lobe residual low grade glioma Post-operative Diagnosis Right frontal lobe residual low grade glioma Operative Method Total tumor excision Specimen Count And Types pieces of tumor Pathology pending Operative Findings 1.About 25 ml grayish, soft tumor located at right frontal lobe with relative clear margin. The ventrcle was also noted after tumor excision. The peripheral brain area became gliotic. 2.Right ACA was identified Operative Procedures 1.ETGA, supine with head fixed with skull clamp 2.Right frontal previous curvature wound was incised open 3.Reflect skin flap anteriorly 4.Craniotomy via previous window 5.Dural tenting 6.Navigation to localize the tumor border 7.Dural opening 8.Tumor excision via the interface of brain and tumor 9.Hemostasis 10.Close dura with one piece of fascia 11.Fix bone back 12.Set one CWV drain then close wound in layers Operators 曾漢民 Assistants 胡朝凱, 游健生 鄭碧蓮 (F,1938/11/08,73y4m) 手術日期 2010/06/25 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 13:42 進入手術室 13:45 麻醉開始 14:20 誘導結束 14:20 抗生素給藥 14:30 手術開始 17:20 手術結束 17:20 麻醉結束 17:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４小時以內 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 記錄__ 手術科部: 外科部 套用罐頭: Simpson grade I tumor excision 開立醫師: 胡朝凱 開立時間: 2010/06/25 17:42 Pre-operative Diagnosis Right temporal to frontal meningioma Post-operative Diagnosis Right temporal to frontal meningioma Operative Method Simpson grade I tumor excision Specimen Count And Types pieces of tumor Pathology pending Operative Findings 1.Hyperosteosis was noted 2.Grayish, elastic tumoe measured about 5 cm located at right temporal to frontal area that compressed the brain. 3.The interface betweem tumor and brain was clear with some vessels attachment. 4.The feeding vessel came from MMA with major bleeding Operative Procedures 1.ETGA, supine with head rotate to left 2.Reverse U shape skin incision was done at right frontal to temporal area 3.Reflect skin flap downward 4.open temporalis muscle 5.Craniotomy 6.Hemostasis 7.Open dura along the border of tumor 8.Tumor was detached from brain via an arachnoid plane 9.The brain vessels was kept in situ 10.close dura with one piece of fascia 11.Set one CWV drain then close wound in layers Operators 曾漢民 Assistants 胡朝凱, 游健生 蘇章樑 (M,1934/03/21,77y11m) 手術日期 2010/06/25 手術主治醫師 賴達明 手術區域 東址 019房 號 診斷 Lumbar Spondylosis 器械術式 Laminectomy for decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:05 進入手術室 08:10 麻醉開始 08:20 誘導結束 08:52 抗生素給藥 09:30 手術開始 12:03 抗生素給藥 13:05 手術結束 13:05 麻醉結束 13:15 送出病患 13:20 進入恢復室 14:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 手術 椎弓切除術（特壓）－二節以內 1 1 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 記錄__ 手術科部: 外科部 套用罐頭: Sublaminar decompression of L3/4, L4/5. 開立醫師: 鍾文桂 開立時間: 2010/06/25 13:40 Pre-operative Diagnosis L3/4, L4/5 lumbar stenosis. Post-operative Diagnosis L3/4, L4/5 lumbar stenosis. Operative Method Sublaminar decompression of L3/4, L4/5. Specimen Count And Types nil Pathology Nil. Operative Findings Hypertrophic ligamentum flavum. Slack roots after decompression. Operative Procedures 1. ETGA, prone position. 2. C-arm fluoroscope for localization of L4 spinous process. 3. Disinfection, draping. 4. Midline incision and dissection. 5. Splinting of L4 spinous process. 6. Laminotomy of L3, L4 and L5. 7. Removal of ligamentum flavum. 8. Well hemostasis. 9. Wound closure in layers. Operators V.S. 賴達明 Assistants R6陳盈志 R4鍾文桂 R1黃世銘 林白玉 (F,1946/09/18,65y5m) 手術日期 2010/06/25 手術主治醫師 賴達明 手術區域 東址 019房 02號 診斷 Spondylolysis, lumbar-sacral(L-S) 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 12:40 報到 13:32 進入手術室 13:35 麻醉開始 13:40 誘導結束 14:10 抗生素給藥 14:22 手術開始 17:10 抗生素給藥 17:40 手術結束 17:40 麻醉結束 17:47 送出病患 17:50 進入恢復室 19:23 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術－後融合，無固定物 1 1 手術 椎間盤切除術－腰椎 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 摘要__ 手術科部: 外科部 套用罐頭: Right hemilaminectomy for disckectomy and bil... 開立醫師: 李建勳 開立時間: 2010/06/25 17:38 Pre-operative Diagnosis L4/5 HIVD with stenosis Post-operative Diagnosis L4/5 HIVD with stenosis Operative Method Right hemilaminectomy for disckectomy and bilateral posteriolateral fusion Specimen Count And Types nil Pathology Nil Operative Findings The L4/5 theca sac and root were relaxed after disckectomy and removal of the ligmentum flavum. Osteoporosis was noted while tried to inserted the transpedicle screw. Bilateral posteriolateral fusion was performed with artificial bone graft. Operative Procedures Under general anesthesia and intubation, the patient was put in prone position. The skin was scrubbed, disinfected with alcohol better-iodine then draped. Midline skin incision was made from L4-5 spinous processess after portable C-arm X-ray localization. The right paraspinal muscles were seperated and retracted with Taylor retractor. Under surgical microscope assistance, the rigth hemilaminectomy was performed with curette and Kerrison punch. The ligmentum flavum was removed by Kerrison punch to expose the dura. The PLL was incised with No. 15 surgical blade and the disc was further removed after curetage by disc clumps. Transpedicle screw was tried to inserted, however did not applied due to osteoporosis. Bilateral posteriolateral fusion was performed with artificial bone graft. After hemostasis, the wound was closed in layers with two hemovac drain tubes set up. Operators VS 賴達明 Assistants R1 黃世銘 R4 鍾文桂 R6 李建勳 相關圖片 蘇振 (M,1957/02/12,55y1m) 手術日期 2010/06/25 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 HIVD 器械術式 Diskectomy lumbar(Others) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 蔡宗良, 時間資訊 00:00 臨時手術NPO 17:02 進入手術室 17:06 麻醉開始 17:12 誘導結束 17:30 抗生素給藥 17:34 手術開始 17:37 進入恢復室 18:30 手術結束 18:30 麻醉結束 18:35 送出病患 19:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術－腰椎 1 1 R 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Mircodiscectomy, L4-5, right-sided 開立醫師: 蔡宗良 開立時間: 2010/06/25 17:57 Pre-operative Diagnosis Herniated lumbar disc, protrusion, L4-5, right-sided Post-operative Diagnosis Herniated lumbar disc, protrusion, L4-5, right-sided Operative Method Mircodiscectomy, L4-5, right-sided Specimen Count And Types nil Pathology None Operative Findings Protruding disc at L4-5, right-sided Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: prone. 3.Skin preparation: the back was shaved and scrubbed with povidone-iodine detergent then painted with povidone-iodine tincture and followed by sterilized adhesive plastic sheet covering. 4.A spinal needle was inserted between spinous processes of L4-5 and a portable X-ray film was taken to locate the correct interspace. 5.Incision: 3-cm, between L4-5 spinous processes, off-midiline at the 1 cm margin of spinous processes. The subcutaneous layer and lumbdorsal fascia were incised then. 6.The aponeurosis of the latissimus dorsi and ileocostalis lumborum muscles at spinous processes of L4-5was incised, the muscles were detached from the interspinous ligament. The multifidus muscles were detached subperiosteally from L5 laminae by a rasp. 7.The paravertebral muscles were retracted by a modified narrow Taylor retractor which was retained constantly by a rubbersling to the side rail of the operating table. 8.Under an operating microscope, the ligamentum flavum was cleaned and incised longitudinally at the lateral part with a No. 11 blade. The lateral portion of this ligament was removed with a small angle Kerrison rongeur, the lateral portion of the laminae and the medial border of the facets were removed too until the margin of the facets and a corridor to the disc that ran lateral to the root was reached. 9. The epidural fat was left undisturbed andpreserved. 10.The compressed L5 root and veins overlying the protruded disc were gently pushed away by placing 2 small cottonoid patties, one above and one below the disc at the floor of the epidural canal. 11.The compressed root was gently pushed further away temporarily by sucker tip in order to expose the herniated disc more clearly. The posterior longitudinal ligament and annulus were incised around the protruded disc with a No. 15 blade. The degenerated disc was removed with microdisc forcepsuntil a substantial amount of the nucleus had been loosened with a cone curette and removed. 12.A piece of subcutaneous fat was resected and covered on -- root. 13.The lumbodorsal fascia was approximated by 3 interruped 2/0 silk stitches. 14.The subcutaneous layer was closed by running suture with 4/0 Dexon and skin by adhesive tape. 15.Course of the surgery: smooth. Operators VS 賴達明 Assistants CR 陳睿生 黃可媗 (F,2006/07/18,5y7m) 手術日期 2010/06/25 手術主治醫師 楊士弘 手術區域 兒醫 062房 04號 診斷 Infantile cerebral palsy, unspecified 器械術式 V-P shunt 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 曾峰毅, 時間資訊 00:51 臨時手術NPO 00:51 開始NPO 07:52 通知急診手術 11:55 進入手術室 12:05 麻醉開始 12:07 誘導結束 12:45 手術開始 13:45 麻醉結束 13:50 手術結束 14:05 送出病患 14:10 進入恢復室 15:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦脊髓液分流管重置 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 曾峰毅 開立時間: 2010/06/25 13:49 Pre-operative Diagnosis Hydrocephalus, status post ventriculoperitoneal shunt insertion, malfunction Post-operative Diagnosis Hydrocephalus, status post ventriculoperitoneal shunt insertion, malfunction Operative Method Ventriculoperitoneal Shunt Revision Specimen Count And Types 3ml CSF was sent to CSF routine, biochemistry profile, and culture. Pathology Nil Operative Findings Clear colorless CSF was drained out via the ventriculostomy. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position. After skin scrubbed, disinfected, and then draped, we made one linear skin incision along previous scalp incision. We enlarged the burr hole with Karrison pouch. We removed previous ventricular catheter, and obliaterated this ventriculostomy with gelfoam. We performed ventricular puncture and inserted ventricular catheter. We reconnect the ventricular catheter to the shunt system. After shunt function checked, we closed the wound in layers. Operators VS 楊士弘 Assistants R3 曾峰毅 Indication Of Emergent Operation 邵慶旭 (M,1926/08/23,85y6m) 手術日期 2010/06/27 手術主治醫師 陳敞牧 手術區域 東址 019房 01號 診斷 Subdural hemorrhage 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林峰盛 ASA 2E 紀錄醫師 陳德福, 時間資訊 20:00 開始NPO 22:30 通知急診手術 13:10 報到 13:18 進入手術室 13:25 麻醉開始 13:32 誘導結束 13:55 抗生素給藥 14:08 手術開始 15:43 麻醉結束 15:43 手術結束 15:50 送出病患 15:53 進入恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 慢性硬腦膜下血腫清除術 1 2 R 手術 慢性硬腦膜下血腫清除術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: bilateral burr hole drainage 開立醫師: 陳德福 開立時間: 2010/06/27 16:02 Pre-operative Diagnosis Chronic subdural hematoma, bilateral fronto-temporo-parietal Post-operative Diagnosis Chronic subdural hematoma, bilateral fronto-temporo-parietal Operative Method bilateral burr hole drainage Specimen Count And Types nil Pathology nil Operative Findings 1.The outer and inner membrane:+ 2.There is 70-80ml darkish and liquified subdural hematoma gushed out spontaneously after opening the outer membrane, bilaterally. 3.The brain expanded well after drainage and one subdural rubber drainage was left in situ. Operative Procedures 1.under ETGA and supine positon 2.skin disinfection and draping over bilateral frontotemporal junction 3.linear incision and burr hole creation 4.dura tenting and dura opening 5.drainage of the subdural hematoma and irrigation with copious normal saline over bilateral subdural space 6.left one subdural rubber draiange in situ bilaterally 7.drain out the air inside the cranium 8.close the wound in layers Operators vs 陳敞牧 Assistants R4 陳德福 Indication Of Emergent Operation 相關圖片 曾子嫣 (F,2010/06/10,1y9m) 手術日期 2010/06/28 手術主治醫師 陳益祥 手術區域 兒醫 067房 01號 診斷 Single liveborn, born in hospital, delivered without mention of cesarean delivery 器械術式 PDA(ligation or Division)Child 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 無麻醉 麻醉主治醫師 ASA 1 紀錄醫師 李維棠, 時間資訊 00:00 臨時手術NPO 10:16 手術開始 13:35 手術結束 醫令資訊 類別 名稱 量 刀 側 手術 存開性動脈導管手術 1 1 L 手術 心包膜切除術 1 2 L 記錄__ 手術科部: 外科部 套用罐頭: PDA ligation + PP window creation 開立醫師: 徐綱宏 開立時間: 2010/06/28 13:57 Pre-operative Diagnosis PDA with CHF Post-operative Diagnosis PDA with CHF Operative Method PDA ligation + PP window creation Specimen Count And Types nil Pathology Nil Operative Findings 1. One large PDA was noted with diameter about 4mm 2. Trantient elevation of diastolic pressure from 30 to 40 mmHg after PDA ligation 3. One PP window was created for pericardial effusion drainage Operative Procedures Under ETG, the patient was put in right decubitus position. Posterolateral thoracotomy was done to enter the pleural cavity. After retracted the lung with wet gauze, the DsAo, LSCA, Ao arch and PDA was dissected out. 2 2-0 silk was looped around the PDA and then ligated. PP window was created. After hemostasis, one chest tube was placed. The wound was closed in layers Operators 陳益祥 Assistants 徐綱宏 李維棠 曾子嫣 (F,2010/06/10,1y9m) 手術日期 2010/06/28 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Single liveborn, born in hospital, delivered without mention of cesarean delivery 器械術式 Spinal tumor biopsy + PDA ligation 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 4 紀錄醫師 曾峰毅, 時間資訊 00:00 臨時手術NPO 09:15 報到 09:15 進入手術室 09:20 麻醉開始 09:40 誘導結束 10:16 手術開始 12:30 13:00 抗生素給藥 13:35 麻醉結束 13:35 13:35 手術結束 13:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 手術 脊椎內脊髓內腫瘤切除術 1 1 記錄__ 手術科部: 套用罐頭: Partial tumor excision at sacral level 開立醫師: 曾峰毅 開立時間: 2010/06/28 11:36 Pre-operative Diagnosis Intraspinal extramedullar tumor, from mid-thoracic level to sacral region with intra-pelvic extraspinal extension Intraspinal intramedullary tumor, from mid-thoracic level to sacrococcygeal region with intra-pelvic extraspinal extension via S2 level Post-operative Diagnosis Intraspinal extramedullar tumor, from mid-thoracic level to sacral region with intra-pelvic extraspinal extension Intraspinal intramedullar tumor (exophytic), from mid-thoracic level to sacrococcygeal region with intra-pelvic extraspinal extension via S2 level Operative Method Partial tumor excision at sacral level Specimen Count And Types Several fragments of one tumor was sent for pathology. Pathology Frozen was sent, but the result was pending while the operation was ended. Frozen biopys showed glioma, grading to be determined. Final pathology was still pending. Operative Findings Well defined, whitish to greyish normo- to hypervascular tumor, located intraspinally extramedullaryly from mid-thoracic level to scral area. The border between neural structure and tumor was clear, but adhesived to each other. Neural tube defect was noted at sacral level, and posterior colume of lower lumbar spine and sacrum was agenesis. Well defined, whitish to greyish normo- to hypervascular tumor, located intraspinally extramedullaryly from mid-thoracic level to scral area. The border between neural structure and tumor was clear, but adhesived to each other. Neural tube defect was noted at sacral level, and posterior colume of lower lumbar spine and sacrum was agenesis. Low-positioned spinal cord was noted at sacral level. Well defined, pinkish to greyish normo- to hypervascular tumor, located intraspinally from mid-thoracic level to scral area. It is suspected that the tumor was exophytic from the spinal cord though it has a capsule. The border between neural structure and tumor could be identified, but adhesived to each other without a clear margin. Loss of laminae was noted at the sacral levels. It was caused by neural tube defect or tumor compression effect was not known. Low-positioned spinal cord was noted at sacral level, attached on right side of the tumor. Operative Procedures With endotracheal general anaesthesia, the patient was put in semi-prone position. After skin shaved, scrubbed, disinfected, and then drape, we made one midline linear skin incision at lower lumbar to scaral area. We dissected to expose the posterior aspect of dura. Midline durotomy was made, and tumor excision was done with tumor forceps and bipolar electrocautery. Hemostasis was done, and dura was closed with 5-0 prolene in water-tight fashion. We closed the wound in layers. With endotracheal general anaesthesia, the patient was put in semi-prone position. After skin shaved, scrubbed, disinfected, and then drape, we made one midline linear skin incision at lower lumbar to scaral area. We dissected to expose the posterior aspect of dura. Midline durotomy was made under microscope, and tumor excision was done with tumor forceps, microscissors, and bipolar electrocautery. Some specimen was sent to frozen study. Hemostasis was done, and dura was closed with 5-0 prolene in water-tight fashion. We closed the wound in layers. Operators VS 郭夢菲 Assistants R3 曾峰毅 簡李阿羽 (F,1941/12/16,70y2m) 手術日期 2010/06/28 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Acoustic tumor 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3 紀錄醫師 蔡宗良, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:05 進入手術室 08:10 麻醉開始 08:30 誘導結束 09:15 抗生素給藥 09:53 手術開始 12:15 抗生素給藥 15:15 抗生素給藥 17:55 麻醉結束 17:55 手術結束 18:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除－手術時間在４～８小時 1 1 L 手術 誘發電位手術監視機–腦神經外科術中特殊儀器使用費 1 0 L 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 12 0 摘要__ 手術科部: 外科部 套用罐頭: C-P Angle Tumor 開立醫師: 蔡宗良 開立時間: 2010/06/28 15:40 Pre-operative Diagnosis Vestibular schwannoma, left-sided Post-operative Diagnosis Vestibular schwannoma, left-sided Operative Method Retrosigmoid approach suboccipital craniotomy Specimen Count And Types 1 piece About size:小 Source:Brain tumor Pathology Report pending Operative Findings 1. Tumor was well-dermacated, rounded and encapsulated, yellowish in color with hard and elastic in consistency. Blood supply was good and tumor bleeds upon removal. 2. Facial nerve was situated anterior cephalad direction of the tumor. Operative Procedures Anesthesia was applied under endotracheal intubation. After Mayfield fixation, the patient was positioned in supine with head rotated 190 degrees to the right. Skin was shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. A S shape retroauricular incision was made. A 2 x 2 cm fascia was harvest to be used as a dura patch during closure. A craniectomy of 4 x 4 cm was made to expose the margin of sigmoid sinus. Dural incision was made in a Y shape patten and reflected to sigmoid and transverse sinus. CSF was drained via cisterna magnum. Consequently, the posterior surface of the C-P angle tumor was well exposed. Under operating microscope the tumor was debulked centrally with the use of CUSA. After the extracanalicular part of the tumor was totally removed, we proceeded to remove the intracanalicular part by opening the IAC after making a inverted V shape dura incision above the IAC. The IAC was fully enlarged and the tumor inside was removed by CUSA. The facial nerve was traced from the IAC towards the pontine side and confirmed by the use of facial nerve stimulator. The blood oozing points on the cerebellar surface where compressed by the tumor previously were packed with gelfoam for hemostasis. Dura was closed with continuous suture with 4/0 prolene to obtain water-tight closure with dural graft. Wound was closed in layers Operators P 杜永光 Assistants CR 陳睿生 R4 蔡宗良 陳聰文 (M,1952/01/15,60y1m) 手術日期 2010/06/28 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Spine tumor 器械術式 Laminectomy C-Spinal(Posterier 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 07:38 報到 08:05 進入手術室 08:10 麻醉開始 08:30 誘導結束 08:50 抗生素給藥 09:10 手術開始 11:30 手術結束 11:30 麻醉結束 11:38 進入恢復室 11:40 送出病患 13:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 惡性病髓腫瘤切除術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Tumor excision 開立醫師: 胡朝凱 開立時間: 2010/06/28 11:28 Pre-operative Diagnosis Left C7 metastatic tumor Post-operative Diagnosis Left C7 metastatic tumor Operative Method Tumor excision Specimen Count And Types pieces of tumor Pathology pending Operative Findings 1.One reddish gray elastic tumor located at left C7 facet joit ad transverse process was oted with easy bleedig. 2.peripheral tissue severe adhesion. 3.The left C7 nerve root was exposed ad preserved. Operative Procedures 1.ETGA, prone with head fixed with skull clamp 2.Previous wound incision 3.Detach previous scar tissue and paravertebral muscle group 4.Resect partial C6~7 facet joint 5.Expose tumor 6.tumor excision with currete 7.Hemostasis with flossil 8.Set one CWV drain 9.Close wound in layers Operators 曾漢民 Assistants 胡朝凱, 游健生 鐘崑榮 (M,1961/05/23,50y9m) 手術日期 2010/06/28 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Cervical Spondylosis 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 11:20 報到 12:00 進入手術室 12:06 麻醉開始 12:20 誘導結束 12:30 抗生素給藥 12:50 手術開始 15:30 抗生素給藥 15:55 手術結束 15:55 麻醉結束 16:04 送出病患 16:07 進入恢復室 18:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術－頸椎 1 1 手術 椎間盤切除術－頸椎 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: C4-6 anterior cervical discectomy and fusion 開立醫師: 游健生 開立時間: 2010/06/28 16:15 Pre-operative Diagnosis C4-6 spodylosis Post-operative Diagnosis C4-6 spodylosis with ossefication of posterior longitudinal ligament Operative Method C4-6 anterior cervical discectomy and fusion Specimen Count And Types nil Pathology nil Operative Findings 1. Spurs at posterior margin of vertebral bodies causing spinal stenosis 2. Ossefication of posterior longitudinal ligament 3. The dura sac expanded well and nerve roots were well decompressed after surgery Operative Procedures 1. Under ETGA, patient was put into supine position with neck hyperextended and right side pelvis elevated. 2. Located the C4-5 intervertebral space by C-arm 3. Anterior neck & right iliac crest were disinfected and draped as usual 4. A 5cm transverse incision was made at C4-5 intervertebral space level 5. The plastisma muscle was transected and mobilized from the underlying superficial cervical fascia which was then opened in vertical direction along the anterior margin of the SCM muscle. 6. The dissection was advanced at the loose plane between SCM muscle and strip muscles until the prevertebral fascia had been reached. 7. Retracted the former structure laterally and the later structures with esophagus and trachea to the opposite side by Cloward cervical retractor. 8. The prevertebral fascia was opened vertically, C4-5 intervertebral space was exposed and identified by C-arm 9. After incision of the annulus fibrosus, the degenerated disc and cartilage plate were removed by curette 10.End-plates were trimed by high-speed air drill and intervertebral spac was widened by a Cloward intervertebral spreader. The spur at the posterior margin of C-body was removed by high speed air drill and fine curette. 11.The posterior longitudinal ligament was cut from bony edge by curette and then removed. Consequently, the spinal dura expanded into the intervertebral space. 12.Repeat above procedure at C5-6 intervertebral space 13.Two blocks of bone graft were taken from right iliac crest, then trimed into appropriated size 14.The intervertebral space was widened by pulling the patients head while the bone grafts were packed into C4-5 & C5-6 intervertebral space tightly by a impactor. 15.Set one mini-hemovac at neck wound 16.Closed the wounds in layers Operators VS 曾漢民 Assistants R5 胡朝凱 R2游健生 劉琮勛 (M,1976/10/01,35y5m) 手術日期 2010/06/28 手術主治醫師 廖漢文 手術區域 東址 000房 號 診斷 Arteriovenous malformation, brain 器械術式 NEURO T.A.E 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 王永彬 ASA 3 時間資訊 08:30 麻醉開始 08:45 誘導結束 13:25 麻醉結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 烏志成 (M,1947/03/16,64y11m) 手術日期 2010/06/28 手術主治醫師 蕭輔仁 手術區域 東址 002房 05號 診斷 Malignant neoplasm of bronchus and lung, unspecified 器械術式 Spinal fusion posterior 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3 紀錄醫師 陳德福, 時間資訊 06:42 臨時手術NPO 06:42 開始NPO 09:42 通知急診手術 13:54 進入手術室 14:05 麻醉開始 14:35 誘導結束 15:00 抗生素給藥 15:05 手術開始 16:13 開始輸血 18:20 抗生素給藥 19:20 手術結束 19:20 麻醉結束 19:35 送出病患 19:35 進入恢復室 20:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 惡性病髓腫瘤切除術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 2 摘要__ 手術科部: 外科部 套用罐頭: 1.T3 tumor excision 2.T1-5 TPS fusion 3.Right... 開立醫師: 陳德福 開立時間: 2010/06/28 19:48 Pre-operative Diagnosis Lung cancer with T3 metastasis, pathologic fracture Post-operative Diagnosis Lung cancer with T3 metastasis, pathologic fracture Operative Method 1.T3 tumor excision 2.T1-5 TPS fusion 3.Right T3 Rhizotomy Specimen Count And Types 2 pieces About size:2*3*2CM Source:BONE TUMOR About size:1*2*0.5CM Source:EPIDURAL TUMOR Pathology pending Operative Findings 1.There is a whitish-greysih elastic tumor invades the T3 at the right pedicle and the body with compression fracture. Some epidural tumor with cord compression is also noticed. The T2-4 epidural tumor and posterior part of the T3 body are removed and the thecal sac expanded well after the decompression. 2.T1-T5 laminectomy and T1-2-4-5 TPS fusion with 1 cross link are performed. 4.0*30mm TPS was implanted over T1&2 and 4.5*40mm TPS was implanted over T4&5. The rods are 15cm and right T3 rhizotomy was done. Operative Procedures Under ETGA and prone position, the skin disinfection and draping was done. Linear incision at midline and the subcutaneous tissue was displaced laterally in order to make a opening of the fascia of the paraspinous muscle . The junction of transverse process and facet joint of T1 to T5 was identified. T1-5 laminectomy was done. The TPS was then implantated at T1-2-4-5 under flouroscopic guided bilaterally. 2 rods was inserted as well. The tumor at the T3 body, right pedicle and eipdural space was removed with tumor forceps, alligator, currettage, and bipolar assisted. One epidural and subcutaneous draiange was left in situ and the wound was closed in layers. Operators VS 蕭輔仁 Assistants R4 陳德福 Indication Of Emergent Operation 相關圖片 陳玉坤 (M,1952/08/01,59y7m) 手術日期 2010/06/29 手術主治醫師 林峰盛 手術區域 西址 035房 06號 診斷 Radiculopathy 器械術式 Nerve block / PC 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 硬肌麻醉 麻醉主治醫師 林峰盛 ASA 1 時間資訊 15:15 麻醉開始 15:17 誘導結束 16:13 進入手術室 16:20 手術開始 16:32 手術結束 16:32 麻醉結束 16:40 送出病患 摘要__ 手術科部: 麻醉部 套用罐頭: LENB 開立醫師: 林峰盛 開立時間: 2010/06/29 16:35 Pre-operative Diagnosis radiculopathy Post-operative Diagnosis radiculopathy Operative Method transforaminal epidural block Specimen Count And Types nil Pathology Nil Operative Findings Operative Procedures LA with 1% xylocaine 5 ml pt in prone position Under fluoroscopic-guidance, transforaminal epidural block was done to right L4&5 level with 23G spinal needle, 40mg Kenacort in 0.5% xylocaine 10ml Operators 林峰盛, Assistants 林文瑛, 章定夫 (M,1973/12/22,38y2m) 手術日期 2010/06/29 手術主治醫師 劉嘉銘 手術區域 東址 025房 01號 診斷 Chronic paranasal sinusitis 器械術式 Endoscopic functional sinus su 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 2 紀錄醫師 邱義霖, 時間資訊 07:44 報到 08:10 進入手術室 08:15 麻醉開始 08:20 誘導結束 08:25 抗生素給藥 08:35 手術開始 13:30 抗生素給藥 13:55 手術結束 13:55 麻醉結束 14:05 送出病患 14:10 進入恢復室 15:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 多竇副鼻竇手術 1 1 L 摘要__ 手術科部: 耳鼻喉部 套用罐頭: Functional endoscopic sinus surgery 開立醫師: 邱義霖 開立時間: 2010/07/01 15:19 Pre-operative Diagnosis Chronic paranasal sinusitis Post-operative Diagnosis Ditto, with iatrogenic skull base defect, status post abdominal fat repair Operative Method Functional endoscopic sinus surgery, left, and abdominal fat skull base defect repair Specimen Count And Types 1 piece About size:3*3mm Source:left nasal tissue Pathology pending Operative Findings Right not done Left infun.: edematous( )polypoid( ) A.Eth.: edematous( ) P.Eth: edematous( )polypoid( ) Maxi.: not checked Fron.: not checked Sph.: edematous( ),polypoid( ),mucopus( ), iatrogenic skull base defect was noted during operation, brain parenchyma exposed, hemostasis of dura and meninges done Operative Procedures (1) Infundibulotomy :L( ) (2) Opening/trimming of ethmoid bulla :L( ) anterior ethmoid :L( ) agger nasi :L( ) frontal recess :L( ) middle turbinate :L( ) (3) Opening/trimming of ground lamella :L( ) posterior ethmoid :L( ) sphenoid sinus :L( ) (4) Widening of maxillary ostium :L( ) aspiration :L( ) irrigation :L( ) (5) Packing with Merocel :L(1) Fingerstall :L(2) Then the skull base defect was noted with large amount of bloody CSF leakage noted. Brain parenchyma was exposed. Neuro surgeon P 曾漢民 was consulted. The abdominal fat was taken and repair with tissue glue was done. Then the lumbar drain was inserted at the L4-L5. The post operative course was satisfactory without CSF rhinorrhea and headache. The patient tolerate the procedure well. Operators 劉嘉銘, Assistants R4林怡岑R2邱義霖 王熊淑惠 (F,1938/04/01,73y11m) 手術日期 2010/06/29 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Lumbar Spondylosis 器械術式 Laminectomy for decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 07:35 報到 08:00 進入手術室 08:05 麻醉開始 08:20 誘導結束 09:00 抗生素給藥 09:20 手術開始 10:40 開始輸血 12:00 抗生素給藥 14:15 手術結束 14:15 麻醉結束 14:20 送出病患 14:25 進入恢復室 15:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術（特壓）－超過二節 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 手術 脊椎融合術－後融合，無固定物 1 2 記錄__ 手術科部: 外科部 套用罐頭: 1.Laminectomy and foraminotomy of L3~5, bilat... 開立醫師: 鍾文桂 開立時間: 2010/06/29 14:47 Pre-operative Diagnosis 1. Lumbar stenosis, L3~5 2. L4/5 spondylolisthesis, grade I. Post-operative Diagnosis 1. Lumbar stenosis, L3~5 2. L4/5 spondylolisthesis, grade I. Operative Method 1.Laminectomy and foraminotomy of L3~5, bilateral. 2. Posterolateral fusion. Specimen Count And Types nil Pathology Nil. Operative Findings Severe stenosis at L4/5 level. Small dura tear at L4/5 level, repaired primarily with Prolene. Hypertrophic facet joint, paraspinal musculature, and ligamentum flavum. Slack thecal sac after decompression. Operative Procedures 1. ETGA, prone position, C-arm fluoroscpe for localization of L3&4 spinous process. 2. Disinfection, and draping. 3. Midline incision and periosteal dissection. 4. Blunt dissection from facet joint to transverse process. 5. Laminectomy and foraminotomy of L3~5 levels. 6. Repair dura tear. 7. Posterolateral fusion. 8. Wound closure in layers. 9. Send the patient to POR smoothly. Operators V.S. 曾勝弘 Assistants R4 鍾文桂 記錄__ 手術科部: 外科部 套用罐頭: 1.Laminectomy and foraminotomy of L3~5, bilat... 開立醫師: 鍾文桂 開立時間: 2010/06/29 14:47 Pre-operative Diagnosis 1. Lumbar stenosis, L3~5 2. L4/5 spondylolisthesis, grade I. Post-operative Diagnosis 1. Lumbar stenosis, L3~5 2. L4/5 spondylolisthesis, grade I. Operative Method 1.Laminectomy and foraminotomy of L3~5, bilateral. 2. Posterolateral fusion. Specimen Count And Types nil Pathology Nil. Operative Findings Severe stenosis at L4/5 level. Small dura tear at L4/5 level, repaired primarily with Prolene. Hypertrophic facet joint, paraspinal musculature, and ligamentum flavum. Slack thecal sac after decompression. Operative Procedures 1. ETGA, prone position, C-arm fluoroscpe for localization of L3&4 spinous process. 2. Disinfection, and draping. 3. Midline incision and periosteal dissection. 4. Blunt dissection from facet joint to transverse process. 5. Laminectomy and foraminotomy of L3~5 levels. 6. Repair dura tear. 7. Posterolateral fusion. 8. Wound closure in layers. 9. Send the patient to POR smoothly. Operators V.S. 曾勝弘 Assistants R4 鍾文桂 林佳勳 (F,1955/04/13,56y11m) 手術日期 2010/06/29 手術主治醫師 曾勝弘 手術區域 西址 033房 號 診斷 Carpal tunnel syndrome 器械術式 Decompression of mediun nerve 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 07:50 報到 08:18 進入手術室 08:20 麻醉開始 08:25 手術開始 08:55 手術結束 09:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 正中神經或尺神經腕部減壓術–單側 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Carpal Tunnel Syndrome 開立醫師: 蔡宗良 開立時間: 2010/06/29 09:09 Pre-operative Diagnosis Carpal Tunnel Syndrome, right-sided Post-operative Diagnosis Carpal Tunnel Syndrome, right-sided Operative Method Transverse carpal ligament release, right-sided Specimen Count And Types Pathology None Operative Findings Median nerve edematous and buldged out after release of TCL Operative Procedures 1.The hand and forearm were sterilized with povidone-iodine tincture, then covered with stockinet. 2.Anesthesia: tourniquet was applied at distal upper arm, then regional block with 15 ml 1% Xylocaine solution was infused through cephalic vein catheter at wrist area. 3. Incision: S shape from vertical palmar crease to transverse wrist crease. 4.The palmaris longus tendon was identified, then the plamar aponeurosis was cut longitidinally along the ulnar side of the palmaris longus tendon. 5. Themedian nerve was identified beneath the palmars longus tendon. Under direct vision, the transverse carpal ligament was divided until no more pressure on the median nerve could be palpated. 6. The skin was closed by interrupted suture with 4/0 nylon.7.The tourniquet was released. The hand and wrist were draped with fluffy dressing and elastic bandage. Operators VS曾勝弘 Assistants R4蔡宗良 張林鈺錚 (F,1943/11/25,68y3m) 手術日期 2010/06/29 手術主治醫師 曾勝弘 手術區域 西址 033房 02號 診斷 Benign neoplasm of scalp 器械術式 Scalp tumor 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 08:35 報到 09:05 進入手術室 09:10 麻醉開始 09:15 手術開始 09:35 手術結束 09:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 頭皮腫瘤 1 1 記錄__ 手術科部: 外科部 套用罐頭: Local excision 開立醫師: 蔡宗良 開立時間: 2010/06/29 09:52 Pre-operative Diagnosis Scalp tumor Post-operative Diagnosis Scalp tumor Operative Method Local excision Specimen Count And Types 1 piece About size:小 Source:scalp Pathology Report pending Operative Findings Shrinked epidermoid cyst with opening sealed. Operative Procedures After disinfection and drapping, local anesthesia was applied. Ellipse skin incision was made and the tumor was removed. The scalp was closed by 2-0 Dexon and 3-0 Nylon. Operators VS 曾勝弘 Assistants R4 蔡宗良 佘上翊 (M,1994/12/08,17y3m) 手術日期 2010/06/29 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Brain tumor 器械術式 Crainotomy Brain Tumor(P-LIN) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 曾峰毅, 時間資訊 00:00 臨時手術NPO 08:35 報到 08:45 進入手術室 08:50 麻醉開始 09:10 誘導結束 09:20 抗生素給藥 11:03 手術開始 12:20 抗生素給藥 15:20 抗生素給藥 15:42 麻醉結束 15:42 手術結束 15:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Glucose 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除－手術時間在４～８小時 1 1 L 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 手術 超音波診查機–腦神經外科術中特殊儀器使用費 1 0 手術 立體定位術－切片 1 2 記錄__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT 開立醫師: 曾峰毅 開立時間: 2010/06/29 16:07 Pre-operative Diagnosis Dysembryoplastic neuroepithelial tumor stauts post excision Post-operative Diagnosis Dysembryoplastic neuroepithelial tumor stauts post excision Operative Method Left craniotomy for tumor excision Specimen Count And Types Several fragments of one tumor was sent for patholgoy. Pathology pending Operative Findings Greyish, ill-defined, encapsuled(gliosis) tumor was noted at some parts of previous tumor cavity. Temporal horn was exposed during tumor excision. Greyish, ill-defined, hypovascular, soft tumor was noted surrounding previous tumor cavity. Some parts was thick up to 8 mm. Temporal horn was exposed during tumor excision. The posterior part of the tumor just attached to the ependymal layer of left occipital horn. This part of tumor was removed by sucker till the ependymal layer was reached. It was not opened. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine with head rotated to right and fixed with heac-clamp. After Navigation registration, we shaved, scrubbed, disinfected, and then draped the scalp, and made skin incision along previous surgical wound. The scalp flap reflected inferiorly, and we removed previous mini-plates and screws. We created craniotomy, and made dura incision in U-shape. Tumor excision was done with tumor forceps, and suction. Hemostasis was done, adn surgicel was paved in the tumor cavity. After water-tight dura closure, we fixed bone graft back with mini-plates. We set one subgaleal CWV, and closed the wound in layers. With endotracheal general anaesthesia, the patient was put in supine with head rotated to right and fixed with skull clamp. After Navigation registration, we shaved, scrubbed, disinfected, and then draped the scalp, and made skin incision along previous surgical wound. The scalp flap was reflected inferiorly, and we removed previous mini-plates and screws. We created craniotomy, and made dura incision in U-shape. Intraoperative echo was used to locate the tumor. Under microscopic view, the tumor was excised with tumor forceps, suction, and bipolar coagulators. We used echo again to confirm almost total excision of the tumor. Hemostasis was done, and Surgicel was paved in the tumor cavity. After water-tight dura closure, we fixed bone graft back with two sets of mini-plates. We set one subgaleal CWV, and closed the wound in layers. Operators VS 郭夢菲 Assistants R3 曾峰毅 陳吳碧娥 (F,1938/12/08,73y3m) 手術日期 2010/06/29 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Lumbar spondylosis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 黃世銘, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:04 進入手術室 08:10 麻醉開始 08:25 誘導結束 08:35 抗生素給藥 09:07 手術開始 11:35 抗生素給藥 12:40 手術結束 12:40 麻醉結束 12:50 送出病患 12:50 進入恢復室 14:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 記錄__ 手術科部: 外科部 套用罐頭: L4~5 TPS and discectomy and cage insertion 開立醫師: 胡朝凱 開立時間: 2010/06/29 12:48 Pre-operative Diagnosis L4~5 spndylolisthesis Post-operative Diagnosis L4~5 spndylolisthesis Operative Method L4~5 TPS and discectomy and cage insertion Specimen Count And Types nil Pathology nil Operative Findings 1.L4 on L5 anterior listhesis was noted. 2.Severe osteoporosis 3.Buldging disc was also noted at L4~5 level Operative Procedures 1.ETGA, prone 2.midline skin incision at L4~5 level 3.Paramedian approach to expose transverse process and facet joint 4.TPS screws insertion 5.Midline dtachment of L4 paraspinal muscle 6.L4 laminectomy 7.Decompression of nerve roots 8.Discectomy of L4~5 and cage insertion 9.Fix rods 10.Close wound in layers Operators 賴達明 Assistants 胡朝凱,黃世銘 呂簡格 (F,1939/12/18,72y2m) 手術日期 2010/06/29 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Spondylolisthesis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 賴達明, 時間資訊 00:00 臨時手術NPO 13:00 報到 13:05 進入手術室 13:10 麻醉開始 13:30 誘導結束 13:45 抗生素給藥 14:00 手術開始 16:34 手術結束 16:34 麻醉結束 16:45 送出病患 16:48 進入恢復室 18:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 手術 椎弓切除術（特壓）－二節以內 1 2 記錄__ 手術科部: 外科部 套用罐頭: L4~5 TPS and discectomy and cage insertion 開立醫師: 胡朝凱 開立時間: 2010/06/29 16:32 Pre-operative Diagnosis L4~5 spondylolisthesis Post-operative Diagnosis L4~5 spondylolisthesis Operative Method L4~5 TPS and discectomy and cage insertion Specimen Count And Types nil Pathology Operative Findings 1.L4 on L5 anterior listhesis was noted. 2.Severe osteoporosis 3.Buldging disc was also noted at L4~5 level Operative Procedures 1.ETGA, prone 2.midline skin incision at L4~5 level 3.Paramedian approach to expose transverse process and facet joint 4.TPS screws insertion 5.Midline dtachment of L4 paraspinal muscle 6.L4 laminectomy 7.Decompression of nerve roots 8.Discectomy of L4~5 and cage insertion 9.Fix rods 10.Close wound in layers Operators 賴達明 Assistants 胡朝凱,黃世銘 江莉娜 (F,1957/01/01,55y2m) 手術日期 2010/06/29 手術主治醫師 賴達明 手術區域 東址 003房 03號 診斷 HIVD 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 黃世銘, 時間資訊 00:00 臨時手術NPO 16:25 報到 16:55 進入手術室 17:00 麻醉開始 17:05 誘導結束 17:20 抗生素給藥 17:32 手術開始 18:30 手術結束 18:30 麻醉結束 18:40 送出病患 18:40 進入恢復室 20:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 椎間盤切除術－腰椎 1 1 摘要__ 手術科部: 外科部 套用罐頭: L4/5 Laminotomy and discectomy 開立醫師: 黃世銘 開立時間: 2010/06/29 18:44 Pre-operative Diagnosis L4/5 HIVD Post-operative Diagnosis L4/5 HIVD Operative Method L4/5 Laminotomy and discectomy Specimen Count And Types Nil Pathology nil Operative Findings 1. Ruptured dise from L4 on L5 and compressed L5 root tightly. 2. Disk became dehydrated Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: prone position. 3. A spinal needle was placed between spinous processes of L4/5 and a X-ray film was taken to locate the correct interspace by C-Arm. 4. Skin preparation: the back was shaved and scrubbed with povidone-iodine detergent then painted with povidone-iodine tincture and followed by sterilized adhesive plastic sheet covering. 5. Incision: 3-cm, between L4/5-spinous processes,off-midiline at the margin of L4/5 spinous processes. The subcutaneous layer and lumbdorsal fascia were incised then. 6. The aponeurosis of the ileocostalis lumborum muscles at spinous processes of L4/5 was incised, the muscles were detached from the interspinous ligament. The multifidus muscles were detached subperiosteally from L4-laminae by a rasp. 7. The paravertebral muscles were retracted by a modified narrow Taylor retractor which was retained constantly by a rubbersling to the side rail of the operating table. 8. Under an operating microscope, the ligamentum flavum was cleaned and incised longitudinally at the lateral part. The lateral portion of this ligament was removed with a small angle Kerrison rongeur, the lateral portion of the laminae and the medial border of the facets were removed too until the margin of the facets and a corridor to the disc that ran lateral to the root was reached. 9. The epidural fat was left undisturbed andpreserved. 10. The compressed L-5 root and veins overlying the protruded disc were gently pushed away 11. The compressed root was gently pushed further away temporarily in order to expose the herniated disc more clearly. The posterior longitudinal ligament and annulus were incised around the protruded disc. The degenerated disc was removed with microdisc forceps until a substantial amount of the nucleus had been loosened with a cone curette and removed. 12. Wound closure in layers 13. Course of the surgery: smooth. Operators VS賴達明 Assistants R5胡朝凱 R1黃世銘 鄭蔡英秀 (F,1934/11/13,77y4m) 手術日期 2010/06/29 手術主治醫師 賴達明 手術區域 東址 005房 03號 診斷 Spinal stenosis, lumbar 器械術式 Laminectomy for decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 17:15 報到 17:55 進入手術室 18:00 麻醉開始 18:05 誘導結束 18:30 抗生素給藥 18:50 手術開始 20:20 手術結束 20:20 麻醉結束 20:25 送出病患 20:35 進入恢復室 22:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 椎弓切除術（特壓）－二節以內 1 1 記錄__ 手術科部: 外科部 套用罐頭: Sublaminar decompression of L4/5 level. 開立醫師: 鍾文桂 開立時間: 2010/06/29 21:00 Pre-operative Diagnosis Lumbar stenosis, L4/5. Post-operative Diagnosis Lumbar stenosis, L4/5. Operative Method Sublaminar decompression of L4/5 level. Specimen Count And Types nil Pathology Nil. Operative Findings Hypertrophic ligamentum flavum. Osteoportic change. Operative Procedures 1. ETGA, prone position. 2. C-arm fluoroscope for localization of L5 spinous process. 3. Disinfection, draping. 4. Midline incision. 5. Spliting of L4&5 spinous process with high spped saw. 6. Laminectomy of L4/5. 7. Sublaminar decompression. 8. Well hemostasis. 9. Re-approximation of L4/5 spinous process. 10 Wound closure in layers after placing one subdural drain. Operators V.S. 賴達明 Assistants R4 鍾文桂 高慧 (F,1955/09/06,56y6m) 手術日期 2010/06/29 手術主治醫師 蕭輔仁 手術區域 東址 003房 04號 診斷 HIVD 器械術式 Radiofrequency coagulation(P-G 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 黃世銘, 時間資訊 18:40 報到 18:55 進入手術室 19:05 抗生素給藥 19:15 麻醉開始 19:16 麻醉結束 19:16 誘導結束 19:17 手術開始 19:45 手術結束 19:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 高頻熱凝療法 1 1 記錄__ 手術科部: 套用罐頭: Bilateral L2 DRG RF 開立醫師: 胡朝凱 開立時間: 2010/06/29 19:51 Pre-operative Diagnosis low back pain Post-operative Diagnosis low back pain Operative Method Bilateral L2 DRG RF Specimen Count And Types nil Pathology nil Operative Findings 1.bilateral L2 DRG was approached and coagulated Operative Procedures 1.Local anesthesia 2.Bilateral L2 neural foramen (DRG) area needle insertion 3.test 4.Radiofrequency ablation Operators 蕭輔仁 Assistants 胡朝凱, 蔡宗良 侯志偉 (M,1984/07/08,27y8m) 手術日期 2010/06/29 手術主治醫師 王國川 手術區域 東址 001房 02號 診斷 Major trauma rated 16 or above on the severeity scale ( Injury severeity score >=16 ) 器械術式 V-P shunt removal, 83048C 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 蔡宗良, 時間資訊 00:00 通知急診手術 11:15 進入手術室 11:20 麻醉開始 11:30 誘導結束 11:48 手術開始 12:05 手術結束 12:05 麻醉結束 12:10 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 肌肉或深部組織腫瘤切除術及異物取出術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Removal of ventriculoperitonea shunt 開立醫師: 蔡宗良 開立時間: 2010/06/29 12:24 Pre-operative Diagnosis Ventriculoperitoneal shunt infection Post-operative Diagnosis Ventriculoperitoneal shunt infection Operative Method Removal of ventriculoperitonea shunt Specimen Count And Types 1 piece About size:小 Source:Ventricle catheter, for tip culture Pathology None Operative Findings VP shunt, no pus discharge Operative Procedures Under general anesthesia, patient was positioned in supine. Woun incision was made on previous wound. The ventricular catheter was removed and sent for tip culture. Hemostasis was performed and the wound was irrigated. The wound was closed in layers. Operators VS 王國川 Assistants R4 蔡宗良 Indication Of Emergent Operation 黃桂淼 (F,1954/05/15,57y9m) 手術日期 2010/06/29 手術主治醫師 蔡翊新 手術區域 東址 005房 02號 診斷 Malignant neoplasm of trachea 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 13:35 報到 14:40 進入手術室 14:45 麻醉開始 14:55 誘導結束 15:55 手術開始 17:30 手術結束 17:30 麻醉結束 17:35 送出病患 17:40 進入恢復室 19:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 腦室腹腔分流手術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 蔡翊新 開立時間: 2010/06/29 17:33 Pre-operative Diagnosis Intraventricular hemorrhage with acute hydrocephalus; right frontoparietal AVM Post-operative Diagnosis Intraventricular hemorrhage with acute hydrocephalus; right frontoparietal AVM Operative Method V-P Shunt, programmable shunt, via left Kocher point Specimen Count And Types 10 ml CSF, sent for cytology, bacterial culture, routine and biochemical studies Pathology Nil. Operative Findings CSF: sanguinous, clear fluid, pressure: 15 cmH2O. VP shunt: programmable, Codman, initial setting: 130 mmH2O; ventricular catheter: 6.2 cm, peritoneal catheter: 35 cm. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 5 cm curvilinear, left frontal, corresponded to the location of left frontal horn. Raney clips were applied to the scalp edge for temporary hemostasis. 5. After the scalp flap had been lifted and reflected anteriorly, a burr hole was made at left Kocher point and the dura was tented by 1 stitch. 6. The dura was opened by a nib incision. Left lateral ventricle was tapped by a ventricular needle, then a Nelaton tube was introduced into the ventricle. Intracranial pressure was measured and CSF was sent for routine study. 7. A nib incision was made at LUQ of the abdomen, then a trocar was pushed into peritoneal cavity. Subsequently, distal 35 cm segment of the peritoneal catheter (open-end) was introduced into the peritoneal cavity through the outer tube of the trochar. The proximal end of this catheter was passed through subcutaneous tunnel at forechest, neck, left retroauricular area and connected the Codman programmable shunt reservoir. The ventricular catheter was inserted to the left frontal horn after connecting to the reservoir. The shunt system was checked to make sure its function was working. 8. The reservoir was fixed to pericranium by 1 stitch. 9. Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 10.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R4鍾文桂Ri鄭允中 廖泰煬 (M,1952/10/11,59y5m) 手術日期 2010/06/30 手術主治醫師 杜永光 手術區域 東址 002房 01號 診斷 Subarachnoid hemorrhage 器械術式 Craniotomy(Aneurysms) P-DUH 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 胡朝凱, 時間資訊 07:25 通知急診手術 08:30 進入手術室 08:35 麻醉開始 08:45 誘導結束 09:15 抗生素給藥 09:40 手術開始 12:26 抗生素給藥 15:26 抗生素給藥 16:55 手術結束 16:55 麻醉結束 17:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 9 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 開顱術摘除血管病變－腦血管瘤－有徵的 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Left pterional approach for aneurysmal clipping 開立醫師: 胡朝凱 開立時間: 2010/06/30 17:21 Pre-operative Diagnosis Left MCA bifurcation aneurysm Post-operative Diagnosis Left MCA bifurcation aneurysm Operative Method Left pterional approach for aneurysmal clipping Specimen Count And Types nil Pathology nil Operative Findings 1.One about 8x4 saccular aneurysm arised from left M1 bifurcation that protruded laterally and downward. 2.One straight sugita clip was applied 3.Atherosclerosis was also noted 4.Proximal control was done within two minutes Operative Procedures Under ETGA, patient was put in supine position with head rotate to right 45 degree and extension that fixed with Mayfield skull clamp. Left curvillinear skin incision was done. Skin flap was reflected anteriorly with facial nerve preservation procedure. Detach temporalis muscle was then performed to exopse zygomatic arch. Craniotomy was done. The sphenoid ridge was drilled to became flat. Dura was cut open as curvillinear line. The frontal lobe was first retracted to expose left optic nerve and ICA. Left sylvian fissure was then opened with microdissection. The sylvian vein was left one temporal side.The aneurysm neck was exposed after tracing M1 backward. Temporary clipping was performed at M1. The aneurysmal neck was then clipped smoothly. Hematoma inside the sylvian fissure was also cleaned. After hemostasis, the dura was closed. Bone was fixed back with miniplate. After one CWV drain setting, the wound was closed in layers. Operators P 杜永光 Assistants 胡朝凱, 游健生 Indication Of Emergent Operation 張淑真 (F,1954/02/15,58y0m) 手術日期 2010/06/30 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Myofascial pain 器械術式 Craniotomy(Aneurysms) P-DUH 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 蔡宗良, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:05 進入手術室 08:10 麻醉開始 08:30 誘導結束 09:00 抗生素給藥 09:33 手術開始 12:00 抗生素給藥 13:55 開始輸血 14:35 麻醉結束 14:35 手術結束 14:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 開顱術摘除血管病變－腦血管瘤－有徵的 1 1 R 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 R 手術 誘發電位手術監視機–腦神經外科術中特殊儀器使用費 1 0 R 記錄__ 手術科部: 外科部 套用罐頭: Pterional approach for clipping of aneurysm, ... 開立醫師: 蔡宗良 開立時間: 2010/06/30 13:05 Pre-operative Diagnosis Aneurysm, anterior cerebral artery, segment 1, right-sided Post-operative Diagnosis Aneurysm, anterior cerebral artery, segment 1, right-sided Operative Method Pterional approach for clipping of aneurysm, right-sided Specimen Count And Types nil Pathology None Operative Findings A 5mm wide-neck aneurysm at right A1 segment which is much larger than the one observed in angiography because most of the part was thrombosed. The aneurysm also protruded towards the optic nerve causing indentation. Ischemia time during temporary clipping: 1st attempt = 4 mins 20 sec, 2nd attempt = 3 mins 10 secs Operative Procedures Under ETGA, the patient was set into supine position with head tilt to left and fixed with Mayfield. The operation field was disinfected and drapped. Left frontal temporal curvilinear incision was done. Temporalis muscle was detached till temporal base expose with muscle cuff left along superior temporal line. Burr hole was made at key hole and then craniotomy window was done with saw. Dura tenting was done. The skull base was drilled to be flattened and spheoid ridge was drill till superior orbital fissure exposure. Linear dura incision was done and the dura was reflected as fish-mouth shape. Optic nerve and internal carotid artery were identified together with anterior cerebral artery. The neck of the aneurysm was dissected. Temporary clip was placed at ICA and distal ACA. A fenestrate 90 degree clip was used for clipping. Hemostasis was done with bipolar and surgicel packing. Dura was closed with 4-0 prolene and bone plate was fixed back with miniplate. One subgaleal CWV drain was set and the wound was closed in layers. Operators P 杜永光 Assistants CR 陳睿生 R4 蔡宗良 李小榮 (M,1947/06/12,64y9m) 手術日期 2010/06/30 手術主治醫師 杜永光 手術區域 東址 003房 02號 診斷 Generalized nonconvulsive epilepsy without mention of intractable epilepsy 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 蔡宗良, 時間資訊 00:00 臨時手術NPO 14:15 報到 15:00 進入手術室 15:05 麻醉開始 15:15 誘導結束 15:45 抗生素給藥 15:56 手術開始 17:45 手術結束 17:45 麻醉結束 18:00 送出病患 18:03 進入恢復室 19:02 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 頭顱成形術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 外科部 套用罐頭: Cranioplasty, left-sided 開立醫師: 蔡宗良 開立時間: 2010/06/30 17:57 Pre-operative Diagnosis Cranial defect, fronto-temporo-parietal, s/p craniectomy, left-sided Post-operative Diagnosis Cranial defect, fronto-temporo-parietal, s/p craniectomy, left-sided Operative Method Cranioplasty, left-sided Specimen Count And Types nil Pathology None Operative Findings Operative Procedures General anesthesia was applied under endotracheal intubation. Patient was positioned in supine with head rotated 60 degrees to the right. Scalp was prepared and disinfected as usual. After drapping, the skin incision was made upon the previous scar. The scalp was reflected and the underlying dura was exposed. The skull plate was fixed back tothe craniotomy window with mini-plate. Two CWV drain was placed, one below the skull plate, another above it. The wound was closed in layers. Operators P 杜永光 Assistants CR 陳睿生 R4 蔡宗良 摘要__ 手術科部: 外科部 套用罐頭: Cranioplasty, left-sided 開立醫師: 廖御佐 開立時間: 2010/06/30 18:05 Pre-operative Diagnosis Cranial defect, fronto-temporo-parietal, s/p craniectomy, left-sided Post-operative Diagnosis Cranial defect, fronto-temporo-parietal, s/p craniectomy, left-sided Operative Method Cranioplasty, left-sided Specimen Count And Types nil Pathology None Operative Findings Cranial defect, fronto-temporo-parietal, s/p craniectomy Operative Procedures General anesthesia was applied under endotracheal intubation. Patient was positioned in supine with head rotated 60 degrees to the right. Scalp was prepared and disinfected as usual. After drapping, the skin incision was made upon the previous scar. The scalp was reflected and the underlying dura was exposed. The skull plate was fixed back tothe craniotomy window with mini-plate. Two CWV drain was placed, one below the skull plate, another above it. The wound was closed in layers. Operators P 杜永光 Assistants CR 陳睿生 R4 蔡宗良 楊俊彩 (M,1953/01/01,59y2m) 手術日期 2010/06/30 手術主治醫師 杜永光 手術區域 東址 005房 04號 診斷 Arteriovenous malformation, brain 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 16:50 報到 16:58 進入手術室 17:00 麻醉開始 17:07 誘導結束 17:20 抗生素給藥 17:50 手術開始 20:25 手術結束 20:25 麻醉結束 20:35 送出病患 20:40 進入恢復室 21:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 頭顱成形術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 摘要__ 手術科部: 外科部 套用罐頭: Cranioplasty 開立醫師: 曾偉倫 開立時間: 2010/06/30 20:46 Pre-operative Diagnosis 1. Left AVM status post craniectomy with AVM excision with skull defect Post-operative Diagnosis 1. Left AVM status post craniectomy with AVM excision with skull defect Operative Method Cranioplasty Specimen Count And Types nil Pathology Nil. Operative Findings 1. A 12 x 8 cm skull defect over left frontal-parietal area Operative Procedures 1. Under ETGA, patient put on supine position with facing to right and mild elevated of left shoulder 2. Disinfected and drapped as usaul 3. Skin incision over previous operation scar 4. Open wound in layers 5. Do dura tenting 6. Place his skull over the defect then fix it with mini-plate 7. Place one CWV drain over sub-cutaneous area 8. Close wound in layers Operators P 杜永光 Assistants R4 鍾文桂 R1 曾偉倫 黃許百合 (F,1939/03/11,73y0m) 手術日期 2010/06/30 手術主治醫師 曾漢民 手術區域 東址 005房 03號 診斷 Pituitary Tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 14:20 報到 14:30 進入手術室 14:35 麻醉開始 14:50 誘導結束 15:10 抗生素給藥 15:30 手術開始 16:18 麻醉結束 16:18 手術結束 16:35 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 經由蝶竇之腦下垂體瘤切除 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Trans-sphenoidal adenoectomy. 開立醫師: 鍾文桂 開立時間: 2010/06/30 17:11 Pre-operative Diagnosis Pituitary macroadenoma. Post-operative Diagnosis Pituitary macroadenoma. Operative Method Trans-sphenoidal adenoectomy. Specimen Count And Types 1 piece About size:< 3 cc. Source:pituitary adenoma. Pathology Pending. Operative Findings The tumor was whitish to pinksih, soft in character. The border was clear. Intact normal gland. No CSF leakage. The tumor was complete excised. Operative Procedures After ETGA, the patient was put in supine position with head mild left tilt. The nasal cavity was well-disinfective, and then we incised into the nasal septum. Dissection was performed along with the periosteum to expose sphenoid sinus anterior wall and sphenoid ostia. After fracture of vomer, sphenoid sinus anterior wall was also fractured. The mucosa was removed. The sella floor was exposed and removed with kerrison. After cruciate form incision, tumor buldged out. And it was further removed with tumor forceps and ring currette. After total excision of tumor was made, the bony graft was put back and followed by compaction of merosel. Operators V.S 曾漢民 Assistants R4 鍾文桂 李宗哲 (M,1979/12/15,32y2m) 手術日期 2010/06/30 手術主治醫師 楊榮森 手術區域 東址 021房 02號 診斷 Lung cancer 器械術式 Bone Biopsy 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 2 紀錄醫師 徐鎮平, 時間資訊 10:15 報到 10:53 進入手術室 10:55 麻醉開始 11:00 誘導結束 11:05 抗生素給藥 11:15 手術開始 11:35 手術結束 11:35 麻醉結束 11:45 進入恢復室 11:45 送出病患 13:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 骨片切取術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 骨科部 套用罐頭: biopsy 開立醫師: 徐鎮平 開立時間: 2010/06/30 11:42 Pre-operative Diagnosis left humerus mass Post-operative Diagnosis left humerus mass Operative Method biopsy Specimen Count And Types 1 piece About size:1 Source:left humerus Pathology pending Operative Findings as diagnosis Operative Procedures 1.ETGA, semi sitting position 2. skin disinfection and drapped 3. skin longitudinal incision along left humerus,and biopsy with culture step by step 4. NS irrigation, close wound in layers Operators 楊榮森, Assistants 方建豐,徐鎮平 陳寰穎 (M,2003/07/05,8y8m) 手術日期 2010/06/30 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Moyamoya disease 器械術式 Brain tumor Crainotomy(Others) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 曾峰毅, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:09 進入手術室 08:15 麻醉開始 09:17 抗生素給藥 09:30 誘導結束 09:51 手術開始 12:17 抗生素給藥 13:25 麻醉結束 13:25 手術結束 13:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱內外血管吻合術 1 1 B 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 記錄__ 手術科部: 外科部 套用罐頭: EC-IC Bypass at bilateral frontal area 開立醫師: 曾峰毅 開立時間: 2010/06/30 13:43 Pre-operative Diagnosis Moyamoya disease, status post bilateral EDAS Moyamoya disease, status post bilateral temporal EDAS Post-operative Diagnosis Moyamoya disease, status post bilateral EDAS Moyamoya disease, status post bilateral temporal EDAS Operative Method EC-IC Bypass at bilateral frontal area Specimen Count And Types Nil Pathology Nil Operative Findings The tissue contact betwwen periosteum and brain was well. The tissue contacted between periosteum and brain was well. The meningeal collaterals were abundant. Operative Procedures With endotracheal general anaesthesia ,the patient was put in supine position with neck flexed. After scalp shaved, scrubbed, disinfected, and then draped, we made one bicoronal skin incision, and reflected the scalp flap inferiorly. We made four V-shape periosteum incisions at bilateral sides of frontal area, and then drilled four burr holes at each side. At every burr hole, we created X-shape durotomy, and inserted the periosteum falp into subarachnoid space after arachnoid membrane disrupted. We closed the wound in layers. With endotracheal general anaesthesia, the patient was put in supine position with neck mildly flexed. After scalp shaved, scrubbed, disinfected, and then draped, we made one bicoronal skin incision, and reflected the scalp flap anteriorly and posteriorly. We made four V-shape periosteum incisions bases at temporal side at bilateral sides of frontal area, totally 8 in number, and then drilled four burr holes at each side. At every burr hole, we created X-shape durotomy, and inserted the periosteum falp into subarachnoid space after the arachnoid membrane was incised under microscopic view. We covered the burr holes and periosteal falp with small pieces of gelfoam to fix the periosteal falp in place, then covered the burr hole with bone ash. Another pieces of surgicel was used to cover the bone ash. We then closed the wound in layers. Operators VS 郭夢菲 Assistants R3 曾峰毅 葉碧蓉 (F,1955/07/29,56y7m) 手術日期 2010/06/30 手術主治醫師 賴達明 手術區域 東址 005房 01號 診斷 Burst fracture 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 07:35 報到 08:00 進入手術室 08:05 麻醉開始 08:15 誘導結束 09:00 抗生素給藥 09:14 手術開始 11:55 開始輸血 12:00 抗生素給藥 13:20 手術結束 13:20 麻醉結束 13:30 送出病患 13:35 進入恢復室 14:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 手術 椎弓切除術（特壓）－二節以內 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 記錄__ 手術科部: 外科部 套用罐頭: 1. Fixation with transpedicle screws at bilat... 開立醫師: 鍾文桂 開立時間: 2010/06/30 13:55 Pre-operative Diagnosis L1 burst fracture with cord compression. Post-operative Diagnosis 1. L1 burst fracture with cord compression. 2. Fracture of right facet joint,L1. Operative Method 1. Fixation with transpedicle screws at bilateral T11,12, and L2 levels, and posterolateral fusion at T12-L1. 2. Hemilaminectomy, right L1. Specimen Count And Types nil Pathology Nil. Operative Findings 1. Osteoportic change, easy oozing( Blood loss 1100cc) 2. The retropulstion part of the burst fracture was removed by curette for cord decompression. 3. Transpedicle screws: 40 mm with two rods. 4. Intact dura mater. Operative Procedures 1. ETGA, prone position. 2. C-arm fluoroscope: localize T1 spinous process. 3. Disinfection and draping. 4. Midline incision and periosteal dissection. 6. Localization of operation region with C-arm. 7. Apply transpedicle screws at L2, T11,T12, bilateral. 8. Removal of right inferior facet, L1. 9. Cord decompression with hemilaminectomy of right L1, and removal of retropulsion part of the burst fracture. 10.Posteolateral fusion at T12-L1 level, mainly at left side after decortication. 11.Placement of two 1/8 hemovac drains after well hemostasis. 12.Wound closure in layers. Operators V.S.賴達明 Assistants R4 鍾文桂 R1曾偉倫. 相關圖片 魏玉禎 (F,1957/12/07,54y3m) 手術日期 2010/06/30 手術主治醫師 柯政郁 手術區域 東址 025房 05號 診斷 Thyroglossal duct cyst 器械術式 excision of thyroglossal duct cyst 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 邱義霖, 時間資訊 12:10 報到 12:20 進入手術室 12:25 麻醉開始 12:30 誘導結束 12:45 抗生素給藥 12:48 手術開始 13:50 手術結束 13:50 麻醉結束 14:10 送出病患 14:12 進入恢復室 15:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 頸部良性腫瘤切除，簡單 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 耳鼻喉部 套用罐頭: Neck mass excision, midline neck 開立醫師: 邱義霖 開立時間: 2010/06/30 20:04 Pre-operative Diagnosis Neck mass, midline Post-operative Diagnosis Neck mass, midline Operative Method Neck mass excision, midline neck Specimen Count And Types 1 piece About size:3*3cm Source:anterior neck mass Pathology Pending Operative Findings a mass about 3x3 cm located at anterior midline, above the strap muscle layer, connected with the pyramidal lobe of thyroid gland Operative Procedures Anesthesia was set up via ETGA. The patient was in supine position with head extended. Skin was disinfected and draped as usual. Local anesthesia with Bosmin rinsed Xylocaine was injected into the subcutaneous tissue around the mass. After marking an incision parallel to the skin crease, an about 2*2cm masses were noted at the midline neck, just below the hyoid bone, cystioc content, attached to the pyramidal lobe of the thyroid gland. The masses were dissecting from the surrounding tissue completely. After hemostasis, a mini hemovac was inserted and then the wound was closed with 2 layers. The patient tolerated the procedure well. Operators 柯政郁, Assistants R4林怡岑R2邱義霖 方葉秀英 (F,1938/08/09,73y7m) 手術日期 2010/06/30 手術主治醫師 王國川 手術區域 東址 001房 03號 診斷 Cerebrovascular accident (CVA) 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 4E 紀錄醫師 曾偉倫, 時間資訊 11:41 開始NPO 11:41 臨時手術NPO 11:42 通知急診手術 12:20 報到 12:20 進入手術室 12:25 麻醉開始 12:45 誘導結束 13:00 抗生素給藥 13:10 手術開始 13:50 開始輸血 15:50 麻醉結束 15:50 手術結束 16:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 腦內血腫清除術 1 1 手術 顱內壓監視置入 1 2 摘要__ 手術科部: 外科部 套用罐頭: Right sub-occipital craniectomy with hematoma... 開立醫師: 曾偉倫 開立時間: 2010/06/30 16:16 Pre-operative Diagnosis Right cerebellar hemorrhage Post-operative Diagnosis Right cerebellar hemorrhage Operative Method Right sub-occipital craniectomy with hematoma evacuation and duroplasty+ ICP monitoring over Freizer point Specimen Count And Types nil Pathology Nil. Operative Findings 1. The CSF was pinkish while inserted the EVD 2. The cerebellum was swelling while opening the dura 3. Some dark-red blod clot removed from the cerebellum ~ 30 c.c. 4. The brain was soft and flat after the hematoma was removed Operative Procedures 1. Under ETGA, patient was put on prone position with mild neck flexion 2. Disinfected and drapped as usual 3. Skin incision over right Freized point then open the skull. 4. Insert a EVD for ICP monitoring 5. Curviliner skin incision over right occipital area with extension to C2 level 6. Open the skin, skull and dura 7. Some dark blood clot buldge from the cerebellum 8. Hematoma evacuation was performed carefully 9. Perform duroplasty and place a CWV drain in sub-cutaneous area 10. Close wound in layers Operators VS 王國川 Assistants R2 游健生 R1 曾偉倫 Indication Of Emergent Operation 摘要__ 手術科部: 外科部 套用罐頭: Right sub-occipital craniectomy with hematoma... 開立醫師: 曾偉倫 開立時間: 2010/06/30 16:20 Pre-operative Diagnosis Right cerebellar hemorrhage Post-operative Diagnosis Right cerebellar hemorrhage Operative Method Right sub-occipital craniectomy with hematoma evacuation and duroplasty+ ICP monitoring over Freizer point Specimen Count And Types nil Pathology Nil. Operative Findings 1. The CSF was pinkish while inserted the EVD 2. The cerebellum was swelling while opening the dura 3. Some dark-red blod clot removed from the cerebellum ~ 30 c.c. 3. Some dark-red blod clot removed from the cerebellum ~ 20 c.c. 4. The brain was soft and flat after the hematoma was removed Operative Procedures 1. Under ETGA, patient was put on prone position with mild neck flexion 2. Disinfected and drapped as usual 3. Skin incision over right Freized point then open the skull. 4. Insert a EVD for ICP monitoring 5. Curviliner skin incision over right occipital area with extension to C2 level 6. Open the skin, skull and dura 7. Some dark blood clot buldge from the cerebellum 8. Hematoma evacuation was performed carefully 9. Perform duroplasty and place a CWV drain in sub-cutaneous area 10. Close wound in layers Operators VS 王國川 Assistants R2 游健生 R1 曾偉倫 Indication Of Emergent Operation 辜秋香 (F,1959/11/20,52y3m) 手術日期 2010/07/01 手術主治醫師 王崇禮 手術區域 東址 021房 01號 診斷 Rheumatoid arthritis 器械術式 sono-guided aspiration 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 林子富 ASA 1 紀錄醫師 葉軒, 時間資訊 07:45 報到 08:07 進入手術室 08:15 麻醉開始 08:25 誘導結束 08:25 抗生素給藥 08:45 手術開始 08:53 手術結束 08:53 麻醉結束 08:55 送出病患 09:03 進入恢復室 10:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 皮下腫瘍，囊腫抽吸 1 0 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 摘要__ 手術科部: 骨科部 套用罐頭: Sonar-guided aspiration 開立醫師: 葉軒 開立時間: 2010/07/01 08:57 Pre-operative Diagnosis Left foot inflammatroy process Post-operative Diagnosis Left foot inflammatroy process, suspected ganglion Operative Method Sonar-guided aspiration Specimen Count And Types nil Pathology Pending Operative Findings Clear gel-like content Operative Procedures 1. Nerve block, in supine position 2. Skin preparation 3. Aspiration under sonar-guided aspiration Operators 陳沛裕, Assistants 葉軒, 王政為, 陳俊和, 廖鼎晨 (M,1966/07/17,45y7m) 手術日期 2010/07/01 手術主治醫師 王成平 手術區域 西址 033房 07號 診斷 Neck mass 器械術式 Benign neck mass excision (sim 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 14:15 進入手術室 14:20 麻醉開始 14:25 手術開始 14:55 手術結束 14:56 送出病患 記錄__ 手術科部: 耳鼻喉部 套用罐頭: Neck mass excision, left 開立醫師: 林冠良 開立時間: 2010/07/01 14:45 Pre-operative Diagnosis Neck mass, left Post-operative Diagnosis Neck mass, left Operative Method Neck mass excision, left Specimen Count And Types 1 piece About size: Source:Neck mass Pathology Pending Operative Findings a mass about 1 x 1 cm located at level V was removed. Operative Procedures The patient was in supine position with head extended and turned right side. Skin was disinfected and draped as usual. Local anesthesia with Bosmin rinsed Xylocaine was injected into the subcutaneous tissue around the mass. After marking an incision parallel to the skin crease, an about 1*1 cm mass was noted at left level V. The mass was dissecting from the surrounding tissue completely. After hemostasis,the wound was closed with 2 layers. The patient tolerated the procedure well. Operators 王成平, Assistants R4 林芳瑩 宋楓 (M,1935/09/09,76y6m) 手術日期 2010/07/01 手術主治醫師 陳敞牧 手術區域 東址 005房 01號 診斷 Lumbar spondylosis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3 紀錄醫師 楊博智, 時間資訊 00:00 臨時手術NPO 07:48 報到 08:05 進入手術室 08:07 麻醉開始 08:15 誘導結束 09:10 抗生素給藥 09:21 手術開始 12:10 抗生素給藥 13:00 開始輸血 13:05 手術結束 13:05 麻醉結束 13:15 送出病患 13:20 進入恢復室 14:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 手術 椎間盤切除術－腰椎 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: L4 laminectomy for L3/4 decompression, and L4... 開立醫師: 陳睿生 開立時間: 2010/07/01 13:21 Pre-operative Diagnosis Lumbar stenosis over L3-5 with L4/5 spondylolithesis Post-operative Diagnosis Lumbar stenosis over L3-5 with L4/5 spondylolithesis Operative Method L4 laminectomy for L3/4 decompression, and L4/5 fixation with TPS; fusion with TLIF PEEK cage Specimen Count And Types nil Pathology Nil Operative Findings Thicken ligamentum flavem was noted over L3/4, 4/5 space, and the thecal sac was well expanded after decompression. Grade. I spondylolithesis was noted over L4/5. The L4/5 space was protruded and degenerative change. transpedicular screws: A-spine 6.5x 45mm screws x4, and 5cm rods x2 Cage: A-spine Rainboo PEEK cage 10mm x1 at L4/5 level Operative Procedures 1. ETGA, prone position and C-arm localized L3-5 level 2. Midline inciaion and split paraspinal muscle to expose the L3-5 lamina 3. Expose the L3/4, 4/5 facets, and identify the transverse process over L4, 5 4. Insert the L4/5 TPS, and C-arm localized 5. L4 laminectomy, and remove of thicken ligamentum flavum over L3/4, and L4/5 6. Remove medial 1/3 of left side L4/5 facet joint 7. Diskectomy over L4/5 disk, and insert the TLIF PEEK cage from left side 8. Set bilateral rods 9. Hemostasis, and set 1/8 hemovac x2 10.Close the wound in layers Operators VS 陳敞牧 Assistants R6 陳睿生, R2 楊博智 羅正良 (M,1967/11/04,44y4m) 手術日期 2010/07/01 手術主治醫師 陳敞牧 手術區域 東址 005房 02號 診斷 Herniation of intervertebral disc, lumbar 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 楊博智, 時間資訊 00:00 臨時手術NPO 13:25 進入手術室 13:30 麻醉開始 13:40 誘導結束 14:00 抗生素給藥 14:23 手術開始 15:45 手術結束 15:45 麻醉結束 15:55 送出病患 15:57 進入恢復室 17:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術－腰椎 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Microdiskectomy 開立醫師: 陳睿生 開立時間: 2010/07/01 16:01 Pre-operative Diagnosis Right side L4/5 rupture disk Post-operative Diagnosis Right side L4/5 rupture disk Operative Method Microdiskectomy Specimen Count And Types nil Pathology Nil Operative Findings The right side L5 nerve root was tightly compressed by the ruptured disk and well decompressed after disk remove. The rupture disk was noted over both medial and lateral side. Operative Procedures 1. ETGA, prone position and C-arm localized L4/5 level 2. Low back midline incision 3. Split right side parrspinal muscle 4. L4/5 laminotomy and remove ligamentum flavum 5. Disk was removed with aligator, disk clump 6. Hemostasis, close the wound in layers Operators VS 陳敞牧 Assistants R6 陳睿生, R2 楊博智 李龍 (M,1962/12/27,49y2m) 手術日期 2010/07/01 手術主治醫師 陳敞牧 手術區域 東址 003房 03號 診斷 Ulnar palsy 器械術式 Neurolysis of the uluar neuve 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 11:55 報到 12:35 進入手術室 12:50 抗生素給藥 12:58 麻醉開始 12:59 麻醉結束 13:00 手術開始 15:05 手術結束 15:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 神經分離術－手．足之神經 1 1 R 手術 正中神經或尺神經腕部減壓術–單側 1 2 R 記錄__ 手術科部: 外科部 套用罐頭: 1. Neurolysis of right ulnar nerve, 2. Decomp... 開立醫師: 李振豪 開立時間: 2010/07/01 15:29 Pre-operative Diagnosis Carpal tunnel syndrome and tardive ulnar palsy, right Post-operative Diagnosis Carpal tunnel syndrome and tardive ulnar palsy, right Operative Method 1. Neurolysis of right ulnar nerve, 2. Decompression of right median nerve Specimen Count And Types Nil Pathology Nil Operative Findings The right ulnar nerve was tightly adhered and severe compressed by fibrotic band. The ulnar nerve was expanded well after neurolysis. The right median nerve was compressed by thickened, calcified transverse carpal ligment. The median nerve was expanded well after decompression. Operative Procedures The patient was put in supine position. The right upper limb was scrubbed and disinfected as usual. One curvilinear skin incision was made at medial aspect of right elbow. The subcutaneous soft tissue was dissected and the ulnar nerve was identified. Neurolysis was done performed. After hemostasis, the wound was closed in layers with 3-0 Dexon and 4-0 Nylon. One linear skin incision was made at right wrist. The subcutaneous soft tissue was dissected and the transverse carpal ligment was identified. The transverse carpal ligment was transected and the median nerve was decompressed well. After hemostasis and irrigation, the wound was then closed in layers with 3-0 Dexon and 4-0 Nylon. Operators VS陳敞牧 Assistants R4李振豪 相關圖片 李昭鶯 (F,1928/02/15,84y0m) 手術日期 2010/07/01 手術主治醫師 林峰盛 手術區域 西址 035房 04號 診斷 Spinal stenosis, lumbar 器械術式 Nerve block / PC 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 硬肌麻醉 麻醉主治醫師 林峰盛 ASA 2 時間資訊 13:00 報到 13:50 進入手術室 13:50 麻醉開始 13:55 誘導結束 14:00 手術開始 14:20 麻醉結束 14:20 手術結束 14:25 送出病患 記錄__ 手術科部: 麻醉部 套用罐頭: LENB 開立醫師: 林峰盛 開立時間: 2010/07/01 14:28 Pre-operative Diagnosis 1.spinal stenosis 2. radiculopathy Post-operative Diagnosis 1. spinal stenosis 2. radiculopathy Operative Method transforaminal epidural block Specimen Count And Types nil Pathology Nil Operative Findings Operative Procedures LA with 1% xylocaine 5 ml pt in prone position Under fluoroscopic-guiddance, transforaminal epidural block was done to level with 23G spinal needle, 60mg Kenacort in 0.5% xylocaine 6ml Operators 林峰盛, Assistants 陳錫徵 (M,1954/06/05,57y9m) 手術日期 2010/07/01 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 Cerebrovascular accident sequelae (CVA) 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 09:55 報到 10:10 進入手術室 10:15 麻醉開始 10:25 誘導結束 10:45 抗生素給藥 10:48 手術開始 12:05 手術結束 12:05 麻醉結束 12:15 送出病患 12:15 進入恢復室 13:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 手術 頭顱成形術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Cranioplasty 開立醫師: 李振豪 開立時間: 2010/07/01 12:16 Pre-operative Diagnosis Right skull defect Post-operative Diagnosis Right skull defect Operative Method Cranioplasty Specimen Count And Types Nil Pathology Nil Operative Findings The cranioplasty was performed with four miniplate(2-3-3-4 holes) and 8 screws. Bone cement was used for coverage of burr hole and reconstruction of temporalis muscle. No CSF leakage was noted during the operation. Operative Procedures Under endotracheal tube general anesthesia, the patient was put at supine position with head rotated to left. The scalp was shaved, scrubbed, and disinfected as usual. The scalp incision was made along previous op scar. The scalp flap was dissected and elevated. The bone edge was exposed and the skull plate was fixed back with miniplates and 6 central tenting. Bone cement was used for cranioplasty. After hemostasis, one subgaleal CWV drain was placed. The scalp was then closed in layers. Operators VS王國川 Assistants R4李振豪, R3王奐之 相關圖片 顏王阿續 (F,1933/08/27,78y6m) 手術日期 2010/07/01 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Major trauma rated 16 or above on the severeity scale ( Injury severeity score >=16 ) 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 髒 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 4 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 08:19 進入手術室 08:19 報到 08:20 麻醉開始 08:25 誘導結束 09:15 手術開始 09:21 抗生素給藥 09:45 麻醉結束 09:45 手術結束 09:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 移前皮瓣移植術 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 記錄__ 手術科部: 外科部 套用罐頭: Debridement and wound closure with advance flap 開立醫師: 李振豪 開立時間: 2010/07/01 10:00 Pre-operative Diagnosis Scalp wound infection Post-operative Diagnosis Ditto Operative Method Debridement and wound closure with advance flap Specimen Count And Types 2 swab and one tissue specimen for culture Pathology Nil Operative Findings Necrotic tissue and abscess formation is noted after removal of eschar and stitches. The necrotic area is mainly within subcutaneous space. No evident infection is noted at subgaleal area. Operative Procedures Under tracheostomy tube general anesthesia, the patient was put in supine position with head rotated to left. The scalp was shaved, scrubbed, and disinfected as usual. The previous stitches and eschar were all removed. Scalp incision was made at frontal area along previous op wound. The devitalized tissue was removed. Gentamicin solution irrigation was used. After hemostasis, one subgaleal CWV drain was placed. The wound was then closed with 2-0 Nylon. Under tracheostomy tube general anesthesia, the patient was put in supine position with head rotated to left. The scalp was shaved, scrubbed, and disinfected as usual. The previous stitches and eschar were all removed. Scalp incision was made at frontal area along previous op wound. The devitalized tissue was removed. Gentamicin solution irrigation was used. After hemostasis, one subgaleal CWV drain was placed. The subgaleal space was dissected. The wound flap was advanced and closed with 2-0 Nylon. Operators VS王國川 Assistants R4李振豪, R3王奐之 相關圖片 陳滿 (F,1940/03/25,71y11m) 手術日期 2010/07/02 手術主治醫師 賴達明 手術區域 東址 019房 02號 診斷 Lumbar Spondylosis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 11:45 報到 12:20 進入手術室 12:30 麻醉開始 12:45 誘導結束 13:10 抗生素給藥 13:37 手術開始 14:50 開始輸血 16:10 抗生素給藥 17:30 手術結束 17:30 麻醉結束 17:36 送出病患 17:42 進入恢復室 19:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術（特壓）－超過二節 1 2 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 記錄__ 手術科部: 外科部 套用罐頭: 1. L2/3 laminotomy. 開立醫師: 鍾文桂 開立時間: 2010/07/02 18:27 Pre-operative Diagnosis L2/3 lumbar stenosis, L3/4 herniated intervertebral disc, and L4/5 spondylolisthesis, grade I. Post-operative Diagnosis L2/3 lumbar stenosis, L3/4 herniated intervertebral disc, and L4/5 spondylolisthesis, grade I. Operative Method 1. L2/3 laminotomy. 2. L3/4 diskectomy and laminectomy. 3. L4/5 laminectomy and interbody fusion with two cages. 4. L2-5 internal fixation and posterolateral fusion. 4. L3-5 internal fixation and posterolateral fusion. Specimen Count And Types nil Pathology Nil. Operative Findings 1. Blood loss: 1100cc. 2. Hypertrophic ligamentum flavum. Moderate osteoporotic change. 3. Transpedicle screws(40mm) at bilateral L2 and L5 levels with two rods. 3. Transpedicle screws(40mm) at bilateral L3 and L5 levels with two rods. Cage: 9mm. 4. Intact dura and roots Operative Procedures 1. ETGA, prone position. 2. C-arm localization at L3-5 pedicles, disinfection, and draping. 3. Midline incision and paraspinal dissection. 4. Internal fixation with transpedicle screws at L5 and L2. 5. Laminectomy at L4/5, L3/4, and laminotomy at L2/3 level. 6. Diskectomy at L3/4 level and insertion of two 9mm cages for interbody fusion. 6. Diskectomy at L3/4, and L4/5 levels and insertion of two 9mm cages for interbody fusion at L4/5 level. 7. Complete internal fixation set with two rods. 8. Posterolateral fusion with autologous bone. 8. Posterolateral fusion with autologous bone at L2-5 levels. 9. Wound closure in layers after placing two 1/8 hemovac drains. 10.Send the patient to POR smoothly. Operators V.S. 賴達明 Assistants R5 鍾文桂 R1何奕瑢 相關圖片 李明潔 (F,1974/08/14,37y7m) 手術日期 2010/07/02 手術主治醫師 葉德輝 手術區域 東址 023房 03號 診斷 Epistaxis 器械術式 CSF kleakage Endoscopic functional sinus su 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 黃麒軒, 時間資訊 13:10 報到 13:36 進入手術室 13:40 麻醉開始 13:45 誘導結束 13:46 抗生素給藥 14:13 手術開始 15:12 手術結束 15:12 麻醉結束 15:25 送出病患 15:28 進入恢復室 16:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 經外側篩竇切除修補腦脊髓液鼻漏 1 1 R 手術 內視鏡功能鼻竇手術－單側 1 2 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Functional endoscopic sinus surgery, right 開立醫師: 黃麒軒 開立時間: 2010/07/04 18:14 Pre-operative Diagnosis CSF leakage, right ethmoid sinus and sphenoid sinus Post-operative Diagnosis Right ethmoid roof meningocele and bony defect, operated Operative Method Functional endoscopic sinus surgery, right External ethmoidectomy for CSF rhiorrhea Specimen Count And Types 1 piece About size:2x2 mm Source:right paranasal sinus Pathology pending Operative Findings Right infun.: OK( V )edematous( )polypoid( )polyp( ) mucopus( ),fungus( ),cyst( ) A.Eth.: OK( V )edematous( )polypoid( )polyp( ) mucopus( ),fungus( ),cyst( ) P.Eth: OK( V )edematous( )polypoid( )polyp( )mucopus( ),fungus( ),cyst( ) Maxi.: OK( V )edematous( )polypoid( )polyp( ) mucopus( ),fungus( ),cyst( ) Fron.: OK( V )edematous( )polypoid( )polyp( ) mucopus( ),fungus( ),cyst( ) Sph.: OK( V )edematous( )polypoid( )polyp( ) mucopus( ),fungus( ),cyst( ) others : After entering posterior ethmoid sinus, a bulging hernia from ethmoid roof was noted, suspect meningocele. Bony defect with Gelfoam packing was noted. Operative Procedures Adipose tissue took from abdominal subcutaneous space Incison about 2 cm over right side lower abdomen. Adipose tissue about 3x3 cm took from subcutaneous layer done. After hemostasis, the wound was closed with 5-0 Nylon. FESS (1) Infundibulotomy :R( V )L( ) (2) Opening/trimming of ethmoid bulla :R( V )L( ) anterior ethmoid :R( V )L( ) agger nasi :R( )L( ) frontal recess :R( )L( ) middle turbinate :R( )L( ) (3) Opening/trimming of ground lamella :R( V )L( ) posterior ethmoid :R( V )L( ) (4) Repair ethmoid roof defect with adipose tissue from abdominal subcutaneous layer. After repairing, we put some tissue glue coating on the fat. (5) Packing with Merocel :R( X1 ) Fingerstall :R( X1 ) Operators AP葉德輝 Assistants R4李亭逸 R2黃麒軒 游麗真 (F,1964/05/15,47y9m) 手術日期 2010/07/02 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Brain Tumor 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:05 進入手術室 08:15 麻醉開始 08:40 誘導結束 09:30 抗生素給藥 09:46 手術開始 13:10 麻醉結束 13:10 手術結束 13:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 顱底瘤手術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Retrosigmoid approach for tumor excision 開立醫師: 游健生 開立時間: 2010/07/02 13:47 Pre-operative Diagnosis Recurrent acoustic neuroma, right Post-operative Diagnosis Recurrent acoustic neuroma, right Operative Method Retrosigmoid approach for tumor excision Specimen Count And Types 1 piece About size:2x1x1cm Source:CN VIII tumor Pathology pending Operative Findings A yellowish elastic firm tumor arising from IAC eroding the petrose bone. The tumor capsule adheres to arachnoid membrane tightly. Operative Procedures Under ETGA, patient was put into supine position with head turned to left and fixed with Mayfield headholder. Her neck was mildly extended with right shoulder elevated. We shaved her hair and disinfect the operation field with B-I. After draping, we incised skin along previous wound. Then, we detached neck muscles and dissected in layers. We harvested a muscle fascia. After K-shape durotomy, we exposed the tumor and removed it piece by piece with CUSA. The part extending upward to petrous bone was curretaged. The tumor was totally excised until a thin layer of capsule left in situ. We stopped bleeding with bipolar and Surgicel packing. We performed duroplasty with the muscle fasia and water-tight continuous 3-0 prolene suture. We placed some Gelfoam and Surgicel over the dura. Finally, we closed the wound in layers. Operators P 杜永光 Assistants R6 胡朝凱 R3 游健生 吳蕙真 (F,1981/02/27,31y0m) 手術日期 2010/07/02 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Acoustic tumor 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 07:47 報到 08:05 進入手術室 08:10 麻醉開始 09:00 誘導結束 09:37 抗生素給藥 10:10 手術開始 12:40 抗生素給藥 14:35 麻醉結束 14:35 手術結束 14:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 R 手術 誘發電位手術監視機–腦神經外科術中特殊儀器使用費 1 0 R 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Right retrosigmoid approach for total tumor r... 開立醫師: 陳睿生 開立時間: 2010/07/02 15:27 Pre-operative Diagnosis Right size CP angle tumor Post-operative Diagnosis Right size CP angle tumor, acoustic neuroma was suspected Operative Method Right retrosigmoid approach for total tumor remove Specimen Count And Types 1 piece About size:pieces Source:tumor Pathology Pending Operative Findings The tumor was soft, yellowish, and well capsuled. The size was about 3cm in diameter. It extended into the internal acoustic meatus, and seems to be origined from the superior vestibular nerve. We drilled out the IAC, and remove the tumor inside it. The facial nerve located at the cephalomedial side of the tumor, and was traced from the nerve exit zone for preservation. After tumor remove, facial nerve stimulation showed positive finding. Operative Procedures 1. ETGA, 3/4 prone position toward right side and head fixed with Mayfield clump 2. Right retroauricular scalp incision about 10cm 3. Make four burr holes and an about 6x6 cm craniotomy window was created 4. Open the dura and drain out CSF from cistern magnum for decompression 5. Retract the cerebellum and expose the tumor 6. Split arachnoid membrane above the tumor, and then open the tumor capsule for central debulking 7. Dissect the tumor capsule from peripheral brain tissue 8. Drill out the internal acoutic meatus to expose the tumor inside it 9. Dissect the tumor from the inferior vestibular nerve 10.Totally remove of the tumor the recheck the facial nerve function 11.Hemostasis with gelfoam anad Tissu-col Duo, and deair 12.Tightly close the dura with fascia graft 13.Fix back the bone graft with #26 wires 7 gages 14.Close the wound in layers Operators VS 曾漢民 Assistants R6 陳睿生, R3 王奐之 相關圖片 林億聖 (M,1984/04/17,27y10m) 手術日期 2010/07/02 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Lymphoma 器械術式 Malignant intraspinal tumor, e 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:03 進入手術室 08:05 麻醉開始 08:10 誘導結束 09:00 抗生素給藥 09:23 手術開始 11:45 手術結束 11:45 麻醉結束 11:55 送出病患 12:10 進入恢復室 13:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 手術 惡性病髓腫瘤切除術 1 1 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 記錄__ 手術科部: 外科部 套用罐頭: Right L4 hemilaminectomy for tumor excision. 開立醫師: 鍾文桂 開立時間: 2010/07/02 12:20 Pre-operative Diagnosis Extradural spinal tumor, L4 with compression of right L4 root, and invasion to L4 vertebral body. Post-operative Diagnosis Extradural spinal tumor, L4 with compression of right L4 root, and invasion to L4 vertebral body. Diffuse large B cell lymphoma , L4 with compression of right L4 root, and invasion to L4 vertebral body. Operative Method Right L4 hemilaminectomy for tumor excision. Specimen Count And Types 1 piece About size:multiple. Source:Extradural spine tumor Pathology Frozen pathology: inflammatory change with lymphocyte predominence, presence of nodules which contain collagen fibers and neutrophils. Cant determine if it is lymphoma under frozen section. Cant determine if it is lymphoma under frozen section. Operative Findings 1. The mass lesion is mild vascularized( not easy oozing), pink-whitish, elastic, firm. 2. It located extradually, surrounding circumferencially over thecal sac and right root at L4 level. 3. The mass lesion also eroded the posterior longitudinal ligament and invaded into the L4 vertebral body. Blood loss: 50 cc. Operative Procedures 1. ETGA, prone position. 2. Disinfection, C-arm localization of L4 level. 3. Midline incision, right paraspinal dissection. 4. L4 hemilaminectomy. 5. Tumor excision for decompression of L4 thecal sac and root and pathology study. 6. Tumor excision at L4 verterbral body. 7. Well hemostasis. 8. Wound closure in layers. Operators V.S. 賴達明 Assistants R5鍾文桂 R1何奕瑢 相關圖片 藍開奎 (M,1929/01/28,83y1m) 手術日期 2010/07/02 手術主治醫師 吳毅暉 手術區域 東址 016房 03號 診斷 Subdural hematoma 器械術式 PAOD stent insertion 手術類別 臨時手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 4 紀錄醫師 周恒文, 時間資訊 11:13 報到 11:50 麻醉開始 11:50 進入手術室 11:55 誘導結束 12:10 抗生素給藥 12:35 手術開始 15:38 手術結束 15:38 麻醉結束 15:52 送出病患 15:57 進入恢復室 17:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 動靜脈造廔術合併人工血管使用（兩處吻合） 1 1 R 手術 內頸靜脈切開，永久導管放置術 1 2 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 記錄__ 手術科部: 外科部 套用罐頭: Brachial-cephalic anastomosis; Cephalic vein ... 開立醫師: 周恒文 開立時間: 2010/07/02 16:05 Pre-operative Diagnosis AV fistula dysfunction Post-operative Diagnosis AV fistula dysfunction Operative Method Brachial-cephalic anastomosis; Cephalic vein patch augmentation Specimen Count And Types 1 piece About size:2mm*15cm Source:thrombus Pathology thrombus Operative Findings 1. A streak of thrombus inside the cephalic vein with flow compromise 2. Endothalium hyperplasia over the cephalic vein of mid-forearm 3. Aneurysmal formation over the radiocephalic anastomosis site 4. Brachial artery: 8mm, Cephalic vein: 15mm, anastomosis site: 12mm Operative Procedures ETGA, supine with right arm extension. Transverse incision over the elbow. Dissect the cephalic vein and brachial artery. Intra-op echo guided localizaion of stenosis and thrombosis. Logitudinal incision along the midforearm cephalic vein and open the cephalic vein. Patch augmentation with 6mm Gortex graft. Anastomose the brachial artery and cephalic vein. Close the wound in layers. Operators 吳毅暉 Assistants 周恒文 鍾晴雄 (M,1944/04/28,67y10m) 手術日期 2010/07/02 手術主治醫師 陳敞牧 手術區域 東址 003房 02號 診斷 Subdural hemorrhage 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 13:20 報到 13:50 進入手術室 14:00 麻醉開始 14:10 誘導結束 14:25 抗生素給藥 14:45 手術開始 15:45 手術結束 15:45 麻醉結束 15:55 送出病患 15:57 進入恢復室 17:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Chronic Subdural Hematoma 開立醫師: 游健生 開立時間: 2010/07/02 16:10 Pre-operative Diagnosis Chronic Subdural Hematoma, right Post-operative Diagnosis Chronic Subdural Hematoma, right Operative Method Drainage of chronic subdural Specimen Count And Types nil Pathology Nil Operative Findings Moderate amount of brown motor-oil like fluid was drained out from subdural space Operative Procedures Under ETGA, patient was put into supine position with head rotated to left and mildly tilted up. Then we shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture. After covered with sterilized adhesive plastic sheet, we made an incision over previous wound and dissected in layers with Coober. Appling self-retaining retractor and Raney clips to wound edge for temporary hemostasis and exposure of previous burrhole. We removed the Gel-foam and thoroughly irrigated subdural space with normal saline through a rubber tube until the drainage was clean. Then, we covered the burrhole with Gel-foam and closed the wound in layers. Finally, we expelled the intracranial air with normal saline thoroughly. Operators VS 陳敞牧 Assistants R6 胡朝凱 R3 游健生 Indication Of Emergent Operation 張傳德 (M,1935/08/26,76y6m) 手術日期 2010/07/02 手術主治醫師 蕭輔仁 手術區域 東址 002房 02號 診斷 Spinal metastasis 器械術式 Spinal fusion posterior 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 曾峰毅, 時間資訊 12:00 開始NPO 20:34 通知急診手術 11:15 報到 12:15 進入手術室 12:20 麻醉開始 12:55 誘導結束 13:00 抗生素給藥 13:16 手術開始 13:45 開始輸血 16:00 抗生素給藥 18:35 麻醉結束 18:35 手術結束 19:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 惡性病髓腫瘤切除術 1 1 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 曾峰毅 開立時間: 2010/07/02 18:04 Pre-operative Diagnosis L2-3 spinal metastasis Post-operative Diagnosis L2-3 spinal metastasis Operative Method L2-3 laminectomy for metastactic tumor excision, and posterior fixation with transpedicular screws at bilateral pedicles of T12, L1, L4, and L5. Specimen Count And Types Multiple fragments of one tumor was sent for pathology. Pathology Pending Operative Findings Hypervascular, greyish to pinkish, ill-defined, fragile tumor was noted at L2-3 level with laminae involved. Thecal sac was released after tumor excision and laminectomy. 45mmx6.5mm A-Spine TPS was inseted at bilateral pedicles of L4 and L5, and 60mmx4.0mm TPS at T12 and L1. Two 20cm rods was put to fix the TPS. One cross-link was set for reinforce the fixation. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After C-arm localization, we scrubbed, disinfected, and then draped the skin, and made one midline linear skin incsiion from T12 to L5. We performed L2-3 laminectomy for tumor excision. TPS was inserted at bilateral pedicle of T12, L1, L4, and L5. After hemostasis, and rod and cross-link set, we put two submuscular hemovacs. The wound was closed in layers. Operators VS 蕭輔仁 Assistants R3 李振豪 R3 曾峰毅 Ri 周書緯 Indication Of Emergent Operation 馬天來 (M,1937/06/10,74y9m) 手術日期 2010/07/02 手術主治醫師 王國川 手術區域 東址 002房 01號 診斷 Dementia, vascular (F01.9) 器械術式 bilateral burr hole drainage of chronic subdural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2E 紀錄醫師 李振豪, 時間資訊 12:00 臨時手術NPO 12:00 開始NPO 14:20 通知急診手術 08:52 進入手術室 08:55 麻醉開始 09:00 誘導結束 09:10 抗生素給藥 09:32 手術開始 11:40 麻醉結束 11:40 手術結束 11:50 送出病患 11:53 進入恢復室 13:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 B 手術 慢性硬腦膜下血腫清除術 1 2 B 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 記錄__ 手術科部: 神經部 套用罐頭: Bilateral burr hole drainage 開立醫師: 李振豪 開立時間: 2010/07/02 12:03 Pre-operative Diagnosis Bilateral chronic subdural hematoma Post-operative Diagnosis Bilateral chronic subdural hematoma Operative Method Bilateral burr hole drainage Specimen Count And Types nil Pathology Nil Operative Findings The outer membrane was noted after dural opening. Motor-oil-like chrnoic subdural hematoma gushed out after open outer membrane. About 150ml chronic subdural hematoma was drained out. The brain was mild expanded after removal of chronic subdural hematoma. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine position. The scalp was shaved, scrubbed, and disinfected as usual. Two transverse scalp incisions were made at bilateral frontal area. Two burr holes were created followed by dural tenting. The dura was opened with cruciform. The margin of dural opening was cauterized with bipolar cautery. The chronic subdural hematoma was drained out and irrigated with normal saline. Two subdural rubber drains were placed and the wound was closed in layers. Deair was performed after wound closure. Operators VS 王國川 Assistants R4李振豪, R3古恬音 Indication Of Emergent Operation 相關圖片 周克舉 (M,1926/07/08,85y8m) 手術日期 2010/07/02 手術主治醫師 劉詩彬 手術區域 東址 008房 02號 診斷 Benign prostatic hypertrophy 器械術式 TUR-P,TUR-BT,TUI-BN,Cystolitho 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 脊髓麻醉 麻醉主治醫師 葉惠敏 ASA 3 紀錄醫師 周博敏, 時間資訊 09:20 報到 09:25 進入手術室 09:41 麻醉開始 09:43 誘導結束 09:53 手術開始 10:06 手術結束 10:06 麻醉結束 10:10 送出病患 10:13 進入恢復室 11:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 經尿道前列腺切開術 1 1 手術 經內視鏡切片（每一診次） 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Spinal anesthesia 1 0 記錄__ 手術科部: 泌尿部 套用罐頭: TUR-BT 開立醫師: 周博敏 開立時間: 2010/07/02 10:20 Pre-operative Diagnosis BPH Post-operative Diagnosis 1. BPH 2.Bladder tumor Operative Method 1. Tansurethral resection of prostate 2. Cystoscopic biopsy Specimen Count And Types 1 piece About size:2mm Source:bladder tumor biopsy Pathology pending Operative Findings 1. uneven bladder wall and polypoid tumor in right posterior wall 2. bulbar urethral stricture Operative Procedures 1. Under satisfactory anesthesia with the patient in the lithotomy position, prepping and draping were performed in the usual sterile method. 2. Urethral sounding to 30Fr was done. A Fr 22 Olympus Resectoscope was inserted into the urethra and bladder, and the whole bladder was inspected carefully. This revealed presence of polypoid tumor located at Rt posterior wall. Trigone and bilateral orifices were identified and inspected carefully. 3. The tumor was resected with resectoscope, piece by piece. 4. Incision of prostate at 5 and 7 oclock 5. Adequate hemostasis was then obtained. 6. A 20Fr. 3-way Foley catheter was inserted and continuous bladder irrigation with normal saline started. 7. The balloon was inflated to 10 cc. 8. The patient was then sent to the recovery room in a stable condition. Operators 劉詩彬, Assistants 張宇鳴,周博敏, 林張玉霜 (F,1952/01/30,60y1m) 手術日期 2010/07/03 手術主治醫師 陳敞牧 手術區域 東址 003房 01號 診斷 Intraspinal abscess 器械術式 Diskectomy cervical(Anterier) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林至芃 ASA 4 紀錄醫師 游皓鈞, 時間資訊 23:55 臨時手術NPO 23:55 開始NPO 07:55 通知急診手術 08:50 報到 09:05 進入手術室 09:15 麻醉開始 09:50 誘導結束 10:00 抗生素給藥 10:30 開始輸血 10:32 手術開始 11:30 抗生素給藥 13:10 麻醉結束 13:10 手術結束 13:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術－頸椎 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 脊椎融合術－前融合，有固定物（＜＝四節） 1 2 R 摘要__ 手術科部: 內科部 套用罐頭: C6/7 diskectomy and anterior fusion with auto... 開立醫師: 游皓鈞 開立時間: 2010/07/03 13:46 Pre-operative Diagnosis C6/7 spondylodiskitis with epidural abscess Post-operative Diagnosis C6/7 spondylodiskitis with epidural abscess Operative Method C6/7 diskectomy and anterior fusion with autologus iliac graft Specimen Count And Types 2 pieces About size:pus Source:pus x6 About size:pieces Source:necrotic bone Pathology Pending Operative Findings Swellinig perivertebral tissue was noted. Pus formation was found at the prevertebral, interdisk, and retrovertebral space. The pus was whitish-yellowish in appearance. The disk was necrotic change and the lower margin of C6 body was also erosive change. The PLL was fragile and swelling. A piece of iliac graft was extracted from the anterior aspect of right iliac bone. Operative Procedures 1. ETGA, supine position and head mild extension 2. Linear incision into the right lower neck 3. Incise into the plastyma muscle, and split the plane between the SCM and trachea, esophagus 4. Expose the prevertebral space, and C-arm localized the C6/7 level 5. Set self retractor, and drain out the pus 6. Remove of necrotic disk, bone fragments 7. Cut down the C6, 7 spurs with Kerrison pounch 8. Remove of necrotic PLL, and drain out the abscess 9. Wound irrigation with gentamicin diluted saline 10.Incise into the RLQ about 6cm in length 11.Expose the iliac crest and cut down a piece of graft about 2x2x1cm 12.Insert the graft into the C6/7 space as fusion graft 13.Hemostasis, set CWV drain at neck and RLQ wound 14.Close the wound in layers Operators VS 陳敞牧 Assistants R6 陳睿生, R1 游皓鈞 Indication Of Emergent Operation 許美華 (F,1951/12/10,60y3m) 手術日期 2010/07/03 手術主治醫師 蔡翊新 手術區域 東址 001房 05號 診斷 Open wound to other and unspecified parts of neck, complicated 器械術式 Neck wound debridement 手術類別 緊急手術 手術部位 頭、頸 傷口分類 污染 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 潘為元, 時間資訊 23:00 開始NPO 23:00 臨時手術NPO 01:55 通知急診手術 03:18 進入手術室 03:18 報到 03:20 麻醉開始 03:50 誘導結束 03:56 手術開始 05:02 麻醉結束 05:02 手術結束 05:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 深部複雜創傷處理－傷口長５－１０公分者 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 摘要__ 手術科部: 創傷醫學部 套用罐頭: Wound debridement and repair 開立醫師: 蔡翊新 開立時間: 2010/07/03 05:26 Pre-operative Diagnosis Anterior neck laceration wound Post-operative Diagnosis Anterior neck laceration wound Operative Method Wound debridement and repair Specimen Count And Types 1 piece About size:3 x 0.5 cm Source:necrotic skin, sent for culture. Pathology Nil. Operative Findings Multiple cutting injury causing a 6 x 3 cm laceration wound at anterior neck around the level of cricoid and thyroid cartilages. The platysma muscle was tear and subcutaneous fat was exposed. The cartilages could be palpated, but not exposed. There was no air leakage. Several venous bleeders were detected and coagulated. Operative Procedures 1. ETGA, supine position with neck extended. 2. Disinfection and drapping. 3. Wound debridement and hemostasis. Some skin debris was excised. 4. Set one mini-hemovac drain. 5. Wound closure layer by layer with 5-0 and 6-0 Nylon. Operators VS蔡翊新 Assistants R6潘為元 Indication Of Emergent Operation 李王秀梅 (F,1951/08/15,60y6m) 手術日期 2010/07/04 手術主治醫師 王國川 手術區域 東址 001房 03號 診斷 Subdural hemorrhage following injury, with no loss of consciousness 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 4E 紀錄醫師 鍾文桂, 時間資訊 12:00 臨時手術NPO 12:00 開始NPO 18:06 通知急診手術 18:40 報到 18:42 進入手術室 18:45 麻醉開始 19:00 抗生素給藥 19:05 誘導結束 19:40 手術開始 22:15 手術結束 22:15 抗生素給藥 22:15 麻醉結束 22:35 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 急性硬腦膜下血腫清除術 1 1 L 手術 顱內壓監視置入 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 記錄__ 手術科部: 外科部 套用罐頭: 1. Evacuation of chronic and subacute subdura... 開立醫師: 鍾文桂 開立時間: 2010/07/04 23:11 Pre-operative Diagnosis Subacute and chronic subdural hemorrhage, left with brain swelling. Post-operative Diagnosis Subacute and chronic subdural hemorrhage, left with brain swelling. Operative Method 1. Evacuation of chronic and subacute subdural hemorrhage. 2. ICP monitor( Codman) implantation. 3. Craniectomy and dural augmentation. Specimen Count And Types 1 piece About size:1 cc. Source:chronic and subacute subdural hemorrhage. Pathology Nil. Operative Findings 1. Mixture of chronic and subacute subdural hemorrhage. 2. An active bleeder from M4 branch. 3. Poor brain expansion after hematoma evacuation. 4. ICP: 1 mmHg, blood loss: 500cc. 5. Craniectomy window: max diameter: 15 cm. Operative Procedures 1. ETGA, supine position, head tilted to right. 2. Shaving, disinfection, and draping. 3. A large question-mark scalp incision. 4. Dissection of subgaleal space, then dissection of periosteal plane and elevate temporalis muscle. 5. Craniectomy and dural tenting. 6. Further temporal craniectomy over sphenoid ridge and sqamous bone. 7. Curvilinear durotomy and evacuation of subdural hematoma. 8. Electrocoagulation of MCA bleeder. 9. Dural augmentation. 9. Dural augmentation; Excision of temporalis muscle for more decompression. 10.Placement of one epidural CWV drain and one subdural ICP monitor. 11.Wound closure in layers. Operators V.S. 王國川 蔡翊新 Assistants 鍾文桂 陳以幸 Indication Of Emergent Operation 張宏安 (M,1962/07/11,49y8m) 手術日期 2010/07/05 手術主治醫師 廖述朗 手術區域 西址 036房 03號 診斷 Band shaped keratopathy 器械術式 Eviceration of eyeball + Reconstruction of orbital socket 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林至芃 ASA 3 紀錄醫師 廖述朗, 時間資訊 00:00 臨時手術NPO 11:00 進入手術室 11:05 麻醉開始 11:10 誘導結束 11:12 抗生素給藥 11:25 手術開始 12:20 手術結束 12:20 麻醉結束 12:25 送出病患 12:30 進入恢復室 13:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 眼窩成形術 1 1 L 手術 眼球內容物剜除術 1 2 記錄__ 手術科部: 眼科部 套用罐頭: Evisceration + Reconstruction of orbital socket with Bioceramic implant 開立醫師: 鄭琪睿 開立時間: 2010/07/04 19:11 Pre-operative Diagnosis Band keratopathy (OS) Absolute glaucoma(OS) Post-operative Diagnosis Band keratopathy (OS) Absolute glaucomoa (OS) Operative Method Evisceration + Reconstruction of orbital socket with Bioceramic implant (OS) Specimen Count And Types nil Pathology Nil Operative Findings Band keratopathy (OS) Band keratopathy with uvea show (OS) Operative Procedures 1.Under endotracheal general anesthesia. 2.Disinfection and draping as usual. 3.Application of an eyelid speculum. 4.Perform 360-degree peritomy. 5.Perform 270-degree sclerotomy with wescott 5.Perform 180-degree sclerotomy with wescott 7.Remove intraocular contents 8.Soaking of inner scleral shell with 95%alcohol. 9.Posterior pole scleral flap is incised after optic nerve is cauterized. 10. Bioceramic implant insert into scleral space. 11.Scleral wound closed with 5-0 Dexon after anterior placement of posterior scleral flap 12.Conjunctival and Tenons capsule is closed with 6-0 Vicryl. 13.Apply Latycin and place conformer 14.Tarsorrhaphy with 4-0 Silk. 15.Latycin patching. Operators 廖述朗, VS 廖述朗 Assistants VS 魏以瑄, R5 朱筱桑 廖碧珍 (F,1951/12/01,60y3m) 手術日期 2010/07/05 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Aneurysm 器械術式 Craniotomy(Aneurysms) P-DUH 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 3 紀錄醫師 游健生, 時間資訊 07:35 報到 08:02 進入手術室 08:10 麻醉開始 08:35 誘導結束 08:55 抗生素給藥 09:38 手術開始 11:55 抗生素給藥 14:20 麻醉結束 14:20 手術結束 14:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 開顱術摘除血管病變－腦血管瘤－無徵的 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Right pterional approach for aneurysm clippings 開立醫師: 游健生 開立時間: 2010/07/05 15:09 Pre-operative Diagnosis Right middle cerebral artery bifurcation aneurysm x2 Post-operative Diagnosis Right middle cerebral artery bifurcation aneurysm x2 Operative Method Right pterional approach for aneurysm clippings Specimen Count And Types nil Pathology Nil Operative Findings One aneurysm has a 4mm wide neck with a 10mm wide dome. The another aneurysm has a 4mm neck with a 6mm wide dome. There was no intra-operative aneurysm rupture. Each temporal clipping time was less than 3mins. There were no SSEP changes during the surgery. The aneurysms arose from M2 bifurcation. One aneurysm has a 4mm wide neck with a 10mm wide dome. The another aneurysm has a 4mm neck with a 6mm wide dome. There was no intra-operative aneurysm rupture. Each temporal clipping time was less than 3mins. There were no SSEP changes during the surgery. Operative Procedures Under ETGA, patient was put into supine position with head turned to left and fixed with Mayfield headholder. We shaved her hair and scrubbed the operation field with Beta-ioidine. Then, we disinfected and draped it as usual. A curved skin incision was made from 1 cm anterior to tragus to 2cm lateral to midline. After applying Raney clips, we flipped the skin flap anteriolaterally together with Yarsagil fat pad till we exposed superior orbital rim and zygoma. We transected the temporalis muscle and flipped it anteriorly to expose key-hole. After burr hole creation at key-hole, we created a 10x7cm craniotomy by saw. We tented the dura along craniotomy edge followed by curvilinear durotomy. Frontal lobe was retracted to expose optic nerve and the arachnoid membrane was opened to drain CSF. After the brain become slack, we opened the Sylvina fissure from proximal to distal to expose right M1 and the aneurysms. We applied temporal clip on M1 for proximal control followed by dissection of aneurysm neck. We clipped the lateral-pointing aneurysm with a straight Sugita clip and the medial-pointing with a fenestrated Sugita clip. After hemostasis, we closed the dura with water-tight continuous prolene suture. We fixed the bone flap with mini-plates and performed central tenting. We set on subgaleal CWV followed by wound closure in layers. Operators Prof. 杜永光 Assistants R6 胡朝凱 R3 游健生 張奕豐 (M,1939/01/31,73y1m) 手術日期 2010/07/05 手術主治醫師 杜永光 手術區域 東址 005房 02號 診斷 Subarachnoid hemorrhage 器械術式 Craniotomy(Aneurysms) P-DUH 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 3 紀錄醫師 游健生, 時間資訊 12:55 報到 13:38 麻醉開始 13:38 進入手術室 13:58 誘導結束 15:00 抗生素給藥 15:10 手術開始 18:00 抗生素給藥 21:10 麻醉結束 21:10 手術結束 21:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 7 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 手術 開顱術摘除血管病變－腦血管瘤－有徵的 1 1 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Interhemispheric approach for anuerysm clipping 開立醫師: 游健生 開立時間: 2010/07/05 21:48 Pre-operative Diagnosis 1. Left anterior cerebral artery (A2) aneurysm, status post rupture 2. Anterior communicating artery aneurysm Post-operative Diagnosis 1. Left anterior cerebral artery (A2) aneurysm, status post rupture 2. Anterior communicating artery aneurysm Operative Method Interhemispheric approach for anuerysm clipping Specimen Count And Types nil Pathology nil Operative Findings There were adhesion and hemosiderin around the left A2 aneurysm suggesting previous rupture. Its neck was about 2mm in width and dome was 4mm. The Acom aneurysm was bilobulated with a 2.1mm neck and a 2mm dome. Intra-operatively, there was no aneurysm rupture and no changes of SSEP or VEP. Operative Procedures Under ETGA, patient was put into supine position with head fixed with Mayfield headholder. We shaved his hair and scrubbed the operation field with Beta-ioidine. After disinfection and draping as usual, we made a bi-coronal incision. We flipped the skin flap anteriorly followed by circle craniotomy at midline with the help of Trephine. A semi-circular durotomy with base at midline was done after dura tenting. We dissected right frontal lobe away from falx and exposed the left A2 aneurysm, bilateral pericallosal artery, and left callosomarginal artery. All encountered vessels were preserved during dissection. After temporal clipping of proximal left pericallosal artery, we dissected the A2 aneurysm and applied a right angle Sugita aneurysm clip at its neck. Then, we decompressed it with bipolar electrocautery. We dissected right frontal lobe away from falx to base tracing the left anterior cerebral artery to expose anterior communicating artery. After dissection of left A1, Acom aneurysm, and right A2, we clipped the Acom aneurysm with another right angle Sugita aneurysm clip after temporal clipping of left A1 as proximal control. We harvested a fasica graft for duroplasty following hemostasis. After closure of dura, we fixed the bone flap with silk sutures. We closed the wound in layers following placement of a subgaleal CWV drain. Operators Prof. 杜永光 Assistants R6 胡朝凱 R3 游健生 梁梅蘭 (F,1950/04/12,61y11m) 手術日期 2010/07/05 手術主治醫師 郭順文 手術區域 東址 018房 01號 診斷 Malignant neoplasm of bronchus and lung, unspecified 器械術式 Thoracoscopy+Open Chest 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 蕭柏妮 ASA 3 紀錄醫師 鄒冠全, 時間資訊 00:53 臨時手術NPO 07:40 報到 08:18 進入手術室 08:25 麻醉開始 09:30 誘導結束 09:40 抗生素給藥 09:55 手術開始 12:06 開始輸血 12:40 抗生素給藥 15:12 15:40 抗生素給藥 16:00 麻醉結束 16:00 16:00 手術結束 16:10 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 單側甲狀腺全葉切除術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 7 0 手術 胸腔鏡肺葉切除術 1 1 L 手術 根除性淋巴切除術（肺葉切除或全肺切除時） 1 3 記錄__ 手術科部: 外科部 套用罐頭: Left lower lobectecomy via VATs, convert to t... 開立醫師: 鄒冠全 開立時間: 2010/07/05 15:22 Pre-operative Diagnosis Left lower lobe adenocarcinoma; old pulmonary TB Post-operative Diagnosis Left lower lobe adenocarcinoma; old pulmonary TB, suspect TB lesion at upper part of left lower lobe Operative Method Left lower lobectecomy via VATs, convert to thoracotomy Specimen Count And Types 4 pieces About size:2*1cm Source:lymph node About size:0.2*0.2cm Source:lymph node About size:1*1cm Source:lymph node About size:10*12*20cm Source:LLL Pathology pending Operative Findings 1. Severe adhesion of lung, pleural space and lymph node 2. A lots of enlarged lymph node noted at Gr. 7, 9, 10 blackish, elastic-firm 3. Small lymph node at Gr.5 4. A tumor about 5*8cm, whitish, elastic-firm at lower part of LLL 5. Several nodule at upper part of LLL, caseous-like discharge inside, sent to culture. 6. Minimal pleural effusion 7. Blood lost: 1600ml Operative Procedures 1. ETGA, with blocker, right decubitus 2. Disinfection, drapping as usual 3. VATS setting: 12-20-10mm 4. Adhesionolysis, dissect left lung from pleural adhesion 5. Divided major fissure with Endo-GIAx2 6. Due to severe adhesion of enlarged lymph node and PA, we convert to thoracotomy 7. Transect hilum with TA50-4.8 due to severe adhesion 8. Hemostatsis, repair hilum 9. Check air leakage and repair 10.Set one Fr.28 chest tube, close wound in layers Operators 郭順文, 林孟暐 Assistants R4蔡東明, R3鄒冠全 摘要__ 手術科部: 外科部 套用罐頭: 甲狀腺 開立醫師: 黃世銘 開立時間: 2010/07/05 16:47 Pre-operative Diagnosis Left thyroid goiter Post-operative Diagnosis Left thyroid goiter Operative Method Left total thyroidectomy Specimen Count And Types 1 piece About size:4x3x3 Source:Left thyroid goiter Pathology Pending Operative Findings 1. A elastic and redish lobulated mass 4×3×3 cm in size located at lower pole of left thyroid gland. 2. Paratracheal lymph node involvement: negative 3. Upper mediastinal lymph node involvement: negative 4. Left recurrent laryngearl nerve: intact Operative Procedures After induction of general anesthesia, the patient was put on supine position with a pillow placed between the scapula. The neck was hyperextended and with chin nose pointed directing anteriorly, the head was stabilized. Using a thyroid drape, the endotracheal tube and the patient`s face were separated from the operation field. Skin incision was performed about two-finger breadth above sternal notch 6 cm in length. The incision was carried down to the platysmamuscle to reach the avascular plane, then the wound was extended with a combination of electrocautery and blunt dissection and was carried to level of the cartilage. The self-retaining retractor was inserted with retraction superiorly and inferiorly. The strap muscles were elevated by forceps, the thyroid lobe was noted by a finger. Exposing the left thyroid lobe was done by dissecting the strap muscle from the surface of the thyroid gland. By placing clamps on the thyroid substance, the thyroid lobe was elevated anteriorly. The middle thyroid veins were individually controlled and divided. Then inferior parathyroid gland was identified and dissected carefully without disruption of the blood supply from the inferior thyroid artery. The branches of inferior thyroid artery were individually divided. The recurrent laryngealnerve was exposed in tracheoesophageal groove at the medial aspect of inferior thyroid artery. It was gently dissected for some distance along tracheoesophageal groove with bipolar electrocautery. After inferior and medial traction on sup. aspect of the thyroid lobe, the space between the thyroid and larynx was opened. The entire thyroid lobe was dissected from trachea from the suspensory ligament, and it was removed from right lobe by division in thymus. After checking bleeding and hemostasis, wound was closed in three layers. Operators VS 吳明勳 Assistants R2 黃世銘 張志龍 (M,1971/02/22,41y0m) 手術日期 2010/07/05 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 3 紀錄醫師 王奐之, 時間資訊 07:30 報到 08:08 進入手術室 08:13 麻醉開始 08:30 誘導結束 08:44 抗生素給藥 08:45 手術開始 11:44 抗生素給藥 12:52 麻醉結束 12:52 手術結束 13:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 顱底瘤手術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Left subfrontal approache for left optic cana... 開立醫師: 陳睿生 開立時間: 2010/07/05 13:19 Pre-operative Diagnosis Bilateral olfactory groove meningioma with recurrence Post-operative Diagnosis Bilateral olfactory groove meningioma with recurrence Operative Method Left subfrontal approache for left optic canal decompression Specimen Count And Types 2 pieces About size:pieces Source:tumor About size:pieces Source:tumor Pathology Pending Operative Findings The tumor was whitish, solid, soft, and mild elastic change. It extended into the frontal base and the ethmoid, sphenoid sinus were also occupied with tumor. Bilateral orbital canal were invaded by the tumor, and we removed almost all the tumor inside the left optic canal. The optic sheath was intact and preserved. Pus like discharge was drained out from the frontal sinus, and sinusitis was impressed. The dura was grossly intact, and was noted erosed by the tumor. Operative Procedures Operators VS 曾漢民 Assistants R6 陳睿生, R3 王奐之 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Left subfrontal approache for left optic cana... 開立醫師: 王奐之 開立時間: 2010/07/05 13:34 Pre-operative Diagnosis Bilateral olfactory groove meningioma with recurrence Post-operative Diagnosis Bilateral olfactory groove meningioma with recurrence Operative Method Left subfrontal approache for left optic canal decompression Left subfrontal approache for left optic canal decompression, Simpson grade IV tumor removal Specimen Count And Types 2 pieces About size:pieces Source:tumor About size:pieces Source:tumor Pathology Pending Operative Findings The tumor was whitish, solid, soft, and mild elastic change. It extended into the frontal base and the ethmoid, sphenoid sinus were also occupied with tumor. Bilateral orbital canal were invaded by the tumor, and we removed almost all the tumor inside the left optic canal. The optic sheath was intact and preserved. Pus like discharge was drained out from the frontal sinus, and sinusitis was impressed. The dura was grossly intact, and was noted erosed by the tumor. Operative Procedures After ETGA, the patient was placed in supine position with head slightly facing rightwardly. A bifrontal scalp incision was made, followed by right frontal craniotomy along the previous craniotomy. Pus-like discharge was then noted from frontal sinus, sent for culture. The brain was retracted, exposing the extradural tumor. The medial frontal base was then drilled off, exposing more tumor, then the tumor was removed piece by piece with tumor forceps and alligator. After removing part of the tumor, the ethmoid sinus & sphenoid sinus were entered. The dural defect was then patched with DuraForm. After meticulous hemostasis, an epidural CWV drain was placed and the skull was fixed back with miniplates. The wound was then closed in layers with Vicryl & Appose. Operators VS 曾漢民 Assistants R6 陳睿生, R3 王奐之 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Left subfrontal approache for left optic cana... 開立醫師: 王奐之 開立時間: 2010/07/05 19:54 Pre-operative Diagnosis Bilateral olfactory groove meningioma with recurrence Post-operative Diagnosis Bilateral olfactory groove meningioma with recurrence Operative Method Left subfrontal approache for left optic canal decompression, Simpson grade IV tumor removal Specimen Count And Types 2 pieces About size:pieces Source:tumor About size:pieces Source:tumor Pathology Pending Operative Findings The tumor was whitish, solid, soft, and mild elastic change. It extended into the frontal base and the ethmoid, sphenoid sinus were also occupied with tumor. Bilateral orbital canal were invaded by the tumor, and we removed almost all the tumor inside the left optic canal. The optic sheath was intact and preserved. Pus like discharge was drained out from the frontal sinus, and sinusitis was impressed. The dura was grossly intact, and was noted erosed by the tumor. Operative Procedures After ETGA, the patient was placed in supine position with head slightly facing rightwardly. A bifrontal scalp incision was made, followed by right frontal craniotomy along the previous craniotomy. Pus-like discharge was then noted from frontal sinus, sent for culture. The brain was retracted, exposing the extradural tumor. The medial frontal base was then drilled off, exposing more tumor, then the tumor was removed piece by piece with tumor forceps and alligator. After removing part of the tumor, the ethmoid sinus & sphenoid sinus were entered. Operators VS 曾漢民 Assistants R6 陳睿生, R3 王奐之 相關圖片 章定夫 (M,1973/12/22,38y2m) 手術日期 2010/07/05 手術主治醫師 劉嘉銘 手術區域 東址 023房 04號 診斷 Chronic paranasal sinusitis 器械術式 remove packing Endoscopic functional sinus su 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 林冠良, 時間資訊 16:55 報到 17:15 進入手術室 17:25 手術開始 17:52 手術結束 18:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 鼻竇內視鏡檢查 1 0 L 記錄__ 手術科部: 耳鼻喉部 套用罐頭: Sinoscope surgery (local) 開立醫師: 邱義霖 開立時間: 2010/07/05 20:41 Pre-operative Diagnosis Chronic paranasal sinusitis, status post operation with skull base defect status post repair Post-operative Diagnosis Ditto Operative Method 1. Sinoscope surgery, left Specimen Count And Types nil Pathology Nil Operative Findings 1. Some yellowish fluid from left superior meatus Operative Procedures 1. Supine position with local anesthesia 2. Remove the nasal packing Merocel Fingerstalk Left: 1 0 3. Some yellowish fluid was noted from left superior meatus 4. Another 2 fingerstalks were inserted into left nostril 5. Patient tolerate will during the procedure. Operators 劉嘉銘, Assistants R4 李亭逸 / R2 林冠良 劉琮勛 (M,1976/10/01,35y5m) 手術日期 2010/07/05 手術主治醫師 廖漢文 手術區域 東址 000房 號 診斷 Arteriovenous malformation, brain 器械術式 Neuro TAE 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 時間資訊 00:00 臨時手術NPO 08:55 麻醉開始 09:10 誘導結束 14:40 麻醉結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 劉哲斌 (M,1955/03/25,56y11m) 手術日期 2010/07/05 手術主治醫師 蕭輔仁 手術區域 東址 003房 02號 診斷 Lumbar spondylosis 器械術式 Radiofrequency coagulation 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 王奐之, 時間資訊 15:07 報到 15:15 進入手術室 15:30 麻醉開始 15:35 誘導結束 15:36 手術開始 15:40 抗生素給藥 16:30 手術結束 16:32 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 高頻熱凝療法 1 1 B 記錄__ 手術科部: 外科部 套用罐頭: Radiofrequency ablation, L2, bilateral 開立醫師: 王奐之 開立時間: 2010/07/05 17:19 Pre-operative Diagnosis Lumbar spondylosis, L2 Post-operative Diagnosis Lumbar spondylosis, L2 Operative Method Radiofrequency ablation, L2, bilateral Specimen Count And Types nil Pathology Nil Operative Findings Ablation catheter placed at L2 intervertebral foramen bilaterally. Motor stimulation: 2Hz Sensory stimulation: 50Hz Ablation temperature: 42 degrees Celsius Ablation time: 180 sec*2 at each side Operative Procedures The patient was placed in prone position. After localization of L2 pedicles with C-arm, 1% Xylocaine were infiltrated at injection site (about 3cm from midline at the level slightly below L2 pedicles). Puncture needle were then used and confirmed the tip location with C-arm. After motor & sensory stimulation, ablation were then performed for 180 sec *2 cycles. The procedure was repeated again at the right side. The injection wounds were covered with bandage and the procedure ended. Operators VS蕭輔仁 Assistants R6陳睿生, R3王奐之 相關圖片 郭世元 (M,1933/01/06,79y2m) 手術日期 2010/07/05 手術主治醫師 王國川 手術區域 東址 001房 02號 診斷 Intracerebral hemorrhage (ICH) 器械術式 V-P shunt 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉漢平 ASA 3E 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 06:34 通知急診手術 11:35 進入手術室 11:40 麻醉開始 11:45 誘導結束 12:41 手術開始 13:30 手術結束 13:30 麻醉結束 13:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室腹腔分流手術 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt via left Kocher point. 開立醫師: 鍾文桂 開立時間: 2010/07/05 14:03 Pre-operative Diagnosis Right parietal-temporal intracerebral hemorrhage status post operation with hydrocephalus. Post-operative Diagnosis Right parietal-temporal intracerebral hemorrhage status post operation with hydrocephalus. Operative Method Ventriculoperitoneal shunt via left Kocher point. Specimen Count And Types 1 piece About size:3cc Source:CSF Pathology Nil. Operative Findings 1. Clear yellowish CSF fluid. 2. 長安 median pressure, ventricular catheter 6.5 cm. Operative Procedures 1. ETGA, head tilted to right. 2. Shaving, disinfection, and draping. 3. Curvilinear incision at left Kocher point 4. Burr hole by high speed drill, followed by durotomy and dural tenting. 5. Transverse linear incision at left upper quadrant of abdomen, dissection until peritoneal cavity is reached. 6. Subcutaneous passage from abdomen to head and insertion of shunt catheter through the tunnel. 7. Connection of shunt system with reservoir and ventricular catherter 8. Ventriculostomy and insertion of ventricular catheter into the same tract. 9. Check the patency of the shunt system; insertion of peritoneal catheter into peritoneal cavity. 10.Wound closure in layers. Operators V.S. 王國川 Assistants 鍾文桂 楊博智 Indication Of Emergent Operation 林獻堂 (M,1975/03/09,37y0m) 手術日期 2010/07/05 手術主治醫師 蔡翊新 手術區域 東址 001房 04號 診斷 Trauma, brain 器械術式 ICP monitoring 手術類別 緊急手術 手術部位 頭、頸 傷口分類 污染 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 4E 紀錄醫師 胡朝凱, 時間資訊 13:00 臨時手術NPO 13:00 開始NPO 18:00 通知急診手術 19:05 進入手術室 19:15 麻醉開始 19:25 誘導結束 19:50 手術開始 20:37 開始輸血 22:55 手術結束 22:55 麻醉結束 23:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 1 L 手術 顱內壓監視置入 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: Left craniectomy decompression 開立醫師: 胡朝凱 開立時間: 2010/07/05 23:33 Pre-operative Diagnosis Left traumatic craniofacial bone fracture and brain contusion Post-operative Diagnosis Left traumatic craniofacial bone fracture and brain contusion Operative Method Left craniectomy decompression Specimen Count And Types Nil Pathology nil Operative Findings 1.Multiple craniofacial bone fracture with bone chips inside the frontal lobe parenchyma. 2.Frontal sinus exposed due to fracture. 3.Frontal lobe became contusion and necrotic 4.Severe brain swelling and left parietal to temporal lobe contusion Operative Procedures Under ETGA, patient was put in supine position with head tilt to right. After well antisepsis and drapping procedure, left burr hole was created and an ICP monitor was inserted. Then left trauma flap skin incision was performed from pre-auricular area upward to 1 cm above ear then turn backward and pass the curvature of skull, followed by another turn upward to 1 cm away from midline and went anterior to 1 cm behind hair line and then crossed the midline with a curvature incision. The subcutaneous soft tissue was then opened by blunt dissection. Periosteum was then incised by elctrocauterization and dissected to open. After 6 burr holes drilled, craniectomy was performed with Midas air drill. Dural tenting was then performed and was followed with curvature dura incision 1 cm away from edge. Fascia flap was utilized to re-union with the dura during dura opening with 4-0 prolene. Chronic subdural effusion was removed. After 2 CWV drains and ICP monitor insertion, wound was closed in layers. Operators 蔡翊新 Assistants 胡朝凱,古恬音 Indication Of Emergent Operation 林彥伶 (F,1966/08/17,45y6m) 手術日期 2010/07/06 手術主治醫師 林至芃 手術區域 西址 036房 02號 診斷 Secondary malignant neoplasm of brain and spinal cord 器械術式 Insertion of hichman or port a 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 林至芃 ASA 3 時間資訊 09:37 報到 11:00 進入手術室 11:05 麻醉開始 11:10 抗生素給藥 11:10 誘導結束 11:30 手術開始 11:55 麻醉結束 11:55 手術結束 12:00 送出病患 記錄__ 手術科部: 麻醉部 套用罐頭: Port-A implantation, internal jugular 開立醫師: 王曼玲 開立時間: 2010/07/06 11:48 Pre-operative Diagnosis Lung cancer Post-operative Diagnosis Ditto Operative Method Port-A implantation, echo-guided Specimen Count And Types Nil Pathology Nil Operative Findings 1.Site: right internal jugular vein, with cut down & echo-guided procedure 2.Patent flow after implantation 3.Others: nil Operative Procedures 1.The patient was set on supine position and bilateral internal jugular veins were checked by echo. 2.After IVGA and local anesthesia applied, transverse skin incision for 3cm was made at pre-cordial area. 3.Undermine the skin at the layerbetween subcutaneous tissue and deep fascia in lateral direction. 4.Direct cut down method was performed to identify internal jugular vein. An IV catheter was inserted via the neck wound and negatively aspirated until venous blood attainable. 5.J-wire was inserted smoothly in rostral direction. An internal jugular catheter with dilator was inserted through the J-wire, and the dilator was then removed. 6.The catheter for Port-A was threaded into the internal jugular vein until mark 26 cm. Skin tunnel between neck and pre-cordial incision was made by the blunt dissection with Kelly clamp. The catheter was then threaded and adapted into the port and locked with restrictor. The port was inserted into the pouch ofpre-cordial incision. 7.Skin was closed layer by layer. Both catheter and the port were perfused with heparin solutionafter implantation. Operators 林至芃 Assistants 王曼玲 江美滿 (F,1959/10/17,52y4m) 手術日期 2010/07/06 手術主治醫師 曾漢民 手術區域 西址 033房 01號 診斷 Carpal tunnel syndrome 器械術式 Decompression of mediun nerve 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 10:25 進入手術室 10:40 麻醉開始 10:45 手術開始 11:25 手術結束 11:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 正中神經或尺神經腕部減壓術–單側 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Carpal tunnel release, right side 開立醫師: 王奐之 開立時間: 2010/07/06 11:33 Pre-operative Diagnosis Carpal tunnel syndrome, right side Post-operative Diagnosis Carpal tunnel syndrome, right side Operative Method Carpal tunnel release, right side Specimen Count And Types Nil Pathology Nil Operative Findings Hypertrophic transverse carpal ligament noted. Operative Procedures The patient was placed in supine position with right arm streched out. After disinfection and draping, a linear skin incision was made at basal palm. The incision was deepened until the transverse carpal ligament was exposed. The ligament was then incised longitudinally until the median nerve perineurium was seen. After meticulous hemostasis, the operation ended with wound suture in layers. Operators VS曾漢民 Assistants R3王奐之 相關圖片 鄭婕 (F,2000/06/23,11y8m) 手術日期 2010/07/06 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Sexual precocity 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 2 紀錄醫師 曾峰毅, 時間資訊 07:55 報到 08:08 進入手術室 08:10 麻醉開始 08:20 誘導結束 08:40 抗生素給藥 09:03 手術開始 09:50 手術結束 09:50 麻醉結束 10:00 送出病患 10:10 進入恢復室 11:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦脊髓液分流管重置 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 曾峰毅 開立時間: 2010/07/06 10:03 Pre-operative Diagnosis Arachnoid cyst, status post cystoperitoenal shunt Post-operative Diagnosis Arachnoid cyst, status post cystoperitoenal shunt Operative Method Cystoperitoneal shunt revision Specimen Count And Types Removed shunt reservoir was sent for culture. Pathology Nil Operative Findings Clear, colorless CSF gushed out while ventricular shunt replacement. Clear, colorless CSF gushed out while intracystic catheter being replaced. Operative Procedures With endotracheal general anaestehsia, tha patient was put in supine position with head rotated to left. After scalp shaved, scrubbed, disinfected, and then draped, we made one skin incision along previous surgical wound. We dissected to expose previous cystoperitoneal shunt. We removed the ventricle catheter and dissected the mobilize shunt reservoir. We cut the shunt distal to shunt reservoir, and removed the reservoir and ventricular cathter. We reconnected the shunt system to another ventricular catheter without reservoir. We inserted the ventricular shunt along the previous route into cyst. We closed the wound in layers after hemostasis. With endotracheal general anaestehsia, tha patient was put in supine position with head rotated to left. After scalp shaved, scrubbed, disinfected, and then draped, we made one skin incision along previous surgical wound. We dissected to expose previous cystoperitoneal shunt. We removed the intracystic catheter, right angled connector, and the Codman fixed pressure reservoir (40 mmH2O). We reconnected the shunt system to another ventricular catheter without reservoir. We inserted the intracystic catheter along the previous route into the cyst. We closed the wound in layers after hemostasis and PaCO2 retention to 40. Operators VS 郭夢菲 Assistants R3 曾峰毅 林聖傑 (M,2010/02/01,2y1m) 手術日期 2010/07/06 手術主治醫師 郭夢菲 手術區域 兒醫 068房 01號 診斷 Other alteration of consciousness 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 4E 紀錄醫師 曾峰毅, 時間資訊 08:48 通知急診手術 09:20 進入手術室 09:20 報到 09:30 麻醉開始 10:30 抗生素給藥 10:40 誘導結束 10:50 手術開始 11:00 開始輸血 12:00 麻醉結束 12:00 手術結束 12:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 硬腦膜外血腫清除術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: craniotomy for EDH evacuation 開立醫師: 胡朝凱 開立時間: 2010/07/06 12:01 Pre-operative Diagnosis RIGHT ACUTE EDH Post-operative Diagnosis RIGHT ACUTE EDH Operative Method craniotomy for EDH evacuation Specimen Count And Types nil Pathology nil Operative Findings 1.Hematoma about 45 ml with severe brain compression 1.Hematoma (blood clot) about 45 ml with severe brain compression 2.The MMA was cut due to trauma and bleeding, and it was coagulated. 2.The right meddile meningeal artery was ruptured due to head trauma and with active bleeding after removeal of the blood clot, and it was coagulated. 3.After hematoma evacuation, the brain was still slack Operative Procedures 1.ETGA, supine with head rotate to left 2.Vertical linear skinn incision was done 2.Vertical linear skin incision was done above right ear 3.Detach temporalis muscle 4.Craniotomy as a 4 x 4 window 5.Hematoma evacuation 6.MMA coagulation 6.Coagulation of ruptured right MMA 7.Insert gelfoam for packing 7.Insert gelfoam for packing in epidural space. 8.dural tenting 8.Multiple dural tenting after saline filling of the subdrual space and elevation of PaCO2 to 39 mmHg 9.Fix bone back with silk and central tenting 9.Fix bone back with multiple silks and central tenting 10.After CWV drain insertion, the wound was closed in layers Operators 郭夢菲 Assistants 胡朝凱,曾峰毅 Indication Of Emergent Operation 林萬益 (M,1947/08/17,64y6m) 手術日期 2010/07/07 手術主治醫師 賴達明 手術區域 東址 003房 03號 診斷 Lung cancer 器械術式 Craniotomy (A.V.M.) P-LIN 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 4E 紀錄醫師 王奐之, 時間資訊 12:00 臨時手術NPO 12:00 開始NPO 23:25 通知急診手術 01:35 進入手術室 01:36 麻醉開始 01:40 誘導結束 02:42 手術開始 05:00 抗生素給藥 07:05 手術結束 07:05 麻醉結束 07:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 顱骨切除術，包括異物移除或減壓或神經切斷 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 摘要__ 手術科部: 內科部 套用罐頭: Left craniectomy for partial hematoma evacuat... 開立醫師: 陳睿生 開立時間: 2010/07/07 10:43 Pre-operative Diagnosis Left frontotemporoparietal ICH with progression Post-operative Diagnosis Left frontotemporoparietal ICH with progression Operative Method Left craniectomy for partial hematoma evacuation, ICP monitor insertion and duroplasty Specimen Count And Types nil Pathology Nil Operative Findings Severe brain swelling was noted after durotomy, diffuse oozing over brain surface. Some black-reddish blood clots were evacuated, no active bleeder was identified. The parietal lobe was noted to be whitish and poor pulsated. The ICP monitor was implanted at parychema, and initial ICP was about 7mmHg. ICP monitor reference: 479 Operative Procedures After ETGA, the patient was placed in supine position with head turned to right. After scalp shaving, disinfection and draping in sterile fashion, a reverse U incision was made at left frontoparietotemporal area. Craniectomy was then followed. After removing the skull, bulging brain was noticed. A semicircular durotomy was then done. 3 corticotomy were done to evacuate the visible blood clots. Due to the severe swelling of the brain surface, partial parietal lobectomy was performed for decompression. Hemostasis was done strictly. After inserting the ICP monitor into parychema, duroplasty was done with fascia and Durafoam. A CWV drain was set, and the woudn was closed in layers. Operators VS 賴達明 Assistants R6 陳睿生, R3 王奐之 Indication Of Emergent Operation 相關圖片 吳豊盛 (M,1925/09/14,86y6m) 手術日期 2010/07/06 手術主治醫師 賴達明 手術區域 東址 003房 號 診斷 Lumbar spondylosis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 楊博智, 時間資訊 07:40 報到 08:08 進入手術室 08:23 麻醉開始 08:35 誘導結束 09:10 抗生素給藥 09:54 手術開始 12:55 抗生素給藥 14:35 手術結束 14:35 麻醉結束 14:45 送出病患 14:45 進入恢復室 15:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 手術 椎弓切除術（特壓）－二節以內 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: 1. Partial L3 and L4 laminectomy for decompre... 開立醫師: 陳睿生 開立時間: 2010/07/06 14:57 Pre-operative Diagnosis Lumbar stenosis over L3-5, and spondylolithesis over L3/4 Post-operative Diagnosis Lumbar stenosis over L3-5, and spondylolithesis over L3/4 Operative Method 1. Partial L3 and L4 laminectomy for decompression; 2. Posterior fixation with percutaneous TPS over L3/4 Specimen Count And Types nil Pathology Nil Operative Findings The thecal sac was tightly compressed by thicken ligamentum flavum over L3/4, 4/5 level. It was well decompressed after removal of ligamentum flavum. Synthes SpiRIT percutaneous TPS system was used for fixation. Screws: 6.5 x 45mm x4; Rods: 5cm x2 Operative Procedures 1. ETGA, prone position and C-arm localized the L3-5 level 2. Low back midline incision 3. Split the lower L3 and L4 spinous process and retracted bilaterally 4. Laminotomy over L3/4, and L4/5 5. Remove of thicken ligamentum flavum at L3/4, 4/5 level 6. Hemostasis, set a 1/8 hemovac, and close the wound in layers 7. About 1cm nip incision at bilateral L3, L4 level (total 4 wounds) 8. Split the paraspinal muscle to identify the L3, 4 transverse process and facet 9. Set the SpiRIT system at L3/4 level under C-arm localization 10.Hemostasis 11.Close the wound in layers, total blood loss: 300ml Operators VS 賴達明 Assistants R6 陳睿生, R2 楊博智 孫任余 (M,1986/10/31,25y4m) 手術日期 2010/07/06 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Dislocations of first cervical vertebra, closed 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 楊博智, 時間資訊 14:40 報到 15:05 進入手術室 15:10 麻醉開始 15:30 誘導結束 15:50 抗生素給藥 16:38 手術開始 18:50 抗生素給藥 19:25 麻醉結束 19:25 手術結束 19:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: C1-2 fixation with transarticular screws, and... 開立醫師: 陳睿生 開立時間: 2010/07/06 20:07 Pre-operative Diagnosis C1-2 subluxation Post-operative Diagnosis C1-2 subluxation Operative Method C1-2 fixation with transarticular screws, and fusion with autologus bone graft Specimen Count And Types nil Pathology Nil Operative Findings C1-2 reduction was noted after retraction. Cannulated screws were used for fixation. Right: 42 x 4.5mm; left: 40 x 4.5mm. C2 spinous process was used as bone graft for posterior fusion. Operative Procedures 1. ETGA, prone position and head fixed with Mayfield clump 2. Neck retraction under C-arm guided for C1-2 close reduction 3. Posterior neck midline incision and split the trapzius muscle and parapspinal muscle 4. Expose the C2-4 spinous process, and dissect to expose the C1 posterior arch, C2 lamina 5. Two skin nip incision at C7 level, and inserted the K-pin from percutaneous tract 6. Insert the transarticular screws under C-arm guided 7. Hemostasis, and set a 1/8 hemovac 8. Remove the C2 spinous process, and use as C1-2 fusion graft 9. Suture back the muscles and close the wound in layers Operators VS 賴達明 Assistants R6 陳睿生; R2 楊博智 王乃 (F,1976/02/14,36y1m) 手術日期 2010/07/06 手術主治醫師 賴達明 手術區域 東址 006房 05號 診斷 Herniation of intervertebral disc 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 胡朝凱, 時間資訊 14:30 報到 14:40 進入手術室 14:45 麻醉開始 14:50 誘導結束 14:50 抗生素給藥 15:44 手術開始 17:25 麻醉結束 17:25 手術結束 17:30 送出病患 17:33 進入恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 椎間盤切除術－腰椎 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: HIVD 開立醫師: 胡朝凱 開立時間: 2010/07/06 17:29 Pre-operative Diagnosis L5~S1 right HIVD Post-operative Diagnosis L5~S1 right HIVD Operative Method HIVD Specimen Count And Types nil Pathology nil Operative Findings one protruded disc located at L5~ S1 level that compressed the S1 nerve root. After decompression, the root became loose. And the disc became dehydrated. Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: semiprone with a bolster beneath -- side and flexed at the waist and knees. 2.prone position 3. Skin preparation: the back was shaved and scrubbed with povidone-iodine detergent then painted with povidone-iodine tincture and followed by sterilized adhesive plastic sheet covering. 4.A spinal needle was inserted between spinous processes of L -- 3.A spinal needle was inserted between spinous processes of L 5~S1 and a portable X-ray film was taken to locate the correct interspace. 5.Incision: 3-cm, between L -spinous processes,off-midiline at 4.Incision: 3-cm, between L5~S1 spinous processes the -- margin of spinous processes. The subcutaneous layer and lumbdorsal fascia were incised then. 6.The aponeurosis of the latissimus dorsi and ileocostalis lumborum 5.The aponeurosis of the latissimus dorsi and ileocostalis lumborum was devided muscles at spinous processes of L -- was incised, the muscles were detached from the interspinous ligament. The multifidus muscles were detached subperiosteally from L - laminae by a rasp. 7.The paravertebral muscles were retracted by a modified narrow 6.The paravertebral muscles were retracted by a modified narrow Taylor retractor which was retained constantly by a rubbersling to the side rail of the operating table. 8.Under an operating microscope, the ligamentum flavum was cleaned 7.Under an operating microscope, the ligamentum flavum was cleaned and incised longitudinally at the lateral part with a No. 11 blade. The lateral portion of this ligament was removed with a small angle Kerrison rongeur, the lateral portion of the laminae and the medial border of the facets were removed too until the margin of the facets and a corridor to the disc that ran lateral to the root was reached. 9. The epidural fat was left undisturbed andpreserved. 8. The epidural fat was left undisturbed andpreserved. 10.The compressed L- root and veins overlying the protruded disc 9.The compressed S1 root and veins overlying the protruded disc were gently pushed away by placing 2 small cottonoid patties, one above and one below the disc at the floor of the epidural canal. 11.The compressed root was gently pushed further away temporarily 10.The compressed root was gently pushed further away temporarily by sucker tip in order to expose the herniated disc more clearly. The posterior longitudinal ligament and annulus were incised around the protruded disc with a No. 15 blade. The degenerated disc was removed with microdisc forcepsuntil a substantial amount of the nucleus had been loosened with a cone curette and removed. 12.A piece of subcutaneous fat was resected and covered on -- 11.A piece of subcutaneous fat was resected and covered on -- root. 13.The lumbodorsal fascia was approximated by 3 interruped 2/0 silk 12.The lumbodorsal fascia was approximated by 3 interruped 2/0 silk stitches. 14.Thesubcutaneous layer was closed by running suture with 4/0 13.Thesubcutaneous layer was closed by running suture with 4/0 Dexon and skin by adhesive tape. 15.Course of the surgery: smooth. Operators 賴達明 Assistants 胡朝凱 楊淑專 (F,1958/09/21,53y5m) 手術日期 2010/07/06 手術主治醫師 陳敞牧 手術區域 東址 005房 01號 診斷 Brain metastasis 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 07:40 報到 08:10 進入手術室 08:20 麻醉開始 09:03 誘導結束 09:30 抗生素給藥 09:45 手術開始 12:30 抗生素給藥 14:03 開始輸血 14:58 15:30 抗生素給藥 18:30 抗生素給藥 19:30 麻醉結束 19:30 手術結束 19:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在８小時以上 1 1 B 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 14 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: 1. Total excision of left frontal tumor via l... 開立醫師: 鍾文桂 開立時間: 2010/07/06 20:22 Pre-operative Diagnosis Metastatic tumor, left frontal and right temporal regions. Post-operative Diagnosis Metastatic tumor, left frontal and right temporal region. Operative Method 1. Total excision of left frontal tumor via left frontal-temporal approach. 2. Subtotal excision of right temporal tumor via right pterionla approach. Specimen Count And Types 1 piece About size:20~30 cc. Source:brain tumor. Pathology Pending. Operative Findings 1. Whitish, firm, well demarcated tumor; easy oozing. 2. Encasement of MCA branches by right temporal tumor; we did not remove this part of the tumor. 3. Intraoperative mapping for motor cortex and ultrasonography for localization of left brain tumor. Operative Procedures 1. ETGA, supine position, head tilted to the right. 2. Shaving, disinfection, and draping. 3. Question-mark-shaped scalp incision and dissection. 4. Temporalis muscle dissection. 5. Craniotomy by high speed drill. 6. dural tenting and durotomy. 7. Intraoperative mapping for motor cortex and ultrasonography for localization of left brain tumor. 8. Trans-sulci dissection to reach the tumor. 9. Central debulking, and tumor resection in piecemeal fashion. 10.Well hemostasis and covering the emptied tumor cavity with Surgicel. 11.Duroplasty with DuraGen;Fixation of skull bone plate 12.Wound closure in layers after placing one subgaleal CWV drain. For right temporal tumor. 13.Removal of the draping for left frontal tumor. 14.Tilted the head to the left; disinfection, and draping. 15.Curvilinear scalp incision and dissection. 16.Craniotomy, dural tenting, and durotomy. 17.Transsulci dissection near superior temporal gyrus. 18.Central debluking, and tumor resection in piecemeal fashion. 19.Well hemostasis. 20.Duroplasty with temporalis fascia and DuraGen. 21.Fixation of skull bone plate. 22.Placement of one CWV drain; wound closure in layers. 23.Send the patient to ICU smoothly. Operators V.S. 陳敞牧 Assistants R5鍾文桂 R1何奕瑢 相關圖片 許新土 (M,1956/11/14,55y4m) 手術日期 2010/07/06 手術主治醫師 王國川 手術區域 東址 001房 03號 診斷 Hydrocephalus 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 游健生, 時間資訊 10:00 臨時手術NPO 10:00 開始NPO 13:55 進入手術室 14:00 麻醉開始 14:05 誘導結束 14:35 手術開始 15:05 手術結束 15:05 麻醉結束 15:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 顱內壓監視置入 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: 1. External ventricular drainage insertion 開立醫師: 游健生 開立時間: 2010/07/08 08:56 Pre-operative Diagnosis Hydrocephalus with ventricle-peritoneal shunt dysfunction Post-operative Diagnosis Hydrocephalus with ventricle-peritoneal shunt dysfunction Operative Method 1. External ventricular drainage insertion 2. Ventricle-peritoneal shunt removal Specimen Count And Types 1 piece About size:4cm in lenght Source:VP shunt ventricle catheter Pathology Nil Operative Findings After removal of ventricle catheter, clear CSF gushed out. The estimated pressure was larger than 10cmH2O. The tip of ventricle catheter was sent for culture. Operative Procedures 1. Under tracheosteal ventilation and general anesthesia, patient was put into supine position with head mildly elevated. 2. After shaving his hair, we disinfected and draped the operation field as usual. 3. Incised over previous scalp wound and dissected in layers. 4. Removed scar tissue and ventricle catheter after identification of VP shunt. Then, obtained tip of the ventricle catheter for culture. 5. Inserted a new ventricle catheter of EVD and fixed it at scalp. 6. Incised below the reservoir and removed it with ventricle and peritoneal catheter. 7. Hemostasis, normal saline irrigation, and closed wound in layers. Operators VS 王國川 Assistants R3 游健生 Indication Of Emergent Operation 林獻堂 (M,1975/03/09,37y0m) 手術日期 2010/07/06 手術主治醫師 蔡翊新 手術區域 東址 003房 04號 診斷 Trauma, brain 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 污染 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 4E 紀錄醫師 胡朝凱, 時間資訊 02:59 通知急診手術 03:30 報到 03:30 進入手術室 03:35 麻醉開始 03:40 誘導結束 04:00 手術開始 04:50 開始輸血 05:00 抗生素給藥 05:50 麻醉結束 05:50 手術結束 06:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 急性硬腦膜下血腫清除術 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 記錄__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 蔡翊新 開立時間: 2010/07/06 05:52 Pre-operative Diagnosis Left frontotemporoparietal epidural hematoma with IICP. Post-operative Diagnosis Left frontotemporiparietal subdural and epidural hematoma with IICP. Operative Method Left frontotemporoparietal extended craniectomy for removal of EDH and SDH. Specimen Count And Types nil Pathology Nil. Operative Findings The ICP before operation climbed up to 84 mmHg. Left frontotemporoparietal epidural and subdural hematoma, about 2 cm in thickness, were evacuated. During craniectomy, massive bleeding was encountered from bone edge and epidural space, some possibly from sagittal sinus. Hypotension was noted and recovered after blood transfusion and fluid challenge. The brain became extremely swelling, then lost its pulsation and became pale. The ICP became 32 mmHg after skin closure. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated (tilted) to right (left). 2. Position: supine with head rotated to right 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 4 cm at anterior-lower temporal area, the skin edge was 4. Incision: via previous wound clipped by Raney clips for temporary hemostasis. The temporalis muscles was incised down to the tempoal squama which was exposed then by applying a self retaining retractor on the muscle. 5. A burr hole was made and the dura was incised for evacuating part of the subdural hematoma, therefore the IICP could be relieved earlier. 6. The incision was extended to a temporal horseshoe, and the 5. The incision was further extended to occipital area temporalis muscle was detached from temporal squama by rasp subsequently. 7. Craniotomy window: --x- - cm, ----, created by making --burr holes then cut by power saw. 8. Dural tenting: by 2/0 silk, -cm in interval, distributed along 6. Extension of craniotomy the edge of skull window. 9. Dural incision: crusade fahion (curvilinear along the edge of 7. Dural incision: radiation fahion skull window) 10.The subdural clot was removed by sucker and those located beyound 8.The subdural clot was removed by sucker the cranial window was washed out by saline irrigation through a Nelaton tube introduced into subdural space. (Because of severe brain swelling, once the dura had been opened for an 1 inch distance and subdural clot cleaned, it was immediatedly covered by anchoring the dural graft on the opening to prevent the fungating of the brain through the dural opening. The procedure of opening the dura and dural graft was advanced in an alternate fashion until the horese shoe shaped dura incision had been completedly closed.) 11.Hemosatasis: the bleeders was stopped by Bovie and oozing surface 9.Hemosatasis: the bleeders was stopped by Bovie and oozing surface was covered with gelfoam. 12.Dural closure:was closed with a piece of dural graft taking from 10.Dural closure:was closed with a piece of durofoam temporalis fascia.(crescent shape-- cm long, -- cm wide) along the whole length of the duralincision in order to create an additional space for the swollen brain. 13.The skull plate was remmoved and burried at subcutaneous layer of right anterior thigh for preservation. 14.Scalp closure: hemostasis was done with monopolar coagulatortouching on the sucker tip. Galea suture was performed by 14.Scalp closure: hemostasis was done with monopolar coagulatortouching on the sucker tip. Galea suture was performed by 1-0 dexon and 2-o nylon continuous suture with 3/0 Dexon and skin by continuous suture with 3/0 nylon. 15.Drain: one, epidural, collected in a surgeon's glove. 16.Blood transfusion: 17.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R6胡朝凱 Indication Of Emergent Operation 胡火亮 (M,1954/03/28,57y11m) 手術日期 2010/07/07 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Brain abscess 器械術式 Brain tumor Crainotomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 古恬音, 時間資訊 07:40 報到 08:03 進入手術室 08:10 麻醉開始 09:10 誘導結束 09:30 抗生素給藥 09:51 手術開始 12:30 抗生素給藥 13:50 麻醉結束 13:50 手術結束 14:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 顱底瘤手術 1 1 摘要__ 手術科部: 外科部 套用罐頭: Right subfrontal approach for total tumor exc... 開立醫師: 胡朝凱 開立時間: 2010/07/07 14:21 Pre-operative Diagnosis Recurrent craniopharyngima Post-operative Diagnosis Recurrent craniopharyngima Operative Method Right subfrontal approach for total tumor excision Specimen Count And Types nil Pathology pending Operative Findings 1.Severe adhesion between dura and brain was noted 2.Some pus like material was noted after craniectomy at right frontal sinus area 3.The tumor eas grayish to yellowish at suprasellar area, with motor oil like material inside the cyst and some calcified part. The interface between brain and tumor was not so clear. After total tumor excision, the basilar artery and pons was seen. A small part of capsule was left in situ at right PCA area to prevent perforator damage. The loor of third ventricle was also exposed. Operative Procedures Under ETGA, patient was put in supine position with head fixed with Mayfield skull clamp. The Wound was incised via previous wound. The skin flap was reflect anteriorly. Craniotomy was done at previous bone window. The dura was opened with the base left at midline. Interhemispheric fissure was opened with sharp dissection. Right frontal lobe was further retract downward gradually. The tumor was exposed before optic chiasm. Central debulky was first done. After that, the capsule was retract inward and dissected. CUSA was also used to resect the tumor part without damage to the vessels.The upward capsule was retract down and resected with currete.Tumor was finally total excised. After hemostasis, The duroplasty was done with durofoam. Bone was fixed back and wound was closed in layers. Operators P 杜永光 Assistants 胡朝凱, 古恬音 郭韋廷 (M,1991/01/17,21y1m) 手術日期 2010/07/07 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Spine tumor 器械術式 Malignant intraspinal tumor, e 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 王奐之, 時間資訊 15:51 進入手術室 15:53 麻醉開始 16:00 誘導結束 16:00 抗生素給藥 16:46 手術開始 18:50 手術結束 18:50 麻醉結束 18:55 送出病患 19:11 進入恢復室 20:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 良性病髓腫瘤切除術 1 1 記錄__ 手術科部: 外科部 套用罐頭: L3-4 laminoplasty for intraspinal tumor excision 開立醫師: 王奐之 開立時間: 2010/07/07 19:08 Pre-operative Diagnosis L3-4 intraspinal tumor, suspected neuroma Post-operative Diagnosis L3-4 intraspinal tumor, suspected neuroma Operative Method L3-4 laminoplasty for intraspinal tumor excision Specimen Count And Types 1 piece About size:1.6*1*1cm Source:intraspinal tumor Pathology Pending Operative Findings A 1.6*1*1 round elastic-firm mass was noted in the thecal sac, with black-reddish appearance, suspected neuroma with hemorrhage. The tumor was removed en bloc with adhered nerve ligation. Operative Procedures After ETGA, the patient was placed in prone position. After skin disinfection and draping in usual sterile fashion, a midline lower back skin incision was made at the level of L3-4. The incision was then deepened to expose the L3-4 spinous processes. The paraspinal muscles were then splitted from the process, exposing the L3-4 lamina. L3 & L4 laminectomy was performed by drilling the junction between facets and the lamina. The thecal sac was opened, followed by tenting. After opening the arachnoid membrane, the tumor was noted and mobilized. The surroundings were dissected and the tumor was removed from adhering nerve. After hemostasis, the dura was closed. The L3-4 lamina was fixed back with miniplates. After setting 1 CWV drain, the wound was closed in layers. Operators VS 曾漢民 Assistants R6 陳睿生, R3 王奐之 相關圖片 章定夫 (M,1973/12/22,38y2m) 手術日期 2010/07/07 手術主治醫師 劉嘉銘 手術區域 東址 026房 02號 診斷 Chronic paranasal sinusitis 器械術式 Remove packing Endoscopic functional sinus su 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 李亭逸, 時間資訊 15:45 報到 16:02 進入手術室 16:13 手術開始 16:56 手術結束 16:57 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 鼻竇內視鏡檢查 1 0 L 記錄__ 手術科部: 耳鼻喉部 套用罐頭: Sinoscope surgery (local) 開立醫師: 李亭逸 開立時間: 2010/07/07 20:20 Pre-operative Diagnosis Chronic paranasal sinusitis, operated with left skull base defect s/p repair Post-operative Diagnosis ditto s/p remove nasal packings, left Operative Method Sinoscope surgery, left Specimen Count And Types nil Pathology Nil Operative Findings 1. No obvious CSF leakage after removing all fingerstalks 2. fibrotic tissue with adipose tissue at the defect site Operative Procedures 1. Supine position with local anesthesia by nasal packing 2. Remove the nasal packing Fingerstalk Left: 4 3. Remove the mucopus and blood clot at left nasal cavity 4. Packing the left nasal cavity with multiple small gelfoams 5. Patient tolerate the whole procedure well Operators AP 劉嘉銘 Assistants R4 李亭逸 謝芳秀 (F,1993/06/26,18y8m) 手術日期 2010/07/07 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Moyamoya disease 器械術式 EC-IC by-pass 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 李振豪, 時間資訊 07:50 報到 08:05 進入手術室 08:10 麻醉開始 08:20 誘導結束 09:00 抗生素給藥 09:17 手術開始 12:00 抗生素給藥 12:15 麻醉結束 12:15 手術結束 12:25 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 手術 顱內外血管吻合術 1 1 R 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 R 手術 朴卜勒氏血流測定（週邊血管） 1 0 記錄__ 手術科部: 外科部 套用罐頭: Encephaloduroarteriosynangiosis, right 開立醫師: 李振豪 開立時間: 2010/07/07 12:50 Pre-operative Diagnosis Moyamoya disease, bilateral, status post left encephaloduroarteriosynangiosis Post-operative Diagnosis Moyamoya disease, bilateral, status post left encephaloduroarteriosynangiosis Moyamoya disease, bilateral, status post left encephaloduroarteriosynangiosis Operative Method Encephaloduroarteriosynangiosis, right Specimen Count And Types Nil Pathology Nil Operative Findings The parietal branch of the right superficial temporal artery was chosen for the synangiosis. Operative Procedures Under ETGA, the patient was put in supine position. The head was tilted to the left. After shaving, the tract of the superficial temporal artery and its branches were outlined by tracing througth Doppler. Under ETGA, the patient was put in supine position. The head was tilted to the left. After shaving, the tract of the right superficial temporal artery and its branches were outlined by tracing through Doppler. After disinfection and draping, the L-shape scalp incision was done. The parietal branch of the right superficial temporal artery and its pedicle graft were lysed from the surroundong soft tissue under microscope for about 1.5cm in width. After disinfection and draping, the L-shape scalp incision was done. The parietal branch of the right superficial temporal artery and its pedicle graft were lysed from the surroundong soft tissue under microscope for about 1.5cm in width and 10 cm in length. The temporalis muscle below was dissected. A 4-cm craniotomy was created with high speed drill. After dural tenting the dura was opened, lysis of the arachnoid membrane surrounding the branch of MCA was done. The arterial pedicle was anchored to the four cornors of the dural opening to let the pedicle lying loosely on the brain surface. The temporalis muscle below was dissected. A 4-cm craniotomy (6 cm including the burr holes) was created with high speed drill. After dural tenting the dura was opened. The lower part of dura was not used because the middle meningeal arteries passed here. Lysis of the arachnoid membrane surrounding the branch of MCA was done under microscopic view. The arterial pedicle was anchored to the four cornors of the dural opening to let the pedicle lying loosely lying on the brain surface. The pedicle had good contact with the exposed MCA branches at the anterior upper part of the opening window. Later, the SMA pedicle was sutured to the dural edges partly by 5-0 prolene then the dura was closed continuously. A piece of DuraForm was placed above and below the dura mater. The bone plate was fixed with 3 wires with a central tenting. The wound was closed in layers. The pedicle had good contact with the exposed MCA branches at the upper part of the opening window. The dura was then closed continuously with 5-0 Prolene. A 3x1cm DuraForm was tailed and placed above and below the dura mater. The bone plate was fixed with 3 wires with a central tenting. The wound was closed in layers. The pedicle had good contact with the exposed MCA branches at the upper part of the opening window. The dura was then closed continuously with 5-0 Prolene. A 3x1 inches DuraForm was tailored and placed above and below the dura mater. The bone plate was fixed with 4 wires with a central tenting. The wound was closed in layers. Operators AP 郭夢菲 Assistants R4 李振豪 相關圖片 林萬益 (M,1947/08/17,64y6m) 手術日期 2010/07/07 手術主治醫師 賴達明 手術區域 東址 013房 01號 診斷 Lung cancer 器械術式 Crainotomy Brain Tumor(P-LIN) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 4E 紀錄醫師 楊博智, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 08:20 進入手術室 08:25 麻醉開始 08:30 誘導結束 08:55 手術開始 09:00 開始輸血 10:05 手術結束 10:05 麻醉結束 10:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 硬腦膜外血腫清除術 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 內科部 套用罐頭: Hematoma evacuation 開立醫師: 陳睿生 開立時間: 2010/07/07 10:14 Pre-operative Diagnosis Left side parietal ICH s/p with EDH Post-operative Diagnosis Left side parietal ICH s/p with EDH Operative Method Hematoma evacuation Specimen Count And Types nil Pathology Nil Operative Findings About 3cm in thickness hematoma was noted at the epidural space. Active bleeder was noted from superior temporal artery. After hematoma removal, the ICP was about 1mmHg. Operative Procedures 1. ETGA, supine position and head right turn 2. Reopen of previous wound 3. Hematoma evacuation 4. Electroligazed the bleeder at STA 5. Set a CWV drain 6. Close the wound in layers Operators VS 賴達明 Assistants R6 陳睿生, R2 楊博智 Indication Of Emergent Operation 翁陳寶鳳 (F,1938/01/19,74y1m) 手術日期 2010/07/07 手術主治醫師 賴達明 手術區域 東址 005房 01號 診斷 Brain metastasis 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳德福, 時間資訊 08:10 進入手術室 08:35 麻醉開始 09:08 誘導結束 09:20 抗生素給藥 09:45 手術開始 11:38 開始輸血 12:20 抗生素給藥 15:20 手術結束 15:20 麻醉結束 15:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４～８小時 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: craniotomy tumor excision, bilateral 開立醫師: 陳德福 開立時間: 2010/07/07 15:54 Pre-operative Diagnosis bilateral motor cotex metastatic tumor Post-operative Diagnosis bilateral motor cotex metastatic tumor Operative Method craniotomy tumor excision, bilateral Specimen Count And Types 1 piece About size:2.0*2.0*2.0cm Source:brain tumor Pathology pending Operative Findings 1.There is 2.0*2.0*2.5cm in sized reddish, elastic, hardish and metastatic tumor at the bilateral medial motor cotex. The gliotic change of the perifocal parenchyma is noticed. 2.Intra-OP mapping for the motor cortex is done and we approach the tumor via transsulcus route. 3.The tumors were removed by CUSA, bipolar, and tumor forceps assisted. Operative Procedures Under ERGA and supine position, the skull was fixed with Mayfield pin type head fixator. The scalp was disinfected and draped as usual. One C shaped incision across midline was made and the 6*10cm in sized and across SSS craniotomy was created. The dura tenting was done and the dura was opened in C shape with midline based, bilaterally. The tumor was identified by intra-OP ultrasound study. The mapping for motor cortex was performed and we removed the tumors were removed by CUSA, bipolar, and tumor forceps assisted with trans-sulcus route. Hemostasis was done and the duroplasty was done with Durofoam and the periosteum. The skull was fixed with miniplates and one subgaleal drainage was left in situ. The wound was closed in layers. Operators VS 賴達明 Assistants R5 陳德福 嚴蓬萊 (M,1936/01/23,76y1m) 手術日期 2010/07/07 手術主治醫師 林子富 手術區域 西址 034房 號 診斷 Lung tumor 器械術式 Port-A Implatation /WOR 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 林子富 ASA 2 紀錄醫師 王曼玲, 時間資訊 00:00 臨時手術NPO 08:20 報到 08:30 進入手術室 08:35 麻醉開始 08:40 抗生素給藥 08:40 誘導結束 08:55 手術開始 09:30 手術結束 09:30 麻醉結束 09:35 送出病患 09:40 進入恢復室 11:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 ｐｏｒｔ–Ａ導管植入術–治療性導管植入術 1 0 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 記錄__ 手術科部: 麻醉部 套用罐頭: Port-A removal and implantation, subclavian 開立醫師: 陳心言 開立時間: 2010/07/07 09:30 Pre-operative Diagnosis Lung cancer Post-operative Diagnosis Ditto Operative Method Removal and implantation of Port-A, echo-guided Specimen Count And Types Nil Pathology Nil Operative Findings 1.Site: left subclavian vein, with echo-guided procedure 2.Patent flow after implantation 3.Others: Operative Procedures 1.The patient was set on supine position and bilateral subclavian veins were checked by echo. 2.After IVGA and local anesthesia applied, skin incision was made along the previous incision site. 3.Uncovered the Port-A, and then removed it.4.Wash the pouch with normal saline. 5.An IV catheter was inserted via the subclavian wound and negatively aspirated until venous blood attainable. 6.J-wire was inserted smoothly in rostral direction. A subclavian catheterwith dilator wasinserted through the J-wire, and the dilator was then removed. 7.The catheter of Port-A was threaded into the subclavian vein until mark 26cm. The catheter was adapted into the port and locked with restrictor. The Port was inserted into the pouch of pre-cordial incision. 7.The catheter of Port-A was threaded into the subclavian vein until mark 26 cm. The catheter was adapted into the port and locked with restrictor. The Port was inserted into the pouch of pre-cordial incision. 8.Skin was closed layer by layer. Both catheter and port were perfused with heparin solution after implantation. Operators 林子富 Assistants 王曼玲 吳裕賢 (M,1968/02/20,44y0m) 手術日期 2010/07/07 手術主治醫師 蕭輔仁 手術區域 東址 003房 02號 診斷 Spinal injury with complication, sequelae 器械術式 Lamino plasty 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 古恬音, 時間資訊 13:40 報到 14:15 進入手術室 14:20 麻醉開始 14:30 誘導結束 15:00 抗生素給藥 15:15 手術開始 17:10 手術結束 17:10 麻醉結束 17:20 進入恢復室 17:20 送出病患 18:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 手術 椎弓整形術 1 1 記錄__ 手術科部: 外科部 套用罐頭: Laminoplasty 開立醫師: 古恬音 開立時間: 2010/07/07 17:29 Pre-operative Diagnosis 1. Cervical stenosis 2. Trauma with spinal cord injury, C3-6 Post-operative Diagnosis 1. Cervical stenosis 2. Trauma with spinal cord injury, C3-6 Operative Method Laminoplasty, C3-6 Specimen Count And Types nil Pathology Nil Operative Findings The cord was compressed by the hypertrophic flavum. The thecal sac expanded well after decompression Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: prone with neck flexed and head fixed by a Mayfield skull clamp 3.Skin preparation: occipital and neck areas were shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4.Incision: midline nape, from suboccipital to lower neck. 5.The trapezius, semispinalis capitis, splenius capitis muscles on both sides were splitted at its origin of ligamentum nuchae, then, together with serratus posterior superior, rectus capitis posterior, obliqus capitis inferior and multifidus were detached from the spinous processes of C3-6 by Bovie, followed by subperiosteal dissection on the laminae. 6.The paravertebral muscles were kept open by self retaining retractors to expose spinous processes and laminae of C3-6. The bleeding from the muscles was stopped by Bovie. 7.The spinous processes of C3-6 were cut at its base by high speed air drill andreserved for later use. 8. The laminal arches were cut through its whole thickness at its midline by a 2 mm head size high speed air drill. The base of the laminae at its laminopedicle juction was cut into a depth of it half thickness by a 1mm head size high speed cutting burr. 9.The lamina on each side was bent to the lateral side by opening a book like action of a Cloward intervertebral spreader. Consequently, the posterior half of the spinal canal was enlarged. 10.The hypertrophic ligmenta flava, esp. at posterior central region were resected. 11.Each gap newly created between the lt and rt leminae at C3-6 after splitting was bridged by the reserved spinous process which was fixed to the laminae by a wire on each end. 12.The new epidural empty space was loosely packed with subcutaneous fatty tissue. 13.A 3 mm width partial laminectomy was done with Kerrison punch at the lower margin of C3-6 lamina and the upper margin of C3-6 lamina. 14.The paravertebral muscles were closed by interrupted sutures with 2/0 silk, subcutaneous layer by continuous suture with 3/0 Dexon and skin by continuous suture with 3/0 nylon. 15.Drain: one, epilaminal, CWV. 16.Course of the surgery:smooth. Operators 蕭輔仁 Assistants R6胡朝凱, R3古恬音 蘇麗玉 (F,1938/08/15,73y6m) 手術日期 2010/07/07 手術主治醫師 蔡翊新 手術區域 東址 003房 05號 診斷 Major trauma rated 16 or above on the severeity scale ( Injury severeity score >=16 ) 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 王永彬 ASA 4E 紀錄醫師 曾偉倫, 時間資訊 21:40 通知急診手術 22:25 進入手術室 22:30 麻醉開始 22:45 誘導結束 22:57 抗生素給藥 22:58 手術開始 01:57 抗生素給藥 02:25 手術結束 02:25 麻醉結束 02:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 急性硬腦膜下血腫清除術 1 1 R 手術 顱內壓監視置入 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 蔡翊新 開立時間: 2010/07/08 01:55 Pre-operative Diagnosis Head injury with right frontotemporal, falx and supratentorial subdural hematoma. Post-operative Diagnosis Head injury with right frontotemporal, falx and supratentorial subdural hematoma. Operative Method Right frontotemporoparietal craniectomy for SDH evacuation and ICP monitoring. Specimen Count And Types nil Pathology Nil. Operative Findings Dark reddish liquified blood gushed out upon opening the dura at first burr hole over right frontal region. Then initial ICP was about 2 mmHg. Subdural blood clots were noted at right frontotemporal region, about 0.8 cm in thickness. Blood clots were evacuation from right temporo-occipital base by retraction of the brain off the skull. The blood clots near the falx were not removed because of risk of bridging vein injury. After skin closure, the ICP was mmHg. Dark reddish liquified blood gushed out upon opening the dura at first burr hole over right frontal region. Then initial ICP was about 2 mmHg. Subdural blood clots were noted at right frontotemporal region, about 0.8 cm in thickness. Blood clots were evacuation from right temporo-occipital base by retraction of the brain off the skull. The blood clots near the falx were not removed because of risk of bridging vein injury. After skin closure, the ICP was 5 mmHg. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: horse shoe-shaped, right frontotemporoparietal region. 5. A burr hole was made at right frontal region and the dura was incised for evacuating part of the subdural hematoma, therefore the IICP could be relieved earlier. 6. Craniectomy window: 14 x 12 cm, right F-T-P, created by making 5 burr holes then cut by power saw. 7. Dural tenting: by 2/0 silk, 2 cm in interval, distributed along the edge of skull window. 8. Dural incision: curvilinear along the edge of skull window. 9. The subdural clot was removed by sucker and those located beyond the cranial window was washed out by saline irrigation. The SDH at temporal base and supratentorial space were evacuated by retraction of the brain off the skull. The SDH near the falx was not removed because of easy bleeding from the bridging veins after the brain was retracted. 10.Hemosatasis: the bleeders was stopped by Bovie and oozing surface was covered with gelfoam. 11.Dura was closed with a piece of dural graft taking from temporalis fascia (crescent shape 12 cm long, 1 cm wide) along the whole length of the dural incision in order to create an additional space for the swollen brain. 12.The skull plate was removed and placed at bone bank for preservation. 13.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 14.Drain: two, epidural, CWV. 15.Blood transfusion: PRBC 2U, platelet 12U. Blood loss: 400 ml. 16.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5鍾文桂R2曾偉倫 Indication Of Emergent Operation 陳玉坤 (M,1952/08/01,59y7m) 手術日期 2010/07/08 手術主治醫師 林峰盛 手術區域 西址 035房 05號 診斷 Failed back syndrome 器械術式 Nerve block / PC 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 林峰盛 ASA 3 時間資訊 14:55 進入手術室 15:00 麻醉開始 15:05 誘導結束 15:07 手術開始 15:40 手術結束 15:40 麻醉結束 15:45 送出病患 記錄__ 手術科部: 麻醉部 套用罐頭: RF lesioning 開立醫師: 林峰盛 開立時間: 2010/07/08 15:47 Pre-operative Diagnosis 1.radiculopathy 2.failed back surgery sydrome Post-operative Diagnosis 1.radiculopathy 2.failed back surgery sydrome Operative Method Pulsed RF RF lesioning Specimen Count And Types nil Pathology Nil Operative Findings Operative Procedures 1.LA with 1%xylocaine. 2.patient in prone position 3. Under fluoroscopic-guidance, bil L3-5 facet block with 0.5% Marcaine 1ml+kenacort 5 per joint 4. diagnostic medial branch block with 1% xylocaine per branch 5. With positive diagnostic block result , RF lesioning was done to right L3&L4; medial branch with 70 degree 70 sec 6. pulsed Rf to right L3&L4; nerve roots 80V 2Hz, 20ms, 120 secx2 Operators 林峰盛, Assistants 王曼玲, 徐劉桂香 (F,1937/01/06,75y2m) 手術日期 2010/07/08 手術主治醫師 賴達明 手術區域 東址 002房 01號 診斷 Subarachnoid hemorrhage 器械術式 Craniotomy(Aneurysms) P-DUH 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 3E 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 07:37 通知急診手術 08:15 進入手術室 08:20 麻醉開始 08:35 誘導結束 09:55 手術開始 12:50 開始輸血 13:25 抗生素給藥 16:25 抗生素給藥 18:15 手術結束 18:15 麻醉結束 18:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 開顱術摘除血管病變－腦血管瘤－有徵的 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 12 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: Right subtemporal approach for aneurysm clipping 開立醫師: 李振豪 開立時間: 2010/07/08 20:42 Pre-operative Diagnosis Ruptured right posterior cerebral artery with subarachnoid hemorrheage Post-operative Diagnosis Ruptured right posterior cerebral artery with subarachnoid hemorrheage Operative Method Right subtemporal approach for aneurysm clipping Specimen Count And Types Nil Pathology Nil Operative Findings No premature rupture was noted during dissection of the aneurysm. Three Sugita clips were used for aneurysm clipping. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine position with head fixed with Mayfield skull clamp. The head was rotated to left. The scalp was shaved, scrubbed, and disinfected as usual. Reverse U shape scalp incision was made at right frontotemporal area and the scalp flap was elevated. The temporalis muscle and periosteum was elevated with facial nerve preservation. Four burr holes were created followed by one 10x12cm craniectomy window. Dural tenting was performed and the C shape dura incision was made which based with skull base. The vein of Labbe was identified during the operation. The temporal lobe was retracted and the tentorial edge was noted. The posterior cerebral artery was exposed and the arachnoid membrane covered the posterior cerebral artery was opened. The neck of the aneurysm was dissected carefully to avoid premature rupture. The branch that lying on the aneurysm was preserved after mobilization. Three Sugita clips were used for aneurysm clipping. Hemostasis was achieved with Surgicel and Gelform. Duroplasty was performed with one 3x3cm Duraform. The skull plate was fixed back with miniplates and 2 wires. One subgaleal CWV drain was placed and the wound was closed in layers. Operators VS賴達明 Assistants R6胡朝凱, R4李振豪 Indication Of Emergent Operation 王政東 (M,1955/10/26,56y4m) 手術日期 2010/07/08 手術主治醫師 陳敞牧 手術區域 東址 003房 01號 診斷 Spinal injury with spinal bone injury 器械術式 Anterior Spinal fusion(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 2 紀錄醫師 陳睿生, 時間資訊 08:00 報到 08:08 進入手術室 08:17 麻醉開始 08:30 誘導結束 09:50 抗生素給藥 10:13 手術開始 13:00 抗生素給藥 15:15 麻醉結束 15:15 手術結束 15:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 Peripheral arterial line inserti 1 0 手術 脊椎融合術－前融合，有固定物（＜＝四節） 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Odontoid screw fixation 開立醫師: 陳睿生 開立時間: 2010/07/08 15:44 Pre-operative Diagnosis Odontoid fracture, type II Post-operative Diagnosis Odontoid fracture, type II Operative Method Odontoid screw fixation Specimen Count And Types nil Pathology Nil Operative Findings A 40mm Synthes cannulated screw was used for fixation. The insertion point was at the lower aspect of C2. Operative Procedures 1. ETGA, supine position and head mild extension 2. C-arm localized the C5 level and C1-2 position 3. Right anterior neck right side transverse incision 4. Dissect the plane between the SCM and trachea, esophagus 5. Expose the prevertebral space and identify the C5-6 level under C-arm 6. Extend to expose the prevertebral space over C2-3 7. Set self-retractor, and drill a groove at upper C3 8. Under biplanar C-arm localization, the odontoid screw was inserted 9. Hemostasis, set a CWV drain 10.Close the wound in layers Operators VS 陳敞牧 Assistants R6 陳睿生, Ri 楊瑞德 (M,1954/06/28,57y8m) 手術日期 2010/07/08 手術主治醫師 蕭輔仁 手術區域 東址 003房 02號 診斷 Fever 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 2 紀錄醫師 陳睿生, 時間資訊 14:57 報到 15:38 進入手術室 15:43 麻醉開始 15:50 誘導結束 17:10 抗生素給藥 17:24 手術開始 20:10 抗生素給藥 21:20 麻醉結束 21:20 手術結束 21:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 手術 椎弓切除術（特壓）－二節以內 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Occipitocervical fusion and fixation, removal... 開立醫師: 陳睿生 開立時間: 2010/07/08 21:53 Pre-operative Diagnosis Tougue cancer with cervical metastasis, C1-2 subluxation Post-operative Diagnosis Tougue cancer with cervical metastasis, C1-2 subluxation Operative Method Occipitocervical fusion and fixation, removal of C1 posterior arch for decompression Specimen Count And Types nil Pathology Nil Operative Findings The C1 and C2 body was noted to be invaded by the tumor, and was fragile, soft. After C1 posterior arch removal, the thecal sac was well expanded. OC fusion was performed with Depuy implants. A piece of bone graft was ertracted fron left posterior illiac crest. Pedicular screw: left C2, 26mm Lateral mass screws: bilateral C3, 4, 18mm The occipital plate was fixed with 15mm screw superiorly, and 14mm screw inferiorly Rods about 12cm x2 Operative Procedures 1. ETGA, prone position and head fix with Mayfield clump 2. Posterior neck midline incision 3. Split trapzius and paraspinal muscle bilaterally 4. Expose the suboccipital region, C1 posterior arch, and C2-4 lamina 5. Dissect the expose the lateral mass 6. Remove of C1 posterior arch with rounger, Kerrison 7. Insert the left C2 pedicular screw, and bilateral C3,4 lateral mass screws, and confirmed with C-arm 8. Fix the occipital plate with screws x2 9. Extract an about 4x2x2 cm bone graft from left posterior iliac crest 10.Set bilateral rods, and fixed tightly 11.Fix the bone graft at the space between the suboccipital region to C2 spinous process, and fix with miniplates x2 12.Hemostasis, set CWV drains at wounds separately 13.Close the wounds in layers Operators VS 蕭輔仁 Assistants CR 胡朝凱; R6 陳睿生 羅黃阿鳳 (F,1941/05/15,70y9m) 手術日期 2010/07/08 手術主治醫師 王國川 手術區域 東址 005房 01號 診斷 Pituitary tumor 器械術式 Brain tumor Crainotomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 2 紀錄醫師 何奕瑢, 時間資訊 07:45 報到 08:08 進入手術室 08:18 麻醉開始 08:48 誘導結束 08:55 抗生素給藥 09:25 手術開始 11:55 抗生素給藥 12:05 麻醉結束 12:05 手術結束 12:10 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除－手術時間在４小時以內 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT 開立醫師: 曾峰毅 開立時間: 2010/07/08 12:08 Pre-operative Diagnosis Recurrent pituitary adenoma Post-operative Diagnosis Recurrent pituitary adenoma Operative Method Left pterional approach for recurrent pituitary tumor removal Specimen Count And Types Several fragments of one tumor was sent for pathology. Pathology Sent for pathology Operative Findings Soft, fragile, hypervascular, greyish tumor was note with its capsule adhesived to left optic nerve, optic tract, and optic chiasm. Optic nerve was decompressed after tumor removed. Operative Procedures With endotracheal general anaesthesiat, the patinet was put in supine position with head rotated to right and head fixed by Mayfield skull clamp. After scalp shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. We made one curvilinear skin incision with frontal facial nerve preserveation, and reflected the scalp flap inferiorly. After detaching temporalis muslce, we drilled three burr holes, and created left pterional craniotomy. After dura tenting along craniotomy windonw, we made one U-shap dura incision. We drained CSF and retracted frontal lobe away from frontal base. We dissected to expose the tumor, and tumor was removed with tumor forceps, and ring currette. Dura was closed in water-tight fashion with 4-0 prolene. Bone graft was fixed back with mini-plates. One CWV was set inframuscullarly, and the wound was closed in layers. Operators VS 王國川 Assistants R4 曾峰毅 R1 何奕瑢 林天來 (M,1943/07/21,68y7m) 手術日期 2010/07/08 手術主治醫師 王國川 手術區域 東址 005房 02號 診斷 Spondylosis,lumbar 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 2 紀錄醫師 何奕瑢, 時間資訊 12:40 進入手術室 12:45 麻醉開始 13:05 誘導結束 13:30 抗生素給藥 13:45 手術開始 15:25 手術結束 16:00 16:25 16:25 麻醉結束 16:35 送出病患 16:37 進入恢復室 17:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 尿道鏡檢查 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 手術 椎間盤切除術－腰椎 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: HIVD 開立醫師: 曾峰毅 開立時間: 2010/07/08 16:18 Pre-operative Diagnosis L4/5 ruptured disc Post-operative Diagnosis L4/5 ruptured disc Operative Method Micordiskectomy of L4/5 Specimen Count And Types Nil Pathology Nil Operative Findings One sequestreted disc was noted beneath the left L4 root at axillary region. The left L4 root was free from tension after diskectomy. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After portable X-ray localizaition, we made one midline skin incision and dissectd paraspinal muscle to expose left lamina of L4. Laminotomy of left L4 lamina was done, and diskectomy was performed with disc clamp, alligator, and currette. After hemostasis, we closed the wound in layers. Operators VS 王國川 Assistants R3 曾峰毅 R1 何奕瑢 R4 曾峰毅 R1 何奕瑢 閔戩 (M,1988/04/09,23y11m) 手術日期 2010/07/08 手術主治醫師 蔡翊新 手術區域 東址 005房 03號 診斷 Head injury, unspecified 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 2 紀錄醫師 何奕瑢, 時間資訊 15:20 報到 16:59 進入手術室 17:05 麻醉開始 17:12 誘導結束 17:28 手術開始 19:10 20:30 抗生素給藥 21:20 麻醉結束 21:20 手術結束 21:20 21:25 進入恢復室 21:25 送出病患 22:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 直視下尿道切開術 1 1 R 手術 頭顱成形術 1 1 R 手術 顱骨重塑模組 1 0 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 泌尿部 套用罐頭: optic urethrotomy 開立醫師: 陳聖復 開立時間: 2010/07/08 18:53 Pre-operative Diagnosis Urethral injury Post-operative Diagnosis Urethral stricture Operative Method Optic urethrotomy Specimen Count And Types Pathology nil Operative Findings 1.pin hole at anterior urethra, a segment around 1-1.5 cm 1.pin hole at anterior urethra, a segment of scar around 1-1.5 cm Operative Procedures Under satisfactory anesthesia with the patient in a lithotomy position, prepping and draping were performed in the usual sterile method. A 23 Fr. urethroscope was inserted into the urethra with well lubrication. A small hole at the 12 o’clock position of the anterior urethra was noted. Fibrous tissue at the anterior urethra and a fibrous ring at the memebranous urethra were noted. Incision at the 12 o’clock position by a cold-knief was performed. A 20Fr. Nephrostomy catheter wasplaced for stenting the urethra. Then he was sent to the recovery room with a stable condition. Operators 王碩盟, Assistants 賴建榮, 陳聖復, 摘要__ 手術科部: 外科部 套用罐頭: Cranioplasty 開立醫師: 曾峰毅 開立時間: 2010/07/08 20:34 Pre-operative Diagnosis Skull bone defect Post-operative Diagnosis Skull bone defect Operative Method Cranioplasty Specimen Count And Types Nil Pathology Nil Operative Findings 3x5cm skull bone defct was located at left forehead. Frontal sinus was exposed, and was packed with beta-iodine gelfoam. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position after urology surgery. We shaved, scrubbed, disinfected, and then draped the scalp, and made bicoronal skin incision. We reflected the sclap flap inferior and expose skull bone defect. We made incision on periosteum along the skull bone defect. Artificial bone graft was fixed back with miniplates and self-tapping screws. After setting one subgaleal CWV, we closed the wound in layers. Operators VS 蔡翊新 Assistants R4 曾峰毅 R1 何奕瑢 羅信泰 (M,1966/11/29,45y3m) 手術日期 2010/07/09 手術主治醫師 杜永光 手術區域 東址 003房 02號 診斷 Respiratory failure, with long-term ventilator use 器械術式 Craniotomy(Aneurysms) P-DUH 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 3 紀錄醫師 游健生, 時間資訊 14:10 報到 14:10 進入手術室 14:15 麻醉開始 15:00 誘導結束 15:20 抗生素給藥 16:00 手術開始 18:20 抗生素給藥 19:35 麻醉結束 19:35 手術結束 19:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 開顱術摘除血管病變－腦血管瘤－有徵的 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Right pterional approach for aneurysm clippin... 開立醫師: 胡朝凱 開立時間: 2010/07/09 19:28 Pre-operative Diagnosis 1. Right MCA bifurcation aneurysm 2. Intracerebral hemorrhage Post-operative Diagnosis 1. Right MCA bifurcation aneurysm 2. Intracerebral hemorrhage Operative Method Right pterional approach for aneurysm clipping and hematoma evacuation Specimen Count And Types nil Pathology Nil Operative Findings There was severe adhesion between dura and brain and inside Sylvian fissure. The aneurysm was about 8mm in size with most of it thrombosed. There was severe adhesion between dura and brain and inside Sylvian fissure. The aneurysm was about 8mm in size with most of it thrombosed. A Sugita straight clip was used to clip the neck of aneurysm. The patency of all branches near the aneurysm were checked under direct vision after clipping. Initial drainage of CSF from right lateral ventricle was bloody but soon became clear. Some CSF was sent for culture, routine, and biochemistry study. Operative Procedures Under tracheostomy ventilation and general anesthesia, patient was put into supine position with head turned to left and mildly tilted up fixed by Mayfield headholder. After shaving, we disinfected and draped the operation field as usual. We made incision over previous wound followed by flipping the skin flap anteriorly. Then, we made a temporal-based U-shape durotomy. We opened the Sylvian fissure carefully and identified the main truck of MCA. By tracing it, we found the aneurysm and dissected it meticulously from surroundings. After applying an temporary clip, the neck of aneurysm was clipped. We performed thrombectomy by opening the dome of aneurysm and removed the thrombus inside with CUSA. After that, we can adjust aneurysmal clip more precisely. Right corticotomy was done and drain the old blood clot out. An EVD was inserted into right lateral ventricle. Then we closed the dura. Wound was tehn closed in layers. Operators Prof. 杜永光 Assistants R6 胡朝凱 R3 游健生 曾郁馨 (F,1982/04/30,29y10m) 手術日期 2010/07/09 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Cavernous angioma 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 2 紀錄醫師 游健生, 時間資訊 07:50 報到 08:05 進入手術室 08:10 麻醉開始 08:45 誘導結束 10:30 抗生素給藥 10:55 手術開始 13:40 麻醉結束 13:40 手術結束 13:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Right subtemporal approach for cavernoma excision 開立醫師: 王奐之 開立時間: 2010/07/09 14:01 Pre-operative Diagnosis Right inferior temporal lobe cavernoma Post-operative Diagnosis Right inferior temporal lobe cavernoma Operative Method Right subtemporal approach for cavernoma excision Specimen Count And Types 1 piece About size:1x1cm Source:right temporal cavernoma Pathology Pending Operative Findings A region with yellowish dicoloration was noted at the surface of right temporal base. The tumor was about 1.2cm in size, reddish to purple in color resembling a raspberry with hemosiderin deposition surrounding it. Operative Procedures Under ETGA, patient was put into supine position. Her head was turned to left with neck extended and fixed by Mayfield headholder. After shaving, we disinfected and draped the operation field as usual. A curvilinear incision was made from 2cm anterior to tragus to 3cm lateral to midline. We dissected in layers with facial nerve preservation procedure to expose cranium followed by 5x6 cm craniotomy. After further inferior extension of the craniotomy window to expose the temporal base by air-drill, we tented the edge of dura followed by temporal-based U-shape durotomy. We gentlely retracted the temporal lobe to expose the temporal base. CSF was first drained out. The lesion was identified just at the surface of temporal base anterior to the petrous ridge. We dissected and removed the lesion along the hemosiderin plane with bipolar electrocautery. After hemostasis, we closed the dura with water-tight continous prolene suture. We fixed the bone flap with mini-plates. Finally, we closed the wound in layers. Operators Prof. 杜永光 Assistants R6 胡朝凱 R3 游健生 張許春嬌 (F,1941/10/14,70y5m) 手術日期 2010/07/09 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Glioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 2 紀錄醫師 王奐之, 時間資訊 07:30 報到 08:05 進入手術室 08:15 麻醉開始 08:58 誘導結束 09:00 手術開始 09:00 抗生素給藥 11:50 麻醉結束 11:50 手術結束 12:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除－手術時間在４小時以內 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Left pterional craniotomy for partial tempora... 開立醫師: 王奐之 開立時間: 2010/07/09 12:23 Pre-operative Diagnosis Left temporal lobe tumor, suspected high grade glioma Post-operative Diagnosis Left temporal lobe tumor, suspected high grade glioma Operative Method Left pterional craniotomy for partial temporal lobectomy Specimen Count And Types 1 piece About size:1*1*1cm Source:left temporal lobe Pathology Pending Operative Findings Yellowish soft brain tumor noted at anterior part of superior temporal gyrus, close to Wernick area. The tumor margin was indistinct. The Sylvian fissure was exposed after tumor removal. Operative Procedures After ETGA, the patient was placed in supine position with head facing rightwardly and fixed with Mayfield skull clamp. After shaving, skin disinfection and draping in sterile fashion, a left frontal curved skin incision was made. The temporalis muscle were reflected down from its origin, followed by left pterional craniotomy. The sphenoid ridge was flattened with Rongeur and drill. After tenting sutures, the dura was opened. The tumor was identified at anterior part of superior temporal gyrus. Partial temporal lobectomy was performed from the temporal tip till 4cm behind the temporal tip. After meticulous hemostasis, the dura was closed water-tight with fascial graft. An epidural CWV drain was set, and the skull was fixed back with miniplates. The temporalis muscles was fixed back with approximate sutures. The wound was then close in layers. Operators VS 曾漢民 Assistants R6 陳睿生, R3 王奐之 相關圖片 許正義 (M,1961/08/25,50y6m) 手術日期 2010/07/09 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Spine tumor 器械術式 Malignant intraspinal tumor, e 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 1 紀錄醫師 王奐之, 時間資訊 12:15 進入手術室 12:20 麻醉開始 12:35 誘導結束 13:00 抗生素給藥 13:08 手術開始 16:10 抗生素給藥 16:20 手術結束 16:20 麻醉結束 16:30 送出病患 16:30 進入恢復室 18:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 誘發電位手術監視機–腦神經外科術中特殊儀器使用費 1 0 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 手術 脊椎內脊髓內腫瘤切除術 1 1 手術 椎弓整形術 1 2 摘要__ 手術科部: 外科部 套用罐頭: T2,3 laminoplasty for total tumor remove 開立醫師: 陳睿生 開立時間: 2010/07/09 16:15 Pre-operative Diagnosis T2,3 intramedullary tumor, suspect cavernoma Post-operative Diagnosis T2,3 intramedullary tumor, suspect cavernoma Operative Method T2,3 laminoplasty for total tumor remove Specimen Count And Types 1 piece About size:pieces Source:tumor Pathology Frozen section: multiple vascular lesion Operative Findings An about 1x1.5x1cm reddish, well margined and vascularized lesion was noted at the T2-3 level cord. It was mainly at the right side, and peripheral hemosiderin deposition was noted. We removed the tumor by right posterior corticotomy. Intra-op MEP and SSEP showed no obvious change. Operative Procedures 1. ETGA, prone position, and head fix with Mayfield 2. Back midline incision at T2-3 level 3. Split the paraspinal muscle to expose the T2,3 lamina 4. Drill down the T2,3 lamina to expose the thecal sac 5. Incise into the dura and tented 6. Split the arachnoid membrane and the intramedullary lesion was noted at the T2 level 7. Split the cord from right posterior region and drain out the hematoma inside the tumor 8. Dissect the tumor lesion from peripheral normal cord under evoked potential stimulation 9. Hemostasis, and the arachnoid membrane, dura were closed water-tighted 10.Fix back the T2,3 lamina with miniplates as laminoplasty 11.Set a CWV drain, and close the wound in layers Operators VS 曾漢民 Assistants R6 陳睿生, R3 王奐之 相關圖片 朱國民 (M,1929/09/16,82y5m) 手術日期 2010/07/09 手術主治醫師 曾漢民 手術區域 東址 005房 03號 診斷 Glioblastoma multiforma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 1 紀錄醫師 王奐之, 時間資訊 15:35 報到 16:45 進入手術室 16:55 麻醉開始 17:05 誘導結束 17:30 手術開始 17:50 抗生素給藥 20:30 麻醉結束 20:30 手術結束 20:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４小時以內 1 1 L 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 L 手術 超音波診查機–腦神經外科術中特殊儀器使用費 1 0 L 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 記錄__ 手術科部: 外科部 套用罐頭: Craniotomy for gross total tumor removal 開立醫師: 王奐之 開立時間: 2010/07/09 21:02 Pre-operative Diagnosis Left parieto-occipital brain tumor Post-operative Diagnosis Left parieto-occipital brain tumor, suspected lymphoma Operative Method Craniotomy for gross total tumor removal Specimen Count And Types 1 piece About size:1*1*1cm Source:left parietooccipital lobe tumor Pathology Pending Operative Findings An infiltrative yellow-whitish tumor noted at left parieto-occipital lobe, with diffused brain swelling. Severe dural adhesion. Operative Procedures After ETGA, the patient was placed in prone position with left occipitus facing upward, and head fixed with Mayfield skull clamp. After shaving, skin disinfection & draping in sterile fashion. A reverse U skin incision was then made at left occipital region, followed by craniotomy. Intra-operative echo was used to confirm tumor location. A 2cm corticotomy was then performed, followed by gross tumor removal; gross tumor and abnormal brain tissue were removed under direct inspection. Hemostasis was completed under microscopic aid. The dural defect was repaired with DuraFoam. The remaining dura was closed with Prolene sutures, the skull was then fixed back with miniplates. After setting a subgaleal CWV drain, the wound was closed in layers. Operators VS 曾漢民 Assistants R6 陳睿生, R3 王奐之 相關圖片 徐銘夆 (M,1982/12/05,29y3m) 手術日期 2010/07/09 手術主治醫師 賴達明 手術區域 東址 019房 號 診斷 Herniation of intervertebral disc, lumbar (HIVD) 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 鍾文桂, 時間資訊 07:50 報到 08:04 進入手術室 08:10 麻醉開始 08:20 誘導結束 09:00 抗生素給藥 09:00 手術開始 12:00 抗生素給藥 14:45 手術結束 14:45 麻醉結束 14:50 送出病患 14:55 進入恢復室 16:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 手術 椎間盤切除術－腰椎 1 2 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 記錄__ 手術科部: 外科部 套用罐頭: 1. Internal fixation of L5/S1 levels with Dyn... 開立醫師: 鍾文桂 開立時間: 2010/07/09 15:09 Pre-operative Diagnosis L5/S1 hernitated intervertebral disc, recurrent. Post-operative Diagnosis L5/S1 hernitated intervertebral disc, recurrent. Operative Method 1. Internal fixation of L5/S1 levels with Dynesis, bilateral. 1. Internal fixation of L5/S1 levels with Dynesys. 2. L5/S1 microsurgical diskectomy, right side approach. Specimen Count And Types nil Pathology Nil. Operative Findings 1. Conjoint S1 and S2 roots. 2. Severe adhesion and scar formation at right S1 root; slack root after decompression. 3. Ruptures disc at L5/S1 level. 4. Dynesis bilateral L5: 40 mm, S1: 40mm, rod: 38mm(left), 40mm(right) 4. Dynesys bilateral L5: 40 mm, S1: 40mm, rod: 38mm(left), 40mm(right) 4. Dynesys bilateral L5: 40 mm, S1: 45mm, rod: 38mm(left), 40mm(right) 5. A small dural tear. closed with Gelfoam. Operative Procedures 1. ETGA, prone position. 2. Disinfection, draping after C-arm localization. 3. Bilateral paraspinal 5-cm incision( 2.5cm away from midline) 4. Dissection of paraspinal muscle. 5. Localization of L5 pedicle and sacrum. 6. Insertion of transpedicle screws and completion of Dynesis system. 7. Wound closure in layers. 8. Midline incision. 9. Dissection and lysis of scar tissue. 10.Diskectomy,extensive. 11.Wound closure in layers after well hemostasis. Operators V.S. 賴達明 Assistants R5 鍾文桂 R2 楊博智 相關圖片 張江福 (F,1945/01/15,67y1m) 手術日期 2010/07/09 手術主治醫師 賴達明 手術區域 東址 001房 02號 診斷 Spinal stenosis, cervical 器械術式 Lamino plasty 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 陳德福, 時間資訊 11:20 報到 11:30 誘導結束 11:35 進入手術室 11:40 麻醉開始 13:00 抗生素給藥 13:20 手術開始 15:50 手術結束 15:55 麻醉結束 16:05 送出病患 16:10 進入恢復室 17:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓整形術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Glucose 1 0 摘要__ 手術科部: 外科部 套用罐頭: C3-5 laminoplaty 開立醫師: 陳德福 開立時間: 2010/07/09 16:22 Pre-operative Diagnosis C3-5 spinal stenosis with myelopathy, OPLL Post-operative Diagnosis C3-5 spinal stenosis with myelopathy Operative Method C3-5 laminoplaty Specimen Count And Types nil Pathology NIL Operative Findings 1.There is severe spinal stenosis over C3-5. 2.Laminoplasty with miniplates fixation was performed. Operative Procedures Uner ETGA and prone position with Mayfield pin type head fixator, the skin was disinfected and draped. One linear incision on the posterior neck was done and the paraspinous muscle was displaced laterally. The spinous process of C2-5 were exposed clearly and the laminotomy was done by air drill with open door fasion. The theca sac was decompressed fully and the C3-5 lamina was fixed with miniplates. After laminoplasty, one hemovac was left in situ. The wound was closed in layers. Operators VS 賴達明 Assistants R4 陳德福 相關圖片 佟振芬 (F,1970/07/20,41y7m) 手術日期 2010/07/09 手術主治醫師 賴達明 手術區域 東址 019房 02號 診斷 Herniation intervertebral disc without myelopathy, thoracic (HIVD) 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 鍾文桂, 時間資訊 14:20 報到 15:05 進入手術室 15:07 麻醉開始 15:15 誘導結束 15:50 抗生素給藥 16:20 手術開始 18:55 手術結束 18:55 麻醉結束 18:58 抗生素給藥 19:05 送出病患 19:15 進入恢復室 20:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術－頸椎 1 1 手術 脊椎融合術－前融合，無固定物（＜＝四節） 1 2 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: 1. Micorsurgical diskectomy, right anterior a... 開立醫師: 鍾文桂 開立時間: 2010/07/09 19:30 Pre-operative Diagnosis C6/7 herniated intervertebral disc. Post-operative Diagnosis C6/7 herniated intervertebral disc. Operative Method 1. Micorsurgical diskectomy, right anterior approach. 2. Anterior fusion with PEEK cage. Specimen Count And Types nil Pathology Nil. Operative Findings 1. A ruptured disc impinged right C7 root. 2. Thickened posterior longitudinal ligament. 3. PEEK cage: 5mm. Operative Procedures 1. ETGA, supine position, neck extended. 2. Disinfection, draping. 3. Linear incision along skin crease at right anterior neck. 4. Incise plastysma muscle, subplatysmal dissection. 5. Dissection along medial border of sternocledomastoid muscle. 6. Splints carotid artery to lateral and esophagus to medial side of dissection with self retractor. 7. Localization of C6/7 disc level with intraoperative fluoroscope. 8. Spints longus collis muscle. 9. Diskectomy by curretes under microscope. 10.Removal of posterior longitudinal ligament with Kerrison punch. 11.Insertion of one 5mm PEEK cage with allostatic bone material. 12.Well hemostasis and placement of one mini-hemovac. 13.Wound closure in layers. Operators V.S. 賴達明 Assistants R5 鍾文桂 R2 楊博智 相關圖片 黃麗清 (F,1970/10/10,41y5m) 手術日期 2010/07/09 手術主治醫師 賴達明 手術區域 東址 020房 04號 診斷 Herniation of intervertebral disc without myelopathy, cervical (HIVD) 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 李振豪, 時間資訊 14:00 報到 14:20 進入手術室 14:25 麻醉開始 14:40 誘導結束 14:50 抗生素給藥 15:05 手術開始 16:35 手術結束 16:35 麻醉結束 16:40 送出病患 16:45 進入恢復室 17:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 椎間盤切除術－腰椎 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: L4-5 microdiskectomy, left 開立醫師: 李振豪 開立時間: 2010/07/09 16:57 Pre-operative Diagnosis L4-5 herniation of intervertebral disc, left Post-operative Diagnosis L4-5 herniation of intervertebral disc, left Operative Method L4-5 microdiskectomy, left Specimen Count And Types nil Pathology Nil Operative Findings The nerve root was compressed tightly by the degenerative, protruding disc. After microdiskectomy, the root was decompressed well. No Thecal sac or root injury was noted during the operation. Operative Procedures Under endotracheal tube general anesthesia, the patient was putin prone position. C-arm X-ray was used for localization of L4-5 space. The skin was scrubbed and disinfected as usual. Linear skin incision with 3cm in length was made at L4-5 level. The subcutaneous soft tissue was dissected and left side paravertebral muscles group were detached. The paravertebral muscles were retracted by a modified narrow Taylor retractor which was retained constantly by a rubber sling to the side rail of the operating table. Under an operating microscope, laminotomy was performed. THe thecal sac and the root were identified. After retraction of the root from lateral side, the buldging disc was noted. Microdiskectomy was performed with curette and disc clamp. After hemostasis and Gelform packing, the wound was closed in layers. Operators VS賴達明 Assistants R4李振豪, R2楊博智 相關圖片 吳進財 (M,1947/12/12,64y3m) 手術日期 2010/07/09 手術主治醫師 蕭輔仁 手術區域 東址 002房 04號 診斷 Intracerebral hemorrhage (ICH) 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 1 紀錄醫師 李振豪, 時間資訊 12:00 臨時手術NPO 12:00 開始NPO 16:00 通知急診手術 18:02 進入手術室 18:05 麻醉開始 18:30 誘導結束 18:40 抗生素給藥 18:55 手術開始 21:30 手術結束 21:30 麻醉結束 21:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 腦內血腫清除術 1 1 手術 顱內壓監視置入 1 2 記錄__ 手術科部: 外科部 套用罐頭: 1. Suboccipital craniectomy and hematoma evac... 開立醫師: 李振豪 開立時間: 2010/07/09 22:28 Pre-operative Diagnosis Cerebellar hemorrhage with ruptured into ventricle and acute obstructive hydrocephalus Post-operative Diagnosis Cerebellar hemorrhage with ruptured into ventricle and acute obstructive hydrocephalus Operative Method 1. Suboccipital craniectomy and hematoma evacuation, 2. Right Frazier"s external ventricular drainage insertion for ICP monitoring Specimen Count And Types Nil Pathology Nil Operative Findings BP drop was noted before the operation. The ICP was more than 15cm H2O after ventricular puncture. Bloody CSF was drained out. About 50ml blood clot was evacuated from the cerebellum and 4th ventricle. The cerebellum became slack after hematoma evacuation. Operative Procedures Under endotracheal tube general anesthesia, the patient was put at prone position with head fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. One 3cm linear skin incision was made at right Frazier"s point followed by one burr hole. The dura was opened and ventricular puncture was performed. The EVD was inserted and fixed at 10cm in length. Externalization was done. Midline skin incision was made from inion to C3 level and the subcutaneous soft tissue was dissected. The paravertebral muscle and suboccipital muscle were detached. The foramen magnum, C1, and C2 was exposed. Four burr holes were created and suboccipital craniectomy with 8x8cm was performed. The dura was opened with V-shape. Trans-vermis approach for cerebellar hematoma was used and the hematoma was evacuated. The fourth ventricle was noted after hematoma evacuation. The aqueduct was total obstructed with hard hematoma. Hemostasis was achieved with bipolar cautery and Surgicel lining. One 3x3 inch DuraForm was used for duroplasty. One epidural CWV drain was placed and the wound was closed in layers. Operators VS蕭輔仁 Assistants R4李振豪 Indication Of Emergent Operation 相關圖片 沈惠婷 (F,1972/08/03,39y7m) 手術日期 2010/07/11 手術主治醫師 杜永光 手術區域 東址 002房 05號 診斷 Brain Tumor 器械術式 Revision of CSF shunt 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林至芃 ASA 3E 紀錄醫師 王奐之, 時間資訊 16:00 臨時手術NPO 16:00 開始NPO 17:28 通知急診手術 18:25 報到 18:31 進入手術室 18:35 麻醉開始 18:40 誘導結束 19:00 抗生素給藥 19:25 手術開始 20:10 手術結束 20:10 麻醉結束 20:26 送出病患 20:30 進入恢復室 21:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦脊髓液分流管重置 1 2 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt revision 開立醫師: 王奐之 開立時間: 2010/07/11 20:34 Pre-operative Diagnosis Ventriculoperitoneal shunt dysfunction Post-operative Diagnosis Ventriculoperitoneal shunt dysfunction Operative Method Ventriculoperitoneal shunt revision Specimen Count And Types Nil Pathology Nil Operative Findings The tip of ventricular catheter was packed with cell debris, re-expansion of reservoir was observed after clearing the debris. The ventricular catheter was changed and reinserted with 7.5cm length. Operative Procedures After ETGA, the patient was placed in supine position with head turned to left. After shaving, skin disinfection and draping in sterile fashion, a curved skin incision was made along previous incision line. The burr hole through right Kocher point was exposed along with the ventricular catheter. The catheter was pulled out and the debris was cleared off. After checking the reservoir function, the ventricular catheter was changed and re-connected to the reservoir, and inserted to the ventricle through the original route. After hemostasis, the wound was closed in layers. Operators P 杜永光 Assistants CR 胡朝凱, R6 陳睿生, R3 王奐之 Indication Of Emergent Operation 相關圖片 曾錦燾 (M,1948/12/13,63y3m) 手術日期 2010/07/12 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Brain abscess 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 07:37 報到 08:08 進入手術室 08:10 麻醉開始 08:20 誘導結束 09:50 手術開始 12:45 抗生素給藥 17:25 麻醉結束 17:25 手術結束 17:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 11 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 凹陷性顱骨骨折之手術－開放骨折 1 1 R 手術 慢性硬腦膜下血腫清除術 1 2 L 摘要__ 手術科部: 外科部 套用罐頭: 1. Right subfrontal approach for skull base d... 開立醫師: 陳國瑋 開立時間: 2010/07/12 17:57 Pre-operative Diagnosis 1. CSF leakage 2. Left subdural empyema Post-operative Diagnosis 1. Right frontal skull base defect with CSF leakage 2. Left fronto-temporal subdural hematoma Operative Method 1. Right subfrontal approach for skull base defect repair 2. Left frontal craniotomy for subdural hematoma evacuation Specimen Count And Types 1x2cm subdural hemomatoma membrane Pathology Pending Operative Findings After durotomy, the arachnoid membrane was thicken and had inflammatory changes. There was some adhesion between arachnoid membrane and right frontal skull base near crista gali. Underneath, there was a bony defect through which nasal sinus cavity could been seen directly. Some dark red fuild was noted at left frontal subdural space encapsulated by membrane. Some fluid was sent for culture. CSF from lumbar drain was clear and some was sent for study. Operative Procedures Under ETGA, patient was put into supine position with neck mildly extended and head fixed by Mayfield headholder. After shaving, we disinfected and draped the operation field as usual. We made a bicoronal incision followed by flipped the skin flap downward till supra-orbital ridge. We created a 5x5 cm rectangular craniotomy at right frontal region with exposure of right frontal sinus. We removed the mucosa and some granulation tissue from the sinus and then packed it with providine-iodine soaked Gelfoam. After dura tenting and frontal-based U-shape durotomy, we identified the adhesion near crista gali between arachnoid membrane and skull base. After adhesiolysis, there was a skull base bony defect which connected to nasal sinus. Then, we packed a periostium flap into the defect followed by coverage with a temporalis muscle fascia flap. We sutured the fascia flap to dura and sealed the edge with Tissucol-Duo. Finally, we packed a layer of Gelfoam and Surgicel. After closure of dura with continuous prolene suture, we sutured the fascia to dura to cover frontal sinus. Then, we fixed the bone flap back with mini-plates after central tenting. We created a 5x5cm circular craniotomy at left frontal region followed by dura tenting. We opened the dura in cruciate fashion. We electrocauteried both the outer and inner membrane of chronic subdural hematoma. After drainage of the hematoma, we set one rubber drain at subdural space and closed the dura with continuous prolene suture. We fixed the bone flap with mini-plates after central tenting. Then, we closed wounds in layers following subgaleal CWV drain placement. Finally, we set one lumbar drain after we turned the patient to left decubitus knee-chest position. Operators Prof. 杜永光 Assistants R6 胡朝凱 R3 游健生 謝昉原 (M,1961/06/05,50y9m) 手術日期 2010/07/12 手術主治醫師 杜永光 手術區域 東址 017房 03號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 13:38 報到 13:40 進入手術室 13:45 麻醉開始 14:30 誘導結束 14:40 抗生素給藥 15:19 手術開始 17:43 開始輸血 17:45 抗生素給藥 20:45 抗生素給藥 22:00 麻醉結束 22:00 手術結束 22:10 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除－手術時間在４～８小時 1 1 R 手術 頭顱成形術 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 9 0 摘要__ 手術科部: 外科部 套用罐頭: Bi-frontal craniotomy for Simpson grade II tu... 開立醫師: 胡朝凱 開立時間: 2010/07/12 21:37 Pre-operative Diagnosis Right frontal parasagittal meningioma Post-operative Diagnosis Right frontal parasagittal meningioma Operative Method Bi-frontal craniotomy for Simpson grade II tumor excision Specimen Count And Types 1 piece About size:2x3cm Source:part of meningioma Pathology pending Operative Findings 1.The Bone became hyperosteosis severely. And tumor extend through dura, bone, into the soft tissue. 2.The tumor was reddish with hypervascualrity, soft, with some necrotic part located mainly iat right frontal lobe and attached to falx. Also, the left frontal lobe was still tumor part measured aboutplane between meningioma and pia was not clear. 2.The tumor was reddish with hypervascualrity, soft, with some necrotic part located mainly at right frontal lobe and attached to falx, measured about 6x5.2 cm. Also, the left frontal lobe was still tumor part measured about 2x4 cm. But the falx and SSS were intact. 3.The plane between tumor and pia was not clear. It seems invaded into pia matter. Operative Procedures Under ETGA, patient was put into supine position with neck midly extended and head fixed with Mayfield headholder. After shaving, we disinfected and draped the operation field as usual. We made a incision via previous wound. Under ETGA, patient was put into supine position with neck midly extended and head fixed with Mayfield headholder. After shaving, we disinfected and draped the operation field as usual. We made a incision via previous wound. The skin flap was dissected to detach from tumor and reflect anteriorly. We made more burr holes besidesd previous ones. Craniectomy was then done. The tumor bleeding was stopped immediately by coagulation and packing. Dura was incised open initially on right side along the tumor dge. It was dissected from lateral side to medial side. The tumor that attach to the falx was also detached with coagulation. After right side total tumor excision, left side linear incision was done along the left tumor border. It was also resected as same with right side tumor.The left side durotomy was tehn closed with prolene continuous suture. The right side durotomy was closed with durofoam. Cranioplsty was then done with wire mesh and bone cement. After a CWV drain insertion, wound was closed in layers. After dura tenting, we fixed the bone flap back with mini-plates. We closed the wound in layers following placement of a subgaleal CWV drain. Operators Prof. 杜永光 Assistants R6 胡朝凱 R3 游健生 陳兆文 (M,1964/10/05,47y5m) 手術日期 2010/07/12 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Lymphoma 器械術式 Brain biopsy -Stereotaxic 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 3 紀錄醫師 古恬音, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:01 進入手術室 08:05 麻醉開始 08:10 誘導結束 08:43 抗生素給藥 08:45 手術開始 11:35 麻醉結束 11:35 手術結束 11:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 手術 立體定位術－切片 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Left frontal burr hole for stereotactic brain... 開立醫師: 古恬音 開立時間: 2010/07/12 11:59 Pre-operative Diagnosis Left frontal lobe white matter lesion, suspected CNS lymphoma Post-operative Diagnosis Left frontal lobe white matter lesion, suspected CNS lymphoma Operative Method Left frontal burr hole for stereotactic brain biopsy Specimen Count And Types 1 piece About size:about 2gm Source:left frontal white matter lesion Pathology Frozen section: normal brain, final report pending Operative Findings Several small pieces of brain tissue were taken under stereotactic localization. Frozen section: normal brain tissue Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head fixed with Mayfield skull clamp. The stereotaxis system was set up. The frontal area scalp was shaved, scrubbed, and disinfected with better iodine. The draping was done in the usual aseptic fashion. One transverse incision was made at left frontal lobe, followed by a burr hole. After durotomy, brain biopsy was made under stereotactic localization. Hemostasis was achieved with bipolar coagulation, and the wound was closed in layers. Operators VS曾漢民 Assistants R6陳睿生 R3古恬音 楊龍喜 (M,1937/11/04,74y4m) 手術日期 2010/07/12 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 3 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 12:00 進入手術室 12:10 麻醉開始 12:45 誘導結束 13:00 抗生素給藥 13:20 手術開始 16:00 抗生素給藥 17:05 手術結束 17:05 麻醉結束 17:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 顱底瘤手術 1 1 L 手術 誘發電位手術監視機–腦神經外科術中特殊儀器使用費 1 0 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 記錄__ 手術科部: 外科部 套用罐頭: Left retrosigmoid approach for tumor excision 開立醫師: 王奐之 開立時間: 2010/07/12 17:43 Pre-operative Diagnosis Left petroclival meningioma Post-operative Diagnosis Left petroclival meningioma Operative Method Left retrosigmoid approach for tumor excision Left retrosigmoid approach for tumor excision, Simpson grade 2 Specimen Count And Types 1 piece About size:3*2*1cm Source:left CP angle tumor Pathology Pending Operative Findings Mild extension into left internal acoustic meatus was noted. The tumor was soft and yellowish, about 3.5cm in diameter. After tumor removal, CN IV, V, VII, VIII and low cranial nerves were exposed and intact. Operative Procedures After ETGA, the patient was placed in 3/4 prone position with left retroauricular area facing upwards; the head was fixed with Mayfield skull clamp. A linear skin incision was made at retroauricular area, and the incision was deepened to expose mastoid process. 4 burr holes were made, followed by retrosigmoid craniotomy. After opening the dura, the cerebellum was retracted posteriorly to expose the tumor. The tumor was then removed piece by piece. After tumor removal, the space was re-filled with normal saline and the dura was closed with fascial graft in water-tight fashion. After setting a subgaleal CWV drain, the wound was closed in layers. Operators VS 曾漢民 Assistants R6 陳睿生, R3 王奐之 相關圖片 曹秀緩 (F,1954/12/03,57y3m) 手術日期 2010/07/12 手術主治醫師 蕭輔仁 手術區域 東址 002房 04號 診斷 Intraventricular hemorrhage 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉漢平 ASA 3E 紀錄醫師 李振豪, 時間資訊 02:00 臨時手術NPO 02:00 開始NPO 12:44 通知急診手術 14:24 報到 14:25 進入手術室 14:30 麻醉開始 14:40 誘導結束 15:00 抗生素給藥 15:21 手術開始 16:05 麻醉結束 16:05 手術結束 16:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 顱內壓監視置入 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Right Kocher"s external ventricular drainage ... 開立醫師: 李振豪 開立時間: 2010/07/12 16:30 Pre-operative Diagnosis Intraventricular hemorrhage with acute obstructive hydrocephalus Post-operative Diagnosis Intraventricular hemorrhage with acute obstructive hydrocephalus Operative Method Right Kocher"s external ventricular drainage as ICP monitoring Specimen Count And Types 1 piece About size:3ml Source:CSF Pathology Nil Operative Findings The brain bulged out while dura opening. The ventricular wall was thickening and became hard. The Opening pressure was more than 15cmH2O. The CSF was pinkish and turbid in character. After 15ml CSF drained out. The brain surface became slack. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine position with head rotated to left. The scalp was shaved, scrubbed, and disinfected as usual. The line scalp incision was made at right Kocher"s point with 3cm in length. One burr hole was created with perforator. After dural tenting, the dura was opened with cruciform. Ventricular puncture was performed with and EVD was inserted and fixed at 6.5cm. Externalization was done. The wound was irrigated and hemostasis was checked. The burr hole was packing with Gelform and the wound was closed in layers. Operators VS蕭輔仁 Assistants R4李振豪 Indication Of Emergent Operation 相關圖片 柯素蘭 (F,1964/12/30,47y2m) 手術日期 2010/07/12 手術主治醫師 林至芃 手術區域 西址 034房 02號 診斷 Breast cancer, female 器械術式 Insertion of hichman or port a 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 林至芃 ASA 3 時間資訊 10:05 進入手術室 10:10 麻醉開始 10:20 誘導結束 10:21 抗生素給藥 10:30 手術開始 11:20 麻醉結束 14:00 手術結束 14:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 ｐｏｒｔ–Ａ導管植入術–治療性導管植入術 1 0 L 記錄__ 手術科部: 麻醉部 套用罐頭: Port-A implantation, subclavian 開立醫師: 王曼玲 開立時間: 2010/07/12 11:12 Pre-operative Diagnosis Breast cancer Post-operative Diagnosis Ditto Operative Method Port-A implantation, echo-guided Specimen Count And Types nil Pathology Nil Operative Findings 1.Site: left subclavian vein, with echo-guided procedure 2.Patent flow after implantation 3.Others: nil Operative Procedures 1.The patient was set on supine position and bilateral subclavian veins were checked by echo. 2.After IVGA and local anesthesia applied, transverse skin incision for 3cm was made at pre-cordial area. 3.Undermine the skin at the layer between subcutaneous tissue and deep fascia in lateral direction. 4.An IV catheter was inserted via the subclavian incision and negatively aspirated until venous blood attainable. 5.J-wire was inserted smoothly in rostral direction. A subclavian catheter with dilator was inserted through the J-wire, and the dilator was then removed. 6.The catheter of Port-A was threaded into the subclavian vein until mark 25 cm. The catheter was adapted into the port and locked with restrictor.The Port was inserted into the pouch of pre-cordial incision. 7.Skin was closed layer by layer. Both catheter and port were perfused with heparin solution after implantation. Operators 林至芃 Assistants 王曼玲 趙卿珍 (F,1962/04/28,49y10m) 手術日期 2010/07/13 手術主治醫師 林至芃 手術區域 西址 037房 02號 診斷 Malignant neoplasm of female breast, unspecified 器械術式 Insertion of hichman or port a 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 林至芃 ASA 3 時間資訊 09:50 報到 10:00 進入手術室 10:10 抗生素給藥 10:15 麻醉開始 10:20 誘導結束 10:30 手術開始 11:05 麻醉結束 11:05 手術結束 11:15 送出病患 記錄__ 手術科部: 麻醉部 套用罐頭: Port-A implantation, internal jugular 開立醫師: 林至芃 開立時間: 2010/07/13 10:49 Pre-operative Diagnosis Breast cancer Post-operative Diagnosis Ditto Operative Method Port-A implantation, echo-guided Specimen Count And Types Nil Pathology Nil Operative Findings 1.Site: right internal jugular vein, with cut down & echo-guided procedure 2.Patent flow after implantation 3.Others: nil Operative Procedures 1.The patient was set on supine position and bilateral internal jugular veins were checked by echo. 2.After IVGA and local anesthesia applied, transverse skin incision for 3cm was made at pre-cordial area. 3.Undermine the skin at the layerbetween subcutaneous tissue and deep fascia in lateral direction. 4.Direct cut down method was performed to identify internal jugular vein. An IV catheter was inserted via the neck wound and negatively aspirated until venous blood attainable. 5.J-wire was inserted smoothly in rostral direction. An internal jugular catheter with dilator was inserted through the J-wire, and the dilator was then removed. 6.The catheter for Port-A was threaded into the internal jugular vein until mark 25 cm. Skin tunnel between neck and pre-cordial incision was made by the blunt dissection with Kelly clamp. The catheter was then threaded and adapted into the port and locked with restrictor. The port was inserted into the pouch ofpre-cordial incision. 7.Skin was closed layer by layer. Both catheter and the port were perfused with heparin solutionafter implantation. Operators 林至芃, Assistants 王曼玲, 劉陳幸子 (F,1944/08/28,67y6m) 手術日期 2010/07/13 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 Cerebral aneurysm 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 何奕瑢, 時間資訊 09:11 報到 09:11 進入手術室 09:15 麻醉開始 09:20 誘導結束 10:07 手術開始 10:21 開始輸血 10:55 麻醉結束 10:55 手術結束 11:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 腦室腹腔分流手術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: VPS, right Kocher point 開立醫師: 陳德福 開立時間: 2010/07/13 11:25 Pre-operative Diagnosis hydrocephalus Post-operative Diagnosis hydrocephalus Operative Method VPS, right Kocher point Specimen Count And Types nil Pathology nil Operative Findings 1.The ventricular opening pressure: 12cmH2O 2.CSF: clear and colorless 3.Intraventricular catheter: 7.0cm and intraperitoneal catheter:25cm 4.One Metronic programmable valve was implanted at the right frontal area, Kocher point. Operative Procedures Under ETGA and supine position, the skin was disinfected and draped as usual. One linear incision on right frontal area and right upper abdomen minilaparotomy were done. One burr hole and dura tenting were done as well. Subcutaneous tunneling and insert ventricular puncture needle. One 7.0cm intraventricular needle was inserted and the programmable valve system was connected. The wounds was closed in layers. Operators VS 王國川 Assistants R5 陳德福 R1 何奕瑢 李游玉梅 (F,1952/04/25,59y10m) 手術日期 2010/07/13 手術主治醫師 曾勝弘 手術區域 東址 003房 03號 診斷 Lumbar Spondylosis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 13:16 進入手術室 13:25 麻醉開始 13:35 誘導結束 14:00 抗生素給藥 14:10 手術開始 15:10 17:00 抗生素給藥 17:16 開始輸血 18:15 手術結束 18:15 18:15 麻醉結束 18:28 送出病患 18:30 進入恢復室 19:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術（特壓）－超過二節 1 1 手術 脊椎融合術－後融合，無固定物 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 手術 正中神經或尺神經腕部減壓術–單側 1 4 記錄__ 手術科部: 外科部 套用罐頭: 1. Decompressive laminectomy of L3/4/5. 開立醫師: 鍾文桂 開立時間: 2010/07/13 18:44 Pre-operative Diagnosis 1. Lumbar stenosis, L3/4/5. 2. Carpal tunnel syndrome, left. Post-operative Diagnosis 1. Lumbar stenosis, L3/4/5. 2. Carpal tunnel syndrome, left. Operative Method 1. Decompressive laminectomy of L3/4/5. 2. Posterolateral fusion at L3/4/5,with autologous and alloplastic bones. 3. Lysis of median nerve, left. Specimen Count And Types Nil. Pathology Nil. Operative Findings Hypertrophic ligamentum flavum. Easy oozing operative field. L3 lateral recess stenosis. Intact dura mater, slack roots after decompression. Hypertrophic palmar retinaculum. Operative Procedures 1. ETGA, supine position, left upper extrimity abducted. 2. Disinfection, draping. 3. Linear 2-cm incision at left hand up to palmar crease. 4. Midline dissection and hemostasis. 5. Lysis of median nerve through incision of palmar retinaculum. 6. Wound closure in layers. 7. Turn the patient in prone position. 8. Disinfection, draping. 9. Midline incision and dissection up to facet joints. 10.Ensurement of dissection level via C-arm fluoroscope. 11.Laminectomy of L3/4/5 levels. 12.Decortication and posterolateral fusion. 13.Wound closure in layers after placing one 1/8 hemovac drain. Operators V.S.曾勝弘 Assistants R5鍾文桂 R3古恬音 林靖淳 (F,1987/10/31,24y4m) 手術日期 2010/07/13 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Cervical Spondylosis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 07:40 報到 08:05 進入手術室 08:10 麻醉開始 08:50 誘導結束 08:56 抗生素給藥 09:16 手術開始 11:56 抗生素給藥 13:20 麻醉結束 13:20 手術結束 13:22 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 手術 椎弓切除術（特壓）－二節以內 1 2 麻醉 Peripheral arterial line inserti 1 0 記錄__ 手術科部: 外科部 套用罐頭: 1. Removal of C1 posterior arch. 開立醫師: 鍾文桂 開立時間: 2010/07/13 13:53 Pre-operative Diagnosis C1-2 subluxation. Post-operative Diagnosis C1-2 subluxation. Operative Method 1. Removal of C1 posterior arch. 2. Fixation of C0-C2-C3-C4 with wiring 2. Fixation of C0-C2-C3 with wiring 3. Posterolateral fusion with alloplastic material Specimen Count And Types nil Pathology Nil. Operative Findings Intraoperative monitoring:SSEP: no change ,MEP: no change. Thickened soft tissues around C2. Hypertrophic C2 spinous process. Wiring with Codman titanium wires over C0-C2-C3-C4. Wiring with Codman titanium wires over C0-C2-C3. Operative Procedures 1. ETGA, prone position, head fixed with 3-pin Mayfield. 2. Shaving, disinfection, and draping. 3. C-arm fluoroscope localization of C-spine. 4. Midline incision from inion to C5 level. 5. Midline dissection to expose occiput to C4 lamina. 6. Removal of C1 posterior arch with Rongeur and 2mm Kerrison punch. 7. 4 burr holes at bilateral occiput. 8. Wiring with Codman titanium wires and mushroom-shaped k-pin over C0-C4. 8. Wiring with Codman titanium wires and mushroom-shaped k-pin over C0-C3. 9. Posterolateral fusion with alloplastic bone graft. 10.Wound closure in layers after placing one CWV drain. Operators V.S. 曾勝弘 Assistants R5鍾文桂 R3古恬音 相關圖片 林鴻 (F,1967/09/13,44y6m) 手術日期 2010/07/13 手術主治醫師 曾勝弘 手術區域 東址 003房 05號 診斷 Neuralgia trigeminal 器械術式 Radiofrequency coagulation(Hun (先IVGA, then patient awake) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 鍾文桂, 時間資訊 17:58 報到 18:44 進入手術室 18:45 麻醉開始 18:55 誘導結束 19:00 抗生素給藥 19:10 手術開始 19:53 手術結束 19:53 麻醉結束 20:02 送出病患 20:05 進入恢復室 21:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 高頻熱凝療法 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 記錄__ 手術科部: 外科部 套用罐頭: Radiofrequency rhizotomy. 開立醫師: 鍾文桂 開立時間: 2010/07/13 20:26 Pre-operative Diagnosis Trigeminal neuralgia,left status post microvascular decompression and radiosurgery. Post-operative Diagnosis Trigeminal neuralgia,left status post microvascular decompression and radiosurgery, status post radiofrequency rhizotomy Operative Method Radiofrequency rhizotomy. Specimen Count And Types nil Pathology Nil. Operative Findings Intraoperative C-arm fluoroscope for localization of CN V3. Twitching of jaw under radiofreuency ablation while adjusting location of the needle. Operative Procedures 1. IVG, head in midline, disinfection, and draping. 2. Localization of left CNV3 with intraoperative fluoroscope by spinal needle. 3. Insertion of radiofrequency ablation set. 4. Ensuring the patients response and pain location at CN V3 regions in awake state. 5. Start ablation 60 degree Celcius, 80 seconds, 50 Hz/sec, 0.1~0.3 A under IVG. 5. Start ablation 80 degree Celcius, 0.1-0.4 V, 50 Hz, 1 msec per cycle,for for 90 seconds under IVG. 6. Removal of needle after completion. Operators V.S. 曾勝弘 Assistants R5 鍾文桂 徐于珺 (F,2002/09/15,9y5m) 手術日期 2010/07/13 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Scalp tumor 器械術式 Sinus pericranii ligation 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:10 進入手術室 08:20 麻醉開始 08:40 誘導結束 09:02 抗生素給藥 09:21 手術開始 10:05 手術結束 10:05 麻醉結束 10:15 送出病患 10:30 進入恢復室 11:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦膜或脊髓突出修補術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Sinus pericranii excision 開立醫師: 李振豪 開立時間: 2010/07/13 10:18 Pre-operative Diagnosis Sinus pericranii, left parietal Post-operative Diagnosis Sinus pericranii, left parietal Operative Method Sinus pericranii excision Sinus pericranii excision and obliteration of the osseous connection Specimen Count And Types 1 piece About size:2x2cm Source:Left parietal sinus pericranii Pathology Pending Operative Findings A 2x2cm sinus pericranii was noted at left parietal area that connected with cortical vein with 2mm in diameter. A 2x2cm sinus pericranii was noted at left parietal area that connected with the intracranial cortical vein through a osseous hole in perietal bone, which was about 2mm in diameter. The blood flow was large, but could be controlled, obliterated and disconnected with bipolar coagulation and bone wax seal. The sinus pericranii had no scalp drainage. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine position with head rotated to right. the scalp was shaved, scrubbed, and disinfected as usual. The reverse U shape scalp incision was made at left parietal area and the scalp flap was dissected. The sinus pericranii was identified and dissected along the margin with bipolar cautery. The the connection with cortical vein was noted and coagulated and devided. The bony defect was sealed with bone wax for several times to secure no more bleeding. The sinus pericranii was then excised totally. After wound irrigation and hemostasis, the wound was closed with 3-0 Vicryl and 3-0 Nylon. The patient stood whole procedure well. Under endotracheal tube general anesthesia, the patient was put in supine position with head rotated to right. the scalp was shaved, scrubbed, and disinfected as usual. The reverse U shape scalp incision was made at left parietal area and the scalp flap was dissected. The sinus pericranii was identified and dissected along the margin with bipolar cautery. The the connection with cortical vein was noted and coagulated. The bony defect was sealed with bone wax. The sinus pericranii was excised totally. After wound irrigation and hemostasis, the wound was closed with 3-0 Vicryl and 3-0 Nylon. The patient stood whole procedure well. Under endotracheal tube general anesthesia, the patient was put in supine position with head rotated to right. the scalp was shaved, scrubbed, and disinfected as usual. The reverse U shape scalp incision was made at left parietal area and the scalp flap was dissected. The sinus pericranii was identified and dissected along the margin with bipolar cautery. The the connection with cortical vein was noted and coagulated and devided. The bony defect was sealed with bone wax for several times to secure no more bleeding. The sinus pericranii was then excised totally. After wound irrigation and hemostasis, the wound was closed with 3-0 Vicryl and 3-0 Nylon. The patient stood whole procedure well. Operators AP郭夢菲 Assistants R4李振豪, R1吳政達 相關圖片 林進來 (M,1935/12/05,76y3m) 手術日期 2010/07/13 手術主治醫師 陳敞牧 手術區域 西址 033房 01號 診斷 Carpal tunnel syndrome 器械術式 Decompression of mediun nerve 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 09:20 進入手術室 09:45 麻醉開始 09:50 手術開始 10:15 手術結束 10:15 麻醉結束 10:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 正中神經或尺神經腕部減壓術–單側 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Carpal Tunnel Syndrome 開立醫師: 游健生 開立時間: 2010/07/13 10:39 Pre-operative Diagnosis Carpal Tunnel Syndrome, right Post-operative Diagnosis Carpal Tunnel Syndrome, right Operative Method Decompression of right median nerve Specimen Count And Types nil Pathology Nil Operative Findings The median nerve was tightly compressed by transverse ligament. It was well decompressed after surgery. Operative Procedures 1.The hand and forearm were sterilized with povidone-iodine tincture, then covered with stockinet. 2.Anesthesia: Local injection of 2% Xylocaine with epinerphrin 3. Linear incision from vertical palmar crease to 1cm above transverse wrist crease. 4.The palmaris longus tendon was identified, then the plamar aponeurosis was cut longitidinally along the ulnar side of the palmaris longus tendon. 5. The median nerve was identified beneath the palmars longus tendon. Under direct vision, the transverse carpal ligament was divided until no more pressure on the median nerve. 6. The skin was closed by interrupted suture with 4/0 nylon after subcutaneous interrupted suture with 3/0 Vircyl. 7. The hand and wrist were draped with fluffy dressing and elastic bandage. Operators VS 陳敞牧 Assistants R3 游健生 楊廖秋連 (F,1940/07/25,71y7m) 手術日期 2010/07/13 手術主治醫師 蕭輔仁 手術區域 東址 005房 02號 診斷 Lumbar Spondylosis 器械術式 Radiofrequency coagulation 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 何奕瑢, 時間資訊 13:20 報到 13:50 進入手術室 13:55 抗生素給藥 14:24 麻醉結束 14:24 麻醉開始 14:24 誘導結束 14:25 手術開始 15:08 手術結束 15:12 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 高頻熱凝療法 1 1 B 摘要__ 手術科部: 外科部 套用罐頭: L2 DRG PRF ablation, bilateral 開立醫師: 陳德福 開立時間: 2010/07/13 15:15 Pre-operative Diagnosis Lumbar spondylosis with radiculopathy Post-operative Diagnosis Lumbar spondylosis with radiculopathy Operative Method L2 DRG PRF ablation, bilateral Specimen Count And Types nil Pathology nil Operative Findings Pulsed radiofrequency for L2 DRG ablation was done bilaterally. The duration was 180 seconds with twice stimulation for each side. Operative Procedures Under LA and prone position, the skin was disinfected and draped as usual. The insertion point for the RFA needle was guided by C-arm flouroscope. The bilateral L2-3 nerve foramen was identified followed by RF ablation. The patient stands the procedure well and one injection to the right posterior back was done for the tender point. Operators vs 蕭輔仁 Assistants R5 陳德福 r1何奕瑢 許新土 (M,1956/11/14,55y4m) 手術日期 2010/07/13 手術主治醫師 王國川 手術區域 東址 003房 03號 診斷 Hydrocephalus 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 何奕瑢, 時間資訊 11:13 報到 11:13 進入手術室 11:20 麻醉開始 11:30 誘導結束 11:50 抗生素給藥 11:58 手術開始 12:45 麻醉結束 12:45 手術結束 12:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Ventriculopleural shunt, left Kocher point 開立醫師: 陳德福 開立時間: 2010/07/13 12:58 Pre-operative Diagnosis hydrocephalus Post-operative Diagnosis hydrocephalus Operative Method Ventriculopleural shunt, left Kocher point Specimen Count And Types nil Pathology nil Operative Findings 1.The ventricular opening pressure: 3cmH2O 2.CSF: clear and colorless 3.Intraventricular catheter: 6.8cm and intrapleural catheter:15cm [4-5th rib space] 4.One Metronic programmable valve was implanted at the left frontal area, Kocher point. Operative Procedures Under ETGA and supine position, the skin was disinfected and draped as usual. One linear incision on left frontal area and left chest with minithoracotomy were done. One burr hole and dura tenting were done as well. Subcutaneous tunneling and insert ventricular puncture needle. One 6.8cm intraventricular catheter was inserted and the programmable valve system was connected. The intrapleural catheter was inserted smoothly. The wounds was closed in layers. Operators VS 王國川 Assistants R5 陳德福 R1 何奕瑢 陳永安 (M,1935/05/04,76y10m) 手術日期 2010/07/13 手術主治醫師 王國川 手術區域 東址 003房 06號 診斷 Subdural hematoma 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3E 紀錄醫師 陳柏如, 時間資訊 12:30 臨時手術NPO 12:30 開始NPO 15:16 通知急診手術 20:50 報到 21:00 進入手術室 21:05 麻醉開始 21:20 誘導結束 21:30 抗生素給藥 21:42 手術開始 22:35 手術結束 22:35 麻醉結束 22:40 送出病患 22:45 進入恢復室 23:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Chronic Subdural Hematoma 開立醫師: 曾峰毅 開立時間: 2010/07/13 22:39 Pre-operative Diagnosis Left chronic subdural hematoma Post-operative Diagnosis Left chronic subdural hematoma Operative Method Left frontal burr hole for subdural hematoma drainage Specimen Count And Types Subdural effusion was sent for cytology. Pathology Nil Operative Findings After durotomy, clear xanthochromic subdural effusion gushed out first, followed by light reddish effusion and old blood clot. There were both outer and inner membranes. Operative Procedures With endotracheal general anaesthesia, the patientw as put in supine position with head roated to right. After scalp shaved, scrubbed, disinfected, and then draped, we made one linear skin incision at left frontal area. We drilled one burr hole with air-drill, and created durotomy. We drained subdural hematoma, and the inserted subdural rubber drain. We closed the wound in layers, and de-air the subdural space. Operators VS 王國川 Assistants R4 曾峰毅 R1 陳柏如 Indication Of Emergent Operation 盧文哲 (M,1941/06/30,70y8m) 手術日期 2010/07/14 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Brain metastasis 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 游健生, 時間資訊 07:35 報到 08:05 進入手術室 08:13 麻醉開始 09:05 誘導結束 09:10 抗生素給藥 09:20 手術開始 12:10 抗生素給藥 15:10 抗生素給藥 17:10 麻醉結束 17:10 手術結束 17:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 10 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除－手術時間在４～８小時 1 1 摘要__ 手術科部: 外科部 套用罐頭: 1. Telovelar approach for 4th ventricle tumor... 開立醫師: 游健生 開立時間: 2010/07/14 17:37 Pre-operative Diagnosis 4th ventricle tumor with CSF seedings Post-operative Diagnosis 4th ventricle tumor with CSF seedings, favor glioma Operative Method 1. Telovelar approach for 4th ventricle tumor excision 2. Craniotomy for right foramen Luschka tumor excision Specimen Count And Types multiple pieces from 4th ventricle tumor and right foramen Luschka tumor Pathology Pending Operative Findings A 1.5 x 1.8 x 1.5cm tumor was noted inside 4th ventricle arising from left ventricle floor. It was soft, nodular, and translucent pink in color. Another 1.4 x 0.7 x 1cm similar tumor was noted at right foramen Luschka with adhesion to low cranial nerves. Operative Procedures Under ETGA, patient was put into supine position. Head was fixed with Mayfield headholder and inion at the highest point of surgical field with neck mildly flexed. After shaving, we disinfected and draped the operation field as usual. A midline incision was made from 2cm above inion to C3 level. We detached the neck muscle to expose laminae of C2, posterior arch of C1, and foramen magnum. We harvested a fasica for later duroplasty. After a 6x4cm craniotomy (including posterior rim of foramen magnum and lateral part of condyle), we opened the dura in U-shape with transverse sinus as base. We opened the cistern magnum and then 4th ventricle by cutting tela choroidea. We retracted bilateral tonsil laterally to expose 4th ventricle. After identifying the tumor inside, we removed it in piecemeal with bipolar electrocautery. Hemostasis was achieved with bipolar coagulation and Surgicel packing. We retracted the right cerebellum medially and exposed the tumor at right foramen Luschka. We removed it intracapsulally in pieces with ring currette and tumor forceps. Then, we excised the capsule with part of it left in situ to protect low cranial nerves adhered. Hemostasis was achieved in similar way. We closed the dura with continuous 3-0 prolene suture and a fasica graft was used for dura repair. Then, we fixed the bone flap with miniplates and placed an epilamina CWV drain. Finally, we closed the wound in layers. Operators Prof. 杜永光 Assistants R6 胡朝凱 R3 游健生 游丁未 (M,1963/10/31,48y4m) 手術日期 2010/07/14 手術主治醫師 杜永光 手術區域 東址 006房 03號 診斷 Facial spasm 器械術式 Microvascular decompression 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 游健生, 時間資訊 15:10 進入手術室 15:15 麻醉開始 15:45 誘導結束 16:00 抗生素給藥 16:50 手術開始 19:00 抗生素給藥 19:40 手術結束 19:40 麻醉結束 19:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 顏面神經解壓術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: microvascular decompression 開立醫師: 胡朝凱 開立時間: 2010/07/14 20:08 Pre-operative Diagnosis left hemifacial spasm Post-operative Diagnosis left hemifacial spasm Operative Method microvascular decompression Specimen Count And Types nil Pathology nil Operative Findings 1.One small artery that may arised from AICA lies between 7th and 8th nerve and compressed the root exit zone. 2.The left VA was prominent and compressed the 7th and 8th complex 3.During operation, BAEP and SSEP were withing normal. Operative Procedures Under endotracheal general anesthesia, patient was put in supine position with head tilt to right and was fixed by Mayfield skull clamp. Skin was shaved and scrubbed with povidone-iodine detergent, then covered with sterilized plastic sheet. Left post-auricular (retrosigmoid) curvillinear incision was made. The sternocleidomastoideus, splenius capitis, oblique capitis superior and part of the trapezius muslces were devided down to C1 level. Craniotomy was then performed as a 5x4 cm bone window to expose the margin of sigmoid sinus. Dural incision was made like "K" shape and reflected to sigmoid sinus. CSF was drained first at foramen magnum cistern until the cerebellum was slack enough for gentle retraction downward. Consequently, the 7th and 8th nerves complex was visualized with minimal cerebellar retraction. Also, the vessels were identified. And the vessels and nerves were seperated with teflon to keep the vessels away from root exit zone. Dural was closed with a fascia graft The muscles were closed by interruped sutures. Then the wound was closed in layers. Operators P 杜永光 Assistants R6 胡朝凱, R3游健生 林足如 (F,1955/11/26,56y3m) 手術日期 2010/07/14 手術主治醫師 曾漢民 手術區域 東址 005房 03號 診斷 Pituitary tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 王奐之, 時間資訊 14:40 報到 15:05 進入手術室 15:10 麻醉開始 15:30 誘導結束 15:40 抗生素給藥 16:19 手術開始 17:27 麻醉結束 17:27 手術結束 17:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經由蝶竇之腦下垂體瘤切除 1 1 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 手術 臉部以外皮膚及皮下腫瘤摘除術　小於２公分 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 記錄__ 手術科部: 外科部 套用罐頭: Trans-sphenoid adenomectomy, partial 開立醫師: 王奐之 開立時間: 2010/07/14 18:02 Pre-operative Diagnosis Pituitary macroadenoma status post excision, with recurrence Post-operative Diagnosis Pituitary macroadenoma status post excision, with recurrence Operative Method Trans-sphenoid adenomectomy, partial Specimen Count And Types 1 piece About size:0.2*0.2*0.2cm Source:pituitary tumor Pathology Pending Operative Findings Soft, yellow-reddish tumor noted at right pituitary fossa and bulged into sphenoid sinus, with invasion into right cavernous sinus, encasing the right ICA. The posterior wall of sphenoid sinus was eroded. Arachnoid membrane posterior to the tumor was absent, CSF gushed out after partial tumor removal. The dural defect was sealed by peritoneal fat and Tissucol Duo. Operative Procedures After ETGA, the patient was placed in supine position with neck extended. After skin and nostrils disinfection, the sphenoid sinus was entered under microscope through the right nostril after breaking the vomer and anterior wall of sphenoid sinus. The tumor encased by the dura was exposed after mucosa removal. After partial tumor removal, CSF gushed out. Hemostasis was achieved meticulously. Then the dural defect was sealed with peritoneal fat obtained from LLQ and Tissucol Duo. The removed mucosa was then put back. The nostrils were then packed with plastic bags coated with BI gel. The operation ends after LLQ wound closure. Operators VS 曾漢民 Assistants R6 陳睿生, R3 王奐之 相關圖片 陳志明 (M,1967/03/30,44y11m) 手術日期 2010/07/14 手術主治醫師 蔡瑞章 手術區域 東址 005房 01號 診斷 Benign neoplasm of brain 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 王奐之, 時間資訊 07:42 報到 08:05 進入手術室 08:15 麻醉開始 08:50 誘導結束 08:56 抗生素給藥 09:24 手術開始 11:40 麻醉結束 11:40 手術結束 11:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４小時以內 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 記錄__ 手術科部: 外科部 套用罐頭: Craniotomy for tumor excision 開立醫師: 王奐之 開立時間: 2010/07/14 12:11 Pre-operative Diagnosis Left anterior high frontal brain tumor, suspected metastasis Post-operative Diagnosis Left anterior high frontal brain tumor, suspected metastasis Operative Method Craniotomy for tumor excision Specimen Count And Types 1 piece About size:1*1*1 Source:left frontal brain tumor Pathology Pending Operative Findings An yellowish elastic tumor with cystic component and clear margin was noted at left anterior high frontal brain tumor, just beneath the brain surface. The tumor measured about 1cm in size, no obvious overlying meningeal involvement. Operative Procedures After ETGA, the patient was placed in supine position with neck slightly flexed. After shaving, skin disinfection and draping in sterile fashion, a small frontal bicoronal skin incision was made about 2cm posterior to the hair-line. A burr hole was made at midline, followed by left frontal craniotomy. After dural opening, the tumor was noted at surface, about 1cm from midline. The tumor was then removed en bloc. After meticulous hemostasis, the raw surface was packed with Surgicel. The dura was then closed with fascial graft in water-tight fashion. The wound was then closed in layers. Operators P 蔡瑞章 Assistants R6 陳睿生, R3 王奐之 相關圖片 趙國荃 (M,1966/11/14,45y4m) 手術日期 2010/07/14 手術主治醫師 蔡瑞章 手術區域 東址 005房 02號 診斷 Herniated Intervertebral Disc ( HIVD ) 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 王奐之, 時間資訊 11:42 報到 12:05 進入手術室 12:13 麻醉開始 12:18 誘導結束 12:34 抗生素給藥 12:53 手術開始 14:45 手術結束 14:45 麻醉結束 14:55 送出病患 14:58 進入恢復室 16:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術－腰椎 1 1 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 記錄__ 手術科部: 外科部 套用罐頭: Microsurgical discectomy 開立醫師: 王奐之 開立時間: 2010/07/14 15:23 Pre-operative Diagnosis Herniated intervertebral disc, right lateral, L4-5 Post-operative Diagnosis Herniated intervertebral disc, right lateral, L4-5 Operative Method Microsurgical discectomy Specimen Count And Types 1 piece About size:0.3*0.2*0.2cm Source:peri-disc tissue Pathology Pending Operative Findings Protruding disc at right lateral side of L4-5 space, partially into the intervertebral foramen. A strange tissue was biopsied near the disc. No obvious root compression was noted. L5 root was identified during the discectomy. Operative Procedures After ETGA, the patient was placed in prone position. After C-arm localization of the L4-5 disc space, a midline skin incision was made. The incision was deepened to expose the L4 spinous process. The right side paraspinal muscles were then detached from L4 process and lamina. The lower part of right side L4 lamina was removed by high-speed drill. The ligamentum flavum was removed by Kerrison punch. The L4-5 disc was then taken out piece by piece. After hemostasis, the wound was closed in layers. Operators P 蔡瑞章 Assistants R6 陳睿生, R3 王奐之 相關圖片 陳柏瑋 (M,1998/10/20,13y4m) 手術日期 2010/07/14 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Nevus 器械術式 Excision of subcutaneous tumor 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 2 紀錄醫師 李振豪, 時間資訊 07:50 報到 08:08 進入手術室 08:12 麻醉開始 08:17 誘導結束 08:30 抗生素給藥 08:43 手術開始 09:22 手術結束 09:22 麻醉結束 09:30 進入恢復室 09:30 送出病患 10:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 臉部以外皮膚及皮下腫瘤摘除術　小於２公分 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Tumor excision 開立醫師: 李振豪 開立時間: 2010/07/14 09:34 Pre-operative Diagnosis Left supraclavicular skin tumor Left supraclavicular skin tumor with repeated bleeding and granulation formation Post-operative Diagnosis Left supraclavicular skin tumor Left supraclavicular skin tumor with repeated bleeding and granulation formation Operative Method Tumor excision Specimen Count And Types 1 piece About size:0.7x0.7x0.8cm Source:Skin tumor Pathology Pending Operative Findings A 0.7x0.7x0.8cm exophytic skin tumor was noted with skin change and easily bleeding. No deep fascia involvement was noted. A 0.7x0.7x0.8cm exophytic skin tumor was noted with skin change (repeated epithelialization) and easily bleeding. No deep fascia involvement was noted. Operative Procedures Under laryngeal mask general anesthesia, the patient was put in supine position. The skin was disinfected and draped as usual. The fusiform skin incision was made along the skin crest. Tumor excision was performed along the subcutaneous plan. After hemostasis, the wound was closed in layers with 4-0 Vicryl and 4-0 Nylon. Under laryngeal mask general anesthesia, the patient was put in supine position. The skin was disinfected and draped as usual. Local anesthesia with 1% Xylocaine 5ml(with epinephrine) was used. The fusiform skin incision was made along the skin crest. Tumor excision was performed along the subcutaneous plan. After hemostasis, the wound was closed in layers with 4-0 Vicryl and 4-0 Nylon. Operators AV郭夢菲 Assistants R4李振豪, Ri田正宗 相關圖片 陳玉明 (M,1976/09/01,35y6m) 手術日期 2010/07/14 手術主治醫師 王國川 手術區域 東址 002房 03號 診斷 Dizziness and vertigo 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林至芃 ASA 2E 紀錄醫師 游健生, 時間資訊 17:08 通知急診手術 22:00 進入手術室 22:00 麻醉開始 22:35 誘導結束 22:50 抗生素給藥 23:15 手術開始 00:55 麻醉結束 00:55 手術結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 慢性硬腦膜下血腫清除術 1 1 B 摘要__ 手術科部: 神經部 套用罐頭: Bilateral burr hole drainage 開立醫師: 游健生 開立時間: 2010/07/15 01:27 Pre-operative Diagnosis Bilateral chronic SDH Post-operative Diagnosis Bilateral chronic SDH Operative Method Bilateral burr hole drainage Specimen Count And Types SDH material x 10 tubes Pathology pending Operative Findings 1.Bilateral parietal to temporal motor oil like old blood was drained out. 2.The brain expanded well after drainage 3.Outer membrane was noted Operative Procedures 1.ETGA, supine 2.Bilateral parietal transverse skin incision 3.Dissecto open periosteum 4.Burr hole drill 5.Open dura 6.open outer membrane and coagulated 7.Inserted EVD and water irrigation 8.Fix EVD drain 9.Close wound in layers 10.De-air Operators 王國川 Assistants 胡朝凱, 游健生 Indication Of Emergent Operation 林文海 (M,1919/01/07,93y2m) 手術日期 2010/07/15 手術主治醫師 杜永光 手術區域 東址 002房 04號 診斷 Subdural hemorrhage or effusion 器械術式 V-P shunt 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林峰盛 ASA 3E 紀錄醫師 陳德福, 時間資訊 10:00 臨時手術NPO 10:00 開始NPO 16:45 報到 17:15 進入手術室 17:20 麻醉開始 17:30 誘導結束 18:00 抗生素給藥 18:12 手術開始 19:35 手術結束 19:35 麻醉結束 19:45 進入恢復室 19:45 送出病患 20:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 4 L 手術 腦室腹腔分流手術 1 1 R 手術 慢性硬腦膜下血腫清除術 1 2 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: 1.VPS revision, programmable valve 2.bilatera... 開立醫師: 陳德福 開立時間: 2010/07/15 19:58 Pre-operative Diagnosis Bilateral chronic subdural hematoma and CSF over drainage [Hydrocephalus s/p VPS] Post-operative Diagnosis Bilateral chronic subdural hematoma and CSF over drainage [Hydrocephalus s/p Operative Method 1.VPS revision, programmable valve 2.bilateral CSDH drainage Specimen Count And Types nil Pathology nil Operative Findings 1.There is 70-80ml liquified subdural hematoma over bilateral fronto-temporo-parietal area. The fluid gushed out spontanously after we open the outer membrane. 2.Outer membrane and inner membrane:+ 3.One programmable valve was replaced on the right frontal area. [Codman, presetting: 130mmH2O] Intraventricular catheter:6.5cm Operative Procedures Under ETGA and supine position, the scalp was disinfected and draped as usual. One curvilinear incision along previous right frontal scalp and linear incision on left frontal area were done. Bilateral Burr hole creation and dura tenting was done. The dura was opened and the outer membrane was opened. We irrigate the subdural space with copious normal saline. The intraventricular catheter was replaced with one programmable shunt valve, Codman. The function was fair and the wound was closed in layers. The air traped in the cranial vault was drained out. Operators P 杜永光 Assistants R6 胡朝凱 R5 陳德福 Indication Of Emergent Operation 相關圖片 盧文哲 (M,1941/06/30,70y8m) 手術日期 2010/07/15 手術主治醫師 杜永光 手術區域 東址 001房 02號 診斷 Brain metastasis 器械術式 V-P shunt 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 1E 紀錄醫師 陳睿生, 時間資訊 10:40 報到 10:42 進入手術室 10:45 麻醉開始 10:50 誘導結束 11:35 手術開始 12:30 麻醉結束 12:30 手術結束 12:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室體外引流 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: EVD insertion at right Kocher^s point 開立醫師: 陳睿生 開立時間: 2010/07/15 12:54 Pre-operative Diagnosis 4th ventricular tumor s/p with acute hydrocephalus Post-operative Diagnosis 4th ventricular tumor s/p with acute hydrocephalus Operative Method EVD insertion at right Kocher^s point Specimen Count And Types nil Pathology Nil Operative Findings The CSF was clear and the initial ICP was about 10cmH2O. The EVD was about 6.5cm in depth. Operative Procedures 1. ETGA, supine position and head neutral position 2. Right frontal curvillinear scalp incision 3. Create a bur hole at right Kocher^s point 4. Dura tenting, and then it was opened 5. Punch the right lateral ventricle, and then the EVD was inserted about 6.5cm in depth 6. Hemostasis, close the wound in layers Operators P 杜永光 Assistants R6 陳睿生 Indication Of Emergent Operation 陳海清 (M,1954/08/18,57y6m) 手術日期 2010/07/15 手術主治醫師 陳敞牧 手術區域 東址 005房 01號 診斷 Hydrocephalus 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 07:44 報到 08:05 進入手術室 08:30 麻醉開始 08:35 誘導結束 08:58 抗生素給藥 09:30 手術開始 11:55 手術結束 11:55 麻醉結束 12:05 送出病患 12:07 進入恢復室 13:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 手術 腦室腹腔分流手術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: V-P shunt revision 開立醫師: 李振豪 開立時間: 2010/07/15 12:27 Pre-operative Diagnosis Hydrocephalus s/p V-P shunt with shunt dysfunction Post-operative Diagnosis Hydrocephalus s/p V-P shunt with shunt dysfunction Operative Method V-P shunt revision Specimen Count And Types 1 piece About size:3ml Source:CSF Pathology Nil Operative Findings The opening pressure was about 5cmH2O after ventricular puncture. The CSF is clear with mild xanthochronic in appearance. Codman programmable reservoir was placed with 70mmH2O as initial pressure setting. The length of ventricular catheter and peritoneal catheter are 6.5cm and 25cm respectively. The previous ventricular catheter was left in situ due to severe adhesion to brain tissue. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine position with head rotated to left. The scalp was shaved, scrubbed, and disinfected as usual. The scalp incision was made along previous wound and the burr hole and V-P shunt was identified. The soft tissue that covered the burr hole was dissected and the brain surface was exposed. The burr hole was extended with curette laterally. We tried to removed the ventricular catheter but severe adhesion was noted. So we cut short the ventricular catheter and left it in situ. Ventricular puncture was performed and new tract was created for ventricular catheter. One 2cm in length linear incision was made at left retroauricular area and the old shunt was exposed. The shunt was cut and the reservoir was removed. New Codman programmable reservoir was placed along the previous tract. Skin incision was made over right upper abdomen along previous wound. The old shunt was identified and the entrance into peritoneal cavity was found. The new shunt was connected with old one at the level of retroauricular area and passed the subcutaneous tunnel while we removed the old shunt from abdominal wound. The new programmable shunt was set up and the function was checked. The peritoneal catheter was placed into intra-abdominal cavity. The ventricular catheter was placed via new puncture tract. The function of the V-P shunt was checked again. After hemostasis, the wound was then close in layers. The pressure was adjusted to 70mmH2O after wound dressing. Operators VS陳敞牧 Assistants R4李振豪 相關圖片 黃金泉 (M,1955/04/20,56y10m) 手術日期 2010/07/15 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 Subdural hemorrhage 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3 紀錄醫師 何奕瑢, 時間資訊 10:00 報到 10:39 進入手術室 10:52 麻醉開始 10:58 誘導結束 11:06 抗生素給藥 11:16 開始輸血 11:25 手術開始 13:35 手術結束 13:35 麻醉結束 13:40 送出病患 13:40 進入恢復室 15:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 頭顱成形術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Cranioplasty 開立醫師: 曾峰毅 開立時間: 2010/07/15 13:42 Pre-operative Diagnosis Status post craniectomy Post-operative Diagnosis Status post craniectomy Operative Method Cranioplasty Specimen Count And Types Nil Pathology Nil Operative Findings Bone graft, 4 pieces, was connected together with wire, and fixed back with mini-plates. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to right. After scalp shaved, scrubbed, disinfected, and then draped, we made skin incision along previuos surgery wound. We dissected the scalp flap, and fixed autologous bone graft back with wire and mini-plates. After 2 subgaleal CWV inserted, we closed the wound in layers. Operators VS 王國川 Assistants R4 曾峰毅 R1 何奕瑢 洪林伸 (F,1932/11/22,79y3m) 手術日期 2010/07/15 手術主治醫師 王國川 手術區域 東址 003房 號 診斷 Ischemic stroke 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 4 紀錄醫師 何奕瑢, 時間資訊 08:15 報到 08:15 進入手術室 08:30 麻醉開始 08:40 誘導結束 09:20 手術開始 10:16 麻醉結束 10:16 手術結束 10:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Glucose 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 手術 腦室腹腔分流手術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt insertion via left... 開立醫師: 曾峰毅 開立時間: 2010/07/15 10:23 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunt insertion via left Kocher point Specimen Count And Types Nil Pathology Nil Operative Findings Clear, colorless CSF was drained via the shunt. Codman programmable shunt was inserted, and valve pressure was set at 100mmH20. Operative Procedures With endonasal trahceal intubation and general anaesthesia, the patient was put in supine position with head rotated to right. After scalp shaved, scrubbed, disinfected, and then draped, we made one linear skin incision at left frontal area. We drilled on burr hole, and created durotomy. One transverse skin incision was made at left upper abdomen, and dissected to get inot peritoneal space with mini-laparotomy. We inserted ventricular catheter, and created subcutaneous tunnel. Catheter was pulled throuth the tunnel, and peritoneal catheter was put into peritoneal space. We checked the function, and then closed the wound in layers. Operators VS 王國川 Assistants R4 曾峰毅 R1 何奕瑢 陳玉明 (M,1976/09/01,35y6m) 手術日期 2010/07/15 手術主治醫師 林峰盛 手術區域 西址 035房 04號 診斷 Dizziness and vertigo 器械術式 Epi catheter implantation/ PC 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 硬肌麻醉 麻醉主治醫師 林峰盛 ASA 2 紀錄醫師 王曼玲, 時間資訊 14:25 進入手術室 14:30 誘導結束 14:30 麻醉開始 14:38 手術開始 15:25 手術結束 15:25 麻醉結束 15:43 進入恢復室 17:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Epidural anesthesia 1 0 手術 治療性導管植入術－希克曼氏導管植入術 1 0 記錄__ 手術科部: 麻醉部 套用罐頭: LENB 開立醫師: 林峰盛 開立時間: 2010/07/15 16:05 Pre-operative Diagnosis 1.Subdural hematoma Post-operative Diagnosis 1.subdural hematoma 2.spontaneous CSF leakage Operative Method cervical epidural catheter insertion Specimen Count And Types nil Pathology Nil Operative Findings serosanguinous fluid noted while advancing epidural catheter, susp. CSF leak into epidural space, but r/o intrathecal migration Operative Procedures 1. LA with 1% xylocaine 5 ml 2. pt in lateral debubitus position 3. Under fluoroscopic-guidance, insert 18G Tuohy needle via C7-T1 interlaminar route into epidural 4. Omnipaque 300 5 ml was injected to confirm the proper position of needle tip 5. insert epidural catheter fluoroscopic-guided cervical epidural cathter insertion Operators 林峰盛, Assistants 王曼玲, 陳柯月嬌 (F,1949/03/01,63y0m) 手術日期 2010/07/16 手術主治醫師 張金堅 手術區域 東址 056房 02號 診斷 Female breast cancer 器械術式 BCT+SLND or ALND 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 2 紀錄醫師 吳昭瑩, 時間資訊 10:45 報到 11:20 進入手術室 11:25 麻醉開始 11:30 誘導結束 12:00 抗生素給藥 12:05 手術開始 15:05 抗生素給藥 16:40 手術結束 16:40 麻醉結束 16:50 送出病患 16:55 進入恢復室 18:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 部份乳房切除術－單側 1 2 R 手術 腋窩淋巴腺清除術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 記錄__ 手術科部: 外科部 套用罐頭: Partial mastectomy+SLND+ALND, right 開立醫師: 黃凱傑 開立時間: 2010/07/16 17:02 Pre-operative Diagnosis Right breast cancer Post-operative Diagnosis Right breast cancer Operative Method Partial mastectomy+SLND+ALND, right Specimen Count And Types 8 pieces About size:3x3 Source:breast About size:0.5x0.5 Source:SLN1 About size:0.5x0.5 Source:SLN2 About size:0.5x0.5 Source:SLN3 About size:0.5x0.5 Source:SLN4 About size:0.5x0.5 Source:SLN5 About size:2x2 Source:AXILLARY LN LEVEL 1 About size:1x1 Source:AXILLARY LN LEVEL 2 Pathology ALND,SLND and breast tumor Operative Findings 1. SLND1,3,4,5: POSITIVE ; SLND2: NEGATIVE 2. ASLND 3. The breast tumor:2 x 2cm, at 2 cm from right nipple, 7 oclock Operative Procedures 1. ETGA, supine 2. Skin disinfection and draping 3. Axillary skin incision 4. Performed SLND, send for imprint cytology, which showed positive, so ALND was performed. 5. Performed PARTIAL masectomy via wound near tumor 6. Hemostasis, normal saline irrigation 7. Set CWVx1 and Close wound in layers Operators 張金堅 Assistants 楊雅雯 吳昭瑩 相關圖片 林勇雄 (M,1941/01/17,71y1m) 手術日期 2010/07/16 手術主治醫師 杜永光 手術區域 東址 001房 02號 診斷 Arteriovenous fistula, acquired 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 陳德福, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 07:18 通知急診手術 10:00 報到 10:30 進入手術室 10:35 麻醉開始 10:45 抗生素給藥 11:05 誘導結束 12:09 手術開始 15:15 抗生素給藥 17:35 麻醉結束 17:35 手術結束 17:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除－手術時間在８小時以上 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: craniotomy tumor excision 開立醫師: 陳德福 開立時間: 2010/07/16 17:55 Pre-operative Diagnosis Left tentoium tumor with recurrent bleeding Post-operative Diagnosis suspect cavernoma bleeding Operative Method craniotomy tumor excision Specimen Count And Types 1 piece About size:0.5*0.5*1CM Source:BRAIN TUMOR Pathology pending Operative Findings 1.There is a 1*1*1.5cm in sized easy bleeding tumor at the left tentorium with previous bleeding and microcalcifications. There are multiple arterial feeders found and some grape like structure was found as well. 2.There is a 1*1cm in sized defect on the tentorium, which may be responsible for the simutaneous supra and infra-tentorial SAH. Operative Procedures Under ETGA and prone position with Mayfield pin type head fixator fixation, the scalp was disinfected and draped as usual. One linear incision on the left occipital scalp was done and one craniotomy with transverse sinus based was done. Dura tenting and dura opening in C shape were done. The left occipital lobe was retracted to expose the tumor on the tentorium. The tumor was then removed with tumor forceps, bipolar coagulator, and sucker assisted. Hemostasis was done and the dura was closed in water tight fasion. The skull was fixed with miniplates. One subgaleal CWV was left in situ. The wound was closed in layers. Operators P 杜永光 Assistants R6 胡朝凱 R5 陳德福 Indication Of Emergent Operation 相關圖片 戴許梅 (F,1942/06/16,69y8m) 手術日期 2010/07/16 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 游健生, 時間資訊 07:32 報到 08:08 進入手術室 08:15 麻醉開始 08:55 誘導結束 09:10 抗生素給藥 09:13 手術開始 12:10 抗生素給藥 15:10 抗生素給藥 17:20 麻醉結束 17:20 手術結束 17:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 10 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Far-lateral approach for Simpson grade II tum... 開立醫師: 游健生 開立時間: 2010/07/16 17:49 Pre-operative Diagnosis Foramen magnum meningioma Post-operative Diagnosis Foramen magnum meningioma Operative Method Far-lateral approach for Simpson grade II tumor excision Specimen Count And Types 1 piece About size:a few pieces Source:foramen magnum tumor Pathology Pending Operative Findings There was a yellow-pink, rubber-like tumor, measuring 1.5 x 1.6 x 2.1 cm, arising from the dura with dura tail at the left latero-ventral side of foramen magnum. The plane between tumor and medullar/upper cervical cord was clear. The medullar and upper cervical cord were pushed backward and compressed by the tumor severely. They were well decompressed after surgery. There were no intra-operative changes in SSEP/MEP (from positioning to the end of surgery). Operative Procedures Under ETGA, patient was put into supine position with left shoulder elevated and retracted caudally. Her head was fixed with Mayfield headholder and turned to right. Neck was mildly flexed to better expose suboccipital region while not compromising the right jugular venous return. After shaving, we disinfected and draped the operation field as usual. A horseshoe like incision was made from C2 level along midline upward to 5cm below inion, laterally to mastoid process along superior nuchal line, and then downward below C1 transverse process. After flipping the skin flap downward, we detached trapezius musucle, splenius capitis muscle, longissimus muscle, semispinalis capitis muscle, and rectus capitis muscle with muscle cuff at superior nuchal line to expose the vertebral artery passing over the posterior arch of C1 and atlanto-occipital joint. We removed the posterior arch by high-speed drill and created a small craniotomy followed by drilling of the medial third of occipital condyle. The tumor was seen after we opened the dura by a paramedian incision. After cutting the arachnoid membrane, we devascularized the tumor from its base and removed it in pieces with scissors. Hemostasis was achieved by bipolar electrocautery. Then, we closed the dura with continous watertight 3-0 prolene suture and a Duraform. Craniotomy flap was replaced and posterior arch of C1 was reconstructed with miniplates. Finally, we closed the wound in layers with a CWV drain placed at epilamina space. Operators Prof. 杜永光 Assistants R6 胡朝凱 R3 游健生 陳定和 (M,1937/02/15,75y0m) 手術日期 2010/07/16 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 王奐之, 時間資訊 07:45 報到 08:05 進入手術室 08:10 麻醉開始 08:40 誘導結束 08:50 手術開始 09:00 抗生素給藥 10:35 開始輸血 12:00 抗生素給藥 13:40 麻醉結束 13:40 手術結束 13:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４～８小時 1 1 L 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Craniotomy for tumor excision 開立醫師: 王奐之 開立時間: 2010/07/16 14:15 Pre-operative Diagnosis Left frontal base meningioma Post-operative Diagnosis Left frontal base meningioma Operative Method Craniotomy for tumor excision Specimen Count And Types 1 piece About size:pieces Source:tumor Pathology Pending Operative Findings The tumor was soft, fragile, and purple in color, with well encapsulation. The vascular supply was mainly from the frontal base and the dura at frontal region. No obvious feeding artery was noted intra-op. It was a well capsuled one and the plane between the capsuled and arachnoid membrane was intact. The dura was tightly attached to the skull and was severely teared while craniotomy. Operative Procedures After ETGA, the patient was placed in supine position with neck slightly flexed and head fixed with Mayfield skull clamp. After shaving, skin disinfection and draping in sterile fashion, a bicoronal skin incision was made. A left frontal craniotomy was then done, severe dural tear occurred due to severe adhesion. A hypervascular tumor was exposed with well encapsulation, and was detached from the arachnoid membrane, followed by removal in pieces. After meticulous hemostasis with bipolar electrocauterization and Gelfoam packing, the dura was closed with multiple fascial graft in water-tight fashion. The skull was fixed back with miniplates and central tenting. After setting a subgaleal CWV, the wound was closed in layers. Operators VS 曾漢民 Assistants R6 陳睿生, R3 王奐之 相關圖片 黃朝琴 (M,1968/08/06,43y7m) 手術日期 2010/07/16 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Glioblastoma multiforma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 王奐之, 時間資訊 13:06 報到 14:12 進入手術室 14:15 麻醉開始 14:20 抗生素給藥 14:30 誘導結束 14:40 手術開始 17:20 抗生素給藥 18:30 麻醉結束 18:30 手術結束 18:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 手術 腦瘤切除－手術時間在４小時以內 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Craniotomy for tumor excision 開立醫師: 王奐之 開立時間: 2010/07/16 18:59 Pre-operative Diagnosis Right frontal lesion, suspected cavernoma Post-operative Diagnosis Right frontal tumor, suspected high grade glioma Operative Method Craniotomy for tumor excision Specimen Count And Types 1 piece About size:2*2*2cm Source:right frontal tumor Pathology Frozen: GBM or other malignant tumor could not be ruled out. Operative Findings Grey-whitish tumor with gliotic change and indistinct margin, with peritumoral angiosis and easy oozing. The right frontal horn was entered after tumor removal. Engorged cortical veins were noted along with suspected arteriovenous shunting. Operative Procedures After ETGA, the patient was placed in supine position with neck slightly flexed and head fixed with Mayfield skull clamp. After shaving, skin disinfection and draping in sterile fashion, a bicoronal skin incision was made. Then a right frontal craniotomy was done, with partial dural tear. After intra-operative ultrasonographic localization of the tumor, a corticotomy was made to enter the tumor cavity. The tumor was then removed piece by piece. After tumor removal, the frontal horn was entered with CSF gushing out. The frontal horn opening was packed with Gelfoam. After hemostasis with bipolar electrocauterization and FloSeal gel, the dura was closed with fascial graft in water-tight fashion. The skull was fixed back with miniplates and central tenting. After setting a subgaleal CWV drain, the wound was closed in layers. Operators VS 曾漢民 Assistants R6 陳睿生, R3 王奐之 相關圖片 黃燦金 (M,1956/02/10,56y1m) 手術日期 2010/07/16 手術主治醫師 葉德輝 手術區域 東址 023房 04號 診斷 Chronic paranasal sinusitis 器械術式 Endoscopic functional sinus su 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 黃麒軒, 時間資訊 13:13 報到 13:30 抗生素給藥 13:35 進入手術室 13:38 麻醉開始 13:42 誘導結束 13:58 手術開始 15:33 手術結束 15:33 麻醉結束 15:40 送出病患 15:43 進入恢復室 16:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 多竇副鼻竇手術 1 2 L 手術 多竇副鼻竇手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 耳鼻喉部 套用罐頭: Functional endoscopic sinus surgery 開立醫師: 黃麒軒 開立時間: 2010/07/16 20:15 Pre-operative Diagnosis Chronic paranasal sinusitis, bilateral Post-operative Diagnosis Ditto, operated Operative Method Functional endoscopic sinus surgery, bilateral Specimen Count And Types 2 pieces About size:1x1 cm Source:Right paranasal sinus About size:1x1 cm Source:Left paranasal sinus Pathology pending Operative Findings Right infun.: OK( )edematous( V )polypoid( )polyp( V ) mucopus( ),fungus( ),cyst( ) A.Eth.: OK( )edematous( V )polypoid( V )polyp( V ) mucopus( ),fungus( ),cyst( ) P.Eth: OK( V )edematous( )polypoid( )polyp( )mucopus( ),fungus( ),cyst( ) Maxi.: OK( )edematous( V )polypoid( V )polyp( ) mucopus( ),fungus( ),cyst( ) Fron.: OK( )edematous( V )polypoid( )polyp( ) mucopus( ),fungus( ),cyst( ) Sph.: OK( )edematous( )polypoid( )polyp( ) mucopus( ),fungus( ),cyst( ) Left infun.: OK( )edematous( V )polypoid( )polyp( V ) mucopus( ),fungus( ),cyst( ) A.Eth.: OK( )edematous( V )polypoid( V )polyp( V ) mucopus(),fungus( ),cyst( ) P.Eth: OK( V )edematous( )polypoid( )polyp( ) mucopus( ),fungus( ),cyst( ) Maxi.: OK( )edematous( V )polypoid( V )polyp( ) mucopus( ),fungus( ),cyst( ) Fron.: OK( )edematous( )polypoid()polyp( )mucopus( ),fungus( ),cyst( ) Sph.: OK( )edematous( )polypoid( )polyp( ) mucopus( ),fungus( ),cyst( ) Operative Procedures (1) Infundibulotomy :R( V )L( V ) (2) Opening/trimming of ethmoid bulla :R( V )L( V ) anterior ethmoid :R( V )L( V ) agger nasi :R( V )L( V ) frontal recess :R( V )L( ) middle turbinate :R( V )L( V ) (3) Opening/trimming of ground lamella :R( V )L( V ) posterior ethmoid :R( V )L( V ) sphenoid sinus :R( )L( ) (4) Widening of maxillary ostium :R( V )L( V ) aspiration :R( V )L( V ) irrigation :R( V )L( V ) (5) Packing with Fingerstall :R( X2 )L( X2 ) Operators AP葉德輝 Assistants R5林怡岑 R2黃麒軒 劉琮勛 (M,1976/10/01,35y5m) 手術日期 2010/07/16 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Arteriovenous malformation, brain 器械術式 Craniotomy (A.V.M.) P-DUH 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 07:40 報到 08:05 進入手術室 08:10 麻醉開始 08:30 誘導結束 09:00 手術開始 09:15 抗生素給藥 12:02 開始輸血 12:27 抗生素給藥 15:30 抗生素給藥 18:28 抗生素給藥 21:28 抗生素給藥 00:38 抗生素給藥 03:38 抗生素給藥 06:38 抗生素給藥 09:38 抗生素給藥 23:00 麻醉結束 23:10 手術結束 23:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 急性硬腦膜下血腫清除術 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 70 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 開顱術摘除血管病變－動靜脈畸型－大型 1 1 R 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 R 記錄__ 手術科部: 外科部 套用罐頭: 1. Excision of arteriovenous malformation via... 開立醫師: 鍾文桂 開立時間: 2010/07/18 10:03 Pre-operative Diagnosis Right frontal-parietal-temporal arteriovenous malformation status post preoperative transarterial embolozation. Post-operative Diagnosis 1. Right frontal-parietal-temporal arteriovenous malformation status post preoperative transarterial embolozation and excision. 2. Brain swelling, severe. 3. Acute subdural hemorrhage, right frontal-temporal-parietal regions. 4. Intracerebral hemorrhage, right temporal. Operative Method 1. Excision of arteriovenous malformation via right subtemporal approach. 2. Extended decompressive craniectomy, right frontal-temporal-parietal. 3. Evacuation of acute subdural hemorrhage and intracerebral hemorrhage. Specimen Count And Types 1 piece About size:Multiple Source:AVM, cerebral. Pathology Pending. Operative Findings 1. Easy oozing operative field;blood loss: 24500 cc. Transfusion PRBC: 66U, FFP: 56U, Platelet: 54U, whole blood: 20U. 2. Multiple feeders from MCA and PCA which were electrocoagulated and clipped; the feeders were hard to coagulate. 7 permanent aneurysm clips were applied to feeders. 3. Severe brain swelling; some parts of the ischemic brain were removed. 4. Intraoperative ultrasonography for localization of intracerebral hemorrhage. 5. A bleeding bridging vein was noted at temporal base which casusd acute subdural hemorrhage. It was electrocoagulated. Most of the acute SDH was removed except the one near falx cerebri. 6. Progressive brain swelling was noted during AVM excision. Extended craniectomy was done for decompression.The operative wound was hard to close. Extensive subgaleal dissection was needed. 5. Operative Procedures 1. Under ETGA, the patient was put in supine position and the head was fixed with 3-pin Mayfield head holder and tilted to the left. 2. Shaving, disinfection, and well draping. 3. We made a reverse-U scalp incision over parietal-temporal regions. Max diamter:8 cm. 4. Craniotomy by high speed drills. 5. Dural tenting and curvilinear durotomy. 6. Coagulation of feeders from PCA starting from temporal region. 7. As the feeders were hard to coagulate, we applied aneurysm clips and temporary clips to the feeders for hemostasis. Some bleeding points were packed with Gelfoam and sealed with Floseal. Gradual hemostasis was achieved. The AVM was excised with gradual dissection and coagulation. 8. Due to brain swelling, some parts of the brain was incarcerated and became ischemic. Some of the ischemic brain was removed. 9. Intraoperative ultrasonography was used for evaluation of possible ICH. ICH was removed. 10.Extended craniectomy was done for brain swelling. We also noted acute subdural hemorrhage and its bleeder from a bridging vein. Hematoma was evacuated and its bleeder was electrocoagulated. 11.Dura augmentation was achieved with DuraFoam,and temporalis fascia. 12.After placing a subgaleal CWV drain, the wound closed in layers. 13.A laceration wound due to head pin was noted at right forehead. It was closed primarily with Nylon. 14.The patient was sent to ICU smoothly after doing follow-up brain CT. Operators V.S. 賴達明 Assistants R6 胡朝凱,陳睿生, R5鍾文桂,R4 李振豪,R2楊博智. 相關圖片 許貴滿 (F,1960/09/06,51y6m) 手術日期 2010/07/16 手術主治醫師 鄭乃禎 手術區域 東址 009房 03號 診斷 Carpal tunnel syndrome 器械術式 Burn Debridment <10 BSA 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 黃柏誠, 時間資訊 16:20 通知急診手術 16:50 報到 17:10 進入手術室 17:20 麻醉開始 17:20 抗生素給藥 17:22 誘導結束 17:25 手術開始 17:45 麻醉結束 17:45 手術結束 17:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 深部複雜創傷處理－傷口長５公分以下者 1 0 L 記錄__ 手術科部: 外科部 套用罐頭: Irrigation and drainage 開立醫師: 黃柏誠 開立時間: 2010/07/16 17:49 Pre-operative Diagnosis carpal tunnel symdrome s/p OP and wound abscess formation Post-operative Diagnosis carpal tunnel symdrome s/p OP and wound abscess formation Operative Method Irrigation and drainage Specimen Count And Types nil Pathology nil Operative Findings 1.wound stiches abcess was diagnosis 2.after irrigation and debridement wound was become clean Operative Procedures 1.supine position 2.disinfection and drape 3.incision from previous left operation scar 4.remove all stiches and debridement 5.N/S irrigation and close wound in layers Operators VS鄭乃禎 Assistants R3黃柏誠 Indication Of Emergent Operation 梁鈞強 (M,1928/08/17,83y6m) 手術日期 2010/07/17 手術主治醫師 王國川 手術區域 東址 027房 號 診斷 Subdural and cerebral hemorrhage 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3E 紀錄醫師 何奕瑢, 時間資訊 14:30 臨時手術NPO 14:30 開始NPO 20:30 通知急診手術 00:05 報到 00:32 進入手術室 00:36 麻醉開始 00:45 誘導結束 01:05 抗生素給藥 01:12 手術開始 01:45 手術結束 01:45 麻醉結束 01:55 送出病患 02:00 進入恢復室 03:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Burr hole drainage, left 開立醫師: 李振豪 開立時間: 2010/07/17 01:51 Pre-operative Diagnosis Chronic subdural hematoma, left Post-operative Diagnosis Chronic subdural hematoma, left Operative Method Burr hole drainage, left Specimen Count And Types 1 piece About size:total 6ml within 3 tubes Source:Chronic subdural hematoma Pathology Nil Operative Findings The outer membrane is noted after dural opening. The motor-oil-like fluid gushed out after opening of the outer membrane. The brain is slack after drainage of the chronic subdural hematoma. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine position with head rotated to right. The scalp was shaved, scrubbed, and disinfected as usual. One transverse linear scalp incision was made at left frontal area with 4cm in length. One burr hole was created and dural tenting was performed. The dura was opened with cruciform shape. The outer membrane of the chronic subdural hematoma was noted. After opening of the outer membrane, the motor-oil-like chronic subdural hematoma gushed out. The edge of the dural opening was cauterized with bipolar cautery. The rubber drain was placed and normal saline irrigation was performed. Hemostasis was achieved and externalization of the rubber drain was done. The burr hole was packing with Gelform. And the wound was then closed in layers. Operators VS王國川 Assistants R4李振豪, R1周聖哲 Indication Of Emergent Operation 相關圖片 王駱美菊 (F,1949/11/19,62y3m) 手術日期 2010/07/17 手術主治醫師 曾漢民 手術區域 東址 003房 01號 診斷 Secondary cancer of Brain and spinal cord 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 胡朝凱, 時間資訊 07:35 報到 08:05 進入手術室 08:15 麻醉開始 08:40 誘導結束 09:00 抗生素給藥 09:24 手術開始 12:00 抗生素給藥 12:50 麻醉結束 12:50 手術結束 13:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４～８小時 1 1 R 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 記錄__ 手術科部: 外科部 套用罐頭: craniotomy for tumor excision 開立醫師: 胡朝凱 開立時間: 2010/07/17 13:21 Pre-operative Diagnosis Right frontal tumor Post-operative Diagnosis Right frontal tumor, suspect metastasis Operative Method craniotomy for tumor excision Specimen Count And Types tumor and cystic wall Pathology pending Operative Findings 1.one about 4 cm reddish elastic tumor located at right frontal lobe with uncclear margin. The peripheral brain was gliotic. 2.One cyst was noted below the tumor with dark yellowish fluid inside. 3.Lateral ventricle did not exposed. Operative Procedures 1.ETGA, supine 2.Bicoronal skin incision 3.Reflect skin flap anteriorly 4.Craniotomy that cross the midline 5.Dural tenting 6.Open dura with the base left at forntal base 7.Dissect tumor along the interface between brain and tumor 8.Totoal tumor excision 9.Resect cystic wall 10.Hemostasis with floseal 11.Close dura with periosteum 12.fixed bone back with miniplate 13.Close wound in layers after one CWV drain insertion Operators 曾漢民 Assistants 胡朝凱, Ri 梁梅蘭 (F,1950/04/12,61y11m) 手術日期 2010/07/17 手術主治醫師 郭順文 手術區域 東址 018房 01號 診斷 Malignant neoplasm of bronchus and lung, unspecified 器械術式 Tracheostomy 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3E 紀錄醫師 蔡東明, 時間資訊 07:13 開始NPO 07:13 臨時手術NPO 12:14 通知急診手術 18:30 報到 18:45 進入手術室 18:50 麻醉開始 19:00 誘導結束 19:12 手術開始 19:30 麻醉結束 19:30 手術結束 20:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 氣管切開造口術 1 0 記錄__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 蔡東明 開立時間: 2010/07/17 19:56 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Ditto Operative Method Tracheostomy Specimen Count And Types nil Pathology None Operative Findings Fr . 7 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators VS郭順文 Assistants R3蔡東明 R1吳昭瑩 Indication Of Emergent Operation 羅藍琴珠 (F,1949/11/21,62y3m) 手術日期 2010/07/17 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Parkinson''s disease 器械術式 Stereotaxic procedure for impl 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 面罩麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 鍾文桂, 時間資訊 07:45 報到 08:10 進入手術室 08:20 麻醉開始 08:25 誘導結束 08:50 抗生素給藥 08:55 手術開始 12:50 抗生素給藥 15:25 麻醉結束 15:25 手術結束 15:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Semi-opened mask inhalation anes 1 0 麻醉 Semi-opened INHALATION GENERAL A 4 0 麻醉 SENI-OPENED INHALATION GENERAL A 6 0 手術 立體定位術－功能性失調 1 1 B 手術 立體定位術－功能性失調 1 2 B 手術 深部腦核電生理定位 1 0 記錄__ 手術科部: 外科部 套用罐頭: Implantation of deep brain stimulation leads ... 開立醫師: 鍾文桂 開立時間: 2010/07/21 15:48 Pre-operative Diagnosis Parkinsons disease. Post-operative Diagnosis Parkinsons disease. Operative Method Implantation of deep brain stimulation leads to bilateral subthalamic nuclei. Specimen Count And Types nil Pathology Nil. Operative Findings 1. The left subthalamic nucleus was noted by microelectrodes recording at the planned tract( one tract only). The recording showed hyperactivity. 2. The right subthalamic nucleus was noted by micoeletrodes recording. Two tracts: 1st: increased background at the planned tract with some hyperactivity neurons. 2nd: 2mm anterior to the planned tract target, increased background with minimal hyperactivity. 3. Test stimulation: decreased rigidity, and tremor at left tract. Operative Procedures 1. Under intravenous anesthesia and local anesthesia, the patient was put in supine position and the head was placed in the midline. 2. After shaving,disinfection, and draping, bicoronal incision was made 3. For lead placement, a nickel-sized (14 mm) burr hole was made 1.5 cm lateral to midline and just anterior to coronal suture. A burr-hole ring is affixed to each opening. 4. Prior to lead placement, microelectrode recording (MER) may be used to provide an additional level of target verification. 4. Prior to lead placement, microelectrode recording (MER)was used to provide an additional level of target verification. 5. Stereotactic frame guidance and techniques are then used to place the lead to the targeted area. 5. Stereotactic frame guidance and techniques were used to place the lead to the targeted area. 6. With the patient awake, a test stimulation was performed to confirm good therapeutic benefit at each side. 7. Finally, the leads were secured and the operative wounds were closed in layers. Operators V.S. 曾勝弘 Assistants R5 鍾文桂 相關圖片 張黃雲娥 (F,1938/02/19,74y0m) 手術日期 2010/07/17 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Spondylosis with myelopathy, cervical 器械術式 Diskectomy cervical(Anterier) 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 2 紀錄醫師 胡朝凱, 時間資訊 00:00 臨時手術NPO 12:50 報到 13:15 進入手術室 13:30 麻醉開始 13:50 抗生素給藥 14:00 誘導結束 14:38 手術開始 17:20 手術結束 17:20 麻醉結束 17:30 送出病患 17:30 進入恢復室 19:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 椎間盤切除術－頸椎 1 1 記錄__ 手術科部: 外科部 套用罐頭: Anterior approach for discectomy and cage ins... 開立醫師: 游健生 開立時間: 2010/07/17 18:06 Pre-operative Diagnosis C3~4 HIVD Post-operative Diagnosis C3~4 HIVD Operative Method Anterior approach for discectomy and cage insertion Specimen Count And Types nil Pathology nil Operative Findings 1.Protrusion disc at C3~4 level, the protruding part became hard and adhesion to PLL. 2.A small unintensive durotomy was found 3.The disc was dehydrated Operative Procedures 1.ETGA, supine 2.Right neck transverse skin incision was done 3.Dissection along the anterior border of SCM muscle to reach the prevertebral space 4.detach longus coli 5.discectomy 6.cage insertion 7.hemostasis 8.Set one CWV drain 9.Close wound in layers Operators 賴達明 Assistants 胡朝凱, Ri 陳文龍 (M,1936/08/14,75y7m) 手術日期 2010/07/17 手術主治醫師 王國川 手術區域 東址 002房 01號 診斷 Head Injury 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3E 紀錄醫師 游健生, 時間資訊 20:30 臨時手術NPO 20:30 開始NPO 21:04 通知急診手術 08:50 報到 09:05 進入手術室 09:10 麻醉開始 09:15 抗生素給藥 09:20 誘導結束 09:50 手術開始 10:30 手術結束 10:30 麻醉結束 10:40 送出病患 10:45 進入恢復室 11:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Burrhole drainage, right 開立醫師: 游健生 開立時間: 2010/07/17 11:00 Pre-operative Diagnosis Right frontotemporoparietal chronic subdural hematoma Post-operative Diagnosis Right frontotemporoparietal chronic subdural hematoma Operative Method Burrhole drainage, right Specimen Count And Types 1 piece About size:9cc Source:subdural hematoma in 3 tubes Pathology Nil Operative Findings Moderated amount dark-red fluid was noted at subdural space, at least 35cc. 10cc was sent for biochemistry and routine study. Operative Procedures Under ETGA, patient was put into supine position with head rotated to left and tilted up. After shaving, we disinfected and draped the operation field as usual. A linear incision was made over right parietal scalp. Wound was retracted by self-retaining retractor. Raney clips were applied to scalp edge for temporary hemostasis. After 2cm diameter trephination, we opened the dura in a cruciate fashion and electrocautery the edge with bipolar. The outer membrane of the hematoma was then opened and coagulated after dura tenting. The liquified old blood in the subdural space was drained, then thoroughly irrigated with N.S. through a rubber tube until the return was pink-red. After fixing the rubber tube, we packed the burrhole with Gelfoam. Then, we closed the wound in layers and expelled the subdural air through rubber tube. Operators VS王國川 Assistants R3游健生 Indication Of Emergent Operation 呂芳燻 (M,1932/01/11,80y2m) 手術日期 2010/07/19 手術主治醫師 郭順文 手術區域 東址 018房 01號 診斷 Bronchus and lung cancer 器械術式 Thoracoscopy+Open Chest 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 趙安怡 ASA 3 紀錄醫師 鄒冠全, 時間資訊 00:05 臨時手術NPO 07:45 報到 08:03 進入手術室 08:10 麻醉開始 08:35 手術開始 08:35 抗生素給藥 08:50 誘導結束 12:30 抗生素給藥 13:00 麻醉結束 13:00 手術結束 13:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 術後止痛 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 手術 胸腔鏡肺葉切除術 1 1 R 手術 根除性淋巴切除術（肺葉切除或全肺切除時） 1 2 R 麻醉 C.V.P. catheter in ubation 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: VATs lobectomy+ lymph node dissection 開立醫師: 李佳穎 開立時間: 2010/07/19 13:20 Pre-operative Diagnosis Right upper lobe lung cancer, adenocarcinoma Post-operative Diagnosis Right upper lobe lung cancer, adenocarcinoma Operative Method VATs lobectomy+ lymph node dissection Specimen Count And Types 4 pieces About size:8*10CM Source:RUL About size:2*2cm Source:Gr.3,4 About size:2*1cm Source:Gr.7 About size:1*1cm Source:Gr.11 Pathology pending Operative Findings 1. A 5*3cm whitish, firm-elastic tumor at RUL 2. Enlarge lymph node, blackish at Gr.7, 3, 4, and 11 3. Minimal pleural effusion Operative Procedures 1. ETGA with blocker, left decubitus 2. Skin disinfection and draping as usual 3. VATs setting: 12-15-40mm 4. Identify tumor, dissect major fissure with Endo-GIA 5. Transect PV, PA, bronchus with Endo-GIA 6. Lymph node dissection of Gr.3,4,7 7. N/S irrigation, hemostasis, check air leakage 8. Set one Fr.28 chest tube, close wound in layers Operators 郭順文, 林孟暐 Assistants CR李佳穎, R3鄒冠全 邱馨儀 (F,1968/06/17,43y8m) 手術日期 2010/07/19 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Facial spasm 器械術式 Microvascular decompression 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 游健生, 時間資訊 07:40 報到 08:06 進入手術室 08:10 麻醉開始 08:50 誘導結束 08:53 抗生素給藥 09:45 手術開始 11:53 抗生素給藥 12:55 麻醉結束 12:55 手術結束 13:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顏面神經減壓術 1 1 L 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 摘要__ 手術科部: 外科部 套用罐頭: Left retrosigmoid approach for microvascular ... 開立醫師: 李振豪 開立時間: 2010/07/19 13:12 Pre-operative Diagnosis Left hemifacial spasm Post-operative Diagnosis left hemifacial spasm Operative Method Left retrosigmoid approach for microvascular decompression Specimen Count And Types nil Pathology Nil Operative Findings An arterial loop from anterior inferior cerebellar artery branch crossed in between the 7th and 8th cranial nerve. It compressed the 7th CN at nerve exit zone. It was pushed and kept away from the nerve with teflon felt cotton. The 7th nerve was well decompressed after surgery. Operative Procedures Under ETGA, patient was put into supine position with left shoulder elevated and pulled caudally. Her head turned right fixed with Mayfield headholder and neck flex to make mastoid process the highest of surgical field. After shaving, we disinfected and draped the operation field as usual. A reversed S-shaped skin incision was made 2.5cm postieror to auricle with center at the junction of tranverse and sigmoid sinus. Then, we dissected the muscles to expose cranium and harvested a fascia. A 2x2cm craniectomy was done at suboccipital retromastoid closed to mastoid tip. We performed a linear durotomy followed by CSF drainage after cutting open the arachnoid membrane. After coagulating a superficial vein, the cerebellum was retracted with retractor posterio-inferiorly to expose the 7th & 8th cranial nerves. An arterial loop from AICA branch crossing in between these two nerves was indentified. It compressed the 7th nerve and was dissected away from the nerve. The arterial loop was kept away from the nerve by inserting teflon felt cotton in between them. We achieved hemostasis and closed the dura with watertight continuous 3-0 prolene suture and a fasica as dura graft. Finally, we closed the wound in layers. Operators Prof. 杜永光 Assistants R6 胡朝凱 R3 游健生 林于喬 (F,1980/12/25,31y2m) 手術日期 2010/07/19 手術主治醫師 杜永光 手術區域 東址 003房 02號 診斷 Spine tumor 器械術式 Malignant intraspinal tumor, e 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 游健生, 時間資訊 12:48 報到 13:25 進入手術室 13:30 麻醉開始 14:15 誘導結束 14:22 抗生素給藥 14:47 手術開始 17:47 抗生素給藥 21:00 手術結束 21:00 麻醉結束 21:15 送出病患 21:20 進入恢復室 22:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 7 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 惡性病髓腫瘤切除術 1 1 摘要__ 手術科部: 外科部 套用罐頭: Laminoplasty for intramedullary tumor excisio... 開立醫師: 游健生 開立時間: 2010/07/19 21:13 Pre-operative Diagnosis T6-10 intramedullary tumor Post-operative Diagnosis T6-10 intramedullary tumor, favor low-grade astrocytoma Operative Method Laminoplasty for intramedullary tumor excision (nearly total tumor excision), T6-10 Specimen Count And Types 1 piece About size:pieces from tumor Source:intramedullary tumor Pathology Pending. Frozen section: grade 2 astrocytoma Operative Findings The tumor was yellowish and soft, extending from T6-T10. The tumor border was not clear. The spinal cord was compressed as paper thin. Part of the tumor protuded out from the cord surface. Part of protuded tumor was not removed because the plane between normal cord was not clear. Pre-operative SSEP was low in amplitude and there was no changes during surgery. Operative Procedures Under ETGA, patient was put into prone position. We located the T6 and T10 pedicle level with C-arm. Then, we scrubbed, disinfected, and draped the operation field as usual. A midline incision was made from T5 spinous process to T10 spinous process. We detached the paraspinal muscle and exposed bilateral T6-10 facet joints and laminae. The laminal arches were removed by cutting through at bilateral laminopedicle juction by a 2 mm head size high speed air drill. It was followed by ligmentum flavum and epidural fat removal. After hemostasis, we opended the dura in layers over the tumor region. The part of tumor expanding out of spinal cord was identified after arachnoid space was opended. We removed part of the tumor for frozen section. Then, we dissected the tumor away from normal cord along the gliotic plane. The tumor was removed in pieces with the help of CUSA. We closed the dura with watertight continuous 3-0 prolene suture. Laminal arches were fixed back with mini-plates. We closed the wound in layers following an epilaminal CWV drain placement. Operators Prof. 杜永光 Assistants R6 胡朝凱 R3 游健生 許恒嘉 (M,1981/08/08,30y7m) 手術日期 2010/07/19 手術主治醫師 杜永光 手術區域 東址 018房 03號 診斷 Aneurysm 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 何奕瑢, 時間資訊 14:53 報到 15:08 進入手術室 15:15 麻醉開始 15:30 誘導結束 15:44 抗生素給藥 16:15 手術開始 17:47 手術結束 17:47 麻醉結束 17:57 送出病患 18:04 進入恢復室 19:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 開顱術摘除血管病變－動靜脈畸型－小型－表淺 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: vascular malformation removal 開立醫師: 陳德福 開立時間: 2010/07/19 18:12 Pre-operative Diagnosis scalp AVM Post-operative Diagnosis scalp AVM Operative Method vascular malformation removal Specimen Count And Types 1 piece About size:0.5 X0.5*1CM Source:scalp AVM Pathology pending Operative Findings 1.There is a vascular malformation with arterial feeders from bilateral anterior branch of STA. The engorged venous draiange is superficial and drained to the scalp layer. 2.The vascular lesion was removed totally under microscope. Operative Procedures The arterial feeders was identified by Doplex. Under ETGA and supine position, the scalp was disinfected and draped as usual. One curvilinear incision along right frontal area was done and the vascular anomaly was identified under microscopic surgery. The arterial feeders was coagulazied and cut first. The engorged venous draiange was removed as well. The wound was then closed in layers. Operators P 杜永光 Assistants R5 陳德福 R1 何奕瑢 相關圖片 張蓓萱 (F,1955/03/20,56y11m) 手術日期 2010/07/19 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 3 紀錄醫師 王奐之, 時間資訊 07:40 報到 08:25 進入手術室 08:30 麻醉開始 08:50 誘導結束 09:10 手術開始 09:10 抗生素給藥 12:10 抗生素給藥 12:50 麻醉結束 12:50 手術結束 12:55 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 顱底瘤手術 1 1 R 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 R 記錄__ 手術科部: 外科部 套用罐頭: Right frontal craniotomy for Simpson grade 3 ... 開立醫師: 王奐之 開立時間: 2010/07/19 13:23 Pre-operative Diagnosis Tuberculum sella meningioma Post-operative Diagnosis Tuberculum sella meningioma Operative Method Right frontal craniotomy for Simpson grade 3 tumor removal Specimen Count And Types 1 piece About size:1.5*1*1cm Source:skull base tumor Pathology Pending Operative Findings A whitish tumor with well encapsulation was noted at pituitary fossa, adjacent to the pituitary gland and pituitary stalk. The optic tracts and optic chiasm were not involved. The superior sagittal sinus was teared during craniotomy, the bleeder was packed with gelfoam and FloSeal. A small part of tumor behind the pituitary stalk was left untouched. Operative Procedures After ETGA, the patient was placed in supine position with neck slightly extended and head fixing with Mayfield skull clamp. After shaving, skin disinfection and draping in sterile fashion, a bicoronal scalp insicion was made. After exposing the frontal bone, a right frontal craniotomy was done. A U-shaped durotomy was performed, and the frontal lobe was retracted upwards. The optic chiasm and right optic tract were identified, exposing the tumor. The tumor was then dissected and removed en bloc. After tumor removal, the pituitary stalk was seen and left untouched. After meticulous hemostasis with bipolar electrocauterization and FloSeal, the dura was close with fascial graft and DuroFoam in water-tight fashion. The skull was then fixed back, and a subgaleal CWV drain was set. The operation ended with wound closure in layers. Operators VS 曾漢民 Assistants R5 鍾文桂, R3 王奐之 相關圖片 戴賴富 (F,1943/02/07,69y1m) 手術日期 2010/07/19 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Pituitary tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 3 紀錄醫師 王奐之, 時間資訊 13:30 進入手術室 13:32 麻醉開始 13:59 誘導結束 14:00 抗生素給藥 14:14 手術開始 15:30 手術結束 15:30 麻醉結束 15:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經由蝶竇之腦下垂體瘤切除 1 1 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 記錄__ 手術科部: 外科部 套用罐頭: Trans-sphenoid adenomectomy 開立醫師: 王奐之 開立時間: 2010/07/19 16:04 Pre-operative Diagnosis Pituitary macroadenoma Post-operative Diagnosis Pituitary macroadenoma Operative Method Trans-sphenoid adenomectomy Specimen Count And Types 1 piece About size:1*1*1cm in pieces Source:pituitary tumor Pathology Pending Operative Findings The tumor is soft in consistency, white-reddish in color. The arachnoid membrane was grossly intact but some CSF leakage was noted after tumor removal; the arachnoid was packed with gelfoam and Tissucol Duo. Operative Procedures After ETGA, the patient was placed in supine position with neck slightly extended. After skin disinfection and draping in sterile fashion, the right nostril was entered. After fraturing the vomer bone and the anterior wall of sphenoid sinus, the pituitary fossa base was then seen. After opening the pituitary base, the tumor was exposed. The tumor was removed piece by piece with tumor forceps. The arachnoid membrane was visualized after tumor removal, CSF leakage was noted and packed with gelfoam & Tissucol Duo. The fracture bone was put back, the nostrils were then packed with nasal packings. Operators VS 曾漢民 Assistants R6 陳睿生, R3 王奐之 相關圖片 詹汝 (F,1959/09/20,52y5m) 手術日期 2010/07/20 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Cervical Spondylosis 器械術式 Anterior Spinal fusion(TZENG) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳德福, 時間資訊 08:10 進入手術室 08:15 麻醉開始 08:25 誘導結束 08:30 抗生素給藥 08:56 手術開始 11:05 麻醉結束 11:10 手術結束 11:15 送出病患 11:20 進入恢復室 13:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術－頸椎 1 1 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 摘要__ 手術科部: 外科部 套用罐頭: Anterior cervical diskectomy and fusion with ... 開立醫師: 陳德福 開立時間: 2010/07/20 11:14 Pre-operative Diagnosis Cervical HIVD with spinal stenosis and radiculopathy, C5-6 Post-operative Diagnosis Cervical HIVD with spinal stenosis and radiculopathy, C5-6 Operative Method Anterior cervical diskectomy and fusion with artificial cage Specimen Count And Types nil Pathology nil Operative Findings 1.There is herniated disc with severe osterphytes formation at the C5-6 level. The bilateral nerve foramina were stenotic and the osteophytes was removed for decompression. 1.There is herniated disc with severe osterphytes formation at the C5-6 level. The bilateral nerve foramina were stenotic and the osteophytes was removed for decompression the nerve roots and spinal cord. 2.The C5-6 disc was removed and one No#6 cervical cage was implanated at the C5-6 level smoothly. Operative Procedures Under ETGA and supine position with neck hyperextension, the skin was disinfected and draped as usual. One linear incision along the skin crease on the left anterior neck was done and the platysma was transected. The areolar plane between the anterior catotid sheath and the cervical muscle was identified. The prevertebral space of C5-6 was found and we check the location under flouroscope. The longus coli muscle was mildly detached and we set Caspar retractor to expose the anterior C5-6 space. The ALL was opened and the C5-6 disc was removed by curretage and aligator. The osteophyte was removed by air-drill and Kerrison. The PLL was opened the expose the dura. The bilateral nerve foramina was decompressed and the thecal sac reexpanded well. One No#6 cervical cage was inserted in the C5-6 space anteriorly. After hemostasis, the wound was closed in layers. Operators AP 曾勝弘 Assistants R5 陳德福 相關圖片 趙簡榮 (M,1949/04/01,62y11m) 手術日期 2010/07/20 手術主治醫師 曾勝弘 手術區域 東址 005房 02號 診斷 Cervical spondylosis 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳德福, 時間資訊 11:20 報到 11:40 進入手術室 11:45 麻醉開始 11:50 誘導結束 12:20 抗生素給藥 12:33 手術開始 15:12 手術結束 15:12 麻醉結束 15:20 送出病患 15:25 進入恢復室 16:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 手術 椎間盤切除術－頸椎 1 1 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 摘要__ 手術科部: 外科部 套用罐頭: anterior cervical diskectomy and fusion with ... 開立醫師: 陳德福 開立時間: 2010/07/20 12:00 Pre-operative Diagnosis Cervical HIVD with spinal stenosis Cervical HIVD with spinal stenosis, c6-7 Post-operative Diagnosis Cervical HIVD with spinal stenosis Cervical HIVD with spinal stenosis, c6-7 Operative Method anterior cervical diskectomy and fusion with artificial cage Specimen Count And Types nil Pathology nil Operative Findings 1.There is herniated disc with severe osterphytes formation at the C5-6 level. The bilateral nerve foramina were stenotic and the osteophytes was removed for decompression the nerve roots and spinal cord. 1.There is herniated disc with severe osterphytes formation at the C6-7 level. The bilateral nerve foramina were stenotic and the osteophytes was removed for decompression the nerve roots and spinal cord. 2.The C6-7 disc was removed and one No#6 cervical cage was implanated at the C6-7 level smoothly. 2.The C6-7 disc was removed and one No#7 cervical cage was implanated at the C6-7 level smoothly. Operative Procedures Under ETGA and supine position with neck hyperextension, the skin was disinfected and draped as usual. One linear incision along the skin crease on the left anterior neck was done and the platysma was transected. The areolar plane between the anterior catotid sheath and the cervical muscle was identified. The prevertebral space of C6-7 was found and we check the location under flouroscope. The longus coli muscle was mildly detached and we set Caspar retractor to expose the anterior C6-7 space. The ALL was opened and the C6-7 disc was removed by curretage and aligator. The osteophyte was removed by air-drill and Kerrison. The PLL was opened the expose the dura. The bilateral nerve foramina was decompressed and the thecal sac reexpanded well. One No#6 cervical cage was inserted in the C-76 space anteriorly. After hemostasis, the wound was closed in layers. Operators AP 曾勝弘 Assistants R5 陳德福 相關圖片 林慧馨 (F,1944/12/23,67y2m) 手術日期 2010/07/20 手術主治醫師 林峰盛 手術區域 西址 035房 08號 診斷 Herniation of intervertebral disc 器械術式 Nerve block / PC 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 硬肌麻醉 麻醉主治醫師 林峰盛 ASA 1 時間資訊 16:00 進入手術室 16:05 麻醉開始 16:07 誘導結束 16:10 手術開始 16:25 手術結束 16:25 麻醉結束 16:35 送出病患 記錄__ 手術科部: 麻醉部 套用罐頭: LENB 開立醫師: 林峰盛 開立時間: 2010/07/20 16:33 Pre-operative Diagnosis HIVD Post-operative Diagnosis HIVD Operative Method LENB& root block Specimen Count And Types nil Pathology Nil Operative Findings Operative Procedures LA with 1% xylocaine 5 ml pt in prone position Under fluoroscopic-guidance, LENB and right L4-5 root block was done to L4-5 level with 18G Tuohy needle, 60mg Kenacort in 0.5% xylocaine 6ml Operators 林峰盛, Assistants 王曼玲, 賴俞嘉 (F,2004/09/04,7y6m) 手術日期 2010/07/20 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Anomalies of spinal cord 器械術式 Cord untethering -KUO 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 2 紀錄醫師 李振豪, 時間資訊 07:53 報到 08:10 進入手術室 08:15 麻醉開始 08:25 誘導結束 09:00 抗生素給藥 09:14 手術開始 10:50 手術結束 10:50 麻醉結束 11:00 進入恢復室 11:00 送出病患 12:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎內脊髓內腫瘤切除術 1 1 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 記錄__ 手術科部: 外科部 套用罐頭: Intramedullary tumor excision for untethering 開立醫師: 李振豪 開立時間: 2010/07/20 11:13 Pre-operative Diagnosis Tethered cord syndrome Post-operative Diagnosis Tethered cord syndrome Operative Method Intramedullary tumor excision for untethering Specimen Count And Types 1 piece About size:0.5x0.3x0.2cm Source:L2 intramedullary tumor Pathology Pending Operative Findings The terminal filum was infiltrated with adipose tissue. The cord was tethered tightly. After transection of the terminal filum at L3 level, the filum was dissected toward proximal part. The filum was infiltrated with adipose tissue and removed at proximal L2 level. The cord was untethered well after removal of the tumor. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in prone position. The L2 spinous process was identified by portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. The midline skin incision was made from L2 to L3 level. The subcutaneous soft tissue was dissected and the paravertebral muscle group was detached. Laminotomy was performed at L2-3 level and the thecal sac was identified. Linear durotomy was performed and the CSF was drained out. The intramedullary tumor was found and the nerve root was dissected from the tumor. After isolation of the tumor from the roots, the distal part of the terminal filum was transected. The tumor was then dissected away from the roots and removed. Hemostasis was achieved with bipolar cautery and Gelform packing. The durotomy was closed with 5-0 Prolene. The wound was then closed in layers with 4-0 silk, 3-0 Vicryl, and 4-0 Nylon. Operators AP郭夢菲 Assistants R4李振豪 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Intramedullary tumor excision for untethering 開立醫師: 郭夢菲 開立時間: 2010/07/20 17:12 Pre-operative Diagnosis Tethered cord syndrome due to intraspinal lipoma Post-operative Diagnosis Tethered cord syndrome due to intraspinal lipoma Operative Method Intramedullary tumor excision for untethering via partial L2 and L3 laminotomy Specimen Count And Types 1 piece About size:0.5x0.3x0.2cm Source:L2 intramedullary tumor Pathology Pending Operative Findings The terminal filum was infiltrated with adipose tissue. The cord was tethered tightly. After transection of the terminal filum at L3 level, the filum was dissected toward proximal part. The filum was infiltrated with adipose tissue and removed at proximal L2 level. The cord was untethered well after removal of the tumor. The conus medullaris and filum terminal were infiltrated with intraspinal cuadal lipoma. There were two nerve roots encased by the adipose tissue. They weredissected and preserved well. The lipoma was subtotally removed and the terminal filum was transected to get a complete untethering. The cord was tethered tightly. After untethering, the terminla cord migrated upward and abd distal end of the filum migrated downward out of the surgical field. The terminal filum was infiltrated with adipose tissue. The cord was tethered tightly. After transection of the terminal filum at L3 level, the filum was dissected toward proximal part. The filum was infiltrated with adipose tissue and removed at proximal L2 level. The cord was untethered well after removal of the tumor. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in prone position. The L2 spinous process was identified by portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. The midline skin incision was made from L2 to L3 level. The subcutaneous soft tissue was dissected and the paravertebral muscle group was detached. Laminotomy was performed at L2-3 level and the thecal sac was identified. Linear durotomy was performed and the CSF was drained out. Under endotracheal tube general anesthesia, the patient was put in prone position. The L2 spinous process was identified by portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. The midline skin incision was made from L2 to L3 level. The subcutaneous soft tissue was dissected and the paravertebral muscle group was detached. Laminotomy was performed at the lower part of L2 and upper of the L-3. The thecal sac was identified under microscopic view. Linear durotomy was performed and the CSF was drained out. The intramedullary tumor was found and the nerve root was dissected from the tumor. After isolation of the tumor from the roots, the distal part of the terminal filum was transected. The tumor was then dissected away from the roots and removed. Hemostasis was achieved with bipolar cautery and Gelform packing. The durotomy was closed with 5-0 Prolene. The wound was then closed in layers with 4-0 silk, 3-0 Vicryl, and 4-0 Nylon. The intramedullary tumor was found and the encased nerve roots were dissected from the tumor. After isolation of the tumor from the roots, the lipoma on the terminal cord was partially removed and the terminal filum was transected. Hemostasis was achieved with bipolar cautery and Gelform packing in epidural space. The durotomy was closed with 5-0 Prolene. The wound was then closed in layers with 4-0 silk, 3-0 Vicryl, and 4-0 Nylon. Under endotracheal tube general anesthesia, the patient was put in prone position. The L2 spinous process was identified by portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. The midline skin incision was made from L2 to L3 level. The subcutaneous soft tissue was dissected and the paravertebral muscle group was detached. Laminotomy was performed at L2-3 level and the thecal sac was identified. Linear durotomy was performed and the CSF was drained out. The intramedullary tumor was found and the nerve root was dissected from the tumor. After isolation of the tumor from the roots, the distal part of the terminal filum was transected. The tumor was then dissected away from the roots and removed. Hemostasis was achieved with bipolar cautery and Gelform packing. The durotomy was closed with 5-0 Prolene. The wound was then closed in layers with 4-0 silk, 3-0 Vicryl, and 4-0 Nylon. Operators AP郭夢菲 Assistants R4李振豪 相關圖片 林婷怡 (F,2005/11/19,6y3m) 手術日期 2010/07/20 手術主治醫師 郭夢菲 手術區域 兒醫 067房 02號 診斷 Lower limb connective tissue benign neoplasm 器械術式 Scalp tumor Suture 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 2 紀錄醫師 李振豪, 時間資訊 10:40 報到 11:10 進入手術室 11:15 麻醉開始 11:25 誘導結束 11:40 抗生素給藥 11:54 手術開始 14:40 抗生素給藥 15:15 手術結束 15:15 麻醉結束 15:40 進入恢復室 15:45 送出病患 16:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 軟組織良性腫瘤切除術，大或深 1 1 R 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 R 手術 石膏副木固定－長腿 1 0 手術 神經分離術–肩，臀關節以上，包括臂神經叢，坐骨神經 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 記錄__ 手術科部: 外科部 套用罐頭: Tumor excision 開立醫師: 李振豪 開立時間: 2010/07/20 16:09 Pre-operative Diagnosis Right popliteal tumor, suspect lipoma Right popliteal tumor, suspect fibrolipoma Post-operative Diagnosis Right popliteal tumor, suspect fibrolipoma Operative Method Tumor excision Specimen Count And Types 1 piece About size:2x1.5x1.5cm Source:Right popliteal fossa tumor Pathology Pending Pending. Previous biopsy at CGMH shoed fibrolipomatous tissue Operative Findings The tumor was hypervascularized, soft to elastic, most well-defined in character. There is much dilated vascular channel within the tumor. The tumor was adhered with the adjacent soft tissue with much fibrotic anchor. The peroneal nerve was well preserved during the operation. The popliteal artery was not exposed but palpable. The tumor was hypervascularized, soft to elastic, most well-defined in character but was adhered with the adjacent soft tissue, especially the muscles with much fibrotic anchor. There is much dilated vascular channel overlying the tumor capsule and within the tumor. The common peroneal nerve was well preserved during the operation. The popliteal artery was not exposed but palpable. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in prone position. The skin was scrubbed, disinfected, and draped as usual. The linear skin incision was made along previous op scar. The subcutaneous soft tissue was dissected and the peroneal nerve was identified. Under operative microscopy assisted, the popliteal fossa tumor was identified ans dissected along the margin. The fibrotic band was transected and the vascular channel was coagulated with bipolar cautery. Hemostasis was checked. One subcutaneous CWV drain was placed and the wound was closed in layers with 3-0 Vicryl and 4-0 Nylon. Under endotracheal tube general anesthesia, the patient was put in prone position. The skin was scrubbed, disinfected, and draped as usual. The linear skin incision was made along previous op scar at right popliteal fossa. The subcutaneous soft tissue was dissected and the common peroneal nerve was identified and protected. Under operative microscopy assisted, the popliteal fossa tumor was identified ans dissected along the margin. The fibrotic band was transected and the vascular channel was coagulated with bipolar cautery. Hemostasis was checked. One subcutaneous CWV drain was placed and the wound was closed in layers with 3-0 Vicryl and 4-0 Nylon. Operators AP郭夢菲 Assistants R4李振豪 洪翌洧 (M,2010/06/13,1y9m) 手術日期 2010/07/20 手術主治醫師 陳益祥 手術區域 兒醫 068房 01號 診斷 先天性心臟病 器械術式 Repair TF, V.S.D., E.C.D.,TC 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 4 紀錄醫師 張得一, 時間資訊 08:25 報到 08:30 進入手術室 08:35 麻醉開始 09:35 誘導結束 09:45 抗生素給藥 09:56 手術開始 12:45 抗生素給藥 14:48 開始輸血 15:45 抗生素給藥 16:45 麻醉結束 16:45 手術結束 16:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 體外心肺循環 1 1 手術 四合群症之修補（Ｔ．Ｆ） 1 1 手術 瓣膜成形術 1 2 手術 主動脈－肺動脈開窗之修補手術 1 4 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 8 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 4 0 麻醉 Hemoglobin (Hb) 4 0 麻醉 測血糖 4 0 麻醉 Ca (Calcium) 4 0 麻醉 Na (Sodium) 4 0 麻醉 K (Potassium) 4 0 麻醉 Cl (Chloride) 4 0 麻醉 Blood gas analysis 4 0 記錄__ 手術科部: 套用罐頭: 1.VSD repair with intracardiac baffle from VS... 開立醫師: 張得一 開立時間: 2010/07/20 17:53 Pre-operative Diagnosis DORV, subaortic VSD, ASD, PDA, LPA sling, trachea stenosis Post-operative Diagnosis DORV, subaortic VSD, ASD, PDA, LPA sling, trachea stenosis Operative Method 1.VSD repair with intracardiac baffle from VSD to aortic valve 2.RVOT patch augmentation 3.PFO closure 4.TVP 5.PDA division 6.LPA reimplantation 7.Slide tracheoplasty Specimen Count And Types nil Pathology nil Operative Findings 1.Situs solitus, levocardia, left arch 2.Severely anterior malalignment of conal septum, with aortic valve overriding on RVOT => DORV 3.Mitral-Aortic discontinuity(+) 4.VSD ~ 1.0cm, PFO: 2mm 5.LPA originating posteriorly from proximal RPA, coursing behind trachea to left hilum 6.MPA: 8mm, RPA: 6mm, LPA: 3mm 7.Long segment of tracheal stenosis, diameter 2mm, after slide tracheoplasty, diameter: 5mm 8.PDA(+), 2.5mm in diameter 9.No innominate vein, PLSVC(+) Operative Procedures 1.ETGA, supine, skin disinfection, midline sternotomy 2.Harvest pericardium, treated with glutaldehyde 3.CPB with innominate a. (via 3mm Goretex), PLSVC, IVC, RAA -> RSVC (cardiotomy suction), cooling to 18^C, PDA division 4.Aortic cross clamp, antegrade cardioplegia infusion (HTK solution) 5.Under low-flow deep hypothermia circulation (flow 50~200ml/min), RA, RVOT were incised 6.INcision of conal septum from VSD 7.VSD repair with intracardiac baffle with 15 x 6-0 pledgetted Prolene suture + Dacron patch 8.RVOT patch augmentation with Goretex patch. 9.TVP by closure of commisure between septal and posterior leaflet 10.PFO primary closure with 5-0 Prolene 11.RA closure, resume CPB, rewarm 12.LPA transection, division of proximal stump with 6-0 Prolene 13.Translocation of LPA left to MPA, end-to side anastomosis of LPA with MPA, augmentation with glualdehyde-treated pericardial patch 14.Slide tracheoplasty(~1/3 length of trachea, with 5-0 Maxon suture 15.Rewarm, deair, wean off CPB 16.Set 4 x C/Ts (mediastinum x 2, bilateral plerual cavities x 2) Set RAP 17.Sternum unapproximated, covered with silicon membrane Operators P 陳益祥 Assistants R5謝永 R3張得一 林梁悅 (F,1939/09/22,72y5m) 手術日期 2010/07/20 手術主治醫師 黃勝堅 手術區域 東址 003房 01號 診斷 Head Injury 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 07:51 報到 08:05 進入手術室 08:12 麻醉開始 08:17 誘導結束 08:29 抗生素給藥 09:01 手術開始 10:45 手術結束 10:45 麻醉結束 10:53 送出病患 10:58 進入恢復室 13:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 頭顱成形術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Cranioplasty. 開立醫師: 鍾文桂 開立時間: 2010/07/20 11:08 Pre-operative Diagnosis Skull bone defect,right frontal-parietal-temporal. Post-operative Diagnosis Skull bone defect,right frontal-parietal-temporal. Operative Method Cranioplasty. Specimen Count And Types nil Pathology Nil. Operative Findings 1. Intact dura mater. 2. autologous skull bone was used.3. blood loss: 100cc. Operative Procedures Under ETGA,the patient was placed in supine position and the head was tilted to the left. After shaving and disinfection, the previous operative wound was incised. Dissection was made along the subgaleal plane. We left the temporalis muscle together with the dura mater below. The patients skull bone which was brought from the refrigirator was disinfected with Gentamicin solution. The bone plate was fixed with miniplates and screws. After placing one subgaleal CWV drian, the wound was closed in layers. The patient was sent to POR smoothly. Operators V.S.黃勝堅 Assistants R5鍾文桂 R2楊博智 相關圖片 李美足 (F,1961/10/26,50y4m) 手術日期 2010/07/20 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Spondylosis without myelopathy, cervical 器械術式 Laminectomy C-Spinal(Posterier 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 10:12 10:30 報到 11:03 進入手術室 11:08 麻醉開始 11:30 誘導結束 11:45 抗生素給藥 12:20 手術開始 14:50 抗生素給藥 15:00 手術結束 15:00 麻醉結束 15:10 送出病患 15:15 進入恢復室 17:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 手術 椎弓整形術 1 1 記錄__ 手術科部: 神經部 套用罐頭: Laminoplasty, open door method, C3-6. 開立醫師: 鍾文桂 開立時間: 2010/07/20 15:30 Pre-operative Diagnosis Cervical stenosis and ossification of posterior longitudinal ligament, C3-6 Post-operative Diagnosis Cervical stenosis and ossification of posterior longitudinal ligament, C3-6 Operative Method Laminoplasty, open door method, C3-6. Specimen Count And Types nil Pathology Nil. Operative Findings Plates and screws for widending of spinal canal. Open door method: left side. Intact dura mater. Operative Procedures Under ETGA, the patient was put prone position and the head was fixed with Mayfield 3-pin head holder. After shaving, disinfection, and draping, midline incision was from C2-C7 level. Midline dissection was made to reach cervical spine. After exposure of C3-C6 lamina, we made grooves over bilateral lamina. The left groove was splited and the left laminae from C3-C6 were elevated. The space was fixed with plates and screws. After well hemostasis and placement of one CWV drain, the wound was closed in layers. Operators V.S 賴達明 Assistants R5鍾文桂 R2 楊博智 相關圖片 李美玉 (F,1956/05/27,55y9m) 手術日期 2010/07/20 手術主治醫師 賴達明 手術區域 西址 033房 01號 診斷 Carpal tunnel syndrome 器械術式 Neurolysis of the uluar neuve 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 08:28 報到 09:10 進入手術室 09:33 麻醉開始 09:35 手術開始 10:05 麻醉結束 10:05 手術結束 10:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 神經分離術－手．足之神經 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Carpal Tunnel Syndrome 開立醫師: 陳睿生 開立時間: 2010/07/20 10:34 Pre-operative Diagnosis Right side carpal tunnel syndrome Post-operative Diagnosis Right side carpal tunnel syndrome Operative Method Carpal Tunnel Syndrome Specimen Count And Types nil Pathology Nil Operative Findings The palmaris longus tendon was thicken and compressed the median nerve tightly. After cutting down the tendon, the reddish nerve was well decompressed. The transverse carpal ligament was thicken and compressed the median nerve tightly. After cutting down the tendon, the reddish nerve was well decompressed. Operative Procedures 1.The hand and forearm were sterilized with povidone-iodine tincture, then covered with stockinet. 2.Anesthesia: tourniquet was applied at distal upper arm, then regional block with 15 ml 1% Xylocaine solution was infused through cephalic vein catheter at wrist area. 3. Incision: S shape from vertical palmar crease to transverse wrist crease. 4.The palmaris longus tendon was identified, then the plamar aponeurosis was cut longitidinally along the ulnar side of the palmaris longus tendon. 5. Themedian nerve was identified beneath the palmars longus tendon. Under direct vision, the transverse carpal ligament was divided until no more pressure on the median nerve could be palpated. 6. The skin was closed by interrupted suture with 4/0 nylon.7.The tourniquet was released. The hand and wrist were draped with fluffy dressing and elastic bandage. Operators VS 賴達明 Assistants R6 陳睿生 彭馨儀 (F,1976/07/12,35y8m) 手術日期 2010/07/21 手術主治醫師 曾漢民 手術區域 東址 005房 03號 診斷 Pituitary Tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 王奐之, 時間資訊 16:05 進入手術室 16:10 麻醉開始 16:40 誘導結束 16:40 抗生素給藥 17:08 手術開始 18:30 手術結束 18:30 麻醉結束 18:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經由蝶竇之腦下垂體瘤切除 1 1 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 記錄__ 手術科部: 外科部 套用罐頭: Trans-sphenoid adenomectomy 開立醫師: 王奐之 開立時間: 2010/07/21 19:05 Pre-operative Diagnosis Acromegaly with pituitary adenoma Post-operative Diagnosis Acromegaly with pituitary adenoma Operative Method Trans-sphenoid adenomectomy Specimen Count And Types 2 pieces About size:pieces Source:pituitary tumor About size:pieces Source:pituitary tissue Pathology Pending Operative Findings Whitish tumor noted at inferior pituitary fossa. Some strange tissue noted at superior part of pituitary fossa, also sent for pathology. Operative Procedures After ETGA, the patient was placed in supine position with neck slightly extended. After skin disinfection and draping in sterile fashion, the right nostril was entered. After fraturing the vomer bone and the anterior wall of sphenoid sinus, the pituitary fossa base was then seen. After opening the pituitary base, the tumor was exposed. The tumor was removed piece by piece with tumor forceps. The arachnoid membrane was visualized after tumor removal, no CSF leakage was encountered. The fractured bone was put back, the nostrils were then packed with nasal packings. Operators VS 曾漢民 Assistants R6 陳睿生, R3 王奐之 相關圖片 范石文卿 (F,1935/04/11,76y11m) 手術日期 2010/07/21 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Neuroma, upper limb 器械術式 Benign intraspinal tumor, exci 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 面罩麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 王奐之, 時間資訊 14:22 進入手術室 14:25 麻醉開始 14:30 誘導結束 14:45 抗生素給藥 15:20 手術開始 15:45 手術結束 15:45 麻醉結束 15:52 送出病患 15:55 進入恢復室 16:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 軟組織良性腫瘤切除術，大或深 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Semi-opened mask inhalation anes 1 0 記錄__ 手術科部: 外科部 套用罐頭: Tumor excision 開立醫師: 王奐之 開立時間: 2010/07/21 16:10 Pre-operative Diagnosis Right brachial plexus neurogenic tumor Post-operative Diagnosis Right brachial plexus neurogenic tumor Operative Method Tumor excision Specimen Count And Types 1 piece About size:2*2*2cm Source:right brachial plexus tumor Pathology Pending Operative Findings A 2*2*2cm yellowish elastic neurogenic tumor was noted adjacent to right brachial plexus with well encapsulation. Operative Procedures After IVG, the patient was placed in supine position and face turned to left. A linear skin incision was made at right lower neck, the incision was further deepened to expose the tumor. The tumor was then dissected from adjacent nerves, and removed en bloc. After hemostasis, the wound was closed in layers. Operators VS 曾漢民 Assistants R6 陳睿生, R3 王奐之 相關圖片 馬子晴 (F,2005/01/24,7y1m) 手術日期 2010/07/21 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Epilepsy 器械術式 Anterior Spinal fusion (Others) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 李振豪, 時間資訊 07:56 報到 08:08 進入手術室 08:15 麻醉開始 08:25 誘導結束 08:35 抗生素給藥 09:10 手術開始 11:35 手術結束 11:35 麻醉結束 11:45 送出病患 11:50 進入恢復室 13:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 手術 腦室腹腔分流手術 1 1 L 手術 神經分離術–肩，臀關節以上，包括臂神經叢，坐骨神經 1 2 L 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 L 記錄__ 手術科部: 外科部 套用罐頭: 1. Neurolysis of left vagus nerve. 開立醫師: 李振豪 開立時間: 2010/07/21 11:58 Pre-operative Diagnosis Refractory epilepsy Post-operative Diagnosis Refractory epilepsy Operative Method 1. Neurolysis of left vagus nerve. 2. Implantation of vagus nerve stimulator Specimen Count And Types Nil Pathology Nil Operative Findings 1. Ths left vagus nerve was isolated from carotid sheath. The generator was placed in left upper anterior chest wall. 1. The left vagus nerve was isolated from carotid sheath. The generator was placed in left upper anterior chest wall. 2. Implantation devices for vagus nerve stimulation therapy: - Cyberonics VNS Therapy Lead Model 302 - Cyberonics VNS Therapy Demipulse Model 103 Generator Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine position with mild neck extension. The skin was scrubbed, disinfected, and draped as usual. One transverse linear skin incision was made at left neck and left forechest with 3 and 4cm in length respectively. The anterior margin of sternocledomastoid muscle was identified after incision of platysma muscle. The deep fascia was opened and the carotid sheath was identified. The carotid sheath was opened and the vagus nerve was isolated. Under endotracheal tube general anesthesia, the patient was put in supine position with mild neck extension. The skin was scrubbed, disinfected, and draped as usual. One transverse linear skin incision was made at left neck and left forechest with 3 and 4cm in length respectively. The anterior margin of sternocledomastoid muscle was identified after incision of platysma muscle. The deep fascia was opened and the carotid sheath was identified. The carotid sheath was opened and the vagus nerve was isolated under microscope. One left forechest subcutaneous pocket was created for pulse generator. The subcutaneous tunnel was created by tunneler. The electrode was passed throught the subcutaneous tunnel. The three spiral anchor was applied over left vagus nerve for lead placement. The lead was connected with generator and the system was checked with Model 201 programming wand and model 250 programming softward. Hemostasis was checked. Two anchoring sutures were made at left neck for secure the lead. The pulse generator was implanted. The wound was then closed in layers with 4-0 Vicryl and 4-0 Prolene. Operators AP 郭夢菲 Assistants R4李振豪 相關圖片 劉誠展 (M,1959/03/28,52y11m) 手術日期 2010/07/21 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Brain metastasis 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 楊博智, 時間資訊 07:42 報到 08:05 麻醉開始 08:05 進入手術室 08:30 誘導結束 08:50 抗生素給藥 09:23 手術開始 12:50 麻醉結束 12:50 手術結束 13:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 腦瘤切除－手術時間在４小時以內 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Left craniotomy for tumor excision 開立醫師: 楊博智 開立時間: 2010/07/21 13:01 Pre-operative Diagnosis Left parietal metastatic tumor Post-operative Diagnosis Left parietal metastatic tumor Operative Method Left craniotomy for tumor excision Specimen Count And Types pieces of tumor Pathology pending Operative Findings The brain was mild swelling. The tumor was isoechoic on sonography. It was well defined and was moderate vascularity, measuring 1.7 cm. It was totally excised under microscopy. Intra-operation mapping showed tumor located at one gyrus behind post-central gyrus. Operative Procedures Under ETGA, patient was put in supine position with head rotate to right and fixed with Mayfield skull clamp. U shape skin incision was done at left parietal area. Skin flap was dissected and opened. After four burr holes drilled, craniotomy was performed as a 7x7 bone window and followed by dural tenting. U shape dural incision was made. The tumor was excised by gently dissection through the interface between tumor and brain tissue by CUSA. Vascular perforation was cauterized. Hemostasis was then performed. After then, dura was closed with prolene. After one CWV drain insertion, wound was closed in layers. Operators 賴達明 Assistants 胡朝凱, 楊博智 徐添興 (M,1935/03/01,77y0m) 手術日期 2010/07/21 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Cervical myelopathy 器械術式 Malignant intraspinal tumor, e 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 徐展陽, 時間資訊 12:40 報到 13:20 進入手術室 13:30 麻醉開始 13:55 誘導結束 14:32 抗生素給藥 15:18 手術開始 17:30 抗生素給藥 19:05 麻醉結束 19:05 手術結束 19:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 良性病髓腫瘤切除術 1 1 手術 椎弓整形術 1 2 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 記錄__ 手術科部: 外科部 套用罐頭: Simpson grade II tumor excision, and C3~4, 6~... 開立醫師: 徐展陽 開立時間: 2010/07/22 00:23 Pre-operative Diagnosis c7 meningioma, C3~4 HIVD Post-operative Diagnosis c7 meningioma, C3~4 HIVD Operative Method Simpson grade II tumor excision, and C3~4, 6~T1 laminoplasty Specimen Count And Types pieces of tumor Pathology pending Operative Findings 1.One yellowish to reddish firm tumor located at C7 level, intradural, extramedullary, that compressed the spinal cord from right side tightly. 2.The dural base attached to the anterior dura with dural tail. Operative Procedures 1.ETGA, prone 2.Midline incision at C3 to T1 level 3.Deatch paravertebral muscle 4.Laminoplasty at C6~T1 level 5.Dural opening 6.Devascularization 7.Tumor debulky with CUSA 8.Dissect tumor from spinal cord and roots with currette 9.Tumor excision 10.Close dura 11.Further laminoplasty at C3~4, C6~T1 level 12.Set CWV drain 13.Close wound in layers Operators 賴達明 Assistants 胡朝凱, 徐展陽 陳仕祥 (M,1972/04/23,39y10m) 手術日期 2010/07/21 手術主治醫師 賴達明 手術區域 東址 005房 01號 診斷 Astrocytoma 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 王奐之, 時間資訊 08:05 進入手術室 08:15 麻醉開始 08:30 誘導結束 08:50 手術開始 08:50 抗生素給藥 11:50 抗生素給藥 13:05 手術結束 13:05 麻醉結束 13:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４小時以內 1 1 L 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 記錄__ 手術科部: 外科部 套用罐頭: Craniotomy for partial tumor removal 開立醫師: 王奐之 開立時間: 2010/07/21 13:25 Pre-operative Diagnosis Bifrontal brain tumor, suspected glioma Post-operative Diagnosis Bifrontal brain tumor, suspected high grade glioma Operative Method Craniotomy for partial tumor removal Specimen Count And Types 1 piece About size:pieces Source:frontal tumor Pathology Frozen: at least grade 2 glioma Operative Findings White-greyish elastic tumor was noted at frontal area with gliotic change, intra-operative frozen section showed findings compatible with at least grade 2 glioma. The tumor margin was unclear. Operative Procedures After ETGA, the patient was placed in supine position with neck slightly flexed; the head was fixed with Mayfield skull clamp. After shaving, skin disinfection and draping in sterile fashion, a bicoronal scalp incision was done. A left frontal craniotomy was performed, and the falx was retracted rightwardly. After retracting the left frontal brain leftwardly, the whitish tumor was noted with poor margin. Some tumor tissue was removed for frozen section. After frozen section report, partial tumor removal was performed. After meticulous hemostasis, the tumor bed was packed with Surgicel. The dura was then closed in water-tight fashion with fascial graft. The skull was fixed back with miniplates. After setting a subgaleal CWV drain, the wound was closed in layers. Operators VS 賴達明 Assistants R6 陳睿生, R3 王奐之 相關圖片 劉月麗 (F,1933/07/09,78y8m) 手術日期 2010/07/21 手術主治醫師 王國川 手術區域 東址 003房 03號 診斷 Compression fracture 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 3E 紀錄醫師 陳德福, 時間資訊 12:52 開始NPO 12:52 臨時手術NPO 19:52 通知急診手術 20:05 抗生素給藥 20:30 報到 20:39 進入手術室 20:45 麻醉開始 20:55 誘導結束 21:38 手術開始 23:40 抗生素給藥 00:15 麻醉結束 00:15 手術結束 00:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 急性硬腦膜下血腫清除術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: craniotomy subdural hematoma evacuation 開立醫師: 陳德福 開立時間: 2010/07/22 00:58 Pre-operative Diagnosis Acute subdural hematoma, left Post-operative Diagnosis acute on chronic subdural hematoma, left Operative Method craniotomy subdural hematoma evacuation Specimen Count And Types 1 piece About size:5*5cm Source:outer membrane of SDH Pathology pending Operative Findings 1.There is acute subdural hematoma formation over the left fronto-temporo-parietal area with mass effect to right side. One bleeder which comes from the bridging vein was found. 2.Outer membrane and inner membrane of the chronic subdural hematoma was also noticed and one piece of outer membrane was sent for pathology examination. 3.After hematoma evacuation, the brain became slacky and pulsatile. One rubber draiange was left in the left subdural space. Operative Procedures Under ETGA and supine position, the scalp was disinfected and draped as usual. One trauma flap on the left scalp was done and we performed a 8*8cm in sized craniotomy. The dura tenting and durotomy were done. The outer membrane came into view the the membrane was cut with coagulation. The acute subdural hematoma was evacuated gradually and the bleeder was identified. We irrigate the subdural space with copious normal saline and one subdural rubber drainage was left in situ. The dura was closed in water tight fasion with Prolene and the skull was fixed with miniplates. One subgaleal CWV was left in situ. The wound was closed in layers. Operators VS 王國川 Assistants R5 陳德福 Indication Of Emergent Operation 相關圖片 徐金龍 (M,1947/11/20,64y3m) 手術日期 2010/07/22 手術主治醫師 陳敞牧 手術區域 東址 001房 02號 診斷 Herniated intervertebral disc (HIVD) 器械術式 Diskectomy thoracic 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3 紀錄醫師 楊博智, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 11:30 進入手術室 11:35 麻醉開始 11:45 誘導結束 12:00 抗生素給藥 12:25 手術開始 14:45 麻醉結束 14:45 手術結束 14:50 送出病患 14:55 進入恢復室 15:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術－脊椎 1 2 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: T11, 12 laminectomy and diskectomy for decomp... 開立醫師: 陳睿生 開立時間: 2010/07/22 15:06 Pre-operative Diagnosis T11-12 spinal stenosis with HIVD Post-operative Diagnosis T11-12 spinal stenosis with HIVD Operative Method T11, 12 laminectomy and diskectomy for decompression, posterior fixation and fusion with transpedicular screw Specimen Count And Types nil Pathology Nil Operative Findings The cord was tightly compressed by the thicken ligamentum flavum and herniated disk especially over right side. After laminectomy, the thecal sac was well expanded. After remove of right side facet joint, mild herniated disk with degenerative PLL was noted and removed. Synthes TPS was used for fixation. Screws: 6.2x45mm x4 Rods: 6cm x2 Operative Procedures 1. ETGA, prone position and C-arm localized the T11-12 level 2. Posterior midline incision about 10cm and then split bilateral paraspinal muscle 3. Expose T10/11, 11/12 facet joints and then transpedicular screws were implanted at T11, 12 level under C-arm localization 4. T11 and partial T12 laminectomy, and then the right side T11 pars intermediate was removed 5. Identify the T11/12 disk and diskectomy was done with curette and disk clump 6. Hemostasis, set bilateral rods and firmly fixation 7. Set a epidural CWV drain 8. Close the wound in layers Operators VS 陳敞牧 Assistants R6 陳睿生, R2 楊博智 Indication Of Emergent Operation 陳建財 (M,1958/02/05,54y1m) 手術日期 2010/07/22 手術主治醫師 陳敞牧 手術區域 東址 005房 03號 診斷 C1-C4 level fracture with unspecified spinal cord injury, closed 器械術式 Debridment-- 5-10cm 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 陳德福, 時間資訊 16:17 進入手術室 16:40 抗生素給藥 16:45 麻醉開始 16:46 手術開始 16:46 麻醉結束 17:03 手術結束 17:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 深部複雜創傷處理－傷口長５－１０公分者 1 0 摘要__ 手術科部: 外科部 套用罐頭: debridement 開立醫師: 陳德福 開立時間: 2010/07/22 17:11 Pre-operative Diagnosis Stitch abscess, neck Post-operative Diagnosis Stitch abscess, neck Operative Method debridement Specimen Count And Types nil Pathology nil Operative Findings There is a stitch abscess with fistula formation at previous posterior neck operation scar. The local inflammation is noticed and the fistula was removed. The wound was closed with Nylon. Operative Procedures Under LA and the skin was disinfected. One fulsiform incision around the abscess was done and the stitch was removed with the fistula. Debridement was done and the wound was closed with Nylon. Operators vs 陳敞牧 Assistants R5 陳德福 許新春 (M,1947/03/03,65y0m) 手術日期 2010/07/22 手術主治醫師 蕭輔仁 手術區域 東址 005房 01號 診斷 Cervical spondylosis 器械術式 Lamino plasty 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 陳德福, 時間資訊 08:00 進入手術室 08:05 麻醉開始 08:15 誘導結束 09:30 抗生素給藥 09:35 手術開始 12:30 抗生素給藥 13:05 手術結束 13:05 麻醉結束 13:15 送出病患 13:17 進入恢復室 14:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 手術 椎弓整形術 1 1 摘要__ 手術科部: 外科部 套用罐頭: C3-7 laminopalasty 開立醫師: 陳德福 開立時間: 2010/07/22 13:24 Pre-operative Diagnosis Cervical spondylosis with stenosis, C3-7 Post-operative Diagnosis Cervical spondylosis with stenosis, C3-7 Operative Method C3-7 laminopalasty Specimen Count And Types nil Pathology nil Operative Findings There is osteophytes formation with multiple stenosis over C3-7 level and the open door type laminoplasty was performed from C3-7 smoothly with miniplates fixation. Operative Procedures Uner ETGA and prone position with Mayfield pin type head fixator, the skin was disinfected and draped. One linear incision on the posterior neck was done and the paraspinous muscle was displaced laterally. The spinous process of C2-7 were exposed clearly and the laminotomy was done by air drill with open door fasion. The theca sac was decompressed fully and the C3-7 lamina was fixed with miniplates. After laminoplasty, one hemovac was left in situ. The wound was closed in layers. Operators vs 蕭輔仁 Assistants r5 陳德福 相關圖片 侯志偉 (M,1984/07/08,27y8m) 手術日期 2010/07/22 手術主治醫師 張金池 手術區域 東址 005房 02號 診斷 Major trauma rated 16 or above on the severeity scale ( Injury severeity score >=16 ) 器械術式 Ommaya reservoir implantation 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 4 紀錄醫師 陳德福, 時間資訊 13:35 進入手術室 13:37 麻醉開始 13:40 誘導結束 14:30 手術開始 15:30 手術結束 15:30 麻醉結束 15:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 歐氏貯囊置放手術 1 1 R 手術 氣管切開造口術 1 0 摘要__ 手術科部: 外科部 套用罐頭: 1.Right frontal Ommaya reservior implantation... 開立醫師: 陳德福 開立時間: 2010/07/22 15:52 Pre-operative Diagnosis Ventriculitis with hydrocephalus and respiratory failure Post-operative Diagnosis Ventriculitis with hydrocephalus and respiratory failure Operative Method 1.Right frontal Ommaya reservior implantation 2.Tracheostomy Specimen Count And Types nil Pathology nil Operative Findings The ventricular opening pressure >25cmH2O and the CSF is yellowish in color. The intraventricular catheter of Ommaya: 6.5cm. One No 8 tracheostomy tube was inserted at the 2nd to 3rd tracheocartilege. Operative Procedures Under ETGA and supine position, the scalp was disinfected as ususal. One curvilinear incision on right frontal area was done and burr hole was created. The dura was opned in cruciate fasion and the ventricular needle was inserted. One Ommaya reservior was implatated. The wound was closed in layers. The neck was positioned in hyperextension position, the skin was disinfected as usual. One linear incision on the neck was done and the pretracheal space was identified. One tracheotomy was done and we set one No 8 tracheostomy tube in situ. The wound was closed with Nylon. Operators VS 王國川 Assistants R5 陳德福 相關圖片 簡傳享 (M,1970/03/04,42y0m) 手術日期 2010/07/22 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Cerebrovascular accident sequelae (CVA) 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3 紀錄醫師 鍾文桂, 時間資訊 07:42 報到 08:03 進入手術室 08:40 麻醉開始 08:54 抗生素給藥 09:05 誘導結束 09:55 手術開始 11:54 抗生素給藥 14:30 麻醉結束 14:30 手術結束 14:38 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 顱內外血管吻合術 1 1 L 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 記錄__ 手術科部: 外科部 套用罐頭: EC-IC bypass, left superficial temporal arter... 開立醫師: 鍾文桂 開立時間: 2010/07/22 14:48 Pre-operative Diagnosis Moyamoya disease status post right EC-IC bypass. Post-operative Diagnosis Moyamoya disease status post bilateral EC-IC bypass. Operative Method EC-IC bypass, left superficial temporal artery - MCA. Specimen Count And Types nil Pathology Nil. Operative Findings Left posterior branch of superficial temporal artery to left M4 branch of middle cerebral artery. Patent bypass. Operative Procedures Under ETGA, the patient was put in supine position. The head was tilted to the left and fixed with Mayfield.The superficial temporal artery pathway was marked out by Duplex ultrasound.Then, the operative area was disinfected and draped.A 10-cm linear iision was made at pre-auricular area.The posterior branch of left superficial temporal artery was dissected from the surrounding soft tissue meticulously. The galea flap remained attaching to the vessel. Then, the dissected artery was resected from its distal part and clipped with a tempoary clip after vessel heparinization.The temporalis muscle was dissected. A 3-cm craniotomy was made.After dural tenting and incision, the arachnoid mater was incised to exposed the underlying vessels.The left M4 branc of middle cerebral artery was applied with temporary clips. The two arteries were prepared for anastomosis. End-to-side anastomosis was done smoothly. The patency was checked with temporary occlusion at each end.The bone plate was trimed to allow smoothlow of the anastomosis.The bone plate was fixed with plates and screws.The wound was closed in layers. The patient was sent to ICU smoothly. End-to-side anastomosis was done smoothly. The patency was checked with temporary occlusion at each end.The bone plate was trimed to allow smooth flow of the anastomosis.The bone plate was fixed with plates and screws.The wound was closed in layers. The patient was sent to ICU smoothly. Operators V.S.王國川 Assistants R6 胡朝凱 R5 鍾文桂 R1 何亦瑢 相關圖片 張玉梅 (F,1964/02/06,48y1m) 手術日期 2010/07/23 手術主治醫師 賴達明 手術區域 東址 003房 03號 診斷 Herniation of intervertebral disc, lumbar 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 游健生, 時間資訊 13:25 進入手術室 13:35 麻醉開始 13:50 誘導結束 14:00 抗生素給藥 14:30 手術開始 16:40 手術結束 16:40 麻醉結束 16:50 送出病患 16:50 進入恢復室 18:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術－頸椎 1 1 手術 骨或軟骨移植術 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 摘要__ 手術科部: 外科部 套用罐頭: Anterior approach for discectomy and autologo... 開立醫師: 游健生 開立時間: 2010/07/23 16:54 Pre-operative Diagnosis C3~4 HIVD Post-operative Diagnosis C3~4 HIVD Operative Method Anterior approach for discectomy and autologous bone graft insertion. Specimen Count And Types nil Pathology nil Operative Findings 1.Dehydrated disc at C3~4 level and protrusion backward that compressed the spinal cord tightly. 2.After decompression, the spinal cord expanded well Operative Procedures 1.ETGA, supine 2.Right neck transverse skin incision at C3~4 level 3.Dissection along with the anterior border of SCM muscle 4.Expose prevertebral space 5.localization with C-arm 6.Discectomy 7.Harvest one bone graft from right superior anterior iliac crest 8.Insert bone graft 9.Hemostasis 10.Set one hemovac then close wound in layers Operators 賴達明 Assistants 胡朝凱, 游健生 游麗真 (F,1964/05/15,47y9m) 手術日期 2010/07/23 手術主治醫師 賴達明 手術區域 東址 005房 03號 診斷 Brain Tumor 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 王奐之, 時間資訊 14:50 進入手術室 14:55 麻醉開始 15:00 誘導結束 15:15 手術開始 15:40 手術結束 15:40 麻醉結束 15:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 氣管切開造口術 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 王奐之 開立時間: 2010/07/23 16:03 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types nil Pathology Nil Operative Findings A Fr.7 low-pressure tracheostomy tube was inserted into the trachea through the 2nd-3rd trancheal cartilage. Operative Procedures After ETGA, the patient was placed in supine position with neck hyperextended. A 1cm midline skin incision was made 2 finger breadth above the sternal notch, the incision was further deepened through dissection. After exposing the 2nd and 3rd tracheal rings, a round trachea opening was made by scalpal. The low-pressure tracheostomy tube was then inserted into the trachea. After confirmation of ventilation, the endotracheal tube was removed and the tracheostomy wound was approximated with 3-0 Nylon sutures. Operators P 杜永光, VS 賴達明 Assistants R6 陳睿生, R3 王奐之 相關圖片 呂永坤 (M,1933/02/02,79y1m) 手術日期 2010/07/23 手術主治醫師 曾漢民 手術區域 東址 003房 02號 診斷 Spinal stenosis, lumbar 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 游健生, 時間資訊 10:05 進入手術室 10:10 麻醉開始 10:30 誘導結束 10:50 抗生素給藥 11:03 手術開始 12:50 手術結束 12:50 麻醉結束 13:00 送出病患 13:03 進入恢復室 14:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 椎弓切除術（特壓）－二節以內 1 1 摘要__ 手術科部: 外科部 套用罐頭: L4 laminectomy for decompression 開立醫師: 游健生 開立時間: 2010/07/23 13:02 Pre-operative Diagnosis L3~5 lateral recess stenosis Post-operative Diagnosis L3~5 lateral recess stenosis Operative Method L4 laminectomy for decompression Specimen Count And Types nil Pathology nil Operative Findings 1.Severe hypertrophic flavum ligment at L3~4 and 4~5 level that compressed the nerve roots tightly. 2.After decompression, the roots expanded well and became loose. 3.Central buldging disc without rupture Operative Procedures 1.ETGA, prone 2.Midline incision at L3~5 level 3.Detach paravertebral muscle 4.Expose L4 lamina 5.L4 laminectomy 6.Remove flavum ligment with kerrison pounch upward and downward 7.Identify bilateral L4, and 5 nerve roots 8.Hemostasis 9.Set one hemovac drain then close wound in layers Operators 曾漢民 Assistants 胡朝凱, 游健生 蔡貞吉 (M,1944/11/14,67y4m) 手術日期 2010/07/23 手術主治醫師 曾漢民 手術區域 東址 005房 號 診斷 Brain Tumor 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 王奐之, 時間資訊 07:50 報到 08:05 進入手術室 08:10 麻醉開始 08:40 誘導結束 09:00 手術開始 09:00 抗生素給藥 12:00 抗生素給藥 12:40 麻醉結束 12:40 手術結束 12:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４小時以內 1 1 L 手術 誘發電位手術監視機–腦神經外科術中特殊儀器使用費 1 0 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Craniotomy for Simpson grade 1 tumor excision 開立醫師: 王奐之 開立時間: 2010/07/23 13:15 Pre-operative Diagnosis Left fronto-parietal brain tumor, suspected meningioma Post-operative Diagnosis Left fronto-parietal brain tumor, suspected meningioma Operative Method Craniotomy for Simpson grade 1 tumor excision Specimen Count And Types 1 piece About size:5*5*5cm Source:left frontoparietal tumor Pathology Pending Operative Findings A well encapsulated whitish hard tumor about 6cm in greatest diameter, with moderate vascularity. The feeding artery came from the branch of left MMA. The surrounding cortical veins were all kept intact. The dura adhered tightly to the overlying skull and was torn after craniotomy. Operative Procedures After ETGA, the patient was placed in supine position with neck flexed, head fixed with Mayfield skull clamp. After shaving, skin disinfection and draping in sterile fashion, a wedge shaped scalp incision was made at left fronto-parietal region. After burr hole drilling, craniotomy was done. Tumor exposed after craniotomy, and it was dissected from surrounding cortical veins. After dissection, the tumor was removed en bloc carefully. Meticulous hemostasis was then achieved and the tumor bed packed with Surgicel. The dura was then closed with fascial graft and DURAform. The skull was fixed back with miniplates and 1 subgaleal CWV drain was set. The operative procedure ended with wound closure in layers. Operators VS 曾漢民 Assistants R6 陳睿生, R3 王奐之 相關圖片 酆東海 (M,1957/02/04,55y1m) 手術日期 2010/07/23 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Glioblastoma multiforma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 時間資訊 13:05 進入手術室 13:10 麻醉開始 13:58 誘導結束 14:30 送出病患 14:30 麻醉結束 14:30 進入恢復室 15:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 林李阿秀 (F,1944/02/06,68y1m) 手術日期 2010/07/23 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Cerebral aneurysm 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 古恬音, 時間資訊 08:45 報到 08:45 進入手術室 08:47 麻醉開始 08:50 抗生素給藥 08:50 誘導結束 09:02 手術開始 09:45 麻醉結束 09:50 手術結束 09:55 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 氣管切開造口術 1 0 摘要__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 古恬音 開立時間: 2010/07/23 10:01 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types nil Pathology None Operative Findings Fr. 7 low pressure cuffed tube inserted via 2nd cartilage of trachea, the position was confirmed with EtCO2. Operative Procedures Under endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators VS賴達明 Assistants R6胡朝凱 R3古恬音 鄭美惠 (F,1951/12/25,60y2m) 手術日期 2010/07/23 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Lumbar Spondylosis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 07:53 報到 08:05 進入手術室 08:15 麻醉開始 08:20 誘導結束 09:05 抗生素給藥 09:23 手術開始 12:10 抗生素給藥 14:15 手術結束 14:15 麻醉結束 14:25 送出病患 14:30 進入恢復室 15:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 手術 椎間盤切除術－腰椎 1 2 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 記錄__ 手術科部: 外科部 套用罐頭: 1. Internal fixation and posterolateral, and ... 開立醫師: 鍾文桂 開立時間: 2010/07/23 14:58 Pre-operative Diagnosis Lumbar spondylolisthesis, L4/5. Herniated intervertebral disc, L4/5. Post-operative Diagnosis Lumbar spondylolisthesis, L4/5. Herniated intervertebral disc, L4/5. Operative Method 1. Internal fixation and posterolateral, and interbody fusion with oblique posterior atrumatic lumbar cage system, L4/5. 2. Microsurgical diskectomy, right side approach, L4/5. 3. Sublaminar decompression, L4/5. Specimen Count And Types nil Pathology Nil. Operative Findings 1." Synthes" oblique posterior atrumatic lumbar cage system, cage 11mm. 2.Transpedicular screws at bilateral L4&5 with two rods. 3.Intact right L4 root. 4.Hypertrophic ligamentum flavum. Operative Procedures Under ETGA, the patient was put in prone position. We localized the inferior margin of L4 spinous process by C-arm fluoroscope. After disfinection and draping, a midline 5-cm incision was made. Paraspinal dissection 2 cm away from midline was made to reach bilateral L4, 5 facet joint. We inserted TPS at bilateral L4,5 levels and checked their locations with C-arm fluoroscope.The internal fixation system was set up with two rods. Midline sublaminar decompression was made with Kerrison punch. Right laminotomy for microsurgical diskectomy was done. We also further resect half of the right L4/5 facet joint for implantation of the OPAL cage. The OPAL cage was inserted. Its location was ensured with C-arm fluoroscope. Posterolateral fusion with autologous bone was done later. Finally, we closed the wound in layers after placing one 1/8 hemovac drain. Operators V.S.賴達明 Assistants R5鍾文桂 R2楊博智 相關圖片 陳洪抄 (F,1945/01/26,67y1m) 手術日期 2010/07/23 手術主治醫師 賴達明 手術區域 東址 019房 02號 診斷 Spinal stenosis, lumbar 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 14:43 進入手術室 14:45 麻醉開始 14:55 誘導結束 15:30 抗生素給藥 15:57 手術開始 18:30 抗生素給藥 21:45 手術結束 21:45 麻醉結束 21:55 送出病患 21:55 進入恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 手術 椎弓切除術（特壓）－二節以內 1 2 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 記錄__ 手術科部: 外科部 套用罐頭: 1. Motion preservation internal fixation with... 開立醫師: 鍾文桂 開立時間: 2010/07/23 22:05 Pre-operative Diagnosis Lumbar stenosis, L3/4/5. Post-operative Diagnosis Lumbar stenosis, L3/4/5. Operative Method 1. Motion preservation internal fixation with Dynesis at L3/4/5 levels. 1. Motion preservation internal fixation with Dynesys at L3/4/5 levels. 2. Sublaminar decompression, L4/5. Specimen Count And Types nil Pathology Nil. Operative Findings Screws: 6.4x45mm, 6 screws, Spacer: right: L4/5 19mm,L3/4 31mm; left L4/5 18mm,L3/4 32mm. A small dural tear with CSF leakage, sealed with Gelfoam. Hypertrophic ligamentum flavum. Blood loss: 500 cc. Operative Procedures Under ETGA, the patient was placed in prone position. We localized bilateral L3,4,5 pedicles with C-arm fluoroscope. After disinfection and draping, midline incision was made. The Dynesis system was set up after paraspinal dissection. We ensured the screws were in place with C-arm fluoroscope. The paraspinal wounds were closed in layers. Then, midline dissection was made with high speed saws. Sublaminar decompression was done with Kerrion and Rongeurs. After placing one CWV drains, the wound was closed in layers. The patient was sent to POR smoothly. Operators V.S. 賴達明. Assistants R5鍾文桂 R2楊博智. 相關圖片 周克舉 (M,1926/07/08,85y8m) 手術日期 2010/07/23 手術主治醫師 陳偉勵 手術區域 東址 011房 02號 診斷 Cataract 器械術式 Phaco+PCIOL 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 09:55 進入手術室 10:15 麻醉開始 10:17 麻醉結束 10:18 手術開始 10:45 手術結束 10:50 送出病患 記錄__ 手術科部: 眼科部 套用罐頭: Phaco-Temporal (陳偉勵) 開立醫師: 許詠瑞 開立時間: 2010/07/22 17:27 Pre-operative Diagnosis Cataract (o ) Post-operative Diagnosis Cataract (o ) Operative Method Phacoemulsification and PCIOL implantation(o ) Specimen Count And Types nil Pathology Nil Operative Findings Cataract (o ) Operative Procedures 1. Under topical / peribulbar anesthesia 2. Disinfection, irrigation and draping. 3. Application of an eyelid speculum. 4. Made a clear corneal incision and penetrate into AC with 2.5mm cresent knife at oclock position . 5. InjectViscoat into the anterior chamber. 6. Continuous circular capsulorrhexis was done with capsular forceps. 7. Made a sideport at oclock position with the MVR blade. 8. Hydrodissection and hydrodelineation were done with BSS. 9. Phacoemulsification of the nucleus by standard divide-and-conquer technique. 10. Aspiration of the residual cortical material with I/A cannula. 11. One-piece PCIOL was implanted into the bag after injection of Viscoat. 12. The residual Viscoatwas washed out by I/A cannula. 13. Inject BSS into AC and check leakage. 14. Subconjunctival injection of Rinderon and Gentamicin. 15. Maxitrol patching. Operators 陳偉勵, Assistants R4 劉耀臨/R4孫仁彬，R3許詠瑞 呂芳燻 (M,1932/01/11,80y2m) 手術日期 2010/07/24 手術主治醫師 郭順文 手術區域 東址 002房 04號 診斷 Bronchus and lung cancer 器械術式 Port-A catheter implatation 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 鄒冠全, 時間資訊 12:10 報到 12:37 進入手術室 12:50 麻醉開始 12:52 麻醉結束 12:54 手術開始 13:32 手術結束 13:37 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 ｐｏｒｔ–Ａ導管植入術–治療性導管植入術 1 0 R 記錄__ 手術科部: 外科部 套用罐頭: Port-A insertion 開立醫師: 鄒冠全 開立時間: 2010/07/24 13:33 Pre-operative Diagnosis Lung cancer Post-operative Diagnosis Lung cancer Operative Method Port-A insertion Specimen Count And Types nil Pathology nil Operative Findings The port-A catheter was inserted to left/right subclavian via puncture method, checked by portable CXR Operative Procedures 1. LA, supine 2. Skin disinfection and draping as usual 3. Insert Port-A via puncture method 4. Checked by portable CXR, close wound in layers Operators 郭順文 Assistants R3鄒冠全 相關圖片 虞有仕 (M,1980/07/03,31y8m) 手術日期 2010/07/24 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Herniation of intervertebral disc (HIVD) 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 蕭柏妮 ASA 1 紀錄醫師 何奕瑢, 時間資訊 07:45 報到 08:00 進入手術室 08:05 麻醉開始 08:15 誘導結束 08:30 抗生素給藥 09:05 手術開始 10:55 手術結束 10:55 麻醉結束 11:00 送出病患 11:03 進入恢復室 12:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 椎間盤切除術－頸椎 1 1 記錄__ 手術科部: 外科部 套用罐頭: Anterior approach for discectomy and cage ins... 開立醫師: 胡朝凱 開立時間: 2010/07/24 11:21 Pre-operative Diagnosis C5~6 HIVD Post-operative Diagnosis C5~6 HIVD Operative Method Anterior approach for discectomy and cage insertion Specimen Count And Types nil Pathology nil Operative Findings 1.Ruptured disc at C5~6 level that compressed the spinal cord tightly 2.The disc became dehydrated 3.After decompression, the spinal cord expanded well Operative Procedures 1.ETGA, supine 2.Right neck transverse skin incision 3.Dissec along the anterior border of SCM to expose prevertebral space 4.detach longus coli muscle 5.discectomy with curette 6.Remove ruptured disc 7.resect PLL with kerrison 8.Insert cage 9.Hemostasis 10.Set one minihemovac drain then clsoe wound in layers Operators 曾漢民 Assistants 胡朝凱, 何奕瑢 陳玉珍 (M,1931/01/02,81y2m) 手術日期 2010/07/24 手術主治醫師 陳敞牧 手術區域 東址 005房 02號 診斷 Malignant neoplasm of bronchus and lung, unspecified 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 蕭柏妮 ASA 3 紀錄醫師 胡朝凱, 時間資訊 00:00 臨時手術NPO 10:40 報到 11:16 進入手術室 11:20 麻醉開始 12:15 誘導結束 12:17 抗生素給藥 12:43 手術開始 13:15 開始輸血 16:00 麻醉結束 16:00 手術結束 16:07 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 惡性病髓腫瘤切除術 1 1 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 2 記錄__ 手術科部: 外科部 套用罐頭: Tumor excision, and T2-3, 5-6 TPS insertion 開立醫師: 胡朝凱 開立時間: 2010/07/24 16:25 Pre-operative Diagnosis T4~5 spinal metastasis Post-operative Diagnosis T4~5 spinal metastasis Operative Method Tumor excision, and T2-3, 5-6 TPS insertion Tumor excision, and T2-3, 6-7 TPS insertion Specimen Count And Types pieces of tumor Pathology pending Operative Findings 1.Grayish to yellowish soft tumor locate at T4~5 level epidural space that compressed the spinal cord from right side tightly. 2.After decompression, the spinal cord expanded well 3.TPS screws: 8, rods x 2, cross link x 2 Operative Procedures 1.ETGA, prone 2.Midline incision at T2~T6 level 2.Midline incision at T2~T7 level 3.Detach paravertebral muscle to expose lamina of T2~T6 3.Detach paravertebral muscle to expose lamina of T2~T7 4.TPS screws insertion 5.Laminectomy of T3~6 6.Tumor excision from epidural space 7.Hemostasis 8.Fixed rods and cross links 9.Set hemovac drain then close wound in layers Operators 陳敞牧 Assistants 胡朝凱, 何奕瑢 余廖碧蘭 (F,1938/05/10,73y10m) 手術日期 2010/07/24 手術主治醫師 孫瑞昇 手術區域 東址 020房 03號 診斷 Osteoarthritis, knee 器械術式 TKR - Nex Gen 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 脊髓麻醉 麻醉主治醫師 黃啟祥 ASA 3 紀錄醫師 陳宣佑, 時間資訊 12:02 進入手術室 12:15 麻醉開始 12:25 誘導結束 12:30 抗生素給藥 12:42 手術開始 13:10 開始輸血 14:40 手術結束 14:40 麻醉結束 14:45 送出病患 14:55 進入恢復室 16:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Spinal anesthesia 1 0 麻醉 SPINAL ANESTHESIA 1 0 手術 膝關節全置換術 1 1 記錄__ 手術科部: 骨科部 套用罐頭: Total knee arthroplasty, left 開立醫師: 陳宣佑 開立時間: 2010/07/24 14:53 Pre-operative Diagnosis Osteoarthritis, left knee Post-operative Diagnosis Osteoarthritis, left knee Operative Method Total knee arthroplasty, left Specimen Count And Types nil Pathology nil Operative Findings 1. Cartilage wearing and subcondral bone exposure 2. Osteophyte formation 3. Varus deformity Operative Procedures Under anesthesia, the patient was postioned in supine. The operation field was disinfected and draped as usual. After inflating air tourniquet with 350 mmHg in pressure, skin was incised along midline of knee, and exposusre of the knee jointwas done with medial approach. Bony preparation of femur, tibia, and patella were performed with ""Zimmer"" jigs subsequently. Total knee prosthesis was applied with cement, Tibia: 2, Femur: D, Patella: 26_mm, Insert: _10_mm. Then air tourniquet was deflated, and hemostasis was done. After cleaning surgical wound with normal saline irrigation, the wound was finally closed in layers. Operators 孫瑞昇, Assistants 陳宣佑,黃俊傑, 陳明峰 李玫 (F,1998/07/08,13y8m) 手術日期 2010/07/26 手術主治醫師 林至芃 手術區域 西址 034房 02號 診斷 Dystonia 器械術式 DCS implantation / PC 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 林至芃 ASA 2 紀錄醫師 王曼玲, 時間資訊 09:50 進入手術室 09:55 麻醉開始 10:00 誘導結束 10:00 手術開始 10:03 麻醉結束 10:03 手術結束 10:05 送出病患 10:10 進入恢復室 11:15 離開恢復室 06:00 臨時手術NPO 醫令資訊 類別 名稱 量 刀 側 手術 腦室內注射留置器或脊髓腔內化學藥物注射 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 記錄__ 手術科部: 套用罐頭: TIT 開立醫師: 王曼玲 開立時間: 2010/07/26 11:25 Pre-operative Diagnosis Dystonia Post-operative Diagnosis Dystonia Operative Method Intrathecal baclofen injection Specimen Count And Types Nil Pathology Nil Operative Findings CSF appearance: Clear, slowly dripped Operative Procedures Under IVGA, patient was held in knee-chest decubitus position, with the lumbar area skin prepped and draped. A 26 Gauge needle was introduced into the L4-L5 intervertebral space and advanced slowly until the dura was penetrated. CSF was tapped without trauma. Baclofen 0.05 mg (volume 1 mL) was injected into the subarachnoid space smoothly. Then the needle was withdrawn completely. Vitals were checked, and she was sent to PACU for monitoring. Operators 林至芃 Assistants 王曼玲 劉陳幸子 (F,1944/08/28,67y6m) 手術日期 2010/07/26 手術主治醫師 郭順文 手術區域 東址 007房 05號 診斷 Cerebral aneurysm 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 污染 麻醉方式 全身麻醉 麻醉主治醫師 趙安怡 ASA 4 紀錄醫師 高明蔚, 時間資訊 08:39 臨時手術NPO 15:11 進入手術室 15:15 麻醉開始 15:17 誘導結束 15:24 手術開始 15:30 手術結束 15:30 麻醉結束 15:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 氣管切開造口術 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 摘要__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 高明蔚 開立時間: 2010/07/26 15:54 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types nil Pathology None Operative Findings Fr.7 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding. Operators 郭順文 Assistants R3高明蔚,R1施廷翰 相關圖片 蔡輝雄 (M,1943/03/02,69y0m) 手術日期 2010/07/26 手術主治醫師 黃書健 手術區域 東址 017房 01號 診斷 Chronic renal failure (CRF) 器械術式 A-V Shunt 手術類別 臨時手術 手術部位 四肢 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 周恒文, 時間資訊 08:24 報到 08:45 進入手術室 09:01 麻醉開始 09:02 誘導結束 09:03 手術開始 09:50 麻醉結束 09:50 手術結束 10:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 末稍血管修補及吻合術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: AVF revision 開立醫師: 周恒文 開立時間: 2010/07/26 10:01 Pre-operative Diagnosis Low flow of AVF Post-operative Diagnosis Low flow of AVF Operative Method AVF revision Specimen Count And Types nil Pathology Operative Findings Intima heperplasia of outflow site near the anastomosis which made the low flow rate Operative Procedures Supine with right arm extension and apply local anesthesia. Wrist incision and dissect the anastomosis site and the venous site and identify the low flow site. Transect the low flow site and end-to-end anastomosis with 7-0 Prolene. Close the wound in layers. Operators 黃書健 Assistants 周恒文 巫美賢 (F,1945/12/07,66y3m) 手術日期 2010/07/26 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Acoustic tumor 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 3 紀錄醫師 王奐之, 時間資訊 07:40 報到 08:05 進入手術室 08:10 麻醉開始 08:45 誘導結束 08:45 抗生素給藥 08:47 手術開始 11:35 抗生素給藥 14:40 抗生素給藥 15:30 麻醉結束 15:30 手術結束 15:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 7 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 顱底瘤手術 1 1 L 手術 誘發電位手術監視機–腦神經外科術中特殊儀器使用費 1 0 L 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 L 記錄__ 手術科部: 外科部 套用罐頭: Left retrosigmoid approach for near-total tum... 開立醫師: 王奐之 開立時間: 2010/07/26 15:55 Pre-operative Diagnosis Left cerebellopontine angle tumor, suspected acoustic neuroma Post-operative Diagnosis Left cerebellopontine angle tumor, suspected acoustic neuroma Operative Method Left retrosigmoid approach for near-total tumor removal Specimen Count And Types 1 piece About size:pieces Source:left CP angle tumor Pathology Pending Operative Findings Yellowish soft tumor with well encapsulation about 4*2*2cm in size was noted at left CP angle. The brainstem was tightly compressed by the tumor and re-expanded after tumor removal. The facial nerve was not identified during the surgery. Some small residual tumor was left near IAC. Intra-operative sigmoid sinus tear was encountered. Operative Procedures After ETGA, the patient was placed in 3/4 prone position with left retroauricular area facing upwards; the head was fixed with Mayfield skull clamp. A linear skin incision was made at retroauricular area, and the incision was deepened to expose mastoid process. 4 burr holes were made, followed by retrosigmoid craniotomy. After opening the dura, the cerebellum was retracted posteriorly to expose the tumor. The tumor was then removed piece by piece. After tumor removal, the space was re-filled with normal saline and the dura was closed with fascial graft in water-tight fashion. The torn sinus was packed with gelfoam and FloSEAL. The wound was closed in layers. Operators VS 曾漢民 Assistants R6 陳睿生, R3 王奐之 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Left retrosigmoid approach for near-total tum... 開立醫師: 王奐之 開立時間: 2010/07/26 15:55 Pre-operative Diagnosis Left cerebellopontine angle tumor, suspected acoustic neuroma Post-operative Diagnosis Left cerebellopontine angle tumor, suspected acoustic neuroma Operative Method Left retrosigmoid approach for near-total tumor removal Specimen Count And Types 1 piece About size:pieces Source:left CP angle tumor Pathology Pending Operative Findings Yellowish soft tumor with well encapsulation about 4*2*2cm in size was noted at left CP angle. The brainstem was tightly compressed by the tumor and re-expanded after tumor removal. The facial nerve was not identified during the surgery. Some small residual tumor was left near IAC. Intra-operative sigmoid sinus tear was encountered. Operative Procedures After ETGA, the patient was placed in 3/4 prone position with left retroauricular area facing upwards; the head was fixed with Mayfield skull clamp. A linear skin incision was made at retroauricular area, and the incision was deepened to expose mastoid process. 4 burr holes were made, followed by retrosigmoid craniotomy. After opening the dura, the cerebellum was retracted posteriorly to expose the tumor. The tumor was then removed piece by piece. After tumor removal, the space was re-filled with normal saline and the dura was closed with fascial graft in water-tight fashion. The torn sinus was packed with gelfoam and FloSEAL. The wound was closed in layers. Operators VS 曾漢民 Assistants R6 陳睿生, R3 王奐之 相關圖片 曹秀緩 (F,1954/12/03,57y3m) 手術日期 2010/07/26 手術主治醫師 王堯弘 手術區域 東址 000房 號 診斷 Intraventricular hemorrhage 器械術式 neuro TAE 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 王永彬 ASA 3 時間資訊 23:33 臨時手術NPO 08:40 麻醉開始 09:25 誘導結束 11:30 麻醉結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 劉承遠 (M,1929/05/22,82y9m) 手術日期 2010/07/26 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Spinal stenosis, cervical 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3 紀錄醫師 游健生, 時間資訊 07:45 報到 08:00 進入手術室 08:05 麻醉開始 08:30 誘導結束 08:34 抗生素給藥 09:30 手術開始 11:05 手術結束 11:05 麻醉結束 11:23 進入恢復室 11:25 送出病患 11:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術－頸椎 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Anterior Discectomy and Fusion, Cervical Spine 開立醫師: 游健生 開立時間: 2010/07/26 11:13 Pre-operative Diagnosis C6-7 herniated intervertebral disc with cervical stenosis Post-operative Diagnosis C6-7 herniated intervertebral disc with cervical stenosis Operative Method Anterior Discectomy and Fusion, Cervical Spine Specimen Count And Types nil Pathology Nil Operative Findings The C6-7 intervertebral disc was degenerated and harden. It protuded posteriorly and compressing the cord. After decompression, the dura sac was well expanded. Stenosis of right intervertebral foramen was noted and the nerve root was free after removal of spurs. A 6# SYNTHES cage was inserted into C6-7 intervertebral space. Operative Procedures Under ETGA, paitne was put into supine position with neck hyperextended by a air cuff placed beneath the shoulder. Left anterior neck was scrubbed with povidone-iodinew detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. A 5 cm, transverse cervical incision was made 2fb above clavicle. The plastysma muscle was transected and mobilized from superficial cervical fascia which was then opened vertically along the anterior margin of SCM muscle. We dissected at the loose plane between SCM muscle and strip muscles until we reached the prevertebral fascia. The former structure was retracted to the lateral and the later structures with esophagus and trachea to the opposite side by Cloward cervical retractor. The prevertebral fascia was opened vertically, C6-7 intervertebral space was exposed and identified by C-arm. We widened the intervertebral space with Caspar. The most medial portion of the longus coli muscles on both sides were detached from the vertebral bodies to provide wider exposure of the vertebral bodies. The anterior longitudinal ligment was incised transversely at the margins of intervertebral space, the annulus fibrosus was cut too. The degenerated disc and cartilage plate were removed by curette and the anterior-inferior rim of vertebral body was resected by Kerrison punch for easier approach to the posterior rim of the intervertebral space. The spur at right neural foramen was removed by Kerrison punch. Consequently, the spinal dura expanded. A cage was packed into the intervertebral space tightly by a impactor. The air cuff beneath the shoulder was deflated, the Cloward cervical retractor removed. Finally, we closed the wound in layers after placement of one mini-hemovac drain. Operators VS 賴達明 Assistants R6 胡朝凱 R3 游健生 林清水 (M,1923/03/22,88y11m) 手術日期 2010/07/26 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Hydrocephalus 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3 紀錄醫師 游健生, 時間資訊 11:01 報到 11:40 麻醉開始 11:50 誘導結束 12:04 抗生素給藥 12:34 手術開始 12:35 進入手術室 13:55 手術結束 13:55 麻醉結束 14:00 送出病患 14:02 進入恢復室 15:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 手術 腦室腹腔分流手術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 游健生 開立時間: 2010/07/26 14:13 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunt via right Kocher"s point Specimen Count And Types 1 piece About size:9ml Source:CSF Pathology Nil Operative Findings The CSF opening pressure was about 10cmH2O. The CSF was clear and 9ml was sent for biochemistry, routine, and culture. The ventricle catheter was 6.5cm in length. The programmable valve (Codman) pressure was set at 100mmH2O. Operative Procedures 1. Under ETGA, patient was put into supine position with head turned to left and right shoulder mildly elevated. 2. After shaving, we disinfected and draped the operation field as usual. 3. A 5cm transverse scalp incision was made over right Kocher"s point 4. Dissected in layers and exposed cranium 5. Created a burrhole and dura-tenting 6. Electrocauterized the dura with bipolar and opened it in cruicate fashion 7. Electrocauterized the dura edge with bipolar and performed corticotomy 8. Inserted the ventricle catheter 9. A 5cm transverse abdominal incision was made over RUQ region 10.Dissected in layers and exposed peritonium 11.Opened the peritonium and inserted the peritoneal catheter 12.Created a subcutaneous tunnel and pass the catheter upward 13.Connected both catheters to a programmable valve and reservoir 14.Closed wounds in layers Operators VS 賴達明 Assistants R6 胡朝凱 R3 游健生 吳進財 (M,1947/12/12,64y3m) 手術日期 2010/07/26 手術主治醫師 蕭輔仁 手術區域 東址 002房 04號 診斷 Intracerebral hemorrhage (ICH) 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 4 紀錄醫師 鍾文桂, 時間資訊 13:36 進入手術室 13:40 麻醉開始 13:44 誘導結束 14:11 手術開始 14:40 手術結束 14:40 麻醉結束 14:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 氣管切開造口術 1 0 記錄__ 手術科部: 外科部 套用罐頭: Tracheostomy. 開立醫師: 鍾文桂 開立時間: 2010/07/26 15:03 Pre-operative Diagnosis Respiratory failure. Post-operative Diagnosis Respiratory failure. Operative Method Tracheostomy. Specimen Count And Types nil Pathology Nil. Operative Findings Fr. 8.0 tracheostomy tube was inserted at 1st and 2nd tracheal rings. Operative Procedures After disinfection and draping, a midline 2 cm incision was made below the cricoid cartilage under local anesthesia. With midline dissection, the 1st and 2nd tracheal rings were reached. A small circumferential excision was made at the tracheal rings. Then, the tracheostomy tube was inserted smoothly. Under close monitoring, good ventilation was noted after tube insertion. Finally, the wound was closed with 3-0 Nylon. The patient was sent back to ICU smoothly. Operators V.S. 蕭輔仁 Assistants R5鍾文桂 R2楊博智 張阿香 (F,1931/08/05,80y7m) 手術日期 2010/07/26 手術主治醫師 何子昌 手術區域 東址 010房 08號 診斷 Cataract 器械術式 Phaco+PCIOL 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 13:10 進入手術室 13:50 手術開始 14:20 手術結束 14:22 送出病患 摘要__ 手術科部: 眼科部 套用罐頭: Phaco-Superior (何子昌) 開立醫師: 吳廷郁 開立時間: 2010/07/23 16:53 Pre-operative Diagnosis Cataract (o ) Post-operative Diagnosis Cataract (o ) Operative Method Phacoemulsification and PCIOL implantation (o ) Specimen Count And Types nil Pathology Nil Operative Findings Cataract (o ) Operative Procedures 1. Under peribulbar anesthesia 2. Disinfection, irrigation and draping 3. Application of eyelid speculum 4. Made a clear corneal incision and penetrate into AC with 2.5mm trapezoid knife at 11 oclock position 5. Inject Viscoat into the anterior chamber 6. Continuous circular capsulorrhexis was done with bent needle and capsular forceps 7. Made a sideport at 3 oclock position with the MVR blade 8. Hydrodissection and hydrodelineation were done with BSS 9. Phacoemulsification of the nucleus by standard divide-and-conquer technique 10. Aspiration of the residual cortical material with I/A tube 11. Foldable PCIOL was implanted into the bag after injection of Viscoat 12. The residual Viscoat was washed outby Simcoe I/A cannula 13. Inject BSS into AC and check leakage, and inject Miostat to AC to constrict the pupil 14. Stromal hydration of the wound with BSS 16. Subconjunctival injection of Rinderon and Gentamycin 17. Lactycin patching Operators 何子昌 Assistants R4陳達慶, R2吳廷郁 林志成 (M,1954/05/16,57y9m) 手術日期 2010/07/27 手術主治醫師 李章銘 手術區域 東址 019房 03號 診斷 Lung tumor 器械術式 Thoracoscopy+Open Chest 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 蔡東明, 時間資訊 14:07 報到 14:50 進入手術室 14:55 麻醉開始 15:25 誘導結束 15:40 抗生素給藥 15:52 手術開始 18:40 抗生素給藥 20:00 麻醉結束 20:00 手術結束 20:10 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 手術 胸腔鏡肺葉切除術 1 1 R 手術 根除性淋巴切除術（肺葉切除或全肺切除時） 1 2 R 麻醉 Peripheral arterial line inserti 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 記錄__ 手術科部: 外科部 套用罐頭: Lobectomy 開立醫師: 蔡東明 開立時間: 2010/07/27 20:34 Pre-operative Diagnosis Lung nodule, right lower lobe Post-operative Diagnosis Lung bronchioalveolar carcinoma, right lower lobe Operative Method VATS right lower lobe Lobectomy + lymphnode dissection Specimen Count And Types 2 pieces About size:20*18cm Source:RLL About size:2*2cm Source:LNs Pathology Pneding Operative Findings 1. Tumor size: 0.8cm, grayish, well-defined, elastic and firm 2. Tumor location: Right lower lobe, B6 3. Tumor invasion to: not to pleura in gross 4. Lymph nodes enlargement: Gr.3,4,7,9,10 Operative Procedures 1. Anesthesia: General anesthesia using single-lumen endotracheal tube. 2. Position: Left decubitus position. An axillary roll is placed under the down side. The operative field is well disinfected and draped. 3. VATS setting. The pleural adhesions are separated using electrocautery. 4. Wedge resection for right lower lobe B6. TGhe frozen biopsy showed BAC. 5. The right lower lobe is retracted anteriorly. The inferior pulmonary ligment is divided.The inferior pulmonary vein is identified, and transectedcc by endoGIA. 6. The fissure between the middle and lower lobes is separated and divided. 7. The pulmonary artery supplying the right lower lobe is identified, and divided. 8. The bronchus to the lower lobe is identified, and transected by endoGIA. 9. Lymph node dissection is done at group 3, 4, 7, 9,10, and 11. 12. After meticulous homeostasis and check-up of air leakage, pulmonary laceration was closed by chromic 3-0. One 28# chest tubes are placed atp posterior aspect of pleural cavity respectively. The wound was closed in layers. Operators VS李章銘 VS林孟暐 Assistants R4蔡東明 Ri林佑華 羅藍琴珠 (F,1949/11/21,62y3m) 手術日期 2010/07/27 手術主治醫師 曾勝弘 手術區域 東址 005房 02號 診斷 Parkinson''s disease 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 徐展陽, 時間資訊 10:10 報到 10:26 進入手術室 10:30 麻醉開始 10:40 誘導結束 11:00 抗生素給藥 11:05 手術開始 12:20 手術結束 12:20 麻醉結束 12:30 進入恢復室 12:30 送出病患 14:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: IPG implantation, left anterior chest 開立醫師: 陳德福 開立時間: 2010/07/27 12:27 Pre-operative Diagnosis Pakinsonism s/p DBS Post-operative Diagnosis Pakinsonism s/p DBS Operative Method IPG implantation, left anterior chest Specimen Count And Types nil Pathology nil Operative Findings One IPG[Metronic] was implantated at the left anterior chest [subclavicle area] smoothly. The function was checked after the connection and subcutanaeous tunnelling. Operative Procedures Under ETGA and supine position, the skin was disinfected and draped as usual. One linear incision on left scalp and left anterior chest was done. The electrodes was identified and one subcutanous packet was created at the left anterior chest. The subcutaneous tunneling was done and the wires was connnected to the IPG. The function of IPG was checked and the wound was closed in layers. Operators AP 曾勝弘 Assistants r5 陳德福 r1徐展陽 哈燕平 (F,1950/08/01,61y7m) 手術日期 2010/07/27 手術主治醫師 曾勝弘 手術區域 東址 005房 03號 診斷 Subjective visual disturbances 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 徐展陽, 時間資訊 12:42 進入手術室 12:50 麻醉開始 13:30 誘導結束 13:55 抗生素給藥 14:20 手術開始 16:05 開始輸血 16:36 手術結束 16:36 麻醉結束 16:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經由蝶竇之腦下垂體瘤切除 1 1 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 粘膜下中隔矯正術 1 2 摘要__ 手術科部: 外科部 套用罐頭: Trans-sphenoidal pituitary adenomectomy 開立醫師: 胡朝凱 開立時間: 2010/07/27 16:57 Pre-operative Diagnosis Pituitary macroadenoma Post-operative Diagnosis Pituitary macroadenoma Operative Method Trans-sphenoidal pituitary adenomectomy Specimen Count And Types 1 piece About size:0.2cm(fragments) Source:pituitary gland Pathology Pending Operative Findings The tumor was yellowish-greyish, soft, fragile, and sized 2.3 cm in diameter. The normal gland was found after tumor excision. There was no CSF leakage. We packed autologous fat tissue in situ. Operative Procedures 1. Under ETGA, intubation, the patient was put in supine position. 2. The facial skin was antiseptic with alcohol better-iodine tincture, and the mucosa of oral and nasal cavity with aqueous better-iodine . 3. The former areas were covered by sterilized adhesive plastic sheets then draped. 4. Under endoscope, the nasal mucosa was coagulated at right norstril. A nasal speculum was applied to displace the nasal mucosa laterally and keep the nasal cavity open constantly for the exposure of the vomer bone and the anterior wall of the sphenoid sinus. 5. The anterior sphenoid wall and posterior sphenoid wall was remove by Chiser and Kerrison punch. 6. The sellar floor dura was coagulated then opened in cruciate fashion. 7. The soft tumor parenchyma was removed by curette and aligator. 8. One linear incision at left abdomen was done for harvesting autologous fat tissue. 9. The arachnoid and the opening of diaphragm sellae was enforcedby packing with gelform as in the sellar cavity. 10. The nasal mucosa returned to its normal position. Right side of the nasal cavities was tightly packed with a segment of Merosal gauze strips which had been soaked with better-iodine ointment. Operators AP 曾勝弘 Assistants R5 陳德福 陳金麗 (F,1951/10/30,60y4m) 手術日期 2010/07/27 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Spine tumor 器械術式 Cord untethering -KUO 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 1 紀錄醫師 李振豪, 時間資訊 07:37 報到 08:06 進入手術室 08:20 麻醉開始 08:30 誘導結束 09:00 抗生素給藥 09:20 手術開始 12:00 抗生素給藥 14:50 手術結束 14:50 麻醉結束 15:00 送出病患 15:05 進入恢復室 16:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 手術 脊椎內脊髓內腫瘤切除術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 記錄__ 手術科部: 外科部 套用罐頭: Intramedullary tumor excision for untethering... 開立醫師: 李振豪 開立時間: 2010/07/27 15:24 Pre-operative Diagnosis Tethered cord syndrome due to intraspinal lipoma Post-operative Diagnosis Tethered cord syndrome due to intraspinal lipoma Operative Method Intramedullary tumor excision for untethering via L5 to S2 laminectomy Intramedullary tumor excision for untethering via L5 laminectomy to bifid S1 and S2 Specimen Count And Types 1 piece About size:3x2x2cm Source:Intradural lipoma Pathology Pending Operative Findings Skin dimpling was noted at S1 level with spinal bifida. After skin incision, the fibrotic band was found beneath the skin dimpling. The fibrotic band can be traced into the intradural space with one about 2x1cm dural defect. The dura incision was made at L5 level and the cord was identified. The terminal cord was infiltrated with adipose tissue and tethered tightly. The adhesion is severe over left side and the junction between cord, roots, and dura is hard to be distinguished. Partial excision of the lipoma and adhesionlysis was performed for untethering of the cord. The cord was untethered well after the operation. 1. Skin dimpling without fistula was noted at S1 level with spinal bifida at S1 and below. The dimple connected to the subcutaneous fibrotic band and could be traced into the epidural fat and going into the intradural space through a 3X2 cm fascial defect and a 2x1cm dural defect. 2. The L5 lamine was bifid and cartilageous. The right laminae along with the spinous process was deformed and bending left ward to became falt. The right lamina of L5 was vertically deformed. The laminae of S1 and below was absence. . The dura incision was made at L5 level and the cord was identified. The terminal cord was infiltrated with adipose tissue and tethered tightly. The adhesion is severe over left side and the junction between cord, roots, and dura is hard to be distinguished. Partial excision of the lipoma and adhesionlysis was performed for untethering of the cord. The cord was untethered well after the operation. 3. The dura incision was made at L5 level and the cord was identified. The terminal cord was infiltrated with adipose tissue and tethered tightly. The untethering could be achieve by dividing the nerves from the liponeurodural junction. The adhesion is severe over left side and the junction between cord, roots, dura and lipomatous tissue was hard to be distinguished, so it was dissected as a whole and untethered to the ventral side instead of complete devision of the nerves. Partial excision of the dorsal part of lipoma and adhesionlysis was performed for untethering of the cord. The cord was untethered well after the operation. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in prone position. The L5 to S2 level was localized by portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. The midline skin incision was made from L5 to S3 level. The subcutaneous soft tissue was dissected and the paravertebral muscle group was detached. The fibrotic band beneath the skin dimpling area was noted and connected with the lipoma and intradural space. L5 to S2 laminectomy was performed. Under endotracheal tube general anesthesia, the patient was put in prone position. The L5 to S2 level was localized by portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. The midline skin incision was made from L5 to S3 level. The subcutaneous soft tissue was dissected and the paravertebral muscle group was detached. The fibrotic band beneath the skin dimpling area was noted and connected with the lipoma and intradural space. L5 laminectomy was performed then the dissection was performed downward to S3 level. Linear durotomy was performed at L5 level and CSF was released. The tethered cord was identified. Adhesionlysis was performed along bilateral lateral side of the cord in order to preserved the roots. Partial lipoma excision was done during adhesionlysis. The adhesionlysis was stopped until the ventral part of the cord was found. Some small dorsal roots were sacrified for adhesionlysis. After untethering of the spinal cord, hemostasis was achieved. The dura was closed with 4-0 Prolene. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Linear durotomy was performed at L5 level and CSF was released. The tethered cord was identified. Adhesionlysis was performed along bilateral lateral side of the cord in order to preserved the roots. Partial lipoma excision was done during adhesionlysis. The adhesionlysis was stopped until the ventral part of the cord was found. Some small dorsal roots were sacrified for adhesionlysis. After untethering of the spinal cord, hemostasis was achieved. The dura was closed with 4-0 Prolene. One epidrual CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Under microscopic vies, linear durotomy was performed at L5 level and CSF was released. The tethered cord was identified. Adhesionlysis was performed along both lateral side of the cord (at the liponeurodural junction) from right side first. The adhesionlysis was stopped until the ventral part of the cord was found. The we went down to the end of thecal sac. We then proceed to the left side. Because of lipomatous tissue infiltrated diffusely with the dorsal and part of the ventral roots over the left side. It made the dura of the left side very thick and extended even to the lateral anterior side of the thecal sac, we dissected the inner layer of the dura along with the preserved roots to untether the cord though it was not divided. Partial lipoma excision was done. After untethering of the spinal cord, hemostasis was achieved. The dura was closed with 4-0 Prolene. One epidrual CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators AP郭夢菲 Assistants R4李振豪, Ri歐淑娟 相關圖片 盧春福 (M,1962/10/29,49y4m) 手術日期 2010/07/27 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Spinal tumor 器械術式 Malignant intraspinal tumor, e 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 07:33 報到 08:00 進入手術室 08:05 麻醉開始 08:25 誘導結束 08:50 抗生素給藥 09:48 手術開始 11:50 抗生素給藥 13:05 開始輸血 14:50 抗生素給藥 15:30 麻醉結束 15:35 手術結束 15:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 良性病髓腫瘤切除術 1 1 手術 椎弓切除術（特壓）－二節以內 1 2 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 7 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: 1. Near total excision of spinal tumor. 開立醫師: 鍾文桂 開立時間: 2010/07/27 16:37 Pre-operative Diagnosis Intradural extramedullary spinal tumor, C3/4 with cord compression. Post-operative Diagnosis Intradural extramedullary spinal tumor, C3/4 with cord compression, suspect schwannoma. Schwannoma, C3/4 with cord compression. Operative Method 1. Near total excision of spinal tumor. 2. C3,C4 laminectomy. Specimen Count And Types 1 piece About size:3 cm Source:C3/4 schwannoma. Pathology Pending. Schwannoma. Operative Findings 1. Firm, whitish, encapsulated tumor with severe adhesion with surrounding soft tissue. 2. Intact spinal cord; compressed spinal cord by the tumor, good cord pulsation of tumor excision. 3. Some of right C4 rootlets were sacrafized as they are the tumor origin. 4. Easy oozing operative field due to epidural vein. 5. Part of the tumor is left due to severe adhesion, much blood loss related unstable vital signs. Operative Procedures Under ETGA, the patient was put in prone position and the head was fixed with 3-pin Mayfield. After shaving and disinfection, midline incision and dissection were made from C2-C4 level. Upper part of C3 and lower part of C4 laminae were removed by Rongeur. After horizontal dural incision, the tumor was exposed. We used CUSA for tumor excision. The tumor was excised first with central debulking. Then, the tumor was excised along the tumor capsule. Some C4 rootlets were excised along with the tumor mass. Severe bleeding from the epidural veins was sealed with Gelfoam and Surgicel. After well hemostasis, the dura mater was closed with DuraFoam. Finally, the wound was closed in layers with in epidural CWV drain. Operators V.S.賴達明 Assistants R5 鍾文桂,R2 楊博智 相關圖片 呂睿棋 (M,1950/05/16,61y9m) 手術日期 2010/07/27 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Lumbar spondylosis 器械術式 Laminectomy for decompression 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 15:20 報到 16:10 進入手術室 16:20 麻醉開始 16:30 誘導結束 16:40 抗生素給藥 17:17 手術開始 18:50 麻醉結束 18:52 手術結束 19:10 進入恢復室 19:10 送出病患 20:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術（特壓）－二節以內 1 1 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 記錄__ 手術科部: 外科部 套用罐頭: Sublaminar decompression, L2/3. 開立醫師: 鍾文桂 開立時間: 2010/07/27 19:19 Pre-operative Diagnosis Lumbar stenosis and herniated intervertebral disc, L2/3. Post-operative Diagnosis Lumbar stenosis and herniated intervertebral disc, L2/3. Operative Method Sublaminar decompression, L2/3. Specimen Count And Types nil Pathology Nil. Operative Findings 1. Hypertrophic ligamentum flavum. 2. Fracture of left L2 inferior facet. 3. Intact dura mater, slack root after decompression. Operative Procedures Under ETGA, the patient was put in prone position. Under C-arm fluoroscopy, L2 spinous process was marked. After disinfection and draping, midline incision was made. The L2 spinous process was splinted into half by high speed saw. Superior portion of L3 and inferior portion of L2 lamina were resected with Kerrison punch. The left L2 inferior facet was removed for further decompression. With well hemostasis, the wound was closed in layers. Operators V.S. 賴達明 Assistants R5 鍾文桂 R2 楊博智 王曾秀雲 (F,1930/12/31,81y2m) 手術日期 2010/07/27 手術主治醫師 陳敞牧 手術區域 東址 001房 02號 診斷 Compression fracture 器械術式 Laminectomy for decompression，Spinal fusion posterior 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 吳政達, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 11:49 報到 12:08 進入手術室 12:10 麻醉開始 12:40 誘導結束 13:00 抗生素給藥 13:30 手術開始 15:34 開始輸血 16:10 手術結束 16:10 麻醉結束 16:25 送出病患 16:25 抗生素給藥 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 椎弓切除術（特壓）－二節以內 1 2 記錄__ 手術科部: 外科部 套用罐頭: T8,9,T12,L1 TPS and T11 laminectomy 開立醫師: 胡朝凱 開立時間: 2010/07/27 16:43 Pre-operative Diagnosis T11 compression fracture Post-operative Diagnosis T11 compression fracture Operative Method T8,9,T12,L1 TPS and T11 laminectomy Specimen Count And Types pieces of granulation tissue Pathology pending Operative Findings 1.osteoporosis was noted 2.T11 fracture and listhesis was also noted 3.Epidural granulation tissue was noted at T11 level 4.Hypertrophic flavum ligment compressed the spinal cord tightly 5.Scoliosis Operative Procedures 1.ETGA, prone 2.Midline skin incision 3.Detach paravertebral muscle group 4.Insert pedicular screws at T9,10,12,and L1 5.Laminectomy of T11 6.Expose dura 7.Remove granulation tissue 8.Fixed rods and cross link 9.Set one hemovac drain 10.Close wound in layers Operators 陳敞牧 Assistants 胡朝凱, 吳政達 Indication Of Emergent Operation 王志遠 (M,1977/07/27,34y7m) 手術日期 2010/07/28 手術主治醫師 杜永光 手術區域 東址 005房 02號 診斷 Pituitary tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 王奐之, 時間資訊 13:10 報到 13:35 進入手術室 13:40 麻醉開始 14:00 誘導結束 14:15 抗生素給藥 14:58 手術開始 16:00 麻醉結束 16:00 手術結束 16:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經由蝶竇之腦下垂體瘤切除 1 1 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 記錄__ 手術科部: 外科部 套用罐頭: Trans-sphenoid pituitary cyst fenestration 開立醫師: 王奐之 開立時間: 2010/07/28 16:30 Pre-operative Diagnosis Pituitary cystic tumor Post-operative Diagnosis Pituitary cyst, suspected Rathke cyst Operative Method Trans-sphenoid pituitary cyst fenestration Trans-sphenoid pituitary cyst removal Specimen Count And Types 1 piece About size:0.2*0.1*0.1cm Source:pituitary cyst Pathology Pending Operative Findings The septum of the sphenoid sinus was noted to be deviated to the right side, with pituitary tumor at the left part of the sella. Mucoid fluid was drained after pituitary cyst fenestration. No CSF leakage was encountered during the operation, the arachnoid membrane was kept intact. Operative Procedures After ETGA, the patient was placed in supine position with neck extended. After skin disinfection, the right nostril was entered under microscopic aid. After removing the mucosa and fracturing the vomer bone along with anterior wall of the sphenoid sinus, the sellar floor was noted. The sellar floor was then fractured opened, exposing the pituitary cyst. The cyst was then fenestrated, mucoid content gushed out and was sucked dry quickly. After meticulous hemostasis, the sellar floor was reconstructed with gelfoam and bone chip. The operation then ends after Marocel packings. After ETGA, the patient was placed in supine position with neck extended. After skin disinfection, the right nostril was entered under microscopic aid. After removing the mucosa and fracturing the vomer bone along with anterior wall of the sphenoid sinus, the sellar floor was noted. The sellar floor was then fractured opened, exposing the pituitary cyst. The cyst was then fenestrated, mucoid content gushed out and was sucked dry quickly. The cyst wall was then pulled out completely. After meticulous hemostasis, the sellar floor was reconstructed with gelfoam and bone chip. The operation then ends after Marocel packings. Operators P 杜永光 Assistants R6 陳睿生, R3 王奐之 相關圖片 王阿琴 (F,1953/06/13,58y9m) 手術日期 2010/07/28 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Aneurysm 器械術式 Craniotomy(Aneurysms) P-DUH 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 游健生, 時間資訊 07:30 報到 08:05 進入手術室 08:10 麻醉開始 08:30 誘導結束 09:07 抗生素給藥 09:37 手術開始 12:12 抗生素給藥 15:12 抗生素給藥 16:45 麻醉結束 16:45 手術結束 16:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 開顱術摘除血管病變－腦血管瘤－無徵的 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 9 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Right dolenc approach for ophthalmic artery a... 開立醫師: 游健生 開立時間: 2010/07/28 17:27 Pre-operative Diagnosis Right ophthalmic artery aneurysm Post-operative Diagnosis Right ophthalmic artery aneurysm Operative Method Right dolenc approach for ophthalmic artery aneurysm clipping Specimen Count And Types nil Pathology Nil Operative Findings An aneurysm, measuring about 1 x 0.6cm, arose at the junction of right ophthalmic artery and internal carotid artery. It pointed out superio-laterally and compressed the optic nerve inferio-laterally resulting in an indentation on optic nerve. The proximal control elasped time was about 2mins. Operative Procedures Under ETGA, patient was put into supine position with right shoulder elevated. Her head was turned to left, tilted up, and fixed with Mayfield headholder. After shaving, we disinfected and draped the operation field as usual. A curvilinear incision was made from 1cm anterior to tragus to 2cm cross the midline. After applying Raney clips, we reflected the skin flap anteriorly with Yasargil fat pad. Then, we flipped temporalis muscle downward with a muscle cuff left at cranium to expose the keyhole and pterion. A frontotemporal craniotomy was done followed by removal of part of sphenoid ridge to expose anterior clinoid process(ACP). We accidentally opened part of frontal sinus. Thus, we packed it with aqueous iodine-soaked gelfoam and sealed it off with bone wax. After dura tenting, we removed ACP extradurally with high-speed air drill. To expose the optic nerve, we removed the roof of optic canal and orbital apex with Kerrison. We exposed 2nd and 3rd branch of trigerminal nerve after gentle retraction of temporal lobe. After coagulation and transection of right middle meningeal artery, we further retracted temporal lobe and exposed petrous ridge. We drilled off part of petrous ridge to expose internal carotid artery(ICA) with preservation of greater superficial petrosal nerve. We looped the ICA with silk as proximal control. After U-shape temporal-based durotomy, we retracted frontal lobe gentlely to expose the optic nerve and aneurysm. The basal cistern was opened for further exposure. We cut the dura flap in the middle and reached the dura ring of ICA. Then, we opened the falciform ligament and dura ring to mobilize optic nerve and ICA. After examining the relationship between the neck of aneurysm and surrounding structure, we applied a curved Sugita clip to the neck following tightening the silk around ICA. After dissection of aneurysm dome, we decompressed it with needle aspiration and bipolar electrocautery. Then, we released ICA and examined the patency of surrounding vessels. We closed the dura with water-tight 3-0 prolene suture. After removal of the silk looping ICA, we achieved hemostasis with Surgicel and Gelfoam. We tented the dura followed by bone flap fixation with miniplates. Finally, we approximated temporalis muscle to muscle cuff with interrupted silk sutures and closed the wound in layers after placement of a subgaleal CWV drain. Operators Prof. 杜永光 Assistants R6 胡朝凱 R3 游健生 李淑芬 (F,1970/01/29,42y1m) 手術日期 2010/07/28 手術主治醫師 曾漢民 手術區域 東址 005房 03號 診斷 Glioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 游健生, 時間資訊 15:50 報到 16:27 進入手術室 16:30 麻醉開始 17:00 誘導結束 17:30 抗生素給藥 17:47 手術開始 19:20 麻醉結束 19:20 手術結束 19:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４小時以內 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for partial tumor excision 開立醫師: 游健生 開立時間: 2010/07/28 20:19 Pre-operative Diagnosis Astrocytoma, status post partial excision, status post radiotherapy, suspect recurrence Post-operative Diagnosis Astrocytoma, status post partial excision, status post radiotherapy, suspect recurrence Operative Method Craniotomy for partial tumor excision Specimen Count And Types 1 piece About size:a few pieces Source:brain tumor Pathology Pending Operative Findings 1.an unclear border, grayish, gelatin like, elastic firm tumor located at left frontal lobe. It was not hypervascular. There seems a plane between brain and tumor. 2.One cyst was noted 1 cm beneath the cortex 3.Some gliotic brain was noted surround the tumor 4.The brain adhered to dura severely at the border of previous durotomy Operative Procedures Under ETGA, patient was put into supine position with head fixed with Mayfield headholder. After shaving along the previous scar, we disinfected and draped the operation field as usual. A bi-coronal incision along previous scar was made. After reflecting the scalp flap anteriorly, we elevated previous bone flap by removal of miniplates. A U-shape sinus-based durotomy was made. There was a cyst lateral to previous tumor cavity and some grayish tissue (tumor) at the medial border of cavity. After locating the contrast-enhanced tumor part by navigation system, we dissected it from normal brain with bipolar and removed in pieces. We further removed some tumor part which had hyperintense signal in T2-weighted image. Hemostasis was achieved by Surgicel and bipolar. We closed the dura by onlay Duraform and Gelfoam packing. Then, we fixed back the bone flap with miniplates and closed wound in layers after placement of a subgaleal CWV drain. Operators VS 曾漢民 Assistants R6 胡朝凱 R3 游健生 呂宗榮 (M,1989/10/06,22y5m) 手術日期 2010/07/28 手術主治醫師 廖漢文 手術區域 東址 000房 號 診斷 器械術式 Other RAD exam/intervention 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 2 時間資訊 14:09 通知急診手術 00:00 開始NPO 10:40 麻醉開始 10:45 誘導結束 11:25 麻醉結束 11:45 進入恢復室 12:40 離開恢復室 葉芳珠 (F,1955/02/16,57y0m) 手術日期 2010/07/28 手術主治醫師 蔡瑞章 手術區域 東址 005房 01號 診斷 Cervical spondylosis without myelopathy 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 王奐之, 時間資訊 08:05 進入手術室 08:10 麻醉開始 08:20 誘導結束 08:50 抗生素給藥 09:17 手術開始 12:15 抗生素給藥 13:00 手術結束 13:00 麻醉結束 13:10 送出病患 13:13 進入恢復室 14:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術－頸椎 1 1 手術 脊椎融合術－前融合，有固定物（＜＝四節） 1 2 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 記錄__ 手術科部: 外科部 套用罐頭: Microsurgical C5-6 & C6-7 discectomy and ante... 開立醫師: 王奐之 開立時間: 2010/07/28 13:26 Pre-operative Diagnosis C5-6 & C6-7 herniated intervertebral disc with cord compression Post-operative Diagnosis C5-6 & C6-7 herniated intervertebral disc with cord compression Operative Method Microsurgical C5-6 & C6-7 discectomy and anterior fusion with autologous bone graft and plate fixation Specimen Count And Types Nil Pathology Nil Operative Findings The C5-6 disc protruded and ruptured to epidural space to compress the cord tightly. The C6-7 disc protruded to compress the cord in a lesser extent. The thecal sac re-expanded well after discectomy. Plate: 37mm (*1) Screws: 4mm in diameter, 14mm in length (*6) Operative Procedures After ETGA, the patient was placed in supine position with neck hyperextended. After skin disinfection and draping in sterile fashion, a linear skin incision at right lower neck was made. The esophagus was retracted toward midline and the vessels were retracted laterally. After careful dissection, the prevertebral fascia was reached. C-arm was used to confirm the C5-6 & C6-7 spaces. Then discectomy of C5-6 & C6-7 were done under microscope. A autologous bone graft was harvested from right iliac crest, about 1.5*1*1cm in size, and splitted into 2 pieces. The 2 pieces of bone graft was then fitted in the C5-6 & C6-7 spaces. Plate was then fixed to the anterior surface of C5-7. After meticulous hemostasis and setting a mini-hemovac drain at neck wound, the wounds were closed in layers. Operators P 蔡瑞章 Assistants R6 陳睿生, R3 王奐之 相關圖片 林智瑜 (F,1998/01/05,14y2m) 手術日期 2010/07/28 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Hydrocephalus 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:05 進入手術室 08:10 麻醉開始 08:20 誘導結束 08:45 抗生素給藥 09:15 手術開始 10:45 手術結束 10:45 麻醉結束 10:55 送出病患 10:55 進入恢復室 12:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 記錄__ 手術科部: 外科部 套用罐頭: Left Kocher"s ventriculo-peritoneal shunt and... 開立醫師: 李振豪 開立時間: 2010/07/28 11:19 Pre-operative Diagnosis Slit ventricle syndrome Slit ventricle syndrome due to VP shunt dysfunction Post-operative Diagnosis Slit ventricle syndrome Slit ventricle syndrome due to VP shunt dysfunction Operative Method Left Kocher"s ventriculo-peritoneal shunt and anti-siphon device implantation Specimen Count And Types 1 piece About size:3ml Source:CSF Pathology Nil Operative Findings 1. The opening pressure is about 10cm H2O with xanthochronic CSF. About 3ml CSF is sampled for routine, glucose, bacterial and fungal culture. 1. The opening pressure is about 10cm H2O with xanthochronic CSF (under PaCO2 30mmHg). About 3ml CSF is sampled for routine, glucose, bacterial and fungal culture. 2. Ventricular catheter: 6.2cm in length Peritoneal catheter: 30cm in length Peritoneal catheter: 25cm in length Anti-siphon device: Codman SIPHONGUARD device Reservoir: Metronic median pressure, Burr hole type Reservoir: Metronic median pressure, Burr hole type 3. The pupils are isocornic after the operation. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine position with head rotated to right. The scalp was shaved, scrubbed, disinfected as usual. The C-shape scalp incision was made at left frontal area and the scalp flap was elevated. The periosteum was opened with cruciform shape followed by one burr hole creation with air-drived perforator. Two dural tenting was done the dura was opened with cricuform shape. The edge of the dura was coagulated with bipolar cautery. Left lateral ventricle puncture was performed with puncture needle and CSF was sampled for routine, glucose, bacterial, and fungal culture. Under endotracheal tube general anesthesia, the patient was put in supine position with head rotated to right. The scalp was shaved, scrubbed, disinfected as usual. The C-shape scalp incision was made at left frontal area and the scalp flap was elevated. The periosteum was opened with cruciform shape followed by one burr hole creation with air-drived perforator. Two dural tenting was done the dura was opened with cricuform shape. The edge of the dura was coagulated with bipolar cautery. Left lateral ventricle successfully punctured once with puncture needle and CSF was sampled for routine, glucose, bacterial, and fungal culture. One transverse linear skin incision was made at left upper abdomen and the subcutaneous tissue was dissected. The rectus sheath was opened and the rectus abdominis muscle was splitted by kelly clamp. After identification of the peritoneum, minilaparotomy was performed. The subcutaneous tunnel was created from left upper abdomen, left forechest(medial to left breast tissue), left neck to left retroauricular area. The shunt was passed through the subcutaneous tunnel. One transverse linear skin incision was made at left upper abdomen and the subcutaneous tissue was dissected. The rectus sheath was opened and the rectus abdominis muscle was splitted by kelly clamp. After identification of the peritoneum, minilaparotomy was performed. The subcutaneous tunnel was created from left upper abdomen, left forechest (medial to left breast tissue), left neck to left retroauricular area. The shunt was passed through the subcutaneous tunnel to exit from the retroauricular puncture wound. The subgaleal tract was created from scalp wound to retroauricular area and the shunt was passed through the subgaleal tract. The V-P shunt was set up with Codman anti-siphon device. The anti-siphon device was placed at retroauricular area. The function of the V-P shunt was checked and the ventricular catheter was placed into left lateral ventricle. Hemostasis was achieved, the peritoneal catheter was placed into peritoneal cavity. The wound was then closed in layers with 3-0 Vicryl and 4-0 Nylon. Operators AP郭夢菲 Assistants R4李振豪, Ri歐淑娟 相關圖片 呂柯葉 (F,1940/01/08,72y2m) 手術日期 2010/07/28 手術主治醫師 賴達明 手術區域 東址 001房 01號 診斷 Spinal myelopathy 器械術式 Spinal fusion posterior 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2E 紀錄醫師 陳德福, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 07:16 通知急診手術 08:52 進入手術室 09:05 麻醉開始 09:45 誘導結束 10:00 抗生素給藥 10:30 手術開始 14:40 手術結束 14:40 麻醉結束 15:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 惡性病髓腫瘤切除術 1 1 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: 1.C2 laminectomy for tumor excision 2.C0-3-4 ... 開立醫師: 陳德福 開立時間: 2010/07/28 15:27 Pre-operative Diagnosis C2 metastatic tumor with cord compression Post-operative Diagnosis C2 metastatic tumor with cord compression Operative Method 1.C2 laminectomy for tumor excision 2.C0-3-4 fusion Specimen Count And Types 1 piece About size:1*1*0.5CM Source:EPIDURAL TUMOR Pathology pending Operative Findings 1.There is epidural and intraosseous tumor at the C2 level with cord compression. The laminectomy of C2 was done and the cord was decompressed after the tumor removal. The tumor is greyish, elastic, hardish and less bloody. 2.C0-3-4 fusion [Depeue] was done smoothly. The Occipital screw:10 &12mm; C3-4 lateral mass screw: 16mm. The angulation:110-125 degree. Operative Procedures Under ETGA and prone position with Mayfield pin type head fixator fixation, the skin was disinfected and draped as usual. One linear incision was done and the paraspinous muscle was displaced laterally. The C2 spinous process was identified followed by exposure the occipital bone to C5 level. The C2 laminectomy was done with air drill assisted. The tumor was remvoed with tumor forceps, currette, aligator, and sucker assisted. The occipital- cervical fusion was done with Depue system. After hemostasis, the wound was closed with one epidural CWV in situ. Operators VS 賴達明 Assistants R5 陳德福 Indication Of Emergent Operation 相關圖片 鄭張鳳珠 (F,1926/01/21,86y1m) 手術日期 2010/07/28 手術主治醫師 賴達明 手術區域 東址 002房 02號 診斷 Cerebral hemorrhage 器械術式 Brain tumor Crainotomy(Others) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 鍾文桂, 時間資訊 03:00 開始NPO 11:00 通知急診手術 12:25 報到 12:50 進入手術室 12:55 麻醉開始 13:10 誘導結束 13:25 抗生素給藥 13:30 開始輸血 13:44 手術開始 16:25 抗生素給藥 17:45 麻醉結束 17:45 手術結束 18:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 急性硬腦膜下血腫清除術 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除－手術時間在４～８小時 1 1 記錄__ 手術科部: 神經部 套用罐頭: 1. Simpson grade II tumor excision. 開立醫師: 鍾文桂 開立時間: 2010/07/28 18:59 Pre-operative Diagnosis 1. Right parietal-temporal intracerebral and acute subdural hemorrhage, suspect tumor bleeding. Post-operative Diagnosis 1. Right temporal convexity meningioma. 2. Right parietal-temporal intracerebral and acute subdural hemorrhage. Operative Method 1. Simpson grade II tumor excision. 2. Evacuation of intracerebral and acute subdural hemorrhage. Specimen Count And Types 1 piece About size:3cm Source:right temporal meningioma. Pathology Gross: whitish, elastic, encapsulated tumor with dural attachment, about 3~4 cm in size. Operative Findings 1. The tumor was surrounded by the intracerebral hemorrhage and acute subdural hemorrhage. The margins are well-defined. 2. A feeding artery from MCA branches was electrocoagulated. 3. The tumor is moderated oozing. 4. A dural defect was repaired with DuraFoam. Operative Procedures Under ETGA, the patient was put in supine position and the head was tilted to the left. After shaving, disinfection, and draping, a 6 cm reverse U scalp incision was made. A craniotomy was created by high speed drill. After dural tenting, a U shape durotomy was incised based on the temporal side for avoiding vein of Labbe injury. We removed the acute subdural hemorrhage first. After central debuling of the tumor mass, the tumor was excised along its capsule. The dural attachment and base were electrocoagulated. The feeding artery was also electrocoagulated with bipol The intracerebral hemorrhage was removed totally. After well hemostasis, the brain surface was covered with Surgicel. The dura mater was closed in water-tight fashion and the defect was repaired by DuraFoam. The skull bone plate was fixed with wires. After placing one CWV drain in subgaleal space, the wound was closed in layers. Operators V.S. 賴達明 Assistants R5 鍾文桂 R1吳政達. Indication Of Emergent Operation 相關圖片 蘇芷誼 (F,1984/11/01,27y4m) 手術日期 2010/07/28 手術主治醫師 林東燦 手術區域 兒醫 062房 05號 診斷 Acute lymphoid leukemia ( ALL ) 器械術式 IT 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 面罩麻醉 麻醉主治醫師 林峰盛 ASA 3 紀錄醫師 林浩百, 時間資訊 00:31 臨時手術NPO 12:00 進入手術室 12:02 麻醉開始 12:05 進入恢復室 12:06 誘導結束 12:10 手術開始 12:21 手術結束 12:21 麻醉結束 12:25 送出病患 13:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Semi-opened mask inhalation anes 1 0 手術 腦室內注射留置器或脊髓腔內化學藥物注射 1 0 記錄__ 手術科部: 套用罐頭: TIT 開立醫師: 林浩百 開立時間: 2010/07/28 12:26 Pre-operative Diagnosis Acute lymphoblastic leukemia Post-operative Diagnosis Acute lymphoblastic leukemia Operative Method Intrathecal chemotherapy Specimen Count And Types 1 piece About size:9ml Source:CSF Pathology CSF routine and cytology Operative Findings CSF appearance: Clear, slowly dripped Operative Procedures Under IVGA, patient was held in knee-chest decubitus position, with the lumbar area skin prepped and draped. A 22G needle was introduced into the L3-L4 intervertebral space and advanced slowly until the dura was penetrated. Total 9mL of CSF was tapped without trauma. Chemotherapy with methotrexate 15mg, hydrocortisone 25mg, and ara-c 40mg in normal saline to 9mL was injected into the subarachnoid space smoothly. Then the needle was withdrawn completely,and the wound was covered with sterile dressing. Operators vs 林東燦 Assistants R 林浩百 陳可麗 (F,1953/10/20,58y4m) 手術日期 2010/07/28 手術主治醫師 侯君翰 手術區域 西址 035房 02號 診斷 Malignant neoplasm of frontal lobe 器械術式 Arthrostomy - Hip joint 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林子富 ASA 3 紀錄醫師 黃鼎鈞, 時間資訊 08:56 進入手術室 09:15 麻醉開始 09:40 誘導結束 09:41 抗生素給藥 09:45 手術開始 11:30 手術結束 11:30 麻醉結束 11:35 送出病患 11:45 進入恢復室 14:09 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 急性化膿性關節炎切開術－股關節 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 摘要__ 手術科部: 骨科部 套用罐頭: Arthrotomy, debridment,and sequestrectomy 開立醫師: 黃鼎鈞 開立時間: 2010/07/28 11:25 Pre-operative Diagnosis Left septic arthritis with femoral head osteomyelitis Post-operative Diagnosis Left septic arthritis with femoral head osteomyelitis Operative Method Arthrotomy, debridment,and sequestrectomy Specimen Count And Types 1 piece About size:small and few Source:femoral capsule Pathology pending. Operative Findings 1.Pus discharge within femoral capsule. 2.femoral head osteomyelitis and erosion . Operative Procedures Under ETT/GA, patient was in right decubitus postion. Skin was disinfected and draped as usual. Skin incision over lateral thigh in anterior-lateral approach. Capsulectomy was performed. Debridment was done. 10000ml normal saline was used to irrigated the wound and hemostasis was done. Wound closed in layers. Operators 侯君翰, Assistants 黃志逢, 黃鼎鈞, 陳明峰, 林育蔚 (M,1977/04/11,34y11m) 手術日期 2010/07/29 手術主治醫師 林峰盛 手術區域 西址 035房 05號 診斷 Atypical face pain 器械術式 Nerve block / PC 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 林峰盛 ASA 2 時間資訊 16:05 進入手術室 16:10 麻醉開始 16:13 誘導結束 16:25 手術開始 16:45 手術結束 16:45 麻醉結束 16:55 送出病患 記錄__ 手術科部: 麻醉部 套用罐頭: Pulsed RF 開立醫師: 林峰盛 開立時間: 2010/07/29 16:51 Pre-operative Diagnosis atypical facial pain Post-operative Diagnosis atypical facial pain Operative Method 1. IV sedation with midazolam and ketamine and LA with 1% xylocaine 2. pt in supine position 3. Under fluoroscopic-guidance, insert 22 G SMK RF meedle into right pterypalatine fissure 4. Neurostimulation with 50 HZ and 2 Hz 0.1-0.5 mV current with positive result 60-80V 2 Hz, 20 ms, 120sec *2 pulsed RF was delivered send pt to POR Specimen Count And Types nil Pathology Nil Operative Findings Operative Procedures Pulsed RF Operators 林峰盛, Assistants 王曼玲, 詹哲銘 (M,1958/01/15,54y1m) 手術日期 2010/07/29 手術主治醫師 賴達明 手術區域 東址 003房 03號 診斷 Spinal tumor 器械術式 Intraspinal intramedullary tum 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3 紀錄醫師 徐展陽, 時間資訊 12:25 報到 13:00 進入手術室 13:05 麻醉開始 13:20 誘導結束 14:10 抗生素給藥 14:25 手術開始 17:10 抗生素給藥 18:40 手術結束 18:40 麻醉結束 18:45 送出病患 18:50 進入恢復室 20:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 良性病髓腫瘤切除術 1 1 手術 腰椎蜘蛛網膜下－腹腔分流手術 1 2 手術 誘發電位手術監視機–腦神經外科術中特殊儀器使用費 1 0 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 記錄__ 手術科部: 外科部 套用罐頭: 1. Total tumor remove, 2. Cystopleural shunt ... 開立醫師: 陳睿生 開立時間: 2010/07/29 19:05 Pre-operative Diagnosis L1/2 intraspinal tumor, subdural arachnoid cyst over T10-L1 level Post-operative Diagnosis L1/2 intraspinal tumor, subdural arachnoid cyst over T10-L1 level Operative Method 1. Total tumor remove, 2. Cystopleural shunt insertion Specimen Count And Types 1 piece About size:pieces Source:intraspinal tumor Pathology Pending Operative Findings The tumor at L1/2 level was soft, fragile and dark grayish in color. It was noted to be tightly adhered to one nerve root. A arachnoid cyst with prominent membrane was noted from T10 to L2 level. It located at the dorsal side of the cord, and a small fistula was noted at the T11-12 level from the dorsal cyst to another ventral one. A cystopleural shunt was inserted from the thecal sac to right side posterior region of pleural cavity. The insertion point was located at T7-8 intercostal space. Intra-op left leg MEP change was noted, and it returned to baseline after the operation. Severe wound adhesion and scar formation was noted. Operative Procedures 1. ETGA, prone position and C-arm localization the L1, T10 level 2. Posterior midline incision along the previous wound 3. Expose the lower T7 lamina and then dissect the plane between the dura and muscle fascia from T8 to L2 level 4. The dura was opened and tented from T10 to L2 under microscope 5. The thicken arachnoid membrane was dissected and the tumor at L1/2 level was noted after nerve root splitting 6. The tumor was totally removed with curette and tumor forceps 7. The arachnoid cyst was exposed and fenestrated 8. A T-tube was inserted at T10 to L1 level, and the distal side of the drain was inserted to the right side pleural space at T7-8 level 9. Hemostasis, close the dura tightly and packed with Durafoam 10.Set an epidural CWV drain 11.Close the wound in layers Operators VS 賴達明 Assistants R6 陳睿生, R1 徐展陽 吳翠英 (F,1955/07/22,56y7m) 手術日期 2010/07/29 手術主治醫師 陳敞牧 手術區域 東址 005房 01號 診斷 Brain tumor 器械術式 Stereotaxic procedure for aspi 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3 紀錄醫師 何奕瑢, 時間資訊 08:35 報到 08:35 進入手術室 08:40 麻醉開始 09:00 誘導結束 09:00 抗生素給藥 09:11 手術開始 12:00 抗生素給藥 13:20 麻醉結束 13:20 手術結束 13:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 立體定位術－切片 1 1 摘要__ 手術科部: 外科部 套用罐頭: Right fromtal stereotatic biopsy 開立醫師: 陳德福 開立時間: 2010/07/29 13:39 Pre-operative Diagnosis Multiple cystic brain lesion, nature to be determinated Post-operative Diagnosis Multiple cystic brain lesion, nature to be determinated Operative Method Right fromtal stereotatic biopsy Specimen Count And Types 1 piece About size:0.5*0.5*0.2CM Source:right frontal tumor Pathology fronzen section: gliotic tissue Operative Findings 1.pieces of grayish brain tissue was taken Operative Procedures 1.ETGA, supine 2.Right frontal transverse skin incision 3.Dissect and burr hole drill 4.Localization with navigator 5.open dura 6.take biopsy 7.hemstasis 8.Close wound in layers Operators 陳敞牧 Assistants 胡朝凱 鄭豐達 (M,1932/03/03,80y0m) 手術日期 2010/07/29 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 CVA 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3 紀錄醫師 吳政達, 時間資訊 10:05 報到 10:43 進入手術室 10:45 麻醉開始 11:00 誘導結束 11:20 抗生素給藥 11:27 手術開始 12:40 手術結束 12:40 麻醉結束 12:46 送出病患 12:53 進入恢復室 13:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 頭顱成形術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Cranioplasty 開立醫師: 吳政達 開立時間: 2010/07/29 12:43 Pre-operative Diagnosis Status post decompressive craniectomy at right Post-operative Diagnosis Status post decompressive craniectomy at right Operative Method Cranioplasty Specimen Count And Types nil Pathology NIL Operative Findings bone graft was fixed back the the original wound bone graft was fixed back to the original wound Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to left. After scalp shaved, scrubbed, disinfected, and then draped, we made skin incision along previous operation wound. We refected the scalp falp inferiorly, and fixed the bone graft back with mini-plates. We closed the wound in layers after one subgaleal CWV inserted. Operators VS 王國川 Assistants R4 曾峰毅 R1 吳政達 許智逢 (M,1978/11/26,33y3m) 手術日期 2010/07/29 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Subarachnoid hemorrhage (SAH) 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3 紀錄醫師 吳政達, 時間資訊 08:07 進入手術室 08:20 麻醉開始 08:21 報到 08:25 誘導結束 08:45 抗生素給藥 09:03 手術開始 10:30 手術結束 10:30 麻醉結束 10:35 進入恢復室 10:35 送出病患 12:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 頭顱成形術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Cranioplasty 開立醫師: 曾峰毅 開立時間: 2010/07/29 10:32 Pre-operative Diagnosis Status post decompressive craniectomy Post-operative Diagnosis Status post decompressive craniectomy Operative Method Cranioplasty Specimen Count And Types Nil Pathology Nil Operative Findings Bone graft was fixed back with miniplates. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to right. After scalp shaved, scrubbed, disinfected, and then draped, we made skin incision along previous operation wound. We refected the scalp falp inferiorly, and fixed the bone graft back with mini-plates. We closed the wound in layers after one subgaleal CWV inserted. Operators VS 王國川 Assistants R4 曾峰毅 R1 吳政達 黃炯勛 (M,1991/12/17,20y2m) 手術日期 2010/07/29 手術主治醫師 王國川 手術區域 東址 002房 01號 診斷 Head injury, unspecified 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3E 紀錄醫師 李振豪, 時間資訊 06:19 通知急診手術 06:54 報到 06:55 進入手術室 07:00 麻醉開始 07:30 誘導結束 07:46 抗生素給藥 08:05 手術開始 08:55 麻醉結束 08:55 手術結束 09:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱內壓監視置入 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Right Kocher"s intracranial pressure monitor ... 開立醫師: 李振豪 開立時間: 2010/07/29 09:27 Pre-operative Diagnosis 1. Traumatic subarachnoid hemorrhage, 2. Diffuse axonal injury Post-operative Diagnosis 1. Traumatic subarachnoid hemorrhage, 2. Diffuse axonal injury Operative Method Right Kocher"s intracranial pressure monitor insertion Specimen Count And Types nil Pathology Nil Operative Findings The subarachnoid hemorrhage and subdural hemorrhage were noted after dura opening. The initial pressure after ICP monitor insertion is 10mmHg. The ICP after wound closure is 7mmHg and 1mmHg after ICU admission. Reference of ICP monitor: 496. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine position. The scalp was shaved, scrubbed, and disinfected as usual. One transverse linear scalp incision was made at right Kocher"s point followed by one burr hole creation. Two dural tenting was performed. The dura was opened with cruciform and the eduge of the dura was coagulated with bipolar cautery. Intra-parenchyma ICP monitor was inserted. After hemostasis, the burr hole was packing with Gelform. The wound was then closed in layers. Operators VS王國川 Assistants R4李振豪 Indication Of Emergent Operation 相關圖片 陳安郎 (M,1942/02/11,70y1m) 手術日期 2010/07/30 手術主治醫師 杜永光 手術區域 東址 003房 02號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 游健生, 時間資訊 14:46 報到 15:25 進入手術室 15:30 麻醉開始 15:50 誘導結束 16:08 抗生素給藥 16:50 手術開始 19:08 抗生素給藥 20:25 麻醉結束 20:25 手術結束 20:35 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 手術 腦瘤切除－手術時間在４～８小時 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Right parieto-occipital craniotomy for Simpso... 開立醫師: 游健生 開立時間: 2010/07/30 20:44 Pre-operative Diagnosis Right parieto-occipital parasagittal meningioma Post-operative Diagnosis Right parieto-occipital parasagittal meningioma Operative Method Right parieto-occipital craniotomy for Simpson grade III excision Specimen Count And Types 1 piece About size:a few pieces Source:meningioma Pathology Pending Operative Findings A whitish tumor, measuring 3.8 x 3.4 x 4 cm in size, was found arising from the dura at right parieto-occipital parasagittal region. It was elastic firm and hypervascularized. It invaded the superior saggital sinus with partial sinus occlusion. The plane between cerebrum and the tumor was clear. There was some hyperosteotic changes at the cranium over the tumor. Operative Procedures Under ETGA, patient was put into prone position with head fixed by Mayfield headholder in neutral position. After shaving, we disinfected and draped the operation field as usual. A hockey-stick scalp incision was made from left paramedian extending to right laterally. We reflected the skin flap posteriorly followed by pericranium flap. Then, we created a 6 x 6cm craniotomy with 3 burrholes 1 cm crossing midline. Hemostasis was achieved with Surgicel and Gelfoam packing. We opened the dura along the lateral border of the tumor. As we reflected the dura flap, we separated the tumor from it with bipolar electrocautery. Then, we dissected the tumor along arachnoid plane away from cerebrum and removed it in pieces. The tumor part which invaded into superior sagittal sinus was left in situ. The dura flap was excised along the SSS border. Hemostasis was achieved with Surgicel packing at tumor bed. We repaired the dura defect with a graft harvested from the pericranium flap by water-tight continuous 3-0 prolene suture. After dura tenting, we fixed the bone flap back with miniplates. Finally, we closed the wound in layers after placement of a subgaleal CWV drain. Operators Prof.杜永光 Assistants R6胡朝凱 R3游健生 李懷龍 (M,1935/12/04,76y3m) 手術日期 2010/07/30 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Brain tumors, malignant 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 王奐之, 時間資訊 07:37 報到 08:02 進入手術室 08:05 麻醉開始 08:50 誘導結束 09:02 手術開始 09:02 抗生素給藥 10:50 麻醉結束 10:50 手術結束 10:55 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 腦瘤切除－手術時間在４小時以內 1 1 L 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 L 摘要__ 手術科部: 外科部 套用罐頭: craniotomy tumor excision 開立醫師: 陳德福 開立時間: 2010/07/30 11:05 Pre-operative Diagnosis Metastatic brain tumor, left high frontal, nature to be determinated Post-operative Diagnosis Metastatic brain tumor, left high frontal, nature to be determinated Operative Method craniotomy tumor excision Specimen Count And Types 1 piece About size:2*2*2CM Source:left brain tumor Pathology pending Operative Findings 1.There is a 2*2*2.5cm in sized intraparenchymal tumor at the left pre-motor gyrus. The tumor is yellowish-greyis, soft, fragile, and superficial with mucin-like material in contents. The tumor was totally removed. 2.The intra-OP ultrasonography and mapping were performed. Operative Procedures Under ETGA and supine position with Mayfield pin type head fixator, the scalp was disinfected and draped as usual. One curvilinear incision was done on left scalp and one 5*6cm in sized craniotomy was doen. The dura tenting and dura opening were performed. Under intra-OP ultrasonography, the tumor was localized. Under microscopic surgery, the arachnoid membrane was opened followed by removing the tumor under tumor forceps, bipolar coagulator, and sucker assisted. The tumor was removed totally and hemostasis was done. The dura was closed in water tight fasion and the skull was fixed with miniplates. One subgaleal CWV was left in situ and the wound was clsoed in layers. Operators VS 曾漢民 Assistants R5 陳德福 R3 王奐之 相關圖片 郭一良 (M,1938/08/22,73y6m) 手術日期 2010/07/30 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Brain metastasis 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 王奐之, 時間資訊 10:30 報到 11:15 進入手術室 11:20 麻醉開始 11:45 誘導結束 12:12 抗生素給藥 12:43 手術開始 15:10 抗生素給藥 15:20 麻醉結束 15:20 手術結束 15:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４小時以內 1 1 L 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: craniotomy tumor excision 開立醫師: 陳德福 開立時間: 2010/07/30 16:05 Pre-operative Diagnosis colon cancer with brain metastasis, left occipital Post-operative Diagnosis colon cancer with brain metastasis, left occipital Operative Method craniotomy tumor excision Specimen Count And Types 1 piece About size:4*3*4CM Source:Left occipital lobe tumor Pathology pending Operative Findings 1.There is a 4*3*5cm in sized tumor at the left occipital lobe with cystic change and hematoma formation. The tumor is reddish, easy bleeding, well demarcated, and compressive. The perifocal edematous change is remarkable. After the tumor removal, the falx could be visualized. Operative Procedures Under ETGA and prone position with Mayfield pin type head fixator, the scalp was disinfected and draped as usual. One curvilinear incision was done on left scalp and one 8*6cm in sized craniotomy was doen. The dura tenting and dura opening were performed. Under intra-OP ultrasonography, the tumor was localized. Corticotomy was performed. Under microscopic surgery, the arachnoid membrane was opened followed by removing the tumor under tumor forceps, bipolar coagulator, and sucker assisted. The tumor was removed totally and hemostasis was done. The dura was closed in water tight fasion and the skull was fixed with miniplates. One subgaleal CWV was left in situ and the wound was clsoed in layers. Operators VS 曾漢民 Assistants R5 陳德福 R3王奐之 相關圖片 黃鑑清 (M,1947/11/16,64y3m) 手術日期 2010/07/30 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Ependymoma 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 07:37 報到 08:05 進入手術室 08:10 麻醉開始 08:40 誘導結束 09:20 抗生素給藥 09:41 手術開始 12:20 抗生素給藥 15:20 麻醉結束 15:20 手術結束 15:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除－手術時間在４～８小時 1 1 L 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 L 記錄__ 手術科部: 外科部 套用罐頭: Total tumor excision via left subtemporal app... 開立醫師: 鍾文桂 開立時間: 2010/07/30 19:54 Pre-operative Diagnosis Left frontal-temporal-parietal tumor. Left frontal-parietal tumor. Post-operative Diagnosis Left frontal-temporal-parietal tumor, suspect high grade glioma. Left frontal-parietal tumor, suspect high grade glioma. Left frontal-parietal anaplastic ependymoma, WHO grade III. Operative Method Total tumor excision via left subtemporal approach. Specimen Count And Types 1 piece About size:3 cm Source:Brain tumor. Pathology Pending. Grade III astrocytoma Operative Findings 1. A cystic lesion located at left frontal-temporal-parietal regions. 2. Yellowish, pinkish, soft tumor; moderate oozing. 3. The cystic content was yellowish,and serous.No hemorrhage inside the cyst. 4. Trans-sulci approach for tumor excision. We located the tumor with the aid of intraoperative ultrasonography. 4. Trans-cortical tumor excision. We located the tumor with the aid of intraoperative ultrasonography. 5. Intraoperative mapping for motor cortex. No motor cortex found in operative field. Operative Procedures 1. ETGA, supine position, head tilted to the right and fixed with Mayfield. 2. Shaving, disinfection and draping. 3. Reverse U scalp incision. 4. Craniotomy by high speed drill. 5. Dural tending and durotomy. 6. Localize tumor mass with ultrasonography and intraoperative mapping for motor cortex. 7. Lysis of arachnoid membrane. 8. Reach the tumor from a nearby sulcus. 9. Drainage of the cystic content. 10.Dissection of the tumor mass from the normal brain parenchyma. 11.Well hemostasis, cover the brain surface with Surgicel. 12.Closure of dura mater, skull bone plate fixation with mini plates& screws. 13.Wound closure in layers after placing one subgaleal CWV drain. 14.Send the patient to ICU smoothly. Operators V.S. 賴達明 Assistants R5 鍾文桂 R2 楊博智 相關圖片 林李阿英 (F,1937/10/07,74y5m) 手術日期 2010/07/30 手術主治醫師 賴達明 手術區域 東址 019房 02號 診斷 Cervical myelopathy 器械術式 OPLL-Anterior Corpectomy VSLai 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 14:48 報到 15:43 進入手術室 15:45 麻醉開始 15:55 誘導結束 16:00 抗生素給藥 16:08 手術開始 19:00 抗生素給藥 19:10 手術結束 19:10 麻醉結束 19:20 送出病患 19:20 進入恢復室 20:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 手術 椎間盤切除術－頸椎 1 1 手術 脊椎融合術－前融合，有固定物（每增加＜＝四節） 1 2 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 記錄__ 手術科部: 外科部 套用罐頭: 1. Cervical diskectomy, C3/4& C4/5. 開立醫師: 鍾文桂 開立時間: 2010/07/30 19:41 Pre-operative Diagnosis 1. Ossification of posterior longitudinal ligament, C3-5. 2. Herniated intervertebral disc, C3/4. Post-operative Diagnosis 1. Ossification of posterior longitudinal ligament, C3-5. 2. Herniated intervertebral disc, C3/4. Operative Method 1. Cervical diskectomy, C3/4& C4/5. 2. Interbody fusion and internal fixation, C3-5. Specimen Count And Types nil Pathology Nil. Operative Findings 1. Ossification of posterior longitudinal ligament at C3/4,C4/5 levels, more severe at C4/5 level. 2. Cervical spine instability during manipulation. 3. Ruptured disc at C3/4 level. 4. Intact dura mater. 5. No change of electric potential during the operation. 6. PEEK cages: 6mm, plate: 35mm, screws: 15mm. Operative Procedures Under ETGA, the patient was place in supine position and the head was extended. After disinfection and draping, a horizontal incision was made at right side of the neck. We reached the cervical vertebrae by insicing the platysma muscle and dissecting along the anterior border of sternocledomastoid muscle. The esophagus and carotid sheath were protected by self retaining retractor. Then, diskectomy at C3/4,C4/5 levels by high speed drill, curretes was achieved. The OPLL was removed by 1 mm Kerrison punch. The spurs were also smoothened by high speed cutting burr. Interbody fusion with PEEK cage was done at C3/4,C4/5 levels. The plates and screws were fixed at C3-5 levels. After placing one mini-hemovac drain at prevertebral space, the wound was closed in layers. Operators V.S. 賴達明 Assistants R5 鍾文桂 R2楊博智 相關圖片 季駱 (M,1988/09/23,23y5m) 手術日期 2010/07/31 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 徐展陽, 時間資訊 07:45 報到 08:00 進入手術室 08:10 麻醉開始 08:50 誘導結束 09:00 抗生素給藥 09:35 手術開始 13:45 手術結束 13:50 麻醉結束 14:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 顱底瘤手術 1 1 記錄__ 手術科部: 外科部 套用罐頭: Right transcortical tumor excision 開立醫師: 胡朝凱 開立時間: 2010/07/31 14:33 Pre-operative Diagnosis Right lateral ventricle central neurocytoma Post-operative Diagnosis Right lateral ventricle central neurocytoma Operative Method Right transcortical tumor excision Specimen Count And Types pieces of tumor Pathology pending Operative Findings 1.One grayish, soft, hypervascular tumor located inside the right lateral ventricle that extended into third and forth ventricle. The tumor attached to the septum pelucidum. The margin was clear. Operative Procedures 1.ETGA, supine 2.Extended previous wound 3.Reflect skin flap laterally 4.Dural opening as teh base left at midline 5.Corticotomy 6.Enter the right lateral ventricle 7.tumor excision via the interface at the attachment area 8. retract the tumor out 9. insert one EVD drain then close wound in layers Operators 曾漢民 Assistants 胡朝凱, 徐展陽 呂嘉倩 (F,1979/11/24,32y3m) 手術日期 2010/07/31 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Arteriovenous malformation, brain 器械術式 Craniotomy(Aneurysms) P-DUH 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3E 紀錄醫師 鍾文桂, 時間資訊 05:29 臨時手術NPO 05:29 開始NPO 18:30 通知急診手術 19:00 報到 19:00 進入手術室 19:05 麻醉開始 19:35 誘導結束 19:45 抗生素給藥 20:25 手術開始 23:00 抗生素給藥 01:20 麻醉結束 01:20 手術結束 01:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 開顱術摘除血管病變－動靜脈畸型－小型－表淺 1 1 L 手術 腦內血腫清除術 1 2 L 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 C.V.P. catheter in ubation 1 0 記錄__ 手術科部: 外科部 套用罐頭: 1. Excision of arteriovenous malformation. 開立醫師: 鍾文桂 開立時間: 2010/08/01 02:08 Pre-operative Diagnosis 1. Suspect intracerebral arteriovenous malformation, left frontal, grade 1. 2. Intracerebral hemorrhage, left frontal. Post-operative Diagnosis 1. Intracerebral arteriovenous malformation, left frontal, grade 1. 2. Intracerebral hemorrhage, left frontal. Operative Method 1. Excision of arteriovenous malformation. 2. Removal of intracerebral hemorrhage. Specimen Count And Types 1 piece About size:2 cm Source:AVM, ICH. Pathology Pending. Operative Findings 1. A 1 cm nidus with feeding arteries from MCA branches and a cortical vein at the brain surface. 2. Presence of gliotic plane around the AVM. 3. Some thrombosed vessels in the nidus. 3. Blood loss: 200 cc. 4. Blood loss: 200 cc. Operative Procedures 1. ETGA, supine position, head tilted to the right. 2. Shaving, disinfection, and draping. 3. A curvilinear scalp incision, then dissection of temporalis muscle. 4. Craniotomy by high speed drill. 5. Dural tenting and durtotomy. 6. Lysis of arachnoid membrane. 7. Evacuation of intracerebral hemorrhage. 8. Excision of arteriovenous malformation. 9. Well hemostasis. 10.Fixation of skull bone plate with plates and screws. 11.Wound closure in layers after placing one CWV drain. 12.Send the patient to ICU smoothly. Operators V.S. 賴達明 Assistants R5鍾文桂 R2陳建銘 Indication Of Emergent Operation 相關圖片 江金清 (M,1956/12/12,55y3m) 手術日期 2010/07/31 手術主治醫師 賴達明 手術區域 東址 003房 號 診斷 Cervical Spondylosis 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 2 紀錄醫師 鍾文桂, 時間資訊 07:44 報到 07:55 進入手術室 08:10 麻醉開始 08:20 誘導結束 08:50 抗生素給藥 09:20 手術開始 11:40 手術結束 11:40 麻醉結束 11:45 送出病患 11:47 進入恢復室 12:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 手術 椎間盤切除術－頸椎 1 1 手術 脊椎融合術－前融合，無固定物（＜＝四節） 1 2 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 記錄__ 手術科部: 外科部 套用罐頭: 1. Diskectomy, C5-6. 開立醫師: 鍾文桂 開立時間: 2010/07/31 12:19 Pre-operative Diagnosis 1. Herniated intervertebral disc, C5-6. Post-operative Diagnosis 1. Herniated intervertebral disc, C5-6. 2. Ossification of posterior longitudinal ligament, C5-6. Operative Method 1. Diskectomy, C5-6. 2. Interbody fusion with PEEK cage, C5-6. Specimen Count And Types nil Pathology Nil. Operative Findings 1. Ruptured disc with impingment of right C6 root. 2. Ossification of posterior longitudinal ligament. 3. Intact and slack dura mater after decompression. 4. PEEK cage: 7mm, with alloplastic bone graft. Operative Procedures 1. ETGA, supine position, neck extended. 2. Horizontal incision at right anterior neck. 3. Incision of platysma muscle and dissection along anterior border of sternocledomastoid muscle. 4. Reach the prevertebral space, seperation of longus collis muscle. 5. Diskectomy and removal of OPLL with currete, high speed cutting burr and Rongeur. 6. Implantation of PEEK cage. 7. Wound closure in layers after placing one mini-hemovac. 8. Send the patient to POR smoothly. Operators V.S. 賴達明 Assistants R5 鍾文桂 Ri 林晨韻 相關圖片 陳映羽 (M,1984/05/21,27y9m) 手術日期 2010/08/01 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Seizure 器械術式 Craniotomy (A.V.M.) P-DUH 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 2E 紀錄醫師 蕭惠壬, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 07:00 通知急診手術 09:25 報到 09:35 進入手術室 09:40 麻醉開始 10:00 誘導結束 10:35 抗生素給藥 10:43 手術開始 13:35 抗生素給藥 16:35 抗生素給藥 17:55 麻醉結束 17:55 手術結束 18:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 開顱術摘除血管病變－動靜脈畸型－中型－表淺 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 9 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Craniotomy for AVM excision 開立醫師: 胡朝凱 開立時間: 2010/08/01 18:11 Pre-operative Diagnosis Right frontal AVM Post-operative Diagnosis Right frontal AVM Operative Method Craniotomy for AVM excision Specimen Count And Types AVM nidus x 1 Pathology pending Operative Findings 1.One about 2.5x1.5 cm grape like AVM with the feeding artery came from Callosomarginal artery. And a superficial drain vein that drained into SSS was also noted. 2.Peripheral hemosiderin and gliotic tissue was noted. Two small cyst with motor oil like material was noted at the bottom of The nidus. Operative Procedures 1.ETGA, supine 2.Head fixed with mayfield skull clamp 3.Curvillinear skin incision one cm anterior to coronal suture 4.Reflect skin flap anteriorly and retract open 5.Craniotomy 4 cm anterior coronal suture and 3 cm posterior to coronal suture 6.Cut open dura with the base left at midline 7.interhemispheric approach to identified the suspect draining vein 8.Dissection was made along the hemosiderin and gliotic plane to made the AVM nidus free 9.The small arteries that supply the nidus was coagulated 10.The draining vein was devided after weck clipping 11.Hemostasis 12.Close dura with fascia graft 13.Fixed bone back with miniplate 14.Set one CWV drain then close wound in layers Operators 王國川 Assistants 胡朝凱, 徐展陽, 蕭惠壬 Indication Of Emergent Operation 李正勇 (M,1939/02/23,73y0m) 手術日期 2010/08/02 手術主治醫師 何子昌 手術區域 西址 032房 13號 診斷 Central retinal vein occlusion 器械術式 Aspiration of vitreous 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 14:30 進入手術室 14:31 麻醉開始 14:32 手術開始 14:33 手術結束 14:33 麻醉結束 14:34 送出病患 摘要__ 手術科部: 眼科部 套用罐頭: IVIA 開立醫師: 何子昌 開立時間: 2010/08/02 14:31 Pre-operative Diagnosis macular edema Post-operative Diagnosis Ditto Operative Method Intravitreal Injection Of Avastin(OS) Specimen Count And Types nil Pathology nil Operative Findings nil Operative Procedures 1.Under topical anesthesia. 2.Disinfection and draping as usual. 3.Apply an eyelid speculum. 4.Intravitreal injection of Avastin 0.05ml 5.Check leakage 6.Iop measurement by digit 7.Check bare VA>ND100cm Operators 何子昌, Assistants 陳芳婷, 蔡員 (F,1936/07/21,75y7m) 手術日期 2010/08/02 手術主治醫師 詹志洋 手術區域 東址 016房 03號 診斷 Esophageal cancer 器械術式 Port-A catheter implatation 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 林哲安, 時間資訊 11:00 進入手術室 11:10 抗生素給藥 11:15 麻醉開始 11:18 誘導結束 11:20 手術開始 11:40 手術結束 11:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 內頸靜脈切開，永久導管放置術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Port-A 開立醫師: 林明賢 開立時間: 2010/08/02 11:44 Pre-operative Diagnosis esophageal cancer Post-operative Diagnosis esophageal cancer Operative Method Port-A catheter implantation, echo guided Specimen Count And Types nil Pathology nil Operative Findings Puncture to right IJV under echo guidance The venous blood flow freely in the Port-A catheter after implantation. Operative Procedures The patient was put on supine position. The operation field was disinfected and draped as usual. Under local anesthesia, we puncture to right IJV under echo guidance. After creating subcutaneous pocket, the Port-A catheter was inserted via peel away sheath. We close the wound in layers. Operators VS詹志洋 Assistants R4林哲安 周昶佑 (M,1975/12/02,36y3m) 手術日期 2010/08/02 手術主治醫師 李章銘 手術區域 東址 000房 號 診斷 Esophageal cancer 器械術式 Port-A catheter Implatation 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 雷秋文, 時間資訊 16:52 報到 16:55 進入手術室 17:05 抗生素給藥 17:19 麻醉開始 17:20 誘導結束 17:22 手術開始 19:25 手術結束 19:35 送出病患 19:35 麻醉結束 醫令資訊 類別 名稱 量 刀 側 手術 ｐｏｒｔ–Ａ導管植入術–治療性導管植入術 1 0 R 記錄__ 手術科部: 外科部 套用罐頭: Port-A 開立醫師: 鄒冠全 開立時間: 2010/08/02 19:25 Pre-operative Diagnosis Esophageal cancer Post-operative Diagnosis Esophageal cancer Operative Method Port-A insertion, right Specimen Count And Types nil Pathology nil Operative Findings The port-A catheter was inserted to right subclavian via puncture method, checked by portable CXR Operative Procedures 1. LA, supine 2. Skin disinfection and draping as usual 3. Insert Port-A via puncture method 4. Checked by portable CXR, close wound in layers Operators VS 李章銘 Assistants R2 雷秋文 伍豊茂 (M,1962/04/01,49y11m) 手術日期 2010/08/02 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Aneurysm 器械術式 ECIC bypass 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 4 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 07:30 報到 08:10 進入手術室 08:30 麻醉開始 09:15 誘導結束 10:00 抗生素給藥 10:40 手術開始 13:00 抗生素給藥 16:00 抗生素給藥 18:10 麻醉結束 18:10 手術結束 18:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱內外血管吻合術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 11 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: EC-IC Bypass (left anterior branch of superio... 開立醫師: 游健生 開立時間: 2010/08/02 18:31 Pre-operative Diagnosis Left middle cerebral artery and anterior cerebral artery occlusion Post-operative Diagnosis Left middle cerebral artery and anterior cerebral artery occlusion Operative Method EC-IC Bypass (left anterior branch of superior temporal artery to left M2 segment) Specimen Count And Types nil Pathology Nil Operative Findings The proximal M2 segment was thrombosed. The anastomosis time last for 86mins. After releasing temporary clips, graft vibration, expansion of graft, and anastomosis site minor leak were noted. No SSEP changes were noted during surgery though poor SSEP of both tibial nerve was noted before surgery. Operative Procedures Under ETGA, patient was put into supine position with right shoulder mildy elevated. His head was turned to right with vertex down fixed by Mayfield headholder. After shaving, we mapped the course of superficial temporal artery(STA) with doppler and shallow skin cuts. Then, we disinfected and draped the operation field as usual. A S-shape scalp incision was made deep to superficial facia. We isolated a 10 cm segment of STA and its anterior branch with surrounding fat tissue. The bleeding from scalp edge was stopped by bipolar coagulator. The STA graft was occluded by a temporary clip and divided at its distal end. We flushed it with heparinized saline to prevent clotting. We reflected the temporalis muscle toward zygoma and splitted it in half. A 6 x 4cm craniotomy centred at tip of Sylvian fissure was done. We tented the dura along the edge of craniotomy window with 2-0 silk followed by cruciate durotomy. The distal end of graft was cut vertically to enlarge the opening followed by methylene blue staining the edge. We opened the sylvian fissure and identified a suitable M2 segment for anastomosis. The arachnoid around the vessel was removed by microscissors and a piece of plastic membrane was placed under the free segment of the artery. Two temporary microvascular clips were applied, 1 cm appart, to the isolated M2 segment, which was then opened by linear incision creating an orifice same as the diameter of the STA graft opening. Heparin solution was used to irrigate the vascular lumen and edge was stained by methylene blue. End-to-end anastomosis was done between the graft and M2 segment with continuous suture of 10/0 monofilament prolene. We sutured the posterior edge loosely first and then tightened each loop one by one to ensure watertight. We suture the anterior edge in same fashion. Then, we packed the anastomosis site with Surgicel followed by removal of temporary clips, proximal end of M2 clip, distal end clip, then the graft clip.The leakage from the anastomosis was successfully stopped by gentle pressure with a small sucker tip. After hemostasis, we closed the dura with 4-0 prolene continuous suture in watertight fashion except the corner of STA graft entering the subdural space. The loose space there was packed with gelfoam around the graft. A dura graft was harvested from temporalis fasica to repair the dura. Then, we fixed the bone flap back with miniplates. Finally, the wound was closed in layers. Operators Prof. 杜永光 Assistants R6 陳睿生 R3 游健生 王顯之 (M,1973/10/02,38y5m) 手術日期 2010/08/02 手術主治醫師 曾漢民 手術區域 東址 005房 號 診斷 Brain Tumor 器械術式 craniotomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 2 紀錄醫師 古恬音, 時間資訊 00:00 臨時手術NPO 07:30 報到 08:08 進入手術室 08:10 麻醉開始 08:35 誘導結束 08:55 抗生素給藥 09:20 手術開始 11:55 抗生素給藥 14:55 麻醉結束 14:55 手術結束 15:03 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 顱底瘤手術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Right frontal craniotomy for transcortical tu... 開立醫師: 胡朝凱 開立時間: 2010/08/02 15:21 Pre-operative Diagnosis Right lateral ventricle tumor, suspected central neurocytoma Post-operative Diagnosis Right lateral ventricle tumor, suspected ependymoma or glioma Operative Method Right frontal craniotomy for transcortical tumor excision Specimen Count And Types 1 piece About size:about 2gm Source:right lateral ventricle tumor Pathology Right frontal craniotomy for transcortical tumor excision Operative Findings The tumor was gray-purplish, fragile, and hypervascular. The attachment site was all around the lateral ventricle except trigone. It occupies the right lateral ventricle with extension to the 3rd ventricle, but the border between the tumor and the ventricle wall was clear.But the tumor seemed mild invasive in character. Frozen section of the tumor showed suspected low-grade glioma or ependymoma. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head flexed and fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected with better iodine. Draping was done in the usual sterile fashion. One U-shaped scalp incision was made at right frontal area, followed by one 8*5cm craniotomy. The dura was opened after peripheral tenting with the base left at midline. Location of motor cortex was confirmed with intraoperative brain mapping, and we localized the tumor with intraoperative sonography. Corticotomy was done in the right frontal area in the vertical fasion, and the tumor was exposed after we reached the right lateral ventricle. Tumor excision was achieved with tumor forceps and biopsy electrocautery from the anterior pole of lateral ventricle to septum, then trigone, and finally 3rd ventricle. The contralateral ventricle was exposed at trigone area. The basal vein was identified and left in situ. After hemostasis, the EVD was inserted. Dura was closed with fascia. Bone was fixed with miniplate. And wound was clsoed in layers after CWV insertion. Operators VS曾漢民 Assistants R6胡朝凱, R3古恬音 陳德仁 (M,1947/07/17,64y7m) 手術日期 2010/08/02 手術主治醫師 林至芃 手術區域 西址 034房 01號 診斷 Brain metastasis 器械術式 Insertion of hichman or port a 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 林至芃 ASA 2 時間資訊 07:30 報到 08:30 進入手術室 08:35 麻醉開始 08:40 誘導結束 08:43 抗生素給藥 08:45 手術開始 09:25 麻醉結束 09:25 手術結束 09:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 ｐｏｒｔ–Ａ導管植入術–治療性導管植入術 1 0 記錄__ 手術科部: 麻醉部 套用罐頭: Port-A implantation, subclavian 開立醫師: 林至芃 開立時間: 2010/08/02 10:00 Pre-operative Diagnosis lung cancer Post-operative Diagnosis Ditto Operative Method Port-A implantation, echo-guided Specimen Count And Types nil Pathology Nil Operative Findings 1.Site: right subclavian vein, with echo-guided procedure 2.Patent flow after implantation 3.Others: nil Operative Procedures 1.The patient was set on supine position and bilateral subclavian veins were checked by echo. 2.After IVGA and local anesthesia applied, transverse skin incision for 3cm was made at pre-cordial area. 3.Undermine the skin at the layer between subcutaneous tissue and deep fascia in lateral direction. 4.An IV catheter was inserted via the subclavian incision and negatively aspirated until venous blood attainable. 5.J-wire was inserted smoothly in rostral direction. A subclavian catheter with dilator was inserted through the J-wire, and the dilator was then removed. 6.The catheter of Port-A was threaded into the subclavian vein until mark 21 cm. The catheter was adapted into the port and locked with restrictor.The Port was inserted into the pouch of pre-cordial incision. 7.Skin was closed layer by layer. Both catheter and port were perfused with heparin solution after implantation. Operators 林至芃, Assistants 林彥君, 高曉梅 (F,1954/02/14,58y1m) 手術日期 2010/08/02 手術主治醫師 黃約翰 手術區域 東址 051房 02號 診斷 Colon cancer 器械術式 L.Colectomy-John, Right hemicolectomy 手術類別 預定手術 手術部位 腹 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林珍榮 ASA 2 紀錄醫師 郭庭均, 時間資訊 09:00 報到 09:58 麻醉開始 10:15 誘導結束 10:30 抗生素給藥 10:55 進入手術室 11:00 手術開始 12:50 手術結束 12:50 麻醉結束 13:00 送出病患 13:05 進入恢復室 14:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 經腹腔鏡右側大腸切除術加吻合術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Laparoscopic right hemicolectomy 開立醫師: 郭庭均 開立時間: 2010/08/02 13:15 Pre-operative Diagnosis Cecum adenocarcinoma Post-operative Diagnosis Cecum adenocarcinoma Operative Method Laparoscopic right hemicolectomy Specimen Count And Types 1 piece About size:30cm Source:A-colon & terminal ileum Pathology Pending Operative Findings A fungating and ulcerative mass, 5.0cm in diameter, was noted over cecum, three-four obvious regional lymph nodes enlargement (sized more than 1.0cm in diameter), no serosa/pararectum involvement. Multiple suspicious peritoneal seeding over terminal ileum and mesentary. Multiple uterine myoma. Mile swelling of right side ovary withour obvious mass. Operative Procedures Under general anesthesia, the patient was positioned in modified lithotomy position with Allen Yellofin strirrups. Made an umbilical incision and place a 10-mm trocar. Another 10-mm trocar was placed in midline prepeubic area. Two 5-mm trocar trocars were placed in bilateral lower quadrant. Mobilized the A-colon after CO2 pneumoperitoneum, upward to the hepatic flexure and downward to ileocecal juuction. The underlying right ureter and gonadal vessels were kept posteriorly in the retroperitoneum. By applying gently anterior retraction on the mobilized right colon, the surgeon exposes the duodenum, which was left unharmed in the retroperitoneum by dividing any remaining tissue tethering the colon to the retroperitoneum. Adhesion between colon and gallbladder were divided under direct view. The gastrocolic ligaments were divided between clamps with preservation of the gastroepiploic vessels along the greater curvature of the stomach. The right branch of middle colic artery was identified and ligated using HemoLacks and EndoClips. The right colic artery and ileocolic vessels were identified and ligated using HemoLacks and EndoClips. The mesentery of right half of the T-colon, ascending colon and terminal ileum were incised piece by piece. The terminal ileum was transected at 10 cm proximal to the ileocecal junction using GIA60. Ileocolic side-to-side anastomosis was done by GIA60. One rubber drain was indwelled at right Douglas pouch. The wound was closed by layers using 1-0 Vicryl, 2-0 Chromic catgut, and 3-0 Nylon sutures. (Remarks: transfusion: nil; minimal blood loss; recorded by R3郭庭均) Operators VS黃約翰 Assistants R3郭庭均,R1陳以幸 相關圖片 黃炯勛 (M,1991/12/17,20y2m) 手術日期 2010/08/02 手術主治醫師 王廷明 手術區域 東址 001房 03號 診斷 Head injury, unspecified 器械術式 ORIF Interlocking Nail-Femoral 手術類別 緊急手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉漢平 ASA 3E 紀錄醫師 黃全敬, 時間資訊 09:59 通知急診手術 13:02 報到 13:05 進入手術室 13:06 麻醉開始 13:08 誘導結束 14:05 手術開始 17:00 抗生素給藥 17:55 麻醉結束 17:55 手術結束 18:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 股骨幹骨折開放性復位術 1 1 R 麻醉 動脈血液檢查全套 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 骨科部 套用罐頭: 1. removal of implants 開立醫師: 黃全敬 開立時間: 2010/08/02 18:12 Pre-operative Diagnosis 1. right femoral shaft fracture, mid-thrid 2. right patellar fracture Post-operative Diagnosis 1. right femoral shaft fracture, mid-thrid 2. right patellar fracture Operative Method 1. removal of implants 2. ORIF with United interlocking nail (11.5*340 mm, proximal screw x2, distal screw x2) Specimen Count And Types nil Pathology nil Operative Findings as diagnosis Operative Procedures 1. ETGA, supine, on fracture table 2. remove K-pin for skeletal traction over distal femur 3. longitudinal skin incision over right lateral hip, lateral approach to piriformis fossa 4. set United interlocking nail step by step with a small wound to check reduction of the fracture site under C-arm control 5. apply proximal screw x2 and distal screw x2 6. N/S irrigation, hemostasis 7. close the wound in layers Operators 王廷明 Assistants 黃全敬, 葉軒, 姜志勇 Indication Of Emergent Operation 曾余阿寶 (F,1939/05/25,72y9m) 手術日期 2010/08/03 手術主治醫師 杜永光 手術區域 東址 002房 06號 診斷 Cerebral aneurysm 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 3E 紀錄醫師 李柏穎, 時間資訊 19:08 報到 19:08 進入手術室 19:10 麻醉開始 19:20 誘導結束 19:30 抗生素給藥 19:49 手術開始 20:25 麻醉結束 20:25 手術結束 20:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室體外引流 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 曾峰毅 開立時間: 2010/08/03 20:31 Pre-operative Diagnosis IVH Post-operative Diagnosis IVH Operative Method External ventricular draiange via right Kocher point Specimen Count And Types CSF was sent for routine and biochemistry profile study. Pathology Nil Operative Findings Bloody CSF was gushed out while ventricular puncture. Opening pressure was more than 30cm H20. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position. After scalp shaved, scrubbed, disinfected, and then draped, we made one linear skin incision at right frontal area. We drilled one burr hole with air drilled, and created durotomy. We insertved ventircular catheter into right lateral ventricle. We closed the wound in layers after hemostasis. Operators P 杜永光 Assistants R4 曾峰毅 R1 李柏穎 Indication Of Emergent Operation 邱品淵 (M,1964/02/02,48y1m) 手術日期 2010/08/03 手術主治醫師 曾勝弘 手術區域 東址 005房 號 診斷 Parkinsonism (F02.3) 器械術式 DBS battery change 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 07:30 報到 08:05 進入手術室 08:20 麻醉開始 08:25 誘導結束 08:45 抗生素給藥 08:50 手術開始 10:25 手術結束 10:25 麻醉結束 10:30 送出病患 10:32 進入恢復室 12:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Change of neurostimulator at the left anterio... 開立醫師: 鍾文桂 開立時間: 2010/08/03 10:46 Pre-operative Diagnosis Parkinson disease status post deep brain stimulation with battery exhaustion Post-operative Diagnosis Parkinson disease status post deep brain stimulation, status post implantation of new neurostimulator. Operative Method Change of neurostimulator at the left anterior chest wall. Specimen Count And Types 1 piece About size:1 Source:wound: culture. Pathology Nil. Operative Findings 1. Medtronic 7428 Neurostimulator serial No. NFD 114398H. 2. The left lead is malfuctioning. We checked the old chart. It is malfunction already. Operative Procedures Under general anesthesia, the patient was put in supine position. After disinfection and draping, the previous operative wound was incised and dissected. We dissected the implanted neurostimulator out of the pocket. The leads were removed from the old neurostimulator and connected to the new neurostimulator. The new one was checked for its functioning by the programmer. Finally, the wound was closed in layers. The patient was sent to POR smoothly. Operators V.S. 曾勝弘 Assistants R5鍾文桂 R1 劉昌杰. 蔣阿慎 (F,1960/05/27,51y9m) 手術日期 2010/08/03 手術主治醫師 曾勝弘 手術區域 東址 005房 02號 診斷 Lumbar spondylosis 器械術式 laminectomy + fusion 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 10:20 報到 10:40 進入手術室 10:50 麻醉開始 11:13 抗生素給藥 11:15 誘導結束 11:40 手術開始 14:05 開始輸血 14:13 抗生素給藥 14:45 手術結束 14:45 麻醉結束 14:55 送出病患 14:57 進入恢復室 16:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術（特壓）－超過二節 1 1 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 手術 椎間盤切除術－腰椎 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: 1. Laminectomy and foraminotomy, L3-5. 開立醫師: 鍾文桂 開立時間: 2010/08/03 15:09 Pre-operative Diagnosis 1. Lumbar stenosis, L3-5. 2. Herniated intervertebral disc, L4/5. Post-operative Diagnosis 1. Lumbar stenosis, L3-5. 2. Herniated intervertebral disc, L4/5. Operative Method 1. Laminectomy and foraminotomy, L3-5. 2. Microsurgical diskectomy, L4/5, right side approach. Specimen Count And Types nil Pathology Nil. Operative Findings Hypertrophic ligamentum flavum over L3-5. Central bulging intervertebral disc at L4/5. A small dural tear at L5 level, right. Operative Procedures Under ETGA, the patient was place in prone position. Under C-arm fuoroscopy, we located L3-5 levels. After disinfection and draping, midline incision and dissection were made. We exposed L3-5 lamina, then performed laminectomy. Later, microsurgical diskectomy at L4/5 levels was done. At the end of decompression, slack roots were noted. With well hemostasis, the wound was closed in layers after placing one 1/8 hemovac. Operators V.S. 曾勝弘 Assistants R5鍾文桂 R1 劉昌杰. 林張琴 (F,1934/09/10,77y6m) 手術日期 2010/08/03 手術主治醫師 曾勝弘 手術區域 東址 005房 03號 診斷 Lumbar Spondylosis 器械術式 laminectomy + fusion 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 14:30 報到 15:10 進入手術室 15:12 麻醉開始 15:20 誘導結束 15:40 抗生素給藥 15:55 手術開始 18:45 手術結束 18:45 麻醉結束 18:55 送出病患 18:56 進入恢復室 20:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 脊椎融合術－後融合，無固定物 1 2 手術 椎弓切除術（特壓）－超過二節 1 1 記錄__ 手術科部: 外科部 套用罐頭: 1. Laminecotomy and foraminotomy,bilateral, L... 開立醫師: 鍾文桂 開立時間: 2010/08/03 19:20 Pre-operative Diagnosis 1. Lumbar stenosis, L3-5. 2. Lumbar spondylolisthesis, grade I, L3/4. Post-operative Diagnosis 1. Lumbar stenosis, L3-5. 2. Lumbar spondylolisthesis, grade I, L3/4. Operative Method 1. Laminecotomy and foraminotomy,bilateral, L3-5. 2. Posterolateral fusion, L3-5. Specimen Count And Types nil Pathology Nil. Operative Findings 1. Hypertrophic ligamentum flavum. 2. Osteoporotic change with unstable spine. 3. Intact dura mater. 4. Slack thecal sac and roots after decompression. 5. Autologous and allostatic bone grafts were used for fusion. 6. Easy oozing operative field. Operative Procedures Under general anesthesia, the patient was put in prone position. We localized L3&L5; by C-arm fluoroscope. After disinfection and draping, midline incision and dissection were made. Laminectomy and foraminotomy were done at L3-5 levels by 3mm and 2 mm Kerrison punch. Further lateral dissection beyound facet joint was done for fusion. Bone materials were placed for posterolateral fusion. After placing one 1/8 hemovac drain, the wound was closed in layers with well hemostasis. The patient was sent to POR smoothly. Operators V.S. 曾勝弘 Assistants R5 鍾文桂 王苡庭 (F,1999/12/04,12y3m) 手術日期 2010/08/03 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Congenital hydrocephalus 器械術式 suboccipital craniectomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 曾峰毅, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:05 進入手術室 08:35 麻醉開始 09:00 誘導結束 09:10 抗生素給藥 09:34 手術開始 12:10 抗生素給藥 12:30 麻醉結束 12:30 手術結束 12:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 超音波診查機–腦神經外科術中特殊儀器使用費 1 0 手術 誘發電位手術監視機–腦神經外科術中特殊儀器使用費 1 0 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 顱骨切除術，包括異物移除或減壓或神經切斷 1 1 手術 椎弓切除術（特壓）－二節以內 1 2 記錄__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 曾峰毅 開立時間: 2010/08/03 12:50 Pre-operative Diagnosis Chiari malformation, type I Post-operative Diagnosis Chiari malformation, type I Operative Method Subocciptal crainectomy and removal of C1 posterior arch Subocciptal crainectomy and removal of C1 posterior arch (laminectomy) Specimen Count And Types Nil Pathology Nil Operative Findings There was fibrotic adhesion noted between dura and C1 posterior arch. Cerebellar pulsation was noted with minimal subdural space under intraoperative sonography after crainecotmy. Cerebellar puslation was satisfactory after durotomy. 1. The cerebellum and the craniovertebral junction were tightly compressed by the marked depressed occipital bone. 2. There was severe epidural fibrotic adhesion at the C1 level and craniovertebral junction. Intraoperative echogram showed that the cerebellar pulsation was present. There was small subdural space at the cerebellar surface, however, the subdural space was absent at the C1 level. Cerebellar puslation was satisfactory after durotomy. 3. The intraoperative SSEP showed decreased wave over the right side. It did not change during the whole course of surgery. Operative Procedures With endotracheal general anesthesia, the patient was put in prone position with head fixed with Mayfield head clamp and neck flexed. After skin shaved, scrubbed, disinfected, and then draped, we made one midline skin incision from inion to C2 level. We disesected to expsoe occpital bone to posterior arch of C1. Suboccipital craniecotmy with removal of C1 posterior arch was done with rongeur and Karrisons. Intraoperative sonography showed limited subdural space after crainectomy. Duroplasty for augmentation was done with autologous fascia graft. The wound was closed in layers. With endotracheal general anesthesia, the patient was put in prone position with head fixed with Mayfield head clamp and neck flexed. After skin shaved, scrubbed, disinfected, and then draped, we made one midline skin incision from inion to C2 level. We dissected to expsoe occpital bone to posterior arch of C1. Suboccipital craniecotmy was performed for 4 cm in height with drills, rhongeurs and Kerrison punches. The posterior arch of C1 was removed with Kerrisons. Intraoperative sonography showed limited subdural space after crainectomy, so duroplasty for augmentation was done with autologous fascia graft. After prolene sutures of the autologous dural graft, we sealed the dural edge with tissue-co-doThe wound was closed in layers. With endotracheal general anesthesia, the patient was put in prone position with head fixed with Mayfield head clamp and neck flexed. After skin shaved, scrubbed, disinfected, and then draped, we made one midline skin incision from inion to C2 level. We dissected to expsoe occpital bone to posterior arch of C1. Suboccipital craniecotmy was performed for 4 cm in height with drills, rhongeurs and Kerrison punches. The posterior arch of C1 was removed with Kerrisons. Intraoperative sonography showed limited subdural space after crainectomy, so duroplasty for augmentation was done with autologous fascia graft. After prolene sutures of the autologous dural graft, we sealed the dural edge with tissue adhesive. The wound was closed in layers. Operators VS 郭夢菲 Assistants R4 曾逢毅 高英茂 (M,1934/08/31,77y6m) 手術日期 2010/08/03 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Herniation of intervertebral disc 器械術式 ACDF 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:05 進入手術室 08:10 麻醉開始 08:30 誘導結束 08:50 抗生素給藥 09:22 手術開始 11:05 手術結束 11:05 麻醉結束 11:20 送出病患 11:25 進入恢復室 12:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術－頸椎 1 1 R 手術 脊椎融合術－前融合，有固定物（＜＝四節） 1 2 R 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: 1.ACDF with cage and plate 開立醫師: 陳德福 開立時間: 2010/08/03 11:10 Pre-operative Diagnosis Traumatic cervical spine injury with C5-6 stenosis Post-operative Diagnosis Traumatic cervical spine injury with C5-6 stenosis Operative Method 1.ACDF with cage and plate Specimen Count And Types nil Pathology nil Operative Findings 1.There is swelling soft tissue at the C5-6 prevertebral area. The compression fracture of the C6 body is noticed and the C5-6 disc was ruptured. The theca sac and bilateral nerve foramen were decompressed. 2.The C5-6 ACDF was performed with Syntheses cage [6mm] and one cervical spine plate [4 screws of 16*4mm]. Operative Procedures Under ETGA and supine position, the neck was hyperextended. The skin was disinfected and draped as usual. One transverse linear incision was done one the right neck and the platysma was transected. The C5-6 prevertebral space was reached after dissecting along the areolar plane. The location of C5-6 was identifed under C-arm fluroscope. The longus coli muscle was displaced laterally and the C5-6 discectomy was performed under microscopic surgery. The PLL was remvoed and the dura sac was expended well. One 6mm Syntheses cervical cage was implatated at the C5-6 level and one plate was implantated at the C5-6 anterior body with 4 16*4mm screw fixation. One minihemovac was left in situ and the wound was closed in layers. Operators VS 賴達明 Assistants r5 陳德福 r2陳國瑋 相關圖片 林邱碧雲 (F,1937/01/14,75y2m) 手術日期 2010/08/03 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Spondyloisthesis, acquired 器械術式 L4-5 TPS 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 11:15 報到 11:40 進入手術室 11:45 麻醉開始 11:55 誘導結束 12:30 抗生素給藥 12:50 手術開始 15:05 抗生素給藥 17:20 手術結束 17:20 麻醉結束 17:35 送出病患 17:35 進入恢復室 19:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 手術 椎間盤切除術－腰椎 1 2 手術 椎弓切除術（特壓）－二節以內 1 4 摘要__ 手術科部: 外科部 套用罐頭: 1.L3-5 fusion with autologous bone and PLIF 2... 開立醫師: 陳德福 開立時間: 2010/08/03 17:34 Pre-operative Diagnosis Lumbar spondylolisthesis with spinal stenosis, L3-5 Post-operative Diagnosis Lumbar spondylolisthesis with spinal stenosis, L3-5 Operative Method 1.L3-5 fusion with autologous bone and PLIF 2.L4-5 diskectomy 3.L5 laminectomy Specimen Count And Types nil Pathology NIL Operative Findings 1.There are grade I spondylolisthesis over the L4-5 and hypertrophic ligamentum flavum over L3-4 with spinal stenosis. The thecal sac was compressed tightly by the osteophytes and ligamentum flavum. The theca sac was decompressed after the L5 laminiectomy and L4 sublaminal decompression [with right hemi-laminotomy]. The L4-5 disc was removed. 2.2 11mm interbody cage [PEEK, Synthes] was inserted at the L4-5. 4 TPS and 2 rods were implantated at L4&5 for posterior fusion. The L3-4 posterior lateral fusion with autologous bone was done. Operative Procedures Under ETGA and prone position, the skin was disinfected and draped as usual. One linear incision at midline was done and the paraspinous msucle was displaced laterally. The L3-5 lamina was exposed and L4-5 TPS was inserted under C-arm flouroscope guided. The L5 laminecotmy and L4-5 diskectomy were performed with Kerrison, Alligator, Disc clamp and currettage assisted. The right L4 hemilaminotomy and sublaminal decompression were done smoothly. The rods was implantated followed by performing L3-4 posterior lateral autologous fusion. Hemostasis and left one hemovac in the epidural space. The wound was then closed in layers. Operators VS 賴達明 Assistants r5 陳德福 R2 陳國瑋 相關圖片 陳玉英 (F,1954/12/16,57y2m) 手術日期 2010/08/03 手術主治醫師 賴達明 手術區域 東址 003房 03號 診斷 Labyrinthine insufficiency 器械術式 L4-5 HIVD 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 17:40 報到 17:50 麻醉開始 17:50 進入手術室 18:05 誘導結束 18:42 抗生素給藥 18:45 手術開始 20:20 手術結束 20:20 麻醉結束 20:38 送出病患 20:40 進入恢復室 21:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術－腰椎 1 1 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: microscopic lumbar diskectomy 開立醫師: 陳德福 開立時間: 2010/08/03 20:29 Pre-operative Diagnosis L4-5 HIVD wit radiculopathy, left Post-operative Diagnosis L4-5 HIVD wit radiculopathy, left Operative Method microscopic lumbar diskectomy Specimen Count And Types nil Pathology NIL Operative Findings 1.There is a protruding disc compressing the left L5 nerve root at the shoulder of the nerve root. Hypertrophic ligamentum flavum is noticed. 2.The nerve root was decompressed after the diskectomy Operative Procedures 1.ETGA and prone position 2.skin disinfection and draping 3.linear incision, midline, 3cm 4.displace the paraspinous muscle laterally 5.Partial laminotomy over the left L4 lamina 6.remove the ligamentum flavum 7.find the protruding disc and remvoe the disc with currette, alligator, and disc clamp assisted 8.hemostasis 9.close the wound in layers Operators VS 賴達明 Assistants r5 陳德福 R2 陳國瑋 相關圖片 何葉雙妹 (F,1944/11/10,67y4m) 手術日期 2010/08/03 手術主治醫師 蕭輔仁 手術區域 西址 033房 02號 診斷 Carpal tunnel syndrome 器械術式 Decompression of mediun nerve 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 09:35 報到 10:25 進入手術室 10:40 麻醉開始 10:44 手術開始 10:44 誘導結束 11:20 麻醉結束 11:20 手術結束 11:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 正中神經或尺神經腕部減壓術–單側 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Decompression of right median nerve 開立醫師: 李振豪 開立時間: 2010/08/03 11:24 Pre-operative Diagnosis Carpal tunnel syndrome, right Post-operative Diagnosis Carpal tunnel syndrome, right Operative Method Decompression of right median nerve Specimen Count And Types nil Pathology Nil Operative Findings The right transverse carpal ligment was hypertrophic and calcified which compressed the right median nerve tightly. The nerve expanded well after transection of the transverse carpal ligment. No motor weakness was noted after the operation. Operative Procedures The patient was put in supine position. The skin was disinfected and draped as usual. Local anesthesia with 2% Xylocaine 5ml was applied. The linear skin incision was made at lower palm and the subcutaneous soft tissue was dissected. The transverse carpal ligment was identified and transected with knife and scissor for decompression of median nerve. After decompression, hemostasis was achieved and wound was irrigated with normal saline solution. The wound was then closed in layers with 4-0 Nylon. Operators VS蕭輔仁 Assistants R4李振豪 相關圖片 鄭秀雲 (F,1939/10/09,72y5m) 手術日期 2010/08/03 手術主治醫師 王國川 手術區域 西址 033房 01號 診斷 Carpal tunnel syndrome 器械術式 Decompression of mediun nerve 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 08:40 報到 09:10 進入手術室 09:29 麻醉開始 09:32 手術開始 09:32 誘導結束 10:10 麻醉結束 10:10 手術結束 10:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 正中神經或尺神經腕部減壓術–單側 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Decompression of right median nerve 開立醫師: 李振豪 開立時間: 2010/08/03 10:21 Pre-operative Diagnosis Carpal tunnel syndrome, right Post-operative Diagnosis Carpal tunnel syndrome, right Operative Method Decompression of right median nerve Specimen Count And Types nil Pathology Nil Operative Findings The transverse carpal ligment was hypertrophic and calcified which tightly compressed the median nerve. The nerve was expanded well after decompression. No fingers weakness was noted after the operation. Operative Procedures The patient was put in supine position. The right hand and forearm was disinfected and draped as usual. Local anesthesia with 2% Xylocaine 5ml was applied. L shape skin incision was made at right wrist and the skin flap was elevated. The subcutanesou fat was dissected and the tendon was splitted to exposed the median nerve. After identified the median nerve, the transverse carpal ligment was transected along the axis of the median nerve. After decompression, hemostasis was achieved. The wound was then closed with 4-0 Vicryl and 5-0 Nylon. Operators VS王國川 Assistants R4李振豪 相關圖片 蘇麗玉 (F,1938/08/15,73y6m) 手術日期 2010/08/03 手術主治醫師 蔡翊新 手術區域 東址 002房 01號 診斷 Major trauma rated 16 or above on the severeity scale ( Injury severeity score >=16 ) 器械術式 tracheostomy 手術類別 緊急手術 手術部位 頭、頸 傷口分類 污染 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 陳睿生, 時間資訊 07:19 開始NPO 07:19 臨時手術NPO 07:19 通知急診手術 08:50 進入手術室 08:50 報到 09:00 麻醉開始 09:05 誘導結束 09:35 手術開始 10:23 麻醉結束 10:23 手術結束 10:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 氣管切開造口術 1 0 記錄__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 陳睿生 開立時間: 2010/08/03 10:26 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Ditto Respiratory failure Operative Method Tracheostomy Specimen Count And Types nil Pathology None Operative Findings Fr. 7, low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators VS蔡翊新 Assistants R6 陳睿生 Indication Of Emergent Operation 黃鴻明 (M,1973/10/23,38y4m) 手術日期 2010/08/04 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Anomalies of cerebrovascular system 器械術式 suboccipital, navigation 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 08:15 報到 08:25 進入手術室 08:35 麻醉開始 09:00 誘導結束 10:00 抗生素給藥 10:47 手術開始 13:00 抗生素給藥 16:00 抗生素給藥 17:55 麻醉結束 17:55 手術結束 18:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 11 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Telovelar approach for cavernoma excision 開立醫師: 游健生 開立時間: 2010/08/04 18:24 Pre-operative Diagnosis Midbrain-pons cavernoma with hemorrhage Post-operative Diagnosis Midbrain-pons cavernoma with hemorrhage Operative Method Telovelar approach for cavernoma excision Specimen Count And Types 1 piece About size:a few pieces Source:cavernoma Pathology Pending Operative Findings The medullary venous malformation was noted on right side. The tegmentum over the hematoma was dark reddish and protuded out. A 3 x 3 x 2.5cm hematoma was noted beneath it. A raspberry like lesion was noted at the wall of hematoma cavity. There were no changes of SSEP/MEP and facial nerve stimulation during the operation. Operative Procedures Under ETGA, patient was put into prone reversed Trendelenburg position with head fixed with Mayfield headholder. After shaving, we disinfected and draped the operation field as usual. A midline incision was made 2cm above inion to C2 spinous process level. We detached paraspinal muscle and exposed Suboccipital cranium, foramen magnum, C1, and C2. A muscle fasica was harvested for later dura plasty usage. After creating 4 burrholes, bilateral suboccipital craniotomy was done. We opened cisterna magnum for CSF drainage following a V-shape durotomy with transverse sinus as base. After opening tela choroidea and bilateral tonsil lateral retraction, the rhomboid fossa was well exposed. The facial colliculi were pushed downward by the intracerebral hematoma and there location was confirmed with facial nerve stimulation. The tegmentum over the hematoma was cut opened away facial colliculi. After removal of hematoma, a raspberry like lesion was noted at the wall of hematoma cavity. We removed it and feeders of the lesion were coagulated with bipolar under intermittent facial nerve stimulation. Hemostasis was achieved with Surgicel packing. We closed the dura with a fascia graft by 4-0 prolene continuous suture. We fixed back bone flap with miniplates. After placement a subgaleal CWV, we closed the wound in layers. Operators Prof.杜永光 Assistants R6 陳睿生 R3 游健生 蔡世豪 (M,1974/06/26,37y8m) 手術日期 2010/08/04 手術主治醫師 主治醫師 手術區域 西址 036房 01號 診斷 Acute myeloid leukemia 器械術式 Insertion of hichman or port a 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 林子富 ASA 2 時間資訊 08:10 報到 09:03 進入手術室 09:40 麻醉開始 09:45 誘導結束 09:50 抗生素給藥 10:05 手術開始 10:50 麻醉結束 10:50 手術結束 11:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 ｐｏｒｔ–Ａ導管植入術–治療性導管植入術 1 0 L 記錄__ 手術科部: 麻醉部 套用罐頭: Port-A implantation, subclavian 開立醫師: 林至芃 開立時間: 2010/08/04 10:53 Pre-operative Diagnosis AML Post-operative Diagnosis Ditto Operative Method Removal and implantation of Port-A, echo-guided Port-A implantation, echo-guided Specimen Count And Types nil Pathology Nil Operative Findings 1.Site: left subclavian vein, with echo-guided procedure 2.Patent flow after implantation 3.Others: 3.Others:NIL Operative Procedures 1.The patient was set on supine position and bilateral subclavian veins were checked by echo. 2.After IVGA and local anesthesia applied, skin incision was made along the previous incision site. 2.After IVGA and local anesthesia applied, transverse skin incision for 3cm was made at pre-cordial area. 3.Uncovered the Port-A, and then removed it.4.Wash the pouch with normal saline. 3.Undermine the skin at the layer between subcutaneous tissue and deep fascia in lateral direction. 5.An IV catheter was inserted via the subclavian wound and negatively aspirated until venous blood attainable. 4.An IV catheter was inserted via the subclavian wound and negatively aspirated until venous blood attainable. 6.J-wire was inserted smoothly in rostral direction. A subclavian catheterwith dilator wasinserted through the J-wire, and the dilator was then removed. 5.J-wire was inserted smoothly in rostral direction. A subclavian catheterwith dilator wasinserted through the J-wire, and the dilator was then removed. 7.The catheter of Port-A was threaded into the subclavian vein until mark 25 cm. The catheter was adapted into the port and locked with restrictor. The Port was inserted into the pouch of pre-cordial incision. 6.The catheter of Port-A was threaded into the subclavian vein until mark 25 cm. The catheter was adapted into the port and locked with restrictor. The Port was inserted into the pouch of pre-cordial incision. 8.Skin was closed layer by layer. Both catheter and port were perfused with heparin solution after implantation. 7.Skin was closed layer by layer. Both catheter and port were perfused with heparin solution after implantation. Operators 林子富, Assistants 林彥君, 高王秀枝 (F,1943/08/11,68y7m) 手術日期 2010/08/04 手術主治醫師 蔡翊新 手術區域 東址 002房 05號 診斷 Intracerebral hemorrhage 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林子富 ASA 3E 紀錄醫師 鍾文桂, 時間資訊 15:27 通知急診手術 16:10 報到 16:23 進入手術室 16:25 麻醉開始 16:35 誘導結束 17:12 抗生素給藥 17:17 手術開始 18:00 麻醉結束 18:00 手術結束 18:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱內壓監視置入 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 蔡翊新 開立時間: 2010/08/04 18:04 Pre-operative Diagnosis IVH at cerebral aqueduct with acute hydrocephalus. Post-operative Diagnosis IVH at cerebral aqueduct with acute hydrocephalus. Operative Method EVD via right Kocher point. Specimen Count And Types 6 tubes, Source:CSF, sent for cytology, routine, BCS, cultures for bacteria, fungus and TB Pathology Nil. Operative Findings CSF: clear, colorless; pressure: 2 cmH2O. EVD via right Kocher point, 6.5 cm in depth. Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: supine with head rotated to right. 3.Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4.Incision: 5 cm linear, right frontal, corresponded to the location of right frontal horn. Raney clips were applied to the scalp edge for temporary hemostasis. 5.A burr hole was made and the dura was tented by 2 stitches. 6.The dura was opened by a nib incision. Rt lateral ventricle was tapped by a ventricular needle, then a 6.5 cm segment of the EVD catheter was introduced into the ventricle. The outer end of the catheter was connected to a reservoir bag. 7.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 8.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5鍾文桂 Indication Of Emergent Operation 呂宗榮 (M,1989/10/06,22y5m) 手術日期 2010/08/04 手術主治醫師 曾漢民 手術區域 東址 005房 03號 診斷 Spinal neuroma 器械術式 laminoplasty for tumor remove 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 古恬音, 時間資訊 00:00 臨時手術NPO 13:50 報到 14:00 進入手術室 14:10 麻醉開始 14:50 誘導結束 15:16 手術開始 18:10 麻醉結束 18:10 手術結束 18:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 良性病髓腫瘤切除術 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Laminoplasty for partial tumor excision 開立醫師: 古恬音 開立時間: 2010/08/04 18:37 Pre-operative Diagnosis C3~6 intradural extramedullary tumor Post-operative Diagnosis C3~6 intradural extramedullary tumor, suspect neurofibroma Operative Method Laminoplasty for partial tumor excision Specimen Count And Types One piece about 4.5cm*1cm Pathology pending Operative Findings 1.One about 4.6 cm yellowish, soft tumor located at C3~6 level, intradural, extramedullary. Several nerve roots were tangled into the tumor. And it extended through right C5 neural foramen. It was the part that we suspect nerve root enlargement. 2.Partial tumor excision was done to prevent nerve roots injury. 3.The cord was compressed by the tumor severely. Operative Procedures 1.ETGA, prone position with head fixed with Mayfield skull clamp 2.Midline incision from C3~C7 level 3.Detach paravertebral muscle groups 4.Perform laminectomy of C3~C6 with high speed air drill 5.Open dura in linear fashion 6.Dissect the tumor from surrounding tissue with dissector, and the part that tingled with nerve roots were left in place 7.Durotomy was closed with 5-o prolene 8.Wound irrigation and set on CWV drain at epidural space 9.Close the wound in layers Operators VS曾漢民 Assistants R6胡朝凱，R3古恬音 李婉如 (F,1983/09/15,28y5m) 手術日期 2010/08/04 手術主治醫師 廖漢文 手術區域 東址 000房 號 診斷 器械術式 Other RAD exam/intervention 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 林峰盛 ASA 3 時間資訊 00:00 開始NPO 09:30 通知急診手術 09:45 麻醉開始 09:50 誘導結束 10:20 麻醉結束 10:30 進入恢復室 11:40 離開恢復室 蘇黃雪蓮 (F,1931/08/14,80y7m) 手術日期 2010/08/04 手術主治醫師 蔡瑞章 手術區域 東址 005房 號 診斷 Spinal canal stenosis 器械術式 L5-S1 TPS 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 古恬音, 時間資訊 00:00 臨時手術NPO 07:30 報到 08:05 麻醉開始 08:05 進入手術室 08:15 誘導結束 08:40 抗生素給藥 08:58 手術開始 11:40 抗生素給藥 12:15 手術結束 12:15 麻醉結束 12:25 進入恢復室 13:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: L5 laminectomy for decompression and posterio... 開立醫師: 古恬音 開立時間: 2010/08/04 12:14 Pre-operative Diagnosis Spondylolisthesis, L4-5, with radiculopathy Post-operative Diagnosis Spondylolisthesis, L4-5, with radiculopathy Operative Method L5 laminectomy for decompression and posterior fusion with transpedicle screw fixation Specimen Count And Types nil Pathology Nil Operative Findings The intraoperative fluorosope showed grade I~II spondylolisthesis, L4 on L5. Degenerative change was noted with marked spur formation. The hypertrophic ligmentum flavum and facet joints compressed the thecal sac tightly. The thecal sac expanded well after decompression. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position. We used fluoroscope to confirm the L4-5 level. The skin of lower back was scrubbed with better iodine, and then draping was done in the usual sterile fashion. One linear midline skin incision was done in lower back, and the paravertebral muscles were detached until exposure of bilateral facet joints. The transpedicle screws were inserted under the guidance of intraoperative fluoroscope. Posterior decompression was achieved with L5 laminectomy and the removal of hypertrophic ligamentum flavum. After normal saline irrigation, one Hemavac drain was placed. The wound was then closed in layers. Operators P蔡瑞章 Assistants R6胡朝凱,R3古恬音 陳秀卿 (F,1944/11/01,67y4m) 手術日期 2010/08/04 手術主治醫師 郭源松 手術區域 東址 012房 03號 診斷 Cellulitis 器械術式 Debridment-- >10cm 手術類別 預定手術 手術部位 四肢 傷口分類 髒 麻醉方式 靜脈麻醉 麻醉主治醫師 葉惠敏 ASA 3 紀錄醫師 游彥辰, 時間資訊 10:50 進入手術室 10:55 麻醉開始 11:00 誘導結束 11:05 抗生素給藥 11:15 手術開始 11:25 手術結束 11:25 麻醉結束 11:30 送出病患 11:33 進入恢復室 12:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 手術 四肢切斷術－指、趾 1 1 L 手術 四肢切斷術－指、趾 1 2 L 手術 深部複雜創傷處理－傷口長５公分以下者 1 0 L 摘要__ 手術科部: 外科部 套用罐頭: left 4th, 5th toes ampuatation with 2nd toe d... 開立醫師: 游彥辰 開立時間: 2010/08/04 11:43 Pre-operative Diagnosis left DM foot with 4th, 5th toe wet gangrene, 2rd toe medial side skin ulceration Post-operative Diagnosis left DM foot with 4th, 5th toe wet gangrene, 2rd toe medial side skin ulceration Operative Method left 4th, 5th toes ampuatation with 2nd toe debridement Specimen Count And Types nil Pathology nil Operative Findings left DM foot with 4th, 5th toe wet gangrene was found with necrotic tissue and unhealthy bone. One skin necrotic lesion was found at 2nd toe medial side about 1x1 cm deep to DIP joint Operative Procedures 1. IVGA 2. supine position 3. Anti spetic preparation 4. toes amputation with wound debridement 5. normal saline irrigation 6. keep wound open with wet gauze dressing Operators VS郭源松 Assistants R4 游彥辰 Ri張哲誠 姚細姬 (F,1950/11/12,61y4m) 手術日期 2010/08/04 手術主治醫師 王國川 手術區域 東址 027房 04號 診斷 Subarachnoid hemorrhage 器械術式 Craniotomy(Aneurysms) P-DUH 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林子富 ASA 2E 紀錄醫師 陳建銘, 時間資訊 10:00 臨時手術NPO 10:00 開始NPO 16:13 通知急診手術 18:55 進入手術室 19:10 麻醉開始 19:30 誘導結束 19:40 抗生素給藥 20:10 手術開始 22:40 抗生素給藥 01:20 開始輸血 01:40 抗生素給藥 02:10 手術結束 02:10 麻醉結束 02:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 開顱術摘除血管病變－腦血管瘤－有徵的 1 1 L 手術 顱內壓監視置入 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Aneurysm-frontotemporal approach 開立醫師: 蔡翊新 開立時間: 2010/08/05 01:54 Pre-operative Diagnosis A-com artery aneurysm rupture with SAH and hydrocephalus. Post-operative Diagnosis A-com artery aneurysm rupture with SAH and hydrocephalus. Operative Method Left pterional craniotomy for aneurysm clipping and left Kocher EVD for ICP monitoring. 3rd ventriculostomy by fenestration of lamina terminalis. Specimen Count And Types 3 tubes Source:CSF Pathology Nil. Operative Findings CSF was initially clear, then became light reddish. The initial pressure was about 12 cmH2O. Much subarachnoid blood with tight adhesion was encountered upon dissection around the preoptic cistern and the aneurysm at A-com complex. A 4 x 4 x 4 mm saccular aneurysm arising from the junction of left A1, A2, and A-com arteries, pointing anteroinferiorly. The dome of the aneurysm adhered tightly to the rectal gyrus and less tightly to left optic nerve and right A2 artery. It was clipped with a 10mm, fenestrated, straight Sugita clip. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right for 45 degree and slightly extended then fixed by Mayfield skull clamp. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: left frontotemporal, curvilinear. The skin edge was clipped by Raney clips for temporary hemostasis. After scalp had been lifted, the temporalis muscle was incised and detached from temporal squama and reflected to lower temporal side. 5. A burr hole was made at left Kocher point for EVD insertion. 6. Craniotomy window: 10x6 cm, left frontotemporal, created by making 3 burr holes then cut by power saw. The lower temporal bone and pterionic ridge were cut by rongeur as low as possible for easy approach to the anterior clinoid. 7. Dural tention: by 2/0 silk, 1.5 cm in interval, distributed along the edge of skull window. 8. Dural incision: curvilinear shape, over-ridding Sylvian fissure and reflected to frontotemporal base. 9. Drainage of CSF was made to slacken down the brain for easy approach to anterior clinoid without undue traction on the brain. 10.Under operating microscope, the suprasellar cistern was opened, meanwhile, the blood pressure was brought down to 100 mmHg. The left optic nerve and ICA came into view. The arachnoid trabeculi and the fibrin (or blood clot) were cleaned out to expose the neck of the aneurysm which located just beneath the edge of tentorial hiatus. The neck of the aneurysm was mobilized gently by a Gage 18 sucker and a fine tip bipolar forceps until it was entirely free. l1.A 10 mm, straight, fenestrated Sugita clip was applied to the neck of the aneurysm. 12.After successful clipping of the aneurysm, the patients BP was brought back to normal, and the exposed field was irrigated with N.S. to make sure no any bleeding. 13.The brain retractors were removed. The dura was closed water-tight by running suture with 4/0 Prolene. 14.Closure of skull window: the skull plate was placed back to craniotomy window and fixed by miniplates and screws. The dura was tented to the center of the skull plate by a 2/0 stitch. The covering muscle was closed by interrupted stitches with 1/ 0 silk. 15.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 16.Drain: one, subgaleal, CWV 17.Blood transfusion: PRBC 2U. Blood loss: 400 ml. 18.Course of the surgery: smooth. Operators VS蔡翊新VS王國川 Assistants R6陳睿生R2陳建銘 Indication Of Emergent Operation 謝忠鋃 (M,1955/01/02,57y2m) 手術日期 2010/08/05 手術主治醫師 賴達明 手術區域 東址 002房 03號 診斷 Central nervous system abscess 器械術式 OPLL-Anterior Corpectomy VSLai 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3E 紀錄醫師 古恬音, 時間資訊 00:00 開始NPO 07:16 通知急診手術 11:48 報到 12:00 進入手術室 12:10 麻醉開始 12:25 誘導結束 13:12 手術開始 13:30 開始輸血 15:55 麻醉結束 15:55 手術結束 16:03 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 椎弓整形術 1 1 摘要__ 手術科部: 外科部 套用罐頭: Laminoplasty 開立醫師: 曾峰毅 開立時間: 2010/08/05 15:52 Pre-operative Diagnosis Suspected tumor metastasis or spondylodiskitis at C5/6 with epidural mass and cord compression Post-operative Diagnosis Suspected tumor metastasis or spondylodiskitis at C5/6 with epidural mass and cord compression Operative Method Laminoplasty, C3-6, open-door fashion Specimen Count And Types Nil Pathology Nil Operative Findings Spinal cord was decompressed well after laminoplasty. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position with head fixed with Mayfield head clamp. We made one midline linear skin incision, and exposed bilateral laminae from C3 to C7. We drilled laminae through at left side from C3 to C6, and performed laminoplasty in open-door fashion with hinge side at right. After one CWV set, we closed the wound in layers after hemostasis. Operators VS 賴達明 Assistants R4 曾峰毅 R3 古恬音 Indication Of Emergent Operation 王洪祿 (M,1940/07/14,71y8m) 手術日期 2010/08/05 手術主治醫師 陳敞牧 手術區域 東址 005房 01號 診斷 Trigeminal nerve disorder 器械術式 retrosigmoid approach 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 4 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:02 進入手術室 08:10 麻醉開始 08:50 誘導結束 09:05 抗生素給藥 09:10 手術開始 12:55 抗生素給藥 14:18 麻醉結束 14:18 手術結束 14:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 顱底瘤手術 1 1 記錄__ 手術科部: 外科部 套用罐頭: Subtotal tumor excision of right trigeminal n... 開立醫師: 鍾文桂 開立時間: 2010/08/05 15:04 Pre-operative Diagnosis Right trigeminal neuroma with brainstem compression. Post-operative Diagnosis Right trigeminal neuroma status post subtotal excision. Operative Method Subtotal tumor excision of right trigeminal neuroma via retrosigmoid approach. Specimen Count And Types 1 piece About size:several pieces Source:brain tumor, trigeminal neuroma. Pathology Pending. Operative Findings 1. The cystic portion of the neuroma was drained. The tumor wall was easy oozing. The tumor encased the trigeminal nerve and the surrounding vessels with severe adhesions. 2. Decreased BAEP at right side. No SEP change intraoperatively. 3. The trigeminal nerve was sacrafized. The facial nerve, lower cranial nerves, and abducens nerve were preserved. 4. The transverse sinus was lacerated during craniotomy. It was packed and sealed with Gelfoam. The dura mater was repaired with fascia graft and DuraFoam. Operative Procedures Under ETGA, the patient was put in 3/4 prone position and the head was fixed with Mayfield. After shaving, disinfection, and draping, a curvilinear scalp incision was made. The fascia was harvested for dural repair. The craniotomy was made using asterion as its center. The dura mater was tented. The cerebellum was retracted. Then, the tumor was explored. The tumor was excised piece by piece. Lysis of the tumor with the surrounding vessels and nerves were done by microscissors and dissectors. The cystic content was drained upon opending the tumor wall. After welll hemostasis, the dura was repaired. The skull bone plate was fixed with dura by 2-0 silk. The wound was closed in layers after placing one CWV drain. The patient was sent to ICU smoothly. Operators V.S. 陳敞牧 Assistants R5 鍾文桂 Ri 蕭義 (M,1935/07/20,76y7m) 手術日期 2010/08/05 手術主治醫師 陳敞牧 手術區域 東址 005房 02號 診斷 Herniation of intervertebral disc (HIVD) 器械術式 synovial cyst 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 14:50 進入手術室 14:55 麻醉開始 14:55 報到 15:10 誘導結束 15:27 抗生素給藥 16:00 手術開始 18:35 手術結束 18:35 麻醉結束 18:55 送出病患 18:55 進入恢復室 19:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術（特壓）－二節以內 1 1 R 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 記錄__ 手術科部: 外科部 套用罐頭: Hemilaminectomy, right side approach, L5-S1. 開立醫師: 鍾文桂 開立時間: 2010/08/05 19:14 Pre-operative Diagnosis 1. Suspect synovial cyst at L5-S1. Post-operative Diagnosis 1. Tarlov cyst at L5-S1. 2. Lumbar stenosis, L5-S1. Operative Method Hemilaminectomy, right side approach, L5-S1. Specimen Count And Types nil Pathology Nil. Operative Findings A bulging portion of the thecal sac was noted after resection of the liagmentum flavum. The bulging part has thin dura mater, dark grayish in color. It impinges the right S1 root. After decompression of the lamina and ligamentum flavum, the root was slack. The right S2 root was also explored. It was slack and intact. Poor wound condition. Some scar and granulation tissues were seen. They may be due to previous manipulations. Operative Procedures Under ETGA, the patient was put in prone position. Under C-arm fluoroscopy, L5/S1 intervertebral disc level was outlined. Midline incision was made. Right side dissection was done. L5-S1 hemilaminectomy, right side approach was achieved with Kerrison and dissectors. The ligamentum flavum was removed by Kerrison. The bulging dura sac was seen. It impinged right S1 root. After further decompression of the laminae, the root was slack. After well hemostasis, the wound was closed in layers. Operators V.S. 陳敞牧 Assistants R5鍾文桂 Ri 曹昌輝 (M,1941/11/08,70y4m) 手術日期 2010/08/05 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Hydrocephalus 器械術式 VP shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3 紀錄醫師 吳俊毅, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:03 進入手術室 09:09 麻醉開始 09:15 誘導結束 09:23 抗生素給藥 09:49 手術開始 10:29 手術結束 10:29 麻醉結束 10:35 送出病患 10:38 進入恢復室 13:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 L 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 吳俊毅 開立時間: 2010/08/05 10:47 Pre-operative Diagnosis Normal pressure hydrocephalus Post-operative Diagnosis Normal pressure hydrocephalus Operative Method V-P Shunt. Left side Specimen Count And Types nil Pathology nil Operative Findings 1. Clear CSF. CSF pressure >10cm H2O 2. Codman programmable V-P shunt, Set pressure 10cmH2O Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: supine with head rotated to right 3.Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 5 cm curvilinear, left occipital, corresponded to the location of left occipital horn. Raney clips were applied to the scalp edge for temporary hemostasis. 5.After the scalp flap had been lifted and reflected anteriorly, a burr hole was made and the dura was tented by 2 stitches. 6.The dura was opened by a nib incision. Left lateral ventricle was tapped by a ventricular needle, then a 8 cm segment of the ventricular catheter was introduced into the ventricle. 7. A nib incision was made at LUQ of the abdomen .distal 20 cm segment of the peritoneal catheter (medium pressure) was introduced into the peritoneal cavity . The proximal end of this catheter was passed through subcutaneous tunnel at forechest, neck, left retroauricular area and connected the reservoir. The shunt systemwas checked to make sure its function was working. 8. The reservoir was fixed 9. Scalp closure: hemostasis 10.Course of the surgery: smooth. Operators VS 王國川 Assistants CR 胡朝凱 R1 吳俊毅 陳淑瑛 (F,1960/01/22,52y1m) 手術日期 2010/08/05 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 Pituitary Tumor 器械術式 TSH 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 吳俊毅, 時間資訊 00:00 臨時手術NPO 10:30 報到 10:47 進入手術室 10:55 麻醉開始 11:05 誘導結束 11:17 抗生素給藥 11:33 手術開始 13:13 送出病患 13:13 麻醉結束 13:13 手術結束 醫令資訊 類別 名稱 量 刀 側 手術 經由蝶竇之腦下垂體瘤切除 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Transnasal trans-sphenoidal approach for tumo... 開立醫師: 胡朝凱 開立時間: 2010/08/05 13:26 Pre-operative Diagnosis pituitary macroadenoma Post-operative Diagnosis pituitary macroadenoma Operative Method Transnasal trans-sphenoidal approach for tumor excision Specimen Count And Types pieces of tumor Pathology pending Operative Findings The tumor was grayish, soft and solid one. It protruded into sphenoid sinus that made the sella floor paper thin. Post-OP arachnopid membrane was seen. The buldging lateral wall nearby the ICA was noted. Severe adhesion and granulation were noted perinasally. Operative Procedures After ETGA, the patient was put in supine position with head mild left tilt. The nasal cavity was well-disinfective, and then we incised into the nasal septum. Dissection was performed along with the periosteum to expose sphenoid sinus anterior wall and sphenoid ostia. After fracture of vomer, sphenoid sinus anterior wall was also fractured. The mucosa was removed. The sella floor was exposed and removed with kerrison. After cruciate form incision, tumor buldged out. And it was further removed with tumor forceps and ring currette. After total excision of tumor was made, the bony graft was put back and followed by compaction of merosel. Operators 王國川 Assistants 胡朝凱, 吳俊毅 張寶 (F,1957/01/18,55y1m) 手術日期 2010/08/05 手術主治醫師 蔡翊新 手術區域 東址 003房 03號 診斷 Facial spasm 器械術式 left retrosigmoid approach 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 吳俊毅, 時間資訊 00:00 臨時手術NPO 13:36 進入手術室 13:40 麻醉開始 14:00 誘導結束 14:00 抗生素給藥 14:15 手術開始 17:00 抗生素給藥 18:40 手術結束 18:40 麻醉結束 18:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦微血管減壓術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Microvascular Decompression 開立醫師: 蔡翊新 開立時間: 2010/08/05 18:16 Pre-operative Diagnosis Left hemifacial spasm. Post-operative Diagnosis Left hemifacial spasm. Operative Method Microvascular decompression via left suboccipital retrosigmoid craniotomy. Specimen Count And Types nil Pathology Nil. Operative Findings An AICA loop adhered to the left facial nerve from anterior aspect at its nerve exit zone and along the intracisternal segment. It was detached and separated from the nerve with Teflon felts. BAEP showed much interference waveforms temporarily during the procedure of microvascular decompression, but it returned to normal after dural closure. Operative Procedures 1. Anesthesia: endrotracheal general. 2. Position: supine with left shoulder elevated and the head turned to right extremely until the airway pressure was tolerable. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with a sterilized adhesive plastic sheet. 4. Incision: 10 cm long, along the retroauricular hair line with center at mastoid tip. 5. Craniectomy: 2.5 x 2.5 cm, suboccipital retromastoid to expose the lower- posterior margin of the junction of transe and sigmoid sinus. 6. Dural incision: inverted T-fashion and reflected to sigmoid sinus. 7. CSF drainage via by opening the pontomedullary cistern for easy retraction of the cerebellum to the medial side. 8. The cerebellum was retracted with the retractor. The 7th & 8th cranial nerves were approached from the space between these 2 nerves and the lower cranial nerves. In such way, the arterial loop from AICA crossly compressed the 7th nerve was dissected away from the nerve without necessity of any touch on the nerve. The arterial loop was kept away from the nerve by interposing the space between them with Teflon felt cotton. 9. Dural closure: continuous suture with 5/0 Prolene to obtain water-tight closure (A piece of fascia, 2 x 1 cm, was used as the dural graft). 10.Skin closure: continuous suture with 2/0 Vicryl for subcutanuous layer and continuous suture with 3/0 nylon for the skin. 11.Drain: none. 12.Course of the surgery: tear of sigmoid sinus occurred during dural opening and the bleeding was stopped with Prolene suture and Gelfoam packing. Operators VS蔡翊新 Assistants R5陳德福R1吳俊毅 諶佳平 (F,1969/12/14,42y3m) 手術日期 2010/08/06 手術主治醫師 鄭文芳 手術區域 兒醫 066房 01號 診斷 Adenomyosis 器械術式 Subtotal hysterectomy 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 2 紀錄醫師 林美邑, 時間資訊 07:38 報到 08:05 進入手術室 08:10 麻醉開始 08:15 誘導結束 08:22 抗生素給藥 08:29 手術開始 09:35 手術結束 09:35 麻醉結束 09:40 送出病患 09:45 進入恢復室 11:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 次全子宮切除術 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 記錄__ 手術科部: 婦產部 套用罐頭: STH 開立醫師: 林美邑 開立時間: 2010/08/06 09:32 Pre-operative Diagnosis adenomyosis Post-operative Diagnosis adenomyosis+ bladder wall endometriosis Operative Method Subtotal hysterectomy Specimen Count And Types 2 pieces About size:6X5X4cm Source:uterus About size:2X2X1cm Source:bladder wall tumor r/o endometriosis Pathology Pending Operative Findings 1, Uterine corpus: 6*5*4cm, globular shape, diffusely thickening of myometrium. Total weight of uterus : 98 gm M1: 1*1cm subserosal myoma at fundus anterior wall severe adhesion with bladder and bladder wall endometriosis 2. ROV: grossly normal LOV: grossly normal bilateral tube: grossly normal 3. one 2X2X1cm bladder wall was noted r/o endometriosis, adhesion with anterior wall of uterus 4. Cul-de-sac: free 5. Estimated blood loss:50ml Blood transfusion:nil Complication:nil Operative Procedures 1. Put the patient on the lithotomy position, vaginal douching and on Foley 2. Skin disinfection with beta-iodine and skin draping. 3. Make a Pfannenstiel skin incision and open the abdominal wall layer by layer. 4. Apply autoretractor and pack up theintestine to expose the uterus. 5. Clamp, cut and ligate the bilateral round ligaments and open the broad ligaments anteriorly along the side of uterus downward to vesicouterine fold bilaterally. 6. Clamp, cut and ligate left infundibulo-pelvic ligaments. 7. Dissect the posterior leaf of broad ligaments overlying the uterosacral ligaments bilaterally. 8. Dissect and reflect the bladder downwards and off the uterine corpus. 9.Clamp, cut and ligate the ascending branches of uterine arteries bilaterally at the level of isthmus of cervix. 10. Cut the uterus through isthmus and grasp the cervical stump by Kockers. 11. Suture the bilateral angles of cervical stump with 1-0 vicryl sutures. 12. Suture the cervical stump with 1-0 vicryl sutures. 13. dissect and remove the bladder wall tumor . Repair the bladder wall with 1-0 vicryl 14. Close the abdomen layer by layer. 15. Skin approximation with 4-0 Dexon. EBL: 400ml, BT: pRBC 2u, Complication: nil Operators 鄭文芳, Assistants 陳宜慧 林美邑 劉張美玲 (F,1965/04/05,46y11m) 手術日期 2010/08/06 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Brain Tumor 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:10 麻醉開始 08:45 誘導結束 09:00 抗生素給藥 09:05 手術開始 11:20 手術結束 11:20 麻醉結束 11:45 進入恢復室 13:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 軟組織良性腫瘤切除術，大或深 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Scalp tumor total excision 開立醫師: 游健生 開立時間: 2010/08/06 11:34 Pre-operative Diagnosis Recurrent meningioma with extracranial extension Post-operative Diagnosis Recurrent meningioma with extracranial extension Operative Method Scalp tumor total excision Specimen Count And Types 1 piece About size:a few pieces Source:scalp tumor Pathology Pending Operative Findings A whitish well-defined elastic firm tumor was noted beneath the subcutaneous layer of left infratemporal scalp. Operative Procedures Under ETGA, patient was put into supine position with left shoulder mildly elevated. Head was turned to right tilted up and fixed with Mayfield headholder. After shaving, we disinfected and draped the operation field as usual. A scalp incision was made along previous scar. We reflected the scalp flap anterio-inferiorly with effort to dissect it away from the subcutaneous tumor. The tumor was then dissected away from temporalis muscle and removed totally. After hemostasis, we closed the wound in layers. Operators Prof.杜永光 Assistants R6陳睿生 R3游健生 張喜香 (F,1957/09/05,54y6m) 手術日期 2010/08/06 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Pituitary Tumor 器械術式 TSH 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 劉昌杰, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:03 進入手術室 08:10 麻醉開始 08:40 誘導結束 08:55 抗生素給藥 09:28 手術開始 10:50 麻醉結束 10:50 手術結束 11:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 經由蝶竇之腦下垂體瘤切除 1 1 記錄__ 手術科部: 外科部 套用罐頭: Endonasal Transphenoid adenomectomy 開立醫師: 胡朝凱 開立時間: 2010/08/06 11:13 Pre-operative Diagnosis Pituitary macroadenoma Post-operative Diagnosis Pituitary macroadenoma Operative Method Endonasal Transphenoid adenomectomy Specimen Count And Types pieces of tumor Pathology pending Operative Findings 1.One about 3.3 cm soft, yellowish tumor located in sella turcica and protruded upward. The normal gland was seen as reddish one. Unintentional durotomy was made. And it was sealed with gelfoam and Tissuco-dul. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head tilted 30 degree to left. 3. Skin preparation: the face and abdominal wall were prepared with povidone-iodine alcohol tincture, and the mucosa of oral and nasal cavity with aqueous povidone-iodine tincture. The former areas were covered by a sterilized adhesive plastic sheet. 4. The nasal submucosa at septum and floor and the subperiostium at upper alveola were infiltrated with 1:100 epinephrine solution. 5. Incision: at right nasal mucosa. 6. The mucosa of nasal septum and floor was dissected away from the septal cartilage and the bony floor on both sides from anterior to posterior and displaced laterally by a long nasal speculum. 7. The septal cartilage was cut at its basal juction by sepatal scissors and then displaced to one side. 8. A Hardys nasal speculum was applied to displace the nasal mucosa laterally and keep the nasal cavity open constantly for the exposure of the vomer bone and the anterior wall of the sphenoid sinus. Before the sinus was opened, the position of the nasal speculum was adjusted under the radioimage intensifier to a direction which directly pointed to the sellar floor. 10.The exposed sinus mucosa was coagulated and resected. 11.Under the guide of radioimage intensifier, the sellar floor was penetrated by a osteotome, then widened by Kerrison punch. 12.The sellar floor dura was coagulated with bipolar forceps, then opened in cruciate fashion. 13.The soft tumor parenchyma was removed by curette and suction, then the capsule was mobilized away from the dura and normal pituitary gland and removed. The final piece of the tumor at suprasellar area sank into the sella spontaneously after the intrasellar tumor had been removed. 14.The sellar floor was reconstructed by supporting a piece of vomer bone between the dura and the margin of the sellar floor. The sphenoidsinus was packed gelfoam and tissuco-dul. 15.The Hardys nasal speculum was removed and the nasal mucosa returned to its normal position. nasal packing was then done. Operators 曾漢民 Assistants R6 胡朝凱 施文雄 (M,1964/11/28,47y3m) 手術日期 2010/08/06 手術主治醫師 曾漢民 手術區域 東址 002房 02號 診斷 Brain tumor 器械術式 Skull tumor 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 10:30 報到 11:00 麻醉開始 11:00 進入手術室 11:05 誘導結束 11:10 抗生素給藥 11:22 手術開始 12:35 手術結束 12:35 麻醉結束 13:02 送出病患 13:05 進入恢復室 14:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 顱骨切除術，包括異物移除或減壓或神經切斷 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Craniectomy for total excision of skull tumor. 開立醫師: 鍾文桂 開立時間: 2010/08/06 12:58 Pre-operative Diagnosis Skull bone tumor, frontal. Post-operative Diagnosis Skull bone tumor, frontal. Operative Method Craniectomy for total excision of skull tumor. Cranioplasty for skull defect. Specimen Count And Types 1 piece About size:3CM Source:SKULL BONE TUMOR Pathology Pending. Operative Findings 1. Erosion of skull bone by the 1.5cm tumor. No tumor is noted over the dura mater. Only some reactive change over the outer layer of the dura mater was noted. 2. The tumor was easy oozing. 3. A 5mm margin skull craniectomy was done for total tumor excision. 4. The skull defect was filled with bone cement and wire mesh. Operative Procedures Under ETGA, the patient was placed in supine position and the head was placed in midline position. After disinfection and draping, a horizontal incision was made over the bulging skin. Right after the skin incision, the tumor was explored. Due to easy oozing, we tried to hemostate the tumor with bipolar electrocoagulator. Then, a small craniectomy for tumor excision was done with 5 mm margin from the tumor. After dural tenting, the bone defect was filled up with bone cement using wire mesh as its framework. The allograft was fixed by mini plates and screws. The wound was closed in layers. Operators V.S. 曾漢民 Assistants R5 鍾文桂 阮敏寬 (M,1941/10/23,70y4m) 手術日期 2010/08/06 手術主治醫師 賴達明 手術區域 東址 001房 04號 診斷 Vertebral column tuberculosis 器械術式 Spinal fusion posterior 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 吳俊毅, 時間資訊 02:40 臨時手術NPO 02:40 開始NPO 15:01 通知急診手術 16:25 報到 16:40 進入手術室 16:45 麻醉開始 17:00 抗生素給藥 17:00 誘導結束 17:42 手術開始 20:00 抗生素給藥 20:35 麻醉結束 20:35 手術結束 20:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術－脊椎 1 1 手術 脊椎融合術－後融合，無固定物 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 曾峰毅 開立時間: 2010/08/06 20:43 Pre-operative Diagnosis Suspected T4/5 spondylodiskitis Post-operative Diagnosis T4/5 tuberculosis spondylodiskitis Operative Method T4/5 hemilaminectomy at right, T4/5 diskectomy, partial corpectomy of T4/5, and posterior fusion with autologous bone graft Specimen Count And Types Several fragments was sent for pathology, and swabs was sent for culture and acid fast stain and TB culture. Pathology Several fragments was sent for pathology Operative Findings Whitish, fragile, caseous tissue was noted at T4/5, involving disc, vertebral body, pars, and pedicles. Those tissue was noted surrounding right T4 root, and compressed the cord tightly. Spinal cord was decompressed after operation. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. Lesion was located by C-arm. After skin scrubbed, disinfected, and then draped, we made one midline skin incisino then curviated to right at caudal side. We dissected the paraspinal muscle at right side from T3 to T6. We performed facetomy of T4/5 at right, and created right hemilaminectomy at T4 and T5. Right T4 root was transected after ligation, and T4/5 diskectomy was performed with partial T4/5 corpectomy. We harvest autologous bone graft from T6 spinal process, and achieved fusion of T4/5. After inserting one hemovac, we closed the wound in layers. Operators VS 賴達明 Assistants R4 曾峰毅 R1 吳俊毅 Indication Of Emergent Operation 全士英 (M,1942/06/10,69y9m) 手術日期 2010/08/06 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Spinal stenosis 器械術式 T11,12,L3 TPS 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 11:20 報到 11:55 進入手術室 12:00 麻醉開始 12:20 誘導結束 13:20 抗生素給藥 13:58 手術開始 16:20 開始輸血 16:30 手術結束 16:40 抗生素給藥 17:20 19:40 抗生素給藥 21:10 麻醉結束 21:10 21:20 送出病患 21:25 進入恢復室 23:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 2 手術 惡性病髓腫瘤切除術 1 1 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 10 0 摘要__ 手術科部: 外科部 套用罐頭: 1. Posteriolateral approach for partial tumor... 開立醫師: 游健生 開立時間: 2010/08/06 21:49 Pre-operative Diagnosis L1,L2 vertebral body tumor Post-operative Diagnosis L1,L2 vertebral body tumor Operative Method 1. Posteriolateral approach for partial tumor removal 2. Posterior approach for T12, L1, L3 transpedicular screw fixation and L1, L2 laminectomy for decompression Specimen Count And Types 1 piece About size:a few pieces Source:L1, L2 tumor Pathology Pending Operative Findings Self bone fusion was noted at L1-L2 level and intervertebral disc was abscent. The bone marrow was relatively healthy. Severe kyphotic change over T12 to L2 level. After laminectomy, the thecal sac was expanded especially over L1, L2 level. Posterior fixation was performed with Synthes transpedicular screws: T12, L1: 6.2 x 40mm L3: 6.2 x 45mm Rod: 130mm cross-link: 50mm at L2 level Operative Procedures Under ETGA, patient was put into right decubitus position. After localization of L1, L2 level, a curvilinear incision was made at middle axillary line. The external, internal, transverse abdominalis muscle were sliptted. We dissected along the plane between peritonium and peritoneal fat to expose the psoas muscle at paraspinal region. The insertion of psoas muscle at L1, L2 level was sliptted and L1, L2 body were identified under C-arm. Some pieces of fused body were harvested for pathology examination and culture. The healthy residual vertebral body was left in situ. We closed the wound in layers after hemostasis and placement of a retroperitoneal CWV. The position was changed to prone position. The T12, L1, L3 pedicles were identified by C-arm. A midline incision was made and paraspinal muscles over T11 to L3 level were sliptted to expose laminae and facet joints. The transpedicular screws were inserted at T12, L1, L3 with C-arm localization. L1 and L2 laminectomy was performed with Rounguer and high-speed drill. After removal of ligamentum flavum and epidural fat, the thecal sac was well expanded. The rods and cross-link were fixed to the screws. Hemostasis was done and two 1/8 hemovac were set at epilamina space. We closed the wound in layers. Operators VS 賴達明 Assistants R6 陳睿生 R3 游健生 喻芝蘭 (F,1963/11/08,48y4m) 手術日期 2010/08/06 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Cervical spondylosis 器械術式 Cervical ACDF 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 07:38 報到 08:05 進入手術室 08:15 麻醉開始 08:20 誘導結束 09:00 抗生素給藥 09:26 手術開始 12:00 抗生素給藥 13:30 手術結束 13:30 麻醉結束 13:40 送出病患 13:45 進入恢復室 14:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術－頸椎 1 1 R 手術 脊椎融合術－前融合，有固定物（每增加＜＝四節） 1 2 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 摘要__ 手術科部: 外科部 套用罐頭: Anterior cervical diskectomy and fusion with ... 開立醫師: 陳國瑋 開立時間: 2010/08/06 13:38 Pre-operative Diagnosis Cervical spondylosis with radiculopathy and myelopathy, C5-6 Post-operative Diagnosis Cervical spondylosis with radiculopathy and myelopathy, C5-6 Operative Method Anterior cervical diskectomy and fusion with artificial disc Specimen Count And Types nil Pathology nil Operative Findings 1.There is herniated disc with severe osterphytes formation at the C5-6 level. The bilateral nerve foramina were stenotic and the osteophytes was removed for decompression the nerve roots and spinal cord. 2.The C5-6 disc was removed and one No#5 artificial cervical disc [Prodisc] was implanated at the C5-6 level smoothly. Operative Procedures Under ETGA and supine position with neck hyperextension, the skin was disinfected and draped as usual. One linear incision along the skin crease on the left anterior neck was done and the platysma was transected. The areolar plane between the anterior catotid sheath and the cervical muscle was identified. The prevertebral space of C5-6 was found and we check the location under flouroscope. The longus coli muscle was mildly detached and we set Caspar retractor to expose the anterior C5-6 space. The ALL was opened and the C5-6 disc was removed by curretage and aligator. The osteophyte was removed by air-drill and Kerrison. The PLL was opened the expose the dura. The bilateral nerve foramina was decompressed and the thecal sac reexpanded well. One No#5 artificial cervical disc [Prodisc] was inserted in the C5-6 space anteriorly. One minivac was left in situ. After hemostasis, the wound was closed in layers. Operators VS 賴達明 Assistants R5 陳德福 R2陳國瑋 相關圖片 林瑞暉 (M,1958/11/27,53y3m) 手術日期 2010/08/06 手術主治醫師 賴達明 手術區域 東址 019房 02號 診斷 Herniation of intervertebral disc 器械術式 Cervical ACDF 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 13:30 報到 14:00 進入手術室 14:05 麻醉開始 14:15 誘導結束 14:40 抗生素給藥 14:55 手術開始 17:11 手術結束 17:11 麻醉結束 17:20 送出病患 17:25 進入恢復室 18:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術－頸椎 1 1 R 手術 脊椎融合術－前融合，有固定物（每增加＜＝四節） 1 2 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Glucose 1 0 摘要__ 手術科部: 外科部 套用罐頭: Anterior cervical diskectomy and fusion with ... 開立醫師: 陳德福 開立時間: 2010/08/06 14:34 Pre-operative Diagnosis Cervical spondylosis with spinal stenosis and radiculopathy, C5-6 Post-operative Diagnosis Cervical spondylosis with spinal stenosis and radiculopathy, C5-6 Operative Method Anterior cervical diskectomy and fusion with artificial cage Specimen Count And Types nil Pathology NIL Operative Findings 1.There is herniated disc with severe osterphytes formation at the C5-6 level. The bilateral nerve foramina were stenotic and the osteophytes was removed for decompression the nerve roots and spinal cord. 2.The C5-6 disc was removed and one No#7 cervical cage was implanated at the C5-6 level smoothly. 2.The C5-6 disc was removed and one No#6 cervical cage was implanated at the C5-6 level smoothly. Operative Procedures Under ETGA and supine position with neck hyperextension, the skin was disinfected and draped as usual. One linear incision along the skin crease on the left anterior neck was done and the platysma was transected. The areolar plane between the anterior catotid sheath and the cervical muscle was identified. The prevertebral space of C5-6 was found and we check the location under flouroscope. The longus coli muscle was mildly detached and we set Caspar retractor to expose the anterior C5-6 space. The ALL was opened and the C5-6 disc was removed by curretage and aligator. The osteophyte was removed by air-drill and Kerrison. The PLL was opened the expose the dura. The bilateral nerve foramina was decompressed and the thecal sac reexpanded well. One No#7 cervical cage was inserted in the C5-6 space anteriorly. After hemostasis, the wound was closed in layers. Under ETGA and supine position with neck hyperextension, the skin was disinfected and draped as usual. One linear incision along the skin crease on the left anterior neck was done and the platysma was transected. The areolar plane between the anterior catotid sheath and the cervical muscle was identified. The prevertebral space of C5-6 was found and we check the location under flouroscope. The longus coli muscle was mildly detached and we set Caspar retractor to expose the anterior C5-6 space. The ALL was opened and the C5-6 disc was removed by curretage and aligator. The osteophyte was removed by air-drill and Kerrison. The PLL was opened the expose the dura. The bilateral nerve foramina was decompressed and the thecal sac reexpanded well. One No#6 cervical cage was inserted in the C5-6 space anteriorly. After hemostasis, the wound was closed in layers. Operators VS 賴達明 Assistants R5陳德福 R2陳國瑋 相關圖片 李蔡玉 (F,1938/04/13,73y11m) 手術日期 2010/08/06 手術主治醫師 賴達明 手術區域 東址 005房 03號 診斷 Lumbar Spondylosis 器械術式 TPS 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 劉昌杰, 時間資訊 00:00 臨時手術NPO 12:15 報到 12:45 進入手術室 12:50 麻醉開始 13:15 誘導結束 13:30 抗生素給藥 13:55 手術開始 16:16 手術結束 16:20 麻醉結束 16:31 送出病患 16:35 進入恢復室 17:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 手術 椎弓切除術（特壓）－二節以內 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: L4~5 TPS and L4 laminectomy 開立醫師: 胡朝凱 開立時間: 2010/08/06 16:28 Pre-operative Diagnosis L4~5 spondylolisthesis Post-operative Diagnosis L4~5 spondylolisthesis Operative Method L4~5 TPS and L4 laminectomy Specimen Count And Types nil Pathology nil Operative Findings 1.Anterior listhesis of L4 on L5. 2.The bone was compact 3.Hypertrophic flavum ligment was noted that compressed the thecal sac and nerve roots Operative Procedures 1.ETGA, prone 2.Midline incision at L3~S1 level 3.Detach paravertebral muscle groups 4.Expose L4 and L5 lamina and facets 5.TPS screws insertion 6.L4 laminectomy and decompression of neural foramen with Kerrison pounch 7.Fix rods 8.Lateral fusion after decortication of L4~5 lamina 9.Set one hemovac drain then close wound in layers. Operators 賴達明 Assistants 胡朝凱, 劉昌杰 黃炯勛 (M,1991/12/17,20y2m) 手術日期 2010/08/06 手術主治醫師 王國川 手術區域 東址 005房 02號 診斷 Head injury, unspecified 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 劉昌杰, 時間資訊 00:00 臨時手術NPO 11:36 進入手術室 11:40 麻醉開始 11:45 誘導結束 11:58 手術開始 12:30 手術結束 12:30 麻醉結束 12:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 氣管切開造口術 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 劉昌杰 開立時間: 2010/08/06 12:45 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Ditto Operative Method Tracheostomy Specimen Count And Types nil Pathology None Operative Findings Fr.8 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures 1. ETGA, supine postition 2. Disinfection, Drapped 3. Local anesthesia is injected with xylocain to the subcutaneous layer. 4. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage.It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. 5. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators 王國川 Assistants R6胡朝凱 R1劉昌杰 呂駿 (M,2010/04/10,1y11m) 手術日期 2010/08/07 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Subdural hemorrhage or effusion (SDE) 器械術式 V-P shunt 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林子富 ASA 3E 紀錄醫師 陳睿生, 時間資訊 00:28 開始NPO 00:28 臨時手術NPO 07:50 通知急診手術 10:00 報到 10:10 進入手術室 10:20 麻醉開始 10:40 誘導結束 11:00 抗生素給藥 11:10 手術開始 11:55 麻醉結束 11:55 手術結束 12:15 送出病患 12:15 進入恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦脊髓液分流管重置 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Cystoperitoneal shunt revision 開立醫師: 陳睿生 開立時間: 2010/08/07 12:29 Pre-operative Diagnosis Subdural effusion s/p cystoperitoneal shunt with dysfunction Post-operative Diagnosis Subdural effusion s/p cystoperitoneal shunt with dysfunction Operative Method Cystoperitoneal shunt revision Specimen Count And Types 2 pieces About size:1 piece Source:drain tube About size:3ml Source:subdural fluid Pathology Nil Operative Findings Old blood clot was noted inside the shunt, and small debris were noted inside the side holes of the shunt. CSF gushed out while removal of previous shunt, and the collected fluid was mild xanthochromic in appearance. A new 4.5cm in lenght cystic shunt was inserted via previous bur hole. Old blood clot was noted inside the shunt, and small debris were noted inside the side holes of the shunt. CSF gushed out while removal of previous shunt, and the collected fluid was mild xanthochromic in appearance. A new 5.5cm in lenght cystic shunt was inserted via previous bur hole after saline irrigation. Operative Procedures 1. ETGA, supine position and head right turn 2. Reopen of previous wound at left retroauricular region 3. Expose the shunt, and removal of the cystic side 4. Reconnect of a new 4.5 cm intracystic portion 4. Reconnect of a new 5.5 cm intracystic portion to a new straight connector 5. Cystic cavity irrigation, and insert the new shunt 6. Hemostasis, fix the shunt at galeal level 6. Hemostasis, fix the shunt at galeal level for two stitches 7. Close the wound in layers Operators AP 郭夢菲 Assistants R6 陳睿生 Indication Of Emergent Operation 黃蔡金露 (F,1934/08/18,77y6m) 手術日期 2010/08/07 手術主治醫師 蕭輔仁 手術區域 東址 003房 03號 診斷 Spondylosis of unspecified site, with myelopathy 器械術式 Laminectomy C-Spinal(Posterier 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 3E 紀錄醫師 游健生, 時間資訊 00:38 臨時手術NPO 00:38 開始NPO 07:38 通知急診手術 13:00 報到 13:09 進入手術室 13:15 麻醉開始 13:30 誘導結束 14:00 抗生素給藥 14:25 手術開始 16:15 手術結束 16:15 麻醉結束 16:25 送出病患 16:32 進入恢復室 19:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 手術 椎弓切除術（特壓）－超過二節 1 1 摘要__ 手術科部: 外科部 套用罐頭: Lower C2 to upper C7 laminectomy for decompre... 開立醫師: 陳睿生 開立時間: 2010/08/07 16:11 Pre-operative Diagnosis Cervical stenosis over C3-6 Post-operative Diagnosis Cervical stenosis over C3-6 Operative Method Lower C2 to upper C7 laminectomy for decompression Specimen Count And Types nil Pathology Nil Operative Findings After laminectomy, the thecal sac was well expanded. Mild thicken ligamentum flavum was noted. The nuchal ligamentum was clacified change. Operative Procedures 1. ETGA, prone position and head hyperflexion, fixed with Mayfield clump 2. Posterior neck midline incision 3. Split the trapzius and bilateral paraspinal muscle to expose the C2-C7 lamina 4. Remove of C3-6 spinous process\ 5. Drill out bilateral lamina-facet juntion over C3-7 6. Remove of C3-6 lamina and ligamentum flavum 7. Drill down and remove the lower C2 and upper C7 for decompression 8. Hemostasis, set an epidural CWV drain 9. Close the wound in layers Operators VS 蕭輔仁 Assistants R6 陳睿生; R3 游健生 Indication Of Emergent Operation 蘇月嬌 (F,1953/10/10,58y5m) 手術日期 2010/08/07 手術主治醫師 王國川 手術區域 東址 002房 01號 診斷 Subdural hemorrhage 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 2E 紀錄醫師 游健生, 時間資訊 00:35 開始NPO 00:35 臨時手術NPO 07:35 通知急診手術 08:10 報到 08:30 進入手術室 08:37 麻醉開始 08:45 誘導結束 08:57 手術開始 08:57 抗生素給藥 10:37 手術結束 10:37 麻醉結束 10:45 送出病患 10:45 進入恢復室 12:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Right burr hole drainage 開立醫師: 胡朝凱 開立時間: 2010/08/07 10:50 Pre-operative Diagnosis Right frontal to parietal chronic SDH Post-operative Diagnosis Right frontal to parietal chronic SDH Operative Method Right burr hole drainage Specimen Count And Types nil Pathology nil Operative Findings 1.Motor oil like old blood clot was drained out from right frontal area. 2.Outer membrane was noted 3.The brain was slack after drainage Operative Procedures 1.ETGA, supine 2.Right parietal transverse skin incision 3.Dissect to open periosteum 4.Burr hole drill 5.Dural tenting 6.Cruciate form dural opening 7.Open outer membrane and coagulation 8.Insert rubber drain and water irrigation 9.Fixed drain then close wound 10.De-air Operators 王國川 Assistants 胡朝凱, 游健生 Indication Of Emergent Operation 張春子 (F,1963/01/10,49y2m) 手術日期 2010/08/07 手術主治醫師 蔡翊新 手術區域 東址 002房 02號 診斷 Subarachnoid hemorrhage 器械術式 Clipping of intracerebral aneurysm 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 3E 紀錄醫師 胡朝凱, 時間資訊 21:00 開始NPO 21:00 臨時手術NPO 10:38 通知急診手術 11:40 進入手術室 11:40 報到 11:45 麻醉開始 11:50 誘導結束 12:40 手術開始 12:56 抗生素給藥 15:50 開始輸血 18:30 麻醉結束 18:30 手術結束 18:35 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 開顱術摘除血管病變－腦血管瘤－有徵的 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Aneurysm-frontotemporal approach 開立醫師: 蔡翊新 開立時間: 2010/08/07 18:14 Pre-operative Diagnosis A-comA aneurysm rupture with SAH and IVH s/p EVD for ICP monitoring. Post-operative Diagnosis A-comA aneurysm rupture with SAH and IVH s/p EVD for ICP monitoring. Operative Method Left pterional craniectomy for aneurysm clipping. Specimen Count And Types 1 piece, Source:bone graft culture Pathology Nil. Operative Findings Thick blood clots and arachnoid fibrins around the prechiasmatic cistern causing adhesion of A-com complex to the basal frontal lobes and bilateral optic nerves. A 5 x 5 mm saccular aneurysm, 3.5 mm in neck width, arising from the A-com artery, pointing right anterosuperiorly, with the dome adhering to the basal frontal lobe. The bilateral A2 arteries were supplied by left A1 which was dominant ACA. No right ACA was detected. Premature rupture of the aneurysm body during dissection was encountered, and it was stopped by bipolar cautery. The aneurysm neck was clipped by a straight, fenestrated, 3.5 mm Sugita clip. Because of severe brain swelling during the whole operation, the craniotomy bone plate was not replaced back. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with right back elevated and head rotated to right for 30 degree and slightly extended then fixed by Mayfield skull clamp. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: left frontotemporal, curvilinear. The skin edge was clipped by Raney clips for temporary hemostasis. After scalp had been lifted, the temporalis muscle was incised and detached from temporal squama and reflected to lower temporal side. 5. Craniotomy window: 8 x 5 cm, left frontotemporal, created by making 2 burr holes then cut by power saw. The lower temporal bone and pterionic ridge were cut by rongeur and airdrill as low as possible. 6. Dural tention: by 2/0 silk, 2 cm in interval, distributed along the edge of skull window. 7. Dural incision: curvilinear shape, over-riding Sylvian fissure and reflected to frontotemporal base. 8. Under operating microscope, the suprasellar cistern was opened. The left optic nerve and ICA came into view. The arachnoid trabeculi and the fibrin and blood clots were cleaned out to expose left A1 artery, A-comA complex and the neck of the aneurysm. The neck of the aneurysm was mobilized gently by a Gage 18 sucker. 9. A straight, fenestrated, 6 mm Sugita clip was shortened by diamond burr to 3.5 mm. The neck of the aneurysm was clipped by the modified Sugita clip sparing the left A2 artery. The right A2 artery was checked to be spared. 10.After successful clipping of the aneurysm, the exposed field was irrigated with N.S. to make sure no any bleeding. 11.The brain retractors were removed. The dura was closed with a piece of 7.6 x 7.6 cm Duroform because of marked brain swelling. The craniotomy bone plate was not replaced back and it was stored at bone bank. 12.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 13.Drain: one, epidural, CWV. 14.Blood transfusion: PRBC 2U; Blood loss: 150 ml. 15.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R6胡朝凱Ri朱彥儒 張春子 (F,1963/01/10,49y2m) 手術日期 2010/08/07 手術主治醫師 蔡翊新 手術區域 東址 002房 05號 診斷 Subarachnoid hemorrhage 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林峰盛 ASA 4E 紀錄醫師 吳俊毅, 時間資訊 03:17 通知急診手術 03:55 進入手術室 03:55 麻醉開始 04:05 誘導結束 04:15 抗生素給藥 04:37 手術開始 05:15 手術結束 05:15 麻醉結束 05:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱內壓監視置入 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 蔡翊新 開立時間: 2010/08/07 05:14 Pre-operative Diagnosis A-comA aneurysm rupture with SAH, IVH and acute hydrocephalus. Post-operative Diagnosis A-comA aneurysm rupture with SAH, IVH and acute hydrocephalus. Operative Method EVD via right Kocher point for ICP monitoring. Specimen Count And Types 3 tubes of CSF, sent for routine, BCS and bacterial culture Pathology Nil. Operative Findings Blood CSF gushed out upon ventricular puncture. Initial pressure: 15 cmH2O. The CSF drainage was sluggish because of high viscosity of the thick blood. Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: supine with head rotated (tilted) to right (left). 3.Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4.Incision: 5 cm linear, right frontal, corresponded to the location of right occipital horn. Raney clips were applied to thescalp edge for temporary hemostasis. 5.A burr hole was made at right Kocher point and the dura was tented by 2 stitches. 6.The dura was opened by a nib incision. Rt lateral ventricle was tapped by a ventricular needle, then a 6 cm segment of the EVD catheter was introduced into the ventricle. The outer end of the catheter was connected to a reservoir bag. 7.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 8.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R4曾峰毅R1吳俊毅 Indication Of Emergent Operation 黃彩詩 (M,1931/09/29,80y5m) 手術日期 2010/08/08 手術主治醫師 蔡翊新 手術區域 東址 026房 01號 診斷 重大創傷且及嚴重程度到達創傷嚴重程度分數16分以上 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 3E 紀錄醫師 游健生, 時間資訊 01:00 開始NPO 01:00 臨時手術NPO 09:35 通知急診手術 10:50 報到 11:00 進入手術室 11:05 麻醉開始 11:25 誘導結束 12:20 抗生素給藥 12:30 手術開始 12:40 開始輸血 15:40 麻醉結束 15:40 手術結束 15:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 手術 急性硬腦膜下血腫清除術 1 1 L 手術 顱內壓監視置入 1 2 L 摘要__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 蔡翊新 開立時間: 2010/08/08 15:28 Pre-operative Diagnosis Left frontotemporoparietal acute SDH. Post-operative Diagnosis Left frontotemporoparietal acute SDH. Operative Method Left frontotemporal craniotomy for SDH removal and ICP monitoring. Specimen Count And Types nil Pathology Nil. Operative Findings Blood clots about 1.5 cm in thickness was noted at subdural space of left F-T-P region, with active bleeding from bridging veins at left temporal skull base. Bleeding tendency was encountered at epidural and subdural spaces. The ICP after skin closure was about 3 mmHg. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 12 cm at left frontotemporal area, the skin edge was clipped by Raney clips for temporary hemostasis. The temporalis muscles was incised down to the tempoal squama which was exposed then by applying a self retaining retractor on the muscle. 5. Craniotomy window: 8 x 6 cm, left F-T, created by making 4 burr holes then cut by power saw. 7. Dural tenting: by 2/0 silk, 2 cm in interval, distributed along the edge of skull window. 8. Dural incision: crusade fahion. 9. The subdural clot was removed by sucker and those located beyond the cranial window was washed out by saline irrigation. 10.Hemosatasis: the bleeders was stopped by Bovie and oozing surface was covered with gelfoam. 11.Dural closure: dura was closed with a piece of dural graft taking from temporalis fascia, 6 x 0.5 cm. 12.The skull plate was fixed back with 4 wires. 13.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 3/0 Dexon and skin by continuous suture with 3/0 nylon. 14.Drain: one, subgaleal, CWV. 15.Blood transfusion: Platelet 24U; Blood loss: 200 ml. 16.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R6陳睿生R3游健生 Indication Of Emergent Operation 張春子 (F,1963/01/10,49y2m) 手術日期 2010/08/08 手術主治醫師 蔡翊新 手術區域 東址 002房 01號 診斷 Subarachnoid hemorrhage 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 4E 紀錄醫師 陳以幸, 時間資訊 19:14 通知急診手術 19:55 進入手術室 20:00 麻醉開始 20:05 誘導結束 20:45 手術開始 22:35 手術結束 22:35 麻醉結束 22:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 急性硬腦膜下血腫清除術 1 2 L 摘要__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 蔡翊新 開立時間: 2010/08/08 22:32 Pre-operative Diagnosis A-comA aneurysm s/p left F-T craniectomy and aneurysm clipping, severe brain swelling. Post-operative Diagnosis A-comA aneurysm s/p left F-T craniectomy and aneurysm clipping, severe brain swelling; left F-T-P acute SDH. Operative Method Left F-T-P extended craniectomy for SDH removal and duroplasty for decompression. Specimen Count And Types nil Pathology Nil. Operative Findings Severe brain swelling with transcalvarial herniation through previous craniectomy window at left F-T area, about 10 x 6 cm. There was SDH, 0.4 cm in thickness, at left F-T-P region. Because of rapid bulging out of the brain, the planned left side EVD procedure was abandoned. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: curvilinear, from the midpoint of previous wound to left parietal area and turned downward to posterior temporal region. The temporalis muscles was reflected inferiorly. 5. Craniectomy window: 12 x 10 cm, left F-T-P, created by making a burr holes then cut by power saw. Together with previous craniectomy, the window became 16 x 12 cm. 6. Dural tenting: by 2/0 silk, 3 cm in interval, distributed along the edge of skull window. 7. Dural incision: curvilinear, parallel to the new skin incision. 8. The subdural clot was removed by sucker. 9. Duroplasty was performed with Durogen patch, 12.5 x 10 cm. 10.The skull plate was removed and stored at bone bank for preservation. 11.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 1/0 Vicryl and skin by continuous suture with 3/0 nylon. 12.Drain: two, epidural, CWV. 13.Blood transfusion: nil. Blood loss: 150 ml. 14.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R4李振豪R1陳以幸 Indication Of Emergent Operation 徐裴欣 (F,1980/08/15,31y6m) 手術日期 2010/08/09 手術主治醫師 吳振吉 手術區域 西址 033房 09號 診斷 Colon cancer of transverse colon 器械術式 Benign neck mass excision (sim 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 林玫君, 時間資訊 16:05 進入手術室 16:10 麻醉開始 16:14 手術開始 16:40 手術結束 16:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 頸部良性腫瘤切除，簡單 1 1 R 記錄__ 手術科部: 內科部 套用罐頭: Extirpation of neck mass,right level IV 開立醫師: 林玫君 開立時間: 2010/08/09 16:39 Pre-operative Diagnosis Excision of neck mass,right level IV Post-operative Diagnosis Ditto,operated Operative Method Extirpation of neck mass,right level IV Specimen Count And Types 1 Pathology Pending Operative Findings Neck mass, right level IV,s/p extirpation Operative Procedures 1.The patient was in supine position with neck hyperextended and turned to the left side. 2.Skin was disinfected and draped as usual. 3.Local anesthesia with Bosmin-rinsed Xylocaine was injected into the subcutaneous tissue around the neck mass after marking. 4.A 2 cm horizontal incision parallel to the skin crease was made. 5.The subcutaneous tissue was cut through. 6.One 1.5 x 1 cm mass were found and dissected from its surrounding tissue with blunt and sharp dissection. 7.The specimen was sent to pathology. 8.After hemostasis, the wound was closed and the patient tolerated the procedure well. Operators VS吳振吉 Assistants R4林芳瑩, R2林玫君 黃春蘭 (F,1957/08/17,54y6m) 手術日期 2010/08/09 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Subclavian steal syndrome 器械術式 VA-CCA bypass 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 07:34 報到 08:02 進入手術室 08:14 麻醉開始 08:30 誘導結束 10:00 抗生素給藥 10:20 手術開始 13:30 抗生素給藥 15:45 麻醉結束 15:45 手術結束 15:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 7 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 顱內外血管吻合術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Left common carotid artery - subclavian bypass 開立醫師: 吳俊毅 開立時間: 2010/08/25 16:56 Pre-operative Diagnosis Left subclavian artery proximal occlusion with steal syndrome Post-operative Diagnosis Left subclavian artery proximal occlusion with steal syndrome Operative Method Left common carotid artery - vertebral artery bypass Specimen Count And Types nil Pathology Nil Operative Findings The nerves exposed during surgery were preserved. The lumen of VA re-expanded after CCA cross-clamps released. VA flow patency was checked by Doppler. There were mild decreased of SSEP amplitude before left CCA cross-clamping and spontaneously recovered during surgery. Operative Procedures Under ETGA, patient was put into supine position with left shoulder mildly elevated. Her neck was extented and head turned to right with Mayfield headholder fixation. After disinfection and draping, a transverse incision was made from sternal notch to lateral, 7cm in length, just above left clavicle. After division of plasytma, we undermined it and exposed sternocleidomastoid(SCM) muscle. Then, we ligated and divided the sternal and clavicular head to expose common carotid artery(CCA), internal jugular vein(IJV), and omohyoid muscle. The CCA was dissected away from carotid sheath and vagus nerve followed by looping with a rubber band. After looping IJV and omohyoid muscle followed by lateral retraction, we dissected along the medial side of anterior scalene muscle and exposed the junction between vertebral artery(VA) and subclavian artery. The phrenic nerve was seen and preserved during dissection. We looped VA after freeing it from surrounding tissue. After systemic heparinization(10,000IU), we clipped the distal VA with two Sugita clips and the proximal VA at junction between VA and subclavian artery. The lumen of VA was irrigated with heparin saline after transection. We enlarged the VA opening by a straight cut and dyed it with methylene blue. An opening at the lateral side of CCA was created with a 6.0mm artery puncture after CCA cross-clamping at both ends. The opening was dyed with methylene blue following heparine saline irrigation of the lumen. End-to-side anastomosis between VA and CCA was performed with continuous 8-0 prolene suture at posterior lumb and interrupted 8-0 prolene suture at anterior after angular suture. After leakage check by releasing the distal cross-clamp, the anastomosis site was wrapped with Surgicel for hemostasis. We checked VA flow with Doppler. The sternal and clavicular head were approximated with 2-0 Vicryl separately. We closed the wound in layers after placement of one mini-hemovac at carotid groove. Operators Prof. 杜永光 Assistants R6 陳睿生 R3 游健生 曹秀緩 (F,1954/12/03,57y3m) 手術日期 2010/08/09 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Intraventricular hemorrhage 器械術式 programmable VP shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 15:45 報到 16:05 進入手術室 16:10 麻醉開始 16:20 誘導結束 16:50 抗生素給藥 17:42 手術開始 19:25 手術結束 19:25 麻醉結束 19:40 送出病患 19:45 進入恢復室 21:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 手術 腦室腹腔分流手術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt insertion via left... 開立醫師: 游健生 開立時間: 2010/08/09 19:53 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunt insertion via left Kocher point Specimen Count And Types 1 piece About size:20cc Source:CSF Pathology Nil Operative Findings The opening pressure was about 5cmH2O. The CSF was clear and 20cc of it was sent for study. The ventricular catheter was 7.5cm. The Codman programmable shunt pressure was set at 10cmH2O. Operative Procedures 1. Under ETGA, patient was in supine position with neck flexed and left shoulder elevated 2. Shaving, disinfection, and draping as usual 3. A transverse scalp incision was made over left Kocher point 4. Trephination and dura tenting 5. Cruciate durotomy and electrocautery edges 6. Ventriculostomy and inserted the ventricular catheter 7. A transverse abdominal incision was made over LUQ region 8. Dissected in layers to expose peritonium 9. Opened peritonium and inserted the peritoneal catheter 10.Passed the catheter subcutaneously upward 11.Connected it with Codman programmable shunt reservoir and ventricular catheter 12.Closed wounds in layers Operators VS 賴達明 Assistants R6 陳睿生 R3 游健生 張黃雲娥 (F,1938/02/19,74y0m) 手術日期 2010/08/09 手術主治醫師 賴達明 手術區域 東址 005房 01號 診斷 Spondylosis with myelopathy, cervical 器械術式 laminoplasty 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:04 進入手術室 08:15 麻醉開始 08:25 誘導結束 08:34 手術開始 08:48 抗生素給藥 10:50 手術結束 10:50 麻醉結束 11:03 送出病患 11:05 進入恢復室 13:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓整形術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: c3~6 LAMINOPLASTY and Lower C2 laminectomy 開立醫師: 胡朝凱 開立時間: 2010/08/09 10:50 Pre-operative Diagnosis c3~6 OPLL Post-operative Diagnosis c3~6 OPLL Operative Method c3~6 LAMINOPLASTY and Lower C2 laminectomy Specimen Count And Types nil Pathology nil Operative Findings 1.Spinal cord was compressed from anterior side. 2.After decompression, it expanded well 3.mild floating of C3~4 level 4.Ligmentum flavum was mild hypertrophy Operative Procedures 1.ETGA, prone 2.Midline skin incision at C2~7 level 3.Detach paravertebral muscle group to expose lower C2~C7 lamina 4.Drill right lamina to expose flavum ligment 5.Drill left side lamina to expose inner table 6.Open lamina as opendoor method aand left axis on left side 7.Use miniplate to fixed lamina 8.Lower C2 laminectomy was then done 9.Set one hemovac drain then close wound in layers Operators 賴達明 Assistants 胡朝凱,陳國瑋,陳睿生 張石隊 (M,1935/09/05,76y6m) 手術日期 2010/08/09 手術主治醫師 王國川 手術區域 東址 005房 02號 診斷 Brain tumor 器械術式 craniotomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 古恬音, 時間資訊 00:00 臨時手術NPO 10:36 報到 11:20 進入手術室 11:25 麻醉開始 11:45 誘導結束 11:45 抗生素給藥 12:02 手術開始 14:45 抗生素給藥 16:48 麻醉結束 16:48 手術結束 17:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除－手術時間在４～８小時 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Tumors excision 開立醫師: 胡朝凱 開立時間: 2010/08/09 16:58 Pre-operative Diagnosis MULTIPLE BRAIN METASTASIS, Right cerebellar, temporal, and parietal lobe Post-operative Diagnosis MULTIPLE BRAIN METASTASIS, Right cerebellar, temporal, and parietal lobe Operative Method Tumors excision Specimen Count And Types three tumor masses Pathology pending Operative Findings 1.Yellowish to reddish tumors measured as 2.5 cm at right parietal lobe, 2.8 cm at right temporal lobe, and 3.2 cm at right cerebellum. 2.peripheral gliotic tissue was noted 3.The tumor was hard and the border was well defined with many small feeding vessels. Operative Procedures 1.ETGA, supine with head fixed with Mayfield skull clamp 2.Right post-auricular curvillinear skin incision 3.Detach nuchal muscle group and periosteum 4.Two craniotomy was performed above and below the transverse sinus 5.cruciate form dural opening 6.tumor excision by dissection along the surrounding plane 7.Transcortical cerebellar tumor excision was also done 8.Close dura with one fascia graft 9.Fixed bone back with wire 10.Set one CWV drain then close wound in layers Operators 王國川 Assistants 胡朝凱,古恬音 林俐伶 (F,1968/04/14,43y11m) 手術日期 2010/08/10 手術主治醫師 蔡翊新 手術區域 東址 002房 06號 診斷 Subarachnoid hemorrhage (SAH) 器械術式 Craniotomy(Aneurysms) VS-TZENG，ICP monitoring 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3E 紀錄醫師 周聖哲, 時間資訊 14:00 臨時手術NPO 14:00 開始NPO 00:10 進入手術室 00:15 麻醉開始 00:30 誘導結束 00:50 抗生素給藥 01:13 手術開始 04:20 抗生素給藥 06:25 手術結束 06:25 麻醉結束 06:35 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 開顱術摘除血管病變－腦血管瘤－有徵的 1 1 R 手術 顱內壓監視置入 1 2 R 摘要__ 手術科部: 外科部 套用罐頭: Aneurysm-frontotemporal approach 開立醫師: 蔡翊新 開立時間: 2010/08/10 05:40 Pre-operative Diagnosis A-comA aneurysm rupture with SAH. Post-operative Diagnosis A-comA aneurysm rupture with SAH. Operative Method Right pterional craniotomy for aneurysm clipping and EVD for ICP monitoring. Specimen Count And Types 3 tubes of CSF, sent for routine, BCS and bacterial culture. Pathology Nil. Operative Findings CSF: sanguinous, pressure: 12 cmH2O. There were blood clots and fibrin adhesion around the prechiasmatic cistern. A saccular aneurysm, 2.5 mm in neck width, 3 x 3 mm in the body, arising from A-com artery and pointing superiorly. It was clipped by a curved, laterally closing, 6-mm Sugita clip. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with right back elevated and head rotated to left for 30 degrees and slightly extended then fixed by Mayfield skull clamp. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: right frontotemporal, curvilinear. The skin edge was clipped by Raney clips for temporary hemostasis. After scalp had been lifted, the temporalis muscle was incised and detached from temporal squama and reflected to lower temporal side. 5. A burr hole was made at right Kocher point for EVD insertion to frontal horn of right lateral ventricle as ICP monitor and to release CSF for brain slackening. 6. Craniotomy window: 8x4 cm, frontotemporal, created by making 3 burr holes then cut by power saw. The lower temporalbone and pterionic ridge (esp. the inner table) were cut by rongeur and airdrill as low as possible for easy approach to the anterior clinoid. 7. Dural tention: by 2/0 silk, 1.5 cm in interval, distributed along the edge of skull window. 8. Dural incision: curvilinear, over-riding Sylvian fissure and reflected to frontotemporal base. 9. Under operating microscope, the suprasellar cistern was opened, meanwhile, the patinet's blood pressure was brought down to 90 mmHg. The right optic nerve and ICA came into view. The arachnoid trabeculi and the fibrin (or blood clot) were cleaned out to expose the neck of the aneurysm which located just beneath the edge of tentorial hiatus. The neck of the aneurysm was mobilized gently by a Gage 18 sucker and a fine tip bipolar forceps until it was entirely free. 10.A curved, laterally closing, 6-mm Sugita clip was applied to the neck of the aneurysm. 11.After successful clipping of the aneurysm, the BP was brought back to normal, and the exposed field was irrigated with N.S. to make sure no any bleeding. 12.The brain retractors were removed. The dura was closed water-tight by running suture with 4/0 Prolene, using a fascial graft. 13.Closure of skull window: the skull plate was placed back to craniotomy window and fixed by miniplates and screws. The dura was tented to the center of the skull plate by a 2/0 stitch. The covering muscle was closed by interrupted stitches with 1/ 0 silk. 14.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 15.Drain: one, epidural, CWV. 16.Blood transfusion: nil. Blood loss: 50 ml. 17.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R6胡朝凱R1周聖哲 Indication Of Emergent Operation 傅慧屏 (F,1963/10/30,48y4m) 手術日期 2010/08/10 手術主治醫師 陳芊 手術區域 產房 090房 07號 診斷 Endometrial hyperplasia 器械術式 D & C for diagnostic /WOR 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 ASA 1 時間資訊 09:30 報到 12:45 進入手術室 12:57 抗生素給藥 12:58 手術開始 13:15 手術結束 13:20 進入恢復室 13:20 送出病患 14:30 離開恢復室 記錄__ 手術科部: 婦產部 套用罐頭: Fractional D&C; 開立醫師: 楊博凱 開立時間: 2010/08/10 13:24 Pre-operative Diagnosis Endocervical lesion Post-operative Diagnosis Endocervical lesion Operative Method Fractional dilatation and curettage Specimen Count And Types 2 pieces About size: Source:endocervix About size: Source:endometrium Pathology Pending. Operative Findings 1. Uterus: Anteversion, 10 cm. 2. Scanty endocervical and some endometrial tissue were curetted out. 3. Estimated blood loss: 15 mL, Blood transfusion: nil, complication: nil. Operative Procedures 1. Put the patient on lithotomy position. 2. Douching, skin disinfection and skin draping as usual. 3. Sounding: Anteversion, 10 cm. 4. Cervical dilatation to Hegar No. 9. 5. Curette endocervical canal and uterine cavity. 6. Pack the vagina with a piece of gauze. Operators 華筱玲 Assistants 楊博凱 陳柯月嬌 (F,1949/03/01,63y0m) 手術日期 2010/08/10 手術主治醫師 張金堅 手術區域 東址 006房 05號 診斷 Female breast cancer 器械術式 Port-A catheter Implatation 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 李柏穎, 時間資訊 15:05 報到 15:45 進入手術室 15:55 抗生素給藥 16:00 麻醉開始 16:05 誘導結束 16:06 手術開始 17:05 手術結束 17:11 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 ｐｏｒｔ–Ａ導管植入術–治療性導管植入術 1 0 摘要__ 手術科部: 外科部 套用罐頭: Port-A 開立醫師: 李柏穎 開立時間: 2010/08/10 17:08 Pre-operative Diagnosis breast cancer Post-operative Diagnosis breast cancer Operative Method Port-A insertion Specimen Count And Types nil Pathology nil Operative Findings Post-operative portable X-ray showed Port-A catheter tip in correct venous branch to SVC and RA junction. Operative Procedures 1. Under endotracheal general anesthesia with the patient in supine position, prepped and draping were performed in the usual sterile method. 2. An incision was made in left side subclavical area. After identification of the cephalic vein, Port-A catheter was inserted. Adequate hemostasis was obtained. Then the wound was closed in layers. Post-operative 3.portable X-ray showed catheter tip in correct venous branch to SVC and RA junction. Operators Assistants 王慧珍 (F,1961/10/08,50y5m) 手術日期 2010/08/10 手術主治醫師 黃思誠 手術區域 兒醫 063房 01號 診斷 Uterine myoma 器械術式 L.A.V.H Dr- P Huang 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 2 紀錄醫師 烏恩慈, 時間資訊 07:40 報到 08:02 進入手術室 08:05 麻醉開始 08:15 誘導結束 08:20 抗生素給藥 08:36 手術開始 10:37 手術結束 10:37 麻醉結束 10:45 進入恢復室 10:45 送出病患 12:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 腹腔鏡全子宮切除術 1 1 記錄__ 手術科部: 婦產部 套用罐頭: LAVH 開立醫師: 烏恩慈 開立時間: 2010/08/10 10:30 Pre-operative Diagnosis Myoma uteri Post-operative Diagnosis Myoma uteri Operative Method Laparoscopic assisted vaginal hysterectomy Specimen Count And Types 1 piece About size:6x4 Source:uterus Pathology pending Operative Findings 1. Uterus:one 5x4 cm myoma at post wal 2. Adnexae: grossly normal 3. Cul-de-sac: free 4. Total weight of uterus: 228gm 5. Estimated blood loss: 100ml Blood transfusion: nil Complication: nil Operative Procedures 1. Put the patient on lithotomy position and vaginal douching. 2. Skin disinfection and draping 3. Insert uterine elevator and on Foley 4. Make a 1cm skin incision below the umbilicus 5. Insert Varess needle and make pneumoperitoneum 6.Insert 10 mmtrocar and laparoscopy 7. Insert 2nd (10mm) and 3rd (5mm) trocar under laparoscopic inspection 8. Injection diluted Pitressin (1:100) into utero-vesical fold and bilateral broad ligament 9. Cut off bilateral round ligaments via electrocauterization 10.Cut off bilateral ovarian ligaments and fallopian tubes via electrocauterization 11. Dissect and ligate bilateral uterine artery with 1-0 Vicryl 12. Dissect and cut off serosa over utero-vesical and utero-rectal fold 13. Submucosal injection of diluted Pitressin (1:100) around the cervix 14. Make incision on the anterior vaginal mucosa and circumcision the cervix. 15. Enter the vesico-cervical space and utero-rectal space with long Kelly. 16.Clamp, cut and suture ligate bilateral utero-sacral ligaments with 1-0 Vicryl 17. Open the peritoneal cavity, anteriorly and posteriorly. 18. Clamp, cut and suture ligate bilateral cardinal ligaments with 1-0 Vicryl 19. Cut the uterus through midline with scissors 20. Morceration of the uterus 21. Clamp,cut and suture ligate bilateral ovarian ligaments and remove the uterus 22. approximate the vaginal stump. 23. Check bleeding and hemostasis underlaparoscopy, inserrt one surgecell and one CWV drain into CDS 24. Remove trocar and repair skin with 3-0 Vicryl Operators 黃思誠, Assistants 黃佩慎, 烏恩慈, 李官馨 (F,1997/07/28,14y7m) 手術日期 2010/08/10 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Moyamoya disease 器械術式 EDAS 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 曾峰毅, 時間資訊 00:00 臨時手術NPO 08:00 報到 08:10 進入手術室 08:15 麻醉開始 08:50 誘導結束 08:50 抗生素給藥 09:33 手術開始 12:08 抗生素給藥 13:05 麻醉結束 13:05 手術結束 13:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Cl (Chloride) 2 0 麻醉 Blood gas analysis 2 0 手術 顱內外血管吻合術 1 1 L 手術 朴卜勒氏血流測定（週邊血管） 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 記錄__ 手術科部: 外科部 套用罐頭: Encephaloduroangiosynotosis 開立醫師: 曾峰毅 開立時間: 2010/08/10 13:23 Pre-operative Diagnosis Moyamoya disease Post-operative Diagnosis Moyamoya disease Operative Method Encephaloduroangiosynotosis Encephaloduroangiosynotosis, left Specimen Count And Types Nil Pathology Nil Operative Findings The contact between STA graft and cortical artery is staisfactory and tension free. The contact between STA graft and cortical artery is staisfactory and tension free. The meinigeal collaterals were slightly increased then normal condition. Operative Procedures With endotracheal general anaesthesia, tha patient was put in supine position with head rotated to right. We located the superficial temporal artery with its branches by vascular doppler. We shaved, scrubbed, disinfected, and then draped, the scalp. We made one curvilinear skin incision, and dissected along the plane between galeal and scalp to preserve the posterior branch of STA. We made the incision at the galeal along the posterior branch of STA, about 1cm away from the STA at both side. We made the incision and split the temporalis muslce. We drilled two burr holes, and then creaed the craniotomy in ovale shape. With endotracheal general anaesthesia, tha patient was put in supine position with head rotated to right. We located the superficial temporal artery with its branches by vascular doppler. We shaved, scrubbed, disinfected, and then draped, the scalp. We made one curvilinear skin incision posterior to the identified STA, and dissected along the plane between galeal and scalp to preserve the posterior branch of STA. We made the incision at the galeal along the posterior branch of STA, about 1cm away from the STA at both side. We made a longitidinal incision and split the temporalis muslce. We drilled two burr holes, and then created the craniotomy in ovale shape. Durotomy was done followed by arachnoid membrane opening. STA graft was approximated to cortical artery after anchoring sutre at two ends of durotomy. Dura was closed in water tight fashion with 3-0 prolene, and Durafoam was put for dura seal. Bone graft was fixed back with wiring and central tenting. The wound was closed in layers. Under microscopic view, durotomy was done followed by arachnoid membrane opening. STA graft was approximated to cortical artery after anchoring sutures at two ends of durotomy. Dura was closed primarily with 4-0 prolene, and Durafoam was put for dura seal. Bone graft was fixed back with 3 wires and central tenting. The wound was closed in layers. Operators VS 郭夢菲 Assistants R4 曾峰毅 王志遠 (M,1977/07/27,34y7m) 手術日期 2010/08/10 手術主治醫師 劉嘉銘 手術區域 東址 025房 01號 診斷 Pituitary tumor 器械術式 Endoscopic functional sinus su 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 蕭柏妮 ASA 3 紀錄醫師 廖怡茹, 時間資訊 07:55 報到 08:00 進入手術室 08:10 麻醉開始 08:15 誘導結束 08:41 手術開始 09:00 抗生素給藥 10:23 手術結束 10:23 麻醉結束 10:30 送出病患 10:35 進入恢復室 11:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 多竇副鼻竇手術 1 1 L 手術 鼻粘連解除術 1 2 R 記錄__ 手術科部: 耳鼻喉部 套用罐頭: Functional endoscopic sinus surgery 開立醫師: 廖怡茹 開立時間: 2010/08/10 21:02 Pre-operative Diagnosis Chronic paranasal sinusitis,left Post-operative Diagnosis Ditto, operated Operative Method Functional endoscopic sinus surgery,left;Lysis of nasal synechia,right Specimen Count And Types Several pieces About size:0.3cm*0.3cm Source:left nasal cavity Pathology pending Operative Findings Left infun.: OK(+) A.Eth.: OK(+) P.Eth.: OK(+) Maxi. : mucopus(+) Operative Procedures (1) Infundibulotomy :L(+ ) (2) Opening/trimming of ethmoid bulla :L(+) anterior ethmoid :L(+) middle turbinate :L(+) (3) Opening/trimming of posterior ethmoid :L(+) (4) Widening of maxillary ostium :L(+) (5) Packing with Fingerstall :R(+):1 ;L(+):3 Operators AP劉嘉銘, Assistants R4孟繁宇, R2廖怡茹 伍豊茂 (M,1962/04/01,49y11m) 手術日期 2010/08/10 手術主治醫師 杜永光 手術區域 東址 002房 04號 診斷 Aneurysm 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林至芃 ASA 4E 紀錄醫師 陳以幸, 時間資訊 17:00 臨時手術NPO 17:00 開始NPO 20:03 通知急診手術 21:10 進入手術室 21:15 報到 21:15 麻醉開始 21:20 誘導結束 22:04 手術開始 23:00 抗生素給藥 00:55 麻醉結束 00:55 手術結束 01:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦內血腫清除術 1 2 L 摘要__ 手術科部: 外科部 套用罐頭: Decompressive craniectomy, hematoma evacuatio... 開立醫師: 陳睿生 開立時間: 2010/08/11 01:42 Pre-operative Diagnosis Left ICA stenosis s/p ECIC bypass; left frontal infarction with hemorrhagic transformation Post-operative Diagnosis Left ICA stenosis s/p ECIC bypass; left frontal infarction with hemorrhagic transformation Operative Method Decompressive craniectomy, hematoma evacuation, and ICP monitor insertion Specimen Count And Types nil Pathology Nil Operative Findings After craniectomy done, severe brain swelling was noted, and massive hematoma was noted at left frontal region. Ischemic change of the brain tissue was noted and easy oozing was noted at the hematoma site. Corticotomy was performed from frontal region for hematoma evacuation. Intraperychema ICP monitor was inserted and the initial ICP was above 35mmHg. Operative Procedures After ETGA, the patient was under supine position and his head was turned to right. We reopened the previous wound and extended as pterional approach. A curvillinear scalp incision was extended posteriorly. The bypass graft was indetified and preserved. The temporalis muscle was dissected and two bur holes were made. Then craniectomy window was extended for decompression. After proper dura tenting, the dura was opened curvillinearly. A small corticotomy was made at left frontal region and hematoma was harvested. However, easy oozing was noted at the hematoma site and packing hemostasis was performed. An intraperychemal ICP monitor was inserted at the corticotomy site. Then the dura was covered back and packed with Durafoam. Two epidural CWV drains and the wound was closed in layers. Operators P 杜永光, VS 蔡翊新 Assistants R6 陳睿生, R1 陳以幸 Indication Of Emergent Operation 葉兆章 (M,1951/02/20,61y0m) 手術日期 2010/08/10 手術主治醫師 曾勝弘 手術區域 東址 005房 號 診斷 HIVD 器械術式 L3-5 laminectomy 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 07:55 報到 08:05 進入手術室 08:10 麻醉開始 08:25 誘導結束 08:55 抗生素給藥 09:30 手術開始 12:00 手術結束 12:00 麻醉結束 12:10 送出病患 12:12 進入恢復室 13:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 手術 椎間盤切除術－腰椎 1 1 記錄__ 手術科部: 外科部 套用罐頭: 1. Microsurgical diskectomy, L4/5, bilateral ... 開立醫師: 鍾文桂 開立時間: 2010/08/10 12:21 Pre-operative Diagnosis 1. Lumbar stenosis, L3/4. 2. Herniated intervertebral disc, L4/5. Post-operative Diagnosis 1. Lumbar stenosis, L3/4. 2. Herniated intervertebral disc, L4/5. Operative Method 1. Microsurgical diskectomy, L4/5, bilateral approach. 2. Decompressive laminectomy, L4. Specimen Count And Types nil Pathology Nil. Operative Findings 1. Hypertrophic ligamentum flavum at L3/4 level. 2. Central bulging disc at L4/5. 3. Engorged epidural veins at L4, right side. 4. Slack thecal sac and roots after decompression. Operative Procedures 1. Anesthesia: ETGA; position: prone. 2. Preparation: C-arm fluoroscope localization of L4/5 level. disinfection & draping. 3. Midline incision and bilateral paraspinal dissection. 4. Laminectomy, L4 and removal of ligamentum flavum with Rongeur, Kerrison punch. 5. Diskectomy,L4/5 under microscope. 6. Well hemostasis, then wound closure in layers. Operators V.S. 曾勝弘 Assistants R5 鍾文桂 Ri . 張遜言 (F,1949/02/14,63y1m) 手術日期 2010/08/10 手術主治醫師 曾勝弘 手術區域 東址 005房 02號 診斷 Lumbar spondylosis 器械術式 laminectomy and posteriolateral fusion 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 11:30 報到 12:25 進入手術室 12:30 麻醉開始 12:40 誘導結束 13:05 抗生素給藥 13:25 手術開始 16:05 抗生素給藥 16:20 開始輸血 17:10 手術結束 17:10 麻醉結束 17:20 送出病患 17:20 進入恢復室 19:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 椎弓切除術（特壓）－超過二節 1 1 手術 脊椎融合術－後融合，無固定物 1 2 記錄__ 手術科部: 外科部 套用罐頭: 1. Decompressive laminectomy, L2-5, bilateral... 開立醫師: 鍾文桂 開立時間: 2010/08/10 17:29 Pre-operative Diagnosis Lumbar stenosis, L2-5. Post-operative Diagnosis Lumbar stenosis, L2-5. Operative Method 1. Decompressive laminectomy, L2-5, bilateral approach. 2. Posterolateral fusion, L2-5. Specimen Count And Types nil Pathology Nil. Operative Findings 1. Severe degenerative change of lumbar spine. 2. Tough spurr formation, hypertrophic ligamentum flavum. 3. The thecal sacs and roots were slack after decompression. 4. Intact dura mater, no CSF leakage. Operative Procedures 1. Anesthesia: ETGA, position: prone. 2. Preparation: C-arm fluoroscope localization of L2-5 levels. disinfection, draping. 3. Midline incision and paraspinal dissection. 4. Decompressive laminectomy and foraminotomy. 5. Posterolateral fusion with autologous and alloplastic bone graft. 6. Wound closure in layers after placing one 1/8 hemovac drain. Operators V.S. 曾勝弘 Assistants R5 鍾文桂 Ri 洪慧卿 (F,1975/01/24,37y1m) 手術日期 2010/08/10 手術主治醫師 曾勝弘 手術區域 西址 033房 01號 診斷 Carpal tunnel syndrome 器械術式 Decompression of mediun nerve 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 08:15 進入手術室 08:30 麻醉開始 08:35 手術開始 09:00 手術結束 09:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 正中神經或尺神經腕部減壓術–單側 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Carpal Tunnel Syndrome 開立醫師: 游健生 開立時間: 2010/08/10 09:16 Pre-operative Diagnosis Right carpal tunnel syndrome Post-operative Diagnosis Right carpal Tunnel Syndrome Operative Method Median nerve decompression Specimen Count And Types nil Pathology Nil Operative Findings Right median nerve was tightly compressed by transverse carpal ligament. It was well decompressed after division of ligament . Operative Procedures 1.The hand and forearm were sterilized with povidone-iodine tincture, then covered with stockinet. 2.Anesthesia: 1% Xylocaine solution was used as local anesthestics 3.Linear incision from vertical palmar crease to transverse wrist crease. 4.The palmaris longus tendon was identified, then the plamar aponeurosis was cut longitidinally along the ulnar side of the palmaris longus tendon. 5. The median nerve was identified beneath the palmars longus tendon. Under direct vision, the transverse carpal ligament was divided until no more pressure on the median nerve could be palpated. 6. The skin was closed by interrupted suture with 4/0 nylon. 7. The hand and wrist were draped with fluffy dressing and elastic bandage. Operators VS 曾勝弘 Assistants R3 游健生 謝枝全 (M,1928/12/28,83y2m) 手術日期 2010/08/10 手術主治醫師 林峰盛 手術區域 西址 035房 05號 診斷 Failed back syndrome 器械術式 Nerve block / PC 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 林峰盛 ASA 3 時間資訊 13:30 報到 14:00 進入手術室 14:15 麻醉開始 14:20 誘導結束 14:25 手術開始 14:50 手術結束 14:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 神經分離術–肩，臀關節以上，包括臂神經叢，坐骨神經 1 1 記錄__ 手術科部: 麻醉部 套用罐頭: Epidural adhesiolysis 開立醫師: 林峰盛 開立時間: 2010/08/10 14:58 Pre-operative Diagnosis failed back syndrome, susp. epidural fibrosis Post-operative Diagnosis failed back syndrome, susp. epidural fibrosis Operative Method epidural adhesiolysis Specimen Count And Types nil Pathology Nil Operative Findings limited contrast filling initially, patent flow after repeated N/S irrigation Operative Procedures 1. IVGA with fentanyl, midazolam and propofol titration2. Put patient in prone position with L-S spine flexion3. Locate L2-S2 vertebral body by C-arm, mark on sacrococcygeal intervertebral space.4. check insertion site by ultrasound again and disinfecon as usual5. Insert 16G Tuohy needle via sacral hiatus.6. Inject contrast medium to demonstrate epidural space spreading, 10. Inject 1% xylocaine in 20 ml solution,followed by 3% NaCl 20 ml, 11. Send patient to POR Operators 林峰盛, Assistants 林彥君, 洪曉宇 (M,1997/08/02,14y7m) 手術日期 2010/08/10 手術主治醫師 郭夢菲 手術區域 兒醫 067房 02號 診斷 Nevus 器械術式 Scalp tumor excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 1 紀錄醫師 曾峰毅, 時間資訊 06:00 臨時手術NPO 12:50 報到 13:27 進入手術室 13:30 麻醉開始 13:45 誘導結束 13:55 抗生素給藥 14:13 手術開始 14:50 手術結束 14:50 麻醉結束 15:05 送出病患 15:10 進入恢復室 16:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 移前皮瓣移植術 1 1 R 手術 頭皮腫瘤 1 2 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 曾峰毅 開立時間: 2010/08/10 15:02 Pre-operative Diagnosis Scalp tumor Scalp tumor (nevus sebacia), right temporal region Post-operative Diagnosis Scalp tumor Scalp tumor (nevus sebacia), right temporal region Operative Method Sclap tumor excision with advance flap Specimen Count And Types Scalp tumor was sent for pathology. Pathology Pending Operative Findings The scalp tumor was 4cm in length, 3cm in width. There was no bony or periosteal involvement. Excision margin is clear in gross. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to left. After sclap shaved, scrubbed, disinfected, and then draped, we made one fishmouth skin incision from right frontal to right parietal. We excise the tumor, and created advance flap at bilateral side of scalp wound. The woound was closed in layers. With endotracheal general anaesthesia, the patient was put in supine position with head rotated to left. After sclap shaved, scrubbed, disinfected, and then draped, we made one fishmouth skin incision from right frontal to right parietal. We excise the tumor, and created advance flap at bilateral side of scalp wound after generous subgaleal dissection. The wound was closed in layers. Operators VS 郭夢菲 Assistants R4 曾峰毅 李維國 (M,1953/09/23,58y5m) 手術日期 2010/08/10 手術主治醫師 賴達明 手術區域 東址 002房 03號 診斷 Spinal injury with complication, sequelae 器械術式 Diskectomy cervical(Anterier) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 劉昌杰, 時間資訊 12:30 臨時手術NPO 12:30 開始NPO 13:02 通知急診手術 14:30 報到 14:50 進入手術室 14:55 麻醉開始 15:15 誘導結束 15:20 抗生素給藥 16:00 手術開始 18:20 抗生素給藥 18:45 手術結束 18:45 麻醉結束 18:55 送出病患 19:00 進入恢復室 20:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 手術 脊椎融合術－前融合，有固定物（＜＝四節） 1 1 手術 肌肉或深部組織腫瘤切除術及異物取出術 1 2 摘要__ 手術科部: 外科部 套用罐頭: Anterior approach for microdiskectomy and fus... 開立醫師: 陳睿生 開立時間: 2010/08/10 19:12 Pre-operative Diagnosis C5-6 HIVD with stenosis Post-operative Diagnosis C5-6 HIVD with stenosis Operative Method Anterior approach for microdiskectomy and fusion with autologus bone graft Specimen Count And Types nil Pathology Nil Operative Findings Narrowing disk space was noted over C5-6 level, and mild calcified PLL was noted especially over C5 leve. The thecal sac was tightly compressed and well expanded after decompression. Autologus bone graft was extracted from anterior aspect of right iliac bone. Operative Procedures 1. ETGA, supine position and neck extension 2. Right side neck transverse skin incision 3. Incise into the plastyma muscle 4. Dissect the plane between the SCM and trachea, esophagus 5. Incise the prevertebral membrane and localize the C5/6 level with C-arm 6. Set self-retractor, and C5/6 diskectomy was done under microscope 7. Drill removing of the spurs 8. Remove of thicken PLL until dura expansion 9. Extract bone graft from the right iliac bone 10.Insert the bone graft into the C5/6 disk space for fusion 11.Hemostasis, set 1/8 hemovac at cervical wound and CWV at RLQ wound 12.Close the wound in layers Operators VS 賴達明 Assistants R6 陳睿生, R1 劉昌杰 Indication Of Emergent Operation 呂九宮 (M,1927/09/05,84y6m) 手術日期 2010/08/10 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Spondylosis with myelopathy, cervical 器械術式 laminoplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 08:00 進入手術室 08:10 麻醉開始 08:20 誘導結束 08:50 抗生素給藥 09:00 手術開始 11:50 手術結束 11:50 麻醉結束 11:55 送出病患 12:00 進入恢復室 13:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 手術 椎弓切除術（特壓）－二節以內 1 1 記錄__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 陳國瑋 開立時間: 2010/08/10 12:11 Pre-operative Diagnosis OPLL of Cervical spnie, C3 and C6 Post-operative Diagnosis OPLL of Cervical spnie, C3 and C6 status post laminectomy C3 and C6 Operative Method C3 and C6 Laminectomy Specimen Count And Types nil Pathology nil Operative Findings 1.Spinal cord at C3 and C6 level was compressed from anterior side. 2.After decompression, it expanded well Operative Procedures 1.ETGA, prone 2.Midline skin incision at C2~6 level 3.Detach paravertebral muscle group to expose lower C2~C6 lamina 4.Drill both side of lamina at C3 and C6 level 5.The lamina was taken out to expose the spinal cord 6.Hemostasis 7.Set one CWV drain 8.Wound closure in layers Operators VS 賴達明 Assistants R5陳德福 R2陳國瑋 摘要__ 手術科部: 外科部 套用罐頭: Laminectomy C3&6; partial laminectomy C2&7 開立醫師: 陳睿生 開立時間: 2010/08/10 12:12 Pre-operative Diagnosis OPLL s/p anterior decompression with adjecent level degeneration, C3&6 Post-operative Diagnosis OPLL s/p anterior decompression with adjecent level degeneration, C3&6 Operative Method Laminectomy C3&6; partial laminectomy C2&7 Specimen Count And Types nil Pathology nil Operative Findings 1.There is hypertrophic ligmentum flavum at the C2-3 and C6-7 level with spinal stenosis. Partial laminectomy of C2&7 with total laminectomy of C3&6 was done smoothly. The thecal sac expended well after the decompression. Operative Procedures Operators VS 賴達明 Assistants R5 陳德福 R2陳國瑋 潘頌華 (M,1928/09/29,83y5m) 手術日期 2010/08/10 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Lumbar Spondylosis 器械術式 L3-5 TPS 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 12:25 進入手術室 12:30 麻醉開始 12:50 誘導結束 13:00 抗生素給藥 13:20 手術開始 16:00 抗生素給藥 17:07 手術結束 17:07 麻醉結束 17:15 送出病患 17:15 進入恢復室 18:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 椎間盤切除術－腰椎 1 2 摘要__ 手術科部: 外科部 套用罐頭: 1.L3-5 TPS fusion 2.L3-4 diskectomy 3.L4-5 la... 開立醫師: 陳德福 開立時間: 2010/08/10 17:13 Pre-operative Diagnosis L3-4 HIVD and spondylosis with L3-5 spinal stenosis Post-operative Diagnosis L3-4 HIVD and spondylosis with L3-5 spinal stenosis Operative Method 1.L3-5 TPS fusion 2.L3-4 diskectomy 3.L4-5 laminectomy 1.L3-5 TPS fusion 2.L3-4 diskectomy 3.L3&4 laminectomy Specimen Count And Types nil Pathology NIL Operative Findings 1.There are spndylosis over the L3-5 and hypertrophic ligamentum flavum over L3-5 with spinal stenosis. The thecal sac was compressed tightly by the osteophytes and ligamentum flavum. The theca sac was decompressed after the L3&4 laminiectomy. The L3-4 protruding disc over right side was removed. 2.6 TPS and 2 rods with 1 cross-link were implantated at L3-5 for posterior fusion. The L3-5 posterior lateral fusion with autologous bone was done. Operative Procedures Under ETGA and prone position, the skin was disinfected and draped as usual. One linear incision at midline was done and the paraspinous msucle was displaced laterally. The L3-5 lamina was exposed and L3-5 TPS was inserted under C-arm flouroscope guided. The L3&4 laminecotmy and L3-4 diskectomy were performed with Kerrison, Alligator, Disc clamp and currettage assisted. The rods was implantated followed by performing L3-5 posterior lateral autologous fusion. Hemostasis and left one hemovac in the epidural space. The wound was then closed in layers. Operators VS 賴達明 Assistants R5 陳德福 R2 陳國瑋 相關圖片 林恒助 (M,1943/04/10,68y11m) 手術日期 2010/08/10 手術主治醫師 賴達明 手術區域 東址 003房 03號 診斷 Neurilemmoma 器械術式 L2 neuroma 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 17:25 進入手術室 17:30 麻醉開始 17:35 誘導結束 17:50 抗生素給藥 18:15 手術開始 19:40 20:20 手術結束 20:20 麻醉結束 20:35 進入恢復室 21:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 椎間盤切除術－腰椎 1 2 手術 良性病髓腫瘤切除術 1 1 摘要__ 手術科部: 外科部 套用罐頭: 1.lumbar tumor excision 2.L4-5 diskectomy and... 開立醫師: 陳國瑋 開立時間: 2010/08/10 20:34 Pre-operative Diagnosis 1.lumbar intradura tumor, neuroma 2.L4-5 HIVD with spinal stenosis, right Post-operative Diagnosis 1.lumbar intradura tumor, neuroma 2.L4-5 HIVD with spinal stenosis, right Operative Method 1.lumbar tumor excision 2.L4-5 diskectomy and decompression Specimen Count And Types 1 piece About size:1*1*1cm Source:lumbar neuroma Pathology Pending Operative Findings 1.There is a 1*1*1cm in sized tumor originating from the lumbar nerve roots with capsule and yellowish contents. The tumor is soft and removed totally. The origin nerve root was preserved well and the dura was closed in water tight fasion. 1.There is a 1*1*1cm in sized tumor originating from the lumbar nerve roots[L2 level] with capsule and yellowish contents. The tumor is soft and removed totally. The origin nerve root was preserved well and the dura was closed in water tight fasion. 2.The right L4 partial laminectomy and decompression were performed smoothly. Operative Procedures Under ETGA and prone position, the skin was disinfected and draped as usual. The location of the L2 and L4-5 were identified under C-arm fluroscope. One linear incision on the L1-2 was done and total L2 & partial L1 laminectomy was done. The dura was opened in midline and the tumor was exposed by dissector assisted. The tumor was then removed under subcapsular tumor excision and the nerve root was preserved. The dura was closed in water tight fasion and one epidural CWV was left in situ. The wound was closed in layers. Another linear incision on the L4-5 level was done and right partial L4 laminectomy with removal of hypertrophic ligamentum flavum. The dura sac was decompressed. The wound was closed in layers. Operators VS賴達明 Assistants R5陳德福 R2陳國瑋 鍾宜辰 (M,1979/10/29,32y4m) 手術日期 2010/08/10 手術主治醫師 蕭輔仁 手術區域 東址 005房 03號 診斷 Lumbar Spondylosis 器械術式 Laminectomy for decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 17:30 進入手術室 17:35 麻醉開始 17:40 誘導結束 18:00 抗生素給藥 18:19 手術開始 19:50 手術結束 19:50 麻醉結束 20:00 送出病患 20:00 進入恢復室 21:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 椎間盤切除術－腰椎 1 1 R 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 R 記錄__ 手術科部: 外科部 套用罐頭: Microsurgical diskectomy,L5/S1, right side ap... 開立醫師: 鍾文桂 開立時間: 2010/08/10 20:07 Pre-operative Diagnosis Hernitated intervertebral disc, L5/S1. Post-operative Diagnosis Hernitated intervertebral disc, L5/S1. Operative Method Microsurgical diskectomy,L5/S1, right side approach Specimen Count And Types nil Pathology Nil. Operative Findings A large ruptured disc impinged right S1 root. The root was slack after decompression. Operative Procedures Under ETGA, the patient was placed in prone position. After disinfection and draping, a 3 cm midline incision was made at L5S1 intervertebral disc level which was localized by intraoperative fluoroscope. Right side dissection was done to expose the inferior margin of L5 and superior margin of S1 laminae. Laminotomy of L5&S1; were achieved by Kerrison. While retracting the thecal sac, the ruptured disc came out. After further diskectomy, the wound was closed in layers. Operators V.S. 王國川 Assistants R5 鍾文桂 記錄__ 手術科部: 外科部 套用罐頭: Microsurgical diskectomy,L5/S1, right side ap... 開立醫師: 鍾文桂 開立時間: 2010/08/10 20:07 Pre-operative Diagnosis Hernitated intervertebral disc, L5/S1. Post-operative Diagnosis Hernitated intervertebral disc, L5/S1. Operative Method Microsurgical diskectomy,L5/S1, right side approach Specimen Count And Types nil Pathology Nil. Operative Findings A large ruptured disc impinged right S1 root. The root was slack after decompression. Operative Procedures Under ETGA, the patient was placed in prone position. After disinfection and draping, a 3 cm midline incision was made at L5S1 intervertebral disc level which was localized by intraoperative fluoroscope. Right side dissection was done to expose the inferior margin of L5 and superior margin of S1 laminae. Laminotomy of L5&S1; were achieved by Kerrison. While retracting the thecal sac, the ruptured disc came out. After further diskectomy, the wound was closed in layers. Operators V.S. 王國川 Assistants R5 鍾文桂 湯張秋霞 (F,1948/11/10,63y4m) 手術日期 2010/08/11 手術主治醫師 王國川 手術區域 東址 005房 02號 診斷 Head Injury 器械術式 VP shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 古恬音, 時間資訊 00:00 臨時手術NPO 12:25 報到 12:55 進入手術室 13:00 麻醉開始 13:05 誘導結束 13:15 抗生素給藥 13:40 手術開始 14:30 手術結束 14:30 麻醉結束 14:40 送出病患 14:43 進入恢復室 15:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Glucose 1 0 手術 腦室腹腔分流手術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 古恬音 開立時間: 2010/08/11 14:35 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method V-P Shunt Specimen Count And Types nil Pathology Nil Operative Findings 1. The opening pressure was about 15cm H2O 2. Clear CSF drained out Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: supine with head rotated lef 3.Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 5 cm curvilinear, right frontal. Raney clips were applied to the scalp edge for temporary hemostasis. 5.After the scalp flap had been lifted and reflected anteriorly, a burr hole was made and the dura was tented by 1 stitche. 6.The dura was opened by a nib incision. Rt lateral ventricle was tapped by a ventricular needle, then a 6.8 cm segment of the ventricular catheter was introduced into the ventricle. The outer end of the catheter was connected to a reservoir. 7. A nib incision was made at RUQ of the abdomen , then a trocar was pushed into peritoneal cavity. Subsequently, distal 20 cm segment of the peritoneal catheter (medium pressure) was introduced into the peritoneal cavity through the outer tube of the trochar. The proximal end of this catheter was passed through subcutaneous tunnel at forechest, neck, rt retroauricular area and connected the reservoir. The shunt systemwas checked to make sure its function was working. 8. The reservoir was fixed to pericranium by 2 stitches. 9. Scalp closure: hemostasis was done with monopolar coagulator touching on the sucker tip. Galea suture was performed by continuous suture with 2/0 Dexon and skin by continuous suture with 3/0 nylon. 10.Course of the surgery: smooth. Operators 王國川 Assistants 胡朝凱,古恬音 王朝木 (M,1968/04/17,43y10m) 手術日期 2010/08/11 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Blepharospasm 器械術式 MVD 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 07:46 報到 08:05 進入手術室 08:10 麻醉開始 08:50 誘導結束 09:20 抗生素給藥 10:00 手術開始 12:15 抗生素給藥 13:05 麻醉結束 13:05 手術結束 13:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顏面神經解壓術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 摘要__ 手術科部: 外科部 套用罐頭: Retrosigmoid approach for left facial nerve m... 開立醫師: 游健生 開立時間: 2010/08/11 13:36 Pre-operative Diagnosis Left hemifacial spasm Post-operative Diagnosis Left hemifacial spasm Operative Method Retrosigmoid approach for left facial nerve microvascular decompression Specimen Count And Types nil Pathology Nil Operative Findings The labyrinth artery gave branches to supply CN VII and CN VIII complex. These vessles were all preserved. It compressed CN VII anteriorly at its exit zone. Also, a branch of AICA passed behind CN VII & CN VIII complex compressing CN VII posteriorly at its exit zone. These vessels were kept away from CN VII by interposing teflon felt cotton. There were no changes of BAEP during the operation. Operative Procedures Under ETGA, patient was put into supine position with left shoulder elevated and retracted caudomedially. His neck extended and head turned to right fixed with Mayfield headholder. After ensuring mastoid process at the highest point, we shaved, disinfected, and draped the operation field as usual. A verticle S-shape scalp incision was made 2cm behind left ear centred at external acoustic meatus. We harvested a fascia graft for later duroplasty use. After dissection, we exposed the cranium and created a 5 x 5cm craniomtomy window. We opened cerebellar cistern to drain CSF till cerebellum became slack following a K-shape durotomy. After gentle retraction of the cerebellum inferiorly, the labyrinth artery was found compressing CN VII anteriorly at its exit zone. Also, a branch of AICA passed behind CN VII & CN VIII complex compressing CN VII posteriorly at its exit zone. We opened the cerebellopontine cistern and medullopontine cistern for further CSF drainage. The vessels were retracted away from CN VII. Teflon felt cotton was gentlely inserted into space between these two vessels and CN VII. We closed the dura with continuous 4-0 prolene suture with a fascia graft. Finally, wound was closed in layers. Operators Prof. 杜永光 Assistants R6 陳睿生 R3 游健生 徐陳玉里 (F,1924/12/12,87y3m) 手術日期 2010/08/11 手術主治醫師 蔡瑞章 手術區域 東址 005房 01號 診斷 Non-Hodgkin's lymphoma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 古恬音, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:05 進入手術室 08:07 麻醉開始 08:25 誘導結束 08:35 抗生素給藥 09:15 手術開始 11:25 抗生素給藥 12:25 麻醉結束 12:25 手術結束 12:35 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦瘤切除－手術時間在４小時以內 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: craniotomy for tumor excision 開立醫師: 胡朝凱 開立時間: 2010/08/11 12:23 Pre-operative Diagnosis LEFT PARIETO-OCCIPITAL TUMOR Post-operative Diagnosis LEFT PARIETO-OCCIPITAL TUMOR Operative Method craniotomy for tumor excision Specimen Count And Types pieces of tumor Pathology Frozen showed lymphoma Operative Findings 1.One grayish to yellowish firm tumor, measured as 2x1 cm, located at left parieto-occipital junction without frankly margin. 2.Peripheral gliotic tissue was noted 3.The brain was mild swelling Operative Procedures 1.ETGA, prone 2.Left reverse U shape skin incision 3.Reflect skin flap 4.Detach periosteum 5.Craniotomy 6.Dural tenting 7.Echo localization 8.Dural opening as the base left on midline 9.Transcortical apprach 10.Identified tumor and dissect the edge with dissector 11.Total tumor excision 12.Close dura 13.Fixed bone back with wire 14.Set one CWV drain then close wound in layers Operators 蔡瑞章 Assistants 胡朝凱, 古恬音 柯明達 (M,1992/07/17,19y7m) 手術日期 2010/08/11 手術主治醫師 郭夢菲 手術區域 兒醫 069房 01號 診斷 Germ cell tumor, mediastinum 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 曾峰毅, 時間資訊 23:50 臨時手術NPO 07:45 報到 08:00 進入手術室 08:10 麻醉開始 08:55 誘導結束 09:00 抗生素給藥 09:55 手術開始 10:38 開始輸血 12:00 抗生素給藥 12:10 手術結束 12:10 麻醉結束 12:25 送出病患 12:30 進入恢復室 14:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 惡性病髓腫瘤切除術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Cl (Chloride) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 曾峰毅 開立時間: 2010/08/11 12:14 Pre-operative Diagnosis Germ cell tumor, with T7 metastasis Post-operative Diagnosis Germ cell tumor, with T7 metastasis Operative Method Laminectomy, lower T6 to upper T8, and partial tumor excision Specimen Count And Types Several fragment of the tumor was sent for pathology. Pathology Pending Operative Findings Hypervascular tumor, well capsuled, was noted at T7 vertebral body with epidural component and spinal cord compression. Spinal cord was free from tension after decompression and tumor excision. Hypervascular tumor, well capsuled, was noted at T7 vertebral body and epidural component anterior and lateral to the spinal cord. The spinal cord was markedly compressed from the anterior part. The spinal cord was free from tension and deviated posteriorly after decompression and limited tumor excision and coagulation. The pedicle and facet joint was not very stable due to tumor invasion. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After C-arm localization, we made one midline linear skin incision from T6 to T8, and dissected bialteral paraspinal muscle to expose bilateral laminae of T6 to T8. Laminectomy from lower T6 to upper T8 was done with rongeur and Kerrisons. Epidural tumor was removed, and hemosatsis was done. After CWV was inserted, we closed the wound in layers. With endotracheal general anaesthesia, the patient was put in prone position. After C-arm localization thouhg it was not clear, we made one midline linear skin incision from T6 to T8, and dissected bialteral paraspinal muscle to expose bilateral laminae of T6 to T8. Laminectomy from lower T6 to upper T8 was done with rongeur and Kerrisons. Under microscopic view, the right epidural tumor was removed a little and the abnormally invaded bone was curetted. We confirmed the location of the operation field again by portable X-ray. Hemosatsis was done. After CWV was inserted, we closed the wound in layers. Operators VS 郭夢菲 Assistants R4 曾峰毅 林素貞 (F,1953/12/18,58y2m) 手術日期 2010/08/11 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Spondylolisthesis 器械術式 C1-2 TAS 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 13:35 進入手術室 13:37 麻醉開始 13:50 誘導結束 15:00 抗生素給藥 15:45 手術開始 18:00 抗生素給藥 19:00 手術結束 19:00 麻醉結束 19:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 手術 肌肉或深部組織腫瘤切除術及異物取出術 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: Transarticular screw for C1-2 fixation 開立醫師: 陳睿生 開立時間: 2010/08/11 19:48 Pre-operative Diagnosis C1-2 subluxation Post-operative Diagnosis C1-2 subluxation Operative Method Transarticular screw for C1-2 fixation Specimen Count And Types nil Pathology Nil Operative Findings Cannulated screws were inserted from the C2 lateral mass to C1 anterior arch bilaterally under C-arm guided. The left side screw was 42mm in length, and the right side screw was 40mm in length. Then a piece of iliac bone was extracted from posterior iliac arch for C1-2 fusion. The bone graft was fixed by miniplates. Post-op C1-2 reduction and immobility was noted. Operative Procedures 1. ETGA, prone position; head was mild flexion for C1-2 reduction, and fixed with Mayfield 2. Posterior neck midline incision and the paraspinal muscle was splitted for C1-3 spinous process, lamina exposure 3. Expose the C2 facet joints and the lateral aspect of C2 spinal cannal was identify and dissect 4. Two percutaneous tunnels were created bilaterally, and the cannulated screws were inserted with guide pins guiding 5. A piece of bone graft was extracted from the right posterior iliac crest, and the bone graft was fixed with C1, 2 by miniplates x2 6. Hemostasis, set CWV drains at C1-2 level and posterior iliac space 7. Close the wounds in layers Operators VS 賴達明 Assistants R6 陳睿生, R3 游健生 陳秀卿 (F,1944/11/01,67y4m) 手術日期 2010/08/11 手術主治醫師 郭源松 手術區域 東址 012房 04號 診斷 Cellulitis 器械術式 Debridment-- >10cm 手術類別 預定手術 手術部位 四肢 傷口分類 污染 麻醉方式 面罩麻醉 麻醉主治醫師 葉惠敏 ASA 3 紀錄醫師 游彥辰, 時間資訊 12:40 進入手術室 12:45 麻醉開始 12:50 誘導結束 12:55 抗生素給藥 13:00 手術開始 13:55 手術結束 13:55 麻醉結束 14:15 送出病患 14:17 進入恢復室 15:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 骨髓炎之死骨切除術或蝶形手術及擴創術（包含指骨、掌骨、蹠骨） 1 2 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Semi-opened mask inhalation anes 1 0 摘要__ 手術科部: 外科部 套用罐頭: Debridement and sequestrectomy 開立醫師: 游彥辰 開立時間: 2010/08/11 14:27 Pre-operative Diagnosis Left DM foot with 4th and 5th toes gangrene, s/p toes open amputation, with wound edge necrosis, and 2nd toes gangrene Post-operative Diagnosis Left DM foot with 4th and 5th toes gangrene, s/p toes open amputation, with wound edge necrosis, and 2nd toes gangrene Operative Method Debridement and sequestrectomy Specimen Count And Types 1 piece About size:fragments Source:Left foot Pathology Pending Operative Findings The wound edge and soft tissue of left 4th and 5th toes were still gangrenous, with unhealthy necrotic bone (proximal phalynx). The left 2nd toe was noticed necrotic and gangrenous change. The circulation of 2nd toe was poor. The unhealthy soft tissue and necrotic bone were resected till metatarasal head area. The wounds were all closed primarily. Operative Procedures Under IVGA, the patient was placed in supine position. Anti-septic preparation was performed. Wound debridement with necrotic bone resection were performed. After N/S irrigation, the wounds were closed primarily. Operators VS郭源松 Assistants R4游彥辰, Int徐漢來 林宗慶 (M,1982/12/25,29y2m) 手術日期 2010/08/12 手術主治醫師 吳耀銘 手術區域 東址 012房 02號 診斷 Liver tumor 器械術式 Laparoscopy Hepatectomy 手術類別 預定手術 手術部位 腹 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 全賀顯, 時間資訊 13:00 報到 13:30 進入手術室 13:35 麻醉開始 13:45 誘導結束 14:00 抗生素給藥 14:05 手術開始 17:00 抗生素給藥 18:35 手術結束 18:35 麻醉結束 18:42 送出病患 18:47 進入恢復室 20:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 肝區域切除術－一區域 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 記錄__ 手術科部: 外科部 套用罐頭: ATYPICAL 開立醫師: 全賀顯 開立時間: 2010/08/12 19:16 Pre-operative Diagnosis Liver tumor Post-operative Diagnosis Liver tumor Operative Method Laparoscopy hepatectomy Specimen Count And Types 1 piece About size:2*2*1 Source:Liver Pathology Pending Operative Findings 1. No cirrhosis, no ascites, one tumor over S5, tumor size 2×2×1cm 2. Location at S5 segment, color white with capsule Operative Procedures 1.ETGA and lithotomy position. 2.Skin disinfection and drap. 3.Laparoscopic setting (10mm,5mm,5mm,5mm), pneumoperitonium 4.Retract the dome of the gallbladder anterior and upward by grasping the fundus. 5.Grasp Hartmanns pouch and retract laterally. Dissect and visualize the cystic duct and common bile duct. 7.Identify liver tumor over S5 segment behind the gall bladder 6.Dissect the liver tumor (partial S5 segment) and gallbladder from the liver using the "hook" electrocautery. 8.Perform repeated irrigations. Place the liver tumor and gallbladder into endoscopic pouch and remove it through the umbilical port. 9.Hemostatsis 10.Close wound in layer. Operators 吳耀銘 Assistants 郭庭均,全賀顯 相關圖片 林阿菊 (F,1951/04/23,60y10m) 手術日期 2010/08/12 手術主治醫師 詹志洋 手術區域 東址 017房 06號 診斷 Biliary tract cancer 器械術式 Port-A catheter implatation 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 林哲安, 時間資訊 17:10 報到 17:40 進入手術室 18:07 麻醉開始 18:08 誘導結束 18:09 手術開始 18:30 麻醉結束 18:30 手術結束 18:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 內頸靜脈切開，永久導管放置術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Permcath/port-A 開立醫師: 林明賢 開立時間: 2010/09/05 16:27 Pre-operative Diagnosis Biliary tract cancer Post-operative Diagnosis s/p port-A insertion Operative Method port-A implantation via right internal jugular vein Specimen Count And Types nil Pathology nil Operative Findings 1. The port-A catheter was inserted via right internal jugular vein by Cut down & echo-guided procedure 2. Patent flow after implantation 3. Tip position located at RA/SVC junction Operative Procedures -Port-A: After skin disinfection and drapping & local anesthesia, echo-guided RIJV cut down and catheterization was performed. Creation of the subcutaneous pocket at right subclavicular area. Tunneliztion, advanced the catheter into the RIJV via the peel-away sheath smoothly. Ensure the catheter tip position by portable CXR. Wound closure in layers after adequate hemostasis. Operators VS詹志洋 Assistants R4林哲安 王志遠 (M,1977/07/27,34y7m) 手術日期 2010/08/12 手術主治醫師 杜永光 手術區域 東址 002房 02號 診斷 Pituitary tumor 器械術式 T.S.H. 手術類別 緊急手術 手術部位 頭、頸 傷口分類 污染 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 06:59 通知急診手術 10:51 進入手術室 10:55 麻醉開始 11:00 抗生素給藥 11:05 誘導結束 12:23 手術開始 13:30 麻醉結束 13:30 手術結束 13:35 送出病患 13:37 進入恢復室 14:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 手術 蝶竇手術 1 2 R 摘要__ 手術科部: 外科部 套用罐頭: Hypophysectomy---Transphenoid 開立醫師: 游健生 開立時間: 2010/08/12 14:20 Pre-operative Diagnosis Sphenoid abscess Post-operative Diagnosis Sphenoid abscess Operative Method Transnasal drainage of sphenoid abscess Specimen Count And Types 1 piece About size: some fluid Source:Fluid accumulated in sphenoid sinus Pathology Nil Operative Findings Generalized nasal mucosa swelling was noted. The mucosa in front of sphenoid sinus buldged out. After cutting open, some fluid with pus gashed out. The necrotic and granulation tissue inside sphenoid sinus were removed. The reparied sellar floor was healthy and left untouched. Operative Procedures Under ETGA, patient was put into supine with head tilted 30 degree to left. The face was prepared with povidone-iodine alcohol tincture, and the mucosa of nasal cavity with aqueous povidone-iodine tincture. The former areas were covered by a sterilized adhesive plastic sheet. A Hardys nasal speculum was applied to displace the nasal mucosa laterally and keep the nasal cavity open constantly for the exposure. The nasal submucosa at septum and floor and the subperiostium at upper alveola were infiltrated with 1:100 epinephrine solution. We explored the right nasal cavity upward along septum till we reached the mucosa in front of sphenoid sinus. We cut open the buldging mucosa and some fluid with pus gashed out from sphenoid sinus. There were some necrotic and granulation tissue inside and removed. The Hardys nasal speculum was removed and the nasal mucosa returned to its normal position. Each side of the nasal cavities was tightly packed with a gauze strips which had been soaked with Better-iodine ointment. Operators Prof. 杜永光 Assistants R6 陳睿生 R3 游健生 Indication Of Emergent Operation 惲煒立 (M,1936/01/09,76y2m) 手術日期 2010/08/12 手術主治醫師 戴槐青 手術區域 東址 015房 03號 診斷 Benign prostatic hypertrophy ( BPH ) 器械術式 TUR-BT 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 靜脈麻醉 麻醉主治醫師 劉治民 ASA 3 紀錄醫師 蔡博超, 時間資訊 10:55 進入手術室 11:08 麻醉開始 11:10 誘導結束 11:10 抗生素給藥 11:15 手術開始 12:05 手術結束 12:05 麻醉結束 12:10 送出病患 12:10 進入恢復室 13:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 手術 碎石洗出術複雜性或大結石　結石＞１公分 1 1 記錄__ 手術科部: 泌尿部 套用罐頭: cystolithotripsy with EHL 開立醫師: 蔡博超 開立時間: 2010/08/12 12:20 Pre-operative Diagnosis Urechal cancer s/p partial cystectomy; Hematuria Post-operative Diagnosis bladder stones Operative Method cystolithotripsy and removal of bladder foreign body Specimen Count And Types nil Pathology nil Operative Findings 1.Three yellowish bladder stones about 3 cm, 2cm, 1 cm, respectively 2. Exposed GIA stitches removal Operative Procedures Under satisfactory anesthesia with the patient in the lithotomy position, skin preparation was performed. A 20Fr. cystoscope was inserted under adequate lubrication.Three yellowish bladder stones were noted on the previous operation site and coating on the GIA stitches. The stones was then crushed by EHL and removed by Ellik evacuator. The exposed stitches were removed by foreign body edhoscopic clump. Finally, a 16Fr. Foley catheter was placed. The patient tolerated the procedure very well and was sent to the recovery room. Operators 戴槐青, Assistants 蔡博超, 柯智群, 吳翠英 (F,1955/07/22,56y7m) 手術日期 2010/08/12 手術主治醫師 陳敞牧 手術區域 東址 003房 01號 診斷 Brain tumor 器械術式 brain tumor 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 胡朝凱, 時間資訊 00:00 臨時手術NPO 08:45 進入手術室 08:45 報到 08:50 麻醉開始 09:20 誘導結束 09:30 抗生素給藥 09:35 手術開始 12:27 抗生素給藥 14:05 麻醉結束 14:05 手術結束 14:12 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４小時以內 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Navigation assisted right forntal tumor excision 開立醫師: 胡朝凱 開立時間: 2010/08/12 14:28 Pre-operative Diagnosis Right frontal tumor Post-operative Diagnosis Right frontal gliotic reaction Operative Method Navigation assisted right forntal tumor excision Specimen Count And Types pieces of tumor Pathology Twice frozen showed gliosis Operative Findings 1.Yellowish and soft with some part of grayish lesion located at right frontal without clear margin was noted. 2.Peripheral soft gliotic tissue was also noted. 3.One small part of necrotic cavity was noted Operative Procedures 1.ETGA, supine 2.Navigation setting 3.Bicoronal skin incision 4.Right frontal craniotomy 5.dura tenting 6.Open dura as the base left on midline 7.Navigation assisted right frontal lesion excision 8.Hemostasis 9.Close dura 10.Fixed bone back with mininplate 11.Close wound in layers after one CWV drain insertion Operators 陳敞牧 Assistants 胡朝凱, Ri 陳張美珠 (F,1948/10/02,63y5m) 手術日期 2010/08/12 手術主治醫師 陳敞牧 手術區域 東址 005房 01號 診斷 Spinal stenosis, cervical 器械術式 T11,12,L2 TPS 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:04 進入手術室 08:10 麻醉開始 08:55 誘導結束 09:00 抗生素給藥 09:44 手術開始 11:17 開始輸血 12:00 抗生素給藥 13:35 麻醉結束 13:53 手術結束 13:55 送出病患 13:58 進入恢復室 16:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 椎弓切除術（特壓）－二節以內 1 2 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 手術 石膏副木固定－長臂 1 0 記錄__ 手術科部: 外科部 套用罐頭: 1. Decompressive laminectomy, L1. 開立醫師: 鍾文桂 開立時間: 2010/08/12 14:12 Pre-operative Diagnosis L1 compression fracture. Post-operative Diagnosis L1 compression fracture. Operative Method 1. Decompressive laminectomy, L1. 2. Internal fixation with transpedical screws at T11,R12,L2,L3 levels. 2. Internal fixation with transpedical screws at T11,T12,L2,L3 levels. 3. Posterolateral fusion with autologous bone at T12,L1,L2 levels. Specimen Count And Types nil Pathology Nil. Operative Findings 1.Compressed thecal sac by the posteriorly bulged compression fraction of L1. 2.8 transpedical screws with two rods and one interlink. Screws: 65x45 T11,12; 60x40 L1,2. Two rods: 150 mm. One interlink. 3. Blood loss: 1400cc. Operative Procedures 1. Anesthesia: endotracheal, general; position: prone. 2. Intraoperative fluoroscopy for localization of T11-L3. 3. Preparation: disinfection, draping. 4. Incision: midline incision and paraspinal dissection. 5. Implantation of transpedical screws and ensureance of their locations by fluoroscope. 6. L1 laminectomy by Rongeurs and Kerrison punch. 7. Completion of internal fixation by rods and interlink; widening of T12-L2 interspace for further thecal sac decompression. 8. Placement of one 1/8 hemovac at epidural space. 9. Wound closure in layers. 10.Sent the patient to POR smoothly. Operators V.S. 陳敞牧 Assistants R5鍾文桂 R1劉昌杰 相關圖片 洪萬程 (M,1975/12/12,36y3m) 手術日期 2010/08/13 手術主治醫師 王國川 手術區域 東址 003房 03號 診斷 重大創傷且及嚴重程度到達創傷嚴重程度分數16分以上 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 蕭柏妮 ASA 4E 紀錄醫師 黃俊傑, 時間資訊 22:47 通知急診手術 23:54 進入手術室 23:54 報到 00:00 麻醉開始 00:20 抗生素給藥 00:20 誘導結束 00:45 手術開始 01:08 開始輸血 03:20 麻醉結束 03:20 手術結束 03:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 急性硬腦膜下血腫清除術 1 1 R 手術 顱內壓監視置入 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: 1. Evacuation of acute subdural hemorrhage. 開立醫師: 鍾文桂 開立時間: 2010/08/13 03:49 Pre-operative Diagnosis Head injury with brain swelling,linear skull bone fracture, and frontal acute subdural hemorrhage. Post-operative Diagnosis Head injury with brain swelling,linear skull bone fracture, and frontal acute subdural hemorrhage. Operative Method 1. Evacuation of acute subdural hemorrhage. 2. Decompressive craniectomy, right frontal-parietal-temporal. 3. ICP monitor implantation with Codman ICP monitor. Specimen Count And Types nil Pathology Nil. Operative Findings 1. Intraparenchymal ICP monitor implantation, intraoperative ICP: 26 mmHg. 2. Severe brain swelling, poor brain pulsation. 3. Intraoperative ultrasonography: some right frontal ICH, no further hemorrhage comparing to pre-op CT. 4. Dilated right pupil: 5mm preoperatively, it became 2mm postoperatively; dilated left pupil:6mm postoperatively. 5. We informed the patients brother about poor prognosis during the operation. 6. A 10cm long linear skull bone fracture at frontal area. 7. Contusion and swelling of right frontal-parietal-temporal scalp and temporalis muscle. Operative Procedures 1. Anesthesia: ETGA, position: supine, head turned to left. 2. Preparation: shaving, disinfection, and draping. 3. Incision: large trauma flap scalp incision. 4. Subgaleal dissection, resection of temporalis muscle. 5. Craniectomy, right frontal-temporal-parietal. 6. Durotomy and dural augmentation with temporalis fascia. 7. Implantation of ICP monitor. 8. Placement of one CWV drain. 9. Wound closure in layers. Operators V.S.王國川 Assistants R5 鍾文桂 R3 游健生 Indication Of Emergent Operation 陳俐伶 (F,1984/09/10,27y6m) 手術日期 2010/08/12 手術主治醫師 蔡翊新 手術區域 東址 001房 03號 診斷 Subarachnoid hemorrhage 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 蕭柏妮 ASA 3E 紀錄醫師 全賀顯, 時間資訊 12:00 臨時手術NPO 12:00 開始NPO 16:20 報到 16:23 進入手術室 16:25 麻醉開始 16:45 誘導結束 17:00 抗生素給藥 17:38 手術開始 20:30 抗生素給藥 21:31 開始輸血 00:00 麻醉結束 00:00 手術結束 00:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 7 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 開顱術摘除血管病變－腦血管瘤－有徵的 1 1 L 手術 顱內壓監視置入 1 2 L 摘要__ 手術科部: 外科部 套用罐頭: Aneurysm-frontotemporal approach 開立醫師: 蔡翊新 開立時間: 2010/08/12 23:35 Pre-operative Diagnosis A-comA aneurysm rupture with SAH. Post-operative Diagnosis A-comA aneurysm rupture with SAH. Operative Method Left pterional craniotomy for aneurysm clipping and wrapping. Left Kocher EVD for ICP monitoring. Specimen Count And Types 3 tubes OF CSF, sent for routine, BCS and culture. Pathology Nil. Operative Findings CSF was sanguinous and initial pressure was more than 15 cmH2O. Diffuse SAH and fibrin adhesions around left Sylvian fissure and prechiasmatic cistern were noted. ICH at right rectal gyrus came out by itself during dissection of the prechiasmatic cistern and was removed by suction. A saccular aneurysm, 1.7 mm in neck width and 5.1 mm in dome height, arising from the A-com artery, pointed anterioinferiorly and adhered to the right rectal gyrus. Premature rupture occurred during dissection of the aneurysm neck before identification of the left A1 artery. The aneurysm was clipped by two straight Sugita clip, 12 and 18 mm in length. It was reinforced by wrapping with a piece of fascia. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with right back elevated and head rotated to right for 30 degrees and slightly extended then fixed by Mayfield skull clamp. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: left frontotemporal, curvilinear. The skin edge was clipped by Raney clips for temporary hemostasis. After scalp had been lifted, the temporalis muscle was incised and detached from temporal squama and reflected to lower temporal side. 5. A burr hole was made at left Kocher point and an EVD catheter was inserted to left frontal horn of lateral ventricle for CSF release and ICP monitor. 6. Craniotomy window: 8 x 6 cm, left frontotemporal, created by making 3 burr holes then cut by power saw. The lower temporal bone and pterionic ridge (esp. the inner table) were cut by rongeur as low as possible for easy approach to the anterior clinoid. 7. Dural tention: by 2/0 silk, 2 cm in interval, distributed along the edge of skull window. 8. Dural incision: curvilinear, over-ridding Sylvian fissure and reflected to frontotemporal base. 9. Under operating microscope, the suprasellar cistern was opened. The left optic nerve and ICA came into view. The arachnoid trabeculi and the fibrin were cleaned out to expose the neck of the aneurysm. However, premature rupture with massive bleeding from the neck of the aneurysm was encountered. Several attempts of clipping failed to stop the bleeding. Temporary clipping of the left ICA was performed, lasting for 6 minutes. The bleeding was finally stopped by clipping with 2 straight Sugita clips near the neck of the aneurysm. The clipping was reinforced by wrapping with a piece of fascia. 10.The brain retractors were removed. The dura was closed water-tight by running suture with 4/0 Prolene. 11.Closure of skull window: the skull plate was placed back to craniotomy window and fixed by miniplates and screws. The dura was tented to the center of the skull plate by a 2/0 stitch. The covering muscle was closed by interrupted stitches with 1/ 0 silk. 12.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Dexon and skin by continuous suture with 3/0 nylon. 13.Drain: one, epidural, CWV. 14.Blood transfusion: PRBC 6U. Blood loss: 1800 ml. 15.Course of the surgery: transient hypotension with BP down to 60~100 mmHg occurred for about 10 minutes during the premature rupture of the aneurysm. Operators VS蔡翊新 Assistants R6胡朝凱R5陳德福R4李振豪R1全賀顯 Indication Of Emergent Operation 陸光亞 (M,1931/06/12,80y9m) 手術日期 2010/08/13 手術主治醫師 杜永光 手術區域 東址 005房 03號 診斷 Hydrocephalus 器械術式 VP shunt, right side 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 14:15 報到 14:50 進入手術室 15:00 麻醉開始 15:05 誘導結束 15:35 抗生素給藥 16:15 手術開始 17:45 手術結束 17:45 麻醉結束 17:55 送出病患 17:55 進入恢復室 19:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 腦室腹腔分流手術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt via right Kocher point 開立醫師: 游健生 開立時間: 2010/08/13 18:14 Pre-operative Diagnosis Normal pressure hydrocephalus Post-operative Diagnosis Normal pressure hydrocephalus Operative Method Ventriculoperitoneal shunt via right Kocher point Specimen Count And Types 1 piece About size:12cc Source:CSF Pathology Nil Operative Findings The opening pressure was abour 5cmH2O. The CSF was clear and 12cc was sent for study. The ventricular catheter was 6.5cm. The Codman nonn-programmable valve pressure was 10cmH2O. Operative Procedures Under ETGA, patient was put into supine position with right should elevated and head tilted up. After shaving, we disinfected and draped the operation field as usual. A transverse scalp incision was made over right Kocher point. After exposure of cranium, a burrhole was made followed by dura tenting. A cruciate durotomy was done followed by electrocautery the edges. After ventriculostomy, a ventricular catheter was inserted. A transverse abdomen incision was made over RUQ. After dissection the abdominal muscle, the peritoneum was exposed and opened. A peritoneal catheter was inserted into peritoneum after passing upward to connect Codman non-programmable valve and reservoir through a subcutaneous tunnel. After complete assembling the system, wounds were closed in layers. Operators Prof. 杜永光 Assistants R6 陳睿生 R3 游健生 林芳如 (F,1943/09/21,68y5m) 手術日期 2010/08/13 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Meningioma 器械術式 right frontal meningioma 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 07:38 報到 08:00 進入手術室 08:05 麻醉開始 08:15 誘導結束 09:00 抗生素給藥 09:01 手術開始 12:00 抗生素給藥 14:35 麻醉結束 14:35 手術結束 14:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４～８小時 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Right frontal craniotomy for Simpson grade II... 開立醫師: 游健生 開立時間: 2010/08/13 14:51 Pre-operative Diagnosis Right frontal convexity meningioma Post-operative Diagnosis Right frontal convexity meningioma Operative Method Right frontal craniotomy for Simpson grade II excision Specimen Count And Types 1 piece About size: 3 x 4 x 2.5 cm Source: tumor Pathology Pending Operative Findings A dura-based tumor was noted at the right frontal lobe region. It was about 3 x 4 x 2.5 cm in size. It was soft, whitish-greyish, hypervascularized, and lobulated with a clear plane separating from brain parenchyma. There was arteriovenous shunting from feeder to cortical vein. The main feeding artery was frontal branch of right middle meiningeal artery. Operative Procedures Under ETGA, patient was put into supine position with neck extended and head fixed with Mayfield headholder. After shaving, we disinfected and draped the operation field as usual. A bi-coronal scalp incision was made. Skin flap was reflected anteriorly until we reached the superior orbital rim. A 5x5 craniotomy window was created 1cm lateral to superior sagittal sinus and 1 cm above the rim. We removed the mucosa inside the opened frontal sinus and packed it with beta-iodine soaked gelfoam. A U-shape durotomy with frontal base as base was done following dura tenting. As we reflected the dura flap anteriorly, we dissected the tumor from it easily. The tumor was dissected between the arachnoid membrane and tumor capsule away from frontal lobe and removed en-bloc with the dura flap. The dura tail was left in situ and electrocauteried by bipolar. Hemostasis was achieved with bipolar electrocautery and Surgicel packing at tumor bed. Some gelfoam was put in the subdural space at the durotomy boreder. We harvested a fascia graft from temporalis muscle. Dura closure and dural plasty with the fascia graft was done with 4-0 prolene continuous suture. Bone flap was fixed back with miniplates and a subgaleal CWV was set. We closed the wound in layers. Operators Prof. 杜永光 Assistants R6 陳睿生 R3 游健生 呂宗榮 (M,1989/10/06,22y5m) 手術日期 2010/08/13 手術主治醫師 王國川 手術區域 東址 005房 02號 診斷 Spinal neuroma 器械術式 wound debridement 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 2 紀錄醫師 古恬音, 時間資訊 00:00 臨時手術NPO 11:35 報到 12:00 進入手術室 12:08 麻醉開始 12:15 誘導結束 12:30 手術開始 12:30 抗生素給藥 14:30 手術結束 14:30 麻醉結束 14:40 送出病患 14:40 進入恢復室 15:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術（特壓）－超過二節 1 2 手術 深部複雜創傷處理－傷口長１０公分以上者 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 記錄__ 手術科部: 外科部 套用罐頭: Debridement and laminectomy 開立醫師: 胡朝凱 開立時間: 2010/08/13 14:25 Pre-operative Diagnosis wOUND INFECTION AND ePIDURAL ABSCESS Post-operative Diagnosis wOUND INFECTION AND ePIDURAL ABSCESS Operative Method Debridement and laminectomy Specimen Count And Types culture tubes x 3 Pathology pending Operative Findings 1.Frank pus gushed out after wound opening 2.Necrotic tissue was also noted 3.The previous bone became whitish and necrotic Operative Procedures 1.ETGA, prone 2.previous wound incision 3.Open layer by layer 4.Debridement with currete 5.Laminectomy by removal of miniplate 6.Water irrigation 7.Set one hemovac 8.Close wound in two layers Operators 王國川 Assistants 胡朝凱, 古恬音 陳莉珊 (F,1960/09/12,51y6m) 手術日期 2010/08/13 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Spinal tumor, malignant 器械術式 Spinal fusion posterior 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3E 紀錄醫師 鍾文桂, 時間資訊 07:40 臨時手術NPO 07:40 開始NPO 14:41 通知急診手術 15:15 報到 15:35 進入手術室 15:40 麻醉開始 15:55 誘導結束 16:05 抗生素給藥 16:32 手術開始 16:45 開始輸血 19:50 抗生素給藥 20:25 手術結束 20:25 麻醉結束 20:35 送出病患 20:40 進入恢復室 21:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 惡性病髓腫瘤切除術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 2 記錄__ 手術科部: 外科部 套用罐頭: 1. Tumor excision for cord decompression, L1-2. 開立醫師: 鍾文桂 開立時間: 2010/08/13 20:58 Pre-operative Diagnosis Metastatic spinal tumor over L1-2 with L1 compression fracture, cord compression, and paraspinal involvement, suspect lung origin. Post-operative Diagnosis Metastatic spinal tumor over L1-2 with L1 compression fracture, cord compression, and paraspinal muscle involvement, suspect lung origin. Operative Method 1. Tumor excision for cord decompression, L1-2. 2. Internal fixation via transpedicle screws implantation, T11,T12, L3, bilateral. 3. Decompressive laminectomy, L1,2. Specimen Count And Types 2 pieces About size:4 cm in diameter. Source:Metastaic tumor. About size:6 cc Source:Metastatic tumor, cystic content, sent for cytology and bacterial culture. Pathology Pending. Operative Findings 1. A cystic lesion at subcutaneous layer at the level of L1, the content was collected for culture and cytology. 2. Moderate oozing tumor, the tumor is brownish, hard, and elastic. 3. Tumor compressed the cord with invasion to laminae, pedicle, spinous process with extradural compression to the L1,L2 roots. The roots and cord were intact and slack after decompression. 4. Internal fixation: screws: L3: 6.2x45, T12:6.2x40,T11: 5.5x40; with two 17cm rods and one crosslink. 5. Operative Procedures Under ETGA, the patient was place in prone position. The T11,T12,L1,L2,L3 levels were located by intraoperative fluoroscope. After disinfection and draping, minline incision and paraspinal dissection were done to expose T11-T3 levels. The transpedical screws were implanted first. Then, excision of the tumor at L1/2 and L1-2 laminectomy were done for cord decompression. After decompression, the whole internal fixation apparatus was completed with rods and crosslink. Two 1/8 hemovac drains were placed at epidural space. The wound was closed in layers. Operators V.S. 賴達明 Assistants R5鍾文桂 R4 曾峰毅 Ri Indication Of Emergent Operation 相關圖片 徐永林 (M,1963/02/10,49y1m) 手術日期 2010/08/13 手術主治醫師 賴達明 手術區域 東址 005房 號 診斷 HIVD 器械術式 C4/5 HIVD 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 2 紀錄醫師 古恬音, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:05 進入手術室 08:10 麻醉開始 08:15 誘導結束 09:05 抗生素給藥 09:11 手術開始 11:40 手術結束 11:40 麻醉結束 11:45 送出病患 11:50 進入恢復室 12:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術－頸椎 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 記錄__ 手術科部: 外科部 套用罐頭: Anterior approach for discectomy and cage ins... 開立醫師: 胡朝凱 開立時間: 2010/08/13 11:49 Pre-operative Diagnosis c4~5 HIVD Post-operative Diagnosis c4~5 HIVD Operative Method Anterior approach for discectomy and cage insertion Specimen Count And Types nil Pathology pending Operative Findings 1.One protruding disc at C4~5 level that compressed the spinal cord tightly. 2.The disc became dehydrated 3.After decompression, the cord expanded well Operative Procedures 1.ETGA, supine 2.Right neck transverse skin incison 3.Dissect along the anterior border of the SCM muscle 4.Expose pre-vertebral space 5.Localization with C-arm 6.Discectomy with currete and kerrison 7.6# CAGE insertion 8.Set one minihemovac drain then clsoe wound in layers Operators 賴達明 Assistants 胡朝凱, 古恬音 林劉美玉 (F,1946/12/15,65y2m) 手術日期 2010/08/13 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Spondylolisthesis 器械術式 L2-5 TPS 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:05 進入手術室 08:15 麻醉開始 08:45 誘導結束 09:15 抗生素給藥 09:31 手術開始 12:20 抗生素給藥 13:07 開始輸血 14:30 麻醉結束 14:30 手術結束 14:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 手術 椎弓切除術（特壓）－超過二節 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: 1.L2-5 TPS and laminectomy 開立醫師: 陳德福 開立時間: 2010/08/13 14:40 Pre-operative Diagnosis L2-5 spondylolisthesis with stenosis Post-operative Diagnosis L2-5 spondylolisthesis with stenosis Operative Method 1.L2-5 TPS and laminectomy Specimen Count And Types nil Pathology nil Operative Findings 1.There are grade I spondylolisthesis over the L2-3 and hypertrophic ligamentum flavum over L2-5 with spinal stenosis. The thecal sac was compressed tightly by the osteophytes and ligamentum flavum. The theca sac was decompressed after the L3-5 laminiectomy. There is a hypertrophic ligamentum flavum which compress the left L3 root. 2.6 TPS and 2 rods with 1 cross-link were implantated at L2,3,5 for posterior fusion. The L2-5 posterior lateral fusion with autologous bone was done. Operative Procedures Under ETGA and prone position, the skin was disinfected and draped as usual. One linear incision at midline was done and the paraspinous msucle was displaced laterally. The L3-5 lamina was exposed and L4-5 TPS was inserted under C-arm flouroscope guided. The L5 laminecotmy and L4-5 diskectomy were performed with Kerrison, Alligator, Disc clamp and currettage assisted. The right L4 hemilaminotomy and sublaminal decompression were done smoothly. The rods was implantated followed by performing L3-4 posterior lateral autologous fusion. Hemostasis and left one hemovac in the epidural space. The wound was then closed in layers. Under ETGA and prone position, the skin was disinfected and draped as usual. One linear incision at midline was done and the paraspinous msucle was displaced laterally. The L2-5 lamina was exposed and L2-3-5 TPS was inserted under C-arm flouroscope guided. The L3-5 laminecotmy was performed with Kerrison, Alligator, Disc clamp and currettage assisted. The rods was implantated followed by performing L2-5 posterior lateral autologous fusion. Hemostasis and left one hemovac in the epidural space. The wound was then closed in layers. Operators VS 賴達明 Assistants R5陳德福 R2陳國瑋 相關圖片 姚細姬 (F,1950/11/12,61y4m) 手術日期 2010/08/13 手術主治醫師 王國川 手術區域 東址 005房 04號 診斷 Subarachnoid hemorrhage 器械術式 V-P shunt 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3E 紀錄醫師 李振豪, 時間資訊 11:00 開始NPO 11:00 臨時手術NPO 16:38 通知急診手術 18:00 報到 18:12 進入手術室 18:20 麻醉開始 18:25 誘導結束 18:41 抗生素給藥 18:53 手術開始 19:30 手術結束 19:30 麻醉結束 19:40 送出病患 19:40 進入恢復室 20:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室腹腔分流手術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Right Kocher"s ventriculoperitoneal shunt imp... 開立醫師: 李振豪 開立時間: 2010/08/13 19:52 Pre-operative Diagnosis 1. Hydrocephalus, 2. A-com aneurysm rupture with diffuse subarachnoid hemorrhage Post-operative Diagnosis 1. Hydrocephalus, 2. A-com aneurysm rupture with diffuse subarachnoid hemorrhage Operative Method Right Kocher"s ventriculoperitoneal shunt implantation Specimen Count And Types 1 piece About size:3ml Source:CSF Pathology Nil Operative Findings The Opening pressure is more than 20cmH2O after ventricular puncture. The CSF is xanthochronic in appearance. One 10cmH2O Codman reservoir is used. The ventricular catheter is 7cm in length and the peritoneal catheter is 30cm in length. Operative Procedures Under endotracheal tube general anesthesia, the patient is put in supine position with head rotated to left. The scalp was shaved, scrubbed, and disinfected as usual. One linear scalp wound was made at right Kocher"s point followed by one burr hole creation. Two dural tenting was done and the cruciform dura incision was made. One transverse linear skin incision was made at right upper abdomen and the subcutaneous soft tissue was dissected. Minilaparotomy was performed and the peritoneal cavity was opened under direct vision. The subcutaneous tunnel was created from right upper abdomen, mid forechest, right neck, and right retroauricular area. A 1cm scalp incision was made at right retroauricular area. The peritoneal catheter was passed. The ventricular catheter was passed from Kocher"s point wound to right retroauricular wound. The V-P shunt is set up and the function was checked. Ventricular puncture was performed and the ventricular catheter was placed into right lateral ventricle. The function of the shunt was checked again and the peritoneal catheter was placed into peritoneal cavity. Hemostasis was achieved and the wound was closed in layers. Operators VS王國川 Assistants R6胡朝凱, R4李振豪 Indication Of Emergent Operation 相關圖片 饒文忠 (M,1967/08/20,44y6m) 手術日期 2010/08/13 手術主治醫師 蔡翊新 手術區域 東址 001房 05號 診斷 Acute respiratory distress syndrome following trauma, surgery, shock 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 4E 紀錄醫師 吳俊毅, 時間資訊 20:38 通知急診手術 21:50 進入手術室 21:54 麻醉開始 22:05 誘導結束 22:15 手術開始 22:20 開始輸血 23:50 手術結束 23:50 麻醉結束 00:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 急性硬腦膜下血腫清除術 1 1 R 手術 顱內壓監視置入 1 2 R 摘要__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 蔡翊新 開立時間: 2010/08/13 23:17 Pre-operative Diagnosis Right frontotemporoparietal acute EDH. Post-operative Diagnosis Right frontotemporoparietal acute EDH and SDH. Operative Method Right frontotemporoparietal craniectomy for evacuation of EDH and SDH, subdural ICP monitoring. Specimen Count And Types nil Pathology Nil. Operative Findings Skull defect about 12 x 12 cm at right frontotemporoparietal area due to previous craniectomy. Epidural blood clots was noted upon lifting the scalp flap, 2.5 cm in thickness. Dural defect due to previous dural incision, cruciate in fashion, with subdural blood clots, 2.5 cm in thickness, extended toward frontal area. The brain was slack after evacuation of the blood clots. The brain surface was pale and the pulsation was weak. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: along previous wound at right frontotemporoparietal area, the skin edge was clipped by Raney clips for temporary hemostasis. 5. The epidural and subdural clots were removed by sucker and those located beyond the cranial window was washed out by saline irrigation. 6. Hemosatasis: the bleeders was stopped by Bovie and oozing surface was covered with Gelfoam. 7. A Codman ICP monitor was inserted to the subdural space. 8. Dural closure: a 12 x 10 cm patch of DuraForm was used for duroplasty. 9. Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 1/0 Vicryl and skin by interrupted mattressed suture with 3/0 nylon. 10.Drain: two, epidural, CWV. 11.Blood transfusion: PRBC 2U, Platelet 24U. 12.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R6胡朝凱R1吳俊毅 Indication Of Emergent Operation 林阿菊 (F,1951/04/23,60y10m) 手術日期 2010/08/14 手術主治醫師 吳耀銘 手術區域 東址 007房 02號 診斷 Biliary tract cancer 器械術式 L.C.(cholecystectomy) 手術類別 預定手術 手術部位 腹 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 2 紀錄醫師 郭庭均, 時間資訊 09:55 進入手術室 10:00 麻醉開始 10:05 誘導結束 10:32 手術開始 11:50 手術結束 11:50 麻醉結束 12:00 送出病患 12:08 進入恢復室 13:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腹腔鏡膽囊切除術 1 1 手術 淋巴腺活體切片 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 內科部 套用罐頭: Laparoscopic Cholecystectomy & lymphnode biopsy 開立醫師: 郭庭均 開立時間: 2010/08/14 12:07 Pre-operative Diagnosis Gallbladder cancer with Winslow foramen lobulated tumor and peritoneal lymphnode Post-operative Diagnosis Gallbladder cancer with Winslow foramen lobulated tumor and peritoneal lymphnode Operative Method Laparoscopic Cholecystectomy & lymphnode biopsy Specimen Count And Types 1 piece About size:10cm Source:GB Pathology Pending Operative Findings 1.Ulcerrative-thickening of the gallbladder fundus wall, peritoneal side, with tiny polys. 2.Multiple large confluent LAPs at bilateral paraaortic region, s/p biopsy of the LAPs nearby the gallbladder. Operative Procedures General anesthesia with endotracheal intubation , supine position. Make an umbilical incision and place a 10-mm trocar through the umbilicus then insufflate CO2 via trocar. Insert the 10-mm laparoscope. Perform laparoscopic inspection and begin exploration for any gross pathology. Under direct vision, insert one 10-mm port at the upper midline, one 5-mm port at the right anterior axillary line, and one 5-mm port at right midclavicular line. Set the table inreverse Trendelenburg with rolling to the left. Retract the dome of the gallbladder anterior and upward by grasping the fundus. Grasp Hartmanns pouch and retract laterally. Dissect and visualize the cystic duct and common bile duct. Carefully ligate the cystic arteries and cystic duct by proximal and distal clipping using EndoClips and Hemolocks. Divide both entities. Dissect the gallbladder from the liver using the "hook" electrocautery. Separate the gallbladder from its bed and obtain hemostasis.Perform repeated irrigations. Place the gallbladder into endoscopic pouch and remove it through the umbilical port. After ascertaining there is no bleeding, remove all tocars under direct vision. Close the umbilical incision by suturing the fascia using 1-0 Vicryl suture and the skin using using 3-0 Nylon sutures interrupedly. Close the skin of the other ports using using 3-0 Nylon sutures interrupedly. Operators VS吳耀銘 Assistants R3郭庭均 相關圖片 王顯之 (M,1973/10/02,38y5m) 手術日期 2010/08/16 手術主治醫師 王國川 手術區域 東址 000房 號 診斷 Brain Tumor 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 2E 紀錄醫師 陳德福, 時間資訊 15:00 臨時手術NPO 15:00 開始NPO 19:09 通知急診手術 23:35 進入手術室 23:40 麻醉開始 23:50 誘導結束 00:30 手術開始 01:00 手術結束 01:00 麻醉結束 01:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 顱內壓監視置入 1 2 L 摘要__ 手術科部: 外科部 套用罐頭: left frontal EVD insertion 開立醫師: 陳德福 開立時間: 2010/08/15 23:51 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method left frontal EVD insertion left frontal EVD insertion with ICP monitoring Specimen Count And Types 1 piece About size:3ML Source:CSF Pathology nil Operative Findings 1.The CSF appearance: clear and mild xanthochromatous change; ventricular opening pressure:18cmH2O 2.One Metronic EVD was inserted at the left Kocher point Operative Procedures 1.ETGA and supine position 2.sklin disinfection and draping 3.curvilinear incision 4.burr hole creation 5.dura opening and insert the ventricular tapping needle 6.insert EVD 7.close the wound in layers Operators VS 王國川 Assistants R5 陳德福 Indication Of Emergent Operation 陳俐伶 (F,1984/09/10,27y6m) 手術日期 2010/08/15 手術主治醫師 王國川 手術區域 東址 001房 03號 診斷 Subarachnoid hemorrhage 器械術式 Craniectomy 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 4E 紀錄醫師 陳德福, 時間資訊 07:00 開始NPO 07:00 臨時手術NPO 12:05 通知急診手術 14:50 進入手術室 14:50 報到 15:00 麻醉開始 15:05 誘導結束 15:53 手術開始 17:00 抗生素給藥 17:52 開始輸血 18:40 麻醉結束 18:40 手術結束 18:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱骨切除術，包括異物移除或減壓或神經切斷 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: 1.left hemicraniectomy 2.ICP monitor insertion 開立醫師: 陳德福 開立時間: 2010/08/15 18:54 Pre-operative Diagnosis aSAH s/p aneurysm clipping, IICP Post-operative Diagnosis aSAH s/p aneurysm clipping, IICP Operative Method 1.left hemicraniectomy 2.ICP monitor insertion Specimen Count And Types nil Pathology nil Operative Findings 1.The brain is swelling and non pulsating after left craniectomy. The ICP after duroplasty is 4mmHg and the EVD is left in situ. Operative Procedures 1.Under ETGA and supine position, draping as usual 2.T shape incison over left scalp 3.left hemicraniectomy 4.dura tenting and dura opening 5.duroplasty 6.insert ICP monitor, subdural 7.hemostasis 8.close the wound in layers Operators VS 王國川 Assistants R5 陳德福 Indication Of Emergent Operation 唐美蓉 (F,1951/01/01,61y2m) 手術日期 2010/08/16 手術主治醫師 簡雄飛 手術區域 東址 009房 03號 診斷 Infection and inflammatory reaction due to nervous system device, implant, and graft 器械術式 Pedicle Flap 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 3 紀錄醫師 黃柏誠, 時間資訊 11:30 報到 11:50 進入手術室 12:00 麻醉開始 12:05 誘導結束 12:40 手術開始 15:05 手術結束 15:05 麻醉結束 15:15 進入恢復室 15:15 送出病患 16:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 肌肉瓣或肌皮瓣 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 記錄__ 手術科部: 外科部 套用罐頭: debridement and SCM muscle flap 開立醫師: 黃柏誠 開立時間: 2010/08/16 15:07 Pre-operative Diagnosis left posterior auricular region DBS device exposure Post-operative Diagnosis left posterior auricular region DBS device exposure Operative Method debridement and SCM muscle flap Specimen Count And Types 1 piece About size:無法計算 Source:DBS tract capsule tissue Pathology pending Operative Findings 1.DBS was exposure 2.5 cm length at left posterior auricular region and device was at subcutaneous layer 2.no pus formation Operative Procedures 1.ETGA prone position 2.disinfection and drape 3.create a linear incision extend from DBS device 4.dissect subcutaneous layers and capusle debridement 5.dissect SCM fascial layer 6.BI solution irrigation and rewire previous contamination line on the device 7.hemostasis 8.close wound in layers Operators VS簡雄飛 Assistants R5官振翔 R3黃柏誠 RI黃幼鳴 吳瑋萍 (F,1979/11/08,32y4m) 手術日期 2010/08/16 手術主治醫師 林至芃 手術區域 西址 037房 03號 診斷 Acute lymphoid leukemia 器械術式 Insertion of hichman or port a 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 黃信豪 ASA 2 紀錄醫師 林彥君, 時間資訊 11:35 報到 11:48 進入手術室 11:50 麻醉開始 11:55 誘導結束 12:00 抗生素給藥 12:18 手術開始 13:20 手術結束 13:20 麻醉結束 13:25 送出病患 13:30 進入恢復室 14:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 ｐｏｒｔ–Ａ導管植入術–治療性導管植入術 1 0 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 記錄__ 手術科部: 麻醉部 套用罐頭: Port-A implantation, subclavian 開立醫師: 吳峻宇 開立時間: 2010/08/16 12:52 Pre-operative Diagnosis ALL Post-operative Diagnosis Ditto Operative Method Port-A implantation, echo-guided Specimen Count And Types Pathology Nil Operative Findings 1.Site: left subclavian vein, with echo-guided procedure 2.Patent flow after implantation 3.Others: nil Operative Procedures 1.The patient was set on supine position and bilateral subclavian veins were checked by echo. 2.After IVGA and local anesthesia applied, transverse skin incision for 3cm was made at pre-cordial area. 3.Undermine the skin at the layer between subcutaneous tissue and deep fascia in lateral direction. 4.An IV catheter was inserted via the subclavian incision and negatively aspirated until venous blood attainable. 5.J-wire was inserted smoothly in rostral direction. A subclavian catheter with dilator was inserted through the J-wire, and the dilator was then removed. 6.The catheter of Port-A was threaded into the subclavian vein until mark 25 cm. The catheter was adapted into the port and locked with restrictor.The Port was inserted into the pouch of pre-cordial incision. 7.Skin was closed layer by layer. Both catheter and port were perfused with heparin solution after implantation. Operators 黃信豪 Assistants 林彥君 楊惠民 (M,1953/04/20,58y10m) 手術日期 2010/08/16 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Brain Tumor 器械術式 left retrosigmoid 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 07:46 報到 08:07 進入手術室 08:15 麻醉開始 08:40 誘導結束 10:00 抗生素給藥 10:50 手術開始 13:00 抗生素給藥 16:00 抗生素給藥 17:20 麻醉結束 17:20 手術結束 17:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱骨切除術，包括異物移除或減壓或神經切斷 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 10 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 摘要__ 手術科部: 外科部 套用罐頭: Left presigmoid approach for tumor excision -... 開立醫師: 游健生 開立時間: 2010/08/16 17:57 Pre-operative Diagnosis Left petro-clival meningioma with supratentorial extension Post-operative Diagnosis Left petro-clival meningioma with supratentorial extension Operative Method Left presigmoid approach for tumor excision - Stage I (craniotomy) Specimen Count And Types Nil Pathology Nil Operative Findings The baseline bilateral BAEP showed poor wave form indicating bilateral hearing impairment. Minor transverse-sigmoid sinus tear was noted intra-op, and repaired with Prolene. The bone graft was divided into three portions and fixed back with miniplates. Operative Procedures Under ETGA, patient was put into supine position with left shoulder elevated. To ensure his left mastoid process at the highest point of operation field, his neck was extended and head turned to right fixed with Mayfield headholder. After shaving, we disinfected and draped the operation field as usual. A question-mark scalp incision was made 4cm posterior to left ear along hairline. The incision started from 3cm below mastoid process then curved to anterior border of auricle. The skin flap was reflected anteriorly till exposure of superior rim of external acoustic meatus. We detached the muscles over mastoid and suboccipital region inferiorly to expose mastoid process. Temporalis muscle was transected and relfected anteriorly to expose squamous portion of temporal bone. After identifying the asterion, a burr hole was made anterior and posterior to it respectively. The sigmoid-transverse sinus junction was exposed after connecting these 2 burr holes with high-speed air drill. Suboccipital craniotomy and mastoidectomy were done with high-speed air drill and osteotome. During the mastoidectomy, endolymphatic sac, Trautmann"s triangle, and superior petrosal sinus were exposed. Minor sigmoid sinus rupture was noted and packed with gelfoam to achieve hemostasis. Then, we extended the craniotomy to temporal bone. After dura tenting, bone flaps were fixed back with miniplates. The wound was closed in layers following placement of subgaleal CWV drain. After identifying the asterion, a burr hole was made anterior and posterior to it respectively. The sigmoid-transverse sinus junction was exposed after connecting these 2 burr holes with high-speed air drill. Suboccipital craniotomy and mastoidectomy were done with high-speed air drill and osteotome. During the mastoidectomy, endolymphatic sac, Trautmann"s triangle, and superior petrosal sinus were exposed. Minor transverse-sigmoid sinus rupture was noted and packed with gelfoam and sutured with prolene to achieve hemostasis. Then, we extended the craniotomy to temporal bone. After dura tenting, bone flaps were fixed back with miniplates. The wound was closed in layers following placement of subgaleal CWV drain. Operators Prof. 杜永光 Assistants R6 陳睿生 R3 游健生 王玟淇 (F,2005/11/25,6y3m) 手術日期 2010/08/16 手術主治醫師 簡穎秀 手術區域 兒醫 062房 07號 診斷 Aromatic L-amino acid decarboxylase deficiency 器械術式 Lumbar puncture 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 林子富 ASA 3 紀錄醫師 陳佩君, 時間資訊 12:00 報到 12:03 進入手術室 12:05 麻醉開始 12:10 誘導結束 12:13 手術開始 12:20 手術結束 12:20 麻醉結束 12:25 送出病患 12:30 進入恢復室 13:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎穿刺 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 記錄__ 手術科部: 套用罐頭: Lumbar 開立醫師: 陳佩君 開立時間: 2010/08/16 12:26 Pre-operative Diagnosis AADC deficiency Post-operative Diagnosis AADC deficiency Operative Method Lumbar puncture Specimen Count And Types 1 piece About size: Source:CSF Pathology CSF studies Operative Findings CSF appearance: Clear, slowly dripped. Operative Procedures After intravenous general anesthesia, the patient was placed in knee-chest decubitus position. The skin overlying the lumbar area was applied with aseptic procedures and draping. A 22-G needle was introduced into the L3-L4 intervertebral space and advanced slowly until the dura was penetrated. Total 3 mL of CSF was collected into 4 sterile test tubes and labeled. Then the needle was withdrawn completely, and the wound was covered with sterile dressing. Operators R1吳仲琳/R3陳佩君/VS簡穎秀 Assistants R3陳佩君 林劉美玉 (F,1946/12/15,65y2m) 手術日期 2010/08/16 手術主治醫師 黃書健 手術區域 東址 005房 04號 診斷 Spondylolisthesis 器械術式 Embolectomy, Thrombectomy 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 陳政維, 時間資訊 22:05 進入手術室 22:33 抗生素給藥 22:53 麻醉開始 22:54 麻醉結束 22:56 手術開始 23:43 手術結束 23:48 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 靜脈血栓切除術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Venous thrombectomy 開立醫師: 陳政維 開立時間: 2010/08/16 23:41 Pre-operative Diagnosis AV shunt dysfunction, with venous thrombosis Post-operative Diagnosis Ditto Operative Method Venous thrombectomy Specimen Count And Types 1 piece About size: Source:Cephalic vein thrombus Pathology Pending Operative Findings Much black thrombus occlusion over mid-forarm of cephalic vein to cephalic-clavical junction. After thrombectomy, the flow was patent. Operative Procedures 1.LA, supine with right arm abduction 2.Skin disinfection and well draped 3.Midforarm incision, identify cephalic vein and venotomy 4.Perform thrombectomy with insurement and Fogarty 5.Hemostasis and heparin iriigation 6.Close the wound in layers Operators VS黃書健 Assistants R4林哲安 R3陳政維 Indication Of Emergent Operation 許王美芳 (F,1958/06/09,53y9m) 手術日期 2010/08/16 手術主治醫師 蔡翊新 手術區域 東址 003房 02號 診斷 Subarachnoid hemorrhage 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 4E 紀錄醫師 劉昌杰, 時間資訊 17:00 臨時手術NPO 17:00 開始NPO 19:53 通知急診手術 20:40 報到 20:40 進入手術室 20:45 麻醉開始 21:00 誘導結束 21:03 抗生素給藥 21:10 手術開始 22:05 麻醉結束 22:05 手術結束 22:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱內壓監視置入 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 蔡翊新 開立時間: 2010/08/16 22:03 Pre-operative Diagnosis Right paraclinoid ICA aneurysm rupture with diffuse SAH, IVH and acute hydrocephalus. Post-operative Diagnosis Right paraclinoid ICA aneurysm rupture with diffuse SAH, IVH and acute hydrocephalus. Operative Method Left Kocher point EVD for ICP monitoring. Specimen Count And Types 2 tubes of CSF, sent for routine and BCS. Pathology Nil. Operative Findings Bloody CSF gushed out upon ventricular puncture, followed by sluggish thick blood. Initial pressure: 15 cmH2O. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 5 cm linear, left frontal, corresponded to the location of left frontal horn. Raney clips were applied to the scalp edge for temporary hemostasis. 5. After the scalp flap had been lifted and reflected anteriorly, a burr hole was made at left Kocher point and the dura was tented by 2 stitches. 6. The dura was opened by a nib incision. Left lateral ventricle was tapped by a ventricular needle, then a 6.5 cm segment of the EVD catheter was introduced into the ventricle. The outer end of the catheter was connected to a reservoir bag. 7. Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 8. Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5鍾文桂R1劉昌杰 Indication Of Emergent Operation 徐裴欣 (F,1980/08/15,31y6m) 手術日期 2010/08/17 手術主治醫師 主治醫師 手術區域 西址 035房 03號 診斷 Colon cancer of transverse colon 器械術式 Insertion of hichman or port a 手術類別 臨時手術 手術部位 胸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 劉治民 ASA 2 紀錄醫師 林彥君, 時間資訊 12:15 進入手術室 12:30 麻醉開始 12:35 誘導結束 12:40 抗生素給藥 12:50 手術開始 14:10 手術結束 14:10 麻醉結束 14:20 送出病患 14:30 進入恢復室 16:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 ｐｏｒｔ–Ａ導管植入術–治療性導管植入術 1 0 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 記錄__ 手術科部: 麻醉部 套用罐頭: Port-A implantation, subclavian 開立醫師: 林彥君 開立時間: 2010/08/17 14:18 Pre-operative Diagnosis Colon cancer Post-operative Diagnosis Ditto Operative Method Port-A implantation, echo-guided Specimen Count And Types nil Pathology Nil Operative Findings 1.Site: left subclavian vein, with echo-guided procedure 2.Patent flow after implantation 3.Others: nil Operative Procedures 1.The patient was set on supine position and bilateral subclavian veins were checked by echo. 2.After IVGA and local anesthesia applied, transverse skin incision for 3cm was made at pre-cordial area. 3.Undermine the skin at the layer between subcutaneous tissue and deep fascia in lateral direction. 4.An IV catheter was inserted via the subclavian incision and negatively aspirated until venous blood attainable. 5.J-wire was inserted smoothly in rostral direction. A subclavian catheter with dilator was inserted through the J-wire, and the dilator was then removed. 6.The catheter of Port-A was threaded into the subclavian vein until mark 26 cm. The catheter was adapted into the port and locked with restrictor.The Port was inserted into the pouch of pre-cordial incision. 7.Skin was closed layer by layer. Both catheter and port were perfused with heparin solution after implantation. Operators 劉治民 Assistants 林彥君, 張林月梅 (F,1930/11/21,81y3m) 手術日期 2010/08/17 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Lumbar Spondylosis 器械術式 TPS 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:05 進入手術室 08:10 麻醉開始 08:40 誘導結束 09:20 抗生素給藥 09:27 手術開始 12:00 開始輸血 12:10 手術結束 12:10 麻醉結束 12:20 送出病患 12:20 進入恢復室 13:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 手術 椎間盤切除術－腰椎 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: 1.L3-4 TPS 2.L3 laminectomy 3.L3-4 Diskectomy 開立醫師: 陳德福 開立時間: 2010/08/17 12:17 Pre-operative Diagnosis Lumbar spondylolisthesis with stenosis , L3-4 Post-operative Diagnosis Lumbar spondylolisthesis with stenosis , L3-4 Operative Method 1.L3-4 TPS 2.L3 laminectomy 3.L3-4 Diskectomy Specimen Count And Types nil Pathology NIL Operative Findings 1.There are osteosclerotic change and hypertrophic ligamentum flavum over the L3-4 with spinal stenosis. The thecal sac was compressed tightly by the osteophytes and ligamentum flavum. The theca sac was decompressed after the L3 laminiectomy. The L3-4 disc was removed. 2.4 TPS 45mm in sized with 2 rods are implatated over L3-4 smoothly. Operative Procedures Under ETGA and prone position, the skin was disinfected and draped as usual. One linear incision at midline was done and the paraspinous msucle was displaced laterally. The L3-4 lamina was exposed and L3-4 TPS was inserted under C-arm flouroscope guided. The L3 laminecotmy and L3-4 diskectomy were performed with Kerrison, Alligator, Disc clamp and currettage assisted. The rods was implantated followed by performing L3-4 posterior lateral autologous fusion. Hemostasis and left one hemovac in the epidural space. The wound was then closed in layers. Operators vs賴達明 Assistants R5陳德福 R2陳國瑋 相關圖片 許進中 (M,1944/09/03,67y6m) 手術日期 2010/08/17 手術主治醫師 蔡瑞章 手術區域 東址 005房 02號 診斷 Brain metastasis 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2E 紀錄醫師 陳睿生, 時間資訊 06:00 開始NPO 06:00 臨時手術NPO 13:55 報到 15:15 進入手術室 15:20 麻醉開始 15:40 抗生素給藥 15:40 誘導結束 16:17 手術開始 18:45 麻醉結束 18:45 手術結束 18:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４小時以內 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for total tumor remove 開立醫師: 陳睿生 開立時間: 2010/08/17 19:18 Pre-operative Diagnosis Right posterior frontal tumor, suspect metastasis Post-operative Diagnosis Right posterior frontal tumor, suspect metastasis Operative Method Craniotomy for total tumor remove Specimen Count And Types 1 piece About size:1x1.5x1.5cm Source:tumor Pathology Pending Operative Findings Some necrotic portion was noted inside the tumor and the color was yellowish-whitish. Two main solid portion was noted in the tumor bed. The larger one was about 1x1.5x1.5 cm at the posterior side of the tumor, and the other one was less then 0.5cm in diameter. The solid portion was whitish, fragile. Poor tumor margin was noted. Operative Procedures 1. ETGA, supine position and head left turn, fix with Mayfield clump 2. Inverse U scalp incision at right F-T region 3. Make four bur holes and an about 8x8 cm craniotomy window was created 4. Proper tenting, and the dura was opened toward the falx 5. Small corticotomy was made and the liquid portion of the tumor was sucked out 6. The corticotomy was extended and the solid portion of the tumor was removed 7. Hemostasis, the tumor site was covered with Surgicel 8. Tightly close the dura after deair 9. The skull graft was fixed back with 4 gages of wires after central tenting 10.Set a subgaleal CWV drain 11.Close the wound in layers Operators P 蔡瑞章 Assistants R6 陳睿生, Ri Indication Of Emergent Operation 陳明郎 (M,1960/05/01,51y10m) 手術日期 2010/08/17 手術主治醫師 蔡瑞章 手術區域 東址 005房 01號 診斷 Malignant neoplasm of cerebrum, except lobes and ventricles 器械術式 biopsy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 07:44 報到 08:05 進入手術室 08:15 麻醉開始 09:05 誘導結束 09:10 抗生素給藥 09:40 手術開始 12:10 抗生素給藥 14:45 麻醉結束 14:45 手術結束 14:55 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 手術 腦組織活體切片 1 1 L 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 記錄__ 手術科部: 外科部 套用罐頭: 1. Tumor biopsy via right frontal craniotomy. 開立醫師: 鍾文桂 開立時間: 2010/08/17 15:35 Pre-operative Diagnosis Grade II astrocytoma, right frontal, status post tumor excision, suspect tumor recurrence. Post-operative Diagnosis Grade II astrocytoma, right frontal, status post tumor excision, suspect tumor recurrence. Operative Method 1. Tumor biopsy via right frontal craniotomy. 2. Cranioplasty with bone cement. Specimen Count And Types 1 piece About size:Multiple Source:Right frontal tumor Pathology Frozen pathology: gliosis. Operative Findings Two cystic compartments with septations. A septae seperated the cysts and the frontal horn of right lateral ventricle. The septae were lysed. Some yellowish soft gliotic tissues were noted over the previous operative cavity. The suspected superficial tumor bed was localized by intraoperative ultrasonography. The suspected deep tumor bed which located in the medial side of frontal horn was excised after opening the frontal horn and noticing the foramen of Monro. Operative Procedures Under ETGA, the patient was placed in supine position and the head was fixed with Mayfield and slightly tilted to the left. After shaving, disinfection and draping, the previous operative wound was incised. The subgaleal plane was dissected. The previous craniotomy bone plate was outlined and removed. A curvilinear dural incision was made. Upon dural opening, the previous operative cavity was exposed. We used ultrasonography to assist tumor biopsy. The two cystic cavity was lysed. The suspected tumor site at the superior cyst was excised for further pathologic evaluation. After opening the septum bwtween the cyst and the lateral ventricle, we identified the foramen of Monro. The suspected tumor bed at the medial side of lateral ventricle was excised for further evaluation. Well hemostasis was achieved with Gelfoam and Surgicel. The dural plasty was done with 3-0 Prolene and fascia graft in water tight fashion. The bone plate was fixed with mini plates and screws. The defect was filled with bone cement. After placing one subgaleal CWV drian, the wound was closed in layers Operators V.S. 蔡瑞章 Assistants R5 鍾文桂. 陳穎蓁 (F,2007/08/09,4y7m) 手術日期 2010/08/17 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Brain cancer 器械術式 Crainotomy Brain Tumor(P-LIN) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:05 進入手術室 08:30 麻醉開始 09:00 誘導結束 09:30 抗生素給藥 09:48 手術開始 12:30 抗生素給藥 14:05 麻醉結束 14:05 手術結束 14:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４～８小時 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 記錄__ 手術科部: 外科部 套用罐頭: Intratentorial supracerebellar approach for t... 開立醫師: 李振豪 開立時間: 2010/08/17 15:12 Pre-operative Diagnosis Cerebellar vermis tumor, suspect glioma Post-operative Diagnosis Cerebellar vermis low grade astrocytoma Cerebellar vermis low grade astrocytoma Operative Method Intratentorial supracerebellar approach for tumor excision Suboccipital craniotomy intratentorial supracerebellar approach for tumor excision Specimen Count And Types 1 piece About size:1x1.6x2.4cm Source:Cerebellar vermis tumor Pathology Frozen section: low grade astrocytoma Operative Findings The tumor is gray-whitish, soft to elastic, hypovascularized, and ill-defined in character with 1x1.6x2.4cm in size which located over midline and left part of upper vermis of cerebellum. The arachnoid membrane was kept intact after tumor removal and the fourth ventricle is not entered. CSF was sampled from the foramen magnum for routine, BCS, culture, and cytology after dural opening. The frozen section showed low grade astrocytoma. The tumor is gray-whitish, soft to elastic, hypovascularized, and ill-defined in character with 1x1.6x2.4cm in size which located over midline and left part of upper vermis of cerebellum. The arachnoid membrane was kept intact after tumor removal and the fourth ventricle is not entered. CSF was sampled from the foramen magnum for routine, BCS, culture, and cytology after dural opening. The frozen section showed low grade astrocytoma. The tumor is gray-whitish, soft to elastic, hypovascularized, and ill-defined in character with 1x1.6x2.4cm in size which located over upper vermis of cerebellum. The arachnoid membrane was kept intact after tumor removal and the fourth ventricle is not entered. CSF is sampled for routine, BCS, culture, and cytology after dural opening. The frozen section showed low grade astrocytoma. Operative Procedures Under endotracheal tube general anesthesia, the patient is put in prone position with head fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. Midline skin incision was made fron inion to C2 level and the subcutaneous soft tissue and muscle groups are dissected along the ligmentum nuchae. The nuchal muscle group was detached to exposure the occipital bone and posterior ring of C1. 6 burr holes were created with high-speed air-drived drill. Karrison punch and air-drived drill were used for craniotomy and the foramen magnum was opened. The V-shaped dural opening was performed after two dural tenting above the transverse sinus. under microscopie view, infratentorial-supracerebellar approach was used for tumor excision. the left supracerebellar drainaing vein was coagulated and excised to facilitate tumor removeal. The other drainaing vein over the right cerebellum was preserved during the operation. We retracted down the left cerebellum and found the sulcus between the anterior and posterior lobes of cerebellum and the tumor was identified after corticotomy and excised with bipolar cautery, microdissector, tumor forceps and sucker. The tumor was removed piece by piece. The arachnoid membrane was kept intact during the operation and the fourth ventricle was not opened. Hemostasis was achieved with Surgicel lining and bipolar cautery. Dura was closed with 4-0 prolene and Tissucol Duo. The skull plate was fixed back with #26 wire x 5. One CWV drain was set up at the subperiosteal level and the wound was then closed in layers with 3-0 Vicryl and 4-0 Nylon. Under endotracheal tube general anesthesia, the patient is put in prone position with head fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. Midline skin incision was made fron inion to C2 level and the subcutaneous soft tissue and muscle groups are dissected along the ligmentum nuchae. The nuchal muscle group was detached to exposure the occipital bone and posterior ring of C1. 6 burr holes were created with high-speed air-drived drill. Karrison punch and air-drived drill were used for craniotomy and the foramen magnum was opened. The V-shaped dural opening was performed after two dural tenting above the transverse sinus. The infratentorial-supracerebellar approach was used for tumor excision. One engorged drainage vein was noted at right cerebellum and preserved during the operation. The tumor was identified after corticotomy and excised with bipolar cautery, microdissector, tumor forceps and sucker. The tumor was removed piece by piece. The arachnoid membrane was kept intact during the operation and the fourth ventricle was not opened. Hemostasis was achieved with Surgicel lining and bipolar cautery. Dura was closed with 4-0 prolene and Tissucol Duo. The skull plate was fixed back with #26 wire x 5. One CWV drain was set up and the wound was then closed in layers with 3-0 Vicryl and 4-0 Nylon. Operators AP 郭夢菲 Assistants R4李振豪 鄭百合 (F,1941/11/01,70y4m) 手術日期 2010/08/17 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Spinal stenosis, lumbar 器械術式 sublaminar decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 12:50 進入手術室 12:55 麻醉開始 13:05 誘導結束 13:10 抗生素給藥 13:35 手術開始 15:40 手術結束 15:40 麻醉結束 15:45 送出病患 15:53 進入恢復室 17:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術（特壓）－二節以內 1 1 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 摘要__ 手術科部: 外科部 套用罐頭: L4-5 partial laminectomy decompression 開立醫師: 陳德福 開立時間: 2010/08/17 15:48 Pre-operative Diagnosis Lumbar stenosis , L4-S1 Post-operative Diagnosis Lumbar stenosis , L4-S1 Operative Method L4-5 partial laminectomy decompression Specimen Count And Types nil Pathology nil Operative Findings 1.There is hypertrophic ligamentum flavum and protruding disc over the L4-5 and L5-S1 space with thecal sac compression. The bilateral L4 laminectomy and right L5 hemilaminectomy were performed for decompression. Operative Procedures Under ETGA and prone position, the skin was disinfected and draped as usual. One linear incision at midline was done and the paraspinous msucle was displaced laterally. The L4-S1 lamina was exposed the bilateral L4 decompressive laminecotmy and right L5 laminectomy were performed with Kerrison, Alligator, Disc clamp and currettage assisted. Hemostasis and left one hemovac in the epidural space. The wound was then closed in layers. Operators VS 賴達明 Assistants R5 陳德福 R2陳國瑋 張起豪 (M,1983/12/01,28y3m) 手術日期 2010/08/17 手術主治醫師 賴達明 手術區域 東址 003房 03號 診斷 HIVD 器械術式 microdiskectomy 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 15:30 報到 16:00 進入手術室 16:05 麻醉開始 16:10 誘導結束 16:25 抗生素給藥 16:47 手術開始 18:55 手術結束 18:55 麻醉結束 19:05 送出病患 19:09 進入恢復室 21:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術－腰椎 1 1 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 摘要__ 手術科部: 外科部 套用罐頭: Lumbar microscopic diskectomy 開立醫師: 陳德福 開立時間: 2010/08/17 19:13 Pre-operative Diagnosis L4-5 HIVD with radiculopathy, right Post-operative Diagnosis L4-5 HIVD with radiculopathy, right Operative Method Lumbar microscopic diskectomy Specimen Count And Types nil Pathology nil Operative Findings 1.There is a buldging central disc at the L4-5 level with theca sac compression. The disc is removed from right side under microscopic surgery smoothly. Operative Procedures Under ETGA and prone position, the skin was disinfected and draped as usual. One linear incision is done and the right paraspinous muscle was displaced laterally. The lower L4 partial laminectomy was done and ligmentum flavum was removed. The nerve root was identified and the disc was removed meticulously. The wound was then closed in layers. Operators VS賴達明 Assistants R5陳德福 R2陳國瑋 相關圖片 陳吉永 (M,1944/09/28,67y5m) 手術日期 2010/08/17 手術主治醫師 蕭輔仁 手術區域 東址 002房 02號 診斷 Malignant neoplasm of liver, primary 器械術式 Spinal fusion posterior 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 劉昌杰, 時間資訊 10:00 通知急診手術 11:02 報到 11:34 進入手術室 11:35 麻醉開始 11:55 誘導結束 13:00 抗生素給藥 13:09 手術開始 15:30 開始輸血 16:00 抗生素給藥 16:55 手術結束 16:55 麻醉結束 17:10 送出病患 17:10 進入恢復室 醫令資訊 類別 名稱 量 刀 側 手術 惡性病髓腫瘤切除術 1 1 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 記錄__ 手術科部: 外科部 套用罐頭: Tumor excision and T8,9,11,12 TPS and T10 bod... 開立醫師: 胡朝凱 開立時間: 2010/08/17 17:13 Pre-operative Diagnosis HCC T10 metastasis Post-operative Diagnosis HCC T10 metastasis Operative Method Tumor excision and T8,9,11,12 TPS and T10 body cage insertion Specimen Count And Types pieces of tumor Pathology pending Operative Findings 1.The T10 vertebral body collapse. 2.Soft, reddish tumor was noted inside the T10 vertebral body and pedicle 3.The tumor was hypervascularity Operative Procedures 1.ETGA, prone 2.Midline incision at T7~T12 level 3.Detach paravertebral muscle group 4.TPS screws insertion 5.T9~T11 laminectomy 6.The right T10 rib head, facet were all excised 7.Tumor and necrotic bone excision to decompressed the spinal cord 8.Body cage insertion via right lateral side 9.Rods fixation 10.fixed cross link 11.Set one hemovac drain then clsoe wound in layers Operators 蕭輔仁 Assistants 胡朝凱,劉昌杰 Indication Of Emergent Operation 黃李秀玉 (F,1953/04/14,58y11m) 手術日期 2010/08/17 手術主治醫師 蕭輔仁 手術區域 東址 002房 03號 診斷 Spinal stenosis, cervical 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 16:45 報到 17:32 進入手術室 17:35 麻醉開始 18:00 誘導結束 18:15 抗生素給藥 18:36 手術開始 21:15 抗生素給藥 22:10 手術結束 22:10 麻醉結束 22:25 送出病患 22:30 進入恢復室 23:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術（特壓）－超過二節 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 記錄__ 手術科部: 內科部 套用罐頭: Laminectomy over C3-T1 開立醫師: 陳睿生 開立時間: 2010/08/17 21:54 Pre-operative Diagnosis Cervical stenosis over C3-T1 Post-operative Diagnosis Cervical stenosis over C3-T1 Operative Method Laminectomy over C3-T1 Specimen Count And Types nil Pathology Nil Operative Findings The thecal sac was tightly compressed especially over C3-4 and C7-T1 level. Calcified ligamentum flavum was noted segmentally. After laminectomy, the thecal sac was well expanded. Operative Procedures 1. ETGA, prone position and head mild flexion, fix with Mayfield 2. Posterior neck linear skin incision about 15cm 3. Split bilateral trapzius and paraspinal muscle via nuchal ligamentum 4. Identify C2, C7 spinous process, and then dissect to expose the C3-T1 spinous process and lamina 5. Drill out the bony outer cortex and bone marrow at the junction between lamina and facet joint from C3 to T1 6. Elevate C3-C7 lamina and then remove 6. Elevate C3-C7 lamina and then remove them. 7. The T1 lamina was removed and decompress the thecal sac with with 1mm Kerrison 8. Hemostasis, set an epidural CWV drain 9. Close the wound in layers Operators VS 蕭輔仁 Assistants R6 陳睿生, R5 鍾文桂, R1 劉昌杰 黃炯勛 (M,1991/12/17,20y2m) 手術日期 2010/08/17 手術主治醫師 王國川 手術區域 東址 002房 01號 診斷 Head injury, unspecified 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 08:45 進入手術室 08:50 麻醉開始 08:55 誘導結束 09:50 手術開始 10:50 手術結束 10:50 麻醉結束 10:55 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室腹腔分流手術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt via left Kocher point 開立醫師: 游健生 開立時間: 2010/08/17 11:11 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunt via left Kocher point Specimen Count And Types 1 piece About size:11cc Source:CSF Pathology Nil Operative Findings The opening pressure was about 10cmH2O. CSF was clean and clear and 11cc was sent for study. The ventricle catheter was 7cm in length. The reservoir was medium pressure. Operative Procedures Under ETGA, patient was put into supine position with neck extended and head turned to right. After shaving, we disinfected and draped the operation field as usual. A curvilinear scalp incision was made over left Kocher point. After dissection to expose cranium, a burrhole was made. Dura tentin and cruciate durotomy followed by ventriculostomy. A 7cm ventricle catheter was inserted into left lateral ventricle. A transverse abdominal incision was made over LUQ. After mini-laparotomy, a peritoneal catheter was inserted into peritoneal cavity and passed upward via subcutaneous tunnel to scalp. We assembled these two catheter to a medium pressure reservoir. Wound closure in layers after hemostasis. Operators VS 王國川 Assistants R3 游健生 黃菊妹 (F,1940/01/03,72y2m) 手術日期 2010/08/18 手術主治醫師 黃昭淵 手術區域 西址 039房 04號 診斷 Bladder cancer 器械術式 Fiberocystoscopy /WOR 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 13:45 進入手術室 13:46 手術開始 13:51 手術結束 13:52 送出病患 鍾阿株 (M,1932/11/22,79y3m) 手術日期 2010/08/18 手術主治醫師 蕭輔仁 手術區域 東址 005房 號 診斷 Osteomyelitis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 古恬音, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:05 進入手術室 08:10 麻醉開始 08:40 誘導結束 09:36 手術開始 11:50 手術結束 11:50 麻醉結束 12:02 送出病患 12:05 進入恢復室 13:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 椎間盤切除術－腰椎 1 2 L 手術 脊椎融合術－前融合，無固定物（＜＝四節） 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 記錄__ 手術科部: 外科部 套用罐頭: Left anterior approach for discectomy and aut... 開立醫師: 胡朝凱 開立時間: 2010/08/18 11:55 Pre-operative Diagnosis L2~3 spondylodiscitis Post-operative Diagnosis L2~3 spondylodiscitis Operative Method Left anterior approach for discectomy and autologous bone insertion Specimen Count And Types pieces of granulation tissue and culture tubes Pathology pending Operative Findings 1.Necrotic tissue and granulation tissue was noted at prevertebral space 2.Some frank pus was noted after granulation tissue opening 3.The disc became necrotic and destructed Operative Procedures 1.ETGA, right decubitus position 2.Right subcostal transverse skin incision 3.Devided three layers of abdominal muscle to expose peritoneum 4.Retroperitoneal approach to expose iliopsoas muscle 5.detach iliopsoas muscle 6.abscess excision with currete 7.Discectomy 8.Harvest one bone chip at right superior iliac crest 9.Insert bone chip 10.Set one hemovac drain 11.close wound in layers Operators 蕭輔仁 Assistants 胡朝凱, 古恬音 林月娥 (F,1951/09/10,60y6m) 手術日期 2010/08/18 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Brain Tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:00 進入手術室 08:10 麻醉開始 08:40 誘導結束 09:30 抗生素給藥 09:40 手術開始 11:30 開始輸血 11:45 麻醉結束 11:45 手術結束 11:55 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 經由蝶竇之腦下垂體瘤切除 1 1 摘要__ 手術科部: 外科部 套用罐頭: Hypophysectomy---Transphenoid 開立醫師: 游健生 開立時間: 2010/08/18 12:40 Pre-operative Diagnosis pituitary tumor Post-operative Diagnosis pituitary tumor Operative Method Trans-sphenoid adenectomy Specimen Count And Types 1 piece About size:a few pieces Source:pituitary tumor Pathology pending Operative Findings Tumor was about 1cm in diameter, whitish and fragile. It buldged out after durotomy. CSF leakage was noted during surgery. Easy tissue oozing was also noted and sinus tear was suspected. Normal pituitary gland was seen after tumor removal. Operative Procedures Under ETGA, patient was put into supine with head tilted 30 degree to left. The face was prepared with povidone-iodine alcohol tincture, and the mucosa of oral and nasal cavity with aqueous povidone-iodine tincture. The former areas were covered by a sterilized adhesive plastic sheet. The nasal submucosa at septum and floor and the subperiostium at upper alveola were infiltrated with 1:100 epinephrine solution. The mucosa of nasal septum was dissected away from the septal cartilage from anterior to posterior and displaced laterally by a long nasal speculum. The septal cartilage was cut at its basal juction by sepatal scissors and then displaced to one side. A Hardys nasal speculum was applied to displace the nasal mucosa laterally and keep the nasal cavity open constantly for the exposure of the vomer bone and the anterior wall of the sphenoid sinus. The exposed sinus mucosa was coagulated and resected. The sellar floor was penetrated by NOMI, then widened by Kerrison punch. The sellar floor dura was opened in cruciate fashion. The soft tumor was removed by curette and suction. The venous oozing was stopped by gelfoam packing. The sellar cavity was packed with gelfoam. The sellar floor was reconstructed by a piece of vomer bone. The sphenoid sinus was packed with gelfoam and filled with Tissucol-dul. The Hardys nasal speculum was removed and the nasal mucosa returned to its normal position. Each side of the nasal cavities was tightly packed with merocel which had been soacked with Better-iodine ointment. Operators Prof. 杜永光 Assistants R6 陳睿生 R3 游健生 林儷蓉 (F,1993/12/03,18y3m) 手術日期 2010/08/18 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Cervical spondylosis 器械術式 Benign intraspinal tumor, exci 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 曾峰毅, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:10 進入手術室 08:15 麻醉開始 08:25 誘導結束 09:00 抗生素給藥 09:26 手術開始 12:00 抗生素給藥 12:37 開始輸血 14:35 手術結束 14:35 麻醉結束 14:45 送出病患 14:50 進入恢復室 16:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 良性病髓腫瘤切除術 1 1 手術 椎弓整形術 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 記錄__ 手術科部: 外科部 套用罐頭: C5 laminectomy, C6-7 Laminoplasty for C5-7 su... 開立醫師: 曾峰毅 開立時間: 2010/08/18 14:58 Pre-operative Diagnosis Neurofibromatosis, type I; C5-7 subdural tumor with epidural extension, and C7 intramedullary tumor Neurofibromatosis, type I. 1. intraspinal tumor, C5-7, with extradural and subdural components. 2. intramedullary tumor, C7 level Post-operative Diagnosis Neurofibromatosis, type I; C5-7 subdural tumor with epidural extension, suspected meningioma, and C7 intramedullary tumor, suspected neurofibroma Neurofibromatosis, type I. 1. intraspinal tumor, C5-7, with extradural and subdural components, suspect meningioma. 2. neurofibroma, left C7 level Operative Method C5 laminectomy, C6-7 Laminoplasty for C5-7 subdurla tumor removal, and C7 intramedullary tumor excision C5 laminectomy, C6-7 Laminoplasty for C5-7 tumor removal, and C7 neurofibroma removal Specimen Count And Types Epidural mass, subdural mass, dura, and intramedullary tumor were sent for pathology separately. Epidural mass, subdural mass, dura, and intradural extramedullary tumor were sent for pathology separately. Pathology Pending Operative Findings One greyish to pinkish, hypervascular, well defined tumor was noted subdurally from C5 to C7. Its border with arachnoid membrane was clear, and infiltrated the dura with extension epidurally. Hypervascularity of the dura was noted, indicating suspected tumor infiltration. Profound vascularity was noted at epidural space near each nerve root exiting site. One well defnied, capsuled, normal to hypervascular tumor was noted intramedullarlly near left C7 root exiting site, and this tumor encased many nerve-like tubular structure. One greyish to pinkish, hypervascular, well defined tumor was located subdurally from C5 to C7. Its border with arachnoid membrane was clear, and infiltrated the dura with extension epidurally. Hypervascularity of the dura was encountered, which indicated suspected tumor infiltration. Profound vascularity was found at epidural space near each nerve root exiting site. One well defnied, capsuled, normal to hypervascular tumor was located intramedullarlly near left C7 root exiting site, and this tumor encased many nerve-like tubular structure. One greyish to pinkish, hypervascular, infiltrative tumor was located outside and inside (infiltrating the dura) the dura from C5 to C7. The outer component was infiltrated into the dura and extended laterally out of the operative field. The inner component of the tumor was fragile, soft, and more at left side that compressed the spinal cord to the right side markedly. It was easily sucked out, but was as hypervascular as the outer component. Its border with arachnoid membrane was clear. Because of the severe infiltration into the dura, the dura was filled with arterialized feeders that profound bleeding was encountered during tumor removal and excision of the dura. Profound vascularity was found at epidural space near each nerve root exiting site. One wellencapsulated, normal to hypervascular tumor was located at the left side of spinal cord. It originated from a fanned out nerve root at left C7 level and compress the spinal cord severly. It could be separated from the spinal cord but could not be removed totally because its original nerve fiber has to be preserved. We debulked the tumor till the fanned out nerve were encountered. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After scalp shaved, scrubbed, disinfected, and then draped, we made one midline linear skin incision from C5 to T1. We dissected paraspinal muscle to expose bilateral laminae of C5 to T1. C5 laminectomy was done with rongeur, and C6-7 laminectomy was done with air-drill. Midline durotomy was done. Epidural mass and subdural mass was removed after meticulose dissetion along the dura plane. A part of dura was excised as well due to suspected tumor infiltration. C7 intramedullary tumor was excised partially. After hemostasis, duroplasty was done with Durofoam and Tissucol-Duo sealing. C5-6 laminae was fixed back with mini-plates. One CWV was inserted, and the wound was closed in layers. With endotracheal general anaesthesia, the patient was put in prone position. After scalp shaved, scrubbed, disinfected, and then draped, we made one midline linear skin incision from C5 to T1. We dissected paraspinal muscle to expose bilateral laminae of C5 to T1. C5 laminectomy was done with rongeur, and C6-7 laminectomy was done with air-drill. Under microscopic view, midline durotomy was done. Epidural mass and subdural mass was removed after meticulose dissetion along the thickened dura plane. The cnetral part of the was excised as well due to marked tumor infiltration that compressed the spinal cord severely. A well encapsulated intradural extramedullary tumor at left C7 level was removed as much as possible till its originated fanned out root was encounter and preserved. After hemostasis, duroplasty was done with subdural Durofoam and Tissucol-Duo sealing followed by another layer of extradural Durofoam and Tissuecol-Duo. C6-7 laminae was fixed back with mini-plates. One CWV was inserted at subperiosteal plane, and the wound was closed in layers. Operators VS 郭夢菲 Assistants R4 曾峰毅 高陳賽治 (F,1934/02/02,78y1m) 手術日期 2010/08/18 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 重大創傷且及嚴重程度到達創傷嚴重程度分數16分以上 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 12:25 進入手術室 12:30 麻醉開始 12:35 誘導結束 13:00 手術開始 13:55 手術結束 13:55 麻醉結束 14:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt via right Kocher point 開立醫師: 游健生 開立時間: 2010/08/18 14:09 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunt via right Kocher point Specimen Count And Types 1 piece About size:10cc Source:CSF Pathology nil Operative Findings The opening pressure was about 10cmH2O. CSF was clean and clear and 10cc was sent for study. The ventricle catheter was 7cm in length. The Codman programmable valve pressure was set at 10cmH2O. Operative Procedures Under ETGA, patient was put into supine position with neck extender and head turned to left. After shaving, we disinfected and draped the operation field as usual. A transverse scalp incision was made over right Kocher point. We created a burrhole followed by dura tenting and electrocautery. After cruciate durotomy, we performed ventriculostomy followed by ventricle catheter insertion. A transverse abdominal incision was made over RUQ region. After mini-laparotomy, we inserted the peritoneal catheter into peritoneal cavity and pass the proximal end upward to scalp via subcutaneous tunnel. We assembled the peritoneal and ventricle catheter to Codman programmable shunt reservoir. Then, we closed wounds in layers. Operators VS 王國川 Assistants R6 陳睿生 R3 游健生 陳可麗 (F,1953/10/20,58y4m) 手術日期 2010/08/18 手術主治醫師 侯君翰 手術區域 西址 035房 02號 診斷 Malignant neoplasm of frontal lobe 器械術式 Debridment >10cm ( leg ) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 黃鼎鈞, 時間資訊 00:00 臨時手術NPO 09:20 報到 09:50 進入手術室 09:55 麻醉開始 10:05 誘導結束 10:09 手術開始 10:35 手術結束 10:35 麻醉結束 10:40 送出病患 10:50 進入恢復室 13:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 深部複雜創傷處理－傷口長５－１０公分者 1 0 L 記錄__ 手術科部: 骨科部 套用罐頭: Debridement 開立醫師: 黃鼎鈞 開立時間: 2010/08/18 10:54 Pre-operative Diagnosis Drain hole wound infection, left Post-operative Diagnosis Drain hole wound infection, left Operative Method Debridement Specimen Count And Types nil Pathology nil Operative Findings A subcutaneous dead space under previous hemovac drainage site without connection with joint. Necrotic tissue over dead space. Operative Procedures Under anesthesia, patient was put in supine position. Skin was disinfected and draped as ususal. Skin incision over previous hemovac outlet sites. Debridement was performed. Wound was irrigated with normal saline and closed in layers. Operators 侯君翰, Assistants 黃鼎鈞, 廖翊廷, 饒文忠 (M,1967/08/20,44y6m) 手術日期 2010/08/18 手術主治醫師 蔡翊新 手術區域 東址 005房 02號 診斷 Acute respiratory distress syndrome following trauma, surgery, shock 器械術式 Tracheostomy 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 古恬音, 時間資訊 00:00 開始NPO 00:00 臨時手術NPO 11:51 通知急診手術 12:26 報到 12:27 進入手術室 12:30 麻醉開始 12:35 誘導結束 12:55 手術開始 13:13 麻醉結束 13:13 手術結束 13:23 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 氣管切開造口術 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 古恬音 開立時間: 2010/08/18 13:28 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types Nil Pathology None Operative Findings Fr 8 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified.Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators VS蔡翊新 Assistants R6胡朝凱,R3古恬音 Indication Of Emergent Operation 劉昇展 (M,1974/01/06,38y2m) 手術日期 2010/08/19 手術主治醫師 黃國皓 手術區域 東址 053房 03號 診斷 Hydronephrosis 器械術式 Double-J ureteral stent insert 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 靜脈麻醉 麻醉主治醫師 劉治民 ASA 3 紀錄醫師 張奕凱, 時間資訊 11:40 報到 12:00 進入手術室 12:05 麻醉開始 12:10 誘導結束 12:20 抗生素給藥 12:25 手術開始 12:35 手術結束 12:35 麻醉結束 12:40 進入恢復室 12:40 送出病患 13:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 手術 雙丁輸尿管導管置入術 1 0 L 摘要__ 手術科部: 泌尿部 套用罐頭: DBJ stent insertion 開立醫師: 張奕凱 開立時間: 2010/08/19 12:42 Pre-operative Diagnosis left obstructive uropathy s/p DBJ Post-operative Diagnosis left obstructive uropathy s/p DBJ Operative Method cystoscopy and DBJ insertion Specimen Count And Types nil Pathology nil Operative Findings 1. previus DBJ encrustration Operative Procedures Under satisfactory anesthesia with the patient in lithotomy position, prepping and drapping was performed in the usual sterile fashion. A Fr 21 Olympus cystoscope was introduced into the bladder cavity under direct vision. Careful inspection was done and 6-26 DBJ was inserted. 16 Fr Foely catheter insertion was done. Patient tolerated the procedure very well and was sent to recovery room in satisfactory condition. Operators 黃國皓, Assistants 張奕凱, 蘇彥榮, 何開敏 (F,1929/04/08,82y11m) 手術日期 2010/08/19 手術主治醫師 曾勝弘 手術區域 東址 003房 02號 診斷 Meningitis 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 李振豪, 時間資訊 22:45 臨時手術NPO 22:45 開始NPO 08:45 通知急診手術 12:13 報到 12:50 進入手術室 13:00 麻醉開始 13:10 誘導結束 13:53 手術開始 15:40 麻醉結束 15:45 手術結束 16:03 送出病患 16:05 進入恢復室 17:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 頭顱穿洞術（止血引流、穿刺檢查） 1 1 B 手術 頭顱穿洞術（止血引流、穿刺檢查） 1 2 B 手術 肌肉或深部組織腫瘤切除術及異物取出術 1 4 R 摘要__ 手術科部: 外科部 套用罐頭: 1. Right Frazier"s V-P shunt ligation 開立醫師: 李振豪 開立時間: 2010/08/19 16:23 Pre-operative Diagnosis 1. Pneumocephalus, 2. Meningioma s/p tumor excision s/p V-P shunt implantation Post-operative Diagnosis 1. Pneumocephalus, 2. Meningioma s/p tumor excision s/p V-P shunt implantation Operative Method 1. Right Frazier"s V-P shunt ligation 2. Bilateral Kocher"s point burr hole for pneumocephalus drainage Specimen Count And Types nil Pathology Nil Operative Findings 1. After set up the position, disinfection, and draping, we tried to sample CSF from reservoir of right Frazier V-P shunt but failed because only air drained out by needle aspiration. 2. The air gushed out after opening of the lateral ventricle. CSF sampling is tried again but failed again because massive pneumocephalus within lateral ventricle. 3. The air was replaced with normal saline. After deair, the puncture site was packing with Gelform No obvious CSF leakage was noted after packing. 4. The spontaneous eye open improved after the operation immediately. Operative Procedures Under tracheostomy tube general anesthesia, the patient is put in supine position with head rotated to left. The scalp was shaved, scrubbed, and disinfected as usual. The skin incision was made at right occipital area along previous op scar and the right Frazier"s V-P shunt was identified. The tube was ligated with 2-0 silk. After hemostasis, the wound was closed with 3-0 Nylon. Two vertical linear wounds were made at bilateral Kocher"s point. Two burr hole were created with air-drived perforator. Two dural tenting was performed in each burr hole and the dura was opened with cruciform fashion. Ventricular puncture was performed with ventricular needle and Two vertical linear wounds were made at bilateral Kocher"s point. Two burr hole were created with air-drived perforator. Two dural tenting was performed in each burr hole and the dura was opened with cruciform fashion. Ventricular puncture was performed with ventricular needle and Nelaton catheter is used for deair. The normal saline was used for deair. The position was changed for deair and the Gelform was used for packing after deair completed. Hemostasis was achieved and the wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. No drain was left after wound closure. Operators VS曾勝弘 Assistants R4李振豪 Indication Of Emergent Operation 相關圖片 簡崇熙 (M,1958/01/10,54y2m) 手術日期 2010/08/19 手術主治醫師 陳敞牧 手術區域 東址 005房 01號 診斷 Spinal stenosis, cervical 器械術式 C3-6 laminoplasty 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 07:35 報到 08:05 進入手術室 08:10 麻醉開始 08:20 誘導結束 09:10 抗生素給藥 09:17 手術開始 11:34 開始輸血 12:25 抗生素給藥 12:45 手術結束 12:45 麻醉結束 12:55 送出病患 13:02 進入恢復室 14:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 Glucose 1 0 手術 椎弓整形術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Laminoplasty, C3-6. 開立醫師: 鍾文桂 開立時間: 2010/08/19 13:16 Pre-operative Diagnosis Spinal stenosis, cervical. Post-operative Diagnosis Spinal stenosis, cervical. Operative Method Laminoplasty, C3-6. Specimen Count And Types nil Pathology Nil. Operative Findings 1. Hypertrophic ligamentum flavum. 2. Miniplates and screws were fixed for open-door laminoplasty, right side. 5,5,6 holes and one elongated 4 hole plates. 3. The cord expands well and intact after decompression. Operative Procedures Under ETGA, the patient was placed in prone position and the head was fixed in Mayfield head holder. After shaving, disinfection, and draping,midline incision and dissection were done until lower part of C2 to upper part of C7 were exposed. Grooving along the bilateral laminae from C3-6 levels were achieved by high speed drills. The spreader opened the epidural space from right side by opening the right groove. The hypertrophic ligamentum flavum was removed by Kerrison. Laminoplasty was achieve by fixation of the miniplates and screws at both ends of the lamina. The C6 spinous process was removed and dissected in to pieces. The bony pieces were fixed on the plates. Finally, the wound was closed in layers after placing one CWV drain. Operators V.S. 陳敞牧 Assistants R5鍾文桂 R1劉昌杰 詹益鄉 (M,1938/04/30,73y10m) 手術日期 2010/08/19 手術主治醫師 陳敞牧 手術區域 東址 005房 02號 診斷 Lumbar spondylosis 器械術式 L3/4 TPS 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 12:08 報到 13:14 進入手術室 13:15 麻醉開始 13:30 誘導結束 13:55 抗生素給藥 14:31 手術開始 17:00 抗生素給藥 17:40 開始輸血 18:15 手術結束 18:15 麻醉結束 18:27 送出病患 18:28 進入恢復室 20:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 手術 椎弓切除術（特壓）－二節以內 1 2 記錄__ 手術科部: 外科部 套用罐頭: 1. Decompressive laminectomy, L3/4. 開立醫師: 鍾文桂 開立時間: 2010/08/19 18:29 Pre-operative Diagnosis 1. Lumbar spondylolisthesis, grade I, L3/4. 2. Lumbar stenosis, L3/4. Post-operative Diagnosis 1. Lumbar spondylolisthesis, grade I, L3/4. 2. Lumbar stenosis, L3/4. Operative Method 1. Decompressive laminectomy, L3/4. 2. Posterolateral fusion and internal fixation with transpedicular screws, L3/4. Specimen Count And Types nil Pathology Nil. Operative Findings 1. Severe stenosis with hypertrophic ligamentum flavem and spur formation at L3/4 level. 2. Two sites of dura tear due to manipulation of the thin dura mater. 3. Blood loss: 1150cc. tranfusion: PRBC 2U. 4. Internal fixation apparatus: screws: 64x45mm,4 screws. with two rods. Operative Procedures Under ETGA, the patient was placed in prone position. After disinfection and draping, the L3/4 level were localized by intraoperative fluoroscope. Midline incision and dissection were done. Later, the transpedicle screws were inserted and the locations were confirmed by intraoperative fluoroscope. L3/4 decompressive laminectomy were done by Kerrison punch. After decompression, the rods were placed at bilateral screws. The posterolateral fusion was achieved with autologous bone graft. After placing one 1/8 hemovac, the wound was closed in layers. The patient was sent to POR smoothly. Operators V.S. 陳敞牧 Assistants R5 鍾文桂 R1 劉昌杰 侯志偉 (M,1984/07/08,27y8m) 手術日期 2010/08/19 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Major trauma rated 16 or above on the severeity scale ( Injury severeity score >=16 ) 器械術式 cranioplasty + VP shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 古恬音, 時間資訊 00:00 臨時手術NPO 07:48 報到 08:05 進入手術室 08:15 麻醉開始 08:20 誘導結束 08:40 抗生素給藥 09:22 手術開始 11:40 抗生素給藥 12:00 手術結束 12:00 麻醉結束 12:10 送出病患 12:15 進入恢復室 13:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 手術 頭顱成形術 1 2 L 手術 腦室腹腔分流手術 1 1 L 手術 肌肉或深部組織腫瘤切除術及異物取出術 1 4 R 記錄__ 手術科部: 外科部 套用罐頭: 1. Cranioplasty 開立醫師: 古恬音 開立時間: 2010/08/19 12:00 Pre-operative Diagnosis 1. Head injury s/p craniectomy, s/p Ommaya reservoir insertion 2. Hydrocephalus Post-operative Diagnosis 1. Head injury s/p craniectomy, s/p Ommaya reservoir insertion 2. Hydrocephalus Operative Method 1. Cranioplasty 1. Cranioplasty with autologus skull plate 2. Left Frazier VP shunt insertion 3. Ommaya reservoir removal Specimen Count And Types CSF*3 tubes, Ommaya reservoir tip Pathology Nil Operative Findings 1. The CSF openning pressure was high, and clear CSF drained out. Ventricular catheter: 10cm, peritoneal catheter: 30cm 1. The CSF openning pressure was high, and clear CSF drained out. The median pressure Metronic reservoir was used for V-P shunt. Ventricular catheter length: 10cm, peritoneal catheter length: 30cm 2. The craniectomy window was distended and became slack after drainage of CSF about 50mL 3. Dura defect was noted during elevation of the scalp flap and one Duroform was used for duroplasty. Operative Procedures 1. ETGA, supine position with head turn to right 2. Scalp was shaved, scrubbed, and disinfected, followed by draping 3. Make a skin insicion at left occipital area and a burr hole 4. Insert the ventricular catheter and drained out 50mL of CSF 5. Make a skin incision at right upper abdomen 6. Connect the VP shunt system after subcutaneous tunneling 7. Incise the skin along previous operation wound of left craniectomy, and detach the scalp 8. Repair the dural defect with Duraform 9. Fix back the bone plate with miniplates and screws, and the bony defect was repaired with Cranioplastic bone cement 10. Set one subgaleal CWV drain, then closed the wound in layers 11. Remove the Ommaya reservoir Operators VS王國川 Assistants R4李振豪, R3古恬音 侯志發 (M,1928/11/29,83y3m) 手術日期 2010/08/19 手術主治醫師 蔡翊新 手術區域 東址 003房 03號 診斷 Intracerebral hemorrhage (ICH) 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 游健生, 時間資訊 17:09 通知急診手術 18:17 進入手術室 18:20 麻醉開始 18:45 誘導結束 18:50 抗生素給藥 19:15 手術開始 19:35 開始輸血 21:50 抗生素給藥 00:00 手術結束 00:00 麻醉結束 00:10 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦內血腫清除術 1 1 R 手術 顱內壓監視置入 1 2 R 摘要__ 手術科部: 外科部 套用罐頭: CVA 開立醫師: 蔡翊新 開立時間: 2010/08/19 23:33 Pre-operative Diagnosis Right frontotemporoparietal ICH. Post-operative Diagnosis Right frontotemporoparietal ICH. Operative Method Right F-T-P craniotomy for ICH evacuation and subdural ICP monitoring. Specimen Count And Types nil Pathology Nil. Operative Findings Mildly tense dura was noted after craniotomy. There was ecchymosis over right inferior frontal gyrus and SAH along distal Sylvian fissure. Blood clots mixed with fragile, grey-reddish brain tissue, about 7 x 6 x 5 cm in size, were evacuated from right frontotemporoparietal lobes. There was no definite bleeder, but perforating arteries were encountered during hematoma evacuation. The brain became slack after ICH removal and ICP after dural closure was 2 mmHg. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: right frontotemporoparietal, curvilinear. The skin edge was clipped by Raney clips for temporary hemostasis. After scalp had been lifted, the temporalis muscle was incised. 5. Craniotomy: A 10 x 8 cm craniotomy was made at right frontotemporal area. 6. Dural tenting: by 2/0 silk, 2 cm in interval, distributed along the edge of skull window. 7. Dural incision: curvilinear along the craniotomy window, reflected anteriorly. 8. A 2 cm cortical incision was made at inferior frontal gyrus, the subcortex and white mater was splitted by brain retractor and sucker until the intracerebral hematoma was exposed. The hematoma was sucked out carefully. The cavity was irrigated with NS and the blood oozing was stopped by Surgicel packing. Before closure of the dura, the hematoma caivty was clean and the brain once bulging was slack. 9. Dural closure: continous sutures with 4/0 Prolene to obtain water-tight closure. A Codman ICP monitor was placed at subdural space. 10.The craniotomy bone plate was fixed back with miniplates and screws. 11.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 12.Drain: one, epidural, CWV. 13.Blood transfusion: PRBC 4U. Blood loss: 500 ml. 14.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R4李振豪R3游健生 Indication Of Emergent Operation 林足如 (F,1955/11/26,56y3m) 手術日期 2010/08/20 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Meningitis 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 古恬音, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:02 進入手術室 08:20 麻醉開始 08:30 誘導結束 09:25 手術開始 10:40 麻醉結束 10:45 手術結束 10:55 進入恢復室 10:55 送出病患 12:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 內視鏡功能鼻竇手術－雙側 1 1 B 記錄__ 手術科部: 外科部 套用罐頭: Repair of dural defect 開立醫師: 胡朝凱 開立時間: 2010/08/20 10:56 Pre-operative Diagnosis post TSH CSF leakage Post-operative Diagnosis post TSH CSF leakage Operative Method Repair of dural defect Specimen Count And Types discharge culture Pathology pending Operative Findings 1.Clear fluid spillage from the bottom of sella floor paramedian area 2.Fatty tissue was used to impact the cavity and tissucal-duowas also used to seal off Operative Procedures 1.ETGA, supine 2.Right nostril was entered 3.Expose mucosa and remove previous bone chip 4.identify the leakage area 5.Harvest one piece of fat at LLQ area 6.impact gelfoam and fatty tissue 7.tissuecal-duo sealing 8.Nasal packing Operators 曾漢民 Assistants 胡朝凱, 古恬音 林劉美玉 (F,1946/12/15,65y2m) 手術日期 2010/08/20 手術主治醫師 黃書健 手術區域 兒醫 066房 02號 診斷 Spondylolisthesis 器械術式 A-V Shunt 手術類別 臨時手術 手術部位 四肢 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 周恒文, 時間資訊 13:30 報到 13:30 進入手術室 13:58 麻醉開始 13:59 誘導結束 14:00 手術開始 14:10 抗生素給藥 16:55 麻醉結束 16:55 手術結束 17:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 動靜脈造廔術合併人工血管使用（兩處吻合） 1 1 R 手術 靜脈血栓切除術 1 2 R 記錄__ 手術科部: 外科部 套用罐頭: Open thrombectomy, Gortex patch augmentation,... 開立醫師: 周恒文 開立時間: 2010/08/20 17:19 Pre-operative Diagnosis Right AV shunt dysfunction Post-operative Diagnosis Thrombus,intima hyperplasia, calcification, multiple stenosis, and cephalo-axillary junction stricture of right AVF Operative Method Open thrombectomy, Gortex patch augmentation, and vascular plasty of right AVF Specimen Count And Types nil Pathology Thrombus formation, intima hyperplasia, intima calcification Operative Findings Multiple stenosis of the right AVF. Inside the lumen is massive organized thrombus, calcification, and intima hyperplasia. The caliber of the cephalo-axillary junction was small: about 5mm in diameter with thrombus inside it. Post-op thrill: + Operative Procedures Local anesthesia. Incision over the right deltopectoral area to approach the cephalo-axillary junction. Transect the stricture area of the cephalic vein and thrombectomy with Fogarty No 5. Another incision over the elbow area to expose the forearm cephalic vein and open the vein. Thrombectomy with Fogarty No 5. Incision over the radiocephalic anastomosis and open the vessel to perform thrombectomy. Patch augmentation with Gortex patch. Direct closure of the forearm cephalic vein with 5-0 Prolene. Vascular palsty of the stricture of the cephalic vein to enlarge the diameter. Close the wound in layers. Operators 黃書健 Assistants 周恒文 宋莉娜 (F,1975/08/31,36y6m) 手術日期 2010/08/20 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Spine tumor 器械術式 C6-T2 intramedullary tumor 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:00 進入手術室 08:10 麻醉開始 08:40 誘導結束 09:50 抗生素給藥 09:58 手術開始 12:50 抗生素給藥 16:00 麻醉結束 16:00 手術結束 16:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 惡性病髓腫瘤切除術 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 8 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: C5-T2 laminectomy for intramedullary tumor ex... 開立醫師: 陳睿生 開立時間: 2010/08/20 16:36 Pre-operative Diagnosis C6-T1 intramedullary tumor Post-operative Diagnosis C6-T1 intramedullary tumor C6-T2 intramedullary tumor Operative Method C5-T2 laminectomy for intramedullary tumor excision Specimen Count And Types amount: size: source: amount: one size: a few pieces source: intramedullary tumor Pathology pending Operative Findings A greyish-yellowish, soft, fragile intramedullary tumor was noted from C6 to T2 level. Syrinx were noted both superior and inferior to the tumor. The tumor was well vascularized and the margin was relatively clear between the tumor and normal cord. Part of it exposed at the surface of cord and had mild adhesion to overlaying dura. Intra-op frozen section showed ependymoma. The baseline of bilateral lower limb SSEP was poor. Transient MEP decrease of right lower limb was noted during operation. Megadose Solu-medrol was given. Operative Procedures Under ETGA, patient was put into prone position with neck flexed and head fixed with Mayfield headholder. After shaving, we disinfected and draped the operation field as usual. A midline skin incision was made from C4 to T3. We detached paraspinal muscle to expose C4 to T3 laminae and medial aspect of facet joints. Laminectomy from C5 to T2 was performed with highspeed drill, Kerrison punch and spreader. After midline durotomy and dura tenting, we cut the pia at midline. Midline cordotomy at both ends were done to expose the rostral and caudal end of intramedullary tumor. We removed some of the tumor with tumor forcep and sent for frozen section. Then, we removed tumor with CUSA as central debuking. The rest of tumor was dissected and removed along the plane between tumor and cord. We approximated the arachnoid membrane with interrupted 5-0 prolene sutures followed by dura closure with continuous 5-0 prolene suture. Under ETGA, patient was put into prone position with neck flexed and head fixed with Mayfield headholder. After shaving, we disinfected and draped the operation field as usual. A midline skin incision was made from C4 to T3. We detached paraspinal muscle to expose C4 to T3 laminae and medial aspect of facet joints. Laminectomy from C5 to T2 was performed with highspeed drill, Kerrison punch and spreader. After midline durotomy and dura tenting, we cut the pia at midline. Midline myelotomy at both ends were done to expose the rostral and caudal end of intramedullary tumor. We removed some of the tumor with tumor forcep and sent for frozen section. Then, we removed tumor with CUSA as central debuking. The rest of tumor was dissected and removed along the plane between tumor and cord. We approximated the arachnoid membrane with interrupted 5-0 prolene sutures followed by dura closure with continuous 5-0 prolene suture. We closed the wound in layers after placement of an epidural CWV. Operators VS 賴達明 Assistants R6 陳睿生 R3 游健生 邱成河 (M,1941/11/26,70y3m) 手術日期 2010/08/20 手術主治醫師 賴達明 手術區域 東址 005房 02號 診斷 Spondylolisthesis 器械術式 L4/5 Dynesys 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 古恬音, 時間資訊 00:00 臨時手術NPO 11:05 麻醉開始 11:05 進入手術室 11:10 誘導結束 11:50 抗生素給藥 12:06 手術開始 14:50 抗生素給藥 15:45 手術結束 15:45 麻醉結束 16:00 送出病患 16:01 進入恢復室 17:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 手術 椎弓切除術（特壓）－二節以內 1 2 記錄__ 手術科部: 外科部 套用罐頭: L4~5 Dyness TPS insertion and lower L3 to L4 ... 開立醫師: 胡朝凱 開立時間: 2010/08/20 15:47 Pre-operative Diagnosis L4~5 facet destruction and apinal stenosis Post-operative Diagnosis L4~5 facet destruction and apinal stenosis Operative Method L4~5 Dyness TPS insertion and lower L3 to L4 laminectomy Specimen Count And Types nil Pathology nil Operative Findings 1.Scoliosis was noted 2.The left L4~5 facet destruction 3.No obvious listhesis 4.Hypertrophic flavum ligment that compressed the nerve roots tightly Operative Procedures 1.ETGA, prone 2.Midline skin incision atL3~5 level 3.Paramedian dissect muscle group to expose L4, L5 transverse process 4.Use transverse process as landmark to insert screws 5.Fixed the cable 6.midline split the L4 spinous process 7.L4 laminectomy 8.remove flavum ligment with Kerrison 9.water irrigation 10.Set one hemovac drain 11.close wound in layers Operators 賴達明 Assistants 胡朝凱, 古恬音 陳義明 (M,1944/12/20,67y2m) 手術日期 2010/08/20 手術主治醫師 賴達明 手術區域 東址 019房 號 診斷 Spondylolisthesis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:05 進入手術室 08:30 麻醉開始 08:50 誘導結束 09:02 抗生素給藥 09:28 手術開始 12:00 抗生素給藥 14:12 手術結束 14:12 麻醉結束 14:18 送出病患 14:20 進入恢復室 15:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術（特壓）－二節以內 1 3 手術 臉部以外皮膚及皮下腫瘤摘除術　小於２公分 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 摘要__ 手術科部: 外科部 套用罐頭: 1.L3-5 TPS 2.L4 laminectomy 3.Left middle fin... 開立醫師: 陳德福 開立時間: 2010/08/20 14:14 Pre-operative Diagnosis 1.Lumbar sondylolisthesis with stenosis, L3-5 2.Left middle finger skin tumor Post-operative Diagnosis 1.Lumbar sondylolisthesis with stenosis, L3-5 2.Left middle finger skin tumor Operative Method 1.L3-5 TPS 2.L4 laminectomy 3.Left middle finger skin tumor excision Specimen Count And Types 1 piece About size:0.5*0.5*0.5CM Source:left middle finger tumor Pathology pending Operative Findings 1.There are spndylosis over the L3-5 and hypertrophic ligamentum flavum over L3-5 with spinal stenosis. The thecal sac was compressed tightly by the osteophytes and ligamentum flavum. The theca sac was decompressed after the L4 laminiectomy. 6 [45mm] TPS was implantated smoothly with 2 rods and 1 cross link. 2.One 0.5*0.5*0.5cm in sized skin tumor at the left middle finger was removed. Operative Procedures Under ETGA and prone position, the skin was disinfected and draped as usual. One linear incision at midline was done and the paraspinous msucle was displaced laterally. The L3-5 lamina was exposed and L3-5 TPS was inserted under C-arm flouroscope guided. The L4 decompressive laminecotmy was performed with Kerrison, Alligator, Disc clamp and currettage assisted. The rods was implantated followed by performing L3-5 posterior lateral autologous fusion. One cross link was set up. Hemostasis and left one hemovac in the epidural space. The wound was then closed in layers. Another fulsiform incison around the left middle finger skin tumor was done and the tumor was removed. The skin was clsoed with Nylon. Operators VS 賴達明 Assistants R5 陳德福 R2陳國瑋 相關圖片 鄭清和 (M,1964/12/19,47y2m) 手術日期 2010/08/20 手術主治醫師 賴達明 手術區域 東址 019房 02號 診斷 HIVD 器械術式 L5/S1 Dynesys 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 陳國瑋, 時間資訊 08:40 臨時手術NPO 14:00 報到 14:33 進入手術室 14:36 麻醉開始 14:42 誘導結束 15:00 抗生素給藥 15:19 手術開始 18:00 抗生素給藥 18:22 手術結束 18:22 麻醉結束 18:30 送出病患 18:35 進入恢復室 19:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 手術 椎間盤切除術－腰椎 1 2 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 摘要__ 手術科部: 外科部 套用罐頭: 1.L5-S1 posterior fusion with Dyneses 2.L5-S1... 開立醫師: 陳國瑋 開立時間: 2010/08/20 18:25 Pre-operative Diagnosis L5-S1 HIVD s/p diskectomy, recurrence, right Post-operative Diagnosis L5-S1 HIVD s/p diskectomy, recurrence, right Operative Method 1.L5-S1 posterior fusion with Dyneses 2.L5-S1 diskectomy Specimen Count And Types nil Pathology nil Operative Findings 1.Dyneses system was implantated over L5-S1 level, TPS:45mm 2.There is scar tissue over previous operation field and the protruding disc is removed. Operative Procedures 1.ETGA and prone position 2.skin disinfection and draping 3.Localize the L5-S1 and made 2 paramedian linear incision 4.dissect soft tissue plane and identify the facet and transverse process of L5 and S1 5.Insert the TPS under C-arm fluroscope 6.connect the Dyneses system 7.Mid line linear incision and perform right L5 hemilaminectomy 8.diskectomy 9.close wounds in layers Operators VS 賴達明 Assistants R5 陳德福 R2陳國瑋 楊長壽 (M,1947/07/20,64y7m) 手術日期 2010/08/20 手術主治醫師 黃凱文 手術區域 東址 007房 02號 診斷 Chest pain 器械術式 R.F.A 叫病人前CALL 黃凱文 53201 手術類別 預定手術 手術部位 腹 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 3 紀錄醫師 蕭惠壬, 時間資訊 13:50 報到 14:20 進入手術室 14:22 麻醉開始 14:27 誘導結束 14:40 抗生素給藥 14:50 手術開始 15:50 麻醉結束 15:52 手術結束 16:00 送出病患 16:02 進入恢復室 17:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 肝腫瘤無線頻率電熱療法－大於３公分（含）小於５公分 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: Echo-guided RFA 開立醫師: 蕭惠壬 開立時間: 2010/08/20 15:07 Pre-operative Diagnosis Hepatocelular carcinoma Post-operative Diagnosis Hepatocelular carcinoma Operative Method Echo-guided RFA Specimen Count And Types nil Pathology Nil Operative Findings Operative Procedures Operators 黃凱文 Assistants 摘要__ 手術科部: 外科部 套用罐頭: Echo-guided RFA 開立醫師: 蕭惠壬 開立時間: 2010/08/20 15:39 Pre-operative Diagnosis Hepatocelular carcinoma Post-operative Diagnosis Hepatocelular carcinoma Operative Method Echo-guided RFA Specimen Count And Types nil Pathology Nil Operative Findings 1. Three recurrent HCCs at S#7(1.2cm), at S#6(2.0cm, 2.4cm) of liver. 2. Right rib bone metastasis 3.2 * 43.1 cm. 3. 3 cm cool-tip RF electrode probe; each tumor abration duration: 12 min Operative Procedures 1. ETGA. Supine position. 2. Disinfected and draped from nipple to suprapubic area. 3. Intra-operation echo was used for identified the tumor location and guided. 4. local injection 1% Xylocain, then RFA respectly. Operators 黃凱文 Assistants 摘要__ 手術科部: 外科部 套用罐頭: Echo-guided radiofrequency ablation(RFA) 開立醫師: 蕭惠壬 開立時間: 2010/08/20 16:09 Pre-operative Diagnosis Hepatocellular carcinoma s/p TAE, s/p RFA, with recurrence Post-operative Diagnosis Hepatocellular carcinoma s/p TAE, s/p RFA, with recurrence Operative Method Echo-guided radiofrequency ablation(RFA) Specimen Count And Types nil Pathology Nil Operative Findings 1. Three recurrent HCCs at S#7(1.2cm), at S#6(2.0cm, 2.4cm) of liver. 2. Right rib bone metastasis 3.2 * 4.3 cm. 3. 3 cm cool-tip RF electrode probe; each tumor abration duration: 12 min Operative Procedures 1. ETGA. Supine position. 2. Disinfected and draped from nipple to suprapubic area. 3. Intra-operation echo was used for identified the tumor location and guided. 4. Local anasthesia injection with 1% Xylocain, then RFA respectly. 5. Cover the wound with gauze. Operators 黃凱文 Assistants 陳錦進 (M,1961/08/18,50y6m) 手術日期 2010/08/20 手術主治醫師 王貞棣 手術區域 東址 001房 02號 診斷 Acute and chronic respiratory failure 器械術式 ORIF with Link anatomical plate 手術類別 緊急手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉漢平 ASA 3E 紀錄醫師 黃鼎鈞, 時間資訊 23:00 開始NPO 23:00 臨時手術NPO 09:54 通知急診手術 12:00 報到 12:20 進入手術室 12:30 麻醉開始 12:35 誘導結束 12:50 手術開始 13:00 開始輸血 16:00 16:45 麻醉結束 16:45 16:45 手術結束 16:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腕、跗、掌、蹠骨骨折開放性復位術 1 2 手術 石膏副木固定－長腿 1 0 手術 股骨幹骨折開放性復位術 1 1 L 記錄__ 手術科部: 骨科部 套用罐頭: 1. ORIF with Link anatomical plate (screw x10... 開立醫師: 黃全敬 開立時間: 2010/08/20 17:09 Pre-operative Diagnosis 1. left femoral supracondylar fracture with intra-articular involvement 2. left 4th metacarpal base fracture 3. left 3rd proximal phalanx fracture 4. laceration wound, left knee Post-operative Diagnosis 1. left femoral supracondylar fracture with intra-articular involvement 2. left 4th metacarpal base fracture 3. left 3rd proximal phalanx fracture 4. laceration wound, left knee Operative Method 1. ORIF with Link anatomical plate (screw x10) and artificial bone substitute grafting for supracondylar fracture 2. ORIF with K-wire x 3 for 4th metacarpal base fracture 3. buddy taping for 3rd proximal phalanx fracture 4. debridement Specimen Count And Types 1 piece About size:culture tube x2 Source:left knee laceration wound Pathology nil Operative Findings 1. left femoral supracondylar fracture, T shaped, with intra-articular involvement, comminuted with bony defect over fracture site 2. left 4th metacarpal base fracture, spiral 3. left 3rd proximal phalanx fracture 4. laceration wound, left knee Operative Procedures 1. anesthesia induction, supine position 2. debride and primary suture of the laceration wound over left knee 3. inflate the torniquet to 350 mmHg, curved skin incision over lateral distal thigh, lateral approach to the knee joint and femur 4. reduce the fracture site and temporarily fix with K-wire, then apply Link anatomical plate 5. graft the fracture site with artificial bone substitute 6. set a 1/8 H/V, deflate the torniqeut, N/S irrigation, hemostasis, close the wound in layerse 7. apply a long leg splint 8. ORIF for 4th metacarpal fracture with K-wire under C-arm control 9. buddy taping of the 3rd proximal phalanx with index finger Operators 王貞棣, Assistants 黃鼎鈞, 葉炳君, 黃全敬, 陳志偉, Indication Of Emergent Operation 鍾明英 (M,1981/02/24,31y0m) 手術日期 2010/08/21 手術主治醫師 陳晉興 手術區域 東址 018房 03號 診斷 Malignant neoplasm of anterior mediastinum 器械術式 Excision of subcutaneous tumor 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 郝政鴻, 時間資訊 15:00 報到 15:20 進入手術室 15:30 抗生素給藥 15:42 手術開始 16:15 手術結束 16:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 臉部以外皮膚及皮下腫瘤摘除術　２公分至４公分 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Tumor excision 開立醫師: 郝政鴻 開立時間: 2010/08/21 16:26 Pre-operative Diagnosis Subcutaneous tumor, back, left side Post-operative Diagnosis Subcutaneous tumor, back, left side Subcutaneous tumor, back, left side, suspect malignancy Operative Method Tumor excision Specimen Count And Types 1 piece About size:2x2 cm Source:back tumor, suspect malignancy Pathology Pending Operative Findings One firm movable subcutaneous tumor, whitish hypercellulity with capsuled was total excised Operative Procedures 1. prone position 2. disinfection and draped as sterile and under local anesthesia 3. Skin incsion and excised tumor 4. Hemostasis and closed wound in layers Operators 陳晉興 Assistants R3郝政鴻 Ri張君瑋 王克書 (M,1965/04/25,46y10m) 手術日期 2010/08/21 手術主治醫師 王國川 手術區域 東址 003房 03號 診斷 顱內出血(ICH) 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 4E 紀錄醫師 鍾文桂, 時間資訊 15:55 通知急診手術 20:00 進入手術室 20:00 報到 20:05 麻醉開始 20:10 誘導結束 20:50 手術開始 21:30 開始輸血 22:30 麻醉結束 22:30 手術結束 22:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱骨切除術，包括異物移除或減壓或神經切斷 1 1 手術 顱內壓監視置入 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 記錄__ 手術科部: 外科部 套用罐頭: 1. Suboccipital craniectomy. 開立醫師: 鍾文桂 開立時間: 2010/08/22 00:13 Pre-operative Diagnosis 1. Obstructive hydrocephalus. 2. Intraventricular hemorrhage. 3. CNS infection. Post-operative Diagnosis 1. Obstructive hydrocephalus. 2. Intraventricular hemorrhage. 3. CNS infection. Operative Method 1. Suboccipital craniectomy. 2. Insertion of ICP monitor via left Frazier point. 3. Insertion of external ventricular catheter to 4 th ventricle. Specimen Count And Types 1 piece About size:10 cc Source:CSF from 4th ventricle and lateral ventricle. Pathology Nil. Operative Findings 1. Easy oozing operative field. 2. Turbid pinkish CSF from 4th ventricle( about 5 mmH2O), clear colorless CSF from lateral ventricle( about 10 mmH2O). 3. Romoval of right Kocher EVD due to catheter obstruction and IVH. 4. Bacterial coated EVDs were inserted. Operative Procedures Under ETGA, the patient was placed in prone position, and the head was fixed in Mayfield 3-pin head holder. After shaving and disinfection, and draping, a linear incision was made at left Frazier point. The EVD was inserted after burr hole and durotomy. The previous operative wound at suboccipital region was incised and dissected. The previous craniotomy skull bone plate was removed. After durotomy, the EVD was inserted at 4th ventricle. Finally, the wound was closed in layers. Operators V.S. 王國川 Assistants R5 鍾文桂 Indication Of Emergent Operation 陳明順 (M,1962/05/26,49y9m) 手術日期 2010/08/21 手術主治醫師 蔡翊新 手術區域 東址 003房 02號 診斷 Cerebral aneurysm 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 4E 紀錄醫師 柯安達, 時間資訊 15:53 通知急診手術 17:05 報到 17:05 進入手術室 17:10 麻醉開始 17:15 誘導結束 17:25 抗生素給藥 17:40 手術開始 18:20 麻醉結束 18:20 手術結束 18:25 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 顱內壓監視置入 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 蔡翊新 開立時間: 2010/08/21 18:13 Pre-operative Diagnosis Right AICA aneurysm rupture with SAH and acute hydrocephalus. Post-operative Diagnosis Right AICA aneurysm rupture with SAH and acute hydrocephalus. Operative Method Right Kocher EVD for ICP monitoring. Specimen Count And Types 3 tubes of CSF, sent for routine, BCS and bacterial culture. Pathology Nil. Operative Findings CSF: clear, pressure > 30 cmH2O. Depth of EVD: 6 cm in frontal horn of right lateral ventricle. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 5 cm linear, right frontal, corresponded to the location of right frontal horn. Raney clips were applied to the scalp edge for temporary hemostasis. 5. After the scalp flap was retracted by a self-retaining retractor, a burr hole was made and the dura was tented by 2 stitches. 6. The dura was opened by a nib incision. Rt lateral ventricle was tapped by a ventricular needle, then a 6 cm segment of the ventricular catheter was introduced into the ventricle. The outer end of the catheter was connected to a reservoir bag. 7. Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 8. Course of the surgery: smooth. Operators VS蔡翊新 Assistants R4曾峰毅R1柯安達 Indication Of Emergent Operation 黃彩雲 (F,1928/09/09,83y6m) 手術日期 2010/08/22 手術主治醫師 蔡翊新 手術區域 東址 003房 04號 診斷 Major trauma rated 16 or above on the severeity scale ( Injury severeity score >=16 ) 器械術式 Brain tumor Crainotomy(Others)，ICP monitoring 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 4E 紀錄醫師 曾峰毅, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 00:10 進入手術室 00:26 麻醉開始 00:35 誘導結束 00:53 開始輸血 01:00 抗生素給藥 01:09 手術開始 03:50 手術結束 03:50 麻醉結束 04:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦內血腫清除術 1 1 R 手術 顱內壓監視置入 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 記錄__ 手術科部: 外科部 套用罐頭: 1. Decompressive craniectomy, right frontal-t... 開立醫師: 鍾文桂 開立時間: 2010/08/22 00:16 Pre-operative Diagnosis 1. Right frontal-temporal intracerebral hemorrhage. Head injury with right frontotemporal contusional hemorrhage, subdural hemorrhage and subarachnoid hemorrhage. Brain swelling. 2. Brain swelling. Post-operative Diagnosis 1. Right frontal-temporal intracerebral hemorrhage. Head injury with right frontotemporal contusional hemorrhage, subdural hemorrhage and subarachnoid hemorrhage. Brain swelling. 2. Brain swelling. Operative Method 1. Decompressive craniectomy, right frontal-temporal-parietal. 1. Decompressive craniectomy, right fronto-temporo-parietal, for removal of SDH and right temporal ICH. 2. Implantation of ICP monitor. 3. Removal and intracerebral hemorrhage. Specimen Count And Types nil Pathology Nil. Operative Findings The dura was slightly tense after craniectomy and SDH gushed out upon dural opening. Initial ICP reading was 4 mmHg. Diffuse SAH and SDH about 1 cm in thickness were noted. Right temporal tip contusional ICH, 5 x 3 x 3 cm, was evacuated. Bleeding tendency was noted during the whole operation. ICP after skin closure was 1 mmHg. Operative Procedures 1. Anesthesia: endotracheal intubation, general. 2. Skin preparation and disinfection. 3. Skin incision: trauma flap at right F-T-P region. 4. A burr hole was made at right temporal area just above the zygomatic arch. SDH was partially removed for initial decompression. ICP monitor was inserted. 5. Craniectomy: 12 x 10 cm, right F-T-P, by making 5 burr holes. The temporal bone was excised down to the base for better decompression of temporal lobe. 6. Dural incision: curvilinear along the craniectomy window and reflected anteriorly. 7. Evacuation of SDH and right temporal contusional ICH. 8. Hemostasis: the rough surface of the brain was packed with Surgicel. The subdural oozing was packed with Gelfoam. 9. Duroplasty: with a piece of DuroForm separated into 3 parts. 10.Skin closure: Galeal closure by continuous suture with 2-0 Vicryl and skin by continuous suture with 3-0 Nylon. 11.Drain: two epidural CWV. 12.Blood transfusion: PRBC 2U, Platelet 24U. Blood loss: 300 ml. 13.Course of surgery: smooth. Operators V.S. 蔡翊新 Assistants R鍾文桂 曾峰毅 Indication Of Emergent Operation 阮敏寬 (M,1941/10/23,70y4m) 手術日期 2010/08/22 手術主治醫師 賴達明 手術區域 東址 001房 02號 診斷 Vertebral column tuberculosis 器械術式 Spinal fusion posterior 手術類別 緊急手術 手術部位 頭、頸 傷口分類 污染 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3E 紀錄醫師 李柏穎, 時間資訊 23:33 臨時手術NPO 23:33 開始NPO 09:30 通知急診手術 15:55 進入手術室 16:00 麻醉開始 16:50 誘導結束 17:10 抗生素給藥 17:21 手術開始 18:30 開始輸血 20:27 抗生素給藥 22:55 手術結束 22:55 麻醉結束 23:05 送出病患 00:05 離開恢復室 23:05 進入恢復室 醫令資訊 類別 名稱 量 刀 側 手術 骨或軟骨移植術 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 記錄__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 曾峰毅 開立時間: 2010/08/22 22:17 Pre-operative Diagnosis T4/5 tuberculosis spondylodiskitis, status post diskectomy and fusion with autologous bone graft, recurrene Post-operative Diagnosis T4/5 tuberculosis spondylodiskitis, status post diskectomy and fusion with autologous bone graft, recurrene Operative Method T4/5 abscess draiange and debridement, fusion with autologous bone graft, fixation with transpedicular screws at T2, T3, T6, and T7. Specimen Count And Types Several fragments of drided tissue was sent for pathology. Pathology Nil Operative Findings Caseous-like tissue was noted at previuos fusion site, more at left, and compressed the cord from anterior tightly. Transpedicular screws, A-spine, 4.5x30mm was insrted at bilateral pedicles of T2 and T3, and right pedicle at T6; 5.0x30mm at left pedicle of T6, 5.0x35mm at bilateral pedielces of T7. 17cm rod was put at right, and 15cm at left. One cross-link was set as well. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After C-arm localization, we made skin incision along previous surgical wound and dissected bilateral paraspinal muscle from T2 to T6. Transpedicular screws was inserted into bilateral laminae of T2, T3, T5, and T6. Spinal process and laminae of T4/5 was removed for autologous bone graft. Previuos fusion site between T4/5 was debrided again, packed with autologous bone graft. Rod was set, and cross-link was put. After hemostasis and one hemovac inserted, we closed the wound in layers. With endotracheal general anaesthesia, the patient was put in prone position. After C-arm localization, we made skin incision along previous surgical wound and dissected bilateral paraspinal muscle from T2 to T6. Transpedicular screws was inserted into bilateral laminae of T2, T3, T5, and T6. Spinal process and laminae of T4/5 was removed for autologous bone graft. In addition, autologous bone graft was harvested from left iliac crest. Previuos fusion site between T4/5 was debrided again, packed with autologous bone graft. Rod was set, and cross-link was put. After hemostasis and one hemovac inserted, we closed the wound in layers. With endotracheal general anaesthesia, the patient was put in prone position. After C-arm localization, we made skin incision along previous surgical wound and dissected bilateral paraspinal muscle from T2 to T6. Transpedicular screws was inserted into bilateral laminae of T2, T3, T5, and T6. Spinal process and laminae of T4/5 was removed for autologous bone graft. In addition, autologous bone graft was harvested from left iliac crest. Previuos fusion site between T4/5 was debrided again, packed with autologous bone graft. Rod was set, and cross-link was put. After hemostasis and two hemovac inserted, we closed the wound in layers. With endotracheal general anaesthesia, the patient was put in prone position. After C-arm localization, we made skin incision along previous surgical wound and dissected bilateral paraspinal muscle from T2 to T6. Transpedicular screws was inserted into bilateral laminae of T2, T3, T5, and T6. Spinal process and laminae of T4/5 was removed for autologous bone graft. In addition, autologous bone graft was harvested from left iliac crest. Previuos fusion site between T4/5 was debrided again, packed with autologous bone graft. Rod was set, and cross-link was put. After hemostasis and two hemovac inserted, we closed the wound in layers. With endotracheal general anaesthesia, the patient was put in prone position. After C-arm localization, we made skin incision along previous surgical wound and dissected bilateral paraspinal muscle from T2 to T7. Transpedicular screws was inserted into bilateral laminae of T2, T3, T6, and T7. Spinal process and laminae of T4/5 was removed for autologous bone graft. In addition, autologous bone graft was harvested from left iliac crest. Previuos fusion site between T4/5 was debrided again, packed with autologous bone graft. Rod was set, and cross-link was put. After hemostasis and two hemovac inserted, we closed the wound in layers. Operators VS 賴達明 Assistants R5 陳德福 R4 曾峰毅 R1 李柏穎 Indication Of Emergent Operation 王淑珍 (F,1960/04/27,51y10m) 手術日期 2010/08/22 手術主治醫師 賴達明 手術區域 東址 001房 01號 診斷 Cervical cancer 器械術式 Spinal fusion posterior 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3E 紀錄醫師 李柏穎, 時間資訊 07:20 通知急診手術 22:20 開始NPO 22:20 臨時手術NPO 08:40 報到 08:50 進入手術室 08:55 麻醉開始 09:20 誘導結束 09:40 抗生素給藥 10:08 手術開始 11:20 開始輸血 13:30 抗生素給藥 15:15 手術結束 15:15 麻醉結束 15:30 送出病患 15:30 進入恢復室 16:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 惡性病髓腫瘤切除術 1 1 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 2 摘要__ 手術科部: 外科部 套用罐頭: 1.T1-4 posterior decompression and fusion wit... 開立醫師: 陳德福 開立時間: 2010/08/22 15:45 Pre-operative Diagnosis Cervical cancer with T2 metastasis, cord compression Post-operative Diagnosis Cervical cancer with T2 metastasis, cord compression Operative Method 1.T1-4 posterior decompression and fusion with TPS 2.T2 body tumor excision Specimen Count And Types 1 piece About size:2*1*2CM Source:T2 TUMOR Pathology pending Operative Findings 1.There is a osteolytic tumor at the T2 body with spinal cord compression. The epidural extension is noticed and the tumor was removed as much as possible via T2 bilateral transpedicle route. The T1-3 laminectomy was performed. One bone cement was inserted into the T2 body as artifical body cage. 2.6 TPS over T1-3-4 was implantated [30mm] with 2 rods and 1 cross link. Operative Procedures Under ETGA and prone position, the skin disinfection and draping were performed as usual. One linear incison along midline was done and the paraspinous muscle was displaced laterally. The C7-T4 was exposed and the T1-3 laminectomy was done. The TPS over T1-3-4 was implanted via C-arm fluoroscopic guidance. The T2 body tumor was removed with currettage and aligator assisted via transpedicle route. One 1.5*1.2*1.5cm in sized bone cement was inserted at the T2 tumor cavity. One cross link and 2 rods were set up. One epidural hemovac was left in situ. The wound was closed in layers. Operators VS 蕭輔仁 Assistants R5 陳德福 R1 李柏穎 Indication Of Emergent Operation 陳靜勳 (F,1976/05/29,35y9m) 手術日期 2010/08/23 手術主治醫師 曾漢民 手術區域 東址 003房 01號 診斷 Brain Tumor 器械術式 Transsphenoid biopsy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 07:55 報到 08:00 進入手術室 08:10 麻醉開始 08:20 誘導結束 08:30 抗生素給藥 08:55 手術開始 09:32 手術結束 09:32 麻醉結束 09:55 送出病患 09:58 進入恢復室 11:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 經由蝶竇之腦下垂體瘤切除 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: Hypophysectomy---Transphenoid 開立醫師: 游健生 開立時間: 2010/08/23 10:19 Pre-operative Diagnosis Sphenoid bone tumor Post-operative Diagnosis Sphenoid bone tumor Operative Method Trans-sphenoid approach for sphenoid bone tumor biopsy Specimen Count And Types 1 piece About size:a few pieces Source:sphenoid bone body tumor Pathology pending Operative Findings Whitish hard tumor with sand-like content was noted at sphenoid bone body. It was well vascularized. The margin between tumor and vomer bone was not clear. Operative Procedures Under ETGA, patient was put into supine with head tilted 30 degree to left. The mucosa of oral and nasal cavity with aqueous povidone-iodine tincture. The nasal areas were covered by a sterilized adhesive plastic sheet. The nasal submucosa at septum and floor and the subperiostium at upper alveola were infiltrated with 1:100 epinephrine solution. The mucosa of nasal septum was incised and dissected away from the septal cartilage from anterior to posterior and displaced laterally by a long nasal speculum. A Hardys nasal speculum was applied to displace the nasal mucosa laterally and keep the nasal cavity open constantly for the exposure of the vomer bone and the anterior wall of the sphenoid bone body. We drilled off the anterior wall and the tumor was exposed. Tumor biopsy was done with osteotome and currette. Hemostasis was achieved with bone wax. The Hardys nasal speculum was removed and the nasal mucosa returned to its normal position. Right nasal cavities was tightly packed with a finger segment of latex gloove soaked with Better-iodine ointment. Operators VS 曾漢民 Assistants R6 陳睿生 R3 游健生 鄭明澤 (M,1959/09/12,52y6m) 手術日期 2010/08/23 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Meningioma 器械術式 Retrosigmoid app, left 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 古恬音, 時間資訊 00:00 臨時手術NPO 07:35 報到 08:05 進入手術室 08:10 麻醉開始 08:30 誘導結束 08:52 抗生素給藥 08:53 手術開始 11:52 抗生素給藥 15:00 麻醉結束 15:00 手術結束 15:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Left retrosigmoid approach for Simpson grade ... 開立醫師: 胡朝凱 開立時間: 2010/08/23 15:20 Pre-operative Diagnosis Left petroclival meningioma Post-operative Diagnosis Left petroclival meningioma Operative Method Left retrosigmoid approach for Simpson grade III tumor excision Specimen Count And Types nil Pathology pending Operative Findings 1.One whitish, elastic but easy sucubal tumor measured about 4.5 x 4.8 x4.6 cm arised from left petroclival area and upward extension via Meckels cave to supratentorial area that compressed the brain stem tightly. 2.Some small vessels were encased inside the tumor 3.The 5th, 7th, 8th, and lower cranial nerves were identified and preserved. 4.Unintended 4th nerve broken was noted. Operative Procedures 1.ETGA, three forth prone position 2.Left retro-sigmoid skin incision 3.Devided neck muscle 4.Identified asterion 5.Made burr holes 6.Craniotomy 7.Y shape dural opening 8.CSF drainage after open cisterna magnum 9.Retract cerebellum downward 10.Identified tumor 11.Devascularization 12.Use CUSA to remove tumor piece by piece 13.Pull out tumor and devided it, a small piece of supratentorial tumor was left in situ 14.Hemostasis 15.Close dura with one piece of fascia 16.Close wound in layers Operators 曾漢民 Assistants 胡朝凱, 古恬音 鄭進財 (M,1945/11/02,66y4m) 手術日期 2010/08/23 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Brain metastasis 器械術式 suboccipital app 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 10:20 報到 10:25 進入手術室 10:30 麻醉開始 11:00 誘導結束 11:30 抗生素給藥 11:55 手術開始 14:30 抗生素給藥 15:06 麻醉結束 15:06 手術結束 15:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除－手術時間在４小時以內 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Left suboccipital craniotomy for gross total ... 開立醫師: 游健生 開立時間: 2010/08/23 15:44 Pre-operative Diagnosis Left cerebellar tumor, favor lung cancer metastasis Post-operative Diagnosis Left cerebellar tumor, favor lung cancer metastasis Operative Method Left suboccipital craniotomy for gross total tumor excision Specimen Count And Types 1 piece About size:a few pieces Source:tumor Pathology Pending Operative Findings The tumor was noted at left cerebellum about 2cm beneath cortex identified by intra-operative ultrasound. It had cystic and solid part. The solid part was yellowish and fragile while the cystic content was light-yellowish. The tumor was totally removed along with the capsule. The cerebellum was slack after tumor removal. Operative Procedures Under ETGA, patient was put into prone position with neck flexed and head fixed with Mayfield headholder. After shaving, we disinfected and draped the operation field as usual. A hockey-stick scalp incision was made 2cm above inion, from left lateral to midline and downward to C3 level. After reflexing the skin flap inferiolaterally, we harvested a muscle facsia for later duroplasty. Neck muscles were detached from superior nuchal line to expose the suboccipital cranium. 4 burrholes were made followed by 4 x 4cm craniotomy. Transverse sinus was exposed with minor venous oozing stopped by gelfoam packing. Intra-operative ultrasound was used to identify the tumor followed by cruciate durotomy. The left cerebellum buldged out after durotomy. A transverse 2cm corticotomy was performed. We exposed the tumor with gentle retraction. Then, we removed the tumor in pieces with tumor forcep. Hemostasis was achieved with bipolar electrocautery and Surgicel packing. The dura was repaired with the facsia graft and continuous 4-0 prolene sutures. The bone flap was fixed back with 4 wires and a subgaleal CWV was placed. Wound was closed in layers. Operators VS 賴達明 Assistants R6 陳睿生 R3 游健生 郭世強 (M,1985/08/03,26y7m) 手術日期 2010/08/23 手術主治醫師 蕭輔仁 手術區域 東址 001房 01號 診斷 C5- C7 level fracture with unspecified spinal cord injury, closed 器械術式 Anterior Spinal fusion (Others) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 鍾文桂, 時間資訊 22:49 臨時手術NPO 22:49 開始NPO 07:49 通知急診手術 08:25 報到 08:45 進入手術室 08:50 麻醉開始 09:45 誘導結束 10:00 抗生素給藥 10:17 手術開始 13:30 抗生素給藥 15:00 手術結束 15:00 麻醉結束 15:05 送出病患 15:10 進入恢復室 16:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術－頸椎 1 1 R 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 記錄__ 手術科部: 外科部 套用罐頭: 1. Miscrosurgical diskectomy, C5/6, right ant... 開立醫師: 鍾文桂 開立時間: 2010/08/23 15:49 Pre-operative Diagnosis Herniated intervertertebral disc, C5-6. Post-operative Diagnosis Herniated intervertertebral disc, C5-6. Operative Method 1. Miscrosurgical diskectomy, C5/6, right anterior approach. 2. Anterior interbody fusion with allograft cage, C5/6. Specimen Count And Types nil Pathology Nil. Operative Findings 1. A right sided ruptured disc through posterior longitudinal ligament to epidural space. 2. 7 mm allograft bone material and cage were implanted at C5/6 level. 3. Intact and slack dura sac after decompression. Operative Procedures Under ETGA, the patient was placed in supine position and the neck was extended. A linear horizontal incision was made in right anterior neck at cricoid cartilage level. After incising the platysma muscle and subplatysmal dissection, we dissected the anterior border of sternocledomastoid muscle until we reached the prevertebral space. The bilateral longus collis muslce were splitted by self retractor. The C5/6 levels were localized by intraoperative fluoroscope. Microsurgical diskectomy was completed with curretes and high speed cutting drill. The allograft cage was implanted at C5/6 level and its location was ensured by intraoperative fluoroscope. After placing a pervertebral CWV drain, the wound was closed in layers. Operators V.S. 蕭輔仁 Assistants R5鍾文桂 R1 吳俊毅. Indication Of Emergent Operation 饒文忠 (M,1967/08/20,44y6m) 手術日期 2010/08/23 手術主治醫師 郭源松 手術區域 東址 000房 號 診斷 Acute respiratory distress syndrome following trauma, surgery, shock 器械術式 ECMO wound site debridement 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 趙安怡 ASA 4 紀錄醫師 官振翔, 時間資訊 13:36 進入手術室 13:40 麻醉開始 13:43 誘導結束 13:46 手術開始 14:15 手術結束 14:15 麻醉結束 14:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 區域筋膜切除術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Debridement 開立醫師: 官振翔 開立時間: 2010/08/23 14:25 Pre-operative Diagnosis RIght inguinal wound, suspect lymph leakage Post-operative Diagnosis RIght inguinal wound, suspect lymph leakage Operative Method Debridement Specimen Count And Types Culture*2 Pathology Nil Operative Findings 1. Some necrotic tissue along with granulation noted over right inguinal wound 2. One 4x3cm eschar noted over right arm Operative Procedures Under general anesthesia, the patient lied in supine position. Antiseptics applied and draped as usual. Debridement performed. Normal saline irrigation. Wound closure with one CWV drain Operators 郭源松, Assistants 官振翔, 陳明順 (M,1962/05/26,49y9m) 手術日期 2010/08/23 手術主治醫師 廖漢文 手術區域 東址 000房 號 診斷 Cerebral aneurysm 器械術式 NEURO T.A.E 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 王永彬 ASA 3E 時間資訊 13:00 通知急診手術 13:35 麻醉開始 13:45 誘導結束 13:47 臨時手術NPO 13:47 開始NPO 15:45 麻醉結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 許輪 (M,1956/04/25,55y10m) 手術日期 2010/08/23 手術主治醫師 蔡翊新 手術區域 東址 019房 02號 診斷 Intracerebral hemorrhage (ICH) 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3E 紀錄醫師 古恬音, 時間資訊 12:00 開始NPO 12:00 臨時手術NPO 18:53 報到 19:00 進入手術室 19:05 麻醉開始 19:15 抗生素給藥 19:15 誘導結束 19:46 手術開始 21:10 麻醉結束 21:10 手術結束 21:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱內壓監視置入 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 蔡翊新 開立時間: 2010/08/23 20:38 Pre-operative Diagnosis Right thalamic ICH with IVH and acute hydrocephalus. Post-operative Diagnosis Right thalamic ICH with IVH and acute hydrocephalus. Operative Method Left Kocher point EVD for ICP monitoring. Specimen Count And Types 3 tubes of CSF, sent for routine, BCS and bacterial culture. Pathology Nil. Operative Findings CSF: sanguinous, pressure: 15 cmH2O Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: supine with head rotated to right. 3.Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4.Incision: 5 cm linear, left frontal, corresponded to the location of left frontal horn. Raney clips were applied to the scalp edge for temporary hemostasis. 5.After the wound was opened by self-retaining retractor, a burr hole was made at left Kocher point and the dura was tented by 2 stitches. 6.The dura was opened by a nib incision. Left lateral ventricle was tapped by a ventricular needle, then a 6 cm segment of the EVD catheter was introduced into the ventricle. The outer end of the catheter was connected to a reservoir bag. 7.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 8.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R6胡朝凱R3古恬音 Indication Of Emergent Operation 楊家福 (M,1924/05/07,87y10m) 手術日期 2010/08/24 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Fracture, lumbar-spine 器械術式 L1 laminectomy, + T12-L2 TPS 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 09:30 報到 09:55 進入手術室 10:00 麻醉開始 10:15 誘導結束 10:50 抗生素給藥 11:07 手術開始 13:50 抗生素給藥 14:15 開始輸血 15:57 手術結束 15:57 麻醉結束 16:05 送出病患 16:10 進入恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 手術 椎弓切除術（特壓）－二節以內 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: T11, 12, L2 TPS and corpectomy with bone ceme... 開立醫師: 鍾文桂 開立時間: 2010/08/24 16:25 Pre-operative Diagnosis L1 compression fracture Post-operative Diagnosis L1 compression fracture Operative Method T11, 12, L2 TPS and corpectomy with bone cement impaction Specimen Count And Types 5 ml tissue from corpectomy Pathology Frozen pathology: degenerative tissue Operative Findings 1.The bone was osteoporotic 2.The L1 hight decreased and retropulsion that compressed the spinal cord tightly 3.Hypertrophic flavum ligment and subfacet ligment Operative Procedures 1.ETGA, prone 2.Midline incision at T11 to L2 level 3.Devided paravertebral muscle group 4.Identified T and L facet joint 5.TPS screws insertion 6.L1 laminectomy 7.Remove left L1 facet joint 8.L1 corpectomy 9.Insert bone cement with one screw insertion 10.Fixed rods and cross links 11.set one hemovac drain 12.close wound in layers Operators V.S. 曾漢民 Assistants R6胡朝凱 R5鍾文桂 相關圖片 林怡伶 (F,1980/06/20,31y8m) 手術日期 2010/08/24 手術主治醫師 曾漢民 手術區域 西址 033房 01號 診斷 Benign neoplasm of scalp 器械術式 Excision of neuroma 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 09:50 進入手術室 10:00 麻醉開始 10:05 手術開始 11:00 手術結束 11:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 肌肉或深部組織腫瘤切除術及異物取出術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Scalp tumor excision 開立醫師: 游健生 開立時間: 2010/08/24 13:43 Pre-operative Diagnosis Scalp tumor, right forehead Post-operative Diagnosis Scalp tumor, right forehead Operative Method Scalp tumor excision Specimen Count And Types 1 piece About size:one piece Source:scalp tumor Pathology Pending Operative Findings A fat-like soft tumor was noted beneath facial muscle. Operative Procedures After shaving, we disinfected and draped the operation field as usual. After local anethesia, we made a transverse scalp incision over the tumor. We dissected in layers and exposed the tumor. We removed it after separating it from surrounding tissue with blunt dissection. Wound was closed after irrigation with normal saline. Operators VS 曾漢民 Assistants R3 游健生 黃陳慧蓁 (F,1940/04/28,71y10m) 手術日期 2010/08/24 手術主治醫師 曾勝弘 手術區域 東址 005房 號 診斷 Juvenile Parkinson 器械術式 change IPG 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:05 進入手術室 08:10 麻醉開始 08:20 誘導結束 08:30 抗生素給藥 08:43 手術開始 09:32 手術結束 09:32 麻醉結束 09:37 送出病患 09:40 進入恢復室 10:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦脊髓液分流管重置 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Re-implantation of neurostimulator for deep b... 開立醫師: 鍾文桂 開立時間: 2010/08/24 09:52 Pre-operative Diagnosis Parkinsons disease. Post-operative Diagnosis Parkinsons disease. Operative Method Re-implantation of neurostimulator for deep brain stimulation. Specimen Count And Types nil Pathology Nil. Operative Findings Re-implantation of Medtronic Kinetra Neurostimulator 7428 serial No. NFD112389H. Implantation site: left anterior chest. Operative Procedures Under ETGA, the patient was placed in supine position. The left anterior chest was exposed and disinfected. After draping,the previous operative wound was incised and dissected. We dissected out the pocket which the neurostimulator was implanted. Then, the neurostimulator was removed from the leads. A new neurostimulator was connected to the leads. Finally, the wound was closed in layers. Operators V.S. 曾勝弘. Assistants R5 鍾文桂 邢秀美 (F,1953/02/28,59y0m) 手術日期 2010/08/24 手術主治醫師 曾勝弘 手術區域 西址 039房 01號 診斷 Carpal tunnel syndrome 器械術式 Decompression of mediun nerve 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 10:25 進入手術室 10:40 麻醉開始 10:45 手術開始 11:05 手術結束 11:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 正中神經或尺神經腕部減壓術–單側 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Carpal Tunnel Syndrome 開立醫師: 游健生 開立時間: 2010/08/24 11:35 Pre-operative Diagnosis Left carpal tunnel syndrome Post-operative Diagnosis Left carpal tunnel syndrome Operative Method Carpal Tunnel Syndrome Specimen Count And Types nil Pathology Nil Operative Findings The median nerve was compressed by transverse carpal ligament. It was well decompressed after ligament division. Operative Procedures 1.The hand and forearm were sterilized with povidone-iodine tincture, then covered with stockinet. 2.local 2% Xylocaine solution was injected 3.Verticle incision from vertical palmar crease to transverse wrist crease. 4.The palmaris longus tendon was identified, then the plamar aponeurosis was cut longitidinally along the ulnar side of the palmaris longus tendon. 5.The median nerve was identified beneath the palmars longus tendon. Under direct vision, the transverse carpal ligament was divided until no more pressure on the median nerve could be palpated. 6. The skin was closed by interrupted suture with 4/0 nylon. 7. The hand and wrist were draped with fluffy dressing and elastic bandage. Operators VS 曾勝弘 Assistants R3 游健生 摘要__ 手術科部: 外科部 套用罐頭: Carpal Tunnel Syndrome 開立醫師: 游健生 開立時間: 2010/08/24 15:52 Pre-operative Diagnosis Left carpal tunnel syndrome Post-operative Diagnosis Left carpal tunnel syndrome Operative Method Carpal Tunnel Syndrome Left median nerve decompression Specimen Count And Types nil Pathology Nil Operative Findings The median nerve was compressed by transverse carpal ligament. It was well decompressed after ligament division. Operative Procedures 1.The hand and forearm were sterilized with povidone-iodine tincture, then covered with stockinet. 2.local 2% Xylocaine solution was injected 3.Verticle incision from vertical palmar crease to transverse wrist crease. 4.The palmaris longus tendon was identified, then the plamar aponeurosis was cut longitidinally along the ulnar side of the palmaris longus tendon. 5.The median nerve was identified beneath the palmars longus tendon. Under direct vision, the transverse carpal ligament was divided until no more pressure on the median nerve could be palpated. 6. The skin was closed by interrupted suture with 4/0 nylon. 7. The hand and wrist were draped with fluffy dressing and elastic bandage. Operators VS 曾勝弘 Assistants R3 游健生 徐銘鴻 (M,1981/02/26,31y0m) 手術日期 2010/08/24 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Tethered cord syndrome 器械術式 untethering 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 2 紀錄醫師 曾峰毅, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:10 進入手術室 08:15 麻醉開始 08:25 誘導結束 08:55 抗生素給藥 09:19 手術開始 12:20 抗生素給藥 12:35 手術結束 12:35 麻醉結束 12:45 送出病患 12:50 進入恢復室 15:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎內脊髓內腫瘤切除術 1 1 手術 良性病髓腫瘤切除術 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 記錄__ 手術科部: 外科部 套用罐頭: L4/5 laminectomy for spinal cord detethering ... 開立醫師: 曾峰毅 開立時間: 2010/08/24 13:10 Pre-operative Diagnosis Tethered cord Tethered cord syndrome due to intradural (intramedullary) lipoma and filum terminale lipoma Post-operative Diagnosis Tethered cord Tethered cord syndrome due to intradural (intramedullary) lipoma and filum terminale lipoma Operative Method L4/5 laminectomy for spinal cord detethering and partial excision of intramedullary lipoma at conus medullaris and filum terminalis Spinal cord detethering by partial excision of intramedullary lipoma, dorsal type at conus medullaris and excision of filum terminalis lipoma via L4/5 laminectomy Specimen Count And Types Intramedullary lipoma was sent for patholgy in several pieces, and filum terminalis lipoma was sent in one fragment. Pathology Pending Operative Findings One well defined lipoma arised from subcutaneous at S1 level extending into subdural space at L5 level, infiltrating dura, and involving spinal cord at L4-5 level. Conus medullaris was enalrged and expanded by lipoma, and was located at L5/S1 level before detethered. Spinal bifida at S1 with deformity of L5 spinous process and laminae was identified. Posterior elements of S1 was agenesis and replaced by one piece of chondral tissue. One lipoma was noted as well at filum terminalis. Cord tethered site was at dorsal aspect of L5 level. After detethering, the cord was free from tension, and conus medullaris was located at L4/5 level. One well defined lipoma arised from subcutaneous at S1 level extending into subdural space at L4 and L5 levels, infiltrating dura, and involving dorsal spinal cord at L4-5 level. The conus medullaris was low-lying and enalarged and expanded by lipoma, and was located at L5/S1 level before detethered. Spinal bifida at S1 with deformity of L5 spinous process and laminae was identified. The spinous process was deviated to the left side and the left lamina of L5 was vertically deformed. The posterior elements of S1 and below was agenesis and replaced by one piece of chondral tissue. One lipoma was noted as well at filum terminalis near the cul-de-sac of thecal sac. There were two cord tethered sites, one was at dorsal aspect of L5 level, the othere was at the caudal end of the spinal cord caused by filum terminale lipoma. After detethering, the cord was free from tension, migrated upward and ventrally, and the conus medullaris was located at L4/5 level. Operative Procedures With endotracheal general anaestehsia, the patient was put in prone position. After back scrubbed, disinfected, and then draped, we made one midline skin incision from L4 to S1. We dissected the paraspinal muscle to expose bilateral laminae of L4 and L5. L4-5 laminectomy was done first with rongeur and Kerrison rongeur to identified the normal dura at L4 level. We dissected epidurally and caudally. Bifida of S1 was identified well. Midline durotomy wad made, and cord was detethered meticulous subdurally. Conus medullaris lipoma was removed partially piece by piece. Filum terminalis was transected, and lipoma in it was removed. Dura was closed in water-tight fashion with 4-0 prolene. After hemostasis, we put one submuscullar CWV drain and closed the wound in layers. With endotracheal general anaestehsia, the patient was put in prone position. After back scrubbed, disinfected, and then draped, we made one midline skin incision from L4 to S2. We dissected the paraspinal muscle to expose bilateral laminae of L4 and L5. L4-5 laminectomy was done first with rongeur and Kerrison rongeur to identified the normal dura at L4 level. Under microscopic view, we dissected epidurally and caudally. Bifida of S1 was identified well and the cartilageous spinous process of S1 was removed. Midline durotomy wad made at L4 level, and lipoduroneural junction was identified and traced bilaterally caudally to the end of thecal sac. The cord was detethered meticulously. The conus medullaris lipoma was removed partially piece by piece. Filum terminalis was transected, and the lipoma at the end of it was removed for complete untethering. Dura was closed in water-tight fashion with 4-0 prolene. After hemostasis, we put one submuscular CWV drain and closed the wound in layers. Operators VS 郭孟菲 Assistants R4 曾峰毅 王秀英 (F,1961/08/09,50y7m) 手術日期 2010/08/24 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Spondylolisthesis 器械術式 L4/5 TPS 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 07:47 報到 08:05 進入手術室 08:15 麻醉開始 08:40 誘導結束 09:00 抗生素給藥 09:25 手術開始 12:00 抗生素給藥 12:25 手術結束 12:25 麻醉結束 12:29 送出病患 12:32 進入恢復室 14:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 手術 椎間盤切除術－腰椎 1 2 摘要__ 手術科部: 外科部 套用罐頭: 1.L4~5 TPS and L4 partial laminectomy 2.L4-5 ... 開立醫師: 陳德福 開立時間: 2010/08/24 12:38 Pre-operative Diagnosis L4-5 spndylolisthesis with radiculopathy Post-operative Diagnosis L4-5 spndylolisthesis with radiculopathy Operative Method 1.L4~5 TPS and L4 partial laminectomy 2.L4-5 diskectomy Specimen Count And Types nil Pathology nil Operative Findings 1.There is grade II spondylolithesis over L4-5 and the spinal stenosis is noticed. The left side lumbar nerve root is encased with adhesive tissue and the L4-5 protruding disc is removed. Autologus bone fusion at the interbody over L4-5 is done. 2. TPS [45mm] over L4-5 and 2 rods was set smoothly. Operative Procedures 1.ETGA, prone 2.Midline incision at L3~S1 level 3.Detach paravertebral muscle groups 4.Expose L4 and L5 lamina and facets 5.TPS screws insertion 6.L4 laminectomy and decompression of neural foramen with Kerrison pounch 7.L4-5 diskectomy and Fix rods 8.Lateral fusion after decortication of L4~5 lamina 9.Set one hemovac drain then close wound in layers. Operators 賴達明 Assistants R5陳德福 R2陳國瑋 相關圖片 趙馮學臻 (F,1933/10/21,78y4m) 手術日期 2010/08/24 手術主治醫師 蕭輔仁 手術區域 東址 003房 03號 診斷 Lumbar Spondylosis 器械術式 L2 RF 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 陳國瑋, 時間資訊 08:00 臨時手術NPO 13:56 報到 14:15 進入手術室 14:25 麻醉開始 14:26 抗生素給藥 14:30 麻醉結束 14:30 誘導結束 14:32 手術開始 15:30 手術結束 15:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 高頻熱凝療法 1 1 摘要__ 手術科部: 外科部 套用罐頭: L2 RF 開立醫師: 陳德福 開立時間: 2010/08/24 15:35 Pre-operative Diagnosis lumbar spondylosis Post-operative Diagnosis lumbar spondylosis Operative Method L2 RF Specimen Count And Types nil Pathology nil Operative Findings Ablation catheter placed at L2 intervertebral foramen bilaterally. Motor stimulation: 2Hz Sensory stimulation: 50Hz Ablation temperature: 42 degrees Celsius Ablation time: 180 sec*2 at each side Operative Procedures The patient was placed in prone position. After localization of L2 pedicles with C-arm, 1% Xylocaine were infiltrated at injection site (about 3cm from midline at the level slightly below L2 pedicles). Puncture needle were then used and confirmed the tip location with C-arm. After motor & sensory stimulation, ablation were then performed for 180 sec *2 cycles. The procedure was repeated again at the right side. The injection wounds were covered with bandage and the procedure ended. Operators VS 蕭輔仁 Assistants R5陳德福 R2陳國瑋 陳可麗 (F,1953/10/20,58y4m) 手術日期 2010/08/24 手術主治醫師 侯君翰 手術區域 東址 022房 02號 診斷 Malignant neoplasm of frontal lobe 器械術式 Close reduction of left hip 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 劉漢平 ASA 3 紀錄醫師 黃鼎鈞, 時間資訊 12:55 報到 13:18 進入手術室 13:20 麻醉開始 13:25 誘導結束 13:26 手術開始 14:10 手術結束 14:10 麻醉結束 14:12 送出病患 14:15 進入恢復室 15:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 手術 股關節脫位徒手復位術 1 1 L 記錄__ 手術科部: 骨科部 套用罐頭: Close reduction 開立醫師: 黃鼎鈞 開立時間: 2010/08/24 14:26 Pre-operative Diagnosis Left hip septic arthritis, dislocation. Post-operative Diagnosis Left hip septic arthritis, dislocation. Operative Method Close reduction Specimen Count And Types nil Pathology nil Operative Findings Hip anterior dislocation Operative Procedures Under anesthesia, patient was placed on fracture table. Arthrocenthesis was done after skin disinfection. Close reduction was done under C-arm guidance. Skin traction was applied. Operators 侯君翰, Assistants 黃鼎鈞, 黃全敬, 陳明峰, 曾錫欽, 閔戩 (M,1988/04/09,23y11m) 手術日期 2010/08/24 手術主治醫師 余宏政 手術區域 東址 007房 02號 診斷 Urethral stricture 器械術式 Opitic uretrotomy 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 靜脈麻醉 麻醉主治醫師 葉惠敏 ASA 2 紀錄醫師 蔡博超, 時間資訊 15:15 報到 15:48 進入手術室 15:55 麻醉開始 16:00 誘導結束 16:13 手術開始 16:30 手術結束 16:30 麻醉結束 16:35 送出病患 16:37 進入恢復室 17:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 直視下尿道切開術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 記錄__ 手術科部: 泌尿部 套用罐頭: optic urethrotomy 開立醫師: 蔡博超 開立時間: 2010/08/24 16:42 Pre-operative Diagnosis Urethral stricture Post-operative Diagnosis Urethral stricture Operative Method Optic urethrotomy Specimen Count And Types nil Pathology nil Operative Findings 1.pin hole at penile urethra about 10 cm from urethral meatus Operative Procedures Under satisfactory anesthesia with the patient in a lithotomy position, prepping and draping were performed in the usual sterile method. A 23 Fr. urethroscope was inserted into the urethra with well lubrication. A small hole at the 12 o’clock position of the penile urethra was noted. Fibrous tissue at the anterior urethra and a fibrous ring at the memebranous urethra were noted. Incision at the 3, 6, 9, 12 o’clock position by a cold-knief was performed. Sounding to 28 Fr was performed. A 3-way 20Fr. Foley catheter wasplaced for stenting the urethra. Then he was sent to the recovery room with a stable condition. Operators 余宏政, Assistants 蔡博超, 姜秉均, 陳錦進 (M,1961/08/18,50y6m) 手術日期 2010/08/24 手術主治醫師 蔡翊新 手術區域 東址 003房 02號 診斷 Acute and chronic respiratory failure 器械術式 tracheostomy 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 陳國瑋, 時間資訊 00:00 開始NPO 00:00 臨時手術NPO 09:14 通知急診手術 12:43 進入手術室 12:43 報到 12:45 麻醉開始 12:50 誘導結束 13:10 手術開始 13:42 麻醉結束 13:42 手術結束 13:43 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 氣管切開造口術 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 陳國瑋 開立時間: 2010/08/24 13:52 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Ditto Operative Method Tracheostomy Specimen Count And Types nil Pathology None Operative Findings Fr. 8 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. A transverse incision approximately 2cm is made 2 finger wide above the sternal notch. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators VS 蔡翊新 Assistants R5 陳德福 R2 陳國瑋 Indication Of Emergent Operation 林足如 (F,1955/11/26,56y3m) 手術日期 2010/08/25 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Meningitis 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 蘇家弘, 時間資訊 00:00 臨時手術NPO 07:38 報到 08:13 進入手術室 08:18 麻醉開始 08:25 誘導結束 08:42 手術開始 10:52 手術結束 10:52 麻醉結束 10:57 送出病患 11:05 進入恢復室 12:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 經外側篩竇切除修補腦脊髓液鼻漏 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 記錄__ 手術科部: 耳鼻喉部 套用罐頭: Sinoscope surgery (local) 開立醫師: 蘇家弘 開立時間: 2010/08/25 10:56 Pre-operative Diagnosis CSF rhinorrhea Post-operative Diagnosis CSF rhinorrhea, operated Operative Method CSF rhinorrhea repair surgery Specimen Count And Types nil Pathology Nil Operative Findings A perforation area was noted at sphenoid sinus Operative Procedures 1. Supine position with ETGA then bilateral nasal packing were done. 2. Remove the nasal packing 3. Expose left nasal cavity with endoscope 4. Some tissue coldou, bone fragment, and surgicel inserted last surgery were noted. 5. Remove all artificial material and the bone. 6. Expose the sphenoid sinus with endoscope 7. A perforation area over sphenoid sinus was noted. 8. Skin incision over left lower quadrant previous wound scar was made. 9. Collect fatty tissue. 10.Fatty tissue was inserted into the perforation area and fixed with tissue colduo. 11.Fixed with 3 layer of fatty tissue and athe bone fragment was fixed on the surface. 12.Left nasal packing with fingerstalk x 1 was made. 13.Skin closure with 2 layer 14.Hemostasis 15.Patient tolerate will during the procedure. Operators 吳振吉, Assistants R2蘇家弘, R4孟繁宇, 章定夫 (M,1973/12/22,38y2m) 手術日期 2010/08/25 手術主治醫師 曾漢民 手術區域 東址 003房 03號 診斷 Brain abscess 器械術式 CSF repair 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3E 紀錄醫師 廖怡茹, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 08:51 通知急診手術 14:15 進入手術室 14:20 麻醉開始 14:25 誘導結束 15:27 手術開始 17:00 抗生素給藥 19:15 21:25 手術結束 21:25 麻醉結束 21:25 21:35 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 手術 腦膜或脊髓膜突出修補術 1 2 B 手術 腦瘤切除－手術時間在４～８小時 1 1 B 手術 多竇副鼻竇手術 1 1 B 手術 多竇副鼻竇手術 1 2 B 摘要__ 手術科部: 套用罐頭: 1.brain 開立醫師: 陳德福 開立時間: 2010/08/25 19:16 Pre-operative Diagnosis CSF leakage with brain abscess Post-operative Diagnosis CSF leakage with brain abscess Operative Method 1.brain 1.brain abecess removal 2.dura defect repair Specimen Count And Types 1 piece About size:2*3*3CM Source:BRAIN ABSCESS Pathology pending Operative Findings 1.There is a brain abcess with perifocal gliosis and thickened arachnoid membrane. The left subfrontal abscess was removed and one 1.5*1.3cm in sized dura and skull base defect was noticed. Severe adhesive change over the defect is noticed. Some previous fat tissue at the bony defect was found and the abscess is remakarbly prulent. 2.The dura defect was repaired with autologous fascia and Tissucol Duo. The mucosa of paranasal sinus is intact. Operative Procedures Under ETGA and supine position, the skull was fixed with Mayfield pin type head fixator. The scalp disinfection and draping were performed as usual. One bicoronal incision was done and a 8*10cm in sized craniotomy window was created. The dura tenting and opening were done. The brain abscess and dura defect were identifed. The abscess with pseudocapsule was removed with bipolar and tumor forceps assisted. The dura defect was repaired with autologous fascia. The dura was closed in water tight fasion and the skull was fixed with miniplates. One subgaleal draiange was left in situ and the wound was closed in layers. Operators VS 曾漢民 Assistants r5陳德福 r2陳國瑋 Indication Of Emergent Operation 記錄__ 手術科部: 耳鼻喉部 套用罐頭: Functional endoscopic sinus surgery 開立醫師: 廖怡茹 開立時間: 2010/08/26 18:47 Pre-operative Diagnosis Chronic paranasal sinusitis Post-operative Diagnosis Ditto, operated Operative Method Functional endoscopic sinus surgery, bil.(V) Specimen Count And Types 2 pieces About size:0.3*0.3cm Source:left nasal cavity About size:0.3*0.3cm Source:right nasal cavity Pathology pending Operative Findings Right infun.: OK( )edematous( )polypoid( )polyp(V) mucopus( ),fungus( ),cyst( ) Maxi.: OK( )edematous( )polypoid( )polyp( ) mucopus(V),fungus( ),cyst( ) Left infun.: OK( )edematous( )polypoid( )polyp( ) mucopus(V),fungus( ),cyst( ) Maxi.: OK( )edematous( )polypoid( )polyp( ) mucopus(V),fungus( ),cyst( ) Operative Procedures (1) Infundibulotomy :R(V)L(V) (2) Opening/trimming of ethmoid bulla :R( )L( ) anterior ethmoid :R( )L( ) agger nasi :R( )L( ) frontal recess :R( )L( ) middle turbinate :R(V)L(V) (3) Opening/trimming of ground lamella :R( )L( ) posterior ethmoid :R( )L( ) sphenoid sinus :R( )L( ) (4) Widening of maxillary ostium :R(V)L(V) aspiration :R(V)L(V) irrigation :R( )L( ) (5) Packing with Merocel :R(1)L(1) Vaseline gauze :R( )L( ) Betta-iodine gauze :R(1)L(1) Fingerstall :R( )L( ) Operators 劉嘉銘, Assistants R4孟繁宇,R2廖怡茹, Indication Of Emergent Operation 蘇芷誼 (F,1984/11/01,27y4m) 手術日期 2010/08/25 手術主治醫師 林東燦 手術區域 兒醫 062房 03號 診斷 Acute lymphoid leukemia ( ALL ) 器械術式 IT 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 林子富 ASA 2 時間資訊 08:00 臨時手術NPO 12:58 報到 13:07 進入手術室 13:15 麻醉開始 13:20 誘導結束 13:23 手術開始 13:38 手術結束 13:38 麻醉結束 13:43 送出病患 13:45 進入恢復室 14:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室內注射留置器或脊髓腔內化學藥物注射 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 陳可麗 (F,1953/10/20,58y4m) 手術日期 2010/08/25 手術主治醫師 侯君翰 手術區域 東址 020房 04號 診斷 Malignant neoplasm of frontal lobe 器械術式 HIP CLOSE REDUCTION 手術類別 緊急手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林至芃 ASA 3E 紀錄醫師 黃鼎鈞, 時間資訊 08:30 臨時手術NPO 08:30 開始NPO 17:35 報到 17:45 進入手術室 17:45 麻醉開始 17:47 誘導結束 17:55 手術開始 18:05 手術結束 18:05 麻醉結束 18:10 送出病患 18:15 進入恢復室 19:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 股關節脫位徒手復位術 1 2 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 骨科部 套用罐頭: Close reduction 開立醫師: 黃鼎鈞 開立時間: 2010/08/25 18:27 Pre-operative Diagnosis Septic arthritis of hip, left, dislocation Post-operative Diagnosis Septic arthritis of hip, left, dislocation Operative Method Close reduction Specimen Count And Types nil Pathology nil Operative Findings Septic arthritis of hip, left, dislocation Operative Procedures Under anesthesia induction, patient was placed on fracture table. Close reduction was done under C-arm guidance. Operators 侯君翰, Assistants 黃鼎鈞, 王政為, 陳明峰, Indication Of Emergent Operation 侯志發 (M,1928/11/29,83y3m) 手術日期 2010/08/25 手術主治醫師 蔡翊新 手術區域 東址 003房 01號 診斷 Intracerebral hemorrhage (ICH) 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 08:29 報到 08:30 進入手術室 08:35 麻醉開始 08:38 誘導結束 09:00 手術開始 09:35 麻醉結束 09:35 手術結束 09:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 氣管切開造口術 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 游健生 開立時間: 2010/08/25 09:55 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types nil Pathology None Operative Findings Fr. 8 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyroid gland was retracted upward. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tube is fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Also, 4 stitches are used at 4 corners. Check bleeding and close the wound with 3-0 nylon. Operators VS 蔡翊新 Assistants R6 陳睿生 R3 游健生 黃國恩 (M,1989/10/23,22y4m) 手術日期 2010/08/25 手術主治醫師 蔡翊新 手術區域 東址 005房 03號 診斷 Subdural hemorrhage 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 林至芃 ASA 2E 紀錄醫師 周聖哲, 時間資訊 03:18 臨時手術NPO 03:18 開始NPO 17:18 通知急診手術 18:15 進入手術室 18:20 麻醉開始 18:40 誘導結束 18:45 手術開始 19:40 開始輸血 21:00 抗生素給藥 00:10 手術結束 00:10 麻醉結束 00:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 硬腦膜外血腫清除術 1 1 L 手術 顱內壓監視置入 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 蔡翊新 開立時間: 2010/08/25 23:51 Pre-operative Diagnosis 1. Left frontotemporal skull fracture with left frontal epidural hematoma and dural defect with CSF leak. 2. Left lateral orbital wall fracture with compression of contents of superior orbital fissure (SOF). Post-operative Diagnosis 1. Left frontotemporal skull fracture with left frontal epidural hematoma and dural defect with CSF leak. 2. Left lateral orbital wall fracture with compression of contents of superior orbital fissure (SOF). Operative Method Left frontotemporal craniotomy for evacuation of left frontal EDH, decompression of left superior orbital fissure (SOF), duroplasty and subdural ICP monitoring. Left frontotemporal craniotomy for evacuation of left frontal EDH, decompression of left superior orbital fissure (SOF), repair of dural defect, duroplasty and subdural ICP monitoring. Specimen Count And Types nil Pathology Nil. Operative Findings Comminuted fracture of left frontotemporal bone, involving the left frontal sinus, with exposure of sinus mucosa. EDH about 4 x 3 x 1 cm was noted beneath the fracture site of frontal area. A dural defect, 4 mm in length, was noted at left frontal tip with active CSF leak. Skull fracture was noted at lateral wall of left orbit, with a 1 x 0.5 cm fragment of bone sinking into the SOF. After removal of the bone fragment, the dura passing through the SOF expanded well. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: curvilinear, left frontotemporal, the skin edge was clipped by Raney clips for temporary hemostasis. 5. Craniotomy window: 10 x 6 cm, left frontotemporal, created by making 3 burr holes then cut by power saw. 6. Dural tenting: by 2/0 silk, 2 cm in interval, distributed along the edge of skull window. 7. Under microscope, the sphenoid ridge was drilled off to flush the anterior and middle cranial fossa. The bone chip sinking into the SOF was removed for decompression. for decompression. The EDH was removed by suction. 8. The mucosa of left frontal sinus was remove and the sinus was packed with many pieces of Gelfoam soaking in better iodine. Then the sinus was sealed by bone wax. 9. The dural defect at left frontal tip was closed by 5-0 Prolene. 10.Dural incision: curvilinear along the edge of skull window. 11.The dural defect was packed with two pieces of DuroGen, one at inside and the other at outside. 12.A Codman ICP monitor was placed at subdural space. Reference level: 490. 13.Dural closure: a piece of dural graft taking from temporalis fascia was used to do the duroplasty. 14.The skull plates were reassembled with 3 26# wires into one large piece and fixed back to the craniotomy window with miniplates and screws. 15.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 16.Drain: one, epidural, CWV. 17.Blood transfusion: PRBC 6U. Blood loss: 2000 ml. 18.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R6陳睿生R1周聖哲 Indication Of Emergent Operation 林育蔚 (M,1977/04/11,34y11m) 手術日期 2010/08/26 手術主治醫師 林峰盛 手術區域 西址 035房 04號 診斷 Atypical face pain 器械術式 Nerve block / PC 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 林峰盛 ASA 2 時間資訊 13:25 進入手術室 13:30 麻醉開始 13:35 誘導結束 13:45 手術開始 14:20 手術結束 14:20 麻醉結束 14:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 高頻熱凝療法 1 1 R 王志遠 (M,1977/07/27,34y7m) 手術日期 2010/08/26 手術主治醫師 劉嘉銘 手術區域 西址 033房 01號 診斷 Pituitary tumor 器械術式 Sinoscopy 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 林玫君, 時間資訊 08:18 進入手術室 08:20 麻醉開始 08:30 手術開始 09:12 手術結束 09:12 麻醉結束 09:17 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 鼻粘連解除術 1 2 B 記錄__ 手術科部: 耳鼻喉部 套用罐頭: Sinoscope surgery (local) 開立醫師: 林玫君 開立時間: 2010/08/27 14:31 Pre-operative Diagnosis Left nasal synechia Post-operative Diagnosis Left nasal synechia, status post adhesion lysis Operative Method 1. Sinoscope surgery, left Specimen Count And Types nil Pathology Nil Operative Findings 1. Left nasal post operation change 2. Synechia of left inferior turbinate and septum Operative Procedures 1. Supine position with Xylocain-bosmin nasal packing 2. Synechia of left inferior turbinatewith nasal septum 2. Synechia of left inferior turbinate with nasal septum 3. Synechia was transacted. 4. Hemostasis 5. Patient tolerate will during the procedure. Operators AP劉嘉銘, Assistants R4林芳瑩,R4林玫君 謝枝全 (M,1928/12/28,83y2m) 手術日期 2010/08/26 手術主治醫師 林峰盛 手術區域 西址 035房 05號 診斷 Failed back syndrome 器械術式 Nerve block / PC 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 林峰盛 ASA 3 時間資訊 14:35 進入手術室 14:40 麻醉開始 14:42 誘導結束 14:50 手術開始 15:05 手術結束 15:05 麻醉結束 15:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 高頻熱凝療法 1 1 記錄__ 手術科部: 麻醉部 套用罐頭: Pulsed RF 開立醫師: 林峰盛 開立時間: 2010/08/26 15:05 Pre-operative Diagnosis Failed back syndrome radiculopathy Post-operative Diagnosis Failed back syndrome radiculopathy Operative Method Pulsed RF Specimen Count And Types nil Pathology Nil Operative Findings Operative Procedures 1. IV sedation with midazolam and LA with 1% xylocaine 2. pt in prone position 3. Under fluoroscopic-guidance, insert 22 G RFK RF meedle into left L5 neuroforamen 4. Neurostimulation with 50 HZ and 2 Hz 0.1-0.5 mV current with positive result 120V, 2 Hz, 20 ms, 120sec *2 pulsed RF was delivered send pt to POR Operators 林峰盛, Assistants 林彥君, 蘇心硯 (F,1981/05/14,30y10m) 手術日期 2010/08/26 手術主治醫師 賴達明 手術區域 東址 002房 03號 診斷 Arteriovenous malformation, brain 器械術式 craniotomy 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林子富 ASA 3 紀錄醫師 吳俊毅, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 11:59 通知急診手術 12:45 進入手術室 12:55 麻醉開始 13:15 誘導結束 13:50 抗生素給藥 14:04 手術開始 16:55 抗生素給藥 19:10 手術結束 19:10 麻醉結束 19:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 開顱術摘除血管病變－腦血管瘤－有徵的 1 1 R 手術 腦內血腫清除術 1 2 R 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for 1. AVM removal, aneurysm clipp... 開立醫師: 陳睿生 開立時間: 2010/08/26 19:43 Pre-operative Diagnosis Right frontal AVM with aneurysmal sac rupture, and ICH Post-operative Diagnosis Right frontal AVM with aneurysmal sac rupture, and ICH Operative Method Craniotomy for 1. AVM removal, aneurysm clipping; 2. ICH removal Specimen Count And Types 1 piece About size:pieces Source:vascular structure Pathology Pending Operative Findings Subcortical ICH and SAH were noted after dura opening. The ICH amount was about 60-80ml. An abnormal vascular structure was noted at right superficial MCA. Aneurysmal formation was noted nearby the nidus. Several drainage veins were noted to the SSS. Initial brain swelling was noted and the post-op pressure was moderate. Operative Procedures 1. ETGA, supine position and head fixed with Mayfield clump and left turn 2. Scalp curvillinear incision as pterion approach 3. Facial nerve preservation, and craniotomy window was made with two bur holes creat 4. Dura tenting, and then the dura was opened along the bony margin 5. Dissect the arachnoid membrane to expose the sylvian fissure 6. Expose the sylvian fissure and find out the subcortical hematoma 7. Hematoma evacuation, and the nidus with aneurysm was noted at the posterior frontal region 8. Excision of the nidus and the aneurysm was clipped with one small curve Sugita clip 9. Hemostasis, close the dura tightly 10.Set an epidural CWV drain; fix back skull graft with miniplates 11.Close the wound in layers Operators VS 賴達明 Assistants R6 陳睿生; R1 吳俊毅 Indication Of Emergent Operation 邵慶旭 (M,1926/08/23,85y6m) 手術日期 2010/08/26 手術主治醫師 陳敞牧 手術區域 東址 005房 02號 診斷 Subdural hematoma (SDH) 器械術式 bilateral cSDH 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 3 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 12:55 報到 13:50 進入手術室 13:55 麻醉開始 14:15 誘導結束 14:20 抗生素給藥 14:43 手術開始 16:45 手術結束 16:45 麻醉結束 16:53 送出病患 17:00 進入恢復室 18:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 手術 慢性硬腦膜下血腫清除術 1 1 B 記錄__ 手術科部: 外科部 套用罐頭: Evacuation of chronic subdural hematoma, bila... 開立醫師: 鍾文桂 開立時間: 2010/08/26 17:08 Pre-operative Diagnosis Chronic subdural hematoma, bilateral fronto-temporo-parietal Post-operative Diagnosis Chronic subdural hematoma, bilateral fronto-temporo-parietal Operative Method Evacuation of chronic subdural hematoma, bilateral. Specimen Count And Types nil Pathology Nil. Operative Findings 1. Motor oil like liquified chronic subdural hemorrhage with some fibrinous debris was drained. 2. No new burr hole was created. 3. Poor brain expansion. Operative Procedures 1.Under ETGA and supine positon 2.Skin disinfection and draping over bilateral frontotemporal junction 3.Linear incision via previous scalp wound. 4.Drainage of the subdural hematoma and irrigation with copious normal saline over bilateral subdural space 6.Left one subdural rubber draiange in situ bilaterally 7.Drain out the air inside the cranium 8.Close the wound in layers. Operators V.S. 陳敞牧 Assistants R5 鍾文桂 詹益鄉 (M,1938/04/30,73y10m) 手術日期 2010/08/26 手術主治醫師 陳敞牧 手術區域 東址 005房 01號 診斷 Lumbar spondylosis 器械術式 Laminectomy for decompression，Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 2 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 07:42 報到 08:05 進入手術室 08:10 麻醉開始 09:00 誘導結束 09:00 抗生素給藥 09:23 手術開始 10:10 開始輸血 13:15 手術結束 13:15 麻醉結束 13:32 送出病患 13:34 進入恢復室 16:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 椎弓切除術（特壓）－二節以內 1 2 記錄__ 手術科部: 外科部 套用罐頭: 1.Decompressive laminectomy, L5& L6. 開立醫師: 鍾文桂 開立時間: 2010/08/26 13:56 Pre-operative Diagnosis L4/5 spondylolisthesis. Post-operative Diagnosis L4/5 spondylolisthesis. Operative Method 1.Decompressive laminectomy, L5& L6. 1.Decompressive laminectomy, L5& part of L6. 2.Internal fixation by implantation of transpedicle screws, L5. 3.Posterolateral fusion with autologous bone graft, L4/5. Specimen Count And Types 1 piece About size:Culture tube x II Source:operative wound. Pathology Nil. Operative Findings 1. 6 lumbar spines. 2. Previous rods linking L3/4 transpedical screws were removed. New rods were implantated at L3-5 levels. Additional transpedicle screws were inserted at L5 level.One interlink was place at L4/5 level. 3. Hypertrophic ligamentum flavum at L4-5 levels. 4. Slack thecal sac and roots after decompression. Operative Procedures Under ETGA, the patient was placed in prone position. After disinfection and draping, the operative wound was re-opened and dissected. Extended operative wound was incised inferiorly to exposed the L5 level. Two transpedicle screws were inserted at L5 level. The positions were checked with intraoperative fluoroscope. Laminectomy at L5 and half of L6 levels was done for decompression. The new rods were placed at L3-5 levels after removal of the rods linking L3-4 level. One interlink was placed at L4-5 level. After completing the internal fixation apparatus, posterolateral fusion at L4/5 level. After placing one CWV drain, the wound was closed in layers. The patient was sent to POR smoothly. Operators V.S.陳敞牧 Assistants R5鍾文桂　R1劉昌杰 相關圖片 鄧文榮 (M,1969/08/18,42y6m) 手術日期 2010/08/26 手術主治醫師 陳敞牧 手術區域 東址 005房 03號 診斷 Lymphoma 器械術式 Ommaya reservoir implantation 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 3 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 17:15 進入手術室 17:20 麻醉開始 17:25 誘導結束 17:45 抗生素給藥 18:01 手術開始 19:00 手術結束 19:00 麻醉結束 19:05 送出病患 19:10 進入恢復室 20:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 歐氏貯囊置放手術 1 1 R 記錄__ 手術科部: 腫瘤醫學部 套用罐頭: Implantation of Ommaya reservoir at right Kocher. 開立醫師: 鍾文桂 開立時間: 2010/08/26 19:19 Pre-operative Diagnosis Lymphoma, suspect CNS metastasis. Post-operative Diagnosis Lymphoma, suspect CNS metastasis. Operative Method Implantation of Ommaya reservoir at right Kocher. Specimen Count And Types 1 piece About size:3 cc Source:CSF for routine, BCS and culture. Pathology Nil. Operative Findings Clear colorless CSF. Ommaya reservoir: intraventricular catheter: 6.5cm. Operative Procedures Under ETGA, the patient was placed in supine position and the head was placed in the midline position. After shaving, disinfection, and draping, a curvilinear wound was incised at right Kocher point. A burr hole was created. The dura mater was tented. After durotomy, the ventricular puncture needle was inserted until CSF gushed out. Then, the Ommaya reservoir was implanted. With well hemostasis, the wound was closed in layers. Operators V.S. 陳敞牧 Assistants R5 鍾文桂 Ri徐勝駿 陳俐伶 (F,1984/09/10,27y6m) 手術日期 2010/08/26 手術主治醫師 蔡翊新 手術區域 東址 003房 03號 診斷 Subarachnoid hemorrhage 器械術式 tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 污染 麻醉方式 全身麻醉 麻醉主治醫師 林珍榮 ASA 3 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 16:00 報到 16:00 進入手術室 16:03 麻醉開始 16:05 誘導結束 16:20 手術開始 16:40 麻醉結束 16:40 手術結束 16:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 氣管切開造口術 1 0 摘要__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 蔡翊新 開立時間: 2010/08/26 16:36 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types nil Pathology None Operative Findings Fr. 8 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures Under general anesthesia via endotracheal tube, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2 cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with silk. Operators VS蔡翊新 Assistants R4李振豪R3游健生 張春子 (F,1963/01/10,49y2m) 手術日期 2010/08/26 手術主治醫師 蔡翊新 手術區域 東址 003房 01號 診斷 Subarachnoid hemorrhage 器械術式 cranioplasty + VP shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林珍榮 ASA 3 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 08:15 報到 08:15 進入手術室 08:25 麻醉開始 08:30 誘導結束 09:00 抗生素給藥 09:20 手術開始 11:05 14:05 麻醉結束 14:05 手術結束 14:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 手術 頭顱成形術 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 蔡翊新 開立時間: 2010/08/26 13:43 Pre-operative Diagnosis 1.A-comA aneurysm rupture with SAH, Hydrocephalus. 2.A-comA aneurysm rupture with brain swelling, s/p craniectomy with left F-T-P skull defect. Post-operative Diagnosis 1.A-comA aneurysm rupture with SAH, Hydrocephalus. 2.A-comA aneurysm rupture with brain swelling, s/p craniectomy with left F-T-P skull defect. Operative Method 1. V-P Shunt, right side. 2. Cranioplasty with autologous bone graft. Specimen Count And Types nil CSF 5ml for routine, BCS, and bacterial culture Pathology Nil. Operative Findings 1. CSF: yellowish, clear. Pressure: 12 cmH2O. Codman shunt: ventricular catheter: 6.2 cm in depth, peritoneal catheter: 30 cm, 10 cmH2O in pressure setting. 2. A 16 x 12 cm skull defect at left F-T-P region. The brain was swollen after scalp flap was reflected, and became slack after drainage of CSF (50 ml) via temporary EVD. The previous Duroform did not heal well with the native dura, so there were many dural defects. Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: supine with head rotated to left. 3.Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 5 cm, linear, right frontal area, along previous wound. 5. Ventricular catheter was inserted to right frontal horn via previous burr hole at right Kocher point. 6. A nib incision was made at RUQ of the abdomen , then a trocar was pushed into peritoneal cavity. Subsequently, distal 30 cm segment of the peritoneal catheter (10 cmH2O in pressure settign) was introduced into the peritoneal cavity through the outer tube of the trochar. The proximal end of this catheter was passed through subcutaneous tunnel at forechest, neck, right retroauricular area and connected the reservoir. The shunt systemwas checked to make sure its function was working. 7. The wounds were closed in layers. 8. Position: supine with head rotated to right. 9. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with a sterilized adhesive plastic sheet. 10.Incision: along the previous operation scar at left F-T-P region, Raney clips were apllied to the scalp edge for temporary hemostasis. 11.The left F-T-P scalp was dissected away from the underlying dura. The dural surface and margin of skull defect were well exposed. 12.The bleeders on the dissected surfaces were coagulated with Bovie painstakingly. DuroGen was used to cover the dural defects. 13.The original skull plates preserved at bone bank were assembled into one piece by miniplates. It was placed back to the skull window then fixed by 3 miniplates and screws. 14.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by interrupted suture with 3/0 nylon. 15.Drain: two subgaleal CWV. 16.Blood transfusion: nil. Blood loss: 300 ml. 17.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R4李振豪Ri張君瑋 曾錦燾 (M,1948/12/13,63y3m) 手術日期 2010/08/27 手術主治醫師 賴達明 手術區域 東址 001房 03號 診斷 Meningitis 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 李振豪, 時間資訊 12:27 通知急診手術 13:28 進入手術室 13:35 麻醉開始 13:40 誘導結束 14:09 手術開始 14:50 手術結束 14:50 麻醉結束 15:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室體外引流 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Left Kocher"s external ventricular drainage 開立醫師: 李振豪 開立時間: 2010/08/27 15:26 Pre-operative Diagnosis Ventriculitis with acute hydrocephalus Post-operative Diagnosis Ventriculitis with acute hydrocephalus Operative Method Left Kocher"s external ventricular drainage Specimen Count And Types 1 piece About size:6ml Source:CSF Pathology Nil Operative Findings The opening pressure is more than 15cmCSF after EVD insertion. The CSF is turbid, yellow-greenish with some fibrin noted after drainage. The EVD is fixed at 7cm in depth. Operative Procedures Under endotracheal tube general anesthesia, the patient is put in supine position. The scalp was shaved, scrubbed, and disinfected as usual. The left frontal skin incision is made along previous op scar. One burr hole was created with air-drived perforator followed by two dural tenting. Cruciform dural incision was made and the ventricular puncture was performed. The EVD was inserted after ventricular puncture and fixed at 7cm in length. Externalization was done. After hemostasis, the wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. The EVD was set up after wound closure. Operators VS賴達明 Assistants R4李振豪 Indication Of Emergent Operation 相關圖片 王顯之 (M,1973/10/02,38y5m) 手術日期 2010/08/27 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Brain Tumor 器械術式 VP shunt 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 劉昌杰, 時間資訊 00:00 臨時手術NPO 14:46 進入手術室 14:48 麻醉開始 14:55 誘導結束 16:28 手術開始 17:32 手術結束 17:32 麻醉結束 17:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 腦室腹腔分流手術 1 2 L 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Left Kocher point Codman programmable shunt i... 開立醫師: 胡朝凱 開立時間: 2010/08/27 17:48 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Left Kocher point Codman programmable shunt insertion Specimen Count And Types culture tube of CSF Pathology nil Operative Findings 1.Opening pressure: about 15 cmH2O 2.Clear CSF 3.Intraventricular catheter: 6.5 cm 4.Programmable shunt setting: 100 mmH2O Operative Procedures 1.ETGA, supine 2.Left previous wound open 3.LUQ minilaparotomy 4.Made a subcutaneous tunnel 5.Pass the catheter 6.Connect to ventricular catheter 7.Ventricular puncture and catheter insertion 8.Insert abdominal catheter 9.Close wound in layers Operators 曾漢民 Assistants 胡朝凱, 劉昌杰 黃文政 (M,1937/12/29,74y2m) 手術日期 2010/08/27 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Brain Tumor 器械術式 left frontal tumor 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 劉昌杰, 時間資訊 00:00 臨時手術NPO 07:48 報到 08:05 進入手術室 08:10 麻醉開始 08:30 誘導結束 09:07 抗生素給藥 09:32 手術開始 12:07 抗生素給藥 14:20 麻醉結束 14:20 手術結束 14:25 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 手術 腦瘤切除－手術時間在４～８小時 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Craniotomy, subfrontal for Simpson grade III ... 開立醫師: 胡朝凱 開立時間: 2010/08/27 14:33 Pre-operative Diagnosis Olfactory groove meningioma Post-operative Diagnosis Olfactory groove meningioma Operative Method Craniotomy, subfrontal for Simpson grade III tumor excision Specimen Count And Types pieces of tumor Pathology pending Operative Findings 1.One reddish, hypervascular tumor arised from olfactory groove with dural tail was noted. The vessels was pushed surround the capsule 2.The border is not clear 3.We left one small piece of tumor at frontal base due to artery encasement Operative Procedures 1.ETGA, supine with head fixed with Mayfield skull clamp 2.Bicoronal skin incision 3.Reflect skin flap 4.Craniotomy 5.Disset tumor via subfrontal approach 6.Incised falx 7.Resect tumor 8.Hemostasis 9.Close dura with prolene 10.Cranioplasty with bone cement 11.Set one CWV drain then clsoe wound in layers Operators 曾漢民 Assistants 胡朝凱, 劉昌杰 黃苡瑄 (F,1973/11/21,38y3m) 手術日期 2010/08/27 手術主治醫師 蔡瑞章 手術區域 東址 019房 03號 診斷 Secondary malignant neoplasm of brain and spinal cord 器械術式 Lamino plasty，Intraspinal intramedullary tum 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 3 紀錄醫師 鍾文桂, 時間資訊 07:00 臨時手術NPO 09:00 開始NPO 17:50 報到 18:16 進入手術室 18:20 麻醉開始 18:35 誘導結束 18:39 抗生素給藥 19:19 手術開始 21:39 抗生素給藥 22:25 開始輸血 23:30 手術結束 23:30 麻醉結束 23:41 送出病患 23:50 進入恢復室 00:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 椎弓切除術（特壓）－超過二節 1 2 手術 惡性病髓腫瘤切除術 1 1 記錄__ 手術科部: 外科部 套用罐頭: 1. Partial tumor excision for cord decompress... 開立醫師: 鍾文桂 開立時間: 2010/08/28 00:09 Pre-operative Diagnosis Intramedullary spinal tumor, cervical; suspect cervical cancer metastasis. Post-operative Diagnosis Intradural extramedullary and intramedullary exophytic tumor, C4-T1, suspect seeding from brain metastasis. Operative Method 1. Partial tumor excision for cord decompression. 2. Decompressive laminectomy and dural augmentation, C3-T1. Specimen Count And Types 1 piece About size:10 ml Source:spinal tumor. Pathology Pending. Operative Findings Two sites of tumor mass were found: one at C4-5 level,right side and the other at C6-T1 level, left side. The cord and the rootlets were compressed by the tumor mass. Some parts of the tumor seemed to be intramedullary in origin. After tumor decompression at C6-T1 level, we could see the posterior longitudinal ligament well. The C-spine bone frame was not stable during decompression. Whitish elastic firm tumor was excised at C4-5 and C6-T1 levels. Some pinkish soft fragile tumor was noted at C6-T1 level. The tumor is not easy oozing. The dura mater was augmented by GoreTex artificial dura. Operative Procedures Under ETGA, the patient was placed in prone position and the head was fixed in Mayfield. Midline incision and dissection from C2-T2 levels were done. Decompressive laminectomy from C3-T1 levels was achieved by Kerrison punch and Rongeur. After durotomy, the tumor was well exposed. The tumor was removed in piecemeal fashion by dissector and tumor forceps. After partial tumor excision, cord decompression was achieved. The dura mater was augmented by GoreTex artificial dura. After placing one CWV drian, the wound was closed in layers. Operators Prof.蔡瑞章 Assistants R5鍾文桂 R4李振豪 Indication Of Emergent Operation 官榮仙 (F,1973/01/06,39y2m) 手術日期 2010/08/27 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Lumbar Spondylosis 器械術式 spinal arachnoid cyst, T11, 12, L2 TPS 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:05 進入手術室 08:10 麻醉開始 08:30 誘導結束 08:55 抗生素給藥 09:38 手術開始 11:55 抗生素給藥 14:45 手術結束 14:45 麻醉結束 14:55 送出病患 14:58 進入恢復室 17:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 良性病髓腫瘤切除術 1 1 手術 腰椎蜘蛛網膜下－腹腔分流手術 1 2 摘要__ 手術科部: 外科部 套用罐頭: 1. Syringopleural shunt placement, T12 to rig... 開立醫師: 游健生 開立時間: 2010/08/27 15:18 Pre-operative Diagnosis 1. T12-L1 syrinx 2. L2 compression fracture with spinal stenosis Post-operative Diagnosis 1. T12-L1 syrinx 2. L2 compression fracture with spinal stenosis Operative Method 1. Syringopleural shunt placement, T12 to right pleural cavity 2. L1 laminectomy and T12 laminotomy with duroplasty Specimen Count And Types nil Pathology Nil Operative Findings A syrinx was noted from T12-L1 with septa. About 1cm myelotomy was done at T12 level. The fluid inside was clean and clear and completely drained. A syringopleural shunt was inserted from the syrinx to the 7th rib level below the right shoulder. The cord and roots were tightly adhering to the dura at the dorsal aspect of L2 level. Duroplasty was performed with fascia graft. Operative Procedures 1.Under ETGA, patient was put into prone position. 2.After disinfection and draping as usual, a midline incision was made over previous wound and extended upward to T11 level. 3.Dissected in layers and detached paraspinal muscles to expose T11 to L2 laminae and medial aspect of facet joint. 4.L1 laminectomy and T12 laminotomy were done with Ronguer, Kerrison, and air-drill. 5.Midline durotomy and T12 myelotomy 6.Examine the cavity of syrinx and drained out the fluid inside. 7.Inserted a syringopleural shunt into the syrinx and right pleural cavity at the 7th rib level. 8.Harvested fascia and performed duroplasty with it by continuous 5-0 prolene suture. 9.Hemostasis and placed gelfoam over the thecal sac. 10.Set one epidural CWV drain and closed wound in layers. Operators VS 賴達明 Assistants R6 陳睿生 R3 游健生 李義昌 (M,1943/10/31,68y4m) 手術日期 2010/08/27 手術主治醫師 賴達明 手術區域 東址 021房 03號 診斷 Lumbar Spondylosis 器械術式 L3-5 TPS 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 12:02 報到 12:08 進入手術室 12:10 麻醉開始 12:40 誘導結束 13:20 抗生素給藥 13:36 手術開始 16:00 開始輸血 16:20 抗生素給藥 17:25 手術結束 17:25 麻醉結束 17:35 送出病患 17:38 進入恢復室 18:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 手術 椎間盤切除術－腰椎 1 2 記錄__ 手術科部: 外科部 套用罐頭: 1. Internal fixation by transpedicle screws a... 開立醫師: 鍾文桂 開立時間: 2010/08/27 18:00 Pre-operative Diagnosis Lumbar stenosis, L3-5. Post-operative Diagnosis Lumbar stenosis, L3-5. Operative Method 1. Internal fixation by transpedicle screws at L3 and L5, bilateral, and posterolateral fusion with autologous bone. 2. Diskectomy, L4/5, and interbody fusion with allograft cage. 3. Decompressive laminectomy, L4. Specimen Count And Types nil Pathology Nil. Operative Findings 1. Hypertrophic ligamentum flavum at L4/5 level. 2. Internal fixation: 4 transpedicle screws: 35x45 at L3 and L5 level, bilateral; one interlink, two rods, Interbody fusion : one cage( 11mm) Operative Procedures Under ETGA, the patient was placed in prone position. After disinfection and draping, the previous operative wound was incised and dissected. After dissection, the locations of L3 and L5 pedicles were ensured by intraoperative fluoroscope. The transpedicle screws were implanted. Then, laminectomy and diskectomy were done. The cage was implanted at L4/5 disk level. Later, we completed the internal fixation apparatus and posterolateral fusion with autologous bone. The wound was closed in layers after placing one epidural 1/8 hemovac drain. Operators V.S.賴達明 Assistants R5 鍾文桂 相關圖片 劉治萍 (F,1963/10/02,48y5m) 手術日期 2010/08/27 手術主治醫師 賴達明 手術區域 東址 002房 01號 診斷 Low back pain 器械術式 right arm tumor 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 面罩麻醉 麻醉主治醫師 鄭淳心 ASA 2 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 08:58 報到 09:00 進入手術室 09:20 麻醉開始 09:25 誘導結束 09:30 抗生素給藥 09:50 手術開始 10:35 手術結束 10:35 麻醉結束 10:40 送出病患 10:42 進入恢復室 11:42 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 神經分離術－手．足之神經 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Semi-opened mask inhalation anes 1 0 記錄__ 手術科部: 外科部 套用罐頭: Neurolysis by excision of right radial neuroma. 開立醫師: 鍾文桂 開立時間: 2010/08/27 11:12 Pre-operative Diagnosis Radial nerve neuroma,right. Post-operative Diagnosis Radial nerve neuroma,right. Operative Method Neurolysis by excision of right radial neuroma. Specimen Count And Types 1 piece About size:2 cm Source:Right radial nerve neuroma. Pathology Pending. Operative Findings 1. White-grayish elastic firm and encapsulated tumor which originated from right radial nerve. It located at dorsal wrist joint, proximal to snuff box. 2. The radial nerve is well preserved. Operative Procedures Under IVG, the operative area was disinfected and draped. A horizontal skin incision was made over the tumor mass. With gradual dissection, the tumor mass was well exposed. The capsule was incised to reach the tumor mass. The tumor was removed in en bloc fashion. After well hemostasis, the wound was closed in layers. Operators V.S. 賴達明 Assistants R5 鍾文桂 林崑祥 (M,1949/04/28,62y10m) 手術日期 2010/08/27 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Lumbar Spondylosis 器械術式 L5/S1 TPS 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:06 進入手術室 08:10 麻醉開始 08:30 誘導結束 09:15 抗生素給藥 09:18 手術開始 12:15 抗生素給藥 13:50 手術結束 13:50 麻醉結束 13:57 送出病患 14:00 進入恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術（特壓）－二節以內 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 摘要__ 手術科部: 外科部 套用罐頭: 1.L5-S1 TPS fusion 2.L5 laminectomy 開立醫師: 陳德福 開立時間: 2010/08/27 14:06 Pre-operative Diagnosis L5-S1 grade II spondylolisthesis with spinal stenosis Post-operative Diagnosis L5-S1 grade II spondylolisthesis with spinal stenosis Operative Method 1.L5-S1 TPS fusion 2.L5 laminectomy Specimen Count And Types nil Pathology nil Operative Findings 1.There are grade II spondylolisthesis over the L5-S1 with spinal stenosis. The right L5-S1 facet joint dispeared. Sacrum bifida is also noticed. The thecal sac was compressed tightly by the osteophytes and ligamentum flavum. The theca sac was decompressed after the L5 laminiectomy. The L4-5 disc was removed. 2.4 TPS and 2 rods were implantated at L5-s1 for posterior fusion. The L5-s1 posterior lateral fusion with autologous bone was done. The L5-S1 disc space is hard to identify. Operative Procedures Under ETGA and prone position, the skin was disinfected and draped as usual. One linear incision at midline was done and the paraspinous msucle was displaced laterally. The L4-S1 lamina was exposed and L5-S1 TPS was inserted under C-arm flouroscope guided. The L5 laminecotmy was performed with Kerrison, Alligator, Disc clamp and currettage assisted. The rods was implantated followed by performing L5-S1 posterior lateral autologous fusion. Hemostasis and left one hemovac in the epidural space. The wound was then closed in layers. Operators VS 賴達明 Assistants r5 陳德福 R2 陳國瑋 曾清村 (M,1957/10/23,54y4m) 手術日期 2010/08/27 手術主治醫師 賴達明 手術區域 東址 019房 02號 診斷 HIVD 器械術式 L4/5 HIVD 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 2 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 13:37 報到 14:08 進入手術室 14:10 麻醉開始 14:25 誘導結束 14:36 抗生素給藥 15:05 手術開始 17:00 手術結束 17:00 麻醉結束 17:20 送出病患 17:25 進入恢復室 18:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術－腰椎 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 摘要__ 手術科部: 外科部 套用罐頭: Lumbar microscopic diskectomy 開立醫師: 陳德福 開立時間: 2010/08/27 16:57 Pre-operative Diagnosis L4-5 HIVD with radiculopathy, right Post-operative Diagnosis L4-5 HIVD with radiculopathy, right Operative Method Lumbar microscopic diskectomy Specimen Count And Types nil Pathology NIL Operative Findings 1.There is a buldging central disc at the L4-5 level with theca sac compression. The disc is removed from right side under microscopic surgery smoothly. Operative Procedures Under ETGA and prone position, the skin was disinfected and draped as usual. One linear incision is done and the right paraspinous muscle was displaced laterally. The lower L4 partial laminectomy was done and ligmentum flavum was removed. The nerve root was identified and the disc was removed meticulously. The wound was then closed in layers. Operators VS賴達明 Assistants R5陳德福 R2陳國瑋 相關圖片 賴明吉 (M,1973/12/31,38y2m) 手術日期 2010/08/27 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Lumbar Spondylosis 器械術式 L4/5 HIVD 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 2 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 15:10 進入手術室 15:15 麻醉開始 15:25 誘導結束 15:30 抗生素給藥 16:10 手術開始 17:30 手術結束 17:30 麻醉結束 17:40 送出病患 17:42 進入恢復室 18:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 椎間盤切除術－腰椎 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: microdiskectomy, L4-5, right 開立醫師: 游健生 開立時間: 2010/08/27 17:51 Pre-operative Diagnosis L4-5 herniated intervertebral disk Post-operative Diagnosis L4-5 rutpured intervertebral disk Operative Method microdiskectomy, L4-5, right Specimen Count And Types nil Pathology Nil Operative Findings The Protuding L4-5 disk compressed L5 right nerve root and thecal sac tightly. The nerve root and thecal sac were well decompressed after surgery. Operative Procedures 1. Under ETGA, prone position 2. Locate L5 upper limit by C-arm 3. After disinfection and draping, midline incision over L5 spinous process 4. Detached right paraspinal muscle off from L5 lamina 5. L5 right laminotomy by air-drill 6. Removed ligamentum flavum and epidural fat to expose L5 nerve root and thecal sac 7. The herniated disk was removed 8. Packed gelfoam over thecal sac 9. Closed wound in layers after hemostasis Operators VS 賴達明 Assistants R6 陳睿生 R3 游健生 酆東海 (M,1957/02/04,55y1m) 手術日期 2010/08/28 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Glioblastoma multiforma 器械術式 craniotomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 3 紀錄醫師 陳德福, 時間資訊 00:00 臨時手術NPO 07:17 報到 08:03 進入手術室 08:10 麻醉開始 08:45 誘導結束 08:50 抗生素給藥 09:15 手術開始 11:50 抗生素給藥 14:50 抗生素給藥 15:15 麻醉結束 15:15 手術結束 15:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在８小時以上 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: brain tumor excision 開立醫師: 陳德福 開立時間: 2010/08/28 15:39 Pre-operative Diagnosis left temporal-insula tumor, suspect GBM Post-operative Diagnosis left temporal-insula tumor, suspect GBM Operative Method brain tumor excision Specimen Count And Types 1 piece About size:2*2*2.5CM Source:left temporal lobe Pathology pending Operative Findings 1.There is a 2*2*3cm in sized brain tumor over the left temporal-insula area. The tumor is greyish, fragile, soft, mild gelatin like and hypovascularized with perifocal gliotic change. The tumor extends from te left temproal lone to the insula through the temporal stump. 2.The MCAs and sylvian veins were all preserved 3.Only piece of tumor adhesion to the vessles was left in situ. Operative Procedures Under ETGA and supine position, the skull was fixed with pin type Mayfield head fixator. The Navigator system is registered. The scalp was disinfected and draped as usual. One curvilinear incision on left sclap was done as pterional approach. One 8*10 cm in sized craniotomy was created and the dura tenting is performed. The dura was opened in C shape and the sylvian fissue was opened under microscopic surgery. While the brain tumor over the left tempral lobe and insula was identified, the tumor was removed by tumor forceps, bipolar coagulator, and sucker assited. The MCA and sylvian vein were all preserved well. The dura then was closed in water tight fasion. The skull was fixed with miniplates and one subgaleal drain was left in situ. The wound was closed in layers. Operators VS 曾漢民 Assistants R5 陳德福 R4 李振豪 錢思達 (M,2000/09/11,11y6m) 手術日期 2010/08/28 手術主治醫師 曾漢民 手術區域 東址 003房 號 診斷 Osteochondromatosis 器械術式 TSH 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 2 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:00 進入手術室 08:05 麻醉開始 08:30 誘導結束 09:00 抗生素給藥 09:17 手術開始 12:00 麻醉結束 12:00 手術結束 醫令資訊 類別 名稱 量 刀 側 手術 經由蝶竇之腦下垂體瘤切除 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 記錄__ 手術科部: 外科部 套用罐頭: Hypophysectomy---Transphenoid 開立醫師: 陳國瑋 開立時間: 2010/08/28 12:39 Pre-operative Diagnosis Pituitary macroadenoma Post-operative Diagnosis Sella tumor with bone origin Operative Method Transphenoid Hypophysectomy Specimen Count And Types 1 piece About size:Tumor fragments about 2~3mm Source:pituitary tumor Pathology Pending Operative Findings 1. Hard and whitish tumor originated from the bony part of the sella was noted. Hard and whitish tumor originated from the bony part of the sella was noted. 1. Hard and whitish tumor originated from the bony part of the sella was noted. 2. Small amout of CSF leakage was noted when entering the sella. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head tilted right. 3. Skin preparation of face and left abdomen was done as usual. 4. The nasal submucosa at septum and floor and the subperiostium at upper alveola were infiltrated with 1:100 epinephrine solution. 5. Incision: at septum of right nostril. 6. The mucosa of nasal septum and floor was dissected away from the septal cartilage and the bony floor on both sides from anterior to posterior and displaced laterally by a long nasal speculum. 7. The septal cartilage was cut at its basal juction by sepatal scissors and then displaced to one side. 8. A Hardy's nasal speculum was applied to displace the nasal mucosa laterally and keep the nasal cavity open constantly for the exposure of the vomer bone and the anterior wall of the sphenoid sinus. 9. Before the sinus was opened, another transverse bone was noted and was broken away. 10. After checked with fluoroscope, the sellar floor was penetrated by a osteotome, then widened by Kerrison punch. 12. Hard and whitish tumor originated from bone was noted and removed with Alligator piece by piece. 13. Check bleeding with Gelform, and then put back the basal bones. The mucosa was pushed back, too. 15. The nasal cavity was packed with finger gloves with Better iodine. Operators VS 曾漢民 Assistants R2 陳國瑋 李文金 (M,1954/10/31,57y4m) 手術日期 2010/08/28 手術主治醫師 許榮彬 手術區域 東址 017房 01號 診斷 Coronary artery disease, post percutaneous transluminal coronary angioplasty (PTCA) 器械術式 O.P.C.A.B 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 3 紀錄醫師 陳政維, 時間資訊 07:58 報到 08:05 進入手術室 08:30 麻醉開始 09:05 誘導結束 09:15 抗生素給藥 09:40 手術開始 12:15 抗生素給藥 13:50 麻醉結束 13:50 手術結束 13:55 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 動脈血液檢查全套 3 0 麻醉 Hemoglobin (Hb) 3 0 麻醉 測血糖 3 0 麻醉 Ca (Calcium) 3 0 麻醉 Na (Sodium) 3 0 麻醉 K (Potassium) 3 0 麻醉 Blood gas analysis 3 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 放置肺動脈導管術 1 0 麻醉 Cardiac out-put 1 0 麻醉 Swan-gang catheterization 1 0 麻醉 T.E.E 1 0 麻醉 Lactic Acid (lactate) 3 0 手術 冠狀動脈繞道手術－三條血管 1 1 記錄__ 手術科部: 外科部 套用罐頭: OPCAB 開立醫師: 陳政維 開立時間: 2010/08/30 17:50 Pre-operative Diagnosis CAD, 3VD, s/p POBAS, ISRS Post-operative Diagnosis CAD, 3VD, s/p POBAS, ISRS Operative Method OPCAB Specimen Count And Types Nil Pathology Nil Operative Findings 1.Fair LV contractility 2.CAD, 3VD: LAD: proximal ISRS, up to 80% LCx: Proximal ISRS, total occlusion beyond OM1 Ruptured ballon in OM2 RCA: Diffuse ISRS, up to 70% Operative Procedures 1.ETGA, supine position, skin disinfection and well draped 2.Medline sternotomy 3.Harvest LIMA, left GSV 4.OPCAB: LIMA-->LAD GSV1: AsAo-->PDA GSV2: AsAo-->OM1-->OM2 5.Hemostasis, set two chest tubes in mediastinum 6.Pericardium approximate partially. 7.Close the wound in layers Operators AP 許榮彬 Assistants R5 謝永？ R3 陳政維 方阿欉 (M,1927/08/12,84y7m) 手術日期 2010/08/29 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Malignant neoplasm of liver, primary 器械術式 Laminectomy for decompression 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 3E 紀錄醫師 鍾文桂, 時間資訊 19:30 臨時手術NPO 19:30 開始NPO 19:39 通知急診手術 21:10 進入手術室 21:22 麻醉開始 21:40 開始輸血 21:45 誘導結束 22:05 抗生素給藥 22:24 手術開始 00:45 手術結束 00:45 麻醉結束 00:55 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 惡性病髓腫瘤切除術 1 1 記錄__ 手術科部: 內科部 套用罐頭: Tumor excision for cord decompression. 開立醫師: 鍾文桂 開立時間: 2010/08/30 01:23 Pre-operative Diagnosis Metastatic spinal tumor, originated from hepatocellular carcinoma, T1. Post-operative Diagnosis Metastatic epidural spinal tumor, originated from hepatocellular carcinoma, T1. Operative Method Tumor excision for cord decompression. Specimen Count And Types 1 piece About size:50 cc Source:HCC with T-spine metastasis. Pathology Pending. Operative Findings Easy oozing tumor mass. The tumor was white-pinkish,and non-encapsulated. Combination of soft and hard tumor was noted. The T1 lamina was already eroded. Part of the T2 spinous process was removed. Intact dura mater. Full decompression of the cord was done. Blood loss: 4300cc. Operative Procedures Under ETGA, the patient was placed in prone position. Midline incision and dissection from C7 to T2 were done. The tumor mass was noted at the level of paraspinal muscle. We gradually excised the tumor with Kerrison, Rongeur, and disc clamp until the dura mater at the level of T1 was well exposed. The tumor was excised totally to achieve well hemostasis and cord compression. After placing one 1/8 hemovac at epidural space, the wound was closed in layers. Operators V.S. 賴達明 Assistants R5 鍾文桂 R1 徐紹剛 Indication Of Emergent Operation 黃清祿 (M,1950/06/25,61y8m) 手術日期 2010/08/30 手術主治醫師 葉德輝 手術區域 西址 033房 02號 診斷 Chronic paranasal sinusitis 器械術式 Lysis of nasal synechia 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 09:45 進入手術室 09:50 麻醉開始 09:55 誘導結束 10:00 手術開始 10:10 手術結束 10:10 麻醉結束 10:15 送出病患 記錄__ 手術科部: 耳鼻喉部 套用罐頭: DIVISION OF NASAL SYNECHIAE BY LASER VAPORAIZ... 開立醫師: 林玫君 開立時間: 2010/08/30 10:09 Pre-operative Diagnosis nasal sunechia, bil Post-operative Diagnosis nasal sunechia, bil s/p operation Operative Method DIVISION OF NASAL SYNECHIAE BY LASER VAPORAIZATION, RIGHT UNDER SINUSCOPE Specimen Count And Types NIL Pathology nil Operative Findings right nasal synechia between nasal septum and inferior turbinate Operative Procedures The patient was in the supine position. Cocaine-bosmin soaked cotton pledgets were applied for intranasal shrinkage. Synechia was noted between nasal septum and bil inferior turbinate. Bilateral synechia was releaseed by cut forceps. The patient stood it well. Operators AP葉德輝, Assistants R4林玫君, R2林芳瑩, 酆東海 (M,1957/02/04,55y1m) 手術日期 2010/08/30 手術主治醫師 曾漢民 手術區域 東址 002房 05號 診斷 Glioblastoma multiforma 器械術式 Left decompressive craniectomy 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3E 紀錄醫師 陳德福, 時間資訊 14:06 通知急診手術 14:35 報到 14:35 進入手術室 14:37 麻醉開始 14:42 誘導結束 15:35 手術開始 18:00 麻醉結束 18:00 手術結束 18:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱骨切除術，包括異物移除或減壓或神經切斷 1 1 L 手術 顱內壓監視置入 1 4 L 手術 顳下減壓術－單側 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 摘要__ 手術科部: 外科部 套用罐頭: 1.left hemicraniectomy 2.ICP monitoring 3.dur... 開立醫師: 陳德福 開立時間: 2010/08/30 18:22 Pre-operative Diagnosis Left MCA territory infarction with IICP and uncal herniation Post-operative Diagnosis Left MCA territory infarction with IICP and uncal herniation Operative Method 1.left hemicraniectomy 2.ICP monitoring 3.duroplasty Specimen Count And Types nil Pathology nil Operative Findings 1.The brain is moderately swelling and the duroplasty is done. After duroplasty, the subdural ICP is about 2mmHg. After the wound clousure, the ICP is 5mmHg. 2.The temporalis muscle is transected. Operative Procedures 1.ETGA and supine position 2.scalp disinfection and draping 3.incision along previous scalp wound and extends to left posterior auricular area 3.left hemicraniectomy and transect the temporalis muscle 4.dura opening and duroplasty 5.set a subdural ICP monitor 6.hemostasis 7.2 subgaleal driange and wound closure Operators VS曾漢民 Assistants R5陳德福 Indication Of Emergent Operation 摘要__ 手術科部: 外科部 套用罐頭: 1.left hemicraniectomy 2.ICP monitoring 3.dur... 開立醫師: 陳德福 開立時間: 2010/08/30 18:23 Pre-operative Diagnosis Left MCA territory infarction with IICP and uncal herniation Post-operative Diagnosis Left MCA territory infarction with IICP and uncal herniation Operative Method 1.left hemicraniectomy 2.ICP monitoring 3.duroplasty Specimen Count And Types nil Pathology nil Operative Findings 1.The brain is moderately swelling and the duroplasty is done. After duroplasty, the subdural ICP is about 2mmHg. After the wound clousure, the ICP is 5mmHg. 2.The temporalis muscle is transected. Operative Procedures 1.ETGA and supine position 2.scalp disinfection and draping 3.incision along previous scalp wound and extends to left posterior auricular area 3.left hemicraniectomy and transect the temporalis muscle 4.dura opening and duroplasty 5.set a subdural ICP monitor 6.hemostasis 7.2 subgaleal driange and wound closure Operators VS曾漢民 Assistants R5陳德福 Indication Of Emergent Operation 摘要__ 手術科部: 外科部 套用罐頭: 1.left hemicraniectomy 2.ICP monitoring 3.dur... 開立醫師: 陳德福 開立時間: 2010/08/30 18:24 Pre-operative Diagnosis Left MCA territory infarction with IICP and uncal herniation Post-operative Diagnosis Left MCA territory infarction with IICP and uncal herniation Operative Method 1.left hemicraniectomy 2.ICP monitoring 3.duroplasty Specimen Count And Types nil Pathology nil Operative Findings 1.The brain is moderately swelling and the duroplasty is done. After duroplasty, the subdural ICP is about 2mmHg. After the wound clousure, the ICP is 5mmHg. 2.The temporalis muscle is transected. Operative Procedures 1.ETGA and supine position 2.scalp disinfection and draping 3.incision along previous scalp wound and extends to left posterior auricular area 3.left hemicraniectomy and transect the temporalis muscle 4.dura opening and duroplasty 5.set a subdural ICP monitor 6.hemostasis 7.2 subgaleal driange and wound closure Operators VS曾漢民 Assistants R5陳德福 Indication Of Emergent Operation 沈延誠 (M,1954/07/28,57y7m) 手術日期 2010/08/30 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Secondary cancer of brain and spinal cord 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 吳俊毅, 時間資訊 00:00 臨時手術NPO 07:35 報到 08:05 進入手術室 08:10 麻醉開始 08:35 誘導結束 08:36 抗生素給藥 09:00 手術開始 11:10 麻醉結束 11:10 手術結束 11:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４小時以內 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Right frontal craniotomy for total tumor excision 開立醫師: 胡朝凱 開立時間: 2010/08/30 11:32 Pre-operative Diagnosis Right frontal metastatic tumor Post-operative Diagnosis Right frontal metastatic tumor Operative Method Right frontal craniotomy for total tumor excision Specimen Count And Types tumor in pieces Pathology pending Operative Findings 1.One soft yellowish tumor with cyst content which was brownish fluid was noted at right frontal lobe. The gyrus covered above the tumor became yellowish and gliotic. The plane between tumor and brain was clear. 2.After tumor excision, brain was slack. Operative Procedures 1.ETGA, supine with head rotate to left 2.Right frontal curvillinear skin incision 3.Reflect skin flap anteriorly 4.Detach temporalis muscle 5.Craniotomy 6.Curvature durotomy 7.Tumor excision after drainage of cyst content 8.Hemostasis 9.Close dura with prolene 10.fixed bone back with miniplate 11.Close wound in layers after one CWV drain insertion Operators 曾漢民 Assistants 胡朝凱, 吳俊毅 吳靜華 (F,1984/01/10,28y2m) 手術日期 2010/08/30 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Glioma 器械術式 awake surgery 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 古恬音, 時間資訊 00:00 臨時手術NPO 10:53 報到 12:05 進入手術室 12:15 麻醉開始 12:25 誘導結束 12:30 抗生素給藥 12:30 手術開始 15:30 抗生素給藥 17:45 麻醉結束 17:45 手術結束 17:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除－手術時間在４～８小時 1 1 L 手術 立體定位術－抽吸 1 2 L 摘要__ 手術科部: 外科部 套用罐頭: Awake surgery for total tumor excision 開立醫師: 胡朝凱 開立時間: 2010/08/30 18:15 Pre-operative Diagnosis Left temporal to frontal glioma Post-operative Diagnosis Left temporal to frontal glioma Operative Method Awake surgery for total tumor excision Specimen Count And Types PIECES OF BRAIN TUMOR, ABOUT 2 GRAMS Pathology pending Operative Findings 1.The tumor was greyish, soft, gel like located at left temporal to frontal lobe area. The margin was relative clear. The MCA lcaoted behind the tumor with some branches encasement. But the vessels was preserved. 2.During awake status, there was no verbal output decrease during stimulation. Operative Procedures 1.GA, supine 2.Left curvature skin incision 3.Pterional approach for craniotomy 4.Curvature durotomy 5.Awake patient up 6.Speech area localization with stimulation 7.Sedation again 8.Tumor excision 9.Hemostasis 10.Close dura 11.fix bone back with miniplate 12.close wound in layers. Operators VS曾漢民 Assistants R6胡朝凱,R3古恬音 胡逸然 (F,1976/02/22,36y0m) 手術日期 2010/08/30 手術主治醫師 戴浩志 手術區域 東址 009房 04號 診斷 Breast cancer, female 器械術式 Debridment-- >10cm 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 黃慧薰 ASA 3 紀錄醫師 黃柏誠, 時間資訊 11:50 進入手術室 11:55 麻醉開始 11:57 誘導結束 12:00 抗生素給藥 12:15 手術開始 13:00 手術結束 13:00 麻醉結束 13:05 送出病患 13:10 進入恢復室 14:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 肌肉或深部組織腫瘤切除術及異物取出術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 記錄__ 手術科部: 外科部 套用罐頭: port-A site revision and skin revision 開立醫師: 黃柏誠 開立時間: 2010/08/30 13:15 Pre-operative Diagnosis breast cancer with bone metastasis s/p port-A implantation and extrusion Post-operative Diagnosis breast cancer with bone metastasis s/p port-A implantation and extrusion Operative Method port-A site revision and skin revision Specimen Count And Types nil Pathology nil Operative Findings 1.a 1.5 cm thin skin site above previous port-A suture site, port-A set was extrusion Operative Procedures 1.ETGA supine position 2.disinfection and drape 3.skin wide excision with falciform shape 4.revision port-A set location 5.hemostasis and BI solution irrigation 6.fixation port-A set and cover tube with muscle insert a CWV drain 7.close wound in layers Operators VS戴浩志 Assistants R5官振翔 R3黃柏誠 RI方聖恩 盧柏誠 (M,1986/09/08,25y6m) 手術日期 2010/08/30 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Brain tumor 器械術式 central neurocytoma 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:05 進入手術室 08:10 麻醉開始 08:35 誘導結束 09:20 抗生素給藥 09:35 手術開始 12:20 抗生素給藥 15:20 抗生素給藥 17:30 麻醉結束 17:30 手術結束 17:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４～８小時 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 11 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Transcortical approach for nearly total tumor... 開立醫師: 游健生 開立時間: 2010/08/30 17:56 Pre-operative Diagnosis Recurrent left lateral ventricle central neurocytoma Post-operative Diagnosis Recurrent left lateral ventricle central neurocytoma Operative Method Transcortical approach for nearly total tumor excision Specimen Count And Types 1 piece About size:a few pieces Source:lateral ventricle tumor Pathology Pending Operative Findings Severe adhesion between dura and arachnoid membrane under previous craniotomy window. The tumor was about 4.8 x 3.5 x 3.8 cm in size inside left lateral ventricle. It was soft, fragile, and grayish white. The septum pallucidum was opened during surgery and the septum was noted protuding to the contralateral side. Intra-op easy oozing of the tumor was noted and the septal vein encased by the tumor was ligated. The tumor was nearly total removed till the expose of ependymal lining and choroid plexus. The external ventricular drainage catheter was 5cm in length inserted in left lateral ventricle. Operative Procedures Under ETGA, patient was put into supine position with head turned to left 5 degrees and tilted up mildly. Head was fixed with Mayfield headholder. After shaving, we disinfected and draped the operation field as usual. A scalp incision was made along previous wound scar. We reflected the skin flap with temporal muscle anteriorly followed by removing previous bone flap. We opened the dura in U-shape with superior sagittal sinus as base. After careful dissection between dura and arachnoid membrane, the previous transcortical tract was exposed. After gentle retraction through it, we exposed the tumor in left lateral ventricle. The tumor was removed in piecemeal. Septal vein encased by the tumor was ligated during tumor removal. We opened the septum pallucidum and checked if there was any tumor in right lateral ventricle. We noted the septum protuded to the contralateral side but there was no tumor. We removed the tumor till ependymal lining and choroid plexus were exposed. Hemostasis was achieved with bipolar and Surgicel packing. An EVD catheter was inserted into left lateral ventricle under direct vision. Then, we harvested 2 muscle fascia for dura repairment. We placed gelfoam beneath the dura flap and closed it with 4-0 prolene continuous suture. Bone flap was fixed back with microplate. After placement of a subgaleal CWV drain, we closed the wound in layers. Operators VS 賴達明 Assistants R6 陳睿生 R3 游健生 匡乃僧 (M,1949/01/23,63y1m) 手術日期 2010/08/30 手術主治醫師 蔡翊新 手術區域 東址 003房 03號 診斷 Intracerebral hemorrhage 器械術式 Craniotomy(Aneurysms) P-DUH 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 3E 紀錄醫師 周聖哲, 時間資訊 10:00 臨時手術NPO 10:00 開始NPO 19:56 通知急診手術 21:00 報到 21:08 進入手術室 21:15 麻醉開始 21:50 抗生素給藥 21:50 誘導結束 22:09 手術開始 00:35 麻醉結束 00:35 手術結束 00:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦內血腫清除術 1 1 R 手術 顱內壓監視置入 1 2 R 摘要__ 手術科部: 外科部 套用罐頭: CVA 開立醫師: 蔡翊新 開立時間: 2010/08/31 00:27 Pre-operative Diagnosis Right putaminal ICH and Sylvian fissure SAH. Post-operative Diagnosis Right putaminal ICH and Sylvian fissure SAH. Operative Method Right frontotemporal craniotomy for ICH evacuation and ICP monitoring. Specimen Count And Types nil Pathology Nil. Operative Findings A 5 x 4 x 3 cm hematoma was noted at the right basal ganglia. The right Sylvian fissure was filled up with SAH. There were some vessels encased in the thick SAH in the Sylvian fissure, which was not removed because of difficulty in proximal control if there really existed an aneurysm. The brain surface became slack, 0.8 cm away from the dura, after ICH evacuation. ICP after skin closure was 4 mmHg. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: right frontotemporal, curvilinear. The skin edge was clipped by Raney clips for temporary hemostasis. After scalp had been lifted, the temporalis muscle was incised and detached from temporal squama and reflected to lower temporal side. 5. Craniotomy: A 6 cm trephine was made at frontotemporal area over-riding the Sylvian fissure with its center 5 cm above external ear canal. 6. Dural tenting: by 2/0 silk, 2 cm in interval, distributed along the edge of skull window. 7. Dural incision: cruciate. 8. A 2 cm cortical incision was made at anterior part of the superior temporal gyrus, the subcortex and white mater was splitted by brain retractor and sucker until the intracerebral hematoma was exposed. The hematoma was sucked out carefully. Those tough clots were removed by forceps. The cavity was irrigated with NS and the blood oozing was stopped by Surgicel packing. Before closure of the dura, the hematoma caivty was clean and the brain once bulging was very slack. 9. Dural closure: interrupted 2/0 silk sutures for key stitches, then continous sutures with 4/0 Prolene to obtain water-tight closure. 10.The trephine button wassimply placed back and fixed with wires. 11.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 12.Drain: one epidural CWV. 13.Blood transfusion: nil. Blood loss: 100 ml. 14.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R6胡朝凱R1周聖哲 Indication Of Emergent Operation 游沛純 (F,2010/05/24,1y9m) 手術日期 2010/08/31 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Apert syndrome 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 曾峰毅, 時間資訊 23:42 臨時手術NPO 07:55 報到 08:08 進入手術室 08:25 麻醉開始 08:30 誘導結束 08:31 手術開始 08:32 手術結束 10:38 抗生素給藥 11:10 11:20 開始輸血 13:38 抗生素給藥 16:38 抗生素給藥 17:20 麻醉結束 17:20 17:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱骨切除術，包括異物移除或減壓或神經切斷 1 1 B 手術 頭顱成形術 1 2 B 手術 顱顏合併手術 1 1 B 手術 顏面骨移植術（先天畸形或外傷腫瘍摘除） 1 1 B 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 10 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 3 0 麻醉 Hemoglobin (Hb) 3 0 麻醉 測血糖 3 0 麻醉 Ca (Calcium) 3 0 麻醉 Na (Sodium) 3 0 麻醉 K (Potassium) 3 0 麻醉 Blood gas analysis 3 0 記錄__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 曾峰毅 開立時間: 2010/08/31 14:08 Pre-operative Diagnosis Apert's syndrome craniosynostosis due to Aperts syndrome Post-operative Diagnosis Apert's syndrome craniosynostosis due to Aperts syndrome Operative Method Bilateral craniectomy with reconstructive carnioplasty Frontal and bilateral parietal craniectomy with expansive reconstructive cranioplasty Specimen Count And Types Nil Pathology Nil Operative Findings Early fusion of bilateral coronral suture with unmathced fusion. Widened, unfused sagittal suture from anterior to posterior fontanelle. Early fusion of bilateral coronral suture with unmathced fusion. Widened, unfused sagittal suture from anterior to posterior fontanelle. The sagittal suture was widely opened and up to 2 cm in width. The posterior fontanel was widely opened, too, and up ot 3x3 finger breath Early fusion of bilateral coronral suture with unmathced fusion. Widened, unfused sagittal suture from anterior to posterior fontanelle. The sagittal suture was widely opened and up to 2 cm in width. The posterior fontanel was widely opened, too, and up ot 3x3 finger breath. The brain was tight and flat (decreased AP diameter) became round after decompression. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head flexed slightly. After scalp shaved, scrubbed, disinfected, and then draped, we made one transverse linear scalp incision at pareital area from one side to the other. Scalp falp was dissected subgaleally, and was reflected anteriorly until superior orbital ridge exposed. We drilled two burr hols at temporal area at each side. Craniectomy was done with dir-drill and Karrison punch. Reconstructive cranioplasty was done with mini-plates. The wound was closed in layers after hemostasis and CWV drain set. With endotracheal general anaesthesia, the patient was put in supine position with head flexed slightly. After scalp shaved, scrubbed, disinfected, and then draped, we made one transverse linear scalp incision at pareital area from one side to the other. Scalp falp was dissected subgaleally, and was reflected anteriorly until superior orbital ridge exposed. We drilled two burr hols at temporal area at each side. Craniectomy was done with dir-drill and Karrison punch. Reconstructive cranioplasty was done with 4-0 Dexon fixation. Bilateral frontal bone was fixed with 4-0 Dexon at supraorbital region, and bilateral parietal bone was rotated direction from horizontal to vertical, like a bridge to connect frontal bone and occipital bone. The wound was closed in layers after hemostasis and CWV drain set. With endotracheal general anaesthesia, the patient was put in supine position with head flexed slightly. After scalp shaved, scrubbed, disinfected, and then draped, we made one transverse linear scalp incision at pareital area from one side to the other. Scalp falp was dissected subgaleally, and was reflected anteriorly until superior orbital ridge exposed. We then dissected the periosteum and reflected it anteriorly. We drilled two burr hols at temporal area at each side. Frontal craniectomy from the supraorbital region to 1 cm behind the coronal suture was done with dir-drill and Karrison punch. Another two burr holes were made at posterior inferior parietal region, then bilateral parietal crniectomy was made. Reconstructive cranioplasty was done with 4-0 Dexon fixation. Bilateral frontal bone was fixed with 4-0 Dexon at supraorbital region, and bilateral parietal bone was rotated direction from horizontal to vertical, like a bridge to connect frontal bone and occipital bone. The wound was closed in layers after hemostasis and CWV drain set. Operators VS 郭夢菲 VS 郭夢菲 VS謝孟祥 Assistants R4 曾峰毅 R4 曾峰毅 R5官振翔 R3黃柏誠 黃銀貞 (F,1943/12/02,68y3m) 手術日期 2010/08/31 手術主治醫師 王碩盟 手術區域 東址 013房 03號 診斷 Diabetes mellitus 器械術式 Adrenalectomy, /Laparscopy 手術類別 預定手術 手術部位 腹 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 3 紀錄醫師 楊智凱, 時間資訊 12:45 報到 13:35 進入手術室 13:38 麻醉開始 13:55 誘導結束 14:15 抗生素給藥 14:55 手術開始 15:50 手術結束 16:02 17:00 麻醉結束 17:00 17:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腹腔鏡腎上腺切除 1 1 R 手術 腹腔鏡腎上腺切除 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 泌尿部 套用罐頭: adrenalectomy, left 開立醫師: 楊智凱 開立時間: 2010/08/31 17:21 Pre-operative Diagnosis Bilateral adrenal tumor Post-operative Diagnosis Bilateral adrenal tumor Operative Method Bilateral laparoscopic adrenalectomy Specimen Count And Types bilateral adrenal gland Pathology pending Operative Findings Adenoma in bilateral adrenal gland Operative Procedures Under the satisfactory endotracheal general anesthesia with the patient in a left flank position, prepping and drapping were performed in the usual sterile method. A 16 Fr. Foley catheter was inserted into the bladder. A 5-12 mm Visiport was created at paraumbilical area with CO2 inflation up to 15mmHg. Three 5mm ports were furtherly placed at right subcostal area and right flank area for grasper ,electrocautery Harmonic scalpel and liver retractor. A retractor was inserted to retract the liver upwards. Adhesiolysis was done first. Dissection was made alongside adrenal gland and IVC by Harmonic scalpel. Ligation of adrenal vessels and connective tissue by Bipolar electracautery device was done meticulously. The adrenal glands was removed from the paraumbilical wound in a gloove as retrieval bag. Adequate hemostasis was obtained . The wound was closed with 5/8 Vicril and skin closed with 3-0 nylon. Shifted the patient in right flank position, prepping and draping were performed in the usual sterile fashion. A 5-12 mm visiport was created at paraumbilicalarea with CO2 inflation up to 15 mmHg. Two 2-mm miniports were furtherly placed at LUQ along mid-clavicular line and anterior axillary line. The ascescending colon was taken down, and the Gerotas fascia was opened. The left adrenal gland was exposed aftercareful dissection. The adrenal vessels were clipped with Hemoloc and divided. The left adrenal gland was delivered and removed after being entrapped into the finger of surgical glove as retrieval bag. Adequate hemostasis was obtained. The wound was closed with 5/8 dexon and skin was closed with 3-0 nylon.The patient tolerated the procedure well and was sent to ICU in stable condition. Operators 王碩盟, Assistants 楊智凱, 姜秉均, 林華德 (M,1925/08/16,86y6m) 手術日期 2010/08/31 手術主治醫師 曾勝弘 手術區域 西址 033房 01號 診斷 Tardy ulnar palsy 器械術式 Neurolysis of the uluar neuve 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 08:40 進入手術室 09:00 麻醉開始 09:05 手術開始 10:05 手術結束 10:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 神經分離術－手．足之神經 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Neurolysis of right ulnar nerve 開立醫師: 李振豪 開立時間: 2010/08/31 10:20 Pre-operative Diagnosis Tardy ulnar palsy, right Post-operative Diagnosis Tardy ulnar palsy, right Operative Method Neurolysis of right ulnar nerve Specimen Count And Types nil Pathology Nil Operative Findings The right ulnar nerve was tightly entrapment at right elbow level with fibrosis. Degenerative change due to previous injury was suspected according to local finding. The nerve was decompressed well after neurolysis. Operative Procedures Under supine position, the skin was disinfected and draped as usual. The local anesthesia with 1% Xylocaine 10ml was given. One curvilinear skin incision was made at medial side of right elbow posterior to medial epicondyle. The subcutaneous soft tissue was dissected and the ulnar nerve was exposed after excision of fibrotic band. The neurolysis was performed along the tract of right ulnar nerve(5cm proximal and distal to epicondyle). Hemostasis was achieved and the wound was then closed in layers with 3-0 Vicryl and 3-0 Nylon. Operators VS曾勝弘 Assistants R4李振豪 李宗德 (M,1953/08/24,58y6m) 手術日期 2010/08/31 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Spondylolisthesis 器械術式 L4/5 TPS 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:00 進入手術室 08:10 麻醉開始 08:25 誘導結束 08:40 抗生素給藥 09:02 手術開始 11:40 抗生素給藥 12:30 手術結束 12:30 麻醉結束 12:40 送出病患 12:41 進入恢復室 14:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 椎間盤切除術－腰椎 1 2 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 摘要__ 手術科部: 外科部 套用罐頭: 1.L4-5 TPS and PEEK fusion 2.L4 laminectomy 3... 開立醫師: 陳德福 開立時間: 2010/08/31 12:24 Pre-operative Diagnosis Lumbar spondylolisthesis with stenosis , L4-5 Post-operative Diagnosis Lumbar spondylolisthesis with stenosis , L4-5 Operative Method 1.L4-5 TPS and PEEK fusion 2.L4 laminectomy 3.L4-5 Diskectomy Specimen Count And Types nil Pathology nil Operative Findings 1.There are osteoporotic change and hypertrophic ligamentum flavum over the L4-5 with spinal stenosis. The thecal sac was compressed by the osteophytes and ligamentum flavum. The theca sac was decompressed after the L4 miniectomy. The L4-5 disc was removed and 2 PEEKs [11mm] were inserted. 2.4 TPS 45mm in sized with 2 rods are implatated over L4-5 smoothly.] Operative Procedures Under ETGA and prone position, the skin was disinfected and draped as usual. One linear incision at midline was done and the paraspinous msucle was displaced laterally. The L4-5 lamina was exposed and L4-5 TPS was inserted under C-arm flouroscope guided. The lower L4 laminecotmy and L4-5 diskectomy were performed with Kerrison, Alligator, Disc clamp and currettage assisted. 2 interbody[L4-5] PEEKs[11mm] were inserted. The rods was implantated followed by performing L4-5 posterior lateral autologous fusion. Hemostasis and left one hemovac in the epidural space. The wound was then closed in layers. Operators vs賴達明 Assistants R5陳德福 R2陳國瑋 相關圖片 陳明四 (F,1959/08/10,52y7m) 手術日期 2010/08/31 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Herniation of intervertebral disc (HIVD) 器械術式 L5/S1 HIVD 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 12:10 報到 12:47 進入手術室 12:50 麻醉開始 12:55 誘導結束 13:00 抗生素給藥 13:30 手術開始 15:50 手術結束 15:50 麻醉結束 16:00 送出病患 16:01 進入恢復室 17:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術－腰椎 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 摘要__ 手術科部: 外科部 套用罐頭: Microscopic discectomy 開立醫師: 陳德福 開立時間: 2010/08/31 15:55 Pre-operative Diagnosis Buldging disc at L5/S1, Central disc Post-operative Diagnosis Buldging disc at L5/S1, Central disc Operative Method Microscopic discectomy Specimen Count And Types nil Pathology nil Operative Findings Buldging disc at L5/S1, Central disc with local adhesion and hyperemia Operative Procedures 1.ETGA, prone, C-arm localization 2.Midline back incision, divide left side paraspinal muscle to expose L5 and S1 lamina 3.L5 laminotomy with drill and then Karrison punch 4.Remove ligmentum flavum till exposure of Thecal sac and S1 root 5.Retract root from shoulder and disc was exposed 6.Cauterize PLL and then incision of the buldging disc, then discectomy was done with Currete and disclamp 7.Hemostasis with gelform packing 8.close wound in layers Operators VS 賴達明 Assistants R5陳德福 R2陳國瑋 相關圖片 李春松 (M,1957/06/06,54y9m) 手術日期 2010/08/31 手術主治醫師 賴達明 手術區域 東址 005房 01號 診斷 Herniation of intervertebral disc 器械術式 C4/5 HIVD 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 07:42 報到 08:02 進入手術室 08:18 麻醉開始 08:23 誘導結束 08:40 抗生素給藥 09:15 手術開始 11:40 抗生素給藥 12:35 手術結束 12:35 麻醉結束 12:40 送出病患 12:50 進入恢復室 14:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 椎間盤切除術－頸椎 1 1 記錄__ 手術科部: 外科部 套用罐頭: 1. Microsurgical diskectomy of C4/5, right an... 開立醫師: 鍾文桂 開立時間: 2010/08/31 13:06 Pre-operative Diagnosis Herniated intervertebral disc, C4/5. Post-operative Diagnosis Herniated intervertebral disc, C4/5. Operative Method 1. Microsurgical diskectomy of C4/5, right anterior approach. 2. Interbody fusion with cervical cage. Specimen Count And Types nil Pathology Nil. Operative Findings 1. Herniated intervertebral disc at C4/5 level. 2. Synthes 9 mm PEEK cage for interbody fusion. 3. Intact dura mater. Operative Procedures Under ETGA, the patient was placed in supine position and the neck was slightly extended. A horizontal incision was made at thyroid cartilage level. We incised through the platysma muscle, and dissected along the anterior border of sternocledomastoid muscle until the prevertebral space was reached. The esophagus was retracted medially and the carotid sheath was retracted laterally. After ensuring the location of C4/5 intervertebral disc level by intraoperative fluoroscopy, diskectomy was achieved by currete, kerrison punch and high speed cutting drill. A 9mm cervical cage was implanted. After placing one mini-hemovac, the wound was closed in layers. Operators V.S. 賴達明 Assistants R5 鍾文桂 盧文哲 (M,1941/06/30,70y8m) 手術日期 2010/09/01 手術主治醫師 賴達明 手術區域 東址 005房 01號 診斷 Brain metastasis 器械術式 VP shunt, programmable 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:10 進入手術室 08:20 麻醉開始 08:25 誘導結束 09:25 手術開始 11:05 手術結束 11:05 麻醉結束 11:10 送出病患 11:15 進入恢復室 12:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 記錄__ 手術科部: 外科部 套用罐頭: Right Kochers point Codman programmable V-P s... 開立醫師: 林哲光 開立時間: 2010/09/01 11:37 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Right Kochers point Codman programmable V-P shunt insertion Specimen Count And Types Pathology Operative Findings Previous burr hole of right Kocher point was noted. CSF seemed clear and transparent and CSF routine, BCS, and culture were sent. Ventricular catheter was 6.5 cm long and abdominal catheter was about 30 cm long. Codman programmable shunt (80mmHg) was inserted. Operative Procedures Under ETGA and supine position with head rotated to left side, skin disinfected and drapped were performed as usual. Previous operative wound skin incision was made. RUQ abdomen skin incision was done and mini-larparotomy was done. The peritoneum was opened and ventricular puncture was inserted. The subcutaneous tunneling was then made via stylate with two neck incision was made. The ventricular catheter was then connected to abdominal catheter with Codman valve and the ventricular catheter was then inserted introduced by ventricular puncture with trajectory composed wiht two planes point to ipisilateral targus and medial canthus. The wounds were then closed in layers. Operators VS賴達明 Assistants R6 胡朝凱, R4 林哲光, R1 李柏穎 相關圖片 袁玉琴 (F,1952/04/17,59y10m) 手術日期 2010/09/01 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Rheumatoid arthritis of spine 器械術式 retropharyngeal odontoidectomy 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:05 進入手術室 08:20 麻醉開始 08:40 誘導結束 09:20 抗生素給藥 09:26 手術開始 12:20 抗生素給藥 13:55 開始輸血 14:25 麻醉結束 14:25 手術結束 14:35 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 脊椎融合術－前融合，無固定物（＜＝四節） 1 1 記錄__ 手術科部: 外科部 套用罐頭: Retropharyngeal approach for odontoidectomy a... 開立醫師: 王奐之 開立時間: 2010/09/01 15:05 Pre-operative Diagnosis Rheumatoid arthritis with odontoid invagination Post-operative Diagnosis Rheumatoid arthritis with odontoid invagination Operative Method Retropharyngeal approach for odontoidectomy and removal of C1 anterior arch Specimen Count And Types 1 piece About size:pieces Source:C1-2 soft tissue Pathology Pending Operative Findings The C2 was deformed and invaginated superiorly. Hard fibrotic tissue was noted between C1 anterior arch & C2 dens. Thecal sac was well re-expanded after odontoidectomy. Easy oozing was noted after odontoidectomy. The C2 was deformed and invaginated superiorly. Hard fibrotic tissue was noted between C1 anterior arch & C2 dens. Thecal sac was well re-expanded after odontoidectomy. Easy oozing was noted after odontoidectomy. An obvious fracture line was noted at dens. Operative Procedures After ETGA, the patient was placed in supine position with neck hyperextended. After skin disinfection and draping, a linear skin incision was made below right mandible. The incision was deepened through plastysma muscle. The submandibular gland, digastric muscles & hypoglossal nerve were retracted superiorly. The plane between cricoid and carotid sheath was dissected and the pre-vertebral membrane was exposed. The pre-vertebral membrane was divided, exposing C1 anterior arch and C3. The anterior arch of C1 was then drilled and removed until C2 was seen. Odontoidectomy was then performed, the inferior end of clivus was also removed to allow full visiualization of the dens tip. The tectorial membrane and upper part of PLL were then removed to ensure full expansion of thecal sac. C-arm was used to confirm the completion of odontoidectomy. After hemostasis, a CWV was inserted and the wound was closed in layers. Operators VS賴達明 Assistants R6陳睿生, R3王奐之 相關圖片 白仁義 (M,1934/02/04,78y1m) 手術日期 2010/09/01 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 Traumatic subdural hemorrhage 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 4E 紀錄醫師 曾峰毅, 時間資訊 15:31 通知急診手術 15:55 進入手術室 16:00 麻醉開始 16:10 誘導結束 16:12 抗生素給藥 16:15 手術開始 17:00 開始輸血 19:12 抗生素給藥 19:20 手術結束 19:20 麻醉結束 19:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦內血腫清除術 1 1 L 手術 顱內壓監視置入 1 2 L 摘要__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 曾峰毅 開立時間: 2010/09/01 19:11 Pre-operative Diagnosis Acute subdural hematoma with frontal contusional intracerebral hemorrhage, bilateral, more at left Post-operative Diagnosis Acute subdural hematoma with frontal contusional intracerebral hemorrhage, bilateral, more at left Operative Method Left crainectomy, ICH evacuation, and ICP monitor insertion Specimen Count And Types Nil Pathology Nil Operative Findings About 2cm SDH was noted at left frontotemporal area. Severe contusion was noted beneath the SDH with left frontal ICH. Post-op ICP was 4mmHg. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to right. After scalp shaved, scrubbed, disinfected, and then draped, we made one curvilinear skin incision, as traumatic flap, at left. We drilled 5 burr holes, and created craniectomy. We tented the dura along the craniectomy window, and harvested autologous fascia graft from temporalis muscle. Curvilinear dura incision was made, and subdural hematoma was removed. Left frontal contusional intracerebral hemorrhage was removed as well. After hemostasis, we packed the surgicel in the hematoma cavity. ICP monitor was inserted into left frontal lobe. Augmentation duroplasty was done with autologous fascia graft and suture. After placing two CWV drain, we closed the wound in layers. Operators VS 王國川 Assistants R4 曾峰毅 R4 林哲光 Indication Of Emergent Operation 黃鈺翔 (M,1997/11/30,14y3m) 手術日期 2010/09/02 手術主治醫師 陳晉興 手術區域 東址 019房 01號 診斷 Primitive neuroectodermal tumor 器械術式 Thoracoscopy 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 蔡東明, 時間資訊 07:46 報到 08:07 進入手術室 08:10 麻醉開始 08:15 誘導結束 08:55 抗生素給藥 09:26 手術開始 10:55 手術結束 10:55 麻醉結束 11:00 送出病患 11:05 進入恢復室 12:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 胸腔鏡肺楔狀或部分切除術 1 1 R 手術 胸腔鏡肺楔狀或部分切除術 1 2 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 記錄__ 手術科部: 外科部 套用罐頭: VATS biopsy 開立醫師: 蔡東明 開立時間: 2010/09/02 11:19 Pre-operative Diagnosis 1.Primitive neuroectodermal tumor, with multiple metastasis 2.Recurrent metastatic neuroectodermal tumor in right lung Post-operative Diagnosis 1.Primitive neuroectodermal tumor, with multiple metastasis 2.Recurrent metastatic neuroectodermal tumor in right lung Operative Method Wedge resection of pulmonary lesion via VATS. Specimen Count And Types 3 pieces About size:4*4cm Source:RUL About size:4*4cm Source:RML About size:3*3cm Source:RLL Pathology Pending Operative Findings 1.Six yellowish, soft, well-defined, elastic firm nodule was noted at right lung field. RUL: 0.5*0.5cm, 0.2*0.2cm(near bullae). RML:2*1.5cm, 1*1cm. RLL: 0.5*0.5cm*II. 2.One 4*4cm elastic bullae was noted at right upper lobe, posterior segment. 3.Some adhesion bands were noted at right lung field and chest wall. 4.Post-operative air-leakage or bleeding: nil. 5.Blood loss: minimal. Operative Procedures 1. Anesthesia: General anesthesia using single-lumen endotracheal tube with endobronchial blocker. 2. Position: left decubitus position. An axillary roll is placed under the down side. The operative field is well disinfected and draped. 3. Camera port: From the seventh intercostal space in the mid-axillary line away from the lesion. 4. VATS port-setting: 5mm thoracoscopy. 5. The pleural adhesions are separated by grasping forceps and by electrocautery. 6. The pulmonary lesion is visualized and stabilized with the grasping forceps. 7. The Endo-GIA stapler (Tyco 4.8mm)is placed across its base. Wedge resection of the pulmonary lesion is performed. 8. After meticulous homeostasis, one 20# chest tubes is placed via the camera port. The lung is ventilated under the direct vision. The skin is closed with 4-0 Nylon sutures. Operators VS陳晉興 Assistants R4蔡東明 Ri林珮愉 徐銘夆 (M,1982/12/05,29y3m) 手術日期 2010/09/02 手術主治醫師 林峰盛 手術區域 西址 035房 05號 診斷 Neuralgia 器械術式 Nerve block / PC 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 神經阻斷 麻醉主治醫師 林峰盛 ASA 2 時間資訊 14:25 進入手術室 14:30 麻醉開始 14:35 誘導結束 14:50 手術開始 15:30 麻醉結束 15:30 手術結束 記錄__ 手術科部: 麻醉部 套用罐頭: Pulsed RF 開立醫師: 林峰盛 開立時間: 2010/09/02 15:41 Pre-operative Diagnosis Radiculopathy Post-operative Diagnosis radiculopathy Operative Method Pulsed RF Specimen Count And Types nil Pathology Nil Operative Findings Operative Procedures 1. pt in prone position 2. Under fluoroscopic-guidance, insert 22 G SMK RF meedle to bil pudendal nerve 3. Neurostimulation with 50 HZ and 2 Hz 0.1-0.5 mV current with positive result 60-80V 2 Hz, 20 ms, 120sec *2 pulsed RF was delivered 4. right pudendal nerve block with 2% lidocaine 10ml , left side with 0.5% Marcaine 5 ml, perineal area was numbed at once send pt to POR Operators 林峰盛, Assistants 林怡萱, 甘秋雄 (M,1941/09/25,70y5m) 手術日期 2010/09/02 手術主治醫師 陳敞牧 手術區域 東址 005房 02號 診斷 Lumbar spondylosis 器械術式 L4-5 laminectomy + TPS 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 傅紹懷, 時間資訊 00:00 臨時手術NPO 11:00 報到 11:45 進入手術室 11:45 麻醉開始 12:05 誘導結束 12:15 抗生素給藥 12:40 手術開始 15:10 抗生素給藥 15:55 手術結束 15:55 麻醉結束 16:10 送出病患 16:12 進入恢復室 18:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 椎弓切除術（特壓）－二節以內 1 2 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 記錄__ 手術科部: 外科部 套用罐頭: 1.L4~5 TPS and 2.L3-4 laminectomy 開立醫師: 陳德福 開立時間: 2010/09/02 16:04 Pre-operative Diagnosis L4-5 spndylosis with radiculopathy Post-operative Diagnosis L4-5 spndylosis with radiculopathy Operative Method 1.L4~5 TPS and 2.L3-4 laminectomy Specimen Count And Types nil Pathology NIL Operative Findings 1.There is hypertrophic ligmentum flavum over L4-5 and the spinal stenosis is noticed. The previous L4 hemilaminectomy window is adhesive with local stenosis. 2. TPS [45mm] over L4-5 and 2 rods was set smoothly. Operative Procedures 1.ETGA, prone 2.Midline incision at L3~S1 level 3.Detach paravertebral muscle groups 4.Expose L4 and L5 lamina and facets 5.TPS insertion 6.L3-4 laminectomy and decompression of neural foramen with Kerrison pounch 7.Fix rods 8.Lateral fusion after decortication of L4~5 lamina 9.Set one hemovac drain then close wound in layers. Operators 陳敞牧 Assistants R5陳德福 R1傅紹懷 相關圖片 侯志偉 (M,1984/07/08,27y8m) 手術日期 2010/09/02 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Major trauma rated 16 or above on the severeity scale ( Injury severeity score >=16 ) 器械術式 bur hole 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:04 進入手術室 08:10 麻醉開始 08:15 誘導結束 09:00 抗生素給藥 09:05 手術開始 09:40 麻醉結束 09:44 手術結束 09:50 送出病患 09:52 進入恢復室 11:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 硬腦膜外血腫清除術 1 2 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: left frontal burr hole drainage 開立醫師: 林哲光 開立時間: 2010/09/02 10:05 Pre-operative Diagnosis Left F-T epidural hematoma Post-operative Diagnosis Left F-T chronic subdural hematoma Operative Method left frontal burr hole drainage Specimen Count And Types nil Pathology Operative Findings Some dark-oil like fluids were drained out after burr hole created. No reepansion of the brain parenchyma was noted after hematoma removal. Operative Procedures Under ETGA and supine position with head rotated to right side, skin disinfected and drapped were performed as usual. Skin incision over the previous operative wound was done and a burr hole was created over the left frontal area over the previous skull bone graft. The hematoma evauation was then performed and a rubber drain was inserted into the burr hole. Deair was done and the wound was then closed in layers. Operators VS 王國川 Assistants R4 林哲光 相關圖片 李王秀梅 (F,1951/08/15,60y6m) 手術日期 2010/09/02 手術主治醫師 蔡翊新 手術區域 東址 005房 01號 診斷 Injury (severeity score >=16) 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 傅紹懷, 時間資訊 00:00 臨時手術NPO 07:35 報到 08:08 進入手術室 08:20 麻醉開始 08:25 誘導結束 08:50 抗生素給藥 09:04 手術開始 11:25 手術結束 11:25 麻醉結束 11:30 送出病患 11:32 進入恢復室 12:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 頭顱成形術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 摘要__ 手術科部: 外科部 套用罐頭: Cranioplasty 開立醫師: 蔡翊新 開立時間: 2010/09/02 11:02 Pre-operative Diagnosis Left frontotemporoparietal skull defect. Post-operative Diagnosis Left frontotemporoparietal skull defect. Operative Method Cranioplasty with autologous bone graft. Specimen Count And Types nil Pathology Nil. Operative Findings A 14 x 12 cm skull defect at left F-T-P region. The brain was relatively swollen after lifting the scalp flap. The temporalis muscle has been excised and the bulk was replaced with a piece of bone cement. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right. 3. Skin preparation:shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with a sterilized adhesive plastic sheet. 4. Incision: along the previous operation scar at left F-T-P region, Raney clips were applied to the scalp edge for temporary hemostasis. 5. The left F-T-P scalp was dissected away from the underlying dura. 6. The bleeders on the dissected surfaces were coagulated with Bovie painstakingly. 7. The edge of the skull defect was exposed. 8. The original skull plate preserved at bone bank was removed and placed back to the skull window then fixed by 3 miniplates and screws and 2 dural tentings at the center of the skull plate. 9. Bone cement paste was spreaded to substitue the bulk of the excised temporalis muscle. 10.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by interrupted mattressed suture with 3/0 nylon. 11.Drain: two epidural CWV. 12.Blood transfusion: nil. Blood loss: 150 ml. 13.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5陳德福R1傅紹懷 王克書 (M,1965/04/25,46y10m) 手術日期 2010/09/02 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 顱內出血(ICH) 器械術式 VP shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 10:25 報到 10:25 進入手術室 10:30 麻醉開始 10:35 誘導結束 11:10 手術開始 13:00 麻醉結束 13:00 手術結束 13:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 L 手術 腦室腹腔分流手術 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Left Frazier and 4th ventricle Codman program... 開立醫師: 林哲光 開立時間: 2010/09/02 14:46 Pre-operative Diagnosis Obstructive hydrocephalus Post-operative Diagnosis Obstructive hydrocephalus Operative Method Left Frazier and 4th ventricle Codman programmable shunt insertion Specimen Count And Types Pathology Operative Findings Ventricular catheters were 5cm long from the skull to 4th ventricle and 10cm long in the left Frazier point. CSF seemed clear and transparent. The reserviors were set over left posterior auricle area and left clavicle for left Frazier and 4th ventrilce respectively. Abdominal catheter was 30 cm long. Codman programmable valve was set 80 mmH2O over lateral horn and fixed prssure 40mmH2O was inserted over 4th ventricle. Some bleeding was noted over the left lower neck when subcutaneous tunneling and could be stopped with direct compression. Operative Procedures Under ETGA and supine position with left shoulder elevated and the head was fixed with Mayfield head clump. LUQ abdominal transverse skin incision was made and minilaparotomy was performed. The peritoneum was identified and opened. Subcutaneous tunneling was then done for 2 tracts repectively over the LUQ abdomen, left chest, and left neck. The ventricular catheter were then introduced to the lateral horn and 4th ventricle along the previous EVD tract after previous operative wounds were opened through suboccipital craniectomy window and Frazier point. The ventricular catheters were then connected to the abdominal catheter with Codman reserviors. The wounds were then closed in layers. Operators VS 王國川 Assistants R4 林哲光 相關圖片 陳明順 (M,1962/05/26,49y9m) 手術日期 2010/09/02 手術主治醫師 蔡翊新 手術區域 東址 001房 05號 診斷 Cerebral aneurysm 器械術式 Burr hole (trephination) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 4E 紀錄醫師 王奐之, 時間資訊 15:18 通知急診手術 16:10 進入手術室 16:17 麻醉開始 16:20 誘導結束 17:02 手術開始 18:13 手術結束 18:13 麻醉結束 18:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 慢性硬腦膜下血腫清除術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Chronic Subdural Hematoma 開立醫師: 蔡翊新 開立時間: 2010/09/02 17:35 Pre-operative Diagnosis Right frontotemporoparietal subdura effusion with mass effect. Post-operative Diagnosis Right frontotemporoparietal subdura effusion with mass effect. Operative Method Right frontotemporal burr hole for removal of subdural hematoma. Specimen Count And Types 3 tubes of subdural effusion, sent for routine, BCS and bacterial culture. Pathology Nil. Operative Findings Sanguinous fluid gushed out upon dural opening. The brain expanded well after drainage of the subdural fluid. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 5 cm, linear, right F-T area. 5. A burr hole was made at right F-T area, 6 cm above right EAC. 6. Dural tenting: by two stitches of 2/0 silk. 7. Dural incision: a nib incision was made to enter the subdural space. 8. The subdural effusion was drained via a EVD tube, which remained as a subdural drain. 9. Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous sutures with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 10.Drain: one, subdural, connected to a reservoir bag. 11.Blood transfusion: nil. 12.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R4林哲光R3王奐之 Indication Of Emergent Operation 相關圖片 蔡美麗 (F,1953/12/06,58y3m) 手術日期 2010/09/03 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 HIVD 器械術式 ACDF + plating 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 2 紀錄醫師 周聖哲, 時間資訊 00:00 臨時手術NPO 07:53 報到 08:05 進入手術室 08:10 麻醉開始 08:25 誘導結束 08:40 抗生素給藥 09:15 手術開始 11:40 抗生素給藥 12:47 手術結束 12:47 麻醉結束 12:55 送出病患 13:00 進入恢復室 14:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術－頸椎 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 脊椎融合術－前融合，無固定物（＜＝四節） 1 2 記錄__ 手術科部: 外科部 套用罐頭: Anteior approach for discectomy and cage inse... 開立醫師: 胡朝凱 開立時間: 2010/09/03 13:08 Pre-operative Diagnosis C5~6, 6~7 HIVD Post-operative Diagnosis C5~6, 6~7 HIVD Operative Method Anteior approach for discectomy and cage insertion Specimen Count And Types nil Pathology nil Operative Findings 1.Protruding discs, especially C6~7 level, compressed the spinal cord tightly. The disc became dehydrated. 2.Mild hypertrophic PLL 3.After decompression, the cord expanded well 4.C5~6 cage: 5# 5.C6~7 cage: 6# 6.After cages insertion, the cages were not movable Operative Procedures 1.ETGA, supine 2.Right neck transverse skin incision 3.Dissection along the anterior border of SCM to expose prevertebral space 4.Detach longus coli muscle 5.Insert retractor 6.Discectomy with currete and drill and kerrison pounch 7.Insert cage 8.Same procedure at C5~6 9.Set one CWV drain then close wound in layers Operators 曾漢民 Assistants 胡朝凱, 周聖哲 楊東霖 (M,1968/06/07,43y9m) 手術日期 2010/09/03 手術主治醫師 蔡瑞章 手術區域 東址 003房 01號 診斷 Brain tumor 器械術式 retrosigmoid approach for tumor remove 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:05 進入手術室 08:15 麻醉開始 08:30 誘導結束 08:55 抗生素給藥 08:55 手術開始 12:00 抗生素給藥 15:00 抗生素給藥 17:10 麻醉結束 17:10 手術結束 17:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 10 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: Right retrosigmoid approach for subtotal tumo... 開立醫師: 王奐之 開立時間: 2010/09/03 17:48 Pre-operative Diagnosis Right cerebellopontine angle tumor, suspected neuroma Post-operative Diagnosis Right cerebellopontine angle tumor, suspected low cranial nerve neuroma Operative Method Right retrosigmoid approach for subtotal tumor removal Specimen Count And Types 1 piece About size:pieces Source:right cerebellopontine angle tumor Pathology Frozen: schwannoma Operative Findings Greyish soft tumor was noted, adhered to low cranial nerves. The tumor extent involved from tentorium to foramen magnum and seemed to be originated from jugular foramen; the right side foramen of Luschka was also involved and the tumor within was removed. CN V, VII & VIII nerves were identified during the operation and well preserved. Operative Procedures Under ETGA, the patient was placed in 3/4 prone position. After skin disinfection and draping in sterile fashion, a curvilinear retroauricular skin incision was made. After harvesting the fascial graft, the incision was deepened to expose the skull. After identifying the asterion, a retrosigmoid craniotomy was done. After a reverse-K dural opening, the cerebellum was retracted posteriorly to expose the tumor. A piece of tumor was sent to frozen section and was reported schwannoma. The tumor was then removed in piecemeal fashion, until the cranial nerves were exposed. After removing the tumor involving foramen of Luschka, some CSF gushed out. Some tumor near the low cranial nerves were left untouched. Facial nerve stimulation was performed to ensure its preservation. After meticulous hemostasis, the dura was closed in water-tight fashion with fascial graft. The bone fragments were fixed back and reinforced with bone cement. After setting 1 CWV drain, the wound was closed in layers. Operators P 蔡瑞章 Assistants R6 陳睿生, R3 王奐之 相關圖片 劉維哲 (M,2010/09/02,1y6m) 手術日期 2010/09/04 手術主治醫師 邱英世 手術區域 兒醫 068房 02號 診斷 Other anomalies of great veins 器械術式 TAPVR re-routing 手術類別 緊急手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 5E 紀錄醫師 施廷翰, 時間資訊 21:10 通知急診手術 21:10 臨時手術NPO 21:10 開始NPO 23:04 進入手術室 23:08 麻醉開始 23:55 誘導結束 00:05 抗生素給藥 00:26 手術開始 02:00 開始輸血 02:20 手術結束 02:20 麻醉結束 02:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 體外心肺循環 1 1 手術 腔靜脈回流右心房異常之修補手術 1 1 手術 Ａ．Ｓ．Ｄ　修補 1 2 手術 存開性動脈導管手術 1 4 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 摘要__ 手術科部: 外科部 套用罐頭: 1. TAPVR re-routing 開立醫師: 謝永 開立時間: 2010/09/04 03:26 Pre-operative Diagnosis TAPVR, supracardiac type, with obstruction; pulmonary congestion+CHF; ASD; PDA Post-operative Diagnosis TAPVR, supracardiac type, with obstruction; ASD; PDA Operative Method 1. TAPVR re-routing 2. ASD closure 3. PDA ligation Specimen Count And Types nil Pathology Operative Findings 1. Sinus solitus, levocardia, Left arch 2. Much pericardial, bilateral pleural effusion 3. RV, RA, mPA engorgement 4. PDA: ~4mm 5. TAPVR: all PVs return to a confluence, with extension to vertical vein, lateral to RA, SVC, draining into SVC-inominal vein junction from posterior side, with obstruction at junction of vertical vein to SVC 6. ASD, secondum type, ~5mm 7. Arrest time: 14mins. Operative Procedures ETGA, supine, skin disinfected Midline sternotomy CPB with AsAo, RA cannulation, cooling to 18C PDA ligation Aortic cross-clamp, antegrade cardioplegia infision Ligate vertical vein, circulatory arrest LA incision over posterior wall PV confluence-vertical vein incision Anastomosis between LA and PV confluence with 7-0 PDS suture RA incision, ASD repair RA closure Resume CPB, rewarm, de-air, wean off CPB Hemostasis, set 3x C/Ts in mediastinum, bilateral pleural cavities. Set PD, epicardial pacemaker leads Sternum unapproximated, coverd with sulicon membrane. Operators P邱英世 VS黃書健 Assistants CR謝永 R1施廷翰 Indication Of Emergent Operation 林美英 (F,1969/07/25,42y7m) 手術日期 2010/09/03 手術主治醫師 賴達明 手術區域 東址 005房 02號 診斷 HIVD 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 2 紀錄醫師 周聖哲, 時間資訊 00:00 臨時手術NPO 12:48 報到 13:15 進入手術室 13:20 麻醉開始 13:30 誘導結束 13:32 抗生素給藥 14:05 手術開始 15:50 手術結束 15:50 麻醉結束 16:05 送出病患 16:05 進入恢復室 17:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術－腰椎 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 記錄__ 手術科部: 外科部 套用罐頭: Posterior approach for discectomy 開立醫師: 胡朝凱 開立時間: 2010/09/03 15:54 Pre-operative Diagnosis L5~S1 HIVD, right Post-operative Diagnosis L5~S1 HIVD, right Operative Method Posterior approach for discectomy Specimen Count And Types nil Pathology nil Operative Findings 1.Protrusion and ruptured disc fragment was noted at L5~S1 level that compressed the right S1 root tightly. 2.After decompression, the root was loosened Operative Procedures 1.ETGA, prone 2.Midline skin incision at L5~S1 level 3.Detach right paravertebral muscle 4.Exposed Right L5 and S1 lamina and neural foramen 5.Resect flavum ligment 6.Identified root and ruptured disc 7.Remove disc with currete and disc clamp 8.Hemostasis 9.Close wound in layers Operators 賴達明 Assistants 胡朝凱, 周聖哲 王怡惠 (F,1954/01/02,58y2m) 手術日期 2010/09/03 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Cervical spondylosis 器械術式 ACDF 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 李柏穎, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:05 進入手術室 08:10 麻醉開始 08:20 誘導結束 09:00 抗生素給藥 09:17 手術開始 13:05 手術結束 13:05 麻醉結束 13:13 進入恢復室 13:15 送出病患 14:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術－頸椎 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 記錄__ 手術科部: 外科部 套用罐頭: Cervical diskectomy and interbody fusion with... 開立醫師: 鍾文桂 開立時間: 2010/09/03 13:19 Pre-operative Diagnosis 1.Herniaton of intervetebral disc at C3-4. 2.Spondylosis, C3/4. 2.Spondylosis and stenosis, C3/4. Post-operative Diagnosis 1.Herniaton of intervetebral disc at C3-4. 1.Herniaton of intervetebral disc at C3-4. 2.Spondylosis, C3/4. 2.Spondylosis and stenosis, C3/4. Operative Method Cervical diskectomy and interbody fusion with PEEK cage. Specimen Count And Types nil Pathology Nil. Operative Findings 1. A PEEK cage, 5mm, at C3/4 level was implanted for interbody fusion. 2. Narrow interverterbral disc space. Presence of spur formation. Intact posterior longitudinal ligament. Operative Procedures 1.ETGA, supine 2.Right neck transverse skin incision 3.Dissection along the anterior border of SCM to expose prevertebral space 4.Detach longus coli muscle 5.Insert retractor 6.Discectomy with currete and drill and kerrison pounch 6.Discectomy and removal of spur with currete and drill and kerrison pounch. 7.Insert cage 8.Same procedure at C5~6 9.Set one mino-hemovac drain then close wound in layers. 8.Set one mino-hemovac drain then close wound in layers. Operators vs賴達明 Assistants R5鍾文桂 R1李柏穎 康隆勝 (M,1966/03/06,46y0m) 手術日期 2010/09/03 手術主治醫師 賴達明 手術區域 東址 019房 02號 診斷 Cervical Spondylosis 器械術式 laminoplasty 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 01:40 誘導結束 12:37 報到 13:25 進入手術室 13:30 麻醉開始 14:20 抗生素給藥 14:25 手術開始 17:25 手術結束 17:25 麻醉結束 17:42 送出病患 17:45 進入恢復室 19:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 椎弓整形術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Laminoplasty,open door method, C3-6. 開立醫師: 鍾文桂 開立時間: 2010/09/03 17:58 Pre-operative Diagnosis Ossification of posterior longitudinal ligament, cerical. Post-operative Diagnosis Ossification of posterior longitudinal ligament, cerical. Operative Method Laminoplasty,open door method, C3-6. Specimen Count And Types nil Pathology Nil. Operative Findings Open door from left side. Complete fracture of C4 lamina, right side. The "door" was wide open and fixed by plates and screws. Operative Procedures Under ETGA, the patient was placed in prone position and the head was fixed by Mayfield. After disinfection and draping, midline incision and dissection were done from C2 to C7 level. Bilateral grooving of lamine from C3-5 level was achieved by high speed cutting burr. The left side laminae was widely opened by spreader. The opened "door" was maintained by mini-plates and screws. Further decompression of the cord by removal of ligamentum flavum was done. The wound was closed in layers after placing one CWV drain. Operators V.S. 賴達明 Assistants 鍾文桂 R5鍾文桂 R1李柏穎 相關圖片 林誠崇 (M,1955/07/30,56y7m) 手術日期 2010/09/04 手術主治醫師 陳敞牧 手術區域 東址 003房 02號 診斷 Predominant disturbance of consciousness 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 4E 紀錄醫師 胡朝凱, 時間資訊 23:23 臨時手術NPO 23:23 開始NPO 00:34 進入手術室 00:38 麻醉開始 01:20 誘導結束 01:50 抗生素給藥 02:05 手術開始 04:30 手術結束 04:30 麻醉結束 04:35 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 手術 顱內壓監視置入 1 2 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除－手術時間在４小時以內 1 1 記錄__ 手術科部: 外科部 套用罐頭: ICH evacuation 開立醫師: 胡朝凱 開立時間: 2010/09/04 06:13 Pre-operative Diagnosis Left occipital ICH, suspect tumor bleeding Post-operative Diagnosis Left occipital ICH, suspect tumor bleeding Operative Method ICH evacuation Specimen Count And Types pieces of hematoma and suspect tumor lesion Pathology pending Operative Findings 1.About 60 ml hematoma was noted at left occipital to parietal lobe area. 2.Some grayish, soft lesion located medial to the hematoma was noted 3.After decompression, the brain became slack Operative Procedures 1.ETGA, prone 2.Left occipital vertical skin incision 3.Detach occipital muscle 4.Craniotomy 5.Dural tenting followed by cruciate form dural opening 6.Hematoma evacuation 7.Close dura 8.insert ICP monitor 9.fixed bone back with miniplate 10.Set one CWV drain 11.Close wound in layers Operators 陳敞牧 Assistants 胡朝凱, Ri Indication Of Emergent Operation 萬皓宇 (M,1995/01/24,17y1m) 手術日期 2010/09/03 手術主治醫師 許文明 手術區域 兒醫 063房 01號 診斷 Malignant neoplasm of anterior mediastinum 器械術式 VATS for tumor biopsy 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 楊博智, 時間資訊 08:07 報到 08:15 進入手術室 08:20 麻醉開始 08:40 誘導結束 09:33 手術開始 10:50 麻醉結束 10:50 手術結束 11:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 肺楔狀或部份切除術 1 1 L 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 摘要__ 手術科部: 套用罐頭: Wedge resection of left lung 開立醫師: 楊博智 開立時間: 2010/09/03 15:06 Pre-operative Diagnosis Mediastinum tumor and multiple lung tumors r/o germ cell tumor Post-operative Diagnosis Mediastinum tumor and multiple lung tumors r/o germ cell tumor Operative Method open tumor biopsy (wedge) Specimen Count And Types 1 piece About size:1x1cm Source:left lung tumor Pathology pending Operative Findings 1. One elastic 2x2cm black tumor on left lung surface, lateral side. Operative Procedures 1.ETGA,right decubital position. 2.Skin disinfection,draped as usual. 3.Identify the tumor by echo-guided method. 4.Oblique skin incision over left 7th intercostal space in left mid-axillary line. 5.Expose the tumor and perform wedge biopsy. 6.Set one 20 Fr chest tube 7.Close the wound in layers. Operators 許文明 Assistants 林昊諭 楊博智 曹秀專 (F,1930/11/03,81y4m) 手術日期 2010/09/04 手術主治醫師 蕭輔仁 手術區域 東址 005房 02號 診斷 Subdural hemorrhage (SDH) 器械術式 Removal of chronic subdural，ICP monitoring 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3E 紀錄醫師 林哲光, 時間資訊 14:28 進入手術室 14:30 麻醉開始 14:50 誘導結束 14:58 抗生素給藥 15:30 手術開始 17:58 抗生素給藥 18:15 麻醉結束 18:25 手術結束 18:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 急性硬腦膜下血腫清除術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: Right F-T-P craniectomy with subdural hematom... 開立醫師: 林哲光 開立時間: 2010/09/05 00:16 Pre-operative Diagnosis Right acute SDH, right frontotemporal contusional ICH, left frontotemporal contusional SAH Post-operative Diagnosis Right acute SDH, right frontotemporal contusional ICH, left frontotemporal contusional SAH Operative Method Right F-T-P craniectomy with subdural hematoma evacuation Specimen Count And Types Pathology Operative Findings Preoperative GCS showed E3M6V2, bilateral pupils 2.5/2.5, L/R +/+. A thin layer of subudral hematoma was noted after dural opening, around 1cm in thickness. Diffuse superficial cortex contussion were also noted. Brain swelling was noted but no bulging above the craniectomy window was noted. Postoperative ICP showed 5 mmHg and pupils showed right 2.5mm and left pinpoint. Operative Procedures Under ETGA and supine position with head rotated to left side, skin disinfected and drapped were performed as usual. Traumatic flap was created and 5 burr holes were created and right F-T-P craniectomy was made. Dura opening was done after dural tenting. Subdural hematoma was evacuated and duroplasty was performed with dura covered and then covered with Duragen. The ICP monitor was inserted over subdural area and the wound was then closed in layers after epidural drain was inserted. Operators VS 蕭輔仁 Assistants R4 林哲光, R2 李維棠 Indication Of Emergent Operation 相關圖片 陳子文 (M,1934/01/13,78y2m) 手術日期 2010/09/05 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Cerebral hemorrhage 器械術式 suboccipital craniotomy 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 5E 紀錄醫師 黃世銘, 時間資訊 08:52 通知急診手術 08:53 開始NPO 09:40 進入手術室 09:40 報到 09:45 麻醉開始 10:05 誘導結束 10:05 抗生素給藥 10:42 手術開始 13:00 開始輸血 15:00 手術結束 15:00 麻醉結束 15:10 抗生素給藥 15:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦內血腫清除術 1 1 L 手術 顱內壓監視置入 1 2 L 摘要__ 手術科部: 外科部 套用罐頭: 1. Suboccipital craniotomy for hematoma evacu... 開立醫師: 陳睿生 開立時間: 2010/09/05 16:04 Pre-operative Diagnosis Cerebellar ICH with acute hydrocephalus Post-operative Diagnosis Cerebellar ICH with acute hydrocephalus Operative Method 1. Suboccipital craniotomy for hematoma evacuation; 2. EVD via right Frazier^s point Specimen Count And Types nil Pathology Nil Operative Findings EVD was inserted via right Frazier^s point, and the CSF was xanthochromic pattern. The EVD was about 10cm in depth. The initial ICP was high. Massive subcortical hematoma was noted at bilateral cerebellar hemisphere. Diffuse oozing was noted but no obvious arterial bleeding was found. Hematoma was evacuated by transcortical approach. 3cm corticotomy was done at the medial side of left inferior cerebellar hemisphere. After hematoma remove, the cerebellar surface was shrinked. Operative Procedures 1. ETGA, prone position and head fixed with Mayfield clump 2. Linear incision at right occipital region, and a bur hole was made at right Frazier^s point 3. Dura tenting and then opening, the right lateral ventricle was punched, and then an EVD was inserted 4. About 15cm linear incision was done at suboccipital region 5. The trapzius muscle was dissected from the suboccipital skull 6. The C1 posterior arch was found and the suboccipital bone was totally exposed 7. Make four bur holes at inion, and suboccipital region 8. An about 8x8cm craniotomy window was done, and the posterior rim of the foramen Magnum was also exposed 9. The dura was opened in an "U" shape with ligation of occipital sinus 10.Corticotomy was done at left inferior cerebellar hemisphere 11.Hematoma was harvested and then hemostasis was done with electrocauterized, and surgicel packing 12.Duroplasty was done with a fascia graft 13.A CWV drain was set at epidural region 14.The wound was closed in layers Operators VS 賴達明 Assistants R6 陳睿生; R2 黃世銘 Indication Of Emergent Operation 王克書 (M,1965/04/25,46y10m) 手術日期 2010/09/05 手術主治醫師 王國川 手術區域 東址 018房 02號 診斷 顱內出血(ICH) 器械術式 Revision of CSF shunt 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 4E 紀錄醫師 王奐之, 時間資訊 10:30 開始NPO 10:30 臨時手術NPO 11:31 通知急診手術 13:40 進入手術室 13:40 報到 13:45 麻醉開始 13:50 誘導結束 14:40 手術開始 15:55 麻醉結束 15:55 手術結束 16:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦脊髓液分流管重置 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt revision 開立醫師: 王奐之 開立時間: 2010/09/05 16:20 Pre-operative Diagnosis Ventriculoperitoneal shunt dislodgment Post-operative Diagnosis Ventriculoperitoneal shunt dislodgment Operative Method Ventriculoperitoneal shunt revision Specimen Count And Types Nil Pathology Nil Operative Findings The 4th ventricle ventricular catheter was noted to be withdrawn from its original position, blood clots noted inside. Current setting: 1. Lateral ventricle shunt: Codman programmable (set to 6cmH2O). 2. 4th ventricle shunt: Medtronic low pressure. Ventricular catheter length: 8.5cm. Operative Procedures After ETGA, the patient was placed in supine position with face turned to right and head fixed with Mayfield skull clamp. Incision were made along previous surgical wounds and deepened to expose the 4th ventricle catheter. The catheter was removed and ventricular puncture was performed smoothly. A new ventricular catheter was inserted and connected with Medtronic low pressure reservoir. After confirmation of smooth CSF flow and meticulous hemostasis, the wounds were all closed in layers. Operators VS 王國川 Assistants R3 王奐之 Indication Of Emergent Operation 相關圖片 陳玲瑛 (F,1958/06/20,53y8m) 手術日期 2010/09/06 手術主治醫師 曾漢民 手術區域 東址 003房 01號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 07:30 報到 08:03 進入手術室 08:10 麻醉開始 08:50 抗生素給藥 08:50 誘導結束 09:13 手術開始 10:30 開始輸血 12:00 麻醉結束 12:00 手術結束 12:08 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除－手術時間在４小時以內 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for Simpson^s grade.I tumor remove 開立醫師: 陳睿生 開立時間: 2010/09/06 11:50 Pre-operative Diagnosis Right frontal extraxial tumor, suspect meningioma Post-operative Diagnosis Right frontal extraxial tumor, suspect falx meningioma Operative Method Craniotomy for Simpson^s grade.I tumor remove Specimen Count And Types 1 piece About size:5x5x5cm Source:right frontal tumor Pathology Pending Operative Findings The tumor was about 5x5x5cm in size. It tightly adhered to the falx, and the superior sagittal sionus was intact. The tumor was soft, and well capsuled. A thin layer of normal brain tissue was noted to be covered at the surface of the tumor. It was also well vascularized, and the main feeding arteries were noted to origined from the ACA branch at the deepest side. It was totally removed and the normal tissue was expanded gradually. Operative Procedures After ETGA, the patient was under prone position and her head was fixed with Mayfield clump. After proper scrabbing, we incised into the frontal region scalp as bicoronal shape. The scalp was retracted downward, and four burr holes were made across the midline, and right side keyhole. An about 8x8cm craniotomy window was created then. After proper dura tenting, the dura was opened along the window margin, and the base was toward the midline. The brain tissue was dissected and the tumor was protruded. The tumor capsule was detached from the peripheral brain tissue and the falx. Several deep feeders from the ACA branch were exposed and ligated. Then the tumor was removed en bloc. Hemostasis was done, and the brain surface was packed with surgicel. The dura was tightly sutured back, and the skull graft was fixed back with miniplates x3. An epidural CWV drain was set, and the wound was closed in layers. Operators VS 曾漢民 Assistants R6 陳睿生; R3 王奐之 相關圖片 于德咸 (M,1967/03/09,45y0m) 手術日期 2010/09/06 手術主治醫師 曾漢民 手術區域 東址 005房 03號 診斷 Herniation of intervertebral disc (HIVD) 器械術式 L3/4 HIVD 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 周聖哲, 時間資訊 00:00 臨時手術NPO 10:50 報到 12:00 進入手術室 12:05 麻醉開始 12:15 誘導結束 12:23 抗生素給藥 12:35 手術開始 15:05 手術結束 15:05 麻醉結束 15:10 送出病患 15:18 進入恢復室 16:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術－腰椎 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 記錄__ 手術科部: 外科部 套用罐頭: Posterior approach for discectomy 開立醫師: 周聖哲 開立時間: 2010/09/06 15:14 Pre-operative Diagnosis L3-L4 HIVD, left Post-operative Diagnosis L3-L4 HIVD, left Operative Method Posterior approach for discectomy Specimen Count And Types Nil Pathology Nil Operative Findings 1.Protrusion and ruptured disc fragment was noted at L3~L4 level that compressed the left L4 root tightly. 2.After decompression, the root was loosened Operative Procedures 1.ETGA, prone 2.Midline skin incision at L3~L4 level 3.Detach left paravertebral muscle 4.Exposed left L3 and L4 lamina and neural foramen 5.Resect flavum ligment 6.Identified root and ruptured disc 7.Remove disc with currete and disc clamp 8.Expose left L4 and L5 lamina and neural foramen to check the disc 8.Hemostasis 9.Hemostasis 9.Close wound in layers 10.Close wound in layers Operators 曾漢民 Assistants 胡朝凱, 周聖哲 魏黃妹 (F,1924/05/15,87y9m) 手術日期 2010/09/06 手術主治醫師 陳敞牧 手術區域 東址 002房 07號 診斷 Subdural hemorrhage (SDH) 器械術式 Left Burr hole drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3E 紀錄醫師 鍾文桂, 時間資訊 12:00 開始NPO 12:00 臨時手術NPO 14:44 通知急診手術 15:20 報到 15:32 進入手術室 15:45 麻醉開始 16:00 誘導結束 16:25 抗生素給藥 16:33 手術開始 18:30 手術結束 18:30 麻醉結束 18:35 送出病患 18:35 進入恢復室 19:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 慢性硬腦膜下血腫清除術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 記錄__ 手術科部: 外科部 套用罐頭: Burr hole for evacuation of chronic subdural ... 開立醫師: 鍾文桂 開立時間: 2010/09/06 18:40 Pre-operative Diagnosis Chronic subdural hemorrhage, left. Post-operative Diagnosis Chronic subdural hemorrhage, left. Operative Method Burr hole for evacuation of chronic subdural hemorrhage. Specimen Count And Types nil Pathology Nil. Operative Findings Motor oil like liquified hematoma was evacuated from left frontal burr hole. Presence of outer membrane. Operative Procedures Under ETGA, the patient was placed in supine position. After shaving, disinfection, and draping, a linear 3-cm scalp incision was made at left frontal region. After creating a burr hole, and durotomy, the liqufied hematoma was drained out. Further evacuation of the hematoma was achieved by normal saline irrigation through the subdural rubber drain. Then, the wound was closed in layers. The subdural air accumulation was evacuated later. Finally, a close drainage system was set. The patient was sent to POR smoothly. Operators V.S. 陳敞牧 Assistants 鍾文桂 王奐之 Indication Of Emergent Operation 李榕甄 (F,1962/11/11,49y4m) 手術日期 2010/09/07 手術主治醫師 侯育致 手術區域 東址 026房 04號 診斷 Cataract 器械術式 Phaco+PCIOL 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 14:25 報到 15:06 進入手術室 15:20 手術開始 15:45 手術結束 15:50 送出病患 記錄__ 手術科部: 眼科部 套用罐頭: Phacoemulsification and PCIOL implantation (od) 開立醫師: 陳達慶 開立時間: 2010/09/07 15:43 Pre-operative Diagnosis Cataract (od) Post-operative Diagnosis Cataract (od) Operative Method Phacoemulsification and PCIOL implantation (od) Specimen Count And Types Pathology Nil Operative Findings Cataract (od) Operative Procedures 1. Under topical anesthesia. 2. Disinfection, irrigation and draping. 3. Application of an eyelid speculum. 4. Made a clear corneal incision and penetrate into AC with 2.5mm trapezoid knife at 10 oclock position. 5. Inject Healon into the anterior chamber. 6. Continuous circular capsulorrhexis was done with bent needle and capsular forceps. 7. Made a sideport at 2 oclock position with the MVR blade. 8. Hydrodissection and hydrodelineation were done with BSS. 9. Phacoemulsification of the nucleus by standard divide-and-conquer technique. 10. Aspiration of the residual cortical material with I/A tube. 11. Foldable PCIOL was implanted into the bag after injection of Viscoat. 12. The residual Healon was washed out by I/A device. 13. Inject BSS into AC and check leakage 14. Stromal hydration of the wound with BSS 16. Topical irrigation of Rinderon and Gentamycin. 17. Maxitrol patching. Operators 侯育致, Assistants R4 陳達慶 吳英秦 (M,1945/06/15,66y8m) 手術日期 2010/09/07 手術主治醫師 曾漢民 手術區域 西址 034房 02號 診斷 Carpal tunnel syndrome 器械術式 Decompression of mediun nerve 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 09:07 報到 10:30 進入手術室 10:44 麻醉開始 10:45 手術開始 11:30 麻醉結束 11:30 手術結束 11:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 正中神經或尺神經腕部減壓術–單側 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Carpal Tunnel Syndrome 開立醫師: 古恬音 開立時間: 2010/09/07 11:04 Pre-operative Diagnosis Carpal Tunnel Syndrome, right side Post-operative Diagnosis Carpal Tunnel Syndrome, right side Operative Method Decompression of medium nerve Decompression of median nerve Specimen Count And Types nil Pathology Nil Operative Findings The medium nerve was compressed tightly by the hypertrophic flexor retinaculum. The median nerve was compressed tightly by the hypertrophic flexor retinaculum. Operative Procedures 1.The hand and forearm were sterilized with povidone-iodine tincture, then covered with stockinet. 2.Anesthesia: tourniquet was applied at distal upper arm, then regional block with 15 ml 1% Xylocaine solution was infused through cephalic vein catheter at wrist area. 3. Incision: vertical incision vertical palmar crease to transverse wrist crease. 4.The palmaris longus tendon was identified, then the plamar aponeurosis was cut longitidinally along the ulnar side of the palmaris longus tendon. 5. Themedian nerve was identified beneath the palmars longus tendon. Under direct vision, the transverse carpal ligament was divided until no more pressure on the median nerve could be palpated. 6. The skin was closed by interrupted suture with 4/0 nylon.7.The tourniquet was released. The hand and wrist were draped with fluffy dressing and elastic bandage. Operators VS曾漢民 Assistants R6胡朝凱,R4林哲光 賴書玄 (M,2010/02/22,2y0m) 手術日期 2010/09/07 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Communicating hydrocephalus 器械術式 VP shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:08 進入手術室 08:30 麻醉開始 09:00 誘導結束 09:05 抗生素給藥 09:35 手術開始 11:15 開始輸血 11:40 手術結束 11:40 麻醉結束 11:50 送出病患 11:55 進入恢復室 13:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Left posterior fossa-peritoneal shunt implant... 開立醫師: 李振豪 開立時間: 2010/09/07 12:21 Pre-operative Diagnosis 1. Hydrocephalus, 2. Large ventricular septal defect Post-operative Diagnosis 1. Hydrocephalus, 2. Large ventricular septal defect Operative Method Left posterior fossa-peritoneal shunt implantation Specimen Count And Types nil Pathology Nil Operative Findings 1. The ventricular catheter: 3cm in length The peritoneal catheter: 35cm in length Reservoir: Codman 40cmH2O fixed pressure reservoir Reservoir: Codman 40mmH2O fixed pressure reservoir 2. The opening pressure is more than 15cmH2O after dura opening. The anterior fontanelle became much soft after the whole procedure. 2. The opening pressure is more than 15cmH2O after dura opening. The anterior fontanelle became much soft but not depressed after the whole procedure. 3. dural sinus bleeding is suspected during dura opening and hemostasis with Gelform packing and bipolar cautery. 3. occipital sinus (intradural) bleeding is suspected during dura widening and hemostasis with Gelform packing and bipolar cautery successfully. Operative Procedures Under endotracheal tube general anesthesia, the patient is put in supine position with head rotated to right. The scalp is shaved, scrubbed, and disinfected as usual. The linear scalp incision is made 2 cm left to midline at left occipital area. The subcutanesou soft tissue and muscle is splitted followed by one burr hole creation with air-drived high speed drill. Under endotracheal tube general anesthesia, the patient is put in supine position with head rotated to right. The scalp is shaved, scrubbed, and disinfected as usual. The linear scalp incision is made 2 cm left to midline and 2 cm caudally to the left transverse sinus at left occipital area. The subcutanesou soft tissue and muscle is splitted followed by one burr hole creation with air-drived high speed drill. Left upper abdomen transverse skin incision is made and the muscle sheath is opened. The muscle is splitted and the peritoneum is identified. The peritoneum is opened and the purse-string suture is left for prevention of herniation. One subcutaneous tunnel is created from left upper abdomen, and left forechest. One 1cm in length skin incision is made at left subclavicle area. The peritoneal catheter is passed through the channel. The subcutaneous channel from occipital wound and left subclavicle wound is created and the 40mmH2O fixed-pressure reservoir is placed. The shunt is set up and the function is checked. The dura is opened and the ventricular catheter is placed into posterior fossa. Hemostasis is achieved and the peritoneal catheter is placed into peritoneal cavity. The wound is then closed with 4-0 Victyl and 4-0 Nylon. Left upper abdomen transverse skin incision is made and the muscle sheath is opened. The muscle is splitted and the peritoneum is identified. The peritoneum is opened and the purse-string suture is left to prevent abdominal hernia formation. One subcutaneous tunnel is created from left upper abdomen, and left forechest. One 1cm in length skin incision is made at left subclavicle area. The peritoneal catheter is passed through the channel. The subcutaneous channel from occipital wound and left subclavicle wound is created and the 40mmH2O fixed-pressure reservoir is placed at the left fore chest. The shunt is set up and the function is checked. The dura is opened and the ventricular catheter is placed into posterior fossa. Hemostasis is achieved and the peritoneal catheter is placed into peritoneal cavity. The woundw were then closed with 4-0 Victyl and 4-0 Nylon. Operators AP郭夢菲 Assistants R4李振豪, Ri楊博鈞 相關圖片 周魏秀蘭 (F,1946/09/15,65y5m) 手術日期 2010/09/07 手術主治醫師 賴達明 手術區域 東址 003房 號 診斷 Spinal cord injury 器械術式 C1-2 transarticular fixation 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 07:43 報到 08:03 進入手術室 08:10 麻醉開始 08:35 抗生素給藥 08:40 誘導結束 10:02 手術開始 11:39 抗生素給藥 13:35 麻醉結束 13:35 手術結束 13:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 記錄__ 手術科部: 外科部 套用罐頭: 1. Internal fixation by transarticular screw,... 開立醫師: 鍾文桂 開立時間: 2010/09/07 14:38 Pre-operative Diagnosis C1-2 subluxation. Atlantoaxial subluxation. Post-operative Diagnosis C1-2 subluxation. Atlantoaxial subluxation. Operative Method 1. Internal fixation by transarticular screw, C1/2. 1. Posterior C1-2 fixation with transarticular screws. 2. Fusion, C1-2. 2. Gallie fusion(double loop), C1-2. Specimen Count And Types nil Pathology Nil. Operative Findings 1. Transarticular screw: 4.5mm x 40mm, left; 4.5mm x 44mm,right. 2. C1-2 fusion by autologous bone graft harvested from left posterior superior iliac spine. The bone was fixed by sublaminar wiring with braided polyester suture. Operative Procedures Under ETGA, the patient was placed in prone position and the head was fixed by Mayfield. After difinfection and draping, midline skin incision was made to expose C1-C2 level. Bilateral articular processes of C1/2 were identified. The insertion point of left transarticular screw ensured by intraoperative fluoroscopy. The tract was ensured by K-pin. Then, the screw was implanted throught the tract which formed by K-pin. The right transarticular screw was implanted in the same way. The right transarticular screw was implanted in the same manner. After haresting autologous bone graft from left posterior superior iliac spine, the bone plate was fixed on the space between C1 &2. After haresting autologous bone graft from left posterior superior iliac spine, the bone plate was fixed between the dorsal portion of the arch of C1 and the posterior spinous process and medial laminar arches of C2 The wound was closed in layers with one CWV drain in place. Operators V.S. 賴達明 Assistants 鍾文桂 李柏穎 相關圖片 陳欣然 (M,1932/04/02,79y11m) 手術日期 2010/09/07 手術主治醫師 王國川 手術區域 東址 001房 04號 診斷 Subdural hematoma 器械術式 Craniectomy for hematoma evacuation 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 蕭柏妮 ASA 4E 紀錄醫師 周聖哲, 時間資訊 00:01 通知急診手術 00:30 進入手術室 00:35 麻醉開始 00:50 誘導結束 00:54 手術開始 01:05 抗生素給藥 01:10 開始輸血 03:25 手術結束 03:25 麻醉結束 03:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 急性硬腦膜下血腫清除術 1 1 手術 顱骨切除術，包括異物移除或減壓或神經切斷 1 2 手術 顱內壓監視置入 1 4 摘要__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 李振豪 開立時間: 2010/09/07 03:27 Pre-operative Diagnosis right frontal temporal parietal acute SDH Post-operative Diagnosis right frontal temporal parietal acute SDH Operative Method 1.right F-T-P craniectomy 2.SDH removal 3.ICP monitoring Specimen Count And Types nil Pathology nil Operative Findings 1.There is acute subdural hematoma over the right frontal-tempral-parietal area with 2cm in thichness. The falx SDH was left in situ. The brain was compressed tightly by the hematoma and became slacky after decompression. No remarkable bridging vein or cortical artierial bleeder was found. 2.The initial ICP after duroplasty is around 1mmHg. After the scalp closure, the ICP is 5mmHg. 3.The right pupil was dilated to 6mm without prompt light reflex while the left pupil was 2mm with prompt light reflex. After the surgery, the pupils became isocoric [2/2] with prompt light reflex. 4.The right temporalis muscle was transected. Operative Procedures 1.ETGA and supine position 2.Skin disinfection and draping 3.right scalp traumatic flap creation 4. 12*14 craniectomy and transect the temporalis muscle 5.dura tenting and open the dura 6.removal the acute SDH 7.duroplasty with autologous temporalis fascia graft 8.insert subdural ICP monitor 9.hemostasis 10.left 2 subgaleal drain in situ 11.close the wound in layers Operators VS 王國川 Assistants r5陳德福 r4 李振豪 r1周聖哲 Indication Of Emergent Operation 曾錦燾 (M,1948/12/13,63y3m) 手術日期 2010/09/08 手術主治醫師 杜永光 手術區域 東址 001房 03號 診斷 Meningitis 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 4E 紀錄醫師 鍾文桂, 時間資訊 00:04 臨時手術NPO 00:04 開始NPO 09:04 通知急診手術 13:10 進入手術室 13:15 麻醉開始 13:18 誘導結束 14:08 手術開始 15:05 手術結束 15:05 麻醉結束 15:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱內壓監視置入 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Ventriculostomy for ICP monitor and CSF drainage. 開立醫師: 鍾文桂 開立時間: 2010/09/08 15:29 Pre-operative Diagnosis 1. Hydrocephalus. 2. Meningitis and ventriculitis. Post-operative Diagnosis 1. Hydrocephalus. 2. Meningitis and ventriculitis. Operative Method Ventriculostomy for ICP monitor and CSF drainage. Specimen Count And Types 1 piece About size:5 cc Source:CSF for routine, culture and BCS. Pathology Nil. Operative Findings 1. Clear yellowish CSF from ventriculostomy. 2. EVD: 6 cm in depth. Operative Procedures Under ETGA, the patient was placed in supine position and the head was in midline position. The previous bicoronal incision was re-incised at right frontal area. A burr hole was made. After durotomy, the ventricular puncture needle was inserted. CSF gushed out in 4-cm depth. Then, the EVD was inserted. The drainage system was connected. Finally, the wound was closed in layers. Operators Prof.杜永光 Assistants R5 鍾文桂 Indication Of Emergent Operation 楊惠民 (M,1953/04/20,58y10m) 手術日期 2010/09/08 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Brain Tumor 器械術式 presigmoid approach for tumor remove 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 07:35 報到 08:02 進入手術室 08:10 麻醉開始 08:40 誘導結束 09:10 抗生素給藥 09:50 手術開始 12:10 抗生素給藥 15:10 抗生素給藥 16:05 送出病患 17:55 麻醉結束 17:55 手術結束 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 12 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Left presigmoid approach for tumor removal 開立醫師: 王奐之 開立時間: 2010/09/08 18:42 Pre-operative Diagnosis Left cerebellopontine angle tumor, suspect petroclival meningioma Left petroclival meningioma Post-operative Diagnosis Left cerebellopontine angle tumor, suspect petroclival meningioma Left petroclival meningioma Operative Method Left presigmoid approach for tumor removal Specimen Count And Types 1 piece About size:pieces Source:left cerebellopontine angle tumor 1 piece About size:pieces Source:Left petroclival meningioma Pathology Pending Operative Findings The tumor was about 3.5cm in greatest diameter, CN V~XI were all pushed away. Low cranial nerves were pushed inferiorly. CN V, CN VII & CN VIII were pushed laterally and became thin; CN VI were pushed medially, CN V~VIII all adhered tightly to the tumor. The tumor seemed to be originating from petroclival bone near the level of CN VII/VIII, which is also the hardest part of the tumor. The tumor also extended to supratentorial area and was also removed. CN VI were sacrificed during tumor removal. Post-operative MEP of right leg seemed decreased. Operative Procedures After ETGA, the patient was placed in supine position with face turned to right and head fixed with Mayfield skull clamp; the left shoulder was pulled inferomedially. A curved retroauricular skin incision was made and further deepened to expose previous craniotomy. The bone were removed, exposing the dura. A linear durotomy was first made at presidmoid area, followed by another linear durotomy above the arcuate eminence. The dura in between the 2 durotomies were then cut open, followed by tentorial cutting through the tentorial edge; CN IV was not found. After application of brain retractor over the cerebellum, the tumor was exposed along with CN VII/VIII. CUSA was then used to remove the tumor in piecemeal fashion. CN V, low cranial nerves were all carefully preserved during tumor removal, but CN VI was sacrificed due to very tight adhesion. Tumor removal was done until the clivus was clearly seen. After mediculous hemostasis, the dura was closed with DuraFoam in water-tight fashion. After setting 1 CWV drain, the wound was closed in layers. Operators P 杜永光 Assistants R6 陳睿生, R3 王奐之 相關圖片 林佩芬 (F,1973/07/18,38y7m) 手術日期 2010/09/08 手術主治醫師 曾漢民 手術區域 東址 005房 03號 診斷 Lumbar Spondylosis 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 周聖哲, 時間資訊 00:00 臨時手術NPO 14:45 進入手術室 15:58 報到 16:25 麻醉開始 16:30 誘導結束 16:50 抗生素給藥 17:08 手術開始 18:35 手術結束 18:35 麻醉結束 18:45 送出病患 18:47 進入恢復室 19:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 椎間盤切除術－腰椎 1 1 記錄__ 手術科部: 外科部 套用罐頭: Posterior approach for discectomy 開立醫師: 周聖哲 開立時間: 2010/09/08 18:52 Pre-operative Diagnosis L4-L5 HIVD, right Post-operative Diagnosis L4-L5 HIVD, right Operative Method Posterior approach for discectomy Specimen Count And Types Nil Pathology Nil Operative Findings 1.Protrusion and ruptured disc fragment was noted at L4~L5 level that compressed the left L5 root tightly. 2.After decompression, the root was loosened Operative Procedures 1.ETGA, prone 2.Midline skin incision at L4~L5 level 3.Detach left paravertebral muscle 4.Exposed left L4 and L5 lamina and neural foramen 5.Resect flavum ligment 6.Identified root and ruptured disc 7.Remove disc with currete and disc clamp 8.Hemostasis 9.Close wound in layers Operators 曾漢民 Assistants 胡朝凱, 周聖哲 黃燦金 (M,1956/02/10,56y1m) 手術日期 2010/09/08 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Neck mass 器械術式 neck mass 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 周聖哲, 時間資訊 06:00 臨時手術NPO 14:00 報到 14:55 進入手術室 15:00 麻醉開始 15:10 誘導結束 15:15 抗生素給藥 15:25 手術開始 16:00 手術結束 16:00 麻醉結束 16:05 送出病患 16:10 進入恢復室 17:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 臉部以外皮膚及皮下腫瘤摘除術　４公分至１０公分 1 1 記錄__ 手術科部: 外科部 套用罐頭: Neck mass excision 開立醫師: 胡朝凱 開立時間: 2010/09/08 15:58 Pre-operative Diagnosis Neck mass Post-operative Diagnosis Suspect lipoma Operative Method Neck mass excision Specimen Count And Types Tumor Pathology pending Operative Findings One soft, elastic, yellowish tumor located in subcutaneous layer with a clear border. It measured about 4.5 cm in diameter. Operative Procedures 1.ETGA, prone 2.Midline skin incision 3.Dissect along the border of tumor 4.Total tumor excision 5.Hemostasis 6.Close wound in layers Operators 曾漢民 Assistants 胡朝凱, 周聖哲 陳仰安 (M,1962/07/05,49y8m) 手術日期 2010/09/08 手術主治醫師 蔡瑞章 手術區域 東址 005房 01號 診斷 Meningioma 器械術式 parasagittal meningioma 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 胡朝凱, 時間資訊 00:00 臨時手術NPO 07:43 報到 08:04 進入手術室 08:20 麻醉開始 08:40 誘導結束 08:40 抗生素給藥 09:20 手術開始 11:40 抗生素給藥 14:30 麻醉結束 14:30 手術結束 14:35 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 手術 腦瘤切除－手術時間在４～８小時 1 1 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 3 0 麻醉 動脈血液檢查全套 3 0 麻醉 Hemoglobin (Hb) 3 0 麻醉 測血糖 3 0 麻醉 Ca (Calcium) 3 0 麻醉 Na (Sodium) 3 0 麻醉 K (Potassium) 3 0 麻醉 Blood gas analysis 3 0 記錄__ 手術科部: 外科部 套用罐頭: Craniotomy for Simpson grade II tumor excision 開立醫師: 胡朝凱 開立時間: 2010/09/08 14:45 Pre-operative Diagnosis Recurrent left occipital to parietal meningioma Post-operative Diagnosis Recurrent left occipital to parietal meningioma Operative Method Craniotomy for Simpson grade II tumor excision Specimen Count And Types tumor x 1 Pathology pending Operative Findings 1.firm, whitish tumor located at left occipital to parietal lobe with a bilobule shape. It arised from falx with SSS invasion. The SSS was total occluded. The border was clear. 2.Much feeders came from falx were noted. 3.The cortical veins were preserved Operative Procedures 1.ETGA, prone psition with head fixed by skull clamp 2.Previous wound was opened and extended 3.Reflect skin flap 4.Remove previous bone graft and made further craniotomy that cross the midline. 5.Bilateral durotomy was done to exposed the tumor border 6.Dissected along the inface between tumor and brain 7.Cut open SSS. And the bleeding was stoped with prolene suture 8.Falx was also partially resected 9.After tumor excision, Hemostasis was done with Antevien 10.Duroplasty with Gortex 11.Fixed bone back with wire 12.Close wound in layers with one CWV drain insertion Operators P 蔡瑞章 Assistants 胡朝凱, 周聖哲 曾筱茹 (F,2004/08/08,7y7m) 手術日期 2010/09/08 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Anomalies of spinal cord 器械術式 untethering 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 07:56 報到 08:08 進入手術室 08:15 麻醉開始 08:30 誘導結束 09:00 抗生素給藥 09:16 手術開始 10:50 手術結束 10:50 麻醉結束 11:00 送出病患 11:05 進入恢復室 12:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 脊椎內脊髓內腫瘤切除術 1 1 記錄__ 手術科部: 外科部 套用罐頭: L4-5 laminotomy for lipoma excision and untet... 開立醫師: 李振豪 開立時間: 2010/09/08 11:13 Pre-operative Diagnosis Tethered cord syndrome Tethered cord syndrome due to filum terminale lipoma Post-operative Diagnosis Tethered cord syndrome Tethered cord syndrome due to filum terminla lipoma Operative Method L4-5 laminotomy for lipoma excision and untethering L4-5 laminotomy for lipoma excision and untethering Specimen Count And Types 1 piece About size:0.3x0.3x2cm Source:Terminal filum Pathology Pending Operative Findings The terminal filum is enlarged and infiltrated by adipose tissue. No adhesion is noted between the filum, roots, or dura. The terminal filum is transected at L4-5 level for untethering. The terminal filum is thiskened up to 2.5 mm in width and infiltrated by adipose tissue. No adhesion is noted between the filum, roots, or dura. The terminal filum is transected at L4-5 level for untethering. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in prone position. The location of L4-5 level was localized by portable C-arm X-ray. The skin was scrubbed, disinfected and draped as usual. Midline skin incision was made at L4-5 level and the subcutaneous soft tissue and paravertebral muscle groups were dissected and detached. Laminotomy at L4-5 level was performed with kerrison punch and rongeur. After exposure of thecal sac, linear durotomy was performed and the terminal filum was identified. About 2cm terminal filum was excised for untethering. Hemostasis was achieved and the dura was closed with 5-0 Prolene. The wound was then closed in layers with 2-0 silk, 3-0 Vicryl and 4-0 Nylon. Under endotracheal tube general anesthesia, the patient was put in prone position. The location of L4-5 level was localized by portable C-arm X-ray. The skin was scrubbed, disinfected and draped as usual. Midline skin incision was made at L4-5 level and the subcutaneous soft tissue and paravertebral muscle groups were dissected and detached. Laminotomy at lower L4 and upper L5 level was performed with kerrison punch and rongeur. Under midcroscopic view, linear durotomy was performed and the terminal filum was identified. About 2cm terminal filum was excised for untethering. Hemostasis was achieved and the dura was closed with 5-0 Prolene. The wound was then closed in layers with 2-0 silk, 3-0 Vicryl and 4-0 Nylon. Operators AP郭夢菲 Assistants R4李振豪, Ri楊博鈞 楊德勖 (M,2003/03/15,8y11m) 手術日期 2010/09/08 手術主治醫師 郭夢菲 手術區域 兒醫 067房 02號 診斷 Seizures 器械術式 Brain biopsy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 11:03 報到 11:25 進入手術室 11:30 麻醉開始 12:05 抗生素給藥 12:10 誘導結束 12:33 手術開始 15:05 抗生素給藥 16:00 麻醉結束 16:00 手術結束 16:10 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 腦瘤切除－手術時間在４小時以內 1 1 R 記錄__ 手術科部: 套用罐頭: Right frontal craniotomy for brain lesion exc... 開立醫師: 李振豪 開立時間: 2010/09/08 16:58 Pre-operative Diagnosis Brain lesion, nature? r/o inflammation or malignancy Diffuse brain lesions, nature? r/o inflammation or malignancy Post-operative Diagnosis Brain lesion, suspect inflammation Diffuse brain lesion, suspect inflammation Operative Method Right frontal craniotomy for brain lesion excisional biopsy Right frontal tumor excision via right frontal craniotomy for pathological confirmation Specimen Count And Types 1 piece About size:Multiple piece of brain tissue with total about 3x2x2cm in size Source:Right frontal brain tissue Pathology Frozen section: much inflammatory cell within brain parenchyma and perivascular area. No evident malignant cell was noted. Operative Findings The brain tissue at right frontal tip is firm in character. But the gross appearance is normal. The gray mater and white mater are also normal. One large cortical drainage vein is preserved during excisional biopsy. No tumor-like tissue was noted during whole procedure. The brain of the exposed right frontal tip region was diffusely firm in the subcortical region with multiple nodularity in character. But the gross appearance is normal. The gray mater and white mater looked normal in gross picture. One large cortical drainage vein is preserved during excision of the right frontal brain. No tumor-like tissue was noted during whole procedure. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine position. The scalp was shaved, scrubbed, and disinfected as usual. Bicoronal scalp incision was made and the scalp flap was elevated. One burr hole was created followed by one 7x5cm craniotomy window. Dural tenting was performed and the dura was opened with curvilinear shape. Excisional biopsy was performed along the inferior and middle frontal gyrus at right frontal tip. Frozen section was sent during the operation. Hemostasis was achieved with Surgicel lining and bipolar electrocautery. The dura was then closed with 4-0 Prolene and the skull plate was fixed back with miniplate and screws. Bone cement was used for burr hole and skull gap coverage. One subgaleal CWV drain was placed and the wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Under endotracheal tube general anesthesia, the patient was put in supine position. The scalp was shaved, scrubbed, and disinfected as usual. Bicoronal scalp incision was made and the scalp flap was elevated. One burr hole was created followed by one 7x5cm craniotomy window. Dural tenting was performed and the dura was opened with curvilinear shape based down. Excision of the meddle frontal fyrus and inward was performed along the inferior and middle frontal gyrus at right frontal tip (1 to 3 cm lateral to the midline). Frozen section was sent during the operation. Hemostasis was achieved with Surgicel lining and bipolar electrocautery. The dura was then closed with 4-0 Prolene and the skull plate was fixed back with miniplate and screws. Bone cement was used for burr hole and skull gap coverage. One subgaleal CWV drain was placed and the wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators AP郭夢菲 Assistants R4李振豪, Ri楊博鈞 余炯震 (M,1962/07/31,49y7m) 手術日期 2010/09/08 手術主治醫師 蕭輔仁 手術區域 東址 001房 04號 診斷 Brain metastasis 器械術式 Ommaya reservoir implantation 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 15:50 進入手術室 16:00 麻醉開始 16:05 誘導結束 16:10 抗生素給藥 16:33 手術開始 17:45 麻醉結束 17:45 手術結束 17:53 送出病患 17:55 進入恢復室 19:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 歐氏貯囊置放手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 內科部 套用罐頭: Ommaya reservoir implantation via right Koche... 開立醫師: 鍾文桂 開立時間: 2010/09/08 18:01 Pre-operative Diagnosis Lung cancer with leptomeningeal carcinomatosis. Post-operative Diagnosis Lung cancer with leptomeningeal carcinomatosis. Operative Method Ommaya reservoir implantation via right Kocher point. Specimen Count And Types 1 piece About size:CSF Source:for routine, culture, and BCS Pathology Nil. Operative Findings Ommaya reservoir: 7 cm. Clear light yellowish CSF gushed out from ventriculostomy. Operative Procedures Under ETGA, the patient was placed in supine position and the head was placed in midline position. After shaving ,disinfection,and draping, a curvilinear scalp incision was made at right frontal area. A burr hole was created. After durotomy, the ventricular puncture needle was inserted until CSF gushed out. Later, the Ommaya reservoir was implanted. Finally, the wound was closed in layers. Operators V.S. 蕭輔仁 Assistants 鍾文桂 Indication Of Emergent Operation 相關圖片 蔡弦恩 (F,1991/07/29,20y7m) 手術日期 2010/09/08 手術主治醫師 王國川 手術區域 東址 001房 01號 診斷 Head Injury 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 3E 紀錄醫師 鍾文桂, 時間資訊 03:35 開始輸血 04:03 通知急診手術 04:03 開始NPO 04:15 進入手術室 04:17 麻醉開始 04:40 誘導結束 04:50 抗生素給藥 05:00 手術開始 08:05 手術結束 08:05 麻醉結束 08:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 急性硬腦膜下血腫清除術 1 1 L 手術 顱內壓監視置入 1 2 L 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 記錄__ 手術科部: 外科部 套用罐頭: 1. Evacuation of acute subdural hemorrhage, l... 開立醫師: 鍾文桂 開立時間: 2010/09/08 08:43 Pre-operative Diagnosis Severe head injury with acute subdural hemorrhage, left and brain swelling. Post-operative Diagnosis Severe head injury with acute subdural hemorrhage, left and brain swelling. Operative Method 1. Evacuation of acute subdural hemorrhage, left. 2. Decompressive craniectomy, left frontal-parietal-temporal. 3. Implantation of ICP monitor. Specimen Count And Types nil Pathology Nil. Operative Findings 1. Moderate brain swelling and acute subdural hemorrhage in left hemisphere. 2. Intraoperative sonography: presence of left temporal ICH and right acute SDH. 3. Intraoperative ICP: 5 mmHg. Operative Procedures Under ETGA, the patient was placed in supine position and the head was tilted to the right. After shaving and disinfection, a question-mark scalp incision was done. A large craniotomy bone plate was removed. After durotomy, the acute SDH was evacuated. The dura mater was augmented by temporalis fascia and muscle. We placed a epidural CWV drain and subdural ICP monitor. The wound was closed in layers. Operators V.S. 王國川 Assistants R5 鍾文桂 R3古恬音 Indication Of Emergent Operation 相關圖片 陳怡理 (F,2000/08/27,11y6m) 手術日期 2010/09/09 手術主治醫師 郭夢菲 手術區域 兒醫 067房 號 診斷 腦內出血 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林至芃 ASA 4E 紀錄醫師 李振豪, 時間資訊 16:51 通知急診手術 17:47 進入手術室 17:50 麻醉開始 18:05 誘導結束 18:40 手術開始 19:20 手術結束 19:20 麻醉結束 19:25 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室體外引流 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Right Kocher"s external ventricular drainage 開立醫師: 李振豪 開立時間: 2010/09/09 19:52 Pre-operative Diagnosis 1. Hydrocephalus, 2. Left thalamic hemorrhage with intraventricular hemorrhage 1. Hydrocephalus, 2. subgaleal effusion, right 3. Left thalamic hemorrhage with intraventricular hemorrhage Post-operative Diagnosis 1. Hydrocephalus, 2. Left thalamic hemorrhage with intraventricular hemorrhage 1. Hydrocephalus, 2. subgaleal effusion, right 3. Left thalamic hemorrhage with intraventricular hemorrhage Operative Method Right Kocher"s external ventricular drainage Right Kocher"s external ventricular drainage and drainage of the subgaleal effusion Specimen Count And Types 2 pieces About size:5ml Source:right subgaleal effusion About size:swab x I Source:Previous burr hole Pathology Nil Operative Findings The CSF leakage from the wound was noted after removal of the Nylon stitches. After opening the scalp wound, the CSF gushed out from both right subgaleal space and previous burr hole. The CSF was xanthochronic in appearance and the subgaleal effusion is slightly reddish. The ICP drop from 11mmHg to 6~7mmHg after CSF gushed out. The subgaleal effusion was sampled for further study. Codman Bactiseal EVD catheter was used and fixed at 6cm in depth. The CSF leakage from the wound was noted after removal of the Nylon stitches. After opening the scalp wound, the CSF gushed out from both right subgaleal space and previous burr hole. The CSF was xanthochronic in appearance and the subgaleal effusion is slightly reddish. The ICP drop from 11mmHg to 6~7mmHg after CSF gushed out. The subgaleal effusion was sampled for further study. Codman Bactiseal EVD catheter was used and fixed at 6cm in depth. Operative Procedures Under endotracheal tube general anesthesia, the patient is put in supine position. The Nylon stitches over frontal part of right craniectomy wound was removed. The scalp was then shaved, scrubbed, and disinfected as usual. The scalp was opened along previous op wound. The subcutaneous soft tissue and previous suture was removed. The right subgaleal effusion was drained out and sent for study. The burr hole was identified and one bacterial culture swab was checked. Gentamicin solution irrigation was performed. The Codman Bactiseal EVD catheter was inserted via previous puncture tract. The function of EVD was checked and externalization was done. The EVD was fixed at 6cm in depth. Hemostasis was achieved and the wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. The EVD was then connected to the EVD set. Under endotracheal tube general anesthesia, the patient is put in supine position. The Nylon stitches over frontal part of right craniectomy wound was removed. The scalp was then shaved, scrubbed, and disinfected as usual. The scalp was opened along the anterior part of the previous craniectomy wound. The subcutaneous soft tissue and previous suture was removed. The right subgaleal effusion was drained out and sent for study. The burr hole was identified and one bacterial culture swab was checked. Gentamicin solution irrigation was performed. The Codman Bactiseal EVD catheter was inserted via previous puncture tract. The function of EVD was checked and externalization was done. The EVD was fixed at 6cm in depth. Hemostasis was achieved and the wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. The EVD was then connected to the EVD set. Operators AP郭夢菲 Assistants R4李振豪 Indication Of Emergent Operation 相關圖片 鄒文智 (M,1954/03/23,57y11m) 手術日期 2010/09/09 手術主治醫師 陳敞牧 手術區域 東址 005房 02號 診斷 Glioma 器械術式 right temporal glioma 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 傅紹懷, 時間資訊 00:00 臨時手術NPO 11:20 進入手術室 11:30 麻醉開始 11:55 誘導結束 12:10 抗生素給藥 12:46 手術開始 15:10 抗生素給藥 17:00 手術結束 17:00 麻醉結束 17:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 癲癇症腦葉切除術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: right anterior temporal lobectomy 開立醫師: 陳德福 開立時間: 2010/09/09 17:24 Pre-operative Diagnosis right temporal lobe tumor with seizure Post-operative Diagnosis right temporal lobe tumor with seizure Operative Method right anterior temporal lobectomy Specimen Count And Types 1 piece About size:5*2.5*3CM Source:right temporal lobe tumor Pathology pending Operative Findings 1.There is a soft, yellowish-greyish, 2.5*3*5cm in sized lesion over the right anterior temporal lobe. The anterior temporal lobectomy was removed, while the right parahippcampus and amygdala were left in situ. The right temproal horn of lateral ventricle was exposed durin the operation. 2.Under microscopic surgery and Nagivator system assisted, the anterior temproal lobectomy was performed smoothly. Operative Procedures 1.Under ETGA and supine position 2.the skull was fixed with Mayfield pin type head fixator 3.scalp disinfection and draping 4.curvilinear incision as right pterional approach with parietal extension 5.8*10 craniotomy 6.dura tenting and dura opening 7.The right middle and inferior temporal gyrus was identified 8.Performing right anterior temporal lobectomy 9.The temporal horn was encountered 10.hemostasis 11.dura closure with prolene in water right fasion 12.the skull was fixed with miniplates 13.left one subgaleal J-P in situ 14.wound closed in layers. Operators VS陳敞牧 Assistants R5陳德福 R1 傅紹懷 洪維 (M,1943/02/25,69y0m) 手術日期 2010/09/09 手術主治醫師 陳敞牧 手術區域 東址 005房 03號 診斷 Chronic renal failure (CRF) 器械術式 V-P shunt, Right 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 傅紹懷, 時間資訊 00:00 臨時手術NPO 17:28 進入手術室 17:35 麻醉開始 17:40 誘導結束 17:50 抗生素給藥 18:15 手術開始 19:15 手術結束 19:15 麻醉結束 19:25 送出病患 19:26 進入恢復室 20:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室腹腔分流手術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: right frontal VPS 開立醫師: 陳德福 開立時間: 2010/09/09 19:22 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method right frontal VPS Specimen Count And Types nil Pathology nil Operative Findings 1.The ventricular opening pressure:3cmH2O, CSF: clear, colorless 2.Intraventricular cath:6.4cm; Intraperitoneal cath: 20cm 3.One medium pressure, Metronic, valve type shunt was implantated at right Kocher point Operative Procedures 1.Under ETGA and supine position 2.Skin disinfection and draping 3.Curvilinear incision at right frontal and burr hole creation 4.Dura tenting and dura opening followed by insert ventricular taping needle 5.Right upper abdomen minilaparotomy 6.Subcutaneous tunneling and connect the tube 7.Insert the valve and check the shunt function 8.Hemostasis and close the wound in layers Operators VS 陳敞牧 Assistants R5 陳德福 R1傅紹懷 邱文達 (M,1971/11/14,40y4m) 手術日期 2010/09/09 手術主治醫師 蕭輔仁 手術區域 東址 002房 01號 診斷 Subdural hemorrhage or effusion 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2E 紀錄醫師 鍾文桂, 時間資訊 01:00 臨時手術NPO 01:00 開始NPO 06:58 通知急診手術 08:30 報到 08:45 進入手術室 08:50 麻醉開始 08:55 誘導結束 08:58 抗生素給藥 09:37 手術開始 10:32 手術結束 10:32 麻醉結束 10:40 送出病患 10:43 進入恢復室 12:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 慢性硬腦膜下血腫清除術 1 1 記錄__ 手術科部: 外科部 套用罐頭: Evacuation of chronic subdural hemorrhage and... 開立醫師: 鍾文桂 開立時間: 2010/09/09 10:49 Pre-operative Diagnosis Chronic subdural hemorrhage and effsion,left frontal-parietal-temporal. Post-operative Diagnosis Chronic subdural hemorrhage and effsion,left frontal-parietal-temporal. Operative Method Evacuation of chronic subdural hemorrhage and effusion. Specimen Count And Types nil Pathology Nil. Operative Findings A thin membrane seperated the chronic subdural hemorrhage(outer) and effusion(inner). Dark red-brown liqified hematoma gushed out after durotomy. Operative Procedures Under ETGA, the patient was placed in supine position and the head was tilted to the right slightly. After shaving,disinfection, and draping, a 5 cm linear scalp incision was done at left frontal region. Then, a burr hole was created. After durotomy, chronic SDH was evacuated. A thin membrane was noted underbeneath. After lysis of the membrane, clear yellowish effusion was noted. A subdural rubber drain was placed.Finally, the wound was closed in layer. Operators V.S. 蕭輔仁 Assistants 鍾文桂 Indication Of Emergent Operation 相關圖片 張碧 (F,1937/06/10,74y9m) 手術日期 2010/09/09 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 Cerebrovascular accident (CVA) 器械術式 cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾峰毅, 時間資訊 00:00 臨時手術NPO 11:20 報到 11:41 進入手術室 11:50 麻醉開始 12:00 誘導結束 12:07 抗生素給藥 12:30 手術開始 13:40 手術結束 13:40 麻醉結束 13:43 送出病患 13:45 進入恢復室 15:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 頭顱成形術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Cranioplasty 開立醫師: 曾峰毅 開立時間: 2010/09/09 13:44 Pre-operative Diagnosis Right MCA territory infarction, status post decompressive craniectomy Post-operative Diagnosis Right MCA territory infarction, status post decompressive craniectomy Operative Method Cranioplasty at right Specimen Count And Types Nil Pathology Nil Operative Findings Bone graft stored in bone bank was fixed back with mini-plates, and fusion with artificial bone graft and bone cement. Operative Procedures With endotracheal general anaesethesia, the patient was put in supine position with head rotated to left. After scalp shaved, scrubbed, disinfected, and then draped, we made the skin incision along previous operation wound. We dissected the scalp flap along the craniectomy window, and reflected it inferiorly. Operation field was irrigated with gentamycin-saline, and hemostasis was done. Bone graft was fixed back with miniplates and screws, and bone cleft was filled with artificial bone graft and bone cement. After one subgaleal CWV set, we closed the wound in layers. Operators VS 王國川 Assistants R4 曾逢毅 陳起濤 (M,1930/01/02,82y2m) 手術日期 2010/09/09 手術主治醫師 王國川 手術區域 東址 003房 號 診斷 Herniation of intervertebral disc 器械術式 L4/5 HIVD 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾峰毅, 時間資訊 00:00 臨時手術NPO 07:37 報到 08:03 進入手術室 08:15 麻醉開始 08:30 誘導結束 08:50 抗生素給藥 09:22 手術開始 11:20 手術結束 11:20 麻醉結束 11:25 送出病患 11:30 進入恢復室 12:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 手術 椎間盤切除術－腰椎 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 摘要__ 手術科部: 外科部 套用罐頭: HIVD 開立醫師: 曾峰毅 開立時間: 2010/09/09 11:21 Pre-operative Diagnosis Sequestrated disc of L3/4, compressing left L4 root Post-operative Diagnosis Sequestrated disc of L3/4, compressing left L4 root Operative Method Microdiskectomy of L3/4 via left L3 laminotomy. Specimen Count And Types Nil Pathology Nil Operative Findings Sequestrated disc from L3/4 intervertebral space compressed left L4 root, which became reluctant after microdikectomy. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After skin scrubbed, disinfected, and then draped, we localized L3/4 intervertebral disc space with C-arm. We made one midline incision from L3 to L4. Paraspinal muscle at left was dissected to expose interlaminal space of L3/4, and was retracted by Taylor retractor. Laminotomy was done, and microdisckectomy was perfomred with disc clamp and alligator. After hemostasis, we closed the wound in layers. Operators VS 王國川 Assistants R4 曾峰毅 陳春心 (M,1935/11/05,76y4m) 手術日期 2010/09/09 手術主治醫師 王國川 手術區域 東址 003房 03號 診斷 Cervical spondylosis 器械術式 ACDF 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 曾峰毅, 時間資訊 00:00 臨時手術NPO 13:35 報到 13:54 進入手術室 14:00 麻醉開始 14:10 抗生素給藥 14:15 誘導結束 14:40 手術開始 17:10 麻醉結束 17:10 手術結束 17:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術－頸椎 1 1 手術 脊椎融合術－前融合，有固定物（＜＝四節） 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Anterior Discectomy and Fusion, Cervical Spine 開立醫師: 曾峰毅 開立時間: 2010/09/09 17:12 Pre-operative Diagnosis Cervical spondylosis, status post C5/6 ACDF, malunion at C5/6, unstable Post-operative Diagnosis Cervical spondylosis, status post C5/6 ACDF, malunion at C5/6, unstable Operative Method Anterior Discectomy and Fusion, Cervical Spine Corpectomy at C5, and partially at C6, diskectomy of C4/5, fusion with body cage and artifical bone graft, fixation with plates Specimen Count And Types Nil Pathology Nil Operative Findings C5/6 disc space status post fusion surgery was unstable now, especially at C5 vertebral body. Medial column of the spine of C5-6 was perserved partially, and posterior longitudinal ligament was not exposed. Post-op C-arm demonstrated good position of body cage and good alingment of plate. Blood loss was about 300ml, and intra-operative SSEP did not show any change. Operative Procedures With endotracheal general With endotracheal general anaesthesia, the patient was put in supine position with neck extended. After C-arm localization, we made one transverse skin incision at right aspect of neck and just beneath the thyroid cartilage. We confirmed the reduction of the deformity after neck extension under C-arm. We transected the platysma muslces, and dissected along the medial side of SCM. Carotid complex was retracted laterally, and trachea and esophagus was retracted medially to expose the prevertebral space form lower C4 to upper C7. C4/5 diskectomy was done first, and corpectomy totally at C5, and partially at upper C6 was carried out with high-speed air-powered cutting burr. Body cage with artificial bone graft was used for fusion, and fixation was done with plates and screws. AFter hemostasis, and one submuscular CWV drain set, we closed the wound in layers. Operators VS 王國川 Assistants R4 曾峰毅 吳克良 (M,1980/03/01,32y0m) 手術日期 2010/09/09 手術主治醫師 蔡翊新 手術區域 東址 005房 01號 診斷 Injury (severeity score >=16) 器械術式 cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 傅紹懷, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:03 進入手術室 08:10 麻醉開始 08:17 誘導結束 08:55 抗生素給藥 09:05 手術開始 10:50 手術結束 10:50 麻醉結束 11:00 送出病患 11:00 進入恢復室 12:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 頭顱成形術 1 1 R 手術 顱骨重塑模組 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 摘要__ 手術科部: 外科部 套用罐頭: Cranioplasty 開立醫師: 蔡翊新 開立時間: 2010/09/09 10:41 Pre-operative Diagnosis Right frontotemporoparietal skull defect. Post-operative Diagnosis Right frontotemporoparietal skull defect. Operative Method Cranioplasty with Bioplate (Codman). Specimen Count And Types nil Pathology Nil. Operative Findings A 10 x 8 cm skull defect at right frontotemporoparietal area. The temporalis muscle has been excised during previous operation because of severe swelling and contamination. The dura was soft. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation:shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with a sterilized adhesive plastic sheet. 4. Incision: along the previous operation scar at right F-T-P area, Raney clips were apllied to the scalp edge for temporary hemostasis. 5. The right F-T-P scalp was dissected away from the underlying dura. 6. The edge of the skull defect was exposed. 7. 3-D CT reconstructed Bioplate (HowMedica, Codman) was placed back to the skull defect and fixed by miniplates and screws. Central tenting was performed with 3 stitches of silk. 8. Cranioplastic Bone cement (Codman) was applied to substitute the bulk of excised temporalis muscle. 9. Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by interrupted suture with 3/0 nylon. 10.Drain: one, epidural, CWV. 11.Blood transfusion: nil. Blood loss: 200 ml. 12.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5陳德福R1傅紹懷 李銘偉 (M,1982/11/12,29y4m) 手術日期 2010/09/09 手術主治醫師 蔡翊新 手術區域 東址 009房 07號 診斷 Injury (severeity score >=16) 器械術式 cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 15:15 報到 15:22 進入手術室 15:25 麻醉開始 15:35 誘導結束 16:00 抗生素給藥 16:25 手術開始 19:00 抗生素給藥 19:20 手術結束 19:20 麻醉結束 19:25 送出病患 19:27 進入恢復室 21:07 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 手術 頭顱成形術 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Cranioplasty 開立醫師: 蔡翊新 開立時間: 2010/09/09 18:50 Pre-operative Diagnosis Left frontotemporoparietal skull defect. Post-operative Diagnosis Left frontotemporoparietal skull defect. Operative Method Cranioplasty with autologous bone graft. Specimen Count And Types nil Pathology Nil. Operative Findings A 14 x 12 cm skull defect at left F-T-P area. The brain was very slack. The scalp was tightly adhered to the underlying dura, which was remnant of Duraform. The temporalis muscle has been excised during previous craniectomy and its bulk was substituted with a piece of bone cement. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right. 3. Skin preparation:shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with a sterilized adhesive plastic sheet. 4. Incision: along the previous operation scar at left F-T-P , Raney clips were apllied to the scalp edge for temporary hemostasis. 5. The left F-T-P scalp was dissected away from the underlying dura. 6. The bleeders on the dissected surfaces were coagulated with Bovie painstakingly. 8. The edge of the skull defect was exposed. 9. The original skull plate preserved at bone bank was placed back to the skull window then fixed by 3 miniplates and 6 screws and a dura tenting at the center of the skull plate. 10.The bulk of the excised temporalis muscle was substituted with a piece of bone cement. 11.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by interrupted suture with 3/0 nylon. 12.Drain: two epidural CWV. 13.Blood transfusion: nil. Blood loss: 250 ml. 14.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R4林哲光Ri楊博鈞 林虹 (F,1988/10/14,23y5m) 手術日期 2010/09/09 手術主治醫師 蔡翊新 手術區域 東址 018房 03號 診斷 Subdural hemorrhage 器械術式 Subtemporal decompression -uni 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林子富 ASA 1E 紀錄醫師 林哲光, 時間資訊 18:00 臨時手術NPO 18:00 開始NPO 20:24 通知急診手術 20:50 進入手術室 21:00 麻醉開始 21:30 誘導結束 21:50 抗生素給藥 22:00 手術開始 00:40 手術結束 00:40 麻醉結束 00:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 急性硬腦膜下血腫清除術 1 1 L 手術 顱內壓監視置入 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 創傷醫學部 套用罐頭: Left F-T-P craniectomy and duroplasty with au... 開立醫師: 林哲光 開立時間: 2010/09/10 00:41 Pre-operative Diagnosis Left acute F-T-P subdural hematoma Post-operative Diagnosis Left acute F-T-P subdural hematoma Operative Method Left F-T-P craniectomy and duroplasty with autologus fascia and ICP monitroing (Codman) Specimen Count And Types Pathology Nil. Operative Findings Preoperative GCS showed E4M6V5 and bilateral pupils were isocoric 3.0/3.0, L/R +/+; Initial ICP showed 18 after a burr hole was created. Bulging brain parenchyma was noted after craniectomy and subdural hematoma was around 30ml at left F-T-P area. A dura lesion with bleeding was noted at left parietal lobe near the SSS. ICP reference is 479. Postoperative ICP showed 4. Preoperative GCS was E4M6V5 and bilateral pupils were isocoric 3.0/3.0, L/R +/+; Initial ICP was 18 mmHg after a burr hole was created. Bulging brain parenchyma was noted after craniectomy and subdural hematoma was around 30ml at left F-T-P area. An active bleeder from the bridging vein leading to superior sagittal sinus was noted at left parietal area. ICP reference was 479. Postoperative ICP was 4 mmHg. Operative Procedures Under ETGA and supine position with head rotated to right side, skin disinfected and drapped were performed as usual. Skin incision was made over the left F-T-P area. Left F-T-P craniectomy was done after burr holes were created. Initial ICP showed 18 after a burr hole was created. The dura was then opened after dural tenting. Hematoma evacuation was then done. Duroplasty was then done with fascia and the wound was then closed in layers after epidural drains x2 were inserted and ICP monitor was inserted over subdural area. Operators VS 蔡翊新 Assistants R6 胡朝凱, R4 林哲光 Indication Of Emergent Operation 相關圖片 鄭孝忠 (M,1960/11/16,51y3m) 手術日期 2010/09/10 手術主治醫師 杜永光 手術區域 東址 025房 04號 診斷 Unspecified peritonitis 器械術式 Vp shunt remove 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 14:32 報到 14:55 進入手術室 15:00 麻醉開始 15:20 誘導結束 15:55 手術開始 16:20 手術結束 16:20 麻醉結束 16:30 進入恢復室 16:30 送出病患 17:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室體外引流 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Removal of ventriculo-peritoneal shunt 開立醫師: 李振豪 開立時間: 2010/09/10 16:39 Pre-operative Diagnosis Ventriculo-peritoneal shunt infection Post-operative Diagnosis Ventriculo-peritoneal shunt infection Operative Method Removal of ventriculo-peritoneal shunt Specimen Count And Types 3 pieces About size:10ml Source:CSF sampled from V-P shunt reservoir. Send for routine, BCS, bacterial and fungal culture About size:one tip culture Source:Ventricular catheter About size:one tip culture Source:Peritoneal catheter Pathology Nil Operative Findings The CSF sampled from V-P shunt reservoir is clear in character. The shunt is removed totally from scalp wound. Operative Procedures Under endotracheal tube general anesthesia, the patient is put in supine position with head rotated to left. The scalp was shaved, scrubbed, and disinfected as usual. The linear scalp incision was made along previous wound and the subcutaneous soft tissue was dissected. The reservoir of V-P shunt was exposed and CSF sampling from reservoir was done. Then we dissected along the margin of reservoir to free the ventricular catheter. The ventricular catheter was removed and sent for tip culture. Then the peritoneal catheter was removed from scalp wound smoothly. The tip of the peritoneal catheter is intact and sent for tip culture also. The wound was then irrigated with Gentamicin solution. Hemostasis was achieved and the burr hole was packing with Gelform. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators Prof.杜永光 Assistants R4李振豪 相關圖片 巫保賢 (M,1976/07/06,35y8m) 手術日期 2010/09/10 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Aneurysm 器械術式 Left side MCA aneurysm 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 2 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:03 進入手術室 08:10 麻醉開始 09:00 誘導結束 09:32 手術開始 09:52 抗生素給藥 12:52 抗生素給藥 15:52 抗生素給藥 19:10 麻醉結束 19:10 手術結束 19:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 14 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 開顱術摘除血管病變－腦血管瘤－巨大的 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Left pterion approach for aneurysm clipping (... 開立醫師: 王奐之 開立時間: 2010/09/10 19:55 Pre-operative Diagnosis Left MCA giant serpentine aneurysm, unruptured Post-operative Diagnosis Left MCA giant serpentine aneurysm, unruptured Operative Method Left pterion approach for aneurysm clipping (excision) Specimen Count And Types 1 piece About size:6*3*1cm Source:left MCA giant aneurysm Pathology Pending Operative Findings A giant serpentine aneurysm arising from left MCA branch was noted at left Sylvian fissure, measuring 6*3*3cm in size, with atherosclerotic change. One obvious inlet artery was noted at lateral surface of the aneurysm, but the outlet was not identified during the surgery. Operative Procedures After ETGA, the patient was placed in supine position with face turned to right and head fixed with Mayfield skull clamp. The course of left STA was traced with Duplex and marked. The skin was then disinfected and draped in usual sterile fashion. A curved skin incision was made at left frontotemporal area, followed by microscopic dissection of STA middle branch. The STA was divided at superior temporal area, heparinization was done through the distal end of the prepared STA. The vessel was then temporarily clipped with an aneurysm clip. The temporalis muscle was then flipped inferiorly to the level of zygomatic arch. A keyhole burr hole was done, followed by pterion craniotomy. After dural tenting, a fish-mouth durotomy was made. The inferior portion of Sylvian fissure was opened gradually until ICA and M1 branch was identified. The superior part of Sylvian fissure was then opened, exposing the aneurysm. After identifying the inlet vessel, the inlet was clipped with aneurysm clip temporarily and 2 small Weck hemoclips. The inlet was then divided, allowing flipping and dissection of the surrounding tissue. After dissection, the aneurysm was removed en bloc. Hemostasis was done meticulously. The skull was put back and fixed with miniplates. An epidural CWV drain was placed, the operative procedure ended with wound closure in layers. Operators P 杜永光 Assistants R6 陳睿生, R3 王奐之 相關圖片 許富女 (F,1942/12/22,69y2m) 手術日期 2010/09/10 手術主治醫師 杜永光 手術區域 東址 005房 01號 診斷 Lumbar Spondylosis 器械術式 L3-5 TPS 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 周聖哲, 時間資訊 00:00 臨時手術NPO 08:07 進入手術室 08:09 麻醉開始 08:30 誘導結束 09:00 抗生素給藥 09:20 手術開始 12:00 抗生素給藥 14:30 手術結束 14:30 麻醉結束 14:40 送出病患 14:45 進入恢復室 17:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術－前融合，有固定物（＜＝四節） 1 1 手術 椎間盤切除術－腰椎 1 2 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 記錄__ 手術科部: 外科部 套用罐頭: L3~5 TPS and L4~5 cage insertion 開立醫師: 胡朝凱 開立時間: 2010/09/10 14:35 Pre-operative Diagnosis L3~4,4~5 spondylolisthesis with L4~5 HIVD Post-operative Diagnosis L3~4,4~5 spondylolisthesis with L4~5 HIVD Operative Method L3~5 TPS and L4~5 cage insertion Specimen Count And Types nil Pathology nil Operative Findings 1.Listhesis of L3 on L4 and L4 on L5 wer noted. 2.Previous operation scar that adhesion to the dura was noted 3.The facets were all hypertrophic. 4.Protruding disc was noted at L4~5 level that compressed the root tightly Operative Procedures Under ETGA, patient was put in prone position. The wound incision was made at midline on previous wound. Dissection was then made to detach paravertebral muscle.Identification of L2~3 spinous process then lamina was made. A artificial plane was made above the dura to expose bilateal L3~5 facets. TPS screws were then inserted and confirmed with C-arm.Identified L4~5 dura at previous laminectomy area and extended laterally to remove facets. Cut open L4~5 disc then discectomy was performed.Cages were then inserted under C-arm guided via bilateral route and the root, thecal sac was protected. Fixed rods then cross link, also. After water irrigation, hemovac drain was inserted and wound was closed in layers. Operators P 杜永光 Assistants 胡朝凱, 周聖哲 魏主美 (F,1941/12/02,70y3m) 手術日期 2010/09/10 手術主治醫師 賴達明 手術區域 東址 005房 02號 診斷 Cervical Spondylosis 器械術式 C4-5, 5-6 HIVD 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 周聖哲, 時間資訊 00:00 臨時手術NPO 15:01 進入手術室 15:16 麻醉開始 15:20 誘導結束 15:40 抗生素給藥 15:45 手術開始 18:15 手術結束 18:30 送出病患 18:30 麻醉結束 20:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術－頸椎 1 1 手術 脊椎融合術－前融合，無固定物（＜＝四節） 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 記錄__ 手術科部: 外科部 套用罐頭: Anteior approach for discectomy and cage inse... 開立醫師: 周聖哲 開立時間: 2010/09/10 18:39 Pre-operative Diagnosis C4~5, 5~6 HIVD Post-operative Diagnosis C4~5, 5~6 HIVD Operative Method Anteior approach for discectomy and cage insertion Specimen Count And Types nil Pathology Pending Operative Findings 1.Protruding discs at the level of C4~5 and C5~6, compressed the spinal cord tightly. The disc became dehydrated. 2.Mild hypertrophic PLL 3.After decompression, the cord expanded well 4.C4~5 cage: 6# 5.C5~6 cage: 5# 6.After cages insertion, the cages were not movable Operative Procedures 1.ETGA, supine 2.Right neck transverse skin incision 3.Dissection along the anterior border of SCM to expose prevertebral space 4.Detach longus coli muscle 5.Insert retractor 6.Discectomy of C5~6 with currete and drill and kerrison pounch 7.Insert cage 8.Same procedure at C4~5 9.Set one CWV drain then close wound in layers Operators 賴達明 Assistants 胡朝凱, 周聖哲 翁清潔 (M,1948/11/02,63y4m) 手術日期 2010/09/10 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Spinal stenosis, cervical 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:07 進入手術室 08:10 麻醉開始 08:30 誘導結束 08:40 抗生素給藥 09:21 手術開始 11:40 抗生素給藥 13:20 手術結束 13:20 麻醉結束 13:30 送出病患 13:32 進入恢復室 14:31 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 手術 椎間盤切除術－頸椎 1 1 R 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: 1. Cervical diskectomy, right anterior approa... 開立醫師: 鍾文桂 開立時間: 2010/09/10 13:08 Pre-operative Diagnosis Herniated intervertebral disc and stenosis, C4/5 with myelopathy. Post-operative Diagnosis Herniated intervertebral disc and stenosis, C4/5 with myelopathy. Operative Method 1. Cervical diskectomy, right anterior approach,C4/5. 2. Interbody fusion with autologous bone graft, C4/5. Specimen Count And Types nil Pathology Nil. Operative Findings 1. Herniated intervertebral disc at C4/5 level. 2. Autologous bone graft was harvested from right anterior superior iliac spine. 3. Intact dura mater. Operative Procedures Under ETGA, the patient was placed in supine position and the neck was slightly extended. After disinfection and draping, a horizontal skin incision was made at superior margin of thyroid cartilage. The platysma muscle was dissected. Further dissection was made at the anterior border of sternocledomastoid muscle until the prevertebral space was reached. The esophagus and trachea were retracted medially and the carotid sheath laterally. The C4/5 intervertebral disc was located by intraoperative fluoroscope. The disc was removed by Kerrison punch, high speed cutting burr, and currete. The PLL was also removed. We harvested the autologous bone graft from anterior superior iliac spine for interbody fusion. With the bone graft in place, the wound was closed in layers. A prevertebral mini-hemovac was inserted. Operators V.S. 賴達明 Assistants R5鍾文桂 R1李柏潁 相關圖片 蔡玉成 (M,1939/08/09,72y7m) 手術日期 2010/09/10 手術主治醫師 賴達明 手術區域 東址 019房 02號 診斷 Spondylolisthesis 器械術式 L3/4 TPS 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 12:40 報到 13:43 進入手術室 13:45 麻醉開始 14:00 誘導結束 14:03 抗生素給藥 14:58 手術開始 18:10 手術結束 18:10 麻醉結束 18:20 送出病患 19:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術（特壓）－二節以內 1 2 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: 1. Internal fixation with transpedicular scre... 開立醫師: 鍾文桂 開立時間: 2010/09/10 18:37 Pre-operative Diagnosis Lumbar spondylolisthesis, L3/4. Post-operative Diagnosis Lumbar spondylolisthesis, L3/4. Operative Method 1. Internal fixation with transpedicular screws and posterolateral fusion with autologous bone graft. 2. Decompressive laminectomy, L3. Specimen Count And Types nil Pathology Nil. Operative Findings Hypertrophic ligamentum flavum. Severely impinged roots, especially right L4 root. 4 transpedicular screws(3.5x 45mm) and two rods. Operative Procedures Under ETGA, the patient was placed in prone position. The L3 and L4 pedicles were located by intraoperative fluoroscopy. After disinfection and draping, 10-cm midline incision and paraspinal dissection were done to expose bilateral L2/3 and L3/4 facet joints. The transverse process of L3 and L4 were also identified. The transpedicle screws were implanted at bilateral L3 and L4 levels. Later, L3 laminectomy was done for decompression. After placing the autologous bone for posterolateral fusion, the internal fixation apparatus was completed with additional two rods. The wound was closed in layers after placing one epidural 1/8 hemovac. Operators V.S. 賴達明 Assistants R5鍾文桂 R1李柏穎 相關圖片 許沈蜜 (F,1943/02/06,69y1m) 手術日期 2010/09/10 手術主治醫師 賴達明 手術區域 東址 001房 02號 診斷 Sciatica 器械術式 L4/5 HIVD 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 1 紀錄醫師 陳德福, 時間資訊 00:00 臨時手術NPO 09:03 進入手術室 09:12 麻醉開始 09:20 誘導結束 10:10 抗生素給藥 10:20 手術開始 11:35 手術結束 11:35 麻醉結束 11:40 送出病患 11:45 進入恢復室 13:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 椎間盤切除術－腰椎 1 1 摘要__ 手術科部: 外科部 套用罐頭: microscopic decompressive hemilaminectomy 開立醫師: 陳德福 開立時間: 2010/09/10 11:51 Pre-operative Diagnosis L4-5 spondylosis with lateral recess stenosis, right Post-operative Diagnosis L4-5 spondylosis with lateral recess stenosis, right Operative Method microscopic decompressive hemilaminectomy Specimen Count And Types nil Pathology nil Operative Findings 1.There is hypertrophic ligmentum flavum with thecal sac and nerve root compression at the right L4-5 space. The right L4 hemilaminectomy and removal of ligmentum flavum were done smoothly. After the decompression, the right L5 nerve root became redundent. Operative Procedures 1.Under ETGA and prone position 2.C-arm floruoscopic localization 3.skin disinfection and draping 4.linear incision along the midline 5.displace the paraspinous muscle laterally, right side 6.hemilaminectomy and removal of the ligmentum flavum 7.identify the nerve root 8.hemostasis 9.close the wound in layers. Operators VS 賴達明 Assistants r5 陳德福 吳永清 (M,1957/09/05,54y6m) 手術日期 2010/09/10 手術主治醫師 王國川 手術區域 東址 002房 06號 診斷 Cerebrovascular accident (CVA) 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 4E 紀錄醫師 古恬音, 時間資訊 15:28 通知急診手術 15:28 開始NPO 15:55 進入手術室 16:00 麻醉開始 16:20 誘導結束 16:20 抗生素給藥 16:57 手術開始 17:30 開始輸血 19:20 抗生素給藥 19:30 手術結束 19:30 麻醉結束 19:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: CVA 開立醫師: 曾峰毅 開立時間: 2010/09/10 19:27 Pre-operative Diagnosis Cerebellar infarction with hemorrhagic transformation Post-operative Diagnosis Cerebellar infarction with hemorrhagic transformation Operative Method Suboccipital craniectomy Suboccipital craniectomy for ICH removal Specimen Count And Types Nil Pathology Nil Operative Findings Hemorrhagic transformation was noted at right cerebellar. Brain pulsation was good, and brain was reluctant after hematoma removed and CSF drained. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. We made one skin incision at right occiptal area, and drilled one burr hole for EVD insrtion. We failed EVD insertion, and closed the wound in layers. We made one midline skin incision from inion to upper neck. We dissected, and harvested the autologous fascia. We drilled 4 burr holes, and then created subocciptal crainectomy. Duro was opened in Y-shape, and arachnoid membrane was opened. Right cerebellar hemorrhage was removed. The duro was closed in water-tight fashion with autologous fascia graft. The wound was closed in layers after one submuscular CWV set. Operators VS 王國川 Assistants R4 曾峰毅 R3 古恬音 Indication Of Emergent Operation 黃國恩 (M,1989/10/23,22y4m) 手術日期 2010/09/10 手術主治醫師 謝孟祥 手術區域 東址 012房 02號 診斷 Zygomatic fracture 器械術式 Zygoma reduction 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 3 紀錄醫師 趙崧筌, 時間資訊 11:02 報到 11:20 進入手術室 11:25 麻醉開始 11:30 誘導結束 11:50 抗生素給藥 12:15 手術開始 14:50 手術結束 14:50 抗生素給藥 14:50 麻醉結束 15:00 送出病患 15:05 進入恢復室 16:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脫手套法正中顏面手術併顏面骨復位術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 摘要__ 手術科部: 外科部 套用罐頭: Open reduction and internal fixation with abs... 開立醫師: 趙崧筌 開立時間: 2010/09/10 15:25 Pre-operative Diagnosis Left zygomatic bone fracture Post-operative Diagnosis Ditto Operative Method Open reduction and internal fixation with absorbable plate system Specimen Count And Types nil Pathology Nil Operative Findings The left zygomatic bone fracture lines found at inferior orbital ring and anterior wall of maxilla, frontozygomatic junction, zygomatic arch and lateral buttress of the maxillary sinus and was reduced by Dingman under Navigator system. One plate system was applied for maxilla stability and the other one was fixed for fracture line over frontozygomatic junction. Operative Procedures ETGA, supine, disinfected and draped Transverse incision along lateral side of the eyebrow Dissect to frontozygomatic junction and identify the fracture line Reduce the zygomatic bone by Dingman and apply plate fixation Make upper gingival sulcus incision and expose the broken maxillary wall Apply the plate system for fixation Do hemostasis, close wounds and compressive bandage dressing Operators 謝孟祥 Assistants 官振翔 趙崧筌 喬嘉 袁玉琴 (F,1952/04/17,59y10m) 手術日期 2010/09/11 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Rheumatoid arthritis of spine 器械術式 OC fusion 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 李柏穎, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:20 麻醉開始 08:45 誘導結束 09:30 抗生素給藥 09:57 手術開始 10:30 開始輸血 12:30 抗生素給藥 14:05 麻醉結束 14:10 手術結束 14:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 手術 椎弓切除術（特壓）－二節以內 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: 1. Occipitocervical fixation and fusion, remo... 開立醫師: 陳睿生 開立時間: 2010/09/11 15:00 Pre-operative Diagnosis Rheumatois arthritis with C1-2 subluxation, s/p retropharyngeal odontoidectomy Post-operative Diagnosis Rheumatois arthritis with C1-2 subluxation, s/p retropharyngeal odontoidectomy Operative Method 1. Occipitocervical fixation and fusion, removal of C1 posterior arch 2. Right posterior iliac bone graft extraction for fusion Specimen Count And Types nil Pathology Nil Operative Findings The thecal sac was tightly compressed by the C1 posterior arch. After C1 posterior arch remove, the thecal sac was well expanded. Posterior fixation was done with Depuy lateral mass screws. C0: plate was fixed with 15mm and 10mm. Right C3 screws: 16x 4.0mm; C4: 14x 3.5mm, left C3: 16x 3.5mm; C4: 16x 3.5mm. Posteriolateral fusion was done from C0 to C4 with right posterior iliac bone graft. Easy oozing was noted. The thecal sac was tightly compressed by the C1 posterior arch. After C1 posterior arch remove, the thecal sac was well expanded. Posterior fixation was done with Depuy lateral mass screws. C0: plate was fixed with 15mm and 8mm. Right C3 screws: 16x 4.0mm; C4: 14x 3.5mm, left C3: 16x 3.5mm; C4: 16x 3.5mm. Posteriolateral fusion was done from C0 to C4 with right posterior iliac bone graft. Easy oozing was noted. Operative Procedures 1. ETGA, prone position and head fixed with Mayfield under neutral position 2. Posterior neck midline incision and the suboccipital region to C4 level was exposed after paraspinal muscle split 3. The C2-4 facets were totally exposed 4. C3,4 lateral mass screws were inserted 5. Removal of C1 posterior arch with rounger 6. Fix the plate to suboccipital region with screws x2 7. Set bilateral rods and expansion of C0 to C2 junction with rods fixation 8. Linear incision over right posterior hip 9. Harvest a piece of posterior iliac crest as bone graft 10.Bony fusion was performed from C0 to C4 with iliac graft and artificial graft 11.Hemostasis, set CWV drains at each wound 12.Close the wound in layers Operators VS 賴達明 Assistants R6 陳睿生, R1 李柏穎 摘要__ 手術科部: 外科部 套用罐頭: 1. Occipitocervical fixation and fusion, remo... 開立醫師: 陳睿生 開立時間: 2010/09/11 15:00 Pre-operative Diagnosis Rheumatois arthritis with C1-2 subluxation, s/p retropharyngeal odontoidectomy Post-operative Diagnosis Rheumatois arthritis with C1-2 subluxation, s/p retropharyngeal odontoidectomy Operative Method 1. Occipitocervical fixation and fusion, removal of C1 posterior arch 2. Right posterior iliac bone graft extraction for fusion Specimen Count And Types nil Pathology Nil Operative Findings The thecal sac was tightly compressed by the C1 posterior arch. After C1 posterior arch remove, the thecal sac was well expanded. Posterior fixation was done with Depuy lateral mass screws. C0: plate was fixed with 15mm and 10mm. Right C3 screws: 16x 4.0mm; C4: 14x 3.5mm, left C3: 16x 3.5mm; C4: 16x 3.5mm. Posteriolateral fusion was done from C0 to C4 with right posterior iliac bone graft. Easy oozing was noted. Operative Procedures 1. ETGA, prone position and head fixed with Mayfield under neutral position 2. Posterior neck midline incision and the suboccipital region to C4 level was exposed after paraspinal muscle split 3. The C2-4 facets were totally exposed 4. C3,4 lateral mass screws were inserted 5. Removal of C1 posterior arch with rounger 6. Fix the plate to suboccipital region with screws x2 7. Set bilateral rods and expansion of C0 to C2 junction with rods fixation 8. Linear incision over right posterior hip 9. Harvest a piece of posterior iliac crest as bone graft 10.Bony fusion was performed from C0 to C4 with iliac graft and artificial graft 11.Hemostasis, set CWV drains at each wound 12.Close the wound in layers Operators VS 賴達明 Assistants R6 陳睿生, R1 李柏穎 林月幼 (F,1960/04/28,51y10m) 手術日期 2010/09/11 手術主治醫師 陳敞牧 手術區域 東址 005房 01號 診斷 Lung cancer 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 4 紀錄醫師 鍾文桂, 時間資訊 23:59 臨時手術NPO 08:00 進入手術室 08:10 麻醉開始 08:15 誘導結束 08:50 抗生素給藥 09:27 手術開始 11:35 手術結束 11:35 麻醉結束 11:40 送出病患 11:42 進入恢復室 12:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 記錄__ 手術科部: 內科部 套用罐頭: Implantation of ventriculoperitoneal shunt, left. 開立醫師: 鍾文桂 開立時間: 2010/09/11 12:01 Pre-operative Diagnosis Lung cancer with leptomeningeal carcinomatosis and hydrocephalus. Post-operative Diagnosis Lung cancer with leptomeningeal carcinomatosis and hydrocephalus. Operative Method Implantation of ventriculoperitoneal shunt, left. Specimen Count And Types 1 piece About size:CSF Source:3CC Pathology Nil. Operative Findings Presence of port A catheter in right chest. Ventricular catheter: 6.7 cm. Medium pressure reservoir. Clear colorless CSF gushed out from ventricular puncture needle. Operative Procedures Under ETGA, the patient was placed in supine position and the head was tilted to the right side. After shaving, draping,and disinfection, a curvilinear scalp incision was made at right Kocher point. A burr hole was made. Another horizontal incision was made at left upper quadrant of abdomen. Blunt dissection was made until reaching the peritoneum. The peritoneal cavity was reached later. A subcutaneous tunnel was made from abdoment to head. Then, the shunt catheter was inserted through the tunnel. The whole shunt system was connected with reservoir and ventricular catheter. After durotomy, the ventricular puncture needle was inserted at right Kocher point. Until CSF gushed out, the ventricular catheter was implanted. The distal tip of the shunt was inserted at peritoneal cavity. Patency of the shunt was checked. Finally, the wounds were closed in layers. Operators V.S. 陳敞牧 Assistants R5 鍾文桂 Ri楊博鈞 吳克良 (M,1980/03/01,32y0m) 手術日期 2010/09/12 手術主治醫師 蔡翊新 手術區域 東址 002房 02號 診斷 Injury (severeity score >=16) 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3E 紀錄醫師 雷秋文, 時間資訊 15:12 開始NPO 15:12 臨時手術NPO 15:12 通知急診手術 15:59 進入手術室 15:59 報到 16:00 麻醉開始 16:20 誘導結束 16:30 手術開始 17:00 抗生素給藥 17:26 開始輸血 18:20 麻醉結束 18:20 手術結束 18:53 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 硬腦膜外血腫清除術 1 2 R 記錄__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 蔡翊新 開立時間: 2010/09/12 17:51 Pre-operative Diagnosis Right frontotemporoparietal skull defect s/p cranioplasty, with epidural hematoma. Post-operative Diagnosis Right frontotemporoparietal skull defect s/p cranioplasty, with epidural hematoma. Operative Method Right frontotemporoparietal craniotomy for EDH removal. Specimen Count And Types 2 culture swab: Source:epidural hematoma Pathology Nil. Operative Findings Epidural hematoma, about 2 cm in thickness, was noted just beneath the cranioplasty bone plate. Loosening of two central tenting was noted. Bleeding tendency was encountered with diffuse oozing from galea, epidural space and bone edge. Platelet and FFP transfusions were needed for better hemostasis. After removal of the EDH, the pulsation of the brain recovered. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: horse shoe-shaped, right frontotemporoparietal area, along previous wound. The skin edge was clipped by Raney clips for temporary hemostasis. 5. Craniotomy: previous Codman Bioplate was removed after cutting the central tentings and removal of the 3 screws. 6. The epidural clot was removed by sucker. 7. Hemosatasis: the bleeders was stopped by Bovie painstakingly. 8. The skull plate was placed back and fixed by original miniplates and screws via different sites. Six central tentings were applied. 9. Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 1/0 Vicryl and skin by interrupted suture with 3/0 nylon. 10.Drain: two, epidural, CWV. 11.Blood transfusion: Platelet 22U, FFP 3U. Blood loss: 550 ml. 12.Course of the surgery: smooth. 12.Course of the surgery: smooth. But generalized skin rash and anaphylatic shock developed after operation, possibly due to allergy to blood transfusion. Solumedrol, IVF and inotropes were given. Operators VS蔡翊新 Assistants R4曾峰毅R1雷秋文 R4曾峰毅R2雷秋文 Indication Of Emergent Operation 陳炳森 (M,1952/05/09,59y10m) 手術日期 2010/09/13 手術主治醫師 婁培人 手術區域 西址 033房 06號 診斷 Neck mass 器械術式 Biopsy lymphnode 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 12:02 進入手術室 12:10 麻醉開始 12:12 手術開始 13:15 手術結束 13:15 麻醉結束 13:20 送出病患 記錄__ 手術科部: 耳鼻喉部 套用罐頭: Neck mass excision(LA) 開立醫師: 林冠良 開立時間: 2010/09/13 13:10 Pre-operative Diagnosis Excision of neck mass, left level V Post-operative Diagnosis Ditto,operated Operative Method Excisional biopsy of left neck mass, level V Specimen Count And Types 1 piece About size:3*2 cm Source:left neck LAP Pathology Pending Operative Findings Neck mass, left level V ,s/p excision Operative Procedures 1.The patient was in supine position with neck hyperextended and turned to the right side. 2.Skin was disinfected and draped as usual. 3.Local anesthesia with Bosmin-rinsed Xylocaine was injected into the subcutaneous tissue around the neck mass after marking. 4.A 2 cm horizontal incision parallel to the skin crease was made. 5.The subcutaneous tissue was cut through. 6.One 3 x 2 cm mass was found and dissected from its surrounding tissue with blunt and sharp dissection. 7.The specimen was sent to pathology. 8.After hemostasis, the wound was closed and the patient tolerated the procedure well. Operators 婁培人 Assistants R2林冠良/ R4孟繁宇 羅信泰 (M,1966/11/29,45y3m) 手術日期 2010/09/13 手術主治醫師 杜永光 手術區域 東址 017房 03號 診斷 Respiratory failure, with long-term ventilator use 器械術式 cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 12:00 進入手術室 12:10 麻醉開始 12:15 抗生素給藥 12:30 誘導結束 13:05 手術開始 16:15 抗生素給藥 17:40 手術結束 17:40 麻醉結束 17:50 送出病患 17:55 進入恢復室 19:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 頭顱成形術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Cranioplasty. 開立醫師: 鍾文桂 開立時間: 2010/09/13 18:06 Pre-operative Diagnosis Right frontal-parietal-temporal skull defect. Post-operative Diagnosis Right frontal-parietal-temporal skull defect. Operative Method Cranioplasty. Specimen Count And Types nil Pathology Nil. Operative Findings Two pieces of autologous skull bone graft. One is harvested from right abdominal wall and the other was gathered from bone bank. The defect was filled up with autologous bone and bone cement. Extended subgaleal dissection was made to reach the skull margin as extended craniectomy was done through the same incision in previous operation. Intact dura mater. Operative Procedures Under ETGA, the patient was placed in supine position and the head was tilted to the left. After shaving, disinfection and draping, the abdominal wound was incised to harvest the bone graft. Later, the scalp wound was incised. Subgaleal dissection was made to expose the craniectomy window. Until the edges of the skull were identified, the bone graft was fixed on it with plates and screws. Further cranioplasty was achieved with the aid of high speed burr and bone cement. After placing one subgaleal CWV drain, the wound was closed in layers. Operators Prof. 杜永光 Assistants R5 鍾文桂 周素貞 (F,1952/09/04,59y6m) 手術日期 2010/09/13 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Trigeminal neuralgia (Cranial nerve V) 器械術式 Trigeminal neuroma 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 07:32 報到 08:05 進入手術室 08:10 麻醉開始 08:40 抗生素給藥 08:42 誘導結束 08:57 手術開始 11:40 抗生素給藥 14:40 抗生素給藥 17:45 麻醉結束 17:45 手術結束 17:55 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 11 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 顱底瘤手術 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Dolenc^s approach for total tumor remove 開立醫師: 陳睿生 開立時間: 2010/09/13 18:14 Pre-operative Diagnosis Left trigeminal tumor, suspect epidermoid cyst, suspect schwannoma Post-operative Diagnosis Left trigeminal tumor at V-3 branch, suspect epidermoid cyst Operative Method Dolenc^s approach for total tumor remove Specimen Count And Types 1 piece About size:pieces Source:tumor Pathology Pending Operative Findings The tumor located at the third branch of left trigeminal nerve. It was gray-whitish, soft and fragile. Thin capsule was also noted. It extended to the Meckel^s cave and the The tumor located at the third branch of left trigeminal nerve. It was gray-whitish, soft and fragile. Thin capsule was also noted. It extended to the Meckel^s cave and the posterior cranial fossa. Foramen rotundum, ovale & spinosum were all eroded and enlarged. Prominent ethmoid sinus was also noticed. Operative Procedures After ETGA, the patient was placed in supine position with face turned 45 degrees to the right and head fixed with Mayfield skull clamp. A curved frontotemporal skin incision was made, followed by a pterion craniotomy. The sphenoid ridge & lower temporal part was then drilled and bite off with rongeur. After drilling of the sphenoid ridge, anterior clinoidectomy was done to allow opening of the optic canal. The temporal dura was slowly peeled off from temporal base, exposing the lateral wall of cavernous sinus. Continued peeling of the temporal dura revealed CN II~VI, MMA & GSPN, exposing the whitish tumor in between CN V2~V3. The bulging tumor part was removed with tumor forceps and the remaining part was aspirated with CUSA. A small portion of posterior fossa tumor was also removed after exposing Meckel^s cave. After meticulous hemostasis and thorough dural tenting, the skull was fixed back with miniplates. An epidural CWV drain was set, the operative procedure ended with wound closure in layers. Operators P 杜永光 Assistants R6 陳睿生, R3 王奐之 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Dolenc^s approach for total tumor remove 開立醫師: 王奐之 開立時間: 2010/09/13 18:36 Pre-operative Diagnosis Left trigeminal tumor, suspect epidermoid cyst, suspect schwannoma Post-operative Diagnosis Left trigeminal tumor at V-3 branch, suspect epidermoid cyst Left intracavernous tumor, suspect epidermoid cyst Operative Method Dolenc^s approach for total tumor remove Dolenc^s approach for total tumor removal Specimen Count And Types 1 piece About size:pieces Source:tumor Pathology Pending Operative Findings The tumor located at the third branch of left trigeminal nerve. It was gray-whitish, soft and fragile. Thin capsule was also noted. It extended to the Meckel^s cave and the The tumor located at the third branch of left trigeminal nerve. It was gray-whitish, soft and fragile. Thin capsule was also noted. It extended to the Meckel^s cave and the posterior cranial fossa. Foramen rotundum, ovale & spinosum were all eroded and enlarged. Prominent ethmoid sinus was also noticed. Operative Procedures After ETGA, the patient was placed in supine position with face turned 45 degrees to the right and head fixed with Mayfield skull clamp. A curved frontotemporal skin incision was made, followed by a pterion craniotomy. The sphenoid ridge & lower temporal part was then drilled and bite off with rongeur. After drilling of the sphenoid ridge, anterior clinoidectomy was done to allow opening of the optic canal. The temporal dura was slowly peeled off from temporal base, exposing the lateral wall of cavernous sinus. Continued peeling of the temporal dura revealed CN II~VI, MMA & GSPN, exposing the whitish tumor in between CN V2~V3. The bulging tumor part was removed with tumor forceps and the remaining part was aspirated with CUSA. A small portion of posterior fossa tumor was also removed after exposing Meckel^s cave. After meticulous hemostasis and thorough dural tenting, the skull was fixed back with miniplates. An epidural CWV drain was set, the operative procedure ended with wound closure in layers. Operators P 杜永光 Assistants R6 陳睿生, R3 王奐之 相關圖片 田許妹 (F,1935/01/22,77y1m) 手術日期 2010/09/13 手術主治醫師 杜永光 手術區域 東址 005房 01號 診斷 Cerebrovascular accident (CVA) 器械術式 Right MCA aneurysm 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 4 紀錄醫師 周聖哲, 時間資訊 00:00 臨時手術NPO 08:10 進入手術室 08:10 報到 08:15 麻醉開始 08:20 開始輸血 08:35 誘導結束 09:20 抗生素給藥 09:25 手術開始 12:20 抗生素給藥 14:35 麻醉結束 14:35 手術結束 14:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦內血腫清除術 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 手術 開顱術摘除血管病變－腦血管瘤－有徵的 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Aneurysm clipping and ICH evacuation 開立醫師: 胡朝凱 開立時間: 2010/09/13 13:56 Pre-operative Diagnosis Right MCA aneurysm rupture with SAH and ICH Post-operative Diagnosis Right MCA aneurysm rupture with SAH and ICH Operative Method Aneurysm clipping and ICH evacuation Specimen Count And Types Pathology Operative Findings Operative Procedures Operators Assistants 記錄__ 手術科部: 外科部 套用罐頭: Aneurysm clipping and ICH evacuation 開立醫師: 胡朝凱 開立時間: 2010/09/13 14:09 Pre-operative Diagnosis Right MCA aneurysm rupture with SAH and ICH Post-operative Diagnosis Right MCA aneurysm rupture with SAH and ICH Operative Method Aneurysm clipping and ICH evacuation Specimen Count And Types nil Pathology nil Operative Findings 1.A saccular aneurym arised from right MCA bifurcation that protruded toward right and mild downward, measured about 0.8 cm with 0.4 cm neck. 2.The ruptured aneurysm caused right temporal lobe an ICH measured about 30 ml and also, SAH. The brain tissue adhesion to aneurysm was also noted. 3.One angled sugita clip was applied for aneurysmal clipping. 4.The brain was slack. Operative Procedures Under ETGA, patient was put in prone position with head fixed with skull clamp and 30 degree left tilting.Right curvature skin incision. Reflect skin flap anteriorly with facvial nerve preservation technique. Detach temporalis muscle downward. Craniotomy was made thereafter. The sphenoid ridge was drilled to make it flat and was followed by dural tenting. Straight dural opening along with the sylvian fissure was performed. Initially, the CSF was drained out by open arachnoid membrane at prechiasmatic cistern. And right ICA was further identified. The sylvian fissure was opened with the superficial sylvian vein left at temporal side. The aneurysm was identified. We applied first clip at the neck and remodeled aneurysm with cauterization. Then a seceond clip was applied distal to MCA. And the first clip was removed. Right temporal ICH was evacuated. After hemostasis, dura was closed with prolene.And Bone was fixed with miniplate. After one CWV drain insertion, wound was closed in layers. Operators P. 杜永光 Assistants 胡朝凱, 周聖哲 陳玥祺 (F,2000/04/11,11y11m) 手術日期 2010/09/13 手術主治醫師 廖漢文 手術區域 東址 000房 號 診斷 Moyamoya disease 器械術式 diagnostic angiography 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 王永彬 ASA 3 時間資訊 00:00 臨時手術NPO 08:30 麻醉開始 08:35 誘導結束 09:30 麻醉結束 09:48 進入恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 鄭進財 (M,1945/11/02,66y4m) 手術日期 2010/09/13 手術主治醫師 林至芃 手術區域 西址 034房 04號 診斷 Lung cancer 器械術式 Insertion of hichman or port a 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 林至芃 ASA 3 時間資訊 09:46 報到 12:10 進入手術室 12:15 麻醉開始 12:20 誘導結束 12:25 手術開始 12:50 手術結束 12:50 麻醉結束 12:55 送出病患 13:47 抗生素給藥 醫令資訊 類別 名稱 量 刀 側 手術 ｐｏｒｔ–Ａ導管植入術–治療性導管植入術 1 0 R 記錄__ 手術科部: 麻醉部 套用罐頭: Port-A implantation, subclavian 開立醫師: 林怡萱 開立時間: 2010/09/13 12:48 Pre-operative Diagnosis Lung cancer Post-operative Diagnosis Ditto Operative Method Port-A implantation, echo-guided Specimen Count And Types nil Pathology Nil Operative Findings 1.Site: right subclavian vein, with echo-guided procedure 2.Patent flow after implantation 3.Others: nil Operative Procedures 1.The patient was set on supine position and bilateral subclavian veins were checked by echo. 2.After IVGA and local anesthesia applied, transverse skin incision for 3cm was made at pre-cordial area. 3.Undermine the skin at the layer between subcutaneous tissue and deep fascia in lateral direction. 4.An IV catheter was inserted via the subclavian incision and negatively aspirated until venous blood attainable. 5.J-wire was inserted smoothly in rostral direction. A subclavian catheter with dilator was inserted through the J-wire, and the dilator was then removed. 6.The catheter of Port-A was threaded into the subclavian vein until mark 22 cm. The catheter was adapted into the port and locked with restrictor.The Port was inserted into the pouch of pre-cordial incision. 7.Skin was closed layer by layer. Both catheter and port were perfused with heparin solution after implantation. Operators 林至芃, Assistants 林怡萱, 張佰峰 (M,1967/02/18,45y0m) 手術日期 2010/09/14 手術主治醫師 黃勝堅 手術區域 東址 001房 04號 診斷 Contusion of face, scalp, and neck except eye(s) 器械術式 Craniotomy (A.V.M.) VS-TZENG 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 王永彬 ASA 4E 紀錄醫師 鍾文桂, 時間資訊 19:49 通知急診手術 20:30 報到 20:30 進入手術室 20:35 麻醉開始 20:45 誘導結束 20:56 開始輸血 21:00 抗生素給藥 21:39 手術開始 00:10 麻醉結束 00:10 手術結束 00:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 硬腦膜外血腫清除術 1 1 R 手術 顱內壓監視置入 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: Right decompressive frontotemporoparietal cra... 開立醫師: 王奐之 開立時間: 2010/09/15 00:29 Pre-operative Diagnosis Bilateral frontal contusional ICH and right parietal EDH Post-operative Diagnosis Ditto Operative Method Right decompressive frontotemporoparietal craniectomy & subdural ICP monitor insertion Specimen Count And Types Nil Pathology Nil Operative Findings Several fracture lines were noted at right frontotemporoparietal area, EDH noted at posterior temporoparietal region, no active bleeder was identified. Diffuse oozing of soft tissue was encountered. ICP monitor reference: 581 Initial ICP: 5~6 Operative Procedures After ETGA, the patient was placed in supine position with face turned to left. A curved skin incision was made as standard traumatic flap. After identifying the fracture lines, craniectomy was made to include the fractured skull. After dural tenting and evacuation of the epidural hematoma, a small dural incision was made to insert the subdural ICP monitor. Hemostasis was achieved. After setting an epidural CWV drain and resection of the temporalis muscle, the wound was closed in layers. Operators VS 黃勝堅 Assistants R5 鍾文桂, R3 王奐之, R1 施廷翰 Indication Of Emergent Operation 劉振麟 (M,1950/12/20,61y2m) 手術日期 2010/09/14 手術主治醫師 周迺寬 手術區域 東址 018房 03號 診斷 Disseminated malignant neoplasm 器械術式 Port-A catheter Removal/WOR 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 陳政維, 時間資訊 15:30 報到 15:35 進入手術室 15:50 麻醉開始 15:52 誘導結束 15:55 手術開始 15:55 麻醉結束 16:15 手術結束 16:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 肌肉或深部組織腫瘤切除術及異物取出術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: removal of Port-A/Permcath 開立醫師: 陳政維 開立時間: 2010/09/14 16:17 Pre-operative Diagnosis fever of Port-A Post-operative Diagnosis ditto Operative Method removal of Port-A catheter Specimen Count And Types Tip culture Pathology nil Operative Findings the catheter was removed totally and the course was smooth Operative Procedures The patient was put on supine position. The operation field was disinfected and draped as usual. Under local anesthesia, the Port-A catheter was removed from previous wound smoothly. The wound was irrigated and closed in layers. Post-op care plan: 1.wound CD QD+PRN 2.pain control with tinten 3.prophylatic antibiotics use Operators VS周迺寬 Assistants R3陳政維 高曉梅 (F,1954/02/14,58y1m) 手術日期 2010/09/14 手術主治醫師 曾勝弘 手術區域 東址 002房 01號 診斷 Malignant neoplasm of ascending colon 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 古恬音, 時間資訊 00:00 開始NPO 00:00 臨時手術NPO 07:00 通知急診手術 08:25 報到 08:42 進入手術室 08:45 抗生素給藥 08:46 麻醉開始 09:10 誘導結束 09:53 手術開始 12:10 抗生素給藥 12:25 麻醉結束 12:25 手術結束 12:35 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除－手術時間在４小時以內 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Left frontal craniotomy for tumor excision 開立醫師: 古恬音 開立時間: 2010/09/14 12:51 Pre-operative Diagnosis Colon cancer with brain metastasis Post-operative Diagnosis Colon cancer with brain metastasis Operative Method Left frontal craniotomy for tumor excision Specimen Count And Types 1 piece About size:2*2*2cm Source:left frontal lobe tumor Pathology Pending Operative Findings The tumor was yellow-grayish, well capsulated, hypovascular, and the consistency was firm. The size was about 2*2*2cm. Brain swelling was noted upon durotomy. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected with better iodine. One U-shaped scalp incision was made at left frontal area. A 5*8cm craniotomy was done after drilling of 4 burr holes. Durotomy was done in the U-shaped fashion with its base at the midline. The tumor was localized with intraoperative sonography. After periphral dissection from the surrounding brain tissue, the tumor was removed en bloc. Hemostasis was achieved with Surgicel lining of the tumor bed. We closed the dura with 4-o prolene and autologous fascia graft then fixed back the skull plate with wires. The wound was then closed in layers. Operators VS曾勝弘 Assistants R6陳睿生, R3古恬因 Indication Of Emergent Operation 李竹英 (F,1953/06/25,58y8m) 手術日期 2010/09/14 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Malignant neoplasm of cranial nerves 器械術式 C3-6 intramedullary tumor 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳德福, 時間資訊 00:00 臨時手術NPO 07:35 報到 08:00 進入手術室 08:10 麻醉開始 08:20 誘導結束 09:09 手術開始 09:55 抗生素給藥 11:55 抗生素給藥 14:50 麻醉結束 14:50 手術結束 15:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 手術 惡性病髓腫瘤切除術 1 1 摘要__ 手術科部: 外科部 套用罐頭: intramedullary tumor excision 開立醫師: 陳德福 開立時間: 2010/09/14 15:26 Pre-operative Diagnosis C3-6 intradural intramedullary tumor with syrinx formation, ependymoma Post-operative Diagnosis C3-6 intradural intramedullary tumor with syrinx formation, ependymoma Operative Method intramedullary tumor excision Specimen Count And Types 1 piece About size:3*1*1CM Source:cervical intramedullary tumor Pathology pending Operative Findings 1.The cervical spinal cord became enlarged and buldging out after C3-7 laminectomy. We approach the tumor via opening the cental raphy. There is a 3*1*1cm in sized greyish-reddish, soft, fragile, partial capsulated and adhesive intramedullary tumor at the C3-6 spinal cord with syrinx formation. The tumor mainly located at the right side of the spinal cord. 2.The intra-OP SSEP and MEP were performed. Decreased SSEP over right arm and MEP over right leg developed during the operation. The tumor was nearly total removed. Operative Procedures Under ETGA and prone position with Mayfield pin type head fixator fixation, the skin was disinfected and draped as usual. One linear incision along midline was done and the paraspinous muscle was displaced laterally. The spinous process of C2-7 was exposed and C3-7 laminectomy was performed. The dura was opening along midline and the pia was opened in midline. The tumor came into view and we dissect the plane between the tumor and normal tissue under microscopic surgery. The margin of the tumor was identified and the tumro was removed in cetral debulking fasion. While the upper and lower syrinx were exposed, the hemostasis was performed. The dura was closed in water tight fasion. One epidural CWV was left in situ. The wound was clsoed in layers. Operators P曾勝弘 Assistants R5陳德福 林聖傑 (M,2010/02/01,2y1m) 手術日期 2010/09/14 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Injury (severeity score >=16) 器械術式 SP shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 07:43 報到 08:05 進入手術室 08:15 麻醉開始 08:45 誘導結束 09:00 抗生素給藥 09:20 手術開始 10:20 手術結束 10:20 麻醉結束 10:50 送出病患 11:00 進入恢復室 12:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Right subduro-peritoneal shunt implantation 開立醫師: 李振豪 開立時間: 2010/09/14 10:53 Pre-operative Diagnosis Right subdural effusion Post-operative Diagnosis Right subdural effusion Operative Method Right subduro-peritoneal shunt implantation Specimen Count And Types 1 piece About size:3ml Source:subdural effusion Pathology Nil Operative Findings 1. The Metronic Barium impregnated ventricular and peritoneal catheter is used for subduro-peritoneal shunt. The subdural catheter is 4cm in length and the peritoneal catheter is 30cm in length. 2. The inner membrane and outer membrane were noted after opening of the dura. 2. The inner membrane and outer membrane was noted after opening of the dura. 3. The subdural effusion is brownish, clear in appearance. No increase turbidity or viscosity was noted. The subdural effusion is sent for routine, biochemistry, and bacterial culture. Operative Procedures Under endotracheal tube general anesthesia, the patient is put in supine position with head rotated to left. The scalp was shaved, scrubbed, and disinfected as usual. The linear skin incision was made along op scar with 3cm in length. The subcutanesou soft tissue and temporalis muscle was splitted to exposed previous burr hole. The Burr hole was extended with Rongeur and Kerrison punches. Two dural tenting was performed and the dura surface was coagulated with bipolar electrocautery. One transverse skin incision was made at right upper abdomen with 2.5cm in length. The subcutaneous soft tissue and rectus abdominis muscle was splitted to exposed the peritoneum. The peritoneal cavity was entered under direct vision and the peritoneal catheter was placed with 30cm in length. The subcutaneous tunnel was created from right upper abdomen, right chest, right neck, right retroauricular area to right parietal area and connected with scalp wound. The proximal part of peritoneal catehter was passed through the subcutaneous tunnel and connected with the ventricular catheter. The dura was opened in linear fashion and the edge of the dura was coagulated with bipolar electrocautery. The inner membrane was noted and opened. The ventricular catheter was then placed into subdural space. Three stat sutures were done for security of the shunt. Hemostasis was achieved and the wound was then closed in layers with 3-0 Vicryl and 4-0 Nylon. Operators AP郭夢菲 Assistants R4李振豪, Ri范遠耀 相關圖片 方伯為 (M,2010/05/19,1y9m) 手術日期 2010/09/14 手術主治醫師 郭夢菲 手術區域 兒醫 067房 02號 診斷 Craniosynostosis 器械術式 craniosynostosis 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 11:30 進入手術室 11:40 麻醉開始 12:00 抗生素給藥 12:45 誘導結束 13:08 手術開始 13:15 開始輸血 15:00 抗生素給藥 17:35 手術結束 17:35 麻醉結束 17:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱骨切除術，包括異物移除或減壓或神經切斷 1 1 B 手術 顱骨縫線早期封閉症手術－顱骨分割法 1 2 B 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: Cranial reconstruction 開立醫師: 李振豪 開立時間: 2010/09/14 18:23 Pre-operative Diagnosis Sagittal synostosis carniosynostosis due to Sagittal synostosis and partial synostosis of coronal and lambdoid sutures Post-operative Diagnosis Sagittal synostosis carniosynostosis due to Sagittal synostosis and partial synostosis of coronal and lambdoid sutures Operative Method Cranial reconstruction Cranial vault reconstruction Specimen Count And Types nil Pathology Nil Operative Findings The skull over posterior part of parietal bone and occipital area is egg-shell like with multiple small skull defect. Narrowing of bilateral parietal area, bilateral pterion, and bilateral retro-auricular area was noted with compression of bilateral hemisphere. Premature closure of sagittal suture and lumboid suture were founded and adhered with dura tightly. 1. the sagittal suture has been closed and has bone ridge formation. 2. The skull over posterior part of parietal bone and occipital area is egg-shell like with multiple small skull defects. 3. Narrowing of bilateral anterior parietal area, bilateral pterion, and bilateral retro-auricular area due to proximal coronal sutures and partial lambdoidal sutures was noted with compression of bilateral hemisphere. 4. Premature closure of sagittal suture and lumboid suture were founded and adhered with dura tightly. Operative Procedures Under endotracheal tube general anesthesia, the patient is put in prone position. The skin was shaved, scrubbed, and disinfected as usual. The Bicoronal-like smotth zigzag scalp incision was made at midpoint between anterior fontanelle and inion. The scalp was elevated toward anterior and posterior and the periosteum was dissected after T-shape incision. Bilateral arietal craniectomy was performed for decompression. The sagittal suture was preserve and reshaped for its bone ridge formation. Many osteotomy with high-speed air-drived drill, Kerrison punches, Rongeur, and scissor was done to the removed parietal bone plates, temporal bones (barrel stave osteotomy), and coronal and lambdoidal sutures for cranial reconstruction. The parietal bone plates was grooving with high speed drill in multiple longitudinal ways to reshape it original bizzar shape and fixed back with 3-0 Vicryl in a floating way for cranial reconstruction. Hemostasis was achieved and one subgaleal CWV drain was placed. The wound was then closed in layers with 3-0 Vicryl and 4-0 Nylon. Under endotracheal tube general anesthesia, the patient is put in prone position. The skin was shaved, scrubbed, and disinfected as usual. The Bicoronal-like scalp incision was made at midpoint between anterior fontanelle and inion. The scalp was elevated and the periosteum was dissected after T-shape incision. Bilateral fronto-temporo-parietal craniectomy was performed for decompression and much osteotomy with high-speed air-drived drill, Kerrison punches, Rongeur, and scissor was done for cranial reconstruction. The osteotomy also performed at resected paramedian vault and fixed back with 3-0 Vicryl for cranial reconstruction. Hemostasis was achieved and one subgaleal CWV drain was placed. The wound was then closed in layers with 3-0 Vicryl and 4-0 Nylon. Under endotracheal tube general anesthesia, the patient is put in prone position. The skin was shaved, scrubbed, and disinfected as usual. The Bicoronal-like scalp incision was made at midpoint between anterior fontanelle and inion. The scalp was elevated and the periosteum was dissected after T-shape incision. Bilateral fronto-temporo-parietal craniectomy was performed for decompression and much osteotomy with high-speed air-drived drill, Kerrison punches, Rongeur, and scissor was done for cranial reconstruction. The osteotomy also performed at resected paramedian vault and fixed back with 3-0 Vicryl for cranial reconstruction. Hemostasis was achieved and one subgaleal CWV drain was placed. The wound was then closed in layers with 3-0 Vicryl and 4-0 Nylon. Operators AP郭夢菲 Assistants R4李振豪, Ri范遠耀 相關圖片 徐銘夆 (M,1982/12/05,29y3m) 手術日期 2010/09/14 手術主治醫師 林峰盛 手術區域 西址 035房 05號 診斷 Neuralgia 器械術式 Nerve block / PC 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 林峰盛 ASA 2 時間資訊 14:20 報到 15:05 進入手術室 15:10 麻醉開始 15:15 誘導結束 15:20 手術開始 16:05 麻醉結束 16:05 手術結束 16:23 送出病患 記錄__ 手術科部: 麻醉部 套用罐頭: LENB 開立醫師: 林怡萱 開立時間: 2010/09/14 16:24 Pre-operative Diagnosis Perineal pain, r/o pudendal neuralgia Post-operative Diagnosis Perineal pain, r/o pudendal neuralgia Operative Method echo-guided pudendal nerve block Specimen Count And Types nil Pathology Nil Operative Findings Operative Procedures LA with 1% xylocaine 5 ml pt in prone position Under fluoroscopic-guidance, pudendal nerve block were done to bil ischial spine level with 21G spinal needle 0.5% Marcaine 10ml Operators 林峰盛, Assistants 林怡萱, 曾清村 (M,1957/10/23,54y4m) 手術日期 2010/09/14 手術主治醫師 賴達明 手術區域 東址 012房 04號 診斷 HIVD 器械術式 Wound treatment-- >10cm 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 古恬音, 時間資訊 00:00 臨時手術NPO 14:55 報到 15:00 進入手術室 15:05 麻醉開始 15:10 誘導結束 15:18 抗生素給藥 15:33 手術開始 16:00 手術結束 16:00 麻醉結束 16:12 送出病患 16:17 進入恢復室 17:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 深部複雜創傷處理－傷口長５－１０公分者 1 0 摘要__ 手術科部: 外科部 套用罐頭: Debridement 開立醫師: 古恬音 開立時間: 2010/09/14 16:16 Pre-operative Diagnosis Wound infection Post-operative Diagnosis Wound infection Operative Method Debridement Specimen Count And Types 1 piece About size:swabs*3 Source:discharge Pathology Nil Operative Findings The pus formation was confined to the epidermal level. The subcutaneous tissue appeared healthy. Operative Procedures 1. ETGA, prone position 2. The skin was scrubbed with better iodine 3. Disinfection and draping was done in the usual sterile fashion 4. Wound incision along the previous operation scarr 5. Debridement was done with currette 6. Irrigation with normal saline about 700mL 7. Hemostasis 8. Wound closure in layers Operators VS賴達明 Assistants R3古恬音 R1傅劭懷 陳文昌 (M,1947/02/01,65y1m) 手術日期 2010/09/14 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Cervical Spondylosis 器械術式 C4/5, 5/6 ACDF + plating 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:00 進入手術室 08:05 麻醉開始 08:20 誘導結束 08:57 抗生素給藥 09:17 手術開始 11:52 抗生素給藥 14:20 手術結束 14:20 麻醉結束 14:30 送出病患 14:31 進入恢復室 16:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 手術 椎間盤切除術－頸椎 1 1 手術 脊椎融合術－前融合，有固定物（＜＝四節） 1 2 記錄__ 手術科部: 外科部 套用罐頭: 1. Diskectomy, C4/5/6,right anterior approach. 開立醫師: 鍾文桂 開立時間: 2010/09/14 14:05 Pre-operative Diagnosis Herniated intervertebral disc and stenosis, C4/5/6. Post-operative Diagnosis Herniated intervertebral disc and stenosis, C4/5/6. Operative Method 1. Diskectomy, C4/5/6,right anterior approach. 2. Interbody fusion with autologous bone graft and internal fixation with plate and screws. Specimen Count And Types nil Pathology Nil. Operative Findings 1. Ruptured disc at C5/6, and herniated disc at C4/5. 2. Spur formation at C4/5/6 level. 3. 1 Plate: 37mm, 6 screws: 4.0x16. 4. Autologous bone graft harvested from right anterior superior iliac spine. Operative Procedures Under ETGA, the patient was placed in supine position and the head was in midline. After disinfection and draping, a horizontal incision was made at right anterior neck. Further dissection was made to reach the prevertebral space. Localization of C4/5 disc level was ensured by intraoperative fluoroscopy. Then, seperaters were set up to retract the esophagus, trachea, and carotid sheath away. Diskectomy of C4/5 and C5/6 were done smoothly. The spur were removed by high speed cutting burr. The autologous bone graft for interbody fusion was harvested from right anterior superior iliac spine. The graft was placed at C3/4,C4/5 interspaces. The plate and screws were implanted and their location was checked by intraoperative fluoroscopy. After placing one prevertebral mini-hemovac drain, the wound was closed in layers. Operators V.S. 賴達明 Assistants R5 鍾文桂 R1李柏穎 鄒曾月燕 (F,1934/09/23,77y5m) 手術日期 2010/09/14 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Thoracic spine (T-spine) fracture 器械術式 T10, 11, L2 TPS 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 14:40 進入手術室 14:41 報到 14:45 麻醉開始 15:00 誘導結束 15:20 抗生素給藥 16:05 手術開始 19:35 手術結束 19:35 麻醉結束 19:45 送出病患 19:48 進入恢復室 21:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術－後融合，有固定物（每增加＜＝六節） 1 1 手術 椎弓切除術（特壓）－二節以內 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 記錄__ 手術科部: 外科部 套用罐頭: 1. Internal fixation with transpedical screws... 開立醫師: 鍾文桂 開立時間: 2010/09/14 19:53 Pre-operative Diagnosis L1 compression fracture. Post-operative Diagnosis L1 compression fracture. Operative Method 1. Internal fixation with transpedical screws at T11,T12, and L2. 2. Decompresive laminectomy, L1. 3. Posterolateral fusion with autologous bone, T11-L2. Specimen Count And Types nil Pathology Nil. Operative Findings Compressed spinal cord by the L1 compression. Bilateral transpedical screws: T11/12: 6.2x35; L2: 6.2x40 Rods: 10cm,right; 11cm,left. One cross link. Intraoperative reduction for compression fracture. Operative Procedures Under ETGA, the patient was placed in prone position. Intraoperative localization of L1 compression fracture was done by fluoroscope. After disinfection and draping, midline incision and paraspinal dissection were made from T11 to L2 level. The transpedical screws were implanted at T11,T12, and L2 levels. Then, L1 laminectomy was done. The internal fixation apparatus was completed with rods and interlink. The posterolateral fusion was achieved by placing autologous bone graft after decortication. The wound was closed in layers after placing one 1/8 hemovac. Operators V.S. 賴達明 Assistants R5鍾文桂 R1李柏穎 高李淑貞 (F,1936/08/15,75y6m) 手術日期 2010/09/14 手術主治醫師 賴達明 手術區域 東址 005房 02號 診斷 Cervical Spondylosis 器械術式 C7-T1 diskectomy + plating 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳德福, 時間資訊 00:00 臨時手術NPO 15:00 報到 15:20 進入手術室 15:28 麻醉開始 15:40 誘導結束 15:50 抗生素給藥 16:16 手術開始 18:50 抗生素給藥 19:10 手術結束 19:10 麻醉結束 19:15 送出病患 19:20 進入恢復室 20:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術－頸椎 1 1 手術 脊椎融合術－前融合，有固定物（每增加＜＝四節） 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: C7-T1 ACDF with cage and plate 開立醫師: 陳德福 開立時間: 2010/09/14 19:12 Pre-operative Diagnosis C7-T1 spondylosis and spondylolisthesis Post-operative Diagnosis C7-T1 spondylosis and spondylolisthesis Operative Method C7-T1 ACDF with cage and plate Specimen Count And Types nil Pathology nil Operative Findings 1.There is herniated disc and spondylolisthesis with moderate osterphytes formation at the C7-T1 level. The bilateral nerve foramina were stenotic and the osteophytes was removed for decompression the nerve roots and spinal cord. 2.The C7-T1 disc was removed and one No#6 cervical cage was implanated at the C7-T1 level smoothly. A 1.8cm in sized plate with 4 [16mm]screws was implatated over the anterior body between C7-T1. Operative Procedures Under ETGA and supine position with neck hyperextension, the skin was disinfected and draped as usual. One linear incision along the skin crease on the left anterior neck was done and the platysma was transected. The areolar plane between the anterior catotid sheath and the cervical muscle was identified. The prevertebral space of C7-T1 was found and we check the location under flouroscope. The longus coli muscle was mildly detached and we set Caspar retractor to expose the anterior C7-T1 space. The ALL was opened and the C7-T1 disc was removed by curretage and aligator. The osteophyte was removed by air-drill and Kerrison. The PLL was opened the expose the dura. The bilateral nerve foramina was decompressed and the thecal sac reexpanded well. One No#6 cervical cage was inserted in the C7-T1 space anteriorly. A 1.8cm in sized plate with 4 [16mm]screws was implatated over the anterior body between C7-T1. One minihemovac was left in situ. After hemostasis, the wound was closed in layers. Operators VS 賴達明 Assistants R5 陳德福 相關圖片 朱戴雪花 (F,1937/03/11,75y0m) 手術日期 2010/09/14 手術主治醫師 林峰盛 手術區域 西址 035房 06號 診斷 Lumbar spondylosis 器械術式 Nerve block / PC 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 硬肌麻醉 麻醉主治醫師 林峰盛 ASA 2 時間資訊 16:25 進入手術室 16:30 麻醉開始 16:35 誘導結束 16:37 手術開始 16:50 手術結束 16:50 麻醉結束 17:00 送出病患 記錄__ 手術科部: 麻醉部 套用罐頭: LENB 開立醫師: 林怡萱 開立時間: 2010/09/14 16:56 Pre-operative Diagnosis 1.Sciatica 2. radiculopathy Post-operative Diagnosis 1. sciatica 2. radiculopathy Operative Method LA with 1% xylocaine 5 ml pt in prone position 3. Under fluoroscopic-guiddance, LENB was done to L5-S1 level with 16G Tuohy needle, 60mg Kenaocrt in 0.5% xylocaine 10ml Specimen Count And Types nil Pathology Nil Operative Findings Operative Procedures LENB Operators 林峰盛, Assistants 林怡萱, 王克書 (M,1965/04/25,46y10m) 手術日期 2010/09/14 手術主治醫師 詹志洋 手術區域 東址 018房 05號 診斷 顱內出血(ICH) 器械術式 AVG Embolectomy, Thrombectomy 手術類別 緊急手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 王永彬 ASA 3E 紀錄醫師 黃俊銘, 時間資訊 16:26 臨時手術NPO 16:26 開始NPO 16:27 通知急診手術 18:35 進入手術室 18:40 麻醉開始 18:55 誘導結束 19:00 手術開始 20:10 手術結束 20:10 麻醉結束 20:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 手術 靜脈血栓切除術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Open thrombectomy 開立醫師: 黃俊銘 開立時間: 2010/09/14 20:32 Pre-operative Diagnosis AVG dysfunction Post-operative Diagnosis AVG thrombosis Operative Method Open thrombectomy Specimen Count And Types 1 piece About size:3*3cm Source:Thrombus in AVG Pathology Pending Operative Findings Much fresh thrombus in AVG, removed with Fr.4 Fogarty balloon catheter Suspect drainage vein stenosis around shoulder Post-OP thrill(+), bruit(+)s Operative Procedures ETGA, supine Skin disinfect, draping Incision over left upper arm Dissect AVG, control proximal and distal Incision over AVG transversely Remove thrombus with Fr.4 Fogarty balloon catheter Repair AVG Hemostasis Wound close in layers Operators 詹志洋 Assistants 周恆文 黃俊銘 Indication Of Emergent Operation 李子良 (M,1966/07/04,45y8m) 手術日期 2010/09/15 手術主治醫師 李崇維 手術區域 東址 000房 號 診斷 器械術式 for brain MRI, brain tumor s/p OP, post OP f/u 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 林子富 ASA 3 時間資訊 08:35 麻醉開始 08:37 誘導結束 09:00 麻醉結束 09:10 進入恢復室 10:25 離開恢復室 許達昕 (M,1966/01/07,46y2m) 手術日期 2010/09/15 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Brain Tumor 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:07 進入手術室 08:10 麻醉開始 08:40 誘導結束 08:50 抗生素給藥 09:00 手術開始 11:50 抗生素給藥 13:46 開始輸血 14:50 抗生素給藥 17:50 抗生素給藥 19:05 麻醉結束 19:05 手術結束 19:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 14 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: Right presigmoid approach for total tumor removal 開立醫師: 王奐之 開立時間: 2010/09/15 20:04 Pre-operative Diagnosis Right cerebellopontine angle epidermoid cyst Post-operative Diagnosis Right cerebellopontine angle epidermoid cyst Operative Method Right presigmoid approach for total tumor removal Specimen Count And Types 1 piece About size:pieces Source:right CP angle tumor Pathology Pending Operative Findings Prominent mastoid air cells were noted. Prominent right side sigmoid sinus and vein of Labbe. The tumor was grey-whitish, fragile and soft in consistency, located at cisternal spaces, more on the right side. CN IV and V were pushed upwardly, CN VI was pushed medially, CN VII & VIII were pushed laterally and low cranial nerves were pushed inferiorly; all nerves were well preserved. Operative Procedures After ETGA, the patient was placed in supine position with face turned to left and head fixed with Mayfield skull clamp. A curved retroauricular skin incision was made, followed by fascia harvesting. The incision was then deepened through muscle layer until bony structures exposed. 1 burr hole was made at asterion, another above the sigmoid sinus. Retrosigmoid & subtemporal craniotomy were performed. Mastoid process was then drilled in between the inner and outer tables, until arcuate eminence and endolymphatic ducts were exposed. The outer table was then cut off. 2 durotomies were made at temporal base and presigmoid area. The tentorium was slowly cut through after ligation of superior petrosal sinus, CN IV was carefully identified at tentorial edge. The tumor was then noted in between the cranial nerves (CN IV~XI) and cisternal spaces, and was removed in piecemeal fashion by tumor forceps, ring currete and CUSA. After meticulous hemostasis, the dura was closed in water-tight fashion. The bones were fixed back with miniplates. After setting a subgaleal CWV drain, the wound was closed in layers. Operators P 杜永光 Assistants R6 陳睿生, R3 王奐之 相關圖片 李秀玫 (F,1980/06/21,31y8m) 手術日期 2010/09/15 手術主治醫師 曾漢民 手術區域 東址 005房 04號 診斷 Pituitary tumor 器械術式 TSH 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 胡朝凱, 時間資訊 00:00 臨時手術NPO 14:35 報到 14:53 進入手術室 14:58 麻醉開始 15:20 誘導結束 15:50 抗生素給藥 15:53 手術開始 16:55 手術結束 16:58 麻醉結束 17:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經由蝶竇之腦下垂體瘤切除 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 記錄__ 手術科部: 外科部 套用罐頭: Endoscopic transsphenoid adenomectomy 開立醫師: 周聖哲 開立時間: 2010/09/15 17:25 Pre-operative Diagnosis Pituitary microadenoma, suspect prolactinoma Post-operative Diagnosis Pituitary microadenoma, suspect prolactinoma Operative Method Transsphenoidal adenomectomy Specimen Count And Types 1 piece About size:0.8cm Source:pituitary tumor Pathology Pending Operative Findings 1. The tumor was yellowish, firm, size 0.8 cm in diameter. The normal gland dropped after tumor excision. CSF leakage was sealed with Tissuecol Duo and gelform packing. 2. A small rupture of arachnoid membran was noted after tumor removal and was sealed with Tissuecol Duo Operative Procedures Under general anethesia and intubation, the patient was put in supine position. The facial skin was antiseptic with alcohol, and the mucosa of oral and nasal cavity with aqueous better-iodine. The face was covered with sterilized adhesive plastic sheets then draped. Under microscope, nasal septum was incised, and a nasal speculum was applied to displace the nasal mucosa laterally and keep the nasal cavity open constantly for the exposure of the vomer bone and the anterior wall of the sphenoid sinus. The anterior sphenoid wall, sphenoid sinus mucosa and sella floor were removed. The dura was coagulated then opened in cruciate fashion. The tumor was removed by curette and aligator. The CSF leakage was sealed with Tissuecol Duo and gelform packing. The bone of anterior sphenoid wall was placed back and the nasal mucosa was returned to its normal position. The nasal mucosa was sealed with Tissuecol Duo. Operators 曾漢民 Assistants 胡朝凱 楊東霖 (M,1968/06/07,43y9m) 手術日期 2010/09/15 手術主治醫師 蔡瑞章 手術區域 東址 005房 01號 診斷 Brain tumor 器械術式 tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 古恬音, 時間資訊 09:41 臨時手術NPO 08:15 進入手術室 08:20 麻醉開始 08:22 誘導結束 08:50 手術開始 09:05 手術結束 09:05 麻醉結束 09:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 氣管切開造口術 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 古恬音 開立時間: 2010/09/15 09:16 Pre-operative Diagnosis Vocal cord palsy Post-operative Diagnosis VOcal cord palsy Operative Method Tracheostomy Specimen Count And Types Nil Pathology None Operative Findings Fr. 8 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators P蔡瑞章 Assistants R6胡朝凱 R3古恬音 陳玥祺 (F,2000/04/11,11y11m) 手術日期 2010/09/15 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Moyamoya disease 器械術式 Moyamoya disease for left side EDAS 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 李振豪, 時間資訊 09:48 進入恢復室 11:05 離開恢復室 00:00 臨時手術NPO 07:55 報到 08:09 進入手術室 08:15 麻醉開始 08:30 誘導結束 09:04 抗生素給藥 09:37 手術開始 12:04 抗生素給藥 13:15 麻醉結束 13:15 手術結束 13:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱內外血管吻合術 1 1 L 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Encephaloduroarteriosynangiosis, left 開立醫師: 李振豪 開立時間: 2010/09/15 15:23 Pre-operative Diagnosis Moyamoya disease, status post right indirect bypass surgery Post-operative Diagnosis Moyamoya disease, status post right indirect bypass surgery Operative Method Encephaloduroarteriosynangiosis, left Specimen Count And Types nil Pathology Nil Operative Findings The parietal branch of the left superficial temporal artery was chosen for the synangiosis. Operative Procedures Under ETGA, the patient was put in supine position. The head was tilted to the right. After shaving, the tract of the right superficial temporal artery and its branches were outlined by tracing through Doppler. After disinfection and draping, the L-shape scalp incision was done. The parietal branch of the left superficial temporal artery and its pedicle graft were lysed from the surroundong soft tissue under microscope for about 1.5cm in width and 8 cm in length. The temporalis muscle below was dissected. A 4-cm craniotomy (6 cm including the burr holes) was created with high speed drill. After dural tenting the dura was opened. Lysis of the arachnoid membrane surrounding the branch of MCA was done under microscopic view. The arterial pedicle was anchored to the four cornors of the dural opening to let the pedicle lying loosely lying on the brain surface. The temporalis muscle below was dissected. A 4-cm craniotomy (6 cm including the burr holes) was created with high speed drill. After dural tenting the dura was opened. Lysis of the arachnoid membrane surrounding the branch of MCA was done under microscopic view. The arterial pedicle was anchored to the four cornors of the dural opening to let the pedicle lying loosely lying on the brain surface. The pedicle had good contact with the exposed MCA branches at the anterior part of the opening window. The dura was then closed continuously with 5-0 Prolene. A 3x1 inches DuraForm was tailored and placed above and below the dura mater. The bone plate was fixed with 4 wires with a central tenting. The wound was closed in layers with 3-0 Vicryl and 4-0 Nylon. Operators AP郭夢菲 Assistants R4李振豪, Ri范遠耀 相關圖片 洪翌洧 (M,2010/06/13,1y9m) 手術日期 2010/09/15 手術主治醫師 郭夢菲 手術區域 兒醫 068房 02號 診斷 先天性心臟病 器械術式 Right subduro-peritoneal shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 12:18 進入手術室 12:18 報到 12:25 麻醉開始 12:45 誘導結束 13:00 抗生素給藥 13:27 手術開始 14:45 麻醉結束 14:45 手術結束 14:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 記錄__ 手術科部: 套用罐頭: Right subduroperitoneal shunt implantation 開立醫師: 李振豪 開立時間: 2010/09/15 15:12 Pre-operative Diagnosis Bilateral subdural effusion Post-operative Diagnosis Bilateral subdural effusion Operative Method Right subduroperitoneal shunt implantation Specimen Count And Types 1 piece About size:8ml Source:subdural effusion Pathology Nil Operative Findings The brownish CSF gushed out after dura opening. The opening pressure is about 10cmH2O. The CSF was sent for routine, biochemistry, and bacterial culture study. The ventricular catheter is about 4cm in length and the peritoneal catheter is 25cm in length. The brownish CSF gushed out after dura opening. The opening pressure is more than 10cmH2O. The CSF was sent for routine, biochemistry, and bacterial culture study. The ventricular catheter is about 4cm in length and the peritoneal catheter is 25cm in length. Operative Procedures Under endotracheal tube general anesthesia, the patient is put in supine position with head rotated to left. The scalp was shaved, scrubbed, and disinfected as usual. One vertical linear scalp incision was made at right parietotemporal area. The subcutaneous soft tissue and temporalis muscle was splitted to exposure the skull. One small burr hole was created followed by two dural tenting. One transverse linear skin incision was made at right upper abdomen and the subcutaneous fat, rectus abdominis muscle, and peritoneum was splitted in order to enter the peritoneal cavity. One subcutaneous tunnel was created from right upper abdomen, right lateral chest, right neck, right retroauricular area, to right scalp wound. The distal part of peritoneal catheter was placed into peritoneal cavity and the proximal part of peritoneal catheter was passed through the subcutaneous tunnel. The Peritoneal catheter is then connected to ventricular catheter. The dura was opened the subdural effusion gushed out. After release the pressure, the ventricular catheter is placed into subdural space. Three anchoring sutures were performed to secure the location of the shunt. Hemostasis was achieved and the wound was then closed in layers. with 4-0 Vicryl and 5-0 Nylon. Operators AP郭夢菲 Assistants R4李振豪 相關圖片 陳子文 (M,1934/01/13,78y2m) 手術日期 2010/09/15 手術主治醫師 賴達明 手術區域 東址 005房 02號 診斷 Cerebral hemorrhage 器械術式 External ventricular drainage + tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 古恬音, 時間資訊 00:00 臨時手術NPO 09:40 進入手術室 09:43 麻醉開始 09:45 誘導結束 10:15 手術開始 11:30 11:50 麻醉結束 11:50 手術結束 11:55 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室體外引流 1 1 手術 氣管切開造口術 1 0 摘要__ 手術科部: 外科部 套用罐頭: External ventricular drainage, right Kocher point 開立醫師: 古恬音 開立時間: 2010/09/15 11:18 Pre-operative Diagnosis Cerebellar hemorrhage with hydrocephalus Post-operative Diagnosis Cerebellar hemorrhage with hydrocephalus Operative Method External ventricular drainage, right Kocher point Specimen Count And Types 1 piece About size:CSF*10mL Source:CSF Pathology Nil Operative Findings The CSF opening pressure was high, about 13cmH2O. CSF with blood stain was drained out. Operative Procedures 1. ETGA, supine position 2. The scalp was shaved and scrubbed with better iodine 3. Disinfection and draping was done as usual 4. Make a linear skin incision at right Kocher point 5. Make a burr hole 6. Insert the ventricular catheter after successful ventricular puncture 7. Connect the EVD system and close the wound in layers Operators VS賴達明 Assistants R6胡朝凱,R3古恬音 記錄__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 蔡立威 開立時間: 2010/09/15 12:02 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types nil Pathology None Operative Findings Fr . 8 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators 李章銘 Assistants R3鄒冠全, Ri 吳語彤 (F,1977/07/07,34y8m) 手術日期 2010/09/16 手術主治醫師 李崇維 手術區域 東址 000房 號 診斷 Carotid body tumor 器械術式 NEURO T.A.E 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 2 時間資訊 13:00 麻醉開始 13:10 誘導結束 16:05 麻醉結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 陳素秋 (F,1962/08/04,49y7m) 手術日期 2010/09/16 手術主治醫師 陳敞牧 手術區域 東址 005房 04號 診斷 Sciatica 器械術式 L4/5 HIVD 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳德福, 時間資訊 00:00 臨時手術NPO 16:45 進入手術室 16:50 麻醉開始 16:55 誘導結束 17:05 抗生素給藥 17:29 手術開始 18:38 手術結束 18:38 麻醉結束 18:48 送出病患 18:54 進入恢復室 20:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術－腰椎 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: microscopic lumbar diskectomy 開立醫師: 陳德福 開立時間: 2010/09/16 18:46 Pre-operative Diagnosis HIVD L4-5, left predominent with ruptured disc Post-operative Diagnosis HIVD L4-5, left predominent with ruptured disc Operative Method microscopic lumbar diskectomy Specimen Count And Types nil Pathology nil Operative Findings There is a ruptured disc with left L5 nerve root compression at the L4-5 disc space. The protruding disc was removed and the nerve became redundent. There is a ruptured disc with left L5 nerve root compression at the L4-5 disc space. The disc migrated upward and laterally. The protruding disc was removed and the nerve became redundent. Operative Procedures Under ETGA and prone position, the skin was disinfected and draped as usual. The L4-5 disc space was identified under C-arm fluroscope. One linear incision at midline was done and the left paraspinous muscle was displaced laterally. The partial L4-5 laminectomy was done and the ligamentum flavum was removed. The protruding disc was identified and removed by alligator, currettege, and disc clamp assisted. The wound was then closed in layers. Operators vs 陳敞牧 Assistants R5 陳德福 相關圖片 劉銀河 (M,1951/10/11,60y5m) 手術日期 2010/09/16 手術主治醫師 陳敞牧 手術區域 東址 005房 02號 診斷 For certification 器械術式 TSH 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳德福, 時間資訊 00:00 臨時手術NPO 11:00 報到 11:32 進入手術室 11:35 麻醉開始 12:05 誘導結束 12:15 抗生素給藥 12:50 手術開始 15:20 麻醉結束 15:20 手術結束 15:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經由蝶竇之腦下垂體瘤切除 1 1 手術 鼻中膈鼻道成形術－單側 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Endoscopic transsphenoid adenomectomy 開立醫師: 陳德福 開立時間: 2010/09/16 15:48 Pre-operative Diagnosis Pituitary macroadenoma with apoplexy Post-operative Diagnosis Pituitary macroadenoma with apoplexy Operative Method Endoscopic transsphnoid adenomectomy Specimen Count And Types 1 piece About size:1*1*1CM Source:pituitary tumor Pathology Pending Operative Findings 1.The tumor was yellowish, soft, size 1.2cm in diameter. The normal gland was found after tumor excision. 2.Previous hematoma was found and removed. Operative Procedures Under general anethesia and intubation, the patient was put in supine position with head tilted 30 degree to left. The facial skin was antiseptic with alcohol better-iodine tincture, and the mucosa of oral and nasal cavity with aqueous better-iodine . The former areas were covered by sterilized adhesive plastic sheets then draped. Under endoscope, the nasal mucosa was coagulated at right norstril. A nasal speculum was applied to displace the nasal mucosa laterally and keep thenasal cavity open constantly for the exposure of the vomer bone and the anterior wall of the sphenoid sinus. The anterior sphenoid wall and posterior sphenoid wall was removed by high speed air drill and Kerrison punch. The sellar floor durawas coagulated then opened in cruciate fashion. The soft tumor parenchyma was removed by curette and aligator. The CSF leakage was sealed with gelform packing. The arachnoid and the opening of diaphragm sellae was enforcedby packing with gelform as in the sellar cavity. The nasal mucosa returned to its normal position. Both of the nasal cavities was tightly packed with a segment of Merosal filled with vaseline gauze strips which had been soaked with better-iodine ointment. Operators VS 陳敞牧 Assistants R5 陳德福 盧元盛 (M,1941/09/15,70y5m) 手術日期 2010/09/16 手術主治醫師 蕭輔仁 手術區域 東址 001房 02號 診斷 Subdural hemorrhage or effusion 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 古恬音, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 07:45 通知急診手術 08:30 報到 08:40 進入手術室 08:45 麻醉開始 08:50 誘導結束 08:56 抗生素給藥 09:21 手術開始 10:35 手術結束 10:35 麻醉結束 10:42 進入恢復室 10:45 送出病患 11:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 慢性硬腦膜下血腫清除術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Burr hole for chronic Subdural Hematoma drainage 開立醫師: 古恬音 開立時間: 2010/09/16 10:50 Pre-operative Diagnosis Right side chronic subdural hematoma Post-operative Diagnosis Right side chronic subdural hematoma Operative Method Burr hole for chronic Subdural Hematoma drainage Specimen Count And Types nil Pathology Nil Operative Findings Motor oil-like substance gushed out upon durotomy, and the brain was slack. Outer membrane was noted. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position. The scalp was shaved, scrubbed, and disinfected with better iodine. One linear scalp incision was made at right frontal area, followed by one burr hole. We opened the dura and the outer membrane of the subdural hematoma. One rubber drain was inserted for irrigation. We performed irrigation until the drainage substance became clear. We left the rubber drain in subdural space after deair. Then the wound was closed in layers. Operators VS蕭輔仁 Assistants R4李振豪,R3古恬音,Ri葉佳衢 Indication Of Emergent Operation 周映輝 (M,1931/12/05,80y3m) 手術日期 2010/09/16 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 CVA 器械術式 cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 古恬音, 時間資訊 00:00 臨時手術NPO 12:30 報到 13:05 進入手術室 13:10 麻醉開始 13:20 誘導結束 13:30 抗生素給藥 13:45 手術開始 15:10 手術結束 15:10 麻醉結束 15:15 送出病患 15:20 進入恢復室 17:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 頭顱成形術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Cranioplasty 開立醫師: 古恬音 開立時間: 2010/09/16 15:00 Pre-operative Diagnosis Right MCA infarction, status post craniectomy Post-operative Diagnosis Right MCA infarction, status post craniectomy Operative Method Cranioplasty Specimen Count And Types Nil Pathology Nil Operative Findings The cranial defect was about 15*13cm. The craniectomy window was slack. Moderate adhesion was noted at the craniectomy window. Incidental durotomy was noted during dissection. Operative Procedures 1. ETGA, supine position with head turned to left 2. The scalp was shaved, scrubbed, and disinfected with better iodine 3. Draping was done in sterile fashion 4. Scalp incision was done along the previous operation scar 5. Dissect the scalp flap from the underneath brain 6. Fix back the skull flap with miniplates and screws 7. Set up one subgaleal CWV drain 8. Wound closure in layers Operators VS王國川 Assistants R3古恬音 R1傅紹懷 陳俐伶 (F,1984/09/10,27y6m) 手術日期 2010/09/16 手術主治醫師 蔡翊新 手術區域 東址 005房 01號 診斷 Subarachnoid hemorrhage 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳德福, 時間資訊 00:00 臨時手術NPO 08:16 進入手術室 08:16 報到 08:20 麻醉開始 08:25 誘導結束 09:20 抗生素給藥 09:23 手術開始 11:00 麻醉結束 11:00 手術結束 11:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 2 R 手術 腦室腹腔分流手術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 外科部 套用罐頭: 1.Removal of subdural hematoma 2.right fronta... 開立醫師: 陳德福 開立時間: 2010/09/16 11:16 Pre-operative Diagnosis Hydrocephalus and right subacute subdural hematoma Post-operative Diagnosis Hydrocephalus and right subacute subdural hematoma Operative Method 1.Removal of subdural hematoma 2.right frontal VPS Specimen Count And Types 1 piece About size:5ML Source:CSF Pathology nil Operative Findings 1.There is subacute subdural hematoma over the right frontal-temporal-parietal area. The liquified subdural hematoma is motor-oil like. The outer membrane is present without formation of inner membrane. The brain reexpanded well after the removal of subdural hematoma. 2.The ventricular opening pressure is about 15cm with clear and colorless CSF drainage. The intraventricualr catheter:7.0cm and intraperitoneal catheter: 25cm. One programmable valve [Codman, 130mmH2O] was implanted at the right Kocher point. Operative Procedures Under ETGA and supine position, the skin was disinfected and draped as usual. One linear incison on the right frontal area was done followed by burr hole creation. The dura tenting was done and the outer membrane was opened. The motor oil like fluid gushed out spontaneously and irrigation of the subdural space with copious normal saline was performed. the wound was then closed in layers. Another linear incision on right Kocher point was done followed by burr hole creation. One minilaparotomy on right upper abdomen was performed and the subcutaneous tunneling is done. Ventricular tapping is performed and we connect the shunt system. The function of valve is checked and the wound was closed in layers. Operators vs 蔡翊新 Assistants R5 陳德福 余廖碧蘭 (F,1938/05/10,73y10m) 手術日期 2010/09/16 手術主治醫師 王國川 手術區域 東址 003房 03號 診斷 Major trauma rated 16 or above on the severeity scale ( Injury severeity score >=16 ) 器械術式 Craniotomy (A.V.M.) VS-TZENG 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 4E 紀錄醫師 傅紹懷, 時間資訊 14:48 通知急診手術 15:45 進入手術室 15:50 麻醉開始 16:00 誘導結束 16:05 抗生素給藥 16:05 手術開始 16:55 開始輸血 19:15 手術結束 19:15 麻醉結束 19:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Suboccipital craniectomy and hematoma evacuation 開立醫師: 胡朝凱 開立時間: 2010/09/16 19:27 Pre-operative Diagnosis left cerebellar traumatic ICH and SDH Post-operative Diagnosis left cerebellar traumatic ICH and SDH Operative Method Suboccipital craniectomy and hematoma evacuation Specimen Count And Types nil Pathology nil Operative Findings 1.About 15 ml SDH and ICH located at left cerebellar area was noted with brain contusion. Epidural bleeding was also noted. 2.The dura adhesion to bone severely. 3.After hematoma removal, the brain became slack 4.Duroplasty was done with durofoam Operative Procedures 1.ETGA, pron with head fixed with skull clamp 2.Left Frazier point EVD insertion was first made 3.Hockysstick skin incision at left occipital area 4.Dissect to open skin flap then muscle 5.Left suboccipital area craniectomy was done 6.Hematoma evacuation 7.Hemostasis 8.Duroplasty with fascia and durofoam 9.close wound in layers after CWV drain insertion Operators 王國川 Assistants 胡朝凱, 古恬音, 傅紹懷 Indication Of Emergent Operation 王金 (F,1950/08/10,61y7m) 手術日期 2010/09/16 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Malignant neoplasm of temporal lobe 器械術式 Crainotomy Brain Tumor(P-LIN) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 傅紹懷, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:03 進入手術室 08:05 麻醉開始 08:35 誘導結束 08:50 抗生素給藥 09:00 手術開始 12:00 抗生素給藥 12:35 麻醉結束 12:35 手術結束 12:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦瘤切除－手術時間在４小時以內 1 1 R 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT 開立醫師: 曾峰毅 開立時間: 2010/09/16 12:33 Pre-operative Diagnosis Right frontal glioblastoma multiforme, status post excision, status post CCRT, suspected recurrence Post-operative Diagnosis Right frontal glioblastoma multiforme, status post excision, status post CCRT, suspected recurrence Operative Method Craniotomy for tumor excision Specimen Count And Types Several fragments of one tumor was sent for pathology. Pathology Frozen biopsy: GBM recurrence is most likely. Operative Findings Greyish, soft, hypervascular tumor was noted at the border of previuos tumor location. Some elastic, firm, yellowish, hypovascular component was noted as well. Blood loss was about 150ml. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to left. After scalp shaved, scrubbed, disinfected, and then draped, we made skin incision along previuos operation scar. We dissected the scalp flap, and removed previous craniotomy graft. Durotomy was done, and the tumor was inspected with sonongraphy. Tumor excision was done, and part of the tumor was sent for frozen biopsy. After hemostasis, we paved the tumor cavity with Surgicels. Duroplasty was done with Durofoam, and one subgaleal CWV was inserted. The bone graft was fixed back with mini-plates. The wound was closed in layers. Operators VS 王國川 Assistants R4 曾峰毅 R1 傅紹懷 謝振煙 (M,1975/04/26,36y10m) 手術日期 2010/09/16 手術主治醫師 王國川 手術區域 東址 003房 03號 診斷 Lymphoma 器械術式 remove ommaya 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳德福, 時間資訊 00:00 臨時手術NPO 15:22 報到 15:50 進入手術室 15:55 麻醉開始 16:00 抗生素給藥 16:05 誘導結束 16:15 手術開始 16:25 手術結束 16:25 麻醉結束 16:30 送出病患 16:35 進入恢復室 17:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 手術 肌肉或深部組織腫瘤切除術及異物取出術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: removal of Ommaya reservior 開立醫師: 陳德福 開立時間: 2010/09/16 16:36 Pre-operative Diagnosis lymphoma s/p right frontal Ommaya reservior implantation Post-operative Diagnosis lymphoma s/p right frontal Ommaya reservior implantation Operative Method removal of Ommaya reservior Specimen Count And Types 1 piece About size:5CM Source:ventricular catheter Pathology nil Operative Findings The right frontal Ommaya reservior was removed. Operative Procedures Under IVG and supine position, the skin disinfection and draping were done as usual. Incision along previous OP scar and identify the Ommaya reservior. Adhesiolysis was done and the Ommaya reservior was removed smoothly. The wound was closed in layers. Operators VS 王國川 Assistants R5 陳德福 余登元 (M,1951/12/01,60y3m) 手術日期 2010/09/17 手術主治醫師 賴達明 手術區域 東址 019房 02號 診斷 Ossification of posterior longitudinal ligament, cervical 器械術式 Lamino plasty 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 12:34 報到 13:32 進入手術室 13:40 麻醉開始 14:10 誘導結束 14:13 抗生素給藥 14:15 手術開始 17:21 抗生素給藥 18:25 手術結束 18:25 麻醉結束 18:35 送出病患 18:36 進入恢復室 20:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓整形術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 記錄__ 手術科部: 外科部 套用罐頭: Laminoplasty,open door method(right side open... 開立醫師: 鍾文桂 開立時間: 2010/09/17 18:04 Pre-operative Diagnosis Ossification of posterior longitudinal ligament, C3-7. Post-operative Diagnosis Ossification of posterior longitudinal ligament, C3-7. Operative Method Laminoplasty,open door method(right side open), C3-C6. Laminectomy(half),C7. Specimen Count And Types nil Pathology Nil. Operative Findings Miniplates and screws were fixed as briges for laminoplasty from C3-C6 levels. The cord was slack after decompression by C7 laminectomy(upper half) and laminoplasty. Partial fracture of C3 level, so upper part of C3 lamina was removed by Kerrison punch. Operative Procedures Under ETGA, the patient was placed in prone position and the head was fixed by Mayfield. After shaving and disinfection, midline incision was made to expose C2-C7 levels. Laminoplasty was achieved by high speed drill. The "door" was opened from the right side and it was fixed by miniplates and screws. After placing one CWV drain, the wound was closed in layers. Operators V.S. 賴達明 Assistants R5鍾文桂 R1李柏穎 相關圖片 李秀珠 (F,1952/08/15,59y6m) 手術日期 2010/09/17 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Spinal metastasis 器械術式 Malignant intraspinal tumor, e 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 周聖哲, 時間資訊 00:00 臨時手術NPO 11:50 報到 12:11 進入手術室 12:15 麻醉開始 12:40 誘導結束 13:00 抗生素給藥 13:16 手術開始 15:05 手術結束 15:05 麻醉結束 15:20 送出病患 15:20 進入恢復室 16:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 惡性病髓腫瘤切除術 1 1 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 記錄__ 手術科部: 外科部 套用罐頭: lower T5 ~ T7 laminectomy for tumor excision 開立醫師: 胡朝凱 開立時間: 2010/09/17 15:18 Pre-operative Diagnosis T5~7 epidural tumor metastasis Post-operative Diagnosis T5~7 epidural tumor metastasis Operative Method lower T5 ~ T7 laminectomy for tumor excision Specimen Count And Types pieces of tumor Pathology pending Operative Findings 1.The left paravertebral muscle at T6 level was involved 2.The tumor was grayish, soft, and hypervascularity that located at T5~7 level and penetrate trough T6 lamina. T6 bilateral facet was also involved. 3.Right T6 root was rhizotomy. Operative Procedures 1.ETGA, prone 2.Midline incision at t5~ T7 level 3.Detach paravertebral muscle 4.Resect tumor that involved the muscle part 5.Laminectomy of lower T5 to T7 6.Resect tumor totally 7.Right T6 rhizotomy 8.Hemostasis 9.Set one CWV drain then close wound in layers Operators 曾漢民 Assistants 胡朝凱, 周聖哲 張文德 (M,1959/12/15,52y2m) 手術日期 2010/09/17 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Aneurysm 器械術式 A-com aneurysm 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:03 進入手術室 08:08 麻醉開始 08:35 誘導結束 09:10 抗生素給藥 09:12 手術開始 12:00 開始輸血 12:10 抗生素給藥 13:00 送出病患 15:10 抗生素給藥 15:55 麻醉結束 15:55 手術結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 8 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 開顱術摘除血管病變－腦血管瘤－無徵的 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Left pterional approach for aneurysm clipping 開立醫師: 王奐之 開立時間: 2010/09/17 16:06 Pre-operative Diagnosis A-com aneurysm, asymptomatic Post-operative Diagnosis A-com aneurysm, asymptomatic Operative Method Left pterional approach for aneurysm clipping Specimen Count And Types nil Pathology Nil Operative Findings The aneurysm was a wild neck one. The dome was about 8mm in diameter, and the neck was about 5mm in diameter. The aneurysm located at the A-com, left A2 junction. A right tilt Sugita clip was applied to aneurysm clipping. After clipping, the aneurysm was punched and electroligated. The proximal control was no longer than 3min. Duplicated A-com arteries were noted. Easy oozing was noted. Operative Procedures After ETGA, the patient was under supine position and the head was 45 degree right tilt, fixed with Mayfield clump. Curvillinear scalp incision was made at left frontotemporal region, and the facial nerve was preserved inside the Yasagil^s fat pad. Two bur holes were made at key hole and posterior temporal line. An about 8x10cm craniotomy window was created mainly at frontal region. Hemostasis, dural tenting, and the sphenoid ridge was drilled flattern. The dura was opened curvillinearly, and then tented. The frontal lobe was retracted upward, and the optic nerve, ICA were noted at the deep side of sphenoid ridge. CSF was drained out from pre-chiasmatic cistern for decompression. We tracted ICA forward to find out the left A1. After lysis of arachnoid membrane and remove of left rectal gyrus, bilateral A1, A2, and duplicated A-com were exposed. The aneurysm was dissected from peripheral vessels, and then proximal control was done at proximal left A1. The aneurysm was clipped with one right side tilt Sugita clip. Then the aneyrusm was punched and electroligated. Hemostasis, and the dura was closed tightly after deair. The bone graft was fixed back with miniplates and central tenting was also performed. An epidural CWV drain was set, and the wound was closed in layers. Operators P 杜永光 Assistants R6 陳睿生, R3 王奐之 相關圖片 酆東海 (M,1957/02/04,55y1m) 手術日期 2010/09/17 手術主治醫師 曾漢民 手術區域 東址 005房 03號 診斷 Glioblastoma multiforma 器械術式 VP shunt + tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 周聖哲, 時間資訊 00:00 臨時手術NPO 15:37 進入手術室 15:40 麻醉開始 15:50 誘導結束 16:45 手術開始 17:00 抗生素給藥 17:57 18:25 麻醉結束 18:25 手術結束 18:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 手術 氣管切開造口術 1 0 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: 1. Ventriculoperitoneal shunt insertion via r... 開立醫師: 王奐之 開立時間: 2010/09/17 18:41 Pre-operative Diagnosis 1. Hydrocephalus 2. Respiratory failure Post-operative Diagnosis 1. Hydrocephalus 2. Respiratory failure Operative Method 1. Ventriculoperitoneal shunt insertion via right Kocher point 2. Tracheostomy Specimen Count And Types 1 piece About size:3ml Source:CSF Pathology Nil Operative Findings Smooth CSF flow noted after shunt insertion, clear and colorless CSF was collected and sent for routine, BCS, bacterial culture. A Fr. 8 low-pressure tracheostomy tube was inserted through 2nd tracheal ring. Operative Procedures After ETGA, the patient was placed in supine position with face turned to left. After skin disinfection & draping in usual sterile fashion, a curved scalp incision was made above right Kocher point, followed by burr hole creation. Dural tenting was then made. A right upper abdominal lienar incision was done, followed by mini-laparotomy. The subcutaneous tunnel was made between the peritoneal & scalp wound. The dura was then opened, ventricular tapping was done smoothly. The shunt was then inserted, smooth CSF flow was confirmed. The wounds were closed in layers after meticulous hemostasis. The draping was removed and the patient was re-draped to expose the central neck. A midline linear skin incision was made, and further deepened until the trachea was seen. A round tracheal incision was made at 2nd tracheal ring, the endotracheal tube was withdrawn and the tracheostomy tube was inserted. The wound was then approximated. Operators VS 曾漢民 Assistants R65 胡朝凱, R3 王奐之, R1 周聖哲 林素娥 (F,1952/10/25,59y4m) 手術日期 2010/09/17 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Meningioma 器械術式 left side craniotomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3E 紀錄醫師 周聖哲, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:03 進入手術室 08:10 麻醉開始 08:45 誘導結束 09:00 抗生素給藥 09:10 手術開始 11:40 麻醉結束 11:40 手術結束 11:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 手術 腦瘤切除－手術時間在４小時以內 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Left frontal craniotomy for Simpson grade I t... 開立醫師: 周聖哲 開立時間: 2010/09/17 12:08 Pre-operative Diagnosis Left frontal parasagittal meningioma Post-operative Diagnosis Left frontal parasagittal meningioma Operative Method Left frontal craniotomy for Simpson grade I tumor excision Specimen Count And Types 1 piece, 5x5x2cm, meningioma Pathology Pending Operative Findings The yellowish, fragile, heterogenous tumor was well defined and attached to the dura, measuring about 5x5x2 cm. It was totally excised. Operative Procedures Under ETGA, patient was put in supine position with head rotate to right and fixed with Mayfield skull clamp. L shape skin incision was done at left frontal area. Skin flap was dissected and opened. After five burr holes drilled, craniotomy was performed as a 10x8 bone window with 0.5 cm away from midline, followed by dural tenting. Dural incision was made carefully beside the tumor margin. The tumor was excised by gently dissection through the interface between tumor and brain tissue. Vascular perforation was cauterized and few cortical veins were preserved. Hemostasis was performed, and duroplasty with fascia was done by prolene. One CWV drain was inserted at subgaleal space after fixation of skull bone with miniplate. Wound was closed in layers. Operators 曾漢民 Assistants 胡朝凱, 周聖哲 周裕欽 (M,1970/12/14,41y3m) 手術日期 2010/09/17 手術主治醫師 曾勝弘 手術區域 東址 019房 05號 診斷 Subdural hemorrhage 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 00:02 送出病患 20:56 通知急診手術 22:00 報到 22:00 進入手術室 22:10 麻醉開始 22:20 誘導結束 22:34 抗生素給藥 22:50 手術開始 23:50 手術結束 23:50 麻醉結束 00:05 進入恢復室 01:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Left frontal burr hole drainage 開立醫師: 林哲光 開立時間: 2010/09/18 00:15 Pre-operative Diagnosis Left F-T-P chronic subdural hematoma Post-operative Diagnosis Left F-T-P chronic subdural hematoma Operative Method Left frontal burr hole drainage Specimen Count And Types Pathology Operative Findings Motor-oil like fluids gushed out after dural incision. The outter and inner membrane formation were noted. Around 60ml hematoma was noted. Hematoma was sent for cytology work-up. Operative Procedures Under ETGA and supine position with head rotated to right side, skin disinfected and drapped were performed as usual. Tranverse skin incision was made over the left frontal area. A burr hole was then created and the dura was opened after dural tenting. Hematoma evacuation was performed. N/S irrigation and deair were then performed. The wound was then closed in layers after subdural drain inserted. Operators 曾勝弘 Assistants R6 陳睿生, R4 林哲光 Indication Of Emergent Operation 相關圖片 沈予新 (M,1964/11/14,47y4m) 手術日期 2010/09/17 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Facial spasm 器械術式 Crainotomy Brain Tumor(P-LIN) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 2 紀錄醫師 李柏穎, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:07 進入手術室 08:10 麻醉開始 08:40 誘導結束 09:00 抗生素給藥 09:10 手術開始 12:16 抗生素給藥 13:10 麻醉結束 13:10 手術結束 13:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 腦微血管減壓術 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Microvascular decompression of facial nerve,left. 開立醫師: 鍾文桂 開立時間: 2010/09/17 13:44 Pre-operative Diagnosis Hemifacial spasm, left. Hemifacial spasm, left. Hemifacial spasm, left. Post-operative Diagnosis Hemifacial spasm, left. Hemifacial spasm, left. Operative Method Microvascular decompression of facial nerve,left. Microvascular decompression of facial nerve,left. Specimen Count And Types nil nil Pathology Nil. Nil. Operative Findings Compression of CN VII/VIII complex by PICA loop. The PICA loop was pushed by left vertebral artery towards VII/VIII complex. Compression of CN VII/VIII complex by PICA loop. The PICA loop was pushed by left vertebral artery towards VII/VIII complex. Compression of CN VII/VIII complex by AICA loop. The AICA loop was pushed by left vertebral artery towards VII/VIII complex. Teflon was inserted to seperate vertebral artery, PICA, and CN VII/VIII complex. Teflon was inserted to seperate vertebral artery, PICA, and CN VII/VIII complex. Teflon cotton was inserted to seperate vertebral artery, AICA, and CN VII/VIII complex. Operative Procedures Under ETGA, the patient was placed in 3/4 prone position and the head was tilted to the right. Under ETGA, the patient was placed in 3/4 prone position and the head was tilted to the right. After disinfection and draping, a curvilinear incision was made at retroauricular area. After disinfection and draping, a curvilinear incision was made at retroauricular area. Then a 5-cm craniotomy was made.The transverse-sigmoid junction as anterior border. Then a 5x5 cm craniotomy was made.The transverse-sigmoid junction as anterior border. Then a 5x5cm craniotomy was made.The transverse-sigmoid junction as anterior border. After durotomy, the cerebellum was retracted posteriorly until the CN VII/VIII, and lower cranial nerves were identified. After durotomy, the cerebellum was retracted posteriorly until the CN VII/VIII, and lower cranial nerves were identified. Teflon cotton was placed to seperate the PICA from vertebral artery and CN VII from PICA. Teflon cotton was placed to seperate the PICA from vertebral artery and CN VII from PICA. Teflon cotton was placed to seperate the AICA from vertebral artery and CN VII from AICA. The pulsation of CN VII was decreased after decompression. The pulsation of CN VII decreased after decompression. The dura mater was closed by 4-0 Prolene. The dura mater was closed by 4-0 Prolene. After placing one CWV drain, the wound was closed in layers. After placing one CWV drain, the wound was closed in layers. The pulsation of CN VII decreased after decompression. The dura mater was closed by 4-0 Prolene. After placing one CWV drain, the wound was closed in layers. Operators V.S. 賴達明 V.S. 賴達明 V.S. 賴達明 Assistants R5鍾文桂 R1李柏穎 R5鍾文桂 R1李柏穎 R5鍾文桂 R1李柏穎 摘要__ 手術科部: 外科部 套用罐頭: Microvascular decompression of facial nerve,left. 開立醫師: 李柏穎 開立時間: 2010/09/21 19:00 Pre-operative Diagnosis Hemifacial spasm, left. Post-operative Diagnosis Hemifacial spasm, left. Operative Method Microvascular decompression of facial nerve,left. Specimen Count And Types nil Pathology Nil. Operative Findings Compression of CN VII/VIII complex by AICA loop. The AICA loop was pushed by left vertebral artery towards VII/VIII complex. Teflon cotton was inserted to seperate vertebral artery, AICA, and CN VII/VIII complex. Operative Procedures Under ETGA, the patient was placed in 3/4 prone position and the head was tilted to the right. After disinfection and draping, a curvilinear incision was made at retroauricular area. Then a 5-cm craniotomy was made.The transverse-sigmoid junction as anterior border. After durotomy, the cerebellum was retracted posteriorly until the CN VII/VIII, and lower cranial nerves were identified. Teflon cotton was placed to seperate the AICA loop from vertebral artery, and CN VII from the AICA loop. The pulsation of CN VII Operators Assistants 林進來 (M,1935/12/05,76y3m) 手術日期 2010/09/17 手術主治醫師 劉詩彬 手術區域 西址 039房 06號 診斷 Hypertrophy (benign) of prostate 器械術式 Fiberocystoscopy /WOR 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 10:15 進入手術室 10:19 麻醉開始 10:20 手術開始 10:23 手術結束 10:25 送出病患 蘇芷誼 (F,1984/11/01,27y4m) 手術日期 2010/09/17 手術主治醫師 林東燦 手術區域 兒醫 063房 06號 診斷 Acute lymphoid leukemia ( ALL ) 器械術式 IT 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 黃啟祥 ASA 2 時間資訊 06:06 臨時手術NPO 14:00 進入手術室 14:05 麻醉開始 14:07 誘導結束 14:16 手術開始 14:33 手術結束 14:33 麻醉結束 14:35 送出病患 14:40 進入恢復室 15:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室內注射留置器或脊髓腔內化學藥物注射 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 陳永安 (M,1935/05/04,76y10m) 手術日期 2010/09/17 手術主治醫師 王國川 手術區域 東址 002房 05號 診斷 Communicating hydrocephalus 器械術式 VP shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 陳德福, 時間資訊 00:00 臨時手術NPO 14:27 進入手術室 14:30 麻醉開始 14:35 誘導結束 15:00 抗生素給藥 15:14 手術開始 15:55 手術結束 15:55 麻醉結束 16:05 送出病患 16:08 進入恢復室 17:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 手術 腦室腹腔分流手術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 陳德福 開立時間: 2010/09/17 16:09 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method V-P Shunt, right Kocher point Specimen Count And Types nil Pathology nil Operative Findings 1.There is clear and colorless CSF drained out after ventricular tapping. 2.The intraventricular catheter:7.0cm ; intraperitoneal catheter:20cm 3.One Codman, fixed pressure valve[100mmH2O] was implatated at the right Kocher point. Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: supine with head tilted to left. 3.Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 5 cm linear, right fontal , corresponded to the location of right lateral horn. Raney clips were applied to the scalp edge for temporary hemostasis. 5.After the scalp flap had been lifted and reflected anteriorly, a burr hole was made and the dura was tented by 2 stitches. 6.The dura was opened by a nib incision. Rt lateral ventricle was tapped by a ventricular needle, then a 7 cm segment of the ventricular catheter was introduced into the ventricle. The outer end of the catheter was connected to a Pudenz reservoir. 7. A nib incision was made at RUQ of the abdomen , then a trocar was pushed into peritoneal cavity. Subsequently, distal 20 cm segment of the peritoneal catheter was introduced into the peritoneal cavity through the outer tube of the trochar. The proximal end of this catheter was passed through subcutaneous tunnel at forechest, neck, rt retroauricular area and connected the reservoir. The shunt systemwas checked to make sure its function was working. 8. The reservoir was fixed to pericranium by 3 stitches. 9. Scalp closure: hemostasis was done with monopolar coagulator touching on the sucker tip. Galea suture was performed by continuous suture with 3/0. Dexon and skin by continuous suture with 3/0 nylon. 10.Course of the surgery: smooth. Operators VS 王國川 Assistants R5 陳德福 何開敏 (F,1929/04/08,82y11m) 手術日期 2010/09/18 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Meningitis 器械術式 Wound treatment-- 5-10cm 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 王永彬 ASA 3 紀錄醫師 周聖哲, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:35 進入手術室 08:40 麻醉開始 09:00 抗生素給藥 09:15 誘導結束 09:58 手術開始 13:00 麻醉結束 13:00 手術結束 13:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦膜或脊髓膜突出修補術 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: Duroplasty 開立醫師: 陳德福 開立時間: 2010/09/18 13:21 Pre-operative Diagnosis CSF leakage with tension pneumocephaly Post-operative Diagnosis CSF leakage with tension pneumocephaly Operative Method Duroplasty Specimen Count And Types nil Pathology nil Operative Findings 1.There is massive amount of air inside the cranium with compression of the bilateral frontal lobe. The dura defect is noticed and we perform duroplasty with autologous temporalis muscle fascia and Tissuco Duo dressing. 2.One 1*0.5cm in sized skull defect with pus like material was found at the left frontal paranasal sinus. The mucosa was removed and the cavity was packed with Gelfoam [Aqua-Beta-iodine]. The defect was repaired with bone wax and Tissueco Duo. Operative Procedures Under ETGA and spuine position, the skin was disinfected and draped as usual. Incision along previous bicoronal scar and performed craniotomy. The left tempralis muscle fasica was harvested. The dura defect and frontal sinus was exposed. The packing with Gelfoam and bone wax was done for the left frontal paranasal sins defect. The duroplasty was performed. The skull was fixed with miniplates and one subgaleal CWV was left in situ. The wound was closed in layers. Under ETGA and spuine position, the skin was disinfected and draped as usual. Incision along previous bicoronal scar and performed craniotomy. The left tempralis muscle fasica was harvested. The dura defect and frontal sinus was exposed. The packing with Gelfoam and bone wax was done for the left frontal paranasal sinus defect. The duroplasty was performed. The skull was fixed with miniplates and one subgaleal CWV was left in situ. The wound was closed in layers. Operators P 曾勝弘 Assistants R5陳德福 R1周聖哲 劉維哲 (M,2010/09/02,1y6m) 手術日期 2010/09/18 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Other anomalies of great veins 器械術式 Ommaya reservoir implantation 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 3E 紀錄醫師 李振豪, 時間資訊 07:38 通知急診手術 11:30 進入手術室 11:35 麻醉開始 11:40 誘導結束 12:07 手術開始 12:35 抗生素給藥 12:40 手術結束 12:40 麻醉結束 13:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 歐氏貯囊置放手術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Right Kocher"s Ommaya reservoir implantation 開立醫師: 李振豪 開立時間: 2010/09/18 13:01 Pre-operative Diagnosis 1. Hydrocephalus, 2. Intraventricular hemorrhage Post-operative Diagnosis 1. Hydrocephalus, 2. Intraventricular hemorrhage 1. Hydrocephalus, 2. subdural effusion, 3. Intraventricular hemorrhage Operative Method Right Kocher"s Ommaya reservoir implantation Specimen Count And Types 1. 3ml subdural collection, 2. 9ml CSF Pathology Nil Operative Findings 1. Metronic neonate reservoir with right angle, small, Barium impregnated intraventricular catheter is used. The catheter length is 35mm. 2. Turbid, brownish subdural collection was noted after dura opening and sampled for study 3. The CSf drained from right lateral ventricle is light brownish, and mild turbid in appearance. 4. Total about 9ml CSF was drained out. The anterior fontanelle was soft and flat after CSF drainage. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine position. The head was shaved, scrubbed, and disinfected as usual. The transverse linear scalp incision was made at right Kocher"s point and the bone edge of right frontal bone was exposed. One burr hole was created with Rongeur and the dura was opened with cruciform in shape. Subgaleal effusion was collected for study. The edge of dura was coagulated. Ventricular puncture was performed and the Nelaton catheter was placed. CSF was sampled for study. One subgaleal pocket was created posterior to the wound and the reservoir was placed. The ventricular catheter was then placed into the right lateral ventricle. Hemostasis was achieved and the wound was then closed in layers with 4-0 Vicryl and 5-0 Nylon. The function of the Ommaya reservoir was checked after wound closure. Operators AP郭夢菲 Assistants R4李振豪 Indication Of Emergent Operation 相關圖片 張桂伸 (M,1934/12/15,77y2m) 手術日期 2010/09/19 手術主治醫師 蔡翊新 手術區域 東址 002房 03號 診斷 Subdural hemorrhage following injury, with loss of consciousness of unspecified duration 器械術式 ICP monitoring 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 王永彬 ASA 4 紀錄醫師 李柏穎, 時間資訊 00:00 開始NPO 00:00 臨時手術NPO 12:37 通知急診手術 13:05 進入手術室 13:05 報到 13:10 麻醉開始 13:15 誘導結束 13:20 開始輸血 13:35 抗生素給藥 13:45 手術開始 17:20 麻醉結束 17:20 手術結束 17:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 急性硬腦膜下血腫清除術 1 1 R 手術 顱內壓監視置入 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 蔡翊新 開立時間: 2010/09/19 16:49 Pre-operative Diagnosis Right frontotemporoparietal, falx and supertentorial acute SDH. Post-operative Diagnosis Right frontotemporoparietal, falx and supertentorial acute SDH. Operative Method Right F-T-P craniectomy for SDH removal and ICP monitoring. Specimen Count And Types nil Pathology Nil. Operative Findings The initial ICP upon first burr hole creation was 19 mmHg. The dura was tense upon craniectomy. Blood clots, about 1 cm in thickness, were evacuated from the subdural space at right F-T-P area. There was a bleeder from the bridging vein at right posterior temporal area. The ICP after duroplasty was 1 mmHg and ICP after skin closure was 1 mmHg. The reference level of Codman ICP monitor was 485. The initial ICP upon first burr hole creation was 19 mmHg. The dura was tense upon craniectomy. Blood clots, about 1 cm in thickness, were evacuated from the subdural space at right F-T-P area. There was a bleeder from the bridging vein at right posterior temporal area. The ICP after duroplasty was 1 mmHg and ICP after skin closure was 3 mmHg. The reference level of Codman ICP monitor was 485. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 4 cm at right frontal area, the skin edge was clipped by Raney clips for temporary hemostasis. 5. A burr hole was made at right frontal area and the dura was incised for insertion of ICP monitor. 6. The incision was extended to a temporal horseshoe, and the temporalis muscle was detached from temporal squama by rasp subsequently. 7. Craniectomy window: 14 x 12 cm, right frontotemporoparietal, created by making 5 burr holes then cut by power saw. 8. Dural tenting: by 2/0 silk, 2 cm in interval, distributed along the edge of skull window. 9. Dural incision: curvilinear along the edge of skull window. 10.The subdural clot was removed by sucker and those located beyond the cranial window was washed out by tumor forceps and saline irrigation 11.Hemosatasis: the bleeders was stopped by Bovie and oozing surface was covered with Surgicel and Gelfoam. 12.Dural closure: closed with a piece of dural graft taking from temporalis fascia. (crescent shape 15 cm long, 2 cm wide) along the whole length of the dural incision in order to create an additional space for the swollen brain. 13.The skull plate was removed and stored in bone bank for preservation. 14.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 15.Drain: two epidural CWV. 16.Blood transfusion: Platelet 36 U. Blood loss: 300 ml. 17.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5陳德福R4林哲光R1李柏穎 Indication Of Emergent Operation 黃鈺翔 (M,1997/11/30,14y3m) 手術日期 2010/09/20 手術主治醫師 郭夢菲 手術區域 兒醫 063房 03號 診斷 Malignant neoplasm of kidney, except pelvis 器械術式 Laminectomy for decompression and T2 tumor excision 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林子富 ASA 3E 紀錄醫師 李振豪, 時間資訊 08:30 臨時手術NPO 08:30 開始NPO 12:12 通知急診手術 13:10 報到 13:15 進入手術室 13:30 麻醉開始 13:50 誘導結束 14:10 抗生素給藥 14:24 手術開始 14:35 開始輸血 17:43 抗生素給藥 18:25 手術結束 18:25 麻醉結束 18:35 送出病患 18:40 進入恢復室 20:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 惡性病髓腫瘤切除術 1 1 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 記錄__ 手術科部: 外科部 套用罐頭: T2 and partial T1, T3 laminectomy for intrasp... 開立醫師: 李振豪 開立時間: 2010/09/20 18:31 Pre-operative Diagnosis 1. T2 intraspinal tumor, metastatic, 2. Primitive neuroectodermal tumor with lung and spine metastasis Post-operative Diagnosis 1. T2 intraspinal tumor, metastatic, 2. Primitive neuroectodermal tumor with lung and spine metastasis Operative Method T2 and partial T1, T3 laminectomy for intraspinal tumor excision and decompression Specimen Count And Types 1 piece About size:Multiple small pieces of spinal tumor Source:T2 intraspinal tumor Pathology Pending Operative Findings The spinous process and lamina was invaded by the tumor and some necrotic tissue was noted during laminectomy. The tumor was reddish, soft, hypervascularized in character. The thecal sac was compressed tightly by the tumor. The margin between the dura and the tumor was clear but adhere tightly to bony compartment. The capsule of the tumor was thick and adhered with bony structure. The thecal sac expanded well after decompression and removal of the tumor. The T2 roots were well preserved during the operation. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in prone position. The T2 level was localized with portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made from T1 to T3 level and the subcutaneous soft tissue and paravertebral muscle group was dissected to exposed the lamina. The T2 and partial T1, T3 laminectomy was performed with Rongeur and Kerrison punches. The tumor was noted after removal of the lamina. The plan between the the tumor and thecal sac was identified with dissector. Uner operative microscope, the tumor was removed with tumor forceps, alligator forceps, and curette. Bilateral T2 roots were well preserved during the whole procedure. Hemostasis was achieved with bipolar electrocautery and Gelform packing. One epidural CWV drain was placed and the wound was then closed in layers with 3-0 Vicryl and 3-0 Nylon. Under endotracheal tube general anesthesia, the patient was put in prone position. The T2 level was localized with portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made from T1 to T3 level and the subcutaneous soft tissue and paravertebral muscle group was dissected to exposed the lamina. The T2 and partial T1, T3 laminectomy was performed with Rongeur and Kerrison punches. The tumor was noted after removal of the lamina. The plan between the the tumor and thecal sac was identified with dissector. Uner operative microscope, the tumor was removed with tumor forceps, alligator forceps, and curette. Bilateral T2 roots were well preserved during the whole procedure. Hemostasis was achieved with bipolar electrocautery and Gelform packing. One epidural CWV drain was placed and the wound was then closed in layers with 3-0 Vicryl and 3-0 Nylon. Operators AP郭夢菲 Assistants R4林哲光, R4李振豪 Indication Of Emergent Operation 劉家豪 (M,1996/12/27,15y2m) 手術日期 2010/09/20 手術主治醫師 杜永光 手術區域 東址 003房 02號 診斷 Malignant neoplasm of brain, unspecified 器械術式 cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 13:45 報到 14:15 進入手術室 14:20 麻醉開始 14:25 誘導結束 14:45 抗生素給藥 15:14 手術開始 18:00 手術結束 18:00 麻醉結束 18:10 進入恢復室 18:12 送出病患 19:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 手術 頭顱成形術 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Cranioplasty with wire-mesh 開立醫師: 王奐之 開立時間: 2010/09/20 18:25 Pre-operative Diagnosis Left sphenoid ridge meningioma, status post craniotomy for tumor excision, with resorption of bone flap Post-operative Diagnosis Left sphenoid ridge meningioma, status post craniotomy for tumor excision, with resorption of bone flap Operative Method Cranioplasty with wire-mesh Specimen Count And Types nil Pathology Nil Operative Findings Partially resorbed bone fragment was noted at left frontotemporal area. The created artificial bone was about 6*7cm in size, ovoid in shape. Operative Procedures After ETGA, the patient was placed in supine position with face turned to right. The scalp was disinfected and draped in usual sterile fashion. A curved scalp incision was then made along previous scar, and deepened to the bone. The flap was then reflected anteroinferiorly, the pericranium was dissected to expose the bony edge. The partially resorbed bone fragment was removed. A piece of oval shaped wire-mesh about 6*7cm in size was After ETGA, the patient was placed in supine position with face turned to right. The scalp was disinfected and draped in usual sterile fashion. A curved scalp incision was then made along previous scar, and deepened to the bone. The flap was then reflected anteroinferiorly, the pericranium was dissected to expose the bony edge. The partially resorbed bone fragment was removed. A piece of oval shaped wire-mesh about 6*7cm in size was created to fit the bony defect, bone cement was applied to both surfaces of the wire-mesh. After setting a subgaleal CWV drain and meticulous hemostasis, the wound was closed in layers. Operators P 杜永光 Assistants R6 陳睿生, R3 王奐之 相關圖片 陳仙女 (F,1943/10/18,68y4m) 手術日期 2010/09/20 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Meningioma 器械術式 right sphenoid ridge meningioma 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 周聖哲, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:03 進入手術室 08:10 麻醉開始 08:35 誘導結束 08:45 抗生素給藥 08:48 手術開始 11:45 抗生素給藥 13:17 麻醉結束 13:17 手術結束 13:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: Right craniotomy for Simpson grade II excision 開立醫師: 胡朝凱 開立時間: 2010/09/20 13:49 Pre-operative Diagnosis Right middle third sphenoid ridge meningioma Post-operative Diagnosis Right middle third sphenoid ridge meningioma Operative Method Right craniotomy for Simpson grade II excision Specimen Count And Types pieces of tumor Pathology pending Operative Findings 1.One reddish hypervascular tumor measured as 5 cm arised from right sphenoid ridge was noted. 2.blood supply came from right MMA, and ophthalmic artery ethmoid branch. 3.The sphenoid ridge was hyperosteosis. 4.The interface between tumor and brain was clear 5.Some vessels attached to the tumor but were all preserved Operative Procedures 1.ETGA, supine with head fixed with skull clamp 2.Right pterional approach was done. 3.Open dura as a curvature incision 4.Devascularization along sphenoid ridge 5.Dissect tumor border along with the arachnoid membrane 6.Resect tumor in two pieces 7.Identified MCA and superficial sylvian vein 8.Hemostasis 9.Close dura with prolene and fascia 10.Fixed bone back with miniplate 11.Close wound in layers Operators 曾漢民 Assistants 胡朝凱, 周聖哲 吳文琛 (M,1953/12/15,58y2m) 手術日期 2010/09/20 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Pituitary Tumor 器械術式 TSH 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 周聖哲, 時間資訊 00:00 臨時手術NPO 13:45 進入手術室 13:50 麻醉開始 14:10 誘導結束 14:30 抗生素給藥 14:42 手術開始 16:30 手術結束 16:30 麻醉結束 16:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 經由蝶竇之腦下垂體瘤切除 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 記錄__ 手術科部: 外科部 套用罐頭: Sublabia trans-sphenoid adenomectomy 開立醫師: 胡朝凱 開立時間: 2010/09/20 16:57 Pre-operative Diagnosis Pituitary macroadenoma Post-operative Diagnosis Pituitary macroadenoma Operative Method Sublabia trans-sphenoid adenomectomy Specimen Count And Types pieces of tumor Pathology pending Operative Findings 1.The tumor was grayish to yellowish, soft, located insided sella turcica with upward extension. Bilateral Cavernous sinus seemed compressed by the tumor. 2.After Tumor removal, the arachnoid membrane was noted and intact. 3.The tumor also expanded into sphenoid sinus and the sella fllor was also eroded. Operative Procedures 1.ETGA, supine 2.Transver incision was made on the superior gingiva 3.Dissect subperiosteally and septal mucosa 4.fractured vomer bone laterally 5.Sphenoid sinus anterior wall was fractured 6.The tumor was dissect with currete 7.Remove tumor until arachnoid membrane was identified 8.Hemostasis 9.Put bone back 10.Approximate mucosa and packing 11.Close gingival wound Operators 曾漢民 Assistants 胡朝凱, 周聖哲 張德宏 (M,1950/03/23,61y11m) 手術日期 2010/09/20 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Cervical spondylosis 器械術式 C4/5, C7/T1 HIVD 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 李柏穎, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:08 進入手術室 08:15 麻醉開始 08:25 誘導結束 08:50 抗生素給藥 09:33 手術開始 11:50 抗生素給藥 13:55 手術結束 13:55 麻醉結束 14:00 送出病患 14:02 進入恢復室 15:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術－頸椎 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: C4-5; C7-T1 anterior cervical diskectomy and ... 開立醫師: 陳德福 開立時間: 2010/09/20 13:57 Pre-operative Diagnosis C4-5; C7-T1 HIVD with radiculopathy and myelopathy Post-operative Diagnosis C4-5; C7-T1 HIVD with radiculopathy and myelopathy Operative Method C4-5; C7-T1 anterior cervical diskectomy and fusion with cages Specimen Count And Types nil Pathology nil Operative Findings 1.There are moderate osterphytes and herniated disc with down migration at the C7-T1 level. There are moderate osterphytes and herniated disc with at the C4-5 level. The bilateral nerve foramina were stenotic and the osteophytes was removed for decompression the nerve roots and spinal cord. 2.The C7-T1 disc was removed and one No#8 cervical cage was implanated at the C7-T1 level smoothly. The C4-5 disc was removed and one No#6 cervical cage was implanated at the C4-5 level smoothly. Operative Procedures Under ETGA and supine position with neck hyperextension, the skin was disinfected and draped as usual. One linear incision along the skin crease on the left anterior neck was done and the platysma was transected. The areolar plane between the anterior catotid sheath and the cervical muscle was identified. The prevertebral space of C7-T1 was found and we check the location under flouroscope. The longus coli muscle was mildly detached and we set Caspar retractor to expose the anterior C7-T1 space. The ALL was opened and the C7-T1 disc was removed by curretage and aligator. The osteophyte was removed by air-drill and Kerrison. The PLL was opened the expose the dura. The bilateral nerve foramina was decompressed and the thecal sac reexpanded well. One No#8 cervical cage was inserted in the C7-T1 space anteriorly. One minihemovac was left in situ. Another procedure for the C4-5 diskectomy [followed by implantation of No#6 cage] from right neck was performed smoothly as above. After hemostasis, the wound was closed in layers. Operators VS賴達明 Assistants R6陳睿生 R5陳德福 R1李柏穎 相關圖片 林陳光慧 (F,1938/10/23,73y4m) 手術日期 2010/09/20 手術主治醫師 蕭輔仁 手術區域 東址 025房 04號 診斷 Lung cancer 器械術式 V-P shunt 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3E 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 09:18 通知急診手術 14:40 報到 15:10 進入手術室 15:50 麻醉開始 15:58 誘導結束 16:00 抗生素給藥 16:36 手術開始 18:10 麻醉結束 18:10 手術結束 18:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 腫瘤醫學部 套用罐頭: Ventriculoperitoneal shunt implantation via l... 開立醫師: 鍾文桂 開立時間: 2010/09/20 18:48 Pre-operative Diagnosis Lung cancer with leptomeningeal carcinomatosis and hydrocephalus. Post-operative Diagnosis Lung cancer with leptomeningeal carcinomatosis and hydrocephalus. Operative Method Ventriculoperitoneal shunt implantation via left Kocher point. Specimen Count And Types 1 piece About size:10CC Source:CSF, for routine, culture, BCS and cytology. Pathology Nil. Operative Findings Clear colorless CSF fluid gushed out. Low pressure. Ventricular catheter: 6.5 cm. Medtronic medium pressure. We explained to the family about her poor lung condition. ICU admission is indicated for postoperative monitoring. Presence of Port-A catheter in right chest. Operative Procedures Under ETGA, the patient was placed in supine position and the head was tilted to the right side. After disinfection and draping, a curvilinear scalp incision and a horizontal abdomen incision were made. Abdominal dissection was made until the peritoneal cavity was reached. A burr hole was created. A subcutaneous tunnel was created from abdomen to head. The peritoneal catheter was implanted. After durotomy, ventriculostomy was done. The ventricular catheter was implanted together with the reservoir. Then, the ventricular catheter was implanted into the abdominal cavity. The patency of the shunt system was checked. The wound was closed in layers. Operators V.S. 蕭輔仁 Assistants R5鍾文桂 Ri謝志慶 Indication Of Emergent Operation 白仁義 (M,1934/02/04,78y1m) 手術日期 2010/09/20 手術主治醫師 王國川 手術區域 東址 011房 02號 診斷 Traumatic subdural hemorrhage 器械術式 VP shunt + tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 11:27 進入手術室 11:28 麻醉開始 11:33 誘導結束 12:18 手術開始 13:45 手術結束 13:45 麻醉結束 13:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 氣管切開造口術 1 0 R 手術 腦室腹腔分流手術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: 1. Implantation of ventriculoperiotneal shunt... 開立醫師: 鍾文桂 開立時間: 2010/09/20 14:13 Pre-operative Diagnosis 1. Hydrocephalus. 2. Respiratory failure. Post-operative Diagnosis 1. Hydrocephalus. 2. Respiratory failure. Operative Method 1. Implantation of ventriculoperiotneal shunt via right Kocher point. 2. Tracheostomy. Specimen Count And Types 1 piece About size:3cc Source:CSF Pathology Nil. Operative Findings 1. V-P shunt: medtronic medium pressure. ventricular catheter: 6.5 cm, peritoneal catheter: 30 cm. 2. Clear colorless CSF. 3. Tracheostomy tube: Fr. 8. Operative Procedures Under ETGA, the patient was placed in supine position and the head was tilted to the left. After shaving and disinfection, a curvilinear scalp incision at right frontal region and a horizontal incision at right upper quadrant of abdomen were done. The abdomen wound was dissected until peritoeanl cavity was reached. A burr hole was drilled and followed by durotomy. A subcutaneous tunnel was created. Then, the peritoneal catheter was inserted. The shunt system was connected with a reservoir. The ventricular cathter was implanted at right Kocher point after ventriculostomy. The patency of the shunt system was checked. Finally, the wounds were closed in layers. Tracheostomy: After disinfection and draping, a vertical incision was made two finger breath above the sternal notch. Blunt dissection was done until the tracheal rings were reached. After incising the 2nd and 3rd tracheal ring, the tracheostomy tube was inserted and fixed. The wound defect was closed primarily. Operators V.S. 王國川 Assistants R5鍾文桂 Ri葉佳衢 張謝利 (F,1926/07/03,85y8m) 手術日期 2010/09/20 手術主治醫師 王國川 手術區域 東址 002房 03號 診斷 Cerebrovascular accident (CVA) 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 4E 紀錄醫師 王奐之, 時間資訊 13:17 開始NPO 13:17 臨時手術NPO 13:17 通知急診手術 21:45 進入手術室 21:48 麻醉開始 22:10 誘導結束 22:40 抗生素給藥 22:45 手術開始 23:35 手術結束 23:35 麻醉結束 23:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱內壓監視置入 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: ICP monitor insertion 開立醫師: 王奐之 開立時間: 2010/09/21 00:01 Pre-operative Diagnosis Left MCA infarction, status post t-PA therapy Post-operative Diagnosis Left MCA infarction, status post t-PA therapy Operative Method ICP monitor insertion Specimen Count And Types Nil Pathology Nil Operative Findings ICP monitor was inserted at left frontal area, 3cm intra-parenchymal. Initial ICP level: 15~16mmHg. Reference: 493. Operative Procedures After ETGA, the patient was placed in supine position with face turned to right. A linear skin incisino was made at left frontal area, followed by burr hole creation. After dural tenting, the dura was opened and the ICP monitor was inserted. After hemostasis and securing the ICP monitor wire, the wound was closed in layers. Operators VS 王國川 Assistants R6 陳睿生, R3 王奐之 Indication Of Emergent Operation 相關圖片 曾錦燾 (M,1948/12/13,63y3m) 手術日期 2010/09/21 手術主治醫師 杜永光 手術區域 東址 002房 04號 診斷 Meningitis 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 陳睿生, 時間資訊 11:38 開始NPO 11:38 臨時手術NPO 11:40 通知急診手術 14:35 進入手術室 14:35 報到 14:40 麻醉開始 14:45 誘導結束 15:17 手術開始 15:45 麻醉結束 15:45 手術結束 15:55 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室體外引流 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: EVD insertion via left Kocher^s point 開立醫師: 陳睿生 開立時間: 2010/09/21 16:13 Pre-operative Diagnosis CNS infection with hydrocephalus Post-operative Diagnosis CNS infection with hydrocephalus Operative Method EVD insertion via left Kocher^s point Specimen Count And Types 4 pieces About size:2.5ml Source:CSF About size:2.5ml Source:CSF About size:2.5ml Source:CSF About size:2.5ml Source:CSF Pathology Nil Operative Findings CSF gushed out while ventricle punching, and initial ICP was above 10cmH2O. The CSF was turbid and mild yellowish. The Metronic ventricular catheter was about 6.2cm in depth. Operative Procedures After ETGA, the patient was under supine position. An about 3cm in length wound was opened along the previous wound at left frontal region. The previous bur hole at left Kocher^s point was exposed. We punched the left lateral ventricle, and an about 6.2cm in length EVD was inserted. The EVD was fixed and the wound was closed in layers Operators P 杜永光 Assistants R6 陳睿生 Indication Of Emergent Operation 許達昕 (M,1966/01/07,46y2m) 手術日期 2010/09/21 手術主治醫師 杜永光 手術區域 東址 003房 03號 診斷 Brain Tumor 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3E 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 20:34 報到 20:34 進入手術室 20:40 麻醉開始 20:50 誘導結束 21:00 手術開始 21:40 抗生素給藥 21:45 開始輸血 23:30 00:20 00:50 抗生素給藥 02:10 麻醉結束 02:10 手術結束 02:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 硬腦膜外血腫清除術 1 2 R 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Lactic Acid (lactate) 2 0 摘要__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 蔡翊新 開立時間: 2010/09/22 02:12 Pre-operative Diagnosis Right CP angle epidermoid cyst s/p presigmoid approach for tumor excision, with cerebellar and cerebral infarction, severe brain swelling and hydrocephalus. Post-operative Diagnosis Right CP angle epidermoid cyst s/p presigmoid approach for tumor excision, with cerebellar and cerebral infarction, severe brain swelling and hydrocephalus. Operative Method 1. Suboccipital craniectomy, duroplasty and right Frazier EVD. 2. Right frontotemporoparietal craniectomy for epidural hematoma evacuation, duroplasty and subdural ICP monitoring. Right temporal muscle excision. Specimen Count And Types nil Pathology Nil. Operative Findings CSF gushed out upon ventricular puncture. Initial pressure was greater than 25 cmH2O. Very tight dura was noted upon suboccipital craniectomy. Right cerebellar hemisphere showed hemorrhagic transformation after infarction. There was eipdural blood clot at right posterior temporal region, 0.5 cm in thickness. The dura was very tight after right frontotemporoparietal craniectomy. The brain bulged out rapidly after dural incision. The brain surface was very pale, the cortical vessels showed dark purple change without evidence of blood flow in them, and there was no brain pulsation. ICP after skin closure was 25 mmHg. Operative Procedures Under general anesthesia via endotracheal intubation, the patient was placed in a prone position with head fixed by a Mayfield skull clamp. The skin was shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. An EVD was inserted to the occipital horn of right lateral ventricle via the right Frazier point. The skin was incised in the midline at occipital and posterior neck. Suboccipital craniectomy, 10 x 6 cm, was made. The dura was incised in a Y-shaped fashion and duroplasty was performed with a piece of 7.5 x 7.5 cm Duroform. The wound was closed in layers with an epidural CWV drain. The patient was turned to a supine position with head rotated to left. The skin was prepared as routine and incised as a trauma flap including part of previous wound at right temporal area. The temporalis muscles was incised down to the tempoal squama. The temporalis muscle was detached from temporal squama by rasp subsequently. A craniectomy, 14 x 12 cm, was created by making 3 burr holes then cut by power saw. Dural tenting was performed by 2/0 silk, 2.5 cm in interval, distributed along the edge of skull window. The epidural hematoma was evacuated. The dura was incised curvilinearly along the edge of skull window. Duroplasty was performed with a piece of 12 x 10 cm Duroform. The skull plate was removed and stored in the bone bank for preservation. Galea suture was performed by continuous suture with 1/0 Vicryl and skin by continuous suture with 2/0 nylon. Two epidural CWV drain was set. Remarks: 1. Blood transfusion: FFP 6U, PRBC 2U, Whole blood 8U. 2. Blood loss: 1300 ml. Operators P杜永光VS蔡翊新 Assistants R6陳睿生R5鍾文桂 Indication Of Emergent Operation 江福修 (M,1958/12/28,53y2m) 手術日期 2010/09/21 手術主治醫師 蔡瑞章 手術區域 東址 023房 05號 診斷 Herniated Intervertebral Disc ( HIVD ) 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 傅紹懷, 時間資訊 00:00 臨時手術NPO 13:52 報到 14:08 進入手術室 14:16 麻醉開始 14:20 誘導結束 15:00 抗生素給藥 15:00 手術開始 17:00 手術結束 17:00 麻醉結束 17:10 送出病患 17:15 進入恢復室 18:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 椎間盤切除術－腰椎 1 1 記錄__ 手術科部: 外科部 套用罐頭: HIVD 開立醫師: 傅紹懷 開立時間: 2010/09/21 17:24 Pre-operative Diagnosis HIVD, L5~S1 Post-operative Diagnosis HIVD, L5~S1 Operative Method L5~S1 diskectomy Specimen Count And Types nil Pathology nil Operative Findings L5~S1 ruptured disc, whitish and soft Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: prone. 3. Skin preparation: the back was scrubbed with povidone-iodine detergent then painted with povidone-iodine tincture and followed by sterilized adhesive plastic sheet covering. 4.A spinal needle was inserted between spinous processes of L5-S1 and a portable X-ray film was taken to locate the correct interspace. 5.Incision: 2-cm, between L5~S1-spinous processes,off-midiline at the right margin of spinous processes. The subcutaneous layer and lumbdorsal fascia were incised then. 6.The aponeurosis of the latissimus dorsi and ileocostalis lumborum muscles at spinous processes of L5--S1 was incised, the muscles were detached from the interspinous ligament. The multifidus muscles were detached subperiosteally from L5-S1 laminae by a rasp. 7.The paravertebral muscles were retracted by a modified narrow Taylor retractor which was retained constantly by a rubbersling to the side rail of the operating table. 8.Under an operating microscope, the ligamentum flavum was cleaned and incised longitudinally at the lateral part with a No. 11 blade. The lateral portion of this ligament was removed with a small angle Kerrison rongeur, the lateral portion of the laminae and the medial border of the facets were removed too until the margin of the facets and a corridor to the disc that ran lateral to the root was reached. 9. The epidural fat was left undisturbed and preserved. 10.The compressed S1 root and veins overlying the protruded disc were gently pushed away by placing 2 small cottonoid patties, one above and one below the disc at the floor of the epidural canal. 11.The compressed root was gently pushed further away temporarily by sucker tip in order to expose the herniated disc more clearly. The posterior longitudinal ligament and annulus were incised around the protruded disc with a No. 15 blade. The degenerated disc was removed with microdisc forcepsuntil a substantial amount of the nucleus had been loosened with a cone curette and removed. 12.The lumbodorsal fascia was approximated by 3 interruped 2/0 silk stitches. 13.The subcutaneous layer was closed by continuous suture with 4/0 Dexon and skin by adhesive tape. 14.Course of the surgery: smooth. Operators 王國川 Assistants 傅紹懷 李文金 (M,1954/10/31,57y4m) 手術日期 2010/09/21 手術主治醫師 洪學義 手術區域 東址 009房 03號 診斷 Coronary artery disease, post percutaneous transluminal coronary angioplasty (PTCA) 器械術式 Debridment-- >10cm 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 脊髓麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 官振翔, 時間資訊 12:20 進入手術室 12:30 麻醉開始 12:35 誘導結束 12:52 手術開始 13:25 手術結束 13:25 麻醉結束 13:30 送出病患 13:31 進入恢復室 14:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Spinal anesthesia 1 0 手術 區域筋膜切除術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Debridement 開立醫師: 官振翔 開立時間: 2010/09/21 13:36 Pre-operative Diagnosis LEft thigh GSV wound infection Post-operative Diagnosis LEft thigh GSV wound infection Operative Method Regional fasciectomy Specimen Count And Types culture*2 and patho*1 Pathology Nil Operative Findings 1. Muich pus accumulation and fatty necrosis over inferior side of left thigh with panniculitis Operative Procedures Under general anesthesia, the patient lied in supine position. Antiseptics applied and draped as usual. Debridement performed. Normal saline irrigation. Wound underwent wet dressing. Operators 洪學義, Assistants 官振翔, 黃柏誠, 黃瑞龍 (M,1947/12/25,64y2m) 手術日期 2010/09/21 手術主治醫師 曾勝弘 手術區域 東址 001房 01號 診斷 Malignant neoplasm of bronchus and lung, unspecified 器械術式 Craniotomy (A.V.M.) VS-TZENG 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 07:13 通知急診手術 08:37 報到 08:55 進入手術室 09:00 麻醉開始 09:20 誘導結束 10:50 抗生素給藥 10:54 手術開始 14:00 抗生素給藥 17:10 麻醉結束 17:10 手術結束 17:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 8 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除－手術時間在４小時以內 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Right temporal and occipital craniotomy for t... 開立醫師: 胡朝凱 開立時間: 2010/09/21 17:03 Pre-operative Diagnosis Right temporal and occipital metastatic tumor Post-operative Diagnosis Right temporal and occipital metastatic tumor Operative Method Right temporal and occipital craniotomy for total tumor excision Specimen Count And Types Two pieces of tumor. Pathology pending Operative Findings 1.One about 1 cm reddish, elastic firm tumor located at right inferior temporal gyrus with well defined margin was noted. 2.Another one about 4 cm reddish, hypervascular, elastic firm tumor with thick capsule located at right occipital lobe with attachment of dura. It also had well defined margin with brain parenchyma. Operative Procedures 1.ETGA, supine with head rotate to left and fixed with skull clamp 2.Right temporal reverse U shape skin incision 3.Reflect the skin flap 4.Craniotomy 5.dural tenting 6.Open dura 7.Tumor dissection along with the border between tumor and brain 8.Hemostasis 9.Close wound in layers 10.Right occipital reverse U shape skin in incision 11.craniotomy 12.Excised the dura and detach the attachment of tumor capsule from dura 13.Resect tumor piece by piece 14.Hemostasis 15.Close dura with fascia 16.fixed bone back with wires 17.Close wound in layers. Operators 曾勝弘 Assistants 胡朝凱, 林哲光 Indication Of Emergent Operation 張李清香 (F,1942/10/26,69y4m) 手術日期 2010/09/21 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Herniation of intervertebral disc 器械術式 C5/6 HIVD 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳德福, 時間資訊 00:00 臨時手術NPO 07:43 報到 08:03 進入手術室 08:20 麻醉開始 08:30 誘導結束 08:35 抗生素給藥 09:09 手術開始 10:57 手術結束 10:57 麻醉結束 11:05 送出病患 11:10 進入恢復室 12:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術－頸椎 1 1 L 麻醉 Peripheral arterial line inserti 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 外科部 套用罐頭: Anterior cervical diskectomy and fusion with ... 開立醫師: 陳德福 開立時間: 2010/09/21 11:15 Pre-operative Diagnosis Cervical HIVD with spinal stenosis and radiculopathy, C5-6 Post-operative Diagnosis Cervical HIVD with spinal stenosis and radiculopathy, C5-6 Operative Method Anterior cervical diskectomy and fusion with artificial cage Specimen Count And Types nil Pathology NIL Operative Findings 1.There is herniated disc with severe osterphytes formation at the C5-6 level. The bilateral nerve foramina were stenotic and the osteophytes was removed for decompression the nerve roots and spinal cord. 2.The C5-6 disc was removed and one No#7 cervical cage was implanated at the C5-6 level smoothly. Operative Procedures Under ETGA and supine position with neck hyperextension, the skin was disinfected and draped as usual. One linear incision along the skin crease on the left anterior neck was done and the platysma was transected. The areolar plane between the anterior catotid sheath and the cervical muscle was identified. The prevertebral space of C5-6 was found and we check the location under flouroscope. The longus coli muscle was mildly detached and we set Caspar retractor to expose the anterior C5-6 space. The ALL was opened and the C5-6 disc was removed by curretage and aligator. The osteophyte was removed by air-drill and Kerrison. The PLL was opened the expose the dura. The bilateral nerve foramina was decompressed and the thecal sac reexpanded well. One No#7 cervical cage was inserted in the C5-6 space anteriorly. After hemostasis, the wound was closed in layers. Operators AP 曾勝弘 Assistants R5 陳德福 相關圖片 周榮田 (M,1971/04/21,40y10m) 手術日期 2010/09/21 手術主治醫師 曾勝弘 手術區域 東址 005房 02號 診斷 Neuropathy 器械術式 Left 2nd finger mass lesion 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 陳德福, 時間資訊 08:00 臨時手術NPO 10:55 報到 11:13 進入手術室 11:30 麻醉開始 11:31 抗生素給藥 11:31 誘導結束 11:32 手術開始 11:38 麻醉結束 11:38 手術結束 11:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 高頻熱凝療法 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Left digital finger pulsed radiofrequency 開立醫師: 陳德福 開立時間: 2010/09/21 11:56 Pre-operative Diagnosis Left digital finger neuroma with intractable pain Post-operative Diagnosis Left digital finger neuroma with intractable pain Operative Method Left digital finger pulsed radiofrequency Specimen Count And Types nil Pathology nil Operative Findings 2 cycles of PRF for the left medial digital finger wer done smoothly. [120 seconds, 42 C] Operative Procedures Under LA and the skin was disinfected and draped as usual, the RF needle was inserted. 2 cycles of PRF for the left medial digital finger wer done smoothly. [120 seconds, 42 C] The wound was covered by gauze. Operators AP 曾勝弘 Assistants R5陳德福 蔡劉阿玉 (F,1937/12/28,74y2m) 手術日期 2010/09/21 手術主治醫師 曾勝弘 手術區域 東址 005房 03號 診斷 Lumbar Spondylosis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 陳德福, 時間資訊 00:00 臨時手術NPO 11:45 報到 12:00 進入手術室 12:15 麻醉開始 12:45 誘導結束 12:45 抗生素給藥 13:01 手術開始 14:30 開始輸血 15:45 抗生素給藥 16:00 手術結束 16:00 麻醉結束 16:10 送出病患 16:12 進入恢復室 17:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術－後融合，無固定物 1 2 手術 椎弓切除術（特壓）－超過二節 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: 1.L3-5 laminectomy 2.L3-5 posterior lateral f... 開立醫師: 陳德福 開立時間: 2010/09/21 16:09 Pre-operative Diagnosis Lumbar spondylolisthesis with spinal stenosis, L3-5 Post-operative Diagnosis Lumbar spondylolisthesis with spinal stenosis, L3-5 Operative Method 1.L3-5 laminectomy 2.L3-5 posterior lateral fusion Specimen Count And Types nil Pathology nil Operative Findings 1.Grade I listhesis of L4 on L5 with neural foramen stenosis 2.The hypertrophic ligamentum flavum is notice over L3-5 level 3.The thecal sac expanded well after laminectomy 4.Autologous bone posterior lateral fusion over L3-5 is performed Operative Procedures 1.ETGA, prone 2.Midline skin incision 3.Detach paravertebral muscle to expose lamina and transverse process of L3~5 4.Laminectomy of L3~5 5.Further widening for exposing L3~5 roots 6.Decortication of L3~5 facet and transeverse process 7.Put bone chips and artificial bone graft to the space 8.Set one hemovac drain then close wound in layers. Operators P 曾勝弘 Assistants R5陳德福 相關圖片 陳佳昀 (F,2010/09/11,1y6m) 手術日期 2010/09/21 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Meningocele 器械術式 Cord untethering -KUO 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 08:20 進入手術室 08:25 麻醉開始 08:40 誘導結束 09:10 抗生素給藥 09:20 手術開始 10:10 手術結束 10:10 麻醉結束 10:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦膜或脊髓突出修補術 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 套用罐頭: Repair of meningocele manque 開立醫師: 李振豪 開立時間: 2010/09/21 10:25 Pre-operative Diagnosis Spinal bifida with meningocele manque Post-operative Diagnosis Spinal bifida with meningocele manque Operative Method Repair of meningocele manque Specimen Count And Types 1 piece About size:1X0.3cm Source:atresic meningocele manque Pathology Pending Operative Findings The atresic meningocele manque is connected to the lipoduroneural junction by a plane of fibrotic lipomatous tissue. There was a small bony defect around 0.5x0.5 cm in size at S3 level. Mild CSF leakage was noted during the operation and repaired. The intrathecal space is not entered during the whole procedure because the structure was too small at this age, we would like to performed untethering when she grows up and has a larger stucture.. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in prone position. The skin was scrubbed, disinfected and draped as usual. The fusiform skin incision was made along the meningocele manque. Under microscopic view, the subcutaneous soft tissue was dissected and the atresic meningocele manque was resected. Hemostasis was achieved. a layer of fascia was dissected and repaired with 5-0 silk. The defect was repaired with 4-0 vicryl and 5-0 Nylon. Operators AP郭夢菲 Assistants R4李振豪 相關圖片 黃柏浩 (M,2000/02/19,12y0m) 手術日期 2010/09/21 手術主治醫師 郭夢菲 手術區域 兒醫 067房 02號 診斷 Malignant neoplasm of cerebellum 器械術式 Crainotomy Brain Tumor(P-LIN) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 10:08 報到 11:00 進入手術室 11:07 麻醉開始 11:40 誘導結束 12:10 抗生素給藥 12:17 手術開始 15:10 抗生素給藥 18:00 開始輸血 18:20 抗生素給藥 21:20 抗生素給藥 21:52 麻醉結束 21:52 手術結束 22:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 14 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 3 0 麻醉 動脈血液檢查全套 3 0 麻醉 Hemoglobin (Hb) 3 0 麻醉 測血糖 3 0 麻醉 Ca (Calcium) 3 0 麻醉 Na (Sodium) 3 0 麻醉 K (Potassium) 3 0 麻醉 Blood gas analysis 3 0 手術 腦瘤切除－手術時間在８小時以上 1 1 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 記錄__ 手術科部: 外科部 套用罐頭: 1. Suboccipital craniotomy for tumor excision... 開立醫師: 李振豪 開立時間: 2010/09/21 22:32 Pre-operative Diagnosis Cerebellar tumor, suspect ependymoma or medulloblastoma Cerebellar tumor, suspect ependymoma or medulloblastoma and hydrocephalus Post-operative Diagnosis Cerebellar medulloblastoma Cerebellar medulloblastoma and hydrocephalus Operative Method 1. Suboccipital craniotomy for tumor excision, 2. Right Frazier"s external ventricular drainage 1. Suboccipital craniotomy for tumor excision, 2. Right Frazier"s external ventricular drainage for ICP monitoring Specimen Count And Types 2 pieces About size:8ml Source:CSF About size:multiple small pieces, 2cm3 Source:cerebellar tumor Pathology Frozen section: medulloblastoma Operative Findings The tumor was white-yellowish after opened the dura. After opened the capsule of the tumor, the tumor became reddish and hypervascularized. The character is soft and fragile in most part. The tumor adhered to vermis, left side cerebellar hemisphere, and lower medulla tightly and thin layer of tumor was left in situ to avoid further damage of brainstem. The anterior wall of 4th ventricle and the outlet of aqueduct was exposed after removal of the tumor. One large artery that encased by the tumor was preserved. The tumor was pinkish and hypervascular. It was larger than 5 cm in diameter. The character of the tumor was soft and fragile in most part and elastic in some part. The tumor originated from the left dorsal surface of the pons and medulla oblongata (the left ventricuflar floor) that made grossly total excision impossible. The tumor extended to the both foramen of Luschka, especially the left side. It also extended posteriorly to the foramne of Magendie, whihc was enlarged markedly that there was no need to incise the vermis for removal of the tumor. The tumor extended downward to the C1 lvele. The aqueduct was exposed well and became patent after removal of the tumor. One large artery that encased by the tumor, came from left cerebellar hemisphere and crossed the dorsal 4th ventricle and went to the right side of vermis, was preserved. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in prone position with head fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. The right occipital vertical, linear scalp incision was made over Frazier"s point. One burr hole was created and two dural tenting was performed. The dura was opened with cruciform and ventricular puncture was performed. The EVD was placed and the function was checked. Externalization was done and the EVD was fixed at 10cm in depth from burr hole. Hemostasis was achieved and the wound was closed in layers with 3-0 Vicryl and 4-0 Nylon. Under endotracheal tube general anesthesia, the patient was put in prone position with head fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. The right occipital vertical, linear scalp incision was made over Frazier"s point. One burr hole was created and two dural tenting was performed. The dura was opened with cruciform and ventricular puncture was performed. The EVD was placed and the function was checked. Externalization was done and the EVD was fixed at 10cm in depth from burr hole. Hemostasis was achieved and the wound was closed in layers with 3-0 Vicryl and 4-0 Nylon. Midline skin incision was made from inion to C2 level. The subcutaneous soft tissue and nuchal muscle group was detached to exposed the suboccipital area and posterior ring of C1. The posterior ring of C1 was removed with high-speed air-drived drills. Four burr hole was made and suboccipital craniectomy was done. The dura was opened with V-shape. The tumor was noted after opening of the dura. Under operative microscope, the tumor was removed with microdissector, tumor forceps, bipolar cautery, and sucker. The anterior wall of 4th ventricle and aqueduct was exposed after removal of the tumor. Hemostasis was achieved with bipolar electrocautery and Surgicel lining. The normal saline solution was infused from EVD to deair. The dura was closed with 4-0 Prolene. One 5x5cm Duraform was placed. The skull plate was fixed back with #26 wires. One CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Midline skin incision was made from inion to C2 level. The subcutaneous soft tissue and nuchal muscle group was detached to exposed the suboccipital area and posterior ring of C1. The posterior ring of C1 was removed with high-speed air-drived drills. Four burr hole was made and suboccipital craniectomy was done. The dura was opened with Y-shape. The tumor was noted after opening of the dura. Under operative microscope, the tumor was removed with microdissector, tumor forceps, bipolar cautery, and sucker. The anterior wall of 4th ventricle and aqueduct was exposed after removal of the tumor. The tumor over the left foramen of Luschka was removed as much as possible. Hemostasis was achieved with bipolar electrocautery and Surgicel lining. The normal saline solution was infused from EVD to deair. The dura was closed with 4-0 Prolene. One 5x5cm Duraform was placed. The skull plate was fixed back with #26 wires. One CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators AP郭夢菲 Assistants R4李振豪 徐一平 (F,1963/01/25,49y1m) 手術日期 2010/09/21 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Facial spasm 器械術式 retrosigmoid approach for MVD 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:08 進入手術室 08:15 麻醉開始 08:50 誘導結束 09:03 抗生素給藥 09:03 手術開始 13:05 抗生素給藥 14:10 麻醉結束 14:10 手術結束 14:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦微血管減壓術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Microvascular decompression of right facial n... 開立醫師: 李柏穎 開立時間: 2010/09/21 14:55 Pre-operative Diagnosis Hemifacial spasm, right Post-operative Diagnosis Hemifacial spasm, right Operative Method Microvascular decompression of right facial nerve. Specimen Count And Types nil Pathology nil Operative Findings Compression of CN VII/VIII complex by right AICA loop. Teflon cotton was inserted to seperate AICA loop and CN VII/VIII complex. Operative Procedures Under ETGA, the patient was placed in 3/4 prone position and the head was tilted to the left. After disinfection and draping, a curvilinear incision was made at retroauricular area and pterion was exposed. Then a 3x3 cm craniotomy was made via retrosigmoid approach. The transverse-sigmoid junction as anterior border. After durotomy, the cerebellum was retracted posteriorly until the CN VII/VIII, and lower cranial nerves were identified. Teflon cotton was placed to seperate the AICA from the CN VII/VIII complex. The pulsation of CN VII decreased after decompression. The dura mater was closed by 4-0 Prolene. After placing one CWV drain, the wound was closed in layers. Operators V.S. 賴達明 Assistants R5鍾文桂 R1李柏穎 簡傳楊 (M,1959/10/13,52y5m) 手術日期 2010/09/22 手術主治醫師 李章銘 手術區域 東址 001房 06號 診斷 Esophagus, malignant 器械術式 Laparoscope jejunostomy 手術類別 緊急手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3E 紀錄醫師 蔡東明, 時間資訊 00:48 開始NPO 00:48 臨時手術NPO 00:48 通知急診手術 05:20 進入手術室 05:30 麻醉開始 05:35 誘導結束 06:00 抗生素給藥 06:20 手術開始 07:30 08:15 手術結束 08:15 麻醉結束 08:20 送出病患 08:20 進入恢復室 09:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 腹腔鏡空腸造廔術 1 1 B 手術 ｐｏｒｔ–Ａ導管植入術–治療性導管植入術 1 0 B 記錄__ 手術科部: 內科部 套用罐頭: laparoscopic jejunostomy + Port-A implantation 開立醫師: 蔡東明 開立時間: 2010/09/22 08:15 Pre-operative Diagnosis Esophageal cancer Post-operative Diagnosis Esophageal cancer Operative Method laparoscopic jejunostomy + Port-A implantation Specimen Count And Types nil Pathology None Operative Findings 1.On feeding jejunostomy was created at the jejunum, 35cm below Treitz. 2.one Port-A catheter was inserted at right sublcavian vein by puncture method. CXR showed that the catheter tip is in correct position. The blood flow is smooth. Operative Procedures 1.ETGA, supine position 2.Skin disinfection and drapping 3.Laparoscopic setting 4.Under laparoscopic guided, one CVC jejunostomy tube was inserted smoothly 5.Close the wound in layers 6.Disinfection for right upper chest 7.Insertion of Port-A catheter in right subclavian vein in puncture method. 8.Close the wound in layers. Operators VS李章銘 Assistants R4蔡東明 R1李柏潁 Indication Of Emergent Operation 吳正義 (M,1939/12/10,72y3m) 手術日期 2010/09/23 手術主治醫師 曾勝弘 手術區域 東址 003房 02號 診斷 Brain tumor 器械術式 Crainotomy Brain Tumor(P-LIN) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 古恬音, 時間資訊 10:40 報到 10:50 進入手術室 10:55 麻醉開始 11:15 誘導結束 11:30 手術開始 11:40 抗生素給藥 14:40 手術結束 14:40 抗生素給藥 14:40 麻醉結束 14:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除－手術時間在４～８小時 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: cranitomy tumor excision 開立醫師: 陳德福 開立時間: 2010/09/23 15:00 Pre-operative Diagnosis right cerebral cystic tumor, suspect metastatic lesion Post-operative Diagnosis right cerebral cystic tumor, suspect metastatic lesion Operative Method cranitomy tumor excision Specimen Count And Types 1 piece About size:3*2*2CM Source:right cerebral tumor Pathology pending Operative Findings 1.There is a cystic tumor at the right intracerebral area with compression to the sensory and motor cortex from parietal lobe. Previous bleeding in the cavity is noticed. The tumor wall is reddish and fragile. 2.The tumor was removed via transsulcus route and the cystic tumor was nearly total rmoved. The occipital horn of lateral ventricle is reached at the end of tumor removal. 3.Intra-OP ultrasonography, SSEP and ECoG were performed. Operative Procedures Under ETGA and supine position, the cranial vault was fixed wiht Mayfield pin type head fixator. The scalp was disinfected and draped as usual. One reverse U shape incision was done and the 8*8cm craniotomy was performed. The dura tenting followed by dura opening in C shape was done. The intra-OP ultrasonography is done for localizing the cystic tumor. The transsulcus appraoch for tumor removal is done and the tumor was removed with suckers, tumor forceps, and bipolar coagulator assisted. While the ventricle is exposed, we stopped the tumor removal. Hemosstasis was done and the skull was fixed with miniplates. The wound was closed in layers. Operators AP 曾勝弘 Assistants R5陳德福 R3王奐之 R3古恬音 王新潔 (F,1972/06/20,39y8m) 手術日期 2010/09/23 手術主治醫師 曾勝弘 手術區域 東址 005房 02號 診斷 Cellulitis 器械術式 Debridment-- >10cm 手術類別 預定手術 手術部位 胸 傷口分類 髒 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾峰毅, 時間資訊 11:02 報到 11:27 進入手術室 11:30 麻醉開始 11:35 誘導結束 11:48 抗生素給藥 11:57 手術開始 12:30 手術結束 12:30 麻醉結束 12:38 送出病患 12:40 進入恢復室 14:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 簡單胸廓擴創術＜１０公分 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Wound debridement and primary closure of the ... 開立醫師: 曾峰毅 開立時間: 2010/09/23 12:45 Pre-operative Diagnosis Parkinsonism, status post bilateral deep brain stimulation, complicated with implanted pulse generator exposed at left chest Post-operative Diagnosis Parkinsonism, status post bilateral deep brain stimulation, complicated with implanted pulse generator exposed at left chest Operative Method Wound debridement and primary closure of the wound. Specimen Count And Types Wound was swabed for culture, and wound debris was sent for culture and pathology. Pathology Wound edge was excised and sent for pathology and culture. Operative Findings Pulse Operative Procedures We turned off the batter of pulse generator. With endotracheal general anaesthesia, the patient was put in supine position. After skin scrubbed, disinfected, and then draped, we extened the left chest wound linearly, and excised the wound edge. The wound was irrigated with gentamycin saline, and debridement was done with curettes. The wound was closed in layers after hemostasis. Operators VS 曾勝弘 Assistants R4 曾峰毅 李秀玫 (F,1980/06/21,31y8m) 手術日期 2010/09/23 手術主治醫師 曾漢民 手術區域 東址 005房 03號 診斷 Pituitary tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 污染 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾峰毅, 時間資訊 13:05 報到 13:09 進入手術室 13:12 麻醉開始 13:20 誘導結束 13:52 手術開始 14:47 手術結束 14:47 麻醉結束 14:55 送出病患 14:57 進入恢復室 16:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 頭顱成形術 1 1 手術 肌肉或深部組織腫瘤切除術及異物取出術 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Trans-sphenoidal approach for CSF leakage rep... 開立醫師: 曾峰毅 開立時間: 2010/09/23 15:01 Pre-operative Diagnosis Status post trans-sphenoidal surgery, complicated with CSF rhinorrhea Post-operative Diagnosis Status post trans-sphenoidal surgery, complicated with CSF rhinorrhea Operative Method Trans-sphenoidal approach for CSF leakage repair with autologous fat graft. Specimen Count And Types CSF was sent for routine, BCS, and culture. Pathology Nil Operative Findings Clear colorless CSF gushed out while we removed previously placed gelfoam and bone graft. The leakage was stopped and sealed after repairment. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head tilted to left and neck extended. After scrubbed, disinfected, and then draped, we made one transverse skin incision at left lower abdomen, and dissected to harvest autologous fat graft. We approach sellar region through trans-sphenoidle corridor via right nostril. Previously placed bone graft and gelfoam was removed. We packed the leakage with autologou fat graft, bone graft, and Tissucol-Duo. The abdomen wound was closed in layers. Operators VS 曾漢民 Assistants R4 曾峰毅 陳許寶雲 (F,1935/07/18,76y7m) 手術日期 2010/09/23 手術主治醫師 林峰盛 手術區域 西址 035房 02號 診斷 Failed back syndrome 器械術式 Nerve block / PC 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 林峰盛 ASA 3 時間資訊 12:30 報到 13:10 進入手術室 13:15 麻醉開始 13:18 誘導結束 13:22 手術開始 14:10 麻醉結束 14:10 手術結束 14:15 送出病患 記錄__ 手術科部: 麻醉部 套用罐頭: Pulsed RF 開立醫師: 林怡萱 開立時間: 2010/09/23 14:14 Pre-operative Diagnosis Failed back syndrome Post-operative Diagnosis Failed back syndrome Operative Method 1. IV sedation with midazolam and LA with 1% xylocaine 2. pt in prone position 3. Under fluoroscopic-guidance, insert 22 G SMK RF meedle into L3-L5 neuroforamen 4. Neurostimulation with 50 HZ and 2 Hz 0.1-0.5 mV current with positive result 60-80V 2 Hz, 20 ms, 120sec *2 pulsed RF was delivered send pt to POR Specimen Count And Types nil Pathology Nil Operative Findings Operative Procedures Pulsed RF Operators 林峰盛, Assistants 林怡萱, 陳子文 (M,1934/01/13,78y2m) 手術日期 2010/09/23 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Cerebral hemorrhage 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 古恬音, 時間資訊 08:30 報到 08:30 進入手術室 08:35 麻醉開始 08:40 誘導結束 09:00 抗生素給藥 09:15 手術開始 10:20 麻醉結束 10:20 手術結束 10:25 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦室腹腔分流手術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt, Left Kocher point 開立醫師: 陳德福 開立時間: 2010/09/23 10:39 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method V-P Shunt, Left Kocher point Specimen Count And Types nil Pathology nil Operative Findings 1.There is clear and colorless CSF drained out after ventricular tapping. 2.The intraventricular catheter:6.5cm ; intraperitoneal catheter:20cm 3.One Metronic, fixed pressure valve[medium pressure] was implatated at the left Kocher point. Operative Procedures 1.under ETGA and supine position 2.skin disinfection and draping 3.curvilinear incision over left frontal and burr hole creation 4.left upper abdomen minilaparotomy 5.subcutaneous tunneling 6.ventricular tapping and insert the intraventricular catheter 7.connect the shunt system 8.check the shunt function 9.close the wound in layers. Operators VS賴達明 Assistants R5陳德福 R3古恬音 闕和松 (M,1965/09/17,46y5m) 手術日期 2010/09/23 手術主治醫師 陳敞牧 手術區域 東址 005房 01號 診斷 Herniation of intervertebral disc, lumbar (HIVD) 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾峰毅, 時間資訊 07:30 報到 08:05 進入手術室 08:10 麻醉開始 08:20 誘導結束 08:35 抗生素給藥 09:05 手術開始 11:02 手術結束 11:02 麻醉結束 11:15 送出病患 11:20 進入恢復室 12:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術－腰椎 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 摘要__ 手術科部: 外科部 套用罐頭: HIVD 開立醫師: 曾峰毅 開立時間: 2010/09/23 11:07 Pre-operative Diagnosis L5/6 intervertebral disc extrution L5/6 intervertebral disc extrusion Post-operative Diagnosis L5/6 intervertebral disc extrution L5/6 intervertebral disc extrusion Operative Method Microdiskectomy of L5/6 Specimen Count And Types Nil Pathology Nil Operative Findings Thecal sac buldged after laminotomy. Extruded disc was removed, and the thecal sac was decompressed. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. The lesion was locolized by C-arm. After skin scrubbed, disinfeted, and the draped, we made one linear midline skin incision from L5 to L6. We dissected the right paraspinal muscle, and laminotomy between L5 and L6 was done. Microdiskectomy was performed. The wound was closed in layers. Operators VS 陳敞牧 Assistants R6陳睿生 R4曾峰毅 林政道 (M,1958/10/26,53y4m) 手術日期 2010/09/23 手術主治醫師 蕭輔仁 手術區域 東址 003房 03號 診斷 Cervical spondylosis 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳德福, 時間資訊 15:04 進入手術室 15:10 麻醉開始 15:15 誘導結束 15:45 抗生素給藥 15:57 手術開始 18:20 手術結束 18:20 麻醉結束 18:27 進入恢復室 18:30 送出病患 19:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 脊椎融合術－前融合，無固定物（＜＝四節） 1 2 手術 椎間盤切除術－頸椎 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: ACDF with autologous iliac crest graft 開立醫師: 陳德福 開立時間: 2010/09/23 18:35 Pre-operative Diagnosis c3-4 HIVD with cord compression Post-operative Diagnosis c3-4 HIVD with cord compression Operative Method ACDF with autologous iliac crest graft Specimen Count And Types nil Pathology nil Operative Findings 1.There C3-4 protruding disc compress the spinal cord and bilateral roots with spurs formation. The theca sac reexpanded well after discectomy and one autologous bone graft from right anterior superior iliac crest was harvested for anterior fusion. Operative Procedures 1.Under ETGA and supine position 2.skin disinfection and draping 3.transverse incision on right neck and dissect till the prevertebral space 4.The location of C3-4 was checked with C-arm fluoroscope 5.anterior diskectomy was performed under microscopic surgery 6.harvest autologous bone graft from right anterior superior iliac crest was harvested for anterior fusion. 7.impact the bone graft at the C3-4 8.left one CWV in situ, neck 9.close the wound in inayers. Operators VS蕭輔仁 Assistants R5陳德福 R1傅紹懷 相關圖片 邱明月 (F,1968/11/02,43y4m) 手術日期 2010/09/24 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Trigeminal neuralgia (Cranial nerve V) 器械術式 Microvascular decompression 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 2 紀錄醫師 王奐之, 時間資訊 07:42 報到 08:05 進入手術室 08:15 麻醉開始 08:35 誘導結束 08:53 手術開始 09:15 抗生素給藥 12:15 抗生素給藥 12:35 麻醉結束 12:35 手術結束 12:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦微血管減壓術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Retrosigmoid approach for microvascular decom... 開立醫師: 王奐之 開立時間: 2010/09/24 13:06 Pre-operative Diagnosis Right side trigeminal neuralgia Post-operative Diagnosis Right side trigeminal neuralgia Operative Method Retrosigmoid approach for microvascular decompression Specimen Count And Types Nil Pathology Nil Operative Findings A small vein was noted attaching to CN V near the root exit zone, but no offending artery was found. AICA was noted in operative field but no adjacent relationship to CN V. Operative Procedures After ETGA, the patient was placed in supine position with face turned to left and head fixed with Mayfield skull clamp. After skin disinfection and draping in usual sterile fashion, a curvilinear retroauricular skin incision was made. After harvesting of fascial graft, the incision was deepened until the bone was exposed. The mastoid process and asterion were identified, a bean-shaped craniotomy was then made at retrosigmoid area. A curved durotomy was made, followed by dural tenting. The cisterna magna was then entered to allow CSF release; the cerebellum then sank downward, allowing exposure of CN V & CN VII/VIII without cerebellum retraction. After identifying the right side CN V with its surrounding structures, the small vein attached to it was electrocauterized and divided. The right side AICA was then pushed farther from CN V and a piece of Teflon was placed in between the vessel and the nerve. After meticulous hemostasis, the dura was closed with fascial graft in water-tight fashion. The bone was placed back, the slits in between the bones were packed with Gelfoam. The wound was then closed in layers. Operators P 杜永光 Assistants R6 胡朝凱, R3 王奐之 相關圖片 江許惠貞 (F,1950/04/03,61y11m) 手術日期 2010/09/24 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Trigeminal neuralgia (Cranial nerve V) 器械術式 Microvascular decompression 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 2 紀錄醫師 周聖哲, 時間資訊 07:40 報到 08:10 進入手術室 08:15 麻醉開始 09:00 誘導結束 09:40 抗生素給藥 09:45 手術開始 12:25 手術結束 12:25 麻醉結束 12:40 送出病患 12:40 抗生素給藥 醫令資訊 類別 名稱 量 刀 側 手術 腦微血管減壓術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Microvascular decompression 開立醫師: 陳睿生 開立時間: 2010/09/24 13:01 Pre-operative Diagnosis Left side trigeminal neuralgia Post-operative Diagnosis Left side trigeminal neuralgia Operative Method Microvascular decompression Specimen Count And Types nil Pathology Nil Operative Findings The left side 5th CN was noted to be compressed by a small artery. A small piece of teflon was packed between the artery and the CN V. Operative Procedures After ETGA, the patient was under 3/4 prone position and head was fixed with Mayfield clump. A curvillinear scalp incision was created at the left retrosigmoid region. The asteron was identify and two bur holes were made. The sigmoid sinus was identified, and then an about 5x5 cm craniotomy window was created. The dura was opened in a curvillinear shape with lateral extension. CSF was drained from the cistern Magnum. Then the cerebellum was retracted posteriorly to expose the CP angle. The CN V, VII, VIII were identified. A small artery was noted across the CN V. Then Telfon patch was packed between the artery and CN V. Hemostasis, the dura was closed with fascia graft. Then the wound was closed in layers. Operators VS 曾漢民 Assistants R6 陳睿生； R1 周聖哲 高玉賢 (F,1992/05/03,19y10m) 手術日期 2010/09/24 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Pituitary Tumor 器械術式 Microvascular decompression 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 2 紀錄醫師 周聖哲, 時間資訊 12:20 報到 13:10 進入手術室 13:15 麻醉開始 13:25 誘導結束 13:50 抗生素給藥 14:05 手術開始 15:25 麻醉結束 15:25 手術結束 15:35 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 經由蝶竇之腦下垂體瘤切除 1 1 R 手術 鼻中膈鼻道成形術－單側 1 2 R 摘要__ 手術科部: 外科部 套用罐頭: Trans-sphenoid approach for cyst remove 開立醫師: 陳睿生 開立時間: 2010/09/24 15:57 Pre-operative Diagnosis Sellar mass, suspect pituitary tumor, suspect cyst Post-operative Diagnosis Sellar mass, suspect Rathke^s cyst Operative Method Trans-sphenoid approach for cyst remove Specimen Count And Types nil Pathology Nil Operative Findings After opening of the anterior sellar floor, a thin layer of yellowish normal gland was noted. A cyst was noted and drained after pnentrating the gland. Neither obvious capsule nor organic mass lesion was noted. After cyst remove, the arachnoid membrane was found. Operative Procedures After ETGA, the patinet was under supine position and the head was right tilt. Bilateral nasal cavities were packed with Bosmin rinsed gauses for hemostasis. Then we incised into the right side nasal septal mucosa under microscope. The vomer bone was noted and removed with punch. The mucosa inside the sphenoid sinus was partially removed and the sellar floor was exposed. The anterior wall of sellar floor was removed and a thin layer of dura was noted. The dura was opened, and we found out the normal gland. The cyst was removed after gland penetrating. After all the arachnoid membrane fell. After hemostasis, the dura was closed with Tissuco-Dul assisted. Vomer bone graft was packed back and the septal mucosa was covered back. Operators VS 曾漢民 Assistants R6 陳睿生, R1 周聖哲 黃耀明 (M,1944/09/02,67y6m) 手術日期 2010/09/24 手術主治醫師 陳炯年 手術區域 東址 007房 01號 診斷 Parkinsonism (F02.3) 器械術式 Closure of PEG 手術類別 緊急手術 手術部位 腹 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 3 紀錄醫師 施廷翰, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 21:00 通知急診手術 07:50 報到 08:08 進入手術室 08:15 麻醉開始 08:20 誘導結束 08:30 抗生素給藥 08:59 手術開始 09:20 手術結束 09:20 麻醉結束 09:25 送出病患 09:30 進入恢復室 10:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 胃造口閉口 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: PEG removal 開立醫師: 施廷翰 開立時間: 2010/09/24 09:37 Pre-operative Diagnosis Parkinsonism Post-operative Diagnosis Parkinsonism Operative Method PEG removal Specimen Count And Types nil Pathology nil Operative Findings Internal bumper removed via EGD Operative Procedures 1. ETGA, supine 2. Perform EGD 3. Loop the internal bumper 4. Cut PEG tube externally 5. Pull out EGD with internal bumper Operators VS陳炯年 Assistants R3陳柏達 R1施廷翰 Indication Of Emergent Operation 鄧迅之 (M,1926/03/15,85y11m) 手術日期 2010/09/24 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3 紀錄醫師 鍾文桂, 時間資訊 08:10 進入手術室 08:25 麻醉開始 09:00 誘導結束 09:40 抗生素給藥 10:00 手術開始 12:15 開始輸血 12:40 抗生素給藥 14:40 手術結束 14:40 麻醉結束 14:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４～８小時 1 1 R 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 記錄__ 手術科部: 外科部 套用罐頭: Gross total tumor excision by right occipital... 開立醫師: 鍾文桂 開立時間: 2010/09/24 15:22 Pre-operative Diagnosis Right occipital-parietal-temporal tumor, suspect glioblastoma multiforme. Post-operative Diagnosis Glioblastoma multiforme,right occipital-parietal-temporal. Metastatic brain tumor,right occipital-parietal-temporal. Operative Method Gross total tumor excision by right occipital cranitomy. Specimen Count And Types 1 piece About size:30 cc Source:Brain tumor. Pathology Frozen pathology: glioblastoma multiforme. Frozen pathology: glioblastoma multiforme. Final pathology: metastatic tumor. suspect origin: lung cancer. Operative Findings Easy oozing tumor mass. Nearly the whole right occipital lobe was excised due to tumor invasion. The posterior part of falx and cerebral tentorium were met after tumor excision. Tumor: soft, grayish-red tumor with gliosis. Blood loss: 800 cc. Fluctuating blood pressure intraoperatively. Multiple bridging veins were met at temporal base. Operative Procedures Under ETGA, the patient was placed in prone position and the head was fixed by Mayfield. A Hokey-stick scalp incision was made at right occipital-parietal-temporal region. After craniotomy and dural tenting, durotomy based on proximal part of superior sagital sinus and transverse sinus was done. The tumor mass is just beneath the dura mater. We excised the tumor in piece meal fashion until the normal brain parenchyma was met. Well hemostasis was achieved by Flosseal and thrombin fluid contained surgicel. After placing one subgaleal CWV drain, the wound was closed in layers. The patient was sent to ICU smoothly. Operators V.S 賴達明 Assistants 鍾文桂 李伯穎 許吳素英 (F,1941/08/17,70y6m) 手術日期 2010/09/24 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Thoracic spondylosis 器械術式 Benign intraspinal tumor, exci 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 王奐之, 時間資訊 13:13 報到 13:24 進入手術室 13:27 麻醉開始 13:45 誘導結束 14:00 抗生素給藥 14:17 手術開始 16:35 手術結束 16:35 麻醉結束 16:45 送出病患 16:49 進入恢復室 17:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 良性病髓腫瘤切除術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: Left T9~11 hemilaminectomy for Simpson grade ... 開立醫師: 王奐之 開立時間: 2010/09/24 16:55 Pre-operative Diagnosis T10 intradural meningioma Post-operative Diagnosis T10 intradural meningioma Operative Method Left T9~11 hemilaminectomy for Simpson grade II tumor excision Specimen Count And Types 1 piece About size:1*0.5*0.5cm Source:T10 intradural tumor Pathology Pending Operative Findings One whitish soft tumor measuring about 1.5*1*0.5cm with clear margin was noted at T10 intradural space. The tumor was easily detached from the spinal cord, some was aspirated by CUSA and the rest was removed en bloc. No SSEP & MEP change were noted intra-operatively. Operative Procedures After ETGA, the patient was placed in prone position. T10 pedicle was localized with C-arm. After skin disinfection and draping in sterile fashion, a 10cm-long midline skin incision was made. The incision was deepened until the spinous process was exposed, then the left side paraspinal muscle were detached from the spine. T9-11 hemilaminectomy were done, allowing exposure of the thecal sac. A longitudinal paramedian durotomy was then made, followed by dural tenting. The tumor came into site, CUSA was used initially for tumor removal. After partial tumor removal, the margin between the tumor and the spinal cord was dissected, the rest of the tumor was then removed en bloc. The adjacent dura was eletrocauterized with bipolar electrocautery. After meticulous hemostasis, the dura was closed in water-tight fashion. After setting a CWV drain, the wound was closed in layers. Operators VS 賴達明 Assistants R6 胡朝凱, R3 王奐之 相關圖片 魏陳秀鑾 (F,1938/12/17,73y2m) 手術日期 2010/09/24 手術主治醫師 賴達明 手術區域 東址 019房 02號 診斷 Spondylolisthesis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 鍾文桂, 時間資訊 15:20 進入手術室 15:25 麻醉開始 15:30 抗生素給藥 15:40 誘導結束 16:18 手術開始 19:00 手術結束 19:00 麻醉結束 19:10 送出病患 19:15 進入恢復室 20:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術（特壓）－二節以內 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 記錄__ 手術科部: 外科部 套用罐頭: 1. Internal fixation with transpedical screws... 開立醫師: 鍾文桂 開立時間: 2010/09/24 18:53 Pre-operative Diagnosis Spondylolisthesis, L4/5. Post-operative Diagnosis Spondylolisthesis, L4/5. Operative Method 1. Internal fixation with transpedical screws and posterolateral fusion,L4/5. 2. Decompressive laminectomy,L5. Specimen Count And Types nil Pathology Nil. Operative Findings 1. Hypertrophic ligamentum flavum. 2. Transpedical screws: 6.2x40mmx 4; rods: 5 cm. 3. Intact dura mater. Operative Procedures Under ETGA, the patient was placed in prone position. The L4 and L5 pedicles were identified by intraoperative fluoroscope. After disinfection and draping, the midline incision was made and followed by paraspinal dissection until L4 and L5 facet joints were exposed. The transpedical screws were implanted and the internal fixation apparatus were fixed. The L5 laminectomy was achieved by Kerrison and Rongeur. Posterolateral fusion was done with autologous bone. After placing one epidural 1/8 hemovac, the wound was closed in layers. Operators V.S. 賴達明 Assistants 鍾文桂 李柏穎 黃哲鑑 (M,1940/05/26,71y9m) 手術日期 2010/09/24 手術主治醫師 蕭輔仁 手術區域 東址 002房 02號 診斷 Spinal metastasis 器械術式 T5-6 tumor excision, TPS 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 3E 紀錄醫師 林哲光, 時間資訊 02:30 臨時手術NPO 02:30 開始NPO 11:05 報到 11:35 進入手術室 11:44 麻醉開始 11:55 誘導結束 12:10 抗生素給藥 12:40 手術開始 15:10 抗生素給藥 18:00 抗生素給藥 18:40 麻醉結束 18:40 手術結束 18:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 惡性病髓腫瘤切除術 1 1 記錄__ 手術科部: 外科部 套用罐頭: T5-T8 laminectomy, T4-5 and T8-9 TPS, tumor b... 開立醫師: 林哲光 開立時間: 2010/09/24 19:48 Pre-operative Diagnosis Multiple spine metastasis, cervical, thoracic, and lumbar, with T6-7 spinal cord compression Post-operative Diagnosis Ditto Operative Method T5-T8 laminectomy, T4-5 and T8-9 TPS, tumor biopsy Specimen Count And Types 1 piece About size:multiple pieces Source:tumor Pathology Pending Operative Findings Preoperative paraplegia was noted and below T6 level sensory loss was also noted. Some reddish, soft-elastic mass lesion was noted over the bilateral side of the T6-7 spinal cord and tightly adherent to T6 roots. Dura sac bulging to the posterior side was also noted after laminectomy. 4 TPS (5.0x35mmx2, 5.5x40mm) were inserted into T4-5, T8-9 respectively with two rods and one cross link. Operative Procedures Under ETGA and prone position, skin disinfected and drapped were performed as usual. Midline skin incision was made and paraspinal muscles were detached. T5-8 laminectomy was performed after TPS were inserted over T4-5 and T8-9. Tumor biopsy was done. Hemostasis was then performed and the wound was then closed in layers after epidural CWV drain inserted. Operators VS 蕭輔仁 Assistants R4 林哲光, R4 李振豪, R4 曾峰毅, Ri 謝 Indication Of Emergent Operation 相關圖片 李子良 (M,1966/07/04,45y8m) 手術日期 2010/09/25 手術主治醫師 杜永光 手術區域 東址 005房 02號 診斷 Meningitis 器械術式 V-P shunt ligation and pneumoventricle drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 3E 紀錄醫師 胡朝凱, 時間資訊 11:00 臨時手術NPO 11:00 開始NPO 15:47 通知急診手術 17:44 進入手術室 17:50 麻醉開始 18:00 誘導結束 18:41 手術開始 19:30 麻醉結束 19:31 手術結束 19:42 送出病患 19:45 進入恢復室 20:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室體外引流 1 1 R 手術 肌肉或深部組織腫瘤切除術及異物取出術 1 2 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Right subclavicular shunt ligation and Left E... 開立醫師: 胡朝凱 開立時間: 2010/09/25 19:55 Pre-operative Diagnosis Pneumocephalus Post-operative Diagnosis Pneumocephalus Operative Method Right subclavicular shunt ligation and Left EVD insertion for air drainage Specimen Count And Types nil Pathology nil Operative Findings 1.massive air was drained out via the nelaton tube that inserted into lateral ventricle 2.The drainage fluid was clear Operative Procedures Under ETGA, patient was put in supine position. After disinfection and drapping, right subclavular transverse skin incision was done. By dissection, the tube was identified. Two stitches was applied for shunt ligation. The wound closure followed. Left previous wound was incised at left frontal area. Dissection was made to expose previous burr hole. Ventricular puncture was done and a nelaton tube was inserted. Water irrigation to drain the air out was performed. The procedure was repeated for several times combined with positional changing until the air diminished. Then the tube was removed followed by wound closure. Operators p 杜永光 Assistants 胡朝凱 Indication Of Emergent Operation 江許惠貞 (F,1950/04/03,61y11m) 手術日期 2010/09/25 手術主治醫師 曾漢民 手術區域 東址 001房 02號 診斷 Trigeminal neuralgia (Cranial nerve V) 器械術式 Suboccipital decompressive craniectomy 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 3E 紀錄醫師 李振豪, 時間資訊 08:55 通知急診手術 10:09 報到 10:10 進入手術室 10:15 麻醉開始 10:20 誘導結束 11:00 手術開始 13:00 抗生素給藥 13:10 麻醉結束 13:10 手術結束 13:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱骨切除術，包括異物移除或減壓或神經切斷 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Suboccipital decompressive craniectomy 開立醫師: 李振豪 開立時間: 2010/09/25 13:44 Pre-operative Diagnosis Cerebellar infarction with brainstem compression Post-operative Diagnosis Cerebellar infarction with brainstem compression Operative Method Suboccipital decompressive craniectomy Specimen Count And Types nil Pathology Nil Operative Findings The posterior fossa was tight(noted from burr hole) and became much release after decompressive craniectomy. The foramen magnum was wide opened for decompression also. Venous bleeding from left side venous plexus around the vertebral artery was noted and hemostasis was achieved with Gelform packing. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in prone positino with head fixed with Mayfield skull holder. The scalp was shaved, scrubbed, and disinfected as usual. The midline skin incision was made from 2cm above inion to C2 level. The subcutaneous soft tissue and nuchal muscle groups were dissected and detached. The posterior ring of C1 and the foramen magnum was identified. Previous left retroauricular craniotomy was identified and the skull plate and miniplates were removed. Two burr holes were made and suboccipital craniectomy was performed. The foramen magnum was opened also for decompression. Hemostasis was achieved and one epidural CWV drain was placed. The wuond was then closed in layers. Operators VS曾漢民 Assistants R6胡朝凱, R4李振豪 Indication Of Emergent Operation 曾齊俊 (M,1963/12/13,48y3m) 手術日期 2010/09/25 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Glioblastoma multiforma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 2 紀錄醫師 周聖哲, 時間資訊 07:45 報到 08:09 進入手術室 08:15 麻醉開始 08:30 誘導結束 08:44 抗生素給藥 08:46 手術開始 11:03 開始輸血 11:45 抗生素給藥 14:45 抗生素給藥 16:12 麻醉結束 16:12 手術結束 16:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 8 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除－手術時間在４～８小時 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Partial tumor excision via right frontal-temp... 開立醫師: 鍾文桂 開立時間: 2010/09/25 16:42 Pre-operative Diagnosis Right temporal-frontal brain tumor, suspect metastatic tumor or glioma. Post-operative Diagnosis Glioblastoma multiforme, right frontal-temporal. Operative Method Partial tumor excision via right frontal-temporal craniotomy. Specimen Count And Types 1 piece About size:5 cc Source:Brain tumor Pathology Frozen pathology: Glioblastoma multiforme. Operative Findings Easy oozing operative field and tumor mass. Intraoperative ultrasonography revealed that the tumor mass locates at the sylvian fissure and encases the MCA and its branches. Two sites of corticotomy were done for tumor removal. One is at inferior frontal region and the other is at superior temporal region. The sylvian fissure was left intact. A small arteriovenous shunting was noted at frontal region. Dural augmentation was acheived with temporalis fascia. We used Flosseal for hemostasis. Operative Procedures Under ETGA, the patient was placed in supine position and the head was fixed by Mayfield and tilted 45 degrees to the left. After shaving and disinfection, a curvilinear scalp incision was done. After dissection, frontal-temporal craniotomy was achieved with high speed drill. Further skull bone removal at temporal area. After durotomy, first corticotomy was done at temporal region. Partial tumor removal was done. Then, further tumor removal at frontal region was done with bipolar electrocautery. Well hemostasis was done with bipolar and Flosseal. The dura mater was closed in water tight fashion and augmented with temporalis fascia. After placing one epidural CWV drain, the wound was closed in layers. Operators V.S. 曾勝弘 Assistants 胡朝凱 鍾文桂 周聖哲 黃玥霖 (F,1989/04/29,22y10m) 手術日期 2010/09/27 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 未提及腦梗塞之腦血栓症(CVA) 器械術式 EC-IC by-pass 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 2 紀錄醫師 王奐之, 時間資訊 07:35 報到 08:04 進入手術室 08:05 麻醉開始 08:40 誘導結束 09:45 手術開始 09:45 抗生素給藥 13:00 抗生素給藥 14:48 麻醉結束 14:48 手術結束 15:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 顱內外血管吻合術 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Left side extracranial-intracranial bypass (S... 開立醫師: 王奐之 開立時間: 2010/09/27 15:26 Pre-operative Diagnosis Moyamoya disease Post-operative Diagnosis Moyamoya disease Operative Method Left side extracranial-intracranial bypass (STA-MCA bypass) Specimen Count And Types nil Pathology Nil Operative Findings Posterior branch of left STA was used for bypass, anastomosed to left side M3 segment. A total of 12 interrupted sutures with 10/0 Nylon were done. Smooth flow was noted after anastomosis. Operative Procedures After ETGA, the patient was placed in supine position with face turned to right and head fixed with Mayfield skull clamp. After tracing the left side STA course with vascular Doppler, the skin was disinfected and draped in usual sterile fashion. The preauricular skin incision began under microscope. The incision was carefully deepened and dissected to preserve the STA to its posterior branch. After dissection to the temporal area, the distal end of the prepared STA segment were transected and the proximal end was clipped with temporary aneurysm clip. The vessel was flushed with heparin. Then a round temporal craniotomy was made, followed by dural tenting and a cruciate durotomy. A M3 artery was identified adjacent to Sylvian vein. After mobilizing a segment of the M3 artery, temporary aneurysm clips were applied to both ends of the vessel. A linear incision was made along the course of the vessel. After 2 anchoring sutures, the prepared STA stump was anastomosed to the M3 artery with interrupted 10/0 Nylon sutures. The clips were then released, smooth blood flow & pulsation were observed. After meticulous hemostasis, the dura was closed. The bone was put back and the muscle flap was also approximiated, leaving the traveling course of the anastomosed STA loose. The skin was then carefully closed in layers. Operators P 杜永光 Assistants R6 胡朝凱, R3 王奐之 相關圖片 曾碧清 (F,1963/09/25,48y5m) 手術日期 2010/09/27 手術主治醫師 王水深 手術區域 東址 000房 號 診斷 Chronic granulocytic leukemia ( CGL ) 器械術式 Port-A catheter Removal/WOR 手術類別 臨時手術 手術部位 胸 傷口分類 污染 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 黃俊銘, 時間資訊 19:20 進入手術室 19:31 麻醉開始 19:32 麻醉結束 19:33 手術開始 19:55 手術結束 20:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 肌肉或深部組織腫瘤切除術及異物取出術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Remove Port-A 開立醫師: 黃俊銘 開立時間: 2010/09/27 20:06 Pre-operative Diagnosis Suspect Port-A infection Post-operative Diagnosis Ditto Operative Method Remove Port-A Specimen Count And Types nil Pathology Nil Operative Findings Intact catheter tip Clean wound bed Operative Procedures Skin disinfect, draping LA Incision along previous scar Remove Port-A Hemostasis, N/S irrigation Wound close in layers Operators 王水深 Assistants 黃俊銘 于德咸 (M,1967/03/09,45y0m) 手術日期 2010/09/27 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Herniation of intervertebral disc (HIVD) 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 周聖哲, 時間資訊 13:12 進入手術室 13:18 麻醉開始 13:24 誘導結束 13:30 抗生素給藥 14:07 手術開始 16:00 手術結束 16:00 麻醉結束 16:10 送出病患 16:10 進入恢復室 17:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 椎間盤切除術－腰椎 1 1 摘要__ 手術科部: 外科部 套用罐頭: L2/3, 3/4 microdiskectomy 開立醫師: 陳睿生 開立時間: 2010/09/27 16:15 Pre-operative Diagnosis L2/3 herniated disk, and L3/4 recurrent herniated disk Post-operative Diagnosis L2/3 herniated disk, and L3/4 recurrent herniated disk Operative Method L2/3, 3/4 microdiskectomy Specimen Count And Types 1 piece About size:3x5x1cm Source:disk Pathology Pending Operative Findings Rupture disk was noted over left L2/3 disk level, and the thecal sac, root were tightly compressed. A piece of recurrent disk was noted at left L3/4 level, adn was removed for decompression. Operative Procedures After ETGA, the patient was under prone position. Low back midline incision along the upper part of previous wound and extended 5cm above. The left L2-4 paraspinal muscles were dissected, and self retractor was set. Under microscope assist, laminotomy was performed at left L2/3 level. After remove of ligamentum flavum, the thecal sac was exposed. A piece of repture disk was removed, and then we incised into the L2/3 disk space. Microdoskectomy was done. Then we re-expose the previous operation site at left L3/4 leve. A piece of residual disk was noted and removed. The disk space was reopened for recheck of other possible residual disk. Hemostasis, and the thecal sac was spreaded with Rinderon. Local Macine injection was performed at the subcutaneous layer, and the wound was closed in layers. Operators VS 曾漢民 Assistants R6 陳睿生, R1 周聖哲 林瑞文 (M,1972/04/30,39y10m) 手術日期 2010/09/27 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 周聖哲, 時間資訊 07:35 報到 08:08 進入手術室 08:10 麻醉開始 08:40 誘導結束 09:00 抗生素給藥 09:22 手術開始 12:00 抗生素給藥 12:50 麻醉結束 12:50 手術結束 13:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除－手術時間在４小時以內 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for Simpson^s grade II tumor remove 開立醫師: 陳睿生 開立時間: 2010/09/27 13:21 Pre-operative Diagnosis Left frontoparietal tumor, suspect meningioma Post-operative Diagnosis Left frontoparietal tumor, suspect meningioma Operative Method Craniotomy for Simpson^s grade II tumor remove Specimen Count And Types 1 piece About size:3x3x1cm Source:tumor Pathology Pending Operative Findings The tumor was whitish, soft, fragile, and well margined. However, it showed invasive pattern and the dura, skull bone, and brain surface were noted to be involved. Vein of Trolar was noted to be adhered with the tumor and was carefully dissected. The dura defect was repaired with fascia graft. Operative Procedures After ETGA, the patient was under supine position; head was fixed with Mayfield clump and right turn. The scalp was incised curvillinearly and and about 6x6cm craniotomy window was created with 5 bur holes made. The dura was tented and then opened along the margin. The tumor was noted to adhered with the dura and brain surface. The tumor was carefully dissected from vein of Trolar and brain surface. The tumor was then totally removed. The dura was electroligated and partially removed. Then the dura defect was repaired with fascia graft after deair. The skull graft was covered back and fixed back with miniplatesx3. Hemostasis, a subgaleal CWV drain was set, and the wound was closed in layers. Operators VS 曾漢民 Assistants R6 陳睿生; R1 周聖哲 黃江阿壹 (F,1946/02/13,66y1m) 手術日期 2010/09/27 手術主治醫師 曾漢民 手術區域 東址 003房 02號 診斷 Radiculopathy 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 王奐之, 時間資訊 15:02 報到 15:15 進入手術室 15:20 麻醉開始 15:30 誘導結束 15:43 抗生素給藥 16:00 手術開始 17:30 手術結束 17:30 麻醉結束 17:40 送出病患 17:41 進入恢復室 18:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 椎弓切除術（特壓）－二節以內 1 1 記錄__ 手術科部: 外科部 套用罐頭: L5 laminectomy and nerve roots decompression 開立醫師: 胡朝凱 開立時間: 2010/09/27 17:31 Pre-operative Diagnosis L4~5, L5~S1 stenosis Post-operative Diagnosis L4~5, L5~S1 stenosis Operative Method L5 laminectomy and nerve roots decompression Specimen Count And Types nil Pathology nil Operative Findings 1.The ligamentum flavum became hypertrophy 2.The thecal sac was pushed backward from anterior. And it expanded well after decompression. 3.The neural foramen were stenosis 4.The L4,5 and S1 nerve roots were identified. Operative Procedures 1.ETGA, prone 2.Midline incision at L4~S1 level 3.Detah paravertebral muscle groups 4.Expose L5 lamina 5.L5 laminectomy 6.resect flavum ligament 7.Resect the hypertrophic connective tissue that made the neural foramen stenosis 8.Identified nerve roots 9.Close wound in layers Operators 曾漢民 Assistants 胡朝凱, 王奐之 黃信維 (M,1995/03/27,16y11m) 手術日期 2010/09/27 手術主治醫師 廖漢文 手術區域 東址 000房 號 診斷 Intracerebral hemorrhage (ICH) 器械術式 Common Carotid Angiography 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 王永彬 ASA 3 時間資訊 08:25 麻醉開始 08:30 誘導結束 09:25 麻醉結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 呂郭素月 (F,1941/03/16,70y11m) 手術日期 2010/09/27 手術主治醫師 賴達明 手術區域 東址 002房 03號 診斷 Lymphoma 器械術式 Stereotaxic procedure for biopsy 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3E 紀錄醫師 傅紹懷, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 06:57 通知急診手術 10:42 報到 11:00 進入手術室 11:05 麻醉開始 11:20 誘導結束 12:00 抗生素給藥 12:15 手術開始 15:00 抗生素給藥 15:45 開始輸血 17:10 麻醉結束 17:10 手術結束 17:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除－手術時間在４～８小時 1 1 摘要__ 手術科部: 外科部 套用罐頭: craniotomy interhemispheric approach tumor ex... 開立醫師: 陳德福 開立時間: 2010/09/27 17:44 Pre-operative Diagnosis brain tumor, splenium of supra-corpus callosum, suspect lymphoma Post-operative Diagnosis brain tumor, splenium of supra-corpus callosum, suspect lymphoma Operative Method craniotomy interhemispheric approach tumor excision Specimen Count And Types 1 piece About size:1*1*1CM Source:brain tumor Pathology pending, frozen:high grade glioma Operative Findings 1.There is a greyish-reddish, soft, fragile, and compressing tumor at the splenium of corpus callosum. The tumor was approached via interhemispheric route from the right side. The tumor was sent for intra operative frozen section and the result showed suspected high grade glioma. 2. Operative Procedures under ETGA and prone position with Mayfield pin type head fixator fixation, the scalp was disinfected and draped as usual. One curvilinear incision and 6*7cm craniotomy which across the midline was performed. The dura tenting is done and the dura was opened in C shape with SSS based. The adhesion between the vessel and dura was remvoed and the right cortex was displaced laterally for exposure the tumor. The tumor was removed with forceps, ring currettage, suckers, and bipolar coagulator assisted. Hemostasis and the tumor was sent for frozen section. The dura was then closed in water tight fasion. The skull was fixed with miniplates. One subgaleal CWV was left in situ and the wound was closed in layers. Operators VS賴達明 Assistants R5陳德福 R1傅紹懷 Indication Of Emergent Operation 陳怡理 (F,2000/08/27,11y6m) 手術日期 2010/09/28 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 腦內出血 器械術式 Bilateral cranioplasty and V-P shunt insertion 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 07:57 報到 08:05 進入手術室 08:20 麻醉開始 08:30 誘導結束 09:10 抗生素給藥 09:48 手術開始 12:10 抗生素給藥 14:53 開始輸血 15:10 抗生素給藥 15:45 手術結束 15:45 麻醉結束 16:00 送出病患 16:00 進入恢復室 18:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 手術 頭顱成形術 1 2 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 7 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: 1. Bilateral cranioplasty with autologous sku... 開立醫師: 李振豪 開立時間: 2010/09/28 15:55 Pre-operative Diagnosis Left thalamic hemorrhage with ruptured into ventricle, status post bilateral decompressive craniectomy and right Kocher"s external ventricular drainage and right frontal intracranial pressure monitor insertion 1. bilateral skull bone defect due to decompressive craniectomy for left thalamic hemorrhage. 2. hydrocepahlus Post-operative Diagnosis Left thalamic hemorrhage with ruptured into ventricle, status post bilateral decompressive craniectomy and right Kocher"s external ventricular drainage and right frontal intracranial pressure monitor insertion 1. bilateral skull bone defect due to decompressive craniectomy for left thalamic hemorrhage. 2. hydrocepahlus Operative Method 1. Bilateral cranioplasty with autologous skull plate 1. Bilateral frontotemporoparietal cranioplasty with autologous skull plate and augmentation wiht bone cement over the gap 2. Right Kocher"s ventriculoperitoneal shunt implantation Specimen Count And Types 1 piece About size:2ml Source:CSF for bacterial culture Pathology Nil Operative Findings Codman burr hole type, programmable V-P shunt is used with initial pressure setting as 130mmH2O. The ventricular and peritoneal catheter length is 6.3cm and 30cm respectively. Total 8 pieces of miniplate(2 holes x 4, 3 holes x 4) and 16 screws are used for fixation of the skull plate. 1. The dura of the craniectomy site was almost gone due to previous stripping. It adhered to the temporalis muscle markedly and was able to be separated at the lower margin of the muscle. 2. Codman burr hole type, programmable V-P shunt is used with initial pressure setting as 130mmH2O. The ventricular and peritoneal catheter length is 6.3cm and 30cm respectively. Total 8 pieces of miniplates (2 holes x 4, 3 holes x 4) and 16 screws are used for fixation of the skull plate. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine position with head rotated to left. The skin was shaved, scrubbed, and disinfected as usual. Abdominal skin incision was made along op scar and the skull plate was take out. Hemostasis was achieved and left side abdominal wound was closed in layers with 3-0 Vicryl and 3-0 Nylon. Under endotracheal tube general anesthesia, the patient was put in supine position with head rotated to left first. The skin was shaved, scrubbed, and disinfected as usual. Abdominal skin incision was made along previous two op wounds and the autogenous skull plates were taken outand soaked in gentamicin solution for later use. Hemostasis was achieved and left side abdominal wound was closed in layers with 3-0 Vicryl and 3-0 Nylon. The right scalp incision was made along op scar and the scalp flap was elevated. Part of the temporalis muscle was dissected and the rest part was left beneath the skull plate. The skull plate was then fixed back with miniplates after hemostasis. Bone cement was used for cosmatic reason. The right scalp incision was made along previous op scar and the scalp flap was reflected down. Part of the temporalis muscle was dissected and the rest part was left beneath the skull plate. The skull plate was then fixed back with miniplates after hemostasis. Bone cement was used for cosmatic reason. The right scalp incision was made along previous op scar and the scalp flap was reflected down. Part of the temporalis muscle was dissected and the rest part was left beneath the skull plate. The skull plate was then fixed back with miniplates and screws after hemostasis and three stitches of central tenting. Bone cement was used to seal the bone gap for cosmatic reason. The subcutaneous tunnel was created from right abdominal wound, right forechest(medial side), right neck, and retroauricular area and connected with right scalp wound. The peritoneal catheter was passed through the subcutaneous tunnel. The V-P shunt was set up and the ventricular catheter was placed into right lateral ventricle via previous burr hole at Kocher"s point. The function of the V-P shunt was checked and the peritoneal catheter was placed into peritoneal cavity. The catheter was fixed with 5 3-0 silk. One subgaleal CWV drain was placed and the wound was closed in layers with 2-0 Vicryl and 3-0 Nylon. The subcutaneous tunnel was created from right abdominal wound, right forechest(medial side), right neck, and retroauricular area and connected with right scalp wound. The peritoneal catheter was passed through the subcutaneous tunnel. The V-P shunt was set up and the ventricular catheter was placed into right lateral ventricle via previous burr hole at Kocher"s point. The function of the V-P shunt was checked and the peritoneal catheter was placed into peritoneal cavity. The catheter was fixed with 5 3-0 silk. One subgaleal CWV drain was placed and the wound was closed in layers with 2-0 Vicryl and 3-0 Nylon. The head was then rotated to right side. The scalp was scrubbed, disinfected, and draped as usual. The scalp incision was made along op scar. The scalp flap was elevated. The periosteum and the temporalis muscle was left adhered with dura for avoid CSF leakage from dura defect. The superficial layers of temporalis muscle was dissected and placed above the skull plate. The rest of the temporalis muscle was left beneath the skull plate. The skull plate was fixed back with miniplates and the bone cement was used for cosmatic reason. Hemostasis was achieved. One subgaleal CWV drain was placed and the wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. The head was then rotated to right side. The scalp was scrubbed, disinfected, and draped as usual. The scalp incision was made along op scar. The scalp flap was elevated. The periosteum and the temporalis muscle was left adhered with dura for avoid CSF leakage from dura defect. The superficial layers of temporalis muscle was dissected and placed above the skull plate. The rest of the temporalis muscle was left beneath the skull plate. After three stitches of central tenting, the skull plate was fixed back with miniplates and the bone cement was used for cosmatic reason. Hemostasis was achieved. One subgaleal CWV drain was placed and the wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators AP郭夢菲 Assistants R4李振豪, Ri黃緒桓 相關圖片 李文金 (M,1954/10/31,57y4m) 手術日期 2010/09/28 手術主治醫師 洪學義 手術區域 東址 009房 04號 診斷 Coronary artery disease, post percutaneous transluminal coronary angioplasty (PTCA) 器械術式 Debridment-- >10cm 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 面罩麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 黃柏誠, 時間資訊 11:40 進入手術室 11:45 麻醉開始 11:55 誘導結束 11:59 手術開始 12:40 手術結束 12:40 麻醉結束 12:45 送出病患 12:48 進入恢復室 13:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Semi-opened mask inhalation anes 1 0 手術 移前皮瓣移植術 1 1 手術 深部複雜創傷處理－傷口長１０公分以上者 1 0 L 記錄__ 手術科部: 外科部 套用罐頭: 1.debridment 2.advancement flap 開立醫師: 黃柏誠 開立時間: 2010/09/28 12:46 Pre-operative Diagnosis 1.CAD 3-V-D s/p POBAS s/p OPCAB 2.left GSV wound infection 3.sternal wound infection Post-operative Diagnosis 1.CAD 3-V-D s/p POBAS s/p OPCAB 2.left GSV wound infection 3.sternal wound infection Operative Method 1.debridment 2.advancement flap Specimen Count And Types nil Pathology nil Operative Findings 1.poor wound healing and pus formation was noted at sternal wound, debridement and closure 2.left thigh wound was not very clean and poor blood supply was noted at median side skin flap Operative Procedures 1.IVG supine position 2.disinfection and drape 3.performed wide exicision at sternal wound several parts. 3.performed wide exicision at sternal wound several parts, then performed advancement flap 4.insert a CWV at longest sternal incision wound 5.left thigh debride was done 6.hemostasis and cover with BOsmin gauze Operators VS洪學義 Assistants R5官振翔 R3黃柏誠 RI謝志慶 黃俊湧 (M,1959/10/13,52y5m) 手術日期 2010/09/28 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Lumbar Spondylosis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 傅紹懷, 時間資訊 07:40 報到 08:05 進入手術室 08:10 麻醉開始 08:15 誘導結束 09:00 抗生素給藥 09:15 手術開始 12:00 抗生素給藥 12:35 手術結束 12:35 麻醉結束 12:47 送出病患 12:50 進入恢復室 14:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 椎弓切除術（特壓）－超過二節 1 1 B 手術 椎間盤切除術－腰椎 1 4 B 手術 脊椎融合術－後融合，無固定物 1 2 B 摘要__ 手術科部: 外科部 套用罐頭: 1.L3-5 laminectomy 2.L3-5 posterior lateral f... 開立醫師: 陳德福 開立時間: 2010/09/28 12:32 Pre-operative Diagnosis Lumbar spondylolisthesis and HIVD with spinal stenosis, L3-5 Post-operative Diagnosis Lumbar spondylolisthesis and HIVD with spinal stenosis, L3-5 Operative Method 1.L3-5 laminectomy 2.L3-5 posterior lateral fusion 3.L4-5 diskectomy Specimen Count And Types nil Pathology nil Operative Findings 1.Grade I listhesis of L4 on L5 and HIVD with neural foramen stenosis 2.The hypertrophic ligamentum flavum is notice over L3-5 level 3.The thecal sac expanded well after laminectomy and diskectomy 4.Autologous bone posterior lateral fusion over L3-5 is performed Operative Procedures 1.ETGA, prone 2.Midline skin incision 3.Detach paravertebral muscle to expose lamina and transverse process of L3~5 4.Laminectomy of L3~5 5.Further widening for exposing L3~5 roots; L4-5 microscopic diskectomy, left 6.Decortication of L3~5 facet and transeverse process 7.Put bone chips and artificial bone graft to the space 8.Set one hemovac drain then close wound in layers. Operators P 曾勝弘 Assistants R5陳德福 R1傅紹懷 相關圖片 謝世元 (M,1961/06/16,50y8m) 手術日期 2010/09/28 手術主治醫師 曾勝弘 手術區域 東址 005房 02號 診斷 Cervical myelopathy 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 傅紹懷, 時間資訊 13:00 進入手術室 13:05 麻醉開始 13:15 誘導結束 13:30 抗生素給藥 14:02 手術開始 15:50 手術結束 15:50 麻醉結束 15:55 送出病患 16:00 進入恢復室 17:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術（特壓）－超過二節 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 摘要__ 手術科部: 外科部 套用罐頭: cervical decompressive laminectomy, C3-7 開立醫師: 陳德福 開立時間: 2010/09/28 15:57 Pre-operative Diagnosis Cervical spondylosis with spinal stenosis, C5/6 Post-operative Diagnosis Cervical spondylosis with spinal stenosis, C5/6 Operative Method cervical decompressive laminectomy, C3-7 Specimen Count And Types nil Pathology ni Operative Findings 1.There is hypertrophic ligamentum flavum with cervical spinal stenosis, especially at the level of C5/6. The cervical decompressive laminectomy from C3-7 was performed smoothly and the theca sac reexpanded well after the surgery. Operative Procedures Under ETGA and prone position with Mayfield pin type head fixator fixation, the skin was disinfected and draped as usual. One linear incision at midline was done and the paraspinous muscle was displaced laterally. The C2-T1 spinous process were identified followed by laminectomy from C3-7 with Kerrison and Rounger assisted. Hemostasis was done and one CWV was left in the epidural space. The wound was then closed in layers. Operators P曾勝弘 Assistants R5陳德福 R1傅紹懷 黃林娥 (F,1943/12/25,68y2m) 手術日期 2010/09/28 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Benign brain tumor 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 07:45 報到 08:00 進入手術室 08:05 麻醉開始 08:45 誘導結束 08:50 抗生素給藥 09:22 手術開始 11:55 抗生素給藥 12:40 麻醉結束 12:40 手術結束 12:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 腦瘤切除－手術時間在４小時以內 1 1 記錄__ 手術科部: 外科部 套用罐頭: Simpson grade II tumor excision via right fro... 開立醫師: 鍾文桂 開立時間: 2010/09/28 13:06 Pre-operative Diagnosis Right frontal parasagital meningioma. Post-operative Diagnosis Right frontal parasagital meningioma. Operative Method Simpson grade II tumor excision via right frontal craniotomy. Specimen Count And Types 1 piece About size:10cc Source:Right frontal parasagital meningioma. Pathology Pending. Operative Findings 1. Blood supply of meningioma: ECA, feeders noted from frontal dura and falx. 2. Grayish whitish elastic hard tumor. The dura attachment was electrocoagulated. The hyperostotic frontal bone overlying the tumor was excised. 3. Dural defect was noted over the tumor mass. It was repaired by temporalis fascia. Operative Procedures Under ETGA, the patient was placed in supine position and the head was slightly tilted to the left. A curvilinear scalp incision was made. A 3 cm frontal craniotomy was achieved by high speed drill. After dural tenting, the durotomy was done based on superior sagital sinus. Then, the tumor was excised in piece meal fashion. The arachnoid plane was dissected. The feeders and overlying dura mater were electrocoagulated. The tumor was excised completely. The dura mater was closed by 3-0 Prolene. The craniotomy plate was fixed by mini plates and screws. The wound was closed in layers after placing one CWV drain. The patient was sent to ICU smoothly. Operators V.S. 賴達明 Assistants 鍾文桂 李柏穎 相關圖片 陳阿來 (M,1946/11/10,65y4m) 手術日期 2010/09/28 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Cervical myelopathy 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 12:30 報到 13:25 進入手術室 13:30 麻醉開始 13:50 誘導結束 13:56 手術開始 14:40 抗生素給藥 17:40 抗生素給藥 18:50 麻醉結束 18:50 手術結束 19:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 手術 椎弓切除術（特壓）－二節以內 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 麻醉 Peripheral arterial line inserti 1 0 記錄__ 手術科部: 外科部 套用罐頭: 1. Internal fixation with transarticular scre... 開立醫師: 李柏穎 開立時間: 2010/09/28 19:39 Pre-operative Diagnosis C1-2 subluxation with cord compression and myelopathy. Post-operative Diagnosis C1-2 subluxation with cord compression and myelopathy. Operative Method 1. Internal fixation with transarticular screws and fusion. 2. Decompressive resection of C1 posterior arch. Specimen Count And Types nil Pathology Nil. Operative Findings Transarticular screw was implanted at left side only because of high risk of vertebral artery injury over the right side. After implantation of transarticular screws, C1 was stable during traction of C1 ring. Transarticular screw: 44mm. Fusion over C2 lateral mass and remanant of C1 posterior arch by autologous bone graft harvested from C1 posterior arch. The bone graft was fixed by mini plates and screws. The dural sac was slack after decompression. Operative Procedures Under ETGA, the patient was placed in prone position and the head was fixed by Mayfield. After shaving,disinfection,and draping, midline incision was made to expose foramen magnum to C3. The transarticular screw was inserted under K-pin guidance and protection of left vertebral artery at C1 level by dissector and continous intraoperative fluoroscopy to ensure the location of the screw. Secondly, the C1 posterior arch was removed by Rongeur and high speed cutting drill. The graft was placed between C1-2 for inter-lateral mass fusion. After placing one CWV drain, the wound was closed in layers. Operators V.S. 賴達明 Assistants R 鍾文桂 李柏穎 張阿珠 (F,1938/11/05,73y4m) 手術日期 2010/09/28 手術主治醫師 賴達明 手術區域 東址 005房 03號 診斷 Lumbar spondylosis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 傅紹懷, 時間資訊 15:25 報到 16:10 進入手術室 16:15 麻醉開始 16:30 抗生素給藥 16:35 誘導結束 16:58 手術開始 19:30 手術結束 19:30 麻醉結束 19:34 進入恢復室 19:35 送出病患 21:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術（特壓）－超過二節 1 2 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: 1.L3-4 partial laminectomy 2.L4-5 fusion with TPS 開立醫師: 陳德福 開立時間: 2010/09/28 19:19 Pre-operative Diagnosis L3/4 and L4/5 HIVD; L4-5 spndylolisthesis with radiculopathy Post-operative Diagnosis L3/4 and L4/5 HIVD; L4-5 spndylolisthesis with radiculopathy Operative Method 1.L3-4 partial laminectomy 2.L4-5 fusion with TPS Specimen Count And Types nil Pathology nil Operative Findings 1.There is grade I spondylolithesis over L4-5 and the spinal stenosis is noticed. The L3/4 and L4/5 HIVD with hypertrophic ligamentum flavum caused lumbar spinal stenosis with L3-4 laminectomy for decompression was done. Autologus bone fusion at the interbody over L4-5 is done. 2. TPS [45 &40 mm] over L4-5 and 2 rods was set smoothly. Operative Procedures 1.ETGA, prone 2.Midline incision at L3~S1 level 3.Detach paravertebral muscle groups 4.Expose L3- L5 lamina and facets 5.TPS insertion under fluroscopic guided 6.L3-4 laminectomy and decompression of neural foramen with Kerrison pounch 7.set up 2 rods 8.Lateral fusion after decortication of L4~5 lamina 9.Set one hemovac drain then close wound in layers. Operators 賴達明 Assistants R5陳德福 R1傅紹懷 徐忠煌 (M,1954/04/16,57y10m) 手術日期 2010/09/28 手術主治醫師 蕭輔仁 手術區域 東址 001房 03號 診斷 Cerebrovascular accident (CVA) 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 王奐之, 時間資訊 03:00 臨時手術NPO 03:00 開始NPO 12:45 通知急診手術 16:00 進入手術室 16:03 麻醉開始 16:10 誘導結束 16:30 抗生素給藥 16:40 手術開始 17:25 麻醉結束 17:25 手術結束 17:35 送出病患 17:37 進入恢復室 18:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 記錄__ 手術科部: 外科部 套用罐頭: Burr hole for subdural hematoma evacuation, r... 開立醫師: 王奐之 開立時間: 2010/09/28 17:47 Pre-operative Diagnosis Chronic subdural hematoma, right side Post-operative Diagnosis Chronic subdural hematoma, right side Operative Method Burr hole for subdural hematoma evacuation, right side Specimen Count And Types Nil Pathology Nil Operative Findings Motor-oil like fluid was noted after opening the outer membrane. Brain expanded quickly after the initial evacuation of the hematoma. An EVD set was used for subdural hematoma drainage. Operative Procedures After ETGA, the patient was placed in supine position with face turned to left. After shaving, skin disinfection & draping in usual sterile fashion, a linear skin incision was made at right fronto-temporal area. A burr hole was then made, followed by dural tenting. A cruciate durotomy was done, followed by penetration of the outer membrane. An EVD catheter was used for flushing of the hematoma. After securing the drain, the wound was closed in layers, followed by deairing. Operators VS 蕭輔仁 Assistants R6 胡朝凱, R3 王奐之 Indication Of Emergent Operation 相關圖片 劉昭惠 (F,1960/12/07,51y3m) 手術日期 2010/09/28 手術主治醫師 王國川 手術區域 西址 033房 01號 診斷 Carpal tunnel syndrome 器械術式 Decompression of mediun nerve 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 09:00 進入手術室 09:10 麻醉開始 09:15 手術開始 09:55 手術結束 09:55 麻醉結束 10:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 正中神經或尺神經腕部減壓術–單側 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Carpal Tunnel Syndrome 開立醫師: 古恬音 開立時間: 2010/09/28 10:06 Pre-operative Diagnosis Carpal Tunnel Syndrome, right side Post-operative Diagnosis Carpal Tunnel Syndrome, right side Operative Method Decompression of median nerve Specimen Count And Types NIL Pathology Nil Operative Findings The median nerve was compressed tightly by the hypertrophic flexor retinaculum. Operative Procedures 1.The hand and forearm were sterilized with povidone-iodine tincture, then covered with stockinet. 2.Anesthesia: tourniquet was applied at distal upper arm, then regional block with 15 ml 1% Xylocaine solution was infused through cephalic vein catheter at wrist area. 3. Incision: S shape from vertical palmar crease to transverse wrist crease. 4.The palmaris longus tendon was identified, then the plamar aponeurosis was cut longitidinally along the ulnar side of the palmaris longus tendon. 5. Themedian nerve was identified beneath the palmars longus tendon. Under direct vision, the transverse carpal ligament was divided until no more pressure on the median nerve could be palpated. 6. The skin was closed by interrupted suture with 4/0 nylon.7.The tourniquet was released. The hand and wrist were draped with fluffy dressing and elastic bandage. Operators VS王國川 Assistants R3古恬音 郭張敏惠 (F,1941/05/06,70y10m) 手術日期 2010/09/29 手術主治醫師 余宏政 手術區域 西址 039房 05號 診斷 Neurogenic bladder 器械術式 Fiberocystoscopy /WOR 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 12:41 報到 13:37 進入手術室 13:39 手術開始 13:43 手術結束 13:45 送出病患 謝靜儀 (F,1983/10/06,28y5m) 手術日期 2010/09/29 手術主治醫師 杜永光 手術區域 東址 003房 02號 診斷 Spinal tumor 器械術式 Malignant intraspinal tumor, e 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 王奐之, 時間資訊 13:35 進入手術室 13:40 麻醉開始 14:20 誘導結束 14:30 抗生素給藥 14:53 手術開始 17:30 抗生素給藥 18:20 手術結束 18:20 麻醉結束 18:30 送出病患 18:33 進入恢復室 20:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 惡性病髓腫瘤切除術 1 1 記錄__ 手術科部: 外科部 套用罐頭: Tumor excision and T2,T4 TPS insertion 開立醫師: 胡朝凱 開立時間: 2010/09/29 18:39 Pre-operative Diagnosis T3 epidural tumor Post-operative Diagnosis T3 epidural tumor Operative Method Tumor excision and T2,T4 TPS insertion Specimen Count And Types pieces of tumor Pathology pending Operative Findings 1.One reddish, soft tumor located at T3 level which involved spinous process, lamina, nilateral pedicle to partial vertebral body. 2.The tumor erroded the bone with a margin bhetween bone and tumor. 3.Dura was intact and nerve roots were all preserved. Operative Procedures Under ETGA, patient was put in prone position. Midline skin incision from T2~T4 level was done. Detach paravertebral muscle and the tumor was exposed gradually. T2 and T4 lamina were exposed. TPS screws were inserted at T2 and T4 pedicle that confirmed by C-arm. T3 lamina was then removed with tumor dissection. Tumor was en-bloc resected. The tumor inside pedicle was also removed with currete. Hemostasis was made with gelfoam and Avetin. Rods were then fixed. AFter one CWV drain insertion, the wound was closed in layers. Operators P 杜永光 Assistants 胡朝凱, 王奐之 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Tumor excision and T2, T4 TPS insertion 開立醫師: 王奐之 開立時間: 2010/10/02 10:40 Pre-operative Diagnosis T3 epidural tumor Post-operative Diagnosis T3 epidural tumor Operative Method Tumor excision and T2, T4 TPS insertion Specimen Count And Types 1 piece About size:pieces Source:T3 tumor Pathology Pending Operative Findings 1. One reddish, soft tumor located at T3 level which involved spinous process, lamina, nilateral pedicle to partial vertebral body. 2. The tumor erroded the bone with a margin bhetween bone and tumor. 3. Dura was intact and nerve roots were all preserved. Operative Procedures Under ETGA, patient was put in prone position. Midline skin incision from T2~T4 level was done. Detach paravertebral muscle and the tumor was exposed gradually. T2 and T4 lamina were exposed. TPS screws were inserted at T2 and T4 pedicle that confirmed by C-arm. T3 lamina was then removed with tumor dissection. Tumor was en-bloc resected. The tumor inside pedicle was also removed with currete. Hemostasis was made with gelfoam and Avetin. Rods were then fixed. AFter one CWV drain insertion, the wound was closed in layers. Operators P 杜永光 Assistants R6 胡朝凱, R3 王奐之 相關圖片 酆東海 (M,1957/02/04,55y1m) 手術日期 2010/09/29 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Glioblastoma multiforma 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 周聖哲, 時間資訊 13:35 進入手術室 13:40 麻醉開始 13:45 誘導結束 14:20 手術開始 15:40 手術結束 15:40 麻醉結束 15:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 頭顱成形術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Cranioplasty 開立醫師: 陳睿生 開立時間: 2010/09/29 15:41 Pre-operative Diagnosis Left MCA infarction status post decompressive craniectomy Post-operative Diagnosis Left MCA infarction status post decompressive craniectomy Operative Method Cranioplasty Specimen Count And Types nil Pathology Nil Operative Findings Autologus bone graft was fixed back with miniplates. Dura tear was noted at temporal base and was repaired with stitiches. Mild brain swelling was also found. Operative Procedures After ETGA, the patinet was under supine position with head right turn. The previous curvillinear scalp wound was reopened. The plane between the galeal and dura was found and dissected carefully. The margin of the skull defect was totally exposed. The dura tear was repaired with stitiches. Autologus skull graft was rinsed with vancomicin solution, and then two pieces were fixed with wires. Then the graft was fixed back to the defect with miniplates x3. Centra tenting was performed, and two CWV drain was set. The wound was closed in layers. Operators VS 曾漢民 Assistants R6 陳睿生, R1 周聖哲 章定夫 (M,1973/12/22,38y2m) 手術日期 2010/09/29 手術主治醫師 劉嘉銘 手術區域 東址 025房 04號 診斷 Brain abscess 器械術式 Sinoscopy under LA 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 林奎佑, 時間資訊 16:10 報到 16:30 進入手術室 16:50 手術開始 17:15 抗生素給藥 17:50 手術結束 17:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 耳鼻喉局部治療－膿或痂皮之取出或抽吸 1 0 B 摘要__ 手術科部: 耳鼻喉部 套用罐頭: Sinoscope surgery (local) 開立醫師: 林奎佑 開立時間: 2010/09/29 17:30 Pre-operative Diagnosis Cerebrospinal fliud rhinorrhe, status post operation Post-operative Diagnosis Cerebrospinal fliud rhinorrhe, status post operation, status post local treatment Operative Method Sinoscopy, local treatment Specimen Count And Types Nil Pathology Nil Operative Findings 1. left nasal post operation change 1. Bilateral nasal post operation change 2. Some discahrge with polypoid change noticed in left nasal cavity over anterior and posterior ethmoid cavity 3. Normal post-operative contition over right nasal cavity Operative Procedures 1. Local anesthesia via nasal packing in left nasal cavity 2. Nasal packing removed, and sinoscope was applpied 3. Left nasal post operation change 4. remove discharge discahrge with polypoid change noticed in left nasal cavity 4. Local treatment for discahrge with polypoid change noticed in left nasal cavity 5. Hemostasis with surgicel packing 5. Hemostasis with surgicel packing in left nasal cavity 6. Patient tolerate will during the procedure. Operators AP 劉嘉銘 Assistants R4 林芳瑩, R2 林奎佑 沈延誠 (M,1954/07/28,57y7m) 手術日期 2010/09/29 手術主治醫師 李章銘 手術區域 東址 057房 05號 診斷 Lung cancer 器械術式 Port-A catheter implatation 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 吳政達, 時間資訊 17:10 進入手術室 17:15 抗生素給藥 17:30 麻醉開始 17:34 誘導結束 17:35 手術開始 18:55 手術結束 18:55 麻醉結束 19:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 ｐｏｒｔ–Ａ導管植入術–治療性導管植入術 1 0 L 摘要__ 手術科部: 外科部 套用罐頭: Port-A implantation 開立醫師: 吳政達 開立時間: 2010/09/29 19:13 Pre-operative Diagnosis Lung cancer Post-operative Diagnosis Lung cancer Operative Method Port-A implantation Specimen Count And Types nil Pathology nil Operative Findings 1. A cephalic vein at cephalic groove 2. Patent Port-A function Operative Procedures 1. Supine position, idendify cephalic groove 2. Skin sterilized and drapped 3. Linear incision alone cephalic groove 4. Dissect the fascia and identify the cephalic vein 5. Port-A insertion into the cephalic vein 6. Fixed the Port-A. 7. Hemostasis. Wound closure. Operators VS黃培銘 Assistants R3高明蔚 R1吳政達 盧宥祥 (M,1974/02/28,38y0m) 手術日期 2010/09/29 手術主治醫師 曾漢民 手術區域 東址 005房 03號 診斷 Glioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 周聖哲, 時間資訊 16:15 進入手術室 16:20 麻醉開始 16:30 抗生素給藥 16:40 誘導結束 16:53 手術開始 19:30 抗生素給藥 20:20 手術結束 20:20 麻醉結束 20:25 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除－手術時間在４小時以內 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for gross tumor remove 開立醫師: 陳睿生 開立時間: 2010/09/29 20:33 Pre-operative Diagnosis Right frontal tumor, suspect glioma Post-operative Diagnosis Right frontal tumor, suspect glioma Operative Method Craniotomy for gross tumor remove Specimen Count And Types 1 piece About size:5x5x5cm Source:tumor Pathology Pending Operative Findings The tumor was about 5x5x5cm, and it was soft, fragile. The tumor mildly attached to the dura, and the margin between the tumor and brain parychema was not very clear. It was well vascularized from the cortical side, and moderate brain swelling was noted intra-op. Intra-op SSEP showed no active change. Operative Procedures After ETGA, the patient was under supine position and head was fixed with Myfield clump. Right frontal curvillinear scalp incision was made, and an about 8x8cm craniotomy window was created with 4 bur holes done. Aftr proper dura tenting, the tumor was localized with intra-op ECHO. The dura was opened and the tumor was noted at subcortical region. Well tumor vascularization was noted and devascularization was done at cortical region. Then the tumor was carefully dissected from peripheral brain parychema, and was removed en bloc. Hemostasis was done with Floceal and surgicel. The dura was closed with fascia graft. The skull graft was fixed back with miniplates with central tenting. A subgaleal CWV drain was set, and the wound was closed in layers. Operators VS 曾漢民 Assistants R6 陳睿生, R1 周聖哲 魏榮彬 (M,1984/09/25,27y5m) 手術日期 2010/09/29 手術主治醫師 蔡瑞章 手術區域 東址 005房 01號 診斷 Arteriovenous malformation, brain 器械術式 Crainotomy Brain Tumor(P-LIN) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 周聖哲, 時間資訊 07:47 報到 08:01 進入手術室 08:15 麻醉開始 08:50 誘導結束 09:00 手術開始 09:08 抗生素給藥 12:08 抗生素給藥 12:50 麻醉結束 12:50 手術結束 12:56 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 開顱術摘除血管病變－動靜脈畸型－小型－表淺 1 1 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for cavernoma removal 開立醫師: 陳睿生 開立時間: 2010/09/29 13:14 Pre-operative Diagnosis Right posterior temporal lesion, suspect cavernoma Post-operative Diagnosis Right posterior temporal lesion, suspect cavernoma Operative Method Craniotomy for cavernoma removal Specimen Count And Types 1 piece About size:pieces Source:tumor Pathology Pending Operative Findings The lesion was dark reddish, multiple lobulated, and the diameter was about 3cm. Peripheral hemosiderin deposition was noted and moderate to severe adhesion was noted between the tumor and brain tissue. Operative Procedures After ETGA, the patient was under supine position and head was fixed with Mayfield clump, turn to left. A curvillinear incision was created at retroauricular region. After two bur holes created, an about 5x5cm craniotomy window was made. The lesion was identified under intra-op ECHO. After dura opening, 1.5cm corticotomy was made and then we extended into the parychema to find out the lesion. The tumor was carefully dissected from brain tissue and then removed. After hemostasis, the dura was closed with fascia graft. The skull graft was fixed back with 3 gages of wires, and central tenting was done. The wound was then closed in layers. Operators P 蔡瑞章 Assistants R6 陳睿生, R1 周聖哲 林芷妍 (F,2009/08/17,2y6m) 手術日期 2010/09/29 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Congenital heart disease 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 07:57 報到 08:10 進入手術室 08:15 麻醉開始 08:25 誘導結束 08:40 抗生素給藥 09:15 手術開始 10:30 手術結束 10:30 麻醉結束 10:40 進入恢復室 10:46 送出病患 11:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 腦室腹腔分流手術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Right Kocher"s ventriculoperitoneal shunt imp... 開立醫師: 李振豪 開立時間: 2010/09/29 10:43 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Right Kocher"s ventriculoperitoneal shunt implantation Specimen Count And Types 1 piece About size:15ml Source:CSF Pathology Nil Operative Findings The opening pressure is more than 30cmH2O after dura opening. The CSF is mild xanthochromic in appearance. Codman burr hole type programmable shunt was placed with initial pressure setting as 130mmH2O. The ventricular catheter is 6cm in length and the peritoneal catheter is 30cm in length. 1. The opening pressure is more than 30cmH2O after dura opening. The CSF is mild xanthochromic in appearance. Codman burr hole type programmable shunt was placed with initial pressure setting as 130mmH2O. The ventricular catheter is 6cm in length and the peritoneal catheter is 30cm in length. 2. the liver was enlarged and about 2 to 3 finger breath below the right costal margin. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine position was head rotated to left side. The scalp was shaved, scrubbed, and disinfected as usual. The curvilinear scalp incision was made at right frontal area which including the op scar. The scalp flap was elevated and the edge of anterior fontanelle was identified. Rongeur was used for creation of burr hole. The dura was opened and ventricular puncture was done. The Nelaton catheter was placed for checking the pressure and CSF sampling. Under endotracheal tube general anesthesia, the patient was put in supine position was head rotated to left side. The scalp was shaved, scrubbed, and disinfected as usual. The curvilinear scalp incision was made at right frontal area which including the previous linear op scar. The scalp flap was elevated and the edge of anterior fontanelle was identified. Rongeur was used for creation of burr hole at 3 cm lateral to the midline. The dura was opened and ventricular puncture was done. The Nelaton catheter was placed for checking the pressure and CSF sampling. The transverse right abdominal scalp insicion was made at the level of umbilicus. The subcutaneous soft tissue and muscle was dissected and splitted. The peritoneum was exposed and minilaparotomy was performed under direct vision. The peritoneal catheter was placed into peritoneal cavity. The subcutaneous tunnel was created from right upper abdomen, right forechest(lateral to areola), right neck, to right retroauricular area. The other small scalp incision was made at right retroauricular area for passed through the catheter to the subcutaneous tunnel. The V-P shunt was set up and the ventricular catheter was placed into right lateral ventricle. The function of the shunt was checked. The reservoir was fixed with 2 stitches. Hemostasis was achieved and the wound was then closed in layers with 3-0 Vicryl and 4-0 Nylon. Operators AP郭夢菲 Assistants R4李振豪, Ri黃緒桓 相關圖片 黃信維 (M,1995/03/27,16y11m) 手術日期 2010/09/29 手術主治醫師 郭夢菲 手術區域 兒醫 067房 02號 診斷 Intracerebral hemorrhage (ICH) 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 11:00 進入手術室 11:05 麻醉開始 11:10 誘導結束 12:34 手術開始 13:55 手術結束 13:55 麻醉結束 14:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 腦室腹腔分流手術 1 1 R 手術 深部傷口處理縫合擴創-小 1 0 記錄__ 手術科部: 外科部 套用罐頭: Right Kocher"s ventriculoperitoneal shunt imp... 開立醫師: 李振豪 開立時間: 2010/09/29 14:35 Pre-operative Diagnosis Cerebellar ICH, IVH with hydrocephalus Post-operative Diagnosis Cerebellar ICH, IVH with hydrocephalus 1. Cerebellar ICH, IVH with hydrocephalus 2.suboccipital wound disruption with CSF leakage Operative Method Right Kocher"s ventriculoperitoneal shunt implantation 1. Right Kocher"s ventriculoperitoneal shunt implantation 2. wound closure Specimen Count And Types 1 piece About size:15ml Source:CSF and subgaleal effusion(posterior fossa) Pathology Nil Operative Findings 1. Subgaleal effusion was noted at occipital area and fine needle aspiration drained more than 50ml CSF(xanthochronic to light brownish in color). The upper part of the occipital wound was necrotic with CSF leakage. Debridement with primary closure was performed. 1. massive subgaleal effusion at occipital area with CSF leakage from the upper end of the wound. Needle aspiration of the fluid of more than 50ml CSF(xanthochronic to light brownish in color) were obtained and sent for studies. 2. Metronic median pressure, burr hole type reservoir was used. The ventricular catheter was 6.5cm and the peritoneal catheter was 30cm in length. The CSF is light xanthochromic without increase cellularity. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine position with head rotated to left. The scalp was shaved and disinfected. Subgaleal tapping was performed for occipital subgaleal effusion. Debridement of upper part of occipital wound was performed and the wound was closed with 3-0 Nylon. The skin was then scrubbed, disinfected, and draped as usual. The curvilinear scalp incision was made at right frontal area followed by one burr hole creation at Kocher"s point. Two dural tenting was performed and the dura was opened with cruciform shape. The edge of the dura was coagulated and ventricular puncture was performed with puncture needle. The Nelaton was placed into right lateral ventricle and the opening pressure was checked. Under endotracheal tube general anesthesia, the patient was put in supine position with head rotated to left. The scalp was shaved and disinfected. Subgaleal tapping was performed for occipital subgaleal effusion. Debridement of upper part of occipital wound was performed and the wound was closed with 3-0 Nylon. The skin was then scrubbed, disinfected, and draped as usual. The curvilinear scalp incision was made at right frontal area followed by one burr hole creation at Kocher"s point. Two dural tenting was performed and the dura was opened with cruciform shape. The edge of the dura was coagulated and ventricular puncture was performed with puncture needle. The Nelaton was placed into right lateral ventricle and the opening pressure was checked. Right upper abdominal transverse skin incision was made and the subcutaneous soft tissue was dissected for minilaparotomy. The subcutaneous tunnel was created from right upper abdomen, right forechest, right neck, and right retroauricular area. Small scalp incision was made at right retroauricular and the catheter was placed throught the tunnel. The distal part of peritoneal catheter was placed into peritoneal cavity. The V-P shunt was set up and the ventricular catheter was placed into right lateral ventricle. The function of the V-P shunt was checked. The reservoir was fixed with three silks. Hemostasis was achieved and the wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators AP郭夢菲 Assistants R4李振豪, Ri黃緒桓 相關圖片 李惠珠 (F,1952/03/28,59y11m) 手術日期 2010/09/29 手術主治醫師 賴達明 手術區域 東址 001房 02號 診斷 Spinal metastasis 器械術式 Spinal fusion posterior 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2E 紀錄醫師 曾峰毅, 時間資訊 00:10 臨時手術NPO 00:10 開始NPO 08:10 通知急診手術 09:55 報到 10:10 進入手術室 10:15 麻醉開始 10:25 誘導結束 10:30 抗生素給藥 11:15 手術開始 13:00 開始輸血 13:30 抗生素給藥 15:00 手術結束 15:00 麻醉結束 15:20 送出病患 15:20 進入恢復室 17:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 惡性病髓腫瘤切除術 1 1 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 曾峰毅 開立時間: 2010/09/29 15:12 Pre-operative Diagnosis Breast cancer, with multiple spinal metastasis and cord compression at T6/7 Post-operative Diagnosis Breast cancer, with multiple spinal metastasis and cord compression at T6/7 Operative Method Laminectomy from T5 to T8 for intraspinal epidural tumor excision, fixation with transpedicular screws at bialteral pedicles at T5, T6, and T8, fusion with autologous bone graft Specimen Count And Types Several pieces were sent for pathology. Pathology Pending Operative Findings Ill-defined, fragile, elastic, mass lesion involved bilateral laminae of T6 and T7, bilateral pedicles of T9, and left pedicle of T6 with epidural component and cord compression. Sythesis 5.5mmx35mm screws was inserted at bilateral peidcles of T5 and T6, 6.0x35mm at bialteral laminae of T8. Two 9cm rods was used for fixation between screws. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After C-arm localization, and the back was scrubbed, disinfected, and then draped. We made one midline linear skin incision from T5 to T9. We dissected bilateral paraspinal muslces and inserted TPS at bilateral pedicels of T5, T6, and T8. Laminectomy from T5 to T8 was done with rongeurs and curettes. Epidural tumor and ligamentum flavum was removed. Hemostasis was done with irrigation and gelfoam packing. Rod fixation was done. After two epidural hemovac inserted, we closed the wound in layers. Operators VS 賴達明 Assistants R4 曾峰毅 Ri 蔡夆杰 Indication Of Emergent Operation 林育蔚 (M,1977/04/11,34y11m) 手術日期 2010/09/30 手術主治醫師 林峰盛 手術區域 西址 035房 09號 診斷 Trigeminal neuralgia 器械術式 DCS implantation / PC 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 林至芃 ASA 2 時間資訊 17:28 進入手術室 17:30 麻醉開始 17:35 誘導結束 17:37 手術開始 18:20 手術結束 18:20 麻醉結束 18:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 三叉神經阻斷術 1 0 B 手術 三叉神經阻斷術 1 0 B 記錄__ 手術科部: 麻醉部 套用罐頭: RF lesioning 開立醫師: 林怡萱 開立時間: 2010/09/30 18:23 Pre-operative Diagnosis Trigeminal neuralgia Post-operative Diagnosis Trigeminal neuralgia Operative Method trigeminal block Specimen Count And Types Pathology Nil Operative Findings Operative Procedures IVGA with midazolam patient in supine position Under fluoroscopic-guidance, insert 22Gblock needle into right foramen ovale neurostimulation with 0.3-0.5mV with positive result inject 0.5% Marcaine 1 ml and kenacort 10mg repeat the same procedure at left side Operators 林峰盛, Assistants 林怡萱, 周韋翰, 曾錦燾 (M,1948/12/13,63y3m) 手術日期 2010/09/30 手術主治醫師 杜永光 手術區域 東址 022房 03號 診斷 Meningitis 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 王奐之, 時間資訊 14:40 進入手術室 14:45 麻醉開始 14:50 誘導結束 15:27 抗生素給藥 15:33 手術開始 16:32 16:50 手術結束 16:50 麻醉結束 16:50 16:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室體外引流 1 1 R 手術 氣管切開造口術 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: 1. EVD insertion via right Kocher point 開立醫師: 王奐之 開立時間: 2010/09/30 17:36 Pre-operative Diagnosis 1. CNS infection with hydrocephalus 2. Respiratory failure Post-operative Diagnosis 1. CNS infection with hydrocephalus 2. Respiratory failure Operative Method 1. EVD insertion via right Kocher point 2. Tracheostomy Specimen Count And Types 1 piece About size:8ml Source:CSF Pathology Nil Operative Findings 1. CSF gushed out while ventricular tapping, initial ICP about 5~10cmH2O. The CSF was clear and yellowish, sent for routine, BCS, bacterial and fungal cultures. The ventricular catheter: about 6cm in depth. 2. A Fr.8 low pressure tracheostomy tube was inserted to the trachea via 2nd-3rd tracheal ring. Operative Procedures After ETGA, the patient was placed in supine position. After shaving, skin disinfection and draping in sterile fashion, a linear skin incision was made at right frontal area, exposing previous right Kocher burr hole. Ventricular tapping was done smoothly, EVD was then inserted. After securing the EVD, the wound was closed in layers. The draping was removed, the neck was then hyperextended, followed by neck skin disinfection. After draping, a midline linear skin incision was made in mid-neck. The incision was deepened until the tracheal ring was exposed. A round tracheal incision was made at 2nd-3rd tracheal ring, followed by tracheostomy tube insertion. After confirmation of the tube position, the wound was approximated. Operators p 杜永光 Assistants R3 王奐之 相關圖片 李傳喜 (M,1937/01/13,75y2m) 手術日期 2010/09/30 手術主治醫師 杜永光 手術區域 東址 001房 02號 診斷 Intracerebral hemorrhage 器械術式 Remove of intracerebral hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 李振豪, 時間資訊 09:38 通知急診手術 09:38 臨時手術NPO 09:38 開始NPO 11:33 進入手術室 11:40 麻醉開始 11:55 誘導結束 12:25 手術開始 12:50 開始輸血 13:00 抗生素給藥 14:50 麻醉結束 14:55 手術結束 15:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: craniotomy ICH evacuation 開立醫師: 陳德福 開立時間: 2010/09/30 14:28 Pre-operative Diagnosis right temporal ICH with brain stem compression Post-operative Diagnosis right temporal ICH with brain stem compression Operative Method craniotomy ICH evacuation Specimen Count And Types nil Pathology nil Operative Findings 1.There is 30-40ml ICH at the right temporal lobe with midbrain compression. The ICH was evacuated via craniotomy and one 1*2cm corticotomy at the right superior temporal gyrus. 2.The brain became slacky and pulsatile after the ICH evacuation. 3.The ICP[right temporal parenchymal] after dura closure was 4-5mmHg. Operative Procedures Under ETGA and supine position with head ratated to left side, the scalp was disinfected and draped as usual. One linear incision ar the right scalp was done and the 4*4cm craniotomy was performed. The dura was opened in cruciate fasion and the ICH gushed out spontaneously after the dura opening. The ICH was evacuated with sucker and tumor forceps assisted. The rough surface of the brain was covered with surgicelle and the dura was closed in water tight fasion. One ICP was left in situ. The skull was fixed with miniplates and the wound was closed in layers. Operators P杜永光 Assistants R5陳德福 R4李振豪 Indication Of Emergent Operation 甘廣雄 (M,1958/07/04,53y8m) 手術日期 2010/09/30 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 古恬音, 時間資訊 07:45 報到 08:08 進入手術室 08:15 麻醉開始 08:45 誘導結束 08:51 抗生素給藥 08:53 手術開始 11:55 抗生素給藥 13:15 麻醉結束 13:15 手術結束 13:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４～８小時 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 摘要__ 手術科部: 外科部 套用罐頭: Pterion approach for tumor remove 開立醫師: 陳睿生 開立時間: 2010/09/30 13:49 Pre-operative Diagnosis Right frontal tumor, suspect glioma Post-operative Diagnosis Right frontal tumor, suspect high grade glioma Operative Method Pterion approach for tumor remove Specimen Count And Types 2 pieces About size:6x6x6cm Source:tumor About size:1x1cm Source:cyst wall Pathology Frozen section: glioma Operative Findings The tumor was whitish, soft, fragile, and translucent in appearance. The tumor extended to the subcortical region and its size was about 6x6x6cm with a huge cyst at the inferiomedial side of the solid lesion. The fluid inside the cyst wall was yellowish, and it extended into the lateral ventricle. The margin between the tumor and normal brain tissue was not clear. The medial and inferior frontal gyrus were well preserved intra-op. Operative Procedures 1. ETGA, supine position and head was fixed with Mayfield clump, left turn 2. Curvillinear scalp incision at frontotemporal region 3. Facial nerve preservation was done 4. Two bur holes made and an about 10x10cm craniotomy window was created 5. Dura tenting and then opened curvillinearly 6. The tumor was identified with intra-op ECHO 7. The margin between the tumor, and normal brain was carefully dissected,and then the tumor was totally removed 8. The cyst wall was opened and fluid inside was drained 9. Hemostasis, and the dura was closed tightly 10.The skull graft was fixed with miniplates after central tenting 11.An epidural CWV drain was set and the wound was closed in layers Operators VS 曾勝弘 Assistants R6 陳睿生, R3 古恬音 徐銘夆 (M,1982/12/05,29y3m) 手術日期 2010/09/30 手術主治醫師 林峰盛 手術區域 西址 035房 06號 診斷 Failed back syndrome 器械術式 Nerve block / PC 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 林峰盛 ASA 1 時間資訊 14:52 進入手術室 14:53 麻醉開始 14:54 誘導結束 14:55 手術開始 15:30 手術結束 15:30 麻醉結束 15:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 高頻熱凝療法 1 1 記錄__ 手術科部: 麻醉部 套用罐頭: Pulsed RF 開立醫師: 林怡萱 開立時間: 2010/09/30 15:36 Pre-operative Diagnosis failed back syndrome Post-operative Diagnosis Failed back syndrome Operative Method 1. IV sedation with midazolam and LA with 1% xylocaine 2. pt in prone position 3. Under fluoroscopic-guidance, insert 22 G SMK RF meedle into neuroforamen 4. Neurostimulation with 50 HZ and 2 Hz 0.1-0.5 mV current with positive result 60-80V 2 Hz, 20 ms, 120sec *2 pulsed RF was delivered 5. Total kenacort 60 mg and 2% lidocaine 4ml are infected into L3 L4 L5 nerve root send pt to POR Specimen Count And Types Pathology Nil Operative Findings Operative Procedures Pulsed RF Operators 林峰盛, Assistants 林怡萱, 蔡俊卿 (M,1924/05/24,87y9m) 手術日期 2010/09/30 手術主治醫師 賴達明 手術區域 東址 001房 03號 診斷 Osteoarthritis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 14:58 報到 15:15 進入手術室 15:25 麻醉開始 15:30 誘導結束 16:17 抗生素給藥 16:30 手術開始 18:30 開始輸血 19:17 抗生素給藥 20:35 手術結束 20:35 麻醉結束 20:40 送出病患 20:41 進入恢復室 21:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 手術 椎弓切除術（特壓）－超過二節 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 摘要__ 手術科部: 外科部 套用罐頭: L2-4 laminectomy for decompression + L2, L4 t... 開立醫師: 李振豪 開立時間: 2010/09/30 20:53 Pre-operative Diagnosis L2-4 spinal stenosis Post-operative Diagnosis L2-4 spinal stenosis Operative Method L2-4 laminectomy for decompression + L2, L4 transpedicular screws fixation L2-4 laminectomy for decompression + L2, L4 transpedicular screws fixation + posteriolateral fusion with autologus bone graft Specimen Count And Types nil Pathology Nil Operative Findings 1. The thecal sac was severe compressed by hypertrophic and calcified ligmentum flavum. THe thecal sac expanded well after decompression. 2. Posterior listhesis of L2 and L3 was noted during the operation. 3. Much marginal spur formation and facet hypertrophy found during the operation. 4. Screws: 6.2 x 45mm x IV, Rods: 8cm x II, Cross link x I Operative Procedures Under endotracheal tube general anesthesia, the patient was put in prone position. The L2-4 level was localized with portable C-arm X-ray. The skin was scrubbed, disinfected and draped as usual. Midline skin incision was made at L2~L4 level. The subcutaneous soft tissue and paravertebral muscle groups were dissected and detached. The L2-4 lamina and bilateral facet joints were exposed. L2-4 laminectomy was performed with rougeur and Kerrison punches for decompression. Foraminotomy also performed. L2 and L4 transpedicular screws were performed under portable C-arm X-ray guided. Hemostasis was achieved with bipolar electrocautery and Gelform packing. After setting the rods and cross links, one epidural Hemovac was placed. Posteriolateral fusion with autologus bone graft was applied and the wound was then closed in layers. Operators VS賴達明 Assistants R6胡朝凱, R4李振豪, R1周聖哲 相關圖片 朱戴雪花 (F,1937/03/11,75y0m) 手術日期 2010/09/30 手術主治醫師 林峰盛 手術區域 西址 035房 08號 診斷 Lumbar spondylosis 器械術式 Nerve block / PC 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 硬肌麻醉 麻醉主治醫師 林峰盛 ASA 2 時間資訊 16:35 進入手術室 16:40 麻醉開始 16:43 誘導結束 16:45 手術開始 17:15 手術結束 17:15 麻醉結束 17:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 末稍神經阻斷術 1 0 手術 末稍神經阻斷術 1 0 手術 末稍神經阻斷術 1 0 記錄__ 手術科部: 麻醉部 套用罐頭: LENB 開立醫師: 林怡萱 開立時間: 2010/09/30 17:24 Pre-operative Diagnosis Lumbar spondylosis Post-operative Diagnosis Lumbar spondylosis Operative Method LA with 1% xylocaine 5 ml pt in prone position 3. Under fluoroscopic-guiddance, LENB was done to L4-L5 level with 16G Tuohy needle, 40mg Kenaocrt in 2% xylocaine 2ml 4. Total 40mg Kenaocrt in 2% xylocaine 2ml are injected into with 23G spinal needle into L4 and L5 neuroforamen Specimen Count And Types Pathology Nil Operative Findings Operative Procedures LENB Operators 林峰盛, Assistants 林怡萱, 周韋翰, 林沂漀 (M,1955/06/03,56y9m) 手術日期 2010/09/30 手術主治醫師 陳敞牧 手術區域 東址 003房 03號 診斷 Herniation of intervertebral disc 器械術式 Diskectomy lumbar(Others) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 13:20 報到 13:30 進入手術室 13:35 麻醉開始 13:40 誘導結束 14:17 手術開始 14:23 抗生素給藥 16:55 手術結束 16:55 麻醉結束 17:00 送出病患 17:05 進入恢復室 18:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 手術 椎間盤切除術－腰椎 1 1 記錄__ 手術科部: 外科部 套用罐頭: L5 left laminotomy with L5-S1 microdisectomy 開立醫師: 林哲光 開立時間: 2010/09/30 17:39 Pre-operative Diagnosis L5-S1 HIVD Post-operative Diagnosis L5-S1 HIVD Operative Method L5 left laminotomy with L5-S1 microdisectomy Specimen Count And Types Pathology Operative Findings Ruptured disc with upward migration direct compressed the left L5 root, bulging of the nerve root was noted and erythematous change was noted. Hypertrophic change of the ligamentume flavum was also noted. The nerve root seemed tension-free after the discectomy. Operative Procedures Under ETGA and prone position, skin disinfected and drapped were performed as usual. Midline skin incision was made and the L5 spinous process was identified. The left paraspinal muscles were detached and L5 laminotomy was done. The ligamentum flavum was removed and the nerve root was exposed well. The ruptured disc was removed and further L5-S1 discectomy was also performed. Rinderon applied to the L5 root and hemostasis was done with Gelfoam packing. The wound was then closed in layers and the skin was closed in Nylon. Operators VS 陳敞牧 Assistants R4 林哲光 相關圖片 王永沛 (M,1932/04/12,79y11m) 手術日期 2010/09/30 手術主治醫師 蕭輔仁 手術區域 東址 005房 02號 診斷 Lumbar Spondylosis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 髒 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾峰毅, 時間資訊 13:03 報到 13:39 進入手術室 13:47 麻醉開始 13:55 誘導結束 14:42 手術開始 18:18 手術結束 18:18 麻醉結束 18:25 送出病患 18:30 進入恢復室 19:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 手術 椎間盤切除術－腰椎 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 曾峰毅 開立時間: 2010/09/30 18:26 Pre-operative Diagnosis Spondylodiskitis, L5/S1 Post-operative Diagnosis Spondylodiskitis, L5/S1 Operative Method L5 laminectomy for diskectomy of L5/S1, fixation with transpedicular screws at bialteral pedicles of L5 and S1, fusion with autologous bone graft. Specimen Count And Types Several fragments of the disc was sent for cultures. Pathology Pending Operative Findings Some granulation tissue was noted at L5/S1 disc space with fragile disc content. Four A-Spine 6.5mmx45mm screws was inserted at bilateral pedicels of L5/S1. Two 4cm rods was used for fixation. Autologous bone graft from L4 to L5 spinous process was used for L5/S1 interbody fusion. Operative Procedures With endotracheal general anaesthesia, the patient was put in sprone position. After locating the lesion with C-arm, we scrubbed, disinfected, and then draped the back. We made one midline skin incision from L4 to S2, and dissected bilateral paraspinal muscles to expose bilateral facets of L4/5 and L5/S1. We inserted transpedicular screws at bilateral pedicles of L5 and S1. Lamienctomy of L5 was done, following by L5/S1 diskectomy. Fusion was done with autologous bone graft from spinous process, and fixation was completed with rod fixation. The wound was irrigated with gentamycin saline, and two hemovac was inserted. The wound was closed in layers. Operators VS 蕭輔仁 Assistants R4 曾峰毅 周克舉 (M,1926/07/08,85y8m) 手術日期 2010/09/30 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Head Injury 器械術式 V-P shunt 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 林哲光, 時間資訊 07:45 報到 08:04 進入手術室 08:10 麻醉開始 08:15 誘導結束 09:15 抗生素給藥 09:20 手術開始 10:30 抗生素給藥 10:35 手術結束 10:35 麻醉結束 10:42 送出病患 10:45 進入恢復室 11:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 腸粘連分離術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Adhesionolysis; Burr hole at right Kocher point 開立醫師: 林哲光 開立時間: 2010/09/30 10:54 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Small intestine adhesion Operative Method Adhesionolysis; Burr hole at right Kocher point Specimen Count And Types nil Pathology Operative Findings previous midline skin incision for gastric cancer was noted. Small intestine adhesion and adherent to the peritoneum were noted after RLQ skin incision was made. A perforation was noted after the peritoneum opened. Operative Procedures Under ETGA and supine position with head rotated to left side and right shoulder elevated, skin disinfected and drapped were performed as usual. Curvilinear skin incision was made over the right Kocher point and a burr hole was created. Dura tenting was done and packed with Gelfoam. The RLQ abdomen transverse skin incision was made and mini-larparotomy was made. Intestine mucosa was noted after the peritoneum was opened. GS man was consulted for intestine repair and the wound was closed in layers. Operators VS 黃約翰, VS 王國川 Assistants R4 林哲光 相關圖片 林助 (M,1928/01/15,84y1m) 手術日期 2010/09/30 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 Hydrocephalus 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 林哲光, 時間資訊 10:30 報到 10:52 進入手術室 11:00 麻醉開始 11:05 誘導結束 11:43 手術開始 11:47 抗生素給藥 13:00 手術結束 13:00 麻醉結束 13:05 送出病患 13:08 進入恢復室 15:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Right Kocher point V-P shunt insertion 開立醫師: 林哲光 開立時間: 2010/09/30 13:24 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Right Kocher point V-P shunt insertion Right Kocher point V-P shunt insertion, Medtronic programmable valve Specimen Count And Types nil Pathology Operative Findings CSF seemd clear and transparent; medium prssure valve, Medtronic programmable valve, was inserted. Ventricular catheter was 6cm long and abdominal catheter was more than 15cm. Operative Procedures Under ETGA and supine position with head rotated to left side and shoulder elevated, skin disinfected and drapped were performed as usual. Transverse skin incision was done over the right Kocher point. A burr hole was created and dura was opened after dural tenting. Ventricular puncture was done with puncture needle. RUQ abdomen skin incision was made and mini-larparotomy was done. Subcutaneous tunneling was then created with Stylate. The abdominal catheter was then conneceted with Medtronic programmable valve to ventricular catheter. The abdominal catheter was then inserted into the abdominal cavity after the function was checked. The wounds were then closed in layers. Operators VS 王國川 Assistants R4 林哲光 相關圖片 曾子嫣 (F,2010/06/10,1y9m) 手術日期 2010/10/01 手術主治醫師 許文明 手術區域 兒醫 062房 04號 診斷 Astrocytoma 器械術式 Closure of stoma 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 林昊諭, 時間資訊 14:10 報到 14:35 進入手術室 14:40 麻醉開始 15:45 誘導結束 16:00 抗生素給藥 16:15 手術開始 16:50 抗生素給藥 18:30 開始輸血 19:20 麻醉結束 19:20 手術結束 19:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 新生兒壞死性腸炎手術，含腸切除及吻合術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 套用罐頭: right hemicolectomy with ileocolic anastomosis 開立醫師: 林昊諭 開立時間: 2010/10/01 19:27 Pre-operative Diagnosis 1.NEC s/p distal ileostomy Post-operative Diagnosis 1.NEC s/p distal ileostomy 2.Ascending colon stricture Operative Method right hemicolectomy with ileocolic anastomosis Specimen Count And Types one 15cm bowel Pathology pending Operative Findings 1.Ascending colon stricture due to previous NEC. 1.Proximal ascending colon stricture due to previous NEC, causing bowel obstruction between ileostomy and cecum. 2.Distal ileum and A-colon were resected. Operative Procedures 1. Under general anesthesia, in supine position. 2. The ileostomy was mobilized by the incision made around the edge of the stoma, the soft tissue of the abdominal wall was freed from the stoma limbs. 3. check colon patency before resection of stoma limbs. 4. End-to-end anastomosis of T-colon and ileum was performed. 5. The wound was closed by layers. Operators 許文明 Assistants R6林昊諭 Ri黃彥鈞 李有利 (M,1959/12/04,52y3m) 手術日期 2010/10/01 手術主治醫師 賴達明 手術區域 東址 019房 02號 診斷 Brain cancer 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 李振豪, 時間資訊 10:40 報到 11:23 進入手術室 11:30 麻醉開始 11:50 誘導結束 12:20 抗生素給藥 12:23 手術開始 15:20 抗生素給藥 18:10 麻醉結束 18:10 手術結束 18:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４～８小時 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 摘要__ 手術科部: 外科部 套用罐頭: Right frontal craniotomy for tumor excision 開立醫師: 李振豪 開立時間: 2010/10/01 18:55 Pre-operative Diagnosis Right frontal oligoastrocytoma, recurrent Post-operative Diagnosis Right frontal oligoastrocytoma, recurrent Operative Method Right frontal craniotomy for tumor excision Specimen Count And Types 1 piece About size:Multiple pieces of brain tumor with total about 5g in weight Source:Right frontal brain tumor Pathology Pending Operative Findings The tumor is gelatinous, gray and reddish, mild hypervascularized in character. The location is mainly at mesial frontal which medial and superior to right lateral ventricle(just below previous craniotomy window). The tumor also adhered to the dura and removed by curette and tumor forceps. The ventricle is entered during tumor excision. The normal brain is yellowish in color and post-irradiation change was favored. The main branches of anterior cerebral artery is well preserved during the operation. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine position with head fixed with Mayfield scalp holder. The scalp was shaved, scrubbed, and disinfected as usual. Scalp incision was made along op scar. The scalp flap was elevated. The previous cranitomy skull plate was removed. Dural tenting was performed. U-shape dural incision was made based at superior sagittal sinus. Under operative microscope, the tumor was removed with tumor forceps, bipolar electrocautery, sucker, and curette. Hemostasis was achieved with bipolar electrocautery and Surgicel lining. The right lateral ventricle was entered during tumor excision and the Gelform was used for coverage of the opening of the right lateral ventricle. The dura was then closed with 4-0 prolene. The skull plate was replaced with miniplates and one subgaleal CWV drain was placed. The wound was closed in layers with 2-0 Vicryl, 3-0 Nylon and Appose staples. Operators VS賴達明 Assistants R4李振豪, R1方怡婷 林薏蕙 (F,1960/12/28,51y2m) 手術日期 2010/10/01 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 游健生, 時間資訊 07:50 報到 08:10 進入手術室 08:15 麻醉開始 08:50 誘導結束 09:05 抗生素給藥 09:10 手術開始 12:05 抗生素給藥 15:00 麻醉結束 15:00 手術結束 15:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４～８小時 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Right fronto-temporal craniotomy for Simpson ... 開立醫師: 游健生 開立時間: 2010/10/01 15:22 Pre-operative Diagnosis Right middle fossa meningioma Post-operative Diagnosis Right middle fossa meningioma Operative Method Right fronto-temporal craniotomy for Simpson grade II tumor excision Specimen Count And Types 1 piece About size:5.5 x 4.8 x 3.8cm Source:meningioma Pathology Pending Operative Findings Easy bleeding from temporal bone was noted. There was hyperosteosis at temporal bone. Mastoid air-cells were encountered during craniotomy and was sealed by bone wax. Middle meningeal artery was cauterized at foramen spinosum. After durotomy, a whitish elastic tumor buldged out. It was 5.5 x 4.8 x 3.8cm in size with dura base at middle fossa base. The plane between tumor and temporal lobe was clear. After tumor removal, the brain returned to neutral position. Operative Procedures Under ETGA, patient was put into supine position with head fixed by Mayfield headholder. Head was turned to left making superior sagittal sinus parallel to floor. After shaving, we disinfected and draped the operation field as usual. A 12cm curvilinear scalp incision was made from 1cm anterior to right tragus to frontal region. The skin flap was reflected anteriorly together with Yasargil fatpad followed by reflecting temporalis muscle inferiorly leaving a muscle cuff at superior temporal line. We created a 6 x 7cm craniotomy via 3 burrholes including the keyhole followed by dura tenting. Mastoid air-cells were encountered during craniotomy and was sealed by bone wax. We identified foramen spinosum and foramen ovale by tracing the middle meningeal artery. It was cauterized at foramen spinosum and sealed with bone wax. Curvilinear durotomy with temporal as base was performed and dura flap reflected inferiorly. The tumor was exposed and cauterized first at its base. Then, we dissected the tumor from temporal lobe easily along the arachnoid plane and removed it in en bloc fashion. The attached dura was cauterized and hemostasis was achieved with bipolar, gelfoam, and Surgicel packing. The dura was closed with 4-0 prolene continuous suture. Bone flap was fixed back with mini-plates with central tenting. After placing a subgaleal CWV drain, the wound was closed in layers. Operators Prof. 杜永光 Assistants R6 胡朝凱 R3 游健生 方培元 (M,1963/03/26,48y11m) 手術日期 2010/10/01 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Glioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 陳國瑋, 時間資訊 07:45 報到 08:05 進入手術室 08:10 麻醉開始 08:45 誘導結束 08:55 抗生素給藥 09:00 手術開始 11:55 抗生素給藥 13:10 麻醉結束 13:10 手術結束 13:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４～８小時 1 1 R 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 摘要__ 手術科部: 外科部 套用罐頭: Right pterional craniotomy for tumor excision 開立醫師: 曾峰毅 開立時間: 2010/10/01 13:18 Pre-operative Diagnosis Right temporal lobe tumor, suspected glioma Post-operative Diagnosis Right temporal glioma, grade to be determined Operative Method Right pterional craniotomy for tumor excision Specimen Count And Types Several fragements of the tumor was sent for pathology. Pathology Frozen: glioma,as least grade II Operative Findings One hypervascular, ill-deinfed, tumor was located at right anterior temporal lobe, just anterior to temporal horn. Frozen section showed glioma, at least low grade. Blood loss was about 350ml. Depakine was loaded at the end of surgery,. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to left and fixed with Mayfield head clamp. After scalp scrubbed, disinfected, and then draped, we made one curvilinear skin incision at right temporal-frontal area. After drilling four burr holes, and created craniotomy windown. Epidural bleeding was stopped with packing and Floseal. Tenting was donw around the craniotomy window, and then durotomy was made. The lesion was identified with sonography. Corticotomy was done at right superior temporal gyrus, and tumor excision was done in piecemeal fashion. Part of tumor was sent for frozen pathology. After tumor removed, hemostasis was done and tumor cavity was paved with Surgicels. Dura was closed in water-tight fashion with 4-0 prolene. Bone graft was fixed back with mini-plates and screws after cenral tenting. After set one subgaleal CWV, and temporalis was sutured back. The wound was closed in layers. Operators VS 曾漢民 Assistants R4 曾峰毅 R2 陳國瑋 李婉如 (F,1983/09/15,28y5m) 手術日期 2010/10/01 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Brain Tumor 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 陳國瑋, 時間資訊 13:10 報到 13:27 進入手術室 13:32 麻醉開始 14:00 抗生素給藥 14:05 誘導結束 14:10 手術開始 17:00 抗生素給藥 18:10 麻醉結束 18:11 手術結束 18:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT 開立醫師: 曾峰毅 開立時間: 2010/10/01 18:30 Pre-operative Diagnosis Craniopharyngioma, status post surgery twice Post-operative Diagnosis Craniopharyngioma, status post surgery twice Operative Method Right pterioanl craniotomy for tumor removal Specimen Count And Types Several fragments of one tumor was sent for pathology. Pathology Pending Operative Findings Pre-fixded optic chiasm was noted with severe adhesion to the tumor. The tumor border was difficult to identifed. One cystic lesion with calcified nodule on the cystic wall was noted located just beneath the optic chiasm. Left visual evoked potential disministed first, and then right visual evoked potential decreased. Operative Procedures With general endotracheal general anaestehsia, the patient was put in supine position with head rotated to left and fixed with Mayfield head clamp. After scalp shaved, scrubbed, disinfected, and then draped, we made one curvilinear skin incision at right frontal area. We created craniotomy after four burr holes drilled. Craniotomy windown was tented, and hemostasis was done. Frontal base was drilled flatened, and sphenoidal ridge was drilled as well. We opened the dura and dissected to expose the sellar region from the right front. Tumor was removed in piecemeal and subcapsully, and the dura was closed in water-tight fashion. Bone graft was fixed back with mini-plates. Temopralis muscle was sutured back, and one subgaleal CWV was placed. The wound was closed in layers. Operators VS 曾漢民 Assistants R4 曾峰毅 陳素琴 (F,1938/03/05,74y0m) 手術日期 2010/10/01 手術主治醫師 蔡瑞章 手術區域 東址 009房 03號 診斷 Meningioma 器械術式 Crainotomy Brain Tumor(P-LIN) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 胡朝凱, 時間資訊 12:56 報到 13:00 進入手術室 13:10 麻醉開始 13:40 誘導結束 13:40 抗生素給藥 14:05 手術開始 16:40 抗生素給藥 19:05 麻醉結束 19:05 手術結束 19:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 手術 腦瘤切除－手術時間在４小時以內 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Pterional approach for Simpson grade II tumor... 開立醫師: 胡朝凱 開立時間: 2010/10/01 19:49 Pre-operative Diagnosis Right sphenoid ridge middle third meningioma with extracranila extension Post-operative Diagnosis Right sphenoid ridge middle third meningioma with extracranila extension Operative Method Pterional approach for Simpson grade II tumor excision Specimen Count And Types pieces of tumor Pathology pending Operative Findings 1.One whitish with some necrotic part elastic firm tumor located at right Sphenoid ridge middle third. The tumor extended through foramen rotundum to extracranial area. 2.The tumor border was clear. 3.Simpson grade II tumor excision was made Operative Procedures 1.ETGA, supine with head fixed with Mayfield skull clamp 2.Right trauma flap skin incision was done 3.Reflect skin and muscle flap downward 4.Craniotomy 5.Removed sphenoid ridge bone as low as possible 6.Resect extracranial part tumor with dissection along the plane between tumor and muscle 7.Curvature dura incision 8.Devascularization 9.Resect tumor piece by piece by dissection along the arachnoid plane 10.The dural defect was covered with durofoam 11.Fixed bone back with miniplate 12.Set one CWV drain then close wound in layers Operators 蔡瑞章 Assistants 胡朝凱, Ri 鄭麗惠 (F,1972/06/05,39y9m) 手術日期 2010/10/01 手術主治醫師 蔡翊新 手術區域 東址 003房 02號 診斷 Subdural hematoma 器械術式 Craniotomy (A.V.M.) VS-TZENG 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 3E 紀錄醫師 曾峰毅, 時間資訊 15:24 通知急診手術 16:15 報到 16:15 進入手術室 16:20 麻醉開始 16:42 誘導結束 16:46 抗生素給藥 17:07 手術開始 18:30 開始輸血 19:46 抗生素給藥 20:15 麻醉結束 20:15 手術結束 20:25 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 手術 顱內壓監視置入 1 2 R 手術 腦內血腫清除術 1 1 R 摘要__ 手術科部: 創傷醫學部 套用罐頭: Right craniectomy for right frontal ICH and S... 開立醫師: 曾峰毅 開立時間: 2010/10/01 20:33 Pre-operative Diagnosis Hemophilia, with acute subural hematoma at right, and right frontal contusional intracerebral hemorrhage Von Willebrand disease, with acute subural hematoma at right, and right frontal contusional intracerebral hemorrhage Post-operative Diagnosis Hemophilia, with acute subural hematoma at right, and right frontal contusional intracerebral hemorrhage Von Willebrand disease, with acute subural hematoma at right, and right frontal contusional intracerebral hemorrhage Operative Method Right craniectomy for right frontal ICH and SDH removal, and ICP monitor insertion. Specimen Count And Types Nil Pathology Nil Operative Findings SDH was about 1cm thick, and brain pulsation was good after hemotoma removed. Right frontal ICH was noted as well. Post-op ICP was about 0cmHg. Operative Procedures With endotracheal general aneasthesia, the patient was put in supine position with head rotated to left. After scalp shaved, scrubbed, disinfected, and then draped, we made one curvilinear skin incision as traditional trauma flap. Craniectomy was done, and the windown edge was tented. Durotomy was performed, and then SDH was removed. Right frontal corticotomy was done for right frontal ICH removal. Hemostasis was achieved, and the hematoma cavity was paved with surgicels. Duroplasty was performed with Durafoam, and ICP monitor was inserted into subdural space. After 2 subgaeal CWV was put, and the wound was closed in layers. Operators VS 蔡翊新 Assistants R5 鍾文桂 R4 曾峰毅 Indication Of Emergent Operation 蕭錦龍 (M,1946/11/01,65y4m) 手術日期 2010/10/02 手術主治醫師 杜永光 手術區域 東址 002房 01號 診斷 Unspecified epilepsy without mention of intractable epilepsy 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 3E 紀錄醫師 曾峰毅, 時間資訊 19:30 臨時手術NPO 19:30 開始NPO 02:46 通知急診手術 03:24 報到 03:25 進入手術室 03:30 麻醉開始 03:45 誘導結束 04:00 抗生素給藥 04:09 手術開始 04:50 麻醉結束 04:50 手術結束 05:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦室體外引流 1 1 摘要__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 曾峰毅 開立時間: 2010/10/02 05:11 Pre-operative Diagnosis AVM, complicated with IVH and acute hydrocephalus Post-operative Diagnosis AVM, complicated with IVH and acute hydrocephalus Operative Method External ventricular drainage via left Kocher point Specimen Count And Types CSF was sent for routine, BCS, and culture. Pathology Nil Operative Findings Opening pressure of the ventricular puncture was about 8 to 10cm H20. Bloody CSF gushed out while ventricle puncutured. Ventricular catheter is about 6.5cm long. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position. After scalp shaved, scrubbed, disinfected, and then draped, we made one linear skin incision at left frontal area. We drilled on burr hole with air-drill, and tented the dura. After durotomy, we performed ventricular puncture. External ventricular drain was inserted along the ventricular puncutre tract. After fixation the drain, we closed the wound in layers. Operators VS 蔡翊新 Assistants R4 曾峰毅 Indication Of Emergent Operation 李婉如 (F,1983/09/15,28y5m) 手術日期 2010/10/02 手術主治醫師 曾漢民 手術區域 東址 002房 02號 診斷 Brain Tumor 器械術式 Debridment-- 5-10cm 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 3E 紀錄醫師 曾峰毅, 時間資訊 04:03 開始NPO 04:03 臨時手術NPO 07:03 通知急診手術 07:40 報到 07:41 進入手術室 07:45 麻醉開始 07:55 誘導結束 08:26 手術開始 08:40 麻醉結束 08:40 手術結束 08:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 深部複雜創傷處理－傷口長５－１０公分者 1 0 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Subgaleal drain insertion 開立醫師: 曾峰毅 開立時間: 2010/10/02 10:53 Pre-operative Diagnosis Subgaleal hematoma Post-operative Diagnosis Subgaleal hematoma Operative Method Subgaleal drain insertion Specimen Count And Types Nil Pathology Nil Operative Findings Old blood gushed out when we opened previuos surgical wound. Operative Procedures With endotracheal general anaestehsia, the patient was put in supine position with head rotated to left. After scalp shaved, scrubbed, disinfected, and then drapde, we removed few stitches of previous surgical wound in front of the ear. We made a small incision wound at high frontal area, and inserted tendon passer to the wound to made a subgaleal tunnel. CWV was placed, and the wound was closed in layers. Operators VS 曾漢民 Assistants R4 李振豪 R4 曾峰毅 Indication Of Emergent Operation 烏家萍 (F,1952/08/26,59y6m) 手術日期 2010/10/02 手術主治醫師 曾勝弘 手術區域 東址 003房 01號 診斷 Malignant neoplasm of female breast, unspecified 器械術式 Crainotomy Brain Tumor(P-LIN) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 3 紀錄醫師 李振豪, 時間資訊 07:44 報到 07:50 進入手術室 08:05 麻醉開始 08:35 誘導結束 08:55 抗生素給藥 09:24 手術開始 11:55 抗生素給藥 13:30 麻醉結束 13:30 手術結束 13:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除－手術時間在４小時以內 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: Craniotomy for total tumor excision 開立醫師: 胡朝凱 開立時間: 2010/10/02 12:52 Pre-operative Diagnosis Right parietal metastatic tumors Post-operative Diagnosis Right parietal metastatic tumors Operative Method Craniotomy for total tumor excision Specimen Count And Types pieces of tumor Pathology pending Operative Findings 1.Two soft, yellowish to reddish tumors located at right parietal lobe were noted. one was at the surface of the brak, and the other was 1 cm in depth from cortex. 2.The tumor margin were clear. 3.The brain was mild swelling with some gliosis surround the tumors. Operative Procedures 1.ETGA, supine with head rotate to left 2.Right reverse U shape skin incision 3.Reflect skin then muscle flap downward 4.Cranitomy 5.Dural tenting 6.Dural opening with the base left at temporal side 7.Localization with echo 8.Dissect tumor around the interface between tumor and brain 9.central debulky was also performed for second tumor removal. 10.Hemostasis 11.Close dura 12.Fixed bone back with wires 13.Close woun in layers after one CWV drain insertion Operators 曾勝弘 Assistants 胡朝凱, 李振豪 黃耀明 (M,1944/09/02,67y6m) 手術日期 2010/10/02 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Parkinsonism (F02.3) 器械術式 Stereotaxic procedure for impl 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 面罩麻醉 麻醉主治醫師 黃慧薰 ASA 3 紀錄醫師 方怡婷, 時間資訊 07:38 報到 07:58 進入手術室 08:45 麻醉開始 09:00 誘導結束 09:15 開始輸血 09:20 抗生素給藥 09:35 手術開始 12:20 抗生素給藥 14:10 麻醉結束 14:10 手術結束 14:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 立體定位術－功能性失調 1 2 R 手術 深部腦核電生理定位 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Semi-opened mask inhalation anes 1 0 手術 立體定位術－功能性失調 1 1 L 麻醉 Semi-opened INHALATION GENERAL A 4 0 麻醉 SENI-OPENED INHALATION GENERAL A 3 0 麻醉 Peripheral arterial line inserti 1 0 記錄__ 手術科部: 神經部 套用罐頭: Insertion of DBS wire at bilateral subthalamu... 開立醫師: 李振豪 開立時間: 2010/10/02 14:42 Pre-operative Diagnosis Parkisons disease Post-operative Diagnosis Parkisons disease Operative Method Insertion of DBS wire at bilateral subthalamus nucleus Specimen Count And Types nil Pathology Nil Operative Findings 1. The identified subthalamic nucleus at left side: 5.8mm in length, right side: 5.2mm in length. 2. The rigidity decreased after wire inserted at stimulation "on". 3. left lateral gaze limitation when stimulation "on" over right subthalamic nucleus. 4. The final targets were at the planned target. Operative Procedures Under IV general anesthesia, the patient was put in supine position. The scalp was shaved, scrubbed and antiseptic with alcohol B-I. Registered the preset localization point to navigator. Bicoronal scalp incision was made with burr hole made at entery point of left frontal region as navigator guided. The DBS wire port was set up and localization of subthalamus nucleus with microelectrode assistance. Inserted the DBS wire and fixed with the port. Waked the patient from the anesthesia and started stimulation from low voltage. Checked the clinical responses while using different voltage for stimulation. Performed the same procedure at right side. After hemostasis, closed the wound in layers. Operators 曾勝弘, Assistants R1方怡婷 黃哲鑑 (M,1940/05/26,71y9m) 手術日期 2010/10/02 手術主治醫師 黃鶴翔 手術區域 東址 008房 08號 診斷 Spinal metastasis 器械術式 TRUS-Biobsy 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 靜脈麻醉 麻醉主治醫師 黃慧薰 ASA 2 紀錄醫師 耿俊閎, 時間資訊 13:17 進入手術室 13:20 麻醉開始 13:25 誘導結束 13:25 抗生素給藥 13:30 手術開始 13:40 手術結束 13:40 麻醉結束 13:45 送出病患 13:50 進入恢復室 14:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 手術 前列腺切片－控取式 1 1 B 記錄__ 手術科部: 泌尿部 套用罐頭: TRUS-P-biopsy 開立醫師: 耿俊閎 開立時間: 2010/10/02 13:49 Pre-operative Diagnosis r/o prostate cancer Post-operative Diagnosis r/o prostate cancer Operative Method TRUSP biopsy Specimen Count And Types 1 piece About size: Source: Pathology pending Operative Findings systemic 6 cores TRUSP biopsy was performed Operative Procedures Under satisfactory anesthesia with the patient in right flank position, prepping and draping was performed in the usual sterile fashion. TRUSP was performed and echo-guided prostate biopsies were performed smoothly with Biopty gun. The cores of tissue specimen were obtained. The biosy area was compressed for several minutes to ensure adequate hemostasis. The patient tolerated the operation well and was sent to the floor in satisfactory condition. Operators 黃鶴翔, Assistants 耿俊閎, 曾任偉, 許陳錦 (F,1950/11/13,61y4m) 手術日期 2010/10/03 手術主治醫師 王國川 手術區域 東址 002房 07號 診斷 Breast cancer, female 器械術式 Ommaya reservoir implantation 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 4E 紀錄醫師 羅偉誠, 時間資訊 14:30 開始NPO 14:30 臨時手術NPO 16:10 通知急診手術 01:44 進入手術室 01:50 麻醉開始 02:00 誘導結束 02:10 報到 02:19 手術開始 03:55 麻醉結束 03:55 手術結束 04:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 歐氏貯囊置放手術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 記錄__ 手術科部: 外科部 套用罐頭: Ommaya reservoir implantation via right Koche... 開立醫師: 王奐之 開立時間: 2010/10/03 04:25 Pre-operative Diagnosis Left breast cancer with leptomeningeal carcinomatosis Post-operative Diagnosis Left breast cancer with leptomeningeal carcinomatosis Operative Method Ommaya reservoir implantation via right Kocher point Specimen Count And Types 1 piece About size:5ml Source:CSF Pathology Nil Operative Findings Brain bulged out upon durotomy. Difficult ventricular puncture due to small frontal horn size. The opening pressure was greater than 20cmH2O, CSF was clear and colorless. 5ml CSF was collected and sent for routine, BCS & bacterial culture. Ventricular catheter length: 6.5cm. Operative Procedures After ETGA, the patient was placed in supine position. After shaving, skin disinfection & draping in usual sterile fashion, a curvilinear skin incision was made at right frontal area. A burr hole at right Kocher point was then done, followed by 2 dural tenting stitches. A small cruciate durotomy was made, followed by a small corticotomy. Ventricular tapping was performed, then a Nelaton tube was used to confirm smooth CSF flow. The reservoir was then inserted. The burr hole was packed with Gelfoam. After meticulous hemostasis, the wound was closed with 2-0 Vicryl & 3-0 Nylon continous sutures. Operators VS 王國川 Assistants R3 王奐之, R1 羅偉誠 Indication Of Emergent Operation 相關圖片 李余勇 (M,1971/05/11,40y10m) 手術日期 2010/10/03 手術主治醫師 賴達明 手術區域 東址 002房 02號 診斷 Intracerebral hemorrhage (ICH) 器械術式 Burr hole (trephination) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 4E 紀錄醫師 游健生, 時間資訊 14:02 開始NPO 14:02 通知急診手術 14:53 進入手術室 14:55 麻醉開始 15:00 誘導結束 15:40 抗生素給藥 15:55 手術開始 16:45 手術結束 16:45 麻醉結束 16:55 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 顱內壓監視置入 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: External ventricle drainage insertion via rig... 開立醫師: 游健生 開立時間: 2010/10/03 17:12 Pre-operative Diagnosis 1. Left thalamic intracerebral hemorrhage with rupture into ventricle 2. Acute hydrocephalus Post-operative Diagnosis 1. Left thalamic intracerebral hemorrhage with rupture into ventricle 2. Acute hydrocephalus Operative Method External ventricle drainage insertion via right Kocher point Specimen Count And Types 3 pieces About size:1cc Source:CSF About size:1cc Source:CSF About size:1cc Source:CSF Pathology Nil Operative Findings Pre-operative GCS was E2M5Vt. Reddish CSF gashed out after ventriculostomy with opening pressure >15cmH2O. A 6.5cm ventricle catheter was inserted into frontal horn of right lateral ventricle. Operative Procedures Under ETGA, supine position with head elevated. After shaving, we disinfected and draped the operation field as usual. A vertical scalp incisino was made at right Kocher region. Dissected in layers and exposed the cranium. Created a burrhole and cauterized the dura. Cruciate durotomy followed by cauterization of edges. Performed ventriculostomy and inserted a ventricle catheter. Closed wound in layers after EVD fixation. Operators VS 賴達明 Assistants R5 鍾文桂 R3 游健生 Indication Of Emergent Operation 陳欣然 (M,1932/04/02,79y11m) 手術日期 2010/10/03 手術主治醫師 王國川 手術區域 東址 002房 01號 診斷 Subdural hematoma 器械術式 V-P shunt 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 4E 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 08:12 通知急診手術 09:35 報到 09:35 進入手術室 09:40 麻醉開始 09:45 誘導結束 10:00 抗生素給藥 10:42 手術開始 12:40 麻醉結束 12:40 手術結束 12:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 慢性硬腦膜下血腫清除術 1 2 R 手術 腦室腹腔分流手術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: 1. Ventriculoperitoneal shunt insertion via l... 開立醫師: 游健生 開立時間: 2010/10/03 13:10 Pre-operative Diagnosis 1. Hydrocephalus 2. chronic subdural hemorrhage, right fronto-temporal Post-operative Diagnosis 1. Hydrocephalus 2. chronic subdural hemorrhage, right fronto-temporal Operative Method 1. Ventriculoperitoneal shunt insertion via left Kocher point 2. Chronic subdural hematoma drainage, right Specimen Count And Types 3 pieces About size:1cc Source:CSF About size:1cc Source:CSF About size:1cc Source:CSF Pathology nil Operative Findings The craniectomy window was buldging before surgery and became slack afterwards. Clear CSF gashed out after ventriculostomy with pressure >15cmH2O. Some was sent for routine, biochemistry, and culture. The ventricle catheter was 7cm in length. The Codman programmable reservoir was set at 12mmHg. Some grayish pink fluid was drained from right subdural space. An EVD tube was inserted into the subdural space for drainage. Operative Procedures 1. Under ETGA, patient in supine position with head turned to right. 2. After shaving, we disinfected and draped as usual. 3. A transverse scalp incision at left Kocher region. 4. Dissected in layers and exposed the cranium. 5. Created a burrhole and cauterized dura 6. Cruciate durotomy and cauterized the edges 7. Ventriculostomy and inserted a ventricle catheter 8. A transverse LUQ abdominal incision and dissected in layers 9. Opened peritonium and inserted peritoneal catheter 10.Passed the catheter to scalp wound via subcutaneous tunnel 11.Connected both catheter to Codman programmable reservoir 12.Closed wounds in layers 13.Turned patient head to left, disinfection and draping 14.Opened the anterior part of previous wound 15.Dissected in layers and opened dura by a small hole 16.Inserted an EVD tube and irrigated with N/S 17.Closed wound in layers after EVD fixation Operators VS 王國川 Assistants R3 游健生 Indication Of Emergent Operation 宋榮泰 (M,1958/09/21,53y5m) 手術日期 2010/10/03 手術主治醫師 蔡翊新 手術區域 東址 005房 01號 診斷 Head Injury 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 4E 紀錄醫師 施廷翰, 時間資訊 00:00 開始NPO 10:30 通知急診手術 10:55 進入手術室 10:55 麻醉開始 11:30 誘導結束 11:30 抗生素給藥 12:00 手術開始 14:30 抗生素給藥 15:00 手術結束 15:00 麻醉結束 15:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 1 R 手術 顱內壓監視置入 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 蔡翊新 開立時間: 2010/10/03 14:35 Pre-operative Diagnosis Right frontotemporal skull fracture with SDH. Post-operative Diagnosis Right frontotemporal skull fracture with EDH, dural tear, SDH and right frontal contusion ICH. Operative Method Right F-T-P craniectomy for removal of EDH, SDH, ICH + duroplasty + ICP monitoring. Excision of right temporalis muscle. Specimen Count And Types nil Pathology Nil. Operative Findings Scalp abrasion and swelling over right frontotemporoparietal regions. Subdural hematoma gushed out upon first burr hole creation and opening of dura at right temporal region. Comminuted skull fractures over right frontotemporal bones with tear of dura beneath the fracture lines, and some EDH was noted upon elevation of bone plate. There was SDH, about 1 cm in thickness, at right F-T-P area with scattered SAH. Right frontal contusional ICH, beneath one of the fracture lines and dura tear, about 10 ml, was evacuated. The temporalis muscle was swollen and it was excised. The ICP after skin closure was mmHg. Scalp abrasion and swelling over right frontotemporoparietal regions. Subdural hematoma gushed out upon first burr hole creation and opening of dura at right temporal region. Comminuted skull fractures over right frontotemporal bones with tear of dura beneath the fracture lines, and some EDH was noted upon elevation of bone plate. There was SDH, about 1 cm in thickness, at right F-T-P area with scattered SAH. Right frontal contusional ICH, beneath one of the fracture lines and dura tear, about 10 ml, was evacuated. The temporalis muscle was swollen and it was excised. The ICP after skin closure was 3 mmHg. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 4 cm at anterior-lower temporal area, the skin edge was clipped by Raney clips for temporary hemostasis. The temporalis muscles was incised down to the tempoal squama which was exposed then by applying a self retaining retractor on the muscle. 5. A burr hole was made and the dura was incised for evacuating part of the subdural hematoma, therefore the IICP could be relieved earlier. 6. The incision was extended to a temporal horseshoe, and the temporalis muscle was detached from temporal squama by rasp subsequently. 7. Craniotomy window: 14 x 12 cm, right F-T-P, created by making 5 burr holes then cut by power saw. 8. Dural tenting: by 2/0 silk, 2 cm in interval, distributed along the edge of skull window. 9. Dural incision: curvilinear along the edge of skull window. 10.The subdural clot was removed by sucker and those located beyond the cranial window was washed out by saline irrigation. 11.Hemosatasis: the bleeders was stopped by Bovie and oozing surface was covered with Surgicel and Gelfoam. 12.A Codman ICP monitor was placed at subdural space at right temporal region. 13.Dural closure: dura was closed with a piece of Duroform (12 x 10 cm) in order to create an additional space for the swollen brain. 14.The right temporalis muscle was excised to avoid brain compression. 15.The skull plate was removed and placed at bone bank for preservation. 16.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 17.Drain: two epidural CWV. 18.Blood transfusion: Nil. Blood loss: 500 ml. 19.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5鍾文桂R1施廷翰 Indication Of Emergent Operation 胡火亮 (M,1954/03/28,57y11m) 手術日期 2010/10/04 手術主治醫師 杜永光 手術區域 東址 003房 02號 診斷 Hydrocephalus 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 游健生, 時間資訊 12:40 報到 13:25 進入手術室 13:38 麻醉開始 13:45 誘導結束 13:56 抗生素給藥 14:48 手術開始 16:25 手術結束 16:25 麻醉結束 16:30 送出病患 16:32 進入恢復室 17:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 腦室腹腔分流手術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt insertion via righ... 開立醫師: 游健生 開立時間: 2010/10/04 16:43 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunt insertion via right Kocher point Specimen Count And Types 1 piece About size:3cc Source:CSF Pathology Nil Operative Findings Clear CSF was drained after ventriculostomy with opening pressure about 10cmH2O. A Codmen programmable reservoir set at 8cmH2O was implanted. The ventricle catheter was 6.5cm in length. Some CSF was sent for routine, biochem, and culture. Operative Procedures Under ETGA, patient was in supine position with head rotated to left and right shoulder elevated. After shaving, we disinfected and draped the operation field as usual. Opened the scalp previous wound at right Kocher region followed by trephination. The dura was cauterized and opened in curciate fashion. The edges was cauterized again followed by ventriculostomy. We inserted a ventricle catheter and connected it with Codmen programmable reservoir. A transverse RUQ abdominal incision was made followed by dissection to expose peritonium. After opening it, we inserted a peritoneal catheter and passed it to scalp wound via subcutaneous tunnel. After assembling the shunt, we closed wounds in layers. Operators Prof. 杜永光 Assistants R6 胡朝凱 R3 游健生 陳萬成 (M,1952/09/14,59y6m) 手術日期 2010/10/04 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Trigeminal neuralgia (Cranial nerve V) 器械術式 Microvascular decompression 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 游健生, 時間資訊 07:45 報到 08:01 進入手術室 08:05 麻醉開始 08:40 誘導結束 08:50 抗生素給藥 09:00 手術開始 11:50 抗生素給藥 13:10 麻醉結束 13:10 手術結束 13:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦微血管減壓術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Right trigerminal nerve microvascular decompr... 開立醫師: 游健生 開立時間: 2010/10/04 13:32 Pre-operative Diagnosis Right trigerminal neuralgia Post-operative Diagnosis Right trigerminal neuralgia Operative Method Right trigerminal nerve microvascular decompression Specimen Count And Types nil Pathology Nil Operative Findings The offending artery from superior cerebellar artery was found beneath trigerminal nerve. The offending vein passed in between trigerminal nerve rootlets. Both offending vessels were packer away from nerve entry zone by Teflon. SSEP monitoring did not change significantly during the surgery. Operative Procedures Under ETGA, patient was in supine position with head fixed by Mayfield headholder. Head rotated to left making sagittal suture parallel to floor and right shoulder elevated. After shaving, we disinfected and draped the operation field as usual. A S-shape scalp incision was made along hairline centred at the level of external acoustic meatus. Dissected in layers and harvested a fascia for later duraplasty. After exposure of cranium, we created a suboccipital craniectomy with burrhole at asterion. Under ETGA, patient was in supine position with head fixed by Mayfield headholder. Head rotated to left making sagittal suture parallel to floor and right shoulder elevated. After shaving, we disinfected and draped the operation field as usual. A S-shape scalp incision was made along hairline centred at the level of external acoustic meatus. Dissected in layers and harvested a fascia for later duraplasty. After exposure of cranium, we created a suboccipital craniotomy with burrhole at asterion. We opened the dura in K-shape and retracted the cerebellum downward gently. The cerebellopontine cistern was opened at the inferior edge of petorsal vein. The offending artery was found beneath trigerminal nerve and the offending vein passed in between trigerminal nerve roots. Teflon was packed in between offending vessels and nerve root gently. The dura was repaired with a fascia and closed with 4-0 prolene in continuous suture followed by air expel. Wound was closed in layers. We opened the dura in K-shape and retracted the cerebellum downward gently. The cerebellopontine cistern was opened at the inferior edge of petorsal vein. The offending artery was found beneath trigerminal nerve and the offending vein passed in between trigerminal nerve roots. Teflon was packed in between offending vessels and nerve root gently. The dura was repaired with a fascia and closed with 4-0 prolene in continuous suture followed by air expel. After bone flap fixation, wound was closed in layers. Operators Prof. 杜永光 Assistants R6 胡朝凱 R3 游健生 陳世明 (M,1940/10/22,71y4m) 手術日期 2010/10/04 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Brain Tumor 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 陳國瑋, 時間資訊 07:45 報到 08:01 進入手術室 08:10 麻醉開始 08:35 誘導結束 08:50 抗生素給藥 08:55 手術開始 11:50 抗生素給藥 12:50 麻醉結束 12:50 手術結束 13:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 顱底瘤手術 1 1 摘要__ 手術科部: 外科部 套用罐頭: craniotomy for tumor excision 開立醫師: 陳德福 開立時間: 2010/10/04 12:52 Pre-operative Diagnosis Craniopharyngioma Post-operative Diagnosis Craniopharyngioma Operative Method craniotomy for tumor excision Specimen Count And Types 1 piece About size:3*4*3CM Source:CYSTIC SUPRASELLAR TUMOR Pathology pending Operative Findings 1.There is a cystic tumor with multiple mural nodule like solid part at the suprasellar area with compression to the optic chiasma and pituitary stalk. The fluid content of the cystic tumor is motor oil like and clear. Some calcification of the tumor was noticed. The puitary stalk is deviated to the left posterior side. 1.There is a cystic tumor with multiple mural nodule like solid part at the suprasellar area with compression to the optic chiasma and pituitary stalk. The fluid content of the cystic tumor is motor oil like and clear. Some calcification of the tumor was noticed. There some tumor inside the third ventricle. The puitary stalk is deviated to the left posterior side. 2.The cystic tumor was remvoed nearly totally after visualization of the basilar artery and opening the lamina terminalis. The putuitary stalk was preserved well. However, severe adhesion between the tumor to the inferior part of the optic chiasma was noticed and there might be some residual tumor in situ. 3.Some floseal was dressed on the rough surface intraoperatively Operative Procedures Under ETGA and supine position with Mayfield pin type head fixator fixation, the skull scalp was disinfected and draped as usual. One curvilinear incision was done as bicoronal incision. One 6*7cm in sized craiotomy which across the midline was done and the dura was opened. The arachnoid membrane and adhesion between the dura and pia surface over the right frontal base and interhemispheric area. The right frontal lobe was retracted laterally by brain retractor. The ACAs and optic chiasma were visualized and the tumor came into view. The tumor was remvoed via the pre-chiasmatic space and the pituitary stalk was identified. The lamina terminalis was opened and some tumor was remvoed as well. Hemostasis is done and the dura was closed in water tight fasion and the skull was fixed with miniplates. One subgaleal drain was left in situ and the wound was closed in layers. Operators VS 曾漢民 Assistants R5 陳德福 R1陳國瑋 陳碧鳳 (F,1956/12/29,55y2m) 手術日期 2010/10/04 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Glioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 陳國瑋, 時間資訊 13:22 進入手術室 13:25 麻醉開始 14:00 抗生素給藥 14:05 誘導結束 14:10 手術開始 17:00 抗生素給藥 18:05 手術結束 18:05 麻醉結束 18:10 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除－手術時間在４～８小時 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: craniotomy tumor excision 開立醫師: 陳德福 開立時間: 2010/10/04 18:22 Pre-operative Diagnosis right cerebral tumor, suspect glioma Post-operative Diagnosis right cerebral tumor, suspect glioma Operative Method craniotomy tumor excision Specimen Count And Types 1 piece About size:1*1*1cm Source:right brain tumor Pathology pending Operative Findings 1.There is a 1.5*1*1cm in sized yellowish, hard, elastic and intraaxial tumor at the right submotor cortex area. The tumor was removed and pathology study was sent. 2.Intra operative Navigator system and motor-sensory cortex mapping were performed. The tumor was removed via transsulcus route just posterior to the right motor cortex. Operative Procedures Under ETGA and prone position with Mayfield pin type head fixator fixation, the scalp was disinfected and draped as usual. One C shape incision over the right vertex was done followed by creating 5*4cm craniotomy. The dura was opened and the arachnoid membrane was remvoed under the guidance of Navigator system. The tumor was identified and removed smoothly. The dura was then closed with Prolene and the skull was fixed with miniplates. The wound was closed in layers. Operators VS 曾漢民 Assistants R5 陳德福 R2陳國瑋 鄭秀男 (M,1941/09/01,70y6m) 手術日期 2010/10/04 手術主治醫師 楊士弘 手術區域 東址 005房 03號 診斷 Spinal metastasis 器械術式 Spinal fusion posterior 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3E 紀錄醫師 鍾文桂, 時間資訊 13:00 開始NPO 17:39 通知急診手術 18:50 報到 19:00 進入手術室 19:05 麻醉開始 19:30 抗生素給藥 19:45 誘導結束 20:00 開始輸血 20:50 手術開始 22:30 抗生素給藥 01:40 抗生素給藥 03:20 麻醉結束 03:20 手術結束 03:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 惡性病髓腫瘤切除術 1 1 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 9 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: 1. Tumor excision via decompressive laminecto... 開立醫師: 鍾文桂 開立時間: 2010/10/05 07:19 Pre-operative Diagnosis Spinal metastasis, T5 and T6 with cord compression. Spinal epidural metastasis, T4-6, with spinal cord compression. Post-operative Diagnosis Spinal metastasis, T5 and T6 with cord compression. Spinal epidural metastasis, T4-6, with spinal cord compression. Operative Method 1. Tumor excision via decompressive laminectomy of T5 ,and part of T4 and T6. 1. Tumor excision via decompressive laminectomy of T4, T5, and left T6, and bilateral T5 pediculectomy. 2. Internal fixation by implantation of transpedicle screws at T3,4,6,7. 2. Posterior fixation and fusion by implantation of transpedicle screws at T3,4,6,7. Specimen Count And Types 2 pieces About size:10CC Source:Metastatic bone. About size:3cc Source:Epidural tumor Pathology Pending. Operative Findings 1. Easy oozing operative field. 2. Transpedicle screws at T3,4,6,7 levels. Only one transpedicle screw was implanted at T4 and T6 level due to metastasis over right side of T4 and T pedicle. Two rods and one interlink were also implanted. 2. Transpedicle screws at T3,4,6,7 levels. Only one side transpedicle screws weres implanted at left T4 and T6 level due to metastasis over left side of T4 and T5 pedicle. Two rods and one cross link were also implanted. 3. Epidural tumor mass surrounded the dural sac located mainly at T5 and T6. The cord was compressed severely by the tumor mass mainly at left lateral and posterior region of T5. Bilateral T5 roots were sacrafizied due to encasement of the tumor. The tumor was red-grayish,mixture of hard and soft components, and well vasculaized. 3. Epidural tumor mass surrounded the dural sac located at T4-5 and left T6. The cord was compressed severely by the tumor mass mainly at lateral and posterior regions of T5. Bilateral T5 roots were sacrafizied due to encasement of the tumor. The tumor was red greyish, elastic, and mixture of hard and soft components, and moderately vasculaized. A small dura tear was noted while dividing the left L5 root from the tumor mass. It was repaired by DuraGen. A small dura tear was noted while dividing the left T5 root from the tumor mass. It was repaired by DuraGen. Preoperative muscle power of lower extrimities: 0-1. Intraoperative gross hematuria was noted. We consulted Urologist. No emergent management was needed. Consultation to Urologist will be done at ward. Operative Procedures 1. ETGA, prone position, head in midline. 2. Disinfection and draping. 3. Midline incision and paraspinal muscle dissection. 4. Laminectomy, T5 and part of T4 and T6. 4. Laminectomy, T4 and T5, and left upper T6. 5. Tumor removal by bipolar electrocautery and tumor forceps. 5. Tumor removal by bipolar electrocautery and tumor forceps, sacrafized bilateral T5 roots for further tumor resection. 5. Tumor removal by bipolar electrocautery, scissor, currets, and tumor forceps. Bilateral T5 roots were ligated by hemoclips and divided to faciliate further tumor resection. 6. Implantation of transpedicle screws and rods. 7. Dura repair with DuraGen. 8. Well hemostasis with bipolar electrocautery and Gelfoam. 9. Placement of two epidural 1/8 hemovac drain. 10.Wound closure in layers. Operators V.S. 楊士弘. Assistants 鍾文桂 Indication Of Emergent Operation 相關圖片 呂福治 (M,1941/10/12,70y5m) 手術日期 2010/10/04 手術主治醫師 王國川 手術區域 東址 009房 號 診斷 Subdural hemorrhage 器械術式 Craniotomy (A.V.M.) VS-TZENG 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 4E 紀錄醫師 曾峰毅, 時間資訊 09:14 開始NPO 09:14 通知急診手術 10:10 進入手術室 10:14 麻醉開始 10:25 誘導結束 10:25 抗生素給藥 10:28 手術開始 12:30 手術結束 12:30 麻醉結束 12:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 急性硬腦膜下血腫清除術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 曾峰毅 開立時間: 2010/10/04 13:08 Pre-operative Diagnosis Acute subdural hematoma, right Post-operative Diagnosis Acute subdural hematoma, right Operative Method Crainectomy, right Specimen Count And Types Nil Pathology Nil Operative Findings Brain pulsation was poor, and severe brain edema was noted while small durotomy made. Intra-operative TCD showed no specific ICH, but two-end flow as found. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head roated to left and right shoulder elevated. One 32 Fr. chest tube was inserted via 7th intercostal space. After scalp shaved, scrubbed, disinfected, and then draped, we made one curvilinear skin incision as trauma flap. Cranectomy was done after 6 burr hole drilled. Dura tenting was done along the craniectomy edge. Durotomy was done, and intra-operative doppler was performed. Duroplasty was done with autologous muscle fascia. After two subgaleal CWV inserted, the wound was closed in layers. Operators VS 王國川 Assistants R5 鍾文桂 R4 曾峰毅 Indication Of Emergent Operation 李何 (F,1933/04/28,78y10m) 手術日期 2010/10/04 手術主治醫師 陳偉勵 手術區域 東址 011房 02號 診斷 Cataract 器械術式 Phaco+PCIOL 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 09:45 進入手術室 10:20 手術開始 10:35 手術結束 10:40 送出病患 記錄__ 手術科部: 眼科部 套用罐頭: Phacoemulsification and PCIOL implantation(od ) 開立醫師: 孫仁彬 開立時間: 2010/10/04 10:30 Pre-operative Diagnosis Cataract (od ) Post-operative Diagnosis Cataract (od ) Operative Method Phacoemulsification and PCIOL implantation(od ) Specimen Count And Types nil Pathology Nil Operative Findings Cataract (od ) Operative Procedures 1. Under topical anesthesia 2. Disinfection, irrigation and draping. 3. Application of an eyelid speculum. 4. Made a clear corneal incision and penetrate into AC with 2.5mm cresent knife at 9 oclock position . 5. InjectViscoat into the anterior chamber. 6. Continuous circular capsulorrhexis was done with capsular forceps. 7. Made a sideport at 11 oclock position with the MVR blade. 8. Hydrodissection and hydrodelineation were done with BSS. 9. Phacoemulsification of the nucleus by standard divide-and-conquer technique. 10. Aspiration of the residual cortical material with I/A cannula. 11. One-piece PCIOL was implanted into the bag after injection of Viscoat. 12. The residual Viscoatwas washed out by I/A cannula. 13. Inject BSS into AC and check leakage. 14. Subconjunctival injection of Rinderon and Gentamicin. 15. Maxitrol patching. Operators 陳偉勵, Assistants R4孫仁彬, 張佰峰 (M,1967/02/18,45y0m) 手術日期 2010/10/05 手術主治醫師 黃勝堅 手術區域 東址 001房 03號 診斷 Contusion of face, scalp, and neck except eye(s) 器械術式 Brain tumor Crainotomy(Others) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 4E 紀錄醫師 胡朝凱, 時間資訊 10:00 臨時手術NPO 10:00 開始NPO 13:35 報到 13:47 進入手術室 13:50 麻醉開始 13:55 誘導結束 14:19 手術開始 14:35 開始輸血 15:55 手術結束 15:55 麻醉結束 16:05 送出病患 16:15 進入恢復室 18:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 硬腦膜外血腫清除術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: EDH evacuation 開立醫師: 胡朝凱 開立時間: 2010/10/05 16:32 Pre-operative Diagnosis right acute EDH Post-operative Diagnosis right acute EDH Operative Method EDH evacuation Specimen Count And Types nil Pathology Nil Operative Findings 1.About 120 ml acute hematoma at right epidural craniectomy window that compressed the dura tightly. 2.After decompression, dura expanded. 3.Diffuse oozing was noted. 4.bleeding tendency was suspect. 5.One active bleeder from STA stump was noted Operative Procedures 1.ETGA, supine 2.Right previous wound incision 3.Reflect skin flap 4.Hematoma evacuation 5.STA stump hemostasis 6.Further hemostasis was performed 7.Gelfoam and surgicel packing was then performed 8.Set two epidural CWV drain 9.Close wound in layers Operators 黃勝堅 Assistants 胡朝凱, Ri Indication Of Emergent Operation 王再雲 (F,1956/11/10,55y4m) 手術日期 2010/10/05 手術主治醫師 王國川 手術區域 東址 002房 08號 診斷 Intracranial abscess 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3E 紀錄醫師 陳德福, 時間資訊 20:35 開始NPO 20:35 通知急診手術 22:20 進入手術室 22:25 麻醉開始 22:40 誘導結束 23:00 手術開始 00:42 手術結束 00:42 麻醉結束 01:00 送出病患 01:03 進入恢復室 02:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 手術 硬腦膜外血腫清除術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: epidural abscess removal 開立醫師: 陳德福 開立時間: 2010/10/06 00:53 Pre-operative Diagnosis epidural abscess, left fontal paranasal sinusitis related Post-operative Diagnosis epidural abscess, left fontal paranasal sinusitis related Operative Method epidural abscess removal Specimen Count And Types 1 piece About size:20ML Source:epidural abscess Pathology nil Operative Findings 1.There is about 20-30ml epidural abscess at the right frontal area with comprssion the the brain. The local inflammation over the left periorbital and scalp is remarkarble. The scalp window was tense before the surgery and the window became slacy after the surgery. 2.There is abscess formation at the left fontal paranasal sinus and the mucosa is thickened. We removed the mucosa and pack the space with BI gelfoam and the bony defect was repaired with autologous fascia. Operative Procedures 1.ETGA and supine position 2.scalp disinfection and draping 3.incision along previous scalp scar 4.iditify the epidural space and remove the abscess 5.identify the left frontal paranasal sinus 6.pack the gelfoam into the sinus and repair with fascia 7.left one epidural CWV 8.close the wound in layers. Operators VS王國川 Assistants r5陳德福 Indication Of Emergent Operation 李鎮邦 (M,1989/11/19,22y3m) 手術日期 2010/10/05 手術主治醫師 杜永光 手術區域 西址 033房 02號 診斷 Scalp tumor 器械術式 Decompression of mediun nerve 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 10:00 進入手術室 10:15 麻醉開始 10:25 手術開始 10:35 手術結束 10:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 頭皮腫瘤 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 曾峰毅 開立時間: 2010/10/05 10:45 Pre-operative Diagnosis Scalp verruca, right retroauricular area Post-operative Diagnosis Scalp verruca, right retroauricular area Operative Method Scalp tumor excision Specimen Count And Types One piece of tumor was sent for pathology. Pathology Pending Operative Findings About 1x1x1.5cm tumor was noted arised from the skin at right retro-auricular area. Operative Procedures The patient was put in prone position with head rotated to left. The scalp was shaved, disinfected, and then draped, fish-mouth shape skin incision was made around the tumor. The tumor was excised, and then the wound was closed with 3-0 nylon in simple sutures. Operators P 杜永光 Assistants R4 曾峰毅 溫鏡清 (M,1951/10/19,60y4m) 手術日期 2010/10/05 手術主治醫師 林至芃 手術區域 西址 034房 02號 診斷 Lymphoma 器械術式 Insertion of hichman or port a 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 林至芃 ASA 3 時間資訊 09:00 報到 09:50 進入手術室 10:05 麻醉開始 10:10 抗生素給藥 10:10 誘導結束 10:25 手術開始 11:10 麻醉結束 11:10 手術結束 11:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 ｐｏｒｔ–Ａ導管植入術–治療性導管植入術 1 0 R 記錄__ 手術科部: 麻醉部 套用罐頭: Port-A implantation, subclavian 開立醫師: 何雨軒 開立時間: 2010/10/05 11:12 Pre-operative Diagnosis Lymphoma Post-operative Diagnosis Ditto Operative Method Port-A implantation, echo-guided Specimen Count And Types nil Pathology Nil Operative Findings 1.Site: right subclavian vein, with echo-guided procedure 2.Patent flow after implantation 3.Others: nil Operative Procedures 1.The patient was set on supine position and bilateral subclavian veins were checked by echo. 2.After IVGA and local anesthesia applied, transverse skin incision for 3cm was made at pre-cordial area. 3.Undermine the skin at the layer between subcutaneous tissue and deep fascia in lateral direction. 4.An IV catheter was inserted via the subclavian incision and negatively aspirated until venous blood attainable. 5.J-wire was inserted smoothly in rostral direction. A subclavian catheter with dilator was inserted through the J-wire, and the dilator was then removed. 6.The catheter of Port-A was threaded into the subclavian vein until mark 22 cm. The catheter was adapted into the port and locked with restrictor.The Port was inserted into the pouch of pre-cordial incision. 7.Skin was closed layer by layer. Both catheter and port were perfused with heparin solution after implantation. Operators 林至芃, Assistants 何雨軒, 邢秀美 (F,1953/02/28,59y0m) 手術日期 2010/10/05 手術主治醫師 曾勝弘 手術區域 西址 033房 01號 診斷 Carpal tunnel syndrome 器械術式 Neurolysis of the uluar neuve 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 08:15 進入手術室 08:25 麻醉開始 08:30 手術開始 08:50 手術結束 09:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 正中神經或尺神經腕部減壓術–單側 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Carpal Tunnel Syndrome 開立醫師: 曾峰毅 開立時間: 2010/10/05 09:07 Pre-operative Diagnosis Right carpal tunnel syndrom Post-operative Diagnosis Right carpal tunnel syndrom Operative Method Median nerve decompression Specimen Count And Types Nil Pathology Nil Operative Findings Median nerve was compressed by trans-carpal ligament tightly. The nerve was decompressed well. Operative Procedures The patient was put in supine position, and right arm was abduected. Local anaestehsiat with lidocaine was used to infiltrate right wrist. Linear skin incision was done, and trans-carpal ligament was transected medticulously. Median nerve was decompressed after ligament transected. The wound was closed in layers after hemostasis. Operators VS 曾勝弘 Assistants R4 曾峰毅 黃耀明 (M,1944/09/02,67y6m) 手術日期 2010/10/05 手術主治醫師 曾勝弘 手術區域 東址 005房 02號 診斷 Parkinsonism (F02.3) 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 10:45 報到 11:03 進入手術室 11:08 麻醉開始 11:18 誘導結束 11:40 抗生素給藥 11:43 手術開始 13:05 手術結束 13:05 麻醉結束 13:13 送出病患 13:15 進入恢復室 15:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室腹腔分流手術 1 2 L 摘要__ 手術科部: 外科部 套用罐頭: Tumor excision 開立醫師: 李振豪 開立時間: 2010/10/05 11:02 Pre-operative Diagnosis Right sciatic neuroma Parkinsonism, status post bilateral subthalamic nucleus electrode implantation Post-operative Diagnosis Right sciatic neuroma Parkinsonism, status post bilateral subthalamic nucleus electrode implantation Operative Method Tumor excision DBS IPG implantation Specimen Count And Types 1 piece About size:1.6x1.6x1.6cm Source:Right sciatic neuroma Nil Pathology Pending Nil Operative Findings The tumor was originated from right sciatic nerve at the level of lower margin of right gluteal muscle. The tumor was 1.6cm in diameter, well-demarcated, elastic to firm, yellowish in character. Lipomatous tissue was noted within the tumor. The right sciatic nerve was well-preserved after tumor excision. The IPG was implanted at left forechest and the DBS was set up completely. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in prone position. The skin was scrubbed, disinfected and draped as usual. The longitudinal curvilinear skin incision was made at right posterior thigh and the subcutaneous soft tissue was dissected. The fascia was opened the the sciatic nerve was exposed between gluteus maximus and biceps femoris muscle. The tumor was noted along the tract of the sciatic nerve. The capsule of the tumor was dissected and the tumor was removed totally. Hemostasis was achieved and the fascia and wound was closed in layers. Under endotracheal tube general anesthesia, the patient was put in supine position with head rotated to right. The scalp was shaved, scrubbed, and disinfected as usual. Linear scalp incision was made at left parietal area and the wire of electrode was pull out. Left forechest transverse skin incision(subclavicular) was performed and one subcutaneous pocket was created for the IPG. The subcutaneous tunnel was created from left parietal area, retroauricular, left neck, to left forechest. One small transverse skin incision at left neck was made for the subcutaneous tunnel. The The wire of IPG was passed through the subcutaneous tunnel and the DBS was set up completely. The function of the DBS was checked. Hemostasis was achieved and the wound was then closed in layers. Operators VS曾勝弘 Assistants R4李振豪, Ri 張建瑋 (M,1977/11/07,34y4m) 手術日期 2010/10/05 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Soft tissue tumor 器械術式 Excision of neuroma 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 李振豪, 時間資訊 07:38 報到 08:00 進入手術室 08:15 麻醉開始 08:20 誘導結束 08:57 抗生素給藥 09:16 手術開始 10:40 手術結束 10:40 麻醉結束 10:50 送出病患 10:52 進入恢復室 11:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 軟組織良性腫瘤切除術，大或深 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Tumor excision 開立醫師: 李振豪 開立時間: 2010/10/05 13:17 Pre-operative Diagnosis Right sciatic neuroma Post-operative Diagnosis Right sciatic neuroma Operative Method Tumor excision Specimen Count And Types 1 piece About size:1.6x1.6x1.6cm Source:Right sciatic neuroma Pathology Pending Operative Findings The tumor was originated from right sciatic nerve at the level of lower margin of right gluteal muscle. The tumor was 1.6cm in diameter, well-demarcated, elastic to firm, yellowish in character. Lipomatous tissue was noted within the tumor. The right sciatic nerve was well-preserved after tumor excision. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in prone position. The skin was scrubbed, disinfected and draped as usual. The longitudinal curvilinear skin incision was made at right posterior thigh and the subcutaneous soft tissue was dissected. The fascia was opened the the sciatic nerve was exposed between gluteus maximus and biceps femoris muscle. The tumor was noted along the tract of the sciatic nerve. The capsule of the tumor was dissected and the tumor was removed totally. Hemostasis was achieved and the fascia and wound was closed in layers. Operators VS曾勝弘 Assistants R4李振豪, Ri 詹國清 (M,1952/08/15,59y6m) 手術日期 2010/10/05 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Central cord syndrome injury 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳德福, 時間資訊 07:35 報到 08:00 進入手術室 08:10 麻醉開始 08:25 誘導結束 08:50 抗生素給藥 09:10 手術開始 11:40 手術結束 11:40 麻醉結束 12:00 送出病患 12:05 進入恢復室 13:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 手術 脊椎融合術－前融合，有固定物（每增加＜＝四節） 1 2 R 手術 椎間盤切除術－頸椎 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: ACDF with cage and plate 開立醫師: 陳德福 開立時間: 2010/10/05 11:51 Pre-operative Diagnosis C3-4 spondylosis with spinal stenosis Post-operative Diagnosis C3-4 spondylosis with spinal stenosis Operative Method ACDF with cage and plate Specimen Count And Types nil Pathology NIL Operative Findings 1.The spontaneous fusion from C4-7 was noticed. The theca sac and bilateral nerve foramen were decompressed by the spondylosis at the C3-4 level. The osteophytes and protruding disc were removed meticulously. 2.The C3-4 ACDF was performed with Syntheses cage [6mm] and one cervical spine plate [4 screws of 18*4mm]. Operative Procedures Under ETGA and supine position, the neck was hyperextended. The skin was disinfected and draped as usual. One transverse linear incision was done one the right neck and the platysma was transected. The C3-4 prevertebral space was reached after dissecting along the areolar plane. The location of C3-4 was identifed under C-arm fluroscope. The longus coli muscle was displaced laterally and the C3-7 discectomy was performed under microscopic surgery. The PLL was remvoed and the dura sac was expended well. One 6mm Syntheses cervical cage was implatated at the C3-4 level and one plate was implantated at the C3-4 anterior body with 4 18*4mm screw fixation. One minihemovac was left in situ and the wound was closed in layers. Operators VS 賴達明 Assistants r5 陳德福 相關圖片 朱何麵 (F,1935/06/08,76y9m) 手術日期 2010/10/05 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Cervical Spondylosis 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳德福, 時間資訊 12:20 進入手術室 12:30 麻醉開始 12:40 誘導結束 13:00 抗生素給藥 13:20 手術開始 17:45 手術結束 17:45 麻醉結束 17:50 送出病患 17:55 進入恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 手術 椎間盤切除術－頸椎 1 1 R 手術 脊椎融合術－前融合，有固定物（＜＝四節） 1 2 摘要__ 手術科部: 外科部 套用罐頭: ACDF with cage and plate 開立醫師: 陳德福 開立時間: 2010/10/05 17:51 Pre-operative Diagnosis C4/5,C5/6 spondylosis with spinal stenosis Post-operative Diagnosis C4/5,C5/6 spondylosis with spinal stenosis Operative Method ACDF with cage and plate Specimen Count And Types nil Pathology NIL Operative Findings 1.There is spondylotic change over the C4-6. The theca sac and bilateral nerve foramen were decompressed by the spondylosis at the C4-6 level. The osteophytes and protruding disc were removed meticulously. 2.The C4/5, 5/6 ACDF was performed with Titanium cage [6mm]-C5/6 and autologous bone graft-C4/5. One cervical spine plate,34mm with 6 screws of 16*4mm were implantated over the C4-6. Operative Procedures Under ETGA and supine position, the neck was hyperextended. The skin was disinfected and draped as usual. One transverse linear incision was done one the right neck and the platysma was transected. The C4-6 prevertebral space was reached after dissecting along the areolar plane. The location of C4-6 was identifed under C-arm fluroscope. The longus coli muscle was displaced laterally and the C4-6 discectomy was performed under microscopic surgery. The PLL was remvoed and the dura sac was expended well. One 6mm Syntheses cervical cage was implatated at the C4-6 level and one plate was implantated at the C4-6 anterior body with 6 16*4mm screw fixation. One minihemovac was left in situ and the wound was closed in layers. The right ASIC was harvested for bone graft. Operators VS 賴達明 Assistants r5 陳德福 林素美 (F,1948/10/10,63y5m) 手術日期 2010/10/05 手術主治醫師 賴達明 手術區域 東址 005房 03號 診斷 HIVD 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 12:50 報到 13:28 進入手術室 13:35 麻醉開始 13:42 誘導結束 13:50 抗生素給藥 14:27 手術開始 15:45 手術結束 15:45 麻醉結束 15:55 進入恢復室 15:55 送出病患 16:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 椎間盤切除術－腰椎 1 1 B 摘要__ 手術科部: 外科部 套用罐頭: L3-4 laminotomy for decompression and diskect... 開立醫師: 李振豪 開立時間: 2010/10/05 16:06 Pre-operative Diagnosis L3-4 herniation of intervertebral disc, left Post-operative Diagnosis L3-4 herniation of intervertebral disc, left Operative Method L3-4 laminotomy for decompression and diskectomy, spinous process splitting method Specimen Count And Types nil Pathology Nil Operative Findings The ligmentum flavum was hypertrophic and calcified with thecal sac compression. The disc was noted at left side and central part with tightly compressed of the root. The root was loose and the thecal sac was expanded well after whole procedure. The ligmentum flavum was hypertrophic and calcified with thecal sac compression. The disc ruptured into left and central part of canal with tightly compressed of the root. The root was loose and the thecal sac was expanded well after whole procedure. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in prone position. The L3-4 level was localized with portable C-arm X-ray. The skin was scrubbed, disinfected and draped as usual. Midline skin incision at L3-4 level was performed and the subcutaneous soft tissue was dissected to exposed the spinous process. High speed air-drived drill was used for splitting of the spinous process. The spinous process was then fractured from base and laminotomy was done with Rongeur and Kerrison punches. After decompression, the root was retracted to right to exposed the herniated disc. diskectomy was performed with alligator, curette, and disc clamp. Hemostasis was achieved and the wound was then closed in layers with 2-0 Vicryl and 4-0 prolene subcuticular suture. Operators VS賴達明 Assistants R4李振豪, Ri 林彥辰 (M,2010/07/06,1y8m) 手術日期 2010/10/05 手術主治醫師 楊士弘 手術區域 兒醫 067房 02號 診斷 Meningitis 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 污染 麻醉方式 全身麻醉 麻醉主治醫師 林至芃 ASA 4E 紀錄醫師 曾峰毅, 時間資訊 14:51 開始NPO 14:51 臨時手術NPO 18:51 通知急診手術 20:25 報到 20:30 進入手術室 20:35 麻醉開始 21:15 誘導結束 21:44 手術開始 22:45 麻醉結束 22:45 手術結束 22:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 摘要__ 手術科部: 外科部 套用罐頭: Chronic Subdural Hematoma 開立醫師: 曾峰毅 開立時間: 2010/10/05 22:50 Pre-operative Diagnosis Left subdural effusion, suspected infection related Post-operative Diagnosis Left subdural effusion, suspected infection related Operative Method Left frontal burr hole for subdural drainage Specimen Count And Types Subdural effusion was sent for culture, routine, and BCS. Pathology Nil Operative Findings Subdural effusion was xanthochromic, turbid, and caused mass effect. The anterior fontanelle was relaxed after drainage. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head roated to right. After scalp shaved, scrubbed, disinfected, and then draped, we made one linear skin incision at right frontal area. We created burr hole by biting the skull bone from the left lateral edge of anterior fontanelle with Karrison rongeur. Durotomy was made, and we inserted one ventricular catheter into subdural space. Subdural space was irrigated with saline after drainage. We fixed the subdural drain, and then closed the wound in layers. Subdural space was de-aired with saline. Operators VS 楊士弘 Assistants R4 曾峰毅 Indication Of Emergent Operation 鄒泰山 (M,1953/04/05,58y11m) 手術日期 2010/10/06 手術主治醫師 吳毅暉 手術區域 東址 016房 02號 診斷 Gastric cancer 器械術式 Port-A Implatation /WOR 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 周恒文, 時間資訊 09:15 報到 09:18 進入手術室 09:27 抗生素給藥 09:30 麻醉開始 09:35 誘導結束 09:37 手術開始 10:05 麻醉結束 10:05 手術結束 10:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 內頸靜脈切開，永久導管放置術 1 1 R 記錄__ 手術科部: 麻醉部 套用罐頭: Port-A catheter implantation, echo guided 開立醫師: 黃郁喬 開立時間: 2010/10/06 10:09 Pre-operative Diagnosis gastric cancer gastric cancer Post-operative Diagnosis gastric cancer gastric cancer Operative Method Port-A catheter implantation, echo guided Port-A catheter implantation, echo guided Specimen Count And Types nil nil Pathology nil nil Operative Findings Puncture to right IJV under echo guidance Puncture to right IJV under echo guidance The venous blood flow freely in the Port-A catheter after implantation. The venous blood flow freely in the Port-A catheter after implantation. Operative Procedures The patient was put on supine position. The operation field was disinfected and draped as usual. Under local anesthesia, we puncture to right IJV under echo guidance. After creating subcutaneous pocket, the Port-A catheter was inserted via peel away sheath. We close the wound in layers. The patient was put on supine position. The operation field was disinfected and draped as usual. Under local anesthesia, we puncture to right IJV under echo guidance. After creating subcutaneous pocket, the Port-A catheter was inserted via peel away sheath. We close the wound in layers. Operators VS吳毅暉 VS吳毅暉 Assistants R周恆文 R徐展陽 R周恆文 R徐展陽 李玉珍 (F,1939/08/05,72y7m) 手術日期 2010/10/06 手術主治醫師 王國川 手術區域 東址 002房 03號 診斷 Head injury, unspecified 器械術式 Brain tumor Crainotomy(Others) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 4E 紀錄醫師 游健生, 時間資訊 19:20 通知急診手術 19:20 開始NPO 20:00 進入手術室 20:01 麻醉開始 20:05 誘導結束 20:10 抗生素給藥 20:35 手術開始 21:25 開始輸血 23:15 抗生素給藥 23:30 手術結束 23:30 麻醉結束 23:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 急性硬腦膜下血腫清除術 1 1 R 手術 顱內壓監視置入 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Right craniectomy and ICP monitor insertion 開立醫師: 胡朝凱 開立時間: 2010/10/06 23:29 Pre-operative Diagnosis Right acute SDH Post-operative Diagnosis Right acute SDH Operative Method Right craniectomy and ICP monitor insertion Specimen Count And Types nil Pathology nil Operative Findings 1.About 1.5 cm in thick acute hematoma located at right frontal-parietal-to temporal area that compressed the brain tightly. 2.After decompression, the brain pulsation was well 3.One active bleeder was noted at right temporal cortical artery. 4.initial post-OP ICP: -3 mmHg Operative Procedures 1.ETGA, supine 2.Right trauma flap skin incision 3.Reflect skin flap and muscle flap downward 4.Craniecomy 5.Dural tenting 6.Dural opening 7.Hematoma evacuation 8.Insert ICP monitor 9.Duroplasty with one piece of fascia 10.Resect temporalis muscle 11.Close wound in layers after two CWV drain insertion Operators 王國川 Assistants 胡朝凱, 游健生 Indication Of Emergent Operation 章定夫 (M,1973/12/22,38y2m) 手術日期 2010/10/06 手術主治醫師 劉嘉銘 手術區域 東址 018房 03號 診斷 Brain abscess 器械術式 Sinoscopy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 郭彥麟, 時間資訊 16:55 報到 16:59 進入手術室 17:12 手術開始 18:20 手術結束 18:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 鼻竇內視鏡檢查 1 0 L 記錄__ 手術科部: 耳鼻喉部 套用罐頭: Sinoscopic exam 開立醫師: 郭彥麟 開立時間: 2010/10/06 20:11 Pre-operative Diagnosis brain abscess s/p debridement, suspected CSF leakage,left Post-operative Diagnosis brain abscess s/p debridement. no CSF leakage Operative Method sinoscope, local flap to cover bare bone area Specimen Count And Types nil Pathology Nil Operative Findings 1. no CSF leakage was noted on the left side. Mucosal regeneration was noted at previous operation site 2. a small bare bone area about 0.5x0.5 cm, covered by local flap Operative Procedures 1.nasal packing with Bosmin-rinsed gauze first 2.removed nasal packing, inserted sinoscope. Many crusts were noted all the way. No CSF leakage was noted 3.mucosal regeneration was noted at previous operation site 4.we disrupted mucosa to stimulate further scarring at medial side of upper middle turbinate 5.a small bare bone area was noted at posterior ethmoid . We cut local tissue to make a flap to cover it. Then Gelform plus Merocel was packed 6.checked bleeding Operators AP劉嘉銘 Assistants R4薛婉儀 R2郭彥麟 莊春月 (F,1967/03/09,45y0m) 手術日期 2010/10/06 手術主治醫師 蔡瑞章 手術區域 東址 005房 01號 診斷 Benign neoplasm of cerebral meninges 器械術式 Crainotomy Brain Tumor(P-LIN) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 08:06 進入手術室 08:15 麻醉開始 08:50 抗生素給藥 08:50 誘導結束 09:03 手術開始 11:50 抗生素給藥 14:50 抗生素給藥 17:50 抗生素給藥 20:50 抗生素給藥 22:30 手術結束 22:30 麻醉結束 22:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 21 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: Simpson grade III tumor excision via right pt... 開立醫師: 鍾文桂 開立時間: 2010/10/06 23:20 Pre-operative Diagnosis Meningioma, dorsum sella. Post-operative Diagnosis Meningioma, upper 1/3 clivus. Operative Method Simpson grade III tumor excision via right pterional approach. Specimen Count And Types 1 piece About size:Multiple Source:Clival meningioma Pathology Pending. Operative Findings Character of tumor: whitish, firm(very),severe adhesion with tentorium cerebri and clivus. Monitoring: Pre-op SSEP: deminished at right side, intra-op: deminished bilaterally, Left>right; MEP: deminished at right side, intra-op: deminished bilaterally, Left>right, BAEP: no change Post-op pupil: right/left: 6/2, no light reflex. A branch of basilar artery to upper pons was injured during tumor dissection Due to severe adhesion of the tumor to the clivus, near total tumor excision was achieved. The brainstem was intact during dissection. The right SCA was pushed posterior-superior-laterally by the tumor mass. Operative Procedures Under ETGA, the patient was placed in supine position and the head was tilted 30 degree to the left and fixed by Mayfield. After disinfection and draping, a curvilinear scalp incision was made. After craniotomy and durotomy, the sylvian fissure was dissected along MCA to reach ICA. Supratentorial portion of the tumor was noted upon reaching ICA. The frontal lobe was retracted superiorly and the temporal lobe was retracted laterally. The tumor was resected through progressive dissection. The tentorium edge to posterior clinoid process was excised along with the tumor mass. Severe adhesion of the tumor with SCA was also noted. We dissected SCA free from the tumor mass. Later, the infratentorial portion was reached. Severe adhesion of the tumor mass at clivus was noted and more difficulty in tumor resection was met. Near total tumor excision was achieved for brainstem decompression and functional preservation. After well hemostasis, the dura mater was closed in water tight fashion. The wound was closed in layers after fixation of bone plate and placement of one subgaleal CWV drain. Operators V.S. 蔡瑞章 王國川 Assistants 鍾文桂 陳國瑋 相關圖片 何開敏 (F,1929/04/08,82y11m) 手術日期 2010/10/06 手術主治醫師 曾勝弘 手術區域 東址 002房 01號 診斷 Meningitis 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 陳德福, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 07:23 通知急診手術 08:30 報到 08:40 進入手術室 08:45 麻醉開始 09:00 抗生素給藥 09:00 誘導結束 09:36 手術開始 11:25 麻醉結束 11:25 手術結束 11:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: craniotomy for subdural fluid removal 開立醫師: 陳德福 開立時間: 2010/10/06 11:44 Pre-operative Diagnosis CSF leakage with meningitis, suspect brain abscess formation Post-operative Diagnosis subdural fluid collection, suspect infection related or subacute subdural hematoma Operative Method craniotomy for subdural fluid removal Specimen Count And Types 1 piece About size:25ML Source:epidural and subdural space Pathology pending Operative Findings 1.There is 25-30ml subdural fluid collection with multiple septation inside at the right frontal area. The fluid is motor oil like without foul order. The previous defect of the frontal sinus is repaired without leakage or pus formation. The fluid is compressive before the drainage. 2.copious normal saline is done and the dura was closed after the irrigation. Operative Procedures Under ETGA and supine position, the scalp was disinfected and draped as usual. Incision along previous bicoronal inciosn scar and the craniotomy was done. The dura was then opened. The subsacute subdural hematoma was removed with sucker and normal saline irrigation is done. The dura was closed and the skull was fixed with miniplates. The wound was closed in layers. Operators AP 曾勝弘 Assistants R5 陳德福 Indication Of Emergent Operation 劉維哲 (M,2010/09/02,1y6m) 手術日期 2010/10/06 手術主治醫師 郭夢菲 手術區域 兒醫 067房 02號 診斷 Other anomalies of great veins 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 曾峰毅, 時間資訊 23:50 臨時手術NPO 09:45 報到 09:45 進入手術室 09:50 麻醉開始 10:00 誘導結束 10:33 手術開始 11:00 抗生素給藥 11:28 手術結束 11:30 11:40 麻醉結束 11:40 11:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 L 手術 肌肉或深部組織腫瘤切除術及異物取出術 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 曾峰毅 開立時間: 2010/10/06 11:59 Pre-operative Diagnosis Hydrocephalus Hydrocephalus due to previous IVH Post-operative Diagnosis Hydrocephalus Hydrocephalus due to previous IVH Operative Method Medtronic, medium pressure, ventriculoperitoneal shunt, via left Kocher point; Ommaya reservoir removal, right Kocher. Specimen Count And Types CSF was sent for culture. Pathology Nil Operative Findings Xanthochromic, clear CSF gushed out when ventriculostomy made. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to right. After scalp shaved, scrubbed, disinfected, and then draped, we made one curvilinear skin incision at right frontal area. We used rongeur to bite the left anterior lateral border of anterior fontanelle. Durotomy was made then, and ventriculostomy once was done. We made another transverse skin incision at left upper abdomen, and dissected to expose peritoneal. We inserted peritoneal catheter, about 30cm. We pull the peritoneal catheter through the subcutaneous tunnel, and to the left parietal area. Metronic, medium pressure valve with ventricular catheter was inserted, and connected with peritoneal catheter. Since the right side neck was inserted with CVP, we chose the left side for VP shunt insertion. With endotracheal general anaesthesia, the patient was put in supine position with head rotated to right. After scalp shaved, scrubbed, disinfected, and then draped, we made one curvilinear skin incision at left frontal area. We used rongeur to bite the left anterior lateral border of anterior fontanelle. Durotomy was made then, and ventriculostomy once was done. We made another transverse skin incision at left upper abdomen, and dissected to expose peritoneal. We inserted peritoneal catheter, about 30cm. We pulled the peritoneal catheter through the subcutaneous tunnel, and to the left parietal area after a stabbing wound at the left retroauricular region was made. Metronic, medium pressure valve with ventricular catheter, 4.5 cm was inserted, and connected with peritoneal catheter. The wounds were closed in layers. We made skin incision at right frontal area along previuos operation wound, and removed Ommaya reservoir. The wound was closed in layers. We made skin incision at right frontal area along previuos operation wound, and removed Ommaya reservoir. The wound was closed in layers after the burr hole was plugged with gelfoam. Operators VS 郭孟菲 VS 郭夢菲 Assistants R4 曾峰毅 李陳愛珠 (F,1940/06/27,71y8m) 手術日期 2010/10/06 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Scalp tumor 器械術式 Scalp tumor 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 07:38 報到 08:30 進入手術室 08:40 麻醉開始 08:42 誘導結束 08:45 手術開始 09:20 手術結束 09:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 頭皮腫瘤 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 曾峰毅 開立時間: 2010/10/06 09:22 Pre-operative Diagnosis Scalp tumor Post-operative Diagnosis Scalp tumor, suspected organised hematoma Operative Method Scalp tumor excision Specimen Count And Types One piece of tumor was sent for pathology. Pathology Pending Operative Findings Capsuled, well-fefined, elastic tumor was noted at left frontal area. Operative Procedures The patient was put in supine position with head rotated to right. We shaved, scrubbed, disinfected, and then draped the sclap. After local anaesthesia, we made one transverse skin incision at left frontal area. The Tumor was removed in en bloc fashion. The wound was closed in layers. Operators VS 郭夢菲 Assistants R4 曾峰毅 呂郭素月 (F,1941/03/16,70y11m) 手術日期 2010/10/06 手術主治醫師 吳毅暉 手術區域 東址 000房 號 診斷 Lymphoma 器械術式 Port-A Implatation /WOR 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 黃俊銘, 時間資訊 17:23 進入手術室 17:37 抗生素給藥 18:00 手術開始 18:35 手術結束 18:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 內頸靜脈切開，永久導管放置術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Port-A 開立醫師: 黃俊銘 開立時間: 2010/10/06 18:36 Pre-operative Diagnosis Lymphoma Post-operative Diagnosis Ditto Operative Method Port-A catheter implantation, echo guided Specimen Count And Types nil Pathology nil Operative Findings Puncture to right IJV under echo guidance The venous blood flow freely in the Port-A catheter after implantation. Operative Procedures The patient was put on supine position. The operation field was disinfected and draped as usual. Under local anesthesia, we puncture to right IJV under echo guidance. After creating subcutaneous pocket, the Port-A catheter was inserted via peel away sheath. We close the wound in layers. Post-op care plan: 1.wound CD QD+PRN2.pain control with tinten 3.prophylatic antibiotics use Operators 吳毅暉 Assistants 黃俊銘 徐展元 潘雲卿 (F,1971/01/31,41y1m) 手術日期 2010/10/06 手術主治醫師 賴達明 手術區域 東址 002房 02號 診斷 Subarachnoid hemorrhage 器械術式 Craniotomy(Aneurysms) P-DUH 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2E 紀錄醫師 方怡婷, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 09:44 通知急診手術 12:05 報到 12:05 進入手術室 12:10 麻醉開始 12:15 誘導結束 12:40 抗生素給藥 13:01 手術開始 16:10 抗生素給藥 18:40 麻醉結束 18:40 手術結束 18:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 開顱術摘除血管病變－腦血管瘤－有徵的 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Left pterional approach for aneurysm clipping... 開立醫師: 胡朝凱 開立時間: 2010/10/06 19:00 Pre-operative Diagnosis A-com aneurysm rupture with SAH and acute hydrocephalus Post-operative Diagnosis A-com aneurysm rupture with SAH and acute hydrocephalus Operative Method Left pterional approach for aneurysm clipping and EVD insertion Specimen Count And Types nil Pathology nil Operative Findings 1.One about 5 mm saccular aneurysm was noted that arised from A-com and protruded upward and anteriorly. 2.Peripheral adhesion was noted. 3.Brain was not so swelling 4.One fenestrated straight Sugita aneurysmal clip was applied. Operative Procedures 1.ETGA, supine with head fixed with Mayfield skull clamp 2.Left pterional approach was performed with facial nerve preservation 3.Craniotomy 4.Dural tenting 5.EVD insertion 6.curvature dural incision 7.Open sylvian fissure 8.Lysis arachnoid membrane 9.Retract frontal lobe 10.identified A2 11.retrograde trace to identified aneurysm 12.suction of rectus gyrus 13.Aneurysm clipping 14.Hemostasis 15.Close wound in layers Operators 賴達明 Assistants 胡朝凱,陳德福,Ri Indication Of Emergent Operation 劉榮輝 (M,1955/03/25,56y11m) 手術日期 2010/10/06 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Spinal Stenosis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 游健生, 時間資訊 07:40 報到 08:05 進入手術室 08:10 麻醉開始 08:30 誘導結束 08:45 手術開始 09:00 抗生素給藥 12:00 抗生素給藥 13:00 開始輸血 15:00 抗生素給藥 15:05 麻醉結束 15:05 手術結束 15:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術－後融合，有固定物（＜＝六節） 1 1 手術 椎弓切除術（特壓）－二節以內 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: C1 laminectomy and C0, C2,3 OC fusion with po... 開立醫師: 胡朝凱 開立時間: 2010/10/06 15:40 Pre-operative Diagnosis C1 duplication and C1-2 subluxation Post-operative Diagnosis C1 duplication and C1-2 subluxation Operative Method C1 laminectomy and C0, C2,3 OC fusion with posterio-lateral fusion Specimen Count And Types Nil Pathology nil Operative Findings 1.C1-2 instability that compressed the spinal cord tightly 2.After decompression, spinal cord expanded well 3.C0 screws 10mm, 9mm 4.C2 laminar screws: 28 mm 5.C3 lateral mass screws: 16 mm 6.Two nonunion spinous process were noted Operative Procedures 1. Under ETGA, patient in prone position with head fixed and neck mildly flexed by Mayfield headholder 2. After shaving, we disinfected and draped the operation field as usual 3. Midline incision from 1cm above inion to C4 level 4. Detached paraspinal and exposed suboccipital cranium and lateral masses of C1 to C3 5. Performed C1 laminectomy 6. Inserted C2 laminar screws, C3 lateral mass screws, and C0 screws with plate followed connecting them with rods 7. Verticle incision at left iliac crest region 8. Detached muscles and harvested an autologous bone graft from crest and splitted it in pieces 9. Decorticated occipital bone and C2 laminae followed by placement of pieces of autologous bone grafts 10.Set one epilamina CWV drain 11.Hemostasis and irrigated wound with N/S and Gentamicin solution 12.Closed wounds in layers Operators VS 賴達明 Assistants R6 胡朝凱 R3 游健生 陳文村 (M,1963/04/01,48y11m) 手術日期 2010/10/06 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Spinal stenosis, cervical 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳德福, 時間資訊 14:42 報到 15:35 進入手術室 15:40 麻醉開始 15:50 誘導結束 15:58 抗生素給藥 16:15 手術開始 18:15 手術結束 18:15 麻醉結束 18:20 送出病患 18:22 進入恢復室 19:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術－頸椎 1 1 R 手術 脊椎融合術－前融合，有固定物（每增加＜＝四節） 1 2 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 外科部 套用罐頭: ACDF with cage 開立醫師: 陳德福 開立時間: 2010/10/06 18:30 Pre-operative Diagnosis C5/6 HIVD with spinal stenosis Post-operative Diagnosis C5/6 HIVD with spinal stenosis Operative Method ACDF with cage Specimen Count And Types nil Pathology nil Operative Findings 1.There is HIVD with cord and nerve roots compression at the level of C5/6. The theca sac was decompressed after the diskectomy and one 6mm cage was implantated at the C5/6. Operative Procedures Under ETGA and supine position, the neck was hyperextended. The skin was disinfected and draped as usual. One transverse linear incision was done one the right neck and the platysma was transected. The C5/6 prevertebral space was reached after dissecting along the areolar plane. The location of C5/6 was identifed under C-arm fluroscope. The longus coli muscle was displaced laterally and the C5/6 discectomy was performed under microscopic surgery. The PLL was remvoed and the dura sac was expended well. One 6mm Syntheses cervical cage was implatated at the C5/6 level. One minihemovac was left in situ and the wound was closed in layers. Operators vs 賴達明 Assistants R5 陳德福 R1洪誌鍵 相關圖片 黃琰宸 (M,1952/05/02,59y10m) 手術日期 2010/10/07 手術主治醫師 陳敞牧 手術區域 東址 003房 04號 診斷 C.O.M. 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 王奐之, 時間資訊 15:30 報到 15:35 麻醉開始 15:50 進入手術室 16:00 誘導結束 16:19 抗生素給藥 16:35 手術開始 18:05 手術結束 18:05 麻醉結束 18:20 送出病患 18:22 進入恢復室 19:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 記錄__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt insertion via righ... 開立醫師: 王奐之 開立時間: 2010/10/07 18:17 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunt insertion via right Kocher point Specimen Count And Types 1 piece About size:5ml Source:CSF Pathology Nil Operative Findings Easy oozing was encountered. Medtronic medium pressure reservoir was used, ventricular catheter: 7cm in length. Clear & colorless CSF was noted, collected and sent for routine, BCS, bacterial culture & cytology. Operative Procedures After ETGA, the patient was placed in supine position with face turned to left and head held high. After shaving, skin disinfection & draping in sterile fashion, linear scalp & abdominal skin incision were made. After mini-laparotomy, a subcutaneous tunnel between the abdominal & scalp incision was made. A burr hole was made over right Kocher point, followed by dural tenting & cruciate durotomy. Ventricular puncture was done successfully via right Kocher point. The catheters were then connected and inserted. After meticulous hemostasis, the wounds were closed in layers. Operators VS 陳敞牧 Assistants R4 李振豪, R3 王奐之 相關圖片 李昭鶯 (F,1928/02/15,84y0m) 手術日期 2010/10/07 手術主治醫師 林峰盛 手術區域 西址 035房 06號 診斷 Low back pain 器械術式 Nerve block / PC 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 硬肌麻醉 麻醉主治醫師 林峰盛 ASA 2 時間資訊 16:25 進入手術室 16:30 麻醉開始 16:32 誘導結束 16:35 手術開始 16:43 手術結束 16:43 麻醉結束 16:47 送出病患 摘要__ 手術科部: 麻醉部 套用罐頭: LENB 開立醫師: 何雨軒 開立時間: 2010/10/07 16:44 Pre-operative Diagnosis 1.spinal stenosis 2. radiculopathy Post-operative Diagnosis 1. spinal stenosis 2. radiculopathy Operative Method LENB Specimen Count And Types nil Pathology Nil Operative Findings Operative Procedures LA with 1% xylocaine 5 ml pt in prone position Under fluoroscopic-guiddance, LENB was done to L4/5 level with 18G Tuohy needle, 60mg Kenacort in 0.5% xylocaine 10ml Operators 林峰盛, Assistants 何雨軒, 沈秀琴 (F,1964/07/26,47y7m) 手術日期 2010/10/07 手術主治醫師 蕭輔仁 手術區域 東址 005房 01號 診斷 Tuberculosis meningitis 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 游健生, 時間資訊 08:06 進入手術室 08:10 麻醉開始 08:25 誘導結束 09:35 手術開始 11:00 抗生素給藥 11:25 手術結束 11:25 麻醉結束 11:40 送出病患 11:43 進入恢復室 13:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 摘要__ 手術科部: 外科部 套用罐頭: 1. Ventriculoperitoneal shunt insertion via l... 開立醫師: 游健生 開立時間: 2010/10/07 11:56 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method 1. Ventriculoperitoneal shunt insertion via left Kocher point 2. Removal of EVD Specimen Count And Types 2 pieces About size:10cc Source:CSF About size:5cm Source:EVD tip Pathology Nil Operative Findings Clear CSF gashed out after ventriculostomy. The opening pressure was >15cmH2O. Some CSF was sent for routine, biochem, culture, and cytology. The ventricle catheter was 6.5cm in length. The Codman programmable valve was used set at 10cmH2O. Removed previous EVD tip was sent for culture. Clear CSF gashed out after ventriculostomy. The opening pressure was >15cmH2O. Some CSF was sent for routine, biochem, culture, and cytology. The ventricle catheter was 6.5cm in length. The Codman programmable valve was used set at 8cmH2O. Removed previous EVD tip was sent for culture. Operative Procedures 1. Under ETGA, supine position with head turned to left 2. After shaving, disinfected and draped as usual 3. Curvilinear scalp incision at left Kocher region 4. Expoused the cranium by soft tissue dissection 5. Trephination and dura tenting 6. Cruciated durotomy after cauterization 7. Cauterized dura edges and ventriculostomy 8. Inserted a ventricle catheter with reservoir and passed it to a retroauricular scalp wound 9. Transverse LUQ abdominal incision and dissected in layers to expose peritonium 10.Opened peritonium and inserted the peritoneal catheter then passed it to retroauricular scalp wound via a subcutaneous tunnel 11.Assembled the shunt and hemostasis 12.Closed wound in layers 13.Curvilinear scalp incision over right EVD and removed the tip of EVD 14.Removed the rest of EVD tube from abdominal EVD exit wound. Operators VS 蕭輔仁 Assistants R5 鍾文桂 R3 游健生 余廖碧蘭 (F,1938/05/10,73y10m) 手術日期 2010/10/07 手術主治醫師 王國川 手術區域 東址 003房 03號 診斷 Major trauma rated 16 or above on the severeity scale ( Injury severeity score >=16 ) 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 王奐之, 時間資訊 13:35 報到 13:50 進入手術室 13:55 麻醉開始 14:00 誘導結束 14:20 抗生素給藥 14:37 手術開始 15:30 手術結束 15:30 麻醉結束 15:33 送出病患 15:35 進入恢復室 16:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt insertion via righ... 開立醫師: 王奐之 開立時間: 2010/10/07 15:38 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunt insertion via right Kocher point Specimen Count And Types Nil Pathology Nil Operative Findings Clear & colorless CSF was noted. Codman programmable shunt was used, ventricular catheter: 7cm. Operative Procedures After ETGA, the patient was placed in supine position with face turned to left and head held high. After shaving, skin disinfection & draping in sterile fashion, scalp & abdominal skin incision along previous wounds were made. After minilaparotomy, a subcutaneous tunnel between the abdominal & scalp incision was made. Ventricular puncture was done successfully via right Kocher point. The catheters were then connected and inserted. After meticulous hemostasis, the wounds were closed in layers. After ETGA, the patient was placed in supine position with face turned to left and head held high. After shaving, skin disinfection & draping in sterile fashion, linear scalp & abdominal skin incision were made. After mini-laparotomy, a subcutaneous tunnel between the abdominal & scalp incision was made. A burr hole was made over right Kocher point, followed by dural tenting & cruciate durotomy. Ventricular puncture was done successfully via right Kocher point. The catheters & programmable reservoir were then connected and inserted. After meticulous hemostasis, the wounds were closed in layers. Operators VS 王國川 Assistants R4 李振豪, R3 王奐之 相關圖片 周克舉 (M,1926/07/08,85y8m) 手術日期 2010/10/07 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Head Injury 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 王奐之, 時間資訊 07:45 報到 08:05 進入手術室 08:10 麻醉開始 08:15 誘導結束 09:00 抗生素給藥 09:10 手術開始 09:52 手術結束 09:52 麻醉結束 10:10 送出病患 10:12 進入恢復室 11:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室腹腔分流手術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt insertion via righ... 開立醫師: 王奐之 開立時間: 2010/10/07 10:01 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunt insertion via right Kocher point Specimen Count And Types Nil Pathology Nil Operative Findings Clear and colorless CSF was noted after ventricular puncture. Opening pressure about 3-5cmH2O. Ventricular catheter length: 6.5cm. Medium pressure reservoir was used. Operative Procedures After ETGA, the patient was placed in supine position with face turned to left and head held high. After shaving, skin disinfection & draping in sterile fashion, scalp & abdominal skin incision along previous wounds were made. After minilaparotomy, a subcutaneous tunnel between the abdominal & scalp incision was made. Ventricular puncture was done successfully via right Kocher point. The catheters were then connected and inserted. After meticulous hemostasis, the wounds were closed in layers. Operators VS 王國川, VS 洪基翔 Assistants R4 李振豪, R3 王奐之 相關圖片 胡庭娟 (F,1956/11/06,55y4m) 手術日期 2010/10/07 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 Herniation of intervertebral disc with myelopathy, cervical (HIVD) 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 王奐之, 時間資訊 10:00 報到 10:17 進入手術室 10:20 麻醉開始 10:30 誘導結束 11:00 抗生素給藥 11:03 手術開始 13:35 手術結束 13:35 麻醉結束 13:40 送出病患 13:42 進入恢復室 14:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 手術 椎間盤切除術－頸椎 1 1 手術 脊椎融合術－前融合，有固定物（＜＝四節） 1 2 記錄__ 手術科部: 外科部 套用罐頭: Anterior cervical discectomy & fusion with cage 開立醫師: 王奐之 開立時間: 2010/10/07 13:48 Pre-operative Diagnosis C5-6 herniated intervertebral disc Post-operative Diagnosis C5-6 herniated intervertebral disc Operative Method Anterior cervical discectomy & fusion with cage Specimen Count And Types Nil Pathology Nil Operative Findings Marginal spur formation was noted. A piece of ruptured disc was seen at the left side. A-Spine #5 cage was inserted to the C5-6 space. Operative Procedures After ETGA, the patient was placed in supine position with neck hyperextended. C-arm was used to localize the C5-6 level. After skin disinfection & draping in sterile fashion, a horizontal linear skin incision was made at right neck along skin crease. The incision was extended through platysma. After seeing the sternocleidomastoid muscle, dissection was made through the groove medial to the muscle. The carotid artery was retracted to the lateral and the esophagus was retracted to the medial side. After reaching the pre-vertebral space, C-arm was used again to confirm the C5-6 disc space. The majority of the disc was removed with disc clamp. Air drill was used to make the intervertebral space flat. Most of the posterior longitudinal ligament was removed with Kerrison punch. Cage was then inserted to the space and confirmed its depth with C-arm. After meticulous hemostasis, the wound was closed in layers. Operators VS 王國川 Assistants R4 李振豪, R3 王奐之 相關圖片 李榕甄 (F,1962/11/11,49y4m) 手術日期 2010/10/08 手術主治醫師 賴達明 手術區域 東址 019房 02號 診斷 Spondyloisthesis, acquired 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 方怡婷, 時間資訊 12:00 進入手術室 12:05 麻醉開始 12:10 誘導結束 12:56 手術開始 13:45 抗生素給藥 14:12 手術結束 14:15 麻醉結束 14:20 送出病患 14:25 進入恢復室 15:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: L4/5 interspinous process device implantation 開立醫師: 陳德福 開立時間: 2010/10/08 14:19 Pre-operative Diagnosis L4/5 instability with neurologenic claudication Post-operative Diagnosis L4/5 instability with neurologenic claudication Operative Method L4/5 interspinous process device implantation Specimen Count And Types nil Pathology nil Operative Findings 1.A 8mm in sized Coflex interspinous process device was implantated at the L4/5 space. Operative Procedures Under ETGA and prone position, the skin was disinfected and draped as usual. The L4/5 space was localized by C-arm fluoroscope. One linear incision was done and the paraspinous muscle was dislaced laterally with preservation of the surpaspinous ligament. The L4/5 interspinous ligament was removed and one 8mm in sized Coflex was implantated in situ. Hemostasis and the wound was closed in layers. Operators VS 賴達明 Assistants R5 陳德福 R1方怡婷 相關圖片 周月卿 (F,1937/06/10,74y9m) 手術日期 2010/10/08 手術主治醫師 賴達明 手術區域 東址 003房 03號 診斷 Spinal Stenosis 器械術式 Diskectomy lumbar 手術類別 臨時手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 2 紀錄醫師 洪誌鍵, 時間資訊 12:20 報到 12:52 進入手術室 12:55 麻醉開始 13:00 手術開始 13:00 誘導結束 13:25 抗生素給藥 15:00 手術結束 15:00 麻醉結束 15:17 送出病患 15:20 進入恢復室 17:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 椎弓切除術(減壓)-二節以內 1 1 記錄__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 胡朝凱 開立時間: 2010/10/08 15:15 Pre-operative Diagnosis L4~5 stenosis Post-operative Diagnosis L4~5 stenosis Operative Method lower L4 and upper L5 Laminectomy for decompression Specimen Count And Types nil Pathology nil Operative Findings 1.Hypertrophic flavum ligment that compressed the thecal sac tightly. And the neural foramen were also narrow. 2.No instability was noted 3.The dura expanded well after decompression Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: prone. 3. Skin Incision: over spinous processes from L4~L5 4. Paraspinal muscle group was detached 5. The paravertebral muscles were retracted by self retractors 6. The spinous processes and laminae of lower L4 and upper L5 were bitten off with rongeurs and Kerrison punch until the posterior half of the spinal canal was widely opened. 7. The hypertrophic ligamenta flava including those at lateral recesses were excised. The epidural venous bleeding was stopped by gelfoam packing. 8. Hemostasis 9.Close wound in layers Operators 賴達明 Assistants 胡朝凱, 洪誌鍵 劉振麟 (M,1950/12/20,61y2m) 手術日期 2010/10/08 手術主治醫師 吳毅暉 手術區域 兒醫 068房 04號 診斷 Disseminated malignant neoplasm 器械術式 Port-A Implatation /WOR 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 黃俊銘, 時間資訊 15:00 報到 15:02 進入手術室 15:05 抗生素給藥 15:25 麻醉開始 15:26 誘導結束 15:27 手術開始 15:58 麻醉結束 15:58 手術結束 16:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 內頸靜脈切開,永久導管放置術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Port-A 開立醫師: 黃俊銘 開立時間: 2010/10/08 16:14 Pre-operative Diagnosis PNET Post-operative Diagnosis PNET Operative Method Port-A catheter implantation, echo guided Specimen Count And Types nil Pathology nil Operative Findings Puncture to right IJV under echo guidance The venous blood flow freely in the Port-A catheter after implantation. Operative Procedures The patient was put on supine position. The operation field was disinfected and draped as usual. Under local anesthesia, we puncture to right IJV under echo guidance. After creating subcutaneous pocket, the Port-A catheter was inserted via peel away sheath. We close the wound in layers. Post-op care plan: 1.wound CD QD+PRN2.pain control with tinten 3.prophylatic antibiotics use Operators 吳毅暉 Assistants 黃俊銘 林秉毅 (M,1987/07/27,24y7m) 手術日期 2010/10/08 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 腦惡性腫瘤 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 2 紀錄醫師 陳國瑋, 時間資訊 07:43 報到 08:05 進入手術室 08:20 麻醉開始 08:40 誘導結束 08:40 抗生素給藥 08:45 手術開始 11:40 抗生素給藥 14:25 麻醉結束 14:25 手術結束 14:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 顱底瘤手術 1 1 記錄__ 手術科部: 外科部 套用罐頭: Total excision of brain tumor via right front... 開立醫師: 鍾文桂 開立時間: 2010/10/08 15:11 Pre-operative Diagnosis Suspect craniopharyngioma. Post-operative Diagnosis Suspect craniopharygioma. Operative Method Total excision of brain tumor via right frontal transcortical approach. Specimen Count And Types 1 piece About size:Multiple Source:brain tumor Pathology Frozen pathology: central neurocytoma and craniopharyngioma are unlikely. Favor high grade tumor. Operative Findings Main tumor mass: encapsulated,mixture of solid and cystic( clear colorless fluid and milk like fluid in large and small cysts) components occupying and enlarging third ventricle. Some " dermoid cyst" like component was also noted, not easy oozing,one small feeder from PCA branch( electrocoagulated), loosely adhesion to the surrounding brain tissue. The frontal tumor was solid, elastic, red-brown in character. Gross total excision of the tumor was achieved. Based on frozen pathology, the main tumor mass and the frontal tumor should be the same pathology. After complete tumor removal, the basilar artery and its perforating branches along with PCA were seen. The perforators were well preserved. Intraoperative VEP, SSEP: no change. Intraoperative ultrasonography: tumor just beneath the craniotomy. Operative Procedures 1. ETGA, supine position, head flexed and tilted to left 5 degrees. 2. Shaving, disinfection, draping. 3. Curvilinear scalp incision, craniotomy,dural tenting,and durotomy. 4. Lysis of arachnoid membrane, ensuring the tumor location via ultrasonography. 5. Transcortical dissection until tumor mass was reached. Excision of right frontal tumor first. 6. Excision of tumor mass located at 3rd ventricle in piece meal fashion by scissor, tumor forceps, and bipolar electrocautery. 7. Well hemostasis and placement of one EVD at 3rd ventricle. 8. Close dura mater in water-tight fashion. 9. Fixation of craniotomy bone with mini plates and screws. 10.Wound closure in layers after placing one subgaleal drain. Operators V.S. 曾漢民 Assistants 鍾文桂 陳國瑋 相關圖片 黃柏浩 (M,2000/02/19,12y0m) 手術日期 2010/10/08 手術主治醫師 林文熙 手術區域 兒醫 063房 04號 診斷 Malignant neoplasm of cerebellum 器械術式 Port-A catheter implatation 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 林昊諭, 時間資訊 00:00 臨時手術NPO 11:54 進入手術室 12:00 麻醉開始 12:05 誘導結束 12:30 手術開始 13:00 抗生素給藥 13:30 手術結束 13:30 麻醉結束 13:35 送出病患 13:35 進入恢復室 14:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 內頸靜脈切開,永久導管放置術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 套用罐頭: Port-A insertion(right cephalic vein) 開立醫師: 邱裕淳 開立時間: 2010/10/08 13:35 Pre-operative Diagnosis Brain ventricular tumor Post-operative Diagnosis Brain ventricular tumor Operative Method Port-A insertion(right cephalic vein) Specimen Count And Types nil Pathology nil Operative Findings intra-operative portable X-ray showed Port-A catheter tip in correct venous branch to SVC. Operative Procedures 1. Under GA with the patient in supine position. 2. An incision was made in right subclavical area. After identification of the right cephalic vein, Port-A catheter was inserted. Adequate hemostasis was obtained. Then the wound was closed in layers. Operators 林文熙 Assistants R6林昊諭 R1邱裕淳 莊文達 (M,1958/12/30,53y2m) 手術日期 2010/10/08 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Backache, unspecified 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 方怡婷, 時間資訊 08:00 報到 08:05 進入手術室 08:10 麻醉開始 08:15 誘導結束 08:30 抗生素給藥 09:06 手術開始 11:30 抗生素給藥 11:38 手術結束 11:38 麻醉結束 11:45 送出病患 11:46 進入恢復室 12:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 手術 椎間盤切除術-腰椎 1 1 摘要__ 手術科部: 外科部 套用罐頭: 1.Lumbar diskectomy and hemilaminectomy for d... 開立醫師: 陳德福 開立時間: 2010/10/08 11:59 Pre-operative Diagnosis L4-5 HIVD S/P diskectomy and interspinous process device implantation, FBSS Post-operative Diagnosis L4-5 HIVD S/P diskectomy and interspinous process device implantation, FBSS Operative Method 1.Lumbar diskectomy and hemilaminectomy for decompression, microscopic Specimen Count And Types nil Pathology NIL Operative Findings 1.The previous L4 laminectomy window healed with new bone formation. Adhesion and fibrotic change of the left L5 nerve root was noticed. The nerve was decompressed with sublaminal decompression and foraminotomy for the L4/5 and L5/S1. 2.The L4/5 disc was removed and there is nearly no residual disk compression. 3.Previous implanatated Corflex was left in situ. Operative Procedures Under ETGA and prone position, the skin was disinfected and draped as usual. Linear incision along previous operation sacr. The paraspinous muscle was displaced laterally via the left side and laminotomy window of L4/5 and L5/S1 were done. The ligamentum flavum was removed and the nerve root was found. We retract the nerve root medially and start to inspect the disc by dissector. The nerve roots of L5 and S1 were identified without remarkable compression. Hemostasis is done and the wound was closed in layers. Operators VS 賴達明 Assistants R4 陳德福 袁玉琴 (F,1952/04/17,59y10m) 手術日期 2010/10/08 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Rheumatoid arthritis of spine 器械術式 Debridment-- >10cm 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 洪誌鍵, 時間資訊 07:43 報到 08:05 進入手術室 08:10 麻醉開始 08:40 誘導結束 09:00 抗生素給藥 09:08 手術開始 09:15 開始輸血 09:22 手術結束 09:22 麻醉結束 09:40 送出病患 09:40 進入恢復室 10:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 深部傷口處理縫合擴創-中 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 摘要__ 手術科部: 外科部 套用罐頭: debridement and closure of the wound 開立醫師: 陳德福 開立時間: 2010/10/08 09:46 Pre-operative Diagnosis Rheumatoid arthritis with C1/2 subluxation, s/p retropharyngeal odontoidectomy, poor surgical wound healing Post-operative Diagnosis Rheumatoid arthritis with C1/2 subluxation, s/p retropharyngeal odontoidectomy, poor surgical wound healing, s/p debridement and closure of the wound Operative Method debridement and closure of the wound Specimen Count And Types nil Pathology nil Operative Findings clean wound with granulation tissue Operative Procedures 1. general anesthesia, place in prone position with caution 2. sheavering hair around the wound, skin preparation, disinfection and draping 3. performed debridment of the previous surgical wound with normal saline and gentamycin solution 4. close the wound with Nylon suture and cover the wound with B-I gauze. Operators VS 賴達明 Assistants R6 胡朝凱, R1 洪誌鍵 吳清隆 (M,1941/02/05,71y1m) 手術日期 2010/10/08 手術主治醫師 賴達明 手術區域 東址 002房 04號 診斷 Cerebrovascular accident (CVA) 器械術式 Brain tumor Crainotomy(Others) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 5E 紀錄醫師 王奐之, 時間資訊 00:00 開始NPO 00:00 臨時手術NPO 12:25 通知急診手術 13:08 進入手術室 13:09 麻醉開始 13:18 誘導結束 13:25 開始輸血 13:36 手術開始 16:40 手術結束 16:50 麻醉結束 17:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱骨切除術,包括異物移除或壓或經切斷 1 1 L 手術 顱內壓視置入 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: CVA 開立醫師: 曾峰毅 開立時間: 2010/10/08 16:45 Pre-operative Diagnosis Left ICA total occlustion at CCA bifurcation Post-operative Diagnosis Left ICA total occlustion at CCA bifurcation Operative Method Left craniectomy with ICP monitor insertion Specimen Count And Types Nil Pathology Nil Operative Findings The brain buldged out while durotomy, and the parenchyma was pale without satisfactory pulsation. Post-operative ICP was about 6mmHg with ICP reference at 485. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to right. After scalp shaved, scrubbed, disinfected, and then draped, we made one curvilinear skin incision at left frontal area. We reflected the scalp flap, and drilled 5 burr holes. We created craniectomy, and tented the drua along the craniectomy window after hemostasis. We harvested autologous fascia graft from temporalis muscle, and creaed durotomy for decompression. We inserted two CWV drains and one ICP monitor. The dura was closed with autologous fascia graft and water-tight suture. The wound was closed in layers. Operators VS 賴達明 Assistants R4 曾峰毅 R3 王奐之 Indication Of Emergent Operation 相關圖片 林秀明 (F,1960/11/19,51y3m) 手術日期 2010/10/08 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Subarachnoid hemorrhage (SAH) 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 2 紀錄醫師 洪誌鍵, 時間資訊 09:55 報到 10:02 進入手術室 10:05 麻醉開始 10:10 誘導結束 10:40 抗生素給藥 11:05 手術開始 12:22 手術結束 12:22 麻醉結束 12:30 送出病患 12:32 進入恢復室 14:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 復健部 套用罐頭: Ventriculoperitoneal shunt insertion via righ... 開立醫師: 陳德福 開立時間: 2010/10/08 12:36 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunt insertion via right Kocher point Specimen Count And Types nil Pathology nil Operative Findings Clear & colorless CSF was noted. Codman programmable shunt was used, ventricular catheter: 7cm. Operative Procedures After ETGA, the patient was placed in supine position with face turned to left and head held high. After shaving, skin disinfection & draping in sterile fashion, linear scalp & abdominal skin incision were made. After mini-laparotomy, a subcutaneous tunnel between the abdominal & scalp incision was made. A burr hole was made over right Kocher point, followed by dural tenting & cruciate durotomy. Ventricular puncture was done successfully via right Kocher point. The catheters & programmable reservoir were then connected and inserted. After meticulous hemostasis, the wounds were closed in layers. Operators VS賴達明 Assistants R6胡朝凱 R1洪誌鍵 陳秀美 (F,1952/05/14,59y10m) 手術日期 2010/10/08 手術主治醫師 賴達明 手術區域 東址 005房 02號 診斷 Herniation of intervertebral disc 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 陳國瑋, 時間資訊 14:45 進入手術室 14:50 麻醉開始 14:55 誘導結束 15:30 抗生素給藥 15:45 手術開始 17:45 手術結束 17:45 麻醉結束 17:55 送出病患 17:57 進入恢復室 19:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-腰椎 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 記錄__ 手術科部: 外科部 套用罐頭: Microsurgical diskectomy, L5/S1, left side ap... 開立醫師: 鍾文桂 開立時間: 2010/10/08 18:12 Pre-operative Diagnosis Herniated intervertebral disc, L5/S1. Post-operative Diagnosis Herniated intervertebral disc, L5/S1. Operative Method Microsurgical diskectomy, L5/S1, left side approach. Specimen Count And Types nil Pathology Nil. Operative Findings A large bulging disc at left L5/S1 level. After decompression, the root was slack. Intact dura mater. Operative Procedures Under ETGA, the patient was placed in prone position. The inferior margin of L5 spinous process was identified under intraoperative fluoroscope. After disinfection and draping, a linear incision was made. Paraspinal dissection was done to reach L5/S1 interlaminar space. The hypertrophic ligamentum flavum was resected. The thecal sac and S1 root was retracted medially to expose the disc level. After incising PLL, the disc was removed by alligator and disc punch. After well hemostasis, the wound was closed in layers. Operators V.S. 賴達明 Assistants 胡朝凱 鍾文桂 陳國瑋 陳素月 (F,1947/08/18,64y6m) 手術日期 2010/10/08 手術主治醫師 賴達明 手術區域 東址 019房 03號 診斷 Lumbar Spondylosis 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 鍾文桂, 時間資訊 14:40 進入手術室 14:45 麻醉開始 15:00 誘導結束 15:20 抗生素給藥 15:35 手術開始 15:50 開始輸血 18:20 抗生素給藥 21:25 手術結束 21:25 麻醉結束 21:35 送出病患 21:40 進入恢復室 22:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 手術 椎弓切除術(減壓)-二節以內 1 2 L 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: 1. Interal fixation with transpedical screws ... 開立醫師: 鍾文桂 開立時間: 2010/10/08 22:16 Pre-operative Diagnosis Grade II spondylolisthesis, L5/S1. Post-operative Diagnosis Grade II spondylolisthesis, L5/S1. Operative Method 1. Interal fixation with transpedical screws at L4, and S1 levels with posterolateral fusion L4/L5/S1. 2. Sublaminar decompression, L5/S1. Specimen Count And Types nil Pathology Nil. Operative Findings Thick hypertrophic ligamentum flavum at L5/S1 level. Partial resection of posterior part of L5 vertebral body. Sublaminar decompression from left lateral wound. Transpedicle screws: Sharp lordotic curve of L4-S1 level, difficulty in adjusting rods during internal fixation. Severe osteoporosis, easy oozing. Operative Procedures Under ETGA, the patient was placed in prone position. The bilateral L4 and S1 pedicles were localized by intraoperative fluoroscope. After disinfection and draping, bilateral lateral paraspinal incision were made from L4 to S1 level. Transpedicle screws were implanted at L4 and S1 level bilaterally. After sublaminar decompression at L5/S1 level, the internal fixation apparatus were completed with rods and caps. Posterolateral fusion was achieved with autologous bone and allografts. A CWV drain was placed at left wound. The wounds were closed in layers. Operators V.S. 賴達明 Assistants 陳德福 鍾文桂 方怡婷 相關圖片 張福旋 (M,1933/10/29,78y4m) 手術日期 2010/10/08 手術主治醫師 黃培銘 手術區域 東址 002房 02號 診斷 Head Injury 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 游皓鈞, 時間資訊 23:16 臨時手術NPO 10:22 報到 10:23 進入手術室 10:25 麻醉開始 10:28 誘導結束 10:42 手術開始 11:00 手術結束 11:05 送出病患 11:05 麻醉結束 醫令資訊 類別 名稱 量 刀 側 手術 氣管切開術 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 游皓鈞 開立時間: 2010/10/08 11:16 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types nil Pathology None Operative Findings Fr.8 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators VS黃培銘 Assistants R3郝政鴻, R1游皓鈞 歐陽佩鈞 (F,1996/12/15,15y2m) 手術日期 2010/10/09 手術主治醫師 郭夢菲 手術區域 兒醫 067房 02號 診斷 Hemiplegic infantile cerebral palsy 器械術式 Cranioplasty 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 3E 紀錄醫師 游健生, 時間資訊 06:01 開始NPO 10:44 通知急診手術 12:55 報到 13:16 進入手術室 13:20 麻醉開始 13:40 誘導結束 14:20 手術開始 16:12 手術結束 16:12 麻醉結束 16:25 送出病患 16:30 進入恢復室 17:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 顱骨切除術,包括異物移除或壓或經切斷 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 C.V.P. catheter in ubation 1 0 手術 深部傷口處理縫合擴創-小 1 0 記錄__ 手術科部: 外科部 套用罐頭: 1. Removal of artificial skull 開立醫師: 游健生 開立時間: 2010/10/09 17:00 Pre-operative Diagnosis Scalp infection due to exposed artificial skull Infection due to exposed artificial (PMMA) skull plate Post-operative Diagnosis Scalp infection due to exposed artificial skull Infection due to exposed artificial (PMMA) skull plate Operative Method 1. Removal of artificial skull 1. Removal of the PMMA artificial skull plate via previous frontotemporal craniotomy wound 2. Debridement and primary closure of scalp wound 2. Debridement and primary closure of rupture scalp wound Specimen Count And Types 1 piece About size:a few pieces Source:necrotic tissue of exposed wound Pathology Nil Operative Findings There was a thick layer of graunlation tissue between scalp and artificial skull. There was a calcified layer on both side of the artificial skull. The posterior border of artificial skull was depressed underneath patient skull. There was some necrotic tissue under the open scalp wound. Some of it was sent for culture. There was a thick layer of graunlation and calcified tissue between scalp and the artificial PMMA skull measuring about 8x8 cm in diameter. There was a calcified layer on both side of the artificial skull graft. The posterior border of artificial skull was depressed underneath patient own skull. There was some necrotic granulation tissue under the exposed open scalp wound. Some of it was sent for culture. Operative Procedures 1. Under ETGA, patient in supine position with head rotated to left. 2. After shaving, disinfected and draped the operation field as usual. 3. Scalp incision along previous wound. 3. We prepared gentamicin solution (2 amp/1000cc) for intraoperative usage and irrigation. Scalp incision along previous wound. 4. Dissected in layers and exposed the border of artificial skull. 4. Dissected in layers and exposed the border of artificial skull plate. 5. Removed wiring and then dissected the artificial skull away from underneath granulation tissue. 5. Removed wiring and then dissected the artificial skull away from underneath granulation tissue. The normal skull bone covering the posterior part of the artificail bone was removed for facilitating removal of the PMMA plate. 6. Removed the artificial skull and placed a subgaleal CWV drain. 7. Debrided the open skull wound and irrigated the operation field with Gentamycin solution. 7. Debrided the exposed open skull wound at the anterior frontal region, and irrigated the operation field with Gentamycin solution. Debridement and closed it. 8. Closed wounds in layers. 8. Closed the frontotemporal wounds in layers. Operators VS 郭夢菲 Assistants R3 游健生 Ri 黃緒恒 Indication Of Emergent Operation 洪翌洧 (M,2010/06/13,1y9m) 手術日期 2010/10/09 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Congenital heart disease 器械術式 Revision of subduro-peritoneal shunt 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 3E 紀錄醫師 游健生, 時間資訊 23:42 臨時手術NPO 05:42 開始NPO 10:00 通知急診手術 11:11 進入手術室 11:15 麻醉開始 11:25 誘導結束 11:40 抗生素給藥 11:48 手術開始 12:40 手術結束 12:40 麻醉結束 12:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦脊髓液分流管重置 1 1 R 手術 慢性硬腦膜下血腫清除術 1 2 L 記錄__ 手術科部: 套用罐頭: Bilateral subdural effusion 開立醫師: 曾峰毅 開立時間: 2010/10/09 12:56 Pre-operative Diagnosis Bilateral subdural effusion, status post right subduro-peritoneal shunt insertion, sustained Bilateral subdural effusion, status post right subduro-peritoneal shunt insertion with shunt functrion insufficiency Post-operative Diagnosis Bilateral subdural effusion, status post right subduro-peritoneal shunt insertion, sustained Bilateral subdural effusion, status post right subduro-peritoneal shunt insertion with shunt functrion insufficiency Operative Method Bilateral subdural effusion 1. Left external drainage 2. right subduroperitoneal shunt revision Specimen Count And Types CSF sent for routine, BCS, and culture. Pathology Nil Operative Findings Chronic subdural effusion, reddish, was noted while durotomy made at left frontal area. 1. Chronic subdural effusion, reddish, was noted while durotomy made at left frontal area. 2. the SP shunt was patent at its subdural end. the diatal function was also good. Operative Procedures With endotracheal general anaestehsia, the patient was put in supine position with head in neutral position. After scalp shvaed, scrubbed, disinfeted, and then draped, we made one transverse linear skin incision at left frontal area, and created one burr hole by biting left anterior border of anterior fontanelle with small rongeur. After durotomy, we inserted subdural drain. The wound was closed in layers. We made another transver skin incision at right frontal area along previous operation wound. We dissected to expose previous subdural shunt. We pulled out the subdural catheter, and checked its function. The subdural catheter was re-inserted into subdural space. The wound was closed in layers. With endotracheal general anaestehsia, the patient was put in supine position with head in neutral position. After scalp shvaed, scrubbed, disinfeted, and then draped, we made one small longitudinal linear skin incision at the left cornor of anterior fontanel. On small burr hole was made here. After durotomy, we inserted subdural drain and fixed it. The wound was closed in layers. We made another transver skin incision at right frontal area along previous operation wound. We dissected to expose previous subdural shunt. We pulled out the subdural catheter, and checked its function both at the prximal and distal ends. The subdural catheter was re-inserted into subdural space. The wound was closed in layers. Operators VS 郭夢菲 Assistants R4 曾峰毅 R3 游健生 Indication Of Emergent Operation 祁寶瓊 (M,1950/05/08,61y10m) 手術日期 2010/10/09 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Cerebrovascular accident (CVA) 器械術式 Craniotomy(Aneurysms) P-DUH 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 4E 紀錄醫師 陳國瑋, 時間資訊 16:05 臨時手術NPO 16:05 開始NPO 16:30 進入手術室 16:35 麻醉開始 16:58 誘導結束 17:05 抗生素給藥 17:15 開始輸血 17:21 手術開始 19:42 手術結束 19:42 麻醉結束 19:55 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦內血腫清除術 1 1 R 記錄__ 手術科部: 復健部 套用罐頭: Right occipital craniotomy for hematoma evacu... 開立醫師: 孫立偉 開立時間: 2010/10/09 20:05 Pre-operative Diagnosis Right Occipital lobar hemorrhage Post-operative Diagnosis Right Occipital lobar hemorrhage Operative Method Right occipital craniotomy for hematoma evacuation Specimen Count And Types nil Pathology Nil Operative Findings 1.About 120 ml acute hematoma located at right occipital lobe was noted. The hematoma seemed not invade into ventricle. 2.No obvious bleeder was noted, and diffuse oozing at rough surface was noted. 3.Bleeding tendency was suspect, and 12U FFP was infused. 4.Before operation, Pupil: R/L : 5.5/2 ; After operation: R/L: 2.5/2 Operative Procedures 1.ETGA, prone with head fixed with skull clamp 2.Linear incision was made at right occipital area 3.Detach muscle 4.Craniotomy 5.Cruciate form dura incision 6.Hematoma evacuation 7.Hemostasis with surgicel and gelfoam 8.Dura closure with durofoam 9.Fixed bone back with miniplate 10.Set one CWV drain then close woun in layers Operators 賴達明 Assistants 胡朝凱, 陳國瑋 Indication Of Emergent Operation 邱陳芋妹 (F,1942/11/21,69y3m) 手術日期 2010/10/09 手術主治醫師 蔡翊新 手術區域 東址 003房 01號 診斷 Malignant neoplasm of frontal lobe 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 洪誌鍵, 時間資訊 00:00 臨時手術NPO 07:35 報到 07:49 進入手術室 08:10 麻醉開始 08:28 抗生素給藥 08:30 誘導結束 08:31 手術開始 11:28 抗生素給藥 13:10 麻醉結束 13:10 手術結束 13:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除-手術時間在4~8小時 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT 開立醫師: 蔡翊新 開立時間: 2010/10/09 12:33 Pre-operative Diagnosis Right frontal brain tumor. Post-operative Diagnosis Right frontal brain tumor, malignant. Operative Method Right frontotemporal craniotomy for grossly total tumor excision. Specimen Count And Types Several piecees, total size about 4.36 x 3.81 x 4.6 cm. Source:brain tumor Pathology Frozen section: malignancy, less likely to be metastatic carcinoma or glioma Operative Findings A 4.36 x 3.81 x 4.6 cm grey reddish, soft-to-elastic, moderately hypervascular tumor at right insular lobe, with scattered old hemorrhage in it. The margins between the tumor and normal brain were clear-cut at superior, medial and posterior aspects, but vague at anterior, inferior and lateral aspects. and There were several engorged arteries coming from right MCA (M2~3) branches. The brain remained slack after tumor excision and the pulsation was good. Frozen section revealed malignant cells, but it was less likely to be metastatic carcinoma or glioma. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: Curviliear, at right frontotemporal region. Raney clips were applied to the scalp edge for temporary hemostasis. 5. Craniotomy window: 10 x 10 cm, right F-T, created by making 4 burr holes then cut by power saw. 6. Dural tenting: by 2/0 silk, 2 cm in interval, distributed along the edge of skull window. 7. Dural incision: curvilinear along the edge of skull window. 8. Tumor excision: 2.5 cm of cerebral cortical incision was made by Greenwood bipolar forceps at right inferior frontal gyrus. The procedure was then carried out deep into white mater until the tumor was exposed. Two fragments of tumor were sent for forzen section. The other parts of the tumor was resected by bipolar forceps along its vague discernible junction with normal white mater as several pieces. The bleeding during the dissection was stopped by bipolar coagulator or by packing with conttonoid patties. Finally, the cavity created after tumor excision was irrigated with NS several times and it was perfectly watery clear before the dural closure. 9. Dural closure: continuous suture with 4/0 Prolene to obtain water-tight closure. 10.Closure of skull window: the skull plate was placed back to craniotomy window and fixed by 3 miniplates and screws. The dura was tented to the center of the skull plate by two 2/0 stitches. The covering muscle was closed by interrupted 1/0 silk stitches. 11.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 1/0 Vicryl and skin by continuous suture with 3/0 nylon. 12.Drain: one, epidural, CWV. 13.Blood transfusion: nil. Blood loss: 80 ml. 14.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R6胡朝凱R1洪誌鍵 邱陳芋妹 (F,1942/11/21,69y3m) 手術日期 2010/10/09 手術主治醫師 蔡翊新 手術區域 東址 005房 01號 診斷 Malignant neoplasm of frontal lobe 器械術式 Crainotomy Brain Tumor(P-LIN) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 游健生, 時間資訊 18:11 通知急診手術 18:45 報到 18:45 進入手術室 18:48 麻醉開始 18:50 誘導結束 19:20 手術開始 21:00 抗生素給藥 22:00 麻醉結束 22:00 手術結束 22:10 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦內血腫清除術 1 2 R 摘要__ 手術科部: 外科部 套用罐頭: CVA 開立醫師: 蔡翊新 開立時間: 2010/10/09 21:18 Pre-operative Diagnosis Right frontal brain tumor s/p excision, with right basal ganglion ICH. Post-operative Diagnosis Right frontal brain tumor s/p excision, with right basal ganglion ICH, suspected bleeding from residual tumor. Operative Method Right frontotemporal craniotomy for ICH evacuation and excision of residual tumor. Specimen Count And Types 1 piece About size: 3 x 0.5 cm Source: brain tumor Pathology Pending. Operative Findings The dura was a little tense after craniotomy. Previous tumor bed was clean, but dark reddish liquified blood and clots gushed out upon pentration through the tumor bed at medial aspect. About 20 ml ICH was evacuated. Thin, grey reddish, jelly-like, hypervascular mass was encoutered after ICH was removed, coating the cavity. This was compatible with enhanced cystic wall on MRI study. After hematoma evacuation and residual tumor excision, the brain was slack. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right left. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: right frontotemporal, curvilinear, along previous wound. The skin edge was clipped by Raney clips for temporary hemostasis. The scalp was lifted, the temporalis muscle was detached from temporal squama and reflected to lower temporal side. 5. Craniotomy: previous craniotomy was lifted after removal of miniplates. 6. Dural incision: curvilinear along craniotomy window. 7. The intracerebral hematoma was sucked out via penetration of previous tumor bed into right basal ganglia. The cystic wall of the tumor was excised. Hemostasis was performed with bipolar coagulator and packing with Surgicel. Before closure of the dura, the hematoma caivty was clean and the brain once bulging was slack. 8. Dural closure: continous sutures with 4/0 Prolene to obtain water-tight closure. 9. The craniotomy plate was placed back and fixed by miniplates and screws. 10.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 1/0 Dexon and skin by continuous suture with 3/0 nylon. 11.Drain: one epidural CWV. 12.Blood transfusion: nil. Blood loss: 200 ml. 13.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R6胡朝凱R3游健生 Indication Of Emergent Operation 莊春月 (F,1967/03/09,45y0m) 手術日期 2010/10/10 手術主治醫師 蔡瑞章 手術區域 東址 001房 04號 診斷 Benign neoplasm of cerebral meninges 器械術式 Craniotomy (A.V.M.) VS-TZENG 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 4E 紀錄醫師 王奐之, 時間資訊 21:36 通知急診手術 22:20 進入手術室 22:20 報到 22:23 麻醉開始 22:26 誘導結束 22:53 手術開始 23:50 開始輸血 01:00 麻醉結束 01:00 手術結束 01:10 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 腦內血腫清除術 1 2 記錄__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT 開立醫師: 曾峰毅 開立時間: 2010/10/11 01:07 Pre-operative Diagnosis Right temporal lobe intracerebral hemorrhage Post-operative Diagnosis Right temporal lobe intracerebral hemorrhage Operative Method Right craniectomy for ICH removal Specimen Count And Types Nil Pathology Nil Operative Findings ICP reference is 465. ICP before craniectomy was about 20cmH20, and was about 5 after wound closure. ICH was noted at right temporal lobe, and blood loss was 100ml. ICP reference is 465. ICP before craniectomy was about 20mmHg, and was about 5mmHg after wound closure. ICH was noted at right temporal lobe, and blood loss was 100ml. Operative Procedures With endotracheal general anaestehsia, the patient was put in supine position with head rotated to left. After scalp shaved, scrubbed, disinfected, and then draped, we made skin incision along previous operation wound, and extended the wound posteriorly in Y-shape. We removed previous craniotomy flap. We drilled three burr holes at right parietal area, and enlarged craniecomy winodw. After durotomy, we evacuated the intracerebral hemorrhage. The dura was closed in water-tight fashion with autologous fascia graft. We inserted subdural ICP monitor, and two epidural drains. The wound was closed in layers. Operators P 蔡瑞章 VS 王國川 Assistants R4 曾峰毅 R3 王奐之 Indication Of Emergent Operation 相關圖片 吳語彤 (F,1977/07/07,34y8m) 手術日期 2010/10/11 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Carotid body tumor 器械術式 EC-IC by-pass 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 2 紀錄醫師 游健生, 時間資訊 07:39 報到 08:00 進入手術室 08:10 麻醉開始 08:50 誘導結束 09:40 抗生素給藥 10:05 手術開始 12:40 抗生素給藥 14:50 麻醉結束 14:50 手術結束 15:02 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除-手術時間在4~8小時 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Dissection of Left carotid body tumor 開立醫師: 游健生 開立時間: 2010/10/12 02:42 Pre-operative Diagnosis Left carotid body tumor Post-operative Diagnosis Left carotid body tumor Operative Method Left carotid body tumor total excision Specimen Count And Types Nil Pathology Nil Operative Findings A hypervascularized, elastic firm, encapsulated tumor was noted at carotid bifurcation encasing the ECA and ICA. The tumor size was 4 x 5 x 3.3cm. The most adhesive location between tumor and carotid artery was at carotid bifurcation. During whole procedure, vital sign was stable. Operative Procedures Under ETGA, patient was in supine position with neck extended, head rotated to right, and left shoulder elevated by towel. After disinfection and draping, a transverse skin incision was made along skin crease with centred at tumor. The plastysma muscle was transected and mobilized from the underlying superficial cervical fascia which was then opened transversely. The diagastric muscle was identified and looped. Facial vein was ligated and divided. Hypoglossal nerve was identified and protected carefully. We meticulously dissected the tumor from surrounding soft tissue while achieved hemostasis with Surgicel and cauterization. The facial and lingual artery were ligated and divided because encased by the tumor. Then, we dissected the tumor away from ICA completely and ECA partially along the subadventitia plane. The ECA was clamped at its origin and divided on both side of the tumor. The proximal stump was secured by 6-0 prolene continuous suture. The tumor was removed en bloc after complete dissection from surrounding tissue. The wound was irrigated and tumor bed packed with Surgicel. After placement of a CWV, the wound was closed in layers. Operators Prof. 杜永光 Assistants R6 胡朝凱 R3 游健生 摘要__ 手術科部: 外科部 套用罐頭: Left carotid body tumor total excision 開立醫師: 游健生 開立時間: 2010/10/12 02:46 Pre-operative Diagnosis Left carotid body tumor Post-operative Diagnosis Left carotid body tumor Operative Method Left carotid body tumor total excision Specimen Count And Types a 4 x 5 x 3.3cm tumor Pathology pending Operative Findings A hypervascularized, elastic firm, encapsulated tumor was noted at carotid bifurcation encasing the ECA and ICA. The tumor size was 4 x 5 x 3.3cm. The most adhesive location between tumor and carotid artery was at carotid bifurcation. During whole procedure, vital sign was stable. Operative Procedures Under ETGA, patient was in supine position with neck extended, head rotated to right, and left shoulder elevated by towel. After disinfection and draping, a transverse skin incision was made along skin crease with centred at tumor. The plastysma muscle was transected and mobilized from the underlying superficial cervical fascia which was then opened transversely. The diagastric muscle was identified and looped. Facial vein was ligated and divided. Hypoglossal nerve was identified and protected carefully. We meticulously dissected the tumor from surrounding soft tissue while achieved hemostasis with Surgicel and cauterization. The facial and lingual artery were ligated and divided because encased by the tumor. Then, we dissected the tumor away from ICA completely and ECA partially along the subadventitia plane. The ECA was clamped at its origin and divided on both side of the tumor. The proximal stump was secured by 6-0 prolene continuous suture. The tumor was removed en bloc after complete dissection from surrounding tissue. The wound was irrigated and tumor bed packed with Surgicel. After placement of a CWV, the wound was closed in layers. Operators Prof. 杜永光 Assistants R6 胡朝凱 R3 游健生 徐純華 (F,1942/08/01,69y7m) 手術日期 2010/10/11 手術主治醫師 曾漢民 手術區域 東址 005房 號 診斷 Spinal metastasis 器械術式 OPLL-Anterior Corpectomy VSLai 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 2 紀錄醫師 陳國瑋, 時間資訊 07:39 報到 08:04 進入手術室 08:05 麻醉開始 08:20 誘導結束 08:50 抗生素給藥 09:01 手術開始 12:10 抗生素給藥 12:40 14:05 手術結束 14:05 麻醉結束 14:15 送出病患 14:16 進入恢復室 15:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 脊椎融合術-前融合,有固定物)≦四節 1 2 手術 惡性脊髓腫瘤切除術 1 1 L 手術 頭顱成形術 1 4 R 摘要__ 手術科部: 外科部 套用罐頭: 1.T1 corpectomy and fusion with expandable ca... 開立醫師: 陳德福 開立時間: 2010/10/11 12:02 Pre-operative Diagnosis T1 body and right frontal skull metastatic tumor, nature to be determinated Post-operative Diagnosis T1 body and right frontal skull metastatic tumor, nature to be determinated Operative Method 1.T1 corpectomy and fusion with expandable cage 2.skull tumor excision and cranioplasty Specimen Count And Types 1 piece About size:1*1*1CM Source:T1 BODY TUMOR Pathology pending; intra-OP frozen section pathology: adenocarcinoma Operative Findings 1.There is a greyish-reddish, soft, fragile and infiltrative tumor occuping the T1 body with lateral extension. The T1 body was collapsed and the spinal cord was compressed by the posterior border of the verterbral body. The C7/T1 and T1/2 cervical spine interbody disc and T1 vertebral body were removed. 2.One expandable cervical body cage was implantated at the T1 level with 4 16mm screws fixation. Bilateral T-1 nerve roots were exposed during the operation. 3.One 4*3*4cm in sized tumor at the right fontal skull with adhesion to the dura was noticed. The tumor was well capsulated and bicortical involved. The tumor was removed with the skull totally and the cranial defect window was repaired with bone semen and wire mesh. Operative Procedures Under ETGA and supine position, the skin was disinfected and draped as usual. One curvilinear incision at the left medial supraclavicular area was done and the prevertebral space was identified. The location of the T1 was checked under C-arm fluroscope and corpectomy with adjacent cervical diskectomy were performed under microscopic surgery. The dura was exposed and the theca sac was decompressed. One expandable cervical body cage was implantated in situ with 4 srews. One minihemovac was left in situ and trhe wound was closed in layers. The scalp was prepared for right frontal craniotomy and one curvilinear incisoin was done. The tumor was identified after scalp reflexion. One tumor-centered 5*5cm in sized craniectomy was done and the dura tenting was performed. The cranioplasty was done with bone semen and wire mesh. The wound was then closed in layers. Operators VS曾漢民 Assistants R5陳德福 R2陳國瑋 黃炯勛 (M,1991/12/17,20y2m) 手術日期 2010/10/11 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 Head injury, unspecified 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 2 紀錄醫師 陳國瑋, 時間資訊 13:55 報到 14:25 進入手術室 14:30 麻醉開始 14:35 誘導結束 14:40 抗生素給藥 15:17 手術開始 16:10 手術結束 16:10 麻醉結束 16:20 送出病患 16:25 進入恢復室 17:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室腹腔分流手術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: revision of shunt valve to programmable valve 開立醫師: 陳國瑋 開立時間: 2010/10/11 16:18 Pre-operative Diagnosis Hydrocephalus s/p VPS, under drainage Post-operative Diagnosis Hydrocephalus s/p VPS, under drainage Operative Method revision of shunt valve to programmable valve Specimen Count And Types nil Pathology nil Operative Findings 1.The previous left Kocher Metronic valve was ligated. 2.One programmable valve, Codman,80mmH2O was implantated at the left Frazier point; Intraventricular catheter:9.5cm 3.Tinea capitis was highly suspected. Operative Procedures 1.GA via tracheostomy and supine position 2.scalp disinfection and draping 3.incision at the left Frazier point 4.burr hole creation and open the dura 5.inser the ventricular needle 6.dissect the previous catheter and ligate it 7.connect the Codman programmable valve and insert the intraventricular catheter 8.close the wound in layers. Operators VS 王國川 Assistants R5 陳德福 R2陳國瑋 余廖碧蘭 (F,1938/05/10,73y10m) 手術日期 2010/10/11 手術主治醫師 王國川 手術區域 東址 001房 02號 診斷 Major trauma rated 16 or above on the severeity scale ( Injury severeity score >=16 ) 器械術式 Burr hole (trephination) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3E 紀錄醫師 李振豪, 時間資訊 10:43 通知急診手術 11:55 報到 11:55 進入手術室 12:00 麻醉開始 12:05 誘導結束 12:33 抗生素給藥 12:57 手術開始 13:28 手術結束 13:28 麻醉結束 13:35 送出病患 13:40 進入恢復室 15:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 2 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Burr hole drainage 開立醫師: 李振豪 開立時間: 2010/10/11 13:49 Pre-operative Diagnosis Right fronto-temporo-parietal chronic subdural hematoma Post-operative Diagnosis Right fronto-temporo-parietal chronic subdural hematoma Operative Method Burr hole drainage Specimen Count And Types 1 piece About size:4ml Source:Chronic subdural hematoma Pathology Nil Operative Findings The outer membrane was noted after dural opening. The motor-oil like fluid gushed out after opening of outer membrane. The brain was slack after drainage of the subdural hematoma. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine position with head rotated to left. The scalp was shaved, scrubbed, and disinfected as usual. Linear scalp incision was made at right fronto-temporal area. The temporalis muscle and fascia was opened and splitted. One burr hole was created followed by two dural tenting. After dura opening, the outer membrane was noted. The outer membrane was opened and the edge was coagulated with bipolar electrocautery. Chronic subdural hematoma was drained out and one EVD tube was placed toward frontal area. Externalization of EVD was done. Hemostasis was achieved with bipolar electrocautery and Gelform packing. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS王國川 Assistants R4李振豪 Indication Of Emergent Operation 相關圖片 李余勇 (M,1971/05/11,40y10m) 手術日期 2010/10/12 手術主治醫師 賴達明 手術區域 東址 001房 04號 診斷 Intracerebral hemorrhage (ICH) 器械術式 Crainotomy Brain Tumor(P-LIN) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 4E 紀錄醫師 游健生, 時間資訊 14:25 通知急診手術 15:05 報到 15:05 進入手術室 15:08 麻醉開始 15:10 誘導結束 15:12 手術開始 15:50 麻醉結束 15:50 手術結束 16:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱內壓視置入 1 1 L 手術 腦室體外引流 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Bilateral external ventricular drainage inser... 開立醫師: 游健生 開立時間: 2010/10/12 16:15 Pre-operative Diagnosis 1. Intraventricular hemorrhage 2. Acute hydrocephalus Post-operative Diagnosis 1. Intraventricular hemorrhage 2. Acute hydrocephalus Operative Method Bilateral external ventricular drainage insertion with ICP monitoring Specimen Count And Types nil Pathology Nil Operative Findings 1. Bloody CSF with some blood clot was drained from bilateral external ventricular drainage, left more than right side 2. Both ventricular catheter length was about 6.5cm 3. The opening pressure of ventricle was moderate Operative Procedures 1. Under ETGA, supine position with head elevated. 2. After shaving, disinfection and draping as usual. 3. Opened previous right scalp wound and debrided. 4. Inserted a new ventricular catheter via previous EVD tract. 5. Verticle scalp incision at left Kocher region. 6. Burrhole created at left Kocher point. 7. Cauterized dura and cruciate durotomy. 8. Ventriculostomy followed by ventricular catheter insertion. 9. Closed wound in layers. Operators VS 賴達明 Assistants R6 胡朝凱 R3 游健生 Indication Of Emergent Operation 李文金 (M,1954/10/31,57y4m) 手術日期 2010/10/12 手術主治醫師 戴浩志 手術區域 東址 000房 號 診斷 Coronary artery disease, post percutaneous transluminal coronary angioplasty (PTCA) 器械術式 S.T.S.G.<10 BSA 手術類別 預定手術 手術部位 四肢 傷口分類 清潔污染 麻醉方式 脊髓麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 阮廷倫, 時間資訊 12:00 報到 12:35 進入手術室 12:35 麻醉開始 12:40 誘導結束 13:40 手術開始 13:50 手術結束 13:50 麻醉結束 13:55 送出病患 13:56 進入恢復室 14:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 多層皮膚移植- 10-20BSA 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Spinal anesthesia 1 0 麻醉 Glucose 1 0 摘要__ 手術科部: 外科部 套用罐頭: STSG 開立醫師: 阮廷倫 開立時間: 2010/10/12 14:02 Pre-operative Diagnosis Left SVG wound poor healing, s/p debridement Post-operative Diagnosis Left SVG wound poor healing, s/p debridement Operative Method STSG Specimen Count And Types Nil Pathology Nil Operative Findings 1. One 5*15 cm open wound with fair granulation tissue over left medial knee region 2. 8/1000 inch, 5*15 cm STSG was harvested from left lateral thigh Operative Procedures Under spinal anesthesia, the patient was put in supine position. After skin disinfection and draped, the wound was then debrided. STSG was harvested from left lateral thigh. After irrigation and hemostasis, the meshed STSG was then inseted to the skin defect. Compressive VAC dressing was used for fixation of STSG. Operators AP戴浩志 Assistants R5阮廷倫 林玉枝 (F,1953/02/10,59y1m) 手術日期 2010/10/12 手術主治醫師 曾勝弘 手術區域 西址 033房 01號 診斷 Carpal tunnel syndrome 器械術式 Decompression of mediun nerve 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 07:30 報到 08:20 進入手術室 08:35 麻醉開始 08:40 手術開始 09:05 手術結束 09:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 正中神經或尺神經腕部減壓術–單側 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Decompression of left median nerve 開立醫師: 李振豪 開立時間: 2010/10/12 09:14 Pre-operative Diagnosis Carpal tunnel syndrome, left Post-operative Diagnosis Carpal tunnel syndrome, left Operative Method Decompression of left median nerve Specimen Count And Types nil Pathology Nil Operative Findings The median nerve was tightly compressed by hypertrophic and calcified transverse carpal ligment. The nerve expanded well after decompression. Operative Procedures The patient was put in supine position. The skin was disinfected and draped as usual. Local anesthesia was applied and one linear skin incision was made at left wrist and palm. The subcutaneous soft tissue and aponeurosis was splitted and the transverse carpal ligment was identified. The transverse carpal ligment was transected for decompression of median nerve. Hemostasis was achieved with bipolar electrocautery and normal saline irrigation. The wound was then closed in layers with 4-0 Nylon. Operators VS曾勝弘 Assistants R4李振豪 馮元 (M,2001/05/11,10y10m) 手術日期 2010/10/12 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Brain tumor 器械術式 Crainotomy Brain Tumor(P-LIN) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 曾峰毅, 時間資訊 23:07 臨時手術NPO 07:50 報到 08:07 進入手術室 08:15 麻醉開始 08:50 誘導結束 09:05 抗生素給藥 09:20 手術開始 12:05 抗生素給藥 13:10 麻醉結束 13:10 手術結束 13:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 誘發電位手術監視機–腦神經外科術中特殊儀器使用費 1 0 手術 超音波診查機–腦神經外科術中特殊儀器使用費 1 0 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 手術 顱底瘤手術 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT 開立醫師: 曾峰毅 開立時間: 2010/10/12 14:02 Pre-operative Diagnosis Intracranial germ cell tumor, status post partial tumor excision, status post chemotherapy, complicated with enlarging cystic component Intracranial mixed germ cell tumor, status post partial tumor excision, status post chemotherapy with enlarging cystic component over the posterior fossa Post-operative Diagnosis Intracranial germ cell tumor, status post partial tumor excision, status post chemotherapy, complicated with enlarging cystic component Intracranial mixed germ cell tumor, status post partial tumor excision, status post chemotherapy with enlarging cystic component over the posterior fossa Operative Method Occipital carniectomy for fourth ventricle cystic tumor excision Specimen Count And Types Part of cystic tumor was sent for patholgy. CSF was sent for ruoine, BCS, culture, AFP, and beta-HCG. Part of cystic tumor was sent for patholgy. CSF was sent for routine, BCS, culture, AFP, and beta-HCG. Pathology Pending Operative Findings The component of the cyst is colorless and clear, but with high viscosity. The cerebellar buldged out the durotomy window during the tumor excision. We sent the patient to the CT, revealing IVH at 4th ventricle, 3rd and bialteral lateral ventricles. The cystic wall was very thick ans could be divided into the outer fibrotic and inner soft fragile part. The cystic content was colorless and clear. The cerebellum became more buldged while the posterior third of the cyst was removed. We used intraoperative echo to evaluate the condition, whihc showed a 2 to 3 well encapsulated hyperechoid lesion with marginal hyperdensity. For the brain was too bulged to go further excision of the tumor, we sent the patient to the CT room after closure of the wound. It revealed IVH at 4th ventricle, 3rd and bilateral lateral ventricles with silghtly dilatation of the ventricle. The cystic wall was very thick ans could be divided into the outer fibrotic and inner soft fragile part. The cystic content was colorless and clear. The cerebellum became more buldged while the posterior third of the cyst was removed. We used intraoperative echo to evaluate the condition, which showed a 2 to 3 well encapsulated hyperechoid lesion with marginal hyperdensity. For the brain was too bulged to go further excision of the tumor, we sent the patient to the CT room after closure of the wound. It revealed IVH at 4th ventricle, 3rd and bilateral lateral ventricles with silghtly dilatation of the ventricle. The intraoperatiev SSEP monitoring showed decreased wave form of the right side from the beginning of surgery and had no change throughout the whold course of surgery. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position with neck flexed, and head fixed with Mayfield head clamp. After scalp shaved, scrubbed, disinfected, and then draped, we made one midline linear skin incision along previous operation wound. Craniotomy window was made with Kerrison rongeur along previous cranitomy window. Durotomy in Y-shape was done. We punctured the cyst via right cerebellar hemisphere, and splited the vermis. The cystic component was decompressed first, and excised partially. Due increaed intracranial pressure, we closed the wound in layers after dura closure. One epidural CWV was inserted. With endotracheal general anaesthesia, the patient was put in prone position with neck flexed, and head fixed with Mayfield head clamp. Intraop. SSEP monitor was set up. After scalp shaved, scrubbed, disinfected, and then draped, we made one midline linear skin incision along previous operation wound over the occipital region. Craniotomy window was made with Kerrison rongeur along previous cranitomy window. Under microscopic view, durotomy in Y-shape was done. We punctured the cyst via right cerebellar hemisphere and aspirated 5 ml of cystic fluid for decompression and studies, and then splited the vermis to reach the cyst. The cystic component was decompressed first, and excised partially. After we resected the left part of the cyst, the 4th ventricle was achieved and some CSF came out. After that the cerebellum became more bulged than just after opening the dura. We adjusted to skull clamp to relieve the neck flexion though the original fexion angle was suitable. The cerebellum was still bulging though not progress. We used intraoperative echo to delineate the intracerebellar condition, which whoed a 2 to 3 cm well defined hyperechoid lesion. It may indicated an intracystic hemoorrhage or a new bleeding.Since further retraction would be dangerous in this situation, we closed the wound in layers after dura closure with one epidural CWV inserted and sent the patient to the CT room for further study. Operators VS 郭夢菲 Assistants R4 曾峰毅 薛智中 (M,1949/11/15,62y3m) 手術日期 2010/10/12 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Spinal stenosis, cervical 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 方怡婷, 時間資訊 08:05 進入手術室 08:20 麻醉開始 08:40 誘導結束 08:50 抗生素給藥 09:07 手術開始 11:10 手術結束 11:10 麻醉結束 11:15 送出病患 11:17 進入恢復室 12:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-頸椎 1 1 R 手術 脊椎融合術-前融合,有固定物(每增加<=四節) 1 2 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 摘要__ 手術科部: 外科部 套用罐頭: ACDF with cage 開立醫師: 陳德福 開立時間: 2010/10/12 11:12 Pre-operative Diagnosis C6/7 HIVD with radiculopathy and myelopathy Post-operative Diagnosis C6/7 HIVD with radiculopathy and myelopathy Operative Method ACDF with cage Specimen Count And Types nil Pathology nil Operative Findings 1.There is HIVD with cord and nerve roots compression at the level of C6/7. The osteophyte formation with nerve root compression was noted especially at the left side. The theca sac was decompressed after the diskectomy and one 8mm cage was implantated at the C6/7. Operative Procedures Under ETGA and supine position, the neck was hyperextended. The skin was disinfected and draped as usual. One transverse linear incision was done one the right neck and the platysma was transected. The C6/7 prevertebral space was reached after dissecting along the areolar plane. The location of C6/7 was identifed under C-arm fluroscope. The longus coli muscle was displaced laterally and the C6/7 discectomy was performed under microscopic surgery. The PLL was remvoed and the dura sac was expended well. One 8mm Syntheses cervical cage was implatated at the C6/7 level. One minihemovac was left in situ and the wound was closed in layers. Operators vs 賴達明 Assistants R5 陳德福 相關圖片 黃朝興 (M,1958/01/06,54y2m) 手術日期 2010/10/12 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 HIVD 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 方怡婷, 時間資訊 11:25 報到 11:40 麻醉開始 11:40 進入手術室 11:45 誘導結束 12:00 抗生素給藥 12:24 手術開始 15:00 抗生素給藥 15:20 手術結束 15:20 麻醉結束 15:30 送出病患 15:35 進入恢復室 16:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-腰椎 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 摘要__ 手術科部: 外科部 套用罐頭: microscopic lumbar diskectomy 開立醫師: 李振豪 開立時間: 2010/10/12 15:24 Pre-operative Diagnosis L4/5 HIVD and ruptured disc with radiculopathy, right Post-operative Diagnosis L4/5 HIVD and ruptured disc with radiculopathy, right Operative Method microscopic lumbar diskectomy Specimen Count And Types nil Pathology nil Operative Findings 1.There is a central buldging and seqeustrated disc with lumbar nerve roots compression and spinal stenosis at the L4/5 level. The nerve roots were compressed tightly from the nerve shoulder before the diskectomy. After diskectomy, the nerve root became redundent and soft. Operative Procedures 1.ETGA and prone position 2.localization under C-arm 3.linear incision 4.L4/5 partial laminectomy 5.removal of ligamentum flavum 6.identify the nerve roots and perform diskectomy with alligator, currettage, disc clamp assisted 7.hemostasis 8.close the wound in layers Operators VS 賴達明 Assistants R5 陳德福 R2方怡婷 相關圖片 林寶桂 (F,1933/08/15,78y6m) 手術日期 2010/10/12 手術主治醫師 賴達明 手術區域 東址 003房 03號 診斷 Spinal stenosis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳德福, 時間資訊 16:10 進入手術室 16:15 麻醉開始 16:30 誘導結束 16:30 抗生素給藥 16:52 手術開始 19:20 手術結束 19:20 麻醉結束 19:30 送出病患 19:31 進入恢復室 20:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 脊椎融合術-後融合,無固定物 1 2 手術 椎弓切除術(減壓)-超過二節 1 1 摘要__ 手術科部: 外科部 套用罐頭: L3-5 partial laminectomy 開立醫師: 陳德福 開立時間: 2010/10/12 19:27 Pre-operative Diagnosis L3-S1 spinal stenosis Post-operative Diagnosis L3-S1 spinal stenosis Operative Method L3-5 partial laminectomy Specimen Count And Types nil Pathology nil Operative Findings 1.There is severe spinal stenosis over L3/4, L4/5 and L5/S1. The hypertrophic ligamentum flavum was removed and partial decompressive laminectomy was done over L3-5. The theca sac reexpanded after the decompression surgery. 2.Posterior-lateral fusion from L3-5 with autologous bone fusion was done. Operative Procedures 1.ETGA and prone position 2.skin disinfection and draping 3.C-arm localization 4.linear incision from L3-5 5.displace the paraspinous muscle laterally 6.perform partial laminectomy and removal of ligamentum flavum from L3-5 7.Posterior-lateral fusion from L3-5 with autologous bone. 8.perform left one drainage in situ 9.close the wound in layers. Operators VS 賴達明 Assistants R5 陳德福 R1 方怡婷 唐雅君 (F,1960/03/27,51y11m) 手術日期 2010/10/12 手術主治醫師 賴達明 手術區域 東址 005房 01號 診斷 Herniated intervertebral disc, lumbar 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 洪誌鍵, 時間資訊 07:50 報到 08:02 進入手術室 08:10 麻醉開始 08:20 誘導結束 09:05 抗生素給藥 09:09 手術開始 10:35 手術結束 10:35 麻醉結束 10:47 送出病患 10:50 進入恢復室 12:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-腰椎 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 外科部 套用罐頭: HIVD 開立醫師: 陳德福 開立時間: 2010/10/12 10:25 Pre-operative Diagnosis HIVD, L4/5 Post-operative Diagnosis HIVD, L4/5 Operative Method laminotomy and disketomy over L4/5 Specimen Count And Types nil Pathology nil Operative Findings 1. hypertrophic ligmentum flavum 2. protuding disc over L4/5 Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: semiprone with a bolster beneath -- side and flexed at the waist and knees. 3. Skin preparation: the back was shaved and scrubbed with povidone-iodine detergent then painted with povidone-iodine tincture and followed by sterilized adhesive plastic sheet covering. 4.A spinal needle was inserted between spinous processes of L4-5 and a portable X-ray film was taken to locate the correct interspace. 5.Incision: 3-cm, between L4-5 pinous processes,off-midiline at the right margin of spinous processes. The subcutaneous layer and lumbdorsal fascia were incised then. 6.The aponeurosis of the latissimus dorsi and ileocostalis lumborum muscles at spinous processes of L4-5 was incised, the muscles were detached from the interspinous ligament. The multifidus muscles were detached subperiosteally from L4-5 laminae by a rasp. 7.The paravertebral muscles were retracted by a modified narrow Taylor retractor which was retained constantly by a rubbersling to the side rail of the operating table. 8.Under an operating microscope, the ligamentum flavum was cleaned and incised longitudinally at the lateral part with a No. 11 blade. The lateral portion of this ligament was removed with a small angle Kerrison rongeur, the lateral portion of the laminae and the medial border of the facets were removed too until the margin of the facets and a corridor to the disc that ran lateral to the root was reached. 9.The epidural fat was left undisturbed andpreserved. 10.The compressed root was gently pushed further away temporarily by sucker tip in order to expose the herniated disc more clearly. The posterior longitudinal ligament and annulus were incised around the protruded disc with a No. 15 blade. The degenerated disc was removed with microdisc forcepsuntil a substantial amount of the nucleus had been loosened with a cone curette and removed. 13.Irrigation of the wound with gentamycin solution. 14.Close the wound in lyaers 15.Course of the surgery: smooth. Operators VS賴達明 Assistants R5鍾文桂 R1洪誌鍵 施黃悅 (F,1936/04/26,75y10m) 手術日期 2010/10/12 手術主治醫師 賴達明 手術區域 東址 005房 02號 診斷 Spondylolisthesis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 10:35 報到 10:56 進入手術室 11:05 麻醉開始 11:20 誘導結束 11:50 手術開始 12:20 抗生素給藥 14:30 抗生素給藥 17:30 麻醉結束 17:30 手術結束 17:30 抗生素給藥 17:40 送出病患 17:40 進入恢復室 19:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 椎弓切除術(減壓)-二節以內 1 2 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 記錄__ 手術科部: 外科部 套用罐頭: 1. Internal fixation and posterolateral fusio... 開立醫師: 鍾文桂 開立時間: 2010/10/12 18:01 Pre-operative Diagnosis 1.Lumbar spondylolisthesis, L3/4&L5;/S1. 2.Herniated intervertebral disc, L4/5. Post-operative Diagnosis 1.Lumbar spondylolisthesis, L3/4&L5;/S1. 2.Herniated intervertebral disc, L4/5. Operative Method 1. Internal fixation and posterolateral fusion, L3-5. 2. Decompressive laminectomy, L3 and L5. Specimen Count And Types nil Pathology Nil. Operative Findings 1. Hypertrophic ligamentum flavum. 2. Osteoporotic change, unstable spine at L3/4 and L5/S1 levels. 3. Internal fixation apparatus: Transpedicle screws at L3 and L5 levels:40mm and two rods. 4. One small iatrogenic dural tear was noted at right L5 level. Operative Procedures Under ETGA, the patient was placed in prone position. After localization of L3-L5 levels, disinfection and draping were done as preparation. Midline incision to expose L3-S1 level was achieved. The transpedicle screws were implanted and their positions were ensured by intraoperative fluoroscopy. Then, decompressive laminectomy and foraminotomy were done at L3 and L5 levels. After placing autologous bone graft for posterolateral fusion, the internal fixation appratus was completed with rods. After placing one 1/8 hemovac drain, the wound was closed in layers. Operators V.S. 賴達明 Assistants R5 鍾文桂 R1洪誌鍵 相關圖片 許陳錦 (F,1950/11/13,61y4m) 手術日期 2010/10/12 手術主治醫師 劉殿楨 手術區域 東址 025房 06號 診斷 Breast cancer, female 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 林玫君, 時間資訊 17:10 進入手術室 17:30 手術開始 17:45 手術結束 17:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 氣管切開術 1 0 摘要__ 手術科部: 內科部 套用罐頭: Tracheostomy 開立醫師: 林奎佑 開立時間: 2010/10/12 17:45 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure,operated Operative Method Tracheostomy Specimen Count And Types nil Pathology Nil Operative Findings A No.7 Low-Pressure cuffed tracheostomy tube was inserted Operative Procedures (1)The patient was in supine position with neck hyperextended. (2)Skin was disinfected and draped as usual. Local anesthesia with Bosmin-rinsed Xylocaine was injected into the subcutaneous tissue and the pretracheal area. (3)A vertical skin incision was made in the midline of lower neck. (4)Subcutaneous tissue, fascia and strap muscles were seperated, then the thyroid gland was seen and hooked upwards with thyroid hooks. (5)The tracheal rings were cut in longitudinal direction. A oval-shaped window was made at the 2 nd to 3 rd tracheal rings. (6)A No.7 Low-Pressure cuffed tracheostomy tube was inserted. (7)The patient tolerated the above procedure well. Operators P. 劉殿楨 Assistants R4 李亭逸, R2 林奎佑, R2 林玫君 王怡 (F,1999/04/19,12y10m) 手術日期 2010/10/13 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Moyamoya disease 器械術式 EDAS 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 曾峰毅, 時間資訊 23:08 臨時手術NPO 07:45 報到 08:08 進入手術室 08:20 麻醉開始 08:55 誘導結束 09:10 抗生素給藥 09:40 手術開始 12:15 抗生素給藥 12:35 麻醉結束 12:35 手術結束 12:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 手術 朴卜勒氏血流測定（週邊血管） 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 顱內外血管吻合術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: EC-IC Bypass 開立醫師: 曾峰毅 開立時間: 2010/10/13 12:50 Pre-operative Diagnosis Moyamoya disease, bilateral, more severe at right Post-operative Diagnosis Moyamoya disease, bilateral, more severe at right Operative Method EDAS at right Specimen Count And Types Nil Pathology Nil Operative Findings Contact between STA and MCA branches are tension-free. Operative Procedures With endotracheal general aenasethesia, the patient was put in supine position with head rotated to left. After scalp shaved, scrubbed, disinfected, and then draped, we localize the STA position and territory by Doppler. We made one curvilinear skin incision and dissected above the galeal to expose posterior branch of right STA. We made the inicion along 1cm away from STA at bilateral side, and created craniotomy 2x6cm, beneath STA. Linear durotomy was done, and arachnoid membrane was teared by forceps. STA graft was anchored at bilateral ends of durotomy, and the dura was closed in water-tight suture and Durofoam. Bone graft was fixed back with wire, and the wound was closed in layers. With endotracheal general aenasethesia, the patient was put in supine position with head rotated to left. After scalp shaved, scrubbed, disinfected, and then draped, we localize the STA position and territory by Doppler. Under microscopic view, we made one curvilinear skin incision and dissected above the galeal to expose posterior branch of right STA. We made the inicion along 1cm away from STA at bilateral side, and created craniotomy 2x6cm, beneath STA. Linear durotomy was done, and arachnoid membrane was separated by forceps. STA graft was anchored at bilateral ends of durotomy, and the dura was closed in water-tight suture and Durofoam. Bone graft was fixed back with 4 wirew, and the wound was closed in layers. Operators VS 郭夢菲 Assistants R4 曾峰毅 曾碧清 (F,1963/09/25,48y5m) 手術日期 2010/10/13 手術主治醫師 吳毅暉 手術區域 東址 018房 03號 診斷 Bone metastasis 器械術式 Port-A Implatation /WOR 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 黃俊銘, 時間資訊 11:10 報到 12:12 進入手術室 12:17 抗生素給藥 12:36 麻醉開始 12:38 手術開始 12:38 誘導結束 13:05 麻醉結束 13:05 手術結束 13:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 內頸靜脈切開,永久導管放置術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Port-A 開立醫師: 黃俊銘 開立時間: 2010/10/13 13:11 Pre-operative Diagnosis CML Post-operative Diagnosis CML Operative Method Port-A catheter implantation, echo guided Specimen Count And Types nil Pathology nil Operative Findings Puncture to right IJV under echo guidance The venous blood flow freely in the Port-A catheter after implantation. Operative Procedures The patient was put on supine position. The operation field was disinfected and draped as usual. Under local anesthesia, we puncture to right IJV under echo guidance. After creating subcutaneous pocket, the Port-A catheter was inserted via peel away sheath. We close the wound in layers. Post-op care plan: 1.wound CD QD+PRN2.pain control with tinten 3.prophylatic antibiotics use Operators 吳毅暉 Assistants 黃俊銘 林連灶 (M,1936/07/05,75y8m) 手術日期 2010/10/13 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Brain Tumor 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 游健生, 時間資訊 07:37 報到 08:05 進入手術室 08:10 麻醉開始 09:00 誘導結束 09:00 抗生素給藥 09:05 手術開始 12:00 抗生素給藥 15:00 麻醉結束 15:00 手術結束 15:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4~8小時 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Craniotomy for Simspon grade I tumor excision 開立醫師: 胡朝凱 開立時間: 2010/10/13 15:19 Pre-operative Diagnosis Falx meningioma Post-operative Diagnosis Falx meningioma Operative Method Craniotomy for Simspon grade I tumor excision Specimen Count And Types 1 piece About size:x Source:x 1 piece About size:2.3 cm Pathology Pending Operative Findings 1.One soft, whitish to yellowish tumor with clear border arised from falx was noted. The tumor compressed corpus callosum splenium area. 2.It did not invaded into inferior sagittal sinus. 3.The ACAs wer identified and preserved. Operative Procedures Under ETGA, patient in supine position with neck flexed and head fixed with Mayfield headholder. After shaving, we disinfected and draped as usual. A U-shape scalp incision was made over vertex. The skin flap was reflected posteriorly. Craniotomy was made across the midline. Dura opening was made with base left at midline. Detach arachnoid membrane that adhere to dura was performed. And also, some small draining veins were sacrificed to release the tension. Interhemispheric approach was done with retactor applied.The tumor was identified and devascularized. The dura was incised along the tumor border.After minimal dissection, the tumor was pull out becaused the margin was clear. Hemostasis was done with surgicel packing. Dura was closed with prolene. Bone was fixed back with wires. After one CWV drain inserion, the wound was closed inlayers. Operators Prof. 杜永光 Assistants R6胡朝凱　R3游健生 Ri林倩宇 何柏慶 (M,1980/05/12,31y10m) 手術日期 2010/10/13 手術主治醫師 杜永光 手術區域 東址 003房 02號 診斷 Arterovenous malformation brain / ( AVM brain ) 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 游健生, 時間資訊 15:22 進入手術室 15:30 麻醉開始 15:55 手術開始 15:55 抗生素給藥 15:55 誘導結束 18:55 抗生素給藥 19:20 送出病患 20:15 麻醉結束 20:15 手術結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 Blood gas analysis 1 0 手術 開顱術摘除血管病變-動靜脈畸型小型表淺 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Craniotomy for total excision 開立醫師: 胡朝凱 開立時間: 2010/10/13 20:54 Pre-operative Diagnosis Left sensory cortex cavernoma Post-operative Diagnosis Left sensory cortex cavernoma Operative Method Craniotomy for total excision Specimen Count And Types one piece of tumor about 0.7 cm Pathology pending Operative Findings 1.One 0.7 cm grape like tumor with purple color located in the suspect of sensory cortex. Some yellowish discolor was noted at cortex. 2.The surrounding brain tissue was yellowish and fragile. 3.One venous malformation was noted and preserved. 4.Intra-op ICG was applied and then patent venous malformation was confirmed. Operative Procedures Under ETGA, patient was put in supine position with head fixed with skull clamp. Preoperative navigation setting was done. Linear incision at left temporal area was made. Trephine was used to made a trephination window. Cruciate form dural incision was done. Localization with navigation was confirmed. Trans-sulcus( suspect central sulcus) approach was then performed. After identified tumor, dissection was made surround the cavernoma with bipolar coagulation. Tumor was finally en-bloc removed. Hemostasis was performed with surgicel packing. Dura was then closed with prolene. Bone was fixed back with miniplate. Then wound was closed. in layers. Operators P 杜永光 Assistants 胡朝凱, 游健生 林子青 (M,1961/07/23,50y7m) 手術日期 2010/10/13 手術主治醫師 曾漢民 手術區域 東址 003房 02號 診斷 Lymphoma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳國瑋, 時間資訊 11:00 報到 11:37 進入手術室 11:45 麻醉開始 12:15 誘導結束 12:20 抗生素給藥 12:45 手術開始 14:15 開始輸血 15:20 抗生素給藥 16:20 麻醉結束 16:20 手術結束 16:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除-手術時間在4小時以內 1 1 L 手術 頭顱成形術 1 2 L 記錄__ 手術科部: 外科部 套用罐頭: Cranioplasty, skull tumor excision 開立醫師: 陳國瑋 開立時間: 2010/10/13 16:34 Pre-operative Diagnosis Skull osteolytic tumor Post-operative Diagnosis Skull osteolytic tumor with epidural and subdural space invasion Operative Method Cranioplasty, skull tumor excision 1. Excison of Skull tumor 2. Cranioplasty Specimen Count And Types 1 piece About size:9cm in diameter Source:skull bone with tumor Pathology Frozen section showed sarcoma or sarcomatoid carcinoma Operative Findings One 7*7*6cm in sized tumor at the right fontal skull with extension to the epidural and subdural space was noticed. The dura was infiltrated by the tumor. The tumor was soft and bicortical involved. The tumor was removed with the skull and the cranial defect window was repaired with bone semen and wire mesh. The dural defect was repaired with fascia and Duraform. One 7*7*6cm in sized tumor at the right fontal skull with extension to the epidural and subdural space was noticed. The dura was infiltrated by the tumor. The tumor was soft and bicortical involved. The tumor was removed with the skull and the cranial defect window was repaired with bone cement and wire mesh. The dural defect was repaired with fascia and Duraform. Operative Procedures Under ETGA and supine position, the skin was disinfected and draped as usual. The scalp was prepared for left frontal craniotomy and one curvilinear incisoin was done. The tumor was identified after scalp reflexion. One tumor-centered 8*8cm in sized craniectomy was done and the dura tenting was performed. The dura was opened and the part of subdural invation was identified and removed. The dura sized 6*4cm was then removed and repaired with fascia. The cranioplasty was done with bone semen and wire mesh. The wound was then closed in layers. Operators VS曾漢民 Assistants R5陳德福 鍾文桂 R2陳國瑋 鄭重雄 (M,1940/04/14,71y11m) 手術日期 2010/10/13 手術主治醫師 曾漢民 手術區域 東址 005房 03號 診斷 Lumbar stenosis 器械術式 Laminectomy for decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 鍾文桂, 時間資訊 16:05 報到 16:50 進入手術室 17:00 麻醉開始 17:10 誘導結束 17:25 抗生素給藥 17:48 手術開始 19:20 手術結束 19:20 麻醉結束 19:30 進入恢復室 19:30 送出病患 21:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術(減壓)-二節以內 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 記錄__ 手術科部: 外科部 套用罐頭: Decompressive laminectomy and foraminotomy, L4. 開立醫師: 鍾文桂 開立時間: 2010/10/13 19:36 Pre-operative Diagnosis Lumbar stenosis, L4/5. Post-operative Diagnosis Lumbar stenosis, L4/5. Operative Method Decompressive laminectomy and foraminotomy, L4. Specimen Count And Types nil Pathology Nil. Operative Findings Paper-thin dura mater, a small dura tear during decompression. Slack bilateral L5 roots after decompression. Hypertrophic ligamentum flavum. Operative Procedures Under ETGA, the patient was placed in prone position. L4 level was ensured by intraoperative fluoroscopy. After disinfection and draping, midline incision and paraspinal dissection were done to expose L4 Lamina. Decompressive laminectomy and bilateral foraminotomy were achieved with 2mm and 3mm Kerrison punch and Rongeur. After decompression, the wound was closed in layers after injecting from Macaine into dermis and fascia layers. Operators V.S. 曾漢民 Assistants 鍾文桂 陳國瑋 蘇芷誼 (F,1984/11/01,27y4m) 手術日期 2010/10/13 手術主治醫師 林東燦 手術區域 兒醫 062房 04號 診斷 Acute lymphoid leukemia ( ALL ) 器械術式 IT 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 林子富 ASA 2 時間資訊 10:00 報到 10:23 進入手術室 10:25 麻醉開始 10:27 誘導結束 10:30 手術開始 10:45 手術結束 10:45 進入恢復室 10:45 麻醉結束 10:47 送出病患 11:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 手術 腦室內注射留置器或脊髓腔內化學藥物注射 1 0 童紹華 (M,1983/01/31,29y1m) 手術日期 2010/10/13 手術主治醫師 楊士弘 手術區域 東址 005房 01號 診斷 Herniation of intervertebral disc, lumbar 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 陳國瑋, 時間資訊 07:40 報到 08:05 進入手術室 08:15 麻醉開始 08:20 誘導結束 08:30 抗生素給藥 09:06 手術開始 11:20 手術結束 11:20 麻醉結束 11:25 送出病患 11:28 進入恢復室 12:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 椎間盤切除術-腰椎 1 1 記錄__ 手術科部: 外科部 套用罐頭: HIVD 開立醫師: 陳國瑋 開立時間: 2010/10/13 11:21 Pre-operative Diagnosis L5S1 herniated disc, lumbar stenosis L5S1 herniated intervertebral disc with right S1 radiculopathy Post-operative Diagnosis L5S1 herniated disc, lumbar stenosis L5S1 herniated intervertebral disc with right S1 radiculopathy Operative Method Microscopic disektomy Microsurgical disektomy Specimen Count And Types nil Pathology nil Operative Findings 1. Buldging disc at right side L5S1 causing nerve root compression was noted 1. Ruptured disc at right side L5S1 causing nerve root compression was noted 1. Ruptured disc at right side L5S1 level causing nerve root compression was noted 2. The theca sac expanded well after decompression 2. The right S1 root was slack after decompression Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: Prone, Check the L5S1 with C arm 3. Skin preparation: the back was shaved and scrubbed with povidone-iodine detergent then painted with povidone-iodine tincture. 4.Incision: 3-cm, at the right margin of spinous processes. 6.The muscles were detached from the interspinous ligament. 7.The paravertebral muscles were retracted by a modified narrow Taylor retractor which was retained constantly by a rubbersling to the side rail of the operating table. 8.Under an operating microscope, the ligamentum flavum was cleaned and incised. The lateral portion of this ligament was removed with a small angle Kerrison rongeur, the lateral portion of the laminae and the medial border of the facets were removed too until the margin of the facets and a corridor to the disc that ran lateral to the root was reached. 9. The epidural fat was left undisturbed and preserved. 10.The compressed S1 root and veins overlying the protruded disc were gently pushed away. 11.The compressed root was gently pushed further away temporarily in order to expose the herniated disc more clearly. The posterior longitudinal ligament and annulus were incised around the protruded disc with a No. 15 blade. The degenerated disc was removed with microdisc forcepsuntil a substantial amount of the nucleus had been loosened with a cone curette and removed. 12.Wound closure in layers with Vicryl, Prolene Operators VS 楊士弘 Assistants R5 鍾文桂 R2 陳國瑋 羅富都 (M,1958/09/10,53y6m) 手術日期 2010/10/14 手術主治醫師 陳敞牧 手術區域 東址 003房 03號 診斷 Spinal stenosis, cervical 器械術式 Lamino plasty 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 13:13 進入手術室 13:20 麻醉開始 13:30 誘導結束 13:45 抗生素給藥 13:47 手術開始 15:45 開始輸血 16:45 抗生素給藥 17:30 手術結束 17:30 麻醉結束 17:35 送出病患 17:35 進入恢復室 18:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓整形術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 記錄__ 手術科部: 外科部 套用罐頭: Laminoplasty,open door method, C3-6. 開立醫師: 鍾文桂 開立時間: 2010/10/14 18:13 Pre-operative Diagnosis Spinal stenosis, C3-C6. Post-operative Diagnosis Spinal stenosis, C3-C6. Operative Method Laminoplasty,open door method, C3-6. Specimen Count And Types nil Pathology Nil Operative Findings Compressed spinal cord. Open door: from right side Intact dura mater. Easy oozing operative field. Operative Procedures Uner ETGA and prone position with Mayfield pin type head fixator, the skin was disinfected and draped. One linear incision on the posterior neck was done and the paraspinous muscle was displaced laterally. The spinous process of C2-5 were exposed clearly and the laminotomy was done by air drill with open door fasion. The theca sac was decompressed fully and the C3-6 lamina was fixed with miniplates. After laminoplasty, one hemovac was left in situ. The wound was closed in layers. Uner ETGA and prone position with Mayfield pin type head fixator, the skin was disinfected and draped. One linear incision on the posterior neck was done and the paraspinous muscle was displaced laterally. The spinous process of C3-6 were exposed clearly and the laminotomy was done by air drill with open door fasion. The theca sac was decompressed fully and the C3-6 lamina was fixed with miniplates. After laminoplasty, one hemovac was left in situ. The wound was closed in layers. Operators V.S. 陳敞牧 Assistants R5 鍾文桂 相關圖片 蔡振裕 (M,1962/03/20,49y11m) 手術日期 2010/10/14 手術主治醫師 蕭輔仁 手術區域 東址 003房 01號 診斷 Hyperhidrosis 器械術式 Endoscopic T2 sympathectomy 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 08:10 進入手術室 08:25 麻醉開始 08:40 誘導結束 08:50 抗生素給藥 09:32 手術開始 10:28 手術結束 10:28 麻醉結束 10:45 送出病患 10:48 進入恢復室 11:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 經內視鏡交感神經切斷術 1 1 B 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Endoscopic sympathectomy,T2 and T3, bilateral. 開立醫師: 鍾文桂 開立時間: 2010/10/14 10:50 Pre-operative Diagnosis Hyperhidrosis palmaris. Post-operative Diagnosis Hyperhidrosis palmaris. Operative Method Endoscopic sympathectomy,T2 and T3, bilateral. Specimen Count And Types nil Pathology Nil. Operative Findings Bilateral T2 and T3 sympathetic ganglions were electrocoagulated. Bilateral temperature at thenar muscle was elevated after electrocoagulation of sympathetic ganglion. (Temp: Right: 33.8->34.2,Left:34.0->34.3) Operative Procedures Under ETGA, the patient was placed in supine position and bilateral upper extrimites were in abduction position. After disinfection, a linear 1.5 cm incision was made at lateral chest at 4th intercostal space,left. Trocar was inserted at the upper margin of 5th rib until pleural space was reached. We identified T2 and T3 sympathetic ganglions under endoscope and eletrocoagulated them.Air was evacuated before wound closure. The same procdure was repeated at the right side. Operators V.S. 蕭輔仁 Assistants R5 鍾文桂 蔡秀絨 (F,1933/08/20,78y6m) 手術日期 2010/10/14 手術主治醫師 蕭輔仁 手術區域 東址 003房 02號 診斷 Compression fracture pathological Spontaneous fracture 器械術式 Radiofrequency coagulation(P-G 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 鍾文桂, 時間資訊 10:50 報到 11:00 進入手術室 11:15 抗生素給藥 11:33 手術開始 12:50 手術結束 12:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 高頻熱凝療法 1 1 B 記錄__ 手術科部: 外科部 套用罐頭: Radiofrequency ablation, L2, bilateral 開立醫師: 鍾文桂 開立時間: 2010/10/14 13:00 Pre-operative Diagnosis Lumbar spondylosis and low back pain. Post-operative Diagnosis Lumbar spondylosis and low back pain. Operative Method Radiofrequency ablation, L2, bilateral Specimen Count And Types nil Pathology Nil Operative Findings Lumbar scoliosis, add more difficulty in localization of foramen. Ablation catheter placed at L2 intervertebral foramen bilaterally. Motor stimulation: 2Hz Sensory stimulation: 50Hz Ablation temperature: 42 degrees Celsius Ablation time: 180 sec*2 at each side Operative Procedures The patient was placed in prone position. After localization of L2 pedicles with C-arm, 1% Xylocaine were infiltrated at injection site (about 3cm from midline at the level slightly below L2 pedicles). Puncture needle were then used and confirmed the tip location with C-arm. After motor & sensory stimulation, ablation were then performed for 180 sec *2 cycles. The procedure was repeated again at the right side. The injection wounds were covered with bandage and the procedure ended. Operators VS蕭輔仁 Assistants R5鍾文桂 張寶 (F,1957/01/18,55y1m) 手術日期 2010/10/14 手術主治醫師 蔡翊新 手術區域 東址 005房 01號 診斷 Facial spasm 器械術式 Microvascular decompression 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 08:05 進入手術室 08:15 麻醉開始 08:36 報到 09:00 誘導結束 09:00 抗生素給藥 09:05 手術開始 12:00 抗生素給藥 13:30 麻醉結束 13:30 手術結束 13:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦微血管減壓術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 摘要__ 手術科部: 外科部 套用罐頭: Microvascular Decompression 開立醫師: 蔡翊新 開立時間: 2010/10/14 13:03 Pre-operative Diagnosis Left hemifacial spasm, recurrence. Post-operative Diagnosis Left hemifacial spasm, recurrence. Operative Method Microvascular decompression via left suboccipital retrosigmoid craniotomy. Specimen Count And Types nil Pathology Nil. Operative Findings Severe adhesion around the pontomedullary cistern was noted. An AICA loop and a tortuous left vertebral artery adhered to the left facial nerve from anteroinferior aspect at its nerve exit zone and along the intracisternal segment. There vessels were detached and separated from the nerve with Teflon felts. Intraoperative BAEP remained normal during the procedure of microvascular decompression. Operative Procedures 1. Anesthesia: endrotracheal general. 2. Position: 3/4 prone position with the head fixed by a Mayfield skull clamp. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with a sterilized adhesive plastic sheet. 4. Incision: 10 cm long, along the retroauricular hair line with center at mastoid tip. 5. Craniotomy: 3 x 2.5 cm, suboccipital retromastoid to expose the lower- posterior margin of the junction of transverse and sigmoid sinus. 6. Dural incision: inverted K-fashion and reflected to sigmoid sinus. 7. Adhesionolysis around the pontomedullary cistern and CSF drainage via by opening the pontomedullary cistern for easy retraction of the cerebellum to the medial side. 8. The cerebellum was retracted with the retractor. The 7th & 8th cranial nerves were approached from the space between these 2 nerves and the lower cranial nerves. In such way, the arterial loop from AICA and the tortuous left VA crossly compressing the 7th nerve were dissected away from the root exit zone without necessity of any touch on the nerve. The arterial loops were kept away from the nerve by interposing the space between them with Teflon felt cotton. 9. Dural closure: continuous suture with 4/0 Prolene to obtain water-tight closure (A piece of fascia, 1 x 0.8 cm, was used as the dural graft). 10.Skin closure: continuous suture with 2/0 Vicryl for subcutanuous layer and continuous suture with 3/0 nylon for the skin. 11.Drain: none. 12.Course of the surgery: left forehead skin laceration at head pin site, s/p primary suture. Operators VS蔡翊新 Assistants R4李振豪 王志遠 (M,1977/07/27,34y7m) 手術日期 2010/10/15 手術主治醫師 劉嘉銘 手術區域 西址 033房 01號 診斷 Allergic rhinitis 器械術式 Lysis of nasal synechia 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 08:20 進入手術室 08:30 麻醉開始 08:45 手術開始 09:30 手術結束 09:35 送出病患 記錄__ 手術科部: 耳鼻喉部 套用罐頭: Sinoscope surgery (local) 開立醫師: 郭彥麟 開立時間: 2010/10/15 09:36 Pre-operative Diagnosis left nasal synechia Post-operative Diagnosis left nasal synechia,s/p KTP laser separation Operative Method KTP laser separation Specimen Count And Types nil Pathology Nil Operative Findings synechia was noted between inferior T and septum, between middle T and septum Operative Procedures 1.nasal packing with local anesthesia first 2.remove packing, inserted sinoscope 3.identify synechia area, used KTP laser for separation 4.after checking bleeding, inserted VG x 2 Operators AP劉嘉銘 Assistants R4林沛廷R2郭彥麟 李雅惠 (F,1978/10/21,33y4m) 手術日期 2010/10/15 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Aneurysm, post-op 器械術式 Craniotomy(Aneurysms) P-DUH 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 游健生, 時間資訊 08:00 進入手術室 08:22 麻醉開始 08:55 誘導結束 09:00 抗生素給藥 09:06 手術開始 12:00 抗生素給藥 14:26 開始輸血 16:00 抗生素給藥 17:10 手術結束 17:10 麻醉結束 17:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 開顱術摘除血管病變 - 腦血管瘤 有病徵的 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 10 0 摘要__ 手術科部: 外科部 套用罐頭: Right pterion approach for aneurysm clipping 開立醫師: 游健生 開立時間: 2010/10/15 17:50 Pre-operative Diagnosis Right middle cerebral artery trifurcation aneurysm, status post clipping with residual Post-operative Diagnosis Right middle cerebral artery trifurcation aneurysm, status post clipping with residual Operative Method Right pterion approach for aneurysm clipping Specimen Count And Types nil Pathology Nil Operative Findings One about 0.8 cm saccular aneurysm was noted at right M2 trifurcation. Previous four aneurysmal clips were also noted with improper location. And the clips were all removed finally. Peripheral adhesion was obvious. One piece of sponge was found encasing the clips. Premature rupture (+). Estimated blood loss was 1000 ml. Previous craniotomy was about 4x3 cm, and it was extended. One curved, one fenestrated, and one oblique Sugita clip were applied. Ischemic time was about 8 minutes. Operative Procedures Under ETGA, patient was in supine position with right shoulder elevated and head rotated to left. Head was fixed by Mayfield headholder. After shaving, we disinfected and draped the operation field as usual. Scalp incision along previous surgery wound and extended it along hairline crossing midline. The skin flap with temporalis muscle was flapped anteriorly. The previous craniotomy window was extended. Linear durotomy was done and severe adhesion between dura, brain, and Sylvian fissure was noted. After careful opening of Sylvian fissure, four aneurysm clips were exposed as well as the base of aneurysm. There was severe adhesion between the clips and surrouding tissue. With careful dissection, M2 trifurcation was noted, and with tracing back, the aneurysm was noted. The neck was further dissected. The first previous clip was removed smoothly with peripheral dissection. But during removal of second aneurysmal clip, premature rupture of aneurysm occurred. It was stopped with M1 proximal control and curved permanant aneurysmal clpping. Another 2 clips were removed later. After further dissection, neck was clipped with fenestrated clip. The parent arteries was confirmed as patent by intraop ICG injection. Hemostasis was performed with Surgicel. Dura was closed with prolene. After one CWV drain insertion, wound was closed in layers. Operators Prof. 杜永光 Assistants R6 胡朝凱 R3 游健生 林麗娟 (F,1969/04/21,42y10m) 手術日期 2010/10/15 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 鍾文桂, 時間資訊 07:40 報到 08:05 進入手術室 08:15 麻醉開始 08:45 誘導結束 09:00 抗生素給藥 09:32 手術開始 12:00 抗生素給藥 12:00 開始輸血 15:00 抗生素給藥 16:20 麻醉結束 16:20 手術結束 16:25 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 8 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 顱底瘤手術 1 1 L 手術 頭顱成形術 1 2 L 記錄__ 手術科部: 外科部 套用罐頭: Simpson grade II tumor excision via left fron... 開立醫師: 鍾文桂 開立時間: 2010/10/15 18:38 Pre-operative Diagnosis Meningioma, sphenoid ridge with intraobital extension. Post-operative Diagnosis Meningioma, sphenoid ridge with intraobital extension. Operative Method Simpson grade II tumor excision via left frontal-orbito-zygomatic approach. Cranioplasty Specimen Count And Types 5 pieces About size:4cm in diameter Source:tumor invading out of skull bone About size:5.5cm in diameter Source:skull bone About size:3cm in diameter Source:intraorbital cavity tumor About size:0.5cm Source:frontal sinus tumor About size:6*6*5cm Source:intracranial tumor Pathology Pending. Operative Findings 1. Severe hyperostosis and tumor invasion over lateral 2/3 sphenoid ridge and superior/lateral orbital wall and lateral part of frontal base. A bulging mass was noted over greater wing of sphenoid after dissecting temporalis muscle. 2. Extension of meningioma into the orbital cavity. The periorbital fat and extraocular muscles were well preserved during tumor dissection although the plane was not easy defined. 3. The dura mater was also invaded by the tumor. The sylvian veins were well preserved. Operative Procedures 1. ETGA, supine position, head fixed by Mayfield, tilted to the right. 2. Pterional scalp incision and temporalis muscle dissection. 3. Craniectomy for resection of skull bone tumor over greater wing of sphenoid bone. 4. Orbital-zygomatic craniotomy for further tumor resection and resection of sphenoid ridge. 5. Resection of tumor over orbital cavity. 6. Resection of tumor over dura mater after durotomy. 7. Resection of subdural tumor and dissection of the tumor from the cerebral parenchyma. 8. Duroplasty with Goretex artificial dura and cranioplasty with wire mesh and bone cement. 9. Wound closure in layers after placing one CWV drain. Operators V.S. 曾漢民 Assistants 鍾文桂 陳國瑋 黃慧 (F,1951/03/25,60y11m) 手術日期 2010/10/15 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Cervical Spondylosis 器械術式 Lamino plasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 方怡婷, 時間資訊 07:45 報到 08:03 進入手術室 08:10 麻醉開始 08:25 誘導結束 08:35 抗生素給藥 08:38 手術開始 11:23 手術結束 11:23 麻醉結束 11:35 送出病患 11:40 進入恢復室 13:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 手術 椎弓整形術 1 1 摘要__ 手術科部: 外科部 套用罐頭: C4-6 laminoplasty; C7 partial laminectomy 開立醫師: 陳德福 開立時間: 2010/10/15 11:35 Pre-operative Diagnosis Cervical OPLL, C4-7 Post-operative Diagnosis Cervical OPLL, C4-7 Operative Method C4-6 laminoplasty; C7 partial laminectomy Specimen Count And Types nil Pathology nil Operative Findings 1.There is OPLL over C4-7 with moderate cord compression. The C4-6 laminoplasty [open door] with miniplates was performed. Upper C7 laminectomy was done and the theca sac expanded well. Operative Procedures Under ETGA and prone position with pin type head fixator fixation, the skin was disinfected and draped. One linear incision along midline was made and the paraspinous muscel was displaced laterally. The C2-7 was identified followed performed C4-6 open dooe fasion laminoplasty with miniplates. The partial C7 laminectomy was done. One CWV was left in situ and the wound was closed in layers. Operators VS 賴達明 Assistants R5陳德福 R1方怡婷 張宗偉 (M,1958/10/01,53y5m) 手術日期 2010/10/15 手術主治醫師 賴達明 手術區域 東址 025房 05號 診斷 Osteomyelitis 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 污染 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 李振豪, 時間資訊 15:15 報到 15:30 進入手術室 15:35 麻醉開始 15:45 誘導結束 16:12 抗生素給藥 16:32 手術開始 18:00 手術結束 18:00 麻醉結束 18:10 送出病患 18:12 進入恢復室 19:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 移前皮瓣移植術 1 1 手術 骨髓炎之死骨切除術或蝶形手術及擴創術(包括:頭骨、顱骨、胸部骨頭、股骨、肋骨、脊 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Fistulectomy, sequestrectomy, and wound closu... 開立醫師: 李振豪 開立時間: 2010/10/15 18:26 Pre-operative Diagnosis Wound infection with right retroauricular fistula Post-operative Diagnosis Wound infection with right retroauricular fistula Operative Method Fistulectomy, sequestrectomy, and wound closure with advancement flap Specimen Count And Types 2 pieces About size:1x2x0.3cm Source:Right retroauricular fistula and sequestrum About size:2 culture swabs Source:Right retroauricular fistula Pathology Pending Operative Findings The right retroauricular fistula was connected to right middle fossa with much infectious granulation tissue and sequestrum. After fistulectomy, debridement, and sequestrectomy, the roof of the temporal bone was noted. No CSF leakage was found during the operation. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine position with head rotated to left side. The scalp was shaved, scrubbed, and disinfected as usual. The retroauricular skin incision was made along op scar. The fusiform skin incision was made for fistulectomy. The fistula was traced and connected to the right middle fossa. Debridement and sequestrectomy were performed by curette. Hemostasis was achieved and the wound was irrigation with normal saline. The scalp over occipital and parietal area was elevated along the subperiosteum plan. Advancement flap was used for primary wound closure. The wound was closed in layers with 2-0 Vicryl and 3-0 Nylon after subgaleal CWV drain placement. Operators VS賴達明, VS謝孟祥 Assistants R5阮廷倫, R4李振豪 黃寶桂 (F,1942/12/30,69y2m) 手術日期 2010/10/15 手術主治醫師 賴達明 手術區域 東址 019房 02號 診斷 Spondyloisthesis, acquired 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 方怡婷, 時間資訊 11:05 報到 12:01 進入手術室 12:10 麻醉開始 12:20 誘導結束 12:35 抗生素給藥 12:55 手術開始 15:10 手術結束 15:10 麻醉結束 15:20 送出病患 15:23 進入恢復室 16:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術(減壓)-二節以內 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 摘要__ 手術科部: 外科部 套用罐頭: laminectomy decompression L3 開立醫師: 陳德福 開立時間: 2010/10/15 15:17 Pre-operative Diagnosis lumbar spondylolisthesis s/p fusion surgery with adjacent degeneration, L3-4 Post-operative Diagnosis lumbar spondylolisthesis s/p fusion surgery with adjacent degeneration, L3-4 Operative Method laminectomy decompression L3 Specimen Count And Types nil Pathology nil Operative Findings 1.There is hypertrophic ligamentum flavum and protruding disc at the level of L3-4 with spinal stenosis. The L3 decompressive laminectomy was done and the theca sac reexpanded well after the surgery. Operative Procedures Under ETGA and prone position, the skin was disinfected and draped as usual. One linear incision along previous operation scar and the paraspinous muscle was displaced laterally to expose the L3 lamina. The L3 lamina and hypertrophic ligamentum flavum was removed and the theca sac was well inspected with full expansion. The wound was then closed in layers. Operators VS 賴達明 Assistants R5陳德福 R1方怡婷 蔡豪君 (M,1983/01/04,29y2m) 手術日期 2010/10/15 手術主治醫師 賴達明 手術區域 東址 019房 03號 診斷 Herniation of intervertebral disc 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 2 紀錄醫師 方怡婷, 時間資訊 15:00 報到 15:30 進入手術室 15:40 麻醉開始 15:45 誘導結束 16:15 抗生素給藥 16:23 手術開始 18:20 手術結束 18:20 麻醉結束 18:25 送出病患 18:27 進入恢復室 20:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 椎間盤切除術-腰椎 1 1 摘要__ 手術科部: 外科部 套用罐頭: Microscopic discectomy 開立醫師: 陳德福 開立時間: 2010/10/15 18:12 Pre-operative Diagnosis L4-5 HIVD, left Post-operative Diagnosis L4-5 HIVD, left Operative Method Microscopic discectomy Specimen Count And Types nil Pathology nil Operative Findings Buldging disc at L4/5 compress left side L5 root Operative Procedures 1.ETGA, prone, C-arm localization 2.Midline back incision, divide left side paraspinal muscle to expose L4 and L5 lamina 3.L4 laminotomy with drill and then Karrison punch 4.Remove ligmentum flavum till exposure of Thecal sac and L5 root 5.Retract root from shoulder and disc was exposed 6.Cauterize PLL and then incision of the buldging disc, then discectomy was done with Currete and disclamp 7.Hemostasis with gelform packing 8.close wound in layers Operators VS 賴達明 Assistants R5 陳德福 R1方怡婷 相關圖片 林彥辰 (M,2010/07/06,1y8m) 手術日期 2010/10/15 手術主治醫師 楊士弘 手術區域 兒醫 067房 01號 診斷 Meningitis 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 髒 麻醉方式 全身麻醉 麻醉主治醫師 蕭柏妮 ASA 3E 紀錄醫師 曾峰毅, 時間資訊 22:04 臨時手術NPO 22:04 開始NPO 13:05 通知急診手術 13:39 進入手術室 13:45 麻醉開始 14:00 誘導結束 14:30 手術開始 15:30 手術結束 15:30 麻醉結束 15:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 慢性硬腦膜下血腫清除術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Chronic Subdural Hematoma 開立醫師: 曾峰毅 開立時間: 2010/10/15 15:35 Pre-operative Diagnosis Meningococcal meningitis, with left subdural effusion, status post drainage, complicated with right subdural effusion Post-operative Diagnosis Meningococcal meningitis, with left subdural effusion, status post drainage, complicated with right subdural effusion Operative Method Subdural drainage, right Specimen Count And Types Turbid subdural fluid was sent for culture. Pathology Nil Operative Findings Turbid, yellowish to whitish, fluid, with much fibrin was drained via right subudral drain. There was thick outer membrane with hypervascularity. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to left. After scalp shaved, scrubbed, disinfected, and then draped, we made one linear skin incision at right frontal area just lateral to right lateral edge of anterior frontanelle. We bite at right frontal edge of anterior frontanell, and then created durotomy. We inserted drain into subdural space, and irrigated the subdural space with normal saline. We closed the wound in layers after hemostasis and drainage fixation. Operators VS 楊士弘 Assistants R4 曾峰毅 Indication Of Emergent Operation 張福旋 (M,1933/10/29,78y4m) 手術日期 2010/10/15 手術主治醫師 戴浩志 手術區域 東址 009房 03號 診斷 Head Injury 器械術式 Debridment-- >10cm 手術類別 緊急手術 手術部位 四肢 傷口分類 污染 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 4E 紀錄醫師 陳思恆, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 12:00 報到 12:00 進入手術室 12:05 麻醉開始 12:08 誘導結束 12:30 手術開始 12:50 開始輸血 13:20 麻醉結束 13:20 手術結束 13:25 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 區域筋膜切除術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Debridement and regional fasciectomy 開立醫師: 陳思恆 開立時間: 2010/10/15 13:34 Pre-operative Diagnosis Right lower leg intramuscular abscess Post-operative Diagnosis Right lower leg intramuscular abscess Operative Method Debridement and regional fasciectomy Specimen Count And Types 1 piece About size:multiple Source:multiple fascia fragments for patho and cultures Pathology pending Operative Findings Some abscess and necrotic fascia and probably the tibial nerve were noted in the anterior and deep posterior compartments during the operation. The necrotic fascia was sent for culture and pathology. Operative Procedures ETGA, supine, antiseptics applied. Incision through the anterior and posterior intermuscular septa. Debridement. Irrigation. Hemostasis. Wet dressing. Operators 戴浩志 Assistants 林之昀,陳思恆,趙崧筌 Indication Of Emergent Operation 朱俊傑 (M,1962/12/01,49y3m) 手術日期 2010/10/16 手術主治醫師 曾漢民 手術區域 東址 003房 01號 診斷 Brain metastasis 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林子富 ASA 3 紀錄醫師 陳國瑋, 時間資訊 07:35 報到 08:09 進入手術室 08:20 麻醉開始 08:40 誘導結束 08:41 手術開始 08:41 抗生素給藥 12:00 抗生素給藥 12:40 麻醉結束 12:40 手術結束 12:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除-手術時間在4小時以內 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Left pterional approach for total tumor excision 開立醫師: 胡朝凱 開立時間: 2010/10/16 12:57 Pre-operative Diagnosis Left frontal metastatic tumor Post-operative Diagnosis Left frontal metastatic tumor Operative Method Left pterional approach for total tumor excision Specimen Count And Types pieces of tumor Pathology pending Operative Findings 1.One about 5 cm cystic tumor located at left frontal lobe was noted. Then content looks like motor oil. 2.The cystic wall was thin with relative clear margin with brain tissue. 3.The main part located at the base of the cyst. 4.There was no invasion into ventricle. Operative Procedures Under ETGA, patient was put in supine position with head rotate to right and fixed with Mayfield skull clamp. Curvillinear skin incision was done at right parietal area. Skin flap was dissected and opened. After burr holes drilled, craniotomy was performed, followed by dural tenting. U shape dural incision was made. Cyst wall was opened and drained the content. The tumor was excised by gently dissection through the interface between tumor and brain tissue. Vascular perforation was cauterized. Hemostasis was then performed. After then, dura was closed with prolene. After one CWV drain insertion, wound was closed in layers. Operators 曾漢民 Assistants 胡朝凱, 陳國瑋 黃碧玉 (F,1945/12/12,66y3m) 手術日期 2010/10/16 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Parkinsonism 器械術式 Stereotaxic procedure for impl 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 面罩麻醉 麻醉主治醫師 林子富 ASA 3 紀錄醫師 陳德福, 時間資訊 07:45 報到 07:55 進入手術室 08:35 麻醉開始 08:40 誘導結束 09:00 抗生素給藥 09:02 手術開始 12:09 抗生素給藥 15:35 手術結束 15:35 抗生素給藥 15:35 麻醉結束 15:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 立體定位術-功能性失調 1 1 L 手術 立體定位術-功能性失調 1 2 R 手術 深部腦核電生理定位 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Semi-opened mask inhalation anes 1 0 麻醉 Semi-opened INHALATION GENERAL A 4 0 麻醉 SENI-OPENED INHALATION GENERAL A 6 0 摘要__ 手術科部: 外科部 套用罐頭: Implantation of bilateral deep brain stimulat... 開立醫師: 陳德福 開立時間: 2010/10/16 15:53 Pre-operative Diagnosis Parkinson disease Post-operative Diagnosis Parkinson disease Operative Method Implantation of bilateral deep brain stimulation, STN Specimen Count And Types nil Pathology nil Operative Findings 1. The left subthalamic nucleus was noted by microelectrodes recording which is anterior to the planned tract. The recording showed hyperactivity. 2. The right subthalamic nucleus was noted by micoeletrodes recording. three tracts: 1st: increased background at the planned tract with some hyperactivity neurons. 2nd: 2mm anterior to the planned tract target, increased background with minimal hyperactivity. 3rd: medial and anterior to the planned tract 3. Test stimulation: decreased rigidity, and tremor at left tract. Operative Procedures 1. Under intravenous anesthesia and local anesthesia, the patient was put in supine position and the head was placed in the midline. 2. After shaving,disinfection, and draping, bicoronal incision was made 3. For lead placement, a nickel-sized (14 mm) burr hole was made 1.5 cm lateral to midline and just anterior to coronal suture. A burr-hole ring is affixed to each opening. 4. Prior to lead placement, microelectrode recording (MER)was used to provide an additional level of target verification. 5. Stereotactic frame guidance and techniques were used to place the lead to the targeted area. 6. With the patient awake, a test stimulation was performed to confirm good therapeutic benefit at each side. 7. Finally, the leads were secured and the operative wounds were closed in layers. Operators P曾勝弘 Assistants R5陳德福 林財旺 (M,1934/10/17,77y4m) 手術日期 2010/10/17 手術主治醫師 蔡翊新 手術區域 東址 002房 01號 診斷 Cerebrovascular accident (CVA) 器械術式 left craniotomy for ICH removal 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林子富 ASA 4E 紀錄醫師 游健生, 時間資訊 12:00 開始NPO 00:42 通知急診手術 01:25 進入手術室 01:30 麻醉開始 01:45 誘導結束 01:50 抗生素給藥 02:20 手術開始 04:55 抗生素給藥 06:30 手術結束 06:30 麻醉結束 06:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 1 L 手術 顱內壓視置入 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: CVA 開立醫師: 蔡翊新 開立時間: 2010/10/17 05:57 Pre-operative Diagnosis Left putaminal ICH with IVH. Post-operative Diagnosis Left putaminal ICH with IVH. Operative Method Left frontotemporal craniotomy for ICH evacuation and left temporal subdural ICP monitoring. Left frontotemporal craniotomy for ICH evacuation and left frontal subdural ICP monitoring. Specimen Count And Types nil Pathology Nil. Operative Findings The dura was tense upon craniotomy was made. The brain was bulging out upon dural opening. A 8.8 x 5.6 x 5.6 cm ICH (about 130 ml) at left basal ganglia was encountered, with several active bleeders from perforating arteries of left MCA. After hematoma evacuation, the brain became very slack. ICP after skin closure was about 1 mmHg. The dura was tense when craniotomy was made. The brain was bulging out upon dural opening. A 8.8 x 5.6 x 5.6 cm ICH (about 130 ml) at left basal ganglia was encountered, with several active bleeders from perforating arteries of left MCA. After hematoma evacuation, the brain became very slack. ICP after skin closure was about 0 mmHg. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: left frontotemporal, linear. The skin edge was clipped by Raney clips for temporary hemostasis. After scalp had been lifted, the temporalis muscle was incised and detached from temporal squama and reflected to lower temporal side. 5. Craniotomy: A 4 cm trephine was made at frontotemporal area over-riding the Sylvian fissure with its center 3 cm above extenal ear canal. 6. Dural tenting: by 2/0 silk, 2 cm in interval, distributed along the edge of skull window. 7. Dural incision: star shaped, dividing the craniotomy into 6 equal parts. 8. A 2 cm opening of arachnoid membrane over a sulcus posterior to the left inferior frontal gyrus was made. The intracerebral hematoma gushed out by itself. Under intraoperative microscope, the subcortex and white mater was splitted by brain retractor and sucker until the main part of intracerebral hematoma was exposed. The hematoma was sucked out carefully. Those tough clot was removed by forceps. The cavity was irrigated with normal saline and the blood oozing was stopped by bipolar coagulator and Surgicel packing. Before closure of the dura, the hematoma caivty was clean and the brain once bulging was very slack. 9. Dural closure: interrupted 2/0 silk sutures for key stitches, then continous sutures with 4/0 Prolene to obtain water-tight closure. A fascia graft was used for duroplasty. 10.The trephine button was placed back and fixed by 3 26# wires. 11.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 12.Drain: none. 13.Blood transfusion: Nil. Blood loss: 100 ml. 14.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5陳德福R3游健生 Indication Of Emergent Operation 蕭錦龍 (M,1946/11/01,65y4m) 手術日期 2010/10/18 手術主治醫師 杜永光 手術區域 東址 001房 03號 診斷 Unspecified epilepsy without mention of intractable epilepsy 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 4E 紀錄醫師 李振豪, 時間資訊 10:42 通知急診手術 12:06 進入手術室 12:10 麻醉開始 12:30 誘導結束 12:53 手術開始 13:20 手術結束 13:20 麻醉結束 13:37 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室體外引流 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Left Kocher"s external ventricular drainage i... 開立醫師: 李振豪 開立時間: 2010/10/18 13:36 Pre-operative Diagnosis 1. Hydrocephalus, 2. arteriovenous malformation rupture with intraventricular hemorrhage Post-operative Diagnosis 1. Hydrocephalus, 2. arteriovenous malformation rupture with intraventricular hemorrhage Operative Method Left Kocher"s external ventricular drainage insertion Specimen Count And Types 1 piece About size:5ml Source:CSF Pathology Nil Operative Findings The CSF is strawberry in color. The opening pressure is about 15cmH2O. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine position. The previous stitches were removed. The skin was shaved, scrubbed, and disinfected as usual. Scalp incision was made along previous wound and the burr hole was exposed after removal of the Gelform. Left Kocher"s point EVD was placed and fixed at 6.5cm in depth. Externalization was done and the EVD was set up. Hemostasis was achieved and the wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators Prof. 杜永光 Assistants R4李振豪, R3王奐之 Indication Of Emergent Operation 相關圖片 官美智 (F,1938/10/25,73y4m) 手術日期 2010/10/18 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Pituitary Tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 游健生, 時間資訊 07:45 報到 08:05 進入手術室 08:15 麻醉開始 08:50 誘導結束 09:00 抗生素給藥 09:10 手術開始 13:15 抗生素給藥 13:32 麻醉結束 13:32 手術結束 13:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 手術 經由蝶竇之腦下垂體瘤切除 1 1 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Transphenoid adenectomy 開立醫師: 游健生 開立時間: 2010/10/18 13:56 Pre-operative Diagnosis Pituitary marcoadenoma, status post transphenoid adenectomy 3 times Post-operative Diagnosis Pituitary marcoadenoma, status post transphenoid adenectomy 4 times Operative Method Transphenoid adenectomy Specimen Count And Types 1 piece About size: 0.1 cm in diameter Source: pituitary tumor Pathology pending Operative Findings One elastic pink tumor was noted. There was some CSF leak intra-operatively. Severe adhesion at sellar region was noted after opening the sellar floor. Operative Procedures Under ETGA, patient was put into supine position with head tilted 30degrees to left. The face and right lower abdomen were prepared with povidone-iodine alcohol tincture, and the mucosa of nasal cavity with aqueous povidone-iodine tincture. Then, they were covered by sterilized adhesive plastic sheet. The nasal submucosa at septum and floor was infiltrated with 1:100 epinephrine solution. An incision was made at mucosa of nasal septum. It was dissected away from the septal cartilage and displaced laterally by a long nasal speculum. A Hardys nasal speculum was applied to displace the nasal mucosa laterally and keep the nasal cavity open constantly for the exposure of the anterior wall of the sphenoid sinus. Before the sinus was opened, the position of the nasal speculum was adjusted under the C-arm to a direction which directly pointed to the sellar floor. The exposed sinus mucosa was coagulated and resected. Under the guide of C-arm, the sellar floor was penetrated by air-drill, then widened by Kerrison punch. The sellar floor dura was coagulated with bipolar forceps, then opened in cruciate fashion. The soft tumor parenchyma was removed by curette and suction. The venous oozing from the dura was stopped by gelfoam packing. The sellar floor was reconstructed by Surgicel and Gelfoam packing followed by Tissucol Duo. The Hardys nasal speculum was removed and the nasal mucosa returned to its normal position. Each side of the nasal cavities was tightly packed with a Better-iodine ointment soacked merocel. Operators Prof. 杜永光 Assistants R6 胡朝凱 R3 游健生 李柔蓁 (F,1955/11/14,56y4m) 手術日期 2010/10/18 手術主治醫師 杜永光 手術區域 東址 003房 02號 診斷 Malignant neoplasm of female breast, nipple and areola 器械術式 Malignant intraspinal tumor, e 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 游健生, 時間資訊 13:52 報到 14:00 進入手術室 14:05 麻醉開始 14:20 誘導結束 14:46 抗生素給藥 15:01 手術開始 17:46 抗生素給藥 19:45 手術結束 19:45 麻醉結束 19:55 送出病患 19:55 進入恢復室 22:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 惡性脊髓腫瘤切除術 1 1 手術 脊椎融合術-前融合,有固定物)≦四節 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: C7 corpectomy, C6 & T1 partial corpectomy, C7... 開立醫師: 游健生 開立時間: 2010/10/18 20:01 Pre-operative Diagnosis C6-T1 vertebral body breast cancer metastasis with C7 pathological fracture and cord compression Post-operative Diagnosis C6-T1 vertebral body breast cancer metastasis with C7 pathological fracture and cord compression Operative Method C7 corpectomy, C6 & T1 partial corpectomy, C7/T1 & C6/7 diskectomy, removal of epidural tumor, and fusion of C6-T1 with expandable cage Specimen Count And Types 1 piece About size: a few piece Source: vertebral body tumor and epidural tumor Pathology Pending Operative Findings A grayish-pink hypervascularized tumor was noted inside C7 vertebral body and extended to epidural space and posterior portion of C6 and T1 body. Thecal sac was compressed by the tumor tightly and well expanded after tumor removal. The SSEP of left lower limb and MEP of right lower limb were impaired before surgery. There were no SSEP / MEP changes during the whole operation. An expandable cage was used to replace C7. (ADD plus, height 17-26mm) Operative Procedures Under ETGA, patient was put into supine position with a cuff placed beneath her shoulder in the middle. The cuff was inflated to extend her neck. After disinfection and draping, a "L"-shape skin incision was made at C7 level which was located by C-arm. The platysmus was transected and mobilized from beneath. The superficial cervical fascia was opened in vertical direction along the anterior margin of the SCM muscle. Dissection was advanced at the loose plane between SCM muscle and strip muscles until the prevertebral fascia had been reached. The former structure was retracted to the lateral and the later structures with esophagus and trachea to the opposite side by Under ETGA, patient was put into supine position with a cuff placed beneath her shoulder in the middle. The cuff was inflated to extend her neck. After disinfection and draping, a "L"-shape skin incision was made at C7 level which was located by C-arm. The platysmus was transected and mobilized from beneath. The superficial cervical fascia was opened in vertical direction along the anterior margin of the SCM muscle. Dissection was advanced at the loose plane between SCM muscle and strip muscles until the prevertebral fascia had been reached. The former structure was retracted to the lateral and the later structures with esophagus and trachea to the opposite side by Cloward cervical retractor. Cloward cervical retractor. C7/T1 intervertebral space was located by C-arm. The most medial portion of the longus coli muscles on both sides were detached from vertebral bodies to provide a wider exposure of the vertebral bodies. The anterior longitudinal ligment was incised transversely at the margins of intervertebral space, the annulus fibrosus was cut too. The disc was removed by currette and disc clamp. C7 body was removed by air-drill and Kerrison. After exposure of tumor, it was removed in pieces. Tumor at posterior portion of C6 and T1 body was also removed. Hemostasis was achieved with bipolar and Gelfoam packing. A cage was inserted in the C7 space to replace C7 body. The position was confirmed by C-arm. Wound was closed in layers after placement of a mini-Hemovac. Operators Prof. 杜永光 Assistants R6 胡朝凱 R3 游健生 張梅蘭 (F,1950/06/25,61y8m) 手術日期 2010/10/18 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Pituitary adenoma : GHoma PRLoma 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 鍾文桂, 時間資訊 07:45 報到 08:10 麻醉開始 08:15 誘導結束 09:08 手術開始 09:08 抗生素給藥 09:08 進入手術室 09:37 手術結束 09:38 麻醉結束 09:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 鼻中膈鼻道成形術-單側 1 2 手術 經由蝶竇之腦下垂體瘤切除 1 1 記錄__ 手術科部: 外科部 套用罐頭: Transsphenoidal hypophysectomy 開立醫師: 鍾文桂 開立時間: 2010/10/18 10:20 Pre-operative Diagnosis Pituitary microadenoma. Pituitary macroadenoma, acromegaly Post-operative Diagnosis Pituitary microadenoma. Pituitary macroadenoma, acromegaly Operative Method Transsphenoidal hypophysectomy Specimen Count And Types 1 piece About size:5 cc Source:pituitary adenoma Pathology pending Operative Findings 1. Soft and red tumor tissue was noted and then removed. 2. The normal gland was noted after tumor removed Operative Procedures Under general anethesia and intubation, the patient was put in supine position. The facial skin was antiseptic with alcohol better-iodine tincture, and the mucosa of oral and nasal cavity with aqueous better-iodine. The abdomen was also sterilized. The former areas were covered by sterilized adhesive plastic sheets then draped. Under microscope, the nasal mucosa was coagulated at right norstril. A nasal speculum was applied to displace the nasal mucosa laterally and keep thenasal cavity open constantly for the exposure of the vomer bone and the anterior wall of the sphenoid sinus. The anterior sphenoid wall and posterior sphenoid wall was removed. The sellar floor dura was coagulated then opened. The soft tumor parenchyma was removed by ring-curette. The CSF leakage was sealed with gelform packing. The arachnoid and the opening of diaphragm sellae was enforced by packing with gelform as in the sellar cavity. The nasal mucosa returned to its normal position. Both of the nasal cavities was tightly packed with a segment of finger-tip gloves. Operators Dr.曾漢民 Assistants R5鍾文桂 R2陳國瑋 記錄__ 手術科部: 外科部 套用罐頭: Transsphenoidal adenectomy 開立醫師: 陳國瑋 開立時間: 2010/10/20 11:54 Pre-operative Diagnosis Pituitary microadenoma. Post-operative Diagnosis Pituitary microadenoma. Operative Method Transsphenoidal adenectomy Specimen Count And Types 1 piece About size:5 cc Source:pituitary adenoma Pathology pending Operative Findings 1. Soft and red tumor tissue was noted and then removed. 2. The normal gland was noted after tumor removed Operative Procedures Under general anethesia and intubation, the patient was put in supine position. The facial skin was antiseptic with alcohol better-iodine tincture, and the mucosa of oral and nasal cavity with aqueous better-iodine. The abdomen was also sterilized. The former areas were covered by sterilized adhesive plastic sheets then draped. Under microscope, the nasal mucosa was coagulated at right norstril. A nasal speculum was applied to displace the nasal mucosa laterally and keep thenasal cavity open constantly for the exposure of the vomer bone and the anterior wall of the sphenoid sinus. The anterior sphenoid wall and posterior sphenoid wall was removed. The sellar floor dura was coagulated then opened. The soft tumor parenchyma was removed by ring-curette. The CSF leakage was sealed with gelform packing. The arachnoid and the opening of diaphragm sellae was enforced by packing with gelform as in the sellar cavity. The nasal mucosa returned to its normal position. Both of the nasal cavities was tightly packed with a segment of finger-tip gloves. Operators Dr.曾漢民 Assistants R5鍾文桂 R2陳國瑋 謝愛卿 (F,1964/06/17,47y8m) 手術日期 2010/10/18 手術主治醫師 曾漢民 手術區域 東址 005房 03號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 2 紀錄醫師 鍾文桂, 時間資訊 11:55 報到 12:19 進入手術室 12:25 麻醉開始 12:50 誘導結束 13:00 抗生素給藥 13:02 手術開始 15:45 麻醉結束 15:45 手術結束 15:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 手術 腦瘤切除-手術時間在4小時以內 1 1 L 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Simpson grade II tumor excision via left fron... 開立醫師: 鍾文桂 開立時間: 2010/10/18 16:34 Pre-operative Diagnosis Parasagital meningioma, left frontal. Post-operative Diagnosis Parasagital meningioma, left frontal. Operative Method Simpson grade II tumor excision via left frontal approach. Specimen Count And Types 1 piece About size:30CC. Source:Meningioma. Pathology Nil. Operative Findings 1.Soft, red-grayish, well defined tumor with feeders from middle meningeal artery and anterior cerebral artery. The tumor that adheres to the falx and frontal skull base was electrocoagulated. 2. Frontal sinus was opened and sealed with bone wax and gelfoam. 3. Moderate brain swelling. Operative Procedures Under ETGA, the patient was placed in supine position. After shaving and disinfection, and draping, a curvilinea scalp incision was made. Then, a craniotomy was created by high speed drill. The opened frontal sinus was closed by bone wax. Durotomy was achieved based on superior sagital sinus. The underbeneath tumor was dissected from the normal brain parenchyma. The feeders were electrocoagulated. The tumor was excised after complete dissection from the brain parenchyma. The residual tumor at the dura surface along the anterior skull base,and falx were electrocoagulated and the tumor along the dura at convexity was removed by currete. The dura mater was closed in water tight fashion and augmented with fascia graft. The craniotomy bone plate was fixed by mini plates and screws. The wound was closed in layers after placing one subgaleal drain. Operators V.S. 曾漢民 Assistants R5鍾文桂 R2陳國瑋 呂世光 (M,1939/03/22,72y11m) 手術日期 2010/10/18 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Synovial cyst 器械術式 Excision of neuroma 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 鍾文桂, 時間資訊 09:26 報到 10:00 進入手術室 10:05 麻醉開始 10:15 誘導結束 10:21 抗生素給藥 10:40 手術開始 11:55 手術結束 11:55 麻醉結束 12:05 送出病患 12:10 進入恢復室 13:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 良性脊髓腫瘤切除術 1 1 記錄__ 手術科部: 外科部 套用罐頭: Excision of synovial cyst. 開立醫師: 鍾文桂 開立時間: 2010/10/18 12:15 Pre-operative Diagnosis Synovial cyst, left L4/5. Post-operative Diagnosis Synovial cyst, left L4/5. Operative Method Excision of synovial cyst. Specimen Count And Types 1 piece About size:5 CC Source:Synovial cyst. Pathology Pending. Operative Findings Yellowish, elastic mass lesion with little whitish content. The left L5 root was compressed by the tumor mass. Intact dura mater, slack left L5 root after decompression. Operative Procedures Under ETGA, the patient was placed in prone position. After localization of L4/5 interspace by intraoperative fluoroscopy, disinfection and draping were done for preparation. Midline incision and left side paraspinal dissection were done at L4/5 level. Lower margin of L4 laminae was excised by Kerrison. The synovial cyst was exposed and resected by Kerrison and allogator. The ligamentum flavum was also resected for further decompression. The left L5 root was slack after decompression. After well hemostasis, the wound was closed in layers. Operators V.S. 曾漢民 Assistants R5鍾文桂 R2陳國瑋 相關圖片 吳佩臻 (F,2005/10/15,6y4m) 手術日期 2010/10/18 手術主治醫師 簡穎秀 手術區域 兒醫 062房 07號 診斷 其他芳香族氨基酸代謝障礙 器械術式 Lumbar puncture 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 面罩麻醉 麻醉主治醫師 林子富 ASA 3 時間資訊 00:00 臨時手術NPO 12:25 報到 12:49 進入手術室 12:53 麻醉開始 12:55 誘導結束 13:43 手術開始 13:53 手術結束 13:53 麻醉結束 14:00 進入恢復室 14:00 送出病患 15:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎穿刺 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Semi-opened mask inhalation anes 1 0 羅富 (M,2009/08/03,2y7m) 手術日期 2010/10/18 手術主治醫師 廖漢文 手術區域 東址 000房 號 診斷 Crouzon syndrome 器械術式 Common Carotid Angiography 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 王永彬 ASA 2 時間資訊 08:31 麻醉開始 08:40 誘導結束 09:58 麻醉結束 10:15 進入恢復室 11:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 黃忠義 (M,1968/12/01,43y3m) 手術日期 2010/10/19 手術主治醫師 蕭輔仁 手術區域 東址 002房 03號 診斷 Intraventricular hemorrhage 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 3E 紀錄醫師 鍾文桂, 時間資訊 23:14 開始NPO 23:14 通知急診手術 23:58 報到 23:58 進入手術室 00:05 麻醉開始 00:10 誘導結束 00:20 抗生素給藥 00:42 手術開始 01:25 麻醉結束 01:25 手術結束 01:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱內壓視置入 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Ventriculostomy for ICP monitoring and CSF dr... 開立醫師: 鍾文桂 開立時間: 2010/10/19 01:45 Pre-operative Diagnosis Intracerebral and intraventricular hemorrhage with acute hydrocephalus. Post-operative Diagnosis Intracerebral and intraventricular hemorrhage with acute hydrocephalus. Operative Method Ventriculostomy for ICP monitoring and CSF drainage( Right Kocher) Specimen Count And Types 1 piece About size:3 cc Source:CSF Pathology Nil. Operative Findings High pressure bloody CSF gushed out upon ventriculostomy. Medtronic EVD, set 7cm. Operative Procedures Under ETGA, the patient was placed in supine position and the head was in midline position. After shaving, disinfection, and draping, a horizontal linear incision was made. Then, a burr hole was done with high speed drill. After durotomy, the ventricular puncture needle was inserted at right Kocher point. The EVD was inserted via the same tract and the drainage system was connected. Finally, the wound was closed in layers. Operators V.S. 蕭輔仁 Assistants R3王奐之 R5鍾文桂 Indication Of Emergent Operation 相關圖片 黃瑞龍 (M,1947/12/25,64y2m) 手術日期 2010/10/19 手術主治醫師 林至芃 手術區域 西址 034房 01號 診斷 Brain cancer 器械術式 Insertion of hichman or port a 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 林至芃 ASA 3 時間資訊 07:50 報到 08:17 進入手術室 08:30 麻醉開始 08:35 抗生素給藥 08:35 誘導結束 08:50 手術開始 09:20 麻醉結束 09:20 手術結束 09:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 內頸靜脈切開,永久導管放置術 1 1 L 記錄__ 手術科部: 麻醉部 套用罐頭: Port-A implantation, internal jugular 開立醫師: 何雨軒 開立時間: 2010/10/19 09:25 Pre-operative Diagnosis Brain cancer Post-operative Diagnosis Ditto Operative Method Port-A implantation, echo-guided Specimen Count And Types nil Pathology Nil Operative Findings 1.Site: left internal jugular vein, with cut down & echo-guided procedure 2.Patent flow after implantation 3.Others: nil Operative Procedures 1.The patient was set on supine position and bilateral internal jugular veins were checked by echo. 2.After IVGA and local anesthesia applied, transverse skin incision for 3cm was made at pre-cordial area. 3.Undermine the skin at the layerbetween subcutaneous tissue and deep fascia in lateral direction. 4.Direct cut down method was performed to identify internal jugular vein. An IV catheter was inserted via the neck wound and negatively aspirated until venous blood attainable. 5.J-wire was inserted smoothly in rostral direction. An internal jugular catheter with dilator was inserted through the J-wire, and the dilator was then removed. 6.The catheter for Port-A was threaded into the internal jugular vein until mark 30 cm. Skin tunnel between neck and pre-cordial incision was made by the blunt dissection with Kelly clamp. The catheter was then threaded and adapted into the port and locked with restrictor. The port was inserted into the pouch ofpre-cordial incision. 7.Skin was closed layer by layer. Both catheter and the port were perfused with heparin solutionafter implantation. Operators 林至芃, Assistants 何雨軒, 黃碧玉 (F,1945/12/12,66y3m) 手術日期 2010/10/19 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Parkinsonism 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 洪誌鍵, 時間資訊 07:40 報到 08:00 進入手術室 08:10 麻醉開始 08:20 誘導結束 08:40 抗生素給藥 08:55 手術開始 10:10 手術結束 10:10 麻醉結束 10:20 送出病患 10:25 進入恢復室 11:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室腹腔分流手術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: IPG implantation 開立醫師: 陳德福 開立時間: 2010/10/19 10:37 Pre-operative Diagnosis Parkinsonism Post-operative Diagnosis Parkinsonism Operative Method IPG implantation Specimen Count And Types nil Pathology nil Operative Findings 1. no infection sign over the leads implanted previously. Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: supine with head rotated to right. 3.Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture. 4. Incision: 4 cm curvilinear, left occipital, dissect and expose the lead implanted previously 5. Incision: 10 cm transverse, about 2 cm below left clavicle, dissect and create a pocket space for IPG implantation 6. A trochar was used to create a subcutanous tuneel connecting with the pocket and sclap wound. 7. The IPG was placed into the pocket space and the cable was placed into the tunnel. 8. Connection of the leads, check the IPG function. 9. irrigation of the wound with gentamycin solution 10. close the wound in layers 11.Course of the surgery: smooth. Operators VS曾勝弘 Assistants R1洪誌鍵 羅富 (M,2009/08/03,2y7m) 手術日期 2010/10/19 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Crouzon syndrome 器械術式 cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 李振豪, 時間資訊 23:49 臨時手術NPO 07:45 報到 08:07 進入手術室 08:10 麻醉開始 08:50 誘導結束 08:55 抗生素給藥 09:38 手術開始 10:15 開始輸血 11:58 抗生素給藥 15:00 抗生素給藥 16:25 麻醉結束 16:25 手術結束 16:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 開顱術摘除血管病變-動靜脈畸型小型表淺 1 1 手術 顱骨切除術,包括異物移除或壓或經切斷 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 9 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 4 0 麻醉 Hemoglobin (Hb) 4 0 麻醉 測血糖 4 0 麻醉 Ca (Calcium) 4 0 麻醉 Na (Sodium) 4 0 麻醉 K (Potassium) 4 0 麻醉 Blood gas analysis 4 0 記錄__ 手術科部: 外科部 套用罐頭: Cranial vault reconstruction 開立醫師: 李振豪 開立時間: 2010/10/19 17:37 Pre-operative Diagnosis Crouzon syndrome Crouzon syndrome with sinus pericranii and marked skull deformity and severe IICP Crouzon syndrome with sinus pericranii formation and marked skull deformity and severe IICP Post-operative Diagnosis Crouzon syndrome Crouzon syndrome with sinus pericranii, marked skull deformity and severe IICP Operative Method Cranial vault reconstruction Cranial vault reconstruction and excision of sinus pericranii Specimen Count And Types nil Pathology Nil Operative Findings Much drainage vein was noted during scalp incision. The sinus pericranium at parieto-occipital area was divided during the operation. The periosteum was adhered at frontal area especially around the anterior fontanelle. The innter table of the skull plate was uneven due to IICP. CSF leakage was noted during central tenting. Hydrocephalus was suspected also because much CSF collection at subdural space. 1. Much engorged drainage veins were noted during scalp incision. They came from the parietal bony defect, which was 1x1 cm in diameter and communicated with the intracranila cortical vein and thus formed the sinus pericranii. 2. The periosteum was adhered at to the bony ridge at the midline and bifrontal area, especially around the anterior fontanelle. The innter table of the whole skull plate was uneven due to marked chronic IICP. 3. The anterior fontanel was still widely opened and the bony margin surrounding the fontanel was bulged out and protruded due to IICP and external brain herniation. 3. Much subarachnoid CSF was noted while seeing through the dura. CSF leakage was noted during central tenting. Hydrocephalus was suspected on CT and supported by the findings of much CSF collection in the subarachnoid space. 4. Much subarachnoid CSF was noted while seeing through the dura. CSF leakage was noted during central tenting. Hydrocephalus was suspected on CT and supported by the findings of much CSF collection in the subarachnoid space. 5. The sagittal suture was ossified and formation of two bony ridges beside the superior sagittal sinus. The midline bone was thus left and reshaped to avoid massive bleeding and sinus injury. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in prone position with head fixed with U-shape head holder. The scalp was shaved, scrubbed, and disinfected as usual. The wave-like scalp incision was made at bilateral temporoparietal area. The scalp flap was elevated. Total 14 burr holes were created followed by bilateral fronto-parieto-temporal craniectomy. The bone around the anterior fontanelle also resected after adhesiolysis the fibrotic band. Under endotracheal tube general anesthesia, the patient was put in prone position with head fixed with U-shape head holder. The scalp was shaved, scrubbed, and disinfected as usual. The wave-like scalp incision was made at bilateral temporoparietal area. The scalp flap was elevated. Total 14 burr holes were created followed by bilateral fronto-parieto-temporal craniectomy. The bone around the anterior fontanelle also resected after adhesiolysis the fibrotic band. Under endotracheal tube general anesthesia, the patient was put in prone position with head fixed with U-shape head holder. The scalp was shaved, scrubbed, and disinfected as usual. The wave-like scalp incision was made at bilateral temporoparietal area. The scalp flap was elevated after coagulation of the drainage veins of sinus pericranii one by one. After the calvaria was exposed, 14 burr holes were created in total followed by bilateral fronto-parieto-temporal craniectomy. The bone around the anterior fontanelle also resected after adhesiolysis the fibrotic band. The midline scalp with 4cm in width was left in situ to avoid injury of the superior sagittal sinus. The midline scalp was divided into three part for cranial reconstruction. Much linear osteotomy was made at occipital area. Bilateral craniectomy was switch for cranial reconstruction. The skull plate was tailed followed by three barrel-stave craniotomy. The rest skull plate was fixed back by silk(as central tenting)according to the shape for cranial reconstruction. The periosteum was placed back and fixed by 2-0 Vicryl. Hemostasis was achieved and one subgaleal CWV drain was inserted. The wound was then closed in layers with 3-0 Vicryl and 4-0 Nylon. The midline skull bone (sagittal suture) with 4cm in width was left in situ then it was divided into three parts for cranial reconstruction (the flat parietal skull may be reexpanded upward after release of tighten brain). Much linear and transverse osteotomy (modified barrel stave craniotomy) were made at occipital area to posteriorly expanded the brain. Bilateral craniectomy was switch for cranial reconstruction. The right parietal plates turned 180 degree for left side reconstruction and vise versa. The parietal bone plate was tailed at the medial part by three wedge shape and transverse craniotomy. The rest skull plate was floatingly fixed back by silk with central tenting) according to the shape for cranial reconstruction. The periosteum was sutured back and fixed by 2-0 Vicryl. Hemostasis was achieved and one subgaleal CWV drain was inserted. The wound was then closed in layers with 3-0 Vicryl and 4-0 Nylon. Operators AP郭夢菲 Assistants R4李振豪 相關圖片 錢蔡玉緞 (F,1957/07/20,54y7m) 手術日期 2010/10/19 手術主治醫師 陳敞牧 手術區域 東址 005房 03號 診斷 Malignant neoplasm of bronchus and lung, unspecified 器械術式 V-P shunt 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 方怡婷, 時間資訊 00:32 臨時手術NPO 00:32 開始NPO 08:32 通知急診手術 13:57 報到 14:25 進入手術室 14:30 麻醉開始 14:38 誘導結束 14:45 抗生素給藥 15:42 手術開始 17:38 手術結束 17:38 麻醉結束 17:55 送出病患 18:00 進入恢復室 19:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 腦室腹腔分流手術 1 1 L 記錄__ 手術科部: 內科部 套用罐頭: V-P Shunt( METRONIC ) 開立醫師: 李振豪 開立時間: 2010/10/19 18:15 Pre-operative Diagnosis Malignant neoplasm of bronchus and lung, Brain metastasis, complicated with hydrocephalus Post-operative Diagnosis Malignant neoplasm of bronchus and lung, Brain metastasis, complicated with hydrocephalus Operative Method V-P Shunt( METRONIC ) Specimen Count And Types 1 piece About size:for lab exam Source:CSF Pathology nil Operative Findings hydrocephalus Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: supine with head rotated to right. 3.Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4.Incision: 5 cm curvilinear, left frontoperiatal, corresponded to the location of left ventricle. Raney clips were applied to the scalp edge for temporary hemostasis. 5.After the scalp flap had been lifted and reflected anteriorly, a burr hole was made and the dura was tented by 1 stitches. 6.The dura was opened by a nib incision. Left lateral ventricle was tapped by a ventricular needle, then a 6.5 cm segment of the ventricular catheter was introduced into the ventricle. The outer end of the catheter was connected to a Pudenz reservoir. 7. A nib incision was made at LUQ of the abdomen , then a trocar was pushed into peritoneal cavity. Subsequently, distal 20 cm segment of the peritoneal catheter (medium pressure) was introduced into the peritoneal cavity through the outer tube of the trochar. The proximal end of this catheter was passed through subcutaneous tunnel at forechest, neck, left retroauricular area and connected the reservoir. The shunt systemwas checked to make sure its function was working. 8. The reservoir was fixed to pericranium by 3 stitches. 9. Scalp closure: hemostasis was done with bipolar coagulator touching on the sucker tip. Galea suture was performed by continuous suture with 3/0 nylon and skin by continuous suture with 3/0 nylon. 10.Course of the surgery: smooth. Operators 陳敞牧 Assistants R5鍾文桂 R1方怡婷 Indication Of Emergent Operation 張富翔 (M,1967/08/25,44y6m) 手術日期 2010/10/19 手術主治醫師 陳敞牧 手術區域 東址 003房 02號 診斷 Malignant neoplasm of brain, unspecified 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳德福, 時間資訊 13:22 報到 14:00 麻醉開始 14:00 進入手術室 14:05 誘導結束 14:50 手術開始 15:45 抗生素給藥 18:55 開始輸血 18:55 抗生素給藥 21:20 麻醉結束 21:20 手術結束 21:25 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 7 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除-手術時間在4~8小時 1 1 R 手術 顱內壓視置入 1 2 摘要__ 手術科部: 外科部 套用罐頭: craniotomy tumor excision 開立醫師: 陳德福 開立時間: 2010/10/19 23:26 Pre-operative Diagnosis Right intraventricular tumor, nature to be determinated Post-operative Diagnosis Right intraventricular tumor, nature to be determinated Operative Method craniotomy tumor excision Specimen Count And Types 1 piece About size:3*3*2CM Source:Right intraventricular tumor Pathology pending; frozen section:malignancy Operative Findings 1.There is a 3*3*3cm in sized tumor at the trigon area of the right lateral ventricle. The tumor is reddish, hypervascularized, elastic, and easy bleeding with capsule formation. The tumor has severe adhesion to the choroid plexus and adjacent vessels. 2.Partial tumor excision is done and part of the tumor was left in situ. 3.Intra-OP cortical mapping and navigation are done. Operative Procedures Under ETGA and supine position, the scalp was disinfected and draped as usual. One reverse U incision was done over the right temporal area. One 8*8cm in sized craniotomy was done and the dura was opened in C shape. Intra-OP cortical mapping and navigation were performed and one corticotomy at the right middle temporal gyrus was done. The tumor was exposre with self retractor and the tumor was remoevd step by step. Some part of the tumor was left in situ due to severe adhesion to the choroid plexus. One EVD tube was left in the tumor cavity and the dura was closed with water tight fasion. The skull was fixed with miniplates and one subgaleal CWV was left in situ. The wound was closed in layers. Operators VS 陳敞牧 Assistants R5 陳德福 張富翔 (M,1967/08/25,44y6m) 手術日期 2010/10/19 手術主治醫師 陳敞牧 手術區域 東址 003房 03號 診斷 Malignant neoplasm of brain, unspecified 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林子富 ASA 3E 紀錄醫師 陳德福, 時間資訊 21:40 進入手術室 21:44 開始NPO 21:44 通知急診手術 21:44 臨時手術NPO 21:45 麻醉開始 21:50 誘導結束 22:27 手術開始 23:05 手術結束 23:05 麻醉結束 23:10 送出病患 23:20 抗生素給藥 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 顱內壓視置入 1 2 L 摘要__ 手術科部: 外科部 套用罐頭: left EVD for ICP monitoring 開立醫師: 陳德福 開立時間: 2010/10/19 23:30 Pre-operative Diagnosis Right intraventricular tumor s/p tumor excision, IVH Post-operative Diagnosis Right intraventricular tumor s/p tumor excision, IVH Operative Method left EVD for ICP monitoring Specimen Count And Types nil Pathology nil Operative Findings 1.One EVD was inserted at the left Kocher point 2.The CSF is clear Operative Procedures Under ETGA and supine position, the scalp was disinfected and draped as usual. One curvilinear incision was done followed by burr hole creation. The dura was opened and the ventricular needle was inserted. One EVD was left in situ and the wound was closed in layers. Operators VS 陳敞牧 Assistants R5 陳德福 Indication Of Emergent Operation 劉韋志 (M,1961/12/26,50y2m) 手術日期 2010/10/19 手術主治醫師 陳敞牧 手術區域 東址 003房 01號 診斷 Brain metastasis 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳德福, 時間資訊 08:00 進入手術室 08:10 麻醉開始 09:00 抗生素給藥 09:10 誘導結束 09:30 手術開始 12:12 抗生素給藥 13:25 手術結束 13:25 麻醉結束 13:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除-手術時間在4~8小時 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: craniotomy tumor excision 開立醫師: 陳德福 開立時間: 2010/10/19 13:40 Pre-operative Diagnosis Right cerebellar tumor, nature to be determinated Post-operative Diagnosis Right cerebellar tumor, malignant metastatic lesion or abscess formation Operative Method craniotomy tumor excision Specimen Count And Types 1 piece About size:3*3*3CM Source:right cerebellar tumor and abscess Pathology pending; frozen section:suspect metastatic lesion Operative Findings 1.There is a 3*3*4cm in sized tumor at the right cerebellum with mass effect which compress the brain stem tightly. The tumor is well demarcated with central necrosis and frank pus formation. The tumor is soft and fragile. We removed the tumor nearly totally via the trans-folia route. 2.The intra-OP frozen section showed malignant metastatic lesion, but the abscess formation could not be excluded. Operative Procedures Under ETGA and prone position with Mayfield pin type head fixator fixation, the scalp was disinfected and draped as usual. One reverse U shape incision was done and the right hemisuboccipital craniotomy was done. The dura was opened in C shape and the cerebellum buldging out. The folia was opened and the tumor came into view. While central debulking procedure, the frank pus gushed out spontaneously and the tumor was removed step by step. Hemostasis was done. The dura was closed and the skull was fixed with miniplates. One subgaleal drainage tube was left in situ and the wound was closed in layers. Operators VS 陳敞牧 Assistants R5 陳德福 李何 (F,1933/04/28,78y10m) 手術日期 2010/10/19 手術主治醫師 王國川 手術區域 東址 002房 01號 診斷 Injury (severeity score >=16) 器械術式 Craniotomy(Aneurysms) VS-TZENG 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 3E 紀錄醫師 王奐之, 時間資訊 06:23 通知急診手術 06:24 開始NPO 06:35 報到 06:38 進入手術室 06:50 麻醉開始 07:30 抗生素給藥 07:30 誘導結束 07:58 手術開始 08:50 開始輸血 10:30 抗生素給藥 11:45 麻醉結束 11:45 手術結束 11:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦內血腫清除術 1 1 L 手術 顱骨切除術,包括異物移除或壓或經切斷 1 2 L 記錄__ 手術科部: 外科部 套用罐頭: Left craniectomy for hematoma evacuation, dur... 開立醫師: 王奐之 開立時間: 2010/10/19 11:31 Pre-operative Diagnosis Acute left side subdural hematoma Post-operative Diagnosis Acute left side subdural hematoma with temporal contusional intracerebral hemorrhage Acute left side subdural hematoma with frontal contusional intracerebral hemorrhage Operative Method Left craniectomy for hematoma evacuation, duroplasty & ICP monitor insertion Specimen Count And Types Nil Pathology Nil Operative Findings Subdural hematoma about 1~2cm thick was noted after durotomy. About 25~30cc contusional ICH was noted at left frontal base. The brain is slacked after hematoma removal. Intra-operative dural tear was encountered, repaired with fascial graft. Initial ICP after closing of dura: -2 mmHg. ICP reference: 499. Operative Procedures After ETGA, the patient was placed in supine position with face turned to right. After skin shaving, disinfection & draping, a curved skin incision was made as standard trauma flap. Temporalis muscle was then reflected downward. After burr holes creation, craniectomy was performed. Fascia was then harvested from temporalis. A near-round durotomy was made, the subdural hematoma was evacuated. Contusional ICH was also removed. After meticulous hemostasis, the dura was closed with fascial graft in water-tight fashion. ICP monitor was then inserted to the subdural area. After setting 1 epidural CWV drain, the wound was closed in layers. After ETGA, the patient was placed in supine position with face turned to right. After skin shaving, disinfection & draping, a curved skin incision was made as standard trauma flap. Temporalis muscle was then reflected downward. After burr holes creation, craniectomy was performed. Fascia was then harvested from temporalis. A near-round durotomy was made, the subdural hematoma was evacuated. Contusional ICH was also removed. The temporalis muscle was then resected. After meticulous hemostasis, the dura was closed with fascial graft in water-tight fashion. ICP monitor was then inserted to the subdural area. After setting 1 epidural CWV drain, the wound was closed in layers. Operators VS 王國川 Assistants R5 鍾文桂, R3 王奐之 Indication Of Emergent Operation 相關圖片 伍家逸 (F,1991/08/15,20y6m) 手術日期 2010/10/19 手術主治醫師 王國川 手術區域 東址 005房 02號 診斷 Herniation of intervertebral disc (HIVD) 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 洪誌鍵, 時間資訊 10:03 報到 10:33 進入手術室 10:35 麻醉開始 10:50 誘導結束 11:15 抗生素給藥 11:38 手術開始 13:55 手術結束 13:55 麻醉結束 14:05 進入恢復室 14:05 送出病患 15:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-腰椎 1 1 手術 椎弓切除術(減壓)-二節以內 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 摘要__ 手術科部: 外科部 套用罐頭: HIVD 開立醫師: 陳德福 開立時間: 2010/10/19 14:18 Pre-operative Diagnosis HIVD, L4/L5 & L5/S1 Post-operative Diagnosis HIVD, L4/L5 & L5/S1 Operative Method 1. diskectomy over L4/L5 & L5/S1 2. hemilaminectomy over L5 Specimen Count And Types nil Pathology nil Operative Findings 1. protuding disk over L4/L5 with compression to nerve root 2. ruptured disk over L5/S1 with compression to nerve root 3. dura pulsation was good after decompression Operative Procedures 1. ETGA, prone position 2. skin preparation and disinfection, drapping as usual 3. localixztion of the correct interspace under the guidence of C-arm 4. a longitudinal skin incision about 4 cm at the midling of lower back at the level of L5 5. dissect and detach paraspinal muscles along the left side of spinal process 6. Under operating microscope, hemilaminectomy was performed with Kerrison rongeur over L5 to expose L4/L5 & L5/S1 discs 7. performed diskectomy over L4/L5 & L5/S1, the protuding and ruptured disks were removed. 8. irrigation of the wound and injection of local anesthesic agent 9. close the wound in layers Operators VS王國川 Assistants R1洪誌鍵 黃重成 (M,1942/05/30,69y9m) 手術日期 2010/10/20 手術主治醫師 林繼昌 手術區域 東址 020房 03號 診斷 Hydrocephalus 器械術式 revision ORIF and debridement, tibial interlocking nail 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉育彰 ASA 3 紀錄醫師 羅婉育, 時間資訊 14:00 報到 14:27 進入手術室 14:33 麻醉開始 14:40 誘導結束 15:10 手術開始 16:35 手術結束 16:35 麻醉結束 16:40 送出病患 16:45 進入恢復室 17:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 深部傷口處理縫合擴創-大 1 0 L 摘要__ 手術科部: 骨科部 套用罐頭: Other-A 開立醫師: 羅婉育 開立時間: 2010/10/20 16:31 Pre-operative Diagnosis Right tibiofibular segmental fracture s/p ORIF with ILN Post-operative Diagnosis Right tibiofibular segmental fracture s/p ORIF with ILN Operative Method Debridement. Specimen Count And Types nil Pathology nil Operative Findings 1. Right tibiofibular segmental fracture s/p ORIF with ILN Operative Procedures Anesthetic induction, supine, skin disinfection, draping, on tourniquet. Skin incision over the previous op scar. Dissected to the implants, remove them. Massive N/S irrigation (10000mL). Re-implant the ILN after irrigation. N/S irrigation, close wound in layers. Operators 林繼昌, Assistants 羅婉育, 江毅彥, 廖翊廷, 李余勇 (M,1971/05/11,40y10m) 手術日期 2010/10/20 手術主治醫師 蕭輔仁 手術區域 東址 002房 03號 診斷 Intracerebral hemorrhage (ICH) 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 4E 紀錄醫師 李振豪, 時間資訊 12:25 通知急診手術 13:01 進入手術室 13:02 麻醉開始 13:05 誘導結束 14:00 手術開始 15:05 手術結束 15:05 麻醉結束 15:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室體外引流 1 1 B 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Bilateral external ventricular drainage revision 開立醫師: 李振豪 開立時間: 2010/10/20 15:40 Pre-operative Diagnosis Intraventricular hemorrhage with hydrocephalus Post-operative Diagnosis Intraventricular hemorrhage with hydrocephalus Operative Method Bilateral external ventricular drainage revision Specimen Count And Types 2 pieces About size:5ml Source:CSF About size:two tip culture Source:bilateral EVD Pathology Nil Operative Findings The opening pressure of left side EVD was more than 25cmH2O. The CSF was red-brownish in character. Malfunction of right side EVD was noted even after EVD revision. Intra-operative irrigation was performed but the function was remain poor. The old EVD was sent for tip culture. The CSF was sent for routine, BCS, and bacterial culture. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine position. The scalp was shaved and scrubbed. The stitches were removed. Disinfection and draped was done as usual. The scalp incision was made along previous wound and the burr hole was identified. THe old EVD was resected and sent for tip culture. The new EVD was placed via previous tract and fixed at about 7cm in depth. Right side EVD irrigation was performed but the function was still poor. Hemostasis was achieved with bipolar electrocautery and Gelform packing. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. The old EVD was removed totally after whole procedure. Operators VS蕭輔仁 Assistants R4李振豪 Indication Of Emergent Operation 相關圖片 郭碧玉 (F,1956/06/14,55y9m) 手術日期 2010/10/20 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Brain Tumor 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 游健生, 時間資訊 08:05 進入手術室 08:12 麻醉開始 08:50 誘導結束 09:05 抗生素給藥 09:09 手術開始 12:58 開始輸血 13:00 抗生素給藥 16:00 抗生素給藥 18:20 手術結束 18:20 麻醉結束 18:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 12 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Left presigmoid approach for epidermoid cyst ... 開立醫師: 游健生 開立時間: 2010/10/20 18:40 Pre-operative Diagnosis Epidermoid cyst excision, left cerebellopontine and prepontine region Post-operative Diagnosis Epidermoid cyst excision, left cerebellopontine and prepontine region Operative Method Left presigmoid approach for epidermoid cyst excision, partial removal Specimen Count And Types a few pieces Source: epidermoid tumor Pathology Pending Operative Findings The tumor was encapsulated with a thin capsule. The content was whitish-pearl in color and cheese-like in consistence. The plan between the capsule and normal tissue was clear. The tumor filled up cerebellomedullary, cerebellopontine, premedullary, prepontine, and ambient cisterns. Brainstem was compressed by it and well decompressed after surgery. The petrosal vein, branches of AICA, basilar artery, trocheal nerve, trigerminal nerve, facial nerve, and CN VII were seen and preserved. All the tumor at left side was removed. Those at right side was left in situ because unable to access. Left sigmoid sinus was the dominant sinus and there was a small perforation during skeletonization. It was repaired by purse-string suture. Operative Procedures Under ETGA, patient in supine position with left shoulder elevated and head fixed by Mayfield headholder. Head was rotated to right and neck extended making mastoid process the highest point of the operation field. After shaving, disinfection and draping as usual. A scalp incision was made along the hairline from above the ear to 4cm below mastoid process. Reflected the skin flap anteriorly and harvested a fascia for later duraplasty use. After dissection, we exposed squamous portion of temporal bone, Henles spine, mastoid process, and occipital triangle. After identifying asterion, a burrhole was created near it followed by extension to suboccipital craniotomy. We skeletonized sigmoid-transverse sinus junction followed by cosmatic mastoidectomy. A tiny perforation at sigmoid-transverse junction was sutured to stop bleeding. After skeletonization of sigmoid sinus, we exposed Trautmann triangle. A temporal craniotomy was performed as an extension of suboccipital craniotomy. Dura tenting along the posterior edge of craniotomy. The dura was opened along the anterior border of sigmoid sinus followed by division of superior petrosal sinus. Then, it was opened along the anterior edge of temporal craniotomy followed by cutting tentorium parallel to petrous ridge. The tumor was identified filling up cerebellomedullary, cerebellopontine, premedullary, prepontine, and ambient cisterns. It was removed in pieces with ring forcep, tumor forcep, and suction. The petrosal vein, branches of AICA, trocheal nerve, trigerminal nerve, facial nerve, and CN VII were seen and preserved during tumor removal. All the tumor at left side was removed. Those at right side was left in situ because unable to access. After hemostasis, the dura was repaired with muscle fascia with 5-0 prolene continuous suture. Bone flaps were fixed back with mini-plates. Wound was closed in layers after placement of an epi-skull CWV drain. Operators Prof. 杜永光 Assistants R6 胡朝凱 R3 游健生 徐純華 (F,1942/08/01,69y7m) 手術日期 2010/10/20 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Spinal metastasis 器械術式 Port-A Implatation /WOR 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 陳國瑋, 時間資訊 07:47 報到 08:05 進入手術室 08:43 抗生素給藥 08:45 麻醉開始 08:50 誘導結束 08:55 手術開始 10:07 手術結束 10:07 麻醉結束 10:13 送出病患 10:15 進入恢復室 11:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 port–A導管植入術–治療性導管植入術 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 記錄__ 手術科部: 外科部 套用罐頭: Port-A 開立醫師: 陳國瑋 開立時間: 2010/10/20 10:24 Pre-operative Diagnosis Rectal cancer with multiple metastasis Post-operative Diagnosis Rectal cancer with multiple metastasis Operative Method Port-A insertion Specimen Count And Types nil Pathology nil Operative Findings The port-A catheter 22cm was inserted through left cephalic vein via cut-down method, checked by C-arm Operative Procedures 1. LA, supine 1. IVG, supine 2. Skin disinfection and draping as usual 3. Local anagesia with lidocaine. 4. Dissection with Kelly and identify the left cephalic vein 5. Insert Port-A 6. Checked by C-arm, close wound in layers with 3-0 and 4-0 Vicryl Operators VS曾漢民 Assistants R5 鍾文桂 R2 陳國瑋 相關圖片 陳國財 (M,1945/04/07,66y11m) 手術日期 2010/10/20 手術主治醫師 孫瑞昇 手術區域 東址 027房 02號 診斷 Injury (severeity score >=16) 器械術式 TER 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3 紀錄醫師 張允亮, 時間資訊 10:38 報到 11:00 進入手術室 11:05 麻醉開始 11:30 抗生素給藥 11:33 手術開始 11:33 誘導結束 14:20 手術結束 14:20 麻醉結束 14:28 送出病患 14:30 進入恢復室 16:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 手術 肘關節全置換術 1 1 L 記錄__ 手術科部: 骨科部 套用罐頭: Total elbow replacement with Zimmer prosthesis 開立醫師: 張允亮 開立時間: 2010/10/20 13:57 Pre-operative Diagnosis Left elbow comminuted fracture with nonunion Post-operative Diagnosis Left elbow comminuted fracture with nonunion Operative Method Total elbow replacement with Zimmer prosthesis Specimen Count And Types nil Pathology nil Operative Findings 1. Left elbow comminuted fracture with nonunion 2. Well preservation of ulnar nerve Operative Procedures 1. ETGA, decubitus, prep & drape 2. Skin incision along left elbow, modified Murray approach 3. Identify ulnar nerve 4. Total elbow replacement, cemented (humerus: small, ulna: extra small) 5. NS irrigation, hemostasis 6. Close wound in layers after H/V x1 Operators 孫瑞昇, Assistants 張允亮, 陳勇璋, 李忠謙, 陳碧蓮 (F,1974/01/13,38y2m) 手術日期 2010/10/20 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Moyamoya disease 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 曾峰毅, 時間資訊 23:52 臨時手術NPO 07:45 報到 08:05 進入手術室 08:10 麻醉開始 08:20 誘導結束 08:50 抗生素給藥 09:14 手術開始 11:43 抗生素給藥 13:47 麻醉結束 13:47 手術結束 13:55 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 手術 顱內外血管吻合術 1 1 R 手術 頭顱成形術 1 2 R 記錄__ 手術科部: 外科部 套用罐頭: Cranioplasty and right encephalomuculosynotosis 開立醫師: 曾峰毅 開立時間: 2010/10/20 14:09 Pre-operative Diagnosis Moyamoya disease, complicated with right temporal ICH, status post craniectomy Moyamoya disease, complicated with right temporal ICH, status post decompressive craniectomy Post-operative Diagnosis Moyamoya disease, complicated with right temporal ICH, status post craniectomy Moyamoya disease, complicated with right temporal ICH, status post decompressive craniectomy Operative Method Cranioplasty and right encephalomuculosynotosis Cranioplasty and right encephalomuculosynotosis and two linar duropexy Specimen Count And Types Nil Pathology Nil Operative Findings After durotomy, relatively pale brain parenchyma was found. Dural flap contacted with brain parenchyma well and tension-free. 1. After durotomy, relatively pale brain parenchyma was found, whihc may be due to moyamoya disease per se or previous ICh insult. 2. Dural flap contacted with brain parenchyma well and tension-free. 3. The skull bone defect was large and up ot 15x12 cm in diameter. Operative Procedures With endotracheal general anaestehsia, the patient was put in supine position with head rotated to left with right shoulder elevated. After scalp shaved, scrubbed, disinfected, and then draped, we made skin incision along previuos operation wound. We dissected and reflected the scalp falp inferiorly. We made two longitudinal durotomy, and reflected the dural edge and muscle intradurally after arachnoid membrane teared under microscope. Duroplasty was done with durofoam, and bone graft was fixed back with mini-plates and bone cement. We closed the wound in layers after one subgaleal CWV. With endotracheal general anaestehsia, the patient was put in supine position with head rotated to left with right shoulder elevated. After scalp shaved, scrubbed, disinfected, and then draped, we made skin incision along previuos operation wound. We dissected and reflected the scalp falp inferiorly. We soaked the previous freezed autologous bone graft in Gentamicin solution for later use. Under microscopic view, we made two longitudinal durotomy, and reflected the dural edge and muscle intradurally after arachnoid membrane torn under microscope. Duroplasty was done with a piece of 10x10 cm durofoam, and bone graft was fixed back with mini-plates and bone cement. We closed the wound in layers after one subgaleal CWV. Operators VS 郭夢菲 Assistants R4 曾峰毅 陳張美珠 (F,1948/10/02,63y5m) 手術日期 2010/10/21 手術主治醫師 張志豪 手術區域 西址 035房 02號 診斷 Upper arm Injury 器械術式 1.Allogeneic bone graft 2.ORIF c Acumed screw 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 面罩麻醉 麻醉主治醫師 林峰盛 ASA 3 紀錄醫師 吳俊毅, 時間資訊 09:10 報到 10:15 進入手術室 10:30 麻醉開始 10:45 誘導結束 10:45 抗生素給藥 11:30 手術開始 14:00 手術結束 14:00 麻醉結束 14:10 進入恢復室 15:20 離開恢復室 14:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 肘關節脫位開放性復位術 1 1 L 手術 骨或軟骨移植術 1 2 L 手術 石膏副木固定－長臂 1 0 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Semi-opened mask inhalation anes 1 0 麻醉 Semi-opened INHALATION GENERAL A 3 0 摘要__ 手術科部: 骨科部 套用罐頭: 1. Open reduction and fixation 開立醫師: 吳俊毅 開立時間: 2010/10/21 14:22 Pre-operative Diagnosis Left elbow coranoid fracture, elbow joint sublaxation Post-operative Diagnosis Left elbow coranoid fracture, elbow joint sublaxation Operative Method 1. Open reduction and fixation 2. Coronoid process allogenic bone graft Specimen Count And Types 1 piece About size:. Source:bone graft culture Pathology nil Operative Findings 1. Bony fragment of coronoid process 2. Unstable elbow joint Operative Procedures 1. IVG with brachial plexus nerve block 2. Skin disinfection and drapped 3. On pneumonic tourniquet 250mmHg 4. Skin incision at medial side of elbow 5. Dissect common flexors origin and open elbow joint 6. Removal bony fragment 7. Allogenic boen graft of coronoid process. Fixation with Acumed screw x2 8. Percutaneous internal fixation between olecranon and humerus with K-pin x1 9. Repair common flexors tendon 10. Close wound in layers Operators 張志豪, Assistants 吳俊毅, 黃哲南, 李錫文 (M,2001/10/04,10y5m) 手術日期 2010/10/21 手術主治醫師 廖漢文 手術區域 東址 000房 號 診斷 Pituitary Tumor 器械術式 Other RAD exam/intervention 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 2 時間資訊 08:30 麻醉開始 08:40 誘導結束 09:36 麻醉結束 10:20 進入恢復室 11:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 楊賴寶鳳 (F,1950/11/20,61y3m) 手術日期 2010/10/21 手術主治醫師 王國川 手術區域 東址 005房 02號 診斷 Lipoma 器械術式 Excision of neuroma 手術類別 臨時手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 12:00 報到 12:57 進入手術室 13:05 麻醉開始 13:15 誘導結束 13:20 抗生素給藥 13:28 手術開始 14:27 手術結束 14:27 麻醉結束 14:35 送出病患 14:36 進入恢復室 16:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 皮下腫瘤摘除術大於 4CM 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Excision of lipoma. 開立醫師: 鍾文桂 開立時間: 2010/10/21 14:40 Pre-operative Diagnosis Lipoma, back, left side. Post-operative Diagnosis Lipoma, back, left side. Operative Method Excision of lipoma. Specimen Count And Types 30 cc lipoma. Pathology Pending. Operative Findings 10 cm lipma at left mid back. Yellowish, soft lipoma.Poor demarcated margin of the lipoma and the normal fat tissue. Operative Procedures Under ETGA, the patient was placed in prone position.After disinfection and draping, a horizontal skin incision was made at the lesion site. Along dissection, the liopma was resected piece by piece. After ensuring gross resection, the wound was closed in layers with one 1/8 hemovac drain at the cavity. Operators V.S. 王國川 Assistants R5 鍾文桂 陳雲興 (M,1951/09/26,60y5m) 手術日期 2010/10/21 手術主治醫師 王國川 手術區域 東址 002房 05號 診斷 Subdural hemorrhage 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林峰盛 ASA 3 紀錄醫師 游健生, 時間資訊 10:00 臨時手術NPO 10:00 開始NPO 14:40 通知急診手術 15:40 報到 16:00 進入手術室 16:07 麻醉開始 16:15 誘導結束 16:20 抗生素給藥 16:48 手術開始 18:15 手術結束 18:15 麻醉結束 18:40 送出病患 18:45 進入恢復室 19:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 B 手術 慢性硬腦膜下血腫清除術 1 2 B 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Chronic Subdural Hematoma 開立醫師: 曾峰毅 開立時間: 2010/10/21 18:12 Pre-operative Diagnosis Bilateral chronic subdural hematoma Post-operative Diagnosis Bilateral chronic subdural hematoma Operative Method Bilateral frontal burr hole for subdural drainage Specimen Count And Types Nil Pathology Nil Operative Findings Yellowish fluid came out first while left durotomy, then followed with dark-reddish fluid. Dark-reddish fluid came out while right durotomy. The brain expansion was well and fast. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position. After scalp shaved, scrubbed, disinfected, and then draped, we made two transverse linear skin incision at bilateral frontal area. We drilled one burr hole at each side, and created durotomy. We inserted rubbder drain at left subdural space, and EVD ventricular catheter at right subdural space. After subdural irrigation, we closed the wound in layers. The subdural space was de-aired. Operators VS 王國川 Assistants R4 曾峰毅 R3 游健生 Indication Of Emergent Operation 張大江 (M,1966/02/10,46y1m) 手術日期 2010/10/21 手術主治醫師 王國川 手術區域 東址 003房 號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 07:45 報到 08:05 進入手術室 08:13 麻醉開始 08:40 誘導結束 09:10 抗生素給藥 09:30 手術開始 12:10 抗生素給藥 12:55 麻醉結束 12:55 手術結束 13:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除-手術時間在4小時以內 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Excision of brain tumor, right pterional appr... 開立醫師: 鍾文桂 開立時間: 2010/10/21 13:18 Pre-operative Diagnosis Astrocytoma, WHO grade II, right frontal-temporal, status post excision, with recurrence. Post-operative Diagnosis Astrocytoma, WHO grade II, right frontal-temporal, status post excision, with recurrence. Operative Method Excision of brain tumor, right pterional approach. Specimen Count And Types 1 piece About size:5cc Source:brain tumor Pathology Pending. Operative Findings Soft pink-whitish tumor at right frontal-temporal area. not well demarcated, encasement of MCA branches( well preserved during tumor excision) Dura defect was repaired with DuraFoam. The skull bone defect was filled with bone cement. Intraoperative ultrasonography was done for tumor localization. The insula was exposed after tumor resection. Operative Procedures Under ETGA, the patient was placed in supine position and the head was tilted to the left. After shaving, disinfection and draping, the previous operative wound was incised and dissected. The miniplates and screws were released. The previous craniotomy was re-opend by high speed drills. Durotomy was done by incising along the previous water-tight sutures. The tumor was localized by intraoperative ultrasonography. The underbeneath tumor was excised in piece meal fashion. The MCA branches were dissected from the tumor. After well hemostasis, the dura mater was repaired with DuraFoam. The craniotomy bone plate was fixed by plates and screws. The defect was filled with bone cement. After placing one subgaleal CWV drain, the wound was closed in layers. Operators V.S. 王國川 Assistants R5 鍾文桂 相關圖片 宋榮泰 (M,1958/09/21,53y5m) 手術日期 2010/10/21 手術主治醫師 蔡翊新 手術區域 東址 005房 01號 診斷 Head Injury 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 李振豪, 時間資訊 08:42 進入手術室 08:45 麻醉開始 08:50 誘導結束 09:35 手術開始 11:00 抗生素給藥 12:35 手術結束 12:35 麻醉結束 12:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 手術 頭顱成形術 1 2 R 摘要__ 手術科部: 外科部 套用罐頭: Cranioplasty 開立醫師: 蔡翊新 開立時間: 2010/10/21 11:47 Pre-operative Diagnosis Right frontotemporoparietal skull defect. Post-operative Diagnosis Right frontotemporoparietal skull defect with epidural/subdural granulation. Operative Method Debridement and Cranioplasty with autologous bone graft. Specimen Count And Types wound culture x 1, wound swab for smear x 1 Pathology Nil. Operative Findings Thick, old subgaleal hematoma, with epidural and subdural necrotic, organized hematoma or granulation tissue, were noted after scalp flap elevation. There was subdural effusion gushed out upon entering the subdural space. Previously applied Duroform did not heal with native dura. Intraoperative swab of the granulation for Gram stain showed no bacteria or PMN. The autologous bone grafts were divided into 3 major pieces because of fracture. The dura had multiple lacerations and repair was performed. After dural closure, the brain was slightly tense. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation:shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with a sterilized adhesive plastic sheet. 4. Incision: along the previous operation scar at right F-T-P area, Raney clips were apllied to the scalp edge for temporary hemostasis. 5. The right F-T-P scalp was dissected away from the underlying dura. 6. The bleeders on the dissected surfaces were coagulated with Bovie painstakingly. 7. The granulation tissue was debrided and previous Duroform was removed. Culture swab was obtained and immediate result of the Gram stain showed no bacteria or PMN. The edge of the skull defect was exposed. 8. The original skull plates preserved at bone bank were removed and re- assembled into one piece with wires. The bone graft was placed back to the skull window then fixed by miniplates and screws. Three dura tentings were placed at the center of the skull plate. 9. Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by interrupted, mattressed suture with 3/0 nylon. 10.Drain: one epidural and one subgaleal CWV drains. 11.Blood transfusion: nil. Blood loss: 250 ml. 12.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R4李振豪Ri梁家豪 相關圖片 劉秋茹 (F,1976/11/02,35y4m) 手術日期 2010/10/22 手術主治醫師 杜永光 手術區域 東址 003房 號 診斷 Pituitary Tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 2 紀錄醫師 游健生, 時間資訊 08:05 進入手術室 08:15 麻醉開始 08:56 誘導結束 09:10 抗生素給藥 09:40 手術開始 12:14 抗生素給藥 12:45 手術結束 12:45 麻醉結束 12:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經由蝶竇之腦下垂體瘤切除 1 1 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 腦內視鏡 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 摘要__ 手術科部: 外科部 套用罐頭: Endoscopic transsphnoid adenomectomy 開立醫師: 游健生 開立時間: 2010/10/22 13:14 Pre-operative Diagnosis Pituitary macroadenoma Post-operative Diagnosis Pituitary macroadenoma Operative Method Endoscopic transsphnoid adenomectomy Specimen Count And Types a few pieces Source: pituitary tumor Pathology Pending Operative Findings The tumor was grayish, elastic, size 1.4cm in diameter. It was at posterior sellar turcica. The normal gland was yellowish pink, found after tumor excision. Minor CSF leakage was noted and self-sealed. The dura opening was covered with Tissuecol Duo and gelfoam packing. Operative Procedures Under general anethesia and intubation, the patient was put in supine position with head tilted 30 degree to left. The facial skin was antiseptic with alcohol better-iodine tincture, and the mucosa of oral and nasal cavity with aqueous better-iodine. The former area were covered by sterilized adhesive plastic sheets then draped. Under endoscope, the nasal mucosa was coagulated at right norstril. A nasal speculum was applied to displace the nasal mucosa laterally and keep nasal cavity open constantly for the exposure of the vomer bone and the anterior wall of the sphenoid sinus. The anterior sphenoid wall and posterior sphenoid wall was remove by high speed air drill and Kerrison punch. The sellar floor dura was coagulated then opened in cruciate fashion. The soft tumor parenchyma was removed by curette and aligator. The CSF leakage sealed by itself. The arachnoid and the opening of diaphragm sellae was enforced by packing with gelfoam in the sellar cavity. The dura opening was covered with Tissuecol Duo and gelfoam packing. Anterior wall of sphenoid sinus was reconstructed by placement of bone pieces, previously removed by Kerrison, over gelfoam packed in sphenoid sinus. The nasal mucosa returned to its normal position. Both nasal cavities were tightly packed with a segment of rubber glove finger filled with vaseline gauze strips which had been soaked with better-iodine ointment. Operators Prof. 杜永光 VS 楊士弘 Assistants R6 胡朝凱 R3 游健生 何進富 (M,1957/02/26,55y0m) 手術日期 2010/10/22 手術主治醫師 曾漢民 手術區域 東址 019房 19號 診斷 Meningioma 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 王奐之, 時間資訊 07:55 報到 08:06 進入手術室 08:15 麻醉開始 08:25 誘導結束 08:35 抗生素給藥 09:46 手術開始 11:15 手術結束 11:15 麻醉結束 11:20 送出病患 11:25 進入恢復室 13:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 頭顱成形術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: cranioplasty 開立醫師: 陳德福 開立時間: 2010/10/22 11:28 Pre-operative Diagnosis Brain tumor s/p tumor excision and craniectomy, with cranial vault defect Post-operative Diagnosis Brain tumor s/p tumor excision and craniectomy, with cranial vault defect Operative Method cranioplasty Specimen Count And Types nil Pathology nil Operative Findings 1.There is a 8*6cm in sized cranial vault defect over the left parietal skull. The cranioplasty was performed smoothly with artifical wire mesh [Codman] and screws. Operative Procedures Under GA with tracheostomy and prone position, the skull was fixed with Mayfield pin type head fixator fixation. The skin was disinfected and draped as usual. Incision along previous operation scar and the epidural plane was identified. The scalp flap was created followed by identifying the bony edege of the cranial vault defect. The defect was repaired with wire mesh and screws. One CWV was left in situ and the wound was closed in layers. Operators VS 曾漢民 Assistants R5 陳德福 R3王奐之 相關圖片 林松柏 (M,1953/12/05,58y3m) 手術日期 2010/10/22 手術主治醫師 曾漢民 手術區域 東址 000房 號 診斷 Ventriculoperitoneal shunt infection 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 王奐之, 時間資訊 11:00 報到 11:40 進入手術室 11:45 麻醉開始 11:50 誘導結束 12:10 抗生素給藥 12:42 手術開始 15:05 抗生素給藥 15:50 手術結束 15:50 麻醉結束 15:55 送出病患 15:57 進入恢復室 16:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4~8小時 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 摘要__ 手術科部: 外科部 套用罐頭: tumor removal 開立醫師: 陳德福 開立時間: 2010/10/22 16:06 Pre-operative Diagnosis Intracerebral foreign body with infection Post-operative Diagnosis Intracerebral foreign body with infection Operative Method tumor removal Specimen Count And Types 1 piece About size:4*3*2 Source:right intra-cerebral foreign body Pathology pending Operative Findings 1.There is a intraventricular catheter of VPS at the right Keens point with severe adhesion to adjacent brain parenchyma. Inflammation tumor formation is noticed and some subgaleal fistula with abscess discharge was noted. 2.The lesion is totally removed and the ventricle is inspected. Operative Procedures Under ETGA and supine position, the scalp was disinfected and draped as usual. One reverse U shape incision was done and the catheter with abscess formation is found. Debridement of the fistula and abscess was done. One 4*4 craniotomy was done and the dura was opened. We removed the tumor via transcortical route and the tumor was removed step by step. The dura was closed in water tight fasion and the skull was fixed with wires. One subgaleal drainage was left in situ and the wound was closed in layers. Operators VS 曾漢民 Assistants R5陳德福 R3王奐之 相關圖片 林蔡美鶯 (F,1946/12/06,65y3m) 手術日期 2010/10/24 手術主治醫師 蔡翊新 手術區域 東址 000房 號 診斷 Other and unspecified intracranial hemorrhage following injury, with loss of consciousness of unspecified duration 器械術式 Craniotomy(Aneurysms) VS-TZENG 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 4E 紀錄醫師 王奐之, 時間資訊 03:11 開始NPO 03:11 通知急診手術 03:45 報到 03:48 進入手術室 03:55 麻醉開始 04:10 誘導結束 04:28 抗生素給藥 04:40 開始輸血 04:50 手術開始 07:28 抗生素給藥 08:25 麻醉結束 08:25 手術結束 08:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 1 L 手術 顱內壓視置入 1 2 L 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 蔡翊新 開立時間: 2010/10/24 07:08 Pre-operative Diagnosis Left frontotemporoparietal acute SDH and left frontal contusion ICH. Post-operative Diagnosis Left frontotemporoparietal acute SDH and left frontal contusion ICH. Operative Method Left F-T-P craniectomy for removal of ICH and SDH, duroplasty and subdural ICP monitoring. Specimen Count And Types nil Pathology Nil. Operative Findings The initial ICP upon first burr hole creation was 3 mmHg. There was SDH, 1 cm in thickness, at left frontotemporoparietal region. Left posterior frontal contusion with ICH, about 20 ml in amount and slightly firm in character, was noted, with several subpial vessels which were possibly the bleeding source of SDH. ICP after wound closure was mmHg. The initial ICP upon first burr hole creation was 3 mmHg. There was SDH, 1 cm in thickness, at left frontotemporoparietal region. Left posterior frontal contusion with ICH, about 20 ml in amount and slightly firm in character, was noted, with several subpial vessels which were possibly the bleeding source of SDH. ICP after wound closure was 5 mmHg. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 4 cm at anterior-lower temporal area, the skin edge was clipped by Raney clips for temporary hemostasis. The temporalis muscles was incised down to the tempoal squama which was exposed then by applying a self retaining retractor on the muscle. 5. A burr hole was made and the dura was incised for evacuating part of the subdural hematoma, therefore the IICP could be relieved earlier. 6. The incision was extended to a temporal horseshoe, and the temporalis muscle was detached from temporal squama by rasp subsequently. 7. Craniotomy window: 14 x 11 cm, left F-T-P, created by making 5 burr holes then cut by power saw. 8. Dural tenting: by 2/0 silk, 2 cm in interval, distributed along the edge of skull window. 9. Dural incision: curvilinear along the edge of skull window. 10.The subdural clot was removed by sucker and those located beyond the cranial window was washed out by saline irrigation. The left frontal contusion ICH was also removed. Some subpial bleeding vessels were coagulated. 11.Hemosatasis: the bleeders was stopped by Bovie and raw surface was covered with Surgicel. Camino ICU monitor was inserted to left temporal subdural space. 12.Dural closure: a piece of dural graft taking from temporalis fascia, crescent shape 15 cm long, 2 cm wide, was sutured along the whole length of the dural incision in order to create an additional space for the swollen brain. 13.The skull plate was removed and stored in the bone bank for preservation. 14.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 15.Drain: two epidural CWV. 16.Blood transfusion: PRBC 4U, Platelet 12U, FFP 6U. Blood loss: 700 ml. 17.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5陳德福R3王奐之 Indication Of Emergent Operation 相關圖片 林文飛 (M,1949/08/30,62y6m) 手術日期 2010/10/25 手術主治醫師 王至弘 手術區域 東址 021房 01號 診斷 Sprains and strains of cruciate ligament of knee 器械術式 Arthroscopy ACL or PCL Dr-Wang 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 脊髓麻醉 麻醉主治醫師 劉漢平 ASA 3 紀錄醫師 羅婉育, 時間資訊 07:30 報到 08:10 進入手術室 08:12 麻醉開始 08:20 誘導結束 08:30 抗生素給藥 08:53 手術開始 09:55 手術結束 09:55 麻醉結束 09:58 送出病患 10:00 進入恢復室 11:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 半月軟骨部分切除或修補術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Spinal anesthesia 1 0 摘要__ 手術科部: 骨科部 套用罐頭: Arthroscopic meniscus repair 開立醫師: 羅婉育 開立時間: 2010/10/25 10:09 Pre-operative Diagnosis Left knee total disruption of ACL; PCL laxity; lateral meniscus posterior horn tear with avulsion fracture at the tibia eminance; tibia plateau contact injury; fibula head avulsion with LCL injury. Post-operative Diagnosis Left knee total disruption of ACL; PCL laxity; lateral meniscus posterior horn tear with avulsion fracture at the tibia eminance; tibia plateau contact injury; fibula head avulsion with LCL injury. Operative Method Arthroscopic meniscus repair Specimen Count And Types nil Pathology nil Operative Findings 1.ACL complete rupture 2.lateral meniscus posterior horn tear with avulsion fracture at the tibia eminance 3.Intact PF, PCL and MM Operative Procedures 1. Anesthesia induction, supine. 2. Prep and drape, set tourniquet. 3. Perform arthroscopic examination. 4. Shaving the torn ACL 5. Remove the avulsion fracture bone. 6. Repair the torn lateral meniscus posterior horn with Fast-Fix suture*2 7. Irrigation and close the wounds Operators 王至弘, Assistants 羅婉育, 廖翊廷, 王晨允 (F,2010/10/19,1y4m) 手術日期 2010/10/25 手術主治醫師 張重義 手術區域 兒醫 000房 號 診斷 Hypoplastic left heart syndrome, congenital 器械術式 Repair TF, V.S.D., E.C.D.,TC 手術類別 緊急手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 4E 紀錄醫師 黃俊銘, 時間資訊 08:48 臨時手術NPO 08:48 開始NPO 08:49 通知急診手術 10:48 進入手術室 10:55 麻醉開始 11:00 誘導結束 11:10 抗生素給藥 11:25 手術開始 13:50 開始輸血 14:30 抗生素給藥 15:15 手術結束 15:15 麻醉結束 15:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 胸(腹)部動靜廔管之切除移植及直接修補手術–降主動脈 1 1 手術 肺動脈結紮 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Balloon atrial septectomy + Bilateral PA band... 開立醫師: 黃俊銘 開立時間: 2010/12/07 18:02 Pre-operative Diagnosis HLHS Post-operative Diagnosis HLHS Operative Method Balloon atrial septectomy + Bilateral PA banding + PDA stenting Specimen Count And Types nil Pathology Nil Operative Findings 1. Situs solitus, levocardia, left arch 2. Hypoplastic LV, AsAo, Arch 3. s/p BAS with 8mm balloon 4. PDA stenting, 9mm 5. Post-OP SpO2 100%, BP 59/42, CVP 7 6. AsAo 1~1.5mm in diameter Operative Procedures ETGA, supine, skin disinfected RCFV catheterization, BAS with 6mm, 8mm balloon Midline sternotomy Bilateral PA banding with 3.5mm Goretex graft distal MPA catheterization Insert PDA 9mm stent (wallstent) Repair MPA Hemostasis, set 2 C/Ts in mediastinum Wound un-approximated, covered with silicon membrane Operators 張重義 王主科 Assistants 林明賢 謝永 黃俊銘 Indication Of Emergent Operation 黃朝鑫 (M,1964/12/29,47y2m) 手術日期 2010/10/25 手術主治醫師 曾漢民 手術區域 東址 003房 02號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 2 紀錄醫師 游健生, 時間資訊 11:49 進入手術室 11:50 麻醉開始 12:12 誘導結束 12:25 抗生素給藥 12:30 手術開始 15:20 手術結束 15:20 麻醉結束 15:25 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除-手術時間在4小時以內 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Right craniotomy for Simpson grade III tumor ... 開立醫師: 胡朝凱 開立時間: 2010/10/25 15:04 Pre-operative Diagnosis Right parasagital meningioma Post-operative Diagnosis Right parasagital meningioma Operative Method Right craniotomy for Simpson grade III tumor excision Specimen Count And Types pieces of tumor Pathology pending Operative Findings The tumor was well defined and was whitish, firm, measuring 3x2.5x2.5 cm. It invaded into SSS. The border was clear. No obvious vessel encasement was noted. Operative Procedures Under ETGA, patient was put in supine position with head rotate to left and fixed with Mayfield skull clamp. U shape skin incision was done at right frontal area. Skin flap was dissected and opened. After burr holes drilled, craniotomy was performed as a 5x5 cm bone window that cross midline, followed by dural tenting. U shape dural incision was made with the base left at midline. The tumor was excised by gently dissection through the interface between tumor and brain tissue. The tumor that attach to the falx was curreted. Vascular perforation was cauterized. Hemostasis was then performed. After then, dura was closed with one piece of fascia. After one CWV drain insertion, wound was closed in layers. Operators 曾漢民 Assistants 胡朝凱, 游健生 邱劉碧蓮 (F,1952/03/30,59y11m) 手術日期 2010/10/25 手術主治醫師 曾漢民 手術區域 東址 005房 13號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 陳國瑋, 時間資訊 07:45 報到 08:08 進入手術室 08:10 麻醉開始 08:15 抗生素給藥 08:20 誘導結束 08:22 手術開始 12:08 12:15 抗生素給藥 13:25 麻醉結束 13:25 13:25 手術結束 13:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4~8小時 1 1 L 手術 經由蝶竇之腦下垂體瘤切除 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: 1. Simpson grade II tumor excision via left f... 開立醫師: 鍾文桂 開立時間: 2010/10/25 14:16 Pre-operative Diagnosis 1. Frontal falcine meningioma, left. 2. Pituitary macroadenoma. Post-operative Diagnosis 1. Frontal falcine meningioma, left. 2. Pituitary macroadenoma. Operative Method 1. Simpson grade II tumor excision via left frontal craniotomy. 2. Trans-sphenoidal adenomectomy. Specimen Count And Types 2 pieces About size:5 cc Source:pituitary adenoma About size:10cc Source:meningioma Pathology Pending. Operative Findings 1. White-pinkish elastic tumor at left side of falx cerebri. Well demarcated, not easy oozing. The tumor attachment at falx was electrocoagulated. Well preserved arachnoid plane. The overlying dura mater was excised and the dura defect was repaired by Durafoam and pericranium fascia. 2. Soft white-pinkish pituitary tumor with presence of pseudocapsule. After tumor removal, the normal gland was noted and bulged out from the durotomy. It was pushed back by gelfoam packing. No CSF leakage intraoperatively. Presence of nasal septal deviation. Operative Procedures Under ETGA, the patient was placed in supine position and the head was fixed by Mayfield. The neck was slightly flexed and the head was in midline position. After shaving, disinfection, and draping, a curvilinear scalp incision was made. A 10-cm craniotomy was made at bilateral frontal region. Feeders from middle meningeal aryery was electrocoagulated. Durotomy was made at left frontal region based on superior sagital sinus. The tumor was excised and dissected along the arachnoid plane. After well hemostasis, the dura was closed with pericranium graft and Durafoam. The craniotomy plate was fixed by wire and mini-plates & screws. The wound was closed in layers. After removal of the Mayfield and head pins, the head was placed on head rest and slightly tilted to left. After disinfection,a nasal speculum was applied to displace the nasal mucosa laterally and keep nasal cavity open constantly for the exposure of the vomer bone and the anterior wall of the sphenoid sinus. The vomer bone and sphenoid sinus was resected for exposure of sellar floor. The sellar floor dura was coagulated then opened in cruciate fashion. The soft tumor parenchyma was removed by ring curette and aligator. The dura opening was covered withgelfoam packing. Anterior wall of sphenoid sinus was reconstructed by placement of bone pieces, previously removed by Kerrison, over gelfoam packed in sphenoid sinus. The nasal mucosa returned to its normal position. Both nasal cavities were tightly packed with a segment of rubber glove finger soaked with better-iodine ointment. Operators V.S. 曾漢民 Assistants 鍾文桂 陳國瑋 張品品 (F,1947/03/20,64y11m) 手術日期 2010/10/25 手術主治醫師 楊士弘 手術區域 東址 005房 02號 診斷 Spinal metastasis 器械術式 OPLL-Anterior Corpectomy VSLai 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 鍾文桂, 時間資訊 13:43 報到 14:07 進入手術室 14:15 麻醉開始 14:25 誘導結束 15:13 手術開始 16:30 抗生素給藥 19:30 手術結束 19:30 麻醉結束 19:35 抗生素給藥 19:45 送出病患 19:50 進入恢復室 20:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 手術 惡性脊髓腫瘤切除術 1 1 手術 脊椎融合術-前融合,有固定物)≦四節 1 2 記錄__ 手術科部: 神經部 套用罐頭: 1. Tumor excision via C7 corpectomy and diske... 開立醫師: 鍾文桂 開立時間: 2010/10/25 19:37 Pre-operative Diagnosis C7 vertebral body metastasis with pathologic compression fracture and spinal cord compression. 1. C7 vertebral body metastasis with pathologic compression fracture and spinal cord compression. 2. Breast cancer, right status post modified radical mastectomy. Post-operative Diagnosis C7 vertebral body metastasis with pathologic compression fracture and spinal cord compression. 1. C7 vertebral body metastasis with pathologic compression fracture and spinal cord compression. 2. Breast cancer, right status post modified radical mastectomy. Operative Method 1. Tumor excision via C7 corpectomy and diskectomy, C6/7 and C7/T1. 2. Interbody fusion and fixation with expandable body cage and plate&screw; at C6-T1. Specimen Count And Types 1 piece About size:15ml Source:C7 vertebral body, invaded by tumor Pathology pending Operative Findings 1. Tumor invasion at prevertebral space, anterior longitudinal ligament, posterior longitudinal ligament, and vertebral body at C7 level. The C7 vertebral body is collapse. Soft,white-pinkish tumor, easy oozing. 2. " A-spine" expandable body cage, plate: 30mm, screws x4: 14mm( at C6& T1 levels) 3. Blood loss: 400cc, Transfusion: 2U PRBC. Operative Procedures Under ETGA and supine position, the skin was disinfected and draped as usual. One linear incision at the left medial supraclavicular area was done and the prevertebral space was identified. The location of the C7 was checked under C-arm fluroscope and corpectomy with adjacent cervical diskectomy were performed under microscopic surgery. The dura was exposed and the theca sac was decompressed. One expandable cervical body cage was implantated in situ with 4 srews and one plate. One CWV drain was left in prevertebral space. Finally, the wound was closed in layers. Operators VS 楊士弘 Assistants R5 鍾文桂 R2 陳國瑋 盧美芬 (F,1954/03/21,57y11m) 手術日期 2010/10/25 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Cervical myelopathy 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 4 紀錄醫師 游健生, 時間資訊 07:30 報到 08:08 進入手術室 08:10 麻醉開始 08:30 誘導結束 08:40 抗生素給藥 08:42 手術開始 11:30 麻醉結束 11:30 手術結束 11:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 椎弓切除術(減壓)-超過二節 1 1 記錄__ 手術科部: 外科部 套用罐頭: C3~4, 6~7 laminectomy 開立醫師: 胡朝凱 開立時間: 2010/10/25 11:15 Pre-operative Diagnosis Cervical stenosis, C3~4, 6~7 Post-operative Diagnosis Cervical stenosis, C3~4, 6~7 Operative Method C3~4, 6~7 laminectomy Specimen Count And Types nil Pathology nil Operative Findings 1.Hypertrophic and calcified flavum ligment were noted at C3~4 and 6~7 level with cord compression. After decompression, cord expanded well. 2.instability was also noted at C3~4 and 6~7 level 3.Thin skin and subcutaneous tissue was noted 4.mild edematous tissue was noted Operative Procedures 1.ETGA, prone with head fixed with skull clamp 2.Midline incision at C3~7 level 3.Detach paravertebral muscle 4.Expose C3~7 lamina 5.Laminectomy with Ronguer and kerrison 6.Remove hypertrophic flavum ligment 7.repeat procedure at C6~7 level 8.Hemostasis 9.Set one CWV drain 10.Close wound in layers Operators 賴達明 Assistants 胡朝凱, 游健生 張碧玉 (F,1954/02/24,58y0m) 手術日期 2010/10/25 手術主治醫師 王國川 手術區域 東址 001房 03號 診斷 Lung cancer 器械術式 V-P shunt 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3E 紀錄醫師 陳德福, 時間資訊 09:00 臨時手術NPO 09:00 開始NPO 11:50 通知急診手術 16:00 報到 16:15 進入手術室 16:20 麻醉開始 16:35 誘導結束 16:42 抗生素給藥 16:57 手術開始 18:00 手術結束 18:00 麻醉結束 18:10 送出病患 18:15 進入恢復室 19:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室體外引流 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 內科部 套用罐頭: VPS, left frontal 開立醫師: 陳德福 開立時間: 2010/10/25 17:54 Pre-operative Diagnosis Lung cancer with meningeal carcinomatosis, hydrocephalus Post-operative Diagnosis Lung cancer with meningeal carcinomatosis, hydrocephalus Operative Method VPS, left frontal Specimen Count And Types 1 piece About size:10ML Source:CSF Pathology pending Operative Findings 1.The ventricular opening pressure: 20cmH20 2.CSF: clear and colorless 3.intraventricular catheter: 7.0cm ; intraperitoneal catheter:20cm 4.One 130mmH2O presetting Codman shunt reservior was implantated at the left Kocher point. Operative Procedures Under ETGA and supine position, the scalp and abdomen were disinfected and draped as usual. One linear incision at left frontal area and burr creation were done. The left upper abdomen minilaparotomy followed by subcutaneous tunneling procedure to the scalp. The dura was opened and the ventricular needle was inserted. The CSF gushed out and we set the intraventricular catheter throught the tract. The function of the shunt system was checked and the wonnds were closed in layers. Operators VS VS 王國川 Assistants R5 R3 R3 R5 陳德福 R3王奐之 R3游健生 Indication Of Emergent Operation 相關圖片 蔡仁松 (M,1942/05/07,69y10m) 手術日期 2010/10/25 手術主治醫師 林至芃 手術區域 西址 035房 03號 診斷 Lung cancer, non-small cell 器械術式 Insertion of hichman or port a 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 林至芃 ASA 3 紀錄醫師 何雨軒, 時間資訊 00:00 臨時手術NPO 10:15 麻醉開始 10:52 報到 11:05 進入手術室 11:20 誘導結束 11:25 抗生素給藥 12:10 手術開始 12:50 手術結束 12:50 麻醉結束 13:00 送出病患 13:05 進入恢復室 14:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 內頸靜脈切開,永久導管放置術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 記錄__ 手術科部: 麻醉部 套用罐頭: Port-A implantation, internal jugular 開立醫師: 何雨軒 開立時間: 2010/10/25 12:56 Pre-operative Diagnosis Malignant neoplasm of anterior wall of nasopharynx Post-operative Diagnosis Ditto Operative Method Port-A implantation, echo-guided Specimen Count And Types nil Pathology Nil Operative Findings 1.Site: right internal jugular vein, with cut down & echo-guided procedure 2.Patent flow after implantation 3.Others: nil Operative Procedures 1.The patient was set on supine position and bilateral internal jugular veins were checked by echo. 2.After IVGA and local anesthesia applied, transverse skin incision for 3cm was made at pre-cordial area. 3.Undermine the skin at the layerbetween subcutaneous tissue and deep fascia in lateral direction. 4.Direct cut down method was performed to identify internal jugular vein. An IV catheter was inserted via the neck wound and negatively aspirated until venous blood attainable. 5.J-wire was inserted smoothly in rostral direction. An internal jugular catheter with dilator was inserted through the J-wire, and the dilator was then removed. 6.The catheter for Port-A was threaded into the internal jugular vein until mark 26.5 cm. Skin tunnel between neck and pre-cordial incision was made by the blunt dissection with Kelly clamp. The catheter was then threaded and adapted into the port and locked with restrictor. The port was inserted into the pouch ofpre-cordial incision. 7.Skin was closed layer by layer. Both catheter and the port were perfused with heparin solutionafter implantation. Operators 林至芃, Assistants 何雨軒, 林財旺 (M,1934/10/17,77y4m) 手術日期 2010/10/25 手術主治醫師 蔡翊新 手術區域 東址 002房 06號 診斷 Cerebrovascular accident (CVA) 器械術式 Tracheostomy 手術類別 緊急手術 手術部位 頭、頸 傷口分類 髒 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3E 紀錄醫師 李振豪, 時間資訊 14:52 通知急診手術 15:28 報到 15:28 進入手術室 15:30 麻醉開始 15:35 誘導結束 15:50 手術開始 16:30 麻醉結束 16:30 手術結束 16:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 氣管切開術 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 李振豪 開立時間: 2010/10/25 16:45 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Ditto Operative Method Tracheostomy Specimen Count And Types nil Pathology None Operative Findings Fr. 8 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures Under endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 Nylon. Operators VS蔡翊新 Assistants R4李振豪 Indication Of Emergent Operation 相關圖片 賴千鶴 (F,1931/12/18,80y2m) 手術日期 2010/10/26 手術主治醫師 蔡翊新 手術區域 東址 001房 04號 診斷 Head injury, unspecified 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3E 紀錄醫師 游健生, 時間資訊 12:00 臨時手術NPO 12:00 開始NPO 22:58 報到 23:00 進入手術室 23:15 麻醉開始 23:25 誘導結束 00:06 抗生素給藥 00:07 手術開始 01:15 手術結束 01:15 麻醉結束 01:30 送出病患 01:40 進入恢復室 02:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 慢性硬腦膜下血腫清除術 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Burr hole for drainage of chronic subdural he... 開立醫師: 鍾文桂 開立時間: 2010/10/26 01:41 Pre-operative Diagnosis Chronic subdural hemorrhage, left frontal-temporal-parietal. Post-operative Diagnosis Chronic subdural hemorrhage, left frontal-temporal-parietal. Operative Method Burr hole for drainage of chronic subdural hemorrhage. Specimen Count And Types nil Pathology Nil. Operative Findings Dark reddish, motor oil-like, liquified blood gushed out upon opening the dura and outer membrane. The brain remained slack after removal of the chronic SDH. Operative Procedures Under ETGA, the patient was placed in supine position and the head was placed in midline. After shaving, disinfection, and draping, a horizontal scalp incision was made at left frontal region. We created a burr hole by using high speed drill. After incising the dura mater and outer membrane of chronic SDH in cruciate fashion, the liquified hematoma gushed out. Further hematoma evacuation was achieved by placing one subdural rubber drain and normal saline irrigation. The wound was closed in layers. The air in the subdural space was evacuation through the close drainage system. Operators V.S. 蔡翊新 Assistants 游健生 Indication Of Emergent Operation 李榕甄 (F,1962/11/11,49y4m) 手術日期 2010/10/26 手術主治醫師 侯育致 手術區域 東址 010房 09號 診斷 Cataract 器械術式 Phaco+PCIOL 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 14:25 報到 16:35 進入手術室 16:40 麻醉開始 16:45 麻醉結束 17:05 手術開始 17:20 手術結束 17:25 送出病患 記錄__ 手術科部: 眼科部 套用罐頭: Phacoemulsification and PCIOL implantation (os ) 開立醫師: 孫仁彬 開立時間: 2010/10/26 17:22 Pre-operative Diagnosis Cataract (os ) Post-operative Diagnosis Cataract (os ) Operative Method Phacoemulsification and PCIOL implantation (os ) Specimen Count And Types nil Pathology Nil Operative Findings Cataract (os ) Operative Procedures 1. Under topical anesthesia. 2. Disinfection, irrigation and draping. 3. Application of an eyelid speculum. 4. Made a clear corneal incision and penetrate into AC with 2.5mm trapezoid knife at 10 oclock position. 5. Inject Healon into the anterior chamber. 6. Continuous circular capsulorrhexis was done with bent needle and capsular forceps. 7. Made a sideport at 2 oclock position with the MVR blade. 8. Hydrodissection and hydrodelineation were done with BSS. 9. Phacoemulsification of the nucleus by standard divide-and-conquer technique. 10. Aspiration of the residual cortical material with I/A tube. 11. Foldable PCIOL was implanted into the bag after injection of Viscoat. 12. The residual Healon was washed out by I/A device. 13. Inject BSS into AC and check leakage 14. Stromal hydration of the wound with BSS 16. Topical irrigation of Rinderon and Gentamycin. 17. Maxitrol patching. Operators 侯育致, Assistants R4孫仁彬, 吳惠 (F,1953/05/31,58y9m) 手術日期 2010/10/26 手術主治醫師 林至芃 手術區域 西址 036房 01號 診斷 Lung cancer 器械術式 Insertion of hichman or port a 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 林至芃 ASA 3 時間資訊 07:55 報到 08:10 進入手術室 08:25 麻醉開始 08:30 誘導結束 08:30 抗生素給藥 08:40 手術開始 09:00 手術結束 09:05 送出病患 09:24 麻醉結束 醫令資訊 類別 名稱 量 刀 側 手術 port–A導管植入術–治療性導管植入術 1 0 R 記錄__ 手術科部: 麻醉部 套用罐頭: Port-A implantation, subclavian 開立醫師: 何雨軒 開立時間: 2010/10/26 09:31 Pre-operative Diagnosis Lung cancer Post-operative Diagnosis Ditto Operative Method Port-A implantation, echo-guided Specimen Count And Types nil Pathology Nil Operative Findings 1.Site: right subclavian vein, with echo-guided procedure 2.Patent flow after implantation 3.Others: nil Operative Procedures 1.The patient was set on supine position and bilateral subclavian veins were checked by echo. 2.After IVGA and local anesthesia applied, transverse skin incision for 3cm was made at pre-cordial area. 3.Undermine the skin at the layer between subcutaneous tissue and deep fascia in lateral direction. 4.An IV catheter was inserted via the subclavian incision and negatively aspirated until venous blood attainable. 5.J-wire was inserted smoothly in rostral direction. A subclavian catheter with dilator was inserted through the J-wire, and the dilator was then removed. 6.The catheter of Port-A was threaded into the subclavian vein until mark 20 cm. The catheter was adapted into the port and locked with restrictor.The Port was inserted into the pouch of pre-cordial incision. 7.Skin was closed layer by layer. Both catheter and port were perfused with heparin solution after implantation. Operators 林至芃, Assistants 何雨軒, 周張水 (F,1939/04/08,72y11m) 手術日期 2010/10/26 手術主治醫師 王國川 手術區域 東址 002房 07號 診斷 Head Injury 器械術式 Left craniotomy for ICH evacuation 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 蕭柏妮 ASA 4E 紀錄醫師 周聖哲, 時間資訊 20:00 臨時手術NPO 20:00 開始NPO 17:37 通知急診手術 19:08 進入手術室 19:10 麻醉開始 19:25 誘導結束 19:55 手術開始 20:47 開始輸血 21:00 抗生素給藥 22:40 手術結束 22:40 麻醉結束 22:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 1 R 手術 顱內壓視置入 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 摘要__ 手術科部: 外科部 套用罐頭: 1.Craniotomy ICH evacuation 2.ICP monitoring 開立醫師: 陳德福 開立時間: 2010/10/26 22:42 Pre-operative Diagnosis Traumatic ICH, SDH, SAH, left frontal-temporal area Post-operative Diagnosis Traumatic ICH, SDH, SAH, left frontal-temporal area Operative Method 1.Craniotomy ICH evacuation 2.ICP monitoring Specimen Count And Types nil Pathology nil Operative Findings 1.There is 0.5-1cm in thickness SDH over the left frontal-temporal area. The temporal ICH compressed the brain tightly and the contusional parenchymal injury is remarkable over the left frontal-temporal area. No skull fracture noticed. 2.The ICH and SDH was removed and the temporal base was well visulized without active bleeding. The ICP at the dura closure is around 2mmHg. Operative Procedures Under ETGA and supine position, the scalp was disinfeced and draped as usual. One curvilinear incision over the left frontal scalp was done and the pterional craniotomy was performed. The dura tenting is done followed by durotomy. The SDH gushed out spontaneously and the ICH was then removed by sucker, tumor forceps and bipolar assisted. The bleeders were coagulized and the rough surface of the parenchyma was covered with surgicelle. The dura was closed in water tight fasion and the skull was fixed with miniplates. One subgaleal CWV was left in situ and the wound was closed in layers. Operators VS王國川 Assistants R5陳德福 R3游健生 R1周聖哲 Indication Of Emergent Operation 楊惠民 (M,1953/04/20,58y10m) 手術日期 2010/10/26 手術主治醫師 王一中 手術區域 東址 010房 07號 診斷 Corneal erosion 器械術式 Excision of lid tumor, benign 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 13:40 進入手術室 14:00 手術開始 14:40 手術結束 14:45 送出病患 記錄__ 手術科部: 眼科部 套用罐頭: permanent tarsorraphy 開立醫師: 孫仁彬 開立時間: 2010/10/26 14:45 Pre-operative Diagnosis persistent epithelial defect (os) Post-operative Diagnosis persistent epithelial defect (os) Operative Method permanent tarsorraphy Specimen Count And Types nil Pathology nil Operative Findings Operative Procedures 1.Under local anesthesia. 2.Disinfection and draping. 3.Dissect anterior and posterior lamina along the gray line 4.Debride the mucosal epithelium of the upper and lower eyelid 5.Connect upper and lower tarsal plates with 6-0 Vicryl(Mattress suture) 6.Connect the upper and lower eyelids with 6-0 Nylon (Interrupt suture) 7.Latycin and Iron Shield covering Operators 王一中, Assistants 孫仁彬, 鄭進財 (M,1945/11/02,66y4m) 手術日期 2010/10/26 手術主治醫師 林至芃 手術區域 西址 036房 03號 診斷 Lung cancer 器械術式 Port-A catheter Removal 手術類別 臨時手術 手術部位 胸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 林至芃 ASA 2 紀錄醫師 何雨軒, 時間資訊 00:00 臨時手術NPO 10:32 報到 10:40 進入手術室 10:45 麻醉開始 10:50 抗生素給藥 10:50 誘導結束 10:58 手術開始 11:20 手術結束 11:20 麻醉結束 11:25 送出病患 11:31 進入恢復室 12:54 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 皮下肌肉或深部異物取出術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 記錄__ 手術科部: 麻醉部 套用罐頭: Port-A remove, GA 開立醫師: 何雨軒 開立時間: 2010/10/26 11:24 Pre-operative Diagnosis Lung cancer Post-operative Diagnosis Ditto Operative Method Removal of Port-A Specimen Count And Types Nil Pathology Nil Operative Findings Tip culture x 1 Operative Procedures 1.Under IVGA and local anesthesia, skin incision was made along the previous incision site. 2.Uncovered the Port-A, and then removed it. 3.Wash the pouch with normal saline. 4.Subcutaneous and skin suture. Operators 林至芃, Assistants 何雨軒, 陳毓和 (F,1929/03/01,83y0m) 手術日期 2010/10/26 手術主治醫師 賴達明 手術區域 東址 001房 01號 診斷 Subarachnoid hemorrhage 器械術式 Burr hole (trephination) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 胡朝凱, 時間資訊 00:00 開始NPO 08:41 通知急診手術 09:17 報到 09:17 進入手術室 09:20 麻醉開始 09:30 誘導結束 09:45 抗生素給藥 10:05 手術開始 10:40 麻醉結束 10:40 手術結束 10:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室體外引流 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Right EVD insertion 開立醫師: 雷秋文 開立時間: 2010/10/26 11:01 Pre-operative Diagnosis SAH and hydrocephalus Post-operative Diagnosis SAH and hydrocephalus Operative Method Right EVD insertion Specimen Count And Types CSF x 3 tubes Pathology nil Operative Findings 1.Pinkish CSF 2.Opening pressure: 10 cmH2O Operative Procedures 1.ETGA, supine 2.Right transverse skin incision 3.Dissect to open periosteum 4.Burr hole drill 5.tenting then durotomy 6.Ventricular puncture 7.EVD insertion 8.Close wound in layers Operators 賴達明 Assistants 胡朝凱 Indication Of Emergent Operation 陳毓和 (F,1929/03/01,83y0m) 手術日期 2010/10/26 手術主治醫師 賴達明 手術區域 東址 003房 04號 診斷 Subarachnoid hemorrhage 器械術式 Craniotomy(Aneurysms) P-DUH 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 蕭柏妮 ASA 4E 紀錄醫師 胡朝凱, 時間資訊 13:51 通知急診手術 17:30 報到 17:30 進入手術室 17:35 麻醉開始 17:38 誘導結束 17:45 抗生素給藥 18:25 手術開始 21:05 抗生素給藥 22:42 開始輸血 00:05 抗生素給藥 01:05 麻醉結束 01:05 手術結束 01:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 7 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 開顱術摘除血管病變 - 腦血管瘤 有病徵的 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Right pterional aproach for aneurysm clipping 開立醫師: 胡朝凱 開立時間: 2010/10/27 01:31 Pre-operative Diagnosis A-com aneurysm rupture with SAH Post-operative Diagnosis A-com aneurysm rupture with SAH Operative Method Right pterional aproach for aneurysm clipping Specimen Count And Types ｎｉｌ Pathology nil Operative Findings 1.One bi-lobule saccular aneurysm was noted at A-com that protruded left ward and upward. It was clipped with one fenestrated and one straight sugita clip. 2.Only right A1 was noted. 3.Premature rupture occurred 4.Severe adhesion and blood clot was noted at pre-chiasmatic cistern Operative Procedures 1.ETGA, supine with head fixed with skull clamp 2.Right pterional approach was done 3.Craniotomy 4.Dural tenting 5.curvature durotomy 6.Open sylvian fissure 7.Retract frontal lobe to identified optic nerve and right ICA 8.Adhesionolysis 9.trace ICA to identify right A1 10.trace A1 and resect rectal gyrus 11.Identified and dissected aneurysm 12.Proximal control 13.Aneurysmal clipping 14.Hemostasis 15.Close wound in layers Operators 賴達明 Assistants 胡朝凱,　Ｒ１ Indication Of Emergent Operation 蔡寸 (F,1946/05/25,65y9m) 手術日期 2010/10/26 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Spondylosis with myelopathy, cervical 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 08:00 進入手術室 08:05 麻醉開始 08:30 抗生素給藥 08:30 誘導結束 09:00 手術開始 11:30 抗生素給藥 12:10 手術結束 12:10 麻醉結束 12:15 送出病患 12:16 進入恢復室 14:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-頸椎 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: C5-6 anterior diskectomy + Cage insertion for... 開立醫師: 李振豪 開立時間: 2010/10/26 12:33 Pre-operative Diagnosis Spondylolisthesis, C5-6 Post-operative Diagnosis Spondylolisthesis, C5-6 Operative Method C5-6 anterior diskectomy + Cage insertion for fusion Specimen Count And Types nil Pathology Nil Operative Findings Marginal spur formation was noted and tailed by drills. The disc was dehydrated. #6 cage was used for anterior fusion. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine position with neck extension. The skin was scrubbed, disinfected and draped as usual. Transverse skin incision was made at right neck. The subcutaneous soft tissue and platysma muscle was dissected and transected. The SCM muscle and carotid sheath was identified. Dissection along the fascia was performed to exposed the pre-vertebral muscle group. The longus colli was detached to exposed the vertebral body. The location of C5-6 was checked by portable C-arm X-ray. Koros was used for maintein the operative field. Under operative microscope, anterior diskectomy was performed with knife, curette, alligator, and kerrison punches. The marginal spur was tailed with high-speed air-drived drills. The PLL also removed and the thecal sac was well expanded. The #6 cage was inserted for fusion. Hemostasis was achieved and one minihemovac was placed. The wound was then closed in layers with 3-0 Vicryl and 4-0 Prolene. Operators VS賴達明 Assistants R4李振豪, R1洪誌鍵 相關圖片 吳碧娥 (F,1937/08/28,74y6m) 手術日期 2010/10/26 手術主治醫師 賴達明 手術區域 東址 005房 號 診斷 Spondylolisthesis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 方怡婷, 時間資訊 07:42 報到 08:00 進入手術室 08:05 麻醉開始 08:15 誘導結束 08:43 抗生素給藥 09:08 手術開始 11:58 抗生素給藥 12:29 開始輸血 14:32 手術結束 14:32 麻醉結束 14:32 送出病患 14:39 進入恢復室 15:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎間盤切除術-腰椎 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: L4-5 TPS fusion and interbody fusion with cag... 開立醫師: 陳德福 開立時間: 2010/10/26 14:34 Pre-operative Diagnosis L4 on 5 spondylolisthesis with spinal stenosis Post-operative Diagnosis L4 on 5 spondylolisthesis with spinal stenosis Operative Method L4-5 TPS fusion and interbody fusion with cage, TLIF 1.L4-5 TPS and interbody fusion with cage, TLIF 2.L4 laminectomy Specimen Count And Types nil Pathology nil Operative Findings 1.There is grade I spondylolisthesis over L4-5 with instability and spinal stenosis. The hypertrophic ligamentum flavum and facet joint was removed for decompression. 2.One 13mm interbody cage and 4 40mm TPSs was implantated at the L4-5. The L4 laminectomy was done and the nerves were decompressed after the procedure. Operative Procedures Under ETGA and prone position, the skin was disinfected and draped as usual. One linear incision at midline was done and we approach the TPS insertion point with paramedium approach. The L4-5 TPS was then implantated under C-arm flouroscope. The L4/5 diskectomy was done via the transpedicular route from right side. One interbody cage was inserted thereafter. The L4 laminectomy was done and hemovac was left in situ. The wound was then closed in layers. Operators VS賴達明 Assistants R5陳德福 R1方怡婷 呂慧卿 (F,1988/09/23,23y5m) 手術日期 2010/10/26 手術主治醫師 賴達明 手術區域 東址 003房 03號 診斷 Hyperhidrosis 器械術式 Endoscopic T2 sympathectomy 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 李振豪, 時間資訊 13:42 報到 13:45 進入手術室 13:50 麻醉開始 14:00 誘導結束 14:00 抗生素給藥 14:31 手術開始 15:25 手術結束 15:25 麻醉結束 15:35 送出病患 15:37 進入恢復室 16:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 經內視鏡交感神經切斷術 1 1 B 摘要__ 手術科部: 外科部 套用罐頭: Endoscopic right T2, left T2 and T3 sympathectomy 開立醫師: 李振豪 開立時間: 2010/10/26 15:46 Pre-operative Diagnosis Hyperhydrosis Post-operative Diagnosis Hyperhydrosis Operative Method Endoscopic right T2, left T2 and T3 sympathectomy Specimen Count And Types nil Pathology Nil Operative Findings The sympathetic trunk at right T2, left T2 and T3 level was identified and transected by electrocautery. The temperature at right wrist was 33.1 oC before sympathectomy and 34.9 oC after the procedure. The temperature at left wrist was 32.9 oC before sympathectomy and 34.7 oC after the procedure. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine position with bilateral upper limbs abduction. The skin was scrubbed, disinfected, and draped as usual. One 1.5cm, transverse skin incision was made at mid-axillary line, 1cm above areola on right chest wall. The subcutaneous soft tissue was dissected and the pleural cavity was entered by Trocar blunt puncture after disconnection of the ventilator. Under endoscopic assisted, the right 2nd rib and sympathetic trunk were identified. Right T2 sympathectomy was performed with electrocautery. Right T3 sympathectomy was tried but failured due to difficult access(to close to lung parenchyma). Hemostasis was checked and deair was done. The wound was closed with 3-0 Nylon. The other 1.5cm transverse skin incision was made at mid-axillary line, 1cm above areola on left chest wall. The subcutaneous soft tissue was dissected and the pleural cavity was entered by Trocar blunt puncture after disconnection of the ventilator. Under endoscopic assisted, the left 2nd rib, 3rd rib and sympathetic trunk were identified. Left T2 and T3 sympathectomy was performed with electrocautery. Hemostasis was achieved and deair was done. The wound was then closed with 3-0 Nylon. Operators VS賴達明, VS蕭輔仁 Assistants R4李振豪, R1洪誌鍵 李錫文 (M,2001/10/04,10y5m) 手術日期 2010/10/26 手術主治醫師 楊士弘 手術區域 兒醫 067房 01號 診斷 Pituitary Tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 曾峰毅, 時間資訊 23:25 臨時手術NPO 07:52 報到 08:10 進入手術室 08:15 麻醉開始 08:45 誘導結束 08:57 抗生素給藥 09:30 手術開始 11:57 抗生素給藥 13:50 麻醉結束 13:50 手術結束 14:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內視鏡 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 經由蝶竇之腦下垂體瘤切除 1 1 摘要__ 手術科部: 外科部 套用罐頭: Endonasal trans-sphenoidal adenomectomy 開立醫師: 曾峰毅 開立時間: 2010/10/26 14:10 Pre-operative Diagnosis Cushing's Disease, pituitary microadenoma Post-operative Diagnosis Cushing's Disease, pituitary microadenoma Operative Method Endonasal trans-sphenoidal adenomectomy Endonasal endoscopic trans-sphenoidal adenomectomy Specimen Count And Types Several fragments of one tumor was sent for pathology. Pathology Pedning Operative Findings Whtish, soft to elastic tumor, about 0.7cm in size, was noted. Pinkish, elastic to firm, normal pituitary gland was preseved. Intra-operative CSF leakage waw noted. Whtish, soft to elastic tumor, about 0.3x0.36cm in size, was noted. Dark=reddish, elastic to firm, normal pituitary gland was preseved. Intra-operative CSF leakage waw noted. Operative Procedures With endotracheal general aneasthesia, the patient was put in supine position. After nasal hair trimmed, we disinected the nasal and oral cavity. We fractured the bilateral medial chonca, and deviated them to lateral. Mucosa was coagulated. Sphenoid sinus floor was exposed, and drilled of. The mucosa of sphenoid sinus was removed, and sella floor was drilled through. Durotomy was done, and tumor was removed with ring currette. Sella and sphenoid sinu was packed with gelfoam and Surgicel. Tissucol-Duo was used for sealing. Merocel was packed into bilateral nasal cavity after middle chonca reduction. With endotracheal general aneasthesia, the patient was put in supine position. After nasal hair trimmed, we disinected the nasal and oral cavity. We fractured (green-stick) the bilateral middle concha, and deviated them to lateral. Mucosa was coagulated. Sphenoid sinus floor was exposed, and drilled of. The mucosa of sphenoid sinus was removed, and sella floor was drilled through. Durotomy was done, and tumor was removed with ring currette. Sella and sphenoid sinu was packed with gelfoam and Surgicel. Tissucol-Duo was used for sealing. Merocel was packed into bilateral nasal cavity after middle concha reduction. Operators VS 楊士弘 Assistants R4 曾峰毅 林見勳 (M,1975/06/25,36y8m) 手術日期 2010/10/26 手術主治醫師 王國川 手術區域 東址 001房 02號 診斷 Brain contusion 器械術式 ICP monitoring 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 王奐之, 時間資訊 10:28 通知急診手術 10:29 開始NPO 11:11 進入手術室 11:15 麻醉開始 11:25 誘導結束 11:42 抗生素給藥 12:18 手術開始 13:10 手術結束 13:10 麻醉結束 13:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 手術 顱內壓視置入 1 1 R 記錄__ 手術科部: 創傷醫學部 套用罐頭: Right frontal ICP monitor insertion 開立醫師: 胡朝凱 開立時間: 2010/10/26 13:00 Pre-operative Diagnosis Head injury with cervical injury Post-operative Diagnosis Head injury with cervical injury Operative Method Right frontal ICP monitor insertion Specimen Count And Types nil Pathology nil Operative Findings 1.Initial ICP: about 13 mmHg Operative Procedures 1.ETGA, supine 2.Right frontal transverse skin incision 3.Dissect to expose bone 4.craniotomy 5.Dural tenting 6.ICP monitor insertion 7.Close wound in layers Operators 王國川 Assistants 胡朝凱, 王奐之 Indication Of Emergent Operation 相關圖片 邱陳芋妹 (F,1942/11/21,69y3m) 手術日期 2010/10/26 手術主治醫師 蔡翊新 手術區域 東址 003房 02號 診斷 Malignant neoplasm of frontal lobe 器械術式 Tracheostomy 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 洪誌鍵, 時間資訊 12:33 進入手術室 12:35 麻醉開始 12:40 誘導結束 13:00 手術開始 13:20 手術結束 13:20 麻醉結束 13:25 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 氣管切開術 1 0 摘要__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 陳德福 開立時間: 2010/10/26 13:38 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Ditto Operative Method Tracheostomy Specimen Count And Types nil Pathology None Operative Findings Fr.7 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators VS蔡翊新 Assistants R4李振豪, R1洪誌鍵 相關圖片 楊末 (F,1945/07/23,66y7m) 手術日期 2010/10/27 手術主治醫師 賴逸儒 手術區域 東址 056房 01號 診斷 Gall Stone 器械術式 L.C.(cholecystectomy) 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 3 紀錄醫師 鄭宗杰, 時間資訊 07:35 報到 08:05 進入手術室 08:15 麻醉開始 08:20 誘導結束 08:30 抗生素給藥 09:00 手術開始 10:05 手術結束 10:05 麻醉結束 10:15 送出病患 10:20 進入恢復室 11:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腹腔鏡膽囊切除術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Laparoscopic cholecystectomy 開立醫師: 鄭宗杰 開立時間: 2010/10/27 10:13 Pre-operative Diagnosis Gall stone Post-operative Diagnosis Gall stone Operative Method Laparoscopic cholecystectomy Specimen Count And Types Gall bladder, 4 x 2 x 2 cm Pathology Pending Operative Findings 1.Mild adhesion between liver surface and abdominal wall, and around subhepatic area. 2.Thickened gall bladder wall. Numerous pigmented stones identified within gall bladder. Operative Procedures 1.ETGA, supine, skin sterize 2.Supraumbilical incision, insert one 5-11mm port, pneumoperitoneum 3.Set another two 5mm and one 2mm port along right subcostal margin 4.Identified cystic duct and artery, ligate them with 5mm hemoclips 5.Harvest gall bladder from liver bed 6.Check bleeding 7.Wound closure Operators 賴逸儒 Assistants 鄭宗杰 曾富美 (F,1944/06/29,67y8m) 手術日期 2010/10/27 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Lumbar spondylosis 器械術式 Laminectomy for decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 11:54 報到 12:18 進入手術室 12:20 麻醉開始 12:30 誘導結束 12:40 抗生素給藥 13:07 手術開始 15:40 抗生素給藥 16:10 麻醉結束 16:12 手術結束 16:20 送出病患 16:23 進入恢復室 18:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 手術 椎弓切除術(減壓)-二節以內 1 1 記錄__ 手術科部: 外科部 套用罐頭: Decompressive sublaminar decompression, L4-5 ... 開立醫師: 王奐之 開立時間: 2010/10/27 16:27 Pre-operative Diagnosis Lumbar stenosis, L4-5 & L5-S1, status post L4/5 Wallis interspinous device implantation Post-operative Diagnosis Lumbar stenosis, L4-5 & L5-S1, status post L4/5 Wallis interspinous device implantation Operative Method Decompressive sublaminar decompression, L4-5 & L5-S1 Specimen Count And Types Nil Pathology Nil Operative Findings Suspect a small unintentional durotomy noted at L5. After decompression, the thecal sac expanded well. Operative Procedures After ETGA, the patient was placed in prone position. The skin was scrubbed, disinfected & draped in sterile fashion. A midline incision along previous scar was made at lower back, and further deepened to the spinous process. The paraspinal muscles and soft tissues were then detached, with the Wallis interspinous device exposed. 4 laminotomy were then made to perform L4-5 & L5-S1 sublaminar decompression. After hemostasis, the wound was closed in layers. Operators VS 賴達明, VS 蕭輔仁 Assistants R5 鍾文桂, R3 王奐之 相關圖片 陳清文 (M,1950/08/23,61y6m) 手術日期 2010/10/27 手術主治醫師 王碩盟 手術區域 東址 015房 05號 診斷 Urinary tract infection 器械術式 TUR-BT, 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 靜脈麻醉 麻醉主治醫師 葉惠敏 ASA 4 紀錄醫師 胡哲源, 時間資訊 13:50 進入手術室 14:00 麻醉開始 14:05 誘導結束 14:07 抗生素給藥 14:15 手術開始 14:35 手術結束 14:35 麻醉結束 14:40 送出病患 14:43 進入恢復室 15:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 手術 膀胱鏡檢查 1 0 手術 經內視鏡切片（每一診次） 1 0 記錄__ 手術科部: 泌尿部 套用罐頭: cystoscopy（biopsy ) 開立醫師: 胡哲源 開立時間: 2010/10/27 14:56 Pre-operative Diagnosis R/O bladder tumor Post-operative Diagnosis cystitis cystica Operative Method cystoscopy and biopsy Specimen Count And Types 1 piece About size:0.2*0.2cm*3 Source:bladder tumor Pathology pending Operative Findings 1. cystitis cystica 2. turbid urine and debris Operative Procedures Under satisfactory anesthesia with the patient in lithotomy position, prepping and drapping was performed in the usual sterile fashion. A Fr 21 Olympus cystoscope was introduced into the bladder cavity under direct vision. Careful inspection revealed the trigone and bilateral ureteral orifices were normal. There was cystitis cystica, turbid urine and debris in bladder. Cup biopsies were obtained from some suspicious areas. A Fr 24 Storz resectoscopewas introduced into the bladder cavity. The biopsy sites and some suspicious areas were fugerated. A Fr 20 3-way Foley catheter was inserted. Patient tolerated the procedure very well and was sent to recovery room in satisfactory condition. Operators 王碩盟, Assistants 伍嘉偉, 胡哲源 馬秀樓 (F,1934/03/01,78y0m) 手術日期 2010/10/27 手術主治醫師 蔡瑞章 手術區域 東址 005房 01號 診斷 Meningioma 器械術式 Crainotomy Brain Tumor(P-LIN) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 陳國瑋, 時間資訊 07:40 報到 08:05 進入手術室 08:15 麻醉開始 08:40 誘導結束 08:40 抗生素給藥 09:25 手術開始 12:05 抗生素給藥 12:10 麻醉結束 12:10 手術結束 12:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 腦瘤切除-手術時間在4小時以內 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Right craniotomy for Simpson grade II tumor e... 開立醫師: 胡朝凱 開立時間: 2010/10/27 11:59 Pre-operative Diagnosis Right sphenoid ridge outer third meningioma Post-operative Diagnosis Right sphenoid ridge outer third meningioma Operative Method Right craniotomy for Simpson grade II tumor excision Specimen Count And Types pieces of tumor Pathology pending Operative Findings 1.One yellowish to whitish, firm tumor located at right temporal tip that arised from right sphenoif ridge outer third portion. 2.Border was clear. No vasculature encasement. 3.Mild hyperosteosis was noted. Operative Procedures 1.ETGA, supine with head fixed with skull clamp. 2.Right curvillinear skin incision 3.Pterional approach was done 4.Further removal of right temporal bone and sphenoid ridge 5.Curvature dural incision along the border of tumor 6.Devascularization was done first at the dural attachment 7.Dissect tumor border 8.Piece by piece tumor excision 9.Resect dura 10.Duroplasty with one piece of fascia 11.fixed bone with miniplate 12.Set one CWV drain then close wound in layers Operators 蔡瑞章 Assistants 胡朝凱,陳國瑋 王生忠 (M,1935/02/09,77y1m) 手術日期 2010/10/27 手術主治醫師 蔡瑞章 手術區域 東址 003房 02號 診斷 Herniated Intervertebral Disc ( HIVD ) 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳國瑋, 時間資訊 12:00 報到 12:45 進入手術室 12:50 麻醉開始 13:00 誘導結束 13:30 抗生素給藥 13:48 手術開始 15:30 手術結束 15:30 麻醉結束 15:40 送出病患 15:41 進入恢復室 16:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-腰椎 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 記錄__ 手術科部: 外科部 套用罐頭: Microsurgical disectomy 開立醫師: 陳國瑋 開立時間: 2010/10/27 15:52 Pre-operative Diagnosis Lumbar 4/5 herniated inter-vertebral disc with radiculopathy Post-operative Diagnosis Lumbar 4/5 herniated inter-vertebral disc with L5 root compression Operative Method Microsurgical disectomy Specimen Count And Types nil Pathology nil Operative Findings The left L5 root was compressed tightly by the herniated disc, it re-expanded well after decompression 1. Disc debrides and fibrotic tissue was noted surrounding the thecal sac 2. The left L5 root was swelling and reddish and compressed tightly, it re-expanded well after decompression 3. Spur formation was also noted Operative Procedures After ETGA, the patient was placed in prone position. The skin was scrubbed, disinfected & draped in sterile fashion. L4 & L5 pedicle level was localized with C-arm. A midline skin incision was then made at lower back, and further deepened until the spinous processes were exposed. The L5 nerve root was identified. Microsurgical disectomy and decompression was performed. After hemostasis, the wound was closed with 906 interruppted sutures, 2-0 Vicryl continuous sutures & 3-0 Nylon continuous sutures. Operators Prof. 蔡瑞章 Assistants R6 胡朝凱 R2 陳國瑋 謝易廷 (M,2010/01/26,2y1m) 手術日期 2010/10/27 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Scalp tumor 器械術式 Scalp tumor excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 2 紀錄醫師 曾峰毅, 時間資訊 23:56 臨時手術NPO 07:46 報到 08:05 進入手術室 08:10 麻醉開始 08:20 誘導結束 08:45 抗生素給藥 09:14 手術開始 10:10 手術結束 10:10 麻醉結束 10:20 送出病患 10:25 進入恢復室 11:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 頭皮腫瘤 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 曾峰毅 開立時間: 2010/10/27 10:17 Pre-operative Diagnosis Scalp tumor, at occipital area Post-operative Diagnosis Scalp tumor, at occipital area Operative Method Scalp tumor excision Specimen Count And Types One tumor, excised en bloc, was sent for frozen and patholgy. Pathology Pending frozen section showed fibrous and myxoid tumor. No malignant tumor cells were seen Operative Findings We found one 4x4x4.5cm capsuled, solid, elastic tumor at occpital area, above the periosteal with clear margin. Parts of tumor margin seemed to be unclear. We found one 4x4x4.5cm not well-encapsuled, solid, elastic tumor at occpital area. It was greyish and hypovascular, but infiltrated into the surrounding galea. There was a clear margin betweent the tumor and the skull bone. The skull was not invaded by the tumor. We found one 4x4x4.5cm not well-encapsuled, solid, elastic tumor at occpital area. It was greyish and hypovascular, but infiltrated into the surrounding galea. Beneath it, there was a clear margin betweent the tumor and the skull bone. The skull was not invaded by the tumor. Operative Procedures With endotracheal general anesthesia, the patient was put in right ducibitus position. After scalp shaved, scrubbed, disinfected, and thne draped, we made one transverse skin incision at occipital area. We dissected around the tumor, and excised the tumor totally. The wound was closed in layers. Operators VS 郭夢菲 Assistants R3 曾峰毅 趙馮學臻 (F,1933/10/21,78y4m) 手術日期 2010/10/27 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Lumbar Spondylosis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 07:40 報到 08:05 進入手術室 08:25 麻醉開始 09:10 抗生素給藥 09:15 誘導結束 09:43 手術開始 11:55 手術結束 11:55 麻醉結束 12:05 進入恢復室 12:05 送出病患 13:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 記錄__ 手術科部: 外科部 套用罐頭: L4-5 transpedical screws & rods fixation with... 開立醫師: 王奐之 開立時間: 2010/10/27 12:10 Pre-operative Diagnosis L4-5 spondylolisthesis, grade I Post-operative Diagnosis L4-5 spondylolisthesis, grade I Operative Method L4-5 transpedical screws & rods fixation with posterior fusion Specimen Count And Types Nil Pathology Nil Operative Findings L4-5 spondylolisthesis, grade I. Thick paraspinal muscles & soft tissue were encountered. Estimated blood loss: 100ml. Operative Procedures After ETGA, the patient was placed in prone position. The skin was scrubbed, disinfected & draped in sterile fashion. L4 & L5 pedicle level was localized with C-arm. A midline skin incision was then made at lower back, and further deepened until the spinous processes were exposed. The paraspinal muscles were splitted from spinous process and the L4 & L5 transverse processes were identified. The transpedical screws were then inserted and confirmed the location with intra-operative C-arm. The rods were then set, followed by posterior fusion with artificial bone. After hemostasis and setting 1 hemovac drain, the wound was closed with 906 interruppted sutures, 2-0 Vicryl continuous sutures & 3-0 Nylon continuous sutures. Operators VS 賴達明 Assistants R5 鍾文桂, R3 王奐之 相關圖片 王中平 (M,1972/08/06,39y7m) 手術日期 2010/10/27 手術主治醫師 賴達明 手術區域 東址 003房 03號 診斷 Herniation of intervertebral disc without myelopathy, cervical 器械術式 Diskectomy cervical 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 王奐之, 時間資訊 16:14 報到 16:35 進入手術室 16:40 麻醉開始 16:50 誘導結束 17:00 抗生素給藥 17:20 手術開始 19:05 手術結束 19:05 麻醉結束 19:15 送出病患 19:22 進入恢復室 21:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 脊椎融合術-前融合,有固定物)≦四節 1 2 手術 椎間盤切除術-頸椎 1 1 記錄__ 手術科部: 外科部 套用罐頭: Anterior C4-5 discectomy and fusion with cage 開立醫師: 王奐之 開立時間: 2010/10/27 19:33 Pre-operative Diagnosis C4-5 herniated intervertebral disc and ossification of posterior longitudinal ligament with spinal stenosis Post-operative Diagnosis C4-5 herniated intervertebral disc and ossification of posterior longitudinal ligament with spinal stenosis Operative Method Anterior C4-5 discectomy and fusion with cage Specimen Count And Types Nil Pathology Nil Operative Findings Ossification of posterior longitudinal ligament was noted. Thick soft tissue resulted in deep operative field. A Synthes 6mm cage was used. Operative Procedures After ETGA, the patient was placed in supine position with neck hyperextended. A horizontal linear skin incision was made at right neck, and further deepened through plastysma muscle. The SCM & carotid artery were then retracted laterally while the esophagus was retracted medially. After reaching the pre-vertebral space, C4-5 space was confirmed with intra-operative C-arm. Discectomy was then done under microscope. After discectomy & removal of PLL, the thecal sac was clearly seen. A cage was then inserted to the C4-5 space. After meticulous hemostasis & setting up a mini-hemovac drain, the wound was closed in layers. Operators VS 賴達明 Assistants R5 鍾文桂, R3 王奐之 相關圖片 鄭秀男 (M,1941/09/01,70y6m) 手術日期 2010/10/27 手術主治醫師 楊士弘 手術區域 東址 001房 03號 診斷 Spinal metastasis 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 陳德福, 時間資訊 00:31 臨時手術NPO 00:31 開始NPO 07:31 通知急診手術 14:48 報到 15:13 進入手術室 15:15 麻醉開始 15:25 誘導結束 15:40 抗生素給藥 15:58 手術開始 16:40 開始輸血 18:30 手術結束 18:30 麻醉結束 18:35 送出病患 18:40 進入恢復室 20:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 急性硬腦膜下血腫清除術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: craniotomy for remvoal of SDH 開立醫師: 陳德福 開立時間: 2010/10/27 18:32 Pre-operative Diagnosis acute on chronic subdural hematoma, left Post-operative Diagnosis acute on chronic subdural hematoma, left subacute subdural hematoma, left, suspect tumor metastasis subacute subdural hematoma, left frontotemporoparietal, suspect tumor metastasis Operative Method craniotomy for remvoal of CSDH craniotomy for membranectomy and remvoal of subdural blood clot and liquid Specimen Count And Types 1 piece About size:2*2CM Source:outer membrabe of CSDH 1 piece About size:2*2CM Source:outer membrabe of subacute SDH Pathology pending Operative Findings 1.There is subacute hematoma with chronic component over the left frontal-tempora-parietal area with parenchyma compression. 1.There was outer membrane under the dura mater. Removal of the membrane revealed blood clot in the subdural space, about 30 ml in amount. 2.There is outer membrane and inner membrane formation and there is 70ml motor oil like fluid gush out after the subacute hematoma was opened. 2.There was 70 ml motor oil like fluid gush out after the blood clot was removed. The brain reexpanded gradually after removal of the pathology. Operative Procedures Under ETGA and supine position, the scalp was disinfected and draped as usual. One curvilinear incision was done over the left frontal-temporal scalp and a 4*3cm in sized craniotomy window was done. The dura was tented and opened in cruciate fasion. The outer membrane and subacute subdural hematoma were noticed. The motor oil like material gushed out then. The subdural space was irrigated with copious normal saline and we left one rubber tube in situ. The dura was closed with prolene and the skull was fixed with miniplates. The wound was then closed in layers and the intracranial air was evacuated. Operators VS楊士弘 Assistants R5陳德福 Indication Of Emergent Operation 張俊德 (M,1953/10/26,58y4m) 手術日期 2010/10/27 手術主治醫師 楊士弘 手術區域 東址 001房 02號 診斷 Intraspinal abscess 器械術式 Laminectomy C-Spinal(Posterier 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 4E 紀錄醫師 陳德福, 時間資訊 23:00 開始NPO 09:20 通知急診手術 10:00 報到 10:19 進入手術室 10:25 麻醉開始 11:00 誘導結束 11:40 手術開始 14:50 手術結束 14:50 麻醉結束 15:00 進入恢復室 15:00 送出病患 16:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 良性脊髓腫瘤切除術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: 1.L1-T1 laminectomy for epidural tumor removal 開立醫師: 陳德福 開立時間: 2010/10/27 15:08 Pre-operative Diagnosis Cervical spine epidural mass lesion with spinal cord comprssion Post-operative Diagnosis Cervical spine epidural mass lesion with spinal cord comprssion, suspect abscess Operative Method 1.L1-T1 laminectomy for epidural tumor removal 1.C1-T1 laminectomy for epidural tumor removal Specimen Count And Types 1 piece About size:0.5*3*2CM Source:Cervical epidural tumor Pathology pending Operative Findings 1.There is 0.5*10*2cm in sized epidural mass lesion with active frank pus discharge over the C1-T1 level. The spinal cord was compressed tightly from dorsal side. The ligamentum flavum was thickened with inflammatory change. 2.Partial C1, C2, C4, C6, and T1 laminectomy and total C2, C3, and C5 laminectomy were performed. The theca sac reexpanded well after the procedure. Operative Procedures Under ETGA and prone position with Mayfield pin type head fixator fixation, the skin was disinfected and draped as usual. One linear incision was done at the midline and the C1-T1 was exposed for laminectomy. The Partial C1, C2, C4, C6, and T1 laminectomy and total C2, C3, and C5 laminectomy were performed. The frank pus discharge was sent for culture and the epidural mass lesion was sent for pathology. One epidural CWV was left in situ and the wound was closed in layers. Operators VS 楊士弘 Assistants R5 陳德福 Indication Of Emergent Operation 伍家逸 (F,1991/08/15,20y6m) 手術日期 2010/10/27 手術主治醫師 王國川 手術區域 東址 005房 03號 診斷 Herniation of intervertebral disc (HIVD) 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳國瑋, 時間資訊 15:30 報到 15:50 進入手術室 15:55 麻醉開始 16:15 誘導結束 16:30 抗生素給藥 16:45 手術開始 17:50 手術結束 17:50 麻醉結束 17:55 送出病患 17:57 進入恢復室 19:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 椎間盤切除術-腰椎 1 2 記錄__ 手術科部: 外科部 套用罐頭: Re-open for L5~S1 discectomy 開立醫師: 陳國瑋 開立時間: 2010/10/27 17:44 Pre-operative Diagnosis Suspect recurrent left L5~S1 HIVD Post-operative Diagnosis Suspect recurrent left L5~S1 HIVD Operative Method Re-open for L5~S1 discectomy Specimen Count And Types nil Pathology pending Operative Findings 1.The L5 nerve root was loosed. No obvious protruding disc. 2.Mild anterior listhesis of L5 on S1 with mild preotruding disc and spur that compressed the S1 root tightly. 3.The nerve root wasmild injected and swelling Operative Procedures 1.ETGA, prone 2.Midline skin incision via previous wound 3.Expose previous laminotomy 4.dissect and remove connective tissue that compressed the nerve root 5.neural foramen widening with kerrison 6.identified S1 root 7.Neural foramen widening 8.Resect partial spur of S1 9.Hemostasis 10.close wound in layers Operators 王國川 Assistants 胡朝凱,陳國瑋 王晨允 (F,2010/10/19,1y4m) 手術日期 2010/10/28 手術主治醫師 黃書健 手術區域 兒醫 068房 02號 診斷 Hypoplastic left heart syndrome, congenital 器械術式 TCPC,JATENE,TAPVR,NORWOOD 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 4 紀錄醫師 張得一, 時間資訊 00:00 臨時手術NPO 13:16 進入手術室 13:16 報到 13:20 麻醉開始 13:22 誘導結束 13:45 手術開始 18:15 開始輸血 23:30 麻醉結束 23:30 手術結束 23:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 主動脈轉位症手術 1 1 手術 體外心肺循環 1 1 手術 四合群症之修補(T.F) 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 12 0 麻醉 動脈血液檢查全套 4 0 麻醉 Hemoglobin (Hb) 4 0 麻醉 測血糖 4 0 麻醉 Ca (Calcium) 4 0 麻醉 Na (Sodium) 4 0 麻醉 K (Potassium) 4 0 麻醉 Blood gas analysis 4 0 記錄__ 手術科部: 外科部 套用罐頭: Norwood procedure + RV-PA shunt + PA debandin... 開立醫師: 張得一 開立時間: 2010/10/29 00:36 Pre-operative Diagnosis HLHS, s/p PDA stenting + bilateral PA banding, with CHF Post-operative Diagnosis Ditto Ditto, with retrograde coarctation Operative Method Norwood procedure + RV-PA shunt + PA debanding + atrial septectomy + PDA stent removal Norwood procedure with RV-PA shunt + bilateral PA debanding + atrial septectomy + PDA stent removal Specimen Count And Types stent Pathology nil Operative Findings 1.Severely dilated RV 2.Hypotension, bradycaria, heart dilation during pericardial cavity exploration => Norwood procedure 3.AsAo: 1.5mm, arch 1.5cm, an focal critical stenosis between innominate a. and LCCA near 0.8mm in diameter, MPA 7mm, PDA 7mm 3.AsAo: 1.5mm, arch 1.5mm, an focal critical stenosis between innominate a. and AsAo near 0.8mm in diameter, MPA 7mm, PDA 7mm 4.ASD: 5mm in diameter, enlarged to 1cm 4.ASD: 5mm in diameter, s/p BAS with tear on IAS 5.Small tricuspid annulus (1.0cm2) -> No TVP was performed 5.No obvious TR on water test 6.Postop AsAo: 75/55 (60), bilateral foot A-line 58/45(50), sinus rhythm, fair contractility, SpO2 80%, FiO2 0.95 6.Postop AsAo: 75/55 (60), left foot A-line 58/45(50), sinus rhythm, fair contractility, SpO2 80%, FiO2 0.95 7.Hypotension, bradycardia, heart dilation after 1st weaning of CPB => ECMO priming, stand-by 7.Hypotension, bradycardia, heart dilation during hemostasis => ECMO priming, but held due to gradually reweaning after cannulation 8.Much bilateral pleural effusion and ascites 9.Circulatory arrest: 109mins 9.45 min via innominate artery, 54 min with selectic cerebral perfusion Operative Procedures ETGA, supine, skin disinfected Remove Silicone membrane, N/S irrigation, set 2x C/Ts in bilteral pleural cavity. Set PD drain. CPB with RAA, innominate a. cannulation (via 3mm Goretex), cooling to 18^C CPB with RAA, MPA, innominate a. cannulation (via 3.5mm Goretex), cooling to 18^C Circulatory arrest with selective antegrade cerebral perfusion (100mo/min), with innominate a. crossclamp, LCCA, LSA snaring. Direct antegrade cardioplegia infusion via AsAo MPA, PDA transection. Remove PDA stent MPA repair Remove bilateral PA banding MPA incision, end-to-side anastomosis from 3mm Goretex to mPA MPA incision, end-to-side anastomosis from 5mm Goretex to mPA AsAo arch incision along lesser curvature Proximal AsAo, MPA anastomosis with 10x interrupted 7-0 Prolene sutures Neo-Ao creation with AsAo-arch-MPA and glutaldehyde-treated autologous pericardiual patch Add IVC cannulation, advance RAA cannulation to SVC AsAo crossclamp, antegrade cardioplegia infusion RA incision, resect IAS to 1.0cm. Check TV pathology RA incision, atrioseptectomy. Check TV pathology Rewarm, deair, Repair RA RVOT incision, end-to-side anastomosis of 5.0mm Goretex to RVOT Wean off CPB Reset CPB by innominate a. (via graft), RAA cannulation Aortic crossclamp, antegrade cardioplegia infusion Neo-Ao incision, check proximal AsAo patency (2.5mm) Rewarm, deair, wean off CPB Rewarm, deair, wean off CPB, severe desaturation and unstable BP => prepare ECMO Hemostasis, set 1x C/T in mediastinum Set epicardial pacemaker leads. Sternum unapproximated. Cover with silicon membrane Operators VS 黃書健 Assistants R5謝永 R3張得一 王彩雲 (F,1929/03/02,83y0m) 手術日期 2010/10/28 手術主治醫師 賴達明 手術區域 東址 003房 03號 診斷 顱內出血 器械術式 Burr hole (trephination), EVD 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 12:34 通知急診手術 15:05 報到 15:15 進入手術室 15:25 麻醉開始 15:35 誘導結束 15:50 抗生素給藥 16:18 手術開始 17:10 麻醉結束 17:10 手術結束 17:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 顱內壓視置入 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: External ventricular drainage via right Koche... 開立醫師: 游健生 開立時間: 2010/10/28 17:43 Pre-operative Diagnosis 1. Intraventricular hemorrhage 2. Acute hydrocephalus Post-operative Diagnosis 1. Intraventricular hemorrhage 2. Acute hydrocephalus Operative Method External ventricular drainage via right Kocher point Specimen Count And Types 1 piece About size:6cc Source:CSF Pathology Nil Operative Findings Pinkish CSF was drained and 6cc was sent for routine, biochem, and culture. The opening pressure was about 10cmH2O. The ventricular catheter was 6.5cm. Operative Procedures 1. Under ETGA, patient in supine position with head tilted up 2. Disinfection and draping as usual after shaving 3. Transverse skin incision was made over right Kocher region 4. Dissected in layers and exposed cranium 5. Created a burr-hole followed by cruciate durotomy 6. Electrocauterized the dura edge then performed ventriculostomy 7. Inserted ventricle catheter and fixed it 8. Closed wound in layers after hemostasis Operators VS 賴達明 Assistants R5 鍾文桂 R3 游健生 Indication Of Emergent Operation 吳徽燦 (M,1935/10/10,76y5m) 手術日期 2010/10/28 手術主治醫師 陳敞牧 手術區域 東址 005房 01號 診斷 Lumbar spondylosis 器械術式 Laminectomy for decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 07:30 報到 08:00 進入手術室 08:05 麻醉開始 08:15 誘導結束 08:47 抗生素給藥 09:04 手術開始 11:47 抗生素給藥 12:35 手術結束 12:35 麻醉結束 12:40 送出病患 12:43 進入恢復室 14:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 椎弓切除術(減壓)-超過二節 1 1 摘要__ 手術科部: 外科部 套用罐頭: L3-4 and partial L2, L5 laminectomy for decom... 開立醫師: 李振豪 開立時間: 2010/10/28 12:50 Pre-operative Diagnosis Spinal stenosis, L2-5 Post-operative Diagnosis Spinal stenosis, L2-5 Operative Method L3-4 and partial L2, L5 laminectomy for decompression Specimen Count And Types nil Pathology Nil Operative Findings The epidural space was filled with scar tissue and adhered to the thecal sac severely. The thecal sac was compressed tightly by the scar tissue and spur. The thecal sac expanded well after decompression. Thin layers of the scar tissue was left on the dura to avoid dura tear. No CSF leakage was noted after whole procedure. Lateral recess stenosis due to spur formation and scar tissue also noted during the operation, especially at left side, and foraminotomy was performed for decompression of the roots. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in prone position. The skin was scrubbed, disinfected, and draped as usual. The skin incision was made along operative scar and the subcutaneous soft tissue was dissected to exposed the spinous process of L2-L5. The paravertebral muscle groups were detached and the spinous process of L3, L4 were totally removed. Partial removal of the L2 and L5 spinous process also performed followed by partial laminectomy. The thecal sac at L2 and L5 level was identified. The plan between granulation tissue, dura, and bone edge was dissected by dissector and curette. Decompression was done with Rongeur, Kerrison punches, and scissor. Foraminotomy also performed for lateral recess stenosis. Hemostasis were achieved with bipolar electrocautery and Gelform packing. The wound was then closed in layres with 2-0 Vicryl and 3-0 Nylon. Under endotracheal tube general anesthesia, the patient was put in prone position. The skin was scrubbed, disinfected, and draped as usual. The skin incision was made along operative scar and the subcutaneous soft tissue was dissected to exposed the spinous process of L2-L5. The paravertebral muscle groups were detached and the spinous process of L3, L4 were totally removed. Partial removal of the L2 and L5 spinous process also performed followed by partial laminectomy. The thecal sac at L2 and L5 level was identified. The plan between granulation tissue, dura, and bone edge was dissected by dissector and curette. Decompression was done with Rongeur, Kerrison punches, and scissor. Foraminotomy also performed for lateral recess stenosis. Hemostasis were achieved with bipolar electrocautery and Gelform packing. One epidural hemovac was placed. The wound was then closed in layres with 2-0 Vicryl and 3-0 Nylon. Operators VS陳敞牧 Assistants R4李振豪, R1方怡婷 陳欣然 (M,1932/04/02,79y11m) 手術日期 2010/10/28 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Subdural hematoma 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 00:40 報到 08:05 進入手術室 08:15 麻醉開始 08:20 誘導結束 08:25 抗生素給藥 09:14 手術開始 11:25 手術結束 11:25 抗生素給藥 11:25 麻醉結束 11:33 送出病患 11:35 進入恢復室 12:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 頭顱成形術 1 2 R 手術 慢性硬腦膜下血腫清除術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 記錄__ 手術科部: 外科部 套用罐頭: 1. Cranioplasty, right frontal-parietal-tempo... 開立醫師: 鍾文桂 開立時間: 2010/10/28 11:49 Pre-operative Diagnosis 1. Skull defect, related to head injury with acute subdural hemorrhage and brain swelling,right F-T-P status post craniectomy and hematoma evacuation 2. Chronic subdural hemorrhage, falx cerebri, right frontal region. Post-operative Diagnosis 1. Skull defect, related to head injury with acute subdural hemorrhage and brain swelling,right F-T-P status post craniectomy and hematoma evacuation 2. Chronic subdural hemorrhage, falx cerebri, right frontal region. Operative Method 1. Cranioplasty, right frontal-parietal-temporal. 2. Evacuation of chronic subdural hemorrhage. Specimen Count And Types nil Pathology Nil. Operative Findings 1. Thickened outer membrane of chronic subdural hemorrhage at falx cerebri. Some semisolid yellow-brown hematoma and some motor oil like chronic SDH at falx region. To reach the cSDH, additional craniotomy was done at midline. 2. Cranioplasty was reached. The temporalis muscle defect was repaired with bone cement. Operative Procedures Under ETGA, the patient was placed in supine position and the head was tilted to the left. After shaving,disinfection, and draping, the previous craniectomy wound was incised and the subgaleal plane was dissected. The skull bone edges were exposed. Further craniotomy was achieved for cSDH removal. The dura mater was incised. After a small corticotomy, the hematoma was reached and evacuated with suction. The dura mater was closed in water tight fashion. The craniectomy bone plate was fixed with miniplates and screws. After dural tenting and placing one subgaleal CWV drain, the wound was closed in layers. Operators V.S. 王國川 Assistants R5鍾文桂 R1洪誌健 蔡弦恩 (F,1991/07/29,20y7m) 手術日期 2010/10/28 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 Head Injury 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 11:10 報到 11:50 進入手術室 11:52 麻醉開始 12:00 誘導結束 12:20 抗生素給藥 12:29 手術開始 14:40 手術結束 14:40 麻醉結束 14:50 送出病患 14:52 進入恢復室 16:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 頭顱成形術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 記錄__ 手術科部: 外科部 套用罐頭: Cranioplasty. 開立醫師: 鍾文桂 開立時間: 2010/10/28 15:02 Pre-operative Diagnosis Skull bone defect, left frontal-temporal-parietal( head injury with severe brain swelling status post craniectomy) Post-operative Diagnosis Skull bone defect, left frontal-temporal-parietal( head injury with severe brain swelling status post craniectomy) Operative Method Cranioplasty. Specimen Count And Types nil Pathology Nil. Operative Findings 1. The contour defect due to resection of temporalis muscle was repaired with bone cement. 2. Intact dura mater. 3. Difficult wound closure due to poor scalp condition. Operative Procedures Under ETGA, the patient was placed in supine position and the head was tilted to the right. After shaving, disinfection, and draping,the previous craniectomy scalp incision was incised and dissection along the subgaleal space was achieved with blunt dissection. The skull bone border was dissected from the scar tissue. The craniectomy bone plate was fixed by mini plates and screws. Further cranioplasty was achieved with bone cement. The wound was closed in layers after placing one subgaleal drain. Operators V.S. 王國川 Assistants R5 鍾文桂 相關圖片 吳永清 (M,1957/09/05,54y6m) 手術日期 2010/10/28 手術主治醫師 王國川 手術區域 東址 005房 02號 診斷 Hydrocephalus 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 12:00 報到 12:53 進入手術室 13:00 麻醉開始 13:05 誘導結束 13:24 抗生素給藥 13:48 手術開始 14:30 手術結束 14:30 麻醉結束 14:40 進入恢復室 14:40 送出病患 15:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 李振豪 開立時間: 2010/10/28 14:50 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunt via right Kocher"s point Specimen Count And Types 1 piece About size:10ml Source:CSF for routine, BCS, and culture Pathology Nil Operative Findings The opening pressure is more than 15cmH2O. The CSF is clear. The ventricular and peritoneal catheters are 7cm and 30cm in length respectively. 長安 burr hole type median pressure reservoir is used. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine position with head rotated to left. The scalp was shaved, scrubbed, and disinfected as usual. 5cm curvilinear scalp incision was made at right frontal area and the scalp flap had been lifted and reflected anteriorly. A burr hole was made at right Kocher"s point followed by two dural tenting stitches. A transverse skin incision was made at right upper abdomen and the subcutaneous soft tissue and rectus abdominis muscle were splitted to exposed the peritoneum. Minilaparotomy was performed and the peritoneal cavity was entered under direct vision. A subcutaneous tunnel was created via right upper abdomen, forechest, neck to right retroauricular area. A 1cm scalp incision was made at right retroauricular area and the shunt was passed throught the tunnel. The dura was opened by a nib incision and right lateral ventricle was tapped by a ventricular needle. Then a 7cm segment of the ventricular catheter was introduced into the ventricle. The shunt system was set up and the function was checked. the peritoneal catheter was placed into peritoneal cavity. Hemostasis was achieved and the wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS王國川 Assistants R4李振豪 相關圖片 林秉禾 (M,1971/10/05,40y5m) 手術日期 2010/10/29 手術主治醫師 杜永光 手術區域 東址 003房 02號 診斷 Brain Tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 游健生, 時間資訊 13:10 報到 13:28 進入手術室 13:35 麻醉開始 14:12 誘導結束 14:30 抗生素給藥 14:50 手術開始 18:10 麻醉結束 18:10 手術結束 18:18 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 經由蝶竇之腦下垂體瘤切除 1 1 摘要__ 手術科部: 外科部 套用罐頭: Hypophysectomy---Transphenoid 開立醫師: 游健生 開立時間: 2010/10/29 18:29 Pre-operative Diagnosis Chordoma, sellar turcica Post-operative Diagnosis Chordoma, sellar turcica Operative Method Hypophysectomy---Transphenoid Specimen Count And Types 1 piece About size:a few pieces Source:tumor Pathology Pending Operative Findings The tumor was grayish-yellow and firm in consistence. It located inside the bone matrix that expanded the bone. It also extended anteriorly. Surrounding tissue adhesion was noted. Intraoperative CSF leak was noted. Operative Procedures Under ETGA, patient was in supine position with head tilted 30 degree to left. The face was prepared with povidone-iodine alcohol tincture, and the mucosa of oral and nasal cavity with aqueous povidone-iodine tincture. The former areas were covered by a sterilized adhesive plastic sheet. The nasal submucosa at septum and floor were infiltrated with 1:100 epinephrine solution. An incision was made at the inferior margin of the nasal septum. The mucosa of nasal septum was dissected away from the septal cartilage from anterior to posterior and displaced laterally by a long nasal speculum. The septal cartilage was cut at its basal juction by sepatal scissors and then displaced to one side. A Hardys nasal speculum was applied to displace the nasal mucosa laterally and keep the nasal cavity open constantly for the exposure of the vomer bone and the anterior wall of the sphenoid sinus. The exposed sinus mucosa was coagulated and resected after sinuse was opened. The sellar floor was penetrated by a osteotome, then widened by Kerrison punch. A tumor was noted inside sellar floor after we drilled off the outer cortex. We removed it in piecemeal. Intraoperative CSF leak was noted. The leak was sealed with Gelfoam, Surgicel, and Tissucol Duo. The venous oozing was stopped by gelfoam packing. The sellar floor was reconstructed by a piece of bone graft from sellar floor between the dura and the margin of the sellar floor. The Hardys nasal speculum was removed and the nasal mucosa returned to its normal position. Each side of the nasal cavities was tightly packed with a merocel strip which had been soacked with Better-iodine ointment. Operators Prof. 杜永光 Assistants R6 胡朝凱 R3 游健生 李余勇 (M,1971/05/11,40y10m) 手術日期 2010/10/29 手術主治醫師 賴達明 手術區域 東址 005房 03號 診斷 Intracerebral hemorrhage (ICH) 器械術式 External ventricular drainage 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 陳國瑋, 鍾文桂, 時間資訊 16:58 進入手術室 17:00 麻醉開始 17:05 誘導結束 17:16 抗生素給藥 18:00 手術開始 18:52 19:30 麻醉結束 19:30 手術結束 19:35 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 氣管切開術 1 0 R 手術 顱內壓視置入 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: 1. Right EVD insertion for ICP monitoring 2. ... 開立醫師: 陳國瑋 開立時間: 2010/10/29 20:04 Pre-operative Diagnosis ICH with respiratory failure status post EVD insertion Post-operative Diagnosis ICH with respiratory failure status post EVD insertion Operative Method 1. Right EVD insertion for ICP monitoring 2. Tracheostomy Specimen Count And Types Tip culutre*II and CSF analysis Pathology nil Operative Findings 1. Bilateral previous EVD were occluded with blood clot Operative Procedures The patient with endotracheal tube was put in supin position. The scalp was shaved, disinfected and the two EVD were removed and two sets of tip culture were sent. Drapping was done as usual. Right EVD insertion was done through previous burr hole. CSF routine and culture were sent. The wound was closed in layers with Vycrl and Nylone. The skin disinfection was done from mandible to lower border of bilateral clavicles. Drapping was done as usual. Lineal incision was done from the inferior border of cricoid cartilage. Dissection was done to expose the tracheal cartilage. One hole was made by electrocautry. Low pressure size of 7.0 was put. Fixation with Nylon was done. Operators VS 賴達明 Assistants R5 鍾文桂 R2 陳國瑋 相關圖片 楊春菊 (F,1952/03/14,60y0m) 手術日期 2010/10/30 手術主治醫師 王國川 手術區域 東址 001房 08號 診斷 Subarachnoid hemorrhage (SAH) 器械術式 Craniotomy(Aneurysms) P-DUH 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3E 紀錄醫師 李振豪, 時間資訊 00:13 進入手術室 00:15 麻醉開始 00:25 誘導結束 01:15 手術開始 04:15 抗生素給藥 06:30 手術結束 06:30 麻醉結束 06:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 開顱術摘除血管病變 - 腦血管瘤 有病徵的 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 摘要__ 手術科部: 外科部 套用罐頭: Left pterional approach and craniectomy for a... 開立醫師: 李振豪 開立時間: 2010/10/30 06:59 Pre-operative Diagnosis A-com aneurysm rupture with diffuse SAH and ICH Post-operative Diagnosis A-com aneurysm rupture with diffuse SAH and ICH Operative Method Left pterional approach and craniectomy for aneurysm clipping Specimen Count And Types 1 piece About size:swab x 1 Source:Skull plate Pathology Nil Operative Findings The aneurysm arised from A-com artery with pointing to right, anterior, and superior. The aneurysm sac shrinkage after clipping. the left A2 segment was patent after the procedure. Third ventriculostomy was tried but failed due to severe brain swelling. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine position with head rotated to right and fixed with Mayfield head clamp. The scalp was shaved, scrubbed, and disinfected as usual. One curvilinear scalp incision was made at left fronto-temporal area and connected with left EVD wound. The scalp flap and temporalis muscle were elevated followed by one 12x8cm craniectomy window. Dural tenting was performed. The Dura was opened with C shape based on skull base. The left optic nerve and internal carotid artery was identified. Adhesionlysis was performed to expose bilateral A1, A2, and chiasma. The aneurysm was noted beneath the left A2. One fenestrated Sugita clip was applied for aneurysm clipping. Third ventriculostomy was tried but failed due to swell of the brain. Hemostasis was achieved and the duroplast with autologous fascia was done. The temporalis muscle was transected. One epidural CWV was placed and the wound was closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS王國川 Assistants R6胡朝凱, R4李振豪, R1方怡婷 Indication Of Emergent Operation 黃素娥 (F,1956/07/10,55y8m) 手術日期 2010/10/29 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Pituitary tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 游健生, 時間資訊 07:39 報到 08:07 進入手術室 08:12 麻醉開始 08:45 誘導結束 09:10 抗生素給藥 09:55 手術開始 12:19 抗生素給藥 12:45 麻醉結束 12:45 手術結束 12:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經由蝶竇之腦下垂體瘤切除 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Endoscopic endonasal transsphenoid adenomectomy 開立醫師: 游健生 開立時間: 2010/10/29 12:55 Pre-operative Diagnosis Pituitary macroadenoma Post-operative Diagnosis Pituitary macroadenoma Operative Method Endoscopic endonasal transsphenoid adenomectomy Specimen Count And Types 1 piece About size:a few pieces Source:pituitary tumor Pathology Pending Operative Findings The tumor was pinkish and soft. The height was about 3cm, width was 1.9cm, and lenght was 1.9cm. The normal gland was pushed on the right lateral side and suprasellar arachnoid membrane collapsed after tumor excision. No CSF leak was noted. Operative Procedures Under general anethesia and intubation, the patient was put in supine position with head tilted 30 degree to left. The facial skin was antiseptic with alcohol better-iodine tincture, and the mucosa of oral and nasal cavity with aqueous better-iodine. The former area was covered by sterilized adhesive plastic sheets then draped. Under endoscope, the nasal mucosa was coagulated at both norstril and dissected to exposure of the vomer bone and the anterior wall of the sphenoid sinus. The anterior sphenoid sinus wall as well as the posterior part of vomer bone were removed by high speed air drill and Kerrison punch. The sellar floor dura was coagulated then opened in cruciate fashion. The soft tumor parenchyma was removed by curette and aligator. After tumor removal, the normal pituitary gland was seen and arachnoid membrane collapsed. Some tumor was further removed between arachnoid membrane folds. The sellar was packed with Gelfoam to achieve hemostasis. The sellar floor was reconstructed with pieces of bone grafts. The sphenoid sinus was packed with Gelfoam and Surgicels. Finally the anterior wall of sphenoid sinus was reconstructed with pieces of bone grafts and supported with Gelfoam. Both sides of nasal cavities were tightly packed with a merocel strip which had been soaked with better-iodine ointment. Operators Prof. 杜永光 VS 楊士弘 Assistants R6 胡朝凱 R3 游健生 蔡添財 (M,1956/04/05,55y11m) 手術日期 2010/10/29 手術主治醫師 葉德輝 手術區域 東址 023房 04號 診斷 Lymphoma 器械術式 FESS 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3 紀錄醫師 蘇家弘, 時間資訊 14:48 報到 15:32 進入手術室 15:40 麻醉開始 15:45 誘導結束 15:55 抗生素給藥 16:05 手術開始 16:47 手術結束 16:47 麻醉結束 16:55 送出病患 17:00 進入恢復室 18:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Glucose 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 手術 多竇副鼻竇手術 1 1 L 記錄__ 手術科部: 內科部 套用罐頭: Functional endoscopic sinus surgery, left 開立醫師: 蘇家弘 開立時間: 2010/10/30 20:45 Pre-operative Diagnosis Chronic paranasal sinusitis, left Post-operative Diagnosis Ditto, operated Operative Method Functional endoscopic sinus surgery, left Specimen Count And Types 1 piece About size:several pieces Source:Left nasal cavity and sinus tissue Pathology pending Operative Findings Left infun.:OK( )edematous( )polypoid( )polyp( )mucopus( )fungus( )cyst( ) A.Eth.:OK( )edematous( )polypoid(+)polyp( )mucopus( )fungus( )cyst( ) P.Eth: OK( )edematous( )polypoid( )polyp( )mucopus( )fungus( )cyst( ) Maxi.: OK( )edematous( )polypoid( )polyp( )mucopus( )fungus(+)cyst( ) Fron.: OK( )edematous( )polypoid( )polyp( )mucopus( )fungus( )cyst( ) Sph.: OK( )edematous( )polypoid( )polyp( )mucopus( )fungus( )cyst( ) septal deviation to ________ bony variation of uncinate process :R( )L( ) enlarged ethmoid bulla :R( )L( ) prominent agger nasi :R( )L( ) concha bullosa :R( )L( ) others : 1. Left maxillary sinus mucosa thickening Operative Procedures (1) Infundibulotomy :R( )L(+) (2) Opening/trimming of ethmoid bulla :R( )L(+) anterior ethmoid :R( )L(+) agger nasi :R( )L( ) frontal recess :R( )L( ) middle turbinate :R( )L(+) (3) Opening/trimming of ground lamella :R( )L( ) posterior ethmoid :R( )L( ) sphenoid sinus :R( )L( ) (4) Widening of maxillary ostium :R( )L(+) aspiration :R( )L(+) irrigation :R( )L(+) (5) Packing with Merocel :R( )L(x1) Vaseline gauze :R( )L( ) Betta-iodine gauze :R( )L( ) Fingerstall :R( )L(x2) Operators 葉德輝, Assistants 蘇家弘, 薛婉儀, 邱劉碧蓮 (F,1952/03/30,59y11m) 手術日期 2010/10/29 手術主治醫師 黃書健 手術區域 東址 017房 02號 診斷 Meningioma 器械術式 Pulmonary thromboendarterectomy 手術類別 緊急手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 4E 紀錄醫師 莊民楷, 時間資訊 16:43 通知急診手術 16:44 開始NPO 16:44 臨時手術NPO 19:27 進入手術室 19:30 麻醉開始 19:40 誘導結束 20:08 手術開始 21:00 抗生素給藥 21:26 開始輸血 23:20 手術結束 23:20 麻醉結束 23:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 肺動脈塞切除術 1 1 手術 體外心肺循環 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 T.E.E 1 0 麻醉 Lactic Acid (lactate) 3 0 麻醉 動脈血液檢查全套 3 0 麻醉 Hemoglobin (Hb) 3 0 麻醉 測血糖 3 0 麻醉 Ca (Calcium) 3 0 麻醉 Na (Sodium) 3 0 麻醉 K (Potassium) 3 0 麻醉 Blood gas analysis 3 0 摘要__ 手術科部: 外科部 套用罐頭: Pulmonary thrombo-embolectomy 開立醫師: 莊民楷 開立時間: 2010/10/30 00:32 Pre-operative Diagnosis Pulmonary embolism, with cardiogenic shock Post-operative Diagnosis Pulmonary embolism, with cardiogenic shock Operative Method Pulmonary thrombo-embolectomy Specimen Count And Types 1 piece About size:4x2cm Source:PA thrombus Pathology pending Operative Findings 1. preoperative PAP 39/22 2. preoperative TEE: severe RA, RV dilatation 3. much thrombus was removed from branches of left PA, mainly from LLPA 4. ECMO was not weaned off after the operation, due to poor RV contractility Operative Procedures 1. ETGA, supine 2. Disinfection and drapping 3. Midline sternotomy 4. AsAo, RAA→IVC/RA→SVC cannulation; on partial CPB, under 34 degree and beating heart, turn off ECMO 5. MPA incision with LPA extension; remove thromboemboli from branches of bilateral PA with forcep and suction 6. Repair MPA, rewarm, wean off CPB, turn on ECMO 7. Hemostasis, set two chest tubes 8. Close the wound in layers Operators VS 黃書健 Assistants R5 徐綱宏, R3 莊民楷 Indication Of Emergent Operation 林惠美 (F,1957/06/10,54y9m) 手術日期 2010/10/29 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 陳國瑋, 時間資訊 07:44 報到 08:00 進入手術室 08:15 麻醉開始 08:30 誘導結束 08:40 抗生素給藥 09:18 手術開始 10:35 麻醉結束 10:35 手術結束 10:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除-手術時間在4小時以內 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Frontal craniotomy with Simpson grade I tumor... 開立醫師: 陳國瑋 開立時間: 2010/10/29 11:00 Pre-operative Diagnosis right frontal falcine meningioma Right frontal falcine meningioma Post-operative Diagnosis right frontal falcine meningioma Right frontal falcine meningioma Operative Method Frontal craniotomy with Simpson grade I tumor excision Specimen Count And Types 1 piece About size:3cm in diameter Source:brain tumor Pathology Pending Operative Findings 1.One yellowish to whitish, firm tumor located at right frontal falcine. 2.The border was clear. No vasculature encasement. 2.The border was clear. No vasculature encasement. 3. Dural invasion into the falx was noted and excised with diameter of 2cm Operative Procedures Under ETGA, patient was put in supine position. Bicoronal skin incision was done at forehead. Skin flap was dissected and opened. After burr holes drilled, craniotomy was performed as a 5x5 cm bone window that cross midline, followed by dural tenting. U shape dural incision was made with the base left at midline. The tumor was excised by gently dissection through the interface between tumor and brain tissue. The tumor that attach to the falx was curreted. Vascular perforation was cauterized. The part of flax that invaded by the tumor was excised and the left frontal lobe was exposed. Hemostasis was then performed. After then, dura was closed with one piece of fascia. The wound was closed in layers. Under ETGA, patient was put in supine position. Bicoronal skin incision was done at forehead. Skin flap was dissected and opened. After burr holes drilled, craniotomy was performed as a 5x5 cm bone window that cross midline, followed by dural tenting. U shape dural incision was made with the base left at midline. The tumor was excised by gently dissection through the interface between tumor and brain tissue. The tumor that attach to the falx was curreted. Vascular perforation was cauterized. The part of flax that invaded by the tumor was excised and the left frontal lobe was exposed. Hemostasis was then performed. After then, dura was closed with one piece of fascia. The bone was put back and the gap was sealed with bone cement. The wound was closed in layers. Operators VS 曾漢民 Assistants R5 鍾文桂 R2 陳國瑋 吳國賢 (M,1972/10/03,39y5m) 手術日期 2010/10/29 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Acoustic tumor 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 2 紀錄醫師 陳國瑋, 時間資訊 10:13 報到 11:03 進入手術室 11:20 麻醉開始 11:58 抗生素給藥 12:00 誘導結束 12:19 手術開始 14:58 抗生素給藥 16:10 麻醉結束 16:10 手術結束 16:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除-手術時間在4小時以內 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: C-P Angle Tumor 開立醫師: 陳國瑋 開立時間: 2010/10/29 17:00 Pre-operative Diagnosis Left vestibular Schwannoma Post-operative Diagnosis Left vestibular Schwannoma Operative Method Tumor excision via retrosigmoid craniotormy,left. Tumor excision via retrosigmoid craniotomy,left. Specimen Count And Types 1 piece About size:20ml Source:brain tumor Pathology Pending Operative Findings 1. The cerebellum was pushed by the tumor toward the dura matter, and it slacked after tumor removal and CSF drainage. 2. One well-defined, firm, whitish to pinkish tumor was noted. The part near the internal acoustic meatus was stiff, and the rest is soft. Some calcification was also noted. 3. CN V, CN VII-CN VIII complex were identified and preserved after tumor removal. The CN VII-CN VIII complex was paper-thin due to tumor compression. 4. The extra-canalicular portion of the tumor was resected totally to relieve brainstem compression. The intracanalicular portion( about 1.7 cm in length) was left intact for functional preservation. Management plan for intracanalicular portion: radiosurgery. 5. The mastoid air cell was opened and sealed with bone wax. Operative Procedures Under ETGA, the patient was placed in supine position and the head was fixed by Mayfield and tilted to the right side. After shaving, disinfection and draping, a curvilinear 15-cm scalp incision was made about 3 cm medial to pinna. After dissection, a 5 cm craniotomy was created. The transverse-sigmoid junction was identified. The opened mastoid air cell was sealed with bone wax. After durotomy, the CSF was drained from pre-pontine cistern for further exposure. The tumor was identified with retraction of cerebellum posteriorly. The tumor was resected in piece meal fashion after central debulking. Well hemostasis was achieved with bipolar electrocautery, gelfoam and surgicel. The dura mater was repaired with fasica graft and sealed in water-tight fashion. The craniotomy was fixed with mini-plates and screws. The wound was closed in layers. Operators V.S. 曾漢民 Assistants 鍾文桂 陳國瑋 林正昇 (M,1956/07/10,55y8m) 手術日期 2010/10/29 手術主治醫師 賴達明 手術區域 東址 001房 03號 診斷 Cervical spondylosis 器械術式 Lamino plasty 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 10:35 報到 10:50 進入手術室 10:55 麻醉開始 11:15 誘導結束 11:30 抗生素給藥 12:02 手術開始 14:40 手術結束 14:40 麻醉結束 14:45 送出病患 14:48 進入恢復室 16:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 手術 椎弓整形術 1 1 摘要__ 手術科部: 神經部 套用罐頭: C3~6 laminoplasty + C7 partial laminectomy 開立醫師: 李振豪 開立時間: 2010/10/29 15:02 Pre-operative Diagnosis Cervical stenosis with myelopathy Post-operative Diagnosis Cervical stenosis with myelopathy Operative Method C3~6 laminoplasty + C7 partial laminectomy Specimen Count And Types nil Pathology Nil Operative Findings Total 4 pieces of miniplates(5 holes x 3 and extended 4 holes x 1) and 8 screws(5mm x 4, 7mm x 4) were used for laminoplasty. The thecal sac expanded well after laminoplasty. No CSF leakage was noted during the procedure. The muscle power recovered to pre-operative status in the POR. 1. Total 4 pieces of miniplates(5 holes x 3 and extended 4 holes x 1) and 8 screws(5mm x 4, 7mm x 4) were used for laminoplasty. The thecal sac expanded well after laminoplasty. No CSF leakage was noted during the procedure. The muscle power recovered to pre-operative status in the POR. 2. One 4cm in diameter lipoma was noted at C6~C7 level. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in prone position with head fixed with Mayfield scalp clamp. The skin was shaved, scrubbed, and disinfected as usual. Midline skin incision was made from C2 to C7 level. The subcutaneous soft tissue and muscle group was dissected and detached from the bony structure to expose the lamina of C2-C7. Laminoplasty was performed with high-speed air-drived drills, and kerrison punches. The ligment was removed also for decompression. The lamina was elevated to toward left side and fixed with miniplates and screws. Hemostasis was achieved with bipolar electrocautery and Gelform packing. One epilaminal CWV drain was placed and the wound was closed in layers with 2-0 Vycryl and 3-0 Nylon. Under endotracheal tube general anesthesia, the patient was put in prone position with head fixed with Mayfield scalp clamp. The skin was shaved, scrubbed, and disinfected as usual. Midline skin incision was made from C2 to C7 level. The subcutaneous soft tissue and muscle group was dissected and detached from the bony structure to expose the lamina of C2-C7. Laminoplasty was performed with high-speed air-drived drills, and kerrison punches. The ligment was removed also for decompression. The tips of C3-6 spinous process was tailed. Partial C7 laninectomy was performed also with drills and kerrison punches. The lamina was elevated toward left side and fixed with miniplates and screws. Hemostasis was achieved with bipolar electrocautery and Gelform packing. One epilaminal CWV drain was placed and the wound was closed in layers with 2-0 Vycryl and 3-0 Nylon. Operators VS賴達明 Assistants R4李振豪, Ri謝瑩 Indication Of Emergent Operation 王淑真 (F,1956/05/16,55y9m) 手術日期 2010/10/29 手術主治醫師 賴達明 手術區域 東址 019房 02號 診斷 Spondylolisthesis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 2 紀錄醫師 方怡婷, 時間資訊 12:10 報到 12:40 進入手術室 12:45 麻醉開始 13:00 誘導結束 13:20 抗生素給藥 13:35 手術開始 17:00 手術結束 17:00 麻醉結束 17:15 送出病患 17:16 進入恢復室 19:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-腰椎 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 摘要__ 手術科部: 外科部 套用罐頭: 1.L4-5 PLIF with PEEK and TPS 2.Lumbar diskec... 開立醫師: 陳德福 開立時間: 2010/10/29 16:59 Pre-operative Diagnosis L4 on 5 spondylolisthesis with instability Post-operative Diagnosis L4 on 5 spondylolisthesis with instability Operative Method 1.L4-5 PLIF with PEEK and TPS 2.Lumbar diskectomy, L4/5 Specimen Count And Types nil Pathology nil Operative Findings 1.There is grade II spondylolisthesis over L4-5 with instability and spinal stenosis. The hypertrophic ligamentum flavum and facet joint was removed for decompression. 2.Two 9mm interbody cages and 4 TPSs was implantated at the L4-5. The partial L4 laminectomy was done and the nerves were decompressed after the procedure. Operative Procedures Under ETGA and prone position, the skin was disinfected and draped as usual. One linear incision at midline was done and we approach the TPS insertion point with paramedium approach. The L4-5 TPS was then implantated under C-arm flouroscope. The L4 laminectomy was done. The L4/5 diskectomy was done and 2 interbody cages were inserted thereafter. The rods were implantated. One hemovac was left in situ. The wound was then closed in layers. Operators VS 賴達明 Assistants r5陳德福 r1方怡婷 劉昭惠 (F,1960/12/07,51y3m) 手術日期 2010/10/29 手術主治醫師 侯君翰 手術區域 西址 035房 02號 診斷 Trigger finger, acquired 器械術式 Triger finger 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 13:25 報到 13:45 進入手術室 13:58 麻醉開始 14:00 手術開始 14:10 麻醉結束 14:10 手術結束 14:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 板機指手術 1 1 R 摘要__ 手術科部: 骨科部 套用罐頭: Trigger finger 開立醫師: 黃志逢 開立時間: 2010/10/29 14:08 Pre-operative Diagnosis right middle trigger finger Post-operative Diagnosis right middle trigger finger s/p A1 pulley release Operative Method A1 pulley release Specimen Count And Types nil Pathology nil Operative Findings entrapment of right middke flexor digit tendon in A1 pulley Operative Procedures 1. under anesthesia, supine position 2. skin disinfection and drapping as usual 3. logitudinal incision of the volar side of 3rd metacarpo-phalangeal joints 4. dissect to the site of A1 pulley and release 5. irrigation of the woundwith normal saline 6. check bleeding and hemostasis 7. close the wound in layers Operators 侯君翰, Assistants 黃志逢, 陳彥宇, 羅月娟 (F,1948/02/08,64y1m) 手術日期 2010/10/31 手術主治醫師 王國川 手術區域 東址 003房 04號 診斷 Acute miliary tuberculosis 器械術式 Ommaya reservoir implantation 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3E 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 04:00 進入手術室 04:05 麻醉開始 04:10 誘導結束 04:26 抗生素給藥 04:36 開始輸血 04:53 手術開始 06:00 手術結束 06:00 麻醉結束 06:10 送出病患 06:10 進入恢復室 07:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 歐氏貯囊置放手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 內科部 套用罐頭: Implantation of Ommaya reservoir via right Ko... 開立醫師: 鍾文桂 開立時間: 2010/10/31 06:40 Pre-operative Diagnosis Tuberculous meningitis with acute hydrocephalus. Post-operative Diagnosis Tuberculous meningitis with acute hydrocephalus. Operative Method Implantation of Ommaya reservoir via right Kocher point. Specimen Count And Types 1 piece About size:3 cc Source:CSF Pathology Nil. Operative Findings Easy oozing scalp and brain parenchyma. Pre-op platelet: 79K s/p transfusion 24U platelet. Codman Ommaya reservoir: 6.5cm. Clear colorless CSF, low pressure. Operative Procedures Under ETGA, the patient was placed in supine position and the head was in midline. After shaving and disinfection, a curvilinear scalp incision was made. A burr hole was created by using high speed drill. After durotomy, ventriculostomy was done. The Ommaya reservoir was implanted through the same tract. After well hemostasis, the wound was closed primarily. Operators V.S. 王國川 Assistants R5 鍾文桂 Indication Of Emergent Operation 記錄__ 手術科部: 內科部 套用罐頭: Implantation of Ommaya reservoir via right Ko... 開立醫師: 鍾文桂 開立時間: 2010/10/31 06:42 Pre-operative Diagnosis Meningitis with acute hydrocephalus. Post-operative Diagnosis Meningitis with acute hydrocephalus. Operative Method Implantation of Ommaya reservoir via right Kocher point. Specimen Count And Types 1 piece About size:3 cc Source:CSF Pathology Nil. Operative Findings Easy oozing scalp and brain parenchyma. Pre-op platelet: 79K s/p transfusion 24U platelet. Codman Ommaya reservoir: 6.5cm. Clear colorless CSF, low pressure. Operative Procedures Under ETGA, the patient was placed in supine position and the head was in midline. After shaving and disinfection, a curvilinear scalp incision was made. A burr hole was created by using high speed drill. After durotomy, ventriculostomy was done. The Ommaya reservoir was implanted through the same tract. After well hemostasis, the wound was closed primarily. Operators V.S. 王國川 Assistants R5 鍾文桂 Indication Of Emergent Operation 葉雪淳 (M,1930/01/18,82y1m) 手術日期 2010/10/31 手術主治醫師 黃國皓 手術區域 東址 005房 03號 診斷 Malignant neoplasm of prostate 器械術式 right DBJ insertion 手術類別 緊急手術 手術部位 腹 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 鄭淳心 ASA 4E 紀錄醫師 伍嘉偉, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 00:00 通知急診手術 01:40 進入手術室 01:45 麻醉開始 01:48 誘導結束 02:00 手術開始 03:08 麻醉結束 03:08 手術結束 03:15 送出病患 03:20 進入恢復室 04:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 經尿道膀胱頸切開術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 記錄__ 手術科部: 泌尿部 套用罐頭: TUR-BN 開立醫師: 伍嘉偉 開立時間: 2010/10/31 03:25 Pre-operative Diagnosis 1. prostate cancer 2. right obstructive uropathy Post-operative Diagnosis 1. benign prostate hyperplasia 2. bladder neck contracture 3.right obstructive uropathy Operative Method Transurethral resection of the bladder neck, palliative Specimen Count And Types pending Pathology pending Operative Findings 1. 7g of prostatic tissue was resected 2. marked intravesicle growth, severe trabeculation with multiple diverticulum 3. bilateral orifice can not be found 4. urethral stricture Operative Procedures Under satisfactory spinal anesthesia, the patient was placed in lithotomy position. Prepping and draping were performed in the usual sterile method. Urethral stricture was noted and a Fr 27. Olympus resectoscope sheath was inserted into the urethra with adequate lubrication. Then the resectoscope was inserted. The bladder neck was resected with cutting loop piece after piece. Bilateral orifice can not be found. The chips were washed out with a Ellik evacuator. Hemostasis was done. A 22 Fr. 3-way Foley catheter was inserted and its balloon was inflated to 20c.c. Continuous N/S irrigation started. The patient tolerated the operation well and was sent to the recovery room with stable condition. Operators 黃國皓, Assistants 伍嘉偉, 賴建榮, Indication Of Emergent Operation 林鎮禮 (M,1937/10/13,74y5m) 手術日期 2010/10/30 手術主治醫師 蔡瑞章 手術區域 東址 003房 01號 診斷 Thoracic spondylosis 器械術式 Laminectomy for decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 陳德福, 時間資訊 07:36 報到 07:57 進入手術室 08:10 麻醉開始 08:20 誘導結束 08:39 抗生素給藥 09:35 手術開始 11:39 抗生素給藥 14:15 手術結束 14:15 麻醉結束 14:25 送出病患 14:28 進入恢復室 16:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術(減壓)-超過二節 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: 1.Laminectomy T9-11 開立醫師: 陳德福 開立時間: 2010/10/30 14:31 Pre-operative Diagnosis Spondylosis with spinal stenosis and myelopathy, T10-11 Post-operative Diagnosis Spondylosis with spinal stenosis and myelopathy, T10-11 Operative Method 1.Laminectomy T9-11 Specimen Count And Types nil Pathology nil Operative Findings 1.There is a 1*1*0.8cm in sized osteophyte with cord compression at the level of T10-11. The hypertrophic ligamentum flavum is noticed at adjacent level with moderate cord compression. 2.After laminectomy, the thecal sac reexpanded well. 3.No dura tear or root injury noticed during this procedure. Operative Procedures Under ETGA and prone position, the skin was disinfected and draped as usual. The T9-11 level was identified under C-arm fluroscope and one linear incision at midline was done. The paraspinous muscle was displaced laterally followed by laminectomy. The osteophyte at the T10-11 was removed with air drill assisted. One epidural hemovac was left in situ and the wound was closed in layers. Operators P 蔡瑞章 Assistants R5 陳德福 張勝雄 (M,1941/02/19,71y0m) 手術日期 2010/10/30 手術主治醫師 王國川 手術區域 東址 002房 04號 診斷 Head injury 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 4E 紀錄醫師 蕭惠壬, 時間資訊 10:22 臨時手術NPO 10:22 開始NPO 18:28 通知急診手術 19:15 麻醉開始 19:45 進入手術室 20:15 誘導結束 20:20 抗生素給藥 20:30 手術開始 22:00 開始輸血 00:40 手術結束 00:40 麻醉結束 00:50 送出病患 23:20 抗生素給藥 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 1 B 手術 腦內血腫清除術 1 2 B 手術 顱內壓視置入 1 4 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Right crainectomy for hematoma evacuation and... 開立醫師: 曾峰毅 開立時間: 2010/10/31 02:25 Pre-operative Diagnosis Bilateral frontal contusional ICH Post-operative Diagnosis Bilateral frontal contusional ICH Operative Method Right crainectomy for hematoma evacuation and ICP monitor insertion. Left craniotomy for ICH evacuation. Specimen Count And Types Nil Pathology Nil Operative Findings Bilateral frontal ICH was removed. Severe adhesion between skull and dura was noted. Brain pulsation was satisfactory after hematoma removal. ICP was about 6mmHg after scalp closure, but climbed to 33mmHg after ICU arrival. EDH is likely. ICP monitor reference is 482. Operative Procedures After endotracheal general anaesthesia, the patient was put in supine position. After scalp shaved, scrubbed, disinfected, and then draped, we made one curvilinear skin incision from right frontal to left frontal area. Scalp flap was reflected, and then created 8 burr holes at right, followed with craniectomy. Dura tear was severe after craniectomy. Right frontal hematom was removed, and then hematoma cavity was paved with Surgicels for hemostasis. Right temporalis muscles was transected, and fascia was harvested. Duroplasty was done with autologous fascia graft, dura garft, and Durofoam. ICP monitor was inserted into subdural space. 5 burr holes was made at left frontal area, and followed by cranitomy. Left frontal hematoma was removed after durotomy. Duroplasty was done with durofoam. After 2 subgaleal CWV inserted, we closed the wound in layers. Operators VS 陳敞牧 Assistants R4 曾峰毅 R2 蕭惠壬 Indication Of Emergent Operation 王智弘 (M,1997/06/07,14y9m) 手術日期 2010/10/30 手術主治醫師 楊士弘 手術區域 東址 003房 02號 診斷 Langerhans' cell histiocytosis 器械術式 Spinal fusion posterior 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 2E 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 07:47 通知急診手術 14:35 進入手術室 14:40 麻醉開始 15:20 誘導結束 15:45 抗生素給藥 16:22 手術開始 18:21 開始輸血 22:35 手術結束 22:35 麻醉結束 22:45 送出病患 22:45 進入恢復室 23:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 惡性脊髓腫瘤切除術 1 1 手術 脊椎融合術-後融合,有固定物(<=六節) 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 8 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: 1. Excision of extraspinal tumor. 開立醫師: 鍾文桂 開立時間: 2010/10/30 23:16 Pre-operative Diagnosis Extradural spinal tumor with pathologic compression fracture, T4. Post-operative Diagnosis Extradural spinal tumor with pathologic compression fracture, T4. Operative Method 1. Excision of extraspinal tumor. 1. Transpedicular excision of extraspinal tumor. 2. T4 laminectomy and corpectomy, T3 hemilaminectomy. 3. Internal fixation with transpedicle screws, T2-T6; Posterolateral fusion, T2-T6. Specimen Count And Types 2 pieces About size:10cc Source:T4 vertebral bone About size:10 cc Source:Extradural tumor Pathology Pending. Operative Findings 1. Encasesed bilateral T4 nerve roots by the tumor mass. Both were resected. 2. The tumor is soft, grayish, and easy oozing. It located mainly in vertebral body and passed through the posterior longitudinal ligament and spread to anterior and lateral regions of spinal canal at T4 and lower T3 level,then pushed the spinal cord posteriorly. After tumor excision, the cord has good pulsation. 1. Encasesed bilateral T4 nerve roots by the tumor mass. Both were divided and clipped. 2. The tumor is soft, grayish, and easy oozing. It located mainly in vertebral body and passed through the posterior longitudinal ligament and spread to anterior and lateral regions of spinal canal at T4 and lower T3 level,then pushed the spinal cord posteriorly. After tumor excision, the cord has good pulsation. 3. A small iatrogenic durotomy was suspected. No further CSF leakage was noted after gelfoam packing. 4. Internal fixation apparatus: 互裕: Screws, poly: T5&6: 5.5x40mm; T3:4.5x35mm; T2:4.5x30mm Rods: 110mm, bilateral, no interlink. Operative Procedures Under ETGA, the patient was placed in prone position. After localization of T4 level with intraoperative fluoroscopy, a 20 cm midline incision was made. Paraspinal dissection was reached to expose T2 to T7 levels. After laminectomy of T4 and lower T3 level, the tumor was dissected from the dura mater and posterior longitudinal ligament. The tumor was resected in piece meal fashion. For further resection, bilateral T4 roots were sacrafized. Corpectomy was reached with curets. After well hemostasis, the transpedicle screws were implanted under the guidance of intraoperative fluoroscopy. After placing two 1/8 hemovac drain, the wound was closed in layers. Operators V.S. 楊士弘 Assistants R5 鍾文桂 Indication Of Emergent Operation 相關圖片 林見勳 (M,1975/06/25,36y8m) 手術日期 2010/10/30 手術主治醫師 王國川 手術區域 東址 005房 01號 診斷 Brain contusion 器械術式 Spinal fusion anterior spinal 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 鍾文桂, 陳國瑋, 時間資訊 08:20 進入手術室 08:25 麻醉開始 08:35 誘導結束 09:55 手術開始 11:00 抗生素給藥 14:50 手術結束 14:50 麻醉結束 14:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-頸椎 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 脊椎融合術-前融合,有固定物(每增加<=四節) 1 2 手術 脊椎融合術-前融合,有固定物)≦四節 1 2 記錄__ 手術科部: 外科部 套用罐頭: 1. Microsurgical diskectomy, C6/7. 開立醫師: 鍾文桂 開立時間: 2010/10/30 15:45 Pre-operative Diagnosis 1. Odontoid fracture, type II. 2. Subluxation, C6-7. 3. Ankylosing spondylitis. Post-operative Diagnosis 1. Odontoid fracture, type II. 2. Subluxation, C6-7. 3. Ankylosing spondylitis. Operative Method 1. Microsurgical diskectomy, C6/7. 2. Internal fixation with plates and screws, C5-T1 Interbody fusion, C6/7. 3. Internal fixation with single lag screw, C2. Specimen Count And Types nil Pathology Nil. Operative Findings 1. Subluxation fracture at C6/7 level, instability was noted. 2. T1 to C2 prevertebral space was exposed for fixation. Part of C3 vertebral body was excised for better fixation of lag screw(44mm) 3. Interbody fusion with PEEK cage. Internal fixation with one plate and screws at C6/7/T1 levels. Operative Procedures Under ETGA, the patient was placed in supine position and the neck was extended. After disinfection and draping, a horizontal linear incision was made at right anterior neck. After dissection, the C6/7 level was identified. Diskectomy, interbody fusion and internal fixation were completed. The position of implantation apparatus were ensured by intraoperative fluoroscopy. Then, anterior superior part of C3 verteberal body was excised by Kerrison. K-pin was inserted as initial guide of lag screw. Then, the lag screw was implanted. Its position was ensure by intraoperative fluoroscopy. Finally the wound was closed in layers after placing one prevertebral CWV drain. Operators V.S. 王國川 Assistants 鍾文桂 陳國瑋 相關圖片 王仁勝 (M,1959/07/16,52y7m) 手術日期 2010/10/30 手術主治醫師 王國川 手術區域 東址 002房 03號 診斷 Head Injury 器械術式 Removal of epidural hematoma，ICP monitoring 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 4E 紀錄醫師 陳國瑋, 陳德福, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 15:05 進入手術室 15:08 麻醉開始 15:15 誘導結束 15:47 手術開始 19:20 手術結束 19:20 麻醉結束 19:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 1 L 手術 顱內壓視置入 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: Hematoma evacualtion and ICP monitoring insertion 開立醫師: 陳國瑋 開立時間: 2010/10/30 19:49 Pre-operative Diagnosis Traumatic frontal and left temporal intracerebral hemorrhage Post-operative Diagnosis Traumatic frontal and left temporal intracerebral hemorrhage Operative Method Hematoma evacualtion and ICP monitoring insertion Specimen Count And Types nil Pathology Nil Operative Findings 1. Contusional ICH at fontal and left tempotal was noted and one fracture line was noted at forehead. 2. The brain was slacked after hematoma removed 3. The ICP after wound closure: 0 mmHg Operative Procedures Under ETGA and supine position, the scalp was disinfeced and draped as usual. One curvilinear incision over the left frontal scalp was done and the pterional craniotomy was performed. The dura tenting is done followed by durotomy. The SDH gushed out spontaneously and the ICH was then removed by sucker, and bipolar assisted. The bleeders were coagulized and the rough surface of the parenchyma was covered with surgicelle. The dura was closed in water tight fasion with augmentation and the skull was fixed with miniplates. One subgaleal CWV and one ICP monitor were left in situ and the wound was closed in layers. Operators VS 王國川 Assistants R5 陳德福 R2 陳國瑋 Indication Of Emergent Operation 王晨允 (F,2010/10/19,1y4m) 手術日期 2010/10/31 手術主治醫師 黃書健 手術區域 兒醫 068房 01號 診斷 Hypoplastic left heart syndrome, congenital 器械術式 TCPC,JATENE,TAPVR,NORWOOD 手術類別 緊急手術 手術部位 胸 傷口分類 清潔 麻醉方式 無麻醉 麻醉主治醫師 ASA 1 紀錄醫師 張得一, 時間資訊 13:19 開始NPO 13:19 通知急診手術 13:19 臨時手術NPO 13:40 手術開始 14:20 手術結束 醫令資訊 類別 名稱 量 刀 側 手術 探查性心包膜切開術 1 2 記錄__ 手術科部: 外科部 套用罐頭: Sternal wound debridement 開立醫師: 張得一 開立時間: 2011/01/07 17:30 Pre-operative Diagnosis HLHS s/p Norwood operation Post-operative Diagnosis HLHS s/p Norwood operation Operative Method Sternal wound debridement Specimen Count And Types culture x 1 Pathology Operative Findings No active bleeder Operative Procedures Under general anesthesia, the pericardial cavity was debrided and irrigated with N/S. Operators VS張重義 VS黃書健 Assistants R3張得一 Indication Of Emergent Operation 李余勇 (M,1971/05/11,40y10m) 手術日期 2010/10/31 手術主治醫師 賴達明 手術區域 東址 002房 01號 診斷 Intracerebral hemorrhage (ICH) 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 4E 紀錄醫師 李振豪, 時間資訊 12:17 通知急診手術 14:02 進入手術室 14:04 麻醉開始 14:15 誘導結束 14:39 手術開始 15:33 手術結束 15:33 麻醉結束 15:38 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室體外引流 1 2 B 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Left Kocher"s EVD insertion + right Kocher"s ... 開立醫師: 李振豪 開立時間: 2010/10/31 16:11 Pre-operative Diagnosis Intraventricular hemorrhage with hydrocephalus, status post external ventricular drainage Post-operative Diagnosis Intraventricular hemorrhage with hydrocephalus, status post external ventricular drainage Operative Method Left Kocher"s EVD insertion + right Kocher"s EVD revision Specimen Count And Types 1 piece About size:8ml Source:CSF for routine, BCS, and culture Pathology Nil Operative Findings The opening pressure is about 25cmH2O after left Kocher"s EVD insertion. The right Kocher"s EVD is obstructed by blood clot and the tube was flashed with normal saline. Operative Procedures Under tracheostomy general anesthesia, the patient was put in supine position. The scalp was shaved, scrubbed, and disinfected as usual. Left frontal scalp incision was made along previous scar and the burr hole was identified. The granulation tissue was removed and the EVD was placed into left lateral ventricle. Externalization was performed and the tube was fixed with 6cm in depth from burr hole. Hemostasis was achieved and the wound was closed in layers. Right frontal wound was opened for EVD revision. The tube was pulled out with normal saline flashing. The blood clot gushed out from the tube. The tube was replaced via right Kocher"s point. Normal saline infusion from left side EVD was performed but did not drain out from right side EVD. So we pulled out right side EVD again and the tube was obstructed by the clot again. The tube was flashed again and placed back into right lateral ventricle. Hemostasis was achieved and the wound was closed in layers. Operators VS賴達明 Assistants R4李振豪 Indication Of Emergent Operation 相關圖片 邱劉碧蓮 (F,1952/03/30,59y11m) 手術日期 2010/10/31 手術主治醫師 曾漢民 手術區域 東址 000房 號 診斷 Meningioma 器械術式 Wound treatment-- <5cm 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 無麻醉 麻醉主治醫師 ASA 1 紀錄醫師 張得一, 時間資訊 15:20 手術開始 16:30 手術結束 09:47 臨時手術NPO 醫令資訊 類別 名稱 量 刀 側 手術 末稍血管修補及吻合術 1 2 記錄__ 手術科部: 外科部 套用罐頭: ECMO removal 開立醫師: 張得一 開立時間: 2010/11/25 12:55 Pre-operative Diagnosis Pulmonary embolism s/p ECMO Post-operative Diagnosis Pulmonary embolism Operative Method ECMO removal Specimen Count And Types nil Pathology Operative Findings Preop BP 143/81, CVP 14, HR 93, SpO2 100% Postop BP 120/78, CVP 18, HR 126, SpO2 100% Operative Procedures Under general anesthesia, left SFA and SFV explored. Vessel repair by 5-0 and 6-0 prolene respectively. Wound closure in layers Operators VS 黃書健 Assistants R4徐綱宏 R3 張得一 朱鄭瑞燕 (F,1936/08/15,75y6m) 手術日期 2010/11/01 手術主治醫師 賴達明 手術區域 東址 002房 03號 診斷 Predominant disturbance of consciousness 器械術式 Craniotomy for ICH evacuation 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 4E 時間資訊 17:30 開始NPO 22:32 通知急診手術 23:45 進入手術室 23:50 麻醉開始 00:00 誘導結束 00:05 抗生素給藥 00:45 手術開始 03:05 抗生素給藥 04:15 手術結束 04:15 麻醉結束 04:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱內壓視置入 1 2 L 手術 腦內血腫清除術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 內科部 套用罐頭: 1. Evacuation of intracerebral hemorrhage. 開立醫師: 鍾文桂 開立時間: 2010/11/01 04:11 Pre-operative Diagnosis Ischmic infact with hemorrhagic transformation, left frontal-parietal-temporal. Post-operative Diagnosis Ischmic infact with hemorrhagic transformation, left frontal-parietal-temporal. Operative Method 1. Evacuation of intracerebral hemorrhage. 2. Placement of ICP monitor( Codman). Specimen Count And Types nil Pathology Pending. Operative Findings 1. Some hard and soft intracerebral hemorrhage with infact brain parenchyma were noted intraoperatively. Slack brain after hematoma removal. 2. ICP after wound closure: -5mmHg. 3. Severe adhesion of dura mater to skull bone, dural defect was repaired by DuraFoam. 4. Preoperative GCS: E1V1M5. Pupil: 3/3. Operative Procedures Under ETGA, the patient was placed in supine position and the head was tilted to right. After shaving, disinfection, and draping, a curvilinear scalp incision was made. After dissection of temporalis muscle and scalp, a 10 cm craniotomy bone plate was achieved with high speed drill and craniotome. After dural tenting and durotomy, the hematoma and infacted brain parenchyma were evacuated by suction and tumor forceps. Well hemostasis was achieved with surgicel. ICP monitor was placed in subdural space. After dural repair with DuraFoam and fixation of bone plate with screws and plates, the wound was closed in layers with one CWV drain. Operators 賴達明 Assistants 李振豪 鍾文桂 黃 李振豪 鍾文桂 Indication Of Emergent Operation 張勝雄 (M,1941/02/19,71y0m) 手術日期 2010/10/31 手術主治醫師 陳敞牧 手術區域 東址 003房 01號 診斷 Head injury 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 4E 紀錄醫師 蕭惠壬, 時間資訊 01:18 通知急診手術 01:20 進入手術室 01:22 開始輸血 01:22 麻醉開始 01:25 誘導結束 01:33 手術開始 02:10 手術結束 02:10 麻醉結束 02:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 硬腦膜外血腫清除術 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 曾峰毅 開立時間: 2010/10/31 02:30 Pre-operative Diagnosis Epidural hematoma after craniectomy Post-operative Diagnosis Epidural hematoma after craniectomy Operative Method Epidural hematoma removal Specimen Count And Types Nil Pathology Nil Operative Findings Diffuse bleeder from scalp edge was noted. Epidural hematoma was about 1cm. ICP after ICU arrival was 0. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to left. After scalp disinfected and draped, we made skin incision at right frontal area along previous skin incisin. Epidural hematoma was removed, and hemostasis was done. We closed the wound in a layers after inserting one subgaleal CWV in addition to another two. Operators VS 陳敞牧 Assistants R4 曾峰毅 R2 蕭惠壬 Indication Of Emergent Operation 楊如忠 (M,1962/06/09,49y9m) 手術日期 2010/11/01 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Glioblastoma multiforma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 鍾文桂, 時間資訊 07:45 報到 08:00 進入手術室 08:15 麻醉開始 08:28 抗生素給藥 08:32 手術開始 08:40 誘導結束 11:40 抗生素給藥 12:45 麻醉結束 12:45 手術結束 12:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Excision of brain tumor, right pterional tran... 開立醫師: 鍾文桂 開立時間: 2010/11/01 13:20 Pre-operative Diagnosis High grade glioma, right insula. Post-operative Diagnosis High grade glioma, right insula. Glioblastoma multiforme, right insula. Operative Method Excision of brain tumor, right pterional transsylvian approach. Specimen Count And Types 1 piece About size:5 cc Source:Right insular tumor. Pathology Frozen pathology: glioblastoma multiforme. Operative Findings 1. Intraaxial grayish-pinkish soft tumor with moderate vascularity. The removed tumor bed was covered with Floseal and surgicel. 2. The MCA branches were well perserved during dissection of middle portion of sylvian fissure. The caudate nucleus was met and preserved during tumor excision. 3. The sphenoid ridge was removed by Rongeur for gaining access to sylvian fissure. Operative Procedures Under ETGA, the patient was placed in supine position and the head was fixed with Mayfield and tilted to left. After shaving,disinfection, and draping, a curvilinear scalp incision was made. Then, a craniotomy was done by using craniotome and high speed drill. The sphenoid ridge was further resected for exposure. After durotomy, the sylvian fissure was dissected and opened. The tumor was noted after opening of sylvian fissure. The tumor was excised in piecemeal fashion. After well hemostasis, the dura mater was closed in watertight fashion. The bone plate was fixed with mini plates and screws. The wound was closed in layers after placing one subgaleal CWV drain. Operators V.S. 曾漢民 Assistants 鍾文桂 相關圖片 王晨允 (F,2010/10/19,1y4m) 手術日期 2010/11/01 手術主治醫師 黃書健 手術區域 ICU 000房 號 診斷 Hypoplastic left heart syndrome, congenital 器械術式 TCPC,JATENE,TAPVR,NORWOOD 手術類別 緊急手術 手術部位 胸 傷口分類 清潔 麻醉方式 無麻醉 麻醉主治醫師 ASA 1 紀錄醫師 張得一, 時間資訊 00:00 開始NPO 00:00 臨時手術NPO 16:55 手術開始 17:45 手術結束 醫令資訊 類別 名稱 量 刀 側 手術 探查性心包膜切開術 1 2 記錄__ 手術科部: 外科部 套用罐頭: Sternum closure 開立醫師: 張得一 開立時間: 2010/12/09 18:06 Pre-operative Diagnosis HLHS s/p Norwood operation Post-operative Diagnosis HLHS s/p Norwood operation Operative Method Sternum closure Specimen Count And Types culture x 1 Pathology Operative Findings No active bleeding Operative Procedures Under general anesthesia, the sternum wound was debrided with N/S irrigation. Then sternum and wound was closed in layers Operators VS 張重義 VS 黃書健 Assistants R3張得一 Indication Of Emergent Operation 蔡清林 (M,1951/03/13,61y0m) 手術日期 2010/11/01 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Brain Tumor 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 古恬音, 時間資訊 07:50 報到 08:03 進入手術室 08:10 麻醉開始 09:00 誘導結束 09:00 抗生素給藥 09:10 手術開始 12:00 抗生素給藥 15:00 抗生素給藥 17:55 麻醉結束 17:55 手術結束 18:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 12 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 手術 顱底瘤手術 1 1 L 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Left pterional approach for tumor excision 開立醫師: 胡朝凱 開立時間: 2010/11/01 18:18 Pre-operative Diagnosis Craniopharyngioma, status post left keyhole approach for subtotal excision, with recurrence Post-operative Diagnosis Craniopharyngioma, status post left keyhole approach for subtotal excision, with recurrence Operative Method Left pterional approach for tumor excision Specimen Count And Types Piecies of tumor, about 1gm Pathology Pending Operative Findings Subdural adhesion was noted upon durotomy, and previous subdural hemorrhage was suspected. There was some elastic blood clots within the Sylvian fissure. The tumor was yellowish and firm, sized 2*2cm. The content of cystic part was yellowish, thick, and semi-fluid. Calcification of the solid part was noted at the posterior aspect of the tumor. There was severe postoperative adhesion between the tumor, the left ICA, and the left optic nerve. Left P-com artery and anterior choroidal artery were pushed aside by the tumor. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head turned to right and fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected with better iodine. Draping was done in sterile fashion. A curvillinear scalp incision was made on the left side as the bicoronal fashion which extended 6cm beyond midline. One 8*10cm craniotomy window was made after drilling 4 burr holes. Durotomy was done after peripheral tenting. The Sylvian fissure was opened, and the blood clot within was removed. Frontal lobe and temporal lobe were then separated until exposure of the ICA and optic nerve. The tumor was removed by CUSA after peripheral dissection. After hemostasis, the tumor bed was lined with Surgicel. Dura was repaired with prolene, and the skull plate was fixed back with miniplates. After setting on subgaleal CWV drain, the wound was closed in layers. Operators P杜永光 Assistants R6胡朝凱,R3古恬音 張陳素月 (F,1956/06/14,55y9m) 手術日期 2010/11/01 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Pituitary tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 2 紀錄醫師 鍾文桂, 時間資訊 12:45 報到 13:00 進入手術室 13:05 麻醉開始 13:35 抗生素給藥 13:35 誘導結束 13:55 手術開始 15:20 麻醉結束 15:20 手術結束 15:23 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 經由蝶竇之腦下垂體瘤切除 1 1 記錄__ 手術科部: 外科部 套用罐頭: Transsphenoidal pituitary adenomectomy. 開立醫師: 鍾文桂 開立時間: 2010/11/01 15:58 Pre-operative Diagnosis Pituitary macroadenoma. Post-operative Diagnosis Pituitary macroadenoma. Operative Method Transsphenoidal pituitary adenomectomy. Specimen Count And Types 2 pieces About size:3 cc Source:pituitary adenoma,sellar portion About size:5cc Source:pituitary adenoma, sphenoid portion. Pathology pending. Operative Findings 1. Small nostrils. 2. Hard vomer bone. Disrupted nasal mucosa. 3. Presence of CSF leakage, packed with gelfoam and TissuCoDuo. 4. The sphenoidal portion of the adenoma was removed along with sinus mucosa. The sellar portion was removed and the arachnoid membrane was seen. Operative Procedures Under general anethesia and intubation, the patient was put in supine position. The facial skin was antiseptic with alcohol, and the mucosa of oral and nasal cavity with aqueous better-iodine. The face was covered with sterilized adhesive plastic sheets then draped. Under microscope, nasal septum was incised, and a nasal speculum was applied to displace the nasal mucosa laterally and keep the nasal cavity open constantly for the exposure of the vomer bone and the anterior wall of the sphenoid sinus. The anterior sphenoid wall, sphenoid sinus mucosa and sella floor were removed along with the sphenoidal portion of the adenoma. The dura was coagulated then opened in cruciate fashion. The tumor was removed by curette and aligator. The CSF leakage was sealed with Tissuecol Duo and gelform packing. The bone of anterior sphenoid wall was placed back and the nasal mucosa was returned to its normal position. The nasal mucosa was sealed with Tissuecol Duo. Operators V.S. 曾漢民 Assistants R5 鍾文桂 相關圖片 陳美珠 (F,1956/03/14,56y0m) 手術日期 2010/11/01 手術主治醫師 曾漢民 手術區域 東址 005房 03號 診斷 Brain metastasis 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 鍾文桂, 時間資訊 15:48 進入手術室 15:50 麻醉開始 16:00 誘導結束 16:25 抗生素給藥 16:49 手術開始 19:20 手術結束 19:20 麻醉結束 19:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 記錄__ 手術科部: 外科部 套用罐頭: Excision of brain tumor and evacuation of int... 開立醫師: 鍾文桂 開立時間: 2010/11/01 20:04 Pre-operative Diagnosis Left occipital metastatic tumor. Left parietal-occipital metastatic tumor. Post-operative Diagnosis Left occipital metastatic tumor with intratumoral bleeding. Left parietal- occipital metastatic tumor with intratumoral bleeding. Operative Method Excision of brain tumor and evacuation of intratumoral hematoma via left occipital transcortical approach. Specimen Count And Types 1 piece About size:3CC Source:LEFT OCCIPITAL TUMOR Pathology Pending. Operative Findings 1. Liquified hematoma in the tumor cavity. Pink-grayish and some light yellowish soft fragile tumor in left occipital region along the cystic wall. Intraoperative ultrasonography was used for localization of tumor mass. After excision of the tumor, falx cerebri was met. 2. The superior sagital sinus was exposed and stayed intact during operation. Operative Procedures Under ETGA, the patient was placed in prone position and the head was fixed in Mayfield. After shaving, disinfection, and draping, a hokey stick scalp incision was made. A craniotomy was achieved with high speed drill. After durotomy, we localized the tumor by using ultrasonography. After corticotomy, the liquified hematoma gushed out. After hematoma evacuation, the tumor was excised in piecemeal fashion. After well hemostasis, the wound was closed in layers with one subgaleal CWV drain. Operators 曾漢民 Assistants 鍾文桂 相關圖片 高林淑美 (F,1940/04/01,71y11m) 手術日期 2010/11/01 手術主治醫師 賴達明 手術區域 東址 002房 04號 診斷 Cerebellar hemorrhage 器械術式 Craniotomy(Aneurysms) Others, craniectomy, decompression, posterior fossa 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 4E 紀錄醫師 陳德福, 時間資訊 15:48 開始NPO 15:48 通知急診手術 16:15 進入手術室 16:15 報到 16:17 麻醉開始 16:30 誘導結束 16:35 開始輸血 16:39 手術開始 16:45 抗生素給藥 20:00 麻醉結束 20:00 手術結束 20:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 1 手術 顱內壓視置入 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 內科部 套用罐頭: 1.suboccipital craniectomy for ICH evacuation... 開立醫師: 陳德福 開立時間: 2010/11/01 20:22 Pre-operative Diagnosis right cerebellar ICH with brain stem compression Post-operative Diagnosis right cerebellar ICH with brain stem compression Operative Method 1.suboccipital craniectomy for ICH evacuation 2.ICP monitoring Specimen Count And Types nil Pathology nil Operative Findings 1.The initial ICP after right Frazier EVD insertion: 7-8cmH2O 2.The cerebellum protrudes after the dura opening via the suboccipital craniectomy. 30-40ml ICH was evacuated from the right cerebellum. IVH and SAH was noticed during the operation. 3.After the operation, the ICP was around 1cmH2O. Operative Procedures Under ETGA and prone position with Mayfield head fixator fixation, the skin was disinfected and draped as usual. One linear incision at the right Frazier point was done followed by inserting a EVD. Linear incision at midline and the suboccipital craniectomy was done for decompression. The dura was then opened in Y shape and the ICH was evacuated via transcortical route. Hemostasis and the dura augmentation procedure was done. One epidural CWV was left in situ and the wound was closed in layers. Operators VS賴達明 Assistants R5 陳德福 R4林哲光 Indication Of Emergent Operation 黃忠義 (M,1968/12/01,43y3m) 手術日期 2010/11/01 手術主治醫師 蕭輔仁 手術區域 東址 018房 02號 診斷 Intraventricular hemorrhage 器械術式 External ventricular drainage 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 王奐之, 時間資訊 12:12 臨時手術NPO 09:32 報到 09:32 進入手術室 09:35 麻醉開始 09:40 誘導結束 10:12 手術開始 11:00 麻醉結束 11:00 手術結束 11:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室體外引流 1 2 L 摘要__ 手術科部: 外科部 套用罐頭: bilateral EVD insertion 開立醫師: 陳德福 開立時間: 2010/11/01 11:15 Pre-operative Diagnosis ICH with hydrocephalus Post-operative Diagnosis ICH with hydrocephalus Operative Method bilateral EVD insertion Specimen Count And Types nil Pathology nil Operative Findings High pressure xanthochromatous CSF gushed out upon ventriculostomy. Medtronic EVD, set 7cm. bilateral. Operative Procedures Under ETGA, the patient was placed in supine position and the head was in midline position. After shaving, disinfection, and draping, a horizontal linear incision was made. Then, a burr hole was done with high speed drill. After durotomy, the ventricular puncture needle was inserted at right Kocher point. Another EVD at the left Kocher point was inserted as well. The EVD was inserted via the same tract and the drainage system was connected. Finally, the wound was closed in layers. Operators V.S. 蕭輔仁 Assistants R3王奐之 R5陳德福 相關圖片 馬景鵬 (M,1958/12/13,53y3m) 手術日期 2010/11/02 手術主治醫師 王一中 手術區域 東址 010房 02號 診斷 Cataract 器械術式 Phaco+PCIOL 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 09:47 進入手術室 10:20 手術開始 10:35 手術結束 10:40 送出病患 記錄__ 手術科部: 眼科部 套用罐頭: Phacoemulsification and PCIOL implantation (od ) 開立醫師: 麥珮怡 開立時間: 2010/11/02 10:29 Pre-operative Diagnosis Cataract (od ) Post-operative Diagnosis Cataract (od ) Operative Method Phacoemulsification and PCIOL implantation (od ) Specimen Count And Types nil Pathology nil Operative Findings Cataract (od ) Operative Procedures 1. Under retrobulbar anesthesia. 2. Disinfection, irrigation and draping. 3. Application of an eyelid speculum. 4. Made a clear corneal incision and penetrate into AC with 2.5mm trapezoid knife at 10 oclock position. 5. Inject Viscoat into the anterior chamber. 6. Continuous circular capsulorrhexis was done with bent needle and capsular forceps. 7. Made a sideport at 2 oclock position with the MVR blade. 8. Hydrodissection and hydrodelineation were done with BSS.9. Phacoemulsification of the nucleus by standard divide-and-conquer technique. 10. Aspiration of the residual cortical material with I/A tube. 11. Extend the cornea wound to 3.2mm by diamond knife. 12. Foldable PCIOL was implanted into the bag after injection of Viscoat. 13. The residual Viscoat was washed out by Simcoe I/A cannula. 14. Inject BSS into AC and check leakage, and inject Miostat to AC to constrict the pupil 15. Stromal hydrationof the wound with BSS 16. Subconjunctival injection of Rinderon and Garamycin. 17. Maxitrol patching. Operators 王一中, Assistants R3麥珮怡 李朝枝 (M,1940/04/15,71y10m) 手術日期 2010/11/02 手術主治醫師 陳敞牧 手術區域 東址 001房 02號 診斷 Multiple bone metastasis 器械術式 Diskectomy thoracic 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 2 紀錄醫師 林哲光, 時間資訊 23:25 開始NPO 07:25 通知急診手術 09:50 報到 10:39 進入手術室 10:45 麻醉開始 11:50 誘導結束 12:20 手術開始 13:09 開始輸血 16:25 手術結束 16:25 麻醉結束 16:35 送出病患 16:36 進入恢復室 18:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 2 手術 惡性脊髓腫瘤切除術 1 1 記錄__ 手術科部: 外科部 套用罐頭: T7 laminectomy and tumor excision with poster... 開立醫師: 林哲光 開立時間: 2010/11/02 17:10 Pre-operative Diagnosis Multiple spine metastasis with T7 cord compression Post-operative Diagnosis Ditto Operative Method T7 laminectomy and tumor excision with posterior fusion at T5-T8 Specimen Count And Types 1 piece About size:multiple pieces Source:tumor Pathology Pending Operative Findings Compression fracture was noted at T7 body and some soft-elastic mass lesion was noted mainly over the left side of the sublaminal space and intervertebral space. The dura sac seemed reexpanded well after laminectomy was done. TPS 5.5x35mmx4 were inserted over T5, T6 and 5.5x40mm were inserted over T8. A cross link and two rods were inserted. Operative Procedures Under ETGA and prone position, skin disinfected and drapped were performed as usual. Midline skin incision was made. The paraspinal muscles were detached and TPS were inserted and checked with Portable X-ray. T7 laminectomy was then performed. SOme tumor was dissected with Currettege. The wound was then closed in layers after hemostasis and one epidural exudrain inserted. Operators VS 陳敞牧 Assistants R4 林哲光 Indication Of Emergent Operation 相關圖片 徐銘夆 (M,1982/12/05,29y3m) 手術日期 2010/11/02 手術主治醫師 林峰盛 手術區域 東址 005房 04號 診斷 Low back pain 器械術式 Nerve block / PC 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 硬肌麻醉 麻醉主治醫師 林峰盛 ASA 1 時間資訊 16:25 進入手術室 16:27 麻醉開始 16:30 誘導結束 16:35 手術開始 17:10 手術結束 17:10 麻醉結束 17:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 硬脊膜外麻醉 1 0 摘要__ 手術科部: 麻醉部 套用罐頭: Intrathecal catheter implantation 開立醫師: 林昱廷 開立時間: 2010/11/02 17:23 Pre-operative Diagnosis failed back syndrome Post-operative Diagnosis failed back syndrome Operative Method caudal epidural block Specimen Count And Types nil Pathology Operative Findings Operative Procedures 1. put patient in prone position. 2. IVGA 3. Check saccral hiatus by ultrasound. determine optimal insertion area. 4. Disinfection as usual. 5. Insert 18G puncture needle into caudal epidural space. Thread the 19G non-kinking catheter under real time fluroscope guide to the desired level. 6. Injected contrast media, which showed epidural obstruction at L5/S1 level 7. Injected 1mg Rideron in 0.5 % xylocaine 4 ml Operators 林峰盛, Assistants 林昱廷, 沈銘榤 (M,1948/11/27,63y3m) 手術日期 2010/11/02 手術主治醫師 吳毅暉 手術區域 東址 016房 03號 診斷 Embolism and thrombosis of iliac artery 器械術式 PAOD stent insertion 手術類別 緊急手術 手術部位 四肢 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 黃俊銘, 時間資訊 13:20 報到 13:30 進入手術室 13:55 麻醉開始 14:00 麻醉結束 14:02 抗生素給藥 14:05 手術開始 14:40 手術結束 14:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 血管整形術 1 0 摘要__ 手術科部: 外科部 套用罐頭: PTA + thrombolytic catheter placement 開立醫師: 黃俊銘 開立時間: 2010/11/02 16:02 Pre-operative Diagnosis ALI, Gr.II Post-operative Diagnosis Ditto Operative Method PTA + thrombolytic catheter placement Specimen Count And Types nil Pathology Nil Operative Findings Right CIA-EIA total thrombosis After PTA with 6*80*80 balloon, right CIA is still not patent Thrombolytic catheter placed from bifurcation to right CFA Operative Procedures Skin disinfect, draping, LA Puncture to right SFA Wiring to abdominal aorta PTA of right CIA-EIA with 6*80*80 balloon Insert thrombolytic catheter Complete angiography Operators 吳毅暉 Assistants 黃俊銘 莊民楷 Indication Of Emergent Operation 沈銘榤 (M,1948/11/27,63y3m) 手術日期 2010/11/03 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Embolism and thrombosis of iliac artery 器械術式 Craniotomy(Aneurysms) Others 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 4E 紀錄醫師 陳德福, 時間資訊 22:52 開始NPO 22:52 臨時手術NPO 22:52 通知急診手術 23:15 進入手術室 23:15 報到 23:20 麻醉開始 23:50 誘導結束 00:10 開始輸血 00:38 手術開始 05:00 抗生素給藥 05:20 麻醉結束 05:20 手術結束 05:25 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦內血腫清除術 1 1 B 手術 顱內壓視置入 1 2 B 摘要__ 手術科部: 外科部 套用罐頭: 其他 Pre-operative Diagnosis ALI, Gr.II Post-operative Diagnosis Ditto Operative Method PTA + thrombolytic catheter placement Specimen Count And Types nil Pathology Nil Operative Findings Right CIA-EIA total thrombosisAfter PTA with 6*80*80 balloon, right CIA is still not patentThrombolytic catheter placed from bifurcation to right CFA/ Operative Procedures Skin disinfect, draping, LAPuncture to right SFAWiring to abdominal aortaPTA of right CIA-EIA with 6*80*80 balloonInsert thrombolytic catheterComplete angiography/ Operators 吳毅暉 Assistants 黃俊銘 莊民楷 Indication Of Emergent Operation 摘要__ 手術科部: 外科部 套用罐頭: 1.Craniotomy ICH evacuation 2.EVD insertion f... 開立醫師: 陳德福 開立時間: 2010/11/03 05:35 Pre-operative Diagnosis left cingulate gyrus ICH with IVH Post-operative Diagnosis left cingulate gyrus ICH with IVH Operative Method 1.Craniotomy ICH evacuation 2.EVD insertion for ICP monitoring Specimen Count And Types nil Pathology nil Operative Findings 1.There is 50-60ml ICH at the left cingulate gyrus with IVH. The brain was swelling before the ICH evacuation and we evacuated the ICH with transcortical route [parietal-occipital junction]. 2.1 EVD was left in the operation coridor and another EVD was inserted at the right Kocher point. Operative Procedures Under ETGA and prone position, the scalp was disinfected and draped as usual. One curvilinear incision was done followed by craniotomy. The dura was opening in C shape and the ICH was localized by ultrasonography. The transcortical approach was done for ICH evacuation. While CSF drained out, one EVD was left in situ. Hemostasis and closed the dura in water tight fasion. The skull was fixed with miniplates and the wound was closed in layers. Then set the patient in supine position and insert one EVD at the right Kocher point. Operators VS賴達明 Assistants R5 陳德福 R4林哲光 Indication Of Emergent Operation 高佳萍 (F,1979/02/07,33y1m) 手術日期 2010/11/02 手術主治醫師 賴達明 手術區域 東址 003房 號 診斷 Dermoid, Epidermal cyst 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 2 紀錄醫師 李振豪, 時間資訊 08:15 報到 08:20 麻醉開始 08:20 進入手術室 09:00 誘導結束 09:10 抗生素給藥 10:12 手術開始 12:10 抗生素給藥 15:10 抗生素給藥 18:10 抗生素給藥 21:20 麻醉結束 21:20 手術結束 21:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 18 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Right retro-sigmoid and subtemporal approach ... 開立醫師: 李振豪 開立時間: 2010/11/02 22:22 Pre-operative Diagnosis right CP angle tumor, favor epidermoid cyst Post-operative Diagnosis right CP angle tumor, favor epidermoid cyst Operative Method Right retro-sigmoid and subtemporal approach for tumor excision Specimen Count And Types 1 piece About size:20g Source:Brain tumor Pathology Pending Operative Findings The tumor was silver-white, soft, fragile, hypovascularized, and well-capsuled in character. The capsule was adhered with brain parenchyma. The location of the right side CN 5,7,8,9,10,11 were displaced due to the tumor. The right CN 6 were encased in the tumor and thin layer of the capsule was left in situ to avoid injury of the nerve. The temporal extension of the tumor was localized by intra-operative sonography. The left side CN6 was noted after removal of the tumor. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in 3/4 prone position with head fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. Reverse U scalp incision with retroauricular extension was made at right temporooccipital area. The scalp flap was elevated. The temporalis muscle and right nuchal muscle group were elevated and divided. 5 burr holes were created followed by one 8x13cm craniotomy window. Dural tenting was performed and partial mastoidectomy was performed to identify the sigmoid sinus. The mastoid air cell was sealed with bone wax. T shape dural incision was made at right retrosigmoid area. After release of CSF, the tumor was identified. Tumor was excised with sucker, ring curette, ring forceps, and tumor forceps. The cranial nerves(CN4,5,6,7,8,9,10,11) were well preserved. Hemostasis was achieved with Surgicel and the dura was closed with 4-0 Prolene. One C-shape dura incision was made at temporal area. Subtemporal approach for tumor excision was performed. The tentorium was incised for removal of the tumor. Intra-operative sonography was used to localize the temporal lobe part of the tumor. Part of the temporal lobe was sacrified for tumor excision. Hemostasis was achieved with Surgicel and bipolar electrocautery. the dura was closed with 4-0 Prolene. Part of the fascia was used as pedicle flap to cover the mastoid air cell. One epidural CWV drain was placed. The skull plate was fixed back with miniplates. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS賴達明 Assistants R4李振豪, R1羅偉誠 何進爐 (M,1954/10/14,57y5m) 手術日期 2010/11/02 手術主治醫師 賴達明 手術區域 東址 023房 04號 診斷 Hydrocephalus 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3 紀錄醫師 王奐之, 時間資訊 13:20 報到 13:50 進入手術室 14:00 麻醉開始 14:10 誘導結束 14:25 抗生素給藥 14:57 手術開始 16:30 手術結束 16:30 麻醉結束 16:35 送出病患 16:45 進入恢復室 18:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 腦室腹腔分流手術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt via right Kocher point 開立醫師: 王奐之 開立時間: 2010/11/02 16:27 Pre-operative Diagnosis Right P-comm aneurysm s/p clipping, with hydrocephalus Right P-comm aneurysm status post clipping, with hydrocephalus Post-operative Diagnosis Right P-comm aneurysm s/p clipping, with hydrocephalus Right P-comm aneurysm status post clipping, with hydrocephalus Operative Method Ventriculoperitoneal shunt via right Kocher point Specimen Count And Types Nil Pathology Nil Operative Findings Clear & colorless CSF was noted. A Codman 10cmH2O-pressured valve was used for reservoir. 3 tubes of CSF specimen were collected for analysis. Ventricular catheter length: 6.5cm. Peritoneal catheter length: 20cm. Operative Procedures After ETGA, the patient was placed in supine position. After skin disinfection and draping in sterile fashion, a curvilinear skin incision was made at right frontal area. Another linear skin incision was made at right side abdomen, further deepened by mini-laparotomy until entering of the peritoneal cavity. A subcutaneous tunnel was then made from abdomen to retroauricular area. After identifying the previous burr hole, ventricular punching was made. The ventricular catheter was then inserted, and connected to the reservoir and the peritoneal catheter. After meticulous hemostasis, the wound was closed in layers. Operators VS 賴達明 Assistants R5 鍾文桂, R3 王奐之 相關圖片 王維錦 (M,1927/03/23,84y11m) 手術日期 2010/11/02 手術主治醫師 賴達明 手術區域 東址 005房 01號 診斷 Other specified pulmonary tuberculosis, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture 器械術式 Spinal fusion anterior spinal 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3 紀錄醫師 陳德福, 時間資訊 08:30 報到 08:34 進入手術室 08:40 麻醉開始 09:10 誘導結束 09:10 抗生素給藥 09:45 手術開始 11:28 開始輸血 12:10 抗生素給藥 14:01 15:10 抗生素給藥 16:40 麻醉結束 16:40 手術結束 16:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-腰椎 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 8 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 椎融合術-前融合,無固定物(≦四節) 1 1 摘要__ 手術科部: 外科部 套用罐頭: 1.Anterior approach L3/4 discectomy with auto... 開立醫師: 陳德福 開立時間: 2010/11/02 17:25 Pre-operative Diagnosis TB spine, L3-5 Post-operative Diagnosis TB spine, L3-5 Operative Method 1.Anterior approach L3/4 discectomy with autologous bone fusion 2.L3-5 fusion with TPS Specimen Count And Types 2 pieces About size:1*2*2cm Source:prevertebral mass About size:1*3*1cm Source:L3/4 disc Pathology pending Operative Findings 1.There is a prevertebral abscess formation over the L3-5 level with L3/4 disc involvement. The L3/4 discectomy was performed and one autologous bone was harvested from the left AIIC for fusion. 2.Previous bone cemen in the L4 body is noticed, however, the bilateral L4 pedicle is erotedad and the L4 body is filled up with soft tissue which failed the L4 TPS implantation. 3.TPS were implantated over the L3 and L5 with one cross link. Operative Procedures Under ETGA and supine position, the abdomen was prepared for surgery. One curvilinear incision over the left lower quadrant abdomen is done and the prevertebral space is exposed with retroperitoneal route. The L3/4 level was check under C-arm flouroscope. The lumbar discectomy was done and 2 pieces of bone was harvested from the left AIIC for L3-4 fusion. 2 drains were left in situ and the wound was closed in layers. Then, the patient was put into prone position. One midline linear incision was done for exposure the L3-5 lamina and facet joints. The TPS were implantated at the L3 and L5. The L4 TPS was failed due to soft vertebral body contexture. The TPS was connected with rods and one cross link. One drain was left in situ. The wound was then closed in layers. Operators VS 賴達明 Assistants R5 陳德福 楊長壽 (M,1947/07/20,64y7m) 手術日期 2010/11/02 手術主治醫師 黃凱文 手術區域 東址 013房 04號 診斷 Hepatic cancer 器械術式 R.F.A 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 2 紀錄醫師 柯惠馨, 時間資訊 12:45 報到 13:02 進入手術室 13:10 麻醉開始 13:15 誘導結束 13:25 手術開始 13:25 抗生素給藥 13:50 手術結束 13:50 麻醉結束 13:55 送出病患 13:58 進入恢復室 17:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 肝腫瘤無線頻率電熱療法－大於５公分（含） 1 0 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Radiofrequency Ablation(RFA) 開立醫師: 柯惠馨 開立時間: 2010/11/02 13:49 Pre-operative Diagnosis Hepatic cancer Post-operative Diagnosis Hepatic cancer Operative Method Radiofrequency Ablation(RFA) Specimen Count And Types nil Pathology Nil Operative Findings Localization of tumor by sonography 5.2*4 cm tumor, RFA for 16 mins. Operative Procedures 1. IVGA with mask, supine position 2. Skin disinfection with B-I. 3. Local anesthesia with Xylocaine. 4. Identify the tumor with intra-operation echo. 5. Perform RFA with 2 needle( 3 cm tip ) to the tumor for 16 mins. 7. Cover the wound with gauze. Operators 黃凱文 Assistants 柯惠馨,葉佳衢 管萬富 (M,1951/10/27,60y4m) 手術日期 2010/11/02 手術主治醫師 王國川 手術區域 東址 027房 03號 診斷 Herniated intervertebral disc (HIVD) 器械術式 Diskectomy cervical(Anterier) 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3E 紀錄醫師 胡朝凱, 時間資訊 23:22 開始NPO 07:22 通知急診手術 14:00 報到 14:19 進入手術室 14:50 麻醉開始 15:05 誘導結束 15:25 抗生素給藥 15:30 手術開始 18:03 手術結束 18:03 麻醉結束 18:10 送出病患 18:13 進入恢復室 19:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎融合術-前融合,無固定物(≦四節) 1 2 手術 椎間盤切除術-頸椎 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Anterior discectomy and cage insertion 開立醫師: 胡朝凱 開立時間: 2010/11/02 18:22 Pre-operative Diagnosis C4~5, 5~6 HIVD Post-operative Diagnosis C4~5, 5~6 HIVD Operative Method Anterior discectomy and cage insertion Specimen Count And Types nil Pathology nil Operative Findings 1.Marginal spur was noted at C4~6 anterior, posterior vertebral body. 2.Protruding disc at C4~5,5~6 level that compressed the nerve root tightly, especially C5~6 level. But there was no obvious ruptured disc was found. Operative Procedures 1.ETGA, supine 2.Right neck transverse skin incision at C5 level 3.Dissect along anterior border of SCM muscle 4.Expose prevertebral space and dissect longus coli muscle 5.Localization of disc 6.Discectomy with currete and disc clamp 7.Drill off posterior marginal spur 8.Remove C5~6 lateral portion disc and PLL 9.6# cage insertion 10.repeat same procedure at C4~5 11.8# cage insertion 12.Hemostasis 13.Close wound in layers after one hemovac drain insertion Operators 王國川 Assistants 胡朝凱 Indication Of Emergent Operation 蕭錦龍 (M,1946/11/01,65y4m) 手術日期 2010/11/03 手術主治醫師 杜永光 手術區域 東址 013房 04號 診斷 Unspecified epilepsy without mention of intractable epilepsy 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 王奐之, 時間資訊 13:35 麻醉開始 13:35 進入手術室 13:40 誘導結束 14:18 手術開始 15:26 手術結束 15:26 麻醉結束 15:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室腹腔分流手術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 曾峰毅 開立時間: 2010/11/03 15:16 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunt via right Kocher point Specimen Count And Types 6ml, colorless, clear CSF was sent for routine exam, BCS, and culture. Pathology Nil Operative Findings Medtronic, fixed medium pressure, ventriculoperitoneal shunt was inserted via right Kocher point. ventricular catheter was about 6.5cm long. Opening pressure was about 20cmH20. Peritoenal catheter was about 20cm long. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position. After skin shaved, scruubed, disinfected, and then draped, we made one transverse skin incision at right upper abdomen. We dissected into peritoneal cavity and inserted peritoneal catheter introducer. We made one curvilinear skin incision at right frontal area, and drilled one burr hole. We created the subcutaneous tunnel and pull through the catheter through the tunnel to right frontal incision wound. After ventricular puncture once, we inserted ventricular catheter, and connected with the system. After checking the shunt function, we inserted the peritoneal shunt into peritoneal space. The wound was closed in layers. Operators P杜永光 Assistants R4 曾峰毅 R3 王奐之 相關圖片 陳古寶玉 (F,1952/03/01,60y0m) 手術日期 2010/11/03 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 古恬音, 時間資訊 07:38 報到 08:05 進入手術室 08:10 麻醉開始 08:30 誘導結束 08:50 手術開始 08:55 抗生素給藥 11:55 抗生素給藥 14:55 抗生素給藥 15:10 麻醉結束 15:10 手術結束 15:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 顱底瘤手術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Right supraorbital keyhole approach for Simps... 開立醫師: 古恬音 開立時間: 2010/11/03 15:18 Pre-operative Diagnosis Right planum sphenoidale meningioma Post-operative Diagnosis Right planum sphenoidale meningioma Operative Method Right supraorbital keyhole approach for Simpson grad II tumor excision Specimen Count And Types 3 peices of tumor, about 2*2cm Pathology Pending Operative Findings The tumor was pinkish, elastic, moderately vascularized, and sized 2cm in diameter. The plane between the tumor and the brain is clear. The right optic nerve was just beneath the tumor and slight compressed by the tumor. Right ACA adhered to the tumor capsule and was released. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head turned to left and fixed with Mayfield skull clamp. The skin was scrubbed with disinfected with better iodine and covered with sterile plastic sheet. One curvillinear skin incision was made within the later 2/3 of right eyebrow. The right supraorbital nerve was identified and preserved. The periosteum was detached in a Y-shaped fashion, followed by keyhole drilling. One small craniotomy window was made just above the orbit, then durotomy was done in a semicircular fashion. The orbital roof was further removed to expose the tumor. The tumor was then detached form planum sphenoidale with bipolar cauterization, and right optic nerve was identified. Dissection was done between the tumor and right frontal lobe. Hemostasis was achieved with bipolar cauterization and Surgicel lining of the dissection plane. Dura was closed with prolene, and bone plate was fixed back with microplates. The wound was then closed in layers. Operators P杜永光 Assistants R6胡朝凱,R3古恬音 莊盈盈 (F,1979/03/12,33y0m) 手術日期 2010/11/03 手術主治醫師 曾漢民 手術區域 東址 003房 02號 診斷 Pituitary tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 古恬音, 時間資訊 15:30 進入手術室 15:35 報到 15:35 麻醉開始 16:05 誘導結束 16:10 抗生素給藥 16:33 手術開始 17:15 開始輸血 18:10 麻醉結束 18:10 手術結束 18:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經由蝶竇之腦下垂體瘤切除 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Hypophysectomy---Transphenoid 開立醫師: 古恬音 開立時間: 2010/11/03 18:35 Pre-operative Diagnosis Pituitary macroadenoma Post-operative Diagnosis Pituitary macroadenoma Operative Method Microscopic transsphenoidal adenomectomy Specimen Count And Types 1 piece About size:about 0.1gm Source:pieces of tumor Pathology Pending Operative Findings The tumor was grayish in color. Excessive venous bleeding was noted during the operation, and the majority of tumor was flused out by the bleeding. Arachnoid pouch was seen at the end of the procedure, and no CSF leakage was noted. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head tilted 30 degree to right. The face and upper abdomen were prepared with povidone-iodine alcohol tincture, and the mucosa of oral and nasal cavity with aqueous povidone-iodine tincture. The former areas were covered by a sterilized adhesive plastic sheet. The mucosa of nasal septum and floor was dissected away from the septal cartilage and the bony floor on both sides from anterior to posterior and displaced laterally by a long nasal speculum. A Hardys nasal speculum was applied to displace the nasal mucosa laterally and keep the nasal cavity open constantly for the exposure of the vomer bone and the anterior wall of the sphenoid sinus. The exposed sinus mucosa was coagulated and resected. The sellar floor was penetrated by a osteotome, then widened by Kerrison punch. The tumor was flushed out by the blood flow, and bleeding was stopped wiyh applying Floseal and packing. The skull base was covered with Gelfoam and bone chips, then bilateral nostrils were packed with glove fingers. Operators VS曾漢民 Assistants R6胡朝凱 呂竹松 (M,1942/12/02,69y3m) 手術日期 2010/11/03 手術主治醫師 蔡瑞章 手術區域 東址 012房 05號 診斷 Nasopharyngeal cancer 器械術式 Port-A catheter implatation 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 許皓淳, 時間資訊 14:30 進入手術室 14:35 麻醉開始 14:40 誘導結束 14:40 抗生素給藥 14:55 手術開始 15:40 手術結束 15:40 麻醉結束 15:45 送出病患 15:46 進入恢復室 16:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 port–A導管植入術–治療性導管植入術 1 0 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 摘要__ 手術科部: 外科部 套用罐頭: Port-A catheter implantation 開立醫師: 李振豪 開立時間: 2010/11/03 15:46 Pre-operative Diagnosis Nasopharyngeal carcinoma with intracranial extension Post-operative Diagnosis Nasopharyngeal carcinoma with intracranial extension Operative Method Port-A catheter implantation Specimen Count And Types nil Pathology Nil Operative Findings Fr 7.5 Chemosite Port-A catheter was implanted via left subclavian vein and fixed at 18cm in depth. The tip of the catheter was within SVC. Operative Procedures Under intravenous general anesthesia, the patient was put in supine position. The skin was disinfected, draped, and draped as usual. Linear skin incision was made at left subclavian area and the subcutaneous soft tissue was dissected to expose the fascia of the pectoralis major. Puncture method was applied and the Port-A catheter was inserted via left subclavian vein. The intra-operative portable X-ray was checked for the location of the catheter. Hemostasis was checked and the Port was fixed with 3 stitches. The wound was then closed in layers with 3-0 Vicryl and 3-0 Nylon. Operators P蔡瑞章 Assistants R4李振豪, R1許皓淳 相關圖片 潘郭月琴 (F,1936/12/02,75y3m) 手術日期 2010/11/03 手術主治醫師 蔡瑞章 手術區域 東址 005房 01號 診斷 Cerebral infarction 器械術式 Stereotaxic procedure for biop 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 鍾文桂, 時間資訊 08:24 報到 08:32 進入手術室 08:40 麻醉開始 09:00 誘導結束 09:08 抗生素給藥 09:18 手術開始 11:42 麻醉結束 11:42 手術結束 11:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦組織活體切片 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Stereotatic biopsy of brain tumor. 開立醫師: 鍾文桂 開立時間: 2010/11/03 12:32 Pre-operative Diagnosis Right thalamic tumor, suspect glioma. Post-operative Diagnosis Right thalamic tumor, suspect glioma. Operative Method Stereotatic biopsy of brain tumor. Specimen Count And Types 1 piece About size:2 cc Source: brain tumor. Pathology Frozen pathology: necrosis. Frozen pathology: necrosis. Permanant pathology: old hematoma, hemorrhagic infarct. Operative Findings 1. Under Medtronic Stealth Navigation System guidance to perform biopsy. Preoperative MRI of brain for navigation imaging. 2. The tumor was hard to aspirate. The aspirated tissue was grayish- pink. At the end of the biopsy, some hematoma was noted. Operative Procedures Under ETGA, the patient was placed in supine position and the head was fixed by Mayfield. The fiducials were confirmed with the navigation system. After ensuing the proposed tract for biopsy, we start disinfection and draping. A linear scalp incision was made. A burr hole was created by high speed drill. After durotomy and setting the stereotatic biopsy frame, the aspiration of brain lesion was performed under the guidance of navigation system. Finally, the wound was closed in layers. Operators Prof. 蔡瑞章 Assistants 鍾文桂 許皓淳 相關圖片 盧澎芳 (F,1950/04/25,61y10m) 手術日期 2010/11/03 手術主治醫師 蔡瑞章 手術區域 東址 005房 02號 診斷 Spondylosis with myelopathy, cervical 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 11:45 報到 12:08 進入手術室 12:15 麻醉開始 12:25 誘導結束 12:35 抗生素給藥 13:32 手術開始 15:40 抗生素給藥 17:20 手術結束 17:20 麻醉結束 17:22 送出病患 17:25 進入恢復室 18:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎融合術-前融合,無固定物(≦四節) 1 2 手術 椎間盤切除術-頸椎 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 記錄__ 手術科部: 外科部 套用罐頭: Anterior C4-5, C5-6 discectomy and fusion wit... 開立醫師: 鍾文桂 開立時間: 2010/11/03 17:50 Pre-operative Diagnosis C4-5 and C5-6 herniated intervertebral disc with spinal stenosis Post-operative Diagnosis ditto Operative Method Anterior C4-5, C5-6 discectomy and fusion with cage Specimen Count And Types nil Pathology nil Operative Findings Posterior and anterior spur formation at C4/5, C5/6 levels, more severe at C4/5 level. The spurs were removed by Kerrison and high speed drill. C4/5 cage: 6mm, C5/6 cage: 7 mm. Operative Procedures After ETGA, the patient was placed in supine position with neck hyperextended. A horizontal linear skin incision was made at right neck, and further deepened through plastysma muscle. The SCM & carotid artery were then retracted laterally while the esophagus was retracted medially. After reaching the pre-vertebral space, C4-5 and C5-6 space was confirmed with intra-operative C-arm. Discectomy was then done under microscope. After discectomy of C4/5& C5/6 level& partial removal of PLL at C5/6 level, the thecal sac was clearly seen. A cage was then inserted to C4-5 and C5-6 space. After meticulous hemostasis & setting up a mini-hemovac drain, the wound was closed in layers. Operators 蔡瑞章 Assistants 鍾文桂, 許皓淳 相關圖片 王彩雲 (F,1929/03/02,83y0m) 手術日期 2010/11/03 手術主治醫師 賴達明 手術區域 東址 001房 01號 診斷 顱內出血 器械術式 V-P shunt 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 王奐之, 時間資訊 00:00 開始NPO 00:00 臨時手術NPO 06:40 通知急診手術 09:00 進入手術室 09:00 報到 09:05 麻醉開始 09:10 誘導結束 10:45 手術開始 11:10 麻醉結束 11:10 手術結束 11:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦室腹腔分流手術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 曾峰毅 開立時間: 2010/11/03 11:08 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunt insertion via left Kocher point. Specimen Count And Types About 6ml xanthochromic CSF was sent for routine exam, BCS, and culture. Pathology Nil Operative Findings Medtronic, fixed medium pressure, shunt was inserted. Ventricular catheter is 6.5cm long, and peritoenal shunt is about 20cm long. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position. After skin shaved, scruubed, disinfected, and then draped, we made one transverse skin incision at left upper abdomen. We dissected into peritoneal cavity and inserted peritoneal catheter introducer. We made one curvilinear skin incision at left frontal area, and drilled one burr hole. We created the subcutaneous tunnel and pull through the catheter through the tunnel to left frontal incision wound. After ventricular puncture once, we inserted ventricular catheter, and connected with the system. After checking the shunt function, we inserted the peritoneal shunt into peritoneal space. The wound was closed in layers. Operators VS 賴達明 Assistants R4 曾峰毅 R3 王奐之 Indication Of Emergent Operation 相關圖片 沈銘榤 (M,1948/11/27,63y3m) 手術日期 2010/11/03 手術主治醫師 吳毅暉 手術區域 東址 016房 02號 診斷 Embolism and thrombosis of iliac artery 器械術式 PAOD stent insertion 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 4 紀錄醫師 羅健洺, 時間資訊 12:30 麻醉開始 12:30 報到 12:30 進入手術室 12:45 誘導結束 13:00 手術開始 13:15 抗生素給藥 14:37 麻醉結束 14:37 手術結束 14:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經動脈導管之栓塞物切除術 1 2 R 手術 血管整形術 1 0 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Angiography and open thrombectomy via right SFA 開立醫師: 羅健洺 開立時間: 2010/11/03 15:07 Pre-operative Diagnosis ALI, Gr II Post-operative Diagnosis ALI, Gr II Operative Method Angiography and open thrombectomy via right SFA Specimen Count And Types 1 piece About size:3X3cm Source:thrombus Pathology Thrombus Operative Findings Right CIA-EIA thrombus was found and after CDT, some thrombus was hemolytic After thrombectomyu, angiography showed no filling defect in right CIA-EIA, no perfusion was found in rihgt IIA Left proximal IIA 75% stenosis was found by angiography Post-op distal pulsation was intact Operative Procedures ETGA, supine, skin sterization, drapped. Angiography was done. Then, open thrombectomy was done via right SFA with guide-wire guided Forgati ballon. SFA was repaired with 6-0 prolene. Hemostasis and post-op angiography was performed. Close wound in layers and removed all sheaths. Operators 吳毅暉 Assistants 羅健洺 周雪江 (F,1943/10/29,68y4m) 手術日期 2010/11/03 手術主治醫師 王國川 手術區域 東址 003房 03號 診斷 Schizophrenic disorders, paranoid type, chronic with acute exacerbation 器械術式 Burr hole for chronic subdural hematoma drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 鍾文桂, 時間資訊 12:00 臨時手術NPO 12:00 開始NPO 19:27 報到 19:30 進入手術室 19:35 麻醉開始 19:45 誘導結束 20:02 抗生素給藥 20:30 手術開始 22:00 手術結束 22:00 麻醉結束 22:10 送出病患 22:12 進入恢復室 23:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 記錄__ 手術科部: 精神部 套用罐頭: Burr hole for evacuation of chronic subdural ... 開立醫師: 鍾文桂 開立時間: 2010/11/03 22:37 Pre-operative Diagnosis Right frontal-parietal-temporal chronic subdural hemorrhage. Post-operative Diagnosis Right frontal-parietal-temporal chronic subdural hemorrhage. Operative Method Burr hole for evacuation of chronic subdural hemorrhage. Specimen Count And Types nil Pathology Nil. Operative Findings 1. Blood-fluid level was noted as clear yellowish fluid gished out at the initial durotomy, then motor-oil like liquified hematoma drained out from the parietal area through rubber drain. 2. Presence of outer membrane, poor brain expansion. Operative Procedures Under ETGA, the patient was placed in supine position and the head was tilted to the left. After shaving, disinfection, and draping, a linear incision was made at right frontal area. A burr hole was created by hand drill. After dural tenting and durotomy, the liquified hematoma gushed out. Further hematoma evacuation was achieved throught rubber drain and normal saline irrigation. After wound closure, the accumulated subdural air was evacuated through rubber drain. Until the irrigated hematoma became pinkish, the closed subdural drainage system was connected. Operators V.S. 王國川 Assistants 鍾文桂 Indication Of Emergent Operation 張俊成 (M,1966/06/20,45y8m) 手術日期 2010/11/04 手術主治醫師 陳晉興 手術區域 東址 019房 02號 診斷 Malignant neoplasm of tonsillar fossa 器械術式 Thoracoscopy 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 廖先啟, 時間資訊 13:40 進入手術室 13:55 麻醉開始 14:25 抗生素給藥 14:30 誘導結束 14:50 手術開始 16:30 17:40 抗生素給藥 17:50 麻醉結束 17:50 手術結束 18:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 胸腔鏡肺楔狀或部分切除術 1 1 R 手術 胸腔鏡肺楔狀或部分切除術 1 2 L 麻醉 Peripheral arterial line inserti 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 記錄__ 手術科部: 外科部 套用罐頭: Lobectomy 開立醫師: 廖先啟 開立時間: 2010/11/04 18:49 Pre-operative Diagnosis Bilateral lung cancer, r/o hypopharyngeal cancer metastasis Post-operative Diagnosis Bilateral lung cancer, r/o hypopharyngeal cancer metastasis Operative Method VATS RLL, LUL, LLL wedge resection Specimen Count And Types 1. RLL tisue, contained 2 tumors; 2. LUL tisue, contained 3 fragements, one with 2 tumors, the ohers one tumor each; 3. LLL tisue, contained 1 tumor Pathology Pending Operative Findings 1. RLL, contained 2 tumors, elastic, pleural retraction(+), central necrosis 2. LUL, contained 3 tumors, elastic, pleural retraction(+) 3. LLL nodule, soft, pleural retraction(-) Operative Procedures 1. Anesthesia: General anesthesia vai tracheostomy tube. 2. Position: Left decubitus position. An axillary roll is placed under the down side. The operative field is well disinfected and draped. 3. Three VATS working ports setting as usual. 4. The pleural adhesions are separated using electrocautery. 5. The right lower lobe is retracted anteriorly. The inferior pulmonary ligment is divided. 6. The right lower lobe tumor sare identified, wedge resection via endo-GIA. 7. Normal saline irrigation, set one 28# chest tube. 8. Close wound in layers. 9. Do the same procedure at left chest. 10. LUL and LLL wedge resection via endo-GIA. 11.Normal saline irrigation, set one 28# chest tube. 12.Close wound in layers. Operators VS陳晉興 Assistants R3廖先啟，Ri黃邦碩 邱林淑真 (F,1945/04/07,66y11m) 手術日期 2010/11/04 手術主治醫師 曾漢民 手術區域 東址 003房 03號 診斷 Cervical spondylosis 器械術式 Decompression of mediun nerve 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 面罩麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 林哲光, 時間資訊 13:20 報到 13:40 進入手術室 13:44 抗生素給藥 13:45 麻醉開始 13:50 誘導結束 14:00 手術開始 15:30 手術結束 15:35 送出病患 15:35 麻醉結束 15:43 進入恢復室 16:43 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Semi-opened mask inhalation anes 1 0 手術 神經分離術-手.足之經 1 1 R 手術 正中神經或尺神經腕部減壓術–單側 1 2 R 記錄__ 手術科部: 外科部 套用罐頭: Neurolysis 開立醫師: 林哲光 開立時間: 2010/11/04 16:05 Pre-operative Diagnosis Right carpal tunnel syndrome; Right tardy ulnar nerve Post-operative Diagnosis Ditto Operative Method Right median nerve decompression; Neurolysis of right ulnar nerve Specimen Count And Types Pathology Operative Findings Hypertrophic change of flexor retinaculum was noted. No erythematous change of the median nerve was noted. The ulnar nerve was identifed and released to transposition. Operative Procedures 1.The hand and forearm were sterilized with povidone-iodine tincture, then covered with stockinet. 2.Anesthesia: IVG 3. Incision: S shape from vertical palmar crease to transverse wrist crease. 4.The palmaris longus tendon was identified, then the plamar aponeurosis was cut longitidinally along the ulnar side of the palmaris longus tendon. 5. Themedian nerve was identified beneath the palmars longus tendon. Under direct vision, the transverse carpal ligament was divided until no more pressure on the median nerve could be palpated. 6. The skin was closed by interrupted suture with 4/0 nylon. 7. The hand and wrist were draped with fluffy dressing and elastic bandage. 1.The entire right arm was disinfected with povidone-iodine tincture then covered with stockinet. 2.Anesthesia: IVG 3.Incision: longitudinal in direction, crossed over the medial epicondyle. 4.The brachial fascia and medial intermusclular septum were opened longitudinally to exposed the ulnar nerve at supracondylar region, a 5 cm segment of this nerve and its mesoneurium were isolated. The fibrous tissue which entraped the nerve at ulnar groove of medial epicondyle was opened and the nerve was released. The nerve was isolated futher distally to the location 1 inch distal to the medial epicondyle. 5.The ulnar nerve was transposed to cubital fossa and anchored there by subcutaneous fat flap. 6. The wound was closed by running suture with 3/0 nylon. 7. The arm was draped with elastic bandage dressing. Operators VS 王國川 Assistants R4 林哲光 林慧馨 (F,1944/12/23,67y2m) 手術日期 2010/11/04 手術主治醫師 林峰盛 手術區域 西址 035房 02號 診斷 Spinal stenosis, lumbar 器械術式 Nerve block / PC 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 硬肌麻醉 麻醉主治醫師 林峰盛 ASA 1 時間資訊 12:30 報到 13:08 進入手術室 13:15 麻醉開始 13:20 誘導結束 13:25 手術開始 14:05 麻醉結束 14:05 手術結束 14:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 硬脊膜外麻醉 1 0 摘要__ 手術科部: 麻醉部 套用罐頭: LENB 開立醫師: 林峰盛 開立時間: 2010/11/04 14:09 Pre-operative Diagnosis 1.spinal stenosis 2. radiculopathy Post-operative Diagnosis 1. spinal stenosis 2. radiculopathy Operative Method LENB Specimen Count And Types nil Pathology Nil Operative Findings Operative Procedures LA with 1% xylocaine 5 ml pt in prone position Under fluoroscopic-guidance, LENB was done to L4/5 level with 18G Tuohy needle, 80mg Kenaocrt in 0.5% xylocaine 8ml Operators 林峰盛, Assistants 林昱廷, 駱罔腰 (F,1933/06/07,78y9m) 手術日期 2010/11/04 手術主治醫師 田郁文 手術區域 東址 006房 01號 診斷 Urinary tract infection (UTI) 器械術式 Whipple 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 林珍榮 ASA 4 紀錄醫師 黃凱傑, 時間資訊 07:40 報到 08:10 進入手術室 08:11 麻醉開始 08:25 誘導結束 08:50 手術開始 10:30 開始輸血 11:00 抗生素給藥 13:15 麻醉結束 13:15 手術結束 13:25 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 Whipple氏胰、十二指腸切除術 幽門保留式 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 摘要__ 手術科部: 內科部 套用罐頭: 1.Pyrolus preserving pancreaticoduodenectomy 開立醫師: 黃凱傑 開立時間: 2010/11/04 13:37 Pre-operative Diagnosis Pancreatic head tumor with obstructive jaundice r/o villous adenoma Post-operative Diagnosis Pancreatic head tumor with obstructive jaundice r/o villous adenoma Operative Method 1.Pyrolus preserving pancreaticoduodenectomy 2.Cholecystectomy Specimen Count And Types 2 pieces About size:25x30cm Source:Omentum and Pancreatic head and Duodenum About size:8x6cm Source:Gall bladder Pathology pending Operative Findings 1.One 3x3cm firm mass was noted at pancretic head with almost compression of duodenum lumen 2.Dilated CBD was noted Operative Procedures 1.ETGA, supine position 2.Skin disinfection and drapped as ususal 3.Midline incision 4.Adhesionlysis and cholecystectomy 5.Dissect the CBD and loop with silk 6.Open lesser sac and dissect of group 8 lymph node and ligation of GDA 7.Open Treitz ligment and mobilization of duodenum 8.Dissect pancreatic head and free posterior wall 9.Transection of CBD, duodenum bulb and pancreatic head 10.Insert one 10inch nelaton tube into P-duct and performed pancreatiojejuno anastomosis 11.Indert one nelaton tube insert CBD and performed choledochojejunostomy 12.Performed duodenojejunostomy after insert NG to distal part 13.Performed feeding jejunopstomy 14.Insert rubber drain at bilateral anastomosis site and insert one CWV in below the mesentary 15.Close wound in lsyers Operators 田郁文 Assistants 黃凱傑 洪婉婷 相關圖片 呂輝雄 (M,1945/01/02,67y2m) 手術日期 2010/11/04 手術主治醫師 陳敞牧 手術區域 東址 005房 02號 診斷 Other myelopathy 器械術式 Lamino plasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 曾峰毅, 時間資訊 12:15 報到 12:29 進入手術室 12:40 麻醉開始 12:50 誘導結束 12:50 抗生素給藥 13:05 手術開始 15:34 手術結束 15:34 麻醉結束 15:45 送出病患 15:47 進入恢復室 17:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓整形術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 神經部 套用罐頭: Laminoplasty, from C3 to C7 開立醫師: 曾峰毅 開立時間: 2010/11/04 15:50 Pre-operative Diagnosis Cervical stenosis Post-operative Diagnosis Cervical stenosis Operative Method Laminoplasty, from C3 to C7 Specimen Count And Types Nil Pathology Nil Operative Findings Spinal cord was compressed tightly by hypertorphic ligamentum flavum. The cord was decompressed after laminoplasty. SSEP at right C7 dermatoma was decreased slightly after laminoplasty. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position with head fixed with Mayfield head clamp. After shaved, scrubbed, disinfected, and then draped, we made one midline linear skin incison from C2 to C7. We dissected paraspinal muscle to expose bilateral laminae from C2 to C7. We drilled the left laminae of C3 to C7 partially, and right laminae of C3 to C7 throughly. As hinge at left, we performed laminopalsty and fixed with mini-plates. The wound was closed in layers after one CWV drain in sertion. Operators VS 陳敞牧 Assistants R4 曾峰毅 黃魏嬌 (F,1937/01/08,75y2m) 手術日期 2010/11/04 手術主治醫師 楊士弘 手術區域 東址 005房 01號 診斷 Lumbar spondylosis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾峰毅, 時間資訊 07:40 報到 08:05 進入手術室 08:25 麻醉開始 08:35 誘導結束 08:40 抗生素給藥 09:29 手術開始 11:40 抗生素給藥 12:06 麻醉結束 12:08 手術結束 12:15 送出病患 12:20 進入恢復室 13:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術(減壓)-超過二節 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 曾峰毅 開立時間: 2010/11/04 12:08 Pre-operative Diagnosis Lumbar stenosis, degenerative scoliosis Post-operative Diagnosis Lumbar stenosis, degenerative scoliosis Operative Method Lower L3 to upper L5 laminectomy Specimen Count And Types Nil Pathology Nil Operative Findings Thecal sac was compressed by thichened ligamentum flavum from L3 to L5 with bilateral lateral recess stenosis. Dura tear was found during laminectomy. Duroplasty was done with suture and Durafoma. Automated fusion of lumbar spine was noted. Spine was stable after decompression. Bloos loss was 350ml. Operative Procedures With endotracheal general anesthesia, the patient was put in prone position. After C-arm localization, we made one midline linear skin incision from L3 to L5. We dissected bilateral paraspinal muscla away from spinous process and laminae from L3 to L5. Lamienctomy was done from lower L3 to upper L5 with rongeur, Karrison rongeur, and air-drill. Ligamentum flavum was removed, and bilateral lateral recesses at L3/4 and L4/5 was decompressed as well. Duro tear was reparied with suture and durofoam. The wound was closed in layers after one CWV inserted. Operators VS 楊士弘 Assistants R4 曾峰毅 李何 (F,1933/04/28,78y10m) 手術日期 2010/11/04 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 Injury (severeity score >=16) 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 林哲光, 時間資訊 12:34 進入手術室 12:35 麻醉開始 12:37 抗生素給藥 12:38 誘導結束 12:45 手術開始 13:00 手術結束 13:00 麻醉結束 13:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 氣管切開術 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 林哲光 開立時間: 2010/11/04 16:45 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Ditto Operative Method Tracheostomy Specimen Count And Types Pathology Operative Findings Fr . 7 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide above the sternal notuch. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. Tracheotomy is made with excision of the ring shaped. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators VS 王國川 Assistants R4 林哲光 張福旋 (M,1933/10/29,78y4m) 手術日期 2010/11/04 手術主治醫師 王國川 手術區域 東址 001房 01號 診斷 Head Injury 器械術式 remove V-P shunt + left lower leg wound debridment 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 阮廷倫, 時間資訊 08:00 臨時手術NPO 08:45 報到 08:50 進入手術室 08:51 麻醉開始 08:55 誘導結束 08:56 抗生素給藥 09:00 手術開始 10:10 麻醉結束 10:10 手術結束 10:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 多層皮膚移植- 10-20BSA 1 1 L 手術 石膏副木固定－長腿 1 0 L 手術 深部傷口處理縫合擴創-小 1 0 摘要__ 手術科部: 外科部 套用罐頭: STSG 開立醫師: 阮廷倫 開立時間: 2010/11/04 10:23 Pre-operative Diagnosis Right leg compartment syndrome s/p fasciotomy Post-operative Diagnosis Right leg compartment syndrome s/p fasciotomy Operative Method STSG Specimen Count And Types Nil Pathology Nil Operative Findings 1. Right lateral leg s/p fasciotomy with good granulation wound bed. The skin defect is about 5*20 cm 2. 8/1000 inch, 100 cm2 STSG was harvested from left thigh Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position. After skin disinfection and draped, the wound was debrided. After minimal advance of detached skin flap, the wound was irrigated and hemostased. STSG was harvested from left thigh. The meshed STSG was applied on the skin defect and compressive tie-over dressing was used. Long-leg splint was used for fixation. Operators AP戴浩志 Assistants R5阮廷倫 記錄__ 手術科部: 外科部 套用罐頭: Removal of shunt catheter below the reservoir. 開立醫師: 鍾文桂 開立時間: 2010/11/04 10:43 Pre-operative Diagnosis Hydrocephalus s/p implantation of ventriculoperitoneal shunt, with shunt infection. Post-operative Diagnosis Hydrocephalus s/p implantation of ventriculoperitoneal shunt, with shunt infection. Operative Method Removal of shunt catheter below the reservoir. Specimen Count And Types Nil Pathology Nil. Operative Findings 1. Externalization of the shunt catheter to the EVD drainage set was noted for infection control( abdominal infection). 2. Removal of the shunt catheter below the programmable reservoir was done. The proximal part of the catheter was ligated by 2-0 silk. Operative Procedures Under general anesthesia, the patient was placed in supine position and the head was tilted to the right. The stiches along the reservoir was removed. After shaving, disinfection, and draping, the pathway of the shunt was palpated. A horizontal incision was made above the shunt catheter 2 cm below the reservoir. The catheter was exposed after dissection. The distal and proximal parts were ligated and the distal( the externalization part) was pulled out from the right upper chest externalization site. Then, the wound was closed primarily. Operators V.S. 王國川 Assistants 鍾文桂 楊涂厭 (F,1946/05/25,65y9m) 手術日期 2010/11/04 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Spinal injury with complication, sequelae 器械術式 Lamino plasty 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 林哲光, 時間資訊 07:40 報到 08:05 進入手術室 08:10 麻醉開始 08:35 誘導結束 09:03 抗生素給藥 09:07 手術開始 12:00 手術結束 12:00 麻醉結束 12:12 進入恢復室 12:12 送出病患 13:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術(減壓)-超過二節 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: C3-5 laminectomy and C6 partial laminectomy 開立醫師: 林哲光 開立時間: 2010/11/04 12:32 Pre-operative Diagnosis C3-6 central canal stenosis, C3-4, C4-5 spondylosis Post-operative Diagnosis Ditto Operative Method C3-5 laminectomy and C6 partial laminectomy Specimen Count And Types Pathology Operative Findings Congestion of the paraspinal muscles were noted. Dura sac rexpanded well was noted after laminectomy. Operative Procedures Under ETGA and prone position, skin disinfected and drapped were performed as usual. Midline skin incision was made. Parspinal muscles were detached. Laminectomy was then performed after drilled over bilateral lamina first. The ligamentum flavum was also removed. Hemostasis wtih Gelfoam packing was then done. The wound was then closed in layers after epidural drain x1 was inserted. Operators VS 王國川 Assistants R4 林哲光 相關圖片 黃國鎮 (M,1952/05/06,59y10m) 手術日期 2010/11/05 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Cavernous angioma 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 古恬音, 時間資訊 07:50 報到 08:03 進入手術室 08:10 麻醉開始 08:50 誘導結束 09:00 抗生素給藥 09:27 手術開始 12:00 抗生素給藥 15:00 抗生素給藥 17:30 麻醉結束 17:30 手術結束 17:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 11 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Dolenc approach for tumor removal 開立醫師: 古恬音 開立時間: 2010/11/05 17:45 Pre-operative Diagnosis Right cavernous sinus tumor, suspected cavernous hemangioma Post-operative Diagnosis Right cavernous sinus cavernous hemangioma Operative Method Dolenc approach for tumor removal Specimen Count And Types 1 piece About size:about 5mm Source:right cavernous sinus tumor Pathology Pending Operative Findings The tumor appeared soft and compressible, and the color was reddish. Many small feeders came from ICA were noted. The rigt cavernous ICA was widened and displaced by the tumor, mild adhesion was also found. Easy bleeding of the epidural space was noted. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head turned 45 degrees to the left and fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected with better iodine. Draping was done in the usual sterile fashion. One curvillinear scalp incision was done in right frontal lobe extending 2cm beyond midline. After drilling 3 hurr holes, on 8*10cm craniotomy window was created. Incidental durotomy was done during and repaired with prolene suture. The dura was detached from the middle cranial fossa carefully, and the temporal dural reflection was cut off to expose the cavernous sinus and anterior clinoid process. All 3 branches of Trigeminal nerve and the middle meningeal artery were identified. The anterior clinoid process was drilled off, and the cavernous sinus was then opened between the CN IV and CN V1. The tumor was coagulated and detached from the cavernous sinus, and the sinus was packed with Gelfoam. The skull plate was fixed back with miniplates. After setting one subgaleal CWV drain, the wound was closed in layers. Operators P杜永光 Assistants R6胡朝凱,R3古恬音 林張寬 (F,1943/11/23,68y3m) 手術日期 2010/11/05 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 鍾文桂, 時間資訊 07:50 報到 08:02 進入手術室 08:20 麻醉開始 08:40 誘導結束 08:50 手術開始 09:00 抗生素給藥 12:00 抗生素給藥 13:11 麻醉結束 13:11 手術結束 13:26 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除-手術時間在4~8小時 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Gross total excision of tumor, suboccipital a... 開立醫師: 許皓淳 開立時間: 2010/11/05 14:00 Pre-operative Diagnosis Right cerebellar hemangioglastoma, status post excision with recurrance and brainstem compression. Right cerebellar hemangioglastoma, recurrent. Post-operative Diagnosis Right cerebellar hemangioglastoma, status post excision with recurrance and brainstem compression. Right cerebellar hemangioglastoma, recurrent. Operative Method Gross total excision of tumor, suboccipital approach. Gross total excision of tumor, infratentorial-supracerebellar approach. Specimen Count And Types 1 piece About size:20cc Source:right cerebellar tumor Pathology Pending. Hemangioglastoma Operative Findings 1. Redish, well-demarcated, well-vascularized, elastic, firm mass lesion with a surrouding yellowish gliotic plane. 2. Multiple feeders from the meningohypophyseal trunk, superior cerebellar artery and posterior cerebral arteries( according to DSA) were electrocoagulated first before tumor excision. Due to the bulk of the tumor, it was resected in 3 pieces during excision. The superior cerebellar artery and 4th ventricle were met after tumor excision. 3. Craniectomy was performed in the previous operation. The right Frazier V-P shunt was intact. Much fibrosis was encountered during dissected of dura mater and subgaleal space, and supratentorium areas. Dura augmentation was achieved with autologous fascia graft. 3. Craniectomy was performed in the previous operation. The right Frazier V-P shunt was intact. Much fibrosis was encountered during dissected of dura mater and subgaleal space, and infratentorium areas. Dura augmentation was achieved with autologous fascia graft. Operative Procedures Under ETGA, the patient was placed in prone position and the head was slightly tilted to the right, and fixed with Mayfield. After shaving, disinfection, and draping, the previous operation wound was incised and dissected along the midline. Until the bony margins of the craniectomy window was met, further bone removal at the superior margin was achieved with 3mm Kerrison until transverse sinus was met. Meticulous durotomy was done despite severe adhesion of the dura mater and right cerebellar hemisphere. Through dissection along the tentorium cerebri, the tumor was devascularized. The tumor was resected after devascularization. After well hemostasis, the dura mater was closed in water-tight fashion. The wound was closed in layers without drains. Operators VS 曾漢民 Assistants 鍾文桂 許皓淳 相關圖片 林麗嬌 (F,1957/12/15,54y2m) 手術日期 2010/11/05 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Lumbar Spondylosis 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 2 紀錄醫師 鍾文桂, 時間資訊 13:10 報到 13:43 進入手術室 13:48 麻醉開始 13:53 誘導結束 14:11 抗生素給藥 14:38 手術開始 16:10 手術結束 16:10 麻醉結束 16:20 送出病患 16:22 進入恢復室 17:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 椎間盤切除術-腰椎 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Posterior L4-5 discectomy 開立醫師: 鍾文桂 開立時間: 2010/11/05 16:22 Pre-operative Diagnosis L4-5 herniated intervertebral disc with radiculopathy Post-operative Diagnosis L4-5 herniated intervertebral disc with radiculopathy Operative Method Posterior L4-5 discectomy Microsurgical discectomy,L4/5. Specimen Count And Types nil Pathology nil Operative Findings Ruptured disc over L4/5 with compression of left root of L5. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: prone with a bolster beneath 3. Skin preparation: the back was shaved and scrubbed with povidone-iodine detergent then painted with povidone-iodine tincture and followed by sterilized adhesive plastic sheet covering. 4.A spinal needle was inserted between spinous processes of L4-5 and a portable X-ray film was taken to locate the correct interspace. 5.Incision: 3-cm, between L4-5 pinous processes,off-midiline at the left margin of spinous processes. The subcutaneous layer and lumbdorsal fascia were incised then. 6.The aponeurosis of the latissimus dorsi and ileocostalis lumborum muscles at spinous processes of L4-5 was incised, the muscles were detached from the interspinous ligament. The multifidus muscles were detached subperiosteally from L4-5 laminae by a rasp. 6.The aponeurosis of the latissimus dorsi and iliocostalis lumborum muscles at spinous processes of L4-5 was incised, the muscles were detached from the interspinous ligament. The multifidus muscles were detached subperiosteally from L4-5 laminae by a rasp. 7.The paravertebral muscles were retracted by a modified narrow Taylor retractor which was retained constantly by a rubbersling to the side rail of the operating table. 8.Under an operating microscope, the ligamentum flavum was cleaned and incised longitudinally at the lateral part with a No. 11 blade. The lateral portion of this ligament was removed with a small angle Kerrison rongeur, the lateral portion of the laminae and the medial border of the facets were removed too until the margin of the facets and a corridor to the disc that ran lateral to the root was reached. 9.The epidural fat was left undisturbed andpreserved. 10.The compressed root was gently pushed further away temporarily by sucker tip in order to expose the herniated disc more clearly. 11. The posterior longitudinal ligament and annulus were incised around the protruded disc with a No. 15 blade. 12. The degenerated disc was removed with microdisc forceps until a substantial amount of the nucleus had been loosened with a cone curette and removed. 13. Irrigation of the wound with gentamycin solution. 13. Irrigation of the wound with gentamycin solution. 14. Close the wound in lyaers 15. Course of the surgery: smooth. Operators 曾漢民 Assistants 鍾文桂 許皓淳 余泰成 (M,2010/08/18,1y6m) 手術日期 2010/11/05 手術主治醫師 郭夢菲 手術區域 兒醫 067房 07號 診斷 Prematurity 器械術式 Ommaya reservoir implantation 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 4E 紀錄醫師 林哲光, 時間資訊 07:42 臨時手術NPO 07:42 開始NPO 07:43 通知急診手術 16:25 進入手術室 16:30 麻醉開始 16:50 誘導結束 17:10 抗生素給藥 17:18 手術開始 18:40 手術結束 18:40 麻醉結束 18:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室腹腔分流手術 1 1 R 麻醉 Peripheral arterial line inserti 1 0 記錄__ 手術科部: 套用罐頭: Right Kocher V-P shunt insertion, Codman prog... 開立醫師: 林哲光 開立時間: 2010/11/05 19:17 Pre-operative Diagnosis Hydrocephalus, suspected post-hermorrhage related Hydrocephalus, suspected post-hermorrhage related, or postinfectious Post-operative Diagnosis Ditto Operative Method Right Kocher V-P shunt insertion, Codman programmable valve Right Kocher V-P shunt insertion, Codman programmable valve, ste pressusre at 60mmH2o Specimen Count And Types Pathology Operative Findings Opening pressure was around 9cmH2O. CSF seemed clear and transparent, CSF routine, culture and BCS were sent. Ventricular catheter is 4.5cm and abdominal catheter is around 25cm long. Opening pressure was more than 9cmH2O. CSF seemed clear and transparent, CSF routine, culture and BCS were sent. Ventricular catheter is 4.5cm and abdominal catheter is around 25 to 30 cm long. Operative Procedures Under ETGA and supine position with head rotated to left side, skin disinfected and drapped were performed as usual. Skin disinfected and drapped were performed as usual. Curvior skin incision was made over the right Kocher point and a burr hole was created with Rongeur. RUQ abdomen transverse skin incision was made and minilarparotomy was done. The abdominal catheter was inserted into the pertioneal cavitiy. Subcutaneous tunneling was done. Another skin incision was made over the right posteior auricle. The ventricular catheter was introduced into the lateral horn with ventricular puncture and then connected to abdominal catheter with programmable valve. The wound was then closed in layers after hemostasis. Operators AP 郭夢菲 Assistants R4 林哲光 Indication Of Emergent Operation 吳寶金 (F,1935/04/02,76y11m) 手術日期 2010/11/05 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Lung tumor 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 2 紀錄醫師 陳德福, 時間資訊 07:50 報到 08:05 進入手術室 08:10 麻醉開始 08:40 誘導結束 09:46 手術開始 12:30 麻醉結束 12:30 手術結束 12:34 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4~8小時 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: craniotomy brain tumor excision 開立醫師: 陳德福 開立時間: 2010/11/05 12:44 Pre-operative Diagnosis Lung cancer with brain metastasis, left Broca area Post-operative Diagnosis Lung cancer with brain metastasis, left Broca area Operative Method craniotomy brain tumor excision Specimen Count And Types 1 piece About size:1.5*1.5*2.0CM Source:LEFT frontal brain tumor Pathology pending Operative Findings 1.There is a 1.5*1.5*2.0cm in sized tumor at the left Broca area with perifocal gliosis. The tumor is soft, fragile, greyish and well demarcated with some capsule formation. The tumor is totally removed and the adjacent vasculature was well preserved. 2.The location of the tumor was checked under intra-OP ultrasonography assisted. Operative Procedures Under ETGA and supine position, the scalp was disinfected and draped as usual. One curvilinear incision over left frontal-temporal area was done followed by creating a 5*5cm in sized craniotomy window. The dura was opened in C shape and the arachnoid membrane was opened. One corticotomy was done followed by tumor removal with tumor forceps and dissector assisted. Hemostasis was done and dura was closed in water tight fasion. The skull was fixed with miniplates and the wound was closed in layers. Operators VS 賴達明 Assistants R5 陳德福 R1張僖 陳瑞堂 (M,1936/05/30,75y9m) 手術日期 2010/11/05 手術主治醫師 賴達明 手術區域 東址 019房 02號 診斷 Herniation of intervertebral disc (HIVD) 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 張僖, 時間資訊 12:00 報到 13:05 進入手術室 13:08 麻醉開始 13:13 誘導結束 13:50 抗生素給藥 13:55 手術開始 18:00 手術結束 18:00 麻醉結束 18:10 進入恢復室 18:10 送出病患 19:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 椎間盤切除術-腰椎 1 2 摘要__ 手術科部: 外科部 套用罐頭: 1.lumbar diskectomy L4/5 2.L4/5 fusion with T... 開立醫師: 陳德福 開立時間: 2010/11/05 18:15 Pre-operative Diagnosis L2/3, 3/4, 4/5 HIVD and spondylosis with spinal stenosis Post-operative Diagnosis L2/3, 3/4, 4/5 HIVD and spondylosis with spinal stenosis Operative Method 1.lumbar diskectomy L4/5 2.L4/5 fusion with TPS 3.L2-3 laminectomy Specimen Count And Types nil Pathology nil Operative Findings 1.There HIVD over L2/3, 3/4 and 4/5 with spondylosis and spinal stenosis. The hypertrophic ligamentum flavum and facet joint was removed for decompression over the L4/5. 2.L4/5 TPS fusion with rods fixation was done. 3.L2-3 laminectomy was performed followed by posteriolateral autologous bone fusion. Operative Procedures Under ETGA and prone position, the skin was disinfected and draped as usual. One linear incision at midline was done and we approach the TPS insertion point with midline approach. The L4-5 TPS was then implantated under C-arm flouroscope. The L2-4 laminectomy was done. The L4/5 diskectomy was done. The rods were implantated. One hemovac was left in situ. The wound was then closed in layers. Operators VS賴達明 Assistants R5陳德福 R1張僖 林芳妃 (F,1962/07/19,49y7m) 手術日期 2010/11/05 手術主治醫師 賴達明 手術區域 東址 027房 03號 診斷 Cervical Spondylosis 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 2 紀錄醫師 李振豪, 時間資訊 13:50 報到 14:10 進入手術室 14:15 麻醉開始 14:20 誘導結束 14:40 抗生素給藥 15:00 手術開始 16:40 手術結束 16:40 麻醉結束 16:50 送出病患 16:54 進入恢復室 17:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-頸椎 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 外科部 套用罐頭: C5-6 diskectomy and anterior fusion with cage 開立醫師: 李振豪 開立時間: 2010/11/05 17:04 Pre-operative Diagnosis C5-6 herniation of intervertebral disc with cervical stenosis Post-operative Diagnosis C5-6 herniation of intervertebral disc with cervical stenosis Operative Method C5-6 diskectomy and anterior fusion with cage Specimen Count And Types nil Pathology Nil Operative Findings Narrowing of the C5-6 disc space was noted with marginal spur formation. The degenerative disc and the posterior longitudinal ligment were removed for decompression. The thecal sac expanded well after decompression. One #7 PEEK cage was used for anterior fusion. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine position with neck extension. The skin was scrubbed, disinfected and draped as usual. One 3cm transverse skin incision was made at right neck along the skin crest. The subcutaneous soft tissue and the platysma muscle was divided. The margin of the SCM muscle was identified and the vertebra was approached via the fascia between carotid sheath and thyroid gland. The prevertebral fascia was opened and the longus collis muscle was detached to exposed the disc space. C5-6 disc space was localized by intra-operative C-arm portable X-ray. Under operative microscope, diskectomy was done with knife, alligator, and karrison punches. The marginal spur was tailed by high-speed air-drived drill. The posterior longitudinal ligment also removed by Karrison punches. One #7 PEEK cage was placed into C5-6 disc space for anterior fusion. Hemostasis was achieved and one minihemovac was placed. The wound was then closed in layers with 3-0 Vicryl and 4-0 Prolene. Operators VS賴達明 Assistants R4李振豪, Ri梁家豪 相關圖片 張輔民 (M,1923/05/01,88y10m) 手術日期 2010/11/05 手術主治醫師 王國川 手術區域 東址 002房 02號 診斷 Pneumonia 器械術式 Removal of chronic subdural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 曾峰毅, 時間資訊 00:00 開始NPO 00:00 臨時手術NPO 10:35 通知急診手術 11:05 報到 11:15 進入手術室 11:25 抗生素給藥 11:45 手術開始 12:35 手術結束 12:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 L 摘要__ 手術科部: 內科部 套用罐頭: Left frontal burr hole for subdural drainage 開立醫師: 曾峰毅 開立時間: 2010/11/05 12:37 Pre-operative Diagnosis Left chronic subdural hemorrhage Post-operative Diagnosis Left chronic subdural hemorrhage Operative Method Left frontal burr hole for subdural drainage Specimen Count And Types Subdural effusion was sent for cytology. Pathology Nil Operative Findings Dark-yellowish subdural effusion was drained while durotomy. Operative Procedures With local anaesthesia, the patient was put in supine positin. After scalp shaved, scrubbed, disinfected, and then draped, we made one transverse linear skin incision at left frontal area. We drilled one burr hole and created durotomy. We inserted subdural rubber drain and drain the subdural effusion. Subdural space was irrigated with normal saline and the wound was closed in layers. The subdural space was de-aired. Operators VS 王國川 Assistants R4 李振豪 R4 曾峰毅 Indication Of Emergent Operation 傅慧屏 (F,1963/10/30,48y4m) 手術日期 2010/11/06 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Brain metastasis 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林至芃 ASA 3 紀錄醫師 羅偉誠, 時間資訊 07:32 報到 08:00 進入手術室 08:28 麻醉開始 08:43 誘導結束 08:50 抗生素給藥 09:35 手術開始 11:50 抗生素給藥 13:15 麻醉結束 13:15 手術結束 13:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: cerebellar meta tumor excision 開立醫師: 胡朝凱 開立時間: 2010/11/06 13:40 Pre-operative Diagnosis Breast cancer multiple brain meta Post-operative Diagnosis Breast cancer multiple brain meta Operative Method cerebellar meta tumor excision Specimen Count And Types 3 pieces of tumor Pathology pending Operative Findings 1. Three metastatic tumor located at left upper, right upper and right lower cerebellar lobe. The tumor border was clear and mild hypervascularity. One cystic part with motor oil like material was noted at left cerebellar tumor. Operative Procedures 1.ETGA, prone 2.Midline skin incision form inion to C2 3.Detach paravertebral muscle groups 4.Expose posterior fossa and C1 posterior arch 5.Craniotomy 6.U shap dural opening with the base ledt at transverse sinus 7.Transcortical tumor excision 8.Hemostasis 9.Close dura with prolene and one piece of fascia 10.fixed bone back with miniplate 11.Close wound in layers Operators 曾漢民 Assistants 胡朝凱, R1 林松柏 (M,1953/12/05,58y3m) 手術日期 2010/11/06 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Ventriculoperitoneal shunt infection 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林至芃 ASA 3 紀錄醫師 蕭惠壬, 時間資訊 00:04 臨時手術NPO 00:04 開始NPO 09:04 通知急診手術 15:53 進入手術室 16:00 麻醉開始 16:25 誘導結束 16:30 抗生素給藥 16:55 手術開始 17:45 手術結束 17:45 麻醉結束 17:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室體外引流 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 記錄__ 手術科部: 外科部 套用罐頭: Right abscess drainage 開立醫師: 胡朝凱 開立時間: 2010/11/06 17:45 Pre-operative Diagnosis Right brain abscess Post-operative Diagnosis Right brain abscess Operative Method Right abscess drainage Specimen Count And Types culture tube x 6 Pathology pending Operative Findings 1.Mild turbid, yellowish fluid was drained out after durotomy. 2.The brain became slack after drainage 3.Codman EVD tube was inserted as 3 cm in length as drainage tube. Operative Procedures 1.ETGA, supine 2.Right previous wound incision 3.Reflect skin flap 4.Previous burr hole opening 5.Fluid content was drained out 6.Tube insertion 7.Irrigation 8.Fixed drain 9.Close wound in layers Operators 曾漢民 Assistants 胡朝凱, 蕭惠壬 Indication Of Emergent Operation 曾嘉一 (M,1937/11/01,74y4m) 手術日期 2010/11/06 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Spinal stenosis, lumbar 器械術式 Laminectomy for decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林至芃 ASA 3 紀錄醫師 鍾文桂, 時間資訊 07:58 進入手術室 08:05 麻醉開始 08:10 誘導結束 08:36 抗生素給藥 09:33 手術開始 11:00 手術結束 11:00 麻醉結束 11:10 送出病患 11:15 進入恢復室 13:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術(減壓)-二節以內 1 1 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 記錄__ 手術科部: 外科部 套用罐頭: Sublarminar decompression and foraminotomy, L... 開立醫師: 鍾文桂 開立時間: 2010/11/06 11:31 Pre-operative Diagnosis Lumbar stenosis, L3/4, L4/5. Post-operative Diagnosis Lumbar stenosis, L3/4, L4/5. Operative Method Sublarminar decompression and foraminotomy, L3/4, L4/5. Specimen Count And Types nil Pathology Nil. Operative Findings Hypertrophic ligamentum flavum at L3/4, L4/5( more severe) levels. Intact dura mater. The roots were slack after decompression. Operative Procedures Under ETGA, the patient was placed in prone position. After disinfection and draping, a linear incision was made at L3/4 and L4/5 levels( checked by intraoperative fluoroscopy). The saw blade splited the L3&L4; spinous process. Sublaminar decompression and foraminotomy at L3 and L4 levels were done with Kerrison. Until the roots and thecal sacs were slack, gelfoam was placed at the epidural space. A epidural 1/8 hemovac drain was placed. The wound was closed in layers. Operators V.S. 賴達明 Assistants R5鍾文桂 吳信彥 (M,1943/08/14,68y7m) 手術日期 2010/11/06 手術主治醫師 王國川 手術區域 東址 003房 03號 診斷 Glioblastoma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林至芃 ASA 3 紀錄醫師 許皓淳, 時間資訊 00:02 臨時手術NPO 00:02 開始NPO 09:02 通知急診手術 15:15 報到 15:33 進入手術室 15:35 麻醉開始 15:40 抗生素給藥 15:50 誘導結束 16:00 手術開始 18:30 開始輸血 18:40 抗生素給藥 21:20 麻醉結束 21:20 手術結束 21:25 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除-手術時間在4~8小時 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 摘要__ 手術科部: 外科部 套用罐頭: Left frontotemporal craniotomy for tumor excision 開立醫師: 許皓淳 開立時間: 2010/11/06 21:43 Pre-operative Diagnosis 1. Cecal tumor; 2. Liver tumor. 3. Left temporal brain tumor with brainstem compression, suspected metastasis Post-operative Diagnosis 1. Cecal tumor; 2. Liver tumor. 3. Left temporal brain tumor with brainstem compression, suspected high grade glioma Operative Method Left frontotemporal craniotomy for tumor excision Specimen Count And Types Several fragments of one tumor was sent for pathology. Pathology Pending Operative Findings Hypervascular, ill-defined, yellowish to greyish, elastic to soft, tumor, about 5x5x6cm in size, was locatd at left temporal lobe, deviating left temporal horn superiorly and causing uncas herniated over tenrorium edge. Operative Procedures with endotracheal general anaesthesia, the patient was put in supine position with head rotated to right and fixed with Mayfield head clamp. After scalp shaved, scrubbed, disinfected, and then draped, we made one curvilinear skin incision at left frontotemporal area. Temporalis muscle was detached from skull bone, and craniotomy was done after four burr holes made. U-shape durotomy was done. We peformed tumor excision via inferior temporal corticotomy. Tumor was removed totally, and afte hemstasis, the dura was closed in water-tight fashion. Bone graft was fixed back with wire and mini-plate. The wound was closed in layers after 2 CWV inserted. Operators VS 王國川 Assistants R6 胡朝凱 R4 曾峰毅 Indication Of Emergent Operation 傅慧屏 (F,1963/10/30,48y4m) 手術日期 2010/11/08 手術主治醫師 曾漢民 手術區域 東址 002房 01號 診斷 Brain metastasis 器械術式 Brain tumor Crainotomy(TZENG)，External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3E 紀錄醫師 鍾文桂, 羅偉誠, 時間資訊 00:00 開始NPO 00:00 臨時手術NPO 08:00 通知急診手術 08:47 報到 08:47 進入手術室 09:00 麻醉開始 09:00 抗生素給藥 09:15 誘導結束 09:48 手術開始 11:15 麻醉結束 11:15 手術結束 11:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱骨切除術,包括異物移除或壓或經切斷 1 2 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 記錄__ 手術科部: 外科部 套用罐頭: 1. Decompressive craniectomy. 開立醫師: 鍾文桂 開立時間: 2010/11/08 12:01 Pre-operative Diagnosis Cerebellar metastasis status post tumor excision with postoperative cerebellar swelling, brainstem compression and acute obstructive hydrocephalus. Post-operative Diagnosis Cerebellar metastasis status post tumor excision with postoperative cerebellar swelling, brainstem compression and acute obstructive hydrocephalus. Operative Method 1. Decompressive craniectomy. 2. Ventriculostomy, left Frazier for CSF drainage and ICP monitoring. Specimen Count And Types CSF for routine, BCS and culture. Pathology Nil. Operative Findings 1. Insertion of EVD site: 2.5 cm lateral to midline, 2.5 cm above inion. Clear CSF gushed out, intraoperative ICP: 5-10 cmH2O. 2. Slack cerebellar hemispheres and good pulsation after craniectomy. Dura mater stayed intact( no dural augmentation). 3. Preoperative GCS: E1V1M5, + abducens palsy and pupils(5/5) L/R: -/- Operative Procedures Under ETGA, the patient was placed in prone position and the head was fixed by Mayfield. After shaving, disinfection, and draping, the left Frazier EVD was inserted. Then, the previous cranitomy wound was opened and the craniotomy window was removed. After normal saline irrigation, a epidural drain was placed. The wound was closed in layers. Operators V.S. 曾漢民 Assistants 鍾文桂 羅偉誠 Indication Of Emergent Operation 相關圖片 黃益川 (M,1947/03/19,64y11m) 手術日期 2010/11/08 手術主治醫師 蔡翊新 手術區域 東址 001房 04號 診斷 Major trauma rated 16 or above on the severeity scale ( Injury severeity score >=16 ) 器械術式 Craniotomy(Aneurysms) Others; left F-T-P craniectomy 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 王永彬 ASA 3E 紀錄醫師 許皓淳, 時間資訊 12:00 開始NPO 16:54 通知急診手術 17:45 進入手術室 17:50 麻醉開始 18:10 抗生素給藥 18:20 誘導結束 18:35 手術開始 20:45 開始輸血 21:40 抗生素給藥 22:35 手術結束 22:35 麻醉結束 22:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 急性硬腦膜下血腫清除術 1 1 L 手術 顱內壓視置入 1 2 L 摘要__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 蔡翊新 開立時間: 2010/11/08 22:09 Pre-operative Diagnosis Left temporoparietal skull fracture, left parietal EDH, left frontotemporoparietal SDH and left frontal and temporal contusion ICH. Post-operative Diagnosis Left temporoparietal skull fracture, left parietal EDH, left frontotemporoparietal SDH and left frontal and temporal contusion ICH. Operative Method Left F-T-P craniectomy for EDH and SDH removal, duroplasty and subdural ICP monitoring. Specimen Count And Types nil Pathology Nil. Operative Findings Linear skull fracture at left temporoparietal bone, 10 cm in length, with acute EDH, 7 x 6 x 2.5 cm, beneath it. Left F-T-P acute SDH, 1 cm in thickness, with active bleeders from Sylvian veins and bridging veins at left temporal and frontal regions. Contusional ICHs were noted at left temporal tip, frontal tip and superior temporal gyrus near the turning of Sylvian fissure. The brain became slack after evacuation of the SDH, but it swollen gradually while doing duroplasty. Intramural hematoma in the left temporalis muscle was noted, so it was excised to avoid postop epidural compression. ICP after duroplasty was 2 mmHg. ICP after wound closure was 2 mmHg. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 10 cm at left parietal area, the skin edge was clipped by Raney clips for temporary hemostasis. 5. A burr hole was made for evacuating part of the epidural hematoma, therefore the IICP could be relieved earlier. 6. The incision was extended to a temporal horseshoe, and the temporalis muscle was detached from temporal squama by rasp subsequently. 7. Craniotomy window: 14 x 12 cm, left F-T-P, created by making 5 burr holes then cut by power saw. Epidural clots were removed. 8. Dural tenting: by 2/0 silk, 1.5 cm in interval, distributed along the edge of skull window. 9. Dural incision: curvilinear along the edge of skull window. 10.The subdural clots were removed by sucker and those located beyond the cranial window were washed out by saline irrigation. Bleeding from the contusion sites and bridging veins were packed with Surgicel. 11.Hemosatasis: the bleeders was stopped by Bovie and oozing surface was covered with Surgicel. 12.Dural closure: was closed with a piece of dural graft taking from temporalis fascia, crescent shape 15 cm long, 1.5 cm wide, along the whole length of the dural incision in order to create an additional space for the swollen brain. 13.The skull plate was removed and stored at bone bank for preservation. 14.An Codman ICP monitor was placed at subdural space of left temporal area. Reference level: 517. 15.The left temporal muscle was excised. 16.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 17.Drain: two, epidural, CWV. 18.Blood transfusion: PRBC 4U. Blood loss: 1000 ml. 19.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5鍾文桂R1許皓淳 Indication Of Emergent Operation 王秀如 (F,1976/05/11,35y10m) 手術日期 2010/11/08 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Moyamoya disease 器械術式 EC-IC by-pass 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 2 紀錄醫師 古恬音, 時間資訊 08:05 進入手術室 08:10 麻醉開始 08:50 誘導結束 09:00 手術開始 09:00 抗生素給藥 12:30 抗生素給藥 15:30 抗生素給藥 17:40 手術結束 17:40 麻醉結束 17:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱內外血管吻合術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 11 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: Right STA-MCA bypass 開立醫師: 古恬音 開立時間: 2010/11/08 14:51 Pre-operative Diagnosis Moyamoya disease, status post left STA-MCA bypass Post-operative Diagnosis Moyamoya disease, status post left STA-MCA bypass Operative Method Right STA-MCA bypass Specimen Count And Types Nil Pathology Nil Operative Findings 1.Total [cortical artery] ischemic time: 62 mins 2.The posterior branch of STA was anastomosed with cortical branch of MCA [EC-IC] bypass in end to side fashion 2.The anterior branch of STA was anastomosed with cortical branch of MCA [EC-IC] bypass in end to side fashion 3.Patent flow after the anastemosis 3.Patent flow after the anastemosis, confirmed by intra-op ICG angiogram. Operative Procedures Under endotracheal general anaesthesia, the patient was put in supine position with head rotated to left. Scalp was shaved and scrubbed, and the course of the superficial temporal artery was mapped out after identification by Doppler. We made one curvillinear skin incision at right frontotemporal region and dissected to isolate anterior branch of STA. Temporalis muscle was incised and reflected inferiorly. One 4x4cm craniotomy window was made and dura tenting was done along the craniectomy window. Cruciate dura incision was done. Under operating microscope, a suitable cortical branch from the MCA was identified and the arachnoid around the vessel was removed by microscissors. Two temporary microvascular clips were applied, 1 cm appart, to the isolated segment of the cortical vessel, which was then opened by cutting off a leaf-like patch of the vascular wall. Heparin solution was used to irrigate the vascular lumen. The STA was occluded by a temporary clip and divided at its distal end. The lumen was irrigated with heparin solution. The advantitia at the vascular stump was trimmed off. The STA was anastomosed end-to-side to the segment of cortical artery interrupted stitches of 10/0 prolene. The vascular clips were released, and the leakage from the anastomosis was successufully stopped by gentle pressure on the patty with a small sucker tip. The dural plasty was performed by contineous prolene suture with muscular fascia .The loose space there was packed with gelfoam around the STA. The corner where STA passed through was bitten off for preventing undue pressure on the STA by the button. After checking bleeder and doing hemostasis, the wound was closed in layers. Operators P 杜永光 Assistants R6胡朝凱,R3古恬音 徐自修 (M,1950/11/15,61y3m) 手術日期 2010/11/08 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 許皓淳, 時間資訊 07:45 報到 08:08 進入手術室 08:15 麻醉開始 08:39 誘導結束 09:05 抗生素給藥 09:10 手術開始 12:05 抗生素給藥 13:15 麻醉結束 13:15 手術結束 13:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: craniotomy for tumor excision 開立醫師: 陳德福 開立時間: 2010/11/08 13:40 Pre-operative Diagnosis left CPA tumor, suspect acoustic neuroma Post-operative Diagnosis left CPA tumor, suspect acoustic neuroma Operative Method craniotomy for tumor excision Specimen Count And Types 1 piece About size:3*3*2.5CM Source:left CPA tumor Pathology pending Operative Findings 1.There is a 3.0*3.0*2.5cm in sized tumor at the left CPA with brain stem compression. The tumor is multiple lobulated with cysts formation. The tumor pushed the left facial nerve away and originated from the vestibular nerve. The fluid contents inside the tumor was yellowish and clear. 2.The facial nerve was identified with intraopeative facial nerve stimulation. No SSEP or BAEP changed during the operation. 3.Small part of the tumor was left in the IAC and the brain stem with other cranial nerves was well inspected after the tumor removal. Operative Procedures Under ETGA and 3/4 prone position with Mayfield pin type head fixator fixation, the skin was disinfected and draped as usual. One curvilinear incision over the left posterior auricular area was done followed by craniotomy to expose the left infratentorial area. The dura was then opened. The CSF was drained out first via the cistern magnum and the cerebellum was retracted with self retractor for exposure the tumor. The tumor was then removed step by step under microscopic surgery. The cranial nerves and adjacent AICA, PICA and petrosal vein were identified. The facial nerve was identified with stimulator and the tumor inside the IAC was removed partially. The dura was then closed with autologous fascia and the skull was fixed with miniplates. The wound was closed in layers. Operators VS 曾漢民 Assistants R5 陳德福 R5 陳德福 R1許皓淳 林陳月嬌 (F,1957/11/25,54y3m) 手術日期 2010/11/08 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 許皓淳, 時間資訊 12:58 報到 13:50 進入手術室 13:55 麻醉開始 14:10 誘導結束 14:20 抗生素給藥 14:32 手術開始 15:05 開始輸血 17:15 麻醉結束 17:15 手術結束 17:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 B 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: craniotomy meningioma excision, Simpson grade II 開立醫師: 陳德福 開立時間: 2010/11/08 17:46 Pre-operative Diagnosis Meningioma, originated from the crista gali Post-operative Diagnosis Meningioma, originated from the crista gali Operative Method craniotomy meningioma excision, Simpson grade II Specimen Count And Types 1 piece About size:3*3*4CM Source:Frontal skull base brain tumor Pathology pending Operative Findings 1.There is a 3*3*4cm in sized dura based tumor at the frontal skull base. The tumor is solid, hardish, fibrotic-elastic, well demarcated, and hypervascularized. The arterial feeders are from the skull base dura and the adjacent intracranial vessels. The tumor was mainly at the left frontal base, but the extension to the right hemisphere through the subfalcine route was noticed during the operation. 2.Simpson grade II tumor excision for the meningioma was done without remarkable vascular injury or dura defect remained. 3.One cyst posterior to the tumor is alos noticed and we drained out the fluid content. Hyperostosis at the crista gali is noticed. Operative Procedures Under ETGA and supine position, the scalp was disinfected and draped as usual. One bicoronal incision was done followed by creating a cross midline craniotomy over the left frontal area. The dura was then opened in C shape and the tumor came into view. The arachnoid plane between the tumor and the parencyma tissue is identified thereafter. We controlled the arterial feeder from the dura base and the intracranial arteries. The tumor was removed with central debulking method and the dura base was coagulized. After hemostasis, the dura was closed with autologous periosteium graft. The skull was fixed with miniplates and one subgaleal CWV was left in situ. The wound was closed in layers. Operators VS 曾漢民 Assistants R5 陳德福 R1許皓淳 蘇芷誼 (F,1984/11/01,27y4m) 手術日期 2010/11/08 手術主治醫師 林東燦 手術區域 兒醫 062房 04號 診斷 Acute lymphoid leukemia ( ALL ) 器械術式 TIT 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 林子富 ASA 2 時間資訊 10:23 報到 10:35 進入手術室 10:38 麻醉開始 10:40 誘導結束 10:43 手術開始 10:52 手術結束 10:52 麻醉結束 10:55 送出病患 11:00 進入恢復室 12:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室內注射留置器或脊髓腔內化學藥物注射 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 李何 (F,1933/04/28,78y10m) 手術日期 2010/11/08 手術主治醫師 王國川 手術區域 東址 005房 03號 診斷 Injury (severeity score >=16) 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 古恬音, 時間資訊 18:05 報到 18:05 進入手術室 18:15 麻醉開始 18:25 誘導結束 18:57 手術開始 20:45 麻醉結束 20:45 手術結束 20:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 頭顱成形術 1 2 L 手術 腦室腹腔分流手術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 外科部 套用罐頭: Cranioplasty 開立醫師: 古恬音 開立時間: 2010/11/08 21:01 Pre-operative Diagnosis Head injury status post craniectomy, with hydrocephalus Post-operative Diagnosis Head injury status post craniectomy, with hydrocephalus Operative Method 1. Cranioplasty with autologous skull plate 2. VP shunt insertion via right Kochers point Specimen Count And Types 1 piece About size:45mL Source:CSF Pathology Pending Operative Findings 1. The CSF openning pressure was about 12cmH2O, xanthochromic CSF drained out after ventricular puncture. 2. Codman medium pressure reservoir was used. Ventricular catheter depth 6.5cm, peritoneal catheter depth 25cm 3. One 12*15 skull defect was noted on the right side. The craniectomy window was distended and became slack after CSF drainage 4. The soft tissue was edematous and fragile Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right. 3. Skin preparation:shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with a sterilized adhesive plastic sheet. 4. Incision: along the previous operation scar, Raney clips were apllied to the scalp edge for temporary hemostasis. 5. The scalp was dissected away from the underlying dura until skull defect were well exposed. 6. One meidum pressure VP shunt was inserted via right Kocher point 7. The original skull plate was then fixed by miniplates 8. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 9.Drain: one, epidural, CWV. Operators VS王國川 Assistants R4李振豪,R3古恬音 黃琰宸 (M,1952/05/02,59y10m) 手術日期 2010/11/09 手術主治醫師 陳敞牧 手術區域 東址 001房 08號 診斷 Obstructive hydrocephalus 器械術式 Burr hole (trephination) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3E 紀錄醫師 鍾文桂, 時間資訊 15:30 臨時手術NPO 15:30 開始NPO 16:48 通知急診手術 22:30 報到 22:35 進入手術室 22:45 麻醉開始 22:50 誘導結束 23:10 抗生素給藥 23:36 手術開始 00:55 手術結束 00:55 麻醉結束 01:05 送出病患 01:10 進入恢復室 02:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Burr hole for evaculation of chronic subdural... 開立醫師: 鍾文桂 開立時間: 2010/11/10 01:34 Pre-operative Diagnosis Chronic subdural hemorrhage, right frontal-temporal-parietal. Post-operative Diagnosis Chronic subdural hemorrhage, right frontal-temporal-parietal. Operative Method Burr hole for evaculation of chronic subdural hemorrhage. Specimen Count And Types nil Pathology Nil Operative Findings Fluid -fluid level: upper: yellowish serous fluid; lower: liquified motor-oil like hematoma. Poor brain expansion.The V-P shunt was left intact. Operative Procedures Under ETGA, the patient was placed in supine position and the head was in midline. After shaving, disinfection,and draping, a horizontal scalp incision was made posterior to reservoir of V-P shunt. After creating a burr hole and durotomy, evacuation of chronic subdural hemorrhage was achieved with irrigation of 600 cc normal saline. Until the drainage fluid became clear pinkish, the wound was closed in layers with one subdural rubber drain. The subdural air accumulation was further evacuated. Finally, closed drainage system was connect. Operators V.S. 陳敞牧 Assistants R5 鍾文桂 Indication Of Emergent Operation 周月梅 (F,1954/05/01,57y10m) 手術日期 2010/11/09 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 07:48 報到 08:00 進入手術室 08:10 麻醉開始 08:40 抗生素給藥 08:45 誘導結束 08:46 手術開始 10:15 開始輸血 11:40 抗生素給藥 13:45 麻醉結束 13:45 手術結束 13:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: Simpson grade II tumor excision via right pte... 開立醫師: 鍾文桂 開立時間: 2010/11/10 01:40 Pre-operative Diagnosis Right temporal base meningioma. Post-operative Diagnosis Right temporal base meningioma. Operative Method Simpson grade II tumor excision via right pterional approach. Simpson grade II tumor excision via frontal-temporal approach. Specimen Count And Types 1 piece About size:50cc Source:meningioma Pathology Gross: hypervascular, whitish-pink, mixture of hard and soft solid tumors, invaded dura has severe adhesion with middle fossa base. Operative Findings High vascularity tumor, the tumor mass originated from middle skull base and pushed the temporal and frontal lobes upward. The sylvian fissure was stayed intact. Dural invasion of the dura mater at the junction of middle fossa base and squamous bone was noted. It was resected and the defect was repaired with temporalis fascia. Blood loss: 2200cc. Operative Procedures Under ETGA, the patient was placed in supine position and the head was tilted to the left. After shaving, disinfection, and draping, a curvilinear scalp incision was made. The craniotomy was created by high speed drill and craniotome. Then, much bleeding was noted from middle skull base and the dural invasion site at the junction of squamous bone and skull base. The bleeders were electrocoagulated b bipolar and sealed with Floseal. After hemostasis and dural tenting, durotomy was achieved. The tumor was noted subsequently. Cental debulking of the tumor under the assisstance of CUSA, then resectionin piece meal fashion was achieved. After well-hemostasis, the dura mater was repaired with temporalis fascia. The craniotomy bone graft was fixed by mini plates and screws. After placing one subgaleal drain, the wound was closed in layers. Operators V.S. 曾漢民 Assistants 鍾文桂 羅偉誠 相關圖片 陳碧蓮 (F,1974/01/13,38y2m) 手術日期 2010/11/09 手術主治醫師 郭夢菲 手術區域 兒醫 067房 02號 診斷 Moyamoya disease 器械術式 EC-IC by-pass (EDAS), left 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 3 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 09:37 報到 10:15 進入手術室 10:20 麻醉開始 10:35 誘導結束 10:58 抗生素給藥 11:55 手術開始 13:58 抗生素給藥 17:25 麻醉結束 17:25 手術結束 17:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 2 L 手術 拆線，每次 1 0 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 手術 朴卜勒氏血流測定（週邊血管） 1 0 記錄__ 手術科部: 外科部 套用罐頭: Encephaloduroateriosynangiosis (EDAS), left STA 開立醫師: 林哲光 開立時間: 2010/11/09 18:13 Pre-operative Diagnosis Moyamoya disease, stage 3 Moyamoya disease with eight ICH and IVH, S/P decompressive craniectomy, and cranioplasty and indirect EC-IC bypass with large double duropexy Post-operative Diagnosis Ditto 1. Ditto 2. Chronic subdural hematoma with outer membrane formation Operative Method Encephaloduroateriosynangiosis (EDAS), left STA 1. Encephaloduroateriosynangiosis (EDAS) and duropexy, left STA 2. removal of subdural collection and outer membrane Removal of stitches of right operative wound 3. Removal of stitches of right operative wound, larger than 20 cm in length Specimen Count And Types Pathology outer membrane of chronic subdural hematoma Operative Findings Left superficial temporal artery with accompanying vein was identified with Doopler. Total 9cm long vascular graft was free and covered near the left M3 portion and surrounding inferior frontal and superior temporal lobe. Outer membrane formation was noted and no obvious inner membrane was noted. Some yellowish hemosiderin contents were noted below the arachnoid membrane. Dura deflect was done and covered over the parenchyma of the frontal and temporal lobe. Left superficial temporal artery with accompanying vein was identified with Doopler. Total 10cm long, 2 cm wide left STA vascular graft was freed under microscopic view and covered near the left M3 portion and surrounding left inferior frontal and superior temporal lobe. Outer membrane formation was noted and no obvious inner membrane was noted. Some yellowish hemosiderin contents were noted below the arachnoid membrane. Duropexy was done and covered over the parenchyma of the frontal and temporal lobe. There were numerous collateral formation on the meninges Operative Procedures Under ETGA and supine position with head rotated to right side, skin disinfected and drapped were performed as usual. A curvilinear skin incision was made over the left frontotemporal area. Left superficial temporal artery was dissected and free with the galea attachment according the previous doopler marking. Two burr holes were created and craniotomy below the STA graft was done. The dura was opened in "I" shape and the arachnoid membrane was opened to expose the more area of the parenchyma after outer membrane was dissected. The edges of dura were deflected and adherent to the associated galea of the vascular graft. The skull bone was then put back and fixed with wires after central tenting. Hemostasis was then done and covered with Duraform. The wound was then closed in layers. Under ETGA and supine position with head rotated to right side, skin disinfected and drapped were performed as usual. A large curvilinear skin incision (like question mark) was made over the left frontotemporal area. Left superficial temporal artery was identified with Doppler and then dissected under microscopic view. It was dissected with the surrounding galea for about 2 cm wide and 10 cm long. The left temporalis muscle was then divided to expose the skull bone. Two burr holes were created just above the bifurcation of the proximal STA, and its distal bifurcation. The craniotomy below the STA graft was then done. The dura was opened in "I" shape and the arachnoid membrane was opened to expose the brain cortex as much possible after the outer membrane was removed and coagulated. The edges of dura were reflected downward to have a good contact with the brain sulci. The STA vascular graft was then placed on the brain surface. We closed the dura by approximate the dura and the galea on both sides of the STA graft with 4-0 prolene. The dural defect was covered with gelfoam to reduce the chance of CSF leakage. The skull bone was then put back and fixed with 4 wires after 2 central tenting. Hemostasis was then done and covered with Duraform. The wound was then closed in layers. Operators AP 郭夢菲 Assistants R4 林哲光 相關圖片 吳東澔 (M,2008/03/24,3y11m) 手術日期 2010/11/09 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Subdural hemorrhage or effusion 器械術式 Revision of CSF shunt (Removal of left S-P shunt) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 2 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:10 進入手術室 08:15 麻醉開始 08:20 誘導結束 08:35 抗生素給藥 08:58 手術開始 09:20 手術結束 09:20 麻醉結束 09:56 送出病患 10:05 進入恢復室 11:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 皮下肌肉或深部異物取出術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Removal of S-P shunt 開立醫師: 林哲光 開立時間: 2010/11/09 09:33 Pre-operative Diagnosis Bilateral subdural effusions s/p S-P shunt, left Bilateral subdural hygroma s/p S-P shunt, left Post-operative Diagnosis Ditto Operative Method Removal of S-P shunt Specimen Count And Types Pathology Operative Findings Subdural catheter was easily movable and total removal of the S-P shunt was performed. Operative Procedures Under ETGA and supine position with head rotated to right side, skin disinfected and drapped were performed as usual. Skin incision along the previous operative wound was done. The abdominal catheter was identified and pulled out along the tract. The subdural catheter was then removed and covered with Gelfoam. The wound was then closed in layers after hemostasis. Under ETGA and supine position with head rotated to right side, skin disinfected and drapped were performed as usual. Skin incision along the previous operative wound was done. The abdominal catheter was identified and pulled out along the tract. The subdural catheter was then removed and covered with Gelfoam. The wound was then closed in layers after hemostasis. The catheter was sent for culture. Operators AP 郭夢菲 Assistants R4 林哲光 吳清隆 (M,1941/02/05,71y1m) 手術日期 2010/11/09 手術主治醫師 林孟暐 手術區域 東址 001房 06號 診斷 Cerebrovascular accident (CVA) 器械術式 Tracheostomy 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 高明蔚, 時間資訊 23:59 開始NPO 23:59 臨時手術NPO 23:59 通知急診手術 14:53 進入手術室 14:55 麻醉開始 15:00 誘導結束 15:13 手術開始 15:25 手術結束 15:25 麻醉結束 15:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 氣管切開術 1 0 摘要__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 高明蔚 開立時間: 2010/11/22 16:05 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheotomy Specimen Count And Types nil Pathology None Operative Findings Fr.8 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound. Operators 林孟暐 Assistants R3高明蔚 Indication Of Emergent Operation 朱鄭瑞燕 (F,1936/08/15,75y6m) 手術日期 2010/11/09 手術主治醫師 賴達明 手術區域 東址 005房 02號 診斷 Intracerebral hemorrhage 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 羅偉誠, 時間資訊 14:23 進入手術室 14:25 麻醉開始 14:30 誘導結束 14:45 手術開始 15:06 手術結束 15:06 麻醉結束 15:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 氣管切開術 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 吳經閔 開立時間: 2010/11/09 15:17 Pre-operative Diagnosis Left ICH with respiratory failure Post-operative Diagnosis Ditto Operative Method Tracheostomy Specimen Count And Types nil Pathology None Operative Findings Fr. 7 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators 賴達明 Assistants 鍾文桂，羅偉誠 楊麗珠 (F,1940/01/26,72y1m) 手術日期 2010/11/09 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Lumbar Spondylosis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 張僖, 時間資訊 07:30 報到 08:03 進入手術室 08:10 麻醉開始 08:15 誘導結束 09:00 抗生素給藥 09:20 手術開始 12:00 抗生素給藥 12:35 手術結束 12:35 麻醉結束 12:40 送出病患 12:43 進入恢復室 14:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: L4~5 TPS and anterior banana cage fusion,TLIF 開立醫師: 胡朝凱 開立時間: 2010/11/09 12:45 Pre-operative Diagnosis L4 on L5 spondylolisthesis Post-operative Diagnosis L4 on L5 spondylolisthesis Operative Method L4~5 TPS and anterior banana cage fusion,TLIF Specimen Count And Types nil Pathology nil Operative Findings 1.L4 on L5 anterior listhesis with neural foramen stenosis 2.TPS screws 6.2 x 4 for 4 screws Operative Procedures 1.ETGA, prone 2.Midline skin incision 3.Detach paravertebral muscle to expose L4 and L5 facet jount 4.TPS screws insertion 5.L4 laminectomy 6.Left L4~5 facet joint removal 7.Lateral approach for discectomy of L4~5 8.Banana cage insertion 9.Hemostasis 10.Close wound in layers after one CWV drain insertion Operators 賴達明 Assistants 胡朝凱, 張僖 劉桂花 (F,1938/04/11,73y11m) 手術日期 2010/11/09 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Herniation of intervertebral disc 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 張僖, 時間資訊 12:20 報到 12:58 進入手術室 13:05 麻醉開始 13:10 誘導結束 14:00 抗生素給藥 14:19 手術開始 17:00 抗生素給藥 17:29 開始輸血 18:30 手術結束 18:30 麻醉結束 18:40 送出病患 18:43 進入恢復室 20:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎弓切除術(減壓)-超過二節 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 記錄__ 手術科部: 外科部 套用罐頭: L4~5 TPS, L4 laminectomy and L1 to L4 laminot... 開立醫師: 胡朝凱 開立時間: 2010/11/09 18:53 Pre-operative Diagnosis L4 on L5 spondylolisthesis and L1 ~5 stenosis Post-operative Diagnosis L4 on L5 spondylolisthesis and L1 ~5 stenosis Operative Method L4~5 TPS, L4 laminectomy and L1 to L4 laminotomy for sublaminar decompression Specimen Count And Types nil Pathology nil Operative Findings 1.hypertrophic flavum ligment that caused nerve root compression 2.L4 on L5 anterior listhesis 3.Instability of L2 on L3, L3 on L4 4.Scoliosis at L4 and L5 level Operative Procedures 1.ETGA, prone 2.Midline incision at L1 to L5 level 3.Detach paravertebral muscle 4.Expose L4 and L5 facet 5.L4~5 TPS screws insertion 6.L4 laminectomy 7.L1 to L4 left side laminotomy for decompression 8.Hemostasis 9.Set one hemovac drain 10.Close wound in layers Operators 賴達明 Assistants 胡朝凱, 張僖 洪筱涵 (F,1992/06/08,19y9m) 手術日期 2010/11/09 手術主治醫師 王國川 手術區域 東址 002房 03號 診斷 Subdural hematoma 器械術式 Removal of acute subdural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 5E 紀錄醫師 李振豪, 時間資訊 12:43 開始NPO 12:43 通知急診手術 13:05 進入手術室 13:10 麻醉開始 13:20 抗生素給藥 13:43 手術開始 13:43 誘導結束 14:00 開始輸血 16:35 手術結束 16:35 麻醉結束 16:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦內血腫清除術 1 1 R 手術 顱內壓視置入 1 2 R 摘要__ 手術科部: 外科部 套用罐頭: Right fronto-temporo-parietal craniectomy for... 開立醫師: 李振豪 開立時間: 2010/11/09 17:06 Pre-operative Diagnosis Right temporo-parietal skull fracture with acute subdural hematoma Post-operative Diagnosis Right temporo-parietal skull fracture with contusional intracerebral hemorrhage and acute subdural hematoma Operative Method Right fronto-temporo-parietal craniectomy for ICH and SDH evacuation Specimen Count And Types 1 piece About size:swab x I Source:Skull plate Pathology Nil Operative Findings The subcutaneous tissue and temporalis muscle was infiltrated with hematoma. The dura tear was noted along the fracture line. Contusional ICH(right high frontal, suspect motor area, and right temporal tip) were noted below the fracture line with active bleeding. Thick acute SDH also noted after dura opening. The brain was swelling after removal of the hematoma. The ICP was 6mmHg after skin closure. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine position with head rotated to left. The scalp was shaved, scrubbed, and disinfected as usual. The traumatic flap scalp incision was made at right fronto-temporo-parietal area and the skin flap was elevated. The periosteum and temporalis muscle was elevated. 5 burr holes were created followed by craniectomy with 12x8cm in size. Dural tenting was done. The dura was opened in C-shape and subdural and intracerebral hematoma was evacuated for decompression. Hemostasis was performed with Surgicel lining and bipolar electrocautery. Intra-operative echo was checked to make sure that there was no new hemorrhage. The temporalis muscle was transected and the fascia was harvested. Dura augmentation was performed with autologus fascia and hemostasis was achieved with Gelform packing and bipolar electrocautery. One epidural CWV was placed and the wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS王國川 Assistants R4李振豪 Indication Of Emergent Operation 相關圖片 王徐秋 (F,1943/07/24,68y7m) 手術日期 2010/11/09 手術主治醫師 蔡翊新 手術區域 東址 005房 03號 診斷 Cerebrovascular accident (CVA) 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 羅偉誠, 時間資訊 15:15 報到 15:23 進入手術室 15:30 麻醉開始 15:35 誘導結束 15:43 抗生素給藥 16:05 手術開始 18:35 手術結束 18:35 麻醉結束 18:43 抗生素給藥 18:45 送出病患 18:50 進入恢復室 20:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 頭顱成形術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Cranioplasty 開立醫師: 蔡翊新 開立時間: 2010/11/09 18:30 Pre-operative Diagnosis Right moddle cerebral artery infarction, status post craniectomy Post-operative Diagnosis Right moddle cerebral artery infarction, status post craniectomy and cranioplasty Operative Method Cranioplasty Specimen Count And Types nil Pathology Nil Operative Findings Skull defect, 12 x 10 cm, at right F-T-P region. The brain was initially swollen, but became slack after CSF release, about 30 c.c., via a temporary right Kocher EVD. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head turned to left. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with a sterilized adhesive plastic sheet. 4. Incision: along the previous operation scar at right F-T-P area, Raney clips were apllied to the scalp edge for temporary hemostasis. 5. The right temporal area scalp and temporalis muscle were dissected away from the underlying dura. 5. The scalp and temporalis muscle flap were reflected from the underlying dura. The dural surface and margin of skull defect were well exposed. 6. The bleeders on the dissected surfaces were coagulated with Bipolar coagulation. 7. The edge of the skull defect was exposed. 8. The original skull plate, preserved in bone bank, was placed back to the skull window then fixed by 3 miniplates and 6 screws. 5 dural tentings were put at the center of the skull plate. 9. Place two CWV drains over epidural space. 10.Scalp closure: hemostasis was done with Galea suture was performed by continuous suture with 2/0 Vicryl and skin by interrupted mattressed suture with 3/0 nylon. 11.Blood transfusion:nil. Blood loss: 200 ml. 12.Course of the surgery: smooth. Operators 蔡翊新 Assistants R5鍾文桂R1羅偉誠 林連喜 (M,1934/10/25,77y4m) 手術日期 2010/11/10 手術主治醫師 林晉 手術區域 東址 022房 01號 診斷 Femoral neck fracture, closed 器械術式 bipolar hemiarthroplasty 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 脊髓麻醉 麻醉主治醫師 陳李魁 ASA 3 紀錄醫師 謝忠佑, 時間資訊 07:31 報到 08:00 進入手術室 08:05 麻醉開始 08:30 誘導結束 08:30 抗生素給藥 08:57 手術開始 09:40 開始輸血 10:20 手術結束 10:20 麻醉結束 10:25 送出病患 10:27 進入恢復室 11:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Spinal anesthesia 1 0 麻醉 SPINAL ANESTHESIA 1 0 麻醉 Peripheral arterial line inserti 1 0 手術 部份關節置換術併整形術–只置換髖臼或股骨或半股關節或半肩關節 1 1 L 摘要__ 手術科部: 骨科部 套用罐頭: left femoral neck fracture, displaced, neglec... 開立醫師: 謝忠佑 開立時間: 2010/11/10 10:22 Pre-operative Diagnosis left femoral neck fracture, displaced, neglected, with soft tissue contracture Post-operative Diagnosis left femoral neck fracture, displaced, neglected, with soft tissue contracture Operative Method left femoral neck fracture, displaced, neglected, with soft tissue contracture bipolar hemiarthroplasty, United Femoral head 26mm +0 Stem 11mm #3 Cap 47mm Specimen Count And Types 1 piece About size: Source:culture x 1 Pathology nil Operative Findings left femoral neck fracture, displaced, neglected, with soft tissue contracture Operative Procedures 1. SA, lateral decubitus 2. prepped and draped 3. longitudinal incision, posterolateral approach to the hip joint, remove the femoral head 4. performed hemiarthroplasty step by step with United bipolar prosthesis 5. check alignment and stability, irrigation, repair joint capsule and muscle, irrgiation, close wound in layers 6. perform adduc Operators 林晉 Assistants 謝忠佑 李奕辰 蔡瓊美 (F,1941/05/06,70y10m) 手術日期 2010/11/10 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Acromegaly 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 許皓淳, 時間資訊 14:25 報到 14:55 進入手術室 15:00 麻醉開始 15:20 抗生素給藥 15:20 誘導結束 15:40 手術開始 16:48 麻醉結束 16:48 手術結束 16:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經由蝶竇之腦下垂體瘤切除 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Transsphenoidal adenomectomy. 開立醫師: 許皓淳 開立時間: 2010/11/10 17:30 Pre-operative Diagnosis Pituitary microadenoma. Post-operative Diagnosis Pituitary microadenoma. Operative Method Transsphenoidal adenomectomy. Specimen Count And Types 1 piece About size:3cc Source:pituitary adenoma. Pathology Nil. Operative Findings Presence of septal deviation. The mucosa over the sphenoid sinus was resected while creating operative corridor. Some adhesion of the adenoma to the pituitary gland was removed. Little CSF leakage was noted. Sealing of the CSF leakage was achieved with TissueCoDuo. Yellowish, soft, fragile adenoma was noted. Operative Procedures Under general anethesia and intubation, the patient was put in supine position. The facial skin was antiseptic with alcohol, and the mucosa of oral and nasal cavity with aqueous better-iodine. The face was covered with sterilized adhesive plastic sheets then draped. Under microscope, nasal septum was incised, and a nasal speculum was applied to displace the nasal mucosa laterally and keep the nasal cavity open constantly for the exposure of the vomer bone and the anterior wall of the sphenoid sinus. The anterior sphenoid wall, sphenoid sinus mucosa and sella floor were removed along with the sphenoidal portion of the adenoma. The dura was coagulated then opened in cruciate fashion. The tumor was removed by curette and aligator. The CSF leakage was sealed with Tissuecol Duo and gelform packing. The bone of anterior sphenoid wall was placed back and the nasal mucosa was returned to its normal position. The nasal mucosa was sealed with Tissuecol Duo. Operators 曾漢民 Assistants R5鍾文桂, R1許皓淳 許証淵 (M,1969/06/30,42y8m) 手術日期 2010/11/10 手術主治醫師 蔡瑞章 手術區域 東址 005房 01號 診斷 Brain cancer 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 許皓淳, 時間資訊 07:32 報到 08:04 進入手術室 08:10 麻醉開始 08:30 誘導結束 08:50 抗生素給藥 09:33 手術開始 12:00 抗生素給藥 14:35 麻醉結束 14:35 手術結束 14:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4~8小時 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Excision of tumor via left frontal-temporal a... 開立醫師: 鍾文桂 開立時間: 2010/11/10 15:08 Pre-operative Diagnosis Left temporal primitive neuroectodermal tumor, recurrent with scalp seeding. Post-operative Diagnosis Left temporal primitive neuroectodermal tumor, recurrent with scalp seeding. Operative Method Excision of tumor via left frontal-temporal approach. Specimen Count And Types 2 pieces About size:30 cc Source:left temporal tumor About size:5 cc Source:scalp tumor Pathology Pending. Operative Findings Mixture of hard and soft, grayish-pink tumor at left temporal area. Invasion to temporal base, tentorium cerebri, cavernous sinus.Due to severe adhesion of the tentorium,some tumor was left on it. After tumor resection, CN III, posterior clinoid process, and basilar artery were noted. The sylvian fissure was left intact. The scalp tumor was resected. Thining of the scalp at the lesion site was noted. We closed the scalp primarily with interrupted mattress sutures. We consulted Plastic Surgeon for planning of wound closure. Operative Procedures Under ETGA, the patient was placed in supine position and the head was tilted to the right. After shaving, disinfection,and draping, the previous operative wound was incised. The scalp tumor was excised. After removal of the bone plate and durotomy, the tumor was removed in piece meal fashion. The tumor at the dural attachment was electrocoagulated. After well hemostasis, the dura mater was closed in water-tight fashion. A subgaleal drain was placed. The wound was closed in layers. Operators Prof. 蔡瑞章 Assistants R5 鍾文桂 R1許皓淳 鄧迅之 (M,1926/03/15,85y11m) 手術日期 2010/11/10 手術主治醫師 林至芃 手術區域 西址 034房 01號 診斷 Cerebrovascular Diseases 器械術式 Insertion of hichman or port a 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 林至芃 ASA 3 時間資訊 07:45 報到 08:12 進入手術室 08:25 麻醉開始 08:28 抗生素給藥 08:28 誘導結束 08:36 手術開始 09:35 麻醉結束 09:35 手術結束 09:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 port–A導管植入術–治療性導管植入術 1 0 R 記錄__ 手術科部: 麻醉部 套用罐頭: Port-A implantation, subclavian 開立醫師: 林昱廷 開立時間: 2010/11/10 09:38 Pre-operative Diagnosis Lung cancer Lung cancer, brain tumor metastasis Lung cancer, brain metastasis Post-operative Diagnosis Ditto Operative Method Port-A implantation, echo-guided Specimen Count And Types nil Pathology Nil Operative Findings 1.Site: right subclavian vein, with echo-guided procedure 2.Patent flow after implantation 3.Others: nil Operative Procedures 1.The patient was set on supine position and bilateral subclavian veins were checked by echo. 2.After IVGA and local anesthesia applied, transverse skin incision for 3cm was made at pre-cordial area. 3.Undermine the skin at the layer between subcutaneous tissue and deep fascia in lateral direction. 4.An IV catheter was inserted via the subclavian incision and negatively aspirated until venous blood attainable. 5.J-wire was inserted smoothly in rostral direction. A subclavian catheter with dilator was inserted through the J-wire, and the dilator was then removed. 6.The catheter of Port-A was threaded into the subclavian vein until mark 21 cm. The catheter was adapted into the port and locked with restrictor.The Port was inserted into the pouch of pre-cordial incision. 7.Skin was closed layer by layer. Both catheter and port were perfused with heparin solution after implantation. Operators 林至芃, Assistants 林昱廷, 張耀仁 (M,1933/01/09,79y2m) 手術日期 2010/11/10 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Herniation of intervertebral disc (HIVD) 器械術式 Diskectomy lumbar (posterior) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 胡朝凱, 時間資訊 08:05 進入手術室 08:10 麻醉開始 08:15 誘導結束 08:45 抗生素給藥 09:10 手術開始 11:05 手術結束 11:05 麻醉結束 11:15 送出病患 11:16 進入恢復室 12:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 椎間盤切除術-腰椎 1 1 手術 椎弓切除術(減壓)-二節以內 1 2 記錄__ 手術科部: 外科部 套用罐頭: L4~5 discectomy with hemilaminectomy and Cofl... 開立醫師: 胡朝凱 開立時間: 2010/11/10 11:13 Pre-operative Diagnosis recurrent L4~5 rupture disc with mild instability Post-operative Diagnosis recurrent L4~5 rupture disc with mild instability Operative Method L4~5 discectomy with hemilaminectomy and Coflex insertion Specimen Count And Types nil Pathology nil Operative Findings 1.One piece of ruptured disc protruded into L4~5 spinal canal that compressed the right L5 nerve root tightly. 2.Hypertrophic flavum ligment 3.Mild instability of L4~5 joint 4.8# coflex was inserted. Operative Procedures 1.ETGA, prone 2.Midline previous wound incision 3.Detach paravertebral muslce 4.Laminotomy of L4~5 level 5.Remove flavum ligment 6.Romeve ruptured disc 7.Discectomy 8.Remove interspinos ligment 9.Coflex insertion 10.Hemostasis 11.close wound in layers Operators 賴達明 Assistants 胡朝凱, Ri 張月貌 (F,1963/02/26,49y0m) 手術日期 2010/11/10 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Herniation of intervertebral disc 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 胡朝凱, 時間資訊 11:05 報到 11:25 進入手術室 11:33 麻醉開始 11:38 誘導結束 12:00 抗生素給藥 12:20 手術開始 14:35 手術結束 14:35 麻醉結束 14:45 送出病患 14:47 進入恢復室 17:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 椎間盤切除術-頸椎 1 1 記錄__ 手術科部: 外科部 套用罐頭: Anterior approach for discectomy and cage fusion 開立醫師: 張得一 開立時間: 2010/11/10 14:50 Pre-operative Diagnosis c5~6 HIVD Post-operative Diagnosis c5~6 HIVD Operative Method Anterior approach for discectomy and cage fusion Specimen Count And Types nil Pathology nil Operative Findings 1.One small piece of ruptured disc was noted at left side C5~6 level that compression to C6 nerve root Operative Procedures 1.ETGA, supine 2.Right neck transverse skin incision 3.Dissection to expose prevertebral space 4.Detach longus coli muscle 5.Localization of C5~6 with C-arm 6.C5~6 discectomy 7.6# cage insertion 8.Set one minihemovac 9.Close wound in layers Operators 賴達明 Assistants 胡朝凱, Ri 楊東壁 (M,1951/03/15,60y11m) 手術日期 2010/11/10 手術主治醫師 賴達明 手術區域 東址 003房 03號 診斷 Cervical spondylosis 器械術式 Spinal fusion anterior spinal 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 胡朝凱, 時間資訊 15:00 進入手術室 15:07 麻醉開始 15:15 誘導結束 15:40 抗生素給藥 15:45 手術開始 18:40 抗生素給藥 18:50 手術結束 18:50 麻醉結束 18:55 送出病患 19:00 進入恢復室 20:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 椎間盤切除術-頸椎 1 1 手術 脊椎融合術-前融合,有固定物)≦四節 1 2 記錄__ 手術科部: 外科部 套用罐頭: Anterior approach for discectomy then cage in... 開立醫師: 胡朝凱 開立時間: 2010/11/10 19:07 Pre-operative Diagnosis C4~5,5~6 HIVD with ruptured disc and collapsed C5 vertebral body Post-operative Diagnosis C4~5,5~6 HIVD with ruptured disc and collapsed C5 vertebral body Operative Method Anterior approach for discectomy then cage insertion with plate fixation Specimen Count And Types pieces of collapsed body bone chips and disc Pathology pending Operative Findings 1.C4~5 level protruding and dehydrated disc was noted that compressed the thecal sac tightly. 2.C5 vertebral body was partial collapsed. 3.The C5~6 disc was also dehydrated and ruptured, and the PLL adhered to dura was also noted. 4.After decompredssion, thecal sac expanded well. 5.7#, 9# cage was inserted at C4~5 and C5~6 level. 33 mm plate was fixed. Operative Procedures 1.ETGA, supine 2.Right neck transverse skin incison 3.Dissect to expose prevertebral space 4.Localization with C-arm 5.Discectomy of C4~5 and 5~6 6.Cage insertion 7.Plate fixation 8.Hemostasis 9.set one hemovac drain 10.close wound in layers Operators 賴達明 Assistants 胡朝凱, Ri 李啟弘 (M,1960/11/12,51y4m) 手術日期 2010/11/10 手術主治醫師 王國川 手術區域 東址 005房 03號 診斷 Intracranial hemorrhage 器械術式 Craniotomy(Aneurysms) VS-TZENG 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林至芃 ASA 4E 紀錄醫師 胡朝凱, 時間資訊 16:29 開始NPO 16:29 臨時手術NPO 16:29 通知急診手術 18:49 進入手術室 18:53 麻醉開始 19:07 誘導結束 19:45 抗生素給藥 19:50 手術開始 22:05 手術結束 22:05 麻醉結束 22:13 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 手術 顱內壓視置入 1 2 R 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 記錄__ 手術科部: 外科部 套用罐頭: Craniectomy for tumor and hematoma excision 開立醫師: 胡朝凱 開立時間: 2010/11/10 22:39 Pre-operative Diagnosis Right frontal tumor Post-operative Diagnosis right frontal tumor with bleeding Operative Method Craniectomy for tumor and hematoma excision Specimen Count And Types pieces of tumor Pathology pending Operative Findings 1.Pre-op pupil dilate 2.Severe brain swelling after craniectomy 3.About 80 ml hematoma was noted at right frontal lobe 4.Some yellowish abnormal lesion was also noted at the hematoma border 5.One AV shunting was noted at right frontal surface Operative Procedures 1.ETGA, supine 2.Right curvillinear skin incision 3.Reflect skin flap 4.Craniectomy 5.Dural opening 6.Corticotomy and hematoma evacuation 7.tumor excision 8.hemostasis 9.ICP monitor was put into brain parenchyma 10.close dura with durofoam 11.Close wound in layers Operators 王國川 Assistants 胡朝凱, 林哲光 Indication Of Emergent Operation 黃素華 (F,1932/11/27,79y3m) 手術日期 2010/11/11 手術主治醫師 黃俊升 手術區域 東址 056房 01號 診斷 Breast cancer, female 器械術式 Left, MRM 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 全賀顯, 時間資訊 08:10 進入手術室 08:10 麻醉開始 08:15 誘導結束 08:22 抗生素給藥 08:45 手術開始 11:45 手術結束 11:45 麻醉結束 11:50 送出病患 12:00 進入恢復室 15:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 單純乳房切除術-單側 1 2 L 手術 腋窩淋巴腺清除術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 記錄__ 手術科部: 外科部 套用罐頭: MRM 開立醫師: 全賀顯 開立時間: 2010/11/11 12:10 Pre-operative Diagnosis Left breast cancer Post-operative Diagnosis Left breast cancer Operative Method Left Modified radical mastectomy. Specimen Count And Types 5 pieces About size:10*5*3 Source:Left Breast tissue About size:1*1*1 Source:LN1 About size:1*1*1 Source:LN2 About size:1*1*1 Source:LN About size:1*1*1 Source:LN Pathology Breast cancer and lymph node Operative Findings 1. SLND1: ;SLND2: No imprint cytology 3. The breast tumor: 2.5x2 cm Operative Procedures 1.Patient was put on supine position with left arm 90 degree abducted. Under ETGA, skin was disinfected and draped as usual. 2.An transverse elliptical incision, including the nipple-areolar complex and the skin over the biopsy wound, from left parasternalto left axillary area was made superiolaterally. 3.The incised skin was grasped and retracted upward with breast clamps for skin flap dissection. Electrocauterization was used for dissection of skin flaps. 4.The dissection reached to the level 1 cmbelow clavicle superiorly, the costal margin inferiorly and the parasternal area medially. Laterally dissecton was extended to the border of latissimus dorsi. 5.The clavipectoral fascia was opened. The axillary vein was exposed and identified. The branches of the axillary vein were devided between ligatures. 6.Axillary lymph node dissection was then performed for level I and II with identification and preserving of the long thoracic and thoracodorsal nerves. Breast tissue was removed en bloc with the axillary lymph nodes. 7.The bleeders were checked meticulously. The operative field was irrigated with warm saline. 8.The wound was closed layer by layers after two CWV drains were left. Blood loss was minimal and the patient stood the whole procedure well. Operators P黃俊升 Assistants R3陳柏達 R1方怡婷 R1全賀顯 相關圖片 陳淑方 (F,1953/07/15,58y7m) 手術日期 2010/11/11 手術主治醫師 陳晉興 手術區域 東址 027房 05號 診斷 Lung cancer 器械術式 Thoracoscopy 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林珍榮 ASA 2 紀錄醫師 劉昌杰, 時間資訊 15:17 進入手術室 15:20 麻醉開始 15:30 誘導結束 15:35 抗生素給藥 16:10 手術開始 17:35 18:50 手術結束 18:50 麻醉結束 19:06 送出病患 19:10 進入恢復室 20:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 胸腔鏡肺楔狀或部分切除術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 根治性甲狀腺切除術(含單側頸部淋巴腺切除術) 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: VATS wedge resection of right upper lobe 開立醫師: 高明蔚 開立時間: 2010/11/11 17:10 Pre-operative Diagnosis 1.Right upper lobe tumor 2.Thyroid cancer Post-operative Diagnosis 1.Right upper lobe tumor 2.Thyroid cancer Operative Method VATS wedge resection of right upper lobe Specimen Count And Types 1 piece About size:6CM Source:RUL Pathology Pending. Operative Findings One 0.5cm in diameter whitish elastic nodule was noted at RUL. Large wedge resection was performed and grossly section margin is free. Operative Procedures ETGA, left decubitus, skin disinfection and draping as usual. VATS setting. Identify lesion location, perform wedge resection with Ethicon EndoGIA60. Check bleeding, set Fr.24 chest tube, then close the wounds in layers. Operators 陳晉興 Assistants CR李佳穎,R3高明蔚,R1劉昌杰 摘要__ 手術科部: 外科部 套用罐頭: Total thyroidectomy 開立醫師: 劉昌杰 開立時間: 2010/11/11 19:01 Pre-operative Diagnosis Thyroid cancer Post-operative Diagnosis Thyroid cancer Operative Method Total thyroidectomy Specimen Count And Types 2 pieces About size:3X3cm Source:right part of thyroid gland About size:3X3cm Source:left part of thyroid gland Pathology pending Operative Findings 1. Multiple hard nodule was found at left thyroid gland 2. Paratracheal lymph node involvement: negative 3. Upper mediastinal lymph node involvement: negative 4. Recurrent laryngeal nerve was identified and preserved Operative Procedures 1. ETGA , put the patient in semi-Fowler position 2. Preparation of skin with Hibitane 3. Mark the location of the incision by 2-0 silk , two finger breadths above the sternal notch 4. Skin incision and formation of flaps 5. Opening of the deep fascia and elevation of the strap muscles 6. Exposure and mobilization of the gland then ligation of supplying vessel with Ligasure 7. Identified bilateral recurrent larygneal nerve 8. Resect the totalthyroid gland and establish good hemostasis Central lymphnode was dissectted 9. Place two surgicel at bilateral site 10. Close the wound in layers Operators 吳明勳 Assistants R1 劉昌杰 楊涂厭 (F,1946/05/25,65y9m) 手術日期 2010/11/11 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 Spinal injury with complication, sequelae 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 14:05 進入手術室 14:10 麻醉開始 14:15 誘導結束 14:30 抗生素給藥 14:50 手術開始 18:12 手術結束 18:12 麻醉結束 18:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 手術 椎間盤切除術-頸椎 1 2 R 摘要__ 手術科部: 外科部 套用罐頭: C4-5, C5-6 anterior cervical diskectomy and f... 開立醫師: 李振豪 開立時間: 2010/11/11 19:00 Pre-operative Diagnosis Herniation of intervertebral disc, C3-4, C4-5, C5-6, with cervical stenosis Post-operative Diagnosis Herniation of intervertebral disc, C3-4, C4-5, C5-6, with cervical stenosis Operative Method C4-5, C5-6 anterior cervical diskectomy and foraminotomy + anterior fusion with cage and plate Specimen Count And Types nil Pathology Nil Operative Findings 1. The marginal spur at C3-4 space was fused tightly. The disc at C4-5 and C5-6 was degenerated with marginal spur formation. OPLL was noted after diskectomy and the OPLL was tightly adhered with the dura. No CSF leakage was noted during the operation. 2. Cage: #7 x II Plate: 37mm x I Screws: 4 x 12mm x VI 3. No SSEP change was noted during whole procedure 4. Goiter(+) Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine position with neck extension. The skin was disinfected and draped as usual. One transverse skin incision was made at skin fold of mid-neck. The subcutaneous soft tissue was dissected. The platysma muscle was transected. THe fascia was opened to enter the plane between SCM muscle and thyroid gland. The pre-vertebral fascia was identified and the spinal needle was used for localization of the C4-5 and C5-6 disc space. After confirm the localization of the disc space by portable C-arm X-ray. Microdiskectomy was performed with knife, alligator, kerrison punches, and high-speed air-drived drill. Two #7 cage were placed for anterior fusion. One 37mm plate and 6 screws were applied under C-arm guided. Hemostasis was achieved and the wound was then closed in layers with 3-0 Vicryl and 4-0 Dexon(subcuticular suture). Operators VS王國川 Assistants R4李振豪, R1羅信偉 相關圖片 蔡仁松 (M,1942/05/07,69y10m) 手術日期 2010/11/11 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Malignant neoplasm of other parts of bronchus or lung 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 07:50 報到 08:00 進入手術室 08:05 麻醉開始 08:50 誘導結束 08:50 抗生素給藥 09:25 手術開始 12:00 抗生素給藥 12:22 13:40 麻醉結束 13:40 手術結束 13:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 腦瘤切除-手術時間在4~8小時 1 1 B 摘要__ 手術科部: 腫瘤醫學部 套用罐頭: Left occipital and right frontal craniotomy f... 開立醫師: 李振豪 開立時間: 2010/11/11 14:03 Pre-operative Diagnosis Left occipital and right frontal metastatic tumor Post-operative Diagnosis Left occipital and right frontal metastatic tumor Operative Method Left occipital and right frontal craniotomy for tumor excision Specimen Count And Types 2 pieces About size:3x2x2cm Source:Left occipital tumor About size:2x1.5x1 Source:Right frontal tumor Pathology Pending Operative Findings The tumor was gray-reddish in color, fragile, and well-demarcated in solid part. Central necrosis(abscess-like) and hematoma within capsule was noted during the operation. The bridging vein and superior sagittal sinus was well preserved at occipital area. The brain was slack after tumor excision. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in prone position with head fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. Reverse U scalp incision was made at left occiptial area and the scalp flap was elevated. The periosteum and the nuchal muscle group was elevated followed by 4 burr holes. One 7x9cm craniotomy window was created and dural tenting was done. The dura was opened based on superior sagittal sinus. The margin of the tumor was identified according to gross appearance. Tumor excision was then performed with bipolar electrocautery, sucker, dissector, and tumor forceps. Hemostasis was achieved with Surgicel lining. part of periosteum was harvested for duroplasty. The dura was closed with 4-0 Prolene. The skull plate was fixed back with five #26 wires. One subgaleal CWV drain was placed and the wound was closed in layers with 2-0 Vicryl and 3-0 Nylon. The patient was put in supine position with head mild rotated to left. The scalp was shaved, scrubbed, and disinfected as usual. Bicoronal scalp incision was made and the scalp flap was elevated. Two burr holes were created followed by one 4x4 craniotomy window. C-shape durotomy was performed based on frontal base. The location of the tumor was identified by intra-operative sonography. Tumor excision was then performed with bipolar electrocautery, sucker, dissector, and tumor forceps. Hemostasis was achieved with Surgicel lining. The skull plate was fixed back with miniplates and bone cement. One subgaleal CWV drain was placed and the wound was closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS王國川 Assistants R4李振豪, R1羅信偉 曾威翰 (M,1981/02/01,31y1m) 手術日期 2010/11/11 手術主治醫師 王國川 手術區域 東址 005房 03號 診斷 Herniation of intervertebral disc (HIVD) 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 林哲光, 時間資訊 14:30 報到 15:20 進入手術室 15:25 麻醉開始 15:30 誘導結束 15:40 抗生素給藥 16:13 手術開始 18:30 手術結束 18:30 麻醉結束 18:35 送出病患 18:36 進入恢復室 19:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-腰椎 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 記錄__ 手術科部: 外科部 套用罐頭: Microdiscectomy 開立醫師: 林哲光 開立時間: 2010/11/11 18:39 Pre-operative Diagnosis L5-S1 ruptured disc, HIVD, with left S1 radiculopathy Post-operative Diagnosis Ditto Operative Method Microdiscectomy Specimen Count And Types Pathology Operative Findings Ruptured disc was noted with compressing left S1 root. Hypertrophic change of ligamentum flavum was noted. Root seemed tension-free after discectomy. Operative Procedures Under ETGA and prone position, skin disinfected and drapped were performed as usual. Midline skin incision was made after localization at L5-S1 level. The left side paraspinal muscles were detached and laminotomy was done. The ligamentum flavum was removed and S1 root was identified. Discectomy was then performed and hemostasis was done with Gelfoam. The wound was then closed in layers. Operators VS 王國川, VS 蔡翊新 Assistants R4 林哲光 黃彩雲 (F,1928/09/09,83y6m) 手術日期 2010/11/11 手術主治醫師 蔡翊新 手術區域 東址 005房 02號 診斷 Injury (severeity score >=16) 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 林哲光, 時間資訊 11:00 報到 11:55 進入手術室 12:00 麻醉開始 12:05 誘導結束 12:15 抗生素給藥 12:42 手術開始 14:55 手術結束 14:55 麻醉結束 15:05 送出病患 15:10 進入恢復室 16:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 頭顱成形術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Cranioplasty 開立醫師: 蔡翊新 開立時間: 2010/11/11 14:29 Pre-operative Diagnosis Right F-T-P skull defect Post-operative Diagnosis Right F-T-P skull defect Operative Method Cranioplasty with autologous bone graft Specimen Count And Types nil Pathology Nil. Operative Findings A 14 x 12 cm skull defect at right F-T-P area. The brain was very slack. Right temporalis muscle was excised during previous craniectomy and it was substituted by a piece of bone cement. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with a sterilized adhesive plastic sheet. 4. Incision: along the previous operation scar at right F-T-P area, Raney clips were applied to the scalp edge for temporary hemostasis. 5. The right F-T-P scalp was dissected away from the underlying dura. 6. The bleeders on the dissected surfaces were coagulated with Bovie painstakingly. 7. The edge of the skull defect was exposed. 8. The original skull plate preserved at bone bank was soaked by Vancomycin solution and placed back to the skull window then fixed by 3 miniplates and 6 screws. Three dura tentings were put at the center of the skull plate. 9. Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by interrupted, mattressed suture with 3/0 nylon. 10.Drain: two epidural CWV. 11.Blood transfusion: nil. Blood loss: 150 ml. 12.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R4林哲光Ri葉芷吟 鄭麗惠 (F,1972/06/05,39y9m) 手術日期 2010/11/11 手術主治醫師 蔡翊新 手術區域 東址 005房 01號 診斷 Head Injury 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 王奐之, 時間資訊 08:05 進入手術室 08:10 麻醉開始 08:15 誘導結束 08:23 報到 08:23 抗生素給藥 09:02 手術開始 11:35 手術結束 11:35 麻醉結束 11:40 送出病患 11:43 進入恢復室 12:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 頭顱成形術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 摘要__ 手術科部: 外科部 套用罐頭: Cranioplasty 開立醫師: 蔡翊新 開立時間: 2010/11/11 11:06 Pre-operative Diagnosis Right F-T-P skull defect. Post-operative Diagnosis Right F-T-P skull defect. Operative Method Cranioplasty with autologous bone graft. Specimen Count And Types nil Pathology Nil. Operative Findings A 14 x 12 cm skull defect at right F-T-P area. The adhesion between the scalp and dura was easily dissected, but that between the temporalis muscle and dura was tight. Oozing from the epidural space was marked. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with a sterilized adhesive plastic sheet. 4. Incision: along the previous operation scar at right F-T-P area, Raney clips were apllied to the scalp edge for temporary hemostasis. 5. The right F-T-P scalp and temporalis muscle were dissected away from the underlying dura. 6. The bleeders on the dissected surfaces were coagulated with Bovie painstakingly. 7. The edge of the skull defect was exposed. 8. The original skull plate preserved at bone bank was removed and soaked with Vancomycin solution. It was placed back to the skull window then fixed by 3 miniplates and 6 screws. Three dural tenting were put at the center of the skull plate. 9. Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by interrupted, mattressed suture with 3/0 nylon. 10.Drain: two epidural CWV. 11.Blood transfusion: nil. Blood loss: 500 ml. 12.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R3王奐之Ri林特暐 相關圖片 楊和雄 (M,1942/12/24,69y2m) 手術日期 2010/11/12 手術主治醫師 葉德輝 手術區域 東址 025房 03號 診斷 Chronic paranasal sinusitis 器械術式 FESS,bil 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 廖怡茹, 時間資訊 11:40 報到 11:55 進入手術室 12:00 麻醉開始 12:05 誘導結束 12:10 抗生素給藥 12:25 手術開始 15:17 手術結束 15:27 麻醉結束 15:36 送出病患 15:40 進入恢復室 16:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 多竇副鼻竇手術 1 1 B 手術 多竇副鼻竇手術 1 2 B 手術 腫瘤切除從額竇 1 4 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 記錄__ 手術科部: 耳鼻喉部 套用罐頭: Functional endoscopic sinus surgery, bilateral 開立醫師: 廖怡茹 開立時間: 2010/11/15 17:01 Pre-operative Diagnosis Chronic paranasal sinusitis Post-operative Diagnosis 1.Chronic paranasal sinusitis, operated 2.right nasal tumor,suspect papilloma,operated Operative Method Functional endoscopic sinus surgery, bilateral Specimen Count And Types Several pieces about size:0.3*0.3cm Source:bilateral nasal cavity Pathology pending Operative Findings Right infun.: OK A.Eth.: nasal tumor suspect papilloma P.Eth: nasal tumor suspect papilloma Maxi.: edematous Fron.: mucopus, nasal tumor suspect papilloma with dura exposure Left infun.: OK A.Eth.: polypoid P.Eth: polypoid Maxi.: edematous Fron.: OK Operative Procedures (1) Infundibulotomy :R(V)L(V) (2) Opening/trimming of ethmoid bulla :R(V)L(V) anterior ethmoid :R(V)L(V) frontal recess :R(V)L(V) middle turbinate :R(V)L(V) (3) Opening/trimming of ground lamella :R(V)L(V) posterior ethmoid :R(V)L(V) sphenoid sinus :R( )L( ) (4) Widening of maxillary ostium :R(V)L(V) aspiration :R(V)L(V) irrigation :R(V)L(V) (5) Packing with Merocel :R(1)L(1) Fingerstall :R(2)L(2) Operators AP葉德輝, Assistants R4孟繁宇,R2廖怡茹, 孫錫華 (F,1935/06/14,76y9m) 手術日期 2010/11/12 手術主治醫師 陳淳 手術區域 西址 039房 11號 診斷 器械術式 Fiberocystoscopy /WOR 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 無麻醉 麻醉主治醫師 ASA 1 時間資訊 11:52 進入手術室 11:55 手術開始 11:57 手術結束 12:00 送出病患 吳彥徵 (F,1983/12/15,28y2m) 手術日期 2010/11/12 手術主治醫師 蔡翊新 手術區域 東址 016房 01號 診斷 Brain abscess 器械術式 Brain biopsy (Others) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3E 紀錄醫師 李振豪, 時間資訊 05:00 開始NPO 07:12 通知急診手術 08:40 報到 08:55 進入手術室 09:00 麻醉開始 09:25 誘導結束 10:03 手術開始 11:00 抗生素給藥 13:40 麻醉結束 13:40 手術結束 13:47 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Left frontal craniotomy for partial left fron... 開立醫師: 李振豪 開立時間: 2010/11/12 15:42 Pre-operative Diagnosis Left frontal brain abscess Post-operative Diagnosis Left frontal cerebritis Operative Method Left frontal craniotomy for partial left frontal lobectomy Specimen Count And Types 1 piece About size:3x3x3 Source:Left frontal cerebritis Pathology Pending Operative Findings Severe brain swelling was noted after dura opening. The brain parenchyma was hypervascularized and fragile. No frank pus discharge was noted during the operation. The capsule formation(+). Late cerebritis was favored. No obvious tumor was noted. The ICP after wound closure was 9mmHg. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine position with head rotated to right. The scalp was shaved, scrubbed, and disinfected as usual. Bicoronal scalp incision was made and the scalp flap was elevated. Facial nerve preservation was applied during elevation of the scalp flap. One burr hole was create at left frontal area followed by one 5x6cm craniotomy window. Dura tear was noted after removal of the skull plate and the brain buldging out. The dura was opened with C-shape. Intra-operative sonography was applied for localization of the abscess and puncture with ventricular needle was tried. However, no abscess drained out was noted. Small corticotomy was performed along the puncture tract and the capsule was noted. Cerebritis was diagnosed. Due to severe brain swelling, partial left frontal lobectomy was done. Hemostasis was achieved with bipolar electrocautery and Surgicel lining. The subdural ICP monitor was placed and the dura was repaired with Duroform. The skull plate was replaced with miniplates and the wound was closed in layers. Operators VS蔡翊新 Assistants R4李振豪 Indication Of Emergent Operation 相關圖片 高偉傑 (M,1986/05/27,25y9m) 手術日期 2010/11/12 手術主治醫師 曾漢民 手術區域 東址 003房 01號 診斷 Lumbar Spondylosis 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 2 紀錄醫師 林哲光, 時間資訊 07:35 報到 08:05 進入手術室 08:10 麻醉開始 08:15 誘導結束 08:50 抗生素給藥 09:07 手術開始 10:20 手術結束 10:20 麻醉結束 10:30 送出病患 10:31 進入恢復室 11:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-腰椎 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Microdiscectomy, L5-S1, left 開立醫師: 林哲光 開立時間: 2010/11/12 10:42 Pre-operative Diagnosis L5-S1 herniated intervertebral disc, with left S1 root compression Post-operative Diagnosis Ditto Operative Method Microdiscectomy, L5-S1, left Specimen Count And Types Pathology Operative Findings Impending ruptured disc with direct compressing the anterior part of the S1 root. Hyperemic change of left S1 root was noted. S1 root seemed tension-free after discectomy. Operative Procedures Under ETGA and prone position, skin disinfected and drapped were performed as usual. Midline skin incision was made after localization at L5-S1 intervertebral space. Left side paraspinal muscles detachment was done and S1 root was identified. Discectomy was then performed under Microscope. Hemostasis was done with Gelfoam. The wound was then closed in layers after Rinderon applied on root and cord and Marcaine applied on the subcutaneous area and fascia. Operators 曾漢民 Assistants R4 林哲光, Ri 葉芷吟 陳秀鳳 (F,1955/09/20,56y5m) 手術日期 2010/11/12 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Lumbar Spondylosis 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 鍾文桂, 時間資訊 07:35 報到 08:03 進入手術室 08:15 麻醉開始 08:30 誘導結束 08:35 抗生素給藥 09:16 手術開始 11:36 手術結束 11:36 麻醉結束 11:50 送出病患 11:52 進入恢復室 13:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術(減壓)-二節以內 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 記錄__ 手術科部: 外科部 套用罐頭: Decompressive laminotomy, L4/5, left side. 開立醫師: 鍾文桂 開立時間: 2010/11/12 11:57 Pre-operative Diagnosis Lumbar stenosis, L4/5. Post-operative Diagnosis Lumbar stenosis, L4/5. Operative Method Decompressive laminotomy, L4/5, left side. Specimen Count And Types nil Pathology Nil. Operative Findings 1. Hypertrophic ligamentum flavum. 1. Hypertrophic ligamentum flavum compressed the thecal sac and roots. 2. Laminotomy of inferior portion of L4 and superior portion of L5 laminae, left side. Further resection of the ligamentum flavum was done from left side to right side.The bilateral L4 roots were slack after decompression. 2. Laminotomy of inferior portion of L4 and superior portion of L5 laminae, left side. Further resection of the ligamentum flavum was done from left side to right side under microscope.The bilateral L4 roots were slack after decompression. 3. Intact dura mater, no drain tube. Operative Procedures Under ETGA, the patient was placed in prone position. After disinfection and draping, midline incision was made at L4/5 level under intraoperative fluoroscopy guidance. Paraspinal dissection to expose left side L4 and L5 laminae were done. Drilling of inferior portion of L4 lamina and superior portion of L5 lamina exposed ligamentum flavum. The ligamentum flavum were resected from left side to right side. Until the roots were slack, the wound was closed in layers. Operators V.S. 曾漢民 蔡翊新 Assistants 鍾文桂 許皓淳 王智弘 (M,1997/06/07,14y9m) 手術日期 2010/11/12 手術主治醫師 賴鴻緒 手術區域 兒醫 062房 02號 診斷 Langerhans' cell histiocytosis 器械術式 Port-A catheter implatation 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 面罩麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 李維棠, 時間資訊 00:00 臨時手術NPO 09:53 報到 10:07 進入手術室 10:15 麻醉開始 10:25 抗生素給藥 10:30 誘導結束 10:41 手術開始 11:55 手術結束 11:55 麻醉結束 12:00 送出病患 12:05 進入恢復室 13:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Semi-opened mask inhalation anes 1 0 手術 內頸靜脈切開,永久導管放置術 1 1 L 記錄__ 手術科部: 套用罐頭: Port-A insertion (left cephalic vein) 開立醫師: 李維棠 開立時間: 2010/11/12 12:04 Pre-operative Diagnosis Histiocytosis with pathologic spine fracture Post-operative Diagnosis Histiocytosis with pathologic spine fracture Operative Method Port-A insertion (left cephalic vein) Specimen Count And Types nil Pathology nil Operative Findings Intra-operative portable X-ray showed Port-A catheter tip in correct venous branch to SVC. Operative Procedures 1. Under GA with the patient in supine position. 2. An incision was made in left subclavical area. After identification of the left cephalic vein, Port-A catheter was inserted. 3. Adequate hemostasis was obtained. Then the wound was closed in layers. Operators 賴鴻緒 Assistants R6林昊諭 R2李維棠 Ri蔡孟儒 劉昭惠 (F,1960/12/07,51y3m) 手術日期 2010/11/12 手術主治醫師 侯君翰 手術區域 西址 035房 03號 診斷 Trigger finger, acquired 器械術式 Hallux valgus osteotomy 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 2 紀錄醫師 葉軒, 時間資訊 13:00 進入手術室 13:10 麻醉開始 13:15 抗生素給藥 13:20 誘導結束 13:35 手術開始 14:05 手術結束 14:05 麻醉結束 14:10 送出病患 14:15 進入恢復室 15:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 大腳趾外翻(骨術) 1 1 R 手術 石膏副木固定－短腿 1 0 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 骨科部 套用罐頭: Collective osteotomy with pinning fixation 開立醫師: 葉軒 開立時間: 2010/11/12 14:02 Pre-operative Diagnosis Hallux valgus, right foot Post-operative Diagnosis Hallux valgus, right foot Operative Method Collective osteotomy with pinning fixation Specimen Count And Types nil Pathology nil Operative Findings Hallux valgus, right foot Operative Procedures 1. ETGA, in supine position 2. Skin preparation and draping 3. Incision at the first MP join of right foot and perform collective osteotomy with pinning fixation 4. Wound closure Operators 侯君翰, Assistants 葉軒, 陳明峰, 羅琇玉 (F,1950/03/28,61y11m) 手術日期 2010/11/12 手術主治醫師 蔡翊新 手術區域 東址 019房 01號 診斷 Subarachnoid hemorrhage (SAH) 器械術式 Craniotomy(Aneurysms) P-DUH 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3E 紀錄醫師 胡朝凱, 時間資訊 03:00 臨時手術NPO 03:00 開始NPO 07:08 通知急診手術 08:05 進入手術室 08:05 報到 08:13 麻醉開始 08:19 誘導結束 08:45 手術開始 08:57 抗生素給藥 11:57 抗生素給藥 14:57 抗生素給藥 15:38 麻醉結束 15:38 手術結束 15:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 7 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 開顱術摘除血管病變 - 腦血管瘤 有病徵的 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Aneurysm-frontotemporal approach 開立醫師: 蔡翊新 開立時間: 2010/11/12 15:15 Pre-operative Diagnosis Anterior communicating artery aneurysm rupture with subarachnoid hemorrhage. Post-operative Diagnosis Anterior communicating artery aneurysm rupture with subarachnoid hemorrhage. Operative Method Left pterional craniotomy for aneurysm clipping. Specimen Count And Types nil Pathology Nil. Operative Findings Subarachnoid hemorrhage at left Sylvian and interhemispheric fissures caused adhesion around the CSF space. The left A1 ACA segment was long and prominent, but right A1 segment was not seen. A saccular aneurysm arising from the anterior communicating artery, 0.5 cm in height and 0.4 cm in neck dimension, pointing to right and superior aspects. It was clipped by a straight 10-mm Sugita clip. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with left back elevated and head rotated to right for 30 degrees and slightly extended then fixed by a Mayfield skull clamp. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with a sterilized adhesive plastic sheet. 4. Incision: left frontotemporal, curvilinear. The skin edge was clipped by Raney clips for temporary hemostasis. After scalp had been lifted, the temporalis muscle was incised and detached from temporal squama and reflected to lower temporal side. 5. Craniotomy window: 10 x 6 cm, left frontotemporal, created by making 4 burr holes then cut by power saw. The lower temporal bone and pterionic ridge were cut by rongeur as low as possible for easy approach to the anterior clinoid. 6. Dural tention: by 2/0 silk, 2 cm in interval, distributed along the edge of skull window. 7. Dural incision: curvilinear, over-ridding Sylvian fissure and reflected to frontotemporal base. 8. Under operating microscope, the deep Sylvian fissure was opened, then the frontal opercula was retracted by self-retaining retractor to expose the A-1 segment of rt ACA. When the dissectio was carried out more distally, the bilateral A2 segments and the aneurysm soon came into view. From that moment on, the patinets blood pressure was brought down to 80 mHg. The neck of the aneurysm was mobilized gently bya Gage 18 sucker and a microdissector until it was entirely free. 9. A straight 10-mm Sugita clip was applied to the neck of the aneurysm. 10.After successful clipping of the aneurysm, the patients BP was brought back to normal, and the exposed field was irrigated with N.S. to make sure no any bleeding. 11.The brain retractors were removed. The dura was closed water-tight by running suture with 4/0 Prolene. 12.Closure of skull window: the skull plate was placed back to craniotomy window and fixed by 3 miniplates and 6 screws. The dura was tented to the centerof the skull plate by two 2/0 stitches. The covering muscle was closed by interrupted stitches with 1/ 0 silk. 13.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 14.Drain: one, epidural, CWV. 15.Blood transfusion: nil. Blood loss: 600 ml. 16.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R6胡朝凱Ri Indication Of Emergent Operation 連朝枝 (M,1932/11/24,79y3m) 手術日期 2010/11/12 手術主治醫師 蔡翊新 手術區域 東址 005房 04號 診斷 Subdural hemorrhage following injury, with no loss of consciousness 器械術式 Burr hole (trephination) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 2E 紀錄醫師 許皓淳, 時間資訊 16:00 開始NPO 16:00 通知急診手術 17:00 進入手術室 17:05 麻醉開始 17:20 誘導結束 17:38 抗生素給藥 17:53 手術開始 20:17 手術結束 20:17 麻醉結束 20:28 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 急性硬腦膜下血腫清除術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Chronic Subdural Hematoma 開立醫師: 蔡翊新 開立時間: 2010/11/12 19:50 Pre-operative Diagnosis Left F-T-P acute on chronic SDH. Post-operative Diagnosis Left F-T-P acute on chronic SDH. Operative Method Left frontotemporal craniotomy for removal of SDH. Specimen Count And Types nil Pathology Nil. Operative Findings Dark reddish liquified blood gushed out upon opening the dura and outer membrane via the first burr hole. There were blood clots about 2.5 cm in thickness, and fibrin septation in the subdural space. Inner membrane was seen coating the brain surface, which remained slack after removal of SDH and even under hypoventilation and position change. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with a sterilized adhesive plastic sheet. 4. Incision: Curvilinear at left frontotemporal area. Raney clips were applied to the scalp edge for temporary hemostasis. 5. Craniotomy: 6 x 5 cm craniotomy at left F-T area, by making 3 burr holes. 6. Dural incision: 3/4 circle along the trephine margin. 7. The outer membrane of the hematoma was coagulated by Bovie along the edge of dural incision, then excised. 8. The liquified old blood and clot in the subdural space was evacuated by sucker. Some fibrin septation were coagulated and divided to avoid future bleeding. 9. Dural closure: interruped 2/0 silk sutures for key stitches, then continuous sutures with 4/0 Prolene to obtain water-tight closure, with a fascia graft. 10.Closure of skull window: the trephine button was placed back and fixed by 3 miniplates and 6 screws. 11.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous sutures with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 12.Drain: one, subdural, connected to a reservoir bag. 13.Blood transfusion: nil. Blood loss: 400 ml (including blood clots). 14.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5鍾文桂R1許皓淳 Indication Of Emergent Operation 王宣懿 (F,2004/11/05,7y4m) 手術日期 2010/11/13 手術主治醫師 楊士弘 手術區域 東址 003房 01號 診斷 C1-C4 level with other specified spinal cord injury 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 陳德福, 時間資訊 08:10 進入手術室 08:35 麻醉開始 09:00 誘導結束 09:40 抗生素給藥 10:30 手術開始 12:40 抗生素給藥 14:55 手術結束 14:55 麻醉結束 15:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 骨或軟骨移植術 1 1 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 脊椎骨折開放性復位術 1 3 記錄__ 手術科部: 外科部 套用罐頭: 1.C1-2 fusion with TAS and autologous bone-wi... 開立醫師: 陳德福 開立時間: 2010/11/13 15:53 Pre-operative Diagnosis Dens fracture, C1-2 subluxation with spinal cord compression and myelopathy Os odontoideum, C1-2 subluxation with spinal cord compression and myelopathy Post-operative Diagnosis Dens fracture, C1-2 subluxation with spinal cord compression and myelopathy Os odontoideum, C1-2 subluxation with spinal cord compression and myelopathy Operative Method 1.C1-2 fusion with TAS and autologous bone-wire fixation [Sonntag] 2.Open reduction of C1-2 fracture/subluxation 1.C1-2 fixation with TAS and autologous bone-wire fixation [Sonntag] 2.Open reduction of C1-2 fracture/subluxation Specimen Count And Types nil Pathology nil Operative Findings 1.There is dens fracture with C1-2 subluxation and spinal instability. The cervical spinal cord was compressed tightly. The foramen magnum was enlarged by Kerrison pounch for decompression. 1.There is Os odontoideum with C1-2 subluxation and spinal instability. The cervical spinal cord was compressed tightly. The foramen magnum was enlarged by Kerrison pounch for decompression. 2.The C1/2 fusion with transarticular screws[3.0mmx36mm; 3.0mmx34mm] was done. One autologous bone from the right posterior iliac crest was inserted into the C1-2 interspinous space with wire fusion [Sonntag fasion]. 2.The C1/2 fixation with transarticular screws[3.0mmx36mm; 3.0mmx34mm] was done. One autologous bone from the right posterior iliac crest was inserted into the C1-2 interspinous space with wire fixation [Sonntag fasion]. 3.The C1/2 was fused without instability after the surgery. 4.The Halovest was removed after the surgery. Operative Procedures Under ETGA and prone position with Halovest fixation, the skin was disinfected and draped as usual. One linear incision along the midline was done for exposure the Occipital bone to C6 level. The wire for Sonntag fixattion was inserted followed by identifying the insertion point of C1/2 TAS. Under Flouroscope, the C1/2 TAS were inserted smoothly. One bone graft was harvested from the right posterior superior iliac crest and the C1-2 interspinous process fusion was done as Sonntag fasion. One CWV was left in situ and the wound was closed in layers. Under ETGA and prone position with Hal-ring fixation, the skin was disinfected and draped as usual. One linear incision along the midline was done for exposure the Occipital bone to C6 level. The wire for Sonntag fixattion was inserted followed by identifying the insertion point of C1/2 TAS. Under Flouroscope, the C1/2 TAS were inserted smoothly. One bone graft was harvested from the right posterior superior iliac crest and the C1-2 interspinous process fusion was done as Sonntag fasion. One CWV was left in situ and the wound was closed in layers. Operators VS 楊士弘 Assistants R5 陳德福 相關圖片 吳璨瑛 (F,1963/09/30,48y5m) 手術日期 2010/11/14 手術主治醫師 蔡翊新 手術區域 東址 001房 01號 診斷 Subarachnoid hemorrhage 器械術式 Craniotomy for aneurysm clipping 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3E 紀錄醫師 陳德福, 時間資訊 02:30 通知急診手術 03:25 進入手術室 03:30 麻醉開始 04:00 誘導結束 04:10 抗生素給藥 04:25 手術開始 07:10 抗生素給藥 09:15 手術結束 09:15 麻醉結束 09:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 開顱術摘除血管病變 - 腦血管瘤 有病徵的 1 1 R 手術 顱內壓視置入 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Aneurysm-frontotemporal approach 開立醫師: 蔡翊新 開立時間: 2010/11/14 09:13 Pre-operative Diagnosis Right MCA bifurcation aneurysm rupture with SAH. Post-operative Diagnosis Right MCA bifurcation aneurysm rupture with SAH. Right frontotemporal acute SDH. Operative Method Right pterional approach for aneurysm clipping and right Kocher EVD for ICP monitoring. Specimen Count And Types 3 tubes of CSF. Pathology Nil. Operative Findings Right frontotemporal SAH and acute SDH, about 0.5 cm in thickness, with brain edema. Initial ICP was 3 cmH2O and rose to 8 cmH2O later. CSF was sanguious. Thick SAH at right Sylvian fissure was encountered, esp around the aneurysm. An saccular aneurysm, 8 mm in height and 5 mm in neck width, arising from the bifurcation of right MCA, directing anterio-superiorly, opposing from the direction of M1 segment. It was clipped with a 7mm lateral bending (135 degrees) Sugita clip. After clipping, the aneurysm was perforated with a fine needle to make sure the obliterance of the blood flow. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with right back elevated and head rotated to-- for 40 2. Position: supine with right back elevated and head rotated to left for 40 degree and slightly extended then fixed by Mayfield skull clamp. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergentfollowed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: ---frontotemporal, curvilinear. The skin edge was clipped by 4. Incision: right frontotemporal, curvilinear. The skin edge was clipped by Raney clips for temporary hemostasis. After scalp had been lifted, the temporalis muscle was incised and detached from temporal squama and reflected to lower temporal side. 5. Craniotomy window: 5x6 cm, frontotemporal, created by making 4 burr holes then cut by power saw. The lower temporalbone and pterionic ridge (esp. the inner table) were cut by rongeur as low as possible for easy approach to the anterior clinoid. 6. Dural tention: by 2/0 silk, ---cm in interval, distributed along the edge 6. Dural tention: by 2/0 silk, 2.5 cm in interval, distributed along the edge of skull window. 7. Dural incision: V shape, over-ridding Sylvian fissure and reflected to frontotemporal base. 8. Ventricular tapping and drainage of CSF was made to slacken down the brain for easy approach to anterior clinoid without undue traction on the brain. 8. A 0.7 cmcortical incision was made with a Scarff bipolar forceps at the anterior location of the rt superior temporal gyrus, then the intracerebral hematoma was sucked out until the brain was slack enough for a easy approach to the insula where the aneurysm located. 9. Under operating microscope, the Sylvian fissure was opened, then the frontal and temporal opercula were retracted by self-retaining retractor inan opposite direction to expose the M-2 segment of rt MCA. When the dissectiomwas carried out more proximally, the aneurysm soon came into view. From that moment on, the patinets blood pressure was brought down to 80 mHg by Nitroprussid. The neck of the aneurysm was mobilized gently bya Gage 18 sucker and a fine tipbipolar forceps until itwas entirely free. 9. The Sylvian vein was coagulated and divided from sphenoparietal sinus, then the temporal tip and the adjacent frontal lobe base were retracted by 2 self 9.The temporal tip and the adjacent frontal lobe base were retracted by 2 self retaining retractors. 10.Under operating microscope, the suprasellar cistern was opened, meanwhile, the patinet's blood pressure was brought down to-- mHg by-- . The right the patinets blood pressure was brought down. The right optic nerve and ICA came into view. The arachnoid trabeculi and the fibrin (or blood clot) were cleaned out to expose the neck of the aneurysm which located just beneath the edge of tentorial hiatus. The neck of the aneurysm was mobilized gently by a Gage 18 sucker and a fine tip bipolar forceps until it was entirely free. l1.A-- Sugita clip was applied to the neck of the aneurysm. l1.A 7cm lateral beding Sugita clip was applied to the neck of the aneurysm. 12.After successful clipping of the aneurysm, the patient's BP was brought back to normal, and the exposed field was irrigated with N.S. to make sure no any bleeding. 13.The brain retractors were removed. Thedura was closed water-tight by 2 2/0 silk for key stitches followed by running suture with 4/0 Dexon. 14.Closure of skull window: the skull plate was placed back to craniotomy window and fixed by 3 Gage 24 wires. The dura was tented to the centerof the skull plate by a 2/0 stitch. The covering muscle was closed by interrupted stitches with 1/ 0 silk. 15.Scalp closure: hemostasis was done with monopolar coagulator touching on the sucker tip. Galea suture was performed by continuous suture with 3/0 Dexon and skin by continuous suture with 3/0 nylon. 16.Drain: one, epidural, collected in a surgeon's glove. 17.Blood transfusion: 18.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5陳德福R4林哲光 Indication Of Emergent Operation 相關圖片 吳瑞彰 (M,1954/02/18,58y0m) 手術日期 2010/11/15 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Pituitary Tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 古恬音, 時間資訊 08:10 進入手術室 08:15 麻醉開始 08:50 誘導結束 09:05 抗生素給藥 09:40 手術開始 12:10 手術結束 12:10 麻醉結束 12:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經由蝶竇之腦下垂體瘤切除 1 1 手術 腦內視鏡 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Endoscopic transsphenoid adenomectomy 開立醫師: 古恬音 開立時間: 2010/11/15 11:34 Pre-operative Diagnosis Pituitary macroadenoma Post-operative Diagnosis Pituitary macroadenoma Operative Method Endoscopic transsphenoidal adenomectomy Specimen Count And Types 1 piece About size:pieces of tumor, about 1gm Source:pituitary tumor Pathology Pending Operative Findings The tumor was grayish, soft, size 3.5cm in diameter, with extension into the sphenoid sinus. The posterior wall of sphenoid sinus was eroded by the tumor. It has a cystic component, and the content was clear fluid. One small perforation was noted at the nasal septum. The normal pituitary gland sank down after tumor removal. No CSF leakage was noted during the operation. Operative Procedures Under general anethesia and intubation, the patient was put in supine position with head tilted 30 degree to left. The facial skin was antiseptic with alcohol better-iodine tincture, and the mucosa of oral and nasal cavity with aqueous better-iodine . The formerareas were covered by sterilized adhesive plastic sheets then draped. Under endoscope, the nasal mucosa was coagulated at both norstril. A nasal speculum was applied to displace the nasal mucosa laterally and keep thenasal cavity open constantly for the exposure of the vomer bone and the anterior wall of the sphenoid sinus. The anterior sphenoid wall was remove by high speed air drill and Kerrison punch, and the tumor part within the sphenid sinus was removed by curette and aligator. The arachnoid and the opening of diaphragm sellae was enforcedby packing with gelform as in the sellar cavity. The nasal mucosa returned to its normal position. Both nasal cavities was tightly packed with a segment of rubber glove finger filled with vaseline gauze strips which had been soaked with better-iodine ointment. The arachnoid and the opening of diaphragm sellae was enforcedby packing with gelform as in the sellar cavity. The nasal mucosa returned to its normal position. Both nasal cavities was tightly packed with Merosel. Operators P杜永光 VS楊士弘 Assistants R6胡朝凱 林靜芬 (F,1961/01/04,51y2m) 手術日期 2010/11/15 手術主治醫師 陳敞牧 手術區域 東址 003房 01號 診斷 Breast cancer, female 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 陳德福, 時間資訊 07:40 報到 08:00 進入手術室 08:10 麻醉開始 08:35 誘導結束 09:00 抗生素給藥 09:32 手術開始 12:00 抗生素給藥 13:30 麻醉結束 13:30 手術結束 13:31 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4~8小時 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: craniotomy tumor excision 開立醫師: 陳德福 開立時間: 2010/11/15 13:25 Pre-operative Diagnosis Breast cancer with brain metastasis, Broca area Post-operative Diagnosis Breast cancer with brain metastasis, Broca area Operative Method craniotomy tumor excision Specimen Count And Types 1 piece About size:4*3*3.5CM Source:left temporal lobe tumor Pathology pending Operative Findings 1.There is a 4*3.5*3cm in sized tumor at the left temporal-frontal junction which is compatible with the Broca area. The insula is compressed to the medial side. The brain was swelling after the dura opening and we made was corticototmy at the left middle temporal gyrus to remove the tumor. 2.The tumor is yelloish-greyish, soft, well demarcated, moderate-vasculized and fragile in nature. After tumor removal, the left sylvian fissure with MCAs was encountered and some CSF drained out spontaneously. The tumor encased the vessels at the surface of insula, therefore, some residual tumor was left in situ. Operative Procedures Under ETGA and supine position with head rotated to the right side, the scalp was disinfected and draped as usual. One curvilinear incision over the left scalp was done followed by a 6*6cm in sized craniotomy. The dura was tented and opened in C shape. After the localization under intra-OP ultrasonography, we made a corticotomy at the left middle temporal gyrus. The tumor was encountered and removed step by step under microscopic surgery. Hemostasis and closure the dura with water tight fasion. The skull was fixed with miniplates and the wound was closed in layers with one subgaleal CWV drainage. Operators VS陳敞牧 Assistants R5陳德福 R1 羅偉誠 林見勳 (M,1975/06/25,36y8m) 手術日期 2010/11/15 手術主治醫師 郭順文 手術區域 東址 023房 04號 診斷 Brain contusion 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 趙安怡 ASA 3 紀錄醫師 高明蔚, 時間資訊 13:35 麻醉開始 13:35 進入手術室 13:37 誘導結束 14:00 手術開始 14:37 手術結束 14:37 麻醉結束 14:45 進入恢復室 14:45 送出病患 15:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 氣管永久造孔術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 高明蔚 開立時間: 2010/11/15 14:52 Pre-operative Diagnosis Cervical spine injury, with respiratory failure Post-operative Diagnosis Cervical spine injury, with respiratory failure Operative Method Tracheostomy, permanent Specimen Count And Types nil Pathology None Operative Findings Fr.8 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Skin is approximated with the cartilage with 4-0 prolene. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding. Operators 郭順文 Assistants CR李佳穎, R3高明蔚 李朝枝 (M,1940/04/15,71y10m) 手術日期 2010/11/16 手術主治醫師 陳敞牧 手術區域 東址 003房 號 診斷 Multiple bone metastasis 器械術式 OPLL- Anterior Corpectomy 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 羅偉誠, 時間資訊 07:35 報到 08:00 進入手術室 08:10 麻醉開始 08:30 誘導結束 08:50 抗生素給藥 09:10 手術開始 09:55 開始輸血 11:50 抗生素給藥 13:00 麻醉結束 13:00 手術結束 13:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 手術 惡性脊髓腫瘤切除術 1 2 摘要__ 手術科部: 外科部 套用罐頭: Anterior Discectomy and Fusion, Cervical Spine 開立醫師: 曾峰毅 開立時間: 2010/11/16 13:40 Pre-operative Diagnosis Prostatic cancer with multiple cervical spine metastasis and cord compression at C5 Post-operative Diagnosis Prostatic cancer with multiple cervical spine metastasis and cord compression at C5 Operative Method Anterior corpectomy of C4 and C5, fusion and fixation with body cage and screws. Specimen Count And Types Several fragments of one tumor was sent for pathology. Pathology Pending Operative Findings Hypervascular tumor occupied C4 and C5 causing vertebral body collapse. Spinal cord as compressed tightly, ans was decompressed well after orpectomy. Body cage was confimred in position under C-arm. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position and neck extended. With C-arm localization, we made one transverse skin incision at right aspect of neck. We dissected along the medial side of SCM, and expose prevertebral space from C4 to c6. COrpectomy was done at C4 and C5, and body cage with artificial bone graft, Simbone, was put. After C-arm confirmation, we closed the wound and put the CWV drainage. 2.Position: supine with neck hyperextended by a air cuff placed beneath the shoulder. Rt side pelvis was elevated too. 3. Skin preparation: the anterior neck and rt iliac crest was shaved and scrubbed with povidone-iodinew detergent followed by painting with povidone-iodine alcohol tincture, then covered with Operators VS 陳敞牧 Assistants R4 曾峰毅 R1 羅偉誠 曹麗華 (F,1953/01/15,59y1m) 手術日期 2010/11/16 手術主治醫師 陳敞牧 手術區域 東址 002房 02號 診斷 Paralysis, unspecified 器械術式 Diskectomy cervical(Anterier) 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 胡朝凱, 時間資訊 09:12 臨時手術NPO 09:12 開始NPO 11:50 報到 12:25 進入手術室 12:30 麻醉開始 12:32 抗生素給藥 12:35 誘導結束 13:07 手術開始 15:00 手術結束 15:00 麻醉結束 15:10 送出病患 15:13 進入恢復室 16:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎融合術-前融合,無固定物(≦四節) 1 2 手術 椎間盤切除術-頸椎 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Glucose 1 0 記錄__ 手術科部: 外科部 套用罐頭: Anterior discectomy and cage insertion 開立醫師: 胡朝凱 開立時間: 2010/11/16 15:04 Pre-operative Diagnosis C4~5 HIVD Post-operative Diagnosis C4~5 HIVD Operative Method Anterior discectomy and cage insertion Specimen Count And Types nil Pathology pending Operative Findings 1.Protruding disc that compressed the spinal cord tightly 2.Hypertrophic PLL was also noted. 3.Marginal spur was noted Operative Procedures 1.ETGA, supine 2.Right neck transverse skin incision 3.Approach to expose prevertebral space 4.Localization with C-arm 5.Discectomy 6.remove PLL 7.Cage insertion 8.hemostasis 9.Close wound in layers after one CWV drain insertion Operators 陳敞牧 Assistants 胡朝凱, Ri 郭力元 Indication Of Emergent Operation 萬皓宇 (M,1995/01/24,17y1m) 手術日期 2010/11/16 手術主治醫師 楊士弘 手術區域 兒醫 067房 01號 診斷 Malignant neoplasm of mediastinum 器械術式 Craniotomy for posterior fossa tumor excision and left tumor excision, port A insertion 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:05 進入手術室 08:10 麻醉開始 08:45 誘導結束 10:00 抗生素給藥 10:12 手術開始 11:50 開始輸血 13:30 抗生素給藥 13:55 16:20 抗生素給藥 18:50 19:20 抗生素給藥 19:40 麻醉結束 19:40 手術結束 19:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4~8小時 1 1 L 手術 port–A導管植入術–治療性導管植入術 1 0 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 15 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 4 0 麻醉 Hemoglobin (Hb) 4 0 麻醉 測血糖 4 0 麻醉 Ca (Calcium) 4 0 麻醉 Na (Sodium) 4 0 麻醉 K (Potassium) 4 0 麻醉 Blood gas analysis 4 0 摘要__ 手術科部: 外科部 套用罐頭: (1) Left frontal craniotomy for brain tumor e... 開立醫師: 林哲光 開立時間: 2010/11/16 19:44 Pre-operative Diagnosis Brain tumor, left frontal lobe and left cerebellar hemisphere, r/o choriocarcinoma metastasis Post-operative Diagnosis Brain tumor, left frontal lobe and left cerebellar hemisphere, r/o choriocarcinoma metastasis Operative Method (1) Left frontal craniotomy for brain tumor excision (2) Left suboccipital craniotomy for brain tumor excision (3) Port-A catheter insertion Specimen Count And Types 3 pieces About size:小 Source:Left frontal lobe tumor About size:小 Source:Left cerebellar hemispheric tumor About size:小 Source:Hematoma capsule, r/o tumor capsule? Pathology Pending Operative Findings (1) A dark purplish subpial tumor was seen in the left frontal lobe, about 0.8 cm in diameter. It was soft fragile, moderately vascularized. The tumor was quite adherent with the brain parenchyma. (2) Another subpial tumor was found in the left cerebellar hermiphere, 3 cm x 3 cm x 3.5 cm under the tentorial surface. Multiple vascular channels were seen on the tumor surface. A central cavity filled with soft blood clot and some hemosiderins was found inside the tumor. A layer of hemosiderin deposition was found outside the tumor surface and very adherent with the brain parenchyma. The cerebellar hemisphere became slack after tumor excision. (3) The tip of the Port-A catheter was found in right atrium by intra-operative X-ray. Operative Procedures Under ETGA and supine position, the head was fixed with Mayfield skull clamp. Registration of the scalp markers was done for intraoperative neuronavigation. A linear incision was made in the left frontal scalp, and a 3 cm x 3 cm craniotomy was done by high speed drills. The dura mater was opened in cruciate shape, and the tumor was removed by opening the pia and dissecting the tumor from the brain parenchyma with bipolar, tumor forceps and microscissors. The tumor bed was packed with Surgicel strips. The dura was closed and skull plate fixed with miniplates and screws. The scalp wound was closed in layers. The patient was then placed in prone position with neck flexed and head fixed with skull clamp. A hocky stick incision was made in the left occipital scalp. A 5 cm x 4 cm left suboccipital craniotomy was made with high speed drills. The dura was opened in U shape and retracted upward toward the transverse sinus. A 1 cm transverse corticotomy was made in the left superior cerebellar hemisphere to expose the tumor. The tumor was dissected from the brain parenchyma with bipolar, tumor forceps and microscissors. The hematoma was sucked out and the thick tumor capsule and hemosiderin deposition were removed in piecemeal fasion. The tumor bed was packed with Gelfoam and Surgicel strips. The dura was closed and skull plate fixed with miniplates and screws. The scalp wound was closed in layers. The patient was then placed in supine position. A transverse skin incision was made across the left deltoid groove. The cephalic vein was dissected out and a venotomy was made for insertion of the Port-A catheter. The wound was closed in layers. Operators 楊士弘 Assistants 林哲光,林昊瑜 秦光美 (F,1956/02/27,56y0m) 手術日期 2010/11/16 手術主治醫師 王國川 手術區域 東址 005房 02號 診斷 Malignant neoplasm of female breast, unspecified 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳德福, 時間資訊 11:05 報到 11:10 麻醉開始 11:10 進入手術室 11:20 誘導結束 11:38 手術開始 11:38 抗生素給藥 14:35 抗生素給藥 14:55 麻醉結束 14:55 手術結束 15:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除-手術時間在4~8小時 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: craniotomy tumor excision 開立醫師: 陳德福 開立時間: 2010/11/16 15:05 Pre-operative Diagnosis Breast cancer with brain metastasis, left parietal lobe Post-operative Diagnosis Breast cancer with brain metastasis, left parietal lobe Operative Method craniotomy tumor excision Specimen Count And Types 1 piece About size:2.5*2*2CM Source:BRAIN TUMOR, LEFT PARIETAL LOBE Pathology pending Operative Findings 1.There is a 2.5*2.5*2.0cm in sized tumor at the left parietal lobe area with perifocal gliosis. The tumor is soft, fragile, greyish-yellowish and well demarcated with capsule-like structure. The tumor is totally removed and the adjacent vasculature was well preserved 2.The location of the tumor was checked under intra-OP ultrasonography assisted. Operative Procedures Under ETGA and prone position, the scalp was disinfected and draped as usual. One curvilinear incision over left parietal area was done followed by creating a 6*5cm in sized craniotomy window. The dura was opened in C shape and the arachnoid membrane was opened. Interhemispheric approach was done followed by tumor removal with tumor forceps and dissector assisted. Hemostasis was done and dura was closed in water tight fasion. The skull was fixed with wires and the wound was closed in layers. Operators VS 王國川 Assistants R5 陳德福 R3 王奐之 黃啟東 (M,1959/03/11,53y0m) 手術日期 2010/11/17 手術主治醫師 蕭輔仁 手術區域 東址 003房 01號 診斷 Head Injury 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 髒 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 羅偉誠, 時間資訊 08:00 進入手術室 08:05 麻醉開始 08:15 誘導結束 08:54 手術開始 10:20 手術結束 10:20 麻醉結束 10:25 送出病患 10:30 進入恢復室 13:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 顱骨切除術,包括異物移除或壓或經切斷 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 曾峰毅 開立時間: 2010/11/17 10:22 Pre-operative Diagnosis Head injury, status post craniectomy, status post cranioplasty, complicated with bone graft infection and epidural empyema Post-operative Diagnosis Head injury, status post craniectomy, status post cranioplasty, complicated with bone graft infection and epidural empyema Operative Method Crainectomy with epidural empyema removal Specimen Count And Types Several swab was sent for culture, and mini-plate and screw was sent as well. Pathology Nil Operative Findings Wound dehiscense was noted, and subgaleal granulation tissue was a lot. Purulent fluid accumulated beneach the skull bone with much granulation tissue at dura. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to left and right shoulder elevated. After scalp shaved, scrubbed, disinfected, and then draped, we made skin incision along previous surgical wound. We removed mini-plates and screws, and removed bone graft. The surgical field we debridment with currette and irrigated with saline and gentamycin. After placing two subgaleal CWV, we closed the wound in layers. Operators VS 蕭輔仁 Assistants R4 曾峰毅 R1 羅偉誠 薛德旺 (M,1922/06/03,89y9m) 手術日期 2010/11/17 手術主治醫師 蔡瑞章 手術區域 東址 005房 01號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 許皓淳, 時間資訊 07:37 報到 08:05 進入手術室 08:20 麻醉開始 08:45 誘導結束 09:03 手術開始 09:25 抗生素給藥 12:24 開始輸血 14:00 抗生素給藥 17:00 抗生素給藥 17:50 麻醉結束 17:50 手術結束 17:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 直視下尿道切開術 1 1 L 手術 腦瘤切除-手術時間在4~8小時 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 11 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 泌尿部 套用罐頭: optic urethrotomy 開立醫師: 楊智凱 開立時間: 2010/11/17 10:49 Pre-operative Diagnosis Benign prostatic hyperplasia Post-operative Diagnosis Benign prostatic hyperplasia Operative Method Optic urethrotomy Sounding to 28 Fr. Specimen Count And Types nil Pathology nil Operative Findings 1. bilateral prostate kissing 2. s/p sounding to 28 Fr. 3. Oozing of prostate 4. high bladder neck Operative Procedures Under satisfactory anesthesia with the patient in a lithotomy position, prepping and draping were performed in the usual sterile method. A 23 Fr. urethroscope was inserted into the urethra with well lubrication. Bilateral prostate kissing and high bladder neck was noted. A 16 Fr. Foley catheter was placed for stenting the urethra. Operators 蒲永孝, Assistants 楊智凱, 記錄__ 手術科部: 外科部 套用罐頭: Simpson grade IV tumor excision 開立醫師: 胡朝凱 開立時間: 2010/11/17 18:06 Pre-operative Diagnosis Left sphenoid ridge inner third meningioma Post-operative Diagnosis Left sphenoid ridge inner third meningioma Operative Method Simpson grade IV tumor excision Specimen Count And Types pieces of tumor Pathology pending Operative Findings 1.One about 6 cm multilobule, soft, grayish tumor located at left frontal-temporal area that arised from sphenoid ridge inner third and anterior clinoid process. 2.The ICA and left M1, M2 branches were encased insided the tumor but were all preserved well. 3.The tumor margin was not so clear and it was hypervascular one. 4.The left optic nerve was adhered by the tumor and pushed downward. 5.Small part of tumor was left in situ because of tumor invasion into cavernous sinus Operative Procedures 1.ETGA, supine with head rotate to right 30 degree and fixed with Mayfild skull clamp 2.Letf curvillinear skin incision was done. 3.Left pterional approach followed. 4.The sphenoid ridge was drilled to make it flatten. 5.Curvature dural opening 6.Sylvian fissure was opened 7.The distal part of tumor was removed piece by piece after central debulking. 8.The ICA was traced back form M2 then M1 9.During reoval of frontal part of tumor, optic nerve was identified 10.The tumor was removed with CUSA also. 11.After hemostasis, dura was close with one piece of periosteum 12.Bone was fixed with miniplate 13.Set one CWV drai then clsoe wound in layers Operators 蔡瑞章 Assistants 王國川, 胡朝凱, 鍾文桂 陳毓和 (F,1929/03/01,83y0m) 手術日期 2010/11/17 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Subarachnoid hemorrhage 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 羅偉誠, 時間資訊 11:00 進入手術室 11:05 麻醉開始 11:10 誘導結束 11:10 抗生素給藥 11:48 手術開始 13:08 13:25 麻醉結束 13:25 手術結束 13:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 L 手術 氣管切開術 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt via right Kocher p... 開立醫師: 曾峰毅 開立時間: 2010/11/17 13:38 Pre-operative Diagnosis Hydrocephalus, respiratory failure Post-operative Diagnosis Hydrocephalus, respiratory failure Operative Method Ventriculoperitoneal shunt via right Kocher point, Medtronic, fixed medium pressure vlave; traheostomy Specimen Count And Types CSF was sent for routine, BCS, and culture. Pathology Nil Operative Findings Opening pressure of ventriculostomy was about 15cmH20. The CSF was clear, minimal yellowish. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to right, and left shoulder elevated. After skin shaved, scrubbed, disinfected, and then draped, we made one curvilinear skin incision at left frontal area. We drilled one burr hole and performed ventriculostomy once. We made one transverse skin incision at left upper abdomen, and entered peritoneal cavity via mini-laparotomy. We created subcutaenous tunnel from left upper abdomen to left occpital area. We inserted ventricular catheter, and connected it to1 peritoneal catheter via the subcutaneous tunnel. We checked the shunt function, and put the catheter into peritoneal cavity. The wound was closed in layers. We changed the patient head in neutral position with neck extended. We made one midline skin incision about 2cm above the sternal notch, and dissected to expose trachea ring. We made incision and insert No 7. lower pressure trachea tube. Operators VS 蕭輔仁 Assistants R4 曾峰毅 R1 羅偉誠 蔡仁松 (M,1942/05/07,69y10m) 手術日期 2010/11/17 手術主治醫師 許巍鐘 手術區域 東址 001房 02號 診斷 Malignant neoplasm of other parts of bronchus or lung 器械術式 esophagoscope 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 靜脈麻醉 麻醉主治醫師 林佩玲 ASA 3 紀錄醫師 林玫君, 時間資訊 12:00 報到 12:35 進入手術室 12:40 麻醉開始 12:55 誘導結束 12:56 手術開始 13:00 手術結束 13:00 麻醉結束 13:05 送出病患 13:10 進入恢復室 15:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 內視鏡喉異物取出術 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 記錄__ 手術科部: 耳鼻喉部 套用罐頭: Laryngoscope assisted foreign body removal 開立醫師: 林玫君 開立時間: 2010/11/19 10:17 Pre-operative Diagnosis Oropharyngeal foreign body Post-operative Diagnosis ditto, removed Operative Method Laryngoscope assisted foreign body removal Specimen Count And Types nil Pathology nil Operative Findings Detal prosthesis was noted at oropharynx, removed Operative Procedures Under IVG. Tongue base was elevated by laryngoscope. Detal prosthesis was noted at oropharynx and removed by forceps. The patient tolerated the operation well. Operators AsP許巍鐘, Assistants R4林芳瑩, R2林玫君, Indication Of Emergent Operation 李晉柱 (M,1926/10/22,85y4m) 手術日期 2010/11/17 手術主治醫師 王國川 手術區域 東址 001房 05號 診斷 Cerebrovascular accident (CVA) 器械術式 Craniotomy(Aneurysms) P-DUH 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 4E 紀錄醫師 許皓淳, 時間資訊 16:14 開始NPO 16:14 通知急診手術 16:34 進入手術室 16:40 麻醉開始 16:55 誘導結束 16:59 開始輸血 17:05 抗生素給藥 17:30 手術開始 18:20 手術結束 18:20 麻醉結束 18:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 慢性硬腦膜下血腫清除術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Left parietal burr hole for subdural drainage 開立醫師: 許皓淳 開立時間: 2010/11/17 18:32 Pre-operative Diagnosis Left chronic subdural hematoma Post-operative Diagnosis Left chronic subdural hematoma Operative Method Left parietal burr hole for subdural drainage Specimen Count And Types nil Pathology nil Operative Findings Dark-reddish subdural effusion gushed out while durotomy. There is outer membrane and inner membrane. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to right. After scalp shaved, scrubbed, disinfeted, and then draped, we made one 3cm skin incision at left parietal area. We drilled one burr hole, and created durotomy. We drained the subdural fluid, and irrigated subdural space with saline. We inserted subdural rubber dain, and closed the wound in layers. We de-ari the subdural space. Operators 王國川 Assistants R5鍾文桂, R1許皓淳 Indication Of Emergent Operation 江麥美珠 (F,1943/06/18,68y8m) 手術日期 2010/11/18 手術主治醫師 王成平 手術區域 西址 033房 07號 診斷 Leukoplakia of oral mucosa, including tongue 器械術式 Biopsy of oral mucosa 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 12:40 報到 13:50 進入手術室 13:56 麻醉開始 13:58 手術開始 14:08 麻醉結束 14:08 手術結束 14:15 送出病患 記錄__ 手術科部: 耳鼻喉部 套用罐頭: Excision of oral lesions(LA) 開立醫師: 林冠良 開立時間: 2010/11/18 13:54 Pre-operative Diagnosis Tongue leukoplakia Post-operative Diagnosis Ditto,operated Operative Method Excision of oral lesion Specimen Count And Types 2 pieces Source:Tongue, anterior About size:0.5*0.5 cm Source:Tongue, posterior Pathology Pending Operative Findings Tongue leukoplakia, right,s/p excisional biopsy Operative Procedures 1.The patient was put in a supine position. 2.Local anesthesia was set up under local Bosmin-Xylocane injection. 3.The operative field was disinfected and draped as usual. 4.Two leukoplakia about 0.5*0.5 cm each in size was noted in right inferior tongue area. 5.Excisional biopsy was done. 6.Not much bleeding was noted. 7.Hemostasis was done carefully. The patient tolerated the entire procedure well. Operators AsP王成平 Assistants 林冠良, 李亭逸, 魏宣章 (M,1944/01/08,68y2m) 手術日期 2010/11/18 手術主治醫師 陳晉興 手術區域 東址 019房 03號 診斷 Malignant neoplasm of cecum 器械術式 Thoracoscopy 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 鄒冠全, 時間資訊 14:25 報到 14:42 進入手術室 14:55 麻醉開始 15:20 誘導結束 15:42 手術開始 18:20 麻醉結束 18:20 手術結束 18:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 術後止痛 1 0 手術 胸腔鏡肺楔狀或部分切除術 1 1 記錄__ 手術科部: 外科部 套用罐頭: VATs S3 segmetectomy 開立醫師: 鄒冠全 開立時間: 2010/11/18 18:30 Pre-operative Diagnosis Colon cancer, suspect lung metastasis Post-operative Diagnosis Colon cancer, suspect lung metastasis Operative Method VATs S3 segmetectomy Specimen Count And Types 1 piece About size:8*5CM Source:RUL, S3 Pathology pending Operative Findings 1. 3*2cm, whitish-elastic tumor at S3, near hilum, so the S3 was removed totally Operative Procedures 1. Epidural anesthesia with IVG, right decubitus 2. Skin disinfection and draping 3. VATS setting: 12-15-25mm 4. Identify tumor, dissect and transect major fissue, PV, PA with harmonic and endo-GIA 5. Hemostasis, N/S irrigation, set one Fr.28 chest tube, close wounds in layers Operators 陳晉興 Assistants CR李佳穎, R3鄒冠全, Ri 李進財 (M,1954/01/01,58y2m) 手術日期 2010/11/18 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 Hydrocephalus 器械術式 V-P shunt 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 08:00 臨時手術NPO 14:10 報到 14:55 進入手術室 15:05 麻醉開始 15:10 誘導結束 15:30 抗生素給藥 15:42 手術開始 16:30 手術結束 16:30 麻醉結束 17:00 送出病患 17:05 進入恢復室 18:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦脊髓液分流管重置 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Revision of ventriculoperitoneal shunt with C... 開立醫師: 鍾文桂 開立時間: 2010/11/18 17:23 Pre-operative Diagnosis Hydrocephlus status post implantation of V-P shunt with shunt malfunction. Post-operative Diagnosis Hydrocephlus status post implantation of V-P shunt with shunt malfunction. Operative Method Revision of ventriculoperitoneal shunt with Codman programmable shunt. Specimen Count And Types 1 piece About size:3cc Source:for routine, BCS, and culture. Pathology Nil. Operative Findings Compressed reservoir due obstruction over ventricular catheter(5 cm long). The Codman programmable shunt(7.0cm) was implanted through a different cerebral tract. The peritoneal catheter was left intact and its patency was checked. Operative Procedures Under ETGa, the patient was placed in supine position and the head was tilted to the left. After shaving, disinfection, and draping, the previous linear scalp wound over right Kocher point was incised. The reservoir was removed. Another scalp wound at right retroauricular area was done at the passage of the peritoneal catheter. The programmable shunt was implanted through the same tract. Then, a new ventriclar pathway was created by ventriculostomy needle. The ventricular catheter was implanted through the same tract. After ensuring the patency of the whole shunt system, the wound was closed in layers. Operators V.S. 王國川 Assistants R5鍾文桂 R1 張 許金崇 (M,1959/03/24,52y11m) 手術日期 2010/11/18 手術主治醫師 陳敞牧 手術區域 東址 005房 02號 診斷 Sciatica 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 10:50 報到 12:00 進入手術室 12:03 麻醉開始 12:10 誘導結束 12:14 抗生素給藥 12:39 手術開始 14:55 手術結束 14:55 麻醉結束 15:03 送出病患 15:05 進入恢復室 16:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 椎間盤切除術-腰椎 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: HIVD 開立醫師: 李振豪 開立時間: 2010/11/18 15:17 Pre-operative Diagnosis Herniation of intervertebral disc, L4-5 Post-operative Diagnosis Herniation of intervertebral disc, L4-5 Operative Method Microdiskectomy, L4-5, left Specimen Count And Types Nil Pathology Nil Operative Findings The ligmentum flavum was hypertrophic. The L4-5 intervertebral disc was bulging(central part) with root compression. The anterior part of the thecal sac was tightly adhered with the fibrous annulus of the disc. The root and the neural foramen decompressed well after microdiskectomy. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in prone position. The skin was scrubbed, disinfected, and draped as usual. The skin incision was made along previous wound. The subcutaneous scar tissue and paravertebral muscle group was detached to exposed the L4 lamina. Laminotomy was performed with high-speed air-drived drills, curette, and Kerrison punches. The hypertrophic ligmentum flavum was removed and the thecal sac and the roots was identified. Microdiskectomy was performed with knife, curette, alligator, and disc clamp. Hemostasis was achieved with bipolar electrocautery and Gelform packing. 4mg Rinderon solution was applied and the wound was closed in layers with 3-0 Vicryl and 4-0 Dexon. Operators VS陳敞牧 Assistants R4李振豪, Ri林特暐 林芳瑜 (F,1993/11/12,18y4m) 手術日期 2010/11/18 手術主治醫師 楊榮森 手術區域 東址 027房 02號 診斷 Primitive neuroectodermal tumor 器械術式 ORIF-Large.Small ""A-O""screw 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林子富 ASA 3 紀錄醫師 何京澤, 時間資訊 08:52 報到 09:25 進入手術室 09:35 麻醉開始 10:10 誘導結束 10:15 抗生素給藥 10:31 手術開始 11:00 開始輸血 11:15 抗生素給藥 12:10 麻醉結束 12:10 手術結束 12:28 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 惡性骨瘤廣泛切除(一次) 1 1 L 手術 開放性或閉鎖性肱骨粗隆或骨幹或踝部骨折,開放性復位術 1 2 L 記錄__ 手術科部: 骨科部 套用罐頭: 1. Tumor wide excision 開立醫師: 何京澤 開立時間: 2010/11/18 12:41 Pre-operative Diagnosis Left humeral shaft pathological fracture , r/o primitive neuroectodermal tumor bony metastasis Post-operative Diagnosis Left humeral shaft pathological fracture , r/o primitive neuroectodermal tumor bony metastasis Operative Method 1. Tumor wide excision 2. ORIF with large AO dynamic compresson plate (9H9S), cemented, with Vancomycion 1000 mg impregnated Specimen Count And Types 1 piece About size:3 cm in diameter Source:Left humeral shaft Pathology Pending Operative Findings 1. Left humeral shaft pathological fracture 2. A 3x3 cm round, whitish-gray, hypereremic, soft tumor at the mid-shaft of the left humerus 3. The axillary neurovascular bundle was identified and well-preserved Operative Procedures 1. ETGA, semi-sitting 2. Skin prepped and draped 3. A 20 cm longitudinal skin incision made at lateral aspect of the left upper arm, trans-deltoid approach 4. The tissues and muscles were dissected and split to reveal the humeral shaft 5. Forty mL 95% ethanol was injected into the tumor for chemocoagulation, followed by wide excision of the tumor 6. ORIF with large AO dynamic compresson plate (9H9S), cemented, with Vancomycion 1000 mg impregnated 7. The wound was irrigated with 95% ethanol and N/S 8. Set 1/8 H/V 9. The wound was closed in layers 10. Arm sling applied Operators 楊榮森, Assistants 何京澤, 黃興耀, 楊世琛 (M,1965/01/09,47y2m) 手術日期 2010/11/18 手術主治醫師 王國川 手術區域 東址 003房 號 診斷 Cerebrovascular accident 器械術式 EC-IC by-pass 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 07:40 報到 08:08 進入手術室 08:20 麻醉開始 09:00 誘導結束 09:10 抗生素給藥 09:49 手術開始 12:10 抗生素給藥 14:25 麻醉結束 14:25 手術結束 14:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱內外血管吻合術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 記錄__ 手術科部: 外科部 套用罐頭: EC-IC bypass, left. 開立醫師: 鍾文桂 開立時間: 2010/11/18 15:21 Pre-operative Diagnosis Moyamoya disease status post right EC-IC bypass. Post-operative Diagnosis Moyamoya disease status post right EC-IC bypass. Operative Method EC-IC bypass, left. Specimen Count And Types nil Pathology Nil. Operative Findings Patent anastomosis of cortical branch of middle cerebral artery and superficial temporal artery. Slack brain caused deepening of the cortical branch of MCA. It gained difficulty in anastomosis as the STA length is just enough to reach the cortical MCA. Operative Procedures Under ETGA, the patient was placed in supine position and head was fixed by Mayfield and tilted to the right. The pathway of the anterior branch of superficial temporal artery was outlined. After shaving, disinfection, and draping, the superficial temporal artery was harvestes by meticulous dissection. The temporalis muscle was dissected. The craniotomy was achieved by high speed drill. After durotomy and dissection of arachnoid membrane, the cortical branch of middle cerebral artery was anastomosed with superficial temporal artery in end to side fashion. Later, the leakage was sealed with TissueCorDuo. After ensuring the patency of anastomosis, the craniotomy plate was fixed by miniplates and the wound was closed in layers with in CWV drain. Operators V.S. 王國川 Assistants 鍾文桂 記錄__ 手術科部: 外科部 套用罐頭: EC-IC bypass, left. 開立醫師: 鍾文桂 開立時間: 2010/11/18 17:51 Pre-operative Diagnosis Moyamoya disease status post right EC-IC bypass. Post-operative Diagnosis Moyamoya disease status post right EC-IC bypass. Operative Method EC-IC bypass, left. Specimen Count And Types nil Pathology Nil. Operative Findings Patent anastomosis of cortical branch of middle cerebral artery and superficial temporal artery. Slack brain caused deepening of the cortical branch of MCA. It gained difficulty in anastomosis as the STA length is just enough to reach the cortical MCA. Slack brain caused deepening of the cortical branch of MCA. It gained difficulty in anastomosis as the STA length is just enough to reach the cortical MCA. Several perforators over the MCA anastomotic site were preserved. Howevere, it gained difficulty for operation. Operative Procedures Under ETGA, the patient was placed in supine position and head was fixed by Mayfield and tilted to the right. The pathway of the anterior branch of superficial temporal artery was outlined. After shaving, disinfection, and draping, the superficial temporal artery was harvestes by meticulous dissection. The temporalis muscle was dissected. The craniotomy was achieved by high speed drill. After durotomy and dissection of arachnoid membrane, the cortical branch of middle cerebral artery was anastomosed with superficial temporal artery in end to side fashion. Later, the leakage was sealed with TissueCorDuo. After ensuring the patency of anastomosis, the craniotomy plate was fixed by miniplates and the wound was closed in layers with in CWV drain. Operators V.S. 王國川 Assistants 鍾文桂 林虹 (F,1988/10/14,23y5m) 手術日期 2010/11/18 手術主治醫師 蔡翊新 手術區域 東址 005房 01號 診斷 Injury (severeity score >=16) 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 07:35 報到 08:05 進入手術室 08:10 麻醉開始 08:15 誘導結束 08:35 抗生素給藥 09:12 手術開始 11:40 手術結束 11:40 麻醉結束 11:45 送出病患 11:47 進入恢復室 13:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 頭顱成形術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 摘要__ 手術科部: 外科部 套用罐頭: Cranioplasty 開立醫師: 蔡翊新 開立時間: 2010/11/18 10:53 Pre-operative Diagnosis Left F-T-P skull defect. Post-operative Diagnosis Left F-T-P skull defect. Operative Method Cranioplasty with autologous bone graft. Specimen Count And Types nil Pathology Nil. Operative Findings A 13 x 12 cm skull defect at left F-T-P region. The brain was initially bulging out and became slack after CSF drainage 50 ml via a temporary EVD set through left Kocher point. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with a sterilized adhesive plastic sheet. 4. Incision: along the previous operation scar at left F-T-P, Raney clips were applied to the scalp edge for temporary hemostasis. 5. The left F-T-P scalp and temporalis muscle were dissected away from the underlying dura. The dural surface and margin of skull defect were well exposed. 6. The bleeders on the dissected surfaces were coagulated with Bovie painstakingly. A temporary EVD was inserted via left Kocher point for CSF drainage. 7. The original skull plate preserved at bone bank was disinfected with Vancomycin solution and placed back to the skull window then fixed by 3 miniplates and 6 screws. Three dural tentings were put at the center of the skull plate. 8.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by interrupted, mattressed suture with 3/0 nylon. 9.Drain: two epidural CWV. 10.Blood transfusion: nil. Blood loss: 60 ml. 11.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R4李振豪Ri林特暐 相關圖片 林玲珍 (F,1951/02/28,61y0m) 手術日期 2010/11/19 手術主治醫師 蔡瑞章 手術區域 東址 005房 01號 診斷 Hydrocephalus 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 2 紀錄醫師 陳德福, 時間資訊 07:35 報到 08:10 進入手術室 08:15 麻醉開始 08:25 誘導結束 08:50 抗生素給藥 09:26 手術開始 10:25 手術結束 10:25 麻醉結束 10:43 送出病患 10:45 進入恢復室 12:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: VPS with programmable valve, right frontal, 開立醫師: 陳德福 開立時間: 2010/11/19 10:25 Pre-operative Diagnosis Pituitary tumor with hydrocephalus Post-operative Diagnosis Pituitary tumor with hydrocephalus Operative Method VPS with programmable valve, right frontal, Specimen Count And Types 1 piece About size:3ML Source:CSF Pathology nil Operative Findings 1.ventricular opening pressure: 10cmH2O 2.CSF: clear, mild yellowish 3.intraventricular catheter:7.0cm; intraperitoneal catheter:20cm 4.One programmable valve[Codman] was implantated at the right frontal area with presetting pressure as 100mmH2O. Operative Procedures Under ETGA and supine position, the scalp and abdomen was disinfected and draped as usual. One linear incision on the right frontal scalp was done and burr hole was created. The dura was opened followed by inserting the ventricular needle. One minilaparotomy was done on the right upper abdomen and the subcutaneous tunnel was created. The intraventricular cath and intraperitoneal cath was connected and the wound was closed in layers. Under ETGA and supine position, the scalp and abdomen was disinfected and draped as usual. One linear incision on the right frontal scalp was done and burr hole was created. The dura was opened followed by inserting the ventricular needle. One minilaparotomy was done on the right upper abdomen and the subcutaneous tunnel was created. The intraventricular cath and intraperitoneal cath was connected and the wound was closed in layers. Under ETGA and supine position, the scalp and abdomen was disinfected and draped as usual. One linear incision on the right frontal scalp was done and burr hole was created. The dura was opened followed by inserting the ventricular needle. One minilaparotomy was done on the right upper abdomen and the subcutaneous tunnel was created. The intraventricular cath and intraperitoneal cath was connected and the wound was closed in layers. Operators P蔡瑞章 Assistants R5陳德福 R3王奐之 R1許皓淳 相關圖片 陳瑞芯 (M,2010/08/09,1y7m) 手術日期 2010/11/19 手術主治醫師 許文明 手術區域 兒醫 063房 01號 診斷 Retinopathy of prematurity 器械術式 Repair of inguinal hernia with 手術類別 預定手術 手術部位 腹 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 柯柏瑞, 時間資訊 08:10 報到 08:12 進入手術室 08:15 麻醉開始 08:20 誘導結束 08:23 抗生素給藥 08:34 手術開始 09:21 麻醉結束 09:21 手術結束 09:25 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 隱睪單側睪丸固定術 1 1 R 手術 嬰兒鼠蹊疝氣 1 2 R 記錄__ 手術科部: 套用罐頭: Herniorrhaphy with high ligation 開立醫師: 柯柏瑞 開立時間: 2010/11/19 09:19 Pre-operative Diagnosis Right inguinal hernia Post-operative Diagnosis Right inguinal hernia 1.Right inguinal hernia; 2. Right undescended testis Operative Method Herniorrhaphy with high ligation 1. Herniorrhaphy with high ligation; 2. Right orchiopexy Specimen Count And Types one 3 cm,herniac sac Pathology Pending Operative Findings 1.indirect type inguinal hernia, no content in herniac sac 2.Right undescended testis Operative Procedures 1. Under GA with the patient in supine position, prepping with Povidone iodine and draping was performed in the usual sterile fashion. 2. An transverse incision along skin crease was made in the right inguinal area. Incision was deepened through layers. The scarpa fascia was opened. The external oblique fascia was opened from external ring. 3. Spermatic cord was looped. Dissection was performed on the antero-medial aspect of the spermatic cord. An indirect herniac sac was noted and mobilized. The sac was opened and extended into distal and proximal ends, the latter was then high-ligated. Adequate hemostasis was obtained. Right testis was noted beside the hernia sac. The testis was mobilized. Transverse skin incision was made at right scrotum. The testis was fixed at the Dartos pouch. 4. Closure of scarpa fascia and the skin was closed subcuticularly. Operators AP許文明 Assistants R6柯柏瑞 黃神添 (M,1938/08/29,73y6m) 手術日期 2010/11/19 手術主治醫師 陳敞牧 手術區域 東址 003房 01號 診斷 Vertebral column malignant neoplasm 器械術式 Malignant intraspinal tumor, e 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 2 紀錄醫師 羅偉誠, 時間資訊 07:40 報到 08:17 進入手術室 08:25 麻醉開始 09:00 誘導結束 09:30 抗生素給藥 09:45 手術開始 12:40 抗生素給藥 13:25 開始輸血 14:50 手術結束 14:50 麻醉結束 15:15 送出病患 15:18 進入恢復室 16:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術(減壓)-超過二節 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 惡性脊髓腫瘤切除術 1 1 記錄__ 手術科部: 外科部 套用罐頭: Excision of intraspinal tumor, C3. 開立醫師: 鍾文桂 開立時間: 2010/11/19 15:50 Pre-operative Diagnosis Metastatic spinal tumor, C3. Post-operative Diagnosis 1. Metastatic spinal tumor, C3. 2. Ossification of posterior longitudinal ligament, C5. Operative Method Excision of intraspinal tumor, C3. Laminectomy of C2-5. Internal fixation, C2-C4. Specimen Count And Types 1 piece About size:3x2cm Source:right pedicel of C2 spine Pathology Frozen pathology: adenocarcinoma Operative Findings 1. The tumor was soft, easy oozing, red, and elastic. It bulged out from right C3 laminae and expands into the paraspinal muscle. It invaded the upper margin of C4 lamine, right C3 lamine, and caused mild compression of the spinal cord. The dura mater was intact. Near total tumor excision was achieved. Some tumor near the vertebral artery was left. 2. Internal fixation: C2 transarticular screw and C3 lateral mass screws with one interlink and two rods. 3. Due to OPLL, the C5 lamine was removed for further decompression. 4. Blood loss: 600cc. Operative Procedures Under ETGA, the patient was placed in prone position and the head was fixed by Mayfield. After shaving, disinfection, and draping, a midline incision and dissection to exposed the C2-C5 levels were done. The tumor was dissected from the paraspinal muscle by meticulous dissection. After implantation of the lateral mass screws at C4 and transarticular screws at C2 levels, further laminectomy from C2-C5 were done. The tumor was resected enbloc while leaving ones near the vertebral artery. Then, the internal fixation apparatus was complete with two rods and one interlink. After meticulous hemostasis, the wound was closed in layers with one epidural 1/8 hemovac. Operators V陳敞牧 Assistants R6胡朝凱,R5鍾文桂,R1羅偉誠 簡振仁 (M,1963/11/09,48y4m) 手術日期 2010/11/19 手術主治醫師 楊榮森 手術區域 西址 035房 03號 診斷 Liver cancer 器械術式 tumor curettage + CHS 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 3 紀錄醫師 何京澤, 時間資訊 12:35 進入手術室 12:40 麻醉開始 12:45 誘導結束 13:10 抗生素給藥 13:29 手術開始 13:45 開始輸血 14:40 手術結束 14:40 麻醉結束 14:40 進入恢復室 14:50 送出病患 17:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 惡性骨瘤廣泛切除(一次) 1 1 L 手術 股骨頸骨折開放性復位術 1 2 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 骨科部 套用罐頭: Wide excision-bone tumor,malignant 開立醫師: 何京澤 開立時間: 2010/11/19 14:32 Pre-operative Diagnosis Right proximal femur tumor with impending pathological fracture, r/o hepatocellular carcinoma metastasis Post-operative Diagnosis Right proximal femur tumor with impending pathological fracture, r/o hepatocellular carcinoma metastasis Operative Method 1. Tumor wide excision 2. Internal fixation with compression hip screw ( Richard 135 degrees, 3H3S, lag screw 95 mm), cemented, with Vancomycin 1000 mg impregnated Specimen Count And Types 1 piece About size:Multiple Source:Right proximal femur Pathology Pending Operative Findings 1. A 3X3 cm whitish-gray, necrotic, soft tumor over the right proximal femur Operative Procedures 1. ETGA, left lateral decubitus 2. Skin prepped and draped 3. A 12 cm longitudinal skin incision made over the lateral side of right hip 4. The muscles and tissues were dissected and split to reveal the right proximal femur 5. The tumor was widly excised and irrigated with 95% ethanol and N/S 6. Internal fixation with compression hip screw ( Richard 135 degrees, 3H3S, lag screw 95 mm), cemented, with Vancomycin 1000 mg impregnated 7. The wound was irirgated with 95% ethanol and N/S 8. Set 1/8 H/V 9. The wound was closed in layers Operators 楊榮森, Assistants 何京澤, 陳明峰, 黃興耀, 陳洪碧珠 (F,1948/10/17,63y4m) 手術日期 2010/11/19 手術主治醫師 蔡翊新 手術區域 東址 005房 05號 診斷 Subarachnoid hemorrhage 器械術式 Aneurysm clipping 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 蕭柏妮 ASA 3E 紀錄醫師 柯安達, 時間資訊 08:00 臨時手術NPO 08:00 開始NPO 19:10 進入手術室 19:15 麻醉開始 19:40 誘導結束 20:06 手術開始 20:26 開始輸血 21:00 抗生素給藥 23:00 抗生素給藥 02:00 抗生素給藥 02:25 手術結束 02:25 麻醉結束 02:35 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 手術 開顱術摘除血管病變 - 腦血管瘤 有病徵的 1 1 L 手術 顱內壓視置入 1 2 L 摘要__ 手術科部: 外科部 套用罐頭: Aneurysm-frontotemporal approach 開立醫師: 蔡翊新 開立時間: 2010/11/20 01:54 Pre-operative Diagnosis Left MCA bifurcation large aneurysm rupture with SAH. Post-operative Diagnosis Left MCA bifurcation large aneurysm rupture with SAH. Operative Method Aneurysm-frontotemporal approach Specimen Count And Types 3 tubes of CSF, sent for routine, BCS and bacterial culture. Pathology Nil. Operative Findings Initial ICP was about 5 cmH2O, measured from the EVD via left Kocher point. Diffuse SAH was noted at left frontotemporal lobes, as well as in the Sylvian fissure. The dome of aneurysm adhered to the dura and ruptured prematurely upon elevation of dural flap. After careful dissection of the aneurysm away from adjacent brain tissue and vessels, a saccular aneurysm was noted arising from the left MCA bifurcation pointing laterally, measured 1.9 cm in height. The left M1 segment was stenotic and the bifurcation was incoperated into the neck of the aneurysm. A right-angled 10 mm, a straight fenetrated 10 mm and a right-angled 5 mm Sugita clips were used to reconstruct the patency of M1 to M2 flow and to obliterate the aneurysm, the latter confirmed by opening the initial perforated site without blood returned. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right for 50 degrees and slightly extended then fixed by Mayfield skull clamp. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with asterilized adhesive plastic sheet. 4. Incision: left frontotemporal, curvilinear. The skin edge was clipped by Raney clips for temporary hemostasis. After scalp had been lifted, the left temporalis muscle was incised and detached from temporal squama and reflected to lower temporal side. 5. Craniotomy window: 10 x 6 cm, left frontotemporal, created by making 4 burr holes then cut by power saw. The lower temporal bone and pterionic ridge (esp. the inner table) were cut by rongeur and drill as low as possible for easy approach to the anterior clinoid. 6. Dural tention: by 2/0 silk, 2 cm in interval, distributed along the edge of skull window. 7. Ventricular tapping via left Kocher point and drainage of CSF was made to slacken down the brain for easy approach to anterior clinoid without undue traction on the brain. 8. Dural incision: curvilinear, over-ridding Sylvian fissure and reflected to left frontotemporal base. The dome of the aneurysm ruptured prematurely upon dural flap elevation. It was packed with cottonoid patty and suction. 9. Under operating microscope, the Sylvian fissure was opened, then the frontal and temporal opercula were retracted by self-retaining retractor in an opposite direction to expose the M-2 segment of left MCA. When the dissection was carried out more proximally, the aneurysm was freed from adjacent brain tissue and vessels. The neck of the aneurysm was mobilized gently by a Gauge 16 sucker and a microdissector until it was entirely free. 10.The suprasellar cistern was opened. The left optic nerve and ICA came into view. The arachnoid trabeculi and the fibrin (or blood clot) were cleaned out to expose the ICA and M1 segment of left MCA. 11.A right-angled 10 mm, a straight fenetrated 10 mm and a right-angled 5 mm Sugita clips were used to reconstruct the patency of M1 to M2 flow and to obliterate the aneurysm, the latter confirmed by opening the initial perforated site without blood returned. 12.After successful clipping of the aneurysm, the patients BP was brought back to normal, and the exposed field was irrigated with N.S. to make sure no any bleeding. 13.The brain retractors were removed. The dura was closed water-tight by running suture with 4/0 Prolene. 14.Closure of skull window: the skull plate was placed back to craniotomy window and fixed by 3 miniplates and 6 screws. The dura was tented to the center of the skull plate by two 2/0 stitches. The covering muscle was closed by interrupted stitches with 1/ 0 silk. 15.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 16.Drain: one, epidural, CWV. 17.Blood transfusion: PRBC 4U, Platelet 12U, FFP 6U. Blood loss: 500 ml. 18.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R6胡朝凱R1柯安達 Indication Of Emergent Operation 晁紹庭 (F,2001/05/25,10y9m) 手術日期 2010/11/21 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Neoplasm of unspecified nature of brain 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 4E 紀錄醫師 鍾文桂, 時間資訊 07:00 臨時手術NPO 07:00 開始NPO 11:35 抗生素給藥 20:45 通知急診手術 22:49 進入手術室 23:00 麻醉開始 23:30 誘導結束 00:08 手術開始 02:35 抗生素給藥 03:10 開始輸血 05:35 抗生素給藥 06:05 手術結束 06:05 麻醉結束 06:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除-手術時間在4~8小時 1 1 手術 顱內壓視置入 1 2 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 記錄__ 手術科部: 套用罐頭: Suboccipital craniotomy for tumor excision + ... 開立醫師: 李振豪 開立時間: 2010/11/21 07:05 Pre-operative Diagnosis Cerebellar tumor with severe obstructive hydrocephalus Post-operative Diagnosis Cerebellar tumor with severe obstructive hydrocephalus Operative Method Suboccipital craniotomy for tumor excision + Right Frazier"s external ventricular drainage for intracranial pressure monitoring Specimen Count And Types 1 piece About size:10cc Source:cerebellar tumor Pathology Pending Operative Findings The tumor was gray-reddish, hypervascularized, ill-defined, fragile to elastic in character. Severe IICP was noted during ventricular puncture(opening pressure > 25cmH2O) and the cerebellar bulging out after dura opening. The tumor was mainly located at vermis with 4.5cm in diameter. Fourth ventricle was entered after tumor excision and the tumor did not invaded into fourth ventricle or brainstem directly. 1. Severe IICP was noted during ventricular puncture with opening pressure higher than 40cmH2O. The cerebellum bulged out even after the CSF was repeatedly released from the EVD. Quick debulking of the tumor at the upper part of the tumor to open the aqueduct was necessary to relieve the ICP. 2. the dura became transparent due to chronic IICP 3. The tumor was mainly located at vermis with 4.5cm in diameter. Fourth ventricle was entered after tumor excision and the tumor did not invaded into fourth ventricle or brainstem directly. The tumor composed of many parts of different characteristics. The upper part was fragile, gray-reddish, hypervascularized, ill-defined, but the lower part was elastic firm, reddish and hypervascular. The lower part was adhered markedly by many feedign arteries, which are coming from the vessels supplying the choroid plexus in the fourth ventricle. Operative Procedures Under endotracheal tube general anesthesia, The patient was put in prone position with head fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. One linear scalp incision was made at right Frazier"s point followed by one burr hole creation. After dural opening, ventricular puncture was performed and EVD tube was inserted. Externalization was done and the wound was then closed in layers. Under endotracheal tube general anesthesia, The patient was put in prone position with head fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. One linear scalp incision was made at right Frazier"s point followed by one burr hole creation. After dural opening, ventricular puncture was performed and EVD tube was inserted for 10 cm. Externalization was done and the wound was then closed in layers. Midline skin incision was made from 1cm above inion to C2 level. The subcutaneous soft tissue was dissected and the nuchal muscle group was detached. Four burr holes were created followed by one 6x3cm craniotomy window. C shape dural incision was performed based with transverse sinus. Central debulking was performed after dural opening due to severe bulging of the cerebellum and brain tumor. The tumor was then removed with sucker, microdissector, and bipolar electrocautery. The fourth ventricle was entered and the tumor was not invaded into the fourth ventricle. Hemostasis was achieved and the dura was closed with 4-0 Prolene. The skull plate was fixed back with three #26 wires. One subgaleal CWV drain was placed and the wound was closed in layers with 2-0 Silk, 2-0 Vicryl and 3-0 Nylon. Midline skin incision was made from 1cm above inion to C2 level. The subcutaneous soft tissue was dissected and the nuchal muscle group was detached. Four burr holes were created followed by one 6x3cm craniotomy window. U shape dural incision was performed based with transverse sinus. Under microscopic view, central debulking at the upper part of the tumor was performed quickly via linear incision of the vermis after dural opening due to persistent severe bulging of the cerebellum. The cerebellum became slacked after removal of the upper part of the tumor and till the aqueduct was reached. The tumor was then removed with sucker, microdissector, tumor forceps and bipolar electrocautery. The fourth ventricle was entered and the tumor was not invaded into the brainstem. Hemostasis was achieved and the dura was closed with 4-0 Prolene after a piece of Durofoam was used to cover the brain surface. The skull plate was fixed back with three #26 wires. Tissue-Col-Duo was applied on the dural suture holes after it was continusouly closed with prolene. One subgaleal CWV drain was placed and the wound was closed in layers with 2-0 Silk, 2-0 Vicryl and 3-0 Nylon. Operators AP郭夢菲 Assistants R5鍾文桂, R4李振豪 Indication Of Emergent Operation 柳閩生 (M,1942/05/16,69y9m) 手術日期 2010/11/20 手術主治醫師 蔡翊新 手術區域 東址 019房 03號 診斷 Predominant disturbance of consciousness 器械術式 Right MCA aneurysm clipping and hematoma evacuation 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 蕭柏妮 ASA 4E 紀錄醫師 方怡婷, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 13:29 通知急診手術 17:35 報到 17:35 進入手術室 17:43 麻醉開始 18:00 誘導結束 18:50 手術開始 21:00 抗生素給藥 22:45 麻醉結束 22:45 手術結束 22:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 開顱術摘除血管病變 - 腦血管瘤 有病徵的 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Aneurysm-frontotemporal approach 開立醫師: 蔡翊新 開立時間: 2010/11/20 22:37 Pre-operative Diagnosis Right distal MCA mycotic aneurysm rupture with right parietal ICH and IVH. Post-operative Diagnosis Right distal MCA mycotic aneurysm rupture with right parietal ICH and IVH. Operative Method Right parietotemporal craniotomy for aneurysm excision and ICH evacuation. Specimen Count And Types 1. 0.8 X 0.5 cm, aneurysm sac, for pathology. 2. blood clots for bacterial culture. Pathology Pending. Operative Findings The brain was bulging out upon dural opening. About 50 ml blood clots were evacuated from right parietal lobe, 0.5 cm beneath the cortical surface and extended into right lateral ventricle. The brain became slack after ICH evacuation, 1 cm away from the dura. A saccular aneurysm, 0.8 cm in height, arising from a cortical segment of right distal MCA. The distal branch arose from the wall of the aneurysm, which showed fibrotic change with some calcification. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with right back elevated and head rotated to left for 90 degrees and slightly extended then fixed by Mayfield skull clamp. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: right temporoparietal, U-shaped. The skin edge was clipped by Raney clips for temporary hemostasis. After scalp had been lifted, the temporalis muscle was incised and detached from temporal squama and reflected to lower temporal side. 5. Craniotomy window: 9 x 9 cm, temporoparietal, created by making 4 burr holes then cut by power saw. 6. Dural tenting: by 2/0 silk, 2 cm in interval, distributed along the edge of skull window. 7. Dural incision: curvilinear. 8. Ventricular tapping was tried, but failed. 9. A 1.5 cm cortical incision was made at right inferior parietal gyrus, then the intracerebral hematoma was sucked out until the brain was slack. 10.Under operating microscope, the body of the aneurysm was mobilized gently bya Gage 18 sucker and a microdissector until it was entirely free. The proximal and distal branches of parent artery were identified, coagulated and divided. The whole aneurysm was removed for pathology. 11.Dural closure: running suture with 4-0 prolene in a water-tight fashion. 12.Closure of skull window: the skull plate was placed back to craniotomy window and fixed by 3 miniplates and 6 screws. The dura was tented to the center of the skull plate by two 2/0 stitches. The covering muscle was closed by interrupted stitches with 1/ 0 silk. 13.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 14.Drain: one, epidural, CWV. 15.Blood transfusion: nil. Blood loss: 120 ml. 16.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R6胡朝凱R5鍾文桂R1方怡婷 Indication Of Emergent Operation 石聰富 (M,1955/01/04,57y2m) 手術日期 2010/11/21 手術主治醫師 李章銘 手術區域 東址 005房 01號 診斷 Esophageal cancer 器械術式 Port-A catheter Implatation 手術類別 緊急手術 手術部位 胸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 蔡東明, 時間資訊 08:16 通知急診手術 09:14 進入手術室 09:14 報到 09:18 抗生素給藥 09:36 麻醉開始 09:37 誘導結束 09:38 手術開始 10:11 麻醉結束 10:11 手術結束 10:13 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 port–A導管植入術–治療性導管植入術 1 0 R 記錄__ 手術科部: 外科部 套用罐頭: Port-A 開立醫師: 蔡東明 開立時間: 2010/11/21 08:58 Pre-operative Diagnosis Esophageal cancer Post-operative Diagnosis Esophageal cancer Operative Method Port-A insertion Specimen Count And Types nil Pathology nil Operative Findings The port-A catheter was inserted to right subclavian via puncture method, checked by portable CXR Operative Procedures 1. LA, supine 2. Skin disinfection and draping as usual 3. Insert Port-A via puncture method 4. Checked by portable CXR, close wound in layers Operators VS李章銘 Assistants R4蔡東明 Indication Of Emergent Operation 曲維銓 (M,1926/11/29,85y3m) 手術日期 2010/11/21 手術主治醫師 蔡翊新 手術區域 東址 003房 02號 診斷 Intracerebral hemorrhage 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 蕭柏妮 ASA 4E 紀錄醫師 李振豪, 時間資訊 15:00 臨時手術NPO 15:00 開始NPO 21:08 進入手術室 21:30 麻醉開始 21:45 誘導結束 21:50 抗生素給藥 21:50 開始輸血 22:09 手術開始 23:00 手術結束 23:00 麻醉結束 23:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Chronic Subdural Hematoma 開立醫師: 蔡翊新 開立時間: 2010/11/21 22:56 Pre-operative Diagnosis Bilateral frontotemporoparietal chronic SDH, left > right. Post-operative Diagnosis Bilateral frontotemporoparietal chronic SDH, left > right. Operative Method Left frontal burr hole for removal of chronic SDH. Specimen Count And Types nil Pathology Nil. Operative Findings Straw-colored fluid gushed out upon opening the dura and outer membrane. There was more reddish blood at the posterior part. The brain was very slack, even after removal of the SDH, Trendelenburg position and hypoventilation. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with a sterilized adhesive plastic sheet. 4. Incision: 5 cm, linear at left frontotemporal area. Raney clips were applied to the scalp edge for temporary hemostasis. 5. A burr hole was made at left frontal region. 6. Dural tenting: by 2/0 silk at 1 cm interval. 7. Dural incision: cruciated. 8. The outer membrane of the hematoma was coagulated by Bovie along the edge of dural incision, then incised. 9. The liquified old blood in the subdural space was evacuated by sucker, then thoroughly irrigated with N.S. through a rubber tube until the return was clean. 10.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous sutures with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 11.Drain: one, subdural, rubber drain. 12.Blood transfusion: nil. Blood loss: minimal. 13.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R4李振豪R1黃鼎鈞 Indication Of Emergent Operation 相關圖片 黃鎮鎧 (M,1941/01/24,71y1m) 手術日期 2010/11/22 手術主治醫師 王國川 手術區域 東址 002房 07號 診斷 Major trauma rated 16 or above on the severeity scale ( Injury severeity score >=16 ) 器械術式 Craniotomy(Aneurysms) P-DUH 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 4E 紀錄醫師 李柏穎, 時間資訊 20:09 開始NPO 20:09 通知急診手術 20:53 進入手術室 20:53 報到 20:55 麻醉開始 21:00 誘導結束 21:02 抗生素給藥 21:10 手術開始 21:20 開始輸血 23:05 麻醉結束 23:05 手術結束 23:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦內血腫清除術 1 1 R 手術 顱內壓視置入 1 2 R 摘要__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 曾峰毅 開立時間: 2010/11/22 23:13 Pre-operative Diagnosis Acute subdural hemorrhage, with skull fracture Post-operative Diagnosis Acute subdural hemorrhage, with skull fracture Operative Method Right craniectomy, and ICP monitor insertion. Specimen Count And Types Bone graft was sent to bone bank for storage after two culture made. Pathology Nil Operative Findings Subdural hematoma was about 3 cm thick, and about 150-200ml in volume. ICP reference is 473. ICP after closure was 1mmHg. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to left. After scalp shaved, scrubbed, disinfected, and then draped, we made one curvilinear skin incision at right frontotemporal area. We dissected temporalis muscle and harvested the muscle fascia. Temporalis muscle was transected. We drilled six burr holes, and then created craniectomy. After dura incision, we removed subdural hematoma. We inserted ICP monitor, and closed the dura with autologous fascia graft and water-tight suture. Two CWV was inserted, and the wound was closed in layers. Operators VS 王國川 Assistants R4 曾峰毅 R1 李柏穎 Indication Of Emergent Operation 周張水 (F,1939/04/08,72y11m) 手術日期 2010/11/22 手術主治醫師 簡雄飛 手術區域 東址 009房 04號 診斷 Head Injury 器械術式 rotation flap 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 3 紀錄醫師 阮廷倫, 時間資訊 00:00 臨時手術NPO 14:00 報到 14:20 進入手術室 14:25 麻醉開始 14:30 抗生素給藥 14:30 誘導結束 14:48 手術開始 15:05 15:20 手術結束 15:20 麻醉結束 15:26 進入恢復室 15:30 送出病患 17:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 移前皮瓣移植術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Debridement + advancement flap for wound closure 開立醫師: 阮廷倫 開立時間: 2010/11/22 15:29 Pre-operative Diagnosis Scalp defect with right heel poor healing wound Post-operative Diagnosis Scalp defect with right heel poor healing wound Operative Method Debridement + advancement flap for wound closure Specimen Count And Types Nil Pathology Nil Operative Findings 1. 1*1.5 cm scalp defect with fair wound bed was noticed over right occipital region 2. Right heel previous laceration wound, s/p suture with wound poor healing, size about 8*1 cm Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position. After skin disinfection and draped, the wounds over scalp and heel were debrided. After irrigation and hemostasis, advancement flaps were created. THe wounds were then closed in layers with 3-0 Monocryl, 4-0 Nylon. Operators AP簡雄飛 Assistants R5阮廷倫 張鳳岐 (M,1930/11/11,81y4m) 手術日期 2010/11/22 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Spondyloisthesis, acquired 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3 紀錄醫師 許皓淳, 時間資訊 07:30 報到 08:10 進入手術室 08:20 麻醉開始 08:30 誘導結束 08:45 抗生素給藥 09:15 手術開始 11:45 抗生素給藥 11:50 手術結束 11:50 麻醉結束 12:00 送出病患 12:01 進入恢復室 13:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 手術 脊椎融合術-前融合,有固定物)≦四節 1 1 手術 椎弓切除術(減壓)-二節以內 1 2 記錄__ 手術科部: 外科部 套用罐頭: L4~5 TPS and cage insertion 開立醫師: 胡朝凱 開立時間: 2010/11/22 12:02 Pre-operative Diagnosis L4~5 spondylolisthesis and HIVD Post-operative Diagnosis L4~5 spondylolisthesis and HIVD Operative Method L4~5 TPS and cage insertion Specimen Count And Types nil Pathology nil Operative Findings 1.Hypertrophic facet joint 2.Hypertrophic flavum ligment 3.L4 on L5 anterior listhesis 4.Screws: 6.2 x 45 x 4 5.Banana cage: 13# 6.Protruding disc that compressed the root tightly Operative Procedures 1.ETGA, prone 2.Midline incision 3.Detach paravertebral muscle group 4.Expose facet and transverse process 5.TPS screws insertion 6.Laminectomy of L4 7.Right partial facet joint was also removed. 8.Discectomy 9.Cage insertion 10.Hemostasis 11.Rods fixation 12.Close wound in layers after one hemovac drain insertion Operators 賴達明 Assistants 胡朝凱,許皓淳 許海濤 (M,1948/11/25,63y3m) 手術日期 2010/11/22 手術主治醫師 楊士弘 手術區域 東址 003房 02號 診斷 Lumbar spondylosis 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3 紀錄醫師 許皓淳, 時間資訊 12:00 報到 12:27 進入手術室 12:30 麻醉開始 12:40 誘導結束 13:00 抗生素給藥 13:15 手術開始 14:10 手術結束 14:10 麻醉結束 14:25 送出病患 14:26 進入恢復室 16:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 手術 椎間盤切除術-腰椎 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Microsurgical diskectomy 開立醫師: 楊士弘 開立時間: 2010/11/22 14:04 Pre-operative Diagnosis Lumbosacral intervertebral disc herniation, L5-S1, right Post-operative Diagnosis Ditto Operative Method Microsurgical diskectomy Specimen Count And Types 1 piece About size:小 Source:Intervertebral disc Pathology Pending Operative Findings A 0.8 cm x 0.7 cm x 0.6 cm sized ruptred disc was found under the right S1 root. The root became relaxed after disc removal. Operative Procedures 1. ETGA, prone. 2. C-arm localization of L5-S1 intervertebral space. 3. Midline incision, L5-S1, 3 cm long. 4. Dissection of right paravertebral muscle of L5 and S1 spinous processes and lamina 5. Removal of ligamentum flavum and lower edge of right L5 lamina. 6. Medial retraction of right S1 root under microscope. 7. Exploration of epidural space and removal of ruptured disc fragment in one piece by alligator forceps. 8. Hemostasis. 9. Wound closure in layers. Operators 楊士弘 Assistants 胡朝凱,許皓淳 周台江 (M,1959/05/08,52y10m) 手術日期 2010/11/22 手術主治醫師 王國川 手術區域 東址 005房 01號 診斷 Subdural hematoma 器械術式 Removal of subdural hematoma (craniotomy) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3E 紀錄醫師 陳德福, 時間資訊 07:01 通知急診手術 08:10 報到 08:40 進入手術室 08:45 麻醉開始 09:10 誘導結束 09:15 抗生素給藥 09:40 手術開始 12:00 開始NPO 12:00 臨時手術NPO 12:20 手術結束 12:20 抗生素給藥 12:20 麻醉結束 12:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 急性硬腦膜下血腫清除術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: subdural hematoma evacuation 開立醫師: 陳德福 開立時間: 2010/11/22 12:52 Pre-operative Diagnosis Acute-Subacute subdural hematoma, left fronto-tempora-parietal area Post-operative Diagnosis Acute-Subacute subdural hematoma, left fronto-tempora-parietal area Operative Method subdural hematoma evacuation Specimen Count And Types nil Pathology nil Operative Findings 1.There is 1.5cm in thickness subdural hematoma with brain parenchyma compression over the left fronto-tempora-parietal area. The outer membrane is found and some motor-oil fuild gushed out spontaneously after dura opening. 2.No remarkable bleeder was found. There was some inflammatory or fibrotic change[whitish color] on the pia over the left frontal-temporal area. Operative Procedures Under ETGA and supine position, the scalp was disinfected and draped as usual. One curvilinear incision over the left scalp was done followed by creating a 6*6cm craniotomy window. The dura was opened and the subdural hematoma was evacuated. One subdural rubber drain was left in situ and the dura was closed in water tight fasion. The skull was fixed with miniplates. The wound was closed in layers. Operators VS王國川 Assistants R5陳德福 Indication Of Emergent Operation 江德貴 (M,1930/02/28,82y0m) 手術日期 2010/11/23 手術主治醫師 王國川 手術區域 東址 001房 05號 診斷 Chronic hepatitis C (HCV) 器械術式 Burr hole (trephination) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林珍榮 ASA 4E 紀錄醫師 王奐之, 時間資訊 23:38 通知急診手術 00:15 報到 00:15 進入手術室 00:20 麻醉開始 00:30 誘導結束 00:31 抗生素給藥 00:35 手術開始 01:05 麻醉結束 01:05 手術結束 01:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 Blood gas analysis 1 0 手術 顱內壓視置入 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: External ventricular drainage via right Koche... 開立醫師: 曾峰毅 開立時間: 2010/11/23 01:11 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method External ventricular drainage via right Kocher point Specimen Count And Types Nil Pathology Nil Operative Findings Light bloody CSF was drained. Opening pressure was about 15cmH2O. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position. After scalp shaved, scrubbed, disinfected, and then draped, we made one transverse skin incision at right frontal area. We drilled one burr hole, and durotomy was made in X-shape. Ventricular puncture was done once, and ventricular catheter was inserted. We fixed the drain, and closed the wound in layers. Operators VS 王國川 Assistants R4 曾峰毅 R3 王奐之 Indication Of Emergent Operation 相關圖片 張堂富 (M,1966/11/16,45y3m) 手術日期 2010/11/23 手術主治醫師 蔡瑞章 手術區域 東址 005房 02號 診斷 Malignant neoplasm of temporal lobe 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 羅偉誠, 時間資訊 10:55 報到 11:10 抗生素給藥 11:15 進入手術室 11:20 麻醉開始 11:40 誘導結束 11:41 手術開始 15:00 麻醉結束 15:00 手術結束 15:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 腦瘤切除-手術時間在4小時以內 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT 開立醫師: 曾峰毅 開立時間: 2010/11/23 15:23 Pre-operative Diagnosis Glioblastoma multiforme, status tumor excision, status post CCRT, suspected recurrence Post-operative Diagnosis Glioblastoma multiforme, status tumor excision, status post CCRT, suspected recurrence Operative Method Craniotomy for tumor excision Specimen Count And Types Tumor was sent for patholgoy. Pathology Pending Operative Findings Well defined, capsuled, normovascular tumor, about 2x2x2.5cm, was located at left temporal lobe. Well defined, capsuled, normovascular tumor, about 2x2x2.5cm, was located at left temporal lobe. Temporal horn was exposed during tumor excision. Operative Procedures With endotracheal general anaesthesia, the patient was put supine position with head rotated to right and fixed with Mayfield clamp. After scalp shaved, scrubbed, disinfected, and then draped, we made skin incision along previuos surgical wound. We removed mini-screws and bone graft. C-shape durotomy was done. Tumor excision was performed. After hemostasis, we de-air subdural space with saline and closed the dura in water-tight suture. We fixed back bone graft with mini-plates and screws. Two CWV were inserted. The wound was closed in layers. Operators VS 蔡瑞章 Assistants R4 曾峰毅 R1 羅偉誠 黃徐冬妹 (F,1949/04/10,62y11m) 手術日期 2010/11/23 手術主治醫師 曾勝弘 手術區域 東址 005房 號 診斷 Spine tumor 器械術式 Benign intraspinal tumor, exci 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 羅偉誠, 時間資訊 07:33 報到 08:05 進入手術室 08:10 麻醉開始 08:15 誘導結束 08:58 手術開始 08:58 抗生素給藥 11:00 手術結束 11:00 麻醉結束 11:05 送出病患 11:06 進入恢復室 12:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-腰椎 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 摘要__ 手術科部: 外科部 套用罐頭: Left L4 hemilaminectomy for sequestrectomy 開立醫師: 曾峰毅 開立時間: 2010/11/23 11:10 Pre-operative Diagnosis L4/5 sequestrated disc with upward mirgration with left L4 root compression, but intraspinal tumor cannot be excluded. Post-operative Diagnosis L4/5 sequestrated disc with upward mirgration with left L4 root compression Operative Method Left L4 hemilaminectomy for sequestrectomy Specimen Count And Types Several pieces of sequestrated disc was sent for pathology. Pathology Pending Operative Findings Sequestrated disc from L4/5 with upward mirgration compromised left L4/5 neural foramen. Left L4 root was identifed clearly, and was decompressed well after sequestrectomy. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After C-arm localization, we scrubbed, disinfeted, and drapde the lower back. We made one midline linear skin incision from L3 spinous process to L4 spinous process, and left paraspinal musle was detached. Left L4 hemilaminectomy was perfromed with drilling and Karrison biting. Sequestratectomy was done meticulously after left L4 root identified. After marcaine infiltrated at wound and Rinderon at left L4 lateral recess, we closed the wound in layers. Operators VS 曾勝弘 Assistants R4 曾峰毅 R1 羅偉誠 林軒宇 (M,2008/08/03,3y7m) 手術日期 2010/11/23 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Hydrocephalus 器械術式 Ommaya reservoir implantation, Removal of V-P shun, C-P shunt and Intraventricular catheter inside the lateral horn 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:05 進入手術室 08:15 麻醉開始 08:55 誘導結束 09:49 手術開始 11:05 11:10 抗生素給藥 12:55 麻醉結束 12:55 手術結束 13:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 歐氏貯囊置放手術 1 2 R 手術 腦內視鏡 1 0 R 手術 腦脊髓液分流管重置 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Glucose 1 0 記錄__ 手術科部: 外科部 套用罐頭: 1. Ommaya reservoir implantation via right Ko... 開立醫師: 李振豪 開立時間: 2010/11/23 13:32 Pre-operative Diagnosis 1. Hydrocephalus and retrocerebellar arachnoid cyst, status post ventriculoperitoneal and cystoperitoneal shunt implantation, complicated with shunt malfunction due to infection, 2. Broken ventricular catheter within right lateral ventricle 1. Hydrocephalus and retrocerebellar arachnoid cyst, status post VP and CP shunt implantation, complicated with shunt malfunction due to infection 2. Broken ventricular catheter within right lateral ventricle Post-operative Diagnosis 1. Hydrocephalus and retrocerebellar arachnoid cyst, status post ventriculoperitoneal and cystoperitoneal shunt implantation, complicated with shunt malfunction due to infection, 2. Broken ventricular catheter within right lateral ventricle 1. Hydrocephalus and retrocerebellar arachnoid cyst, status post VP and CP shunt implantation, complicated with shunt malfunction due to infection 2. Broken ventricular catheter within right lateral ventricle Operative Method 1. Ommaya reservoir implantation via right Kocher"s approach, 2. Removal of right Frazier"s ventriculoperitoneal shunt and cystoperitoneal shunt, 3. Intracerebral endoscopy for removal of the broken ventricular catheter 1. Ommaya reservoir implantation via right Kocher"s point 2. Removal of right Frazier"s VP shunt and posterior fossa CP shunt, 3. Neuroendoscope to remove the previous disconnected ventricular catheteral via right Frazier point Specimen Count And Types 3 pieces About size:2ml Source:CSF About size:tip culture Source:ventricular catheter of V-P shunt About size:tip culture Source:Proximal catheter of cystoperitoneal shunt Pathology Nil Operative Findings Infectious granulation tissue was noted around the reservoir of V-P and C-P shunt. After entered the right lateral ventricle, the Ommaya reservoir was identified with tip slightly contact with right thalamus. The 1st ventricular catheter was noted at the medial side of the ventriculostomy and adhered with the adjacent brain parenchyma. Adhesionlysis was performed and the ventricular catheter was removed smoothly with endoscopic clamp. The integrity of the shunt was checked after removing all part of the shunt. 1. Marked infectious granulation tissue was noted around the reservoir of VP and C-P shunts. 2. After entered the right lateral ventricle, the Ommaya reservoir was identified with tip slightly contact with right thalamus. The previous disconnected ventricular catheter was noted at the medial side of the ventriculostomy and adhered with the adjacent brain parenchyma. Adhesionlysis was performed and the ventricular catheter was removed smoothly with endoscopic clamp. The removed parts of both the infected VP and CP shunts was checked and confirmed that every part of them was all removed. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine position. The scalp was shaved, scrubbed, and disinfected as usual. The C-shape scalp incision was made at right Kocher"s point and the scalp flap was elevated. One burr hole was created by perforator followed by dural tenting x 2. The dura was opened and ventriculostomy was performed with ventricular needle. The Ommaya reservoir was placed and fixed with 3-0 stitches. Hemostasis was achieved and the wound was closed in layers with 3-0 Vicryl and 4-0 Nylon. The position was changed to left decubitus. The scalp was shaved, scrubbed, and disinfected again. The scalp incision over right Frazier"s point was made along previous op scar and the ventricular catheter was removed after cut off the connection to peritoneal catheter. 2.7mm intracerebral endoscopy was used to enter the lateral ventricle and the 1st ventricle catheter was found. The catheter was pulled out after adhesionlysis. Hemostasis was achieved and Gelform packing to avoid CSF leakage was done. The wound was closed in layers with 3-0 Vicryl and 4-0 Nylon. The position was changed to left decubitus. The scalp was shaved, scrubbed, and disinfected again. The scalp incision over right Frazier"s point was made along previous op scar and the ventricular catheter was removed after cut off the connection to peritoneal catheter. 2.7mm Neuroendoscope (Handy- Oi-Pro) was used to enter the lateral ventricle to identify the previous disconnected ventricuflar catheter. We used the scope to push it from the surrounding brain tissu, then it was pulled out with grasps smoothly. Hemostasis was achieved and Gelform packing to avoid CSF leakage was done. The wound was closed in layers with 3-0 Vicryl and 4-0 Nylon. The other two scalp incision over right retroauricular area and right nuchal area were made along op scar. The reservoir of cystoperiotoneal shunt was identified and removed. The Y connector and the peritoneal catheter also removed smoothly. Debridement of the wounds were performed with curette and irrigated with Gentamicin solution. The wounds were then closed in layers with 3-0 vicryl and 4-0 Nylon. The other two scalp incision over right retroauricular area and right nuchal area were made along previous op scar. The reservoir of cystoperiotoneal shunt was identified and removed. The Y connector and the peritoneal catheter also removed smoothly. Debridement of the wounds were performed with curette and irrigated with Gentamicin solution. The wounds were then closed in layers with 3-0 vicryl and 4-0 Nylon. Operators AP郭夢菲 Assistants R4李振豪, Ri何汶璁 相關圖片 彭錦鵬 (M,1952/09/25,59y5m) 手術日期 2010/11/23 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Cervical myelopathy 器械術式 Lamino plasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 張僖, 時間資訊 07:36 報到 08:05 進入手術室 08:15 麻醉開始 08:50 抗生素給藥 08:56 手術開始 09:25 誘導結束 11:10 手術結束 11:10 麻醉結束 11:20 送出病患 11:25 進入恢復室 12:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 手術 椎弓整形術 1 1 摘要__ 手術科部: 外科部 套用罐頭: C3-4 laminoplasty 開立醫師: 陳德福 開立時間: 2010/11/23 11:10 Pre-operative Diagnosis Cervical OPLL with spinal stenosis and cord compression, C3-4 Post-operative Diagnosis Cervical OPLL with spinal stenosis and cord compression, C3-4 Operative Method C3-4 laminoplasty Specimen Count And Types nil Pathology nil Operative Findings 1.There is OPLL with severe spinal cord compression over the C3-4 level. 2.C3-4 open door type laminoplasty was done with miniplates fixation. 3.Partial C5 laminectomy was done for decompression [upper part]. Operative Procedures Under ETGA and prone position with Mayfield pin type head fixator fixation, the skin was disinfected and draped as usual. One liner incision along midline was done and the C2-5 lamina was exposed. The oped door type laminoplasty with miniplates was performed smoothly. Partial C5 laminectomy was done. One CWV was left in situ and the wound was closed in layers. Operators VS 賴達明 Assistants R5 陳德福 R1張僖 陳瑞芯 (M,2010/08/09,1y7m) 手術日期 2010/11/24 手術主治醫師 郭夢菲 手術區域 兒醫 067房 03號 診斷 Retinopathy of prematurity 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 11:40 報到 11:47 進入手術室 11:50 麻醉開始 12:10 誘導結束 12:30 手術開始 13:00 抗生素給藥 14:02 麻醉結束 14:02 手術結束 14:10 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室腹腔分流手術 1 1 L 記錄__ 手術科部: 套用罐頭: Left Kocher point V-P shunt insertion, medium... 開立醫師: 林哲光 開立時間: 2010/11/24 15:00 Pre-operative Diagnosis Hydrocephalus Posthemorrhagic and postinfectious hydrocephalus Post-operative Diagnosis Ditto Operative Method Left Kocher point V-P shunt insertion, medium pressure (burr hole, Medtronic), 5-11 cmH2O 1. V-P shunt insertion, Left Kocher point, with Metronic medium pressure setting, burr hole typed reservoir (5-11 cmH2O) 2. Removal of Ommaya reservoir Specimen Count And Types Pathology nil Operative Findings CSF seemed yellowish but transparent. Intraventricular catheter was 4.6cm long and abdominal catheter was 25cm long. Medium pressure valve was 5-11 cmH2O. The CSF was yellowish but transparent. The original insertion site of the Ommaya reservoir was 2 cm in frontl of the left Kochers point. 2. The new intraventricular catheter was 4.6cm long and abdominal catheter was 25cm long. Medium pressure valve was 5-11 cmH2O. Operative Procedures Under ETGA and supine position with head mild rotated to right side, skin disinfected and drapped were performed as usual. A curvilinear skin incision was made including the previous Ommaya. The ommaya was removed and gelfoam packing over the previous tract of ventricular puncture was done. The edge of anterior frontanell was identified and some skull bone was removed to expose the left Kocher point. Ventricular catheter was introduced to lateral horn with ventricular puncture along the imaginary line which is composed with two planes pointing to the ipislateral targus and medial cathus. Left abdominal transverse skin incision was made and minilarparotomy was done. The abdominal catheter was then connected to ventricular catheter with valve. The wound was then closed in layers. Under ETGA and supine position with head mild rotated to right side, skin disinfected and drapped were performed as usual. A large curvilinear skin incision was made at left frontal region to include the previous Ommaya reservoir. The ommaya was removed smoothly and gelfoam packing over the previous tract of ventricular puncture was done. The edge of anterior frontanell was identified and some skull bone was removed to expose the left Kocher point. Ventricular catheter was introduced to lateral horn with ventricular puncture along the imaginary line which is composed with two planes pointing to the ipislateral tragus and medial cathus. Left abdominal transverse skin incision was made and minilarparotomy was done. A subcutaneous tunnel was made between the laparotomy and craniotomy wound, then the abdominal catheter was connected to ventricular catheter with the medium pressure valve. The wound was then closed in layers after meticulous hemostasis. Operators AP 郭夢菲 Assistants R4 林哲光 相關圖片 陳榮銘 (M,1944/03/28,67y11m) 手術日期 2010/11/24 手術主治醫師 梁金銅 手術區域 東址 052房 01號 診斷 Colon cancer 器械術式 Anterior resection (+/- Hartmann) 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 林峰盛 ASA 2 紀錄醫師 游皓鈞, 時間資訊 08:09 進入手術室 08:15 麻醉開始 08:30 誘導結束 09:15 手術開始 13:00 抗生素給藥 16:30 手術結束 16:30 麻醉結束 16:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 結腸全切除術併行直腸切除術及迴腸造口 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 9 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: Subtotal colectomy with ileostomy 開立醫師: 游皓鈞 開立時間: 2010/11/24 17:16 Pre-operative Diagnosis Sigmoid cancer with multiple metastasis Post-operative Diagnosis Sigmoid cancer with multiple metastasis Operative Method Subtotal colectomy with ileostomy Specimen Count And Types 4 pieces About size:total colon with 30 cm ileum Source:containing 10*10 cm tumor About size:6*6 cm Source:tumor attached to the abdominal wall About size:1*1 cm Source:proximail site of anastomosis About size:1*1 cm Source:distal site of anastomosis Pathology pending Operative Findings 1. One fungative, hard tumor, 10cm-in-diameter at proximal sigmoid colon with severe adhesion of ileum 2. Peritoneal seeding(+) with bloody ascites around 30mL 3. Liver metastasis at S2/S4 and tumor invasion to the anterior abdominal wall 4. Blood loss : 750mL Operative Procedures 1. ETGA, lithotomy position 2. Disinfected and drapped as usual 3. Midline incision from 5 cm below the umbilicus to 5 cm below the xiphoid process 4. Identified the tumor at proximal sigmoid and adhesionolysis between ileum and sigmoid colon, ascites was aspirated for culture and cytology 5. Resected the superior rectum and SD-junction by GIA60 6. Deattached the left collateral ligament up to splenic flexure 7. Deattached the right collateral ligament up to hepatic flexure 8. Deattached the gastrocolonic ligament to mobilized the whole colon 9. Resected the ileum by electrocautry with 250 cm small intestine preserved 10. Removed the specimen from ileum to superior rectum which contained the t tumor 11. Resected the tumor invasion to the anteior abdominal wall 12. Irrigated with warm normal saline 13. Ileorectal end-to-end anastomosis by CEEA30 14. Inserted 4 rubber dain, 2 at RUQ abdomen(one in right subdiaphragm, one in subhepatic edge), 2 at LLQ abdomen(one in left subdiaphragm, one in douglas pouch) 15. Identified the ileum 50 cm from the anastomotic site for ileostomy 16. Closed the wound in layers 17. Made one loop ileostomy 5 cm right away from the umbilicus Operators P梁金銅 Assistants R5鄭宗杰, R3郭庭均, R1游皓鈞, Ri陳漢揚 相關圖片 林裕紛 (M,1961/09/16,50y5m) 手術日期 2010/11/24 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Acromegaly 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 許皓淳, 時間資訊 13:36 進入手術室 14:42 麻醉開始 15:05 誘導結束 15:30 抗生素給藥 16:30 手術開始 17:20 手術結束 17:20 麻醉結束 17:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 經由蝶竇之腦下垂體瘤切除 1 1 記錄__ 手術科部: 外科部 套用罐頭: Transsphenoidal pituitary adenomectomy 開立醫師: 鍾文桂 開立時間: 2010/11/24 17:52 Pre-operative Diagnosis Pituitary microadenoma Post-operative Diagnosis Pituitary microadenoma Operative Method Transsphenoidal pituitary adenomectomy Specimen Count And Types 1 piece About size:1*1*1cm Source:Pituitary tumor Pathology pending Operative Findings Whitish, soft, fragile tumor. Some part of the tumor seems to be adhered to the normal gland severely. Some CSF leakage was noted. The normal gland was left intact. Operative Procedures Under general anethesia and intubation, the patient was put in supine position. The facial skin was antiseptic with alcohol, and the mucosa of oral and nasal cavity with aqueous better-iodine. The face was covered with sterilized adhesive plastic sheets then draped. Under microscope, nasal septum was incised, and a nasal speculum was applied to displace the nasal mucosa laterally and keep the nasal cavity open constantly for the exposure of the vomer bone and the anterior wall of the sphenoid sinus. The anterior sphenoid wall, sphenoid sinus mucosa and sella floor were removed along with the sphenoidal portion of the adenoma. The dura was coagulated then opened in cruciate fashion. The tumor was removed by curette and aligator. The CSF leakage was sealed with gelform packing. The bone of anterior sphenoid wall was placed back and the nasal mucosa was returned to its normal position. The nasal mucosa was sealed with gelfoam and iodine-ointment coating gloves. Operators VS曾漢民 Assistants R5鍾文桂 鄭張白華 (F,1948/12/22,63y2m) 手術日期 2010/11/24 手術主治醫師 蔡瑞章 手術區域 東址 005房 01號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 許皓淳, 時間資訊 07:42 報到 08:06 進入手術室 08:15 麻醉開始 08:45 誘導結束 08:50 手術開始 11:20 開始輸血 14:10 麻醉結束 14:10 手術結束 14:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4~8小時 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Simpson grade II tumor excision via subfronta... 開立醫師: 鍾文桂 開立時間: 2010/11/24 14:51 Pre-operative Diagnosis Olfactory groove meningioma. Post-operative Diagnosis Olfactory groove meningioma. Operative Method Simpson grade II tumor excision via subfrontal approach. Specimen Count And Types 1 piece About size:50cc Source:meningioma Pathology Pending. Operative Findings Opening of orbital roof and bilateral frontal sinus and cribriform plate upon craniotomy. The tumor was firm, elastic, well demarcated. CUSA had little role in tumor excision as the firm characteristic of the tumor. The feeders from ethmoidal artery and ACA were electrocoagulated. The right olfactory nerve was sacrafized. The bilateral ACA was not seen. The right optic nerve was intact. Blood loss: 1700cc. The dura mater was repaired by periosteum. The skull defect was repaired by bone cement. Operative Procedures Under ETGA, the patient was placed in supine position and the head was fixed by Mayfield and in extension position. After scalp incision and preservation of the periosteum and facial nerve, bifrontal craniotomy was made. The superior sagital sinus was ligated. After coagulation of the feeders, the tumor was excised in piece-meal fashion. The feeders from the cranial base was electrocoagulated to achieve full hemostasis. The frontal sinus was sealed with TissuCorDuo, Gelfoam, and pericranium. The dura mater was repaired with pericranium. The periorbita was covered with Durafoam. After dural tenting, the bone plate was fixed by mini screws and plates. The wound was closed in layers with one subgaleal CWV drain. Operators V.S. 蔡瑞章 王國川 Assistants 鍾文桂 許浩淳 李政庭 (M,2005/03/31,6y11m) 手術日期 2010/11/24 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Ventriculomegaly 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 07:43 報到 08:00 進入手術室 08:15 麻醉開始 08:25 誘導結束 08:50 抗生素給藥 09:14 手術開始 10:28 手術結束 10:28 麻醉結束 10:35 送出病患 10:45 進入恢復室 11:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Right Kocher point Codman programmable V-P sh... 開立醫師: 林哲光 開立時間: 2010/11/24 11:43 Pre-operative Diagnosis Retrocerebellar arachnoid cyst s/p C-P shunt Retrocerebellar arachnoid cyst with ventriculomegaly, s/p C-P shunt with transtentorial herniation Post-operative Diagnosis Ditto Operative Method Right Kocher point Codman programmable V-P shunt insertion Specimen Count And Types Pathology nil Operative Findings CSF opening pressure was around 0cmH2O, CSF seemed clear and transparent. Intraventricular catheter was 6.2cm long and abdominal catheter was 30cm long. Valve pressure was set 12cmH2O. CSF opening pressure was around 10 cmH2O, CSF seemed clear and transparent. Intraventricular catheter was 6.2cm long and abdominal catheter was 30cm long. Valve pressure was set at 12cmH2O. Operative Procedures Under ETGA and supine position with head mild rotated to left side, skin disinfected and drapped were performed as usual. Curvilinear skin incision was made over the right Kocher point, a burr hole was then created. The dura was then opened after dura tenting. Ventricular puncture was done with stylate. Transverse skin incision was made over right abdomen. The peritoneum was then identifed and opened. The abdominal catheter was then inserted. Subcutaneous tunneling was then done. The abdominal catheter was then connected to ventricular catheter with Codman programmable valve. The valve was then fixed at periosteum. The wound was then closed in layers. Under ETGA and supine position with head mild rotated to left side, skin disinfected and drapped were performed as usual. Curvilinear skin incision was made over the right Kocher point, a burr hole was then created. The dura was then opened after dura tenting. Ventricular puncture was done with stylate. Transverse skin incision was made over right abdomen. The peritoneum was then identifed and opened. The abdominal catheter was then inserted. Subcutaneous tunneling was then done. A small stabbing wound was performed to facilitate the passage of the shunt. The abdominal catheter was then connected to ventricular catheter with Codman programmable valve (for Children). The valve was then fixed at periosteum. The wounds were then closed in layers. Operators AP 郭夢菲 Assistants R4 林哲光 相關圖片 孫祥芸 (F,2003/07/28,8y7m) 手術日期 2010/11/24 手術主治醫師 郭夢菲 手術區域 兒醫 067房 02號 診斷 Dislocations of second cervical vertebra, closed 器械術式 Closed reduction 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 黃信豪 ASA 1 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 10:15 報到 10:55 進入手術室 11:00 麻醉開始 11:08 誘導結束 11:09 手術開始 11:13 手術結束 11:13 麻醉結束 11:14 送出病患 11:20 進入恢復室 12:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 手術 頭骨頸椎牽引-一次 1 0 記錄__ 手術科部: 外科部 套用罐頭: Close reduction of C1-C2 開立醫師: 林哲光 開立時間: 2010/11/24 17:29 Pre-operative Diagnosis Atlatoaxial rotatory subluxation Post-operative Diagnosis Ditto Operative Method Close reduction of C1-C2 Close reduction of C1-C2 and external fixation with SOMI brace Specimen Count And Types Pathology nil Operative Findings Wry neck with rotated to right side was noted when awaked. Neck became soft and could be adjusted in the neutral position after anesthesia. Wry neck with ㄎhead rotated to right side and dchin to left in cock-ribin position noted when awaked. Neck became soft and could be reduced to the neutral position after IV genral anesthesia. Wry neck with the head rotated to right side and the chin to left in cock-ribin position noted when awaked. Neck became soft and could be reduced to the neutral position after IV genral anesthesia. marked wry neck with the head rotated to right side and the chin to left in cock-ribin position noted when awaked. Neck became soft and could be reduced to the neutral position after IV genral anesthesia. Operative Procedures Under IVG and supine position, the neck was put back to the neutral position and fixed with cervical collar, Somi brace, use. Under IVG and supine position, the neck was reduced to the neutral position and fixed with SOMI brace. Operators AP 郭夢菲 Assistants R4 林哲光 陳志勇 (M,1973/11/23,38y3m) 手術日期 2010/11/24 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Herniation of intervertebral disc (HIVD) 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 古恬音, 時間資訊 07:35 報到 08:03 進入手術室 08:10 麻醉開始 08:20 誘導結束 08:50 抗生素給藥 08:55 手術開始 11:50 抗生素給藥 12:15 手術結束 12:15 麻醉結束 12:27 送出病患 12:28 進入恢復室 13:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-頸椎 1 1 手術 脊椎融合術-前融合,有固定物)≦四節 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 記錄__ 手術科部: 外科部 套用罐頭: Anterior approach for discectomy with plate f... 開立醫師: 胡朝凱 開立時間: 2010/11/24 12:03 Pre-operative Diagnosis c3~4 HIVD and listhesis Post-operative Diagnosis c3~4 HIVD and listhesis Operative Method Anterior approach for discectomy with plate fixation Specimen Count And Types nil Pathology nil Operative Findings 1.Narrowed disc space with marginal spur formation, and the disc protruded posteriorly that compressed the spinal cord tightly. 2.Hypertrophic PLL 3.The Cage: 6# 4.Plate : 26 mm Operative Procedures 1.ETGA, supine 2.Right neck transverse skin incision 3.Dissect to expose prevertebral space 4.detach longus coli muscle 5.Discectomy of C3~4 level 6.PLL was also removed with kerrison 7.cage insertion 8.Plate fixation 9.Hemostasis 10.close wound in layers Operators 賴達明 Assistants 胡朝凱, 古恬音 藍永順 (M,1936/09/06,75y6m) 手術日期 2010/11/24 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Low back pain 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 古恬音, 時間資訊 12:38 進入手術室 12:45 麻醉開始 12:50 誘導結束 13:10 抗生素給藥 13:24 手術開始 16:35 手術結束 16:35 麻醉結束 16:42 進入恢復室 18:30 離開恢復室 18:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎弓切除術(減壓)-二節以內 1 2 摘要__ 手術科部: 外科部 套用罐頭: L4~5 TPS and L4 laminectomy 開立醫師: 古恬音 開立時間: 2010/11/24 16:43 Pre-operative Diagnosis L4 on L5 spondylolisthesis Post-operative Diagnosis L4 on L5 spondylolisthesis Operative Method L4~5 TPS and L4 laminectomy Specimen Count And Types Pathology nil Operative Findings 1.Instability between L4 to L5 2.Hypertrophic flavum ligment and stenotic lateral recess 3.Screws: 6.2 x 45 Operative Procedures 1.ETGA, prone 2.Midline skin incision at L4~5 level 3.Detach paravertebral muscle groups to expose L4~5 lamina and facet joint 4.Identified transverse process to located L4 and L5 pedicle 5.Screws insertion 6.L4 laminectomy 7.Remove flavum ligment 8.Identified L4, L5 roots and decompression 9.rods fixation 10. Posterolateral fusion with autologous bone graft 11. Set on Hemovac at epidural space 12. Wound closure in layers Operators VS賴達明 Assistants R6胡朝凱,R3古恬音 林榮宗 (M,1946/05/26,65y9m) 手術日期 2010/11/24 手術主治醫師 賴達明 手術區域 東址 001房 04號 診斷 Lumbar Spondylosis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 羅偉誠, 時間資訊 14:53 報到 15:13 進入手術室 15:15 麻醉開始 15:25 誘導結束 15:30 抗生素給藥 16:04 手術開始 18:36 抗生素給藥 19:00 手術結束 19:00 麻醉結束 19:15 送出病患 19:20 進入恢復室 20:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎弓切除術(減壓)-二節以內 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 曾峰毅 開立時間: 2010/11/24 19:12 Pre-operative Diagnosis Lumbar stenosis at L4/5 Post-operative Diagnosis Lumbar stenosis at L4/5 Operative Method Midline laminectomy for L4/5 decopression and posterior instrumentation with Dynesys system at L4 and L5. Specimen Count And Types Nil Pathology Nil Operative Findings Dynesys screws was inserted at bilateral pedicles of L4 and L5. Severe lumbar stenosis at L4/5 was caused by hypertrophic ligamentum flavum. Thecal sac was decompressed well after decompression. Blood loss was about 50ml. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After C-arm localization, we made one midline skin incision from L4 to L5. We inserted bialteral transpedicular screws, Dynesys, Zimmer, at L4 and L5. We set the Dyneses system with cord and spacer. Midline splitting of spinous process of L4 was done,a dn sublaminar decompression was performed with Karrisons and rongeurs. After set 2 hemovac, we closed the wound in layers. Operators VS 賴達明 Assistants R4 曾峰毅 R1 羅偉誠 連朝枝 (M,1932/11/24,79y3m) 手術日期 2010/11/24 手術主治醫師 蔡翊新 手術區域 東址 005房 03號 診斷 Subdural hematoma 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3E 紀錄醫師 游皓鈞, 時間資訊 15:00 開始NPO 17:30 通知急診手術 18:23 進入手術室 18:25 麻醉開始 18:30 誘導結束 18:55 抗生素給藥 19:06 手術開始 21:45 手術結束 21:45 麻醉結束 21:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 手術 急性硬腦膜下血腫清除術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 蔡翊新 開立時間: 2010/11/24 21:04 Pre-operative Diagnosis Left F-T-P subacute SDH. Post-operative Diagnosis Left F-T-P subacute SDH. Operative Method Left frontotemporal craniotomy for SDH evacuation. Specimen Count And Types 3 tubes of SDH, sent for routine, BCS and bacterial culture. Pathology Nil. Operative Findings Previous operative wound at left frontotemporal area, with a 6 x 5 cm cranitomy beneath it. Dark reddish liquified blood drained out upon dural opening. There were blood clots at subdural space, 1 cm in thickness. Outer membrane oozing was noted. There was a layer of inner membrane covering the brain surface, probably limiting the brain expansion. Some subarachnoid ecchymosis was noted. Oozing from the distant blood clots and fibrin septation was packed with Surgicel and Gelfoam. The brain expanded a little after evacuation of SDH. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with a sterilized adhesive plastic sheet. 4. Incision: 4 cm at left frontal area along previous wound, the skin edge was clipped by Raney clips for temporary hemostasis. 5. A previous burr hole was used and the dura was incised for evacuating part of the subdural hematoma, therefore the IICP could be relieved earlier. 6. The incision was extended to temporal region along previous wound. 7. Craniotomy window: 6 x 5 cm, left F-T, created by removal of the screws. 8. Dural incision: curvilinear along the edge of skull window. 9. The subdural clot was removed by sucker and those located beyond the cranial window was washed out by saline irrigation through a rubber tube introduced into subdural space. 10.Hemosatasis: the bleeders was stopped by Bovie and oozing surface was covered with Surgicel and gelfoam. 11.Dura was closed with a piece of dural graft previously taking from temporalis fascia. 12.The skull plate was placed back and fixed by original miniplates and screws. 13.Scalp closure: Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 14.Drain: one subdural rubber drain, connected to a reservoir bag. 15.Blood transfusion: nil. 16.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R4李振豪R1游皓鈞 Indication Of Emergent Operation 王榮華 (M,1930/03/19,81y11m) 手術日期 2010/11/25 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 Hydrocephalus 器械術式 V-P shunt 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 13:00 報到 13:42 進入手術室 13:50 麻醉開始 14:00 誘導結束 14:30 抗生素給藥 14:35 手術開始 15:15 麻醉結束 15:16 手術結束 15:25 送出病患 15:26 進入恢復室 16:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室腹腔分流手術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt insertion via righ... 開立醫師: 王奐之 開立時間: 2010/11/25 15:31 Pre-operative Diagnosis Normal pressure hydrocephalus Post-operative Diagnosis Normal pressure hydrocephalus Operative Method Ventriculoperitoneal shunt insertion via right Kocher point Specimen Count And Types nil Pathology Nil Operative Findings Ventricular catheter length: 7cm. Peritoneal catheter length: 20cm. Codman programmable valve was used, pre-set to 80 mmH2O. Clear CSF was noted after ventricular puncture. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position. After skin shaved, scruubed, disinfected, and then draped, we made one transverse skin incision at right upper abdomen. We dissected into peritoneal cavity and inserted peritoneal catheter introducer. We made one linear skin incision at right frontal area, and drilled one burr hole. We created the subcutaneous tunnel and pull through the catheter through the tunnel to right frontal incision wound. After ventricular puncture once, we inserted ventricular catheter, and connected with the system. After checking the shunt function, we inserted the peritoneal shunt into peritoneal space. The wounds were closed in layers. Operators VS 王國川 Assistants R5 鍾文桂, R3 王奐之 相關圖片 吳彥徵 (F,1983/12/15,28y2m) 手術日期 2010/11/25 手術主治醫師 蔡翊新 手術區域 東址 001房 03號 診斷 Brain abscess 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 髒 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳德福, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 07:05 通知急診手術 09:00 報到 09:00 進入手術室 09:05 麻醉開始 09:20 誘導結束 10:02 手術開始 11:00 抗生素給藥 11:35 麻醉結束 11:35 手術結束 11:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 L 手術 顱內壓視置入 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT 開立醫師: 蔡翊新 開立時間: 2010/11/25 11:20 Pre-operative Diagnosis Left frontal brain abscess. Post-operative Diagnosis Left frontal brain abscess. Operative Method Craniotomy for ICT Specimen Count And Types 2 tubes of pus from brain abscess, sent for smear and bacterial culture. Pathology Nil. Operative Findings s/p left frontal craniotomy, with partial frontal lobectomy and duroplasty with Duroform. Intraoperative ultrasound revealed a loculated cyst at left frontal lobe, with pus content. 9 c.c. pus was drawn from the abscess. The brain was edematous. ICP after bone plate fixed back was 9 mmHg. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: curvilinear along previous wound at left frontotemporal region. Raney clips were applied to the scalp edge for temporary hemostasis. 5. Craniotomy window: 6 x 5 cm, left frontal, elevated by removal of screws. 6. Remove previous Duroform. 7. Under guidance of intraoperative ultrasound, the abscess was punctured with ventricular needle and aspiration was performed via a Nelaton tube. 8. Hemostasis: The blood oozing points from several locations on the bare surface were packed with Surgicel. 9. Dural closure: A 6 x 6 cm Duroform was used for duroplasty. A Codman ICP monitor was set at subdural space (Reference: 482). 10.Closure of skull window: the skull plate was placed back to craniotomy window and fixed by previous 3 miniplates and 6 screws. 11.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by interrupted mattressed suture with 3/0 nylon. 12.Drain: one subgaleal CWV. 13.Blood transfusion: nil. 14.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5陳德福Ri Indication Of Emergent Operation 張勝雄 (M,1941/02/19,71y0m) 手術日期 2010/11/25 手術主治醫師 陳敞牧 手術區域 東址 005房 01號 診斷 Head injury 器械術式 VP shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 時間資訊 07:42 報到 08:05 進入手術室 08:15 麻醉開始 08:30 誘導結束 09:45 送出病患 09:45 麻醉結束 李保秀 (F,1940/03/09,72y0m) 手術日期 2010/11/25 手術主治醫師 蕭輔仁 手術區域 東址 005房 02號 診斷 Spinal Stenosis 器械術式 Radiofrequency coagulation 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 李振豪, 時間資訊 14:25 報到 15:05 進入手術室 15:10 抗生素給藥 15:19 手術開始 16:20 手術結束 16:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 高頻熱凝療法 1 1 B 摘要__ 手術科部: 外科部 套用罐頭: Pulse Radiofrequency ablation, bilateral L2 d... 開立醫師: 李振豪 開立時間: 2010/11/25 16:32 Pre-operative Diagnosis Failed back syndrome Post-operative Diagnosis Failed back syndrome Operative Method Pulse Radiofrequency ablation, bilateral L2 dorsal root ganglion Specimen Count And Types nil Pathology Nil Operative Findings 180sec x 2 cycle pulse radiofrequency was applied at the level of bilateral L2 dorsal root ganglion. No acute complication was noted. Operative Procedures The patient was put in prone position. The skin was disinfected as usual. Local anesthesia with 1% Xylocaine 10ml was applied. Under C-arm portable X-ray guided, pulse radiofrequency ablation for bilateral L2 dorsal root ganglion was performed. The patient stood whole procedure well. Operators VS蕭輔仁 Assistants R4李振豪, Ri林特瑋 林梓城 (M,1924/12/06,87y3m) 手術日期 2010/11/25 手術主治醫師 王國川 手術區域 東址 001房 01號 診斷 Acute myeloid leukemia 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 4E 紀錄醫師 李振豪, 時間資訊 02:58 報到 03:00 進入手術室 03:10 麻醉開始 03:30 誘導結束 03:54 手術開始 04:00 開始輸血 07:45 麻醉結束 07:45 手術結束 07:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 急性硬腦膜下血腫清除術 1 1 R 手術 顱內壓視置入 1 2 R 摘要__ 手術科部: 外科部 套用罐頭: Right fronto-temporo-parietal craniotomy for ... 開立醫師: 李振豪 開立時間: 2010/11/25 07:43 Pre-operative Diagnosis Right acute subdural hematoma Post-operative Diagnosis Right acute subdural hematoma Operative Method Right fronto-temporo-parietal craniotomy for hematoma evacuation Specimen Count And Types nil Pathology Nil Operative Findings Outer membrane was noted after drual opening. No inner membrane was found. Subacute with acute subdural hematoma was favored. No active bleeder was noted after removal of the subdural hematoma. Mild swelling of the brain was noted after removal of the hematoma. The ICP after wound closure was 3mmHg. ICP monitor reference: 519. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine position with head rotated to left. The scalp was shaved, scrubbed, and disinfected as usual. The traumatic flap scalp incision was made at right fronto-temporo-parietal area and elevated. The temporalis muscle was elevated with periosteum. Six burr holes were created followed by one 15x12cm craniotomy window. Dural tenting was performed with 2cm in interval. The C-shape durotomy based with temporal area was done. Subdural hematoma evacuation was performed with sucker. Normal saline irrigation was performed for small amount residual hematoma at the edge of the op field. Hemostasis was achieved with Surgicel lining. The dura was then closed with 4-0 Prolene. The subdural ICP monitor and one epidural CWV drain were placed. The skull plate was fixed back with miniplates. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon and one subgaleal CWV drain. Operators VS王國川 Assistants R4李振豪, R3古恬音, R1游皓鈞 Indication Of Emergent Operation 相關圖片 陳盈君 (F,1983/02/06,29y1m) 手術日期 2010/11/25 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Headache 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 王奐之, 時間資訊 08:05 進入手術室 08:15 麻醉開始 09:00 誘導結束 09:00 抗生素給藥 09:05 手術開始 12:00 抗生素給藥 13:15 手術結束 13:15 麻醉結束 13:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除-手術時間在4小時以內 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Left suboccipital craniotomy for tumor excision 開立醫師: 王奐之 開立時間: 2010/11/25 13:16 Pre-operative Diagnosis Left cerebellar tumor, suspected pilocytic astrocytoma Post-operative Diagnosis Left cerebellar tumor, suspected pilocytic astrocytoma Operative Method Left suboccipital craniotomy for tumor excision Specimen Count And Types 1 piece About size:3*3*2cm Source:cerebellar tumor Pathology Frozen section: pilocytic astrocytoma Operative Findings A greyish elastic tumor with gliotic change was noted at left cerebellar hemisphere, well-vascularized and with distinct border, measuring about 3cm for the solid part. Cystic part contained yellowish fluid, aspirated and sent for cytology. The capsule of cystic part was also removed. The 4th ventricle was not entered. Operative Procedures After ETGA, the patient was placed in prone position with neck flexed and head fixed with Mayfield skull clamp. After shaving, skin disinfection and draping in usual sterile fashion, a reversed hockey-stick incision was made at left suboccipital area. The incision was further deepened, and a piece of fascial graft was harvested. After dissection, the bone was exposed, identifying the inion and midline structures. After making 4 burr holes, a suboccipital craniotomy was done. A fish-mouth durotomy was done, the cerebellum bulged out after durotomy. A corticotomy was made at the center, and further deepened until the fluid in the cystic part gushed out. After aspiring all the fluids, the adjacent solid part of the tumor was carefully dissected from surrounding cerebellum en bloc. The capsule of cystic part of the tumor was also removed. After removing the tumor, meticulous hemostasis was achieved; the tumor bed was packed with Surgicel. The dura was then closed with the fascial graft in water-tight fashion with 4-0 Prolene. The muscle were approximated and fixed to the bone. After setting a subgaleal CWV drain, the scalp was closed in layers. Operators VS 王國川 Assistants R5 鍾文桂, R3 王奐之 相關圖片 黃進章 (M,1951/11/25,60y3m) 手術日期 2010/11/25 手術主治醫師 王國川 手術區域 東址 005房 02號 診斷 C1-C4 level with central cord syndrome 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 林哲光, 時間資訊 10:05 報到 10:20 進入手術室 10:25 麻醉開始 10:35 誘導結束 10:40 抗生素給藥 12:10 手術開始 13:45 抗生素給藥 14:45 麻醉結束 14:45 手術結束 14:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-頸椎 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: anterior cervical discectomy with fusion, C3-... 開立醫師: 林哲光 開立時間: 2010/11/25 15:14 Pre-operative Diagnosis C3-4 central canal stenosis with central cord syndrome Post-operative Diagnosis Ditto Operative Method anterior cervical discectomy with fusion, C3-4, with cage and plate fixation Specimen Count And Types Pathology Operative Findings Ruptured disc was noted and prominent ostophytes formation were noted. 6# cage was used and one plate was used for fixation. Ruptured disc was noted and prominent ostophytes formation were noted. 6x12mm vigor PEEK and one cervical plate, 16x26mm, were used for fixation. Operative Procedures Under ETGA and supine position with head mild extended, skin disinfected and drapped were performed as usual. Transverse skin incision was made over the upper edge of thyroid cartilage after C-arm localization at C3-4 level. Right ICA and esophagus were identified and dissected along the carotid triange. The vertebral bodies were identified and retractor were applied. C3-4 discectomy was then done and cage was inserted into the intervertebral space and fixed with the plate. The wound was then closed in layers after mini-H/V x1 was inserted over the paravertebral space. Operators VS 王國川 Assistants R4 林哲光 林秉禾 (M,1971/10/05,40y5m) 手術日期 2010/11/26 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Brain Tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 污染 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 古恬音, 時間資訊 07:50 報到 08:05 進入手術室 08:20 麻醉開始 09:00 抗生素給藥 09:07 誘導結束 09:20 手術開始 11:00 抗生素給藥 11:55 麻醉結束 11:55 手術結束 12:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 內視鏡功能鼻竇手術-單側 1 2 R 手術 腦內視鏡 1 0 R 摘要__ 手術科部: 外科部 套用罐頭: Endoscopic debridement and skull base repair 開立醫師: 古恬音 開立時間: 2010/11/26 12:17 Pre-operative Diagnosis Sellar chordoma, s/p transsphenoidal tumor excision, with CSF leakage and meningitis Post-operative Diagnosis Sellar chordoma, s/p transsphenoidal tumor excision, with CSF leakage and meningitis Operative Method Endoscopic debridement and skull base repair Specimen Count And Types 1 piece About size:0.5cm Source:sphenoid sinus Pathology Pending Operative Findings Some whitish soft granulation tissue and pus were noted in the sphenoid sinus and were collected for culture and pathology. One perforation was noted at sellar floor with CSF leakage. Operative Procedures Under general anethesia and intubation, the patient was put in supine position with head tilted 30 degree to right. The facial skin was antiseptic with alcohol better-iodine tincture, and the mucosa of oral and nasal cavity with aqueous better-iodine . The formerareas were covered by sterilized adhesive plastic sheets then draped. Surgical microscope was used to approach the sphenoid sinus after removal of vomar bone and the anterior wall of sphenoid sinus. The pus and granulation tissue was removed with suction after collecting specimen, then and sellar floor perforation was identified. Autologous fat graft was harvested from left upper abdomen to pack the sellar floor perforation, which was further sealed with Gelfoam packing and Tissucol duo. The right nostril was packed with Merosel. Lumbar drain insertion was done at the end of procedure. Operators P杜永光 VS楊士弘 Assistants R6胡朝凱 陳古寶玉 (F,1952/03/01,60y0m) 手術日期 2010/11/26 手術主治醫師 杜永光 手術區域 東址 003房 02號 診斷 Meningioma 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 古恬音, 時間資訊 12:08 報到 12:20 進入手術室 12:25 麻醉開始 12:30 誘導結束 12:55 抗生素給藥 13:20 手術開始 14:30 手術結束 14:30 麻醉結束 14:41 送出病患 14:45 進入恢復室 16:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 2 B 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Bilateral subdural-peritoneal shunt 開立醫師: 古恬音 開立時間: 2010/11/26 14:36 Pre-operative Diagnosis Bilateral subdural effusion Post-operative Diagnosis Bilateral subdural effusion Operative Method Bilateral subdural-peritoneal shunt Specimen Count And Types Nil Pathology Nil Operative Findings CSF like clear fluid was noted at bilateral subdural space Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head turned to left. The scalp and anterior chest to abdomen was scrubbed and disinfected with better iodine. Draping was done in usual sterile fashion. Two linear scalp incision was made at bilateral frontal area followed by burr hole drilling. The dura was the opened for drain tube insertion. Another linear incision was then made at left upper abdomen, and the subcutanous tunnel was created. Bilateral subdural drain tube was connected with a Y-shaped connector, which was connected to peritoneal catheter. After hemostasis, the wounds were closed in layers. Operators P杜永光 Assistants R6胡朝凱, R3古恬音 劉湘玲 (F,1991/02/20,21y0m) 手術日期 2010/11/26 手術主治醫師 賴達明 手術區域 東址 003房 03號 診斷 Unspecified intracranial hemorrhage 器械術式 External ventricular drainage 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 古恬音, 時間資訊 14:20 報到 14:57 進入手術室 15:05 麻醉開始 15:10 誘導結束 15:40 手術開始 16:14 手術結束 16:14 麻醉結束 16:22 送出病患 16:25 進入恢復室 17:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室體外引流 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Left Kocher point EVD insertion 開立醫師: 胡朝凱 開立時間: 2010/11/26 16:01 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Left Kocher point EVD insertion Specimen Count And Types CSF x 3 tubes Pathology nil Operative Findings 1.Clear CSF with opening pressure about 15 cmH2O 2.Intraventricular catheter: 6.5 cm Operative Procedures 1.ETGA, supine 2.Left previous wound incision 3.Expose previous burr hole 4.Ventricular puncture 5.Catheter insertion 6.Fix catheter to skin 7.Close wound in layers Operators 賴達明 Assistants 胡朝凱, 古恬音 黃永富 (M,1950/10/10,61y5m) 手術日期 2010/11/26 手術主治醫師 謝孟祥 手術區域 東址 012房 02號 診斷 Meningioma 器械術式 Operation for craniosynostosis 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 3 紀錄醫師 陳志軒, 時間資訊 11:52 報到 12:25 進入手術室 12:30 麻醉開始 12:35 誘導結束 13:00 抗生素給藥 13:09 手術開始 15:35 手術結束 15:35 麻醉結束 15:45 進入恢復室 15:45 送出病患 16:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 頭顱成形術 1 2 R 手術 皮腱膜移位術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 記錄__ 手術科部: 外科部 套用罐頭: Others 開立醫師: 陳志軒 開立時間: 2010/11/26 16:08 Pre-operative Diagnosis Status post craniotomy with temporal hollowing Post-operative Diagnosis Status post craniotomy with temporal hollowing Operative Method 1. Cranioplasty with Titanium mesh 2. Rotation flap Specimen Count And Types nil Pathology nil Operative Findings One 6x2cm in size bone defect was noted between temporal bone, frontal bone, and maxillary bone. The defect was reconstruction with Titanium mesh and superior temporalis fascia. One 7mm CWV was put in subcutaneous space. Operative Procedures Under endotracheal general anathesia, patient was put in supine position. Disinfection and drapping were performed as usual. We make one curve incision along previous scar. Then neurogurgeon dissected to expose bone defect. We took over and reconstructed bone defect with Titanium mesh. We mobilzed right superior temporalis fascia and repair the dumpling area. We put one 7mm CWV into subcutaneous space. We closed the wounds in layers. Operators 謝孟祥 Assistants 阮廷倫 曾峰毅 陳志軒 劉來成 (M,1952/04/01,59y11m) 手術日期 2010/11/26 手術主治醫師 曾漢民 手術區域 東址 005房 號 診斷 Cervical Spondylosis 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 許皓淳, 時間資訊 07:40 報到 08:05 進入手術室 08:10 麻醉開始 08:20 誘導結束 08:40 抗生素給藥 09:07 手術開始 11:37 抗生素給藥 13:20 手術結束 13:20 麻醉結束 13:30 送出病患 13:31 進入恢復室 14:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 手術 椎間盤切除術-頸椎 1 1 手術 脊椎融合術-前融合,有固定物(每增加<=四節) 1 2 摘要__ 手術科部: 外科部 套用罐頭: Microsurgical diskectomy, C4/5&C5;/6. 開立醫師: 許皓淳 開立時間: 2010/11/26 16:07 Pre-operative Diagnosis Herniated intervertebral disc and stenosis, C4/5&C5;/6 with radiculopathy Post-operative Diagnosis Herniated intervertebral disc and stenosis, C4/5&C5;/6 with radiculopathy Operative Method Microsurgical diskectomy, C4/5&C5;/6. Internal fixation and interbody fusion,C4-6. Specimen Count And Types nil Pathology nil Operative Findings Severe spur formation mainly at left side of C4/5 and C5/6 level( more at C5/6 level). Anterior fixation with 44mm plate and 2 screws at C4&C6;, 1 screw at C5(right)- A-spine. Interbody fusion at C4/5 &C5;/6: 6mm cage with allograft bone. Operative Procedures Under ETGA, the patient was placed in spine position and the neck was slightly extended. After localization of C5 level, disinfection and draping were prepared. With a horizontal linear incision, dissection along the anterior border of sternocledomastoid muscle to reach the prevertebral space was reached. The bilateral longus collis muscle was dissected laterally. C4/5&C5;/6 intervertebral disc was resected and the spurs were drilled by high speed drill. As the roots were slack after decompression, the interbody fusion was achieved with two cages and internal fixation was done with plates and screws. With well hemostasis and placement of one prevertebral mini-hemovac, the wound was closed in layers. Operators 曾漢民 Assistants 鍾文桂 許皓淳 陳金木 (M,1937/08/20,74y6m) 手術日期 2010/11/26 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 許皓淳, 時間資訊 13:00 報到 13:40 進入手術室 13:45 麻醉開始 14:30 誘導結束 14:40 抗生素給藥 14:50 手術開始 17:40 抗生素給藥 19:30 麻醉結束 19:30 手術結束 19:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4~8小時 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Simpson grade IV tumor excision. 開立醫師: 鍾文桂 開立時間: 2010/11/26 20:07 Pre-operative Diagnosis Falcine meningioma, anterior 1/3. Post-operative Diagnosis Falcine meningioma, anterior 1/3. Operative Method Simpson grade IV tumor excision. Specimen Count And Types 1 piece About size:10 cc Source:meningioma Pathology Pending. Operative Findings 1. Right frontal craniotomy for tumor excision. 2. Tumor: mixture of soft and hard components, elastic, pinkish; pushed the falx and bilateral ACA towards the left side, encasement of one callosomarginal branch of ACA( due to difficulty in seperating the tumor from the artery, some part of the tumor,0.3x2cm, was left. ) 3. The corpus callosum was met after tumor excision. Lateral ventricle was not met during tumor excision. A cortical draining vein was kept intact. 4. Prominent arachnoid villi( need much effort to achieve well hemostasis), intact superior sagital sinus. The left frontal lobe was noted due to dura tear. The dural defect was repaired with pericranium. Operative Procedures Under ETGA, the patient was placed in supine position and the head was in midline position. After shaving, disinfection, and draping, a bicoronal scalp incision was made. After scalp dissection, right frontal craniotomy was achieved with high speed drill. After well hemostasis over the dura mater, the durotomy was done based on superior sagital sinus. Devascularization was achieved with coagulating the supplying arteries from the falx. The tumor was removed in piece-meal fashion. To preserve ohe callosomarginal branch, some part of the tumor was left. Duroplasty was done with pericranium. After dural tenting and fixation of the bone plate with mini-plates and screws, the wound was closed in layers with one subgaleal drian. Operators V.S. 曾漢民 Assistants 鍾文桂 許皓淳 孫祥芸 (F,2003/07/28,8y7m) 手術日期 2010/11/26 手術主治醫師 郭夢菲 手術區域 兒醫 067房 06號 診斷 Dislocations of second cervical vertebra, closed 器械術式 closed reduction 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 蕭柏妮 ASA 2 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 09:39 通知急診手術 11:15 報到 11:25 進入手術室 11:35 麻醉開始 11:37 誘導結束 11:40 手術開始 11:59 手術結束 11:59 麻醉結束 12:02 送出病患 12:05 進入恢復室 13:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 手術 頭骨頸椎牽引-一次 1 0 記錄__ 手術科部: 外科部 套用罐頭: Close reduction of C1-C2 開立醫師: 林哲光 開立時間: 2010/11/26 14:03 Pre-operative Diagnosis Atlatoaxial rotatory subluxation Post-operative Diagnosis Ditto Operative Method Close reduction of C1-C2 Close reduction of C1-C2 and external fixation with SOMI brace after adding pdding to the inner suface of the SOMI brace Specimen Count And Types Pathology nil Operative Findings Wry neck with the head rotated to right side and the chin to left in cock-ribin position noted when awaked. Neck became soft and could be reduced to the neutral position after IV genral anesthesia. Operative Procedures Under IVG and supine position, the neck was reduced to the neutral position and fixed with SOMI brace. We adjust the thickness of the SOMI brace by adding many pads to the inner side of the brace to fit the patient size. Under IVG and supine position, the neck was reduced to the neutral position and fixed with SOMI brace. Operators AP 郭夢菲 Assistants R4 林哲光 Indication Of Emergent Operation 翁邦基 (M,1930/08/25,81y6m) 手術日期 2010/11/26 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Spondyloisthesis, acquired 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 張僖, 時間資訊 07:50 報到 08:05 進入手術室 08:10 麻醉開始 08:15 誘導結束 08:37 抗生素給藥 09:10 手術開始 11:37 抗生素給藥 12:05 手術結束 12:05 麻醉結束 12:15 送出病患 12:16 進入恢復室 13:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎弓切除術(減壓)-二節以內 1 2 摘要__ 手術科部: 外科部 套用罐頭: 1.L3-5 partial laminectomy 2.L3/4 L4/5 inters... 開立醫師: 陳德福 開立時間: 2010/11/26 12:10 Pre-operative Diagnosis Lumbar spondylosis with spinal stenosis, L3/4, 4/5 Post-operative Diagnosis Lumbar spondylosis with spinal stenosis, L3/4, 4/5 Operative Method 1.L3-5 partial laminectomy 2.L3/4 L4/5 interspinous process device implantation Specimen Count And Types nil Pathology nil Operative Findings 1.There is hypertrophic ligamentum flavum and facet joints over the L3-5. The herniated intervertebral disc was also noticed over L3-5. The theca sac and nerve roots were decompressed after partial L3-5 laminectomy. 2.Interspinous process device implantation [Coflex, 10mm for L4/5 and 8mm for L3/4] was done smoothly. Operative Procedures Under ETGA and prone position, the location of L3-5 was identified under C-arm fluroscope. The skin was disinfected and draped as usual. One linear incision was done and the paraspinous muscle was displaced laterally. The L3-5 lamina was exposed and partial laminectomy was done. The Interspinous process device implantation was done smoothly. The wound was closed in layers. Operators VS賴達明 Assistants R5陳德福 R1張僖 王金菊 (F,1952/07/25,59y7m) 手術日期 2010/11/26 手術主治醫師 賴達明 手術區域 東址 019房 02號 診斷 HIVD 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳德福, 時間資訊 12:18 報到 12:18 進入手術室 12:30 麻醉開始 12:35 誘導結束 12:50 抗生素給藥 13:03 手術開始 14:05 手術結束 14:05 麻醉結束 14:15 送出病患 14:16 進入恢復室 15:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 椎間盤切除術-腰椎 1 1 摘要__ 手術科部: 外科部 套用罐頭: microscopic lumbar diskectomy 開立醫師: 陳德福 開立時間: 2010/11/26 14:06 Pre-operative Diagnosis HIVD L4-5, left predominent Post-operative Diagnosis HIVD L4-5, left predominent Operative Method microscopic lumbar diskectomy Specimen Count And Types nil Pathology NIL Operative Findings There is a herniated disc with left L5 nerve root compression at the L4-5 disc space. The disc migrated upward and laterally. The protruding disc was removed and the nerve became redundent. Operative Procedures Under ETGA and prone position, the skin was disinfected and draped as usual. The L4-5 disc space was identified under C-arm fluroscope. One linear incision at midline was done and the left paraspinous muscle was displaced laterally. The partial L4-5 laminectomy was done and the ligamentum flavum was removed. The protruding disc was identified and removed by alligator, currettege, and disc clamp assisted. The wound was then closed in layers. Operators vs 賴達明 Assistants R5 陳德福 r1張僖 相關圖片 林聖淯 (M,1987/04/14,24y11m) 手術日期 2010/11/26 手術主治醫師 賴達明 手術區域 東址 019房 03號 診斷 Hyperhidrosis 器械術式 Endoscopic T2 sympathectomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳德福, 時間資訊 14:22 進入手術室 14:25 麻醉開始 14:35 誘導結束 14:50 抗生素給藥 15:03 手術開始 15:40 手術結束 15:40 麻醉結束 15:57 進入恢復室 16:00 送出病患 16:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 經內視鏡交感神經切斷術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 陳德福 開立時間: 2010/11/26 14:19 Pre-operative Diagnosis Hyperhidrosis Post-operative Diagnosis Hyperhidrosis Operative Method Bilateral thoracoscopic T2-3 sympathectomy Specimen Count And Types nil Pathology Nil Operative Findings Temperature Preop Lowest Postop Right hand Right hand 35.1 33.8 34.1 Left hand Left hand 35.3 33.9 34.0 Operative Procedures 1. Anesthesia : single lumen endotracheal general anesthesia 2. Position : supine, with both arms put on the arm tables, 90 degrees abduction and external rotation at the shoulders, and mild flexion at the elbows to expose both axillary areas. 3. Skin preparation : both axilla and chest were scrubbed with povidone-iodine detergent, painted with povidone-iodine tincture and draped as usual. 4. Made a 1.0 cm incision at the anterior axillary line, 3nd intercostal space, just under the lateral margin of Pectoralis major muscle. After the arterial oxygen saturation kept at 100%, the ventilator was disconnected, with the lung to a relatively mild atelectatic state. Then the trocar was inserted into the right pleural space carefully, followed by the thoracoscope. Then we identified the sympathetic chain and electrocauterized the sympathetic trunk over T2 and T3 level completely with a electrocauterization probe. The effect was monitored by the finger temperature probes connected to the thumb of the patients hand. Before the oxygen saturation falling down to 80%, we removed the probe and thoracoscope gentlely, followed with a suction tube to drain the air in pleural space. The ventilator was reconnected with forced positive ventilation to expand the lung tissue. The drain tube was removed after the expansion of the lung and the skin was closed with 3/0 nylon suture. Operators vs賴達明 Assistants r5陳德福 r1張僖 簡傳楊 (M,1959/10/13,52y5m) 手術日期 2010/11/26 手術主治醫師 蔡翊新 手術區域 東址 005房 04號 診斷 Intracranial abscess 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 髒 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 3E 紀錄醫師 施廷翰, 時間資訊 23:08 通知急診手術 23:08 臨時手術NPO 23:08 開始NPO 00:10 進入手術室 00:20 麻醉開始 00:35 抗生素給藥 00:40 誘導結束 01:00 手術開始 01:45 抗生素給藥 02:25 開始輸血 04:25 手術結束 04:25 麻醉結束 04:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 急性硬腦膜下血腫清除術 1 1 L 手術 顱內壓視置入 1 2 L 摘要__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 蔡翊新 開立時間: 2010/11/26 03:42 Pre-operative Diagnosis Left frontotemporoparietal chronic SDH. Post-operative Diagnosis Left frontotemporoparietal subdural empyema. Operative Method Left frontotemporal craniotomy for removal of subdural empyema and subdural drain for ICP monitoring. Specimen Count And Types (1) 1 test tube: pus coating for pathology (2) 5 test tubes, 3 swabs: for pus culture (3) 1 test tube, 1 swab: for Gram stain Pathology pending. Operative Findings Flank pus gushed out upon opening the dura. There were a lot of pus and fibrin formation at subdural space of left F-T-P area. Some small patches of pus were noted beneath the arachnoid membrane of left frontotemporal lobes, leaving untouched to avoid excessive bleeding. Bleeding tendency was noted and we gave him DDAVP infusion (4 vials / 100 ml) for better hemostasis. The brain expanded after removal of subdural pus. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 4 cm at left frontotemporal area, the skin edge was clipped by Raney clips for temporary hemostasis. 5. A burr hole was made and the dura was incised for evacuating part of the subdural empyema. 6. The incision was extended to a 12 cm wound at left F-T area, and the temporalis muscle was detached from temporal squama by rasp subsequently. 7. Craniotomy window: 8 x 6 cm, left F-T, created by making 2 burr holes then cut by power saw. 8. Dural tenting: by 2/0 silk, 2 cm in interval, distributed along the edge of skull window. 9. Dural incision: curvilinear along the edge of skull window. 10.The subdural pus was removed by sucker and those located beyond the cranial window was washed out by saline irrigation. A EVD tube was placed at subdural space as subdural drain and ICP monitor. 11.Hemosatasis: the bleeders was stopped by Bovie and oozing surface was packed with Surgicel. 12.Dural closure: was closed with a piece of dural graft taking from temporalis fascia. 13.The skull plate was placed back and fixed by 3 wires. 14.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 15.Drain: one epidural CWV, one subdural drain as ICP monitor. 16.Blood transfusion: PRBC 2U, Platelet 12U. Blood loss: * Remarks: Tienam 500 mg was given intraoperatively as we knew the lesion was subdural empyema. DDAVP 4 vials/100 ml N/S was given intraoperatively because of bleeding tendency. Gentamicin solution was used for subdural space irrigation. Operators VS蔡翊新 Assistants R5陳德福R1施廷翰 Indication Of Emergent Operation 周金龍 (M,1931/08/14,80y7m) 手術日期 2010/11/26 手術主治醫師 蔡翊新 手術區域 東址 002房 05號 診斷 Cerebrovascular accident (CVA) 器械術式 Craniotomy(Aneurysms) VS-TZENG 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 3E 紀錄醫師 方怡婷, 時間資訊 18:35 通知急診手術 18:36 開始NPO 19:10 報到 19:13 進入手術室 19:15 麻醉開始 19:30 抗生素給藥 19:35 誘導結束 19:50 手術開始 20:20 開始輸血 22:30 抗生素給藥 23:00 麻醉結束 23:00 手術結束 23:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦內血腫清除術 1 1 R 記錄__ 手術科部: 創傷醫學部 套用罐頭: Right craniotomy for hematoma evacuation and ... 開立醫師: 胡朝凱 開立時間: 2010/11/26 23:31 Pre-operative Diagnosis Right putaminal ICH Post-operative Diagnosis Right putaminal ICH Operative Method Right craniotomy for hematoma evacuation and ICP monitor insertion Specimen Count And Types nil Pathology nil Operative Findings 1.About 100 ml hematoma was noted at right putaminal area. 2.Diffuse oozing was noted on the surface of brain paranchyma 3.the brain became glotic Operative Procedures 1.ETGA, supine 2.right temporal to parietal area vertical skin incision 3.dissect skin and muscle flap 4.craniotomy 5.cruciate form dural excision 6.Superior temporal gyrus was opened 7.Hematoma was then evacuate 8.Hemostasis with surgicel 9.ICP monitor insertion 10.Close dura 11.close wound in layers Operators 蔡翊新,王國川 Assistants 胡朝凱,王奐之,方怡婷 Indication Of Emergent Operation 康文正 (M,1973/05/17,38y9m) 手術日期 2010/11/27 手術主治醫師 陳敞牧 手術區域 東址 002房 號 診斷 Brain cancer 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 3E 紀錄醫師 鍾文桂, 時間資訊 09:00 臨時手術NPO 09:00 開始NPO 17:11 進入手術室 17:15 麻醉開始 17:45 誘導結束 17:50 抗生素給藥 18:40 手術開始 21:15 開始輸血 00:00 手術結束 00:00 麻醉結束 00:10 送出病患 23:55 抗生素給藥 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4~8小時 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Excision of brain tumor with parietal-tempora... 開立醫師: 鍾文桂 開立時間: 2010/11/28 00:37 Pre-operative Diagnosis Right parietal-temporal tumor, suspect glioblastoma multiforme. Post-operative Diagnosis Right parietal-temporal tumor, suspect glioblastoma multiforme. Operative Method Excision of brain tumor with parietal-temporal craniotomy. Specimen Count And Types 1 piece About size:30cc Source:brain tumor Pathology Pending. Oligoastrocytoma, anaplastic Operative Findings Tumor: Two main tumor mass: one at parietal, the other at temporal region with cyst formation( three cysts at parietal and one cyst at temporal). Cyst content: clear corlorless fluid. compatible with MRI findings. high vascularity, elastic, hard, pinkish-gray. Intraoperative ultrasonography was done to localized the tumor mass. The brain was slack after tumor excision. Operative Procedures Under ETGA, the patient was placed in supine position and the head was tilted to the left. After shaving, disinfection, and draping, a reverse U shape scalp incision was made at right temporal-parietal areas. Craniotomy was achieved with high speed drill. We localized the tumor with intraoperative ultrasonography. After durotomy, we resected with tumor at temporal region first.Then under the guidance of ultrasonography, we resected the tumor at parietal region. After well hemostasis, the dura mater was augmented with fascia graft. The skull bone with fixed by plates and screws. The wound was closed in layers with one subgaleal CWV drain. Operators V.S. 陳敞牧 Assistants R5鍾文桂 R1劉昌杰 Indication Of Emergent Operation 許振耀 (M,1935/02/20,77y0m) 手術日期 2010/11/27 手術主治醫師 王國川 手術區域 東址 001房 號 診斷 Headache 器械術式 Left acute SDH 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 4E 紀錄醫師 古恬音, 時間資訊 12:00 臨時手術NPO 12:00 開始NPO 19:25 進入手術室 19:30 麻醉開始 19:55 誘導結束 20:00 抗生素給藥 20:22 手術開始 20:25 開始輸血 23:25 手術結束 23:25 麻醉結束 23:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 1 L 手術 顱內壓視置入 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 神經部 套用罐頭: 1. Decompressive craniectomy for hematoma eva... 開立醫師: 古恬音 開立時間: 2010/11/28 00:57 Pre-operative Diagnosis Head injury with acute SDH and ICH, left side Post-operative Diagnosis Head injury with acute SDH, SAH, ICH, and skull fracture, left side Operative Method 1. Decompressive craniectomy for hematoma evacuation 2. Duroplasty with autologous fascia graft 3. ICP monitor insertion Specimen Count And Types nil Pathology Nil Operative Findings Excessive venous bleeding from skull was noted during craniectomy. There was much blood clot in the subdural spaceat left fronto-temporo-parietal region, originating from temporal ICH. Some SAH was also noted. Bleeding from one bridging vein and skull fracture line was noted at left temporal base. The brain became swollen during hematoma evacuation and turned slack with good pulsation after the hematoma was removed. ICP after duroplasty: 4mmHg. Operative Procedures 1. ETGA, supine position with head turned to right 2. Scalp shaving, scrubbing and disinfection 3. Draping in the usual sterile fashion 4. Scalp incision at trauma flap 5. Harvert fascia graft and resect the temporalis muscle 5. Decompressive craniectomy after drilling 6 burr holes 6. Durotomy in fish mouth fashion after peripheral tenting 7. Evacuation of the SDH and ICH. Hemostasis of temporal base bleeder with bone wax, Gelfoam, and Surgicel 8. Duroplasty with autologous fascia graft 9. Set up ICP monitor 10. Place one epidural CWV drain 11. Wound closure in layers Operators VS王國川 Assistants R3古恬音 R1呂育全 Indication Of Emergent Operation 張俊德 (M,1953/10/26,58y4m) 手術日期 2010/11/27 手術主治醫師 戴浩志 手術區域 東址 009房 02號 診斷 Intraspinal abscess 器械術式 Local Flap 手術類別 預定手術 手術部位 脊椎 傷口分類 污染 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 3 紀錄醫師 阮廷倫, 時間資訊 09:30 報到 09:40 進入手術室 09:45 麻醉開始 09:50 誘導結束 10:10 手術開始 10:40 手術結束 10:40 麻醉結束 10:50 進入恢復室 10:50 送出病患 11:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 移前皮瓣移植術 1 1 手術 深部傷口處理縫合擴創-中 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Debridement + advancement flap for wound closure 開立醫師: 阮廷倫 開立時間: 2010/11/27 11:17 Pre-operative Diagnosis Posterior neck wound, s/p I&D; Post-operative Diagnosis Posterior neck wound, s/p I&D; Operative Method Debridement + advancement flap for wound closure Specimen Count And Types Nil Pathology Nil Operative Findings 1. 6 cm linear open wound with good granulation wound bed over posterior neck was noticed 2. T1 spinous process exposure was also noticed Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position. After skin disinfection and draped, the wound was debrided. The exposed T1 spinous process was also removed to reduce pressure point. After hemostasis and irrigation, the wound was closed in layers with 2-0 Dexon, 3-0 Nylon after placing one CWV drain. Operators AP戴浩志 Assistants R5阮廷倫 江德貴 (M,1930/02/28,82y0m) 手術日期 2010/11/27 手術主治醫師 王堯弘 手術區域 東址 000房 號 診斷 Chronic hepatitis C (HCV) 器械術式 BA aneurysm TAE 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林峰盛 ASA 5E 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 20:05 麻醉開始 20:20 誘導結束 23:20 麻醉結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 周金龍 (M,1931/08/14,80y7m) 手術日期 2010/11/27 手術主治醫師 蔡翊新 手術區域 東址 005房 01號 診斷 Cerebrovascular accident (CVA) 器械術式 Craniotomy(Aneurysms) P-DUH 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 3E 紀錄醫師 全賀顯, 時間資訊 02:00 進入手術室 02:05 麻醉開始 02:10 誘導結束 02:30 開始輸血 02:35 手術開始 05:00 抗生素給藥 06:00 手術結束 06:00 麻醉結束 06:08 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦內血腫清除術 1 2 R 摘要__ 手術科部: 外科部 套用罐頭: CVA 開立醫師: 蔡翊新 開立時間: 2010/11/27 05:52 Pre-operative Diagnosis Right basal ganglia ICH s/p craniotomy for ICH evacuation and ICP monitor, with recurrent ICH and IVH. Post-operative Diagnosis Right basal ganglia ICH s/p craniotomy for ICH evacuation and ICP monitor, with recurrent ICH and IVH. Operative Method Right frontotemporal craniotomy for ICH evacuation and left Kocher EVD. Specimen Count And Types nil Pathology Nil. Operative Findings Sanguinous CSF gushed out upon ventricular tapping via left Kocher point. About 80 c.c. ICH was noted at right basal ganglia, most of which was rebleeding after previous ICH evacuation. Bleeding tendency was still marked and oozing from raw surface was difficult to stop. The brain became slack after ICH evacuation and CSF drainage. Postop ICP was mmHg. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. An EVD was inserted to frontal horn of left lateral ventricle via a burr hole made at left Kocher point. 5. Incision: right frontotemporal, curvilinear, along previous wound. The skin edge was clipped by Raney clips for temporary hemostasis. After scalp had been lifted, the temporalis muscle was incised and detached from temporalsquama and reflected to lower temporal side. 6. Craniotomy: A 6 x 5 cm trephine was made at right frontotemporal area over-ridding the Sylvian fissure. 7. Dural tenting: by 2/0 silk, 2 cm in interval, distributed along the edge of skull window. 8. Dural incision: 3/4 circle along the trephine margin. 9. The ICH was sucked out carefully. Those tough clot was removed by forceps. The cavity was irrigated with NS and the blood oozing was stopped by gelfoam packing. Before closure of the dura, the hematoma caivty was clean and the brain once bulging was slack. 10.Dural closure: Duroform was used for duroplasty. Previous ICP monitor was placed back into the hematoma cavity. 11.The trephine button was fixed back with 3 wires. 12.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 13.Drain: none. 14.Blood transfusion: PRBC 4U, Platelet 24U, FFP 6U. Blood loss: 1100 ml. 15.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R6胡朝凱R1全賀顯 Indication Of Emergent Operation 許振耀 (M,1935/02/20,77y0m) 手術日期 2010/11/28 手術主治醫師 王國川 手術區域 東址 001房 05號 診斷 Headache 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 4E 紀錄醫師 古恬音, 時間資訊 00:00 報到 00:02 麻醉開始 00:02 進入手術室 00:05 誘導結束 00:12 手術開始 00:47 開始輸血 01:05 麻醉結束 01:05 手術結束 01:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 硬腦膜外血腫清除術 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Hematoma evacuation 開立醫師: 古恬音 開立時間: 2010/11/28 01:22 Pre-operative Diagnosis Acute epidural hematoma Post-operative Diagnosis Acute epidural hematoma Operative Method Hematoma evacuation Specimen Count And Types Nil Pathology Nil Operative Findings Large amount of fresh blood clot was noted at epidural space with brain compression. No active bleeder was noted after hematoma evacuation. The craniectomy window became slack after the procedure. Operative Procedures 1. ETGA, supine position with head turned to right 2. Open the wound 3. Hematoma evacuation 4. Check bleeding 5. Revision of CWV drain 6. Wound closure in layers Operators VS王國川 Assistants R3古恬音, R1呂育全 Indication Of Emergent Operation 李子良 (M,1966/07/04,45y8m) 手術日期 2010/11/29 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Brain Tumor 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 3 紀錄醫師 古恬音, 時間資訊 07:50 報到 08:10 進入手術室 08:20 麻醉開始 08:25 誘導結束 09:10 抗生素給藥 09:15 手術開始 09:40 手術結束 09:40 麻醉結束 10:03 送出病患 10:05 進入恢復室 11:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦脊髓液分流管重置 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: VP shunt revision 開立醫師: 胡朝凱 開立時間: 2010/11/29 09:40 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method VP shunt revision Specimen Count And Types nil Pathology nil Operative Findings 1.Previous ligation was noted at right subclavicular area 2.Clear CSF with pressure 3.Patent shunt catheter Operative Procedures 1.ETGA, supine 2.Right clavicular transverse skin incison 3.Expose shunt catheter 4.Identified ligation 5.Cut catheter and re-connect with a stright connector 6.Close wound Operators P 杜永光 Assistants 胡朝凱, 古恬音 江麥美珠 (F,1943/06/18,68y8m) 手術日期 2010/11/29 手術主治醫師 王成平 手術區域 東址 025房 02號 診斷 Tongue cancer 器械術式 Partial glossectomy + SOHND 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 2 紀錄醫師 郭彥麟, 時間資訊 09:15 報到 09:35 進入手術室 09:45 麻醉開始 09:50 誘導結束 09:55 抗生素給藥 10:07 手術開始 12:20 手術結束 12:20 麻醉結束 12:30 送出病患 12:31 進入恢復室 13:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 口腔或口咽腫瘤切除,並頸淋巴腺根除術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 記錄__ 手術科部: 耳鼻喉部 套用罐頭: Hemi/partial glossectomy + SOHND 開立醫師: 郭彥麟 開立時間: 2010/11/29 14:51 Pre-operative Diagnosis Tongue cancer,right, cT1N0Mx Post-operative Diagnosis right tongue cancer, operated Operative Method Partial glossectomy adn supraomohyoid neck dissection,right Specimen Count And Types 2 pieces About size:3x3 cm Source:right tongue tumor About size:5x5cm Source:right neck tissue Pathology pending Operative Findings 1.The tumor was about 1x1cm cm at the lateral border of right tongue 2.no suspicious LAP > 1cm was noted Operative Procedures 1.The patient was in supine position and was set up with general anesthesia via nasal intubation. The operation field for neck dissection was draped and disinfected as well. 2.Skin incision was made as shown in Fig. The skin flaps were elevated at the subplatysmal plane, anteriorly to the midline neck, and superiorly to the mandible. Then we removed areolar tissue along IJV.and then freed submandibular gland with level I lymph node. Facial vessels and Wharton duct were ligated. After hemostasis check-up, a 1/8 hemovac was inserted. The operation wound was then closed in 2 layers. The oral cavity was irrigated with Aq-Hibitane after a mouth gag wasapplied. 3.After rising mouth with aqua-Hibitane we did wide excision of the right tongue tumor, with 1cm safe margin. Hemostasis was achieved with ligation and sutured the tongue wound 4.patient tolerated the surgery well Operators Asp王成平 Assistants R4薛婉儀 R2郭彥麟 李正勇 (M,1939/02/23,73y0m) 手術日期 2010/11/29 手術主治醫師 何子昌 手術區域 西址 000房 02號 診斷 Central retinal vein occlusion 器械術式 Aspiration of vitreous 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 13:35 進入手術室 13:36 麻醉開始 13:38 誘導結束 13:40 手術開始 13:40 麻醉結束 13:42 送出病患 13:42 手術結束 記錄__ 手術科部: 眼科部 套用罐頭: IVIA 開立醫師: 楊中美 開立時間: 2010/11/29 13:40 Pre-operative Diagnosis macular edema Post-operative Diagnosis Ditto Operative Method Intravitreal Injection Of Avastin(OU) Specimen Count And Types nil Pathology nil Operative Findings nil Operative Procedures 1.Under topical anesthesia. 2.Disinfection and draping as usual. 3.Apply an eyelid speculum. 4.Intravitreal injection of Avastin 0.05ml 5.Check leakage 6.Iop measurement by digit 7.Check bare VA>ND100cm Operators 何子昌, Assistants 何威廷 郭碧玉 (F,1956/06/14,55y9m) 手術日期 2010/11/29 手術主治醫師 杜永光 手術區域 東址 003房 02號 診斷 Brain Tumor 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 2 紀錄醫師 古恬音, 時間資訊 10:10 報到 10:30 進入手術室 10:40 麻醉開始 10:50 誘導結束 11:45 抗生素給藥 12:23 手術開始 14:45 抗生素給藥 17:45 抗生素給藥 19:45 麻醉結束 19:45 手術結束 19:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 10 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 顱底瘤手術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Right far lateral approach for tumor excision 開立醫師: 胡朝凱 開立時間: 2010/11/29 18:50 Pre-operative Diagnosis Cerebellopontine angle epidermoid cyst Post-operative Diagnosis Cerebellopontine angle epidermoid cyst Operative Method Right far lateral approach for tumor excision Specimen Count And Types 1 piece About size:pieces of tumor Source:epidermoid cyst Pathology Pending Operative Findings The tumor was pearly-white in color and cheese-like in consistency. It was also well defined with a thin transparent capsule. The tumor filled up the prepontine cistern and right cerebellopontine angle, with brainstem compression. Brainstem was decompressed well after the surgery. Cranial nerves were pushed away. The basilar artery, left CN VI, right CN VII-VIII complex were identified during the surgery and well preserved. One small piece of capsule was left in situ to prevent structure damage. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with right shoulder elevated, head turned to left and fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected with better iodine, then draping was done in usual sterile fashion. One reverse U-shaped scalp incision was made at occipital-cervical junction. Muscles and soft tissue were dissected until exposure of occipitus and lateral mass of C1. The right vertebral artery was detached from C1, and the posterior arch of C1 was removed. Craniotomy was done at right occipital area, including the foramen magnum. Dura was opened in linear fashion, then the cistern magnum was punctured for CSF drainage. The tumor was removed piece by piece with tumor forceps and suction. The tumor capsule was also removed entirely. Dura was closed with 4-0 prolene and autologous fascia graft, and the skull plate was fixed back with miniplates. After setting one subgaleal CWV drain, the wound was closed in layers. Operators P杜永光 Assistants R6 胡朝凱, R3 古恬音 許春嬌 (F,1949/06/27,62y8m) 手術日期 2010/11/29 手術主治醫師 廖漢文 手術區域 東址 000房 號 診斷 Aneurysm 器械術式 right ICA aneurysm, for TAE 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 王永彬 ASA 3 時間資訊 08:35 麻醉開始 08:40 誘導結束 10:35 麻醉結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 CHUA TECOBEATASY (F,1930/02/10,82y1m) 手術日期 2010/11/29 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 3 紀錄醫師 許皓淳, 時間資訊 07:47 報到 08:03 進入手術室 08:13 麻醉開始 08:30 誘導結束 08:42 手術開始 08:42 抗生素給藥 10:56 麻醉結束 10:56 手術結束 11:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 R 手術 頭顱成形術 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: 1.craniectomy tumor excision 2.cranioplasty 開立醫師: 陳德福 開立時間: 2010/11/29 11:07 Pre-operative Diagnosis Meningioma with skull extension, right convexity Post-operative Diagnosis Meningioma with skull extension, right convexity Operative Method 1.craniectomy tumor excision 2.cranioplasty Specimen Count And Types 1 piece About size:3*3*3CM Source:right frontal lobe extraaxial tumor with skull infiltration Pathology pending Operative Findings 1.There was a 3*3*3cm in sized irregular shape tumor at the right frontal convexity with skull extension. The SSS is clean without tumor involvement. 2.The tumor is soft with dura base. After Simpson grade I tumor excision, the dura defect was repaired with Gortex and Duraform. The craniectomy window was repaired with Metal-Mesh [Codman]. Operative Procedures Under ETGA and supine position with Mayfield pin type head fixator fixation, the scalp was disinfected and draped as usual. One curvilinear incision was done and the 6*6cm in sized craniotomy [tumor centered] was created. The tumor came into view and the dura was opened in circular fasion. The tumor was then removed along the epi-arachnoid plane totally with the dura. The dura was repaired with Gortex and Duraform. The cranioplasty was perform smoothly with Mesh. The wound was closed in layer with one CWV drainage. Operators VS 曾漢民 Assistants R5 陳德福 R1許皓淳 黃彥瑋 (M,1982/08/21,29y6m) 手術日期 2010/11/29 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Pituitary tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 2 紀錄醫師 許皓淳, 時間資訊 10:54 報到 11:27 進入手術室 11:30 麻醉開始 11:40 誘導結束 11:55 抗生素給藥 12:11 手術開始 13:15 麻醉結束 13:15 手術結束 13:25 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 手術 經由蝶竇之腦下垂體瘤切除 1 1 摘要__ 手術科部: 外科部 套用罐頭: Transsphenoidal pituitary adenomectomy 開立醫師: 許皓淳 開立時間: 2010/11/29 13:34 Pre-operative Diagnosis Pituitary microadenoma Post-operative Diagnosis Pituitary microadenoma Operative Method Transsphenoidal pituitary adenomectomy Specimen Count And Types 1 piece About size:1cc Source:Pituitary tumor Pathology pending Operative Findings 1.There is a 1*1*1.2cm in sized cystic lesion at the left pituitary. Previous hemorrhage with liguified hematoma was found. The tumor was removed totally under microscopic adenomectomy. 2.No CSF leakage noticed during the procedure. Operative Procedures Under general anethesia and intubation, the patient was put in supine position. The facial skin was antiseptic with alcohol, and the mucosa of oral and nasal cavity with aqueous better-iodine. The face was covered with sterilized adhesive plastic sheets then draped. Under microscope, nasal septum was incised, and a nasal speculum was applied to displace the nasal mucosa laterally and keep the nasal cavity open constantly for the exposure of the vomer bone and the anterior wall of the sphenoid sinus. The anterior sphenoid wall, sphenoid sinus mucosa and sella floor were removed along with the sphenoidal portion of the adenoma. The dura was coagulated then opened in cruciate fashion. The tumor was removed by curette and aligator. The CSF leakage was sealed with gelform packing. The bone of anterior sphenoid wall was placed back and the nasal mucosa was returned to its normal position. Operators 曾漢民 Assistants R5陳德福 陳棗 (F,1945/11/12,66y4m) 手術日期 2010/11/29 手術主治醫師 曾漢民 手術區域 東址 005房 03號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 3 紀錄醫師 許皓淳, 時間資訊 13:40 報到 13:45 麻醉開始 14:20 誘導結束 14:20 抗生素給藥 14:37 進入手術室 16:05 手術開始 16:10 麻醉結束 16:10 手術結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 腦瘤切除-手術時間在4小時以內 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: craniotomy tumor excision, Simpson grade I 開立醫師: 陳德福 開立時間: 2010/11/29 14:17 Pre-operative Diagnosis Menigioma, left frontal convexity Post-operative Diagnosis Menigioma, left frontal convexity Operative Method craniotomy tumor excision, Simpson grade I Specimen Count And Types 1 piece About size:3*3*3CM Source:LEFT FRONTAL LOBE BRAIN TUMOR Pathology Pending Operative Findings 1.There was a 3*3*2.5 cm in sized tumor at the left frontal convexity. The tumor was yellowish, elastic, well demarcated, dura based, extra axial, and moderte vascularized. The arterial feeder of the tumor came from the MMA and the tumor with dura base was removed totoally as Simpson grade I surgery. Operative Procedures Under ETGA and supine position with Mayfield pin type head fixator fixation, the scalp was disinfected and draped as usual. One curvilinear incision was done and the 6*6cm in sized craniotomy [tumor centered] was created. The tumor came into view and the dura was opened in circular fasion. The tumor was then removed along the epi-arachnoid plane totally with the dura. The dura was repaired with Gortex and Duraform. The cranioplasty was perform smoothly with Mesh. The wound was closed in layer with one CWV drainage. Under ETGA and supine position, the scalp was disinfected and draped as usual. One curvilinear incision was done and the 5*5cm in sized craniotomy [tumor centered] was created. The tumor came into view and the dura was opened in circular fasion. The tumor was then removed along the epi-arachnoid plane totally with the dura. The dura was repaired with periosteum. The skull was fixed with miniplates. The wound was closed in layer with one CWV drainage. Under ETGA and supine position, the scalp was disinfected and draped as usual. One curvilinear incision was done and the 5*5cm in sized craniotomy [tumor centered] was created. The tumor came into view and the dura was opened in circular fasion. The tumor was then removed along the epi-arachnoid plane totally with the dura. The dura was repaired with periosteum. The skull was fixed with miniplates. The wound was closed in layer with one CWV drainage. Operators VS曾漢民 Assistants R5陳德福 R1許皓淳 謝棋漢 (M,1995/11/22,16y3m) 手術日期 2010/11/29 手術主治醫師 郭夢菲 手術區域 兒醫 066房 06號 診斷 Arteriovenous malformation, brain 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 2E 時間資訊 15:21 通知急診手術 16:02 報到 16:02 進入手術室 16:03 麻醉開始 16:15 誘導結束 16:40 抗生素給藥 17:00 手術開始 17:50 麻醉結束 17:50 手術結束 18:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦室體外引流 1 1 記錄__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 郭夢菲 開立時間: 2010/12/01 10:40 Pre-operative Diagnosis right thalamic hemorrhage with IVH and hydrocepahlus Post-operative Diagnosis right thalamic hemorrhage with IVH and hydrocepahlus Operative Method external ventricular drainage via right kocher point Specimen Count And Types nil Pathology nil Operative Findings bloody CSF gushed out from the ventricular puncture site with opening pressure higher than 30 cm H2O Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: supine with head mildly rotated (tilted) to left. 3.Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 5 cm curvilinear, right frontal, corresponded to the location of right frontal horn. Raney clips were applied to the scalp edge for temporary hemostasis. 5.After the scalp flap had been lifted and reflected anteriorly, a burr hole was made and the dura was tented by 2 stitches. 6.The dura was opened by a nib incision. Rt lateral ventricle was tapped by a ventricular needle, then a 6.6 cm segment of the ventricular catheter was introduced into the ventricle. The outer end of the catheter was connected to the EVD set 7. Scalp closure: hemostasis was done then the wound was closed in layers. Operators 郭夢菲 Assistants 林哲光 Indication Of Emergent Operation 鄭美惠 (F,1965/10/16,46y4m) 手術日期 2010/11/29 手術主治醫師 蔡翊新 手術區域 東址 001房 03號 診斷 Lung cancer 器械術式 V-P shunt 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 4E 紀錄醫師 鍾文桂, 時間資訊 12:00 臨時手術NPO 12:00 開始NPO 13:09 通知急診手術 14:20 進入手術室 14:20 報到 14:25 麻醉開始 14:30 誘導結束 14:50 抗生素給藥 15:30 手術開始 16:50 手術結束 16:50 麻醉結束 17:00 送出病患 17:02 進入恢復室 19:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 記錄__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 蔡翊新 開立時間: 2010/11/29 16:46 Pre-operative Diagnosis Lung cancer with cancer meningitis and acute hydrocephalus. Post-operative Diagnosis Lung cancer with cancer meningitis and acute hydrocephalus. Operative Method V-P Shunt via right Kocher point. Specimen Count And Types 6 tubes of CSF, sent for routine, BCS, india ink, cytology, cultures for bacteria, fungus and TB. 6 tubes of CSF, sent for routine, BCS, india ink, cytology, cultures for bacteria, fungus. Pathology nil. Operative Findings CSF gushed strongly out upon puncturing the ventricle, the pressure was greater than 30 cmH2O. The CSF was clear, but there were some debris drifting in it. Ventricular catheter: medium-pressure, 7 cm, about 5.5 cm beneath the dura. Peritoneal catheter: 30 cm in depth. Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: supine with head rotated to left. 3.Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with a sterilized adhesive plastic sheet. 4. Incision: 5 cm curvilinear, right frontal, corresponded to the location of right frontal horn. Raney clips were applied to the scalp edge for temporary hemostasis. 5.After the scalp flap had been lifted and reflected anteriorly, a burr hole was made at right Kocher point and the dura was tented by 2 stitches. 6.The dura was opened by a nib incision. Rt lateral ventricle was tapped by a ventricular needle, then a 7 cm segment of the ventricular catheter was introduced into the ventricle. The outer end of the catheter was connected to a Pudenz reservoir. 7. A minilaparotomy was made at RUQ of the abdomen , then a trocar was pushed into peritoneal cavity. Subsequently, distal 30 cm segment of the peritoneal catheter (low pressure) was introduced into the peritoneal cavity through the outer tube of the trochar. The proximal end of this catheter was passed through subcutaneous tunnel at forechest, neck, right retroauricular area and connected the reservoir. The shunt system was checked to make sure its function was working. 8. The reservoir was fixed to pericranium by 3 stitches. 9. Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 10.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5鍾文桂Ri廖書玲 Indication Of Emergent Operation 宋炎輝 (M,1951/06/21,60y8m) 手術日期 2010/11/30 手術主治醫師 杜永光 手術區域 東址 005房 01號 診斷 Aneurysm 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 古恬音, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 12:20 通知急診手術 13:05 進入手術室 13:10 麻醉開始 13:15 誘導結束 13:36 手術開始 13:55 抗生素給藥 14:25 15:35 麻醉結束 15:35 手術結束 15:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦室體外引流 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Right Kocher point EVD 開立醫師: 古恬音 開立時間: 2010/11/30 15:33 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Right Kocher point EVD Specimen Count And Types Nil Pathology Nil Operative Findings Clear CSF drained out upon ventriculostomy. The opening pressure is high. Ventricular catheter: 5cm Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position. On linear scalp incision was made at right frontal area, followed by burr hole creation. The dura was opened in cruciate fashion. Ventricular catheter was inserted after ventriculostomy. After fixation of the ventricular catheter, the wound was closed in layers Operators P杜永光 Assistants R6胡朝凱 R3古恬音 Indication Of Emergent Operation 王盛泰 (M,1954/09/11,57y6m) 手術日期 2010/11/30 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Herniation of intervertebral disc (HIVD) 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 張僖, 時間資訊 11:50 報到 12:15 進入手術室 12:30 麻醉開始 13:00 誘導結束 13:00 抗生素給藥 13:10 手術開始 16:00 抗生素給藥 16:18 手術結束 16:18 麻醉結束 16:30 送出病患 16:33 進入恢復室 18:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-腰椎 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 摘要__ 手術科部: 外科部 套用罐頭: L4~5 TPS and L4 laminectomy 開立醫師: 陳德福 開立時間: 2010/11/30 12:44 Pre-operative Diagnosis L4 on L5 spondylolisthesis L4 on L5 spondylolisthesis and HIVD with spinal stenosis Post-operative Diagnosis L4 on L5 spondylolisthesis L4 on L5 spondylolisthesis and HIVD with spinal stenosis Operative Method L4~5 TPS and L4 laminectomy 1.L4~5 TPS and L4 laminectomy 2.Lumbar discectomy with interbody cage implantation, L4/5 Specimen Count And Types nil Pathology NIL Operative Findings 1.Instability between L4 to L5 2.Hypertrophic flavum ligment and stenotic lateral recess 2.Hypertrophic flavum ligment,HIVD and stenotic lateral recess 3.Screws: 6.2 x 45 4.Interbody cage:13mm x2 Operative Procedures 1.ETGA, prone 2.Midline skin incision at L4~5 level 3.Detach paravertebral muscle groups to expose L4~5 lamina and facet joint 4.Identified transverse process to located L4 and L5 pedicle 5.Screws insertion 6.L4 laminectomy 7.Remove flavum ligment 8.Identified L4, L5 roots and decompression 8.Identified L4, L5 roots and decompression followed by L4/5 discectomy with interbody cage implantation 9.rods fixation 10. Posterolateral fusion with autologous bone graft 11. Set on Hemovac at epidural space 12. Wound closure in layers Operators VS賴達明 Assistants R5陳德福,R1張僖 林金枝 (F,1939/09/15,72y5m) 手術日期 2010/11/30 手術主治醫師 王國川 手術區域 東址 001房 03號 診斷 Other and unspecified intracranial hemorrhage following injury, with prolonged (more than 24 hours) loss of consciousness and without return to pre-existing conscious level 器械術式 Craniotomy(Aneurysms) P-DUH 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 4E 紀錄醫師 古恬音, 時間資訊 16:31 通知急診手術 17:09 進入手術室 17:10 麻醉開始 17:35 誘導結束 17:40 抗生素給藥 18:03 手術開始 18:45 開始輸血 20:50 抗生素給藥 21:05 手術結束 21:05 麻醉結束 21:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 1 R 手術 顱內壓視置入 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: 1. Decompressive craniectomy for hematoma eva... 開立醫師: 古恬音 開立時間: 2010/11/30 21:31 Pre-operative Diagnosis Head injury with SDH, ICH, and skull fracture Post-operative Diagnosis Head injury with SDH, ICH, and skull fracture Operative Method 1. Decompressive craniectomy for hematoma evacuation 2. Duroplasty with autologous fascia graft 3. ICP monitor insertion Specimen Count And Types nil Pathology Nil Operative Findings 1. Moderate amount of subacute hematoma was noted at subdural space. There was also to foci of ICH at right frontal and temporal lobe. The brain was swollen upon durotomy. Good pulsation was noted after removal of ICH. Excessive venous bleeding from osteoporotic bone was noted during craniotomy 2. ICP after wound closure 2mmHg. Reference: 496 Operative Procedures 1. ETGA, supine position with head turned to left 2. Scalp shaving, scrubbing, and disinfection 3. Draping in usual sterile fashion 4. Scalp incision as trauma flap 5. Dissect the soft tissue and muscle, and harvest fascia graft 6. 8*12cm cranitomy window was done after drilling 5 burr holes 7. Dura was opened in fish mouth fashion after peripheral tenting 8. The subdural hematoma was removed with suction, and the two ICHs were evacuated 9. The raw surface was covered with Surgicel to achieve hemostasis 10. Duroplasty was performed with autologous fascia graft 11. ICP monitor was inserted with tip at right temporal tip 12. Set 2 epidural CWV drains 13. Wound closure in layers Operators 王國川 Assistants R4李振豪 R3古恬音 R1羅偉誠 Indication Of Emergent Operation 陳文雄 (M,1938/11/07,73y4m) 手術日期 2010/11/30 手術主治醫師 曾勝弘 手術區域 東址 002房 01號 診斷 Spinal cord metastasis 器械術式 Benign intraspinal tumor, exci 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 07:50 報到 08:06 進入手術室 08:10 麻醉開始 08:20 誘導結束 09:00 抗生素給藥 09:32 手術開始 11:58 抗生素給藥 12:10 麻醉結束 12:10 手術結束 12:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 手術 惡性脊髓腫瘤切除術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Left C1 hemilaminectomy for total tumor excision 開立醫師: 李振豪 開立時間: 2010/11/30 12:31 Pre-operative Diagnosis C1 intraspinal tumor with thecal sac compression, suspect neurogenic tumor, rule out malignancy Post-operative Diagnosis C1 intraspinal tumor with thecal sac compression, suspect malignancy Operative Method Left C1 hemilaminectomy for total tumor excision Specimen Count And Types 1 piece About size:1X1.5X2cm Source:C1 intraspinal tumor Pathology Pending Operative Findings The posterior ring of the C1 was thick than usual and erosion of left posterior arch was noted. The tumor was yellowish, firm to elastic, well-capsulated, hypervascularized, and 2.4x1.7x2.1cm in size. There were much fibrotic bands between thecal sac and the tumor capsule. The tumor was originated from left C1 root and left C1 rhizotomy was performed for total tumor excision. No CSF leakage or SSEP change after whole procedure. The thecal sac expanded slightly after tumor excision. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in prone position with head fixed with Mayfield scalp clamp. The skin was shaved, scrubbed, and disinfected as usual. Midline skin incision from inion to C2 level was performed. The subcutaneous soft tissue and paravertebral muscle group were devided and detached. The spinous process of C2 and posterior arch of C1 was identified. The tumor was noted after dissected the epilaminal soft tissue. Left C1 hemilaminectomy was done with Kerrison punche. Central debulking of the tumor was performed first and the capsule was dissected with microdissector and microscissor. The stump of left C1 root was transected after ligation with 2-0 silk and coagulated with bipolar electrocautery. Hemostasis was achieved with bipolar electrocautery, Surgicel lining, and Gelform packing. The wound was irrigated with normal saline and one CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS 曾勝弘 Assistants R4李振豪, R1羅偉誠 謝文章 (M,1962/05/25,49y9m) 手術日期 2010/11/30 手術主治醫師 曾勝弘 手術區域 東址 002房 02號 診斷 Brain cancer 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 11:55 報到 12:30 進入手術室 12:38 麻醉開始 13:05 誘導結束 13:06 抗生素給藥 13:10 手術開始 16:06 抗生素給藥 17:10 麻醉結束 17:10 手術結束 17:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 摘要__ 手術科部: 外科部 套用罐頭: Left frontal craniotomy for tumor excision 開立醫師: 李振豪 開立時間: 2010/11/30 17:42 Pre-operative Diagnosis Left frontal tumor, suspect GBM recurrence Post-operative Diagnosis Left frontal tumor, suspect GBM recurrence Operative Method Left frontal craniotomy for tumor excision Specimen Count And Types 1 piece About size:3x3.5x3cm Source:Left frontal tumor Pathology Pending Operative Findings The tumor was gray-yellowish in color, gelatinous, moderate vascularized, and ill-defined in character. The normal brain was mild yellowish which post-irradiation change was favored. The dura was partially invaded and removed with the tumor. The cystic component was connected to the left lateral ventricle due to previous operation. The CSF was sampled for routine, BCS, bacterial culture, and cytology. Intra-operative sonography was used for tumor localization. The main trunk of ACA was well preserved. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine position with head fixed with Mayfield scalp clamp. The scalp was shaved, scrubbed, and disinfected as usual. The scalp incision was made along operative scar over bicoronal area. The scalp flap was elevated and the periosteum was preserved. The previous craniotomy was identified after elevation of the periosteal flap. The screws and miniplates were removed and the skull plate was removed by elevator and dissector. C-shape durotomy based with superior sagittal sinus was done. CSF sampling was performed after opening the cystic part of the tumor. The specimen will be sent for cytology, routine, BCS, and bacterial culture. Left frontal lobectomy along the craniotomy window edge was performed with sucker, bipolar electrocautery, and dissector. The mesial frontal lobe also resected according to MRI finding. Hemostasis was achieved with bipolar electrocautery and Surgicel lining. The lateral ventricle was occluded with one large Gelform packing. Duroplasty with periosteal flap was done and the skull plate was fixed back with miniplates and screws. One large Gelform was placed between the dura and the skull plate. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS曾勝弘 Assistants R4李振豪, R1羅偉誠 林郁真 (F,2009/10/28,2y4m) 手術日期 2010/11/30 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Ependymoma 器械術式 Brain tumor Crainotomy(Others) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 09:00 進入手術室 09:00 報到 09:02 麻醉開始 10:10 誘導結束 10:40 抗生素給藥 10:53 手術開始 13:40 抗生素給藥 14:50 開始輸血 16:20 麻醉結束 16:20 手術結束 16:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4~8小時 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 7 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 3 0 麻醉 Hemoglobin (Hb) 3 0 麻醉 測血糖 3 0 麻醉 Ca (Calcium) 3 0 麻醉 Na (Sodium) 3 0 麻醉 K (Potassium) 3 0 麻醉 Blood gas analysis 3 0 記錄__ 手術科部: 外科部 套用罐頭: Far-lateral apporach with partial tumor excision 開立醫師: 林哲光 開立時間: 2010/11/30 17:42 Pre-operative Diagnosis Suspected right cerebellar peduncle glioma with brainstem and cerebellum compression Suspected right cerebellar peduncle glioma with brainstem and cerebellum extension Post-operative Diagnosis Suspected high grade glioma or ependymoma 1. high grade glioma or ependymoma at right cerebellar peduncle or foramen of Luschka with pontine, prepontine, cerebellomedullary cistern, and cerebellar extension. 2. tumor bleeding at the lower part Operative Method Far-lateral apporach with partial tumor excision Suboccipital craniotomy and transtelovelar apporach with subtotal tumor excision Specimen Count And Types Pathology Fozen reported high grade glioma or susepcted ependymoma Fozen reported high grade glioma or susepcted ependymoma (no rosette formation was noted in the frozen section tissue) Operative Findings A well-encapsulated greyish-yellowish mass lesion was noted at right cerebellomedullary junction. Some old blood clots were noted inside the cistern and covered the low cranial nerves. Tumor bleeding was suspected. The tumor was soft-elastic, greyish-yellowish, nodularity, with some nerves and vessles were encased inside the tumor. There was previous bleeding at the lower part of the tumor. The tumor part here was covered with abundant blood vessels. 2. The tumor was well-encapsulated in some part. It was greyish-pinkish, hypervacular, and fragile. It originated from the right inferior cerebellar peduncle dor the foramen of Luschka, and indentated into the right side brainstem. It also extended to the prepontine and right cerebellomedullary cistern. Some old blood clots were noted inside the cistern and covered the low cranial nerves. Previous tumor bleeding was suspected. Some nerves and vessles were encased inside the tumor, especially the lower part of the tumor. Operative Procedures Under ETGA and prone position, skin disinfected and drapped were performed as usual. Mildline skin incision was made through inion to the C2 level. The paraspinal muscles were detached in the midline and C2 spinous process was identified. 4 burr holes were created near the foramen magnum and transverse sinus and craniotomy was then performed. The dura was then opened in reverse Y-shaped with sinus side as the base. The arachnoid membrane was excised and opened and cerebellomedullary cistern was opened. The tumor was exposed and some hematoma was noted. Hematoma was evacuated at first and some greyish-yellowish nodularity components were noted and tumor excision was performed. Dura was then closed in water-tie and reinforced with Tissu cul-do. Skull bone was then put back and fixed with wires. The wound was then closed in layers. Under ETGA and prone position, skin disinfected and drapped were performed as usual. Mildline skin incision was made through inion to the C2 level. The paraspinal muscles were detached in the midline. 4 burr holes were created then craniotomy was performed from below the transverse sinuses to the foramen of magnum. The dura was then opened in reverse Y-shaped with sinus side as the base. The arachnoid membrane was excised and opened and cisterna magnum to release the CSF. The brain became slacken. Under microscopic view, transtelovelar approach was done to the right side. The cerebellum was retracted to the lateral side to expose the lower part of the 4th ventricle. The tumor was identified and some hematoma was noted at its lower part. Hematoma was evacuated at first then tumor debulking was performed as much as possible till some brainstem was identified and the cistern was exposed. The lower part of the tumor was try to be removed, but it was penetrated by abundant vessels and some possible nerved, so this part was left. Dura was then closed in water-tie and reinforced with Tissu cul-do and Derofoam after meticulous hemostasis. Skull bone was then put back and fixed with 4 wires. The wound was then closed in layers. Operators AP 郭夢菲 Assistants R4 林哲光 相關圖片 高冏淯 (M,1931/03/12,81y0m) 手術日期 2010/11/30 手術主治醫師 蔡翊新 手術區域 東址 003房 04號 診斷 Cerebrovascular accident (CVA) 器械術式 Removal of ICH 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 3E 紀錄醫師 羅偉誠, 時間資訊 18:28 通知急診手術 18:28 臨時手術NPO 18:28 開始NPO 21:05 進入手術室 21:05 報到 21:10 麻醉開始 21:40 誘導結束 21:40 抗生素給藥 21:49 手術開始 22:15 開始輸血 00:40 抗生素給藥 01:00 麻醉結束 01:00 手術結束 01:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 1 L 手術 顱內壓視置入 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: CVA 開立醫師: 蔡翊新 開立時間: 2010/12/01 00:15 Pre-operative Diagnosis Left putaminal ICH. Post-operative Diagnosis Left putaminal ICH. Operative Method Left frontotemporal craniotomy for ICH evacuation; Right Kocher point EVD for ICP monitoring. Specimen Count And Types nil Pathology Nil. Operative Findings CSF was clear and the pressure was about 10 cmH2O. A 5.5 x 4.5 x 3.6 cm (45 ml) ICH was encountered at left putamen. There was no definite bleeder detected. After ICH evacuation, the brain became slack, 1 cm away from the dura. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with a sterilized adhesive plastic sheet. 4. A burr hole was made at right Kocher point to insert an EVD to right lateral ventricle. 5. Incision: left frontotemporal, curvilinear. The skin edge was clipped by Raney clips for temporary hemostasis. After scalp had been lifted, the temporalis muscle was incised and detached from temporal squama and reflected to lower temporal side. 6. Craniotomy: A 6 x 5 cm craniotomy was made at left frontotemporal area over-riding the Sylvian fissure with its center 5 cm above extenal ear canal. 7. Dural tenting: by 2/0 silk, 2 cm in interval, distributed along the edge of skull window. 8. Dural incision: cruciate. 9. The posterior part of left Sylvian fissure was opened to expose the insula. The subcortex and white mater was splitted by brain retractor and sucker until the intracerebral hematoma was exposed. The hematoma was sucked out carefully. The cavity was irrigated with NS and the blood oozing was stopped by Surgicel packing. Before closure of the dura, the hematoma caivty was clean and the brain once bulging was very slack. 10.Dural closure: a fascia graft was used, interrupted 2/0 silk sutures for key stitches, then continous sutures with 4/0 Prolene to obtain water-tight closure. 11.The craniotomy bone plate was fixed back with 3 miniplates and 6 screws. 12.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 13.Drain: none. 13.Drain: one subgaleal CWV drain. 14.Blood transfusion: PRBC 2U, Platelet 12U. Blood loss: 200 ml. 15.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R4曾峰毅R1羅偉誠 Indication Of Emergent Operation 林榮宗 (M,1946/05/26,65y9m) 手術日期 2010/11/30 手術主治醫師 賴達明 手術區域 東址 005房 02號 診斷 Lumbar Spondylosis 器械術式 Decompression of mediun nerve 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 陳德福, 時間資訊 16:00 報到 16:16 進入手術室 16:20 麻醉開始 16:25 誘導結束 16:30 手術開始 16:50 麻醉結束 16:50 手術結束 16:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 正中神經腕部減壓術-雙側 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: medium nerve decompression 開立醫師: 陳德福 開立時間: 2010/11/30 16:55 Pre-operative Diagnosis Right CTS Post-operative Diagnosis Right CTS Operative Method medium nerve decompression Specimen Count And Types nil Pathology nil Operative Findings The right medium nerve was compressed tightly by hypertrophic ligament Operative Procedures Under LA, the skin was disinfected as usual. Linear incision and dissect the soft tissue. The transver ligament was identified follwoed by nerve decompression. The wound was closed in layers. Operators VS 賴達明 Assistants R5 陳德福 謝美鳳 (F,1979/09/16,32y5m) 手術日期 2010/11/30 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Cervical fracture 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 張僖, 時間資訊 08:05 進入手術室 08:15 麻醉開始 08:25 誘導結束 08:37 報到 08:50 抗生素給藥 08:55 手術開始 11:50 手術結束 11:50 抗生素給藥 11:50 麻醉結束 12:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(每增加<=六節) 1 1 手術 脊椎融合術-後融合,無固定物 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: 1.C1-2 fixation with TAS and autologous bone-... 開立醫師: 陳德福 開立時間: 2010/11/30 12:07 Pre-operative Diagnosis C1-2 subluxation with spinal instability, rheumatoid arthritis related Post-operative Diagnosis C1-2 subluxation with spinal instability, rheumatoid arthritis related Operative Method 1.C1-2 fixation with TAS and autologous bone-wire fixation [Gallie] 2.Open reduction of C1-2 fracture/subluxation Specimen Count And Types nil Pathology nil Operative Findings 1.There are C1-2 subluxation and spinal instability. 2.The C1/2 fixation with transarticular screws[4.5mmx44mm; 4.5mmx42mm] was done. One autologous bone from the right posterior iliac crest was inserted into the C1-2 interspinous space with wire fixation [Gallie fasion]. 2.The C1/2 fixation with transarticular screws[4.5mmx44mm; 4.5mmx42mm] was done. One autologous bone from the right posterior iliac crest was inserted into the C1-2 interspinous space with Ticron fixation [Gallie fasion]. 3.The C1/2 was fused without instability after the surgery. Operative Procedures Under ETGA and prone position with head fixator fixation, the skin was disinfected and draped as usual. One linear incision along the midline was done for exposure the Occipital bone to C5 level. The string for Galle fixattion was inserted followed by identifying the insertion point of C1/2 TAS. Under Flouroscope, the C1/2 TAS were inserted smoothly. One bone graft was harvested from the right posterior superior iliac crest and the C1-2 interspinous process fusion was done as Galle fasion. One CWV was left in situ and the wound was closed in layers. Operators vs 賴達明 Assistants R5 陳德福 r1張僖 周以平 (M,1948/07/28,63y7m) 手術日期 2010/11/30 手術主治醫師 賴達明 手術區域 西址 033房 04號 診斷 Carpal tunnel syndrome 器械術式 Decompression of mediun nerve 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 11:43 進入手術室 12:05 麻醉開始 12:07 誘導結束 12:08 手術開始 12:35 手術結束 12:35 麻醉結束 12:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 正中神經或尺神經腕部減壓術–單側 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Carpal Tunnel Syndrome 開立醫師: 王奐之 開立時間: 2010/11/30 12:41 Pre-operative Diagnosis Carpal tunnel syndrome, right Post-operative Diagnosis Carpal tunnel syndrome, right Operative Method Carpal tunnel release, right Specimen Count And Types nil Pathology Nil Operative Findings The median nerve was compressed tightly by transverse retinaculum. Operative Procedures 1. The hand and forearm were sterilized with povidone-iodine tincture, then covered with stockinet. 2. Anesthesia: local anesthesia with 1% Xylocaine. 3. Incision: linear from vertical palmar crease to transverse wrist crease. 4. The palmaris longus tendon was identified, then the plamar aponeurosis was cut longitidinally along the ulnar side of the palmaris longus tendon. 5. The median nerve was identified beneath the palmars longus tendon. Under direct vision, the transverse carpal ligament was divided until no more pressure on the median nerve could be palpated. 6. The skin was closed by interrupted suture with 4/0 nylon. 7. The hand and wrist were draped with fluffy dressing and elastic bandage. Operators VS 賴達明 Assistants R5 鍾文桂 R3 王奐之 相關圖片 陳綏燕 (F,1953/12/01,58y3m) 手術日期 2010/11/30 手術主治醫師 陳敞牧 手術區域 西址 032房 03號 診斷 Carpal tunnel syndrome 器械術式 Decompression of mediun nerve 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 09:06 報到 10:40 進入手術室 10:58 麻醉開始 11:00 手術開始 11:18 麻醉結束 11:20 手術結束 11:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 正中神經或尺神經腕部減壓術–單側 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Carpal Tunnel Syndrome 開立醫師: 王奐之 開立時間: 2010/11/30 11:31 Pre-operative Diagnosis Carpal tunnel syndrome, right Post-operative Diagnosis Carpal tunnel syndrome, right Operative Method Carpal tunnel release, right Specimen Count And Types nil Pathology Nil Operative Findings The median nerve was compressed tightly by transverse retinaculum. The nerve sheath expanded well after decompression. Operative Procedures 1. The hand and forearm were sterilized with povidone-iodine tincture, then covered with stockinet. 2. Anesthesia: tourniquet was applied at distal upper arm, then regional block with 15 ml 1% Xylocaine solution was infused through cephalic vein catheter at wrist area. 3. Incision: linear from vertical palmar crease to transverse wrist crease. 4. The palmaris longus tendon was identified, then the plamar aponeurosis was cut longitidinally along the ulnar side of the palmaris longus tendon. 5. The median nerve was identified beneath the palmars longus tendon. Under direct vision, the transverse carpal ligament was divided until no more pressure on the median nerve could be palpated. 6. The skin was closed by interrupted suture with 4/0 nylon. 7. The hand and wrist were draped with fluffy dressing and elastic bandage. Operators VS 陳敞牧 Assistants R5 鍾文桂, R3 王奐之 相關圖片 韓其芳 (M,1965/02/01,47y1m) 手術日期 2010/11/30 手術主治醫師 蕭輔仁 手術區域 東址 003房 03號 診斷 Herniation of intervertebral disc, lumbar (HIVD) 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 張僖, 時間資訊 16:00 報到 16:38 進入手術室 16:50 麻醉開始 17:00 誘導結束 17:00 抗生素給藥 17:28 手術開始 19:48 手術結束 19:48 麻醉結束 20:04 進入恢復室 20:05 送出病患 21:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術(減壓)-二節以內 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 摘要__ 手術科部: 外科部 套用罐頭: 1.L3-4 partial laminectomy 開立醫師: 陳德福 開立時間: 2010/11/30 19:49 Pre-operative Diagnosis L3/4 &L4;/5 HIVD and spondylosis with spinal stenosis Post-operative Diagnosis L3/4 &L4;/5 HIVD and spondylosis with spinal stenosis Operative Method 1.L3-4 partial laminectomy Specimen Count And Types nil Pathology nil Operative Findings 1.There is hypertrophic facet joints, hypertrophic ligamentum flavum, and HIVD over the L3/4 and L4/5 with spinal stenosis. The theca sac was compressed tightly. 2.Partial L3 and total L4 laminectomy was done for decompression. Operative Procedures Under ETGA and prone position, the skin was disinfected and draped as usual. Linear incision followed by displacing the paraspinous muscle laterally, the partial L3 and total L4 laminectomy was done. The wound was then closed in layers with one CWV drainage. Operators VS 賴達明 VS 蕭輔仁 Assistants R5 陳德福 R1張僖 楊濰萍 (F,1969/07/06,42y8m) 手術日期 2010/11/30 手術主治醫師 王國川 手術區域 東址 001房 02號 診斷 Brain metastasis 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 08:53 通知急診手術 10:50 報到 11:28 進入手術室 11:35 麻醉開始 12:00 誘導結束 12:30 抗生素給藥 12:39 手術開始 15:30 抗生素給藥 15:50 麻醉結束 15:50 手術結束 16:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 記錄__ 手術科部: 外科部 套用罐頭: craniotomy for total tumor excision 開立醫師: 胡朝凱 開立時間: 2010/11/30 16:17 Pre-operative Diagnosis Right frontal metastatic tumor Post-operative Diagnosis Right frontal metastatic tumor Operative Method craniotomy for total tumor excision Specimen Count And Types pieces of tumor Pathology pending Operative Findings 1.One grape like tumor located atright frontal lobe without atachment to the frontal dura. The color was yellowish. And there was acystic part with motor like material inside. 2.The wall was thin and the plane was clear. 3.Frontal sinus was opened and was sealed with one piece of periosteum Operative Procedures 1.ETGA, supine 2.Bicorona skin incision 3.Reflect skin flap downward 4.Craniotomy 5.Dural tenting 6.U shape durotomy with the base left at midline 7.The posterior part of tumor was dissected initially 8.The cyst part was opened and the content was drained out. 9.The tumor was further dissected along the border 10.Total tumor excisin was achieved 11.Hemostasis 12.Dural closure 13.Fixed bone back with miniplate 14.Set one CWV drain then close woun in layers Operators 王國川 Assistants 胡朝凱, Ri Indication Of Emergent Operation 李徐昭慧 (F,1947/12/01,64y3m) 手術日期 2010/12/01 手術主治醫師 杜永光 手術區域 東址 005房 02號 診斷 Herniation intervertebral disc without myelopathy, thoracic (HIVD) 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳蔚蔚, 時間資訊 13:10 報到 13:25 進入手術室 13:35 麻醉開始 13:45 誘導結束 13:55 抗生素給藥 14:20 手術開始 16:35 手術結束 16:35 麻醉結束 16:45 送出病患 16:47 進入恢復室 18:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 椎弓切除術(減壓)-二節以內 1 1 摘要__ 手術科部: 外科部 套用罐頭: L4 &5 parital laminectomy 開立醫師: 陳德福 開立時間: 2010/12/01 16:38 Pre-operative Diagnosis L4/5 HIVD, recurrent Post-operative Diagnosis L4/5 HIVD, recurrent Operative Method L4 &5 parital laminectomy Specimen Count And Types nil Pathology nil Operative Findings 1.There is severe adhesion over previous operation field at L4/5 interlamina space. The right L5 nerve root was surounded by fibrotic tissue. 2.L4/5 partial laminectomy was done for decompression. Operative Procedures Under ETGA and prone position, the skin was didinfected and draped as usual. One linear along previous operation scar was done followed by displacing the paraspinous muscle lateral over the right side. The L4/5 partial laminectomy was done and the residual ligamentum flavum was remvoed as well. The nerve root was identified and severe adhesion was noticed. The wound was then closed in layers. Operators VS蕭輔仁 Assistants R5陳德福 R1陳蔚蔚 夏睿 (M,2000/04/03,11y11m) 手術日期 2010/12/01 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Other named variants lymphoma, lymph nodes of head face and neck 器械術式 Brain tumor Crainotomy(Others) 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 12:07 報到 12:18 進入手術室 12:22 麻醉開始 12:43 誘導結束 13:10 抗生素給藥 13:28 手術開始 15:10 開始輸血 16:00 抗生素給藥 16:05 麻醉結束 16:05 手術結束 16:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦組織活體切片 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Right occipital craniotomy for tumor biopsy 開立醫師: 李振豪 開立時間: 2010/12/01 16:48 Pre-operative Diagnosis Perifalcial tumor, nature to be determined? Perifalcial tumor with diffuse meningeal spreading, nature to be determined? Post-operative Diagnosis Perifalcial tumor, nature to be determined? Perifalcial tumor with diffuse meningeal spreading, nature to be determined? Operative Method Right occipital craniotomy for tumor biopsy Specimen Count And Types 2 pieces About size:swab x 4 Source:Subdural tumor About size:multiple small pieces of the tumor Source:Subdural tumor Pathology Frozen section: much pleomorphic cell was noted. Suspect malignancy. Infectious process is not favored. Frozen section: much pleomorphic cells was noted. Suspect malignancy. Infectious process is not favored. Operative Findings Multiple white-yellowish, elastic to firm, hypervascularized, well-defined lesions were noted after dural opening. Thickening of the arachnoid membrane around the nodular lesion also noted. The nodular lesion was extended from dura to falx. The brain was severe swelling but not hard in character. 1. The brain was marked swelling that herniated out when the dura was opened. It persisted to be swelling during the whole course of operation though not hard in character. due to marked brain swelling, retraction of the brain to expose the main lesion at the parafalcine region was not possible. 2. Multiple white-yellowish, elastic to firm, hypervascularized, well-defined lesions were noted after dural opening on the subdural and subarachnoid spaces. Thickening of the arachnoid membrane around the nodular lesion also noted. The nodular lesion was extended from below the dura at the parasagittal area to falx. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in prone position with head fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. The hockey stick scalp incision was made at right occipital area. The scalp flap and the periosteum was elevated. Six burr holes were created followed by one 6x8cm craniotomy window. After dural tenting, the U-shape dural incision was made based with superior sagittal sinus. The brain bulging out after dural opening. The subdural tumor and parafalcial tumor biopsy was performed and sent for frozen section. Hemostasis was achieved with bipolar electrocautery, Surgicel, and Gelform packing. The dura was then closed with 4-0 Prolene. One 2x2 inches Duraform was covered and the skull plate was fixed back with 3 miniplates and 6 screws. One subgaleal CWV drain was placed and the wound was closed in layers with 2-0 Vicryl and 3-0 Nylon. Under endotracheal tube general anesthesia, the patient was put in prone position with head fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. The hockey-stick scalp incision was made at right occipital area. The scalp flap and the periosteum was elevated. Six burr holes were created crossing the medline followed by one 6x8cm craniotomy window. After dural tenting, the U-shape dural incision was made based with superior sagittal sinus. The brain bulged out so much after dural opening that some mild cortical abrasions were noted after the dura was opened. We covered the abrasion area with surgicel and gelfoam. During the whole course of surgery, we needed to keep on press the exposed cortex to prevent further bulging out of the brain. The subdural tumor and superior parafalcial tumor biopsy was performed and sent for frozen section under microscope. Hemostasis was achieved with bipolar electrocautery, Surgicel, and Gelform packing. The dura was then closed with 4-0 Prolene. One 2x2 inches Duraform was covered and the skull plate was fixed back with 3 miniplates and 6 screws. One subgaleal CWV drain was placed and the wound was closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators AP郭夢菲 Assistants R4李振豪, Ri黃柔瑄 相關圖片 洪茂坤 (M,1948/02/10,64y1m) 手術日期 2010/12/01 手術主治醫師 李章銘 手術區域 東址 019房 01號 診斷 Liver cancer 器械術式 Thoracoscopy+Open Chest 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 蔡東明, 時間資訊 08:08 報到 08:17 進入手術室 08:30 麻醉開始 08:50 誘導結束 09:23 抗生素給藥 09:57 手術開始 12:40 麻醉結束 12:40 手術結束 13:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 胸腔鏡肺膜剝脫術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: VATS biopsy 開立醫師: 蔡東明 開立時間: 2010/12/01 12:50 Pre-operative Diagnosis Empyema, right Post-operative Diagnosis Empyema, right Operative Method VATS decortication Specimen Count And Types 1 piece About size:4*4 Source:Pleura Pathology Pending Operative Findings 1.Much yellowish and lobulated pleural effusion in right thoracic cavity. The amount is 1800ml. 2.Thickness and fibrin pias were noted at right pleura space. After decortication, the lungs expanded well without restriction or air-leakage. Operative Procedures 1. Anesthesia: General anesthesia using double-lumen endotracheal tube. 2. Position: left decubitus position. An axillary roll is placed under the down side. The operative field is well disinfected and draped. 3. Camera port: From the seventh intercostal space in the mid-axillary line away from the lesion. 4. Working ports: First: From the fifth intercostal space in the anterior axillary line. Second: From the fifth intercostal space in the posterior axillary line. 5. The pleural adhesions are separated by grasping forceps and by electrocautery. Suction of right thoracic fluid and perform decortication. 6. The specimen issent for pathological examination and TB, fungus, and bacteria cultures. 9. After meticulous homeostasis, two 28# chest tubes is placed via the camera port. The lung is ventilated under the direct vision. The skin is closed with 4-0 Nylon sutures. Operators VS李章銘 Assistants R4蔡東明 Ri嚴正翰 林夢玉 (F,1956/12/24,55y2m) 手術日期 2010/12/01 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Aneurysm 器械術式 Craniotomy(Aneurysms) P-DUH 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 游健生, 時間資訊 07:50 報到 08:05 進入手術室 08:15 麻醉開始 08:55 誘導結束 09:00 抗生素給藥 09:10 手術開始 12:05 抗生素給藥 15:05 抗生素給藥 17:20 開始輸血 17:35 麻醉結束 17:35 手術結束 17:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 11 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 開顱術摘除血管病變 - 腦血管瘤 無病徵的 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Left Dolenc"s approach for aneursym clipping 開立醫師: 游健生 開立時間: 2010/12/01 18:06 Pre-operative Diagnosis Left internal carotid paraclinoidal aneurysm Post-operative Diagnosis Left internal carotid paraclinoidal aneurysm Operative Method Left Dolenc"s approach for aneursym clipping Specimen Count And Types nil Pathology Nil Operative Findings A 6.19 x 4.79 mm aneursym was seen at medial side of distal part of ICA cavernous portion pointing posterior-inferiorlly. Part of the aneursym was intradural evidenced by distal dura ring crossing it. Two fenestrated curved-blade Sugita clips were used to clip the neck of aneursym in facing fashion. The patency of ICA was checked by intra-operative indocyanine angiography. No enhancement was seen in aneursym after clipping. The petrous part of ICA was exposed for proximal control with Forgaty catheter insertion after drilling of the petrous ridge lateral to GSPN. Operative Procedures Under ETGA, patient was in supine position with head fixed with Mayfield headclamp. Her head was rotated 30degrees to right and downward about 15degrees. After shaving, we disinfected and draped the operation field including left neck for proximal control as usual. A curvilinear scalp incision from 1cm anterior to tragus, extending superiorly, then curved anteriorly from superior temporal line to midline just behind hairline. The skin flap was elevated and reflected anteriorly together with Yarsagil fatpad. Temporalis muscle flap was elevated and reflected anteriorly with muscle cuff at superior temporal line. Frontotemporal craniotomy was done with three burrholes at keyhole, base of temporal bone squamous portion, and posterior limit of exposed superior temporal line. Anterior extension was parellel to superior orbital rim and frontal sinus was opened. We removed the mucosa followed by the posterior wall removal. Dura tenting along the posterior border of craniotomy window. Dura was dissected away from skull base to expose sphenoid ridge followed by drilling. The roof and lateral wall of optic canal were drilled with diamond bur to paper-thin and removed easily by microdissector. Optic strut was drilled in the same way to expose cavernous sinus. The foramen spinosum and middle meningeal artery were exposed by gentle elevation of temporal tip followed by artery ligation and division. The greater superficial petrosal nerve was identified after extraudural dissection medially. The petrosal portion of ICA was exposed after drilling of the roof of carotid canal (petrosal bone lateral to GSPN). A 5F Fogarty catheter was inserted into carotid canal as proximal control. A curved durotomy along the superior craniotomy window was done. We cut the dura flap in half straightly deep to C4 segment of ICA. We identified the porximal and distal dura ring and opened latter to expose the lateral wall of cavernous sinus. After opening the lateral wall, we exposed the cavernous portion of ICA by repeat Gelfoam packing and cutting the septa inside cavernous sinus. After mobilzation of cavernous portion of ICA, an aneursym was seen at the medial side of distal part pointing posterior-inferiorlly. Two fenestrated curved-blade Sugita clips were used to clip the neck of aneursym in facing fashion. The patency of ICA was checked by intra-operative indocyanine angiography. No enhancement was seen in aneursym after clipping. Hemostasis was achieved with Gelfoam packing. Dura was closed with 4-0 prolene continuous suture. Fogarty catheter was removed. Dura tenting along the anterior border of craniotomy window was done. Frontal sinus was packed with Betadine-soaked Gelfoam and sealed with fascia. After central tenting, bone flap was fixed back with mini-plates. An epi-cranial CWV drain was placed. Wound was closed in layers. Operators Prof. 杜永光 Assistants R6 胡朝凱 R3 游健生 莊春月 (F,1967/03/09,45y0m) 手術日期 2010/12/01 手術主治醫師 蔡瑞章 手術區域 東址 005房 01號 診斷 Benign neoplasm of cerebral meninges 器械術式 Cranioplasty，V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:10 進入手術室 08:20 麻醉開始 08:30 誘導結束 09:00 抗生素給藥 09:50 手術開始 12:00 抗生素給藥 13:00 手術結束 13:00 麻醉結束 13:10 送出病患 13:12 進入恢復室 14:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 頭顱成形術 1 2 R 手術 腦室腹腔分流手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 復健部 套用罐頭: 1. Cranioplasty. 開立醫師: 鍾文桂 開立時間: 2010/12/01 13:23 Pre-operative Diagnosis 1. Skull bone defect, right frontal-temporal-parietal. 2. Hydrocephalus. Post-operative Diagnosis 1. Skull bone defect, right frontal-temporal-parietal. 2. Hydrocephalus. Operative Method 1. Cranioplasty. 2. Ventriculoperitoneal shunt implantation via right Kocher. Specimen Count And Types 1 piece About size:CSF Source:For routine, BCS and bacterial culture. Pathology Nil. Operative Findings Codman 10mmH2O V-P shunt was implanted. ventricular catheter: 7cm, peritoneal catheter: 25cm. Cranioplasty with autologous bone, repaired with defects with bone cements. Operative Procedures Under ETGA, the patient was placed in supine position and the head was tilted to the left. After shaving, disinfection, and draping, the previous craniectomy wound was incised.Dissected was made to seperate the galea and dura mater. A burr hole was drilled on the right Kocher point. After durotomy, negaton tube was inserted through the ventriculostomy. A linear incision was made at right upper quadrant of abdomen. Peritoneal cavity was reached. Tunnel passer was inserted. After connected the V-P shunt catheters, the ventricular and peritoneal cathters were implanted through ventriculostomy and to peritoneal cavity. The shunt system was checked for its patency. The two pieces of autologous bone was connected by wires and miniplates and screws. The bone plates were fixed by plates and screws. The skull defect was repaired with bone cement. After placing one subgaleal CWV drain, the wound was closed in layers. Operators V.S. 蔡瑞章 王國川 Assistants 鍾文桂 陳蔚蔚 王維錦 (M,1927/03/23,84y11m) 手術日期 2010/12/01 手術主治醫師 賴達明 手術區域 東址 002房 02號 診斷 Other specified pulmonary tuberculosis, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 鍾文桂, 時間資訊 13:15 進入手術室 13:20 麻醉開始 13:21 誘導結束 13:38 手術開始 14:20 手術結束 14:20 麻醉結束 14:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 氣管切開術 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Tracheostomy. 開立醫師: 鍾文桂 開立時間: 2010/12/01 14:34 Pre-operative Diagnosis Respiratory failure. Post-operative Diagnosis Respiratory failure. Operative Method Tracheostomy. Specimen Count And Types nil Pathology Nil. Operative Findings Tracheostomy tube Fr 8.0 was inserted. Operative Procedures Under general anesthesia, the patient was placed in supine position and the head was in midline position. A horizontal incision was made 2 finger breath above the sternal notch. Through midline dissection, the tracheal rings were reached. Linear incision was made on the tracheal ring. Then, the tracheostomy tube was inserted. After ensuring good ventilation through the tracheostomy tube, the opened wound was closed with one stich. Operators V.S. 賴達明 Assistants 鍾文桂 陳德福 洪萬男 (M,1939/07/25,72y7m) 手術日期 2010/12/01 手術主治醫師 蔡翊新 手術區域 東址 002房 04號 診斷 腦內出血 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 3E 紀錄醫師 羅偉誠, 時間資訊 18:00 開始NPO 00:36 通知急診手術 01:21 進入手術室 01:25 麻醉開始 01:50 誘導結束 01:50 抗生素給藥 02:02 手術開始 02:55 手術結束 02:55 麻醉結束 03:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱內壓視置入 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: CVA 開立醫師: 曾峰毅 開立時間: 2010/12/01 02:30 Pre-operative Diagnosis Left thalamic ICH with IVH and obstructive hydrocephalus Post-operative Diagnosis Left thalamic ICH with IVH and obstructive hydrocephalus Operative Method External ventricular drainage via right Kocher point Specimen Count And Types Nil Pathology Nil Operative Findings Bloody CSF was drained out while ventricular puncture. Opening pressure was about 8cmH20. Ventricular catheter was about 6.5cm long. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position. After head shaved, scrubbed, disinfected, and then draped, we made one transverse linear skin incision at right frontal area. We drilled one burr hole, and created durotomy. After ventricular puncture, we inserted ventricular catheter. The catheter was fixed on the skin, and the wound was closed in layers. Operators VS 蔡翊新 Assistants R3 古恬音 R1 羅偉誠 Indication Of Emergent Operation 李玉珍 (F,1939/08/05,72y7m) 手術日期 2010/12/02 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Subdural hemorrhage following injury, with no loss of consciousness 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 李振豪, 時間資訊 07:38 報到 08:05 進入手術室 08:15 麻醉開始 08:20 誘導結束 09:00 抗生素給藥 09:07 手術開始 10:20 手術結束 10:20 麻醉結束 10:25 送出病患 10:26 進入恢復室 11:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 頭顱成形術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Cranioplasty with autologous skull plate 開立醫師: 李振豪 開立時間: 2010/12/02 10:10 Pre-operative Diagnosis Right skull defect Post-operative Diagnosis Right skull defect Operative Method Cranioplasty with autologous skull plate Specimen Count And Types nil Pathology Nil Operative Findings Total three miniplates(2-3-3 holes), six screws, and autologous skull plate were used for cranioplasty. No CSF leakage was noted during whole procedure. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine position with head rotated to left. The scalp was shaved, scrubbed, and disinfected as usual. The scalp incision was made along operative scar over right frontotemporoparietal area and the bone edge of the skull defect was exposed. Central tenting with six 2-0 silk were done and the skull plate was fixed back with three miniplates and 6 screws. Bone cement for cranioplaty and reconstruction of temporalis muscle was applied. After irrigation with gentamicin solution, one subgaleal CWV drain was placed and the wound was closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS王國川 Assistants R4李振豪, Ri廖書翎 相關圖片 李宗哲 (M,1979/12/15,32y2m) 手術日期 2010/12/02 手術主治醫師 林峰盛 手術區域 西址 035房 06號 診斷 Lung cancer 器械術式 Nerve block / PC 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 林峰盛 ASA 3 紀錄醫師 賴佳欣, 時間資訊 05:00 臨時手術NPO 17:20 進入手術室 17:25 麻醉開始 17:27 誘導結束 17:36 手術開始 18:30 手術結束 18:30 麻醉結束 18:35 進入恢復室 19:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 神經分離術–肩,臀關節以上,包括臂神經叢,坐骨神經 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 記錄__ 手術科部: 麻醉部 套用罐頭: Thoracic paravertebral neurolysis 開立醫師: 林峰盛 開立時間: 2010/12/02 18:28 Pre-operative Diagnosis Lung ca with T8-T10 metastasis Post-operative Diagnosis Lung ca with T8-T10 metastasis Operative Method Thoracic paravertebral plexus neurolysis Specimen Count And Types nil Pathology nil Operative Findings Contrast medium spread in longitudinal paravertebral space but only below T10 level No epidural spreading Operative Procedures 1.Put patient in prone position with T spine flexion 2.IV general anesthesia with morphine midazolam and fentanyl titration 3.Locate T10 vertebral body by C-arm. 4.Check needle trajectory to paravertebral space by ultrasound. 5. Insert 22G insulated needle toward T11-T12 level under tunnel view and realtime ultrasound guidance 6. Check needle movement under AP and lateral view 7. Locate needle tip at paravertebral space 8. Inject contrast medium to demonstrate longitudinal paravertebral space spreading and no epidural spreading 9. Inject 1% xylocaine 15 ml then inject 95% alcohol 15 ml for plexus destruction. 10. Check vital signs and send patient to PACU. Operators 林峰盛, Assistants 賴佳欣, 黃信男 (M,1967/06/12,44y9m) 手術日期 2010/12/02 手術主治醫師 陳敞牧 手術區域 東址 005房 02號 診斷 Spondyloisthesis, acquired 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 游皓鈞, 時間資訊 10:30 報到 11:25 進入手術室 11:30 麻醉開始 11:45 誘導結束 11:50 抗生素給藥 12:20 手術開始 14:54 抗生素給藥 15:30 開始輸血 16:40 手術結束 16:40 麻醉結束 16:46 進入恢復室 16:50 送出病患 17:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎間盤切除術-腰椎 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 記錄__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 曾峰毅 開立時間: 2010/12/02 16:36 Pre-operative Diagnosis Spondylolisthesis L4/5, grade II Post-operative Diagnosis Spondylolisthesis L4/5, grade II Operative Method L4/5 transforaminal lumbar interbody fusion with cage and autologous bone graft, fixation with transpedicular screws. Specimen Count And Types Nil Pathology Nil Operative Findings Grade II spondylolisthesis, 6.0x50mm screws x4, and 50mm rods x2. Cage height is 10mm. Blood loss: 3000ml. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After back scrubbed, disinfected and then draped, we made one midline skin incision from L3 spinous process to S1. We inserted transpedicular screws at bilateral pedicles of L4 and L5. We perfromed L4 laminectomy and L4/5 diskectomy. Fusion was done with banana cage and autologous bone graft. We fixed the screws with rods, and closed the wound in layers after two hemovacs. Operators VS 陳敞牧 Assistants R4 曾峰毅 R1 游皓鈞 童鈺翔 (M,1988/09/05,23y6m) 手術日期 2010/12/02 手術主治醫師 蕭輔仁 手術區域 東址 002房 01號 診斷 Abdominal pain, unspecified site 器械術式 1. Spinal fusion posterior 2. left radial head fracture ORIF 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2E 紀錄醫師 王政為, 陳德福, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 06:54 通知急診手術 08:30 進入手術室 08:35 麻醉開始 09:00 誘導結束 09:43 抗生素給藥 09:50 手術開始 12:43 抗生素給藥 15:43 抗生素給藥 16:10 18:20 麻醉結束 18:20 手術結束 18:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 橈骨、尺骨骨折開放性復位術 1 1 L 手術 石膏副木固定－長臂 1 0 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 12 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎弓切除術(減壓)-超過二節 1 2 摘要__ 手術科部: 外科部 套用罐頭: 1.T12-L1 discectomy 2.T11-L3 fixation with TP... 開立醫師: 陳德福 開立時間: 2010/12/02 15:32 Pre-operative Diagnosis L1 comminuted fracture with spinal cord compression Post-operative Diagnosis L1 comminuted fracture with spinal cord compression Operative Method 1.T12-L1 discectomy 2.T11-L3 fixation with TPS and autologous bone graft 3.T12-L1 laminectomy Specimen Count And Types nil Pathology nil Operative Findings 1.There is comminuted fracture of L1 with fracture-dislocation and spinal cord angulation. The left L2 facet joint fracture is also noticed. Epidural hematoma and massive subcutaneous hematoma are remarkable. 2.No frank CSF leakage during the operation. 3.T12-L1 laminecotmy for decompression and diskectomy were done smoothly. 4.The T11-T12-L2-L3 fixation was done with 8 TPS[5.5*40mm and 6.5*40mm] and autologous bone graft. Operative Procedures Under ETGA and prone position, the skin was disinfected and draped as usual. One linear incision over T10-L3 was done and the paraspinal muscle was displaced laterally. The TPS over T11-T12-L2-L3 were inserted. The T12-L1 laminectomy was done and the thecal sac was inspected. The T12-L1 diskectomy was also performed. The open reduction of the fracture dislocated spine was performed and the rods were fixed with one cross link. 2 hemovac was inserted and the wound was closed in layers. Operators VS蕭輔仁 Assistants R5陳德福 Indication Of Emergent Operation 記錄__ 手術科部: 骨科部 套用罐頭: Open reduction for fracture of radius,ulna 開立醫師: 黃哲南 開立時間: 2010/12/02 17:56 Pre-operative Diagnosis Left radial head fracture, Mason type IV Post-operative Diagnosis 1. Left radial head fracture, Mason type IV 2. Left ulna coronoid process tip fracture Operative Method ORIF with mini-plate, left radial head Specimen Count And Types nil Pathology Nil Operative Findings 1. Comminuted fracture of left radial head; one of the fragments (consisting about 15% of articular surface) was too small to be fixed 2. Minimally displaced fracture of tip of coronoid process; no gross posterior instability of elbow joint was noted Operative Procedures 1. ETGA, supine, on air-tourniquet 250mmHg 2. Skin disinfection and draping 3. Incision and dissection using Kocher`s approach; forearm was put in full-pronation during dissection to avoid injury to posterior interosseous nerve 4. Assemble radial head fragments using "on-table" technique, temporarily fix with 1.0mm K-wire and then apply two interfragmentary screws 5. Reduce radial head to radial neck and fix with 2.7mm buttress plate (5H5S) 6. Check ROM and stability 7. Normal saline irrigation, hemostasis, close wound in layers 8. Apply long arm splint Operators 王廷明 Assistants 王政為, 黃哲南 Indication Of Emergent Operation 王秀梅 (F,1949/05/30,62y9m) 手術日期 2010/12/02 手術主治醫師 蕭輔仁 手術區域 東址 003房 03號 診斷 Herniation of intervertebral disc (HIVD) 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 李振豪, 時間資訊 16:33 進入手術室 16:35 麻醉開始 16:40 誘導結束 16:50 抗生素給藥 17:10 手術開始 19:05 手術結束 19:05 麻醉結束 19:15 送出病患 19:17 進入恢復室 21:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-腰椎 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 外科部 套用罐頭: L4-5 microdiskectomy, left + sublaminar decom... 開立醫師: 李振豪 開立時間: 2010/12/02 19:25 Pre-operative Diagnosis Herniation of intervertebral disc, L4-5, left Post-operative Diagnosis Herniation of intervertebral disc, L4-5, left Operative Method L4-5 microdiskectomy, left + sublaminar decompression Specimen Count And Types nil Pathology Nil Operative Findings The left L5 root was tightly compressed by bulging disc and pushed posteriomedially. The root was decompressed well after microdiskectomy. The thecal sac was adhered with epidural soft tissue and ligment and incidental durotomy with 2mm in size was noted during the operation. The durotomy was repaired with 5-0 prolene to avoid further CSF leakage. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in prone position. The L4-5 disc space was localized by portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made with 3cm in length and the subcutaneous soft tissue was dissected. The left side paravertebral muscle group was detached to exposed left L4 lamina. Laminotomy was performed with high-speed air-drived drill. Sublaminar decompression was performed with Kerrison punches. Left L4 microdiskectomy was done with knife, curette, alligator, and disc clamp. The incidental durotomy was repaired and hemostasis was achieved with bipolar electrocautery and Gelform packing. The wound was then closed in layers with 2-0 Vicryl, 3-0 Dexon, and 4-0 Vicryl. Operators VS蕭輔仁 Assistants R4李振豪 黃阿梅 (F,1942/08/05,69y7m) 手術日期 2010/12/02 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 Spinal stenosis, lumbar 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 李振豪, 時間資訊 10:32 進入手術室 10:38 麻醉開始 10:50 誘導結束 11:20 抗生素給藥 11:29 手術開始 14:20 抗生素給藥 15:55 手術結束 15:55 麻醉結束 16:05 送出病患 16:12 進入恢復室 18:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎間盤切除術-腰椎 1 4 手術 椎弓切除術(減壓)-超過二節 1 2 摘要__ 手術科部: 外科部 套用罐頭: L2-4 laminectomy for decompression + L2-4 tra... 開立醫師: 李振豪 開立時間: 2010/12/02 16:18 Pre-operative Diagnosis L2-3, L3-4 spondylolisthesis with herniation of intervertebral disc and canal stenosis Post-operative Diagnosis L2-3, L3-4 spondylolisthesis with herniation of intervertebral disc and canal stenosis Operative Method L2-4 laminectomy for decompression + L2-4 transpedicular screws for posterio fixation and posterior lateral fusion with autologous bone graft + L3-4 microdiskectomy and fusion with #11 cage Specimen Count And Types nil Pathology Nil Operative Findings Scoliosis of L-spine was noted especially L3-4 level. L2-3 disc space was severe narrowing and microdiskectomy was failed. Marginal spur, hypertrophic ligmentum flavum, and herniation of intervertebral disc cause severe compression of the thecal sac and lateral recess stenosis. After decompression, the thecal sac expanded well. Instrumentation 1. L2: 6x40mm screws x 2 L3: 6x40mm screws x 2 L4: 6x45mm screws x 1(right), 6.5x45mm screws x 1(left) 2. Rods: 8cm x 2 3. Cross links: 5cm x 1 Operative Procedures Under endotracheal tube general anesthesia, the patient was put in prone position. The location of L2 to L4 pedicle were confirmed by portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. The midline skin incision from L2 to L4 level was made and the subcutaneous soft tissue was dissected. The paravertebral muscle group was detached for expose of L2 to L4 lamina and facet joints. L2 to L4 laminectomy was performed for decompression. L2 to L4 transpedicular screws were placed under C-arm portable X-ray guided. L2-3 microdiskectomy was tried but failed due to severe narrowing of the disc space. L3-4 microdiskectomy was done and one #11 PEEK cage was placed. Hemostasis was achieved and the TPS were set up with two rods and one cross-links. One Hemovac drain was placed and the wound was then closed in layers. Operators VS王國川 Assistants R4李振豪, Ri廖書翎 張桂伸 (M,1934/12/15,77y2m) 手術日期 2010/12/02 手術主治醫師 蔡翊新 手術區域 東址 005房 01號 診斷 Major trauma rated 16 or above on the severeity scale ( Injury severeity score >=16 ) 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 游皓鈞, 時間資訊 07:48 報到 08:09 進入手術室 08:20 麻醉開始 08:30 誘導結束 08:50 抗生素給藥 09:00 手術開始 10:55 手術結束 10:55 麻醉結束 11:05 送出病患 11:10 進入恢復室 12:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 頭顱成形術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 外科部 套用罐頭: Cranioplasty 開立醫師: 蔡翊新 開立時間: 2010/12/02 10:46 Pre-operative Diagnosis Right F-T-P skull defect. Post-operative Diagnosis Right F-T-P skull defect. Operative Method Cranioplasty with autologous bone graft. Specimen Count And Types nil Pathology Nil. Operative Findings A 14 x 12 cm skull defect at right F-T-P area. The temporalis muscle adhered tightly to the dura and detachment was so difficult that we did not elevate it. The brain was swollen during the operation, but the bone could still be placed back. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation:shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with a sterilized adhesive plastic sheet. 4. Incision: along the previous operation scar at right F-T-P area, Raney clips were apllied to the scalp edge for temporary hemostasis. 5. The right frontotemporoparietal scalp was dissected away from the underlying dura. 6. The bleeders on the dissected surfaces were coagulated with Bovie painstakingly. 7. The edge of the skull defect was exposed. 8. The original skull plate preserved at bone bank was soaked with Gentamicin solution and placed back to the skull window then fixed by 3 miniplates and 6 screws, and two dural tenting at the center of the skull plate. 9. Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by interrupted, mattressed suture with 3/0 nylon. 10.Drain: two, epidural, CWV. 11.Blood transfusion: nil. Blood loss: 150 ml. 12.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R4曾峰毅R1游皓鈞 鄭祺永 (M,2010/07/21,1y7m) 手術日期 2010/12/03 手術主治醫師 郭夢菲 手術區域 兒醫 065房 02號 診斷 Macrocephalus 器械術式 Subduro-peritoneal shunt + external drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 蕭柏妮 ASA 2 紀錄醫師 李振豪, 時間資訊 20:46 通知急診手術 00:00 開始NPO 00:00 臨時手術NPO 14:30 報到 14:35 進入手術室 14:36 麻醉開始 14:42 誘導結束 15:15 手術開始 15:45 抗生素給藥 17:20 麻醉結束 17:20 手術結束 17:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 手術 腦室腹腔分流手術 1 1 R 記錄__ 手術科部: 套用罐頭: Right subduro-peritoneal shunt implantation 開立醫師: 李振豪 開立時間: 2010/12/03 18:05 Pre-operative Diagnosis Bilateral subdural collection Post-operative Diagnosis Bilateral subdural hematoma Operative Method Right subduro-peritoneal shunt implantation Specimen Count And Types 1 piece About size:6ml Source:subdural collection Pathology Nil Operative Findings The opening pressure is much more than 10cmH2O. The initial character of the subdural collection was brownish and turned to bloody later. The specimen was sampled for routine, BCS, and culture(bacteria, fungus, and mycobacteria). BP drop was noted after release the subdural collection. The bloody subdural collection was placed for more than 20minutes and no blood clot formation was noted. Old blood was favored. After normal saline irrigation, the character became light reddish. Intra-operative echo was checked and no obvious newly change of brain parenchyma noted. The opening pressure is much more than 10cmH2O. The initial character of the subdural collection was brownish and turned to to be bright red later. There was no clot formation of the subdural fluid. The specimen was sampled for routine, BCS, and culture(bacteria, fungus, and mycobacteria). BP drop to 69 mmHg was noted for a short period of time after slowly release of the subdural collection. but soon correctoed to be more than 80 mmHg. The bloody subdural collection was placed for more than 20minutes and no blood clot formation was noted. Old blood was favored. After normal saline irrigation, the character became light reddish. Intra-operative echo was checked and no obvious newly change of brain parenchyma and no medline shift noted. The length of subdural and peritoneal catheter was 4cm and 30cm respectively and connected with one connector. No reservoir was placed. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine position with head rotated to left. The scalp was shaved, scrubbed, and disinfected as usual. Linear skin incision was made at right temporal area and the temporalis msucle was splitted. Curette and Ronguer were used for creation of burr hole followed by two dural tenting. One transverse skin incision was made at right abdomen for minilaparotomy. After opening of the peritoneum, the peritoneal catheter was placed with 30cm in length. The subcutaneous tunnel from right abdomen, forechest, right neck, to right temporal area was created. The shunt was passed throught the tunnel and connected to the proximal catheter. The dura was opened for drainage of the subdural collection. Normal saline irrigation was performed during the operation. After hemostasis, the proximal catheter was placed into subdural space. The shunt was fixed with three stitches. The wound was then closed in layers with 4-0 Vicryl and 4-0 Nylon. Operators AP郭夢菲 Assistants R4李振豪 Indication Of Emergent Operation 相關圖片 夏睿 (M,2000/04/03,11y11m) 手術日期 2010/12/03 手術主治醫師 郭夢菲 手術區域 兒醫 067房 03號 診斷 Other named variants lymphoma, lymph nodes of head face and neck 器械術式 Neck lymph node biopsy 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 面罩麻醉 麻醉主治醫師 蕭柏妮 ASA 3 紀錄醫師 李振豪, 時間資訊 20:39 通知急診手術 00:00 開始NPO 00:00 臨時手術NPO 09:30 進入手術室 09:30 報到 09:48 麻醉開始 09:58 誘導結束 10:05 手術開始 10:32 麻醉結束 10:32 手術結束 10:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 頸部良性腫瘤切除,簡單 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Semi-opened mask inhalation anes 1 0 摘要__ 手術科部: 外科部 套用罐頭: Right neck lymph node biopsy 開立醫師: 李振豪 開立時間: 2010/12/03 10:50 Pre-operative Diagnosis Right neck lymphadenopathy, r/o hematologic malignancy Post-operative Diagnosis Right neck lymphadenopathy, r/o hematologic malignancy Operative Method Right neck lymph node biopsy Specimen Count And Types 1 piece About size:1x1.5x1cm Source:right neck lymph node Pathology Frozen: pending Frozen: malignancy, compatible with perifalcial tumor. Suspect lymphoma Operative Findings The lymph node over right neck was bean-like, fragile, yellowish, well-capsulated in character. The each size was around 1~1.5cm in diameter. No adjacent soft tissue invasion was noted. Operative Procedures Under intravenous general anesthesia, the patient was put in supine position with head rotated to left. The skin was scrubbed, disinfected, and draped as usual. 1.5cm transverse skin incision was made at right neck along the skin crest. The subcutaneous soft tissue was dissected and lymph node biopsy was done. After hemostasis, the wound was closed in layers with 4-0 Vicryl and 4-0 Nylon. Operators AP郭夢菲 Assistants R4李振豪 Indication Of Emergent Operation 陳榮銘 (M,1944/03/28,67y11m) 手術日期 2010/12/03 手術主治醫師 梁金銅 手術區域 東址 056房 03號 診斷 Colon cancer 器械術式 Port-A catheter implatation 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 楊惠馨, 時間資訊 15:45 進入手術室 15:50 抗生素給藥 15:55 麻醉開始 15:57 誘導結束 16:00 手術開始 16:30 手術結束 16:30 麻醉結束 16:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 port–A導管植入術–治療性導管植入術 1 0 R 記錄__ 手術科部: 外科部 套用罐頭: port-A implantation, right subclavian vein 開立醫師: 楊惠馨 開立時間: 2010/12/03 16:37 Pre-operative Diagnosis Colon cancer Post-operative Diagnosis Colon cancer Operative Method port-A implantation, right subclavian vein Specimen Count And Types nil Pathology nil Operative Findings port-A tip was over svc Operative Procedures 1.Disinfection, drapping, local anesthesia 2.Skin incision over lateral right subclavical area 3.Inserted the port-A catheter via puncture method 4.Check by portable 4.Check by intra-operative CXR 5.Wound closure in layers Operators P梁金銅 Assistants R3 楊惠馨 相關圖片 郭環 (F,1946/12/16,65y2m) 手術日期 2010/12/03 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 游健生, 時間資訊 07:45 報到 08:05 進入手術室 08:17 麻醉開始 08:35 誘導結束 09:10 手術開始 09:10 抗生素給藥 12:10 抗生素給藥 13:00 開始輸血 15:10 抗生素給藥 16:20 麻醉結束 16:20 手術結束 16:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 8 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 顱底瘤手術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Left Kawase approach for Simpson grade IV tum... 開立醫師: 游健生 開立時間: 2010/12/03 16:39 Pre-operative Diagnosis Left petroclival meningioma Post-operative Diagnosis Left petroclival meningioma Operative Method Left Kawase approach for Simpson grade IV tumor excision Specimen Count And Types A few small pieces About size:1 x 1 x 2cm Source:petroclival meningioma Pathology Pending Operative Findings The tumor was pinkish, soft, and hypervascularized. It had a base at lateral wall of canvernous sinus and extended upward to suprasellar region, posteriorly along clivus and tentorium, medially crossing behind clivus to contralateral side. It filled up the canvernous sinus. CN III to CN VI were seen and preserved during surgery. Operative Procedures Under ETGA, patient was in supine position with left shoulder elevated and head fixed with Mayfield headclamp. Her head was rotated 45 degrees to right and her neck was mildly extended. After shaving, we disinfected and draped the operation field as usual. A curvillinear scalp incision was made 1cm anterior to tragus and extended to 2cm cross midline with 1cm behind hairline. The skin flap was elevated and reflected anteriorly together with Yasargil fatpad followed by temporalis muscle flap reflection with a muscle cuff at superior temporal line. A craniotomy was made with three burrholes at keyhole, squamous portion of temporal bone, and end of superior temporal line. We extended the craniotomy window further by removal of sphenoid ridge and part of squamous portion. Dura tending was done along the posterior border of craniotomy window. With the middle meningeal artery coagulated and divided, the temporal lobe was dissected away from skull base extradurally till exposure of CN V3. Then, we drilled off the apex of orbital floor and anterior clinoidal process to mobilize optic nerve and expose cavernous sinus. Curvilinear durotomy was performed and temporal lobe gentlely elevated with retractor to expose the tumor. It was attacked from anterolaterally and removed in piecemeal. Optic tract, CN III, IV, and carotid artery giving off posterior communicating artery were seen as we attacked more posteriorly. After removing part of the tumor behind clivus, we located the CN V3 extradurally and drilled off the petrous bone just behind it(Kawase"s rhomboid) to expose the presigmoid dura. Small durotomy from temporal to presigmoid dura crossing tentorium was done to enter the anterosuperior cerebellopontine angle. The tumor was seen on both side of the tentorium and removed with preservation of CN V and CN VI. The dura defect was sealed with Duraform, Surgicel packing, and Tissucol Duo. After hemostasis with Surgicel packing, dura was closed with 4-0 prolene continuous suture with air expellation. Dura tenting along the anterior border of craniotomy window was done followed by central tenting. The bone flap was fixed back with mini-plates. A CWV drain was placed. Wound was closed in layers. Operators Prof. 杜永光 Assistants R6 胡朝凱 R3 游健生 張連生 (M,1951/07/01,60y8m) 手術日期 2010/12/03 手術主治醫師 杜永光 手術區域 東址 003房 02號 診斷 Hydrocephalus 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 游健生, 時間資訊 16:40 報到 16:48 進入手術室 16:50 麻醉開始 16:55 誘導結束 17:25 抗生素給藥 17:33 手術開始 18:35 手術結束 18:35 麻醉結束 18:45 送出病患 18:46 進入恢復室 19:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室腹腔分流手術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: VP shunt 開立醫師: 游健生 開立時間: 2010/12/03 19:01 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method VP shunt Specimen Count And Types 1 piece About size:9ml Source:CSF Pathology nil Operative Findings CSF was clear and colorless. The opening pressure was about 10cmH2O. The ventricle catheter was 6.5cm. Medtronic non-programmable reservoir (medium pressure) was used. Operative Procedures Under ETGA, patient was in supine position with right shoulder elevated and head rotated to left. After shaving, we disinfected and draped the operation field as usual. A curved scalp incision was made at right Kocher region. The skin flap was elevated and reflected. A burrhole was created followed by dura tenting. After cauterization, cruciate durotomy was done. The edges were cauterized and ventriculostomy was performed. The ventricle catheter connected to reservoir was inserted and fixed. A transverse abdominal incision was made at RUQ. After dissection, the peritonium was reached and opened. The peritoneal catheter was inserted and proximal end was passed upward to scalp wound via a subcutaneous tunnel. Assembled the peritoneal catheter to reservoir. Hemostasis was achieved and wounds were closed in layers. Operators Prof. 杜永光 Assistants R6 胡朝凱 R3 游健生 廖茂堂 (M,1957/08/20,54y6m) 手術日期 2010/12/03 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Lumbar Spondylosis 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 鍾文桂, 時間資訊 07:45 報到 08:05 進入手術室 08:10 麻醉開始 08:20 誘導結束 08:40 抗生素給藥 09:13 手術開始 10:20 手術結束 10:20 麻醉結束 10:25 送出病患 10:28 進入恢復室 11:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-腰椎 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Microsurgical discectomy, L3/4. 開立醫師: 鍾文桂 開立時間: 2010/12/03 10:31 Pre-operative Diagnosis Herniated intervertebral disc,L3/4. Post-operative Diagnosis Herniated intervertebral disc,L3/4. Operative Method Microsurgical discectomy, L3/4. Specimen Count And Types 1 piece About size:2 pieces Source:ruptured disc Pathology Pending. Operative Findings Calcified ruptured disc was noted after left L4 laminotomy. Severely engorged epidural vein was noted beside the thecal sac. The intervertebral disc was not further resected after removal of the ruptured disc. Operative Procedures Under ETGA, the patient was placed in prone position. After ensuring the L3/4 disc space with intraoperative fluoroscopy, the operative field was prepared. Midline incision and paraspinal dissection at left side were done. The L4 laminitomy was achieved with high speed cutting burr and Kerrison. The hyerptrophic ligamentum flavum was removed along with the ruptured disc. After well hemostasis and injection of Macaine to wound edges and fascia and Rinderon to epidural space, the wound was closed in layers. Operators 曾漢民 Assistants 鍾文桂，陳蔚蔚 金志華 (M,1956/04/10,55y11m) 手術日期 2010/12/03 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 鍾文桂, 時間資訊 10:10 報到 10:39 進入手術室 10:45 麻醉開始 11:00 誘導結束 11:02 手術開始 11:50 抗生素給藥 12:35 麻醉結束 12:35 手術結束 12:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 頭顱穿洞術(止血引流、穿刺檢查),每加一孔 2 1 手術 頭顱穿洞術(止血引流、穿刺檢查) 1 1 記錄__ 手術科部: 外科部 套用罐頭: Burr holes for craniotomy. 開立醫師: 鍾文桂 開立時間: 2010/12/03 13:23 Pre-operative Diagnosis Meningioma, posterior 1/3 falcine. Post-operative Diagnosis Meningioma, posterior 1/3 falcine. Operative Method Burr holes for craniotomy. Specimen Count And Types nil Pathology Nil. Operative Findings Pre-operative CTV: occlusion of distal portion of superior sagital sinus. Intraoperative findings: severe oozing from skull bone upon drilling of burr holes. We suspect that venous collaterals for the occluded SSS were from skull dipole veins. After discussing with the family about high risk of morbidity, the wound was closed in layers. Operative Procedures Under ETGA, the patient was placed in prone position, and the head was placed in midline position with Mayfield. After preparation, a 10-cm linear vertical scalp incision was made. After periosteal dissection and harvesting pericranium for future cranioplasty, we use high speed drill to create three burr holes. After well hemostasis, the wound was closed in layers. Operators V.S. 曾漢民 Assistants 鍾文桂 陳蔚蔚 陳奕穎 (F,1977/07/27,34y7m) 手術日期 2010/12/03 手術主治醫師 曾漢民 手術區域 東址 005房 03號 診斷 Brain tumors, malignant 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 鍾文桂, 時間資訊 12:50 報到 13:15 麻醉開始 13:15 進入手術室 13:45 誘導結束 14:00 抗生素給藥 14:15 手術開始 14:50 開始輸血 17:00 抗生素給藥 17:45 麻醉結束 17:45 手術結束 17:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除-手術時間在4小時以內 1 1 L 記錄__ 手術科部: 婦產部 套用罐頭: Gross total excision of brain tumor via left ... 開立醫師: 鍾文桂 開立時間: 2010/12/03 18:41 Pre-operative Diagnosis Anaplastic astrocytoma, left frontal s/p stereotatic biopsy. Post-operative Diagnosis Anaplastic astrocytoma, left frontal s/p stereotatic biopsy, s/p grossly total tumor excision. Operative Method Gross total excision of brain tumor via left frontal craniotomy. Specimen Count And Types 1 piece About size:20cc Source:brain tumor Pathology Pending. Operative Findings Elastic, firm, whitish tumor with moderate vascularity. The tumor was excised in en bloc fashion. The tumor location and possible residuals were checked by intraoperative ultrasonography. Easy oozing operative field. Low Hb intraoperatively. A cortical vein was transvering the corticotomy. It was well preserved. Operative Procedures Under ETGA, the patient was placed in supine position and the head was in midline position. After shaving, disinfection, and draping, a hokey-stick shape scalp incision was made. After dissection, we use high speed drill to create craniotomy window. After dural tenting and durotomy, the tumor was excised under the guidance of intraoperative ultrasonography. After tumor removal in en bloc fashion, the possible residual tumor was checked by ultrasound. The residurals were resected further. After well hemostasis, the craniotomy bone plate was fixed by miniplates and screws. The wound was closed in layers with one subgaleal CWV drain. Operators 曾漢民 Assistants 鍾文桂 陳蔚蔚 陳昱瑋 (M,1991/06/02,20y9m) 手術日期 2010/12/03 手術主治醫師 蔡瑞章 手術區域 東址 002房 03號 診斷 Hydrocephalus 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 曾峰毅, 時間資訊 13:25 進入手術室 13:35 麻醉開始 13:45 誘導結束 14:00 抗生素給藥 14:26 手術開始 15:45 手術結束 15:45 麻醉結束 15:50 送出病患 15:53 進入恢復室 17:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦脊髓液分流管重置 1 2 R 手術 腦內血腫清除術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 曾峰毅 開立時間: 2010/12/03 16:04 Pre-operative Diagnosis status post ventriculoperitoneal shunt insertion at right Kocher's point, complicated with slit ventricle and bilateral chronic subdural hematoma Post-operative Diagnosis status post ventriculoperitoneal shunt insertion at right Kocher's point, complicated with slit ventricle and bilateral chronic subdural hematoma Operative Method Ventriculoperitoneal shunt revision to programmable shunt, Codman, 10cmH20, and right frontal burr hole for subdural drainage Specimen Count And Types Nil Pathology Nil Operative Findings Codman, programmable shunt, set at 10cmH20 was inserted. Subdural dural, drak-reddish, fluid collection was drained via the subdural drian. Opening pressure of the subdural space was not high. Operative Procedures With endotracheal general anaesthesia,the patient was put in supine position with head rotated to left. We made one skin incision along previous surgical wound at right frontal and removed previuos inserted ventricular catheter. We made one transverse skin incision at right occipital and transected the catheter. We inserted Codman programmable shunt along previuos right Kocher's tract, and reconnected the shunt. We drilled another burr hole at right frontotemporal area, and inserted subdural drain. We closed the wound in layers, and de-air the subdural space via subdural rubber drain. Operators P 蔡瑞章 Assistants R4 曾峰毅 晁紹庭 (F,2001/05/25,10y9m) 手術日期 2010/12/03 手術主治醫師 許文明 手術區域 兒醫 062房 01號 診斷 Neoplasm of unspecified nature of brain 器械術式 Port-A catheter implatation 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 柯柏瑞, 時間資訊 07:50 報到 08:08 進入手術室 08:15 麻醉開始 08:20 誘導結束 08:20 抗生素給藥 08:50 手術開始 10:50 手術結束 10:50 麻醉結束 10:52 送出病患 11:00 進入恢復室 12:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 手術 內頸靜脈切開,永久導管放置術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Port-A implant 開立醫師: 柯柏瑞 開立時間: 2010/12/03 10:56 Pre-operative Diagnosis Neoplasm of unspecified nature of brain Post-operative Diagnosis Neoplasm of unspecified nature of brain Operative Method Port-A implant Specimen Count And Types nil Pathology nil Operative Findings Port-A catheter at RA-SVC junction Bloow flow smoothly in the catheter Operative Procedures 1.General anesthesia, mask breathing, skin disinfection, supine position 2.Transverse skin incision at right upper chest and right lower neck 3.Identify right int. jugular vein 4.Port-A implant into int. jugular vein by cut down method 5.Intra-OP CXR to confirm the location 6.Hemostasis and close the wound by layers Operators 許文明 Assistants 柯柏瑞 孫祥芸 (F,2003/07/28,8y7m) 手術日期 2010/12/03 手術主治醫師 郭夢菲 手術區域 兒醫 067房 04號 診斷 Subluxation of lens 器械術式 Close reduction of C1-2 subluxation 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 蕭柏妮 ASA 3 紀錄醫師 李振豪, 時間資訊 20:41 通知急診手術 00:00 開始NPO 00:00 臨時手術NPO 10:48 進入手術室 11:00 麻醉開始 11:03 手術開始 11:03 誘導結束 11:22 麻醉結束 11:22 手術結束 11:25 送出病患 11:30 進入恢復室 12:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 手術 頭骨頸椎牽引-一次 1 0 記錄__ 手術科部: 外科部 套用罐頭: Close reduction of C1-C2 and external fixatio... 開立醫師: 李振豪 開立時間: 2010/12/03 11:51 Pre-operative Diagnosis Atlatoaxial rotatory subluxation Post-operative Diagnosis Atlatoaxial rotatory subluxation Operative Method Close reduction of C1-C2 and external fixation with SOMI brace. Specimen Count And Types nil Pathology Nil Operative Findings Wry neck with the head rotated to right side and the chin to left in cock-ribin position noted when awaked. Neck became soft and could be reduced to the neutral position after IV genral anesthesia. Operative Procedures Under IVG and supine position, the neck was reduced to the neutral position and fixed with SOMI brace. Portable X-ray was checked after whole procedure. Operators AP 郭夢菲 Assistants R4李振豪 Indication Of Emergent Operation 相關圖片 范進結 (M,1953/03/11,59y0m) 手術日期 2010/12/03 手術主治醫師 賴達明 手術區域 東址 003房 03號 診斷 Herniated intervertebral disc (HIVD) 器械術式 Diskectomy lumbar 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 3E 紀錄醫師 周聖哲, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 12:18 通知急診手術 18:40 報到 19:00 進入手術室 19:05 麻醉開始 19:10 誘導結束 19:50 抗生素給藥 19:51 手術開始 21:20 手術結束 21:20 麻醉結束 21:25 送出病患 21:30 進入恢復室 22:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 椎間盤切除術-腰椎 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Right discectomy 開立醫師: 胡朝凱 開立時間: 2010/12/03 21:29 Pre-operative Diagnosis Right L4~5 HIVD Post-operative Diagnosis right L4~5 disc extrusion and spur formation Operative Method Right discectomy Specimen Count And Types nil Pathology Nil Operative Findings 1.Hypertrophic flavum ligment 2.Injected L5 nerve root 3.Extrusion L4~5 disc that compressed the nerve root tightly 4.Spur formation and narrowed disc space, and partially fusion was suspect Operative Procedures 1.ETGA, prone position 2.midline skin incision at L4~5 level 3.Detach right paravertebral muscle 4.Expose L4 and L5 lamina 5.Laminotomy at right L4~5 and remove flavum ligment 6.Discectomy with currete 7.partial removal of spur 8.Hemostasis 9.Close wound in layers Operators VS賴達明 Assistants 胡朝凱, 周聖哲 Indication Of Emergent Operation 關蔡美玉 (F,1949/10/16,62y4m) 手術日期 2010/12/03 手術主治醫師 賴達明 手術區域 東址 019房 02號 診斷 Brain metastasis 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 黃鼎鈞, 時間資訊 12:15 報到 12:38 進入手術室 12:40 麻醉開始 12:43 抗生素給藥 13:15 誘導結束 13:42 手術開始 15:45 抗生素給藥 16:40 麻醉結束 16:40 手術結束 16:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4~8小時 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: craniotomy tumor excision, simpson grade I 開立醫師: 陳德福 開立時間: 2010/12/03 13:15 Pre-operative Diagnosis Right fontal convexity meningioma Post-operative Diagnosis Right fontal convexity meningioma Operative Method craniotomy tumor excision, simpson grade I Specimen Count And Types 1 piece About size:5*5*5CM Source:right brain tumor Pathology pending Operative Findings 1.There was a 6*5*4.5 cm in sized tumor at the right frontal convexity. The tumor was yellowish, elastic, well demarcated, dura based, extra axial, and moderte vascularized. The arterial feeder of the tumor came from the MMA and the tumor with dura base was removed totoally as Simpson grade I surgery. 1.There was a 6*5*4.5 cm in sized tumor at the right frontal convexity. The tumor was yellowish, soft-elastic, well demarcated, dura based, extra axial, and moderte vascularized. The contexture of the tumor is "sand-like" and there is some calcification inside the tumor. The arterial feeder of the tumor came from the MMA and the tumor with dura base was removed totoally as Simpson grade I surgery. Operative Procedures Under ETGA and supine position, the scalp was disinfected and draped as usual. One curvilinear incision was done and the 5*5cm in sized craniotomy [tumor centered] was created. The tumor came into view and the dura was opened in circular fasion. The tumor was then removed along the epi-arachnoid plane totally with the dura. The dura was repaired with periosteum. The skull was fixed with miniplates. The wound was closed in layer with one CWV drainage. Operators VS賴達明 Assistants R5陳德福 R1黃鼎鈞 高楊玉珍 (F,1951/06/04,60y9m) 手術日期 2010/12/03 手術主治醫師 賴達明 手術區域 東址 019房 03號 診斷 Spondylolisthesis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 黃鼎鈞, 時間資訊 16:20 報到 16:50 抗生素給藥 17:00 進入手術室 17:05 麻醉開始 17:12 誘導結束 17:40 手術開始 19:50 抗生素給藥 20:12 開始輸血 20:30 手術結束 20:30 麻醉結束 20:40 送出病患 20:45 進入恢復室 21:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 脊椎融合術-後融合,有固定物(每增加<=六節) 1 2 手術 脊椎融合術-前融合,有固定物)≦四節 1 1 手術 椎間盤切除術-腰椎 1 4 摘要__ 手術科部: 外科部 套用罐頭: 1.L4~5 TPS and L4 laminectomy 2.Lumbar discec... 開立醫師: 陳德福 開立時間: 2010/12/03 17:16 Pre-operative Diagnosis L4 on L5 spondylolisthesis and HIVD with spinal stenosis Post-operative Diagnosis L4 on L5 spondylolisthesis and HIVD with spinal stenosis Operative Method 1.L4~5 TPS and L4 laminectomy 2.Lumbar discectomy with interbody cage implantation, L4/5 Specimen Count And Types nil Pathology NIL Operative Findings 1.Instability between L4 to L5 2.Hypertrophic flavum ligment,HIVD and stenotic lateral recess 3.Screws: 6.2 x 45mm 3.Screws: 6.2 x 40mm 4.Interbody cage:12mm x2 4.Interbody cage:11mm x2 Operative Procedures 1.ETGA, prone 2.Midline skin incision at L4~5 level 3.Detach paravertebral muscle groups to expose L4~5 lamina and facet joint 4.Identified transverse process to located L4 and L5 pedicle 5.Screws insertion 6.L4 laminectomy 7.Remove flavum ligment 8.Identified L4, L5 roots and decompression followed by L4/5 discectomy with interbody cage implantation 9.rods fixation 10. Posterolateral fusion with autologous bone graft 11. Set on Hemovac at epidural space. 12. Wound closure in layers Operators VS賴達明 Assistants R5陳德福,R1 R5陳德福,R1黃鼎鈞 利豐田 (M,1971/02/22,41y0m) 手術日期 2010/12/03 手術主治醫師 蔡翊新 手術區域 東址 003房 04號 診斷 Subdural and cerebral hemorrhage 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 2E 紀錄醫師 周聖哲, 時間資訊 00:00 開始NPO 20:41 通知急診手術 21:50 報到 21:55 進入手術室 21:57 麻醉開始 22:12 誘導結束 22:30 抗生素給藥 22:48 手術開始 23:45 手術結束 23:45 麻醉結束 23:55 送出病患 00:05 進入恢復室 01:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Burr hole for chronic subdural hematoma drainage 開立醫師: 古恬音 開立時間: 2010/12/03 23:20 Pre-operative Diagnosis Left chronic subdural hematoma Post-operative Diagnosis Left chronic subdural hematoma Operative Method Burr hole for chronic subdural hematoma drainage Specimen Count And Types nil Pathology Nil Operative Findings Motor-oil like substance gushed out upon durotomy. The brain expanded well after hematoma drainage Operative Procedures 1. ETGA, supine position 2. Scalp shaving, scrubbing, and disinfection 3. Draping in usual sterile fashion 4. Make a transverse linear scalp incision at left frontal area 5. Drilling of one burr hole 6. Dura was opened in cruciate fashion after tenting 7. Insert one rubber drain for irrigation, which was done in four directions 8. Fix the subdural rubber drain at frontal area 9. Deair 10. Wound clousre in layers Operators VS蔡翊新 Assistants R6胡朝凱 R1周聖哲 Indication Of Emergent Operation 宋炎輝 (M,1951/06/21,60y8m) 手術日期 2010/12/04 手術主治醫師 黃國皓 手術區域 東址 002房 02號 診斷 Aneurysm 器械術式 Fiberocystoscopy /WOR 手術類別 緊急手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 靜脈麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 周淇業, 時間資訊 00:00 開始NPO 00:00 臨時手術NPO 08:09 通知急診手術 11:02 進入手術室 11:02 報到 11:15 麻醉開始 11:20 誘導結束 11:34 手術開始 12:25 麻醉結束 12:25 手術結束 12:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 手術 膀胱造口術 1 1 摘要__ 手術科部: 泌尿部 套用罐頭: Cystostomy 開立醫師: 周淇業 開立時間: 2010/12/04 12:39 Pre-operative Diagnosis Dysuria with AUR, suspect BPH or urethral injury Post-operative Diagnosis Suspect urethral obstruction, s/p Trocar cystostomy Operative Method Urethroscopy and Trocar cystostomy Specimen Count And Types nil Pathology Nil. Operative Findings 1. Velvet urethral mucosa at bulbourethral, can not identify true lumen to bladder 2. 16Fr. Trocar cystostomy was done smoothly under echo guidance Operative Procedures 1. Adequate anesthesia with lithotomy position 2. Antiseptic and drapping 3. Urethroscopy and can not identify true lumen to bladder 4. Echo-guided trocar cystostomy was done smoothly, insert 16Fr. cystostomy tube and fixation 5. Sent patient to ICU Operators 黃國皓 Assistants 周淇業 Indication Of Emergent Operation 李安韻 (F,1978/06/29,33y8m) 手術日期 2010/12/04 手術主治醫師 曾漢民 手術區域 東址 003房 01號 診斷 Spinal neuroma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 2 紀錄醫師 陳蔚蔚, 時間資訊 08:00 報到 08:10 進入手術室 08:25 麻醉開始 08:55 誘導結束 09:00 抗生素給藥 09:05 手術開始 11:50 麻醉結束 11:50 手術結束 12:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術(減壓)-二節以內 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 良性脊髓腫瘤切除術 1 1 記錄__ 手術科部: 外科部 套用罐頭: 1. Excision of spinal tumor. 開立醫師: 鍾文桂 開立時間: 2010/12/04 12:33 Pre-operative Diagnosis Intraspinal extradural tumor, C1-2. Post-operative Diagnosis Intraspinal extradural tumor, C1-2. Operative Method 1. Excision of spinal tumor. 2. C1 laminectomy. Specimen Count And Types 1 piece About size:5 CC Source:SPINAL TUMOR Pathology Pending. Operative Findings 1. Red-brown, well demarcated tumor, originated from left C2 root; moderate vascularity. 2. Intact dura mater and vertebral artery. Operative Procedures Under ETGA, the patient was placed in prone position and the head was fixed by Mayfield. After shaving, disinfection, and draping, midline vertical 10-cm linear incision was made. After dissection, the foramen magnus, C1 and C2 were identified. After dissection of the vertebral artery from the vertebral groove, the C1 posterior arch was resected by high speed drill. Then, the tumor was exposed and excised in en bloc fashion from the nerve root. After well hemostasis, the posterior arch of C1 was fixed back by miniplates and screws. The wound was closed in layers with one CWV drain. Operators V.S. 曾漢民 Assistants 陳蔚蔚 曾國修 (M,1963/05/11,48y10m) 手術日期 2010/12/04 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Parkinson''s Disease 器械術式 Stereotaxic procedure for impl 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 面罩麻醉 麻醉主治醫師 詹偉弘 ASA 2 紀錄醫師 陳德福, 時間資訊 07:55 報到 08:05 進入手術室 08:20 麻醉開始 08:25 誘導結束 09:15 抗生素給藥 09:30 手術開始 12:15 抗生素給藥 15:05 麻醉結束 15:05 手術結束 15:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 立體定位術-功能性失調 1 1 B 手術 立體定位術-功能性失調 1 2 B 手術 深部腦核電生理定位 1 0 B 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Semi-opened mask inhalation anes 1 0 麻醉 Semi-opened INHALATION GENERAL A 4 0 麻醉 SENI-OPENED INHALATION GENERAL A 6 0 摘要__ 手術科部: 外科部 套用罐頭: Implantation of bilateral deep brain stimulat... 開立醫師: 陳德福 開立時間: 2010/12/04 15:25 Pre-operative Diagnosis Parkinson disease Post-operative Diagnosis Parkinson disease Operative Method Implantation of bilateral deep brain stimulation, STN Specimen Count And Types nil Pathology NIL Operative Findings 1. The left subthalamic nucleus was noted by microelectrodes recording which is compatible with the planned tract. The recording showed hyperactivity. 2. The right subthalamic nucleus was noted by micoeletrodes recording. Two tracts: 1st: increased background at the planned tract with some hyperactivity neurons. 2nd: 2mm lateral to the planned tract target, increased background with hyperactivity 3. Test stimulation: decreased rigidity, and tremor at bilateral tract. Operative Procedures 1. Under intravenous anesthesia and local anesthesia, the patient was put in supine position and the head was placed in the midline. 2. After shaving,disinfection, and draping, bicoronal incision was made 3. For lead placement, a nickel-sized (14 mm) burr hole was made 1.5 cm lateral to midline and just anterior to coronal suture. A burr-hole ring is affixed to each opening. 4. Prior to lead placement, microelectrode recording (MER)was used to provide an additional level of target verification. 5. Stereotactic frame guidance and techniques were used to place the lead to the targeted area. 6. With the patient awake, a test stimulation was performed to confirm good therapeutic benefit at each side. 7. Finally, the leads were secured and the operative wounds were closed in layers. Operators P曾勝弘 Assistants R5陳德福 劉韋志 (M,1961/12/26,50y2m) 手術日期 2010/12/04 手術主治醫師 陳坤源 手術區域 東址 012房 03號 診斷 Thyroid cancer 器械術式 Total thyroidectomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 洪誌鍵, 時間資訊 13:20 報到 13:34 進入手術室 13:38 麻醉開始 13:43 誘導結束 13:50 抗生素給藥 13:57 手術開始 15:50 手術結束 15:50 麻醉結束 15:59 進入恢復室 16:00 送出病患 17:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Glucose 1 0 手術 雙側甲狀腺全葉切除術 1 1 B 摘要__ 手術科部: 外科部 套用罐頭: Total thyroidectomy 開立醫師: 鄭宗杰 開立時間: 2010/12/04 15:46 Pre-operative Diagnosis Thyroid cancer Post-operative Diagnosis Thyroid cancer Operative Method Total thyroidectomy Specimen Count And Types 2 pieces About size:3x3x2cm Source:left lobe, thyroid About size:3x3x2cm Source:right lobe, thyroid Pathology pending Operative Findings 1. A hard white ill defined mass 2×2×2 cm in size located at lower pole of left thyroid gland. 2. Paratracheal lymph node involvement: negative 3. Upper mediastinal lymph node involvement: negative Operative Procedures 1. ETGA , put the patient in supine position 2. Preparation of skin with betadine solution 3. Transverse skin incision at two finger above sternal notch and formation of flaps 4. Opening of the deep fascia and elevation of the strap muscles 5. Exposure and mobilization of the gland then ligation of supplying vessel with silk 6. Identified bilateral recurrent larygneal nerve 7. Resect the totalthyroid gland and establish good hemostasis 8. Place two mini-hemovac for drainage 9. Close the wound in layers Operators VS陳坤源, Assistants R1洪誌鍵 Ri陳怡穎 夏睿 (M,2000/04/03,11y11m) 手術日期 2010/12/05 手術主治醫師 楊士弘 手術區域 兒醫 067房 01號 診斷 Other named variants lymphoma, lymph nodes of head face and neck 器械術式 Craniectomy 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 4E 紀錄醫師 吳政達, 時間資訊 03:31 通知急診手術 04:55 報到 04:55 進入手術室 05:00 麻醉開始 05:05 誘導結束 05:40 抗生素給藥 05:48 手術開始 07:55 麻醉結束 07:55 手術結束 08:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱骨切除術,包括異物移除或壓或經切斷 1 1 R 手術 顱內壓視置入 1 2 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 摘要__ 手術科部: 外科部 套用罐頭: Right frontotemporoparietal craniectomy + ICP... 開立醫師: 楊士弘 開立時間: 2010/12/05 06:54 Pre-operative Diagnosis Right cerebral hemisphere swelling; brain tumor s/p biopsy Post-operative Diagnosis Right cerebral hemisphere swelling; brain tumor s/p biopsy Operative Method Right frontotemporoparietal craniectomy + ICP monitor insertion Specimen Count And Types nil Pathology Nil Operative Findings After elevation of the craniectomy flap, the dura was tense. Opening of the dura revealed subdural tumor, soft elastic, nodular, and whitish, in the parietal region. The ICP was 10 mmHg after duroplasty and scalp closure without replacement of skull flap. The skull plate was stored in sterile glove and plastic bags and will be stored in -70 degrees fridge. Operative Procedures 1. ETGA, supine with head rotated to left. 2. Right frontotemporoparietal scalp incision with posterior limb of incision based over anterior limb of previous wound. 3. Right frontotemporoparietal craniectomy, 12 cm x 11 cm. 4. U-shaped dural incision. 5. Harvest of temporalis fascia and use of a piece of large durofoam for duroplasty. 6. Insertion of a subdural ICP monitor. 7. One subgaleal CWV drain. 8. Wound closure in layers. Operators 楊士弘/郭夢菲 Assistants 陳德福,李振豪,吳政達 Indication Of Emergent Operation 吳順吉 (M,2009/11/02,2y4m) 手術日期 2010/12/05 手術主治醫師 邱英世 手術區域 東址 000房 號 診斷 Tetralogy of Fallot 器械術式 Repair TF, V.S.D., E.C.D.,TC 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 無麻醉 麻醉主治醫師 ASA 1 紀錄醫師 黃俊銘, 時間資訊 00:00 開始NPO 00:00 臨時手術NPO 11:00 通知急診手術 11:55 報到 12:50 進入手術室 13:30 手術開始 14:05 手術結束 14:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 體外循環維生系統(ECMO)建立(第一次) 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: ECMO set up 開立醫師: 黃俊銘 開立時間: 2010/12/05 14:22 Pre-operative Diagnosis TOF s/p right BTS, desaturation s/p CPR Post-operative Diagnosis Ditto Operative Method ECMO set up Specimen Count And Types nil Pathology Nil Operative Findings 12A cannula in right CCA, 3cm 14V cannula in right IJV, 8cm CVP insertion via right EJV, 10cm Pump speed 2300 blood flow 1.05 L/min Operative Procedures ETGA, supine, Skin disinfect, draping Incision over right neck Dissect and control right IJV and CCA Insert 12A cannula in CCA, 14V cannula in IJV, cutdown method Run ECMO Insert CVP via EJV, cutdown method Wound close Operators 邱英世 黃書健 Assistants 黃俊銘 Indication Of Emergent Operation 周易璟 (M,1989/07/18,22y7m) 手術日期 2010/12/05 手術主治醫師 蔡翊新 手術區域 東址 003房 01號 診斷 Cerebellar or brain stem contusion, with prolonged (more than 24 hours) loss of conscious and without return to pre-existing conscious level 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3E 紀錄醫師 吳政達, 時間資訊 01:10 開始NPO 01:10 臨時手術NPO 01:10 通知急診手術 01:42 進入手術室 01:45 麻醉開始 02:10 抗生素給藥 02:10 誘導結束 02:33 手術開始 03:18 手術結束 03:18 麻醉結束 03:25 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 顱內壓視置入 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 摘要__ 手術科部: 外科部 套用罐頭: ICP monitoring, right frontal 開立醫師: 陳德福 開立時間: 2010/12/05 02:24 Pre-operative Diagnosis Traumatic brain injury with skull fracture, suspect diffuse axonal injury Post-operative Diagnosis Traumatic brain injury with skull fracture, suspect diffuse axonal injury Operative Method ICP monitoring, right frontal Specimen Count And Types nil Pathology nil Operative Findings 1.There is suspected ASH over the inter-peduncular cistern and skull fracture at the suboccipital area. 2.One Codman ICP monitor was inserted at the right frontal lobe with pressure of mmHg. 2.One Codman ICP monitor was inserted at the right frontal lobe with pressure of 5 mmHg. Operative Procedures Under ETGA and supine position, the scalp was disinfected and draped as usual. One linear incision was done at the right frontal area followed by burr hole creation. The dura was then opened and the ICP was inserted. Hemostasis was done and the wound was closed in layers. Operators VS蔡翊新 Assistants R4曾峰毅 R1楊 R4曾峰毅 R1吳政達 Indication Of Emergent Operation 李碧珠 (F,1946/08/16,65y6m) 手術日期 2010/12/06 手術主治醫師 劉治民 手術區域 西址 034房 01號 診斷 Female breast cancer 器械術式 Insertion of hichman or port a 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 劉治民 ASA 2 時間資訊 07:40 報到 08:20 進入手術室 08:25 麻醉開始 08:30 抗生素給藥 08:30 誘導結束 08:40 手術開始 09:20 麻醉結束 10:45 手術結束 10:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 port–A導管植入術–治療性導管植入術 1 0 L 記錄__ 手術科部: 麻醉部 套用罐頭: Port-A implantation, subclavian 開立醫師: 賴佳欣 開立時間: 2010/12/06 09:25 Pre-operative Diagnosis breast cancer Post-operative Diagnosis Ditto Operative Method Port-A implantation, echo-guided Specimen Count And Types nil Pathology Nil Operative Findings 1.Site:left subclavian vein, with echo-guided procedure 2.Patent flow after implantation 3.Others: nil Operative Procedures 1.The patient was set on supine position and bilateral subclavian veins were checked by echo. 2.After IVGA and local anesthesia applied, transverse skin incision for 3cm was made at pre-cordial area. 3.Undermine the skin at the layer between subcutaneous tissue and deep fascia in lateral direction. 4.An IV catheter was inserted via the subclavian incision and negatively aspirated until venous blood attainable. 5.J-wire was inserted smoothly in rostral direction. A subclavian catheter with dilator was inserted through the J-wire, and the dilator was then removed. 6.The catheter of Port-A was threaded into the subclavian vein until mark 24 cm. The catheter was adapted into the port and locked with restrictor.The Port was inserted into the pouch of pre-cordial incision. 7.Skin was closed layer by layer. Both catheter and port were perfused with heparin solution after implantation. Operators 劉治民 Assistants 賴佳欣, 黃鎮鎧 (M,1941/01/24,71y1m) 手術日期 2010/12/06 手術主治醫師 郭順文 手術區域 東址 007房 02號 診斷 Major trauma rated 16 or above on the severeity scale ( Injury severeity score >=16 ) 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 趙安怡 ASA 3 紀錄醫師 高明蔚, 時間資訊 09:30 報到 09:30 進入手術室 09:35 麻醉開始 09:38 誘導結束 09:40 手術開始 10:10 麻醉結束 10:10 手術結束 10:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 氣管切開術 1 0 手術 支氣管鏡檢查 1 0 摘要__ 手術科部: 創傷醫學部 套用罐頭: Tracheotomy, percutaneous puncutre method, un... 開立醫師: 高明蔚 開立時間: 2010/12/06 10:22 Pre-operative Diagnosis Respiratory failure, s/p intubation Post-operative Diagnosis Respiratory failure, s/p intubation Operative Method Tracheotomy, percutaneous puncutre method, under visualization of bronchoscopy Specimen Count And Types nil Pathology Nil Operative Findings #8 low pressure cuffed tube inserted via 2nd cartilage. Operative Procedures ETGA, supine, skin disinfection and draping as usual. Bronchoscopy setting. Skin incision. Insert introducing catheter, then insert the guidewire. Introduce the lesser dilator. Introduce the larger dilator. Insert the trachostomy tube. Check bleeding and fix the tube with umbilical tape. Operators 郭順文 Assistants R3高明蔚,R3鄒冠全,R1許皓淳 李玉珍 (F,1939/08/05,72y7m) 手術日期 2010/12/06 手術主治醫師 王國川 手術區域 東址 001房 02號 診斷 Subdural hemorrhage following injury, with no loss of consciousness 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 4E 紀錄醫師 古恬音, 時間資訊 08:30 臨時手術NPO 08:30 開始NPO 08:58 通知急診手術 10:32 報到 10:54 進入手術室 11:00 麻醉開始 11:30 誘導結束 11:45 抗生素給藥 11:48 手術開始 12:28 開始輸血 13:20 手術結束 13:20 麻醉結束 13:30 送出病患 13:32 進入恢復室 14:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 硬腦膜外血腫清除術 1 2 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 王國川 開立時間: 2010/12/06 13:39 Pre-operative Diagnosis epidural hemorrhage Post-operative Diagnosis epidural hemorrhage Operative Method Craniotomy for epidural hematoma evacuation Specimen Count And Types nil Pathology nil Operative Findings liquified hematoma about 50 cc at epidural space Operative Procedures 1. ETGA 2. incision over previous scar 3. craniotomy with screw driver 4. irrigation and hematoma evacuation 5. close the wound by layer. Operators 王國川 Assistants Indication Of Emergent Operation 林秋吉 (M,1944/04/10,67y11m) 手術日期 2010/12/06 手術主治醫師 杜永光 手術區域 東址 002房 01號 診斷 Intracerebral hemorrhage 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 2E 紀錄醫師 陳德福, 時間資訊 01:26 開始NPO 01:26 通知急診手術 02:00 進入手術室 02:05 麻醉開始 02:15 誘導結束 02:20 抗生素給藥 02:50 手術開始 03:20 手術結束 03:20 麻醉結束 03:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 手術 顱內壓視置入 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: right frontal EVD insertion 開立醫師: 陳德福 開立時間: 2010/12/06 03:22 Pre-operative Diagnosis left thalamic ICH with IVH and hydrocephalus Post-operative Diagnosis left thalamic ICH with IVH and hydrocephalus Operative Method right frontal EVD insertion Specimen Count And Types nil Pathology nil Operative Findings 1.CSF: pinkish-reddish with opening pressure of 15cm-H2O 2.One Metronic EVD was inserted at the right frontal area Operative Procedures Under ETGA and supine position, the scalp was disinfected and draped as usual. One curvilinear incision at the right frontal followed by burr hole creation was done. Under ETGA and supine position, the scalp was disinfected and draped as usual. One curvilinear incision at the right frontal followed by burr hole creation was done. The dura was opened and ventriucular tapping was performed. Under ETGA and supine position, the scalp was disinfected and draped as usual. One curvilinear incision at the right frontal followed by burr hole creation was done. The dura was opened and ventriucular tapping was performed. The EVD tube was inserted thereafter and the wound was closed in layers. Operators P杜永光 Assistants R5陳德福 Indication Of Emergent Operation 黃枝雄 (M,1945/01/03,67y2m) 手術日期 2010/12/06 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 未提及腦梗塞之腦血栓症(CVA) 器械術式 EC-IC by-pass 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 游健生, 時間資訊 08:09 進入手術室 08:15 麻醉開始 08:55 誘導結束 09:30 開始輸血 10:00 抗生素給藥 10:22 手術開始 12:35 手術結束 12:35 麻醉結束 12:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 頸動脈結紮術-進性,血流遮斷器置入 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Left internal carotid artery stump ligation 開立醫師: 游健生 開立時間: 2010/12/06 13:02 Pre-operative Diagnosis Left internal carotid artery occlusion with stump syndrome Post-operative Diagnosis Left internal carotid artery occlusion with stump syndrome Operative Method Left internal carotid artery stump ligation Specimen Count And Types nil Pathology nil Operative Findings Severe adhesion between vessels and surrounding soft tissue was noted. The neck soft tissue had fibrotic changes. The internal jugular vien was atrophic and proximal ICA had weak pulsation. After ligation of stump, no pulse was felt at proximal ICA. Operative Procedures Under ETGA, patient in supine position with head rotated to right and left shoulder elevated. We disinfected and draped the operation field as usual. A 5cm transverse neck incision at left submandibular region. The platysma muscle was transected and the superficial cervical fascia was opened along the anterior border of the sternocleidomastoid muscle. The digastric muscle was identified and looped. The dissection was advanced at carotid triangle until the common carotid artery and its major branches were isloated. The CCA was then looped. The external carotid artery was left undisturbed as much as possible to prevent spasm. The internal carotid artery (ICA) was controlled by two 1/0 silk loops, each with 2 turns around the artery. Then, we tied the proximal one to occlude the stump. All loops were removed followed by hemostasis. After a mini-hemovac placement at carotid triangle, wound was closed in layers. Operators Prof. 杜永光 Assistants R6 胡朝凱 R3 游健生 李淑芬 (F,1970/01/29,42y1m) 手術日期 2010/12/06 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Malignant neoplasm of frontal lobe 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 陳德福, 時間資訊 10:10 報到 10:23 進入手術室 10:30 麻醉開始 10:40 誘導結束 10:42 抗生素給藥 10:45 手術開始 14:40 麻醉結束 14:40 手術結束 14:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4~8小時 1 1 B 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: craniotomy tumor excision 開立醫師: 陳德福 開立時間: 2010/12/06 14:59 Pre-operative Diagnosis Recurrent Glioma suspect high grade transformation Post-operative Diagnosis Recurrent Glioma suspect high grade transformation Operative Method craniotomy tumor excision Specimen Count And Types 3 pieces About size:0.5*0.5*0.5CM Source:left frontal lobe tumor About size:1*1*1cm Source:left mesial frontal tumor About size:0.5*0.5*0.5cm Source:Tumor at the Broca area Pathology pending pending; intra-OP frozen: glioma Operative Findings 1.There is greyish and soft tumor at the left frontal base and Broca area with perifocal gliosis. There is also cyst formation over previous operation field. 2.After the tumor excisional biopsy, CSF gushed out spontanously. 3.The dura defect was repaired with Gortex and Tissueco Duo. Operative Procedures Under ETGA and supine position with Mayfield pin type head fixator fixation, the scalp was disinfected and draped as usual. Incision along previous operation scar and the craniotomy was done. The dura was opened and the tumor was identified under microscope. The tumor was then removed and we checked the lesion with Navigation system and ultrasonography. The dura was then repaired with Gortex and the skull was fixed with miniplates. The wound was closed in layers. Operators VS 曾漢民 Assistants R5 陳德福 R1陳蔚蔚 張阿秀 (F,1943/12/02,68y3m) 手術日期 2010/12/06 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 陳蔚蔚, 時間資訊 07:40 報到 08:00 進入手術室 08:05 麻醉開始 08:30 誘導結束 08:40 抗生素給藥 08:45 手術開始 10:00 麻醉結束 10:00 手術結束 10:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 B 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: craniotomy tumor excision, Simpson grade I 開立醫師: 陳德福 開立時間: 2010/12/06 10:01 Pre-operative Diagnosis left frontal convexity meningioma Post-operative Diagnosis left frontal convexity meningioma Operative Method craniotomy tumor excision, Simpson grade I Specimen Count And Types 1 piece About size:2.5*2.5*2.5CM Source:left cerebral convexity tumor Pathology pending Operative Findings 1.There was a 2.5*3*3cm in sized regular shape tumor at the left frontal convexity without skull extension. The SSS is clean without tumor involvement. 2.The tumor is soft with dura base. After Simpson grade I tumor excision, the dura defect was repaired with autologous periosteum. Operative Procedures Under ETGA and supine position with Mayfield pin type head fixator fixation, the scalp was disinfected and draped as usual. One curvilinear incision was done and the 6*6cm in sized craniotomy [tumor centered] was created. The tumor came into view and the dura was opened in circular fasion. The tumor was then removed along the epi-arachnoid plane totally with the dura. The dura was repaired with periosteum. The cranioplasty was perform smoothly with miniplates. The wound was closed in layer with one CWV drainage. Operators VS曾漢民 Assistants R5陳德福 R1陳蔚蔚 姚宏武 (M,1973/06/17,38y8m) 手術日期 2010/12/06 手術主治醫師 曾漢民 手術區域 東址 003房 02號 診斷 Hemangioma of intracranial structures 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 2 紀錄醫師 游健生, 時間資訊 12:30 報到 13:06 進入手術室 13:10 麻醉開始 13:45 誘導結束 13:50 手術開始 14:10 抗生素給藥 17:30 麻醉結束 17:30 手術結束 17:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 腦瘤切除-手術時間在4小時以內 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Left craniotomy for tumor excision 開立醫師: 游健生 開立時間: 2010/12/06 17:44 Pre-operative Diagnosis Left Pre-motor gyrus cavernoma with bleeding Post-operative Diagnosis Left Pre-motor gyrus cavernoma with bleeding Operative Method Left craniotomy for tumor excision Specimen Count And Types Two kinds of tumor, one was yelloish, and the other was grayish. Pathology pending Operative Findings 1.One about 2.5x1 cm tumor located at left pre-motor gyrus and 2 cm beneath the cortex. The tumor was yellowish with surround hemosiderin deposition. A cyst was noted with motor oil like content. The plane was relative clear. 2.After removal of the tumor, some grayish to whitish, irregular shape lesion was noted at the bottom of the cavernoma. Not clear border. Operative Procedures Under ETGA, patient was put in supine position with head fixed with Mayfield skull clamp. U shape skin incision was done at left parietal area 2 cm anterior to coronal suture. Skin flap was dissected and opened. After burr holes drilled, craniotomy was performed as a 5x5 bone window, followed by dural tenting. U shape dural incision was made with the base left at midline. Pre-cetral sulcus was opened after mapping localization. Transsulcus approach was performed. The tumor was identified and well dissected. It was excised by gently dissection through the interface between tumor and brain tissue. Feeder was cauterized. Some small pieces of grayish tumor was also taken out for pathology. Hemostasis was then performed. After then, dura was closed with prolene. After one CWV drain insertion, wound was closed in layers. Operators VS曾漢民 Assistants R6胡朝凱, R3游健生 顏素英 (F,1957/12/01,54y3m) 手術日期 2010/12/06 手術主治醫師 賴達明 手術區域 東址 005房 03號 診斷 Vascular malformation 器械術式 Laminectomy for decompression 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3E 紀錄醫師 雷秋文, 時間資訊 10:00 臨時手術NPO 10:00 開始NPO 14:58 報到 15:25 進入手術室 15:30 麻醉開始 15:40 誘導結束 15:45 手術開始 16:10 抗生素給藥 21:35 手術結束 21:35 麻醉結束 21:50 送出病患 21:53 進入恢復室 23:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 良性脊髓腫瘤切除術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: C6-T2 laminectomy for subdural hematoma evacu... 開立醫師: 李振豪 開立時間: 2010/12/06 22:06 Pre-operative Diagnosis Subdural collection, suspect hematoma or abscess formation Post-operative Diagnosis Subarachnoid hematoma, suspect vascular malformation-related bleeding Operative Method C6-T2 laminectomy for subdural hematoma evacuation C6-T2 laminectomy for subarachnoid hematoma evacuation Specimen Count And Types 1 piece About size:1X1X2.5cm Source:Subdural hematoma Pathology Pending Operative Findings Subarachnoid hematoma was noted after dural opening. Much small spiral arteries were noted at the surface of the spinal cord after removal of the hematoma. some nerve root was encased within the hematoma. The nerve roots were preserved during the operation. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in prone position with head fixed with Mayfield scalp clamp. The scalp was shaved, scrubbed, and disinfected as usual. Midline skin incision was made from C6 to T2 level. The subcutaneous soft tissue and paravertebral muscle group were dissected and detached. C6 to T2 laminectomy was performed with Rongeur and Kerrison punches. Linear durotomy was performed and the subarachnoid hematoma was noted. The arachnoid membrane was opened and hematoma evacuation with microdissector, sucker, and ENT forceps. Hemostasis was achieved and the dura was closed in layers with 5-0 Prolene. The Gelform was placed at epidural space and one epidural CWV drain was left. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS賴達明 Assistants R4李振豪, R2雷秋文 Indication Of Emergent Operation 張勝雄 (M,1941/02/19,71y0m) 手術日期 2010/12/06 手術主治醫師 陳敞牧 手術區域 東址 002房 01號 診斷 Head injury 器械術式 V-P shunt 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3E 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 08:15 通知急診手術 09:20 進入手術室 09:20 麻醉開始 09:35 誘導結束 09:50 抗生素給藥 10:13 手術開始 13:10 開始輸血 13:35 手術結束 13:35 麻醉結束 13:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 頭顱成形術 1 2 R 手術 腦室腹腔分流手術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: 1. Implantation of ventriculoperitoeal shunt. 開立醫師: 鍾文桂 開立時間: 2010/12/08 14:51 Pre-operative Diagnosis 1. Right frontal skull defect. 2. Hydrocephalus. Post-operative Diagnosis 1. Right frontal skull defect. 2. Hydrocephalus. Operative Method 1. Implantation of ventriculoperitoeal shunt. 2. Cranioplasty. Specimen Count And Types nil Pathology Nil. Operative Findings 1. Autologous skull bone graft was fixed back. The remaining dural defect was repaired with bone cement. 2. V-P shunt: Codman programmable 80 mmH2O, at right Kocher. Operative Procedures Under ETGA, the patient was placed in supine position and the head was tilted to the left. After shaving, disinfection, and draping, the previous craniotomy wound and a linear incision at right upper quadrant of abdomen were incised. After dissection, the scalp was elevated from the underlying temporalis muscle and dura mater. The subcutaneous tunnel was created from abdomen to head. The shunt system was connected after ventricular puncture. The shunt was checked patent. The skull was fixed by miniplates and screws. The remaining dural defect was repaired by bone cements. The wound was closed in layers with one subgaleal drain. Operators V.S. 陳敞牧 Assistants 鍾文桂 Indication Of Emergent Operation 曲維銓 (M,1926/11/29,85y3m) 手術日期 2010/12/06 手術主治醫師 郭順文 手術區域 東址 007房 01號 診斷 Intracerebral hemorrhage 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 趙安怡 ASA 3 紀錄醫師 高明蔚, 時間資訊 08:20 報到 08:20 進入手術室 08:25 麻醉開始 08:28 誘導結束 08:47 手術開始 09:03 麻醉結束 09:03 手術結束 09:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 氣管切開術 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 高明蔚 開立時間: 2010/12/06 09:07 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types nil Pathology None Operative Findings Fr . 8 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube after checking bleeding. Operators 郭順文 Assistants R3高明蔚, R3鄒冠全 孫良發 (M,1935/11/30,76y3m) 手術日期 2010/12/06 手術主治醫師 蔡翊新 手術區域 東址 003房 03號 診斷 Brain contusion 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3E 紀錄醫師 鍾文桂, 時間資訊 00:00 開始NPO 08:40 通知急診手術 19:05 進入手術室 19:05 報到 19:10 麻醉開始 19:25 開始輸血 19:30 誘導結束 19:45 抗生素給藥 20:11 手術開始 22:45 麻醉結束 22:45 手術結束 22:53 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 急性硬腦膜下血腫清除術 1 1 R 手術 顱內壓視置入 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: 1. Decompressive craniectomy and removal of s... 開立醫師: 鍾文桂 開立時間: 2010/12/06 23:27 Pre-operative Diagnosis Head injury with acute subdural hemorrhage, right frontal-parietal-temporal. Post-operative Diagnosis Head injury with acute subdural hemorrhage, right frontal-parietal-temporal. Operative Method 1. Decompressive craniectomy and removal of subdural hemorrhage. 2. Insertion of ICP monitor,Camino. Specimen Count And Types nil Pathology Nil. Operative Findings 1. Active bleeder: a cortical artery near sylvian fissure at frontal lobe. 2. Severe adhesion of the dura mater with skull bone. Lacerated dura mater during craniotomy. Dural defect was repaired and augmented with DuraFoam. 3. Easy oozing operative field. Patient took Plavix daily. 4. ICP monitor: intraoperatively: 3-5mmHg; after wound closure: 10-15mmHg. Operative Procedures Under ETGA, the patient was placed in supine position and the head was tilted to the left. After shaving, disinfection, and draping, a curvilinear scalp incision was made. After periosteal dissection and elevation of temporalis muscle, a 12*10 cm craniectomy was achieved. The dura mater was seperated from the skull bone. After durotomy, the subdural hemorrhage was evacuated by suction. The active bleeder from a cortical artery was electrocoagulated. After well hemostasis, a subdural ICP was inserted. The DuraFoam was placed along the dural defect. After placing two epidural CWV drain, the wound was closed in layers. Operators V.S. 蔡翊新 Assistants R5 鍾文桂 Indication Of Emergent Operation 陳周月雲 (F,1947/09/01,64y6m) 手術日期 2010/12/07 手術主治醫師 楊榮森 手術區域 東址 020房 01號 診斷 Lung cancer 器械術式 Tumor curettage+THR -United 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 脊髓麻醉 麻醉主治醫師 劉漢平 ASA 3 紀錄醫師 謝忠佑, 時間資訊 07:35 報到 08:07 進入手術室 08:15 麻醉開始 08:20 誘導結束 08:30 抗生素給藥 08:50 手術開始 09:12 開始輸血 10:50 手術結束 10:50 麻醉結束 10:55 送出病患 10:58 進入恢復室 12:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 惡性骨瘤廣泛切除(一次) 1 1 L 手術 股關節全置換術 1 2 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Spinal anesthesia 1 0 麻醉 SPINAL ANESTHESIA 1 0 摘要__ 手術科部: 骨科部 套用罐頭: 1. tumor excision and curettage 開立醫師: 謝忠佑 開立時間: 2010/12/07 11:05 Pre-operative Diagnosis lunb cancer, left acetabulum metastasis Post-operative Diagnosis lunb cancer, left acetabulum metastasis Operative Method 1. tumor excision and curettage 2. THA, United prosthesis Head 28 neck -3, Cup 48mm Stem 9mm, #1, Specimen Count And Types 1 piece About size: Source:pathology and cytology Pathology pending Operative Findings yellowish-red tumor tissue excised and curetted from the left acetabulum Operative Procedures 1. SA, lateral decubitus 2. prepped and draped 3. longidutinal incision along the posterior border of the femur and curved posteriorly, Kocher-Langenbach approach, with posterior capsulotomy 4. remove the femoral head, curetted and excised the tumor lesion over the whole acetabulm, apply autologous bone graft from the femora head. prepare the acetabulum and insert the prosthesis 5. prepare the femur canal , then insert the stem and reduce the hip joint 6. check stability , irrigation ,repair the soft tissue , then close wound in layers afte setting 1/8 h/v x 1 Operators 楊榮森, Assistants 謝忠佑, 黃興耀, 簡士承 (M,1985/05/31,26y9m) 手術日期 2010/12/07 手術主治醫師 林子富 手術區域 西址 036房 01號 診斷 Hepatocellular carcinoma (HCC) 器械術式 Port-A Implatation /WOR 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 林子富 ASA 3 紀錄醫師 賴佳欣, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:10 進入手術室 08:15 麻醉開始 08:15 抗生素給藥 08:20 誘導結束 08:35 手術開始 09:05 手術結束 09:05 麻醉結束 09:10 送出病患 09:15 進入恢復室 10:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 手術 port–A導管植入術–治療性導管植入術 1 0 R 記錄__ 手術科部: 麻醉部 套用罐頭: Port-A implantation, subclavian 開立醫師: 賴佳欣 開立時間: 2010/12/07 09:10 Pre-operative Diagnosis hepatocellular carcinoma Post-operative Diagnosis Ditto Operative Method Port-A implantation, echo-guided Specimen Count And Types nil Pathology Nil Operative Findings 1.Site: right subclavian vein, with echo-guided procedure 2.Patent flow after implantation 3.Others: nil Operative Procedures 1.The patient was set on supine position and bilateral subclavian veins were checked by echo. 2.After IVGA and local anesthesia applied, transverse skin incision for 3cm was made at pre-cordial area. 3.Undermine the skin at the layer between subcutaneous tissue and deep fascia in lateral direction. 4.An IV catheter was inserted via the subclavian incision and negatively aspirated until venous blood attainable. 5.J-wire was inserted smoothly in rostral direction. A subclavian catheter with dilator was inserted through the J-wire, and the dilator was then removed. 6.The catheter of Port-A was threaded into the subclavian vein until mark 23 cm. The catheter was adapted into the port and locked with restrictor.The Port was inserted into the pouch of pre-cordial incision. 7.Skin was closed layer by layer. Both catheter and port were perfused with heparin solution after implantation. Operators 林子富, Assistants 賴佳欣, 曾國修 (M,1963/05/11,48y10m) 手術日期 2010/12/07 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Parkinson''s Disease 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 游皓鈞, 時間資訊 07:32 報到 08:05 進入手術室 08:10 麻醉開始 08:15 誘導結束 08:32 抗生素給藥 09:00 手術開始 10:35 手術結束 10:35 麻醉結束 10:45 送出病患 10:47 進入恢復室 11:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 腦室腹腔分流手術 1 2 L 記錄__ 手術科部: 外科部 套用罐頭: IPG implantation 開立醫師: 游皓鈞 開立時間: 2010/12/07 10:52 Pre-operative Diagnosis Parkinson disease status post implantation of bilateral deep brain stimulation Post-operative Diagnosis Parkinson disease status post implantation of bilateral deep brain stimulation Operative Method IPG implantation Specimen Count And Types nil Pathology nil Operative Findings 1. Two leads inserted previously Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture. 4. Incision: 4 cm curvilinear, left occipital, dissect and expose the lead implanted previously 5. Incision: 10 cm transverse, about 2 cm below left clavicle, dissect and create a pocket space for IPG implantation 6. A trochar was used to create a subcutanous tuneel connecting with the pocket and sclap wound. 7. The IPG was placed into the pocket space and the cable was placed into the tunnel. 8. Connection of the leads, check the IPG function. 9. irrigation of the wound with gentamycin solution 10. close the wound in layers 11.Course of the surgery: smooth. Operators P曾勝弘 Assistants R5鍾文桂, R1游皓鈞 陳碧惠 (F,1956/08/01,55y7m) 手術日期 2010/12/07 手術主治醫師 曾勝弘 手術區域 西址 033房 01號 診斷 Carpal tunnel syndrome 器械術式 Neurolysis of the uluar neuve 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 10:25 進入手術室 10:45 麻醉開始 10:47 手術開始 11:05 手術結束 11:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 正中神經或尺神經腕部減壓術–單側 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Carpal Tunnel Syndrome 開立醫師: 古恬音 開立時間: 2010/12/07 11:12 Pre-operative Diagnosis Left carpal tunnel syndrome Post-operative Diagnosis Left carpal tunnel syndrome Operative Method Medium nerve decompression Specimen Count And Types nil Pathology Nil Operative Findings The medium nerve was compressed tightly by the hypertrophic flexor retinaculum. Operative Procedures 1. The hand and forearm were sterilized with povidone-iodine tincture, then covered with stockinet. 2. Anesthesia: local anesthesia with xylocaine 3. Incision: linear skin incision just distal to the skin crease 4. The median nerve was identified beneath the palmars longus tendon. Under direct vision, the transverse carpal ligament was divided until no more pressure on the median nerve could be palpated. 6. The skin was closed by interrupted suture with 4/0 nylon. Operators VS曾勝弘 Assistants R3古恬音 蕭素妍 (F,1953/10/25,58y4m) 手術日期 2010/12/07 手術主治醫師 曾勝弘 手術區域 西址 033房 02號 診斷 Scalp tumor 器械術式 Excision of neuroma 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 11:20 進入手術室 11:32 麻醉開始 11:35 手術開始 12:20 手術結束 12:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 頭皮腫瘤 1 1 摘要__ 手術科部: 外科部 套用罐頭: Tumor excision 開立醫師: 古恬音 開立時間: 2010/12/07 12:26 Pre-operative Diagnosis Scalp tumor Post-operative Diagnosis Scalp lipoma Operative Method Tumor excision Specimen Count And Types 1 piece About size:7*5CM Source:SCALP TUMOR Pathology Pending Operative Findings One 7*5 soft tumor was noted at right inferior occipital area. The tumor invaded the epidermis level. Operative Procedures 1. Supine position, local anesthesia 2. Make a fusiform scalp incision along the axis of the tumor 3. Dissect the tumor from peripheral tissue 4. Resect the redundant scalp 5. Wound closure in layers Operators VS曾勝弘 Assistants R3古恬音 林郁真 (F,2009/10/28,2y4m) 手術日期 2010/12/07 手術主治醫師 許巍鐘 手術區域 兒醫 066房 02號 診斷 Ependymoma 器械術式 BRONCHOSCOPY-COMPLICATED 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 許雅晴, 時間資訊 13:12 報到 13:28 進入手術室 13:30 麻醉開始 13:31 誘導結束 13:33 手術開始 13:50 麻醉結束 13:50 手術結束 14:02 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 管、支 管、細支 管異物除去術- 管鏡 1 1 手術 支氣管鏡檢查 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 套用罐頭: Flexible and Rigid bronchoscope 開立醫師: 許雅晴 開立時間: 2010/12/07 17:50 Pre-operative Diagnosis Brain tumor, swallowing disorder Post-operative Diagnosis Right vocal palsy, Subglottic granulation Operative Method Flexible and Rigid bronchoscope Specimen Count And Types 2 pieces About size:0.2*0.2cm Source:interarytenoid About size:0.2*0.2cm Source:upper esophagus Pathology pending Operative Findings Pharynx: Nasopharynx mild adenoid Tongue base: ok, saliva pooling Vallecula: ok, saliva pooling Hypopharynx: ok, saliva pooling Larynx: Epiglottis____normal______________________________ Aryepiglottic fold__normal________________________ Arytenoid cartilage_______normal__________________ Accesory cartilage_______normal_____________ True vocal fold____right vocal palsy_________ False vocal folds__normal_________________________ Subglotttis_______granulation tissue Trachea:___normal________ Carina: ___normal__________________________________ Right main bronchus:____normal_____________________ Left main bronchus______mild bronchomalacia_____________________ Others:______________________________________ Operative Procedures The patient was in supine position. Jet ventilation was used for impending airway obstruction. Rigid bronchoscopy was set and larynx, subglottis, trachea, carina, bilateral main bronchus, and right upper, middle, lower; left upper and lowerbronchus were checked. Operators Asp 許巍鐘 Assistants R3 許雅晴 蔡武雄 (M,1945/02/10,67y1m) 手術日期 2010/12/07 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Cervical Spondylosis 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 黃鼎鈞, 時間資訊 07:30 報到 08:10 進入手術室 08:15 麻醉開始 08:20 誘導結束 09:12 手術開始 09:40 抗生素給藥 11:35 手術結束 11:35 麻醉結束 11:40 送出病患 11:45 進入恢復室 12:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-頸椎 1 1 R 手術 脊椎融合術-前融合,有固定物(每增加<=四節) 1 2 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 摘要__ 手術科部: 外科部 套用罐頭: 1.ACDF with cage 2.right foraminotomy, C5/6 開立醫師: 陳德福 開立時間: 2010/12/07 11:23 Pre-operative Diagnosis C5/6 HIVD with spinal stenosis and right foraminal stenosis Post-operative Diagnosis C5/6 HIVD with spinal stenosis and right foraminal stenosis Operative Method 1.ACDF with cage 2.right foraminotomy, C5/6 Specimen Count And Types nil Pathology nil Operative Findings 1.There is HIVD with cord and nerve roots compression at the level of C5/6. The theca sac was decompressed after the diskectomy and one 6mm cage was implantated at the C5/6. 2.Right foraminotomy for C5/6 was performed and the nerve root was well visualized after the decompression. Operative Procedures Under ETGA and supine position, the neck was hyperextended. The skin was disinfected and draped as usual. One transverse linear incision was done one the right neck and the platysma was transected. The C5/6 prevertebral space was reached after dissecting along the areolar plane. The location of C5/6 was identifed under C-arm fluroscope. The longus coli muscle was displaced laterally and the C5/6 discectomy was performed under microscopic surgery. The PLL was remvoed and the dura sac was expended well. One 6mm Syntheses cervical cage was implatated at the C5/6 level. One minihemovac was left in situ and the wound was closed in layers. Operators vs 賴達明 Assistants R5 陳德福 R1黃鼎鈞 相關圖片 林雪玉 (F,1948/06/12,63y9m) 手術日期 2010/12/07 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Spondylolisthesis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 黃鼎鈞, 時間資訊 12:00 進入手術室 12:05 麻醉開始 12:15 誘導結束 12:20 抗生素給藥 12:41 手術開始 15:20 抗生素給藥 16:05 手術結束 16:05 麻醉結束 16:10 送出病患 16:10 進入恢復室 17:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術(減壓)-二節以內 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 手術 脊椎融合術-後融合,無固定物 1 1 摘要__ 手術科部: 外科部 套用罐頭: 1.L2-3 fusion with Dyneses 2.L2 laminotomy 開立醫師: 陳德福 開立時間: 2010/12/07 15:49 Pre-operative Diagnosis L2-3 HIVD and spondylosis with spinal stenosis Post-operative Diagnosis L2-3 HIVD and spondylosis with spinal stenosis Operative Method 1.L2-3 fusion with Dyneses 2.L2 laminotomy Specimen Count And Types nil Pathology nil Operative Findings 1.There is hypertrophic ligamentum flavum and facet joint over the L2/3 level. The L2/3 HIVD is also noticed. The L2 laminotomy for decompression was performed and the theca sac was decompressed after the procedure. 2.The L2-3 posterior fusion was done with Dyneses system [Screw: 45mm]. Operative Procedures Under ETGA and prone position, the skin was disinfected and draped as usual. One linear incision was done and the paraspinous muscle was displaced laterally. The L2-3 facets and transverse process were identified followed by inserting the TPS. The location of the TPS was checked under C-arm fluroscope. The L2 laminotomy was performed smoothly and the wound was closed in layers with one epidural hemovac. Operators VS賴達明 Assistants R5陳德福 R1黃鼎鈞 洪維 (M,1943/02/25,69y0m) 手術日期 2010/12/07 手術主治醫師 陳敞牧 手術區域 東址 005房 03號 診斷 Normal pressure hydrocephalus 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 游皓鈞, 時間資訊 14:10 報到 15:05 進入手術室 15:10 麻醉開始 15:15 誘導結束 15:35 抗生素給藥 16:00 手術開始 18:00 手術結束 18:00 麻醉結束 18:10 送出病患 18:13 進入恢復室 19:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦脊髓液分流管重置 1 1 R 手術 慢性硬腦膜下血腫清除術 1 2 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 記錄__ 手術科部: 外科部 套用罐頭: 1. Revision of ventriculoperitoneal shunt to ... 開立醫師: 鍾文桂 開立時間: 2010/12/07 18:34 Pre-operative Diagnosis 1. Chronic subdural hemorrhage, left F-P. 2. Hydrocephalus. Post-operative Diagnosis 1. Chronic subdural hemorrhage, left F-P. 2. Hydrocephalus. Operative Method 1. Revision of ventriculoperitoneal shunt to programmable shunt. 2. Evacuation of chronic subdural hemorrhage. Specimen Count And Types nil Pathology Nil. Operative Findings 1. Liquified hematoma with some organized blood clot was noted during hematoma evacuation. The brain expands fairly. About 20 cc hematoma was evacuated. 2.From Medtronic medium pressure to Codman programmable shunt, inital setting 100 mmH20; revision of ventricular catheter and the reservoir only. ventricular: 6.5cm. The patency of the peritoneal shunt was checked well before the new connection. Operative Procedures Under ETGA, the patient was placed in supine position and the head was tilted to the left side. After shaving, disinfection, and draping, a linear incision was made at left frontal region. After a burr hole creation and durotomy, chronic SDH was evacuated. No drain was placed. The wound was closed in layers subsequently. The curvilinear scalp incision over the V-P shunt reservoir was incised and dissected. After measuring the length needed for the new shunt system, the peritoneal shunt was opened at retroauricular area. The new shunt system passed through the scalp and connected with the disconnected peritoneal shunt. Then, Medtronic reservoir and ventricular catheter was removed. The new ventricular catheter was inserted through the same tract. After ensuring the patency of the new shunt, the wounds were closed in layers. Operators V.S. 陳敞牧 Assistants 鍾文桂 游皓鈞 蕭易強 (M,1954/08/21,57y6m) 手術日期 2010/12/07 手術主治醫師 陳敞牧 手術區域 東址 005房 02號 診斷 Contusion, back 器械術式 Lamino plasty 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 游皓鈞, 時間資訊 10:18 報到 11:05 麻醉開始 11:10 誘導結束 11:25 抗生素給藥 11:59 進入手術室 12:00 手術開始 14:30 抗生素給藥 14:45 手術結束 14:45 麻醉結束 14:55 送出病患 14:58 進入恢復室 16:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓整形術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 記錄__ 手術科部: 外科部 套用罐頭: laminoplasty from C3 to C6 開立醫師: 游皓鈞 開立時間: 2010/12/07 14:40 Pre-operative Diagnosis Herniated intervertebral disc(HIVD) at C5-C6 level Post-operative Diagnosis Herniated intervertebral disc(HIVD) at C5-C6 level Operative Method laminoplasty from C3 to C6 Specimen Count And Types nil Pathology nil Operative Findings Spinal cord was compressed tightly by hypertorphic ligamentum flavum. The cord was decompressed after laminoplasty Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position with head fixed with Mayfield head clamp. After shaved, scrubbed, disinfected, and then draped, we made one midline linear skin incison from C3 to C6. We dissected paraspinal muscle to expose bilateral laminae from C3 to C6. We drilled the left laminae of C3 to C6 partially, and right laminae of C3 to C6 throughly. As hinge at left, we performed laminopalsty and fixed with mini-plates. The wound was closed in layers after one CWV drain in sertion. Operators VS陳敞牧 Assistants R5鍾文桂, R1游皓鈞 相關圖片 何冠毅 (M,2009/10/09,2y5m) 手術日期 2010/12/07 手術主治醫師 楊士弘 手術區域 兒醫 067房 01號 診斷 Acrocephlosyndactyly 器械術式 Cranio-orbital reconstruction 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 雷秋文, 林冠良, 李振豪, 時間資訊 00:00 臨時手術NPO 08:00 報到 08:05 進入手術室 08:05 麻醉開始 08:10 誘導結束 08:21 手術開始 08:30 手術結束 09:30 抗生素給藥 10:10 10:50 開始輸血 12:30 抗生素給藥 15:45 抗生素給藥 18:45 抗生素給藥 19:15 麻醉結束 19:15 19:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 支氣管鏡檢查 1 0 手術 顱骨切除術,包括異物移除或壓或經切斷 1 1 手術 頭顱成形術 1 2 手術 顱顏合併手術 1 1 手術 顏面骨移植術(先天畸形或外傷腫瘍摘除) 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 14 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 4 0 麻醉 Hemoglobin (Hb) 4 0 麻醉 測血糖 4 0 麻醉 Ca (Calcium) 4 0 麻醉 Na (Sodium) 4 0 麻醉 K (Potassium) 4 0 麻醉 Blood gas analysis 4 0 記錄__ 手術科部: 耳鼻喉部 套用罐頭: Flexible bronchoscope 開立醫師: 林冠良 開立時間: 2010/12/07 16:32 Pre-operative Diagnosis Apert syndrome Post-operative Diagnosis Apert syndrome, operated Operative Method Flexible bronchoscope Specimen Count And Types nil Pathology nil Operative Findings Nose__normal__Choana___not check____ Pharynx: Nasopharynx___not check___ Tongue base___hypertrophy____ Vallecula___normal____ Hypopharynx___normal____ Larynx: Epiglottis___normal____ Aryepiglottic fold___normal____ Arytenoid cartilage___normal____ Accesory cartilage___normal____ True vocal fold___normal____ False vocal folds___normal____ Subglotttis___patent___ Trachea:___patent___ Carina: ___patent____ Right main bronchus:___patent____ Left main bronchus___patent____ Others:______________________________________ Operative Procedures The patient was put in supine position with neck hyperextended. After IVF was setup, flexible bronchoscope was applied into the nostril. From the nasal cavity and nasopharynx till bilateral bronchi were examed. Adenoid vegetation and bilateral tonsillar hypertrophy were noted under the bronchoscopy. The pharynx, larynx, trachea, carina and bilateral bronchi were smooth and patent. Operators AsP許巍鐘 Assistants R2林冠良/ R3許雅晴 摘要__ 手術科部: 外科部 套用罐頭: Cranio-orbital reconstruction 開立醫師: 李振豪 開立時間: 2010/12/07 18:06 Pre-operative Diagnosis Acrocephalosyndatyly Apert syndrome with acrocephalosyndatyly and bicoronal craniosynostosis Post-operative Diagnosis Acrocephalosyndatyly Apert syndrome with acrocephalosyndatyly and bicoronal craniosynostosis Operative Method Cranio-orbital reconstruction Specimen Count And Types nil Pathology Nil Operative Findings The bicoronal suture was fused tightly with frontal bossing. The margin of the anterior and posterior fontanelle were adhered with dura and skull edge tightly. The zygomatic arch was low set and the sphenoid ridge was much high then usuals. During craniotomy, 4 incidental durotomy was noted and all repaired with 4-0 prolene. Subarachnoid hemorrhage was noted during the operation. No evident CSF leakage was noted after repair of durotomy and covered with Durogen. A large cavity over frontal area was noted after cranio-orbital reconstruction. The dura was bulging but not tense by palpation during wound closure. The bicoronal suture was fused tightly with frontal bossing. The margin of the anterior and posterior fontanelle were adhered with dura and skull edge tightly. The zygomatic arch was low set and the sphenoid ridge was much high then usuals. During craniotomy, 4 incidental durotomy was noted and all repaired with 4-0 prolene. Subarachnoid hemorrhage was noted during the operation. No evident CSF leakage was noted after repair of durotomy and covered with Durogen. A large epidrual space over frontal area was noted after cranio-orbital reconstruction. The dura was bulging but not tense by palpation during wound closure. Operative Procedures The plastic surgeon already elevated scalp flap and periosteum. We dissected the margin of the anterior and posterior fontanelle to expose the bone edge. High-speed air-drived drills was used for craniectomy. The fronto-temporo-parietal skull plate was removed with 4 pieces. The ortibal bar was removed with oscillating saw. Hemostasis was achieved with gelform packing and bipolar electrocautery. Incidental durotomy was noted after craniectomy and repaired with 4-0 prolene. One 4 x 5 inches Durogen was used to prevent CSF leakage. Further cranio-orbital reconstruction will be performed by plastic surgeon. Operators VS楊士弘 Assistants R4李振豪 記錄__ 手術科部: 外科部 套用罐頭: Cranio reconstruction 開立醫師: 阮廷倫 開立時間: 2010/12/07 19:44 Pre-operative Diagnosis Alpert syndrome with Brachycephaly Post-operative Diagnosis Alpert syndrome with Brachycephaly Operative Method Cranio reconstruction Specimen Count And Types nil Pathology nil Operative Findings Brachycephaly with protruding anterior fontanelle Operative Procedures 1. Supine position, ETGA 2. Skin disinfection and drapped 3. bicoronal incision was made 4. We dissect and raised the scalp forward to the superior orbital space through the subgaleal space 5. Then we dissect the periosteum forward to the superior orbital space. 6. We resected the frontal bone and frontal bar. Then reposition was done with mini-plate. 7. We resected the temporal-parietal bone and reposition was done, the residual bone was used for covering the bone defect 8. one CWV drain was set over the superior orbital area 9. We recovered the periosteum 10. Checked bleeder and Closed the wound in layers with 3-0 and 4-0 vicryl. Operators VS 謝孟祥，VS 楊士宏 Assistants R5 阮廷倫，R4 李振豪，R2 雷秋文 賴燈炎 (M,1924/09/28,87y5m) 手術日期 2010/12/07 手術主治醫師 王國川 手術區域 東址 001房 02號 診斷 Subdural hematoma 器械術式 Burr hole drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 胡朝凱, 時間資訊 10:00 臨時手術NPO 10:00 開始NPO 02:00 通知急診手術 08:55 報到 09:09 進入手術室 09:12 麻醉開始 09:20 誘導結束 09:22 抗生素給藥 09:55 手術開始 10:45 手術結束 10:45 麻醉結束 11:10 進入恢復室 13:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 手術 慢性硬腦膜下血腫清除術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Right burr hole drainage 開立醫師: 胡朝凱 開立時間: 2010/12/07 10:52 Pre-operative Diagnosis Right chronic SDH Post-operative Diagnosis Right chronic SDH Operative Method Right burr hole drainage Specimen Count And Types Nil Pathology nil Operative Findings 1.Motor oil massive amount hematoma was drained out at right frontal-parietal-temporal area. 2.The brain was slack even after drainage 3.Outer membrane was noted Operative Procedures 1.ETGA, supine 2.Right parietal area transverse skin incision 3.Dissect skin flap 4.open periosteum 5.Burr hole drill 6.Open dura then outer membrane 7.Rubber drain insertion and irrigation 8.Close wound then de-air Operators 王國川 Assistants 胡朝凱 Indication Of Emergent Operation 林蔡美鶯 (F,1946/12/06,65y3m) 手術日期 2010/12/07 手術主治醫師 蔡翊新 手術區域 東址 002房 02號 診斷 Other and unspecified intracranial hemorrhage following injury, with loss of consciousness of unspecified duration 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 胡朝凱, 時間資訊 10:50 報到 11:10 進入手術室 11:20 麻醉開始 11:25 誘導結束 11:35 抗生素給藥 12:10 手術開始 13:40 手術結束 13:40 麻醉結束 13:50 送出病患 13:51 進入恢復室 15:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 頭顱成形術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 記錄__ 手術科部: 外科部 套用罐頭: Left cranioplasty 開立醫師: 胡朝凱 開立時間: 2010/12/07 14:02 Pre-operative Diagnosis Left skull defect Post-operative Diagnosis Left skull defect Operative Method Left cranioplasty Specimen Count And Types nil Pathology nil Operative Findings 1.Left previous craniectomy window measured as 18 x14 cm 2.Autologous bone was fixed back 3.Partial temporalis muscle was preserved. 4.The craniectomy window was slack Operative Procedures 1.ETGA, supine 2.Left previous wound skin incision 3.Reflect skin flap between the interface of galea and dura 4.Hemostasis 5.Reflect temporalis muscle 6.Fixed bone back with miniplate and central tenting 7.set two CWV drain, one beneath the bone, and the other above the bone 8.Fixed muscle to the bone 9.Close wound in layers Operators 蔡翊新 Assistants 胡朝凱 沈淑芬 (F,1962/05/06,49y10m) 手術日期 2010/12/08 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Acromegaly 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 14:20 進入手術室 14:25 麻醉開始 15:00 誘導結束 15:00 抗生素給藥 15:35 手術開始 17:05 手術結束 17:05 麻醉結束 17:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經由蝶竇之腦下垂體瘤切除 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 記錄__ 手術科部: 外科部 套用罐頭: Transsphenoidal adenomectomy. 開立醫師: 鍾文桂 開立時間: 2010/12/08 17:46 Pre-operative Diagnosis Pituitary microadenoma. Post-operative Diagnosis Pituitary microadenoma. Operative Method Transsphenoidal adenomectomy. Specimen Count And Types 1 piece About size:3cc Source:pituitary adenoma Pathology Pending. Operative Findings Severe bleeding from the nasal mucosa and the venous plexus anterior to the adenoma. The bleeding from the venous plexus was stopped by gelfoam packing. Yellowish, soft, fragile adenoma was excised. Much CSF leakage was noted. It was sealed with gelfoam and TissueColDuo. Operative Procedures Under general anethesia and intubation, the patient was put in supine position. The facial skin was antiseptic with alcohol, and the mucosa of oral and nasal cavity with aqueous better-iodine. The face was covered with sterilized adhesive plastic sheets then draped. Under microscope, nasal septum was incised, and a nasal speculum was applied to displace the nasal mucosa laterally and keep the nasal cavity open constantly for the exposure of the vomer bone and the anterior wall of the sphenoid sinus. The anterior sphenoid wall, sphenoid sinus mucosa and sella floor were removed along with the sphenoidal portion of the adenoma. The dura was coagulated then opened in cruciate fashion. The tumor was removed by curette and aligator. The CSF leakage was sealed with Tissuecol Duo and gelform packing. The bone of anterior sphenoid wall was placed back and the nasal mucosa was returned to its normal position. The nasal mucosa was sealed with Tissuecol Duo. Operators V.S. 曾漢民 Assistants 鍾文桂 王玗青 (F,1954/08/18,57y6m) 手術日期 2010/12/08 手術主治醫師 蔡瑞章 手術區域 東址 005房 01號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 08:05 進入手術室 08:10 麻醉開始 08:50 誘導結束 09:00 抗生素給藥 09:38 手術開始 12:00 抗生素給藥 13:40 手術結束 13:40 麻醉結束 13:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Simpson grade II tumor excision. 開立醫師: 鍾文桂 開立時間: 2010/12/08 14:02 Pre-operative Diagnosis Right frontal convexity meningioma. Post-operative Diagnosis Right frontal convexity meningioma. Operative Method Simpson grade II tumor excision. Specimen Count And Types 3 pieces About size:10 cc Source:skull bone About size:3 cc Source:arachnoid membrane with possible tumor invasion. About size:10 cc Source:Tumor mass Pathology Pending. Operative Findings Tumor character: mixture of soft, grayish-pink, and calcified parts. Well-delineated. Feeders: from middle meningeal artery. The tumor invades the dura mater and through the inner table of the skull bone. The inner table and bone marrow of the involved skull were also excised. The remaining craniotomy plate was fixed back. Operative Procedures Under ETGA, the patient was placed in supine position and the head was placed in the midline. After shaving, disinfection, and draping, a reverse U shape incision was made. After dissection, the craniotomy was achieved by using high speed drills. The skull bone was elevated together with part of the tumor mass. After dural tenting and durotomy, the tumor was resected en bloc. After well hemostasis, the dura was repaired with pericranium. The remaining skull plate after resection of the invaded tumor was fixed by wires and plate/screws. The wound was closed in layers after placing one subgaleal CWV drain. Operators Prof. 蔡瑞章 Assistants 鍾文桂 陳蔚蔚 謝棋漢 (M,1995/11/22,16y3m) 手術日期 2010/12/08 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Arteriovenous malformation, brain 器械術式 EVD revision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 李振豪, 時間資訊 08:05 報到 08:06 進入手術室 08:07 麻醉開始 08:10 誘導結束 09:18 手術開始 10:30 麻醉結束 10:30 手術結束 10:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室體外引流 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 記錄__ 手術科部: 外科部 套用罐頭: Right Kocher"s external ventricular drainage ... 開立醫師: 李振豪 開立時間: 2010/12/08 10:54 Pre-operative Diagnosis Right thalamic arteriovenous malformation ruptured with right thalamic and intraventricular hemorrhage, status post right Kocher"s external ventricular drainage Post-operative Diagnosis Right thalamic arteriovenous malformation ruptured with right thalamic and intraventricular hemorrhage, status post right Kocher"s external ventricular drainage Operative Method Right Kocher"s external ventricular drainage revision Specimen Count And Types Wound swab for bacterial culture x I Pathology Nil Operative Findings The subgaleal hematoma was noted after wound opening. The wound was debrided and irrigated with Gentamicin solution. The EVD tract also filled with hematoma and removed. The CSF is still bloody and irrigated with gentamicin solution via EVD tube. The subgaleal hematoma was noted after wound opening. The wound was debrided and irrigated with Gentamicin solution. The EVD tract also filled with hematoma and removed. The CSF is still bloody and irrigated with gentamicin solution via EVD tube for more than 30 minutes. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine position. The previous EVD was removed. The scalp was shaved, scrubbed, and disinfected as usual. The scalp incision was made along previous wound and the scalp flap was elevated. The burr hole was identified. One wound swab was sampled for bacterial culture. The wound was irrigated with gentamicin solution. The EVD tube was placed via previous EVD tract but the function is not satisfied. New tract was created with ventricular needle. The EVD was placed again and ventricular drainage with gentamicin solution was done. Externalization was done and the EVD was fixed at 6.5cm in depth from burr hole. Hemostasis was achieved and the wound was closed in layers. Operators AP郭夢菲 Assistants R4李振豪, Ri廖書翎 相關圖片 盧美芬 (F,1954/03/21,57y11m) 手術日期 2010/12/08 手術主治醫師 賴達明 手術區域 東址 003房 03號 診斷 Cervical myelopathy 器械術式 OPLL-Anterior Corpectomy VSLai 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 胡朝凱, 時間資訊 14:30 報到 14:55 進入手術室 15:00 麻醉開始 15:15 誘導結束 15:30 抗生素給藥 15:53 手術開始 18:30 抗生素給藥 19:10 手術結束 19:10 麻醉結束 19:20 送出病患 19:22 進入恢復室 20:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-頸椎 1 1 手術 脊椎融合術-前融合,有固定物)≦四節 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: C3~4 ACDF with plate fixation and C6~7 ACDF w... 開立醫師: 胡朝凱 開立時間: 2010/12/08 19:34 Pre-operative Diagnosis C3~4 HIVD with listhesis and C6~7 HIVD Post-operative Diagnosis C3~4 HIVD with listhesis and C6~7 HIVD Operative Method C3~4 ACDF with plate fixation and C6~7 ACDF with autologous bone Specimen Count And Types nil Pathology nil Operative Findings 1.Anterior listhesis of C3 on C4 2.Posterior extrusion disc without ruptured was noted at C3~4 level 3.Partial alcified and hypertrophic PLL that adhesion to dura was noted. 4.An unintended durotomy was done 5.instability was noted at L3~4 level 6.Partial fusion at C6~7 level was also noted Operative Procedures 1.ETGA, supine 2.Right neck transverse skin incision at submandibular area was done 3.Dissect along with the anterior border of SCM muscle to expose prevertebral sapce was done 4.Localization 5.Dissect longus coli muscle 6.Discectomy 7.Harvest autologous bone graft from right iliac creast 8.Insert bone graft then fixed plate 9.Right transverse skin incision above the clavicle was done 10.Repeat previous procedure to do discectomy and fusion at C6~7 level without plate fixation 11.Set one CWV drain then clsoe wound in layers Operators 賴達明 Assistants 胡朝凱, Ri 蕭麗華 (F,1964/01/22,48y1m) 手術日期 2010/12/08 手術主治醫師 賴達明 手術區域 東址 001房 02號 診斷 Tumor, spine unspecified 器械術式 Benign intraspinal tumor, exci 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 黃鼎鈞, 時間資訊 00:15 臨時手術NPO 00:15 開始NPO 08:15 通知急診手術 11:00 報到 11:32 進入手術室 11:40 麻醉開始 12:00 抗生素給藥 12:00 誘導結束 13:15 手術開始 13:52 開始輸血 15:00 抗生素給藥 18:06 抗生素給藥 21:00 抗生素給藥 21:25 麻醉結束 21:25 手術結束 21:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 良性脊髓腫瘤切除術 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 12 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: 1.Intradural extramedullary tumor excision 2.... 開立醫師: 陳德福 開立時間: 2010/12/08 21:50 Pre-operative Diagnosis Intradural extramedullary tumor, cervical-thoracic Post-operative Diagnosis Intradural extramedullary tumor, cervical-thoracic, suspect neurilemomma Operative Method 1.Intradural extramedullary tumor excision 2.C3-T4 laminoplasty Specimen Count And Types 1 piece About size:1*1*1CM Source:intraspinal tumor Pathology pending Operative Findings 1.There is a intradural extramedullary tumor with spinal cord compression at the C3-T4 level. The tumor is 1.5*1.5*14cm in size and there is cyst formation inside the tumor. The tumor is yellowish, soft, well capsulated, and originated from the right C7 nerve root. There is a small part of the tumor penetrating the right C7 nerve foraman. The spinal cord was compressed tightly from the ventral to the dorsal side. 2.The tumor is totoally removed and the C3-T4 laminoplasty was performed with miniplates. Operative Procedures Under ETGA and prone position, the skin was disinfected and draped as usual. One linear incision along midline was done and the paraspinal muscle was displaced laterally. The C3-T4 laminotomy was done and the dura was opened in linear fasion along the right paramedian line. The tumor and the spinal cord were inspected. The right dentate ligament and arachonoid membrane was cut and the tumor was removed with CUSA assisted. The tumor was debulked and removed step by step. The dura was then closed in water tight fasion and the C3-T4 laminoplasty with miniplates was done. The wound was finally closed in layers. Operators VS 賴達明 Assistants R5 陳德福 R1黃鼎鈞 Indication Of Emergent Operation 黃彩雲 (F,1933/10/13,78y5m) 手術日期 2010/12/08 手術主治醫師 賴達明 手術區域 東址 003房 04號 診斷 Subarachnoid hemorrhage (SAH) 器械術式 Craniotomy(Aneurysms) P-DUH 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 3E 紀錄醫師 邱裕淳, 時間資訊 15:24 開始NPO 15:24 臨時手術NPO 15:24 通知急診手術 20:50 進入手術室 20:50 報到 20:55 麻醉開始 21:00 誘導結束 21:45 手術開始 02:55 麻醉結束 02:55 手術結束 03:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 開顱術摘除血管病變 - 腦血管瘤 有病徵的 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: Left craniotomy for aneurysmal clipping 開立醫師: 蕭博懷 開立時間: 2010/12/09 03:28 Pre-operative Diagnosis Left MCA bifurcation aneurysm with ruptured SAH Post-operative Diagnosis Left MCA bifurcation aneurysm with ruptured SAH Operative Method Left craniotomy for aneurysmal clipping Specimen Count And Types Nil Pathology nil Operative Findings 1.Mild brain swelling was noted. 2.diffuse SAH was noted especially at sylvian fissure 3.Atherosclerotic change of vessels 4.one 4.5 mm saccular aneurysm at MCA bifurcation protruding upward and letarally, peripheral hematoma was noted 5.One straight Sugita clip was applied Operative Procedures 1.ETGA, supine with head fixed with skull clamp and rotate to right for 45 degree 2.Left pterional approach was done 3.durotomy as a curvature fasion 4.Open sylvian fissure 5.The optico-carotid cistern was opened to drain the CSF 6.M2 parietal branch was identified first then trace back to exposed aneurysm dome and M1 7.The whole segment of M1 was exposed to prepare for proximal control 8.The temporal branch was further dissected to identified the relation between aneurysm and branches 9.After well identified aneurysmal neck, clipping was done without proximal control 10.Hemostasis 11.close dura with durofoam 12.Fixed bone back with miniplate 13.Close wound in layers after one CWV insertion Operators 賴達明 Assistants 胡朝凱, R1 Indication Of Emergent Operation 陳雪琴 (F,1933/11/02,78y4m) 手術日期 2010/12/08 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Radiculopathy 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 游健生, 時間資訊 07:30 報到 08:05 進入手術室 08:10 麻醉開始 08:25 誘導結束 09:00 抗生素給藥 09:22 手術開始 11:25 手術結束 11:25 麻醉結束 11:35 送出病患 11:36 進入恢復室 13:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎弓切除術(減壓)-二節以內 1 2 摘要__ 手術科部: 外科部 套用罐頭: L2~3 TPS with posteriolateral fusion and L2~3... 開立醫師: 游健生 開立時間: 2010/12/08 11:36 Pre-operative Diagnosis SPINAL STENOSIS OF L2~3 Post-operative Diagnosis SPINAL STENOSIS OF L2~3 Operative Method L2~3 TPS with posteriolateral fusion and L2~3 laminotomy decompression Specimen Count And Types nil Pathology nil Operative Findings 1.Hypertrophic facet 2.Hypertrophic flavum ligment that compressed the cauda equina 3.severe Osteoporosis 4.Screws: 4 x 6.0 Operative Procedures 1.ETGA, prone 2.Midline incision at L1~3 level 3.Detach paravertebral muscle muscle 4.Expose facet and transverse process 5.Screws insertion 6.Laminotomy of L2~3 7.Excised flavum ligment 8.posterior lateral fusion with autologous bone graft after decortication 9.Fixed rods 10.close wound in layers after hemovac drain insertion Operators 賴達明 Assistants 胡朝凱, 游健生 王沈友春 (F,1923/04/12,88y11m) 手術日期 2010/12/08 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Lumbar spondylosis 器械術式 Laminectomy for decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 游健生, 時間資訊 11:05 報到 11:56 進入手術室 12:00 麻醉開始 12:30 誘導結束 12:45 抗生素給藥 13:07 手術開始 14:20 手術結束 14:20 麻醉結束 14:30 送出病患 14:35 進入恢復室 16:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-腰椎 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Left microscopic discectomy 開立醫師: 胡朝凱 開立時間: 2010/12/08 14:37 Pre-operative Diagnosis LEFT L3~4 HIVD Post-operative Diagnosis LEFT L3~4 HIVD Operative Method Left microscopic discectomy Specimen Count And Types nil Pathology nil Operative Findings 1.One seqeustrated disc protruded from left L3~4 disc space downward that compressed the left L4 nerve root. 2.The PLL was intact 3.Mild instability at L3 on L4 level Operative Procedures 1.ETGA, prone 2.Midline skin incision at L3~4 level 3.Detach left paravertebral muscle 4.Drill the left L3 lamina 5.Laminotomy with Kerrison 6.Excised the flavum ligment 7.Incised open PLL 8.Discectomy with currete 9.removed ruptured disc 10.Hemostais 11.Close wound in layers Operators 賴達明 Assistants 胡朝凱, 游健生 張勝雄 (M,1941/02/19,71y0m) 手術日期 2010/12/08 手術主治醫師 陳敞牧 手術區域 東址 002房 03號 診斷 Head injury 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 游健生, 時間資訊 12:36 通知急診手術 12:50 進入手術室 12:58 麻醉開始 13:05 誘導結束 13:20 手術開始 16:10 手術結束 16:10 麻醉結束 16:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 硬腦膜外血腫清除術 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Removal of epidural hematoma 開立醫師: 游健生 開立時間: 2010/12/08 16:07 Pre-operative Diagnosis Right frontal-temporal epidural hematoma Post-operative Diagnosis Right frontal-temporal epidural hematoma Operative Method Removal of epidural hematoma Specimen Count And Types nil Pathology Nil Operative Findings 1. Little EDH and SDH. 2. Severe edematous changes of temporalis muscle with mass effect 3. Severe adhesion between temporalis muscle and dura. Operative Procedures 1. Under ETGA, patient in supine position with head rotated to left 2. After shaving, we disinfected and draped the operation field as usual 3. Scalp incision over previous wound 4. Elevated skin flap followed by removal of bone flap 5. Removed EDH 6. Dissected temporalis muscle from dura and removed SDH 7. Resected part of the edematous muscle for decompression 8. Achieved hemostasis and placed one subgaleal CWV drain 9. Central tenting x 3 followed by bone flap fixation 10.Comsetic augmentation of bone flap with bone cement 11.Closed wound in layers Operators VS 陳敞牧 Assistants R4 曾峰毅 R4 李振豪 R3 游健生 Indication Of Emergent Operation 賴朝獻 (M,1924/08/20,87y6m) 手術日期 2010/12/08 手術主治醫師 蔡翊新 手術區域 東址 002房 04號 診斷 Subdural hemorrhage 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 3E 紀錄醫師 游健生, 時間資訊 06:00 開始NPO 08:18 通知急診手術 16:55 進入手術室 17:05 麻醉開始 17:10 誘導結束 17:20 抗生素給藥 17:35 手術開始 20:05 麻醉結束 20:05 手術結束 20:10 送出病患 20:13 進入恢復室 22:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 慢性硬腦膜下血腫清除術 1 1 L 手術 慢性硬腦膜下血腫清除術 1 2 R 摘要__ 手術科部: 外科部 套用罐頭: Chronic Subdural Hematoma 開立醫師: 蔡翊新 開立時間: 2010/12/08 18:52 Pre-operative Diagnosis Bilateral F-T-P chronic subdural hematoma. Post-operative Diagnosis Bilateral F-T-P chronic subdural hematoma. Operative Method Bilateral frontotemporal burr holes for removal of chronic SDH. Specimen Count And Types nil Pathology Nil. Operative Findings Dark reddish liquified blood gushed out upon opening the dura and outer membrane. A layer of greyish membrane was noted at the surface of the brain, possibly fibrin coating at inner membrane. The brain remained slack after drainage of the subdural hematoma. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: linear at bilateral frontotemporal areas. Raney clips were applied to the scalp edge for temporary hemostasis. 5. Two burr holes were made at bilateral frontotemporal region, one at each side. 6. Dural tenting: by 2/0 silk at 1 cm interval, distributed along the edge of the burr hole. 7. Dural incision: Cruciate. 8. The outer membrane of the hematoma was coagulated by Bovie along the edge of dural incision, then exicsed. 9. The liquified old blood in the subdural space was evacuated by sucker, then thoroughly irrigated with N.S. through a rubber tube until the return was clean. The left side inner membrane of the hematoma was opened by a nib incision. 10.Scalp closure:hemostasis was done with bipolar coagulator. Galea suture was performed by continuous sutures with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 11.Drain: two, subdural, connected to reservoir bags. 12.Blood transfusion: nil. 13.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R4李振豪R3游健生 Indication Of Emergent Operation 吳順吉 (M,2009/11/02,2y4m) 手術日期 2010/12/09 手術主治醫師 黃書健 手術區域 兒醫 067房 02號 診斷 Tetralogy of Fallot 器械術式 Repair TF, V.S.D., E.C.D.,TC 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 4E 紀錄醫師 林明賢, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 10:00 通知急診手術 13:25 進入手術室 13:30 麻醉開始 13:40 誘導結束 14:04 手術開始 15:15 開始輸血 16:30 手術結束 16:30 麻醉結束 16:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 T.E.E 1 0 麻醉 動脈血液檢查全套 3 0 麻醉 Hemoglobin (Hb) 3 0 麻醉 測血糖 3 0 麻醉 Ca (Calcium) 3 0 麻醉 Na (Sodium) 3 0 麻醉 K (Potassium) 3 0 麻醉 Blood gas analysis 3 0 手術 四合群症之繞道手術 1 1 手術 頸(肢體)動靜廔管之切除移植及直接修補,右繞道手術 1 2 記錄__ 手術科部: 外科部 套用罐頭: Btshunt 開立醫師: 林明賢 開立時間: 2011/01/06 12:09 Pre-operative Diagnosis TOF, s/p right mBT shunt, desaturation and under ECMO support Post-operative Diagnosis TOF, s/p right mBT shunt, desaturation and under ECMO support Operative Method Modified Blalock-Taussig shunt operation, remove ECMO Specimen Count And Types nil Pathology nil Operative Findings 1.fair heart contractility 2.innominate artery: 6mm in diameter, MPA: 10mm in diameter 3.shunt: 5mm Goretex tube graft 4.post-op thrill:(+) 5.pre-op SpO2:80%, FiO2:50%+ECMO support Post-op SpO2:90-95%, FiO2:60%, no ECMO Operative Procedures 1. ETGA, supine position, median sternotomy 2.partial pericardiectomy and identify innominate artery, vein and MPA 3.partial clamp innominate artery 4.anastomosed a 5mm Goretex tube graft to innominate artery and to MPA 5.hemostasis and weaning off ECMO 6.surgical membrane loop shunt and innominate artery, cover shunt, innominate vein, aorta and MPA with pericardial patch Operators 黃書健 Assistants 林明賢 Indication Of Emergent Operation 凌永 (M,1938/05/12,73y10m) 手術日期 2010/12/09 手術主治醫師 蕭輔仁 手術區域 東址 003房 03號 診斷 Lumbar Spondylosis 器械術式 Radiofrequency coagulation 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 曾峰毅, 時間資訊 16:15 報到 16:50 進入手術室 17:00 抗生素給藥 17:10 麻醉開始 17:13 手術開始 18:18 麻醉結束 18:18 手術結束 18:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 高頻熱凝療法 1 1 摘要__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 曾峰毅 開立時間: 2010/12/09 18:18 Pre-operative Diagnosis Lumbar spondylosis Post-operative Diagnosis Lumbar spondylosis Operative Method Radiofrequency ablation to bilateral L2 dorsal root ganglion. Specimen Count And Types nil Pathology Nil Operative Findings Radiofrequency at 42 degrees Celsius, 180sec, 20msec per pulse, and 2Hz in pulse rate was performed to bilateral L2 dorsal root ganglion. Operative Procedures With C-arm guidance and local anaesthesia, tha patient was put in prone position. After back scrubbed, disinfected, and then draped, we performed radiofrequency ablation to bilateral L2 dorsal root ganglion. Operators VS 蕭輔仁 Assistants R4 曾峰毅 盧振輝 (M,1968/01/25,44y1m) 手術日期 2010/12/09 手術主治醫師 王國川 手術區域 東址 005房 03號 診斷 Cerebrovascular accident (CVA) 器械術式 Craniectomy and ICP monitor insertion 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 蕭柏妮 ASA 4E 紀錄醫師 張僖, 時間資訊 19:02 通知急診手術 19:25 報到 19:27 進入手術室 19:30 麻醉開始 19:40 誘導結束 19:50 抗生素給藥 20:14 手術開始 22:00 開始輸血 22:50 抗生素給藥 00:15 麻醉結束 00:15 手術結束 00:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱內壓視置入 1 4 手術 腦內血腫清除術 1 1 R 手術 顳下減壓術 - 單側 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 神經部 套用罐頭: 1.Craniectomy ICH evacuation 2.ICP monitoring 開立醫師: 陳德福 開立時間: 2010/12/09 23:42 Pre-operative Diagnosis Right MCA territory infarct with hemorrhagic transformation and brain stem compression Post-operative Diagnosis Right MCA territory infarct with hemorrhagic transformation and brain stem compression Operative Method 1.Craniectomy ICH evacuation 2.ICP monitoring Specimen Count And Types nil Pathology nil Operative Findings 1.There was cerebral infarct over the right MCA territory and the brain was buldging out after the craniectomy without prompt pulsation. 1.There was cerebral infarct over the right MCA territory and the brain was buldging out after the craniectomy without prompt pulsation. 2.The cortical veins was almost stasis and the brain tissue was fragile over the right frontal-temporal region. The intra-OP ultrasonography showed multiple foci of hemorrhagic transformation and the ventricles were compressed. The ICH, IVH and right frontal-temporal lobe were evacuated for lowering the IICP and the lateral ventricle was eventually encountered. 3.One EVD was left in the right lateral ventricle and one ICP monitor was left over the right subdural space with initial ICP of 1-2mmHg while scalp closure. 4.The right temporalis muscle was transected. 5.ICP reference is 491, and ICP while wound closed was 2cmH20. Operative Procedures Under ETGA and supine position, the scalp was disinfected and draped as usual. One traumatic flap over the right scalp was done and the hemicraniectomy was performed followed by dura tenting. The right temporalis fascia was harvested for duraplasty. The dura was opened and the ICH, IVH and part of the right frontal-temporal were evacuated. Hemostasis was done and the EVD was left in the right lateral ventricle. One subdural ICP monitor was left in situ and the dura was closed in water tight fasion with autologous fascia augmentation. The scalp was then closed in layers with 2 CWV drains. Operators VS王國川 Assistants R4曾峰毅 R1張僖 Indication Of Emergent Operation 李宗哲 (M,1979/12/15,32y2m) 手術日期 2010/12/09 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Lung cancer 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 15:40 報到 16:04 進入手術室 16:10 麻醉開始 16:15 誘導結束 17:07 手術開始 18:50 手術結束 18:50 麻醉結束 19:00 送出病患 19:01 進入恢復室 20:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 內科部 套用罐頭: Ventriculoperitoneal shunt via right Kocher"s... 開立醫師: 李振豪 開立時間: 2010/12/09 19:21 Pre-operative Diagnosis Hydrocephalus, suspect leptomeningeal carcinomatosis-related Post-operative Diagnosis Hydrocephalus, suspect leptomeningeal carcinomatosis-related Operative Method Ventriculoperitoneal shunt via right Kocher"s point Specimen Count And Types 1 piece About size:10ml Source:CSF Pathology Nil Operative Findings The opening pressure during ventricular puncture was more than 30cmH2O. Median pressure burr hole type reservoir was placed. The length of ventricular and peritoneal catheter was 7cm and 30cm respectively. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine position with head rotated to left. The scalp was shaved, scrubbed, and disinfected as usual. One curvilinear scalp incision was made at right Kocher"s point. The scalp flap was elevated followed by one burr hole creation. Two dural tenting was performed. One transverse skin incision was made at right lower abdomen and the subcutaneous soft tissue was dissected. The fascia of rectus abdominis was transected and the muscle was splitted to exposed the peritoneum. Minilaparotomy was performed and the trocar was placed into peritoneal cavity under direct vision. One subcutaneous tunnel was created from right abdomen, right forechest, neck, to retroauricular area. One small transverse scalp incision was made and the peritoneal catheter was placed through the tunnel. The dura was opened with cruciform fashion. Ventricular puncture was performed with ventricular needle. The Ventricular catheter was placed into right lateral ventricle and the V-P shunt was set up. The peritoneal catheter was placed into peritoneal cavity. Hemostasis was achieved and the wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS曾漢民 Assistants R4李振豪, Ri江韻 相關圖片 魏麗珍 (F,1959/03/05,53y0m) 手術日期 2010/12/09 手術主治醫師 陳敞牧 手術區域 東址 005房 01號 診斷 Spine bone metastasis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 07:45 報到 08:08 進入手術室 08:15 麻醉開始 09:00 抗生素給藥 09:05 誘導結束 09:13 手術開始 11:00 開始輸血 12:30 抗生素給藥 15:40 手術結束 15:40 麻醉結束 15:50 送出病患 15:51 進入恢復室 19:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 惡性脊髓腫瘤切除術 1 1 手術 脊椎融合術-後融合,有固定物(<=六節) 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 7 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: C7-T2 laminectomy for tumor excision + left T... 開立醫師: 李振豪 開立時間: 2010/12/09 16:04 Pre-operative Diagnosis T1-2 chordoma with myelopathy Post-operative Diagnosis T1-2 chordoma with myelopathy Operative Method C7-T2 laminectomy for tumor excision + left T1, T2 rhizotomy + C6 lateral mass screws, right C7, T3, and T4 transpedicular screws for posterior fusion Specimen Count And Types 1 piece About size:5x4x3cm Source:T1-2 spinal tumor Pathology Pending Operative Findings 1. The tumor was with-grayish, hard(necrotic over central part) with moderate hypervascularized. The main tumor was located within left C6 to T2 paravertebral muscle. The margin between muscle and the tumor was not so clear. The left T1 and T2 lamina and facet joints were eroded by the tumor. The thecal sac was compressed tightly by the tumor and expanded well after laminectomy and tumor excision. Left T1 and T2 roots were encased withint the tumor and rhizotomy was done. 2. Posterior instrumentation C6 lateral mass screws: 3.5mm x 14mm x II C7 transpedicular screws: 3.5mm x 18mm x I T3 transpedicular screws: 4.0mm x 22mm x II T4 transpedicular screws: 4.0mm x 24mm x II Rods x II Cross-link x I Operative Procedures Under endotracheal tube general anesthesia, the patient was put in prone position with head fixed with Mayfield skull clamp. The C7 level was identified by C-arm portable X-ray. The skin was shaved, scrubbed, and disinfected as usual. The midline skin incision was made from C5 to T4 level. The subcutaneous soft tissue was dissected and the paravertebral muscle group was detached. Paraspinal tumor debulking was performed. The C6 lateral mass screws, right C7, bilateral T3, T4 transpedicular screws were placed under C-arm guided. C7-T2 laminectomy was performed with intraspinal tumor excision. Left T1 and T2 rhizotomy was performed with Hemoclip. Hemostasis was performed and the TPS was set up with 2 rods and one cross-link. One epidural CWV drain was placed and the wound was closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS陳敞牧 Assistants R4李振豪, Ri江韻 李何 (F,1933/04/28,78y10m) 手術日期 2010/12/09 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Injury (severeity score >=16) 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾峰毅, 時間資訊 07:50 報到 08:09 進入手術室 08:15 麻醉開始 08:20 抗生素給藥 08:20 誘導結束 08:59 手術開始 09:47 10:15 麻醉結束 10:15 手術結束 10:15 10:20 送出病患 10:25 進入恢復室 11:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦脊髓液分流管重置 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 慢性硬腦膜下血腫清除術 1 2 摘要__ 手術科部: 外科部 套用罐頭: Right frontal burr hole for subdural drainage... 開立醫師: 曾峰毅 開立時間: 2010/12/09 10:32 Pre-operative Diagnosis Hydrocephalus, status post fixed pressure ventriculoperitoneal shunt insertion via left Kocher's point, complicated with over drainage Post-operative Diagnosis Hydrocephalus, status post fixed pressure ventriculoperitoneal shunt insertion via left Kocher's point, complicated with over drainage Operative Method Right frontal burr hole for subdural drainage; left Kocher ventriculoperitoneal shunt revision to Codman programmable shunt, pressure set at 10cmH20. Specimen Count And Types Nil Pathology nil Operative Findings Previous Codman fixed pressure valve was 7cmH20. Right subdural fluid collection was light yellowish. Codman prgrammable shunt was set at 10cmH20. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to left. After scalp shaved, scrubbed, disinfected, and then draped. We made one transverse skin incision at right frontal area, and drilled one burr hole. We inserted subdural catheter, and fixed the subdural drain. We closed the wound, and changed the patients position to head rotated to right. We re-disinfected and draped the scalp. We made one skin incision in part of previuos trauamatic flap wound, and another small transverse skin inciison at left post-auricular area. We removed previous fixed pressure valve, and revised to a programmable valve. We closed the wound in layers. Operators VS 王國川 Assistants R4 曾峰毅 蔡淑惠 (F,1957/08/25,54y6m) 手術日期 2010/12/09 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾峰毅, 時間資訊 10:20 報到 10:40 進入手術室 10:50 麻醉開始 11:02 抗生素給藥 11:10 誘導結束 11:20 手術開始 14:14 抗生素給藥 16:05 麻醉結束 16:05 手術結束 16:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除-手術時間在4~8小時 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT 開立醫師: 曾峰毅 開立時間: 2010/12/09 16:30 Pre-operative Diagnosis Falx meningioma Post-operative Diagnosis Falx meningioma Operative Method Right frontal craniotomy for tumor excision, Simpson grade II Specimen Count And Types Several fragments of one tumor was sent for pathology. Pathology Pending Operative Findings One well defined, whitish, elastic to soft, dura-based tumor arised from anterior falx, pushing callosal marginal artery anteriorly. Operative Procedures With endotracheal general aneasethesia, the patient was put pin supine position with head rotated to right 30 degress and fixed with Mayfield head clamp. We made bicoronal skin incision, and reflected the scalp flap inferiorly. We drill six burr holes, and created right frontal craniotomy. After dura tenting, we made one U-shape dura flap with base near superior sagittal sinus. We detachted the tumor base at falx, and performed tumor excision totally. Tumor base was cogaulated. Dura was closed in water-tight fashion. Bone graft was fixed back with miniplates. Bone fissure was filled with bone cement. After one subgaleal CWV, we closed the wound in layers. Operators VS 王國川 Assistants R4 曾峰毅 宋炎輝 (M,1951/06/21,60y8m) 手術日期 2010/12/10 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Aneurysm 器械術式 Craniotomy(Aneurysms) P-DUH 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 游健生, 時間資訊 08:48 報到 08:48 進入手術室 08:55 麻醉開始 09:10 誘導結束 09:49 手術開始 11:00 抗生素給藥 16:00 開始輸血 17:00 抗生素給藥 22:20 麻醉結束 22:20 手術結束 22:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 19 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 體外循環維生系統(ECMO)建立(第一次) 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Left transsylvian transcavernous approach for... 開立醫師: 游健生 開立時間: 2010/12/10 23:04 Pre-operative Diagnosis 1. Basilar tip giant aneurysm with partial thrombosis 2. Obstructive hydrocephalus, status post EVD insertion via right Kocher"s point Post-operative Diagnosis 1. Basilar tip giant aneurysm with partial thrombosis 2. Obstructive hydrocephalus, status post EVD insertion via right Kocher"s point Operative Method Left transsylvian transcavernous approach for aneurysm clipping Specimen Count And Types nil Pathology Nil Operative Findings The brain was not swallon and became slack after CSF drainage 30cc via EVD. A giant aneurysm was seen originated from tip of basilar extending anteriorly and upward about 2.5cm above sella pushing pons backward. Its size was about 3.2x 2.7 x 3.2 cm. There were fibrotic tissue and blood clots inside the aneurysm. Bilateral PCA were originated at the neck of aneurysm. Duration of thrombectomy and aneurysm clipping was about 73mins. Brain ischemic protection was hypothermia (20C) with ECMO flow 500ml/min. Two large straight Sugita clips were applied to the aneurysm. Intra-operative ICG angiography showed patent bilateral PCA and basilar artery flow. There was a small residual aneursym sac at neck. There was no enhancement probably due to thickened aneurysm wall. Operative Procedures Under ETGA, patient was in supine position with head fixed with Mayfield headclamp and rotated 30degrees to right. After shaving, we disinfected and draped the operation field as usual with exposure of bilateral inguinal area for later ECMO use. A curvilinear scalp incision was made from 1cm anteroinferior to tragus to 4cm cross midline 2cm behind hairline. The skin was elevated and reflected anteriorly with Yasargil fatpad. The zygoma was exposed and its arch was removed. The temporalis muscle, cut with muscle cuff at superior temporal line, was elevated and reflected anteriorly. The craniotomy extended from keyhole posteriorly along the wound border to squamous portion of temporal bone, then back to keyhole. Dura tenting along the posterior border of craniotomy window. The temporal tip dura was peeled off from skull base to expose the sphenoid ridge. Anterior clinoidal process was drilled as well as the apex roof of orbit. The falciform ligament was cut to free the optic nerve. The brain became slack after CSF drainage 30cc via EVD. Curvilinear durotomy was done with anterior border of craniotomy as base centering at sylvian fissure then the dura flap was cut in half. The sylvian fissure was opened from anterior to posterior carefully to preserve sylvian vien and MCA. As we dissected more medially, the dome of aneurysm, ICA, P-com, anterior choroidal artery, CN I, CN II, CN III, CN IV, posterior clinoidal process, and tentorium were exposed. Then, Tissucol Duo was injected into cavernous sinus to occlude it. The posterior clinoidal process and left side of dorsum sellae were drilled off to expose the neck of aneurysm. VA ECMO was installed via left femoral vessels by cardiovascular surgeons with cut-down method. Patient was cooled down to core temperature 20C and ECMO flow down to about 500ml/min. The aneurysm was cut open in cruciate fashion. Thrombi were removed with CUSA and tumor forcep. Temporal clip was applied to basilar artery to decrease bleeding. The dome of aneursym was removed for exposure of neck. The orifice of bilateral PCA and basilar artery were seen. Two large straight Sugita clips were applied to the aneurysm. Intra-operative ICG angiography showed patent bilateral PCA and basilar artery flow. ECMO flow was increased to 3000ml/min and patient was then rewarmed. After 200J DC shock, rhythm was converted from VT to sinus and pulsatile arterial flow was noted. Hemostasis was achieved with Tissucol Duo and Surgicel packing. Dura was closed by 4-0 prolene continuous suture followed by air expellation. After dura tenting, bone flap and zygomatic arch were fixed with mini-plates. A subgaleal CWV was placed and wound was closed in layers. ECMO was removed. Operators Prof. 杜永光 Assistants R6 胡朝凱 R3 游健生 黃菊妹 (F,1940/01/03,72y2m) 手術日期 2010/12/10 手術主治醫師 黃昭淵 手術區域 西址 038房 04號 診斷 Bladder cancer 器械術式 Fiberocystoscopy /WOR 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 09:27 報到 10:06 進入手術室 10:08 手術開始 10:18 手術結束 10:20 送出病患 林陳瓊珍 (F,1931/01/12,81y2m) 手術日期 2010/12/10 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 鍾文桂, 時間資訊 07:45 報到 08:05 進入手術室 08:10 麻醉開始 08:35 誘導結束 08:35 抗生素給藥 08:40 手術開始 11:35 抗生素給藥 12:40 麻醉結束 12:40 手術結束 12:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Simpson grade II tumor excision. 開立醫師: 鍾文桂 開立時間: 2010/12/10 13:10 Pre-operative Diagnosis Parasagital meningioma, left frontal. Post-operative Diagnosis Parasagital meningioma, left frontal. Operative Method Simpson grade II tumor excision. Specimen Count And Types 1 piece About size:30 cc Source:braint tumor. Pathology Pending. Operative Findings Tumor character: well demarcated, grayish-red, soft, elastic. Some parts of the arachnoid plane were not so clear. However, well dissection still could achieved. At the posterior part of the tumor, we noted a cyst part which is compatible with MRI findings. Two feeding arteries from ACA were noted and electrocoagulated. The tumor which extended to the lateral wall of the superior sagital sinus was partially resected and electrocoagulated. The tumor also extended to the inner table of the skull bone. It was drilled away. Severe adhesion of the dura to the skull bone. The dural defect was repaired by GoreTex. Operative Procedures Under general anesthesia, the patient was placed in supine position and the head was fixed by Mayfield in midline position. After shaving, disinfection, and draping, bicoronal incision was made. After dissection, a 7-cm craniotomy was created by using high speed drill. The dura mater was electrocoagulated for hemostasis. After durotomy and dural tenting, the tumor was excised along its margin. The feeders were electrocoagulated. After complete tumor resection and well hemostasis, we placed surgicel along the brain surface. The dural defect was repaired with GoreTex. The craniotomy bone plate was fixed by miniplates and screws. The wound was closed in layers with one subgaleal drain in situ. Operators 曾漢民 Assistants 鍾文桂 陳蔚蔚 鄭秀芳 (F,1953/12/06,58y3m) 手術日期 2010/12/10 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Pituitary Tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 鍾文桂, 時間資訊 12:10 報到 13:07 進入手術室 13:10 麻醉開始 13:28 誘導結束 13:50 抗生素給藥 13:55 手術開始 15:20 麻醉結束 15:20 手術結束 15:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 經由蝶竇之腦下垂體瘤切除 1 1 記錄__ 手術科部: 外科部 套用罐頭: Transsphenoidal adenomectomy. 開立醫師: 鍾文桂 開立時間: 2010/12/10 15:48 Pre-operative Diagnosis Pituitary microadenoma. Post-operative Diagnosis Pituitary microadenoma. Operative Method Transsphenoidal adenomectomy. Specimen Count And Types 1 piece About size:2 cc Source:pituitary adenoma. Pathology Pending. Operative Findings Severe oozing from the cavernous sinus wall. It was packed with gelfoam. A very hard calcified lesion at right lateral side of the adenoma. It was resected totally. Presence of CSF leakage. Yellowish-white soft fragile tumor was noted. The normal gland is anterior to the adenoma. Operative Procedures Under general anethesia and intubation, the patient was put in supine position. The facial skin was antiseptic with alcohol, and the mucosa of oral and nasal cavity with aqueous better-iodine. The face was covered with sterilized adhesive plastic sheets then draped. Under microscope, nasal septum was incised, and a nasal speculum was applied to displace the nasal mucosa laterally and keep the nasal cavity open constantly for the exposure of the vomer bone and the anterior wall of the sphenoid sinus. The anterior sphenoid wall, sphenoid sinus mucosa and sella floor were removed. The dura was coagulated then opened in cruciate fashion. The tumor was removed by curette and aligator. The calcified lesion was removed by alligator and dissector. The CSF leakage was sealed with Tissuecol Duo and gelform packing. The bone of anterior sphenoid wall was placed back and the nasal mucosa was returned to its normal position. The nasal mucosa was sealed with Tissuecol Duo. After placing two iodine-coating finger gloves, the patient was sent to ICU smoothly. Operators 曾漢民 Assistants 鍾文桂 劉宏治 (M,1951/09/16,60y5m) 手術日期 2010/12/10 手術主治醫師 曾漢民 手術區域 東址 005房 03號 診斷 Glioblastoma multiforma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 鍾文桂, 時間資訊 15:45 進入手術室 15:50 麻醉開始 16:10 誘導結束 16:15 手術開始 16:15 抗生素給藥 19:15 抗生素給藥 20:00 手術結束 20:00 麻醉結束 20:10 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除-手術時間在4小時以內 1 1 R 手術 立體定位術-切片 1 2 記錄__ 手術科部: 外科部 套用罐頭: Gross total tumor excision. 開立醫師: 鍾文桂 開立時間: 2010/12/11 08:38 Pre-operative Diagnosis Right frontal brain tumor. Post-operative Diagnosis High grade glioma, right frontal. Operative Method Gross total tumor excision. Specimen Count And Types 1 piece About size:2cc Source:brain tumor Pathology Pending. Operative Findings Under nagivation and ultrasonography guidance, we located the tumor. We excised the tumor transcorically. The tumor is hypervascularized, pinkish, fragile, soft, and not well delineated. Intraoperative mapping showed that the tumor should locate in premotor area. Prominent arachnoid villi and cortical vein were noted over the durotomy. We preserve the above structures well during durotomy.. They caused severe epidural bleeding. We achieved well hemostasis by using Floseal. Operative Procedures Under ETGA, the patient was placed in supine position and the head was fixed by Mayfield. After registration of the fucidals with the navigator, disinfection, shaving and draping were done. A U shape scalp incision was made at right frontal-parietal region. After craniotomy and durotomy, we planned our corticotomy by locating the tumor under the guidance of navigator and ultrasound, and intraoperative mapping. After corticotomy, the tumor was noted and excised in piece-meal fashion. The dural defect was repaired by galea. The bone plate was fixed by mini screws and plates. The wound was closed in layers with one subgaleal CWV drain. Operators 曾漢民 Assistants 鍾文桂 陳蔚蔚 賴書玄 (M,2010/02/22,2y0m) 手術日期 2010/12/10 手術主治醫師 郭夢菲 手術區域 兒醫 065房 03號 診斷 Congenital hydrocephalus 器械術式 Removal of chronic subdural 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 蕭柏妮 ASA 3 紀錄醫師 李振豪, 時間資訊 13:20 報到 13:27 進入手術室 13:30 麻醉開始 13:40 誘導結束 13:43 抗生素給藥 14:24 手術開始 15:45 手術結束 15:45 麻醉結束 15:55 送出病患 16:10 進入恢復室 18:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 手術 慢性硬腦膜下血腫清除術 1 2 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 慢性硬腦膜下血腫清除術 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: bilateral burr hole for external drainage 開立醫師: 李振豪 開立時間: 2010/12/10 16:19 Pre-operative Diagnosis Bilateral subdural collection, suspect hemorrhage Post-operative Diagnosis Bilateral chronic subdural hematoma Operative Method bilateral burr hole for external drainage Specimen Count And Types 1 piece About size:10ml Source:subdural hematoma Pathology Nil Operative Findings The thick, dark-red, non-coagulable fluid gushed out after dura opening. Chronic subdural hematoma was favored. The left side pressure is much higher then right side. The thick, dark-red, non-coagulable fluid gushed out after dura opening. Chronic subdural hematoma was favored. The left side pressure is much higher then right side. Outer membrane The wound was alightly more easily bleeding than normal. The aspirin effect may be still there though it was dicontinued for 10 days according to the mothers statement. The subdural collection was thick, dark-red, non-coagulable blood. It gushed out after dura opening. Chronic subdural hematoma was favored. The left side pressure is much higher than right side. There was outer membrane formation. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine. The scalp was shaved, scrubbed, and disinfected as usual. Two linear scalp incision was made at bilateral frontal area. Two burr hole were created at bilateral frontal area followed by two dural tenting in each burr hole. Durotomy was performed for external drainage of subdural collection. After release the intracranial pressure, EVD was placed into bilateral subdural space with 3cm in depth. Externalization of the EVD was performed. After hemostasis, the wound was then closed in layers with 4-0 Vicryl and 4-0 Nylon. Under endotracheal tube general anesthesia, the patient was put in supine. The scalp was shaved, scrubbed, and disinfected as usual. Two linear scalp incision was made at bilateral temporaoparietal area. Two burr hole were created at each side, respectively, followed by two dural tenting in each burr hole. Durotomy then incision of the outer membrane was performed for external drainage of subdural collection. Esternal drainage tube was placed into bilateral subdural space with 3cm in depth. Externalization of the EVD was performed. After hemostasis, the wound was then closed in layers with 4-0 Vicryl and 4-0 Nylon. Operators AP郭夢菲 Assistants Ri吳沛燊 相關圖片 李秋香 (F,1934/10/11,77y5m) 手術日期 2010/12/10 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Spondylosis 器械術式 Laminectomy for decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 游皓鈞, 時間資訊 08:05 報到 08:10 進入手術室 08:20 麻醉開始 08:40 誘導結束 08:46 抗生素給藥 09:12 手術開始 10:25 手術結束 10:25 麻醉結束 10:50 送出病患 10:51 進入恢復室 12:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術(減壓)-二節以內 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: L1 laminectomy 開立醫師: 陳德福 開立時間: 2010/12/10 10:19 Pre-operative Diagnosis Lumbar stenosis with cord compression, L1-2 Post-operative Diagnosis Lumbar stenosis with cord compression, L1-2 Operative Method L1 laminectomy Specimen Count And Types nil Pathology nil Operative Findings 1.The T12-L2 fixation with TPS is noticed. There was hypertrophic ligamentum flavum and buldging disc at the level of L1/2 with severe spinal stenosis and cord compression. The L1-upper L2 laminectomy was done and the theca sac reexpanded well after the decompression. Operative Procedures Under ETGA and prone position, the skin was disinfected and draped as usual. One linear incision along the midline was done and the paraspinous muscle was displaced laterally to expose the L1 lamina. L1 laminectomy was performed with air drill and Karrison. Autologous bone fusion was done at the L1 level. The theca sac expanded well and the wound was then closed in layers. Operators VS賴達明 Assistants R5陳德福 R1游皓鈞 相關圖片 陳樹木 (M,1936/03/18,75y11m) 手術日期 2010/12/10 手術主治醫師 賴達明 手術區域 東址 019房 03號 診斷 Cervical spondylosis 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 游皓鈞, 時間資訊 13:50 報到 14:42 進入手術室 14:45 麻醉開始 15:00 誘導結束 15:00 抗生素給藥 15:37 手術開始 18:00 抗生素給藥 19:40 手術結束 19:40 麻醉結束 19:48 送出病患 19:49 進入恢復室 22:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 椎間盤切除術-頸椎 1 1 R 手術 脊椎融合術-前融合,有固定物)≦四節 1 2 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 記錄__ 手術科部: 外科部 套用罐頭: 1.C3/4, 4/5, 5/6 diskectomy 2.C3-4-5-6 anteri... 開立醫師: 陳德福 開立時間: 2010/12/10 19:42 Pre-operative Diagnosis Cervical spondylosis with spinal stenosis and myelopathy Post-operative Diagnosis Cervical spondylosis with spinal stenosis and myelopathy Operative Method 1.C3/4, 4/5, 5/6 diskectomy 2.C3-4-5-6 anterior fusion with plate Specimen Count And Types nil Pathology nil Operative Findings 1.The theca sac and bilateral nerve foramen were decompressed by the spondylosis at the C3/4, 4/5 and 5/6 level. The osteophytes and protruding disc were removed meticulously. 2.The C3-6 ACDF was performed with autologous iliac bone and one cervical spine plate [6 screws of 16*4mm]. Operative Procedures Under ETGA and supine position, the neck was hyperextended. The skin was disinfected and draped as usual. One transverse linear incision was done one the right neck and the platysma was transected. The C3-6 prevertebral space was reached after dissecting along the areolar plane. The location of C3-4 was identifed under C-arm fluroscope. The longus coli muscle was displaced laterally and the C3-6 discectomy was performed under microscopic surgery. The PLL was remvoed and the dura sac was expended well. Three autologous iliac bone graft were implatated at the C3-6 level and one plate was implantated at the C3-6 anterior body with 6 16*4mm screw fixation. One minihemovac was left in situ and the wound was closed in layers. Operators VS 賴達明 Assistants r5 陳德福 r1游皓鈞 相關圖片 陳秋榮 (M,1947/11/21,64y3m) 手術日期 2010/12/10 手術主治醫師 賴達明 手術區域 東址 019房 02號 診斷 Cervical Spondylosis 器械術式 Lamino plasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 游皓鈞, 時間資訊 10:40 報到 11:00 進入手術室 11:05 麻醉開始 11:15 誘導結束 11:20 抗生素給藥 12:05 手術開始 14:20 手術結束 14:20 麻醉結束 14:30 送出病患 14:35 進入恢復室 16:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 椎弓整形術 1 1 摘要__ 手術科部: 外科部 套用罐頭: C4-6 laminoplasty 開立醫師: 陳德福 開立時間: 2010/12/10 14:09 Pre-operative Diagnosis Cervical spondylosis with spinal stenosis and myelopathy, C4-6 Post-operative Diagnosis Cervical spondylosis with spinal stenosis and myelopathy, C4-6 Operative Method C4-6 laminoplasty Specimen Count And Types nil Pathology nil Operative Findings 1.There is hypertrophic ligamentum flavum and HIVD over the C4-6 level with spinal cord compression. The C4-6 laminoplasty was performed with miniplates fixation. Operative Procedures Under ETGA and prone position with Mayfield pin type head fixator fixation, the skin was disinfected and draped as usual. One linear incision along the midlien was done and the paraspinous muscle was displaced laterally for exposure the C3-6 lamina. The C4-6 laminoplasty was performed with miniplates fixation smoothly and one CWV drain was left in situ. The wound was closed in layers. Operators VS賴達明 Assistants R5陳德福 R1游皓鈞 相關圖片 張勝雄 (M,1941/02/19,71y0m) 手術日期 2010/12/10 手術主治醫師 陳敞牧 手術區域 東址 005房 04號 診斷 Head injury 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林峰盛 ASA 4E 紀錄醫師 鍾文桂, 時間資訊 19:54 通知急診手術 21:00 進入手術室 21:05 麻醉開始 21:15 誘導結束 21:40 手術開始 21:56 開始輸血 00:05 手術結束 00:05 麻醉結束 00:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 硬腦膜外血腫清除術 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Evacuation of acute epidural hemorrhage. 開立醫師: 鍾文桂 開立時間: 2010/12/11 08:56 Pre-operative Diagnosis Acute epidural hemorrhage, right frontal-parietal-temporal. Post-operative Diagnosis Acute epidural hemorrhage, right frontal-parietal-temporal. Operative Method Evacuation of acute epidural hemorrhage. Specimen Count And Types nil Pathology Nil. Operative Findings Indication for CT scan: postoperative seizure. CT findings: acute epidural hematoma. Some dark red-brown liquid blood gushed out upon opening the scalp wound. Hematoma at epidural space were evacuated. Slack brain. Codman ICP monitor at subdural space. Intraoperative ICP: 0~ -10mmHg. Two epidural CWV drains were placed. 6 stiches of epidural tenting were done to reduce epidural space. Operative Procedures Under ETGA, the patient was placed in supine position and the head was tilted to the left. After disinfection and draping, the stiches were removed. The craniotomy bone plate was also removed. The epidural hematoma were evacuated. After placing two epidural CWV drain and one subdural ICP monitor. After dural tenting, the craniotomy bone plate was fixed by miniplates and screws. The wounds were closed in layers. Operators 陳敞牧 Assistants 鍾文桂 Indication Of Emergent Operation 蘇芷誼 (F,1984/11/01,27y4m) 手術日期 2010/12/10 手術主治醫師 楊士弘 手術區域 兒醫 067房 03號 診斷 Acute lymphoid leukemia, without mention of remission 器械術式 Burr hole (trephination) 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 蕭柏妮 ASA 4 紀錄醫師 李振豪, 時間資訊 11:25 報到 11:25 進入手術室 11:30 開始輸血 11:30 麻醉開始 11:50 誘導結束 12:10 手術開始 13:00 抗生素給藥 15:20 麻醉結束 15:20 手術結束 15:25 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除-手術時間在4小時以內 1 1 L 摘要__ 手術科部: 套用罐頭: Left temporoparietal craniectomy for partial ... 開立醫師: 楊士弘 開立時間: 2010/12/10 15:31 Pre-operative Diagnosis Left temporoparietal subdural lesion, r/o tumor or abscess Post-operative Diagnosis Left temporoparietal subdural lesion, tumor (leukemia recurrence) favored Operative Method Left temporoparietal craniectomy for partial tumor excision Specimen Count And Types 1 piece About size:小 Source:subdural mass lesion Pathology pending Frozen section: atypical cell, favor leukemia-related Operative Findings The dura was rather tense. A thick membrane was encountered after opening of dura mater through the first burr hole. Saline irrigation of the subdural space with a Nelaton tube resulted in return of only 10 c.c. of serosanginuous fluid. Therefore the scalp wound and craniotomy were extended further. Opening of the dural mater revealed a subdural mass ,comprising of two layers. The superficial layer was elastic soft, greyish yellow, moderately vascularized. It was adherent to the dura. Inside this layer there was some content of fluid, most of which was light reddish fluid, but some pus like material was found also inside. The deep layer was elastic, yellowish, mildly vascularized, and quite adherent with pia surface. The brain expanded well after partial removal of the mass. Operative Procedures 1. ETGA, supine, head rotated to right. 2. Left parietal burr hole. 3. Opening of dura mater for removal of subdural layer. 4. Irrigation of subdural space with normal saline; little fluid returned. 5. Left temporoparietal craniotomy, 4 cm x 4 cm. 6. Cruciate opening of dura mater. 7. Coagulation and incision of subdural mass. 8. Detachment of mass lesion from dura and pia. 9. Excision of subdural mass. 10. Closure of dura mater; placement of a piece of Durofoam on dural surface. 11. Scalp wound closure in layers. Operators 楊士弘 Assistants 李振豪 王秀梅 (F,1949/05/30,62y9m) 手術日期 2010/12/10 手術主治醫師 蕭輔仁 手術區域 東址 001房 04號 診斷 Herniation of intervertebral disc (HIVD) 器械術式 Diskectomy lumbar 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林峰盛 ASA 3E 紀錄醫師 曾峰毅, 時間資訊 18:55 報到 19:25 進入手術室 19:30 麻醉開始 19:40 誘導結束 19:50 抗生素給藥 20:01 手術開始 21:00 手術結束 21:00 麻醉結束 21:15 送出病患 21:16 進入恢復室 00:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 椎間盤切除術-腰椎 1 2 L 摘要__ 手術科部: 外科部 套用罐頭: HIVD 開立醫師: 曾峰毅 開立時間: 2010/12/10 21:08 Pre-operative Diagnosis L4/5 HIVD, status post left hemilaminectomy for diskectomy, recurrence Post-operative Diagnosis L4/5 HIVD, status post left hemilaminectomy for diskectomy, recurrence Operative Method Microdiskectomy of L4/5 Specimen Count And Types One piece of disc, and two culture swab was sent for pathology and exam. Pathology Nil Operative Findings Suspected granulation formation around previuos laminectomy site, L4/5 intervertebral disc space, and left L5 root lateral recess. Left L5 root was relaxed after surgery. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. We made skin incision along previous operation wound, and dissection along previous surgical tract. Diskectomy was done furhter, and lateral recess of left L5 root was widened. The wound was closed in layers after hemostasis. Operators VS 蕭輔仁 Assistants R4 曾峰毅 Indication Of Emergent Operation 顏美彩 (F,1955/06/25,56y8m) 手術日期 2010/12/11 手術主治醫師 杜永光 手術區域 東址 002房 01號 診斷 Respiratory failure, with long-term ventilator use 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 4E 紀錄醫師 游健生, 時間資訊 17:30 開始NPO 17:30 臨時手術NPO 19:36 通知急診手術 20:00 報到 20:00 進入手術室 20:10 麻醉開始 20:45 誘導結束 20:50 抗生素給藥 21:00 開始輸血 21:14 手術開始 22:35 麻醉結束 22:35 手術結束 22:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室體外引流 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: External ventricular drainage insertion via r... 開立醫師: 游健生 開立時間: 2010/12/11 23:06 Pre-operative Diagnosis 1.Left thalamic intracerebral hemorrhage extending to midbrain with intraventricular hemorrhage 2.Acute hydrocephalus Post-operative Diagnosis 1.Left thalamic intracerebral hemorrhage extending to midbrain with intraventricular hemorrhage 2.Acute hydrocephalus Operative Method External ventricular drainage insertion via right Kocher point Specimen Count And Types 1 piece About size:5cc Source: CSF Pathology Nil Operative Findings Pink CSF was drained with opening pressure >20cmH2O. 5cc was sent for routine, BSC, and culture. The ventricular catheter was about 6cm. Operative Procedures Under ETGA, patient was in supine position with neck mildly flexed. After shaving, we disinfected and draped the operation field as usual. A transverse scalp incision over right Kocher region. After dissection, the cranium was exposed and burrhole was created. After dura tenting, dura was electrocauterized followed by cruciated durotomy. Edges were cauterized followed by ventriculostomy. The ventricular catheter was inserted. Hemostasis was achieved and wound was closed in layers. Operators Prof. 杜永光 Assistants R6 胡朝凱 R3 游健生 Indication Of Emergent Operation 王朝輝 (M,1948/11/14,63y4m) 手術日期 2010/12/12 手術主治醫師 王國川 手術區域 東址 002房 02號 診斷 Subdural hemorrhage 器械術式 Bilateral burr hole drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2E 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 07:31 通知急診手術 22:55 報到 23:00 進入手術室 23:10 麻醉開始 23:15 誘導結束 00:19 手術開始 02:40 麻醉結束 02:40 手術結束 02:50 送出病患 02:55 進入恢復室 03:55 離開恢復室 23:25 抗生素給藥 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 手術 慢性硬腦膜下血腫清除術 1 1 B 摘要__ 手術科部: 外科部 套用罐頭: Drainage bilateral subdural effusion 開立醫師: 游健生 開立時間: 2010/12/13 06:10 Pre-operative Diagnosis Bilateral chronic subdural hematoma Post-operative Diagnosis Bilateral subdural effusion Operative Method Drainage bilateral subdural effusion Specimen Count And Types nil Pathology Nil Operative Findings Bilateral clear subdural fluid was drained. Right subdural effusion was more than left. A rubbed drain was placed at right subdural space. An EVD tube was placed at left subdural space. Operative Procedures 1. Under ETGA, supine position with head elevated 2. Shaving, disinfection, and draping 3. Transverse scalp incision over right frontal region 4. Dissected in layers to expose cranium and created a burrhole 5. Dura tenting and cauterized dura 6. Durotomy and cauterized edges 7. Opened the outer membrane and cauterized 8. Irrigated and drained subdural fuild by rubber tube 9. Placed the tube a subdural space 10.Close wound in layers 11.Repeat above procedure on left side with EVD tube instead of rubber tube Operators VS 王國川 Assistants R6 胡朝凱 R3 游健生 Indication Of Emergent Operation 吳烏埒 (F,1950/10/01,61y5m) 手術日期 2010/12/11 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Pituitary Tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3 紀錄醫師 游皓鈞, 時間資訊 07:45 報到 08:06 進入手術室 08:10 麻醉開始 08:30 誘導結束 08:50 抗生素給藥 09:00 手術開始 10:05 麻醉結束 10:05 手術結束 10:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經由蝶竇之腦下垂體瘤切除 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 記錄__ 手術科部: 外科部 套用罐頭: Transnasal trans-sphenoidal approach for tumo... 開立醫師: 胡朝凱 開立時間: 2010/12/11 10:16 Pre-operative Diagnosis pituitary macroadenoma Post-operative Diagnosis pituitary macroadenoma Operative Method Transnasal trans-sphenoidal approach for tumor excision Specimen Count And Types Pieces of tumor Pathology Nil Operative Findings The tumor was whitish, soft one. Post-OP dura and arachnopid membrane was seen. Mild CSF leak was noted but was sealed with Tissucal-duo. The buldging lateral wall nearby the ICA was noted. Operative Procedures After ETGA, the patient was put in supine position with head mild left tilt. The nasal cavity was well-disinfective, and then we incised into the nasal septum. Dissection was performed along with the periosteum to expose sphenoid sinus anterior wall and sphenoid ostia. After fracture of vomer, sphenoid sinus anterior wall was also fractured. The mucosa was removed. The sella floor was exposed and removed with kerrison. After cruciate form incision, tumor buldged out. And it was further removed with tumor forceps and ring currette. After total excision of tumor was made, the bony graft was put back and followed by compaction of merosel. Operators 曾漢民 Assistants 胡朝凱, 游皓鈞 黃彩雲 (F,1933/10/13,78y5m) 手術日期 2010/12/12 手術主治醫師 賴達明 手術區域 東址 017房 01號 診斷 Subarachnoid hemorrhage (SAH) 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3E 紀錄醫師 鍾文桂, 時間資訊 06:00 臨時手術NPO 06:00 開始NPO 08:42 通知急診手術 09:45 進入手術室 09:50 麻醉開始 10:00 誘導結束 10:50 手術開始 11:25 手術結束 11:25 送出病患 11:30 麻醉結束 醫令資訊 類別 名稱 量 刀 側 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 顱內壓視置入 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Ventriculostomy for ICP monitoring and CSF dr... 開立醫師: 鍾文桂 開立時間: 2010/12/12 13:25 Pre-operative Diagnosis Acute obstructive hydrocephalus. Post-operative Diagnosis Acute obstructive hydrocephalus. Operative Method Ventriculostomy for ICP monitoring and CSF drainage. Specimen Count And Types 1 piece About size:10 cc Source:CSF, sent glucose,TP, routine. Pathology Nil. Operative Findings ICP: 5-10 mmH2O, Clear yellowish -pink CSF. Right Kocher ventriculostomy. Operative Procedures Under ETGA, the patient was placed in supine position and the head was in midline position. After disinfection and draping, a horizontal scalp incision was made at right Kocher point. After creating a burr hole and durotomy, the ventricular puncture needle was inserted until the CSF gushed out. The EVD was inserted through the same tract. The wound was closed in layers. The EVD catheter was connected with the drainage system. Operators 蕭輔仁 Assistants 鍾文桂 Indication Of Emergent Operation 林泰誠 (M,1948/08/06,63y7m) 手術日期 2010/12/13 手術主治醫師 蕭輔仁 手術區域 東址 005房 04號 診斷 Contusion of face, scalp, and neck except eye(s) 器械術式 Laminectomy C-Spinal(Posterier 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 4E 紀錄醫師 羅偉誠, 時間資訊 16:00 開始NPO 23:45 通知急診手術 00:37 進入手術室 00:40 麻醉開始 01:10 誘導結束 01:15 開始輸血 01:30 抗生素給藥 01:45 手術開始 04:30 抗生素給藥 05:15 手術結束 05:15 麻醉結束 05:25 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 椎弓切除術(減壓)-超過二節 1 1 記錄__ 手術科部: 外科部 套用罐頭: Cervical Laminectomy 開立醫師: 林怡萱 開立時間: 2010/12/13 05:01 Pre-operative Diagnosis Cervical spinal cord compression Post-operative Diagnosis Cervical spinal cord compression Operative Method Cervical Laminectomy Specimen Count And Types nil Pathology Nil Operative Findings Laminectomy of cervical spine in C2 to partial C7 Poor cord pulsation after decompression. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: prone with neck flexed and head fixed by a Mayfield skull clamp 3. Skin preparation: occipital and neck areas were shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: medline nape, from suboccipital to lower neck. 5. The trapezius, semispinalis capitis, splenius capitis muscles on both sides were splitted at itsorigin of ligamentum nuchae, then, together with serratus posterior superior, rectus capitis posterior, obliqus capitis inferior and multifidus were detached from the spinous processes of C2-7 by Bovie, followed by subperiosteal dissection on the laminae. 6. The paravertebral muscles were kept open by self retaining retractors to expose spinous processes and laminae of C2-7. The bleeding from the muscles was stopped by Bovie. 7. The spinous processes and laminae of C2-7 were bitten off by different type of rongeurs and Kerrison punch until posterior half of the spinal canal was widely opened and the cord had been well decompressed. The hypertrophic ligamenta flava including those at lateral recesses wereresected. The epidural venous bleeding was stopped by gelfoam packing. 8. The paravertebral muscles were closed by interrupted sutures with 506, subcutaneous layer by continuous suture with 2/0 Dexon and skin by continuous suture with 3/0 nylon. 13.Drain: one, epilaminal, CWV. 14.Blood transfusion: pRBC 2U, platelet 12U, Cryoprecipitate 6U 15.Course of the surgery: smooth. Operators V蕭輔仁 Assistants R5鍾文桂，R1羅偉誠 Indication Of Emergent Operation 林秋吉 (M,1944/04/10,67y11m) 手術日期 2010/12/13 手術主治醫師 杜永光 手術區域 東址 002房 02號 診斷 Intracerebral hemorrhage 器械術式 EVD insertion 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3E 紀錄醫師 曾峰毅, 時間資訊 08:27 臨時手術NPO 08:27 開始NPO 08:28 通知急診手術 11:20 進入手術室 11:21 麻醉開始 11:22 誘導結束 11:28 手術開始 12:15 手術結束 12:15 麻醉結束 12:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室體外引流 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 曾峰毅 開立時間: 2010/12/13 12:32 Pre-operative Diagnosis Intraventricular hemorrhage Post-operative Diagnosis Intraventricular hemorrhage Operative Method External ventricular drainage Specimen Count And Types Nil Pathology Nil Operative Findings Light reddish CSF was drained. Opening pressure was about 8cm H20. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position. We removed previous EVD. We made one skin incision along previuos operation wound. We inserted EVD ventricular catheter via right Kocher's point. The wound was closed in layers. Operators P 杜永光 Assistants R4 曾峰毅 Indication Of Emergent Operation 莊定風 (M,1939/10/27,72y4m) 手術日期 2010/12/13 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Transient ischemic attack (TIA) 器械術式 Carotid endarterectomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 4 紀錄醫師 游健生, 時間資訊 07:43 報到 08:05 麻醉開始 08:05 進入手術室 08:40 誘導結束 09:10 手術開始 09:10 抗生素給藥 12:20 抗生素給藥 12:50 麻醉結束 12:50 手術結束 13:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 動脈內膜切除術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Right carotid endarterectomy 開立醫師: 游健生 開立時間: 2010/12/13 13:26 Pre-operative Diagnosis right internal carotid artery stenosis Post-operative Diagnosis right internal carotid artery stenosis Operative Method Right carotid endarterectomy Specimen Count And Types nil Pathology Nil Operative Findings Yellowish hard fragile plaque was noted in the intima. The intima was removed totally in the exposed segment. The ischemic time was about 18mins. The lowest oxygen shown by Cerebral Oximeter was 65% on right side. Operative Procedures Under ETGA, patient was in supine position with head rotated to left and neck mildly extended by elevating right shoulder. After disinfection and draping, an oblique submandibular right neck incision was made about 8cm in length. The platysma muscle was transected and mobilized from superficial cervical fascia. The fascia was opened and diagastric muscle was identified and looped. The common carotid artery, internal carotid, and external carotid artery were carefully dissected along with superior thyroid artery. During the dissection, the carotid sinus was injected with 2% Xylocaine. superior thyroid artery, CCA, ICA, and ECA were looped twice respectively. A verticle incision was made from proximal ICA to distal CCA. It was deepened in layers to reach intima. The muscular layer was then carefully dissected away from intima to 3/4 of the circumflex. Anchoring stitch was put on both ends of the incision. Loops were tightened sequentially from superiror thyroid artery, ECA, ICA, and CCA. The intima was removed as much as possible. The lumen was irrigated with heparin solution. Closed the incision from both ends. Before complete closure, we loosened the CCA loop for air expellation. Then, ICA, ECA, superior thyroid artery loop were loosened and removed. Hemostasis was achieved with Surgicel coverage. One mini-hemovac drain was placed and wound was closed in layers. Anchoring stitch was put on both ends of the incision. Loops were tightened sequentially from superiror thyroid artery, ECA, ICA, and CCA. The intima was removed as much as possible. The lumen was irrigated with heparin solution. Closed the incision from both ends. Before complete closure, we loosened the CCA loop for air expellation. Then, ICA, ECA, superior thyroid artery loop were loosened and removed. Hemostasis was achieved with Surgicel coverage. One CWV drain was placed and wound was closed in layers. Operators Prof. 杜永光 Assistants R6 胡朝凱 R3 游健生 蔡崇凱 (M,1932/11/12,79y4m) 手術日期 2010/12/13 手術主治醫師 郭順文 手術區域 東址 007房 01號 診斷 Lung cancer, non-small cell 器械術式 Thoracoscopy+Open Chest 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 趙安怡 ASA 3 紀錄醫師 蔡東明, 時間資訊 07:48 報到 08:05 進入手術室 08:10 麻醉開始 08:45 誘導結束 09:10 抗生素給藥 09:39 手術開始 11:07 麻醉結束 11:07 手術結束 11:42 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 胸腔鏡肺楔狀或部分切除術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: VATS wedge resection 開立醫師: 蔡東明 開立時間: 2010/12/13 11:20 Pre-operative Diagnosis 1.Lung adenocarcinoma, right lower lobe 2.Old pulmonary tuberculosis Post-operative Diagnosis 1.Lung adenocarcinoma, right lower lobe 2.Old pulmonary tuberculosis Operative Method VATS wedge resection Specimen Count And Types 2 pieces About size:8*8cm Source:RLL About size:2*2cm Source:Gr.7 LNs Pathology Pending Operative Findings 1.Moderate pulmonary adhesions between right lung and chest wall 2.There is one 3*3cm, yellowish, firm, well-defined, round mass with central cavitation was noted at right lower lobe, posterior basal segment. 3.There is enlarge, soft and blackish lymphnodes were noted at Gr.7. Operative Procedures 1. Anesthesia: General anesthesia using double-lumen endotracheal tube. 2. Position: Left decubitus position. An axillary roll is placed under the down side. The operative field is well disinfected and draped. 3. Camera port: From the seventh intercostal space in the mid-axillary line away from the lesion. 4. Working ports: First: From the fifth intercostal space in the anterior axillary line. Second: From the fifth intercostal space in the posterior axillary line. 5. The pleural adhesions are separated by grasping forceps and by electrocautery. 6. The pulmonary lesion is visualized and stabilized with the grasping forceps. 7. The Endo-GIA stapler is placed across its base. Wedge resection of the pulmonary lesion is performed. 8. The specimen issent for pathological examination and TB, fungus, and bacteria cultures. 9. After meticulous homeostasis, one 24# chest tubes is placed via the camera port. The lung is ventilated under the direct vision. The intercostal space is closed with 2-0 Vicryl. The skin is clsoed with 3-0 Nylon. Operators VS郭順文 Assistants R4蔡東明 Ri林軒毓 陳國財 (M,1945/04/07,66y11m) 手術日期 2010/12/13 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Hydrocephalus 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 鍾文桂, 時間資訊 12:35 報到 14:50 進入手術室 14:55 麻醉開始 15:05 誘導結束 15:15 抗生素給藥 16:15 手術開始 17:30 開始輸血 18:15 手術結束 18:15 麻醉結束 18:22 進入恢復室 18:25 送出病患 19:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: Implantation of ventriculoperitoneal shunt. 開立醫師: 鍾文桂 開立時間: 2010/12/13 20:26 Pre-operative Diagnosis Normal pressure hydrocephalus. Post-operative Diagnosis Normal pressure hydrocephalus. Operative Method Implantation of ventriculoperitoneal shunt. Specimen Count And Types 1 piece About size:3 cc Source:CSF for routine, TP, glucose and bacterial culture. Pathology Nil. Operative Findings An active epidural bleeding upon durotomy. Blood loss: 1400cc. Codman programmable shunt: 80 mmH2O, ventricular catheter: 6.5 cm, to right Kocher. Operative Procedures Under ETGA, the patient was placed in supine position and the head was tilted to the left. After shaving, disinfection, and draping, a linear scalp and abdominal incision were made. A burr hole was created. The abdominal dissection was made until the peritoneal cavity was reached. The subcutaneous tunnel was done. The shunt system were connected. After durotomy and well hemostasis of the epidural bleeding, ventriculostomy was performed. The ventricular catheter was inserted throught the same tract. After ensuring the patency of the shunt system, the wounds were closed in layers. Operators V.S.曾漢民 Assistants 鍾文桂 胡朝凱 游健生 陳秉崇 (M,1949/01/03,63y2m) 手術日期 2010/12/13 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 4 紀錄醫師 鍾文桂, 時間資訊 07:43 報到 08:00 進入手術室 08:05 麻醉開始 08:30 誘導結束 08:30 抗生素給藥 08:39 手術開始 10:05 開始輸血 11:26 抗生素給藥 14:20 麻醉結束 14:20 手術結束 14:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4~8小時 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: Simpson grade IV tumor excision. 開立醫師: 鍾文桂 開立時間: 2010/12/13 15:10 Pre-operative Diagnosis Parasagital meningioma, right parietal. Post-operative Diagnosis Parasagital meningioma, right parietal. Operative Method Simpson grade IV tumor excision. Specimen Count And Types 1 piece About size:20 cc Source:meningioma. Pathology Pending. Operative Findings Easy oozing operative field.Mainly from the venous collaterals from superior sagital sinus to dipole veins. Blood loss: 3000cc. Flosseal was used for hemostasis. Feeders from ACA and middle meningeal artery were electrocoagulated. The tumor invaded the superior sagital sinus and enlarged the sinus cavity. The sinus was not totally occluded by the tumor mass. We achieved tumor excision in the sinus by transecting the SSS and also in the falx cerebri. The sinus was sealed with Gelfoam. The tumor was firm,grayish-red, well delineated. It invaded through the dural mater to the inner table of skull bone. A large cortical vein was noted over the tumor mass. It was well preserved. Some tumor anterior to the cortical vein was not removed. Operative Procedures Under ETGA, the patient was placed in prone position and the head was fixed by Mayfield. After shaving, disinfection, and draping, a reverse U shape scalp incision was made. After dissection, a 10 cm craniotomy was made. Well hemostasis of the severe epidural bleeding was achieved by using Flosseal, bipolar electrocautery, and Gelfoam. Durotomy was done along the exposed tumor mass. The tumor was excised along the superior sagital sinus and falx cerebri first, then to the right parasagital main mass in piece meal fashion. Well hemostasis was done after tumor excision. The dural defect was repaired by DuraFoam and pericranium. After dural tenting and fixation of te bone plate, the wound was closed in layers with one subgaleal CWV drain in situ. Operators 曾漢民 Assistants 鍾文桂 陳蔚蔚 徐艮漢 (M,1967/05/12,44y10m) 手術日期 2010/12/13 手術主治醫師 曾漢民 手術區域 東址 003房 02號 診斷 Brain Tumor 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 游健生, 時間資訊 13:10 報到 13:20 進入手術室 13:25 麻醉開始 14:00 誘導結束 14:00 抗生素給藥 14:05 手術開始 17:00 抗生素給藥 17:10 開始輸血 19:30 麻醉結束 19:30 手術結束 19:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Right fronto-temporal craniotomy for tumor ex... 開立醫師: 游健生 開立時間: 2010/12/13 20:53 Pre-operative Diagnosis Recurrent craniopharyngioma Post-operative Diagnosis Recurrent craniopharyngioma Operative Method Right fronto-temporal craniotomy for tumor excision Specimen Count And Types 1 piece About size:3 x1 x1cm Source:suprasellar tumor Pathology pending Operative Findings A soft fresh like tumor, 3 x1 x1 cm, was noted at the suprasellar region just anterior the pituitary stalk. The tumor severely adherded to adjcent structure including right optic nerve and piuitary stalk. Operative Procedures Under ETGA, supine position with head rotated to left 30 degrees. Head was fixed with Mayfield headholder. After shaving, we disinfected and draped the operation field as usual. Scalp incision was made with previous bicoronal incision and a transverse incision extending posteriorly. After skin flap elevation with Yasargil fapad, temporalis muscle was elevated and reflected posteriorly. Right fronto-temporal craniotomy with removal of superior orbital ring was done. Dura tenting along posterior craniotomy window. U-shape durotomy with anterior cranitomy window as base. Right frontal lobe was gentlely elevated to expose the suprasellar region. A soft fresh like tumor was noted in front of pituitary stalk. It was carefully dissected away from surroundings along arachnoid membrane. During the dissection, pituitary stalk and optic nerve were seen and preserved. Hemostasis was achieved with Surgicel packing after complete tumor removal in pieces. Dura was closed with 4-0 continous prolene suture. After central tenting, bone flap was fixed back with mini-plates. An epidural CWV was placed. Wound was closed in layers. Operators VS 曾漢民 Assistants R6胡朝凱 R5鍾文桂 R3游健生 簡士承 (M,1985/05/31,26y9m) 手術日期 2010/12/13 手術主治醫師 楊榮森 手術區域 東址 020房 號 診斷 Hepatocellular carcinoma (HCC) 器械術式 Tumor curettage + Bipolar 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 脊髓麻醉 麻醉主治醫師 劉漢平 ASA 3 紀錄醫師 謝忠佑, 時間資訊 09:45 報到 10:05 進入手術室 10:10 麻醉開始 10:15 誘導結束 10:25 抗生素給藥 10:37 手術開始 10:48 開始輸血 11:55 手術結束 11:55 麻醉結束 12:00 送出病患 12:02 進入恢復室 14:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 惡性骨瘤廣泛切除(一次) 1 1 L 手術 部份關節置換術併整形術–只置換髖臼或股骨或半股關節或半肩關節 1 2 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Spinal anesthesia 1 0 摘要__ 手術科部: 骨科部 套用罐頭: 1. tumor excision 開立醫師: 謝忠佑 開立時間: 2010/12/13 11:40 Pre-operative Diagnosis 1. HCC, multiple metastasis , with left proximal femur involvement 2. left hip, bipolar hemiarthroplasty Post-operative Diagnosis 1. HCC, multiple metastasis 2. left hip, bipolar hemiarthroplasty Operative Method 1. tumor excision 2. bipolar hemiarthroplasty, left hip Specimen Count And Types 1 piece About size: Source:pathology Pathology pending Operative Findings necrotic, reddish-uyellow tissue surrounding the left hip, and in the proximal femur incomplete fracture at the junction of femoral head and neck Operative Procedures 1. SA, lateral decubitus 2. prepped and draped 3. longitudinal incision, posteriolateral approach to the hip joint with inversed T-shaped capsulotomy 4. hemostasis, remove the femoral head, curetted the tumor tissue from the left proximal femur , irrigation with 95% alcohol and copious normal saline 5. prepare the IM canal, insert the bipolar prosthesis, with cement 6. reduced the joint, check alignment and stability, set 1/8 h/v x 1 7. close wound in layers Operators 楊榮森, Assistants 謝忠佑, 黃興耀, 徐水火 (M,1954/07/30,57y7m) 手術日期 2010/12/13 手術主治醫師 郭順文 手術區域 東址 007房 02號 診斷 頸部退化性脊椎炎(Cervical spondylosis) 器械術式 Mediastinoscope 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 趙安怡 ASA 4 紀錄醫師 蔡東明, 時間資訊 11:55 報到 12:08 進入手術室 12:10 麻醉開始 12:30 抗生素給藥 12:30 誘導結束 13:00 手術開始 13:40 麻醉結束 13:40 手術結束 14:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 由頸部進入縱膈腔切開術合併探查或引流 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Mediastinoscopic mediastinal lymphnode dissection 開立醫師: 蔡東明 開立時間: 2010/12/13 13:50 Pre-operative Diagnosis 1.Cervical medullary tumor 2.Mediastinal lymphadenopathy, suspect sarcoidosis Post-operative Diagnosis 1.Cervical medullary tumor 2.Mediastinal lymphadenopathy, suspect sarcoidosis Operative Method Mediastinoscopic mediastinal lymphnode dissection Specimen Count And Types 1 piece About size:1*1CM Source:anterior mediastinal lymphnodes Pathology Pending Operative Findings 1.One 1*1cm round, grayish, elastic and firm, well-defined lymphnodes were noted at anterior mediastinum, right below sternal notch. 2.After lymphnode dissection, there is no active bleeding or oozing. Operative Procedures 1.ETGA, supine position 2.Skin disinfection and drapping 3.Skin incision and neck, 2cm above sternal notch. 4.Under mediastinoscopic guided, lymphnode dissection is complete 5.Hemostasis. Close the wound in layers. Operators VS郭順文 Assistants R4蔡東明 Ri嚴正翰 韓其芳 (M,1965/02/01,47y1m) 手術日期 2010/12/13 手術主治醫師 蕭輔仁 手術區域 東址 002房 01號 診斷 Wound infection postoperative 器械術式 Debridment-- >10cm，Laminectomy for decompression 手術類別 緊急手術 手術部位 脊椎 傷口分類 髒 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 2E 紀錄醫師 曾峰毅, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 08:58 報到 08:58 進入手術室 09:05 麻醉開始 09:15 誘導結束 09:42 手術開始 10:45 手術結束 10:45 麻醉結束 10:50 送出病患 10:52 進入恢復室 12:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術(減壓)-二節以內 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Wound debridement, and laminectomy (sequestre... 開立醫師: 曾峰毅 開立時間: 2010/12/13 10:53 Pre-operative Diagnosis Spinal stenosis, status post laminectomy for decompression, complicated with wound infection Post-operative Diagnosis Spinal stenosis, status post laminectomy for decompression, complicated with wound infection Operative Method Wound debridement, and laminectomy (sequestrectomy) Specimen Count And Types Three cultrue swab was sent for culture, and two piece of sequestrated bone was sent for pathology. Pathology Nil Operative Findings About 2cm wound dehiscence was noted at caudal portion of previous wound. Purulent discharge with debris was found in the deep wound. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After back scrubbe, disinfected, and then draped, we made one midline skin incisin along previous operation wound. We deride the wound, and removed the residual spinous process and lamina. After hemostasis, we placed one epidural CWV, and closed the wound in layers. Operators VS 蕭輔仁 Assistants R4 曾峰毅 Indication Of Emergent Operation 李應睦 (M,1945/07/15,66y7m) 手術日期 2010/12/13 手術主治醫師 王國川 手術區域 東址 002房 07號 診斷 Subarachnoid hemorrhage 器械術式 aneurysm clipping 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林至芃 ASA 3E 紀錄醫師 許皓淳, 時間資訊 10:00 臨時手術NPO 10:00 開始NPO 18:14 通知急診手術 20:09 報到 20:09 進入手術室 20:16 麻醉開始 20:40 誘導結束 21:15 抗生素給藥 21:32 手術開始 00:12 抗生素給藥 02:30 麻醉結束 02:30 手術結束 02:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 開顱術摘除血管病變 - 腦血管瘤 有病徵的 1 1 L 手術 顱內壓視置入 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Aneurysm-frontotemporal approach 開立醫師: 蔡翊新 開立時間: 2010/12/14 01:34 Pre-operative Diagnosis Left anterior choroidal artery aneurysm rupture with SAH. Post-operative Diagnosis Left anterior choroidal artery aneurysm rupture with SAH. Operative Method Left pterional craniotomy for aneurysm clipping and left Kocher EVD for ICP monitoring. Specimen Count And Types 3 tubes of CSF, sent for routine, BCS and bacterial culture Pathology nil. Operative Findings Subarachnoid hematoma with adhesion was noted around the left Sylvian fissure and prechiasmatic cistern. A 5.8 mm x 3.8 mm saccular aneurysm arising from the junction of left ICA and left anterior choroidal artery, pointing posterolaterally. The dome of the aneurysm was adhered tightly to left p-com artery. The anterior choroidal artery was initially compromised by the clipping, which was demonstrated by intraop ICG injection, and it became patent after adjustment of the clip. The ischemic time was about 7 minutes. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right for 40 degree and slightly extended then fixed by Mayfield skull clamp. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with a sterilized adhesive plastic sheet. 4. Incision: left frontotemporal, curvilinear. The skin edge was clipped by Raney clips for temporary hemostasis. After scalp had been lifted, the temporalis muscle was incised and detached from temporal squama and reflected to lower temporal side. 5. An EVD was inserted to left frontal horn of lateral ventricle via left Kocher point. 6. Craniotomy window: 10 x 6 cm, left frontotemporal, created by making 3 burr holes then cut by power saw. The lower temporal bone and pterionic ridge (esp. the inner table) were cut by rongeur as low as possible for easy approach to the anterior clinoid. 7. Dural tention: by 2/0 silk, 2 cm in interval, distributed along the edge of skull window. 8. Dural incision: curvilinear, over-ridding Sylvian fissure and reflected to frontotemporal base. 9. Under operating microscope, the Sylvian fissure and prechiasmatic cistern were opened, then the frontal and temporal opercula were retracted by self-retaining retractor in an opposite direction to expose the aneurysm. When the dissection was carried out more proximally, the aneurysm soon came into view. From that moment on, the patinet blood pressure was brought down to 80 mmHg. The neck of the aneurysm was mobilized gently bya Gage 18 sucker and a fine microdissector until it was entirely free. l0.A 15 mm straight Sugita clip was applied to the neck of the aneurysm. The patency of the anterior choroidal artery was checked by intraop ICG injection under IR800 mode of Pentero Microscope. The clip was adjusted to relieve the compromise to the artery. 11.After successful clipping of the aneurysm, the patient's BP was brought back to normal, and the exposed field was irrigated with N.S. to make sure no any bleeding. 12.The brain retractors were removed. The dura was closed water-tight by running suture with 4/0 Prolene. 13.Closure of skull window: the skull plate was placed back to craniotomy window and fixed by 3 miniplates and 6 screws. The dura was tented to the center of the skull plate by two 2/0 stitches. The covering muscle was closed by interrupted stitches with 1/ 0 silk. 14.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 15.Drain: one, epidural, CWV. 16.Blood transfusion: nil. Blood loss: 16.Blood transfusion: nil. Blood loss: 300 ml. 17.Course of the surgery: smooth. Operators VS蔡翊新VS王國川 Assistants R6胡朝凱R1許皓淳 Indication Of Emergent Operation 林育蔚 (M,1977/04/11,34y11m) 手術日期 2010/12/14 手術主治醫師 曾勝弘 手術區域 東址 003房 02號 診斷 Atypical face pain 器械術式 Radiofrequency coagulation 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 11:40 報到 11:50 進入手術室 12:05 抗生素給藥 12:10 麻醉開始 12:15 誘導結束 12:32 手術開始 13:15 麻醉結束 13:15 手術結束 13:23 送出病患 13:25 進入恢復室 醫令資訊 類別 名稱 量 刀 側 手術 高頻熱凝療法 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Pulse stimulation 開立醫師: 李振豪 開立時間: 2010/12/14 13:42 Pre-operative Diagnosis Trigeminal neuralgia, right V2 Post-operative Diagnosis Trigeminal neuralgia, right V2 Operative Method Pulse stimulation Specimen Count And Types nil Pathology Nil Operative Findings 1. CSF was noted after the needle was placed in the location of Gasserian ganglion. No puncture into oral cavity was noted during whole procedure. 2. Stimulation mode: Pulse duration: 1mS, Stimulation rate: 50Hz and 2 Hz, threshold voltage: 0.6V 3. Pulse stimulation: Temp: 41 oC, 180sec for 2 cycles Pulse duration: 20mS, Pulse rate: 2Hz Operative Procedures Under intravenous general anesthesia with Propofol, the patient was put in supine position. The skin was disinfected and draped as usual. Skin puncture about 2cm lateral to right mouth angle was performed. The RF needle was advanced further to the location of Gasserian ganglion. C-arm portable X-ray was used to confirm the location of needle tip. The anesthesia was discontinued and the patient was waked up. Stimulation was checked and pulse stimulation was done. The needle was removed and the wound was covered. Operators VS曾勝弘, VS楊士弘 Assistants R4李振豪 相關圖片 鄭祖倫 (M,2009/06/04,2y9m) 手術日期 2010/12/14 手術主治醫師 許巍鐘 手術區域 兒醫 062房 02號 診斷 Laryngomalacia 器械術式 BRONCHOSCOPY-COMPLICATED 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 面罩麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 林冠良, 時間資訊 09:16 報到 09:20 進入手術室 09:25 麻醉開始 09:27 誘導結束 09:29 手術開始 09:35 手術結束 09:35 麻醉結束 09:45 送出病患 09:50 進入恢復室 11:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 管、支 管、細支 管異物除去術- 管鏡 1 1 手術 支氣管鏡檢查 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Semi-opened mask inhalation anes 1 0 記錄__ 手術科部: 耳鼻喉部 套用罐頭: Flexible bronchoscope 開立醫師: 林冠良 開立時間: 2010/12/14 11:54 Pre-operative Diagnosis 1.Laryngomalacia 2. Bilateral vocal fold palsy 3. AADC Post-operative Diagnosis 1.Laryngomalacia 2. Bilateral vocal fold palsy 3. AADC Operative Method Flexible bronchoscope and rigid bronchoscope Specimen Count And Types nil Pathology nil Operative Findings Nose__normal___Choana___normal____ Pharynx: Nasopharynx___normal____ Tongue base___normal____ Vallecula_____normal____ Hypopharynx___normal____ Larynx: Epiglottis____normal____ Aryepiglottic fold____normal_______ Arytenoid cartilage___collapse_____ Accesory cartilage____normal_______ True vocal fold_______paralysis____ False vocal folds_____paralysis____ Subglotttis______patent_______ Trachea:_________patent_______ Carina: _________patent_______ Right main bronchus:_____patent_______ Left main bronchus_______patent_______ Others:_____Nil______ Operative Procedures The patient was put in supine position with neck hyperextended. After IVF was setup, flexible bronchoscope was applied into the nostril. From the nasal cavity and nasopharynx till bilateral bronchi were examed. Adenoid vegetation was noted under the bronchoscopy. Then rigid bronchoscopy was set and larynx, subglottis, trachea, carina, bilateral main bronchus, and right upper, middle, lower; left upper and lowerbronchus were checked. The patient tolerated the whole procedure well. Operators AsP許巍鐘 Assistants R2林冠良/ R3許雅晴 楊惠民 (M,1953/04/20,58y10m) 手術日期 2010/12/14 手術主治醫師 王一中 手術區域 東址 010房 04號 診斷 Ptosis/Brow ptosis 器械術式 Correction of Brow Ptosis (Sin 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 10:45 進入手術室 11:05 手術開始 12:05 手術結束 12:10 送出病患 記錄__ 手術科部: 眼科部 套用罐頭: permanent tarsorraphy 開立醫師: 陳達慶 開立時間: 2010/12/14 12:04 Pre-operative Diagnosis persistent epithelial defect (os) Post-operative Diagnosis persistent epithelial defect (os) Operative Method permanent tarsorraphy Specimen Count And Types Pathology nil Operative Findings Operative Procedures 1. Under local anesthesia. 2. Disinfection and draping. 3. Dissect anterior and posterior lamina along the gray line 4. Debride the mucosal epithelium of the upper and lower eyelid 5. Connect upper and lower tarsal plates with 6-0 Vicryl(direct suture) 6. Connect the upper and lower eyelids with 6-0 Nylon (Interrupt suture) 7. Latycin and Iron Shield covering Operators 王一中, Assistants R4 陳達慶 R3 莊超偉 陳萬國 (M,1953/12/18,58y2m) 手術日期 2010/12/14 手術主治醫師 杜永光 手術區域 東址 003房 04號 診斷 Senile dementia, uncomplicated 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 3E 紀錄醫師 鍾文桂, 時間資訊 10:56 臨時手術NPO 10:56 開始NPO 11:56 通知急診手術 19:00 進入手術室 19:02 麻醉開始 19:10 誘導結束 19:25 抗生素給藥 19:58 手術開始 21:43 手術結束 21:45 麻醉結束 21:50 送出病患 21:53 進入恢復室 22:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 B 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 記錄__ 手術科部: 神經部 套用罐頭: Evacuation of chronic subdural hemorrhage. 開立醫師: 鍾文桂 開立時間: 2010/12/14 22:02 Pre-operative Diagnosis Chronic subdural hemorrhage, bilateral. Post-operative Diagnosis Chronic subdural hemorrhage, bilateral. Operative Method Evacuation of chronic subdural hemorrhage. Specimen Count And Types nil Pathology Nil. Operative Findings Red-brownish fluid drained out from the subdural space. More fluid collection at right F-T-P region. The brain expands poorly after evacuation of right F-T-P subdural hemorrhage. Presence of inner and outer membranes. The brain over the left side expanded well(inner membrane sticks to the dura) after evacuation, so no subdural drain was placed over the left side. Operative Procedures Under general anesthesia, the patient was placed in supine position and the head was in midline. After shaving, disinfection, and draping, two linear incision were made at bilateral parietal area. After creating burr holes and durotomy,the subdural hemorrhage were evacuated. Further evacuation was achieved by irrigation of normal saline through the rubber drain. After wound closure, air evacuation was done at right side. Operators 杜永光 Assistants 鍾文桂 鍾文桂 方怡婷 Indication Of Emergent Operation 詹世陽 (M,1958/03/15,53y11m) 手術日期 2010/12/14 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Brain tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾峰毅, 時間資訊 08:00 進入手術室 08:05 麻醉開始 08:50 誘導結束 08:50 抗生素給藥 09:15 手術開始 10:50 手術結束 10:50 麻醉結束 10:58 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經由蝶竇之腦下垂體瘤切除 1 1 手術 鼻中膈造形術 1 3 手術 皮下肌肉或深部異物取出術 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Endoscopic transsphenoid adenomectomy 開立醫師: 曾峰毅 開立時間: 2010/12/14 11:10 Pre-operative Diagnosis Pituitary macroadenoma with apoplexy Post-operative Diagnosis Pituitary macroadenoma with apoplexy Operative Method Trans-sphenoidal adenomectomy Specimen Count And Types Several fragments of one tumor was sent for pathology. Pathology Pending Operative Findings The tumor was yellowish, soft, size 3cm in diameter. The normal gland was found after tumor excision. CSF leakage was sealed with fat graft and gelform packing. Operative Procedures Under general anethesia and intubation, the patient was put in supine position with head tilted 30 degree to left. The facial skin was antiseptic with alcohol better-iodine tincture, and the mucosa of oral and nasal cavity with aqueous better-iodine. We made mucosa incision at septal area of right nostril. We knock downt the vomer, and removed the mucosa in the sphenoidal sinus. We removed the sellar floor with alligator, and made one X-shape dura incision. Tumor removal was doen piece by pice, hemostasis was performed with packing. We harvested fat graft from left lower abdoemn, and packed the fat graft with gelfoam into sellar cavity and sphenoidal sinus. Vomer graft was put back, and nasal cavity was packed with merocels. Operators VS 曾勝弘 Assistants R4 曾峰毅 林讌珍 (F,1994/12/06,17y3m) 手術日期 2010/12/14 手術主治醫師 曾勝弘 手術區域 東址 005房 02號 診斷 Brain tumor 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾峰毅, 時間資訊 11:05 報到 11:16 進入手術室 11:20 麻醉開始 11:25 誘導結束 11:40 抗生素給藥 12:03 手術開始 13:40 手術結束 13:40 麻醉結束 13:50 送出病患 13:52 進入恢復室 14:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 腦室腹腔分流手術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 曾峰毅 開立時間: 2010/12/14 13:48 Pre-operative Diagnosis Arachnoid cyst at anterior portion of middle fossa Arachnoid cyst at anterior portion of left middle fossa Post-operative Diagnosis Arachnoid cyst at anterior portion of middle fossa Arachnoid cyst at anterior portion of left middle fossa Operative Method Cystoperitoneal shunt Specimen Count And Types Nil Pathology nil Operative Findings Clear, colorless fluid gushed out while cyst punctured. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to right. After scalp shaved, scrubbed, disinfected, and then draped, we made one curvilinear skin incision at left frontal area. We drilled one burr hole, and inserted ventricular catheter. We made one transverse skin incision at left upper abdomen, and dissected to insert peritoneal catheter. We created subcutaneous tunnel and connceted shunt all together. The wound was closed in layers after shunt function checked. Operators VS 曾勝弘 Assistants R4 曾峰毅 秋隆 (M,1955/10/20,56y4m) 手術日期 2010/12/14 手術主治醫師 蕭輔仁 手術區域 東址 003房 01號 診斷 Acute osteomyelitis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 胡朝凱, 時間資訊 07:45 報到 08:02 進入手術室 08:05 麻醉開始 08:15 誘導結束 09:23 手術開始 11:23 手術結束 11:23 麻醉結束 11:30 送出病患 11:35 進入恢復室 12:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 骨內固定物拔除術-其他部位 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 記錄__ 手術科部: 內科部 套用罐頭: Debridement and removal of instrumentation 開立醫師: 胡朝凱 開立時間: 2010/12/14 11:36 Pre-operative Diagnosis L4~5 Osteomyelitis Post-operative Diagnosis L4~5 Osteomyelitis Operative Method Debridement and removal of instrumentation Specimen Count And Types Culture tube x 3 Pathology nil Operative Findings 1.Frank pus was noted at subcutaneous layer 2.Some granulation tissue was also noted at instrument area Operative Procedures 1.ETGA, prone 2.Previous wound incision 3.debride subcutaneous granulation tissue 4.incised paravertebral muscle to expose the screws 5.Remove screws 6.Hemostasis 7.Set two hemovac drain then clsoe wound in layers Operators 蕭輔仁 Assistants 胡朝凱, 邱宇任 陳勤程 (M,1980/03/03,32y0m) 手術日期 2010/12/15 手術主治醫師 鄭淳心 手術區域 西址 034房 01號 診斷 Acute lymphoid leukemia 器械術式 Port-A Implatation /WOR 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 鄭淳心 ASA 2 紀錄醫師 賴佳欣, 時間資訊 00:00 臨時手術NPO 08:10 進入手術室 08:25 麻醉開始 08:27 誘導結束 08:45 手術開始 09:50 手術結束 09:50 麻醉結束 09:55 送出病患 10:00 進入恢復室 11:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 手術 port–A導管植入術–治療性導管植入術 1 0 R 記錄__ 手術科部: 麻醉部 套用罐頭: Port-A implantation, subclavian 開立醫師: 賴佳欣 開立時間: 2010/12/15 09:53 Pre-operative Diagnosis leukemia Post-operative Diagnosis Ditto Operative Method Port-A implantation, echo-guided Specimen Count And Types nil Pathology Nil Operative Findings 1.Site: right subclavian vein, with echo-guided procedure 2.Patent flow after implantation 3.Others: nil Operative Procedures 1.The patient was set on supine position and bilateral subclavian veins were checked by echo. 2.After IVGA and local anesthesia applied, transverse skin incision for 3cm was made at pre-cordial area. 3.Undermine the skin at the layer between subcutaneous tissue and deep fascia in lateral direction. 4.An IV catheter was inserted via the subclavian incision and negatively aspirated until venous blood attainable. 5.J-wire was inserted smoothly in rostral direction. A subclavian catheter with dilator was inserted through the J-wire, and the dilator was then removed. 6.The catheter of Port-A was threaded into the subclavian vein until mark 27 cm. The catheter was adapted into the port and locked with restrictor.The Port was inserted into the pouch of pre-cordial incision. 7.Skin was closed layer by layer. Both catheter and port were perfused with heparin solution after implantation. Operators 鄭淳心, Assistants 賴佳欣, 林泰安 (M,1948/06/30,63y8m) 手術日期 2010/12/15 手術主治醫師 杜永光 手術區域 東址 003房 號 診斷 Pituitary tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 游健生, 時間資訊 07:35 報到 08:03 進入手術室 08:10 麻醉開始 08:50 誘導結束 09:00 抗生素給藥 09:32 手術開始 11:30 麻醉結束 11:30 手術結束 11:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 經由蝶竇之腦下垂體瘤切除 1 1 摘要__ 手術科部: 外科部 套用罐頭: Endoscopic transsphenoid adenomectomy 開立醫師: 游健生 開立時間: 2010/12/15 11:37 Pre-operative Diagnosis Pituitary macroadenoma Post-operative Diagnosis Pituitary macroadenoma Operative Method Endoscopic transsphenoid adenomectomy Specimen Count And Types 1 piece About size: Source: Pathology Pending Operative Findings The tumor bulged out after durotomy. It was yellowish, soft, size 1.1 x 1.5 x 1.3cm in diameter. The normal gland was found and suprasellar cistern arachnoid membrane dropped downward after tumor removal. There was no CSF leakage. Operative Procedures Under ETGA, patient was in supine position with head tilted 30 degree to left. The facial skin was disinfected with alcohol better-iodine tincture, and the mucosa of oral and nasal cavity with aqueous better-iodine. The former areas were covered by sterilized adhesive plastic sheets then draped. Under endoscope, the nasal mucosa was coagulated at both norstrils. The posterior part of vomer, anterior sphenoid wall, and posterior sphenoid wall were removed by high speed air-drill and Kerrison punch. The sellar floor dura was coagulated then opened in cruciate fashion. The soft tumor was removed by ring curette and aligator. Some gelfoam were packed into sellar cavity for hemostasis. The dura was covered with Surgicel and gelfoam. The posterior sphenoid wall was reconstructed with bone fragments and gelfoam. The nasal mucosa returned to its normal position. The nasal cavities was tightly packed with better-iodine ointment soaked Merocel. Operators Prof. 杜永光 VS 楊士弘 Assistants R6 胡朝凱 R3 游健生 賴貴微 (F,1939/10/16,72y4m) 手術日期 2010/12/15 手術主治醫師 杜永光 手術區域 東址 003房 02號 診斷 Brain Tumor 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 游健生, 時間資訊 11:50 報到 12:20 進入手術室 12:25 麻醉開始 13:25 誘導結束 13:30 手術開始 14:10 抗生素給藥 17:15 抗生素給藥 19:40 麻醉結束 19:40 手術結束 19:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 7 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for Simpson grade IV tumor excisio... 開立醫師: 游健生 開立時間: 2010/12/15 19:55 Pre-operative Diagnosis Right parietal parasagital meningioma Post-operative Diagnosis Right parietal parasagital meningioma Operative Method Craniotomy for Simpson grade IV tumor excision and cranioplsty Specimen Count And Types Pieces of tumor Pathology pending Operative Findings 1.One 5 x 4 cm, yellowish, elastic and firm tumor located at right parietal parasagital area that invaded into superior sagittal sinus. It penetrated across dura and bone that made skull bone buldging out. 2.The tumor border was clear 3.One prominent occipital artery and meningeal artery were noted and cauterized. Operative Procedures Under ETGA, patient was put in prone position with head fixed with Mayfield skull clamp. U shape skin incision was done at right parietal area. Skin flap was dissected and opened. After burr holes drilled, craniotomy was performed that crosses the midline, followed by dural tenting. U-shape dural incision was made with the base left at midline. The tumor was dissected from posterior part through the interface between tumor and brain tissue. Vascular perforators were cauterized. The major part of tumor was excised. And the tumor that invaded into SSS was left in situ. Hemostasis was then performed. After then, dura was closed with Durofoam. Skull was fixed back with miniplate. And the defect was covered with bone cement. After one CWV drain insertion, wound was closed in layers. Operators P 杜永光 Assistants 胡朝凱, 游健生 朱松雄 (M,1942/10/15,69y4m) 手術日期 2010/12/15 手術主治醫師 蔡瑞章 手術區域 東址 005房 01號 診斷 Brain Tumor 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 07:37 報到 08:05 進入手術室 08:18 麻醉開始 08:50 誘導結束 08:55 抗生素給藥 09:05 手術開始 12:20 抗生素給藥 12:30 麻醉結束 12:30 手術結束 13:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: Simpson grade II tumor excision, right fronta... 開立醫師: 鍾文桂 開立時間: 2010/12/15 13:13 Pre-operative Diagnosis Anterior 1/3 falcine meningioma. Post-operative Diagnosis Anterior 1/3 falcine meningioma. Operative Method Simpson grade II tumor excision, right frontal craniotomy. Specimen Count And Types 1 piece About size:20cc Source:brain tumor Pathology Pending. Operative Findings The grayish-red, elastic, soft, and well delineated tumor was noted in the interhemispheric space. The tumor adhered the falx cerebri and penetrated through it to the contralateral side. At its lateral wall, the tumor has poor delineation with the brain parenchyma. A cortical vein was noted at the posterior margin of the tumor mass. It was preserved well. The tumor encased a pericallosal artery. The artery was well preserved. However, a small piece of tumor was left on it. The dural defect was repaired by pericranium. Operative Procedures Under ETGA, the patient was placed in supine position and the head was fixed by Mayfield in neck flexion position. After shaving, disinfection, and draping, bicoronal scalp incision was made. After dissection, a 6 cm craniotomy was created. The durotomy was based on superior sagital sinus. After retracting the brain parenchyma to expose the interhemispheric space, the tumor was noted at the falx cerebri. Devascularization of the tumor along the falx was done. The tumor was resected in piecemeal fashion. The tumor-attached falx was excised along with the tumor expanding to the contralateral side. After electrocoagulation of the falx and further hemostasis, the dura was repaired by pericranium. The craniotomy window was fixed by mini plates and screws. The wounds were closed in layers with one sugaleal CWV drain. Operators 蔡瑞章 王國川 Assistants 鍾文桂 陳蔚蔚 朱政霖 (M,1983/10/14,28y5m) 手術日期 2010/12/15 手術主治醫師 蔡瑞章 手術區域 東址 005房 02號 診斷 大腦梗塞Cerebral infarction 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 12:23 報到 13:13 進入手術室 13:15 麻醉開始 13:20 誘導結束 13:50 抗生素給藥 14:16 手術開始 14:46 開始輸血 16:50 抗生素給藥 17:35 手術結束 17:35 麻醉結束 17:50 送出病患 17:52 進入恢復室 19:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 頭顱成形術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Cranioplasty. 開立醫師: 鍾文桂 開立時間: 2010/12/15 18:16 Pre-operative Diagnosis Skull defect, right frontal-temporal-parietal. Post-operative Diagnosis Skull defect, right frontal-temporal-parietal. Operative Method Cranioplasty. Specimen Count And Types nil Pathology Nil. Operative Findings Autologous skull bone graft was used for cranioplasty. The remaining bone defect was repaired by bone cement. Due to bulging of the cerebrum, 200cc Mannitol was given to achieve better cranioplasty. Dura: intact. Operative Procedures Under ETGA, the patient was placed in supine position and the head was tilted to the left. After shaving, disinfection, and draping, the previous operative wound was incised and dissected. The subgaleal plane was further dissection to expose the bony defect. The autologous bone graft was fixed by mini plates and screws. After dural tenting, further triming of the bony edges was done. After placing two subgaleal CWV drains, the wound was closed in layers. Operators 蔡瑞章 Assistants 鍾文桂 陳蔚蔚 張惟傑 (M,1968/09/01,43y6m) 手術日期 2010/12/15 手術主治醫師 蕭輔仁 手術區域 東址 002房 02號 診斷 Thoracic myelopathy 器械術式 Spinal fusion posterior 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2E 紀錄醫師 陳德福, 時間資訊 00:28 臨時手術NPO 00:28 開始NPO 08:28 通知急診手術 11:20 報到 12:00 進入手術室 12:05 麻醉開始 12:15 誘導結束 13:01 手術開始 17:00 手術結束 17:00 抗生素給藥 17:00 麻醉結束 17:10 送出病患 17:11 進入恢復室 19:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術(減壓)-二節以內 1 1 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 復健部 套用罐頭: 1.removal of epidural mass 2.Laminectomy T2-5... 開立醫師: 陳德福 開立時間: 2010/12/15 17:07 Pre-operative Diagnosis T3/4 epidural abscess with spinal cord compression Post-operative Diagnosis T3/4 epidural abscess or fibrotic change with spinal cord compression Operative Method 1.removal of epidural mass 2.Laminectomy T2-5 and right costotranversectomy T3-4 Specimen Count And Types 1 piece About size:0.5*0.2*1CM Source:EPIDURAL MASS Pathology pending Operative Findings 1.There is minimal pus like material formation at the doral side epidural space of the T3/4 level with spinal cord encasement. The T2-5 laminectomy was performed and part of the epidural mass was removed for decompression. Right costotranversectomy of T3-4 was done and the ventral side of the spinal cord was inspected. 2.Due to severe fibrotic change, one piece of Durafoam was covered on the epidural space. Operative Procedures Under ETGA and prone position, the skin was disinfected and draed as usual. One linear incision along previous scar was done and the T2-6 level was inspected. The T2-6 laminectomy was done followed by performing the costotranversectomy of T3-4 to exposure the ventral side of the spinal cord. Hemostasis was done and the wound was closed in layers with 2 epidural drainage. Operators VS 蕭輔仁 Assistants R5 陳德福 Indication Of Emergent Operation 蔡仁松 (M,1942/05/07,69y10m) 手術日期 2010/12/15 手術主治醫師 郭順文 手術區域 東址 027房 04號 診斷 Malignant neoplasm of other parts of bronchus or lung 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 高明蔚, 時間資訊 00:00 臨時手術NPO 14:50 進入手術室 14:55 麻醉開始 15:00 誘導結束 15:24 手術開始 15:42 手術結束 15:42 麻醉結束 15:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 氣管切開術 1 0 摘要__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 高明蔚 開立時間: 2010/12/15 15:54 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types nil Pathology None Operative Findings Fr.8 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Low postioned thyroid cartilage. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators 郭順文 Assistants R3高明蔚,Ri嚴正翰 鄒旭妤 (F,2010/09/10,1y6m) 手術日期 2010/12/16 手術主治醫師 楊士弘 手術區域 兒醫 069房 01號 診斷 Intracerebral hemorrhage (ICH) 器械術式 Decompressive craniectomy 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 4E 紀錄醫師 李振豪, 時間資訊 10:06 通知急診手術 11:06 進入手術室 11:06 報到 11:10 麻醉開始 11:15 誘導結束 11:50 抗生素給藥 12:09 手術開始 12:40 開始輸血 14:25 麻醉結束 14:25 手術結束 14:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 急性硬腦膜下血腫清除術 1 1 L 手術 顱內壓視置入 1 2 L 麻醉 Peripheral arterial line inserti 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 摘要__ 手術科部: 套用罐頭: 1. Left frontotemporoparietal craniectomy for... 開立醫師: 楊士弘 開立時間: 2010/12/16 14:26 Pre-operative Diagnosis Head injury with skull fracture, acute subdural hematoma, and brain swelling Post-operative Diagnosis Head injury with skull fracture, acute subdural hematoma, and brain swelling Operative Method 1. Left frontotemporoparietal craniectomy for removal of acute SDH 2. ICP monitor insertion Specimen Count And Types nil Pathology Nil Operative Findings 1. Subperiosteal hematoma and a linear skull fracture was noted in the parietal bone, 5 cm long. 2. Subdural blood clots, 0.5 cm thick, was found over the left temporoparietal region after dural opening. 3. Progressive brain swelling after opening of dura mater. 4. ICP = 22 mmHg after wound closure. Operative Procedures 1. ETGA, supine, head rotated toward right. 2. Left frontotemporoparietal scalp incision and craniectomy, 10 cm x 8 cm. 3. Opening of dura over left parietal region, 5 cm long, for removal of SDH. 4. Multiple short dural opening, 1.0 cm, over frontal, temporal, and parietal regions for check and removal of SDH. 5. Duroplasty with a piece of pericranium and Durofoam. 6. Insertion of a subdural ICP monitor. 7. One CWV subgaleal drain. 8. Wound closure in layers. Operators 楊士弘 Assistants 李振豪 Indication Of Emergent Operation 呂盛成 (M,1985/01/13,27y2m) 手術日期 2010/12/16 手術主治醫師 蕭輔仁 手術區域 東址 005房 01號 診斷 Spinal neuroma 器械術式 Lamino plasty 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾峰毅, 時間資訊 23:05 臨時手術NPO 07:45 報到 08:05 進入手術室 08:20 麻醉開始 08:45 誘導結束 08:50 抗生素給藥 08:50 手術開始 11:50 抗生素給藥 13:30 麻醉結束 13:30 手術結束 13:43 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 良性脊髓腫瘤切除術 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: Cervical Laminectomy 開立醫師: 曾峰毅 開立時間: 2010/12/16 13:41 Pre-operative Diagnosis Intradural extramedullary tumor involving left C2 root, and antoher involving right C3 root, suspected neuroma Post-operative Diagnosis Intradural extramedullary tumor involving left C2 root, and antoher involving right C3 root, suspected neuroma Operative Method Cervical Laminectomy at C1-3 for intradural tumor excision Specimen Count And Types Fragments of two tumor were sent for pathology. Pathology Pending Operative Findings Well defined, elastic, normovascular, intradural extramedullar tumor was noted involving left C2 root with extraforaminal extensino, and antoher involving right C3 root. Operative Procedures with endotracheal general anaesthesia, the patient was put in prone position. After scalp shaved, scrubbed, disinfected, and then draped, we made one midline linear skin incision from Subocciptal area to C3 spinous process. We dissected bilateral paraspinal muscle from C1 to C3, and peformed C1-3 laminectomy. We made one midline durotomy, and performed partial excisiont of left C2 root tumor and total excision of right C3 root tumor. We closed the dura in water tight fashion by suture and artificial dura. After setting one CWV, we closed the wound in layers. Operators VS 蕭輔仁 Assistants R4 曾峰毅 Ri 江韻 鄭孝忠 (M,1960/11/16,51y3m) 手術日期 2010/12/16 手術主治醫師 杜永光 手術區域 東址 003房 號 診斷 Head Injury 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 古恬音, 時間資訊 07:50 報到 08:05 進入手術室 08:20 麻醉開始 09:10 誘導結束 09:15 抗生素給藥 09:50 手術開始 12:12 手術結束 12:12 麻醉結束 12:20 送出病患 12:28 進入恢復室 13:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 手術 腦室腹腔分流手術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 古恬音 開立時間: 2010/12/16 12:27 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunt insertion Specimen Count And Types 1 piece About size:CSF 5 cc Source:CSF Pathology Nil Operative Findings The CSF opening pressure was about 8cmH20, and clear colorless CSF was drained out after ventriculostomy. Codman medium pressure reservoir was used. The ventricular catheter depth 6.5cm, peritoneal catheter depth 20cm. Post-inflammatory adhesion was noted within the peritoneal cavity. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head rotated left. The skin was shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 5 cm curvilinear scalp incision was made at right frontal area. A burr hole was made and the dura was opened in cruciate fashion. Right lateral ventricle was tapped by a ventricular needle, then a 6.5 cm segment of the ventricular catheter was introduced into the ventricle. The outer end of the catheter was connected to a reservoir. A transverse incision was made at RUQ of the abdomen , then a trocar was pushed into peritoneal cavity. Subsequently, distal 20 cm segment of the peritoneal catheter was introduced into the peritoneal cavity through. The proximal end of this catheter was passed through subcutaneous tunnel at forechest, neck, right retroauricular area and connected the reservoir. The shunt systemwas checked to make sure its function was working. The wounds were closed in layers Operators P 杜永光 Assistants R5鍾文桂, R3古恬音 張淑 (F,1999/07/27,12y7m) 手術日期 2010/12/16 手術主治醫師 廖漢文 手術區域 東址 000房 號 診斷 Moyamoya disease 器械術式 Diagnostic cerebral angiography 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 3 時間資訊 08:35 麻醉開始 08:45 誘導結束 09:40 麻醉結束 09:52 進入恢復室 11:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 楊長壽 (M,1947/07/20,64y7m) 手術日期 2010/12/16 手術主治醫師 陳敞牧 手術區域 東址 003房 02號 診斷 Back pain 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 胡朝凱, 時間資訊 11:43 報到 12:50 進入手術室 13:00 麻醉開始 13:20 誘導結束 14:00 抗生素給藥 14:00 手術開始 15:55 開始輸血 16:50 手術結束 16:50 麻醉結束 17:00 送出病患 17:01 進入恢復室 18:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 惡性脊髓腫瘤切除術 1 1 手術 脊椎融合術-後融合,有固定物(<=六節) 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 記錄__ 手術科部: 外科部 套用罐頭: Tumor excision and T9~T11 TPS 開立醫師: 胡朝凱 開立時間: 2010/12/16 17:07 Pre-operative Diagnosis HCC T10 metastasis Post-operative Diagnosis HCC T10 metastasis Operative Method Tumor excision and T9~T11 TPS Specimen Count And Types one piece of tumor mass Pathology pending Operative Findings 1.One about 7 cm reddish, hypervascular tumor located at T10 level with T10 left lamina destruction and muscular invasion was noted. 2.T9 ~ T11 TPS, screws: 40 x 55, cross link x 1 3.Pleura was intact 4.left T10 nerve root was devided 5.Some part of T9 lamina was erroded by tumor Operative Procedures 1.ETGA, prone 2.Midline skin incision at T9~11 level 3.Detach paravertebral muscle group 4.Detach tumor from muscle via capsule 5.TPS screws insertion 6.Remove T10 lamina 7.Remove epidural tumor 8.Hemostasis 9.Fixed rods 10.Set one hemovac drain 11.Close wound in layers Operators 陳敞牧 Assistants 胡朝凱, Ri 姚細姬 (F,1950/11/12,61y4m) 手術日期 2010/12/16 手術主治醫師 廖漢文 手術區域 東址 000房 號 診斷 Subarachnoid hemorrhage 器械術式 Left petrous ICA aneurysm TAE 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 3 時間資訊 15:15 麻醉開始 15:20 誘導結束 18:00 麻醉結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 潘美虹 (F,1972/10/29,39y4m) 手術日期 2010/12/16 手術主治醫師 廖漢文 手術區域 東址 000房 號 診斷 Subarachnoid hemorrhage 器械術式 Right VA dissecting aneurysm for TAE 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 3E 時間資訊 13:15 麻醉開始 13:20 誘導結束 15:00 麻醉結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 葛瓦琪 (F,1945/02/20,67y0m) 手術日期 2010/12/17 手術主治醫師 柯政郁 手術區域 東址 020房 03號 診斷 Malignant neoplasm of parotid gland 器械術式 Oral tumor excision with radic 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 翁宇成, 時間資訊 13:40 進入手術室 13:45 麻醉開始 13:55 誘導結束 13:55 抗生素給藥 14:08 手術開始 14:50 手術結束 14:50 麻醉結束 15:00 送出病患 15:05 進入恢復室 16:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 舌部份/楔狀切除術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 耳鼻喉部 套用罐頭: Partial glossectomy 開立醫師: 廖怡茹 開立時間: 2010/12/19 00:10 Pre-operative Diagnosis Tongue cancer,right Post-operative Diagnosis Tongue cancer,right, operated Operative Method Partial glossectomy Specimen Count And Types 2 pieces About size:1 piece ,size about 3X3 cm Source:right tongue lesion About size:1 piece ,size about 1X1 cm Source:right deep margin Pathology pending Operative Findings The tumor was about 2.0*1.5 cm at the right tongue border. Operative Procedures The patient was in supine position and was set up with general anesthesia via nasal intubation. The operation field for neck dissection was draped and disinfected as well. The oral cavity was irrigated with Aq-Hibitane after a mouth gag wasapplied. An ulcerative and indurative mass over right tongue border, measuring 2.0*1.5 cm was noted. Wide excision was made along the lesion with 1 cm section margin. Hemostasis was achieved with ligation and eletrocauterization. After hemostasis check-up, the operation wound was then achieved with ligation and eletrocauterization. The patient tolerated the whole procedure well. Operators P柯政郁 Assistants R4林沛廷,R2翁宇成 吳彥徵 (F,1983/12/15,28y2m) 手術日期 2010/12/17 手術主治醫師 蔡翊新 手術區域 東址 003房 03號 診斷 Brain abscess 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 污染 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3E 紀錄醫師 游皓鈞, 時間資訊 14:00 開始NPO 15:00 通知急診手術 17:37 報到 18:00 進入手術室 18:03 麻醉開始 18:15 誘導結束 18:55 抗生素給藥 18:55 手術開始 21:55 抗生素給藥 22:40 麻醉結束 22:40 手術結束 22:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除-手術時間在4小時以內 1 1 L 手術 腦室體外引流 1 2 R 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT 開立醫師: 蔡翊新 開立時間: 2010/12/17 22:07 Pre-operative Diagnosis Left frontal brain abscess, hydrocephalus. Post-operative Diagnosis Left frontal brain abscess, hydrocephalus. Operative Method Left frontal craniotomy for brain abscess drainage and excision; Right Kocher EVD. Specimen Count And Types 1 piece About size: 3 x 2 cm, Source: capsule of brain abscess. 4 tubes of CSF, sent for bacterial culture, routine, BCS. 2 tube of pus, Source: brain abscess, sent for culture and smear. Pathology Pending (capsule of brain abscess) Operative Findings 1. CSF: clear; pressure: 20 cmH2O. 2. A 3.83 x 2.54 x 2.04 cm abscess located at left frontal lobe, just beneath the lateral ventricle and above skull base. The content was white-yellowish pus. The capsule was elastic-firm and hypervascular. The wall of left frontal horn of lateral ventricle ruptured during initial puncture of the abscess and CSF flow was packed with Gelfoam. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: Left coronal incision along previous wound. Raney clips were applied to the scalp edge for temporary hemostasis. 5. A burr hole was made at right Kocher point for EVD insertion. 6. Craniotomy window: 6 x 5 cm, left frontal, by removal of previous miniplates and screws. 7. Intraoperative ultrasound was used to localize the abscess. Ventricular needle was used to puncture the abscess, then a Nelaton tube was inserted to the abscess along the tract. 4 ml flank pus was tapped out. The abscess was explored along the tract. The capsule was excised. 8. Hemostasis: The hemostasis during the resection of the abscess capsule was obtained satisfactorily by bipolar coagulator and suction on the patties packing on the bleeders. The blood oozing point from several locations on the bare surface were packed with Surgicel for complete hemostasis. Finally, the cavity created after abscess excision was irrigated with NS several times and it was perfectly watery clear. 9. A 2 x 2 inches of Duroform was used to repair the dural defect. 10.Closure of skull window: the skull plate was placed back to craniotomy window and fixed by previous miniplates and screws. 11.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 12.Drain: one, subgaleal, CWV. one ventricular, which was connected to the ICP monitor. 13.Blood transfusion: nil. Blood loss: 50 ml. 14.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5鍾文桂R1游皓鈞 Indication Of Emergent Operation 葉許素卿 (F,1939/10/14,72y5m) 手術日期 2010/12/17 手術主治醫師 杜永光 手術區域 東址 002房 01號 診斷 Subarachnoid hemorrhage (SAH) 器械術式 Craniotomy(Aneurysms) P-DUH 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3E 紀錄醫師 陳德福, 時間資訊 00:13 臨時手術NPO 00:13 開始NPO 07:13 通知急診手術 08:55 進入手術室 09:00 麻醉開始 09:15 誘導結束 09:20 抗生素給藥 09:30 手術開始 12:50 抗生素給藥 14:06 開始輸血 14:30 手術結束 14:30 麻醉結束 14:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 開顱術摘除血管病變 - 腦血管瘤 有病徵的 1 1 R 手術 顱內壓視置入 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: 1.craniotomy for aneurysm clipping 2.EVD inse... 開立醫師: 陳德福 開立時間: 2010/12/17 14:44 Pre-operative Diagnosis Aneurysmal SAH, right ICA aneurysm [P-com] Post-operative Diagnosis Aneurysmal SAH, right ICA aneurysm [P-com] Operative Method 1.craniotomy for aneurysm clipping 2.EVD insertion for ICP monitoring Specimen Count And Types 1 piece About size:3ML Source:CSF Pathology nil Operative Findings 1.There is diffuse SAH and the brain was swelling. There is a 1.0 in sized aneurysm originated from the right ICA with posterior projection. The neck of the aneurysm is between the orifice of the anterior choroidal artery and P-com artery. The shape of the anerysm is irregular with doughter aneurysm formation. There is severe atherosclerotic change of the right ICA. 2.The aneurysm was clipped with a fenestrated Sugita clip and the anterior choroidal artery and P-com artery were well preserved. Operative Procedures Under ETGA and supine position with Mayfield pin type head fixator fixation, the scalp disinfection and draping were done as usual. One curvilinear incision was done as Pterional approach with right facial nerve preservation. The right sphenoid ridge was drilled to make it flat. One EVD was inserted at the right Kocher point. The craniotomy was done and the dura was opened in fish mouth fasion. The right optic neve and ICA was exposed under brain retractor after opening the sylvian fissure. The neck of the aneurysm was exposed and the adjacent vasculature was well inspected. The aneurysm was then clipped with a fenestrated Sugita clip and the patency of the anterior choroidal artery and P-com artery was checked. The dura was closed in water tight fasion and the skull was fixed with miniplates. One subgaleal drain was left in situ and the wound was closed in layers. Operators P 杜永光 Assistants R5 陳德福 Indication Of Emergent Operation 吳滿 (F,1957/01/19,55y1m) 手術日期 2010/12/17 手術主治醫師 杜永光 手術區域 東址 002房 02號 診斷 Cerebrovascular accident (CVA) 器械術式 Left craniotomy for ICH evacuation 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3E 紀錄醫師 陳德福, 時間資訊 13:03 通知急診手術 13:04 開始NPO 15:27 進入手術室 15:29 麻醉開始 15:45 誘導結束 16:12 手術開始 18:30 手術結束 18:30 麻醉結束 18:35 送出病患 18:45 抗生素給藥 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 1 L 手術 顱內壓視置入 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: craniotomy ICH evacuation and ICP monitoring 開立醫師: 陳德福 開立時間: 2010/12/17 18:37 Pre-operative Diagnosis left putaminal ICH Post-operative Diagnosis left putaminal ICH Operative Method craniotomy ICH evacuation and ICP monitoring Specimen Count And Types nil Pathology nil Operative Findings 1.There is 40ml ICH at the left putamen with severe brain swelling and midline structure compression. 2.The ICH was evacuated followed by inserting one ICP monitor. The ICP was 2-3 mmHg after the skull fixation. Operative Procedures Under ETGA and supine position, the scalp was disinfected and draped as usual. One curvilinear incision at the left scalp was done and the craniotomy was performed. The dura was opened after intra-OP ultrasonography localization. The ICH was evacuated via the middle temporal gyrus route and hemostasis was done. One intraparenchyma ICP was left in situ and the skull was fixed with miniplates. The wound was closed in layers. Operators P 杜永光 Assistants r5 陳德福 Indication Of Emergent Operation 賴仕懷 (M,1966/02/25,46y0m) 手術日期 2010/12/17 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Facial spasm 器械術式 Microvascular decompression 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 游健生, 時間資訊 07:45 報到 08:05 進入手術室 08:10 麻醉開始 08:45 誘導結束 09:30 抗生素給藥 10:05 手術開始 12:26 抗生素給藥 13:20 麻醉結束 13:20 手術結束 13:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦微血管減壓術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Retrosigmoid approach for facial nerve decomp... 開立醫師: 游健生 開立時間: 2010/12/17 13:39 Pre-operative Diagnosis Left hemifacial spasm Post-operative Diagnosis Left hemifacial spasm Operative Method Retrosigmoid approach for facial nerve decompression Specimen Count And Types nil Pathology Nil Operative Findings A posterior inferior cerebellar artery loop compressed the CN VII from behind (inferoposterior). Teflon was packed between PICA and CN VII. After that, CN VII was free from compression. Operative Procedures Under ETGA, patient was in supine position with head fixed by Mayfield headclamp. Head was rotated to right with left shoulder elevated to make left mastoid process the highest point of operation field. After shaving, the operation was disinfected and draped. A sigmoid shape retroauriclle scalp incision was done centered at external acoustic meatus. Neck muscles were dissected to expose the cranium. A fascia graft was harvested for later duroplasty. A 3 x 2 cm craniotomy was done with sigmoid sinus as anterior border and transverse sinus as superior border. After a K-shape durotomy, cerebellum was gentlely retracted and cerebellopontine cistern was opened to drain CSF. The CN VII / VIII complex was seen with a PICA loop compressing the CN VII from behind (inferoposterior). The offending artery was sucked away followed by teflon packing between it and CN VII. The complex was stablized by gelfoam packing. Hemostasis was achieved with Surgicel. Dura was repaired with a fascia graft and 4-0 prolene continuous suture. Bone flap was put back with a gelfoam underneath and wound was closed in layers. Operators Prof. 杜永光 Assistants R6胡朝凱 R3游健生 賴王梅 (F,1943/12/18,68y2m) 手術日期 2010/12/17 手術主治醫師 杜永光 手術區域 東址 003房 02號 診斷 Facial spasm 器械術式 Microvascular decompression 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 游健生, 時間資訊 13:25 報到 13:45 進入手術室 13:50 麻醉開始 14:10 誘導結束 14:15 抗生素給藥 14:40 手術開始 17:10 手術結束 17:10 麻醉結束 17:15 抗生素給藥 17:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦微血管減壓術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 摘要__ 手術科部: 外科部 套用罐頭: Retrosigmoid approach for facial nerve decomp... 開立醫師: 游健生 開立時間: 2010/12/17 17:21 Pre-operative Diagnosis Left hemifacial spasm Post-operative Diagnosis Left hemifacial spasm Operative Method Retrosigmoid approach for facial nerve decompression Specimen Count And Types nil Pathology Nil Operative Findings Two possible offending arteries were seen. One compressed from inferoposterior direction and another one from superioposterior direction. Both offending arteries were pushed away by dissector followed by teflon packing between them and CN VII/ CN VIII complex. The CN VII was free from compression after surgery. There were no significant BAEP changes during surgery. Operative Procedures Under ETGA, patient was in supine position with head fixed by Mayfield headclamp. Head was rotated to right with left shoulder elevated to make left mastoid process the highest point of operation field. After shaving, the operation was disinfected and draped. A sigmoid shape retroauriclle scalp incision was done centered at external acoustic meatus. Neck muscles were dissected to expose the cranium. A fascia graft was harvested for later duroplasty. A 3 x 2 cm craniotomy was done with sigmoid sinus as anterior border and transverse sinus as superior border. After a K-shape durotomy, cerebellum was gentlely retracted and cerebellopontine cistern was opened to drain CSF. The CN VII / VIII complex and two possible offending arteries were seen. One artery compressed from inferoposterior direction and another one from superioposterior direction. Both offending arteries were pushed away by dissector followed by teflon packing between them and CN VII/ CN VIII complex. The complex was stablized by gelfoam packing. Hemostasis was achieved with Surgicel. Dura was repaired with a fascia graft and 4-0 prolene continuous suture. Bone flap was put back with a gelfoam underneath and wound was closed in layers. Operators Prof. 杜永光 Assistants R6胡朝凱 R3游健生 曾愛玉 (F,1942/08/03,69y7m) 手術日期 2010/12/17 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 2 紀錄醫師 鍾文桂, 時間資訊 07:45 報到 08:07 進入手術室 08:15 麻醉開始 09:05 誘導結束 09:30 手術開始 11:50 麻醉結束 11:50 手術結束 12:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除-手術時間在4小時以內 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Simpson grade I tumor excision, right frontal... 開立醫師: 鍾文桂 開立時間: 2010/12/18 00:34 Pre-operative Diagnosis Right frontal parasagital meningioma. Post-operative Diagnosis Right frontal parasagital meningioma. Operative Method Simpson grade I tumor excision, right frontal craniotomy. Specimen Count And Types 1 piece About size:10cc Source:brain tumor. Pathology Pending. Operative Findings 1. A well delineated, elastic, yellowish-pink tumor was noted at right frontal parasagital area. A large cortical vein was noted at the craniotomy window. It was well preserved. 2. The dural defect was repaired by the pericranium. The frontal sinus was sealed by bone wax. Operative Procedures Under ETGA, the patient was placed in supine position and the head was in midline. After shaving, disinfection, and draping, bicoronal incision was made. After dissection, the craniotomy was created. The durotomy was done along the tumor margin. After en bloc excision of the tumor, the brain surface was covered with surgicel. The tumor-attached dura mater was excised and the defect was repaired by pericranium. After fixation of the bone plate, the wound was closed in layers with one subgaleal CWV drain. Operators 曾漢民 Assistants 鍾文桂 陳蔚蔚 朱政霖 (M,1983/10/14,28y5m) 手術日期 2010/12/17 手術主治醫師 蔡瑞章 手術區域 東址 006房 03號 診斷 大腦梗塞Cerebral infarction 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3E 時間資訊 12:38 通知急診手術 13:40 進入手術室 13:45 麻醉開始 13:55 誘導結束 14:00 抗生素給藥 14:05 手術開始 16:25 手術結束 16:25 麻醉結束 16:35 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 硬腦膜外血腫清除術 1 2 R 摘要__ 手術科部: 外科部 套用罐頭: Cranitomy for hematoma evacuation 開立醫師: 古恬音 開立時間: 2010/12/17 16:17 Pre-operative Diagnosis Acute epidural hematoma Post-operative Diagnosis Acute epidural hematoma Operative Method Cranitomy for hematoma evacuation Specimen Count And Types nil Pathology Nil Operative Findings Much fresh blood clot was noted at the epidural space with mass effect on the brain. The brain began to expand after hematoma evacuation. No obvious active bleeding was noted. Operative Procedures 1. ETGA, supine position with head turned to left 2. Scalp was disinfected with better iodine then draped 3. Skin incision was done along previous wound after removal of Nylon sutures 4. Remove the skull plate 5. Hematoma evacuation was done with suction 6. Search for bleeders, then normal saline irrigation of the dura 7. Central tenting*7 8. Fix the skull plate with miniplates 9. Set on epidural CWV drain 10. Repair the skull defect with bone cement 11. Close the wound in layers Operators P蔡瑞章 VS王國川 Assistants R5鍾文桂 R3古恬音 Ri邱宇任 Indication Of Emergent Operation 林文琴 (F,1933/02/05,79y1m) 手術日期 2010/12/17 手術主治醫師 蔡瑞章 手術區域 東址 019房 03號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 游皓鈞, 時間資訊 11:33 進入手術室 11:35 麻醉開始 11:55 誘導結束 12:30 抗生素給藥 12:40 手術開始 15:30 抗生素給藥 15:40 手術結束 15:40 麻醉結束 15:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除-手術時間在4~8小時 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT 開立醫師: 曾峰毅 開立時間: 2010/12/17 15:42 Pre-operative Diagnosis Brain metastatic tumor, origin to be determined Post-operative Diagnosis Brain metastatic tumor, origin to be determined Operative Method Left frontoparietal craniotomy for tumor excision Specimen Count And Types Several fragments of one tumor was sent for pathology. Pathology Pending Operative Findings Greyish to yellowish, elastic, fragile, moderately vascular, ill-defined, subcortical tumor was noted at pariteal lobe. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with left shoulder elevated and head fixed with Mayfield head clamp. After scalp shaved, scrubbed, disinfected, and then draped, we made one reversed U-shape skin incision at left frontoparietal area. We drilled four burr holes, and created one 6x6cm craniotomy. After dural tenting around the craniotomy window, we made one U-shape dura incision with sono-guidance. Tumor excision was done. Dural closure was done with water-tight suture and autologuous periosteal graft. Bone graft was fixed back with mini-plates, and the wound was closed in layers after on subgaleal CWV. Operators P 蔡瑞章 Assistants R4 曾峰毅 R1 游皓鈞 孫祥芸 (F,2003/07/28,8y7m) 手術日期 2010/12/17 手術主治醫師 謝孟祥 手術區域 東址 009房 02號 診斷 Dislocations of cervical vertebra, unspecified, closed 器械術式 Left chin wound debridement 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 2 紀錄醫師 黃柏誠, 時間資訊 00:00 臨時手術NPO 08:45 進入手術室 08:50 麻醉開始 08:50 抗生素給藥 08:55 誘導結束 09:05 手術開始 09:50 手術結束 09:50 麻醉結束 09:52 送出病患 09:55 進入恢復室 11:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 移前皮瓣移植術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: debridement + advancement flap 開立醫師: 黃柏誠 開立時間: 2010/12/17 09:29 Pre-operative Diagnosis left chin pressure sore Post-operative Diagnosis left chin pressure sore Operative Method debridement + advancement flap Specimen Count And Types nil Pathology nil Operative Findings 1. a 2.5 x 1.5 cm spindle shape, imflammation erythematous change of left chin pressure sore Operative Procedures 1.Laryngeal mask GA 2.supine position 3.disinfection and drape 4.incision along pressure sore margin 5.hemostasis 6.advancement flap was done 7.close wound in layers with -0Dexon and 6-0 Monosyn Operators VS謝孟祥 Assistants CR黃傑慧 R3黃柏誠 RI楊允中 黃彩雲 (F,1933/10/13,78y5m) 手術日期 2010/12/17 手術主治醫師 蕭輔仁 手術區域 東址 019房 01號 診斷 Subarachnoid hemorrhage (SAH) 器械術式 External ventricular drainage 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 游皓鈞, 時間資訊 23:11 臨時手術NPO 08:30 報到 08:30 進入手術室 08:35 麻醉開始 08:45 誘導結束 09:12 手術開始 09:30 麻醉結束 09:30 手術結束 09:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室體外引流 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 曾峰毅 開立時間: 2010/12/17 09:33 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method External ventricular drainage via right Kocher point Specimen Count And Types CSF was sent for routine, BCS, and culture. Pathology Nil Operative Findings Light reddish CSF was drained, and opening pressure about 25cmH20. Operative Procedures With endotracheal general anesthesia, we put the patient in supine position. After scalp shaved, scrubbed, disinfected, and then drapded. We made skin incision along previous right frontal EVD wound. We inserted new EVD catheter via previuos burr hole at right Kocher point. We fixed the EVD, and closed the wound in a layers. Operators VS 蕭輔仁 Assistants R4 曾峰毅 王佳淑 (F,1973/02/28,39y0m) 手術日期 2010/12/18 手術主治醫師 林志峰 手術區域 東址 003房 01號 診斷 Septic shock 器械術式 External ventricular drainage 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 4 紀錄醫師 鍾文桂, 林玫君, 時間資訊 23:17 臨時手術NPO 08:25 進入手術室 08:29 麻醉開始 08:32 誘導結束 08:52 手術開始 11:43 12:30 麻醉結束 12:30 手術結束 12:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室體外引流 1 4 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 手術 經外側篩竇切除修補腦髓液鼻 1 1 R 手術 多竇副鼻竇手術 1 2 R 記錄__ 手術科部: 外科部 套用罐頭: Insertion of external ventricular drainage. 開立醫師: 鍾文桂 開立時間: 2010/12/18 12:58 Pre-operative Diagnosis Hydrocephalus. Post-operative Diagnosis Hydrocephalus. Operative Method Insertion of external ventricular drainage. Removal of ventriculoperitoneal shunt. Specimen Count And Types 2 pieces About size: Source:ventricular catheter. About size:3cc Source:CSF for routine, culture, and TP, glucose. Pathology Nil. Operative Findings Turbid, pinkish CSF with pressure -2mmH2O was noted intraoperatively. The EVD tract was through the same one in V-P shunt. Operative Procedures Under ETGA, the patient was placed in supine position and the head in midline. After shaving, disinfection, and draping, the previous operative wound was incised. The ventricular catheter along with the reservoir was removed. The EVD was inserted through the same tract. After ensuring its patency, the wound was closed in layers. Then, the externalized peritoneal catheter was pulled out from right upper chest. Operators 蔡瑞章 Assistants 鍾文桂 記錄__ 手術科部: 外科部 套用罐頭: CSF leakage repair by abdominal fat 開立醫師: 林玫君 開立時間: 2010/12/19 22:45 Pre-operative Diagnosis CSF leakage Post-operative Diagnosis CSF leakage, operated Operative Method CSF leakage repair by abdominal fat Specimen Count And Types nil Pathology nil Operative Findings CSF leakage from sphemoid sinus Operative Procedures The patient was in supine position. After GA was set up, the operative field including abdominal skin was disinfected and draped as usual. Bosmin solution was injected to right inferior abdominal from skin to submucosal fat. Skin incision was as figure 1. The abdominal fat was retrieved by blunt dissection. Then the incision wound was closed with sutures. Sinoscopy was applied to the right side and CSF leakage from sphenoid sinus opening was found. Previous stuffed fat was noted inside the sphenoid sinus. Abdominal fat was packed into the sphenoid sinus and Tissue-glu was used to fix fat in sphenoid sinus. Several pieces of gelfoam were inserted to cover fat. Then 2 piece of the fingerstall were packed in right nasal cavity. After checking bleeding, the operation was finished smoothly. The patient tolerated the whole procedure well. Then 2 piece of the fingerstall and one Merocel were packed in right nasal cavity. After checking bleeding, the operation was finished smoothly. The patient tolerated the whole procedure well. Operators VS林志峰 Assistants R4林芳瑩 R3許軍偉 R2林玫君 陳國棟 (M,1950/11/29,61y3m) 手術日期 2010/12/18 手術主治醫師 陳晉興 手術區域 東址 018房 03號 診斷 Lung cancer 器械術式 Port-A catheter implatation 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 黃世銘, 時間資訊 14:40 進入手術室 14:45 抗生素給藥 15:03 手術開始 16:00 手術結束 16:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 port–A導管植入術–治療性導管植入術 1 0 L 摘要__ 手術科部: 外科部 套用罐頭: Port-A cut down 開立醫師: 黃世銘 開立時間: 2010/12/18 15:58 Pre-operative Diagnosis Lung cancer Post-operative Diagnosis Lung cancer Operative Method Port-A implantation by surgical cut down Specimen Count And Types Nil Pathology nil Operative Findings 1. Port-A catheter was inserted into SVC via left cephalic vein 2. Post-operative portable X-ray showed Port-A catheter tip in correct venous branch to SVC. Operative Procedures 1. Local anesthesia with the patient in supine position, prepped and draping were performed in the usual sterile method. 2. An incision was made in left side neck and subclavical area. After identification of the cephalic vein, Port-A catheter was inserted. 3. Adequate hemostasis was obtained. 4. Post-operative portable X-ray showed catheter tip in correct venous branchto SVC. Then the wound was closed in layers. Operators VS陳晉興 Assistants R2黃世銘 孫叢生 (M,1942/12/24,69y2m) 手術日期 2010/12/18 手術主治醫師 杜永光 手術區域 東址 003房 03號 診斷 Intracerebral hemorrhage 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 4E 紀錄醫師 賴碩倫, 時間資訊 14:30 開始NPO 19:57 通知急診手術 20:45 報到 20:45 進入手術室 20:46 麻醉開始 21:10 誘導結束 21:15 抗生素給藥 21:25 手術開始 23:40 麻醉結束 23:40 手術結束 23:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦內血腫清除術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 記錄__ 手術科部: 外科部 套用罐頭: Right craniotomy for hematoma evacuation 開立醫師: 胡朝凱 開立時間: 2010/12/19 00:33 Pre-operative Diagnosis Right putaminal ICH Post-operative Diagnosis Right putaminal ICH Operative Method Right craniotomy for hematoma evacuation Specimen Count And Types nil Pathology nil Operative Findings 1.About 60 ml hematoma located at right putaminal area was noted. 2.Ther was no active bleeder was noted 3.the brain became slack after hematoma evacuation Operative Procedures Under ETGA, patient was put in supine position with head rotate to left. Right vertical linear skin incision above the right ear was done. Detach and separate temporalis muscle followed. One about 6x5 cm craniotomy window was made followed by dural tenting.Cruciate form dural opening was then done. Corticotomy was made at right inferior frontal gyrus. Hematoma was approached after 0.5 cm depth advance. Hematoma was evacuate with suction. Hemostasis was done with surgicel. BP was elevated up to 135 mmHg to check bleeding. Dura was closed with prolene after ICP monitor insertion. After central tenting, bone was fixed with wire. Wound was then closed in layers Operators P. 杜永光 Assistants 胡朝凱, 賴碩倫 Indication Of Emergent Operation 蘇金連 (F,1948/02/15,64y0m) 手術日期 2010/12/18 手術主治醫師 曾勝弘 手術區域 東址 005房 號 診斷 Parkinson''s disease 器械術式 Stereotaxic procedure for impl 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 陳李魁 ASA 3 紀錄醫師 胡朝凱, 時間資訊 07:37 報到 08:00 進入手術室 08:10 麻醉開始 08:30 誘導結束 08:50 抗生素給藥 09:20 手術開始 13:10 麻醉結束 13:10 手術結束 13:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 立體定位術-功能性失調 1 2 R 手術 立體定位術-功能性失調 1 1 L 手術 深部腦核電生理定位 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 麻醉 Peripheral arterial line inserti 1 0 記錄__ 手術科部: 外科部 套用罐頭: Insertion of DBS wire at bilateral subthalamu... 開立醫師: 胡朝凱 開立時間: 2010/12/18 16:36 Pre-operative Diagnosis Parkisons disease Post-operative Diagnosis Parkisons disease Operative Method Insertion of DBS wire at bilateral subthalamus nucleas Specimen Count And Types NIL Pathology Nil Operative Findings 1. The identified subthalamic nucleus at left side: in length, right side: in length. 2. The rigidity decreased after wire inserted at stimulation "on". Operative Procedures Under IV general anesthesia, the patient was put in supine position. The scalp was shaved, scrubbed and antiseptic with alcohol B-I. Registered the preset localization point to navigator. Bicoronal scalp incision was made with burr hole made at entery point of left frontal region as navigator guided. The DBS wire port was set up and localization of subthalamus nucleus with microelectrode assistance. Inserted the DBS wire and fixed with the port. Waked the patient from the anesthesia and started stimulation from low voltage. Checked the clinical responses while using different voltage for stimulation. Performed the same procedure at right side. After hemostasis, closed the wound in layers. Operators 曾勝弘 Assistants 胡朝凱 謝雅玲 (F,1975/06/20,36y8m) 手術日期 2010/12/18 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 Malignant neoplasm of brain 器械術式 Crainotomy Brain Tumor(P-LIN) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 2 紀錄醫師 古恬音, 時間資訊 08:04 開始NPO 08:04 臨時手術NPO 08:04 通知急診手術 12:40 報到 13:15 進入手術室 13:18 麻醉開始 13:33 誘導結束 13:52 抗生素給藥 14:16 手術開始 17:05 抗生素給藥 17:55 麻醉結束 17:55 手術結束 18:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Right fronto-temporal craniatomy for tumor ex... 開立醫師: 古恬音 開立時間: 2010/12/18 18:19 Pre-operative Diagnosis Right temporal lobe tumor, suspected high-grade glioma Post-operative Diagnosis Right temporal lobe tumor, suspected high-grade glioma Operative Method Right fronto-temporal craniatomy for tumor excision Specimen Count And Types 1 piece About size:pieces of tumor, about 1gm Source:tumor Pathology Pending Operative Findings There was one large infiltrative tumor at the right temporal lobe. The tumor was about 10cm in maximal diameter, and multiple cystic components with clear fluid content were noted. The cystic part was grayish, soft and fragile, and the solid part was elastic-firm and jelly-like. The margin between the tumor and the normal brain was not clear. The temporal horn of right lateral ventricle was opened during tumor dissection Operative Procedures 1. ETGA, supine position with head turned to left 2. Scalp was shaver, scrubbed, and disinfected with better iodine 3. Draping was done in usual sterile fashion 4. Make a question mark scalp incision at right frontotemporal region, followed by one 8*6cm craniotomy 5. Dura was opened in U-shaped after peripheral tenting 6. Localize the tumor with ultrasound 7. Approach the tumor with transcortical method 8. Dissect the tumor from the normal brain tissue, the extent included Sylvian fissure 9. Hemostasis with bipolar coagulation and Surgicel lining 10. Repair dura with prolene suture and autologous fascia graft 11. Fix the skull plate back with miniplates 12. Set on subgaleal CWV drain 13. Close the wound in layers Operators VS王國川 Assistants R3古恬音 R2賴碩倫 Indication Of Emergent Operation 潘美虹 (F,1972/10/29,39y4m) 手術日期 2010/12/18 手術主治醫師 蔡翊新 手術區域 東址 001房 04號 診斷 Subarachnoid hemorrhage 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 3E 紀錄醫師 古恬音, 時間資訊 17:00 臨時手術NPO 17:00 開始NPO 20:36 通知急診手術 21:29 進入手術室 21:48 麻醉開始 22:00 誘導結束 22:24 手術開始 23:00 手術結束 23:00 麻醉結束 23:10 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 顱內壓視置入 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: External ventricular draiange via right Koche... 開立醫師: 古恬音 開立時間: 2010/12/18 23:27 Pre-operative Diagnosis Subarachnoid hemorrhage with acute hydrocephalus Post-operative Diagnosis Subarachnoid hemorrhage with acute hydrocephalus Operative Method External ventricular draiange via right Kocher point Specimen Count And Types 1 piece About size:CSF 5cc Source:CSF Pathology Nil Operative Findings The CSF opening pressure was about 30cmH2O. Pinkish CSF gushed out upon ventriculostomy. Ventricular catheter depth: 6.5cm Operative Procedures 1. ETGA, supine position 2. Scalp shaving, scrubbing, and disinfection 3. Draping in usual sterile fashion 4. Scalp incision at right frontal area 5. Make a burr hole 6. Durotomy in cruciate fashion after tenting 7. Ventricular puncture, then insertion of ventricular catheter 8. Check drain function 9. Close the wound in layers Operators VS蔡翊新 Assistants R3古恬音 Indication Of Emergent Operation 楊雨潤 (M,2007/11/07,4y4m) 手術日期 2010/12/19 手術主治醫師 楊士弘 手術區域 兒醫 067房 01號 診斷 Contusion, chest 器械術式 Spinal fusion anterior spinal 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3E 紀錄醫師 李振豪, 時間資訊 00:00 開始NPO 00:00 臨時手術NPO 10:57 通知急診手術 12:10 進入手術室 12:10 報到 12:15 麻醉開始 12:35 誘導結束 13:38 手術開始 14:15 抗生素給藥 15:00 開始輸血 18:55 麻醉結束 18:55 手術結束 19:10 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 動脈血液檢查全套 4 0 麻醉 Hemoglobin (Hb) 4 0 麻醉 測血糖 4 0 麻醉 Ca (Calcium) 4 0 麻醉 Na (Sodium) 4 0 麻醉 K (Potassium) 4 0 麻醉 Blood gas analysis 4 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎間盤切除術-椎 1 2 摘要__ 手術科部: 套用罐頭: 1. Right costotransversectomy for posterior T... 開立醫師: 楊士弘 開立時間: 2010/12/19 19:12 Pre-operative Diagnosis Fracture dislocation of thoracic spine, T2-3, with spinal cord compression Post-operative Diagnosis Fracture dislocation of thoracic spine, T2-3, with spinal cord compression Operative Method 1. Right costotransversectomy for posterior T2 corpectomy and spinal cord decompression 2. Transpedicle screw fixation from T1-4 with autologous bone fusion Specimen Count And Types nil Pathology Nil Operative Findings 1. There was disruption of the supraspinous and interspinous ligaments of T2-3 and the T2-3 facet joints. 2. The right parietal pleura was torn with herniation of right lung tissue into the T2-3 disc space 3. Burst fracture of the T2 vertebral body was found, with posterior bulging of the bone fragment against the spinal cord. 4. After removal of the posterior half of T2 vertebral body, the spinal cord was free from compression by fractured bone. 5. Transpedicle screws and rods were inserted into bilateral T1 and T4 pedicles: T1 screws: 3.5 mm x 16 mm T4 screws: 3.5 mm x 18 mm rods: 6 cm long each 6. High EtCO2 was noted before closure of wound, and improved after changing position from prone to supine and reinsertion of right chest tube. ps: CSF leak was noted after wound opening. A small dura rent was found at the lateral surface of T2 cord. The defect was repaired with Durofoam. Operative Procedures 1. ETGA, prone, head fixed with Mayfield clamp. 2. Midline incision from C7 to T5. 3. Dissection of paraspinal muscles from spinous processes, lamina, and transverse processes. 4. Resection of right T2, T3 facets, transverse processes, pedicles, and proximal ribs (3 cm long) for posterolateral exposure of T2 vertebral body. 5. Division of right T2 root. 6. Reduction of herniated lung tissue from T2-3 disc space. 7. Corpectomy of posterior T2 vertebral body by air drill, kerrison, currets. 8. Resection of left T2, T3 facets for checking of completeness of corpectomy. 9. Durofoam wrapping of exposed dura surface of T2 cord. 10. Insertion of pedicle screws at bilateral T1, 4 with rod connection at each side. 10. Insertion of pedicle screws at bilateral T1, 4 with rod connection at each side. The resected facets and ribs were decorticated and placed over the decorticated surfaces of T1-4 lamina and transverse processes for bone fusion 11. One epilaminal epidural drain. 12. Wound closure. Operators 楊士弘 Assistants 李振豪 Indication Of Emergent Operation 黃中平 (M,1957/02/01,55y1m) 手術日期 2010/12/20 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Brain tumor 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 鍾文桂, 時間資訊 07:45 報到 08:05 進入手術室 08:10 麻醉開始 08:15 誘導結束 09:00 抗生素給藥 09:28 手術開始 10:00 手術結束 10:00 麻醉結束 10:10 送出病患 10:15 進入恢復室 11:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 顱骨切除術,包括異物移除或壓或經切斷 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Craniectomy for tumor biopsy. 開立醫師: 鍾文桂 開立時間: 2010/12/20 10:24 Pre-operative Diagnosis Suspect fibrous dysplasia of skull bone, left frontal. Post-operative Diagnosis Suspect fibrous dysplasia of skull bone, left frontal. Operative Method Craniectomy for tumor biopsy. Specimen Count And Types 1 piece About size:2CC Source:SKULL TUMOR Pathology Pending. Operative Findings After drilling off the outer table of the skull bone, some hard, elastic, whitish-pink tumor were noted along with some bony destruction. not easy oozing. The bony defect was repaied by bone wax, about 0.5cm in diameter. Operative Procedures Under ETGA, the patient was placed in supine position and the hea was slightly tilted to the right. After shaving, disinfection, and draping, a linear scalp incision was made at left frontal region, just behind the hair line. After dissection of the temporalis muscle, we used small high speed drill to create a 1-cm craniotomy. After reaching the soft mass lesion, we further resect the tumor by Kerrison punch. After gathering enough specimen, the bony defect was filled with bone wax. Then, the wound was closed in layers with no drain. Operators 曾漢民 Assistants 鍾文桂 陳蔚蔚 陳阿秀 (F,1953/07/09,58y8m) 手術日期 2010/12/20 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Aneurysm 器械術式 EC-IC by-pass 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 游健生, 時間資訊 08:04 進入手術室 08:20 麻醉開始 08:40 誘導結束 09:42 手術開始 10:15 抗生素給藥 13:15 抗生素給藥 16:15 抗生素給藥 18:45 手術結束 18:45 麻醉結束 18:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 開顱術摘除血管病變 - 腦血管瘤 無病徵的 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 13 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Left Dolenc"s approach for aneurysm clipping 開立醫師: 游健生 開立時間: 2010/12/20 19:02 Pre-operative Diagnosis 1. Left ICA aneurysm 2. Right posterior communicating artery aneurysm Post-operative Diagnosis 1. Left superior hypophyseal artery aneurysm 2. Right posterior communicating artery aneurysm Operative Method Left Dolenc"s approach for aneurysm clipping Specimen Count And Types nil Pathology Nil Operative Findings Baseline SSEP of left lower limb was not good. Intra-operative decrease of left arm SSEP was noted. It returned to its baseline after revision of aneursym clips and elevated BP. The aneurysm is about 1cm in diameter at left ICA distal to ophthalmic artery origin, pointing supero-medially beneath the optic nerve. Two Sugita fenestration clips with curved blade were applied to the neck of aneurysm. The patency of ICA, P-com artery, anterior choroidal artery, ACA, & MCA was confirmed by intra-operative ICG angiography. Operative Procedures Under ETGA, patient was in supine position with head rotated to right 45 degrees and fixed by Mayfield headclamp. After shaving, we disinfected and draped the operation field as usual. A curvilinear scalp incision 1cm anterior to tragus extended upward then anteriorly to hairline crossing midline. The skin flap was reflected together with Yasargil fatpad followed by temporalis muscle reflection. A 7x4 cm craniotomy was done. The middle meningeal artery was identified and coagulated. The anterior clinoidal process was drilled off extradurally. The lateral wall and orifice of optic canal were opened to mobilize optic nerve. A curvilinear durotomy with anteroinferior border of craniotomy as base was done. The lateral inferior part of aneurysm was seen inferior lateral to optic nerve. After exposure of optic chiasm and the contralateral optic nerve, a mild bulging of chiasm was seen probably due to aneurysm beneath. To have proximal control, the petrosal segment of ICA was exposed by drilling off the ceiling of carotid canal at petrosal bone just lateral to greater superficial petrosal nerve and behind CN V3 extradurally. A 5Fr Fogarty catheter was inserted into the carotid canal. It would be inflated to compress the carotid artery if proximal control was needed. The dura flap was cut in half directing downward optic nerve. The falciform ligament and proximal dura ring were cut to further mobilize optic nerve and carodit artery. The lateral wall of cavernous sinus was opened to expose cavernous segment of carotid artery with gelfoam packing for hemostasis. The ophthalmic artery was seen by gentle elevation of optic nerve. The Fogarty catheter balloon was inflated. A temporal clip was applied to ICA just proximal to ACA origin. Three Sugita fenestration clips with curved blade were applied to the neck of aneurysm. After adjustment, the patency of ICA, P-com artery, anterior choroidal artery, ACA, & MCA was confirmed by intra-operative ICG angiography. The temporal clip was removed and Fogarty catheter balloon was deflated. However, right upper limb SSEP decreased. After revision, only 2 Sugita fenestration clips with curved blade were applied to the neck of aneurysm. The patency of ICA, P-com artery, anterior choroidal artery, ACA, & MCA was confirmed by intra-operative ICG angiography. Dura was closed with 4-0 prolene. After dura tenting along the craniotomy window edge and central tenting, bone flap was fixed back with miniplates. A subgaleal CWV was placed. Wound was closed to layers. Operators Prof. 杜永光 Assistants R6 胡朝凱 R3 游健生 張嘉芳 (F,1954/07/07,57y8m) 手術日期 2010/12/20 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Brain metastasis 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 鍾文桂, 時間資訊 10:21 報到 10:35 進入手術室 10:45 麻醉開始 11:00 誘導結束 11:05 抗生素給藥 11:20 手術開始 14:00 手術結束 14:00 抗生素給藥 14:00 麻醉結束 14:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Left frontal craniotomy for tumor excision. 開立醫師: 鍾文桂 開立時間: 2010/12/20 14:26 Pre-operative Diagnosis Right breast infiltrating ductal carcinoma with left frontal metastasis. Post-operative Diagnosis Right breast infiltrating ductal carcinoma with left frontal metastasis. Operative Method Left frontal craniotomy for tumor excision. Specimen Count And Types 1 piece About size:10CC Source:BRAIN TUMOR Pathology Pending. Operative Findings 1. Grayish-red soft, poorly delineated, fragile tumor in moderate vascularity. The tumor was close to the frontal horn of lateral ventricle, so the ventricle wall was opened. The opening was sealed with TissuCol Duo. 2. The cystic component of the tumor was noted right after coricotomy. It was yellowish, turbid, and serous. The tumor location was ensured by intraoperative ultrasonography. 3. The dural defect was repaired by pericranium. The venous bleeding from the superior sagital sinus was hemostated by gelfoam. Operative Procedures Under ETGA, the patient was placed in supine position and the head was tilted to the right. After shaving, disinfection, and draping, the curvilinear scalp incision was done. After dissection, the 8-cm craniotomy was created. After durotomy, the localization of the tumor was ensured by ultrasonography. After corticotomy, the tumor was excised in en bloc fashion. Well hemostasis was achieved with bipolar electrocoagulation and surgicel. After water tight closure of the dura mater and fixation of the skull bone, the wound was closed in layers with one subgaleal drain. Operators 曾漢民 Assistants 鍾文桂 陳蔚蔚 張富翔 (M,1967/08/25,44y6m) 手術日期 2010/12/20 手術主治醫師 陳敞牧 手術區域 東址 002房 02號 診斷 Malignant neoplasm of kidney, except pelvis 器械術式 V-P shunt 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3E 紀錄醫師 李振豪, 時間資訊 08:30 臨時手術NPO 08:30 開始NPO 08:42 通知急診手術 10:10 報到 10:30 進入手術室 10:40 麻醉開始 10:45 誘導結束 11:00 抗生素給藥 11:28 手術開始 13:15 手術結束 13:15 麻醉結束 13:30 送出病患 13:31 進入恢復室 14:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 腦室腹腔分流手術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt implantation 開立醫師: 李振豪 開立時間: 2010/12/20 13:36 Pre-operative Diagnosis Isolated right temporal horn with hydrocephalus due to right lateral ventricle tumor Post-operative Diagnosis Isolated right temporal horn with hydrocephalus due to right lateral ventricle tumor Operative Method Ventriculoperitoneal shunt implantation Specimen Count And Types nil Pathology Nil Operative Findings The opening pressure is more than 15cmH2O after opening the dura. The CSF was clear in character. The subdural space was connected to the right temporal horn due to previous operation. Codman programmable valve reservoir with 100mmH2O as initial pressure setting was placed into right subdural space for drainage of isolated right temporal horn. The ventricular catheter was 5cm in length and the peritoneal catheter was 30cm in length. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine position with head rotated to left. The scalp was shaved, scrubbed, and disinfected as usual. Linear scalp incision was made at right temporal area followed by one burr hole creation at previous craniotomy skull plate. Two dural tenting was done and the dura was opened with cruciform fashion. The dura and the arachnoid membrane was coagulated with bipolar electrocautery. One transverse skin incision was made at right upper quadrient abdomen. The subcutaneous soft tissue was dissected and the fascia of rectus abdominis was opened. The muscle was splitted to expose the peritoneum. Minilaparotomy was performed and the trocar was placed into the peritoneal cavity. The subcutaneous tunnel was created from right upper abdomen, right forechest, right neck, to right temporal wound. The peritoneal catheter was placed throught the subcutaneous tunnel. The ventricular catheter, programmable valve reservoir, and the peritoneal catheter were connected. The ventricular catheter was placed into right subdural space and the function was checked. Hemostasis was achieved and the wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS陳敞牧 Assistants R4李振豪, Ri姜士中 Indication Of Emergent Operation 相關圖片 李百生 (M,1948/08/05,63y7m) 手術日期 2010/12/21 手術主治醫師 杜永光 手術區域 東址 005房 04號 診斷 Cerebrovascular accident (CVA) 器械術式 occipital craniectomy 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 3 紀錄醫師 陳德福, 時間資訊 18:16 通知急診手術 18:50 報到 18:50 進入手術室 18:55 麻醉開始 19:30 誘導結束 19:55 抗生素給藥 20:15 手術開始 21:02 開始輸血 23:30 抗生素給藥 00:20 麻醉結束 00:20 手術結束 00:35 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦內血腫清除術 1 1 手術 顱內壓視置入 1 2 摘要__ 手術科部: 神經部 套用罐頭: 1.suboccipital craniectomy and duroplasty 2.r... 開立醫師: 陳德福 開立時間: 2010/12/22 00:41 Pre-operative Diagnosis Cerebellar infact with hemorrhagic transformation and hydrocephalus Post-operative Diagnosis Cerebellar infact with hemorrhagic transformation and hydrocephalus Operative Method 1.suboccipital craniectomy and duroplasty 2.right Frazier EVD for monitoring Specimen Count And Types nil Pathology nil Operative Findings 1.There is cerebellar infarct with hemorrhagic transformation and hydrocephalus. The EVD opening pressure: 20cmH2O with clear CSF. 2.suboccipital craniecotmy and duroplasty were done and the cerebellum was sweling after the durotomy. 3.Posterior arch of C1 was removed for decompression. Operative Procedures Under ETGA and prone position with Mayfield pin type head fixator fixation, the scalp was disinfected and draped as usual. One linear incision was done at the right Frazier point followed by performing burr hole and dura opening. The EVD was inserted and fixed at 8cm intraventricular catheter. One linear incision at midline was done, the suboccipital approach with craniectomy was done. The dura was opened in Y shape and the laminectomy was done. The duroplasty was done with autologous muscle fascia and Durofoam. One CWV was left in situ and the wound was then closed in layers. Operators P 杜永光 Assistants R5 陳德福 Indication Of Emergent Operation 林添順 (M,1927/06/12,84y9m) 手術日期 2010/12/21 手術主治醫師 王國川 手術區域 東址 001房 03號 診斷 Old cerebrovascular accident 器械術式 drainage of brain abscess 手術類別 緊急手術 手術部位 頭、頸 傷口分類 污染 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 胡朝凱, 時間資訊 00:00 開始NPO 00:00 臨時手術NPO 08:39 通知急診手術 09:30 報到 09:55 進入手術室 10:00 麻醉開始 10:10 誘導結束 10:55 手術開始 12:20 麻醉結束 12:20 手術結束 12:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 記錄__ 手術科部: 內科部 套用罐頭: Echo guided burr hole drainage 開立醫師: 胡朝凱 開立時間: 2010/12/21 12:47 Pre-operative Diagnosis Right brain abscess Post-operative Diagnosis Right brain abscess Operative Method Echo guided burr hole drainage Specimen Count And Types Culture tube x 6 Pathology pending Operative Findings 1.Two brain abscess was noted at right temporal lobe and right occipital parietal junction. 2.Greenish and sticky content was drained out after echo guided puncture 3.clearer CSF was also drained out when draining abscess at right parietal area. Operative Procedures 1.ETGA, supine with head rotate to left 2.Right temporal curvature skin incision was noted 3.Reflect skin and muscle flap downward 4.Two burr holes were made at right temporal and occipital to parietal area 5.Under echo guided, puncture to abscess was done 6.The content was sucked out 7.One nelaton tube was inserted at right parietal abscess cavity 8.Fixed nelaton tube 9.Close wound in layers Operators 王國川,蔡翊新 Assistants 胡朝凱, Ri Indication Of Emergent Operation 莊秀珍 (F,1955/10/30,56y4m) 手術日期 2010/12/21 手術主治醫師 黃凱文 手術區域 東址 013房 05號 診斷 Cholangiocarcinoma 器械術式 Lobectomy 手術類別 預定手術 手術部位 腹 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 陳蔚蔚, 時間資訊 15:20 報到 15:58 進入手術室 16:03 麻醉開始 16:18 誘導結束 16:50 手術開始 21:10 抗生素給藥 22:00 手術結束 22:00 麻醉結束 22:05 送出病患 22:10 進入恢復室 00:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 左肝葉切除術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 總膽管切開及T形管引流 1 2 記錄__ 手術科部: 外科部 套用罐頭: Lobectomy 開立醫師: 陳蔚蔚 開立時間: 2010/12/21 22:32 Pre-operative Diagnosis cholangiocarcinoma Post-operative Diagnosis cholangiocarcinoma Operative Method Lt lobectomy of the liver + cholancystectomy Specimen Count And Types 7 Pathology 7 Operative Findings 1. one 5cm elastic yellowish tumor over left lobe of liver 2. tumor thrombus in left CBD 3. LN dissection: group 12A, 12B, 13 4. gall bladder 5. blood loss: 300cc Operative Procedures 1. ETGA, supine, disinfected, drapped 2. Right subcostal incision with cephalic extension, then further pulled upper-wards and lateral-wards 3. IHD, left hepatic artery and left portal vein were indetified and ligated seperately. 4. the gall bladder was firstly removed to expose the hilar structure of the liver 5. The ligamentum teres was ligated and divided for traction of the liver and lymph node dissection was performed. 6. intraoperative ultrasonography was performed to locate the tumor and to detect any unsuspected new lesions in the liver 7. By temporarily tightening of the vascular tapes, the planed resection line was marked on the liver surface between the ischemic zone and non-ischemic zone. 8. The liver parenchyma was then divided gradually with CUSA. 9. The exposed vascular structure and bile ducts were divided after ligation or clipping with vascular clip. 10.When the resection was completed, detailed hemostasis of the raw surface was performed by electrocauterization and suture ligation of the bleeder. 11.one T-tube was placed in the CBD 12.the raw surface of the liver was covered with Surgicel 13.the surgical wound was closed in three layers with two rubber drains setting in left subphrenic space and right subhepatic space. Operators 黃凱文 Assistants 廖御佐,陳蔚蔚 相關圖片 李宗哲 (M,1979/12/15,32y2m) 手術日期 2010/12/21 手術主治醫師 林峰盛 手術區域 西址 035房 11號 診斷 Lung cancer 器械術式 Nerve block / PC 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 林峰盛 ASA 3 紀錄醫師 賴佳欣, 時間資訊 08:00 臨時手術NPO 18:40 報到 19:00 進入手術室 19:02 麻醉開始 19:05 誘導結束 19:10 手術開始 20:05 手術結束 20:05 麻醉結束 20:10 進入恢復室 20:10 送出病患 21:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 手術 神經分離術–肩,臀關節以上,包括臂神經叢,坐骨神經 1 2 摘要__ 手術科部: 麻醉部 套用罐頭: Thoracic paravertebral neurolysis 開立醫師: 林峰盛 開立時間: 2010/12/21 20:00 Pre-operative Diagnosis Lung ca with T8 metastasis Post-operative Diagnosis Lung ca with T8 metastasis Operative Method Thoracic paravertebral plexus neurolysis Specimen Count And Types nil Pathology nil Operative Findings Contrast medium spread in longitudinal paravertebral space No epidural spreading Operative Procedures 1.Put patient in prone position with T spine flexion 2.IV general anesthesia with morphine midazolam and fentanyl titration 3.Locate T6 vertebral body by C-arm. 4.Check needle trajectory to paravertebral space by ultrasound. 5. Insert 22G insulated needle toward T8 level under tunnel view and realtime ultrasound guidance 6. Check needle movement under AP and lateral view 7. Locate needle tip at paravertebral space 8. Inject contrast medium to demonstrate longitudinal paravertebral space spreading and no epidural spreading 9. Inject 1% xylocaine 15 ml then inject 95% alcohol 15 ml for plexus destruction. 10. Check vital signs and send patient to PACU. Operators 林至芃, 林峰盛, Assistants 賴佳欣, 王憶嘉, 蘇金連 (F,1948/02/15,64y0m) 手術日期 2010/12/21 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Parkinson''s disease 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 黃鼎鈞, 時間資訊 07:55 報到 08:07 進入手術室 08:25 麻醉開始 08:30 誘導結束 08:50 抗生素給藥 08:59 手術開始 10:20 手術結束 10:20 麻醉結束 10:30 送出病患 10:33 進入恢復室 11:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室腹腔分流手術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: IPG implantation 開立醫師: 黃鼎鈞 開立時間: 2010/12/21 09:48 Pre-operative Diagnosis Parkinson disease status post implantation of bilateral deep brain stimulation Post-operative Diagnosis Parkinson disease status post implantation of bilateral deep brain stimulation Operative Method IPG implantation Specimen Count And Types nil Pathology nil Operative Findings 1. Two leads inserted previously Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture. 4. Incision: 4 cm curvilinear, left occipital, dissect and expose the lead implanted previously 5. Incision: 10 cm transverse, about 2 cm below left clavicle, dissect and create a pocket space for IPG implantation 6. A trochar was used to create a subcutanous tuneel connecting with the pocket and sclap wound. 7. The IPG was placed into the pocket space and the cable was placed into the tunnel. 8. Connection of the leads, check the IPG function. 9. irrigation of the wound with gentamycin solution 10. close the wound in layers 11.Course of the surgery: smooth. Operators P曾勝弘 Assistants R5鍾文桂, R1黃鼎鈞 相關圖片 李守成 (M,1922/10/20,89y4m) 手術日期 2010/12/21 手術主治醫師 曾勝弘 手術區域 東址 005房 02號 診斷 Cervical Spondylosis 器械術式 Laminectomy C-Spinal(Posterier 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 10:02 報到 10:45 進入手術室 10:50 麻醉開始 11:10 誘導結束 11:25 抗生素給藥 11:48 手術開始 13:45 手術結束 13:45 麻醉結束 14:05 進入恢復室 14:05 送出病患 15:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 椎弓切除術(減壓)-超過二節 1 1 記錄__ 手術科部: 外科部 套用罐頭: Laminectomy, C3-7. 開立醫師: 鍾文桂 開立時間: 2010/12/21 13:21 Pre-operative Diagnosis Spinal stenosis, C3-C7. Post-operative Diagnosis Spinal stenosis, C3-C7. Operative Method Laminectomy, C3-7. Specimen Count And Types nil Pathology Nil. Operative Findings 1. severe stenosis at C3-7 levels. 2. intact dura mater, slack cord after decompression. Operative Procedures Under ETGA, the patient was placed in prone position and the head was fixed by Mayfield. After shaving, disinfection, and draping, midline incision was made at C2-C7 levels. After midline and paraspinal dissection, the C2-C7 laminae were exposed. After laminectomy of C3-C7 levels and well hemostasis, the wound was closed in layers with one epidural CWV drain. Operators 曾勝弘 Assistants 鍾文桂 胡朝凱 黃鼎鈞 謝枝全 (M,1928/12/28,83y2m) 手術日期 2010/12/21 手術主治醫師 曾勝弘 手術區域 東址 005房 03號 診斷 Lumbar spondylosis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 黃鼎鈞, 時間資訊 13:35 報到 14:15 進入手術室 14:22 麻醉開始 14:36 抗生素給藥 14:45 誘導結束 15:21 手術開始 17:05 開始輸血 17:40 手術結束 17:40 麻醉結束 17:50 送出病患 17:50 進入恢復室 19:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術(減壓)-超過二節 1 1 手術 脊椎融合術-後融合,無固定物 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 記錄__ 手術科部: 外科部 套用罐頭: L3~partial S1 lumbar Laminectomy with L3~4 Po... 開立醫師: 胡朝凱 開立時間: 2010/12/21 17:57 Pre-operative Diagnosis l3~5 STENOSIS Post-operative Diagnosis L3~5 stenosis Operative Method L3~partial S1 lumbar Laminectomy with L3~4 Posterior lateral Fusion Specimen Count And Types nil Pathology nil Operative Findings 1.Adhesion was noted at previous operation area of L4~5 2.One small un-intended durotomy was done and was sealed with prolene 3.Hypertrophic flavum ligment and fibrotic scar tissue was noted and removed 4.L3~S1 nerve roots was identified and became loose after laminectomy Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: prone. 3. Skin preparation: the back was shaved and scrubbed with povidone-iodine detergent then painted with povidone-iodine tincture and followed by sterilized adhesive plastic sheet covering. 4. A spinal needle was inserted between spinous processes of L3~S1 and a portable X-ray film was taken to locate the correct interspace. 5. Incision was done at previous wound and extended upward. 6. The paravertebral muscles were detached and retracted 7. The spinous processes and laminae of L3~S1 were bitten off with rongeurs and Kerrison punch until the posterior half of the spinal canal was widely opened. (The spinous process and the lamina of -- was removed as a whole piece by cutting through the base of the lamina with Kerrison punch on both sides.) The hypertrophic ligamenta flava including those at lateral recesses were excised. The epidural venous bleeding was stopped by gelfoam packing. 8. L3~4transverse process was exposed 9. Decortication 10.Put bone chips to L3~4 lateral pocket 11.Hemostasis 12.Close wound in layers after one hemovac drain insertion Operators 曾勝弘 Assistants 胡朝凱, 黃鼎鈞 朱駿忠 (M,1947/02/05,65y1m) 手術日期 2010/12/21 手術主治醫師 賴達明 手術區域 東址 001房 02號 診斷 Subdural hemorrhage (SDH) 器械術式 right cSDH burrhole drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 王永彬 ASA 2E 紀錄醫師 游健生, 時間資訊 20:00 開始NPO 00:53 通知急診手術 05:05 報到 05:15 進入手術室 05:20 麻醉開始 05:30 誘導結束 06:36 抗生素給藥 06:50 手術開始 07:25 手術結束 07:25 麻醉結束 07:30 送出病患 07:35 進入恢復室 09:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 慢性硬腦膜下血腫清除術 1 1 摘要__ 手術科部: 外科部 套用罐頭: Burrhole for chronic subdural hemorrhage 開立醫師: 游健生 開立時間: 2010/12/23 18:27 Pre-operative Diagnosis Right chronic subdural hemorrhage Post-operative Diagnosis Right chronic subdural hemorrhage Operative Method Burrhole for chronic subdural hemorrhage Specimen Count And Types nil Pathology Nil Operative Findings Dark-red thick fluid was drained from subdural space with initial gash out. 5cm rubber tube was inserted anterior into subdural space as drainage. Operative Procedures 1. Under ETGA, supine position 2. Shaving, disinfection, and draping 3. Transverse scalp incision at right parietal region 4. Dissection and burrhole creation 5. Cauterized dura then cruciate durotomy 6. Opened outer membrane and cauterized it 7. Drain subdural hematoma 8. Inserted rubber tube 9. Hemostasis 10.Closed wound in layers and expelled air Operators VS 賴達明 Assistants R6 胡朝凱 R3 游健生 Indication Of Emergent Operation 魏玉禎 (F,1957/12/07,54y3m) 手術日期 2010/12/21 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Herniation of intervertebral disc (HIVD) 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 游皓鈞, 時間資訊 07:40 報到 08:05 進入手術室 08:11 麻醉開始 08:15 誘導結束 09:00 抗生素給藥 09:30 手術開始 12:00 抗生素給藥 12:40 手術結束 12:40 麻醉結束 12:47 送出病患 12:50 進入恢復室 14:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-腰椎 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Right side L4/5 laminotomy for diskectomy and... 開立醫師: 陳睿生 開立時間: 2010/12/21 12:55 Pre-operative Diagnosis L4/5 ruptured disk with root compression Post-operative Diagnosis L4/5 ruptured disk with root compression Operative Method Right side L4/5 laminotomy for diskectomy and Coflex implantation at L4/5 level Specimen Count And Types nil Pathology Nil Operative Findings The ruptured disk with peripheral granulation formation was noted at right L4/5 level. Thicken ligamentum flavum with root compression was noted over L5 level, and then removed. An 8mm Coflex was implanted at L4/5 intraspinous space. Operative Procedures 1. ETGA, prone position, and C-arm localize L4/5 level 2. Low back midline incision via previous wound 3. Right side subperiosteum dissection to expose the L4/5 lamina 4. Lower L4 and upper L5 laminotomy and partially remove the L4/5 facet 5. Remove of granulation tissue and then find out the L4/5 disk space 6. Remove of ruptured disk 7. Expose the thecal sac at L5 level, and remove the thicken ligamentum flavum 8. Hemostasis, remove the L4/5 interspinous ligamentum 9. Insert an 8mm Coflex at the L4/5 interspinous space 10.Close the wound in layers Operators VS 賴達明 Assistants R6 陳睿生; R1 游皓鈞 廖亞女 (F,1951/03/04,61y0m) 手術日期 2010/12/21 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Lumbar Spondylosis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 游皓鈞, 時間資訊 13:06 進入手術室 13:08 麻醉開始 13:15 誘導結束 13:20 抗生素給藥 13:55 手術開始 16:20 抗生素給藥 17:06 手術結束 17:06 麻醉結束 17:15 送出病患 17:17 進入恢復室 18:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-腰椎 1 2 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 摘要__ 手術科部: 外科部 套用罐頭: Transfacet lateral interbody fusion and trans... 開立醫師: 陳睿生 開立時間: 2010/12/21 17:27 Pre-operative Diagnosis L3/4 sopndylolithesis , grade.I; with HIVD Post-operative Diagnosis L3/4 sopndylolithesis , grade.I; with HIVD Operative Method Transfacet lateral interbody fusion and transpedicular screw for fixation at L3/4 Specimen Count And Types nil Pathology Nil Operative Findings Thicken ligamentum flavum with severe thecal sac compression was noted at L3/4 level. Severe spur formation with grade.I lithesis was noted. Synnthes 6.2 x 40 mm screws were implanted at L3/4 level, and 6cm rods were fixed. A 10mm banana cage was inserted from right side facet joint space. Operative Procedures 1. ETGA, prone position, and C-arm localize the L3/4 level 2. Low back midline incision, and do bilateral periosteal dissection to expose the L3/4 spinous process, lamina 3. L3/4 transverse processes were identified, and transpedicle screws were inserted under C-arm guidence 4. Perform right L3/4 laminotomy and the right side facet joint was also removed 5. L3/4 diskectomy was done 6. Autologus bone grafts and 10mm banana cage was inserted for fusion 7. Set bilateral rods with right side compression 8. Hemostasis, set a 1/8 hemovac, and close the wound in layers Operators VS 賴達明 Assistants R6 陳睿生; R1 游皓鈞 劉昭惠 (F,1960/12/07,51y3m) 手術日期 2010/12/21 手術主治醫師 王國川 手術區域 西址 033房 01號 診斷 Carpal tunnel syndrome 器械術式 Decompression of mediun nerve 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 08:45 報到 09:25 進入手術室 09:35 麻醉開始 09:45 手術開始 10:15 手術結束 10:25 送出病患 摘要__ 手術科部: 外科部 套用罐頭: Carpal Tunnel Syndrome 開立醫師: 古恬音 開立時間: 2010/12/21 10:24 Pre-operative Diagnosis Carpal Tunnel Syndrome, left Post-operative Diagnosis Carpal Tunnel Syndrome, left Operative Method Decompression of median nerve Specimen Count And Types nil Pathology Nil Operative Findings The left median nerve was compressed tightly by the hypertrophic flexor retinaculum Operative Procedures 1.The hand and forearm were sterilized with povidone-iodine tincture, then covered with stockinet. 2.Anesthesia: loca with 10ml 1% Xylocaine solution 3.Incision: S shape from vertical palmar crease to transverse wrist crease. 4.The palmaris longus tendon was identified, then the plamar aponeurosis was cut longitidinally along the ulnar side of the palmaris longus tendon. 5.The median nerve was identified beneath the palmars longus tendon. Under direct vision, the transverse carpal ligament was divided until no more pressure on the median nerve could be palpated. 6.The skin was closed by interrupted suture with 4/0 nylon. Operators vs王國川 Assistants 古恬音 顏美彩 (F,1955/06/25,56y8m) 手術日期 2010/12/22 手術主治醫師 杜永光 手術區域 東址 005房 02號 診斷 Respiratory failure, with long-term ventilator use 器械術式 External ventricular drainage 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 陳蔚蔚, 時間資訊 23:51 臨時手術NPO 11:45 進入手術室 11:50 麻醉開始 11:55 誘導結束 12:30 抗生素給藥 12:32 手術開始 12:55 手術結束 12:55 麻醉結束 13:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室體外引流 1 1 摘要__ 手術科部: 外科部 套用罐頭: Extraventricular drainage revision 開立醫師: 陳睿生 開立時間: 2010/12/22 13:12 Pre-operative Diagnosis Left thalamic hemorrhage with IVH and hydrocephalus Post-operative Diagnosis Left thalamic hemorrhage with IVH and hydrocephalus Operative Method Extraventricular drainage revision Specimen Count And Types nil Pathology Nil Operative Findings The Metronic EVD was inserted via right Kocher^s point. The deepth was about 6.2cm. The CSF was xanthochromic pattern, and ICP was high. Operative Procedures 1. ETGA, supine position 2. Reopen the previous wound 3. Insert an EVD and the depth was 6.2cm 4. Fixation of the EVD and close the wound in layers Operators P 杜永光 Assistants R6 陳睿生; R1 陳蔚蔚 宋炎輝 (M,1951/06/21,60y8m) 手術日期 2010/12/22 手術主治醫師 杜永光 手術區域 東址 057房 02號 診斷 Aneurysm 器械術式 Tracheostomy 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 王永彬 ASA 4 紀錄醫師 黃世銘, 時間資訊 00:00 臨時手術NPO 10:14 報到 10:15 進入手術室 10:20 麻醉開始 10:25 誘導結束 10:32 手術開始 10:40 麻醉結束 10:40 手術結束 10:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 氣管切開術 1 0 摘要__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 高明蔚 開立時間: 2010/12/22 10:47 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types nil Pathology None Operative Findings Fr. 8 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tubE after checking bleeding. Operators 郭順文 Assistants R3高明蔚, R2黃世銘 莊貴龍 (M,1946/10/15,65y4m) 手術日期 2010/12/22 手術主治醫師 李伯皇 手術區域 東址 013房 01號 診斷 Liver cancer 器械術式 Lobectomy 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 葉育彰 ASA 3 紀錄醫師 張廷碩, 時間資訊 07:35 報到 08:05 進入手術室 08:10 麻醉開始 08:30 誘導結束 08:40 抗生素給藥 09:30 手術開始 09:54 11:40 抗生素給藥 13:45 手術結束 13:45 麻醉結束 13:50 送出病患 13:55 進入恢復室 16:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 肝區域切除術-三區域 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 直視下尿道切開術 1 1 手術 膽囊切除術 1 3 摘要__ 手術科部: 泌尿部 套用罐頭: optic urethrotomy 開立醫師: 張奕凱 開立時間: 2010/12/22 09:51 Pre-operative Diagnosis BPH post TUR-P Post-operative Diagnosis bladder neck contracture Operative Method Optic urethrotomy Specimen Count And Types nil Pathology nil Operative Findings 1.pin hole at prostate urethra, high bladder neck with fibrotic change Operative Procedures Under satisfactory anesthesia with the patient in a lithotomy position, prepping and draping were performed in the usual sterile method. A 23 Fr. urethroscope was inserted into the urethra with well lubrication. A small hole at the 12 o’clock position of the prostate urethra with massive fibrotic change was noted. Incision at the 12 o’clock position by a cold-knief was performed. A 2-way 20Fr. silicon Foley catheter wasplaced for stenting the urethra. Then he was sent to the recovery room with a stable condition. Operators 張宏江, Assistants 張奕凱, 張宇鳴, 相關圖片 記錄__ 手術科部: 泌尿部 套用罐頭: optic urethrotomy 開立醫師: 廖御佐 開立時間: 2010/12/22 13:56 Pre-operative Diagnosis LIVER TUMOR Post-operative Diagnosis LIVER TUMOR S/P LEFT LOBECTOMY Operative Method Lt lobectomy of the liver Specimen Count And Types 2 pieces About size:4X3 CM Source:GALLBLADDER About size:8X6 CM Source:LEFT LOBE OF LIVER Pathology PENDING Operative Findings 1. Cirrhosis ( + ) tumor number ( 1 ) tumor size ( 2 ) ×( 2 ) ×( 2 )cm 2. Location at segment ( 4 ) color ( BROWNISH ) 3. Satellite nodule ( nil ) rupture ( nil ) 4. Portal vein thrombosis ( nil ) Hepatic veinthrombosis ( nil ) 5. Resection segment ( 2,3,4 ) Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position and the whole abdominal skin was disinfected with painting of alcoholic povidon betaiodine. The operation field was then wrapped with surgical towel as usual. Right subcostal incision with cephalic extension was made with electronic tissue cauterizer. The upper operation field was then further pulled upper-wards and lateral-wards with Kent self-retractor. The ligamentum teres was ligated and divided for traction of the liver.After dividing the falciform ligament to the level of IVC, intraoperative ultrasonography was performed to locate the tumor and to detect any unsuspected new lesions in the liver. After this, the gall bladder was firstly removed to expose the hilar structure of the liver. The right hepatic artery and right portal vein was isolated firstly and was looped with different vascular tape for temporary vascular control during liver parenchymal resection. The right triangular ligament and coronary ligament were divided with electrocauterizer and then the right lobe of the liver could be freely pulled out from behind the costal cage and could be approached easily. By temporarily tightening of the vascular tapes, the planed resection line was marked on the liver surface between the ischemic zone and non-ischemic zone. The liver parenchyma was then divided gradually with CUSA. The exposed vascular structure and bile ducts were divided after ligation or clipping with vascular clip. When the resection was completed, detailed hemostasis of the raw surface was performed by electrocauterization and suture ligation of the bleeder. After this, the raw surface of the liver was covered with Surgicel and then the surgical wound was closed in three layers with two rubber drains left in the wound space. The muscular layer was closed with two layers of continuous suture with one ""O"" Vicryl. The subcutaneous layer was closed with two ""O"" chromic catgut and then the epidermis approximated with interrupted suture with three Nylon. Operators 李伯皇 Assistants CR廖御佐 R1張廷碩 相關圖片 盧振輝 (M,1968/01/25,44y1m) 手術日期 2010/12/22 手術主治醫師 郭順文 手術區域 東址 057房 03號 診斷 Cerebrovascular accident (CVA) 器械術式 Tracheostomy 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 王永彬 ASA 4 紀錄醫師 黃世銘, 時間資訊 00:00 臨時手術NPO 11:07 報到 11:07 進入手術室 11:08 麻醉開始 11:10 誘導結束 11:20 手術開始 11:30 麻醉結束 11:30 手術結束 11:35 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 氣管切開術 1 0 摘要__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 高明蔚 開立時間: 2010/12/22 11:35 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types nil Pathology None Operative Findings Fr. 8 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators 郭順文 Assistants R3高明蔚, R2黃世銘 鄭伊君 (F,1969/11/18,42y3m) 手術日期 2010/12/22 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Acoustic tumor 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 游健生, 時間資訊 08:05 進入手術室 08:11 麻醉開始 08:55 誘導結束 09:00 抗生素給藥 09:05 手術開始 11:55 開始輸血 12:00 抗生素給藥 15:00 抗生素給藥 17:35 手術結束 17:35 麻醉結束 17:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 11 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Right retrosigmoid approach for tumor excision 開立醫師: 游健生 開立時間: 2010/12/22 18:00 Pre-operative Diagnosis Right cerebellopontine tumor Post-operative Diagnosis Right vestibular neuroma Operative Method Right retrosigmoid approach for tumor excision Specimen Count And Types 1 piece About size: 2x1x1 cm Source:right CP angle tumor Pathology Pending Operative Findings An encapuslated yellow-pinkish tumor with elastic consistence originated from vestibular nerve. It was about 2 x 1.6 x 1.8cm and compressed the low cranial nerves inferiorly and CN V superiorly. It pushed CN VII foreward. It extended into internal acoustic cannal making the meatus widened. CN V, CN VII, and low cranial nerves were decompressed after tumor excision. The baseline BAEP was poorer on right side and some worsening of the wave form was seen during operation. Operative Procedures Under ETGA, patient in supine position with head fixed by Mayfield headclamp. It was rotated to left and neck extended to make mastoid process the highest point of operatiof field. After shaving, we disinfected and draped the operation field as usual. A S-shape incision 1cm behind right auricle along hairline was done. Soft tissue was dissected to expose asterion after a fascia was harvested for duraplasty. A 2x4cm craniotomy below transverse sinus was done with 2 burrholes(one at asterion). We sercued a 2mm sigmoid sinus perforation with Gelfoam packing followed by suture of the perforation. After K-shape durotomy, cerebellopontine CSF was drained and Mannitol was given for better surgical exposure. The tumor was seen after we gentlely retracted the cerebellum downward. We cut open the capsule of the tumor and removed it in pieces with ring curette and CUSA intra-capsulely. The superolateral part of internal acoustic meatus was drilled off to expose tumor inside the canal. The intra-canal part was then removed with CUSA. Finally, the capsule was carefully dissected and removed away from CN VII, cocholeal nerve, and vestibular nerve. Hemostasis was achieved with Surgicel and gelfoam packing. Dura was closed with a fascia sutured continuously by 4-0 prolene. The bone flap was put back with a Gelfoam covering on both side and fixed with mini-plates. Wound was closed in layers. Operators Prof. 杜永光 Assistants R6 胡朝凱 R3 游健生 蔡添財 (M,1956/04/05,55y11m) 手術日期 2010/12/22 手術主治醫師 王水深 手術區域 東址 018房 06號 診斷 Lymphoma 器械術式 Port-A catheter Removal/WOR 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 羅健洺, 時間資訊 20:30 報到 20:45 進入手術室 21:02 麻醉開始 21:05 麻醉結束 21:06 手術開始 21:15 手術結束 21:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 皮下肌肉或深部異物取出術 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: removal of Port-A/Permcath 開立醫師: 羅健洺 開立時間: 2010/12/22 21:31 Pre-operative Diagnosis r/o Port-A infection Post-operative Diagnosis ditto Operative Method removal of Port-A catheter Specimen Count And Types 1 piece About size:Port-A tip culture Source: Pathology nil Operative Findings the catheter was removed totally and the course was smooth Operative Procedures The patient was put on supine position. The operation field was disinfected and draped as usual. Under local anesthesia, the Port-A catheter was removed from previous wound smoothly. The wound was irrigated and closed in layers. Operators 王水深, Assistants 羅健洺, 劉智仁 (M,1988/08/16,23y6m) 手術日期 2010/12/22 手術主治醫師 曾漢民 手術區域 東址 005房 03號 診斷 Hydrocephalus 器械術式 V-P shunt 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳蔚蔚, 時間資訊 00:00 臨時手術NPO 12:55 報到 13:18 進入手術室 13:25 麻醉開始 13:40 誘導結束 14:00 抗生素給藥 14:30 手術開始 15:45 手術結束 15:45 麻醉結束 15:50 送出病患 15:55 進入恢復室 17:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 陳睿生 開立時間: 2010/12/22 16:06 Pre-operative Diagnosis Congenital hydrocephalus with shunt malfunction Post-operative Diagnosis Congenital hydrocephalus with shunt malfunction Operative Method V-P Shunt via right Kocher^ s point Specimen Count And Types 3 pieces About size:3ml Source:CSF About size:3ml Source:CSF About size:5ml Source:CSF Pathology Nil Operative Findings The ICP was about 10cm H2O, and CSF was clear. A Metronic medium shunt set was inserted via right Kocher^s point. The intraventricular catheter was about 6.2cm in length, and the intra-abdominal catheter was about 15cm in length. Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: supine with head tilted to right. 3.Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 5 cm curvilinear, right frontal, corresponded to the location of right frontal horn. 5.After the scalp flap had been lifted and reflected anteriorly, a burr hole was made and the dura was tented by 2 stitches. 6.The dura was opened by a nib incision. Rt lateral ventricle was tapped by a ventricular needle, then a 6.2 cm segment of the ventricular catheter was introduced into the ventricle. The outer end of the catheter was connected to a reservoir. 7. A 3cm incision was made at RUQ of the abdomen , then mini-laparotomy was performed to expose the peritoneal cavity. Subsequently, distal 15 cm segment of the peritoneal catheter (medium pressure) was introduced into the peritoneal cavity through the outer tube of the trochar. The proximal end of this catheter was passed through subcutaneous tunnel at forechest, neck, rt retroauricular area and connected the reservoir. The shunt system was checked to make sure its function was working. 8. The reservoir was fixed to pericranium by 3 stitches. 9. Scalp closure: hemostasis was done with monopolar coagulator touching on the sucker tip. Galea suture was performed by continuous suture with 3/0. Dexon and skin by continuous suture with 3/0 nylon. 10.Course of the surgery: smooth. Operators VS 曾勝弘 Assistants R6 陳睿生; R1 陳蔚蔚 朱以德 (M,1966/12/13,45y3m) 手術日期 2010/12/22 手術主治醫師 曾漢民 手術區域 東址 002房 05號 診斷 Pituitary tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 15:00 報到 15:10 進入手術室 15:15 麻醉開始 15:20 抗生素給藥 15:45 誘導結束 16:09 手術開始 17:05 麻醉結束 17:05 手術結束 17:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 經由蝶竇之腦下垂體瘤切除 1 1 手術 鼻中膈鼻道成形術-雙側 1 2 記錄__ 手術科部: 內科部 套用罐頭: Transsphenoidal adenomectomy. 開立醫師: 鍾文桂 開立時間: 2010/12/22 17:40 Pre-operative Diagnosis Pituitary microadenoma. Post-operative Diagnosis Pituitary microadenoma. Operative Method Transsphenoidal adenomectomy. Specimen Count And Types 1 piece About size:1cc Source:adenoma. Pathology Pending. Operative Findings Severe oozing from the nasal mucosa and the cavernous sinus. The oozing was sealed by gelfoam. Presence of CSF leakage. Whitish-pink fragile tumor was noted. The pituitary gland was noted after tumor excision. The sellar floor was paper-thin. Operative Procedures Under general anethesia and intubation, the patient was put in supine position. The facial skin was antiseptic with alcohol, and the mucosa of oral and nasal cavity with aqueous better-iodine.The face was covered with sterilized adhesive plastic sheets then draped. Under microscope, nasal septum was incised, and a nasal speculum was applied to displace the nasal mucosa laterally and keep the nasal cavity open constantly for the exposure of the vomer bone and the anterior wall of the sphenoid sinus. The anterior sphenoid wall, sphenoid sinus mucosa and sella floor were removed.The dura was coagulated then opened in cruciate fashion. The tumor was removed by curette and aligator. The calcified lesion was removed by alligator and dissector. The CSF leakage was sealed with Tissuecol Duo and gelform packing. The bone of anterior sphenoid wall was placed back and the nasal mucosa was returned to its normal position. The nasal mucosa was sealed with Tissuecol Duo.The middle terbinae and the nasal septum was placed back to its position. After placing two iodine-coating finger gloves, the patient was sent to ICU smoothly. Operators 曾漢民 Assistants 鍾文桂 蔡盛家 (M,1975/02/21,37y0m) 手術日期 2010/12/22 手術主治醫師 蔡瑞章 手術區域 東址 005房 01號 診斷 Herniation of intervertebral disc (HIVD) 器械術式 lumbar diskectomy 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳蔚蔚, 時間資訊 08:04 進入手術室 08:15 麻醉開始 08:20 誘導結束 09:10 抗生素給藥 09:26 手術開始 11:00 手術結束 11:00 麻醉結束 11:14 進入恢復室 11:15 送出病患 12:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 椎間盤切除術-腰椎 1 1 摘要__ 手術科部: 外科部 套用罐頭: Microdiskectomy over L4/5 開立醫師: 陳睿生 開立時間: 2010/12/22 11:15 Pre-operative Diagnosis L4/5 HIVD with roots compression Post-operative Diagnosis L4/5 HIVD with roots compression Operative Method Microdiskectomy over L4/5 Specimen Count And Types nil Pathology Nil Operative Findings Laminotomy was performed over left L4/5 level. Disk protrusion was noted and the root, thecal sac were tightly compressed. Calcified central disk was also noted and partially removed. Operative Procedures 1. ETGA, prone position and C-arm localize the L4/5 level 2. Expose the right side L4/5 lamina with periosteal dissection 3. Perform right side L4/5 laminotomy 4. Remove of ligamentum flavum, and expose the thecal sac and root 5. Split and protect the thecal sac 6. Do L4/5 diskectomy 7. Hemostasis, and close the wound in layers Operators P 蔡瑞章 Assistants R6 陳睿生, R1 陳蔚蔚 林軒宇 (M,2008/08/03,3y7m) 手術日期 2010/12/22 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Hydrocephalus 器械術式 Right Kocher"s Ommaya reservoir remove + EVD insertion 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 蕭柏妮 ASA 3 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 07:42 報到 08:05 進入手術室 08:15 麻醉開始 08:20 誘導結束 09:14 手術開始 09:50 手術結束 09:50 麻醉結束 10:00 送出病患 10:10 進入恢復室 11:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室體外引流 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: 1. Remove right Kocher"s Ommaya reservoir, 2.... 開立醫師: 李振豪 開立時間: 2010/12/22 10:16 Pre-operative Diagnosis Hydrocephalus, status post V-P shunt implantation, complicated with CNS infection, status post remove of V-P shunt and Ommaya reservoir implantation Hydrocephalus, status post V-P and CP shunt implantation, complicated with CNS infection, status post remove of V-P shunt and Ommaya reservoir implantation Hydrocephalus, status post V-P and CP shunt implantation, complicated with CNS infection, status post remove of V-P, CP shunts and Ommaya reservoir implantation Post-operative Diagnosis Hydrocephalus, status post V-P shunt implantation, complicated with CNS infection, status post remove of V-P shunt and Ommaya reservoir implantation Hydrocephalus, status post V-P and CP shunt implantation, complicated with CNS infection, status post remove of V-P and CP shunt and Ommaya reservoir implantation Operative Method 1. Remove right Kocher"s Ommaya reservoir, 2. External ventricular drainage via right Kocher"s point Specimen Count And Types CSF 6ml for routine, BCS, and bacterial culture; Ommaya tip culture x I Pathology Nil Operative Findings The CSF gushed out after scalp incision. The CSF was clear in character and sampled for routine, BCS, and bacterial culture. The EVD was inserted and the opening pressure is more than 20cmH2O. The CSF gushed out after scalp incision. The CSF was clear in character and sampled for routine, BCS, and bacterial culture. The EVD was inserted for 6 cm and the opening pressure is more than 20cmH2O. The Ommaya reservoir was removed and the tip was sent for culture, too. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine position with head rotated to left. The scalp was shaved, scrubbed, and disinfected as usual. The scalp incision was made along op scar and the scalp flap was elevated. The Ommaya reservoir was removed and the EVD was inserted with 6cm in depth. Externalization was done and the burr hole was packing with Gelform. Hemostasis was achieved and the wound was closed in layers with 3-0 Vicryl and 4-0 Nylon. Operators AP郭夢菲 Assistants R4李振豪, Ri范齡勻 相關圖片 蔡承諺 (M,2010/09/14,1y6m) 手術日期 2010/12/23 手術主治醫師 郭夢菲 手術區域 兒醫 069房 01號 診斷 Empyema 器械術式 Burr hole drainage, bilateral 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 4E 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 08:18 通知急診手術 11:25 進入手術室 11:30 麻醉開始 12:40 誘導結束 13:25 手術開始 14:40 手術結束 14:40 麻醉結束 14:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 慢性硬腦膜下血腫清除術 1 1 L 手術 慢性硬腦膜下血腫清除術 1 2 R 記錄__ 手術科部: 套用罐頭: Bilateral burr hole for external drainage of ... 開立醫師: 李振豪 開立時間: 2010/12/23 14:54 Pre-operative Diagnosis Bilateral subdural collection, suspect subdural hematoma or effusion Post-operative Diagnosis Bilateral subdural hygroma Operative Method Bilateral burr hole for external drainage of subdural collection Specimen Count And Types 1 piece About size:15ml Source:subdural collection Pathology Nil Operative Findings The subdural effusion was xanthochronic in color. Blood-tinged over right side was noted. The opening pressure was more than 15cmH2O. The anterior fontanelle became depressed after external drainage. The subdural effusion was xanthochronic in color. More blood-tinged over right side was noted. The opening pressure was more than 15cmH2O. The anterior fontanelle became depressed after external drainage. There were outer membrane formation. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine position. The scalp was shaved, scrubbed, and disinfected as usual. Two linear scalp incision was made at bilateral temporal area. Two burr holes were created followed by dural tenting. The dura was opened and the EVD tube was inserted into subdural space for external drainage. Hemostasis was checked and the burr holes were packing with Gelform. After externalization of the external drainage, the wound was closed in layers with 3-0 Vicryl and 4-0 Nylon. Under endotracheal tube general anesthesia, the patient was put in supine position. The scalp was shaved, scrubbed, and disinfected as usual. Two linear scalp incision was made at bilateral temporal area. Two burr holes were created followed by dural tenting. The dura and outer membrane were coagulated then opened and the EVD tube was inserted into subdural space for external drainage for 4 cm in length. Hemostasis was checked and the burr holes were packing with Gelform. After externalization of the external drainage, the wound was closed in layers with 3-0 Vicryl and 4-0 Nylon. Operators AP郭夢菲 Assistants R4李振豪 Indication Of Emergent Operation 相關圖片 劉昇展 (M,1974/01/06,38y2m) 手術日期 2010/12/23 手術主治醫師 黃國皓 手術區域 東址 007房 03號 診斷 Malignant neoplasm of sigmoid colon 器械術式 Double-J ureteral stent insert 手術類別 預定手術 手術部位 腹 傷口分類 清潔 麻醉方式 面罩麻醉 麻醉主治醫師 林珍榮 ASA 2 紀錄醫師 楊智凱, 時間資訊 15:35 報到 15:50 進入手術室 15:55 麻醉開始 16:00 誘導結束 16:16 手術開始 16:34 手術結束 16:34 麻醉結束 16:58 送出病患 17:00 進入恢復室 18:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 雙丁輸尿管導管置入術 1 0 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Semi-opened mask inhalation anes 1 0 記錄__ 手術科部: 腫瘤醫學部 套用罐頭: cystoscopy and left DBJ replacement 開立醫師: 楊智凱 開立時間: 2010/12/23 16:59 Pre-operative Diagnosis left obstructive uropathy Post-operative Diagnosis left obstructive uropathy Operative Method cystoscopy and left DBJ replacement Specimen Count And Types nil Pathology nil Operative Findings Fr.7-26cm DBJ was replaced Operative Procedures Under satisfactory anesthesia with the patient in lithotomy position, prepping and drapping was performed in the usual sterile fashion. A Fr 21 Olympus cystoscope was introduced into the bladder cavity under direct vision. Careful inspection was done and left DBJ was replaced. Patient tolerated the procedure very well and was sent to recovery room in satisfactory condition. Operators 黃國皓, Assistants 楊智凱, 翁文慶, 林秋吉 (M,1944/04/10,67y11m) 手術日期 2010/12/23 手術主治醫師 杜永光 手術區域 東址 005房 03號 診斷 Intracerebral hemorrhage 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 鍾文桂, 時間資訊 23:59 臨時手術NPO 16:10 報到 16:10 進入手術室 16:15 麻醉開始 16:30 誘導結束 17:00 抗生素給藥 17:57 手術開始 19:20 19:38 手術結束 20:00 麻醉結束 20:00 20:07 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 氣管切開術 1 0 R 手術 腦室腹腔分流手術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 記錄__ 手術科部: 外科部 套用罐頭: 1. Implantation of ventriculoperitoneal shunt... 開立醫師: 鍾文桂 開立時間: 2010/12/23 20:33 Pre-operative Diagnosis 1. Hydrocephalus. 2. Respiratory failure. Post-operative Diagnosis 1. Hydrocephalus. 2. Respiratory failure. Operative Method 1. Implantation of ventriculoperitoneal shunt, right Kocher. 2. Tracheostomy. Specimen Count And Types 1 piece About size:CSF Source:routine, culture, BCS. Pathology Nil. Operative Findings Medtronic medium pressure, ventricular catheter: 6.5 cm, peritoeanl catheter:30 cm. The previous ventriculotomy window was used for the shunt. We tried the same tract several times to achieve CSF drainage. CSF: pinkish, clear. Tracheostomy tube: 8.0 Fr. Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: supine with head rotated to right. 3.Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with a sterilized adhesive plastic sheet. 4. Incision: 6 cm curvilinear, right frontal, corresponded to the location of right frontal horn. Raney clips were applied to the scalp edge for temporary hemostasis. 5.After the scalp flap had been lifted and reflected anteriorly,right lateral ventricle was tapped by a ventricular needle, then a 6.5 cm segment of the ventricular catheter was introduced into the ventricle. The outer end of the catheter was connected to a Pudenz reservoir. 6.A minilaparotomy was made at RUQ of the abdomen, then a trocar was pushed into peritoneal cavity. Subsequently, distal 30 cm segment of the peritoneal catheter (medium pressure) was introduced into the peritoneal cavity through the outer tube of the trochar. The proximal end of this catheter was passed through subcutaneous tunnel at forechest, neck, left retroauricular area and connected the reservoir. The shunt system was checked to make sure its function was working. 7. The reservoir was fixed to pericranium by 3 stitches. 8. Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 9.After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2 cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. 10.Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tube is fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. 11.Course of the surgery: smooth. Operators Prof .杜永光 Assistants R5鍾文桂Ri徐卿晃 鄭伊君 (F,1969/11/18,42y3m) 手術日期 2010/12/23 手術主治醫師 杜永光 手術區域 東址 003房 03號 診斷 Acoustic tumor 器械術式 Craniotomy(Aneurysms) P-DUH 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3E 紀錄醫師 胡朝凱, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 16:15 通知急診手術 16:55 報到 16:55 進入手術室 17:05 麻醉開始 17:10 誘導結束 17:38 抗生素給藥 17:39 手術開始 19:50 開始輸血 20:38 抗生素給藥 21:10 麻醉結束 21:10 手術結束 21:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 顱骨切除術,包括異物移除或壓或經切斷 1 2 記錄__ 手術科部: 外科部 套用罐頭: posterior fossa craniectomy for decompression... 開立醫師: 胡朝凱 開立時間: 2010/12/23 21:27 Pre-operative Diagnosis cerebellar swelling with acute hydrocephalus Post-operative Diagnosis cerebellar swelling with acute hydrocephalus Operative Method posterior fossa craniectomy for decompression and left Frazier EVD insertion Specimen Count And Types culture tube x 3 Pathology Nil Operative Findings 1.Opening pressure around 18 cmH2O 2.Clear CSF 3.Brain was mild swelling but not buldging out after dural opening 4.Duroplasty was done with one piece of fascia Operative Procedures Under ETGA, patient was put in prone position with head fixed with Mayfield skull clamp. Extended wound from previous retroauricular area as a reverse U shape. Reflect skin then muscle flap downward. Further retraction for detachment of suboccipital muscle group. Remove previous bone graft. Dissect epidural space. Posterior fossa craniectomy was then done with upper edge at transverse sinus. V shape durotomy was done. And two pieces of fascia was harvest to perform duroplasty. After setting one CWV drain, wound was closed in layers. Operators P 杜永光 Assistants 陳睿生, 胡朝凱 Indication Of Emergent Operation 李昭鶯 (F,1928/02/15,84y0m) 手術日期 2010/12/23 手術主治醫師 楊士弘 手術區域 東址 005房 02號 診斷 Lumbar spondylosis 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 23:57 臨時手術NPO 11:18 報到 11:55 進入手術室 12:00 麻醉開始 12:05 誘導結束 12:40 抗生素給藥 12:56 手術開始 15:50 手術結束 15:50 麻醉結束 16:00 送出病患 16:05 進入恢復室 17:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-腰椎 1 1 手術 椎弓切除術(減壓)-二節以內 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 摘要__ 手術科部: 外科部 套用罐頭: Right L4 hemilaminectomy for right L4-5 diske... 開立醫師: 楊士弘 開立時間: 2010/12/23 15:56 Pre-operative Diagnosis L4-5 HIVD, L4-5 spondylolisthesis, with central canal and lateral recess stenosis Post-operative Diagnosis L4-5 HIVD, L4-5 spondylolisthesis, with central canal and lateral recess stenosis Operative Method Right L4 hemilaminectomy for right L4-5 diskectomy and central plus left L4 sublaminar decompression Specimen Count And Types 2 pieces About size:小 Source:L4-5 disc About size:小 Source:ligamentum flavum, r/o calcification Pathology pending Operative Findings The ligamentum flavum over L4-5 interspace was very thick and partially calficied. The laminar bone and facet joints were hypertrophic also. The L4-5 disc was bulging and fused with the PLL. The above pathology resulted in compression of the thecal sac and bilateral L5 roots, which were free of tension after decompression. Operative Procedures 1. ETGA, prone. 2. C-arm fluoroscopic localization of L4-5 interspace. 3. Low back midline incision, L4-5 4. Dissection and lateral retraction of right paravertebral muslces from spinous processes and lamina. 5. Right hemilaminectomy of lower 2/3 of L4 lamina with air drill, under microscopy. 6. Sublaminar decompression of bony central canal and left L4-5 lateral recess. 7. Removal of hypertrophic ligamentum flavum by Kerrison punches. 8. Removal of medial third of right L4-5 facet joints. 9. Medial retraction of right L5 root for diskectomy by knife and alligator forceps. 10. Hemostasis. 11. Insertion of one mini-HV drain. 12. Wound closure in layers. Operators 楊士弘 Assistants 鍾文桂 洪筱涵 (F,1992/06/08,19y9m) 手術日期 2010/12/23 手術主治醫師 王國川 手術區域 東址 000房 號 診斷 Fracture of vault of skull, closed with subarachnoid, subdural, and extradural hemorrhage, with loss of consciousness of unspecified duration 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 古恬音, 時間資訊 13:15 報到 13:48 進入手術室 13:54 麻醉開始 14:00 誘導結束 14:10 抗生素給藥 14:20 手術開始 15:44 手術結束 15:44 麻醉結束 15:50 送出病患 15:52 進入恢復室 17:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 頭顱成形術 1 1 R 手術 顱骨重塑模組 1 0 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Cranioplasty 開立醫師: 曾峰毅 開立時間: 2010/12/23 15:36 Pre-operative Diagnosis Skull defect Post-operative Diagnosis Skull defect Operative Method Cranioplasty with artificial bone graft Specimen Count And Types Nil Pathology Nil Operative Findings Bone graft was fixed back with plates and screws. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to left, and right shoulder elevated. After scalp shaved, scrubbed, disinfected, and then draped, we made one skin incision along prevsious operation wound. We reflected scalp flap. We fixed artificial bone graft with plates and screws, and central tenting. Wound was irrigated with gentamycin and saline. Bone cement was used for reconstruction of right temporalis muscle, and filling of the bone edge. After two subgaleal CWV inserted, we closed the wound in layers. Operators VS 王國川 Assistants R4 曾峰毅 R3 古恬音 林月霞 (F,1949/10/20,62y4m) 手術日期 2010/12/23 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Cerebrovascular accident (CVA) 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 古恬音, 時間資訊 07:40 報到 08:06 進入手術室 08:10 麻醉開始 08:40 誘導結束 08:55 手術開始 11:22 開始輸血 11:23 抗生素給藥 13:25 麻醉結束 13:25 手術結束 13:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Right pterional approach for tumor excision 開立醫師: 古恬音 開立時間: 2010/12/23 13:53 Pre-operative Diagnosis Pituitary macroadenoma, s/p transsphenoidal adenomectomy, with parasellar extension Post-operative Diagnosis Pituitary macroadenoma, s/p transsphenoidal adenomectomy, with parasellar extension Operative Method Right pterional approach for tumor excision Specimen Count And Types 1 piece About size:2GM Source:pieces of tumor Pathology Pending Operative Findings There was one large tumor at right fronro-temporal area with mass effect on the brain. The tumor was extension of pituitary macroadenoma through the cavernous sinus, and the size was about 7cm. The tumor was well-encapsulated, gray-reddish, soft, fragile, and very hypervascular. There was much liquified old blood clot within the tumor, about 100mL. The tumor capsule was left in place. The right MCA, ICA, and optic nerve were identified during the procedure and well preserved. Operative Procedures 1. ETGA, supine position with head turned to left and fixed with Mayfield skull clamp 2. The scalp was shaved, scrubbed, and disinfected with better iodine 3. Draping was done in usual sterile fashion 4. One curvillinear scalp incision was made at right fronto-temporal region 5. 8*10 cm craniotomy was made after drilling of 3 burr holes 6. Durotomy was made in U-shaped fashion afte peripheral tenting 7. The Sylvian fissure was opened with careful dissection until exposure of the tumor. 8. The tumor capsuled was opened, and liquified blood clot drained out 9. The tumor was removed with ring curette and suction 10. Hemostasis was done with Floseal, Gelfoam packing, and Surgicel lining 11. Dura was repaired with prolene continuous suture, and the skull plate was fixed back with miniplates 12. After settin one subgeleal CWV drain, the wound was closed in layers Operators VS王國川 Assistants R3古恬音 孫良發 (M,1935/11/30,76y3m) 手術日期 2010/12/23 手術主治醫師 蔡翊新 手術區域 東址 005房 01號 診斷 Brain contusion 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 鍾文桂, 時間資訊 23:56 臨時手術NPO 08:35 報到 08:35 進入手術室 08:40 麻醉開始 08:45 誘導結束 09:20 抗生素給藥 09:38 手術開始 11:00 11:30 麻醉結束 11:30 11:30 手術結束 11:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 L 手術 氣管切開術 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 蔡翊新 開立時間: 2010/12/23 10:39 Pre-operative Diagnosis Head injury s/p craniectomy; Hydrocephalus; respiratory failure. Post-operative Diagnosis Head injury s/p craniectomy; Hydrocephalus; Respiratory failure. Operative Method Left Kocher ventriculoperitoneal shunt; Tracheostomy. Specimen Count And Types 3 tubes of CSF, sent for routine, BCS and culture. Pathology Nil Operative Findings CSF: clear; pressure: 8 cmH2O. Ventricular catheter: 6.5 cm in depth; Peritoneal catheter: 25 cm; Valve: medium-pressure. Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: supine with head rotated to right. 3.Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with a sterilized adhesive plastic sheet. 4. Incision: 6 cm curvilinear, left frontal, corresponded to the location of left frontal horn. Raney clips were applied to the scalp edge for temporary hemostasis. 5.After the scalp flap had been lifted and reflected anteriorly, a burr hole was made at left Kocher point and the dura was tented by 2 stitches. 6.The dura was opened by a nib incision. Left lateral ventricle was tapped by a ventricular needle, then a 6.5 cm segment of the ventricular catheter was introduced into the ventricle. The outer end of the catheter was connected to a Pudenz reservoir. 7.A minilaparotomy was made at LUQ of the abdomen, then a trocar was pushed into peritoneal cavity. Subsequently, distal 25 cm segment of the peritoneal catheter (medium pressure) was introduced into the peritoneal cavity through the outer tube of the trochar. The proximal end of this catheter was passed through subcutaneous tunnel at forechest, neck, left retroauricular area and connected the reservoir. The shunt system was checked to make sure its function was working. 8. The reservoir was fixed to pericranium by 3 stitches. 9. Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 10.After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2 cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. 11.Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tube is fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. 12.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5鍾文桂Ri徐卿晃 孫良發 (M,1935/11/30,76y3m) 手術日期 2010/12/23 手術主治醫師 蔡翊新 手術區域 東址 003房 04號 診斷 Brain contusion 器械術式 Cranioplasty, right 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3E 紀錄醫師 黃鼎鈞, 時間資訊 17:30 開始NPO 17:30 臨時手術NPO 20:30 通知急診手術 21:50 進入手術室 21:50 報到 21:55 麻醉開始 22:00 誘導結束 22:46 手術開始 00:55 開始輸血 01:35 麻醉結束 01:35 手術結束 01:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 急性硬腦膜下血腫清除術 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 摘要__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 蔡翊新 開立時間: 2010/12/24 01:25 Pre-operative Diagnosis Right frontotemporoparietal subdural effusion and skull defect. Post-operative Diagnosis Right frontotemporoparietal subacute subdural hematoma, epidural hematoma and skull defect. Operative Method Craniotomy for subdural hematoma evacuation and cranioplasty with autologous bone graft. Specimen Count And Types nil Pathology Nil. Operative Findings Skull defect, 13 x 11 cm, at right frontotemporoparietal region. Dark reddish blood and blood clots were noted at subdural space and epidural space, mixed with previously placed Duroform. There was a cortical artery with active bleeding at right temporal lobe. Multiple dural defects were repaired with Prolene, but there was still a 4 x 4 cm dural defect, which was repaired with Duroform. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with a sterilized adhesive plastic sheet. 4. Incision: right frontotemporoparietal area along previous wound, the skin edge was clipped by Raney clips for temporary hemostasis. 5. The skin flap was reflected toward the zygoma and the epidural and subdural hematoma were evacuated. 6. Hemosatasis: the bleeders was stopped by Bovie and oozing surface was covered with gelfoam. 7. Dural closure: most dural defects were repaired with continuous suture of 4/0 Prolene. The residural dural defect was repaired with a piece of 5 x 5 cm Duroform. 8. The skull plate stored at bone bank was soaked with Vancomycin solution, then placed back to the craniectomy window and fixed with 3 miniplates and 6 screws. Five Central tentings were placed. Large amount of normal saline and Vancomycin solution were used for wound irrigation. 9. Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by interrupted suture with 3/0 nylon. 10.Drain: two epidural CWV drains. 11.Blood transfusion: PRBC 3U, Blood loss: 500 ml. 12.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5陳德福R1黃鼎鈞 Indication Of Emergent Operation 鍾金佑 (M,1951/08/08,60y7m) 手術日期 2010/12/24 手術主治醫師 賴達明 手術區域 東址 003房 03號 診斷 Cerebrovascular accident (CVA) 器械術式 Craniotomy(Aneurysms) P-DUH 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 3E 紀錄醫師 洪誌鍵, 時間資訊 16:55 通知急診手術 19:00 報到 19:00 進入手術室 19:10 麻醉開始 19:15 誘導結束 19:40 手術開始 19:40 抗生素給藥 22:40 抗生素給藥 01:40 抗生素給藥 02:40 開始輸血 04:40 抗生素給藥 05:20 麻醉結束 05:20 手術結束 05:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 12 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 開顱術摘除血管病變 - 腦血管瘤 有病徵的 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Pterion approach for aneurysm clipping 開立醫師: 陳睿生 開立時間: 2010/12/25 06:10 Pre-operative Diagnosis Right side P-com aneurysm, ruptured with SAH Post-operative Diagnosis Right side P-com aneurysm, ruptured with SAH Operative Method Pterion approach for aneurysm clipping Specimen Count And Types Nil Pathology nil Operative Findings An about 2cm in diameter aneurysm was noted at distal ICA. The neck was about 1.5cm in diameter.It protruded inferiolaterally, and was supposed to origin from P-com. Multiple daughter aneurysms were noted above the aneurysm, and it was adhered wtih the temporal lobe tightly at the medial upper portion of the aneurysm sac. Flow jet was noted inside the sac. One Sugita angle clip and two fenestrated clips were applied, and we fenestrated the sac after clipping. The P-com, and the CN III were noted and well preserved after the surgery. Operative Procedures 1. ETGA, the patient was under supine position and head was fixed with Mayfield clump 2. Right frontotemporal scalp curvillinear incision 3. Facial nerve preservation and dissect the temporalis muscle 4. Create three burr holes and an about 8x10cm craniotomy window was created 5. The sphenoid ridge was flattern and the superior orbital fissure was identified. The anterior clinoid process was removed. 6. Open the dura and the sylvian fissure was dissected to exposure 7. The optic nerve, and ICA were identified, and the aneurysm was found out while tracting the ICA 8. Partial remove of the temporal tip and hematoma to expose the proximal and distal neck of the aneurysm 9. Clips were applied 10.Hemostasis, fix back the skull and set a CWV drain 11.Close the wound in layers Operators VS 賴達明 Assistants R6 陳睿生, R1 洪誌鍵 Indication Of Emergent Operation 張偉明 (M,1948/06/11,63y9m) 手術日期 2010/12/24 手術主治醫師 王國川 手術區域 東址 002房 04號 診斷 Head injury, unspecified 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 3E 紀錄醫師 胡朝凱, 時間資訊 00:17 臨時手術NPO 00:17 開始NPO 17:17 通知急診手術 18:40 報到 18:42 進入手術室 18:55 麻醉開始 19:30 誘導結束 20:00 抗生素給藥 20:15 手術開始 21:00 抗生素給藥 21:25 麻醉結束 21:25 手術結束 21:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 B 手術 慢性硬腦膜下血腫清除術 1 2 B 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 記錄__ 手術科部: 創傷醫學部 套用罐頭: Bilateral burr hole drainage 開立醫師: 胡朝凱 開立時間: 2010/12/24 21:41 Pre-operative Diagnosis Bilateral chronic subdural effusion Post-operative Diagnosis Bilateral chronic subdural effusion Operative Method Bilateral burr hole drainage Specimen Count And Types Nil Pathology nil Operative Findings 1.Bilateral tea color like clear fluid was drained out without motor oil like material was noted. 2.After drainage, brain was still slack Operative Procedures 1.ETGA, supine 2.Bilateral transverse skin incision at parietal area 3.Cruciate form periosteum opening 4.Burr hole drill 5.Open dura 6.Insert EVD catheter as a subdural drain 7.water irrigation 8.Fix drain 9.close wound in layers 10.De-air Operators 王國川 Assistants 胡朝凱 Indication Of Emergent Operation 蔡崇凱 (M,1932/11/12,79y4m) 手術日期 2010/12/24 手術主治醫師 杜永光 手術區域 東址 002房 01號 診斷 Subdural hemorrhage 器械術式 Subtemporal decompression -uni 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3E 紀錄醫師 陳德福, 時間資訊 20:00 開始NPO 03:25 通知急診手術 05:35 進入手術室 05:40 麻醉開始 06:00 誘導結束 06:45 抗生素給藥 07:05 手術開始 08:00 手術結束 08:00 麻醉結束 08:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 慢性硬腦膜下血腫清除術 1 1 摘要__ 手術科部: 外科部 套用罐頭: burr hole drainage 開立醫師: 陳德福 開立時間: 2010/12/24 08:21 Pre-operative Diagnosis left CSDH with mass effect Post-operative Diagnosis left CSDH with mass effect Operative Method burr hole drainage Specimen Count And Types nil Pathology nil Operative Findings 1.There is 2.5cm in thickness CSDH over the left fronta-temporal-parietal area with mass effect. Transtentorial and subfalcal herniation were noted. The CSDH[80-100ml] gushed out after the opening of the outer membrane. 2.Inner membrane:+, the brain reexpanded partially after the normal saline irrigation and elevation of the pCO2. Operative Procedures Under ETGA and supine position, the scalp was disinfected and draped as usual. One linear incision at the left scalp was done and one burr hole was created. The dura was opened and the outer membrane was opened thereafter. The motor oil like fluid gushed out and the subdural space was irrigated with normal saline. One subdural rubber drain was left in situ and the wound was closed in layers. Operators P 杜永光 Assistants r5 陳德福 Indication Of Emergent Operation 田佳蓉 (F,1998/01/31,14y1m) 手術日期 2010/12/24 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Arteriovenous malformation, brain 器械術式 Craniotomy (A.V.M.) P-DUH 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 游健生, 時間資訊 07:35 報到 08:07 進入手術室 08:15 麻醉開始 08:50 誘導結束 08:50 抗生素給藥 08:54 手術開始 11:58 抗生素給藥 15:05 開始輸血 15:20 麻醉結束 15:20 手術結束 15:35 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 手術 開顱術摘除血管病變-- 動靜脈畸型小型深部 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Right parietal craniotomy interhemispheric tr... 開立醫師: 游健生 開立時間: 2010/12/24 16:21 Pre-operative Diagnosis Intraventricular arteriovenous malformation, right lateral ventricle Post-operative Diagnosis Intraventricular arteriovenous malformation, right lateral ventricle Operative Method Right parietal craniotomy interhemispheric transcallosal approach for arteriovenous malformation excision Specimen Count And Types 1 piece About size: 1x1 cm Source:arteriovenous malformation Pathology Pending Operative Findings We accessed the lesion via transcallosal approach. An about 1.5cm callostomy was done at the splenium portion of the corpus callosum. The well vascularized lesion was noted in front of the trigone of the right lateral ventricle. The nidus was about 1.5cm in diameter, and engorged feeding artery, drainage vein were noted to drain to the lateral upper portion of the ventricle. The lesion was noted to attach to the medial wall of the ventricle. After totally removal of the lesion, an Medtronic EVD was inserted from the callostomy, and post-OP ICP was about 0-5 cmH2O. Operative Procedures Under ETGA, patient was in prone position and head fixed with Mayfield headclamp. Head was rotated to right making right parietal region the highest point. After shaving, we disinfected and draped the operation as usual. A U-shape scalp incision 1cm crossing midline was made at right parietal region. The skin flap and pericranium flap were elevated separately. A 6 x 5 cm craniotomy was done followed by dura tenting. A U-shape durotomy with superior sagittal sinus as base. We gently retracted right cerebrum downward and falx upward. The splenium of corpus callosum was seen after dissection. We entered the right lateral ventricle via a 1.5cm callostomy. Choroid plexus was coagulated as we explored posteriorly. The vascular lesion was seen attached at the medial wall of ventricle. The engorged feeding artery and draining vien were seen an coagulated. The nidus was removed in pieces with bipolar. After complete lesion removal, hemostasis was achieved with Surgicel packing. A Medtronic EVD was inserted in right lateral ventricle via callostomy. Dura was closed with 4-0 prolene continuous suture. Bone flap was fixed back with mini-plates. A subgaleal CWV was placed. Wound was closed in layers. Operators Prof. 杜永光 Assistants R6陳睿生 R3游健生 何進富 (M,1957/02/26,55y0m) 手術日期 2010/12/24 手術主治醫師 曾漢民 手術區域 東址 003房 02號 診斷 Hydrocephalus 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 游健生, 時間資訊 15:52 進入手術室 16:00 麻醉開始 16:20 誘導結束 16:50 抗生素給藥 17:10 報到 17:16 手術開始 18:20 手術結束 18:20 麻醉結束 18:25 送出病患 18:30 進入恢復室 20:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 腦室腹腔分流手術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Ventriculo-peritoneal shunt insertion via rig... 開立醫師: 游健生 開立時間: 2010/12/24 18:49 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculo-peritoneal shunt insertion via right Kocher"s point Specimen Count And Types 2 pieces About size:10cc Source:CSF About size:6cm Source:ventricular catheter Pathology Nil Operative Findings Very low opening pressure. Clear CSF was drained out for cytology, biochemistry, routine, and culture. 6.5cm ventricle catheter was used. Codman programmable valve set at 80mmH2O. Operative Procedures 1. Under ETGA, supine position head rotated to left 2. Shaving, disinfection, and draping 3. Scalp incision over previous wound 4. Dissected to expose previous VP shunt reservoir and removed shunt 5. A transverse abdominal RUQ incision was made 6. Dissected in layers and opened peritoneum 7. Inserted peritoneal catheter and passed it upward via subcutaneous tunnel 8. Inserted ventricle catheter via previous burrhole 9. Assembled them to Codman programmable reservoir 10.Closed wounds in layers Operators VS 曾漢民 Assistants R6 陳睿生 R3 游健生 游高干 (F,1926/08/30,85y6m) 手術日期 2010/12/24 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 陳蔚蔚, 時間資訊 07:30 報到 08:08 進入手術室 08:15 麻醉開始 08:40 誘導結束 09:00 抗生素給藥 09:25 手術開始 11:10 開始輸血 12:00 抗生素給藥 12:15 麻醉結束 12:15 手術結束 12:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Left crainiotomy for Simpson grade two tumor... 開立醫師: 胡朝凱 開立時間: 2010/12/24 12:34 Pre-operative Diagnosis Left sphenoid ridge meningioma Post-operative Diagnosis Left sphenoid ridge middle third meningioma Operative Method Left crainiotomy for Simpson grade two tumor excision Specimen Count And Types pieces of tumor Pathology pending Operative Findings 1.One about 6 cm yellowish, elastic tumor located at left frontal base with the feeding artery from ethmoid and meddle meningeal artery. 2.The attachment was noted at left sphenoid ridge middle third area. 3.The interface between tumor and brain was clear. 4.Some vessels were pushed away by tumor without encasement and were all preserved. Operative Procedures Under ETGA, patient was put in supine position with head mild rotate to right. Bicoronal skin incision was done. Skin flap was dissected and opened. After four burr holes drilled that cross midline, craniotomy was performed as a 7x7 bone window, followed by dural tenting. U shape dural incision was made with the base left at midline. Devascularization was performed along the tumor base. The tumor was excised by gently dissection through the interface between tumor and brain tissue. Vascular perforation was cauterized. Hemostasis was then performed. After then, dura was closed with prolene. After one CWV drain insertion, wound was closed in layers. Operators 曾漢民 Assistants 胡朝凱, 陳蔚蔚 黃怡寧 (F,1960/10/24,51y4m) 手術日期 2010/12/24 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Astrocytoma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 胡朝凱, 時間資訊 12:25 報到 12:35 進入手術室 12:50 麻醉開始 13:10 誘導結束 13:30 抗生素給藥 13:45 手術開始 17:00 抗生素給藥 17:25 麻醉結束 17:25 手術結束 17:35 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除-手術時間在4小時以內 1 1 記錄__ 手術科部: 外科部 套用罐頭: Right craniotomy for total tumor excision 開立醫師: 胡朝凱 開立時間: 2010/12/24 17:45 Pre-operative Diagnosis Right frontal tumor Post-operative Diagnosis Right frontal anaplastic astrocytoma Operative Method Right craniotomy for total tumor excision Specimen Count And Types pieces of tumor Pathology Frozen: anaplastic astrocytoma Operative Findings 1.Whitish to grayish, elastic tumor located at right frontal lobe and extended into right lateral ventricle. 2.Some part of tumor has a clear border with brain parenchyma, some part not. 3.One cortical vein was sacrificed. 4.ACAs were identified and well preserved. Operative Procedures Under ETGA, patient was put in supine position with head mild rotate to left. Bicoronal skin incision was done. Skin flap was dissected and opened. After three burr holes drilled that cross midline, craniotomy was performed as a 7x7 bone window, followed by dural tenting. U shape dural incision was made with the base left at frontal area. Corticotomy was performed after echo localization. The tumor was excised by gently dissection through the interface between tumor and brain tissue. Vascular perforation was cauterized. Hemostasis was then performed. After then, dura was closed with prolene. After one CWV drain insertion, wound was closed in layers. Operators 曾漢民 Assistants 胡朝凱, 陳蔚蔚 蔡阿森 (M,1950/11/13,61y4m) 手術日期 2010/12/24 手術主治醫師 賴達明 手術區域 東址 001房 03號 診斷 Multiple myeloma 器械術式 Malignant intraspinal tumor, e 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 2E 紀錄醫師 陳德福, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 12:10 報到 12:43 進入手術室 12:50 麻醉開始 13:15 誘導結束 13:30 抗生素給藥 14:15 手術開始 16:30 抗生素給藥 17:10 手術結束 17:10 麻醉結束 17:20 送出病患 17:21 進入恢復室 19:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 惡性脊髓腫瘤切除術 1 1 手術 脊椎融合術-後融合,有固定物(<=六節) 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: 1.T7 transpedicle corpectomy 2.T5-9 fixation ... 開立醫師: 陳德福 開立時間: 2010/12/24 17:16 Pre-operative Diagnosis T7 extradural tumor with cord compression, suspect multiple myeloma Post-operative Diagnosis T7 extradural tumor with cord compression, suspect multiple myeloma Operative Method 1.T7 transpedicle corpectomy 2.T5-9 fixation with TPS 1.T7 transpedicle corpectomy 2.T6-9 fixation with TPS Specimen Count And Types 1 piece About size:1*1*1CM Source:T7 tumor Pathology pending; intra-OP frozen section: small blue round cell, nature ? Operative Findings 1.There is a extradural tumor with spinal cord compression at the T7 level. The tumor is verterbral body centered with extension to the lamina from the transpedicle route. 2.The tumor is reddish, soft, and gelly like. 3.After tumor removal, small piece of bone cemen was impacted into the vertebral body and the T6-9 fixation with done with TPS and one cross link. Operative Procedures Under ETGA and prone position, the scalp was disinfected and draped as usual. One linear incision was done from T5-9 level and the TPS of T6/8/9 was done under C-arm fluroscope guided. The tumor excision was performed smoothly with tumor forceps and currettage. The vertebral body was fill up with bone cemen and the TPS was connected with rods and cross link. One hemovac was left in situ and the wound was closed in layers. Operators VS賴達明 Assistants R5 陳德福 Indication Of Emergent Operation 陳碧來 (M,1931/02/16,81y0m) 手術日期 2010/12/24 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Lumbar spondylosis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 黃鼎鈞, 時間資訊 08:10 進入手術室 08:15 麻醉開始 08:40 抗生素給藥 08:40 誘導結束 09:20 手術開始 11:40 抗生素給藥 12:00 手術結束 12:00 麻醉結束 12:13 送出病患 12:15 進入恢復室 13:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 脊椎融合術-前融合,有固定物)≦四節 1 1 手術 椎間盤切除術-腰椎 1 3 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: L4 partial lamienctomy, upper; L4/5 diskectom... 開立醫師: 曾峰毅 開立時間: 2010/12/24 12:17 Pre-operative Diagnosis Spondylolisthesis, L4/5, grade II Post-operative Diagnosis Spondylolisthesis, L4/5, grade II Operative Method L4 partial lamienctomy, upper; L4/5 diskectomy; L4/5 posterior fusion with PEEK cages and autologous bone graft, posterior fixation with transpedicular screws Specimen Count And Types Nil Pathology Nil Operative Findings Sytheses transpedicular screws, 4.5x62 mm, x4, were inserted into bilateral pedicles of L4 and L5. Two 11mm high PEEK bone cages were inserted into L4/5 intervertebral disc. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After C-arm localization, we scrubbed, disinfected, and then draped, the back. We made midline skin incision from L4 to L5, and dissected bilateral paraspinal muscles away from bilateral laminae. Transpedicular screws were inserted at bilateral pedicles of L4 and L5. Lower partial laminectomy was done at L4 for decompression, and L4/5 diskectomy was peformed and fused with bilateral PLIF PEEK cages and autologous bone graft. The wound was closed in layers after gentamycin-saline irrigation and one hemovac inserted. Operators VS 賴達明 Assistants R4 曾峰毅 R1 黃鼎鈞 許淑華 (F,1976/03/10,36y0m) 手術日期 2010/12/24 手術主治醫師 賴達明 手術區域 東址 019房 02號 診斷 Spine tumor 器械術式 Intraspinal intramedullary tum 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 2 紀錄醫師 黃鼎鈞, 時間資訊 11:50 報到 12:30 進入手術室 12:38 麻醉開始 12:50 誘導結束 13:10 抗生素給藥 13:35 手術開始 15:35 手術結束 15:35 麻醉結束 15:40 送出病患 15:43 進入恢復室 17:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 良性脊髓腫瘤切除術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 摘要__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 曾峰毅 開立時間: 2010/12/24 15:24 Pre-operative Diagnosis Left L3 schwannoma, extraformainal Post-operative Diagnosis Left L3 schwannoma, extraformainal Operative Method Tumor excision Specimen Count And Types Several fragments of one tumor was sent for pathology. Pathology Nil Operative Findings Well capsulated, elastic, greyish, tumor was noted with cystic component containing xanthocrhomic fluid involving left L3 root. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position. After back scrubbed, disinfected, and then draped, we made one longitudinal skin incison at left flank area, about 8.5cm away from the midline. We dissected paraspinal muscle and identified left transverse process of L4 and L5. Tumor excision was done in piecemeal fashion, and the wound was closed in layers after hemostasis. Operators VS 賴達明 Assistants R4 曾峰毅 R1 黃鼎鈞 楊雨潤 (M,2007/11/07,4y4m) 手術日期 2010/12/24 手術主治醫師 楊士弘 手術區域 兒醫 067房 04號 診斷 Contusion, chest 器械術式 Spinal fusion posterior 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 蕭柏妮 ASA 3E 紀錄醫師 李振豪, 時間資訊 12:00 臨時手術NPO 12:00 開始NPO 14:11 通知急診手術 18:20 進入手術室 18:25 麻醉開始 18:35 誘導結束 19:25 手術開始 21:00 抗生素給藥 21:45 麻醉結束 21:45 手術結束 21:53 送出病患 21:55 進入恢復室 23:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 深部傷口處理縫合擴創-大 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 摘要__ 手術科部: 外科部 套用罐頭: Adjustment of T4 transpedicular screws 開立醫師: 李振豪 開立時間: 2010/12/24 22:05 Pre-operative Diagnosis Malposition of T4 transpedicular screws Post-operative Diagnosis Malposition of T4 transpedicular screws Operative Method Adjustment of T4 transpedicular screws Specimen Count And Types nil Pathology Nil Operative Findings Inadequate depth of bilateral T4 transpedicular screws were noted by C-arm portable X-ray. The T4 transpedicular screws were shifted to 3.5mm x 22mm. The rods were changed to 4cm in length. No CSF leakage was noted during whole procedure. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in prone position with head fixed with Mayfield skull clamp. The skin was scrubbed, disinfected, and draped as usual. The stitches were removed and the wound was opened. The transpedicular screws were identified. The nods, rods, and T4 transpedicular screws were removed. High speed air-drived drill was used to create small corticotomy. Under C-arm portable X-ray guided, 1mm K-pine was used as the guidance of the transpedicular screws. After confirm the location of the K-pine, 3mm in diameter, 22mm in length cannulated screws were inserted for tapping. The cannulated screws and K-pine were removed and the 3.5mm in diameter, 22mm in length lateral mass screws were used as transpedicular screws. Hemostasis were achieved. The rods and nods were fixed back. One CWV drain was placed. The wound was then closed in layers with 2-0, 3-0 Vicryl, and 4-0 Nylon. Operators VS楊士弘 Assistants R4李振豪 Indication Of Emergent Operation 陳瑞吉 (M,1956/09/10,55y6m) 手術日期 2010/12/25 手術主治醫師 王國川 手術區域 東址 002房 05號 診斷 Malignant neoplasm of sigmoid colon 器械術式 Ommaya reservoir implantation 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 3E 紀錄醫師 游健生, 時間資訊 05:24 開始NPO 05:24 臨時手術NPO 19:24 通知急診手術 23:37 進入手術室 23:50 麻醉開始 23:55 誘導結束 00:10 抗生素給藥 00:48 手術開始 02:00 手術結束 02:00 麻醉結束 02:10 進入恢復室 03:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 歐氏貯囊置放手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 腫瘤醫學部 套用罐頭: Ommaya implantation via right Kocher"s point 開立醫師: 游健生 開立時間: 2010/12/25 02:17 Pre-operative Diagnosis Cancerous meningitis with increased intracranial pressure Post-operative Diagnosis Cancerous meningitis with increased intracranial pressure Operative Method Ommaya implantation via right Kocher"s point Specimen Count And Types 1 piece About size:10cc Source:CSF Pathology Nil Operative Findings Clear CSF gashed out after puncture. 10CC CSF was sent for routine, culture, biochem, and cytology study. Opening pressure was above 20cmH2O. The ventricle catheter was 6.5cm. Operative Procedures 1. Under ETGA, supine position 2. Shaving, disinfection, and draping 3. A curve scalp incision on right Kocher"s region 4. Elevated skin flap and created a burrhole 5. Dura tenting then cauterized dura 6. cruciate durotomy followed by ventriculostomy 7. Inserted Ommaya with ventricle catheter 8. Fixed Ommaya then closed wound in layers Operators VS王國川 Assistants R6胡朝凱 R3游健生 Indication Of Emergent Operation 林睦修 (M,1965/04/23,46y10m) 手術日期 2010/12/25 手術主治醫師 陳晉興 手術區域 東址 018房 02號 診斷 Lung cancer 器械術式 Thoracoscopy+Open Chest 手術類別 緊急手術 手術部位 胸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 2 紀錄醫師 許皓淳, 時間資訊 21:05 通知急診手術 23:06 開始NPO 23:06 臨時手術NPO 10:39 報到 10:48 進入手術室 10:50 麻醉開始 11:00 誘導結束 11:20 抗生素給藥 11:36 手術開始 12:20 麻醉結束 12:20 手術結束 13:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 胸腔鏡肺膜剝脫術 1 1 R 摘要__ 手術科部: 腫瘤醫學部 套用罐頭: VATS decortication, right side. 開立醫師: 許皓淳 開立時間: 2010/12/25 12:33 Pre-operative Diagnosis Lung cancer with distant metastasis, with persistent pneumothorax Post-operative Diagnosis Lung cancer with distant metastasis, with persistent pneumothorax Suspect diffused pleural metastasis. Operative Method VATS decortication, right side. Specimen Count And Types 1 piece About size:1cm Source:Pleural peal, suspect tumor seeding Pathology Pending Operative Findings Diffuse whitish to yellowish, thickened, evenful pleura with multiple nodular lesion and easy bleeding, highly suspected pleural metastasis. Adhesion of RUL to chest wall was noticed. Under saline irrigation, no obvious air leakage was noticed at RUL and RLL. Both lobes had good expansion after adhesiolysis and decortication. RML was not flatted, suspect tumor occupied. Operative Procedures DLETGA, left decubitus, skin disinfection and draping as usual. VATS setting (pervious hole for chest tube as camera port, another incision was made at anterior chest about 2cm (wound protecter used)) Adesiolysis, decorticationi, check air leakage. Check bleeding, set Fr.32 chest tube and close the wounds in layers. Operators 陳晉興 Assistants R3高明蔚,R1許皓淳 Indication Of Emergent Operation 高燕輝 (M,1940/04/02,71y11m) 手術日期 2010/12/25 手術主治醫師 杜永光 手術區域 東址 008房 03號 診斷 Subdural hemorrhage 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 3 紀錄醫師 李振豪, 時間資訊 07:21 臨時手術NPO 07:21 開始NPO 08:21 通知急診手術 12:42 報到 13:05 進入手術室 13:10 麻醉開始 13:35 誘導結束 13:40 抗生素給藥 13:58 手術開始 15:18 手術結束 15:18 麻醉結束 15:28 送出病患 15:35 進入恢復室 16:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 頭顱穿洞術(止血引流、穿刺檢查) 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: Burr hole drainage 開立醫師: 李振豪 開立時間: 2010/12/25 15:42 Pre-operative Diagnosis Left fronto-temporo-parietal chronic subdural hematoma Post-operative Diagnosis Left fronto-temporo-parietal chronic subdural hematoma Operative Method Burr hole drainage Specimen Count And Types 20ml chronic subdural hematoma Pathology Nil Operative Findings The motor-oil content gushed out after dura opening. Septation of the hematoma was noted during the operation. The brain was slack after hematoma evacuation. Blood clot(+), outer and inner membrane(+). The character of subdural drainage became reddish at the end of the operation. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine position with head rotated to right. The scalp was shaved, scrubbed, and disinfected as usual. Linear scalp incision was made at left fronto-temporal area and the subcutaneous soft tissue was dissected. One burr hole was created followed by two dural tenting. The dura was opened with cruciform in fashion. Hematoma evacuation was done with normal saline irrigation. One subdural rubber drain was left and the wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators Prof. 杜永光 Assistants R4李振豪, R2蔡立威 Indication Of Emergent Operation 相關圖片 陳文濤 (M,1946/02/26,66y0m) 手術日期 2010/12/25 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Unspecified site of spinal cord injury without evidence of spinal bone injury 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 3 紀錄醫師 鍾文桂, 時間資訊 07:53 報到 08:00 進入手術室 08:05 麻醉開始 08:30 誘導結束 08:45 抗生素給藥 09:38 手術開始 11:45 抗生素給藥 14:15 手術結束 14:15 麻醉結束 14:25 送出病患 14:30 進入恢復室 15:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎融合術-前融合,無固定物(≦四節) 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 椎間盤切除術-頸椎 1 1 記錄__ 手術科部: 外科部 套用罐頭: Microsurgical diskectomy, C4/5. 開立醫師: 鍾文桂 開立時間: 2010/12/25 14:37 Pre-operative Diagnosis Herniated intervertebral disc , C4/5. Post-operative Diagnosis Herniated intervertebral disc , C4/5. Operative Method Microsurgical diskectomy, C4/5. Interbody fusion with autologous bone graft, C4/5. Specimen Count And Types nil Pathology Nil. Operative Findings 1. Prominent protruding anterior spur formation at C4/5 level. 2. Herniated disc and thickening of posterior longitudinal ligament are noted intraoperatively. 3. Autologous iliac bone was harvested for interbody fusion. Operative Procedures Under ETGA, the patient was placed in supine position and the head in midline position. After disinfection and draping, a horizontal incision was made at the level of thyroid cartilage. After dissection along the anterior border of sternocledomastoid muscle, the cervical spine was exposed. The C4/5 level was ensured by intraoperative fluoroscopy. The anterior spur was excised by Kerrison, Rongeur and high speed cutting drill. The intervertebral disc was resected along with the end plates and spurs. The posterior longitudinal ligament was also excised with intact dura mater. The harvested iliac bone was placed at the C4/5 intervertebral space. After placing one prevertebral mini-hemovac drain, the wounds were closed in layers. Operators V.S. 賴達明 Assistants R5 鍾文桂 游益慶 (M,1976/07/17,35y7m) 手術日期 2010/12/25 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Cervical spondylosis with myelopathy 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 3 紀錄醫師 鍾文桂, 時間資訊 14:15 報到 14:38 進入手術室 14:40 麻醉開始 14:50 誘導結束 15:05 抗生素給藥 15:40 手術開始 19:30 手術結束 19:30 麻醉結束 19:40 送出病患 19:43 進入恢復室 21:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 手術 椎間盤切除術-頸椎 1 1 記錄__ 手術科部: 外科部 套用罐頭: Microsurgical diskectomy, . 開立醫師: 鍾文桂 開立時間: 2010/12/25 20:14 Pre-operative Diagnosis Herniated intervertebral disc, C4/5. Post-operative Diagnosis Herniated intervertebral disc, C4/5. Operative Method Microsurgical diskectomy, . Microsurgical diskectomy,C4/5 . Implantation of artificial disc,C4/5. Specimen Count And Types nil Pathology Nil. Operative Findings A large ruptured disc at left side of the intervertebral space. The posterior longitudinal ligament was excised. The end plates were preserved. Artificial disc: Prodisc-C size L, height 5mm. Because the implant initial position compressed the spinal cord, we used prophylatic megadose steroid for the cord injury. Immediate postoperatively, the muscle power of all four extrimities is at least 4-. Operative Procedures Under ETGA, the patient was placed in supine position and head in midline. After disinfection, a horizontal incision was made at right anterior neck. After dissection along the anterior border of the sternocledomastoid muscle, the prevertebral space was identified. The midline was outlined for future implantation. After ensuring the C4/5 disc level, the disc was excised by currete, alligator, and 1mm kerrison. Then, the artificial disc was inserted and its position was checked by intraoperative fluoroscopy. After placing one prevertebral mini-hemovac drain, the wound was closed in layers. Operators V.S.賴達明 Assistants R5 鍾文桂 劉勇成 (M,1975/11/28,36y3m) 手術日期 2010/12/25 手術主治醫師 賴達明 手術區域 東址 005房 01號 診斷 Urinary tract infection (UTI) 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 2 紀錄醫師 胡朝凱, 時間資訊 07:28 報到 08:05 進入手術室 08:15 麻醉開始 08:50 誘導結束 09:15 抗生素給藥 09:50 手術開始 12:15 抗生素給藥 15:00 開始輸血 15:15 抗生素給藥 16:30 手術結束 16:30 麻醉結束 16:40 送出病患 16:45 進入恢復室 17:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-椎 1 2 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 9 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: Posteior approach for discectomy via left T12... 開立醫師: 胡朝凱 開立時間: 2010/12/25 16:36 Pre-operative Diagnosis T11~T12, T12~L1, L1~L2 HIVD with cord compression Post-operative Diagnosis T11~T12, T12~L1, L1~L2 HIVD with cord compression Operative Method Posteior approach for discectomy via left T12 and L1 facetomy, T12 to L2 TPS fixation and posterior lateral fusion. Specimen Count And Types nil Pathology Nil Operative Findings 1.Ruptured disc and marginal spur were noted at T11~L2 level that compressed the cord severely. The disc became dehydrated. 2.Some part of disc adhered to dura tightly. 3.Right T11, L1, L2 and left T11, T12, L2 TPS were inserted. Screws: 40x65 x 6. Rods x 2. crosslink x 1 Operative Procedures 1.ETGA, prone position 2.Midline skin incision at T11 to L2 level 3.Detach paravertebral muscle 4.Expose T11~L2 facet joint and lamina 5.screws insertion 6.Left T12, L1 facetomy 7.Discectomy from the left side 8.Hemostasis 9.Fixed rods 10.Fixed cross link 11.Lateral fusion with autologous bone after decortication 12.Set one hemovac drain 13.Close wound in layers Operators 賴達明 Assistants 胡朝凱, 游皓鈞 梁哲愷 (M,1997/08/16,14y6m) 手術日期 2010/12/25 手術主治醫師 楊士弘 手術區域 兒醫 067房 01號 診斷 Brain tumor 器械術式 Neuroendoscope for tumor biopsy + EVD 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林峰盛 ASA 3E 紀錄醫師 游皓鈞, 時間資訊 11:11 通知急診手術 00:00 開始NPO 00:00 臨時手術NPO 08:58 進入手術室 08:58 報到 09:10 麻醉開始 09:37 抗生素給藥 09:45 誘導結束 10:30 手術開始 12:45 抗生素給藥 14:05 手術結束 14:10 麻醉結束 14:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦組織活體切片 1 1 R 手術 顱內壓視置入 1 2 R 手術 腦內視鏡 1 0 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 套用罐頭: Ventriculoscopic tumor biopsy + septostomy + ... 開立醫師: 楊士弘 開立時間: 2010/12/25 14:41 Pre-operative Diagnosis Third ventricular tumor with obstructive hydrocephalus Post-operative Diagnosis Third ventricular tumor with obstructive hydrocephalus Operative Method Ventriculoscopic tumor biopsy + septostomy + ICP monitor insertion (by ventricular drain) Specimen Count And Types 1 piece About size:小 Source:brain tumor Pathology Frozen pathology: germ cell tumor Operative Findings A greyish red, soft fragile, moderately vascularized tumor was seen to abut the right foramen of Monro from the third ventricle. After septostomy the left ventricle was entered. Brisk bleeding was noted from the left septal vein during fenetration of the septum pellucidum, and stopped after irrigation of Lactate Ringer solution. Operative Procedures 1. ETGA, supine, head fixed with Mayfield skull clamp. 2. Right frontal burr hole at Kocher point. 3. Tapping of the right lateral ventricle and insertion of a ventricular drain for CSF sampling. 4. Removal of the drain and insertion of a Fr. 14 peel-away sheath. 5. Insertion of the Oi ventriculoscope. 6. Coagulation of the tumor surface with monopolar cautery. 7. Removal of tumor piece by piece with tumor forceps. 8. Opening of the septum pellucidum by monopolar coagulation and tumor forceps. 9. Insertion of the ventricular drain into the right frontal horn, then externalization through scalp 2 cm away from the incision wound. 10. Wound closure in layers. Operators 楊士弘 Assistants 游皓鈞 Indication Of Emergent Operation 相關圖片 張添勝 (M,1969/06/05,42y9m) 手術日期 2010/12/25 手術主治醫師 蔡翊新 手術區域 東址 001房 03號 診斷 Subdural hematoma 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 四肢 傷口分類 髒 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 4E 紀錄醫師 趙崧筌, 蔡立威, 賴昆鴻, 時間資訊 13:37 通知急診手術 13:37 開始NPO 14:55 報到 14:55 進入手術室 14:55 開始輸血 15:00 麻醉開始 15:05 誘導結束 15:50 手術開始 16:10 17:10 17:20 17:30 抗生素給藥 18:10 19:15 麻醉結束 19:15 手術結束 19:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 急性硬腦膜下血腫清除術 1 1 R 手術 顱內壓視置入 1 2 R 手術 深部傷口處理縫合擴創-大 1 0 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 脛骨骨折開放性復位術 1 1 R 手術 指、趾關節脫位開放性復位術 1 2 L 手術 石膏副木固定－長腿 1 0 L 手術 石膏副木固定－短腿 1 0 L 摘要__ 手術科部: 外科部 套用罐頭: Debridement and wound approximation 開立醫師: 趙崧筌 開立時間: 2010/12/25 17:14 Pre-operative Diagnosis Degloving injury of right foot and lower leg Post-operative Diagnosis Degloving injury of right foot and lower leg Operative Method Debridement and wound approximation Specimen Count And Types nil Pathology Nil Operative Findings The degloving injury more involved the medial side of the lower leg, dorsum and medial side of the foot and plantar heel. No active bleeding was found and the oozing blood was with fat droplets. The exposed cutaneous nerves, tendons, and muscles were covered by the skin envelope as much and slack as possible with still about 4 cm in width, 20 cm in length of raw surface exposure. Tibial complete fracture was also noted. The degloving injury more involved the lateral side of the lower leg, dorsum and lateral side of the foot and plantar heel. No active bleeding was found and the oozing blood was with fat droplets. The exposed cutaneous nerves, tendons, and muscles were covered by the skin envelope as much and slack as possible with still about 4 cm in width, 20 cm in length of raw surface exposure. Tibial complete fracture was also noted. Operative Procedures ETGA, supine, disinfected and draped Give copious irrigation (8000 ml N/S) and debride the wound Approximate the wound Apply wet dressing packing over raw surface Operators 戴浩志 Assistants 趙崧筌 Indication Of Emergent Operation 摘要__ 手術科部: 骨科部 套用罐頭: 1. Debridement 開立醫師: 賴昆鴻 開立時間: 2010/12/25 18:09 Pre-operative Diagnosis 1. Both foot degloving injury 2. Right distal tibia fracture, open type III 3. Right calcaneous fracture, comminuted 4. Left tibia plateau fracture, type V 5. Right big toe dislocation over IP joint Post-operative Diagnosis 1. Both foot degloving injury 2. Right distal tibia fracture, open type III 3. Right calcaneous fracture, comminuted 4. Left tibia plateau fracture, type V 5. Right big toe dislocation over IP joint Operative Method 1. Debridement 2. ORIF with pin x2 over right distal tibia Specimen Count And Types nil Pathology nil Operative Findings 1. Right foot degloving injury with tendon, nerve exposure. No active bleeding noted, oozing suspected from fracture site due to oil dropped. 2. Right distal tibia fracture, 3. Right calcaneous fracture, comminuted 4. Left tibia plateau fracture, type V 5. One transverse wound over left knee, with patella esposure. 6. Left first toe degloving injury, laceration extend to ankle, 7. Left 1st, 4th toe nail dettachment. Operative Procedures 1. UTGA, supine position. 2. Skin disinfection, draped. 3. Irrigation with saline, performed debridement. 4. Set one penrose over left knee wound, then closed in layers. 5. Reduction right tibia fracture and fixed with K-pin x3. 6. Reduced and fixed left big toe with K-pin. 7. Applied short leg splint over right leg. Long-leg splint over left leg. Operators 林偉彭, Assistants 葉炳君, 賴昆鴻, 陳志偉, Indication Of Emergent Operation 摘要__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 蔡翊新 開立時間: 2010/12/25 19:59 Pre-operative Diagnosis Head injury with right temporal skull fracture and bilateral acute SDH. Post-operative Diagnosis Head injury with right temporal skull fracture and bilateral acute SDH. Operative Method Right F-T-P craniectomy for SDH evacuation and subdural ICP monitoring. Specimen Count And Types nil Pathology Nil. Operative Findings Right parietal scalp laceration s/p suture. Right temporal muscle contusion with intramural hematoma was noted. Copious bleeding from subdural space upon first burr hole creation and it came from a bridging vein. SDH was noted at right F-T-P region, with active bleeding from the bridging veins. Several bridging veins were abnormal in location, possibly due to previous head injury. ICP after duroplasty was 0 mmHg, and that after skin closure was 2 mmHg. The right temporalis muscle was excised to prevent postop epidural compression. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with a sterilized adhesive plastic sheet. 4. Incision: 4 cm at right frontal area, the skin edge was clipped by Raney clips for temporary hemostasis. 5. A burr hole was made and the dura was incised for evacuating part of the subdural hematoma, therefore the IICP could be relieved earlier. However, copious bleeding from the bridging vein was not possible to stop. So craniectomy was performed subsequently. 6. The incision was extended to a temporal horseshoe, and the temporalis muscle was detached from temporal squama by rasp subsequently. 7. Craniotomy window: 12 x 10 cm, right F-T-P, created by making 5 burr holes then cut by power saw. 8. Dural tenting: by 2/0 silk, 2 cm in interval, distributed along the edge of skull window. 9. Dural incision: curvilinear along the edge of skull window. 10.The subdural clot was removed by sucker and those located beyond the cranial window was also evacuated. Bleeding from the base of temporal lobe was packed with Surgicel and Gelfoam. 11.Dural closure: was closed with a piece of dural graft taking from temporalis fascia, crescent shape 12 cm long, 1.5 cm wide, along the whole length of the dural incision in order to create an additional space for the swollen brain. 12.The skull plate was removed and stored at bone bank for preservation. 13.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 3/0 Dexon and skin by continuous suture with 3/0 nylon. 14.Drain: two, epidural, CWV. 15.Blood transfusion: PRBC 9U, Platelet 12U, FFP 6U. Blood loss: 2200 ml (bleeding from lower limbs surgery was not included). 16.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R4李振豪R2蔡立威Ri Indication Of Emergent Operation 廖瑋 (F,1975/03/10,37y0m) 手術日期 2010/12/26 手術主治醫師 蔡翊新 手術區域 東址 001房 01號 診斷 Subdural hemorrhage following injury, unspecified state of consciousness 器械術式 Left side ICP monitor (+- decompressive craniectomy) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 4E 紀錄醫師 蔡立威, 時間資訊 16:00 開始NPO 01:10 通知急診手術 02:05 進入手術室 02:10 麻醉開始 02:30 誘導結束 02:30 抗生素給藥 02:40 手術開始 02:46 開始輸血 02:50 抗生素給藥 05:00 手術結束 05:00 麻醉結束 05:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 急性硬腦膜下血腫清除術 1 1 L 手術 顱內壓視置入 1 2 L 手術 頭皮腫瘤 1 4 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 蔡翊新 開立時間: 2010/12/26 04:36 Pre-operative Diagnosis 1.Occipital scalp laceration. 2.Fracture at vertex along sagittal suture with left frontotemporoparietal SDH and brain swelling. 3.Upper lip laceration. Post-operative Diagnosis 1.Occipital scalp laceration. 2.Fracture at vertex along sagittal suture with left frontotemporoparietal SDH and severe brain swelling. 3.Upper lip laceration. Operative Method 1.Suture of occipital scalp laceration. 2.Left F-T-P craniectomy for SDH evacuation, duroplasty and ICP monitoring. 3.Suture of lip laceration. Specimen Count And Types nil Pathology Nil. Operative Findings 1. A 10 cm deep laceration at occipital scalp, with massive active bleeding from occipital artery. 2. Initial ICP before craniectomy was 64 mmHg. The dura was very tense after craniectomy, when ICP was still 63 mmHg. Thin SDH was noted at left F-T-P area. The brain bulged out very rapidly and severely upon dural opening. There was no pulsation of brain. Massive infarction due to occlusion of superior sagittal sinus was suspected. After skin closure, the ICP was 31 mmHg. 3. A through-through laceration at upper lip was noted, 1.5 cm at skin side and 3 cm at mucosal side. Operative Procedures 1. Anesthesia: endotracheal general. 2. The occipital scalp laceration was closed in two layers to stop bleeding from occipital artery. 3. Position: supine with head rotated to right. 4. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with a sterilized adhesive plastic sheet. 5. Incision: standard trauma flap at left F-T-P area, and the temporalis muscle was detached from temporal squama by rasp subsequently. 6. Craniectomy window: 12 x 10 cm, left F-T-P, created by making 5 burr holes then cut by power saw. 7. Dural incision: curvilinear along the edge of skull window. 8. The subdural clot was removed by sucker. 9. Dural closure: A piece of 4 x 5 inches Duroform was used for duroplasty. 10.The skull plate was removed and stored at bone bank for preservation. 11.Scalp closure: Galea suture was performed by continuous suture with 1/0 Vicryl and skin by continuous suture with 2/0 nylon. 12.Drain: two epidural CWV. 13.The upper lip laceration was sutured in layers. 14.Blood transfusion: PRBC 8U, FFP 3U, Platelet 12U 15.Course of the surgery: cessation of brain circulation was impressed. The poor prognosis was informed to the family during operation. Operators VS蔡翊新 Assistants R5鍾文桂R4李振豪R2蔡立威 Indication Of Emergent Operation 黃郁惠 (F,1970/11/09,41y4m) 手術日期 2010/12/27 手術主治醫師 廖漢文 手術區域 東址 000房 號 診斷 Arteriovenous malformation, brain 器械術式 Intracranial AVM for TAE 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 時間資訊 11:30 麻醉開始 11:35 誘導結束 14:00 麻醉結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 郭詠婕 (F,2004/10/19,7y4m) 手術日期 2010/12/27 手術主治醫師 簡穎秀 手術區域 兒醫 062房 06號 診斷 Aromatic L-amino acid decarboxylase deficiency 器械術式 Lumbar puncture 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 葉惠敏 ASA 3 時間資訊 12:50 報到 13:29 進入手術室 13:35 麻醉開始 13:40 誘導結束 13:47 手術開始 13:54 手術結束 13:54 麻醉結束 14:07 送出病患 14:15 進入恢復室 15:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 麻醉 Glucose 1 0 手術 脊椎穿刺 1 0 林秀貴 (F,1944/11/01,67y4m) 手術日期 2010/12/27 手術主治醫師 王國川 手術區域 東址 001房 03號 診斷 Head Injury 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3E 紀錄醫師 鍾文桂, 時間資訊 08:00 開始NPO 08:00 臨時手術NPO 14:50 報到 15:15 進入手術室 15:20 麻醉開始 15:50 誘導結束 16:15 手術開始 17:25 抗生素給藥 18:00 麻醉結束 18:00 手術結束 18:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Partial excision and drainage of brain absces... 開立醫師: 鍾文桂 開立時間: 2010/12/27 18:17 Pre-operative Diagnosis Left frontal abscess. Post-operative Diagnosis Left frontal abscess. Operative Method Partial excision and drainage of brain abscess via left frontal craniotomy. Specimen Count And Types 1 piece About size:5cc Source:brain abscess,. for culture, gram stain. Pathology Nil. Operative Findings 1. Some liquified hematoma and grayish-red pus formation in the abscess cavity. The cavity wall was firm and stiff. Parital excision of the abscess wall was done. 2. The ventricle was opened. A EVD catheter was placed at the abscess cavity. 3. Intraoperarive ultrasonography was done to localize the abscess. Operative Procedures Under ETGA, the patient was placed in supine position and the head was slightly tilted to the right. After shaving, disinfection, and draping, a curvilinear incision was made at bicoronal area. After dissection, the 6 cm craniotomy was created. After durotomy, we localized the abscess by ultrasonography. By corticotomy, the abscess cavity was reached. The content was evacuated and part of the wall was excised. After well hemostasis, a EVD catheter was placed at the emptied cavity. Then, the wound was closed in layers with one subgaleal CWV drain after dura closure and fixation of craniotomy bone plate. Operators V.S.王國川 Assistants R5 鍾文桂 Indication Of Emergent Operation 陳進宗 (M,1947/05/29,64y9m) 手術日期 2010/12/27 手術主治醫師 吳毅暉 手術區域 東址 000房 號 診斷 Abdominal pain 器械術式 Port-A catheter Removal (bed side) 手術類別 緊急手術 手術部位 胸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 12:15 開始NPO 12:15 通知急診手術 13:00 手術開始 13:10 手術結束 醫令資訊 類別 名稱 量 刀 側 手術 皮下肌肉或深部異物取出術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: removal of Port-A/Permcath 開立醫師: 陳政維 開立時間: 2010/12/27 13:18 Pre-operative Diagnosis fever of Permcath Post-operative Diagnosis ditto Operative Method removal of permcath catheter Specimen Count And Types 1 catheter tip culture Pathology nil Operative Findings the catheter was removed totally and the course was smooth Operative Procedures The patient was put on supine position. The operation field was disinfected and draped as usual. Under local anesthesia, the permcath was removed from previous wound smoothly. The wound was irrigated and closed in layers. Post-op care plan: 1.wound CD QD+PRN 2.pain control with tinten 3.prophylatic antibiotics use Operators VS吳毅暉 Assistants R3陳政維 Indication Of Emergent Operation 林月娥 (F,1952/02/24,60y0m) 手術日期 2010/12/27 手術主治醫師 杜永光 手術區域 東址 002房 01號 診斷 Intracerebral hemorrhage (ICH) 器械術式 ICH removal + EVD left side 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 1 紀錄醫師 鍾文桂, 時間資訊 07:01 通知急診手術 08:05 進入手術室 08:05 麻醉開始 08:10 誘導結束 08:51 抗生素給藥 09:10 手術開始 09:55 手術結束 09:55 麻醉結束 10:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室體外引流 1 1 R 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Ventriculostomy, right Kocher. 開立醫師: 鍾文桂 開立時間: 2010/12/27 10:47 Pre-operative Diagnosis Left thalamic hemorrhage with intraventricular hemorrhage and acute hydrocephalus. Post-operative Diagnosis Left thalamic hemorrhage with intraventricular hemorrhage and acute hydrocephalus. Operative Method Ventriculostomy, right Kocher. Specimen Count And Types 1 piece About size:3 cc Source:CSF: sent for routine, culture and BCS. Pathology Nil. Operative Findings Clear pinkish CSF drained out from the EVD tube. Low ICP, around 1- -1 cmH2O. Ventricular catheter: 6.5 cm. Operative Procedures Under ETGA, the patient was placed in supine position and the head was in midline position. After shaving, disinfection, and draping, a vertical linear scalp incision was made at right Kocher point. After creating a burr hole and durotomy, the ventricular puncture needle was inserted at right Kocher point. Then, the EVD catheter was inserted through the same tract. After well hemostasis, the wound was closed in layers. Operators Prof. 杜永光 Assistants R5 鍾文桂 Indication Of Emergent Operation 張基應 (M,1929/12/26,82y2m) 手術日期 2010/12/27 手術主治醫師 杜永光 手術區域 東址 007房 02號 診斷 Subdural hematoma 器械術式 Bilateral burr hole drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3E 紀錄醫師 張僖, 時間資訊 13:00 臨時手術NPO 13:00 開始NPO 21:04 通知急診手術 22:40 報到 22:43 進入手術室 22:50 麻醉開始 22:55 誘導結束 23:23 抗生素給藥 23:47 手術開始 01:10 手術結束 01:10 麻醉結束 01:20 送出病患 01:25 進入恢復室 02:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 手術 慢性硬腦膜下血腫清除術 1 1 B 手術 慢性硬腦膜下血腫清除術 1 2 B 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 記錄__ 手術科部: 外科部 套用罐頭: Bilateral burr hole drainage 開立醫師: 胡朝凱 開立時間: 2010/12/28 01:39 Pre-operative Diagnosis Bilateral chronic subdural hematoma Post-operative Diagnosis Bilateral chronic subdural hematoma Operative Method Bilateral burr hole drainage Specimen Count And Types nil Pathology nil Operative Findings 1.Bilateral motor oil like subdural hematoma was drained out 2.Bilateral outer membrane was noted 3.Brain was slack after drainage 4.Some blood clot was also noted at left side Operative Procedures 1.Under ETGA, patient was put supine position. Bilateral transverse skin incision was done. Dissection was made to expose skull bone. Burr hole drilling followed. After dural tenting, cruciate form dural incision. Outer membrane was opened then. Rubber drain was inserted and water irrigation followed. Four direction irrigation was performed. Fixed rubber drain was done. Close wound was performed layer by layer. De-air was performed last. Operators P 杜永光 Assistants 胡朝凱, 張僖 Indication Of Emergent Operation 陳張玉真 (F,1941/05/13,70y10m) 手術日期 2010/12/27 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 HIVD 器械術式 Laminectomy for decompression 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 08:00 進入手術室 08:05 麻醉開始 08:15 誘導結束 08:52 抗生素給藥 09:15 手術開始 11:06 開始輸血 11:58 抗生素給藥 12:20 手術結束 12:20 麻醉結束 12:30 送出病患 12:30 進入恢復室 13:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術(減壓)-超過二節 1 1 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: L3-4 laminectomy and L5 partial laminectomy 開立醫師: 游健生 開立時間: 2010/12/27 12:50 Pre-operative Diagnosis L3-5 spinal stenosis Post-operative Diagnosis L3-5 spinal stenosis Operative Method L3-4 laminectomy and L5 partial laminectomy Specimen Count And Types nil Pathology Nil Operative Findings The thecal sac was compressed by hypertrophic ligamentum flavum tightly resulting in stenosis of spinal canal from L3 to L5, most severe at L4 and L5. The dura adhered to ligamentum flavum tightly at L5 on right side and a small dura tear, about 0.5cm, was noted during surgery. It was closed with 4-0 prolene continuous suture and no more CSF leak was noted. The thecal sac was well decompressed after laminectomy and removal of ligamentum flavum. Operative Procedures Under ETGA, patient was in prone position. After locating L3-5, we disinfected and draped the operation field. A midline skin incision was made from L3 to L5. Paraspinal muscles were detached from spinous processes and laminae. The L3 & L4 spinous processes and laminae were removed by Ronguer and Kerrison. Part of L5 spinous process and laminae were then removed for better decompression. Ligamentum flavum was removed totally. A small dura tear on right side at L5 was noted. It was closed with 4-0 prolene continuous suture. Hemostasis was achieved with Gelfoam packing. Wound was closed in layers with an epidural hemovac drainage in place. Operators Prof. 杜永光 Assistants R6陳睿生 R3游健生 賴建元 (M,1981/02/11,31y1m) 手術日期 2010/12/27 手術主治醫師 葉德輝 手術區域 東址 025房 01號 診斷 Malignant neoplasm of cerebrum, except lobes and ventricles 器械術式 Endoscopic functional sinus su 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 郭彥麟, 時間資訊 07:42 報到 08:05 進入手術室 08:10 麻醉開始 08:15 誘導結束 08:37 手術開始 10:38 手術結束 10:38 麻醉結束 10:42 送出病患 10:45 進入恢復室 11:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 多竇副鼻竇手術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: endoscopic sinoscopic surgery 開立醫師: 郭彥麟 開立時間: 2010/12/29 20:42 Pre-operative Diagnosis sphenoid cancer, frontal abscess Post-operative Diagnosis 1.sphenoid cancer 2.right maxillary sinusitis, s/p debridement by sinonasal endoscope Operative Method endoscopic sinoscopic surgery Specimen Count And Types 1 piece About size:< 1cm Source:nasal tissue Pathology pending Operative Findings 1.no obvious pus was noted from bilateral frontal sinuses ; mucopus from right maxillary sinus Operative Procedures 1.The patient was in supine position The operative field was disinfected and draped as usual. Cocaine-Bosmin soaked cotton pledgets were applied for intranasal anesthesia and shrinkage. 2.we opening the uncinate process of right side and mucopus leaked out. So we opened the maxillary sinus and cleared it 3.We used Burr to trim the bone, made the way to the right frontal sinus. No pus was noted. Then we opened the left frontal sinuns, and still no pus was noted. 4.after hemostasis, we inserted nasal packing bilateral : merocel x 2 ; F/S x1 Operators AP葉德輝 Assistants R4林沛廷 R2郭彥麟 林慧馨 (F,1944/12/23,67y2m) 手術日期 2010/12/27 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Lumbar spondylosis 器械術式 Lumbar TPS 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 陳蔚蔚, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:05 進入手術室 08:10 麻醉開始 08:25 誘導結束 08:50 抗生素給藥 09:00 手術開始 11:52 抗生素給藥 14:56 抗生素給藥 15:38 手術結束 15:38 麻醉結束 15:48 送出病患 15:50 進入恢復室 17:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 7 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎弓切除術(減壓)-二節以內 1 2 記錄__ 手術科部: 外科部 套用罐頭: Percutaneous L4,5 TPS, L4~5 laminectomy for d... 開立醫師: 胡朝凱 開立時間: 2010/12/27 16:00 Pre-operative Diagnosis L4 on L5 spondylolisthesis and spinal stenosis Post-operative Diagnosis L4 on L5 spondylolisthesis and spinal stenosis Operative Method Percutaneous L4,5 TPS, L4~5 laminectomy for decompression, and anterior fusion with autologouds bone Specimen Count And Types ligment and ganglion cyst for two bottles Pathology pending Operative Findings 1.Instability of L4 on L5 was noted. 2.Hypertrophic flavum ligment 3.Right L5 nerve root was compressed with a ganglion cyst 4.screws: 45 x 67 x 4 Operative Procedures 1.ETGA, prone 2.Midline skin incision at L4~5 spinous process level 3.Split spinous process 4.Fracture spinous process and lamina junction 5.Laminectomy and remove flavum ligment to expose L5 nerve root 6.Close wound in layers 7.Bilateral paravertebral skin incision 2.5 cm away from midline 8.Dissect and cut open fascia to expose L4 and L5 facet 9.Under fluoroscopy, screws were inserted after guide pin insertion and localization 10.Fixed left rod first 11.Right L4~5 discectomy via lateral route 12.Injected bone cement to the anterior border 13.Impact autologous bone into the disc cavity 14.Injected bone cement as posterior border 15.Fixed rod right side 16.Close wound in layers Operators p 林瑞明, VS 曾勝弘 Assistants 胡朝凱, 陳蔚蔚 呂郭素月 (F,1941/03/16,70y11m) 手術日期 2010/12/27 手術主治醫師 吳毅暉 手術區域 兒醫 068房 01號 診斷 Nodular lymphoma, unspecified site, extranodal solid organ sites 器械術式 Port-A catheter Removal/WOR 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 陳政維, 時間資訊 09:40 報到 09:45 進入手術室 09:55 麻醉開始 09:56 誘導結束 09:57 手術開始 10:10 麻醉結束 10:10 手術結束 10:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 皮下肌肉或深部異物取出術 1 1 記錄__ 手術科部: 外科部 套用罐頭: removal of Port-A/Permcath 開立醫師: 陳政維 開立時間: 2010/12/27 10:22 Pre-operative Diagnosis fever of Port-A Post-operative Diagnosis ditto Operative Method removal of Port-A catheter Specimen Count And Types nil Pathology nil Operative Findings the catheter was removed totally and the course was smooth Operative Procedures The patient was put on supine position. The operation field was disinfected and draped as usual. Under local anesthesia, the Port-A catheter was removed from previous wound smoothly. The wound was irrigated and closed in layers. Post-op care plan: 1.wound CD QD+PRN 2.pain control with tinten 3.prophylatic antibiotics use Operators VS吳毅暉 Assistants R3陳政維 黃彩雲 (F,1933/10/13,78y5m) 手術日期 2010/12/27 手術主治醫師 賴達明 手術區域 東址 003房 03號 診斷 Subarachnoid hemorrhage (SAH) 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 15:21 進入手術室 15:30 麻醉開始 15:35 誘導結束 16:30 手術開始 17:35 手術結束 17:35 麻醉結束 17:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室腹腔分流手術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt via left Kocher"s ... 開立醫師: 游健生 開立時間: 2010/12/27 17:55 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunt via left Kocher"s point Specimen Count And Types 1 piece About size:10cc Source:CSF Pathology Nil Operative Findings Opening pressure was less than 5cmH2O. Xanthochromic CSF was drained after ventricular puncture. The ventricle catheter was 6.5cm in length. Medtronic non-programmable medium pressure reservoir was used. Operative Procedures Under ETGA, patient in supine position with head rotated to right and left should elevated. After shaving, we disinfected and draped the operation field as usual. Part of the wound near left Kocher region was opened. Previous burrhole for craniotomy was found and debrided. Dura tenting followed by cruciate durotomy and cauterization of dura edge. Ventriculostomy followed by insertion of ventricle catheter. A transverse LUQ abdominal incision was done. Peritoneum was opened after dissection. Peritoneal catheter was inserted and the proximal end was passed upward to scalp wound via a subcutaneous tunnel. VP shunt was assembled with Medtronic non-programmable medium pressure reservoir. Achieved hemostasis and wounds closed in layers. Operators VS 賴達明 Assistants R6 陳睿生 R3 游健生 林美雁 (F,1948/09/15,63y5m) 手術日期 2010/12/27 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 Hydrocephalus 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 12:47 進入手術室 12:55 麻醉開始 13:05 誘導結束 13:10 抗生素給藥 13:45 手術開始 14:44 手術結束 14:44 麻醉結束 14:53 送出病患 14:55 進入恢復室 17:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt via left Kocher"s ... 開立醫師: 游健生 開立時間: 2010/12/27 14:58 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunt via left Kocher"s point Specimen Count And Types 4cc CSF Pathology Nil Operative Findings The opening pressure was about 10cmH2O. Clear CSF gashed out after ventricular puncture. 4cc CSF was sent for culture. The ventricle catheter was about 7cm in lenght. The Codmen programmable shunt pressure was set at 10cmH2O. Operative Procedures Under ETGA, patient in supine position with head rotated to right and left shoulder elevated. After shaving, we disinfected and draped the operation field as usual. A transverse scalp incision was made over left Kocher region. The cranium was exposed after dissection followed by burrhole creation. Dura tenting and cruciate durotomy followed by cauterization of dura edges. Ventriculostomy then inserted ventricle catheter. A transverse abdominal incision was made at LUQ. The peritoneum was opened after dissection. A peritoneal catheter was inserted and the proximal end was passed upward to scalp wound via subcutaneous tunnel. Assembled the VP shunt to Codmen programmable reservoir. Created a subgaleal pocket and implanted the reservoir. Hemostasis and closed wounds in layers. Operators VS 王國川 Assistants R6 陳睿生 R3 游健生 顏美彩 (F,1955/06/25,56y8m) 手術日期 2010/12/28 手術主治醫師 杜永光 手術區域 東址 002房 03號 診斷 Respiratory failure, with long-term ventilator use 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 曾峰毅, 時間資訊 00:48 開始NPO 00:48 臨時手術NPO 08:48 通知急診手術 11:35 麻醉開始 11:35 進入手術室 11:38 抗生素給藥 11:50 誘導結束 12:03 手術開始 12:41 12:57 手術結束 12:57 麻醉結束 12:57 13:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室體外引流 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 曾峰毅 開立時間: 2010/12/28 13:16 Pre-operative Diagnosis Hydrocephalus, status post external ventricular drainage, occluded Post-operative Diagnosis Hydrocephalus, status post external ventricular drainage, occluded Operative Method External ventricular drainage revision Specimen Count And Types Nil Pathology Nil Operative Findings Opening pressure was above 15cm H20, and the revised catheter was occluded by hematoma. We cleaned the catheter with saline. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position. After scalp shaved, scrubbed, disinfected, and then draped, we removed prevsious EVD catheter, and made skin incison along previuos operation wound. We inserted another new EVD catheter, and closed the wound in layers. EVD function was poor after wound closure. We re-drapded the patient, and re-opened the wound. The catheter was clean and fluxed with saline. The wound was closed in layers. Operators P 杜永光 Assistants R4 曾峰毅 Indication Of Emergent Operation 趙晟宇 (M,1962/08/09,49y7m) 手術日期 2010/12/28 手術主治醫師 李章銘 手術區域 東址 018房 02號 診斷 Lung cancer 器械術式 Thoracoscopy+Open Chest 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 蔡東明, 時間資訊 12:38 報到 13:26 進入手術室 13:30 麻醉開始 13:50 誘導結束 14:10 抗生素給藥 14:30 手術開始 19:05 麻醉結束 19:05 手術結束 19:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 胸腔鏡肺葉切除術 1 1 L 手術 根除性淋巴切除術(肺葉切除或全肺切除時) 1 2 L 麻醉 術後止痛 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: VATS left lower lobe lobectomy + lymphnode di... 開立醫師: 蔡東明 開立時間: 2010/12/28 19:29 Pre-operative Diagnosis Lung squamous cell carcinoma, left lower lobe Post-operative Diagnosis Lung squamous cell carcinoma, left lower lobe Operative Method VATS left lower lobe lobectomy + lymphnode dissection Specimen Count And Types 2 pieces About size:22*18cm Source: About size:4*4cm Source:LNs Pathology Frozen biopsy: no malignancy in N2 lymphnodes Operative Findings 1. Tumor size: 10*8cm 2. Tumor location: left lower lobe 3. Tumor invasion to: viceral pleura, partial lingular lobe, bronchus 4. Lymph nodes enlargement: Gr.5,7,11 Operative Procedures 1. Anesthesia: General anesthesia using single-lumen endotracheal tube with endobronchial blocker. An epidural anesthesia catheter is placed prior to the operation. 2. Position: Right decubitus position. An axillary roll is placed under the down side. The operative field is well disinfected and draped. 3. VATS setting. The pleural adhesions are separated using electrocautery. 4. Lymphnodes dissection in Gr.5,7. The forzen biopsy reported no malignancy. The fissure between the upperand lower lobes is separated and divided by endoGIA (Tyco 60/3.5mm). 5. The pulmonary vessels supplying the left lower lobe is identified and divided by endoGIA (Tyco 30/2.5mm). 6. The left lower lobe is retracted anteriorly. The inferior pulmonary ligment is divided.The inferior pulmonary vein is identified and divided by endoGIA (Tyco 45/3.0mm). 7. The bronchus to the lower lobe is identified and divided by endoGIA. 8. The pleural cavity is irrigated with normal saline solution and well hematostasis 9. After meticulous homeostasis and check-up of air leakage, one 28# chest tubes are placed at posterior aspect of pleural cavity respectively. The intercostal space is closed with 2-0 Vicryl. The skin is clsoed with 3-0 Nylon. Operators VS李章銘 Assistants R4蔡東明 R2黃世銘 Ri黃葳瑜 鄭玉枝 (F,1942/01/10,70y2m) 手術日期 2010/12/28 手術主治醫師 林峰盛 手術區域 西址 035房 06號 診斷 Lumbar spondylosis 器械術式 Nerve block / PC 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 硬肌麻醉 麻醉主治醫師 林峰盛 ASA 1 時間資訊 16:00 麻醉開始 16:00 進入手術室 16:05 誘導結束 16:07 手術開始 16:15 手術結束 16:15 麻醉結束 16:20 送出病患 摘要__ 手術科部: 麻醉部 套用罐頭: LENB 開立醫師: 林峰盛 開立時間: 2010/12/28 16:17 Pre-operative Diagnosis radiculopathy Post-operative Diagnosis radiculopathy Operative Method Transforaminal epidural steroid injection Specimen Count And Types nil Pathology Nil Operative Findings Operative Procedures LA with 1% xylocaine 5 ml pt in prone position Under fluoroscopic-guiddance, Transforaminal epidural steroid injection was done to left L4, L5 level with 23G spinal needle, 4mg Rinderon in 0.5% xylocaine 6ml Operators 林峰盛, Assistants 賴佳欣, 劉逸閩 (M,1935/07/16,76y7m) 手術日期 2010/12/28 手術主治醫師 賴達明 手術區域 東址 001房 01號 診斷 Fracture, thoracic-spine 器械術式 Spinal fusion posterior 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 吳俊毅, 古恬音, 時間資訊 00:00 開始NPO 00:00 臨時手術NPO 07:17 通知急診手術 08:52 報到 08:52 進入手術室 09:10 麻醉開始 09:30 誘導結束 10:32 手術開始 11:00 抗生素給藥 11:27 開始輸血 17:00 抗生素給藥 17:15 18:10 麻醉結束 18:10 手術結束 18:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 10 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 橈骨、尺骨骨折開放性復位術 1 1 R 摘要__ 手術科部: 臨床心理中心 套用罐頭: 1. Laminectomy of T8 & T9 for decompression 開立醫師: 古恬音 開立時間: 2010/12/28 16:37 Pre-operative Diagnosis Transection of T8 vertebral body with dislocation Post-operative Diagnosis Transection of T8 vertebral body with dislocation Operative Method 1. Laminectomy of T8 & T9 for decompression 2. Disectomy T8/T9 and anterior fusion with autologous bone graft 3. T6-7, T9-10 transpedicle screw fixation and posterolateral fusion with autologous bone Specimen Count And Types nil Pathology Nil Operative Findings 1. The was one oblique fracture line across the T8 vertebral body with upward dislocation. Some epidural hematoma was noted. 2. The T8-9 intervertebral disc was disrupted and removed 3. Excessive bleeding was noted from the fracture line, but no bleeder could be identified 4. Easy oozing from muscle and soft tissue was also noted 5. SSEP of lower limbs flattened during the procedure. Right leg SSEP returned to normal, but left leg SSEP only recovered partially. 6. Screws 30mm*4, 35mm*4, rod 130mm*2, cross link*1 Operative Procedures 1. ETGA, prone position 2. Skin was scrubbed and disinfected with better iodine, then draping was done in usual sterile fashion 3. Midline skin incision was made from T6 to T10 level, about 20cm in length 4. The soft tissue was dissected, and the paravertebral muscles were detached until the exposure of bilateral facet joints 5. Perform T8-9 laminectomy for decompression with Rongeur and Kerrison punch. The disrupted T8-9 disc was removed with curette 6. Hemostasis of T8 fracture line with Floseal, Surgicel, and Gelfoam packing 7. Insert T6,7,10,11 transpedicle screws, then connected with rods and cross link 8. Posterolateral fusion with autologous bone 9. Set one epidural hemovac drain 10. Close the wound in layers Operators 賴達明 Assistants 陳睿生,鍾文桂,古恬音 Indication Of Emergent Operation 摘要__ 手術科部: 骨科部 套用罐頭: ORIF with Zimmer locking plate (8H8S, 2 compr... 開立醫師: 吳俊毅 開立時間: 2010/12/28 18:08 Pre-operative Diagnosis Right distal radius fracture Post-operative Diagnosis Right distal radius fracture Operative Method ORIF with Zimmer locking plate (8H8S, 2 compression, 6 locking) Specimen Count And Types nil Pathology nil Operative Findings distal radius fracture with dorsal angulation Operative Procedures 1. ETGA. supine position 2. Skin prepare, disinfection and dressing 3. On pneumonic torniquet. 4. Henry approach 5. Dissect to fracture site 6. ORIF with Zimmer locking plate 7. Closed wound in layers Operators 侯君翰, Assistants 吳俊毅, 林家聖, 陳彥宇, Indication Of Emergent Operation 林月娥 (F,1952/02/24,60y0m) 手術日期 2010/12/28 手術主治醫師 杜永光 手術區域 東址 002房 04號 診斷 Intracerebral hemorrhage (ICH) 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 曾峰毅, 時間資訊 00:50 臨時手術NPO 00:50 開始NPO 08:50 通知急診手術 13:28 進入手術室 13:30 麻醉開始 13:35 誘導結束 13:37 抗生素給藥 13:49 手術開始 14:01 手術結束 14:01 麻醉結束 14:08 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室體外引流 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 創傷醫學部 套用罐頭: External ventricular drainage, revision, via ... 開立醫師: 曾峰毅 開立時間: 2010/12/28 14:12 Pre-operative Diagnosis Hydrocephalus, status post external ventricular drainage, occluded Post-operative Diagnosis Hydrocephalus, status post external ventricular drainage, occluded Operative Method External ventricular drainage, revision, via right Kocher point Specimen Count And Types Nil Pathology Nil Operative Findings Opening pressure was above 15cm H20. Light reddish CSf was drained with some small blood clot. Operative Procedures With endotrachela general anaesthesia, the patient was put in supine position. We removed previous EVD catheter. We scrubbed, disinfected, and then draped the scalp, and made skin incision along previous operation wound. We inserted EVD catheter, and closed the wound in layers. Operators P 杜永光 Assistants R4 曾峰毅 Indication Of Emergent Operation 哈燕平 (F,1950/08/01,61y7m) 手術日期 2010/12/28 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Pituitary tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:00 進入手術室 08:10 麻醉開始 08:50 誘導結束 09:00 抗生素給藥 09:10 手術開始 11:40 麻醉結束 11:40 手術結束 11:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經由蝶竇之腦下垂體瘤切除 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 記錄__ 手術科部: 外科部 套用罐頭: Transphenoid pituitary adenectomy 開立醫師: 游皓鈞 開立時間: 2010/12/28 12:04 Pre-operative Diagnosis Pituitary macroadenoma Post-operative Diagnosis Pituitary macroadenoma Operative Method Transphenoid pituitary adenectomy Specimen Count And Types nil Pathology nil Operative Findings 1. CSF leak was noted at sphenoid sinus 2. No definite tumor bulging was noticed. We checked the location of surgical mean by intraoperative C-arm but still did not discover the definite tumor lesion. Operative Procedures Under general anethesia and intubation, the patient was put in supine position. The facial skin was antiseptic with alcohol, and the mucosa of oral and nasal cavity with aqueous better-iodine. The face was covered with sterilized adhesive plastic sheets then draped. Under microscope, nasal septum was incised, and a nasal speculum was applied to displace the nasal mucosa laterally and keep the nasal cavity open constantly for the exposure of the vomer bone and the anterior wall of the sphenoid sinus. The anterior sphenoid wall, sphenoid sinus mucosa and sella floor were removed along with the sphenoidal portion of the adenoma. We checked the location of tumor and surgical means by intraoperative C-arm. But no definite tumor bulging or lesion was found. Therefore we closed the wound and the nasal mucosa was sealed with Tissuecol Duo. Operators 曾勝弘, Assistants R5鐘文桂, R1游皓鈞 記錄__ 手術科部: 外科部 套用罐頭: Transphenoid pituitary adenectomy 開立醫師: 游皓鈞 開立時間: 2010/12/29 08:27 Pre-operative Diagnosis Pituitary macroadenoma Post-operative Diagnosis Pituitary macroadenoma Operative Method Transphenoid approach to explore the pituitary tumor with nasal septal reconstruction Specimen Count And Types nil Pathology nil Operative Findings 1. CSF leak was noted at sphenoid sinus 2. No definite tumor bulging was noticed. We checked the location of surgical mean by intraoperative C-arm but still did not discover the definite tumor lesion. Operative Procedures Under general anethesia and intubation, the patient was put in supine position. The facial skin was antiseptic with alcohol, and the mucosa of oral and nasal cavity with aqueous better-iodine. The face was covered with sterilized adhesive plastic sheets then draped. Under microscope, nasal septum was incised, and a nasal speculum was applied to displace the nasal mucosa laterally and keep the nasal cavity open constantly for the exposure of the vomer bone and the anterior wall of the sphenoid sinus. The anterior sphenoid wall, sphenoid sinus mucosa and sella floor were removed along with the sphenoidal portion of the adenoma. We checked the location of tumor and surgical means by intraoperative C-arm. But no definite tumor bulging or lesion was found. Therefore we closed the wound and the nasal mucosa was sealed with Tissuecol Duo. Operators 曾勝弘, Assistants R5鐘文桂, R1游皓鈞 記錄__ 手術科部: 外科部 套用罐頭: Transphenoid pituitary adenectomy 開立醫師: 鍾文桂 開立時間: 2010/12/29 09:21 Pre-operative Diagnosis Pituitary macroadenoma Post-operative Diagnosis Pituitary macroadenoma Operative Method Transphenoid pituitary adenectomy Specimen Count And Types nil Pathology nil Operative Findings 1. CSF leak was noted at sphenoid sinus 2. No definite tumor bulging was noticed. We checked the location of surgical mean by intraoperative C-arm but still did not discover the definite tumor lesion. Operative Procedures Under general anethesia and intubation, the patient was put in supine position. The facial skin was antiseptic with alcohol, and the mucosa of oral and nasal cavity with aqueous better-iodine. The face was covered with sterilized adhesive plastic sheets then draped. Under microscope, nasal septum was incised, and a nasal speculum was applied to displace the nasal mucosa laterally and keep the nasal cavity open constantly for the exposure of the vomer bone and the anterior wall of the sphenoid sinus. The anterior sphenoid wall, sphenoid sinus mucosa and sella floor were removed along with the sphenoidal portion of the adenoma. We checked the location of tumor and surgical means by intraoperative C-arm. But no definite tumor bulging or lesion was found. Therefore we closed the wound and the nasal mucosa was sealed with Tissuecol Duo. Operators 曾勝弘, Assistants R5鍾文桂, R1游皓鈞 莊美麗 (F,1958/11/04,53y4m) 手術日期 2010/12/28 手術主治醫師 曾勝弘 手術區域 東址 005房 02號 診斷 Back mass 器械術式 Scalp tumor Suture 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 游皓鈞, 時間資訊 00:00 臨時手術NPO 11:40 報到 12:05 進入手術室 12:10 麻醉開始 12:15 誘導結束 12:25 抗生素給藥 13:00 手術開始 14:45 手術結束 14:45 麻醉結束 14:50 送出病患 14:55 進入恢復室 16:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 皮下腫瘤摘除術大於 4CM 1 1 記錄__ 手術科部: 外科部 套用罐頭: Tumor excision 開立醫師: 游皓鈞 開立時間: 2010/12/28 14:40 Pre-operative Diagnosis Subcutaneous tumor at C4 or C5 level Post-operative Diagnosis Subcutaneous tumor at C5 level Operative Method Tumor excision Specimen Count And Types 1 piece About size:6*6 cm Source:subcutaneous tumor Pathology pending Operative Findings One 8*8 cm soft and fatty subcutaneous tumor around C4 or C5 level Operative Procedures 1. ETGA with prone position 2. Disinfected and drapped as usual 3. One midline vertical incision from the top to the bottom of the tumor 4. Dissected to the depth of the tumor and then aparted the tumor by self-retractor 4. Excised the right part of the tumor with 1 cm margin below the skin then Removed. Excised the left part of the tumor by the same mean 5. Adequate hemostasis and irrigated with normal saline 6. Closed the wound in layers Operators 曾勝弘 Assistants R5鐘文桂, R1游皓鈞 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Tumor excision 開立醫師: 游皓鈞 開立時間: 2010/12/29 08:25 Pre-operative Diagnosis Subcutaneous tumor at the neck Post-operative Diagnosis Subcutaneous tumor at the neck Operative Method Tumor excision Specimen Count And Types 1 piece About size:6*6 cm Source:subcutaneous tumor Pathology pending Operative Findings One 8*8 cm soft and fatty subcutaneous tumor around C4 or C5 level Operative Procedures 1. ETGA with prone position 2. Disinfected and drapped as usual 3. One midline vertical incision from the top to the bottom of the tumor 4. Dissected to the depth of the tumor and then aparted the tumor by self-retractor 4. Excised the right part of the tumor with 1 cm margin below the skin then Removed. Excised the left part of the tumor by the same mean 5. Adequate hemostasis and irrigated with normal saline 6. Closed the wound in layers Operators 曾勝弘 Assistants R5鐘文桂, R1游皓鈞 相關圖片 涂玉盞 (F,1956/10/01,55y5m) 手術日期 2010/12/28 手術主治醫師 曾勝弘 手術區域 東址 005房 03號 診斷 Trigeminal neuralgia (Cranial nerve V) 器械術式 Radiofrequency coagulation 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 面罩麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 游皓鈞, 時間資訊 00:00 臨時手術NPO 14:15 報到 15:00 進入手術室 15:05 麻醉開始 15:10 誘導結束 15:20 抗生素給藥 15:20 手術開始 16:23 手術結束 16:23 麻醉結束 16:28 送出病患 16:30 進入恢復室 17:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 高頻熱凝療法 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Semi-opened mask inhalation anes 1 0 記錄__ 手術科部: 外科部 套用罐頭: radiofrequency coagulation 開立醫師: 游皓鈞 開立時間: 2010/12/28 16:37 Pre-operative Diagnosis trigeminal neuralgia Post-operative Diagnosis trigeminal neuralgia Operative Method radiofrequency coagulation Specimen Count And Types nil Pathology nil Operative Findings The position of the RF needle was found to be 5 mm below the sellar floor and at the clivus. Stimulation with 50 Hz, 1 ms, and up to 0.4 V reproduced facial pain and numbness at right V3 territory. Stimulation with 2 Hz, 1 ms, up to 0.5 Volt did not produce contraction of jaw or ocular movement. Lesioning was made with 80 degrees Celsius for 90 seconds. Operative Procedures Operators 曾勝弘 Assistants 游皓鈞 記錄__ 手術科部: 外科部 套用罐頭: radiofrequency coagulation 開立醫師: 游皓鈞 開立時間: 2010/12/28 16:42 Pre-operative Diagnosis trigeminal neuralgia Post-operative Diagnosis trigeminal neuralgia Operative Method radiofrequency(RF) coagulation Specimen Count And Types nil Pathology nil Operative Findings The position of the RF needle was found to be 5 mm below the sellar floor and at the clivus. Stimulation with 50 Hz, 1 ms, and up to 0.4 V reproduced facial pain and numbness at right V3 territory. Stimulation with 2 Hz, 1 ms, up to 0.5 Volt did not produce contraction of jaw or ocular movement. Lesioning was made with 60 degrees Celsius for 60 seconds and 80 degrees Celsius for 90 seconds. Operative Procedures 1. IVGA, supine, face disinfected with Hibitane solution. 2. Insertion of RF needle at a point 3 cm lateral to the oral commissure, into the left foramen ovale. The position was confirmed by C-arm fluoroscopy. 3. RF stimulation to confirm the left V3 territory was stimulated while the motor function of V nerve was not elicited. 4. RF lesioning: 60 degrees celsius for 60 seconds and 80 degrees Celsius for 90 seconds. 5. The needle was removed and the needle puncture site was taped with a bandaide. Operators 曾勝弘 Assistants 游皓鈞 記錄__ 手術科部: 外科部 套用罐頭: radiofrequency coagulation 開立醫師: 游皓鈞 開立時間: 2010/12/28 16:42 Pre-operative Diagnosis trigeminal neuralgia, left Post-operative Diagnosis trigeminal neuralgia, left Operative Method radiofrequency(RF) coagulation Specimen Count And Types nil Pathology nil Operative Findings The position of the RF needle was found to be 5 mm below the sellar floor and at the clivus. Stimulation with 50 Hz, 1 ms, and up to 0.4 V reproduced facial pain and numbness at right V3 territory. Stimulation with 2 Hz, 1 ms, up to 0.5 Volt did not produce contraction of jaw or ocular movement. Lesioning was made with 60 degrees Celsius for 60 seconds and 80 degrees Celsius for 90 seconds. Operative Procedures 1. IVGA, supine, face disinfected with Hibitane solution. 2. Insertion of RF needle at a point 3 cm lateral to the oral commissure, into the left foramen ovale. The position was confirmed by C-arm fluoroscopy. 3. RF stimulation to confirm the left V3 territory was stimulated while the motor function of V nerve was not elicited. 4. RF lesioning: 60 degrees celsius for 60 seconds and 80 degrees Celsius for 90 seconds. 5. The needle was removed and the needle puncture site was taped with a bandaide. Operators 曾勝弘 Assistants 游皓鈞 余承軒 (M,1974/02/12,38y1m) 手術日期 2010/12/28 手術主治醫師 賴達明 手術區域 東址 003房 號 診斷 Spinal tumor 器械術式 Intraspinal intramedullary tum 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 黃鼎鈞, 時間資訊 00:00 臨時手術NPO 07:42 報到 08:03 進入手術室 08:15 麻醉開始 08:45 誘導結束 09:00 抗生素給藥 09:30 手術開始 12:00 抗生素給藥 12:30 麻醉結束 12:30 手術結束 12:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 手術 良性脊髓腫瘤切除術 1 1 手術 椎弓整形術 1 2 記錄__ 手術科部: 外科部 套用罐頭: Right C5~7 laminoplasty and T1 laminectomy fo... 開立醫師: 胡朝凱 開立時間: 2010/12/28 12:52 Pre-operative Diagnosis Right C5~T1 epidural tumor Post-operative Diagnosis Right C5~T1 epidural tumor Operative Method Right C5~7 laminoplasty and T1 laminectomy for total tumor excision Specimen Count And Types whole piece of tumor Pathology pending Operative Findings 1.One about 5x3 cm elastic firm, whitish to yellowish timor located at C5~T1 level epidurally with clear margin. 2.No obvious nerve root adhesion was noted 3.C5~7 nerve roots were identified and preserved. 4.Intra-op SSEP remained the same. 4.Intra-op SSEP remained the same. 5.The cord was compressed to left tightly, and after tumor removal, the cord became loose. Operative Procedures 1.ETGA, prone with head fixed with skull clamp 2.Midline skin incsion at C5~ T2 level 3.Detach paravertebral muscle to expose C5~T2 lamina 4.T1 laminectomy 5.Tumor biopsy and sent to frozen 6.C5~7 laminoplasty with the axis left at left 7.Epidural tumor removal with currete dissection along with the interface of tumor and dura 8.Identified nerve roots then preserved them 9.Fixed miniplate 10.Set one hemovac drain then close wound in layers Operators 賴達明 Assistants 胡朝凱, 黃鼎鈞 林俊雄 (M,1946/08/25,65y6m) 手術日期 2010/12/28 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Cervical Spondylosis 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 黃鼎鈞, 時間資訊 00:00 臨時手術NPO 12:23 報到 13:00 進入手術室 13:05 麻醉開始 13:15 誘導結束 13:25 抗生素給藥 13:55 手術開始 16:25 抗生素給藥 16:45 手術結束 16:45 麻醉結束 16:55 送出病患 16:58 進入恢復室 18:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-頸椎 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 記錄__ 手術科部: 外科部 套用罐頭: Anterior cervical discectomy and fusion with ... 開立醫師: 胡朝凱 開立時間: 2010/12/28 17:01 Pre-operative Diagnosis C3~5 HIVD Post-operative Diagnosis C3~5 HIVD Operative Method Anterior cervical discectomy and fusion with autologous bone Specimen Count And Types Nil Pathology nil Operative Findings 1.protrusion disc that compressed the spinal cord tightly at C3~5 level. 2.The PLL became thick 3.Marginal spur: (+) 4.The disc was dehydrated Operative Procedures 1.ETGA, supine 2.Right neck transverse skin incision at level between hydoid bone and thyroid bone 2.Dissect along with the anterior border of SCM muscle 3.Expose preverterbal space 4.Detach longus coli muscle 5.Discectomy was done with currete and kerrison pounch 6.Remove PLL 7.Harvest two autologous bone from right anterior superior iliac crest 8.Insert autologous bone 9.Set one minihemovac then close wound in layers Operators 賴達明 Assistants 胡朝凱, 黃鼎鈞 朱戴雪花 (F,1937/03/11,75y0m) 手術日期 2010/12/28 手術主治醫師 賴達明 手術區域 東址 002房 05號 診斷 Lumbar Spondylosis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳睿生, 時間資訊 00:00 臨時手術NPO 15:15 報到 15:25 進入手術室 15:30 麻醉開始 15:40 誘導結束 16:20 抗生素給藥 16:40 手術開始 19:20 抗生素給藥 19:35 手術結束 19:35 麻醉結束 19:45 送出病患 19:48 進入恢復室 01:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎間盤切除術-腰椎 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 摘要__ 手術科部: 外科部 套用罐頭: L4-S1 posteriolateral fusion with transpedicu... 開立醫師: 陳睿生 開立時間: 2010/12/28 20:13 Pre-operative Diagnosis L4/5, L5/S1 spondylolithesis, grade I; with stenosis Post-operative Diagnosis L4/5, L5/S1 spondylolithesis, grade I; with stenosis Operative Method L4-S1 posteriolateral fusion with transpedicular screws, L4/5 diskectomy and cage fusion , and L5/S1 laminotomy for decompression Specimen Count And Types nil Pathology Nil Operative Findings L4-S1 grade I spondylolithesis was noted and the thecal sac, roots were tightly compressed. The left side L4/5 facet joints was removed for diskectomy. LEft side L5-S1 laminotomy was done and ligamentum flavum was removed for decompression. Synthes TPS: 6.2 x 40 mm over L4, 5; and 7.0 x 35 mm over S1; 6 cm rods x2; crosslink x1 Banana PEEK cage: 13mm Operative Procedures 1. ETGA, prone position and C-arm localize the L4-S1 level 2. Low back incision and split bilateral paraspinal muscle 3. Expose the L4-S1 lamina and spinous process 4. Insert L4-S1 transpedicular screws under C-arm 5. L4-5 laminotomy and remove of left side facet joints 6. L4/5 diskectomy and insert a 13mm banana cage under C-arm recheck 7. L5-S1 left side laminotomy, and remove ligamentum flavum for decompression 8. Fix bilateral rods and crosslink 9. Set a 1/8 hemovac and close the wound in layers Operators VS 賴達明 Assistants R6 陳睿生; R3 游健生 鄭國龍 (M,1964/10/11,47y5m) 手術日期 2010/12/29 手術主治醫師 杜永光 手術區域 東址 009房 04號 診斷 Subarachnoid hemorrhage (SAH) 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 李振豪, 時間資訊 04:00 臨時手術NPO 04:00 開始NPO 13:13 通知急診手術 14:50 進入手術室 14:50 麻醉開始 15:10 誘導結束 15:20 抗生素給藥 15:27 手術開始 16:35 手術結束 16:35 麻醉結束 16:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 腦室體外引流 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: External ventricular drainage via right Koche... 開立醫師: 李振豪 開立時間: 2010/12/29 17:39 Pre-operative Diagnosis Subarachnoid hemorrhage with hydrocephalus Post-operative Diagnosis Subarachnoid hemorrhage with hydrocephalus Operative Method External ventricular drainage via right Kocher"s point Specimen Count And Types 1 piece About size:10ml Source:CSF for routine, BCS, and bacterial culture Pathology Nil Operative Findings The brain parenchyma bulging out after dura opening. The opening pressure after ventricular puncture is more than 30cmH2O. The CSF was light reddish with some debris. The EVD was fixed at 7cm in depth. The pupil size was R/L 3mm/2mm without light reflex after whole procedure. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine position. The scalp was shaved, scrubbed, and disinfected as usual. The linear scalp incision was made at right frontal area followed by one burr hole creation. Two dural tenting was done. 100ml Mannitol was given intra-operatively. The dura was opened with cruciform in shape and ventricular puncture was performed with ventricular needle. The EVD tube was inserted and fixed at 7cm in depth. Hemostasis was achieved and the wound was then closed in layers. Operators Prof. 杜永光 Assistants R4 李振豪 Indication Of Emergent Operation 相關圖片 肖雅君 (F,1955/11/19,56y3m) 手術日期 2010/12/29 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Brain tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 08:02 進入手術室 08:10 麻醉開始 08:45 誘導結束 08:50 抗生素給藥 10:10 手術開始 11:50 抗生素給藥 15:10 手術結束 15:10 麻醉結束 15:13 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 經由蝶竇之腦下垂體瘤切除 1 1 摘要__ 手術科部: 外科部 套用罐頭: Trans-sphenoid approach for tumor excision 開立醫師: 游健生 開立時間: 2010/12/29 15:55 Pre-operative Diagnosis Pituitary macroadenoma Post-operative Diagnosis sellar tumor, favor meningioma Operative Method Trans-sphenoid approach for tumor excision Specimen Count And Types a fe pieces About size: 1x1cm Source: sellar tumor Pathology Pending Operative Findings A 1.5cm yellowish elastic tumor was noted at sellar cavity. The outer dura was hypervascularized. Tumor was in between the two layer of dura at sellar. Venous bleeding probably from cavernous sinus was noted. Intra-operative CSF leak was noted and sealed by Gelfoam packing and Tissucol Duo. Operative Procedures Under ETGA, patient was in supine with head tilted 30 degree to left. The face and abdomen were prepared with povidone-iodine alcohol tincture, and the mucosa of oral and nasal cavity with aqueous povidone-iodine tincture. Both areas were covered by sterilized adhesive plastic sheet. The nasal mucosa at anterior wall of sphenoid sinus and posterior vomer of both nostril was cauterized and removed. The anterior wall of sphenoid sinus and posterior vomer was drilled. The mucosa of sphenoid sinus was removed followed by drilling of posterior wall of sphenoid sinus. When we enlarged the opening of sellar floor, large venous bleeding was encountered. We confirmed our dissection direction by intra-operative C-arm. However, due to continuous bleeding and nasal mucosa swelling, we converted to microscopic approach. The nasal submucosa at septum was incised and dissected subperiosteallly and lifted from anterior to posterior and displaced laterally by a long nasal speculum. A Hardys nasal speculum was applied to displace the nasal mucosa laterally and keep the nasal cavity open constantly for the exposure of the opened sphenoid sinus. The sellar floor dura was coagulated with bipolar forceps, then opened in cruciate fashion. The elastic tumor parenchyma was removed by aligator and curette. Intra-operative disruption of arachnoid membrane was noted. We tired to curette bilateral part of tumor but encoutered venous bleeding. Cavernous sinus bleeding was suspected and controlled by Gelfoam packing. We left the rest of tumor in situ. The sellar cavity was packed by Gelfoam and sealed with Tissucol Duo. Sellar floor was reconstructed by bone grafts. The Hardys nasal speculum was removed and the nasal mucosa returned to its normal position. Each side of the nasal cavities was tightly packed with a Better-iodine ointment soacked Merocel. We inserted a lumbar drain via midline approach finally. Operators Prof. 杜永光 VS 楊士弘 Assistants R6 陳睿生 R3 游健生 林水溳 (M,1949/12/16,62y2m) 手術日期 2010/12/29 手術主治醫師 杜永光 手術區域 東址 003房 02號 診斷 Ossification of posterior longitudinal ligament (OPLL) (OPLL) 器械術式 Lamino plasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 15:15 報到 15:40 進入手術室 15:45 麻醉開始 15:55 誘導結束 16:30 手術開始 16:35 抗生素給藥 19:35 抗生素給藥 20:30 手術結束 20:30 麻醉結束 20:43 進入恢復室 20:45 送出病患 22:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓整形術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 摘要__ 手術科部: 外科部 套用罐頭: Laminoplasty, C3-4, and partial laminectomy, C2 開立醫師: 游健生 開立時間: 2010/12/29 21:04 Pre-operative Diagnosis Ossefication of posterior longitudinal ligament with cervical stenosis, C2-4 Post-operative Diagnosis Ossefication of posterior longitudinal ligament with cervical stenosis, C2-4 Operative Method Laminoplasty, C3-4, and partial laminectomy, C2 Specimen Count And Types nil Pathology Nil Operative Findings There was osseficaiton of posterior longitudinal ligament resulting in stenosis of spinal canal from C2 to C4. After decompression, the thecal sac was well decompressed. Operative Procedures Under ETGA, patient was in prone position with head fixed with Mayfield headclamp. His neck was flexed and shoulder retracted backward. After shaving, we disinfected and draped the operation field as usual. Midline incision from 1cm below inion to C5 level. Paraspinal muscles were detached along midline to expose the laminae and spinous processes. C2-4 spinous processes were removed followed by partial laminectomy of inferior C2 laminea. Left lateral border of C3-4 laminea was drilled deep to bone marrow. Right lateral border of C3-4 laminea was drilled through inner cortex. The ligamentum flavum was removed. A 4-hole mini-plate was used to bridge between C3 lamina and lateral mass on right side. A bone graft was put in between. Similar procedure was done on C4. Finally, some bone grafts were placed on left lateral border as posterolateral fusion. After hemostasis, a epilaminar CWV was placed. Wound was closed in layers. Operators Prof. 杜永光 Assistants R6 陳睿生 R3 游健生 李婉如 (F,1983/09/15,28y5m) 手術日期 2010/12/29 手術主治醫師 李崇維 手術區域 東址 000房 號 診斷 器械術式 Other RAD exam/intervention 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 范守仁 ASA 3 時間資訊 16:00 通知急診手術 00:00 開始NPO 08:50 麻醉開始 08:55 誘導結束 09:47 進入恢復室 12:05 離開恢復室 歐莉莉 (F,1947/07/11,64y8m) 手術日期 2010/12/29 手術主治醫師 曾漢民 手術區域 東址 005房 03號 診斷 Brain cancer 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳蔚蔚, 時間資訊 00:00 臨時手術NPO 13:30 進入手術室 13:40 麻醉開始 14:10 誘導結束 14:22 手術開始 20:20 手術結束 20:20 抗生素給藥 20:20 麻醉結束 20:25 送出病患 20:25 抗生素給藥 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4~8小時 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Right parietal-occipital craniotomy for total... 開立醫師: 胡朝凱 開立時間: 2010/12/29 20:44 Pre-operative Diagnosis Right parietal-occipital glioma Post-operative Diagnosis Right parietal-occipital glioma Operative Method Right parietal-occipital craniotomy for total tumor excision Specimen Count And Types Pieces of tumor Pathology pending Operative Findings 1.One about 5 x 4 cm grayish, elastic tumor was noted at right parietal-occipital junction without a clear margin. The tumor was hyperechoic on sonography. 2.The right lateral venttricle was exposed and tumor seeding on ventricular wall was noted. 3.Thalamus was also identified without damage. Operative Procedures Under ETGA, patient was put in prone position with head rotate to right and fixed with Mayfield skull clamp. U shape skin incision was done at right parietal to occipital area. Skin flap was dissected and opened. After burr holes drilled, craniotomy was performed as a 7x7 bone window one cm away from midline, followed by dural tenting. U shape dural incision was made with the base left at base. The tumor was excised by gently dissection through the suspicious interface between tumor and brain tissue. Vascular perforation was cauterized. EVD was inserted after exposure of lateral ventricle. Hemostasis was then performed. After then, dura was closed with prolene. After one CWV drain insertion, wound was closed in layers. Operators 曾漢民 Assistants 胡朝凱, 陳蔚蔚 林軒宇 (M,2008/08/03,3y7m) 手術日期 2010/12/29 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Hydrocephalus 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:10 進入手術室 08:15 麻醉開始 08:25 誘導結束 09:30 手術開始 11:00 手術結束 11:00 麻醉結束 11:07 送出病患 11:11 進入恢復室 12:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 腦室腹腔分流手術 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt via left Kocher"s ... 開立醫師: 李振豪 開立時間: 2010/12/29 11:28 Pre-operative Diagnosis Hydrocephalus Hydrocephalus, S/P VP shunt and CP shunt with infection, S/P ommaya then EVD Post-operative Diagnosis Hydrocephalus Hydrocephalus, S/P VP shunt and CP shunt with infection, S/P ommaya then EVD Operative Method Ventriculoperitoneal shunt via left Kocher"s point Specimen Count And Types 1 piece About size:15ml Source:CSF Pathology Nil Operative Findings The opening pressure was more than 20cmH2O. The CSF was light xanthochromic but not turbid. 10mg/5ml Vancomycin solution was used for intrathecal injection. Metronic adult burr hole type high pressure reservoir(110~170mmH2O) was used for V-P shunt. The length of ventricular and peritoneal catheter was 6.5cm and 30cm respectively. The opening pressure was more than 20cmH2O. The CSF was light xanthochromic but not turbid. 10mg/5ml Vancomycin solution was used for intrathecal injection. Metronic adult burr hole type high pressure reservoir(110~170mmH2O) was used for V-P shunt. The length of ventricular and peritoneal catheter was 6.3cm and 30cm, respectively. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine position with head rotated to right. The scalp was shaved, scrubbed, and disinfected as usual. The C-shape scalp incision was made at left frontal area followed by one burr hole creation at Kocher"s point. Two dural tenting was done. The dura was opened with cruciform fashion followed by ventriculostomy with ventricular needle. The Nelaton catheter was inserted into left lateral ventricle and intrathecal 10mg Vancomycin injection was done. The Nelaton catheter was clamp for 20~30 minutes. Under endotracheal tube general anesthesia, the patient was put in supine position with head rotated to right. The scalp was shaved, scrubbed, and disinfected as usual. The C-shape scalp incision was made at left frontal area followed by one burr hole creation at Kocher"s point. Two dural tenting was done. The dura was opened with cruciform fashion followed by ventriculostomy with ventricular needle. The Nelaton catheter was inserted into left lateral ventricle and intrathecal 10mg Vancomycin injection was doneand retained there for about 20-30 minutes. Left upper abdomen transverse skin incision was made and the subcutaneous soft tissue was dissected to expose the fascia of the rectus abdominis. The fascia was opened and the muscle was splitted. Minilaparotomy was performed and the peritoneal catheter was placed under direct vision. One subcutaneous tunnel was created from left upper abdomen, left forechest, left neck, and retroauricular area. One 1cm skin incision was made at left temporal area. The peritoneal catheter was passed through the subcutaneous tunnel and connected to the scalp wound. The V-P shunt was set up with Metronic high pressure reservoir and ventricular catheter. The Nelaton catheter was removed and the ventricular catheter was inserted into the lateral ventricle. The reservoir was fixed with 3 sutures. Hemostasis was achieved with Gelform packing and bipolar electrocautery. The wound was then closed in layers with 3-0 Vicryl and 4-0 Nylon. Operators AP郭夢菲 Assistants R4李振豪, Ri范齡勻 相關圖片 游宏達 (M,1953/09/08,58y6m) 手術日期 2010/12/29 手術主治醫師 賴達明 手術區域 東址 005房 02號 診斷 Sciatica 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳蔚蔚, 時間資訊 00:00 臨時手術NPO 10:40 進入手術室 10:45 麻醉開始 10:50 誘導結束 11:15 抗生素給藥 11:30 手術開始 13:10 手術結束 13:10 麻醉結束 13:18 送出病患 13:20 進入恢復室 14:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 椎間盤切除術-頸椎 1 1 記錄__ 手術科部: 外科部 套用罐頭: Bilateral laminotomy for sublaminar decompression 開立醫師: 胡朝凱 開立時間: 2010/12/29 13:17 Pre-operative Diagnosis L4~5 foraminal stenosis Post-operative Diagnosis L4~5 foraminal stenosis Operative Method Bilateral laminotomy for sublaminar decompression Specimen Count And Types nil Pathology nil Operative Findings 1.Hypertrophic flavum ligment that compressed the L5 nerve roots tightly 2.The roots were injected, after decompression, roots became loose 3.A small piece of ruptured disc was noted at right L4~5 level Operative Procedures 1.ETGA, prone 2.Midline skin incision at L4~5 level 3.Detach bilateral paravertebral muscle 4.Expose bilateral L4~5 lamina 5.Laminotomy 6.Remove flavum ligment 7.Identified nerve roots 8.hemostasis 9.close wound in layers Operators 賴達明 Assistants 胡朝凱, 陳蔚蔚 張富翔 (M,1967/08/25,44y6m) 手術日期 2010/12/29 手術主治醫師 陳敞牧 手術區域 東址 005房 01號 診斷 Malignant neoplasm of kidney, except pelvis 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳蔚蔚, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:03 進入手術室 08:08 麻醉開始 08:13 誘導結束 09:10 手術開始 10:20 手術結束 10:20 麻醉結束 10:30 送出病患 10:32 進入恢復室 11:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦脊髓液分流管重置 1 1 B 記錄__ 手術科部: 外科部 套用罐頭: Left programmable shunt insertion and right s... 開立醫師: 胡朝凱 開立時間: 2010/12/29 10:36 Pre-operative Diagnosis Subdural shunt obstruction and hydrocephalus Post-operative Diagnosis Subdural shunt obstruction and hydrocephalus Operative Method Left programmable shunt insertion and right subdural catheter revision Specimen Count And Types CSF tubes x 4 Pathology nil Operative Findings 1.Opening pressure: around 15 cmH2O 2.Previous programmable shunt obstruction with hematoma and debris 3.Codman programmable shunt setting: 10 cmH2O was inserted at left ventricle 4.The subdural drain was change into catheter without valve 5.Clear CSF Operative Procedures 1.ETGA, supine 2.Right temporal previous wound open 3.Left froontal burr hole previous wound opening 4.Pass subcutaneous catheter and connect to programmable shunt 5.Connect cathter to Y connector and then subdural catheter 6.Ventricular puncture 7.Insert ventricular catheter and subdural catheter 8.Close wound in layers Operators 陳敞牧 Assistants 胡朝凱, 陳蔚蔚 潘以宏 (M,1922/09/24,89y5m) 手術日期 2010/12/29 手術主治醫師 蔡翊新 手術區域 東址 010房 06號 診斷 Subdural hemorrhage following injury, with loss of consciousness of unspecified duration 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 4E 紀錄醫師 游皓鈞, 時間資訊 12:36 臨時手術NPO 12:36 開始NPO 15:00 報到 15:25 進入手術室 15:30 麻醉開始 15:45 誘導結束 16:07 手術開始 18:00 抗生素給藥 18:37 開始輸血 20:05 麻醉結束 20:05 手術結束 20:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 急性硬腦膜下血腫清除術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 慢性硬腦膜下血腫清除術 1 2 L 摘要__ 手術科部: 外科部 套用罐頭: Chronic Subdural Hematoma 開立醫師: 曾峰毅 開立時間: 2010/12/29 16:58 Pre-operative Diagnosis Right subacute subdural hematoma; left chronic subdural hematoma Post-operative Diagnosis Right chronic subdural hematoma, left subdural effusion, suspected external hydrocephalus Right subacute subdural hematoma, left subdural effusion, suspected external hydrocephalus Operative Method Bilateral frontal burr hole for subdural drainage Right parieto-temporal craniotomy for removal of subdural hematoma; left frontoparietal burr hole for drainage of subdural effusion. Specimen Count And Types Nil Pathology Nil Operative Findings Clear, colorless sudbural effusion was noted at left, and dark-brownish, motor-oil-like subdural fluid at right with outer and inner membrane and septation. Clear, colorless subdural effusion was noted at left side. Dark-reddish, motor oil-like subdural fluid gushed out at right side burr hole creation. There were much fibrin debris and blood clots washed out during normal saline irrigation to the subdural space. So craniotomy was performed and fibrin septation and semi-liquid and solid blood clots were evacuated. Easy oozing from raw surface of septation was noted. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head in neutral position. After scalp shaved, scrubbed, disinfected, and then draped, we made one transverse skin incision at frontal area of each side. We drilled one burr hole and created durotomy at each side. Subdural drainage and irrigation with saline was performed. We inserted one rubber drain at subdural space, and closed the wound in layers. We de-air the subdural space with saline. With endotracheal general anaesthesia, the patient was put in supine position with head slightly tilted to left. After scalp shaved, scrubbed, disinfected, and then draped, we made one transverse skin incision at frontotemporal area of each side. We drilled one burr hole and created durotomy at each side. Subdural drainage and irrigation with saline was performed. We inserted one rubber drain at left subdural space and connected it to a reservoir bag. Craniotomy at right parietotemporal, 7 x 5 cm, was performed by creating 3 burr holes. The dura was opened in a curvilinear fashion along the edge of craniotomy window. Subdural blood clots were evacuated by suction. Hemostasis was performed with bipolar coagulator and packing with Surgicel. A subdural drain (EVD tube) was placed and connected to a dripping chamber and a reservoir bag. The dura was closed with 4-0 Prolene in a water-tight fashion. The bone plate was placed back and fixed with 3 miniplates and 6 screws. An epidural CWV was placed. The wound was closed in layers. Operators VS 蔡翊新 Assistants R4 曾峰毅 R1 游皓鈞 Indication Of Emergent Operation 黃郁惠 (F,1970/11/09,41y4m) 手術日期 2010/12/30 手術主治醫師 杜永光 手術區域 東址 005房 03號 診斷 Arteriovenous malformation, brain 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2E 紀錄醫師 鍾文桂, 時間資訊 14:06 通知急診手術 14:07 開始NPO 14:07 臨時手術NPO 14:44 進入手術室 14:50 麻醉開始 15:00 誘導結束 15:03 開始輸血 15:30 抗生素給藥 15:41 手術開始 16:15 手術結束 16:15 麻醉結束 16:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室體外引流 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Insertion of external ventricular drainage ca... 開立醫師: 鍾文桂 開立時間: 2010/12/30 17:35 Pre-operative Diagnosis Right frontal-parietal arteriorvenous malformation with intracerebral hemorrhage,and intraventricular hemorrhage. Post-operative Diagnosis Right frontal-parietal arteriorvenous malformation with intracerebral hemorrhage,and intraventricular hemorrhage. Operative Method Insertion of external ventricular drainage catheter, right Kocher. Insertion of external ventricular drainage catheter, left Kocher. Ventriculostomy, left Kocher. Specimen Count And Types 1 piece About size:CSF Source:for routine, culture, and BCS Pathology Nil. Operative Findings CSF: pinkish, clear. Pressure: 5 cmH2O. Right Kocher EVD, Medtronic 3.0,6.5 cm in depth. Left Kocher EVD, Medtronic 3.0,6.5 cm in depth. Operative Procedures Under ETGA, the patient was placed in supine position and head in midline. After shaving, disinfection, and draping, the curvilinear incision was made at right Kocher point. After creating a burr hole and durotomy, the ventriculostomy was done. Then, the EVD catheter was inserted through the same tract. After collecting CSF for study, the wound was closed in layers. Under ETGA, the patient was placed in supine position and head in midline. After shaving, disinfection, and draping, the curvilinear incision was made at right Kocher point. After creating a burr hole and durotomy, the ventriculostomy was done. Then, the EVD catheter was inserted through the same tract. After collecting CSF for study and connecting the catheter to the closed drainage system, the wound was closed in layers. Under ETGA, the patient was placed in supine position and head in midline. After shaving, disinfection, and draping, the curvilinear incision was made at left Kocher point. After creating a burr hole and durotomy, the ventriculostomy was done. Then, the EVD catheter was inserted through the same tract. After collecting CSF for study and connecting the catheter to the closed drainage system, the wound was closed in layers. Operators Prof 杜永光 Assistants R6陳睿生 R5鍾文桂 Indication Of Emergent Operation 宋炎輝 (M,1951/06/21,60y8m) 手術日期 2010/12/30 手術主治醫師 杜永光 手術區域 東址 005房 02號 診斷 Aneurysm 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 李振豪, 時間資訊 00:35 臨時手術NPO 10:10 進入手術室 10:15 麻醉開始 10:18 誘導結束 11:11 手術開始 14:10 手術結束 14:10 麻醉結束 14:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 手術 腦室腹腔分流手術 1 1 B 摘要__ 手術科部: 內科部 套用罐頭: Bilateral subduro-peritoneal shunt 開立醫師: 李振豪 開立時間: 2010/12/30 14:36 Pre-operative Diagnosis Bilateral sbudural collection, suspect subdural effusion Post-operative Diagnosis Bilateral subdural effusion Operative Method Bilateral subduro-peritoneal shunt Specimen Count And Types 1 piece About size:10ml Source:Subdural collection for routine, BCS, and bacterial culture Pathology Nil Operative Findings The opening pressure was more than 15cmH2O after dural opening. The subdural effusion was light xanthochromic in character. The effusion was not turbid or increase viscotisy. The subdural catheters over bilateral subdural space was connected with one Y connector. The subdural catheter was 6cm in depth bilaterally. The peritoneal catheter was 30cm in length. No fixed pressure reservoir was placed. Operative Procedures Under tracheal tube general anesthesia, the patient was put in supine position. The scalp was shaved, scrubbed, and disinfected as usual. The scalp incision was made over right temporal area and previous op wound over left frontal area. One burr hole was created over right temporal area. The burr hole over left frontal area was extended toward forehead to reach the location of the subdural effusion. Dural tenting was performed with total 4 stitches. One transverse skin incision was made at right upper abdomen. The subcutaneous soft tissue was dissected and the fascia of rectus abdominis was opened. Minilaparotomy was performed. The subcutaneous tunnel was created from right upper abdomen, right forechest, right neck, to right retroauricular area. The peritoneal catheter was passed throught the tunnel. The dura was opened with cruciform in shape. The subdural catheter was placed into bilateral subdural space. After sampling of subdural effusion for study, the subdural catheters and peritoneal catheter were connected to the Y connector. Hemostasis was achieved with bipolar electrocautery and Gelform packing. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators Prof. 杜永光 Assistants R4李振豪, Ri陳怡穎 相關圖片 李建國 (M,1950/02/01,62y1m) 手術日期 2010/12/30 手術主治醫師 王國川 手術區域 東址 001房 01號 診斷 Intracerebral hemorrhage 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 4E 紀錄醫師 黃鼎鈞, 時間資訊 08:49 開始NPO 08:49 通知急診手術 08:53 進入手術室 08:55 麻醉開始 09:00 抗生素給藥 09:05 誘導結束 09:15 手術開始 09:30 開始輸血 11:30 手術結束 11:30 麻醉結束 11:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 硬腦膜外血腫清除術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 神經部 套用罐頭: Left craniotomy for EDH evacuation 開立醫師: 胡朝凱 開立時間: 2010/12/30 12:02 Pre-operative Diagnosis Left parietal-occipital-occipital junction EDH Post-operative Diagnosis Left parietal-occipital-occipital junction EDH Operative Method Left craniotomy for EDH evacuation Specimen Count And Types nil Pathology nil Operative Findings 1.Around 200 ml Hematoma located at left parietal-occipital-occipital junction area was noted with tight brain compression. 2.There was no SDH 3.The left temporal bone fracture was noted and Middle Meningeal Artery was cut off and active bleeding. 4.High opening pressure after burr hole drill Operative Procedures 1.ETGA, right decubitus 2.Left parietal and occipital area reverse U shape skin incsion 3.Reflect skin flap downward 4.Burr hole drill 5.Craniotomy 6.Hematoma evacuation 7.Dural tenting 8.Dural opening 9.check bleeding 10.Set ICP monitor 11.Fixed bone back with wires after central tenting 12.set one CWV drain then close wound Operators 王國川 Assistants 胡朝凱, 黃鼎鈞 Indication Of Emergent Operation 吳彥徵 (F,1983/12/15,28y2m) 手術日期 2010/12/30 手術主治醫師 蔡翊新 手術區域 東址 005房 01號 診斷 Brain abscess 器械術式 External ventricular drainage 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 07:45 報到 08:07 進入手術室 08:15 麻醉開始 08:20 誘導結束 08:55 手術開始 09:30 手術結束 09:30 麻醉結束 09:35 送出病患 09:38 進入恢復室 10:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室體外引流 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: External ventricular drainage via right Koche... 開立醫師: 蔡翊新 開立時間: 2010/12/30 09:21 Pre-operative Diagnosis 1. Hydrocephalus, 2. Brain abscess s/p drainage and excision Post-operative Diagnosis 1. Hydrocephalus, 2. Brain abscess s/p drainage and excision Operative Method External ventricular drainage via right Kocher"s point Specimen Count And Types 3 tubes of CSF for routine, BCS, and bacterial culture Pathology Nil Operative Findings CSF: clear, pressure: 5 cmH2O. EVD depth: 6.5 cm below the cortical surface. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine position. The scalp was shaved, scrubbed, and disinfected as usual. Scalp incision was made along previous wound to expose the burr hole over right Kocher"s point. Ventricular needle was used to puncture the right frontal horn of lateral ventrial. An EVD tube was inserted via the tract. The wound was closed in layers. Operators VS蔡翊新 Assistants R4李振豪 相關圖片 蔡添財 (M,1956/04/05,55y11m) 手術日期 2010/12/30 手術主治醫師 杜永光 手術區域 東址 002房 01號 診斷 Lymphoma 器械術式 Ommaya reservoir implantation 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 游皓鈞, 時間資訊 23:05 臨時手術NPO 23:05 開始NPO 07:05 通知急診手術 09:22 報到 09:45 進入手術室 09:50 麻醉開始 09:55 誘導結束 09:58 抗生素給藥 10:30 手術開始 11:15 麻醉結束 11:15 手術結束 11:43 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 歐氏貯囊置放手術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Ommaya reservoir implantation 開立醫師: 游皓鈞 開立時間: 2010/12/30 10:57 Pre-operative Diagnosis Brain metastasis Post-operative Diagnosis Brain metastasis Operative Method Right Kocher point ommaya reservoir implantation Specimen Count And Types 1 piece About size:1 cc*3 Source:CSF Pathology Nil Operative Findings Clear CSF drained out after ventricular puncture. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position. The scalp was shaved, scrubbed, antiseptic with alcohol B-I then draped. A curvilinear skin incision was made at right frontal region followed by burr hole creation. The dura was incised after tenting with 3-0 silk. A ventricular puncture needle was used to puncture then shifted to the ommaya reservoir. After checked the reservoir function, the wound was closed in layers. Operators P杜永光, Assistants R5鍾文桂, R1游皓鈞 Indication Of Emergent Operation 相關圖片 王正忠 (M,1967/10/17,44y4m) 手術日期 2010/12/30 手術主治醫師 陳敞牧 手術區域 東址 002房 03號 診斷 Spinal stenosis, cervical 器械術式 Lamino plasty 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 15:09 進入手術室 15:15 麻醉開始 15:25 誘導結束 15:45 抗生素給藥 15:50 手術開始 18:55 抗生素給藥 19:00 手術結束 19:00 麻醉結束 19:05 送出病患 19:06 進入恢復室 20:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓整形術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 摘要__ 手術科部: 外科部 套用罐頭: C3-6 laminoplasty for decompression 開立醫師: 李振豪 開立時間: 2010/12/30 19:02 Pre-operative Diagnosis Cervical stenosis with myelopathy Post-operative Diagnosis Cervical stenosis with myelopathy Operative Method C3-6 laminoplasty for decompression Specimen Count And Types Nil Pathology Nil Operative Findings 1. The thecal sac was expanded well after laminoplasty. Left upper limb SSEP waveform was poor before the operation. No SSEP change noted after the procedure. 2. Miniplate: 5, 5, 6, and extended 4 holes, total 4 pieces Screws: 5mm screws x 8 7mm screws x 4 Operative Procedures Under endotracheal tube general anesthesia, the patient was put in prone position with head fixed with Mayfield scalp clamp. The scalp was shaved, scrubbed, and disinfected as usual. Midline skin incision was made from C2 to C7 level. The subcutaneous soft tissue and paravertebral muscle group were dissected and detached. The C2 to C7 spinous process and lamina was exposed. The high-speed air-drived drills were used to make two groove over bilateral C3 to C7 lamina. Laminoplasty was performed and fixed with miniplates and screws. The spinous process of C5 an C6 was harvested for autologous bone graft. The bone graft was fixed at miniplates with screws. Hemostasis was achieved with bipolar electrocautery and Gelform packing. One CWV drain was placed. The wound was then closed in layers with 2-0 vicryl and 3-0 Nylon. Operators VS陳敞牧 Assistants R4李振豪, Ri陳怡潁 許李秀冬 (F,1938/05/08,73y10m) 手術日期 2010/12/30 手術主治醫師 陳敞牧 手術區域 東址 003房 04號 診斷 Spine compression, sequelae 器械術式 Laminectomy for decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 18:35 進入手術室 18:40 麻醉開始 18:50 誘導結束 19:05 抗生素給藥 19:20 手術開始 21:05 手術結束 21:05 麻醉結束 21:15 送出病患 21:16 進入恢復室 22:16 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 椎弓切除術(減壓)-二節以內 1 1 摘要__ 手術科部: 外科部 套用罐頭: Sublaminar decompression, L4-5 開立醫師: 李振豪 開立時間: 2010/12/30 21:45 Pre-operative Diagnosis Lumbar stenosis, L4-5 Post-operative Diagnosis Lumbar stenosis, L4-5 Operative Method Sublaminar decompression, L4-5 Specimen Count And Types nil Pathology Nil Operative Findings The ligmentum flavum was hypertrophic and tightly compressed the thecal sac. The thecal sac expanded well after decompression. One small incidental durotomy was noted during the operation but the arachnoid membrane was intact. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in prone position. The L4-5 level was localized with portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision at L4-5 level was made and the subcutaneous soft tissue, right paravertebral muscle group were detached. The interlaminar space between L4 and L5 was identified. Under operative microscope, laminotomy was performed with high speed air-drived drills and Kerrison punches. Sublaminar decompression was performed and the ligmentum flavum was removed. Hemostasis was achieved and the wound was then closed in layers with 2-0 Vicryl and 3-0 Dexon(subcuticular suture). Operators VS陳敞牧 Assistants R4李振豪, Ri陳怡穎 陳永安 (M,1935/05/04,76y10m) 手術日期 2010/12/30 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Lung cancer 器械術式 Bilateral CSDH drainage, shunt revision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 古恬音, 時間資訊 07:45 報到 08:08 進入手術室 08:15 麻醉開始 08:20 誘導結束 09:08 抗生素給藥 09:09 手術開始 10:04 10:45 麻醉結束 10:45 手術結束 10:45 10:50 送出病患 10:55 進入恢復室 12:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 腦脊髓液分流管重置 1 1 R 手術 慢性硬腦膜下血腫清除術 1 2 R 手術 慢性硬腦膜下血腫清除術 1 4 L 摘要__ 手術科部: 外科部 套用罐頭: 1. Bilateral burr hole for chronic subdural h... 開立醫師: 古恬音 開立時間: 2010/12/30 10:25 Pre-operative Diagnosis Bilateral chronic subdural hematoma, suspected ventriculoperitoneal shunt overdrainage Post-operative Diagnosis Bilateral chronic subdural hematoma, suspected ventriculoperitoneal shunt overdrainage Operative Method 1. Bilateral burr hole for chronic subdural hematoma drainage, with EVD system 1. Bilateral burr hole for chronic subdural hematoma drainage, left with EVD system, right with rubber drain 2. Revision of ventriculoperitoneal shunt, with Codman programmable valve Specimen Count And Types Subdural hematoma 3mL Pathology Nil Operative Findings 1. Light brownish fluid gushed out after left side durotomy, followed by small amount of liquified blood 2. Dark red motor-oil like substance drained out of right side durotomy 3. The brain was slack 4. Shunt revised with Codman programmable valve, 120mmH2O Operative Procedures 1. ETGA, supine position with head turned to right 2. Scalp incision along previous operation wound 3. Remove the soft tissue from previous burr hole 4. Insert the EVD catheter to left subdural space, then de-air 5. Close the wound in layers 6. Turn his head to left side 7. Make 2 scalp incision at right frontal region 8. Drill one burr hole for subdural hematoma drainage 9. Insert the EVD catheter to right subdural space, then de-air 10. Revise VP shunt with Codman programmable valve, 120mmH2O Operators 王國川 Assistants 曾峰毅,古恬音 王仁勝 (M,1959/07/16,52y7m) 手術日期 2010/12/30 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 重大創傷且及嚴重程度到達創傷嚴重程度分數16分以上 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 古恬音, 時間資訊 10:57 報到 11:10 進入手術室 11:20 麻醉開始 11:30 誘導結束 11:32 抗生素給藥 11:55 手術開始 13:05 手術結束 13:05 麻醉結束 13:10 送出病患 13:12 進入恢復室 14:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 頭顱成形術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Cranioplasty 開立醫師: 曾峰毅 開立時間: 2010/12/30 13:12 Pre-operative Diagnosis Skull defect Post-operative Diagnosis Skull defect Operative Method Cranioplasty at left Specimen Count And Types Nil Pathology nil Operative Findings Bone graft was fixed back with mini-plates. Operative Procedures With endotracheal general anasethesia, the patient was put in supine position with head rotated to right. After scalp shaved, scrubbed, disinfected, and then draped, we made skin incision along previous operation wound. We reflected the scalp flap inferiorly, and fixed back the bone graft with mini-plates. After inserted on subgaleal CWV, we closed the wound in layers. Operators VS 王國川 Assistants R4 曾峰毅 R3 古恬音 劉為幹 (M,1935/05/29,76y9m) 手術日期 2010/12/30 手術主治醫師 王國川 手術區域 東址 002房 04號 診斷 Malignant neoplasm of liver, primary 器械術式 Spinal fusion anterior spinal 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 游皓鈞, 時間資訊 10:00 開始NPO 15:50 通知急診手術 19:45 報到 19:55 進入手術室 20:10 麻醉開始 20:40 誘導結束 21:00 抗生素給藥 21:10 手術開始 22:50 開始輸血 01:50 麻醉結束 01:50 手術結束 02:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 惡性脊髓腫瘤切除術 1 1 手術 脊椎融合術-前融合,有固定物)≦四節 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 神經部 套用罐頭: C6 and partial C5 corpectomy for tumor excisi... 開立醫師: 胡朝凱 開立時間: 2010/12/31 01:46 Pre-operative Diagnosis C6 HCC metastasis Post-operative Diagnosis C6 HCC metastasis Operative Method C6 and partial C5 corpectomy for tumor excision and artificial cage insertion then C3~7 plate fixation Specimen Count And Types pieces of tumor Pathology pending Operative Findings 1.reddish, hypervascular tumor invaded into partial C5 and C6 vertebral body and extended along prevertebral space was noted. Some residual tumor was also noted. 2.Easy bleeding was noted. Estimate blood loss: 1400 ml 3.Marginal spur was prominent 4.thick cortex 5.The tumor located mainly at left side of vertebral body 6.The dura was compressed tightly initially. After decompression, it became loose. Operative Procedures 1.ETGA, supine 2.Right neck oblique skin incision 3.Dissection along with the anterior border of SCM muscle to expose prevertebral space 4.resect tumor with currete and kerrison pounch 5.Resect PLL to expose dura 6.Hemostasis with Floseal 7.artificial body cage was inserted 8.Plate fixation 9.Set one CWV drain 10.Close wound in layers Operators 王國川 Assistants 胡朝凱, 游皓鈞 Indication Of Emergent Operation 吳立言 (F,1973/09/21,38y5m) 手術日期 2010/12/30 手術主治醫師 王國川 手術區域 東址 003房 03號 診斷 Herniation of intervertebral disc, lumbar (HIVD) 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 古恬音, 時間資訊 13:18 報到 13:30 進入手術室 13:35 麻醉開始 13:45 誘導結束 14:00 抗生素給藥 14:13 手術開始 15:35 手術結束 15:35 麻醉結束 15:45 進入恢復室 15:45 送出病患 17:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 椎間盤切除術-腰椎 1 1 摘要__ 手術科部: 外科部 套用罐頭: HIVD 開立醫師: 曾峰毅 開立時間: 2010/12/30 15:45 Pre-operative Diagnosis Lumbar disc, L4/5 Post-operative Diagnosis Lumbar disc, L4/5 Operative Method Microdiskectomy, L4/5, via right L4/5 laminotomy. Specimen Count And Types Nil Pathology Nil Operative Findings Protruding disc, L4/5, compressed the right L5 root tightly. The root was decompressed well after diskectomy. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position. After back scrubbed, disinfected, and then draped, we made one midline skin incision from L4 to L5 with C-arm localization. We dissected right paraspinal muscle, and created L4/5 laminotomy. L4/5 disckectomy was done. The wound was closed in layers. Operators VS 王國川 Assistants R4 曾峰毅 R3 古恬音 許世昌 (M,1964/03/29,47y11m) 手術日期 2010/12/31 手術主治醫師 楊士弘 手術區域 東址 000房 03號 診斷 Malignant neoplasm of connective and other soft tissue of pelvis 器械術式 OPLL- Anterior Corpectomy 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 蕭柏妮 ASA 3 紀錄醫師 洪誌鍵, 時間資訊 00:00 臨時手術NPO 13:50 報到 14:00 進入手術室 14:10 麻醉開始 14:50 誘導結束 15:30 抗生素給藥 15:48 手術開始 18:00 開始輸血 18:30 抗生素給藥 21:30 抗生素給藥 23:15 麻醉結束 23:15 手術結束 23:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 惡性脊髓腫瘤切除術 1 1 手術 脊椎融合術-後融合,有固定物(<=六節) 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 10 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 麻醉 動脈血液檢查全套 3 0 麻醉 Hemoglobin (Hb) 3 0 麻醉 測血糖 3 0 麻醉 Ca (Calcium) 3 0 麻醉 Na (Sodium) 3 0 麻醉 K (Potassium) 3 0 麻醉 Blood gas analysis 3 0 摘要__ 手術科部: 外科部 套用罐頭: 1. C2 laminectomy, left facetomy for tumor ex... 開立醫師: 楊士弘 開立時間: 2010/12/31 23:51 Pre-operative Diagnosis C2 vertebral tumor, C1-2 spinal instability Post-operative Diagnosis C2 vertebral tumor, C1-2 spinal instability Operative Method 1. C2 laminectomy, left facetomy for tumor excision 2. Occipitocervical fusion and fixation (Depuy Summit system) from C0-C4 Specimen Count And Types 1 piece About size:小 Source:C2 vertebral tumor Pathology Pending Operative Findings 1. The spinous process, lamina, and left C2 facet were softened, eroded, and partially replaced by a soft fragile, greyish red, moderately vascularized tumor. 2. The alignment of cervical spine was fair. 3. The position of the occipitocervical fixation construct was O.K. by intra-op. C-arm check. Operative Procedures 1. ETGA, prone, head fixed with skull clamp. 2. Posterior midline incision, inion to C5. 3. Subperiosteal dissction of paravertebral muscle for exposure of suboccipital bone, C1-C5 lamina and facets. 4. Laminectomy and left facetomy of C2 vertebrae for removal of tumor by Rongeur, Kerrison, currete, and dissector. 5. Insertion of an inverted Y occipital plate and two screws (11 mm and 10 mm long) on suboccipital bone. 6. Insertion of bilateral lateral mass screws into C1, C3, and C4: C1: 30 mm (22 mm thread + 8 mm shank), 3.5 mm in diameter C3, C4: 16 mm long, 3.5 mm in diameter 7. Bridging of screws on each side with a rod. 8. Bridging of both rods with a cross link. 9. Decortication of suboccipital bone, C1, right C1, C3, and C4 lamina for on-lay bone graft by calcim hydroxyappatite. 10. One epilaminal CWV drain. 11. Wound closure in layers. Operators 楊士弘 Assistants 陳睿生 陳睿生,古恬音, 陳睿生,古恬音,洪誌鍵 張偉明 (M,1948/06/11,63y9m) 手術日期 2010/12/31 手術主治醫師 王國川 手術區域 東址 001房 03號 診斷 Head injury, unspecified 器械術式 Left subduro-peritoneal shunt 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 鍾文桂, 時間資訊 09:30 臨時手術NPO 09:30 開始NPO 12:26 通知急診手術 15:40 進入手術室 15:50 抗生素給藥 15:50 麻醉開始 16:00 誘導結束 16:39 手術開始 17:01 開始輸血 17:25 手術結束 17:25 麻醉結束 17:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室腹腔分流手術 1 1 L 記錄__ 手術科部: 創傷醫學部 套用罐頭: Implantation of subdural-peritoneal shunt,left. 開立醫師: 鍾文桂 開立時間: 2010/12/31 17:51 Pre-operative Diagnosis Bilateral subdural effusion, frontal-parietal. Post-operative Diagnosis Bilateral subdural effusion, frontal-parietal. Operative Method Implantation of subdural-peritoneal shunt,left. Specimen Count And Types nil Pathology Nil. Operative Findings Subdural effusion: clear yellowish, high pressure) gushed out from the durotomy. Shunt: Codman 100mmH2O, subdural catheter: 5cm, peritoneal catheter: 30 cm. Operative Procedures Under ETGA, the patient was placed in supine position and head tilted to the right. After shaving, disinfection, and draping, a linear incision was made at left frontal region. After creating a burr hole and durotomy, the subdural effusion gushed out. A minilaparotomy was made at LUQ. The peritoneal cavity was reached. The subcutaneous tunnel was created from abdomen to head. After connecting the shunt system, the subdural catheter and peritoneal catheter were placed. After checking the shunt patency, the wounds were closed in layers. Operators 王國川 Assistants 鍾文桂 Indication Of Emergent Operation 吳彥徵 (F,1983/12/15,28y2m) 手術日期 2010/12/31 手術主治醫師 蔡翊新 手術區域 東址 000房 號 診斷 Brain abscess 器械術式 VP shunt 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 3E 紀錄醫師 游健生, 時間資訊 13:00 臨時手術NPO 13:00 開始NPO 14:36 通知急診手術 18:15 進入手術室 18:25 麻醉開始 18:35 誘導結束 19:17 手術開始 21:25 麻醉結束 21:25 手術結束 21:35 送出病患 21:37 進入恢復室 22:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 摘要__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt, right side 開立醫師: 游健生 開立時間: 2010/12/31 21:42 Pre-operative Diagnosis Hydrocephalus, status post EVD insertion Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunt, right side Specimen Count And Types nil Pathology nil Operative Findings Clear CSF was drained after ventricle catheter insertion. The ventricle catheter was 6.5cm in length. The peritoneal catheter was about 30cm in length. Codman programmable shunt was set at 10cmH2O. Operative Procedures 1. Under ETGA, supine position with head rotated to left 2. After shaving, we disinfected and draped the operation field 3. Opened the previous EVD wound and debrided 4. A transverse abdominal incision over RUQ 5. Dissected in layers and opened the peritonium 6. Inserted peritoneal catheter 7. Passed the proximal end upward via a subcutaneous tunnel 8. Connected both catheters to Codman programmable reservoir 9. Removed EVD and inserted ventricle catheter via the EVD tract 10.Closed wounds in layers Operators VS 蔡翊新 Assistants R3 游健生 Indication Of Emergent Operation 盧金木 (M,1951/03/14,61y0m) 手術日期 2010/12/31 手術主治醫師 杜永光 手術區域 東址 001房 05號 診斷 Bacterial meningitis 器械術式 remove VP shunt 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 3E 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 08:53 通知急診手術 20:25 進入手術室 20:30 麻醉開始 20:35 誘導結束 21:20 手術開始 21:45 手術結束 21:45 麻醉結束 21:55 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室體外引流 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Removal of ventriculoperitoneal shunt. 開立醫師: 鍾文桂 開立時間: 2010/12/31 22:08 Pre-operative Diagnosis Ventriculitis. Post-operative Diagnosis Ventriculitis. Operative Method Removal of ventriculoperitoneal shunt. Specimen Count And Types 1 piece About size:1cc Source:CSF Pathology Nil. Operative Findings Collapsed reservoir. Clear pinkish CSF. The whole shunt was removed. Operative Procedures Under ETGA, the patient was placed in supine position and head in midline. After disinfection, shaving, and draping, the previous scalp incision was incised and opened. After dissection, the whole shunt system was pulled out. Both tips were collected for culture. The wound was closed in layers. Operators 杜永光 Assistants 鍾文桂 Indication Of Emergent Operation 林純瑛 (F,1962/10/17,49y4m) 手術日期 2010/12/31 手術主治醫師 杜永光 手術區域 東址 003房 號 診斷 Brain Tumor 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 07:47 報到 08:05 進入手術室 08:15 麻醉開始 08:50 誘導結束 09:10 抗生素給藥 10:00 手術開始 12:10 抗生素給藥 15:10 抗生素給藥 16:10 麻醉結束 16:10 手術結束 16:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 8 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Right Dolenc"s approach for Simpson grade IV ... 開立醫師: 陳睿生 開立時間: 2010/12/31 16:37 Pre-operative Diagnosis Inner third sphenoid ridge meningioma Post-operative Diagnosis Inner third sphenoid ridge meningioma Operative Method Right Dolenc"s approach for Simpson grade IV tumor excision Specimen Count And Types 1 piece About size: Source: Pathology Pending Operative Findings The tumor was reddish, firm and well defined. It tightly adhered with the medial temporal base dura and the lateral aspect of the cavernous sinus. Temporal bone and sphenoid ridge, anterior clinoid were also noted to be invaded by the tumor. The tumor extends into the cavernous sinus and orbital cavity, and occupied the medial part of the sinus. The CNs were pushed laterally by the tumor. The lower surface of temporal base was erosed by the tumor. The tumor inside the cavernous sinus and orbital wall was left due to difficult approaching. The right orbital roof and right lateral planuium sella were drilled out to decompress the optic nerve. VEP showed no change peri-op. Operative Procedures Under ETGA, patient was in supine position with right shoulder elevated. Her head was fixed by Mayfield headholder and rotated to left 45degrees. A curvilinear scalp incision from 1 cm anterior to tragus, extended upward along hair line, and cross midline 1cm. The skin flap was elevated and reflected anteriorly togeter with Yasargil fatpad. The temporalis muscle was transected leaving a 1cm-wide muscle cuff on cranium, then elevated and reflected inferiorly. We created one burrhole at keyhole and another one at posterior border of wound below superior temporal line. A craniotomy was done followed by dura tenting along posterior border of it. The right temporal lobe was elevated and middle meningeal artery was ligated and transected. Then, we drilled off anterior clinoid process, the superior and inferolateral part of optic canal to decompress the optic nerve. The tumor at cavernous sinus was exposed. The lateral wall of orbit and anterior part of middle cranial fossa were removed due to tumor invasion. A curvilinear durotomy with sphenoid ridge as base was done. The Sylvian fissure was opened from anterior to middle. The tumor was seen at temporal tip dura and dissected away from temporal tip along arachnoid plane. We cut the dura along tumor border and removed the tumor in piecemeal. As we approached the cavernous sinus, the tumor was peeled off from the lateral wall of cavernous sinus. Gasserian ganglion, CN V, CV IV and CV III were seen and preserved. Bleeding from posterior cavernous sinus was stopped by gelfoam packing. Residual tumor surface was covered by Surgicel. Dura defect due to tumor removal was repaired by Duraform. Durotomy was closed with continuous 4-0 prolene suture. Bone flap was fixed back with mini-plates. Subgaleal CWV drain was placed. Wound closed in layers. Operators Prof. 杜永光 Assistants R6陳睿生 R3游健生 摘要__ 手術科部: 外科部 套用罐頭: Right Dolenc"s approach for Simpson grade IV ... 開立醫師: 游健生 開立時間: 2010/12/31 16:38 Pre-operative Diagnosis Inner third sphenoid ridge meningioma Post-operative Diagnosis Inner third sphenoid ridge meningioma Operative Method Right Dolenc"s approach for Simpson grade IV tumor excision Specimen Count And Types a few pieces Source: tumor Pathology Pending Operative Findings The tumor was reddish, firm and well defined. It tightly adhered with the medial temporal base dura and the lateral aspect of the cavernous sinus. Temporal bone and sphenoid ridge, anterior clinoid were also noted to be invaded by the tumor. The tumor extends into the cavernous sinus and orbital cavity, and occupied the medial part of the sinus. The CNs were pushed laterally by the tumor. The lower surface of temporal base was erosed by the tumor. The tumor inside the cavernous sinus and orbital wall was left due to difficult approaching. The right orbital roof and right lateral planuium sella were drilled out to decompress the optic nerve. VEP showed no change peri-op. Operative Procedures Under ETGA, patient was in supine position with right shoulder elevated. Her head was fixed by Mayfield headholder and rotated to left 45degrees. A curvilinear scalp incision from 1 cm anterior to tragus, extended upward along hair line, and cross midline 1cm. The skin flap was elevated and reflected anteriorly togeter with Yasargil fatpad. The temporalis muscle was transected leaving a 1cm-wide muscle cuff on cranium, then elevated and reflected inferiorly. We created one burrhole at keyhole and another one at posterior border of wound below superior temporal line. A craniotomy was done followed by dura tenting along posterior border of it. The right temporal lobe was elevated and middle meningeal artery was ligated and transected. Then, we drilled off anterior clinoid process, the superior and inferolateral part of optic canal to decompress the optic nerve. The tumor at cavernous sinus was exposed. The lateral wall of orbit and anterior part of middle cranial fossa were removed due to tumor invasion. A curvilinear durotomy with sphenoid ridge as base was done. The Sylvian fissure was opened from anterior to middle. The tumor was seen at temporal tip dura and dissected away from temporal tip along arachnoid plane. We cut the dura along tumor border and removed the tumor in piecemeal. As we approached the cavernous sinus, the tumor was peeled off from the lateral wall of cavernous sinus. Gasserian ganglion, CN V, CV IV and CV III were seen and preserved. Bleeding from posterior cavernous sinus was stopped by gelfoam packing. Residual tumor surface was covered by Surgicel. Dura defect due to tumor removal was repaired by Duraform. Durotomy was closed with continuous 4-0 prolene suture. Bone flap was fixed back with mini-plates. Subgaleal CWV drain was placed. Wound closed in layers. Operators Prof. 杜永光 Assistants R6陳睿生 R3游健生 陳邱秋香 (F,1934/09/12,77y6m) 手術日期 2010/12/31 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Pituitary tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 4 紀錄醫師 陳蔚蔚, 時間資訊 00:00 臨時手術NPO 07:48 報到 08:04 進入手術室 08:10 麻醉開始 08:40 誘導結束 08:45 抗生素給藥 09:22 手術開始 10:23 麻醉結束 10:23 手術結束 10:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 經由蝶竇之腦下垂體瘤切除 1 1 記錄__ 手術科部: 外科部 套用罐頭: Trans-sphenoid adenomectomy 開立醫師: 胡朝凱 開立時間: 2010/12/31 10:51 Pre-operative Diagnosis Pituitary macroadenoma Post-operative Diagnosis Pituitary macroadenoma Operative Method Trans-sphenoid adenomectomy Specimen Count And Types pieces of tumor Pathology pending Operative Findings 1.yellowish, soft tumor with some dark reddish part was noted inside sella turcica. 2.After tumor removal, arachnoid membrane was noted. 3.CSF leakage was noted during operation. 4.The sella floor became thin Operative Procedures After ETGA, the patient was put in supine position with head mild left tilt. The nasal cavity was well-disinfective, and then we incised into the nasal septum. Dissection was performed along with the periosteum to expose sphenoid sinus anterior wall and sphenoid ostia. After fracture of vomer, sphenoid sinus anterior wall was also fractured. The mucosa was removed. The sella floor was exposed and removed with kerrison. After cruciate form incision, tumor buldged out. And it was further removed with tumor forceps and ring currette. After total excision of tumor was made, the bony graft was put back and followed by compaction of merosel. Operators 曾漢民 Assistants 胡朝凱,陳蔚蔚 黃洋 (M,1957/11/01,54y4m) 手術日期 2010/12/31 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Lung cancer 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 陳蔚蔚, 時間資訊 10:25 報到 10:52 進入手術室 11:05 麻醉開始 11:25 抗生素給藥 11:40 手術開始 11:40 誘導結束 12:32 手術結束 12:32 麻醉結束 12:53 送出病患 12:57 進入恢復室 14:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 慢性硬腦膜下血腫清除術 1 1 R 記錄__ 手術科部: 內科部 套用罐頭: Right subdural drainage 開立醫師: 胡朝凱 開立時間: 2010/12/31 12:44 Pre-operative Diagnosis Right subdural effusion Post-operative Diagnosis Right subdural effusion Operative Method Right subdural drainage Specimen Count And Types one piece of dura. Effusion x 4 tubes Pathology pending Operative Findings 1.Clear effusion was noted after dural opening 2.Brain was slack after drainage 3.No obvious outer or inner membrane Operative Procedures 1.ETGA, supine 2.Right parietal area vertical skin incision 3.Dissect to expose skull 4.Burr hole drill 5.Dural biopsy 6.Insert rubber drain 7.irrigation 8.Close wound in layers 9.De-air Operators 曾漢民 Assistants 胡朝凱, 陳蔚蔚 魏仰賢 (M,1927/05/05,84y10m) 手術日期 2010/12/31 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Lumbar Spondylosis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 黃鼎鈞, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:10 進入手術室 08:15 麻醉開始 08:45 誘導結束 09:00 抗生素給藥 09:21 手術開始 12:00 抗生素給藥 12:15 手術結束 12:15 麻醉結束 12:25 送出病患 12:30 進入恢復室 13:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎融合術-前融合,無固定物(≦四節) 1 2 手術 椎間盤切除術-腰椎 1 4 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 曾峰毅 開立時間: 2010/12/31 12:12 Pre-operative Diagnosis Degenerative disc disease, L4/5, with spinal stenosis Post-operative Diagnosis Degenerative disc disease, L4/5, with spinal stenosis Operative Method Posterior lumbar interbody fusion, L4/5, with PEEK cages and autologous bone graft; posterior fixation with transpedicular screws Specimen Count And Types Nil Pathology Nil Operative Findings Lumbar stenosis was noted at L4/5, compressing thecal sac tightly. The thecal sac was decompressed well after laminectomy. Instrumentation position was checked by C-arm. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After C-arm localization, we scrubbed, disinfected, and then draped the back. We made one midline skin incision from L4 to L5. Paraspinal muscles were dissected, and TPS was inserted into bilateral pedicles of L4 and L5. Laminectomy was done at lower L4, and diskectomy of L4/5 was performed. Posterior lumbar interbody fusion was done with PEEK cages and autologous bone graft. Rod was used to fixed the TPS. The wound was closed in layers after one hemovac inserted. Operators VS 賴達明 Assistants R4 曾峰毅 R1 黃鼎鈞 陳美香 (F,1963/02/06,49y1m) 手術日期 2010/12/31 手術主治醫師 賴達明 手術區域 東址 019房 02號 診斷 Pituitary tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 2 紀錄醫師 黃鼎鈞, 時間資訊 00:00 臨時手術NPO 12:28 報到 12:55 進入手術室 13:00 麻醉開始 13:35 誘導結束 13:45 抗生素給藥 14:09 手術開始 16:00 麻醉結束 16:00 手術結束 16:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經由蝶竇之腦下垂體瘤切除 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Transnasal trans-sphenoidal adenomectomy 開立醫師: 曾峰毅 開立時間: 2010/12/31 16:19 Pre-operative Diagnosis Pituitary macroadenoma, non-functional Post-operative Diagnosis Pituitary macroadenoma, non-functional Operative Method Transnasal trans-sphenoidal adenomectomy Specimen Count And Types Several fragments of one tumor was sent for pathology. Pathology Pending Operative Findings Hypervascular, greyish, soft, fragile tumor was noted in the sellae, compatible with adenoma. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with neck slightly extended. We made a mucosa incision at medial septum of right nostril, and knocked the vomer off. We removed the sphenoidal sinus mucosa with alligator, and removed sellar floor. Durotomy was made, followed by tumor removal. Hemostasis was performed, and vomer graft was put back. Nasal septum reduction was performed. Merocels with used to filled the nostril. Operators VS 賴達明 Assistants R4 曾峰毅 R1 黃鼎鈞 錢潘美鳳 (F,1935/08/12,76y7m) 手術日期 2010/12/31 手術主治醫師 賴達明 手術區域 東址 005房 03號 診斷 Lumbar stenosis 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 陳蔚蔚, 時間資訊 00:00 臨時手術NPO 13:05 報到 13:09 進入手術室 13:15 麻醉開始 13:30 誘導結束 13:40 抗生素給藥 14:02 手術開始 15:45 手術結束 15:45 麻醉結束 15:48 送出病患 15:50 進入恢復室 16:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-腰椎 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: L4~5 sublaminar decompression 開立醫師: 胡朝凱 開立時間: 2010/12/31 15:57 Pre-operative Diagnosis L4~5 stenosis Post-operative Diagnosis L4~5 stenosis Operative Method L4~5 sublaminar decompression Specimen Count And Types Nil Pathology nil Operative Findings 1.Hypertrophic flavum ligment at L4~5 level that compressed the nerve roots tightly. 2.No spinal instability 3.L5 Nerve roots was identified and became loose after decompression. Operative Procedures 1.ETGA, prone 2.Midline skin incision at L4~5 level 3.Split L4 spinous process 4.Expose L4 lamina 5.Laminectomy with ronguer and kerrison pounch 6.Remove flavum ligement piece by piece by kerrison 7.Identified nerve roots 8.Hemostasis then close wound in layers Operators 賴達明 Assistants 胡朝凱,陳蔚蔚 萬皓宇 (M,1995/01/24,17y1m) 手術日期 2010/12/31 手術主治醫師 許文明 手術區域 兒醫 063房 02號 診斷 Malignant neoplasm of mediastinum 器械術式 Lobecomy & thoracoplasty or br 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 劉昌杰, 時間資訊 10:05 報到 10:12 進入手術室 10:25 麻醉開始 11:00 誘導結束 11:48 抗生素給藥 12:01 手術開始 14:50 開始輸血 14:50 抗生素給藥 17:25 麻醉結束 17:25 手術結束 17:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 肺楔狀或部份切除術 1 2 L 手術 惡性縱隔腔腫瘤切除 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: 1. Exploratory laparoscopy 2. Tumor excision ... 開立醫師: 吳峻宇 開立時間: 2010/12/31 18:10 Pre-operative Diagnosis Choriocarcinoma, left anterior mediastinum Post-operative Diagnosis Choriocarcinoma, left anterior mediastinum, locally advanced Operative Method 1. Exploratory laparoscopy 2. Tumor excision of anterior mediastinal tumor 3. Wedge resection of left lung metastasis Specimen Count And Types 2 pieces About size:10x8x5cm Source:Choriocarcinoma, left pleural space About size:1x1cm Source:lung meta Pathology pending Operative Findings 1. Severe Pleural adhesions were noted 2. Locally advanced, ivasion to surrounding tissue was noted 3. Lung metastasis was noted , wedge resection was performed 4. This huge tumor was well-defined, capsulated, however, with invasion at apex part. Operative Procedures 1. Anesthesia: General anesthesia using double-lumen endotracheal tube. 2. Position: right decubitus position. An axillary roll is placed under the down side. The operative field is well disinfected and draped. 3. Performed exploratory thoracoscopy, severe adhesion was noted 4. Then converted to Thoracotomy 5. Blunt dissection of surrounding tissue, hemostasis with electrocautey 6. Resect apex part of tumor 7. Wedge resection of left lung metastasis 8. Hemostasis, normal saline irrigation 9. Set one 24 Fr. chest tube in apex part 10. Close wounds in layers Operators 許文明 Assistants R6 柯柏瑞 R1 劉昌杰 林維第 (M,1924/06/29,87y8m) 手術日期 2010/12/31 手術主治醫師 王國川 手術區域 東址 001房 04號 診斷 Intracerebral hemorrhage 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 2 紀錄醫師 鍾文桂, 時間資訊 12:30 臨時手術NPO 12:30 開始NPO 15:21 通知急診手術 18:05 報到 18:05 進入手術室 18:25 麻醉開始 18:40 誘導結束 18:50 抗生素給藥 19:05 手術開始 19:25 麻醉結束 19:25 手術結束 19:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 慢性硬腦膜下血腫清除術 1 1 記錄__ 手術科部: 神經部 套用罐頭: Insertion of external ventricular drainage ca... 開立醫師: 鍾文桂 開立時間: 2010/12/31 19:55 Pre-operative Diagnosis Intraventricular hemorrhage with acute obstructive hydrocephalus. Post-operative Diagnosis Intraventricular hemorrhage with acute obstructive hydrocephalus. Operative Method Insertion of external ventricular drainage catheter, right Kocher. Specimen Count And Types 1 piece About size:3cc Source:CSF: routine, culture, BCS. Pathology Nil. Operative Findings Right Kocher EVD, 6.5 cm, opening pressure about 5 cmH2O. Clear pinkish CSF. Operative Procedures Under ETGA, the patient was placed in supine position and head in midline. After shaving, disinfection and draping, a linear scalp incision was made. After creating a burr hole, ventriculostomy was done and the EVD catheter was placed through the same tract. After ensuring its patency, the closed drainage system was connected. The wound was closed in layers. Operators 王國川 Assistants 鍾文桂 Indication Of Emergent Operation 黃輝榮 (M,1948/05/17,63y9m) 手術日期 2011/01/01 手術主治醫師 陳敞牧 手術區域 東址 001房 02號 診斷 Subdural hematoma 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 胡朝凱, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 09:29 通知急診手術 12:17 進入手術室 12:20 麻醉開始 12:30 抗生素給藥 12:40 誘導結束 13:09 手術開始 13:55 麻醉結束 13:55 手術結束 14:05 送出病患 14:10 進入恢復室 15:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 慢性硬腦膜下血腫清除術 1 1 B 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 手術 頭皮腫瘤 1 2 B 記錄__ 手術科部: 外科部 套用罐頭: Right burr hole drainage and left tumor excision 開立醫師: 胡朝凱 開立時間: 2011/01/01 14:04 Pre-operative Diagnosis Right chronic SDH and left frontal atheroma Post-operative Diagnosis Right chronic SDH and left frontal atheroma Operative Method Right burr hole drainage and left tumor excision Specimen Count And Types scalp tumor x 1 Pathology pending Operative Findings 1.Right motor oil like hematoma was drained out with some clot was noted. 2.The brain was slack after drainage 3.Outer membrane was noted 4.One about 1 cm scal tumor with clear margin was noted at left frontal area. Operative Procedures 1.ETGA, supine 2.Right parietal vertical skin incison 3.Dissect to open skull 4.Bur hole drill 5.Dural tenting followed by dural incision 6.coagulate outer membrane then open it 7.Insert rubber drain 8.water irrigation 9.Close wound in layers 10.De-air 11.Left scalp incision 12.tumor excison 13.Close wound Operators 陳敞牧 Assistants 胡朝凱, Ri Indication Of Emergent Operation 鄧友琮 (M,1978/05/24,33y9m) 手術日期 2011/01/01 手術主治醫師 蕭輔仁 手術區域 東址 001房 05號 診斷 Lumbar spine (L-spine) fracture 器械術式 Spinal fusion posterior 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2E 紀錄醫師 伍嘉偉, 時間資訊 15:00 臨時手術NPO 15:00 開始NPO 19:17 通知急診手術 21:00 進入手術室 21:00 報到 21:05 麻醉開始 21:10 誘導結束 21:29 抗生素給藥 21:32 手術開始 21:45 22:19 00:30 抗生素給藥 01:30 手術結束 01:30 麻醉結束 02:00 送出病患 02:05 進入恢復室 04:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術(減壓)-二節以內 1 2 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 膀胱鏡檢查 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 泌尿部 套用罐頭: cystoscopy 開立醫師: 伍嘉偉 開立時間: 2011/01/01 21:52 Pre-operative Diagnosis r/o urethral stricture Post-operative Diagnosis urethral stricture Operative Method urethroscopy and cystoscopy Specimen Count And Types nil Pathology nil Operative Findings 1. a stricture site over middle urethra with tough angle Operative Procedures Under satisfactory anesthesia with the patient in lithotomy position, prepping and drapping was performed in the usual sterile fashion. A Fr 17 Olympus urethro-cystoscope was introduced into the bladder cavity under direct vision. Careful inspection revealed the Lt hemitrigone and Lt ureteral orifice was normal. Then change to 21 Fr cystoscopy. A Fr 18 Foley catheter was inserted. Patient tolerated the procedure very well and was sent to recovery room in satisfactory condition. Operators 黃昭淵, Assistants 伍嘉偉, Indication Of Emergent Operation 記錄__ 手術科部: 外科部 套用罐頭: L3 and lower L2 laminectomy and L2~4 TPS with... 開立醫師: 胡朝凱 開立時間: 2011/01/02 01:45 Pre-operative Diagnosis L3 compression fracture Post-operative Diagnosis L3 compression fracture Operative Method L3 and lower L2 laminectomy and L2~4 TPS with posterior lateral fusion Specimen Count And Types nil Pathology nil Operative Findings 1.mild instability of L3 on L4 2.retrograde protrusion of L3 vertebral body was noted 3.The thecal sac became loose after laminectomy 4.Screws: 6.0 x 45 x 6 cross link x 1 rods 10 cm x 2 Operative Procedures 1.ETGA, prone 2.Midline skin incision on L2~4 level 3.Detach paravertebral muscle 4.Expose L2~4 lamina 5.L3 and lower L2 laminectomy 6.Identified roots 7.L2~4 TPS screws insertion 8.Impact protrusion bone back 9.Fixed rods and cross link 10.lateral fusion with autologous bone chips 11.Set one CWV drain 12.Close wound in layers Operators VS.蕭輔仁 Assistants 胡朝凱, 何奕瑢 Indication Of Emergent Operation 張茂霖 (M,1918/04/04,93y11m) 手術日期 2011/01/02 手術主治醫師 王國川 手術區域 東址 002房 02號 診斷 Major trauma rated 16 or above on the severeity scale ( Injury severeity score >=16 ) 器械術式 Craniotomy(Aneurysms) VS-TZENG 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 5E 紀錄醫師 王奐之, 時間資訊 22:16 通知急診手術 22:42 報到 22:42 進入手術室 22:45 麻醉開始 23:10 誘導結束 23:15 抗生素給藥 23:15 開始輸血 23:25 手術開始 01:45 麻醉結束 01:45 手術結束 01:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 急性硬腦膜下血腫清除術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Right side F-T-P craniectomy and ICP monitor ... 開立醫師: 王奐之 開立時間: 2011/01/03 01:32 Pre-operative Diagnosis Acute subdural hematoma & subarachnoid hemorrhage, bilateral Post-operative Diagnosis Acute subdural hematoma & subarachnoid hemorrhage, bilateral Operative Method Right side F-T-P craniectomy and ICP monitor insertion Specimen Count And Types nil Pathology Nil Operative Findings Initial ICP was 47mmHg before craniectomy. Bulging brain was noted after durotomy. Poor brain surface pulsation. Reference: 507. Initial ICP was 47mmHg before craniectomy. A fronto-parietal fracture line was noted and included in the craniectomy. Bulging brain was noted after durotomy. Poor brain surface pulsation. Reference: 507. Initial ICP was 47mmHg before craniectomy. A fronto-parietal fracture line was noted and included in the craniectomy. Bulging brain was noted after durotomy. Poor brain surface pulsation. ICP after skin closure: 26mmHg. Reference: 507. Operative Procedures After ETGA, the patient was placed in supine position with head turned to left. After hair shaving, skin disinfection & draping in sterile fashion, a large question-mark skin incision was made, followed by trauma flap creation. After making burr holes, F-T-P craniectomy was performed. After dural tenting, a curved durotomy was made. Subdural hematoma then evacuated. Duroplasty was performed with temporalis fascial graft, with 4-0 Prolene in water-fashion. After setting a subdural ICP monitor insertion and 2 subgaleal CWV, the wound was closed in layers. After ETGA, the patient was placed in supine position with head turned to left. After hair shaving, skin disinfection & draping in sterile fashion, a large question-mark skin incision was made, followed by trauma flap creation. After making burr holes, F-T-P craniectomy was performed. After dural tenting, a curved durotomy was made. Subdural hematoma then evacuated. Duroplasty was performed with temporalis fascial graft, with 4-0 Prolene in water-fashion. After setting a subdural ICP monitor insertion and 1 subgaleal CWV, the wound was closed in layers. Operators VS王國川 Assistants R4李振豪,R3王奐之,R2陳志軒 Indication Of Emergent Operation 相關圖片 劉珮琳 (F,1980/12/28,31y2m) 手術日期 2011/01/03 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Moyamoya disease 器械術式 EC-IC by-pass 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 古恬音, 時間資訊 00:00 臨時手術NPO 07:32 報到 08:06 進入手術室 08:15 麻醉開始 08:35 誘導結束 09:00 抗生素給藥 09:49 手術開始 12:00 抗生素給藥 15:10 抗生素給藥 17:30 麻醉結束 17:30 手術結束 17:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱內外血管吻合術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 11 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: EC-IC bypass (left superficial temporal arter... 開立醫師: 古恬音 開立時間: 2011/01/03 17:43 Pre-operative Diagnosis Moyamoya disease Post-operative Diagnosis Moyamoya disease Operative Method EC-IC bypass (left superficial temporal artery to middle cerebral artery) Specimen Count And Types nil Pathology Nil Operative Findings 1.Total [cortical artery] ischemic time: 72 mins 2.The posterior branch of STA was anastomosed with cortical branch of MCA [EC-IC] bypass in end to side fashion 3.Patent flow after the anastemosis, confirmed by intra-op ICG angiogram. Operative Procedures Under endotracheal general anaesthesia, the patient was put in supine position with head rotated to right. Scalp was shaved and scrubbed, and the course of the superficial temporal artery was mapped out after identification by Doppler. We made one curvillinear skin incision at left frontotemporal region and dissected to isolate anterior posterior of STA. Temporalis muscle was incised and reflected inferiorly. One 4x4cm craniotomy window was made and dura tenting was done along the craniectomy window. Cruciate dura incision was done. Under operating microscope, a suitable cortical branch from the MCA was identified and the arachnoid around the vessel was removed by microscissors. Two temporary microvascular clips were applied, 1 cm appart, to the isolated segment of the cortical vessel, which was then opened by cutting off a leaf-like patch of the vascular wall. Heparin solution was used to irrigate the vascular lumen. The STA was occluded by a temporary clip and divided at its distal end. The lumen was irrigated with heparin solution. The advantitia at the vascular stump was trimmed off. The STA was anastomosed end-to-side to the segment of cortical artery interrupted stitches of 10/0 prolene. The vascular clips were released, and the leakage from the anastomosis was successufully stopped by gentle pressure on the patty with a small sucker tip. The dural plasty was performed by continuous prolene suture with muscular fascia .The loose space there was packed with gelfoam around the STA. The corner where STA passed through was bitten off for preventing undue pressure on the STA by the button. After checking bleeder and doing hemostasis, the wound was closed in layers. Operators P杜永光 Assistants R6陳睿生 R3古恬音 江麥美珠 (F,1943/06/18,68y8m) 手術日期 2011/01/03 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 柯安達, 時間資訊 00:00 臨時手術NPO 07:37 報到 08:04 進入手術室 08:10 麻醉開始 08:20 誘導結束 08:30 抗生素給藥 08:58 手術開始 10:43 麻醉結束 10:43 手術結束 10:55 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除-手術時間在4小時以內 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Left pterional Simpson grade I tumor excision 開立醫師: 胡朝凱 開立時間: 2011/01/03 11:07 Pre-operative Diagnosis Left frontal convexity meningioma Post-operative Diagnosis Left frontal convexity meningioma Operative Method Left pterional Simpson grade I tumor excision Specimen Count And Types 2.2 cm tumor Pathology pending Operative Findings 1.One about 2.2 cm whitish, firm tumor located at left frontal convexity area that attached to dura. 2.The border was clear. 3.Calcified capsule was also noted. 4.Brain mild swelling after tumor removal 5.Hyperosteosis was also noted. Operative Procedures Under ETGA, patient was put in supine position with head rotate to right. Curvillinea skin incision was done at left frontal area. Skin flap was dissected and opened. After burr holes drilled, craniotomy was performed. Circular dural incision was made along with the border of tumor. The tumor was excised by gently dissection through the interface between tumor and brain tissue. Vascular perforation was cauterized. Hemostasis was then performed. After then, dura was closed with prolene and one piece of fascia. Bone was fixed back with miniplate. Wound was closed in layers. Operators 曾漢民 Assistants 胡朝凱,　柯安達 翁素玉 (F,1960/02/22,52y0m) 手術日期 2011/01/03 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Brain metastasis 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 柯安達, 時間資訊 00:00 臨時手術NPO 10:40 報到 11:06 進入手術室 11:15 麻醉開始 11:35 誘導結束 11:40 手術開始 12:10 抗生素給藥 15:10 抗生素給藥 16:40 麻醉結束 16:40 手術結束 16:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4~8小時 1 1 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 記錄__ 手術科部: 外科部 套用罐頭: Posterior fossa craniectomy infratentorial tu... 開立醫師: 胡朝凱 開立時間: 2011/01/03 17:04 Pre-operative Diagnosis Cerebellar vermis metastasis tumor Post-operative Diagnosis Cerebellar vermis metastasis tumor Operative Method Posterior fossa craniectomy infratentorial tumor excision Specimen Count And Types pieces of tumor Pathology pending Operative Findings 1.One about 3.2 cm reddish, hypervascular tumor located at cerebellar upper vermis area was noted without a clear margin 2.There was some yellowish content drain out from lower part of tumor 3.No adhesion to dura of tentoreum was noted Operative Procedures 1.ETGA, prone position 2.Midline skin incision from 2 cm above inion down to C2 level 3.Detach splenium muscles 4.Identified C1 posterior arch 5.After burr hole drill, craniecomt was performed 6.Y shape dural incision was done 7.Infratentorial approach and sacrificed pre-central veins 8.Corticotomy and tumor excision with suction after devascularization 9.Tumor was total removed 10.Close dura with one piece of fascia 11.Fixed upper part of bone back with miniplate 12.Set one CWV drainthen clsoe wound in layers Operators 曾漢民 Assistants 胡朝凱, 柯安達 鍾亞璇 (F,1977/05/27,34y9m) 手術日期 2011/01/03 手術主治醫師 廖漢文 手術區域 東址 000房 號 診斷 Carotid body tumor 器械術式 NEURO T.A.E 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 王永彬 ASA 2 時間資訊 08:30 麻醉開始 08:40 誘導結束 09:45 麻醉結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 黃顯臣 (M,1927/09/03,84y6m) 手術日期 2011/01/03 手術主治醫師 林昌平 手術區域 東址 010房 06號 診斷 Cataract 器械術式 Phaco+PCIOL 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 12:25 進入手術室 12:45 手術開始 12:55 手術結束 13:00 送出病患 記錄__ 手術科部: 眼科部 套用罐頭: Phacoemulsification and PCIOL implantation (o ) 開立醫師: 許詠瑞 開立時間: 2011/01/03 12:50 Pre-operative Diagnosis Cataract (o ) Post-operative Diagnosis Cataract (o ) Operative Method Phacoemulsification and PCIOL implantation (o ) Specimen Count And Types nil Pathology Nil Operative Findings Cataract (o ) Operative Procedures 1. Under topical anesthesia 2. Disinfection, irrigation and draping 3. Application of an eyelid speculum 4. Made a clear corneal incision and penetrate into AC with 2.5mm cresent knife at oclock position 5. Inject Viscoat into theanterior chamber 6. Continuous circular capsulorrhexis was done with capsular forceps 7. Made a sideport at oclock position with the MVR blade 8. Hydrodissection and hydrodelineation were done with BSS 9. Phacoemulsification of thenucleus by chopper technique 10. Aspiration of the residual cortical material with I/A cannula 11. One-piece PCIOL was implanted into the bag after injection of Viscoat 12. The residual Viscoat was washed out by I/A cannula 13. Inject BSS into AC and check leakage 14. Subconjunctival injection of Rinderon and Gentamicin 15. Maxitrol patching Operators 林昌平, Assistants R4 陳達慶 R3 許詠瑞 蔡蕭金月 (F,1940/02/03,72y1m) 手術日期 2011/01/03 手術主治醫師 王國川 手術區域 東址 018房 02號 診斷 Dementia, vascular (F01.9) 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 11:50 報到 13:40 進入手術室 13:50 麻醉開始 14:00 誘導結束 14:05 抗生素給藥 14:36 手術開始 15:20 手術結束 15:20 麻醉結束 15:37 送出病患 15:42 進入恢復室 16:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 曾峰毅 開立時間: 2011/01/03 15:18 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunt, right Kocher Specimen Count And Types CSF was sent for culture, routine, and BCS. Pathology Nil Operative Findings Clear, colorless CSF was drained while ventriculostomy. Medtronic, programmable, shunt was inserted, and set at medium pressure, 1.5, about 7-9 mmHg. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position. After scalp shaved, scrubbed, disinfected, and then draped, we made one transverse skin incision at right frontal area. We drilled one burr hole, and inserted ventricular catheter. We made one transverse skin incision at right upper abdomen, and dissected into peritoneal cavity. We inserted peritoneal catheter. We created subcutaneous tunnels, and connected shunt system together. We checked the shunt function and closed the wound in layers. Operators VS 王國川 Assistants R4 曾峰毅 R3 王奐之 相關圖片 葉雪淳 (M,1930/01/18,82y1m) 手術日期 2011/01/03 手術主治醫師 黃國皓 手術區域 東址 015房 05號 診斷 Malignant neoplasm of prostate 器械術式 P.C.N. pig tail 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 呂育全, 時間資訊 15:50 報到 16:00 進入手術室 16:13 抗生素給藥 16:27 麻醉開始 16:29 手術開始 16:29 誘導結束 16:47 手術結束 16:52 送出病患 16:52 麻醉結束 醫令資訊 類別 名稱 量 刀 側 手術 皮下穿刺腎造廔術（單側） 1 0 R 記錄__ 手術科部: 泌尿部 套用罐頭: Pigtail PCN 開立醫師: 呂育全 開立時間: 2011/01/03 16:56 Pre-operative Diagnosis Right hydronephrosis Post-operative Diagnosis Right hydronephrosis Operative Method Right pigtail PCN Specimen Count And Types nil Pathology nil Operative Findings 1. Dilated renal pelvis and collecting system 2. The pigtail catheter was introduced into the right renal lower calyx, set 10.5cm. Operative Procedures 1. Under satisfactory local anesthesia, the patient was placed in prone position. 2. Prepping and draping were performed in the usual sterile method. 3. Dilated renal collecting system was identified. Adequate puncture path was chosen. The puncture needle was introduced into the collecting system under ultrasonographic guidance. 4. The guide-wire was inserted into right renal lower calyx under sono-guidedance. 5. The tract was dilated with dilators, and the pigtail catheter was introduced into the renal pelvis smoothly through the guidewire. 6. The guidewire was removed. 7. After the fluid was drained out, the tube was fixed on the skin. 8.The patient tolerated the operation well, and was sent back to ward in stable condition. Operators 黃國皓, Assistants 蘇彥榮,呂育全 孫叢生 (M,1942/12/24,69y2m) 手術日期 2011/01/03 手術主治醫師 郭順文 手術區域 東址 016房 02號 診斷 Intracerebral hemorrhage 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 趙安怡 ASA 3 紀錄醫師 蔡東明, 時間資訊 00:00 臨時手術NPO 10:53 進入手術室 10:55 麻醉開始 11:00 誘導結束 11:22 手術開始 11:45 手術結束 11:45 麻醉結束 11:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 氣管切開術 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 蔡東明 開立時間: 2011/01/03 11:54 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types nil Pathology None Operative Findings Fr . 8 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators VS郭順文 Assistants R4蔡東明 R1陳柏如 張添勝 (M,1969/06/05,42y9m) 手術日期 2011/01/03 手術主治醫師 戴浩志 手術區域 東址 002房 01號 診斷 Subdural hematoma 器械術式 Debridment-- >10cm 手術類別 緊急手術 手術部位 四肢 傷口分類 污染 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 3E 紀錄醫師 范垂嘉, 官振翔, 時間資訊 00:00 開始NPO 00:00 臨時手術NPO 07:00 通知急診手術 08:25 報到 08:25 進入手術室 08:35 麻醉開始 08:45 誘導結束 09:15 手術開始 11:30 12:40 麻醉結束 12:40 手術結束 12:48 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 骨髓炎之死骨切除術或蝶形手術及擴創術(包含指骨、掌骨、蹠骨) 1 1 手術 區域筋膜切除術 1 2 B 手術 骨骼外固定器裝置術 1 1 B 摘要__ 手術科部: 骨科部 套用罐頭: Closed reduction and external fixation 開立醫師: 范垂嘉 開立時間: 2011/01/03 11:17 Pre-operative Diagnosis Right distal tibial shaft comminuted fx, open, Gustilo IIIb Post-operative Diagnosis Right distal tibial shaft comminuted fx, open, Gustilo IIIb Operative Method Closed reduction and external fixation Specimen Count And Types nil Pathology nil Operative Findings 1.Comminuted fx of right distal tibia shaft 2.Fracture of the medial malleolus 3.Massive soft tissu defect over anterolateral aspect of the distal shin 4.Degloving injury to the foot and ankle Operative Procedures 1.ETGA, supine 2.Prep and drape 3.Remove previous K-pins x3 4.Place Schantz pins (tibial shaft x2, calcaneus x3) 5.Closed reduction and assemble the external fixation apparatus 6.Insert two 3.0mm K-pins for interfragmentary fixation 7.Plastic surgeon take-over Operators 林偉彭 Assistants 黃偉程,張允亮,羅婉育,范垂嘉 Indication Of Emergent Operation 摘要__ 手術科部: 外科部 套用罐頭: Debridement 開立醫師: 官振翔 開立時間: 2011/01/03 12:56 Pre-operative Diagnosis Bilateral legs severe degloving injury Post-operative Diagnosis Bilateral legs severe degloving injury Operative Method Bilateral leg Regional fasciectomy and left great toe sequestrectomy Specimen Count And Types Nil Pathology Nil Operative Findings 1. Bilateral legs severe degloving injury: Right leg full-thickness skin necrosis with involvement of foot heel area, dorsum, lower leg, medial and lateral malleolus with some pus formation Left leg great toe wet gangrene change s/p toe amputation and sequestrectomy Operative Procedures Under general anesthesia, the patient lied in supine position. Antiseptics applied and draped as usual. Debridement of devitalized tissue. Left great toe amputation. Normal saline irrigation. Wound underwent wet dressing. Operators 戴浩志, Assistants 官振翔, Indication Of Emergent Operation 鍾亞璇 (F,1977/05/27,34y9m) 手術日期 2011/01/04 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Carotid body tumor 器械術式 Diskectomy cervical(Anterier)，Carotid endarterectomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 10:22 進入手術室 10:30 麻醉開始 10:50 誘導結束 10:55 抗生素給藥 11:15 手術開始 12:15 手術結束 12:15 麻醉結束 12:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 動脈內膜切除術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Tumor excision 開立醫師: 李振豪 開立時間: 2011/01/04 12:34 Pre-operative Diagnosis Right neck tumor, suspect carotid body tumor,s tatus post TAE Post-operative Diagnosis Right neck tumor, suspect carotid body tumor,s tatus post TAE Operative Method Tumor excision Specimen Count And Types 1 piece About size:1.6x2.5x3cm Source:Right carotid body tumor Pathology Pending Operative Findings The tumor was 1.6x2.5x3cm in size, soft, well-demarcated, dark-red to purple in color. The tumor was adhered to carotid sheath at the level of burfication of CCA. The feeding artery arised from sternocleidomastoid branches of right occipital artery which coagulated and transected for total removal of the tumor. No hypoglossal nerve EP change noted during whole procedure. The jugular vein and carotid artery were also well preserved during whole procedure. Blood loss: minimal Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine position with head rotated to left. The skin was scrubbed, disinfected and draped as usual. The transverse skin incision was made along skin crest over right submandibular area. The subcutaneous soft tissue and platysma muscle was dissected and transected. The edge of the SCM muscle and the tumor were identified. The tumor was dissected along the capsule with Kelly and bipolar electrocautery. The adhered band and feeding artery were coagulated and transected. After total removal of the tumor, hemostasis was achieved with bipolar electrocautery and Surgicel lining. The wound was then closed in layers with 3-0 Vicryl and 4-0 Dexon. Operators VS曾漢民 Assistants R4李振豪, R2陳建銘 黃兆仁 (M,1951/03/07,61y0m) 手術日期 2011/01/04 手術主治醫師 侯育致 手術區域 東址 026房 03號 診斷 Cataract 器械術式 Phaco+PCIOL 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 12:05 進入手術室 12:07 麻醉開始 12:10 麻醉結束 12:35 手術開始 12:50 手術結束 12:55 送出病患 記錄__ 手術科部: 眼科部 套用罐頭: Phacoemulsification and PCIOL implantation (os ) 開立醫師: 孫仁彬 開立時間: 2011/01/04 13:01 Pre-operative Diagnosis Cataract (os ) Post-operative Diagnosis Cataract (os ) Operative Method Phacoemulsification and PCIOL implantation (os ) Specimen Count And Types nil Pathology Nil Operative Findings Cataract (os ) Operative Procedures 1. Under topical anesthesia. 2. Disinfection, irrigation and draping. 3. Application of an eyelid speculum. 4. Made a clear corneal incision and penetrate into AC with 2.5mm trapezoid knife at 10 oclock position. 5. Inject Healon into the anterior chamber. 6. Continuous circular capsulorrhexis was done with bent needle and capsular forceps. 7. Made a sideport at 2 oclock position with the MVR blade. 8. Hydrodissection and hydrodelineation were done with BSS. 9. Phacoemulsification of the nucleus by standard divide-and-conquer technique. 10. Aspiration of the residual cortical material with I/A tube. 11. Foldable PCIOL was implanted into the bag after injection of Viscoat. 12. The residual Healon was washed out by I/A device. 13. Inject BSS into AC and check leakage 14. Stromal hydration of the wound with BSS 16. Topical irrigation of Rinderon and Gentamycin. 17. Maxitrol patching. Operators 侯育致, Assistants R4孫仁彬, 羅泰舜 (M,1944/02/25,68y0m) 手術日期 2011/01/04 手術主治醫師 曾勝弘 手術區域 東址 005房 號 診斷 Neurofibromatosis 器械術式 Benign intraspinal tumor, exci，Excision of neuroma 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 07:30 報到 08:06 進入手術室 08:10 麻醉開始 08:15 誘導結束 08:29 抗生素給藥 08:50 手術開始 09:52 手術結束 09:52 麻醉結束 10:00 送出病患 10:02 進入恢復室 12:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 頭皮腫瘤 1 1 R 手術 皮下腫瘤摘除術小於2CM 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Tumor excision 開立醫師: 李振豪 開立時間: 2011/01/04 10:08 Pre-operative Diagnosis 1. Scalp tumor, suspect neurofibroma 2. Right wrist tumor, suspect recurrent neurofibroma Post-operative Diagnosis 1. Scalp tumor, suspect neurofibroma 2. Right wrist tumor, suspect recurrent neurofibroma Operative Method Tumor excision Specimen Count And Types 2 pieces About size:1x1x1cm Source:scalp tumor About size:1x1x0.5cm; 0.6x1x0.2cm Source:right wrist tumor Pathology Pending Operative Findings The scalp tumor was 1x1x1cm in size, well capsulated, white-yellowish, firm, and moderate vascularized. The scar tissue over wrist was thick and hard in character with moderate adhesion. There were two right wrist tumors with similar character as scalp tumor. The size was 1x1x0.5cm and 0.6x1x0.2cm respectively. The right wrist tumors originated from the superficial nerve. The junction was transected and the nerve was preserved well anatomically. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine position. The Scalp was shaved, scrubbed, and disinfected as usual. The linear scalp incision was made at left frontal area with 2cm in length. The subcutaneous tumor was identified and dissected. After removal of the scalp tumor, hemostasis was achieved with bipolar electrocautery. The wound was then closed with 3-0 Nylon. One linear skin incision along the forearm to wrist was made with 5cm in length. The subcutaneous soft tissue and scar tissue was dissected to exposed the tumor. After dissection along the tumor, the junction between the tumor and the nerve was transected. Hemostasis was achieved with bipolar electrocautery. The wound was then closed in layers with 3-0 Vicryl and 4-0 Nylon. Compressive wound dressing was applied over right wrist wound. Operators VS曾勝弘 Assistants R4李振豪, R2陳建銘 黃柏叡 (M,2004/07/25,7y7m) 手術日期 2011/01/04 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Head Injury 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 2 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:05 進入手術室 08:10 麻醉開始 08:40 誘導結束 08:50 抗生素給藥 09:10 手術開始 10:25 進入恢復室 10:35 手術結束 10:35 麻醉結束 10:50 送出病患 11:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 頭顱成形術 1 2 R 手術 硬腦膜外血腫清除術 1 1 R 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 記錄__ 手術科部: 外科部 套用罐頭: 1. Evacuation of epidural hematoma via right ... 開立醫師: 鍾文桂 開立時間: 2011/01/04 11:30 Pre-operative Diagnosis Head injury with depressed skull fracture,right parietal. Post-operative Diagnosis 1. Head injury with depressed skull fracture and epidural hematoma,right parietal. 2. Caput succadaneum and cephalhematoma, right parietal. 2. Cephalhematoma, right parietal. Operative Method 1. Evacuation of epidural hematoma via right parietal craniotomy. 1. Evacuation of epidural hematoma and cephalohematoma via right parietal craniotomy. 2. Cranioplasty. Specimen Count And Types nil Pathology Nil. Operative Findings 1. Dark red-brown liquified hematoma as caput succadaneum gushed out upon scalp incision. 1. The saclp over the injured site was swelling and filled with subperiosteal hamatoma. Dark red-brown liquified hematoma as cephalohematoma gushed out upon scalp incision deep to the periosteum. 2. The depressed skull plate was split into halves after craniotomy. Their shape was remodeled by high speed drills. 2. The depressed skull plate was about 4.5X4.5 cm in size. It was split into two halves after craniotomy. Their shape was remodeled by high speed drills. 3. Epidural hematoma with some hemosiderin deposition at the pericranium was noted at the anterior parietal portion of the depressed fracture. The dura was intact. 3. Epidural hematoma about 5 to 10 cc with some hemosiderin deposition was noted at the posterior portion of the depressed fracture area. The dura was intact. Operative Procedures Under ETGA, the patient was placed in supine position and the head was tilted to the left. After shaving, disinfection, and draping, the curvilinear scalp incision was made right along the edge of the bulging mass. After dissection, the depressed fracture was exposed. Craniotomy was created 0.5 cm from the edges of the depressed skull fracture. Dural tenting was done along the craniotomy edges. The epidural hematoma was evcuated by suction and currete. Under ETGA, the patient was placed in supine position and the head was tilted to the left. After shaving, disinfection, and draping, the curvilinear scalp incision was made right along the edge of the bulging mass. After dissection, the depressed fracture was exposed. A small burr hole was made at the inferior margin of the depressed fracture site. We dissected the epidural space then use drill to create a craniotomy along the margin of the depressed fracture. Dural tenting was done along the craniotomy edges. The epidural hematoma was evcuated by suction and currettage. The depressed skull fracture was split into halves and reconstructed into one piece by mini plate and screws. The bone plate was fixed by wires. Central tenting was done. The depressed skull fracture was split into halves and reconstructed into one piece by mini plate and screws. The bone plate was fixed back to the surrounding skull by 2 wires because the miniscrew were too long fot his skull thickness. Central tenting was done. After well hemostasis, the wound was closed in layers without drain in situ. Operators V.S. 郭夢菲 Assistants R5 鍾文桂 陳張貴美 (F,1940/03/17,71y11m) 手術日期 2011/01/04 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Lumbar spondylosis 器械術式 Laminectomy for decompression，Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 邱裕淳, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:02 進入手術室 08:10 麻醉開始 08:15 誘導結束 09:00 抗生素給藥 09:25 手術開始 12:10 抗生素給藥 12:45 手術結束 12:45 麻醉結束 12:50 送出病患 12:58 進入恢復室 14:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 椎弓切除術(減壓)-二節以內 1 2 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 記錄__ 手術科部: 外科部 套用罐頭: L4~5 TPS and anterior cage insertion 開立醫師: 胡朝凱 開立時間: 2011/01/04 12:54 Pre-operative Diagnosis l4~5 spondylolisthesis Post-operative Diagnosis l4~5 spondylolisthesis Operative Method L4~5 TPS and anterior cage insertion Specimen Count And Types nil Pathology nil Operative Findings 1.Anterior listhesis of L4 on L5 2.Spinal canal became narrowed 3.Flavum ligment was hypertrophic 4.After decompression, the thecal sac expanded well 5.L5 nerve roots was also noted and decompressed 6.Cage: 11#, Screws 65 x 40 x 4 Operative Procedures 1.ETGA, prone 2.Midline skin incision 3.Detach paravertebral muscle to expose L4 and L5 lamina and facet 4.TPS screws insertion and confirmed with C-arm 5.L4 laminectomy 6.Discectomy 7.Cage insertion 8.Fixed rods 9.Hemostasis 10.Set one hemovac drain then clsoe wound in layers Operators 賴達明 Assistants 胡朝凱, 邱裕淳 顏秋香 (F,1948/11/27,63y3m) 手術日期 2011/01/04 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Lumbar spondylosis 器械術式 Laminectomy for decompression，Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 11:57 報到 13:15 進入手術室 13:20 麻醉開始 13:30 誘導結束 13:34 抗生素給藥 13:35 手術開始 13:50 14:15 18:25 手術結束 18:25 麻醉結束 18:30 送出病患 18:35 進入恢復室 19:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 拔指甲-每指.趾 1 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 摘要__ 手術科部: 外科部 套用罐頭: 1. L3, L4, and L5 transpedicular screws for p... 開立醫師: 李振豪 開立時間: 2011/01/04 18:40 Pre-operative Diagnosis 1. L3 on 4, L4 on 5 spondylolisthesis 2. Intraspinal tumor, nature? 3. Tinea unguium Post-operative Diagnosis 1. L3 on 4, L4 on 5 spondylolisthesis 2. Intraspinal tumor, suspect neuroma or ganglioma 3. Tinea unguium Operative Method 1. L3, L4, and L5 transpedicular screws for posterior fixation + L3/4, L4/5 laminotomy for decompression and tumor excision + pateriolateral fusion with autologous bone graft 2. Nail extraction, left thumb Specimen Count And Types 1 piece About size:1x0.8x0.6cm Source:Intraspinal tumor Pathology Pending Operative Findings 1. The left thumb nail was hyperkeratosis and fragile. The anterior third of nail bed was unhealth. 2. The L3/4, L4/5 facet joint was degenerative with spur formation. The ligmentum flavum was hypertrophic with moderate thecal sac compression. After decompression, the thecal sac was expanded well. No CSF leakage was noted during whole procedure 3. Transpedicular screws: 6.5 x 40mm x VI (L3, L4, and L5) Rods: 8cm over right side and 9cm over left side Cross-link(-) 4. One intraspinal tumor with 1x0.8x0.6cm in size, well-capsulated, elastic to firm, whitish in content. No CSF leakage was noted after removal of the tumor. Ganglioma or neuroma was suspected. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine position. The left hand was disinfected and draped as usual. The scissor was used for nail extraction. One #8 penrose was sutured to the nail bed with 3-0 Nylon for protection of nail bed. The wound was dressed with compressive dressing. The patient was put in prone position. The transverse process of L3 to L5 was identified with portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision from L3 to L5 was made and the subcutaneous soft tissue was dissected. The paravertebral muscle group were detached. L3 to L5 transpedicular screws was placed and the location was checked by portable C-arm X-ray. L3/4, L4/5 laminotomy for decompression and L5 intraspinal tumor excision was done. Posteriolateral fusion was performed with autologous bone graft. After hemostasis, one Hemovac was placed. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS賴達明 Assistants R4李振豪, R1邱裕淳 王榮華 (M,1930/03/19,81y11m) 手術日期 2011/01/04 手術主治醫師 王國川 手術區域 東址 001房 04號 診斷 Nodular lymphoma, unspecified site, extranodal solid organ sites 器械術式 Burr hole (trephination), Right Chronic SDH 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林子富 ASA 3E 紀錄醫師 鍾文桂, 時間資訊 13:30 臨時手術NPO 13:30 開始NPO 13:54 通知急診手術 21:00 報到 21:20 進入手術室 21:25 麻醉開始 21:35 誘導結束 21:50 抗生素給藥 22:01 手術開始 22:30 手術結束 22:30 麻醉結束 22:50 送出病患 22:55 進入恢復室 23:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 手術 慢性硬腦膜下血腫清除術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Evacuation of chronic subdural hemorrhage. 開立醫師: 鍾文桂 開立時間: 2011/01/04 22:39 Pre-operative Diagnosis Chronic subdural hemorrhage, right frontal-parietal-temporal. Post-operative Diagnosis Chronic subdural hemorrhage, right frontal-parietal-temporal. Operative Method Evacuation of chronic subdural hemorrhage. Specimen Count And Types nil Pathology Nil. Operative Findings 1. Dark red-brown liquified hematoma in subdural space, about 100cc. 2. Poor brain expansion. 3. Presence of inner and outer membrane. Operative Procedures Under ETGA, the patient was placed in supine position and head was tilted to the left. After shaving, disinfection, and draping, a linear incision was made at right temporal area. After creating a burr hole and durotomy, the liquified hematoma drained out. It was further evacuated from the rubber drain. Then, a subdural rubber drain was placed in situ. After wound closure, the subdural air was evacuated by normal saline irrigation. Finally, the subdural drain was connected with a closed drainage system. Operators V.S. 王國川 Assistants R5鍾文桂 Indication Of Emergent Operation 蔡尊五 (M,1934/06/03,77y9m) 手術日期 2011/01/04 手術主治醫師 張宏江 手術區域 東址 015房 02號 診斷 Ureteral stone, left 器械術式 U.R.S.-S.M. 手術類別 預定手術 手術部位 腹 傷口分類 清潔 麻醉方式 面罩麻醉 麻醉主治醫師 葉惠敏 ASA 2 紀錄醫師 黃冠棠, 時間資訊 09:25 進入手術室 09:30 麻醉開始 09:35 誘導結束 09:35 抗生素給藥 09:47 手術開始 10:45 手術結束 10:45 麻醉結束 10:50 送出病患 10:53 進入恢復室 11:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Semi-opened mask inhalation anes 1 0 手術 輸尿管鏡取石術或碎石術–併用超音波或電擊方式 1 1 L 記錄__ 手術科部: 泌尿部 套用罐頭: URS-SM 開立醫師: 翁文慶 開立時間: 2011/01/04 10:57 Pre-operative Diagnosis Left ureteral stone with hydronephrosis Post-operative Diagnosis Left ureteral stone with hydronephrosis. BPH, Left UVJ stricture Operative Method URS-SM Specimen Count And Types nil Pathology nil Operative Findings A yellowish stone obstructed at left middle ureter with hydronephrosis and stricture was crushed by Laser(Energy:1.2J,Frequency:10/s), bilateral kissing prostate. Operative Procedures Under satisfactory anesthesia with the patient in the lithotomy position, skin preparation was performed. A cystoscope was inserted into the bladder and a guidewire was then introduced into the ureteral orifice. A 6 Fr. ureteroscope was introduced into the ureter. A yellowish stone obstructed at left middle ureter with hydronephrosis and stricture was crushed by Laser(Energy:1.2J,Frequency:10/s), bilateral kissing prostate. A Fr.6-26cm DBJ catheter was inserted. A 16 Fr. Foley catheter was placed in the urinary bladder. The patient tolerated the operation well and was sent to the recovery room in stable condition. Operators 張宏江, Assistants 伍嘉偉,黃冠棠 顏美彩 (F,1955/06/25,56y8m) 手術日期 2011/01/05 手術主治醫師 杜永光 手術區域 東址 016房 04號 診斷 Respiratory failure, with long-term ventilator use 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 07:02 通知急診手術 14:55 報到 14:55 進入手術室 15:00 麻醉開始 15:02 誘導結束 15:30 抗生素給藥 15:46 手術開始 16:30 麻醉結束 16:30 手術結束 16:41 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室體外引流 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Revision of external ventricular drainage cat... 開立醫師: 鍾文桂 開立時間: 2011/01/05 17:03 Pre-operative Diagnosis Left thalamic intracerebral hemorrhage with obstructive hydrocephalus. Post-operative Diagnosis Left thalamic intracerebral hemorrhage with obstructive hydrocephalus. Operative Method Revision of external ventricular drainage catheter, right Kocher. Specimen Count And Types 1 piece About size:3cc Source:CSF Pathology Nil. Operative Findings 1. Previous EVD catheter was occluded by blood clots. 2. CSF: pinkish, clear CSF. sent for routine BCS, and bacterial culture. Operative Procedures Under ETGA, the patient was placed in supine position and the head was in midline position. The previous EVD was removed. After shaving, disinfection, and draping, the previous right Kocher scalp wound was opened. The new EVD catheter was placed through the same tract. After checking its patency, the wound was closed in layers and the catheter was connected with closed drainage system. Operators Prof. 杜永光 Assistants R5 鍾文桂 Indication Of Emergent Operation 陳莉華 (F,1959/07/07,52y8m) 手術日期 2011/01/05 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 07:47 報到 08:03 進入手術室 08:10 麻醉開始 08:30 誘導結束 08:50 抗生素給藥 08:53 手術開始 11:50 抗生素給藥 14:50 抗生素給藥 15:45 麻醉結束 15:45 手術結束 15:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 7 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Right side pterional craniotomy for combined ... 開立醫師: 王奐之 開立時間: 2011/01/05 16:21 Pre-operative Diagnosis Right intracavernous meningioma with intradural extension Post-operative Diagnosis Right intracavernous meningioma with intradural extension Operative Method Right side pterional craniotomy for combined subtemporal & trans-sylvian tumor removal Specimen Count And Types 1 piece About size:pieces Source:right cavernous sinus Pathology Pending Operative Findings 1. Prominent frontal sinus, sealed with gelfoam, bone wax & periosteum. 2. The extradural tumor was left untouched. 3. The optic canal was decompressed after anterior clinoidectomy, tumor invasion into ACP was noted. Operative Procedures After ETGA, the patient was placed in supine position with head turned to left and fixed with Mayfield skull clamp. The scalp was shaved, disinfected and draped in usual steril fashion. A preauricular curved skin incision was made, the temporalis muscle was refleced down and pterional craniotomy was done. After drilling flat the sphenoid ridge, the 2 layers of dura were splitted from the dural reflecion at temporal base, and the extradural portion of tumor was explored. Anterior clinoidectomy was done to expose the most anterior part of cavernous sinus. After further drilling of the orbitofrontal base, a curvilinear durotomy was done. Sylvian fissure was opened and the intradural tumor was peeled off from tumor & removed in piecemeal fashion. After tumor removal, the tentorial edge was exposed. After hemostasis, the dura was closed in water-tight fashion with 4-0 Prolene. The dura was tented and the bone was fixed back after setting a epidural CWV drain. The wound was closed in layers. Operators P 杜永光 Assistants R6 陳睿生, R3 王奐之 相關圖片 王佳淑 (F,1973/02/28,39y0m) 手術日期 2011/01/05 手術主治醫師 蔡瑞章 手術區域 東址 016房 03號 診斷 Septic shock 器械術式 V-P shunt 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 4E 紀錄醫師 曾峰毅, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 07:03 通知急診手術 12:30 報到 12:30 進入手術室 12:45 麻醉開始 12:48 誘導結束 13:00 抗生素給藥 13:15 手術開始 14:19 麻醉結束 14:19 手術結束 14:25 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室腹腔分流手術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 曾峰毅 開立時間: 2011/01/05 13:59 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunt via left Kocher point. Specimen Count And Types Nil Pathology Nil Operative Findings Codman, fixed pressure, 10mmHg, was inserted via left Kocher point. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to right. We shaved, scrubbed, disinfected, and then draped the scalp, and made one skin incision at left frontal area. We drilled one burr hole at left Kocher point and created durotomy and then ventriculostomy. We made one transverse skin incision at left upper abdomen, and dissected into peritoneal space. We created subcutaneous tunnel, and inserted peritoneal, ventricular, and subcutaneous catheter. We connected the shunt, and checked its function. The wounds were closed in layers. Operators P 蔡瑞章 VS 王國川 Assistants R5 鍾文桂 R4 曾峰毅 Indication Of Emergent Operation 曾碧清 (F,1963/09/25,48y5m) 手術日期 2011/01/05 手術主治醫師 賴達明 手術區域 東址 005房 02號 診斷 Cervical spondylosis with myelopathy 器械術式 Intraspinal intramedullary tum 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 柯安達, 時間資訊 00:00 臨時手術NPO 13:52 進入手術室 13:55 麻醉開始 14:30 抗生素給藥 14:40 誘導結束 15:06 手術開始 17:30 抗生素給藥 18:40 開始輸血 18:55 手術結束 18:55 麻醉結束 19:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 良性脊髓腫瘤切除術 1 1 手術 脊椎融合術-後融合,有固定物(<=六節) 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 記錄__ 手術科部: 外科部 套用罐頭: Total tumor excision, C4~5 laminectomy then r... 開立醫師: 胡朝凱 開立時間: 2011/01/05 19:21 Pre-operative Diagnosis C5 left nerve root neuroma Post-operative Diagnosis C5 left nerve root neuroma Operative Method Total tumor excision, C4~5 laminectomy then right C4~5 kateral mass screws Specimen Count And Types pieces of tumor Pathology pending Operative Findings 1.One yellowish, elastic tumor with clear border located at left C4~5 level and extended through foramen intradurally. It arised from one dorsal root of C5 and it was sacrificed. 2.The spinal cord was compressed tightly initially. Operative Procedures 1.ETGA, prone 2.Midline incision at C2 to C6 level 3.Detach paravertebral muscles 4.C4~5 laminectomy with Ronguer 5.Left C4~5 facet joint was removed to exposed the C5 nerve root 6.Dural incision 7.Intradural tumor excision with central debulky 8.The tumor that extended via the foramen was further resected after longitudinal dural incision along with the root 9.The C5 motor root was identified and preserved 10.Dural was closed with prolene 11.Hemostasis 12.Set one CWV drain then clsoe wound in layers Operators 賴達明 Assistants 胡朝凱,　柯安達 曾洪 (M,1925/05/04,86y10m) 手術日期 2011/01/05 手術主治醫師 陳敞牧 手術區域 東址 005房 01號 診斷 Malignant neoplasm of prostate 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 柯安達, 時間資訊 00:00 臨時手術NPO 07:47 報到 08:05 進入手術室 08:15 麻醉開始 08:45 誘導結束 08:50 抗生素給藥 09:38 手術開始 11:50 抗生素給藥 13:25 手術結束 13:25 麻醉結束 13:35 送出病患 13:45 進入恢復室 醫令資訊 類別 名稱 量 刀 側 手術 惡性脊髓腫瘤切除術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: T12, L1, L3,L4 TPS insertion and L2~3 laminec... 開立醫師: 胡朝凱 開立時間: 2011/01/05 13:37 Pre-operative Diagnosis L2 pathologic fracture Post-operative Diagnosis L2 pathologic fracture Operative Method T12, L1, L3,L4 TPS insertion and L2~3 laminectomy and partial removal of epidural tumor Specimen Count And Types pieces of vertebrl body bony part and tumor Pathology pending Operative Findings 1.The thecal sac was compressed from anterior tightly due to the pathologic fracture. 2.Instability of L2~4 level was also noted. 3.TPS screws: 62 x 45 x 8, rods x 2, cross link x 1 4.The vertebral body was firm with some grayish tumor tissue inside 5.L2 and L3 nerves roots were identified and decompressed Operative Procedures 1.ETGA, prone 2.Midline skin incision at T12~L4 level 3.Detach paravertebral muscle 4.Identified facet joint 5.Screws insertion 6.L2~3 laminectomy 7.Remove bilateral L2~3 facet 8.Resect partial tumor and bony part that protruded and compressed the thecal sac 9.Hemostasis 10.Fixed rods and cross link 11.Close wound in layers after one hemovac drain insertion Operators 陳敞牧 Assistants 胡朝凱, 柯安達 張偉明 (M,1948/06/11,63y9m) 手術日期 2011/01/06 手術主治醫師 王國川 手術區域 東址 002房 04號 診斷 Head injury, unspecified 器械術式 S-P shunt 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林峰盛 ASA 3E 紀錄醫師 陳睿生, 時間資訊 21:00 臨時手術NPO 21:00 開始NPO 22:47 通知急診手術 23:40 進入手術室 23:45 麻醉開始 00:00 誘導結束 00:20 抗生素給藥 00:30 手術開始 01:05 麻醉結束 01:05 手術結束 01:18 送出病患 01:20 進入恢復室 02:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 手術 腦室腹腔分流手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Right side subduroperitoneal shunt 開立醫師: 陳睿生 開立時間: 2011/01/06 01:23 Pre-operative Diagnosis Bilateral subdural effusion Post-operative Diagnosis Bilateral subdural effusion Operative Method Right side subduroperitoneal shunt Specimen Count And Types nil Pathology Nil Operative Findings A Codman 10mmH2O shunt set was inserted for drainage. The subdural catheter was about 5cm in length. While dura opening, thicken outter membrane was noted. The pressure inside the subdural space was >20cmH2O. The subdural fluid was light yellowish. Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: supine with head rotated to left. 3.Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 3 cm linear, right temporal region at preauriclar space. 5.After the scalp flap had been retracted, a burr hole was made and the dura was tented by 2 stitches. 6.The dura and outer membrane were opened by a nib incision. The subdural space was opened, then a 5 cm segment of the catheter was introduced into the subdural space. The outer end of the catheter was connected to a Codman 10mmH2O reservoir. 7. A 3cm incision was made at RUQ of the abdomen , then minilaparotomy was performed to expose the peritoneal cavity. Subsequently, distal 20 cm segment of the peritoneal catheter was introduced into the peritoneal cavity through the outer tube of the trochar. The proximal end of this catheter was passed through subcutaneous tunnel at forechest, neck, rt retroauricular area and connected the reservoir. The shunt systemwas checked to make sure its function was working. 8. Scalp closure: hemostasis was done with monopolar coagulator touching on the sucker tip. Galea suture was performed by continuous suture with 3/0. Dexon and skin by continuous suture with 3/0 nylon. Operators VS 王國川 Assistants R6 陳睿生 Indication Of Emergent Operation 林秉禾 (M,1971/10/05,40y5m) 手術日期 2011/01/06 手術主治醫師 杜永光 手術區域 東址 002房 02號 診斷 Brain Tumor 器械術式 V-P shunt 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 08:31 通知急診手術 10:55 進入手術室 11:00 麻醉開始 11:05 誘導結束 12:26 手術開始 14:20 手術結束 14:20 麻醉結束 14:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 G-anesthesia (2-4 hours,each 30 3 0 手術 腦室腹腔分流手術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Right VP shunt 開立醫師: 胡朝凱 開立時間: 2011/01/06 13:37 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Right VP shunt Specimen Count And Types CSF specimen x 3 tubes Pathology nil Operative Findings 1.Opening pressure: around 13 cmH2O 2.Medtronic median pressure reservior was used 3.Ventricular cathe: 6.5 cm 4.peritoneal catheter: 25 cm Operative Procedures Under ETGA, patient was put in supine with head rotated to left. Skin was shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 5 cm curvilinear skin incision was made at right Kocher point. After the scalp flap had been lifted and reflected anteriorly, a burr hole was made and the dura was tented by 2 stitches. The dura was then opened by a nib incision. Rt lateral ventricle wastapped by a ventricular needle, then a 6 cm segment of the ventricular catheter was introduced into the ventricle. The outer end of the catheter was connected to a Medtronic reservoir. A nib incision was made at RUQ of the abdomen , then minilaparotomy was performed to enter peritoneal cavity. Subsequently, distal 20 cm segment of the peritoneal catheter was introduced into the peritoneal cavity. The proximal end of this catheter was passed through subcutaneous tunnel at forechest, neck, rt retroauricular area and connected the reservoir. The shunt systemwas checked to make sure its function was working. The reservoir was fixed to pericranium by 3 stitches. Scalp closure after hemostasis. Operators P 杜永光 Assistants R6 胡朝凱, R4 林哲光, Ri Indication Of Emergent Operation 王富美 (F,1940/04/24,71y10m) 手術日期 2011/01/06 手術主治醫師 陳敞牧 手術區域 東址 005房 01號 診斷 Lung cancer 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳建銘, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:06 進入手術室 08:15 麻醉開始 08:25 誘導結束 08:49 抗生素給藥 09:24 手術開始 10:46 手術結束 10:46 麻醉結束 10:57 送出病患 11:00 進入恢復室 12:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt via right Kocher"s... 開立醫師: 李振豪 開立時間: 2011/01/06 11:11 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunt via right Kocher"s point Specimen Count And Types 1 piece About size:10ml Source:CSF Pathology Nil Operative Findings The opening pressure was about 15cmH2O. The CSF was clear but mild increase in viscotisy. The Metronic median pressure reservoir was used. The ventricular catheter was 6.5cm in length. The peritoneal cathater was 30cm in length. Total 10ml CSF was sampled for routine, biochemistry, culture, and cytology. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine position with head rotated to left. The scalp was shaved, scrubbed, and disinfected as usual. One curvilinear scalp incision was made at right frontal area and the scalp flap was elevated. One burr hole was created at right Kocher"s point followed by two dural tenting. One transverse skin incision was made at right upper abdomen. The subcutaneous soft tissue was dissected and the the rectus abdominis muscle was splitted. Minilaparotomy was done to enter the peritoneal cavity. The subcutaneous tunnel was created from right upper abdomen, right forechest, right neck, to right retroauricular area. The peritoneal catheter was passed through the tunnel. The dura was opened in cruciform fashion. The ventriculostomy was performed with ventricular needle. CSF was sampled for routine, BCS, culture, and cytology. The ventricular catheter was connected to the fixed pressure reservoir and peritoneal catheter. The function of the shunt was checked. The ventricular catheter was introduced into the right lateral ventricle. The reservoir was fixed with 3 stitches. The function of the shunt was checked again. The peritoneal catheter was placed into peritoneal cavity. Hemostasis was achieved and the wound was then closed in layers. Operators VS陳敞牧 Assistants R4李振豪, R2陳建銘 相關圖片 葉景昌 (M,1950/09/03,61y6m) 手術日期 2011/01/06 手術主治醫師 蕭輔仁 手術區域 東址 005房 02號 診斷 Anomalies of spine, unspecified 器械術式 Laminectomy C-Spinal(Posterier 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 10:30 報到 11:20 進入手術室 11:25 麻醉開始 11:45 誘導結束 11:50 抗生素給藥 11:55 手術開始 13:30 開始輸血 14:50 抗生素給藥 18:45 抗生素給藥 19:05 手術結束 19:05 麻醉結束 19:15 送出病患 19:20 進入恢復室 20:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 7 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 椎弓切除術(減壓)-二節以內 1 2 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 摘要__ 手術科部: 外科部 套用罐頭: 1. C3-7 and partial T1 laminectomy for decomp... 開立醫師: 李振豪 開立時間: 2011/01/06 20:26 Pre-operative Diagnosis 1. Cervical stenosis, status post anterior fusion and instrumentation with instrumentation failure and re-stenosis 2. T10-11 stenosis Post-operative Diagnosis 1. Cervical stenosis, status post anterior fusion and instrumentation with instrumentation failure and re-stenosis 2. T10-11 stenosis Operative Method 1. C3-7 and partial T1 laminectomy for decompression + C4, C5, C6 lateral mass screws and T1 transpedicular screws for posterior fixation 2. T10-11 laminectomy for decompression Specimen Count And Types Nil Pathology Nil Operative Findings 1. The cervical spine was severe degenerative with much spur formation. The ligmentum flavum was adhered with the thecal sac tightly. After laminectomy, the thecal sac expanded well. The bony structure of C7 lateral mass was destructed. So we did not perform lateral mass screws at C7 level. 2. Left Right 2.Screws Level Left Right Screws: C4 3.5 x 18mm 3.5 x 18mm lateral mass C4 3.5 x 18mm 3.5 x 18mm lateral mass C5 3.5 x 16mm 3.5 x 18mm lateral mass C6 3.5 x 18mm 3.5 x 16mm lateral mass T1 3.5 x 24mm 3.5 x 24mm transpedicular screws Rods: 8cm x II Cross link: 5cm x I 3. The hypertrophic ligmentum flavum and marginal spur compressed the thecal sac at T10-T11 level tightly. The thecal sac expanded well after laminectomy. 4. No CSF leakage was noted during whole procedure. 5. Bleeding tendancy Operative Procedures Under endotracheal tube general anesthesia, the patient was put in prone position with head fixed with Mayfield scalp clamp. The T10/T11 disc space was localized with portable C-arm X-ray. The scalp was shaved, scrubbed, and disinfected. Midline skin incision was made from C2 to T1. The subcutaneous soft tissue and paravertebral muscle group were dissected and detached. After exposure of the C3 to T1 lamina, C3 to C7 and partial laminectomy was performed with Midas high-speed air-drived drill, Kerrison punches, and Rongeur. C4, C5, C6 lateral mass screws and T1 transpedicular screws were inserted and the rods and cross-link were set up for posterior fixation. Hemostasis was achieved and one CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Under endotracheal tube general anesthesia, the patient was put in prone position with head fixed with Mayfield scalp clamp. The T10/T11 disc space was localized with portable C-arm X-ray. The scalp was shaved, scrubbed, and disinfected. Midline skin incision was made from C2 to T1. The subcutaneous soft tissue and paravertebral muscle group were dissected and detached. After exposure of the C3 to T1 lamina, C3 to C7 and partial laminectomy was performed with Midas high-speed air-drived drill, Kerrison punches, and Rongeur. C4, C5, C6 lateral mass screws and T1 transpedicular screws were inserted and the rods and cross-link were set up for posterior fixation. Hemostasis was achieved and one CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. The midline skin incision at T10-T11 level was made and the subcutaneous soft tissue and paravertebral muscle group were dissected and detached. T10-T11 laminectomy was done with Kerrison punches and Rongeur. Hemostasis was achieved and one CWV drain was left. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS蕭輔仁 Assistants R4李振豪, R4林哲光, R2陳建銘 相關圖片 林添順 (M,1927/06/12,84y9m) 手術日期 2011/01/06 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Old cerebrovascular accident 器械術式 Crainotomy Brain Tumor(P-LIN) 手術類別 預定手術 手術部位 頭、頸 傷口分類 污染 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 07:44 報到 08:04 進入手術室 08:10 麻醉開始 08:20 誘導結束 09:09 手術開始 10:45 抗生素給藥 11:05 麻醉結束 11:05 手術結束 11:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除-手術時間在4小時以內 1 2 R 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT 開立醫師: 曾峰毅 開立時間: 2011/01/06 11:08 Pre-operative Diagnosis Right parietal and temporal abscess, status post drainage and antibiotics, residual Post-operative Diagnosis Right parietal and temporal abscess, status post drainage and antibiotics, residual Operative Method Right craniotomy for abscess drainage. Right parietal craniotomy for abscess drainage. Specimen Count And Types One swab was sent for culture. Pathology Nil Operative Findings Jelly-like, debris, was noted at right parietal area, near ventricle. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with right shoulder elevated and head rotated to left. We scrubbed, shaved, disinfected, and then draped the scalp. We made scalp incision along previuos curvilinear operation wound and extended 1cm at bilateral end of surgical wound. We drilled two burr holes, and connected previous two burr holes to a craniotomy. We performed right pareital abscess excision via prevsious corticotomy under sonography-quidance. After hemostasis, the bone graft was fixed back with miniplates. After one subgaleal CWV, we closed the wound in layers. Operators VS 王國川 Assistants R4 曾峰毅 R3 王奐之 蔡安庭 (F,1973/02/18,39y0m) 手術日期 2011/01/06 手術主治醫師 王國川 手術區域 東址 003房 03號 診斷 Lumbar Spondylosis 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 13:10 報到 13:40 進入手術室 13:45 麻醉開始 13:50 誘導結束 14:10 抗生素給藥 14:34 手術開始 16:40 手術結束 16:40 麻醉結束 16:58 送出病患 17:00 進入恢復室 18:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術(減壓)-二節以內 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 摘要__ 手術科部: 外科部 套用罐頭: HIVD 開立醫師: 王奐之 開立時間: 2011/01/06 16:30 Pre-operative Diagnosis L5-S1 lateral recess stenosis Post-operative Diagnosis L5-S1 lateral recess stenosis Operative Method Microscopic discectomy & sublaminar decompression, L5-S1, left. Specimen Count And Types nil Pathology Nil Operative Findings The left S1 root was clearly seen and well preserved. Hypertrophic ligamentum flavum was noted, with protruding disc, resulting in lateral recess stenosis. Operative Procedures After ETGA, the patient was placed in prone position. After skin disinfection & draping in sterile fashion, a K-pin was used for localization of L5-S1 interspinous space and confirmed with C-arm. A longitudinal skin incision was made with the K-pin at center, and the incision was deepened through fascial layer. Tubal retractor was then inserted. Under an operating microscope, the ligamentum flavum was cleaned and incised longitudinally at the lateral part with a No. 11 blade. The lateral portion of this ligament was removed with a small angle Kerrison rongeur, the lateral portion of the laminae and the medial border of the facets were removed too until the margin of the facets and a corridor to the disc that ran lateral to the root was reached. After identifying left S1 root, the lateral recess was well decompressed. The protrusion part of the disc was removed. After meticulous hemostasis, the wound was then closed in layers. Operators VS 王國川 Assistants R4 曾峰毅 R4 曾峰毅, R3 王奐之 相關圖片 楊春菊 (F,1952/03/14,60y0m) 手術日期 2011/01/06 手術主治醫師 王國川 手術區域 東址 000房 號 診斷 Aneurysm 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 11:00 報到 11:30 進入手術室 11:35 麻醉開始 11:40 誘導結束 11:50 抗生素給藥 12:14 手術開始 13:15 手術結束 13:15 麻醉結束 13:30 送出病患 13:35 進入恢復室 15:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 頭顱成形術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Cranioplasty 開立醫師: 曾峰毅 開立時間: 2011/01/06 13:24 Pre-operative Diagnosis Status post craniectomy Post-operative Diagnosis Status post craniectomy Operative Method Cranioplasty, left Specimen Count And Types Nil Pathology Nil Operative Findings Bone graft was fixed back with mini-plates, and bene defect was filled with artificial bone graft and bone cement. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to right. After scalp shaved, scrubbed, disinfected, and then draped, we made skin incision along previous operation wound. We fixed bone graft back with mini-plates, and bene defect was filled with artificial bone graft and bone cement. We put one subgaleal CWV, and closed the wound in layers. Operators VS 王國川 Assistants R4 曾峰毅 R3 王奐之 相關圖片 林泰誠 (M,1948/08/06,63y7m) 手術日期 2011/01/06 手術主治醫師 詹志洋 手術區域 東址 017房 03號 診斷 Contusion of face, scalp, and neck except eye(s) 器械術式 Permcath 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 黃俊銘, 時間資訊 11:15 進入手術室 11:30 抗生素給藥 11:35 麻醉開始 11:37 誘導結束 11:40 手術開始 11:55 手術結束 11:55 麻醉結束 12:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 內頸靜脈切開,永久導管放置術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Permcath/port-A 開立醫師: 黃俊銘 開立時間: 2011/01/06 12:10 Pre-operative Diagnosis ESRD Post-operative Diagnosis s/p Permcath, port-A insertion ESRD s/p Permcath Operative Method permcath/port-A implantation via right internal jugular vein permcath implantation via right internal jugular vein Specimen Count And Types nil Pathology nil Operative Findings 1. The permcath/port-A catheter was inserted via right internal jugular vein by 1. The permcath catheter was inserted via right internal jugular vein by Cut down & echo-guided procedure echo-guided procedure 2. Patent flow after implantation 3. Tip position located at RA/SVC junction Operative Procedures -Anesthesia: local/IVG/ETGA, the patient was put on supine position. The operation field was disinfected and draped as usual. -Anesthesia: local, the patient was put on supine position. The operation field was disinfected and draped as usual. -Permcath catheter was implanted on right/left side upper chest with cut down/puncture method under echo-guided procedure. The catheter was advenced via the peel-away sheath smoothly after tunnelization. -Permcath catheter was implanted on right/left side upper chest with puncture method under echo-guided procedure. The catheter was advenced via the peel-away sheath smoothly after tunnelization. -The flow was checked and flushed with heparin solution. The wounds were closure by 2-0 Nylon. Local compression for hemostasis. -Port-A: After skin disinfection and drapping & local anesthesia, echo-guided RIJV cut down and catheterization was performed. Creation of the subcutaneous pocket at right subclavicular area. Tunneliztion, advanced the catheter into the RIJV via the peel-away sheath smoothly. Ensure the catheter tip position by portable CXR. Wound closure in layers after adequate hemostasis. Post-op care plan: 1.wound CD QD+PRN 2.pain control with tinten 3.prophylatic antibiotics use Operators 詹志洋 Assistants 黃俊銘 房玲玲 (F,1956/05/26,55y9m) 手術日期 2011/01/07 手術主治醫師 杜永光 手術區域 東址 003房 02號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 2 紀錄醫師 古恬音, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:50 進入手術室 08:55 麻醉開始 09:30 誘導結束 09:50 抗生素給藥 10:00 手術開始 13:22 開始輸血 15:50 抗生素給藥 16:45 麻醉結束 16:45 手術結束 16:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 8 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Right presigmoid craniotomy 開立醫師: 古恬音 開立時間: 2011/01/07 16:59 Pre-operative Diagnosis Right petroclival meningioma Post-operative Diagnosis Right petroclival meningioma Operative Method Right presigmoid craniotomy Specimen Count And Types Nil Pathology Nil Operative Findings Prominent right side transverse-sigmoid sinus was noted. Incidental rupture of the sinus was noted during creation of craniotomy window and was repaired with prolene suture. The brain became swollen towards the end of the procedure Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with right shoulder elevated, head turned to left and fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected with better iodine then covered with sterile plastic sheet. Draping was the done in usual sterile fashion. One reverse U-shaped scalp incision was made at right temporal region just above the auricle, with extension to the retroauricular region. Soft tissue was dissected, and the temporalis muscle was reflected inferiorly. After drilling of burr holes, on bean-shaped craniotomy window was done with bone plates removed in 3 pieces. The craniotomy window included both supratentorial and infratentorial region. Epidural oozing was noted, and hemostasis was achieved with Gelfoam packing and peripheral tenting. After central tenting at supratentorial area, the bone plate was fixed back with miniplates and screws. The wound was then closed in layers. After drilling of burr holes, on bean-shaped craniotomy window was done with bone plates removed in 3 pieces. The craniotomy window included both supratentorial and infratentorial region. Epidural oozing was noted, and hemostasis was achieved with Gelfoam packing and peripheral tenting. After central tenting at supratentorial area, the bone plate was fixed back with miniplates and screws. After setting one subgaleal CWV drain, the wound was losed in layers. Operators P杜永光 Assistants R6陳睿生 R3古恬音 劉麗真 (F,1955/07/20,56y7m) 手術日期 2011/01/07 手術主治醫師 曾漢民 手術區域 東址 001房 01號 診斷 Malignant neoplasm of female breast, unspecified 器械術式 Ommaya reservoir implantation 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 2E 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 08:00 通知急診手術 08:55 報到 09:45 進入手術室 09:55 麻醉開始 10:00 誘導結束 10:35 手術開始 11:45 手術結束 11:45 麻醉結束 11:55 送出病患 11:57 進入恢復室 13:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 歐氏貯囊置放手術 1 1 R 記錄__ 手術科部: 腫瘤醫學部 套用罐頭: Ommaya reservoir implantation, right Kocher. 開立醫師: 鍾文桂 開立時間: 2011/01/07 11:00 Pre-operative Diagnosis Right breast cancer with carcinomatous leptomeningitis. Post-operative Diagnosis Right breast cancer with carcinomatous leptomeningitis. Operative Method Ommaya reservoir implantation, right Kocher. Ommaya reservoir implantation, left Kocher. Specimen Count And Types 1 piece About size:CSF Source:routine,culture,BCS Pathology Nil. Operative Findings Clear CSF gushed out from puncture needle. Opening pressure: Operative Procedures Under ETGA, the patient was placed in supine position and the head in midline. After shaving, disinfection, and draping, a curvilinear scalp incision was made at left Kocher point. Then, a burr hole was done by using high speed drill. After durotomy, ventriculostomy was achieved. The Ommaya reservoir ventricular catheter was placed through the same tract. CSF for study was collected through the reservoir. Finally, the wound was closed in layers. Operators V.S. 曾漢民 Assistants R3 王奐之 Indication Of Emergent Operation 相關圖片 徐玉嬌 (F,1953/02/15,59y0m) 手術日期 2011/01/07 手術主治醫師 曾漢民 手術區域 東址 001房 03號 診斷 Subdural hemorrhage 器械術式 Burr hole (trephination) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 4E 紀錄醫師 李振豪, 時間資訊 00:00 開始NPO 14:23 通知急診手術 14:50 報到 15:03 進入手術室 15:07 麻醉開始 15:35 誘導結束 15:53 手術開始 17:05 麻醉結束 17:05 手術結束 17:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 頭顱穿洞術(止血引流、穿刺檢查) 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Burr hole drainage 開立醫師: 李振豪 開立時間: 2011/01/07 17:24 Pre-operative Diagnosis Chronic subdural hematoma, right fronto-temporo-parietal Post-operative Diagnosis Chronic subdural hematoma, right fronto-temporo-parietal Operative Method Burr hole drainage Specimen Count And Types 1 piece About size:10ml Source:subdural hematoma Pathology Nil Operative Findings The motor oil-like subdural hematoma gushed out after open outer membrane. The inner membrane was noted after drainage of subdural hematoma. The brain was slack during whole procedure. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine position with head rotated to left. The scalp was shaved, scrubbed, and disinfected as usual. The linear scalp incision was made at right frontal area followed by one burr hole creation. After dural tenting, the dura was opened by cruciform fashion. The outer membrane was opened and coagulated. Chronic subdural hematoma was drained out and the subdural space was irrigated with normal saline. Hemostasis was achieved and one rubber drain was left within subdural space. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS曾漢民 Assistants R4李振豪 Indication Of Emergent Operation 相關圖片 陳雲飛 (M,1926/02/12,86y1m) 手術日期 2011/01/07 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Brain metastasis 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 柯安達, 時間資訊 00:00 臨時手術NPO 07:30 報到 08:20 進入手術室 08:30 麻醉開始 09:00 誘導結束 09:10 手術開始 09:42 抗生素給藥 12:15 麻醉結束 12:15 手術結束 12:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 R 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 記錄__ 手術科部: 外科部 套用罐頭: Right occipital craniotomy for total tumor ex... 開立醫師: 胡朝凱 開立時間: 2011/01/07 12:33 Pre-operative Diagnosis Right occipital tumor, suspect metastasis Post-operative Diagnosis Right occipital tumor, suspect metastasis Operative Method Right occipital craniotomy for total tumor excision Specimen Count And Types tumor mass x 1 Pathology pending Operative Findings 1.Brain buldged out after dural opening 2.The tumor was soft, yellowish to reddish, measured as 2x1 cm, located at right occipital lobe. The border was not clear. Some yellowish material content was noted insided the tumor. Operative Procedures Under ETGA, patient was put in prone position with head fixed with Mayfield skull clamp. U shape skin incision was done at right occipital area. Skin flap was dissected and opened. After four burr holes drilled, craniotomy was performed as a 7x7 bone window one cm away cross midline, followed by dural tenting. U shape dural incision was made with the base left at transverse sinus. The tumor was excised by gently dissection through the interface between tumor and brain tissue. Vascular perforation was cauterized. Hemostasis was then performed. After then, dura was closed with prolene. After one CWV drain insertion, wound was closed in layers. Operators 曾漢民 Assistants 胡朝凱, 柯安達 林育慶 (M,1976/04/24,35y10m) 手術日期 2011/01/07 手術主治醫師 曾漢民 手術區域 東址 012房 04號 診斷 Neurofibromatosis 器械術式 Scalp tumor Suture 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 2 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 11:20 報到 12:35 進入手術室 12:45 麻醉開始 12:50 誘導結束 13:00 抗生素給藥 13:13 手術開始 13:35 手術結束 13:35 麻醉結束 13:45 送出病患 13:50 進入恢復室 14:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 頭皮腫瘤 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Tumor excision 開立醫師: 王奐之 開立時間: 2011/01/07 13:42 Pre-operative Diagnosis Left parietal scalp tumor Post-operative Diagnosis Left parietal scalp tumor Operative Method Tumor excision Specimen Count And Types 1 piece About size:1*1*1cm Source:left parietal scalp tumor Pathology Pending Operative Findings A 1*1*1cm hypervascularized pinkish tumor was removed en bloc. A large arterial feeder was coagulated and divided. Operative Procedures After ETGA, the patient was placed in supine position with face turned to right. After scalp shaving, disinfection & draping in sterile fashion, a linear incision was made, followed by coagulation of the arterial feeder. The tumor was then dissected and removed en bloc. After hemostasis, the wound was closed with Appose and 3-0 Nylon. Operators VS 曾漢民 Assistants R3 王奐之, Ri 陳怡頡 相關圖片 蔡榮杰 (M,1978/10/05,33y5m) 手術日期 2011/01/07 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Lumbar Spondylosis 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 柯安達, 時間資訊 00:00 臨時手術NPO 12:40 報到 12:48 進入手術室 12:50 麻醉開始 13:00 誘導結束 13:28 抗生素給藥 13:43 手術開始 15:32 手術結束 15:32 麻醉結束 15:46 送出病患 15:50 進入恢復室 17:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 椎間盤切除術-腰椎 1 1 記錄__ 手術科部: 外科部 套用罐頭: Posterior approach for discectomy 開立醫師: 胡朝凱 開立時間: 2011/01/07 15:45 Pre-operative Diagnosis RIGHT L5~S1 HIVD Post-operative Diagnosis RIGHT L5~S1 HIVD Operative Method Posterior approach for discectomy Specimen Count And Types nil Pathology nil Operative Findings 1.Protruding and calcified disc at right L5~S1 level that compressed the right S1 nerve roots tightly was noted. 2.The root became injected. After decompression, it became loose. Operative Procedures 1.ETGA, prone 2.Midline skin incision at L5~ S1 level 3.Deatch right paravertebral muscle 4.Resect flavum ligment 5.Identified S1 root and thecal sac 6.discectomy with currete and kerrison 7.Hemostasis 8.Close wound in layers Operators 曾漢民 Assistants 胡朝凱, 柯安達 郭詠婕 (F,2004/10/19,7y4m) 手術日期 2011/01/07 手術主治醫師 曾勝弘 手術區域 兒醫 069房 02號 診斷 Aromatic L-amino acid decarboxylase deficiency 器械術式 Burr hole (trephination) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 12:26 報到 12:55 進入手術室 13:00 麻醉開始 13:30 抗生素給藥 13:38 誘導結束 13:45 手術開始 15:00 麻醉結束 15:00 手術結束 15:03 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 頭皮腫瘤 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 C.V.P. catheter in ubation 1 0 記錄__ 手術科部: 套用罐頭: Implantation of stereotatic fiducials. 開立醫師: 鍾文桂 開立時間: 2011/01/07 15:05 Pre-operative Diagnosis L-aromatic amino acid decarboxylase deficiency. Post-operative Diagnosis L-aromatic amino acid decarboxylase deficiency. Operative Method Implantation of stereotatic fiducials. Specimen Count And Types nil Pathology Nil. Operative Findings 9 metalic fiducial were implanted on the skull. Operative Procedures Under ETGA, the patient was placed in supine position and head in midline. After shaving, disinfection, and draping, 9 small scalp incisions were made. At the incision site, the metalic fucidals were implanted. Further hemostasis was achieved by purse-string 4-0 Nylon sutre at the incision sites. After wound dressing, the patient was sent to CT room for stereotatic imaging study. Operators V.S. 曾勝弘 Assistants R5 鍾文桂 陳松柏 (M,1937/10/02,74y5m) 手術日期 2011/01/07 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Lumbar spondylosis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:23 進入手術室 08:25 麻醉開始 08:35 誘導結束 09:00 抗生素給藥 09:36 手術開始 12:00 抗生素給藥 12:40 開始輸血 14:20 手術結束 14:20 麻醉結束 14:30 送出病患 14:35 進入恢復室 15:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 記錄__ 手術科部: 外科部 套用罐頭: L3-4 PLIF with Cage (9mm) 開立醫師: 林哲光 開立時間: 2011/01/07 14:52 Pre-operative Diagnosis L3-4 ruptured disc, right, with spondylolisthesis, grade I Post-operative Diagnosis Ditto Operative Method L3-4 PLIF with Cage (9mm) L3-4 TLIF with Cage (9mm) Specimen Count And Types Pathology Operative Findings A ruptured disc was noted with direct compressing from the anterior side to the right L3 root. The nerve root seemed reexpanded well after discectomy and cage insertion. Previous right L4 hemilaminectomy was noted and adhesion between the dura and paraspinal soft tissue was noted. Four 45mm TPS and two rods were used for posterior fusion. A ruptured disc was noted with direct compressing from the anterior side to the right L3 root. The nerve root seemed reexpanded well after discectomy and cage insertion. Previous right L4 hemilaminectomy was noted and adhesion between the dura and paraspinal soft tissue was noted. Four 45mm TPS and two rods, 5cm, were used for transforaminal fusion. Operative Procedures Under ETGA and prone position, skin disinfected and drapped were performed as usual. Midline skin incision was made after C-arm localization for L3, L4 pedicles. The paraspinal muslces were detached and the adhesionolysis of the right L4 was noted. TPS were inserted and checked with C-arm. L3-4 discectomy was performed and cage was inserted. Two rods were inserted. The wound was then closed in layers after epidural drain insertion and hemostasis. Operators VS 賴達明 Assistants R4 林哲光 相關圖片 黃宋秀梅 (F,1946/12/15,65y2m) 手術日期 2011/01/07 手術主治醫師 賴達明 手術區域 東址 027房 03號 診斷 Spondylosis with myelopathy, lumbar 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 賴達明, 時間資訊 00:00 臨時手術NPO 12:30 報到 12:55 進入手術室 13:00 麻醉開始 13:26 誘導結束 14:20 抗生素給藥 14:30 手術開始 16:00 開始輸血 17:20 抗生素給藥 17:30 手術結束 17:30 麻醉結束 17:45 送出病患 17:53 進入恢復室 19:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 記錄__ 手術科部: 外科部 套用罐頭: L4-5 TLIF 開立醫師: 林哲光 開立時間: 2011/01/07 19:57 Pre-operative Diagnosis L4-5 spondylolisthesis, grade I Post-operative Diagnosis Ditto Operative Method L4-5 TLIF Specimen Count And Types Pathology Operative Findings Cage 9mm was inserted and four 40mm TPS and two 5cm rods were used for transforminal fusion. Intraoperative dura tear was noted but no more CSF leakage was noted after dura closure with Prolene. Operative Procedures Under ETGA and prone position, skin disinfected and drapped were performed as usual. Midline skin incision was made over the L4-5 area after C-arm localization. Paraspinal muscles were detached and bilateral pedicles, facet joints were exposed. TPS were inserted via transforaminal and checked with C-arm. L4 laminectomy was performed. THe wound was then closed in layers after epidural drain inserted and hemostasis. Operators VS 賴達明 Assistants R4 林哲光, R1 邱裕淳 林琴 (F,1945/03/17,66y11m) 手術日期 2011/01/07 手術主治醫師 賴達明 手術區域 東址 019房 03號 診斷 Hydrocephalus 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 15:00 進入手術室 15:05 麻醉開始 15:10 誘導結束 16:00 抗生素給藥 16:06 手術開始 18:13 手術結束 18:13 麻醉結束 18:25 送出病患 18:30 進入恢復室 19:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 記錄__ 手術科部: 外科部 套用罐頭: Implantation of programmable ventriculoperito... 開立醫師: 鍾文桂 開立時間: 2011/01/07 18:37 Pre-operative Diagnosis Normal pressure hydrocephalus. Post-operative Diagnosis Normal pressure hydrocephalus. Operative Method Implantation of programmable ventriculoperitoneal shunt, right Kocher. Specimen Count And Types 1 piece About size:3cc Source:CSF: routine, culture, BCS. Pathology Nil. Operative Findings 1. Codman programmable V-P shunt: 100mmH2O, right Kocher, ventricular catheter: 6.5cm, peritoneal catheter: 30cc. Operative Procedures Under ETGA, the patient was placed in supine position and head tilted to the left. After shaving, disinfection, and draping, linear incisions at right Kocher point and RUQ of abdomen were done. After dissection, the peritoneal cavity was reached. A burr hole was created at right Kocher. The subcutaneous tunnel was created from abdomen to head. The shunt catheter was placed through the tunnel. The shunt system was connected. After durotomy and ventriculostomy, the ventricular catheter was placed at right Kocher point. After ensuring the shunt patency, the peritoneal catheter was placed in peritoneal cavity. Finally, the wounds were closed in layers. Operators V.S. 賴達明 Assistants 鍾文桂 王奐之 相關圖片 賴書玄 (M,2010/02/22,2y0m) 手術日期 2011/01/07 手術主治醫師 許文明 手術區域 東址 000房 號 診斷 Inguinal hernia 器械術式 Repair of inguinal hernia with 手術類別 預定手術 手術部位 腹 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 3 紀錄醫師 林昊諭, 時間資訊 10:50 報到 11:42 進入手術室 11:45 麻醉開始 11:52 誘導結束 11:53 抗生素給藥 12:03 手術開始 12:29 手術結束 12:29 麻醉結束 12:33 送出病患 12:36 進入恢復室 13:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 嬰兒鼠蹊疝氣 1 1 B 手術 嬰兒鼠蹊疝氣 1 1 B 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Herniorrhaphy and high ligation 開立醫師: 林昊諭 開立時間: 2011/01/07 12:34 Pre-operative Diagnosis bilateral inguinal hernia, indirect type Post-operative Diagnosis bilateral inguinal hernia, indirect type Operative Method Herniorrhaphy and high ligation Specimen Count And Types one 0.5cm hernia sac, one 0.7cm hernia sac Pathology pending Operative Findings bilateral indirect type inguinal hernia, no content in herniac sac Operative Procedures 1. Under endotracheal general anesthesia with the patient in supine position, prepping with Povidone iodine and draping was performed in the usual sterile fashion. 2. An transverse incision along skin crease was made in the bilaterali nguinal area. Incision was deepened through layers. The scarpa fascia was opened. The external oblique fascia was opened from external ring. 3. Spermatic cord was looped. Dissection was performed on the antero-medialaspect of the spermatic cord. An indirect herniac sac was noted and mobilized. The sac was opened and extended into distal and proximal ends, the latter was then high-ligated. Adequate hemostasis was obtained. 4. Closure was proceeded with interrupted catgut on the scarpa fasciaand the skin was closed subcuticularly. Operators 許文明 Assistants R6林昊諭 顏美彩 (F,1955/06/25,56y8m) 手術日期 2011/01/08 手術主治醫師 杜永光 手術區域 東址 005房 02號 診斷 Respiratory failure, with long-term ventilator use 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 4E 紀錄醫師 李振豪, 時間資訊 15:37 通知急診手術 16:03 進入手術室 16:03 報到 16:05 麻醉開始 16:15 誘導結束 16:24 手術開始 16:38 開始輸血 17:00 手術結束 17:00 抗生素給藥 17:00 麻醉結束 17:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室體外引流 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Revision of external ventricular drainage 開立醫師: 李振豪 開立時間: 2011/01/08 17:28 Pre-operative Diagnosis 1. Hydrocephalus, 2. Left thalamic intracerebral hemorrhage and intraventricular hemorrhage Post-operative Diagnosis 1. Hydrocephalus, 2. Left thalamic intracerebral hemorrhage and intraventricular hemorrhage Operative Method Revision of external ventricular drainage Specimen Count And Types 1 piece About size:15ml Source:CSF for routine, BCS, and bacterial culture; 2. EVD tip culture Pathology Nil Operative Findings The previous EVD was occluded by blood clot. The opening pressure was about 15cmH2O after place the new EVD. The CSF was red-brownish in color and was sampled for routine, BCS, and bacterial culture. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine position. The scalp was shaved, scrubbed, and disinfected as usual. The stitches were removed and the right frontal wound was opened. The previous EVD was cut off and sent for tip culture. The new EVD was inserted and fixed with 6.5cm in depth from brain surface. The CSF was sampled and sent for CSF study. Hemostasis was achieved with Gelform packing and bipolar electrocautery. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators Prof. 杜永光 Assistants R4 李振豪 Indication Of Emergent Operation 相關圖片 郭詠婕 (F,2004/10/19,7y4m) 手術日期 2011/01/08 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Aromatic L-amino acid decarboxylase deficiency 器械術式 Stereotaxic procedure for func 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 3 紀錄醫師 邱裕淳, 時間資訊 00:00 臨時手術NPO 08:07 進入手術室 08:10 麻醉開始 09:05 誘導結束 09:20 抗生素給藥 09:25 手術開始 13:05 抗生素給藥 15:10 手術結束 15:10 麻醉結束 15:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 立體定位術-功能性失調 1 2 B 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 立體定位術-功能性失調 1 1 B 記錄__ 手術科部: 套用罐頭: stereotactic adeno-associated virus injection... 開立醫師: 胡朝凱 開立時間: 2011/01/08 15:39 Pre-operative Diagnosis L-aromatic aminoacid decarboxylase deficiency Post-operative Diagnosis L-aromatic aminoacid decarboxylase deficiency Operative Method stereotactic adeno-associated virus injection to bilateral putamen Specimen Count And Types nil Pathology Nil Operative Findings 1. Four total four tracts was done. Each tract, 80 ul was injected Operative Procedures Under ETGA, the patient was put in supine position. The scalp was shaved, scrubbed and antiseptic with alcohol B-I. Registered the preset localization point to navigator. Bicoronal scalp incision was made with burr hole made at entery point of left frontal region as navigator guided. The port was set up. Injected needle was inserted. The virus was then injected with each 2 mm for 5 minutes. Performed the same procedure at right side. After hemostasis, closed the wound in layers. Operators 曾勝弘 Assistants 胡朝凱, 邱裕淳 林裕鴻 (M,1979/04/27,32y10m) 手術日期 2011/01/09 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Subarachnoid hemorrhage 器械術式 Craniotomy(Aneurysms) P-DUH 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 3E 紀錄醫師 柯安達, 時間資訊 09:00 臨時手術NPO 09:00 開始NPO 15:07 通知急診手術 23:15 進入手術室 23:15 報到 23:20 麻醉開始 23:55 誘導結束 00:00 抗生素給藥 00:17 手術開始 03:10 抗生素給藥 06:05 抗生素給藥 07:50 麻醉結束 07:50 手術結束 08:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 9 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 開顱術摘除血管病變 - 腦血管瘤 有病徵的 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Right pterional approach for aneurysm clipping 開立醫師: 胡朝凱 開立時間: 2011/01/09 08:17 Pre-operative Diagnosis A-com aneurysm Post-operative Diagnosis A-com aneurysm Operative Method Right pterional approach for aneurysm clipping Specimen Count And Types NIL Pathology nil Operative Findings 1.One about 1 cm saccular aneurysm arised from A-com that supplied by right A1 was identified. It protruded upward and leftward. 2.One oblique and one fenestrated sugita clips was applied at neck for aneurysmal clipping 3.recurrent artery and right A2 were identified and preserved 4.Some adhesion and old hematoma was noted Operative Procedures 1.ETGA, supine with head rotate to left and fixed with skull clamp 2.Right curvillinear skin incision 3.Reflect skin flap anteriorly 4.Craniotomy 5.dural tenting 6.curvature dural incision 7.Retract frontal lobe downward to expose optic chiasm and right ICA 8.By tracing ICA then ACA, aneurysm was exposed. 9.rectus gyrus was sacrificed partially 10.further dissection to expose aneurysmal neck 11.oblique clip applied 12.One fenestation clip was further applied 13.hemostasis 14.Close wound in layers Operators 賴達明 Assistants 胡朝凱, 柯安達 Indication Of Emergent Operation 鄒旭妤 (F,2010/09/10,1y6m) 手術日期 2011/01/08 手術主治醫師 楊士弘 手術區域 兒醫 066房 01號 診斷 Intracerebral hemorrhage (ICH) 器械術式 Cranioplasty，V-P shunt 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2E 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 13:10 報到 13:15 進入手術室 13:30 麻醉開始 13:55 誘導結束 14:05 抗生素給藥 14:40 手術開始 17:05 抗生素給藥 17:45 麻醉結束 17:45 手術結束 17:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 頭顱成形術 1 2 L 手術 慢性硬腦膜下血腫清除術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 套用罐頭: 1. Cranioplasty with autologous bone grafts. 開立醫師: 鍾文桂 開立時間: 2011/01/08 18:23 Pre-operative Diagnosis 1. Skull defect, left frontal-temporal-parietal. 2. Subdural fluid collection, suspect effusion. Post-operative Diagnosis 1. Skull defect, left frontal-temporal-parietal. 2. Chronic subdural hematoma, left frontal-temporal-parietal. Operative Method 1. Cranioplasty with autologous bone grafts. 2. Evacuation of chronic subdural hemorrhage. Specimen Count And Types 1 piece About size:3cc Source:subdural hematoma, liqufied. Pathology Nil. Operative Findings 1. Partial calcification of dura mater under craniectomy wound, mainly at temporal area. 2. Shrinkage of craniectomy window due to brain atrophy, comparing to skull craniectomy autologous graft. 3. Xanochromic fluid from subdural space, compatible with chronic subdural hematoma. drained by subdural drain(using EVD catheter.) 4. Intact dura mater. Operative Procedures Under ETGA, the patient was placed in supine position and the head was tilted to the right. After shaving, disinfection, and draping, the previous operative wound was incised and dissected until the dura was well identified. The temporalis muscle was also dissected from the dura mater. A small durotomy was created. The subdural drain was placed in situ and connected with closed drainage system. Then, the autologous bone graft was fixed by microplates/3mm screws and 2-0 silk strings. 4 stiches of dura tenting and an epidural CWV drain were done. The temporalis muscle was fixed on the skull bone. After well hemostasis, the wound was closed in layers. Operators V.S. 楊士弘 Assistants R5 鍾文桂 Indication Of Emergent Operation 林睦修 (M,1965/04/23,46y10m) 手術日期 2011/01/08 手術主治醫師 蕭輔仁 手術區域 東址 005房 03號 診斷 Spinal metastasis 器械術式 Spinal fusion posterior 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 4E 紀錄醫師 柯安達, 時間資訊 08:00 臨時手術NPO 08:00 開始NPO 13:16 通知急診手術 15:42 報到 17:39 進入手術室 17:45 麻醉開始 18:15 誘導結束 19:00 抗生素給藥 19:08 開始輸血 19:15 手術開始 22:00 抗生素給藥 22:40 麻醉結束 22:40 手術結束 22:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 惡性脊髓腫瘤切除術 1 1 手術 脊椎融合術-後融合,有固定物(<=六節) 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: lower L1 to upper L3 laminectomy and tumor ex... 開立醫師: 胡朝凱 開立時間: 2011/01/08 22:58 Pre-operative Diagnosis L2 metastatic tumor with thecal sac compression Post-operative Diagnosis L2 metastatic tumor with thecal sac compression Operative Method lower L1 to upper L3 laminectomy and tumor excision, and T12, L1, L3, L4 TPS Specimen Count And Types pieces of tumor Pathology pending Operative Findings 1.Reddish to grayish soft tumor located at epidural area and extended to left lamina. The thecal sac and nerve roots was compressed tightly. 2.The L2 roots was identified and preserved. 3.After tumor removal, the thecal sac expanded well 4.Some tumor was still noted anterior to thecal sac. 5.T12 screws: 60x45, L1,L3,L4 screws: 65x45 Operative Procedures 1.ETGA, prone 2.Midline skin incision at T12 to L4 level 3.Detach paravertebral muscle 4.TPS screws insertion 5.Laminectomy 6.partial Tumor excision 7.hemostasis 8.Fixed rods and cross links 9.Close wound in layers after one hemovac drain insertion Operators 蕭輔仁 Assistants 胡朝凱, 柯安達 Indication Of Emergent Operation 謝錫錂 (M,1953/01/29,59y1m) 手術日期 2011/01/09 手術主治醫師 杜永光 手術區域 東址 018房 01號 診斷 Amebiasis 器械術式 Brain tumor Crainotomy(Others) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 污染 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 3E 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 10:20 通知急診手術 14:56 進入手術室 15:05 麻醉開始 15:45 誘導結束 15:50 開始輸血 16:20 手術開始 17:00 抗生素給藥 18:10 手術結束 18:10 麻醉結束 18:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 頭顱穿洞術(止血引流、穿刺檢查) 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Trephination for abscess drainage 開立醫師: 陳睿生 開立時間: 2011/01/09 18:11 Pre-operative Diagnosis Left basal ganglion abscess with compression Post-operative Diagnosis Left basal ganglion abscess with compression Operative Method Trephination for abscess drainage Specimen Count And Types 2 pieces About size:10ML Source:ABSCESS About size:10ML Source:ABSCESS Pathology Nil Operative Findings We drained the abscess from inferior temporal gyrus. The abscess was yellowish and semi-solid pattern. Some debris was noted inside it. We drained about 40ml abscess and do cavity irrigation with normal saline. An EVD was left inside the cavity. Mild hardish abscess cavity was noted. Operative Procedures After ETGA, the patient was under supine position with head right turn. An about 5cm curvillinear scalp incision was made at left temporal side. Then a 3x3 cm trephination was created. After proper tenting, the dura was opened. We punched the abscess cavity from inferior temporal gyrus. Two drain tubes were inserted and abscess aspiration with normal saline irrigation was done. After that an EVD was inserted for continuous drain. The dura was suture closed and the bone flap was set back. The wound was finally closed in layers. Operators P 杜永光 Assistants R6 陳睿生; R5 鍾文桂 Indication Of Emergent Operation 丁妙堂 (M,1919/10/11,92y5m) 手術日期 2011/01/10 手術主治醫師 曾漢民 手術區域 東址 002房 01號 診斷 Subdural hemorrhage 器械術式 Burr hole (trephination) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 2E 紀錄醫師 鍾文桂, 時間資訊 12:00 臨時手術NPO 12:00 開始NPO 14:27 通知急診手術 02:50 報到 03:00 進入手術室 03:06 麻醉開始 03:15 誘導結束 03:43 抗生素給藥 04:10 手術開始 05:05 手術結束 05:05 麻醉結束 05:15 送出病患 05:20 進入恢復室 07:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 慢性硬腦膜下血腫清除術 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Evacuation of chronic subdural hemorrhage. 開立醫師: 鍾文桂 開立時間: 2011/01/10 05:41 Pre-operative Diagnosis Chronic subdural hemorrhage, left frontal-temporal-parietal. Post-operative Diagnosis Chronic subdural hemorrhage, left frontal-temporal-parietal. Operative Method Evacuation of chronic subdural hemorrhage. Specimen Count And Types nil Pathology Nil. Operative Findings Dark brown liquified hematoma in subdural space, about 50 cc in amount. Presence of inner and outer membrane. Poor brain expansion. Fluctuation of blood pressure intraoperatively. Operative Procedures Under ETGA, the patient was placed in supine position and the head was tilted to the right slightly. After shaving, disinfection, and draping, a linear scalp incision at left temporal area was done. A burr hole was created. After durotomy and incision of the outer membrane, the liqified hematoma drained out. Further hematoma evacuation was achieved through the rubber drain. Some normal saline irrigation to drain the hematoma more was done. Then, the subdural drain was placed in situ. The wound was closed in layers. Further subdural air evacuation was done. Finally, a closed drainage system was connected to the rubber drain. Operators V.S. 曾漢民 Assistants R5鍾文桂 R1陳柏如 Indication Of Emergent Operation 錢周艷雲 (F,1942/08/02,69y7m) 手術日期 2011/01/09 手術主治醫師 蕭輔仁 手術區域 東址 019房 01號 診斷 Nodular lymphoma, unspecified site, extranodal solid organ sites 器械術式 Spinal fusion posterior 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 1 紀錄醫師 林哲光, 時間資訊 08:28 臨時手術NPO 08:28 開始NPO 08:30 通知急診手術 12:45 報到 12:52 進入手術室 12:55 麻醉開始 13:30 誘導結束 14:00 抗生素給藥 14:47 手術開始 15:35 開始輸血 17:00 抗生素給藥 19:05 麻醉結束 19:05 手術結束 19:10 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎弓切除術(減壓)-超過二節 1 2 記錄__ 手術科部: 外科部 套用罐頭: T5,T6 laminectomy and posterior fusion with T... 開立醫師: 林哲光 開立時間: 2011/01/09 19:52 Pre-operative Diagnosis T5,T6 spine metastasis with cord compression and myelopathy Post-operative Diagnosis Ditto Operative Method T5,T6 laminectomy and posterior fusion with TPS at T3,T4,T7,T8 Specimen Count And Types 1 piece About size: Source:tumor Pathology Pending Operative Findings Pre-operative bilateral lower limbs MP were 0 and hyperextension of the bilateral upper limbs were also noted. Urine retention could not be confirmed but anal tone still positive. The cord was tightly compressed by the posterior protruding mass lesion at T5, T6 level. The dura sac seemed bulging to posterior side after laminectomy. The cord was surrounded by the tumor from bilateral laminae. The tumor was yellowish, soft-to-elastic in characteristics. Four TPS 5mmx35mm were inserted over bilateral T3 and T4. Three TPS 5mmx40mm were inserted at bilateral T8 and left T7. Two 5cm rods were implanted and 5cm cross-link was used. Osteoporosis was noted during the operation. Dura tear was also noted and was repaired with silk and covered with Gelfoam. Easily touch bleeding of the tumor was noted and intraoperative blood loss was around 1500ml. Operative Procedures Under ETGA and prone position, skin disinfected and drapped were performed as usual. Midline skin incision was made at T2-T9 level. The paraspinal muscles were then detahced. T5-T6 laminectomy was performed and partial tumor removal was done. TPS were then inserted to T3,T4,T7,T8. Rods were then inserted with reinforced by Cross-link. The wound was then closed in layers after epidural drain was inserted. Operators VS 蕭輔仁 Assistants R4 林哲光 Indication Of Emergent Operation 吳仁皆 (M,1944/08/16,67y6m) 手術日期 2011/01/09 手術主治醫師 蔡翊新 手術區域 東址 005房 04號 診斷 重大創傷且及嚴重程度到達創傷嚴重程度分數16分以上 器械術式 Removal of acute subdural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 4E 紀錄醫師 蔡立威, 時間資訊 00:29 通知急診手術 02:00 報到 02:05 進入手術室 02:10 麻醉開始 02:40 誘導結束 02:45 抗生素給藥 03:00 開始輸血 03:04 手術開始 05:45 抗生素給藥 06:40 手術結束 06:40 麻醉結束 06:50 送出病患 17:30 開始NPO 17:30 臨時手術NPO 醫令資訊 類別 名稱 量 刀 側 手術 急性硬腦膜下血腫清除術 1 1 R 手術 顱內壓視置入 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 蔡翊新 開立時間: 2011/01/09 05:43 Pre-operative Diagnosis Right frontotemporoparietal acute SDH. Post-operative Diagnosis Right frontotemporoparietal acute SDH. Operative Method Right F-T-P craniotomy for SDH evacuation and ICP monitoring. Specimen Count And Types nil Pathology Nil. Operative Findings The dura was mildly tense after craniotomy. Acute SDH, 1.5 cm in maximal thickness, was noted at right F-T-P area. There was no active bleeder detected. After evacuation of SDH, the brain was slack. ICP after duroplasty was 0 mmHg. ICP after skin closure was mmHg. The dura was mildly tense after craniotomy. Acute SDH, 1.5 cm in maximal thickness, was noted at right F-T-P area. There was no active bleeder detected. After evacuation of SDH, the brain was slack. ICP after duroplasty was 0 mmHg. ICP after skin closure was 0 mmHg. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: trauma flap at right F-T-P area, the skin edge was clipped by Raney clips for temporary hemostasis. The temporalis muscles was incised down to the tempoal squama which was exposed then by applying a self retaining retractor on the muscle. 5. Craniotomy window: 14 x 12 cm, right F-T-P, created by making 5 burr holes then cut by power saw. 6. Dural tenting: by 2/0 silk, 2 cm in interval, distributed along the edge of skull window. 7. Dural incision: curvilinear along the edge of skull window. 8. The subdural clot was removed by sucker and those located beyond the cranial window was washed out by saline irrigation. 9. Hemostasis: the bleeders was stopped by Bovie and oozing surface was covered with Surgicel. 10.Dural closure: was closed with a piece of dural graft taking from temporalis fascia (crescent shape, 12 cm long, 2 cm wide) along the whole length of the dural incision in order to create an additional space for the swollen brain. 11.The skull plate was placed back and fixed by 3 miniplates and 6 screws. 12.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 13.Drain: two epidural CWV. 14.Blood transfusion: PRBC 4U. Blood loss: 500 ml. 15.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R4李振豪R2蔡立威 Indication Of Emergent Operation 黃郁惠 (F,1970/11/09,41y4m) 手術日期 2011/01/10 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Arteriovenous malformation, brain 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 08:18 進入手術室 08:20 麻醉開始 08:25 誘導結束 08:50 抗生素給藥 09:00 手術開始 11:50 抗生素給藥 14:50 抗生素給藥 16:48 手術結束 16:48 麻醉結束 16:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 開顱術摘除血管病變 - 動靜脈畸型中型表淺 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 9 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦室體外引流 1 2 L 記錄__ 手術科部: 外科部 套用罐頭: 1. Craniotomy for AVM removal 2. EVD revision 開立醫師: 王奐之 開立時間: 2011/01/10 17:03 Pre-operative Diagnosis Right parietal arteriovenous malformation, Spetzler-Martin grade II, s/p TAE, with ICH & IVH, s/p EVD through left Kocher point Post-operative Diagnosis Right parietal arteriovenous malformation, Spetzler-Martin grade II, s/p TAE, with ICH & IVH, s/p EVD through left Kocher point Operative Method 1. Craniotomy for AVM removal 2. EVD revision Specimen Count And Types 1 piece About size:4*3*2cm Source:right parietal AVM Pathology Pending Operative Findings 1. Thickened arachnoid membrane was noted. 2. 2 major arterial feeders from lateral aspect and multiple engorged superficial draining veins were noted, all identified and divided. 3. The nidus is about 4cm in greatest diameter. 4. A small arterial bleeding was encountered intra-operatively, controlled by temporary clipping and electrocauterization. 5. Brain swelling was noticed, managed with Mannitol & EVD drainage. 6. EVD revision was done via left Kocher point, fixed at 7cm. Operative Procedures After ETGA, the patient was placed in prone position with head fixed in Mayfield skull clamp. After shaving, disinfection and draping in sterile fashion, a reversed U-shape incision was made at right posterior parietal area, followed by craniotomy. A curved durotomy was made and reflected inferiorly to expose the brain surface. After identifying the arterial feeders and draining veins, the vessels were electrocauterized and divided; the nidus was dissected from surrounding brain tissue. The nidus was then removed en bloc. After meticulous hemostasis, the dura was closed with 4-0 Prolene in water-tight fashion. The bone was fixed back, and the wound was closed in layers after setting a subgaleal CWV drain. The patient was then placed in supine position. After shaving, disinfection and draping in sterile fashion, skin incision along previous wound was made. The old EVD was then removed, and a new EVD was inserted via the same tract. The wound was then closed in layers. Operators P 杜永光 Assistants R6 陳睿生, R3 王奐之 相關圖片 林煌英 (F,1956/09/11,55y6m) 手術日期 2011/01/10 手術主治醫師 曾漢民 手術區域 東址 016房 01號 診斷 Malignant neoplasm of female breast, unspecified 器械術式 Ommaya reservoir implantation 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 08:16 通知急診手術 09:20 報到 09:22 進入手術室 09:35 麻醉開始 09:45 誘導結束 10:03 抗生素給藥 10:22 手術開始 11:00 手術結束 11:00 麻醉結束 11:10 送出病患 11:15 進入恢復室 12:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 歐氏貯囊置放手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 腫瘤醫學部 套用罐頭: Ommaya reservoir implantation, right Kocher. 開立醫師: 鍾文桂 開立時間: 2011/01/10 11:55 Pre-operative Diagnosis Breast invasive ductal carainoma, stage III with leptomeningeal metastases. Post-operative Diagnosis Breast invasive ductal carainoma, stage III with leptomeningeal metastases. Operative Method Ommaya reservoir implantation, right Kocher. Specimen Count And Types 1 piece About size:5CC Source:CSF for routine, cytology, BCS, bacteria culture. Pathology Nil. Operative Findings 1. Right Kocher Ommaya, ventricular catheter: 6.5cm. 2. Clear colorless CSF. Operative Procedures Under ETGA, the patient was placed in supine and head in midline position. After shaving, disinfection, and draping, a curvilinear scalp incision was made at right Kocher point. After dissection, a burr hole was created. Durotomy was followed by ventriculostomy. Then, Ommaya reservoir was implanted through the same tract. The wound was closed in layers. Operators V.S. 曾漢民 Assistants R5 鍾文桂 Indication Of Emergent Operation 簡志宏 (M,1988/02/29,24y0m) 手術日期 2011/01/10 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 2 紀錄醫師 柯安達, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:22 進入手術室 08:25 麻醉開始 08:40 誘導結束 09:08 抗生素給藥 09:08 手術開始 11:38 開始輸血 12:08 抗生素給藥 14:55 麻醉結束 14:55 手術結束 15:07 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: Right craniotomy for supratentorial tumor exc... 開立醫師: 胡朝凱 開立時間: 2011/01/10 15:28 Pre-operative Diagnosis Right petroclival meningioma Post-operative Diagnosis Right petroclival meningioma Operative Method Right craniotomy for supratentorial tumor excision Specimen Count And Types pieces of tumor Pathology pending Operative Findings 1.Reddish, soft, measured about 6x4 cm tumor located at right temporal that penetrated through right temporal bone and cavernous sinus was noted. 2.The tumor extended through tentorium and pushed the forth nerve and third nerve away. 3.Right ICA horizontal portion was exposed 4.The feeder came from meningohypophyseal trunk and was sacrificed 5.The supratentorial tumor was complete resected. The infratentorial part was left in situ. Operative Procedures Under ETGA, patient was put in supine position with head rotate to left and fixed with Mayfield skull clamp. UQuestion mark shape skin incision was done at right parietal area. Skin flap was dissected and opened. After burr holes drilled, craniotomy was performed as low as possible followed by dural tenting. U shape dural incision was made. Decascularization was initially performed. The tumor was excised piece by piece. And with gently dissection through the interface between tumor and brain tissue. The supratentorial part tumor was excised. some tumor adhere to dura was further coagulated. Vascular perforation was also cauterized. Tentorium was partially cut opened to expose forth nerve. A little part of infratentorial tumor was excised. Hemostasis was then performed. After then, dura was closed with prolene. After one CWV drain insertion, wound was closed in layers. Operators 曾漢民 Assistants 胡朝凱,柯安達 陳義順 (M,1960/06/18,51y8m) 手術日期 2011/01/10 手術主治醫師 蔡瑞章 手術區域 東址 005房 02號 診斷 Brain abscess 器械術式 Brain tumor Crainotomy(Others) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 柯安達, 時間資訊 00:00 臨時手術NPO 14:45 報到 15:32 進入手術室 15:35 麻醉開始 15:50 開始輸血 16:00 誘導結束 16:10 抗生素給藥 16:42 手術開始 18:00 麻醉結束 18:00 手術結束 18:06 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Posterior fossa small craniotomy for abscess ... 開立醫師: 胡朝凱 開立時間: 2011/01/10 17:54 Pre-operative Diagnosis Left cerebellar abscess Post-operative Diagnosis Left cerebellar abscess Operative Method Posterior fossa small craniotomy for abscess aspiration Specimen Count And Types pus x 3 tubes Pathology pending Operative Findings 1.Frank pus was aspirated out under echo guided 1.Frank pus was aspirated out under echo guided, about 4 ml 2.After aspiration, the abscess shrinkage under echo view Operative Procedures 1.ETGA, prone with head fixed with skull clamp 2.Left paramedian vertical skin incision 4 cm away from midline 3.Dissect skin flap and muscle group 4.Expose posterior fossa skull 5.2 cm craniotomy 6.under echo guide, abscess aspiartion was done 7.gentamycin irrigation 8.Close wound in layers Operators P 蔡瑞章 Assistants 胡朝凱, 柯安達 祝王雲玉 (F,1929/05/10,82y10m) 手術日期 2011/01/10 手術主治醫師 侯育致 手術區域 東址 002房 03號 診斷 Dry eye 器械術式 Penetrating keratoplasty(PKP) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3E 紀錄醫師 黃宇軒, 時間資訊 20:40 通知急診手術 23:30 開始NPO 23:30 臨時手術NPO 09:00 進入手術室 09:10 麻醉開始 09:25 誘導結束 09:30 手術開始 10:50 麻醉結束 10:50 手術結束 11:30 送出病患 11:34 進入恢復室 13:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Glucose 1 0 手術 穿透性角膜移植術 1 1 L 記錄__ 手術科部: 眼科部 套用罐頭: PKP 開立醫師: 黃宇軒 開立時間: 2011/01/10 10:53 Pre-operative Diagnosis Aphakic bullous keratopathy(os) Post-operative Diagnosis Aphakic bullous keratopathy(os) Operative Method Penetrating keratoplasty(os) Specimen Count And Types 1 piece About size:7.5 X 7.5 MM Source:Recipient cornea Pathology Receipient cornea(os) Operative Findings Aphakic bullous keratopathy(os) Operative Procedures 1.Under general anesthesia 2.Disinfection, irrigation and draping. 3.Apply a lid speculum. 4.Traction sutures over inferior rectus 5.Trephine the donor cornea with a 8.0 mm trephine 6.Trephine the recipient cornea with a 7.5 mm trephine and removal of cornea button with the cornea scissors 7.Inject Healon into AC 8.Suture the donor button in place with interrupted 10-0 Nylon sutures with 16 stiches 9.Check astigmatism and adjustment of the sutures 10.Bury the suture knots. 11.Remove residual Healon by Simcoe I/A 12.Form AC with BSS and check leakage 13.Subconjunctival injection of rinderon and gentamicin. 14.Healon patching. . Donor size: 8.0 mm Recipient size: 7.5 mm . Donor data: Eye bank# 11-13 OS Age: 71 y/o M COD: Multi-system failure TOD: 2011-01-01 21:07 TOE: 2011-01-03 09:20 ECC: 2409 cell/mm2 Operators VS侯育致 Assistants R5許祺鑫, R4黃宇軒 Indication Of Emergent Operation 周映輝 (M,1931/12/05,80y3m) 手術日期 2011/01/10 手術主治醫師 李章銘 手術區域 東址 018房 02號 診斷 Cerebrovascular accident (CVA) 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 趙安怡 ASA 3 紀錄醫師 陳志軒, 時間資訊 14:08 報到 14:08 進入手術室 14:10 麻醉開始 14:15 抗生素給藥 14:15 誘導結束 14:25 手術開始 14:42 麻醉結束 14:42 手術結束 14:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 氣管切開術 1 0 記錄__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 陳志軒 開立時間: 2011/01/10 14:54 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types nil Pathology None Operative Findings Fr.8 low pressure cuffed tube inserted trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and cover the wound with iodine gauze. Operators 李章銘 Assistants 郝政鴻 陳志軒 相關圖片 陳怡理 (F,2000/08/27,11y6m) 手術日期 2011/01/11 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:10 進入手術室 08:12 麻醉開始 08:55 誘導結束 09:25 抗生素給藥 09:57 手術開始 13:26 抗生素給藥 14:00 開始輸血 15:05 麻醉結束 15:05 手術結束 15:10 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 超音波診查機–腦神經外科術中特殊儀器使用費 1 0 手術 腦瘤切除-手術時間在4~8小時 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Transciliary supraorbital keyhole approach fo... 開立醫師: 鍾文桂 開立時間: 2011/01/11 15:51 Pre-operative Diagnosis Thalamic tumor with intratumoral bleeding,left status post bilateral craniectomy, cranioplasty, and implantation of ventriculoperitoneal shunt. Thalamic tumor with intratumoral bleeding, left, status post bilateral craniectomy, cranioplasty, and implantation of ventriculoperitoneal shunt. Post-operative Diagnosis Optic-hypothalamic glioma, left. suspect Optic chiasm-hypothalamic glioma, left. Operative Method Transciliary supraorbital keyhole approach for subtotal tumor excision. 1.left Transciliary supraorbital keyhole approach for partial tumor excision. 2. augmented cranioplasty with bone cement over the lateral side of the craniotomy window. Specimen Count And Types 1 piece About size:Multiple Source:brain tumor Pathology Frozen pathology: low grade glioma. Operative Findings 1. Tumor character: pinkish,firm and elastic in the more peripheral part of the tumor.In the more central part, the tumor became more suckable, soft, elastic and in high-vascularity.In more posterior part of the tumor, some old hematoma with granulation tissue was noted. The anatomy there became vague. 1. Tumor character: pinkish, firm and elastic in the more peripheral part of the tumor. In the more central part, the tumor became more suckable, soft, elastic and in high-vascularity. In more posterior part of the tumor, some old hematoma with granulation tissue was noted. The anatomy was vague due to the diffuse location of the tumor. The left optic nerve was deniavted to right side and became horizontally located. The left ICA was pushed laterally that made the optic-carotic cistern very wide. The tumor alos infiltrated into the left medial temporal region, and posterior to the pituitary gland. 2. Intraoperative ultrasonography was used to localize the tumor margin. 2. Intraoperative ultrasonography was used to localize the tumor at the frontal base. This part was not visible under microscope because there was a thin layer of normal corten covering the tumor. 3. The optic nerve was pushed laterally by the tumor. The left ICA was identified at the lateral side of the tumor mass. Operative Procedures Under ETGA, the patient was placed in supine position and the head was slightly tilted to the right and fixed by Mayfield 3-pin head holder. After disinfection, and draping, a linear 8 cm incision was made along the left eyebrow. Dissection was done to expose the superior orbital rim. A burr hole was created at the anterior margin of superior temporal line. Then, a keyhole craniotomy was achieved by using craniotome. Under ETGA, the patient was placed in supine position and the head was 30 degree tilted to the right and retroflected for 30 degrees, and fixed by Mayfield 3-pin head holder. After disinfection, and draping, a linear 7 cm incision was made along the left eyebrow. Dissection was done to expose the superior orbital rim. A burr hole was created at the anterior margin of superior temporal line. Then, a keyhole craniotomy was achieved by using craniotome. The inner table of the frontal bone and orbital rood was drilled wasy extradurally to facilitae the visual angle. After dural tenting and durotomy, the frontal base was widely exposed by retraction of the frontal lobe and CSF drainage from the subarachnoid space. The tumor was identified at frontal base and it was removed in piecemeal fashion. After dural tenting and durotomy, the frontal base was widely exposed by retraction of the frontal lobe and CSF drainage from the cistern surrounding the vague left optic nerve. The brain became slackened.The tumor was identified at left side of the left optic nerve, which was preserved, then it was debulked over the left side till the left laterally displaced ICA was seen. The frozen section showed a low grade glioma. The frontal base tumor was tried to be removed but it was covered with normal cortex, that made further removal difficult. After well hemostasis, the dura mater was closed in water-tight fashion and sealed with DuraFoam. The craniotomy plate was fixed by 2-0 Vicryl. Further cranioplasty was done with bone cement. Finally, the wound was closed in layers. After well hemostasis, the dura mater was closed in water-tight fashion and sealed with DuraFoam under. The craniotomy plate was fixed by 2-0 Vicryl. Further cranioplasty was done with bone cement. Finally, the wound was closed in layers. Operators V.S. 郭夢菲 Assistants R5 鍾文桂 蔡承諺 (M,2010/09/14,1y6m) 手術日期 2011/01/11 手術主治醫師 郭夢菲 手術區域 兒醫 067房 02號 診斷 Empyema 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 15:35 進入手術室 15:40 麻醉開始 16:15 誘導結束 17:10 手術開始 17:15 開始輸血 20:55 手術結束 20:55 麻醉結束 21:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 急性硬腦膜下血腫清除術 1 1 L 手術 急性硬腦膜下血腫清除術 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 麻醉 Lactic Acid (lactate) 4 0 記錄__ 手術科部: 外科部 套用罐頭: 1. Decortication of subdural empyema. 開立醫師: 鍾文桂 開立時間: 2011/01/11 21:41 Pre-operative Diagnosis 1. Subdural empyema, left frontal-temporal-parietal. 1. Subdural empyema, bilateral frontal-temporal-parietal region, more pachymeningeal reaction over left side 2. Subacute epidural hemorrhage, right parietal. 2. acute epidural hemorrhage, right frontotemporal region. Post-operative Diagnosis 1. Subdural empyema, left frontal-temporal-parietal. 1. Subdural empyema, bilateral frontal-temporal-parietal region, more pachymeningeal reaction over left side 2. Subacute subdural hemorrhage, right frontal-parietal-temporal. Operative Method 1. Decortication of subdural empyema. 1. Removal of diffuse pachymeningeal fibrinous tissure caused by the subdudral empyema via left frontoparietal craniotomy 2. Evacuation of subacute subdural hemorrhage. 2. Evacuation of subacute subdural hemorrhage via right frontaparietal craniotomy. Specimen Count And Types 1 piece About size:3cc Source:for bacterial culture. Pathology Nil. Operative Findings 1. Light green-yellowish gelly-like empyema with membrane formation at left subdural space. 1. Light yellowish gelly-like fibrinous tissue, 0.5 cm in thickness caused by the subdural enmpyema was noted distribulted over the surface of left frontotemporoparietal region. The subdural space was filled with come yellowish fluid. there were membrane formation above and under the jelly like fibrinous tisse. 2. Organized subacute subdural hematoma with inner and outer membrane formation was noted at right subdural space. It is not the epidural hemorrhage as we expected to see and MRI presented. 2. Organized subacute subdural hematoma with inner and outer membrane formation was noted at right subdural space. It is not the epidural hemorrhage as we expected to see and MRI presented. Operative Procedures Under ETGA, the patient was placed in supine position and head in midline. After shaving, disinfection, and draping, a linear scalp incision was made along the previous incision at right parietal-temporal region. A 5-cm craniotomy was created along the previous burr hole. After dural tenting and durotomy, the subdural hematoma was evacuated. After well hemostasis and water-tight dural closure, the craniotomy bone plate was fixed by 2-0 silk. The wound was closed in layers with one subdural drain in situ. Under ETGA, the patient was placed in supine position and head in midline. After shaving, disinfection, and draping, the previous linear scalp incision over the right temporal region was enparged to cover the parietal and frontal region. A 5-cm craniotomy was created with previous burr hole as the center of it. After dural tenting and durotomy, the outer membrane was coagulated and removed then the subdural hematoma was evacuated with the aid of headlight. After well hemostasis and water-tight dural closure with aid of the Durofoam, the craniotomy bone plate was fixed by 2-0 silk. The wound was closed in layers with one subdural drain in situ. A curvilinear scalp incision was made along the previous left parietal region. The 5-cm craniotomy window was created. After durotomy and dural tenting, decortication of the subdural empyema was done. Further gentamicin-contained normal saline was irrigated to the subdural space. After well hemostasis and water-tight dural closure, the craniotomy bone plate was fixed by 2-0 silk. The wound was closed in layers with one subdural drain in situ. A curvilinear scalp incision was made along the previous left temporal linear incision. A burr hoel was made above previous burr hole. The dural was open, and thick fibrinous tissue was noted, which could not be drained out, so we do a 5-cm craniotomy window for craniotomy. After durotomy and dural tenting, removeal of the thick , diffuse fibrinous tissue was done. The subdural space was thoroughly irrigated with gentamicine solution as the right side. After well hemostasis and water-tight dural closure, the craniotomy bone plate was fixed by 2-0 silk. The wound was closed in layers with one subdural drain in situ. Operators V.S. 郭夢菲 Assistants R5 鍾文桂 林謝阿蜜 (F,1933/02/24,79y0m) 手術日期 2011/01/11 手術主治醫師 賴達明 手術區域 東址 001房 01號 診斷 Cerebral aneurysm 器械術式 Craniotomy(Aneurysms) VS-TZENG 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 4E 紀錄醫師 陳睿生, 時間資訊 00:00 開始NPO 00:00 臨時手術NPO 08:03 通知急診手術 08:26 進入手術室 08:26 報到 08:30 抗生素給藥 08:40 麻醉開始 08:50 誘導結束 09:21 手術開始 12:30 抗生素給藥 13:20 麻醉結束 13:20 手術結束 13:27 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 開顱術摘除血管病變 - 腦血管瘤 有病徵的 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Pterional approach for aneurysms clipping 開立醫師: 陳睿生 開立時間: 2011/01/11 13:45 Pre-operative Diagnosis Right P-com and MCA aneurysm with right side ptosis Post-operative Diagnosis Right P-com and MCA aneurysm with right side ptosis Operative Method Pterional approach for aneurysms clipping Specimen Count And Types nil Pathology Nil Operative Findings Two unruptures aneurysms were noted. The first one was located at right MCA M1 portion. It located at the junction of M1 and one branch. The aneurysm was about 5mm in diameter and protruded upward. Two curve Sugita clips were applied for clipping. The P-com aneurysm was about 1cm in neck and 2cm in height. A curvillinear Sugita clip was applied, and the P-com was well preserved. The aneyrusm was ruptured after clipping and no more bleeding was noted. Operative Procedures 1. ETGA, supine position with head left turn and fix with Mayfield clump 2. Right frontotemporal curvillinear scalp incision was made and facial nerve preservation was done 3. The temporalis muscle was incised and an about 8x6 cm craniotomy window was created 4. After proper tenting, the dura was opened curvillinearly 5. CSF was drained from interpudental cistern and then the sylvian fissure was widely opened 6. We traced the MCA and identified the MCA aneurysm 7. With proper retracting, the aneurysm was clipped with two curvular clipps 8. The P-com aneurysm was noted while tracting the ICA 9. The neck was well dissected and a curvular clip was applied 10.After proper hemostasis, the dura was tightly closed with deair 11.Fix back skull graft with miniplates x3 12.Set a CWV drain, and close the wound in layers Operators VS 賴達明 Assistants R6 陳睿生; R1 柯安達 Indication Of Emergent Operation 陳圓仔 (F,1960/02/01,52y1m) 手術日期 2011/01/11 手術主治醫師 賴達明 手術區域 東址 002房 04號 診斷 Cerebral aneurysm 器械術式 Craniotomy(Aneurysms) P-DUH 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 柯安達, 時間資訊 00:40 開始NPO 00:40 臨時手術NPO 12:40 通知急診手術 13:48 報到 13:50 進入手術室 13:55 麻醉開始 14:10 抗生素給藥 14:25 誘導結束 14:35 手術開始 19:10 麻醉結束 19:10 手術結束 19:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 開顱術摘除血管病變 - 腦血管瘤 有病徵的 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Pterion approach for aneurysm clipping 開立醫師: 陳睿生 開立時間: 2011/01/12 15:46 Pre-operative Diagnosis Left P-com aneurysm with oculomotor nerve compression Post-operative Diagnosis Left P-com aneurysm with oculomotor nerve compression Operative Method Pterion approach for aneurysm clipping Specimen Count And Types nil Pathology Nil Operative Findings The aneurysm was found at the junction of ICA and P-com. It protruded inferiomedially. The neck of the aneurysm was about 1cm and the height was about 2cm. A curvillinear Sugita clip was applied for clipping. After that the sac was ruptured and no more bleeding was noted. Easy oozing was noted at the extradural temporal region. Operative Procedures 1. ETGA, supine position and head right turn with Mayfield fixation 2. Curvillinear scalp incision was created at left frontotemporal region 3. After facial nerve preservation, the temporalis muscle was incised and dissected 4. 3 bur holes were made and an about 6x8cm craniotomy window was done 5. Proper dura tenting was done 6. The sphenoid ridge was flattern and MMA was electroligated for hemostasis 7. The dura was opened curvillinearly and then CSF was drained from cistern for decompression 8. The sylvian fissure was dissected to open, and the optic nerve and ICA was localized 9. The P-com and the aneurysm were found with frontal and temporal retraction 10.A curvillinear Sugita clip was applied for clipping 11.Hemostasis, tightly close the dura 12.After central tenting, the skull graft was fixed back with miniplates x3 13.Set an epidural CWV drain, and close the wound in layers Operators VS 賴達明 Assistants R6 陳睿生; R4 李振豪; R1 柯安達 Indication Of Emergent Operation 鍾珈如 (F,1983/03/21,28y11m) 手術日期 2011/01/11 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Spine tumor 器械術式 Benign intraspinal tumor, exci 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 邱裕淳, 時間資訊 00:00 臨時手術NPO 08:07 進入手術室 08:20 麻醉開始 08:30 抗生素給藥 08:35 誘導結束 08:36 手術開始 12:05 手術結束 12:05 麻醉結束 12:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 手術 良性脊髓腫瘤切除術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Cervical Laminectomy 開立醫師: 曾峰毅 開立時間: 2011/01/11 12:13 Pre-operative Diagnosis Intraspinal tumor, extradural with extraforaminal extension via right C2/3 neural foramen, suspected neurilemmoma Post-operative Diagnosis Right C2 neurilemmoma, extradural with extraformanimal extension Operative Method Right C2 hemilaminectomy and facectomy for total tumor excision. Specimen Count And Types Several fragments of one tumor was sent for pathology. Pathology Pending Operative Findings Well capsuled, greyish, elastic, tumor arising from right C2 root was noted with extraforaminal dumbell-shaped extension. Right C2 root was sacrificed for total tumor excision. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position with head fixed with Mayfield. We shaved, scurbbed, disinfected, and then draped the skin. We made midline skin incision to expose from C1 posterior ring to C3 spinous process. We dissected right paraspinal muscle. We drilled the right C2 lamina and C2/3 facet to expose the tumor. We removed the tumor totally in intracapsular and piecemeal fashion. After hemostasis with Surgicel, we fixed C2/3 spinous process with Dacron and fused with artifical bone graft. After one submuscular CWV set, we closed the wound in layers. Operators VS 賴達明 Assistants R4 曾峰毅 R1 邱裕淳 康石彩權 (F,1932/01/10,80y2m) 手術日期 2011/01/11 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Hydrocephalus 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 邱裕淳, 時間資訊 00:00 臨時手術NPO 12:30 進入手術室 12:35 麻醉開始 12:40 誘導結束 13:00 抗生素給藥 13:22 手術開始 14:35 手術結束 14:35 麻醉結束 14:48 送出病患 14:50 進入恢復室 15:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 曾峰毅 開立時間: 2011/01/11 14:43 Pre-operative Diagnosis Normal pressure hydrocephalus Post-operative Diagnosis Normal pressure hydrocephalus Operative Method Programmable ventriculoperitoneal shunt via right Kocher point. Specimen Count And Types CSF was sent for routine, BCS, and culture. Pathology Nil Operative Findings Codman programmable shunt, set at 140mm H20. Ventricular catheter is about 6cm long. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to left, and right shoulder elevated. We scrubbed, shaved, disinfected, and then draped the surgical area. We made one transverse skin incision at right frontal area, and drilled one burr hole. We created durotomy and then ventriculostomy. We made one transverse skin incision at right upper abdomen, and inserted peritoenal catheter. We created subcutaneous tunnel and connected the shunt together. We checked the shunt function, and closed the wound in layers. Operators VS 賴達明 Assistants R4 曾峰毅 R1 邱裕淳 杜道清 (M,1926/01/06,86y2m) 手術日期 2011/01/11 手術主治醫師 侯君翰 手術區域 東址 001房 02號 診斷 Femoral shaft fracture, closed 器械術式 ORIF Interlocking Nail-Femoral 手術類別 緊急手術 手術部位 四肢 傷口分類 清潔 麻醉方式 脊髓麻醉 麻醉主治醫師 劉漢平 ASA 3E 紀錄醫師 陳宣佑, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 00:43 通知急診手術 14:12 進入手術室 14:20 麻醉開始 14:25 誘導結束 15:00 抗生素給藥 15:10 手術開始 17:20 手術結束 17:20 麻醉結束 17:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 股骨幹骨折開放性復位術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Spinal anesthesia 1 0 麻醉 SPINAL ANESTHESIA 2 0 記錄__ 手術科部: 骨科部 套用罐頭: ORIF with INL(proximal screwx2, distal screwx2) 開立醫師: 江毅彥 開立時間: 2011/01/11 17:46 Pre-operative Diagnosis Left femoral shaft fracture, mid-third Post-operative Diagnosis Left femoral shaft fracture, mid-third Operative Method ORIF with INL(proximal screwx2, distal screwx2) Specimen Count And Types nil Pathology nil Operative Findings Left femoral shaft fracture, mid-third Operative Procedures 1.Under SA, the patient was placed in supine position on fracture table 2.Skin disinfection and set up drapping 3.. Skin incision over proximal lateral thigh 4. Dissect soft tissue to expose the greater trochanter 5. Apply interlocking nail (10*360 mm) with two distal screws and two proximal screw under C-arm guidance 6. Check the alignment with C-arm 7. Normal saline irrigation and hemostasis 8. Close the wound in layer Operators 侯君翰, Assistants 陳宣佑, 賴昆鴻, 黃全敬, 江毅彥, Indication Of Emergent Operation 林文華 (M,1956/09/14,55y6m) 手術日期 2011/01/11 手術主治醫師 蕭輔仁 手術區域 東址 005房 01號 診斷 C5-C7 level fracture with unspecified spinal cord injury, closed 器械術式 OPLL- Anterior Corpectomy 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 胡朝凱, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:05 進入手術室 08:10 麻醉開始 08:25 誘導結束 09:00 抗生素給藥 09:20 手術開始 12:00 抗生素給藥 13:05 手術結束 13:05 麻醉結束 13:15 送出病患 13:22 進入恢復室 15:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 手術 脊椎融合術-前融合,有固定物)≦四節 1 2 手術 椎間盤切除術-頸椎 1 1 記錄__ 手術科部: 外科部 套用罐頭: C7 partial corpectomy with autologous bone in... 開立醫師: 胡朝凱 開立時間: 2011/01/11 13:20 Pre-operative Diagnosis c7 FRACTURE DISLOCATION Post-operative Diagnosis c7 FRACTURE DISLOCATION Operative Method C7 partial corpectomy with autologous bone insertion and C5,6,7,T1 plate fixation Specimen Count And Types nil Pathology nil Operative Findings 1.Anterior listhesis of C6 on C7 2.The ALL, and C6~7 disc and C7 upper body were fractured and destructed 3.The plate measured 6.6 cm 4.The pre-spinal cord space was freed. Operative Procedures 1.ETGA, supine 2.Right neck oblique skin incision 3.Dissection along with the anterior border of SCM muscle 4.Dissection to expose prevertebral space 5.Detach longus coli muscle 6.C6~7 disc and upper border of C7 body was removed 7.Harvest one bone graft from right iliac crest 8.insert bone graft 9.plate fixation 10.Set one CWV drain 11.close wound in layers Operators 蕭輔仁 Assistants 胡朝凱 蘇萬佑 (M,1962/01/06,50y2m) 手術日期 2011/01/11 手術主治醫師 蕭輔仁 手術區域 東址 005房 02號 診斷 C5-C7 level with central cord syndrome 器械術式 Laminectomy C-Spinal(Posterier 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 胡朝凱, 陳思恆, 時間資訊 00:00 臨時手術NPO 13:15 報到 13:40 進入手術室 13:45 麻醉開始 14:00 誘導結束 14:30 手術開始 16:33 17:00 麻醉結束 17:00 手術結束 17:00 17:10 送出病患 17:15 進入恢復室 18:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 鼻骨骨折閉鎖復位術 1 1 手術 椎弓整形術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 記錄__ 手術科部: 創傷醫學部 套用罐頭: laminoplasty C4~7, open door 開立醫師: 胡朝凱 開立時間: 2011/01/11 16:34 Pre-operative Diagnosis Cervical stenosis Post-operative Diagnosis Cervical stenosis Operative Method laminoplasty C4~7, open door Specimen Count And Types nil Pathology nil Operative Findings 1.Hypertrophic PLL that compressed the thecal sac tightly 2.After laminoplasty, thecal sac expanded well Operative Procedures 1.Anesthesia: endotracheal general. 2. Position: prone with neck flexed and head fixed by a Mayfield skull clamp 3.Skin preparation: occipital and neck areas were shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: medline nape, from suboccipital to lower neck. 5.The trapezius, semispinalis capitis, splenius capitis muscles on both sides were splitted at its origin of ligamentum nuchae, then, together with serratus posterior superior, rectus capitis posterior, obliqus capitis inferior and multifidus were detached from the spinous processes of C4~7, followed by subperiosteal dissection on the laminae. 6.bleeding from the muscles was stopped by Bovie. 7.The spinous processes of C4~7were cut at its base by high speed air drill andreserved for later use. 8. The right laminal arches were cut through its whole thickness. The left side laminae at its laminopedicle juction was cut into a depth of it half thickness by a 1mm head size high speed cutting burr. 9.The lamina was bent to the left side by opening a door like action of a Cloward intervertebral spreader. Consequently, the posterior half of the spinal canal was enlarged. 10.The hypertrophic ligmenta flava, esp. at posterior central region were resected. 11.Each gap newly created after splitting was bridged by the reserved spinous process which was fixed to the laminae by a miniplate on each end. 12.A 3 mm width partial laminectomy was done with Kerrison punch at the lower margin of C2 lamina and the upper margin of C7 lamina. 13.The paravertebral muscles were closed by interrupted sutures with 2/0 silk, subcutaneous layer by continuous suture with 3/0 Dexon and skin by continuous suture with 3/0 nylon. 14.Drain: one, epilaminal, CWV. Operators 蕭輔仁 Assistants 胡朝凱 記錄__ 手術科部: 外科部 套用罐頭: Reduction of nasal bone fracture 開立醫師: 陳思恆 開立時間: 2011/01/11 17:04 Pre-operative Diagnosis Nasal bone fracture Post-operative Diagnosis Nasal bone fracture Operative Method Reduction of nasal bone fracture Specimen Count And Types Pathology nil Operative Findings Nasal bone fracture with leftward and inward deviation. After reduction, the axis of the nasal bone was corrected. Operative Procedures Take over from NS under ETGA. Packing with Bosmine gauze at both nostrils. Reduction of nasal bone. Merocel packing. Splinting. Operators 戴浩志 Assistants 陳思恆 戴隆行 (M,1955/06/03,56y9m) 手術日期 2011/01/11 手術主治醫師 王國川 手術區域 東址 002房 03號 診斷 Brain concussion 器械術式 ICP monitoring 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 林哲光, 時間資訊 09:55 通知急診手術 11:42 進入手術室 11:45 麻醉開始 12:00 抗生素給藥 12:20 誘導結束 12:43 手術開始 13:20 手術結束 13:20 麻醉結束 13:35 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 顱內壓視置入 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Left frontal intraparenchymal ICP insertion 開立醫師: 林哲光 開立時間: 2011/01/11 13:47 Pre-operative Diagnosis Head injury with left temporal SAH Post-operative Diagnosis Ditto Operative Method Left frontal intraparenchymal ICP insertion Specimen Count And Types nil Pathology Nil Operative Findings Brain seemed not bulging after dura opening. Initial ICP showed -1 mmHg and close ICP showed 5 mmHg. Reference of ICP is 468. Operative Procedures Under ETGA and supine position with head rotated to right side, skin disinfected and drapped were performed as usual. Linear skin incision was made near the left Kocher point. Burr hole was created and dura was opened after dural tenting. ICP catheter was then inserted to the left frontal area and fixed on the skin. The wound was then closed in layers. Operators VS 王國川 Assistants R4 林哲光 Indication Of Emergent Operation 吳素蔥 (F,1958/12/24,53y2m) 手術日期 2011/01/11 手術主治醫師 蔡翊新 手術區域 西址 030房 01號 診斷 Scalp tumor 器械術式 Scalp tumor 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 09:12 報到 09:25 進入手術室 09:40 麻醉開始 09:50 手術開始 10:20 手術結束 10:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 頭皮腫瘤 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Tumor excision 開立醫師: 林哲光 開立時間: 2011/01/11 10:24 Pre-operative Diagnosis Left occipital scalp mass Post-operative Diagnosis Suspected atheroma Operative Method Tumor excision Specimen Count And Types One 3cm sized mass lesion Pathology Pending Operative Findings One grayish, well-demarcated, soft-elastic, 3cm sized mass lesion was noted at subcutaneous area of left occipital area with some pus inside. The capsule was intact during the operation. Operative Procedures Skin disinfected and drapped were performed as usual. Local anesthesia was done around the mass and fusiform skin incision was made. The total tumor revmoal was done. The wound was then closed after hemostasis. Operators VS 蔡翊新 Assistants R4 林哲光 林郁真 (F,2009/10/28,2y4m) 手術日期 2011/01/11 手術主治醫師 許巍鐘 手術區域 兒醫 062房 03號 診斷 Ependymoma 器械術式 BRONCHOSCOPY-COMPLICATED 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 面罩麻醉 麻醉主治醫師 陳李魁 ASA 3 紀錄醫師 林其懋, 時間資訊 00:00 臨時手術NPO 10:05 報到 10:14 進入手術室 10:15 麻醉開始 10:20 誘導結束 10:22 手術開始 10:40 手術結束 10:40 麻醉結束 10:56 送出病患 11:00 進入恢復室 12:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Semi-opened mask inhalation anes 1 0 手術 管、支 管、細支 管異物除去術- 管鏡 1 1 手術 支氣管鏡檢查 1 0 摘要__ 手術科部: 外科部 套用罐頭: Rigid and flexible bronchoscope 開立醫師: 林其懋 開立時間: 2011/01/11 19:15 Pre-operative Diagnosis Right vocal palsy Post-operative Diagnosis Right vocal palsy Operative Method Rigid and flexible bronchoscope Specimen Count And Types 2 pieces About size:0.1*0.1cm Source:interarytenoid area About size:0.1*0.1cm Source:upper esophagus Pathology pending Operative Findings Nose: normal, Choana: normal Pharynx: Nasopharynx: normal Tongue base: normal Vallecula: normal Hypopharynx: normal Larynx: Epiglottis: normal Aryepiglottic fold: normal Arytenoid cartilage: normal Accesory cartilage: normal True vocal fold: right vocal palsy with right vocal cord atrophy False vocal folds: normal Subglotttis: some erosion and granulation Trachea: normal Carina: normal Right main bronchus: normal Left main bronchus: normal Others: nil Operative Procedures The patient was put in supine position with neck hyperextended. After IVF was setup, flexible bronchoscope was applied into the nostril. From the nasal cavity and nasopharynx till bilateral bronchi were examed.Then jet ventilation was used for impending airway obstruction. Rigid bronchoscopy was set and larynx, subglottis, trachea, carina, bilateral main bronchus, and right upper, middle, lower; left upper and lower bronchus were checked. Operators AsP許巍鐘 Assistants R3林其懋 張添勝 (M,1969/06/05,42y9m) 手術日期 2011/01/11 手術主治醫師 李章銘 手術區域 東址 018房 03號 診斷 Subdural hematoma 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 陳志軒, 時間資訊 13:23 進入手術室 13:23 報到 13:25 麻醉開始 13:30 誘導結束 13:40 手術開始 14:09 14:45 麻醉結束 14:45 手術結束 14:47 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 氣管切開術 1 0 記錄__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 陳志軒 開立時間: 2011/01/11 13:55 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types NIL Pathology None Operative Findings Fr.8 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and cover the wound by iodine-gauze. Operators 李章銘 Assistants 高明蔚,陳志軒 相關圖片 郭兆烜 (M,1945/03/05,67y0m) 手術日期 2011/01/12 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Pituitary tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 古恬音, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:10 麻醉開始 08:43 誘導結束 09:00 抗生素給藥 09:33 手術開始 12:00 手術結束 12:00 麻醉結束 12:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內視鏡 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 經由蝶竇之腦下垂體瘤切除 1 1 摘要__ 手術科部: 外科部 套用罐頭: Endoscopic transsphenoid adenomectomy 開立醫師: 古恬音 開立時間: 2011/01/12 11:18 Pre-operative Diagnosis Pituitary macroadenoma Post-operative Diagnosis Pituitary macroadenoma Operative Method Endoscopic transsphenoidal adenomectomy Specimen Count And Types 1 piece About size:small Source:pituitary tumor Pathology Pending Operative Findings The tumor was grayish, soft, size 2.7 cm in diameter. The tumor deepened and eroded the sellar floor with invasion into the sphenoid sinus. The thickened mucosa of sphenoid sinus covered the bottom of the tumor, and some whitish mucus drained out during the procedure. The normal gland was found after tumor excision. No CSF leakage was noted during the operation. Operative Procedures Under general anethesia and intubation, the patient was put in supine position with head tilted 30 degree to left. The facial skin was antiseptic with alcohol better-iodine tincture, and the mucosa of oral and nasal cavity with aqueous better-iodine. The former areas were covered by sterilized adhesive plastic sheets then draped. Under endoscope, the nasal mucosa was coagulated at right norstril. A nasal speculum was applied to displace the nasal mucosa laterally and keep thenasal cavity open constantly for the exposure of the vomer bone and the anterior wall of the sphenoid sinus. The anterior sphenoid wall was remove by high speed air drill and Kerrison punch. The mucosa covering the tumor was opened with a knife, then the mucus was removed with suction. The soft tumor parenchyma was removed by ring curette. The arachnoid and the opening of diaphragm sellae was enforced by packing with gelform as in the sellar cavity. The nasal mucosa returned to its normal position. Right side of the nasal cavities was tightly packed with a segment of rubber glove finger filled with vaseline gauze strips which had been soaked with better-iodine ointment. The mucosa covering the tumor was opened with a knife, then the mucus was removed with suction. The soft tumor parenchyma was removed by ring curette. The arachnoid and the opening of diaphragm sellae was enforced by packing with gelform as in the sellar cavity. The nasal mucosa returned to its normal position. Both nasal cavities was tightly packed with a segment of rubber glove finger filled with vaseline gauze strips which had been soaked with better-iodine ointment. Operators P杜永光 VS楊士弘 Assistants R6陳睿生 鄭欣蓉 (F,1976/02/29,36y0m) 手術日期 2011/01/12 手術主治醫師 蔡瑞章 手術區域 東址 005房 01號 診斷 Herniated Intervertebral Disc ( HIVD ) 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 柯安達, 時間資訊 07:44 報到 08:04 進入手術室 08:08 麻醉開始 08:13 誘導結束 08:55 抗生素給藥 09:06 手術開始 11:10 手術結束 11:10 麻醉結束 11:15 送出病患 11:20 進入恢復室 13:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 椎間盤切除術-腰椎 1 1 記錄__ 手術科部: 外科部 套用罐頭: Right discectomy 開立醫師: 胡朝凱 開立時間: 2011/01/12 11:21 Pre-operative Diagnosis L5~S1 ruptured disc, right Post-operative Diagnosis L5~S1 ruptured disc, right Operative Method Right discectomy Specimen Count And Types nil Pathology nil Operative Findings 1.One about 2 cm in length dehydrated disc was pull out at right L5~S1 disc space that extended upward and compressed the nerve root tightly 2.After decompression, the root became loose 3.Unintended durotomy was done and sealed with prolene Operative Procedures 1.ETGA, prone 2.Midline skin incision at L5~S1 level 3.Deatch right paravertebral muscle 4.Laminotomy 5.pull out the ruptured disc 6.Hemostasis 7.Close wound in layers Operators P 蔡瑞章 Assistants 胡朝凱, 曾峰毅,　柯安達 林賴秋月 (F,1940/10/12,71y5m) 手術日期 2011/01/12 手術主治醫師 曾勝弘 手術區域 東址 005房 02號 診斷 Dystonia 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 柯安達, 時間資訊 11:05 報到 11:28 進入手術室 11:35 麻醉開始 11:40 誘導結束 11:44 抗生素給藥 11:55 手術開始 12:30 手術結束 12:30 麻醉結束 12:35 送出病患 12:40 進入恢復室 16:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Implantable Pulse generator revision 開立醫師: 柯安達 開立時間: 2011/01/12 12:37 Pre-operative Diagnosis Meige syndrome Post-operative Diagnosis Meige syndrome Operative Method Implantable Pulse generator revision Specimen Count And Types nil Pathology nil Operative Findings generator over left chest wall Operative Procedures 1. ETGA 2. Supine position 3. An incision was made at the previous scar 4. The previous implantable pulse generation was found and removed 5. The new pulse generator was placed at previous space 6. Test the implantable pulse generator function 7. adequate hemostasis and close the wound by layer Operators 曾勝宏 Assistants 胡朝凱 柯安達 鄭祺永 (M,2010/07/21,1y7m) 手術日期 2011/01/12 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Macrocephalus 器械術式 Removal of chronic subdural 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 2 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 07:43 報到 08:10 進入手術室 08:12 麻醉開始 08:35 誘導結束 09:00 抗生素給藥 09:40 手術開始 11:12 手術結束 11:12 麻醉結束 11:17 送出病患 11:25 進入恢復室 12:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 超音波診查機–腦神經外科術中特殊儀器使用費 1 0 手術 慢性硬腦膜下血腫清除術 1 1 L 手術 慢性硬腦膜下血腫清除術 1 2 R 記錄__ 手術科部: 外科部 套用罐頭: Drainage of subdural effusion, bilateral. 開立醫師: 鍾文桂 開立時間: 2011/01/12 11:37 Pre-operative Diagnosis Subdural effusion, bilateral status post right subdural-peritoneal shunt implantation. Chronic subdural hematoma, bilateral status post right subdural-peritoneal shunt implantation Post-operative Diagnosis Subdural effusion, bilateral status post right subdural-peritoneal shunt implantation. chronic subdural hematoma, bilateral, status post right subdural-peritoneal shunt implantation. Operative Method Drainage of subdural effusion, bilateral. 1. Drainage of subdural hematoma, bilateral. 2. check Patency of SP shunt, right Specimen Count And Types 1 piece About size:3cc Source:Subdural effusion. Pathology Nil. Operative Findings 1. Red, bloody( less bloody comparing to previous operation) subdural effusion, left. After drainage, the anterior fontanelle became concave with good pulsation. 1. Red, bloody subdural collection, though less dark red than previous surgery. The left side is more red than right side. The intracranial pressure was high, and the anterior fontanelle became alsckened good pulsation after decompression. 2. Pinkish subdural effusion, right. We checked the patency of the subudral-peritoneal shunt. It is patent. Some debris was noted over the subdural catheter. It was cleaned. 2. The subudral-peritoneal shunt was partially occluded with some fine debris in the subdural catheter thouhg it was good in position. We checked its patency and found that the distal peritoneal end may have some resistence though the irrigation fluid could pass down. Operative Procedures Under ETGA, the patient was placed in supine position and the head in midline position. After shaving, disinfection, and draping, a linear scalp wound was incised at left parietal area. After creating a burr hole and durotomy, the subdural effusion drained out. Further evacuation by normal saline irrigation was achieved by placing a subdural drain. Then, the wound was closed in layers with the subdural drain in situ. Under ETGA, the patient was placed in supine position and the head in neutral position. After shaving, disinfection, and draping, a linear scalp wound was incised at left parietal area. After creating a burr hole and durotomy, the subdural hematoma was slowely drained out to prevent BP change. Further irrigation by normal saline was achieved by placing a subdural drain. Then, the wound was closed in layers with the subdural drain in situ. The same procedure was repeated at the right side. The same procedure was repeated at the right side. The previous scalp wound for the subdural-peritoneal shunt was incised and dissected to expose the shunt catheter. The shunt catheter was pulled out from the burr hole to check its patency. After ensuring its patency, the wound was closed in layers. The previous scalp wound for the subdural-peritoneal shunt was incised and dissected to expose the shunt catheter. The shunt catheter was pulled out from the burr hole to check its patency. The fine debris was cleaned out then saline irrigation through the shunt toward the peritoneal end was undertaken. After ensuring its patency, the wound was closed in layers. Operators V.S. 郭夢菲 Assistants R5 鍾文桂 魏銘甫 (M,2004/06/04,7y9m) 手術日期 2011/01/12 手術主治醫師 郭夢菲 手術區域 兒醫 067房 02號 診斷 Acute myeloid leukemia 器械術式 Wound treatment-- <5cm 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 3 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 11:10 報到 11:30 進入手術室 11:40 麻醉開始 11:50 誘導結束 12:25 手術開始 12:40 手術結束 12:40 麻醉結束 12:50 送出病患 12:50 抗生素給藥 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 頭皮腫瘤 1 1 記錄__ 手術科部: 套用罐頭: Biopsy of forehead tumor. 開立醫師: 鍾文桂 開立時間: 2011/01/12 14:32 Pre-operative Diagnosis Acute myloid leukemia with gabella chloroma. craniofacial junction tumor, suspect acute myloid leukemia with meatstasis (chloroma) Post-operative Diagnosis Acute myloid leukemia with gabella chloroma. craniofacial junction tumor, suspect acute myloid leukemia with meatstasis (chloroma) Operative Method Biopsy of forehead tumor. Incisional Biopsy Specimen Count And Types 1 piece About size:1cc Source:scalp tumor. Pathology Nil. Operative Findings 1. Pink-grayish soft elastic tumor at forehead. 1. The whole skin over the forehead and the scalp was diffusely covered with scaling. There were bulla formation over both ears. The skin was diffusely thin and easily abraded. 2. The tumore over the craniofacial junction (glabella) was soft fragile and was well-encapsulated. 2. Critical patient condition, sent to ICU postoperatively. 2. Due to preexisted critical patient condition, the patient was sent to ICU postoperatively. Operative Procedures Under ETGA, the patient was placed in supine position. After disinfection and draping, 1 1-cm linear scalp incision was made at frontal midline, 5 cm above the gabella mass. After dissection, the tumor was reached. Biopsy was done by using alligator and tumor forceps. After getting enough spicemens, the wound was closed primarily. Under ETGA, the patient was placed in supine position. We used oil to removed the diffuse desquamation for encourage disinfection. After draping, one 1-cm linear scalp incision was made at left frontal region (there is a right frontal abrasion wound, so it could not be performed at this area), 5 cm above the gabella mass. After subperioateal dissection to open the tumor capsule, the tumor was reached. Biopsy was done by using alligator and tumor forceps. After getting enough spicemens, the wound was closed primarily. We covered the whole dressing area with OTM ointment to prevent skin injury by dressing. Operators V.S. 郭夢菲 Assistants R5 鍾文桂 陳立軒 (M,1985/06/28,26y8m) 手術日期 2011/01/12 手術主治醫師 許榮彬 手術區域 東址 016房 01號 診斷 Acute endocarditis, unspecified 器械術式 A.V.R. 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 4E 紀錄醫師 李維棠, 時間資訊 22:06 臨時手術NPO 22:06 開始NPO 05:00 通知急診手術 06:05 進入手術室 06:10 麻醉開始 06:40 誘導結束 07:23 手術開始 11:58 開始輸血 13:00 手術結束 13:00 抗生素給藥 13:00 麻醉結束 13:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 體外心肺循環 1 1 手術 胸(腹)部動靜廔管之切除移植及直接修補手術–升主動脈 1 2 手術 主動脈瓣或二尖瓣或三尖瓣之置換手術 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 T.E.E 1 0 麻醉 Lactic Acid (lactate) 3 0 麻醉 動脈血液檢查全套 4 0 麻醉 Hemoglobin (Hb) 4 0 麻醉 測血糖 3 0 麻醉 Ca (Calcium) 4 0 麻醉 Na (Sodium) 4 0 麻醉 K (Potassium) 4 0 麻醉 Blood gas analysis 4 0 記錄__ 手術科部: 外科部 套用罐頭: AVR with Sorin 23mm mechanical valve + AsAo g... 開立醫師: 李維棠 開立時間: 2011/01/12 14:11 Pre-operative Diagnosis Acute endocarditis, moderate to severe AR, bicuspid aortic valve Post-operative Diagnosis Acute endocarditis, moderate to severe AR, bicuspid AV, AsAo aneurysm, moderate AS Operative Method AVR with Sorin 23mm mechanical valve + AsAo grafting with 28mm Hemashield Specimen Count And Types 1. aortic valve leaflet 2. ascending aorta aneurysm 3. culture x2 Pathology pending Operative Findings 1. Aoritc valve: bicuspid, some vegetation over leaflet, moderate AR was noted, tew commissure 2. Two supravalvular paravalvular abscess were noted over left commissure, two subvalvular prarvalvular abscess were note over right commisure 3. All vegetation and leaflet were removed 4. AsAo aneurysm was found. Maximal diameter around 5cm. Aortic root was not dilated. 5. Post-op: without paravalvular leakage or AR were found. No A-V block was noted. Operative Procedures 1. ETGA, supine, skin sterilized and draped 2. Median sternotomy, cannulation from AsAo, RAA-> SVC,IVC 3. On CPB, hypothermia to 28C 4. AXC, antegrade and retrograde cardioplegia, RUPV venting 5. Aortotomy, remove AsAo aneurysm. Revove aortic valve and vegetation 6. Repair subvalvular abscess hole with Hemashield patch(4-0 Prolene continue suture) 7. AVR with Sorin 23mm mechanical valve 8. AsAo grafting with 28mm Hemashield vascular graft, warming 9. Weaning from CPB gradually 10. Set two chest tube (28,32) in mediasternum 11. Hemostasis and close the wound in layers Operators AP.許榮彬 Assistants R4羅健洺 R2李維棠 Indication Of Emergent Operation 蔡足味 (F,1968/03/13,44y0m) 手術日期 2011/01/12 手術主治醫師 林志峰 手術區域 東址 003房 04號 診斷 Female breast cancer 器械術式 Benign neck mass excision (sim 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 16:00 報到 16:45 進入手術室 17:00 麻醉開始 17:05 手術開始 17:05 誘導結束 17:50 麻醉結束 17:50 手術結束 17:55 送出病患 摘要__ 手術科部: 耳鼻喉部 套用罐頭: incisional biopsy of neck mass, right 開立醫師: 葉國安 開立時間: 2011/01/12 17:51 Pre-operative Diagnosis neck mass, right Post-operative Diagnosis neck mass, right, operated Operative Method incisional biopsy of neck mass, right Specimen Count And Types 2 piece About size:1*1cm Source:neck mass tissue, About size:1*1cm Source:neck mass tissue Pathology 1*1cm, neck mass X II, pending Operative Findings Neck mass, right, status post incisional biopsy Operative Procedures 1.The patient was in supine position with neck hyperextended and turned to the left side. And neck echo was applied to confirm the location of the neck mass. 2.Skin was disinfected and draped as usual. 3.Local anesthesia with Bosmin-rinsed Xylocaine was injected into the subcutaneous tissue around the neck mass after marking. 4.A 2 cm horizontal incision parallel to the skin crease was made. 5.The subcutaneous tissue was cut through. 6.two 1*1 cm mass were found and dissected from its surrounding tissue with blunt and sharp dissection. 7.The specimen was sent to pathology. 8.After hemostasis, the wound was closed and the patient tolerated the procedure well. Operators VS 林志峰 Assistants R4 薛婉儀, R2 葉國安 吳劉錐 (F,1937/04/30,74y10m) 手術日期 2011/01/12 手術主治醫師 蕭輔仁 手術區域 東址 002房 02號 診斷 Fever 器械術式 Debridment-- >10cm 手術類別 緊急手術 手術部位 脊椎 傷口分類 髒 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 曾峰毅, 時間資訊 00:24 臨時手術NPO 00:24 開始NPO 07:24 通知急診手術 09:15 報到 09:47 進入手術室 10:00 麻醉開始 10:20 誘導結束 10:59 手術開始 12:15 手術結束 12:15 麻醉結束 12:30 送出病患 12:32 進入恢復室 14:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-腰椎 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: HIVD 開立醫師: 曾峰毅 開立時間: 2011/01/12 12:45 Pre-operative Diagnosis Status post lumbar posterior fusion surgery, complicated with infection, status post instrumentation removal, complicated with Extensive abscess at L2-3 disc space, L1-3 epidural space, and L1-S1 posterior paraspinal region Status post lumbar posterior fusion surgery, complicated with infection, status post instrumentation removal, complicated with extensive abscess at L2-3 disc space, L1-3 epidural space, and L1-S1 posterior paraspinal region Post-operative Diagnosis Status post lumbar posterior fusion surgery, complicated with infection, status post instrumentation removal, complicated with Extensive abscess at L2-3 disc space, L1-3 epidural space, and L1-S1 posterior paraspinal region Status post lumbar posterior fusion surgery, complicated with infection, status post instrumentation removal, complicated with extensive abscess at L2-3 disc space, L1-3 epidural space, and L1-S1 posterior paraspinal region Operative Method Paraspinal and L2/3 abscess draiange Specimen Count And Types Sent for cultures. Pathology Nil Operative Findings Purulent discharge accumulated with previuos L2/3 laminectomy site. Debirs with fragile tissue was debrided from posterior paraspinal region at L1 to L4. L2/3 disk abscess formation was drained. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After back scrubbed, disinfected, and then draped, we made skin incision along the upper two-third of previous wound. We dissected, drained the abscess, and debrided the wound. We closed the wound in layers after one submuscular CWV inserted. Operators VS 蕭輔仁 Assistants R4 曾峰毅 Indication Of Emergent Operation 戴隆行 (M,1955/06/03,56y9m) 手術日期 2011/01/12 手術主治醫師 林繼昌 手術區域 東址 020房 03號 診斷 Brain concussion 器械術式 ORIF Interlocking Nail-Femoral 手術類別 緊急手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林子富 ASA 4E 紀錄醫師 葉炳君, 時間資訊 09:00 開始NPO 09:00 臨時手術NPO 10:41 通知急診手術 13:38 進入手術室 13:38 報到 13:40 麻醉開始 13:50 誘導結束 14:16 手術開始 15:34 開始輸血 16:25 麻醉結束 16:25 手術結束 16:35 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 股骨幹骨折開放性復位術 1 1 L 記錄__ 手術科部: 創傷醫學部 套用罐頭: ORIF with ILN, Zimmer, 13 x 400mm, proximal s... 開立醫師: 江毅彥 開立時間: 2011/01/12 16:07 Pre-operative Diagnosis left femoral shaft fracture Post-operative Diagnosis left femoral shaft fracture Operative Method ORIF with ILN, Zimmer, 13 x 400mm, proximal screws(5.5mm) x 2, distal screws(5.5mm) x 2 ORIF,close nailing with ILN, Zimmer, 13 x 400mm, proximal screws(5.5mm) x 2, distal screws(5.5mm) x 2 Specimen Count And Types nil Pathology nil Operative Findings left femoral shaft fracture Operative Procedures 1.ETGA, supine on fracture table 2.disinfection and draping 3.skin incision, awl through the piriformis fossa 4.insertion of the guide pin through fracture site under C-arm guided 5.reaming of the canal to 15 6.insertion of the nail 7.screw the proximal and distal screws 8.check alignment and stability under C-arm 9.N/S irrigation, close wound Operators 林繼昌 Assistants 葉炳君,范垂嘉 Indication Of Emergent Operation 張嘉芳 (F,1954/07/07,57y8m) 手術日期 2011/01/12 手術主治醫師 詹志洋 手術區域 東址 003房 05號 診斷 Brain metastasis 器械術式 Port-A Implatation /WOR 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 張得一, 時間資訊 18:30 報到 18:40 進入手術室 18:45 抗生素給藥 18:56 麻醉開始 18:58 麻醉結束 18:58 誘導結束 19:00 手術開始 20:05 手術結束 20:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 內頸靜脈切開,永久導管放置術 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Permcath/port-A 開立醫師: 張得一 開立時間: 2011/01/12 20:12 Pre-operative Diagnosis Breast cancer Post-operative Diagnosis Breast cancer s/p port-A insertion Operative Method Port-A implantation via left internal jugular vein Specimen Count And Types nil Pathology nil Operative Findings 1. The port-A catheter was inserted via left internal jugular vein by Cut down & echo-guided procedure 2. Rule out stenosis over innominate vein 3. Patent flow after implantation Operative Procedures After skin disinfection and drapping & local anesthesia, echo-guided RIJV cut down and catheterization was performed. Creation of the subcutaneous pocket at left subclavicular area. Tunneliztion, advanced the catheter into the RIJV via the peel-away sheath smoothly. Wound closure in layers after adequate hemostasis. Operators 詹志洋, Assistants 張得一, 相關圖片 陳憬蓉 (F,1989/11/23,22y3m) 手術日期 2011/01/13 手術主治醫師 廖漢文 手術區域 東址 000房 號 診斷 Arteriovenous malformation, brain 器械術式 NEURO T.A.E 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 2 時間資訊 11:30 麻醉開始 11:40 誘導結束 13:50 麻醉結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 徐玉嬌 (F,1953/02/15,59y0m) 手術日期 2011/01/13 手術主治醫師 曾漢民 手術區域 東址 003房 04號 診斷 Subdural hemorrhage 器械術式 Burr hole (trephination) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3E 紀錄醫師 王奐之, 時間資訊 09:00 臨時手術NPO 09:00 開始NPO 09:36 通知急診手術 15:30 報到 15:45 麻醉開始 15:50 進入手術室 16:00 誘導結束 16:30 手術開始 17:53 手術結束 17:53 麻醉結束 18:10 送出病患 18:11 進入恢復室 19:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 慢性硬腦膜下血腫清除術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Chronic Subdural Hematoma 開立醫師: 曾峰毅 開立時間: 2011/01/13 17:57 Pre-operative Diagnosis Chronic subdural hematoma, status post burr hole for subdural drainage, complicated with subacute subdural hematoma Post-operative Diagnosis Chronic subdural hematoma, status post burr hole for subdural drainage, complicated with subacute subdural hematoma Operative Method Subacute subdural hematoma Specimen Count And Types Nil Pathology Nil Operative Findings Firm to elastic, dark-brownish, hematoma was noted at subdural space. There was both inner and outer membrane. The brain expansion after hematoma removal is limited due to restriction by thick inner membrane. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to left. After scalp shaved, scrubbed, disinfected, and then draped, we made skin incision along previous operation wound and extended it at both end. We created 5x5cm craniotomy, and made durotomy in X-shape. We removed subdural hematoma, and irrigated with saline. We closed the dura and inserted one subdural rubber drain. Subdural space was de-aired with saline. The wound was closed in layers. Operators VS 曾漢民 Assistants R4 曾峰毅 R3 王奐之 Indication Of Emergent Operation 相關圖片 陳昱揚 (M,1997/06/06,14y9m) 手術日期 2011/01/13 手術主治醫師 曾漢民 手術區域 東址 003房 03號 診斷 Seizure Disorder 器械術式 V-P shunt 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 2 紀錄醫師 王奐之, 時間資訊 13:13 報到 13:25 進入手術室 13:30 麻醉開始 13:40 誘導結束 13:50 抗生素給藥 14:13 手術開始 15:05 手術結束 15:05 麻醉結束 15:17 送出病患 15:20 進入恢復室 16:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦脊髓液分流管重置 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 曾峰毅 開立時間: 2011/01/13 15:14 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunt revision Specimen Count And Types Previuos shunt catheter tips were sent for cultures. Pathology Nil Operative Findings Codman, programmable, ventriculoperitoneal shunt, pressure set at 80mmH20, was used. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to left. After scalp shaved, scrubbed, disinfected, and then draped, we made skin incision along previous operation wound at right frontal area. We removed previous shunt ventricular catheter, and inserted new ventricular catheter along the same tract. We created mini-laparotomy at right upper abdomen, and inserted peritoneal catheter. Subcutaneous tunnel was created, and the shunt was connected altogether. We chekced the shunt function, and closed the wound in layers. Operators VS 曾漢民 Assistants R4 曾峰毅 R3 王奐之 相關圖片 許張美麗 (F,1939/09/13,72y6m) 手術日期 2011/01/13 手術主治醫師 廖漢文 手術區域 東址 000房 號 診斷 Meningioma 器械術式 NEURO T.A.E 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 2 時間資訊 00:00 臨時手術NPO 08:30 麻醉開始 09:20 誘導結束 10:35 麻醉結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 陳圓仔 (F,1960/02/01,52y1m) 手術日期 2011/01/13 手術主治醫師 賴達明 手術區域 東址 001房 05號 診斷 Cerebral aneurysm 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 4E 紀錄醫師 劉昌杰, 時間資訊 02:52 開始NPO 02:52 臨時手術NPO 02:52 通知急診手術 03:20 進入手術室 03:20 報到 03:22 麻醉開始 03:30 誘導結束 03:40 抗生素給藥 03:55 手術開始 06:10 麻醉結束 06:10 手術結束 06:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 腦內血腫清除術 1 2 L 記錄__ 手術科部: 創傷醫學部 套用罐頭: Left craniotomy for hematoma evacuation 開立醫師: 胡朝凱 開立時間: 2011/01/13 06:33 Pre-operative Diagnosis post aneurysmal clipping, left frontal ICH Post-operative Diagnosis post aneurysmal clipping, left frontal ICH Operative Method Left craniotomy for hematoma evacuation Specimen Count And Types nil Pathology nil Operative Findings 1.About 40 ml hematoma located at left frontal lobe that extended from left sylvian fissure into parenchyma. 2.One small bleeder inside the sylvian fissure was identified and coagulated Operative Procedures 1.ETGA, supine 2.Left previous wound incision 3.Craniotomy 4.Dura opening via previous fashion 5.further opening sylvian fissure 6.Hemostasis by bipolar and surgicel 7.hematoma evacuation 8.Hemostasis 9.dural closure with prolene 10.fixed bone back with miniplate 11.Close wound in layers after CWV drain insertion Operators 賴達明 Assistants 胡朝凱,劉昌杰 Indication Of Emergent Operation 林黎花 (F,1932/05/28,79y9m) 手術日期 2011/01/13 手術主治醫師 賴達明 手術區域 東址 002房 02號 診斷 Intracerebral hemorrhage (ICH) 器械術式 cerebellar ICH 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 4E 紀錄醫師 李振豪, 時間資訊 09:37 開始NPO 09:37 通知急診手術 10:30 報到 10:40 進入手術室 10:45 麻醉開始 11:00 誘導結束 11:30 抗生素給藥 11:30 手術開始 12:35 開始輸血 15:20 麻醉結束 15:20 手術結束 15:23 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Suboccipital craniectomy for hematoma evacuation 開立醫師: 李振豪 開立時間: 2011/01/13 15:30 Pre-operative Diagnosis Cerebellar hemorrhage Post-operative Diagnosis Cerebellar hemorrhage Operative Method Suboccipital craniectomy for hematoma evacuation Specimen Count And Types nil Pathology Nil Operative Findings The cerebellar bulging out after dura opening. The hematoma was about 20ml in volume. The ventricle was not entered during whole procedure. The cerebellar became slack after hematoma evacuation. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in prone position with head fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. The midline skin incision was made at suboccipital area. The subcutaneous soft tissue and muscle group was dissected and detached. The fascia was harvested during the procedure. Five burr holes were created followed by suboccipital craniectomy. V-shape durotomy was performed. The hematoma was evacuated by right corticotomy. Hemostasis was achieved with bipolar electrocautery and Surgicel lining. Duroplasty was done with durofoam. The wound was then closed in layers after placing one CWV drain. Operators VS賴達明 Assistants R6胡朝凱, R4李振豪 Indication Of Emergent Operation 相關圖片 程李玉珍 (F,1924/01/14,88y2m) 手術日期 2011/01/13 手術主治醫師 黃正賢 手術區域 東址 010房 02號 診斷 Cataract 器械術式 Phaco + P.C.I.O.L.+ PPV 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 吳郁芊, 時間資訊 11:20 進入手術室 11:47 手術開始 12:55 手術結束 13:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 眼坦部玻璃體切除術-簡單 1 1 L 手術 白內障囊外摘出術併植入人工水晶體 1 2 L 記錄__ 手術科部: 眼科部 套用罐頭: PPV + phaco 開立醫師: 吳郁芊 開立時間: 2011/01/13 13:05 Pre-operative Diagnosis cataract and vitreous hemorrhage (os) Post-operative Diagnosis cataract and vitreous hemorrhage (os) Operative Method Phacoemulsification + PCIOL implantation + simple PPV (os) Specimen Count And Types nil Pathology nil Operative Findings dense cataract, VH Operative Procedures 1. Under retrobulbar anesthesia 2. Disinfection and draping as usual, apply an eyelid speculum 3. 360-degree peritomy and hemostasis with cautery. 4. Three-port sclerotomy was made andapplied light pipe, infusion cannula, and microvit through the sclerotomy wound 5. Made a clear corneal incision and penetrate into AC with 2.5mm trapezoid knife at 11 oclock position 6. Inject Viscoat into the anterior chamber 7. Continuous circular capsulorrhexis was done with bent needle and capsular forceps 8. Made a sideport at 3 oclock position with the MVR blade 9. Hydrodissection and hydrodelineation were done with BSS 10. Phacoemulsification of the nucleus by standard divide-and-conquer technique 11. Aspiration of the residual cortical material with I/A tube 12. Foldable PCIOL was implanted into the bag after injection of Viscoat 13. The residual Viscoat was washed out by Simcoe I/A cannula 14. Vitrectomy by vitrector and microscissor 15. Close sclerotomy wound with 9-0 Nylon 16. Close conjunctival wound with 8-0 Vicryl 17. Subconjunctival injection of Rinderon and Gentamicin 18. Latycin and Atropine patching Recorded by R3 Operators 黃正賢, Assistants 劉耀臨,吳郁芊 李志軒 (M,1979/12/31,32y2m) 手術日期 2011/01/13 手術主治醫師 陳敞牧 手術區域 東址 005房 02號 診斷 Facial mass 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 1 紀錄醫師 陳建銘, 時間資訊 00:00 臨時手術NPO 14:25 進入手術室 14:30 麻醉開始 14:35 誘導結束 14:40 抗生素給藥 15:00 手術開始 16:10 手術結束 16:10 麻醉結束 16:20 送出病患 16:21 進入恢復室 17:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 頭顱成形術 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Tumor excision and cranioplasty 開立醫師: 陳建銘 開立時間: 2011/01/13 16:37 Pre-operative Diagnosis Left frontal skull bone tumor Post-operative Diagnosis Left frontal skull bone tumor Operative Method Tumor excision and cranioplasty Specimen Count And Types One about 1.5*1.5cm skull bone tumor Pathology Pending Operative Findings One about 1.5*1.5cm skull bone tumor,fragile and easy bleeding with invasion to outter cortex Operative Procedures 1.ETGA,supine 2.skin disinfection and draped 3.linear incision about 5cm 4.expose the skull bone lesion and excision 5.hemostasis with boe wax 6.cranioplasty with the use of the bone cement 7.closed the wound in layers Operators VS陳敞牧 Assistants R4林哲光 R2陳建銘 許世昌 (M,1964/03/29,47y11m) 手術日期 2011/01/13 手術主治醫師 詹志洋 手術區域 兒醫 067房 03號 診斷 Malignant neoplasm of connective and other soft tissue of pelvis 器械術式 Port-A Implatation /WOR 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 黃俊銘, 時間資訊 15:47 報到 16:00 進入手術室 16:15 抗生素給藥 16:20 麻醉開始 16:25 誘導結束 16:30 手術開始 16:55 手術結束 17:00 送出病患 17:00 麻醉結束 醫令資訊 類別 名稱 量 刀 側 手術 內頸靜脈切開,永久導管放置術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Port-A 開立醫師: 黃俊銘 開立時間: 2011/01/13 17:20 Pre-operative Diagnosis Epitheliod sarcoma Post-operative Diagnosis Ditto Operative Method Port-A catheter implantation, echo guided Specimen Count And Types nil Pathology nil Operative Findings Puncture to right IJV under echo guidance The venous blood flow freely in the Port-A catheter after implantation. Operative Procedures The patient was put on supine position. The operation field was disinfected and draped as usual. Under local anesthesia, we puncture to right IJV under echo guidance. After creating subcutaneous pocket, the Port-A catheter was inserted via peel away sheath. We close the wound in layers. Post-op care plan: 1.wound CD QD+PRN2.pain control with tinten 3.prophylatic antibiotics use Operators 詹志洋 Assistants 黃俊銘 張偉明 (M,1948/06/11,63y9m) 手術日期 2011/01/13 手術主治醫師 王國川 手術區域 東址 002房 03號 診斷 Head injury, unspecified 器械術式 V-P shunt 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3E 紀錄醫師 李振豪, 時間資訊 07:30 臨時手術NPO 07:30 開始NPO 15:47 通知急診手術 18:25 進入手術室 18:30 麻醉開始 18:35 誘導結束 18:40 抗生素給藥 19:05 手術開始 19:55 麻醉結束 19:55 手術結束 20:02 送出病患 20:05 進入恢復室 22:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦室腹腔分流手術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt implantation via l... 開立醫師: 李振豪 開立時間: 2011/01/13 20:11 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunt implantation via left Frazier"s point Specimen Count And Types nil Pathology Nil Operative Findings The opening pressure is less than 10cmH2O. The CSF was clear in character. The Metronic programmable valve reservoir(pressure setting 1.5) was placed. The left subduro-peritoneal shunt was transected and the peritoneal catheter was connected to the reservoir of V-P shunt. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine position with head rotated to right. The stitches were removed. The scalp was shaved, scrubbed, and disinfected as usual. The linear scalp incision was made over left Frazier"s point. One burr hole was created with two dural tenting. The dura was opened and ventricular puncture was performed with ventricular needle. The ventricular catheter was fixed with 9cm in depth and connected to programmable valve reservoir. One transverse scalp incision was made at left retroauricular area and the peritoneal catheter of left subduro-peritoneal shunt was exposed. The subcutaneous tunnel from left Frazier"s wound to left retroauricular wound was created and the programmable valve reservoir was passed through the tunnel. The peritoneal catheter of S-P shunt was transected and connected to the reservoir of V-P shunt. The proximal part of S-P shunt was left in situ. The function of the V-P shunt was checked and the wound was closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS王國川 Assistants R4李振豪 Indication Of Emergent Operation 相關圖片 黃鎮鎧 (M,1941/01/24,71y1m) 手術日期 2011/01/13 手術主治醫師 王國川 手術區域 東址 003房 號 診斷 Subdural hemorrhage 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 2 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 07:57 報到 08:09 進入手術室 08:25 麻醉開始 08:40 誘導結束 09:14 手術開始 11:10 手術結束 11:10 麻醉結束 11:20 送出病患 11:22 進入恢復室 12:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 頭顱成形術 1 2 R 手術 腦室腹腔分流手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 手術 移前皮瓣移植術 1 4 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 曾峰毅 開立時間: 2011/01/13 11:09 Pre-operative Diagnosis Status post craniecotmy, complicated with hydrocephalus Post-operative Diagnosis Status post craniecotmy, complicated with hydrocephalus Operative Method Craniotplaty, right, and programmbale ventriculoperitoneal shunt was inserted via right Kocher point, set at 130mmH20. Specimen Count And Types Nil Pathology Nil Operative Findings Codman, programmbale, ventriculoperitoneal shunt was inserted via right Kocher point, set at 130mmH20. Ventricular catheter was about 7cm long. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to left. We shaved, scrubbed, disinfected, and then draped the operation field, and made incision along the previous operation wound. We made one durotomy at right frontal area-Kocher point, and performed ventriculostomy. General surgeon performed mini-laparotomy at right upper abdomen, and inserted peritoneal catheter. We created subcutaneous tunnel, and connected the shunt together after fixing the bone graft back with mini-plates and bone cement. After one subgaleal CWV drains inserted, the wound was closed in layers. Operators VS 王國川 VS 洪基翔 Assistants R4 曾峰毅 R3 王奐之 相關圖片 林錦榮 (M,1940/08/15,71y6m) 手術日期 2011/01/13 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 Intracerebral hemorrhage (ICH) 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 11:00 報到 11:35 進入手術室 11:40 麻醉開始 11:50 誘導結束 12:00 抗生素給藥 12:22 手術開始 13:00 手術結束 13:00 麻醉結束 13:10 送出病患 13:13 進入恢復室 15:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 曾峰毅 開立時間: 2011/01/13 13:11 Pre-operative Diagnosis Subdural effusion, left Post-operative Diagnosis Subdural effusion, left Operative Method Left subduroperitoneal shunt Specimen Count And Types Nil Pathology Nil Operative Findings Pressure of subdural effusion was about 5cmH20, and the character clear and colorless. Codman fixed pressure shunt, 10mmH20 was used. Pressure of subdural effusion was about 5cmH20, and the character was clear and colorless. Codman fixed pressure shunt, 10mmH20 was used. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to right. After scalp shaved, scrubbed, disinfected, and then draped, we made one transverse skin incision at right fronatl area. We drilled one burr hole and created durotomy. We inserted subdural catheter. Another transverse skin incision was done at left upper abdomen for mini-laparotomy. We inserted peritoenal catheter, and connected the shunt altogether in subcutaneous tunnel. We chekced the shunt function, and then closed the wound in layers. Operators VS 王國川 Assistants R4 曾峰毅 R3 王奐之 相關圖片 陳秀誠 (M,1966/07/23,45y7m) 手術日期 2011/01/13 手術主治醫師 紀乃新 手術區域 東址 017房 03號 診斷 Acute myocardial infarction (AMI) 器械術式 D.A.A (Bentells or Grafting) 手術類別 緊急手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 4E 紀錄醫師 陳政維, 時間資訊 17:02 開始NPO 17:02 通知急診手術 19:00 進入手術室 19:10 麻醉開始 19:50 誘導結束 20:00 抗生素給藥 20:18 手術開始 22:00 開始輸血 22:40 手術結束 22:40 麻醉結束 22:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 放置肺動脈導管術 1 0 麻醉 Cardiac out-put 1 0 麻醉 Swan-gang catheterization 1 0 麻醉 T.E.E 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 冠狀動脈繞道手術 -三條血管 1 1 記錄__ 手術科部: 外科部 套用罐頭: OPCAB 開立醫師: 陳政維 開立時間: 2011/01/13 23:27 Pre-operative Diagnosis Traumatic LAD dissection with AMI Post-operative Diagnosis Ditto Operative Method OPCAB Specimen Count And Types nil Pathology Nil Operative Findings 1.Fair ventricular contractility 2.CAG: LM: petent, LAD: long dissection to LM, LCX: patent, RCA: mid CTO 3.CABG: SVG1-->LAD, SVG2-->OM-->PDA Operative Procedures 1.Supine position, ETGA, skin disinfection 2.Median sternotomy 3.Harvest left and right GSV 4.Perform CABG with GSV1 to LAD and GSV2 to OM and PDA 5.Hemostasis and set two chest tubes in mediastinum 6.Close the wound in layers Operators VS紀乃新 Assistants R5徐綱宏 R3陳政維 Indication Of Emergent Operation 黃益川 (M,1947/03/19,64y11m) 手術日期 2011/01/13 手術主治醫師 蔡翊新 手術區域 東址 005房 01號 診斷 Injury (severeity score >=16) 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3 紀錄醫師 陳建銘, 時間資訊 00:00 臨時手術NPO 08:08 進入手術室 08:10 麻醉開始 08:20 誘導結束 08:30 抗生素給藥 09:12 手術開始 11:45 抗生素給藥 11:58 13:55 手術結束 13:55 麻醉結束 14:11 送出病患 14:15 進入恢復室 15:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 手術 腦室腹腔分流手術 1 1 R 手術 頭顱成形術 1 2 L 記錄__ 手術科部: 外科部 套用罐頭: Left F-T-P Cranioplasty with autologous bone ... 開立醫師: 蔡翊新 開立時間: 2011/01/13 13:41 Pre-operative Diagnosis Left F-T-P skull defect; Hydrocephalus. Post-operative Diagnosis Left F-T-P skull defect; Hydrocephalus. Operative Method Left F-T-P Cranioplasty with autologous bone graft; Right Kocher VP shunt with (Codman) programmable shunt. Specimen Count And Types 3 tubes of CSF, sent for routine, BCS and culture. Pathology Nil. Operative Findings 1. A 14 x 12 cm skull defect at left frontotemporoparietal region. The dura was a little bulging after the scalp flap was elevated. The left temporal muscle has been excised during previous surgery and the bulk was replaced by a piece of bone cement for cosmetic reason. 2. 2.CSF: clear, pressure: 15 cmH2O. Codman programmable shunt was set at 12cmH2O. Ventricular catheter: 6.5 cm in depth, peritoneal catheter: 20 cm in depth. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right. 3. Skin preparation:shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with a sterilized adhesive plastic sheet. 4. Incision: along the previous operation scar at left F-T-P area, Raney clips were apllied to the scalp edge for temporary hemostasis. 5. The left F-T-P scalp and temporalis muscle were dissected away from the underlying dura. 6. The bleeders on the dissected surfaces were coagulated with Bovie painstakingly. 7. The edge of the skull defect was exposed. 8. The original skull plate preserved at bone bank was soaked with Vancomycin solution and placed back to the skull window then fixed by 3 miniplates and 6 screws, and 3 dural tentings at the center of the skull plate. 9. Bone cement paste was applied to replace the bulk of previously excised temporal muscle. 10.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by interrupted mattressed suture with 3/0 nylon. 11.Drain: two epidural CWV drains. 12.Position: supine with head rotated to right. 13.Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 14.Incision: 4 cm linear, right frontal, corresponded to the location of right frontal horn. Raney clips were applied to the scalp edge for temporary hemostasis. 15.A burr hole was made at right Kocher point and the dura was tented by 2 stitches. 16.The dura was opened by a nib incision. Rt lateral ventricle was tapped by a ventricular needle, then a 6.5 cm segment of the ventricular catheter was introduced into the ventricle. The outer end of the catheter was connected to a Codman programmable shunt reservoir. 17.A minilaparotomy was made at RUQ of the abdomen, then a trocar was pushed into peritoneal cavity. Subsequently, distal 20 cm segment of the peritoneal catheter was introduced into the peritoneal cavity through the outer tube of the trochar. The proximal end of this catheter was passed through subcutaneous tunnel at forechest, neck, right retroauricular area and connected the reservoir. The shunt system was checked to make sure its function was working. 18.The angler was fixed to pericranium by 1 stitch. 19.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 20.Blood transfusion: nil. Bloos loss: 180 ml. 21.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R4林哲光R2陳建銘Ri 相關圖片 喻芝蘭 (F,1963/11/08,48y4m) 手術日期 2011/01/13 手術主治醫師 林峰盛 手術區域 西址 034房 03號 診斷 Fibromyalgia 器械術式 Nerve block / PC 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 林峰盛 ASA 2 時間資訊 11:05 進入手術室 11:10 麻醉開始 11:15 誘導結束 11:28 手術開始 11:40 手術結束 11:40 麻醉結束 11:45 送出病患 摘要__ 手術科部: 麻醉部 套用罐頭: Echo-guided scalene muscle injection 開立醫師: 林峰盛 開立時間: 2011/01/13 11:45 Pre-operative Diagnosis Thoracic outlet syndrome Post-operative Diagnosis Thoracic outlet syndrome Operative Method Echo-guided scalene muscle injection interscalane block Specimen Count And Types nil Pathology Operative Findings Operative Procedures IV sedation with fentanyl set patient in supine postion echo-guided left ant. and middle scalene muscle injection with 0.125% Marcaine 10 ml plus kenacort 10 mg interscalene block Operators 林峰盛 Assistants 林宜樺 陳張美珠 (F,1948/10/02,63y5m) 手術日期 2011/01/13 手術主治醫師 張志豪 手術區域 西址 032房 01號 診斷 Soft tissue infection 器械術式 Debridement, elbow 手術類別 預定手術 手術部位 四肢 傷口分類 污染 麻醉方式 全身麻醉 麻醉主治醫師 林峰盛 ASA 2 紀錄醫師 方怡婷, 時間資訊 07:50 報到 08:05 進入手術室 08:10 麻醉開始 08:20 誘導結束 08:45 抗生素給藥 09:00 手術開始 10:10 手術結束 10:10 麻醉結束 10:15 送出病患 10:20 進入恢復室 11:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 骨髓炎之死骨切除術或蝶形手術及擴創術(包括:頭骨、顱骨、胸部骨頭、股骨、肋骨、脊 1 1 L 手術 滑膜切除術或關節囊切除術-肩關節、肘關節、腕關節或踝關節 1 2 L 記錄__ 手術科部: 骨科部 套用罐頭: 1.SEGUSTRECTOMY FOR OSTEOMYELITIS 開立醫師: 方怡婷 開立時間: 2011/01/13 10:31 Pre-operative Diagnosis Left elbow coranoid fracture with joint sublaxation, s/p Open reduction and fixation; Coronoid process allogenic bone graft, soft tissue infection with osteomyelitis Post-operative Diagnosis Left elbow coranoid fracture with joint sublaxation, s/p Open reduction and fixation; Coronoid process allogenic bone graft, soft tissue infection with osteomyelitis Operative Method 1.SEGUSTRECTOMY FOR OSTEOMYELITIS 2.SYNOVECTOMY OR/AND CAPSULECTOMY Specimen Count And Types 2 piece About size: Source:1.pus formation 2.unhealthy fibrotic tissue Pathology pending Operative Findings 1.Left elbow coranoid fracture with joint sublaxation, s/p Open reduction and fixation; Coronoid process allogenic bone graft, soft tissue infection with osteomyelitis 2.pus formation 3.unhealthy fibrotic tissue Operative Procedures 1. Anesthetic induction, supine position. 2. Skin disinfected and draped. 3. Skin incision over previous operation scar (posterio-medial *1 lateral *1) and . 4. Dissected and exposed the inflammation side; then segustrectomy and wide synovectomy were performed. 5. Irrigated with normal saline, then, alcohol irrigation, then, normal saline irrigation and hemostasis. 6. Closed wound by layers after 1/8 h/v was inserted. Operators 張志豪, Assistants 方怡婷, 陳其泉 (M,1959/05/10,52y10m) 手術日期 2011/01/14 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Brain Tumor 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 古恬音, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:05 進入手術室 08:10 麻醉開始 08:40 誘導結束 09:00 手術開始 09:10 抗生素給藥 12:10 抗生素給藥 15:10 抗生素給藥 18:10 抗生素給藥 19:00 麻醉結束 19:00 手術結束 19:10 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 14 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 顱底瘤手術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Left far lateral approach for tumor excision 開立醫師: 古恬音 開立時間: 2011/01/14 19:25 Pre-operative Diagnosis Left cerebellopontine angle tumor, suspected low cranial nerve neuroma Post-operative Diagnosis Left 9th nerve neuroma Operative Method Left far lateral approach for tumor excision Specimen Count And Types 1 piece About size:1GM Source:BRAIN TUMOR Pathology Pending Operative Findings The tumor was whitish-graysih in color and elastic in consistency. It composed by intradural and intra-foraminal portions. The intra-foraminal portion widened and filled the left jugular foramen. The intra-dural portion contained a large cystic component, with light brownish fluid inside. The tumor firmly attached to CN IX and X, and was supposed to be origined from either of these two nerces. The CN VII and VIII were compressed lateriosuperiorly. The left occipital condyle was partially removed to expose the lesion. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position. The left shoulder was elevated, and the head was turned to right and fixed with Mayfield skull clamp. One reverse U-shaped scalp incision was made at the craniocervical junction. The muscles were detached layer to layer until the occipital condyle was exposed. The left vertebral artery was identified and well preserved. One 3*3 craniotomy window was made at the left occipital area, and then the dura was opened in fish-mouth fashion. The CSF was drained, and the cerebellum sank low. The left cerebellar hemisphere was retracted to expose the tumor. Then the tumor was cerafully dissected from the low cranial nerves. Tumor removal was done with tumor forceps. The intra-foraminal part was also removed. The tumor bed was lined with Surgicel for hemostasis. After fixing back the bone plate with miniplates, the muscles were approximated. One epidural CWV drain was set, then the wound was closed in layers. Operators P杜永光 Assistants R6陳睿生　R3古恬音 許張美麗 (F,1939/09/13,72y6m) 手術日期 2011/01/14 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 柯安達, 時間資訊 00:00 臨時手術NPO 08:20 進入手術室 08:30 麻醉開始 09:00 誘導結束 09:00 抗生素給藥 09:10 手術開始 12:00 抗生素給藥 13:50 手術結束 13:50 麻醉結束 14:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 R 麻醉 Peripheral arterial line inserti 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: Right occipital fossa craniotomy for Simpson ... 開立醫師: 胡朝凱 開立時間: 2011/01/14 14:22 Pre-operative Diagnosis Right cerebellar tentorium meningioma Post-operative Diagnosis Right cerebellar tentorium meningioma Operative Method Right occipital fossa craniotomy for Simpson grade II tumor excision Specimen Count And Types pieces of tumor Pathology pending Operative Findings 1.About 5 cm reddish to yellowish, firm tumor located at right posterior fossa arised from right cerebellar convexity to tentorium that compressed the cerebellum tightly. 2.The tumor border was clear and attached to part of lower cranial nerves. The nerves was all preserved. 3.The duroplasty was done with Gortex artificial dura. Operative Procedures Under endotracheal general anesthesia, patient was put in 3/4 prone position with head fixed by Mayfield skull clamp. Skin was shaved and scrubbed with povidone-iodine detergent, then covered with sterilized adhesive plastic sheet. Right reverse U shape skin incision was made. Craniotomy was then performed. Dural incision was made and reflected to sigmoid sinus. The vessels that supplied the tumor were first devascularized. Central debulky was then performed. The tumor border was then further dissected along the interface of arachnoid plane and tumor. The tumor attached to dura was cauterized. Hemostasis was performed. And duroplasty was done. Fixed bone back with miniplate was followed by wound closure. Operators 曾漢民 Assistants 胡朝凱, 柯安達 高張壽惠 (F,1942/10/15,69y4m) 手術日期 2011/01/14 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 4 紀錄醫師 柯安達, 時間資訊 00:00 臨時手術NPO 14:00 報到 14:22 進入手術室 14:30 麻醉開始 15:00 誘導結束 15:00 抗生素給藥 15:10 手術開始 18:00 抗生素給藥 18:05 麻醉結束 18:05 手術結束 18:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Left Keyhole craniotomy for Simpson grade II ... 開立醫師: 胡朝凱 開立時間: 2011/01/14 18:22 Pre-operative Diagnosis Planum sphenoidale meningioma Post-operative Diagnosis Planum sphenoidale meningioma Operative Method Left Keyhole craniotomy for Simpson grade II tumor excision Specimen Count And Types pieces of tumor Pathology pending Operative Findings 1.The tumor was soft, reddish one arised form planum sphenoidale that protruded toward left. It measured about 3 cm 2.The tumor border was clear 3.After tumor excision, bilateral optic nerve and pituitary stalk was visualized and well preserved. Operative Procedures 1.ETGA, supine 2.Left supraorbital curvature skin incision at eyebrow area 3.Dissect to expose skull 4.Small craniotomy without opening orbital rim 5.dura opening 6.Retract frontal lobe downward 7.Devascularization 8.Tumor excision by sucker 9.Hemostasis with Floseal 10.Dural closure with prolene 11.fixed bone back with microplate 12.Close wound in layers Operators 曾漢民 Assistants 胡朝凱, 柯安達 高裕棠 (M,1965/09/13,46y6m) 手術日期 2011/01/14 手術主治醫師 賴達明 手術區域 東址 001房 04號 診斷 Intracerebral hemorrhage (ICH) 器械術式 Craniotomy (A.V.M.) P-LIN 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 3E 紀錄醫師 王奐之, 時間資訊 21:12 通知急診手術 21:50 進入手術室 21:55 麻醉開始 22:15 誘導結束 22:30 抗生素給藥 22:53 手術開始 02:05 手術結束 02:05 麻醉結束 02:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱內壓視置入 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 腦內血腫清除術 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Craniotomy for hematoma removal & ICP monitor... 開立醫師: 鍾文桂 開立時間: 2011/01/15 02:23 Pre-operative Diagnosis Left putaminal ICH Post-operative Diagnosis Left putaminal ICH Operative Method Craniotomy for hematoma removal & ICP monitor insertion Specimen Count And Types Nil Pathology Nil Operative Findings Large hematoma (about 50~60ml) with organized clots. No obvious active bleeder identified. ICP after skin closure: 4mmHg. ICP monitor reference: 500. Operative Procedures After ETGA, the patient was placed in supine position with face turned to right. After shaving, skin disinfection & draping in sterile fashion, a linear skin incision was made at left frontoemporal area. A temporal burr hole was made, followed by craniotomy. The hematoma was localized with intra-operative echo, and a corticotomy was made. After deepened dissection through the corticotomy, the hematoma cavity was entered. The hematoma was then removed in pieces with sucker and tumor forceps. The hematoma cavity was then packed with Surgicel after total removal of hematoma. The ICP monitor was inserted into the hematoma cavity. After meticulous hemostasis, the bone was put back and the wound was closed in layers. Operators VS 賴達明 Assistants R5 鍾文桂, R3 王奐之 Indication Of Emergent Operation 相關圖片 周輝龍 (M,1950/04/26,61y10m) 手術日期 2011/01/14 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Lumbar spondylosis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 邱裕淳, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:06 進入手術室 08:15 麻醉開始 08:45 誘導結束 09:00 抗生素給藥 09:15 手術開始 12:00 抗生素給藥 12:30 手術結束 12:30 麻醉結束 12:35 送出病患 12:40 進入恢復室 14:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎弓切除術(減壓)-二節以內 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: L2/3 and L4/5 laminotomy for sublaminar decom... 開立醫師: 曾峰毅 開立時間: 2011/01/14 12:46 Pre-operative Diagnosis Lumbar stenosis at L2/3 and L4/5 Post-operative Diagnosis Lumbar stenosis at L2/3 and L4/5 Operative Method L2/3 and L4/5 laminotomy for sublaminar decompression, posterior fixation with transpedicular screws at bialteral pedicles of L2 and L3, posterolateral fusion with autologous bone graft Specimen Count And Types Nil Pathology Nil Operative Findings Hypertrophic ligamentum flavum was noted at L2/3 and L4/5. Thecal sac and nerve roots were decompressed well after the surgery. 健伸(免術前審查) transpedicular screws, 45mmx6.5mm, x4 were used. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After C-arm localization, we made one midline skin incision from L1 spinous process to L4 spinous process. We dissected bilateral paraspinal muscle, and performed fixation to L2/3 with transpedicular screws. Posterolateral fusion was done as well with autologous bone graft. L2/3 and L4/5 laminotomty for done for sublaminar decompressino. After hemostasis and two hemovac drains placed, we closed the wound in layers. Operators VS 賴達明 Assistants R4 曾峰毅 R1 邱裕淳 蘇建愷 (M,1947/06/15,64y8m) 手術日期 2011/01/14 手術主治醫師 賴達明 手術區域 東址 019房 02號 診斷 Lumbar stenosis 器械術式 Laminectomy for decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 邱裕淳, 時間資訊 00:00 臨時手術NPO 12:25 報到 12:55 進入手術室 13:05 麻醉開始 13:10 誘導結束 13:30 抗生素給藥 13:50 手術開始 16:20 手術結束 16:20 麻醉結束 16:30 送出病患 16:35 進入恢復室 17:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Glucose 1 0 手術 椎弓切除術(減壓)-超過二節 1 1 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 曾峰毅 開立時間: 2011/01/14 16:40 Pre-operative Diagnosis Lumbar stenosis, L3-S1 Post-operative Diagnosis Lumbar stenosis, L3-S1 Operative Method Sublaminar decompression at biltearl side of L3/4 and right side of L4/5 and L5/S1 Specimen Count And Types Nil Pathology Nil Operative Findings Hypertrophic ligamentum compromise lateral recesses at bilteral L3/4, and right side of L4/5 and L5/S1. Neural structures were decompressed well after the surgery. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After C-arm localization, we scrubbed, disinfected, and then draped the back. We made one paramedian longitudinal skin incision about 2cm away from midline. We performed sublaminar decompression at bilateral side of L3/4, and right side of L4/5 and L5/S1 via tubal dilator. We closed the wound in layers after hemostasis. Operators VS 賴達明 Assistants R4 曾峰毅 R1 邱裕淳 王治仁 (M,1925/09/18,86y5m) 手術日期 2011/01/15 手術主治醫師 曾漢民 手術區域 東址 002房 03號 診斷 Subdural hemorrhage following injury, unspecified state of consciousness 器械術式 Burr hole (trephination) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3E 紀錄醫師 林哲光, 時間資訊 08:30 臨時手術NPO 08:30 開始NPO 08:46 通知急診手術 17:10 報到 17:25 進入手術室 17:30 麻醉開始 17:40 誘導結束 18:00 抗生素給藥 18:30 手術開始 20:00 麻醉結束 20:00 手術結束 20:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 手術 慢性硬腦膜下血腫清除術 1 1 B 手術 慢性硬腦膜下血腫清除術 1 2 B 記錄__ 手術科部: 外科部 套用罐頭: Bilateral burr hole drainage 開立醫師: 林哲光 開立時間: 2011/01/15 20:27 Pre-operative Diagnosis Bilateral chronic subdural hematoma Post-operative Diagnosis Ditto Operative Method Bilateral burr hole drainage Specimen Count And Types Pathology Nil Operative Findings Motor-oil like fluids was gushed out after outter membrane was opened, bilaterally. Inner membrane and outter membrane formation were noted. Operative Procedures Under ETGA and supine position, skin disinfected and drapped were performed as usual. Bilateral transverse skin incision were made. Two burr holes were created. After irrigation, two subdural drains were inserted and deair was performed. The wounds were then closed in layers after hemostasis. Operators VS 曾漢民 Assistants R4 林哲光, R6 陳睿生 Indication Of Emergent Operation 陳淑方 (F,1953/07/15,58y7m) 手術日期 2011/01/15 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Brain metastasis 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林峰盛 ASA 3 紀錄醫師 柯安達, 時間資訊 07:38 報到 08:00 進入手術室 08:15 麻醉開始 09:05 誘導結束 09:10 手術開始 09:30 抗生素給藥 12:30 手術結束 12:30 抗生素給藥 12:30 麻醉結束 12:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Left side suboccipital craniotomy for cerebel... 開立醫師: 陳睿生 開立時間: 2011/01/15 13:13 Pre-operative Diagnosis Multiple brain metastasis, suspect lung cancer origin, with brain stem compression Post-operative Diagnosis Multiple brain metastasis, suspect lung cancer origin, with brain stem compression Operative Method Left side suboccipital craniotomy for cerebellar tumor remove Specimen Count And Types 2 pieces About size:pieces Source:tumor About size:pieces Source:dural attaching mass Pathology Pending Operative Findings An about 4cm in diameter left side cerebellar tumor mass with huge cystic component was noted. The tumor was yellowish whitish, and firm one. The fluid content was light yellowish. The tumor was well capsuled and the plane between the tumor and brain tissue was sticky. The tumor extended to the cerebellar surface and the dura was mildly invasion. Operative Procedures 1. ETGA, 3/4 prone position with head fixed with Mayfield clump 2. Left suboccipital inverse U scalp incision 3. Four burr holes made and an about 6x6cm craniotomy window was created 4. The dura was opened and then the tumor was noted to attach to the dura 5. Drain the fluid inside for decompression 6. The tumor was removed piece by piece 7. the mass attached to the dura was removed 8. Hemostasis, close the dura tightly 9. Fix back the skull graft with miniplates x3 10.Set a subgaleal CWV drain and close the wound in layers Operators VS 曾漢民 Assistants R6 陳睿生; R1 柯安達 趙晟宇 (M,1962/08/09,49y7m) 手術日期 2011/01/15 手術主治醫師 李章銘 手術區域 東址 018房 04號 診斷 Lung cancer 器械術式 Port-A catheter implatation 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 陳志軒, 時間資訊 15:05 報到 15:12 進入手術室 15:20 抗生素給藥 15:29 麻醉開始 15:30 手術開始 15:30 誘導結束 15:58 手術結束 16:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 port–A導管植入術–治療性導管植入術 1 0 R 記錄__ 手術科部: 外科部 套用罐頭: Port-A 開立醫師: 陳志軒 開立時間: 2011/01/15 15:57 Pre-operative Diagnosis LLL lung cancer s/p lobectomy Post-operative Diagnosis LLL lung cancer s/p lobectomy Operative Method Port-A insertion Specimen Count And Types nil Pathology nil Operative Findings 1. Port-A catheter was inserted into SVC via right subclavicular vein 2. Post-operative portable X-ray showed Port-A catheter tip in correct venous branch to SVC. Operative Procedures 1. Under local anesthesia with the patient in supine position, prepped and draping were performed in the usual sterile method. 2. An incision was made in right side neck and subclavicalarea. 3. Percutaneous puncture of right subclavicular vein, then Port-A catheter was inserted. 4. Adequate hemostasis was obtained. Post-operative portable X-ray showed catheter tip in correct venous branchto SVC. Then the wound was closed in layers. Operators 李章銘 Assistants R3郝政鴻 R2陳志軒 相關圖片 劉漢盟 (M,1965/05/05,46y10m) 手術日期 2011/01/16 手術主治醫師 賴達明 手術區域 東址 003房 03號 診斷 Unspecified intracranial hemorrhage 器械術式 Craniotomy REMOVAL OF RIGHT PUTAMINAL ICH 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 4E 紀錄醫師 林哲光, 時間資訊 22:27 通知急診手術 22:28 開始NPO 23:25 進入手術室 23:30 麻醉開始 23:40 誘導結束 00:00 抗生素給藥 00:15 手術開始 03:05 手術結束 03:05 麻醉結束 03:10 抗生素給藥 03:13 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦內血腫清除術 1 1 R 手術 顱內壓視置入 1 2 R 記錄__ 手術科部: 外科部 套用罐頭: Craniotomy for hematoma evacuation, ICP monit... 開立醫師: 陳睿生 開立時間: 2011/01/16 03:06 Pre-operative Diagnosis Right side putaminal ICH Post-operative Diagnosis Right side putaminal ICH Operative Method Craniotomy for hematoma evacuation, ICP monitor insertion Specimen Count And Types nil Pathology Nil Operative Findings The hematoma was about 60ml involume. While dura oepning, the brain parychema was severely swelling, and the hematoma gushed out while corticotomy. The corticotomy was performed via inferior temporal gyrus. Some active bleeder was noted from lenticulostriate arteries. Post- op intracerebral pressure was about was about 4mmHg. Operative Procedures 1. ETGA, supine position with head left turn 2. Right frontotemporal curvillinear scalp incision 3. An about 5x7cm craniotomy window was created after temporalis muscle dissection 4. After dura tenting, the dura was opened crucially 5. An about 2cm corticotomy was created via inferior temporal gyrus 6. Hematoma evacuation was done, and active bleeder was electrogauterized 7. Hemostasis with surgicel 8. ICP monitor insertion subdurally 9. Close the dura with fascia graft 10.Close the wound in layers Operators VS 賴達明 Assistants R6 陳睿生; R4 林哲光 Indication Of Emergent Operation 王浚羽 (M,1994/06/05,17y9m) 手術日期 2011/01/15 手術主治醫師 楊士弘 手術區域 東址 003房 01號 診斷 Hyperhidrosis 器械術式 Endoscopic T2 sympathectomy 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林峰盛 ASA 2 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 07:50 進入手術室 08:05 麻醉開始 08:12 誘導結束 08:22 抗生素給藥 08:48 手術開始 09:21 手術結束 09:21 麻醉結束 09:35 送出病患 09:40 進入恢復室 10:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 經內視鏡交感神經切斷術 1 1 B 記錄__ 手術科部: 外科部 套用罐頭: Endoscopic sympathomectomy, T2, bilateral. 開立醫師: 鍾文桂 開立時間: 2011/01/15 09:48 Pre-operative Diagnosis Hyperhydrosis palmaris. Post-operative Diagnosis Hyperhydrosis palmaris. Operative Method Endoscopic sympathomectomy, T2, bilateral. Specimen Count And Types nil Pathology Nil. Operative Findings Temperature of the palms: Right/left: pre-op: 33.1/31.6, coagulation: 32.2/30.7, final: 33.1/32.7 Operative Procedures Under ETGA, the patient was placed in supine position and bilateral upper extrimities are in abduction position. After disinfection, and draping, one 1-cm linear incision was made at left lateral chest wall. After trocar dissection, the pleural space was reached. The T2 sympathetic ganglion was coagulated under endoscopic guidance. The same procedure was repeated at the right side. Finally, the wounds were closed primarily. Operators V.S. 楊士弘 Assistants R5 鍾文桂 Ri郭映揆 陳榮銘 (M,1944/03/28,67y11m) 手術日期 2011/01/15 手術主治醫師 梁金銅 手術區域 東址 012房 04號 診斷 Malignant neoplasm of hepatic flexure colon 器械術式 Port-A catheter Removal 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 覃紹殷, 時間資訊 16:22 報到 16:30 進入手術室 16:32 麻醉開始 16:35 麻醉結束 16:40 抗生素給藥 16:50 手術開始 17:25 手術結束 17:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 皮下肌肉或深部異物取出術 1 1 R 記錄__ 手術科部: 腫瘤醫學部 套用罐頭: Port-A catheter removal 開立醫師: 覃紹殷 開立時間: 2011/01/15 17:28 Pre-operative Diagnosis 1. Port-A infection 2. Sigmoid colon cancer, stage IVB, with multiple metastasis Post-operative Diagnosis 1. Port-A infection 2. Sigmoid colon cancer, stage IVB, with multiple metastasis Operative Method Port-A catheter removal Specimen Count And Types nil Pathology Nil Operative Findings 1. Port-A wound infection was noted with port exposure and small amount of yellowish, turbid pus discharge. 2. The catheter was removed totally and the course was smooth Operative Procedures 1. Local anesthesia, supine position. 2. Skin disinfection. 3. An incision was made over previous scar. 4. Dissect the port-A catheter and port from fascia with eletrocautery knife. 5. Remove port-A set. A suture with 3-0 Dexon was done to seal the catheter tunnel. 6. Hemostasis. 7. Close wounds in layers with 3-0 Dexon, 4-0 Dexon. 7. Close wounds in layers with 3-0 Dexon, 4-0 Nylon. Operators 梁金銅 Assistants R2覃紹殷 相關圖片 劉春玉 (F,1962/11/15,49y3m) 手術日期 2011/01/15 手術主治醫師 蔡翊新 手術區域 東址 002房 08號 診斷 Subarachnoid hemorrhage (SAH) 器械術式 ICP monitoring 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 3E 紀錄醫師 鍾文桂, 時間資訊 04:16 通知急診手術 04:17 開始NPO 04:49 報到 05:00 進入手術室 05:05 麻醉開始 05:15 誘導結束 05:45 抗生素給藥 05:50 開始輸血 06:09 手術開始 06:50 麻醉結束 06:50 手術結束 07:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 顱內壓視置入 1 1 R 手術 淺部傷口處理縫合擴創-中 1 0 L 記錄__ 手術科部: 外科部 套用罐頭: ICP monitor insertion 開立醫師: 鍾文桂 開立時間: 2011/01/15 07:10 Pre-operative Diagnosis Traumatic SAH Post-operative Diagnosis Traumatic SAH Operative Method ICP monitor insertion Specimen Count And Types Nil Pathology Nil Operative Findings Initial ICP: 8mmHg. ICP after skin closure: 5mmHg. Reference: 518. Operative Procedures After ETGA, the patient was placed in supine position with face turned to left. After shaving, skin disinfection & draping in sterile fashion, a linear skin incision was made at right frontal area. Then a burr hole was made, followed by 1 dural tenting stitch and 1 small durotomy. The ICP monitor was then inserted to subdural space. After meticulous hemostasis, the wound was closed in layers. Operators VS 蔡翊新 Assistants R5 鍾文桂, R3 王奐之 Indication Of Emergent Operation 顏美彩 (F,1955/06/25,56y8m) 手術日期 2011/01/17 手術主治醫師 杜永光 手術區域 東址 013房 02號 診斷 Respiratory failure, with long-term ventilator use 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 4 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 14:05 進入手術室 14:10 麻醉開始 14:20 誘導結束 15:29 手術開始 17:30 18:00 麻醉結束 18:00 手術結束 18:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 氣管切開術 1 0 R 手術 腦室腹腔分流手術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: 1. Implantation of ventriculoperitoneal shunt... 開立醫師: 鍾文桂 開立時間: 2011/01/17 19:05 Pre-operative Diagnosis 1. Left thalamic hemorrhage with obstructive hydrocephalus and intraventricular hemorrhage. 2. Respiratory failure. Post-operative Diagnosis 1. Left thalamic hemorrhage with obstructive hydrocephalus and intraventricular hemorrhage. 2. Respiratory failure. Operative Method 1. Implantation of ventriculoperitoneal shunt, right Kocher. 2. Tracheostomy. Specimen Count And Types 1 piece About size:3cc Source:CSF Pathology Nil. Operative Findings 1. Low ICP. clear pinkish CSF, collected for routine, BCS and culture. Medtronic median pressure. Ventricular catheter: 6.5cm, peritoneal catheter: 30cm 2. Tracheostomy: Fr. 7.0 Operative Procedures Under ETGA, the patient was placed in supine position and head tilted to the left. After shaving, disinfection, and draping, a linear incision was made at RUQ of abdomen. After dissection, the peritoneal cavity was reached. The subcutaneous tunnel was created from abdomen to head. The shunt catheter was placed through the tunnel. The previous operative wound was incised and extended. After dissection, the previous ventriculostomy was identified. The shunt sytem with reservoir and ventricular catheter were conencted. The ventricular catheter was placed into the same ventriculostomy tract. After ensuring the patency of the shunt,the peritoneal catheter was placed into peritoneal cavity. The wound was closed in layers. Under ETGA, the patient was placed in supine position and the head in midline. After disinfection, a linear vertical skin incision was made below the cricoid cartilage. Under midline dissection, the tracheal ring was reached. After linear coagulation, the endotrachael tube cuff was identified. The ET tube was pulled out progressively. Then, the tracheostomy tube was placed into trachea. After ensuring good ventilation, the tracheostomy tube was placed in situ. Operators Prof. 杜永光 Assistants R5鍾文桂 Ri林均鴻 鄭土定 (M,1958/07/30,53y7m) 手術日期 2011/01/17 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Paraplegia 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 古恬音, 時間資訊 00:00 臨時手術NPO 07:32 報到 08:05 進入手術室 08:10 麻醉開始 08:45 誘導結束 09:10 抗生素給藥 09:20 手術開始 12:10 抗生素給藥 15:10 抗生素給藥 18:10 抗生素給藥 19:40 開始輸血 21:10 抗生素給藥 21:20 麻醉結束 21:20 手術結束 21:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 18 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Right retrosigmoid approach for tumor excision 開立醫師: 古恬音 開立時間: 2011/01/17 21:40 Pre-operative Diagnosis Right cerebellopontine angle tumor, suspected acoustic neuroma Post-operative Diagnosis Right cerebellopontine angle tumor, suspected acoustic neuroma Operative Method Right retrosigmoid approach for tumor excision Specimen Count And Types 1 piece About size:small Source:right CPA tumor Pathology Pending Operative Findings The tumor sized 5cm in diameter with upward, downward extension and compression to the midbrain. It was yellowish in color and elastic in consistency. There was multiple cystic components, and the content was light brownish fluid. The tumor was well-encapsulated but the intracanal part adhered to the facial nerve tightly. The trigeminal nerve and facial nerve were compressed upward. The inferior vestibular nerve and cochlear nerve were compressed downward and well-preserved. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with right shoulder elevated. His head was turned to left and fixed with Mayfield skull clamp. The scalp was shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. One curvillinear scalp incision was made at the retroauricular area followed by harvest of fascial graft. Then one 5*3cm craniotomy window was made to expose the margin of sigmoid sinus. Durotomy was done in cruciate fashion. CSF within cistern magna was drained the cerebellum was slack enough to be retracted. The surface of the tumor was coagulated, and the cystic part was drained. The tumor was carefully dissected from the surrounding tissue along the arachnoid plane. Tumor removal was done with CUSA. The dura of petrous bone at posterior wall of the internal acoustic meatus was coagulated and stripped off. Then, the posterior wall of the internal acoustic meatus was fully opened by high speed air drill until the deepest part of intracanal tumor had been well exposed. The intracanal tumor was also removed by CUSA to expose the intracanal portion of the facial nerve and residual VIII nerve. The raw surface was lined with Surgicel for hemostasis, then duroplasty was done with autologous fascial graft. The bone plate was fixed back with miniplates. The wound was closed in alyers. Operators P杜永光 Assistants R6陳睿生 R3古恬音 郭宗德 (M,1933/02/27,79y0m) 手術日期 2011/01/17 手術主治醫師 曾漢民 手術區域 東址 002房 05號 診斷 Subdural hemorrhage following injury, unspecified state of consciousness 器械術式 Burr hole (trephination) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3E 紀錄醫師 陳國瑋, 時間資訊 13:00 臨時手術NPO 13:00 開始NPO 17:05 通知急診手術 22:52 進入手術室 22:55 麻醉開始 23:00 誘導結束 23:10 抗生素給藥 23:39 手術開始 00:45 麻醉結束 00:45 手術結束 01:00 送出病患 01:05 進入恢復室 02:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 慢性硬腦膜下血腫清除術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Chronic Subdural Hematoma 開立醫師: 曾峰毅 開立時間: 2011/01/18 00:26 Pre-operative Diagnosis Chronic subdural hematoma, at right Post-operative Diagnosis Chronic subdural hematoma, at right Operative Method Right frontal burr hole for subdural draiange Specimen Count And Types Nil Pathology Nil Operative Findings Motor-oil like fluid was drained from subdural space. There was outer and inner membrane, and the brain parenchyma expansion was limited even after hypercapnia. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to left. After scalp shaved, scurbbed, disinfected, and then draped, we made one transverse skin incision at right frontal area. We drilled the burr hole, and created durotomy. Outer membrane was opened and cauterized. Subdural rubber drain was inserted for drainage and irrigation. We closed the wound in layers, and de-air the subdural space. Operators VS 曾漢民 Assistants R4 曾峰毅 R3 王奐之 R2 陳國瑋 Indication Of Emergent Operation 陳德景 (M,1977/06/11,34y9m) 手術日期 2011/01/17 手術主治醫師 曾漢民 手術區域 東址 005房 號 診斷 Acromegaly 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 柯安達, 時間資訊 00:00 臨時手術NPO 07:33 報到 08:05 進入手術室 08:10 麻醉開始 08:40 誘導結束 08:55 抗生素給藥 09:15 手術開始 10:15 麻醉結束 10:15 手術結束 10:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經由蝶竇之腦下垂體瘤切除 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 記錄__ 手術科部: 外科部 套用罐頭: Trans-sphenoid adenomectomy 開立醫師: 胡朝凱 開立時間: 2011/01/17 10:32 Pre-operative Diagnosis GH tumor Post-operative Diagnosis GH tumor Operative Method Trans-sphenoid adenomectomy Specimen Count And Types pieces of tumor Pathology pending Operative Findings 1.The tumor was whitish to yellowish, soft, and enlarged sella turcica and buldged downward. 2.After tumor removal, the arachnoid membrane and bilateral cavernous sinus were visualized. Operative Procedures After ETGA, the patient was put in supine position with head mild left tilt. The nasal cavity was well-disinfective, and then we incised into the nasal septum. Dissection was performed along with the periosteum to expose sphenoid sinus anterior wall and sphenoid ostia. After fracture of vomer, sphenoid sinus anterior wall was also fractured. The mucosa was removed. The sella floor was exposed and removed with kerrison. After cruciate form incision, tumor buldged out. And it was further removed with tumor forceps and ring currette. After total excision of tumor was made, the bony graft was put back and followed by compaction of merosel. Operators VS 曾漢民 Assistants 胡朝凱, 柯安達 陳炳崑 (M,1959/10/02,52y5m) 手術日期 2011/01/17 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Glioblastoma multiforma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 柯安達, 時間資訊 00:00 臨時手術NPO 09:58 報到 10:40 進入手術室 10:45 麻醉開始 11:10 誘導結束 11:23 抗生素給藥 11:24 手術開始 14:25 抗生素給藥 15:20 麻醉結束 15:20 手術結束 15:25 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除-手術時間在4~8小時 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Right craniotomy for total tumor excision 開立醫師: 胡朝凱 開立時間: 2011/01/17 15:38 Pre-operative Diagnosis Right temporal GBM Post-operative Diagnosis Right temporal GBM Operative Method Right craniotomy for total tumor excision Specimen Count And Types pieces of tumor Pathology Frozen:ＧＢＭ Operative Findings 1.One about 5 cm irregular shape, grayish tumor that invaded into brain parenchyma was noted at right temporal lobe that extended from superior temporal gyrus to inferior temporal gyrus. The tumor was elastic firm like rubber. And there was part of tumor with clear margin. Operative Procedures Under ETGA, patient was put in supine position with head rotate to left and fixed with Mayfield skull clamp. Curvillinear skin incision was done at right pterional area. Skin and muscle flap was dissected and opened. After burr holes drilled, craniotomy was performed followed by dural tenting. U shape dural incision was made. The tumor was excised by gently dissection through the interface between tumor and brain tissue. Vascular perforation was cauterized. Hemostasis was then performed. After then, dura was closed with prolene. After one CWV drain insertion, wound was closed in layers. Operators 曾漢民 Assistants 胡朝凱, 柯安達 謝桂菊 (F,1961/12/09,50y3m) 手術日期 2011/01/17 手術主治醫師 曾漢民 手術區域 東址 005房 03號 診斷 Glioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 柯安達, 時間資訊 00:00 臨時手術NPO 15:05 報到 15:50 進入手術室 15:55 麻醉開始 16:10 誘導結束 16:10 抗生素給藥 16:15 手術開始 19:10 抗生素給藥 20:02 開始輸血 20:35 抗生素給藥 21:00 麻醉結束 21:00 手術結束 21:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4~8小時 1 1 L 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 記錄__ 手術科部: 外科部 套用罐頭: Left craniotomy for tumor excision 開立醫師: 胡朝凱 開立時間: 2011/01/17 21:39 Pre-operative Diagnosis Left frontal Glioma Post-operative Diagnosis Left frontal Glioma Operative Method Left craniotomy for tumor excision Specimen Count And Types pieces of tumor Pathology pending Operative Findings 1.One about 7 cm grayish, elastic firm tumor located at left frontal lobe with peripheral edema was noted. The tumor had no clear border. It was hypervascular and easy bleeding. Operative Procedures Under ETGA, patient was put in supine position with head fixed with Mayfield skull clamp. Bicoronal skin incision was done. Skin flap was dissected and opened. After burr holes drilled, craniotomy was performed as a 7x7 bone window one cm away from midline, followed by dural tenting. U shape dural incision was made with the base left at midline. Corticotomy was done at middle frontal gyrus. The tumor was excised by gently dissection and suction through the interface between tumor and brain tissue. Vascular perforation was cauterized. Hemostasis was then performed. After then, dura was closed with prolene. After one CWV drain insertion, wound was closed in layers. Operators vs 曾漢民 Assistants 胡朝凱, 柯安達 高銘欣 (M,1933/12/10,78y3m) 手術日期 2011/01/17 手術主治醫師 王水深 手術區域 東址 017房 01號 診斷 冠狀動脈疾病 CAD, coronary artery disease 器械術式 O.P.C.A.B 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 4 紀錄醫師 張得一, 時間資訊 07:33 報到 08:05 進入手術室 08:15 麻醉開始 09:00 誘導結束 09:20 抗生素給藥 09:58 手術開始 12:05 開始輸血 12:20 抗生素給藥 15:20 抗生素給藥 16:45 麻醉結束 16:45 手術結束 17:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 冠狀動脈繞道手術 -三條血管 1 1 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 放置肺動脈導管術 1 0 麻醉 Cardiac out-put 1 0 麻醉 Swan-gang catheterization 1 0 麻醉 T.E.E 1 0 麻醉 Lactic Acid (lactate) 3 0 麻醉 動脈血液檢查全套 3 0 麻醉 Hemoglobin (Hb) 3 0 麻醉 測血糖 3 0 麻醉 Ca (Calcium) 3 0 麻醉 Na (Sodium) 3 0 麻醉 K (Potassium) 3 0 麻醉 Blood gas analysis 3 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 9 0 記錄__ 手術科部: 內科部 套用罐頭: OPCAB 開立醫師: 張得一 開立時間: 2011/01/19 20:08 Pre-operative Diagnosis CAD, 3VD Post-operative Diagnosis Ditto Operative Method OPCAB Specimen Count And Types nil Pathology Operative Findings Fair ventricular contractility CAG: LM distal 30% LAD ostium 90% LCx ostium 30% RCA mid 70% CABG: LIMA - LAD SVG-DX-OM-PDA Operative Procedures ETGA, supine, median sternotomy Harvest LIMA and left GSV OPCAB: LIMA-LAD SVG-Dx-OM-PDA Set chest tubes x 2 Hemostasis Wound closure in routine Operators P王水深 VS王植賢 Assistants R5徐綱宏 R3張得一 林文飛 (M,1949/08/30,62y6m) 手術日期 2011/01/18 手術主治醫師 曾漢民 手術區域 東址 001房 01號 診斷 Subdural hemorrhage following injury, with no loss of consciousness 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2E 紀錄醫師 曾峰毅, 時間資訊 08:11 臨時手術NPO 08:11 開始NPO 08:11 通知急診手術 09:00 進入手術室 09:05 麻醉開始 09:15 誘導結束 09:40 抗生素給藥 09:49 手術開始 10:38 手術結束 10:38 麻醉結束 10:50 送出病患 10:50 進入恢復室 12:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Chronic Subdural Hematoma 開立醫師: 曾峰毅 開立時間: 2011/01/18 10:46 Pre-operative Diagnosis Chronic subdural hematoma, left Post-operative Diagnosis Chronic subdural hematoma, left Operative Method Left frontal burr hole for subdural drainage Specimen Count And Types Nil Pathology Nil Operative Findings Dark-reddish subdural effusion gushed out while durotomy. There was outer and inner membrane. The brain expansion a little after decompression and hypercapnia. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to right. After scalp shaved, scrubbed, disinfected, and then draped, we made one transverse skin incision at left frontal area. We drilled one burr hole and created durotomy. Outer membrane was opened and cauterized, and subdural rubber drain was inserted for drainage and irrigation. We closed the wound in layers after subdural de-air. Operators VS 曾漢民 Assistants R4 曾峰毅 Indication Of Emergent Operation 蔡郭玉穎 (F,1933/01/06,79y2m) 手術日期 2011/01/18 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Spinal stenosis 器械術式 Laminectomy for decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 07:32 報到 08:01 進入手術室 08:05 麻醉開始 08:15 誘導結束 08:40 抗生素給藥 08:49 手術開始 10:32 開始輸血 11:17 手術結束 11:17 麻醉結束 11:25 送出病患 11:35 進入恢復室 13:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 椎弓切除術(減壓)-二節以內 1 2 手術 脊椎融合術-後融合,無固定物 1 1 摘要__ 手術科部: 外科部 套用罐頭: L4-5 laminectomy for decompression + posterio... 開立醫師: 李振豪 開立時間: 2011/01/18 11:25 Pre-operative Diagnosis L4 on 5 spondylolisthesis with canal stenosis Post-operative Diagnosis L4 on 5 spondylolisthesis with canal stenosis Operative Method L4-5 laminectomy for decompression + posteriolateral fusion with autologous bone graft and Sinbone Specimen Count And Types nil Pathology Nil Operative Findings The marginal spur and hypertrophic ligmentum flavum compressed the thecal sac tightly. The thecal sac expanded well after laminectomy. The foraminotomy(L4, L5, and S1) also performed during the procedure. The L4 and L5 was unstable. Posteriolateral fusion was performed with autologous bone graft and Sinbone. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in prone position. The location of L4-5 was identified with portable C-arm X-ray. The skin was scrubbed, disinfected and draped as usual. Midline skin incision was made at L4-5 level. The subcutaneous soft tissue was dissected and the paravertebral muscle groups were detached. After expose the laminar of L4 and L5, laminectomy was performed for decompression. Decortication was performed followed by posteriolateral fusion with autologous bone graft. Hemostasis was achieved and one Hemovac drain was placed. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS曾勝弘 Assistants R4李振豪, R2陳建銘 相關圖片 夏睿 (M,2000/04/03,11y11m) 手術日期 2011/01/18 手術主治醫師 郭夢菲 手術區域 兒醫 067房 02號 診斷 Lymphoma 器械術式 Brain biopsy (P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 13:18 報到 14:00 進入手術室 14:05 麻醉開始 14:20 誘導結束 14:30 抗生素給藥 14:54 手術開始 15:38 開始輸血 17:30 抗生素給藥 17:35 18:45 18:50 20:30 抗生素給藥 20:55 麻醉結束 20:55 手術結束 21:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 3 0 麻醉 Hemoglobin (Hb) 3 0 麻醉 測血糖 3 0 麻醉 Ca (Calcium) 3 0 麻醉 Na (Sodium) 3 0 麻醉 K (Potassium) 3 0 麻醉 Blood gas analysis 3 0 手術 歐氏貯囊置放手術 1 2 L 手術 頭顱成形術 1 1 R 手術 port–A導管植入術–治療性導管植入術 1 0 記錄__ 手術科部: 外科部 套用罐頭: 1. Cranioplasty with autologous bone graft. 開立醫師: 鍾文桂 開立時間: 2011/01/18 21:14 Pre-operative Diagnosis 1. Right frontal-parietal-temporal skull defect. 1. Right frontal-parietal-temporal skull defect status post decompressive craniectomy 2. Lymphoma. 2. Lymphoma, status post craniotomy and tumor biospy and neck tumor biopsy. Post-operative Diagnosis 1. Right frontal-parietal-temporal skull defect. 1. Right frontal-parietal-temporal skull defect status post decompressive craniectomy. 2. Lymphoma. 2. Lymphoma, status post craniotomy and tumor biospy and neck tumor biopsy. Operative Method 1. Cranioplasty with autologous bone graft. 2. Ommaya reservoir implantation, left Kocher. 3.Port-A implantation (right subclavian vein) Specimen Count And Types 1 piece About size:CSF Source:for routine, culture, BCS and cytology. Pathology Nil. Operative Findings CSF: clear pinkish CSF, Ommaya reservoir: ventricular catheter:6.8cm. Its tip position was ensured by intraoperative ultrasonography. Cranioplasty with autologous bone graft. Blood loss: 600cc Operative Procedures Under ETGA, the patient was placed in supine position. After shaving, disinfection, and draping, a curvilinear scalp incision was made at left Kocher point. After creating a burr hole and durotomy, the ventriculostomy was performed under the guidance of ultrasonogram. Then, Ommaya reservoir was placed at the same tract. The wound was closed in layers. Under ETGA, the patient was placed in supine position. Port-A was implanted by puncture method into right subclavian vein after failure of right external jugular vein (cut-down method). After shaving, disinfection, and draping, a curvilinear scalp incision was made at left Kocher point. After creating a burr hole and durotomy, the ventriculostomy was performed under the guidance of ultrasonogram. Then, Ommaya reservoir was placed at the same tract. The wound was closed in layers. Some CSF was drawn to confirm the patency of the Ommaya reservoir. Then, the patients head was tilted to the left. After disinfection and draping, the previous operative wound was incised and dissected to expose the dura mater. The autologous bone graft was placed and fixed by miniplates and screws. A epidural drain was placed in situ. The wound was closed in layers. Then, the patients head was tilted to the left, the operative wound was incised along the previous right frontotemporoperietao and occipital incision. It was dissected to expose the dura mater. The right remporalis muscle was dissected and reflected downward. The autologous bone graft was placed and fixed by miniplates and screws after soaking in the gentamicin solution for more than 30 minutes. The temporalis muscle was fixed bace to the miniplates then a subgaleal drain was placed in situ. The wound was closed in layers. Port-A was implanted by puncture method into right subclavian vein after failure of right external jugular vein (cut-down method). Operators V.S. 郭夢菲 林文熙 Assistants R5 鍾文桂 林昊諭 相關圖片 陳謙毓 (F,2009/12/24,2y2m) 手術日期 2011/01/18 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Tethered cord syndrome 器械術式 Cord untethering -KUO 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 2 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 07:53 報到 08:05 進入手術室 08:15 麻醉開始 08:55 誘導結束 09:00 抗生素給藥 09:20 手術開始 12:00 抗生素給藥 13:20 手術結束 13:20 麻醉結束 13:46 送出病患 13:55 進入恢復室 15:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 手術 脊椎內脊髓內腫瘤切除術 1 1 手術 椎弓整形術 1 2 記錄__ 手術科部: 外科部 套用罐頭: 1. Untethering of tethered cord. 開立醫師: 鍾文桂 開立時間: 2011/01/18 15:00 Pre-operative Diagnosis 1. Tethered cord syndrome. 1. Tethered cord syndrome. 2. Lipomyelomeningocele. 3. Lipoma, filum terminale. Post-operative Diagnosis 1. Tethered cord syndrome. 2. Lipomyelomeningocele. 3. Lipoma, filum terminae. Operative Method 1. Untethering of tethered cord. 2. Laminoplasty, L3-L5. 3. Resection of filum terminale lipoma, and excision of subcutaneous lipoma. Specimen Count And Types 1 piece About size:20cc Source:lipoma Pathology Pending. Operative Findings 1. A large subcutaneous lipoma at lumbar-sacral junction. It was excised. It is connected to the extra and intra dural lipoma through a 0.5 cm dural defect at L4 level. 2. An aberrant nerve root which exits at L5 level. It was preserved. Elevated heart rate was noted while we manipulated near the nerve. Probably a sensory root. 3. The " tethered" part of the lipoma was released. The other parts of the intradural lipoma was left intact. Operative Procedures Under ETGA, the patient was placed in prone position. After disinfection, draping, a vertical linear incision was made at L-S junction. After bilateral subcutaneous dissection, the subcutaneous lipoma was excised. The L5-L3 laminoplasty was done by using 1mm Kerrison punch. The tract of the lipoma from the spina bifida to the extradural space was dissected. Further lipoma excision was done to gain more exposure. Later, the intradural lipoma was exposed after durotomy. Further dissection was done to delineate the lipoma from the surrounding meninges. Then, the tethered part was identified and the bulk of the lipoma was excised with a small piece left on the conus medullaris. Distally, we identified the filum terminale and its lipoma. We resected the lipoma from the filum terminale. The dura mater was closed primarily with 5-0 Prolene. The laminae were fixed back by 2-0 silk. The wound was closed in layers. Under ETGA, the patient was placed in prone position. After disinfection, draping, a vertical linear incision was made at L-S junction. After bilateral subcutaneous dissection, the subcutaneous lipoma was excised. The L5-L3 laminoplasty was done by using 1mm Kerrison punch. The tract of the lipoma from the spina bifida to the extradural space was dissected. Further lipoma excision was done under microscopic niew to gain more exposure. Later, the intradural lipoma was exposed after durotomy. Further dissection was done to delineate the lipoma from the surrounding meninges (lipoduroneural junsction). A complete untethering of the placode was successfully done. The bulk of the lipoma was excised with a small piece left on the conus medullaris. Distally, we identified the filum terminale and its infiltrating lipoma. We resected the filum terminale lipoma. The dura mater was closed primarily with 5-0 Prolene. The laminae were fixed back by 2-0 silk. The wound was closed in layers. Operators V.S. 郭夢菲 Assistants R5 鍾文桂 陳玥伶 (F,2009/05/25,2y9m) 手術日期 2011/01/18 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Subdural hemorrhage (SDH) 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 蕭柏妮 ASA 4E 紀錄醫師 陳國瑋, 時間資訊 02:54 通知急診手術 03:20 進入手術室 03:35 麻醉開始 04:15 抗生素給藥 04:30 誘導結束 04:55 手術開始 05:18 開始輸血 06:10 手術結束 06:10 麻醉結束 06:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 急性硬腦膜下血腫清除術 1 1 L 手術 顱內壓視置入 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 曾峰毅 開立時間: 2011/01/18 06:31 Pre-operative Diagnosis Acute subdural hematoma, at left Acute subdural hematoma, at left frontotemporal Post-operative Diagnosis Acute subdural hematoma, at left Acute subdural hematoma, at left frontotemporal Operative Method Left craniectomy for acute subdural hematoma removal; ICP monitor insertion Left frontotemporal decompressive craniectomy for acute subdural hematoma removal; ICP monitor insertion Specimen Count And Types Nil Pathology Nil Operative Findings About 1cm thick subdural hematoma, acute, firm, was noted at left frontotemporal area. Brain swelling was severe, and the brain parenchyma pulsation was minimal. ICP after wound closure was about 7mmHg, but the systolic blood pressure was poor even with inotropic agent support. 1. There were some bruis over the extremities and suprapubic area. 2. About 1cm thick subdural hematoma, acute, firm, was noted at left frontotemporal area, especially the frontal region. The IICP was so severe that when a small opening of the dura was made, the hamatoma was squeezed out. After the hematoma evacuation, the brain swelling developed. It was severe, and the brain parenchyma pulsation was minimal. ICP after wound closure was about 7mmHg, but the systolic blood pressure was poor even with inotropic agent support. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to right. After scalp shaved, scrubbed, disinfected, and then draped, we made one curvilinear skin incision at left. We created durotomy in C-shape, and removed the subdural hematoma. We inserted ICP monitor in subdural space, and performed hemostasis with gelfoam. Duroplasty was done with artificial dura graft and the wound was closed in layers after one subgaleal CWV inserted. With endotracheal general anaesthesia, the patient was put in supine position with head rotated to right. After scalp shaved, scrubbed, disinfected, and then draped, we made one curvilinear skin incision at left frontotemporal region. We created durotomy in C-shape. The dural was opened step by step to release the pressure gradually since there was no A-Line inserted (difficult insertion), then we removed the subdural hematoma. We inserted ICP monitor in subdural space, and performed hemostasis with gelfoam. Duroplasty was done with artificial dura graft, durofoam, and interrupted silk because of massive brain swelling, and the wound was closed in layers after one subgaleal CWV inserted. The bone plates were stored in deep freezer. Operators VS 郭夢菲 Assistants R4 曾峰毅 R2 陳國瑋 Indication Of Emergent Operation 郭淑媛 (F,1948/06/12,63y9m) 手術日期 2011/01/18 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Spinal cord injury 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 07:32 報到 08:00 進入手術室 08:10 麻醉開始 08:30 誘導結束 08:50 抗生素給藥 09:20 手術開始 11:20 手術結束 11:20 麻醉結束 11:30 送出病患 11:35 進入恢復室 12:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-前融合,有固定物)≦四節 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 記錄__ 手術科部: 外科部 套用罐頭: C5-6 diskectomy with anterior fusion with Cag... 開立醫師: 林哲光 開立時間: 2011/01/18 11:35 Pre-operative Diagnosis C5-6 HIVD Post-operative Diagnosis Ditto Operative Method C5-6 diskectomy with anterior fusion with Cage (Synthes) Specimen Count And Types Pathology Nil Operative Findings C5-6 bulging disc with canal stenosis was noted. Dura seemed reexpanded well after diskectomy. 6mm Synthes cage was inserted. Operative Procedures Under ETGA and supine position with head mild hyperextension, skin disinfected and drapped were performed as usual. Transverse skin incision was made at the middle level of thyroid cartilage. Dissection was performed along the plane between carotid triangle and esophagus. The longus colis were detached from the vertebral body. C5-6 diskectomy was done and cage was inserted. The wound was the closed in layers after mini-H/V inserted over paravertebral area. Operators VS 賴達明 Assistants R4 林哲光, R1 邱裕淳 記錄__ 手術科部: 外科部 套用罐頭: C5-6 diskectomy with anterior fusion with Cag... 開立醫師: 林哲光 開立時間: 2011/01/18 11:37 Pre-operative Diagnosis C5-6 HIVD Post-operative Diagnosis Ditto Operative Method C5-6 diskectomy with anterior fusion with Cage (Synthes) Specimen Count And Types Pathology Nil Operative Findings C5-6 bulging disc with canal stenosis was noted. Dura seemed reexpanded well after diskectomy. 6mm Synthes cage was inserted. Operative Procedures Under ETGA and supine position with head mild hyperextension, skin disinfected and drapped were performed as usual. Transverse skin incision was made at the middle level of thyroid cartilage. Dissection was performed along the plane between carotid triangle and esophagus. Operators Assistants 楊錫鏗 (M,1948/04/01,63y11m) 手術日期 2011/01/18 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Lumbar spondylosis 器械術式 Laminectomy for decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 11:17 報到 11:40 進入手術室 11:45 麻醉開始 11:50 誘導結束 12:50 抗生素給藥 13:10 手術開始 14:15 手術結束 14:15 麻醉結束 14:25 送出病患 14:30 進入恢復室 15:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 椎弓切除術(減壓)-二節以內 1 1 記錄__ 手術科部: 外科部 套用罐頭: Interspinous sublaminal decompression 開立醫師: 林哲光 開立時間: 2011/01/18 14:32 Pre-operative Diagnosis L4-5 canal stenosis Post-operative Diagnosis Ditto Operative Method Interspinous sublaminal decompression Specimen Count And Types Pathology Operative Findings Hypertrophic chnage of ligamentum flavum was noted. Erythematous change of bilateral roots were noted and dura seemed reexpanded well after decompression. Operative Procedures Under ETGA and prone position, skin disinfected and drapped were performed as usual. Midline skin incision was made at L4-5 disc level after C-arm localization. Saw incision at spinous process and fractured at lamina level. Lower part of the spinous process were removed and sublaminal ligamenum flavum removal was done. Bilateral neural foramens were also exposed well and decompressed. The wound was then closed in layers after hemostasis. Operators VS 賴達明 Assistants R4 林哲光, R1 邱裕淳 李其樺 (M,1989/12/04,22y3m) 手術日期 2011/01/18 手術主治醫師 楊士弘 手術區域 東址 005房 02號 診斷 Herniation of intervertebral disc, lumbar (HIVD) 器械術式 Diskectomy lumbar(Others) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 10:55 報到 11:46 進入手術室 11:50 麻醉開始 11:55 誘導結束 12:11 抗生素給藥 12:30 手術開始 14:10 手術結束 14:10 麻醉結束 14:15 送出病患 14:20 進入恢復室 15:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-腰椎 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 外科部 套用罐頭: Microdiskectomy, L4-5, right 開立醫師: 李振豪 開立時間: 2011/01/18 14:32 Pre-operative Diagnosis L4-5 ruptured intervertebral disc with right L5 root compression Post-operative Diagnosis L4-5 ruptured intervertebral disc with right L5 root compression Operative Method Microdiskectomy, L4-5, right Specimen Count And Types 1 piece About size:1.5x1x0.7cm Source:ruptured disc Pathology Pending Operative Findings The right L5 root and thecal sac was compressed by ruptured disc tightly. After removal of the ruptured disc, the root and thecal sac became much loose. The rupture site was at the lower edge of the disc space. Degenerative change over the disc was not significant. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in prone position. The location of L4-5 disc space was identified with portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. The midline skin incision was made at L4-5 level. The subcutaneous soft tissue and right side paravertebral muscle groups were detached. Laminotomy was performed with Kerrison punches. The thecal sac and right L5 root were identified. After retraction of the thecal sac, the ruptured disc was noted. The ruptured disc was removed with alligator. Microdiskectomy was performed with curette and alligator. Hemostasis was achieved with bipolar electrocautery and Gelform packing. Rinderon solution was applied around the root. The wound was then closed in layers with 2-0, 3-0 Vicryl, and 4-0 Dexon. Operators VS楊士弘 Assistants R4李振豪, R2陳建銘 相關圖片 魏熹 (M,1921/03/23,90y11m) 手術日期 2011/01/18 手術主治醫師 蔡翊新 手術區域 東址 002房 07號 診斷 Head injury, unspecified 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3E 紀錄醫師 王奐之, 時間資訊 04:13 通知急診手術 04:50 進入手術室 05:00 麻醉開始 05:20 誘導結束 05:30 抗生素給藥 05:50 手術開始 07:08 開始輸血 08:50 抗生素給藥 09:42 手術結束 09:42 麻醉結束 09:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 1 R 手術 顱內壓視置入 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 蔡翊新 開立時間: 2011/01/18 10:15 Pre-operative Diagnosis Head injury with right F-T-P acute SDH, right frontal contusional ICH and left parietal EDH. Post-operative Diagnosis Head injury with right F-T-P acute SDH, contusional ICH and left parietal EDH. Operative Method Right F-T-P craniotomy for removal of ICH and SDH + subdural ICP monitoring. Specimen Count And Types nil Pathology Nil. Operative Findings Subdural blood clots, about 1.5 cm in thickness, at right F-T-P area. There were two contusional ICHs at right frontal base and inferior frontal gyrus, each about 15 ml in size. The brain became slack after hematoma evacuation. The subdural bleeding from the brain base was packed with Surgicel and Gelfoam. ICP after first burr hole was 2 mmHg and after skin closure was -11 mmHg. Reference of Codman ICP monitor: 488. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: trauma flap at right F-T-P area, the skin edge was clipped by Raney clips for temporary hemostasis. The temporalis muscles was incised down to the tempoal squama. 5. A burr hole was made at right frontal area and the dura was incised for evacuating part of the subdural hematoma, therefore the IICP could be relieved earlier. 6. The incision was extended to a temporal horseshoe, and the temporalis muscle was detached from temporal squama by rasp subsequently. 7. Craniotomy window: 15 x 11 cm, right F-T-P, created by making 5 burr holes then cut by power saw. 8. Dural tenting: by 2/0 silk, 2-cm in interval, distributed along the edge of skull window. 9. Dural incision: curvilinear along the edge of skull window. 10.The subdural clot was removed by sucker and those located beyond the cranial window was washed out by saline irrigation. Both ICHs at right frontal lobe were evacuated and the hematoma cavities were packed with Surgicel. 11.Hemosatasis: the bleeders was stopped by Bovie and oozing surface was covered with Surgicel. 12.Dural closure: was closed with continuous suture by 4-0 Prolene. The dural tear at right frontal area was repaired with a piece of Durofoam, 3 x 3 inches. 13.The skull plate was fixed back with 3 miniplates and 6 screws. Four central tentings were placed. A Codman ICP monitor was placed at right frontal subdural space. 14.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 15.Drain: two, epidural, CWV. 16.Blood transfusion: PRBC 4U, FFP 6U. Blood loss: 1700 ml. 17.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R3王奐之R2何奕瑢 Indication Of Emergent Operation 相關圖片 摘要__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 王奐之 開立時間: 2011/01/18 10:20 Pre-operative Diagnosis Head injury with right F-T-P acute SDH, right frontal contusional ICH and left parietal EDH. Post-operative Diagnosis Head injury with right F-T-P acute SDH, contusional ICH and left parietal EDH. Operative Method Right F-T-P craniotomy for removal of ICH and SDH + subdural ICP monitoring. Specimen Count And Types nil Pathology Nil. Operative Findings Subdural blood clots, about 1.5 cm in thickness, at right F-T-P area. There were two contusional ICHs at right frontal base and inferior frontal gyrus, each about 15 ml in size. The brain became slack after hematoma evacuation. The subdural bleeding from the brain base was packed with Surgicel and Gelfoam. ICP after first burr hole was 2 mmHg and after skin closure was -11 mmHg. Reference of Codman ICP monitor: 488. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: trauma flap at right F-T-P area, the skin edge was clipped by Raney clips for temporary hemostasis. The temporalis muscles was incised down to the tempoal squama. 5. A burr hole was made at right frontal area and the dura was incised for evacuating part of the subdural hematoma, therefore the IICP could be relieved earlier. 6. The incision was extended to a temporal horseshoe, and the temporalis muscle was detached from temporal squama by rasp subsequently. 7. Craniotomy window: 15 x 11 cm, right F-T-P, created by making 5 burr holes then cut by power saw. 8. Dural tenting: by 2/0 silk, 2-cm in interval, distributed along the edge of skull window. 9. Dural incision: curvilinear along the edge of skull window. 10.The subdural clot was removed by sucker and those located beyond the cranial window was washed out by saline irrigation. Both ICHs at right frontal lobe were evacuated and the hematoma cavities were packed with Surgicel. 11.Hemosatasis: the bleeders was stopped by Bovie and oozing surface was covered with Surgicel. 12.Dural closure: was closed with continuous suture by 4-0 Prolene. The dural tear at right frontal area was repaired with a piece of Durofoam, 3 x 3 inches. 13.The skull plate was fixed back with 3 miniplates and 6 screws. Four central tentings were placed. A Codman ICP monitor was placed at right frontal subdural space. 14.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 15.Drain: two, epidural, CWV. 16.Blood transfusion: PRBC 4U, FFP 6U. Blood loss: 1700 ml. 17.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R3王奐之 R1何奕瑢 Indication Of Emergent Operation 相關圖片 浦玲珠 (F,1931/06/01,80y9m) 手術日期 2011/01/18 手術主治醫師 蔡翊新 手術區域 東址 001房 03號 診斷 Subdural hematoma 器械術式 Burr hole (trephination) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 陳睿生, 時間資訊 08:00 臨時手術NPO 08:00 開始NPO 11:31 通知急診手術 15:03 報到 15:05 麻醉開始 15:05 進入手術室 15:20 誘導結束 15:30 抗生素給藥 15:54 手術開始 17:05 手術結束 17:05 麻醉結束 17:15 送出病患 17:16 進入恢復室 19:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 慢性硬腦膜下血腫清除術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Chronic Subdural Hematoma 開立醫師: 陳睿生 開立時間: 2011/01/18 17:28 Pre-operative Diagnosis Left frontotemporoparietal chronic subdural hematoma Post-operative Diagnosis Left frontotemporoparietal chronic subdural hematoma Operative Method Bur holes for hemaotma drainage Specimen Count And Types 1 piece About size:10ml Source:chronic hematoma Pathology Nil Operative Findings About 40ml motor-oil like hemolysis fluid was drained while outer membrane opened. Two bur holes were made. One was at posterior frontal, and the other one located at parietal region. Operative Procedures After ETGA, the patient was under supine position and head right turn. Two 3cm linear incision was created at left posterior frontal and parietal separately. Bur hole was made at each wound. After dura tenting, the dura and outer membrane of the chronic subdural hematoma were opened. Hematoma was drained and then normal saline was used for irrigation. After that, the wounds were closed in layers. Deair was performed properly. Operators VS 蔡翊新 Assistants R6 陳睿生 Indication Of Emergent Operation 洪翌洧 (M,2010/06/13,1y9m) 手術日期 2011/01/18 手術主治醫師 陳益祥 手術區域 兒醫 068房 02號 診斷 Complex congenital heart disease 器械術式 TCPC,JATENE,TAPVR,NORWOOD 手術類別 緊急手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 4E 紀錄醫師 黃俊銘, 時間資訊 14:34 開始NPO 14:34 臨時手術NPO 14:34 通知急診手術 16:20 進入手術室 16:30 麻醉開始 16:35 誘導結束 17:05 開始輸血 17:05 手術開始 21:00 手術結束 21:00 麻醉結束 21:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 管支 管再造術 1 1 手術 體外心肺循環 1 1 摘要__ 手術科部: 外科部 套用罐頭: Sliding tracheoplasty + ECMO removal 開立醫師: 黃俊銘 開立時間: 2011/01/20 17:37 Pre-operative Diagnosis Tracheal stenosis s/p sliding tracheoplsty with recurrence, s/p V-V ECMO Post-operative Diagnosis Ditto Operative Method Sliding tracheoplasty + ECMO removal Specimen Count And Types nil Pathology Nil Operative Findings 1. Intra-OP bronchoscopy showed severe tracheal stenosis immediate above previous tracheoplasty site. The smallest diameter is about 2mm with about 5mm in length 2. Pre-OP SpO2 85%(1.0) PaCo2 130 Post-OP SpO2 100%(0.6) PaCO2 35 Operative Procedures Supine, ETGA, resternotomy Cannulation via AsAo/RAA, on CPB and off ECMO, cooling to 33C Dissect and loop trachea Performed intra-OP bronchoscopy to confirmed the stenotic site Performed sliding tracheoplasty with one T-incision over the ant. surface of proximal trachea and one T-incision over the post. surface of distal trachea Anastomosed the trachea with 5-0 Maxon continuous suture over the post. surface and multiple interrupted Maxon over ant. and lateral surface of the trachea Weanoff CPB Hemostasis, set 4 C/Ts and PD Suternum left unapproximated Operators 陳益祥 Assistants 徐綱宏 黃俊銘 羅健洺 Indication Of Emergent Operation 張添勝 (M,1969/06/05,42y9m) 手術日期 2011/01/18 手術主治醫師 戴浩志 手術區域 東址 009房 07號 診斷 Subdural hematoma 器械術式 Debridment-- >10cm 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 官振翔, 時間資訊 15:30 報到 15:42 進入手術室 15:47 麻醉開始 15:50 誘導結束 16:10 手術開始 16:55 手術結束 16:55 麻醉結束 17:00 送出病患 17:10 進入恢復室 18:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 多層皮膚移植- 10-20BSA 1 1 B 手術 深部傷口處理縫合擴創-大 1 0 摘要__ 手術科部: 外科部 套用罐頭: Debridement with STSG 開立醫師: 官振翔 開立時間: 2011/01/18 17:17 Pre-operative Diagnosis Bilateral leg avulsion injury Post-operative Diagnosis Bilateral leg avulsion injury Operative Method Debridement and STSG Specimen Count And Types Nil Pathology Nil Operative Findings 1. History of bilateral leg avulsion injury, left leg s/p great toe amputation Right leg open fracture s/p ESF fixation 2. Left leg relative fair wound bed with healthy granulation tissue 3. Right leg still much necrotic and pyogenic granulation noted Operative Procedures Under general anesthesia, patient lied at supine position. We excised the devitalized tissue. We harvested the 8/1000-inch in thickness STSG from left thigh with air-drive Zimmer dermatome. We applied the STSG on the skin defect and then bolster dressing. We applied long leg splint for immobilization. Right leg debridement performed and normal saline irrigation. WOund under wet dressing Operators 戴浩志, Assistants 官振翔, 吳曉東 (M,1958/06/01,53y9m) 手術日期 2011/01/19 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Pituitary Tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 柯安達, 時間資訊 00:00 臨時手術NPO 13:40 報到 13:45 進入手術室 13:50 麻醉開始 14:15 誘導結束 14:44 抗生素給藥 15:30 手術開始 16:40 麻醉結束 16:40 手術結束 16:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 經由蝶竇之腦下垂體瘤切除 1 1 記錄__ 手術科部: 外科部 套用罐頭: Trans-sphenoid adenomectomy 開立醫師: 胡朝凱 開立時間: 2011/01/19 17:02 Pre-operative Diagnosis pITUITARY MACROADENOMA Post-operative Diagnosis pITUITARY MACROADENOMA Operative Method Trans-sphenoid adenomectomy Specimen Count And Types pieces of tumor Pathology pending Operative Findings The tumor was whitish, soft and soft one. Post-OP arachnoid membrane was seen. The buldging lateral wall nearby the cavernous sinus was noted. Operative Procedures After ETGA, the patient was put in supine position with head mild left tilt. The nasal cavity was well-disinfective, and then we incised into the nasal septum. Dissection was performed along with the periosteum to expose sphenoid sinus anterior wall and sphenoid ostia. After fracture of vomer, sphenoid sinus anterior wall was also fractured. The mucosa was removed. The sella floor was exposed and removed with kerrison. After cruciate form incision, tumor buldged out. And it was further removed with tumor forceps and ring currette. During operation, cavernous sinus was exposed. After total excision of tumor was made, the bony graft was put back and followed by compaction of merosel. Operators 曾漢民 Assistants 胡朝凱, 柯安達 莊瑞明 (M,1950/10/15,61y4m) 手術日期 2011/01/19 手術主治醫師 黃書健 手術區域 東址 016房 04號 診斷 Chronic renal failure 器械術式 Port-A catheter implatation 手術類別 臨時手術 手術部位 胸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 14:15 報到 15:26 進入手術室 15:30 麻醉開始 15:35 誘導結束 15:40 手術開始 16:00 麻醉結束 16:00 手術結束 16:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 內頸靜脈切開,永久導管放置術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Replace the Permcath with a new Permcath 開立醫師: 周恒文 開立時間: 2011/01/19 16:07 Pre-operative Diagnosis ESRD s/p Permcath insertion with cuff of the Permcath dislocation Post-operative Diagnosis ESRD s/p Permcath insertion with cuff of the Permcath dislocation Operative Method Replace the Permcath with a new Permcath Specimen Count And Types nil Pathology Operative Findings The cuff of the Permcath dislocated and was exposed. Operative Procedures Local anesthesia, supine. Neck incision to expose the catheter and, through the site, the guidewire was inserted. Remove the old Permcath. Make a new tunnel and through the guidewire and peel-off sheath, the new Permcath was inserted. The flow of Permcath was checked and both were good. Operators 黃書健 Assistants 周恒文 陳艷莉 (F,1956/10/13,55y5m) 手術日期 2011/01/19 手術主治醫師 張道遠 手術區域 兒醫 065房 04號 診斷 Malignant neoplasm of corpus uteri, except isthmus 器械術式 RAH 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 2 紀錄醫師 鍾繼賢, 時間資訊 15:50 進入手術室 15:52 麻醉開始 16:05 誘導結束 16:07 抗生素給藥 16:15 手術開始 19:07 抗生素給藥 20:05 手術結束 20:05 麻醉結束 20:15 送出病患 20:15 進入恢復室 21:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 手術 子宮頸癌全子宮根除術 1 1 手術 後腹膜腔淋巴腺切除術 1 2 手術 膀胱造口術 1 4 摘要__ 手術科部: 婦產部 套用罐頭: Radical abdominal hysterectomy + bilateral sa... 開立醫師: 鍾繼賢 開立時間: 2011/01/19 20:21 Pre-operative Diagnosis Cervical cancer, stage IB1 Post-operative Diagnosis Uterine malignancy, poorly differentiated, suspect endometrial cancer or cervical cancer Operative Method Radical abdominal hysterectomy + bilateral salpingo-oophorectomy + bilateral pelvic lymph node dissection + SPD insertion Specimen Count And Types 5 pieces About size:11x10x9 cm Source:Uterus and bilateral adnexa About size:2x2x2 cm Source:Right iliac lymph nodes About size:2x2x2 cm Source:Right obturator lymph nodes About size:2x2x2 cm Source:Left iliac lymph nodes About size:2x2x2 cm Source:Left obturator lymph nodes Pathology Frozen: poorly differentiated malignancy Operative Findings 1. Uterus: Rvfl, 8x7x6 cm, mutiple small 1 cm polypoid mass at fundus noted, depth of invasion into myometrium < 1/2, much necrotic tissue noted. Cervix: One cauliflower mass with much necrotic tissue about 4x4x4 cm noted at central cervix. 2. Bilateral Ovaries: grossly normal. 3. Bilateralallopian tubes: grossly normal. 4. Cul-de-sac: No adhesion bands. 5. Right parametrium: size : 1 cm, Induration (-); Left parametrium: size : 1 cm, Induration (-); 6. Vagina cuff: 2 cm , gross tumor (-), section margin free (+) 7. Bilateralpelvic lymphnodes: Normal Enlarged Induration Right external iliac (+) (-) (-) Right obturator and hypogastric (+) (-) (-) Left external iliac (+) (-) (-) Left obturator and hypogastric (+) (-) (-) 8. Estimated blood loss: 950 ml Blood transfusion: nil Complication: nil Operative Procedures 1. Put the patient on the lithotomy position. 2. Vaginal douching and skin disinfection. 3. Dissect the cervical tumor and remove it, send for frozen. 3. Submucosal injection of diluted Pitressin (1:100) around the cervix and bladder base. 4. Make incision on the anterior vaginal mucosa and circumcision the cervix. 5. Dissect the vagina and suture it around cervix. 6. Put the patient on the lithotomy position and prepare as usual. 7. Make and infraumbilical vertical skin incision and open the abdominal wall layer by layer. 8. Clamp, cut and suture ligate the right round ligament. 9. Enter into the right para-vesical space down to the pelvic floor. 10. Clamp, cut and suture ligate the right infundibulo-pelvic ligament. 11. Do the similar procedures as (3), (4), (5) over the left side. 12. En bloc dissection of the left external and internal iliac LN. 13. Explore the left obturator fossa, identify the left obturator nerve and remove the obturator LN en bloc. 14. Stretch the left umbilical ligament and ligate the left uterine artery. 15. Free the left ureter from posterior sheath of the broad ligament. 16. Open the left para-rectal space. 17. Clamp, cut and ligate the left cardinal ligament. 18. Clamp, cut and ligate the posterior sheath of the broad ligament. 19. Do the similar procedures (7) to (13) over the right side. 20. Dissect the recto-vaginal septum to open the recto-vaginal space. 21. Cut the bilateral recto-vaginal fascia and clamp bilateral utero-sacral ligaments. 22. Dissect the vesico-uterine fascia and push urinary bladder downward to the upper third of vagina. 23. Open the bilateral ureteral tunnels by clamp and ligate anterior and posterior utero-vesical sheaths 24. Cut the bilateral utero-sacral ligaments. 25. Clamp and cut the upper thirdof vagina to remove the whole uterus and its appendages. 26. Suture the bilateralvaginal stump angles. 27. Place and fix the bilateral vaginal drains at the retroperitoneal space. 28. Approximate the bilateral round ligament stump and its ipsilateral adnexal stump. 29. Insert two CWV into bilateral retroperitoneal space and reperitonealization 30. Check bleeders, hemostasis and then close abdominal wall layer by layer. 31. SPD was inserted and fixed over supra-pubicarea. 32. Approximate the skin wound with Appose. Operators 張道遠, Assistants 鍾繼賢, 黃佩慎, 劉筑恬 (F,2010/06/14,1y9m) 手術日期 2011/01/19 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Tethered cord syndrome 器械術式 Cord untethering -KUO 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 2 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:08 進入手術室 08:10 麻醉開始 08:23 誘導結束 08:44 抗生素給藥 09:30 手術開始 11:44 抗生素給藥 14:44 抗生素給藥 15:40 手術結束 15:40 麻醉結束 15:47 送出病患 15:50 進入恢復室 17:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 7 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 脊椎內脊髓內腫瘤切除術 1 1 手術 椎弓整形術 1 2 記錄__ 手術科部: 外科部 套用罐頭: 1. Untethering of spinal cord. 開立醫師: 鍾文桂 開立時間: 2011/01/19 16:17 Pre-operative Diagnosis 1. Tethered cord syndrome. 2. Lipomyelomeningocele. Post-operative Diagnosis 1. Tethered cord syndrome. 2. Lipomyelomeningocele. Operative Method 1. Untethering of spinal cord. 1. Untethering of spinal cord. 2. Laminoplasty, L4-5. 2. Laminoplasty, L2-4. Specimen Count And Types 1 piece About size:10cc Source:lipoma Pathology Pending. Operative Findings 1. The lipoma-compressed spinal cord was pushed away to right anterior part of the spinal canal. The left roots were stretched and elevated to the lateral to posterior part of the spinal canal. The roots adheres severely to th dura sac. Some of them were sacrafized during dissection. 1. The was a huge subcutanepous lipoma measuring about 6X6 com in size. There was a dimple in the center of it, which connected to a closed dermal sinus tract and blended into the lipomatous tissue and penetrated into the extradural portion. 2. The extradural fat was large too, and extended ipward to L2 at the left side of the thecal sac. It could be removed with sucker from the nerve roots on the multiple levels of left side. 2. The extradural fat was large too, and extended upward to L2 at the left side of the thecal sac. It could be removed with sucker from the nerve roots on the multiple levels of left side. 3. The intradural lipoma was large. It compressed the deformed spinal cord to right anterior part of the spinal canal, and made the spinal cord clockwise rotated from the cuadal view. The left dorsal roos was thus turned to the superficial and adhered to the lipoduroneural junction tightly. Some aberrant left dorsal root came out and blended into the extradural fat, it was sacrafized to get a complete untethering. 3. The intradural lipoma was large. It compressed the deformed spinal cord to right anterior part of the spinal canal, and made the spinal cord clockwise rotated from the caudal view. The left dorsal roos was thus turned to the superficial and adhered to the lipoduroneural junction tightly. Some aberrant left dorsal root came out and blended into the extradural fat, it was sacrafized to get a complete untethering. 2. Severe adhesion of the arachnoid mater and the dura mater was noted, more severe over the right side. 4. The lamina was widely opened and bifid. The left lamina was pushed backward and became vertical in position. Severe fibrotic change and adhesion of the arachnoid mater was noted from L2 and below. 3. We used CUSA to resect the lipoma in the tethered part. 5. We used CUSA to resect the lipoma in the tethered part. 4. The dura mater was closed primarily. We placed muscle graft overlying the dura mater for further dural augmentation. 6. The dura mater was closed primarily. We placed muscle graft overlying the dura mater for further dural augmentation. 6. The dura mater was closed primarily. We reflected a muscle flap from the left paravertebral muscle overlying the sutured dura mater for further dural protection. 4. A dermal sinus tract presented as a dense fibrous band was noted during dissection. Operative Procedures Under ETGA, the patient was placed in prone position. After disinfection, draping, a linear vertical incision was made at L-S junction. After resection of the subcutaneous lipoma, the extra to intra-spinal lipoma tract was identified. Laminoplasty was done at L4-5 levels. Then, the extradural intraspinal lipma was pulled out meticulously( from L2 to L4). The bulk of the remaining lipoma was resected by CUSA. Dissection of the dura mater and the surrounding soft tissue and arachnoid was achieved. The tethered part of the lipoma was resected further. Then, the dura was closed primarily. The laminae were fixed by 2-0 silk. The wound was closed in layers. Under ETGA, the patient was placed in prone position. After disinfection, draping, a linear vertical incision was made at L-S region. After resection of the subcutaneous lipoma, the extra to intra-spinal lipoma tract was identified. The deformed left lamina was trimmed away to facilitatel the exposure of futher lipoma under. Laminoplasty was done at L2-4 and it was reflected upward. Under microscopic view, the extradural fat was removed till the upper margin of the facial ring was reached. the dura was opened from the L2 level, then the dissection began of the left side and turned to the right side. The extradural and intradural lipoma was debulked with CUSA to facilitate to identify the deformed anatomy of the spinal cord. The lipoduroneural junction was traced downward till the cul-de-sac of the thecal sac was reached. Under ETGA, the patient was placed in prone position. After disinfection, draping, a linear vertical incision was made at L-S region. After resection of the subcutaneous lipoma, the extra to intra-spinal lipoma tract was identified. The deformed left lamina was trimmed away to facilitatel the exposure of futher lipoma under. Laminoplasty was done at L2-4 and it was reflected upward. Under microscopic view, the extradural fat was removed till the upper margin of the facial ring was reached. the dura was opened from the L2 level, then the dissection began from the left side and turned to the right side. The extradural and intradural lipoma was debulked with CUSA to facilitate to identify the deformed anatomy of the spinal cord. The lipoduroneural junction was traced downward till the cul-de-sac of the thecal sac was reached. We created a layer of dura using some of the lipoma at right side for priimary closure of dura. After complete untethering of the spinal cord was achieved, The dura was closed primarily. The L2-4 laminae were fixed by 2-0 silk to restore the laminal position. The wound was closed in layers. Operators V.S. 郭夢菲 Assistants R5 鍾文桂 Ri林均鴻 徐琇文 (F,1958/01/10,54y2m) 手術日期 2011/01/19 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Female breast cancer 器械術式 Ommaya reservoir implantation 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 古恬音, 時間資訊 00:00 臨時手術NPO 10:25 報到 10:40 進入手術室 10:45 麻醉開始 10:55 誘導結束 11:08 抗生素給藥 11:28 手術開始 12:08 手術結束 12:08 麻醉結束 12:17 送出病患 12:20 進入恢復室 13:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 歐氏貯囊置放手術 1 1 R 摘要__ 手術科部: 腫瘤醫學部 套用罐頭: Ommaya implantation 開立醫師: 陳睿生 開立時間: 2011/01/19 12:06 Pre-operative Diagnosis Breast cancer with suspect cancerous meningitis Post-operative Diagnosis Breast cancer with suspect cancerous meningitis Operative Method Ommaya implantation Specimen Count And Types 4 pieces About size:6ml Source:CSF About size:1ml Source:CSF About size:1ml Source:CSF About size:1ml Source:CSF Pathology Pending Operative Findings The CSF was mild turbid. The ICP was about 5-10cmH2O. The ommaya reservior was implanted at right Kocher^s point, and the intraventricular catheter was about 6.5cm in length. Operative Procedures 1. ETGA, supine position 2. Curvillinear scalp incision at right frontal region 3. Create a bur hole at right Kocher^s point 4. Dura tenting, and then open the dura 5. A small corticortomy was done and the ventricle was punched 6. Insert the ommaya reservior 7. Hemostasis, close the wound in layers Operators VS 賴達明 Assistants R3 古恬音 相關圖片 陳榮銘 (M,1944/03/28,67y11m) 手術日期 2011/01/19 手術主治醫師 周迺寬 手術區域 東址 016房 06號 診斷 Malignant neoplasm of hepatic flexure colon 器械術式 Port-A Implatation /WOR 手術類別 臨時手術 手術部位 胸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 張得一, 時間資訊 17:40 報到 17:50 進入手術室 18:00 抗生素給藥 18:20 麻醉開始 18:23 手術開始 18:23 誘導結束 18:23 麻醉結束 19:05 手術結束 19:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 內頸靜脈切開,永久導管放置術 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Permcath/port-A 開立醫師: 張得一 開立時間: 2011/01/19 19:07 Pre-operative Diagnosis Colon cancer Post-operative Diagnosis Colon cancer s/p port-A insertion Operative Method port-A implantation via left internal jugular vein Specimen Count And Types nil Pathology nil Operative Findings 1. The port-A catheter was inserted via left internal jugular vein by Cut down & echo-guided procedure 2. Patent flow after implantation Operative Procedures After skin disinfection and drapping & local anesthesia, echo-guided RIJV cut down and catheterization was performed. Creation of the subcutaneous pocket at left subclavicular area. Tunneliztion, advanced the catheter into the LIJV via the peel-away sheath smoothly. Wound closure in layers after adequate hemostasis. Operators 周迺寬, Assistants 張得一, 陳進宗 (M,1947/05/29,64y9m) 手術日期 2011/01/19 手術主治醫師 吳毅暉 手術區域 東址 016房 03號 診斷 End stage renal disease (ESRD) 器械術式 Permcath 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 07:45 報到 14:10 進入手術室 14:20 麻醉開始 14:23 誘導結束 14:25 手術開始 15:05 手術結束 15:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 內頸靜脈切開,永久導管放置術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Permcath/port-A 開立醫師: 周恒文 開立時間: 2011/01/19 15:08 Pre-operative Diagnosis ESRD Post-operative Diagnosis ESRD s/p Permcath Operative Method permcath implantation via right internal jugular vein Specimen Count And Types nil Pathology nil Operative Findings 1. The permcath catheter was inserted via right internal jugular vein by echo-guided procedure 2. Patent flow after implantation 3. Tip position located at RA/SVC junction Operative Procedures -Anesthesia: local, the patient was put on supine position. The operation field was disinfected and draped as usual. -Permcath catheter was implanted on right side upper chest with cut down/puncture method under echo-guided procedure. The catheter was advenced via the peel-away sheath smoothly after tunnelization. -The flow was checked and flushed with heparin solution. The wounds were closure by 2-0 Nylon. Local compression for hemostasis. Operators 吳毅暉 Assistants 周恒文 林煌英 (F,1956/09/11,55y6m) 手術日期 2011/01/20 手術主治醫師 楊榮森 手術區域 東址 027房 01號 診斷 Malignant neoplasm of female breast, unspecified 器械術式 THR - United(備註) 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3 紀錄醫師 范垂嘉, 時間資訊 07:32 報到 08:05 進入手術室 08:15 麻醉開始 08:40 誘導結束 08:45 抗生素給藥 08:55 手術開始 09:05 開始輸血 10:35 手術結束 10:35 麻醉結束 10:45 送出病患 10:46 進入恢復室 12:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 惡性骨瘤廣泛切除(一次) 1 1 R 手術 股關節全置換術 1 2 R 摘要__ 手術科部: 腫瘤醫學部 套用罐頭: Tumor curretage and totoal hip arthroplasty w... 開立醫師: 范垂嘉 開立時間: 2011/01/20 10:48 Pre-operative Diagnosis Breast cancer with right acetabular and proximal femoral metastases Post-operative Diagnosis Breast cancer with right acetabular and proximal femoral metastases Operative Method Tumor curretage and totoal hip arthroplasty with United prothesis, right Specimen Count And Types 1.Pieces of bone tumor for pathology 2.Femoral intramedullary bone and marrow for cytology Pathology Pieces of bone tumor Operative Findings 1.Uninted implants: cup: 50mm, liner: 50/32mm, head: 32/+0mm, stem: 9mm, #1 2.Soft and fragile bone tumor with much blood supply at the superior aspect of the acetabulum and the proximal femur Operative Procedures 1.ETGA, left decubitus 2.Prep and drape 3.Posterior approach the the hip and dislocate the femoral head 4.Saw the femoral neck and retrive it as autograft 5.Debride the soft tissue in the acetabulum and ream it to 50mm 6.Curretage of the acetabular tumor and fill the gap with autograft 7.Apply the cup (50mm) with vancomycin impregnanted cement 8.Fix with 5 screws and apply the liner 9.Ream and broach the proximal femor 10.Apply the stem (9mm, #1) with vancomycin impregnanted cement 11.Assemble the head (32mm/+0mm) 12.Reduce the hip joint and repair the capsule and short rotators 13.Irrigation and close the wound over an 1/8" H/V Operators 楊榮森 Assistants 林蔚鑫,黃興耀,黃哲南,范垂嘉 陳艷莉 (F,1956/10/13,55y5m) 手術日期 2011/01/20 手術主治醫師 張道遠 手術區域 兒醫 065房 04號 診斷 Malignant neoplasm of corpus uteri, except isthmus 器械術式 Double-J ureteral insert/WOR 手術類別 臨時手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 面罩麻醉 麻醉主治醫師 詹偉弘 ASA 1 紀錄醫師 林威佑, 時間資訊 14:55 報到 15:00 進入手術室 15:30 麻醉開始 15:35 誘導結束 15:46 手術開始 18:22 手術結束 18:22 麻醉結束 18:36 送出病患 18:43 進入恢復室 19:42 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 雙丁輸尿管導管置入術 1 0 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Semi-opened mask inhalation anes 1 0 麻醉 Semi-opened INHALATION GENERAL A 2 0 記錄__ 手術科部: 泌尿部 套用罐頭: cystoscopy（biopsy ) 開立醫師: 賴建榮 開立時間: 2011/01/20 20:19 Pre-operative Diagnosis Cervical cancer Post-operative Diagnosis Cervical cancer Operative Method cystoscopy, URS ,and DBJ insertion Specimen Count And Types nil Pathology Nil Operative Findings 1. Left ureteral orifice and lower ureter stricture status post URS and DBJ insertion 2. Right ureteral orifice was absent 3. Fr. 6-24 DBJ was inserted Operative Procedures Under satisfactory anesthesia with the patient in lithotomy position, prepping and drapping was performed in the usual sterile fashion. A Fr 21 Olympus cystoscope was introduced into the bladder cavity under direct vision. Careful inspection revealed the Left hemitrigone and Left ureteral orifice was normal. A Fr. 6 URS was introduced. LUO stricture and left lower ureter stricture were noted. A Fr.6-24 DBJ was inserted. There were many polyps covering the Right hemitrigone and Right ureteral orifice. RUO was absent. Patient tolerated the procedure very well and was sent to recovery room in satisfactory condition. Operators 李苑如, Assistants 林威佑, 賴建榮, 楊國家 (M,1952/08/05,59y7m) 手術日期 2011/01/20 手術主治醫師 陳敞牧 手術區域 東址 005房 01號 診斷 Hydrocephalus 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:05 進入手術室 08:20 麻醉開始 08:25 誘導結束 08:35 抗生素給藥 09:06 手術開始 10:50 手術結束 10:50 麻醉結束 11:00 送出病患 11:00 進入恢復室 12:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 手術 腦室腹腔分流手術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 李振豪 開立時間: 2011/01/20 11:13 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method V-P Shunt Ventriculo-peritoneal shunt via right Kocher"s point Specimen Count And Types 1 piece About size:6ml Source:CSF for routine, BCS, and bacterial culture Pathology Nil Operative Findings The opening pressure is about 15cmH2O. The CSF is clear in character without increase viscosity. The Codman programmable valve reservoir was placed with initial pressure setting 100mmH2O. The Ventricular catheter was 7cm in length. The peritoneal catheter was 30cm in length. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine position with head rotated to left. The scalp was shaved, scrubbed, and disinfected as usual. 3cm linear scalp incision was made at right Kocher"s point followed by one burr hole creation. Two dural tenting was done. One 3cm transverse skin incision was made at right upper abdomen and the subcutaneous soft tissue was dissected. The rectus abdominis muscle was splitted and minilaparotomy was done. The trocar was introduced into peritoneal cavity under direct vision. The subcutaneous tunnel from right upper abdomen, right forechest, right neck, to right retroauricular area was created. The peritoneal catheter was passed throught the tunnel. The ventricular catheter was connected with the programmable valve reservoir. One 1cm scalp incision was made at right retroauricular area and reservoir was passed through subgaleal space and connected to the peritoneal catheter. Cruciform durotomy was done and ventricular puncture was performed with ventricular needle. After CSF sampling, the ventricular catheter was placed into the right lateral ventricle. The function of the shunt was checked. The peritoneal catheter was placed into the peritoneal cavity. Hemostasis was achieved with bipolar electrocautery and Gelform packing. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS陳敞牧 Assistants R4李振豪, R2陳建銘 相關圖片 鍾明英 (M,1981/02/24,31y0m) 手術日期 2011/01/20 手術主治醫師 陳敞牧 手術區域 東址 005房 02號 診斷 Malignant neoplasm of thymus 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 11:32 報到 11:36 進入手術室 11:40 麻醉開始 12:00 誘導結束 12:15 抗生素給藥 12:49 手術開始 14:08 開始輸血 15:15 抗生素給藥 15:53 麻醉結束 15:53 手術結束 16:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 椎弓切除術(減壓)-二節以內 1 2 手術 惡性脊髓腫瘤切除術 1 1 摘要__ 手術科部: 外科部 套用罐頭: T9-T12 laminectomy for decompression + intras... 開立醫師: 李振豪 開立時間: 2011/01/20 16:16 Pre-operative Diagnosis Primitive neuroectodermal tumor with intraspinal invasion and cord compression Post-operative Diagnosis Primitive neuroectodermal tumor with intraspinal invasion and cord compression Operative Method T9-T12 laminectomy for decompression + intraspinal tumor excision + right T9, T10 rhizotomy Specimen Count And Types 1 piece About size:1x1x1cm Source:Intraspinal tumor Pathology Nil Operative Findings There is a large tumor over left posterior thoracic wall with 20 The tumor was red-grayish, soft, hypervascular, and well-demarcated in character. The dura was not invaded but the right side roots were encased by the tumor. More than half of the spinal canal was occupied by the tumor at T9 to T11 level(extended into spinal canal via neural foramen). The thecal sac expanded well after removal of the intraspinal tumor. The extraspinal part was left in situ. The lower limbs SSEP was poor before the operation. No SSEP change was noted after whole procedure. Blood loss: 1200ml Operative Procedures Under endotracheal tube general anesthesia, the patient was put in prone position. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made from T9 to T12 level. The subcutaneous soft tissue was dissected and the paravertebral muscle groups were detached. The laminae of T9 to T12 were exposed. T9 to T11 laminectomy and intraspinal tumor excision was performed for decompression. Right T9 and T10 rhizotomy also done with Hemoclip during the operation. Hemostasis were achieved with bipolar electrocautery and Gelform packing. One CWV was placed. The wound was closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS陳敞牧 Assistants R4李振豪, R2陳建銘 相關圖片 謝鎔竹 (F,1980/08/20,31y6m) 手術日期 2011/01/20 手術主治醫師 蕭輔仁 手術區域 東址 002房 02號 診斷 Herniation of intervertebral disc 器械術式 Diskectomy lumbar 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 2E 紀錄醫師 曾峰毅, 時間資訊 05:00 臨時手術NPO 05:00 開始NPO 12:35 進入手術室 12:43 麻醉開始 12:55 誘導結束 13:05 抗生素給藥 13:34 手術開始 14:35 麻醉結束 14:35 手術結束 14:40 送出病患 14:43 進入恢復室 16:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 椎間盤切除術-腰椎 1 1 記錄__ 手術科部: 外科部 套用罐頭: Left microscopic discectomy 開立醫師: 胡朝凱 開立時間: 2011/01/20 14:31 Pre-operative Diagnosis Left L5~S1 HIVD Post-operative Diagnosis Left L5~S1 HIVD Operative Method Left microscopic discectomy Specimen Count And Types nil Pathology nil Operative Findings One ruptured disc extruded from L5~S1 level and compressed the left S1 root tightly. Operative Procedures Under endotracheal general anesthesia, patient was put in prone position. Pre-Op fluoroscopic localization was performed. The back was shaved and scrubbed with povidone-iodine detergent then painted with povidone-iodine tincture and followed by sterilized adhesive plastic sheet covering. Incision was made as 3-cm, between L5~S1 spinous processes. The subcutaneous layer and lumbdorsal fascia were incised then the aponeurosis of the latissimus dorsi and ileocostalis lumborum muscles at spinous processes of L 5~S1 was incised, the muscles were detached from the interspinous ligament. The multifidus muscles were detached subperiosteally from L5~S1 laminae by a rasp. The paravertebral muscles were retracted by a modified narrow Taylor retractor which was retained constantly by a rubbersling to the side rail of the operating table. Under an operating microscope, the ligamentum flavum was cleaned and incised longitudinally at the lateral part.The lateral portion of this ligament was removed with a small angle Kerrison rongeur, the lateral portion of the laminae and the medial border of the facets were removed too until the margin of the facets and a corridor to the disc that ran lateral to the root was reached. The epidural fat was left undisturbed andpreserved. The compressed L5 root and veins overlying the protruded disc were gently pushed away by placing 2 small cottonoid patties, one above and one below the disc at the floor of the epidural canal. The compressed root was gently pushed further away temporarily by sucker tip in order to expose the herniated disc more clearly. The posterior longitudinal ligament and annulus were incised around the protruded disc with a No. 15 blade. The degenerated disc was removed with microdisc forceps until a substantial amount of the nucleus had been loosened with a cone curette and removed. The lumbodorsal fascia was approximated by 3 interruped 2/0 silk stitches. Thesubcutaneous layer was closed by running suture with 4/0 Dexon and skin by adhesive tape. Operators VS 蕭輔仁 Assistants 胡朝凱, 曾峰毅 Indication Of Emergent Operation 戴隆行 (M,1955/06/03,56y9m) 手術日期 2011/01/20 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 Brain concussion 器械術式 Craniotomy(Aneurysms) Others 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 10:45 進入手術室 10:50 麻醉開始 11:05 誘導結束 11:28 手術開始 15:40 手術結束 15:40 麻醉結束 15:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Left pterional craniotomy for hematoma removal 開立醫師: 王奐之 開立時間: 2011/01/20 16:03 Pre-operative Diagnosis Traumatic subarachnoid hemorrhage, intracerebral hemorrhage with large hematoma at left Sylvian fissure Post-operative Diagnosis Traumatic subarachnoid hemorrhage, intracerebral hemorrhage with large hematoma at left Sylvian fissure Operative Method Left pterional craniotomy for hematoma removal Specimen Count And Types nil Pathology nil Operative Findings A large organized clot was noted in left Sylvian fissure. Vasospasm was visualized at distal M1 segment and MCA trifurcation. After hematoma removal and vigorous flush with normal saline, the left side MCA became obviously larger in diameter. No apparent aneurysm was noted. Operative Procedures After ETGA, the patient was placed in supine position with face turned to right, and the head was fixed with Mayfield skull clamp. After shaving, disinfection & draping in sterile fashion, a curved pre-auricular skin incision was made, followed by left pterional craniotomy. After cauterizing the middle meningeal artery and dural tenting, a curved durotomy was done and the dura was reflected inferiorly to expose the contused brain surface. The Sylvian fissure was opened by cutting open the arachnoid membrane along the Sylvian vein. The hematoma was removed piece by piece by sucker, until the left side MCA (M1 & M2) were identified. After hematoma removal, the subarachnoid space was flushed with large amount of normal saline. After meticulous hemostasis, the bone was placed back and fixed with miniplates. The temporalis muscle was approximated. After setting 2 subgaleal CWV drain, the wound was closed in layers. Operators VS 王國川 Assistants R4 林哲光, R3 王奐之 相關圖片 古銀盡 (F,1947/01/21,65y1m) 手術日期 2011/01/20 手術主治醫師 王國川 手術區域 東址 027房 05號 診斷 重大創傷且及嚴重程度到達創傷嚴重程度分數16分以上 器械術式 Evacuation of contusional ICH 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3E 紀錄醫師 李振豪, 時間資訊 13:00 臨時手術NPO 13:00 開始NPO 20:31 通知急診手術 21:50 進入手術室 22:00 麻醉開始 22:10 誘導結束 22:15 抗生素給藥 22:50 開始輸血 22:54 手術開始 01:23 抗生素給藥 01:50 手術結束 01:50 麻醉結束 02:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦內血腫清除術 1 1 L 手術 顱內壓視置入 1 2 L 摘要__ 手術科部: 外科部 套用罐頭: Left fronto-temporal craniotomy for left temp... 開立醫師: 李振豪 開立時間: 2011/01/21 03:03 Pre-operative Diagnosis Left temporal and bifrontal contusional intracerebral hemorrhage Post-operative Diagnosis Left temporal and bifrontal contusional intracerebral hemorrhage Operative Method Left fronto-temporal craniotomy for left temporal hematoma evacuation Specimen Count And Types nil Pathology Nil Operative Findings The ICP after one burr hole creation was 10mmHg. The left parietal area EDH was noted at the margin at craniotomy window. The EDH was left in situ since no active bleeding was noted. The subdural hematoma was noted after dural opening. The brain was mild swelling initially. Contusional ICH over left temporal tip was evacuated. The temporal horn of left lateral ventricle was noted after removal of the contusional ICH. The contusional ICH was mainly within temporal tip, inferior temporal gyrus, and lower part of middle temporal gyrus. The brain became slack after removal of the ICH and SDH. The ICP after wound closure was 0mmHg. ICP reference: 492. The scalp was severe swelling due to thick subgaleal hematoma. The ICP after one burr hole creation was 10mmHg. The left parietal area EDH was noted at the margin at craniotomy window. The EDH was left in situ since no active bleeding was noted. The subdural hematoma was noted after dural opening. The brain was mild swelling initially. Contusional ICH over left temporal tip was evacuated. The temporal horn of left lateral ventricle was noted after removal of the contusional ICH. The contusional ICH was mainly within temporal tip, inferior temporal gyrus, and lower part of middle temporal gyrus. The brain became slack after removal of the ICH and SDH. The ICP after wound closure was 0mmHg. ICP reference: 492. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine position with head rotated to right. The scalp was shaved, scrubbed, and disinfected as usual. The question mark scalp incision was made over left fronto-temporo-parietal area. The scalp flap was elevated. Four burr holes were created followed by one 10x10cm craniotomy window. Dural tenting was performed and the dura was opened with C-shape. Subdural hematoma and left temporal contusional ICH was evacuated. Hemostasis was achieved with bipolar electrocautery and Surgicel lining. Duroplasty was performed with periosteum. The ICP monitor was inserted into subdural space with tip at left temporal area. The skull plate was fixed back with miniplates. One CWV drain was placed and the temporalis muscle was fixed back. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS王國川 Assistants R4李振豪, R1邱裕淳 Indication Of Emergent Operation 相關圖片 李進財 (M,1954/01/01,58y2m) 手術日期 2011/01/20 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Fever 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 08:20 進入手術室 08:20 報到 08:25 麻醉開始 08:27 誘導結束 09:00 抗生素給藥 09:25 手術開始 09:53 麻醉結束 09:53 手術結束 10:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 皮下肌肉或深部異物取出術 1 1 摘要__ 手術科部: 外科部 套用罐頭: Right side V-P shunt removal 開立醫師: 王奐之 開立時間: 2011/01/20 10:26 Pre-operative Diagnosis Cerebellar hemorrhage with hydrocephalus, s/p V-P shunt insertion, with suspected shunt infection Post-operative Diagnosis Cerebellar hemorrhage with hydrocephalus, s/p V-P shunt insertion, with suspected shunt infection Operative Method Right side V-P shunt removal Specimen Count And Types 2 pieces About size:3cm Source:VP shunt tip About size:3cm Source:VP shunt tip Pathology Pending Operative Findings No pus was noted at erythematous V-P shunt tunnel. Clear CSF noted in shunt reservoir but some debris was noted. Operative Procedures After ETGA, the patient was placed in supine position with face turned to left. After shaving, disinfection and draping in sterile fashion, a linear wound was made along previous right frontal scalp; 2 other linear skin incision were made at right post-auricular area and right mid-clavicular area. The shunt were then transected into 3 parts and removed from the 3 wounds. After hemostasis, the wounds were closed in layers. Operators VS 王國川 Assistants R4 林哲光, R3 王奐之 相關圖片 洪翌洧 (M,2010/06/13,1y9m) 手術日期 2011/01/20 手術主治醫師 陳益祥 手術區域 兒醫 067房 01號 診斷 Complex congenital heart disease 器械術式 sterum closure 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 4 紀錄醫師 黃世銘, 時間資訊 14:56 臨時手術NPO 08:58 報到 08:58 進入手術室 09:05 麻醉開始 09:15 誘導結束 09:40 手術開始 10:45 送出病患 10:45 麻醉結束 10:45 手術結束 醫令資訊 類別 名稱 量 刀 側 手術 探查性心包膜切開術 1 1 手術 內頸靜脈切開,永久導管放置術 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 套用罐頭: Sternum closure, Right internal jugular vein ... 開立醫師: 黃世銘 開立時間: 2011/01/20 11:03 Pre-operative Diagnosis Tracheal stenosis status post traeoplasty x2, with sternum unapproximated Post-operative Diagnosis Tracheal stenosis status post traeoplasty x2, with sternum closure Operative Method Sternum closure, Right internal jugular vein repair, removal of ECMO cannula, right internal jugular vein CVC insertion, and PD removal Specimen Count And Types nil Pathology Nil Operative Findings No bleeder or hematoma in pericardial cavity Airway(peak): 30cmH2O After checked adequate urine output, Removal of PD Pre operative CVP: 8mmHg, Post operative CVP: 11mmHg Operative Procedures ETGA, supine position, skin disinfected Remove silicon membrane Normal saline and BI irrigation Hematasis, Pericardium covered with surgical membrane Wound closure Right internal jugular vein exploration Remove right internal jugular vein ECMO cannula Cut down incision of right internal jugular vein CVC Wound closure Remove PD Operators VS 陳義祥 Assistants R5謝永, R2黃世銘 喻芝蘭 (F,1963/11/08,48y4m) 手術日期 2011/01/20 手術主治醫師 林峰盛 手術區域 西址 034房 05號 診斷 Radiculopathy 器械術式 Nerve block / PC 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 林峰盛 ASA 2 時間資訊 12:30 進入手術室 12:31 麻醉開始 12:35 誘導結束 12:40 手術開始 13:00 手術結束 13:10 送出病患 摘要__ 手術科部: 麻醉部 套用罐頭: LENB 開立醫師: 林峰盛 開立時間: 2011/01/20 13:03 Pre-operative Diagnosis radiculopathy Post-operative Diagnosis radiculopathy Operative Method Cervical root block Specimen Count And Types nil Pathology Nil Operative Findings Operative Procedures IV sedation with fentany l& LA with 1% xylocaine 5 ml pt in supine position Under fluoroscopic-guiddance, cervical root block was done to left C4-5 level with 23G spinal needle, 1mg Rinderon in 0.5% xylocaine 6ml Operators 林峰盛, Assistants 林宜樺, 吳宜勳 (M,1981/10/12,30y5m) 手術日期 2011/01/21 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Brain Tumor 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 1 紀錄醫師 古恬音, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:50 進入手術室 08:55 麻醉開始 09:30 誘導結束 09:50 抗生素給藥 09:50 手術開始 12:50 抗生素給藥 12:55 開始輸血 15:50 抗生素給藥 18:05 麻醉結束 18:05 手術結束 18:16 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 顱底瘤手術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 10 0 摘要__ 手術科部: 外科部 套用罐頭: Left Dolencs approach for tumor excision 開立醫師: 古恬音 開立時間: 2011/01/21 18:26 Pre-operative Diagnosis Left cavernous sinus tumor, suspected neuroma Post-operative Diagnosis Left cavernous sinus neuroma, 5th or 6th nerve origin Operative Method Left Dolencs approach for tumor excision Specimen Count And Types 1 piece About size:small Source:left cavernous sinus neuroma Pathology Pending Operative Findings There were tumors both lateral and medial to the internal carotid artery. The tumors were soft and yellowish. They were well-encapsulated and could be easily detached from the surrounding tissue. The CN III, CN IV, CN V1, CN V2, and CN VI were identified during the operation. They were in their originial places. The internal carotid artery was pushed laterally side. The frontal sinus was opened during creation of craniotomy window, and the space was packed with iodine-soaked Gelform and sealed with bone wax. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head turned to right and fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected with better iodine. Draping was done in usual sterile fashion. One curvillinear scalp incision was made at left frontotemporal region with extension beyond midline. The temporalis muscle was detached and reflected posteriorly. One 8*12 craniotomy window was created after drilling 3 burr holes, and peripheral tenting was done. The frontal sinus was opened, and the mucosa was removed. Frontal sinus was then packed with iodine-soaked Gelfoam and sealed with bone wax. The sphenoid ridge was furher drilled off until the CN V2 and V3 could be identified. The temporal lobe was retracted inferiorly to expose the cavernous sinues, and the left orbital roof was removed with air drill and Rongeur. The anterior clinoid process was also removed. The cavernous sinus was opened, then both tumors were removed after careful peripheral dissection. The space previously occupied with tumor was then packed with Gelfoam, and the raw surfaced was covered by Surgicel. The skull bone was fixed back with miniplates after central tenting. After setting one epidural CWV drain, the wound was closed in layers. Operators 杜永光 Assistants R6陳睿生 R3古恬音 黃麗月 (F,1942/09/06,69y6m) 手術日期 2011/01/21 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Acromegaly 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 柯安達, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:01 進入手術室 08:10 麻醉開始 08:50 誘導結束 09:00 抗生素給藥 09:21 手術開始 10:27 麻醉結束 10:27 手術結束 10:37 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經由蝶竇之腦下垂體瘤切除 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Transnasal trans-sphenoidal approach for tumo... 開立醫師: 柯安達 開立時間: 2011/01/21 11:07 Pre-operative Diagnosis GROWTH HORMONE TUMOR Post-operative Diagnosis GROWTH HORMONE TUMOR Operative Method Transnasal trans-sphenoidal approach for tumor excision Specimen Count And Types pieces of tumor Pathology pending Operative Findings The tumor was yellowish to reddish, soft but with some solid part. It was hypervascular with easy bleeding. Some part of tumor located at left side adhered to cavernous sinus tightly and we left it in situ. Post-OP arachnopid membrane wasn’t seen very clearly. Operative Procedures After ETGA, the patient was put in supine position with head mild left tilt. The nasal cavity was well-disinfective, and then we incised into the nasal septum. Dissection was performed along with the periosteum to expose sphenoid sinus anterior wall and sphenoid ostia. After fracture of vomer, sphenoid sinus anterior wall was also fractured. The mucosa was removed. The sella floor was exposed and removed with kerrison. After cruciate form incision, tumor buldged out. And it was further removed with tumor forceps and ring currette. Due to bleeding, subtotal tumor excision was made, the bony graft was put back and followed by compaction of merosel. Operators VS. 曾漢民 Assistants 胡朝凱，柯安達 鄧亞芬 (F,1986/02/13,26y1m) 手術日期 2011/01/21 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Cushing syndrome 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 柯安達, 時間資訊 00:00 臨時手術NPO 11:30 報到 11:39 進入手術室 11:45 麻醉開始 12:05 誘導結束 12:35 抗生素給藥 12:45 手術開始 13:40 麻醉結束 13:40 手術結束 14:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 經由蝶竇之腦下垂體瘤切除 1 1 記錄__ 手術科部: 外科部 套用罐頭: Transnasal trans-sphenoidal approach for tumo... 開立醫師: 柯安達 開立時間: 2011/01/21 14:06 Pre-operative Diagnosis Cushing syndrome Post-operative Diagnosis Cushing syndrome Operative Method Transnasal trans-sphenoidal approach for tumor excision Specimen Count And Types one piece Pathology pending Operative Findings The tumor was whitish, soft. Post-OP arachnopid membrane was seen. Old hematoma was noted inside the tumor. Unintended durotomy was done and sealed with Tissucal-duo. Operative Procedures 1. After ETGA, the patient was put in supine position with head mild left tilt. The nasal cavity was well-disinfective, and then we incised into the nasal septum. 2. Dissection was performed along with the periosteum to expose sphenoid sinus anterior wall and sphenoid ostia. 3. After fracture of vomer, sphenoid sinus anterior wall was also fractured. The mucosa was removed. 4. The sella floor was exposed and removed with kerrison. After cruciate form incision, tumor buldged out. And it was further removed with tumor forceps and ring currette. 5. After total excision of tumor was made, the bony graft was put back and followed by compaction of merosel. Operators 曾漢民 Assistants 胡朝凱, 柯安達 洪永建 (M,1960/04/12,51y11m) 手術日期 2011/01/21 手術主治醫師 曾漢民 手術區域 東址 005房 03號 診斷 Nasopharynx cancer ( NPC ) 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 柯安達, 時間資訊 00:00 臨時手術NPO 13:40 報到 14:12 進入手術室 14:15 麻醉開始 14:30 誘導結束 14:39 抗生素給藥 15:05 手術開始 16:48 17:30 抗生素給藥 17:55 麻醉結束 17:55 手術結束 18:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦室腹腔分流手術 1 1 B 記錄__ 手術科部: 外科部 套用罐頭: bilateral craniotomy for drainage 開立醫師: 柯安達 開立時間: 2011/01/21 18:30 Pre-operative Diagnosis bilateral redionecrosis cystic lesion Post-operative Diagnosis bilateral redionecrosis cystic lesion Operative Method bilateral craniotomy for drainage Specimen Count And Types CSF about 60 cc Pathology nil Operative Findings yellowish and turbid fluid were drainage from bilateral cystic lesion, the left side fluid with some bloody content Operative Procedures Under ETGA, patient was put in supine position with head tilt to right. After well antisepsis and drapping procedure, left trauma flap skin incision was performed from pre-auricular area upward to 1 cm above ear then turn backward and pass the curvature of skull, followed by another turn upward to 1 cm away from midline and went anterior to 1 cm behind hair line and then crossed the midline with a curvature incision. The subcutaneous soft tissue was then opened by blunt dissection. Periosteum was then incised by elctrocauterization and dissected to open. After 1 burr holes drilled, craniotomy was performed with Midas air drill. Nelaton tube was inserted for cystic fulid drainage. Dural tenting was then performed and was followed with curvature dura incision 1 cm away from edge. Duro-form was utilized to re-union with the dura. The bone was put back in the original area and fixed with mini-plate and screws.And wound was closed in layers. Then we turned the position with head tilt to left.After well antisepsis and drapping procedure, left trauma flap skin incision was performed from pre-auricular area upward to 1 cm above ear then turn backward and pass the curvature of skull, followed by another turn upward to 1 cm away from midline and went anterior to 1 cm behind hair line and then crossed the midline with a curvature incision. The subcutaneous soft tissue was then opened by blunt dissection. Periosteum was then incised by elctrocauterization and dissected to open. After 1 burr holes drilled, craniotomy was performed with Midas air drill. Nelaton tube was inserted for cystic fulid drainage. Dural tenting was then performed and was followed with curvature dura incision 1 cm away from edge. Duro-form was utilized to re-union with the dura. The bone was put back in the original area and fixed with mini-plate and screws.And wound was closed in layers. Operators 曾漢民 Assistants 胡朝凱 柯安達 陳昆山 (M,1948/02/16,64y0m) 手術日期 2011/01/21 手術主治醫師 賴達明 手術區域 東址 027房 05號 診斷 Subarachnoid hemorrhage 器械術式 Craniotomy(Aneurysms) P-DUH 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 王永彬 ASA 4E 紀錄醫師 何奕瑢, 時間資訊 16:50 開始NPO 16:50 通知急診手術 17:25 進入手術室 17:25 報到 17:30 麻醉開始 17:40 誘導結束 17:50 抗生素給藥 17:51 手術開始 17:59 開始輸血 21:00 抗生素給藥 23:00 麻醉結束 23:00 手術結束 23:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 開顱術摘除血管病變 - 腦血管瘤 有病徵的 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 神經部 套用罐頭: Left craniectomy and aneurysmal clipping and ... 開立醫師: 胡朝凱 開立時間: 2011/01/21 22:48 Pre-operative Diagnosis Left ACA aneurysm ruptured with SAH and ICH Post-operative Diagnosis Left ACA aneurysm ruptured with SAH and ICH Operative Method Left craniectomy and aneurysmal clipping and left temporal ICH evacuation Specimen Count And Types nil Pathology nil Operative Findings 1.Brain swelling was noted 2.Severe SAH and mild SDH was also noted. 3.Left temporal and sylvian fissure ICH about 40 ml. 4.One saccular aneurysm was noted arised from left A1 protruded upward and posteriorly. 5.Intra-op mild rupture was noted. 6.Proxymal control about 8 minutes with good collateral perfusion was noted. 7.Two straight Sugita clip was applied. Operative Procedures 1.ETGA, supine 2.Left Trauma flap was incised 3.Reflect skin and muscle flap anteriorly 4.craniectomy 5.Sphenoid ridge was drilled to be flap 6.open dura as curvillinear fashion 7.Open sylvian fissure 8.Temporal ICH evacuation 9.Retract frontal lobe to identified ICA, MCA then A1 10.Trace A1 to identify aneurysm 11.Proximal control 12.Aneurysm clipping 13.Hemostasis 14.Duroplasty with surofoam 15.Close wound in layers after ICP monitor and CWV drain insertion Operators 賴達明 Assistants 胡朝凱, 何奕瑢 Indication Of Emergent Operation 陳立軒 (M,1985/06/28,26y8m) 手術日期 2011/01/21 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Acute endocarditis, unspecified 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 4E 紀錄醫師 李振豪, 時間資訊 03:25 通知急診手術 03:45 報到 03:50 進入手術室 03:55 麻醉開始 04:05 誘導結束 04:20 抗生素給藥 04:25 手術開始 04:32 開始輸血 08:25 麻醉結束 08:25 手術結束 08:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 開顱術摘除血管病變 - 腦血管瘤 有病徵的 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 顱內壓視置入 1 2 摘要__ 手術科部: 外科部 套用罐頭: Left fronto-temporo-parietal craniectomy for ... 開立醫師: 李振豪 開立時間: 2011/01/21 10:13 Pre-operative Diagnosis Left parietal intracerebral hemorrhage, suspect mycotic aneurysm or coagulopathy related Post-operative Diagnosis Left parietal intracerebral hemorrhage, favor mycotic aneurysm related Operative Method Left fronto-temporo-parietal craniectomy for hematoma evacuation and removal of mycotic aneurysm Specimen Count And Types 1 piece About size:1x1x0.5cm Source:Vascular lesion, suspect mycotic aneurysm Pathology pending Operative Findings The hematoma was near 100ml in volume and well organized. The lateral ventricle was not entered during the operation. The aneurysm was located at the occipital part of the hematoma which mycotic aneurysm was highly suspected(firm, distal located with much branch arising from the aneurysm). The brain became slack initially after removal of the hematoma but swelling later during wound closure. The ICP after wound closure was 7mmHg. Bleeding tendancy(+). ICP reference: 479. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine position with head rotated to right. The scalp was shaved, scrubbed, and disinfected as usual. The question mark scalp incision was made over left side. After elevation of the scalp flap, five burr holes were created followed by craniectomy. Dural tenting was performed. The dura was opened with C-shape. The rolandic vein was identified. One 1.5cm corticotomy was performed and hematoma was evacuated with tumor forceps and sucker. However, active bleeder was noted after removal of the the hematoma. Further dissection was performed. One aneurysm was noted at near occipital area. Mycotic aneurysm was highly suspected. The aneurysm was resected. Hemostasis was acheived with bipolar electrocautery and Surgicel lining. Duroplasty with periosteum was done. Two CWV drain and the ICP monitor were placed. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Under endotracheal tube general anesthesia, the patient was put in supine position with head rotated to right. The scalp was shaved, scrubbed, and disinfected as usual. The question mark scalp incision was made over left side. After elevation of the scalp flap, five burr holes were created followed by craniectomy. Dural tenting was performed. The dura was opened with C-shape. The rolandic vein was identified. One 1.5cm corticotomy was performed and hematoma was evacuated with tumor forceps and sucker. However, active bleeder was noted after removal of the the hematoma. Further dissection was performed. One aneurysm was noted at near occipital area. Mycotic aneurysm was highly suspected. The aneurysm was resected. Hemostasis was acheived with bipolar electrocautery and Surgicel lining. Duroplasty with periosteum was done. Two CWV drain and the ICP monitor were placed. The wound was then closed in layers with 2-0 Vicryl and Appose staples. Operators VS賴達明 Assistants R4李振豪, R2陳國瑋 Indication Of Emergent Operation 相關圖片 黃皆華 (M,1925/03/04,87y0m) 手術日期 2011/01/21 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Spondyloisthesis, acquired 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 邱裕淳, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:00 進入手術室 08:10 麻醉開始 08:25 誘導結束 08:38 抗生素給藥 09:22 手術開始 10:11 開始輸血 11:35 手術結束 11:35 麻醉結束 11:46 送出病患 11:50 進入恢復室 12:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術(減壓)-二節以內 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 曾峰毅 開立時間: 2011/01/21 11:44 Pre-operative Diagnosis Lumbar stenosis, L3-5 Post-operative Diagnosis Lumbar stenosis, L3-5 Operative Method Splited laminectomy for C3-5 sublaminar decompression Specimen Count And Types Nil Pathology Nil Operative Findings Hypertrophic ligamentum flavum was noted at C3-5, compressing the thecal sac tightly, and compromising bilateral lateral recessed. Thecal sac and nerve roots were decompressed well after the surgery. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After C-arm localization, we scrubbed, disinfected, and then draped the patients back. We made one midline skin incision from C3 to C4 spinous process. We drilled through the spinous process, and splited the spinous process. Sublaminar decompression was done though C3/4 and C4/5 laminotomy. The wound was closed in layers after hemostasis. Operators VS 賴達明 Assistants R4 曾峰毅 R1 邱裕淳 陳惠英 (F,1950/12/06,61y3m) 手術日期 2011/01/21 手術主治醫師 賴達明 手術區域 東址 019房 02號 診斷 Spondylolisthesis 器械術式 Laminectomy for decompression，Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 邱裕淳, 時間資訊 00:00 臨時手術NPO 11:52 報到 12:00 進入手術室 12:05 麻醉開始 12:15 誘導結束 12:50 抗生素給藥 13:12 手術開始 16:20 抗生素給藥 16:30 手術結束 16:30 麻醉結束 16:40 送出病患 16:45 進入恢復室 18:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 脊椎融合術-前融合,有固定物)≦四節 1 2 手術 椎間盤切除術-腰椎 1 4 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 曾峰毅 開立時間: 2011/01/21 16:39 Pre-operative Diagnosis Spondylolisthesis, L4/5 Post-operative Diagnosis Spondylolisthesis, L4/5 Operative Method L4/5 transforaminal interbody fusion with PEEK cage and autolgous bone graft; posterior fixation with transpedicular screws. Specimen Count And Types Nil Pathology Nil Operative Findings Synthes transpedicular screws were inserted at bilateral pedicles of L4 and L5. Synthes banana TLIF cage was inserted into L4/5. Thecal sac and bilateral L5 roots were compromise by hypertrophic ligamentum flavum. Neural structure was decompressed well after the proceduer. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After C-arm localization, we scrubbed, disinfected, and then draped the patients back. We made one longitudinal skin incision, about 3cm away left to the midline, and dissected to paraspinal area. We inserted transpedicular scerws at left pedicles of L4 and L5, and peformed left facetectomy of L4/5. L4/5 diskectomy and sublaminar decompression to bilateral lateral recesses were performed, and fusion was done with banana cage and autologous bone graft. We set up the rod and knots. We inserted hemovac, and closed the wound in in layers. We made another longitudinal skin incision, about 3cm right to midline. We inserted transpedicular screws at right pedicles of L4 and L5. After rod and knots set up, we closed the wound in layers. Operators VS賴達明 Assistants R4 曾峰毅 R1 邱裕淳 蔡雅雯 (F,1985/08/31,26y6m) 手術日期 2011/01/21 手術主治醫師 賴達明 手術區域 東址 019房 03號 診斷 Herniation of intervertebral disc 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 1 紀錄醫師 邱裕淳, 時間資訊 00:00 臨時手術NPO 16:35 報到 17:05 進入手術室 17:10 麻醉開始 17:15 誘導結束 17:33 抗生素給藥 17:47 手術開始 19:50 麻醉結束 19:50 手術結束 20:00 送出病患 20:05 進入恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 椎間盤切除術-腰椎 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: HIVD 開立醫師: 曾峰毅 開立時間: 2011/01/21 19:58 Pre-operative Diagnosis Protruding disc, right side, L5/S1 Post-operative Diagnosis Protruding disc, right side, L5/S1 Operative Method L5/S1 microdiskectomy Specimen Count And Types Nil Pathology Nil Operative Findings Protruding disc, L5/S1, compromising right lateral recess of L5/S1 severely. There was severe adhesion between disc fragment with surrouding tissue with engorged veins. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After C-arm localization, we scrubbed, disinfected, and then draped the back. We made one midline skin incision and dissected right paraspinal muscle to expose right lamine of L5. We removed the ligamentum flavum, and performed diskectomy. After hemostasis, the wound was closed in layers. Operators VS 賴達明 Assistants R4 曾峰毅 R1 邱裕淳 陳秀誠 (M,1966/07/23,45y7m) 手術日期 2011/01/21 手術主治醫師 王國川 手術區域 東址 001房 01號 診斷 Acute myocardial infarction (AMI) 器械術式 Burr hole (trephination) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3E 紀錄醫師 鍾文桂, 時間資訊 00:00 開始NPO 00:00 臨時手術NPO 07:45 通知急診手術 09:05 報到 09:10 進入手術室 09:15 麻醉開始 09:25 誘導結束 10:00 開始輸血 10:03 手術開始 11:03 麻醉結束 11:03 手術結束 11:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 慢性硬腦膜下血腫清除術 1 1 L 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Evacuation of subdural hematoma. 開立醫師: 鍾文桂 開立時間: 2011/01/21 11:50 Pre-operative Diagnosis Subdural hematoma, left frontal-parietal-temporal. Post-operative Diagnosis Subdural hematoma, left frontal-parietal-temporal. Operative Method Evacuation of subdural hematoma. Specimen Count And Types nil Pathology Nil. Operative Findings Yellowish-red fluid drained out from the subdural space. pressure about 5 cmH2O initially. Easy oozing operative field( the patient keeps taking aspirin). Medtronic EVD catheter as subdural drain. Unstable vital signs intraoperatively. Operative Procedures Under ETGA, the patient was placed in supine position and the head slightly tilted to the right. After shaving, disinfection, and draping, a linear scalp incision was made at left parietal area. Then a burr hole was created. After durotomy, the subdural hematoma gushed out. The subdural drain was placed in situ. Finally, the wound was closed in layers. Operators V.S. 王國川 Assistants R5 鍾文桂 Indication Of Emergent Operation 劉春玉 (F,1962/11/15,49y3m) 手術日期 2011/01/21 手術主治醫師 戴浩志 手術區域 東址 009房 04號 診斷 Subarachnoid hemorrhage (SAH) 器械術式 Debridment-- >10cm 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 4 紀錄醫師 蕭惠壬, 時間資訊 00:00 臨時手術NPO 13:30 進入手術室 13:40 麻醉開始 13:50 誘導結束 14:08 手術開始 15:05 手術結束 15:05 麻醉結束 15:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 移前皮瓣移植術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Debridement and primary closure 開立醫師: 蕭惠壬 開立時間: 2011/01/21 15:09 Pre-operative Diagnosis Right lateral thigh laceration wound Post-operative Diagnosis Right lateral thigh laceration wound Operative Method Debridement and primary closure Specimen Count And Types nil Pathology Nil Operative Findings 1. A 6*2 cm deep laceration wound at right lateral thigh. Muscle exposure was found. Operative Procedures Under general anesthesia, the patient lied in supine position. Antiseptics applied and draped as usual. We excised the devitalized tissue. Check bleeding then hemostasis was done. Normal saline irrigation. One CWV drain was set. Wound close in layer Operators 戴浩志 Assistants 趙崧筌 蕭惠壬 相關圖片 蔡尊五 (M,1934/06/03,77y9m) 手術日期 2011/01/21 手術主治醫師 張宏江 手術區域 西址 039房 05號 診斷 Hypertrophy (benign) of prostate 器械術式 Removal of double-J 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 10:30 報到 10:48 進入手術室 10:50 麻醉開始 10:52 手術開始 10:55 手術結束 10:56 送出病患 柳閩生 (M,1942/05/16,69y9m) 手術日期 2011/01/21 手術主治醫師 許榮彬 手術區域 東址 017房 01號 診斷 Mitral valve insufficiency and aortic valve insufficiency 器械術式 M.V.R. (請排兩位刷手) 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 陳政維, 時間資訊 07:50 報到 08:05 進入手術室 08:15 麻醉開始 09:00 誘導結束 09:32 手術開始 12:05 手術結束 12:10 送出病患 12:10 麻醉結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 放置肺動脈導管術 1 0 麻醉 Cardiac out-put 1 0 麻醉 Swan-gang catheterization 1 0 麻醉 T.E.E 1 0 麻醉 Lactic Acid (lactate) 3 0 麻醉 動脈血液檢查全套 3 0 麻醉 Hemoglobin (Hb) 3 0 麻醉 測血糖 3 0 麻醉 Ca (Calcium) 3 0 麻醉 Na (Sodium) 3 0 麻醉 K (Potassium) 3 0 麻醉 Blood gas analysis 3 0 手術 體外心肺循環 1 1 手術 瓣膜成形術 1 1 記錄__ 手術科部: 外科部 套用罐頭: MVP 開立醫師: 陳政維 開立時間: 2011/01/21 12:48 Pre-operative Diagnosis IE, MR Post-operative Diagnosis Ditto Operative Method MVP Specimen Count And Types 1 piece About size: Source:vegetation Pathology Pending Operative Findings 1.Good LV contractility 2.Mitral valve: P3 chordae rupture, leading to eccentric MR Vegetation over medial commisural chordae, around 0.5cm in diameter 3.Post-OP: sinus rhythm, trival MR Operative Procedures 1.ETGA, supine position, skin disinfection 2.Midline sternotomy 3.CPB with AsAo, RAA-->SVC, IVC cannulation, cooling to 28C 4.Aortic crossclump, antegrade cardioplegia infusion 5.LA incision 6.MVP with plication of P3 and medial wooler annuloplasty*2 with 2-0 pledgetted Ticron sutures 7.LA closure 8.Rewarm, deair, wean-off CPB 9.Hemostasis, set two chest tubes in mediastinum 10.Pericardium closure 11.Wound closure in layers Operators AP許榮彬 Assistants R5謝永 R3陳政維 吳銅鐘 (M,1932/04/28,79y10m) 手術日期 2011/01/22 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Subarachnoid hemorrhage (SAH) 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 4E 紀錄醫師 曾峰毅, 時間資訊 00:13 開始NPO 00:13 臨時手術NPO 13:13 通知急診手術 15:15 進入手術室 15:15 報到 15:20 麻醉開始 15:30 誘導結束 15:45 開始輸血 15:48 抗生素給藥 16:11 手術開始 16:40 麻醉結束 16:40 手術結束 16:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Chronic Subdural Hematoma 開立醫師: 曾峰毅 開立時間: 2011/01/22 17:00 Pre-operative Diagnosis Subdural effusion, right Post-operative Diagnosis Subdural effusion, right Operative Method Right frontal burr hole for subdural drainage Specimen Count And Types Nil Pathology Nil Operative Findings Xanthochromic subdural effusion gushed out after outer membrane opened. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to left. After scalp shaved, scrubbed, disinfected, and then draped, we made ons transverse skin incision at right frontal area. We drilled one burr hole, and created durotomy. We opened the outer membrane, and inserted subdural drain. We closed the wound in layers after de-air the subdural space. Operators VS 賴達明 Assistants R4 曾峰毅 Indication Of Emergent Operation 鍾孟宏 (M,1968/01/18,44y1m) 手術日期 2011/01/22 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Intracerebral hemorrhage 器械術式 Removal of ICH 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 4E 紀錄醫師 蕭惠壬, 時間資訊 17:05 臨時手術NPO 17:05 開始NPO 21:05 通知急診手術 21:30 進入手術室 21:35 麻醉開始 21:55 誘導結束 22:00 抗生素給藥 22:34 手術開始 02:00 抗生素給藥 02:30 手術結束 02:30 麻醉結束 02:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 神經部 套用罐頭: Craniotomy for hematoma evacuation, and ICP m... 開立醫師: 陳睿生 開立時間: 2011/01/23 03:06 Pre-operative Diagnosis Left putaminal ICH with SAH Post-operative Diagnosis Left putaminal ICH with SAH Operative Method Craniotomy for hematoma evacuation, and ICP monitor insertion Specimen Count And Types nil Pathology Nil Operative Findings While dura opneing, diffuse SAH was noted. An about 2cm corticotomy was created at middle temporal gyrus, and large amount of hematoma was drained while corticotomy done. A subdural ICP monitor wasset, and the initial ICP was 3-4 mmHg post-op. Reference of the ICP monitor: 487 Operative Procedures 1. ETGA, supine position and head right turn 2. An about 10cm curvillinear scalp incision at left frontotemporal region 3. The temporalis muscle was dissected and an about 6x8cm craniotomy window was created 4. The dura was opened after tenting 5. The middle temporal gyrus was identify and an about 2cm corticotomy was made 6. The hematoma was drained and proper hemostasis was done under microscope 7. Set a subdural ICP monitor, and the dura was tightly closed 8. The skull was fixed back with miniplates x3 9. The muscle and wound were closed in layers Operators VS 賴達明 Assistants R6 陳睿生, R2 蕭惠壬 Indication Of Emergent Operation 高銘欣 (M,1933/12/10,78y3m) 手術日期 2011/01/22 手術主治醫師 王國川 手術區域 東址 001房 01號 診斷 冠狀動脈疾病 CAD, coronary artery disease 器械術式 Laminectomy C-Spinal(Posterier 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 3E 紀錄醫師 劉昌杰, 時間資訊 23:50 通知急診手術 00:00 開始NPO 00:00 臨時手術NPO 08:27 進入手術室 08:40 麻醉開始 08:55 誘導結束 09:17 抗生素給藥 09:31 手術開始 10:55 開始輸血 11:55 手術結束 11:55 麻醉結束 12:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 椎弓切除術(減壓)-超過二節 1 1 摘要__ 手術科部: 外科部 套用罐頭: C3-6 laminectomy for decompression 開立醫師: 陳睿生 開立時間: 2011/01/22 12:17 Pre-operative Diagnosis Cervical stenosis with cord compression Post-operative Diagnosis Cervical stenosis with cord compression Operative Method C3-6 laminectomy for decompression Specimen Count And Types nil Pathology Nil Operative Findings The cord was well expanded after laminectomy. Easy oozing was noted from the muscle, lamina, and epidural veins. Operative Procedures 1. ETGA, prone position with head fixed with Mayfield clump 2. Posterior neck midline incision at C2-C7 level 3. Incise into the nuchal ligament to expose the C2-6 spinous process 4. Dissect the paraspinal muscles to expose C3-6 lamina 5. Make grooves at bilateral lamina-facet junction with high speed drill 6. C3-7 laminectomy and remove of ligamentum flavum 7. Hemostasis, set an epidural CWV drain 8. Close the wound in layers Operators VS 王國川 Assistants R6 陳睿生, R1 劉昌傑 Indication Of Emergent Operation 陳昆山 (M,1948/02/16,64y0m) 手術日期 2011/01/23 手術主治醫師 賴達明 手術區域 東址 018房 02號 診斷 Subarachnoid hemorrhage 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 4E 紀錄醫師 曾峰毅, 時間資訊 13:09 通知急診手術 13:40 報到 13:40 進入手術室 13:45 麻醉開始 13:47 誘導結束 14:28 手術開始 15:05 麻醉結束 15:05 手術結束 15:10 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦室體外引流 1 2 R 記錄__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 曾峰毅 開立時間: 2011/01/23 15:23 Pre-operative Diagnosis Acute hydrocephalus Post-operative Diagnosis Acute hydrocephalus Operative Method External ventricular drainage via right Kocher point. Specimen Count And Types Nil Pathology Nil Operative Findings Light-reddish CSF gushed out while ventriculostomy. Opening pressure was above 30cmH20. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position. After scalp shaved, scrubbed, disinfected, and then draped, we made one longitudinal skin incision at right frontal area. We drilled one burr hole, and created durotomy. We inserted ventricular catheter, and closed the wound in layers. Operators VS 賴達明 Assistants R4 曾峰毅 Indication Of Emergent Operation 章家和 (M,1939/07/05,72y8m) 手術日期 2011/01/23 手術主治醫師 賴達明 手術區域 東址 018房 03號 診斷 Intracranial hemorrhage, trauma 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 4E 紀錄醫師 曾偉倫, 時間資訊 00:00 開始NPO 15:05 通知急診手術 15:42 進入手術室 15:45 麻醉開始 16:05 抗生素給藥 16:15 誘導結束 16:33 手術開始 16:34 開始輸血 19:30 抗生素給藥 19:45 手術結束 19:45 麻醉結束 19:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 1 L 手術 顳下減壓術 - 單側 1 2 L 手術 顱內壓視置入 1 4 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 曾峰毅 開立時間: 2011/01/23 19:32 Pre-operative Diagnosis Acute subdural hematoma with contusional hemorrhage at left frontal and temporal area Post-operative Diagnosis Acute subdural hematoma with contusional hemorrhage at left frontal and temporal area Operative Method Left frontal craniectomy for SDH and ICH removal; ICP monitor insertion Specimen Count And Types Nil Pathology Nil Operative Findings Initial ICP was about 18mmHg, and dropped to 3 after craniectomy and wound closure. Acute subdural hematoma was removed, and contusional ICH gushed out spontaenously from left temporal lobe and left frontal lobe. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to right. After scalp shaved, scrubbed, disinfected, and then draped, we made one curvilinear skin incision at left frontotemporal area. We drilled first burr hole, and then inserted ICP monitor to check ICP. 6 more burr holes was made followed by craniectomy peformed. Dura was tented around the craniectomy edge, and C-shape durotomy was done. Subdural hematoma was revoved, and contusional hemorrhage at left frontal and temporal area was evacuated via corticotomy. After hemostasis, the duro was closed in water-tight fahsion with autologous fascia graft. We inserted subdural ICP monitor, and two epidural CWV. We approximated the temoralis muscle and fascia, and the wound was closed in layers. Operators VS 賴達明 Assistants R4 曾峰毅 R3 王奐之 R2 曾偉倫 Indication Of Emergent Operation 王朝輝 (M,1948/11/14,63y4m) 手術日期 2011/01/23 手術主治醫師 王國川 手術區域 東址 019房 01號 診斷 Facial Laceration wound 器械術式 Burr hole (trephination) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 3E 紀錄醫師 曾偉倫, 時間資訊 11:50 開始NPO 11:50 通知急診手術 19:15 報到 19:25 進入手術室 19:30 麻醉開始 19:50 誘導結束 20:05 抗生素給藥 20:24 手術開始 21:40 手術結束 21:40 麻醉結束 21:50 送出病患 21:55 進入恢復室 22:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 手術 慢性硬腦膜下血腫清除術 1 1 B 手術 慢性硬腦膜下血腫清除術 1 2 B 摘要__ 手術科部: 外科部 套用罐頭: Chronic Subdural Hematoma 開立醫師: 曾峰毅 開立時間: 2011/01/23 21:12 Pre-operative Diagnosis Bilateral chronic subdural hematoma, status post burr hole for drainage, recurrence Post-operative Diagnosis Bilateral chronic subdural hematoma, status post burr hole for drainage, recurrence Operative Method Bilateral frontal burr hole for subdural drainage Specimen Count And Types Nil Pathology Nil Operative Findings Dark-reddish gushed out while durotomy at both sides. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position. After scalp shaved, scrubbed, disinfected, and then draped, we made one transverse skin incision at frontal area of each side. We drilled one burr hole at each side, and created durotomy. Outer membrane was opened at both sides, and subdural drain was inserted for drainage and irrigation. The wound was closed in layers, and subdural space was de-aired. Operators VS 王國川 Assistants R4 曾峰毅 R3 王奐之 R2 曾偉倫 Indication Of Emergent Operation 胡正輝 (M,1972/08/09,39y7m) 手術日期 2011/01/24 手術主治醫師 曾漢民 手術區域 東址 003房 01號 診斷 Glioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 2 紀錄醫師 古恬音, 時間資訊 00:00 臨時手術NPO 08:45 報到 08:50 進入手術室 09:00 麻醉開始 09:15 誘導結束 10:00 手術開始 10:00 抗生素給藥 13:40 麻醉結束 13:40 手術結束 13:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除-手術時間在4小時以內 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Right occipital crnaiotomy for tumor excision... 開立醫師: 古恬音 開立時間: 2011/01/24 14:00 Pre-operative Diagnosis Right occipital tumor, suspected high grade glioma Post-operative Diagnosis Right occipital tumor, suspected high grade glioma Operative Method Right occipital crnaiotomy for tumor excision under nagivation guidance Specimen Count And Types 1 piece About size:small Source:right occipital tumor Pathology Frozen section: gliosis or low grade glioma Operative Findings There was one irregular-shaped, infiltrative tumor at right occipital lobe. The border between the tumor and the brain was not clear, and gliotic change of surrounding tumor was found. The tumor was elastic firm in consistency and grayish in color. Right lateral ventricle was entered during tumor removal, and part of the choroid plexus was removed. The surrounding brain appeared healthy after tumor removal. Operative Procedures 1. ETGA, prone position with head fixed with Mayfield skull clamp 2. Scalp shaving, scrubbing, and disfinection 3. Draping in usual sterile fashion 4. One reverse U shaped scalp invision at right occipital area 5. 6*8 craniotomy window was done after drilling 4 burr holes 6. Durotomy in U shape with base at lower end after peripheral tenting 7. Localize the tumor with sonography 8. Make a linear corticotomy and confirm tumor location with navigation 9. Remove the tumor with bipolar coagulation, suction, and tumor forceps 10. Hemostasis with Surgicel lining of tumor bed 11. Fix the bone flap back with miniplates 12. Set on subgaleal CWV drain, and close the wound in layers Operators VS曾漢民 Assistants R6陳睿生 R3古恬音 孫維君 (F,1961/08/06,50y7m) 手術日期 2011/01/24 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Acromegaly 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 2 紀錄醫師 柯安達, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:00 進入手術室 08:05 麻醉開始 08:30 誘導結束 08:45 抗生素給藥 08:59 手術開始 11:05 麻醉結束 11:05 手術結束 11:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經由蝶竇之腦下垂體瘤切除 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Transnasal trans-sphenoidal approach for tumo... 開立醫師: 胡朝凱 開立時間: 2011/01/24 11:19 Pre-operative Diagnosis Acromegaly Post-operative Diagnosis Acromegaly Operative Method Transnasal trans-sphenoidal approach for tumor excision Specimen Count And Types Pathology pending Operative Findings There were two tumors with whitish to yellowish in color and solid. The larger one located at right side and the smaller one located at left side. It attached to arachnoid membrane tightly. Unintended durotomy with CSF leak was noted. Operative Procedures After ETGA, the patient was put in supine position with head mild left tilt. The nasal cavity was well-disinfective, and then we incised into the nasal septum. Dissection was performed along with the periosteum to expose sphenoid sinus anterior wall and sphenoid ostia. After fracture of vomer, sphenoid sinus anterior wall was also fractured. The mucosa was removed. The sella floor was exposed and removed with kerrison. After cruciate form incision, tumor buldged out. And it was further removed with tumor forceps and ring currette. After total excision of tumor was made, the bony graft was put back and followed by compaction of merosel. Operators 曾漢民 Assistants 胡朝凱,柯安達 李翠華 (F,1970/11/07,41y4m) 手術日期 2011/01/24 手術主治醫師 曾漢民 手術區域 東址 003房 02號 診斷 Pituitary Tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 古恬音, 時間資訊 00:00 臨時手術NPO 13:55 報到 14:10 進入手術室 14:15 麻醉開始 14:28 誘導結束 14:50 抗生素給藥 15:00 手術開始 16:37 麻醉結束 16:37 手術結束 16:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經由蝶竇之腦下垂體瘤切除 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Endoscopic transsphenoid adenomectomy 開立醫師: 古恬音 開立時間: 2011/01/24 16:59 Pre-operative Diagnosis Pituitary macroadenoma Post-operative Diagnosis Pituitary macroadenoma Operative Method Microscopic transsphenoidal adenomectomy Specimen Count And Types 1 piece About size:small pieces of tumor Source:pituitary tumor Pathology Pending Operative Findings The tumor was yellowish, there was some sticky fluid content. The lower part of the tumor was yellowish and firm, and located posteriorly to the normal gland. The sticky fluid was noted above the solid part. Operative Procedures Under general anethesia and intubation, the patient was put in supine position with head tilted 30 degree to left. The facial skin was antiseptic with alcohol better-iodine tincture, and the mucosa of oral and nasal cavity with aqueous better-iodine . The former areas were covered by sterilized adhesive plastic sheets then draped. Under microscope, the nasal mucosa was detached form the nasal saeptum. A nasal speculum was applied to displace the nasal mucosa laterally and keep the nasal cavity open constantly for the exposure of the vomer bone and the anterior wall of the sphenoid sinus. The anterior sphenoid wall and posterior sphenoid wall was removed. The sellar floor durawas coagulated then opened in cruciate fashion. The soft tumor parenchyma was removed by curette and aligator. The CSF leakage was sealed with Tissuecol Duo nad gelform packing. The arachnoid and the opening of diaphragm sellae was enforcedby packing with gelform as in the sellar cavity. The nasal mucosa returned to its normal position. Right side of the nasal cavities was tightly packed with a segment of rubber glove finger filled with vaseline gauze strips which had been soaked with better-iodine ointment. Operators VS曾漢民 Assistants R6陳睿生 林王雪娥 (F,1946/03/25,65y11m) 手術日期 2011/01/24 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Brain tumors, malignant 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 柯安達, 時間資訊 00:00 臨時手術NPO 11:50 進入手術室 11:53 麻醉開始 12:20 誘導結束 12:50 抗生素給藥 13:00 手術開始 15:50 抗生素給藥 16:25 手術結束 16:25 麻醉結束 16:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 顱骨切除術,包括異物移除或壓或經切斷 1 1 R 手術 頭顱成形術 1 2 R 記錄__ 手術科部: 外科部 套用罐頭: Tumor excision and cranioplasty 開立醫師: 胡朝凱 開立時間: 2011/01/24 17:01 Pre-operative Diagnosis Brain metastasis with skll bone invasion Post-operative Diagnosis Brain metastasis with skll bone invasion Operative Method Tumor excision and cranioplasty Specimen Count And Types TUMOR outside and inside the dura and bone graft Pathology Frozen: metastasis adenocarcinoma Operative Findings 1.One whitish firm tumor located at right parietal area with bony errosion and extension across the SSS without sinus invasion. Operative Procedures 1.ETGA, supine with skull clamp fixation 2.U shape skin incision at right parietal area. 3.Reflect skin flap 4.Craniectomy along with the tumor border 5.Resect tumor outside the dura with coagulation 6.U shape durotomy with the base left at midline 7.Dissect tumor along the interface between tumor and brain parenchyma 8.Detach tumor away from dura 9.Close dura with prolene 10.Cranioplasty with wire mesh 11.Close wound in layers after CWV drain insertion Operators 曾漢民 Assistants 胡朝凱, 柯安達 劉瑞清 (M,1959/03/05,53y0m) 手術日期 2011/01/24 手術主治醫師 蕭輔仁 手術區域 東址 002房 05號 診斷 spinal cord injury 器械術式 Spinal fusion posterior 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林至芃 ASA 3E 紀錄醫師 徐紹剛, 時間資訊 17:06 開始NPO 17:06 通知急診手術 17:55 報到 18:08 進入手術室 18:15 麻醉開始 18:45 誘導結束 19:43 手術開始 19:52 抗生素給藥 20:20 開始輸血 22:50 抗生素給藥 00:00 麻醉結束 00:00 手術結束 00:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 椎弓切除術(減壓)-超過二節 1 2 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 記錄__ 手術科部: 外科部 套用罐頭: T4,5 Lumbar Laminectomy and T2,3,6,7 TPS and ... 開立醫師: 胡朝凱 開立時間: 2011/01/25 00:18 Pre-operative Diagnosis T4,5 fracture dislocation with spinal cord compression Post-operative Diagnosis T4,5 fracture dislocation with spinal cord compression Operative Method T4,5 Lumbar Laminectomy and T2,3,6,7 TPS and Posterior lateral Fusion Specimen Count And Types nil Pathology nil Operative Findings 1.T4 and T5 vertebral body, facet joint and spinous process fractured was noted with instability. 2.The cord was compressed with bony distruction and angulation was noted at T3 to T4 level 3.After laminectomy, the cord expanded waell 4.Screws: T2,3: 40x50, T6,7: 45x50 Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: prone. 3.Midline skin incision from from T2~T8 4.Detach paravertebral muscle 5.T3~6 laminectomy 6.TPS screws insertion 7.Posterior lateral fusion with autologous bone chips 8.Fixed rods with extension bending 9.Fixed cross links 10.Hemostasis 11.Set one CWV drain then close wound in layers Operators VS 蕭輔仁 Assistants R6胡朝凱 R4林哲光 R1徐紹剛 Indication Of Emergent Operation 連金良 (M,1958/08/28,53y6m) 手術日期 2011/01/25 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 頸部退化性脊椎炎(Cervical spondylosis) 器械術式 Laminectomy for decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 07:35 報到 08:00 進入手術室 08:10 麻醉開始 08:48 抗生素給藥 08:50 誘導結束 09:12 手術開始 11:48 抗生素給藥 13:45 麻醉結束 13:45 手術結束 14:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術(減壓)-超過二節 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: C1-2 and T1-2 laminectomy for posterior decom... 開立醫師: 李振豪 開立時間: 2011/01/25 14:15 Pre-operative Diagnosis Ossification of the posterior longitudinal ligament with C1-2, T1-2 stenosis and myelopathy Post-operative Diagnosis Ossification of the posterior longitudinal ligament with C1-2, T1-2 stenosis and myelopathy Operative Method C1-2 and T1-2 laminectomy for posterior decompression Specimen Count And Types nil Pathology Nil Operative Findings The C1-2 thecal sac was tightly compressed by the hypertrophic, calcified ligmentum flavum and PLL, especially from right side and push the thecal sac to left side. Mild CSF leakage was noted after removal of the OPLL and calcified ligmentum flavum. the thecal sac expanded well after decompression. The T1-2 level thecal sac also compressed tightly by hypertrophic ligmentum flavum. After laminectomy and removal of the hypertrophic ligmentum flavum, the thecal sac also expanded well. The SSEP and MEP was very poor, especially lower limbs, before the operation. The SSEP and MEP flattened during C1-2 laminectomy and came back to baseline after laminectomy done. No further EP change till the wound closure. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in prone position with head fixed with Halo-vest and Mayfield scalp clapm system. The scalp was shaved, scrubbed, and disinfected as usual. The midline skin incision was made from C0 to T2 level. The subcutaneous soft tissue was dissected and the paravertebral muscle groups were detached. After exposure of the laminae, laminectomy was performed with Rongeur, Kerrison punches, and Midas diamond drill. The scar tissue that covered the C3 to C7 level thecal sac was not opened. Hemostasis was achieved followed by two CWV placement. The wound was then closed in layers with 2-0 vicryl and 3-0 Nylon. Operators VS曾勝弘 Assistants R4李振豪, R2陳建銘 廖忠慶 (M,1949/05/30,62y9m) 手術日期 2011/01/25 手術主治醫師 曾勝弘 手術區域 西址 030房 02號 診斷 Carpal tunnel syndrome 器械術式 Neurolysis of the uluar neuve 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 11:00 報到 11:15 進入手術室 11:20 麻醉開始 11:25 手術開始 13:30 手術結束 13:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 神經分離術-上臂.前臂.大腿.小腿處之神經 1 1 手術 正中神經或尺神經腕部減壓術–單側 1 2 摘要__ 手術科部: 外科部 套用罐頭: Neurolysis 開立醫師: 古恬音 開立時間: 2011/01/25 13:43 Pre-operative Diagnosis 1. Carpal tunnel syndrome, right 2. Tardy ulnar palsy, right Post-operative Diagnosis 1. Carpal tunnel syndrome, right 2. Tardy ulnar palsy, right Operative Method 1. Median nerve decompression 2. Neurolysis of right ulnar nerve Specimen Count And Types nil Pathology Nil Operative Findings 1. The median nerve was compressed tightly by the hypertrophic flexor retinaculum 2. No obvious compression of the ulnar nerve was noted Operative Procedures 1.The entire right arm was disinfected with povidone-iodine tincture then covered with stockinet. 2.Anesthesia: 1% xylocaine local use at wrist and elbow 3.Incision: 2cm at right, 7 cm, longitudinal in direction, crossed over the medial epicondyle. 4. The flexor retinaculum was divided to decompress median nerve 5. The brachial fascia and medial intermusclular septum were opened longitudinally to exposed the ulnar nerve at supracondylar region, a 5 cm segment of this nerve and its mesoneurium were isolated. The fibrous tissue which entraped the nerve at ulnar groove of medial epicondyle was opened and the nerve was released. The nerve was isolated futher distally to the location 1 inch distal to the medial epicondyle. 6. The wounds was closed by running suture with 3/0 nylon at elbow and 4/0 at wrist 7. The arm was draped with elastic bandage dressing. Operators 曾勝弘 Assistants 陳睿生 古恬音 陳艷莉 (F,1956/10/13,55y5m) 手術日期 2011/01/25 手術主治醫師 張道遠 手術區域 兒醫 061房 03號 診斷 Malignant neoplasm of corpus uteri, except isthmus 器械術式 LSC and right DBJ insertion 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 2 紀錄醫師 柯智群, 時間資訊 13:00 進入手術室 13:05 麻醉開始 13:10 誘導結束 13:15 抗生素給藥 13:36 手術開始 14:05 16:15 抗生素給藥 17:10 手術結束 17:10 麻醉結束 17:15 送出病患 17:20 進入恢復室 18:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 手術 輸尿管膀胱吻合術－單側 1 1 手術 腹腔鏡腸粘連剝離術 1 2 記錄__ 手術科部: 泌尿部 套用罐頭: ureteroneocystostomy 開立醫師: 柯智群 開立時間: 2011/01/25 17:04 Pre-operative Diagnosis Right ureteral stricture with hydronephrosis Post-operative Diagnosis Right ureteral stricture with hydronephrosis Operative Method Right ureteroneocystostomy (Politano-Leadbetter method) Specimen Count And Types nil Pathology nil Operative Findings Right lower ureteral blind-end stricture. We failed to inserted a guidewire and performed URS. Operative Procedures Under the satisfactory endotracheal general anesthesia with the patient in a lithotomy position, prepping and draping were in the usual sterile fashion. Took over GYN surgeons operation. We failed to inserted a guidewire into right ureteral orifice under cystoscopy, and failed to performed URS. A lower abdominal midline incision was performed and the incision was deepened thereafter, dissected into peritoneal space. The paravesical space was explored performed ureterolysis. Bladder was opened on the midline with cautery. The ureter was reimplanted at cephalad and lateral site. The ureter was pulled through retrovesical tunnel into the bladder. Attention was paid to avoid any kinking of the ureter. A submucosal tunnel was created (1:5 ratio of tunnel length to ureter diameter) by dissecting the overlying mucosa from muscle layer with suture scissors. Mucosa was separated and ureter was put in tunnel bed with ureteral orifice located at original site. Two anchor sutures with 4-0 vicryl was made at tip. Ureter stump was spatulated and the anastomosis was completed with 4 interrupted vicryl 4-0 sutures in mucosa-to-mucosa coaptation. The bladder was closed with two-layer of 3-0 vicryl running watertight sutures. The paravesical space was drained with a #7 CW drain. Then, Gyn surgeon took over the operation. Operators 李苑如, Assistants 柯智群, 相關圖片 摘要__ 手術科部: 婦產部 套用罐頭: Laparoscopic adhesiolysis 開立醫師: 鍾繼賢 開立時間: 2011/01/25 17:34 Pre-operative Diagnosis Right ureteral stricture Post-operative Diagnosis Right ureteral stricture Operative Method Laparoscopic adhesiolysis Specimen Count And Types nil Pathology Pending Operative Findings 1. Uterus: absent 2. RAD: absent 3. LAD: absent 4. Cul-de-sac: Mild adhesion noted 5. Retroperitoneal adhesion (+) 6. Right ureteral remarkable stricture. 5. Estimated blood loss: 30 ml Blood transfusion: nil Complication: nil Operative Procedures 1. Put the patient on the lithotomy position. 2. Vaginal douching with beta-iodine. 3. Skin disinfection with beta-iodine and skin drapping as usual, then insert the Foley catheter. 4. The pneumoperitoneum is induced after inserting a sharp Veress needle through the subumbilical incision wound. 5. Insert a 10 mm trocar into the peritoneal cavity via the subumbilical incision wound. 6. 2nd (5mm) and 3rd (5mm) punctures were made under laparoscopic inspection. 7. Adhesiolysis to free the stricture of right ureter. 8. Irrigate the pelvic space with normal saline. 9. Check bleeding and hemostasis. 10. Remove trocars and repair abdominal incision wounds. Operators 張道遠, Assistants 鍾繼賢, 相關圖片 葉雲淇 (F,1998/06/16,13y8m) 手術日期 2011/01/25 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Moyamoya disease 器械術式 Moyamoya P-DUH 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 2 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 07:55 報到 08:00 進入手術室 08:10 麻醉開始 08:38 誘導結束 09:20 抗生素給藥 09:35 手術開始 12:20 抗生素給藥 13:25 麻醉結束 13:25 手術結束 13:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱內外血管吻合術 1 1 L 手術 朴卜勒氏血流測定（週邊血管） 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: EDAS at right. 開立醫師: 鍾文桂 開立時間: 2011/01/25 13:46 Pre-operative Diagnosis Moyamoya disease, bilateral, more severe at left. Post-operative Diagnosis Moyamoya disease, bilateral, more severe at left. Operative Method EDAS at right. EDAS at left. Specimen Count And Types nil Pathology Nil. Operative Findings Contact between STA and MCA branches are tension-free. 1. multiple meningeal collateral circulation was found. The two layers of dura were filled with small collaterals. 2. Contact between STA and MCA branches are tension-free. Operative Procedures With endotracheal general aenasethesia, the patient was put in supine position with head rotated to left. After scalp shaved, scrubbed, disinfected, and then draped, we localize the STA position and territory by Doppler. Under microscopic view, we made one curvilinear skin incision and dissected above the galeal to expose posterior branch of right STA. We made the inicion along 1cm away from STA at bilateral side, and created craniotomy 2x6cm, beneath STA. Linear durotomy was done, and arachnoid membrane was separated by forceps. STA graft was anchored at bilateral ends of durotomy, and the dura was closed in water-tight suture and Durofoam. Bone graft was fixed back with 4 wires, and the wound was closed in layers. With endotracheal general aenasethesia, the patient was put in supine position with head rotated to left. After scalp shaved, scrubbed, disinfected, and then draped, we localize the STA position and territory by Doppler. Under microscopic view, we made one curvilinear skin incision and dissected above the galeal to expose posterior branch of right STA. We made the inicion along 1cm away from STA at bilateral side, and created craniotomy 2x6cm, beneath STA. Linear durotomy was done, and arachnoid membrane was separated by forceps. STA graft was anchored at bilateral ends of durotomy, and the dura was closed in water-tight suture and Durofoam. Bone graft was fixed back with 2 wires, and the wound was closed in layers. With endotracheal general aenasethesia, the patient was put in supine position with head rotated to right. After scalp shaved, scrubbed, disinfected, and then draped, we localize the STA position and territory by Doppler. Under microscopic view, we made one curvilinear skin incision and dissected above the galeal to expose posterior branch of right STA. We made the inicion along 1cm away from STA at bilateral side, and created craniotomy 2x6cm, beneath STA. Linear durotomy was done, and arachnoid membrane was separated by forceps. STA graft was anchored at bilateral ends of durotomy, and the dura was closed in water-tight suture and Durofoam. Bone graft was fixed back with 2 wires, and the wound was closed in layers. With endotracheal general aenasethesia, the patient was put in supine position with head rotated to right. After scalp shaved, scrubbed, disinfected, and then draped, we localize the STA position and territory by Doppler. Under microscopic view, we made one curvilinear skin incision and dissected above the galeal to expose posterior branch of right STA. We made the inicion along 1cm away from STA at bilateral side, and created craniotomy 2x6cm, beneath STA, after linear incision of the left temporalis muscle. After dural tenting, linear durotomy was done, and arachnoid membrane was separated by forceps. STA graft was anchored at bilateral ends of durotomy, we placed gelfoam to push the graft anteriorly for better sontact between the graft and the MCA and the dura was closed in water-tight suture and Durofoam. Bone graft was fixed back with 2 wires, and the wound was closed in layers. Operators VS 郭夢菲 Assistants R5 鍾文桂 周志容 (M,1965/08/14,46y7m) 手術日期 2011/01/25 手術主治醫師 賴達明 手術區域 東址 002房 01號 診斷 顱內出血(ICH) 器械術式 Craniotomy (A.V.M.) P-LIN 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 胡朝凱, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 07:30 通知急診手術 08:33 進入手術室 08:40 麻醉開始 08:50 誘導結束 09:20 手術開始 09:50 抗生素給藥 13:00 抗生素給藥 16:00 抗生素給藥 19:00 抗生素給藥 20:50 手術結束 20:50 麻醉結束 21:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 16 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 開顱術摘除血管病變 - 動靜脈畸型中型表淺 1 1 R 手術 開顱術摘除血管病變 - 腦血管瘤 有病徵的 1 2 R 記錄__ 手術科部: 外科部 套用罐頭: Right craniotomy for AVM excision and ANeurys... 開立醫師: 胡朝凱 開立時間: 2011/01/25 21:33 Pre-operative Diagnosis Right ACA pericallosal aneurysm with ruptured and Right frontal AVM Post-operative Diagnosis Right ACA pericallosal aneurysm with ruptured and Right frontal AVM Operative Method Right craniotomy for AVM excision and ANeurysmal clipping Specimen Count And Types about 3 cm AVM Pathology Pending Operative Findings 1.One about 1 cm saccular aneurysm was noted at right ACA pericallosal branch protruded upward. A thin layer of daughter aneurysm was also noted. A tilted straight Sugita aneurysmal clip was applied to clip the neck. The proximal control took 4.5 minutes. 2.The AVM located at right frontal lobe with 3 feeders came from ACA. The drainage vein was one large cortical vein. It was measured about 3 cm with clear margin and about 0.5 cm in depth from cortex. Operative Procedures 1.ETGA, supine with head fixed with Mayfield skull clamp 2.Bicoronal skin incision 3.Refelct skin flap and periosteum 4.Craniotomy was done one cm across the midline, and 5 cm anteriorly and 3 cm posteriorly to coronal suture respectedly. 5.Dural incision was done with base left at midline 6.Frontal falx was cut opened 7.Retracted frontal lobe laterally 8.Identified bilateral ACAs and trace posteriorly to identified aneurysm 9.Expose the neck and appleied aneurysmal clip with proximal control 10.Superior frontal gyrus corticotomy 11.Identified feeders then clipped with aneurysmal clip 12.dissect AVM border with coagulation 13.Devided the feeders 14.Resected AVM after devided the drainage vein 15.Hemostasis 16.Close dura with durofoam 17.Fixed bone back and close wound in layers after one CWV drain insertion Operators 賴達明 Assistants 胡朝凱 Indication Of Emergent Operation 黃坤華 (M,1957/01/26,55y1m) 手術日期 2011/01/25 手術主治醫師 賴達明 手術區域 東址 003房 號 診斷 Lumbar spondylosis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 邱裕淳, 時間資訊 00:00 臨時手術NPO 07:35 報到 08:00 進入手術室 08:10 麻醉開始 08:20 誘導結束 08:40 抗生素給藥 09:26 手術開始 11:50 抗生素給藥 12:25 手術結束 12:25 麻醉結束 12:26 送出病患 12:30 進入恢復室 13:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 脊椎融合術-前融合,有固定物)≦四節 1 2 手術 椎間盤切除術-腰椎 1 4 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 曾峰毅 開立時間: 2011/01/25 12:14 Pre-operative Diagnosis Spondylolishesis, L4/5, grade II Post-operative Diagnosis Spondylolishesis, L4/5, grade II Operative Method Transforaminal lumbar interbody fusion of L4/5 with PEEK cage and autologous bone graft; posterior fixation with transpedicular screws at L4 and L5. Specimen Count And Types Nil Pathology Nil Operative Findings Sytheses 6.2x45 mm transpedicular screws were inserted into bilateral pedicles of L4 and L5. 5 cm rod was used for psoterior fixation. Hypertrophic ligamentum flavum compressed the thecal sac and right L4/5 foramen tightly. Neural structure was decompressed well after the surgery. Operative Procedures With endotracheal general anaesthesia the patient was put in prone position. After back scrubbed, disinfected, and then draped, we made one midline skin incision from L4 spinous process to L5 spinous process. We dissected paraspinal muscle, and inserted transpedicular screws into bilateral pedicles of L4 and L5. Laminectomy of L4 was performed, followed by right L4/5 facetectomy. L4/5 diskectomy was done, and then fusion with PEEK cage and autologous bone graft. Posterior fixation was achieved after rods set. and left posterolateral fusion at L4/5 was also performed with autologous bone graft. After one hemovac inserted, the wound was closed in layers. Operators VS 賴達明 Assistants R4 曾峰毅 R1 邱裕淳 許致軒 (M,1978/03/07,34y0m) 手術日期 2011/01/25 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Hydrocephalus 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 邱裕淳, 時間資訊 00:00 臨時手術NPO 12:00 報到 12:47 進入手術室 12:55 麻醉開始 13:05 誘導結束 13:30 抗生素給藥 13:50 手術開始 15:25 手術結束 15:25 麻醉結束 15:40 送出病患 15:45 進入恢復室 17:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 腦室腹腔分流手術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 曾峰毅 開立時間: 2011/01/25 15:27 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunt via right Kocher point Specimen Count And Types Nil Pathology Nil Operative Findings Codman, fixed-pressure, 100 mmHg, shunt was inserted via right Kocher point, with anti-siphon device. Clear, colorless, CSF gushed out while ventriculostomy. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position. After scalp shaved, scrubbed, disinfected, and then draped, we made one transverse skin incision at right frontal area. We drilled one burr hole, and inserted ventricular catheter. We made one transverse skin incision at right upper abdomen, and dissected into peritoneal cavity. We inserted peritoneal catheter. We created subcutaneous tunnels, and connected shunt system together. We made antoher incision at right clavicular area, and cut the shunt catheter. We connected the anti-siphon device. We checked the shunt function and closed the wound in layers. Operators VS 賴達明 Assistants R4 曾峰毅 R1 邱裕淳 劉湘玲 (F,1991/02/20,21y0m) 手術日期 2011/01/25 手術主治醫師 賴達明 手術區域 東址 005房 02號 診斷 Unspecified intracranial hemorrhage 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 23:20 臨時手術NPO 14:25 報到 14:33 進入手術室 14:40 麻醉開始 14:42 抗生素給藥 14:42 誘導結束 15:33 手術開始 17:20 手術結束 17:20 麻醉結束 17:32 送出病患 17:40 進入恢復室 18:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 外科部 套用罐頭: Ventriculo-peritoneal shunt via left Frazier"... 開立醫師: 李振豪 開立時間: 2011/01/25 17:26 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculo-peritoneal shunt via left Frazier"s point Specimen Count And Types 1 piece About size:10ml Source:CSF for routine, BCS, and bacterial culture Pathology Nil Operative Findings The opening pressure is about 15cmH2O. The CSF is clear in character without increase viscosity. The Codman fixed pressure valve reservoir(10cmH2O) was placed. The Ventricular catheter was 10cm in length. The peritoneal catheter was 30cm in length. Operative Procedures Under tracheostomy tube general anesthesia, the patient was put in supine position with head rotated to right. The scalp was shaved, scrubbed, and disinfected as usual. 3cm linear scalp incision was made at left Frazier"s point followed by one burr hole creation. Two dural tenting was done. One 3cm transverse skin incision was made at left upper abdomen and the subcutaneous soft tissue was dissected. The rectus abdominis muscle was splitted and minilaparotomy was done. The trocar was introduced into peritoneal cavity under direct vision. The subcutaneous tunnel from left upper abdomen, midline of forechest, left neck, to left retroauricular area was created. The peritoneal catheter was passed throught the tunnel. The ventricular catheter was connected with the reservoir. One 1cm scalp incision was made at left retroauricular area and reservoir was passed through subgaleal space and connected to the peritoneal catheter. Cruciform durotomy was done and ventricular puncture was performed with ventricular needle. After CSF sampling, the ventricular catheter was placed into the left lateral ventricle. The function of the shunt was checked. The peritoneal catheter was placed into the peritoneal cavity. Hemostasis was achieved with bipolar electrocautery and Gelform packing. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS賴達明 Assistants R4李振豪, R2陳建銘 相關圖片 鍾金佑 (M,1951/08/08,60y7m) 手術日期 2011/01/25 手術主治醫師 賴達明 手術區域 東址 003房 03號 診斷 Cerebrovascular accident (CVA) 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 邱裕淳, 時間資訊 00:00 臨時手術NPO 16:00 進入手術室 16:10 麻醉開始 16:15 誘導結束 16:40 抗生素給藥 16:47 手術開始 17:50 手術結束 17:50 麻醉結束 17:55 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室腹腔分流手術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 曾峰毅 開立時間: 2011/01/25 17:52 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunt vis left Kocher point Specimen Count And Types Nil Pathology Nil Operative Findings Codman, fixed pressure, 100 mmHg, was inserted via left Kocher point. Colorless, clera CSF gushed out while ventriculostomy. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position. After scalp shaved, scrubbed, disinfected, and then draped, we made one transverse skin incision at right frontal area. We drilled one burr hole, and inserted ventricular catheter. We made one transverse skin incision at right upper abdomen, and dissected into peritoneal cavity. We inserted peritoneal catheter. We created subcutaneous tunnels, and connected shunt system together. We checked the shunt function and closed the wound in layers. With endotracheal general anaesthesia, the patient was put in supine position. After scalp shaved, scrubbed, disinfected, and then draped, we made one transverse skin incision at left frontal area. We drilled one burr hole, and inserted ventricular catheter. We made one transverse skin incision at right upper abdomen, and dissected into peritoneal cavity. We inserted peritoneal catheter. We created subcutaneous tunnels, and connected shunt system together. We checked the shunt function and closed the wound in layers. Operators VS 賴達明 Assistants R4 曾峰毅 R1 邱裕淳 李建國 (M,1950/02/01,62y1m) 手術日期 2011/01/25 手術主治醫師 郭順文 手術區域 東址 019房 01號 診斷 Intracerebral hemorrhage 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 廖先啟, 時間資訊 23:38 臨時手術NPO 08:16 報到 08:16 進入手術室 08:20 麻醉開始 08:25 誘導結束 08:39 手術開始 08:45 麻醉結束 08:45 手術結束 08:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 氣管切開術 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 廖先啟 開立時間: 2011/01/25 08:49 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types Nil Pathology None Operative Findings Fr.8 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators VS郭順文 Assistants R3廖先啟，R3郝政鴻 吳彥徵 (F,1983/12/15,28y2m) 手術日期 2011/01/25 手術主治醫師 蔡翊新 手術區域 東址 001房 01號 診斷 Brain abscess 器械術式 Ommaya implantation 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2E 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 08:46 通知急診手術 09:37 進入手術室 09:40 麻醉開始 09:45 誘導結束 10:33 手術開始 11:22 麻醉結束 11:22 手術結束 11:30 送出病患 11:35 進入恢復室 12:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 歐氏貯囊置放手術 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Ommaya inserted at left frontal horn via left... 開立醫師: 林哲光 開立時間: 2011/01/25 11:48 Pre-operative Diagnosis Brain abscess status post craniotomy with drainage, complicated with isolated hydrocephalus, left lateral ventricle Post-operative Diagnosis Ditto Operative Method Ommaya inserted at left frontal horn via left Kocher point Specimen Count And Types Pathology Nil Operative Findings CSF seemed clear and transparent. Opening pressure was around 10cmH2O. Culture (Fungus, Bacterial, TB), routine and BCS were sent. Operative Procedures Under ETGA and supine position with head mild rotated to right side, skin disinfected and drapped were performed as usual. Skin incision was made along the previous operative wound and the left Kocher point was exposed. A burr hole was created and the dura was opened after dural tenting. Ommaya was then inserted by ventricular puncture. The Ommaya was then fixed on the skull and the wound was then closed in layers. Operators VS 蔡翊新 Assistants R4 林哲光 Indication Of Emergent Operation 相關圖片 鄭國龍 (M,1964/10/11,47y5m) 手術日期 2011/01/25 手術主治醫師 胡瑞恒 手術區域 東址 026房 05號 診斷 Subarachnoid hemorrhage (SAH) 器械術式 Hepatectomy for cadaveric-Donor 手術類別 緊急手術 手術部位 腹 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 5E 紀錄醫師 蕭博懷, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 15:59 通知急診手術 18:00 進入手術室 18:05 麻醉開始 18:20 誘導結束 18:25 手術開始 19:46 麻醉結束 22:45 手術結束 23:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 屍體捐肝取 1 1 手術 屍體捐腎切除術 1 1 手術 心臟摘取 1 3 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 眼球剜出術 1 1 記錄__ 手術科部: 外科部 套用罐頭: 肝右葉 開立醫師: 蕭博懷 開立時間: 2011/01/25 22:01 Pre-operative Diagnosis SAH, brain death for organ donation Post-operative Diagnosis SAH, brain death for organ donation Operative Method Removal of heart, liver, kidney Specimen Count And Types nil Pathology nil Operative Findings 1.good organ for donation Operative Procedures 1.under general anesthesia 2.skin incision and laparotomy and thoracotomy 2.dissection of all organ views 3.removal of all oragn under organ protect perfusion , post heart arrest 4.close the sterun bone by wires 5.closed the wound layer by layer Operators 胡瑞恒 何明志 何承懋 王水深 黃書健 Assistants CVS CR 徐剛宏 R3陳政偉 Trauma fellow 蕭博懷 nurse 劉純伶 許瑞萍 管俐貞 林巧玲 Indication Of Emergent Operation 記錄__ 手術科部: 外科部 套用罐頭: Removal of heart, liver, kidney 開立醫師: 吳郁芊 開立時間: 2011/01/25 23:10 Pre-operative Diagnosis SAH, brain death for organ donation Post-operative Diagnosis SAH, brain death for organ donation Operative Method Removal of heart, liver, kidney Removal of heart, liver, kidney, and cornea Specimen Count And Types nil Pathology nil Operative Findings 1.good organ for donation Operative Procedures 1.under general anesthesia 2.skin incision and laparotomy and thoracotomy 3.dissection of all organ views 4.removal of all oragn under organ protect perfusion , post heart arrest 5.close the sterun bone by wires 6.closed the wound layer by layer 7.skin and lash infection 8.apply lid speculum 9.360 degree peritomy and dissect tenon tissue 10.identify and suture 4 rectus muscle 11.cut rectus muscle and optic nerve 12.remove eyeball 13.repeat 8-11 on the other eye 14.fill orbital cavity with gauze and close lid with 6-0 nylon on ou Operators 胡瑞恒 何明志 何承懋 王水深 黃書健 侯育致 Assistants CVS CR 徐剛宏 R3陳政偉 Trauma fellow 蕭博懷 oph R4 吳郁芊 R1 許雅睿 nurse 劉純伶 許瑞萍 管俐貞 林巧玲 Indication Of Emergent Operation 陳憬蓉 (F,1989/11/23,22y3m) 手術日期 2011/01/26 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Arteriovenous malformation, brain 器械術式 Craniotomy (A.V.M.) P-DUH 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 古恬音, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:06 進入手術室 08:15 麻醉開始 08:20 誘導結束 09:00 抗生素給藥 09:35 手術開始 11:35 12:00 抗生素給藥 15:00 抗生素給藥 18:00 抗生素給藥 18:45 麻醉結束 18:45 手術結束 19:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 開顱術摘除血管病變- 動靜脈畸型中型深部 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 13 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: 1. Suboccipital craniotomy for AVM excision 開立醫師: 古恬音 開立時間: 2011/01/26 19:24 Pre-operative Diagnosis Left cerebellar AVM, Spetzler-Martin grade II, with previous hemorrhage, status post suboccipital craniectomy, status post TAE Post-operative Diagnosis Left cerebellar AVM, Spetzler-Martin grade II, with previous hemorrhage, status post suboccipital craniectomy, status post TAE Operative Method 1. Suboccipital craniotomy for AVM excision 2. Right Frazier point EVD insertion Specimen Count And Types about 5mm. Source: cerebellar AVM Pathology Pending Operative Findings There was much subgalea fluid collection around previous operation field, and skull defect was noted. Some abnormal vessels were noted at the surface of left cerebellar hemisphere, and the diameter was about 5cm. Two main superficial feeders were identified and coagulated. After careful peripheral dissection, some feeders were also noted beneath the arteriovenous malformation, probably branches of the SCA. The venous drainage was mainly superficial. Embolizing material was noted within the lumen of superficial feeders and the nidus. There was much subgalea fluid collection around previous operation field, and skull defect was noted. Some abnormal vessels were noted at the surface of left cerebellar hemisphere, and the diameter of the midus was about 5cm. Two main superficial feeders were identified and occluded with Onyx. Both of them were electroligated. After careful peripheral dissection, some deep feeders were also noted beneath the arteriovenous malformation, probably branches of the SCA. The venous drainage was mainly superficial. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position with head fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected with better iodin, then draping was done in usual sterile fashion. One vertical scalp incision was made at right Frazier point, and EVD catheter was inserted. Then another midline linear incision was made at occpital area along previous operation scar. The soft tissue was dissected until the surface of cerebellum was exposed. Some abnormal vessels were noted at the brain surface. The feeders were identified, coagulated, and cut one by one. Careful peripheral dissection was done, and some small feeders were also noted. The whole arteriovenous malformation was removed after all feeders were coagulated and cut. After meticulous hemostasis, the raw surface was covered with Surgicel. Duraform was used to cover the dural defect. After setting on epidural CWV drain, the wound was closed in layers. Operators 杜永光 Assistants 陳睿生, 古恬音 張萬來 (M,1936/05/12,75y10m) 手術日期 2011/01/26 手術主治醫師 曾漢民 手術區域 東址 002房 04號 診斷 Prostate cancer 器械術式 Burr hole (trephination) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 曾峰毅, 時間資訊 12:00 臨時手術NPO 12:00 開始NPO 13:03 通知急診手術 14:12 報到 14:32 進入手術室 14:40 麻醉開始 14:47 誘導結束 14:48 抗生素給藥 15:16 手術開始 15:50 手術結束 15:50 麻醉結束 16:08 進入恢復室 17:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 慢性硬腦膜下血腫清除術 1 1 R 摘要__ 手術科部: 腫瘤醫學部 套用罐頭: Right frontal burr hole for subdural drainage 開立醫師: 曾峰毅 開立時間: 2011/01/26 16:21 Pre-operative Diagnosis Subdural effusion, right Post-operative Diagnosis Subdural effusion, right Operative Method Right frontal burr hole for subdural drainage Specimen Count And Types Biopsy of dura and burr hole edge was sent for pathology. Subdural effusion was sent for CSF routine, BCS, culture, and cytology. Pathology Pending Operative Findings Midly turbid, xanthocrhomic, subdural effusion gushed out while durotomy. There was outer and inner membrane. Hypertrophic dura and frigle skull bone was found. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position. After scalp shaved, scrubbed, disinfected, and then draped, we made one transverse skin incision at right frontal area. We drilled one burr hole, and created durotomy. Dura was sampled for pathology. We opened the outer membrane, and inserted subdural drain. The wound was closed in layers, and then subdural de-air was done. Operators VS 曾漢民 Assistants R4 曾峰毅 Indication Of Emergent Operation 林英惠 (F,1978/10/31,33y4m) 手術日期 2011/01/26 手術主治醫師 曾漢民 手術區域 東址 005房 06號 診斷 Pituitary gland disorder unspecified 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 柯安達, 時間資訊 00:00 臨時手術NPO 15:52 進入手術室 15:55 麻醉開始 16:20 誘導結束 16:20 抗生素給藥 16:40 手術開始 17:40 手術結束 17:40 麻醉結束 17:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經由蝶竇之腦下垂體瘤切除 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Transnasal trans-sphenoidal approach for tumo... 開立醫師: 胡朝凱 開立時間: 2011/01/26 17:51 Pre-operative Diagnosis Acromegaly, pituitary tumor Post-operative Diagnosis Acromegaly, pituitary tumor Operative Method Transnasal trans-sphenoidal approach for tumor excision Specimen Count And Types Pieces of tumor Pathology pending Operative Findings The tumor was yellowish, solid one. It has clear border with arachnoid membrane. Unintended CSF leak was noted during operation. Mild adhesion during opening sella floor was noted. Operative Procedures After ETGA, the patient was put in supine position with head mild left tilt. The nasal cavity was well-disinfective, and then we incised into the nasal septum. Dissection was performed along with the periosteum to expose sphenoid sinus anterior wall and sphenoid ostia. After fracture of vomer, sphenoid sinus anterior wall was also fractured. The mucosa was removed. The sella floor was exposed and removed with kerrison. After cruciate form incision, tumor buldged out. The tumor was dissected along the interface. And it was further removed with tumor forceps and ring currette. After total excision of tumor was made, the bony graft was put back and followed by compaction of merosel. Operators 曾漢民 Assistants 胡朝凱 柯安達 吳順吉 (M,2009/11/02,2y4m) 手術日期 2011/01/26 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Tetralogy of Fallot 器械術式 Removal of epidural hematoma 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 4 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 08:45 進入手術室 08:50 麻醉開始 09:20 誘導結束 09:45 手術開始 10:55 手術結束 10:55 麻醉結束 11:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 2 B 手術 慢性硬腦膜下血腫清除術 1 1 B 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 套用罐頭: Burr holes for evacuation of subdural effusion. 開立醫師: 鍾文桂 開立時間: 2011/01/26 11:14 Pre-operative Diagnosis Subdural fluid collection, bilateral frontal-temporal-parietal. Chronic subdural hematoma, bilateral frontal-temporal-parietal. Post-operative Diagnosis Subdural effusion, bilateral frontal-temporal-parietal. Subdural effusion(mild hematoma), bilateral frontal-temporal-parietal., bilateral frontal-temporal-parietal. Operative Method Burr holes for evacuation of subdural effusion. Specimen Count And Types 1 piece About size:6 cc Source:subdural effusion. Pathology Nil. Operative Findings 1. Clear yellowish subdural effusion was noted after durotomy. High pressure. 1. Clear yellowish subdural effusion was noted after durotomy. High pressure. Medtronic EVD catheter as subdural drain were placed. ( 3cm in depth) 1. Clear yellowish subdural effusion with blood tinged was noted after durotomy. High intracranial pressure. Medtronic EVD catheter as subdural drain were placed. ( 3cm in depth) 2. Low intracranial pressure, poor brain expansion. 2. poor brain expansion after durotomy and drainage of subdural collection. 3. Easy oozing operative field. 3. Easy oozing operative field at subcutaneous level. Operative Procedures Under ETFA, the patient was placed in supine position and the head was in midline position. After shaving, disinfection, and draping, two linear scalp incisions were made at bilateral parietal areas. After creating a burr hole and durotomy at each side, we placed subdural drains at subdural space and collected them to closed drainage system. Finally, the wounds were closed in layers. After shaving, disinfection, and draping, two linear scalp incisions were made at bilateral parietal bone about 1 cm behind the posterior margin of anterior fontanel. After creating a burr hole and durotomy at each side, we placed subdural drains at subdural space and connected them to closed drainage system. Finally, the wounds were closed in layers after the burr holes were covered with a piece of gelfoam. Operators V.S.郭夢菲 Assistants R5 鍾文桂 Ri林均鴻 王麗娟 (F,1968/12/07,43y3m) 手術日期 2011/01/27 手術主治醫師 賴達明 手術區域 東址 019房 04號 診斷 Acute myeloid leukemia 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林子富 ASA 5E 紀錄醫師 李振豪, 時間資訊 23:04 通知急診手術 23:55 進入手術室 23:55 報到 23:56 麻醉開始 00:05 誘導結束 00:30 開始輸血 00:50 手術開始 03:55 麻醉結束 03:55 手術結束 04:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 1 L 手術 顱內壓視置入 1 2 L 手術 腦室體外引流 1 4 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 內科部 套用罐頭: Left frontal craniotomy for intracerebral hem... 開立醫師: 李振豪 開立時間: 2011/01/27 03:44 Pre-operative Diagnosis Left frontal intracerebral hemorrhage Post-operative Diagnosis Left frontal intracerebral hemorrhage Operative Method Left frontal craniotomy for intracerebral hematoma evacuation Specimen Count And Types nil Pathology Nil Operative Findings Malposition of the endotracheal tube was noted before the operation and re-intubation was performed by the anesthesiologist. The left frontal hematoma was about 50~60ml in volume. The left lateral ventricle was entered after removal of the hematoma. The brain became slack after removal of the hematoma. Bleeding tendancy(+). The ICP after wound closure: ICP reference: 490. Malposition of the endotracheal tube was noted before the operation and re-intubation was performed by the anesthesiologist. The left frontal hematoma was about 50~60ml in volume. The left lateral ventricle was entered after removal of the hematoma. The brain became slack after removal of the hematoma. Bleeding tendancy(+). The ICP after wound closure:-2mmHg. ICP reference: 490. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine position. The scalp was shaved, scrubbed, and disinfected as usual. The bicoronal scalp incision was made. The Scalp flap was elevated and the periosteum was preserved for duroplasty. Four burr hole was created followed by one 8x6cm craniotomy window. C-shape dura oepning was performed based with superior sagittal sinus. One 1.5cm corticotomy was performed for hematoma evacuation. After hematoma evacuation, hemostasis was achieved with bipolar electrocautery and Surgicel lining. The EVD was placed into left lateral ventricle under direct vision. One subdural ICP monitor was also placed. The dura was closed with duroplasty. The skull plate was replaced with miniplates. One CWV drain was left in subgaleal space. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS賴達明 Assistants R4李振豪, R3王奐之, R2覃紹英 Indication Of Emergent Operation 相關圖片 王怡霖 (F,1980/09/18,31y5m) 手術日期 2011/01/27 手術主治醫師 曾漢民 手術區域 東址 003房 03號 診斷 Herniation intervertebral disc without myelopathy, thoracic (HIVD) 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 2 紀錄醫師 曾峰毅, 時間資訊 00:00 臨時手術NPO 12:15 報到 12:40 進入手術室 12:45 麻醉開始 13:00 誘導結束 13:10 抗生素給藥 13:38 手術開始 16:05 手術結束 16:05 麻醉結束 16:10 送出病患 16:13 進入恢復室 17:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-頸椎 1 1 手術 椎融合術-前融合,無固定物(≦四節) 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Anterior approach for discectomy and cage fusion 開立醫師: 胡朝凱 開立時間: 2011/01/27 15:59 Pre-operative Diagnosis C5~6 HIVD and OPLL Post-operative Diagnosis C5~6 HIVD and OPLL Operative Method Anterior approach for discectomy and cage fusion Specimen Count And Types nil Pathology nil Operative Findings 1.A dehydrated disc at C5~6 level was noted and posterior extrusion that compressed the cord tightly. 2.PLL ruptured was noted 3.OPLL was also noted Operative Procedures 1.ETGA, supine 2.Right neck transverse skin incision 3.Devided platysma muscle 4.Dissection was made along the anterior border of SCM muscle 5.expose prevertebral space 6.Detach longus coli muscle 7.Discectomy with currete and kerrison 8.Further resection of PLL 9.5# cage insertion 10.Hemostasis 11.Close wound in layers after one minihemovac drain insertion Operators 曾漢民 Assistants 胡朝凱, 曾峰毅 林錦榮 (M,1940/08/15,71y6m) 手術日期 2011/01/27 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Intracerebral hemorrhage (ICH) 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 3 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:06 進入手術室 08:15 麻醉開始 08:20 誘導結束 08:35 抗生素給藥 09:06 手術開始 10:00 手術結束 10:00 麻醉結束 10:10 送出病患 10:15 進入恢復室 11:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦室腹腔分流手術 1 1 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 曾峰毅 開立時間: 2011/01/27 09:57 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunt, via right Kocher point Specimen Count And Types CSF was sent for culture and routine Pathology Nil Operative Findings Clear, colorless, CSF gushed out while ventriculostomy. Codman programmable shunt was used, and was set at 120 mmHg. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position. After scalp shaved, scrubbed, disinfected, and then draped, we made one transverse skin incision at right frontal area. We drilled one burr hole, and inserted ventricular catheter. We made one transverse skin incision at right upper abdomen, and dissected into peritoneal cavity. We inserted peritoneal catheter. We created subcutaneous tunnels, and connected shunt system together. We checked the shunt function and closed the wound in layers. Operators VS 王國川 Assistants R4 曾峰毅 R3 王奐之 相關圖片 高銘欣 (M,1933/12/10,78y3m) 手術日期 2011/01/27 手術主治醫師 王國川 手術區域 東址 005房 01號 診斷 冠狀動脈疾病 CAD, coronary artery disease 器械術式 Anterior Spinal fusion(TZENG) 手術類別 臨時手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 4E 紀錄醫師 李振豪, 時間資訊 09:00 進入手術室 09:00 報到 09:05 麻醉開始 09:10 誘導結束 09:11 抗生素給藥 09:51 手術開始 10:25 開始輸血 14:10 麻醉結束 14:10 手術結束 14:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-頸椎 1 1 R 手術 脊椎融合術-前融合,有固定物)≦四節 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: C4-5, C5-6, C6-7 anterior cervical diskectomy... 開立醫師: 李振豪 開立時間: 2011/01/27 14:35 Pre-operative Diagnosis Cervical spondylosis and OPLL with canal stenosis and myelopathy Post-operative Diagnosis Cervical spondylosis and OPLL with canal stenosis and myelopathy Operative Method C4-5, C5-6, C6-7 anterior cervical diskectomy and fusion with cage and fixation with plate Specimen Count And Types nil Pathology Nil Operative Findings 1. C5-C6 transdiscal fracture was noted after exposure of the c-spine. The marginal spur formation with degenerative change was remarkable. The disc space narrowing and covered by anterior marginal spur. The C5 and C6 body was decrease in height. The thecal sac was compressed by OPLL, marginal spur at C4 to C7 level. The ruptured disc at C4-5 level was removed during the operation. The thecal sac expanded after decompression. 2. Instrumentation and cage C4/5: #7 PEEK cage C5/6: #8 PEEK cage C6/7: #7 PEEk cage Plate: 70mm Screws: 3.4 x 14mm x IV ; 3.4 x 16mm x II Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine position. The skin was scrubbed, disinfected and draped as usual. The curvilinear skin incision was made at right neck along the skin crest. The subcutaneous soft tissue and platysma muscle was transected. The prevertebral space was approached via the plane between thyroid gland and carotid sheath. The preverbetral fascia was opened and the longus colli muscle was detached to expose the C-spine. The location of C5-6 disc space was identified with portable C-arm X-ray. Anterior cervical diskectomy and fusion with cage was performed at C4/5, C5/6, and C6/7 level. The plate and screws also applied for anterior fixation. Hemostasis was achieved and one CWV drain was placed. The wound was then closed in layers with 3-0 Vicryl and 4-0 Dexon. Operators VS王國川 Assistants R4李振豪, R2陳建銘 相關圖片 陳國棟 (M,1950/11/29,61y3m) 手術日期 2011/01/27 手術主治醫師 蔡翊新 手術區域 東址 001房 03號 診斷 Malignant tumor, spine 器械術式 OPLL-Anterior Corpectomy VSLai 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 3E 紀錄醫師 柯安達, 時間資訊 07:00 臨時手術NPO 07:00 開始NPO 12:47 通知急診手術 16:23 進入手術室 16:35 麻醉開始 17:10 抗生素給藥 17:10 誘導結束 17:35 手術開始 18:30 開始輸血 20:10 抗生素給藥 21:36 手術結束 21:36 麻醉結束 21:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 惡性脊髓腫瘤切除術 1 1 R 手術 脊椎融合術-前融合,有固定物)≦四節 1 2 R 摘要__ 手術科部: 外科部 套用罐頭: Anterior Discectomy and Fusion, Cervical Spine 開立醫師: 曾峰毅 開立時間: 2011/01/27 21:57 Pre-operative Diagnosis Spinal metastasis, T5 Post-operative Diagnosis Spinal metastasis, T5 Operative Method T5 corpectomy, anterior fusion with body cage and autologou bone graft, anterior fixation with plate and screws Specimen Count And Types Several fragments of tumor was sent for pathology. Pathology Pending Operative Findings Moderate vascularized, soft, tumor was noted occupying T5 vertebral body. After corpectomy, spinal cord was relaxed. Operative Procedures With endotracheal general anaesthesia, the patient was pus in left decubitus position. Thoracic surgeon pefromed right thoracotomy via 5th intercostal space after skin scrubbed, disinfected, and then draped. T5 corpectomy was done, and anterior fusion with body cage and autologous bone graft from right 5th rib. Anterior fixation was done with Medtronic plate and screws. After hemostasis, and two Fr. 32 chest tube inserted, the wound was closed in layers. Operators VS 蔡翊新 Assistants R4 曾峰毅 R1 柯安達 Indication Of Emergent Operation 張品品 (F,1947/03/20,64y11m) 手術日期 2011/01/27 手術主治醫師 詹志洋 手術區域 東址 017房 07號 診斷 Malignant neoplasm of female breast, nipple and areola 器械術式 Port-A Implatation /WOR 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 黃俊銘, 時間資訊 20:20 報到 20:25 進入手術室 20:45 抗生素給藥 20:50 麻醉開始 20:52 麻醉結束 20:52 誘導結束 20:54 手術開始 21:23 手術結束 21:28 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 內頸靜脈切開,永久導管放置術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Port-A 開立醫師: 黃俊銘 開立時間: 2011/01/27 21:42 Pre-operative Diagnosis Lung cancer Post-operative Diagnosis Ditto Operative Method Port-A catheter implantation, echo guided Specimen Count And Types nil Pathology nil Operative Findings Puncture to right IJV under echo guidance The venous blood flow freely in the Port-A catheter after implantation. Operative Procedures The patient was put on supine position. The operation field was disinfected and draped as usual. Under local anesthesia, we puncture to right IJV under echo guidance. After creating subcutaneous pocket, the Port-A catheter was inserted via peel away sheath. We close the wound in layers. Post-op care plan: 1.wound CD QD+PRN2.pain control with tinten 3.prophylatic antibiotics use Operators 詹志洋 Assistants 謝永 黃俊銘 宋炎輝 (M,1951/06/21,60y8m) 手術日期 2011/01/28 手術主治醫師 杜永光 手術區域 東址 001房 04號 診斷 Aneurysm 器械術式 S-P shunt REVIOSION 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2E 紀錄醫師 鍾文桂, 時間資訊 09:00 臨時手術NPO 09:00 開始NPO 15:25 進入手術室 15:35 麻醉開始 15:40 誘導結束 16:33 手術開始 18:40 手術結束 18:40 麻醉結束 18:45 送出病患 18:47 進入恢復室 20:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 腦脊髓液分流管重置 1 1 記錄__ 手術科部: 外科部 套用罐頭: Bilateral subdural shunt revision 開立醫師: 李振豪 開立時間: 2011/01/28 18:56 Pre-operative Diagnosis Subdural effusion, bilateral frontal-temporal-parietal, Left> right. Post-operative Diagnosis Subdural effusion, bilateral frontal-temporal-parietal, Left> right. Operative Method Bilateral subdural shunt revision Specimen Count And Types 1 piece About size:3CC Source:SUBDURAL EFFUSION. Pathology Nil Operative Findings Clear light yellowish subdural effusion was drained out from the burr holes. Low pressure at the left side. Higher pressure at right side( gushed out). The Codman V-P shunt ventricular catheter was placed 4cm in depth at right subdural space. The old Medtronic ventricular catheter was placed at left subdural space. Operative Procedures Under tracheostomy tube general anesthesia, the patient was put in supine position with head rotated to left. The scalp was shaved, scrubbed, and disinfected as usual. The scalp incision was made along previous wound over left frontal , right temporal, and right retroauricular area. The old subdural catheter was identified and removed. The Y-connector also identified from right retroauricular wound and removed. One 10mmH2O Codman fixed pressure reservoir was placed below the Y connector. The position of the subdural catheters were rechecked and reconnected to the Y connector, then to the reservoir. After ensuring the shunt patency, the wounds were closed in layers. Operators Prof.杜永光 Assistants R5鍾文桂, R4李振豪 Indication Of Emergent Operation 李百生 (M,1948/08/05,63y7m) 手術日期 2011/01/28 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Cerebrovascular accident (CVA) 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 古恬音, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:03 進入手術室 08:05 麻醉開始 09:05 誘導結束 09:20 抗生素給藥 09:50 手術開始 10:50 手術結束 10:50 麻醉結束 10:55 送出病患 11:00 進入恢復室 13:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt insertion via righ... 開立醫師: 古恬音 開立時間: 2011/01/28 11:03 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunt insertion via right Kocher point Specimen Count And Types 1 piece About size:CSF 10mL Source:CSF Pathology Nil Operative Findings 1. Mildly turbid CSF gushed out after verntriculostomy, and the opening pressure was high 2. Medium pressure Metronic reservoir was used. 3. Ventricular catheter: 6.5cm, peritoneal catheter: 30cm Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: supine with head rotated left. 3.Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 5 cm curvilinear, right frontal. Raney clips were applied to the scalp edge for temporary hemostasis. 5.After the scalp flap had been lifted and reflected anteriorly, a burr hole was made and the dura was tented by 1 stitche. 6.The dura was opened by a nib incision. Right lateral ventricle was tapped by a ventricular needle, then a 6.5 cm segment of the ventricular catheter was introduced into the ventricle. 7. A nib incision was made at RUQ of the abdomen. Subsequently, distal 30 cm segment of the peritoneal catheter (medium pressure) was introduced into the peritoneal cavity through the outer tube of the trochar. The proximal end of this catheter was passed through subcutaneous tunnel at forechest, neck, right retroauricular area and connected the reservoir. The shunt systemwas checked to make sure its function was working. 8. The reservoir was fixed to pericranium by 2 stitches. 9. Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Dexon and skin by continuous suture with 3/0 nylon. Operators 杜永光 Assistants 陳睿生 古恬音 柳雅心 (F,2003/02/20,9y0m) 手術日期 2011/01/28 手術主治醫師 王廷明 手術區域 東址 027房 02號 診斷 Club foot, acquired 器械術式 Posterior release of ankle 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉漢平 ASA 3 紀錄醫師 羅婉育, 時間資訊 08:55 報到 09:23 進入手術室 09:40 麻醉開始 09:50 誘導結束 09:50 抗生素給藥 09:59 手術開始 13:20 手術結束 13:20 麻醉結束 13:30 送出病患 13:33 進入恢復室 15:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 骨內翻外翻 2 1 B 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 摘要__ 手術科部: 骨科部 套用罐頭: 1. release of subtalar joint and ankle joint,... 開立醫師: 羅婉育 開立時間: 2011/01/28 13:41 Pre-operative Diagnosis bilateral club foot Post-operative Diagnosis bilateral club foot Operative Method 1. release of subtalar joint and ankle joint, both feet. 2. Arthroeresis with two 2.0 K pin of the TN and CC joint, both feet. Specimen Count And Types nil Pathology nil Operative Findings 1. tight heel cord 2. severe adhesion over the subtalar and ankle joint Operative Procedures Anesthetic induction, supine, skin disinfection, draping, on tourniquet. Skin incision over the right posterior ankle form posteromedial to posterolateral ankle. Dissected to the subtalar joint, and release the joint capsule. Dissected to the ankle joint, and release the joint capsule. Release the TN and CC joint capsule. Fix the TN and CC joint, each with 2.0 K pin. Perform the above procedure for the left side. N/S irrigation, close the wound in layers. Apply bilateral short leg cast. Operators 王廷明, Assistants 羅婉育, 陳勇璋, 黃明東 陳昆山 (M,1948/02/16,64y0m) 手術日期 2011/01/28 手術主治醫師 賴達明 手術區域 東址 000房 號 診斷 Subarachnoid hemorrhage 器械術式 NEURO T.A.E 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉健強 ASA 3E 時間資訊 06:00 臨時手術NPO 06:00 開始NPO 10:35 麻醉開始 10:40 誘導結束 11:55 麻醉結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 林修達 (M,1961/07/20,50y7m) 手術日期 2011/01/28 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Arteriovenous malformation, brain 器械術式 Craniotomy (A.V.M.) P-DUH 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 古恬音, 時間資訊 00:00 臨時手術NPO 11:17 報到 11:25 進入手術室 11:30 麻醉開始 11:45 誘導結束 11:50 抗生素給藥 12:00 手術開始 15:45 抗生素給藥 19:00 抗生素給藥 21:40 麻醉結束 21:40 手術結束 21:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 12 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 開顱術摘除血管病變 - 腦血管瘤 無病徵的 1 1 L 手術 開顱術摘除血管病變-動靜脈畸型小型表淺 1 2 L 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for AVM excision and aneurysm clipping 開立醫師: 古恬音 開立時間: 2011/01/28 22:21 Pre-operative Diagnosis Left frontal arteriovenous malformation with flow related aneurysms Post-operative Diagnosis Left frontal arteriovenous malformation with flow related aneurysms Operative Method Craniotomy for AVM excision and aneurysm clipping Specimen Count And Types 1 piece About size:1cm Source:left frontal AVM Pathology Pending Operative Findings 1. There were some abnormal dilated vessels at the surface of left medial frontal lobe; the size of the nidus was around 2.5cm. The main feeder was superficial and coursed around the posterolateral aspect of the nidus. Some small feeders were also present beneath the nidus. 2. Three flow related aneurysms were noted on the feeders of AVM. The largest one was about 1cm in diameter, located at the callosomarginal artery. Another smaller aneurysm was noted at the pericallosal artery. A third one was also noted at callosomarginal artery. 3. No residual AVM or aneurysm was noted with intra-op ICG angiogram 4. Prominent frontal sinuses were noted. They were opened during craniotomy. Operative Procedures 1. ETGA, supine position with head fixed with Mayfield skull clamp 2. Scalp shaving, scrubbing, and disinfection with better iodine 3. Make a bicoronal scalp incision behind the harline 4. Reflect the scalp flap 5. Make a 8*12 cranitomy window at high frontal area just left to the superior sagittal sinus 6. Durotomy in U-shaped with base at the SSS after peripheral tenting 7. Retract the left frontal lobe and identify the aneurysms on the ACA branches 8. Clip the largest aneurysm with a L-shaped Sugita aneurysm clip, and the smaller one was clipped with a fenestrated type Sugita aneuryms clip. 9. Dissect the main feeder of the aneurysm and electroligate it. Carefully dissect around the periphery of the AVM and electroligate all other smaller feeders 10. Check intra-op ICG angiogram 11. Line the raw surface with Surgicel 12 Duroplasty with autologous fascial graft 13. Fix skull plate back with miniplates 14. Set one subgaleal CWV drain and close the wound in layers Operators 賴達明 Assistants 陳睿生.古恬音 王清梅 (F,1962/01/03,50y2m) 手術日期 2011/01/28 手術主治醫師 賴達明 手術區域 東址 005房 02號 診斷 Herniation of intervertebral disc 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 陳建銘, 時間資訊 00:00 臨時手術NPO 13:58 進入手術室 14:25 麻醉開始 14:30 誘導結束 14:50 手術開始 15:35 抗生素給藥 16:50 手術結束 16:50 麻醉結束 17:05 送出病患 17:10 進入恢復室 18:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 椎間盤切除術-腰椎 1 1 記錄__ 手術科部: 外科部 套用罐頭: Left foraminotomy for discectomy with endosco... 開立醫師: 胡朝凱 開立時間: 2011/01/28 16:57 Pre-operative Diagnosis L4~5 HIVD, left side Post-operative Diagnosis L4~5 HIVD, left side Operative Method Left foraminotomy for discectomy with endoscopic and microscopic assistance Specimen Count And Types nil Pathology pending Operative Findings 1.protrusion disc from L4~5 level that compressed the central part and left L5 nerve root tightly. 2.After decompression, the root became loose Operative Procedures 1.ETGA, prone 2.Left L4~5 level paramedian skin incision about 2.5 cm 3.dilated the muscle layer to expose L4~5 interlamina area 4.Confirmed with C-arm 5.Holder and tube fixation 6.Remove soft tissue 7.Resect flavum ligment 8.Retract nerve root medially 9.discectomy under microscopic assitance 10.close wound in layers Operators 賴達明 Assistants 胡朝凱, 陳建銘 張玉梅 (F,1964/02/06,48y1m) 手術日期 2011/01/28 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Herniation of intervertebral disc with myelopathy, cervical (HIVD) 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 1 紀錄醫師 邱裕淳, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:10 麻醉開始 08:30 誘導結束 08:40 抗生素給藥 09:02 手術開始 12:20 手術結束 12:20 麻醉結束 12:35 送出病患 12:38 進入恢復室 14:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎弓切除術(減壓)-二節以內 1 2 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 曾峰毅 開立時間: 2011/01/28 12:14 Pre-operative Diagnosis Lumbar stenosis, L4/5 Post-operative Diagnosis Lumbar stenosis, L4/5 Operative Method L4 laminectomy, posterior fixation of L4-5 with transpedicular screws, posterolateral fusion with autologous bone graft. Specimen Count And Types Nil Pathology Nil Operative Findings L3/4 and L4/5 facet joints were deformed severely with osteoslcerosis change. Hypertrophic ligamentum flavum compressed the thecal sac and bilateral lateral recess of L4/5 tightly. Neural structures were decompressed well after the surgery. Four Syntheses transpedicular screws, 6.2x45 mm, were used. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After C-arm localization, we scrubbed, disinfected, and then draped the back. We made one midline skin incision, and dissected parapspinal muslces to expose bilateral laminae of L3 to L5. We inserted transpedicular screws to bilaeral pedicles of L4 and L5, and performed L4 laminectomy for decompression. After fixation with rods, we performed posterolateral fusion with autologous bone graft. We inserted one hemovac, and closed the wound in layers. Operators VS 賴達明 Assistants R4 曾峰毅 R1 邱裕淳 張孟然 (M,1969/02/05,43y1m) 手術日期 2011/01/28 手術主治醫師 賴達明 手術區域 東址 019房 02號 診斷 Spinal neuroma 器械術式 Intraspinal intramedullary tum 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 2 紀錄醫師 邱裕淳, 時間資訊 13:00 臨時手術NPO 12:50 進入手術室 12:55 麻醉開始 13:40 誘導結束 14:30 抗生素給藥 14:36 手術開始 17:30 抗生素給藥 19:20 手術結束 19:20 麻醉結束 19:27 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 手術 良性脊髓腫瘤切除術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Cervical Laminectomy 開立醫師: 曾峰毅 開立時間: 2011/01/28 19:11 Pre-operative Diagnosis Intradural extramedullar tumor at right side of C5/6 spinal cord, suspected schwannoma Post-operative Diagnosis Intradural extramedullar tumor at right side of C5/6 spinal cord, suspected schwannoma Operative Method C4/5 laminopalsty for intradural extramedullary tumor excision Specimen Count And Types Several fragments of one tumor was sent for pathology. Pathology Pending Operative Findings Well capsuled, hypervascular, greyish, elastic tumor was noted at C4/5 intradrullary extramedullary. Adhesion to right C5 root was found, and preservation of the root was not achieved. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position with head fixed with Mayfield head clamp. We shaved, scrubbed, disinfected, and then draped the neck, and then made one midline skin incision. We dissected bilalteral paraspinal muscle to expose bilateral laminae of C4/5. We performed laminectomy of C4/5, and right paramedian durotomy longitudinally. Tumor excision was done with assitance of CUSA. Duroplasty was done with water-tight suture. Laminoplasty was done with mini-plates. The wound was closed in layers after one CWV. Operators VS 賴達明 Assistants R4 曾峰毅 R6 胡朝凱 R4 曾峰毅 R1 邱裕淳 莊博瑜 (M,2002/05/15,9y9m) 手術日期 2011/01/28 手術主治醫師 楊士弘 手術區域 東址 005房 01號 診斷 Tethered cord syndrome 器械術式 Intraspinal intramedullary tum 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:15 麻醉開始 08:35 誘導結束 09:00 抗生素給藥 09:50 手術開始 11:50 抗生素給藥 13:30 手術結束 13:30 麻醉結束 13:45 進入恢復室 15:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 手術 脊椎內脊髓內腫瘤切除術 1 1 手術 椎弓整形術 1 2 摘要__ 手術科部: 外科部 套用罐頭: 1. L5 en bloc laminectomy for division and re... 開立醫師: 楊士弘 開立時間: 2011/01/28 13:31 Pre-operative Diagnosis Tethered cord syndrome due to terminal filament lipoma Post-operative Diagnosis Tethered cord syndrome due to terminal filament lipoma Operative Method 1. L5 en bloc laminectomy for division and resection of terminal filament lipoma 2. L5 laminoplasty with microplate and screws Specimen Count And Types 1 piece About size:小 Source:terminal filament Pathology Pending Operative Findings A yellowish terminal filament was seen amid the cauda equina roots after dural opening. Intra-op. bipolar stimulation of the filum did not elicit EMG response of legs and anus, while stimulation of other nerve roots elicited the EMG response of foot and anus. The SSEP remained intact during the course of surgery. The proximal filum ascends out of surgical field after bipolar coagulation and excision of a segment of 0.5 cm of filum. Operative Procedures 1. ETGA, prone. 2. C-arm localization of L5-S1 3. Midline vertical incision from L4-S1. 4. L5 en bloc laminectomy by high speed air drill and kerrison punches. 5. Midline durotomoy with knife and nerve hood. 6. Exploration for the terminal filament. 7. Bipolar stimulation of the filum and roots for correct identification of filum. 8. Bipolar coagulation and excision of a 0.5 cm segment of terminal filament. 9. Fixation of the L5 lamina back with one microplate and two screws on each sides. 10. Wound closure in layers. Operators 楊士弘 Assistants 鍾文桂 相關圖片 吳卓月嬌 (F,1928/07/22,83y7m) 手術日期 2011/01/28 手術主治醫師 王國川 手術區域 東址 018房 02號 診斷 Intracerebral hemorrhage (ICH) 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3E 紀錄醫師 王奐之, 時間資訊 11:47 通知急診手術 12:35 報到 12:50 進入手術室 12:55 麻醉開始 13:20 抗生素給藥 13:30 誘導結束 14:12 手術開始 14:46 麻醉結束 14:46 手術結束 14:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室體外引流 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: EVD insertion via left Kocher point 開立醫師: 王奐之 開立時間: 2011/01/28 14:59 Pre-operative Diagnosis Right thalamic ICH & IVH with hydrocephalus Post-operative Diagnosis Right thalamic ICH & IVH with hydrocephalus Operative Method EVD insertion via left Kocher point Specimen Count And Types Nil Pathology Nil Operative Findings Pinkish CSF was noted after ventrilar puncture. Opening pressure: 5~10cmH2O. Operative Procedures After ETGA, the patient was placed in supine position. After scalp shaving, disinfection & draping in sterile fashion, a linear incision was made at left frontal area. A burr hole over left Kocher point was then made, followed by 2 tenting stitches. Ventricular puncture was done, followed by insertion of EVD catheter. After hemostasis, the EVD was secured and the wound was closed in layers. Operators VS 王國川 Assistants R3 王奐之 Indication Of Emergent Operation 相關圖片 陳雪琴 (F,1933/11/02,78y4m) 手術日期 2011/01/28 手術主治醫師 葉德輝 手術區域 東址 023房 01號 診斷 Oral ulcer 器械術式 Biopsy of oral mucosa 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 葉國安, 時間資訊 07:40 報到 08:02 進入手術室 08:05 麻醉開始 08:10 誘導結束 08:15 抗生素給藥 08:35 手術開始 08:44 手術結束 08:44 麻醉結束 09:10 送出病患 09:15 進入恢復室 10:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 舌部份/楔狀切除術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 耳鼻喉部 套用罐頭: Oral tumor excision 開立醫師: 葉國安 開立時間: 2011/01/28 08:47 Pre-operative Diagnosis Left tongue ulcer Post-operative Diagnosis Left tongue ulcer, operated Operative Method Excision of left tongue ulcer Specimen Count And Types 1 piece About size:1.5*1.5cm Source:left tongue ulcer Pathology Pending Operative Findings Left tongue ulcer, 1*1cm Operative Procedures The patient was in supine position. General anesthesia was set up via endotracheal tube. The operation field was draped and disinfected as usual. The oral cavity was irrigated with Aq-Hibitane and a mouth gag was applied. An oral ulcer was seen at left tongue and excised with a safe margin of 0.5cm. After hemostasis, the wound was closed with 4-0 Vicryl. The patient tolerated the whole procedure well. Operators 葉德輝, Assistants R5 范振華, R2 葉國安 陳昱揚 (M,1997/06/06,14y9m) 手術日期 2011/01/30 手術主治醫師 蕭輔仁 手術區域 東址 018房 01號 診斷 Hydrocephalus 器械術式 Revision of CSF shunt 手術類別 緊急手術 手術部位 腹 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 3E 紀錄醫師 鍾文桂, 時間資訊 09:30 臨時手術NPO 09:30 開始NPO 16:24 通知急診手術 17:35 報到 17:47 進入手術室 17:50 麻醉開始 17:55 誘導結束 18:05 抗生素給藥 18:23 手術開始 19:00 手術結束 19:00 麻醉結束 19:25 送出病患 19:30 進入恢復室 22:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦脊髓液分流管重置 1 2 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Revision of ventriculoperitoneal shunt by rep... 開立醫師: 鍾文桂 開立時間: 2011/01/30 19:17 Pre-operative Diagnosis Hydrocephalus status post revision of ventriculoperiotneal shunt, with shunt malfunctuion. Post-operative Diagnosis Hydrocephalus status post revision of ventriculoperiotneal shunt, with shunt malfunctuion. Operative Method Revision of ventriculoperitoneal shunt by repositioning of the peritoneal catheter. Specimen Count And Types 1 piece About size:3cc Source:CSF Pathology Nil. Operative Findings Looping of the peritoneal catheter at the pseudocavity between the anterior rectus sheath and fasia layer. Some clear colorless fluid collection was noted at the pseudocavity. We placed the peritoneal catheter into the peritoneal cavity with the help from General Surgeon on duty. The V-P shunt is patent. CSF gushed out while compressing the reservoir. Operative Procedures Operators Assistants Indication Of Emergent Operation 記錄__ 手術科部: 外科部 套用罐頭: Revision of ventriculoperitoneal shunt by rep... 開立醫師: 鍾文桂 開立時間: 2011/01/30 19:22 Pre-operative Diagnosis Hydrocephalus status post revision of ventriculoperiotneal shunt, with shunt malfunctuion. Post-operative Diagnosis Hydrocephalus status post revision of ventriculoperiotneal shunt, with shunt malfunctuion. Operative Method Revision of ventriculoperitoneal shunt by repositioning of the peritoneal catheter. Specimen Count And Types 1 piece About size:3cc Source:CSF Pathology Nil. Operative Findings Looping of the peritoneal catheter at the pseudocavity between the anterior rectus sheath and fasia layer. Some clear colorless fluid collection was noted at the pseudocavity. Looping of the peritoneal catheter at the pseudocavity between the anterior rectus sheath and fasia layer. Some clear colorless fluid collection was noted at the pseudocavity. The peritoneal catheter was kept intact during dissection. We placed the peritoneal catheter into the peritoneal cavity with the help from General Surgeon on duty. The V-P shunt is patent. CSF gushed out while compressing the reservoir. Operative Procedures Under ETGA, the patient was placed in supine position. After disinfection and draping, the previous abdominal wound was incised and dissected until the peritoneal catheter was well exposed. Then, further dissection was made to reach the peritoeal cavity. After placing one purse string at the peritoneum, the peritoneal catheter was placed into the peritoneal cavity. Finally, the wound was closed in layers. Operators V.S. 蕭輔仁 Assistants R5鍾文桂 R3張正傑 Indication Of Emergent Operation 陳玥伶 (F,2009/05/25,2y9m) 手術日期 2011/01/31 手術主治醫師 郭夢菲 手術區域 兒醫 067房 04號 診斷 Subdural hemorrhage (SDH) 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 3E 紀錄醫師 鍾文桂, 時間資訊 12:50 開始NPO 12:50 臨時手術NPO 12:50 通知急診手術 16:05 進入手術室 16:15 麻醉開始 17:05 誘導結束 18:02 手術開始 18:55 手術結束 18:55 麻醉結束 19:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 R 手術 顱內壓視置入 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: 1. Evacuation of chronic subdural hemorrhage. 開立醫師: 鍾文桂 開立時間: 2011/01/31 19:41 Pre-operative Diagnosis Head injury with acute subdural hemorrhage and brain swelling status post hematoma evacuation and decompressive craniectomy, with 1. Chronic subdural hemorrhage,right frontal-temporal-parietal. 1. subacute subdural effusion,right frontal-temporal-parietal. 2. Hydrocephalus. Post-operative Diagnosis Head injury with acute subdural hemorrhage and brain swelling status post hematoma evacuation and decompressive craniectomy, with 1. Chronic subdural hemorrhage,right frontal-temporal-parietal. 1. subacute subdural effusion,right frontal-temporal-parietal. 2. Hydrocephalus. Operative Method 1. Evacuation of chronic subdural hemorrhage. 1. Evacuation of subdural hemorrhage 2. Ventriculostomy for ICP monitoring and CSF drainage. Specimen Count And Types 1 piece About size:2cc/10cc Source:CSF/Subdural hematoma. Pathology Nil. Operative Findings 1. Low intracranial pressure, Medtronic EVD catheter, 6cm in depth. Clear colorless CSF. 2. Light brownish chronic subdural hemorrhage, right. 2. Light brownish subdural hemorrhage, right. It compressed the brain tissue downward for about 0.5 cm in depth. Operative Procedures Under ETGA, the patient was placed in supine position and the head in midline position. After removal of the Codman ICP monitor and suturing one stich at this site, pre-operative preparation, shaving, disinfection, and draping were done. Under ETGA, the patient was placed in supine position and the head in midline position. After removal of the Codman ICP monitor and suturing one stich at the exit site, which was leaking, pre-operative preparation, shaving, disinfection, and draping were done. A linear horizontal scalp incision was made at right Kocher area. After dissection, a small trephination was done along right anterior border of anterior fontanelle. Meticulous incision of the dura mater and outer membrane of the chronic subdural hemorrhage was achieved with 15# blade and 27# needle. The chronic subdural hemorrhage was evacuated until the brain parenchyma got more superficial. We asked the anethesiologist to elevate the PaCO2, and then the chronic subdural hemorrhage was evacuated until the brain parenchyma got more superficial. After corticotomy, the ventricular puncture needle was inserted until the CSD drained out. The EVD catheter was placed through the same tract. After corticotomy, the ventricular puncture needle was inserted until the CSF drained out. The EVD catheter was placed through the same tract. Finally,the wound was closed in layers and the EVD catheter was connected to closed drainage system. Finally,the wound was closed in layers and the EVD catheter was connected to closed drainage system for ICP monitoring. Operators V.S. 郭夢菲 Assistants R5 鍾文桂 Indication Of Emergent Operation 高世昌 (M,1960/01/29,52y1m) 手術日期 2011/01/31 手術主治醫師 賴達明 手術區域 東址 002房 02號 診斷 Subarachnoid hemorrhage (SAH) 器械術式 Craniotomy(Aneurysms) Others 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3E 紀錄醫師 邱裕淳, 時間資訊 00:13 臨時手術NPO 00:13 開始NPO 00:14 通知急診手術 11:15 進入手術室 11:15 報到 11:20 麻醉開始 11:45 誘導結束 11:55 手術開始 12:18 抗生素給藥 15:18 抗生素給藥 18:18 抗生素給藥 20:10 麻醉結束 20:10 手術結束 20:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 開顱術摘除血管病變 - 腦血管瘤 有病徵的 1 1 L 手術 開顱術摘除血管病變 - 腦血管瘤 無病徵的 1 2 L 手術 開顱術摘除血管病變 - 腦血管瘤 無病徵的 1 4 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 10 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: Left craniotomy and anteior clinoidectomy for... 開立醫師: 胡朝凱 開立時間: 2011/01/31 20:46 Pre-operative Diagnosis Left MCA aneurysm, suspect ruptured, and A-com, Left ICA aneurysms Post-operative Diagnosis Left MCA aneurysm, suspect ruptured, and A-com, Left ICA aneurysms Operative Method Left craniotomy and anteior clinoidectomy for three aneurysmal clipping Specimen Count And Types nil Pathology nil Operative Findings 1.One about 5 mm saccular aneurysm arised upward and anteriorly from left M2 bifurcation with surrounding adhesion and hematoma. Premature rupture was noted. After temporary clip twice within 3 minutes, one straight Sugita clip was applied. 2.One about 4 mm saccular aneurysm arised from A-com that protruded posteriorly without peripheral adhesion. One curved sugita clip was applied. 3.One about 7 mm carotid cave aneurysm was noted also. One fenestrated, angled sugita clip was applied. Operative Procedures 1.ETGA, supine with head fixed with Mayfied skull clamp 2.Left Pterional craniotomy was done 3.Anteior clinoidectomy with Diamond bur 4.Open dura as curvillinear fashion 5.Open sylvian fissure 6.Identified MCA aneurysm 7.Proximal control 8.Aneurysmal clipping 9.Left rectus gyrus resection 10.Identified A1 then A2 and then aneurysm 11.Aneurysmal clipping 12.Dissect to separate optic nerve and ICA 13.fenestrated aneurysmal clipping 14.Close dura after hemostasis 15.Fixed bone back with miniplate 16.Close wound in layers after CWV drain insertion Operators 賴達明 Assistants 胡朝凱，邱郁淳 Indication Of Emergent Operation 陳英世 (M,1945/01/05,67y2m) 手術日期 2011/01/31 手術主治醫師 蕭輔仁 手術區域 東址 006房 03號 診斷 頸椎脊髓損傷 器械術式 Laminectomy C-Spinal(Posterier 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 11:30 通知急診手術 12:13 進入手術室 12:30 麻醉開始 12:50 誘導結束 13:00 抗生素給藥 13:55 手術開始 15:10 開始輸血 16:00 抗生素給藥 17:25 手術結束 17:25 麻醉結束 17:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 椎弓整形術 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: C3-C6 laminoplasty 開立醫師: 林哲光 開立時間: 2011/01/31 18:03 Pre-operative Diagnosis C3, C4 OPLL with central canal stenosis and acute spinal cord injury Post-operative Diagnosis Ditto Operative Method C3-C6 laminoplasty Specimen Count And Types Pathology Operative Findings Easily touch bleeding of the paraspinal muscles and engorgement of the epidural veins were noted. Dura sac seemed re-expanded well after laminoplasty was done. Operative Procedures Under ETGA and prone position with head fixed with Mayfield head clump, skin disinfected and drapped were performed as usual. Midline skin incision was made at C2-C7 level. Paraspinal muscles were detached. Laminoplasty by open-door with left side as pivot was done and fixed with mini-plates. The wound was then closed in layers after hemostasis and paravertebral CWV drain inserted. Operators VS 蕭輔仁 Assistants R4 林哲光, R1 柯安達 Indication Of Emergent Operation 相關圖片 鄒泰山 (M,1953/04/05,58y11m) 手術日期 2011/01/31 手術主治醫師 蕭輔仁 手術區域 東址 001房 02號 診斷 Malignant neoplasm of cardia of stomach 器械術式 Ommaya reservoir implantation 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 4E 紀錄醫師 王奐之, 時間資訊 12:32 通知急診手術 14:00 進入手術室 14:05 麻醉開始 14:10 誘導結束 14:50 手術開始 15:40 手術結束 15:40 麻醉結束 15:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 歐氏貯囊置放手術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 內科部 套用罐頭: Ommaya reservoir implantation via right Koche... 開立醫師: 王奐之 開立時間: 2011/01/31 16:03 Pre-operative Diagnosis Advanced gastric cancer with leptomeningeal carcinomatosis Post-operative Diagnosis Advanced gastric cancer with leptomeningeal carcinomatosis Operative Method Ommaya reservoir implantation via right Kocher point Specimen Count And Types Nil Pathology Nil Operative Findings Mildly turbid CSF gushed out while ventricular puncture, opening pressure >15cmH2O. CSF sent for routine, BCS, bacterial culture & cytology. Operative Procedures After ETGA, the patient was placed in supine position. The scalp was shaved, disinfected, and draped in sterile fashion. A linear skin incision was then made at right frontal area, followed by burr hole creation at right Kocher point. 2 dural tenting stitches were applied, followed by a cruciated durotomy. After hemostasis, ventricular puncture was done, followed by Ommaya catheter insertion. After securing the Ommaya reservoir, the wound was closed in layers. Operators VS 蕭輔仁 Assistants R3 王奐之 Indication Of Emergent Operation 相關圖片 張偉明 (M,1948/06/11,63y9m) 手術日期 2011/01/31 手術主治醫師 王國川 手術區域 東址 005房 04號 診斷 Head injury, unspecified 器械術式 Revision of CSF shunt 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 4E 紀錄醫師 李振豪, 時間資訊 08:00 開始NPO 08:00 臨時手術NPO 12:13 通知急診手術 14:56 進入手術室 14:56 報到 15:00 麻醉開始 15:03 誘導結束 15:41 手術開始 15:57 麻醉結束 15:57 手術結束 16:02 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦脊髓液分流管重置 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Revision of right subduro-peritoneal shunt 開立醫師: 李振豪 開立時間: 2011/01/31 16:13 Pre-operative Diagnosis Right subdural effusion, status post subduro-peritoneal shunt impalntation, with malfunction of the shunt Post-operative Diagnosis Right subdural effusion, status post subduro-peritoneal shunt impalntation, with malfunction of the shunt Operative Method Revision of right subduro-peritoneal shunt Specimen Count And Types nil Pathology Nil Operative Findings The opening pressure was 10cmH2O after remove the subdural catheter. The CSF was clear in character. There was some debris withint the subdural catheter. The debris was removed and the subdural catheter was placed back into the subdural space. The function of the shunt was checked again and the reservoir expanded well after compression. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine position with head rotated to left. The scalp was shaved, scrubbed, and disinfected as usual. The scalp incision was made along previous wound and the subdural catheter was identified. The debris within the subdural catheter was removed and the function of the shunt was checked. Hemostasis was achieved, the wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS王國川 Assistants R4李振豪 Indication Of Emergent Operation 相關圖片 張添勝 (M,1969/06/05,42y9m) 手術日期 2011/01/31 手術主治醫師 戴浩志 手術區域 東址 003房 04號 診斷 Subdural hematoma 器械術式 S.T.S.G.<10 BSA 手術類別 預定手術 手術部位 四肢 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 3 紀錄醫師 蕭惠壬, 時間資訊 12:10 進入手術室 12:30 麻醉開始 12:35 誘導結束 12:40 手術開始 13:00 抗生素給藥 13:30 手術結束 13:30 麻醉結束 13:35 送出病患 13:38 進入恢復室 14:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 多層皮膚移植- 10-20BSA 1 1 R 手術 多層皮膚移植–每增加100平方公方 3 1 R 摘要__ 手術科部: 外科部 套用罐頭: Debridement and STSG 開立醫師: 蕭惠壬 開立時間: 2011/01/31 14:01 Pre-operative Diagnosis Bilateral leg avulsion injury Post-operative Diagnosis Bilateral leg avulsion injury Operative Method Debridement and STSG Specimen Count And Types nil Pathology Nil Operative Findings 1. History of bilateral leg avulsion injury, left leg s/p great toe amputation Right leg open fracture s/p ESF fixation 2. Small area of necrotic and pyogenic granulation noted over right leg. Almost area was granulation tissue. Operative Procedures 1. Under ETGA, patient lied at supine position. We disinfected and draped operation field as usual. 2. We excised the devitalized tissue with curettage and scisors. 3. We harvested the 8/1000-inch in thickness STSG from right thigh with air-drive Zimmer dermatome. 4. We applied the STSG on the skin defect and then tie-over 5. The right thigh STSG donor site was covered with Kaltostat. Operators 戴浩志 Assistants 阮廷倫 蕭惠壬 連金良 (M,1958/08/28,53y6m) 手術日期 2011/02/01 手術主治醫師 蕭輔仁 手術區域 東址 005房 05號 診斷 頸部退化性脊椎炎(Cervical spondylosis) 器械術式 Spinal fusion posterior 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 蕭柏妮 ASA 3E 紀錄醫師 胡朝凱, 時間資訊 13:30 臨時手術NPO 13:30 開始NPO 16:41 通知急診手術 19:30 報到 19:36 進入手術室 19:45 麻醉開始 19:55 誘導結束 20:35 手術開始 20:45 抗生素給藥 22:50 手術結束 22:50 麻醉結束 23:00 送出病患 23:05 進入恢復室 00:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 椎弓切除術(減壓)-二節以內 1 1 記錄__ 手術科部: 外科部 套用罐頭: Duroplasty 開立醫師: 胡朝凱 開立時間: 2011/02/01 23:05 Pre-operative Diagnosis C2 CSF leakage Post-operative Diagnosis C2 CSF leakage Operative Method Duroplasty Specimen Count And Types CSF x 3 tubes Pathology nil Operative Findings 1.One small durotomy was noted with CSF leakage at right C2 level. Fluid accumulation at C1~2 an T1 level was noted. 2.After decompression, thecal sac expanded well. Operative Procedures 1.ETGA, prone with head fixed with skull clamp 2.Wound re-open 3.Identified dura 4.Identified leak point 5.Use fascia and Tissucal-duo to repair the leakage 6.Hemostasis 7.Close wound in layers Operators 蕭輔仁 Assistants 胡朝凱, Ri Indication Of Emergent Operation 劉興鈞 (M,1955/10/11,56y5m) 手術日期 2011/02/01 手術主治醫師 楊榮森 手術區域 東址 020房 01號 診斷 Bone metastasis 器械術式 Bone biopsy, right radial neck 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 面罩麻醉 麻醉主治醫師 劉漢平 ASA 3 紀錄醫師 黃全敬, 時間資訊 07:31 報到 08:02 進入手術室 08:10 麻醉開始 08:20 誘導結束 08:30 抗生素給藥 08:42 手術開始 09:05 手術結束 09:05 麻醉結束 09:07 送出病患 09:10 進入恢復室 10:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Semi-opened mask inhalation anes 1 0 手術 良性骨瘤刮除術及骨移植 1 1 R 手術 石膏副木固定－長臂 1 0 R 記錄__ 手術科部: 骨科部 套用罐頭: bone biopsy 開立醫師: 黃全敬 開立時間: 2011/02/01 09:28 Pre-operative Diagnosis bone tumor, right proximal radius Post-operative Diagnosis bone tumor, right proximal radius Operative Method bone biopsy Specimen Count And Types 1 piece About size:samll pieces of tumor Source:right proxiaml radius Pathology pending Operative Findings 1. whitish, soft bone tumor over right proximal radius, sent for pathology examination 2. no frank pus formation Operative Procedures 1. anesthesia induction, supine position 2. skin disinfection, draped 3. longitudinal skin incision over right forearm, soft tissue dissection to proximal radius 4. make a window, perform bone biopsy with curette, and collect specimen for cytology 5. irrigate with 95% alcohol, apply gelfoam 6. N/S irrigation, hemostasis, close the wound in layers 7. infect local analgesics around the wound 8. apply a long arm splint Operators 楊榮森, Assistants 黃全敬, 蘇盈豪, 黃哲南, 方建豐, 戴隆行 (M,1955/06/03,56y9m) 手術日期 2011/02/01 手術主治醫師 廖漢文 手術區域 東址 000房 號 診斷 Brain concussion 器械術式 NEURO T.A.E 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林珍榮 ASA 3E 時間資訊 17:00 通知急診手術 17:00 臨時手術NPO 17:00 開始NPO 14:02 麻醉開始 14:22 誘導結束 16:05 麻醉結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 涂茂森 (M,1977/08/21,34y6m) 手術日期 2011/02/01 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Cellulitis 器械術式 Removal of epidural empyema 手術類別 緊急手術 手術部位 頭、頸 傷口分類 污染 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3E 紀錄醫師 鍾文桂, 時間資訊 11:00 臨時手術NPO 11:00 開始NPO 12:10 通知急診手術 08:58 進入手術室 09:00 麻醉開始 09:20 誘導結束 10:00 抗生素給藥 10:06 手術開始 11:00 抗生素給藥 11:10 手術結束 11:10 麻醉結束 11:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 深部傷口處理縫合擴創-大 1 0 L 手術 顱骨切除術,包括異物移除或壓或經切斷 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: 1. Craniectomy of the allograft skull bone gr... 開立醫師: 鍾文桂 開立時間: 2011/02/01 11:45 Pre-operative Diagnosis Epidural empyema, left frontal-temporal-parietal. Post-operative Diagnosis Epidural empyema, left frontal-temporal-parietal. Operative Method 1. Craniectomy of the allograft skull bone graft. 2. Evacuation of the epudural empyema and debridement of the scalp. Specimen Count And Types 1 piece About size:10cc Source:epidural empyema. Pathology Nil. Operative Findings 1. Some red-yellowish granulation tissue and pus formation at epidural space. Some yellowish serous pus was also noted during evacuation. 2. The allograft skull bone, formed by wire mesh and bone cement, was seperated into several pieces and interwined with the granulomatous tissue. 3. The scalp was thickened. The dura mater was also thickened and coated with some fibrious tissue. The scalp layers were vague. Operative Procedures Under ETGA, the patient was placed in supine position and head tilted to the right. After shaving, disinfection, and draping, the previous scalp wound was incised and dissected until the allograft bone graft was well exposed. The drained pus was collected for culture. The mini plates and screws were removed along with the allograft skull graft. Further debridement of the epidural space and the scalp was achieved by using currete. Finally, the wound was closed primarily by interrupted 2-0 Nylon sutures with two epidural CWV drains in situ. Operators V.S.王國川 Assistants R5 鍾文桂 Indication Of Emergent Operation 吳政德 (M,1976/10/16,35y4m) 手術日期 2011/02/02 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Cerebrovascular accident (CVA) 器械術式 Craniotomy(Aneurysms) P-DUH 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 2E 紀錄醫師 鍾文桂, 時間資訊 06:00 臨時手術NPO 06:00 開始NPO 11:16 通知急診手術 13:10 進入手術室 13:10 麻醉開始 13:15 誘導結束 13:35 抗生素給藥 13:50 手術開始 16:35 抗生素給藥 16:50 開始輸血 18:30 手術結束 18:30 麻醉結束 18:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱內壓視置入 1 2 L 手術 開顱術摘除血管病變 - 腦血管瘤 有病徵的 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: 1. Aneurysmal clipping by interhemispheric ap... 開立醫師: 鍾文桂 開立時間: 2011/02/04 02:22 Pre-operative Diagnosis Left anterior cerebral artery aneurysm, ruptured. Post-operative Diagnosis Left anterior cerebral artery aneurysm, ruptured. Operative Method 1. Aneurysmal clipping by interhemispheric approach. 2. Insertion of ICP monitor. Specimen Count And Types nil Pathology Nil. Operative Findings A 4mm saccular aneurysm at the junction of pericallosal and callosomarginal artery was noted after dissection of the left interhemispheric space. One L shaped aneurysmal clip was used The falx cerebri was left intact. During dissection a cortical drainage vein was sacrafized to get access to the aneurysm. Severe adhesion of the SAH and some fibrotic tissue to the surrounding structures was noted during dissection. The superior sagital sinus was left intact during craniotomy. Gradual brain swelling was noted intraoperatively. So the craniotomy bone plate was not placed back. Operative Procedures Under ETGA, the patient was placed in supine position and the head was fixed on Mayfield. After shaving, disinfection and draping, a curvilinear scalp incision was made at bilateral frontal regions. After pericranium dissection and craniotomy, the dura mater was opened based on superior sagital sinus. Then, dissection was achieved between the falx cerebri and left frontal lobe. Until the bilateral ACA, the junction of pericallosal and callosomarginal artery were identified, dissection was made to expose the neck of the aneurysm. One aneurysmal clip was applied to the neck. After ensuring the patency of the pericallosal and callosomarginal arteries, the dura mater was augmented with DuraGen and pericranium due to the swollen brain. Finally the wound was closed in layers with one subgaleal drian in situ. Operators V.S. 賴達明 Assistants R5 鍾文桂 Indication Of Emergent Operation 趙阮美英 (F,1944/10/24,67y4m) 手術日期 2011/02/02 手術主治醫師 賴達明 手術區域 東址 003房 03號 診斷 Subarachnoid hemorrhage (SAH) 器械術式 Craniotomy(Aneurysms) Others 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 3E 紀錄醫師 鍾文桂, 時間資訊 12:00 臨時手術NPO 12:00 開始NPO 17:58 通知急診手術 19:27 報到 19:27 進入手術室 19:30 麻醉開始 20:15 誘導結束 20:30 抗生素給藥 20:48 手術開始 23:21 開始輸血 23:30 抗生素給藥 01:12 麻醉結束 01:12 手術結束 01:19 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 開顱術摘除血管病變 - 腦血管瘤 有病徵的 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Left craniotomy for aneurysmal clipping 開立醫師: 胡朝凱 開立時間: 2011/02/03 01:29 Pre-operative Diagnosis Left P-com aneurysm Post-operative Diagnosis Left P-com aneurysm Operative Method Left craniotomy for aneurysmal clipping Specimen Count And Types nil Pathology nil Operative Findings 1.One about 7 mm saccular aneurysm arised from left P-com protruding laterally and downward. 2.Peripheral hematoma was noted 3.One ENT shape aneurysmal clip was applied at the neck without compromise of anterior choroidal and P-com artery 4.Proximal control: 3 minutes Operative Procedures 1.ETGA, supine with head fixed with skull clamp 2.Left curvillinear skin incision 3.pterional craniotomy 4.curved dural incision 5.Open sylvian fissure 6.Retract frontal lobe to exposed optic nerve 7.dissected arachnoid membrane and adhesion band to expose ICA then P-com 8.Identified aneurysmal neck 9.Proximal control 10.Aneurysm clipping 11.Hemostasis 12.Close dura with durofoam and prolene 13.Fixed bone back with miniplate 14.Close wound in layers after one CWV drain insertion Operators 賴達明 Assistants 胡朝凱,鍾文桂,游建生 Indication Of Emergent Operation 吳政德 (M,1976/10/16,35y4m) 手術日期 2011/02/03 手術主治醫師 賴達明 手術區域 東址 021房 01號 診斷 Cerebrovascular accident (CVA) 器械術式 Craniectomy 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 3E 紀錄醫師 鍾文桂, 時間資訊 10:13 臨時手術NPO 10:13 開始NPO 17:13 通知急診手術 19:00 進入手術室 19:05 報到 19:05 麻醉開始 19:10 誘導結束 19:40 抗生素給藥 20:00 手術開始 22:08 開始輸血 23:00 抗生素給藥 00:30 麻醉結束 00:30 手術結束 00:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 顱骨切除術,包括異物移除或壓或經切斷 1 2 L 記錄__ 手術科部: 外科部 套用罐頭: Decompressive craniectomy, left frontal-tempo... 開立醫師: 鍾文桂 開立時間: 2011/02/04 02:00 Pre-operative Diagnosis Left ACA aneurysm, ruptured status post aneurysmal clipping with severe brain swelling. Post-operative Diagnosis Left ACA aneurysm, ruptured status post aneurysmal clipping with severe brain swelling. Operative Method Decompressive craniectomy, left frontal-temporal parietal. Specimen Count And Types nil Pathology Nil. Operative Findings 1. Preoperative ICP 17mmHg, postoperative ICP 6 mmHg. 2. The ischemic and incarcerated brain at the previous craniectomy herniated from the duroplasty. Gradual swelling of the brain parenchyma intraoperatively. 3. Fair brain palsation after decompression with a 15 cm skull plate. 4. Severe bleeding from the arachnoid granulations and cortical veins. Operative Procedures Under ETGA, the patient was placed in supine position and the head tilted to the right. After shaving, disinfection, and draping, the previous operative wound was re-opened. Further scalp incision was made at parietal-temporal region. After further craniectomy at parietal-temporal regions and well hemostasis of the arachnoid granulations, the dura mater was opened and augmented with pericranium and DuraGen. The temporalis muscle was placed in situ. Two CWV drains were placed at epidural space. The ICP monitor was placed at parietal region. Finally, the wound was closed in layers. Operators V.S. 賴達明 Assistants R5鍾文桂 R4曾峰毅 R1吳政達 Indication Of Emergent Operation 劉振麟 (M,1950/12/20,61y2m) 手術日期 2011/02/03 手術主治醫師 詹志洋 手術區域 東址 022房 01號 診斷 Disseminated malignant neoplasm 器械術式 Port-A catheter Removal/WOR 手術類別 緊急手術 手術部位 胸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 張得一, 時間資訊 10:09 通知急診手術 20:20 報到 20:20 進入手術室 20:39 麻醉開始 20:42 手術開始 20:42 誘導結束 21:05 麻醉結束 21:05 手術結束 21:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 皮下肌肉或深部異物取出術 1 1 R 記錄__ 手術科部: 腫瘤醫學部 套用罐頭: Port-A removal 開立醫師: 張得一 開立時間: 2011/02/03 21:09 Pre-operative Diagnosis Port-A infection Post-operative Diagnosis Port-A infection Operative Method Port-A removal Specimen Count And Types culture x 1, tip culture x 1 Pathology Operative Findings Pus was seen with exposure of the Port-A through a 0.4x0.4cm skin wound Inflammation(+) Operative Procedures Local anesthesia Skin prepare and drape Remove the Port-A N/S and B-I solution irrigation Close wound with 3-0 Vicryls and 3-0 Nylon Operators VS 詹志洋 Assistants R3 張得一 Indication Of Emergent Operation 林尊煌 (M,1952/06/05,59y9m) 手術日期 2011/02/04 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Brain tumors, malignant 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 王永彬 ASA 3E 紀錄醫師 羅偉誠, 時間資訊 00:18 臨時手術NPO 00:18 開始NPO 08:18 通知急診手術 14:05 報到 14:20 進入手術室 14:30 麻醉開始 14:50 誘導結束 14:57 抗生素給藥 15:32 手術開始 18:00 抗生素給藥 18:42 麻醉結束 18:42 手術結束 18:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除-手術時間在4小時以內 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for total tumor removal 開立醫師: 羅偉誠 開立時間: 2011/02/04 19:06 Pre-operative Diagnosis Right frontal tumor with bleeding, suspect HCC metastasis Post-operative Diagnosis Right frontal tumor with bleeding, suspect HCC metastasis Operative Method Craniotomy for total tumor removal Specimen Count And Types 1 piece About size:5cmx3cmx3cm Source:right frontal brain tumor Pathology Pending Operative Findings The tumor was gray-whitish, and soft one. It was lobulated and well capsuled. Peripheral hemosiderin deposition was noted and some hematoma was also noted inside the tumor. After total removal of the tumor, a small leakage was noted from the right lateral ventricle, and was well packed. The dura was repaired with fascia graft. Operative Procedures 1. ETGA, supine position and head fixed with Mayfield clump 2. Bicoronal scalp incision and the anterior edge of the right temporal muscle was dissected 3. Two bur holes were made and an about 10x10cm craniotomy window was created 4. Proper tenting, ECHO guided tumor localization, and then the dura was opened in a crucial shape 5. An about 5cm corticotomy was done and the tumor was exposed 6. Dissect the plane between the brain parychema and tumor capsule 7. Remove the tumor piece by piece 8. Hemostasis, deair, and close the dura with fascia graft 9. Fixed the skull graft with miniplates x3, and central tented 10.Set an epidural CWV drain 11.Close the wound in layers Operators VS 王國川 Assistants R6 陳睿生, R1 羅偉誠 Indication Of Emergent Operation 林尊煌 (M,1952/06/05,59y9m) 手術日期 2011/02/07 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 Brain tumors, malignant 器械術式 Right frontal sinus repair 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3E 紀錄醫師 范玉君, 時間資訊 12:30 臨時手術NPO 12:30 開始NPO 12:57 通知急診手術 15:20 報到 15:40 進入手術室 15:50 麻醉開始 15:55 誘導結束 16:25 手術開始 17:10 手術結束 17:10 麻醉結束 17:18 送出病患 17:20 進入恢復室 19:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 顱骨切除術,包括異物移除或壓或經切斷 1 2 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Craniectomy for repair of frontal sinus and d... 開立醫師: 胡朝凱 開立時間: 2011/02/07 17:24 Pre-operative Diagnosis CSF leakage Post-operative Diagnosis CSF leakage Operative Method Craniectomy for repair of frontal sinus and dural leak Specimen Count And Types nil Pathology nil Operative Findings 1.Clear CSF spillage from the suture line of previous duroplasty 2.Frontal sinus was opened previously and it was sealed with one piece of fascia and Tissucal-duo Operative Procedures 1.ETGA, supine 2.skin incision via previous wound 3.Reflect skin flap and muscle flap 4.Previous bone graft removal 5.Insert gelfoam then packed with tissucal-duo, then one piece of fascia insertion, followed by tissucal-duo packing 6.duroplasty suture line was sealed with tissucal-duo 7.Fixed bone graft back 8.Close wound in layers after CWV drain insertion Operators 王國川 Assistants 胡朝凱, 范玉君 Indication Of Emergent Operation 楊春菊 (F,1952/03/14,60y0m) 手術日期 2011/02/07 手術主治醫師 王國川 手術區域 東址 003房 03號 診斷 Cellulitis 器械術式 Left, craniectomy 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3E 紀錄醫師 范玉君, 時間資訊 10:00 開始NPO 10:00 臨時手術NPO 12:24 通知急診手術 17:44 進入手術室 17:50 麻醉開始 18:05 誘導結束 18:19 手術開始 19:10 送出病患 19:10 麻醉結束 19:10 手術結束 醫令資訊 類別 名稱 量 刀 側 手術 顱骨切除術,包括異物移除或壓或經切斷 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 記錄__ 手術科部: 外科部 套用罐頭: Left craniectomy and debridement 開立醫師: 胡朝凱 開立時間: 2011/02/07 19:22 Pre-operative Diagnosis Left epidural abscess Post-operative Diagnosis Left epidural abscess Operative Method Left craniectomy and debridement Specimen Count And Types pus cultrue tubes x 3 Pathology pending Operative Findings 1.frank pus was noted at subgalea to epidural space 2.Dura was intact 3.Granulation tissue was also noted that adhered to dura Operative Procedures 1.ETGA, supine 2.Left previous skin incision 3.Reflect skin flap anteriorly 4.Remove bone cement then previous bone graft 5.Debridment of granulation tissue and pus 6.gentamycin water irrigation 7.set two CWV drain 8.close wound with whole layer Nylon suture Operators 王國川 Assistants 胡朝凱, 范玉君 Indication Of Emergent Operation 傅邦正 (M,1962/12/27,49y2m) 手術日期 2011/02/08 手術主治醫師 吳毅暉 手術區域 東址 016房 02號 診斷 Acute leukemia of unspecified cell type 器械術式 Port-A Implatation /WOR 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 羅健洺, 時間資訊 10:45 報到 10:55 進入手術室 11:00 麻醉開始 11:05 誘導結束 11:10 手術開始 11:25 麻醉結束 11:25 手術結束 11:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 內頸靜脈切開,永久導管放置術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Port-A 開立醫師: 陳政維 開立時間: 2011/02/08 11:14 Pre-operative Diagnosis Lymphoma Post-operative Diagnosis Ditto Operative Method Port-A catheter implantation, echo guided Specimen Count And Types nil Pathology nil Operative Findings Puncture to right IJV under echo guidance The venous blood flow freely in the Port-A catheter after implantation. Operative Procedures The patient was put on supine position. The operation field was disinfected and draped as usual. Under local anesthesia, we puncture to right IJV under echo guidance. After creating subcutaneous pocket, the Port-A catheter was inserted via peel away sheath. We close the wound in layers. Post-op care plan: 1.wound CD QD+PRN 2.pain control with tinten 3.prophylatic antibiotics use Operators VS吳毅暉 Assistants R4羅健洺 陳椲彬 (M,2001/05/05,10y10m) 手術日期 2011/02/08 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(Others) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:05 進入手術室 08:10 麻醉開始 08:39 誘導結束 08:45 抗生素給藥 09:42 手術開始 15:15 麻醉結束 15:15 手術結束 15:25 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除-手術時間在4~8小時 1 1 記錄__ 手術科部: 外科部 套用罐頭: Suboccipital craniotomy for total tumor excision. 開立醫師: 鍾文桂 開立時間: 2011/02/08 18:37 Pre-operative Diagnosis Low grade astrocytoma, cerebellar tonsil, recurrent. Right cerebellar tonsil low grade astrocytoma, S/P, with recurrence Post-operative Diagnosis Low grade astrocytoma, cerebellar tonsil, recurrent. Right cerebellar tonsil low grade astrocytoma, S/P, with recurrence Operative Method Suboccipital craniotomy for total tumor excision. Suboccipital craniectomy for total tumor excision. Specimen Count And Types 1 piece About size:5cc Source:cerebellar tumor Pathology Pending. Operative Findings The suboccipital craniectomy is more on the right side. Severe scar formation during dissection of the midline and dura mater due to previous opreation. The dura mater was thickened and tough. Intraoperative ultrasonography was used to locate the tumor mass. The orevious suboccipital craniectomy was located at right side with extension across the midline to left for 1cm distance. Severe scar formation was noted at the skin, subcutaneous and paraspinal and dural levels due to previous opreation. The dura mater was thickened and tough. The posterior ring of C1 has been removed in previous operation. Intraoperative ultrasonography was used to locate the tumor mass before opening the dura. Suboccipital craniectomy was performed in previous operation. The C1 posterior arch was removed. Some cartilaginous change was noted over the area. Some cartilaginous change was noted over the C1 area. Two major components of the gray-reddish elastic tumor mass were noted. One located at the right cerebellar hemisphere attached to the surrounding firm and elastic gliosis. The other located at midline vermis region has severe attachment to the dura mater.A cystic part was noted. After decompression, the foramen Magendi and the floor of 4 ventricle were noted. The right PICA and upper cervical roots were well preserved. Two major components of the gray-reddish elastic tumor mass were noted. One located and originated at the right cerebellar tonsil with extension to the foramen of Megendie and to the dorsal surface of right cerviomedullary junction. This part of tumor was soft and hypervascular at the medial side with some cystic formation and hard and fibrotic at the right lateral margin. The other part was located close to midline and was just located beneath the upper part of the dural opening with marked attachment to the dura mater. After decompression, the foramen Magendi and the lower part of the floor of the 4th ventricle were noted. The right PICA and upper cervical roots were well preserved. The dural defect was repaired by TissueCoDuo. The dural defect was reinforced by TissueCoDuo after primary closure of it. Operative Procedures Under ETGA, the patient was placed in prone position. The head was fixed by 3-pin Mayfield head holder and in midline position. After shaving, disinfection, and draping, the previous operative wound was incised. trimming of the hypertrophic scar tissue was done for cosmetics. After midline dissection, we outlined the previous craniectomy window with meticulous lysis of the scar tissue. Further craniectomy was done with 2mm and 3mm Kerrison punch. Then, the dura mater was incised in curvilinear fashion. The CSF from the cisterna magna was drained for further decompression. The tumor mass was seperated from the dura mater by using dissector. The tumor was excised in two steps according to the two major components of the tumor. After well hemostasis, the dura mater was repaired with TissueCoDuo and 4-0 Prolene. Finally, the wound was closed in layers. Under ETGA, the patient was placed in prone position. The head was fixed by 3-pin Mayfield head holder and in midline position. After shaving, disinfection, and draping, the previous operative wound was incised. Trimming of the hypertrophic scar tissue was done for cosmetics. After midline dissection, we outlined the previous craniectomy window with meticulous lysis of the scar tissue. Further craniectomy was done with 2mm and 3mm Kerrison punch. Then, the dura mater was incised in curvilinear fashion under microscpoc view. The CSF from the cisterna magna was drained for further decompression. The tumor mass was seperated from the dura mater by using dissector. The tumor was excised in two steps according to the two major components of the tumor. After total excison of the tumor and well hemostasis, the dura mater was closde primarily with 4-0 prolene then reinforced with TissueCoDuo. Finally, the wound was closed in layers without drainage tube left. Operators V.S. 郭夢菲 Assistants R5 鍾文桂 卓美華 (F,1973/02/17,39y0m) 手術日期 2011/02/08 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Spinal neuroma 器械術式 Benign intraspinal tumor, exci 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 07:37 報到 08:03 進入手術室 08:12 麻醉開始 08:25 誘導結束 08:35 抗生素給藥 08:37 手術開始 11:45 抗生素給藥 13:30 麻醉結束 13:30 手術結束 13:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 良性脊髓腫瘤切除術 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Intraspinal tumor excision 開立醫師: 李振豪 開立時間: 2011/02/08 13:48 Pre-operative Diagnosis Intraspinal tumor, suspect C2 neuroma Post-operative Diagnosis Left C2 neuroma Operative Method Intraspinal tumor excision Specimen Count And Types 1 piece About size:10g Source:Intraspinal tumor Pathology Pending Operative Findings The poor waveform of SSEP over four limbs(especially right) were noted before the operation. The MEP over right side limbs were absent before the operation. The tumor was encountered after detached the paraspinal muscle group. The left C1 and C2 lamina were erosed by the tumor. The tumor was well capsulated, firm, whitish, and hypervascularized in character which originated from the left C2 root. The thecal sac was tightly compressed by the tumor was decompressed well after total removal of the tumor. No obvious EP change was noted during whole procedure. The intrathecal space was not entered and no CSF leakage was noted during the operation. The left C2 root was transected for total removal of the tumor. The poor waveform of SSEP over four limbs(especially right) were noted before the operation. The MEP over right side limbs were absent before the operation. The tumor was encountered after detached the paraspinal muscle group. The left C1 and C2 lamina were erosed by the tumor. The tumor was 2.5x4x3cm in size, well capsulated, firm, whitish, and hypervascularized in character which originated from the left C2 root. The thecal sac was tightly compressed by the tumor was decompressed well after total removal of the tumor. No obvious EP change was noted during whole procedure. The intrathecal space was not entered and no CSF leakage was noted during the operation. The left C2 root was transected for total removal of the tumor. Operative Procedures Under nasal endotracheal tube general anesthesia, the patient was put in prone position with head fixed with Mayfield scalp clamp. The scalp was shaved, scrubbed, and disinfected as usual. The midline skin incision was made at C1-2 level. The subcutaneous soft tissue and paravertebral muscle group were detached to expose the tumor. The capsule of the tumor was identified. The junction between the bony structure and the tumor was exposed. The capsule was opened and the tumor was debulking with bipolar electrocautery, sucker, tumor forceps, scissor, and CUSA. After central debulking, the tumor was removed totally. The left C2 root was transected for total removal of the tumor. Hemostasis was achieved with bipolar electrocautery and Surgicel packing. The wound was then closed in layers. Operators VS賴達明 Assistants R4李振豪, R2曾偉倫 相關圖片 潘黃枝葉 (F,1957/07/01,54y8m) 手術日期 2011/02/08 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Meningioma 器械術式 Benign intraspinal tumor, exci 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 13:35 報到 14:03 進入手術室 14:08 麻醉開始 14:20 誘導結束 14:23 抗生素給藥 14:25 手術開始 17:05 麻醉結束 17:05 手術結束 17:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 良性脊髓腫瘤切除術 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: C2-3 laminotomy for tumor excision 開立醫師: 李振豪 開立時間: 2011/02/08 17:06 Pre-operative Diagnosis C2-3 intraspinal tumor, suspect meningioma Post-operative Diagnosis C2-3 intraspinal tumor, suspect meningioma Operative Method C2-3 laminotomy for tumor excision Specimen Count And Types 1 piece About size:2g Source:Intraspinal tumor Pathology Pending Operative Findings The tumor was 0.8x0.8x0.4cm in size, whitish, soft, hypovascularized in character and attached to the posterior part of thecal sac. The spinal cord was compressed but not invaded by the tumor. The tumor was total removed. No SSEP or MEP change was noted during whole procedure. The tumor was 0.8x0.8x0.4cm in size, well-capsulated, whitish, soft, hypovascularized in character and attached to the posterior part of thecal sac. The spinal cord was compressed but not invaded by the tumor. The tumor was total removed. No SSEP or MEP change was noted during whole procedure. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in prone position with head fixed with Mayfield scalp clapm. The midline skin incision was made at C2-3 level. The subcutaneous soft tissue and paravertebral muscle group were detached. Laminotomy at C2-3 level was performed with Rongeur, Midas air-drived drills and Kerrison punches. Linear durotomy was performed with knife and the tumor was identified after dura opening. The dura was removed by microdissector and curette. The dura was closed with 5-0 Prolene. Hemostasis was achieved with bipolar electrocautery and Gelform packing. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS賴達明 Assistants R4李振豪, R2曾偉倫 相關圖片 劉敦仁 (M,1954/03/24,57y11m) 手術日期 2011/02/08 手術主治醫師 賴達明 手術區域 東址 005房 03號 診斷 Lumbar spondylosis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾峰毅, 時間資訊 13:10 報到 13:20 進入手術室 13:25 麻醉開始 13:35 誘導結束 13:56 抗生素給藥 14:12 手術開始 16:40 手術結束 16:40 麻醉結束 16:55 進入恢復室 18:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎弓切除術(減壓)-二節以內 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 曾峰毅 開立時間: 2011/02/08 16:51 Pre-operative Diagnosis Spinal stenosis, L4/5 Post-operative Diagnosis Spinal stenosis, L4/5 Operative Method L4 laminectomy; posterior fixatiion with TPS at L4/5; posterolateral fusion with autologous bone graft. Specimen Count And Types Nil Pathology Nil Operative Findings Hypertrophic ligamentum flavum compressed the thecal sac tightly. The neural structures were decompressed well after the surgery. Synthese 6.5 mm x 45 mm transpedicular screws and 5 cm rods were used for posterior fixation. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After C-arm localization, we scrubbed, disinfected, and then draped the back. We made one midline skin incision and dissected the paraspinal muscles of L4/5 to expose bilateral laminae of L4/5. We inserted transpedicular screws into bilateral pedicles of L4/5, and peformed L4 laminectomy for decompression. Rods was set for fixation after posterolateral fusion with autologous bone graft. We inserted two hemovacs, and closed the wound in layers. Operators VS 賴達明 Assistants R4 曾峰毅 Ri 王逸萍 鍾阿株 (M,1932/11/22,79y3m) 手術日期 2011/02/08 手術主治醫師 蕭輔仁 手術區域 東址 005房 01號 診斷 Intraspinal abscess 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 曾峰毅, 時間資訊 07:50 報到 08:00 進入手術室 08:05 麻醉開始 08:20 誘導結束 08:20 抗生素給藥 09:00 手術開始 11:10 手術結束 11:10 麻醉結束 11:22 送出病患 11:24 進入恢復室 13:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 曾峰毅 開立時間: 2011/02/08 11:17 Pre-operative Diagnosis L2/3 spondylodiskitis, resovled Post-operative Diagnosis L2/3 spondylodiskitis, resovled Operative Method Posterior fixation with transpedicular screws at L2/3, and posteroloateral fusion with artifical and autologous bone graft Specimen Count And Types Nil Pathology Nil Operative Findings Four A-Spine 6.5 mm x 4.5 cm transpedicular screws was used with two 6 cm rods. Simbone HT was used for fusion. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After C-arm localization, we scrubbed, disinfected, and then draped the back. We made midline skin incision, and dissected paraspinal muslces to expose bilateral laminae of L2/3. We performed posterior fixation with TPS at L2/3. We removed spinous processes of L2/3, and achieved posterolateral fusion with artificial bone graft and autologous bone graft after decortication of laminae. We inserted two hemovac, and closed the wound in layers. Operators VS 蕭輔仁 Assistants R4 曾峰毅 Ri 王逸萍 周月卿 (F,1937/06/10,74y9m) 手術日期 2011/02/08 手術主治醫師 蕭輔仁 手術區域 東址 005房 02號 診斷 Spinal Stenosis 器械術式 Radiofrequency coagulation 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 曾峰毅, 時間資訊 11:16 報到 11:44 進入手術室 11:50 抗生素給藥 12:10 手術開始 12:55 手術結束 13:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 高頻熱凝療法 1 1 B 摘要__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 曾峰毅 開立時間: 2011/02/08 13:01 Pre-operative Diagnosis Low back pain Post-operative Diagnosis Low back pain Operative Method Raiofrequency for neuromodulation Specimen Count And Types Nil Pathology Nil Operative Findings Neuromodulation was performed. Operative Procedures The patient was put in prone positino. After C-arm localization, we inserted radiofrequency into bilatearl neural foramen of L2. Radiofrequency for neuromodulation was performed. We injected steroid and local anaestehsiat to bilateral SI joints. Operators VS 蕭輔仁 Assistants R4 曾峰毅 蕭錦龍 (M,1946/11/01,65y4m) 手術日期 2011/02/10 手術主治醫師 杜永光 手術區域 東址 001房 06號 診斷 Patent ductus arteriosus 器械術式 VP shunt ligation 手術類別 緊急手術 手術部位 胸 傷口分類 清潔 麻醉方式 面罩麻醉 麻醉主治醫師 葉惠敏 ASA 3E 紀錄醫師 鍾文桂, 時間資訊 13:00 臨時手術NPO 13:00 開始NPO 15:27 通知急診手術 23:23 報到 00:05 進入手術室 00:18 麻醉開始 00:20 抗生素給藥 00:22 誘導結束 00:39 手術開始 00:50 手術結束 00:50 麻醉結束 00:55 送出病患 01:00 進入恢復室 02:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Semi-opened mask inhalation anes 1 0 手術 深部傷口處理縫合擴創-小 1 0 R 記錄__ 手術科部: 外科部 套用罐頭: Ligation of ventriculoperiotneal shunt at rig... 開立醫師: 鍾文桂 開立時間: 2011/02/10 01:08 Pre-operative Diagnosis Hydrocephalus status post V-P shunt implantation, with slit ventricles. Post-operative Diagnosis Hydrocephalus status post V-P shunt implantation, with slit ventricles. Operative Method Ligation of ventriculoperiotneal shunt at right clavicle. Specimen Count And Types nil Pathology Nil. Operative Findings Transparent peritoneal shunt catheter was explored after dissection. Two ligation sites above and below the wound incision. Operative Procedures Under ETGA, the patient was placed in supine position. After disinfection and draping, a linear 1.5 cm incision was made at right clavicle upon palpating the shunt catheter site. After dissection, the catheter was exposed. Ligation of the catheter was achieved by 2-0 silk above and below the wound incision. Finally the wound was closed in layers. Operators Prof. 杜永光 Assistants R5 鍾文桂 Indication Of Emergent Operation 黃卓梅妹 (F,1942/01/23,70y1m) 手術日期 2011/02/09 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Spine tumor 器械術式 Benign intraspinal tumor, exci 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 王奐之, 時間資訊 07:58 報到 08:00 進入手術室 08:10 麻醉開始 08:30 誘導結束 08:37 手術開始 08:40 抗生素給藥 11:40 抗生素給藥 13:15 麻醉結束 13:15 手術結束 13:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 良性脊髓腫瘤切除術 1 1 R 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 記錄__ 手術科部: 外科部 套用罐頭: Tumor excision 開立醫師: 胡朝凱 開立時間: 2011/02/09 13:33 Pre-operative Diagnosis Right C2-3 intradural extramedullary tumor, suspected neuroma Post-operative Diagnosis Right C2-3 intradural extramedullary tumor, suspected neuroma Operative Method Tumor excision Specimen Count And Types 1 piece About size:pieces Source:intradural tumor Pathology Pending Operative Findings Whitish elastic tumor were noted at right C2-3 level, arising from the posterior ramus and motor part of C2 root, compressing the cord tightly. The tumor extended through right C2 neural foramen, the foramen was not enlarged. No SSEP or MEP change was encountered throughout the operative procedure. Operative Procedures After ETGA, the patient was placed in prone position with head fixed in Mayfield skull clamp and neck extended. After skin disinfection and draping in sterile fashion, a midline skin incision was made at posterior upper neck. The incision was deepened until C2-4 spinous process were exposed. The paraspinal muscles were then detached from C2-4 spinous process and lamina. Right side C2-3 lamina were drilled open, the C2-3 lamina were flipped to the left side, exposing the right aspect of thecal sac. A longitudinal durotomy was made, the tumor was then dissected from the dura and nearby nerve roots. Central debulky was done initially, the tumor was removed in piecemeal fashion by currette and tumor forceps. Capsule was left in situ with preservation of nerve roots. After tumor removal and achieving meticulous hemostasis with Gelfoam packing, the dura was closed with 5-0 Prolene in continuous suture. The C2-3 lamina was fixed back with mini-plates. The paraspinal muscles were approximated and the wound was closed in layers after one CWV drain insertion. Operators P 杜永光 Assistants R6 胡朝凱, R3 王奐之 相關圖片 葉榮華 (M,1922/03/20,89y11m) 手術日期 2011/02/09 手術主治醫師 蔡瑞章 手術區域 東址 005房 04號 診斷 Subdural hemorrhage 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 3E 紀錄醫師 鍾文桂, 時間資訊 18:00 臨時手術NPO 18:00 開始NPO 21:17 報到 21:30 進入手術室 21:35 麻醉開始 21:45 誘導結束 21:45 開始輸血 21:50 抗生素給藥 23:00 手術開始 23:40 麻醉結束 23:40 手術結束 23:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 記錄__ 手術科部: 外科部 套用罐頭: Burr hole for evacuation of chronic subdural ... 開立醫師: 鍾文桂 開立時間: 2011/02/09 23:59 Pre-operative Diagnosis Left frontal-temporal-parietal chronic subdural hemorrhage. Post-operative Diagnosis Left frontal-temporal-parietal chronic subdural hemorrhage. Operative Method Burr hole for evacuation of chronic subdural hemorrhage. Specimen Count And Types nil Pathology Nil. Operative Findings Clear reddish subdural hemorrhage with low pressure. Difficult Foley insertion due to urethral stricture( BPH s/p op). We consulted Urologist for Foley insertion. Operative Procedures Under ETGA, the patient was placed in supine position and the head tilted to the right. After shaving, disinfection, and draping, a horizontal linear scalp incision was made. Then, a burr hole was created. After dural tenting and durotomy, the subdural hemorrhage drained out. We placed a subdural rubber drain in situ. Finally, the wound was closed in layers. Operators V.S. 蔡翊新 Assistants R5 鍾文桂 Indication Of Emergent Operation 陳玥伶 (F,2009/05/25,2y9m) 手術日期 2011/02/09 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Subdural hemorrhage (SDH) 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 08:20 報到 08:21 進入手術室 08:25 麻醉開始 08:35 誘導結束 09:52 手術開始 10:40 開始輸血 11:00 抗生素給藥 13:10 麻醉結束 13:10 手術結束 13:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 頭顱成形術 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Cranioplasty with autologous bone graft, left... 開立醫師: 鍾文桂 開立時間: 2011/02/09 16:53 Pre-operative Diagnosis Severe head injury with acute SDH, status post craniectomy,left frontal-temporal-pareital. Skull bone defect after acute SDH, status post craniectomy,left frontal-temporal-pareital. Post-operative Diagnosis Severe head injury with acute SDH, status post craniectomy ,left frontal-temporal-pareital.. Skull bone defect after acute SDH, status post craniectomy,left frontal-temporal-pareital. Operative Method Cranioplasty with autologous bone graft, left frontal-temporal-pareital. Specimen Count And Types nil Pathology Nil. Operative Findings Large areas of dural defect were noted. They were repaired with DuraFoam. A small part of brain parenchyma was injured at temporal area. Large areas of dural defect were noted. They were previously repaired with DuraFoam. The brain was mildly swollen, but the ICP could be reduced by releasing some CSF from the EVD drainage system. The dura and temporalis muscle were retracted toward the temporal base side. Two pieces of the autologous bone was fixed by # 27 wires. Two pieces of the autologous bone was fixed by 3 #28 wires. Operative Procedures After ETGA, the patient was placed in supine position and the head tilted to the right. After shaving, disinfection, and draping, the previous operative wound was incised and dissected meticulously along the subgaleal space. The craniectomy margin was outlined by dissection of the fibrotic tissue. Then, DuraFoam was placed over the dural defect. Bridged sutures from the remaining dura mater to the craniectomy dural edges were made. The autologous bone graft was fixed by micro plates and screws. After ETGA, the patient was placed in supine position and the head tilted to the right. After shaving, disinfection, and draping, the previous operative wound was incised and dissected meticulously along the subgaleal space. The craniectomy margin was outlined by dissection of the fibrotic tissue. Then, three pieces of DuraFoam (3X1.5 inches for two, and 3X1 inches for one) were placed over the dural defect. Many bridged sutures from the remaining dura mater to the craniectomy dural edges were made with silk to hold the DuroFoam in place. The autologous bone graft was fixed by micro plates and screws. After placing one subgaleal CWV drain, the wound was closed in layers. Operators V.S. 郭夢菲 Assistants R5 鍾文桂 賴彩燕 (F,1958/11/10,53y4m) 手術日期 2011/02/09 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Sciatica 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 王奐之, 時間資訊 13:45 進入手術室 13:50 麻醉開始 13:55 誘導結束 14:00 抗生素給藥 14:32 手術開始 17:05 手術結束 17:05 麻醉結束 17:15 送出病患 17:20 進入恢復室 18:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 記錄__ 手術科部: 外科部 套用罐頭: L4~5 TPS and cage insertion 開立醫師: 胡朝凱 開立時間: 2011/02/09 17:14 Pre-operative Diagnosis L4~5 spondylolisthesis and spinal stenosis Post-operative Diagnosis L4~5 spondylolisthesis and spinal stenosis Operative Method L4~5 TPS and cage insertion Specimen Count And Types nil Pathology nil Operative Findings 1.Anterior listhesis of L4 on L5 2.hypertrophic flavum ligment 3.After decompression, the thecal sac and nerve roots became loose 4.Screws: 60x40 x 4, 5 cm rods Operative Procedures 1.ETGA, prone 2.Midline skin incision at L4~5 level 3.Deatch paravertebral muscle 4.TPS screws insertion 5.Laminectomy of L4 6.discectomy 7.cage insertion 8.Fixed rods 9.Hemostasis and insert hemovac drain 10.Close wound in layers Operators 賴達明 Assistants 胡朝凱, 王奐之 相關圖片 陳威江 (M,1982/09/27,29y5m) 手術日期 2011/02/09 手術主治醫師 賴達明 手術區域 東址 005房 01號 診斷 Neoplasm of unspecified nature of brain 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 張廷碩, 時間資訊 07:45 報到 08:03 進入手術室 08:14 麻醉開始 08:40 誘導結束 08:55 抗生素給藥 08:55 手術開始 10:40 開始輸血 11:55 抗生素給藥 14:45 麻醉結束 14:45 手術結束 15:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除-手術時間在4~8小時 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Craniectomy for Simpson^s grade.II total tumo... 開立醫師: 陳睿生 開立時間: 2011/02/09 15:39 Pre-operative Diagnosis Right occipital tumor, suspect meningioma with bone invasion Post-operative Diagnosis Right occipital tumor, suspect meningioma with bone invasion Operative Method Craniectomy for Simpson^s grade.II total tumor remove and cranioplasty with mesh plate Specimen Count And Types 2 pieces About size:8x8x8cm Source:tumor About size:3x3cm Source:bone Pathology Pending Operative Findings The tumor was about 8x8x8 cm in size. It was an extraxial one and the plane between the tumor capsule and brain cortex was clear. The tumor was dark reddish and well vascularized. Some supply vessels were noted. Whitish capsule was noted and several drainage veins were noted. A thick cortical vein was noted across the tumor at medial side. The sinus margin was teared intra-op and packing hemostased. Two sites of dura invasion was noted at right occipital region, and bony invasion was also noted. The dura was repaired with fascia and the craniectomy space was packed with mesh plate. Operative Procedures 1. ETGA, prone position, head right tilt and fixed with Mayfield clump 2. Incise into the right occipital scalp at inverse U shape 3. An about 12x12 cm craniectomy was created 4. After dura tenting, the dura was opened along the craniectomy window 5. The tumor was identified and the plane between the arachnoid membrane and tumor capsule was dissected 6. The tumor capsule was carefully exposed, and superficial drainage veins were electroligated 7. After tumor remove, hemostasis was done; a bleeding deep cortical vein and the teared sinus margin were well hemostated 8. The wound was extended at right parietal region about 5cm, and another 5x5cm craniectomy window was opened to remove the invaded skull 9. The involved dura was removed and the dura was repaired with fascia graft 10.The skull defect was repaired with mesh plate 11.A subgaleal CWV drain was set, and the wound was closed in layers Operators VS 賴達明 Assistants R6 陳睿生 R1 張廷碩 郭張敏惠 (F,1941/05/06,70y10m) 手術日期 2011/02/09 手術主治醫師 賴達明 手術區域 東址 005房 02號 診斷 Spine tumor 器械術式 Benign intraspinal tumor, exci 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 張廷碩, 時間資訊 14:40 報到 15:23 進入手術室 15:30 麻醉開始 15:40 誘導結束 15:40 抗生素給藥 16:00 手術開始 18:40 抗生素給藥 20:10 麻醉結束 20:10 手術結束 20:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 良性脊髓腫瘤切除術 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: C2, C3 laminoplasty for Simpson Gr. III tumor... 開立醫師: 陳睿生 開立時間: 2011/02/09 20:46 Pre-operative Diagnosis C2-3 intraspinal tumor, suspect meningioma Post-operative Diagnosis C2-3 intraspinal tumor, suspect meningioma Operative Method C2, C3 laminoplasty for Simpson Gr. III tumor remove C2, C3 laminoplasty for Simpson Gr. II tumor remove Specimen Count And Types 1 piece About size:pieces Source:tumor Pathology Pending Operative Findings The tumor was whitish, soft, and capsuled. The capsule was mildly adhered with the arachnoid membrane. The tumor was located at the dorsal side and mainly left. C2, 3 laminoplasty was performed with miniplates at C3 level. Intra-op SSEP showed no obvious change. Operative Procedures 1. ETGA, prone position and head fixed with Mayfield 2. Posterior neck midline incision 3. Split latissmus dorsi and paraspinal muscles and expose the C2-C3 spinous process, and lamina 4. Do lower C2 and C3 laminectomy with high speed drill 5. Hemostasis, incise into the dura and tented 6. Identify the tumor and central debulked 7. C2 hemilaminectomy was done to extend the dura opening 8. Dissect the tumor capsule from the dura, and totally remove of the tumor 9. The residual tumor capsule was electroligated 10.The dura was tightly closed and the C2,3 lamina was fixed back with miniplates 11.A CWV drain was set, and the wound was closed in layers Operators VS 賴達明 Assistants R6 陳睿生, R1 張廷碩 張志豪 (M,1991/06/04,20y9m) 手術日期 2011/02/09 手術主治醫師 賴達明 手術區域 東址 003房 03號 診斷 Herniation of intervertebral disc (HIVD) 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 王奐之, 時間資訊 17:25 進入手術室 17:30 麻醉開始 17:45 誘導結束 17:53 抗生素給藥 18:19 手術開始 20:00 手術結束 20:00 麻醉結束 20:10 送出病患 20:15 進入恢復室 21:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 椎間盤切除術-腰椎 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Microscopic discectomy 開立醫師: 胡朝凱 開立時間: 2011/02/09 19:48 Pre-operative Diagnosis Right L4~5 HIVD Post-operative Diagnosis Right L4~5 HIVD Operative Method Microscopic discectomy Specimen Count And Types nil Pathology nil Operative Findings 1.Protruding disc that compressed the right L5 nerve root was noted. And the root became flattened due to the compression. 2.The disc was not dehydrated 3.After decompression, the root became loose Operative Procedures 1.ETGA, prone 2.Midline skin incision at L4~5 level 3.Detach paravertebral muscle 4.Right L4 laminotomy 5.Resect flavum ligment 6.identified nerve root and retract medially 7.discectomy 8.hemostasis 9.Close wound in layers Operators 賴達明 Assistants 胡朝凱, 王奐之 相關圖片 張偉明 (M,1948/06/11,63y9m) 手術日期 2011/02/09 手術主治醫師 黃培銘 手術區域 東址 023房 04號 診斷 Head injury, unspecified 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 4 紀錄醫師 蔡東明, 時間資訊 14:05 報到 14:05 進入手術室 14:10 麻醉開始 14:15 抗生素給藥 14:15 誘導結束 14:27 手術開始 14:40 麻醉結束 14:40 手術結束 14:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 氣管切開術 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 蔡東明 開立時間: 2011/02/09 14:56 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types Nil Pathology None Operative Findings Fr . 8 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators VS黃培銘 Assistants R4蔡東明 許進興 (M,1940/07/09,71y8m) 手術日期 2011/02/09 手術主治醫師 蔡翊新 手術區域 東址 001房 02號 診斷 Injury (severeity score >=16) 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 4E 紀錄醫師 曾峰毅, 時間資訊 04:00 臨時手術NPO 04:00 開始NPO 10:45 通知急診手術 11:40 進入手術室 11:45 麻醉開始 11:50 抗生素給藥 11:50 誘導結束 12:20 手術開始 13:00 手術結束 13:00 麻醉結束 13:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱內壓視置入 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 曾峰毅 開立時間: 2011/02/09 13:09 Pre-operative Diagnosis IVH Post-operative Diagnosis IVH Operative Method External ventricular drainage, right Kocher Specimen Count And Types CSF was sent for routine, BCS, and culture. Pathology Nil Operative Findings Light-pinkish CSF drained while ventriculostomy. Light-pinkish CSF drained while ventriculostomy. Opening pressure was about 2 cmH20, and dropped to 10 cm H20 after 15ml CSF drained. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position. After head shaved, scrubbed, disinfected, and then draped, we made one transverse skin incision at right frontal area. We drilled one burr hole, and then created durotomy. We inserted ventricular cathter, and closed the wound in layers. Operators VS 蔡翊新 Assistants R4 曾峰毅 Indication Of Emergent Operation 顏素英 (F,1957/12/01,54y3m) 手術日期 2011/02/09 手術主治醫師 張道遠 手術區域 兒醫 065房 03號 診斷 Menopause 器械術式 VTH+SSS+APR 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 2 紀錄醫師 烏恩慈, 時間資訊 14:50 報到 15:05 進入手術室 15:15 麻醉開始 15:20 誘導結束 15:25 抗生素給藥 15:38 手術開始 17:36 手術結束 17:36 麻醉結束 17:42 送出病患 17:45 進入恢復室 19:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 經陰道骨盆底重建手術(含子宮切除術,陰道懸吊術,陰道前後壁修補含子宮切除術但不含尿 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 記錄__ 手術科部: 婦產部 套用罐頭: VTH 開立醫師: 烏恩慈 開立時間: 2011/02/09 17:48 Pre-operative Diagnosis 1.Uterine prolapse stageIV 2. rectocele stage II 3.cystocele stage II Post-operative Diagnosis Ditto Operative Method Vaginal total hysterectomy+SSS + AP repaiir Specimen Count And Types 2 pieces About size:4x3 cm Source:uterus About size:2x2 cm Source:vaginal wall Pathology pending Operative Findings 1. Uterus: prolapge stage IV with edematous change 2. Bilateral adnexa: atrophic change 3. Cystocele: stage II 4. Rectocele: stageII 5. Estimated blood loss:50ml Blood transfusion: nil Complication: nil Operative Procedures 1. Put the patient on the lithotomy position. 2. Vaginal douching and skin disinfection. 3. Submucosal injection of diluted Pitressin (1:100) around the cervix and bladder base. 4. Make incision on the anterior vaginal mucosa and circumcision the cervix. 5. Enter the vescio-cervical space and utero-rectal space with long Kelly. 6. Clamp, cut and suture ligate bilateral vesico-cervical ligaments. 7. Clamp, cut and suture ligate bilateral utero-sacral ligaments. 8. Open the peritoneal cavity, anteriorly and posteriorly. 9. Clamp, cut and suture ligate bilateral cardinal ligaments and broad ligaments. 10. Clamp, cut and suture ligate bilateral tubo-ovarian ligaments and remove the uterus 11. Reperitonization. 12. Approximate the vaginal stump. 13Perform A repair 14. performed P reapir and SSS 13. Pack the vagina with gauze Operators 張道遠, Assistants 烏恩慈, 陳進合 (M,1932/01/27,80y1m) 手術日期 2011/02/10 手術主治醫師 蔡瑞章 手術區域 東址 001房 01號 診斷 Subdural hemorrhage or effusion 器械術式 Burr hole (trephination) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3E 紀錄醫師 李振豪, 時間資訊 00:00 開始NPO 07:53 通知急診手術 09:00 進入手術室 09:05 麻醉開始 09:15 誘導結束 09:20 抗生素給藥 09:43 手術開始 10:55 麻醉結束 10:55 手術結束 11:05 送出病患 11:07 進入恢復室 13:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 頭顱穿洞術(止血引流、穿刺檢查) 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Burr hole drainage 開立醫師: 李振豪 開立時間: 2011/02/10 11:18 Pre-operative Diagnosis Left subdural chronic subdural hematoma Post-operative Diagnosis Left subdural chronic subdural hematoma Operative Method Burr hole drainage Specimen Count And Types 2 pieces About size:0.5cm2 Source:dura About size:15ml Source:subdural collection Pathology Pending Operative Findings The chronic subdural hematoma was brownish in color with increase in viscosity. Septation was noted and the septum was opened during the operation. After open the septum, the subdural effusion was noted with light yellowish in character. The brain remain slack after drainage of the chronic subdural hematoma. Outer membrane and inner membrane were all noted. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine position. The scalp was shaved, scrubbed, and disinfected as usual. The transverse scalp incision was made at left frontal area followed by one burr hole creation. Two dural tenting was performed. One 0.5cm2 dura was excised and sent for pathology. The subdural hematoma was drained and sampled for routine, biochemistry, culture, and cytology study. One subdural rubber drain was placed. Hemostasis was achieved with bipolar electrocautery and gelform packing. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators Prof.蔡瑞章 Assistants R4李振豪, Ri賴品泉 Indication Of Emergent Operation 相關圖片 王南凱 (M,1970/02/19,42y0m) 手術日期 2011/02/10 手術主治醫師 蔡瑞章 手術區域 東址 001房 02號 診斷 Intracranial abscess 器械術式 Burr hole (trephination) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 髒 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 11:28 進入手術室 11:30 麻醉開始 11:35 誘導結束 12:17 手術開始 12:50 抗生素給藥 13:25 手術結束 13:25 麻醉結束 13:40 抗生素給藥 13:43 進入恢復室 15:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 頭顱穿洞術(止血引流、穿刺檢查) 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Burr hole for subdural empyema drainage 開立醫師: 李振豪 開立時間: 2011/02/10 13:51 Pre-operative Diagnosis Left frontal subdural empyema Post-operative Diagnosis Left frontal subdural empyema Operative Method Burr hole for subdural empyema drainage Specimen Count And Types 2 pieces About size:3ml Source:Subudral empyema for bacterial, fungal, and mycobacterial culture About size:1 swab Source:subdural empyema, for gram stain Pathology Nil Operative Findings The subdural empyema was capsulated. The abscess was whitich and thick in character. Much debris was noted during irrigation. The brain expanded rapidly after drainage of the subdural empyema. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine position. The scalp was shaved, scrubbed, and disinfected as usual. The linear scalp incision was made at left frontal area followed by one burr hole creation. Two dural tenting was performed. The dura was opened and the capsule of the empyema was noted. After opening of the capsule of empyema, the abscess gushed out. The specimen was sampled for Gram stain, bacterial, fungal, and mycobacterial culture. The #8 nelaton was used for irrigation of the subdural empyema. After irrigation with normal saline solution, Gentamicin solution(1amp in 500ml N/S) also applied for irrigation. Hemostasis was achieved with bipolar electrocautery. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators Prof.蔡瑞章 Assistants R4李振豪, Ri賴品泉 Indication Of Emergent Operation 相關圖片 伍惇 (M,1940/06/07,71y9m) 手術日期 2011/02/10 手術主治醫師 楊榮森 手術區域 東址 021房 21號 診斷 Malignant neoplasm of rectosigmoid junction 器械術式 PD+PI 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3 紀錄醫師 黃全敬, 時間資訊 15:51 報到 16:05 進入手術室 16:10 麻醉開始 16:45 誘導結束 16:50 抗生素給藥 17:05 手術開始 17:38 開始輸血 18:50 抗生素給藥 20:40 麻醉結束 20:40 手術結束 20:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎弓切除術(減壓)-超過二節 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 骨科部 套用罐頭: 1. posterior instrumentation with pedicle scr... 開立醫師: 黃全敬 開立時間: 2011/02/10 20:14 Pre-operative Diagnosis sigmoid colon cancer with multiple spine metastasis, with cord compression , T7-L1 Post-operative Diagnosis sigmoid colon cancer with multiple spine metastasis, with cord compression , T7-L1 Operative Method 1. posterior instrumentation with pedicle screw x 8 (bilateral T5, T6, L1, L2), rod x2, cross-link x2 2. posterior decompression, T7-L1 Specimen Count And Types 1 piece About size:small pieces of tissue Source:spine Pathology pending Operative Findings 1. spinal cord compression over T7-L1 2. good dural pulsation after decompression 3. marked fibrosis over paraspinal muscles, tumor invasion over multiple levels of spinal lamina Operative Procedures 1. ETGA, prone position on R-F table 2. skin disinfection, draped 3. midline skin incision, dissect to spinal lamina 4. perform posterior instrumentation with pedicle screw x8, rod x2, and cross-link x2 5. perform posterior decompression, T7-L1 6. N/s irrigation, hemostasis 7. set a 1/8 hemovac drain 8. close the wound in layers Operators 楊榮森, Assistants 黃全敬, 蘇盈豪, 黃哲南, 方建豐, 王晨允 (F,2010/10/19,1y4m) 手術日期 2011/02/10 手術主治醫師 黃書健 手術區域 兒醫 068房 01號 診斷 Hypoplastic left heart syndrome, congenital 器械術式 TCPC,JATENE,TAPVR,NORWOOD 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 4E 紀錄醫師 謝永, 時間資訊 00:15 通知急診手術 01:10 報到 01:10 進入手術室 01:15 麻醉開始 01:35 誘導結束 01:45 手術開始 02:10 抗生素給藥 05:10 抗生素給藥 05:16 開始輸血 06:00 麻醉結束 06:00 手術結束 06:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 體外心肺循環 1 1 手術 胸(腹)部動靜廔管之切除移植或直接修補手術–主動脈弓 1 1 手術 四合群症之繞道手術 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 T.E.E 1 0 麻醉 動脈血液檢查全套 4 0 麻醉 Hemoglobin (Hb) 4 0 麻醉 測血糖 4 0 麻醉 Ca (Calcium) 4 0 麻醉 Na (Sodium) 4 0 麻醉 K (Potassium) 4 0 麻醉 Blood gas analysis 4 0 記錄__ 手術科部: 外科部 套用罐頭: Aortoplasty + RV-PA conduit revision 開立醫師: 謝永 開立時間: 2011/03/22 11:40 Pre-operative Diagnosis HLHS, s/p Norwood procedure, with severe CoA, CHF, r/o RV-PA conduit stenosis Post-operative Diagnosis HLHS, s/p Norwood procedure, with severe CoA, CHF, RV-PA conduit stenosis Operative Method Aortoplasty + RV-PA conduit revision Specimen Count And Types nil Pathology None Operative Findings 1.Severe adhesion in pericardial cavity, bilateral pleural cavities 2.PAP: 17-18 => Abort BDG shunt creation 3.A focal stenosis at anastomosis between previous percardial patch and native DsAo, ~ 2 mm in diameter 4.Pre-op Upper-Lower limb BP PG: 70 mmHg, Post-OP: 7 mmHg 5.Intimal hyperplasia of previous RV-PA conduit, with severe stenosis 6.Bilateral PA: 3 # Hegar dilator could pass by 7.Circulatory arrest: 31 mins 8.Post-op U/O: (+) 9.Obstructed LSCA orifice from arch Operative Procedures Under supine position, the patient was intubated with general anesthesia. After skin disinfection, re-do sternotomy was performed, with adhesiolysis. CPB was set by cannulation of AsAo and RAA, with cooling to 18C. Aortic crossclamp was performed, follwoed by antegrade cardioplegia infusion. RV-PA conduit was removed. End-to end anastomosis from 6 mm GOretex graft was perfromed to bifurcation of bilateral PAs. Innominate a. was cannulated via prevoius 3.5 mm graft. Circulatory arrest was performed, wtih selective antegrade cerebral perfusion via graft, ~ 50-100 ml/min. Neo-AO was augmented with bovine pericardial patch. After rewarming and de-ari, CPB was weaned off. Hemostasis was achieved. 2 x chest tubes were set in mediastenum. Wound was left approximated and covered with silicone membrane. Operators 黃書健 Assistants 謝永？ Indication Of Emergent Operation Refarctory desaturation 王榮華 (M,1930/03/19,81y11m) 手術日期 2011/02/10 手術主治醫師 王國川 手術區域 東址 003房 03號 診斷 Headache 器械術式 Removal of epidural hematoma 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 13:35 報到 13:48 進入手術室 13:55 麻醉開始 14:10 誘導結束 14:25 抗生素給藥 14:48 手術開始 17:15 手術結束 17:15 麻醉結束 17:20 送出病患 17:23 進入恢復室 19:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 R 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 摘要__ 手術科部: 外科部 套用罐頭: Right fronto-temporo-parietal craniotomy for ... 開立醫師: 游健生 開立時間: 2011/02/10 17:37 Pre-operative Diagnosis Right fronto-temporo-parietal chronic subdural hematoma Post-operative Diagnosis Right fronto-temporo-parietal chronic subdural hematoma Operative Method Right fronto-temporo-parietal craniotomy for chronic subdural hematoma removal Specimen Count And Types 1 piece About size: 2x2cm Source: outer membrane of cSDH Pathology pending Operative Findings Multiple septa were noted inside chronic subdural hematoma. The thickness of outer membrane was 5mm. After removal of the hematoma, the brain was seen with good pulsation and expanded gradually. Operative Procedures Under ETGA, patient was in supine position with head rotated to left and right shoulder elevated. After shaving, we disinfected and draped the operation field as usual. A curvilinear scalp incision from anterior to tragus to 4cm behind hairline. The soft tissue was dissected and cranium was exposed. A 6x3cm craniotomy was done. After tenting along craniotomy window, we opened the dura in cruciate fashion. Part of the outer membrane was removed followed by cSDH and part of inner membrane. The subdural space was irrigated throughoutly. Duraplasty with a fascia harvested from temporalis muscle was done. After central tenting, the bone graft was fixed back with mini-plates. A subgaleal CWV drain was set and wound was closed in layers. Operators VS 王國川 Assistants R6 陳睿生 R3 游健生 李淑貞 (F,1964/07/03,47y8m) 手術日期 2011/02/10 手術主治醫師 王國川 手術區域 東址 003房 號 診斷 Pituitary tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 2 紀錄醫師 游健生, 時間資訊 07:42 報到 08:03 進入手術室 08:10 麻醉開始 08:15 誘導結束 08:45 抗生素給藥 09:05 手術開始 11:25 麻醉結束 11:25 手術結束 11:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經由蝶竇之腦下垂體瘤切除 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 記錄__ 手術科部: 外科部 套用罐頭: Transphenoidal approach for adenomectomy 開立醫師: 游健生 開立時間: 2011/02/10 11:52 Pre-operative Diagnosis Pituitary macroadenoma Post-operative Diagnosis Pituitary macroadenoma Operative Method Transphenoidal approach for adenomectomy Specimen Count And Types a few pieces from pituitary tumor Pathology pending Operative Findings The sellar floor was enroded by tumor to a paper-thin layer of bone. The tumor was dark-reddish, soft and fragile. The mucosa layer of the sphenoid sinus was encased by the tumor. After exposing of the arachnoid membrane, intraoperative CSF leakwas noted. Baseline VEP of right eye was poorer than left eye. Operative Procedures Under ETGA, patient was in supine with head tilted 30 degree to left. The face was prepared with povidone-iodine alcohol tincture, and the mucosa of oral and nasal cavity with aqueous povidone-iodine tincture. The former areas were covered by a sterilized adhesive plastic sheet. The nasal submucosa at septum and floor and the subperiostium at upper alveola were infiltrated with Xylocaine solution. The mucosa of nasal septum was dissected away from the septal cartilage and displaced laterally by a long nasal speculum after incision. A Hardys nasal speculum was applied to displace the nasal mucosa laterally and keep the nasal cavity open constantly for the exposure of the vomer bone and the anterior wall of the sphenoid sinus. After opening the anterior wall, exposed sinus mucosa was coagulated and resected. After the sellar floor was removed, the sellar floor dura was coagulated and opened. We noticed we entered the sellar cavity at its anterior region by intra-operative C-arm. The soft tumor parenchyma was exposed and removed by curette and suction. The venous oozing from the dura was stopped by gelfoam packing. CSF leak was sealed by Tissuco-Duo.The sellar cavity and sphenoid sinus were packed with Gelfoam. The Hardys nasal speculum was removed and the nasal mucosa returned to its normal position. Each side of the nasal cavities was tightly packed with a finger segment of gloove which had been soacked with Better-iodine ointment. Operators VS王國川 Assistants R6陳睿生 R3游健生 巫德福 (M,1950/11/09,61y4m) 手術日期 2011/02/10 手術主治醫師 王國川 手術區域 東址 005房 02號 診斷 Cervical spondylosis 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3 紀錄醫師 曾峰毅, 時間資訊 12:05 報到 12:30 進入手術室 12:35 麻醉開始 13:00 誘導結束 13:12 手術開始 13:15 抗生素給藥 14:15 15:52 麻醉結束 15:52 手術結束 16:00 抗生素給藥 16:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 手術 椎間盤切除術-頸椎 1 1 手術 脊椎融合術-前融合,有固定物)≦四節 1 2 手術 正中神經或尺神經腕部減壓術–單側 1 4 R 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Anterior Discectomy and Fusion, Cervical Spine 開立醫師: 曾峰毅 開立時間: 2011/02/10 16:04 Pre-operative Diagnosis Cervical spondylosis, and spondylolisthesis, C3/4; carpal tunnel syndrome, right Post-operative Diagnosis Cervical spondylosis, and spondylolisthesis, C3/4; carpal tunnel syndrome, right Operative Method Anterior Discectomy and Fusion, Cervical Spine, at C3/4; median nerve decompression at right Specimen Count And Types Nil Pathology Nil Operative Findings Spondylolisthesis grade I to II at C3/4 was reduced after diskectomy and fusion. Hypertrophic ligament compressed the median nerve tightly. The nerve was decompressed well after neurolysis. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with right arm abduction. After skin scrubbed, disinfected, and then draped, we made one longitudinal skin incision at right wrist, we dissected to expose the flexor reticulum. Median nerve was decompressed well after neurolysis. The wound was closed in layers. We redraped the neck. We made one trasverse skin incision along the superior border of thyroid cartilage. We dissected to expose the C3/4 intervertebral space after C-arm confirmation. Cervical diskectomy was done at C3/4, and anterior fusion was performed with bone cage and artificial bone graft. We placed the plate, and inserted the screws for fixation. The wound was closed in layers after one CWV insertion. Operators VS 王國川 Assistants R4 曾峰毅 李玉珍 (F,1939/08/05,72y7m) 手術日期 2011/02/10 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 Head Injury 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3 紀錄醫師 陳睿生, 時間資訊 00:00 臨時手術NPO 11:50 報到 12:00 進入手術室 12:05 麻醉開始 12:15 誘導結束 12:43 抗生素給藥 12:45 手術開始 13:25 手術結束 13:25 麻醉結束 13:35 送出病患 13:40 進入恢復室 15:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 陳睿生 開立時間: 2011/02/10 13:30 Pre-operative Diagnosis Acute SDH s/p, with hydrocephalus Post-operative Diagnosis Acute SDH s/p, with hydrocephalus Operative Method V-P Shunt at left Kocher^s point Specimen Count And Types nil Pathology Nil Operative Findings The ICP was about 5-10cm H2O, and the CSF was xanthochromic pattern. Codman programmable shunt was inserted at left Kocher^s point, and the intraventricular catheter was about 7cm. Initial shunt setting was 10cmH2O. Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: supine with head rotated to left. 3.Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 3 cm linear, left frontal, corresponded to the location of Kocher^s point. 5.After the scalp flap had been lifted and reflected anteriorly, a burr hole was made and the dura was tented by 2 stitches. 6.The dura was opened by a nib incision. Left lateral ventricle was tapped by a ventricular needle, then a 7 cm segment of the ventricular catheter was introduced into the ventricle. The outer end of the catheter was connected to a reservoir. 7. Minilaporotomy was performed at LUQ to expose the intra-peritoneal space. 8. The reservoir was inserted at a subgaleal pocket over left parietal. 9. Scalp closure: hemostasis was done with monopolar coagulator touching on the sucker tip. Galea suture was performed by continuous suture with 3/0. Dexon and skin by continuous suture with 3/0 nylon. 10.Course of the surgery: smooth. Operators VS 王國川 Assistants R6 陳睿生 吳彥徵 (F,1983/12/15,28y2m) 手術日期 2011/02/10 手術主治醫師 蔡翊新 手術區域 東址 005房 01號 診斷 Brain abscess 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 2 紀錄醫師 曾峰毅, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:03 進入手術室 08:10 麻醉開始 08:25 誘導結束 09:09 抗生素給藥 09:35 手術開始 11:40 手術結束 11:40 麻醉結束 11:55 送出病患 12:00 進入恢復室 13:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 蔡翊新 開立時間: 2011/02/10 11:41 Pre-operative Diagnosis Hydrocephalus, isolated ventricle at left frontal and temporal horns. Post-operative Diagnosis Hydrocephalus, isolated ventricle at left frontal and temporal horns. Operative Method V-P Shunt, left Kocher and Frazier points, connecting by Y-connector, Codman programmable shunt. Specimen Count And Types 3 tubes of CSF, sent for bacterial culture, BCS and routine. Pathology Nil. Operative Findings 1. CSF: clear, crystal, pressure: > 15 cmH2O. 2. Dilated left temporal horn was detected by intraop ultrasound. 3. Ommaya reservoir was removed from left Kocher point. 4. Programmable shunt was set at 12 cmH20. Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: supine with head rotated to right. 3.Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4.Incision: 5 cm linear, left Frazier point, corresponded to the location of left occipital horn. Raney clips were applied to the scalp edge for temporary hemostasis. 5.After the scalp flap had been lifted and reflected anteriorly, a burr hole was made and the dura was tented by 3 stitches. 6.The dura was opened by a nib incision. Left temporal horn was tapped by a ventricular needle under guidance of intraoperative ultrasound, then a 10 cm segment of the ventricular catheter was introduced into the ventricle. The Ommaya reservoir at left Kocher point was removed and another ventricular catheter was introduced into the left frontal horn. The outer ends of both catheters were connected to a Y-connector, then to the Codman programmable shunt device. 7.A minilaparotomy was made at LUQ of the abdomen, then a trocar was pushed into peritoneal cavity. Subsequently, distal 25 cm segment of the peritoneal catheter was introduced into the peritoneal cavity through the outer tube of the trochar. The proximal end of this catheter was passed through subcutaneous tunnel at forechest, neck, left retroauricular area and connected the device. The shunt system was checked to make sure its function was working. 8.The catheters and Y-connector were fixed to pericranium by 3 stitches. 9.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by interrupted suture with 3/0 nylon. 10.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R4曾峰毅Ri鄭敬承 喻芝蘭 (F,1963/11/08,48y4m) 手術日期 2011/02/10 手術主治醫師 林峰盛 手術區域 西址 034房 01號 診斷 Radiculopathy 器械術式 Nerve block / PC 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 林峰盛 ASA 1 時間資訊 08:40 進入手術室 08:45 麻醉開始 08:50 誘導結束 09:00 手術開始 10:00 手術結束 10:00 麻醉結束 10:05 送出病患 10:10 進入恢復室 11:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 高頻熱凝療法 1 1 L 摘要__ 手術科部: 麻醉部 套用罐頭: Pulsed RF 開立醫師: 林峰盛 開立時間: 2011/02/10 11:06 Pre-operative Diagnosis Radiculopathy Post-operative Diagnosis radiculopathy Operative Method Pulsed RF Specimen Count And Types nil Pathology Nil Operative Findings Operative Procedures 1. IV sedation with midazolam and LA with 1% xylocaine 2. pt in supine position 3. Under fluoroscopic-guidance, insert 22 G SMK RF meedle into right C4-5 neuroforamen 4. Neurostimulation with 50 HZ and 2 Hz 0.1-0.5 mV current with positive result 60-80V 2 Hz, 20 ms, 120sec *2 pulsed RF was delivered send pt to POR Operators 林峰盛, Assistants 陳心言, 陳怡理 (F,2000/08/27,11y6m) 手術日期 2011/02/11 手術主治醫師 林文熙 手術區域 兒醫 062房 01號 診斷 Brain tumor 器械術式 Port-A catheter implatation 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 面罩麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 陳以幸, 時間資訊 07:30 報到 08:09 進入手術室 08:15 麻醉開始 08:20 誘導結束 08:33 手術開始 09:52 手術結束 09:52 麻醉結束 09:55 送出病患 09:56 進入恢復室 11:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 內頸靜脈切開,永久導管放置術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 套用罐頭: port-A implantation 開立醫師: 陳以幸 開立時間: 2011/02/11 10:00 Pre-operative Diagnosis diffuse astrocytoma, WHO grade II Post-operative Diagnosis diffuse astrocytoma, WHO grade II Operative Method port-A implantation Specimen Count And Types nil Pathology nil Operative Findings Catheter in correct position at SVC Operative Procedures 1.Under ETGA and supine position 2.Transverse skin incision was done at right suprasternal area, between SCM 3.Looping of internal jugular vein 4.Purse string suture for fixation of catheter 5.Portable x-ray for confirmation of the position 6.Wound closure in layers Operators VS林文熙 Assistants R1陳以幸 王晨允 (F,2010/10/19,1y4m) 手術日期 2011/02/11 手術主治醫師 黃書健 手術區域 兒醫 068房 06號 診斷 Hypoplastic left heart syndrome, congenital 器械術式 Bed-side sternal closure 手術類別 緊急手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 ASA 1 紀錄醫師 徐綱宏, 時間資訊 00:00 開始NPO 00:00 臨時手術NPO 15:26 通知急診手術 18:05 手術開始 18:05 進入手術室 18:45 送出病患 18:45 手術結束 醫令資訊 類別 名稱 量 刀 側 手術 探查性心包膜切開術 1 2 記錄__ 手術科部: 外科部 套用罐頭: Sternum closure 開立醫師: 陳國瑋 開立時間: 2011/02/12 11:50 Pre-operative Diagnosis Unapproximated sternum Post-operative Diagnosis Unapproximated sternum Operative Method Sternum closure Specimen Count And Types nil Pathology Nil Operative Findings 1. No active bleeding was noted 2. Pre-OP CVP:13 ABP:107/50 Post OP CVP:15 ABP:99/55 3. Surgical membrane coverage Operative Procedures Under ETGA the patient was put in supine position. The plastic membrane was removed and the old blood clot was removed from the pericardial cavity. The wound was irrigated with copious N/S. Sugical membrane was used to cover the heart and the wound was closed in layers Operators 黃書健 Assistants 徐綱宏 Indication Of Emergent Operation 陳昆山 (M,1948/02/16,64y0m) 手術日期 2011/02/11 手術主治醫師 賴達明 手術區域 東址 023房 03號 診斷 Subarachnoid hemorrhage 器械術式 V-P shunt 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 4 紀錄醫師 曾峰毅, 時間資訊 23:55 臨時手術NPO 13:02 報到 13:03 進入手術室 13:05 麻醉開始 13:10 誘導結束 13:11 抗生素給藥 13:46 手術開始 14:49 15:15 麻醉結束 15:15 手術結束 15:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 手術 氣管切開術 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 曾峰毅 開立時間: 2011/02/11 15:42 Pre-operative Diagnosis Hydrocephalus, respiratory failure Post-operative Diagnosis Hydrocephalus, respiratory failure Operative Method Ventriculoperitoneal shunt via right Kocher point; tracheostomy Specimen Count And Types CSF was sampled for routine, BCS, and culture. Pathology Nil Operative Findings Codman, fixed pressure, 100 mmmH20, shunt was inserted via right Kocher point. Fr. 8 low pressure tube was used for tracheostomy. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position. After scalp shaved, scrubbed, disinfected, and then draped, we made one transverse skin incision at right upper abdomen. We dissected to created mini-laparotomy. We made one longitudinal skin incision at right frontal area, and created subcutaneous tunnel to right upper abdomen. We insert ventricular catheter via previous burr hole, and connected shunt altogeterh. We checked the shunt function, and inserted peritoneal catheter. The wound was closed in layers. We re-draped the patient, and made midline logitudinal skin incision at lower neck. We dissected to expose trachea ring, and performed tracheostomy. We inserted Fr. low pressure tube. Operators VS 賴達明 Assistants R4 曾峰毅 李楊菊 (F,1944/10/01,67y5m) 手術日期 2011/02/11 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Spondylolisthesis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 王奐之, 時間資訊 07:40 報到 08:03 進入手術室 08:10 麻醉開始 08:15 誘導結束 08:50 抗生素給藥 09:10 手術開始 11:50 抗生素給藥 12:25 開始輸血 14:50 抗生素給藥 15:24 麻醉結束 15:24 手術結束 15:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 記錄__ 手術科部: 外科部 套用罐頭: L4~S1 TPS and L4~5,L5~S1 cage insertion 開立醫師: 胡朝凱 開立時間: 2011/02/11 15:27 Pre-operative Diagnosis L4~S1 spondylolisthesis Post-operative Diagnosis L4~S1 spondylolisthesis Operative Method L4~S1 TPS and L4~5,L5~S1 cage insertion Specimen Count And Types nil Pathology nil Operative Findings 1.Anterior listhesis of L4 L5 and L5 on S1. 2.Narrowed and degenerated disc space 3.Hypertrophic flavum ligment and fibrosis 4.Instability of L4 to S1 5.The nerve roots were compressed tightly 6.TPS screws: 45x62 x 6, rods: 90 mm, cross link x 1 7.Cage L4~5: 9#, L5~S1: 11# Operative Procedures 1.ETGA, prone 2.Midline skin incision at L3~S1 level 3.Deatch paravertebral muscle group 4.TPS screws insertion 5.Laminectomy of L4~5 6.resect partial of left L4~5 and L5~S1 facet joint 7.Discectomy 8.Banana cage insertion 9.Hemostasis 10.Close wound in layers after hemovac drain insertion Operators 賴達明 Assistants 胡朝凱, 王奐之 相關圖片 周賢如 (F,1956/08/06,55y7m) 手術日期 2011/02/11 手術主治醫師 賴達明 手術區域 東址 005房 02號 診斷 Bone metastasis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 腹 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 張廷碩, 時間資訊 13:20 報到 13:35 進入手術室 13:40 麻醉開始 13:50 誘導結束 14:30 抗生素給藥 14:51 手術開始 17:30 抗生素給藥 17:40 開始輸血 18:50 手術結束 18:50 麻醉結束 18:58 送出病患 19:00 進入恢復室 20:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 惡性脊髓腫瘤切除術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 2 摘要__ 手術科部: 外科部 套用罐頭: L2 partial corpectomy for decompression, and ... 開立醫師: 陳睿生 開立時間: 2011/02/11 19:20 Pre-operative Diagnosis L2 mass lesion with root compression, suspect metastasis Post-operative Diagnosis L2 mass lesion with root compression, suspect metastasis Operative Method L2 partial corpectomy for decompression, and L1, 3 TPS fixation Specimen Count And Types 1 piece About size:pieces Source:tumor Pathology Pending Operative Findings The tumor was mainly over L2 right side pedicle, body, and epidural space. The right L1,2 roots were tightly compressed by the tumor. Easy oozing was noted. After partial corpectomy, the body space was fulfilled with bone cement. L1,3 TPS was set with Synthes screws. The intervertebral screws were 6.2 x40mm x4, rods were 6cm x2, and crosslink x1. Operative Procedures 1. ETGA, prone position and C-arm localized L1-3 level 2. Low back midline incision 3. Split paraspinal muscles and expose L1-3 spinous process and lamina 4. Set transpedicular screws over L1, 3 under C-arm guidence 5. Partial L1, and L2 laminectomy for thecal sac decompression 6. Remove of right L2 pedicle, and decompress the L1,2 roots 7. Partial L2 corpectomy for tumor remove 8. Refill the body space with bone cement 9. Set bilateral rods, and a crosslink 10.Hemostasis, set an epidural 1/8 hemovac 11.Close the wound in layers Operators VS 賴達明 Assistants R6 陳睿生, R1 張廷碩 蔡坤楠 (M,1945/04/07,66y11m) 手術日期 2011/02/11 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Scoliosis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 2 紀錄醫師 李振豪, 時間資訊 07:35 報到 08:05 進入手術室 08:10 麻醉開始 08:30 誘導結束 09:10 抗生素給藥 09:25 手術開始 11:22 開始輸血 12:15 抗生素給藥 15:10 抗生素給藥 16:10 手術結束 16:10 麻醉結束 16:17 送出病患 16:20 進入恢復室 17:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 8 0 摘要__ 手術科部: 外科部 套用罐頭: L3-5 transpedicular screws and transforaminal... 開立醫師: 李振豪 開立時間: 2011/02/11 16:33 Pre-operative Diagnosis Scoliosis of L spine with spondylolisthesis, L3-5 Post-operative Diagnosis Scoliosis of L spine with spondylolisthesis, L3-5 Operative Method L3-5 transpedicular screws and transforaminal lumbar interbody fusion with cage and autologous bone graft Specimen Count And Types nil Pathology Nil Operative Findings 1. The L3-5 vertebra was scoliotic and rotated to left side. The facet joints were all hypertrophic, especially at L4-5. Narrowing of the L3-4, L4-5 disc space, especially right side was noted and expanded by distraction and interbody cage. The right L4 root(with intact dura) was exposed during the operation and contact with the screw due to fracture of part of right L4 pedicle. The root and screw were departed with soft tissue and Gelform packing. CSF leakage was noted during the operation. 2. Posterior instrumentation and interbody fusion Screws: 6.2mm x 45mm X VI Cage: #11 PEEK cage X II Rods: right side: 10cm, left side: 9cm Operative Procedures Under endotracheal tube general anesthesia, the patient was put in prone position. The location of pedicles of L3-5 were localized with portable C-arm X-ray. The skin was scubbed, disinfected, and draped as usual. The midline skin incision was made from L2 to S1 level. The subcutaneous soft tissue was dissected. The paravertebral muscle groups were detached to exposed the lamina and facet joints. L3-5 transpedicular screws were inserted under C-arm portable X-ray guided. Right side hemilaminectomy and facetectomy were performed and the L3-4, L4-5 disc was identified. The right L4 root noted during the operation and preserved well. L3-4, L4-5 diskectomy was performed with Curette, alligator, and disc clamp. The autologous bone graft was placed into the disc space with one #11 PEEK cage in each disc space. The transpedicular screws were set up with two rods. Hemostasis was achieved and one CWV drain was placed at hemilaminectomy site. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS賴達明 Assistants R4李振豪, R2曾偉倫 相關圖片 賴建霖 (M,1969/10/09,42y5m) 手術日期 2011/02/11 手術主治醫師 賴達明 手術區域 東址 000房 01號 診斷 Cerebellar hemorrhage 器械術式 Craniotomy(Aneurysms) VS-TZENG 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 4E 紀錄醫師 曾偉倫, 時間資訊 01:00 臨時手術NPO 01:00 開始NPO 02:56 通知急診手術 03:37 進入手術室 03:40 麻醉開始 04:10 誘導結束 04:20 抗生素給藥 04:45 手術開始 06:10 開始輸血 09:50 手術結束 09:50 麻醉結束 10:10 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 開顱術摘除血管病變-動靜脈畸型小型表淺 1 1 L 手術 顱內壓視置入 1 2 L 手術 腦室體外引流 1 4 L 摘要__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 曾峰毅 開立時間: 2011/02/11 10:30 Pre-operative Diagnosis Dura arteriovenous fistula, complicated with SDH, IVH, ICH Post-operative Diagnosis Dura arteriovenous fistula, complicated with SDH, IVH, ICH Operative Method Left occipital craniotomy for dural arteriovenous fistula coagualtion, ICH removal, ICP monitor insertion; external ventricular drainage insertion via left Frazier point. Specimen Count And Types Nil Pathology Nil Operative Findings Abundant arterial flow was noted from bilateral occpital arteries while scalp incision. Multiple and much arterial blood flow was noted in the bone sinus while craniotomy. Bloody CSF with clot was drained via the external ventricular drainage. Codman ICP monitor reference was 493, and the ICP was about 10 cm H20 after the wound closure (still prone position). Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position with head fixed with Mayfield head clamp. After sclap shaved, scrubbed, disinfected, and then draped, we made one reverse-U-shape skin incision at left occipital area. We drilled nine burr holes, and then created craniotomy. We tented the craniotomy window, and made one U-shape durotomy. ICH evacuation was done, and hemostasis was achieved. EVD was inserted vai left Frazier point into left lateral ventricle. We put one suhbdural ICP monitor, and closed the dura in water-tight fashion with prolene suture and autologous fascia graft. Bone graft was fixed back with wires, and the wound was closed in layers. Operators VS 賴達明 Assistants R6 胡朝凱 R4 曾峰毅 R2 曾偉倫 Indication Of Emergent Operation 李陳麗欽 (F,1947/03/13,65y0m) 手術日期 2011/02/11 手術主治醫師 楊士弘 手術區域 東址 005房 01號 診斷 Dislocations of cervical vertebra, closed 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 張廷碩, 時間資訊 07:46 報到 08:05 進入手術室 08:10 麻醉開始 08:35 誘導結束 08:50 抗生素給藥 08:55 手術開始 11:50 抗生素給藥 13:20 麻醉結束 13:20 手術結束 13:23 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 骨或軟骨移植術 1 1 摘要__ 手術科部: 外科部 套用罐頭: Transarticular screw fixation over C1-2, fusi... 開立醫師: 陳睿生 開立時間: 2011/02/11 13:43 Pre-operative Diagnosis C1-2 subluxation with cord compression Post-operative Diagnosis C1-2 subluxation with cord compression Operative Method Transarticular screw fixation over C1-2, fusion and fixation with autologus bone graft and sublaminar wiring Specimen Count And Types nil Pathology Nil Operative Findings C1-2 fixation was done with cannulated screws; the right side was 40mm, and the left side was 42mm. A bone graft was extracted from right posterior iliac crest for fusion, and the bone graft was fixed with the decorticated C1-2 lamina by sublaminar wiring. Operative Procedures 1. ETGA, prone position and head fixed with Mayfield clump 2. C-arm guided C1-2 close reduction 3. Posterior neck midline incision, and split of latissmus dorsi, paraspinal muscle to expose the suboccipital region, C1 posterior arch, and C2-4 spinous process 4. Dissect to expose C1 posterior arch, C2-3 lamina 5. Insert the K-pin percutaneously from right C2 lower facet joint, and protruded to C1 anterior arch under C-arm guidance 6. Insert right side cannulated screw (40mm) 7. Do the same procedure over left C1-2 juntion, and insert the cannulates screw (42mm) 8. Linear incision over right low back, and expose the right posterior iliac crest 9. Extract an about 3x3x2 cm bone graft 10.C1 posterior arch and upper C2 lamina decortication 11.Fix the bone graft and C1-2 lamina with Sonntag sublaminar wiring 12.Hemostasis, set a CWV drain, and close the wound in layers Operators VS 楊士弘 Assistants R6 陳睿生, R1 張廷碩 李進財 (M,1954/01/01,58y2m) 手術日期 2011/02/11 手術主治醫師 李柏居 手術區域 東址 002房 03號 診斷 Fever 器械術式 I&D; 手術類別 緊急手術 手術部位 腹 傷口分類 污染 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3E 紀錄醫師 洪浩雲, 時間資訊 16:45 進入手術室 16:50 麻醉開始 16:55 誘導結束 17:12 手術開始 17:35 手術結束 17:35 麻醉結束 17:50 送出病患 17:55 進入恢復室 19:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腹壁膿瘍引流術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Debridement, abscess drain 開立醫師: 洪浩雲 開立時間: 2011/02/11 17:47 Pre-operative Diagnosis Abdominal wall abscess formation Post-operative Diagnosis Ditto Operative Method Debridement and drain abdominal wall abscess Specimen Count And Types 1 piece About size:3cm Source:abdominal wall Pathology Pending Operative Findings 1. Two abscess formation at RLQ abdominal wall, one beneath the anterior sheath and the other above the posterior fascia. 2. Subcutaneous fat became hard and inflammed. Operative Procedures 1. Under general anesthesia, he lied at prone supine position. We disinfected and drapped as usual. 2. Right paramidline incision was made at RLQ area. 3. Culture and debridement was performed and copious normal saline irrigation. Wound wet dressing Operators 李柏居 Assistants 洪浩雲, 許松鈺 Indication Of Emergent Operation 趙卿珍 (F,1962/04/28,49y10m) 手術日期 2011/02/12 手術主治醫師 蔡瑞章 手術區域 東址 001房 01號 診斷 Malignant neoplasm of female breast, nipple and areola 器械術式 Right side Ommaya reservoir implantation 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3E 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 09:50 報到 10:24 進入手術室 10:27 通知急診手術 10:33 麻醉開始 10:45 誘導結束 10:50 抗生素給藥 11:18 手術開始 11:55 手術結束 11:55 麻醉結束 12:23 送出病患 12:25 進入恢復室 13:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 歐氏貯囊置放手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 腫瘤醫學部 套用罐頭: Ommaya reservoir implantation via right Koche... 開立醫師: 李振豪 開立時間: 2011/02/12 12:02 Pre-operative Diagnosis 1. Hydrocephalus, suspect leptomeningeal carcinomatosis 2. Breast cancer with multiple brain metastasis Post-operative Diagnosis 1. Hydrocephalus, suspect leptomeningeal carcinomatosis 2. Breast cancer with multiple brain metastasis Operative Method Ommaya reservoir implantation via right Kocher"s approach Specimen Count And Types 1 piece About size:15ml Source:CSF Pathology Nil Operative Findings The CSF is clear in character with mild increase in viscosity. The Opening pressure is around 10cmH2O. Total 20ml CSF was sampled for routine, BCS, culture, and cytology study. The brain became slack after CSF sampling. The CSF is clear in character with mild increase in viscosity. The Opening pressure is around 10cmH2O. The ommaya reservoir catheter was 7cm in length. Total 20ml CSF was sampled for routine, BCS, culture, and cytology study. The brain became slack after CSF sampling. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine position. The scalp was shaved, scrubbed, and disinfected as usual. The curvilinear scalp incision was made at right frontal area followed by one burr hole creation. The dura was tenting with two stitches. The cruciform durotomy was done and ventriculostomy was performed with ventricular needle. The Ommaya reservoir was placed and fixed with three stitches. Hemostasis was achieved with bipolar electrocautery and Gelform packing. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators Prof.蔡瑞章 Assistants R4李振豪 Indication Of Emergent Operation 相關圖片 賴建霖 (M,1969/10/09,42y5m) 手術日期 2011/02/12 手術主治醫師 賴達明 手術區域 東址 002房 03號 診斷 Cerebellar hemorrhage 器械術式 Left side decompressive craniectomy 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 4E 紀錄醫師 賴碩倫, 時間資訊 12:44 通知急診手術 13:35 進入手術室 13:40 麻醉開始 13:45 誘導結束 14:33 手術開始 17:25 手術結束 17:25 麻醉結束 17:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱骨切除術,包括異物移除或壓或經切斷 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Left craniectomy and duroplasty 開立醫師: 胡朝凱 開立時間: 2011/02/12 17:43 Pre-operative Diagnosis Left occipital dural AVF ruptured Post-operative Diagnosis Left occipital dural AVF ruptured Operative Method Left craniectomy and duroplasty Specimen Count And Types nil Pathology nil Operative Findings 1.Swelling brain was noted with pulsation 2.SDH about 0.5 cm thick was noted 3.Duroplasty with one piece of fascia Operative Procedures 1.ETGA, supine 2.Left trauma flap skin incision 3.Reflect skin flap 4.Reflect temporalis muscle 5.Burr hole drill 6.Craniectomy 7.dural tenting 8.Curvature dural opening 9.Duroplasty with fascia 10.resect temporalis muscle 11.set two CWV drain 12.Close wound in layers Operators 賴達明 Assistants 胡朝凱, 賴碩倫 Indication Of Emergent Operation 劉興鈞 (M,1955/10/11,56y5m) 手術日期 2011/02/12 手術主治醫師 楊榮森 手術區域 東址 020房 01號 診斷 Lung cancer, non-small cell 器械術式 (備註)Tumor excision and reconstruction 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林峰盛 ASA 3 紀錄醫師 黃全敬, 時間資訊 08:00 報到 08:05 進入手術室 08:10 麻醉開始 08:15 誘導結束 08:21 抗生素給藥 08:38 手術開始 10:25 手術結束 10:25 麻醉結束 10:30 送出病患 10:31 進入恢復室 11:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 惡性骨瘤廣泛切除(一次) 1 1 R 手術 橈骨、尺骨骨折開放性復位術 1 2 R 手術 石膏副木固定－長臂 1 0 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 記錄__ 手術科部: 骨科部 套用罐頭: 1. tumor wide excision 開立醫師: 黃全敬 開立時間: 2011/02/12 10:16 Pre-operative Diagnosis right proximal radius tumor, malignant metastatic carcinoma right proximal radius tumor, malignant metastatic carcinoma, with pathological fracture Post-operative Diagnosis right proximal radius tumor, malignant metastatic carcinoma right proximal radius tumor, malignant metastatic carcinoma, with pathological fracture Operative Method 1. tumor wide excision 2. reconstruction of proximal radius with allo-graft and ORIF with DCP (8H8S) Specimen Count And Types 1 piece About size:7*4*3 cm Source:right proximal rardius Pathology pending Operative Findings 1. a 6x4x3 cm tumor over right proximal radius, firm, ill-defined, with invasion to supinator muscle 1. a 6x4x3 cm tumor over right proximal radius, firm, ill-defined, with invasion to supinator muscle, with pathological fracture 2. 7 cm of proximal radius and the tumor were excised 3. posterior interosseous nerve preserved Operative Procedures 1. ETGA, supine position, on arm board 2. skin incision over right forearm, with previous biopsy tract excised, soft tissue dissection to the tumor 3. excise the tumor with proximal radius 4. irrigate with 95% alcohol 5. set the allo-graft proximal radius, ORIF with DCP (8H8S) 6. reattach biceps tendon, repair annular ligament 7. N/S irrigation, hemostasis, set one 1/8" hemovac drain 8. close the wound in layers 9. apply a long arm splint Operators 楊榮森, Assistants 黃全敬, 蘇盈豪, 黃哲南, 邱美嬌 (F,1961/02/21,51y0m) 手術日期 2011/02/14 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Aneurysm 器械術式 EC-IC by-pass 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 王奐之, 時間資訊 07:40 報到 08:05 進入手術室 08:08 麻醉開始 08:25 誘導結束 08:55 手術開始 08:59 抗生素給藥 11:59 抗生素給藥 15:00 抗生素給藥 17:10 開始輸血 18:00 抗生素給藥 18:38 抗生素給藥 21:00 抗生素給藥 00:00 抗生素給藥 00:50 麻醉結束 00:50 手術結束 01:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 開顱術摘除血管病變- 腦血管瘤 .巨大的 1 1 R 手術 顱內外血管吻合術 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 25 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Right pterional approach for aneurysm clippin... 開立醫師: 王奐之 開立時間: 2011/02/16 09:38 Pre-operative Diagnosis Right MCA giant aneurysm Post-operative Diagnosis Right MCA giant aneurysm Operative Method Right pterional craniectomy for aneurysm clipping & STA-MCA bypass Specimen Count And Types Nil Pathology Nil Operative Findings 1st proximal control: 3m53s; 2nd proximal control: 2m58s; 3rd proximal control: 1m50s; 4th proximal control: 8m5s; 5th proximal control: 15m40s. 1 small aneurysm (< 5mm) was noted before entering the giant aneurysm. The aneurysm was about 4cm in diameter with multilobulation, the inlet (M1) and outlet (M2) makes a sharp angle in between, resulting in difficult clipping. Significant blood loss was encountered after cutting open the aneurysm. A short segment of dissection was suspected near the aneurysm. The craniotomy bone was not put back for prevention of IICP. Initial ICP: 3, and became 7~8 after wound closure; ICP monitor reference: 506. Operative Procedures After ETGA, the patient was placed in supine position with head fixed in Mayfield skull clamp, face turned to left side. The traveling course of right STA was localized with Doppler. After scalp shaving, skin disinfection and draping in sterile fashion, a curvilinear skin incision was made at preauricular area to make a standard pterional craniotomy. After incision, the subgaleal space was dissected to identify and mobilize the STA. After transecting the distal end of STA, the vessel was flushed with heparin and clamped with temporary clip. Pterional craniotomy was then done, followed by dural tenting. The sphenoid ridge was drilled flat, followed by a fishmouth durotomy. The Sylvian fissure was opened, and the aneurysm was visualized directly under the Sylvian vein. Right ICA and proximal MCA were identified, the aneurysm neck was dissected. The aneurysm was then cut open for thrombectomy, but significant bleeding was encountered, causing inability for good cliipping. After several proximal control attempts, partial clipping was done. Intra-operative ICG showed no flow to the M2 vessel distal to the aneurysm, the M1 & M2 connecting to the aneurysm was clipped and transected; the thrombus inside the aneurysm was removed by CUSA. The previously prepared STA was then checked and STA-M2 end-to-side anastomosis was done. After meticulous hemostasis, duroplasty was done in water-tight fashion. A subgaleal ICP monitor was placed, and a epidural CWV drain was set. The wound was then closed in layers. Operators P 杜永光 Assistants R6 胡朝凱, R3 王奐之 相關圖片 陳錦輝 (M,1944/10/18,67y4m) 手術日期 2011/02/14 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Benign neoplasm of pituitary gland 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 張廷碩, 時間資訊 07:45 報到 08:05 進入手術室 08:10 麻醉開始 08:45 抗生素給藥 08:50 誘導結束 09:40 手術開始 10:54 開始輸血 11:30 麻醉結束 11:30 手術結束 11:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經由蝶竇之腦下垂體瘤切除 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Microscopically endonasal transsphenoid adeno... 開立醫師: 陳睿生 開立時間: 2011/02/14 16:55 Pre-operative Diagnosis Pituitary macroadenoma Post-operative Diagnosis Pituitary macroadenoma Operative Method Microscopically endonasal transsphenoid adenoectomy Specimen Count And Types 1 piece About size:PIECES Source:TUMOR Pathology Pending Operative Findings The tumor was whitish, solid and well capsuled. The sellar floor was paper- thin and removed. After total remove of the tumor, the arachnoid membrane was noted to fall down. Intra-op CSF leakage was noted. Intra-op easy oozing was noted. Operative Procedures After ETGA, the patient was under supine position and head mild extension. Nasal spectulum was set at right nastril. We incised into the mucosal septum and fracture the bone septum. The bony septum was pulled contralaterally and the vomer bone was exposed. Bilateral osteum was identified and the vomer bone was removed to expose the sphenoid sinus. The sinus mucosa was removed and the sellar floor was identified. The sellar floor was opened and then the dura was cut to harvest the tumor. The tumor was curetted and then removed with ring curette and tumor forceps. Finally, the arachnoid membrane falling down was noted. Intra-op CSF leakage was noted. The dura and sphenoid sinus was covered with gelfoam and tapped with Tissucol Duo. The vomer bone graft was packed back and the nasal septum was closed. The nastril was packed with plastic bag. Operators VS 曾漢民 Assistants R6 陳睿生, R1 張廷碩 戴淑麗 (F,1950/01/06,62y2m) 手術日期 2011/02/14 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Brain cancer 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 張廷碩, 時間資訊 11:40 報到 12:12 進入手術室 12:15 麻醉開始 12:40 誘導結束 12:44 手術開始 12:50 抗生素給藥 15:50 抗生素給藥 16:35 麻醉結束 16:35 手術結束 16:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4~8小時 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for total tumor remove 開立醫師: 陳睿生 開立時間: 2011/02/14 17:07 Pre-operative Diagnosis Right parietoccipital GBM with radiation necrosis and recurrence Post-operative Diagnosis Right parietoccipital GBM with radiation necrosis and recurrence Operative Method Craniotomy for total tumor remove Specimen Count And Types 2 specimens: 1st: 3x3 cm, tumor; 2nd: pieces, suspect radiation necrosis Pathology Pending Operative Findings An about 3x3cm gliosis mass was noted at the medial side of previous tumor. The mass lesion was whitish and translucent. A huge cyst was noted lateral to the mass, and capsule was noted around the cyst. Some yellow whitish mass was noted in front of the cyst, and radiation necrosis was suspect. All the tumor, cyst and suspect radiation necrosis portion were removed intra-op. Operative Procedures After ETGA, the patient was under prone position and head fixed with Mayfield clump. We reopened previous wound and the skull graft was removed by loosing of previous miniplates. After intra-op ECHO guidance, the dura was opened around the craniotomy window. The mass lesion was identified and was removed with devascularization. The cyst and radiation necrotic portion was dissected from normal brain tissue carefully. After totally removed of these lesions, proper hemostasis was done. The dura was suture back and the defect was covered with Durafoam. After central tenting, the skull graft was fixed back with miniplates. A subgaleal CWV drain was set, and the wound was closed in layers. Operators VS 曾漢民 Assistants R6 陳睿生, R1 張廷碩 賴建霖 (M,1969/10/09,42y5m) 手術日期 2011/02/14 手術主治醫師 廖漢文 手術區域 東址 000房 號 診斷 Cerebellar hemorrhage 器械術式 NEURO T.A.E 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 4 時間資訊 00:00 臨時手術NPO 15:00 麻醉開始 15:10 誘導結束 15:45 麻醉結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 陳秀誠 (M,1966/07/23,45y7m) 手術日期 2011/02/14 手術主治醫師 黃培銘 手術區域 東址 018房 04號 診斷 Acute myocardial infarction (AMI) 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 趙安怡 ASA 3 紀錄醫師 廖先啟, 時間資訊 00:00 臨時手術NPO 13:43 報到 13:43 進入手術室 13:50 麻醉開始 13:55 誘導結束 14:00 手術開始 14:20 麻醉結束 14:20 手術結束 14:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 支氣管鏡檢查 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 氣管切開術 1 0 記錄__ 手術科部: 外科部 套用罐頭: Tracheostomy via punture 開立醫師: 廖先啟 開立時間: 2011/02/14 13:39 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy via punture Specimen Count And Types nil Pathology nil Operative Findings Fr. 8 low pressure cuffed tube inserted via punture method smoothly, checked by bronchoscopy. Operative Procedures 1. ETGA, supine 2. Skin disinfection and draping 3. longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage 4. Needle punture to trachea, checked by bronchoscopy 5. Insert guide wire and dilator 6. Insert tracheostomy with dilator 7. Fixatation of tracheostomy Operators VS黃培銘 Assistants R4蔡東明，R3廖先啟 黃進聰 (M,1952/05/12,59y10m) 手術日期 2011/02/14 手術主治醫師 蔡翊新 手術區域 東址 001房 05號 診斷 Intracerebral hemorrhage 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 4E 紀錄醫師 曾峰毅, 時間資訊 14:08 通知急診手術 14:40 進入手術室 14:42 麻醉開始 14:45 誘導結束 15:02 手術開始 15:16 開始輸血 15:45 手術結束 15:45 麻醉結束 15:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室體外引流 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 曾峰毅 開立時間: 2011/02/14 16:07 Pre-operative Diagnosis Thalamic ICH with IVH and acute hydrocephalus Post-operative Diagnosis Thalamic ICH with IVH and acute hydrocephalus Operative Method Bilateral Kocher EVD revision Specimen Count And Types Nil Pathology Nil Operative Findings Opening pressure of EVD was above 15 cmH20. Some blood clots were drained as well. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position. We disinfecteda, and then draped the patient's head. We removed previous bilateral Kocher EVD, and opened the wound along previous scalp wound. We re-inserted ventricular catheter into bilateral ventricles. The wound was closed in layers. Operators VS 蔡翊新 Assistants R4 曾峰毅 Indication Of Emergent Operation 黃進聰 (M,1952/05/12,59y10m) 手術日期 2011/02/14 手術主治醫師 蔡翊新 手術區域 東址 016房 02號 診斷 Intracerebral hemorrhage 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 4E 紀錄醫師 曾峰毅, 時間資訊 09:22 通知急診手術 10:43 進入手術室 10:45 麻醉開始 10:50 開始輸血 11:05 誘導結束 11:06 抗生素給藥 11:14 手術開始 12:45 手術結束 12:45 麻醉結束 12:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱內壓視置入 1 1 R 手術 腦室體外引流 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 蔡翊新 開立時間: 2011/02/14 12:23 Pre-operative Diagnosis Left thalamic ICH, IVH and acute hydrocephalus. Post-operative Diagnosis Left thalamic ICH, IVH and acute hydrocephalus. Operative Method Bilateral Kocher point EVD for ICP monitoring. Specimen Count And Types 3 tubes of CSF, sent for routine, BCS and culture. Pathology Nil. Operative Findings CSF was bloody at left ventricle and reddish at right. Intracranial pressure was 2 cmH2O at left (sluggish flow due to thick blood in the CSF). ICP measured by right EVD was cmH2O. Both EVDs were 6.5 cm in depth. CSF was bloody at left ventricle and reddish at right. Intracranial pressure was 2 cmH2O at left (sluggish flow due to thick blood in the CSF). ICP measured by right EVD was 15 cmH2O. Both EVDs were 6.5 cm in depth. Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: supine. 3.Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4.Incision: 5 cm linear, bilateral frontal, corresponded to the location of bilateral frontal horns. Raney clips were applied to the scalp edge for temporary hemostasis. 5.After the scalp wounds were opened by self-retaining retractors, a burr hole was made at each Kocher point and the dura was tented by 2 stitches. 6.The dura was opened by a nib incision. Bilateral ventricles were tapped by a ventricular needle, then a 6.5 cm segment of the ventricular catheter was introduced into each ventricle. The outer end of the catheter was connected to a reservoir bag. 7.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 8.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R4曾峰毅 Indication Of Emergent Operation 周楊不碟 (F,1951/09/02,60y6m) 手術日期 2011/02/15 手術主治醫師 蔡翊新 手術區域 東址 002房 05號 診斷 Subdural hemorrhage 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 3E 時間資訊 21:00 開始NPO 23:55 通知急診手術 01:30 報到 01:48 進入手術室 01:50 麻醉開始 02:15 抗生素給藥 02:20 誘導結束 03:18 手術開始 05:04 抗生素給藥 05:55 麻醉結束 05:55 手術結束 06:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 1 R 手術 顱內壓視置入 1 2 R 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 蔡翊新 開立時間: 2011/02/15 05:40 Pre-operative Diagnosis Right frontotemporal acute on chronic SDH, right frontotemporal contusional ICH. Post-operative Diagnosis Right frontotemporal acute on chronic SDH, right frontotemporal contusional ICH. Operative Method Right frontotemporal craniotomy for removal of ICH, SDH and insertion of subdural ICP monitoring. Specimen Count And Types nil Pathology Nil. Operative Findings Two linear skin incisions at right temporal region with 2 burr holes of previous operation. Thick outer membrane and SDH were noted at right frontotemporal area, with liquified blood, blood clots and fibrin materials. Contusional ICH at right frontotemporal lobe, just beneath one of previous burr hole, about 10 c.c. in amount. The brain was not bulging after removal of SDH and ICH. ICP after duroplasty and cranioplasty was 1 mmHg. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: a small trauma flap was made at right frontotemporal region, including the posterior wound of previous incision. The skin edge was clipped by Raney clips for temporary hemostasis. The temporalis muscles was incised down to the tempoal squama. 5. Craniotomy window: 12 x 10 cm, right frontotemporal, created by making 4 burr holes then cut by power saw. 6. Dural tenting: by 2/0 silk, 2-cm in interval, distributed along the edge of skull window. 7. Dural incision: curvilinear along the edge of skull window. 8. The subdural clot was removed by sucker. The outer membrane was excised and the cut-edge was coagulated with bipolar coagulator. The contusional ICH was evacuated. 9. Hemosatasis: the bleeders was stopped by Bovie and oozing surface was covered with Surgicel. 10.Dural closure: was closed with a piece of Durofoam for duroplasty. 11.The skull plate was placed back and fixed with 3 miniplates and 6 screws. 12.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by staples. 13.Drain: one, epidural, CWV. 14.Blood transfusion: nil. Blood loss: 600 ml. 15.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R3王奐之R2范玉君 Indication Of Emergent Operation 相關圖片 王明德 (M,1922/10/20,89y4m) 手術日期 2011/02/14 手術主治醫師 王水深 手術區域 東址 001房 02號 診斷 Varicose veins 器械術式 Varicose Vein Stripping 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 面罩麻醉 麻醉主治醫師 趙安怡 ASA 3 紀錄醫師 羅健洺, 時間資訊 15:04 臨時手術NPO 11:23 報到 11:46 進入手術室 11:50 麻醉開始 11:55 抗生素給藥 11:55 誘導結束 12:13 手術開始 13:05 手術結束 13:05 麻醉結束 13:10 送出病患 13:15 進入恢復室 14:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Semi-opened mask inhalation anes 1 0 手術 長及短隱靜脈的結紮,分離和完全剝出-單側 1 1 R 手術 其他小靜脈曲張之縫合,結紮或剝除 1 2 B 記錄__ 手術科部: 外科部 套用罐頭: varicose vein 開立醫師: 羅健洺 開立時間: 2011/02/14 13:17 Pre-operative Diagnosis Lower limbs varicose vein (Bilateral) Post-operative Diagnosis Lower limbs varicose vein (Bilateral) s/p EVRF + Muller's phlebectomy Operative Method EVRF + Muller's phlebectomy Specimen Count And Types 1 piece About size:multiple Source:variocose veins multiple variocose veins Pathology pending Operative Findings 1. engorged varicose vein over lower legs, telangiectasia (+) 2. Data: right: 120 degrees, 15W, 1min 40secs, 5cycles, 31cm Operative Procedures -Under IVG, the patient was posed in supine position with. adequate skin disinfection and drapping. -EVRF: Echo-guided bilateral GSV catheterization and sheath insertion. EVRF from 2cm distalto GSV/CFV junction to the distal of GSV near to the knee. -Muller phlebectomy: bilateral Muller's phlebectomy via multiple small stabbing wounds. -Hemostasis, wounds closure. Compression by bandage. Operators 王水深, Assistants 羅健洺, 楊戴尾 (F,1936/03/11,76y0m) 手術日期 2011/02/15 手術主治醫師 曾勝弘 手術區域 西址 039房 01號 診斷 Ulnar palsy 器械術式 Neurolysis of the uluar neuve 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 08:45 報到 09:15 進入手術室 09:35 麻醉開始 09:40 手術開始 10:35 手術結束 10:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 神經分離術-上臂.前臂.大腿.小腿處之神經 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Neurolysis 開立醫師: 游健生 開立時間: 2011/02/15 11:03 Pre-operative Diagnosis Right ulnar nerve palsy Post-operative Diagnosis Right ulnar nerve palsy Operative Method Neurolysis Specimen Count And Types nil Pathology Nil Operative Findings A fibrotic band compressing the ulnar nerve about 1cm distal to ulnar groove. It was opened and nerve became free of compression. Operative Procedures 1.The entire right arm was disinfected with povidone-iodine tincture then covered with stockinet. 2. local anesthesia was used 3. Incision: 8 cm, longitudinal in direction, crossed over the medial epicondyle. 4.The brachial fascia and medial intermusclular septum were opened longitudinally to exposed the ulnar nerve at supracondylar region. 5. A 5 cm segment of this nerve and its mesoneurium were isolated. The fibrous tissue which entraped the nerve 1cm distal to ulnar groove was opened and the nerve was released. The nerve was isolated further 5cm distally and proximally to the medial epicondyle. 6. The wound was closed by interrupted suture with 4/0 nylon. 7. The arm was draped with elastic bandage dressing. Operators VS 曾勝弘 Assistants R3 游健生 劉恒瑀 (M,2010/09/16,1y5m) 手術日期 2011/02/15 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Spinal cord disease,others 器械術式 Cord untethering -KUO，Repair of meningocele or enccp 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 2 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 07:44 報到 08:05 進入手術室 08:20 麻醉開始 08:40 誘導結束 09:25 手術開始 09:30 抗生素給藥 12:05 手術結束 12:05 麻醉結束 12:25 進入恢復室 13:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓整形術 1 2 手術 脊椎內脊髓內腫瘤切除術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 記錄__ 手術科部: 外科部 套用罐頭: 1. Untethering of tethered cord. 開立醫師: 鍾文桂 開立時間: 2011/02/15 19:47 Pre-operative Diagnosis 1. Tethered cord syndrome. 2. Lipomyelocystocele. 3. Lipoma, filum terminale. Post-operative Diagnosis 1. Tethered cord syndrome. 2. Lipomyelocystocele. 3. Lipoma, filum terminale. Operative Method 1. Untethering of tethered cord. 1. complete untethering of the tethered cord by excision of the subcutaneous lipoma thenalong the tract to remove the intradural dosal lipoma. 2. Laminoplasty, L3-L5. 3. Resection of filum terminale lipoma, and excision of subcutaneous lipoma. Specimen Count And Types 1 piece About size:10cc Source:1. Subcutaneous lipoma. 2. lipoma at cysto-dural junction. 2. lipoma at lipodural junction. 3. Filum terminale lipoma Pathology Pending. Operative Findings 1. A large subcutaneous lipoma at lumbar-sacral junction. It was excised. It is connected to the extra and intra dural lipoma through a 0.5 cm dural defect at L5 level. 1. A large subcutaneous lipoma at lumbar-sacral junction. It was excised. It is connected to the extra- and intradural lipoma through a 1.0 cm dural defect at L5 level. The L4 lamine was cartilageous change due to poor development. 2. The intradural part of the lipoma was totally excised. 2. The lower end of the intradural dorsal lipoma was excised along with the lipomatous tract. It upper part had a smooth arachnoid plane and its size was not large, so we left it intact to reduce future retethering. 3. The filum terminale lipoma was resected. 3. The filum terminale was thick up to 2.5 mm and fully infiltrated with lipoma. It was resected. Operative Procedures Under ETGA, the patient was placed in prone position. After disinfection, draping, a vertical linear incision was made at L-S junction. After bilateral subcutaneous dissection, the subcutaneous lipoma was excised. The L5-L3 laminoplasty was done by using 1mm Kerrison punch. The tract of the lipoma from the spina bifida to the extradural space was dissected. Further lipoma excision was done under microscopic niew to gain more exposure. Later, the intradural lipoma was exposed after durotomy. Further dissection was done to delineate the lipoma from the surrounding meninges (lipoduroneural junsction). A complete untethering of the placode was successfully done. Under ETGA, the patient was placed in prone position. After disinfection, draping, a vertical linear incision was made at L-S junction. After bilateral subcutaneous dissection, the subcutaneous lipoma was excised and the tract connecting to the lamina was identified. The L3-L4 laminoplasty was done by using 1mm Kerrison punch. The L3,4 laminae were reflected upward. The tract of the lipoma from the spina bifida to the extradural space was dissected. Further lipoma excision was done under microscopic niew to gain more exposure. Later, the intradural lipoma was exposed after durotomy. Further dissection was done to delineate the lipoma from the surrounding meninges (lipoduroneural junsction). A complete untethering of the placode was successfully done. The bulk of the lipoma was excised with a small piece left on the conus medullaris. Distally, we identified the filum terminale and its infiltrating lipoma. We resected the filum terminale lipoma. The dura mater was closed primarily with 5-0 Prolene. The laminae were fixed back by 2-0 silk. The wound was closed in layers. The bulk of the lipoma was excised with the upper part of it left on the conus medullaris since the surface was smooth. Distally, we identified the filum terminale and its infiltrating lipoma. We resected the filum terminale lipoma. The dura mater was closed primarily with 5-0 Prolene. The laminae flap was fixed back by 2-0 silk. The wound was closed in layers after revising the redundant skin. Operators V.S. 郭夢菲 Assistants R5 鍾文桂 王曜銘 (M,1997/05/08,14y10m) 手術日期 2011/02/15 手術主治醫師 郭夢菲 手術區域 兒醫 067房 02號 診斷 Moyamoya disease 器械術式 Moyamoya P-DUH，Cord untethering -KUO 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 12:02 報到 12:35 進入手術室 12:40 麻醉開始 13:00 誘導結束 13:35 抗生素給藥 13:42 手術開始 17:45 麻醉結束 17:45 手術結束 17:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱內外血管吻合術 1 1 L 手術 朴卜勒氏血流測定（週邊血管） 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Encephaloduroarteriosynangiosis, left. 開立醫師: 鍾文桂 開立時間: 2011/02/15 18:16 Pre-operative Diagnosis Moyamoya disease, bilateral, more severe at left. Post-operative Diagnosis Moyamoya disease, bilateral, more severe at left. Operative Method Encephaloduroarteriosynangiosis, left. Specimen Count And Types nil Pathology Nil. Operative Findings 1. Long segment of posterior branch( 6 cm) was dissected. 1. Long segment of posterior branch(7.5cm) was dissected. 2. Contact between STA and MCA branches are tension-free. 2. Contact between STA and MCA branches are tension-free and about 6 cm long. The anterior branch of left STA was sacrifice for getting a longer segment of the graft. Operative Procedures With endotracheal general aenasethesia, the patient was put in supine position with head rotated to right. After scalp shaved, scrubbed, disinfected, and then draped, we localize the STA position and territory by Doppler. Under microscopic view, we made one curvilinear skin incision and dissected above the galeal to expose posterior branch of left STA. We made the inicion along 1cm away from STA at bilateral side, and created craniotomy 2x6cm, beneath STA, after linear incision of the left temporalis muscle. After dural tenting, linear durotomy was done, and arachnoid membrane was separated by forceps. STA graft was anchored at bilateral ends of durotomy, we placed gelfoam to push the graft anteriorly for better contact between the graft and the MCA and the dura was closed in water-tight suture and Durofoam. Bone graft was fixed back with 4 wires, and the wound was closed in layers. With endotracheal general aenasethesia, the patient was put in supine position with head rotated to right. After scalp shaved, scrubbed, disinfected, and then draped, we localize the STA position and territory by Doppler. Under microscopic view, we made one curvilinear skin incision and dissected above the galeal to expose posterior branch of left STA. We made the inicion along 1cm away from STA at bilateral side, and created craniotomy 2x6cm, beneath STA, after linear incision of the left temporalis muscle. Two burr holes were made then craniotomy was done. After dural tenting, linear durotomy was done, and arachnoid membrane was separated by forceps. STA graft was anchored at bilateral ends of durotomy, we placed gelfoam to push the graft anteriorly for better contact between the graft and the MCA and the dura was closed in water-tight suture and Durofoam. Bone graft was fixed back with 4 wires, and the wound was closed in layers. Operators VS 郭夢菲 Assistants R5 鍾文桂 鄒寶蓮 (F,1943/07/27,68y7m) 手術日期 2011/02/15 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Astrocytoma 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾偉倫, 時間資訊 07:50 報到 08:05 進入手術室 08:10 麻醉開始 09:00 誘導結束 09:30 抗生素給藥 09:50 手術開始 12:05 麻醉結束 12:05 手術結束 12:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦組織活體切片 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Frontal craniotomy for tumor biopsy 開立醫師: 陳睿生 開立時間: 2011/02/15 12:11 Pre-operative Diagnosis Multiple intracranial mass lesion, suspect lymphoma, suspect metastasis Post-operative Diagnosis Multiple intracranial mass lesion, suspect lymphoma, suspect metastasis Operative Method Frontal craniotomy for tumor biopsy Specimen Count And Types 1 piece About size:PIECES Source:tumor Pathology Pending Operative Findings We accessed the right frontal tumor by small craniotomy. The tumor was gray-whitish, and mild elastic pattern. It located at subcortical region, and was a well margin one. Operative Procedures 1. ETGA, supine position and head mild left turn 2. Curvillinear scalp incision at right frontal region 3. Make an about 4x4cm craniotomy 4. Dura tenting, and then opened the dura 5. An about 2cm corticotomy was created, and then the tumor was harvested at about 1 cm in depth 6. Send for frozen biopsy 7. Hemostasis, close the dura tightly 8. Fix back the skull graft with miniplate, and covered with bone cement 9. Close the wound in layers Operators VS 賴達明 Assistants R6 陳睿生, R2 曾偉倫 凌永 (M,1938/05/12,73y10m) 手術日期 2011/02/15 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Lumbar Spondylosis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾偉倫, 時間資訊 12:15 報到 12:20 進入手術室 12:34 麻醉開始 12:45 誘導結束 13:00 抗生素給藥 13:20 手術開始 16:20 抗生素給藥 17:00 手術結束 17:00 麻醉結束 17:10 送出病患 17:17 進入恢復室 18:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術(減壓)-二節以內 1 4 手術 椎間盤切除術-腰椎 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 摘要__ 手術科部: 外科部 套用罐頭: L3/4, L4/5 right lamonectomy with L4/5 discec... 開立醫師: 曾偉倫 開立時間: 2011/02/15 17:37 Pre-operative Diagnosis Lumbar stenosis L3/4, L4/5 Post-operative Diagnosis Lumbar stenosis L3/4, L4/5 Operative Method L3/4, L4/5 right lamonectomy with L4/5 discectomy + posterior fusion with TPS over L3, L5 + L4/5 posterior lumbar interbody fusion with PEEK cage and autologous bone graft Specimen Count And Types nil Pathology Nil Operative Findings 1. Hypertrophic ligamentum flavum witn narrowed spinal canal 2. Thecal sac and neural structures were decompressed well after the surgery 3. Facet arthropathy with thickening over L3/4 and 4/5 Operative Procedures After general anesthesia, the patient was put on prone position. We localize the L3-4-5 facet joint with C-arm then mark the location over the skin. We scrubbed, disinfected, and then draped the patients back. Mid-line skin incision alone the L3/5 spinous process. After we open the wound and dissected paraspinal muscles, Right L3-5 laminotomy was peformed with L4/5 diskectomy. The TPS was placed over L3 and L5 pedicle and L4/5 posterior lumbar interbody fusion with PEEK cage and autologous bone graft was performed. After the bleeders checked, we placed a hemovac drain. The wound was closed in layers. Operators VS 賴達明 Assistants R6 陳睿生 R2 曾偉倫 楊春晨 (M,1929/04/05,82y11m) 手術日期 2011/02/15 手術主治醫師 賴達明 手術區域 東址 005房 01號 診斷 Peptic ulcer, acute, with perforation 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾峰毅, 時間資訊 07:40 報到 08:05 進入手術室 08:10 麻醉開始 08:50 抗生素給藥 09:00 誘導結束 09:07 手術開始 11:50 抗生素給藥 12:15 開始輸血 12:30 手術結束 12:30 麻醉結束 12:40 送出病患 12:42 進入恢復室 14:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 脊椎融合術-前融合,有固定物)≦四節 1 2 手術 椎間盤切除術-腰椎 1 4 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 曾峰毅 開立時間: 2011/02/15 12:48 Pre-operative Diagnosis Lumbar stenosis, L3-5, spondylolisthesis, L3/4, grade I Post-operative Diagnosis Lumbar stenosis, L3-5, spondylolisthesis, L3/4, grade I Operative Method Posterior decompression, L3/4, and L4/5; posterior fixation with transpedicular screws at L3 and L4; transforaminal lumbar interbody fusion with PEEK cage and autologous bone graft Specimen Count And Types Nil Pathology Nil Operative Findings Hypertrophic ligamentum flavum compressed the thecal sac tightly. Thecal sac and neural structures were decompressed well after the surgery. Syntheses transpedicualr screws, rods, PEEK cages were used for TLIF. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After C-arm localization, we scrubbed, disinfected, and then draped the back. We made midline skin incision from L3 to L4 spinous process, and dissected paraspinal muscles. We inserted TPS into bilateral pedicles of L3 and L4. We performed split laminectomy of L4, and laminectomy fo L3 for decompression to bilateral lateral recesses. We peformed L3/4 disectomy and achieved fusion with PEEK banana cage and autologous bone graft. Fixation was achieved with two rods set. After one hemovac inserted, we closed the wound in layers. Operators VS 賴達明 Assistants R4 曾峰毅 Ri 王逸萍 張家豪 (M,1975/06/08,36y9m) 手術日期 2011/02/15 手術主治醫師 賴達明 手術區域 東址 005房 02號 診斷 Herniation of intervertebral disc (HIVD) 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾峰毅, 時間資訊 12:15 報到 12:51 進入手術室 12:55 麻醉開始 13:05 誘導結束 13:30 抗生素給藥 13:42 手術開始 15:50 手術結束 15:50 麻醉結束 16:00 送出病患 16:02 進入恢復室 17:02 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎間盤切除術-腰椎 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 摘要__ 手術科部: 外科部 套用罐頭: HIVD 開立醫師: 曾峰毅 開立時間: 2011/02/15 16:03 Pre-operative Diagnosis L4/5 HIVD Post-operative Diagnosis L4/5 HIVD Operative Method L4/5 microdiscetomy via right laminotomy, and posterior stablization with Coflex Specimen Count And Types Nil Pathology Nil Operative Findings Extruding disc at L4/5 compromised the spinal canal. Thecal sac was decompressed well after discectomy. Coflex 12 mm high was inserted. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After C-arm localization, we scrubbed, disinfected, and then draped the patient's back. we made one midline skin incision to expose spinous process of L4 and L5. Right L4 laminotomy was peformed to do the L4/5 diskectomy. We performed sublaminar decompression, and removed the interspinous process of L4/5. We inserted Coflex into L4/5 interspinous space, and closed the wound in layers. Operators VS 賴達明 Assistants R4 曾峰毅 李余勇 (M,1971/05/11,40y10m) 手術日期 2011/02/15 手術主治醫師 賴達明 手術區域 東址 002房 04號 診斷 Intracerebral hemorrhage (ICH) 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 14:45 報到 14:53 進入手術室 14:55 麻醉開始 15:00 誘導結束 15:53 手術開始 16:50 手術結束 16:50 麻醉結束 16:59 送出病患 17:08 進入恢復室 18:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt insertion via righ... 開立醫師: 王奐之 開立時間: 2011/02/15 16:58 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunt insertion via right Frazier point Specimen Count And Types nil Pathology Nil Operative Findings Clear CSF was noted after ventricular puncture. Opening pressure: 0~5cmH2O. Medtronic medium pressure reservoir was used, ventricular catheter length: 9cm. Operative Procedures After ETGA, the patient was placed in supine position with face turned to left. After scalp shaving, skin disinfection and draping in sterile fashion, a curved skin incision was made at right occipital area. A Frazier point burr hole was made, followed by dural tenting. Abdominal wound was made at RUQ, mini-laparatomy was done. Subcutaneous tunnel was made from abdominal wound to the scalp wound, after connecting the shunt reservoir and catheters, ventricular tapping was done after cruciate durotomy. After confirming smooth CSF flow and hemostasis, the wounds were closed in layers. Operators VS 賴達明 Assistants R6 胡朝凱, R3 王奐之 相關圖片 莊朝宗 (M,1938/09/22,73y5m) 手術日期 2011/02/15 手術主治醫師 林偉彭 手術區域 東址 016房 01號 診斷 Fracture of olecranon process of ulna, closed 器械術式 ORIF - Patellar Fr(K-pin,wire 手術類別 緊急手術 手術部位 四肢 傷口分類 清潔 麻醉方式 面罩麻醉 麻醉主治醫師 劉漢平 ASA 3E 紀錄醫師 黃偉程, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 02:34 通知急診手術 08:40 報到 08:50 進入手術室 08:55 麻醉開始 09:30 誘導結束 09:40 抗生素給藥 09:50 手術開始 10:52 手術結束 10:52 麻醉結束 10:55 送出病患 11:00 進入恢復室 12:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 橈骨、尺骨骨折開放性復位術 1 1 L 手術 石膏副木固定－長臂 1 0 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Semi-opened mask inhalation anes 1 0 記錄__ 手術科部: 骨科部 套用罐頭: ORIF with TBW 開立醫師: 黃偉程 開立時間: 2011/02/15 08:55 Pre-operative Diagnosis left olecranon fracture ,comminuted Post-operative Diagnosis left olecranon fracture ,comminuted Operative Method ORIF with TBW Specimen Count And Types nil Pathology nil Operative Findings comminuted fracture Operative Procedures 1.Nerve block ,supine 2.sterilize the skin and drap 3.skin incision along the ulna crest 4.ORIF with TBW 5.irrigation of the wound with n/s and close the wound 6.apply long arm splint Operators 林偉彭, Assistants 黃偉程, Indication Of Emergent Operation 王思茹 (F,1980/05/16,31y9m) 手術日期 2011/02/15 手術主治醫師 陳敞牧 手術區域 東址 005房 03號 診斷 Intracranial hemorrhage 器械術式 Brain tumor Crainotomy(Others) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 羅偉誠, 時間資訊 13:00 開始NPO 13:00 臨時手術NPO 16:01 通知急診手術 16:40 報到 16:40 進入手術室 16:45 麻醉開始 16:55 誘導結束 17:33 抗生素給藥 17:36 手術開始 18:00 開始輸血 21:45 麻醉結束 21:45 手術結束 21:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 開顱術摘除血管病變-動靜脈畸型小型表淺 1 1 手術 腦內血腫清除術 1 2 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for hematoma and tumor remove, ICP... 開立醫師: 陳睿生 開立時間: 2011/02/15 22:21 Pre-operative Diagnosis Left temporal ICH, suspect tumor with bleeding Post-operative Diagnosis Left temporal ICH, suspect tumor with bleeding Operative Method Craniotomy for hematoma and tumor remove, ICP monitor insertion Specimen Count And Types 2 pieces About size:pieces Source:tumor About size:pieces Source:hematoma Pathology Pending Operative Findings Moderate brain swelling was noted intra-op. Several pieces of mass lesion was noted beneath to the hematoma. The mass was gray-whitish, soft, and solid. Tumor with bleeding was impressed. The hematoma was diffuse pattern, and peripheral brain tissue was fragile, and easy oozing. A subdural ICP monitor was inserted. After duroplasty done, the ICP was about 8mmHg. ICP monitor reference: 501 Operative Procedures 1. ETGA, supine position and head right turn 2. Left frontotemporal curvillinear scalp incision as trauma flap 3. After two bur holes made, an about 12x12cm craniotomy window was created 4. After proper dura tenting, the dura was opened 5. The hematoma with mass lesion was identified mainly at left middle and inferior temporal gyrus 6. After hematoma evacuation, the mass lesion was also removed 7. Hemostasis, and the tumor side was packed with surgicel 8. Duroplasty was done with fascia graft 9. A subdural ICP monitor was inserted 10.Fix back the skull graft, and set a subgaleal CWV drain 11.Close the wound in layers Operators VS 陳敞牧 Assistants R6 陳睿生, R1 羅偉誠 Indication Of Emergent Operation 朱玉華 (F,1957/09/18,54y5m) 手術日期 2011/02/15 手術主治醫師 楊士弘 手術區域 西址 039房 03號 診斷 Carpal tunnel syndrome 器械術式 Decompression of mediun nerve 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 09:55 報到 13:00 進入手術室 13:22 麻醉開始 13:25 手術開始 14:10 手術結束 14:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 正中神經或尺神經腕部減壓術–單側 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Carpal Tunnel Syndrome 開立醫師: 游健生 開立時間: 2011/02/15 14:33 Pre-operative Diagnosis Left Carpal Tunnel Syndrome Post-operative Diagnosis Left Carpal Tunnel Syndrome Operative Method Median nerve decompression Specimen Count And Types nil Pathology Nil Operative Findings The median nerve was compressed tightly at distal part by transverse carpal ligament. It was released after the ligament was opened. Operative Procedures 1.The left hand and forearm were sterilized with povidone-iodine tincture, then covered with stockinet. 2. Local anesthesia injection. 3. Vertical incision from vertical palmar crease to transverse wrist crease. 4. The palmaris longus tendon was identified, then the plamar aponeurosis was cut longitidinally along the ulnar side of the palmaris longus tendon. 5. The median nerve was identified beneath the palmars longus tendon. Under direct vision, the transverse carpal ligament was divided until no more pressure on the median nerve could be palpated. 6. The skin was closed by interrupted suture with 4/0 nylon. 7. The hand and wrist were draped with fluffy dressing and elastic bandage. Operators VS 楊士弘 Assistants R3 游健生 李美倫 (F,1957/09/10,54y6m) 手術日期 2011/02/15 手術主治醫師 蕭輔仁 手術區域 西址 039房 02號 診斷 Carpal tunnel syndrome 器械術式 Decompression of mediun nerve 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 09:20 報到 11:15 進入手術室 11:40 麻醉開始 11:45 手術開始 12:40 送出病患 12:42 手術結束 醫令資訊 類別 名稱 量 刀 側 手術 正中神經或尺神經腕部減壓術–單側 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Carpal Tunnel Syndrome 開立醫師: 游健生 開立時間: 2011/02/15 12:42 Pre-operative Diagnosis Left Carpal Tunnel Syndrome Post-operative Diagnosis left Carpal Tunnel Syndrome Operative Method Carpal Tunnel Syndrome Specimen Count And Types nil Pathology Nil Operative Findings The median nerve was compressed tightly at distal part by transverse carpal ligament. It was released after the ligament was opened. Operative Procedures 1.The left hand and forearm were sterilized with povidone-iodine tincture, then covered with stockinet. 2. Local anesthesia injection 3. vertical incision from vertical palmar crease to transverse wrist crease. 4.The palmaris longus tendon was identified, then the plamar aponeurosis was cut longitidinally along the ulnar side of the palmaris longus tendon. 5. The median nerve was identified beneath the palmars longus tendon. Under direct vision, the transverse carpal ligament was divided until no more pressure on the median nerve could be palpated. 6. The skin was closed by interrupted suture with 4/0 nylon. 7. The hand and wrist were draped with fluffy dressing and elastic bandage. Operators VS 蕭輔仁 Assistants R3 游健生 高銘欣 (M,1933/12/10,78y3m) 手術日期 2011/02/15 手術主治醫師 郭順文 手術區域 東址 002房 02號 診斷 冠狀動脈疾病 CAD, coronary artery disease 器械術式 Tracheostomy 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3E 紀錄醫師 廖先啟, 時間資訊 00:00 開始NPO 00:00 臨時手術NPO 09:33 通知急診手術 11:20 進入手術室 11:20 報到 11:22 麻醉開始 11:25 誘導結束 11:50 手術開始 12:25 麻醉結束 12:25 手術結束 12:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 氣管切開術 1 0 手術 支氣管鏡檢查 1 0 記錄__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 廖先啟 開立時間: 2011/02/15 12:38 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types Nil Pathology None Operative Findings Fr. 8 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators VS郭順文 Assistants CR李佳穎，R3廖先啟 Indication Of Emergent Operation 左旻仟 (F,1983/11/14,28y4m) 手術日期 2011/02/16 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Goiter nodular 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 王奐之, 時間資訊 07:30 報到 08:06 進入手術室 08:10 麻醉開始 09:00 誘導結束 09:20 抗生素給藥 09:50 手術開始 12:20 抗生素給藥 13:15 手術結束 13:15 麻醉結束 13:20 送出病患 13:20 開始輸血 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 經由蝶竇之腦下垂體瘤切除 1 1 摘要__ 手術科部: 內科部 套用罐頭: Endoscopic trans-sphenoid adenomectomy 開立醫師: 王奐之 開立時間: 2011/02/16 12:55 Pre-operative Diagnosis Pituitary macroadenoma Post-operative Diagnosis Pituitary macroadenoma Operative Method Endoscopic trans-sphenoid adenomectomy Specimen Count And Types 1 piece About size:pieces Source:pituitary tumor Pathology Pending Operative Findings Yellowish jelly-like content were noted after durotomy. After evacuation of the jelly-like content with suction and currette, the normal pituitary gland and stalk were directly seen. The jelly-like content were sent for pathology and culture. CSF leakage was encountered intra-operatively, lumbar drain was inserted after the operation. Operative Procedures After ETGA, the patient was placed in supine position with head placed on horseshoe head rest, with neck slightly extended. After skin disinfection and draping in sterile fashion, the anterior wall of sphenoid sinus was drilled open and vomer was removed under endoscopic visualization. After entering the sphenoid sinus, the medial septum was removed for direct access to the sellar floor. The sellar floor was then fractured open, and enlarged with punch. A cruciate durotomy was done, followed by evacuation of the pituitary tumor content. After hemostasis, the bone chip was put back and Tissucol-Duo was applied. Marocel were packed to both nostrils. Operators P 杜永光, VS 楊士弘 Assistants R6 胡朝凱, R3 王奐之 相關圖片 周易正 (M,1971/07/28,40y7m) 手術日期 2011/02/16 手術主治醫師 曾漢民 手術區域 東址 003房 04號 診斷 Glioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 游健生, 時間資訊 15:15 報到 15:25 進入手術室 15:30 麻醉開始 15:50 誘導結束 16:20 手術開始 16:20 抗生素給藥 19:20 抗生素給藥 19:55 麻醉結束 19:55 手術結束 20:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 腦瘤切除-手術時間在4小時以內 1 1 R 手術 立體定位術-切片 1 2 R 摘要__ 手術科部: 外科部 套用罐頭: Navigation system-assisted craniotomy for gro... 開立醫師: 游健生 開立時間: 2011/02/16 20:29 Pre-operative Diagnosis Right medial frontal gyrus low-grade glioma Post-operative Diagnosis Right medial frontal gyrus low-grade glioma Operative Method Navigation system-assisted craniotomy for gross total tumor excision Specimen Count And Types 1 piece About size:a few pieces Source:brain tumor Pathology pending Operative Findings The tumor was about 2x2x2cm in volume located at right medial frontal gyrus. It was milky white in color and gelatin in consistence. The tumor did not have clear border with surrounding brain parenchyma. The posterior resection margin was defined by the arachnoid membrane between medial frontal gyrus and pre-motor gyrus. Operative Procedures 1. Under ETGA, patient was in supine position with head fixed by Mayfield headclamp. 2. Neck was flexed about 45 degrees with patent venous return 3. Set up nagivation system and located the tumor 4. After shaving, we disinfected and draped the operation field as usual 5. A U-shape scalp incision was made at right frontal region just above the tumor 6. Skin flap was reflected anteriorly with pericranium left on skull 7. After 3 burrholes, a 5 x 5cm craniotomy was done followed by dura tenting 8. U-shape durotomy with base at superior saggital sinus 9. Intra-operative ultrasound and nagivation were used to locate the tumor 10.Intra-operative mapping of the motor cortex was done 11.We removed the tumor in pieces under microscope and achieved gross total excision 12.Hemostasis with Surgicel packing on tumor bed 13.Dura was repaired and closed with continous suture by 4-0 prolene with a pericranium graft 14.After central tenting and placement a gelform over the dura, bone flap was fixed back with mini-plates 15.Wound was closed in layers Operators VS 曾漢民 Assistants R6 陳睿生 R3 游健生 劉吳容妹 (F,1945/08/25,66y6m) 手術日期 2011/02/16 手術主治醫師 蔡瑞章 手術區域 東址 001房 01號 診斷 Subdural hematoma 器械術式 Burr hole (trephination) for chronic subdural hematoma drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 李振豪, 時間資訊 18:00 臨時手術NPO 18:00 開始NPO 03:59 通知急診手術 04:50 報到 04:53 麻醉開始 04:53 進入手術室 04:58 誘導結束 05:15 抗生素給藥 05:30 手術開始 06:30 手術結束 06:30 麻醉結束 06:45 送出病患 06:48 進入恢復室 09:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 頭顱穿洞術(止血引流、穿刺檢查) 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Left frontal burr hole drainage 開立醫師: 李振豪 開立時間: 2011/02/16 06:49 Pre-operative Diagnosis Left fronto-temporo-parietal chronic subdural hematoma with uncal herniation Post-operative Diagnosis Left fronto-temporo-parietal chronic subdural hematoma with uncal herniation Operative Method Left frontal burr hole drainage Specimen Count And Types 2 pieces About size:0.5cm x 0.5cm Source:Dura About size:15ml Source:subdural hematoma Pathology Nil Operative Findings Motor oil-like chronic subdural hematoma gushed out after opening the outer membrane. The outer membrane was about 0.3cm in thickness. The inner membrane also noted after chronic subdural hematoma drainage. The brain remain slack after removal of the subdural hematoma. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position. The scalp was shaved, scrubbed, and disinfected as usual. The linear scalp incision was made at left frontal area followed by one burr hole creation. Two dural tenting was done. One 0.5cm x 0.5cm dura was excised and sent for pathology. The outer membrane was opened and chronic subdural hematoma was drained out. The subdural space was irrigated with more than 500ml normal saline solution and one subdural rubber drain was placed. Hemostasis was achieved with bipolar electrocautery and Gelform packing. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators Prof.蔡瑞章 Assistants R4李振豪 Indication Of Emergent Operation 相關圖片 歐陽佩鈞 (F,1996/12/15,15y2m) 手術日期 2011/02/16 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Epidural hematoma 器械術式 craniotomy 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 蕭柏妮 ASA 4E 紀錄醫師 羅偉誠, 時間資訊 02:24 臨時手術NPO 02:24 開始NPO 02:25 通知急診手術 03:25 進入手術室 03:30 麻醉開始 03:50 抗生素給藥 04:00 誘導結束 04:22 手術開始 04:55 開始輸血 06:50 手術結束 06:50 麻醉結束 07:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 硬腦膜外血腫清除術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Craniotomy for hematoma evacuation 開立醫師: 陳睿生 開立時間: 2011/02/16 07:05 Pre-operative Diagnosis Left frontotemporal epidural hematoma Left frontotemporal acute epidural hematoma Post-operative Diagnosis Left frontotemporal epidural hematoma Left frontotemporal acute epidural hematoma Operative Method Craniotomy for hematoma evacuation Craniotomy for hematoma evacuation Specimen Count And Types nil Pathology Nil Operative Findings About 4cm in thickness hematoma was noted at left frontotemporal region. After hematoma removal, the brain was expanded gradually. A previous set VP shunt was noted intra-op, and our craniotomy was below the shunt set. No obvious active bleeder was noted. About 4cm in thickness hematoma was noted at left frontotemporal region. Before decompression, the brain was compressed deeply and poor pulsated, after hematoma removal, the brain expanded gradually and slowly. We also increased the PaCO2 to 40 mmHg to improved the brain expansion. A previous set VP shunt was noted, and our craniotomy was designed to locate below and anterior to the shunt set. No obvious active bleeder or fracture was noted. Operative Procedures After ETGA, the patient was under supine position and head right turn. A curvillinear scalp incision was made at left frontotemporal region. After partial incision of the temporalis muscle, an about 4x6cm craniotomy window was made. The hematoma was identified, and then evacuated. After proper hemostasis, the dura was proper tented. Then an epidural CWV drain was set and the skull graft was fixed back with wires x3. Central tenting was done. The temporalis muscle was sutured back and the wound was closed in layers. After ETGA, the patient was under supine position and head right turn. A curvillinear scalp incision was made at left frontotemporal region. After partial incision of the temporalis muscle, an about 4x6cm craniotomy window was made. The hematoma was identified, and then evacuated. After proper hemostasis, the dura was properly tented for more than 15 stitches to decrease the epidural space. Then an epidural CWV drain was set and the skull graft was fixed back with wires x3. Central tenting was done. The temporalis muscle was sutured back and the wound was closed in layers. Operators AP 郭夢菲 Assistants R6 陳睿生, R1 羅偉誠 Indication Of Emergent Operation 李春桃 (F,1932/08/29,79y6m) 手術日期 2011/02/16 手術主治醫師 賴達明 手術區域 東址 016房 01號 診斷 Glioblastoma multiforma 器械術式 Brain tumor Crainotomy(Others) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 07:23 通知急診手術 08:55 進入手術室 09:00 麻醉開始 09:40 抗生素給藥 09:40 誘導結束 09:55 手術開始 12:40 抗生素給藥 12:55 開始輸血 15:40 抗生素給藥 17:45 手術結束 17:45 麻醉結束 17:55 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 10 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除-手術時間在8小時以上 1 1 L 手術 其他超音波 1 0 L 記錄__ 手術科部: 外科部 套用罐頭: Left frontal craniotomy for tumor excision. 開立醫師: 鍾文桂 開立時間: 2011/02/16 18:39 Pre-operative Diagnosis Corpus callosum high grade glioma. Post-operative Diagnosis Corpus callosum high grade glioma. Operative Method Left frontal craniotomy for tumor excision. Specimen Count And Types 1 piece About size:20cc Source:brain tumor. Pathology Pending. Operative Findings 1. Grayish-red soft hypervascularized tumor with cystic change( clear yellowish content) and multifocal intratumoral hematoma. The tumor invaded in to the lateral ventricular wall and encased the ACA. The tumor was localized by using intraoperative ultrasonography. 2. A large cortical drainage vein was noted at the craniotomy site. It was kept intact. The corticotomy was posterior to the vein. 3. The left ACA and bilateral lateral ventricle were met during tumor excision. An EVD catheter was placed at the ventricle. 4. Slack brain after tumor excision. 5. The dural defect was repaired by DuraFoam and pericranium. Severe adhesion of the dura mater to the skull bone. Operative Procedures Under ERGA, the patient was placed in supine position and head fixed by 3-pin Mayfield head holder in midline position. After shaving, disinfection, and draping, the curvilinear scalp incision was made. After dissection, a 6-cm craniotomy was created. After dural tenting, the durotomy was made based on superior sagital sinus. After using ultrasound for tumor localization, the corticotomy was done posterior to the large cortical drainage vein. Then, the tumor was reached and excised in piecemeal fashion. After total tumor excision and well hemostasis,the EVD was placed in the ventricle cavity.The brainsurface was covered with Surgicel. The dura mater was closed and repaired with DuraFoam and pericranium. The bone plate was fixed by miniplates and screws. The wound was closed in layers with one CWV drain in situ. Operators V.S. 賴達明 Assistants R5 鍾文桂 Ri賴品泉 Indication Of Emergent Operation 黃美美 (F,1979/01/01,33y2m) 手術日期 2011/02/16 手術主治醫師 賴達明 手術區域 東址 005房 01號 診斷 Lumbar spondylosis 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 張廷碩, 時間資訊 08:03 進入手術室 08:05 麻醉開始 08:10 誘導結束 08:38 抗生素給藥 09:00 手術開始 10:10 手術結束 10:10 麻醉結束 10:18 送出病患 10:20 進入恢復室 11:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-腰椎 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Microdiskectomy of L4/5 開立醫師: 曾峰毅 開立時間: 2011/02/16 10:25 Pre-operative Diagnosis L4/5 HIVD, compromising thecal sac and right lateral recess Post-operative Diagnosis L4/5 HIVD, compromising thecal sac and right lateral recess Operative Method Microdiskectomy of L4/5 Specimen Count And Types Nil Pathology Nil Operative Findings Severe adheion with hypervascular fibrosis was noted at previous lamiotomy site. Sequestrated disc was noted compromising left lateral recess. Nueral structures were decompressed well. Incidental durotomy was noted at left L5 root, and was sealed with artificial dura. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After C-arm localization, we scrubbed, disinfected, and then draped the back. We made one midline skin incision and dissected left paraspinal muscles. We performed left L4/5 laminotomy and then diskectomy. Incidental durotomy was sealed with Durafoam. The wound was closed in layers. Operators VS 賴達明 Assistants R4 曾峰毅 R1 張廷碩 唐堅平 (F,1957/09/18,54y5m) 手術日期 2011/02/16 手術主治醫師 楊士弘 手術區域 東址 005房 02號 診斷 Lung cancer 器械術式 Malignant intraspinal tumor, e 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 張廷碩, 時間資訊 10:25 報到 10:32 進入手術室 10:35 麻醉開始 11:05 抗生素給藥 11:20 誘導結束 11:50 手術開始 12:20 開始輸血 14:05 抗生素給藥 17:00 手術結束 17:00 麻醉結束 17:05 抗生素給藥 17:08 送出病患 17:10 進入恢復室 18:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 惡性脊髓腫瘤切除術 1 1 手術 脊椎融合術-後融合,有固定物(<=六節) 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 內科部 套用罐頭: 1. T12 laminectomy, facectomy, and bilateral ... 開立醫師: 楊士弘 開立時間: 2011/02/16 17:04 Pre-operative Diagnosis Vertebral and epidural metastasis of T12, with spinal cord compression; lung cancer Post-operative Diagnosis Vertebral and epidural metastasis of T12, with spinal cord compression; lung cancer Operative Method 1. T12 laminectomy, facectomy, and bilateral pediculectomy for tumor excision 2. Transpedicle screws and rods fixation of T10, T11, L1, and L2 Specimen Count And Types 2 pieces About size:小: Source:epidural tumor About size:小: Source:vertebral tumor Pathology pending Operative Findings The T12 lamina, facets and pedicles were softened and eroded by tumor tissues. An adherent epidural mass was found around the posterior and lateral epidural spaces. The thecal sac reexpanded well after tumor excision. The T12 lamina, facets and pedicles were softened and eroded by tumor tissues. An soft, greyish red, fragile, adherent epidural mass was found around the posterior and lateral epidural spaces. The thecal sac reexpanded well after tumor excision. Tanspedicle screws (A-spine system) were inserted to: T10: 35 mm x 5.5 mm (left), 40 mm x 6.0 mm (right) T11: 40 mm x 5.5 mm, bilateral L1: 45 mm x 5.5 mm, bilateral L2: 45 mm x 5.5 mm, bilateral Rods: one 15 cm long rod on each side Cross link x 1 Operative Procedures 1. ETGA, prone 2. Midline incision from T10 to L2 3. Dissection and retraction of paravertebral muscles off spinal processes and lamina 4. Insertion of pedicle screws to T10, T11, L1, L2 pedicles, under C-arm guide 5. Resection of T12 and lower T11 lamina, bilateral lower T11-12 and upper T12-L1 facets, bilateral T12 pedicles 6. Dissection and excision of epdiural tumor off dural surface 7. Hemostasis 8. Screws linking with one rod on each side 9. One cross link to bridge both rods 10. Two epilaminal HV drains 11. Wound closure in layers Operators 楊士弘 楊士弘 Assistants 曾峰毅, 張碩文 曾峰毅, 張廷碩 曾峰毅, 張廷碩 邱美嬌 (F,1961/02/21,51y0m) 手術日期 2011/02/17 手術主治醫師 杜永光 手術區域 東址 002房 01號 診斷 Aneurysm 器械術式 right craniectomy 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 4E 紀錄醫師 鍾文桂, 時間資訊 06:31 通知急診手術 07:10 報到 07:10 進入手術室 07:10 麻醉開始 07:20 誘導結束 08:07 手術開始 09:15 開始輸血 11:25 麻醉結束 11:28 手術結束 11:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱骨切除術,包括異物移除或壓或經切斷 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: Right extended craniectomy 開立醫師: 胡朝凱 開立時間: 2011/02/17 11:19 Pre-operative Diagnosis Right MCA terriroty infarction with brain swelling Post-operative Diagnosis Right MCA terriroty infarction with brain swelling Operative Method Right extended craniectomy Specimen Count And Types nil Pathology nil Operative Findings 1.Right temporal and parietal lobe became whitish 2.Intra-op ICG angiography showed no enhacement of graft artery. But cortical arteries was enhaced partially. 3.Brain was swelling. And after wound closure, ICP level was 7 mmHg Operative Procedures Under ETGA, patient was put in supine position with head rotate to left. Right previous wound incision was done followed by an extended skin incision posteriorly. Reflect skin flap was made and the previous dural tenting were released. Extended craniectomy was then performed. Further dural tenting followed. Intra-op ICG angiography was performed to check flow patency of graft and cortical arteries. Radiation fashion durotomy was done followed by duroplasty with durofoam. After CWV drains insertion, the wound was closed in layers. Operators P 杜永光 Assistants 胡朝凱, 鍾文桂 Indication Of Emergent Operation 王南凱 (M,1970/02/19,42y0m) 手術日期 2011/02/17 手術主治醫師 葉德輝 手術區域 東址 025房 02號 診斷 Intracranial abscess 器械術式 FESS,left 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 蕭柏妮 ASA 2 紀錄醫師 林玫君, 時間資訊 10:25 報到 10:55 進入手術室 11:00 麻醉開始 11:05 誘導結束 11:30 手術開始 12:45 手術結束 12:45 麻醉結束 12:50 進入恢復室 12:50 送出病患 13:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 粘膜下中隔矯正術 1 1 L 手術 多竇副鼻竇手術 1 1 L 記錄__ 手術科部: 耳鼻喉部 套用罐頭: Functional endoscopic sinus surgery 開立醫師: 林玫君 開立時間: 2011/02/17 18:07 Pre-operative Diagnosis Chronic paranasal sinusitis, left and nasal septal deviation Post-operative Diagnosis Ditto, operated Operative Method Functional endoscopic sinus surgery, left and NSD Functional endoscopic sinus surgery, left and submucosal resection of septum Specimen Count And Types 2 pieces About size:small pieces Source:septum About size:small pieces Source:left nose Pathology pending Operative Findings Left infun.: mucopus A.Eth.: polypoid P.Eth: not checked Maxi.: mucopus Fron.: mucopus Sph.: not checked septal deviation to left prominent agger nasi :L(V) Operative Procedures The patient was in the supine position. After disinfection and drap were done, xylocaine-bosmin soaked cotton pledgets were applied for intranasal anesthesia and shrinkage. The superior lateral portion of choana was infiltrated by long needle with the anesthetics for sphenopalatin ganglion block. The nasal septum was infiltrated with the same anesthetics at both sides along the perichondrial plane, then a Killian incision was made first at the left septum. The mucoperichondrium was elevated till the septal cartilage, vomer, and maxillary crest were exposed. The right-sided mucoperichondrium was separated too, with the whole part of cartilage freed. Another incision was done before the bony part of the septum. The deviated septal cartilage, the inferior part of the vomer bone, and the maxillary crest were were removed, then the mucosal flap was turned down to cover the raw surface. The Killian incision was closed with 1 stitch of 3-0 monocyrl. (1) Infundibulotomy :L(V) (2) Opening/trimming of ethmoid bulla :L(V) anterior ethmoid :L(V) agger nasi :L(V) frontal recess :L(V) middle turbinate :L(V) (3) Opening/trimming of ground lamella :nil posterior ethmoid :nil sphenoid sinus :nil (4) Widening of maxillary ostium :L(V) aspiration :L(V) irrigation :L(V) (5) Packing with Merocel :L(1) Operators 葉德輝, Assistants R4曾怡凡,R2林玫君, 卜惠生 (M,1972/09/12,39y6m) 手術日期 2011/02/17 手術主治醫師 陳敞牧 手術區域 東址 005房 01號 診斷 Herniation of intervertebral disc (HIVD) 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 2 紀錄醫師 曾峰毅, 時間資訊 08:10 進入手術室 08:15 麻醉開始 08:25 誘導結束 09:00 抗生素給藥 09:05 手術開始 12:00 抗生素給藥 12:40 手術結束 12:40 麻醉結束 12:48 送出病患 12:50 進入恢復室 18:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 手術 椎間盤切除術-頸椎 1 1 手術 脊椎融合術-前融合,有固定物)≦四節 1 2 摘要__ 手術科部: 外科部 套用罐頭: Anterior Discectomy and Fusion, Cervical Spine 開立醫師: 曾峰毅 開立時間: 2011/02/17 12:46 Pre-operative Diagnosis HIVD, C7/T1 Post-operative Diagnosis HIVD, C7/T1 Operative Method Anterior Discectomy and Fusion with PEEK cage and artificial bone graft at C7/T1 Specimen Count And Types Nil Pathology Pending Operative Findings Thecal sac was decompressed well after the surgery. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with neck extended. After C-arm localization, we scrubbed, disinfected, and then draped the patient. We made one transverse skin incision at right lower neck, and expose prevertebral space. We performed anterior diskectomy at C7/T1 after C-arm confirmation. Fusion was achieved with PEEK cage and artificial bone graft. After one mini-hemovac placed, we closed the wound in layers. Operators VS 陳敞牧 Assistants R4 曾峰毅 江謙文 (M,1939/04/22,72y10m) 手術日期 2011/02/17 手術主治醫師 蕭輔仁 手術區域 東址 005房 02號 診斷 Diskitis 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3 紀錄醫師 曾峰毅, 時間資訊 13:02 進入手術室 13:05 麻醉開始 13:20 誘導結束 13:30 抗生素給藥 15:00 手術開始 16:20 手術結束 16:20 麻醉結束 16:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-腰椎 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: HIVD 開立醫師: 曾峰毅 開立時間: 2011/02/17 16:36 Pre-operative Diagnosis Diskitis, L4/5 Post-operative Diagnosis Diskitis, L4/5 Operative Method Endoscopic diskectomy, L4/5 Specimen Count And Types Disc was sent for culture and pathology. Pathology Pending Operative Findings Fragile, fragmented disc tissue with much granulation was noted. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. With C-arm localization, we inserted K-pin into L4/5 disc space via right flank, about 12 cm away from midline. We inserted the sheath and the endoscope. Diskectomy was performed, and the wound was closed in layers. Operators VS 蕭輔仁 Assistants R4 曾峰毅 李淑貞 (F,1964/07/03,47y8m) 手術日期 2011/02/17 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 Pituitary tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 2 紀錄醫師 李振豪, 時間資訊 09:50 報到 10:05 進入手術室 10:10 麻醉開始 10:20 誘導結束 10:50 手術開始 11:45 麻醉結束 11:45 手術結束 12:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經外側篩竇切除修補腦髓液鼻 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: Repair of CSF leakage 開立醫師: 李振豪 開立時間: 2011/02/17 12:01 Pre-operative Diagnosis Pituitary tumor, status post trans-nasal trans-sphenoidal adenomectomy, complicated with CSF leakage Post-operative Diagnosis Pituitary tumor, status post trans-nasal trans-sphenoidal adenomectomy, complicated with CSF leakage Operative Method Repair of CSF leakage Specimen Count And Types nil Pathology Nil Operative Findings Much CSF gushed out after enter the sphenoid sinus and removal of the Gelform packing. One 1x1cm defect at the arachnoid membrane was identified with direct visualization of the ACA and brain parenchyma. The CSf was clear in character. The defect was repaired with Duraform, Gelform, Duraform, autologous fat, and Gelform packing in order. Tissucol Duo was applied between every layers of packing. Lumbar drain was placed after the operation. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine position. The skin was scrubbed, disinfected, and draped as usual. One 3cm transverse skin incision was made at right upper abdomen and the fat was harvested. Hemostasis was achieved and the wound was closed in layers with 2-0 Vicryl and 3-0 Nylon. Under operative microscopy, the nasal mucosa was opened and the sphenois sinus was entered along the previous wound. The skull base defect was identified and the Gelform was removed. The defect of the arachnoid membrane was noted. The defect was packing with Duraform, Gelform, Duraform, autologous fat, and Gelform in order. Tissucol Duo was applied between every layers of packing. The nasal septum and the mucosa was pushed back to the neutral position. Bilateral nasal cavity was packing with finger tips of gloves and Beta-iodine ointment. The position was changed to left decubitus. After antiseptic procedure, the previous stitche was removed. Lumbar drain was placed via L4-5 space, midline approach. The depth was fixed at 15cm. One stat suture was done at the puncture site. Operators VS王國川, VS楊士弘 Assistants R4李振豪 黃崇端 (M,1926/11/10,85y4m) 手術日期 2011/02/17 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Scalp tumor 器械術式 Scalp tumor Suture 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 李振豪, 時間資訊 07:40 報到 08:05 進入手術室 08:15 麻醉開始 08:20 麻醉結束 08:20 誘導結束 08:25 抗生素給藥 08:52 手術開始 09:30 手術結束 09:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 頭皮腫瘤 1 1 摘要__ 手術科部: 外科部 套用罐頭: Tumor excision 開立醫師: 李振豪 開立時間: 2011/02/17 09:47 Pre-operative Diagnosis Scalp tumor, occipital area Post-operative Diagnosis Scalp epidermoid cyst, occipital area Operative Method Tumor excision Specimen Count And Types 1 piece About size:5cm in diameter tumor Source:Scalp tumor Pathology Pending Operative Findings The tumor was 5.8 x 5.5 x 2.7cm in size, well-capsulated, soft, moderate vascularized in character. The content was keratin-riched material which compatible with epidermoid cyst. Intra-operative rupture(+). The galea was intact without direct invasion. Operative Procedures The patient was put in prone position. The scalp was shaved, scrubbed, and disinfected as usual. The curvilinear scalp incision was made above the tumor dissected along the capsule of the tumor. The capsule ruptured during the operation and the content of the tumor was sucked out for decompression. The tumor was removed totally and sent for pathology. The wound was irrigated with Gentamicin solution. Hemostasis was achieved. The scalp was tailed for redundant skin. The wound was then closed in layers with 3-0 Nylon. The patient was put in prone position. The scalp was shaved, scrubbed, and disinfected as usual. Local anesthesia with 1% Xylocaine + epinephrine was applied. The curvilinear scalp incision was made above the tumor dissected along the capsule of the tumor. The capsule ruptured during the operation and the content of the tumor was sucked out for decompression. The tumor was removed totally and sent for pathology. The wound was irrigated with Gentamicin solution. Hemostasis was achieved. The scalp was tailed for redundant skin. The wound was then closed in layers with 3-0 Nylon. Operators VS王國川 Assistants R4李振豪 相關圖片 吳宜恒 (M,1975/12/08,36y3m) 手術日期 2011/02/17 手術主治醫師 王國川 手術區域 東址 003房 03號 診斷 Traumatic brain injury 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 2 紀錄醫師 李振豪, 時間資訊 12:40 進入手術室 12:45 麻醉開始 12:53 誘導結束 13:00 抗生素給藥 13:25 手術開始 15:15 手術結束 15:15 麻醉結束 15:23 送出病患 15:25 進入恢復室 16:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 頭顱成形術 1 1 R 手術 顱骨重塑模組 1 0 R 摘要__ 手術科部: 外科部 套用罐頭: Cranioplasty with artificial skull plate 開立醫師: 李振豪 開立時間: 2011/02/17 15:37 Pre-operative Diagnosis Right fronto-temporo-parietal skull defect Post-operative Diagnosis Right fronto-temporo-parietal skull defect Operative Method Cranioplasty with artificial skull plate Specimen Count And Types nil Pathology Nil Operative Findings One 3x6cm free flap was noted at right frontotemporal area. The dura defect also noted below the free flap. During elevation of the scalp flap, the pedicle of the free flap was not found. Much collateral blood supply from brain surface was noted. The artifial skull plate(cranioperfect, DHEF) was used for cranioplasty and fixed with four miniplates and eight screws. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head rotated to left. The scalp was shaved, scrubbed, and disinfected as usual. The scalp incision was made along previous op scar with bicoronal extension. The scalp flap was elevated and the margin of the skull defect was identified. The artificial skull plate was applied for cranioplasty and fixed with miniplates and screws. Four central tenting was done after fixation of the skull plate. Hemostasis was achieved with bipolar electrocautery. One Subgaleal CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS王國川 Assistants R4李振豪, Ri賴品泉 相關圖片 林鎮禮 (M,1937/10/13,74y5m) 手術日期 2011/02/17 手術主治醫師 田郁文 手術區域 東址 006房 01號 診斷 Pancreas cancer 器械術式 Pancreatico-duodenectomy, Whip 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 林珍榮 ASA 3 紀錄醫師 洪浩雲, 時間資訊 07:39 報到 07:45 進入手術室 07:50 麻醉開始 08:45 誘導結束 08:50 抗生素給藥 08:58 手術開始 09:45 開始輸血 11:50 抗生素給藥 14:55 麻醉結束 14:55 手術結束 15:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 Whipple 氏、十二指腸切除術 1 1 摘要__ 手術科部: 外科部 套用罐頭: WHIPPLE 開立醫師: 洪浩雲 開立時間: 2011/02/17 14:34 Pre-operative Diagnosis Pancreas head tumor Post-operative Diagnosis Ditto Operative Method Whipple's Procedure Specimen Count And Types 1 piece About size:15cm Source:Stomach, duodenum, pancreas, GB, omentum Pathology Pending Operative Findings 1. Tumor location: Pancreatic head 2. Tumor size: 1.5cm. 3. Tumor character: well-defined, cause CBD compression 4. CBD diameter: 1.2cm, pancreatic duct diameter: 0.6cm 5. Pancreatic parenchyma: firm, chronic inflammatary change with severe adhesion 6. Severe jaundice, yellowish intestinal and omentum color. Operative Procedures After the abdomen was opened through a upper midline incision, the resectibility of the tumor was determined by (1) mobilizing the duodenum upward and medially (Kochers maneuver), (2) mobilizing the stomach (after the gastrohepatic omentum and the gastrocolic omentum were partially incised), and (3) exploring the root of the mesentery and dissecting a plane between the portal vein and the neck of the pancreas. The resection was initiated by dividing (1) the common bile duct (CBD) at its supraduodenal portion, (2) the gastroduodenal artery near its origin from the hepatic artery, and (3) the stomach by performing subtotal gastrectomy. LN dissection was done for Gr. 8. After adhesionolysis around the pancreas head, the specimen was removed. The construction was started by advancing the limp of the upper jejunum retrocolically. The pancreaticojejunostomy was performed in an end-to-side fashion, in which a 10# Nelaton tube was inserted as a stent. A choledochojejunostomy was then constructed with a 12# Nelaton tube as a stent. The gastrojejunostomy was performed antecolically 20cm below the choledochojejunostomy. A feeding jejunostomy was done with T-tube. The abdomen was closed in layers after irrigation with copious warm normal saline solution and insertion of rubber drain tubes in right subhepatic space and left pancreaticojejunal anastomotic area. A CWV drain was inserted to gastrojejunostomy anastomosis site. Operators 田郁文 Assistants 洪浩雲, 吳政達 相關圖片 陳樹木 (M,1936/03/18,75y11m) 手術日期 2011/02/17 手術主治醫師 鄭乃禎 手術區域 西址 036房 04號 診斷 Epidermal cyst 器械術式 Partial mastectomy-- unilatera 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 15:15 進入手術室 15:25 麻醉開始 15:28 誘導結束 15:30 手術開始 15:52 手術結束 15:52 麻醉結束 15:56 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 皮下腫瘤摘除術中2-4 CM 1 1 記錄__ 手術科部: 外科部 套用罐頭: Tumor excision-Trunk 開立醫師: 黃傑慧 開立時間: 2011/02/17 15:54 Pre-operative Diagnosis Back subcutaneous tumor, with skin perforation, suspected epidermal cyst Post-operative Diagnosis Back subcutaneous tumor, with skin perforation, suspected epidermal cyst Operative Method Tumor excision Specimen Count And Types 1 piece About size:3x3 cm Source:back sub-Q tumor Pathology Pending Operative Findings One 3 x 3 cm subcutaneous tumor noted over back at T2-T3 level Operative Procedures Under local anesthesia, the patient lied in supine position. Antiseptics applied and draped as usual. Elliptical skin incision over back , . Dissection to exposed tumor. Tumor excision performed and normal saline irrigation. Wound closure in layers Operators 鄭乃禎 Assistants 黃傑慧 相關圖片 許黃瑜 (M,1968/11/10,43y4m) 手術日期 2011/02/18 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Pituitary tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 張廷碩, 時間資訊 08:15 進入手術室 08:25 麻醉開始 09:00 誘導結束 09:30 抗生素給藥 09:48 手術開始 11:45 手術結束 11:45 麻醉結束 12:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 經由蝶竇之腦下垂體瘤切除 1 1 摘要__ 手術科部: 外科部 套用罐頭: Endonasal transsphenoid adenectomy 開立醫師: 陳睿生 開立時間: 2011/02/18 12:20 Pre-operative Diagnosis Pituitary macroadenoma status post, with recurrence Post-operative Diagnosis Pituitary macroadenoma status post, with recurrence Operative Method Endonasal transsphenoid adenectomy Specimen Count And Types 1 piece About size:pieces Source:tumor Pathology Nil Operative Findings Nasal septum granulation formation without bony septum was noted due to previous operation. The tumor waas whitish, soft, and fragile. It located mainly at left side and some part was firm. Intra-op cavernous sinus was exposed and well packed. The arachnoid membrane was noted after tumor remove, and CSF leakage was noted intra-op. Operative Procedures 1. ETGA, supine position and head right turn 2. After well disinfection, we use a nasal spectulum to extend the right nastril 3. The nasal septum was dissected to expose the mucosa of sphenoid sinus 4. Remove of mucocele in the sinus, and then the sellar floor was identified 5. The sellar floor was opened and the cavernous sinus and dura at sellar floor were identified 6. The dura was opened and the tumor was removed with ring curette and tumor forceps 7. The sinus bleeding was packed for hemostasis, and CSF leakage was noted after tumor remove 8. The dura opened was packed with gelfoam and tissuco Duo 9. The nasal septum was pulled back and the nastril was packed with plastic bag Operators VS 曾漢民 Assistants R6 陳睿生, R1 張廷碩 黃美綢 (F,1955/01/05,57y2m) 手術日期 2011/02/18 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 張廷碩, 時間資訊 12:15 進入手術室 12:20 麻醉開始 12:35 誘導結束 13:20 抗生素給藥 13:26 手術開始 15:30 手術結束 15:30 麻醉結束 15:43 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for Simpson^s grade. II tumor remove 開立醫師: 陳睿生 開立時間: 2011/02/18 16:00 Pre-operative Diagnosis Left frontal parasagittal meningioma Post-operative Diagnosis Left frontal parasagittal meningioma Operative Method Craniotomy for Simpson^s grade. II tumor remove Specimen Count And Types 1 piece About size:2x2cm Source:tumor Pathology Pending Operative Findings The tumor located at left middle frontal gyrus. The diameter was about 2x2cm, and the tumor was a whitish, well margin extra-axial one. A bridging vein was noted in front of the tumor. It was well preserved peri-op. Operative Procedures 1. ETGA, supine position and head flexion 2. The navigation system was set 3. Left frontal linear scalp incision 4. An about 4x4cm craniotomy was created 5. Dura was well tented and then the dura was opened 6. The tumor was identified, and a bridging vein was noted in front of the tumor 7. Dissect the plane between the tumor and arachnoid membrane 8. Totally remove of the tumor, and then the dura was electroligated 9. Hemostasis, and then the dura was closed with galeal graft 10.Fixed back the skull graft with miniplates 11.Close the wound in layers Operators VS 曾漢民 Assistants R6 陳睿生, R1 張廷碩 李碧花 (F,1954/10/15,57y4m) 手術日期 2011/02/18 手術主治醫師 曾漢民 手術區域 東址 007房 03號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 張廷碩, 時間資訊 15:05 進入手術室 15:08 麻醉開始 15:30 抗生素給藥 15:40 誘導結束 15:50 手術開始 18:30 抗生素給藥 18:50 手術結束 18:50 麻醉結束 18:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 R 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for Simpson^s grade.III tumor remove 開立醫師: 陳睿生 開立時間: 2011/02/18 19:14 Pre-operative Diagnosis Right occipital parasagittal meningioma Post-operative Diagnosis Right occipital parasagittal meningioma Operative Method Craniotomy for Simpson^s grade.III tumor remove Specimen Count And Types 1 piece About size:pieces Source:tumor Pathology Pending Operative Findings The tumor was whitish, hardish, and multiple lobulated. It was noted to be origined from the falx and superior sagittal sinus. The margin between the tumor and normal brain tissue was not very clear at some sites. The tumor was noted to extend into the superior sagittal sinus, and the tumor inside it was partially removed. Mild brain swelling was noted. Operative Procedures 1. ETGA, prone position and head fixed with Mayfield clump 2. Right occipital inverse "U" scalp incision 3. Make four bur boles and then an about 8x8cm craniotomy window was done 4. Proper dura tenting, and then the dura was opened curvillinearly 5. The tumor was found at the margin between the falx and occipital lobe 6. The plane between the tumor base and the falx was dissected 7. The tumor was also dissected from the brain parychema 8. Totally remove of the tumor 9. Hemostasis, and then the dura was closed with galeal graft 10.The skull graft was fixed back with miniplates 11.A subgaleal CWV drain was set, and the wound was closed in layers Operators VS 曾漢民 Assistants R6 陳睿生, R1 張廷碩 曹為棠 (M,1939/05/24,72y9m) 手術日期 2011/02/18 手術主治醫師 蔡瑞章 手術區域 東址 003房 01號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 胡朝凱, 時間資訊 07:47 報到 08:05 進入手術室 08:10 麻醉開始 09:00 誘導結束 09:00 抗生素給藥 09:10 手術開始 12:00 抗生素給藥 15:00 抗生素給藥 16:50 麻醉結束 16:50 手術結束 16:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4~8小時 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 9 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: Left subfrontal for Simpson grade IV tumor ex... 開立醫師: 胡朝凱 開立時間: 2011/02/18 17:14 Pre-operative Diagnosis Planum sphenoidale meningioma Post-operative Diagnosis Planum sphenoidale meningioma Operative Method Left subfrontal for Simpson grade IV tumor excision Specimen Count And Types pieces of tumor Pathology pending Operative Findings 1.One hard, whitish tumor arised from planum sphenoidale with a clear margin. Moderate vascularity. 2.A-com and A2 was encased inside the tumor that we can not identify well. So we left a piece of tumor in situ. 3.Bilateral optic nerve were compressed by the tumor initially. After tumor removal, bilateral nerve became free. 4.Duroplasty was made with artificial dura (COOK) Operative Procedures 1.ETGA, supine 2.Bicoronal skin incision 3.Reflect skin flap anteriorly 4.Craniotomy that cross the midline 5.Incised the dura and separate anterior part of superior sagittal sinus 6.Retract frontal lobe downward to expose tumor 7.Devascularization 8.Debulky piece by piece 9.dissect tumor border to expose optic nerves 10.Tumor removal 11.Hemostasis 12.Duroplasty 13.Fixed bone back with miniplate 14.Close wound in layers after one CWv drain insertion Operators P 蔡瑞章 Assistants 胡朝凱, Ri 徐庭達 (M,1937/09/15,74y5m) 手術日期 2011/02/18 手術主治醫師 蔡瑞章 手術區域 東址 002房 03號 診斷 Malignant neoplasm of other parts of bronchus or lung 器械術式 Ommaya reservoir implantation 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 王奐之, 時間資訊 13:37 報到 13:50 進入手術室 14:00 麻醉開始 14:10 誘導結束 14:34 手術開始 15:36 手術結束 15:36 麻醉結束 15:46 送出病患 15:48 進入恢復室 16:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 歐氏貯囊置放手術 1 1 R 摘要__ 手術科部: 神經部 套用罐頭: Ommaya reservoir implantation via right Koche... 開立醫師: 王奐之 開立時間: 2011/02/18 15:41 Pre-operative Diagnosis Leptomeningeal carcinomatosis with hydrocephalus Post-operative Diagnosis Leptomeningeal carcinomatosis with hydrocephalus Operative Method Ommaya reservoir implantation via right Kocher point Specimen Count And Types Nil Pathology Nil Operative Findings Clear CSF was noted after ventricular puncture. CSF collected and sent for routine, BCS & bacterial culture. Opening pressure: 10-15cmH2O. Operative Procedures After ETGA, the patient was placed in supine position. After scalp shaving, scrubbing, disinfection and draping in sterile fashion, a curvilinear skin incision was made at right frontal area. A burr hole was made over right Kocher point, followed by dural tenting. A small cruciate durotomy was done, and ventricular puncture was done after hemostasis. Ommaya reservoir was then inserted. The wound was closed in layers after securing the reservoir. Operators P 蔡瑞章 Assistants R3 王奐之, Ri 王逸萍 相關圖片 張佰峰 (M,1967/02/18,45y0m) 手術日期 2011/02/18 手術主治醫師 黃勝堅 手術區域 東址 019房 01號 診斷 Injury (severeity score >=16) 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 李振豪, 時間資訊 07:45 報到 08:00 進入手術室 08:10 麻醉開始 08:15 誘導結束 08:30 抗生素給藥 08:50 手術開始 09:00 開始輸血 10:40 手術結束 10:40 麻醉結束 10:50 送出病患 10:53 進入恢復室 12:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 Blood gas analysis 1 0 麻醉 K (Potassium) 1 0 手術 頭顱成形術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Cranioplasty with autologous skull plate 開立醫師: 李振豪 開立時間: 2011/02/18 10:37 Pre-operative Diagnosis Right fronto-temporo-parietal skull defect Post-operative Diagnosis Right fronto-temporo-parietal skull defect Operative Method Cranioplasty with autologous skull plate Specimen Count And Types nil Pathology Nil Operative Findings The skull fracture with displacement was noted at the parieto-temporal part. The displacement was reducted and fixed with miniplates. The skull plate was fixed back with miniplates and screws. No CSF leakage was noted during the operation. The dura was intact after elevation of the scalp flap. Bleeding tendancy(+) Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head rotated to left. The scalp was shaved, scrubbed, and disinfected as usual. The scalp incision was made along op scar and the scalp flap was elevated to exposed the craniectomy window. The edge of the craniectomy was identified. The fracture line over the skull plate with displacement was noted and fixed with two miniplates and four screws. The skull plate was place in the Gentamicin solution for more than 10 minutes. The autologous skull plate was then fixed back with three miniplates and six screws. Four central tenting was done after fixed the skull plate. Two subgaleal CWV drain was placed and the wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS黃勝堅 Assistants R4李振豪m, R2曾偉倫 R4李振豪, R2曾偉倫 相關圖片 曾碧清 (F,1963/09/25,48y5m) 手術日期 2011/02/18 手術主治醫師 吳毅暉 手術區域 兒醫 068房 02號 診斷 Spondylosis with myelopathy, cervical 器械術式 Port-A catheter Removal/WOR 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 莊民楷, 時間資訊 09:45 報到 09:55 進入手術室 10:05 麻醉開始 10:07 誘導結束 10:08 手術開始 10:27 手術結束 10:33 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 皮下肌肉或深部異物取出術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Port-A removal 開立醫師: 莊民楷 開立時間: 2011/02/18 10:31 Pre-operative Diagnosis CML Post-operative Diagnosis CML Operative Method Port-A removal Specimen Count And Types nil Pathology Nil Operative Findings 1. no obvious fluid accumulation or debris over port-A pocket 2. port-A was removed intactlty Operative Procedures 1. LA, supine 2. Disinfection and drapping 3. Skin incision along previous scar 4. Dissect to expose port-A, then remove it 5. Hemostasis, saline irrigation 6. Close the wound in layers Operators VS 吳毅暉 Assistants R3 莊民楷 嚴世任 (M,1971/06/28,40y8m) 手術日期 2011/02/18 手術主治醫師 楊士弘 手術區域 東址 019房 02號 診斷 Pituitary gland benign neoplasm 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 2 紀錄醫師 曾偉倫, 時間資訊 10:15 報到 11:28 進入手術室 11:30 麻醉開始 12:00 誘導結束 12:05 抗生素給藥 12:50 手術開始 15:05 抗生素給藥 15:55 麻醉結束 15:55 手術結束 16:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經由蝶竇之腦下垂體瘤切除 1 1 手術 腦內視鏡 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Endoscopic transsphenoidal adenomectomy 開立醫師: 李振豪 開立時間: 2011/02/18 16:26 Pre-operative Diagnosis Pituitary macroadenoma Post-operative Diagnosis Pituitary macroadenoma Operative Method Endoscopic transsphenoidal adenomectomy Specimen Count And Types 1 piece About size:multiple small pieces with total 3g in weight Source:pituitary tumor Pathology Pending Operative Findings The tumor was whitish to mild reddish mixed with some dark-red component. Previous hemorrhage due to apoplexy was favored. The character of the tumor was soft, 3.3 x 3.5 x 2.3cm in size, and hypervascularized. The normal gland was found after tumor excision. The arachnoid pouch was intact after removal of the tumor. The arachnoid membrane was whitish and thickened. No CSF leakage was noted after removal of the tumor. After tumor excision, the space was checked with 30 degree endoscope, no evident residual tumor was found. The tumor was whitish to mild reddish mixed with some dark-red component. Previous hemorrhage due to apoplexy was favored. The character of the tumor was soft, 3.3 x 3.5 x 2.3cm in size, and hypervascularized. The sellar floor was eroded by the tumor with only egg shell in thickness. The normal gland was found after tumor excision. The arachnoid pouch was intact after removal of the tumor. The arachnoid membrane was whitish and thickened. No CSF leakage was noted after removal of the tumor. After tumor excision, the space was checked with 30 degree endoscope, no evident residual tumor was found. Operative Procedures Under endotracheal general anethesia, the patient was put in supine position with head tilted 30 degree to left. The facial skin, the mucosa of oral and nasal cavity was disinfected and draped as usual. Under endoscope, bilateral middle concha was pushed laterally to enlarge the operative field. The nasal mucosa around the opening of sphenoid sinus was coagulated via bilateral norstril. The vomer bone was fractured and the anterior wall of the sphenoid was exposed. Midas air-drived drill was used to enter the sphenoid sinus. The mucosa of the sphenoid sinus was opened and the sellar floor was identified. The sellar floor was opened with air-drived drill and Kerrison punch. The sellar floor dura was coagulated then opened in cruciate fashion. The soft tumor parenchyma was removed by ring curette and alligator. After tumor excision, the space was checked by 30 degree endoscope. The arachnoid and the opening of diaphragm sellae was enforced by packing with gelform as in the sellar cavity. The vomer bone was placed back for the repairment of the sellar flow. the sphenoid sinus was packing with Gelform also. The middle concha was pushed back to neutral position. Bilateral nasal cavities were tightly packed with a segment of rubber glove finger which had been soaked with better-iodine ointment. Operators VS楊士弘 Assistants R4李振豪, R2曾偉倫 王詳喻 (M,2003/06/28,8y8m) 手術日期 2011/02/18 手術主治醫師 楊士弘 手術區域 兒醫 067房 01號 診斷 Right atrial isomerism 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 污染 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 4 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 08:35 進入手術室 08:35 報到 08:40 麻醉開始 09:15 誘導結束 09:59 手術開始 10:00 開始輸血 11:00 抗生素給藥 11:20 麻醉結束 11:20 手術結束 11:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 套用罐頭: Burr hole for abscess drainage. 開立醫師: 鍾文桂 開立時間: 2011/02/18 11:52 Pre-operative Diagnosis Brain abscess, left frontal. Post-operative Diagnosis Brain abscess, left frontal. Operative Method Burr hole for abscess drainage. Specimen Count And Types 1 piece About size:50CC Source:BRAIN ABSCESS Pathology Culture: pending. Operative Findings 1. According to MRI study, three abscess cavities with small connection ot each other at left frontal region were noted. Under intraoperative sonography guidance, we aspirated the more anterior, smaller one first. Turbid serous green-yellowish fluid was aspirated. Then, we aspirated the posterior larger abscess cavity with thick green-yellowish pus. 1. According to MRI study, three abscess cavities with small connection to each other at left frontal region were noted. Under intraoperative sonography guidance, we aspirated the more anterior, smaller one first. Turbid serous green-yellowish fluid was aspirated. Then, we aspirated the posterior larger abscess cavity with thick green-yellowish pus. 2. The EVD catheter( 長安)was placed in the larger abscess cavity for drainage. Operative Procedures Under ETGA, the patient was placed in supine position and head in midline. After shaving, disinfection, and draping, a linear incision was made just anterior to coronal suture. After creating an oval shape 3-cm craniotomy by using high speed drill and durotomy, the ventricular puncture needle was inserted into the abscess cavity under sonography guidance. Then, aspiration of the abscess content was done through the puncture needle. Normal saline irrigation of the abscess cavity was achieved after placing the EVD catheter into the abscess. After shaving, disinfection, and draping, a linear incision was made just anterior to coronal suture. After creating an oval shape 2 x 1.5 cm burr hole by using high speed drill and durotomy, the ventricular puncture needle was inserted into the abscess cavity under sonography guidance. Then, aspiration of the abscess content was done through the puncture needle. Normal saline irrigation of the abscess cavity was achieved after placing the EVD catheter into the abscess cavity. Finally, the EVD catheter was connected to closed drainage system. The wound was closed in layers. Operators V.S. 楊士弘 Assistants R5 鍾文桂 Indication Of Emergent Operation 孫月梅 (F,1954/04/20,57y10m) 手術日期 2011/02/18 手術主治醫師 王國川 手術區域 東址 001房 06號 診斷 Intracerebral hemorrhage 器械術式 Removal of ICH 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 4E 紀錄醫師 張廷碩, 時間資訊 22:06 通知急診手術 22:06 臨時手術NPO 22:06 開始NPO 22:35 進入手術室 22:45 麻醉開始 22:50 抗生素給藥 22:55 誘導結束 23:00 手術開始 02:30 手術結束 02:30 麻醉結束 02:40 抗生素給藥 02:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 1 手術 顱內壓視置入 1 2 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 摘要__ 手術科部: 外科部 套用罐頭: CVA 開立醫師: 曾峰毅 開立時間: 2011/02/19 02:13 Pre-operative Diagnosis Cerebellar hemorrhage, suspected tumor bleeding Post-operative Diagnosis Cerebellar hemorrhage Operative Method Suboccipital craniectomy for hematoma evacuation; external ventricular drainage via right Frazier point Specimen Count And Types Nil Pathology Nil Operative Findings Codman antibiotic-coated EVD was inserted via right Frazier point. Opening pressure was about 20 cmH20. Pinkish CSF drained. After hematoma removed, there was not suspected neoplasm identifed. However, there were some abnormal feeding arteries noted in dorsal aspect of 4th ventricle. Arteriovenous malformation was suspected. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position with head fixed by Mayfield head clamp. After scalp shaved, scrubbed, disinfected, and then draped, we made one midline skin incision from inion to C2, and another longitudinal skin incision at right Frazier point. We drilled one burr hole at right Frazier, and performed ventriculostomy. Ventricular drain was inserted. Autologous fascia was harvested. We dissected the muscle to expose inion to C2 spinous process. We drilled six burr holes, and created craniotomy. Corticotomy was done at left cerebellar hemisphere, and hemotoma was removed. After hemostasis, we performed duroplasty with autologous fascia graft and water-tight suture. We inserted subgaleal CWV and closed the wound in layers. Operators VS 王國川 Assistants R6 胡朝凱 R4 曾峰毅 R1 張廷碩 Indication Of Emergent Operation 魏麗珍 (F,1959/03/05,53y0m) 手術日期 2011/02/18 手術主治醫師 黃培銘 手術區域 東址 017房 02號 診斷 Coccyx malignant neoplasm 器械術式 Thoracoscopy 手術類別 預定手術 手術部位 胸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 蕭柏妮 ASA 3 紀錄醫師 高明蔚, 時間資訊 09:35 報到 09:45 進入手術室 09:50 麻醉開始 10:20 誘導結束 10:34 手術開始 11:00 抗生素給藥 12:10 麻醉結束 12:10 手術結束 12:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 胸腔鏡肺膜剝脫術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: VATS decortication and hemostasis 開立醫師: 高明蔚 開立時間: 2011/02/18 12:45 Pre-operative Diagnosis Left hemothorax, massive Post-operative Diagnosis Left hemothorax, massive, suspect cancer pleural seeding with tumor bleeding Operative Method VATS decortication and hemostasis Specimen Count And Types 2 pieces About size:multiple Source:Suspect tumor About size:multiple Source:left chest cavity hematoma Pathology Pending Operative Findings Massive hematoma and active tumor oozing was noticed at whole chest cavity. Diffuse cancer seeding was noticed, especially at upper lung field, pericardium, costophrenic angles and diaphragm. Operative Procedures ETGA, right decubitus, skin disinfection and draping as usual. VATS setting (camera port via previous chest tube wound) Remove hematoma, decortication. Bosmine saline irrigation. Set Fr.28 chest and Fr.32 chest tube, each x1. Close the wounds in layers. Operators 黃培銘 Assistants R3高明蔚,Ri楊允中 楊春晨 (M,1929/04/05,82y11m) 手術日期 2011/02/19 手術主治醫師 李柏居 手術區域 東址 002房 02號 診斷 Peptic ulcer, acute, with perforation 器械術式 Exploratory laparatomy 手術類別 緊急手術 手術部位 腹 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林至芃 ASA 3E 紀錄醫師 全賀顯, 時間資訊 00:00 開始NPO 00:00 臨時手術NPO 09:00 通知急診手術 11:08 報到 11:30 進入手術室 11:40 麻醉開始 12:05 誘導結束 12:15 手術開始 14:50 麻醉結束 14:50 手術結束 15:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 小腸切除術加吻合術 1 1 記錄__ 手術科部: 外科部 套用罐頭: Partial segmentectomy and side to side anasto... 開立醫師: 全賀顯 開立時間: 2011/02/19 15:42 Pre-operative Diagnosis Ileus Post-operative Diagnosis Ischemic bowel suspect of volvulus or thrombus related Operative Method Partial segmentectomy and side to side anastomosis Specimen Count And Types 1 piece About size: Source:Small bowel Pathology Ischemial bowel Operative Findings 1. Severe ileus over small bowel and large bowel 2. Ischemic bowel over ileum, reddish and swelling ,length total 60cm, from 40cm above ileocecal valve to 100cm above ileocecal valve 3. Massive reddish ascites: 800ml Operative Procedures 1. Under general anesthesia, the patient was placed in supine position. The skin was disinfected with alcohol better-iodine from the level of symphysis pubis to nipple area. 2. A medial incision was made above the pubic bone 3cm to the above umbilicus 2cm. 3. The incision was deepened through the anterior rectus sheath. The rectus abdominis was split in the line of its fibers, and then the abdomen was opened. 4. We performed bowel decompression by push the digestion to NG and suct it out. Massive reddish ascites was also suct out 5. We identified ischemic bowel over ileum, length total 60cm, from 40cm above ileocecal valve to 100cm above ileocecal valve. 6. We transected the ischemic bowel by GIA-80 and performed side to side anastomosis with GIA-60. 7. Bilateral rubber drainage were placed over Douglas porch. 8. Hemostasis and wound closed in layer. Operators VS李柏居 Assistants R3陳柏達 R1全賀顯 Indication Of Emergent Operation 相關圖片 周留協 (M,1935/09/04,76y6m) 手術日期 2011/02/19 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Communicating hydrocephalus 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林至芃 ASA 3 紀錄醫師 曾偉倫, 時間資訊 07:40 報到 07:50 進入手術室 08:00 麻醉開始 08:10 誘導結束 08:50 抗生素給藥 09:10 手術開始 10:10 手術結束 10:10 麻醉結束 10:20 送出病患 10:23 進入恢復室 11:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 曾偉倫 開立時間: 2011/02/19 10:16 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method V-P Shunt Specimen Count And Types nil Pathology Nil. Operative Findings 1. Clear CSf drain from the ventricle 2. The VP shunt functioned well 3. The Codman HAKIM programmable shunt was placed Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: supine with head rotated (tilted) to right. 2.Position: supine with head tilted to the left. 3.Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 5 cm curvilinear, right frontal, corresponded to the location of right frontal horn. Raney clips were applied to the scalp edge for temporary hemostasis. 5.After the scalp flap had been lifted and reflected anteriorly, a burr hole was made and the dura was tented by 2 stitches. 6.The dura was opened by a nib incision. Rt lateral ventricle was tapped by a ventricular needle, then a 8 cm segment of the ventricular catheter was introduced into the ventricle. The outer end of the catheter was connected to a Codman programmable reservoir. 7. A nib incision was made at RUQ of the abdomen , then a trocar was pushed into peritoneal cavity. Subsequently, distal 20 cm segment of the peritoneal catheter (medium pressure) was introduced segment of the peritoneal catheter was introduced into the peritoneal cavity through the outer tube of the trochar. The proximal end of this catheter was passed through subcutaneous tunnel at forechest, neck, right retroauricular area and connected the reservoir. The shunt systemwas checked to make sure its function was working. 8. The reservoir was fixed to pericranium by 3 stitches. 9. Scalp closure: hemostasis was done with monopolar coagulator touching on the sucker tip. Galea suture was performed by continuous suture with 3/0 Dexon and skin by continuous suture with 3/0 nylon. 10.Course of the surgery: smooth. Operators VS 王國川 Assistants R5 鍾文桂 R2 曾偉倫 葉雪淳 (M,1930/01/18,82y1m) 手術日期 2011/02/19 手術主治醫師 黃國皓 手術區域 東址 006房 04號 診斷 Malignant neoplasm of prostate 器械術式 Removal of double-J 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 靜脈麻醉 麻醉主治醫師 林至芃 ASA 3 紀錄醫師 黃冠棠, 時間資訊 09:50 進入手術室 09:52 麻醉開始 09:55 誘導結束 10:05 抗生素給藥 10:13 手術開始 10:37 10:45 手術結束 10:50 送出病患 10:50 麻醉結束 10:55 進入恢復室 12:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 手術 皮下穿刺腎造廔術（單側） 1 0 R 手術 經膀胱鏡逆行尿管導管 1 0 R 記錄__ 手術科部: 泌尿部 套用罐頭: Pigtail PCN 開立醫師: 黃冠棠 開立時間: 2011/02/19 11:03 Pre-operative Diagnosis right hydronephrosis Post-operative Diagnosis right hydronephrosis Operative Method right pigtail PCN and removal of DBJ Specimen Count And Types nil Pathology nil Operative Findings 1. Right pigtail PCN was inserted 2. Right DBJ was removed Operative Procedures 1. Under satisfactory local anesthesia, the patient was placed in right flank position. 2. Prepping and draping were performed in the usual sterile method. 3. The guide-wire was inserted into right renal pelvis through the previous pigtail PCN. 4. The tract was dilated with dilators, and the pigtail catheter was introduced into the renal pelvis smoothly through the guidewire. 6. The guidewire was removed. 7. After the fluid was drained out, the tube was fixed on the skin. 8. Then the patient was placed in lithotomy position, prepping and drapping was performed in the usual sterile fashion. 9.A Fr 21 Olympus cystoscope was introduced into the bladder cavity under direct vision. 10.Careful inspection was done andbilateral DBJ was removed. 11.Patient tolerated the procedure very well and was sent to recovery room in satisfactory condition. Operators 黃國皓, Assistants 周淇業, 黃冠棠 林雪非 (F,2007/04/02,4y11m) 手術日期 2011/02/20 手術主治醫師 楊士弘 手術區域 兒醫 067房 01號 診斷 Influenza with other manifestations 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 4E 紀錄醫師 胡朝凱, 時間資訊 17:38 通知急診手術 19:23 進入手術室 19:25 麻醉開始 19:30 誘導結束 20:03 手術開始 20:18 開始輸血 21:00 抗生素給藥 21:44 麻醉結束 21:49 手術結束 21:55 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 顱內壓視置入 1 2 L 手術 腦內血腫清除術 1 1 記錄__ 手術科部: 套用罐頭: Left craniectomy and EVD, ICP monitor inserti... 開立醫師: 胡朝凱 開立時間: 2011/02/20 22:11 Pre-operative Diagnosis Left parietal ICH , diffuse brain swelling Post-operative Diagnosis Left parietal ICH , diffuse brain swelling Operative Method Left craniectomy and EVD, ICP monitor insertion, and partial ICH evacuation Specimen Count And Types CSF X 3 TUBES Pathology nil Operative Findings 1.Severe brain swelling 2.Left SDH was noted 3.After EVD insertion, opening pressure was more then 30 cmH2O 4.Three small dural opening was done, but the brain and some ICH buldged out severely 5.After dural closure, ICP was about 80 mmHg, (SBP: 90 mmHg) Operative Procedures 1.ETGA, supine with head rotate to right 2.Rever U shape skin incision at left parietal to temporal area 3.Reflect skin flap downward 4.Right frontal burr hole drill followed by EVD insertion 5.Left craniectmoy with the edge 1 cm away from midline 6.ICP monitor insertion at frontal area 7.cruciate form dural opening 8.Hematoma evacuation 9.Set one CWV drain then close wound in layers Operators 楊士弘 Assistants 胡朝凱 Indication Of Emergent Operation 陳旺城 (M,1949/04/10,62y11m) 手術日期 2011/02/21 手術主治醫師 王國川 手術區域 東址 002房 05號 診斷 Headache 器械術式 craniotomy for aneurysm clipping 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林至芃 ASA 3E 紀錄醫師 施廷翰, 時間資訊 08:00 開始NPO 08:00 臨時手術NPO 23:39 通知急診手術 00:02 進入手術室 00:05 麻醉開始 00:10 誘導結束 00:45 抗生素給藥 01:07 手術開始 05:05 麻醉結束 05:05 手術結束 醫令資訊 類別 名稱 量 刀 側 手術 開顱術摘除血管病變 - 腦血管瘤 有病徵的 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 創傷醫學部 套用罐頭: Left pterional approach for aneurysmal clipping 開立醫師: 胡朝凱 開立時間: 2011/02/21 05:41 Pre-operative Diagnosis A-com aneurysm with ruptured Post-operative Diagnosis A-com aneurysm with ruptured Operative Method Left pterional approach for aneurysmal clipping Specimen Count And Types CSf x 3 tubes Pathology nil Operative Findings 1.One saccular, 1 cm aneurysm was noted at A-com protruded to right. And Bilateral A2 was also noted arised from aneurysmal neck. 2.Prominent Right A1 and atresia right A1 3.Two fenestrated aneurysmal clips were applied. 4.After EVD insertion, opening pressure was about 10 cmH2O Operative Procedures 1.ETGA, supine with head rotate to right and fixed with skull clamp 2.Left curvillinear skin incsion and EVD insertion 3.Reflect skin flap then muscle downward 4.Craniotomy 5.Curvillinear dural opening 6.release optic nerve 7.identified ICA then trace left A1 to expose bilateral A2 and aneurysm 8.dissect aneurysmal neck 9.Aneurysmal clipping 10.Hemostasis 11.Close dura 12.Fixed bone back then close wound in layers Operators 王國川 Assistants 胡朝凱, R1 Indication Of Emergent Operation 柯慶良 (M,1954/11/17,57y3m) 手術日期 2011/02/20 手術主治醫師 蔡翊新 手術區域 東址 002房 04號 診斷 Subdural hemorrhage following injury, with loss of consciousness of unspecified duration 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林至芃 ASA 4E 紀錄醫師 施廷翰, 時間資訊 19:09 通知急診手術 19:52 進入手術室 19:55 麻醉開始 20:05 誘導結束 20:30 抗生素給藥 20:45 手術開始 20:55 開始輸血 23:30 手術結束 23:30 麻醉結束 23:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 急性硬腦膜下血腫清除術 1 1 R 手術 顱內壓視置入 1 2 R 摘要__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 蔡翊新 開立時間: 2011/02/20 23:16 Pre-operative Diagnosis Head injury with right frontotemporoparietal acute SDH, left temporal skull fracture with EDH and brain swelling. Post-operative Diagnosis Head injury with right frontotemporoparietal acute SDH, left temporal skull fracture with EDH and brain swelling. Operative Method Right frontotemporoparietal craniectomy for removal of SDH, duroplasty and ICP monitoring. Specimen Count And Types nil Pathology Nil. Operative Findings Initial ICP after first burr hole creation was 25 mmHg. After craniectomy, the dura was tense and ICP was 24 mmHg. Acute SDH, about 0.3 cm in thickness, and diffuse SAH were noted at right frontotemporoparietal region. The brain bulged rapidly after dural opening. ICP after skin closure was about 10 mmHg. Bleeding tendency was noted during the whole procedure. The temporalis muscle was swollen and it was excised to gain more space. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 4 cm at right frontal area, the skin edge was clipped by Raney clips for temporary hemostasis. 5. A burr hole was made and the dura was incised for evacuating part of the subdural hematoma, therefore the IICP could be relieved earlier. ICP monitor was inserted to check initial ICP. 6. The incision was extended to a temporal horseshoe, and the temporalis muscle was detached from temporal squama by rasp subsequently. 7. Craniectomy window: 13 x 11 cm, right F-T-P, created by making 4 burr holes then cut by power saw. 8. Dural tenting: by 2/0 silk, 2 cm in interval, distributed along the edge of skull window. 9. Dural incision: curvilinear along the edge of skull window. 10.The subdural clot was removed by sucker. The temporalis muscle was excised to prevent epidural mass effect. 11.Hemosatasis: the bleeders was stopped by Bovie and oozing surface was covered with gelfoam. 12.Dural closure: Duroplasty was performed with a piece of 4" x 5" Durofoam to create an additional space for the swollen brain. 13.The skull plate was removed and placed in bone bank for preservation. 14.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 15.Drain: two, epidural, CWV. 16.Blood transfusion: PRBC 4U, FFP 6U, Platelet 12U. Blood loss: 1000 ml. 17.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R4李振豪R1施廷翰 Indication Of Emergent Operation IICP, uncal herniation 錢勝利 (M,1948/10/30,63y4m) 手術日期 2011/02/21 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Spondylosis with myelopathy, lumbar 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 張廷碩, 時間資訊 12:45 進入手術室 12:50 麻醉開始 13:00 誘導結束 13:00 抗生素給藥 13:30 手術開始 15:25 手術結束 15:25 麻醉結束 15:32 送出病患 15:35 進入恢復室 16:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 手術 椎弓切除術(減壓)-二節以內 1 1 摘要__ 手術科部: 外科部 套用罐頭: HIVD 開立醫師: 曾峰毅 開立時間: 2011/02/21 15:29 Pre-operative Diagnosis Lumbar stenosis, L3/4 Post-operative Diagnosis Lumbar stenosis, L3/4 Operative Method Left L3/4 laminotomy for bialteral sublaminar decompression Specimen Count And Types Nil Pathology Nil Operative Findings Hypertrophic ligamentum flavum compressed the thecal sac tightly. Bilateral lateral recess and thecal sac were decompressed well after the opertaion. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After C-arm localziation, we scrubbed, disinfected, and then draped the back. We made on midline skin incision, and dissected left paraspinal muscle. L3/4 left laminotomy was performed to decompress bilateral lateral recess. The wound was closed in layers. Operators VS 曾漢民 Assistants R4 曾峰毅 R1 張廷碩 黃彥傑 (M,1957/09/10,54y6m) 手術日期 2011/02/21 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Lumbar stenosis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 2 紀錄醫師 張廷碩, 時間資訊 07:45 報到 08:15 進入手術室 08:20 麻醉開始 08:30 誘導結束 09:00 抗生素給藥 09:05 手術開始 12:00 抗生素給藥 12:10 手術結束 12:10 麻醉結束 12:20 送出病患 12:25 進入恢復室 13:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 脊椎融合術-前融合,有固定物)≦四節 1 2 手術 椎間盤切除術-腰椎 1 4 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 曾峰毅 開立時間: 2011/02/21 12:12 Pre-operative Diagnosis Spondylolisthesis, L4/5, grade I Post-operative Diagnosis Spondylolisthesis, L4/5, grade I Operative Method Posterior decompression with L4 laminectomy; L4/5 posterior fixation with transpedicular screws; transforaminal lumbar interbody fusion with PEEK cage and autologous bone graft Specimen Count And Types Nil Pathology Nil Operative Findings Medtronic transpedicular screws, 6.5x45 mm screws was inserted into bilateral pedicles of L4 and L5. 5 cm rods were used for fixation. PEEK cage, 10 mm high, was used for fusion. Spondylolisthesis was reduced after cage insertion. Hypertrophic ligamentum flavum compressed the thecal sac and bilateral lateral recesses tightly. Neural structures were decompressed well after laminectomy. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After localized by C-arm, and back scrubbed, disinfected, and then draped, we made one midline skin incision to dissect paraspinal muscles of L4/5. We inserted transpedicular screws into bilateral pedicles of L4 and L5. We performed L4 laminectomy and L4/5 right facectomy. Diskectomy was performed, and posterior fusion was done with PEEK cage and autologous bone graft. We achieved fixation with rods, and inserted one hemovac. The wound was closed in layers. Operators VS 曾漢民 Assistants R4 曾峰毅 R1 張廷碩 劉宗禮 (M,1939/11/22,72y3m) 手術日期 2011/02/21 手術主治醫師 楊永健 手術區域 東址 012房 01號 診斷 Late effect of burn of other extremities 器械術式 Burn Debridment <10 BSA，S.T.S.G.<10 BSA 手術類別 預定手術 手術部位 四肢 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 3 紀錄醫師 游皓鈞, 時間資訊 07:55 報到 08:07 進入手術室 08:10 麻醉開始 08:15 誘導結束 08:40 手術開始 09:50 手術結束 09:50 麻醉結束 10:00 送出病患 10:05 進入恢復室 11:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 多層皮膚移植- 10-20BSA 1 1 R 手術 多層皮膚移植–每增加100平方公方 3 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: debridement with STSG 開立醫師: 游皓鈞 開立時間: 2011/02/21 09:57 Pre-operative Diagnosis Burn wound over right calf Post-operative Diagnosis Burn wound over right calf Operative Method debridement with STSG Specimen Count And Types 1 piece About size: Source:wound culture*2 Pathology nil Operative Findings 1. One 10*25 cm wound with eschar formation and necrotic tissue over right calf 2. Area of STSG was around 450 cm2 in depth of 10/1000 inch Operative Procedures After general anesthesia with intubation, he was put in supine position. Right lower extremity was disinfected with hibitane and drapped to expose surgical field. We performed debridement of the wound and meanwhile hemostasis by electrocautry and bosmin gauze compression. STSG was harvested from the right thigh with area of 450 cm2 in depth of 10/1000 inch. STSG was applied to wound fixed by appose. The wound was covered with vaseline gauze, wet cotton rool, elastic band, respectively. The donor site was covered with op-site. Finally we applied the long splint on right leg. Operators VS楊永健 Assistants R4陳建璋, R1游皓鈞, Ri馬欣婕 葉妤 (F,2001/03/24,10y11m) 手術日期 2011/02/21 手術主治醫師 廖漢文 手術區域 東址 000房 號 診斷 Moyamoya disease 器械術式 Common Carotid Angiography 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 王永彬 ASA 1 時間資訊 00:00 臨時手術NPO 08:45 麻醉開始 08:50 誘導結束 09:20 麻醉結束 10:00 進入恢復室 11:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 蔡婕榆 (F,2009/11/26,2y3m) 手術日期 2011/02/21 手術主治醫師 廖漢文 手術區域 東址 000房 號 診斷 Arteriovenous malformation, brain 器械術式 NEURO T.A.E 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 王永彬 ASA 2 時間資訊 00:00 臨時手術NPO 10:25 麻醉開始 11:15 誘導結束 14:50 麻醉結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 翁金蓮 (F,1950/10/08,61y5m) 手術日期 2011/02/21 手術主治醫師 陳敞牧 手術區域 東址 003房 01號 診斷 Female breast cancer 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3 紀錄醫師 游健生, 時間資訊 07:42 報到 08:15 進入手術室 08:20 麻醉開始 09:00 誘導結束 09:25 抗生素給藥 10:14 手術開始 12:25 抗生素給藥 13:20 麻醉結束 13:20 手術結束 13:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 腫瘤醫學部 套用罐頭: Suboccipital craniotomy for right cerebellar ... 開立醫師: 游健生 開立時間: 2011/02/21 14:02 Pre-operative Diagnosis Breast cancer with multiple intracranial metastasis Post-operative Diagnosis Breast cancer with multiple intracranial metastasis Operative Method Suboccipital craniotomy for right cerebellar metastasis removal Specimen Count And Types 1 piece About size:tumor Source:2x2cm Pathology Pending Operative Findings The tumor was gray-whitish, solid, and firm. The margin between the tumor and the dura was clear. However, the plane between the tumor and brain parenchyma was not clear, and mild adhesive. The foramen Magnum was opened during surgery for decompression. Mild brain swelling was noted. Operative Procedures 1. Under ETGA, patient was put into prone position with head fixed by Mayfield headholder and neck in flexion. 2. After shaving, we disinfected and draped the operation field as usual. 3. A hockey stick scalp incision was made from C1 at midline to inion and extended to right and turned donw and mastoid region 4. Skin flap was elevated followed by muscle flap and a fascia was harvest for later duroplasty 5. Four burrhole were created followed by right suboccipital craniotomy and formen magnum opening 6. After U-shape durotomy with transverse sinus as base, we drained out some CSF for decompression. The right cerebellum dropped down and the gray-whitish tumor was exposed at right upper corner. 7. The tumor was grossly removed totally in pieces followed by hemostasis with Surgicel packing 8. Dura was repaired and closed with fascia by continuous 4-0 prolene suture 9. Bone flap was fixed by with mini-plates and a subgaleal CWV drain was placed. 10. Wound was closed in layers Operators VS 陳敞牧 Assistants R6 陳睿生 R3 游健生 李宸瑄 (F,1956/08/26,55y6m) 手術日期 2011/02/22 手術主治醫師 王國川 手術區域 東址 002房 06號 診斷 Subarachnoid hemorrhage (SAH) 器械術式 Craniotomy(Aneurysms) P-DUH 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 王永彬 ASA 4E 紀錄醫師 全賀顯, 時間資訊 12:00 開始NPO 21:47 通知急診手術 22:35 進入手術室 22:40 麻醉開始 22:45 誘導結束 23:30 抗生素給藥 00:01 手術開始 03:11 抗生素給藥 05:40 手術結束 05:40 麻醉結束 05:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 開顱術摘除血管病變 - 腦血管瘤 有病徵的 1 1 L 手術 顱內壓視置入 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Left side decompressive craniectomy, pteriona... 開立醫師: 陳睿生 開立時間: 2011/02/22 06:18 Pre-operative Diagnosis A-com aneurysm rupture with diffuse SAH Post-operative Diagnosis A-com aneurysm rupture with diffuse SAH Operative Method Left side decompressive craniectomy, pterional approach for aneurysm clipping and EVD insertion Specimen Count And Types nil Pathology Nil Operative Findings The aneurysm was about 4mm in neck and 7-8mm in height. It located between bilateral A2, and protruded superiorly. A Sugita fenestrated clip was applied from left A2 side. A left Kocher^s EVD was inserted and the CSF was xanthochromic. The EVD was 7cmc in depth. ICP was more than 10cm H2O initially. Diffuse SAH was noted intra-op, and the brain was severe swelling. Craniectomy with remove of temporalis muscle was done for decompression. Operative Procedures 1. ETGA, the patient was under supine position, and head right turn, fixed with Mayfield clump 2. Left frontotemporal curvillinear scalp incision and insert a left Kocher^s EVD 3. Drain CSF for decompression 4. The temporalis muscle was dissected, and an about 8x8cm craniectomy window was made with two bur holes at key hole and superior temporal line 5. Proper dura tenting, and the sphenoid ridge was flattern 6. The dura was opened along the craniectomy window, and the frontal lobe was retracted upward to expose the optic nerve 7. Drain CSF from cistern for decompression, and then adhesionlysis was done between the optic nerve, ICA, and the inferior aspect of frontal lobe 8. Bilateral rectal gyrus was removed for expose of the aneurysm 9. The ICA was dissected and the ACA was traced from the proximal side 10.Bilateral A2 were identified, and then the aneurysm was found between bilateral A2 11.Proper adhesionlysis was done between the aneurysm and bilateral A2; then a Sugita fenestrated clip was applied under temporary A1 clipping 12.Third ventriculostomy was done 13.Hemostasis, and the dura was closed with fascia graft 14.Temporalis muscle was removed for decompression 15.Set anepidural CWV drain, and the wound was closed in layers Operators VS 王國川 Assistants R6 陳睿生, R1 全賀顯 Indication Of Emergent Operation 黃惠瑜 (F,1975/08/27,36y6m) 手術日期 2011/02/21 手術主治醫師 廖漢文 手術區域 東址 000房 號 診斷 Arteriovenous malformation, brain 器械術式 NEURO T.A.E 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 王永彬 ASA 2 時間資訊 00:00 臨時手術NPO 15:10 麻醉開始 15:15 誘導結束 18:05 麻醉結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 柯慶良 (M,1954/11/17,57y3m) 手術日期 2011/02/21 手術主治醫師 蔡翊新 手術區域 東址 005房 01號 診斷 Subdural hemorrhage following injury, with loss of consciousness of unspecified duration 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林至芃 ASA 4E 紀錄醫師 李振豪, 時間資訊 00:38 通知急診手術 01:05 報到 01:10 進入手術室 01:20 麻醉開始 01:30 誘導結束 01:55 手術開始 02:18 開始輸血 04:25 麻醉結束 04:25 手術結束 04:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 急性硬腦膜下血腫清除術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 蔡翊新 開立時間: 2011/02/21 04:23 Pre-operative Diagnosis Left temporo-occipital skull fracture with frontotemporoparietal EDH and SDH. Post-operative Diagnosis Left temporo-occipital skull fracture with frontotemporoparietal EDH and SDH. Operative Method Left frontotemporoparietal craniotomy for removal of EDH and SDH. Specimen Count And Types nil Pathology Nil. Operative Findings Linear fracture at left temporo-occipital region and EDH at left frontotemporoparietal region, 2 cm in thickness, were noted. The dura was torn beneath the fracture line and the brain was lacerated. SDH about 1 cm in thickness was noted at left F-T-P area. The ICP after skin closure was 0 mmHg. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: a smaller trauma flap was made at left F-T-P region. 5. Craniotomy window: 10 x 10 cm, left F-T-P, created by making 4 burr holes then cut by power saw. 6. The EDH was removed by sucker. The epidural space was packed with Surgicel and Gelfoam. 7. Dural tenting: by 1/0 silk, 1.5 cm in interval, distributed along the edge of skull window. 8. Dural incision: crusade fahion, including the laceration of the dura. 9. The subdural clot was removed by sucker. 10.Hemosatasis: the bleeders was stopped by Bovie and oozing surface was covered with Surgicel and Gelfoam. 11.Dural closure: was closed with a piece of dural graft taking from temporalis fascia. 12.The skull plate was placed back and fixed by 3 miniplates and 6 screws. 13.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 14.Drain: one, epidural, CWV. 15.Blood transfusion: PRBC 4U. Blood loss: 400 ml. 16.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R4李振豪 Indication Of Emergent Operation 相關圖片 官美智 (F,1938/10/25,73y4m) 手術日期 2011/02/21 手術主治醫師 林昌平 手術區域 東址 010房 06號 診斷 Cataract 器械術式 Phaco+PCIOL 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 11:56 進入手術室 12:10 手術開始 12:40 手術結束 12:43 送出病患 記錄__ 手術科部: 眼科部 套用罐頭: Phaco-Temporal (林昌平) 開立醫師: 吳郁芊 開立時間: 2011/02/21 12:34 Pre-operative Diagnosis Cataract (od) Post-operative Diagnosis Cataract (od) Operative Method Phacoemulsification and PCIOL implantation (od) Specimen Count And Types nil Pathology Nil Operative Findings Cataract (od) Operative Procedures 1. Under topical anesthesia 2. Disinfection, irrigation and draping 3. Application of an eyelid speculum 4. Made a clear corneal incision and penetrate into AC with 2.5mm cresent knife 5. Inject Viscoat into theanterior chamber 6. Continuous circular capsulorrhexis was done with capsular forceps 7. Made a sideport with the MVR blade 8. Hydrodissection and hydrodelineation were done with BSS 9. Phacoemulsification of thenucleus by chopper technique 10. Aspiration of the residual cortical material with I/A cannula 11. One-piece PCIOL was implanted into the bag after injection of Viscoat 12. The residual Viscoat was washed out by I/A cannula 13. Inject BSS into AC and check leakage 14. Subconjunctival injection of Rinderon and Gentamicin 15. Maxitrol patching Operators 林昌平, Assistants 劉耀臨, 吳郁芊 江李梅鳳 (F,1942/11/04,69y4m) 手術日期 2011/02/21 手術主治醫師 林至芃 手術區域 西址 034房 01號 診斷 Acute myeloid leukemia 器械術式 Remove ""Implant Port"" 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 林至芃 ASA 2 時間資訊 08:00 報到 08:12 進入手術室 08:15 麻醉開始 08:17 誘導結束 08:30 手術開始 08:50 麻醉結束 08:50 手術結束 08:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 皮下肌肉或深部異物取出術 1 1 R 記錄__ 手術科部: 麻醉部 套用罐頭: Port-A remove, GA 開立醫師: 陳心言 開立時間: 2011/02/21 08:20 Pre-operative Diagnosis AML Post-operative Diagnosis Ditto Operative Method Removal of Port-A Specimen Count And Types nil Pathology Nil Operative Findings NIL Operative Procedures 1.Under IVGA and local anesthesia, skin incision was made along the previous incision site. 2.Uncovered the Port-A, and then removed it. 3.Wash the pouch with normal saline. 4.Subcutaneous and skin suture. Operators 林至芃, Assistants 陳心言, 簡振仁 (M,1963/11/09,48y4m) 手術日期 2011/02/21 手術主治醫師 楊榮森 手術區域 東址 020房 02號 診斷 Liver cancer 器械術式 ORIF w/ CHS, left hip 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉漢平 ASA 3 紀錄醫師 黃全敬, 時間資訊 10:00 報到 10:25 進入手術室 10:30 麻醉開始 10:40 誘導結束 10:45 抗生素給藥 11:01 手術開始 11:25 開始輸血 12:15 麻醉結束 12:30 進入恢復室 14:00 離開恢復室 12:15 手術結束 12:25 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Glucose 1 0 手術 惡性骨瘤廣泛切除(一次) 1 1 L 手術 股骨頸骨折開放性復位術 1 2 L 記錄__ 手術科部: 骨科部 套用罐頭: 1. tumor curettage 開立醫師: 黃全敬 開立時間: 2011/02/21 11:58 Pre-operative Diagnosis left proximal femur tumor, suspect HCC metastasis, with impending pathological fracture Post-operative Diagnosis left proximal femur tumor, suspect HCC metastasis, with impending pathological fracture Operative Method 1. tumor curettage 2. open reduction and internal fixation with Smith & Nephew CHS (135 degree, 3H3S, lag screw 95 mm, compression screw x1) Specimen Count And Types 1 piece About size:small pieces of tumor Source:left proximal femur tumor Pathology pending Operative Findings 1. whitish, firm tumors over left proximal femur, intertrochanter to subtrochanteric area, sent for pathology examination 2. no fracture ntoed Operative Procedures 1. ETGA, lateral decubitus position 2. skin disinfection, draped 3. skin incision over left hip, lateral approach to the femur 4. inset the guide pin, ream the tract 5. perform tumor curettage, irrigate with 95% alcohol 6. set leg screw and then the side plate 7. apply compression screw x1 and side plate screw x3 8. N/S irrigation, hemostasis, set a 1/8 hemovac drain 9. close the wound in layers Operators 楊榮森, Assistants 黃全敬, 蘇盈豪, 黃哲南, 林怡君 (F,1982/04/21,29y10m) 手術日期 2011/02/22 手術主治醫師 林至芃 手術區域 西址 037房 03號 診斷 Germ cell tumor, ovary 器械術式 Port-A Implatation /WOR 手術類別 臨時手術 手術部位 胸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 林至芃 ASA 3 紀錄醫師 陳心言, 時間資訊 14:10 報到 14:12 進入手術室 14:25 抗生素給藥 14:25 麻醉開始 14:30 誘導結束 14:35 手術開始 14:53 手術結束 14:53 麻醉結束 15:00 送出病患 15:06 進入恢復室 16:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 手術 port–A導管植入術–治療性導管植入術 1 0 R 記錄__ 手術科部: 麻醉部 套用罐頭: Port-A implantation, subclavian 開立醫師: 陳心言 開立時間: 2011/02/21 21:14 Pre-operative Diagnosis Ovarian cancer Post-operative Diagnosis Ditto Operative Method Port-A implantation, echo-guided Specimen Count And Types nil Pathology Nil Operative Findings 1.Site: right subclavian vein, with echo-guided procedure 2.Patent flow after implantation 3.Others: nil Operative Procedures 1.The patient was set on supine position and bilateral subclavian veins were checked by echo. 2.After IVGA and local anesthesia applied, transverse skin incision for 3cm was made at pre-cordial area. 3.Undermine the skin at the layer between subcutaneous tissue and deep fascia in lateral direction. 4.An IV catheter was inserted via the subclavian incision and negatively aspirated until venous blood attainable. 5.J-wire was inserted smoothly in rostral direction. A subclavian catheter with dilator was inserted through the J-wire, and the dilator was then removed. 6.The catheter of Port-A was threaded into the subclavian vein until mark 21 cm. The catheter was adapted into the port and locked with restrictor.The Port was inserted into the pouch of pre-cordial incision. 7.Skin was closed layer by layer. Both catheter and port were perfused with heparin solution after implantation. Operators 林至芃, Assistants 陳心言, 羅吳明寰 (F,1936/02/24,76y0m) 手術日期 2011/02/22 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Trigeminal neuralgia (Cranial nerve V) 器械術式 Radiofrequency coagulation 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 面罩麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 曾峰毅, 時間資訊 00:00 臨時手術NPO 08:02 進入手術室 08:25 麻醉開始 08:30 誘導結束 08:30 抗生素給藥 08:41 手術開始 09:50 手術結束 09:50 麻醉結束 09:57 送出病患 10:00 進入恢復室 11:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 高頻熱凝療法 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Semi-opened mask inhalation anes 1 0 摘要__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 曾峰毅 開立時間: 2011/02/22 09:55 Pre-operative Diagnosis Left trigeminal neuralgia Post-operative Diagnosis Left trigeminal neuralgia Operative Method Radiofrequency for partial rhizotomy to left maxillary nerve. Specimen Count And Types Nil Pathology Nil Operative Findings 90 seconds of 80 degrees Celsius were given for partial rhizotomy. Operative Procedures With intravenous general anaesthesia, the patient was put in supine position. After disincetion, we inserted radiofrequency catheter into left foramen ovale. We confirmed the location after patient woke up. We put the patient back into asleep, and peformed radiofrequency. Operators VS 曾勝弘 Assistants R4 曾峰毅 唐美蓉 (F,1951/01/01,61y2m) 手術日期 2011/02/22 手術主治醫師 曾勝弘 手術區域 東址 005房 02號 診斷 Infection and inflammatory reaction due to nervous system device, implant, and graft 器械術式 Debridment-- 5-10cm 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾峰毅, 時間資訊 00:00 臨時手術NPO 10:12 進入手術室 10:20 麻醉開始 10:30 誘導結束 10:53 手術開始 11:20 手術結束 11:20 麻醉結束 11:37 送出病患 11:40 進入恢復室 13:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 移前皮瓣移植術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 曾峰毅 開立時間: 2011/02/22 11:32 Pre-operative Diagnosis Poor healing of right frontal wound Post-operative Diagnosis Poor healing of right frontal wound Operative Method Debridement, advance flap, and primary closure of the wound. Specimen Count And Types Wound swabs were sent for culture. Pathology Nil Operative Findings Granulation with purulent discharge was noted from poor-healed wound. A lot of tension was found at wound, and then advanced the scalp flap. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position. After scalp shaved, scrubbed, disinfected, and then draped, we made one fish-mouth skin incision around the granulation and extanded the the wound from bilateral wound edge. We trimmed the wound edge. We advanced the scalp flap at bilatearl side of wound and peformed debridement. Wound was closed in layers. Operators VS 曾勝弘 Assistants R4 曾峰毅 葉妤 (F,2001/03/24,10y11m) 手術日期 2011/02/22 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Moyamoya disease 器械術式 Moyamoya P-DUH，Cord untethering -KUO，EC-IC by-pass 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 10:00 進入恢復室 11:25 離開恢復室 07:45 報到 08:03 進入手術室 08:18 麻醉開始 08:50 誘導結束 09:05 抗生素給藥 09:35 手術開始 12:10 抗生素給藥 12:45 麻醉結束 12:45 手術結束 12:55 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Glucose 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 顱內外血管吻合術 1 1 R 手術 朴卜勒氏血流測定（週邊血管） 1 0 R 記錄__ 手術科部: 外科部 套用罐頭: Encephaloduroarteriosynangiosis, right. 開立醫師: 鍾文桂 開立時間: 2011/02/22 13:13 Pre-operative Diagnosis Moyamoya disease, bilateral, more severe at right. Post-operative Diagnosis Moyamoya disease, bilateral, more severe at right. Operative Method Encephaloduroarteriosynangiosis, right. Specimen Count And Types nil Pathology Nil Operative Findings 1. Long segment of posterior branch(7cm) was dissected. The caliber of the STA was narrow. 1. Long segment of posterior branch(7.5cm) was dissected. The caliber of the STA was narrow. 2. Contact between STA and MCA branches are tension-free and about 6 cm long. The anterior branch of left STA was intact during dissection. Operative Procedures With endotracheal general aenasethesia, the patient was put in supine position with head rotated to left. After scalp shaved, scrubbed, disinfected, and then draped, we localize the STA position and territory by Doppler. Under microscopic view, we made one curvilinear skin incision and dissected above the galeal to expose posterior branch of left STA. We made the inicion along 1cm away from STA at bilateral side, and created craniotomy 2x6cm, beneath STA, after linear incision of the right temporalis muscle. Two burr holes were made then craniotomy was done. After dural tenting, linear durotomy was done, and arachnoid membrane was separated by forceps. STA graft was anchored at bilateral ends of durotomy, we placed gelfoam to push the graft anteriorly for better contact between the graft and the MCA and the dura was closed in water-tight suture and Durofoam. Bone graft was fixed back with 4 wires, and the wound was closed in layers. Operators VS 郭夢菲 Assistants R5 鍾文桂 蔡婕榆 (F,2009/11/26,2y3m) 手術日期 2011/02/22 手術主治醫師 郭夢菲 手術區域 兒醫 067房 02號 診斷 Arteriovenous malformation, brain 器械術式 Craniotomy (A.V.M.) P-DUH 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 12:45 報到 13:15 進入手術室 13:20 麻醉開始 13:30 誘導結束 13:50 抗生素給藥 13:59 手術開始 14:55 開始輸血 16:50 抗生素給藥 21:55 手術結束 22:00 麻醉結束 22:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 開顱術摘除血管病變 - 動靜脈畸型中型表淺 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 9 0 麻醉 動脈血液檢查全套 4 0 麻醉 Hemoglobin (Hb) 4 0 麻醉 測血糖 4 0 麻醉 Ca (Calcium) 4 0 麻醉 Na (Sodium) 4 0 麻醉 K (Potassium) 4 0 麻醉 Blood gas analysis 4 0 記錄__ 手術科部: 外科部 套用罐頭: Right frontal craniotomy for excision of arte... 開立醫師: 鍾文桂 開立時間: 2011/02/22 23:16 Pre-operative Diagnosis Arteriovenous malformation, right frontal status post transarterial embolization. Post-operative Diagnosis Arteriovenous malformation, right frontal status post transarterial embolization. Operative Method Right frontal craniotomy for excision of arteriovenous malformation. Specimen Count And Types 1 piece About size:5 cc Source:AVM, brain. Pathology Pending. Operative Findings 1. Several arterial feeders from anterior cerebral artery were noted. They were embolized by coils and Onyx. The feeders were excised and further clipped at their proximal ends. Severe adhesion around the vessles was noted. It may be related to the embolization. 1. Several arterial feeders from anterior cerebral artery were noted. They were embolized by coils and Onyx. The feeders were excised and further clipped at their proximal ends. Severe adhesion around the vessles was noted. It may be related to the embolization. 2. A large aneurysm was noted right beside the falx cerebri. It was excised totally. During the excision process, a small tear over the superior sagital sinus was sealed with gelfoam. Some venous congestion along the falx was noted. 2. A large aneurysmal dilatation was noted right to the falx cerebri and just beneath or closed to the superior sagittal sinus. It was excised totally. During the excision process, a small tear over the medial wall of the aneurym may be contacting the superior sagittal sinus was noted and sealed with two wecks and the middle of it was packed with Surgicel and two pieces of gelfoam. Numerous venous congestion along the falx was noted like network due to previous veous hypertension was noted. 3. The AVM was embloized rather well, but the surrounding brain surface was noted to expanded a little, which looked like tiny AVM, were removed totally area by area. 3. The dural defect was sealed with DuraFoam. Total blood loss: 300cc. 4. The dural defect was sealed with DuraFoam. Total blood loss: 300cc. Operative Procedures Under ETGA, the patient was placed in supine position and head in the midline. After shaving, disinfection, and draping, the bicoronal scalp incision was made. After dissection, a 6-cm craniotomy was made at right frontal region and crossing the superior sagital sinus. After dural tenting and durotomy, meticulous dissection of the AVM from the dural attachment was done. The arachnoid membrane was dissected. Then, the AVM was dissected from the brain surface. Coagulation and clipping of the feeders were done. While encountering the aneurysm which has severe adhesion to the falx cerebri and superior sagital sinus, gradual clipping of the anerysmal wall for hemostasis and dissection from its attachment were done. Finally the AVM was excised totally. The exposed brain surface was covered with surgicel. The SSS defect was sealed with gelfoam. Under ETGA, the patient was placed in supine position and head in the midline. After shaving, disinfection, and draping, the bicoronal scalp incision was made. After dissection, a 5x6-cm craniotomy was made at right frontal region and crossing the superior sagital sinus to the left side. After dural tenting and durotomy, meticulous dissection of the AVM from the dural attachment was done under microscopic view. The arachnoid membrane was dissected. Then, the AVM was dissected from the normal brain surface. Coagulation and clipping of the feeders were done. While encountering the aneurysm which has severe adhesion to the falx cerebri and superior sagital sinus, gradual clipping of the anerysmal wall for hemostasis and dissection from its attachment were done. Finally the AVM was excised totally. Some residual occult AVM on the dissected brain surface was noted to expand after a while, they were excised completely. The exposed brain surface was covered with surgicel. The SSS defect was sealed with gelfoam. The dura mater was closed with 4-0 Prolene and repaied with DuraFoam. The skull bone plate was fixed by microplates and screws. The wound was closed in layers with one subgaleal CWV drian. The dura mater was closed with 4-0 Prolene and repaired with DuraFoam. The skull bone plate was fixed by microplates and screws. The wound was closed in layers with one subgaleal CWV drian. Operators V.S. 郭夢菲 Assistants R5 鍾文桂 陳玉坤 (M,1952/08/01,59y7m) 手術日期 2011/02/22 手術主治醫師 林峰盛 手術區域 西址 035房 07號 診斷 Syringomyelia 器械術式 Nerve block / PC 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 林峰盛 ASA 3 時間資訊 14:25 報到 14:28 進入手術室 14:33 麻醉開始 14:35 誘導結束 14:40 手術開始 14:53 麻醉結束 14:53 手術結束 14:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 末稍神經阻斷術 4 0 R 摘要__ 手術科部: 麻醉部 套用罐頭: LENB 開立醫師: 林峰盛 開立時間: 2011/02/22 14:56 Pre-operative Diagnosis 1.spinal stenosis 2. radiculopathy Post-operative Diagnosis 1. spinal stenosis 2. radiculopathy Operative Method transforaminal root block Specimen Count And Types nil Pathology Nil Operative Findings Operative Procedures LA with 1% xylocaine 5 ml pt in prone position Under fluoroscopic-guidance, Root block was done to right L2-5 level with 23G spinal needle, 1 mg rinderon in 0.5% xylocaine 8ml Operators 林峰盛, Assistants 陳心言, 周靜 (F,1949/04/12,62y11m) 手術日期 2011/02/22 手術主治醫師 陳敞牧 手術區域 東址 003房 01號 診斷 Low Back Pain 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 08:03 進入手術室 08:10 麻醉開始 08:15 誘導結束 08:30 抗生素給藥 08:55 手術開始 10:55 手術結束 10:55 麻醉結束 11:34 送出病患 11:40 進入恢復室 12:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-腰椎 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 記錄__ 手術科部: 外科部 套用罐頭: Microdiskectomy 開立醫師: 李振豪 開立時間: 2011/02/22 11:22 Pre-operative Diagnosis Herniation of intervertebral disc, L4-5, right Post-operative Diagnosis Herniation of intervertebral disc, L4-5, right Operative Method Microdiskectomy Specimen Count And Types nil Pathology Nil Operative Findings Ruptured disc with caudal migration was noted which pushed the root upward. Adhesion around the sequested disc was noted. The disc was degenerative and calcified in character. The root and neural foramen were decompressed well after microdiskectomy. The thecal sac was intact and no CSF leakage was noted. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position. The location of the L4-5 disc space was localized with portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. The midline skin incision was made at L4-5 level with 3cm in length. The subcutaneous soft tissue was dissected. The right side paravertebral muscle groups were detached and the lamina was exposed. Laminotomy was performed with Kerrison punch followed by removing the ligmentum flavum. The thecal sac and nerve root was identified. The disc space was entered but empty disc space with ruptured disc was found. The sequestrated disc was migrated caudally and pushed the nerve root upward. the sequestrated disc was removed and the microdiskectomy was performed with curette, alligator, and disc clamp. Hemostasis was achieved with bipolar electrocautery and Gelform packing. Rinderon suspension was applied around the root. The wound was then closed in layers with 2-0 Vicryl and 4-0 Dexon(subcuticular suture). Operators VS陳敞牧 Assistants R4李振豪, R2曾偉倫 相關圖片 江淑惠 (F,1965/03/05,47y0m) 手術日期 2011/02/22 手術主治醫師 楊士弘 手術區域 東址 003房 02號 診斷 Carpal tunnel syndrome (CTS) 器械術式 median nerve decompression 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 11:46 進入手術室 11:52 麻醉開始 11:58 誘導結束 12:00 抗生素給藥 12:08 手術開始 12:25 手術結束 12:25 麻醉結束 12:30 送出病患 12:35 進入恢復室 13:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 正中神經或尺神經腕部減壓術–單側 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 摘要__ 手術科部: 外科部 套用罐頭: Decompression of left median nerve 開立醫師: 李振豪 開立時間: 2011/02/22 12:41 Pre-operative Diagnosis Carpal tunnel syndrome, bilateral Post-operative Diagnosis Carpal tunnel syndrome, bilateral Operative Method Decompression of left median nerve Specimen Count And Types nil Pathology Nil Operative Findings The transverse carpal ligament was hypertrophic and calcified which tightly compressed the median nerve. After transection of the transverse carpal ligament, the median nerve was decompressed well. Operative Procedures Under intravenous general anesthesia with Propofol, the patient was put in supine position. The left hand was scrubbed, disinfected, and draped as usual. The L shape skin incision was made at left wrist. The tendon of palmaris longus superficialis was retracted and the transverse carpal ligment was identified. The transverse carpal ligment was transected by knife and scissor. After decompression of the median nerve, hemostasis was checked. The wound was then closed in layers with 4-0 Vicryl and 5-0 Nylon. Operators VS王國川 Assistants R4李振豪, R2曾偉倫 相關圖片 許龍榮 (M,1958/05/19,53y9m) 手術日期 2011/02/22 手術主治醫師 楊士弘 手術區域 西址 039房 02號 診斷 Carpal tunnel syndrome 器械術式 Decompression of mediun nerve 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 10:00 報到 10:35 進入手術室 10:40 麻醉開始 10:50 手術開始 11:40 手術結束 11:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 正中神經或尺神經腕部減壓術–單側 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Carpal tunnel release, right 開立醫師: 王奐之 開立時間: 2011/02/22 11:47 Pre-operative Diagnosis Carpal tunnel syndrome, right Post-operative Diagnosis Carpal tunnel syndrome, right Operative Method Carpal tunnel release, right Specimen Count And Types nil Pathology Nil Operative Findings Hypertrophic flexor retinaculum was noted, the nerve sheath expanded well after decompression. Operative Procedures The patient was placed in supine position with right arm stretched out. After skin disinfection and draping in sterile fashion, a linear skin incision was made at right wrist, and the incision was deepened until visualization of flexor retinaculum. The retinaculum was then cut by scissors until full release. After hemostasis, the wound was closed with 4-0 Dexon and 3-0 Nylon in interrupted sutures. Operators VS 楊士弘 Assistants R3 王奐之 相關圖片 陳哲雄 (M,1962/02/20,50y0m) 手術日期 2011/02/22 手術主治醫師 王國川 手術區域 東址 005房 03號 診斷 Glioblastoma multiforma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾峰毅, 時間資訊 00:00 臨時手術NPO 12:02 進入手術室 12:05 麻醉開始 12:50 誘導結束 13:00 抗生素給藥 13:15 手術開始 16:00 抗生素給藥 16:45 手術結束 16:45 麻醉結束 16:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT 開立醫師: 曾峰毅 開立時間: 2011/02/22 17:20 Pre-operative Diagnosis Left temporal tumor with cystic component, suspected glioblastoma multiforme Post-operative Diagnosis Left temporal tumor with cystic component, suspected glioblastoma multiforme Operative Method Left craniotomy for tumor excision Specimen Count And Types Several fragment of one tumor was sent for pathology. Pathology Pending Operative Findings One hypervascular, greyish, fragile to glatin-textured tumor was noted at left temporal lobe with cystic component containing high-viscosity fluid. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to right and fixed with Mayfield head clamp. After scalp shaved, scrubbed, disinfected, and then draped, we made one curvilinear skin incision at left frontotemporal area. We reflected the scalp flap, and drilled five burr holes. We created craniotomy, and tented the dura along the craniotomy window. We made one U-shape dura incision and performed corticotomy at temporo-frontal junction. We drained the cystic component first, and achievd tumor excision. Tumor cavity was paved with Surgicel and was coverred with Floseal for hemostasis. We closed the dura in water-tight fashion and fixed the bone graft back with mini-plates. We placed one subgaleal CWV, and closed the wound in layers. Operators VS 王國川 Assistants R4 曾峰毅 Ri 賴品泉 賴月嬌 (F,1962/08/23,49y6m) 手術日期 2011/02/23 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Brain tumors, malignant 器械術式 Stereotaxic procedure for biop 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 張廷碩, 時間資訊 00:00 臨時手術NPO 13:43 進入手術室 13:45 麻醉開始 13:50 誘導結束 14:20 抗生素給藥 14:20 手術開始 17:00 手術結束 17:00 麻醉結束 17:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 手術 立體定位術-切片 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Left burr hole steretactic biopsy 開立醫師: 胡朝凱 開立時間: 2011/02/23 17:18 Pre-operative Diagnosis Left basal ganglion tumor Post-operative Diagnosis Left basal ganglion tumor Operative Method Left burr hole steretactic biopsy Specimen Count And Types pieces of tumor Pathology Frozen: favor malignant brain tumor Operative Findings 1.Three different target were set 2.The tumor looks grayish Operative Procedures 1.ETGA, supine with head fixed with skull clamp 2.Navigation registration 3.Left frontal vertical skin incision 4. Burr hole drill 5.Under navigation guide, lesion biopsy was done and the specimen was sent to fozen section. 6.Hemostasis 7.Close wound in layers Operators VS 曾漢民 Assistants 胡朝凱,張廷碩 黃為泉 (M,1962/03/31,49y11m) 手術日期 2011/02/23 手術主治醫師 蔡瑞章 手術區域 東址 005房 01號 診斷 Spinal tumor 器械術式 Intraspinal intramedullary tum 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 張廷碩, 時間資訊 00:00 臨時手術NPO 07:55 報到 08:05 進入手術室 08:15 麻醉開始 08:25 誘導結束 08:38 手術開始 08:50 抗生素給藥 12:00 抗生素給藥 12:30 麻醉結束 12:30 手術結束 12:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 手術 良性脊髓腫瘤切除術 1 1 手術 椎弓整形術 1 2 記錄__ 手術科部: 外科部 套用罐頭: Total tumor excision with laminoplasty 開立醫師: 胡朝凱 開立時間: 2011/02/23 12:19 Pre-operative Diagnosis Left C4~5 neuroma Post-operative Diagnosis Left C4~5 neuroma Operative Method Total tumor excision with laminoplasty Specimen Count And Types 1 cm tumor mass Pathology pending Operative Findings 1.One about 1.2 cm, yellowish, soft tumor located at left C4~5 level that arised from C5 dorsal root. 2.Border was clear. 3.The tumor compressed the spinal cord tightly. 4.Before operation, left lower limb SSEP was worse. During whole procedure, EP remained the same. Operative Procedures 1.ETGA, prone 2.Midline skin incision at C1 to C7 level 3.Detach paravertebral muscle to expose C3 to C7 lamina 4.Laminoplasty with the axis left at right 5.Durotomy 6.Identified the tumor 7.Dissect tumor inside the capsule 8.En-bloc tumor excision with nerve preservation 9.Close dura with prolene 10.Fix lamina with miniplate 11.Close wound in layers after CWV drain insertion Operators P 蔡瑞章 Assistants 胡朝凱, 張廷碩 陳虹霖 (M,2005/08/14,6y7m) 手術日期 2011/02/23 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Epilepsy 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 07:47 報到 08:10 進入手術室 08:18 麻醉開始 08:25 誘導結束 08:45 抗生素給藥 09:15 手術開始 11:30 手術結束 11:30 麻醉結束 11:35 送出病患 11:37 進入恢復室 12:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 神經分離術–肩,臀關節以上,包括臂神經叢,坐骨神經 1 2 L 手術 腦室腹腔分流手術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 記錄__ 手術科部: 外科部 套用罐頭: Implantation of vagus nerve stimulatior,left. 開立醫師: 鍾文桂 開立時間: 2011/02/23 11:58 Pre-operative Diagnosis Refractory epilepsy. Post-operative Diagnosis Refractory epilepsy. Operative Method Implantation of vagus nerve stimulatior,left. Implantation of vagus nerve stimulatior (Cyberronic model 103),left. Specimen Count And Types nil Pathology Nil. Operative Findings 1. The left vagus nerve was isolated from carotid sheath. The generator was placed in left upper anterior chest wall. 2. Implantation devices for vagus nerve stimulation therapy: - Cyberonics VNS Therapy Lead Model 302 - Cyberonics VNS Therapy Demipulse Model 103 Generator Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine position with mild neck extension. The skin was scrubbed, disinfected, and draped as usual. One transverse linear skin incision was made at left neck and left forechest with 3 and 4cm in length respectively. The anterior margin of sternocledomastoid muscle was identified after incision of platysma muscle. The deep fascia was opened and the carotid sheath was identified. The carotid sheath was opened and the vagus nerve was isolated under microscope. Under endotracheal tube general anesthesia, the patient was put in supine position with mild neck extension. The skin was scrubbed, disinfected, and draped as usual. One transverse linear skin incision was made at left neck and left forechest with 3 and 4cm in length respectively. The anterior margin of sternocledomastoid muscle was identified after incision of platysma muscle. The deep fascia was opened and the carotid sheath was identified. The carotid sheath was opened and the vagus nerve was isolated under microscope. One left forechest subcutaneous pocket was created for pulse generator. The subcutaneous tunnel was created by tunneler. The electrode was passed throught the subcutaneous tunnel. The three spiral anchor was applied over left vagus nerve for lead placement. The lead was connected with generator and the system was checked with Model 201 programming wand and model 250 programming softward. Hemostasis was checked. Two anchoring sutures were made at left neck for secure the lead. The pulse generator was implanted. The wound was then closed in layers with 4-0 Vicryl and 4-0 Prolene. Operators V.S. 郭夢菲 Assistants R5 鍾文桂 李有忠 (M,1938/01/08,74y2m) 手術日期 2011/02/23 手術主治醫師 楊士弘 手術區域 東址 003房 01號 診斷 Other spinal stenosis 器械術式 Malignant intraspinal tumor, e 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 07:38 報到 08:03 進入手術室 08:05 麻醉開始 09:10 誘導結束 09:20 抗生素給藥 09:33 手術開始 11:30 開始輸血 12:20 抗生素給藥 12:55 手術結束 12:55 麻醉結束 13:07 送出病患 13:10 進入恢復室 15:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 2 手術 惡性脊髓腫瘤切除術 1 1 摘要__ 手術科部: 外科部 套用罐頭: L4 tumor excision and L4, S1 transpedicle scr... 開立醫師: 王奐之 開立時間: 2011/02/23 13:19 Pre-operative Diagnosis Small cell lung cancer with multiple spinal metastases Post-operative Diagnosis Small cell lung cancer with multiple spinal metastases Operative Method L4 tumor excision and L4, S1 transpedicle screws fixation Specimen Count And Types 1 piece About size:pieces Source:L4 vertebral and epidural tumor Pathology Pending Operative Findings Whitish soft tumor was noted at L4 pedicles and vertebral body. The tumor was removed in pieces with alligator and curette. Hypertrophic facet joints were noted. Unintentional durotomy was encountered intra-operatively (at L5-S1 level) and repaired with DuraForm. Whitish soft tumor was noted at in the epidural space medial to L4 pedicles and posterior to vertebral body. The tumor was removed in pieces with alligator and curette. Hypertrophic facet joints were noted. Unintentional durotomy was encountered intra-operatively (at L4-L5 level) and repaired with DuraForm. Operative Procedures After ETGA, the patient was placed in prone position. The L4-S1 level was localized by C-arm. After skin disinfection and draping in sterile fashion, a midline incision was made at lower lumbar area. The incision was then deepened until the spinous processes were seen. The paraspinal muscles were detached from the bone until exposure of L4-S1 transverse processes. Laminectomy was performed with rongeur and Kerrison punch, followed by tumor removal in pieces. L4 & S1 transpedicle screws were then inserted under C-arm guide. After rods insertion and hemostasis, the wound was closed in layers after setting 1 hemovac drain. Operators VS 楊士弘 Assistants R6 陳睿生, R3 王奐之 相關圖片 黃妍君 (F,2004/07/22,7y7m) 手術日期 2011/02/23 手術主治醫師 楊士弘 手術區域 兒醫 067房 02號 診斷 Epilepsy 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 12:15 進入手術室 12:16 報到 12:25 麻醉開始 12:30 誘導結束 13:35 抗生素給藥 13:39 手術開始 15:06 手術結束 15:06 麻醉結束 15:15 送出病患 15:20 進入恢復室 16:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 腦脊髓液分流管重置 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Revision of CSF shunt by replacement of the m... 開立醫師: 楊士弘 開立時間: 2011/02/23 15:20 Pre-operative Diagnosis Hydrocephalus s/p ventriculoperitoneal shunt, with under drainage Post-operative Diagnosis Hydrocephalus s/p ventriculoperitoneal shunt, with under drainage Operative Method Revision of CSF shunt by replacement of the medium pressure valve with a programmable valve Specimen Count And Types 3 pieces About size:小 Source:CSF About size:小 Source:CSF About size:小 Source:CSF Pathology Nil Operative Findings A medium pressure Medtronic valve was found under the right frontal scalp wound. The ventricular catheter was removed from the ventricle without difficulty. The CSF was clear, and the pressure was low (~5-8 cm H2O) A medium pressure Medtronic valve was found under the right frontal scalp wound. The ventricular catheter was removed from the ventricle without difficulty. The CSF was clear, and the pressure was low (~5-8 cm H2O). Codman programmable shunt, set initial pressure: 7cmH20. Operative Procedures 1. ETGA, supine. 1. ETGA, supine. 2. Preparation: shaving, disinfection, and draping. 3. Incision along the previous scalp and abdominal wounds. 4. Exposure of the Medtronic reservoir and remove it from ventriculostomy. 5. Exposure of the peritoneal catheter from the abdominal incision. 6. Place the programmable shunt through the newly created subcutaneous tunnel and connect it to the Medtronic transparent shunt catheter. 7. Place the ventricular catheter to the ventriculostomy. 8. Ensure the patency of the shunt system. 9. Wound closure in layers. Operators 楊士弘 Assistants 鍾文桂 張偉明 (M,1948/06/11,63y9m) 手術日期 2011/02/23 手術主治醫師 王國川 手術區域 東址 001房 02號 診斷 Head injury, unspecified 器械術式 VP shunt 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 4E 紀錄醫師 曾峰毅, 時間資訊 09:00 臨時手術NPO 09:00 開始NPO 12:43 通知急診手術 14:45 報到 14:45 進入手術室 14:50 麻醉開始 14:55 誘導結束 15:15 抗生素給藥 15:42 手術開始 16:30 麻醉結束 16:30 手術結束 16:35 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室腹腔分流手術 1 1 L 摘要__ 手術科部: 內科部 套用罐頭: Ventriculoperitoneal shunt revision via left ... 開立醫師: 曾峰毅 開立時間: 2011/02/23 16:35 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunt revision via left Kocher point Specimen Count And Types Nil Pathology Nil Operative Findings Opening pressure while left Kocher ventriculostomy was about 5 cmH20. Colorless, clear CSF drained out. Opening pressure while left Kocher ventriculostomy was about 5 cmH20. Colorless, clear CSF drained out. Medtronic, programmable, 1.0, shunt was used. Operative Procedures With enootracheal general anaesthesia, the patient was put in supine position wih head rotated to right. We made skin incision at left frontal and left occipital area. We inserted left Kocher ventricular catheter via previous Kocher burr hole, and disconnected previuos left Frazier shunt at occipital area. We connected left Kocher ventricular catheter to new reservoir, and then connected to previuos peritoneal catheter at left occipital area. We ligated previous Frazier shunt, and then closed the wound in layers. Operators VS 王國川 Assistants R4 曾峰毅 Indication Of Emergent Operation 莊朝宗 (M,1938/09/22,73y5m) 手術日期 2011/02/24 手術主治醫師 蕭輔仁 手術區域 東址 005房 02號 診斷 Fracture of olecranon process of ulna, closed 器械術式 Burr hole (trephination) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3 紀錄醫師 曾峰毅, 時間資訊 00:00 臨時手術NPO 09:33 進入手術室 09:35 麻醉開始 09:45 誘導結束 10:40 手術開始 11:09 手術結束 11:09 麻醉結束 11:18 送出病患 11:20 進入恢復室 12:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Chronic Subdural Hematoma 開立醫師: 曾峰毅 開立時間: 2011/02/24 11:13 Pre-operative Diagnosis Bilateral chronic subdural hematoma Post-operative Diagnosis Bilateral chronic subdural hematoma Operative Method Bilatearl burr hole for subdural effusion. Specimen Count And Types Nil Pathology Nil Operative Findings Clear, xanthocrhomic subdural effusion gushed out while durotomy at right. Minimal subdural effusion at left. Subdural drain was placed at right. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position. After scalp shaved, scrubbed, disinfected, and then draped, we made one transverse skin incision at frontal area of each side. We drilled one burr hole at each side, and created durotomy. We inserted subdural drain into right subdural space, and closed the wound in layers. We de-air the subdural space. Operators VS 蕭輔仁 Assistants R4 曾峰毅 Ri 王逸萍 葉高鳳娥 (F,1954/12/08,57y3m) 手術日期 2011/02/24 手術主治醫師 楊士弘 手術區域 東址 005房 01號 診斷 Scalp mass 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3 紀錄醫師 曾峰毅, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:10 麻醉開始 08:15 誘導結束 08:40 手術開始 09:10 手術結束 09:10 麻醉結束 09:20 送出病患 09:25 進入恢復室 10:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 頭顱成形術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 曾峰毅 開立時間: 2011/02/24 09:21 Pre-operative Diagnosis Right forehead skull tumor Post-operative Diagnosis Right forehead skull tumor Operative Method Skull tumor removal with cranioplasty Specimen Count And Types Several fragments of the tumor was sent for pathology. Pathology Nil Operative Findings One firm, osteogenic, well-defined, tumor, about 1 cm in diameter, was noted arising from right forehead. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine positino. We made one transverse skin incision at right forehead. We used osteotome and air-drill to remove the tumor and to smooth the forehead contour. The wound was closed in layers. Operators VS 楊士弘 Assistants R4 曾峰毅 Ri 王逸萍 李進財 (M,1954/01/01,58y2m) 手術日期 2011/02/24 手術主治醫師 李柏居 手術區域 東址 006房 02號 診斷 Fever 器械術式 closure of wound 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 林珍榮 ASA 3 紀錄醫師 洪浩雲, 時間資訊 13:40 進入手術室 13:45 麻醉開始 13:50 誘導結束 14:00 手術開始 14:30 手術結束 14:30 麻醉結束 15:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腹壁膿瘍引流術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 洪浩雲 開立時間: 2011/02/24 14:24 Pre-operative Diagnosis Abdominal wall abscess S/P I&D; Post-operative Diagnosis Ditto Operative Method Abdominal wound debridement Specimen Count And Types nil Pathology Nil Operative Findings 1. Abdominal wound about 8cm, with abscess formation Operative Procedures 1. General anesthesia with endotracheal intubation, supine position. 2. Prepare the skin as usuakl setting. 3. Debride the abdominal wound, N/S irrigation. 4. Set a CWV into the abscess cavity. 5. Wound close in layers, use retention suture for skin layer. Operators 李柏居 Assistants 范玉君 黃惠瑜 (F,1975/08/27,36y6m) 手術日期 2011/02/24 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Arteriovenous malformation, brain 器械術式 Craniotomy (A.V.M.) P-LIN 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 07:46 報到 08:04 進入手術室 08:20 麻醉開始 08:50 誘導結束 09:00 抗生素給藥 09:08 手術開始 12:40 抗生素給藥 15:53 麻醉結束 15:53 手術結束 16:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 開顱術摘除血管病變 - 動靜脈畸型中型表淺 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 7 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: AVM 開立醫師: 李振豪 開立時間: 2011/02/24 16:54 Pre-operative Diagnosis Right temporal arteriovenous malformation Post-operative Diagnosis Right temporal arteriovenous malformation Operative Method Right frontotemporal craniotomy for AVM excision Specimen Count And Types 1 piece About size:2 x 2 x 2cm Source:AVM nidus Pathology Pending Operative Findings The feeding artery from temporal branch of MCA was embolized. The nidus was supplied by three major feeding arteries(one from temporal branch and two from frontal branches of MCA) and many small feeding arteries. One small feeding artery from dura also noted during dura opening. One AVM-related venous aneurysm was noted within the nidus and removed with nidus. The AVM was 3.5cm in size. The two major drainage veins were shrinkage gradually during the opeartion. The color of the drainage vein also turned from red to dark red. Total removal of the nidus of AVM was done during the operation. Operative Procedures Under endotracheal general anesthesia, the patient was put in left decubitus position with head fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. The reverse U scalp incision was made at right frontotemporal area and the scalp flap was elevated. Five burr holes were created followed by one 10x8cm craniotomy window. Dura tenting was done. Under operating microscope, The C-shape dura opening was created based with skull base. The drainage vein of the AVM was identified after opening the dura. The dissection was started along the drainage vein and the nidus was noted. Dissection was performed along the border of the nidus. The feeding arteries were coagulated and divided from the nidus during dissection. After divided most of the feeding arteries and the nidus had been dissected free, the drainage vein was divided after Hemoclip use. Hemostasis was achieved with bipolar electrocautery and Surgicel lining. Duroplasty was done with fascia graft. The exposed air cell was sealed with bone wax and fascia. The skull plate was fixed back with miniplates and screws. The temporalis muscle was fixed back and one CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS王國川 Assistants R4李振豪, Ri 相關圖片 林金枝 (F,1939/09/15,72y5m) 手術日期 2011/02/24 手術主治醫師 王國川 手術區域 東址 005房 03號 診斷 Intracerebral hemorrhage 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3 紀錄醫師 曾峰毅, 時間資訊 00:00 臨時手術NPO 10:53 報到 11:45 進入手術室 11:47 麻醉開始 11:55 誘導結束 11:56 抗生素給藥 12:35 手術開始 15:00 手術結束 15:00 麻醉結束 15:16 送出病患 15:20 進入恢復室 16:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 手術 頭顱成形術 1 2 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 曾峰毅 開立時間: 2011/02/24 15:04 Pre-operative Diagnosis Skull defect with hydrocephalus Post-operative Diagnosis Skull defect with hydrocephalus Operative Method Cranioplsty at right, ventriculoperitoneal shunt via right Kocher point, Codman, programmable Specimen Count And Types Nil Pathology Nil Operative Findings Codman, programmable VPS was inserted via right Kocher, and initial pressure was set at 100 mmH20. Opening pressure of ventriculostomy was about 5 cmH20. Bone graft was fixed back with mini-plates. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to left. After scalp shaved, scrubbed, disinfected, and then draped, we made the skin incision along previous operation wound. We performed ventriculostomy via right Kocher point, and fixed back bone graft with minipaltes. We made one transverse skin incision at right upper abdomen, and inserted peritoneal trochar. We created subcutaneous tunnel, and connected shunt altogether. We placed one subgaleal CWV, and closed the wound in layers. Operators VS 王國川 Assistants R4 曾峰毅 Ri 王逸萍 房玲玲 (F,1956/05/26,55y9m) 手術日期 2011/02/25 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:05 進入手術室 08:10 麻醉開始 09:00 誘導結束 09:05 抗生素給藥 09:15 手術開始 12:30 抗生素給藥 13:10 開始輸血 15:30 抗生素給藥 18:30 抗生素給藥 19:30 麻醉結束 19:30 手術結束 19:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 15 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Combined right presigmoid and subtemporal app... 開立醫師: 王奐之 開立時間: 2011/02/25 20:14 Pre-operative Diagnosis Large right petroclival meningioma Post-operative Diagnosis Large right petroclival meningioma Operative Method Combined right presigmoid and subtemporal approach for Simpson grade 4 tumor removal Specimen Count And Types 1 piece About size:pieces Source:right petroclival tumor Pathology Pending Operative Findings Large greyish elastic tumor noted at right petroclival area, with extension to middle fossa and foramen magnum. Due to large tumor and brain swelling, difficult exposure was encountered, the craniotomy was enlarged at subtemporal area and the superior semicircular canal was drilled open to allow wider exposure. Partial right temporal lobectomy was done during and after tumor removal due to severe swelling. Significant bleeding was encountered during the surgery, the bleeding site was packed with gelfoam and Tissucol Duo. Right PCA & SCA were noted intra-operatively and preserved. The tumor at high level, near cavernous sinus and below pons was left untouched. Operative Procedures After ETGA, the patient was placed in supine position with face turned to left, head fixed in Mayfield skull clamp. After scalp shaving, scrubbing, disinfection and draping in sterile fashion, a curved skin incision at post-auricular with extension to subtemporal area was made along previous operation scar. After dissecting the subgaleal soft tissue, the bone was exposed. Previously-fixed miniplates and screws were removed, followed by removal of bone flap, exposing the dural surface. Temporal durotomy was carefully made to avoid injury to the vein of Labbe, presigmoid durotomy was then done. The two durotomies were connected after ligation of superior petrosal vein. The tentorium was cut through to the edge to allow connection of subtemporal and presigmoid space. The craniotomy was enlarged with saw and drill. Tumor removal was then performed with CUSA and tumor forceps in piecemeal fashion. After hemostasis, the dura was closed with DuraForm and approximated with 4-0 Prolene. The bone flaps were fixed back with miniplates and screws, the operation ended with wound closure in layers after placement of a subgaleal CWV drain. Operators P. 杜永光 Assistants R6 陳睿生, R3 王奐之 相關圖片 陳謝玉 (F,1924/11/13,87y4m) 手術日期 2011/02/25 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Pituitary tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 張廷碩, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:00 進入手術室 08:15 麻醉開始 08:50 誘導結束 09:00 抗生素給藥 09:35 手術開始 10:23 麻醉結束 10:23 手術結束 10:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經由蝶竇之腦下垂體瘤切除 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: TSH 開立醫師: 胡朝凱 開立時間: 2011/02/25 10:31 Pre-operative Diagnosis Pituitary macroadenoma Post-operative Diagnosis Pituitary macroadenoma Operative Method TSH Specimen Count And Types pieces of tumor Pathology pending Operative Findings 1. The sella floor was erroded 2.Tumor was yellowish and soft. 3.After tumor removal, arachnoid membrane was noted. 4.CSF leak was also noted. But it was sealed with tissucal-duo. Operative Procedures After ETGA, the patient was put in supine position with head mild left tilt. The nasal cavity was well-disinfective, and then we incised into the nasal septum. Dissection was performed along with the periosteum to expose sphenoid sinus anterior wall and sphenoid ostia. After fracture of vomer, sphenoid sinus anterior wall was also fractured. The mucosa was removed. The sella floor was exposed and removed with kerrison. Tumor buldged out. And it was further removed with tumor forceps and ring currette. After total excision of tumor was made, the bony graft was put back and followed by compaction of merosel. Operators VS 曾漢民 Assistants 胡朝凱, 張廷碩 莊惠喻 (F,1990/10/07,21y5m) 手術日期 2011/02/25 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 1 紀錄醫師 張廷碩, 時間資訊 00:00 臨時手術NPO 10:25 報到 10:50 進入手術室 11:00 麻醉開始 11:00 抗生素給藥 11:25 誘導結束 11:35 手術開始 14:00 抗生素給藥 17:20 抗生素給藥 17:25 麻醉結束 17:25 手術結束 17:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: Left frontal-orbital-orbital craniotomy for n... 開立醫師: 胡朝凱 開立時間: 2011/02/25 17:52 Pre-operative Diagnosis Left trigeminal neuroma Post-operative Diagnosis Left trigeminal neuroma Operative Method Left frontal-orbital-orbital craniotomy for nearly total tumor excision Specimen Count And Types pieces of tumor Pathology pending Operative Findings 1.One hard, yellowish tumor located at left temporal area and posterior fossa. The tumor border was clear. But it attached to brain stem tightly, we left a small piece in situ. 2.The tumor expanded meckel cave widely. But no obvious trigeminal nerve was noted. Operative Procedures 1.ETGA, supine with head rotated to right and fixed with skull clamp 2.Left curvillinear skin incision was done 3.Reflect skin flap downward 4.Left frontal-temporal-orbital craniotomy 5.Retract temporal dura downward 6.Open dura 7.Dissect tumor border and remove it piece by piece with CUSA 8.One small piece of tumor was left in situ at brain stem area 9.Hemostasis 10.Close dura with one piece of fascia 11.fixed bone back with miniplate 12.Close wound in layers Operators VS. 曾漢民 Assistants 胡朝凱, 張廷碩 邱貳定 (M,1936/01/30,76y1m) 手術日期 2011/02/25 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Cervical Spondylosis 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 08:07 進入手術室 08:15 麻醉開始 08:30 誘導結束 08:45 抗生素給藥 09:10 手術開始 11:45 抗生素給藥 12:55 手術結束 12:55 麻醉結束 13:05 送出病患 13:10 進入恢復室 14:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 脊椎融合術-前融合,有固定物)≦四節 1 2 手術 椎間盤切除術-頸椎 1 1 摘要__ 手術科部: 外科部 套用罐頭: Anterior Discectomy and Fusion, Cervical Spine 開立醫師: 李振豪 開立時間: 2011/02/25 13:33 Pre-operative Diagnosis Cervical stenosis with osification of posterior longitudinal ligment, status post C3-5 laminoplasty Post-operative Diagnosis Cervical stenosis with osification of posterior longitudinal ligment, status post C3-5 laminoplasty Operative Method C4-5, C5-6 anterior discectomy, foraminotomy, and anterior fusion with cage and plate Specimen Count And Types nil Pathology Nil Operative Findings 1. The marginal spur at C4-5, C5-6 level covered the disc space. The C4-5, C5-6 disc was degenerative and bulging posteriorly. The PLL also calcified and thick which cause compression of the thecal sac. The thecal sac expanded well after removal of the PLL. No CSF leakage was noted during the operation. Mild tear of the muscle fiber of the esophagus was noted but the innre layer was intact. 2. Cage: #7 PEEK cage x II Plate: 37mm x I Screws: 4.0 x 16mm x VI Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with neck extension. The skin was scrubbed, disinfected and draped as usual. Transverse skin incision was made at right neck along the skin crest. The subcutaneous soft tissue was dissected and the platysma muscle was transected. The plane between thyroid gland and the SCM muscle was dissected. The SCM muscle and carotid sheath were pushed laterally in order to exposed the C-spine. After retraction of the thyroid cartilage and esophagus, the prevertebral fascia was identified. The prevertebral fascia was opened vertically, the lesion intervertebral space was exposed and identified by intraoperative portable X-ray. The most medial portion of the longus coli muscles on both sides were detached from the vertebral bodies to providea wider exposure of the vertebral bodies. The marginal spur was removed with disc clamp and Rongeur. The diskectomy was performed with curette, alligator, Kerrison punches, and Midas air-drived drills. Removal of PLL and foraminotomy also performedat C4-5, C5-6 level. Two #7 PEEK cage and one plate was applied for anterior fusion and fixation. The location of the cage and plate was checked with intra-operative X-ray. Hemostasis was achieved. One Mini-Hemovac was placed. The wound was then closed in layers with 3-0 Vicryl and 4-0 Dexon. Operators VS賴達明 Assistants R4李振豪, R2曾偉倫 相關圖片 黃琰宸 (M,1952/05/02,59y10m) 手術日期 2011/02/25 手術主治醫師 陳敞牧 手術區域 東址 001房 06號 診斷 Subdural hemorrhage or effusion 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林子富 ASA 3E 紀錄醫師 曾峰毅, 時間資訊 08:52 臨時手術NPO 08:52 開始NPO 18:52 通知急診手術 20:15 進入手術室 20:20 麻醉開始 20:30 誘導結束 21:00 抗生素給藥 21:08 手術開始 22:00 手術結束 22:00 麻醉結束 22:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 B 手術 慢性硬腦膜下血腫清除術 1 2 B 手術 深部傷口處理縫合擴創-小 1 0 B 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Chronic Subdural Hematoma 開立醫師: 曾峰毅 開立時間: 2011/02/25 21:53 Pre-operative Diagnosis Hydrocephalus, status post VPS, complicated with bilateral subdural effusion, suspected over drainage Post-operative Diagnosis Hydrocephalus, status post VPS, complicated with bilateral subdural effusion, suspected over drainage Operative Method Bilateral burr hole for subdural drain, and shunt ligation Specimen Count And Types CSF was sent for routine, culture, BCS, and cytology. Pathology Nil Operative Findings Light-reddish subdural effusion was noted at bilateral subdural space. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position. After skin shaved, scrubbed, disinfected, and then draped, we made one transverse skin incision at right calvicular area, and ligated the shunt. The wound was closed in layers. We made one skin incision along previous operation wound at left frontal area. We inserted subdural drain via previous burr hole. We made one skin incision at right temporal area, and drilled one burr hole. Subdural drain was inserted. The wound was closed in layers. Subdural space at bilateral side were de-air. Operators VS 陳敞牧 Assistants R6 陳睿生 R4 曾峰毅 Indication Of Emergent Operation 李淑貞 (F,1964/07/03,47y8m) 手術日期 2011/02/25 手術主治醫師 王國川 手術區域 東址 019房 02號 診斷 Pituitary tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 污染 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 14:05 進入手術室 14:10 麻醉開始 14:15 誘導結束 15:03 手術開始 16:50 手術結束 16:50 麻醉結束 17:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經外側篩竇切除修補腦髓液鼻 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 外科部 套用罐頭: Repair of CSF leakage 開立醫師: 李振豪 開立時間: 2011/02/25 17:28 Pre-operative Diagnosis Pituitary tumor, status post trans-sphenoidal adenomectomy, with CSF leakage Post-operative Diagnosis Pituitary tumor, status post trans-sphenoidal adenomectomy, with CSF leakage Operative Method Repair of CSF leakage Specimen Count And Types nil Pathology Nil Operative Findings The skull base defect with active CSF leakage was at the bottom of the the sellar floor. The defect was repaired with Gelform, Duraform, Tissucol Duo, autologous fat packing, Gelform, and tissue glu. No more CSF leakage was noted after the operation. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position. The skin was scrubbed, disinfected, and draped as usual. Under endoscope, the previous packing material was removed till. The upper part of the sellar floor was repaired well. However, one dura defect with active CSF leakage was noted at the bottom of the sellar floor. One 2.5cm transverse skin incision was made at left abdomen. About 2x2x2cm autologous fat was harvested for CSF repair. The defect was repaird with Gelform, Duraform, Tissucol Duo, about 5ml autologous fat, Gelform, and tissue glu packing. No further CSF leakage was noted after whole procedure. The nasal packing was performed with one finger part of glove and Merocel. Operators VS王國川, VS楊士弘, VS葉德輝 Assistants R4李振豪 江楊鳳珠 (F,1950/01/22,62y1m) 手術日期 2011/02/26 手術主治醫師 蔡翊新 手術區域 東址 019房 03號 診斷 Cerebral aneurysm, nonruptured 器械術式 Craniotomy(Aneurysms) P-DUH 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林子富 ASA 3E 紀錄醫師 陳蔚蔚, 時間資訊 12:54 臨時手術NPO 12:54 開始NPO 18:54 通知急診手術 00:00 麻醉開始 00:35 誘導結束 00:40 抗生素給藥 01:00 手術開始 03:40 抗生素給藥 04:20 手術結束 04:20 麻醉結束 04:30 送出病患 23:53 進入手術室 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 開顱術摘除血管病變 - 腦血管瘤 有病徵的 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Pterional approach for aneurysm clipping 開立醫師: 陳睿生 開立時間: 2011/02/26 04:47 Pre-operative Diagnosis Right P-com aneurysm rupture with SAH Post-operative Diagnosis Right P-com aneurysm rupture with SAH Operative Method Pterional approach for aneurysm clipping Specimen Count And Types nil Pathology Nil Operative Findings The aneurysm originated from right P-com. It protruded posteriolaterally, and the neck was about 4mm. Intra-op diffuse SAH was noted and the brain was mild swelling. A tilt Sugital clip was applied parallel to the ICA. Operative Procedures 1. ETGA, supine position and head left turn and fixed with Mayfield clump 2. Right frontal curvillinear scalp incision 3. Split temporalis muscle and then three bur holes made 4. An about 6x8 cm craniotomy window was created 5. After proper dura tenting and sphenoid ridge flattern, the dura was opened curvillinearly 6. The frontal lobe was retracted upward, and the optic nerve was identified 7. The ICA was noted and P-com with aneurysm was noted after temporal retraction 8. Dissect between the aneurysm and arachnoid membrane, and then a tilt Sugita clip was applied 9. Hemostasis, and the dura was closed tightly 10.The skull flap was covered and fixed with miniplate 11.Set an epidural CWV drain, and close the wound in layers Operators VS 蔡翊新 Assistants R6 陳睿生, R1 陳蔚蔚 Indication Of Emergent Operation 謝增吉 (M,1942/12/10,69y3m) 手術日期 2011/02/26 手術主治醫師 賴達明 手術區域 東址 001房 01號 診斷 Spinal cord disease 器械術式 Diskectomy cervical(Anterier) 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林子富 ASA 3E 紀錄醫師 張廷碩, 時間資訊 23:48 臨時手術NPO 23:48 開始NPO 07:48 通知急診手術 09:00 報到 09:30 進入手術室 09:35 麻醉開始 10:00 誘導結束 10:15 抗生素給藥 10:30 手術開始 13:15 抗生素給藥 14:18 手術結束 14:18 麻醉結束 14:25 送出病患 14:30 進入恢復室 16:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 椎間盤切除術-頸椎 1 1 手術 脊椎融合術-前融合,有固定物)≦四節 1 2 摘要__ 手術科部: 外科部 套用罐頭: Anterior Discectomy and Fusion, Cervical Spine 開立醫師: 曾峰毅 開立時間: 2011/02/26 14:17 Pre-operative Diagnosis C4/5, C5/6, C6/7, HIVD Post-operative Diagnosis C4/5, C5/6, C6/7, HIVD Operative Method Anterior Discectomy and Fusion with PEEK cage and artificial bone graft at C4/5, C5/6, and C6/7; anterior fixation with plate and screws at C4-7 Specimen Count And Types Nil Pathology Nil Operative Findings Syntheses cage, plate, screws were used for anterior fixation and interbody fusion. Thecal sac was decompressed well after discectomy. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with neck extended. After scrubbed, disinfected, and then draped the skin, we made one transverse skin incision at right anterior neck. We dissected along the medial side of SCM, and omohyoid muscle to expose the prevertebral space. Anterior diskectomy was performed at C6/7, followed by fusion with PEEK cage and artificial bone graft. The same procedure was done at C5/6, and then C4/5. Plate with screws was used for fixation at C4-7. After one mini-hemovac set, we closed the wound in layers. Operators VS 賴達明 Assistants R4 曾峰毅 R1 張廷碩 Indication Of Emergent Operation 朱建華 (M,1975/10/20,36y4m) 手術日期 2011/02/26 手術主治醫師 楊士弘 手術區域 東址 003房 01號 診斷 Herniation of intervertebral disc 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林子富 ASA 1 紀錄醫師 鍾文桂, 時間資訊 23:14 臨時手術NPO 08:01 進入手術室 08:10 麻醉開始 08:20 誘導結束 09:00 抗生素給藥 09:20 手術開始 11:40 手術結束 11:40 麻醉結束 11:45 送出病患 11:50 進入恢復室 13:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-腰椎 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: Microsurgical diskectomy 開立醫師: 楊士弘 開立時間: 2011/02/26 11:30 Pre-operative Diagnosis L5-S1 HIVD,left, ruptured Post-operative Diagnosis L5-S1 HIVD,left, ruptured Operative Method Microsurgical diskectomy Specimen Count And Types 1 piece About size:小 Source:ruptured disc Pathology pending Operative Findings The PLL over L5-S1 disc level was noted to be bulging. A subligamental ruptured disc was found after cruciate incision on the PLL, and a 4 cm x 0.5 cm x 0.5 cm disc fragment was removed. The S1 root reexpanded and was free from tension after disc removal. Operative Procedures 1. ETGA, prone. 2. C-arm localization of L5-S1. 3. Low back midline incision from L5 to S1. 4. Partial laminectomy of left lower L5 lamina. 5. Removal of yellow ligament. 6. Medial retraction of thecal sac. 7. Incision on PLL for disc removal under microscopy. 8. Placement of an autologous fat graft over the thecal sac and S1 root. 9. Rinderon irrigation over epidural space. 10. Wound closure in layers. Operators 楊士弘 Assistants 鍾文桂 鄭國基 (M,1959/07/08,52y8m) 手術日期 2011/02/26 手術主治醫師 蔡翊新 手術區域 東址 018房 01號 診斷 Other and unqualified skull fracture, closed with other and unspecified intracranial hemorrhage, with loss of consciousness of unspecified duration 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林子富 ASA 3E 紀錄醫師 曾峰毅, 時間資訊 23:44 通知急診手術 00:56 進入手術室 00:58 麻醉開始 01:15 誘導結束 01:35 抗生素給藥 02:03 手術開始 05:25 手術結束 05:35 麻醉結束 05:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 1 R 手術 顱內壓視置入 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 曾峰毅 開立時間: 2011/02/26 05:34 Pre-operative Diagnosis Bilateral frontal contusional ICH Post-operative Diagnosis Bilateral frontal contusional ICH Operative Method Head Injury Specimen Count And Types Nil Pathology Nil Operative Findings Initial opening ICP was above 30 mmHg. Right frontal contusion with ICH was noted. ICP after wound closure was about 2 mmHg. ICP monitor reference is 490. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine positin with head rotated to left. After scalp shaved, scrubbed, disinfected, and then draped, we made one question-marked skin incision at right frontotemporal area. We drilled one burr hole at temporal area, and inserted subdural ICP. We checked the ICP, and drilled another four burr holes to make a craniectomy. Dura was tented along the craniectomy window. We performed durotomy, and right frontal ICH removal. After hemostasis, we performed duroplasty with durofoam. We inserted subdural ICP monitor, and two epidural CWV. The wound was closed in layers. Operators VS 蔡翊新 Assistants R4 曾峰毅 Ri 賴品泉 Indication Of Emergent Operation 房玲玲 (F,1956/05/26,55y9m) 手術日期 2011/03/01 手術主治醫師 杜永光 手術區域 東址 002房 04號 診斷 Brain tumor 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 陳睿生, 時間資訊 12:53 通知急診手術 13:30 進入手術室 13:35 麻醉開始 13:40 誘導結束 14:00 抗生素給藥 14:22 手術開始 15:05 手術結束 15:05 麻醉結束 15:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱內壓視置入 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Left Kocher^s point EVD 開立醫師: 陳睿生 開立時間: 2011/03/01 15:43 Pre-operative Diagnosis Right petroclival meningioma s/p with acute hydrocephalus Post-operative Diagnosis Right petroclival meningioma s/p with acute hydrocephalus Operative Method Left Kocher^s point EVD Specimen Count And Types 4 pieces About size:CSF Source:3ml About size:CSF Source:3ml About size:CSF Source:3ml About size:CSF Source:3ml Pathology Nil Operative Findings The CSF was xanthochromic in pattern. The initial ICP was above 20cmH2O. The Metronic EVD was about 6.3cm in depth. Operative Procedures After ETGA, the patient was under prone position. A curvillinear scalp incision was made over left frontal region. A burr hole was made over left Kocher^s point. The dura was well tented, and then opened. The lateral ventricle was punched and the then an EVD was inserted for drain. The EVD was fixed and the wound was closed in layers. Operators P 杜永光 Assistants R6 陳睿生 Indication Of Emergent Operation 郭志偉 (M,1980/02/26,32y0m) 手術日期 2011/03/01 手術主治醫師 曾漢民 手術區域 西址 039房 01號 診斷 Scalp tumor 器械術式 Scalp tumor 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 08:45 報到 09:20 進入手術室 09:35 09:35 麻醉開始 09:38 手術開始 09:58 手術結束 10:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 頭皮腫瘤 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Tumor excision 開立醫師: 李振豪 開立時間: 2011/03/01 10:08 Pre-operative Diagnosis Left parietal scalp tumor Post-operative Diagnosis Left parietal scalp tumor Operative Method Tumor excision Specimen Count And Types 1 piece About size:0.6x0.6x0.5cm Source:scalp tumor Pathology Pending Operative Findings The scalp tumor was 0.6x0.6x0.5cm in size, exophytic(skin tag-like), and soft in character. Hyperpigmentation(-), hyperkeratosis(-), hairy(-), subcutaneous involvement(-). The scalp tumor was 1.0x0.8x0.4cm in size, exophytic(skin tag-like), and soft in character. Hyperpigmentation(-), hyperkeratosis(-), hairy(-), subcutaneous involvement(-). Operative Procedures The scalp was shaved, scrubbed, and disinfected as usual. Local anesthesia with Xylocain and epinephrine was given. The fusiform scalp incision was made around the tumor. The tumor was excised totally. Hemostasis was achieved. Undermining was performed and the wound was closed in layers with 3-0 Nylon. Operators VS曾漢民 Assistants R4李振豪 相關圖片 黃重成 (M,1942/05/30,69y9m) 手術日期 2011/03/01 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Colon cancer of hepatic flexure colon 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾峰毅, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:15 麻醉開始 08:20 誘導結束 08:35 抗生素給藥 09:00 手術開始 10:05 手術結束 10:05 麻醉結束 10:13 送出病患 10:16 進入恢復室 13:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt, right Kocher point 開立醫師: 曾峰毅 開立時間: 2011/03/01 10:22 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunt, right Kocher point Specimen Count And Types CSF was sent for routine, BCS, cytology, and culture. Pathology Nil Operative Findings Slightly turbid, colorless CSF gushed out. Opening pressure was 5-10 cmH20. Medtronic, medium pressure, fixed pressure valve, was used. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to left. After scalp shave, scrubbed, disinfected, and then draped, we made one transverse skin incision at right upper abdomen, and created mini-laparotomy. We created subcutaneous tunnel to right occipital area. We made on curvilinear skin incision at right frontal area, and drilled one burr hole. After durotomy and dura tenting, ventriculostomy was performed once, and then ventricular catheter was inserted. We connected shunt altogether, and checked the function. The wound was closed in layers. Operators VS 曾勝弘 Assistants R4 曾峰毅 相關圖片 羅玉梅 (F,1955/04/25,56y10m) 手術日期 2011/03/01 手術主治醫師 曾勝弘 手術區域 東址 005房 02號 診斷 Brain tumors, malignant 器械術式 Stereotaxic procedure for biop 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾峰毅, 時間資訊 00:00 臨時手術NPO 10:25 進入手術室 10:35 麻醉開始 10:40 誘導結束 10:40 抗生素給藥 12:03 手術開始 13:20 手術結束 13:20 麻醉結束 13:28 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 腦組織活體切片 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 曾峰毅 開立時間: 2011/03/01 13:26 Pre-operative Diagnosis Brain tumor Post-operative Diagnosis Brain tumor Operative Method Left parietal burr hole for brain biopsy under Navigation. Specimen Count And Types Several fragments of the tumor was sent for pathology. Pathology Frozen: lymphoma, Final pathology is pending Operative Findings Whitish, soft, fragile brain tissue was got. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to right, and fixed with Mayfield head clamp. After scalp shaved, scrubbed, disinfected, and then draped, we localized the tumor under navigation. We made one longitudinal skin incision at left parietal area, and created one burr hole. Brain biopsy was performed. The wound was closed in layers. Operators VS 曾勝弘 Assistants R4 曾峰毅 陳宜宿 (M,1952/02/16,60y0m) 手術日期 2011/03/01 手術主治醫師 曾勝弘 手術區域 東址 005房 03號 診斷 Trigeminal neuralgia (Cranial nerve V) 器械術式 Radiofrequency coagulation 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 曾峰毅, 時間資訊 00:00 臨時手術NPO 13:50 進入手術室 13:54 抗生素給藥 13:55 麻醉開始 14:00 誘導結束 14:00 手術開始 14:10 手術結束 14:10 麻醉結束 14:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 高頻熱凝療法 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 曾峰毅 開立時間: 2011/03/01 14:20 Pre-operative Diagnosis Facial pain over left maxillary area, suspected trigeminal neuralgia Post-operative Diagnosis Facial pain over left maxillary area, suspected trigeminal neuralgia Operative Method Radiofrequency rhizotomy for left V2 partial rhizotomy Radiofrequency for left V2 nerve stimulation Specimen Count And Types Nil Pathology Nil Operative Findings RF needle induced the same pain as the patient complained. RF needle induced the same pain as the patient complained. Needle entry point was about 1.5 cm away from the nostril wing, and direction is about 60 degress upward, and 20 degrees laterally. Operative Procedures With local anaesthesia, the patient was put in supine position. After skin disinfected, and then draped, we inserted radiofrequency needle into left infraorbital foramen. RF was performed for partial rhizotomy. Operators VS 曾勝弘 Assistants R4 曾峰毅 張自發 (M,1967/10/16,44y4m) 手術日期 2011/03/01 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Spine tumor 器械術式 Intraspinal intramedullary tum 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 蔡立威, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:15 麻醉開始 08:40 誘導結束 09:20 抗生素給藥 09:45 手術開始 12:20 抗生素給藥 13:45 手術結束 13:45 麻醉結束 13:50 送出病患 13:55 進入恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 手術 脊椎內脊髓內腫瘤切除術 1 1 摘要__ 手術科部: 外科部 套用罐頭: T1-3 laminectomy for intramedullary tumor removal 開立醫師: 蔡亮如 開立時間: 2011/03/01 14:19 Pre-operative Diagnosis T2 intradural intramedullary tumor, suspected cavernoma T2 intradural intramedullary tumor, probably cavernoma Post-operative Diagnosis T2 intradural intramedullary tumor, suspected cavernoma T2 intradural intramedullary tumor, cavernoma is very likely Operative Method T1-3 laminectomy for intramedullary tumor removal Specimen Count And Types 1 piece About size:pieces Source:intramedullary tumor Pathology Pending Operative Findings 1. Engorged epidural vein was found 1. Engorged epidural vein 2. The intramedullary tumor contained degenerated vascular structure and was surrounded by hematoma. A hemosiderin plane surrounds the tumor. 2. The intramedullary tumor has a gross apprearance of mulberry. The cavity contained degenerated venous structure and was surrounded by blood degradation products. The tumor was surrounded by a yellowish indicating a hemosiderin stained tissue. Operative Procedures After ETGA, the patient was placed in prone position. After skin disinfection and draping in sterile fashion, a midline skin incision was made from C7 to T3 level. The incision was deepened until the spinous processes were seen. T1-3 laminectomy was performed. Dura was opened and tackled up. The spinal cord was incised according the the nature plane at the dorsal median sulcus. The tumor with the hematoma was removed gross totally until the hemosiderin plane was visible. The arachnoid membrane was closed with 6-0 prolene. The dura was closed with 5-0 prolene. A CWV drain was placed and the wound was closed in layers. Operators VS 賴達明 Assistants R5 蔡宗良, R3 王奐之, R2蔡立威 R5 蔡宗良, R3 王奐之, R2 蔡立威 相關圖片 陳宗偉 (M,1967/09/24,44y5m) 手術日期 2011/03/01 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 HIVD 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 蔡立威, 時間資訊 00:00 臨時手術NPO 13:20 報到 14:14 進入手術室 14:20 麻醉開始 14:25 誘導結束 14:50 抗生素給藥 15:02 手術開始 17:20 手術結束 17:20 麻醉結束 17:28 送出病患 17:30 進入恢復室 18:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 椎間盤切除術-頸椎 1 1 手術 椎融合術-前融合,無固定物(≦四節) 1 2 摘要__ 手術科部: 外科部 套用罐頭: Anterior Discectomy and Fusion, Cervical Spine 開立醫師: 蔡立威 開立時間: 2011/03/01 17:39 Pre-operative Diagnosis C5-6 HIVD Post-operative Diagnosis C5-6 HIVD Operative Method Anterior Discectomy and artificial disc implantation, C5-6 Anterior Discectomy and artificial disc(Codman, 5mm in height) implantation, C5-6 Specimen Count And Types nil Pathology nil Operative Findings C5-6 bulding disc, s/p resection The position of artificial disc was checked by fluoroscopy Operative Procedures Under endotracheal general anesthesia, supine position, we performed skin disinfection and drapping as usual. A transverse right upper neck skin incision was done. Then C5-6 intervertebral disc was identified and rechecked by fluoroscopy. We resected the C5-6 disc and implanted a artificial disc. The artificial disc position was also checked by fluoscopy. Finally, the wound was closed in layers. Operators VS賴達明 Assistants R5蔡宗良, R2蔡立威 林志成 (M,1954/05/16,57y9m) 手術日期 2011/03/01 手術主治醫師 賴達明 手術區域 東址 003房 03號 診斷 Herniation of intervertebral disc without myelopathy, cervical (HIVD) 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 蔡立威, 時間資訊 00:00 臨時手術NPO 17:45 進入手術室 17:50 麻醉開始 17:55 誘導結束 18:00 抗生素給藥 18:30 手術開始 20:15 手術結束 20:15 麻醉結束 20:25 送出病患 20:30 進入恢復室 21:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 椎間盤切除術-頸椎 1 1 手術 椎融合術-前融合,無固定物(≦四節) 1 2 摘要__ 手術科部: 外科部 套用罐頭: Anterior Discectomy and cervios cage(5mm) imp... 開立醫師: 蔡立威 開立時間: 2011/03/01 20:30 Pre-operative Diagnosis C5-6 HIVD Post-operative Diagnosis C5-6 HIVD Operative Method Anterior Discectomy and cervios cage(5mm) implantation, C5-6 Anterior cervical discectomy with fusion, C5-6 Specimen Count And Types nil Pathology nil Operative Findings C5-6 bulding disc, s/p resection The position of cage was checked by fluoroscopy Operative Procedures Under endotracheal general anesthesia, supine position, we performed skin disinfection and drapping as usual. A transverse right upper neck skin incision was done. Then C5-6 intervertebral disc was identified and rechecked by fluoroscopy. We resected the C5-6 disc and implanted a cage. The cage position was also checked by fluoscopy. Finally, the wound was closed in layers. Under endotracheal general anesthesia, supine position, we performed skin disinfection and drapping as usual. A transverse right upper neck skin incision was done. Then C5-6 intervertebral disc was identified and rechecked by fluoroscopy. We resected the C5-6 disc and implanted a 5-mm height Synthes Cervious cage. The cage position was also checked by fluoroscopy. Finally, the wound was closed in layers. Operators VS賴達明 Assistants R5蔡宗良, R2蔡立威 劉興鈞 (M,1955/10/11,56y5m) 手術日期 2011/03/01 手術主治醫師 陳敞牧 手術區域 東址 027房 05號 診斷 Secondary malignant neoplasm of bone and bone marrow 器械術式 Spinal fusion posterior 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林峰盛 ASA 3E 紀錄醫師 李振豪, 時間資訊 10:54 通知急診手術 16:30 報到 17:10 進入手術室 17:15 麻醉開始 17:45 誘導結束 17:54 抗生素給藥 18:24 手術開始 18:30 開始輸血 20:54 抗生素給藥 21:55 手術結束 21:55 麻醉結束 22:00 送出病患 22:10 進入恢復室 23:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 惡性脊髓腫瘤切除術 1 1 手術 脊椎融合術-後融合,有固定物(<=六節) 1 2 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 李振豪 開立時間: 2011/03/01 22:28 Pre-operative Diagnosis Pathological compression fracture and intraspinal tumor with spinal cord compression, suspect lung cancer metastasis Post-operative Diagnosis Pathological compression fracture and intraspinal tumor with spinal cord compression, suspect lung cancer metastasis Operative Method Lumbar Laminectomy (and/or Posterior Fusion) T5 to T8 laminectomy for intraspinal tumor excision + Left T5, T6, T8, T9 and right T5, T9 transpedicular screws for posterior fixation T5 to T8 laminectomy for intraspinal tumor excision + Left T5, T6, T8, T9 and right T5, T9 transpedicular screws for posterior fixation + right T6, T7 rhizotomy Specimen Count And Types 1 piece About size:20g Source:Intraspinal tumor Pathology Pending Operative Findings 1. The tumor was mainly located at posterio-lateral part of the intraspinal space with right paravertebral muscle extension. The bony structure of right T6, T7 and partial T8 were destructed by the tumor. The tumor was whith-grayish in character, firm, moderate vascularized, and fragile. The margin between dura and the tumor was clear but ill-defined between the tumor and the paraspinal soft tissue. The thecal sac was decompressed well after partial tumor excision. No incidental durotomy or CSF leakage noted during whole procedure. 1. The tumor was mainly located at posterio-lateral part of the intraspinal space with right paravertebral muscle extension. The bony structure of right T6, T7 and partial T8 were destructed by the tumor. The tumor was whith-grayish in character, firm, moderate vascularized, and fragile. The margin between dura and the tumor was clear but ill-defined between the tumor and the paraspinal soft tissue. The thecal sac was decompressed well after partial tumor excision. Right T6 and T7 roots were encased by the tumor. Right T6, T7 rhizotomy was done during the operation. No incidental durotomy or CSF leakage noted during whole procedure. 2. Posterior instrumentation T5: 5.0 x 35mm transpedicular screws x II T6: 5.5 x 35mm transpedicular screws x I, left T7: 5.5 x 35mm transpedicular screws x I, left T8: 5.5 x 35mm transpedicular screws x II Rods: 15cm x II Cross link x I Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position. The level of T5 to T9 was identified by portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made from T5 to T9 level. The subcutaneous soft tissue and paravertebral muscle group were dissected and detached. The bilateral laminae was exposed. Left T5, T6, T8, T9, and right T5, T9 transpedicular screws was applied under portable C-arm X-ray guided. T5 to T8 laminectomy was performed and the intraspinal tumor excision was done for decompression. Hemostasis was achieved. The rods and cross link was applied for set up the posterior fixation. The wound was irrigated with Gentamicin solution. One Hemovac was placed. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Under endotracheal general anesthesia, the patient was put in prone position. The level of T5 to T9 was identified by portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made from T5 to T9 level. The subcutaneous soft tissue and paravertebral muscle group were dissected and detached. The bilateral laminae was exposed. Left T5, T6, T8, T9, and right T5, T9 transpedicular screws was applied under portable C-arm X-ray guided. T5 to T8 laminectomy was performed and the intraspinal tumor excision was done for decompression. Right T6 and T7 rhizotomy was performed with Hemoclip. Hemostasis was achieved. The rods and cross link was applied for set up the posterior fixation. The wound was irrigated with Gentamicin solution. One Hemovac was placed. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS陳敞牧 Assistants R4李振豪, R1何奕容 Indication Of Emergent Operation 楊湯玉松 (F,1943/09/14,68y6m) 手術日期 2011/03/01 手術主治醫師 楊士弘 手術區域 西址 039房 02號 診斷 Carpal tunnel syndrome 器械術式 Decompression of mediun nerve 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 09:20 報到 10:15 進入手術室 10:45 麻醉開始 10:50 手術開始 11:25 手術結束 11:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 正中神經或尺神經腕部減壓術–單側 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Carpal Tunnel Syndrome 開立醫師: 李振豪 開立時間: 2011/03/01 11:35 Pre-operative Diagnosis Carpal tunnel syndrome, right Post-operative Diagnosis Carpal tunnel syndrome, right Operative Method Decompression of right median nerve Specimen Count And Types nil Pathology Nil Operative Findings The transverse carpal ligment was hypertrophic and calcified which compressed the right median nerve tightly. Degeneration of the nerve was noted during the operation. The right median nerve was decompressed well after transection of the transverse carpal ligment. Operative Procedures The right hand and forearm were sterilized with povidone-iodine tincture, then covered with stockinet. Local anesthesia was applied with 10ml 1% Xylocaine + epinephrine at right wrist area. A 1.5cm in length linear skin incision was made at right wrist near the skin crest. The aponeurosis of palmaris longus was identified, then the plamar aponeurosis was cut longitidinally. The transverse carpal ligment was identified and transected with knife and scissor under direct vision. After divided of the transverse carpal ligment, the median nerve was decompressed well. Hemostasis was achieved. The wound was then closed in layers with 3-0 Vicryl and 4-0 Nylon. The hand and wrist were draped with fluffy dressing and elastic bandage. Operators VS楊士弘 Assistants R4李振豪 相關圖片 孫月梅 (F,1954/04/20,57y10m) 手術日期 2011/03/01 手術主治醫師 王國川 手術區域 東址 005房 04號 診斷 Intracerebral hemorrhage 器械術式 Crainotomy Brain Tumor(P-LIN) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾峰毅, 時間資訊 00:00 臨時手術NPO 14:30 報到 14:45 進入手術室 14:55 麻醉開始 15:15 抗生素給藥 15:15 誘導結束 15:20 手術開始 18:05 麻醉結束 18:05 手術結束 18:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除-手術時間在4小時以內 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT 開立醫師: 曾峰毅 開立時間: 2011/03/01 18:21 Pre-operative Diagnosis Left cerebellar tumor, metastasis Post-operative Diagnosis Left cerebellar tumor, metastasis Operative Method Cerebellar tumor excision Specimen Count And Types Several fragments of the tumor was sent for pathology. Pathology Pending Operative Findings One capsulated, hypervascular, greyish, soft to fragile, mucinous tumor, was noted at left cerebellar hemisphere. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position with head fixed with Mayfield head clamp. We made skin incision along previous operation wound and created durotomy along previous durotomy. Left cerebellar hemispheric corticotomy was made for tumor excision. Hemostasis was peformed with surgicel packing and paving. We closed the dura in water-tight fahsion and closed the wound in layers after one epidural CWV set. Operators VS 王國川 Assistants R4 曾峰毅 楊俐娟 (F,1970/02/20,42y0m) 手術日期 2011/03/02 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:05 進入手術室 08:10 麻醉開始 08:45 誘導結束 09:04 手術開始 09:20 抗生素給藥 12:20 抗生素給藥 15:20 抗生素給藥 16:20 麻醉結束 16:20 手術結束 16:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4~8小時 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 8 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Left subfrontal approach for Simpson grade 2 ... 開立醫師: 王奐之 開立時間: 2011/03/02 17:03 Pre-operative Diagnosis Planum sphenoidale meningioma Post-operative Diagnosis Planum sphenoidale meningioma Operative Method Left subfrontal approach for Simpson grade 2 tumor removal Specimen Count And Types 1 piece About size:pieces Source:left frontal tumor Pathology Pending Operative Findings Large frontal base tumor was noted with attachment to the planum sphenoidale. Bilateral ACA adhered to the tumor, the A-com artery was expanded in length; a small artery arising from right ACA went into the tumor. The left side olfactory nerve was sacrificed to allow better retraction, the right side olfactory nerve and bilateral optic nerves were preserved. Operative Procedures After ETGA, the patient was placed in supine position with head fixed in Mayfield skull clamp. After shaving, skin disinfection and draping in sterile fashion, a curvilinear bifrontal scalp incision was made. The scalp was then reflected down to supraorbital area, followed by burr hole drilling and left frontal craniotomy creation. A fishmouth durotomy was then done, followed upward retraction of the left frontal lobe. After electrocauterization of the ethmoidal artery and identifying bilateral optic nerves and olfactory nerves, the left side olfactory nerve was sacrificed. The tumor was then removed in central debulking fashion with CUSA. The remaining tumor capsule was carefully dissected from ACA, a small branch supplying the tumor from ACA was electrocauterized. The tumor capsule was removed, and frontal base dura was electrocauterized. After meticulous hemostasis, dural closure was done in water-tight fashion. The bone flap was fixed back with miniplates, the wound was closed in layers after setting 1 subgaleal CWV drain. Operators P. 杜永光 Assistants R6 陳睿生, R3 王奐之 相關圖片 鍾懿芬 (F,1972/01/24,40y1m) 手術日期 2011/03/02 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Acromegaly 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 14:58 進入手術室 15:00 麻醉開始 15:20 誘導結束 15:30 抗生素給藥 15:55 手術開始 17:15 手術結束 17:15 麻醉結束 17:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 經由蝶竇之腦下垂體瘤切除 1 1 摘要__ 手術科部: 外科部 套用罐頭: Microscopic transsphnoid adenomectomy 開立醫師: 曾偉倫 開立時間: 2011/03/02 17:38 Pre-operative Diagnosis Pituitary macroadenoma Post-operative Diagnosis Pituitary macroadenoma Operative Method Microscopic transsphnoid adenomectomy Specimen Count And Types 1 piece About size:0.5x0.5x0.5 Source:Ptuitary tumor Pathology Pending Operative Findings The tumor was yellowish, soft, size 1x1x1 cm in diameter. The normal gland was found after tumor excision. CSF leakage was sealed with Tissuecol Duo nad gelform packing. Operative Procedures Under general anethesia and intubation, the patient was put in supine position with head tilted 30 degree to left. The facial skin was antiseptic with alcohol better-iodine tincture, and the mucosa of oral and nasal cavity with aqueous better-iodine. The formerareas were covered by sterilized adhesive plastic sheets then draped. Under endoscope, the nasal mucosa was coagulated at right norstril. A nasal speculum was applied to displace the nasal mucosa laterally and keep thenasal cavity open constantly for the exposure of the vomer bone and the anterior wall of the sphenoid sinus. The anterior sphenoid wall and posterior sphenoid wall was remove by high speed air drill and Kerrison punch. The sellar floor dura was coagulated then opened in cruciate fashion. The soft tumor parenchyma was removed by curette and aligator. The CSF leakage was sealed with Tissuecol Duo nad gelform packing. The arachnoid and the opening of diaphragm sellae was enforcedby packing with gelform as in the sellar cavity. The nasal mucosa returned to its normal position. Right side of the nasal cavities was tightly packed with a segment of rubber glove finger filled with vaseline gauze strips which had been soaked with better-iodine ointment. Operators VS 曾漢民 Assistants R5 鍾文桂 R2 曾偉倫 蔣李阿月 (F,1938/06/20,73y8m) 手術日期 2011/03/02 手術主治醫師 蔡瑞章 手術區域 東址 005房 01號 診斷 Meningioma 器械術式 Crainotomy Brain Tumor(P-LIN) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 07:43 報到 08:06 進入手術室 08:15 麻醉開始 08:40 誘導結束 08:57 抗生素給藥 08:58 手術開始 10:57 開始輸血 11:57 抗生素給藥 14:25 麻醉結束 14:25 手術結束 14:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: Right pterional approach for Simpson grade II... 開立醫師: 鍾文桂 開立時間: 2011/03/02 15:04 Pre-operative Diagnosis Right frontal brain tumor, suspect meningioma Post-operative Diagnosis Inner one-third sphenoid ridge meningioma, right. Operative Method Right pterional approach for Simpson grade II tumor excision Specimen Count And Types 1 piece About size:4x3x3 cm Source:Right frontal brain tumor Pathology Panding. Operative Findings The tumor was elastic, firm, and gray-reddish, hypervascularized. We used CUSA to aid tumor excision. Encasement of internal carotid artery and right optic nerve by the tumor. Both structures were pushed inward and downward by the tumor mass. A large A-V shunting at temporal side was noted. It was electrocoagulated. The memebrane of Liliequist was opened and the posterior fossa was exposed. The bilateral optic nerve, right olfactory nerve, and oculomoter nerve were identified and kept intact. Severe adhesion of the dura mater to the skull bone. It was repaired by Surgidesign artifical dura mater. Operative Procedures Under ETGA, the patient was placed in supine position and head was fixed by 3 pin Mayfield and rotated to the left in 30 degrees. After shaving, disinfection, and draping, the pterional approach was done with curvilinear scalp incision and 6-cm craniotomy. The middle meningeal artery was electrocoagulated. Then, the dura mater was opened. The tumor was exposed while retracting the frontal lobe. The tumor-attached dura mater was electrocoagulated. The tumor was excised in piecemeal fashion. After well hemostasis, the dura mater was repaired by using artificial dura. The craniotomy plate was fixed by mini plates and screws. The wound was closed in layers after placing one subgaleal CWV drain. Operators P 蔡瑞章 VS 王國川 Assistants R5 鍾文桂 R2 曾偉倫 陳瑞芯 (M,2010/08/09,1y7m) 手術日期 2011/03/02 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Retinopathy of prematurity 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 3 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 08:15 報到 08:20 進入手術室 08:25 麻醉開始 08:45 誘導結束 08:50 抗生素給藥 09:30 手術開始 10:20 麻醉結束 10:20 手術結束 10:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室腹腔分流手術 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Revision of left Kocher point V-P shunt with ... 開立醫師: 林哲光 開立時間: 2011/03/02 10:52 Pre-operative Diagnosis Hydrocephalus Hydrocephalus, S/P VP shunt inser5tion with slit ventricle formation Post-operative Diagnosis Ditto Operative Method Revision of left Kocher point V-P shunt with Codman programmable valve Revision of left Kocher point V-P shunt with adding Codman programmable valve Specimen Count And Types Pathology nil Operative Findings Slit ventricle was noted before the operation and CSF aspiration amount was few from the reservior, The CSF seemed clear and tranasparent initially but mild reddish content was noted. Programmable valve was set 80. The CSF was sent for culture. Slit ventricle was noted before the operation and CSF aspiration amount was few from the reservior, The CSF seemed clear and tranasparent initially but mild reddish content was noted. The pressure setting of the programmable valve was set at 80 mmH2O. The CSF was sent for culture. Operative Procedures Under ETGA and supine position with head rotated to right side, skin disinfected and drapped were performed as usual. Skin incision was done along the previous operative wound. The previous valve and abdominal catheter was exposed and disconnected. The programmable valve was then connected to the previous valve and abdominal catheter after subcutanous pocket was created at right posterior auricle area. The wound was then closed in layers. Under ETGA and supine position with head rotated to right side, skin disinfected and drapped were performed as usual. Skin incision was done along the previous operative wound over the left Kocher point. The previous valve and abdominal catheter was exposed and disconnected. The programmable valve was then connected to the previous valve and abdominal catheter after subcutanous pocket was created at right posterior auricle area. The wound was then closed in layers. Operators 郭夢菲 Assistants R4 林哲光, Ri 范晅睿 相關圖片 陳昆山 (M,1948/02/16,64y0m) 手術日期 2011/03/02 手術主治醫師 賴達明 手術區域 東址 005房 03號 診斷 Subarachnoid hemorrhage 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 18:00 進入手術室 18:05 麻醉開始 18:10 誘導結束 18:45 手術開始 19:20 手術結束 19:20 麻醉結束 19:25 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 深部傷口處理縫合擴創-中 1 0 L 摘要__ 手術科部: 外科部 套用罐頭: Debridment and wound closeure 開立醫師: 曾偉倫 開立時間: 2011/03/02 19:42 Pre-operative Diagnosis Left ACA aneurysm ruptured with SAH and ICH status post Left craniectomy and aneurysmal clipping and left temporal ICH evacuation Post-operative Diagnosis Left craniectomy wound infection with dehesience Operative Method Debridment and wound closeure Specimen Count And Types 1 piece About size:3 Source:Wound cultures Pathology Nil. Operative Findings 1. Several wound dehesience with pus formation over the left craniectomy wound 2. Wound culture will be sent Operative Procedures 1. Under GA, patient put on supine position with head tilt to right 2. Perform debridment over the wound 3. Irrigate the wound with gentamycin solution 4. Wound closure with 3-0 Nylon Operators VS 賴達明 Assistants R5 鍾文桂 R2 曾偉倫 陳美女 (F,1942/06/30,69y8m) 手術日期 2011/03/02 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Cervical spondylosis 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾峰毅, 時間資訊 00:00 臨時手術NPO 15:43 報到 17:00 進入手術室 17:05 麻醉開始 17:15 誘導結束 17:15 抗生素給藥 17:51 手術開始 20:30 抗生素給藥 20:55 手術結束 20:55 麻醉結束 21:05 送出病患 21:10 進入恢復室 22:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 手術 椎間盤切除術-頸椎 1 1 手術 脊椎融合術-前融合,有固定物)≦四節 1 2 摘要__ 手術科部: 外科部 套用罐頭: Anterior cervical discectomy and fusion with ... 開立醫師: 曾峰毅 開立時間: 2011/03/02 20:54 Pre-operative Diagnosis Cervical stenosis, C4-5 & C5-6 Post-operative Diagnosis Cervical stenosis, C4-5 & C5-6 Operative Method Anterior cervical discectomy and fusion with PEEK cage and artificial bone garft, C4-5 & C5-6 Specimen Count And Types nil Pathology Nil Operative Findings Thecal sac was compromised by herniated disc and prominent osteophytes. Neural structures were decompressed well after the surgery. Two Syntheses PEEK cervical cage, 6 mm in height, were used. Operative Procedures After ETGA, the patient was placed in supine position with neck hyperextended. A right neck linear skin incision was made, deepened through plastysma muscle and dissected through the medial border of SCM muscle, until the prevertebral space was reached. After C-arm localization of C4-5 & C5-6 space, discectomy was done. PEEK cages with artificial bone graft were inserted for fusion. After hemostasis and gentamycin-saline irrigation, we inserted one mini-hemovac into pervertebral space. The wound was closed in layers. Operators VS 賴達明 Assistants R4 曾峰毅, R3 王奐之 相關圖片 周俊荇 (M,1942/09/08,69y6m) 手術日期 2011/03/02 手術主治醫師 楊士弘 手術區域 東址 002房 02號 診斷 Malignant neoplasm of liver, primary 器械術式 Anterior Corpectomy, C4 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 07:16 通知急診手術 09:58 進入手術室 10:00 麻醉開始 10:25 誘導結束 10:30 抗生素給藥 11:00 手術開始 13:30 抗生素給藥 15:55 手術結束 15:55 麻醉結束 16:05 送出病患 16:08 進入恢復室 18:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 惡性脊髓腫瘤切除術 1 1 手術 脊椎融合術-前融合,有固定物)≦四節 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Anterior Corpectomy C4 開立醫師: 陳睿生 開立時間: 2011/03/03 12:33 Pre-operative Diagnosis Metastatic epidural spinal cord compression, C4 Post-operative Diagnosis Metastatic epidural spinal cord compression, C4 Operative Method Anterior Corpectomy C4 Anterior Corpectomy of C4 for vertebral tumor excision Anteior cervical fusion, C3-5 Anteior cervical fixation and fusion, C3-5 Specimen Count And Types 1 piece About size:Small Source:Spine Pathology Report pending Operative Findings C4 vertebral body together with C3-4 and C4-5 disc were necrotic and filled with viable metastatic tissue mass, which is whitish in color and tense in character. The thecal sac below C4 was impinged by the collapsed C4 vertebra. C4 vertebral body together with C3-4 and C4-5 disc were necrotic and filled with viable metastatic tissue mass, which is whitish in color and tense in character. The PLL was infiitrated by the tumor and became rather thick. The thecal sac was tightly compressed by the collapsed C4 vertebra and reexpanded well after decompression. Operative Procedures Under general endotracheal intubation anesthesia, the patient was positioned in supine with neck hyperextended by a air cuff placed beneath the shoulder. Skin was prepped and drapped as usual. An wound incision of 4 cm was made and extended from anterior margin of sternocleidomastoid (SCM) muscle to thyroid cartilage. The plastysma muscle was transected and mobilized from the underlying superficial cervical fascia which was then opened in vertical direction along the anterior margin of the SCM muscle. The dissection was advanced at the loose plane between SCM muscle and strip muscles until the prevertebral fascia had been reached. The former structure was retracted to the lateral and the later structures with esophagus and trachea to the opposite side by Cloward cervical retractor. The prevertebral fascia was opened vertically, the lesion intervertebral space was exposed and identified by intraoperative portable X-ray. The most medial portion of the longus coli muscles on both sides were detached from the vertebral bodies to providea wider exposure of the vertebral bodies. The anterior longitudinal ligment was incised transversely at the margins of intervertebral space, the annulus fibrosus was cut too. The degenerated disc and cartilage plate were removed by curette and the anterior-inferior rim of C3-4 and C4-5 disc was resected by Kerrison punch for easier approach to the posterior rim of the intervertebral space. The surfaces of vertebral bodies at this intervertebral space. The C4 vertebral body was removed by rougeurs and Kerrison's punch. An expandable mesh was placed at the C4 body space with it's position fluoroscopically confirmed. Wound was closed in layers after placing a Mini-HemoVac. The C4 vertebral body was removed by rougeurs and Kerrisons punch. An expandable mesh was placed at the C4 body space with its position fluoroscopically confirmed. Wound was closed in layers after placing a Mini-HemoVac. Operators VS 賴達明 VS 楊士弘 Assistants R5 蔡宗良 Indication Of Emergent Operation acute myelopathy due to spinal tumor metastasis 相關圖片 謝育偉 (M,1969/01/05,43y2m) 手術日期 2011/03/02 手術主治醫師 楊士弘 手術區域 東址 002房 03號 診斷 Malignant neoplasm of trachea 器械術式 Laminectomy for decompression, T1-T4; posterior fusion, C4-T8 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 鍾文桂, 時間資訊 00:00 抗生素給藥 00:00 臨時手術NPO 00:00 開始NPO 07:18 通知急診手術 16:00 報到 16:10 進入手術室 16:20 麻醉開始 16:45 誘導結束 17:15 抗生素給藥 17:48 手術開始 19:05 開始輸血 20:15 抗生素給藥 03:20 麻醉結束 03:20 手術結束 03:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 14 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 惡性脊髓腫瘤切除術 1 1 手術 脊椎融合術-後融合,有固定物(<=六節) 1 2 摘要__ 手術科部: 外科部 套用罐頭: Tumor excision for spinal cord decompression;... 開立醫師: 楊士弘 開立時間: 2011/03/03 04:06 Pre-operative Diagnosis Spinal metastasis, T1-4, with spinal cord compression Post-operative Diagnosis Spinal metastasis, T1-4, with spinal cord compression Operative Method Tumor excision for spinal cord decompression; posterior instrumented fixation from C3 to T8 Specimen Count And Types 1 piece About size:小 Source:spinal tumor, T1-3 Pathology pending Operative Findings Easy bleeding of paraspinal soft tissue and vertebral bone were noted. The T1-3 spinous processes and lamina were destructed by tumor, which extended to the facets, pedicles, vertebral bodies, and epidural space. The spinal cord was tightly compressed by the tumor and became free from tension after debulking of tumor posteriorly and laterally from the thecal sac. Lateral mass screws were inserted into C3-C6, and transpedicle screws into T5-8 (except the left T7 due to fracture of pars. One rod (thin cranial part for lateral mass screws and thick caudal part for pedicle screws) was placed on each side for bridging of screws. Three cross links were fixed across both rods. Blood loss = 4500 c.c. Operative Procedures 1. ETGA, prone, head fixed with skull clamps. 2. Midline incision, C2 to T8. 3. Dissection of paraspinal muscles off from spinous process and lamina. 4. Insertion of lateral mass screws into C3-6 vertebrae. 5. Insertion of pedicle screws into T5-8 pedicles (excpet left T7, which had broken transverse process). 6. Laminectomy of lower C7 and upper T4 for exposure of intact dura. 7. Tumor excision along plane of dura surface by dissector, currets, suction, and bipolar coagulator. 8. Hemostasis. 9. Two HV drain in epilaminal space. 10. Wound closure in layers. Operators 楊士弘 Assistants 蔡宗良 Indication Of Emergent Operation 吳瑋萍 (F,1979/11/08,32y4m) 手術日期 2011/03/02 手術主治醫師 林志峰 手術區域 西址 032房 04號 診斷 Acute lymphoid leukemia, without mention of remission 器械術式 Endoscopic functional sinus su 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 林玫君, 時間資訊 15:10 進入手術室 15:15 麻醉開始 15:20 誘導結束 15:35 手術開始 16:55 手術結束 16:55 麻醉結束 17:30 送出病患 17:35 進入恢復室 18:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 多竇副鼻竇手術 1 1 R 手術 多竇副鼻竇手術 1 1 L 手術 鼓膜切開術 1 1 L 手術 鼓膜切開術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 耳鼻喉部 套用罐頭: 1.Functional endoscopic sinus surgery, bil 2.... 開立醫師: 林玫君 開立時間: 2011/03/02 17:11 Pre-operative Diagnosis 1.Acute paranasal sinusitis, bilateral 2.Bilateral otitis media with effusion Post-operative Diagnosis Ditto, operated Operative Method 1.Functional endoscopic sinus surgery, bil 2. Myringotomy, bilateral Specimen Count And Types 2 pieces About size:0.2X0.2CM Source:RIGHT NOSE About size:0.2X0.2CM Source:LEFT NOSE Pathology pending Operative Findings Right infun.: mucopus A.Eth.: mucopus P.Eth: not checked Maxi.: mucopus Fron.: not checked Sph.: not checked Right Left infun.: mucopus A.Eth.: mucopus P.Eth: not checked Maxi.: mucopus Maxi.: mucopus/mucocele Fron.: not checked Sph.: not checked septal deviation to ________ septal perforation(+) septal deviation (-) bony variation of uncinate process(-) enlarged ethmoid bulla (-) prominent agger nasi cell(-) Operative Procedures (1) Infundibulotomy :R(V)L(V) (2) Opening/trimming of ethmoid bulla :R(V)L(V) anterior ethmoid :R(V)L(V) agger nasi :R( )L( ) frontal recess :R( )L( ) middle turbinate :R(V)L(V) (3) Opening/trimming of ground lamella :R( )L( ) posterior ethmoid :R( )L( ) sphenoid sinus :R( )L( ) (4) Widening of maxillary ostium :R(V)L(V) aspiration :R(V)L(V) irrigation :R(V)L(V) (5) Packing with Merocel :R( 1 )L( 1 ) Vaseline gauze :R( )L( ) Betta-iodine gauze :R( 1 )L( 1 ) Fingerstall :R( 2 )L( 2 ) Then the patients head was turned to the left side. Radial incision was made over the anterio-inferior quadrant of the right eardrumand serous ear effusion was sucked out. The head was then turned to the right side. The procedure was done similar to the right. Middle ear fluid was serous, which was aspirated. The patient tolerated the whole procedure well. Then the patients head was turned to the left side. Radial incision was made over the anterio-inferior quadrant of the right eardrum and serous ear effusion was sucked out. The head was then turned to the right side. The procedure was done similar to the right. Middle ear fluid was serous, which was aspirated. The patient tolerated the whole procedure well. Operators VS林志峰, Assistants R3 林彥翰, R2林玫君, 王天河 (M,1953/01/13,59y2m) 手術日期 2011/03/02 手術主治醫師 王國川 手術區域 東址 002房 01號 診斷 Intraspinal abscess 器械術式 C6 corpectomy for drainage of retropharyngeal and epidural abscess 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 林峰盛 ASA 3E 紀錄醫師 李振豪, 時間資訊 18:00 開始NPO 18:00 臨時手術NPO 04:07 通知急診手術 05:20 報到 05:35 麻醉開始 05:35 進入手術室 06:05 誘導結束 06:15 開始輸血 06:36 手術開始 08:50 抗生素給藥 09:00 抗生素給藥 09:30 麻醉結束 09:30 手術結束 09:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 良性脊髓腫瘤切除術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: C6 corpectomy + removal of epidural abscess 開立醫師: 李振豪 開立時間: 2011/03/02 10:27 Pre-operative Diagnosis 1. Epidural abscess, C4 to C7 2. Retropharyngeal abscess, C2 to C7 Post-operative Diagnosis 1. Epidural abscess, C4 to C7, with C6 osteomyelitis and C6-7 diskitis 2. Retropharyngeal abscess, C2 to C7 Operative Method C6 corpectomy + removal of epidural abscess Specimen Count And Types 1 piece About size:multiple small piece Source:C6 body and epidural infectious granulation tissue Pathology Pending Operative Findings The C6 vertebra was unstable. Bony destruction of C6 vertebral body and suspect C6-7 diskitis was noted. After C6 corpectomy, the infectious granulation tissue and some frank pus filled the epidural space shown. The granulation tissue was adhered with the dura in some part. One small incidental durotomy was noted during dissection but the arachnoid membrane was intact. No CSF leakage was found after whole procedure. The thecal sac expanded well after decompression. There was some granulation tissue within retropharyngeal space but no frank pus was noted at the level of C5-6. No instrumentation was performed due to S. aureus infection(blood culture). Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position. The location of C6-7 level was identified by portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. The transverse skin incision was made at right lower neck. The platysma muscle and the subcutaneous soft tissue was dissected. The pre-vertebral space was entered through the plane between thyroid gland and carotid sheath. After exposure of the vertebral body, the C6-7 disc space was identified by portable C-arm X-ray. C6 corpectomy was performed with Midas air-drived drills, Rongeur, and Kerrison punches. The epidural infectious granulation tissue and the abscess was removed. Hemostasis was achieved. The wound was irrigated with Vancomycin solution. The wound was then closed in layers with 3-0 Vicryl and 4-0 Nylon. Operators VS王國川 Assistants R5蔡宗良, R4李振豪 Indication Of Emergent Operation 郭景 (M,1927/04/03,84y11m) 手術日期 2011/03/02 手術主治醫師 王國川 手術區域 東址 015房 02號 診斷 Brain, metastasis 器械術式 Right DBJ replacement 手術類別 預定手術 手術部位 腹 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 黃慧薰 ASA 3 紀錄醫師 黃冠棠, 時間資訊 09:04 進入手術室 09:08 麻醉開始 09:12 誘導結束 09:18 抗生素給藥 09:24 手術開始 09:40 手術結束 09:40 麻醉結束 09:45 送出病患 09:50 進入恢復室 10:51 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 經膀胱鏡逆行尿管導管 1 0 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 記錄__ 手術科部: 泌尿部 套用罐頭: DBJ stent removal 開立醫師: 黃冠棠 開立時間: 2011/03/02 10:00 Pre-operative Diagnosis Right ureteral cancer status post DBJ insertion Post-operative Diagnosis Right ureteral cancer status post DBJ removal Operative Method cystoscopy and removal of DBJ Specimen Count And Types nil Pathology nil Operative Findings 1. Moderate tabeculation of bladder 2. Right DBJ was removed 3. Fail to insert right DBJ due to probable stricture or obstruction of right ureter. Operative Procedures Under satisfactory anesthesia with the patient in lithotomy position, prepping and drapping was performed in the usual sterile fashion. A Fr 21 Olympus cystoscope was introduced into the bladder cavity under direct vision. Careful inspection was done and right DBJ was removed. A guidewire was inserted into right ureter but could not pass through. Stricture or obstruction of right ureter was suspected. Bleeding from right ureter was noticed then. A 18 Fr. 3-way Foley was inserted for bladder irrigation. Patient tolerated the procedure very well and was sent to recovery room in satisfactory condition. Operators 張宏江, Assistants 張宇鳴, 黃冠棠 孫實勇 (M,1968/03/05,44y0m) 手術日期 2011/03/03 手術主治醫師 郭順文 手術區域 東址 005房 03號 診斷 Lung cancer 器械術式 Port-A catheter implatation 手術類別 緊急手術 手術部位 胸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 郝政鴻, 時間資訊 23:00 進入手術室 23:05 抗生素給藥 23:24 麻醉開始 23:25 手術開始 23:25 誘導結束 00:00 手術結束 00:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 port–A導管植入術–治療性導管植入術 1 0 R 記錄__ 手術科部: 外科部 套用罐頭: Port-A puncture 開立醫師: 郝政鴻 開立時間: 2011/03/04 00:06 Pre-operative Diagnosis Lung cancer Post-operative Diagnosis Lung cancer Operative Method Port-A implantation via right subclavican cein by percutaneous puncture Specimen Count And Types nil Pathology nil Operative Findings 1. Port-A catheter was inserted into SVC via right subclavicular vein 2. Post-operative portable X-ray showed Port-A catheter tip in correct venous branch to SVC. Operative Procedures 1. Under endotracheal general anesthesia with the patient in supine position, prepped and draping were performed in the usual sterile method. 2. An incision was made in right side neck and subclavicalarea. 3. Percutaneous puncture of right subclavicular vein, then Port-A catheter was inserted. 4. Adequate hemostasis was obtained. Post-operative portable X-ray showed catheter tip in correct venous branchto SVC. Then the wound was closed in layers. Operators VS郭順文 Assistants R3郝政鴻 Indication Of Emergent Operation 徐裴欣 (F,1980/08/15,31y6m) 手術日期 2011/03/03 手術主治醫師 林至芃 手術區域 西址 032房 01號 診斷 Colon cancer of transverse colon 器械術式 Port-A Implatation /WOR 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 林至芃 ASA 2 紀錄醫師 吳峻宇, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:05 進入手術室 08:10 麻醉開始 08:15 誘導結束 08:35 手術開始 09:00 手術結束 09:00 抗生素給藥 09:00 麻醉結束 09:05 送出病患 09:10 進入恢復室 10:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 皮下肌肉或深部異物取出術 1 1 L 手術 port–A導管植入術–治療性導管植入術 1 0 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 記錄__ 手術科部: 麻醉部 套用罐頭: Port-A removal and implantation, subclavian 開立醫師: 吳峻宇 開立時間: 2011/03/03 09:04 Pre-operative Diagnosis Post-operative Diagnosis Ditto Operative Method Removal and implantation of Port-A, echo-guided Specimen Count And Types Pathology Nil Operative Findings 1.Site: left subclavian vein, with echo-guided procedure 2.Patent flow after implantation 3.Others: Operative Procedures 1.The patient was set on supine position and bilateral subclavian veins were checked by echo. 2.After IVGA and local anesthesia applied, skin incision was made along the previous incision site. 3.Uncovered the Port-A, and then removed it.4.Wash the pouch with normal saline. 5.An IV catheter was inserted via the subclavian wound and negatively aspirated until venous blood attainable. 6.J-wire was inserted smoothly in rostral direction. A subclavian catheterwith dilator wasinserted through the J-wire, and the dilator was then removed. 7.The catheter of Port-A was threaded into the subclavian vein until mark 29 cm. The catheter was adapted into the port and locked with restrictor. The Port was inserted into the pouch of pre-cordial incision. 8.Skin was closed layer by layer. Both catheter and port were perfused with heparin solution after implantation. Operators 林至芃 Assistants 陳艷莉 (F,1956/10/13,55y5m) 手術日期 2011/03/03 手術主治醫師 李苑如 手術區域 東址 007房 07號 診斷 Endometrial cancer 器械術式 Cystoscopy，Removal of double-J 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 靜脈麻醉 麻醉主治醫師 劉治民 ASA 2 紀錄醫師 蔡博超, 時間資訊 14:15 進入手術室 14:20 麻醉開始 14:22 誘導結束 14:34 手術開始 14:45 手術結束 14:45 麻醉結束 14:50 送出病患 14:52 進入恢復室 15:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 雙丁輸尿管導管置入術 1 0 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 記錄__ 手術科部: 泌尿部 套用罐頭: Cystoscopy with right DBJ removal and left DBJ replacement 開立醫師: 蔡博超 開立時間: 2011/03/03 14:58 Pre-operative Diagnosis bilateral hydronephrosis status post DBJ insertion; Endometrial cancer status post radical surgery Post-operative Diagnosis bilateral hydronephrosis status post DBJ insertion; Endometrial cancer status post radical surgery Operative Method cystoscopy with removal of right DBJ and replacement of left DBJ Specimen Count And Types nil Pathology nil Operative Findings Bilateral DBJ mild encrustation. The right side ureteral orifice was erythematous and previous operative suture(Monocryl)retention was noted. Left DBJ was replaced smoothly Operative Procedures Under satisfactory anesthesia with the patient in lithotomy position, prepping and drapping was performed in the usual sterile fashion. A Fr 21 Olympus cystoscope was introduced into the bladder cavity under direct vision. Careful inspection was done and Right side DBJ was removed. Left side DBJ was replaced. Patient tolerated the procedure very well and was sent to recovery room in satisfactory condition. Operators 李苑如, Assistants 蔡博超, 翁文慶, 周萬英 (M,1949/12/20,62y2m) 手術日期 2011/03/03 手術主治醫師 陳敞牧 手術區域 東址 005房 02號 診斷 Brain Tumor 器械術式 Crainotomy Brain Tumor(P-LIN) 手術類別 預定手術 手術部位 頭、頸 傷口分類 污染 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3 紀錄醫師 曾峰毅, 時間資訊 00:00 臨時手術NPO 12:23 報到 13:12 進入手術室 13:20 麻醉開始 13:40 誘導結束 13:48 手術開始 13:48 抗生素給藥 18:50 麻醉結束 18:50 手術結束 19:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 顱底瘤手術 1 1 摘要__ 手術科部: 外科部 套用罐頭: Right subfrontal approach for tumor excision 開立醫師: 曾峰毅 開立時間: 2011/03/03 18:40 Pre-operative Diagnosis Suprasellar cystic tumor, suspected craniopharyngioma Post-operative Diagnosis Suprasellar cystic tumor, suspected craniopharyngioma Operative Method Right subfrontal approach for tumor excision Specimen Count And Types Tumor was sent for pathology. Pathology Pending Operative Findings One cystic tumor, well defined, but adhesion to pituitary stalk, capsulated, was noted at suprasellar region, deviated optic chiasm upward with adhesion to it. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with neck extended and head fixed with Mayfield head clamp. We shaved, scrubbed, disinfected, and then draped the scalp, we made one bicoronal skin incision. We reflected scalp flap inferiorly, and drill four burr holes to created right frontal craniotomy. We made one C-shape durotomy based at midline, and then retracted right frontal lobe away from frontal base. We performed tumor excision en bloc with mediculous dissection from optic nerve and pituitary stalk. After hemostasis, we closed the dura in water-tight fashion. Bone graft was fixed back with mini-plates. We inserted two subgaleal CWV, and closed the wound in layers. Operators VS 陳敞牧 Assistants R4 曾峰毅 李進財 (M,1954/01/01,58y2m) 手術日期 2011/03/03 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 Fever 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 11:50 進入手術室 11:54 麻醉開始 11:56 誘導結束 12:20 抗生素給藥 12:25 手術開始 13:10 手術結束 13:10 麻醉結束 13:18 送出病患 13:20 進入恢復室 15:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室腹腔分流手術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt via left Kocher"s ... 開立醫師: 李振豪 開立時間: 2011/03/03 13:25 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunt via left Kocher"s point Specimen Count And Types 1 piece About size:5ml Source:CSF Pathology Nil Operative Findings The CSF was clear in character. The opening pressure was more than 20cmH2O. The Codman programmable valve reservoir was placed with initial pressure setting as 80mmH2O. The ventricular catheter was 7cm in depth from skull surface and the peritoneal catheter was 30cm in length. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head rotated to right. The scalp was shaved, scrubbed, and disinfected as usual. The transverse scalp incision was made at left Kocher"s point followed by one burr hole creation. Two dural tenting was done. Left upper abdomen transverse skin incision was made and the subcutaneous soft tissue was dissected to exposed the peritoneum. The peritoneal cavity was entered under direct vision. The subcutaneous tunnel from left upper abdomen, left forechest, neck, retroauricular area was created with one 1.5cm scalp incision at left retroauricular area. The peritoneal catheter was placed through the subcutaneous tunnel. The reservoir was passed through the subcutaneous space and connected to the peritoneal catheter. The cruciform dura incision was made and ventriculostomy was performed with ventricular needle. The ventricular catheter was placed into left lateral ventricle. The function of the V-P shunt was checked. Total 15ml CSF was sampled. The peritoneal catheter was placed into peritoneal cavity. Hemostasis was achieved. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS王國川 Assistants R4李振豪, R1彭元宏 相關圖片 李淑貞 (F,1964/07/03,47y8m) 手術日期 2011/03/03 手術主治醫師 王國川 手術區域 東址 003房 04號 診斷 Pituitary tumor 器械術式 T.S.H. 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3 紀錄醫師 林其懋, 時間資訊 08:30 臨時手術NPO 08:30 開始NPO 15:12 報到 15:30 進入手術室 15:38 麻醉開始 15:45 誘導結束 16:10 手術開始 18:45 手術結束 18:45 麻醉結束 18:50 送出病患 18:52 進入恢復室 19:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 經外側篩竇切除修補腦髓液鼻 1 1 手術 粘膜下中隔矯正術 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 摘要__ 手術科部: 耳鼻喉部 套用罐頭: 1. Repair of CSF leakage 2. Submucosal resect... 開立醫師: 林其懋 開立時間: 2011/03/03 18:54 Pre-operative Diagnosis Pituitary tumor, status post trans-sphenoidal adenomectomy, with CSF leakage, status post repair of CSF leakage twice Post-operative Diagnosis Pituitary tumor, status post trans-sphenoidal adenomectomy, with CSF leakage, status post repair of CSF leakage twice Operative Method 1. Repair of CSF leakage 2. Submucosal resection of nasal septum Specimen Count And Types nil Pathology nil Operative Findings Skull base defect from sphenoid sinus wall with CSF leakage Nasal packing with: Right: V.G. x 1 Left : V.G. x 2 Operative Procedures The patient was in the supine position. After disinfection and drap were done, xylocaine-bosmin soaked cotton pledgets were applied for intranasal anesthesia and shrinkage. The nasal septum was infiltrated with the same anesthetics at both sides along the perichondrial plane, then a Killian incision was made first at the left septum. The mucoperichondrium was elevated till the septal cartilage, vomer, and maxillary crest were exposed. The right-sided mucoperichondrium was separated too, with the whole part of cartilage freed. Another incision was done before the bony part of the septum. The anterior nasal septum was resected as bone graft. Fat tissue was resected from right abdomen as graft. Then, under the endoscope asistant, The skull base defect was identified from sphenoid sinus wall. The fat tissue and bone graft were inserted into the defect. Then, Tissucol Duo was used about 5 ml for consolidation. Then one piece of the vaselin gauze was packed in right nasal cavity and two piece of the vaselin gauze for the left side. The patient tolerated the whole procedure well. Operators AsP吳振吉 Assistants R3林其懋 Indication Of Emergent Operation 摘要__ 手術科部: 耳鼻喉部 套用罐頭: 1. Repair of CSF leakage 2. Submucosal resect... 開立醫師: 林其懋 開立時間: 2011/03/03 18:55 Pre-operative Diagnosis Pituitary tumor, status post trans-sphenoidal adenomectomy, with CSF leakage, status post repair of CSF leakage twice Post-operative Diagnosis Pituitary tumor, status post trans-sphenoidal adenomectomy, with CSF leakage, status post repair of CSF leakage twice Operative Method 1. Repair of CSF leakage 2. Submucosal resection of nasal septum 1. Repair of CSF leakage under endoscopy 2. Submucosal resection of nasal septum Specimen Count And Types nil Pathology nil Operative Findings Skull base defect from sphenoid sinus wall with CSF leakage Nasal packing with: Right: V.G. x 1 Left : V.G. x 2 Operative Procedures The patient was in the supine position. After disinfection and drap were done, xylocaine-bosmin soaked cotton pledgets were applied for intranasal anesthesia and shrinkage. The nasal septum was infiltrated with the same anesthetics at both sides along the perichondrial plane, then a Killian incision was made first at the left septum. The mucoperichondrium was elevated till the septal cartilage, vomer, and maxillary crest were exposed. The right-sided mucoperichondrium was separated too, with the whole part of cartilage freed. Another incision was done before the bony part of the septum. The anterior nasal septum was resected as bone graft. Fat tissue was resected from right abdomen as graft. Then, under the endoscope asistant, The skull base defect was identified from sphenoid sinus wall. The fat tissue and bone graft were inserted into the defect. Then, Tissucol Duo was used about 5 ml for consolidation. Then one piece of the vaselin gauze was packed in right nasal cavity and two piece of the vaselin gauze for the left side. The patient tolerated the whole procedure well. Operators AsP吳振吉 Assistants R3林其懋 Indication Of Emergent Operation 劉國章 (M,1952/04/12,59y11m) 手術日期 2011/03/03 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Cervical myelopathy 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 07:32 報到 08:10 進入手術室 08:15 麻醉開始 08:25 誘導結束 08:55 抗生素給藥 09:10 手術開始 11:13 手術結束 11:13 麻醉結束 11:20 送出病患 11:22 進入恢復室 12:22 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-頸椎 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 摘要__ 手術科部: 外科部 套用罐頭: Anterior Discectomy and Fusion, Cervical Spine 開立醫師: 李振豪 開立時間: 2011/03/03 11:46 Pre-operative Diagnosis C4-5 herniation of intervertebral disc with cord compression Post-operative Diagnosis C4-5 herniation of intervertebral disc with cord compression Operative Method C4-5 anterior cervical discectomy, foraminotomy, and fusion with cage Specimen Count And Types nil Pathology Nil Operative Findings The C4-5 disc space was narrow and covered by marginal spur. The disc was degenerative and herniated into spinal canal with caudal migration. The thecal sac was compressed tightly by the herniated disc. The posterior longitudinal ligment was not calcified. Bilateral neural foramen stenosis, especially left side also noted during decompression. After whole procedure, the thecal sac expanded well except upper part(beneath the C4 body). No CSF leakage or dural injury was noted. One #5 PEEK cage was used for C4-5 anterior fusion. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with neck extension. The location of C4-5 disc space was identified by portable C-arm X-ray. The skin was scrubbed, disinfected and draped as usual. The transverse skin incision was made at right mid neck. The subcutaneous soft tissue and platysma muscle was divided. The plane between SCM muscle, carotid sheath, and thyroid gland was dissected to entered the prevertebral space. The prevertebral fascia was opened and the disc was identified. The location of C4-5 disc was checked again by intra-op portable C-arm X-ray. Bilateral medial portion of the longus colli muscle was devided and diskectomy was performed with kerrison, curette, alligator, and Midas air-drived drills. The PLL also removed during the operation. Hemostasis was achieved and the PEEK cage was inserted for anterior fusion. One MiniHemovac was placed and the wound was closed in layers with 3-0 Vicryl and 4-0 Dexon. Operators VS王國川 Assistants R4李振豪, R1彭元宏 相關圖片 吳新興 (M,1937/04/15,74y10m) 手術日期 2011/03/03 手術主治醫師 蔡翊新 手術區域 東址 003房 03號 診斷 Head Injury 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 1 紀錄醫師 彭元宏, 時間資訊 00:00 臨時手術NPO 13:33 進入手術室 13:40 麻醉開始 13:45 誘導結束 13:45 抗生素給藥 14:15 手術開始 15:05 手術結束 15:05 麻醉結束 15:07 送出病患 15:10 進入恢復室 16:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室腹腔分流手術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 蔡翊新 開立時間: 2011/03/03 15:00 Pre-operative Diagnosis Hydrocephalus. Post-operative Diagnosis Hydrocephalus. Operative Method Left Kocher VP Shunt, Codman programmable. Specimen Count And Types nil Pathology Nil. Operative Findings CSF: clear, pressure: 20 cmH2O. Ventricular catheter: 6.5 cm in depth, Peritoneal catheter: 25 cm in depth. Reservoir setting: 12 cmH2O. Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: supine with head rotated to right. 3.Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 5 cm linear, left frontal, corresponded to the location of left frontal horn. Raney clips were applied to the scalp edge for temporary hemostasis. 5.After the scalp flap had been lifted and reflected anteriorly, a burr hole was made at left Kocher point and the dura was tented by 2 stitches. 6.The dura was opened by a nib incision. Left lateral ventricle was tapped by a ventricular needle, then a 6.5 cm segment of the ventricular catheter was introduced into the ventricle. The outer end of the catheter was connected to a Codman Programmable reservoir. 7. A minilaparotomy was made at LUQ of the abdomen, then a trocar was pushed into peritoneal cavity. Subsequently, distal 25 cm segment of the peritoneal catheter was introduced into the peritoneal cavity through the outer tube of the trochar. The proximal end of this catheter was passed through subcutaneous tunnel at forechest, neck, left retroauricular area and connected the reservoir. The shunt system was checked to make sure its function was working. 8. Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 9. Blood loss: minimal. 10.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R4李振豪R1彭元宏 相關圖片 許天賜 (M,1948/07/09,63y8m) 手術日期 2011/03/03 手術主治醫師 蔡翊新 手術區域 東址 005房 01號 診斷 Injury (severeity score >=16) 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3 紀錄醫師 曾峰毅, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:15 麻醉開始 08:20 誘導結束 08:48 抗生素給藥 09:06 手術開始 11:40 11:48 抗生素給藥 12:35 手術結束 12:35 麻醉結束 12:55 送出病患 12:58 進入恢復室 15:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 手術 頭顱成形術 1 1 L 手術 顱骨重塑模組 1 0 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Cranioplasty with Bioplate (Codman); Right Fr... 開立醫師: 曾峰毅 開立時間: 2011/03/03 12:20 Pre-operative Diagnosis Left F-T-P skull defect; Hydrocephalus. Post-operative Diagnosis Left F-T-P skull defect; Hydrocephalus. Operative Method Cranioplasty with Bioplate (Codman); Right Frazier VP shunt (Codman programmable). Cranioplasty with Bioplate (Codman); Right Kocher VP shunt (Codman programmable). Specimen Count And Types CSF was sent for routine, BCS, and cultures Pathology Nil. Operative Findings 1. A 14 x 12 cm bone defect at left frontotemporoparietal area. There was adhesion between dura and scalp. The temporalis muscle was dissected away from the dura before cranioplasty. 2. CSF: clear, opening pressure: 5 cmH2O. The shunt threshold was set at 14 cmH2O. 2. CSF: clear, opening pressure: 5 cmH2O. The shunt threshold was set at 14 cmH2O. Ventricular catheter was 7 cm in depth and peritoneal catheter 20 cm. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with a sterilized adhesive plastic sheet. 4. Incision: along the previous operation scar at left F-T-P area, Raney clips were apllied to the scalp edge for temporary hemostasis. 5. The left F-T-P scalp and temporalis muscle were dissected away from the underlying dura. 6. The bleeders on the dissected surfaces were coagulated with Bovie painstakingly. 7. The edge of the skull defect was exposed. 8. 3-D CT reconstructed Bioplate was placed to the craniectomy window and fixed by 4 miniplates and 8 screws. Five central tentings were applied. 9. Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by interrupted suture with 3/0 nylon. 10.Drain: two subgaleal CWV drains. 11.The patient was repositioned with head rotated to left. 12.Skin preparation as usual. 13.Incision: 5 cm linear at right parietal region. A burr hole was made at right Frazier point. 13.Incision: 5 cm linear at right frontal region. A burr hole was made at right Kocher point. 14.The dura was opened by a nib incision. Rt lateral ventricle was tapped by a ventricular needle, then a 9 cm segment of the ventricular catheter was introduced into the ventricle. The outer end of the catheter was connected to a Codman programmable reservoir. 14.The dura was opened by a nib incision. Rt lateral ventricle was tapped by a ventricular needle, then a 7 cm segment of the ventricular catheter was introduced into the ventricle. The outer end of the catheter was connected to a Codman programmable reservoir. 15.A minilaparotomy was made at RUQ of the abdomen, then a trocar was pushed into peritoneal cavity. Subsequently, distal 20 cm segment of the peritoneal catheter was introduced into the peritoneal cavity through the outer tube of the trochar. The proximal end of this catheter was passed through subcutaneous tunnel at forechest, neck, rt retroauricular area and connected the reservoir. The shunt system was checked to make sure its function was working. 16.The wounds were closed in layers. 17.Blood transfusion: PRBC 2U. Blood loss: about 500 mL 18.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R4曾峰毅 Ri柯嘉怡 相關圖片 簡淑華 (F,1972/08/06,39y7m) 手術日期 2011/03/04 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Brain Tumor 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:10 麻醉開始 08:20 誘導結束 09:00 抗生素給藥 09:20 手術開始 12:00 抗生素給藥 14:25 手術結束 14:25 麻醉結束 14:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4~8小時 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Left frontal craniotomy for tumor removal und... 開立醫師: 王奐之 開立時間: 2011/03/04 15:06 Pre-operative Diagnosis Left frontal tumor, suspected low grade glioma Post-operative Diagnosis Left frontal tumor, suspected low grade glioma Operative Method Left frontal craniotomy for tumor removal under navigation Specimen Count And Types 1 piece About size:pieces Source:left frontal tumor Pathology Pending Operative Findings Whitish elastic tumor was noted at left superior frontal gyrus. The tumor appeared more whitish than surrounding brain tissue and more elastic. Several crossing cortical veins were preserved. The T2 hyperintense area was removed totally. Operative Procedures After ETGA, the patient was placed in supine position with head fixed in Mayfield skull clamp. A bicoronal frontal incision was made, followed by left frontal craniotomy. After an U-shaped durotomy, the tumor was directly visible. After confirming the tumor border with navigational probe, 3 corticomies were done to remove the tumor in pieces. After tumor removal and achieving hemostasis, the dura was closed in water-tight fashion with 4-0 Prolene. The bone was placed back and fixed with miniplates. The wound was then closed in layers after placement of a subgaleal CWV drain. Operators P.杜永光 Assistants R6陳睿生, R3王奐之 相關圖片 楊海慶 (M,1931/03/12,81y0m) 手術日期 2011/03/04 手術主治醫師 杜永光 手術區域 東址 003房 02號 診斷 Pituitary tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 14:55 進入手術室 15:00 麻醉開始 15:20 誘導結束 16:00 抗生素給藥 16:10 手術開始 18:20 手術結束 18:20 麻醉結束 18:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經由蝶竇之腦下垂體瘤切除 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 摘要__ 手術科部: 外科部 套用罐頭: Endoscopic trans-sphenoid adenomectomy 開立醫師: 王奐之 開立時間: 2011/03/04 17:58 Pre-operative Diagnosis Non-functional pituitary macroadenoma Post-operative Diagnosis Non-functional pituitary macroadenoma Operative Method Endoscopic trans-sphenoid adenomectomy Specimen Count And Types 1 piece About size:pieces Source:pituitary tumor Pathology Pending Operative Findings Greyish soft fragile tumor was noted in sellar area. No CSF leakage was encountered after the procedure. Operative Procedures After ETGA, the patient was placed in supine position with head put on a head-rest. After nasal packing with epinephrine gauze, skin disinfection and draping in sterile fashion, the anterior wall of sphenoid sinus was reached under endoscope. After fracturing the posterior nasal septum and vomer along with the anterior wall of sphenoid sinus, the sellar floor was visible. The sellar floor was then opened, followed by cruciate durotomy. The tumor was then removed in pieces with ring currette. After hemostasis, the bone was placed back to reconstruct the anterior wall of sphenoid sinus. The nasal cavities were packed with Marocel and the operation ended. Operators P杜永光, VS楊士弘 Assistants R6陳睿生, R3王奐之 相關圖片 林英惠 (F,1978/10/31,33y4m) 手術日期 2011/03/04 手術主治醫師 曾漢民 手術區域 東址 001房 04號 診斷 Pituitary gland disorder 器械術式 T.S.H. 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林至芃 ASA 2E 紀錄醫師 林其懋, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 08:42 通知急診手術 16:10 報到 16:30 進入手術室 16:35 麻醉開始 16:45 誘導結束 17:00 手術開始 17:00 抗生素給藥 17:40 手術結束 17:40 麻醉結束 17:53 送出病患 17:55 進入恢復室 19:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 經外側篩竇切除修補腦髓液鼻 1 1 摘要__ 手術科部: 耳鼻喉部 套用罐頭: Repair of CSF leakage under endoscopy 開立醫師: 林其懋 開立時間: 2011/03/04 21:09 Pre-operative Diagnosis CSF leakage Post-operative Diagnosis CSF leakage Operative Method Repair of CSF leakage under endoscopy Specimen Count And Types nil Pathology nil Operative Findings Skull base defect at sphenoid sinus roof with CSF leakage Nasal packing: right: VG*2 Operative Procedures The patient was in the supine position. After disinfection and drap were done, xylocaine-bosmin soaked cotton pledgets were applied for intranasal anesthesia and shrinkage. The superior lateral portion of choana was infiltrated by long needle with the anesthetics for sphenopalatin ganglion block. The fat tissue was resected from rihgt abdomen as graft. The skull base defect was identified at sphenoid sin us roof under endoscopy. Then the fat tissue was inserted into the defect. Tissucol duo was then used for consolidation. Then two piece of the vaselin gauze were packed in right nasal cavity. The patient tolerated the whole procedure well. Operators AsP吳振吉 Assistants R3林其懋 Indication Of Emergent Operation 連吳堂 (M,1962/11/01,49y4m) 手術日期 2011/03/04 手術主治醫師 曾漢民 手術區域 東址 023房 01號 診斷 Pituitary tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 曾峰毅, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:05 進入手術室 08:15 麻醉開始 08:25 誘導結束 08:35 抗生素給藥 08:55 手術開始 09:50 麻醉結束 09:50 手術結束 10:02 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經由蝶竇之腦下垂體瘤切除 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: Hypophysectomy---Transphenoid 開立醫師: 曾峰毅 開立時間: 2011/03/04 10:27 Pre-operative Diagnosis Pituitary macroadenoma, non-functional Post-operative Diagnosis Pituitary macroadenoma, non-functional Operative Method Transnasal trans-sphenoidal adenomectomy Specimen Count And Types Tumor was sent for pathology. Pathology Pending Operative Findings One greyish, soft, fragile, hypervascular tumor with pseudocapsule was found in sellae. Pituitary gland was identified and preserved well. CSF leakage was noted during the tumor removal. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with neck extended. We made one incision at the mucosa of right medial nasal well. We knocked off the vomer, and removed the mucosa of sphenoid sinus. Thinned sellar floor was removed, and one incision was made at dura exposed. Tumor excision was performed in piecemeal fashion. Sellae was packed with gelfoam and Tissucol-Duo. Nasal was packed with vaseline packing. Operators VS 曾漢民 Assistants R4 曾峰毅 相關圖片 莊文輝 (M,1954/05/27,57y9m) 手術日期 2011/03/04 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 08:35 報到 08:45 進入手術室 08:50 麻醉開始 09:30 誘導結束 09:32 抗生素給藥 09:38 手術開始 13:04 抗生素給藥 14:45 麻醉結束 14:45 手術結束 15:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4~8小時 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: Left occipital craniotomy for Simpson grade I... 開立醫師: 鍾文桂 開立時間: 2011/03/04 17:50 Pre-operative Diagnosis Tentorial meningioma, left. Post-operative Diagnosis Tentorial meningioma, left. Operative Method Left occipital craniotomy for Simpson grade IV tumor excision. Specimen Count And Types 1 piece About size:5cc Source:meningioma Pathology Pending. Operative Findings Yellowish, soft fragile tumor attaches to the tentorium cerebri, left side. Its lateral part adheres to the brain parenchyma severely. It took us some time to find the arachnoid plane. The ambient cistern, splenium of corpus callosum and internal cerebral vein were met after tumor excision. A small incision was made at the tentorium. However, severe venous bleeding was noted and packed with Gelfoam. We decided not to remove the tumor mass in infratentorial region. Intraoperative ultrasonography was used to localize the occipital horn of lateral ventricle for ventriculostomy and the tumor mass. Intraoperative monitoring: sensory reception of left upper extrimity decreased. Operative Procedures Under ETGA, the patient was placed in prone position and head fixed by Mayfield. After shaving, disinfection, and draping, a reverse U scalp incision was made. A 6 cm craniotomy was created by using high speed drill. After localizing the tumor and ventriculostomy, the durotomy was made based on superior sagital sinus. The left occipital lobe was retracted laterally after CSF drainage. The tumor was excised in piecemeal fahsion after devascularization. After well hemostasis, the dura mater was closed in water-tight fashion. Operators 曾漢民 Assistants 鍾文桂 曾偉倫 相關圖片 黃中平 (M,1957/02/01,55y1m) 手術日期 2011/03/04 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Brain tumor 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 15:20 進入手術室 15:25 麻醉開始 15:35 誘導結束 16:00 抗生素給藥 16:14 手術開始 17:25 手術結束 17:25 麻醉結束 17:47 進入恢復室 18:47 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 手術 顱骨切除術,包括異物移除或壓或經切斷 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Craniectomy with skull lesion resection 開立醫師: 曾偉倫 開立時間: 2011/03/04 18:01 Pre-operative Diagnosis Left skull lesion, suspect fibrodysplasia Post-operative Diagnosis Left skull lesion, suspect fibrodysplasia Operative Method Craniectomy with skull lesion resection Specimen Count And Types 2 pieces About size:3x3x3 cm Source:Skull lesion About size:1x0.5x0.5 cm Source:Skull lesion Pathology Pending Operative Findings 1. The left frontal osteolytic lesion was localized with C-arm 2. Some elastic, whitish, fibrotic tissue below the cortical bone over the lesion 3. Some sand-like content within the bone marrow Operative Procedures Under ETGA, we place the patient over supine position. We localized the the osteolytic lesion with C-arm. After we shaved, scrubbed, disinfected and drapped, we made a curvilinear skin incision. The wound was opened in layers and we resect the bone lesion with curette and Rongour. The wound was closed with 3-0 vicryl after the bleeders checked. Operators VS 曾漢民 Assistants R5 鍾文桂 R2 曾偉倫 相關圖片 李語萱 (F,2009/02/02,3y1m) 手術日期 2011/03/04 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Other anomalies of spine 器械術式 Laminectomy and tumor biopsy 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 3E 紀錄醫師 林哲光, 時間資訊 07:00 開始NPO 07:00 臨時手術NPO 10:38 通知急診手術 13:10 報到 13:35 進入手術室 13:45 麻醉開始 14:00 誘導結束 14:20 抗生素給藥 14:30 手術開始 16:25 手術結束 16:25 麻醉結束 16:40 送出病患 16:40 進入恢復室 18:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎內脊髓內腫瘤切除術 1 1 手術 椎弓整形術 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 記錄__ 手術科部: 外科部 套用罐頭: Partial laminotomy and tumor excision at L5 o... 開立醫師: 林哲光 開立時間: 2011/03/04 16:35 Pre-operative Diagnosis Intradural intramedullary tumor, T11-S2, r/o ependymoma Intradural intramedullary tumor, T11-S2, suspect ependymoma and rule out astrocytoma Post-operative Diagnosis Ditto Intradural intramedullary tumor, T11-S2, suspect ependymoma and rule out germ cell tumor Operative Method Partial laminotomy and tumor excision at L5 or S1 level; Laminoplasty 1. Partial excision of the tumor. 2.laminoplasty of L5 (or S1) level Specimen Count And Types 1 piece About size:Multiple small pices Source:intraspinal tumor 1 piece About size:Multiple small pices Source: intraspinal malignant tumor Pathology Frozen showed myxopapillary without reticular form, rule out ependymoma or germ cell tumor Frozen showed reticular cell pattern, suspect myxopapillary ependymoma or germ cell tumor Operative Findings A tumor capsule was noted and multi-lobulated intradural, greyish tumor compressed the filum terminalis and cauda equina to the lateral sides. The tumor was soft in consistancy and easily touch bleeding and tore into pices were noted. A hypervascular, fragile tumor with capsule was noted at the laminotomy level in the intradural intramedullary location. The filum terminale and some nerves were contained in the tumor, but they could be separated from the tumor with suction. Operative Procedures Under ETGA and prone position, skin disinfected and drapped were performed as usual. Midline skin incision was made at L4-S1 level. The paraspinal muscles were detached and L5 or S1 laminotomy was done. The dura was then opened in midline incision and tumor capsule was also opened. Debulking of the tumor was done and sent for frozen. The dura was then closed in water-tie method after hemostasis with Surgecell and Gelfoam packing. The wound was then closed in layers. Under ETGA and prone position, skin disinfected and drapped were performed as usual. Midline skin incision was made at L4-S1 level. The paraspinal muscles were detached and L5 (or S1) laminotomy was doneby using 1-0 Kerrison punches on both sides of the lamina and then it was reflected upward and fixed with a stay suture temporarily. Under microscopic view, the dura was then opened in midline and tumor capsule was also opened. Debulking of the tumor was done and sent for frozen. The tumor at this level was removed as much as possible with suction for frozensection and paraffin section. The bleeding surface was then packed with cottonoid till the bleeding stopped, then it was covered with Surgicel. The dura was then closed in water-tight fashion after hemostasis. Laminoplasty was performed by suturing back the lamina at the laigementum flavum for 4 stitches and at the supraspinous ligment. The wound was then closed in layers. Operators AP 郭夢菲 Assistants R4 林哲光 Indication Of Emergent Operation 相關圖片 高裕棠 (M,1965/09/13,46y6m) 手術日期 2011/03/04 手術主治醫師 賴達明 手術區域 東址 017房 02號 診斷 Intracerebral hemorrhage (ICH) 器械術式 Debridment-- 5-10cm 手術類別 預定手術 手術部位 頭、頸 傷口分類 髒 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 16:50 報到 17:30 進入手術室 17:30 麻醉開始 17:35 誘導結束 18:16 手術開始 19:59 手術結束 19:59 麻醉結束 20:10 進入恢復室 20:10 送出病患 21:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 顱骨切除術,包括異物移除或壓或經切斷 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 記錄__ 手術科部: 外科部 套用罐頭: Left frontal craniectomy and abscess removal 開立醫師: 林哲光 開立時間: 2011/03/04 20:28 Pre-operative Diagnosis Left scalp wound dehiscence with subgaleal and epidural abscess Post-operative Diagnosis Ditto Operative Method Left frontal craniectomy and abscess removal Left temporal craniectomy and abscess removal Specimen Count And Types 1 piece About size:4x3cm sized skull bone Source: Pathology Operative Findings Subgaleal pocket with pus formation was noted after wound opening. The skull bone palte seemed free and granulation tissue formation filled the gap of the skull bone. Epidural granulation tissue formation was also noted and removed by currettege. The necortic tissue of the temporalis muslce was also removed and debrided until bleeding. Operative Procedures Under ETGA and supine position with head mild rotated to right side, skin disinfected and drapped were performed as usual. Skin incision was made and the muscle was dissected. The pus was gushed out after the wound opening and swab culture was sent. The skull bone was removed then after granulation tissue removed. THe epidural granulation tissue was also removed by currettege. The wound was well irrigated with vancomycin in N/S. The wound was then closed in layers after skin edge trimming. Operators AP 賴達明 Assistants R4 林哲光, R4 李振豪 相關圖片 黃蕙卿 (F,1931/12/16,80y2m) 手術日期 2011/03/04 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Spondyloisthesis, acquired 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 蔡立威, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:05 進入手術室 08:15 麻醉開始 08:50 誘導結束 09:00 抗生素給藥 09:30 手術開始 12:00 抗生素給藥 13:00 手術結束 13:00 麻醉結束 13:15 送出病患 13:16 進入恢復室 14:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎弓切除術(減壓)-超過二節 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: 1. Posterior instrumentation, transpedicular ... 開立醫師: 蔡立威 開立時間: 2011/03/04 13:22 Pre-operative Diagnosis Spondylolisthesis, Grade I, L4-5 Herniated lumbar disc, L5-S1, left-sided Lumbar spinal stenosis, L3-4, & L4-5 Post-operative Diagnosis Spondylolisthesis, Grade I, L4-5 Herniated lumbar disc, L5-S1, left-sided Lumbar spinal stenosis, L3-4, & L4-5 Operative Method 1. Posterior instrumentation, transpedicular screw and rod fixation, L4-5 2. Posterior decompression, bilateral laminotomy, L3-4, & L4-5 3. Microdiscectomy, L5-S1, left-sided Specimen Count And Types nil Pathology nil Operative Findings 1. Facet hypertrophy, L3-4, L4-5, and L5-S1, bilateral 2. Hypertrophy of L3-4 and L4-5 ligmentum flavum, causing severe lumbar spinal stenosis 3. Protrusion of L5-S1 intervertebral disc, impinging left-sided S1 root at the shoulder segment. Operative Procedures Under endotracheal general anesthesia, prone position, we did skin disinfection and drapping as usual. Skin incision was posterior midline, about from L3-S1 level. Then we performed periosteal dissection. transpedicular screws (6.2 x 40 mm) were inserted bilaterally to L4 and L5. L3-4 and L4-5 laminotomy were then performed, followed by L4-5 total facetectomy to the left. The microscope was brought into operation room. L4-5 discectomy were prepared for transforaminal interbody fusion. A 10-mm height Synthes cage packed with autologuous bone fragments was implantated for L5-S1 vertebral body fusion. Finally, L4-L5 screws were fixed by Synthes rods. Copious saline irrigation was performed after hemostasis. One 1/4 HemoVac was inserted in paraspinal space. The wound was closed in layers. Operators VS賴達明 Assistants R5蔡宗良,R2蔡立威 賴愈楷 (M,1937/07/31,74y7m) 手術日期 2011/03/04 手術主治醫師 賴達明 手術區域 東址 019房 02號 診斷 Lumbar Spondylosis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 蔡立威, 時間資訊 00:00 臨時手術NPO 12:40 報到 13:35 進入手術室 13:40 麻醉開始 14:10 誘導結束 14:30 抗生素給藥 14:49 手術開始 17:45 抗生素給藥 19:10 開始輸血 19:23 手術結束 19:23 麻醉結束 19:30 送出病患 19:35 進入恢復室 21:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎弓切除術(減壓)-超過二節 1 2 摘要__ 手術科部: 外科部 套用罐頭: 1. Posterior instrumentation, transpedicular ... 開立醫師: 蔡立威 開立時間: 2011/03/04 19:43 Pre-operative Diagnosis 1. Spondylolisthesis, Grade I, L2-3, L3-4, L4-5 2. Lumbar spinal stenosis, L2-3, L3-4, & L4-5 Post-operative Diagnosis 1. Spondylolisthesis, Grade I, L2-3, L3-4, L4-5 2. Lumbar spinal stenosis, L2-3, L3-4, & L4-5 Operative Method 1. Posterior instrumentation, transpedicular screw and rod fixation, L4-5 2. Posterior decompression, bilateral laminotomy, L2; laminectomy, L3, & L4 3. Transforaminal lumbar interbody fusion, L4-5 3. Transforaminal lumbar interbody fusion, L4-5, with cage Specimen Count And Types nil Pathology nil Operative Findings 1. Hypertrophy of L2-3, L3-4 and L4-5 ligmentum flavum, causing severe lumbar spinal stenosis 2. Scoliosis Operative Procedures Under endotracheal general anesthesia, prone position, we did skin disinfection and drapping as usual. Skin incision was posterior midline, about from L3-S1 level. Then we performed periosteal dissection. transpedicular screws (6.2 x 45 mm) were inserted bilaterally to L4 and L5. L2 bilateral laminotomy and L3 L4 laminectomy were then performed. L4-5 discectomy were prepared for transforaminal interbody fusion. A 9-mm height Synthes cage packed with autologuous bone fragments was implantated for L5-S1 vertebral body fusion. Finally, L4-L5 screws were fixed by Synthes rods. Copious saline irrigation was performed after hemostasis. One 1/8 HemoVac was inserted in paraspinal space. The wound was closed in layers. Operators VS賴達明 Assistants R5蔡宗良,R2蔡立威 陳旺城 (M,1949/04/10,62y11m) 手術日期 2011/03/05 手術主治醫師 王國川 手術區域 東址 001房 05號 診斷 Headache 器械術式 right side subdural EVD 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林至芃 ASA 3E 紀錄醫師 王奐之, 時間資訊 20:22 通知急診手術 23:20 報到 23:20 進入手術室 23:25 麻醉開始 23:30 誘導結束 00:00 手術開始 00:35 麻醉結束 00:35 手術結束 00:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 頭顱穿洞術(止血引流、穿刺檢查) 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Subdural drain insertion, right 開立醫師: 王奐之 開立時間: 2011/03/05 01:02 Pre-operative Diagnosis Subdural effusion, right Post-operative Diagnosis Subdural effusion, right Operative Method Subdural drain insertion, right Specimen Count And Types nil Pathology Nil Operative Findings Xanthochromic effusion gushed out after dural opening, collected and sent for routine, BCS and culture. Medtronic EVD was used as subdural drain. Operative Procedures After ETGA, the patient was placed in supine position. After shaving, skin disinfection and draping in sterile fashion, a linear skin incision was made at right frontal area. A burr hole was made, followed by 2 dural tenting stitches and a small cruciate durotomy. Drainage tube was then inserted to frontal direction. After securing the subdural drain, the wound was closed in layers after hemostasis. Operators VS王國川 Assistants R3王奐之 Indication Of Emergent Operation 相關圖片 周昶佑 (M,1975/12/02,36y3m) 手術日期 2011/03/04 手術主治醫師 李章銘 手術區域 東址 018房 01號 診斷 Esophageal cancer 器械術式 VATS Esophagectomy+Total ScopyGastrectube reconstruction 手術類別 預定手術 手術部位 胸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 廖先啟, 時間資訊 07:58 報到 08:10 進入手術室 08:20 麻醉開始 08:45 誘導結束 09:30 抗生素給藥 09:50 手術開始 12:30 抗生素給藥 13:56 15:30 抗生素給藥 17:20 麻醉結束 17:20 手術結束 17:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 10 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 胸腔鏡食道切除術 1 1 R 手術 食道再造術–以胃管重建 1 1 B 手術 腹腔鏡空腸造廔術 1 3 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 記錄__ 手術科部: 外科部 套用罐頭: 1. Laparoscopic gastric tube mobilization & j... 開立醫師: 廖先啟 開立時間: 2011/03/04 17:57 Pre-operative Diagnosis Lower third esophageal cancer, adenocarconoma, s/p CCRT Post-operative Diagnosis Lower third esophageal cancer, adenocarconoma, s/p CCRT Operative Method 1. Laparoscopic gastric tube mobilization & jejunostomy 2. Ivor-Lewis esophagectomy for lower third esophageal lesions 3. VATS end-to-side gastroesophagectomy via DSD PCEA (transoral ovil) 4. Gr.106(R),107,9,10 LNs dissection Specimen Count And Types Esophagus; stomach stump; LNs Pathology Pending Operative Findings 1. One 3.0cm length, firm to elastic whitish tumor over lower third esophagus, protruding mass(-), wall thickening(+), with clip localization 2. Safe margin: 10cm above tumor and 5cm below tumor. 3. Intra-op frozen pathology: margin free. 5. Blood loss: 275ml Operative Procedures 1. ETGA, supine with lithotomy position. 2. Skin disinfection then drapped. 3. Four abdominal working ports setting as usual. 4. Mobilization of gastric tube by Ligasure. 5. Open the E-G junction area and crus muscle. 6. Esopagectomy at stomach body site, below tumor 3cm 7. Suture connection of the gastric tube to esophagus stump. 8. Inserted the gastric tube into thoracic cavity. 9. Create left jejunostomy via puncture method, 10.Set two rubber drains: left subphrenic area and right hepatic area. 12.Close wound in layers then start thoracic stage, set one 24# chest tube at left chest. 13.Left decubitus position, skin disinfection then drapped. 14.Four VATS working ports setting as usual. 15.Mobilize the esophagus till azygus vein level. 16.Gr.106(R),107,9,10LNs dissection. 17.VATS esopagectomy, above tumor 10cm. 18.VATS end-to-side gastroesophagectomy via CEEA staple 20.Normal saline irrigation. 21.Set one 28# chest tube, close wound in layers. Operators VS李章銘 Assistants CR李佳穎，R3廖先啟，Ri程郁文 柯慶良 (M,1954/11/17,57y3m) 手術日期 2011/03/04 手術主治醫師 郭順文 手術區域 東址 002房 02號 診斷 Subdural hemorrhage following injury, with loss of consciousness of unspecified duration 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3E 紀錄醫師 郝政鴻, 時間資訊 11:25 報到 11:27 進入手術室 11:28 麻醉開始 11:35 誘導結束 11:56 手術開始 12:00 麻醉結束 12:00 手術結束 12:06 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 氣管切開術 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 郝政鴻 開立時間: 2011/03/04 13:15 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types nil Pathology None Operative Findings Fr . 8 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators VS 郭順文 Assistants R3郝政鴻 鄭國基 (M,1959/07/08,52y8m) 手術日期 2011/03/04 手術主治醫師 蔡翊新 手術區域 東址 001房 03號 診斷 Other and unqualified skull fracture, closed with other and unspecified intracranial hemorrhage, with loss of consciousness of unspecified duration 器械術式 Left side craniectomy 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3E 紀錄醫師 曾峰毅, 時間資訊 11:29 通知急診手術 13:35 進入手術室 13:40 麻醉開始 13:50 誘導結束 14:05 抗生素給藥 14:10 手術開始 15:00 15:55 手術結束 15:55 麻醉結束 15:55 16:08 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 硬腦膜外血腫清除術 1 1 R 手術 慢性硬腦膜下血腫清除術 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 曾峰毅 開立時間: 2011/03/04 16:25 Pre-operative Diagnosis Left chronic subdural hematoma, left epidural hematoma Left chronic subdural hematoma, right epidural hematoma Post-operative Diagnosis Left chronic subdural hematoma, left epidural hematoma Left chronic subdural hematoma, right epidural hematoma Operative Method Left frontal burr hole for subdural drainage, and right side epidural hematoma removal Specimen Count And Types Nil Pathology Nil Operative Findings ICP before the operation was about 31 mmHg, and dropped to 5 mmHg, after left frontal burr hole drainage. About 1 cm epidural hematoma was noted at right side, and the temporalis muscle was perserved. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to right. After scalp shaved, scrubbed, disinfected, and then draped, we made one skin incision at left frontal area, and drilled one burr. Dura was incised, and subdural effusion was drained. The wound was closed in layers after hemostasis. We turned the head to left. We re-disinfected and draped the scalp. We made skin incision along previous operation. We reflected the scalp flap, and removed epidural hematoma. We performed duroplasty with durofoam, and inserted silicon pad between dura and temporalis muscle. After inserted two CWVs, the wound was closed in layers. Operators VS 蔡翊新 Assistants R4 曾峰毅 Indication Of Emergent Operation 林秋玉 (F,1976/12/23,35y2m) 手術日期 2011/03/05 手術主治醫師 曾漢民 手術區域 東址 003房 01號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 07:31 報到 08:02 進入手術室 08:08 麻醉開始 08:20 誘導結束 08:32 抗生素給藥 08:32 手術開始 10:50 開始輸血 11:32 抗生素給藥 13:55 麻醉結束 13:55 手術結束 14:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4~8小時 1 1 R 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 記錄__ 手術科部: 外科部 套用罐頭: Right frontal craniotomy for gross total tumo... 開立醫師: 鍾文桂 開立時間: 2011/03/05 17:55 Pre-operative Diagnosis Right lateral ventricle tumor with extension to left lateral ventricle and foramen of Monro. Post-operative Diagnosis Right lateral ventricle tumor with extension to left lateral ventricle and foramen of Monro. Operative Method Right frontal craniotomy for gross total tumor excision. Specimen Count And Types 1 piece About size:10cc Source:brain tumor Pathology Pending. Operative Findings 1. Grayish-red, soft, fragile, hypervascularized tumor located at right lateral ventricle with extension to the left lateral ventricle and foramen of Monro. Intraoperatively, the temporal, frontal,occipital horns were explored. Septem pallucidum was opened and the right lateral ventricle was reached. After excision of the tumor in right lateral ventricle, right caudate nucleus was met. Due to the high vascularity, we used Floseal to help us achieve hemostasis. An EVD catheter was placed at frontal horn of lateral ventricle after tumor excision. 2. Ipsilateral thalamostriae vein and internal cerebral vein were well preserved. A large cortical vein at medial posterior of the craniotomy window was preserved. 3. Intraoperative ultrasonography was used to locate the tumor mass. After tumor removal, we also used it to see if residual tumor is present. Operative Procedures Under ETGA, the patient was placed in supine position and the head was slightly in flexsion position and tilted to the left 30 degrees. The head was fixed by 3-pin head holder. After shaving, disinfection, and draping, the U shape scalp incision was made at right frontal area( 1 cm posterior to coronal suture, 6 cm anterior to coronal suture). Then, craniotomy was achieved with high speed drill. After durotomy and dural tenting, a 2-cm corticotomy was made. After reaching the right lateral ventricle, the tumor was removed by suction and excision in piece-meal fashion. After well hemostasis, an EVD was inserted. The dura mater was closed in water-tight fashion and reparied with pericranium. The skull bone plate was fixed by miniplates and screws. The wound was closed in layers with one subgaleal CWV drain. Operators 曾漢民 Assistants 鍾文桂 相關圖片 龔上模 (M,1944/05/30,67y9m) 手術日期 2011/03/05 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Parkinson''s Disease 器械術式 Stereotaxic procedure for impl 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 面罩麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 陳睿生, 時間資訊 00:00 臨時手術NPO 07:31 報到 08:03 進入手術室 08:20 麻醉開始 08:30 誘導結束 09:00 抗生素給藥 09:51 手術開始 12:00 抗生素給藥 15:00 抗生素給藥 17:03 麻醉結束 17:03 手術結束 17:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 立體定位術-功能性失調 1 1 L 手術 立體定位術-功能性失調 1 2 R 手術 深部腦核電生理定位 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Semi-opened mask inhalation anes 1 0 麻醉 Semi-opened INHALATION GENERAL A 4 0 麻醉 SENI-OPENED INHALATION GENERAL A 9 0 摘要__ 手術科部: 外科部 套用罐頭: Insertion of DBS wire at bilateral subthalamu... 開立醫師: 范玉君 開立時間: 2011/03/05 17:25 Pre-operative Diagnosis Parkison's disease, Post-operative Diagnosis Parkison's disease Operative Method Insertion of DBS wire at bilateral subthalamus nucleas Specimen Count And Types nil Pathology Nil Operative Findings 1. The identified subthalamic nucleus at left side: 5.8mm in length, right side: 4.0 mm in length. 2. The rigidity decreased after wire inserted at stimulation "on". 3. Left eye with left-ward gaze limitation when stimulation "on" over left subthalamic nucleus. 4. Identification of both sides subthalamic nucleus were 2mm lateral to the initially planned target. Operative Procedures Under IV general anesthesia, the patient was put in supine position. The scalp was shaved, scrubbed and antiseptic with alcohol B-I. Registered the preset localization point to navigator. Bicoronal scalp incision was made with burr hole made at entery point of left frontal region as navigator guided. The DBS wire port was set up and localization of subthalamus nucleus with microelectrode assistance. Inserted the DBS wire and fixed with the port. Waked the patient from the anesthesia and started stimulation from low voltage. Checked the clinical responses while using different voltage for stimulation. Performed the same procedure at right side. After hemostasis, closed the wound in layers. Operators Professor 曾勝弘 Assistants R5 蔡宗良 吳瑋萍 (F,1979/11/08,32y4m) 手術日期 2011/03/05 手術主治醫師 林志峰 手術區域 東址 000房 號 診斷 Acute lymphoid leukemia, without mention of remission 器械術式 Endoscopic functional sinus su 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 廖怡茹, 時間資訊 12:30 報到 12:58 進入手術室 13:00 麻醉開始 13:05 麻醉結束 13:18 手術開始 14:25 手術結束 14:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 鼻竇內視鏡檢查 1 0 B 記錄__ 手術科部: 耳鼻喉部 套用罐頭: 1. Sinoscope surgery, bilateral 開立醫師: 廖怡茹 開立時間: 2011/03/08 15:57 Pre-operative Diagnosis Chronic paranasal sinusitis, status post operation 2.Leukemia Post-operative Diagnosis Chronic paranasal sinusitis, status post operation 2.Leukemia Operative Method 1. Sinoscope surgery, bilateral Specimen Count And Types nil Pathology Nil Operative Findings 1. Bilateral nasal post operation change 2. Bilateral nasal mucosa diffuse oozing Operative Procedures 1. Supine position 2. Remove the nasal packing Merocel Fingerstalk VG iodoform Right: 4 Left: 1 2 1 3. Hemostasis 4. Nasal paking again because of diffuse oozing Right: VG*3 , Left:gauze*1,VG*2 5. Patient tolerate will during the procedure. Operators 林志峰, Assistants R3許雅晴,R2廖怡茹, 林添 (M,1935/01/11,77y2m) 手術日期 2011/03/06 手術主治醫師 楊士弘 手術區域 東址 002房 01號 診斷 Compression fracture, pathological, spontaneous 器械術式 Spinal fusion posterior 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 3E 紀錄醫師 陳以幸, 時間資訊 23:19 臨時手術NPO 23:19 開始NPO 07:19 通知急診手術 08:40 報到 08:43 進入手術室 08:45 麻醉開始 09:00 誘導結束 09:35 抗生素給藥 09:54 手術開始 12:01 開始輸血 12:44 抗生素給藥 16:00 麻醉結束 16:00 手術結束 16:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 7 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎間盤切除術-椎 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 摘要__ 手術科部: 外科部 套用罐頭: 1. L1 laminectomuy, right facetomy and pedicu... 開立醫師: 楊士弘 開立時間: 2011/03/06 15:56 Pre-operative Diagnosis Burst fracture of L1 vertebrae with spinal cord compression Post-operative Diagnosis Burst fracture of L1 vertebrae with spinal cord compression Operative Method 1. L1 laminectomuy, right facetomy and pediculectomy for partial L1 corpectomy 2. Posterior fixation by transpedicle screws and rods from T11 to L3 3. Posterolateral fusion from T11 to L3 with autologous bone graft Specimen Count And Types Nil Pathology Nil Operative Findings The vertebral bone was osteoporotic. After L1 laminectomy, the thecal sac bulged out posteriorly. The right L1 root was exposed after removal of facet and pedicle. The posterior surface of L1 vertebral body was found te be bulging posteriorly against the thecal sac. The bulging vertebrae was dissected from the anterior surface of thecal sac, and the a reverse angled currete was placed on the posteriorly bulging vertebrae bone and hammered away anteriorly. The thecal sac was free from compression then. Pedicle screws, 6.5 mm in diameter and 45 mm long each, were inserted into bilateral T11, T12, L2, L3 pedicles. The position was confirmed by intra-op. fluoroscopy. Then one 17 cm long rod was placed on each side and fixed to the screws. A cross link was used to bridge both rods. Operative Procedures 1. ETGA, prone. 2. Midline incision, T11 to L3. 3. Dissection and retraction of paraspinal muscles away from spinous process, lamina, facets, and transverse processes. 4. Insertion of pedicles screws into T11, T12, L2, and L3. 5. Resection of L1 lamina, right T12-L1 and L1-L2 facets, and right L1 pedicle. 5. Resection of L1 lamina, right T12-L1 and L1-L2 facets, and right L1 pedicle for posterolateral decompression of thecal sac. 6. Parital posterior corpectomy by currets and hammer, for anterior decompression of thecal sac. 7. Decortication of T11 to L3 lamina, spinous processes, and transverse processes. 8. Placement of resected bones strips and chips over decorticated vertebral bone surface. 9. Insertion of two epilaminal HV drains. 10. Wound closure in layers. Operators 楊士弘 Assistants 蔡宗良, 陳以幸 Indication Of Emergent Operation 鄭國基 (M,1959/07/08,52y8m) 手術日期 2011/03/06 手術主治醫師 蔡翊新 手術區域 東址 002房 02號 診斷 Other and unqualified skull fracture, closed with other and unspecified intracranial hemorrhage, with loss of consciousness of unspecified duration 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 4E 紀錄醫師 曾峰毅, 時間資訊 16:25 通知急診手術 16:55 報到 16:55 進入手術室 17:00 麻醉開始 17:03 誘導結束 17:12 手術開始 17:30 麻醉結束 17:30 手術結束 17:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Subdural drainage 開立醫師: 曾峰毅 開立時間: 2011/03/06 17:56 Pre-operative Diagnosis Left chronic subdural hematoma Post-operative Diagnosis Left chronic subdural hematoma Operative Method Subdural drainage Specimen Count And Types Nil Pathology Nil Operative Findings Dark-reddish subdural effusion gushed out while we pushed brain parenchyma downward. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to right. We made skin incision along previous left frontal wound. We inserted subdural drainage into subdural space. The wound was closed in layers. Operators VS 蔡翊新 Assistants R5 蔡宗良 R4 曾峰毅 Indication Of Emergent Operation 鄭永茂 (M,1926/07/04,85y8m) 手術日期 2011/03/06 手術主治醫師 蔡翊新 手術區域 東址 003房 02號 診斷 Other and unspecified intracranial hemorrhage following injury, with loss of consciousness of unspecified duration 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 4E 紀錄醫師 鍾文桂, 時間資訊 00:00 通知急診手術 00:55 報到 00:55 進入手術室 01:00 開始輸血 01:00 麻醉開始 01:20 誘導結束 01:30 抗生素給藥 01:40 手術開始 02:10 麻醉結束 02:15 手術結束 02:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 顱內壓視置入 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Burr hole for implantation of ICP monitor. 開立醫師: 鍾文桂 開立時間: 2011/03/06 02:59 Pre-operative Diagnosis 1. Bilateral frontal contusional intracerebral hemorrhage. 2. Right frontal-temporal-parietal acute subdural hemorrhage. Post-operative Diagnosis 1. Bilateral frontal contusional intracerebral hemorrhage. 2. Right frontal-temporal-parietal acute subdural hemorrhage. Operative Method Burr hole for implantation of ICP monitor. Specimen Count And Types nil Pathology Nil. Operative Findings Initial ICP before wound closure: 3mmHg, after wound closure: 18mmHg. Presence of acute and chronic subdural hemorrhage at right frontal region. Operative Procedures Under ETGA, the patient was placed in supine position and the head tilted to the left. After shaving, disinfection, and draping, a linear scalp incision was made at right frontal region. After creating a burr hole by using high speed drill, the dura mater was incised in cruciate fashion. Then, the ICP monitor was placed in subdural space. After well hemostasis, the wound was closed in layers. Operators 蔡翊新 Assistants 鍾文桂 Indication Of Emergent Operation 相關圖片 曾繁凱 (M,1986/02/16,26y0m) 手術日期 2011/03/06 手術主治醫師 蔡翊新 手術區域 東址 003房 01號 診斷 Major trauma rated 16 or above on the severeity scale ( Injury severeity score >=16 ) 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 4E 紀錄醫師 陳志軒, 時間資訊 11:10 通知急診手術 11:46 報到 11:47 進入手術室 11:50 麻醉開始 11:55 抗生素給藥 12:10 誘導結束 12:15 手術開始 13:20 開始輸血 14:35 麻醉結束 14:35 手術結束 14:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 1 R 手術 顱內壓視置入 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 蔡翊新 開立時間: 2011/03/06 14:02 Pre-operative Diagnosis Right frontotemporoparietal acute SDH and right frontotemporal contusion ICH with brain swelling. Post-operative Diagnosis Right frontotemporoparietal acute SDH and right frontotemporal contusion ICH with brain swelling. Operative Method Right F-T-P craniectomy for removal of SDH and ICH, duroplasty and ICP monitoring. Specimen Count And Types nil Pathology Nil. Operative Findings Left occipital scalp contusion was noted. Initial ICP upon first burr hole creation was 54 mmHg. The dura was tense upon craniectomy. Right frontotemporoparietal acute SDH, 18 x 15 x 1.5 cm, was evacuated. Two active bleeders from cortical vessels were noted at right frontal and temporal lobes, near the contusion sites around Sylvian fissure. Contusion ICHs at right frontal and temporal lobes were also evacuated. ICP after skin closure was mmHg. Reference of Codman ICP monitor: 506. Left occipital scalp contusion was noted. Initial ICP upon first burr hole creation was 54 mmHg. The dura was tense upon craniectomy. Right frontotemporoparietal acute SDH, 18 x 15 x 1.5 cm, was evacuated. Two active bleeders from cortical vessels were noted at right frontal and temporal lobes, near the contusion sites around Sylvian fissure. Contusion ICHs at right frontal and temporal lobes were also evacuated. ICP after skin closure was 3 mmHg. Reference of Codman ICP monitor: 506. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 6 cm at anterior-lower temporal area, the skin edge was clipped by Raney clips for temporary hemostasis. The temporalis muscles was incised down to the tempoal squama which was exposed then by applying a self retaining retractor on the muscle. 5. A burr hole was made and the dura was incised for evacuating part of the subdural hematoma, therefore the IICP could be relieved earlier. 6. The incision was extended to a temporal horseshoe, and the temporalis muscle was detached from temporal squama by rasp subsequently. 7. Craniectomy window: 14 x 12 cm, right F-T-P, created by making 5 burr holes then cut by power saw. 8. Dural tenting: by 2/0 silk, 2 cm in interval, distributed along the edge of skull window. 9. Dural incision: curvilinear along the edge of skull window. 10.The subdural clots and contusional ICH were removed by sucker. 11.Hemosatasis: the bleeders was stopped by Bovie and oozing surface was covered with Surgicel and Gelfoam. 12.Dural closure: was closed with two piece of DuroGen along the whole length of the dural incision in order to create an additional space for the swollen brain. A silastic sheet was placed at epidural space to prevent future adhesion between galea and dura. A Codman ICP monitor was placed at subdural space of right frontal area. 13.The skull plate was removed and stored at bone bank for preservation. 14.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 15.Drain: two, epidural, CWV. 16.Blood transfusion: PRBC 4U, Blood loss: 1200 ml. 17.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R4曾峰毅R2陳志軒 Indication Of Emergent Operation 曾繁凱 (M,1986/02/16,26y0m) 手術日期 2011/03/06 手術主治醫師 蔡翊新 手術區域 東址 003房 03號 診斷 Major trauma rated 16 or above on the severeity scale ( Injury severeity score >=16 ) 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 4E 紀錄醫師 陳志軒, 時間資訊 16:42 通知急診手術 17:18 誘導結束 17:20 報到 17:20 進入手術室 17:25 麻醉開始 17:35 手術開始 17:40 開始輸血 18:15 抗生素給藥 19:19 麻醉結束 19:19 手術結束 19:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 硬腦膜外血腫清除術 1 1 L 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 蔡翊新 開立時間: 2011/03/06 19:06 Pre-operative Diagnosis Left occipital skull fracture with epidural hematoma at occipital and suboccipital regions. Post-operative Diagnosis Left occipital skull fracture with epidural hematoma at occipital and suboccipital regions. Operative Method Left occipital craniotomy for EDH evacuation. Specimen Count And Types nil Pathology Nil. Operative Findings ICP before skin incision was 54 mmHg. It dropped to 24 mmHg after first burr hole creation and partial removal of EDH. Epidural hematoma, 10 x 8 x 3.5 cm, was noted at left occipital area upon craniotomy, crossing supra- and infra-tentorial space. The dural was still tense after EDH removal, possibly because of compression of right craniectomy window (head rotated to right side and the brain was compressed by the table). ICP after skin closure was 23 mmHg. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right and left shoulder elevated by sheets. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: a paramedian linear incision at left occipital region, the skin edge was clipped by Raney clips for temporary hemostasis. 5. A burr hole was made at inion and the EDH was removed partially, therefore the IICP could be relieved earlier. 6. The incision was extended to a Hockey-stick shape. 7. Craniotomy window: 8 x 6 cm, left occipital, created by making 4 burr holes then cut by power saw. 8. Dural tenting: by 1/0 silk, 2 cm in interval, distributed along the edge of skull window. 9. The epipdural clot was removed by sucker and the bleeding was packed with tenting and Gelfoam packing. 11.The skull plate was placed back and fixed with 4 24# wires and 3 central tentings. 12.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 13.Drain: one, epidural, CWV. 14.Blood transfusion: FFP6U, PRBC 2U. Blood loss: 300 ml. 15.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5蔡宗良R2陳志軒 Indication Of Emergent Operation 謝周寶滿 (F,1951/05/22,60y9m) 手術日期 2011/03/07 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Aneurysm 器械術式 Craniotomy(Aneurysms) P-DUH 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:05 進入手術室 08:10 麻醉開始 08:17 誘導結束 08:45 抗生素給藥 08:50 手術開始 11:45 抗生素給藥 14:50 抗生素給藥 16:15 麻醉結束 16:15 手術結束 16:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 開顱術摘除血管病變 - 腦血管瘤 無病徵的 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 8 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Left pterional approach for aneurysm clipping 開立醫師: 王奐之 開立時間: 2011/03/07 14:33 Pre-operative Diagnosis Left paraclinoid ICA aneurysm (superior hypophyseal aneurysm) Post-operative Diagnosis Left paraclinoid ICA aneurysm (superior hypophyseal aneurysm) Operative Method Left pterional approach for aneurysm clipping Specimen Count And Types nil Pathology Nil Operative Findings A saccular aneurysm about 4-5mm in size, with the neck about 4-5mm, was noted at left paraclinoid area (in between ophthalmic artery and posterior communicating artery), protruding inward and downwardly. A prominent posterior communicating artery was noted. A fenestrated angled Sugita aneurysm clip was applied for clipping. Intra-operative ICG angiography showed no flow to the aneurysm and confirmed the patency of ICA, ophthalmic artery, and posterio communicating artery. A saccular aneurysm about 4-5mm in size, with the neck about 4-5mm, was noted at left paraclinoid area (in between ophthalmic artery and posterior communicating artery), protruding inward and downwardly. A prominent posterior communicating artery was noted. A fenestrated angled Sugita aneurysm clip was applied for clipping. Intra-operative ICG angiography showed no flow to the aneurysm and confirmed the patency of ICA, ophthalmic artery, and posterior communicating artery. Operative Procedures After ETGA, the patient was placed in supine position with head fixed in Mayfield skull clamp and face turned to right. After scalp shaving, disinfection and draping in sterile fashion, a left preauricular curvilinear incision was made. After facial nerve preservation, a standard pterional craniotomy was performed. After dural edge tenting, the sphenoid ridge was drilled and anterior clinoidectomy was done. The optic canal was then drilled open as well. A fishmouth durotomy was performed and the Sylvian fissure was opened. After identifying the intradural ICA and CN II, the optic sheath and the distal dural ring around ICA were cut open to allow more dissection of ICA. The aneurysm could not be seen in a single angle of view. A fenestrated Sugita aneurysm clip was then applied, followed by ICG angiography. After meticulous hemostasis, the dura was closed in water-tight fashion. The bone was put back and fixed with miniplates. The wound was then closed in layers after placement of a subgaleal CWV drain. Operators P 杜永光 Assistants R6 陳睿生, R3 王奐之 相關圖片 王治仁 (M,1925/09/18,86y5m) 手術日期 2011/03/07 手術主治醫師 郭順文 手術區域 東址 018房 04號 診斷 Pneumonia 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 趙安怡 ASA 3 紀錄醫師 高明蔚, 時間資訊 00:00 臨時手術NPO 16:20 進入手術室 16:20 報到 16:29 抗生素給藥 16:30 麻醉開始 16:32 誘導結束 16:41 手術開始 16:50 麻醉結束 16:50 手術結束 16:55 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 氣管切開術 1 0 摘要__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 高明蔚 開立時間: 2011/03/07 18:18 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types nil Pathology None Operative Findings Fr.7 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 1cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators 郭順文 Assistants R3高明蔚 賴欽生 (M,1972/07/07,39y8m) 手術日期 2011/03/07 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Malignant neoplasm of sphenoidal sinus 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:08 進入手術室 08:15 麻醉開始 08:35 誘導結束 09:00 抗生素給藥 09:36 手術開始 12:00 開始輸血 13:28 14:38 14:38 手術結束 14:48 麻醉結束 14:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 R 手術 鼻內惡性腫瘤切除術 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: Subfrontal approach with complete tumor resection 開立醫師: 曾偉倫 開立時間: 2011/03/07 13:48 Pre-operative Diagnosis Nasalpharyngeal carcinoma status post concurrent chemoradiation therapy with recurrence + intracranial invasion Post-operative Diagnosis Nasalpharyngeal carcinoma status post concurrent chemoradiation therapy with recurrence + intracranial invasion Operative Method Subfrontal approach with complete tumor resection Specimen Count And Types 3 pieces About size:1x1x1 cm Source:Tumor in ethmoid sinus About size:0.5x0.5x0.5 cm Source:Tumor within right lamina papyrasia About size:0.5x0.3x0.3 cm Source:Tumor and mucosa in sphenoid sinus Pathology Pending Operative Findings 1. Some whitish soft tumor within the ethmoid sinus with extension to right lamia papyrasia, sphenoid sinus 2. Tumor adhesion to a small part of frontal base dura 3. The residule tumor within nasal cavity was checked and removed by ENT doctors Operative Procedures Under ETGA, patient put on supine position with mild neck flexion. After we scrubbed, disinfected and drapped, we made a bi-coronal frontal skin incision. The pericranium and skull bone graft was harvest and packed. Craniotomy was performed with high speed drill and we open the dura. The frontal sinus was disinfected with aqua beta-Iodine and sealed with bone wax and Gelfoam. We retract the frontal lobes and remove the tumor with tumor forceps. The cribiform plate was open and we remove the tumor within the ethmoid sinus. Part of the frontal base dura removed and the sphenoid sinus was opened for rumot resection. We reconstructed the frontal base with fascia and bone graft. A CWV drain was plased over the sub-galeal space. We close the wound after well hemostasis. Operators VS 曾漢民 Assistants R5 蔡宗良 R5 鍾文桂 R2 曾偉倫 記錄__ 手術科部: 外科部 套用罐頭: Subfrontal approach with complete tumor resection 開立醫師: 郭彥麟 開立時間: 2011/03/07 18:25 Pre-operative Diagnosis sinonasal cancer, right Post-operative Diagnosis sinonasal cancer, right, operated Operative Method Endoscopic tumor resection Specimen Count And Types 4 pieces About size:<1cm Source:right nasal tumor About size:<1cm Source:no.2 medial margin About size:<1cm Source:no.3 lateral margin About size:<1cm Source:right frontal recess Pathology pending Operative Findings no bulky tumor was noted, only pathlogic mucosa near right frontal recess and around middle turbinate Operative Procedures 1.nasal packing with bosmin + xylocaine pledgets bilaterally. then removed them and checked left first. synechia between inferior turbinate and septum was released 2.checked the right side. no bulky tumor was seen, only raw surface with little amount of CSF leakage from sutured site. We removed middle turbinate and the mucosa around it. Frontal sinus was already opened and we did not see obvious tumor. So we used Gelfoam and tissucol duo to cover the possible CSF leakage site 3.nasal packing : right : F/S x3, Merocel x 1 ; left : F/S x 1 Operators AP婁培人 Assistants R4薛婉儀 R2郭彥麟 陳建銘 (M,1976/07/14,35y8m) 手術日期 2011/03/07 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Secondary cancer of brain and spinal cord 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 14:00 報到 15:07 進入手術室 15:10 麻醉開始 15:26 誘導結束 15:35 抗生素給藥 15:45 手術開始 17:25 開始輸血 18:35 抗生素給藥 19:05 麻醉結束 19:05 手術結束 19:10 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 顱底瘤手術 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Left orbital-zygomatic approach with tumor re... 開立醫師: 鍾文桂 開立時間: 2011/03/07 19:51 Pre-operative Diagnosis Nasalpharyngeal carcinoma status post concurrent chemoradiation therapy with recurrence Post-operative Diagnosis Nasalpharyngeal carcinoma status post concurrent chemoradiation therapy with recurrence and temporal base invasion. Operative Method Left orbital-zygomatic approach with tumor rescetion Specimen Count And Types 1 piece About size:3x3x2 cm Source:Left temporal tumor Pathology pending Operative Findings 1. A soft red-grayish, hypervascularized tumor over left temporal lobe. Two main cysts with turbid yellowish mucious content were noted during tumro excison. The tumor invades into the cavernous sinus. Many feeders from the middle skull base. It was hard to achieve hemostasis. We also noted trigeminal nerve fibers during tumor excision. Edematous brain parenchyma was noted. 2. A 2x2x0.5 corticotomy was made on the middle gyrus of temporal lobe. Operative Procedures Under ETGA, the patient was placed on supine position with his face tilt to right. After we scrubbed, disinfected and drapped the patient, a curvilinear skin incision was made over left frontal-temporal area. We preformed orbital-zygomatic craniectomy and open the dura. The tumor was localized via intra-operative echo and a corticotomy was performed above the tumor. We resected the tumor with bipolar forceps and tumor forceps. The cavernous sinus was exposed and we packed the gelfoam above it. We closed the dura after complete hemostasis and a CWV drain was placed. The wound was closed with 2-0 Vicryl and Appose. Operators VS 曾漢民 Assistants R5 鍾文桂 R2 曾偉倫 相關圖片 王麗娟 (F,1968/12/07,43y3m) 手術日期 2011/03/07 手術主治醫師 郭順文 手術區域 東址 018房 03號 診斷 Acute myeloid leukemia 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 趙安怡 ASA 4 紀錄醫師 高明蔚, 時間資訊 00:00 臨時手術NPO 15:24 報到 15:24 進入手術室 15:30 麻醉開始 15:35 手術開始 15:35 誘導結束 15:42 麻醉結束 15:42 手術結束 15:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 氣管切開術 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 高明蔚 開立時間: 2011/03/07 15:53 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types nil Pathology None Operative Findings Fr.7 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 1cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators 郭順文 Assistants R3高明蔚, R1全賀顯 吳潘雪子 (F,1937/09/07,74y6m) 手術日期 2011/03/07 手術主治醫師 黃昭淵 手術區域 西址 039房 08號 診斷 Hematuria 器械術式 Fiberocystoscopy /WOR 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 14:25 進入手術室 14:32 手術開始 14:35 手術結束 14:38 送出病患 許天賜 (M,1948/07/09,63y8m) 手術日期 2011/03/07 手術主治醫師 蔡翊新 手術區域 東址 003房 02號 診斷 Injury (severeity score >=16) 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 3E 紀錄醫師 李振豪, 時間資訊 14:00 臨時手術NPO 14:00 開始NPO 17:58 通知急診手術 18:45 進入手術室 18:50 麻醉開始 19:00 誘導結束 19:05 抗生素給藥 19:22 手術開始 19:43 開始輸血 21:15 手術結束 21:15 麻醉結束 21:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 硬腦膜外血腫清除術 1 2 L 摘要__ 手術科部: 外科部 套用罐頭: Left craniotomy for evacuation of epidural he... 開立醫師: 李振豪 開立時間: 2011/03/07 21:45 Pre-operative Diagnosis Left acute epidural hematoma Post-operative Diagnosis Left acute epidural and subgaleal hematoma Operative Method Left craniotomy for evacuation of epidural hematoma Specimen Count And Types nil Pathology Nil Operative Findings The programmable valve pressure was adjusted to 200mmH2O before the operation. The subgaleal hematoma with 0.3cm in thickness was noted after elevation of the scalp flap. The Epidural hematoma was about 4cm in thickness. After removal of the epidural hematoma. The brain did not expanded after removal of the epidural hematoma. Even under 10 central tenting, the dura still not fit the skull plate well. The pulsation of the brain was good during the operation. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head rotated to right. The scalp was shaved, scrubbed, removed stitches, and disinfected as usual. The scalp incision was made along previous wound. The scalp flap was elevated after removal of the Vicryl. The subgaleal hematoma was evacuated. The artificial skull plate, miniplates, and screws were removed and the epidural hematoma was evacuated. Hemostasis was achieved with bipolar electrocautery and Gelform packing. One small dural defect near the posterior margin of the craniotomy window was noted and repaired. Two CWV drain was placed over epidural space. 10 central tenting was performed. The epidural space was packing with Gelform. The skull plate was fixed back with miniplates and scrwes. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS蔡翊新 Assistants R4李振豪 Indication Of Emergent Operation 相關圖片 房玲玲 (F,1956/05/26,55y9m) 手術日期 2011/03/08 手術主治醫師 杜永光 手術區域 東址 003房 03號 診斷 Brain tumor 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3E 紀錄醫師 蔡宗良, 時間資訊 14:25 通知急診手術 22:33 進入手術室 22:45 麻醉開始 22:50 誘導結束 23:17 手術開始 00:00 手術結束 00:00 麻醉結束 00:10 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 顱內壓視置入 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: ICP monitoring, via Kocher point, right-sided 開立醫師: 陳志軒 開立時間: 2011/03/09 00:26 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method ICP monitoring, via Kocher point, right-sided Specimen Count And Types 1 piece About size:小 Source:CSF Pathology none Operative Findings 1. ICP: high 2. CSF: light reddish Operative Procedures Endotracheal intubation was employed for general anesthesia. Patient was put in supine position with head in neutral position. Scalp was prepped and drapped in the usual manner. A cresent wound incision was made at the Kocher point with a burr hole made underneath. A Medtronics mid-size ventricular drain was punctured. The drain tube was fixed and the wound was closed in layers. Operators VS 杜永光 Assistants R5蔡宗良, R2陳志軒 Indication Of Emergent Operation 張萬來 (M,1936/05/12,75y10m) 手術日期 2011/03/09 手術主治醫師 蒲永孝 手術區域 東址 002房 05號 診斷 Prostate cancer 器械術式 blood clots evacuation 手術類別 緊急手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 靜脈麻醉 麻醉主治醫師 詹偉弘 ASA 3E 紀錄醫師 姜秉均, 時間資訊 11:00 臨時手術NPO 11:00 開始NPO 23:41 進入手術室 23:45 麻醉開始 23:50 誘導結束 00:02 手術開始 00:30 手術結束 00:30 麻醉結束 00:35 送出病患 00:40 進入恢復室 02:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 碎石取出術,簡單(在膀胱內壓碎並除去)結石<1cm 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 記錄__ 手術科部: 泌尿部 套用罐頭: blood clot evacuation 開立醫師: 姜秉均 開立時間: 2011/03/09 00:47 Pre-operative Diagnosis irradiation cystitis with blood clot tamponade Post-operative Diagnosis irradiation cystitis with blood clot tamponade Operative Method Blood clot evacuation and TUR-coagulation Specimen Count And Types nil Pathology nil Operative Findings 1. around 200ml blood clot in the urinary bladder. 2. diffused bladder and prostate oozing Operative Procedures 1. Under satisfactory anesthesia with the patient in the lithotomy position, prepping and draping were performed in the usual sterile method. 2. Massive blood clots were noted and evacuated. 3. After the clot was removed, bleedingpoint was checked. 4. The hemostasis was obtained by resectoscope. 5. A 22 Fr. 3-way Foley catheter was inserted and continuous bladder irrigation with normal saline started. 6. The patient was then sent to the recovery room in a stable condition. Operators 蒲永孝, Assistants 姜秉均, Indication Of Emergent Operation 龔上模 (M,1944/05/30,67y9m) 手術日期 2011/03/08 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Parkinson''s Disease 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾峰毅, 時間資訊 00:00 臨時手術NPO 07:38 報到 08:00 進入手術室 08:10 麻醉開始 08:10 抗生素給藥 08:15 誘導結束 08:51 手術開始 10:18 手術結束 10:18 麻醉結束 10:24 送出病患 10:28 進入恢復室 11:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 曾峰毅 開立時間: 2011/03/08 10:24 Pre-operative Diagnosis Parkinsonism Post-operative Diagnosis Parkinsonism Operative Method Implantable pulse generator implantation Specimen Count And Types Nil Pathology Nil Operative Findings IPG function was OK after insertion. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to right. After skin scrubbed, disinfected, and then draped, we made one longitudinal skin incision at left occipital area to retrieve the wire. We made another skin incision at left upper chest, and created subcutaneous pouch. One subcutaneous tunnel was created from left occipital area to left upper chest wound to inserted the wires. We connected the wire to IPG, and checked the function. We put the IPG into left upper chest pouch, and closed the wound in layers. Operators VS 曾勝弘 Assistants R4 曾峰毅 潘子涵 (F,1986/04/09,25y11m) 手術日期 2011/03/08 手術主治醫師 曾勝弘 手術區域 東址 005房 02號 診斷 Pituitary adenoma : GHoma PRLoma 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾峰毅, 時間資訊 00:00 臨時手術NPO 10:10 報到 10:35 進入手術室 10:50 麻醉開始 11:00 抗生素給藥 11:30 誘導結束 11:53 手術開始 14:19 抗生素給藥 14:30 麻醉結束 14:30 手術結束 14:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經由蝶竇之腦下垂體瘤切除 1 1 手術 粘膜下中隔矯正術 1 2 手術 皮下肌肉或深部異物取出術 1 4 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 摘要__ 手術科部: 外科部 套用罐頭: Hypophysectomy---Transphenoid 開立醫師: 曾峰毅 開立時間: 2011/03/08 14:46 Pre-operative Diagnosis Pituitary prolactinoma Post-operative Diagnosis Pituitary prolactinoma Operative Method Transnasal trans-sphenoidal adenomectomy Specimen Count And Types Several fragments of one tumor was sent for pathology. Pathology Nil Operative Findings One capsulated, firm to elastic, yellowish, hypervascular tumor was removed from the sellae. Therre was no CSF leakage during the operation, and VAP did not change after the operation as well. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with neck extended. We made one incision at medial nasal wall of right nostril, and dissected to expose vomer. Vomer was knocked off, and spheniod sinus mucosa was removed. After C-arm localization, we opened the sellar floor, and made incision at the sellar dura. Tumor was removed in piecemeal fashion, and hemostasis was performed with gelfoam packing. Autologous fat graft was harvested from left lower abdomen, and inserted into sphenoidal sinus. Bone graft was put back, and merocels was put into bilateral nostril for mucosa reduction. Operators VS 曾勝弘 Assistants R4 曾峰毅 相關圖片 蘇靖棠 (M,2007/03/14,5y0m) 手術日期 2011/03/08 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Craniosynostosis 器械術式 Cranioplasty for scaphocephaly 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 2 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:08 進入手術室 08:15 麻醉開始 08:45 誘導結束 09:00 抗生素給藥 09:40 手術開始 10:20 開始輸血 12:00 抗生素給藥 15:00 抗生素給藥 17:00 麻醉結束 17:00 手術結束 17:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱顏合併手術 1 1 B 手術 頭顱成形術 1 2 B 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 10 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 3 0 麻醉 Hemoglobin (Hb) 3 0 麻醉 測血糖 3 0 麻醉 Ca (Calcium) 3 0 麻醉 Na (Sodium) 3 0 麻醉 K (Potassium) 3 0 麻醉 Blood gas analysis 3 0 記錄__ 手術科部: 外科部 套用罐頭: Craniofacial reconstruction 開立醫師: 林哲光 開立時間: 2011/03/08 18:05 Pre-operative Diagnosis Craniosynostosis, scaphocephaly Post-operative Diagnosis Ditto Operative Method Craniofacial reconstruction Craniofacial reconstruction and cranioplasty by cranial vault reconstruction Specimen Count And Types Pathology Operative Findings Bilateral frontotemporal bone depression were noted, the gross was scaphoid in shape. 1. prolonged AP diameter of the skull with frontal bossing 2. Marked indentation over the coroanl suture that made the head shape bizzare Operative Procedures Under ETGA and supine position, skin disinfected and drapped were performed as usual. Bifrontal skin incision was made and the muscle falp was deflected. 8 burr holes were created (four surrounding the SSS and another four created at bilateral keyholes and temporal area). Craniotomy was done and three respective skull plate was dissected. The frontal part was incised as sunburst and deflected to correct the curve of the skull bone. The other two bilateral frontotemporal bone were incised to four pieces. The left skull bone was put to the right side and vice versa after the curve was fit to the relatively normal skull bone formation. The skull bones were fixed with microplates. The bony defects were covered with Duragen and some bony fragments. The wound was then closed in layers after subgaleal drain care. Under ETGA and supine position, skin disinfected and drapped were performed as usual. Bifrontal (bicoronal) zigzag skin incision was made and the betemporal muscle falp was deflected downward. 8 burr holes were created (four surrounding the SSS and another four created at bilateral keyholes and temporal area). Calvaria bone resection was done and three respective skull plate was dissected. The frontal part was incised as sunburst and deflected to correct the abnormal concave curve of the skull bone. The other two bilateral frontotemporal bone were incised to four pieces. The left skull bone was put to the right side and vice versa after the curve was fit to the relatively normal skull shape after multiple grooves were made with ghth speed drill at the inner surface of the bone plate. The skull bones were fixed with multiplemicroplates and screws as designed. Since the correctiona made the intracranial space increase, the large bone defect over the left parietal part was covered with a web shape miniplate (6X4 holes). The bony defects were covered with Duragen and some bony fragments. The periosteum and the temporalis muscle were sutured back. The wound was then closed in layers after subgaleal drain left in space. Operators AP 郭夢菲 Assistants R4 林哲光 相關圖片 簡扶真 (F,1956/06/12,55y9m) 手術日期 2011/03/08 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Cerebral aneurysm 器械術式 Brain tumor Crainotomy(Others) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 蔡立威, 時間資訊 00:00 臨時手術NPO 08:00 進入手術室 08:10 麻醉開始 08:35 誘導結束 08:55 手術開始 09:10 抗生素給藥 12:10 抗生素給藥 13:35 手術結束 13:35 麻醉結束 13:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 手術 腦微血管減壓術 1 1 L 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Microvascular Decompression 開立醫師: 蔡立威 開立時間: 2011/03/08 13:54 Pre-operative Diagnosis left hemifacial spasm Post-operative Diagnosis left hemifacial spasm Operative Method Microvascular Decompression Specimen Count And Types nil Pathology nil Operative Findings Ventral side of the facial nerve was compressed a arterial loop of PICA. Ventral side of the facial nerve was compressed by an arterial loop of PICA. Operative Procedures 1. Anesthesia: endrotracheal general. 2. Position: park-bench with left side up. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with a sterilized adhesive plastic sheet. 4. Incision: 6 cm long, along the retroauricular hair line with center at mastoid tip.(retroauricular with center at the junction of tranverse and sigmoid sinus.) 5. Craniectomy: 2x2 cm, suboccipital retromastoid closed tomastoid tip.(to 5. Craniectomy: 2x2 cm, suboccipital retromastoid closed to mastoid tip.(to expose the lower-posterior margin of the junction of transe and sigmoid sinus.) 6. Dural incision: epsilon fashion and reflected to sigmoid sinus. 7. CSF drainage via spinal tap was done for easy retraction of the cerebellum tothe medial side. 8. The cerebellum was retracted with the retractor in a direction from posterior-inferior to anterior-superior, i.e. from lower cerebelum to the flocullus. Therefore, the 7th & 8th cranial nerves were approach from the space between these 2 nerves and the lower cranial nerves. In such way, the arterial loop from PICA crossly compressed the 7th nerve was dissected 8. The arterial loop from PICA crossly compressed the 7th nerve was dissected away from the nerve without necessity of any touch on the nerve. The arterial loop was kept awayfrom the nerve by interposing the space between arterial loop was kept away from the nerve by interposing the space between them with teflon felt cotton.(The cerebellum was retracted to expose the them with teflon felt cotton. junction of petrous bone and tentorium, then the arachnoid membrane was opened and the petrousal vein was carefully mobilized (coagulated and divided). The arterial loop (branch of superior cerebellar artery) which crossly compressed the trigeminal nerve was isolated and pushed away from the nerve, then the space was interposed with teflon felt cotton to keep the nerve free from vascular compression.) 9. Dural closure: continuous 4-0 Prolene to obtain water-tight closure with fascial graft. 10.Skin closure: continuous suture with 3/0 Dexon forsubcutanuous layer and continuous suture with 3/0 nylon for the skin. 11. Drain: none. 12. Course of the surgery:smooth. Operators VS賴達明 Assistants R5蔡宗良,R2蔡立威 姚盧高美 (F,1948/10/28,63y4m) 手術日期 2011/03/08 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Spondyloisthesis, acquired 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 蔡立威, 時間資訊 00:00 臨時手術NPO 13:55 進入手術室 14:00 麻醉開始 14:10 誘導結束 14:50 抗生素給藥 15:00 手術開始 19:10 手術結束 19:10 麻醉結束 19:20 送出病患 19:22 進入恢復室 21:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎弓切除術(減壓)-二節以內 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: 1. Posterior instrumentation, transpedicular ... 開立醫師: 蔡立威 開立時間: 2011/03/08 19:30 Pre-operative Diagnosis Spondylolisthesis, Grade I, L4-L5 Lumbar spinal stenosis, L4-5 Post-operative Diagnosis Spondylolisthesis, Grade I, L4-L5 Lumbar spinal stenosis, L4-5 Operative Method 1. Posterior instrumentation, transpedicular screw and rod fixation, L4-5 2. Posterior decompression, left side laminectomy, L4-5 2. Posterior decompression, left side laminectomy, L4 3. Discectomy, L4-5 Specimen Count And Types nil Pathology nil Operative Findings Hypertrophy of L4-5 ligmentum flavum, causing severe lumbar spinal stenosis Operative Procedures Under endotracheal general anesthesia, prone position, we did skin disinfection and drapping as usual. Skin incision was posterior midline, about from L3-S1 level. Then we performed periosteal dissection. transpedicular screws (6.0 x 40 mm) were inserted bilaterally to L4 and L5. L4-5 left side laminectomy was then performed. L4-5 discectomy were prepared for transforaminal interbody fusion. A 9-mm height Synthes cage packed with autologuous bone fragments was implantated for L4-5 vertebral body fusion. Finally, L4-L5 screws were fixed by Synthes rods. Copious saline irrigation was performed after hemostasis. One HemoVac was inserted in paraspinal space. The wound was closed in layers. Under endotracheal general anesthesia, prone position, we did skin disinfection and drapping as usual. Skin incision was posterior midline, about from L3-S1 level. Then we performed periosteal dissection. transpedicular screws (6.0 x 40 mm) were inserted bilaterally to L4 and L5. L4 left side laminectomy was then performed. L4-5 discectomy were prepared for transforaminal interbody fusion. A 9-mm height Synthes cage packed with autologuous bone fragments was implantated for L4-5 vertebral body fusion. Finally, L4-L5 screws were fixed by Synthes rods. Copious saline irrigation was performed after hemostasis. One HemoVac was inserted in paraspinal space. The wound was closed in layers. Operators VS賴達明 Assistants R5蔡宗良,R2蔡立威 蔡品緻 (F,1980/10/03,31y5m) 手術日期 2011/03/08 手術主治醫師 賴達明 手術區域 東址 019房 03號 診斷 Spinal stenosis, lumbar 器械術式 Excision of neuroma 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 蔡立威, 時間資訊 00:00 臨時手術NPO 19:08 報到 19:20 進入手術室 19:30 麻醉開始 19:35 誘導結束 20:05 抗生素給藥 20:19 手術開始 21:20 手術結束 21:20 麻醉結束 21:30 送出病患 21:35 進入恢復室 22:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 軟組織良性腫瘤切除術,大或深 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: tumor excision 開立醫師: 蔡立威 開立時間: 2011/03/08 21:13 Pre-operative Diagnosis Retroperitoneal tumor, suspect neurilemmoma Post-operative Diagnosis Retroperitoneal tumor, suspect neurilemmoma Operative Method tumor excision Specimen Count And Types 1 piece About size:4*4cm Source:retroperitoneum Pathology pending Operative Findings One 4*4cm and one 1*1cm was noted at right retroperitoneum, lateral to right quadratus lumborum muscle. Pink in color, well-marginated, soft and fragile One 4*4cm and one 1*1cm neurogenic tumors were noted at right retroperitoneum, lateral to right quadratus lumborum muscle. Pink in color, well-marginated, soft and fragile Operative Procedures Under endotracheal general anesthesia, prone position, we did skin disinfection and drapping as usual. A transverse skin incision was performed over right back, L3-L4 level. After retraction of psoas muscle, we identified the tumoe and then resected them. Finally, the wound was closed in layers. Operators VS賴達明 Assistants R5蔡宗良,R2蔡立威 何東鏘 (M,1935/10/20,76y4m) 手術日期 2011/03/08 手術主治醫師 王一中 手術區域 東址 000房 02號 診斷 Cataract 器械術式 Phaco+PCIOL 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 09:50 進入手術室 09:55 麻醉開始 10:00 麻醉結束 10:07 手術開始 10:25 手術結束 10:35 送出病患 記錄__ 手術科部: 眼科部 套用罐頭: Phacoemulsification and PCIOL implantation (od ) 開立醫師: 麥珮怡 開立時間: 2011/03/08 10:20 Pre-operative Diagnosis Cataract (od ) Post-operative Diagnosis Cataract (od ) Operative Method Phacoemulsification and PCIOL implantation (od ) Specimen Count And Types nil Pathology nil Operative Findings Cataract (od ) Operative Procedures 1. Under retrobulbar anesthesia. 2. Disinfection, irrigation and draping. 3. Application of an eyelid speculum. 4. Made a clear corneal incision and penetrate into AC with 2.5mm trapezoid knife at 10 oclock position. 5. Inject Viscoat into the anterior chamber. 6. Continuous circular capsulorrhexis was done with bent needle and capsular forceps. 7. Made a sideport at 2 oclock position with the MVR blade. 8. Hydrodissection and hydrodelineation were done with BSS.9. Phacoemulsification of the nucleus by standard divide-and-conquer technique. 10. Aspiration of the residual cortical material with I/A tube. 11. Extend the cornea wound to 3.2mm by diamond knife. 12. Foldable PCIOL was implanted into the bag after injection of Viscoat. 13. The residual Viscoat was washed out by Simcoe I/A cannula. 14. Inject BSS into AC and check leakage, and inject Miostat to AC to constrict the pupil 15. Stromal hydrationof the wound with BSS 16. Subconjunctival injection of Rinderon and Garamycin. 17. Maxitrol patching. Operators 王一中, Assistants R3麥珮怡 陳林專 (F,1933/12/05,78y3m) 手術日期 2011/03/08 手術主治醫師 楊士弘 手術區域 東址 016房 01號 診斷 Intraspinal abscess 器械術式 Incision and debridement for paraspinal abscess, lumbar 手術類別 緊急手術 手術部位 脊椎 傷口分類 污染 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 彭元宏, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 08:55 報到 09:25 進入手術室 09:30 麻醉開始 09:40 誘導結束 10:25 手術開始 11:27 開始輸血 12:50 手術結束 12:50 麻醉結束 13:00 送出病患 13:05 進入恢復室 14:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 深部傷口處理縫合擴創-大 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 記錄__ 手術科部: 外科部 套用罐頭: Debridement of abscess,lumbar. 開立醫師: 鍾文桂 開立時間: 2011/03/08 14:07 Pre-operative Diagnosis Paraspinal abscess with suspected spondylodiskitis of lumbar spine. Post-operative Diagnosis Paraspinal abscess with suspected spondylodiskitis of lumbar spine. Operative Method Debridement of abscess,lumbar. Specimen Count And Types 1 piece About size:30cc Source:abscess content for bacterial, fungal, TB culture. Pathology Pending. Operative Findings 1. One fistula tract from skin( penetrated out) to paraspinal muscle and regions near the instruments at left with an abscess cavity at subcutaneous area. 2. Two fisutla tracts from subcutaneous area to paraspinal region. A large abscess cavity at the subcutaenous area was noted. Pus was collected for culture. 3. We were not able to identify the origin of the fistula tracts at paraspinal muscles. Operative Procedures Under ETGA, the patient was placed in prone position. After disinfection, draping, the previous operative wound was incisied and dissected. Undermining of the skin to reach the abscess cavity was done. Further dissection to expose the lower part of the spinal instrumentation was achieved. The fistula tracts and the abscess cavity was further debrided. Vancomycin contained normal saline was irrigated into the operative wound. After well hemostasis, the wound was closed in layers. One 1/8 hemovac drain was placed in paraspinal muscle and the other was placed above the fascia layer. Operators 楊士弘 Assistants R5鍾文桂 R1彭元宏 Indication Of Emergent Operation 相關圖片 吳瑋萍 (F,1979/11/08,32y4m) 手術日期 2011/03/08 手術主治醫師 林志峰 手術區域 西址 034房 01號 診斷 Acute lymphoid leukemia, without mention of remission 器械術式 Endoscopic functional sinus su 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 王永彬 ASA 3 紀錄醫師 邱義霖, 時間資訊 08:55 報到 08:58 進入手術室 09:00 麻醉開始 09:10 誘導結束 09:25 手術開始 11:22 開始輸血 13:00 手術結束 13:00 麻醉結束 13:10 送出病患 13:15 進入恢復室 14:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 鼻內電燒術 1 0 B 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 摘要__ 手術科部: 內科部 套用罐頭: Electrocauterization 開立醫師: 邱義霖 開立時間: 2011/03/08 13:20 Pre-operative Diagnosis 1. Remove previous nasal packing 2. Leukemia Post-operative Diagnosis 1. Remove previous nasal packing, repacking done 2. Leukemia Operative Method Electrocauterization Specimen Count And Types nil Pathology nil Operative Findings Diffuse bleeding over bilateral nasal cavity Operative Procedures The patient was in supine position The operative field was disinfected and draped as usual. Previous nasal packing were removed under sinuscope assisted. Then much diffuse bleeding was noted. tTissue codu was used at elft side nasal cavity to block the spehnoid sinus bleeding with success. However, the bleeding can not be stop. Thus, renasal packing was done. The above procedure was completed smoothly. The patient tolerated the whole procedure well. Operators vs林志峰 Assistants R3邱義霖 王啟柱 (M,1912/02/04,100y1m) 手術日期 2011/03/08 手術主治醫師 蕭輔仁 手術區域 東址 005房 03號 診斷 Fracture of multiple cervical vertebra, closed 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾峰毅, 時間資訊 00:00 臨時手術NPO 14:40 報到 14:55 進入手術室 15:00 麻醉開始 15:20 誘導結束 15:47 抗生素給藥 16:45 手術開始 18:52 抗生素給藥 20:00 麻醉結束 20:00 手術結束 20:18 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 曾峰毅 開立時間: 2011/03/08 20:17 Pre-operative Diagnosis Odontoid fracture Post-operative Diagnosis Odontoid fracture Operative Method Occipitocervical fixation and fusion with autologous bone graft and artificial bone graft Specimen Count And Types Nil Pathology Nil Operative Findings Depuy lateral mass scerws, 16 mm long, were inserted into bialteral lateral mass of C3 and C4. Y-shape plates was used, and two 16 mm long screws were used for plate fixation. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position with head fixed with Halo-vest. After skin shaved, scrubbed, disinfected, and then draped, we made one midline skin incison from inion to C6 spinous process. We dissected paraspinal muscles to expose laminae from C1 to C4. We inserted lateral mass screws into bilateral lateral mass of C3 and C4, and implanted Y-shape plate at occipital bone with screws fixation. Rod was used for fixation as well, and then C1-2 lamina decortication was peformed. Fusion was done with artificial bone graft and autologous bone graft. After one hemovac, the wound was closed in layers. Operators VS 蕭輔仁 Assistants R4 曾峰毅 許進興 (M,1940/07/09,71y8m) 手術日期 2011/03/08 手術主治醫師 蔡翊新 手術區域 東址 002房 05號 診斷 Injury (severeity score >=16) 器械術式 V-P shunt 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 鍾文桂, 時間資訊 09:48 通知急診手術 14:32 進入手術室 14:35 麻醉開始 14:40 誘導結束 15:32 手術開始 16:25 手術結束 16:25 麻醉結束 16:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Implantation of ventriculoperitoneal shunt vi... 開立醫師: 鍾文桂 開立時間: 2011/03/08 16:59 Pre-operative Diagnosis Hydrocephalus. Post-operative Diagnosis Hydrocephalus. Operative Method Implantation of ventriculoperitoneal shunt via right Kocher. Specimen Count And Types 1 piece About size:3 cc Source:CSF for routine, culture, and glucose/TP. Pathology Nil. Operative Findings Clear light yellowish CSF, pressure: 7cmH2O. Medtronic medium pressure V-P shunt was used. Ventricular catheter: 6.5cm, peritoneal catheter: 25cm. Operative Procedures Under ETGA, the patient was placed in supine position and the head was tilted to the left side. After shaving,disinfection, and draping, the previous burr hole incision was opened. A incision was made at right upper quadrant of abdomen. After dissecting into the peritoneal cavity, the shunt catheter was placed through the created subcutaneous tunnel. The ventriculostomy was done. The reservoir connected ventricular catheter was placed into the ventriculostomy. The shunt catheter was connected to the reservoir. After ensuring the shunt patency, the shunt was placed into the peritoneal cavity. The wounds were closed in layers. Operators 蔡翊新 Assistants R5 鍾文桂 Indication Of Emergent Operation 相關圖片 謝鴻經 (M,1950/04/01,61y11m) 手術日期 2011/03/08 手術主治醫師 蔡翊新 手術區域 東址 002房 01號 診斷 Traumatic brain injury 器械術式 ICP monitoring 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 3E 紀錄醫師 李振豪, 時間資訊 05:19 通知急診手術 06:10 報到 06:10 進入手術室 06:15 麻醉開始 06:20 誘導結束 06:30 抗生素給藥 06:48 手術開始 07:42 麻醉結束 07:42 手術結束 07:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 顱內壓視置入 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Right frontal ICP monitoring 開立醫師: 李振豪 開立時間: 2011/03/08 08:39 Pre-operative Diagnosis Traumatic brain injury with contusional ICH, SDH, and SAH Post-operative Diagnosis Traumatic brain injury with contusional ICH, SDH, and SAH Operative Method Right frontal ICP monitoring Specimen Count And Types nil Pathology Nil Operative Findings The reddish CSF gushed out after opening the dura. The ICP was 3~5mmHg after wound closure. ICP reference: 487 Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine position. The scalp was shaved, scrubbed, and disinfected as usual. The linear scalp incision was made at right frontal area followed by one burr hole creation. Three dural tenting was performed for hemostasis. The dura was opened and the ICP monitor was inserted. Hemostasis was achieved with bipolar electrocautery and Gelform packing. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS王國川 Assistants R4李振豪 Indication Of Emergent Operation 相關圖片 胡火亮 (M,1954/03/28,57y11m) 手術日期 2011/03/09 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Brain Tumor 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:06 進入手術室 08:15 麻醉開始 08:40 誘導結束 09:03 手術開始 09:10 抗生素給藥 12:10 抗生素給藥 14:15 麻醉結束 14:15 手術結束 14:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 R 手術 歐氏貯囊置放手術 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: 1. Right subfrontal approach for partial tumo... 開立醫師: 王奐之 開立時間: 2011/03/09 14:32 Pre-operative Diagnosis 1. Craniopharyngioma with recurrence 2. Left side chronic subdural hematoma Post-operative Diagnosis 1. Craniopharyngioma with recurrence 2. Left side chronic subdural hematoma Operative Method 1. Right subfrontal approach for partial tumor removal 1. Right interhemispheric approach for cyst aspiration and partial tumor removal 2. Left side burr hole for chronic subdural hematoma evacuation Specimen Count And Types 1 piece About size:pieces Source:anterior cranial base tumor Pathology Pending Operative Findings Severe adhesion was noted at subgaleal and subdural region. The anterior superior sagittal sinus was injured during durotomy and ligated with sutures. The lesion noted on T2WI MRI is mostly cystic content with only scanty tumor cells. An Ommaya reservoir was set in the cystic portion of the tumor and fixed at midline frontal area. Dark reddish fluid was drained from left side burr hole. Operative Procedures After ETGA, the patient was placed in supine position and head fixed in Mayfield skull clamp with face slightly turned to left. After scalp shaving, disinfection and draping in sterile fashion, a curvilinear preauricular incision was made along previous scar. The scalp was reflected anteriorly and the previously fixed miniplates were removed. Previous right frontal craniotomy bone flap was removed. After dural tenting, a L-shaped durotomy was done and the dura was reflected towards the midline. The frontal lobe was then retracted superiorly, revealing the cystic tumor. The cystic content were mostly aspirated; the thin tumor capsule was left untouched. After meticulous hemostasis, an Ommaya reservoir was then set with its tip lies at the cystic portion of the tumor. The dura was closed in water-tight fashion with 4-0 Prolene. The bone was fixed back and the Ommaya was secured. A burr hole was made at left frontal area, followed by a small cruciate durotomy and chronic subdural hematoma evacuation. A rubber drain was set as subdural drain. After setting a subgaleal CWV drain, securing the subdural drain and deairing, the wound was closed in layers. After dural tenting, a L-shaped durotomy was done and the dura was reflected towards the midline. The frontal lobe was then retracted lateral and superiorly, revealing the cystic tumor. The cystic content were mostly aspirated; the thin tumor capsule was left untouched. After meticulous hemostasis, an Ommaya reservoir was then set with its tip lies at the cystic portion of the tumor. The dura was closed in water-tight fashion with 4-0 Prolene. The bone was fixed back and the Ommaya was secured. A burr hole was made at left frontal area, followed by a small cruciate durotomy and chronic subdural hematoma evacuation. A rubber drain was set as subdural drain. After setting a subgaleal CWV drain, securing the subdural drain and deairing, the wound was closed in layers. Operators P 杜永光 Assistants R6 陳睿生, R3 王奐之 相關圖片 陳修爵 (M,1934/03/20,77y11m) 手術日期 2011/03/09 手術主治醫師 杜永光 手術區域 東址 003房 02號 診斷 Carotid stenosis 器械術式 Carotid endarterectomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 14:31 進入手術室 14:35 麻醉開始 14:43 報到 14:55 誘導結束 15:05 抗生素給藥 15:45 手術開始 18:45 麻醉結束 18:45 手術結束 18:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 動脈內膜切除術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 摘要__ 手術科部: 外科部 套用罐頭: Right ICA endarterectomy 開立醫師: 王奐之 開立時間: 2011/03/09 19:33 Pre-operative Diagnosis Right proximal ICA stenosis Post-operative Diagnosis Right proximal ICA stenosis Operative Method Right ICA endarterectomy Specimen Count And Types nil Pathology Nil Operative Findings Thick plaque was noted at proximal ICA, ECA and CCA junction, about 3cm in length. A Dacron VSD patch was applied to the proximal ICA for wall strengthening. CCA ischemia time: 25 minutes. Operative Procedures After ETGA, the patient was placed in supine position with neck hyperextended and head turned to left. An oblique linear skin incision was made at right upper neck (right beneath the mandibular angle). After dissecting through platysma and retracted SCM muscles medially, the carotid sheath was opened. After identifying the right side CCA, ECA and ICA, a linear incision along CCA-ICA was done throught the arterial wall but not the plaque. The atherosclerotic plaque was then dissected off from the arterial wall. Proximal & distal controls were then done, and the plaque was pulled out en bloc. The incision was then closed with 4-0 Prolene in continuous suture. The ICA segment was augmented with a Dacron VSD patch. After meticulous hemostasis and setting a mini-hemovac, the wound was closed in layers. Operators P 杜永光 Assistants R6 陳睿生, R3 王奐之 相關圖片 賴月嬌 (F,1962/08/23,49y6m) 手術日期 2011/03/09 手術主治醫師 王水深 手術區域 東址 017房 02號 診斷 Brain tumors, malignant 器械術式 Port-A catheter implatation 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 張得一, 時間資訊 09:40 報到 09:56 進入手術室 10:09 麻醉開始 10:10 誘導結束 10:12 手術開始 10:29 手術結束 10:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 內頸靜脈切開,永久導管放置術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Port-A 開立醫師: 張得一 開立時間: 2011/03/09 10:35 Pre-operative Diagnosis Lymphoma Post-operative Diagnosis Lymphoma s/p Port-A implantation Operative Method Port-A catheter implantation, echo guided Specimen Count And Types nil Pathology nil Operative Findings Puncture to right IJV under echo guidance The venous blood flow freely in the Port-A catheter after implantation. Operative Procedures The patient was put on supine position. The operation field was disinfected and draped as usual. Under local anesthesia, we puncture to right IJV under echo guidance. After creating subcutaneous pocket, the Port-A catheter was inserted via peel away sheath. We close the wound in layers. Operators P王水深 Assistants R3張得一 林秋玉 (F,1976/12/23,35y2m) 手術日期 2011/03/09 手術主治醫師 曾漢民 手術區域 東址 018房 04號 診斷 Brain tumor 器械術式 Debridment-- 5-10cm 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 14:55 報到 15:05 進入手術室 15:07 麻醉開始 15:10 誘導結束 15:30 手術開始 15:33 手術結束 15:33 麻醉結束 15:40 送出病患 15:50 進入恢復室 16:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 深部傷口處理縫合擴創-小 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 摘要__ 手術科部: 外科部 套用罐頭: Remove drainage tube 開立醫師: 曾偉倫 開立時間: 2011/03/09 18:31 Pre-operative Diagnosis Right lateral ventricle tumor with extension to left lateral ventricle and foramen of Monro status post tumor resection Post-operative Diagnosis Right lateral ventricle tumor with extension to left lateral ventricle and foramen of Monro status post tumor resection Operative Method Remove drainage tube Specimen Count And Types nil Pathology Nil Operative Findings 1. CWV drain was free, difficult drain removal at ward. Operative Procedures Under IVG, the patient was put on supine position. After we disinfected and drapped, we removed the stitches and sub-cutaneous suture. The drain was removed and the wound was closed. Operators VS 曾漢民 Assistants R5 鍾文桂 王綱領 (M,1943/03/04,69y0m) 手術日期 2011/03/09 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Subdural and cerebral hemorrhage 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:05 進入手術室 08:25 麻醉開始 08:48 抗生素給藥 08:50 誘導結束 09:17 手術開始 11:48 抗生素給藥 12:02 麻醉結束 12:02 手術結束 12:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 急性硬腦膜下血腫清除術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Left parietal craniotomy for evacuation of su... 開立醫師: 鍾文桂 開立時間: 2011/03/09 12:42 Pre-operative Diagnosis Bilateral chronic subdural hemorrhage status post op with left frontal-temporal-parietal subacute subdural hemorrhage. Post-operative Diagnosis Bilateral chronic subdural hemorrhage status post op with left frontal-temporal-parietal subacute subdural hemorrhage. Operative Method Left parietal craniotomy for evacuation of subacute subdural hemorrhage. Specimen Count And Types 1 piece About size:5cc Source:outer membrane of subacute SDH. Pathology Pending. Operative Findings 1. Presence of inner and outer membrane. Intact inner membrane after hematoma evacuation. 2. Organized gelly like red-brown hematoma was noted in F-T-P subdural space. 3. Presence of some bridging veins in the operative field. They were electrocoagulated. 4. Mild brain expansion after hematoma evacuation. Operative Procedures Under ETGA, the patient was placed in supine position and the head was tilted to the right. After shaving, disinfection and draping, the previous two operative wounds for burr hole were incised and a reverse U scalp incision was made finally. After pericranium dissection, a 6 cm craniotomy was made. After durotomy, the outer membrane was excised at the craniotomy window. The subdural hematoma was evacuated through suction. After well hemostasis, the dura mater was closed in water tight fashion with a subdural drain in situ. The craniotomy plate was fixed by mini plates ans screws. The wound was closed in layers. Operators 曾漢民 蔡翊新 Assistants 鍾文桂 曾偉倫 相關圖片 李慶同 (M,1953/10/01,58y5m) 手術日期 2011/03/09 手術主治醫師 曾漢民 手術區域 東址 005房 03號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 14:55 進入手術室 15:00 麻醉開始 15:10 誘導結束 15:55 手術開始 17:00 抗生素給藥 18:10 手術結束 18:10 麻醉結束 18:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Right temporal-parietal craniotomy for tumor... 開立醫師: 曾偉倫 開立時間: 2011/03/09 18:45 Pre-operative Diagnosis Small cell carcinoma of lung with right temporal-parietal metastasis. Post-operative Diagnosis Small cell carcinoma of lung with right temporal-parietal metastasis. Operative Method Right temporal-parietal craniotomy for tumor excision. Specimen Count And Types 1 piece About size:10cc Source:brain tumor Pathology Pending. Operative Findings Grayish-red elastic soft,hypervascularized tumor at right temporal parietal area. Serous brownish cystic content in the tumor. Intraoperative ultrasonography was used to localize the tumor. Thin dura mater. severe adhsion of the dura mater to the skull bone. The dural defects were repaired by DuraFoam. Operative Procedures Under ETGA, the patient was placed in supine position and the head was tilted to the left side. After shaving, disinfection, and draping, a reverse U scalp incision was made just above the right ear lobe. After scalp dissection, a 5 cm craniotomy was created. After durotomy and a small corticotomy, the tumor was excised in piece meal fashion and suction. After total tumor excision and well hemostasis, the dura mater was closed primarily and repaired by DuraFoam. The bone plate was fixed by wires. A CWV drain was placed above the skull bone. The wound was closed in layers. Operators VS 曾漢民 Assistants R5 鍾文桂 R2 曾偉倫 相關圖片 石聰富 (M,1955/01/04,57y2m) 手術日期 2011/03/09 手術主治醫師 李章銘 手術區域 東址 019房 01號 診斷 Esophageal cancer 器械術式 VATS Esophagectomy+Total ScopyGastrectube reconstruction 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 全賀顯, 黃麒軒, 時間資訊 07:50 報到 08:10 進入手術室 08:17 麻醉開始 09:15 誘導結束 09:15 抗生素給藥 09:50 手術開始 12:15 抗生素給藥 14:15 14:16 15:15 抗生素給藥 16:30 18:15 抗生素給藥 18:35 麻醉結束 18:35 手術結束 18:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 術後止痛 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 13 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 胸腔鏡食道切除術 1 1 R 手術 食道再造術–以胃管重建 1 1 手術 腹腔鏡空腸造廔術 1 3 手術 舌骨上區清除術 1 1 L 手術 舌骨上區清除術 1 2 R 記錄__ 手術科部: 外科部 套用罐頭: esophagectomy,staple 開立醫師: 全賀顯 開立時間: 2011/03/09 19:53 Pre-operative Diagnosis Esophageal cancer Post-operative Diagnosis Esophageal cancer Operative Method VATS Esophagectomy and total scopy gastrectube reconstruction Specimen Count And Types Esophagus, stomach and lymph node Pathology Squamous cell carcinoma Operative Findings 1. Tumor location: lower 1/3 of the esophagus. 2. Tumor invasion(T3): Muscle wall 3. Lymph nodes enlargement: 107 mild enlargement Operative Procedures 1. Anesthesia: General anesthesia using double-lumen endotracheal tube. 2. Position: Left decubitus position. An axillary roll is placed under the down side. The operative field is well disinfected and draped. 3. Camera port: From the seventh intercostal space in the mid-axillary line away from the lesion. 4. Working ports: First: From the fifth intercostal space in the anterior axillary line. Second: From the fifth intercostal space in the posterior axillary line. Third: From the seventh intercostal space in the posterior axillary line. 5. The pleural adhesions are separated by grasping forceps and by electrocautery. 6. The intrathoracic portion of the esophagus is dissected. The esophagus, encased in its periareolar tissue containing the paratracheal, subcarinal, paraesophageal, and parahiatal nodes (group 105, 106, 107(mild enlarge), 108, 109, 110) is pulled into the right thorax. Inferiorly, blunt dissection was performed to the level of esophagogastric junction. Superiorly, the esophagus is bluntly dissected into the neck. 6. The esophagus is then divided superiorly and inferiorly and then we marked it with colored cotton. 9. After meticulous homeostasis, one 28# chest tubes is placed via the camera port. The lung is ventilated under the direct vision. The skin is closed with 4-0 Nylon sutures. 9. The patient is moved to supine position with neck hyperextension. The endotracheal tube was changed to single lumen tube. 10. The anterior part of neck, chest, and abdomen are disinfected and draped as usual. 11. Make an transverse incision over left side of umbilical and place a 10-mm trocar through the wound then insufflate CO2 via trocar. 12. Insert the 10-mm laparoscope. Perform laparoscopic inspection and begin exploration. 13. Under direct vision, insert a 5-mm port at the upper left and right area, Insert the 10-mm right lower area. 14. The lesser sac was opened through the greater omentum. The greater omentum is detached from the greater curvature of the stomach with preservation of gastroepiploic arch. The short gastric artery was divided, and the dissection continued along the left crus. 15. On the right side, the gastrohepatic ligament was dissected upward to the right crus and downward to the pylorus. The left gastric artery was identified and divided close to where it comes off the celiac axis. Lymph nodes in the vicinity of the celiac axis are dissected. 16. A Kocher maneuver is done for release of duodenum. Pyloroplasty is done. The lesser curvature side of stomach was resected partially including cardia with stapler.The right gastric and gastroepiploic arteries are preserved as pedicles of gastric tube. 17. Simultaneously, an oblique incision was made at anterior border of bilateral sternocleidomaststoid muscle. The muscle was retracted posteriorly and esophagus was identified and mobilized. Group 104 lymph nodes were dissected. Retrosternal tunnel was created by blunt dissection. 18. The gastric tube was passed up through the retrosternal tunnel and advanced to the neck. was passed through the pyloric incision and advanced upward to the neck out of the fundus. The cervical side-to-side esophagogastrostomy was performed by GIA-60 two times. 19. The outer layer of anastomosis is reinforced using 4-0 Maxon interrupted sutures. 20. The pyloric incision was closed. The neck incision was closed and three drain tubes were placed around the anastomosis. 21. A jejunostomy (use double lumen) by laparoscopic method was created at about 30 cm below the Treitz ligament. 22. Two rubber drain tubes were placedat right infrahepatic and left subphrenic area. Then the port incision was closed layer by layer. The patient was sent to SICU for postoperative care. Operators VS李章銘 Assistants R5李佳穎 R3高明蔚 R1全賀顯 記錄__ 手術科部: 耳鼻喉部 套用罐頭: Selective neck dissection, bilateral, level I... 開立醫師: 黃麒軒 開立時間: 2011/03/12 18:44 Pre-operative Diagnosis Esophageal cancer Post-operative Diagnosis Esophageal cancer, operated Operative Method Selective neck dissection, bilateral, level II, III, IV Specimen Count And Types 1.Right neck lymphoareolar tissue 1.Right neck lymphoareolar tissue, 2.5x2.5 cm 2.Left neck lymphoareolar tissue 2.Left neck lymphoareolar tissue, 3x3 cm Pathology pending Operative Findings Small lymph nodes over bilateral neck Operative Procedures The patient was in supine position with the head rotated toward left side and was set up with general anesthesia. The operation field for neck dissection was draped and disinfected as usual. Skin incision was made as shown the figure. The skin flaps were elevated at the subplatysmal plane, anteriorly to the midline of neck, posteriorly to the posterior border of SCM muscle, inferiorly down to the clavicle, and superiorly to the mandible. Some small lymph nodes, about 1 cm in size, were identified at the level II and III. The lymphoareolar tissue, lateral to the strap muscles and midline of the submental area, superior to clavicle, inferior to left mandible, below the SCM muscle (level II, III and partial IV), was then removed with blunt and sharp dissection from the bottom upwards. SCM muscle, internal jugular vein, phrenic nerve and spinal accessory nerve were preserved. The same procedures were performed on the left side. After hemostasis, a CWV drain was inserted. The operation wound was then closed layer by layer with 4-0 Vicryl and 5-0 Nylon. Operators AsP王成平 Assistants R4孟繁宇 R2黃麒軒 黃禹瑞 (M,2009/05/26,2y9m) 手術日期 2011/03/09 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Hydrocephalus 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 1E 紀錄醫師 林哲光, 時間資訊 07:55 報到 08:05 進入手術室 08:20 麻醉開始 08:25 誘導結束 09:10 抗生素給藥 09:31 手術開始 10:25 手術結束 10:25 麻醉結束 10:31 送出病患 10:34 進入恢復室 11:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室腹腔分流手術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 郭夢菲 開立時間: 2011/03/09 13:19 Pre-operative Diagnosis Hydrocephalus, S/P VP shunt insertion with slit ventricle formaiton Post-operative Diagnosis Hydrocephalus, S/P VP shunt insertion with slit ventricle formaiton Operative Method V-P Shunt revision by adding Codman programmable reservoir V-P Shunt revision by adding Codman programmable reservoir with pressure setting 110mmH2O Specimen Count And Types nil Pathology nil Operative Findings The ventricle was small on preop MRI which was supported by the scanty CSF flowing out from the disconnected shunt. The CSF was clear and transparent. Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: supine with head rotated to left 3.Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4.Incision: 4 cm along with pervious op scar over the right Kocher point. 5.The shunt was disconnected between the medium pressure reserbvoir and the distal catheter, then the programmable reservoir was connected onto the shunt chamber. 6.Anothere small linear incision was made at the postauricualr region. The distal catheter including the previous antisiphon device (Delta chamber) was disseted out an =removed. 7. A subcutaneous tunnel was made between the scalp and postauricular wounds then the programmable reservoir was passed downward and then connected onto the distal catheter with an additional length of distal catheter for about 5 cm. 8. Scalp closure: hemostasis was done. Galea suture was performed by continuous suture with 3/0. vicryl and skin by continuous suture with both 3/0 and 4-0 nylon. 9.Course of the surgery: smooth. Operators Assistants 王秀琴 (F,1935/12/29,76y2m) 手術日期 2011/03/09 手術主治醫師 賴達明 手術區域 東址 002房 01號 診斷 Compression fracture, pathological, spontaneous 器械術式 Spinal fusion posterior 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 陳睿生, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 08:21 通知急診手術 09:12 報到 09:40 麻醉開始 09:45 進入手術室 09:45 誘導結束 10:25 抗生素給藥 11:06 手術開始 13:25 抗生素給藥 15:23 手術結束 15:23 麻醉結束 15:30 送出病患 15:35 進入恢復室 17:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎弓切除術(減壓)-二節以內 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: 1. Posterior instrumentation, transpedicular ... 開立醫師: 陳睿生 開立時間: 2011/03/09 17:12 Pre-operative Diagnosis Compression fracture of T12 with spinal cord compression Post-operative Diagnosis Compression fracture of T12 with spinal cord compression Operative Method 1. Posterior instrumentation, transpedicular screw T10, T11, T12, and L1 with rod and cross-link fixation 2. Laminectomy, T12 Specimen Count And Types None Pathology None Operative Findings Facet hypertrophy and canal stenosis caused by hypertrophy of ligmentum flavum. Operative Procedures Under endotracheal general anesthesia, prone position, we did skin disinfection and drapping as usual. Skin incision was posterior midline, about from T10-L1 level. Then we performed periosteal dissection. transpedicular screws were inserted bilaterally from T10 to L1. T12 laminectomy were then performed. Finally, L4-L5 screws were fixed by Synthes rods and Cross-link. Autologous bone grafts were placed bilaterally to the rods. Copious saline irrigation was performed after hemostasis. One 1/8 HemoVac was inserted in paraspinal space. The wound was closed in layers. T12 laminectomy were then performed. Finally, T10 to L1 screws were fixed by Synthes rods and Cross-link. Autologous bone grafts were placed bilaterally to the rods. Copious saline irrigation was performed after hemostasis. One 1/8 HemoVac was inserted in paraspinal space. The wound was closed in layers. Operators VS 賴達明 Assistants R5 蔡宗良, Intern 柯嘉怡 Indication Of Emergent Operation 林景富 (M,1975/08/30,36y6m) 手術日期 2011/03/09 手術主治醫師 賴達明 手術區域 東址 005房 02號 診斷 Pituitary tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 12:20 進入手術室 12:25 麻醉開始 13:05 誘導結束 13:15 抗生素給藥 13:35 手術開始 14:30 手術結束 14:30 麻醉結束 14:42 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經由蝶竇之腦下垂體瘤切除 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Trans-sphenoid Hypophysectomy 開立醫師: 曾偉倫 開立時間: 2011/03/09 14:39 Pre-operative Diagnosis Pituitary macroadenoma Post-operative Diagnosis Pituitary macroadenoma Operative Method Trans-sphenoid Hypophysectomy Specimen Count And Types 1 piece About size:0.5x0.5x0.3 cm Source:Pituitary tumor Pathology Pending Operative Findings 1. The tumor was grey-reddish, soft hypervasculized tumor over sellar area whitch pushed the pituitary gland to the left side 2. Minor CSF leak was noted intra-operatively 3. The normal gland was intact Operative Procedures Under ETGA, the patient was put in supine position with head tilted 30 degree to left. The facial skin was antiseptic with alcohol better-iodine tincture, and the mucosa of oral and nasal cavity with aqueous better-iodine. The formerareas were covered by sterilized adhesive plastic sheets then draped. Under endoscope, the nasal mucosa was coagulated at right norstril. A nasal speculum was applied to displace the nasal mucosa laterally and keep thenasal cavity open constantly for the exposure of the vomer bone and the anterior wall of the sphenoid sinus. The anterior sphenoid wall and posterior sphenoid wall was remove by high speed air drill and Kerrison punch. The sellar floor dura was coagulated then opened in cruciate fashion. The soft tumor parenchyma was removed by curette and aligator. The CSF leakage was sealed with gelform packing. The arachnoid and the opening of diaphragm sellae was enforcedby packing with gelform as in the sellar cavity. The nasal mucosa returned to its normal position. Right side of the nasal cavities was tightly packed with a segment of rubber glove finger filled with vaseline gauze strips which had been soaked with better-iodine ointment. Operators VS 賴達明 Assistants R5 鍾文桂 R2 曾偉倫 相關圖片 廖福林 (M,1988/07/28,23y7m) 手術日期 2011/03/09 手術主治醫師 蔡翊新 手術區域 東址 011房 02號 診斷 重大創傷且及嚴重程度到達創傷嚴重程度分數16分以上 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 4E 紀錄醫師 林哲光, 時間資訊 09:55 通知急診手術 10:25 進入手術室 10:25 報到 10:30 麻醉開始 10:45 誘導結束 10:50 抗生素給藥 11:10 手術開始 13:55 手術結束 13:55 抗生素給藥 13:55 麻醉結束 14:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 硬腦膜外血腫清除術 1 1 R 手術 顱內壓視置入 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 創傷醫學部 套用罐頭: Right pterional approach and EDH removal; ICP... 開立醫師: 林哲光 開立時間: 2011/03/09 14:58 Pre-operative Diagnosis Right temporal EDH Post-operative Diagnosis Ditto Operative Method Right pterional approach and EDH removal; ICP monitoring at subdural area of right temporal part Specimen Count And Types Pathology Operative Findings Pre-operative GCS was M5. Around 10ml EDH was noted at right temporal base and tip. The dura seemed not very bulging after craniotomy and ICP was 5mmHg when the ICP is inserted due to unintentional dural tear when removal of the sphenoid ridge. Around 4cm long fracture line was noted at right temporal bone and part of the bone marrow was exposed and some bleeding was noted. The bleeding was ceased after bone wax package. The close pressure was around 7 mmHg. Operative Procedures Under ETGA and supine position with head mild rotated to left side, skin disinfected and drapped were performed as usual. A curvilinear skin incision was made at right F-T area. A burr hole was created at right temporal base after temporalis muscle was dissected. The dura seemed not bulging very hard. Another three burr two burr holes were created at keyhole and the temporal line. Craniotomy was then performed. The sphenoid ridge was removed and the temporal base and tip were exposed with temporal lobe retraction. EDH was removed. The dura tear was closed. ICP was inserted in subdural area right temporal area near the temopral line. The skull bone was fixed with mini-plates after dural tening, central tenting and epidural drain insertion. The wound was then closed in layers. Operators VS 蔡翊新 Assistants R4 林哲光 Indication Of Emergent Operation 相關圖片 江美滿 (F,1959/10/17,52y4m) 手術日期 2011/03/09 手術主治醫師 許博欽 手術區域 兒醫 069房 03號 診斷 Uterine myoma 器械術式 L.A.V.H 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 楊育絜, 時間資訊 14:20 進入手術室 14:25 麻醉開始 14:35 誘導結束 14:40 抗生素給藥 15:02 手術開始 17:10 手術結束 17:10 麻醉結束 17:15 送出病患 17:20 進入恢復室 18:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 手術 腹腔鏡全子宮切除術 1 1 摘要__ 手術科部: 婦產部 套用罐頭: LAVH 開立醫師: 楊育絜 開立時間: 2011/03/09 17:26 Pre-operative Diagnosis Myoma uteri Post-operative Diagnosis Myoma uteri Operative Method Laparoscopic assisted vaginal hysterectomy Specimen Count And Types 1 piece About size:183gm Source:uterus Pathology pending Operative Findings 1. Uterus: avfl, one 4x4cm subserosal myoma over right fundus 2. Adnexae: grossly normal 3. Cul-de-sac: free 4. Total weight of uterus: 183gm 5. Estimated blood loss: 100ml Blood transfusion: nil Complication: nil One CWV drain from right at CDS Operative Procedures 1. Put the patient on lithotomy position and vaginal douching. 2. Skin disinfection and draping 3. Insert uterine elevator and on 12# Foley 4. Make a 1cm skin incision below the umbilicus 5. Insert Varess needle and make pneumoperitoneum 6.Insert 10 mmtrocar and laparoscopy 7. Insert 2nd (10mm) and 3rd (5mm) trocar under laparoscopic inspection 8. Injection diluted Pitressin (1:100) into utero-vesical fold and bilateral broad ligament 9. Cut off bilateral round ligaments via electrocauterization 10.Cut off bilateral ovarian ligaments and fallopian tubes via electrocauterization 11. Dissect and cut off serosa over utero-vesical and utero-rectal fold 12. Submucosal injection of diluted Pitressin (1:100) around the cervix 13. Make incision on the anterior vaginal mucosa and circumcision the cervix. 14. Enter the vesico-cervical space and utero-rectal space with long Kelly. 15.Clamp, cut and suture ligate bilateral utero-sacral ligaments with 1-0 Vicryl 16. Open the peritoneal cavity, anteriorly and posteriorly. 17. Clamp, cut and suture ligate bilateral cardinal ligaments with 1-0 Vicryl 18. Cut the uterus through midline with scissors 19. Morceration of the uterus 20. Clamp,cut and suture ligate bilateral ovarian ligaments and remove the uterus 21. Reperitonealization and approximate the vaginal stump. 22. Check bleeding and hemostasis under laparoscopy. Insert one CWV drain from right at CDS 23. Remove trocar and repair skin with 3-0 Vicryl Operators 許博欽, Assistants 楊育絜, 黃佩慎, 羅玉梅 (F,1955/04/25,56y10m) 手術日期 2011/03/10 手術主治醫師 曾勝弘 手術區域 東址 005房 03號 診斷 Brain tumors, malignant 器械術式 Port-A catheter Implatation 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 蔡立威, 時間資訊 00:00 臨時手術NPO 13:55 進入手術室 14:15 麻醉開始 14:16 誘導結束 14:17 手術開始 15:10 手術結束 15:12 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 port–A導管植入術–治療性導管植入術 1 0 摘要__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 蔡立威 開立時間: 2011/03/10 14:54 Pre-operative Diagnosis CNS lymphoma Post-operative Diagnosis CNS lymphoma Operative Method Port-A insertion via right cephalic vein. Specimen Count And Types Nil Pathology Nil Operative Findings The catheter position is satisfactory under chest X-ray. Blood drawing is smooth. Operative Procedures The patient was put in supine position. After local anaesthesia, we made one linear skin incision at right upper chest. We dissected to expose cephalic vein. We inserted port-A catheter, and check the catheter position by portable x-ray. We fixed the port, and closed the wound in layers. Operators VS 曾勝弘 Assistants R4 曾峰毅 R2 蔡立威 徐裴欣 (F,1980/08/15,31y6m) 手術日期 2011/03/10 手術主治醫師 曾勝弘 手術區域 東址 003房 03號 診斷 Colon cancer of transverse colon 器械術式 Ommaya reservoir implantation 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 14:25 報到 14:45 進入手術室 14:50 麻醉開始 14:55 誘導結束 15:10 抗生素給藥 15:30 手術開始 16:10 手術結束 16:10 麻醉結束 16:25 送出病患 16:30 進入恢復室 17:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 歐氏貯囊置放手術 1 1 R 摘要__ 手術科部: 腫瘤醫學部 套用罐頭: Ommaya reservoir implantation via right Koche... 開立醫師: 李振豪 開立時間: 2011/03/10 16:20 Pre-operative Diagnosis Colon cancer with leptomeningeal carcinomatosis Post-operative Diagnosis Colon cancer with leptomeningeal carcinomatosis Operative Method Ommaya reservoir implantation via right Kocher"s point Specimen Count And Types 1 piece About size:5ml Source:CSF Pathology Nil Operative Findings The Opening pressure is more than 25cmH2O. The CSF is clear in character but mild increase in viscosity. The depth of Ommaya reservoir catheter is 6.5cm. The CSF is sent for routine, BCS, and bacterial culture. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position. The scalp was shaved, scrubbed, and disinfected as usual. The C-shape scalp incision was made at right frontal area followed by one burr hole creation. Two dural tenting was done. the dura was opened and the edge of dura incision was coagulated for hemostasis. Ventriculostomy was performed with ventricular needle. The ommaya reservoir was placed and fixed with four sutures. Total 5ml CSF was sampled for study. Hemostasis was achieved. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS曾勝弘 Assistants R4李振豪, R1彭元宏 相關圖片 徐阿賢 (M,1936/10/05,75y5m) 手術日期 2011/03/10 手術主治醫師 陳敞牧 手術區域 東址 005房 01號 診斷 Normal pressure hydrocephalus 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3 紀錄醫師 曾峰毅, 時間資訊 00:00 臨時手術NPO 07:30 報到 08:08 進入手術室 08:18 麻醉開始 08:25 誘導結束 08:28 抗生素給藥 09:03 手術開始 10:08 手術結束 10:08 麻醉結束 10:13 送出病患 10:15 進入恢復室 11:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 曾峰毅 開立時間: 2011/03/10 10:10 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunt, right Kocher Specimen Count And Types CSF was sent for routine, BCS, and culture. Pathology Nil Operative Findings Medtronic, fixed pressure, medium pressue shunt was used. Opening pressure was about 10 mmH20. Clear, colorless, CSF gused out while ventriculostomy. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to left. After scalp shave, scrubbed, disinfected, and then draped, we made one transverse skin incision at right upper abdomen, and created mini-laparotomy. We created subcutaneous tunnel to right occipital area. We made on curvilinear skin incision at right frontal area, and drilled one burr hole. After durotomy and dura tenting, ventriculostomy was performed once, and then ventricular catheter was inserted. We connected shunt altogether, and checked the function. The wound was closed in layers. Operators VS 陳敞牧 Assistants R4 曾峰毅 相關圖片 陳旺城 (M,1949/04/10,62y11m) 手術日期 2011/03/10 手術主治醫師 郭順文 手術區域 東址 000房 04號 診斷 Headache 器械術式 trachostomy 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3 紀錄醫師 高明蔚, 時間資訊 13:00 臨時手術NPO 13:00 開始NPO 15:25 進入手術室 15:32 麻醉開始 15:35 誘導結束 15:38 手術開始 15:46 手術結束 15:46 麻醉結束 15:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 氣管切開術 1 0 摘要__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 高明蔚 開立時間: 2011/03/10 15:53 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types nil Pathology None Operative Findings Fr.8 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 1cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators 郭順文 Assistants R3高明蔚,R3廖先啟 Indication Of Emergent Operation respiratory failure 楊美慎 (F,1939/11/10,72y4m) 手術日期 2011/03/10 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Moyamoya disease 器械術式 EC-IC by-pass 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:06 進入手術室 08:12 麻醉開始 08:45 誘導結束 09:10 手術開始 09:30 抗生素給藥 11:35 麻醉結束 11:35 手術結束 11:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 血管探查 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Left side superficial temporal artery exploration 開立醫師: 李振豪 開立時間: 2011/03/10 12:07 Pre-operative Diagnosis Left M1 severe stenosis Post-operative Diagnosis Left M1 severe stenosis Operative Method Left side superficial temporal artery exploration Specimen Count And Types nil Pathology Nil Operative Findings The anterior branch of left side superficial temporal artery was exposed but the flow was inadequate after transection of the artery. The posterior branch was dissected further but the flow still not satisficated. Heparin solution irrigation was performed but the flow still not good. Dissection or thrombosis related inadequate flow was favored. The surgery was abandoned due to poor quality of the left STA. Further operation with vein graft will be arranged later. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head fixed with Mayfield skull clamp. The course of the left superficial temporal artery was identified by Doppler. The skin was shaved, scrubbed, and disinfected as usual. Under operative microscope, the curvilinear scalp incision was made at left fronto-temporal area. The main trunk of superficial temporal artery was identified. The anterior branch was traced along the course of superficial temporal artery and transected with about 8cm in length. However, the flow was inadequate even after Heparin solution irrigation. The posterior branch of the left STA was exposed and transected with 6cm in length. Unfortunateoly, the flow still not satisficated. Dissection was suspected. The stump of anterior and posterior branch of the STA was shortened and the flow became good only 1cm distal to the bifurcation. The hemoclip was applied to the stump of the vessel. Hemostasis was achieved. The wound was then closed in layers with 4-0 Vicryl and 4-0 Nylon. Operators VS王國川 Assistants R4李振豪, R1彭元宏 相關圖片 盧振輝 (M,1968/01/25,44y1m) 手術日期 2011/03/10 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 Cerebrovascular accident (CVA) 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 12:00 報到 12:20 進入手術室 12:30 麻醉開始 12:40 誘導結束 12:50 抗生素給藥 13:00 手術開始 14:16 手術結束 14:16 麻醉結束 14:25 送出病患 14:26 進入恢復室 16:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 手術 頭顱成形術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Cranioplasty 開立醫師: 李振豪 開立時間: 2011/03/10 14:10 Pre-operative Diagnosis Right ICA infarction, status post decompressive craniectomy Post-operative Diagnosis Right ICA infarction, status post decompressive craniectomy Operative Method Cranioplasty with autologous skull plate Specimen Count And Types nil Pathology Nil Operative Findings The autologous skull plate was used for cranioplasty and fixed with miniplates and screws. Bone cement was used for coverage of burr hole, bone gap, and reconstruction of temporalis muscle shape. Operative Procedures Under tracheostomy general anesthesia, the patient was put in supine position with head rotated to left. The scalp was shaved, scrubbed, and disinfected as usual. The scalp incision was made along the operative scar. The scalp flap was elevated and and the bone edge of the craniectomy was exposed. Total eight central tenting was performed. The autologous skull plate was fixed back with miniplates and screws after placing one epidural CWV drain. Hemostasis was achieved. Bone cement was applied for coverage of the burr hole, bone gap, and reconstruction of the shape of temporalis muscle. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS王國川 Assistants R4李振豪, R1彭元宏 相關圖片 陳玥祺 (F,2000/04/11,11y11m) 手術日期 2011/03/10 手術主治醫師 廖漢文 手術區域 東址 000房 號 診斷 Moyamoya disease 器械術式 Moyamoya follow-up 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 2 時間資訊 08:30 麻醉開始 08:40 誘導結束 09:20 麻醉結束 09:42 進入恢復室 10:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 李慧英 (F,1951/03/02,61y0m) 手術日期 2011/03/11 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Cervical myelopathy 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:00 進入手術室 08:10 麻醉開始 08:20 誘導結束 09:00 抗生素給藥 09:27 手術開始 11:40 手術結束 11:40 麻醉結束 11:45 送出病患 11:48 進入恢復室 13:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-前融合,有固定物)≦四節 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: Anterior C5-6 microsurgical discectomy and fu... 開立醫師: 王奐之 開立時間: 2011/03/11 12:00 Pre-operative Diagnosis C5-6 HIVD with cord compression Post-operative Diagnosis C5-6 HIVD with cord compression Operative Method Anterior C5-6 microsurgical discectomy and fusion with PEEK cage Specimen Count And Types nil Pathology Nil Operative Findings Herniated disc with downward protrusion was noted at C5-6 level. Severe adhesion between the upper part of PLL with the dura was encountered. A 6mm Synthes PEEK cage was used for fusion. Operative Procedures After ETGA, the patient was placed in supine position and neck hyperextended. An oblique skin incision was made at right neck along the skin crease. After dissection through the platysma, SCM was retrated laterally and the esophagus was retracted medially. After reaching the prevertebral space, the longus colli muscles were detached from the vertebra. The C5-6 disc space was confirmed with intra-operative C-arm. Discectomy and cage insertion was then done under microscope. After hemostasis and setting up a mini-hemovac, the wound was closed in layers. Operators P 杜永光, VS 楊士弘 Assistants R6 陳睿生, R3 王奐之 相關圖片 莊文輝 (M,1954/05/27,57y9m) 手術日期 2011/03/11 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 12:02 進入手術室 12:08 麻醉開始 12:20 誘導結束 12:45 手術開始 12:55 抗生素給藥 15:20 開始輸血 16:00 抗生素給藥 19:00 抗生素給藥 21:25 手術結束 21:25 麻醉結束 21:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4~8小時 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 11 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: Left occipital craniectomy for Simpson grade ... 開立醫師: 曾偉倫 開立時間: 2011/03/11 21:48 Pre-operative Diagnosis Left tentorial meningioma Post-operative Diagnosis Left tentorial meningioma Operative Method Left occipital craniectomy for Simpson grade IV tumor excision Left suboccipital craniectomy for Simpson grade IV tumor excision Specimen Count And Types 1 piece About size:3x3x3 cm Source:Tentorial meningioma Pathology Pending Operative Findings 1. A 3x3x3 cm hard, white-yellowish hypervascularized tumor over left cerebellar area with adhesion with the tentorium 1. A 3x3x3 cm hard, white-yellowish hypervascularized tumor over left tentorium with compression to cerebellum 2. Venous bleeding occurred several times during the tumor dissection 3. Severe brain swelling after the operation 4. The post-operative ICP: 16-17 cm-H2O, the pressure decreased to 7 cm-H2O after we drained 20ml CSF 5. The craniectomy was kept due to brain swelling Operative Procedures Under ETGA, we fixed his head with Mayfield and he was put on prone position with mild neck flexion. After we srubbed, disinfected and drapped, a linear skin incision was made over the midline. We drained the CSF 30ml from the EVD. The craniectomy was performed over the cerebellar area and the dura was opened. We retract the right cerebellum downward and the tumor was exposed. Tumor excision was performed with CUSA, bipolar forceps and scissors. The hemostasis was achieved with Floseal, Gelfoam and Surgicel. We closed the dura with Durafoam. The wound was closed in layers after a CWV placed. Under ETGA, we fixed his head with Mayfield and he was put on prone position with mild neck flexion. After we srubbed, disinfected and drapped, a linear skin incision was made over the midline. We drained the CSF 30ml from the EVD. The craniectomy was performed over the suboccipital area and the dura was opened. We retract the right cerebellum downward and the tumor was exposed. Tumor excision was performed with CUSA, bipolar forceps and scissors. The hemostasis was achieved with Floseal, Gelfoam and Surgicel. We closed the dura with Durafoam. The wound was closed in layers after a CWV placed. Operators VS 曾漢民 Assistants R5 鍾文桂 R2 曾偉倫 相關圖片 張瑞香 (F,1942/08/10,69y7m) 手術日期 2011/03/11 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Spine tumor 器械術式 Benign intraspinal tumor, exci 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:05 進入手術室 08:15 麻醉開始 08:40 誘導結束 08:47 手術開始 08:53 抗生素給藥 11:30 手術結束 11:30 麻醉結束 11:45 抗生素給藥 11:48 送出病患 11:50 進入恢復室 13:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 脊椎腔內動靜脈畸型切除術-二節以內 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: C7/T1 hemilaminectomy and foraminotomy for ex... 開立醫師: 鍾文桂 開立時間: 2011/03/11 12:17 Pre-operative Diagnosis Right extradural tumor, C7-T1 level Post-operative Diagnosis Right venous malformation, C7-T1 level Operative Method C7/T1 hemilaminectomy and foraminotomy for excision of venous malformation. Specimen Count And Types 1 piece About size:0.3x0.3x0.2 cm Source:Spinal venous malformation Pathology Pending Operative Findings 1. Dark-blue congested venous malformation over epidural space of posterior portion of C7-T1 junction with extension to the foramen. The venous malformations were electrocoagulated. 2. The SSEP of median n. showed no change during the operation. 3. Initially, we suspect an intradural mass, so durotomy was made. Only some indentation of the spinal cord was noted. No mass lesion was noted from C7-T1 level. The dura mater was closed primarily. 4. Further decompression of C8 root was performed via foriminotomy 5. The post-operative C8 root was loose Operative Procedures Under ETGA, we fixed the patients head with Mayfield and the patient was in prone position. After shaving, disinfection, and draping, a midline incision and right paraspinal dissection were made at C6-T1 level. The C7-T1 hemilaminectomy was done with Kerrison and high speed drill. After removal of the ligamentum flavum, durotomy was made but there was no intradural lesion. We closed the dura primarily. We extended the laminotomy and the venous malformation was found. The venous malformation was removed with electrocautery. We performed the foraminotoy for removal the extention of the venous malformation. The C8 root was loose after then. A CWV drain was placed after complete hemostasis and we closed the wound in layers. Operators VS 曾漢民 Assistants R5 鍾文桂 R2 曾偉倫 相關圖片 王信子 (F,1937/07/13,74y8m) 手術日期 2011/03/11 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Spondyloisthesis, acquired 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 11:30 報到 12:07 進入手術室 12:10 麻醉開始 12:20 誘導結束 12:40 抗生素給藥 13:04 手術開始 15:40 抗生素給藥 16:30 開始輸血 18:10 手術結束 18:10 麻醉結束 18:20 送出病患 18:23 進入恢復室 01:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: L4 laminectomy for decompression, L4-5 transp... 開立醫師: 王奐之 開立時間: 2011/03/11 18:34 Pre-operative Diagnosis L4-5 spondylolisthesis, grade 2 Post-operative Diagnosis L4-5 spondylolisthesis, grade 2 Operative Method L4 laminectomy for decompression, L4-5 transpedical screws fixation, and L4-5 banana cage insertion Specimen Count And Types nil Pathology Nil Operative Findings Grade spondylolisthesis at L4-5 level was noted, the thecal sac was compressed tightly. Right L5 root was noted intra-operatively and preserved. Severe narrowing of L4-5 space was noted, a 11mm Synthes PEEK banana cage was used after discectomy. Estimated blood loss: 1500ml. Operative Procedures After ETGA, the patient was placed in prone position. After localization of L4-5 space, a midline linear incision was made at lower back. The incision was deepened until the spinous processes were exposed. The paraspinal muscles were detached from the spinous process, and then the facet joints were exposed. After identifying the L4 & L5 transverse processes, 4 transpedical screws were inserted and the position was confirmed with intra-operative C-arm. L4 right hemi-laminectomy was then done, follwed by L4-5 partial facetomy. L4-5 discectomy was then done, followed by banana cage insertion. The rods were then set. After hemostasis, the wound was closed in layers after setting a hemovac drain. Operators VS 賴達明 Assistants R6 陳睿生, R3 王奐之 相關圖片 呂敏揚 (M,1961/11/28,50y3m) 手術日期 2011/03/11 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Spinal tumor 器械術式 Intraspinal intramedullary tum 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 2 紀錄醫師 蔡立威, 時間資訊 00:00 臨時手術NPO 07:36 報到 08:10 進入手術室 08:15 麻醉開始 08:30 誘導結束 09:00 抗生素給藥 10:04 手術開始 12:00 抗生素給藥 15:00 抗生素給藥 17:35 手術結束 17:35 麻醉結束 17:40 送出病患 17:45 進入恢復室 19:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 11 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 脊椎內脊髓內腫瘤切除術 1 1 摘要__ 手術科部: 外科部 套用罐頭: T7 and T8 laminectomy for tumor excision 開立醫師: 蔡立威 開立時間: 2011/03/11 18:32 Pre-operative Diagnosis T8 intramedullary tumor, suspect ependymoma Post-operative Diagnosis T8 intramedullary tumor, Schwannoma Operative Method T7 and T8 laminectomy for tumor excision Specimen Count And Types 1 piece About size:0.5cm Source:T8 spinal cord Pathology Frozen pathology: Schwannoma Operative Findings 1. Tumor was moderately hard in consistency, grey in color, and highly vascular. The lesion was intramedullary despite frozen section result was Schwannoma. The lower pole of the tumor was less adhering to the spinal cord and connects to the syrinx of the distal spinal cord. 2. The spinal cord was displaced to the right as the tumor mostly situated on the left. 3. Intraoperative SSEP and MEP were within normal limits Operative Procedures Under endotracheal general anesthesia, patient was put in prone position. After confirmation of T8 level fluoroscopically, we did skin disinfection and drapping as usual. Periosteal dissection was performed from T7 to T9. T7-8 laminectomy was performed. Microscope was brought into the surgical field. Dura was opened and tackled up with 3-0 silk sutures. Tumor was removed by bipolar cautery, CUSA, and blunt dissection using mircrodissectors. Dura was closed in a water-tight fashion with 5-0 Prolene. The wound was closed in layers after meticulous hemostasis, copious saline irrigation and CWV placement. Operators VS賴達明 Assistants R5蔡宗良,R2蔡立威 李榕甄 (F,1962/11/11,49y4m) 手術日期 2011/03/11 手術主治醫師 賴達明 手術區域 東址 019房 02號 診斷 Spondylosis 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 蔡立威, 時間資訊 00:00 臨時手術NPO 17:35 報到 18:00 進入手術室 18:10 麻醉開始 18:35 誘導結束 18:55 抗生素給藥 19:20 手術開始 21:20 手術結束 21:20 麻醉結束 21:30 送出病患 21:37 進入恢復室 23:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 椎間盤切除術-頸椎 1 1 手術 椎融合術-前融合,無固定物(≦四節) 1 2 摘要__ 手術科部: 外科部 套用罐頭: C4-5 anterior discectomy and fusion with cage 開立醫師: 蔡立威 開立時間: 2011/03/11 21:43 Pre-operative Diagnosis C4-5 HIVD Post-operative Diagnosis C4-5 HIVD Operative Method C4-5 anterior discectomy and fusion with cage Specimen Count And Types nil Pathology nil Operative Findings C4-5 bulging disc Operative Procedures Under endotracheal general anesthesia, supine position, we did skin disinfection and drapping as usual. Right upper neck skin incision over old scar. Then we dissect some muscle and vessel structure to identify C4-5 disc. The disc was checked by fluoroscopy. Then anterior discectomy was done, followed by fusion with 6mm cage. After well hemostasis, we inserted a minihemovac. The wound was closed in layers. Operators VS賴達明 Assistants R5蔡宗良,R2蔡立威 何冠毅 (M,2009/10/09,2y5m) 手術日期 2011/03/11 手術主治醫師 謝孟祥 手術區域 東址 012房 01號 診斷 Acrocephlosyndactyly 器械術式 Division+ grommet insertion 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 2 紀錄醫師 陳以幸, 張睿紘, 時間資訊 07:53 報到 08:05 進入手術室 08:25 麻醉開始 08:35 誘導結束 08:37 抗生素給藥 08:39 手術開始 09:07 11:40 抗生素給藥 14:11 手術結束 14:11 麻醉結束 14:17 送出病患 14:22 進入恢復室 15:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 手術 顯微鏡下鼓膜切開術,併鼓室通 管插入 1 1 L 手術 顯微鏡下鼓膜切開術,併鼓室通 管插入 1 1 L 手術 皮膚全層植補術FTSG–每增加10平方公方 1 1 L 手術 皮膚全層植補術-FTSG 1 1 L 手術 併指多指(趾)切除 1 1 L 手術 多指(趾)切除每多加一個 1 1 L 摘要__ 手術科部: 耳鼻喉部 套用罐頭: G 開立醫師: 張睿紘 開立時間: 2011/03/11 09:15 Pre-operative Diagnosis Apert syndrome, bilateral otitis media with effusion Post-operative Diagnosis Apert syndrome, bilateral otitis media with effusion Operative Method Grommet insertion, Bilateral Specimen Count And Types nil Pathology nil Operative Findings Bilateral eardrums: dullness Left middle ear effusion: mucoid ear effusion Right middle ear effusion:mucoid ear effusion Operative Procedures The patient was put in supine position. After general anesthesia was set up via the endotracheal intubation, then the patients head was turned to the left side. Radial incision was made over the anterio-inferior quadrant of the right eardrumand mucoid ear effusion was sucked out. Then one 1.27mm Grommet tube was inserted smoothly. The head was then turned to the right side. The procedure was done similar to the right. Middle ear fluid was mucoid, which was aspirated. 1.27mm Grommet tube was inserted smoothly. The patient tolerated the whole procedure well. Operators Asp許巍鐘, Assistants R4張睿紘, 摘要__ 手術科部: 外科部 套用罐頭: Others 開立醫師: 官振翔 開立時間: 2011/03/11 14:32 Pre-operative Diagnosis Apert syndrome, syndactyly Post-operative Diagnosis Apert syndrome, syndactyly Operative Method Division of syndactyly of thumb and little finger, FTSG Specimen Count And Types Nil Pathology Nil Operative Findings 1. History of Apertsyndrome 2. Bilateral hand syndactyly with thumb-2 finger soft tissue fusion,incomplete. Ring-little finger soft tissue fusion, incomplete. 2-3-4 complete with bone fusion. Operative Procedures ETGA, supine. Antiseptics and drapped as usual. Division of thumb and little finger with Z plasty. HArvest FTSG from bilateral inguinal area. FTSG inset with tie over dressing. On short arm splint. Operators 謝孟祥, Assistants 官振翔, 陳以幸 范萬玉英 (F,1948/03/26,63y11m) 手術日期 2011/03/12 手術主治醫師 賴達明 手術區域 東址 003房 號 診斷 Herniation of intervertebral disc (HIVD) 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 2 紀錄醫師 蔡立威, 時間資訊 00:00 臨時手術NPO 07:33 報到 08:03 進入手術室 08:15 麻醉開始 08:30 誘導結束 09:00 抗生素給藥 09:14 手術開始 10:55 手術結束 10:55 麻醉結束 11:05 送出病患 11:10 進入恢復室 13:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-腰椎 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Glucose 1 0 摘要__ 手術科部: 外科部 套用罐頭: L5-S1 microdiscectomy 開立醫師: 蔡立威 開立時間: 2011/03/12 11:14 Pre-operative Diagnosis L5-S1 HIVD Post-operative Diagnosis L5-S1 HIVD Operative Method L5-S1 microdiscectomy Specimen Count And Types nil Pathology nil Operative Findings L5-S1 bulging disc, with rupture , protruding to S1 level After discectomy, the thecal sac and roots were well decompressed Operative Procedures Under endotracheal general anesthesia, prone position, we localized L5-S1 disc position by fluoroscopy. Then we did skin disinfection and drapping as usual. Skin incision over L4-S1 level. Then we did microdiscectomy through left side approach. After well hemostasis, we closed the wound in layers. Operators VS賴達明 Assistants R6陳睿生,R2蔡立威 李建國 (M,1950/02/01,62y1m) 手術日期 2011/03/12 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 Intracerebral hemorrhage 器械術式 V-P shunt 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 3 紀錄醫師 陳睿生, 時間資訊 00:00 臨時手術NPO 11:00 報到 11:35 進入手術室 11:45 麻醉開始 11:50 誘導結束 12:20 抗生素給藥 12:25 手術開始 13:10 手術結束 13:10 麻醉結束 13:20 送出病患 13:25 進入恢復室 15:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室腹腔分流手術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Left kocher VP shunt implantation 開立醫師: 陳睿生 開立時間: 2011/03/12 13:30 Pre-operative Diagnosis Acute hydrocephalus Post-operative Diagnosis Acute hydrocephalus Operative Method Left kocher VP shunt implantation Specimen Count And Types 2 pieces About size:2ml Source:CSF About size:2ml Source:CSF Pathology Nil Operative Findings The CSF was xanthochromic pattern, and the ICP was 5-10cmH2O. A Metronic programmable shunt was inserted from left Kocher^s point, and the intra-ventricular catheter was about 7cm in length. The initial setting was 10cm H2O. Operative Procedures 1. ETGA, supine position with head right turn 2. Left frontal linear scalp incision and make a burr hole at kocher^s point 3. Dura tenting 4. Linear skin incision at LUQ about 3cm, and then minilaparotomy was done to expose the intraperitoneal cavity 5. Create a subcutaneous tunnel from LUQ to left frontal region with one connection wound 6. Insert the intra-abdominal catheter, and then connect with the reservior and 7cm intraventricular catheter 7. Dura opening, and then a small corticotomy was done 8. Punch the lateral ventricle, and the intra-ventricular catheter was inserted 9. Hemostasis, and the reservior was implanted at the subcutaneous pocket at left retroauricular region 10.Hemostasis, and close the wound in layers Operators VS 王國川 Assistants R6 陳睿生 吳彥徵 (F,1983/12/15,28y2m) 手術日期 2011/03/12 手術主治醫師 蔡翊新 手術區域 東址 002房 03號 診斷 Brain concussion 器械術式 Cranioplasty and wound treatment 手術類別 緊急手術 手術部位 頭、頸 傷口分類 髒 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 3E 紀錄醫師 林哲光, 時間資訊 17:39 通知急診手術 17:39 開始NPO 18:40 進入手術室 18:40 報到 18:45 麻醉開始 18:45 誘導結束 18:55 抗生素給藥 19:10 手術開始 21:05 麻醉結束 21:05 手術結束 21:10 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 深部複雜臉部創傷處理–中 5公分至10公分 1 0 L 手術 頭顱成形術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 記錄__ 手術科部: 外科部 套用罐頭: Cranioplasty with previous left frontal skull... 開立醫師: 林哲光 開立時間: 2011/03/12 20:49 Pre-operative Diagnosis Scalp laceration wound at forehead and frontal part, upper lip laceration wound Post-operative Diagnosis Ditto Operative Method Cranioplasty with previous left frontal skull bone and wound repair Specimen Count And Types Pathology Operative Findings Around 10 cm long laceration wound was noted at forehead to previous frontal skin incision. The miniplate was exposed and the deformity of the miniplate was noted. The previous skull bone plate was depressed also. The upper lip laceration wound was noted with ocularis muscle exposed. Operative Procedures Under ETGA and supine position with head mild rotated to right side, skin disinfected and drapped were performed as usual. The scalp laceration wound was irrigated with Genta-C in N/S. The deformity one of the miniplates was removed and another miniplate was used for skull bone fixation. The wound was closed in 2-0 Vicryl for subcutaneous layer, 5-0 Nylon for forehead wound and 3-0 Nylon for scalp wound after a subgleal drain insertion. Under ETGA and supine position with head mild rotated to right side, skin disinfected and drapped were performed as usual. The scalp laceration wound was irrigated with Genta-C in N/S. The deformity one of the miniplates was removed and another miniplate was used for skull bone fixation. The wound was closed in 2-0 Vicryl for subcutaneous layer, 5-0 Nylon for forehead wound and 3-0 Nylon for scalp wound after a subgleal drain insertion. The lip laceration wound was closed in layers. Operators VS 蔡翊新 Assistants R4 林哲光, R4 游彥辰 Indication Of Emergent Operation 相關圖片 陳正雄 (M,1943/11/26,68y3m) 手術日期 2011/03/13 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Cerebrovascular accident (CVA) 器械術式 External ventricular drainage, RIGHT 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 3E 紀錄醫師 林哲光, 時間資訊 02:00 開始NPO 06:52 通知急診手術 07:40 進入手術室 07:40 報到 07:45 麻醉開始 07:50 誘導結束 08:15 抗生素給藥 08:37 手術開始 08:45 開始輸血 10:03 麻醉結束 10:03 手術結束 10:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦室體外引流 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Right Kocher point EVD insertion (3.5mm) 開立醫師: 林哲光 開立時間: 2011/03/13 10:41 Pre-operative Diagnosis Left thalamic ICH with ruptured into ventricle Post-operative Diagnosis Ditto Operative Method Right Kocher point EVD insertion (3.5mm) Specimen Count And Types Pathology Operative Findings Pre-operative GCS was M4 before intubation. Reddish, transparent CSF gushed out when ventricular puncture was performed. The intraventricular EVD was 7cm long. Operative Procedures Under ETGA and supine position, skin disinfected and drapped were performed as usual. Curvilinear skin incision around the right Kocher point was done. A burr hole was then created. The dura was then opened after dural tenting. THe EVD was then inserted via ventricular puncture. The EVD was then fixed on the scalp and the wound was then closed in layers. Operators AP 賴達明 Assistants R4 林哲光 Indication Of Emergent Operation 相關圖片 陳正雄 (M,1943/11/26,68y3m) 手術日期 2011/03/14 手術主治醫師 賴達明 手術區域 東址 002房 03號 診斷 Cerebrovascular accident (CVA) 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 4E 紀錄醫師 徐展陽, 時間資訊 22:57 通知急診手術 23:41 進入手術室 23:45 麻醉開始 00:20 誘導結束 00:30 手術開始 04:50 手術結束 04:50 麻醉結束 05:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: Craniotomy and intracranial hematoma evacuation 開立醫師: 鍾文桂 開立時間: 2011/03/14 05:06 Pre-operative Diagnosis Intracranial hemorrhage and intraventricular hemorrhage Intraventricular hemorrhage with acute obstructive hydrocephalus. Post-operative Diagnosis Intracranial hemorrhage and intraventricular hemorrhage Intraventricular hemorrhage with acute obstructive hydrocephalus. Operative Method Craniotomy and intracranial hematoma evacuation Craniotomy for evacuation of intraventricular hemorrhage. Specimen Count And Types nil Pathology nil Operative Findings 1) Previous EVD was place via right Kocher point 2) Marked amount of blood clot gushed out from the lateral ventricle. 2) Marked amount of blood clot gushed out from the lateral ventricle. The hematoma in ipsilateral and contralateral frontal horn,ipsilateral temporal horn and occipital horn was evacuated under microscope. The choroid plexus were preserved. The ventricular wall was collapsed after hematoma evacuation. The EVD was met during evacuation and left intact. 3) Intraoperative ultrasonography for localization of hematoma. Operative Procedures 1. ETGA, prone position, head fixed by Mayfield skull clamp. 2. Skin shaved and scrubbed with povidone-iodine detergent, then covered with sterilized adhesive plastic sheet. 3. Made a reverse U incision over posterior skull with Raney clips. The bleeding from the muscles was stopped by Bovie. 5. Craniotomy window 5 cm x 5 cm was made over left occipital area. 6. Apply intra-operative sonography to identify the hematoma 7. Made a 0.5cm corticotomy, and evacuate the blood clot by suction. 8. Hemostasis by surgicel and sponge. 9. Close dura by 4-0 Prolene suture, then fix the skull bone by mini-plate, then remove Raney clips; 10. Closed wound in layers with one subgaleal CWV drain. Operators VS賴達明 Assistants R5鍾文桂 R1徐展陽 Indication Of Emergent Operation 相關圖片 張正衡 (M,1931/09/20,80y5m) 手術日期 2011/03/13 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Subarachnoid hemorrhage 器械術式 Craniotomy(Aneurysms) P-DUH 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 3E 紀錄醫師 徐展陽, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 09:25 通知急診手術 10:55 進入手術室 11:05 麻醉開始 11:10 誘導結束 12:00 抗生素給藥 12:15 手術開始 13:15 開始輸血 13:30 抗生素給藥 13:52 抗生素給藥 15:15 抗生素給藥 16:00 手術結束 16:00 麻醉結束 16:14 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱內壓視置入 1 2 手術 開顱術摘除血管病變 - 腦血管瘤 有病徵的 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Pterional approach for aneurysm clipping 開立醫師: 陳睿生 開立時間: 2011/03/13 16:43 Pre-operative Diagnosis Left side P-com aneurysm rupture with SAH Post-operative Diagnosis Left side P-com aneurysm rupture with SAH Operative Method Pterional approach for aneurysm clipping Specimen Count And Types nil Pathology nil Operative Findings The aneurysm was about 5mm in neck and 8mm height. The aneurysm protruded inferiorlaterally, and moderately attached to the CN III. After craniotomy done, a Keen^s point EVD was inserted with one metronic EVD. The initial ICP was about 5-10cm H2O. The aneurysm was clipped with one beyonet shape Sugita clip, and the aneurysm was ruptured after clipping. Easy oozing was noted intra-op. Operative Procedures 1. ETGA, the head was right tilt and fixed with Mayfield clump 2. Left frontotemporal curvillinear scalp incision 3. The temporalis muscle was excised with facial nerve preservation 4. After three bur holes made, an about 8x8 cm craniotomy window was done 5. Proper dura tenting, and then the dura was opened curvillinearly 6. A Keen^s point EVD was inserted due to brain swelling 6. A paine^s point EVD was inserted due to brain swelling 7. The frontal lobe was retracted upward, and then the optic nerve, and ICA were identified 8. The aneurysm was noted near to P-com 9. The temporal lobe was retracted posteriorly to fully expose the aneurysm 10.After neck dissection, a beyonet shape Sugita clip was applied for clipping 11.Hemostasis, and the dura was tightly closed 12.The skull flap was fixed back with central tenting 13.A CWV drain was set below the temporalis muscle 14.The wound was closed in layers Operators VS賴達明 Assistants CR陳睿生 R5鍾文桂 R1徐展陽 Indication Of Emergent Operation 黃友仁 (M,1929/03/05,83y0m) 手術日期 2011/03/13 手術主治醫師 王國川 手術區域 東址 005房 01號 診斷 重大創傷且及嚴重程度到達創傷嚴重程度分數16分以上 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 4E 紀錄醫師 鍾文桂, 時間資訊 14:26 臨時手術NPO 14:26 開始NPO 14:27 通知急診手術 14:50 報到 14:55 進入手術室 14:55 麻醉開始 15:10 誘導結束 15:23 抗生素給藥 15:25 手術開始 16:00 開始輸血 17:30 麻醉結束 17:30 手術結束 17:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱內壓視置入 1 2 R 手術 急性硬腦膜下血腫清除術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: 1. Decompressive craniectomy, right frontal-t... 開立醫師: 鍾文桂 開立時間: 2011/03/13 18:01 Pre-operative Diagnosis Traumatic acute subdural hemorrhage and contusional intracerebral hemorrhage. Post-operative Diagnosis Traumatic acute subdural hemorrhage and contusional intracerebral hemorrhage. Operative Method 1. Decompressive craniectomy, right frontal-temporal-parietal for evacuation of acute subdural hemorrhage. 2. Insertion of ICP monitor. Specimen Count And Types nil Pathology Nil. Operative Findings Pre-op pupil: 6/6, post-op pupil: 5/6 Blood loss: 1200cc Poor brain palsation after durotomy. After wound closure, ICP 40mmHg(BP:120/70mmHg under Dopamine, Levophed, and Bosmin.)Subdural ICP monitor. 2-cm thick acute subdural hemorrhage. Partial temporal and frontal lobectomy was done for further decompression. The temporalis muscle was resected for further decompression. Dura mater adheres to the skull bone severely. Operative Procedures Under ETGA, the patient was placed in supine position and the head was tilted to the left side. After shaving, disinfection, and draping, a large 15-cm trauma scalp flap was created. After obtaining a 15-cm craniectomy skull bone window, the dura mater was opened. The subdural hematoma was evacuated with suction. For further decompression, the partial frontal and temporal lobectomy was achieved and temporalis muscle was resected with harvested temporalis fascia for duroplasty. After placing one subdural ICp monitor and one subgaleal CWV drain, the wound was closed in layers. Operators V.S.王國川 Assistants R5 鍾文桂 Indication Of Emergent Operation 相關圖片 林鳳英 (F,1948/03/21,63y11m) 手術日期 2011/03/14 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Brain Tumor 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 王奐之, 時間資訊 20:13 臨時手術NPO 07:40 報到 08:03 進入手術室 08:05 麻醉開始 08:15 誘導結束 09:05 抗生素給藥 09:05 手術開始 12:05 抗生素給藥 14:25 麻醉結束 14:25 手術結束 14:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除-手術時間在4~8小時 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for Simpson grade 2 tumor removal 開立醫師: 王奐之 開立時間: 2011/03/14 14:46 Pre-operative Diagnosis Right parasagittal meningioma (posterior third) Post-operative Diagnosis Right parasagittal meningioma (posterior third) Operative Method Craniotomy for Simpson grade 2 tumor removal Specimen Count And Types 1 piece About size:pieces Source:right parietal tumor Pathology Pending Operative Findings Whitish elastic-firm tumor was noted at right parietal area, adjacent to sensory cortex. Severe adhesion to one adjacent drain vein was encountered and the vein could not be preserved. The tumor originated from the superior sagittal sinus and invaded into the sinus lumen. The tumor was removed totally in pieces with electrocauterization of the SSS dura. The tumor could be dissected from the surrounding brain parenchyma with effort. Operative Procedures After ETGA, the patient was placed in supine position with neck flexed to make a semi-sitting postiion. After scalp shaving, skin disinfection and draping in sterile fashion, a reversed V-shaped incision was made at right parietal area. After reflecting the skin flap, a quandrigular craniotomy window was made. After dural tenting, a fishmouth durotomy was done, reflecting the SSS side, exposing the tumor. The tumor was then removed in pieces. The tumor invaded into the SSS was removed with CUSA. The remaining tumor capsule was also detached from the surroundings. The SSS dura was electrocauterized. After meticulous hemostasis, the dura was closed with 4-0 Prolene in water-tight fashion. The bone was fixed back with miniplates & wires, the wound was then closed in layers after setting 1 subgaleal CWV drain. Operators P 杜永光 Assistants R6 陳睿生, R3 王奐之 相關圖片 關劍涵 (M,1983/07/13,28y8m) 手術日期 2011/03/14 手術主治醫師 杜永光 手術區域 東址 003房 02號 診斷 Pituitary tumor 器械術式 Debridment-- 5-10cm 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 2 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 14:15 報到 14:45 進入手術室 14:50 麻醉開始 15:00 誘導結束 15:25 抗生素給藥 15:50 手術開始 17:10 手術結束 17:10 麻醉結束 17:32 送出病患 17:35 進入恢復室 18:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 頭顱成形術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 外科部 套用罐頭: Cranioplasty 開立醫師: 王奐之 開立時間: 2011/03/14 17:43 Pre-operative Diagnosis Left temporal depression Post-operative Diagnosis Left frontotemporal skull defect Operative Method Cranioplasty Specimen Count And Types nil Pathology Nil Operative Findings A left frontotemporal skull defect resulted in previous burr hole creation was noted. 5 small holes were made for fixation of the bone cement (for the purpose of artifical hinge), the thickness of the bone cement was decided by comparison with the right side. Operative Procedures After ETGA, the patient was placed in supine position with face turned to left. After scalp shaving, skin disinfection & draping in sterile fashion, a curvilinear skin incision was made along previous scar. After dissection and incision on the temporalis, the skull defect was exposed. Bone cement were then applied to the skull defect and made flat. After hemostasis, the temporalis was approximated and the wound was closed in layers. Operators P 杜永光 Assistants R6 陳睿生, R3 王奐之 相關圖片 蔡彥伶 (F,1985/11/29,26y3m) 手術日期 2011/03/14 手術主治醫師 廖漢文 手術區域 東址 000房 號 診斷 Arteriovenous malformation, brain 器械術式 frontal AVM for TAE 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 王永彬 ASA 2 時間資訊 00:00 開始NPO 08:00 通知急診手術 13:30 麻醉開始 13:35 誘導結束 17:10 麻醉結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 張黛雯 (F,1964/05/05,47y10m) 手術日期 2011/03/14 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 08:15 報到 08:20 進入手術室 08:30 麻醉開始 08:45 誘導結束 09:15 抗生素給藥 09:40 手術開始 12:15 抗生素給藥 13:50 麻醉結束 13:50 手術結束 13:55 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除-手術時間在4小時以內 1 1 記錄__ 手術科部: 外科部 套用罐頭: Right parietal craniotomy for Simpson grade I... 開立醫師: 鍾文桂 開立時間: 2011/03/14 14:14 Pre-operative Diagnosis Right parietal parasagital meningioma, recurrent. Post-operative Diagnosis Right parietal parasagital meningioma, recurrent. Operative Method Right parietal craniotomy for Simpson grade II tumor excision. Specimen Count And Types 1 piece About size:5cc Source:Meningioma Pathology Pending. Operative Findings 1. Grayish, soft, moderate vascularized tumor in invasion into the falx cerebri. Hyperostosis, calcification over the lateral wall of superior sagital sinus, and thickening of the sinus wall were noted. We excised the involved falx cerebri and electrocoagulated the wall of the superior sagital sinus.The tumor at contralateral side of the falx was also removed. 2. The dural defect was repaired by Biodesign artificial dura. Operative Procedures Under ETGA, the patient was placed in 3/4 prone position and the right parietal area was exposed. The previous operation wound was extended 3-cm posteriorly. The craniotomy window was obtained by high speed drill. After durotomy and dural tenting, the tumor was excised along the arachnoid plane. The involoved falx was excised. The wall of superior sagital sinus was electrocoagulated. After well hemostasis and duroplasty, the craniotomy plate was fixed by miniplates and screws. Thw wound was closed in layers without drain. Operators 曾漢民 Assistants 鍾文桂 曾偉倫 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Right parietal craniotomy for Simpson grade I... 開立醫師: 鍾文桂 開立時間: 2011/03/14 14:15 Pre-operative Diagnosis Right parietal parasagital meningioma, recurrent. Post-operative Diagnosis Right parietal parasagital meningioma, recurrent. Operative Method Right parietal craniotomy for Simpson grade II tumor excision. Specimen Count And Types 1 piece About size:5cc Source:Meningioma Pathology Pending. Operative Findings 1. Grayish, soft, moderate vascularized tumor in invasion into the falx cerebri. Hyperostosis, calcification over the lateral wall of superior sagital sinus, and thickening of the sinus wall were noted. We excised the involved falx cerebri and electrocoagulated the wall of the superior sagital sinus.The tumor at contralateral side of the falx was also removed. 2. The dural defect was repaired by Biodesign artificial dura. Operative Procedures Under ETGA, the patient was placed in 3/4 prone position and the right parietal area was exposed. The previous operation wound was extended 3-cm posteriorly. The craniotomy window was obtained by high speed drill. After durotomy and dural tenting, the tumor was excised along the arachnoid plane. The involoved falx was excised. The wall of superior sagital sinus was electrocoagulated. After well hemostasis and duroplasty, the craniotomy plate was fixed by miniplates and screws. Thw wound was closed in layers without drain. Operators 曾漢民 Assistants 鍾文桂 曾偉倫 相關圖片 摘要__ 手術科部: 外科部 套用罐頭: Right parietal craniotomy for Simpson grade I... 開立醫師: 曾偉倫 開立時間: 2011/03/14 14:17 Pre-operative Diagnosis Right parietal parasagital meningioma, recurrent. Post-operative Diagnosis Right parietal parasagital meningioma, recurrent. Operative Method Right parietal craniotomy for Simpson grade II tumor excision. Specimen Count And Types 1 piece About size:5cc Source:Meningioma Pathology Pending. Operative Findings 1. Grayish, soft, moderate vascularized tumor in invasion into the falx cerebri. Hyperostosis, calcification over the lateral wall of superior sagital sinus, and thickening of the sinus wall were noted. We excised the involved falx cerebri and electrocoagulated the wall of the superior sagital sinus.The tumor at contralateral side of the falx was also removed. 2. The dural defect was repaired by Biodesign artificial dura. Operative Procedures Under ETGA, the patient was placed in 3/4 prone position and the right parietal area was exposed. The previous operation wound was extended 3-cm posteriorly. The craniotomy window was obtained by high speed drill. After durotomy and dural tenting, the tumor was excised along the arachnoid plane. The involoved falx was excised. The wall of superior sagital sinus was electrocoagulated. After well hemostasis and duroplasty, the craniotomy plate was fixed by miniplates and screws. Thw wound was closed in layers without drain. Operators 曾漢民 Assistants 鍾文桂 曾偉倫 相關圖片 孫實勇 (M,1968/03/05,44y0m) 手術日期 2011/03/14 手術主治醫師 郭順文 手術區域 東址 018房 01號 診斷 Lung cancer 器械術式 Thoracoscopy+Open Chest (Sleeve lobectomy) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 趙安怡 ASA 2 紀錄醫師 蔡東明, 時間資訊 07:56 報到 08:07 進入手術室 08:15 麻醉開始 08:47 誘導結束 09:05 抗生素給藥 09:31 手術開始 12:05 抗生素給藥 15:30 開始輸血 15:55 抗生素給藥 18:55 抗生素給藥 20:40 麻醉結束 20:40 手術結束 20:48 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 17 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 胸腔鏡肺葉切除術 1 1 L 手術 根除性淋巴切除術(肺葉切除或全肺切除時) 1 2 L 手術 支氣管鏡檢查 1 0 記錄__ 手術科部: 內科部 套用罐頭: Throacoscopic assisted thoracotomy for left u... 開立醫師: 蔡東明 開立時間: 2011/03/14 22:11 Pre-operative Diagnosis Lung cancer, left upper lobe Post-operative Diagnosis Lung cancer, left upper lobe Operative Method Throacoscopic assisted thoracotomy for left upper lobe sleeve lobectomy and mediastinal lymphnode dissection + bronchoscopic examination Specimen Count And Types 2 pieces About size:15*20CM Source:LUL About size:4*4CM Source:MEDIASTINAL LYMPHNODE Pathology Pending Operative Findings 1.One 4*4cm hardish, round grayish, hypervascular tumor was noted at left upper lobe, near hilum. Sleeve lobectomy was done, and bronchoscopy showed no visiable tumor lesion after bronchial resection. 2.Multiple elastic, firm and irregular lymphnodes were noted at Gr.3,5,7,10,11,12. The largest lymphadenopathy was located at Gr.5. After lymphnode dissection, the left phrenic / vagus nerve are preserved. 3.The tumor invades to partial left pulmonary artery, and sleeve resection of pumonary arterial main trunk was done. 4.There is no active air-leakage or bleeding after surgery. There is no pleural seeding. Operative Procedures 1. Anesthesia: General anesthesia using double-lumen endotracheal tube. 2. Position: Right decubitus position. An axillary roll is placed under the down side. The operative field is well disinfected and draped. 3. VATS setting. Thoracoscopic examination showed no pleural seeding or malignant lesion. Left posterolateral thoracotomy is made through the forth intercostal space. 4. The left lower lobe is retracted anteriorly. The inferior pulmonary ligment is divided. 5. The fissure between the middle and lower lobes is separated and divided. Carefully mobilze left phrenic nerve and preserve it. 6. The pulmonary vessels supplying the left upper lobe is identified, doubly ligated, suture-ligated and divided. Sleeve resection of left main pulmonary trunk was done. 7. The bronchus to the upper lobe is identified and transected with endoBIA. Sleeve resection of left upper lobe bronchs was done. 8. The pleural cavity is irrigated with normal saline. 9. Lymph node dissection is done at group 3,5,7,10,11,12. 12. After meticulous homeostasis and check-up of air leakage, two 28# chest tubes are placed at anterior and posterior aspect of pleural cavity respectively. The intercostal space is closed with interrupted 2# Chromic sutures. The muscle layer is closed with 1-0 Vicryl sutures and the subcutaneous layer is closed with 2-0 Vicryl sutures. Subcutical 3-0 Prolene sutures are used for closure of the skin. Operators VS郭順文 Assistants R5李佳穎 R4蔡東明 Ri吳昭瑩 Ri全賀顯 伍惇 (M,1940/06/07,71y9m) 手術日期 2011/03/14 手術主治醫師 曾勝弘 手術區域 東址 019房 02號 診斷 Malignant neoplasm of rectosigmoid junction 器械術式 Burr hole for chronic subdural hematoma drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 4E 紀錄醫師 覃紹殷, 時間資訊 13:00 臨時手術NPO 13:00 開始NPO 15:16 通知急診手術 21:55 報到 22:00 進入手術室 22:01 麻醉開始 22:15 開始輸血 22:15 誘導結束 22:55 手術開始 23:00 抗生素給藥 23:50 手術結束 23:50 麻醉結束 00:05 送出病患 00:15 進入恢復室 01:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 腫瘤醫學部 套用罐頭: Bur hole for drainage 開立醫師: 陳睿生 開立時間: 2011/03/15 00:02 Pre-operative Diagnosis Left F-T-P chronic subdural hemorrhage, suspect leptomeningosis related Post-operative Diagnosis Left F-T-P chronic subdural hemorrhage, suspect leptomeningosis related Operative Method Bur hole for drainage Specimen Count And Types 4 pieces About size:pieces Source:dura About size:3ml Source:subdural fluid About size:3ml Source:subdural fluid About size:3ml Source:subdural fluid Pathology Pending Operative Findings The subdural fluid was xanthochromic pattern, and the initial pressure was moderate. Some hemosiderin deposition with motor oil pattern was drained. The brain pulsation was fair. Outer membrane was noted. Operative Procedures 1. ETGA, supine position, and head right turn 2. Linear scalp incision wwas done over left frontal 3. Create a bur hole, and dura tenting was done 4. The dura and outer membrane were opened 5. The subdural fluid was drained, and then we inserted a rubber drain for saline irrigation 6. The rubber drain was fixed 7. Hemostasis, and the wound was closed in layers Operators VS 曾勝弘 Assistants R6 陳睿生, R2 覃紹殷 Indication Of Emergent Operation 王余賢英 (F,1949/05/02,62y10m) 手術日期 2011/03/14 手術主治醫師 賴達明 手術區域 東址 002房 03號 診斷 Cerebrovascular accident (CVA) 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 4E 紀錄醫師 李柏穎, 時間資訊 00:48 通知急診手術 01:25 進入手術室 01:30 麻醉開始 01:50 誘導結束 02:00 抗生素給藥 02:17 手術開始 05:10 手術結束 05:10 麻醉結束 05:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱骨切除術,包括異物移除或壓或經切斷 1 1 R 麻醉 C.V.P. catheter in ubation 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 顱內壓視置入 1 2 摘要__ 手術科部: 神經部 套用罐頭: Right F-T-P decompressive craniectomy, duropl... 開立醫師: 王奐之 開立時間: 2011/03/14 05:47 Pre-operative Diagnosis Large right MCA infarction Post-operative Diagnosis Large right MCA infarction Operative Method Right F-T-P decompressive craniectomy, duroplasty and ICP monitor insertion Specimen Count And Types nil Pathology Nil Operative Findings Bulging of brain parenchyma was noted after opening of dura. Some brain tissue was already necrotic at the edge of craniectomy. Initial ICP after placement: 9. ICP after skin closure: 16. ICP monitor reference value: 515. Estimated blood loss: 300ml. Operative Procedures After ETGA, the patient was placed in supine position with face turned to left. After scalp shaving, disinfection and draping in sterile fashion, a standard trauma flap was done at right F-T-P area. After reflecting the temporalis muscle downwards, craniectomy was done. The dura was then opened, duroplasty was performed with temporalis fascial graft. A subgaleal ICP monitor was placed and secured. After hemostasis and setting up 2 epidural CWV drains, the wound was closed in layers. After ETGA, the patient was placed in supine position with face turned to left. After scalp shaving, disinfection and draping in sterile fashion, a standard trauma flap was done at right F-T-P area. After reflecting the temporalis muscle downwards, craniectomy was done. The dura was then opened, duroplasty was performed with temporalis fascial graft. A subdural ICP monitor was placed and secured. After hemostasis and setting up 2 epidural CWV drains, the wound was closed in layers. Operators VS 賴達明 Assistants R3 王奐之, R1 李柏穎 Indication Of Emergent Operation saving life 相關圖片 王余賢英 (F,1949/05/02,62y10m) 手術日期 2011/03/14 手術主治醫師 賴達明 手術區域 東址 001房 03號 診斷 Cerebrovascular accident (CVA) 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 4E 紀錄醫師 游皓鈞, 時間資訊 16:15 通知急診手術 16:55 進入手術室 16:55 報到 16:56 麻醉開始 17:50 抗生素給藥 18:00 誘導結束 18:02 手術開始 20:30 麻醉結束 20:30 手術結束 20:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 顱骨切除術,包括異物移除或壓或經切斷 1 2 R 摘要__ 手術科部: 神經部 套用罐頭: Extensive craniectomy and partial frontal lob... 開立醫師: 陳睿生 開立時間: 2011/03/14 20:21 Pre-operative Diagnosis Right MCA infarction with brain swelling Post-operative Diagnosis Right MCA infarction with brain swelling Operative Method Extensive craniectomy and partial frontal lobectomy for decompression Specimen Count And Types 1 piece About size: Source:skull culture Pathology Nil Operative Findings Severe brain swelling was noted while craniectomy. Poor brain pulsation was also noted. Temporalis muscle was cut for decompression, and the craniectomy was extended. Partial frontal lobectomy was done for decompression. The ICP downgraded from 30mmHg to 6mmHg peri-op. Operative Procedures 1. ETGA, supine position, and head left turn 2. Reopen of the scalp flap, and the scalp incision extended posteriorly 3. Extensive craniectomy was done and then proper dural tenting was done 4. The temporal bone was also removed for decompression 5. Reopen of the dura, and partial frontal lobectomy was done for decompression 6. The dura was covered back with Durafoam 7. Set two epidural CWV drains 8. Teh wound was closed in layers Operators VS 賴達明 Assistants R6 陳睿生, R1 游皓鈞 Indication Of Emergent Operation 周留協 (M,1935/09/04,76y6m) 手術日期 2011/03/14 手術主治醫師 王國川 手術區域 東址 016房 03號 診斷 Communicating hydrocephalus 器械術式 Burr hole (trephination), Right frontal, subdural drain insertion 手術類別 緊急手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 3E 紀錄醫師 彭元宏, 林哲光, 時間資訊 00:00 開始NPO 10:30 通知急診手術 13:15 報到 13:32 麻醉開始 13:32 進入手術室 13:32 誘導結束 14:15 抗生素給藥 14:18 手術開始 15:30 16:10 手術結束 16:10 麻醉結束 16:25 送出病患 16:30 進入恢復室 17:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 頭顱穿洞術(止血引流、穿刺檢查),每加一孔 1 1 手術 單純膀胱頸切開術 1 1 記錄__ 手術科部: 外科部 套用罐頭: Right frontal burr hole and subdural drainage 開立醫師: 林哲光 開立時間: 2011/03/14 15:39 Pre-operative Diagnosis Right F-T-P chronic SDH Post-operative Diagnosis Ditto Operative Method Right frontal burr hole and subdural drainage Specimen Count And Types Pathology Operative Findings Mixed blood clot and sand-like fluids contents were noted after dural opening. The outer membrane was noted and inner membrane was not visible due to small operative wound and depressed brain parenchyma. Operative Procedures Under ETGA and supine position with head mild rotated to left side, skin disinfected and drapped were performed as usual. Linear skin incision was made and temporalis muscle was partially incised. A burr hole was created. The dura was then opened after dural tenting. The outter membrane was coagulized with bipolar. The subdural drain insertion with N/S irrigation. Deair was then done. The subdural drain was fixed on the skin through a subcutaneous tunnel. The wound was then closed in layers. Operators VS 王國川 Assistants R5 蔡宗良, R4 林哲光 Indication Of Emergent Operation 記錄__ 手術科部: 泌尿部 套用罐頭: TUR-BN 開立醫師: 彭元宏 開立時間: 2011/03/14 16:41 Pre-operative Diagnosis 1. benign prostate hyperplasia 2. bladder neck contracture Post-operative Diagnosis 1. benign prostate hyperplasia 2. bladder neck contracture Operative Method Transurethral resection of the bladder neck Specimen Count And Types nil Pathology pending Operative Findings 1. 1g of prostatic tissue was resected 2. bladder neck incision at 5 and 7 oclock Operative Procedures Under satisfactory spinal anesthesia, the patient was placed in lithotomy position. Prepping and draping were performed in the usual sterile method. Urethral meatus stricture was noted and was dilated with Sounding to Fr 30. A Fr 27. Olympus resectoscope sheath was inserted into the urethra with adequate lubrication. Then the resectoscope was inserted. The bladder neck was incised at 5 and 7 oclock and was resected with cutting loop piece after piece. The chips were washed out with a Ellik evacuator. Hemostasis was done. A 22 Fr. 3-way Foley catheter was inserted and its balloon was inflated to 10c.c. Continuous N/S irrigation started. The patient tolerated the operation well and was sent to the recovery room with stable condition. Operators 劉詩彬, Assistants 彭元宏, Indication Of Emergent Operation 陳古寶玉 (F,1952/03/01,60y0m) 手術日期 2011/03/15 手術主治醫師 杜永光 手術區域 東址 003房 03號 診斷 Subdural hemorrhage or effusion 器械術式 Burr hole (trephination) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 3 紀錄醫師 林哲光, 時間資訊 11:30 臨時手術NPO 11:30 開始NPO 15:05 通知急診手術 20:50 進入手術室 21:25 麻醉開始 21:30 誘導結束 21:57 抗生素給藥 22:15 手術開始 23:50 麻醉結束 23:50 手術結束 00:00 送出病患 00:05 進入恢復室 01:07 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 記錄__ 手術科部: 外科部 套用罐頭: Left frontal subdural drain insertion 開立醫師: 林哲光 開立時間: 2011/03/16 00:20 Pre-operative Diagnosis Left chronic subdural hematoma Post-operative Diagnosis Ditto Operative Method Left frontal subdural drain insertion Specimen Count And Types Pathology Operative Findings Status post bilateral subdural drain insertion connected with Y-connector and abdominal catheter through the LUQ abdomen. Some sand like dark-reddish sticky fluids gushed out after subdural catheter removed. Much granulation tissue formation was noted around the burr hole. Around 3cm long rubber drain was inserted to subdural space. Operative Procedures Under ETGA and supine position with head mild rotated to right side, skin disinfected and drapped were performed as usual. Skin incisions were made at previous operative wounds of bilateral burr hole sites. Two subdural catheters were removed and the abdominal catheter was put away from the scalp wound smoothly. The left frontal burr hole was extended with punch and Currette. N/S irrigation through the subdural drain was performed in four directions and Deair was done. The wounds were then closed in layers after subdural was put through the subcuatneous tunneling and fixed on the scalp. Operators P 杜永光 Assistants R4 林哲光 Indication Of Emergent Operation 相關圖片 張萬來 (M,1936/05/12,75y10m) 手術日期 2011/03/15 手術主治醫師 劉詩彬 手術區域 東址 008房 09號 診斷 Prostate cancer 器械術式 bil pigtail insertion 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 伍嘉偉, 時間資訊 20:15 報到 20:15 進入手術室 20:23 麻醉開始 20:25 手術開始 20:25 麻醉結束 21:00 手術結束 21:11 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 皮下穿刺腎造廔術（單側） 1 0 B 記錄__ 手術科部: 泌尿部 套用罐頭: Pigtail PCN 開立醫師: 伍嘉偉 開立時間: 2011/03/15 21:04 Pre-operative Diagnosis bilateral hydronephrosis Post-operative Diagnosis bilateral hydronephrosis Operative Method bilateral pigtail PCN Specimen Count And Types nil Pathology nil Operative Findings Dilated bilateralrenal pelvis and collecting system Operative Procedures 1. Under satisfactory local anesthesia, the patient was placed in prone position. 2. Prepping and draping were performed in the usual sterile method. 3. Dilated renal collecting system was identified. Adequate puncture path was chosen. The puncture needle was introduced into the collecting system under ultrasonographic guidance. 4. The guide-wire was inserted into right renal pelvis under sono-guidedance. 5. The tract was dilated with dilators, and the pigtail catheter was introduced into the renal pelvis smoothly through the guidewire. 6. The guidewire was removed. 7. After the fluid was drained out, the tube was fixed on the skin. 8. Another side was performed as previous procedure. 8. The patient tolerated the operation well, and was sent back to ward in stable condition. Operators 蒲永孝, Assistants 伍嘉偉, 賴建榮, Indication Of Emergent Operation 江嵐 (F,1977/04/15,34y10m) 手術日期 2011/03/15 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Brain tumor 器械術式 Crainotomy Brain Tumor(P-LIN) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:03 進入手術室 08:15 麻醉開始 08:45 誘導結束 08:50 抗生素給藥 09:15 手術開始 11:50 抗生素給藥 12:20 麻醉結束 12:20 手術結束 12:25 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除-手術時間在4小時以內 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Right frontal craniotomy for tumor excision 開立醫師: 李振豪 開立時間: 2011/03/15 12:55 Pre-operative Diagnosis Right frontal tumor, suspect ganglioglioma or xanthoastrocytoma Post-operative Diagnosis Right frontal tumor, suspect ganglioglioma or xanthoastrocytoma Operative Method Right frontal craniotomy for tumor excision Specimen Count And Types 1 piece About size:3X2X2cm Source:Right frontal tumor Pathology Frozen section: some xanthochromic appearance and neuron was noted in frozen section. Ganglioglioma or xanthoastrocytoma was suspected. Waiting for special stain. Operative Findings The tumor was 2x2x2cm in size(solid part), elastic to firm, gray-reddish, moderate vascularization, and well-demarcated in character. The cystic component was noted medial to the tumor with serous-like content. After tumor excision, the tumor bed brain parenchyma was edematous with mild yellowish in gross appearance. The brain was slack after tumor excision. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position. The scalp was shaved, scrubbed, and disinfected as usual. Bicoronal scalp incision was made followed by three burr hole creation. One 5x7cm craniotomy window was done and dural tenting was performed along the bone edge. The C-shape durotomy was performed based with midline. Intra-operative sonography was used to identified the tumor location. The border of the tumor was dissected with bipolar electrocautery, sucker, and ENT forceps. The specimen was sent for frozen section. Hemostasis was achieved with bipolar electrocautery and Surgicel lining. Duroplasty was performed with artificial dura. The epidural space was packing with one 5x7cm Gelform. The skull plate was fixed back with miniplates and screws. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS曾勝弘 Assistants R4李振豪, Ri 相關圖片 林月英 (F,1934/06/06,77y9m) 手術日期 2011/03/15 手術主治醫師 曾勝弘 手術區域 東址 005房 02號 診斷 Cervical spondylosis with myelopathy 器械術式 Laminectomy C-Spinal(Posterier 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 12:20 報到 12:50 進入手術室 12:55 手術開始 12:55 麻醉開始 13:15 誘導結束 13:40 抗生素給藥 14:50 開始輸血 16:10 手術結束 16:10 麻醉結束 16:35 送出病患 16:36 進入恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 椎弓切除術(減壓)-超過二節 1 1 摘要__ 手術科部: 外科部 套用罐頭: C3-7 laminectomy for decompression 開立醫師: 李振豪 開立時間: 2011/03/15 16:42 Pre-operative Diagnosis Cervical stenosis with myelopathy Post-operative Diagnosis Cervical stenosis with myelopathy Operative Method C3-7 laminectomy for decompression Specimen Count And Types nil Pathology Nil Operative Findings The thecal sac was compressed tightly by ligmentum flavum. The thecal sac expanded well after decompression. The SSEP was poor before the operation and slightly improved in waveform after whole procedure. No CSF leakage or incidental durotomy was noted. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position with head fixed by a Mayfield skull clamp.The occipital and neck areas were shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. Midline skin incision from suboccipital to lower neck was made. The subcutaneous soft tissue and paravertebral muscle groups were detached. The spinous process and bilateral laminae from C3 to C7 were exposed. Laminectomy was performed with Rongeurs and Kerrison punches. The ligmentum flavum also removed for decompression. Hemostasis was achieved with Gelform packing and Bipolar electrocautery. One epidural CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators vs曾勝弘 Assistants R4李振豪, Ri 相關圖片 游武彥 (M,1942/12/04,69y3m) 手術日期 2011/03/15 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Lumbar Spondylosis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 蔡立威, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:10 麻醉開始 08:20 誘導結束 09:15 手術開始 09:20 抗生素給藥 12:30 抗生素給藥 14:22 手術結束 14:22 麻醉結束 14:35 送出病患 14:37 進入恢復室 15:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎弓切除術(減壓)-二節以內 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: 1. Posterior instrumentation, transpedicular ... 開立醫師: 蔡立威 開立時間: 2011/03/15 14:40 Pre-operative Diagnosis 1.L3-4 spondylolisthesis 2.L3-4, L4-5 lumbar spinal stenosis Post-operative Diagnosis 1.L3-4 spondylolisthesis 2.L3-4, L4-5 lumbar spinal stenosis Operative Method 1. Posterior instrumentation, transpedicular screw and rod fixation, L3-5 2. L3 laminectomy 3. Discectomy, L3-4 3. L3-4 Discectomy with cage fusion Specimen Count And Types nil Pathology nil Operative Findings 1. Hypertrophy of L3-4 and L4-5 ligmentum flavum, causing severe lumbar spinal stenosis Operative Procedures Under endotracheal general anesthesia, prone position, we did skin disinfection and drapping as usual. Skin incision was posterior midline, about from L3-S1 level. Then we performed periosteal dissection. transpedicular screws were inserted bilaterally to L3 and L5. L3 laminectomy were then performed. L3-4 discectomy was performed. A 11-mm height Synthes cage packed with autologuous bone fragments was implantated for L3-4 vertebral body fusion. Finally, L3-L5 screws were fixed by Synthes rods. Copious saline irrigation was performed after hemostasis. One 1/8 HemoVac was inserted in paraspinal space. The wound was closed in layers. Operators VS賴達明 Assistants R5蔡宗良,R2蔡立威 李新一 (M,1940/03/20,71y11m) 手術日期 2011/03/15 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Spondylosis,cervical&myelopathy; 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 蔡立威, 時間資訊 00:00 臨時手術NPO 14:45 進入手術室 14:50 麻醉開始 15:00 誘導結束 15:20 抗生素給藥 15:50 手術開始 18:20 抗生素給藥 19:00 手術結束 19:00 麻醉結束 19:05 送出病患 19:10 進入恢復室 20:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-頸椎 1 1 手術 脊椎融合術-前融合,有固定物)≦四節 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 摘要__ 手術科部: 外科部 套用罐頭: 1.C3-4 Anterior Discectomy and cage fusion 開立醫師: 蔡立威 開立時間: 2011/03/15 19:14 Pre-operative Diagnosis C3-4 HIVD Post-operative Diagnosis C3-4 HIVD Operative Method 1.C3-4 Anterior Discectomy and cage fusion 2.C3-5 plate fixation Specimen Count And Types nil Pathology nil Operative Findings the cage was 6mm in height, position was checked by fluoroscopy Operative Procedures Under endotracheal general anesthesia, supine position, we performed skin disinfection and drapping as usual. A transverse right upper neck skin incision was done. Then C3-4 intervertebral disc was identified and rechecked by fluoroscopy. Microscope was brought into the operation field. We resected the C3-4 disc and implanted a cage. The cage position was also checked by fluoroscopy. Then we performed plate fixation(C3-5). A minihemovac was placed in prevertebral fascia. Finally, the wound was closed in layers. Operators VS賴達明 Assistants R5蔡宗良,R2蔡立威 郭福照 (M,1926/07/12,85y8m) 手術日期 2011/03/15 手術主治醫師 蕭輔仁 手術區域 東址 005房 03號 診斷 Lumbar spondylosis 器械術式 Radiofrequency coagulation 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 李振豪, 時間資訊 12:00 臨時手術NPO 15:50 報到 16:44 進入手術室 17:15 抗生素給藥 17:24 麻醉開始 17:25 麻醉結束 17:25 誘導結束 17:26 手術開始 18:20 手術結束 18:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 高頻熱凝療法 1 1 B 摘要__ 手術科部: 外科部 套用罐頭: 1. Bilateral L2 dorsal root ganglion radiofre... 開立醫師: 李振豪 開立時間: 2011/03/15 18:34 Pre-operative Diagnosis Low back pain Post-operative Diagnosis Low back pain Operative Method 1. Bilateral L2 dorsal root ganglion radiofrequency stimulation 2. Right L5 paravertebral muscle local injection with Marcaine + Rinderon Specimen Count And Types nil Pathology Nil Operative Findings The location of bilateral L2 dorsal root ganglion was identified under C-arm fluoroscopy guided. Radiofrequency stimulation was performed two cycles in each side. Acute complication(-), CSF (-) Operative Procedures The patient was put in prone position. The skin was disinfected and draped as usual. Under C-arm fluoroscopy guided, the location of bilateral L2 dorsal root ganglion was identified. Radiofrequency stimulation was done with two cycles in each side. Local injection with Marcaine + Rinderon suspension of right L5 paravertebral tender point also performed during the operation. Operators VS蕭輔仁 Assistants R4李振豪 相關圖片 葛瓦琪 (F,1945/02/20,67y0m) 手術日期 2011/03/15 手術主治醫師 柯政郁 手術區域 東址 023房 03號 診斷 Sublingual gland cancer 器械術式 Radical neck lymphatic dissect 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 翁宇成, 時間資訊 09:50 報到 09:55 進入手術室 10:00 麻醉開始 10:15 抗生素給藥 10:20 誘導結束 10:30 手術開始 13:40 手術結束 13:40 麻醉結束 13:48 送出病患 13:50 進入恢復室 15:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 舌骨上區清除術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 記錄__ 手術科部: 耳鼻喉部 套用罐頭: MRND, right, left 開立醫師: 翁宇成 開立時間: 2011/03/15 13:33 Pre-operative Diagnosis Neck metastatic tumor, left Post-operative Diagnosis Neck metastatic tumor, left, operated Operative Method The patient was in supine position with the neck hyperextended. General anesthesia was then set up. The neck was then rotated toward the right side. The operation field was disinfected and draped as usual. A skin incision was made. The skin flaps were elevated at subplatysmal plane (medially to the midline of neck, laterally to the posterior border of the SCM muscle, superiorly to the mandible, inferiorly to the clavicle). The external jugular vein was identified and carefully preserved. The SCM muscle was severed near the inferior end and dissected out upward. Lymphoareolar tissue of level V was dissected, followed by the dissection of those in level III and level II. An tumor beneath the SCM muscle at level III was seen, with no compression to the IJV. IJV was preserved, while the common carotid artery and vagus nerve were identified and preserved. The SCM muscle was then severed at the superior end and was separated from the scalene muscle group. Spinal accessory nerve was also and preserved. After hemostasis, the wound was closed in layers with a 1/8 minihemo-vac in place for drainage. The patient tolerated the whole procedure well. Specimen Count And Types 1 piece About size:about 10*10cm Source:left neck lymphoid tissue Pathology 1 piece About size:about 10*10cm Source:left neck lymphoid tissue Operative Findings left neck lymphoid tissue with tumor Operative Procedures Modified radical neck dissection, left, type 2 Operators P柯政郁, Assistants R2翁宇成, R4張睿紘, R5王士豪, 記錄__ 手術科部: 耳鼻喉部 套用罐頭: MRND, right, left 開立醫師: 翁宇成 開立時間: 2011/03/15 13:33 Pre-operative Diagnosis Neck metastatic tumor, left Post-operative Diagnosis Neck metastatic tumor, left, operated Operative Method The patient was in supine position with the neck hyperextended. General anesthesia was then set up. The neck was then rotated toward the right side. The operation field was disinfected and draped as usual. A skin incision was made. The skin flaps were elevated at subplatysmal plane (medially to the midline of neck, laterally to the posterior border of the SCM muscle, superiorly to the mandible, inferiorly to the clavicle). The external jugular vein was identified and carefully preserved. The SCM muscle was severed near the inferior end and dissected out upward. Lymphoareolar tissue of level V was dissected, followed by the dissection of those in level III and level II. An tumor beneath the SCM muscle at level III was seen, with no compression to the IJV. IJV was preserved, while the common carotid artery and vagus nerve were identified and preserved. The SCM muscle was then severed at the superior end and was separated from the scalene muscle group. Spinal accessory nerve was also and preserved. After hemostasis, the wound was closed in layers with a 1/8 minihemo-vac in place for drainage. The patient tolerated the whole procedure well. Specimen Count And Types 1 piece About size:about 10*10cm Source:left neck lymphoid tissue Pathology 1 piece About size:about 10*10cm Source:left neck lymphoid tissue Operative Findings left neck lymphoid tissue with tumor Operative Procedures Modified radical neck dissection, left, type 2 Operators P柯政郁, Assistants R2翁宇成, R4張睿紘, R5王士豪, 記錄__ 手術科部: 耳鼻喉部 套用罐頭: The patient was in supine position with the n... 開立醫師: 翁宇成 開立時間: 2011/03/18 00:23 Pre-operative Diagnosis Neck metastatic tumor, left Post-operative Diagnosis Neck metastatic tumor, left, operated Operative Method The patient was in supine position with the neck hyperextended. General anesthesia was then set up. The neck was then rotated toward the right side. The operation field was disinfected and draped as usual. A skin incision was made. The skin flaps were elevated at subplatysmal plane (medially to the midline of neck, laterally to the posterior border of the SCM muscle, superiorly to the mandible, inferiorly to the clavicle). The external jugular vein was identified and carefully preserved. The SCM muscle was severed near the inferior end and dissected out upward. Lymphoareolar tissue of level V was dissected, followed by the dissection of those in level III and level II. An tumor beneath the SCM muscle at level III was seen, with no compression to the IJV. IJV was preserved, while the common carotid artery and vagus nerve were identified and preserved. The SCM muscle was then severed at the superior end and was separated from the scalene muscle group. Spinal accessory nerve was also and preserved. After hemostasis, the wound was closed in layers with a 1/8 minihemo-vac in place for drainage. The patient tolerated the whole procedure well. Specimen Count And Types 1 piece About size:about 10*10cm Source:left neck lymphoid tissue Pathology 1 piece About size:about 10*10cm Source:left neck lymphoid tissue Operative Findings left neck lymphoid tissue with tumor Operative Procedures Modified radical neck dissection, left, typeII Operators P柯政郁, Assistants R2翁宇成, R4張睿紘, R5王士豪, 邱仕堯 (M,1962/11/22,49y3m) 手術日期 2011/03/15 手術主治醫師 蔡翊新 手術區域 東址 002房 03號 診斷 Cerebrovascular accident (CVA) 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 鍾文桂, 時間資訊 12:20 開始NPO 12:20 通知急診手術 13:10 報到 13:20 進入手術室 13:30 麻醉開始 13:40 誘導結束 13:50 抗生素給藥 14:00 開始輸血 14:10 手術開始 16:50 抗生素給藥 17:40 手術結束 17:40 麻醉結束 17:45 送出病患 17:50 17:50 抗生素給藥 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦內血腫清除術 1 1 R 手術 顱內壓視置入 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 記錄__ 手術科部: 外科部 套用罐頭: 1. Decompressive craniectomy for removal of c... 開立醫師: 鍾文桂 開立時間: 2011/03/15 20:18 Pre-operative Diagnosis Traumatic contusional ICH, acute SDH, right frontal-parietal-temporal. Post-operative Diagnosis Traumatic contusional ICH, acute SDH, right frontal-parietal-temporal. Operative Method 1. Decompressive craniectomy for removal of contusional ICH and acute SDH. 2. Insertion of subdural ICP monitor. Specimen Count And Types nil Pathology Nil. Operative Findings 1. Before craniotomy: Codman ICP monitor: 20mmHg, after craniectomy: 14mmHg. 2. Moderate brain swelling intraoperatively. 3. Severe brain contusion with contusional ICH at frontal and temporal poles. Organized solid ICH was encountered. 4. Easy oozing operative field. Transfusion: PRBC 6U, FFP 12U, PLT 12U. 5. Dural augmentation with DuraFoam, covered with silicon dressing epidurally 6. The temporalis muscle was resected for further decompression. Operative Procedures Under ETGA, the patient was placed in supine position and the head was tilted to the left side. After shaving, disinfection, and draping, a 20 cm curvilinear scalp incision was made. After scalp dissection and resection of the temporalis muscle was resected. A small burr hole at temporal side was done. After durotomy, the ICP monitor was inserted to get initial ICP. Then, a 15-cm craniectomy window was created. After dural tenting, a curvilinear durotomy was obtained. The contused brain parenchyma and intracerebral hematoma were evacuated at temporal and frontal poles. The subdural hematoma was also evacuated. After well hemostasis, the dura mater was augmented with DuraFoam. After placing two epidural CWV drain, a thin film of silicon dressing was covered. After fixation of the ICP monitor, the wound was closed in layers. Operators 蔡翊新 Assistants R5 鍾文桂 Indication Of Emergent Operation 相關圖片 邱仕堯 (M,1962/11/22,49y3m) 手術日期 2011/03/15 手術主治醫師 蔡翊新 手術區域 東址 005房 04號 診斷 Cerebrovascular accident (CVA) 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 4E 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 18:40 進入手術室 18:45 麻醉開始 18:47 誘導結束 18:50 手術開始 18:55 開始輸血 19:53 手術結束 19:53 麻醉結束 20:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 硬腦膜外血腫清除術 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 蔡翊新 開立時間: 2011/03/15 19:55 Pre-operative Diagnosis Right frontotemporoparietal SDH s/p craniectomy with postop EDH and IICP. Post-operative Diagnosis Right frontotemporoparietal SDH s/p craniectomy with postop EDH and IICP. Operative Method Evacuation of EDH. Specimen Count And Types nil Pathology Nil. Operative Findings ICP was 56 mmHg before operation. The right F-T-P craniectomy window was very tense. Upon opening the wound, blood and blood clots gushed out and the ICP dropped to 25 mmHg immediately. After fully reflection of the scalp flap, epidural hematoma about 3 cm in thickness was encountered. After EDH removal, the ICP was 1 mmHg, but the brain was a little bulging out. ICP after skin closure was 3 mmHg. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: right F-T-P trauma flap, along previous wound. 5. The epidural clot was removed by sucker. 6. Hemosatasis: the bleeders was stopped by Bovie and oozing surface was covered with gelfoam. 7. Two epidural CWV drains were set. 8. Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 9. Blood transfusion: PRBC 2U. Blood loss: 400 ml. 10.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5鍾文桂 Indication Of Emergent Operation 相關圖片 蔡彥伶 (F,1985/11/29,26y3m) 手術日期 2011/03/16 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Arteriovenous malformation, brain 器械術式 Craniotomy (A.V.M.) P-DUH 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 07:30 報到 08:05 進入手術室 08:10 麻醉開始 08:40 誘導結束 09:00 抗生素給藥 09:03 手術開始 12:00 抗生素給藥 15:00 抗生素給藥 18:00 抗生素給藥 18:10 開始輸血 21:00 抗生素給藥 21:30 麻醉結束 21:30 手術結束 21:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 19 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 顱內壓視置入 1 2 R 手術 開顱術摘除血管病變- 動靜脈畸型大型 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: 1. Right posterior frontal craniotomy for AVM... 開立醫師: 王奐之 開立時間: 2011/03/16 22:41 Pre-operative Diagnosis Right posterior frontal arteriovenous malformation, Spetzler-Martin grade 3 Post-operative Diagnosis Right posterior frontal arteriovenous malformation, Spetzler-Martin grade 3 Operative Method 1. Right posterior frontal craniotomy for AVM removal 2. ICP monitor insertion Specimen Count And Types 1 piece About size:2*2*4cm Source:right frontal AVM Pathology Pending Operative Findings A portion of tangling vessels were noted at posterior frontal brain surface. The AVM nidus was noted inferior and deep to the tangling vessels, apart with small distance. Intra-operative mapping failed to identify sensory-motor cortex. Multiple arterial feeders of various sizes and large draining veins were noted. Significant blood loss and marked brain swelling after AVM removal were encountered, ICP monitor was inserted for intensive ICP management. Initial ICP: 6 mmHg after wound closure. ICP reference level: 484. Operative Procedures After ETGA, the patient was placed in supine position with face turned to left and head fixed in Mayfield skull clamp. After scalp shaving, disinfection and draping in sterile fashion, a slightly sigmoidal-shaped curvilinear skin incision was made at right frontotemporal area. A round craniotomy window was made, followed by a curved durotomy, exposing the AVM. After dissection, AVM nidus border, arterial feeders and draining veins were identified and ligated. The AVM nidus was then removed, hemostasis was achieved by packing and FloSeal. The dura was closed with 4-0 Prolene in water-tight fashion. The bone was then fixed back with miniplates. The wound was closed in layers after securing the ICP monitor and setting a subgeal CWV drain. Operators P.杜永光 Assistants R6 陳睿生, R3 王奐之 相關圖片 蔡彥伶 (F,1985/11/29,26y3m) 手術日期 2011/03/17 手術主治醫師 杜永光 手術區域 東址 018房 03號 診斷 Arteriovenous malformation, brain 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 4E 紀錄醫師 王奐之, 時間資訊 23:18 通知急診手術 23:19 開始NPO 23:19 臨時手術NPO 23:40 報到 23:40 進入手術室 23:45 麻醉開始 23:50 誘導結束 01:20 抗生素給藥 02:30 手術開始 04:20 抗生素給藥 05:50 麻醉結束 05:50 手術結束 06:10 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 手術 腦內血腫清除術 1 2 R 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for intracerebral hematoma evacuat... 開立醫師: 王奐之 開立時間: 2011/03/17 06:35 Pre-operative Diagnosis Right posterior frontal AVM s/p excision, with post-op right frontotemporal ICH Post-operative Diagnosis Right posterior frontal AVM s/p excision, with post-op right frontotemporal ICH Operative Method Craniotomy for intracerebral hematoma evacuation & excision of residual AVM Specimen Count And Types 1 piece About size:pieces Source:right posterior frontal AVM Pathology Pending Operative Findings Residual AVM nidus was noted and totally removed. Estimated blood loss: 1800ml. Blood transfusion: PRBC 10U, FFP: 6U, Plt: 12U. Operative Procedures After ETGA, the patient was placed in supine position with face turned to left and head fixed in Mayfield skull clamp. After scalp shaving, disinfection and draping in sterile fashion, a slightly sigmoidal-shaped curvilinear skin incision was made at right frontotemporal area along previous wound. The previous craniotomy bone was removed, followed by a curved durotomy along previous durotomy, exposing the post-operative cavity. Hematoma was evacuated and bleeding were controlled with packing, electrocauterization & FloSeal application. The residual AVM nidus was also removed. The dura was closed with 4-0 Prolene in water-tight fashion. The bone was then fixed back with miniplates. The wound was closed in layers after securing the ICP monitor and setting a subgeal CWV drain. Operators P.杜永光 Assistants R6 陳睿生, R3 王奐之 Indication Of Emergent Operation 相關圖片 柳翰璋 (M,1973/08/08,38y7m) 手術日期 2011/03/16 手術主治醫師 曾漢民 手術區域 東址 005房 03號 診斷 Spine tumor 器械術式 Benign intraspinal tumor, exci 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾偉倫, 鍾文桂, 時間資訊 00:00 臨時手術NPO 14:45 報到 15:38 進入手術室 15:43 麻醉開始 15:55 誘導結束 16:10 抗生素給藥 16:24 手術開始 19:10 抗生素給藥 20:00 手術結束 20:00 麻醉結束 20:20 送出病患 20:28 進入恢復室 21:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓整形術 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 手術 良性脊髓腫瘤切除術 1 1 記錄__ 手術科部: 外科部 套用罐頭: C7 laminectomy and T1-T2 laminoplasty for tum... 開立醫師: 鍾文桂 開立時間: 2011/03/16 20:33 Pre-operative Diagnosis 1. Spinal tumor, C6-7, suspect neurilemmoma. 2. Neurofibromatosis, type 2 Post-operative Diagnosis 1. Spinal tumor, multiple, suspect neurilemmoma. 2. Neurofibromatosis, type 2 Operative Method C7 laminectomy and T1-T2 laminoplasty for tumor excision. Specimen Count And Types 1 piece About size:2x2x2 cm Source:Spinal tumor Pathology Pending Operative Findings 1. Multiple soft, whitish, intradural extramedullary tumor. The tumor was surrounded by nerve fibers. The largest one is over C6-C7 level 2. Intra-operative MEP showed no significance shange, but the SSEP over right leg showed decreased amplitude comparing to the patients baseline 3. C7 laminectomy was performed. Only T1-2 laminoplasty was performed. Operative Procedures Under ETGA, we fixed the patients head with Mayfield and place him on prone position. After we scrubbed, disinfected and drapped, a linear skin incision was made over mid-line at C7-T2 level. Paraspinal muscle was dissected.C7-T1 open-book laminoplasty was achieved through high speed drill. The dura was opened and piece-meal tumor resection was performed meticulously. After well hemostasis, the dura mater was closed in water-tigh fashion. T1-2 laminae was fixed by miniplates and screws. The wound was closed in layers with one epidural CWV drain in situ. Operators VS 曾漢民 Assistants R5 鍾文桂 R2 曾偉倫 相關圖片 吳佩芸 (F,1974/09/11,37y6m) 手術日期 2011/03/16 手術主治醫師 賴達明 手術區域 東址 005房 01號 診斷 Brain abscess 器械術式 Burr hole (trephination) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 08:09 進入手術室 08:20 麻醉開始 08:50 誘導結束 09:00 抗生素給藥 09:28 手術開始 11:00 抗生素給藥 11:25 手術結束 11:25 麻醉結束 11:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 慢性硬腦膜下血腫清除術 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Triphination with abscess drainage 開立醫師: 鍾文桂 開立時間: 2011/03/16 11:50 Pre-operative Diagnosis Left frontal brain bascess Post-operative Diagnosis Left frontal brain bascess Operative Method Triphination with abscess drainage Left frontal craniotomy for abscess drainage Specimen Count And Types 1 piece About size:3 Smear tubes Source: for bacteria, fungus, mycobacterial culture Pathology Nil Operative Findings 1. A 4x4x3 cm brain abscess over left frontal area 2. Red-yellow-green pus drained out from the abscess cavity. 3. Intraoperative ultrasonography was done for localizing the abscess cavity. Operative Procedures Under ETGA, the patient was placed in supine position and the head was tilted to the right. After shaving, disinfection, and draping, a 8 cm linear scalp incision was made at preauricular area. After splitting the temporalis muscle, a 2 cm craniotomy was created by using high speed drill. After localizing the abscess cavity under ultrasonography guidance, a small cruciate durotomy was done. The abscess cavity was reached by ventriclar puncture needle. The negaton tube was placed through the same tract. The pus was collected for culture. After well hemostasis, the wound was closed in layers and the craniotomy plate was placed back. Operators VS 賴達明 Assistants R5 鍾文桂 R2 曾偉倫 相關圖片 吳張照美 (F,1940/07/03,71y8m) 手術日期 2011/03/16 手術主治醫師 賴達明 手術區域 東址 005房 02號 診斷 Ossification of posterior longitudinal ligament (OPLL) (OPLL) 器械術式 Laminectomy C-Spinal(Posterier 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 11:54 進入手術室 12:00 麻醉開始 12:10 誘導結束 13:00 抗生素給藥 13:10 手術開始 15:05 手術結束 15:05 麻醉結束 15:18 送出病患 15:20 進入恢復室 17:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓整形術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: Laminoplasty, C3-4 開立醫師: 曾偉倫 開立時間: 2011/03/16 15:16 Pre-operative Diagnosis OPLL with cervical stenosis, C2-C4 Post-operative Diagnosis OPLL with cervical stenosis, C2-C4 Operative Method Laminoplasty, C3-4 Specimen Count And Types nil Pathology Nil. Operative Findings 1. Occificate posterior longitudinal ligament over C2-4 level with spinal canal stenosis 2. The dura was kept intact during the whole procedure 3. The spinal cord was loose after the laminoplasty Operative Procedures Under ETGA, we fixed her head with Mayfield and placed her to prone position. After we scrubbed, disinfected and drapped, a mid line skin incision was done over C1-C5 level. We opened the wound in layers and dissect the paraspinal muscle. The laminoplasty was performed over C3-4 and the lamina was opened from the right. A CWV drain was placed after complete hemostasis. The wound was closed in layers. Operators VS 賴達明 Assistants R5 蔡宗良 R5 鍾文桂 R2 曾偉倫 相關圖片 羅崧瑜 (M,2002/04/03,9y11m) 手術日期 2011/03/16 手術主治醫師 楊士弘 手術區域 兒醫 067房 01號 診斷 Chiari malformation 器械術式 Suboccipital craniectomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 07:55 報到 08:05 進入手術室 08:15 麻醉開始 08:50 誘導結束 09:20 抗生素給藥 09:45 手術開始 12:12 麻醉結束 12:12 手術結束 12:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱骨切除術,包括異物移除或壓或經切斷 1 1 手術 椎弓切除術(減壓)-二節以內 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Bilateral suboccipital craniectomy and C1 lam... 開立醫師: 林哲光 開立時間: 2011/03/16 12:57 Pre-operative Diagnosis Chiari malformation type I Post-operative Diagnosis Ditto Operative Method Bilateral suboccipital craniectomy and C1 laminectomy Ssuboccipital craniectomy and C1 laminectomy for posterior fossa decompression Specimen Count And Types Pathology Operative Findings A sharp angle was noted from the occiptal part to the foramen magnum, small posterior fossa was noted. The dura sac of medulla oblongata seemed re-expanded after craniectomy was performed. The hypertrophy of the occpitoatlantal ligament was noted and opened according the echo finding. The echo showed piston movement of the tonsil before the ligament ligation. The lower occipital bone to angle deep to reach the foramen magnum, so a small posterior fossa was noted. The dura sac of posterior fossa seemed after craniectomy and laminectomy, and further expanded after release of occpitoatlantal ligament. Piston movement of the tonsil was noted before the ligament release, and improved after ligment release. Operative Procedures Under ETGA and prone position with head fixed with Mayfield head clump, skin disinfected and drapped were performed as usual. Midline skin incision from inion to C2 spinous process was done. Incision between the avascular plane Latissmus dorsi and paraspinal muscles. Two burr holes were created below the inion and around 3x2cm craniectomy was done. C1 laminectomy was also performed. The occipitoatlantal ligament was excised after intraoperative sonography. The wound was then closed in layers after epidural drain insertion. Under ETGA and prone position with head fixed with Mayfield head clump, skin disinfected and drapped were performed as usual. Midline skin incision from inion to C2 spinous process was done. Incision between the avascular plane Trapezius muscle and paraspinal muscles. Two burr holes were created below the inion and around 3x2cm craniectomy was done. C1 laminectomy was also performed. The occipitoatlantal ligament was excised after intraoperative sonography. The wound was then closed in layers after epidural drain insertion. Under ETGA and prone position with head fixed with Mayfield head clamp, skin disinfected and drapped were performed as usual. Midline skin incision from inion to C2 spinous process was done. Incision between the avascular plane Trapezius muscle and paraspinal muscles. Two burr holes were created below the inion and a 3x3cm craniectomy was done. C1 laminectomy was also performed. The occipitoatlantal ligament was transected vertically and pull laterally after intraoperative sonography. The wound was then closed in layers after epidural drain insertion. Operators VS 楊士弘 Assistants R4 林哲光 相關圖片 張偉明 (M,1948/06/11,63y9m) 手術日期 2011/03/16 手術主治醫師 王國川 手術區域 東址 016房 01號 診斷 Head injury, unspecified 器械術式 Remove V-P shunt, left 手術類別 緊急手術 手術部位 頭、頸 傷口分類 髒 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 陳睿生, 時間資訊 00:00 開始NPO 00:00 臨時手術NPO 00:42 通知急診手術 08:40 進入手術室 08:42 麻醉開始 08:45 誘導結束 09:13 手術開始 10:30 手術結束 10:35 麻醉結束 10:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 皮下肌肉或深部異物取出術 1 1 L 手術 皮下肌肉或深部異物取出術 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 內科部 套用罐頭: Remove of bilateral SP shunts and VP shunt 開立醫師: 陳睿生 開立時間: 2011/03/16 10:59 Pre-operative Diagnosis Subdural empyema Post-operative Diagnosis Subdural empyema Operative Method Remove of bilateral SP shunts and VP shunt Specimen Count And Types Culture swab x2. Both sent for laboratory investigation. Pathology None Operative Findings 1. Purulent pus discharge at subdural space from the left-sided SP shunt insertion site. CSF flow was clear and colorless. Pressure is subjectively high. 2. No purulent pus discharge at subdural space form the right and the wound was clear. Operative Procedures 1. Supine, head rotated to the right. 2. Usual prepping and draping. 3. Linear skin incision over the previous wounds. 4. Specimen obtained for culture. 5. Irrigation, with copious saline and gentamicin added saline. 6. Wound is closed with single layer 3-0 Nylon 7. Head rotated to the left. 8. Two linear wounds, the SP shunt was removed. 9. Wound is irrigated with copious saline. 10. Woiund is closed by single layer 3-0 Nylon. Operators VS 王國川 Assistants R5 蔡宗良, Intern 柯佳宜 R5 蔡宗良, Intern 柯嘉怡 Indication Of Emergent Operation uncontrolled infection KITAMURA HARUMASA (M,1948/04/08,63y11m) 手術日期 2011/03/17 手術主治醫師 杜永光 手術區域 東址 002房 02號 診斷 Subarachnoid hemorrhage 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 3E 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 14:13 進入手術室 14:15 麻醉開始 14:20 誘導結束 15:05 抗生素給藥 15:40 手術開始 16:35 手術結束 16:35 麻醉結束 16:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱內壓視置入 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 創傷醫學部 套用罐頭: Insertion of external ventricular drainage ca... 開立醫師: 曾偉倫 開立時間: 2011/03/28 16:45 Pre-operative Diagnosis Hydrocephalus. Post-operative Diagnosis Hydrocephalus. Operative Method Insertion of external ventricular drainage catheter for ICP monitoring and CSF drainage. Specimen Count And Types 1 piece About size:3cc Source:CSF Pathology Nil. Operative Findings Clear pinkish CSF drained out from puncture needle. Low ICP. Codman EVD catheter was inserted at left Kocher point. Operative Procedures Under ETGA, the patient was placed in supine position and head in midline position. After shaving, disinfection, and draping, a linear scalp incision was made at left Kocher point. After creating a burr hole and durotomy, the ventricular puncture needle was inserted at left Kocher point. After ensuring the patency of the catheter, the wound was closed in layers. Operators Prof. 杜永光 Assistants R5 鍾文桂 Indication Of Emergent Operation obstructive hydrocephalus. 相關圖片 陳正印 (M,1961/04/10,50y11m) 手術日期 2011/03/17 手術主治醫師 杜永光 手術區域 東址 019房 03號 診斷 Intracerebral hemorrhage 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 王永彬 ASA 3E 紀錄醫師 陳以幸, 時間資訊 20:45 通知急診手術 20:50 進入手術室 20:55 麻醉開始 21:10 誘導結束 21:20 開始輸血 21:25 抗生素給藥 21:25 手術開始 00:25 抗生素給藥 01:10 送出病患 01:10 麻醉結束 01:10 手術結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦內血腫清除術 1 1 R 手術 顱內壓視置入 1 2 R 摘要__ 手術科部: 外科部 套用罐頭: CVA 開立醫師: 曾峰毅 開立時間: 2011/03/18 01:29 Pre-operative Diagnosis Right putaminal ICH with IVH Post-operative Diagnosis Right putaminal ICH with IVH Operative Method Right craniotomy for ICH evacaution and ICP monitor insertion Specimen Count And Types Nil Pathology Nil Operative Findings About 120 ml ICH was noted at right basal ganglion. Right lateral ventricle was not entered. Codman ICP monitor reference is 459, and ICP after wound closure was -3 mmHg. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated left. After scalp shaved, scrubbed, disinfected, and then draped, we made one curvilinear skin incision right frontal area. We drilled four burr holes, and then created right frontal craniotomy. We made durotomy, and removed ICH via right frontal coricotomy. Hemostasis was done with surgicel packed in the hemotoma cavity. Dura was closed in water-tight fashion, and ICP monitor was inserted into subdural space. Bone graft was fixed back with miniplates, and after two CWV inserted, the wound was closed in layers. Operators P 杜永光 VS 蔡翊新 Assistants R4 曾峰毅 R1 陳以幸 Indication Of Emergent Operation Saving life. 孟粹珠 (F,1939/04/17,72y10m) 手術日期 2011/03/18 手術主治醫師 賴達明 手術區域 東址 027房 06號 診斷 Lung cancer 器械術式 T spine metastasis resection with Spinal fusion posterior 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 王永彬 ASA 3E 時間資訊 08:30 開始NPO 08:30 臨時手術NPO 09:47 通知急診手術 21:20 進入手術室 22:30 麻醉開始 23:00 誘導結束 23:30 開始輸血 00:04 手術開始 02:40 麻醉結束 02:45 手術結束 02:50 送出病患 22:10 報到 23:50 抗生素給藥 醫令資訊 類別 名稱 量 刀 側 麻醉 Hemoglobin (Hb) 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 2 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 惡性脊髓腫瘤切除術 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 摘要__ 手術科部: 外科部 套用罐頭: 1. Removal of intraspinal tumor via laminecto... 開立醫師: 陳睿生 開立時間: 2011/03/18 02:48 Pre-operative Diagnosis Metastatic epidural spinal cord compression, T3 Post-operative Diagnosis Metastatic epidural spinal cord compression, T3 Operative Method 1. Removal of intraspinal tumor via laminectomy of T3 and T4 2. Posterior instrumentation, TPS over T2 and T4 with bilateral rods and cross-link fixation. Specimen Count And Types 1 piece About size:小 Source:Epidural space Pathology Report pending Operative Findings 1. Epidural mass at T3 and T4 compressing spinal cord Operative Procedures 1. ETGA, prone 2. Mayfield headclamp fixation 3. Fluoroscopic confirmation of level 4. Routine prepping and drapping 5. Linear skin incision and periosteal dissection from T1 to T4 6. Transpedicular screw fixation, T2 and T4, followed by laminectomy for decompression of T3 and T4. 7. Removal of epidural mass. 8. Rods fixation, bilateral, with cross-link 9. 1L N/S irrigation 10. CWV placement 11. Wound closed in layers. Operators VS 賴達明 Assistants R5 蔡宗良, R2 蕭惠壬 Indication Of Emergent Operation Mestastatic spinal cord compression 鄭若梅 (F,1942/03/04,70y0m) 手術日期 2011/03/17 手術主治醫師 陳敞牧 手術區域 東址 005房 03號 診斷 Scalp Laceration wound 器械術式 Laminectomy C-Spinal(Posterier 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 3 紀錄醫師 曾峰毅, 時間資訊 00:00 臨時手術NPO 12:20 報到 12:28 進入手術室 12:40 麻醉開始 13:20 誘導結束 13:25 抗生素給藥 13:30 手術開始 15:50 手術結束 15:50 麻醉結束 16:12 送出病患 16:15 進入恢復室 17:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓整形術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Laminoplasty 開立醫師: 曾峰毅 開立時間: 2011/03/17 15:56 Pre-operative Diagnosis Cervical stenosis Post-operative Diagnosis Cervical stenosis Operative Method Laminoplasty, C4-6 Specimen Count And Types Nil Pathology Pending Operative Findings Spinal cord was decompressed well after laminoplasty. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position with head fixed with Mayfield head clamp. We made one midline skin incision to expose spineous process of C3 to C7. Laminoplasty with hinge at right was done on C4-6. Mini-plates was used for fixation. After one CWV insertion, the wound was closed in layers. Operators VS 陳敞牧 Assistants R4 曾峰毅 詹進福 (M,1951/09/23,60y5m) 手術日期 2011/03/17 手術主治醫師 陳敞牧 手術區域 東址 001房 04號 診斷 Spondylosis with myelopathy, cervical 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 3 紀錄醫師 陳睿生, 時間資訊 00:00 臨時手術NPO 15:05 報到 15:25 進入手術室 15:30 麻醉開始 15:43 誘導結束 15:45 抗生素給藥 16:14 手術開始 19:10 手術結束 19:10 抗生素給藥 19:10 麻醉結束 19:25 送出病患 19:26 進入恢復室 20:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 手術 椎間盤切除術-頸椎 1 1 手術 椎融合術-前融合,無固定物(≦四節) 1 2 摘要__ 手術科部: 外科部 套用罐頭: Anterior Discectomy and Fusion, Cervical Spine 開立醫師: 陳睿生 開立時間: 2011/03/17 19:32 Pre-operative Diagnosis Herniated cervical disc, C5-6 Post-operative Diagnosis Herniated cervical disc, C5-6 Operative Method Anterior Discectomy and Fusion, Cervical Spine Specimen Count And Types None Pathology None Operative Findings 1. Redundant PLL 2. Ruptured disc fragment found incarcerating in between the PLL 3. A 7-mm height cage filled with artificial bone substitutes was impacted into C5-6 disc space. Operative Procedures 1. ETGA, supine 2. Routinely prepped and drapped. 3. Linear skin incision 4. Open platysma 5. Go throught the plane between streps muscles and SCM 6. Retract streps and dissect medially along the carotid sheath. 7. Open the prevertebral fascia and dissect the longus colli for retraction. 8. Fluoroscopic confirmation using spinal needle. 9. Discectomy under operating microscope. 10. Open PLL until dura is directly visible. 11. Cage impacted into the disc space 12. Wound irrigation and meticulous hemostasis. 13. Wound closed in layers. Operators VS陳敞牧 Assistants R5蔡宗良, Intern高承詣 王天河 (M,1953/01/13,59y2m) 手術日期 2011/03/17 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 Intraspinal abscess 器械術式 OPLL- Anterior Corpectomy 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林珍榮 ASA 3 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 15:05 進入手術室 15:10 麻醉開始 15:20 誘導結束 15:43 手術開始 17:00 抗生素給藥 19:05 手術結束 19:05 麻醉結束 19:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 手術 脊椎融合術-前融合,有固定物)≦四節 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Anterior fusion and fixation with expandable ... 開立醫師: 李振豪 開立時間: 2011/03/17 19:25 Pre-operative Diagnosis C6-7 osteomyelitis and epidural abscess, status post C6 corpectomy for abscess drainage Post-operative Diagnosis C6-7 osteomyelitis and epidural abscess, status post C6 corpectomy for abscess drainage Operative Method Anterior fusion and fixation with expandable body cage, plate, and screws Specimen Count And Types nil Pathology Nil Operative Findings Severe adhesion and granulation tissue was noted along the previous operation tract and the C6 space. No obvious pus was noted during the operation. The granulation at C7 level was soft in character. The expandable body cage and sinbone were used for anterior fusion. The 44mm plates and four 14mm screws were applied for anterior fixation. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with neck extension. The skin was scrubbed, disinfected and draped as usual. The skin incision was made along previous wound and the soft tissue was dissected to entered the pre-vertebral space. After exposure of the C6 location, the marginal spur of C7 was removed. The curette was used for remove the granulation tissue at C7 epidural space. The expandable body cage which filled with sinbone was used for anterior fusion. The plate from C5 to C7 was applied with four screws fixation. Hemostasis was achieved and one CWV drain was placed. The wound was then closed in layers with 3-0 Vicryl and 3-0 Nylon. Operators VS王國川 Assistants R4林哲光, R4李振豪 相關圖片 李秀氣 (F,1949/02/13,63y1m) 手術日期 2011/03/17 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Brain tumor 器械術式 Crainotomy Brain Tumor(P-LIN) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林珍榮 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 08:06 進入手術室 08:15 麻醉開始 09:00 誘導結束 09:00 抗生素給藥 09:05 手術開始 12:14 抗生素給藥 14:25 手術結束 14:25 麻醉結束 14:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 L 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 摘要__ 手術科部: 外科部 套用罐頭: Left retrosigmoid approach for tumor excision... 開立醫師: 李振豪 開立時間: 2011/03/17 14:54 Pre-operative Diagnosis Left petroclival meningioma Post-operative Diagnosis Left petroclival meningioma Operative Method Left retrosigmoid approach for tumor excision, Simpson grade IV Specimen Count And Types 1 piece About size:2x2x2cm Source:Left petroclival tumor Pathology Pending Operative Findings The low cranial nerve was pushed downward, outward by the tumor. The facial nerve was pushed upward and outward. The tumor was adhered to the dura and part of brainstem tightly. The tumor also extended into jugular foramen. The tumor was whith-grayish, moderate vascularized, elastic to firm, well-capsulated in most part, and 3.1 x 2.8 x 1.7cm in size. Thin layer of tumor(0.2cm in thickness) was left in the brainstem surface due to severe adhesion. The tumor that attached to the dura base was coagulated with bipolar electrocautery. The left side BAEP was poor before the operation and no obvious BAEP change noted during the operation. Left facial stimulation was positive after tumor removal. The left CN VI was noted after total removal of the tumor. Operative Procedures Under endotracheal general anesthesia, the patient was put in right decubitus position with head fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. The curvilinear scalp incision was made at left retroauricular area. The subcutaneous soft tissue and nuchal muscle was divided. The periosteum was harvested for duroplasty. Three burr hole was created followed by 3x5cm craniotomy window. Dural tenting was performed. Pi shape durotomy was performed. The cistern around the foramen magnum was opened and CSF was released. The cerebellum was retracted and the tumor was identified. The low cranial nerve and VII, VIII complex was identified and dissected from the tumor surface. The tumor was removed by CUSA, bipolar electrocautery, microscissor, and tumor forceps. The tumor that adhered to the dura was coagulated with bipolar electrocautery. Hemostasis was achieved with bipolar electrocautery and Surgicel lining. Duroplasty was done with periosteum. The skull plate was fixed back with two # 26 wires and one central tenting. Bone cement was applied for coverage the bone gap. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS王國川 Assistants R4李振豪 相關圖片 柯慶良 (M,1954/11/17,57y3m) 手術日期 2011/03/17 手術主治醫師 蔡翊新 手術區域 東址 005房 01號 診斷 Subdural hemorrhage following injury, with loss of consciousness of unspecified duration 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 3 紀錄醫師 曾峰毅, 時間資訊 00:00 臨時手術NPO 07:50 進入手術室 07:50 報到 08:15 麻醉開始 08:20 誘導結束 08:30 抗生素給藥 09:00 手術開始 10:50 手術結束 10:50 麻醉結束 10:55 送出病患 11:00 進入恢復室 12:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 頭顱成形術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Cranioplasty 開立醫師: 蔡翊新 開立時間: 2011/03/17 10:13 Pre-operative Diagnosis Right frontotemporoparietal skull defect. Post-operative Diagnosis Right frontotemporoparietal skull defect. Operative Method Cranioplasty with autologous bone graft, duroplasty with Durofoam. Specimen Count And Types nil Pathology Nil. Operative Findings A 12 x 10 cm skull defect at right frontotemporoparietal area. Subgaleal effusion was drained upon scalp flap reflection. Dural defect was noted along previous dural incision because of unhealing of previous Durofoam and it was covered with a new piece of Durofoam. The right temporalis muscle has been excised during previous operation and it was replaced with a piece of bone cement. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation:shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with a sterilized adhesive plastic sheet. 4. Incision: along the previous operation scar at right F-T-P area, Raney clips were apllied to the scalp edge for temporary hemostasis. 5. The right F-T-P scalp was dissected away from the underlying dura. 6. The edge of the skull defect was exposed. 7. The original skull plate preserved at bone bank was placed back to the skull window then fixed by 3 miniplates, 6 screws and 5 dural tentings at the center of the skull plate. 8. Bone cement paste was shaped into a triangular piece and replaced the bulk of temporalis muscle. 9. Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by interrupted suture with 3/0 nylon. 10.Drain: two, epidural, CWV. 11.Blood transfusion: nil. Blood loss: 200 ml. 12.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R4曾峰毅Ri林鈴 相關圖片 曾繁凱 (M,1986/02/16,26y0m) 手術日期 2011/03/17 手術主治醫師 蔡翊新 手術區域 東址 005房 02號 診斷 Major trauma rated 16 or above on the severeity scale ( Injury severeity score >=16 ) 器械術式 Tracheostomy 手術類別 預定手術 手術部位 胸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 4E 紀錄醫師 曾峰毅, 時間資訊 00:00 臨時手術NPO 11:18 報到 11:18 進入手術室 11:22 麻醉開始 11:25 誘導結束 11:39 手術開始 12:00 麻醉結束 12:00 手術結束 12:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 氣管切開術 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 曾峰毅 開立時間: 2011/03/17 12:13 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types Nil Pathology Nil Operative Findings Tracheostomy tube no.8 was used. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with neck extended. We made one midline skin incision 2 cm above the sternal notch, and dissected to expose trachea layer by layer. We made one incision at trachea, and inserted low pressure tracheostomy tube. Operators VS 蔡翊新 Assistants R4 曾峰毅 Ri 林鈴 馮淑芳 (F,1926/06/12,85y9m) 手術日期 2011/03/17 手術主治醫師 蔡翊新 手術區域 東址 002房 號 診斷 重大創傷且及嚴重程度到達創傷嚴重程度分數16分以上 器械術式 Removal of chronic subdural 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 王永彬 ASA 4E 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 17:20 進入手術室 17:20 報到 17:25 麻醉開始 17:40 誘導結束 18:00 抗生素給藥 18:15 手術開始 19:33 開始輸血 21:00 抗生素給藥 21:10 麻醉結束 21:10 手術結束 21:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 急性硬腦膜下血腫清除術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 蔡翊新 開立時間: 2011/03/17 21:34 Pre-operative Diagnosis Right frontotemporoparietal acute on chronic SDH. Post-operative Diagnosis Right frontotemporoparietal acute on chronic SDH. Operative Method Right frontotemporal craniotomy for SDH removal. Specimen Count And Types nil Pathology Nil. Operative Findings Previous craniotomy at right frontotemporal area, 8 x 6 cm in size and fixed with 3 miniplates and 6 screws. Blood clots at subdural space of right F-T-P area, 15 x 12 cm in area and 2 cm in thickness, was evacuated. Cortical contusion at right temporal area was noted, with active bleeder from one cortical artery and one bridging vein. The brain remained slack after SDH removal, about 1 cm beneath the dura. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: along previous wound at right F-T-P area, the skin edge was clipped by Raney clips for temporary hemostasis. 5. Previous craniotomy bone plate was removed. Craniotomy window: 8 x 6 cm, right F-T-P. 6. Dural incision: curvilinear along the edge of skull window. 7. The subdural clot was removed by sucker and those located beyond the cranial window was washed out by saline irrigation. The bleeders were stopped by Bovie and oozing surface was covered with Surgicel. 8. Dural closure: with 4-0 Prolene. 9. The bone plate was fixed back with original miniplates and screws. 10.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by interrupted suture with 3/0 nylon. 11.Drain: one subdural rubber drain, one epidural CWV drain. 12.Blood transfusion: PRBC 2U, Platelet 12U. Blood loss: 500 ml. 13.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5鍾文桂R5蔡宗良 吳翠英 (F,1955/07/22,56y7m) 手術日期 2011/03/17 手術主治醫師 楊榮森 手術區域 東址 027房 02號 診斷 Osteoarthritis, hip 器械術式 THA, R 手術類別 預定手術 手術部位 四肢 傷口分類 髒 麻醉方式 脊髓麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 黃俊傑, 時間資訊 09:30 進入手術室 09:35 麻醉開始 09:45 誘導結束 09:48 抗生素給藥 10:00 手術開始 11:00 手術結束 11:00 麻醉結束 11:05 送出病患 11:08 進入恢復室 13:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 急性化膿性關節炎切開術-股關節 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Spinal anesthesia 1 0 記錄__ 手術科部: 骨科部 套用罐頭: Arthrotomy, and debridement 開立醫師: 黃俊傑 開立時間: 2011/03/17 10:48 Pre-operative Diagnosis Right hip OA suspect infection Post-operative Diagnosis Chondrolysis of right hip joint , infection related Operative Method Arthrotomy, and debridement Specimen Count And Types 5 pieces About size: Source: About size: Source: About size: Source: About size: Source: About size: Source: Pathology nil Operative Findings Pus formation and granulation tissue formation over right hip joint Operative Procedures 1.Sa, decubitus, prepped ,disinfected and draped as uaual 2.Incision over right hip joint ,posterior approach 3.Right hip capsulotomy , much pus formation 4.collect tissue and culture 5.irrigation with providine, normal saline 6.apply hemovac then close the wound Operators 楊榮森, Assistants 廖翊廷, 林蔚鑫, 黃俊傑　,施哲仁 房玲玲 (F,1956/05/26,55y9m) 手術日期 2011/03/18 手術主治醫師 杜永光 手術區域 東址 002房 04號 診斷 Brain tumor 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 14:19 進入手術室 14:25 麻醉開始 14:30 誘導結束 15:31 手術開始 16:10 手術結束 16:10 麻醉結束 16:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室腹腔分流手術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt insertion via left... 開立醫師: 王奐之 開立時間: 2011/03/18 16:35 Pre-operative Diagnosis Post-operative intraventricular hemorrhage and hydrocephalus Post-operative Diagnosis Post-operative intraventricular hemorrhage and hydrocephalus Operative Method Ventriculoperitoneal shunt insertion via left Kocher point Specimen Count And Types Nil Pathology Nil Operative Findings Slight xanchromic CSF was noted intra-operatively. Medium pressure Medtronic valve was used. CSF was collected and sent for routine, BCS, bacterial & fungal cultures. Slight xanthochromic CSF was noted intra-operatively. Medium pressure Medtronic valve was used. CSF was collected and sent for routine, BCS, bacterial & fungal cultures. Operative Procedures After ETGA, the patient was placed in supine position with face turned to right. After scalp shaving, disinfection and draping in sterile fashion, a curved incision along previous wound was made at left frontal area. A linear skin incision was made at LUQ, and a mini-laparotomy was done. A subcutaneous tunnel was made from abdominal wound to left posterior occipital area, and further advanced to left frontal wound. Peritoneal catheter and ventricular catheters were then connected and secured. After confirming shunt function, the wound was closed in layers after hemostasis. Operators P.杜永光 Assistants R6 陳睿生, R3 王奐之 相關圖片 陳明信 (M,1981/04/30,30y10m) 手術日期 2011/03/18 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Astrocytoma 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:20 進入手術室 08:25 麻醉開始 09:15 誘導結束 09:30 抗生素給藥 09:40 手術開始 12:30 抗生素給藥 14:10 麻醉結束 14:10 手術結束 14:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除-手術時間在4小時以內 1 1 R 手術 腦室體外引流 1 2 R 摘要__ 手術科部: 外科部 套用罐頭: Midline frontal craniotomy for interhemispher... 開立醫師: 王奐之 開立時間: 2011/03/18 14:49 Pre-operative Diagnosis Right intraventricular tumor, suspected glioma or central neurocytoma Post-operative Diagnosis Right intraventricular tumor, suspected glioma or central neurocytoma Operative Method Midline frontal craniotomy for interhemispheric transcallosal intraventricular tumor removal Specimen Count And Types 1 piece About size:pieces Source:right intraventricular tumor Pathology Pending Operative Findings Purplish soft fragile tumor was noted at right lateral ventricle after callosotomy. The tumor was distinct from surrounding tissue. A medtronic EVD was set in the right lateral ventricle after tumor removal. Operative Procedures After ETGA, the patient was placed in supine position and face turned to right and head fixed in Mayfield skull clamp. A curvilinear skin incision was made at frontal area, followed by craniotomy creation. A fishmouth durotomy was done, the dural flap was reflected to the midline. Interhemispheric route was taken, and the corpus callosum was noted. A small callosotomy was done (about 1~1.5cm in diameter), the ventricle was then entered, exposing the tumor. The tumor was then removed in pieces. After hemostasis and setting 1 EVD, the dura was closed in water-tight fashion. The bone was fixed back with miniplates and screws, the wound was closed in layers after setting 1 subgaleal CWV drain. Operators P. 杜永光 Assistants R6 陳睿生, R3 王奐之 相關圖片 莊承澧 (F,1983/06/09,28y9m) 手術日期 2011/03/18 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Acoustic neuroma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 1 紀錄醫師 曾偉倫, 鍾文桂, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:06 進入手術室 08:15 麻醉開始 08:50 誘導結束 09:00 抗生素給藥 09:05 手術開始 12:00 抗生素給藥 14:50 抗生素給藥 15:05 麻醉結束 15:05 手術結束 15:12 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 顱底瘤手術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 摘要__ 手術科部: 外科部 套用罐頭: Left post-auricular craniotomy with tumor exc... 開立醫師: 曾偉倫 開立時間: 2011/03/18 15:27 Pre-operative Diagnosis Left cerebropontine angle, suspect acoutic neuroma Post-operative Diagnosis Left cerebropontine angle, suspect acoutic neuroma Operative Method Left post-auricular craniotomy with tumor excision Specimen Count And Types 1 piece About size:4x4x3 cm Source:CP angle tumor Pathology Pending Operative Findings 1. An elastic, whitish, hypervascularized 4x4x3 cm CP angle tumor araised from the left CN7 and CN8 boundle which pushed the CN5 upward. The tumor extend to internal acoustic canal 1. An elastic, whitish, hypervascularized 5x4.5x4.5 cm CP angle tumor araised from the left CN7 and CN8 boundle which pushed the CN5 upward. The tumor extend to internal acoustic canal 2. The lower cranial nerve, CN4, CN5 and CN7 were identified and preserved 3. Intraoperative BAEP, SSEP showed no significant change 4. A small piece of tumor was left within internal acoustic canel Operative Procedures Under ETGA, we fixed the patients head with Mayfield and put her on right 3/4 prone position. After we scrubbed, disinfected amd drapped, a curvilinear skin incision was made over her left post auricular area. The craniectomy was made and we opened the dura. Some CSF was drained for creating operative space. The lower cranial nerve was identified and preserved. The tumor resection was perfomred with bipolar forceps, tumor forceps, scissors and CUSA. CN4, CN5 and CN7 were idntified during tumor resection. The wall of internal acoustic canel was opened with drill for tumor resection. The dura was repaired with fascia and the skulled was placed back with miniplate. After the hemostasis was done, we closed the wound in layers. Operators VS 曾漢民 Assistants R5 鍾文桂 R2 曾偉倫 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Left post-auricular craniotomy with tumor exc... 開立醫師: 鍾文桂 開立時間: 2011/03/23 08:15 Pre-operative Diagnosis Left cerebropontine angle, suspect acoutic neuroma Post-operative Diagnosis Left cerebropontine angle, suspect acoutic neuroma Operative Method Left retrosigmoid approach for subtotal tumor excision Specimen Count And Types 1 piece About size:4x4x3 cm Source:CP angle tumor Pathology Pending Operative Findings 1. An elastic, whitish, hypervascularized 5x4.5x4.5 cm CP angle tumor araised from the left CN7 and CN8 boundle which pushed the CN5 upward. The tumor extend to internal acoustic canal 2. The lower cranial nerve, CN4, CN5 and CN7 were identified and preserved 3. Intraoperative BAEP, SSEP showed no significant change 4. A small piece of tumor was left within internal acoustic canel Operative Procedures Under ETGA, we fixed the patients head with Mayfield and put her on right 3/4 prone position. After we scrubbed, disinfected amd drapped, a curvilinear skin incision was made over her left post auricular area. The craniectomy was made and we opened the dura. Some CSF was drained for creating operative space. The lower cranial nerve was identified and preserved. The tumor resection was perfomred with bipolar forceps, tumor forceps, scissors and CUSA. CN4, CN5 and CN7 were idntified during tumor resection. The wall of internal acoustic canel was opened with drill for tumor resection. The dura was repaired with fascia and the skulled was placed back with miniplate. After the hemostasis was done, we closed the wound in layers. Operators VS 曾漢民 Assistants R5 鍾文桂 R2 曾偉倫 相關圖片 張宏安 (M,1962/07/11,49y8m) 手術日期 2011/03/18 手術主治醫師 曾漢民 手術區域 東址 003房 06號 診斷 Brain metastasis 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 曾偉倫, 鍾文桂, 時間資訊 00:00 臨時手術NPO 14:15 報到 14:43 進入手術室 14:50 麻醉開始 15:15 誘導結束 15:45 抗生素給藥 16:00 手術開始 17:40 手術結束 17:45 麻醉結束 17:50 送出病患 17:53 進入恢復室 18:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 顱骨切除術,包括異物移除或壓或經切斷 1 1 L 手術 頭皮腫瘤 1 2 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 記錄__ 手術科部: 外科部 套用罐頭: 1. Craniectomy and cranioplasty with titanium... 開立醫師: 鍾文桂 開立時間: 2011/03/18 18:01 Pre-operative Diagnosis Esophageal cancer with scalp and skull metastasis,left parietal-occipital. Post-operative Diagnosis Esophageal cancer with scalp and skull metastasis,left parietal-occipital. Operative Method 1. Craniectomy and cranioplasty with titanium mesh, left parietal-occipital. 2. Scalp tumor excision, left parietal-occipital. Specimen Count And Types 2 pieces About size:5cm Source:scalp tumor About size:6 cm Source:skull tumor. Pathology Pending. Operative Findings 1. White-yellowish elastic, and firm tumor at galeal layer in left parietal-occipital region. 2. The previous craniotomy window was removed. Operative Procedures Under ETGA, the patient was placed in prone position and the head in midline position. After shaving, disinfection, and draping, the previous craniotomy scalp wound was incised and dissected. The scalp tumow was excised by using electrocoagulation. Then, the craniotomy skull plate was removed after dissection. The titanium plate was fixed on the skull defect. After well hemostasis, the wound was closed in layers with one subgaleal CWV drain. Operators 曾漢民 Assistants 鍾文桂 曾偉倫 相關圖片 洪碧霞 (F,1940/09/03,71y6m) 手術日期 2011/03/18 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Congenital lumbosacral spondylolisthesis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 蔡立威, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:05 進入手術室 08:20 麻醉開始 08:35 誘導結束 09:00 抗生素給藥 09:32 手術開始 12:00 抗生素給藥 12:55 開始輸血 14:40 手術結束 14:40 麻醉結束 14:55 送出病患 14:57 進入恢復室 16:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎弓切除術(減壓)-二節以內 1 2 摘要__ 手術科部: 外科部 套用罐頭: 1. Posterior instrumentation, transpedicular ... 開立醫師: 蔡立威 開立時間: 2011/03/18 15:07 Pre-operative Diagnosis 1. L3-4 HIVD 2. Lumbar spinal stenosis, L3-4 3. Spondylolisthesis, L3-4, grade II Post-operative Diagnosis 1. L3-4 HIVD 2. Lumbar spinal stenosis, L3-4 3. Spondylolisthesis, L3-4, grade II Operative Method 1. Posterior instrumentation, transpedicular screw and rod fixation, L3-5 2. Posterior decompression, bilateral laminotomy, L3-4, & L4-5 3. Discectomy, L3-4, & L4-5 4. Left L3-4, L4-5 facetomy Specimen Count And Types nil Pathology nil Operative Findings 1. Hypertrophy of L3-4 and L4-5 ligmentum flavum, causing severe lumbar spinal stenosis 2. Protrusion of L3-4 intervertebral disc to posterior side of L4 body 3. Two cages were both 9mm in height Operative Procedures Under endotracheal general anesthesia, prone position, we did skin disinfection and drapping as usual. Skin incision was posterior midline, about from L3-S1 level. Then we performed periosteal dissection. transpedicular screws were inserted bilaterally to L3, L4 and L5. L3-4 and L4-5 laminotomy were then performed. L3-4 and L4-5 discectomy were performed. Two 9-mm height Synthes cage packed with autologuous bone fragments was implantated for L3-4 and L4-5 vertebral body fusion. Finally, L3-L4-L5 screws were fixed by Synthes rods. Copious saline irrigation was performed after hemostasis. One HemoVac was inserted in paraspinal space. The wound was closed in layers. Operators VS賴達明 Assistants R5蔡宗良,R2蔡立威 蔡江山 (M,1933/12/01,78y3m) 手術日期 2011/03/18 手術主治醫師 賴達明 手術區域 東址 001房 02號 診斷 Hydrocephalus 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 曾峰毅, 時間資訊 00:00 臨時手術NPO 10:55 報到 11:20 進入手術室 11:40 麻醉開始 11:45 誘導結束 11:50 抗生素給藥 12:18 手術開始 13:20 手術結束 13:20 麻醉結束 13:30 送出病患 13:31 進入恢復室 15:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 曾峰毅 開立時間: 2011/03/18 13:10 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunt, programmable, right Kocher Specimen Count And Types CSF was sent for routien, BCS, and culture. Pathology Nil Operative Findings Codman, programmable, Hakim valve, set at 100 mmH20, was used. Clear, colorless CSF gushed out while ventriculostomy. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to left. After scalp shave, scrubbed, disinfected, and then draped, we made one transverse skin incision at right upper abdomen, and created mini-laparotomy. We created subcutaneous tunnel to right occipital area. We made on curvilinear skin incision at right frontal area, and drilled one burr hole. After durotomy and dura tenting, ventriculostomy was performed once, and then ventricular catheter was inserted. We connected shunt altogether, and checked the function. The wound was closed in layers. Operators VS 賴達明 Assistants R4 林哲光 R4 曾峰毅 相關圖片 林震芳 (M,1951/12/05,60y3m) 手術日期 2011/03/18 手術主治醫師 王國川 手術區域 東址 001房 04號 診斷 Contusion, scalp 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 3E 紀錄醫師 曾峰毅, 時間資訊 07:00 臨時手術NPO 07:00 開始NPO 16:02 通知急診手術 16:38 報到 16:40 進入手術室 16:45 麻醉開始 17:00 誘導結束 17:05 抗生素給藥 17:20 手術開始 19:10 麻醉結束 19:10 手術結束 19:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 硬腦膜外血腫清除術 1 1 R 手術 顱內壓視置入 1 2 摘要__ 手術科部: 創傷醫學部 套用罐頭: Right craniotomy for epidural hematoma remova... 開立醫師: 曾峰毅 開立時間: 2011/03/18 19:26 Pre-operative Diagnosis Acute epidural hematoma, right parietal Post-operative Diagnosis Acute epidural hematoma, right parietal Operative Method Right craniotomy for epidural hematoma removal and ICP monitor insertion Specimen Count And Types Nil Pathology Nil Operative Findings About 3 cm thick epidural hematoma was noted at right paietal with one transverse linear skull fracture. About 3 cm thick epidural hematoma was noted at right paietal with one transverse linear skull fracture. Codman ICP monitor reference is 479. ICP after wound closure was 4 mmHg. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to left. AFter scalp shaved, scrubbed, disinfected, and then draped, we made one U-shape skin incision at right pareital area. We drilled four burr holes, and then created craniotomy. We tented the dura along the craniotomy window, and removed the epidural hematoma. We inserted ICP monitor into subdural space, and then fixed the bone graft back with miniplates. The wound was closed in layers with one subgaleal CWV. Operators VS 王國川 Assistants R4 曾峰毅 Ri 柯雅琳 Indication Of Emergent Operation Life saving 林茂榮 (M,1934/06/23,77y8m) 手術日期 2011/03/18 手術主治醫師 劉詩彬 手術區域 東址 008房 06號 診斷 Benign prostatic hypertrophy 器械術式 TRUS-Biobsy 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 靜脈麻醉 麻醉主治醫師 葉惠敏 ASA 3 紀錄醫師 呂育全, 時間資訊 12:15 報到 12:40 進入手術室 12:50 麻醉開始 12:51 誘導結束 12:52 手術開始 12:57 手術結束 12:57 麻醉結束 13:15 進入恢復室 14:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 手術 前列腺切片-控取式 1 1 記錄__ 手術科部: 泌尿部 套用罐頭: TRUS-P-biopsy 開立醫師: 姜秉均 開立時間: 2011/03/18 12:55 Pre-operative Diagnosis r/o prostate cancer Post-operative Diagnosis r/o prostate cancer Operative Method TRUSP biopsy Specimen Count And Types 4 pieces About size:1.7*0.1*0.1*3 Source:Prostate LL About size:1.7*0.1*0.1*3 Source:Prostate RL About size:1.7*0.1*0.1*3 Source:Prostate LM About size:1.7*0.1*0.1*3 Source:Prostate RM Pathology pending Operative Findings systemic 12 cores TRUSP biopsy was performed Operative Procedures Under satisfactory anesthesia with the patient in left decubitus position, prepping and draping was performed in the usual sterile fashion. TRUSP was performed and echo-guided prostate biopsies were performed smoothly with Biopty gun. The cores of tissue specimen were obtained. The biosy area was compressed for several minutes to ensure adequate hemostasis. The patient tolerated the operation well and was sent to the floor in satisfactory condition. Operators 劉詩彬, Assistants 呂育全, 林威佑, 何冠毅 (M,2009/10/09,2y5m) 手術日期 2011/03/18 手術主治醫師 謝孟祥 手術區域 東址 012房 01號 診斷 Acrocephlosyndactyly 器械術式 Debridment-- >10cm 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 面罩麻醉 麻醉主治醫師 葉惠敏 ASA 3 紀錄醫師 陳以幸, 時間資訊 07:37 報到 08:08 進入手術室 08:20 麻醉開始 08:22 誘導結束 08:23 手術開始 08:34 手術結束 08:34 麻醉結束 08:40 送出病患 08:45 進入恢復室 09:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Semi-opened mask inhalation anes 1 0 手術 深部傷口處理縫合擴創-小 1 0 L 摘要__ 手術科部: 外科部 套用罐頭: debridement 開立醫師: 陳以幸 開立時間: 2011/03/18 08:34 Pre-operative Diagnosis Apert syndrome, with syndactyly, status post left hand devision Post-operative Diagnosis Apert syndrome, with syndactyly, status post left hand devision Operative Method debridement Specimen Count And Types nil Pathology nil Operative Findings 1.Tie over was well-located at surgical wound site 2.FTSG was well-covered after tie over removal 3.FTSG take rate:100% Operative Procedures 1.Supine position, mask anethesia 2.gradually remove the covering bandage and gauze, remove the tie over totally Operators VS謝孟祥 Assistants R5官振翔 R1陳以幸 葉徐桂蘭 (F,1932/11/21,79y3m) 手術日期 2011/03/19 手術主治醫師 曾漢民 手術區域 東址 001房 06號 診斷 Glioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 王永彬 ASA 3 時間資訊 00:00 臨時手術NPO 12:43 報到 13:05 進入手術室 13:10 麻醉開始 13:30 誘導結束 13:40 抗生素給藥 13:56 手術開始 16:40 抗生素給藥 17:30 麻醉結束 17:30 手術結束 17:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除-手術時間在4小時以內 1 1 L 手術 顱內壓視置入 1 2 摘要__ 手術科部: 外科部 套用罐頭: Left frontal craniectomy with tumor resection 開立醫師: 陳睿生 開立時間: 2011/03/19 17:53 Pre-operative Diagnosis Left frontal tumor, suspect glioblastomy multiforme Post-operative Diagnosis Left frontal tumor, suspect glioblastomy multiforme Operative Method Left frontal craniectomy with tumor resection Left frontal craniotomy with tumor resection Specimen Count And Types 1 piece About size:5x5x5 cm Source:Left frontal tumor Pathology Pending Operative Findings The tumor was whitish, soft, and mild gelastic change. It was about 5x5x6cm in size, and mainly at left frontal region with corpus callosum extension. The margin between the tumor and normal brain tissue was not very clear. The frontal horn of bilateral ventricles were opened intra-op, and an EVD was inserted at the tumor cavity. Initial ICP was about 5cm H2O. ACA was noted intra-op and well preserved. The dura was ruptured and repaired with artificial graft. Operative Procedures 1. ETGA, the patient was under supine position and head fixed with Mayfield clump 2. Bicoronal scalp incision was done and an about 6x8 cm craniotomy window was made with five bur holes 3. Proper dura tenting and retracted, intra-op ECHO was used to identify the tumor 4. Corticotomy was done from anterior frontal gyrus, and the tumor was noted subcortically 5. The margin between the tumor and normal brain tissue was carefully identified, and the vessels around the tumor margin was electroligated 6. The tumor was removed piece by piece, and bilateral frontal horn was exposed after tumor removal 7. Hemostasis with Floceal, and the residual tumor was checked and removed 8. Insert an EVD at tumor cavity 9. The dura was repaired with Durafoam 10.The skull graft was fixed back with miniplates, and a subgaleal CWV drain was set 11.The wound was closed in layers Operators VS 曾漢民 Assistants R6 陳睿生, R2 曾偉倫 相關圖片 陳春長 (M,1947/12/10,64y3m) 手術日期 2011/03/19 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Parkinson''s disease 器械術式 Stereotaxic procedure for impl 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 面罩麻醉 麻醉主治醫師 王永彬 ASA 2 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 07:40 報到 07:52 進入手術室 08:20 麻醉開始 08:25 誘導結束 08:30 抗生素給藥 08:50 手術開始 09:15 開始輸血 11:30 抗生素給藥 14:30 抗生素給藥 16:55 麻醉結束 16:55 手術結束 17:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Semi-opened mask inhalation anes 1 0 麻醉 Semi-opened INHALATION GENERAL A 4 0 麻醉 SENI-OPENED INHALATION GENERAL A 9 0 手術 立體定位術-功能性失調 1 2 R 手術 立體定位術-功能性失調 1 1 L 手術 深部腦核電生理定位 1 0 B 記錄__ 手術科部: 外科部 套用罐頭: Insertion of DBS wire at bilateral subthalamu... 開立醫師: 鍾文桂 開立時間: 2011/03/19 17:07 Pre-operative Diagnosis Parkisons disease Post-operative Diagnosis Parkisons disease Operative Method Insertion of DBS wire at bilateral subthalamus nucleas Specimen Count And Types nil Pathology Nil Operative Findings 1. The identified subthalamic nucleus at left side: mm in length, right side: mm in length. 2. The rigidity decreased after wire inserted at stimulation "on". 3. Left eye with left-ward gaze limitation when stimulation "on" over leftsubthalamic nucleus. 4. The final target was to the planned target. 3. The final target was to the planned target. 5. Due to agitation and confusion status of the patient during left side localization and some blood was noted in our detector needle, emergent CT of brain was done to confirm if ICH is present. Since only some postoperative change was noted, the right side localization was performed next. 4. Due to agitation and confusion status of the patient during left side localization and some blood was noted in our detector needle, emergent CT of brain was done to confirm if ICH is present. Since only some postoperative change was noted, the right side localization was performed next. Operative Procedures Under IV general anesthesia, the patient was put in supine position. The scalp was shaved, scrubbed and antiseptic with alcohol B-I. Registered the preset localization point to navigator. Bicoronal scalp incision was made with burr hole made at entery point of left frontal region as navigator guided. The DBS wire port was set up and localization of subthalamus nucleus with microelectrode assistance. Inserted the DBS wire and fixed with the port. Waked the patient from the anesthesia and started stimulation from low voltage. Checked the clinical responses while using different voltage for stimulation. Performed the same procedure at right side. After hemostasis, closed the wound in layers. Operators VS 曾勝弘 VS 曾勝弘 戴春暉( intraoperative monitoring) Assistants R5 鍾文桂 相關圖片 林美伶 (F,1971/09/30,40y5m) 手術日期 2011/03/19 手術主治醫師 楊士弘 手術區域 東址 003房 01號 診斷 Herniation of intervertebral disc (HIVD) 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 王永彬 ASA 1 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 07:58 進入手術室 08:05 麻醉開始 08:10 誘導結束 08:18 抗生素給藥 09:22 手術開始 11:18 抗生素給藥 13:15 手術結束 13:15 麻醉結束 13:25 送出病患 13:29 進入恢復室 13:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-腰椎 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 摘要__ 手術科部: 外科部 套用罐頭: Microendoscopic diskectomy, L4-5 開立醫師: 曾偉倫 開立時間: 2011/03/19 13:24 Pre-operative Diagnosis L4-5 Herniated intervetebral disc, left Post-operative Diagnosis L4-5 Herniated intervetebral disc, left Operative Method Microendoscopic diskectomy, L4-5 Specimen Count And Types nil Pathology Nil. Operative Findings 1. A ruptured disc, 4 cm x 2 cm 1 cm in size, was found under the left L5 root. The disc was ruptured near the midline of L4-5 disc and migrated caudally and leftward. 2. The left root became slack after decompression. Operative Procedures Under ETGA, we placed the patient to prone position. The L4-5 level was located with C-arm. After we scrubbed, disinfected and drapped the patient, a 1.5 cm vertical skin incision was made over right para spinal area (1.5cm from midline) of L4-5. The para spinal muscle was seperated by tubings and the scope was set up. Left lower laminectomy of L4 and medial L4-5 facetomy was performed with drill, and the diskectomy was done by knife and disk forceps, first under endoscope then microscope. We closed the wound after complete hemostasis. Operators VS 楊士弘 Assistants R6 陳睿生 R2 曾偉倫 相關圖片 陳靜宜 (F,1984/11/07,27y4m) 手術日期 2011/03/21 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:18 麻醉開始 08:56 誘導結束 09:20 抗生素給藥 09:30 手術開始 12:38 抗生素給藥 13:05 開始輸血 15:35 抗生素給藥 18:35 抗生素給藥 22:05 手術結束 22:05 麻醉結束 22:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在8小時以上 1 1 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 20 0 摘要__ 手術科部: 外科部 套用罐頭: 1. Bifrontal craniotomy for interhemispheric ... 開立醫師: 王奐之 開立時間: 2011/03/21 22:30 Pre-operative Diagnosis Large frontal base tumor, suspected bone-origin tumor with intranasal & intracranial involvement Post-operative Diagnosis Large frontal base tumor, suspected bone-origin tumor with intranasal & intracranial involvement Operative Method 1. Bifrontal craniotomy for interhemispheric & subfrontal partial tumor removal (removal of intracranial portion) 2. Subdural ICP monitor insertion Specimen Count And Types 1 piece About size:pieces Source:frontal base tumor Pathology Pending Operative Findings 1. Intracranial cystic tumor part was noted with yellowish and sticky fluid. The lower part of the tumor was hard and multilobulated, easy bleeding was noted while removing the tumor in pieces. Difficult hemostasis was encountered, resulted in massive intra-operative bleeding (estimated blood loss: 15000ml). The intranasal portion of the tumor was left untouched. Bifrontal contusional ICH was noted intraoperatively and the hematoma was evacuated, the contused brain parenchyma was also partially removed. 2. ICP reference value: 482. Initial ICP after wound closure: 6 mmHg. Operative Procedures After ETGA, the patient was placed in supine position with head fixed in Mayfield skull clamp. After scalp shaving, disinfection and draping, a bifrontal skin incision was made, followed by bifrontal craniotomy. A fishmouth bifrontal durotomy was done with ligation of the anterior part of the superior sagittal sinus. After reflecting the dura inferiorly, a interhemispheric approach was adapted first to remove the cystic portion of the tumor. Then the frontal base portion of the tumor was approached extradurally, the tumor was removed pieces by pieces to the orbital roof and the olfactory groove. Tumor anterior to the sellar area was then removed intradurally. Hemostasis was achieved with Floseal & surgicel packings. The contused frontal lobes were partially removed. The dura was then closed with periosteal graft by 4-0 Prolene. After inserting 1 subdural ICP monitor, the bone flap was fixed back with miniplates. The wound was closed in layers after setting 1 subgaleal CWV drain. Operators P.杜永光 Assistants R6 陳睿生, R3 王奐之 相關圖片 陳銀樹 (M,1943/10/20,68y4m) 手術日期 2011/03/21 手術主治醫師 廖漢文 手術區域 東址 000房 號 診斷 Intracerebral hemorrhage 器械術式 TAE for cerebellar vascular malformation 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 王永彬 ASA 3 時間資訊 00:00 臨時手術NPO 09:50 麻醉開始 10:10 誘導結束 13:20 麻醉結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 簡志宏 (M,1988/02/29,24y0m) 手術日期 2011/03/21 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 3 紀錄醫師 曾偉倫, 曾偉倫, 時間資訊 00:00 臨時手術NPO 10:42 報到 11:13 進入手術室 11:20 麻醉開始 11:46 抗生素給藥 12:00 誘導結束 12:05 手術開始 14:46 抗生素給藥 16:00 麻醉結束 16:00 手術結束 16:10 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 顱底瘤手術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Right retrosigmoid approach for Simpson Grade... 開立醫師: 鍾文桂 開立時間: 2011/03/21 16:36 Pre-operative Diagnosis Right petroclival meningioma status post supratentorial tumor excision Post-operative Diagnosis Right petroclival meningioma status post supratentorial tumor excision Operative Method Right retrosigmoid approach for Simpson Grade II tumor resection. Specimen Count And Types 1 piece About size:4x4x3 cm Source:Brain tumor Pathology Pending Operative Findings 1. Soft, grayish-pink, elastic tumor at right petroclival region, with encasement of right abducens, trigeminal, CNVII-VIII complex. The oculomotor nerve along with the membrane of Liliquest was intact. The trigeminal nerve was destroyed during dissection. 2. Intraoperative facial nerve stimulation ensured the intact facial nerve. Operative Procedures Under ETGA, we fixed the patients head with Mayfield clamp. He was placed on left 3/4 prone position. After we shaved, scrubbed, disinfected and drapped, a curivinear skin incision was made over left post-auricular area. We open the wound in layers. The craniotomy was created by high speed drill. Further craniotomy was achieved by Kerrison to expose the transverse-sigmoid sinus junction. Then, after dural tenting, durotomy was made. After draining CSF from cisterna magnum, the cerebellar hemisphere was retracted posteriorly. The tumor was exposed and excised in piecemeal fashion by using tumor forceps, CUSA, and suction. After total tumor excision and well hemostasis, the dura mater was closed in water-tight fashion and augmented with scalp fascia.The craniotomy plate was fixed by mini-plates. The wound was closed in layers with one subgaleal CWV drain. Operators VS 曾漢民 Assistants R5 鍾文桂 R2 曾偉倫 相關圖片 李慶同 (M,1953/10/01,58y5m) 手術日期 2011/03/21 手術主治醫師 王水深 手術區域 東址 017房 04號 診斷 Brain tumor 器械術式 Port-A catheter implatation 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 陳政維, 時間資訊 18:30 報到 18:53 進入手術室 19:15 手術開始 19:30 手術結束 19:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 內頸靜脈切開,永久導管放置術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Port-A 開立醫師: 陳政維 開立時間: 2011/03/21 19:33 Pre-operative Diagnosis Lung cancer Post-operative Diagnosis s/p Port-A implantation Operative Method Port-A catheter implantation, echo guided Specimen Count And Types Nil Pathology nil Operative Findings Puncture to right IJV under echo guidance The venous blood flow freely in the Port-A catheter after implantation. Operative Procedures The patient was put on supine position. The operation field was disinfected and draped as usual. Under local anesthesia, we puncture to right IJV under echo guidance. After creating subcutaneous pocket, the Port-A catheter was inserted via peel away sheath. We close the wound in layers. Post-op care plan: 1.wound CD QD+PRN2.pain control with tinten 3.prophylatic antibiotics use Operators P王水深 Assistants R3陳政維 林寬和 (M,1941/06/01,70y9m) 手術日期 2011/03/21 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Herniation of intervertebral disc (HIVD) 器械術式 Laminectomy for decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 2 紀錄醫師 曾偉倫, 曾偉倫, 時間資訊 00:00 臨時手術NPO 08:02 報到 08:09 進入手術室 08:15 麻醉開始 08:30 誘導結束 09:00 抗生素給藥 09:16 手術開始 10:52 手術結束 10:52 麻醉結束 11:00 送出病患 11:05 進入恢復室 12:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 椎弓切除術(減壓)-二節以內 1 1 記錄__ 手術科部: 外科部 套用罐頭: Sublaminar decompression, L4/5. 開立醫師: 鍾文桂 開立時間: 2011/03/21 10:51 Pre-operative Diagnosis Lumbar stenosis, L4/5. Post-operative Diagnosis Lumbar stenosis, L4/5. Operative Method Sublaminar decompression, L4/5. Specimen Count And Types nil Pathology Nil. Operative Findings Hypertrophic ligamentum flavum with thecal sac and root compression. The roots were slack after decompression. Intact dura mater. Operative Procedures Under ETGA, the patient was placed in prone position. After localization of L4/5 disc level by intraoperative fluoroscopy, the wound was disinfected and draped. A vertical linear 5-cm incision was made at L4/5 level. After paraspinal dissection at left side, the L4 hemilaminectomy was done. The spinous process was partially drilled for contralateral exposure. The hypertrophic ligamentum flavum was resected by Kerrisons. After well decompression, the wound was closed in layers. Operators 曾漢民 Assistants R5 鍾文桂 R2 曾偉倫 蔡宜真 (F,1948/05/03,63y10m) 手術日期 2011/03/21 手術主治醫師 蕭輔仁 手術區域 東址 026房 03號 診斷 Malignant neoplasm of kidney, except pelvis 器械術式 Anterior Spinal fusion (Others) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3E 紀錄醫師 蔡宗良, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 11:35 通知急診手術 15:08 報到 15:41 進入手術室 15:50 麻醉開始 16:20 誘導結束 16:58 手術開始 17:20 抗生素給藥 20:45 麻醉結束 20:45 手術結束 20:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 惡性脊髓腫瘤切除術 1 1 手術 脊椎融合術-前融合,有固定物)≦四節 1 2 摘要__ 手術科部: 外科部 套用罐頭: 1. Removal of intraspinal tumor via anterior ... 開立醫師: 楊博智 開立時間: 2011/03/21 21:10 Pre-operative Diagnosis Metastatic epidural spinal cord compression, C6 & C7 Post-operative Diagnosis Metastatic epidural spinal cord compression, C6 & C7 Operative Method 1. Removal of intraspinal tumor via anterior corpectomy of C6 and C7 2. Anterior fusion with mesh with plate fixed at C4, C5 and T1 Specimen Count And Types 1 piece About size:小 Source:metastic tumor Pathology Report pending Operative Findings Necrotic and deformed C6 and C7 with tumor invasion all over the prevertebral fascia extended into posterior longitudinal ligament and epidural space. Operative Procedures 1. ETGA, supine, head mildly extended 2. Routinely prepped and drapped 3. Skin incision over the SCM border approximately 6 cm 4. SCM was detached from the streps muscles until the prevertebral fascia has been reached. 5. Self-retaining retractors were fixed at all four directions 6. Fluoroscopic confirmation of the planned corpectomy 7. Microscope was brought into the operation field 8. Corpectomy of C6 and C7. 9. Removal of epidural tumor 10. Mesh impacted into the vertebral space of C6-7 11. Plate was fixed at C4, C5 and T1, with fluoroscopic confirmation. 12. Wound irrigated with gentamicin added N/S 13. Wound closed in layers. Operators VS 蕭輔仁 Assistants R5 蔡宗良 Indication Of Emergent Operation Metastatic epidural spinal cord compression 許天賜 (M,1948/07/09,63y8m) 手術日期 2011/03/21 手術主治醫師 蔡翊新 手術區域 東址 002房 02號 診斷 Injury (severeity score >=16) 器械術式 Tracheostomy 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3E 紀錄醫師 蔡宗良, 時間資訊 08:32 通知急診手術 09:30 進入手術室 09:32 麻醉開始 09:35 誘導結束 09:45 抗生素給藥 09:57 手術開始 10:23 手術結束 10:23 麻醉結束 10:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 氣管切開術 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 蔡翊新 開立時間: 2011/03/21 10:31 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types nil Pathology None Operative Findings Fr. 8 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyroid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators VS蔡翊新 Assistants R5蔡宗良Ri曾亮瑋 Indication Of Emergent Operation Respiratory failure, difficult in weaning off ventilator. 謝鴻經 (M,1950/04/01,61y11m) 手術日期 2011/03/21 手術主治醫師 郭順文 手術區域 東址 007房 02號 診斷 Traumatic brain injury 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3 紀錄醫師 廖先啟, 時間資訊 14:25 進入手術室 14:30 麻醉開始 14:32 誘導結束 14:32 抗生素給藥 14:40 手術開始 14:45 手術結束 14:45 麻醉結束 14:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 氣管切開術 1 0 記錄__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 廖先啟 開立時間: 2011/03/21 14:55 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types Nil Pathology None Operative Findings Fr. 8 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators VS郭順文 Assistants CR李佳穎，R3廖先啟 王南凱 (M,1970/02/19,42y0m) 手術日期 2011/03/22 手術主治醫師 葉德輝 手術區域 西址 033房 13號 診斷 Intracranial abscess 器械術式 Endoscopic functional sinus su 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 林奎佑, 時間資訊 13:30 報到 14:15 進入手術室 14:25 麻醉開始 14:30 手術開始 14:50 手術結束 14:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 鼻竇內視鏡檢查 1 0 L 記錄__ 手術科部: 耳鼻喉部 套用罐頭: Sinoscope surgery (local) 開立醫師: 林奎佑 開立時間: 2011/03/22 15:04 Pre-operative Diagnosis Acute paranasal sinusitis, left Post-operative Diagnosis Acute paranasal sinusitis, left, operated Operative Method 1. Sinoscope surgery, left Specimen Count And Types 1 piece About size:up to 0.1x0.1x0.1cm Source:left sinonasal tissue Pathology 1. multiple sinonasal tissue, left, up to 0.1x0.1x0.1cm, pending Operative Findings 1. Left frontal sinus contained with mucopus 2. Synechia of left middle turbinate with lateral nasal wall. Operative Procedures 1. Supine position with left nasal packing done 2. Remove the nasal packing 3. widening of natural ostium of left frontal sinus 4. Mucopus from left frontal sinus drained 5. Hemostasis and one fingerstall packed 6. Patient tolerate will during the procedure. Operators AP 葉德輝 Assistants R4 李亭逸, R2 林奎佑 陳周月雲 (F,1947/09/01,64y6m) 手術日期 2011/03/22 手術主治醫師 陳韻如 手術區域 東址 010房 06號 診斷 Cataract 器械術式 Phaco+PCIOL 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 12:45 進入手術室 12:55 麻醉開始 13:00 麻醉結束 13:10 手術開始 13:56 手術結束 14:05 送出病患 記錄__ 手術科部: 眼科部 套用罐頭: Phacoemulsification and PCIOL implantation (os) 開立醫師: 麥珮怡 開立時間: 2011/03/22 13:58 Pre-operative Diagnosis Cataract (os) Post-operative Diagnosis Cataract (os) Operative Method Phacoemulsification and PCIOL implantation (os) Specimen Count And Types nil Pathology Nil Operative Findings Cataract (os) Operative Procedures 1. Under peribulbar anesthesia 2. Disinfection, irrigation and draping 3. Application of eyelid speculum 4. Made a clear corneal incision and penetrate into AC with 2.5mm trapezoid knife at 11 oclock position 5. Inject Viscoat into the anterior chamber 6. Continuous circular capsulorrhexis was done with bent needle and capsular forceps 7. Made a sideport at 3 oclock position with the MVR blade 8. Hydrodissection and hydrodelineation were done with BSS 9. Phacoemulsification of the nucleus by standard divide-and-conquer technique 10. Aspiration of the residual cortical material with I/A tube 11. Foldable PCIOL was implanted into the bag after injection of Viscoat 12. The residual Viscoat was washed outby Simcoe I/A cannula 13. Inject BSS into AC and check leakage, and inject Miostat to AC to constrict the pupil 14. Stromal hydration of the wound with BSS 16. Subconjunctival injection of Rinderon and Gentamycin 17. Lactycin patching Operators VS王一中, Assistants R5陳韻如, R3麥珮怡 陳春長 (M,1947/12/10,64y3m) 手術日期 2011/03/22 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Parkinson''s disease 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾峰毅, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:07 進入手術室 08:15 麻醉開始 08:25 誘導結束 08:45 抗生素給藥 08:50 手術開始 09:50 手術結束 09:50 麻醉結束 10:02 送出病患 10:05 進入恢復室 11:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室腹腔分流手術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 曾峰毅 開立時間: 2011/03/22 09:57 Pre-operative Diagnosis Parkinson's disease Post-operative Diagnosis Parkinson's disease Operative Method Impulse generator implantation Specimen Count And Types Nil Pathology Nil Operative Findings Impulse generator function is well. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to right. After scalp shaved, scrubbed, disinfected, and then draped, we made one longitudinal skin incision at left occipital area to retrieve the wire. We made another transverse skin incision at left upper chest to create subcutaneous pouch. We created subcutaneous tunnel to connected two wound, and connceted the wire to impulse generator. We checked the IPG function, and closed the wound in layers after put IPG into left upper chest pouch. Operators VS 曾勝弘 Assistants R4 曾峰毅 李肇嚴 (M,1928/08/07,83y7m) 手術日期 2011/03/22 手術主治醫師 曾勝弘 手術區域 東址 005房 02號 診斷 Parkinson''s disease 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾峰毅, 時間資訊 00:00 臨時手術NPO 10:15 進入手術室 10:15 麻醉開始 10:20 誘導結束 10:25 手術開始 10:25 抗生素給藥 11:20 手術結束 11:20 麻醉結束 11:32 送出病患 11:35 進入恢復室 13:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室腹腔分流手術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 曾峰毅 開立時間: 2011/03/22 11:26 Pre-operative Diagnosis Parkinson's disease Post-operative Diagnosis Parkinson's disease Operative Method Impulse generator revision Specimen Count And Types Nil Pathology Nil Operative Findings New IPG function is well. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position. After skin scrubbed, disinfected, and then draped, we made one transverse skin incision at right upper chest. We exposed previous IPG, and removed it. We changed one new IPG, and checked the function. The wound was closed in layers. Operators VS 曾勝弘 Assistants R4 曾峰毅 蕭明珠 (F,1951/07/10,60y8m) 手術日期 2011/03/22 手術主治醫師 曾勝弘 手術區域 東址 005房 03號 診斷 Atypical face pain 器械術式 Radiofrequency coagulation 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 曾峰毅, 時間資訊 00:00 臨時手術NPO 11:00 報到 11:43 進入手術室 11:53 麻醉開始 11:54 抗生素給藥 11:56 手術開始 12:13 麻醉結束 12:13 手術結束 12:18 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 高頻熱凝療法 1 1 摘要__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 曾峰毅 開立時間: 2011/03/22 12:18 Pre-operative Diagnosis Right supraorbital neuralgia Post-operative Diagnosis Right supraorbital neuralgia Operative Method Radiofrequency for neuromodulation to right supraorbital nerve. Specimen Count And Types Nil Pathology Nil Operative Findings 41 degrees Celsius, 180 secs in duration, 20 ms for pulse duration, 2 Hz for pulse frequency was used for neuromodulation. Operative Procedures With local anaesthesia, the patient was put in supine position. After skin disinfected and draped, we inserted radiofrequency needle into right supraorbital foramen. Radiofrequency ablation was performed, and we changed the needle direction along the nerve direction. We performed radiofrequency again. Operators VS 曾勝弘 Assistants R4 曾峰毅 崔裕振 (M,1973/04/08,38y11m) 手術日期 2011/03/22 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 HIVD 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 蔡立威, 時間資訊 00:00 臨時手術NPO 08:06 進入手術室 08:20 麻醉開始 08:25 誘導結束 08:55 抗生素給藥 09:18 手術開始 12:00 抗生素給藥 13:00 手術結束 13:00 麻醉結束 13:12 送出病患 13:15 進入恢復室 14:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-頸椎 1 1 手術 椎融合術-前融合,無固定物(≦四節) 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Anterior Discectomy and artificial disc impla... 開立醫師: 蔡立威 開立時間: 2011/03/22 13:20 Pre-operative Diagnosis C4-5 HIVD Post-operative Diagnosis C4-5 HIVD Operative Method Anterior Discectomy and artificial disc implantation, C4-5 Specimen Count And Types nil Pathology nil Operative Findings C4-5 bulding disc, s/p resection The position of artificial disc(6*15*17mm) was checked by fluoroscopy Operative Procedures Under endotracheal general anesthesia, supine position, we performed skin disinfection and drapping as usual. A transverse right upper neck skin incision was done. Then C4-5 intervertebral disc was identified and rechecked by fluoroscopy. We resected the C4-5 disc under microscopic assistance and implanted a artificial disc. The artificial disc position was also checked by fluoscopy. Finally, the wound was closed in layers. Operators VS賴達明 Assistants R5蔡宗良, R2蔡立威 莊朝宗 (M,1938/09/22,73y5m) 手術日期 2011/03/22 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Hydrocephalus 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 蔡立威, 時間資訊 00:00 臨時手術NPO 13:25 進入手術室 13:35 麻醉開始 13:40 誘導結束 14:44 手術開始 15:55 手術結束 15:55 麻醉結束 16:08 送出病患 16:10 進入恢復室 18:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 腦室腹腔分流手術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 蔡立威 開立時間: 2011/03/22 16:15 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method V-P Shunt Specimen Count And Types nil Pathology nil Operative Findings CSF clear and colorless Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: supine with head rotated to right . 3.Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4.Incision: 4 cm linear, previous left-sided Kocher point. 5.After the scalp flap had been lifted and reflected. 6.The dura was opened by a nib incision. Lt lateral ventricle was tapped by a ventricular needle, then a 6.5 cm segment of the ventricular catheter was introduced into the ventricle. The outer end of the catheter was connected to a Codman Hakim programmable reservoir. 7. A nib incision was made at LUQ of the abdomen, then a trocar was pushed into peritoneal cavity. Subsequently, distal 30 cm segment of the peritoneal catheter zero pressure was introduced into the peritoneal cavity through the outer tube of the trochar. The proximal end of this catheter was passed through subcutaneous tunnel at forechest, neck, rt retroauricular area and connected the reservoir. The shunt systemwas checked to make sure its function was working. 8. Scalp closure: hemostasis was done with monopolar coagulator touching on the sucker tip. Galea suture was performed by continuous suture with 3/0. Dexon and skin by continuous suture with 3/0 nylon. 9.Course of the surgery: smooth. Operators VS賴達明 Assistants R5蔡宗良,R2蔡立威 鄒桂芝 (F,1948/07/29,63y7m) 手術日期 2011/03/22 手術主治醫師 賴達明 手術區域 西址 039房 01號 診斷 Carpal tunnel syndrome 器械術式 Decompression of mediun nerve 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 08:50 報到 09:15 進入手術室 09:35 麻醉開始 09:40 手術開始 10:03 麻醉結束 10:03 手術結束 10:06 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 正中神經或尺神經腕部減壓術–單側 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Carpal tunnel release, left 開立醫師: 王奐之 開立時間: 2011/03/22 10:15 Pre-operative Diagnosis Carpal tunnel syndrome, left Post-operative Diagnosis Carpal tunnel syndrome, left Operative Method Carpal tunnel release, left Specimen Count And Types nil Pathology Nil Operative Findings Hypertrophic flexor retinaculum was note intra-operatively, the nerve sheath expanded well after decompression. Operative Procedures The patient was placed in supine position with left arm extended out and placed on an arm rest. The skin was disinfected & draped in sterile fashion. After local anesthesia, a linear skin incision was made at proximal palm, further dissected to expose the flexor retinaculum. The flexor retinaculum was then incised and cut fully with scissors, until the nerve sheath became fully expanded. After hemostasis, the wound was closed in layers. Operators VS 賴達明 Assistants R3 王奐之 相關圖片 黃鈺翔 (M,1997/11/30,14y3m) 手術日期 2011/03/22 手術主治醫師 楊士弘 手術區域 兒醫 067房 01號 診斷 Primitive neuroectodermal tumor 器械術式 Anterior Spinal fusion (Others) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 07:55 報到 08:05 進入手術室 08:20 麻醉開始 08:55 誘導結束 09:10 抗生素給藥 09:55 手術開始 12:10 抗生素給藥 15:10 抗生素給藥 15:25 手術結束 15:25 麻醉結束 15:40 送出病患 15:45 進入恢復室 17:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 惡性脊髓腫瘤切除術 1 1 手術 脊椎融合術-前融合,有固定物)≦四節 1 2 記錄__ 手術科部: 套用罐頭: C6 corpectomy and anterior fusion with cervic... 開立醫師: 林哲光 開立時間: 2011/03/22 15:57 Pre-operative Diagnosis Primitive neuroectodermal tumor with multiple metastasis, C6 compression fracture with cord compression Post-operative Diagnosis Ditto Operative Method C6 corpectomy and anterior fusion with cervical PMMA graft and cervical plate (32mm) and 4 screws (4mmx12mmx3 and 4.3mmx14mmx1) 1. C6 corpectomy for tumor excision 2. C6 PMMA graft and C5-7 cervical plate (32mm) and 4 screws (4mmx12mmx3 and 4.3mmx14mmx1) fixation Specimen Count And Types 1 piece About size: small pieces Source: tumor Pathology Pending Operative Findings C6 compression fracture was noted with some soft, yellowish-greyish, mass lesions eroded the vertebral body to the bilateral lateral mass. Cord compression was also noted. The dura sac was re-expanded well after PLL removal and tumor excision. A 1.5x0.8x1cm sized PMMA graft was inserted into the C6 level after corpectomy was performed. The right C6 root was exposed well and the shoulder was free under microscope. C6 compression fracture was noted with some soft, yellowish-greyish, mass lesions eroded the vertebral body to the bilateral lateral mass. Cord compression was also noted. The dura sac was re-expanded well after PLL removal and tumor excision. A 1.5x0.8x1cm sized PMMA graft was inserted into the C6 level after corpectomy was performed. The right C6 root was exposed well and the root axilla was free under microscope. Operative Procedures Under ETGA and supine position with head mild extended, skin disinfected and drapped were performed as usual. Transverse skin incision was made at left C6 level after C-arm localization. The plane between carotid triangle and esophagus was dissected and C6 body was exposed well with retractor. C6 corpectomy was then performed and tumor excision was done. The PMMA graft was then inserted into the C6 level and fixed with the cervical plate and screws. The wound was then closed in layers after mini-H/V inserted over the paravertebral area. Under ETGA and supine position with head mild extended, skin disinfected and drapped were performed as usual. Transverse skin incision was made at left C6 level after C-arm localization. The plane between carotid triangle and esophagus was dissected and C6 body was exposed well with retractor. C6 corpectomy and C5-6, C6-7 discectomy were then performed, and tumor excision was done. The PLL was removed. The PMMA graft was then inserted into the C6 level and fixed with the cervical plate and screws. The wound was then closed in layers after mini-H/V inserted over the prevertebral area. Operators VS 楊士弘 Assistants R4 林哲光 相關圖片 江謙文 (M,1939/04/22,72y10m) 手術日期 2011/03/22 手術主治醫師 蕭輔仁 手術區域 東址 005房 04號 診斷 Diskitis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾峰毅, 時間資訊 23:22 臨時手術NPO 12:08 報到 12:27 進入手術室 12:30 麻醉開始 12:43 抗生素給藥 12:45 誘導結束 13:18 手術開始 15:43 抗生素給藥 15:50 手術結束 15:50 麻醉結束 16:02 送出病患 16:05 進入恢復室 17:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎弓切除術(減壓)-二節以內 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Posterior fixation with transpedicular screws... 開立醫師: 曾峰毅 開立時間: 2011/03/22 16:07 Pre-operative Diagnosis Sondylodiskitis, L4/5, status post complete course of antibiotics Post-operative Diagnosis Sondylodiskitis, L4/5, status post complete course of antibiotics Operative Method Posterior fixation with transpedicular screws at L4, L5, and S1; L4 laminectomy for decompression; posterolateral fusion with autologous bone graft Specimen Count And Types Two wound culture was sent for culture. Pathology Nil Operative Findings Thecal sac was compressed by hypertrophic ligamentum flavum tightly. Six a-spine transpedicular screws, 45 mm long and 6.5 mm in diameter, were used with two 6 cm rods and one corss-link. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After C-arm localization, we scrubbed, disinfected, and then draped the back. We made one midline skin incision and dissected to expose bilateral laminae of L4 to S1. We inserted transpedicular screws into bilateral pedicles of L4, L5, and S1. L4 laminectomy was done, and furhter bilateral L4/5 foraminotomy was achieved. Posterior fixation with achieved with two 7 cm rods and one cross-link. After one hemovac set, the wound was closed in layers. Operators VS 蕭輔仁 Assistants R4 曾峰毅 韓其芳 (M,1965/02/01,47y1m) 手術日期 2011/03/22 手術主治醫師 王一中 手術區域 東址 010房 02號 診斷 Cataract 器械術式 Phaco+PCIOL 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 09:30 進入手術室 09:32 麻醉開始 09:35 麻醉結束 09:44 手術開始 10:05 手術結束 10:10 送出病患 記錄__ 手術科部: 眼科部 套用罐頭: Phaco-Superior ( 王一中) 開立醫師: 麥珮怡 開立時間: 2011/03/22 09:57 Pre-operative Diagnosis Cataract (od ) Post-operative Diagnosis Cataract (od ) Operative Method Phacoemulsification and PCIOL implantation (od ) Specimen Count And Types nil Pathology nil Operative Findings Cataract (od ) Operative Procedures 1. Under retrobulbar anesthesia. 2. Disinfection, irrigation and draping. 3. Application of an eyelid speculum. 4. Made a clear corneal incision and penetrate into AC with 2.5mm trapezoid knife at 10 oclock position. 5. Inject Viscoat into the anterior chamber. 6. Continuous circular capsulorrhexis was done with bent needle and capsular forceps. 7. Made a sideport at 2 oclock position with the MVR blade. 8. Hydrodissection and hydrodelineation were done with BSS.9. Phacoemulsification of the nucleus by standard divide-and-conquer technique. 10. Aspiration of the residual cortical material with I/A tube. 11. Extend the cornea wound to 3.2mm by diamond knife. 12. Foldable PCIOL was implanted into the bag after injection of Viscoat. 13. The residual Viscoat was washed out by Simcoe I/A cannula. 14. Inject BSS into AC and check leakage, and inject Miostat to AC to constrict the pupil 15. Stromal hydrationof the wound with BSS 16. Subconjunctival injection of Rinderon and Garamycin. 17. Maxitrol patching. Operators 王一中, Assistants R3麥珮怡 陳銀樹 (M,1943/10/20,68y4m) 手術日期 2011/03/23 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Intracerebral hemorrhage 器械術式 Craniotomy (A.V.M.) P-DUH 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 08:10 進入手術室 08:20 麻醉開始 08:30 誘導結束 09:10 手術開始 09:30 抗生素給藥 12:30 抗生素給藥 15:18 手術結束 15:18 麻醉結束 15:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 開顱術摘除血管病變-動靜脈畸型小型表淺 1 1 手術 顱內壓視置入 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Suboccipital craniotomy for total AVM removal... 開立醫師: 陳睿生 開立時間: 2011/03/23 15:35 Pre-operative Diagnosis Left cerebellar AVM (S-M Gr.II) rupture with ICH Post-operative Diagnosis Left cerebellar AVM (S-M Gr.II) rupture with ICH Operative Method Suboccipital craniotomy for total AVM removal, right Frazier^s EVD insertion Specimen Count And Types 1 piece About size:pieces Source:AVM Pathology Pending Operative Findings The AVM was about 1cm in diameter, and it located at the superiomedial aspect of the left cerebellar hemisphere. The feeding arteries were mainly from the SCA, AICA, and PICA, and were noted to be embolized during previous TAE. Several superficial drainage veins were found and mainly drained to the ipsilateral transverse sinus. The nidus of the AVM was net like and no obvios arterial or venous aneurysm was found. Intra-op angiography was used to localize the AVM perioperatively. A right Frazier EVD was inserted, and the depth was about 10cm. Initial ICP was about 10cmH2O. Operative Procedures Operators P 杜永光 Assistants R6 陳睿生; R3 王奐之 相關圖片 摘要__ 手術科部: 外科部 套用罐頭: Suboccipital craniotomy for total AVM removal... 開立醫師: 王奐之 開立時間: 2011/03/23 15:47 Pre-operative Diagnosis Left cerebellar AVM (S-M Gr.II) rupture with ICH Left cerebellar AVM (Spetzler-Martin grade 1~2) with rupture, resulting in ICH & 4th ventricle IVH Post-operative Diagnosis Left cerebellar AVM (S-M Gr.II) rupture with ICH Left cerebellar AVM (Spetzler-Martin grade 1~2) with rupture, resulting in ICH & 4th ventricle IVH Operative Method Suboccipital craniotomy for total AVM removal, right Frazier^s EVD insertion Suboccipital craniotomy for total AVM removal, right Frazier EVD insertion Specimen Count And Types 1 piece About size:pieces Source:AVM Pathology Pending Operative Findings The AVM was about 1cm in diameter, and it located at the superiomedial aspect of the left cerebellar hemisphere. The feeding arteries were mainly from the SCA, AICA, and PICA, and were noted to be embolized during previous TAE. Several superficial drainage veins were found and mainly drained to the ipsilateral transverse sinus. The nidus of the AVM was net like and no obvios arterial or venous aneurysm was found. Intra-op angiography was used to localize the AVM perioperatively. A right Frazier EVD was inserted, and the depth was about 10cm. Initial ICP was about 10cmH2O. The AVM was about 1cm in diameter, and it was located at the superiomedial aspect of the left cerebellar hemisphere. The feeding arteries were mainly from left SCA, AICA, and PICA, and were noted to be embolized during previous TAE procedure. Several superficial draining veins were found and mainly drained to the ipsilateral transverse sinus. The nidus of the AVM was net-like and no obvious arterial or venous aneurysm was found. Intra-operative ICG angiography was used to localize the AVM. A right Frazier EVD was inserted prior to AVM removal, and the depth was about 10cm. Initial ICP was about 10cmH2O. Operative Procedures After ETGA, the patient was placed in prone position with head fixed in Mayfield skull clamp. After scalp shaving, disinfection and draping in sterile fashion, a linear skin incision was made at right Frazier point, followed by burr hole creation and EVD insertion. Another linear incision was made at suboccipital midline position (from inion to C2 level), further deepened through the nuchal muscles. The paraspinal muscles were dissected from the bone to expose C0-C2. After detaching the muscles, 3 burr holes were made, followed by midline suboccipital craniotomy. A fishmouth durotomy was made, CSF release was done from cisterna magna. After arachonid membrane dissection, ICG was used for localization of the AVM nidus. The nidus were then dissected from surrounding cerebellar parenchyma, draining veins were all ligated. The nidus was then removed en bloc. After hemostasis, the dura was closed in water-tight fashion with a fascial graft. After setting 1 subgaleal CWV drain, the wound was closed in layers. Operators P 杜永光 Assistants R6 陳睿生; R3 王奐之 相關圖片 林新龍 (M,1963/04/30,48y10m) 手術日期 2011/03/23 手術主治醫師 杜永光 手術區域 東址 005房 01號 診斷 Trigeminal neuralgia (Cranial nerve V) 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 07:55 報到 08:05 進入手術室 08:15 麻醉開始 09:00 誘導結束 09:10 抗生素給藥 09:15 手術開始 12:10 抗生素給藥 12:20 麻醉結束 12:20 手術結束 12:35 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦微血管減壓術 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Microvascular decompression of left trigemina... 開立醫師: 鍾文桂 開立時間: 2011/03/23 12:17 Pre-operative Diagnosis Left trigeminal neuralgia. Post-operative Diagnosis Left trigeminal neuralgia. Operative Method Microvascular decompression of left trigeminal nerve. Specimen Count And Types nil Pathology Nil. Operative Findings Thinning of the upper portion of the trigeminal nerve at the root exit zone. The prominent superior cerebellar artery pushed the trigeminal nerve anteriorly. The lower cranial nerves, CN VII/VIII complex were identified. Operative Procedures Under endrotracheal general anesthesia, we fixed the patients head with Mayfield clamp and placed the patient to supine position. The patients head was tilted to right with mild flexion. After we scrubbed, disinfected and drapped, a 6 cm long, along the retroauricular hair line skin incision with center at mastoid tip was made. A 2x2 cm, suboccipital retromastoid craniectomy was made then the dura was opened. The CSF was drained via cisterna magnum. The cerebellum was sunked, and the 5th, 7th, 8th and low cranial nerves were identified. The arterial loop from superior cerebellar artery was found and it pushed the CNV from superior aspect. We placed the teflon graft to seperate the SCA and CNV. Operators P 杜永光 Assistants R5 鍾文桂 R2 曾偉倫 相關圖片 蕭素娥 (F,1962/06/30,49y8m) 手術日期 2011/03/23 手術主治醫師 吳振吉 手術區域 西址 033房 05號 診斷 Otitis media with effusion 器械術式 Gromment placement (ntuh made) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 11:00 報到 11:43 進入手術室 11:45 麻醉開始 11:46 麻醉結束 11:47 手術開始 12:05 手術結束 12:10 送出病患 記錄__ 手術科部: 耳鼻喉部 套用罐頭: Grommet tube insertion, right 開立醫師: 廖怡茹 開立時間: 2011/03/23 11:54 Pre-operative Diagnosis OME, right Post-operative Diagnosis OME, right,operated Operative Method Grommet tube insertion, right Specimen Count And Types nil Pathology Nil Operative Findings right MEE(+) Operative Procedures 1.The patient was put in supine position. 2.After local anestehsia of external auditory canal, the face was disinfected and draped as usual. 3.Her head was turned to the left side. 4.Radial incision was made over the anterio-inferior quadrant of the right eardrum and middle ear effusion was sucked out. 5.Then one 1.27mm Grommet tube was inserted smoothly. 6.The patient tolerated the whole procedure well. Operators AsP吳振吉, Assistants R4李亭逸,R2廖怡茹, 黃金妹 (F,1936/09/03,75y6m) 手術日期 2011/03/23 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Glioblastoma multiforma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 曾偉倫, 時間資訊 00:00 臨時手術NPO 13:35 報到 13:45 進入手術室 13:52 麻醉開始 14:10 誘導結束 14:30 抗生素給藥 14:30 手術開始 17:30 抗生素給藥 17:45 麻醉結束 17:45 手術結束 18:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 顱底瘤手術 1 1 L 摘要__ 手術科部: 內科部 套用罐頭: Left orbito-frontal-zygomatic craniotomy for ... 開立醫師: 曾偉倫 開立時間: 2011/03/23 18:20 Pre-operative Diagnosis Left temporal brain tumor, suspect high grade glioma Post-operative Diagnosis Left temporal brain tumor, suspect high grade glioma Operative Method Left orbito-frontal-zygomatic craniotomy for tumor resection Specimen Count And Types 1 piece About size:4x3x3 cm Source:Left temporal tumor Pathology Pending Operative Findings 1. A white-yellowish soft 3x3x3 cm tumor over left temporal area, a corticotomy was made for tumor approach 2. The margin between tumor and normal brain tissue was ill 3. Part of the tumor below anterior choloidal artery was kept for preserving the blood supply of normal brain tissue 4. The corticotomy size ~1.5 x 1 cm Operative Procedures Under ETGA, we placed the patient on supine position. After we scrubbed, disinfected and drapped, a cuvilinear skin incision was made over her left frontal-parietal area. The orbital-frontal-zygomatic craniectomy was made. The tumor was localized by intra-operative sonography and the dura was open in curvilinear fasion. Cortitocomy was made over mid temporal gyrus and the tumor resection was done with bipolar and tumor forceps. Part of the temporal tip was resected during the operation for achieving maximum resection of the tumor. The dura was closed after compltet hemostasis with Surgicel and Gelfoam. A CWD drain was plased after we fixed the craniectomy skull with miniplate. The wound was closed in layers. Operators VS 曾漢民 Assistants R5 鍾文桂 R2 曾偉倫 相關圖片 記錄__ 手術科部: 內科部 套用罐頭: Left orbito-frontal-zygomatic craniotomy for ... 開立醫師: 曾偉倫 開立時間: 2011/03/23 18:23 Pre-operative Diagnosis Left temporal brain tumor, suspect high grade glioma Post-operative Diagnosis Left temporal brain tumor, suspect high grade glioma Operative Method Left orbito-frontal-zygomatic craniotomy for tumor resection Specimen Count And Types 1 piece About size:4x3x3 cm Source:Left temporal tumor Pathology Pending Operative Findings 1. A white-yellowish soft 3x3x3 cm tumor over left temporal area, a 0.5x1.0cm corticotomy was made at middle temporal gyrus, 1.5cm posterior to the temporal tip. 2. The margin between tumor and normal brain tissue was ill-defined. The temporal horn of the lateral ventricle was opened and the choroid plexus was preserved. 3. Part of the tumor below anterior choloidal artery was kept for preserving the blood supply of normal brain tissue Operative Procedures Under ETGA, we placed the patient on supine position. After we scrubbed, disinfected and drapped, a cuvilinear skin incision was made over her left frontal-parietal area. The orbital-frontal-zygomatic craniectomy was made. The tumor was localized by intra-operative sonography and the dura was open in curvilinear fasion. Cortitocomy was made over mid temporal gyrus and the tumor resection was done with bipolar and tumor forceps. Part of the temporal tip was resected during the operation for achieving maximum resection of the tumor. The dura was closed after compltet hemostasis with Surgicel and Gelfoam. A CWD drain was plased after we fixed the craniectomy skull with miniplate. The wound was closed in layers. Operators VS 曾漢民 Assistants R5 鍾文桂 R2 曾偉倫 相關圖片 李春桃 (F,1932/08/29,79y6m) 手術日期 2011/03/23 手術主治醫師 郭順文 手術區域 東址 007房 04號 診斷 Glioblastoma multiforma 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 3 紀錄醫師 廖先啟, 時間資訊 15:05 報到 15:05 進入手術室 15:07 麻醉開始 15:10 誘導結束 15:10 抗生素給藥 15:20 手術開始 15:30 手術結束 15:30 麻醉結束 15:45 送出病患 15:46 進入恢復室 16:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 氣管切開術 1 0 記錄__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 廖先啟 開立時間: 2011/03/23 15:32 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types Nil Pathology None Operative Findings Fr.7 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators VS郭順文 Assistants R3廖先啟，Ri洪士鈞 陳正雄 (M,1943/11/26,68y3m) 手術日期 2011/03/23 手術主治醫師 賴達明 手術區域 東址 009房 05號 診斷 Cerebrovascular accident (CVA) 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 蔡宗良, 高明蔚, 時間資訊 00:00 臨時手術NPO 14:30 進入手術室 14:35 麻醉開始 14:40 誘導結束 15:22 手術開始 16:55 手術結束 17:05 17:15 麻醉結束 17:15 17:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 L 手術 氣管切開術 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 蔡宗良 開立時間: 2011/03/23 16:58 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method V-P Shunt Specimen Count And Types 1 piece About size:CSF x3 Source: Pathology None Operative Findings 1. CSF: serosanginous 2. ICP: high Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: supine with head rotated (tilted) to right (left). 2.Position: supine with head rotated to right. 3.Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 5 cm curvilinear, right occipital, corresponded to the 4. Incision: 5 cm curvilinear at left-sided Kocher point. location of right occipital horn. Raney clips were applied to the scalp edge for temporary hemostasis. 5.After the scalp flap had been lifted and reflected anteriorly, a burr hole was made and the dura was tented by 2 stitches. 6.The dura was opened by a nib incision. Rt lateral ventricle was 6.The dura was opened by a nib incision. Left lateral ventricle was tapped by a ventricular needle, then a 8 cm segment of the tapped by a ventricular needle, then a 6.5 cm segment of the ventricular catheter was introduced into the ventricle. The outer end of the catheter was connected to a Pudenz reservoir. end of the catheter was connected to a Medtronics middle-pressure reservoir. 7. A nib incision was made at RUQ of the abdomen , then a trocar was pushed into peritoneal cavity. Subsequently, distal 20 cm was pushed into peritoneal cavity. Subsequently, distal 30 cm segment of the peritoneal catheter (medium pressure) was introduced segment of the peritoneal catheter (zero pressure) was introduced into the peritoneal cavity through the outer tube of the trochar. The proximal end of this catheter was passed through subcutaneous tunnel at forechest, neck, rt retroauricular area and connected the tunnel at forechest, neck, left retroauricular area and connected the reservoir. The shunt systemwas checked to make sure its function was working. 8. The reservoir was fixed to pericranium by 3 stitches. 9. Scalp closure: hemostasis was done with monopolar coagulator touching on the sucker tip. Galea suture was performed by continuous suture with 3/0. Dexon and skin by continuous suture with 3/0 nylon. 10.Course of the surgery: smooth. Operators VS 賴達明 Assistants R5 蔡宗良 摘要__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 蔡宗良 開立時間: 2011/03/23 17:20 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types Nil Pathology None Operative Findings Fr.8 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators 郭順文 Assistants R3高明蔚,R4蔡忠良 吳凡 (M,1992/11/22,19y3m) 手術日期 2011/03/23 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Herniation of intervertebral disc (HIVD) 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 14:57 報到 15:35 進入手術室 15:42 麻醉開始 15:45 誘導結束 16:00 抗生素給藥 16:35 手術開始 18:30 手術結束 18:30 麻醉結束 18:40 送出病患 18:43 進入恢復室 19:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 椎間盤切除術-腰椎 1 1 摘要__ 手術科部: 外科部 套用罐頭: Microsurgical discectomy, L5-S1 開立醫師: 王奐之 開立時間: 2011/03/23 19:03 Pre-operative Diagnosis L5-S1 HIVD Post-operative Diagnosis L5-S1 HIVD Operative Method Microsurgical discectomy, L5-S1 Specimen Count And Types Nil Pathology Nil Operative Findings Protruding disc was noted at right L5-S1 level, which compressed the thecal sac and S1 nerve root tightly. After discectomy, the thecal sac & nerve root expanded well. Operative Procedures After ETGA, the patient was placed in prone position. The L5-S1 disc space was localized with C-arm. After skin scrubbing, disinfection and draping in sterile fashion, a midline linear incision was made at L5-S1 level (about 3cm in length). The incision was deepened until the spinous process was exposed. The right side paraspinal muscles were detached from the spinous process, exposing the ligamentum flavum. After removing the ligamentum flavum, the thecal sac and nerve root were retracted medially with nerve hook. Protruding disc was then seen and removed in pieces. After hemostasis, the wound was closed in layers. Operators VS 賴達明 Assistants R6 陳睿生, R3 王奐之 相關圖片 鍾秀蓮 (F,1937/04/17,74y10m) 手術日期 2011/03/23 手術主治醫師 陳慕師 手術區域 東址 010房 04號 診斷 Cataract 器械術式 Aspiration of vitreous 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 13:42 進入手術室 13:55 手術開始 14:00 手術結束 14:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 結膜下注射 1 0 L 記錄__ 手術科部: 眼科部 套用罐頭: Subtenon injection of Kenacort 30mg (os) 開立醫師: 楊琇斐 開立時間: 2011/03/23 13:59 Pre-operative Diagnosis Macular edema (os) Post-operative Diagnosis Macular edema (os) Operative Method Subtenon injection of Kenacort 30mg (os) Specimen Count And Types nil Pathology nil Operative Findings Macular edema (os) Operative Procedures 1.Under topical anesthesia. 2.Disinfection and draping as usual. 3.Apply an eyelid speculum. 4.Subtenon injection of Kenacort (os) 5.Check bare VA>ND100cm Operators Prof 陳慕師 Assistants R5許祺鑫, R2林暄婕 劉興鈞 (M,1955/10/11,56y5m) 手術日期 2011/03/23 手術主治醫師 洪學義 手術區域 東址 009房 02號 診斷 Secondary malignant neoplasm of bone and bone marrow 器械術式 Debridment-- >10cm 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 3 紀錄醫師 官振翔, 時間資訊 09:20 報到 09:50 進入手術室 09:55 麻醉開始 10:00 誘導結束 10:22 手術開始 11:10 手術結束 11:10 麻醉結束 11:15 送出病患 11:17 進入恢復室 12:17 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 移前皮瓣移植術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Debridement 開立醫師: 官振翔 開立時間: 2011/03/23 11:04 Pre-operative Diagnosis Spine wound poor healing Post-operative Diagnosis Spine wound poor healing Operative Method Advancement flap wound closure Specimen Count And Types Culture*1 Pathology Nil Operative Findings 1. Spine wound poor healing with eschar and cellitis sign 2. No pus or necrotic tissue noted 3. No prothesis exposure Operative Procedures Under general anesthesia, the patient lied in prone position. Antiseptics applied and draped as usual. Debridement performed. Normal saline irrigation. Performe advancement flap elevation. Wound closure with one CWV drain Operators 洪學義, Assistants 官振翔, 陳以幸 張偉明 (M,1948/06/11,63y9m) 手術日期 2011/03/23 手術主治醫師 王國川 手術區域 東址 016房 01號 診斷 Head injury, unspecified 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 蔡宗良, 時間資訊 00:00 開始NPO 00:00 臨時手術NPO 07:25 通知急診手術 08:35 進入手術室 08:35 報到 08:40 麻醉開始 08:43 誘導結束 09:30 手術開始 10:00 麻醉結束 10:00 手術結束 10:10 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 顱內壓視置入 1 1 R 摘要__ 手術科部: 內科部 套用罐頭: Intracranial pressure monitoring, via ventric... 開立醫師: 蔡宗良 開立時間: 2011/03/23 10:24 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Intracranial pressure monitoring, via ventriculostomy of right-sided Kochers point Specimen Count And Types 3 pieces About size:小 Source:CSF About size:小 Source:CSF About size:小 Source:CSF Pathology None Operative Findings 1. Intracranial pressure: high 2. CSF: clear, colorless Operative Procedures 1. ETGA, supine 2. Head in neutral position 3. Routinely prepped and drapped 4. Linear incision over Kocher point 5. Burr-hole, tackling suture, and dura opening 6. Ventriculostomy 7. Exit drain approximately 15 cm away from insertion. 8. Wound closed in layers Operators VS 王國川 Assistants R5 蔡宗良 Indication Of Emergent Operation Hydrocephalus, increased intracranial pressure 潘秀芬 (F,1974/10/28,37y4m) 手術日期 2011/03/24 手術主治醫師 賴達明 手術區域 東址 005房 02號 診斷 Herniation of intervertebral disc 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 2 紀錄醫師 曾峰毅, 時間資訊 00:00 臨時手術NPO 13:05 報到 13:25 進入手術室 13:30 麻醉開始 13:35 誘導結束 13:45 抗生素給藥 14:15 手術開始 17:15 手術結束 17:15 麻醉結束 17:25 送出病患 17:30 進入恢復室 18:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎間盤切除術-腰椎 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 摘要__ 手術科部: 外科部 套用罐頭: Microdiskectomy, L4/5; dynamic stablization o... 開立醫師: 曾峰毅 開立時間: 2011/03/24 17:47 Pre-operative Diagnosis Sequestrated disc, L4/5 Post-operative Diagnosis Sequestrated disc, L4/5 Operative Method Microdiskectomy, L4/5; dynamic stablization of L4/5 with Coflex Specimen Count And Types Nil Pathology Nil Operative Findings Sequsrated disc compromised left L5 root severely. The left L5 root was decompressed well after disc removal. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position. After back scrubbed, disinfected, and then draped, we made one midline skin incision to expose left L4/5 interlaminar foramen. We removed ligamentum flavum and sequestrated disc. L4/5 Discectomy was performed as well. Incidental durotomy was sealed with Prolene suture and artificial dura - Durofoam. We inserted Colfex, 12 mm high, between spinouos process of L4 and L5. The wound was closed in layers after gentamycin solution irrigation. Operators VS 賴達明 VS 蕭輔仁 Assistants R4 曾峰毅 黃麗茹 (F,1953/03/24,58y11m) 手術日期 2011/03/24 手術主治醫師 陳敞牧 手術區域 東址 005房 01號 診斷 Trigeminal neuralgia 器械術式 Brain tumor Crainotomy(Others) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 2 紀錄醫師 曾峰毅, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:05 進入手術室 08:10 麻醉開始 08:30 誘導結束 08:50 抗生素給藥 08:50 手術開始 11:50 抗生素給藥 13:00 麻醉結束 13:00 手術結束 13:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦微血管減壓術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Microvascular decompression 開立醫師: 曾峰毅 開立時間: 2011/03/24 13:20 Pre-operative Diagnosis Atypical trigeminal neuralgia Post-operative Diagnosis Atypical trigeminal neuralgia Operative Method Microvascular decompression Specimen Count And Types Nil Pathology Nil Operative Findings There was no specific offeding vessels compromising right trigeminal nerve. We divided petrosal vein and trigeminal vein, and packed Teflon around the right trigeminal nerve. Operative Procedures With endotracheal general anaethesia, the patient was put in 3/4 prone posiiton with head fixe dwith Mayflield head clamp. We made one curvilinear skin incision along the right auricle, and created one burr hole at right asterion. We created one 3x4 cm craniotomy, and made one U-shape dura incision. We retarted cerebellum posteriorly, and dissected arachnoid membrane. We packed teflon around the right trigeminal nerve, and closed the dura in water-tight fashion. We fixed bone graft with wires, and closed the wound in layers. Operators VS 陳敞牧 Assistants R4 曾峰毅 林柏佑 (M,2006/03/10,6y0m) 手術日期 2011/03/24 手術主治醫師 楊士弘 手術區域 東址 001房 02號 診斷 Hydrocephalus 器械術式 Revision of CSF shunt, left 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 2E 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 10:08 通知急診手術 12:35 報到 12:58 進入手術室 13:05 麻醉開始 13:10 誘導結束 13:50 抗生素給藥 14:00 手術開始 16:05 手術結束 16:05 麻醉結束 16:15 送出病患 16:20 進入恢復室 17:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦脊髓液分流管重置 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 記錄__ 手術科部: 外科部 套用罐頭: Revision of ventriculoperitoneal shunt 開立醫師: 林哲光 開立時間: 2011/03/24 17:02 Pre-operative Diagnosis Dysfunction of ventriculoperitoneal shunt Post-operative Diagnosis Dysfunction of ventriculoperitoneal shunt Operative Method Revision of ventriculoperitoneal shunt Specimen Count And Types 5 pieces About size:小 Source:CSF About size:小 Source:CSF About size:小 Source:CSF About size:小 Source:ventricular catheter About size:小 Source:peritoneal catheter Pathology Nil Operative Findings The peritoneal catheter was retrieved from the abdominal wound. No CSF flow was noted even with manual pumping of the shunt reservoir. The slit valve was noted to have a soft tissue plug. The ventricular catheter was then removed from the scalp wound, and CSF gushed out from the brain tract. The pressure was more than 30 cmH2O measured by a Nelaton tube inserted into the ventricle. The CSF was clear and colorless. Implantation of a new 70 mmH2O Codman shunt was done. CSF drained well through the catheter before insertion of the peritoneal catheter. Ventricular catheter was 9cm long and abdominal catheter was more than 40 cm long. Operative Procedures Under ETGA and supine position with head rotated to right side, skin disinfected and drapped were performed as usual. Skin incision was made at previous operative wound of RUQ abdomen. The abdominal catheter was exposed well and removed from the peritoneal cavity. The shunt seemed dysfunction under pumping. The scalp wound was then opened and the ventricular catheter was exposed. The ventricular catheter was removed and put a Negadon to the keep the trajectory. Gush of the CSF was noted. The abdominal catheter was then introduced along the previous subcutanous tract and connected to ventricular catheter after adequate valve position was set at left posterior auricle area. The ventricular catheter was then inserted into the ventricle. The abdominal catheter was then inserted into the peritoneal cavity via minilarparotomy. The wound was then closed in layers. Operators 楊士弘 Assistants 林哲光 Indication Of Emergent Operation acute hydrocephalus due to V-P shunt dysfunction 相關圖片 陳旺城 (M,1949/04/10,62y11m) 手術日期 2011/03/24 手術主治醫師 王國川 手術區域 東址 003房 03號 診斷 Headache 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 14:50 進入手術室 14:50 報到 15:00 麻醉開始 15:05 誘導結束 15:30 抗生素給藥 15:32 手術開始 16:18 開始輸血 16:55 手術結束 16:55 麻醉結束 17:15 送出病患 17:17 進入恢復室 19:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室腹腔分流手術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Subduro-peritoneal shunt implantation, right side 開立醫師: 李振豪 開立時間: 2011/03/24 17:10 Pre-operative Diagnosis Bilateral subdural effusion Post-operative Diagnosis Bilateral subdural effusion Operative Method Subduro-peritoneal shunt implantation, right side Specimen Count And Types Nil Pathology Nil Operative Findings The subdural effusion was xanthochromic in character. Not turbid or viscous in appearance. The opening pressure was more than 10cmH2O. The subdural catheter was 4cm in length. The right Frazier"s approach for V-P shunt insertion was tried but failed due to difficult access to the lateral ventricle. The subdural effusion was xanthochromic in character. Not turbid or viscous in appearance. The opening pressure was more than 10cmH2O. The subdural catheter was 4cm in length. One 10mmH2O fixed pressure reservoir was placed for testing and manual pumping. The right Frazier"s approach for V-P shunt insertion was tried but failed due to difficult access to the lateral ventricle. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head rotated to left. The scalp was shaved, scrubbed, and disinfected as usual. The linear scalp incision was made at right temporal area followed by one burr hole creation. Two dural tenting was done. Right upper abdomen transverse skin incision was made and minilaparotomy was performed to enter the peritoneal cavity. The subcutaneous tunnel from right upper abdomen, forechest, neck, and retroauricular area was created. The peritoneal catheter was introduced through the subcutaneous tunnel. The subduro-peritoneal shunt was set up. The dura was opened and subdural catheter was inserted to the subdural space. The function of the shunt was checked. The peritoneal catheter was placed into peritoneal cavity. The wound was closed in layers with 2-0 Vicryl and 3-0 Nylon. Linear scalp incision was made at right Frazier"s point and followed by one burr hole creation. Two dural tenting was performed. Cruciform durotomy was done. Ventriculostomy was tried but failed due to difficult access to right lateral ventricle. Hemostasis was achieved with bipolar electrocautery and Gelform packing. The wound was closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS王國川 Assistants R4李振豪, R1彭元宏 相關圖片 陳文明 (M,1959/03/15,52y11m) 手術日期 2011/03/24 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Brain metastasis 器械術式 Crainotomy Brain Tumor(P-LIN) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 07:55 報到 08:10 進入手術室 08:15 麻醉開始 09:00 誘導結束 09:10 抗生素給藥 09:50 手術開始 12:15 麻醉結束 12:15 手術結束 12:27 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除-手術時間在4小時以內 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Left occipital craniotomy for tumor excision 開立醫師: 李振豪 開立時間: 2011/03/24 12:47 Pre-operative Diagnosis Left occipital brain tumor, suspect metastasis Post-operative Diagnosis Left occipital brain tumor, suspect metastasis Operative Method Left occipital craniotomy for tumor excision Specimen Count And Types 1 piece About size:1.7 x 1.5 x 2.0cm and 0.7cm in diameter Source:Left occipital brain tumor Pathology Pending Operative Findings The tumor was reddish, soft, well-defined, and hypervascularized in character. The size of the tumor was 1.7 x 1.5 x 2.0cm. The other small tumor with 0.7cm in size was noted at the edge of the craniotomy window. Severe swelling of the brain was noted during the operation. The incarcerated brain was pushed back after duroplasty. The pulsation and charcater of the swelling brain parenchyma was within normal appearance. No evident ICH was noted after dural closure by intra-operative sonography. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in prone position with head fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. The reverse U shape scalp incision was made at left occipital area. The scalp and periosteum was elevated. Five burr holes were created followed by 5x4cm craniotomy window. Dural tenting was performed. The location of the tumor was identified by intra-operative sonography. The C-shape durotomy was done. The largest tumor was excised via one 1.5cm corticotomy. The other 0.7cm in diameter tumor was excised. Hemostasis was achieved with bipolar electrocautery and Surgicel lining. Duroplasty was performed with periosteum. The skull plate was fixed back with five #26 wires. One subgaleal CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS王國川 Assistants R4李振豪, R1彭元宏 相關圖片 林秀貴 (F,1944/11/01,67y4m) 手術日期 2011/03/24 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 Head Injury 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 13:00 進入手術室 13:05 麻醉開始 13:10 誘導結束 13:30 抗生素給藥 13:40 手術開始 14:20 手術結束 14:20 麻醉結束 14:27 送出病患 14:30 進入恢復室 16:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Ventriculo-peritoneal shunt implantation via ... 開立醫師: 李振豪 開立時間: 2011/03/24 14:36 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculo-peritoneal shunt implantation via right Kocher"s approach Specimen Count And Types 1 piece About size:5ml Source:CSF Pathology Nil Operative Findings The CSF was clear in character with high opening pressure. The ventricular wall was hard. The Codman programmable valve reservoir with initial setting as 120mmH2O was placed. The ventricular catheter and peritoneal catheter was 7cm and 30cm in length respectively. No traumatic tapping was noted during the operation. The CSF was sampled for routine, BCS, and bacterial culture. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head rotated to left. The scalp was shaved, scrubbed, and disinfected as usual. The 4cm linear scalp incision was made at right frontal area followed by one burr hole creation. Two dural tenting was done. Right upper abdomen transverse skin incision was made and the minilaparotomy was performed to enter the peritoneal cavity. The subcutaneous tunnel from right abdomen, forechest, neck, and retroauricular area was created. One 1.5cm scalp incision was made at right retroauricular area. The peritoneal catheter was introduced through the subcutaneous tunnel. The ventricular catheter and peritoneal catheter was connected to set up the shunt. Cruciform durotomy was performed and right lateral ventricle was punctured with ventricular needle. The ventricular catheter was placed into right lateral ventricle. The function of the shunt was checked. CSF was sampled for study. The peritoneal catheter was placed into peritoneal cavity under direct vision. Hemostasis was achieved. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS王國川 Assistants R4李振豪, R1彭元宏 相關圖片 陳碧雲 (F,1963/10/08,48y5m) 手術日期 2011/03/25 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Facial spasm 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 1 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:15 麻醉開始 08:25 誘導結束 09:20 抗生素給藥 09:55 手術開始 12:25 抗生素給藥 12:45 手術結束 12:45 麻醉結束 12:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦微血管減壓術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Right side retrosigmoid approach for microvas... 開立醫師: 王奐之 開立時間: 2011/03/25 11:43 Pre-operative Diagnosis Right hemifacial spasm Post-operative Diagnosis Right hemifacial spasm Operative Method Right side retrosigmoid approach for microvascular decompression Specimen Count And Types Nil Pathology Nil Operative Findings An obvious offending left AICA loop around CN VII/VIII complex was noted, which was pushed away after dissection and kept apart with Teflon. Operative Procedures After ETGA, the patient was placed in supine position with face turned to left and head fixed in Mayfield skull clamp. A curvilinear skin incision was made at right retroauricular area, after harvesting a fascial graft, the incision was further deepened to expose the mastoid process and the asterion. A burr hole was made above asterion, followed by retrosigmoid craniotomy. A fishmouth durotomy was made, followed by CSF release from the cisterns. The cerebellum sank down after CSF release, exposing the cranial nerves and brainstem. The CN VII/VIII complex was identified, and a nearby offending vessel was dissected and pushed away from the nerve. After inserting Teflon in between the vessel and the nerve, hemostasis was achieved meticulously. The dura was closed with fascial graft, followed by placing back the bone flap with miniplates. The wound was then closed in layers. Operators P.杜永光 Assistants R6 陳睿生, R3 王奐之 相關圖片 黃清祿 (M,1950/06/25,61y8m) 手術日期 2011/03/25 手術主治醫師 曾漢民 手術區域 東址 002房 01號 診斷 Malignant neoplasm of other specified sites of nervous system 器械術式 V-P shunt 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 曾峰毅, 時間資訊 23:40 臨時手術NPO 23:40 開始NPO 07:00 通知急診手術 09:10 報到 09:20 進入手術室 09:30 麻醉開始 09:40 誘導結束 10:33 手術開始 11:50 手術結束 11:50 麻醉結束 12:05 送出病患 12:10 進入恢復室 13:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 腦室腹腔分流手術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 曾峰毅 開立時間: 2011/03/25 11:51 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunt, right Kocher, Medtronic, fixed-low-pressure Specimen Count And Types Nil Pathology Nil Operative Findings Opening pressure was 5 cmH20. colorless, slightly turbid, CSF was drained. Medtronic, fixed-low-pressure valve was used. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to left. After scalp shave, scrubbed, disinfected, and then draped, we made one transverse skin incision at right upper abdomen, and created mini-laparotomy. We created subcutaneous tunnel to right occipital area. We made on curvilinear skin incision at right frontal area, and drilled one burr hole. After durotomy and dura tenting, ventriculostomy was performed once, and then ventricular catheter was inserted. We connected shunt altogether, and checked the function. The wound was closed in layers. Operators VS 曾漢民 Assistants R4 曾峰毅 Indication Of Emergent Operation IICP 相關圖片 吳瑞琴 (F,1965/12/02,46y3m) 手術日期 2011/03/25 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Brain metastasis 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 曾偉倫, 曾偉倫, 時間資訊 00:00 臨時手術NPO 07:48 報到 08:07 進入手術室 08:20 麻醉開始 08:40 誘導結束 08:50 抗生素給藥 08:55 手術開始 11:55 麻醉結束 11:55 手術結束 12:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 顱底瘤手術 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Left retro-sigmoid approach for tumor excision. 開立醫師: 鍾文桂 開立時間: 2011/03/25 12:11 Pre-operative Diagnosis Left cerebellopontine angle tumor, suspect brain metastasis. Post-operative Diagnosis Left cerebellopontine angle metastatic tumor. Operative Method Left retro-sigmoid approach for tumor excision. Specimen Count And Types 1 piece About size:3.5x3x2 Source:Cerebellar tumor Pathology Pending Operative Findings 1. A 4x3x2 cm yellowish, hard, elastic tumor over left cerebellopontine angle. The tumor adheres to the dura firmly. The vascularity of the tumor was high. It encased the branches of AICA. The vessel was electrocoagulated. 2. The PICA was idnetified and the surrounding tumor was left Operative Procedures Under ETGA, the patient was put on 3/4 prone position with her head fixed with Mayfield clamp. After we shaved, scrubbed, disinfected and drapped, a linear horizontal skin incision was made over left retroauricular area. Craniectomy was made after harvesting fascia graft. The sigmoid and transverse sinus were identified. The curivilinear dura incision was made behind the sinus. Corticotomy was made over left cerebellar area and the tumor resection was performed with bioplar forceps, tumor forceps and scissors in piecemeal fashion. After well hemostasis, The dura mater was repaired by fascia graft. The craniotomy plate was fixed by miniplates and screws. The wound was closed in layers without drain tube. Operators VS 曾漢民 Assistants R5 鍾文桂 R2 曾偉倫 相關圖片 王兩興 (M,1937/03/03,75y0m) 手術日期 2011/03/25 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Lung cancer 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 曾偉倫, 曾偉倫, 時間資訊 00:00 臨時手術NPO 12:15 進入手術室 12:21 麻醉開始 12:30 誘導結束 12:40 抗生素給藥 12:45 手術開始 15:35 手術結束 15:35 麻醉結束 15:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Left parietal-occipital cramiotomy with tumor... 開立醫師: 曾偉倫 開立時間: 2011/03/25 15:45 Pre-operative Diagnosis Right parietal-occipital brain tumor, suspect metastasis Post-operative Diagnosis Right parietal-occipital brain tumor, suspect metastasis Operative Method Left parietal-occipital cramiotomy with tumor excision Specimen Count And Types 1 piece About size:4x4x3 cm Source:Brain tumor Pathology Pending Operative Findings 1. A 5x4x4 cm whitish, soft, hypervascularized tumor was found over the parietal and occipital lobe. Some tumor necrosis was found within the tumor. 2. Brain swelling while open the dura, but the brain became slack after tumor resection Operative Procedures Under ETGA, we put the patient on prone position after we fixed his head with Mayfield clapm. After we shaved, scrubbed, disinfected and drapped, a hocky stick skin incision was made. We localized the tumor with intra-operative sonography then craniectomy was made with drill. A U shape durotomy was made after was made above the tumor. A 1.0 x 1.0 cm corticotomy was made and the tumor resection was performed with bipolar forceps, tumor forceps and scissors. We closed the dura with 3-0 Prolene after complete hemostasis. The skull was fixed with mini-plates and screw. We close the wound in layers after a CWV drain was placed. Operators VS 曾漢民 Assistants R5 鍾文桂 R2 曾偉倫 相關圖片 林甲 (F,1937/01/07,75y2m) 手術日期 2011/03/25 手術主治醫師 曾漢民 手術區域 東址 003房 02號 診斷 Subdural hematoma 器械術式 Burr hole (trephination) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 13:20 麻醉開始 13:25 誘導結束 14:00 抗生素給藥 14:15 手術開始 14:16 進入手術室 15:30 手術結束 15:30 麻醉結束 15:37 送出病患 15:40 進入恢復室 16:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 慢性硬腦膜下血腫清除術 1 1 B 摘要__ 手術科部: 外科部 套用罐頭: Bilateral burr hole for subdural drainage 開立醫師: 王奐之 開立時間: 2011/03/25 15:42 Pre-operative Diagnosis Bilateral chronic subdural hematoma Post-operative Diagnosis Bilateral chronic subdural hematoma Operative Method Bilateral burr hole for subdural drainage Specimen Count And Types Nil Pathology Nil Operative Findings Motor-oil like fluid was drained from bilateral burr hole. The brain re-expanded partially after drainage. Operative Procedures After ETGA, the patient was placed in supine position. After shaving, disinfection & draping in sterile fashion, 2 linear incisions were made at bilateral frontotemporal area. A burr hole was made at each side, followed by dural tenting and cruciate durotomies. One rubber drain was inserted to each burr hole for subdural drainage. After drainage of hematoma, the rubber drains were secured and the wounds were closed. The operative procedure ended after deairing. Operators VS 曾漢民 Assistants R6 陳睿生, R3 王奐之 相關圖片 施翠微 (F,1921/10/23,90y4m) 手術日期 2011/03/25 手術主治醫師 曾勝弘 手術區域 東址 019房 03號 診斷 Subdural hemorrhage or effusion 器械術式 Left subduro-peritoneal shunt implantation 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林峰盛 ASA 3E 紀錄醫師 鍾文桂, 時間資訊 07:30 臨時手術NPO 07:30 開始NPO 10:17 通知急診手術 19:20 報到 19:50 進入手術室 20:00 麻醉開始 20:05 抗生素給藥 20:15 誘導結束 20:50 手術開始 22:00 手術結束 22:00 麻醉結束 22:05 送出病患 22:10 進入恢復室 23:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 手術 腦室腹腔分流手術 1 1 L 記錄__ 手術科部: 內科部 套用罐頭: Implantation of subdural-peritoneal shunt,left. 開立醫師: 鍾文桂 開立時間: 2011/03/25 22:21 Pre-operative Diagnosis Subdural fluid collection, suspect effusion or chronic hemorrhage, left frontal-temporal-parietal. Post-operative Diagnosis Subdural effusion, left frontal-temporal-parietal. Operative Method Implantation of subdural-peritoneal shunt,left. Specimen Count And Types 1 piece About size:15cc Source:subdural effusion. Pathology Nil. Operative Findings Clear colorless subdural effusion, low pressure. Codman 1cmH2O shunt was implanted. The patency of the shunt was ensure before wound closure. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine position with head rotated to right. The scalp was shaved, scrubbed, and disinfected as usual. The left temporal scalp linear incision was made followed by one burr hole creation. Two dural tenting was done. The linear durotomy was performed and the subdural effusion gushed out. The specimen was sampled for study. Left upper abdomen transverse skin incision was made and minilaparotomy was performed to enter the peritoneal cavity. After creating subcutaneous tunnel from abdomen to head, the shunt catheter was passed through the same tract. The subdural catheter was placed in subdural space and the peritoneal catheter was placed in peritoneal cavity. Finally, the wounds were closed in layers. Operators VS曾勝弘 Assistants R5鍾文桂, R4李振豪 Indication Of Emergent Operation 相關圖片 摘要__ 手術科部: 內科部 套用罐頭: Implantation of subdural-peritoneal shunt,left. 開立醫師: 鍾文桂 開立時間: 2011/03/25 22:27 Pre-operative Diagnosis Subdural fluid collection, suspect effusion or chronic hemorrhage, left frontal-temporal-parietal. Post-operative Diagnosis Subdural effusion, left frontal-temporal-parietal. Operative Method Implantation of subdural-peritoneal shunt,left. Specimen Count And Types 1 piece About size:15cc Source:subdural effusion. Pathology Nil. Operative Findings Clear colorless subdural effusion, low pressure. Codman 1cmH2O shunt was implanted. The patency of the shunt was ensure before wound closure. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine position with head rotated to right. The scalp was shaved, scrubbed, and disinfected as usual. The left temporal scalp linear incision was made followed by one burr hole creation. Two dural tenting was done. The linear durotomy was performed and the subdural effusion gushed out. The specimen was sampled for study. Left upper abdomen transverse skin incision was made and minilaparotomy was performed to enter the peritoneal cavity. After creating subcutaneous tunnel from abdomen to head, the shunt catheter was passed through the same tract. The subdural catheter was placed in subdural space and the peritoneal catheter was placed in peritoneal cavity. Finally, the wounds were closed in layers. Operators VS曾勝弘 Assistants R5鍾文桂, R4李振豪 Indication Of Emergent Operation Right side weakness, cognitive function impairment 相關圖片 蔡方素屏 (F,1937/06/21,74y8m) 手術日期 2011/03/25 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Hydrocephalus 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 蔡立威, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:05 進入手術室 08:25 麻醉開始 08:30 誘導結束 08:45 抗生素給藥 09:20 手術開始 11:25 手術結束 11:25 麻醉結束 11:35 送出病患 11:40 進入恢復室 12:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 摘要__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunting, via right-side... 開立醫師: 蔡立威 開立時間: 2011/03/25 11:41 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunting, via right-sided Kochers point Specimen Count And Types 1 piece About size:小 Source:CSF x 3 Pathology None Operative Findings 1. CSF: clear, colorless 2. ICP: normal Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: supine with head rotated to left . 3.Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4.Incision: 4 cm linear, previous right-sided Kocher point. 5.After the scalp flap had been lifted and reflected. 6.The dura was opened by a nib incision. Lt lateral ventricle was tapped by a ventricular needle, then a 6.5 cm segment of the ventricular catheter was introduced into the ventricle. The outer end of the catheter was connected to a Codman Hakim programmable reservoir. 7. A nib incision was made at RUQ of the abdomen, then a trocar was pushed into peritoneal cavity. Subsequently, distal 30 cm segment of the peritoneal catheter zero pressure was introduced into the peritoneal cavity through the outer tube of the trochar. The proximal end of this catheter was passed through subcutaneous tunnel at forechest, neck, rt retroauricular area and connected the reservoir. The shunt systemwas checked to make sure its function was working. 8. Scalp closure: hemostasis was done with monopolar coagulator touching on the sucker tip. Galea suture was performed by continuous suture with 3/0. Dexon and skin by continuous suture with 3/0 nylon. 9.Course of the surgery: smooth. Operators VS賴達明 Assistants R5蔡宗良,R2蔡立威 呂敏雲 (F,1941/01/07,71y2m) 手術日期 2011/03/25 手術主治醫師 賴達明 手術區域 東址 019房 02號 診斷 Lung cancer 器械術式 Brain biopsy (P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 蔡立威, 時間資訊 00:00 臨時手術NPO 11:35 報到 11:50 進入手術室 12:00 麻醉開始 12:20 誘導結束 12:55 抗生素給藥 13:25 手術開始 15:55 抗生素給藥 18:10 開始輸血 18:50 麻醉結束 18:50 手術結束 19:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4~8小時 1 1 L 手術 立體定位術-切片 1 2 L 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: 1. Brain tumor removal, via left-sided fronto... 開立醫師: 蔡宗良 開立時間: 2011/03/25 19:17 Pre-operative Diagnosis Brain tumor, frontal lobe and temporal lobe, left-sided, suspect metastasis Post-operative Diagnosis Metastatic adenocarcinoma, frontal lobe and temporal lobe, left-sided Operative Method 1. Brain tumor removal, via left-sided fronto-temporal craniotomy 2. Frameless navigation for tumor localization Specimen Count And Types 1 piece About size:小 Source:Brain Pathology Frozen section: papillary structure, suspect metastatic adenocarcinoma Operative Findings 1. Brain was not particular edematous 2. Both tumors were 1-2 mm below cortex 3. Both tumors were grey in color, fragile, and moderately vascularized. Tumor-brain border was clear cut and easily separable. Operative Procedures Patient was in ETGA and head rotated 80 degrees to the right with Mayfield head-clamp fixation. Navigational equiments were employed for tumor localization. Scalp were routinely prepped and drapped. A inverted U incision was made and the scalp was reflected. Four burr holes were made and a craniotomy as depicted was made. Dura was opened and the tumor was again localized. Tumor specimen was sent for frozen section. Tumor was removed with tumor forceps in piecemeal manner. All bleeders were controlled. Dura was closed in a water-tight fashion. Skull plate was fixed back to the craniotomy window with G8 wires. An CWV drain was placed above the skull plate. Wound was closed in layers. Operators VS賴達明 Assistants R5蔡宗良,R2蔡立威 陳靜慧 (F,1966/11/06,45y4m) 手術日期 2011/03/25 手術主治醫師 賴達明 手術區域 東址 003房 03號 診斷 Herniation of intervertebral disc 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 2 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 15:56 進入手術室 16:00 麻醉開始 16:30 誘導結束 17:00 抗生素給藥 17:25 手術開始 20:00 抗生素給藥 22:35 手術結束 22:35 麻醉結束 22:45 送出病患 22:47 進入恢復室 23:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 脊椎融合術-前融合,有固定物)≦四節 1 1 B 手術 椎間盤切除術-腰椎 1 2 B 摘要__ 手術科部: 外科部 套用罐頭: Paramedian appproach for L5-S1 TPS fixation &... 開立醫師: 陳睿生 開立時間: 2011/03/25 22:58 Pre-operative Diagnosis L5-S1 HIVD with L5 lateral body fracture, status post microsurgical discectomy Post-operative Diagnosis L5-S1 HIVD with L5 lateral body fracture, status post microsurgical discectomy Operative Method Paramedian appproach for L5-S1 TPS fixation & re-do microdiskectomy Specimen Count And Types Nil Pathology Nil Operative Findings Microdiskectomy was performed via right side incision. Left side L5-S1 posteriolateral fusion was noted after previous procedure. The disk was degenerative change and the right L5 root was tightly compressed. TPS: Synthes, 6.2x 40mm x4; rods: Synthes, 5cm x2 Operative Procedures After ETGA, the patient was placed in prone position. L5-S1 disc space was localized with C-arm. After scrubbing, disinfection and draping in sterile fashion, bilateral paramedian skin incisions were made at lower back. The incision was deepened to the fascial layer, and then L5 transverse processes was identified by splitting. Bilateral L5-S1 transpedicle screws were implanted from bilateral skin incision with Thompson retractor. Under microscope, right side L5 partial laminectomy was performed, and the thecal sac was decompressed with L5-S1 diskectomy. Bilateral rods were implanted and fixed. After hemostasis and setting up 2 hemovacs, the wound was closed in layers. Operators VS 賴達明 Assistants R6 陳睿生, R3 王奐之 相關圖片 葉雲鵬 (M,1978/09/19,33y5m) 手術日期 2011/03/25 手術主治醫師 蔡翊新 手術區域 東址 019房 04號 診斷 Epidural hemorrhage 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林峰盛 ASA 3E 紀錄醫師 蕭博懷, 時間資訊 22:50 進入手術室 23:00 麻醉開始 23:25 誘導結束 23:30 手術開始 23:30 抗生素給藥 00:24 開始輸血 01:40 手術結束 01:40 麻醉結束 01:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 硬腦膜外血腫清除術 1 1 L 手術 顱內壓視置入 1 2 L 摘要__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 蔡翊新 開立時間: 2011/03/26 01:25 Pre-operative Diagnosis Left temporoparietal skull fracture with epidural hematoma. Post-operative Diagnosis Left temporoparietal skull fracture with epidural hematoma. Operative Method Left temporoparietal craniotomy for epidural hematoma evacuation and subdural ICP monitoring. Specimen Count And Types nil Pathology Nil. Operative Findings Anteroposterior linear fracture of left temporoparietal skull was noted. Beneath it was epidural hematoma, 10 x 8 cm in area and 3 cm in maximal thickness. There were bleeding sources from fracture line and dural surface. Massive bleeding was encountered while packing the medial aspect of the epidural space, possibly from granulations near the superior sagittal sinus. The dura was slack after evacuation of the EDH. ICP was inserted to the subdural space of left temporal area and the ICP after cranioplasty was 5 mmHg. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: curvilinear at left temporoparietal region, the skin edge was clipped by Raney clips for temporary hemostasis. The temporalis muscles was incised down to the tempoal squama. 5. A burr hole was made at posterior parietal region for evacuating part of the epidural hematoma, therefore the IICP could be relieved earlier. 6. Craniotomy window: 8 x 8 cm, left temporoparietal, created by making 3 burr holes then cut by power saw. 7. The epidural hematoma was evacuated by sucker. 8. Dural tenting: by 2/0 silk, 1.5-cm in interval, distributed along the edge of skull window. 9. Hemosatasis: the bleeders was stopped by Bovie and oozing surface was covered with Gelfoam. 10.A nib incision of dura was done at anterior aspect and normal saline was instilled into subdural space to facilitate dural tenting and packing of epidural space. Then a subdural Codman ICP monitor was set at subdural space via the nib incision. 11.The fractured skull plates were assembled back with two 26# wires and fixed by 3 miniplates and 6 screws. 12.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 13.Drain: one epidural CWV. 14.Blood transfusion: PRBC 2U. Blood loss: 1000 ml. 15.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5鍾文桂R5蕭博懷 Indication Of Emergent Operation massive EDH with IICP. 林俊雄 (M,1946/08/25,65y6m) 手術日期 2011/03/25 手術主治醫師 楊永健 手術區域 西址 030房 02號 診斷 Sebaceous cyst 器械術式 Excision of facial skin tumor- 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 10:40 報到 10:50 進入手術室 11:05 手術開始 11:30 手術結束 11:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 臉部腫瘤切除術直徑大於2CM 1 1 黃國恩 (M,1989/10/23,22y4m) 手術日期 2011/03/25 手術主治醫師 謝孟祥 手術區域 東址 012房 02號 診斷 Fracture of vault of skull, closed with subarachnoid, subdural, and extradural hemorrhage, with 器械術式 Operation for craniosynostosis 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 3 紀錄醫師 陳以幸, 時間資訊 11:35 報到 11:45 進入手術室 12:00 麻醉開始 12:05 誘導結束 12:40 抗生素給藥 12:50 手術開始 15:50 手術結束 15:50 麻醉結束 16:00 送出病患 16:05 進入恢復室 17:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 手術 頭顱成形術 1 1 摘要__ 手術科部: 外科部 套用罐頭: Debridement 開立醫師: 官振翔 開立時間: 2011/03/25 16:08 Pre-operative Diagnosis Frontal hallowing with depression Post-operative Diagnosis Frontal hallowing with depression Operative Method Cranioplasty with bone source remodeling Specimen Count And Types Nil Pathology Nil Operative Findings 1. Frontal hallowing with left frontal bone depression 2. Mild atrophy of soft tissue over left temporal-frontal area 3. BOne source spacing 20gm Operative Procedures Under general anesthesia, the patient lied in supine position. Antiseptics applied and draped as usual. Hemicoronal incision and dissect to expose bone defect. Bone source remodeling. Wound closure with one CWV drain Operators 謝孟祥, Assistants 官振翔, 陳以幸 莊文輝 (M,1954/05/27,57y9m) 手術日期 2011/03/26 手術主治醫師 曾漢民 手術區域 東址 003房 02號 診斷 Meningioma 器械術式 Tracheostomy 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 3 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 07:01 通知急診手術 14:08 進入手術室 14:10 麻醉開始 14:15 誘導結束 14:27 手術開始 14:45 手術結束 14:45 麻醉結束 14:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 氣管切開術 1 0 摘要__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 李振豪 開立時間: 2011/03/26 14:58 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types Nil Pathology Nil Operative Findings Fr. 8 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators VS曾漢民 Assistants R4李振豪, R1彭元宏 Indication Of Emergent Operation Respiratory failure, prolonged intubation 相關圖片 任寶美 (F,1955/10/29,56y4m) 手術日期 2011/03/26 手術主治醫師 賴達明 手術區域 東址 002房 02號 診斷 Subarachnoid hemorrhage (SAH) 器械術式 Craniotomy(Aneurysms) VS-TZENG 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 4E 紀錄醫師 羅偉誠, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 07:03 通知急診手術 08:10 進入手術室 08:16 麻醉開始 08:20 誘導結束 10:29 手術開始 11:00 抗生素給藥 11:30 開始輸血 17:00 抗生素給藥 18:30 手術結束 18:30 麻醉結束 18:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 開顱術摘除血管病變 - 腦血管瘤 有病徵的 1 1 手術 顱內壓視置入 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 12 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Combine pterional and subfrontal craniectomy ... 開立醫師: 陳睿生 開立時間: 2011/03/26 19:39 Pre-operative Diagnosis Acom aneurysm with rupture, diffuse SAH, right frontal ICH, and SDH, with brain swelling Post-operative Diagnosis Acom aneurysm with rupture, diffuse SAH, right frontal ICH, and SDH, with brain swelling Operative Method Combine pterional and subfrontal craniectomy for aneurysm clipping and deompression Specimen Count And Types nil Pathology Nil Operative Findings Two aneurysms were noted at A-com. The bigger and rupture one was about 6mm in height and 3mm in neck, and noted protruding anteriorly. The smaller one was noted protruded posteriolaterally. A straight Sugita clip was applied to the smaller one, and one fenestrated right angle Sugita clip, one straight clip were applied to the larger one. Two more straight Sugita clips were applied to the junction of left A1 and A-com due to incidental tear of the ACA. Massive hematoma was noted at right frontal base and sylvian fissure. Right F-T SDH was also noted and arachnoid membrane tear was noted at sylvian region. Subdural ICP monitor was inserted for continuous monitor. The initial ICP was about 5mmHg, and reference was 508. Operative Procedures 1. ETGA, the patient was under supine position and head extension, fixed with Mayfield clump 2. Right frontotemporal scalp incision with left frontal extension 3. Right side facial nerve preservartion, and then the temporalis muscle was dissected 4. Six bur holes made, and then a craniectomy was created from left frontotemporal to right frontal region 5. Hemostasis, and proper dura tenting was done 6. The dura was opened along the craniectomy margin, and the SSS was ligated from anterior 1/3 7. Evacuation the right F-T SDH, and the SAH inside the sylvian fissure 8. Interhemispheric approach was tried to expose bilateral ACA but failed 9. The right frontal was retracted from frontal base, and the hematoma here was carefully evacuated 10.Bilateral A1, A2, and A-com with two aneurysms were identified at the deep side of the hematoma 11.The neck of the aneurysms were dissected, and a straight Sugita clip was applied to the smaller aneurysm 12.A fenestrated right angle Sugita clip was applied to the larger one; however, aneurysm rupture with bleeding was noted during clipping 13.A straight clip was applied to the dome of the aneurysm for hemostasis 14.Incidental ipsilateral ACA tear was noted, and two straight clips were applied for repair 15.Hemostasis, the dura was closed with fascia graft and Durafoam 16.A subdural ICP monitor was inserted, and two epidural CWV drains were implanted 17.The wound was closed in layers Operators VS 賴達明 Assistants R6 陳睿生, R1 羅偉誠 Indication Of Emergent Operation Aneurysm rupture with diffuse SAH 黃慕香 (M,1942/10/14,69y5m) 手術日期 2011/03/26 手術主治醫師 賴達明 手術區域 東址 003房 04號 診斷 Intracerebral hemorrhage 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 4E 紀錄醫師 李振豪, 時間資訊 20:00 臨時手術NPO 20:00 開始NPO 22:14 通知急診手術 22:45 進入手術室 22:50 麻醉開始 23:15 誘導結束 23:15 抗生素給藥 23:15 開始輸血 23:39 手術開始 00:50 手術結束 00:50 麻醉結束 00:55 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦室體外引流 1 1 B 手術 腦室體外引流 1 2 B 麻醉 C.V.P. catheter in ubation 1 0 摘要__ 手術科部: 外科部 套用罐頭: Bilateral external ventricular drainage via b... 開立醫師: 李振豪 開立時間: 2011/03/27 01:18 Pre-operative Diagnosis Right thalamic hemorrhage with ruptured into ventricle and acute hydrocephalus Post-operative Diagnosis Right thalamic hemorrhage with ruptured into ventricle and acute hydrocephalus Operative Method Bilateral external ventricular drainage via bilateral Kocher"s point Specimen Count And Types 1 piece About size:15ml Source:CSF Pathology Nil Operative Findings Bloody CSF gushed out after puncture of the lateral ventricle. The opening pressure was more than 15cmH2O. The EVD was fixed at 7cm in depth bilaterally. The function of the EVD was checked after whole procedure and it work well. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine position. The scalp was shaved, scrubbed, and disinfected as usual. Bilateral linear scalp incision was made followed by burr hole creation over bilateral Kocher"s point. Dural tenting was performed. The dura was opened with cruciform and the edge was coagulated by bipolar electrocautery. Bilateral lateral ventricle ventriculostomy was done with ventricular needle. The EVD was inserted and fixed at 7cm in depth. Externalization was performed. Hemostasis was achieved with Gelform packing and bipolar electrocautery. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS賴達明 Assistants R4李振豪 Indication Of Emergent Operation IICP with rapid deterioration of GCS score 相關圖片 謝翁玉枝 (F,1942/06/23,69y8m) 手術日期 2011/03/26 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Cervical Spondylosis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 3 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:04 進入手術室 08:10 麻醉開始 08:50 誘導結束 08:50 抗生素給藥 08:58 手術開始 12:00 抗生素給藥 13:10 麻醉結束 13:10 手術結束 13:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 摘要__ 手術科部: 外科部 套用罐頭: C1-2 transarticular screws fixation and Sonnt... 開立醫師: 李振豪 開立時間: 2011/03/26 13:54 Pre-operative Diagnosis C1-2 subluxation Post-operative Diagnosis C1-2 subluxation Operative Method C1-2 transarticular screws fixation and Sonntag fusion with autologous bone graft Specimen Count And Types nil Pathology Nil Operative Findings The C1-2 was unstable before the transarticular screws fixation. Under portable C-arm fluoroscopy guided, TAS was performed and the C1-2 was fixed well. The size of cannulated screws 4.5 x 40mm x II. Right iliac bone was harvested for Sonntag fusion. The thecal sac was intact and no incidental durotomy or CSF leakage was noted after whole procedure. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position with head fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. The linear scalp incision was made from suboccipital to C3 level. The subcutaneous soft tissue and paravertebral muscle was dissected and detached. The C0, foramen magnum, laminae of C1 and C2 were exposed. Two small skin incision was made and the guide tube was inserted. The K-pin was inserted under fluoroscopy as guidance of the cannulated screws. The Cannulated screws was implanted and the depth of the TAS was checked by fluoroscopy. Linear skin incision was made at right lower back and the iliac bone was harvested for autologous bone graft. Decortication of C1 and C2 laminae was performed. The harvested iliac bone was fixed between C1 and C2 with TiCron. Hemostasis was achieved and one CWV drain was placed at neck wound. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS賴達明 Assistants R4李振豪, R1彭元宏 相關圖片 李長熹 (M,1944/11/25,67y3m) 手術日期 2011/03/26 手術主治醫師 李章銘 手術區域 東址 020房 03號 診斷 Lung tumor 器械術式 Port-A catheter implatation 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 蔡東明, 時間資訊 13:38 報到 13:43 進入手術室 13:47 抗生素給藥 14:00 麻醉開始 14:01 誘導結束 14:02 手術開始 14:35 麻醉結束 14:35 手術結束 14:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 port–A導管植入術–治療性導管植入術 1 0 R 記錄__ 手術科部: 外科部 套用罐頭: Port-A 開立醫師: 蔡東明 開立時間: 2011/03/26 13:46 Pre-operative Diagnosis Lung cancer Post-operative Diagnosis Lung cancer Operative Method Port-A insertion Specimen Count And Types nil Pathology nil Operative Findings The port-A catheter was inserted to right subclavian via puncture method, checked by portable CXR Operative Procedures 1. LA, supine 2. Skin disinfection and draping as usual 3. Insert Port-A via puncture method 4. Checked by portable CXR, close wound in layers Operators VS李章銘 Assistants R4蔡東明 范博修 (M,1993/04/07,18y11m) 手術日期 2011/03/27 手術主治醫師 蔡翊新 手術區域 東址 005房 03號 診斷 Traumatic brain injury 器械術式 ICP monitoring, decompressive craniectomy 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 蕭柏妮 ASA 4E 紀錄醫師 蔡宗良, 時間資訊 19:55 通知急診手術 20:30 報到 20:30 進入手術室 20:35 麻醉開始 21:00 手術開始 21:05 誘導結束 22:10 麻醉結束 22:10 手術結束 22:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱內壓視置入 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Intraparenchymal intracranial pressure monito... 開立醫師: 蔡宗良 開立時間: 2011/03/27 22:29 Pre-operative Diagnosis Diffuse brain contusion with increased intracranial pressure Post-operative Diagnosis Diffuse brain contusion with increased intracranial pressure Operative Method Intraparenchymal intracranial pressure monitoring, via left-sided Kochers point Specimen Count And Types nil Pathology None Operative Findings 1. Intracranial pressure is 18 mmHg during insertion. Operative Procedures 1. ETGA supine head turn 70 degrees to the right. 2. Routinely prepped and drapped 3. Linear wound incision was made 4. Burr hole was made 5. ICP monitor probe was inserted 3 cm into the parenchyma. 6. Wound is closed in layers Operators VS 蔡翊新 VS 王國川 Assistants R5 蔡宗良 R1吳昭瑩 Indication Of Emergent Operation INCREASED INTRACRANIAL PRESSURE KITAMURA HARUMASA (M,1948/04/08,63y11m) 手術日期 2011/03/28 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Subarachnoid hemorrhage 器械術式 Wound treatment-- <5cm 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3E 紀錄醫師 蔡立威, 時間資訊 13:01 通知急診手術 14:55 進入手術室 14:55 報到 15:00 麻醉開始 15:05 誘導結束 15:30 抗生素給藥 15:45 手術開始 16:12 手術結束 16:12 麻醉結束 16:18 送出病患 10:00 開始NPO 10:00 臨時手術NPO 醫令資訊 類別 名稱 量 刀 側 手術 顱內壓視置入 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Intracranial pressure monitoring, via right-s... 開立醫師: 蔡宗良 開立時間: 2011/03/28 16:26 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Intracranial pressure monitoring, via right-sided Kochers point Specimen Count And Types 1 piece About size:小 x3 Source:CSF Pathology None Operative Findings 1. CSF: bloody 2. ICP: high Operative Procedures 1. ETGA supine, head in neutral position 2. Routine prepped and drapped 3. Wound incision over previous wound 4. Ventriculostomy performed on previous Kochers point tract 5. Wound closed in layers Operators VS賴達明 Assistants R5蔡宗良, R2蔡立威 Indication Of Emergent Operation increased intracranial pressure. 蔡玉芬 (F,1962/08/11,49y7m) 手術日期 2011/03/28 手術主治醫師 曾漢民 手術區域 東址 005房 03號 診斷 Brain Tumor 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 2 紀錄醫師 曾偉倫, 鍾文桂, 時間資訊 00:00 臨時手術NPO 12:26 進入手術室 12:30 麻醉開始 12:31 報到 12:50 抗生素給藥 13:00 誘導結束 13:34 手術開始 15:50 抗生素給藥 15:55 麻醉結束 15:55 手術結束 16:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Right sub-frontal approach for tumor resection 開立醫師: 鍾文桂 開立時間: 2011/03/28 16:29 Pre-operative Diagnosis Craniopharyngioma Post-operative Diagnosis Craniopharyngioma Operative Method Right sub-frontal approach for tumor resection Specimen Count And Types 1 piece About size:1x1x0.8 cm Source:Sellar tumor Pathology Pending Operative Findings 1. A yellow-whitish 1x1x0.8 cm soft tumor over sellar area whitch push the optic chisma upward leftward. 2. Severe adhesion of the capsule of craniopharygioma with the surrounding pituitary stalk, and hypophyseal arteries, and optic nerve. A small part of the craniopharyngioma was left on the pituitary stalk due to severe adhesion. 3. After resection, the basilar artery was identified. Operative Procedures Under ETGA, the patient was placed in supine position and the head was in midline position. After shaving, disinfection, and draping, bicoronal scalp incision was made. A 5 cm craniotomy was created by high speed drill. Further flattening of the frontal skull base was achieved by high speed drill. The frontal sinus was sealed with bonewax. After durotomy, the frotnal lobe was retracted away from the frontal base until the craniopharygioma was identified. Meticuloud dissection from the normal structures were performed by using dissector, ring forceps, and bipolar forceps. After well hemostasis, the brain surface was covered with surgicel. The dura mater was closed in water-tight fashion. The craniotomy plate was fixed by miniplates and screws. The wound was closed in layers with one subgaleal CWV drain. Operators VS 曾漢民 Assistants R5 鍾文桂 R2 曾偉倫 相關圖片 劉宗禮 (M,1939/11/22,72y3m) 手術日期 2011/03/28 手術主治醫師 楊永健 手術區域 東址 012房 01號 診斷 Burn, leg 器械術式 S.T.S.G.<10 BSA 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 3 紀錄醫師 徐展陽, 時間資訊 08:01 進入手術室 08:08 麻醉開始 08:12 誘導結束 08:15 抗生素給藥 08:22 手術開始 09:00 手術結束 09:00 麻醉結束 09:05 送出病患 09:10 進入恢復室 10:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 多層皮膚移植- 10-20BSA 1 1 R 手術 石膏副木固定－長腿 1 0 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Burn-debridement and STSG 開立醫師: 徐展陽 開立時間: 2011/03/28 09:12 Pre-operative Diagnosis Right leg post-burn wound Post-operative Diagnosis Right leg post-burn wound Operative Method Burn-debridement and STSG Specimen Count And Types nil Pathology Nil Operative Findings 1) Poor healing wound over right leg was noted 2) Skin defect: 60cm2 3) Donor site: right thigh, 10/1000 inch in depth Operative Procedures Under general anesthesia, patient lied at supine position. Antiseptics was apllied and drapped as usual. We excised the devitalized tissue. We harvested the 10/1000-inch in thickness STSG right thigh with air-drive Zimmer dermatome. We applied the STSG on the skin defect. We applied long leg splint over right leg for immobilization. Operators VS楊永健 Assistants R4游彥辰 R1徐展陽 Ri陳建志 何為墩 (M,1951/04/21,60y10m) 手術日期 2011/03/28 手術主治醫師 曾勝弘 手術區域 東址 001房 04號 診斷 Headache 器械術式 Burr hole (trephination) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3E 紀錄醫師 陳以幸, 時間資訊 13:00 開始NPO 19:38 通知急診手術 20:45 報到 21:00 進入手術室 21:05 麻醉開始 21:10 誘導結束 21:45 抗生素給藥 21:52 手術開始 22:50 手術結束 22:50 麻醉結束 23:00 送出病患 23:05 進入恢復室 00:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Glucose 2 0 摘要__ 手術科部: 內科部 套用罐頭: Left side burr hole for subdural hematoma eva... 開立醫師: 王奐之 開立時間: 2011/03/28 22:55 Pre-operative Diagnosis Left side chronic subdural hematoma Post-operative Diagnosis Left side chronic subdural hematoma Operative Method Left side burr hole for subdural hematoma evacuation Specimen Count And Types Nil Pathology Nil Operative Findings Dark reddish fluid gushed out after incision of outer membrane. The brain partially re-expanded after hematoma evacuation. Operative Procedures After ETGA, the patient was placed in supine position with face slightly turned to right. After scalp shaving, disinfection and draping in sterile fashion, a linear scalp incision was made at left fronto-temporal area. A burr hole was then made, followed by 2 tenting stitches. A cruciate durotomy was done, followed by incision of the hematoma outer membrane. A rubber drain was then inserted to drain the hematoma. After evacuating most of the hematoma, the wound was closed in layers. The operation ended after deairing procedure. Operators VS 曾勝弘 Assistants R3 王奐之, R1 陳以幸 Indication Of Emergent Operation Brainstem compression 相關圖片 張溪明 (M,1933/08/18,78y6m) 手術日期 2011/03/28 手術主治醫師 賴達明 手術區域 東址 003房 號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(Others) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 蔡立威, 時間資訊 00:00 臨時手術NPO 08:10 進入手術室 08:15 麻醉開始 08:50 誘導結束 09:00 手術開始 09:00 抗生素給藥 12:00 抗生素給藥 14:25 手術結束 14:25 麻醉結束 14:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4~8小時 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 摘要__ 手術科部: 外科部 套用罐頭: Removal of brain tumor, frontal lobe, right-sided 開立醫師: 蔡宗良 開立時間: 2011/03/28 14:54 Pre-operative Diagnosis Brain tumor, frontal lobe, right-sided Post-operative Diagnosis Brain tumor, frontal lobe, right-sided Operative Method Removal of brain tumor, frontal lobe, right-sided Specimen Count And Types 1 piece About size:小 Source:Brain parenchyma Pathology Frozen section did not reveal any brain tumor. Operative Findings 1. Brain pia mater was diffusely yellowish in color and seemed to have diffuse hemosiderin deposit. Tumor invasion was directly visible from the surface and therefore was taken for frozen section study. A 2 cm diameter cystic lesion was located at the frontal side of the Sylvian fissure with dark-reddish fluid and hematoma clots within. The fluid content was sent for cytology study. Surrounding the cystic lesion were tissues with greenish to yellowish in color and mucinous-like. The more deeper tissues are slightly more elastic and are more yellowish than normal brain parenchyma. 2. Brain slackened 1.5 cm after brain tumor removal Operative Procedures Patient was put under ETGA and positioned in supine with head turned 80 degrees to the left after Mayfield head-clamp fixation. The scalp was routinely prepped and drapped. An inverted U-shaped scalp incision was made. A 5 x 5 cm craniotomy window was made after which tack-up sutures were performed at at 1.5 cm interval. A U-shaped durotomy was made basing at the zygomatic side. Tumor invasion was directly visible from the surface and therefore was taken for frozen section study. The tumor was removed by tumor forceps with bipoloar cautery for hemostasis. After meticulous hemostasis and Surgicel packing, the dura was closed. Skull plate was fixed back to the craniotomy window with 3 mini-plates. After placing a CWV, the wound was closed in layers. Operators VS賴達明 Assistants R5蔡宗良, R2蔡立威 賴榮德 (M,1942/06/25,69y8m) 手術日期 2011/03/28 手術主治醫師 廖漢文 手術區域 東址 000房 號 診斷 Subarachnoid hemorrhage 器械術式 TAE of AcomA anuerysm 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 王永彬 ASA 3 時間資訊 00:00 臨時手術NPO 12:10 麻醉開始 12:20 誘導結束 15:10 麻醉結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 葉雲鵬 (M,1978/09/19,33y5m) 手術日期 2011/03/28 手術主治醫師 蔡翊新 手術區域 東址 001房 03號 診斷 Epidural hemorrhage 器械術式 Left temporal ICH evacuation 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3E 紀錄醫師 彭元宏, 時間資訊 12:32 通知急診手術 13:39 進入手術室 13:39 報到 13:40 麻醉開始 13:50 誘導結束 14:23 手術開始 15:05 開始輸血 18:00 麻醉結束 18:00 手術結束 18:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦內血腫清除術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: CVA 開立醫師: 蔡翊新 開立時間: 2011/03/28 17:14 Pre-operative Diagnosis Left temporal delayed contusion ICH. Post-operative Diagnosis Left temporal delayed contusion ICH. Operative Method Left frontotemporal craniotomy for ICH evacuation. Specimen Count And Types nil Pathology Nil. Operative Findings The dura was slightly tense upon craniotomy and ICP was 15 mmHg. The brain bulged out upon dural opening, and ICP dropped to 8 mmHg. After echo localization of the hematoma, a 2.5 x 2.2 x 2.2 cm dense blood clot and a 5 x 4 x 4 cm liquified blood were evacuated. There was no active bleeder detected. The ICP became 3 mmHg after dural closure. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: left frontotemporal, curvilinear, including part of previous incision. The skin edge was clipped by Raney clips for temporary hemostasis. After scalp had been lifted, the temporalis muscle was incised and detached from temporal squama and reflected to lower temporal side. 5. Craniotomy: A 4 cm trephine was made at left frontotemporal area over-riding the left temporal lobe with its center 3 cm above extenal ear canal. 6. Dural tenting: by 2/0 silk, 1.5 cm in interval, distributed along the edge of skull window. 7. Dural incision: 3/4 circle along the trephine margin. 8. After localization of the ICH with intraoperative ultrasound, a 1.5 cm cortical incision was made at anterior part of the superior temporal gyrus, the subcortex and white mater was splitted by brain retractor and sucker until the intracerebral hematoma was exposed. The hematoma was sucked out carefully. The cavity was irrigated with NS and the blood oozing was stopped by Surgicel packing. Before closure of the dura, the hematoma cavity was clean and the brain became less bulging. 9. Dural closure: interrupted 2/0 silk sutures for key stitches, then continous sutures with 4/0 Prolene to obtain water-tight closure. 10.The trephine button was placed back and fixed with miniplates and screws 11.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Dexon and skin by continuous suture with 3/0 nylon. 12.Drain: one subgaleal CWV. 13.Blood transfusion: PRBC 4U. Blood loss: 200 ml. 14.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R4李振豪R1彭元宏 Indication Of Emergent Operation IICP, ICH about 50 ml. 彭忠信 (M,1939/08/29,72y6m) 手術日期 2011/03/28 手術主治醫師 黃鶴翔 手術區域 東址 008房 07號 診斷 Benign prostatic hypertrophy (BPH) 器械術式 T U R - P 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 脊髓麻醉 麻醉主治醫師 黃慧薰 ASA 3 紀錄醫師 黃冠棠, 時間資訊 12:15 進入手術室 12:25 麻醉開始 12:30 誘導結束 12:45 手術開始 13:45 手術結束 13:45 麻醉結束 13:50 送出病患 13:55 進入恢復室 14:58 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 經尿道攝護腺切除術-切除之攝護腺重量5至15公克 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Spinal anesthesia 1 0 記錄__ 手術科部: 泌尿部 套用罐頭: TUR-P 開立醫師: 黃冠棠 開立時間: 2011/03/28 13:57 Pre-operative Diagnosis benign prostate hyperplasia Post-operative Diagnosis benign prostate hyperplasia s/p TURP Operative Method Transurethral resection of the prostate Specimen Count And Types 1 piece About size:7 g Source:prostate Pathology pending Operative Findings 1. 7g of prostatic tissue was resected 2. bilateral lobes of the prostate kiss together 3. bladder trabeculation 4. marked intravesical growth of medial lobe of the prostate Operative Procedures Under satisfactory spinal anesthesia, the patient was placed in lithotomy position. Prepping and draping were performed in the usual sterile method. Urethral meatus stricture was noted and was dilated with Sounding to Fr 30. A Fr 27. Olympus resectoscope sheath was inserted into the urethra with adequate lubrication. Then the resectoscope was inserted. Bulbar urethral stricture was noted. Bilateral lobes of prostate were resected with cutting loop piece after piece. The chips were washed out. Hemostasis was done. A 22 Fr. 3-way Foley catheter was inserted and its balloon was inflated to 50c.c. Continuous N/S irrigation started. The patient tolerated the operation well and was sent to the recovery room with stable condition. Operators 黃鶴翔, Assistants 闕舜仁, 黃冠棠 黃靖安 (M,1979/05/17,32y9m) 手術日期 2011/03/29 手術主治醫師 曾漢民 手術區域 東址 002房 03號 診斷 Glioblastoma multiforma 器械術式 Brain biopsy (TZENG) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 08:02 通知急診手術 13:30 報到 13:43 進入手術室 13:45 麻醉開始 13:55 誘導結束 14:00 抗生素給藥 14:21 手術開始 16:00 麻醉結束 16:00 手術結束 16:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦組織活體切片 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Left parietal trephination for tumor biopsy 開立醫師: 陳睿生 開立時間: 2011/03/29 16:28 Pre-operative Diagnosis Left parietal tumor, suspect high grade glioma Post-operative Diagnosis Left parietal tumor, suspect high grade glioma Operative Method Left parietal trephination for tumor biopsy Specimen Count And Types 2 pieces About size:pieces Source:tumor About size:pieces Source:tumor Pathology Frozen section: glioma Operative Findings 1. The tumor was soft, fragile, and grayish in appearance. The margin between normal brain tissue and the tumor was not clear. Some cystic or necrotic change was noted inside the tumor under ECHO examination, but no obvious necrotic tissue was noted under frozen section. 2. Severe brain swelling after the biopsy was done and the dura was not closed. Operative Procedures After ETGA, the patient was under prone position and head fixed with Mayfield clump. Linear scalp incision was done at left parietal region. Then about 5x8 cm craniotomy window was done. Proper dura tenting was performed and then the dura was opened curvillinearly. After intra-op ECHO survey, an about 2cm small corticotomy was done. Tumor biopsy was preformed with bipolar forceps, tumor forceps and suction. The frozen section showed glioma without necrosis and tumor biopsy was pefromed again. The dura was kept open due to brain swelling and we covered the dura defect with Gelfoam. We fixed the skull with miniplate and screws. The wound was closed with 3-0 Vicryl and Appose. Operators VS 曾漢民 Assistants R6 陳睿生 R2 曾偉倫 Indication Of Emergent Operation Severe IICP for urgent tissue diagnosis 相關圖片 傅思豪 (M,1978/07/12,33y8m) 手術日期 2011/03/29 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 HIVD 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾峰毅, 時間資訊 00:00 臨時手術NPO 07:44 報到 08:07 進入手術室 08:10 麻醉開始 08:20 誘導結束 08:30 抗生素給藥 08:48 手術開始 11:10 手術結束 11:10 麻醉結束 11:15 送出病患 11:25 進入恢復室 12:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 椎間盤切除術-頸椎 1 1 手術 脊椎融合術-前融合,有固定物)≦四節 1 2 摘要__ 手術科部: 外科部 套用罐頭: Anterior Discectomy and Fusion, Cervical Spine 開立醫師: 曾峰毅 開立時間: 2011/03/29 11:14 Pre-operative Diagnosis HIVD, C5/6 Post-operative Diagnosis HIVD, C5/6 Operative Method Anterior cervical discectomy and fusion with bone cage and artificial bone graft, C5/6 Specimen Count And Types Nil Pathology Nil Operative Findings Thecal sac was decompressed well after discectomy. Syntheses cervical cage, 6 mm in height, was used with artificial bone graft, Simbone HT. Thecal sac was decompressed well after discectomy. Synthes cervical cage, 6 mm in height, was used with artificial bone graft, Simbone HT. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with neck extended. After skin scrubbed, disinfected, and then draped, we made one transverse skin incision at left anterior aspect of the neck. We dissected through platysma and along the medial border of SCM to expose prevertebral space. We coagulated the longus coli and dissected to expose C5/6 intervertebral space with C-arm confirmation. Anterior diskectomy was performed, and fusion with artificial cage and artificial bone graft was done. The wound was closed in layers. Operators VS 曾勝弘 Assistants R4 曾峰毅 單娟娟 (F,1966/02/05,46y1m) 手術日期 2011/03/29 手術主治醫師 曾勝弘 手術區域 東址 005房 02號 診斷 Back pain 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾峰毅, 時間資訊 00:00 臨時手術NPO 11:30 進入手術室 11:35 麻醉開始 11:50 誘導結束 11:55 抗生素給藥 12:15 手術開始 14:55 抗生素給藥 14:58 手術結束 14:58 麻醉結束 15:05 送出病患 15:08 進入恢復室 16:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 手術 椎間盤切除術-頸椎 1 1 手術 脊椎融合術-前融合,有固定物)≦四節 1 2 摘要__ 手術科部: 外科部 套用罐頭: Anterior Discectomy and Fusion, Cervical Spine 開立醫師: 曾峰毅 開立時間: 2011/03/29 15:01 Pre-operative Diagnosis HIVD, C5/6, C6/7 Post-operative Diagnosis HIVD, C5/6, C6/7 Operative Method Anterior Discectomy and Fusion, Cervical Spine Anterior cervical discetomy, fusion with cage and artificial bone graft, at C5/6 and C6/7 Specimen Count And Types nil Pathology Nil Operative Findings Thecal sac was decompressed well. Synthes cervical cages were used (6mm at C6/7, 8mm at C5/6). Simbone HT bone graft was used. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with neck extended. After skin scrubbed, disinfected, and then draped, we made one transverse skin incision at left anterior aspect of the neck. We dissected through platysma and along the medial border of SCM to expose prevertebral space. We coagulated the longus coli and dissected to expose C5/6 and C6/7 intervertebral space with C-arm confirmation. Anterior diskectomy was performed, and fusion with artificial cage and artificial bone graft was done. The wound was closed in layers. With endotracheal general anaesthesia, the patient was put in supine position with neck extended. After skin scrubbed, disinfected, and then draped, we made one transverse skin incision at left anterior aspect of the neck. We dissected through platysma and along the medial border of SCM to expose prevertebral space. We coagulated the longus coli and dissected to expose C5/6 and C6/7 intervertebral space with C-arm confirmation. Anterior diskectomy of C5/6 and C6/7 was performed, and fusion with cages and artificial bone graft was done. The wound was closed in layers. Operators VS 曾勝弘 Assistants R4 曾峰毅 陳睿妤 (F,2003/02/16,9y0m) 手術日期 2011/03/29 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Diabetes insipidus 器械術式 Brain tumor Crainotomy(Others) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 07:55 報到 08:05 進入手術室 08:15 麻醉開始 08:50 誘導結束 08:58 抗生素給藥 09:49 手術開始 11:58 抗生素給藥 14:58 抗生素給藥 15:25 麻醉結束 15:25 手術結束 15:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 顱底瘤手術 1 1 記錄__ 手術科部: 外科部 套用罐頭: Right frontal craniotomy and subfrontal appro... 開立醫師: 林哲光 開立時間: 2011/03/29 16:43 Pre-operative Diagnosis Stalk tumor, suspected histiocytosis X or germinoma Pituitary Stalk tumor, suspected langhan cell histiocytosis or germ cell tumor Post-operative Diagnosis Stalk tumor, suspected histiocytosis X or germinoma Pituitary Stalk tumor, suspected langhan cell histiocytosis or germ cell tumor Operative Method Right frontal craniotomy and subfrontal approach tumor biopsy Right frontal craniotomy and subfrontal approach for tumor biopsy Specimen Count And Types 1 piece About size:2mmx1mm Source:tumor Pathology Pending Operative Findings Thickening of the pituitary stalk was noted near the optic chiasm, which was hard in consistency. Part of the thickening stalk was excised for pathology. Bradycardia was noted when trying to excise further mass lesion and we decided not to perform the biopsy. Two microminiplates were applied for skull bone fixation. (miniplate was also used but removed due to a bulging thing at forehead) 1. The pituitary stalk was normal in apperance and slight thinner than normal at the its lower part neat the junction between the stalk and the pituiraty gland. It deviated and adhered to the right optic nerve. 2. The pituitary stalk was diffusely enlarged and became firm at the upper part, whihc was located just beneath the optic chiasm. We cut it longitudinally and could not get other part of differnt characters in the center of the stalk. Diffuse change of the pituitary stalk was thus confirmed. 3. Part of the thickening stalk was excised for pathology. More tissue was tended to get by traction of the upper stalk but bradycardia occured for two times. We then decided not to excise more. Operative Procedures Under ETGA and supine position with head mild rotated to left side, skin disinfected and drapped were performed as usual. Bifrontal skin incision was made and a burr hole was created at right keyhole. Right frontal craniotomy was then performed and the dura was then opened after dural tenting. The frontal lobe was then retracted to expose the optic nerve after arachnoid membrane was opened layer by layer. The optic chiasm was then identified and pituitary stalk was identified. The thickening part of the pituitary stalk was noted and a incision was made at the thikening part. The part of the thikening part was then excised and sent for pathology. After hemostasis, the dura was then closed in water-tie method with Prolene. Deair was done and the skull bone was put back and fixed with microminiplates. The wound was then closed in layers after a subgaleal drain inserted. Under ETGA and supine position the head was fixed with three-pin Mayfield skull clamp with head extended toward the horizontal plane for 45 degree. The skin was disinfected and drapped usual. Bifrontal skin incision was made and a burr hole was created at right keyhole. Right frontal craniotomy was then performed and the dura was then opened after dural tenting. The frontal lobe was then retracted to expose the optic nerve after arachnoid membrane was opened layer by layer for CSF drainage. Under microscopic view, the optic nerves and chiasm were identified and pituitary stalk was identified under the right optic nerve. The thickening part of the pituitary stalk was noted and a incision was made at the thikening part by a fine needle. It did not show different characteristic tumor tissue, so diffuse firm change was donfirmed. The lower part of the thikening stalk was then excised and sent for pathology. The specimen was only 1 mm in size and too samll for frozen section, wo we tried to get more tissue, but the stalk was retracted upward to the hypothalamus and beneath the optic chiasm. We then opened tje cistern between the right optic nerve and carotic artery to pull the tumor. It could be pull down a little but bradycardia occured two times, so we decided not to get more for the safety. After hemostasis, the dura was then closed in water-tie method with Prolene. Miniplate and miniscrews were used to fix back the skull plate, but it looked bulky on her thin skull, so we decided to remove them and used two sets of microminiplates and screw for skull bone fixation. The wound was then closed in layers after a subgaleal drain inserted. Operators AP 郭夢菲 Assistants R4 林哲光 相關圖片 張正衡 (M,1931/09/20,80y5m) 手術日期 2011/03/29 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Subarachnoid hemorrhage 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 蔡立威, 時間資訊 00:00 臨時手術NPO 08:08 進入手術室 08:10 麻醉開始 08:15 誘導結束 09:00 抗生素給藥 09:16 手術開始 10:43 手術結束 10:43 麻醉結束 10:55 送出病患 10:55 進入恢復室 12:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 創傷醫學部 套用罐頭: V-P Shunt via left side Kocher point 開立醫師: 蔡立威 開立時間: 2011/03/29 10:57 Pre-operative Diagnosis hydrocephalus Post-operative Diagnosis hydrocephalus Operative Method V-P Shunt via left side Kocher point Specimen Count And Types nil Pathology nil Operative Findings 1. CSF: clear, colorless 2. ICP: normal Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: supine with head rotated to right. 3.Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4.Incision: 4 cm linear, previous left-sided Kocher point. 5.After the scalp flap had been lifted and reflected. 6.The dura was opened by a nib incision. Lt lateral ventricle was tapped by a ventricular needle, then a 6.5 cm segment of the ventricular catheter was introduced into the ventricle. The outer end of the catheter was connected to a Codman Hakim programmable reservoir with anti-sihpon placed at the left clavicular area. 7. A nib incision was made at LUQ of the abdomen, then a trocar was pushed into peritoneal cavity. Subsequently, distal 30 cm segment of the peritoneal catheter zero pressure was introduced into the peritoneal cavity through the outer tube of the trochar. The proximal end of this catheter was passed through subcutaneous tunnel at forechest, neck, rt retroauricular area and connected the reservoir. The shunt systemwas checked to make sure its function was working. 8. Scalp closure: hemostasis was done with monopolar coagulator touching on the sucker tip. Galea suture was performed by continuous suture with 3/0. Dexon and skin by continuous suture with 3/0 nylon. 9.Course of the surgery: smooth. Operators VS賴達明 Assistants R5蔡宗良, R2蔡立威 蔡方素屏 (F,1937/06/21,74y8m) 手術日期 2011/03/29 手術主治醫師 林偉彭 手術區域 東址 022房 05號 診斷 Hydrocephalus 器械術式 Bipolar heniarthroplasty, United 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 脊髓麻醉 麻醉主治醫師 劉漢平 ASA 3 紀錄醫師 陳宣佑, 時間資訊 00:00 臨時手術NPO 13:37 報到 13:55 進入手術室 14:12 麻醉開始 14:15 誘導結束 14:15 抗生素給藥 14:58 手術開始 15:43 開始輸血 16:10 手術結束 16:10 麻醉結束 16:12 送出病患 16:15 進入恢復室 17:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Spinal anesthesia 1 0 手術 股骨頸骨折開放性復位術 1 1 R 記錄__ 手術科部: 骨科部 套用罐頭: ORIF with CHS(Richard, 3H3S, 135 degrees, 75m... 開立醫師: 陳宣佑 開立時間: 2011/03/29 16:15 Pre-operative Diagnosis Right femoral neck base fracture Post-operative Diagnosis Right femoral neck base fracture Operative Method ORIF with CHS(Richard, 3H3S, 135 degrees, 75mm lag screw) Specimen Count And Types nil Pathology nil Operative Findings Right intertrochanteric fracture Operative Procedures 1. Under ETGA, the patient was placed on the fracture table 2. Closed reduction of the fracture under C-arm 3. Scrub the operative field with iodine solution. Perform skin disinfection with alcohol-iodine. Set up draping 4. Incise along the femur on the left lateral proximal thigh 5. Apply the guide pin under C-arm 6. Perform internal fixation 135 degree CHS plate (3H3S) and 75 mm lag screw 7. Check the anatomic alignment under C-arm 8. Normal saline irrigation. Hemostasis. 9. Close the wound in layers. Dress the wound with sterile gauze. Operators 林偉彭, Assistants 陳宣佑, 姜志勇, 蔡美金 (F,1958/01/02,54y2m) 手術日期 2011/03/29 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Neck pain 器械術式 C1-2 transarticular screw fixation 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 蔡立威, 時間資訊 00:00 臨時手術NPO 11:05 進入手術室 11:10 麻醉開始 11:40 誘導結束 11:55 手術開始 12:10 抗生素給藥 15:10 抗生素給藥 15:15 手術結束 15:15 麻醉結束 15:28 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 摘要__ 手術科部: 外科部 套用罐頭: Posterior instrumentation and fusion, via lef... 開立醫師: 蔡立威 開立時間: 2011/03/29 15:33 Pre-operative Diagnosis Subluxation of C1-2 with myelopathy Post-operative Diagnosis Subluxation of C1-2 with myelopathy Operative Method Posterior instrumentation and fusion, via left-sided C1-2 transarticular screw and autograft fixation Specimen Count And Types nil Pathology None Operative Findings A 4.5 mm transarticular screw was used. Operative Procedures 1. ETGA, Mayfield fixation and prone position. 2. Reduction via extension with fluoroscopic confirmation. 3. Midline incision and periosteal dissection from C1 to C3. 4. Left-sided C1-2 facet joint was exposed 5. Screw insertion point was located at right-sided lateral mass just 1 mm above the C1-2 facet joint. 6. Horizontal trajectory was 0 degree and and verticle trajectory was aimed at anterior tubercle of C1 according to pre-OP imagery planning. 7. Autograft was harvested from posterior superior tubercle of pelvis and fixed with Ticron sutures at decorticated C1 and C2 spinous processes. 8. CWV drain was placed and wound was closed in layers. Operators VS賴達明 Assistants R5蔡宗良,R2蔡立威 楊長智 (M,1947/09/28,64y5m) 手術日期 2011/03/29 手術主治醫師 賴達明 手術區域 東址 003房 03號 診斷 Spinal stenosis, lumbar 器械術式 Laminectomy for decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 蔡立威, 時間資訊 00:00 臨時手術NPO 15:00 報到 15:45 進入手術室 15:55 麻醉開始 16:05 誘導結束 16:11 抗生素給藥 16:35 手術開始 18:25 手術結束 18:25 麻醉結束 18:30 送出病患 18:35 進入恢復室 19:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術(減壓)-二節以內 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 外科部 套用罐頭: Laminotomy for posterior decompression, L3-4 ... 開立醫師: 蔡宗良 開立時間: 2011/03/29 18:39 Pre-operative Diagnosis Lumbar spinal stenosis, L3-4 & L4-5 Post-operative Diagnosis Lumbar spinal stenosis, L3-4 & L4-5 Operative Method Laminotomy for posterior decompression, L3-4 and L4-5 Specimen Count And Types nil Pathology None Operative Findings 1. Hypertrophy of ligmentum flavum. 2. Severe stenosis of spinal canal including lateral recess. Operative Procedures 1. ETGA, prone 2. Skin routinely prepped and drapped. 3. Confirmation of L3-4 and L4-5 by fluoroscope. 4. Midline skin incision with spinal process split by high speed saw and retracted bilaterally. 5. Laminotomy was performed with roungeurs and Kerrisons punch. 6. Lateral recess was also decompressed. 7. Wound was closed in layers after gentamicin-saline irrigation. Operators VS賴達明 Assistants R5蔡宗良, R2蔡立威 鮑威 (M,1930/11/21,81y3m) 手術日期 2011/03/29 手術主治醫師 林峰盛 手術區域 西址 035房 06號 診斷 Low back pain 器械術式 Nerve block / PC 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 林峰盛 ASA 2 時間資訊 17:00 報到 17:30 進入手術室 17:32 麻醉開始 17:34 誘導結束 17:35 手術開始 17:50 麻醉結束 17:50 手術結束 17:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 硬脊膜外麻醉 1 0 R 手術 末稍神經阻斷術 1 0 R 記錄__ 手術科部: 麻醉部 套用罐頭: LENB 開立醫師: 吳峻宇 開立時間: 2011/03/29 17:55 Pre-operative Diagnosis low back pain Post-operative Diagnosis low back pain Operative Method LA with 1% xylocaine 5 ml pt in prone position 3. Under fluoroscopic-guiddance, L4-5 nerve root block with 60mg Kenaocrt in 0.5% xylocaine 10ml Specimen Count And Types Pathology Nil Operative Findings Operative Procedures LENB Operators 林峰盛 Assistants 吳峻宇 楊春菊 (F,1952/03/14,60y0m) 手術日期 2011/03/29 手術主治醫師 王國川 手術區域 東址 016房 01號 診斷 Aneurysm 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 2E 紀錄醫師 鍾文桂, 時間資訊 19:00 開始NPO 06:18 通知急診手術 07:00 報到 07:17 進入手術室 07:20 麻醉開始 07:25 誘導結束 08:00 抗生素給藥 08:24 手術開始 09:15 麻醉結束 09:15 手術結束 09:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 手術 顱內壓視置入 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Insertion of external ventricular drainage tu... 開立醫師: 鍾文桂 開立時間: 2011/03/29 09:48 Pre-operative Diagnosis Hydrocephalus. Post-operative Diagnosis Hydrocephalus. Operative Method Insertion of external ventricular drainage tube for ICP monitoring and CSF drainage. Specimen Count And Types 1 piece About size:3cc Source:CSF Pathology Nil. Operative Findings Clear pinkish CSF. Low pressure 5-10 cmH2O. Right Kocher Medtronic EVD, 7cm. Operative Procedures Under ETGA, the patient was placed in supine position and head in midline. After shaving, disinfection, and draping, the previous scalp linear incision at right Kocher point was incised and dissected. The granulation tissue at the burr hole was excised. Then, the ventricular puncture needle was inserted at right Kocher point. The EVD tube was inserted and its patency was ensured. After connecting to closed drainage system, the wound was closed in layers. Operators 王國川 Assistants R5 鍾文桂 Indication Of Emergent Operation Acute hydrocephalus. 李陳阿粉 (F,1948/07/14,63y8m) 手術日期 2011/03/29 手術主治醫師 王國川 手術區域 東址 005房 03號 診斷 Malignant neoplasm of liver, primary 器械術式 Brain tumor Crainotomy(Others) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 曾峰毅, 時間資訊 00:00 臨時手術NPO 15:31 進入手術室 15:35 麻醉開始 15:50 抗生素給藥 15:55 誘導結束 16:00 手術開始 16:45 開始輸血 18:20 手術結束 18:20 麻醉結束 18:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除-手術時間在4小時以內 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT 開立醫師: 曾峰毅 開立時間: 2011/03/29 18:41 Pre-operative Diagnosis Right parietal brain tumor, metastasis Post-operative Diagnosis Right parietal brain tumor, metastasis Operative Method Right pareiatl craniotomy for tumor excision Specimen Count And Types Several fragments of the tumor was sent for pathology. Pathology Pending Operative Findings One capsulated, intraaxial, normal-vascularized tumor was ntoed at right parietal lobe with a little adhesion to the dura. Intra-tumor bleeding was noted. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position with head fixed by Mayfield head clamp. We shaved, scrubbed, disinfected, and then draped the scalp, and made one U-shape skin incision at right pareital area. We drilled five burr holes, and created craniotomy window. We made one C-shape dura incision, and removed the tumor. After hemostasis, we performed duroplasty with autologous fascia. The bone graft was fixed back with wires. The wound was closed in layers after one subgaleal CWV. Operators VS 王國川 Assistants R4 曾峰毅 謝淑卿 (F,1954/11/11,57y4m) 手術日期 2011/03/29 手術主治醫師 王國川 手術區域 西址 039房 01號 診斷 Carpal tunnel syndrome 器械術式 Neurolysis of the uluar neuve 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 08:40 報到 09:45 進入手術室 09:58 麻醉開始 10:03 手術開始 10:30 麻醉結束 10:30 手術結束 10:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 內視鏡腕道減壓術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Carpal Tunnel Syndrome 開立醫師: 曾偉倫 開立時間: 2011/03/29 10:37 Pre-operative Diagnosis Carpal Tunnel Syndrome, left hand Post-operative Diagnosis Carpal Tunnel Syndrome, left hand Operative Method Neurolysis for Carpal Tunnel Syndrome, left hand Specimen Count And Types nil Pathology Nil. Operative Findings 1. The median nerve was compressed by flexor retinaculum 2. The pre-operative NCV was poor Operative Procedures 1.The hand and forearm were sterilized with povidone-iodine tincture, then covered with stockinet. 2.Anesthesia: tourniquet was applied at distal upper arm, then regional block with 15 ml 1% Xylocaine solution was infused through cephalic vein catheter at wrist area. 3. Incision: S shape from vertical palmar crease to transverse wrist crease. 4.The palmaris longus tendon was identified, then the plamar aponeurosis was cut longitidinally along the ulnar side of the palmaris longus tendon. 5. Themedian nerve was identified beneath the palmars longus tendon. Under direct vision, the transverse carpal ligament was divided until no more pressure on the median nerve could be palpated. 6. The skin was closed by interrupted suture with 4/0 nylon.7.The tourniquet was released. The hand and wrist were draped with fluffy dressing and elastic bandage. Operators VS 王國川 Assistants R2 曾偉倫 伍家逸 (F,1991/08/15,20y6m) 手術日期 2011/03/29 手術主治醫師 林峰盛 手術區域 西址 035房 03號 診斷 Failed back syndrome 器械術式 Nerve block / PC 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 林峰盛 ASA 1 時間資訊 13:40 報到 14:20 進入手術室 14:25 麻醉開始 14:30 誘導結束 14:38 手術開始 15:00 麻醉結束 15:00 手術結束 15:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 硬脊膜外麻醉 1 0 記錄__ 手術科部: 麻醉部 套用罐頭: LENB 開立醫師: 吳峻宇 開立時間: 2011/03/29 15:02 Pre-operative Diagnosis fail back syndrome Post-operative Diagnosis fail back syndrome Operative Method LA with 1% xylocaine 5 ml pt in prone position 3. Under fluoroscopic-guiddance, LENB by caudal cath was done to level with 16G Tuohy needle, 60mg Kenaocrt in 0.5% xylocaine 10ml Specimen Count And Types Pathology Nil Operative Findings Operative Procedures LENB Operators 林峰盛 Assistants 吳峻宇 陳正印 (M,1961/04/10,50y11m) 手術日期 2011/03/30 手術主治醫師 黃培銘 手術區域 東址 025房 04號 診斷 Intracerebral hemorrhage 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 林子富 ASA 4 紀錄醫師 蔡東明, 時間資訊 14:15 進入手術室 14:18 麻醉開始 14:20 誘導結束 14:30 手術開始 14:55 手術結束 14:55 麻醉結束 15:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 氣管切開術 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 蔡東明 開立時間: 2011/03/30 15:05 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types nil Pathology None Operative Findings Fr . 8 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators VS黃培銘 Assistants R4蔡東明 R1全賀顯 莊文輝 (M,1954/05/27,57y9m) 手術日期 2011/03/30 手術主治醫師 曾漢民 手術區域 東址 001房 03號 診斷 Meningioma 器械術式 V-P shunt 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 曾峰毅, 時間資訊 10:26 通知急診手術 12:15 進入手術室 12:20 麻醉開始 12:22 誘導結束 13:00 手術開始 13:50 手術結束 13:50 麻醉結束 13:55 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室腹腔分流手術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt, right Kocher 開立醫師: 曾峰毅 開立時間: 2011/03/30 13:46 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunt, right Kocher Specimen Count And Types CSF was sent for routine, culture, and BCS. Pathology Nil Operative Findings Opening pressure of ventriculostomy was about 10-15 cmH20. Codman, programmable, shunt was used (set at 100 mmH20). Xanthochromic CSF was drained while ventriculostomy. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to left. After scalp shave, scrubbed, disinfected, and then draped, we made one transverse skin incision at right upper abdomen, and created mini-laparotomy. We created subcutaneous tunnel to right occipital area. We made on curvilinear skin incision at right frontal area, and drilled one burr hole. After durotomy and dura tenting, ventriculostomy was performed once, and then ventricular catheter was inserted. We connected shunt altogether, and checked the function. The wound was closed in layers. Operators VS 曾漢民 Assistants R4 李振豪 R4 曾峰毅 Indication Of Emergent Operation IICP 相關圖片 錢彩蓮 (F,1957/10/31,54y4m) 手術日期 2011/03/30 手術主治醫師 曾漢民 手術區域 東址 005房 03號 診斷 Pituitary tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾偉倫, 鍾文桂, 時間資訊 00:00 臨時手術NPO 13:30 報到 13:37 進入手術室 13:47 麻醉開始 14:00 抗生素給藥 14:10 誘導結束 14:35 手術開始 15:52 麻醉結束 15:52 手術結束 16:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 經由蝶竇之腦下垂體瘤切除 1 1 摘要__ 手術科部: 外科部 套用罐頭: Trans-sphnoid adenomectomy 開立醫師: 曾偉倫 開立時間: 2011/03/30 16:11 Pre-operative Diagnosis Pituitary macroadenoma Post-operative Diagnosis Pituitary macroadenoma Operative Method Trans-sphnoid adenomectomy Specimen Count And Types 1 piece About size:0.5x0.5x0.5 cm Source:pituitary tumor Pathology Pending Operative Findings 1. The tumor was whit-yellowish, soft, size 2x1x1 cm in diameter. The normal gland was found intact after tumor excision. 2. CSF leakage due to incidental durotomy was sealed with Tissuecol Duo, Floseal, nasal mucosa, and gelform packing. Operative Procedures Under general anethesia and intubation, the patient was put in supine position with head tilted 30 degree to left. The facial skin was antiseptic with alcohol better-iodine tincture, and the mucosa of oral and nasal cavity with aqueous better-iodine . The formerareas were covered by sterilized adhesive plastic sheets then draped. Under endoscope, the nasal mucosa was coagulated at right norstril. A nasal speculum was applied to displace the nasal mucosa laterally and keep thenasal cavity open constantly for the exposure of the vomer bone and the anterior wall of the sphenoid sinus. The anterior sphenoid wall and posterior sphenoid wall was remove by high speed air drill and Kerrison punch. The sellar floor durawas coagulated then opened in cruciate fashion. The soft tumor parenchyma was removed by curette and aligator. The CSF leakage was sealed with Tissuecol Duo, floseal and gelform packing. The arachnoid and the opening of diaphragm sellae was enforced by packing with gelform as in the sellar cavity. The nasal mucosa returned to its normal position. Right side of the nasal cavities was tightly packed with a segment of rubber glove finger filled with vaseline gauze strips which had been soaked with better-iodine ointment. Operators VS 曾漢民 Assistants R5 鍾文桂 R2 曾偉倫 相關圖片 蔡正安 (M,1942/12/16,69y2m) 手術日期 2011/03/30 手術主治醫師 蔡瑞章 手術區域 東址 001房 04號 診斷 Spinal metastasis 器械術式 Spinal fusion posterior 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 蔡宗良, 時間資訊 08:30 臨時手術NPO 08:30 開始NPO 10:45 通知急診手術 14:12 進入手術室 14:35 麻醉開始 14:55 誘導結束 15:00 抗生素給藥 15:31 手術開始 16:42 開始輸血 18:00 抗生素給藥 21:10 手術結束 21:10 麻醉結束 21:20 送出病患 21:24 進入恢復室 23:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 惡性脊髓腫瘤切除術 1 1 手術 脊椎融合術-後融合,有固定物(<=六節) 1 2 手術 脊椎融合術-後融合,有固定物(每增加<=六節) 1 2 摘要__ 手術科部: 外科部 套用罐頭: 1. Removal of intraspinal tumor, T7 and T10 開立醫師: 蔡宗良 開立時間: 2011/03/30 21:52 Pre-operative Diagnosis Metastatic epidural spinal cord compression, T7 and T10 Post-operative Diagnosis Metastatic epidural spinal cord compression, T7 and T10 Operative Method 1. Removal of intraspinal tumor, T7 and T10 2. Posterior decompression, laminectomy of T7 and T10 3. Posterolateral fusion, transpedicular screws T6, T8, T9, T11 and T12 and rod fixation with cross-link x2 Specimen Count And Types 1 piece About size:小 Source:epidural space Pathology Report pending Operative Findings 1. Epidural mass with spinal cord compression at T7 and T10. 2. Tumor was grey in color and vascularity is high. 3. Lamina of T7 and T10 were partially necrotic, indicating tumor invasion. Operative Procedures 1. ETGA, prone postion 2. Fluoroscopic confirmation of planned levels. 3. Routinely prepped and drapped. 4. Linear wound incision from T6 to T12, followed by periosteal dissssection. 5. Transpedicular screw insertion with fluoroscopic confirmation. 6. Laminectomy and tumor removal of T7 and T10. 7. Rod fixation after bending in lordosis angle. 8. Crosslink fixation at T7 and T10 level. 9. Copious saline irrigation with 2 amp of gentamicin. 10. Hemovac was placed at bilateral gutters. 11. Wound was closed in layers. Operators VS 蔡瑞章 Assistants R5 蔡宗良, R4 曾峰益 Indication Of Emergent Operation 傅邦正 (M,1962/12/27,49y2m) 手術日期 2011/03/30 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Acute leukemia of unspecified cell type 器械術式 Ommaya reservoir implantation 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾偉倫, 鍾文桂, 時間資訊 00:00 臨時手術NPO 08:27 報到 08:30 進入手術室 08:35 麻醉開始 08:40 誘導結束 08:55 抗生素給藥 09:25 手術開始 10:30 手術結束 10:30 麻醉結束 10:37 送出病患 10:40 進入恢復室 11:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 歐氏貯囊置放手術 1 1 R 摘要__ 手術科部: 內科部 套用罐頭: Ommaya reservoir implantation, right Kocher. 開立醫師: 鍾文桂 開立時間: 2011/03/30 10:26 Pre-operative Diagnosis Adult T-cell lymphoma with CNS involvement. Post-operative Diagnosis Adult T-cell lymphoma with CNS involvement. Operative Method Ommaya reservoir implantation, right Kocher. Specimen Count And Types 1 piece About size:3CC Source:CSF, routine, culture, BCS. Pathology Nil. Operative Findings Low intracranial pressure: 0-2cmH2O. Clear light yellowish-pinkish CSF. Multiple puncture was done due to small ventricular size and low pressure. Medtronic Ommaya reservoir: 7cm. Operative Procedures Under ETGA, the patient was placed in supine position and the head was placed in midline position. After shaving, disinfection, and draping,a curvilinear scalp incision was made at right Kocher point. The Under ETGA, the patient was placed in supine position and the head was placed in midline position. After shaving, disinfection, and draping,a curvilinear scalp incision was made at right Kocher point.After dissection a burr hole was created. Durotomy was done in cruciate fashion. With a small corticotomy, the ventricular puncture needle was inserted at right Kocher point. Then, the Ommaya reservoir was implanted through the same tract. After ensuring the reservoirs patency, the wound was closed in layers. Operators 曾勝弘 Assistants 鍾文桂 曾偉倫 相關圖片 記錄__ 手術科部: 內科部 套用罐頭: Ommaya reservoir implantation, right Kocher. 開立醫師: 鍾文桂 開立時間: 2011/03/30 10:32 Pre-operative Diagnosis Adult T-cell lymphoma with CNS involvement. Post-operative Diagnosis Adult T-cell lymphoma with CNS involvement. Operative Method Ommaya reservoir implantation, right Kocher. Specimen Count And Types 1 piece About size:3CC Source:CSF, routine, culture, BCS. Pathology Nil. Operative Findings Low intracranial pressure: 0-2cmH2O. Clear light yellowish-pinkish CSF. Multiple puncture was done due to small ventricular size and low pressure. Medtronic Ommaya reservoir: 7cm. Operative Procedures Under ETGA, the patient was placed in supine position and the head was placed in midline position. After shaving, disinfection, and draping,a curvilinear scalp incision was made at right Kocher point.After dissection a burr hole was created. Durotomy was done in cruciate fashion. With a small corticotomy, the ventricular puncture needle was inserted at right Kocher point. Then, the Ommaya reservoir was implanted through the same tract. After ensuring the reservoirs patency, the wound was closed in layers. Operators 曾勝弘 Assistants 鍾文桂 曾偉倫 相關圖片 摘要__ 手術科部: 內科部 套用罐頭: Ommaya reservoir implantation, right Kocher. 開立醫師: 鍾文桂 開立時間: 2011/03/30 10:32 Pre-operative Diagnosis Adult T-cell lymphoma with CNS involvement. Post-operative Diagnosis Adult T-cell lymphoma with CNS involvement. Operative Method Ommaya reservoir implantation, right Kocher. Specimen Count And Types 1 piece About size:3CC Source:CSF, routine, culture, BCS. Pathology Nil. Operative Findings Low intracranial pressure: 0-2cmH2O. Clear light yellowish-pinkish CSF. Multiple puncture was done due to small ventricular size and low pressure. Medtronic Ommaya reservoir: 7cm. Operative Procedures Under ETGA, the patient was placed in supine position and the head was placed in midline position. After shaving, disinfection, and draping,a curvilinear scalp incision was made at right Kocher point.After dissection a burr hole was created. Durotomy was done in cruciate fashion. With a small corticotomy, the ventricular puncture needle was inserted at right Kocher point. Then, the Ommaya reservoir was implanted through the same tract. After ensuring the reservoirs patency, the wound was closed in layers. Operators 曾勝弘 Assistants 鍾文桂 曾偉倫 相關圖片 詹文宏 (M,1956/08/23,55y6m) 手術日期 2011/03/30 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Brain tumor 器械術式 Crainotomy Brain Tumor(P-LIN) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 08:03 進入手術室 08:10 麻醉開始 09:00 誘導結束 09:12 手術開始 09:20 抗生素給藥 12:20 抗生素給藥 13:23 手術結束 13:23 麻醉結束 13:26 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4~8小時 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for Simpson grade 2 tumor removal 開立醫師: 王奐之 開立時間: 2011/03/30 13:57 Pre-operative Diagnosis Right posterior falx meningioma Post-operative Diagnosis Right posterior falx meningioma Operative Method Craniotomy for Simpson grade 2 tumor removal Specimen Count And Types 1 piece About size:3*4*3cm Source:right parietal tumor Pathology Pending Operative Findings Whitish elastic tumor was removed in pieces, the tumor did not attach to the overlying convexity dura but adhered to the falx tightly. A small portion of superior sagittal sinus was invaded. Operative Procedures After ETGA, the patient was placed in prone position. After scalp shaving, disinfection & draping in sterile fashion, a reverse V-shaped skin incision was made. 4 burr holes were made, followed by craniotomy creation. An U-shaped durotomy was then done and the dura was reflected medially, exposing the tumor. The tumor was dissected from the surrounding parenchyma and removed in pieces, with the tumor capsule removed completely. A small portion of tumor that invaded the superior sagittal sinus was also removed. The attaching falx was electrocauterized thoroughly. After meticulous hemostasis, the dura was closed with periosteal graft in water fashion by 4-0 Prolene. After central tenting and setting 1 subgaleal CWV drain, the wound was closed with 2-0 Vicryl & 3-0 Nylon. Operators VS 賴達明 Assistants R6 陳睿生, R3 王奐之 相關圖片 余玉萍 (F,1980/10/14,31y5m) 手術日期 2011/03/31 手術主治醫師 賴達明 手術區域 東址 005房 01號 診斷 Head Injury 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 2 紀錄醫師 曾峰毅, 時間資訊 00:00 臨時手術NPO 08:06 進入手術室 08:10 麻醉開始 08:20 誘導結束 08:42 抗生素給藥 09:12 手術開始 11:42 抗生素給藥 12:18 開始輸血 12:55 手術結束 12:55 麻醉結束 13:08 送出病患 13:10 進入恢復室 14:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎弓切除術(減壓)-超過二節 1 2 摘要__ 手術科部: 外科部 套用罐頭: C5-7 laimectomy for posterior decompression; ... 開立醫師: 曾峰毅 開立時間: 2011/03/31 13:15 Pre-operative Diagnosis Fracture dislocation, T5-7 Post-operative Diagnosis Fracture dislocation, T5-7 Operative Method C5-7 laimectomy for posterior decompression; transpedicular screw insertion at bilateral pedicles of T4, T5, T7, and T8 for posterior fixation; posterolateral fusion with autologous and artificial bone graft T4-8 Specimen Count And Types nil Pathology Nil Operative Findings Fracture dislocation was noted at T5/6, causing spine angulation. Thecal sac was decompressed well after T5-7 laminectomy. A-spine, transpedicular screws, 5.0 x 30 mm, were inserted at bilateral pedicles of T4 and T5; 5.5x 35 mm at T7 and T8. Simbone HT were used for posterolateral fusion. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position. After back scrubbed, disinfected, and then draped, we made one midline skin incison form spinous processes of T3 to T9. We dissected paraspinal muscles, and inserted transpedicular screws into bilateral pedicles of T4, T5, T7, and T8. Laminectomy of T5-6 was done for decompression. Two 13 cm rods with one crosslink were used for posterior fixation. Posterolateral fusion was performed with artificial and autologous bone graft. After two submuscular hemovac inserted, the wound was closed in layers. Operators VS 賴達民 VS 蕭輔仁 Assistants R4 曾峰毅 楊春菊 (F,1952/03/14,60y0m) 手術日期 2011/03/31 手術主治醫師 廖漢文 手術區域 東址 000房 號 診斷 Aneurysm 器械術式 TAE for right ACA aneurysm 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 2 時間資訊 00:00 臨時手術NPO 09:15 麻醉開始 09:25 誘導結束 11:05 麻醉結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 陳文明 (M,1959/03/15,52y11m) 手術日期 2011/03/31 手術主治醫師 王國川 手術區域 東址 002房 08號 診斷 Brain metastasis 器械術式 left occipital craniotomy for ICH removal 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 4E 紀錄醫師 蔡宗良, 時間資訊 23:00 臨時手術NPO 23:00 開始NPO 00:04 通知急診手術 00:28 報到 00:35 進入手術室 00:40 麻醉開始 00:55 誘導結束 01:00 抗生素給藥 01:10 手術開始 01:36 開始輸血 02:22 手術結束 02:55 麻醉結束 03:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦內血腫清除術 1 1 L 手術 顱內壓視置入 1 2 L 摘要__ 手術科部: 外科部 套用罐頭: 1. Craniotomy for removal of intracerebral he... 開立醫師: 蔡宗良 開立時間: 2011/03/31 03:19 Pre-operative Diagnosis Intracerebral hemorrhage, occipital lobe, left-sided Post-operative Diagnosis Intracerebral hemorrhage, occipital lobe, left-sided Operative Method 1. Craniotomy for removal of intracerebral hemorrhage 2. Intracranial pressure monitoring Specimen Count And Types 1 piece About size:小 Source:Brain Pathology Report pending Operative Findings 1. Increased intracranial pressure; tense dura. 2. Approximately 50 mL ICH was removed. 3. A bleeder located behind a residual HCC tumor was noted and coagulated. Operative Procedures 1. ETGA, Mayfield head-clamp, prone position. 2. Scalp routinely prepped and drapped. 3. Skin incision on previous wound. 4. Wire removed to mobilize skull plate. 5. Dura was opened. 6. Remove ICH. 7. Surgicel and Gelfoam packing. 8. Check bleeding. 9. Subdural ICP probe placement. 10. Skull plate returned to previous craniotomy window. 11. CWV drain placed subgaleal. 12. Wound closed in layers. Operators VS 王國川 Assistants R5 蔡宗良, R2 覃紹殷 Indication Of Emergent Operation Increased intracranial pressure. 李白燕 (F,1926/07/10,85y8m) 手術日期 2011/03/31 手術主治醫師 王國川 手術區域 東址 009房 05號 診斷 Head Injury 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 4E 紀錄醫師 蔡宗良, 時間資訊 00:00 開始NPO 00:00 臨時手術NPO 11:36 通知急診手術 12:30 報到 12:30 進入手術室 12:40 麻醉開始 12:48 抗生素給藥 13:10 誘導結束 13:30 手術開始 13:48 開始輸血 17:00 麻醉結束 17:00 手術結束 17:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 1 R 手術 顱內壓視置入 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: 1. Removal of intracerebral hemorrhage, front... 開立醫師: 蔡宗良 開立時間: 2011/04/02 21:28 Pre-operative Diagnosis Contusional brain hemorrhage, bilateral frontal base Post-operative Diagnosis Contusional brain hemorrhage, bilateral frontal base Operative Method 1. Removal of intracerebral hemorrhage, frontal base, left-sided 2. Decompressive craniectomy, left-sided, fronto-temporal 3. Intracranial pressure monitoring, subdural, left-sided Specimen Count And Types nil Pathology None Operative Findings 1. Approximately 100 mL intracerebral hemorrhage clot evacuated from frontal base. 2. Brain slackened 1 cm from dura after clot removal. 3. Intracranial pressure upon scalp closure = 2 mmHg. Operative Procedures 1. ETGA, head rotatated to the right. 2. Routinely prepped and drapped. 3. Trauma flap wound incision. 4. U shaped durotomy. 5. ICH removal. 6. Duroplasty. 7. ICP monitor installation. 8. Two CWV drain placement. 9. Wound closed in layers. Operators VS 王國川, VS 蔡翊新 Assistants R5 蔡宗良 Indication Of Emergent Operation INCREASED INTRACRANIAL PRESSURE 黃久珊 (F,1978/07/23,33y7m) 手術日期 2011/03/31 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Glioma 器械術式 Crainotomy Brain Tumor(P-LIN) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 08:06 進入手術室 08:15 麻醉開始 08:45 誘導結束 09:05 抗生素給藥 09:13 手術開始 12:05 抗生素給藥 15:10 抗生素給藥 16:15 手術結束 16:15 麻醉結束 16:23 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 8 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 手術 腦瘤切除-手術時間在4~8小時 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Left frontal craniotomy for tumor excision 開立醫師: 李振豪 開立時間: 2011/03/31 16:44 Pre-operative Diagnosis Left frontal tumor, suspect high grade glioma Post-operative Diagnosis Left frontal high grade glioma Operative Method Left frontal craniotomy for tumor excision Specimen Count And Types 1 piece About size:6 x 4 x 5 cm Source:Left frontal glioma Pathology Frozen section: high grade glioma, favor grade III Operative Findings The high grade part of the tumor was graish and yellowish in color, elastic to firm, hypervascularized, and ill-defined. The low grade part was slightly yellowish in color and soft in character. The high grade part was mainly around the cystic part and frontal base. Intra-operative sonography was used for identified the border of the tumor. The lateral ventricle was not entered during the operation. Awake surgery was tried but failed due to persisted lethargy of the patient. Nasal intubation was performed after we gave up the awake surgery. The high grade part was removed totally but some part of the low grade gumor was left in situ for preservation of the language function. Operative Procedures Under intravenous general anesthesia, the patient was put in supine position with head fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. Bicoronal scalp incision was made and the scalp flap was elevated. Two burr hole was created followed by one 6x6cm craniotomy window. Dural tenting was performed along the edge of the craniotomy window. C shape durotomy was performed. The location of the tumor and cystic part was identified by intra-operative sonography. Cystic part of the tumor was opened for swelling of the brain. The Propofol infusion was stopped but the patient was lethargy even after more than one and half hour later. Under the consideration of the patient safely, nasal intubation was performed under broncoscopy-guided and general anesthesia was applied again. The tumor excision was performed with bipolar electrocautery and sucker under echo guided. Frozen section was sent and the result confirmed the diagnosis of high grade glioma. Hemostasis was achieved with bipolar electrocautery and Surgicel lining. The dura was closed with 4-0 Prolene. The skull plate was fixed back with miniplate and screws. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon after placing one subgaleal CWV drain. Operators VS王國川 Assistants R4李振豪 相關圖片 黃葉德 (M,1951/06/12,60y9m) 手術日期 2011/03/31 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 Hydrocephalus 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 16:37 進入手術室 16:42 麻醉開始 16:47 誘導結束 16:50 抗生素給藥 17:22 手術開始 18:00 手術結束 18:00 麻醉結束 18:06 送出病患 18:09 進入恢復室 19:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Glucose 1 0 摘要__ 手術科部: 外科部 套用罐頭: Ventriculo-peritoneal shunt implantation via ... 開立醫師: 李振豪 開立時間: 2011/03/31 18:10 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculo-peritoneal shunt implantation via right Kocher"s point Specimen Count And Types nil Pathology Nil Operative Findings The CSF was clear in character without increase in viscousity. The opening pressure was more than 15cmH2O. The ventricular wall was hard. The Codman programmable valve reservoir was implanted with initial pressure setting as 12cmH2O. The ventricular and peritoneal catheter was 7 and 30cm in length respectively. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head rotated to left. The scalp was shaved, scrubbed, and disinfected as usual. The 4cm linear scalp incision was made at right frontal area followed by one burr hole creation. Two dural tenting was done. Right upper abdomen transverse skin incision was made and the minilaparotomy was performed to enter the peritoneal cavity. The subcutaneous tunnel from right abdomen, forechest, neck, and retroauricular area was created. One 1.5cm scalp incision was made at right retroauricular area. The peritoneal catheter was introduced through the subcutaneous tunnel. The ventricular catheter and peritoneal catheter was connected to set up the shunt. Cruciform durotomy was performed and right lateral ventricle was punctured with ventricular needle. The ventricular catheter was placed into right lateral ventricle. The function of the shunt was checked. CSF was sampled for study. The peritoneal catheter was placed into peritoneal cavity under direct vision. Hemostasis was achieved. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS王國川 Assistants R4李振豪, Ri曾亮瑋 相關圖片 黃坤明 (M,1967/07/12,44y8m) 手術日期 2011/03/31 手術主治醫師 王國川 手術區域 東址 005房 03號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(Others) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 2 紀錄醫師 曾峰毅, 時間資訊 00:00 臨時手術NPO 13:18 進入手術室 13:20 麻醉開始 14:00 誘導結束 14:10 抗生素給藥 14:10 手術開始 18:05 手術結束 18:05 麻醉結束 18:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT 開立醫師: 曾峰毅 開立時間: 2011/03/31 18:25 Pre-operative Diagnosis Left convexity meningioma Post-operative Diagnosis Left convexity meningioma Operative Method Left frontoparietal craniotomy for tumor exicision, Simpson grade I Specimen Count And Types Several fragments of one tumor was sent for pathology. Pathology Pending Operative Findings One extraaxial dura-based, firm to elastic, well-capsulated, about 6-7cm, tumor located at left frontoparietal region. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head fixed in Mayfield head clamp. After scalp shaved, scrubbed, disinfected, and then draped, we made one U-shape skin incision at left frontopareital area. We drilled for burr holes, and then created craniotomy. We made dura incision around the tumor base, and dissected the arachnoid membrane plane around the tumor. The dura was closed in water-tight fahsion, and bone graft was fixed back with wires. The wound was closed in layers after CWV insertion. Operators VS 王國川 Assistants R4 曾峰毅 黃金坤 (M,1937/03/04,75y0m) 手術日期 2011/03/31 手術主治醫師 吳耀銘 手術區域 東址 013房 02號 診斷 Gall bladder stone and Common bile duct stone with acute and chronic cholecystitis with obstruction 器械術式 Cholecystectomy 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 林珍榮 ASA 4 紀錄醫師 何奕瑢, 時間資訊 11:52 報到 12:08 進入手術室 12:10 麻醉開始 12:30 誘導結束 12:45 抗生素給藥 12:51 手術開始 14:40 麻醉結束 14:40 手術結束 14:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 膽囊切除術 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 套用罐頭: Cholecystectomy (Open approach) 開立醫師: 鄭宗杰 開立時間: 2011/03/31 14:28 Pre-operative Diagnosis Chronic cholecystitis Post-operative Diagnosis Chronic cholecystitis Operative Method Cholecystectomy (Open approach) Specimen Count And Types Gall bladder, 6 x 3 x 1.5 cm Pathology Pending Operative Findings 1.Mild cirrhotic change of liver parenchyma 2.Severe adhesion around subhepatic space, the proximal T-colon was also adhesed tightly to the gall bladder 3.Contracted gall bladder, with thickened gall bladder wall, and filled with turbid bile within it. Operative Procedures 1.ETGA, supine, skin sterize 2.Right subcostal laparotomy 3.Adhesiolysis, divide mesocolon and T-colon away from gall bladder 4.Retrograde cholecystectomy: divide gall bladder from liver bed first, then double ligate the cystic duct and artery by silk tie 5.N/S irrigation, check bleeding 6.Set one rubber drain tube at subphepatic area 7.Wound closure Operators VS吳耀銘 Assistants R5鄭宗杰, R1何奕瑢, Ri王怡人 相關圖片 KITAMURA HARUMASA (M,1948/04/08,63y11m) 手術日期 2011/04/01 手術主治醫師 黃培銘 手術區域 東址 002房 01號 診斷 Subarachnoid hemorrhage 器械術式 Tracheostomy 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 鄒冠全, 時間資訊 14:50 通知急診手術 23:59 開始NPO 23:59 臨時手術NPO 08:25 進入手術室 08:30 麻醉開始 08:35 誘導結束 08:50 手術開始 09:00 手術結束 09:00 麻醉結束 09:06 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 氣管切開術 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 鄒冠全 開立時間: 2011/04/01 09:09 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types nil Pathology None Operative Findings Fr . 7, 8 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators 黃培銘 Assistants R3鄒冠全,Ri Indication Of Emergent Operation 王黃麗惠 (F,1936/02/05,76y1m) 手術日期 2011/04/01 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Brain tumors, malignant 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:15 麻醉開始 08:40 誘導結束 09:25 抗生素給藥 09:30 手術開始 12:15 抗生素給藥 15:40 手術結束 15:40 麻醉結束 15:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 C.V.P. catheter in ubation 1 0 手術 腦瘤切除-手術時間在4~8小時 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 7 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: Left pterional approach for tumor excision 開立醫師: 游健生 開立時間: 2011/04/01 16:08 Pre-operative Diagnosis 1. Left temporal lobe tumors, suspect metastasis 2. Left petrous-clival tumor, favor meningioma 2. Left tentorial tumor, favor meningioma Post-operative Diagnosis 1. Left temporal lobe tumors, suspect metastasis 2. Left petrous-clival tumor, favor meningioma 2. Left tentorial tumor, favor meningioma Operative Method Left pterional approach for tumor excision Specimen Count And Types 2 pieces About size: A. 1 x 1 x 1cm B. 2 x 2.5 x 2cm Source: A. left temporal tip tumor B. Left mesial temporal tumor Pathology Pending Operative Findings A greyish purple soft tumor was noted at anterolateral surface of left temporal tip with moderate vascularity. Tumor size: 1.2 x 1.5 x 1.6cm. The tumor had a clear margin and there was a glotic plane between tumor and normal brain parenchyma. Another greyish purple soft tumor was noted at inferomedial surface of left temporal tip with moderate vascularity. Tumor size: 2.4 x 2.8 x 1.8cm. There was also a gliotic plane between tumor and normal brain parenchyma. The third tumor was found beneath tentorial edge. It was pink and elastic. Trochear nerve lay over the tumor and was flattened by the tumor. Simpson grade IV tumor excision was achieved. Operative Procedures Under ETGA, patient was in supine position with head rotated to right and left shoulder elevated. Neck was mildly extended and head fixed with headclamp. After shaving, we disinfected and draped the operation field as usual. A S-shape scalp incision was made from anterior to tragus extending across midline along hairline. Skin flap was elevated with facial nerve preservation and reflected anteriorly. The temporal muscle was elevated and reflected inferiorly with a muscle cuff at cranium. After 3 burrhole creation, a fronto-temporal craniotomy was done followed by removal of outer third sphenoid ridge. After dural tenting along craniotomy border, a T-shape durotomy was done as figure. After opeing proximal Sylvian fissure, a tumor was noted at left temporal tip. It was totally removed in piecemeal along the glotic plane between normal brain parenchyma and tumor. The temporal tip was retracted for examination of inferomedial surface and another tumor was found. It was totally removed in piecemeal with CUSA. After we directed our view more posteriorly, the third tumor was identified beneath the tentorial edge. The trochear nerve lay over the tumor and was flattened by it. Part of the tumor was moreved by CUSA. Trochear nerve was severed and both ends were approximated and fixed by Tissucol-Duo. Hemostasis was achieved by bipolar electrocautery and Surgicel packing. Dura was closed with 4-0 prolene continous suture. Bone flap was fixed back with mini-plates. Temporal bone defect was repaired by bone cement. Wound was closed in layers after placement of a CWV drain under temporalis muscle. Operators Prof. 杜永光 Assistants R6 陳睿生 R3 游健生 黃文麗 (F,1969/07/08,42y8m) 手術日期 2011/04/01 手術主治醫師 杜永光 手術區域 東址 003房 02號 診斷 Malignant neoplasm of temporal lobe 器械術式 Brain biopsy (Others) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 15:30 報到 16:03 進入手術室 16:10 麻醉開始 16:25 誘導結束 16:30 抗生素給藥 16:37 手術開始 18:50 麻醉結束 18:50 手術結束 19:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦組織活體切片 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: Trephination for tumor biopsy, right parietal 開立醫師: 游健生 開立時間: 2011/04/01 19:13 Pre-operative Diagnosis Diffuse right parietal to posterior frontal lobe tumor, suspect low-grade glioma Post-operative Diagnosis Diffuse right parietal to posterior frontal lobe tumor, suspect high-grade glioma Operative Method Trephination for tumor biopsy, right parietal Specimen Count And Types a few pieces About size: 0.5x 0.3 x0.2cm Source:Right parietal tumor Pathology pending Operative Findings Severe brain swelling was noted and some brain tissue protuded out after durotomy. The protuding brain tissue surface was whitish-grey and gelatin-like to hard consistence which we suspected to be part of the tumor. Some was biopsied and sent for frozen section and pathology study. Frozen section: high-grade glioma Operative Procedures Under ETGA, patient was in prone position with head fixed by headclamp. After shaving, we disinfected and draped the operation field as usual. We localized the tumor according to MRI. A paramedian scalp incision was made 2.5cm right to midline. Scalp was retracted and cranium exposed. A trephination, 5cm in diameter, was made followed by dura tenting. A U-shape durotomy was done. We excised some tumor tissue for frozen section and pathology study. After frozen section confirmed malignacy, we placed a Gelfoam over brain surface and closed the dura by interrupted suture. Bone flap was fixed back with mini-plates. Wound was closed in layers. Operators Prof. 杜永光 Assistants R6陳睿生 R3游健生 李正勇 (M,1939/02/23,73y0m) 手術日期 2011/04/01 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Brain tumor 器械術式 awake surgery, left temporal tumor 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 07:30 報到 08:06 進入手術室 08:25 麻醉開始 08:35 誘導結束 08:53 抗生素給藥 08:59 手術開始 11:53 抗生素給藥 13:35 麻醉結束 13:35 手術結束 13:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 手術 立體定位術-切片 1 2 L 摘要__ 手術科部: 外科部 套用罐頭: Parieto-temporal craniotomy for tumor excision 開立醫師: 陳國瑋 開立時間: 2011/04/01 21:01 Pre-operative Diagnosis Left parietal brain tumor, suspect high grade glioma or metastasis. Post-operative Diagnosis Left parietal high grade glioma. Operative Method Parieto-temporal craniotomy for tumor excision Specimen Count And Types 1 piece About size: Source: Pathology Frozen section suspect high grade glioma. Operative Findings 1. Grayish-pink tumor with calcification and moderate vascularity at left parieto-tempotal region. 2. Intraoperative navigation and ultrasoography were used for tumor localization. 3. Intravenous anesthesia with propofol was used. The patient was awake for functional monitoring. Naming of numbers and photos were used while stimulating the operative area. No disturbance of naming was noted. Operative Procedures The patient was put in supine position with left shoulder elevated. The head was fixed by Mayfield. After setting the navigation, skin incision of an U shape was made at parieto-tempotal region. Craniotomy and dural incision were done. MRI navigation and ultrosonography was used to identify the tumor. The patient was awakened. After checking the elequent area. Corticortomy was done and tumor was removed in piece-meal fasion. After well hemostasis, the dura was closed in water-tied fasion, and the wound was closed in layers. Operators VS 曾漢民 Assistants R6 鍾文桂 R2 陳國瑋 相關圖片 劉運財 (M,1965/02/06,47y1m) 手術日期 2011/04/01 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 14:06 進入手術室 14:10 麻醉開始 14:24 抗生素給藥 14:35 誘導結束 14:50 手術開始 17:24 抗生素給藥 17:25 手術結束 17:25 麻醉結束 17:35 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 手術 腦瘤切除-手術時間在4小時以內 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Left retrosigmoid approach for subtotal tumor... 開立醫師: 鍾文桂 開立時間: 2011/04/01 18:08 Pre-operative Diagnosis Left acoustic neuroma. Post-operative Diagnosis Left acoustic neuroma. Operative Method Left retrosigmoid approach for subtotal tumor excision. Specimen Count And Types Multiple small pieces. Pathology Pending. Operative Findings 1. A tortous AICA overlying the tumor was noted. It disturbs tumor resection. It was intact during tumor resection. 2. The tumor was whitish, encapsulated, mild vascularized. The tumor was resected about half of its volume. The brainstem part of the tumor was free and does not compress the brainstem. The CN VII/VIII complex was not identified during tumor resection. 3. A bridging vein to the sigmoid sinus caused moderate oozing. The bleeding was ceased after Gelfoam packing. Operative Procedures Under ETGA, the patient was placed in 3/4 prone position and the head was fixed by Mayfield.After shaving, disinfection, and draping, a linear scalp incision was made 3 cm posterior to the external acoustic meatus. After dissection and craniotomy, the border of transverse and sigmoid sinus were identified. After a T-shpae durotomy, the CSF from cisterna magnum, the cerebellar hemisphere was retracted posteriorly. Then, the tortoused AICA was lysed from the surrounding arachnoid band partially. The tumor was resected in piece-meal fashion. After well hemostasis, the dura mater was repaired with fascia graft. The craniotomy plate was fixed by miniplates and screws. The wound was closed in layers with one subgaleal drain. Operators VS 曾漢民 Assistants R5鍾文桂 R2陳國瑋 相關圖片 阮姝睿 (F,2001/05/30,10y9m) 手術日期 2011/04/01 手術主治醫師 郭夢菲 手術區域 東址 002房 05號 診斷 Malignant neoplasm of cerebrum, except lobes and ventricles 器械術式 Ommaya reservoir implantation 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 鍾文桂, 時間資訊 00:00 開始NPO 00:00 臨時手術NPO 16:25 報到 16:42 進入手術室 16:45 麻醉開始 16:50 誘導結束 17:00 抗生素給藥 17:30 手術開始 21:10 麻醉結束 21:10 手術結束 21:25 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 頭顱穿洞術(止血引流、穿刺檢查) 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Burr hole for evacuation of pneumoventricle. 開立醫師: 鍾文桂 開立時間: 2011/04/01 23:02 Pre-operative Diagnosis Tension pneumoventricle. Post-operative Diagnosis Tension pneumoventricle. Operative Method Burr hole for evacuation of pneumoventricle. Specimen Count And Types nil Pathology Nil. Operative Findings 1. About 70cc air was evacuated through the reservoir in right Kocher and negaton tube in left Kocher. 2. We planned to implant Ommaya reservoir into the left lateral ventricle for further air evacuation. We inserted negaton tube into lateral ventricle with normal saline irrigation to evacuate air. However,while trying to insert Ommaya reservoir, ventriclar puncture revealed only some brain parenchyma and blood clots after several trials. Intraoperative brain echo revealed puncture tracts. We did emergent CT of brain for follow-up. It revealed hydrocephalus with pneumoventricle. No ICH was noted. Then, we sent the patient to ICU for close monitoring. Post-op pupil: 3/3. Operative Procedures Under ETGA, the patient was placed in supine position and the head in midline. After shaving,disinfection,and draping, a curvilinear scalp incision was made at left Kocher point. After creating a burr hole and cruciate durotomy, the ventriclar puncture needle was inserted at left Kocher point. The negaton tube was inserted through the same tract. Normal saline irrigation along with air evacuation was done smoothly. Further air evacuation was done at right V-P shunt reservoir. After well hemostasis, the wound was closed in layers. Operators AP 郭夢菲 Assistants R5鍾文桂 R3王奐之 Indication Of Emergent Operation Tension pneumoventricle with right side weakness. 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Burr hole for evacuation of pneumoventricle. 開立醫師: 郭夢菲 開立時間: 2011/04/06 17:19 Pre-operative Diagnosis Tension pneumoventricle. Post-operative Diagnosis Tension pneumoventricle. Operative Method Burr hole for evacuation of pneumoventricle. Specimen Count And Types nil Pathology Nil. Operative Findings 1. About 70cc air was evacuated through the reservoir in right Kocher and nelaton tube in left Kocher. 2. We planned to implant Ommaya reservoir into the left lateral ventricle for further air evacuation. We inserted nelaton tube into left lateral ventricle with normal saline irrigation to evacuate air. However, while trying to insert Ommaya reservoir, ventricular puncture revealed only some debris after several trials. Intraoperative brain echo revealed puncture tracts. We did emergent CT of brain for follow-up. It revealed hydrocephalus with less pneumoventricle but tight brain. No ICH was noted. Then, we sent the patient to ICU for close monitoring. Post-op pupil: 3/3, symmetric. Operative Procedures Under ETGA, the patient was placed in supine position and the head in midline. After shaving, disinfection,and draping, a curvilinear scalp incision was made at left Kocher point. After creating a burr hole and cruciate durotomy, the ventriclar puncture needle was inserted at left Kocher point. The nelaton tube was inserted through the same tract. The table was tilted toward the left side to facilitate the drainage of the air in the ventricle. Normal saline irrigation along with air evacuation was done smoothly, but the air came out less then expected. Bradycardia was noted during the procedure, so we evacuated the air from the right shunt valve for about 70 to 80 cc. The bradycardia improved byt recurred. We then did intraop. sonography to cinfirm that there was no ICH. After well hemostasis, the wound was closed in layers and we sent the patient for CT evaluation for the cause of bradycardia. It showed diffuse tight brain though the pneumoventricel became less. Operators AP 郭夢菲 Assistants R5鍾文桂 R3王奐之 Indication Of Emergent Operation Tension pneumoventricle with right side weakness. 相關圖片 章家和 (M,1939/07/05,72y8m) 手術日期 2011/04/01 手術主治醫師 賴達明 手術區域 東址 005房 03號 診斷 Cerebral hemorrhage (Intracerebral hemorrage, ICH) due to birth trauma 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 陳以幸, 時間資訊 00:00 臨時手術NPO 18:03 報到 18:12 進入手術室 18:15 麻醉開始 18:25 誘導結束 18:36 抗生素給藥 18:58 手術開始 20:35 手術結束 20:35 麻醉結束 20:45 送出病患 20:50 進入恢復室 21:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 頭顱成形術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 外科部 套用罐頭: cranioplasty 開立醫師: 陳以幸 開立時間: 2011/04/01 19:38 Pre-operative Diagnosis SDH and ICH status post craniectomy Post-operative Diagnosis SDH and ICH status post craniectomy Operative Method cranioplasty Specimen Count And Types nil Pathology nil Operative Findings 1.bony defect of previous craniectomy site, with mild adhesion 2.intact dura after scalp incision Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right. 3. Skin preparation:shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered witha sterilized adhesive plastic sheet. 4. Incision: along the previous operation scar at left frontotemporal area, Raney clips were apllied to the scalp edge for temporary hemostasis. 5. The scalp and temporalis muscle were dissected away from the underlying dura. 5. The scalp ad temporalis muscle flap were easily reflected from the under- lying silastic sheet which was then removed. The dural surface and margin of skull defect were well exposed. 6. The bleeders on the dissected surfaces were coagulated with Bovie painstakingly. 7. The edge of the skull defect was exposed. 8. The original skull plate preserved at bone bank was placed back to the skull window then fixed by 3 wires and a dura tenting at the center of the skull plate. 9.Multiple drill holes were made on the skull plate. 10.The artificial skull plate was fixed to the skull with 3 wires. 11.Scalp closure: hemostasis was done with monopolar coagulator touching on the sucker tip. Galea suture was performed by continuous suture with 3/0 Dexonand skin by continuous suture with 3/0 nylon. Operators 賴達明 Assistants 蔡宗良 陳國瑋 彭秀英 (F,1932/09/14,79y6m) 手術日期 2011/04/01 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Lumbar spondylosis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 蔡宗良, 時間資訊 00:00 臨時手術NPO 08:10 進入手術室 08:15 麻醉開始 08:30 誘導結束 09:20 抗生素給藥 09:40 手術開始 12:20 抗生素給藥 13:15 手術結束 13:15 麻醉結束 13:25 送出病患 13:26 進入恢復室 17:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎弓切除術(減壓)-二節以內 1 2 摘要__ 手術科部: 外科部 套用罐頭: 1. Laminotomy for decompression, L4 開立醫師: 蔡宗良 開立時間: 2011/04/01 13:33 Pre-operative Diagnosis Spondylolisthesis with lumbar spinal stenosis, L4-5 Post-operative Diagnosis Spondylolisthesis with lumbar spinal stenosis, L4-5 Operative Method 1. Laminotomy for decompression, L4 2. Posterolateral fusion, L4-5 with transpedicle screws at bilateral L4 and L5 with rod fixation. Specimen Count And Types nil Pathology None Operative Findings 1. Facet hypertrophy of L4-5 facet. 2. Hypertrophy of ligmentum flavum of L4-5 3. S/P laminectomy of L3 4. Incidental durotomy at L4-5 level s/p 5-0 Prolene suture. Operative Procedures 1. ETGA, prone 2. Fluoroscopic confirmation of L4-5 level. 3. Routinely prepped and drapped. 4. Periosteal dissection of L4-5. 5. Transpedicular screws insertion to L4 and L5 pedicle with fluoroscopic confirmation. 6. Laminotomy of L4 with ligmentum flavum removal. 7. 5-0 Prolene suture of dura. 8. Gelfoam packing. 9. Rod fixation of bilateral L4-5 10. CWV drain placement. 11. Wound closed in layers. Operators VS 賴達明 Assistants 蔡宗良 陳以幸 黃李秀珠 (F,1941/08/21,70y6m) 手術日期 2011/04/01 手術主治醫師 賴達明 手術區域 東址 019房 02號 診斷 Spondyloisthesis, acquired 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 蔡宗良, 時間資訊 00:00 臨時手術NPO 12:35 報到 13:35 進入手術室 13:40 麻醉開始 14:10 誘導結束 14:13 抗生素給藥 14:36 手術開始 17:13 抗生素給藥 17:30 開始輸血 18:30 手術結束 18:30 麻醉結束 18:36 送出病患 18:38 進入恢復室 21:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎弓切除術(減壓)-二節以內 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: 1. Laminectomy for decompression of L3 and L4 開立醫師: 蔡宗良 開立時間: 2011/04/01 18:46 Pre-operative Diagnosis Spondylolisthesis, L3-4 and L4-5 Lumbar spinal stenosis, L3-4 and L4-5 Post-operative Diagnosis Spondylolisthesis, L3-4 Lumbar spinal stenosis, L3-4 and L4-5 Operative Method 1. Laminectomy for decompression of L3 and L4 2. Transforaminal interbody fusion, L3-4 and L4-5 3. Posterior instrumentation with transpedicle screws and rods, bilateral, L3-4-5 Specimen Count And Types nil Pathology None Operative Findings 1. Facet hypertrophy of L3-4-5. 2. Hypertrophy of ligmentum flavum of L3-4-5 3. Spondylolisthesis of L3-4 Operative Procedures 1. ETGA, prone 2. Fluoroscopic confirmation of L4-5 level. 3. Routinely prepped and drapped. 4. Periosteal dissection of L4-5. 5. Transpedicular screws insertion to L3, L4 and L5 pedicle with fluoroscopic confirmation. 6. Laminotomy of L3 and L4 with ligmentum flavum removal. 7. Transforaminal lumbar interbody fusion with cage, L3-4 and L4-5 8. Gelfoam packing. 9. Rod fixation of bilateral L4-5 10. CWV drain placement. 11. Wound closed in layers. Operators 賴達明 Assistants 蔡宗良 陳以幸 黃菊妹 (F,1940/01/03,72y2m) 手術日期 2011/04/01 手術主治醫師 黃昭淵 手術區域 西址 039房 10號 診斷 Malignant neoplasm of bladder, part unspecified 器械術式 Fiberocystoscopy /WOR 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 11:38 進入手術室 11:40 手術開始 11:43 手術結束 11:45 送出病患 吳潘雪子 (F,1937/09/07,74y6m) 手術日期 2011/04/01 手術主治醫師 戴槐青 手術區域 東址 008房 06號 診斷 Hematuria 器械術式 URS bx + cystoscopy 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 面罩麻醉 麻醉主治醫師 葉惠敏 ASA 3 紀錄醫師 彭元宏, 時間資訊 14:40 報到 15:03 進入手術室 15:05 麻醉開始 15:10 誘導結束 15:21 手術開始 16:10 手術結束 16:10 麻醉結束 16:15 送出病患 16:18 進入恢復室 17:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 診斷性輸尿管鏡檢，包括輸尿管膀胱接合處，擴張術及膀胱鏡術 1 0 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Semi-opened mask inhalation anes 1 0 記錄__ 手術科部: 泌尿部 套用罐頭: URS (biopsy) 開立醫師: 彭元宏 開立時間: 2011/04/01 16:30 Pre-operative Diagnosis 1. Right upper ureter and UP junction mass 2. Hematuria Post-operative Diagnosis 1. Right upper ureter and UP junction mass 2. Hematuria 3. Bladder trigone leision, r/o bladder cancer Operative Method URS and biopsy, RP catheter stenting Specimen Count And Types 4 pieces About size:0.1*0.1cm Source:right ureter mass biopsy About size:0.1*0.1cm Source:bladder trigone leision About size:10cc Source:right ureter wash cytology About size:40cc Source:bladder leision wash cytology Pathology pending Operative Findings 1.UVJ mass, upper ureter mass, right side => silkish mass with blood clot => biopsy and wash cytology had been done smoothly 2.hematuria in the left renal pelvis 3.trigone leision, r/o bladder cancer => silkish mass with blood clot => biopsy and wash cytology had been done smoothly Operative Procedures Under satisfactory anesthesia with the patient in the lithotomy position, skin preparation was performed. A cystoscope was inserted into the bladder and a guidewire was then introduced into the ureteral orifice. A 6 Fr. ureteroscope was introduced into the ureter. Upper ureter mass and UPJ mass was noted.The mass feature was as the followed: => silkish mass with blood clot => biopsy and wash cytology had been done smoothly On the other hand, trigone leision was noted. Erythematous change was noted. Biopsy and wash cytology had been done smoothly. A RP catheter was inserted. A 16 Fr. Foley catheter was placed in the urinary bladder. The patient tolerated the operation well and was sent to the recovery room in stablecondition. Operators 戴槐青, Assistants 彭元宏, 周博敏, 吳彭安 (F,1949/06/21,62y8m) 手術日期 2011/04/02 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Spine tumor 器械術式 Benign intraspinal tumor, exci 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:05 進入手術室 08:15 麻醉開始 08:30 抗生素給藥 08:30 誘導結束 09:05 手術開始 11:15 手術結束 11:15 麻醉結束 11:25 送出病患 11:30 進入恢復室 12:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 良性脊髓腫瘤切除術 1 1 手術 椎弓整形術 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: Laminoplasty,T9-10 for Simpson grade II spina... 開立醫師: 鍾文桂 開立時間: 2011/04/02 11:49 Pre-operative Diagnosis Intradural extramedullary spinal tumor,T9-10. Post-operative Diagnosis Intradural extramedullary spinal meningioma,T9-10. Operative Method Laminoplasty,T9-10 for Simpson grade II spinal tumor excision Specimen Count And Types 1 piece About size:10cc Source:spinal tumor Pathology Pending. Operative Findings 1. Two whitish frackles of calcification over the arachnoid membrane after durotomy. They were sent for pathology. 2. Dural-attached whitish-pink well delineated tumor at right lateral side of the spinal canal. It compressed the roots and the cord to the left side. 3. The T9-10 laminae were fixed by miniplates and screws. Operative Procedures Under ETGA, the patient was placed in prone position. After ensuring the location of T9-10 under intraoperative fluoroscopy, disinection, and draping, a 6 cm midline incision was made at the localized area. After paraspinal dissection, T9-10 laminoplasty was achieved with high speed drill. Further decompression was done with Kerrison. A linear durotomy was obtained to expose the tumor mass. The tumor was resected in piecemeal fashion. The tumor attached dural base was further removed by ring currete and electrocoagulated with bipolar. The dura was closed in water-tight fashion by 5-0 Prolene. The T9-10 laminae were fixed by miniplates and screws. After placing one 1/8 hemovac drain over the lamine, the wound was closed in layers. Operators 曾漢民 Assistants R5 鍾文桂 Ri 黃張照枝 (F,1939/08/28,72y6m) 手術日期 2011/04/02 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Brain tumor 器械術式 Crainotomy Brain Tumor(P-LIN) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3 紀錄醫師 陳以幸, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:00 進入手術室 08:05 麻醉開始 08:30 誘導結束 08:45 抗生素給藥 09:00 手術開始 10:15 開始輸血 12:00 抗生素給藥 15:00 抗生素給藥 18:00 抗生素給藥 20:10 麻醉結束 20:10 手術結束 20:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 16 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Retrosigmoid approach suboccipital craniotomy... 開立醫師: 蔡宗良 開立時間: 2011/04/02 20:42 Pre-operative Diagnosis Meningioma, petroclival, right-sided Post-operative Diagnosis Meningioma, petroclival, right-sided Operative Method Retrosigmoid approach suboccipital craniotomy for Simpsons grade IV removal of tumor Specimen Count And Types Pathology Report pending Operative Findings Tumor was greyish in color, moderately vascular, elastic and firm in consistency. Cranial nerves V, VII-VIII, lower cranial nerves were all encapsulated by the tumor. SCA and VA are visible after tumor was partially removed. Operative Procedures Patient was positiend in three quater prone after Mayfield head-clamp fixation under general anesthesia. A S-shaped scalp incision was made. The sternocleidomastoideus, splenius capitis, oblique capitis superior and part ofthe trapezius muscles were devided until the posterior arch and transverse process of C1 was palpable. A craniectomy of 3 x 3 cm, suboccipital retromastoid, to expose the margin of sigmoid sinus. Dura was incised in epsilon fashion and reflected to sigmoid sinus. CSF was drained via opening of cisterna magna. Under operating microscope, the cerebellum was retracted and the tumor exposed. The removal of the tumor was progressed by CUSA, bipolar cautery and tumor forceps. Great attention was paid to mobilize the tumor away from the brain stem and to identify the cranial nerves. After most part of the tumor except those of anterior superior part where the cranial nerve behind on its anterior surface had been identified. The blood oozing points on the cerebellar surface where compressed by the tumor previously were packed with gelfoam for hemostasis. The blood in the C-P angle cistern was washed out by NS irrigation. Dura was closed closure interrupted 2/0 silk suture for key stitches, then continuous suture with 4/0 prolene to obtain water-tight closure with dural graft. Wound was closed in layers after hemostasis was done with monopolar coagulator. Operators 賴達明 Assistants 蔡宗良 陳以幸 洪浩剛 (M,1988/05/24,23y9m) 手術日期 2011/04/02 手術主治醫師 楊士弘 手術區域 東址 005房 02號 診斷 Hyperhidrosis 器械術式 Endoscopic T2 sympathectomy 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 10:50 報到 11:40 進入手術室 11:45 麻醉開始 11:55 誘導結束 12:00 抗生素給藥 12:19 手術開始 13:00 手術結束 13:00 麻醉結束 13:15 送出病患 13:18 進入恢復室 14:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 經內視鏡交感神經切斷術 1 1 B 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Endoscopic T2 sympathectomy, both sides 開立醫師: 楊士弘 開立時間: 2011/04/02 13:14 Pre-operative Diagnosis Hyperhidrosis Post-operative Diagnosis Hyperhidrosis Operative Method Endoscopic T2 sympathectomy, both sides Specimen Count And Types nil Pathology Nil Operative Findings The right sympathetic trunk was identified after insertion of thoracoscope. It was coagulated and divided by monopolar coagulator over the secondary rib. The left sympathetic trunk was also ablated as described above. Operative Procedures 1. ETGA, supine. 2. Transverse skin incision at right T3 level and anterior axillary line. 3. Insertion of thoracoscope. 4. Coagulation of T2 sympathetic trunk. 5. Removal of endoscope and deair. 6. Wound closure by two 3-0 Nylon stitches. 7. Repeat 2-6 over left side. Operators 楊士弘 Assistants 鍾文桂 相關圖片 許清太 (M,1942/01/05,70y2m) 手術日期 2011/04/03 手術主治醫師 賴達明 手術區域 東址 002房 03號 診斷 Intracerebral hemorrhage (ICH) 器械術式 Craniotomy(Aneurysms) Others 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3E 紀錄醫師 許皓淳, 時間資訊 12:39 臨時手術NPO 12:39 開始NPO 20:39 通知急診手術 21:00 報到 21:00 進入手術室 21:05 麻醉開始 21:15 誘導結束 21:35 抗生素給藥 21:40 手術開始 00:35 麻醉結束 00:35 手術結束 00:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 1 R 手術 顱內壓視置入 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for hematoma evacuation, and ICP m... 開立醫師: 陳睿生 開立時間: 2011/04/04 00:20 Pre-operative Diagnosis Right basal ganglion ICH with uncal herniation Post-operative Diagnosis Right basal ganglion ICH with uncal herniation Operative Method Craniotomy for hematoma evacuation, and ICP montior insertion Specimen Count And Types nil Pathology Nil Operative Findings Massive hematoma was noted while corticotomy done. Several active bleeders were noted after hematoma remove, and all of them were well electroligated. The brain surface shrinked after hematoma remove. The ventricle was also noted at the deepest side of the hematoma. A subdural ICP monitor was inserted and the initial ICP was about 1mmHg. Reference: 492 Operative Procedures 1. ETGA, supine position and head left turn 2. Curvillinear frontotemporal scalp incision, and the temporalis muscle was also incised 3. Two bur holes made, and then an about 5x8 cm craniotomy window was created 4. The dura was opened and an about 2.5cm corticotomy was done at medial temporal gyrus 5. The hematoma was identified and partially decompressed 6. After dura tenting, the hematoma was evacuated under microscope 7. Several active bleeders were noted and electroligated 8. The raw surface was packed with surgicel 9. Insert a subdural ICP monitor 10.The dura was closed with fascia graft and Durafoam 11.Fix back the skull graft with miniplates x3 12.Suture close the temporalis muscle 13.Close the wound in layers Operators VS 賴達明 Assistants R6 陳睿生, R3 游健生, R1 許皓淳 Indication Of Emergent Operation Uncal herniation 莊正雄 (M,1939/08/28,72y6m) 手術日期 2011/04/05 手術主治醫師 蔡瑞章 手術區域 東址 002房 01號 診斷 Gastric cancer 器械術式 Debridment-- >10cm 手術類別 緊急手術 手術部位 脊椎 傷口分類 髒 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 3E 紀錄醫師 蔡宗良, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 09:45 通知急診手術 12:58 進入手術室 13:05 麻醉開始 13:10 誘導結束 13:20 抗生素給藥 13:46 手術開始 14:47 麻醉結束 14:47 手術結束 14:55 送出病患 15:00 進入恢復室 16:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 皮下肌肉或深部異物取出術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Debridement of infected wound 開立醫師: 蔡宗良 開立時間: 2011/04/05 15:02 Pre-operative Diagnosis Wound infection, thoracic spine Post-operative Diagnosis Wound infection, thoracic spine Operative Method Debridement of infected wound Specimen Count And Types 1 piece About size:小 Source:wound, for culture Pathology None Operative Findings 1. Poor healing of wound 2. Few granulomatous tissue Operative Procedures 1. ETGA, prone 2. Routinely prepped and drapped 3. Open the wound and remove previous sutures. 4. Debridement with currettage and copious N/S irrigation. 5. Placement of Hemovac 6. Wound trimmed with blade 7. Wound then closed in single layer 2-0 Nylon interrupted mattress. Operators VS 蔡瑞章 Assistants R5 蔡宗良, R1邱裕淳 Indication Of Emergent Operation 杜道清 (M,1926/01/06,86y2m) 手術日期 2011/04/05 手術主治醫師 賴達明 手術區域 東址 002房 03號 診斷 Cerebrovascular accident (CVA) 器械術式 Burr hole (trephination) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 2E 紀錄醫師 陳國瑋, 時間資訊 13:00 開始NPO 17:43 通知急診手術 20:50 報到 20:55 進入手術室 21:00 麻醉開始 21:15 誘導結束 21:25 抗生素給藥 21:48 手術開始 23:10 手術結束 23:10 麻醉結束 23:15 送出病患 23:18 進入恢復室 00:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Left side burr hole for subdural hematoma eva... 開立醫師: 王奐之 開立時間: 2011/04/05 23:23 Pre-operative Diagnosis Left side chronic subdural hematoma Post-operative Diagnosis Left side chronic subdural hematoma Operative Method Left side burr hole for subdural hematoma evacuation & subdural drain placement Specimen Count And Types Nil Pathology Nil Operative Findings Massive amount of motor-oil like fluid gushed out after durotomy. The brain re-expanded poorly after hematoma evacuation. Operative Procedures After ETGA, the patient was placed in supine position. After scalp shaving, disinfection & draping in sterile fashion, a linear skin incision was made at left frontotemporal area. A burr hole was made, followed by 2 tenting stitches at the edge. A cruciate durotomy was done, followed by incision of the outer membrane of hematoma. A rubber drain was inserted into the subdural space to evacuate the subdural hematoma. After evacuating most of the hematoma, the drain was secured. The wound was then closed in layers. The operation ended after deairing. Operators VS 賴達明 Assistants R3 王奐之, R2 陳國瑋 Indication Of Emergent Operation brainstem compression 相關圖片 林柏佑 (M,2006/03/10,6y0m) 手術日期 2011/04/05 手術主治醫師 楊士弘 手術區域 兒醫 068房 02號 診斷 Infantile cerebral palsy, unspecified 器械術式 Revision of CSF shunt 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3E 紀錄醫師 蔡宗良, 時間資訊 03:00 開始NPO 12:09 通知急診手術 18:50 報到 18:55 進入手術室 19:00 麻醉開始 19:05 誘導結束 19:45 抗生素給藥 20:00 手術開始 21:05 手術結束 21:05 麻醉結束 21:10 送出病患 21:15 進入恢復室 22:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦脊髓液分流管重置 1 2 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Shunt revision 開立醫師: 楊士弘 開立時間: 2011/04/05 21:09 Pre-operative Diagnosis Dysfunction of ventriculoperitoneal shunt Post-operative Diagnosis Dysfunction of ventriculoperitoneal shunt Operative Method Shunt revision Specimen Count And Types Nil Pathology Nil Operative Findings CSF gushed out from shunt tract after removal of the ventricular catheter. A resistance was felt at a depth of 4-5 cm when tapping of the ventricle from the left Frazier point. A new ventricular catheter was then inserted with the guide wire inside to a depth of 9 cm, the guide wire was removed, and the catheter was cut and connected with the previously implanted shunt reservoir. Operative Procedures 1. ETGA, supine, head rotated to right. 2. Scalp and abdomen wound incision along previous scar. 3. Removal of the ventricular catheter. 4. Insertion of a new ventricular catheter, 9 cm long. 5. Connection of the new catheter with the reservoir. 6. Pulling down of the shunt tube in the abdominal wound to avoid kinking. 7. Wound closure in layers. Operators 楊士弘 Assistants 蔡宗良 Indication Of Emergent Operation Acute hydrocephalus due to VP shunt dysfunction 林簡美英 (F,1951/10/10,60y5m) 手術日期 2011/04/06 手術主治醫師 杜永光 手術區域 東址 003房 02號 診斷 Herniation of intervertebral disc (HIVD) 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 12:20 進入手術室 12:30 麻醉開始 12:35 誘導結束 12:40 抗生素給藥 13:10 手術開始 14:20 手術結束 14:20 麻醉結束 14:26 送出病患 14:30 進入恢復室 15:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-腰椎 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Microscopic disectomy 開立醫師: 陳國瑋 開立時間: 2011/04/06 14:38 Pre-operative Diagnosis HIVD L45 Post-operative Diagnosis HIVD L45 Operative Method Microscopic disectomy Specimen Count And Types nil Pathology nil Operative Findings The ruptured and downward migration disc fragment from the L4~L5 disc compressed the right L5 root tightly. The root was free after diskectomy. Operative Procedures Under endotracheal general anesthesia, patient was put in prone position. Pre-Op fluoroscopic localization was performed. The back was shaved and scrubbed with povidone-iodine detergent then painted with povidone-iodine tincture and followed by sterilized adhesive plastic sheet covering. Incision was made as 3-cm, between L4~5 spinous processes. The subcutaneous layer and lumbdorsal fascia were incised then the aponeurosis of the latissimus dorsi and ileocostalis lumborum muscles at spinous processes of L4~5 was incised, the muscles were detached from the interspinous ligament. The multifidus muscles were detached subperiosteally from L4~5 laminae by a rasp. The paravertebral muscles were retracted by a modified narrow Taylor retractor which was retained constantly by a rubbersling to the side rail of the operating table. Under an operating microscope, the ligamentum flavum was cleaned and incised longitudinally at the lateral part.The lateral portion of this ligament was removed with a small angle Kerrison rongeur, the lateral portion of the laminae and the medial border of the facets were removed too until the margin of the facets and a corridor to the disc that ran lateral to the root was reached. The epidural fat was left undisturbed andpreserved. The compressed L5 root and veins overlying the protruded disc were gently pushed away by placing 2 small cottonoid patties, one above and one below the disc at the floor of the epidural canal. The compressed root was gently pushed further away temporarily by sucker tip in order to expose the herniated disc more clearly. The posterior longitudinal ligament and annulus were incised around the protruded disc with a No. 15 blade. The degenerated disc was removed with microdisc forceps until a substantial amount of the nucleus had been loosened with a cone curette and removed. The lumbodorsal fascia was approximated by 3 interruped 2/0 silk stitches. The subcutaneous layer was closed by running suture with 4/0 Dexon and skin by adhesive tape Operators P 杜永光 Assistants 胡朝凱 陳國瑋 相關圖片 陳俊孝 (M,2008/04/16,3y10m) 手術日期 2011/04/06 手術主治醫師 杜永光 手術區域 兒醫 067房 01號 診斷 Benign neoplasm of Rathke's pouch 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:05 進入手術室 08:15 麻醉開始 08:40 誘導結束 09:30 抗生素給藥 10:15 手術開始 12:30 抗生素給藥 14:30 麻醉結束 14:30 手術結束 14:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4~8小時 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Right frontal craniotomy for pituitary tumor ... 開立醫師: 游健生 開立時間: 2011/04/06 15:25 Pre-operative Diagnosis Pituitary tumor, favor Rathke"s cyst Post-operative Diagnosis Pituitary tumor, favor Rathke"s cyst Operative Method Right frontal craniotomy for pituitary tumor excision Specimen Count And Types 1 piece About size: 0.5 x 0.5 cm Source:pituitary tumor Pathology Pending Operative Findings A 2 x 2cm soft, yellowish, well-encapsulated, cystic tumor was noted at sellar-suprasellar region. It pushed bilateral optic nerve superolaterally and optic chiasm upward. The tumor contained milky-white mucoid content. Normal pinkish pituitary gland parenchyma was seen after tumor removal. Operative Procedures Under ETGA, patient was in supine position with head fixed by head holder and neck mildly extended. After shaving, we disinfected and draped the operation field as usual. A bi-coronal scalp incision was made followed by skin flap elevation and reflection. The supra-orbital rim and supra-orbital nerve were exposed and reserved. After a burrhole creation, a 5x5 right frontal craniotomy was done followed by dura tenting along the edges. After U-shape durotomy, gentle retraction on the base of frontal lobe was applied to expose the basal cistern. It was opened and CSF was drained. Bilateral optic nerve and right ICA were seen. Then, oflactory nerve was separated from the base of frontal lobe gently for more extensive exposure but less tension for retraction of frontal lobe. The tumor was exposed just posterior to tuberculum sellar pushing contralateral optic nerve to inferolateral aspect. It was centrally debulked by sucking out mucoid content. The solid part and capsule were removed in pieces. Normal pinkish pituitary gland parenchyma was seen after tumor removal. Hemostasis was achieved with Surgicel packing. Dura was closed with prolene continuous suture. Bone flap was fixed back with mini-plates after central tenting. After subgaleal CWV drain placement, wound was closed in layers. Operators Prof 杜永光 Assistants R6 陳睿生 R3 游健生 黃慕香 (M,1942/10/14,69y5m) 手術日期 2011/04/06 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Intracerebral hemorrhage 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 08:12 進入手術室 08:13 麻醉開始 08:15 誘導結束 09:19 手術開始 10:10 手術結束 10:10 麻醉結束 10:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Ventriculo-peritoneal shunt implantation via ... 開立醫師: 李振豪 開立時間: 2011/04/06 10:29 Pre-operative Diagnosis 1. Hydrocephalus, 2. Right thalamic ICH and IVH Post-operative Diagnosis 1. Hydrocephalus, 2. Right thalamic ICH and IVH Operative Method Ventriculo-peritoneal shunt implantation via left Kocher"s point Specimen Count And Types 1 piece About size:5ml Source:CSF Pathology Nil Operative Findings The CSF was red-brownish in color. The CSF gushed out after opening the wound. The Codman programmable valve reservoir was implanted with initial pressure setting as 100mmH2O. The ventricular catheter and peritoneal catheter was 7 and 20cm in length respectively. The CSF was sampled for routine, BCS and bacterial culture. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head rotated to right. The EVD and wound stitches were removed. The scalp was shaved, scrubbed, and disinfected as usual. The scalp incision was made along left frontal wound and the burr hole was identified. The Nelaton was inserted to left lateral ventricle and CSF was sampled. left upper abdomen transverse skin incision was made and the minilaparotomy was performed to enter the peritoneal cavity. The subcutaneous tunnel from left abdomen, forechest, neck, and retroauricular area was created. One 1.5cm scalp incision was made at left retroauricular area. The peritoneal catheter was introduced through the subcutaneous tunnel. The ventricular catheter and peritoneal catheter was connected to set up the shunt. The ventricular catheter was placed into left lateral ventricle. The function of the shunt was checked. The peritoneal catheter was placed into peritoneal cavity under direct vision. Hemostasis was achieved. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS賴達明 Assistants R4李振豪, R3王奐之 相關圖片 張俊成 (M,1966/06/20,45y8m) 手術日期 2011/04/06 手術主治醫師 王國川 手術區域 東址 005房 01號 診斷 Secondary cancer of lung 器械術式 Brain tumor Crainotomy(Others) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳國瑋, 時間資訊 00:19 臨時手術NPO 07:37 報到 08:00 進入手術室 08:30 麻醉開始 08:50 誘導結束 09:00 抗生素給藥 09:25 手術開始 11:25 麻醉結束 11:25 手術結束 11:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除-手術時間在4小時以內 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Left craniotomy for total tumor excision 開立醫師: 胡朝凱 開立時間: 2011/04/06 11:28 Pre-operative Diagnosis Left frontal metastatic tumor Post-operative Diagnosis Left frontal metastatic tumor Operative Method Left craniotomy for total tumor excision Specimen Count And Types one 2.5x1.5 cm tumor Pathology pending Operative Findings 1.One about 2.5 cm, firm, whitish to yellowish tumor located at left posterior frontal lobe. 2.Two veins lies on the tumor surface and were all preserved well. 3.The tumor border was clear. 4.Brain was mild swelling Operative Procedures 1.ETGA, supine 2.left curvillinear skin incision 3.Detach temporalis muscle and periosteum 4.Craniotomy 5.dura was opened as curvature fashion 6.Trans-sulcus tumor dissection 7.tumor excision 8.Hemostasis 9.Dural closure 10.Fixed bone back with wires 11.Close wound in layers Operators 王國川 Assistants 胡朝凱, 陳國瑋 相關圖片 摘要__ 手術科部: 外科部 套用罐頭: Left craniotomy for total tumor excision 開立醫師: 胡朝凱 開立時間: 2011/04/06 12:01 Pre-operative Diagnosis Left frontal metastatic tumor Post-operative Diagnosis Left frontal metastatic tumor Operative Method Left craniotomy for total tumor excision Specimen Count And Types one 2.5x1.5 cm tumor Pathology pending Operative Findings 1.One about 2.5 cm, firm, whitish to yellowish tumor located at left posterior frontal lobe. 2.Two veins lies on the tumor surface and were all preserved well. 3.The tumor border was clear. 4.Brain was mild swelling Operative Procedures 1.ETGA, supine 2.left curvillinear skin incision 3.Detach temporalis muscle and periosteum 4.Craniotomy 5.dura was opened as curvature fashion 6.Trans-sulcus tumor dissection 7.tumor excision 8.Hemostasis 9.Dural closure 10.Fixed bone back with wires 11.Close wound in layers Operators 王國川 Assistants 胡朝凱, 陳國瑋 相關圖片 盧慶瑞 (M,1962/07/27,49y7m) 手術日期 2011/04/06 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 Scalp mass 器械術式 Scalp tumor Suture 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 00:21 臨時手術NPO 10:35 進入手術室 10:40 麻醉開始 10:45 誘導結束 10:50 抗生素給藥 11:06 手術開始 11:51 手術結束 11:51 麻醉結束 12:07 送出病患 12:08 進入恢復室 13:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 頭皮腫瘤 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Right retroauricular scalp tumor excision 開立醫師: 李振豪 開立時間: 2011/04/06 12:11 Pre-operative Diagnosis Right retroauricular scalp tumor, suspect atheroma Post-operative Diagnosis Right retroauricular scalp tumor, suspect atheroma or teratoma Operative Method Right retroauricular scalp tumor excision Specimen Count And Types 1 piece About size:7x7x5cm Source:Right retroauricular tumor Pathology Pending Operative Findings The tumor was well-capsulated, 7x7x5cm in size, hypervascularized, and filled with pus-like keratin-enriched material. Some hairs also noted within the tumor. The skull was eroded and depressed by the tumor but not connected with intracranial space. Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine position with head rotated to left. The scalp was shaved, scrubbed, and disinfected as usual. Local anesthesia with 2% Xylocaine 10ml was applied around the tumor. The fusiform scalp incision was made at right retroauricular area. The tumor was dissected along the capsule. Decompression of the tumor was performed by 18G needle aspiration. Tumor excision was done after decompression. Hemostasis was achieved with bipolar electrocautery. The wound was irrigated with normal saline and Gentamicin solution. One CWV drain was placed. The wound was then closed in layers with 3-0 Nylon. Operators VS王國川 Assistants R4李振豪 相關圖片 柯勝嚴 (M,1983/01/11,29y2m) 手術日期 2011/04/07 手術主治醫師 廖漢文 手術區域 東址 000房 號 診斷 Arteriovenous malformation, brain 器械術式 NEURO T.A.E 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 2 時間資訊 09:10 麻醉開始 09:30 誘導結束 16:10 麻醉結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 Peripheral arterial line inserti 1 0 張境軒 (M,1967/08/24,44y6m) 手術日期 2011/04/07 手術主治醫師 黃正賢 手術區域 東址 010房 01號 診斷 Vitreous hemorrhage 器械術式 P.P.V.- simple 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 吳郁芊, 時間資訊 08:05 進入手術室 09:17 手術開始 10:06 手術結束 10:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 眼坦部玻璃體切除術-簡單 1 1 L 手術 光線凝固治療-簡單 1 2 L 記錄__ 手術科部: 眼科部 套用罐頭: PPV (simple / peeling) 開立醫師: 吳郁芊 開立時間: 2011/04/07 10:01 Pre-operative Diagnosis Traumatic vitreous hemorrhage (os) Post-operative Diagnosis Traumatic vitreous hemorrhage (os) Traumatic vitreous hemorrhage, subretinal hemorrhage with fibrosis and hemorrahgic chroidal detachment (os) Operative Method simple PPV + endolaser (os) Specimen Count And Types nil Pathology nil Operative Findings subretinal blood clot and fibrosis, hemorrhage CD Operative Procedures 1. Under retrobulbar anesthesia 2. Disinfection and draping as usual, apply an eyelid speculum. 3. 360-degree peritomy and hemostasis with cautery. 3. Three sclerotomy were made then apply light probe, microvit, and infusion line throughthe sclerotomy wounds. 4. Vitrectomy was performed with Microvit 5. Removal of posterior hyaloid 6. Apply endolaser. 7. Close sclerotomy wound with 9-0 Nylon 8. Close conjunctival wound with 6-0 Vicryl. 9. Subconjunctival injection of Rinderon and Gentamicin. 10. Atropine and Latycin patching. Operators 黃正賢, Assistants R4陳達慶, R4吳郁芊 周秋隆 (M,1961/04/21,50y10m) 手術日期 2011/04/07 手術主治醫師 陳敞牧 手術區域 東址 005房 02號 診斷 Spinal stenosis 器械術式 Laminoplasty C3-5 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 09:23 報到 10:00 進入手術室 10:03 麻醉開始 10:30 誘導結束 10:35 抗生素給藥 10:40 手術開始 13:40 抗生素給藥 13:50 手術結束 13:50 麻醉結束 14:00 送出病患 14:05 進入恢復室 15:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 椎弓整形術 1 1 摘要__ 手術科部: 外科部 套用罐頭: C3-6 laminoplasty 開立醫師: 李振豪 開立時間: 2011/04/07 14:10 Pre-operative Diagnosis C3-6 cervical stenosis with myelopathy Post-operative Diagnosis C3-6 cervical stenosis with myelopathy Operative Method C3-6 laminoplasty Specimen Count And Types nil Pathology Nil Operative Findings The thecal sac expanded well after laminoplasty. Total 4 miniplates and 8 screws were used for laminoplasty. No CSF leakage or incidental durotomy noted after whole procedure. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position with head fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. Midline skin incision was made from C2 to C7 level. The subcutaneous soft tissue and paravertebral muscle group was detached. The C3-6 laminae was exposed. The spinous processes of C3-6 were cut at it base by bone cutter. Laminoplasty was performed with Midas air-drived drills and miniplates. Hemostasis was achieved and one epidural CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS陳敞牧 Assistants R4李振豪, R1陳以幸, R1陳宣佑 張俊成 (M,1966/06/20,45y8m) 手術日期 2011/04/07 手術主治醫師 王國川 手術區域 東址 027房 05號 診斷 Secondary cancer of lung 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 無麻醉 麻醉主治醫師 ASA 4E 紀錄醫師 王國川, 時間資訊 12:00 開始NPO 12:00 臨時手術NPO 17:32 報到 17:49 進入手術室 18:15 抗生素給藥 18:20 手術開始 19:45 手術結束 19:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱骨切除術,包括異物移除或壓或經切斷 1 2 張俊成 (M,1966/06/20,45y8m) 手術日期 2011/04/07 手術主治醫師 王國川 手術區域 東址 027房 05號 診斷 Secondary cancer of lung 器械術式 CRANIOTOMY, HEMATOMA EVACUATION 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 4E 紀錄醫師 胡朝凱, 時間資訊 16:48 開始NPO 16:48 臨時手術NPO 16:48 通知急診手術 17:49 進入手術室 17:55 麻醉開始 18:00 誘導結束 18:20 手術開始 19:45 手術結束 19:45 麻醉結束 19:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦內血腫清除術 1 2 L 記錄__ 手術科部: 外科部 套用罐頭: craniotomy for ICH evacuation 開立醫師: 胡朝凱 開立時間: 2011/04/07 20:01 Pre-operative Diagnosis Left frontal ICH Post-operative Diagnosis Left frontal ICH Operative Method craniotomy for ICH evacuation Specimen Count And Types nil Pathology nil Operative Findings 1.about 35 ml hematoma was noted at left frontal area. 2.No obvious residual tumor or bleeder was noted. 3.After decompression, the brain was slack Operative Procedures 1.ETGA, supine 2.Previous wound incision 3.Dissect to open and remove previous bone graft 4.Open dura 5.Hematoma evacuation 6.Hemostasis 7.Close dura 8.Fixed bone back 9.Close wound in layers Operators 王國川 Assistants 胡朝凱 Indication Of Emergent Operation Acute right muscle power deterioration 侯李隔 (F,1928/08/14,83y7m) 手術日期 2011/04/08 手術主治醫師 王國川 手術區域 東址 002房 04號 診斷 Subdural hemorrhage (SDH) 器械術式 1. Left subdural hematoma evacuation, 2. EVD insertion 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3E 紀錄醫師 鍾文桂, 時間資訊 21:56 通知急診手術 00:35 報到 00:40 進入手術室 00:45 麻醉開始 00:50 誘導結束 01:35 手術開始 03:25 麻醉結束 03:25 手術結束 03:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 手術 顱內壓視置入 1 2 手術 急性硬腦膜下血腫清除術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: 1. Left frontal-temporal craniotomy for evacu... 開立醫師: 鍾文桂 開立時間: 2011/04/08 04:16 Pre-operative Diagnosis 1. Left parietal-occipital infarction with hemorrhagic transformation. 2. Left frontal-parietal-temporal acute subdural hemorrhage. Post-operative Diagnosis 1. Left frontal-parietal-temporal acute subdural hemorrhage. 2. Left parietal-occipital infarction with hemorrhagic transformation. Operative Method 1. Left frontal-temporal craniotomy for evacuation of acute subdural hemorrhage. 2. Insertion of EVD catheter for ICP monitoring and CSF drainage. Specimen Count And Types 1 piece About size:3cc Source:CSF Pathology Nil. Operative Findings 1. Easy oozing from the osteoporotic skull bone. 2. Organized red-brownish hematoma at subdural space. Mild brain expansion after hematoma evacuation. No active bleeder. 3. ICP at initial puncture was about 5 cmH2O. CSF: pinkish, clear. 4. Poor cortical vessel condition. narrow caliber, some constriction. Operative Procedures Under ETGA, the patient was placed in supine position and the head was tilted to the right side. After shaving, disinfection, and draping, a curvilinear 10-cm scalp incision was made. After dissection, a 6-cm craniotomy was obtained by high speed drill. After dural tenting and durotomy, the subdural hematoma was evacuated. After well hemostasis, the dura mater was closed in watertight fashion and the dural defect was repaired with fascia graft. The EVD catheter was inserted under ultrasound guidance. The craniotomy plate was fixed by miniplates and screws. The wound was closed in layers with one subgaleal drain in situ. Operators 王國川 Assistants 鍾文桂 蕭博懷 Indication Of Emergent Operation 相關圖片 徐慶南 (M,1950/12/05,61y3m) 手術日期 2011/04/07 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Carotid stenosis 器械術式 EC-IC by-pass 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3 紀錄醫師 蔡宗良, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:10 麻醉開始 08:50 誘導結束 09:00 抗生素給藥 09:36 手術開始 12:00 抗生素給藥 14:20 手術結束 14:20 麻醉結束 14:27 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱內外血管吻合術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: EC-IC Bypass 開立醫師: 蔡宗良 開立時間: 2011/04/07 14:41 Pre-operative Diagnosis Internal carotid artery stenosis, right-sided Post-operative Diagnosis Internal carotid artery stenosis, right-sided Operative Method Extracranial-intracranial bypass, superficial temporal artery to middle cerebral artery segment 4, right-sided Specimen Count And Types nil Pathology None Operative Findings Flow check of proximal STA with Doppler after anastomosis was very well. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation:shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture. The course of the superficial temporal artery was mapped out with methylene blue after identification by palpation, then the skin was covered with a sterilized adhesive plastic sheet. 4. Isolation of the superficial temporal artery (STA): a 5 cm segment of this artery together with its surrounding fat tissue was isolated by sharp dissection after the scalp incision along the arterial course had been made. The bleeding from scalp edge was stopped by bipolar coagulator. 5. Scalp incision: the incision for arterial isolation was then extended backward to form a horse shoe shape temporal flap. Raney clips were applied to scalp edge for temporary hemostais. 6. Craniotomy window: 4 cm trephine centered at angular gyrus (about 5 cm above the external auditory canal) 7. Dural tenting: by 2/0 silk, 1 cm in interval, distributed along the edge of skull window. 8.Dural incision: crusade fashion (curlinear along the edge of skull window). 9. Under operating microscope, a suitable cortical branch from the MCA was identified and the arachnoid around the vessel was removed by microscissors. A piece of plastic membrane was placed under the free segment of the artery. 10.Two temporary microvascular clips were applied, 1 cm appart, to the isolated segment of the cortical vessel, which was then opened by cutting off a leaf-like patch of the vascular wall (same size as the diameter of the STA). Heparin solution was used to irrigate the vascular lumen. 11.The STA was occluded by a temporary clip and divided at its distal end. The lumen was irrigated with heparin solution. The adventitia at the vascular stump was trimmed off. 12.The STA was anastomosed end-to-side to the segment of cortical artery with interrupted stitches of 10/0 monofilament nylon. 13.The plastic membrane was folded back with a small patty to drape around the anastomosing site, then the vascular clips were released, the first one was on distal end of the cortical vessel, the2nd one was on the STA and the last one, on the proximal end of the cortical artery. The leakage from the anastomosis was successufully stopped by gentle pressure on the patty with a small sucker tip. 14.Dural closure: interruped 2/0 silk sutures for key stitches, then with 4/0 Dexon. The loose space there was packed with gelfoam around the STA. 15.The trephine fixed back mini-plates. The corner where STA passed through was bitten off for preventing undue pressure on the STA. 16.Scalp closure: hemostasis was done with monopolar coagulator touching on the sucker tip. Galea suture was performed by continuous suture with 3/0 Dexon and skin by continuous suture with 4/0 nylon. 17.Drain: CSV. 18.Blood transfusion: none 19.Course of the surgery: smooth. Operators VS 王國川 Assistants R5 蔡宗良 姜徐玉英 (F,1939/01/25,73y1m) 手術日期 2011/04/08 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:10 麻醉開始 09:00 誘導結束 09:10 抗生素給藥 09:15 手術開始 12:20 抗生素給藥 13:05 手術結束 13:05 麻醉結束 13:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Right parietal craniotomy for Simpson grade I... 開立醫師: 游健生 開立時間: 2011/04/08 15:43 Pre-operative Diagnosis 1. Right parietal parasagittal meningioma 2. Basilar tip aneurysm Post-operative Diagnosis 1. Right parietal parasagittal meningioma 2. Basilar tip aneurysm Operative Method Right parietal craniotomy for Simpson grade I tumor excision Specimen Count And Types 1 piece About size:3 x 2.6 x 2.6cm Source:brain tumor Pathology pending Operative Findings A soft, yellowish, well-defined tumor was noted at right parietal region. It was separated easily from brain surface along arachnoid membrane. It arose from convexity dura and did not invaded sagittal sinus. All cortical veins encountered were preserved. Operative Procedures Under ETGA, patient was in supine position with head fixed by headclamp and neck flexed. After shaving, we disinfected and draped the operation field as usual. A V-shape scalp incision was made at right parietal region with one side at midline. After two burrhole creation, a 5 x 5cm craniotomy was done followed by dura tenting along craniotomy window. A U-shape durotomy was done with base at sagittal sinus. The tumor was separated from brain surface along arachnoid membrane gently with cottonoid. The tumor was removed in pieces while cortical veins encountered were prevented from damage. Sagittal sinus and falx were identified and left untouched. Hemostasis was achieved with Surgicel covering the tumor bed. The part of dura attached by tumor was removed. Duroplasty was done with fascia graft harvested from aponeurosis. After central tenting, bone flap was fixed back with mini-plates. Wound was closed in layers. Operators Prof. 杜永光 Assistants R6 陳睿生 R3 游健生 曾碧玉 (F,1951/01/08,61y2m) 手術日期 2011/04/08 手術主治醫師 賴達明 手術區域 東址 005房 02號 診斷 Brain abscess 器械術式 Brain tumor Crainotomy(Others) 手術類別 預定手術 手術部位 頭、頸 傷口分類 污染 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 12:35 報到 12:53 進入手術室 13:10 麻醉開始 13:30 抗生素給藥 13:35 誘導結束 13:58 開始輸血 14:00 手術開始 15:46 麻醉結束 15:46 手術結束 15:58 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 立體定位術-抽吸 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: stereotactic burr hole aspiration 開立醫師: 陳國瑋 開立時間: 2011/04/08 16:16 Pre-operative Diagnosis right parietal abscess Post-operative Diagnosis right parietal abscess Operative Method stereotactic burr hole aspiration Specimen Count And Types culture tubes x 3 and pus for pathology Pathology pending Operative Findings 1.Frank pus was aspirated 2.The entry point was posterior to the sensory cortex 3.The depth from entry to target point was 13.1 cm Operative Procedures 1.ETGA, supine 2.Navigation localization 3.Vertical wound incision 4.Dissect to open skin flap 5.Burr hole drill 6.open dura 7.aspiration needle insertion under navigation guided 8.pus aspiration 9.water irrigation 10.close wound in layers Operators 賴達明, 蕭輔仁 Assistants 胡朝凱, 陳國瑋 相關圖片 林承輝 (M,1965/12/12,46y3m) 手術日期 2011/04/08 手術主治醫師 賴達明 手術區域 東址 019房 02號 診斷 HIVD 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 陳以幸, 時間資訊 00:00 臨時手術NPO 11:50 報到 12:25 進入手術室 12:35 麻醉開始 13:00 誘導結束 13:30 抗生素給藥 14:05 手術開始 16:30 手術結束 16:30 麻醉結束 16:43 送出病患 16:45 進入恢復室 18:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-腰椎 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: discectomy 開立醫師: 陳以幸 開立時間: 2011/04/08 16:52 Pre-operative Diagnosis HIVD, L5-S1 Post-operative Diagnosis HIVD, L5-S1 Operative Method discectomy Specimen Count And Types nil Pathology nil Operative Findings bulging disc over L5-S1 level, with root compression Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: semiprone with a bolster beneath -- side and flexed at the waist and knees. 3. Skin preparation: the back was shaved and scrubbed with povidone-iodine detergent then painted with povidone-iodine tincture and followed by sterilized adhesive plastic sheet covering. 4.A spinal needle was inserted between spinous processes of L5-S1 and a portable X-ray film was taken to locate the correct interspace. 5.Incision: 3-cm, between L5-S1 spinous processes,midiline at the margin of spinous processes. The subcutaneous layer and lumbdorsal fascia were incised then. 6.The aponeurosis of the latissimus dorsi and ileocostalis lumborum muscles at spinous processes of L5 -S1 was incised, the muscles were detached from the interspinous ligament. The multifidus muscles were detached subperiosteally from L5-S1 laminae by a rasp. 7.The paravertebral muscles were retracted by a modified gelpi which was retained constantly by a rubbersling to the side rail of the operating table. 8.Under an operating microscope, the ligamentum flavum was cleaned and incised longitudinally at the lateral part with a No. 11 blade. The lateral portion of this ligament was removed with a small angle Kerrison rongeur, the lateral portion of the laminae and the medial border of the facets were removed too until the margin of the facets and a corridor to the disc that ran lateral to the root was reached. 9. The epidural fat was left undisturbed andpreserved. 10.The compressed L5-S1root and veins overlying the protruded disc were gently pushed away by placing 2 small cottonoid patties, one above and one below the disc at the floor of the epidural canal. 11.The compressed root was gently pushed further away temporarily by sucker tip in order to expose the herniated disc more clearly. The posterior longitudinal ligament and annulus were incised around the protruded disc with a No. 15 blade. The degenerated disc was removed with microdisc forcepsuntil a substantial amount of the nucleus had been loosened with a cone curette and removed. 12.A piece of subcutaneous fat was resected and covered on -- root. 13.The lumbodorsal fascia was approximated by 3 interruped 2/0 silk stitches. 14.Thesubcutaneous layer was closed by running suture with 4/0 Dexon and skin by adhesive tape. 15.Course of the surgery: smooth. Operators 賴達明 Assistants 蔡宗良 陳以幸 楊煌 (M,1971/12/06,40y3m) 手術日期 2011/04/08 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 HIVD 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 2 紀錄醫師 陳以幸, 時間資訊 00:00 臨時手術NPO 07:55 報到 08:05 進入手術室 08:10 麻醉開始 08:30 誘導結束 08:45 抗生素給藥 09:15 手術開始 12:10 手術結束 12:10 麻醉結束 12:20 送出病患 12:23 進入恢復室 13:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 手術 椎間盤切除術-頸椎 1 1 手術 椎融合術-前融合,無固定物(≦四節) 1 2 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: Anterior Discectomy and Fusion, Cervical Spine 開立醫師: 陳以幸 開立時間: 2011/04/08 12:31 Pre-operative Diagnosis 1.C4-5 HIVD 2.kyphosis Post-operative Diagnosis 1.C4-5 HIVD 2.kyphosis Operative Method Anterior Discectomy and Fusion, Cervical Spine Specimen Count And Types nil Pathology nil Operative Findings 1.narrowed intervertebral space, C4-5, with spur formation 2.Mild subcutaneous tissue adhesion due to previous operation Operative Procedures 1. Anesthesia: endotracheal general 2.Position: supine with neck hyperextended by a air cuff placed beneath the shoulder. Rt side pelvis was elevated too. 3. Skin preparation: the anterior neck was shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4.Incision; cm, transverse middle cervical, extended from anterior margin of sternocleidomastoid (SCM) muscle to thyroid cartilage. 5. The plastysma muscle was transected and mobilized from the underlying superficial cervical fascia which was then opened in vertical direction along the anterior margin of the SCM muscle. 6.The dissection was advanced at the loose plane between SCM muscle and strip muscles until the prevertebral fascia had been reached. The former structure was retracted to the lateral and the later structures with esophagus and trachea to the opposite side by Cloward cervical retractor. 7.The prevertebral fascia was opened vertically, the lesion intervertebral space was exposed and identified by intraoperative portable X-ray 8.The most medial portion of the longus colli muscles on both sides were detached from the vertebral bodies to provide a wider exposure of the vertebral bodies. 9.The anterior longitudinal ligment was incised transversely at the margins of intervertebral space, the annulus fibrosus was cut too. 10.The degenerated disc and cartilage plate were removed by curette andthe anterior-inferior rim of C 4-5 vertebral body was resected by Kerrison punch for easier approach to the posterior rim of the intervertebral space. 11.The intervertebral spac was widened by a Cloward interveetebral spreader. The sclerotic spondylotic bar at the posterior margin of C-,4,5 bodies and the spur at foramen Luscka were removed by high speed air drill and fine curette. The posterior longitudinal ligament was cut from bony edge by curette and then removed. Consequently, the spinal dura expanded into the intervertebral space. 12.The surfaces of vertebral bodies at this intervertebral space was trimed by high speed air drill to creat a biconcave intervertebral space. 13.A cervios, wedge-shaped, 6mm size cage was put into the intervertebral space 14.The air cuff beneath the shoulder was deflated, the Cloward cervical retractor removed. 15.Wound closure: continuous suture with 4/0 Dexon for plastisma and continuous suture with 4/0 nylon on the skin. 17.Drain:minivac 18.Blood transfusion:nil 19.Course of the surgery: smooth. Operators 賴達明 Assistants 蔡宗良 陳以幸 陳林專 (F,1933/12/05,78y3m) 手術日期 2011/04/08 手術主治醫師 楊士弘 手術區域 東址 005房 01號 診斷 Intraspinal abscess 器械術式 Laminectomy for decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 時間資訊 00:00 臨時手術NPO 08:07 進入手術室 08:20 麻醉開始 08:35 誘導結束 09:30 手術開始 10:24 抗生素給藥 11:43 12:00 手術結束 12:00 12:00 麻醉結束 12:13 送出病患 12:15 進入恢復室 13:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 經皮腎臟造廔術-單側(豬尾巴) 1 1 R 手術 椎間盤切除術-腰椎 1 1 摘要__ 手術科部: 外科部 套用罐頭: Endoscopic debridement 開立醫師: 陳國瑋 開立時間: 2011/04/08 10:44 Pre-operative Diagnosis L45 paraspinal abscess L4-5 spondylodiskitis L4-5 spondylodiskitis Post-operative Diagnosis L45 paraspinal abscess L4-5 spondylodiskitis L4-5 spondylodiskitis Operative Method Endoscopic debridement Percutaneous endoscopic debridement Percutaneous endoscopic debridement Specimen Count And Types 1 piece About size:pieces Source:paraspinal abscess Pathology pending Operative Findings friable necrotic tissue was found in the L4-5 disk space. No frank pus was noted. Pedicle screw of left L5 was noted. Friable necrotic tissue was noted at L4-5 disc space. No frank pus was noted. The right pedicle screw of L5 was noted. Operative Procedures After ETGA, the patient was put in prone position. Localization of L45 with C-arm. Skin disinfection and draping was done as usual. Endoscope was inserted at about 10cm right to spinal process to reach L45 paraspinal space. Debridement was done under endoscope. After ETGA, the patient was put in prone position. Localization of L45 with C-arm. Skin disinfection and draping was done as usual. Endoscope was inserted at about 10cm right lateral to spinal process to reach L4-5 paraspinal space under C-arm. Debridement and saline irrigation was done under endoscope. The wound was closed with Nylon. After ETGA, the patient was put in prone position. Localization of L4-5 with C-arm. Skin disinfection and draping was done as usual. Endoscope was inserted at about 10cm right lateral to spinal process to reach L4-5 paraspinal space. Debridement and normal saline irrigation was done under endoscope. The wound was closed with Nylon. Operators 楊士弘 Assistants 胡朝凱 陳國瑋 相關圖片 摘要__ 手術科部: 外科部 套用罐頭: Percutaneous endoscopic debridement 開立醫師: 陳國瑋 開立時間: 2011/04/08 11:40 Pre-operative Diagnosis L4-5 spondylodiskitis Post-operative Diagnosis L4-5 spondylodiskitis Operative Method Percutaneous endoscopic debridement Specimen Count And Types 1 piece About size:pieces Source:paraspinal abscess Pathology pending Operative Findings friable necrotic tissue was found in the L4-5 disk space. No frank pus was noted. Pedicle screw of left L5 was noted. Operative Procedures After ETGA, the patient was put in prone position. Localization of L45 with C-arm. Skin disinfection and draping was done as usual. Endoscope was inserted at about 10cm right lateral to spinal process to reach L4-5 paraspinal space under C-arm. Debridement and saline irrigation was done under endoscope. Suction of the necrotic disc space by 7-Fr. sheath was also done. The wound was closed with Nylon. Operators 楊士弘 Assistants 胡朝凱 陳國瑋 相關圖片 記錄__ 手術科部: 泌尿部 套用罐頭: Pigtail PCN 開立醫師: 柯智群 開立時間: 2011/04/08 12:10 Pre-operative Diagnosis Right hydronephrosis Post-operative Diagnosis Right hydronephrosis Operative Method Right pigtail PCN Specimen Count And Types nil Pathology nil Operative Findings Dilated renal pelvis and collecting system Operative Procedures Under satisfactory general anesthesia, the patient was placed in prone position. Prepping and draping were performed in the usual sterile method. Dilated renal collecting system was identified. Adequate puncture path was chosen. The puncture needle was introduced into the collecting system under ultrasonographic guidance. The guide-wire was inserted into right renal pelvis under sono-guidedance. The tract was dilated with dilators, and the pigtail catheter was introduced into the renal pelvis smoothly through the guidewire. The guidewire was removed. After the fluid was drained out, the tube was fixed on the skin. The patient tolerated the operation well, and was sent to POR for further post-op observation and management. Operators 戴槐青, Assistants 柯智群, 相關圖片 李白燕 (F,1926/07/10,85y8m) 手術日期 2011/04/08 手術主治醫師 林孟暐 手術區域 東址 025房 03號 診斷 Head Injury 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 劉漢平 ASA 3 紀錄醫師 廖先啟, 時間資訊 14:24 進入手術室 14:25 麻醉開始 14:28 誘導結束 14:35 手術開始 14:45 手術結束 14:45 麻醉結束 14:47 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 氣管切開術 1 0 記錄__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 廖先啟 開立時間: 2011/04/08 14:51 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types nil Pathology None Operative Findings Fr . 7 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators V林孟暐 Assistants R3鄒冠全, R3廖先啟 KITAMURA HARUMASA (M,1948/04/08,63y11m) 手術日期 2011/04/09 手術主治醫師 杜永光 手術區域 東址 006房 06號 診斷 Subarachnoid hemorrhage 器械術式 V-P shunt 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林峰盛 ASA 3 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 13:25 進入手術室 13:30 麻醉開始 13:35 誘導結束 14:30 手術開始 15:11 手術結束 15:11 麻醉結束 15:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt insertion via righ... 開立醫師: 王奐之 開立時間: 2011/04/09 15:32 Pre-operative Diagnosis Intraventricular hemorrahge with hydrocephalus Post-operative Diagnosis Intraventricular hemorrahge with hydrocephalus Operative Method Ventriculoperitoneal shunt insertion via right Kocher point Specimen Count And Types Nil Pathology Nil Operative Findings Slightly pinkish CSF was noted. Codman medium pressure reservoir was used. Ventricular catheter length: 6.5cm. Peritoneal catheter length: 30cm. Operative Procedures After ETGA, the patient was placed in supine position with head turned to left. After scalp shaving, disinfection and draping in sterile fashion, the incision of previous right Kocher point was re-opened. A linear skin incision was made at RUQ area, followed by mini-laparotomy. After creating the subcutaneous tunnel and assembly of the shunt, the ventricular catheter was inserted, and the peritoneal catheter was also inserted after confirmation of smooth CSF flow. After meticulous hemostasis, the wounds were closed in layers. Operators P杜永光 Assistants R6陳睿生, R3王奐之, R1陳宣佑 相關圖片 賴正炎 (M,1945/09/30,66y5m) 手術日期 2011/04/09 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Parkinson's Disease 器械術式 Stereotaxic procedure for impl 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 面罩麻醉 麻醉主治醫師 林峰盛 ASA 3 紀錄醫師 胡朝凱, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:23 麻醉開始 08:30 誘導結束 08:45 開始輸血 08:50 抗生素給藥 08:55 手術開始 11:50 抗生素給藥 14:50 抗生素給藥 15:30 手術結束 15:30 麻醉結束 15:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 立體定位術-功能性失調 1 1 手術 深部腦核電生理定位 1 0 手術 立體定位術-功能性失調 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Semi-opened mask inhalation anes 1 0 麻醉 Semi-opened INHALATION GENERAL A 4 0 麻醉 SENI-OPENED INHALATION GENERAL A 6 0 記錄__ 手術科部: 外科部 套用罐頭: Insertion of DBS wire at bilateral subthalamus nucleas 開立醫師: 胡朝凱 開立時間: 2011/04/09 15:51 Pre-operative Diagnosis Parkisons disease Post-operative Diagnosis Parkisons disease Operative Method Insertion of DBS wire at bilateral subthalamus nucleas Specimen Count And Types nil Pathology Nil Operative Findings 1. The rigidity decreased after wire inserted at stimulation "on". 2. No EOM limitation or neurologic deficit 3. The final target was 2mm lateral to the planned target. Operative Procedures Under IV general anesthesia, the patient was put in supine position. The scalp was shaved, scrubbed and antiseptic with alcohol B-I. Registered the preset localization point to navigator. Bicoronal scalp incision was made with burr hole made at entery point of left frontal region as navigator guided. The DBS wire port was set up and localization of subthalamus nucleus with microelectrode assistance. Inserted the DBS wire and fixed with the port. Waked the patient from the anesthesia and started stimulation from low voltage. Checked the clinical responses while using different voltage for stimulation. Performed the same procedure at right side. After hemostasis, closed the wound in layers. Operators 曾勝弘 Assistants 胡朝凱 楊欣怡 (F,1973/09/21,38y5m) 手術日期 2011/04/09 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林峰盛 ASA 3 紀錄醫師 陳宣佑, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:10 麻醉開始 08:20 誘導結束 08:40 抗生素給藥 09:52 手術開始 11:40 抗生素給藥 14:40 抗生素給藥 15:00 開始輸血 17:35 手術結束 17:35 麻醉結束 17:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在8小時以上 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 11 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for Simpsons grade 2 removal of pa... 開立醫師: 蔡宗良 開立時間: 2011/04/09 17:58 Pre-operative Diagnosis Meningioma, parasaggital, left-sided, middle-third Post-operative Diagnosis Meningioma, parasaggital, left-sided, middle-third Operative Method Craniotomy for Simpsons grade 2 removal of parasaggital meningioma, left-sided, middle-third Specimen Count And Types 1 piece About size:小 Source:brain Pathology Report pending. Operative Findings 1. Tumor consistency: greyish in color, elastic, moderately hard, not easily suckable. Vascular supply was abundant at the falx area. Tumor falx attachment was at the falx. 2. Bridging vein morphology: two large bridging vein one at the frontal side and the other at occipital side, located at the subarachonid space between the normal brain and the tumor. Bridging veins were preserved. Operative Procedures Patient was put under ETGA. Fluoroscope was used to identify the emissary vein to avoid injury to the emissasry vein. The head was then fixed with Mayfield head clamp. Patient was positioned in three-quater prone positioned and rotated towards the right. Scalp was routinely prepped and drapped. An inverted U shape scalp incision was made and a 6 x 5 craniotomy window was made. The meningeal vessels above the dura was coagulated. A inverted U shaped durotomy was made. Microscope was brought into the operating field. The tumor subarachnoid plane was identified and packed with cotton pad. The tumor was then removed by bipolar cautery, Bayonet suction and tumor forceps step by step. Tumor attachment at the falx area was coagulated with bipolar cautery. After meticulous hemostasis, the dura was closed by 4-0 Prolene in water-tight fashion. Skull plate was fixed back to the craniotomy window wiht 7 G8 wires. The wounds was closed in layers after placement of one subgaleal CWV drain. Operators VS 王國川 Assistants R5 蔡宗良, R1陳宣佑 葉妤 (F,2001/03/24,10y11m) 手術日期 2011/04/11 手術主治醫師 廖漢文 手術區域 東址 000房 號 診斷 Moyamoya disease 器械術式 Common Carotid Angiography 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 王永彬 ASA 3 時間資訊 09:00 麻醉開始 09:15 誘導結束 09:45 麻醉結束 11:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 王怡 (F,1999/04/19,12y10m) 手術日期 2011/04/11 手術主治醫師 廖漢文 手術區域 東址 000房 號 診斷 Moyamoya disease 器械術式 Common Carotid Angiography 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 王永彬 ASA 3 時間資訊 10:20 麻醉開始 10:30 誘導結束 11:10 麻醉結束 11:17 進入恢復室 12:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 曾碧清 (F,1963/09/25,48y5m) 手術日期 2011/04/11 手術主治醫師 王水深 手術區域 東址 001房 06號 診斷 Fitting and adjustment of vascular catheter 器械術式 Port -A implantation 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 趙安怡 ASA 2 紀錄醫師 羅健洺, 時間資訊 17:05 臨時手術NPO 17:00 報到 17:40 進入手術室 17:45 麻醉開始 17:50 誘導結束 18:00 抗生素給藥 18:00 手術開始 18:15 手術結束 18:15 麻醉結束 18:20 送出病患 18:25 進入恢復室 20:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 內頸靜脈切開,永久導管放置術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 記錄__ 手術科部: 外科部 套用罐頭: Permcath/port-A 開立醫師: 羅健洺 開立時間: 2011/04/11 18:27 Pre-operative Diagnosis Leukemia Post-operative Diagnosis Leukemia s/p Port-A insertion Operative Method Port-A implantation via right internal jugular vein Specimen Count And Types nil Pathology nil Operative Findings 1. The Port-A catheter was inserted via right internal jugular vein by echo-guided procedure 2. Patent flow after implantation Operative Procedures -Anesthesia: IVG, the patient was put on supine position. The operation field was disinfected and draped as usual. -Port-A: After skin disinfection and drapping & local anesthesia, echo-guided RIJV cut down and catheterization was performed. Creation of the subcutaneous pocket at right subclavicular area. Tunneliztion, advanced the catheter into the RIJV via the peel-away sheath smoothly. Wound closure in layers after adequate hemostasis. Operators 王水深, Assistants 羅健洺, 任寶美 (F,1955/10/29,56y4m) 手術日期 2011/04/11 手術主治醫師 賴達明 手術區域 東址 016房 01號 診斷 Subarachnoid hemorrhage (SAH) 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 蔡宗良, 時間資訊 00:09 臨時手術NPO 00:09 開始NPO 08:08 通知急診手術 09:00 進入手術室 09:05 麻醉開始 09:13 誘導結束 09:37 手術開始 09:40 抗生素給藥 09:52 手術結束 09:53 麻醉結束 10:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 慢性硬腦膜下血腫清除術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Subdural drain placement, right-sided 開立醫師: 蔡宗良 開立時間: 2011/04/11 10:28 Pre-operative Diagnosis Subdural hygroma Post-operative Diagnosis Subdural hygroma Operative Method Subdural drain placement, right-sided Specimen Count And Types 1 piece About size:小 x 3 Source:CSF Pathology None Operative Findings 1. CSF: serosanginous; pressure: high (CSF gushed out during scalp incision) Operative Procedures 1. ETGA, supine, head rotated 60 degrees to the left 2. Scalp routinely prepped and drapped. 3. Scalp incision over previous wound, approx. 2 cm 4. Drain (EVD tube) inserted towards the subdural space 5. Drain fixation 6. CSF collection 7. Wound closed in layers. Operators VS 賴達明 Assistants R5 蔡宗良 Indication Of Emergent Operation Increased intracranial pressure with deteriorating GCS 周謝欽 (M,1956/02/10,56y1m) 手術日期 2011/04/11 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Cervical spondylosis 器械術式 Lamino plasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 08:01 進入手術室 08:08 麻醉開始 08:30 誘導結束 08:36 手術開始 08:45 抗生素給藥 11:45 抗生素給藥 12:00 手術結束 12:00 麻醉結束 12:10 送出病患 12:13 進入恢復室 13:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓整形術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: C3,4 laminectomy and C5,6 laminoplasty 開立醫師: 游健生 開立時間: 2011/04/11 12:31 Pre-operative Diagnosis C3-5 ossification of posterior longitudinal ligament with severe cervical stenosis and myelopathy Post-operative Diagnosis C3-5 ossification of posterior longitudinal ligament with severe cervical stenosis and myelopathy Operative Method C3,4 laminectomy and C5,6 laminoplasty Specimen Count And Types nil Pathology Nil Operative Findings Severe thecal sac compression due to OPLL and hypertrophic ligamentum flavum was noted. It was well decompressed after laminectomy and laminoplasty. Pre-operation SSEP waveform was poor on both side with right side a bit better. There was no obvious waveform changes during surgery. Operative Procedures Under nasal ETGA, patient was put into prone position with head fixed by headclamp and neck flexed. Pre-operative SSEP showed poor waveform. After shaving, we disinfected and draped the operation field as usual. A midline incision was made from C2 to C7. We dissected in layers and exposed C2 to C6 spinous process and laminae. We drilled off whole layer C3,4 laminae on both side and C5,6 on right side. C3,4 laminae were removed. We drilled off C5,6 laminae on left side till inner table then flapped both laminae up. We removed the hypertrophic ligamentum flavum for further decompression. C5,6 laminea were connected to right lateral mass with mini-plates. After hemostasis and wound irrigation with Gentamycin solution, we set one epidural CWV drain and closed the wound in layers. Operators VS 賴達明 Assistants R6 陳睿生 R3 游健生 黃福連 (M,1939/06/07,72y9m) 手術日期 2011/04/11 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Cervical spondylosis 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 12:20 進入手術室 12:25 麻醉開始 12:35 誘導結束 12:55 抗生素給藥 13:15 手術開始 15:55 抗生素給藥 16:55 手術結束 16:55 麻醉結束 17:03 送出病患 17:05 進入恢復室 18:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-前融合,有固定物)≦四節 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: C3/4 and C5/6 anterior diskectomy and fusion ... 開立醫師: 游健生 開立時間: 2011/04/11 17:13 Pre-operative Diagnosis C3/4 and C5/6 herniated intervertebral disc with spinal stenosis and myelopathy Post-operative Diagnosis C3/4 and C5/6 herniated intervertebral disc with spinal stenosis and myelopathy Operative Method C3/4 and C5/6 anterior diskectomy and fusion with cage Specimen Count And Types nil Pathology Nil Operative Findings Herniated disc were noted at C3/4 and C5/6 level with thecal sac compression. It was well decompressed after diskectomy. 5# cage was used at C3/4 and 6# cage was used at C5/6. Operative Procedures 1. Under ETGA, patient was in supine position with neck extended. 2. Disinfection and draping 3. A transverse neck incision at C4/5 level on right side 4. Transected and mobilized platysma muscle 5. Opened anterior cervical facisa just anterior to SCM muscle 6. Dissected along the avascular plane to expose vertebral bodies 7. Localized C3/4 and C5/6 intervertebral space by C-arm 8. Performed C3/4 diskectomy under microscope and inserted a cage 9. Repeated above procedure at C5/6 level 10.Confirmed cage position by C-arm 11.Hemostasis and irrigration with Gentamycin solution 12.Closed wound in layers with a mini-MV in place Operators VS 賴達明 Assistants R6 陳睿生 R3 游健生 吳懷遠 (M,1942/01/10,70y2m) 手術日期 2011/04/11 手術主治醫師 賴達明 手術區域 東址 005房 01號 診斷 Herniation of intervertebral disc without myelopathy, cervical (HIVD) 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 07:42 報到 08:06 進入手術室 08:10 麻醉開始 08:25 誘導結束 08:44 抗生素給藥 09:02 手術開始 11:44 抗生素給藥 12:35 手術結束 12:35 麻醉結束 12:45 送出病患 12:50 進入恢復室 13:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-頸椎 1 1 手術 脊椎融合術-前融合,有固定物(每增加<=四節) 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: ACDF and plate fixation 開立醫師: 胡朝凱 開立時間: 2011/04/11 12:38 Pre-operative Diagnosis c3~4,4~5 HIVD Post-operative Diagnosis c3~4,4~5 HIVD Operative Method ACDF and plate fixation Specimen Count And Types nil Pathology nil Operative Findings 1.Protruding disc at C3~4, and 4~5 level that compressed the cord tightly. 2.hypertrophic PLL 3.After decompression, thecal sac expanded well 4.Cage x2: #5, Plate: 37 mm Operative Procedures 1.ETGA, supine 2.Transverse skin incision 3.Dissect along with the anterior border of SCM to open prevertebral space 4.Detach longus coli muscle 5.Discectomy 6.Cage insertion 7.Plate fixation 8.Set one hemovac 9.Close wound in layers. Operators 賴達明 Assistants 胡朝凱, 陳國瑋 相關圖片 蔡旺興 (M,1966/09/10,45y6m) 手術日期 2011/04/11 手術主治醫師 賴達明 手術區域 東址 005房 02號 診斷 Radiculopathy 器械術式 Lamino plasty 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 12:30 報到 13:05 進入手術室 13:10 麻醉開始 13:20 誘導結束 13:30 抗生素給藥 13:34 手術開始 16:10 手術結束 16:10 麻醉結束 16:15 進入恢復室 16:20 送出病患 17:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓整形術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: C3~5 laminoplasty 開立醫師: 陳國瑋 開立時間: 2011/04/11 16:24 Pre-operative Diagnosis Cervical OPLL Post-operative Diagnosis Cervical OPLL Operative Method C3~5 laminoplasty Specimen Count And Types nil Pathology nil Operative Findings 1.The sipnal cord was compressed tightly from anterior 2.Hypertrophic flavum ligment 3.the axis was left at right Operative Procedures 1.ETGA, prone 2.Midline skin incision 3.Dissect to expose C3~5 lamina 4.Drill right lamina cortex 5.Drill off left lamina 6.Laminoplasty with miniplate fixation 7.Set one CWV drain 8.Close wound in layers Operators 賴達明 Assistants 胡朝凱, 陳國瑋 相關圖片 賴榮德 (M,1942/06/25,69y8m) 手術日期 2011/04/11 手術主治醫師 王國川 手術區域 東址 002房 02號 診斷 Subarachnoid hemorrhage 器械術式 V-P shunt 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3E 紀錄醫師 王奐之, 時間資訊 12:31 通知急診手術 15:00 進入手術室 15:05 麻醉開始 15:10 誘導結束 15:11 抗生素給藥 15:52 手術開始 16:35 手術結束 16:35 麻醉結束 16:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室腹腔分流手術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt insertion via righ... 開立醫師: 王奐之 開立時間: 2011/04/11 16:54 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunt insertion via right Kocher point Specimen Count And Types Nil Pathology Nil Operative Findings A medium pressure Medtronic valve was used. Opening pressure upon ventricular puncture was about 15cmH2O, slight xanthochromic CSF was collected and sent for routine, BCS & bacterial culture. Operative Procedures After ETGA, the patient was placed in supine position with face turned to left. After scalp shaving, disinfection & draping in sterile fashion, a curved incision was made at right frontal area. A burr hole was created at right Kocher point, followed by 2 tenting stitches. Another linear skin incision was made at right upper quadrant of abdomen, followed by mini-laparotomy. After creating the subcutaneous tunnel from the abdominal wound to the right frontal wound, the shunt assembly was done. Ventricular puncture was done, followed by shunt insertion. After securing the shunt and meticulous hemostasis, the wounds were closed in layers. Operators VS 王國川 Assistants R3 王奐之, Ri 洪士鈞 Indication Of Emergent Operation IICP 相關圖片 李蔡玉 (F,1938/04/13,73y11m) 手術日期 2011/04/11 手術主治醫師 陳偉勵 手術區域 東址 011房 03號 診斷 Cataract 器械術式 Phaco+PCIOL 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 10:05 送出病患 10:27 進入手術室 10:40 手術開始 11:03 手術結束 記錄__ 手術科部: 眼科部 套用罐頭: Phacoemulsification and PCIOL implantation(os) 開立醫師: 劉傳方 開立時間: 2011/04/11 11:02 Pre-operative Diagnosis Cataract (os) Post-operative Diagnosis Cataract (os) Operative Method Phacoemulsification and PCIOL implantation(os) Specimen Count And Types nil Pathology Nil Operative Findings Cataract (os) Operative Procedures 1. Under topical anesthesia 2. Disinfection, irrigation and draping. 3. Application of an eyelid speculum. 4. Made a clear corneal incision and penetrate into AC with 2.5mm cresent knife at 3 oclock position . 5. InjectViscoat into the anterior chamber. 6. Continuous circular capsulorrhexis was done with capsular forceps. 7. Made a sideport at 6 oclock position with the MVR blade. 8. Hydrodissection and hydrodelineation were done with BSS. 9. Phacoemulsification of the nucleus by standard divide-and-conquer technique. 10. Aspiration of the residual cortical material with I/A cannula. 11. One-piece PCIOL was implanted into the bag after injection of Viscoat. 12. The residual Viscoatwas washed out by I/A cannula. 13. Inject BSS into AC and check leakage. 14. Subconjunctival injection of Rinderon and Gentamicin. 15. Maxitrol patching. Operators 陳偉勵, Assistants R4黃宇軒,R3劉傳方 錢嘉明 (M,1951/09/14,60y6m) 手術日期 2011/04/11 手術主治醫師 郭文宏 手術區域 兒醫 069房 01號 診斷 Breast mass 器械術式 Right, tumor excision 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 面罩麻醉 麻醉主治醫師 黃啟祥 ASA 3 紀錄醫師 許松鈺, 時間資訊 08:30 報到 08:35 進入手術室 08:40 麻醉開始 08:45 誘導結束 08:50 抗生素給藥 08:59 手術開始 09:22 手術結束 09:22 麻醉結束 09:27 送出病患 09:30 進入恢復室 10:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Semi-opened mask inhalation anes 1 0 手術 部份乳房切除術-單側 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Tumor excision 開立醫師: 許松鈺 開立時間: 2011/04/11 09:38 Pre-operative Diagnosis Right breast tumor Post-operative Diagnosis Right breast tumor Operative Method Tumor excision Specimen Count And Types 1 piece About size:1.5X2CM Source:Right breast tumor Pathology pending Operative Findings One elastic, encapsulated tumor over 3oclock, just beside nipple was noted. Operative Procedures 1. IVGA, supine position, skin disinfection 2. Make skin incision along areola just above the tumor 3. Perform tumor excision 4. Hemosatasis and close the wound in layers Operators 郭文宏 Assistants 許松鈺, Ri 相關圖片 唐美蓉 (F,1951/01/01,61y2m) 手術日期 2011/04/12 手術主治醫師 曾勝弘 手術區域 東址 005房 02號 診斷 Infection and inflammatory reaction due to nervous system device, implant, and graft 器械術式 Debridment-- 5-10cm 手術類別 預定手術 手術部位 頭、頸 傷口分類 髒 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 10:28 進入手術室 10:33 麻醉開始 10:40 誘導結束 10:40 抗生素給藥 11:05 手術開始 11:30 手術結束 11:30 麻醉結束 11:50 送出病患 11:57 進入恢復室 13:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 頭皮腫瘤 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Wound debridement with primary closure 開立醫師: 李振豪 開立時間: 2011/04/12 11:44 Pre-operative Diagnosis Right frontal wound infection Post-operative Diagnosis Right frontal wound infection Operative Method Wound debridement with primary closure Specimen Count And Types 1 piece About size:Swab x III Source:right frontal wound Pathology Nil Operative Findings The pus gushed out during scalp shaving. The eschar was removed and one 0.3cm in diameter wound was noted. The subcutaneous space was filled with necrotic tissue. Fusiform scalp incision with 0.4cm in width was removed. The wire was identified during the procedure and protected well. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position. The scalp was shaved, scrubbed, and disinfected as usual. Wound debridement was performed with curette and scissor. The wound edge was trimmed. Undermining was performed along the subgaleal space. The wound was irrigated with Vancomycin and Gentamicin solution. Hemostasis was achieved and the wound was closed in layers with 3-0 Nylon interrupted suture. Operators VS曾勝弘 Assistants R4李振豪, Ri蔡佳穎 相關圖片 賴正炎 (M,1945/09/30,66y5m) 手術日期 2011/04/12 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Parkinson's Disease 器械術式 generator implantation 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 08:08 進入手術室 08:15 麻醉開始 08:20 誘導結束 08:40 抗生素給藥 08:52 手術開始 09:55 手術結束 09:55 麻醉結束 10:10 送出病患 10:15 進入恢復室 12:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 2 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Implantable pulse generator implantation 開立醫師: 李振豪 開立時間: 2011/04/12 10:19 Pre-operative Diagnosis Parkinson"s disease, status post deep brain stimulation wire implantation Post-operative Diagnosis Parkinson"s disease, status post deep brain stimulation wire implantation Operative Method Implantable pulse generator implantation Specimen Count And Types nil Pathology Nil Operative Findings The IPG was place at left forechest and the function of the DBS was ok after connected all compartment together. The operative course was smooth and the patient tolerate whole procedure well. Operative Procedures Under endotracheal tube general anesthesia, The patient was put in supine position with head rotated to right. The scalp was shaved, scrubbed, and disinfected as usual. Linear scalp incision was made at left parieto-occipital area and the end of wire was pulled out. Left forechest transverse skin incision was made and the subcutaneous pocket was created above the fascia of pectoralis major. The subcutaneous tunnel was created from left forechest, left neck, to left retroauricular area. The wire was passed through the subcutaneous tunnel and the deep brain stimulation was set up with the implantable pulse generator. The function of the DBS was checked. Hemostasis was achieved. The wound was then closed in layers.(scalp: 2-0 Vicryl and 3-0 Nylon, forechest: 3-0 Vicryl and 4-0 Vicryl subcuticular suture) Operators VS曾勝弘 Assistants R4李振豪, Ri 相關圖片 蔡月玲 (F,1954/05/18,57y9m) 手術日期 2011/04/12 手術主治醫師 曾勝弘 手術區域 西址 039房 02號 診斷 Carpal tunnel syndrome 器械術式 Decompression of mediun nerve 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 09:55 報到 10:20 進入手術室 10:30 麻醉開始 10:33 手術開始 10:55 麻醉結束 10:55 手術結束 11:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 正中神經或尺神經腕部減壓術–單側 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Carpal tunnel release, right 開立醫師: 王奐之 開立時間: 2011/04/12 10:56 Pre-operative Diagnosis Carpal tunnel syndrome, right Post-operative Diagnosis Carpal tunnel syndrome, right Operative Method Carpal tunnel release, right Specimen Count And Types nil Pathology Nil Operative Findings Hypertrophic flexor retinaculum was noted. The nerve sheath expanded well after decompression. Operative Procedures The patient was placed in supine position with right arm stretched out on a arm rest. After disinfection and draping in sterile fashion, local anesthesia was applied to the surgical field. A linear skin incision was made at proximal palm, and further deepened until the flexor retinaculum was exposed. The flexor retinaculum was then cut thoroughly until fully decompression of the median nerve. After hemostasis, the wound was closed in layers. Operators VS 曾勝弘 Assistants R3 王奐之 相關圖片 葉妤 (F,2001/03/24,10y11m) 手術日期 2011/04/12 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Moyamoya disease 器械術式 Moyamoya /EDAS Dr.郭 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 10:05 進入恢復室 07:50 報到 08:08 進入手術室 08:10 麻醉開始 08:35 誘導結束 08:42 抗生素給藥 10:07 手術開始 11:42 抗生素給藥 14:05 送出病患 14:53 麻醉結束 14:53 手術結束 醫令資訊 類別 名稱 量 刀 側 手術 顱內外血管吻合術 1 1 L 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 手術 朴卜勒氏血流測定（週邊血管） 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 3 0 麻醉 Hemoglobin (Hb) 3 0 麻醉 測血糖 3 0 麻醉 Ca (Calcium) 3 0 麻醉 Na (Sodium) 3 0 麻醉 K (Potassium) 3 0 麻醉 Blood gas analysis 3 0 摘要__ 手術科部: 外科部 套用罐頭: Encephaloduroarteriosynangiosis,left. 開立醫師: 鍾文桂 開立時間: 2011/04/12 16:49 Pre-operative Diagnosis Moyamoya disease status post encephaloduroarteriosynangiosis, right. Post-operative Diagnosis Moyamoya disease status post encephaloduroarteriosynangiosis, right. Operative Method Encephaloduroarteriosynangiosis,left. Specimen Count And Types nil Pathology Nil. Operative Findings 1. Due to the small caliber of posterior branch of the STA, we harvested both the posterior branch of STA and posterior auricular artery for synangiosis. Both arteries were dissected 6 cm long. 2. Small moymoya collaterals were noted at the cortical surface. Operative Procedures With endotracheal general aenasethesia, the patient was put in supine position with head rotated to right. After scalp shaved, scrubbed, disinfected, and then draped, we localize the position and territory of posterior branch of STA and posterior auricular artery by Doppler. Under microscopic view, we made a T- shape scalp incision and dissected above the galeal to expose both arteries. We made the inicion along 1cm away from the artery at bilateral side, and created craniotomy 5x5cm, beneath the arteries, after linear incision of the left temporalis muscle. After dural tenting, linear durotomy was done, and arachnoid membrane was separated by forceps. Artery graft were anchored at bilateral ends of durotomy, we placed gelfoam to push the graft anteriorly for better contact between the graft and the MCA and the dura was closed in water-tight suture and Durofoam. Bone graft was fixed back with 3 wires, and the wound was closed in layers. Operators 郭夢菲 Assistants R5 鍾文桂 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Encephaloduroarteriosynangiosis,left. 開立醫師: 郭夢菲 開立時間: 2011/04/14 10:21 Pre-operative Diagnosis Moyamoya disease status post encephaloduroarteriosynangiosis, right. Post-operative Diagnosis Moyamoya disease status post encephaloduroarteriosynangiosis, right. Operative Method Encephaloduroarteriosynangiosis, left. Specimen Count And Types nil Pathology Nil. Operative Findings 1. Due to the small caliber of posterior branch of the STA, we harvested both the posterior branch of STA and posterior auricular artery for synangiosis. Both arteries were dissected 6 cm long. 2. Many small moymoya collaterals were noted at the cortical surface. Operative Procedures With endotracheal general aenasethesia, the patient was put in supine position with head rotated to right. After scalp shaved, scrubbed, disinfected, and then draped, we localize the position and territory of posterior branch of STA and posterior auricular artery by Doppler. Under microscopic view, we made a T- shape scalp incision and dissected above the galeal to expose both arteries. We made the inicion along 1cm away from the artery at bilateral side, and created craniotomy 5x5cm, beneath the arteries, after linear incision of the left temporalis muscle. After dural tenting, linear durotomy was done, and arachnoid membrane was separated by forceps. Artery graft were anchored at bilateral ends of durotomy, we placed gelfoam between the dura and the grafts for a better contact between the graft and the MCA, and then the dura was closed in water-tight suture and Durofoam. Bone graft was fixed back with 3 wires, and the wound was closed in layers. Operators 郭夢菲 Assistants R5 鍾文桂 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Encephaloduroarteriosynangiosis,left. 開立醫師: 郭夢菲 開立時間: 2011/04/14 10:21 Pre-operative Diagnosis Moyamoya disease status post encephaloduroarteriosynangiosis, right. Post-operative Diagnosis Moyamoya disease status post encephaloduroarteriosynangiosis, right. Operative Method Encephaloduroarteriosynangiosis, left. Specimen Count And Types nil Pathology Nil. Operative Findings 1. Due to the small caliber of posterior branch of the STA, we harvested both the posterior branch of STA and posterior auricular artery for synangiosis. Both arteries were dissected 6 cm long. 2. Many small moymoya collaterals were noted at the cortical surface. Operative Procedures With endotracheal general aenasethesia, the patient was put in supine position with head rotated to right. After scalp shaved, scrubbed, disinfected, and then draped, we localize the position and territory of posterior branch of STA and posterior auricular artery by Doppler. Under microscopic view, we made a T- shape scalp incision and dissected above the galeal to expose both arteries. We made the inicion along 1cm away from the artery at bilateral side, and created craniotomy 5x5cm, beneath the arteries, after linear incision of the left temporalis muscle. After dural tenting, linear durotomy was done, and arachnoid membrane was separated by forceps. Artery graft were anchored at bilateral ends of durotomy, we placed gelfoam between the dura and the grafts for a better contact between the graft and the MCA, and then the dura was closed in water-tight suture and Durofoam. Bone graft was fixed back with 3 wires, and the wound was closed in layers. Operators 郭夢菲 Assistants R5 鍾文桂 相關圖片 黃張照枝 (F,1939/08/28,72y6m) 手術日期 2011/04/12 手術主治醫師 郭順文 手術區域 東址 016房 07號 診斷 Brain tumor 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 4 紀錄醫師 鄒冠全, 時間資訊 15:21 進入手術室 15:25 麻醉開始 15:27 抗生素給藥 15:30 誘導結束 15:39 手術開始 15:55 手術結束 15:55 麻醉結束 16:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 氣管切開術 1 0 記錄__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 鄒冠全 開立時間: 2011/04/12 16:04 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types nil Pathology None Operative Findings Fr . 7 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators 郭順文 Assistants R3鄒冠全, Ri 陳天惠 (M,1928/01/28,84y1m) 手術日期 2011/04/12 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Ossification of posterior longitudinal ligament (OPLL) (OPLL) 器械術式 Laminectomy C-Spinal(Posterier 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳以幸, 時間資訊 00:00 臨時手術NPO 08:07 進入手術室 08:20 麻醉開始 08:25 誘導結束 08:40 抗生素給藥 08:44 手術開始 10:50 手術結束 10:50 麻醉結束 11:20 送出病患 11:23 進入恢復室 12:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術(減壓)-二節以內 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: Cervical Laminectomy,C4-5 開立醫師: 陳以幸 開立時間: 2011/04/12 11:16 Pre-operative Diagnosis Cervical spondylosis and occification of posterior longitudinal ligament with spinal stenosis at C4-5. Post-operative Diagnosis Cervical spondylosis and occification of posterior longitudinal ligament with spinal stenosis at C4-5. Operative Method Cervical Laminectomy,C4-5 Specimen Count And Types nil Pathology nil Operative Findings 1.spinal stenosis at C4-5 2.occification of posterior longitudinal ligament , C4-6 3.hypertrophic ligmentum flavum, C4-6 Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: prone with neck flexed and head fixed by a Mayfield skull clamp 3. Skin preparation: occipital and neck areas were shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: medline nape, from suboccipital to lower neck. 5. The trapezius, semispinalis capitis, splenius capitis muscles on both sides were splitted at itsorigin of ligamentum nuchae, then, together with serratus posterior superior, rectus capitis posterior, obliqus capitis inferior and multifidus were detached from the spinous processes of C4-5 by Bovie, followed by subperiosteal dissection on the laminae. 6. The paravertebral muscles were kept open by self retaining retractors to expose spinous processes and laminae of C4-5. The bleeding from the muscles was stopped by Bovie. 7. The spinous processes and laminae of C4-5 were bitten off by different type of rongeurs and Kerrison punch until posterior half of the spinal canal was widely opened and the cord had been well decompressed. The hypertrophic ligamenta flava including those at lateral recesses wereresected. The epidural venous bleeding was stopped by gelfoam packing. 8.The paravertebral muscles were closed by interrupted sutures with 2/0 silk, subcutaneous layer by continuous suture with 3/0 Dexon and skin by Appose. 9.Drain: one, epilaminal, CWV. 14.Blood transfusion:nil 15.Course of the surgery: smooth. Operators 賴達明 Assistants 蔡宗良 陳以幸 余淑媛 (F,1952/01/18,60y1m) 手術日期 2011/04/12 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Cervical Spondylosis 器械術式 C laminectomy+ lateral mass screw 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 陳以幸, 時間資訊 00:00 臨時手術NPO 11:30 進入手術室 11:35 麻醉開始 11:45 誘導結束 11:51 手術開始 11:51 抗生素給藥 14:55 抗生素給藥 16:00 手術結束 16:00 麻醉結束 16:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 手術 椎弓切除術(減壓)-超過二節 1 2 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 摘要__ 手術科部: 外科部 套用罐頭: Posterior Fusion for Cervical Spine 開立醫師: 陳以幸 開立時間: 2011/04/12 16:18 Pre-operative Diagnosis 1.C3-C4, C4-C5 subluxation with stenosis Post-operative Diagnosis 1.C3-C4,C4-C5 subluxation with stenosis Operative Method Posterior Fusion for Cervical Spine 1.Posterior Fusion for Cervical Spine,C3-C6 2.laminoplasty, C3-C5 Specimen Count And Types 1 piece About size: Source:C4 spinous process Pathology pending Operative Findings 1.hypertrophy of ligmentum flavum, C3-C5 2.degenrative of spinous process, C3-C4 Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: prone, under radioimage intensifier, the dislocated C-3-6 vertebra was reduced by hyperextension of the neck, then the head was fixed with a Mayfield skull clamp. 3. The general anesthesia was reversed towake up the patient for checking the patients cord function. After no bad effect on cord function by changing position and reduction maneuver had been found, the patient was put back to sleep again. 4.Skin preparation: occipital and neck areas wereshaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 5. Incision: medline nape, from suboccipital to lower neck. 6.The trapezius, semispinalis capitis, splenius capitis muscles on both sides were splitted at its origin of ligamentum nuchae, then, together with serratus posterior superior, rectus capitis posterior, obliqus capitis inferior and multifidus were detached from the spinous processes of C-3-6 by Bovie. Finally, the muscles were detached from the laminae by subperiosteal dissection. 7.The paravertebral muscles were kept open by self retaining retractors to expose spinous processes and laminae of C3-6. The bleeding fromthe muscles was stopped by Bovie. 8. The superior faccet of C 3-6 was resected by Kerrison punch on both sides to dislock the posteriorly displaced superior facet of C3- 6which had interfered the satisfactory reduction. Subsequently, the displaced C3-6was further reduced to a perfect position after releasing the Mayfield clamp. 8.Interlaminal window of C3-6 on both sides were widened by high speed air drill to facilitate passing wire loop around the lamina 9.The ligamenta flava were detached fromthe laminae by angle curette and special designed dissector. 10.A No. 24 - wire loop was passed around each lamina of C 3-6 respectively on each side. 11.Posterior fusion of C3-6 was made by only graft with the rib segment fixed on the laminae on each side and fastened by the wire loops passing through the drill holes on the rib segment. The wires were cross twisted with the opposite upperone. 13.The paravertebral muscles were closed by interrupted sutures with 2/0 silk, subcutaneous layer by continuous suture with 3/0 Dexon and skin by continuous suture with 3/0 nylon. 14.Drain: one, epilaminal, hemovac. 15.Blood transfusion:nil 16.Courseof the surgery: smooth. Operators 賴達明 蕭輔仁 Assistants 蔡宗良 陳以幸 朱益賦 (M,1976/02/16,36y0m) 手術日期 2011/04/12 手術主治醫師 李章銘 手術區域 東址 019房 01號 診斷 Lung Tumor 器械術式 Thoracoscopy+Open Chest 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 3 紀錄醫師 賴碩倫, 時間資訊 07:44 報到 08:08 進入手術室 08:15 麻醉開始 08:45 誘導結束 09:00 抗生素給藥 09:30 手術開始 12:00 抗生素給藥 15:10 手術結束 15:10 麻醉結束 15:25 送出病患 15:30 進入恢復室 16:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 手術 胸腔鏡肺楔狀或部分切除術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: VATS biopsy 開立醫師: 賴碩倫 開立時間: 2011/04/12 15:38 Pre-operative Diagnosis RLL tumor s/p colon cancer metastasis Post-operative Diagnosis RLL tumor s/p colon cancer metastasis Operative Method Wedge resection of pulmonary lesion via VATS. Specimen Count And Types 3 pieces About size:1x1cm Source:RLL tumor About size:1x2cm Source:RLL tumor About size:2x3cm Source:RLL tumor Pathology pending Operative Findings 1. Severe adhesion of lung parenchyma to pleura 2. Three whitish solid tumors noticed at right lower lung 3. Air leakage:(+), mild Operative Procedures 1. Anesthesia: General anesthesia using single-lumen endotracheal tube. 2. Position: left decubitus position. An axillary roll is placed under the down side. The operative field is well disinfected and draped. 3. Camera port: From the seventh intercostal space in the mid-axillary line away from the lesion. 4. Working ports: First: From the fifth intercostal space in the anterior axillary line. Second: From the fifth intercostal space in the posterior axillary line. 5. The pleural adhesions are separated by grasping forceps and by electrocautery. 6. The tumor is visualized and stabilized with the grasping forceps. 7. The Endo-GIA stapler is placed across its base. Wedge resection of the pulmonary lesion is performed. 8. After meticulous homeostasis, one 28# chest tubes is placed via the camera port. The lung is ventilated under the direct vision. The skin is closed with 4-0 Nylon sutures. Operators 李章銘 Assistants 蔡東明 郝政鴻 賴碩倫 鄭玉汝 (F,1956/05/12,55y10m) 手術日期 2011/04/12 手術主治醫師 楊士弘 手術區域 西址 034房 04號 診斷 Carpal tunnel syndrome 器械術式 Decompression of mediun nerve 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 12:10 進入手術室 12:25 麻醉開始 12:30 手術開始 13:05 手術結束 13:05 麻醉結束 13:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 正中神經或尺神經腕部減壓術–單側 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Carpal tunnel releasem, right 開立醫師: 王奐之 開立時間: 2011/04/12 12:11 Pre-operative Diagnosis Carpal tunnel syndrome, right Post-operative Diagnosis Carpal tunnel syndrome, right Operative Method Carpal tunnel releasem, right Specimen Count And Types nil Pathology Nil Operative Findings Hypertrophic flexor retinaculum was noted. The nerve sheath expanded well after decompression. Operative Procedures The patient was placed in supine position with right arm stretched out on a arm rest. After disinfection and draping in sterile fashion, local anesthesia was applied to the surgical field. A linear skin incision was made at proximal palm, and further deepened until the flexor retinaculum was exposed. The flexor retinaculum was then cut thoroughly until fully decompression of the median nerve. After hemostasis, the wound was closed in layers. Operators VS 楊士弘 Assistants R3 王奐之 相關圖片 劉振麟 (M,1950/12/20,61y2m) 手術日期 2011/04/12 手術主治醫師 蕭輔仁 手術區域 東址 003房 03號 診斷 Disseminated malignant neoplasm 器械術式 Laminectomy for decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳以幸, 時間資訊 00:00 臨時手術NPO 16:08 報到 16:28 進入手術室 16:40 麻醉開始 17:05 誘導結束 17:20 抗生素給藥 18:00 手術開始 20:20 抗生素給藥 20:45 開始輸血 21:50 手術結束 21:50 麻醉結束 22:00 送出病患 22:10 進入恢復室 22:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 惡性脊髓腫瘤切除術 1 1 手術 脊椎融合術-後融合,有固定物(<=六節) 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: 1.intraspinal tumor excision via laminectomy,... 開立醫師: 陳以幸 開立時間: 2011/04/12 22:17 Pre-operative Diagnosis Ewing tumor with epiadural metastasis Post-operative Diagnosis Ewing tumor with epiadural metastasis Operative Method 1.intraspinal tumor excision via laminectomy, T11-L2 2.posterolateral fusion, transpedicle screws T10, T11, L1, L2, with rod and crosslinkage Specimen Count And Types 1 piece About size: Source:spinal tumor Pathology pending Operative Findings 1.necrotic T12 lamina and pedicle due to tumor invasion and tumor metastasis 2.compression fracture of L1 3.severe spinal stenosis 4.one yellowish, elastic, ill-defined tumor was noted over T12 level, extradural area Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: prone. 3. Skin preparation: the back was shaved and scrubbed with povidone-iodine detergent then painted with povidone-iodine tincture and followed by sterilized adhesive plastic sheet covering. 4. wound incision: from T10-L2, followed by periosteal dissection 5. transpedicle screw insertion, T10, T11, L1, L2 6. Laminectomy, T11,T12,L1,L2 7. Transpedicle screw and rod fixation and crosslinkage 8. Hemostasis, set one hemovac to epidural space 9. Close the wound in layers Operators 蕭輔仁 Assistants 蔡宗良 陳以幸 汪瑞珍 (F,1925/04/02,86y11m) 手術日期 2011/04/12 手術主治醫師 蕭輔仁 手術區域 東址 005房 04號 診斷 Sciatica 器械術式 Radiofrequency coagulation 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 19:05 報到 19:13 進入手術室 19:16 抗生素給藥 19:30 麻醉開始 19:32 誘導結束 19:33 手術開始 20:10 手術結束 20:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 高頻熱凝療法 1 1 B 摘要__ 手術科部: 外科部 套用罐頭: Radiofrequency stimulation, bilateral L2 dors... 開立醫師: 李振豪 開立時間: 2011/04/12 21:02 Pre-operative Diagnosis Bilateral sciatica Post-operative Diagnosis Bilateral sciatica Operative Method Radiofrequency stimulation, bilateral L2 dorsal root Specimen Count And Types nil Pathology Nil Operative Findings 1. Bilateral L2 dorsal root was identified by portable C-arm X-ray and sensory/motor stimulation test. No acute complication was noted after the procedure. 2. Temp: 42 oC, Time: 180sec x 2 cycles each side Operative Procedures The patient was put in prone position. The location of L2 was identified by portable C-arm X-ray. The skin was disinfected and draped as usual. Bilateral L2 dorsal root radiofrequency stimulation was performed under portable C-arm guided. The patient stood whole procedure well. The patient was put in prone position. The location of L2 was identified by portable C-arm X-ray. The skin was disinfected and draped as usual. Local anesthesia was performed with 1% Xylocaine 10ml. Bilateral L2 dorsal root radiofrequency stimulation was performed under portable C-arm guided. The patient stood whole procedure well. Operators VS蕭輔仁 Assistants R4李振豪 相關圖片 蔡李梅 (F,1940/10/22,71y4m) 手術日期 2011/04/12 手術主治醫師 王國川 手術區域 東址 005房 03號 診斷 Dizziness and giddiness 器械術式 Brain tumor Crainotomy(Others) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 12:05 進入手術室 12:15 麻醉開始 12:45 誘導結束 12:45 抗生素給藥 12:57 手術開始 15:45 抗生素給藥 17:30 手術結束 17:30 麻醉結束 17:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 頭皮腫瘤 1 2 R 手術 顱底瘤手術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: 1. Right retrosigmoid suboccipital craniotomy... 開立醫師: 李振豪 開立時間: 2011/04/12 18:04 Pre-operative Diagnosis 1. Right posterior fossa tumor, suspect meningioma 2. Scalp lipoma Post-operative Diagnosis 1. Right posterior fossa tumor, suspect neuroma or meningioma 2. Scalp lipoma Operative Method 1. Right retrosigmoid suboccipital craniotomy for tumor excision 2. Scalp lipoma excision Specimen Count And Types 2 pieces About size:3.5X1.5X3cm Source:Right retroauricular lipoma About size:multiple pieces with total 3x3x3cm Source:Right posterior fossa tumor Pathology Frozen section: Spindle cell, suspect neuroma Operative Findings The scalp lipoma was encountered during the operation and excised smoothly. The right posterior fossa tumor was noted after burr hole creation. The inner table of the skull bone was eroded by the tumor. The tumor was white-yellowish, elastic to firm, 4.6 x 4 x 4.2cm in size, moderate vascularized in character. Both intra- and extra-dural part was noted during the operation. The tumor adhered with the arachnoid membrane but not invaded into the cerebellar parenchyma. Thin layer tumor was left in the arachnoid membrane for suspect neuroma by frozen section. Right upper limb SSEP flattened was noted during the operation and partial recovered after duroplasty. Mild right lower limb SSEP change also noted during the operation and full recovered after whole procedure. Operative Procedures Under endotracheal general anesthesia, the patient was put in park bench position with head fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. The curvilinear scalp incision was made over right retroauricular area. The lipoma was encountered and excised. The scalp flap was elevated and the nuchal muscle was divided. Periosteum was harvested for duroplasty. Four burr holes were created followed by 4x4cm craniotomy window. The tumor was noted after craniotomy. The dura was opened with stellate shape. Debulking was performed with tumor forceps, bipolar electrocautery. The specimen was sent for frozen section. The tumor was dissected along the capsule and thin layer of tumor was left within the capsule because neuroma was suspected by frozen section. Hemostasis was achieved with bipolar electrocautery and Surgicel lining. Duroplasty was done with periosteum. The Skull plate was fixed back with four #26 wires. One subgaleal CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS王國川 Assistants R4李振豪, Ri蔡佳穎 相關圖片 林連喜 (M,1934/10/25,77y4m) 手術日期 2011/04/12 手術主治醫師 余宏政 手術區域 東址 008房 03號 診斷 Benign prostatic hypertrophy 器械術式 T U R - P 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 脊髓麻醉 麻醉主治醫師 葉惠敏 ASA 2 紀錄醫師 陳柏誠, 時間資訊 11:57 報到 12:20 進入手術室 12:25 麻醉開始 12:35 誘導結束 12:45 手術開始 13:50 手術結束 13:50 麻醉結束 13:55 送出病患 14:00 進入恢復室 15:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 經尿道攝護腺切除術-切除之攝護腺重量15至50公克 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Spinal anesthesia 1 0 記錄__ 手術科部: 泌尿部 套用罐頭: TUR-P 開立醫師: 陳柏誠 開立時間: 2011/04/12 14:04 Pre-operative Diagnosis benign prostate hyperplasia Post-operative Diagnosis benign prostate hyperplasia Operative Method Transurethral resection of the prostate Specimen Count And Types 16 gm prostate chips Pathology Operative Findings 1. 16 g of prostatic tissue was resected 2. bilateral lobes of the prostate kiss together 3. mild bladder trabeculation 4. balloon was inflated to 50 cc. Operative Procedures Under satisfactory spinal anesthesia, the patient was placed in lithotomy position. Prepping and draping were performed in the usual sterile method. A Fr 27. Olympus resectoscope sheath was inserted into the urethra with adequate lubrication. Then the resectoscope was inserted.Bilateral lobes of prostate were resected with cutting loop piece after piece. The chips were washed out with a Ellik evacuator. Hemostasis was done. A 22 Fr. 3-way Foley catheter was inserted and its balloon was inflated to 50c.c. Continuous N/S irrigation started. The patient tolerated the operation well and was sent to the recovery room with stable condition. Operators 余宏政, Assistants 陳柏誠, 翁文慶, 簡志宏 (M,1988/02/29,24y0m) 手術日期 2011/04/13 手術主治醫師 許巍鐘 手術區域 西址 033房 08號 診斷 Cerumen impaction 器械術式 Gromment placement (ntuh made) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 12:50 報到 13:40 進入手術室 13:42 麻醉開始 13:44 誘導結束 13:45 手術開始 14:25 手術結束 14:30 送出病患 記錄__ 手術科部: 耳鼻喉部 套用罐頭: Grommet tube insertion, bilateral 開立醫師: 郭彥麟 開立時間: 2011/04/13 14:25 Pre-operative Diagnosis OME,right Post-operative Diagnosis OME,rightoperated Operative Method Grommet tube insertion, bilateral Specimen Count And Types nil Pathology Nil Operative Findings right serous middle ear effusion Operative Procedures 1.The patient was put in supine position. 2.After local anestehsia of external auditory canal, the face was disinfected and draped as usual. 3.Her head was turned to the left side. 4.Radial incision was made over the anterio-inferior quadrant of the right eardrum and serous middle ear effusion was sucked out. 5.Then one 1.27mm Grommet tube was inserted smoothly. 6.The head was then turned to the right side. The procedure was done similar to the right. Middle ear fluid was aspirated. 7.The patient tolerated the whole procedure well. Operators Asp許巍鐘 Assistants R4林沛廷R2郭彥麟 陳義順 (M,1960/06/18,51y8m) 手術日期 2011/04/13 手術主治醫師 詹偉弘 手術區域 西址 034房 04號 診斷 Acute lymphoid leukemia 器械術式 Port-A Implatation /WOR 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 詹偉弘 ASA 2 紀錄醫師 許銘哲, 時間資訊 00:00 臨時手術NPO 12:20 進入手術室 12:30 麻醉開始 12:35 誘導結束 12:40 抗生素給藥 12:45 手術開始 13:25 手術結束 13:25 麻醉結束 13:30 送出病患 13:40 進入恢復室 14:23 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 手術 port–A導管植入術–治療性導管植入術 1 0 R 記錄__ 手術科部: 麻醉部 套用罐頭: Port-A implantation, subclavian 開立醫師: 許銘哲 開立時間: 2011/04/13 13:29 Pre-operative Diagnosis ALL Post-operative Diagnosis Ditto Operative Method Port-A implantation, echo-guided Specimen Count And Types nil Pathology Nil Operative Findings 1.Site: right subclavian vein, with echo-guided procedure 2.Patent flow after implantation 3.Others: nil Operative Procedures 1.The patient was set on supine position and bilateral subclavian veins were checked by echo. 2.After IVGA and local anesthesia applied, transverse skin incision for 3cm was made at pre-cordial area. 3.Undermine the skin at the layer between subcutaneous tissue and deep fascia in lateral direction. 4.An IV catheter was inserted via the subclavian incision and negatively aspirated until venous blood attainable. 5.J-wire was inserted smoothly in rostral direction. A subclavian catheter with dilator was inserted through the J-wire, and the dilator was then removed. 6.The catheter of Port-A was threaded into the subclavian vein until mark 24cm. The catheter was adapted into the port and locked with restrictor.The Port was inserted into the pouch of pre-cordial incision. 7.Skin was closed layer by layer. Both catheter and port were perfused with heparin solution after implantation. Operators 詹偉弘, Assistants 許銘哲, 莊正雄 (M,1939/08/28,72y6m) 手術日期 2011/04/13 手術主治醫師 蔡瑞章 手術區域 東址 005房 01號 診斷 Gastric cancer 器械術式 Port-A catheter Implatation 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:00 進入手術室 08:15 抗生素給藥 08:42 麻醉開始 08:43 誘導結束 08:45 手術開始 10:35 麻醉結束 10:35 手術結束 10:37 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 port–A導管植入術–治療性導管植入術 1 0 L 摘要__ 手術科部: 外科部 套用罐頭: Port-A cut down 開立醫師: 陳國瑋 開立時間: 2011/04/13 10:47 Pre-operative Diagnosis Gastric cancer with spine metastasis Post-operative Diagnosis Gastric cancer with spine metastasis Operative Method Port-A implantation by percutaneous puncture Specimen Count And Types nil Pathology nil Operative Findings 1. Port-A catheter was inserted into SVC via left subclavian vein 2. Post-operative portable X-ray showed Port-A catheter tip in correct venous branch to SVC. Operative Procedures 1. Local anesthesia with the patient in supine position, prepped and draping were performed in the usual sterile method. 2. An incision was made in left side deltopectoral groove. After identification of the cephalic vein, Port-A catheter was inserted. However, the portable X ray showed looping of the catheter. The Port-A was then removed. 3. Percutaneous puncture was done and the port was inserted smoothly 4. Post-operative portable X-ray showed catheter tip in correct venous branchto SVC. Then the wound was closed in layers. Operators 蔡瑞章 Assistants 曾峰毅 陳國瑋 相關圖片 張陳碧霜 (F,1937/12/30,74y2m) 手術日期 2011/04/13 手術主治醫師 曾勝弘 手術區域 東址 003房 03號 診斷 Cerebrovascular accident (CVA) 器械術式 STA biopsy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 18:12 報到 18:15 進入手術室 18:20 抗生素給藥 18:36 麻醉開始 18:38 誘導結束 18:39 手術開始 19:15 麻醉結束 19:15 手術結束 19:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 頭皮腫瘤 1 1 摘要__ 手術科部: 外科部 套用罐頭: Left superficial temporal artery biopsy 開立醫師: 游健生 開立時間: 2011/04/13 19:27 Pre-operative Diagnosis Temporal arteritis Post-operative Diagnosis Temporal arteritis Operative Method Left superficial temporal artery biopsy right superficial temporal artery biopsy Specimen Count And Types 1 piece About size:1.5cm Source:superficial temporal artery Pathology Pending Operative Findings Hardening and thickening of superficial temporal artery wall. Weak pulsation of STA. Operative Procedures 1. Locate distal STA by doppler and shaving 2. Under local anesthesia, a 3cm curvilinear incision was made just 2cm above distal STA 3. Dissected along subcutaneous layer and identified distal STA 4. Freed distal STA and ligated on both end 5. Removed specimen and hemostasis 6. Wound irrigation and closed in layers Operators VS 曾勝弘 Assistants R6 陳睿生 R3 游健生 李語萱 (F,2009/02/02,3y1m) 手術日期 2011/04/13 手術主治醫師 彭信逢 手術區域 東址 000房 號 診斷 Malignant neoplasm of spinal cord 器械術式 Other RAD exam/intervention 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 范守仁 ASA 3 時間資訊 10:00 麻醉開始 10:05 誘導結束 11:05 麻醉結束 11:12 進入恢復室 12:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 王怡 (F,1999/04/19,12y10m) 手術日期 2011/04/13 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Moyamoya disease 器械術式 Moyamoya /EDAS Dr.郭 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 07:58 報到 08:10 進入手術室 08:15 麻醉開始 08:40 誘導結束 08:45 抗生素給藥 09:25 手術開始 11:50 抗生素給藥 12:41 麻醉結束 12:41 手術結束 12:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 朴卜勒氏血流測定（週邊血管） 1 0 L 手術 顱內外血管吻合術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: EDAS,left. 開立醫師: 鍾文桂 開立時間: 2011/04/14 09:13 Pre-operative Diagnosis Moyamoya disease status post right EDAS. Post-operative Diagnosis Moyamoya disease status post right EDAS. Operative Method EDAS,left. Specimen Count And Types nil Pathology Nil. Operative Findings We harvested 7 cm of posterior branch of STA as graft. Contact between STA and MCA branches are tension-free. Operative Procedures With endotracheal general aenasethesia, the patient was put in supine position with head rotated to left. After scalp shaved, scrubbed, disinfected, and then draped, we localize the STA position and territory by Doppler. Under microscopic view, we made one curvilinear skin incision and dissected above the galeal to expose posterior branch of left STA. We made the inicion along 1cm away from STA at bilateral side, and created craniotomy 2x6cm, beneath STA. Linear durotomy was done, and arachnoid membrane was separated by forceps. STA graft was anchored at bilateral ends of durotomy, and the dura was closed in water-tight suture and Durofoam. Bone graft was fixed back with 4 wires, and the wound was closed in layers. Operators 郭夢菲 Assistants R5 鍾文桂 記錄__ 手術科部: 外科部 套用罐頭: EDAS,left. 開立醫師: 郭夢菲 開立時間: 2011/04/14 10:17 Pre-operative Diagnosis Moyamoya disease status post right EDAS. Post-operative Diagnosis Moyamoya disease status post right EDAS. Operative Method EDAS,left. Specimen Count And Types nil Pathology Nil. Operative Findings We harvested 7 cm of posterior branch of STA as graft. Contact between STA and MCA branches are tension-free. Operative Procedures With endotracheal general aenasethesia, the patient was put in supine position with head rotated to right. After scalp shaved, scrubbed, disinfected, and then draped, we localize the STA position and territory by Doppler. Under microscopic view, we made one curvilinear skin incision and dissected above the galeal to expose posterior branch of left STA. We made the inicion along 1cm away from STA at bilateral side, and created craniotomy 2x6cm, beneath STA after incision of the temporalis muscle. Linear durotomy was done, and arachnoid membrane was separated by forceps. STA graft was anchored at bilateral ends of durotomy, and the dura was closed in water-tight suture and Durofoam. Bone graft was fixed back with 4 wires, and the wound was closed in layers. Operators 郭夢菲 Assistants R5 鍾文桂 任寶美 (F,1955/10/29,56y4m) 手術日期 2011/04/13 手術主治醫師 賴達明 手術區域 東址 000房 02號 診斷 Subarachnoid hemorrhage (SAH) 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 4E 紀錄醫師 曾峰毅, 時間資訊 01:51 抗生素給藥 10:33 通知急診手術 11:20 進入手術室 11:20 報到 11:30 麻醉開始 11:40 誘導結束 12:15 手術開始 13:30 麻醉結束 13:30 手術結束 13:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室腹腔分流手術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Chronic Subdural Hematoma 開立醫師: 曾峰毅 開立時間: 2011/04/13 13:48 Pre-operative Diagnosis Subdural effusion, at left Post-operative Diagnosis Subdural effusion, at left Operative Method Left subduroperitoneal shunt Specimen Count And Types Nil Pathology Nil Operative Findings Left subdural effusion, about 2cm thick, xanthochromic, with mass effect was noted. Codman, fixed-pressure valve at 10 mmH20, was used. Operative Procedures With endotracheal general anaesthesia, the patinet was put in supine position with head rotated to right. We made one transverse skin incision at left upper abdomen and performed mini-laparotomy. We created subcutaneous tunnel from LUQ to left occipital area. We made another skin incision at left frontal area, and drilled one burr hole. We inserted ventricular catheter, peritoneal catheter, and connected the shutn altogether. The wound was closed in layers. Operators VS 賴達明 Assistants R4 曾峰毅 Indication Of Emergent Operation Uncal herniation at left 蔡旺興 (M,1966/09/10,45y6m) 手術日期 2011/04/13 手術主治醫師 賴達明 手術區域 東址 000房 號 診斷 Radiculopathy 器械術式 Diskectomy cervical (Posterie 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 蔡宗良, 時間資訊 05:00 臨時手術NPO 05:00 開始NPO 08:35 通知急診手術 13:35 報到 13:50 進入手術室 14:12 麻醉開始 14:20 誘導結束 14:52 手術開始 16:30 手術結束 16:30 麻醉結束 16:40 送出病患 16:43 進入恢復室 17:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 硬腦膜外血腫清除術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 外科部 套用罐頭: Removal of epidural hemotoma, via previous wo... 開立醫師: 蔡宗良 開立時間: 2011/04/13 17:04 Pre-operative Diagnosis Epidural hematoma with spinal cord compression, s/p laminoplasty, C3-5 Post-operative Diagnosis Epidural hematoma with spinal cord compression, s/p laminoplasty, C3-5 Operative Method Removal of epidural hemotoma, via previous wound, C3-5 Specimen Count And Types nil Pathology none Operative Findings 1. Hematoma was present between the epidural space and the elevated lamina. Hematoma was not easily suckable and did not squeeze out upon fascia release. 2. Laminae fixation by mini-plates were firm. 3. Previous drain function was well. Operative Procedures 1. ETGA, Mayfield head fixation, prone positioning 2. Routine prepping and drapping. 3. Open previous wound, remove all sutures 4. Retractors applied. 5. Remove all hematoma with tumor forceps, irrigation, and suction. 6. CWV placement. Cut previous drain. 7. 3000 mL saline irrigation 8. Wound closed in layers. 9. Remove previous CWV drain. Operators VS 賴達明 Assistants R5 蔡宗良 Indication Of Emergent Operation Epidural hematoma with spinal cord compression 張振芳 (M,1951/01/24,61y1m) 手術日期 2011/04/13 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Pituitary tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 游健生, 時間資訊 14:21 臨時手術NPO 07:45 報到 08:02 進入手術室 08:10 麻醉開始 08:45 誘導結束 09:00 抗生素給藥 09:45 手術開始 10:58 麻醉結束 10:58 手術結束 11:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經由蝶竇之腦下垂體瘤切除 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 摘要__ 手術科部: 外科部 套用罐頭: Hypophysectomy---Transphenoid 開立醫師: 游健生 開立時間: 2011/04/13 11:18 Pre-operative Diagnosis Pituitary growth-hormone secreting microadenoma Post-operative Diagnosis Pituitary growth-hormone secreting microadenoma Operative Method Hypophysectomy---Transphenoid Specimen Count And Types 1 piece About size:a few pieces Source:pituitary tumor Pathology Pending Operative Findings A soft yellowish tumor was noted after durotomy. It was located inferoanterior to normal gland. After tumor removal, pinkish normal pituitary gland was seen. Operative Procedures 1. Under ETGA, patient was in supine position with head tilted 30 degree to left. 2. The face and LUQ abdomen were prepared with povidone-iodine alcohol tincture, and the mucosa of oral and nasal cavity with aqueous povidone-iodine tincture. Both were covered by a sterilized adhesive plastic sheet. 3. The nasal submucosa at septum was infiltrated with 1:100 epinephrine solution. 4. The mucosa of nasal septum was dissected away from the septal cartilage after incision and displaced laterally by a long nasal speculum. 5. The septal cartilage was cut at its basal juction by sepatal scissors and then displaced to one side. 6. A Hardys nasal speculum was applied to displace the nasal mucosa laterally and keep the nasal cavity open constantly for the exposure of the vomer bone and the anterior wall of the sphenoid sinus. 7. After removal of anterior wall of sphenoid sinus, the exposed sinus mucosa was coagulated and resected. The sellar floor was penetrated by an osteotome, then widened by Kerrison punch. 8.The sellar floor dura was coagulated with bipolar forceps, then opened in cruciate fashion. 9.The soft tumor parenchyma was removed by curette and suction. After the final piece of the tumor was removed, normal pituitary gland sank into sellar cavity. 10.The sellar floor was reconstructed by supporting a piece of vomer bone between the dura and the margin of the sellar floor. The sphenoid sinus was packed with gelfoam. 11.The Hardys nasal speculum was removed and the nasal mucosa returned to its normal position. Each side of the nasal cavities was tightly packed with Merocel which had been soacked with Better-iodine ointment. Operators VS 賴達明 Assistants R6 陳睿生 R3 游健生 梁慧敏 (F,1976/01/07,36y2m) 手術日期 2011/04/13 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Spondylolisthesis, acquired 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 11:26 進入手術室 11:36 麻醉開始 11:50 誘導結束 12:00 抗生素給藥 12:47 手術開始 15:00 抗生素給藥 17:10 手術結束 17:10 麻醉結束 17:20 送出病患 17:25 進入恢復室 18:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 B 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: L5/S1 fixation with transpedicle screws 開立醫師: 游健生 開立時間: 2011/04/13 17:35 Pre-operative Diagnosis L5/S1 spondylolithesis Post-operative Diagnosis L5/S1 spondylolithesis Operative Method L5/S1 fixation with transpedicle screws L5/S1 diskectomy and fusion with cage Specimen Count And Types nil Pathology Nil Operative Findings Left L5 pars fracture with L5/S1 Grade I spondylolithesis was noted. L5/S1 intervertebral disc protusion with hypertrophic ligamentum flavum resulted in bilateral lateral recess stenosis. PEEK bannar cage 9mm was inserted. Fixation system: Right TPS at S1: 6.2 x 30mm Other TPS: 6.2 x 40mm x3 Rods: 5cm x2 Operative Procedures 1. Under ETGA, prone position 2. Locate L5, S1 pedicles 3. Disinfection and draping 4. Paramedian incision at L5-S1 level 2cm left lateral to midline 5. Dissected in layers and exposed L4/5 and L5/S1 facets 6. Inserted transpedicle screws under C-arm guide 7. Repeated above procedure on right side 8. Removed left L5 pars interarticularis and hypertrophic ligamentum flavum 9. Performed L5 diskectomy transforaminally and inserted cage 10.Confirm position by C-arm 11.Performed lateral recess decompression on right side 12.Connect L5/S1 TPS with rod on both side 13.Hemostasis and irrigation with Gentamycin solution 14.Wounds closed in layers after hemovac placement Operators VS 賴達明 Assistants R6 陳睿生 R3 游健生 黃亮昇 (M,1969/08/20,42y6m) 手術日期 2011/04/13 手術主治醫師 李崇維 手術區域 東址 000房 號 診斷 器械術式 Other RAD exam/intervention 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 范守仁 ASA 3 時間資訊 00:00 開始NPO 08:30 通知急診手術 09:00 麻醉開始 09:05 誘導結束 09:35 麻醉結束 09:50 進入恢復室 11:35 離開恢復室 黃俊嘉 (M,1971/11/26,40y3m) 手術日期 2011/04/13 手術主治醫師 楊士弘 手術區域 東址 005房 02號 診斷 Bacterial meningitis 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 10:37 報到 10:48 進入手術室 10:50 麻醉開始 10:55 誘導結束 11:00 抗生素給藥 11:32 手術開始 12:40 手術結束 12:40 麻醉結束 12:45 送出病患 12:48 進入恢復室 13:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室腹腔分流手術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 陳國瑋 開立時間: 2011/04/13 12:43 Pre-operative Diagnosis Non-small cell lung cancer, with leptomeningeal carcinomatosis, bone metastasis Post-operative Diagnosis Non-small cell lung cancer, with leptomeningeal carcinomatosis, bone metastasis Operative Method V-P Shunt through right Kocher point Specimen Count And Types 1 piece About size:8ml Source:CSF Pathology nil Operative Findings 1. The intracranial pressure was over 20cm H2O 2. The shunt was put 30 cm into the peritoneal cavity and 6cm into ventricle 2. The shunt was put 30 cm into the peritoneal cavity and 6cm into ventricle 3. The V-P shunt of medium pressure was implanted Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: supine with head tilted) to left. 3.Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 5 cm curvilinear, right frontal, corresponded to the 4. Incision: 5 cm curvilinear, right frontal. location of right occipital horn. Raney clips were applied to the scalp edge for temporary hemostasis. 5.After the scalp flap had been lifted and reflected anteriorly, a burr hole was made and the dura was tented by 2 stitches. burr hole was made and the dura was tented by 1 stitch. 6.The dura was opened by a nib incision. Rt lateral ventricle was 6.The dura was opened by a nib incision. Left lateral ventricle was tapped by a ventricular needle, then a 8 cm segment of the tapped by a ventricular needle, then a 6.5 cm segment of the ventricular catheter was introduced into the ventricle. The outer end of the catheter was connected to a Pudenz reservoir. end of the catheter was connected to a reservoir. 7. A nib incision was made at RUQ of the abdomen , then a trocar 7. A skin incision of 5cm was made at RUQ of the abdomen , minilaparotomy was done and trochar was inserted. Distal 30cm segment of the peritoneal catheter was introduced through the outer tube of the trochar. was pushed into peritoneal cavity. Subsequently, distal 20 cm segment of the peritoneal catheter (medium pressure) was introduced into the peritoneal cavity through the outer tube of the trochar. The proximal end of this catheter was passed through subcutaneous tunnel at forechest, neck, rt retroauricular area and connected the reservoir. The shunt systemwas checked to make sure its function was working. 8. The reservoir was fixed to pericranium by 3 stitches. 8. The reservoir was fixed to pericranium by 2 stitches. 9. Scalp closure: hemostasis was done with monopolar coagulator touching on the sucker tip. Galea suture was performed by continuous suture with 3/0. Dexon and skin by continuous suture with 3/0 nylon. 10.Course of the surgery: smooth. Operators 楊士弘 Assistants 胡朝凱 陳國瑋 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 陳國瑋 開立時間: 2011/04/13 12:53 Pre-operative Diagnosis Non-small cell lung cancer, with leptomeningeal carcinomatosis, bone metastasis Post-operative Diagnosis Non-small cell lung cancer, with leptomeningeal carcinomatosis, bone metastasis Operative Method V-P Shunt through right Kocher point Specimen Count And Types 1 piece About size:8ml Source:CSF Pathology nil Operative Findings 1. The intracranial pressure was over 20cm H2O 2. The shunt was put 30 cm into the peritoneal cavity and 6cm into right ventricle 3. The V-P shunt of medium pressure was implanted Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: supine with head tilted) to left. 3.Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 5 cm curvilinear, right frontal. 5.After the scalp flap had been lifted and reflected anteriorly, a burr hole was made and the dura was tented by 1 stitch. 6.The dura was opened by a nib incision. Left lateral ventricle was tapped by a ventricular needle, then a 6.5 cm segment of the ventricular catheter was introduced into the ventricle. The outer end of the catheter was connected to a reservoir. 7. A skin incision of 5cm was made at RUQ of the abdomen , minilaparotomy was done and trochar was inserted. Distal 30cm segment of the peritoneal catheter was introduced through the outer tube of the trochar. The proximal end of this catheter was passed through subcutaneous tunnel at forechest, neck, rt retroauricular area and connected the reservoir. The shunt systemwas checked to make sure its function was working. 8. The reservoir was fixed to pericranium by 2 stitches. 9. Scalp closure: hemostasis was done with monopolar coagulator touching on the sucker tip. Galea suture was performed by continuous suture with 3/0. Dexon and skin by continuous suture with 3/0 nylon. 10.Course of the surgery: smooth. Operators 楊士弘 Assistants 胡朝凱 陳國瑋 相關圖片 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 陳國瑋 開立時間: 2011/04/13 13:06 Pre-operative Diagnosis Non-small cell lung cancer, with leptomeningeal carcinomatosis, bone metastasis Post-operative Diagnosis Non-small cell lung cancer, with leptomeningeal carcinomatosis, bone metastasis Operative Method V-P Shunt through right Kocher point Specimen Count And Types 1 piece About size:8ml Source:CSF Pathology nil Operative Findings 1. The intracranial pressure was over 20cm H2O 2. The shunt was put 30 cm into the peritoneal cavity and 6cm into right ventricle 3. The V-P shunt of medium pressure was implanted Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: supine with head tilted) to left. 3.Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 5 cm curvilinear, right frontal. 5.After the scalp flap had been lifted and reflected anteriorly, a burr hole was made and the dura was tented by 1 stitch. 6.The dura was opened by a nib incision. Left lateral ventricle was tapped by a ventricular needle, then a 6.5 cm segment of the ventricular catheter was introduced into the ventricle. The outer end of the catheter was connected to a reservoir. 7. A skin incision of 5cm was made at RUQ of the abdomen , minilaparotomy was done and trochar was inserted. Distal 30cm segment of the peritoneal catheter was introduced through the outer tube of the trochar. The proximal end of this catheter was passed through subcutaneous tunnel at forechest, neck, rt retroauricular area and connected the reservoir. The shunt systemwas checked to make sure its function was working. 8. The reservoir was fixed to pericranium by 2 stitches. 9. Scalp closure: hemostasis was done with monopolar coagulator touching on the sucker tip. Galea suture was performed by continuous suture with 3/0. Dexon and skin by continuous suture with 3/0 nylon. 10.Course of the surgery: smooth. Operators 楊士弘 Assistants 胡朝凱 陳國瑋 相關圖片 吳瑋萍 (F,1979/11/08,32y4m) 手術日期 2011/04/13 手術主治醫師 詹偉弘 手術區域 西址 034房 05號 診斷 Acute lymphoid leukemia, without mention of remission 器械術式 Port-A catheter Removal/WOR 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 許銘哲, 時間資訊 00:00 臨時手術NPO 13:40 進入手術室 13:50 麻醉開始 13:55 誘導結束 14:00 手術開始 14:25 手術結束 14:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 皮下肌肉或深部異物取出術 1 1 L 記錄__ 手術科部: 麻醉部 套用罐頭: Port-A remove, LA 開立醫師: 許銘哲 開立時間: 2011/04/13 14:29 Pre-operative Diagnosis Bacteremia Post-operative Diagnosis Ditto Operative Method Removal of Port-A Specimen Count And Types nil Pathology Nil Operative Findings Tip culture x 1 Operative Procedures 1.Under local anesthesia, skin incision was made along the previous incision site. 2.Uncovered the Port-A, and then removed it. 3.Wash the pouch with normal saline. 4.Subcutaneous and skin suture. Operators 詹偉弘, Assistants 許銘哲, 沈賢圳 (M,1956/11/10,55y4m) 手術日期 2011/04/13 手術主治醫師 蕭輔仁 手術區域 東址 005房 03號 診斷 Esophageal cancer 器械術式 Laminectomy for decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 12:42 報到 13:05 進入手術室 13:15 麻醉開始 14:00 誘導結束 14:10 抗生素給藥 14:40 手術開始 17:10 抗生素給藥 18:40 麻醉結束 18:40 手術結束 18:55 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎弓切除術(減壓)-超過二節 1 2 摘要__ 手術科部: 外科部 套用罐頭: C3~4 lateral mass screws, and C7~T1 TPS fixation 開立醫師: 陳國瑋 開立時間: 2011/04/13 19:01 Pre-operative Diagnosis c5~6 pathologic fracture with cord compression Post-operative Diagnosis c5~6 pathologic fracture with cord compression Operative Method C3~4 lateral mass screws, and C7~T1 TPS fixation Specimen Count And Types nil Pathology nil Operative Findings 1.Neck became kyphotic that couldntbe reducted 2.Cord was compressed tightly 3.C3~4 lateral mass screws: 16 mm x 4 4.C7~T1 TPS screws: 24 mm x 2 and 30 mm x 2 5.Easy touch bleeding Operative Procedures 1.ETGA, prone 2.Midline skin incision 3.Dissect to detach paravertebral muscle and expose C3~T1 lamina and lateral mass 4.C3~4 lateral mass screws insertion 5.C7~T1 TPS insertion 6.C4~7 laminectomy 7.Fixed rods 8.fixed cross link 9.Set one CWV drain 10.Close wound in layers Operators 蕭輔仁 Assistants 胡朝凱, 陳國瑋 黃明崑 (M,1959/01/06,53y2m) 手術日期 2011/04/13 手術主治醫師 黃培銘 手術區域 東址 025房 03號 診斷 Lung tumor 器械術式 Thoracoscopy+Open Chest 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 李佳穎, 時間資訊 16:35 報到 17:05 進入手術室 17:10 麻醉開始 17:35 誘導結束 17:40 抗生素給藥 18:01 手術開始 20:05 20:40 抗生素給藥 20:45 麻醉結束 20:45 手術結束 20:55 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 術後止痛 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 胸腔鏡肺楔狀或部分切除術 1 1 R 手術 根除性淋巴切除術(肺葉切除或全肺切除時) 1 2 R 手術 port–A導管植入術–治療性導管植入術 1 0 R 記錄__ 手術科部: 外科部 套用罐頭: VATS pleural biospy and lymph node dissection... 開立醫師: 鄒冠全 開立時間: 2011/04/13 20:59 Pre-operative Diagnosis RUL lung cancer, squamous cell carcinoma Post-operative Diagnosis RUL lung cancer, squamous cell carcinoma with pleural invasion Operative Method VATS pleural biospy and lymph node dissection, bullectomy; Port-A insertion Specimen Count And Types 3 pieces About size:2*1CM Source:RLL bulla About size:2*1CM Source:Gr.7 About size:2*1CM Source:Gr. 3+4 Pathology Forzen: pleural: cancer invasion(+) Operative Findings 1. A pleural patch near the RUL tumor, suspect cancer invasion, s/p biopsy and frozen: positive 2. Gr.3+4 LAP(+), Gr.7: mild 3. The Port-A was inserted via puncture method smoothly Operative Procedures 1. DLETGA, left decubitus 2. Skin disinfection and draping 3. VATS setting: 12-12-12mm 4. Identify pleural lesion and biopsy to send frozen: positive 5. Perform lymph node dissection with harmonic 6. N/S irrigation, close wounds in layers 7. Redraping, supine 8. Perform port-A insertion via puncture method, checked by portable CXR Operators 黃培銘 Assistants R3鄒冠全, Ri 陳秀誠 (M,1966/07/23,45y7m) 手術日期 2011/04/13 手術主治醫師 紀乃新 手術區域 兒醫 068房 03號 診斷 Acute myocardial infarction (AMI) 器械術式 AVF thrombectomy 手術類別 臨時手術 手術部位 四肢 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 莊民楷, 時間資訊 10:40 報到 11:10 進入手術室 11:21 抗生素給藥 11:30 麻醉開始 11:31 誘導結束 11:32 手術開始 11:57 手術結束 12:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 靜脈血栓切除術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: AVF thrombectomy 開立醫師: 莊民楷 開立時間: 2011/04/13 12:17 Pre-operative Diagnosis Right radio-cephalic AVF thrombosis Post-operative Diagnosis Right radio-cephalic AVF thrombosis Operative Method AVF thrombectomy Specimen Count And Types nil Pathology Nil Operative Findings 1. one 1.5x0.5cm thrombus was removed from venous side of AVF 2. mild stenosis was found over venous side, proximal to anastomosis site 3. postoperative thrill and bruit: good Operative Procedures 1. LA, supine 2. Disinfection and drapping 3. Longitudinal skin incision over right cephalic vein (venous side of AVF) 4. Dissect to expose AVF 5. Right cephalic vein incision after proximal control 6. Thrombectomy with Fogarty balloon 6. Thrombectomy with 4# Fogarty balloon 7. Repair right cephalic vein with 6-0 prolene suture 8. Hemostasis, close the wound in layers Operators VS 紀乃新 Assistants R3 莊民楷 范博修 (M,1993/04/07,18y11m) 手術日期 2011/04/13 手術主治醫師 鄭乃禎 手術區域 西址 031房 03號 診斷 Traumatic brain injury 器械術式 Reduction of mandible;simple 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 趙崧筌, 時間資訊 13:40 麻醉開始 13:40 進入手術室 13:55 抗生素給藥 14:00 手術開始 15:55 誘導結束 17:40 抗生素給藥 18:35 手術結束 18:35 麻醉結束 18:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顎間固定法 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 手術 下顎骨骨折開放性復位(簡單) 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: 1.Open reduction and internal fixation of man... 開立醫師: 趙崧筌 開立時間: 2011/04/13 19:06 Pre-operative Diagnosis Mandible comminuted fracture at right symphysis, parasymphysis and body Post-operative Diagnosis Mandible comminuted fracture at right symphysis, parasymphysis and body Operative Method 1.Open reduction and internal fixation of mandible fracture 2.Intermaxillary fixation Specimen Count And Types nil Pathology Nil Operative Findings Mandible comminuted fracture at right symphysis, parasymphysis and body were found. ORIF was performed with 4 hole-4 screwx2, 5 hole-4 screw linear and 7 hole-4 screw L fashion miniplates. IMF with lingual splint was also done after occlusion correction. Operative Procedures ETGA via nasal airway, supine, disinfected and draped Make chin incision along scar and reduce the mandible fracture manually Apply IMF with lingual splint Onlay miniplates for fixation Close wound in layers with one mini H/V placement Operators 鄭乃禎 Assistants 黃傑慧 趙崧筌 李榮堂 (M,1941/02/23,71y0m) 手術日期 2011/04/14 手術主治醫師 賴達明 手術區域 東址 002房 06號 診斷 Subdural hemorrhage or effusion 器械術式 Burr hole drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 3E 紀錄醫師 胡朝凱, 時間資訊 22:30 臨時手術NPO 22:30 開始NPO 01:45 通知急診手術 04:50 報到 05:00 進入手術室 05:05 麻醉開始 05:10 誘導結束 05:20 抗生素給藥 06:10 手術開始 06:50 手術結束 06:50 麻醉結束 06:55 送出病患 06:58 進入恢復室 08:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Right burr hole drainage 開立醫師: 胡朝凱 開立時間: 2011/04/14 07:05 Pre-operative Diagnosis Right chronic SDH Post-operative Diagnosis Right chronic SDH Operative Method Right burr hole drainage Specimen Count And Types nil Pathology nil Operative Findings 1.Motor oil like old blood was drained out at right frontal to parietal area. 2.Brain was slack 3.Outer membrane was noted Operative Procedures 1.ETGA, supine 2.Right parietal area transverse skin incision 3.Dissec to open periosteum 4.Burr hole drill 5.Cut open dura then outer membrane 6.Insert rubber drain 7.water irrigation 8.Fixed rubber drain 9.Close wound in layers 10.De-air Operators 賴達明 Assistants 胡朝凱 Indication Of Emergent Operation left side acute weakness 江朝源 (M,1953/07/31,58y7m) 手術日期 2011/04/14 手術主治醫師 廖漢文 手術區域 東址 000房 號 診斷 Subarachnoid hemorrhage 器械術式 NEURO T.A.E 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 3 時間資訊 12:35 麻醉開始 12:40 誘導結束 13:45 麻醉結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麥廖瑞珍 (F,1953/04/01,58y11m) 手術日期 2011/04/14 手術主治醫師 陳敞牧 手術區域 東址 005房 02號 診斷 Spinal stenosis, lumbar 器械術式 Laminectomy for decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 1 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 14:20 報到 14:53 進入手術室 15:00 麻醉開始 15:05 誘導結束 15:10 抗生素給藥 15:44 手術開始 17:45 手術結束 17:45 麻醉結束 17:50 送出病患 17:53 進入恢復室 19:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 椎弓切除術(減壓)-二節以內 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Sublaminar decompression 開立醫師: 李振豪 開立時間: 2011/04/14 17:57 Pre-operative Diagnosis Lumbar stenosis, L3-4 Post-operative Diagnosis Lumbar stenosis, L3-4 Operative Method Sublaminar decompression Specimen Count And Types nil Pathology Nil Operative Findings The thecal sac was compressed tightly by the hypertrophic ligmentum flavum. Moderate adhesion was noted during dissection. The thecal sac expanded well after decompression. Incidental durotomy with CSF leakage was noted during the procedure and packing with Gelform. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position. The location of L3-4 interlaminar space was localized by portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made at L3-4 level. The subcutaneous soft tissue and right paravertebral muscle group were detached and divided. L3-4 laminotomy was performed with Midas air-drived drills and kerrison punches. Sublaminar decompression was done. Hemostasis was achieved with bipolar electrocautery and Gelform packing. The wound was then closed in layers with 2-0 Vicryl and 4-0 Dexon. Operators VS陳敞牧 Assistants R4李振豪, R1陳宣佑 黃俊嘉 (M,1971/11/26,40y3m) 手術日期 2011/04/14 手術主治醫師 林至芃 手術區域 西址 036房 05號 診斷 Bacterial meningitis 器械術式 Port-A catheter Removal/WOR 手術類別 臨時手術 手術部位 胸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 08:00 臨時手術NPO 16:35 進入手術室 16:45 麻醉開始 16:50 手術開始 17:20 手術結束 17:20 麻醉結束 17:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 皮下肌肉或深部異物取出術 1 1 L 記錄__ 手術科部: 麻醉部 套用罐頭: Port-A remove, LA 開立醫師: 許銘哲 開立時間: 2011/04/14 17:30 Pre-operative Diagnosis NSCLC Post-operative Diagnosis Ditto Operative Method Removal of Port-A Specimen Count And Types nil Pathology Nil Operative Findings Thrombosis of Port-A catheter Operative Procedures 1.Under local anesthesia, skin incision was made along the previous incision site. 2.Uncovered the Port-A, and then removed it. 3.Wash the pouch with normal saline. 4.Subcutaneous and skin suture. Operators 林至芃, Assistants 許銘哲, 吳雪麗 (F,1956/04/06,55y11m) 手術日期 2011/04/14 手術主治醫師 蕭輔仁 手術區域 東址 001房 04號 診斷 Malignant histiocytosis, extranodal solid organ sites 器械術式 Spinal fusion posterior 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 2E 紀錄醫師 蔡宗良, 時間資訊 00:00 開始NPO 00:00 臨時手術NPO 09:39 通知急診手術 12:01 進入手術室 12:05 麻醉開始 12:30 誘導結束 12:36 抗生素給藥 12:37 手術開始 15:36 抗生素給藥 18:35 手術結束 18:35 麻醉結束 18:36 抗生素給藥 18:46 送出病患 18:50 進入恢復室 20:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 惡性脊髓腫瘤切除術 1 1 手術 脊椎融合術-後融合,有固定物(<=六節) 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 摘要__ 手術科部: 外科部 套用罐頭: 1. Removal of intraspinal tumor, malignant, v... 開立醫師: 蔡宗良 開立時間: 2011/04/14 19:11 Pre-operative Diagnosis Metastatic epidural spinal cord compression, T2 Post-operative Diagnosis Metastatic epidural spinal cord compression, T2 Operative Method 1. Removal of intraspinal tumor, malignant, via laminectomy T1-3 2. Posterior instrumentation C7, T1, T3-4 with transpedicular screws, rod, and cross-linkage. Specimen Count And Types 1 piece About size:小 Source:epidural space Pathology Report pending Operative Findings 1. Necrotic and floating T2 lamina and spinous process. Osteolytic lesion involved right-sided pedicle, transverse process, and anterior vertebra. Tumor morphology was circumferential to the thecal sac. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: prone. 3. Skin preparation: the back was shaved and scrubbed with povidone-iodine detergent then painted with povidone-iodine tincture and followed by sterilized adhesive plastic sheet covering. 4. wound incision: from C7-T4, followed by periosteal dissection 5. transpedicle screw insertion, C7, T1, T3, & T4 6. Laminectomy, T1-3; removal of epidural mass; costotransversectomy with anterior decompression, via right-side. 7. Transpedicle screw and rod fixation and crosslinkage 8. Hemostasis, set one hemovac to epidural space 9. Close the wound in layers Operators VS 蕭輔仁 Assistants R5 蔡宗良 Indication Of Emergent Operation Spinal cord compression 秀群 (F,1942/06/02,69y9m) 手術日期 2011/04/14 手術主治醫師 蕭輔仁 手術區域 東址 003房 02號 診斷 Lung cancer 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 2 紀錄醫師 曾峰毅, 時間資訊 00:00 臨時手術NPO 10:18 進入手術室 10:22 麻醉開始 10:30 抗生素給藥 10:38 誘導結束 10:40 手術開始 13:30 抗生素給藥 14:25 手術結束 14:25 麻醉結束 14:28 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎弓切除術(減壓)-二節以內 1 2 摘要__ 手術科部: 外科部 套用罐頭: Cervical Laminectomy 開立醫師: 曾峰毅 開立時間: 2011/04/14 14:17 Pre-operative Diagnosis C2 metastasis with atlantoaxial instability Post-operative Diagnosis C2 metastasis with atlantoaxial instability Operative Method C1 laminectomty; occipitocervical fixation with lateral mass screws at C3 and C4 and plate at C0 Specimen Count And Types Nil Pathology Nil Operative Findings Atlantoaxial instability caused spinal canal stenosis at C1. Thecal sac was decompressed well after C1 laminectomy. Depuy, lateral mass screws, 3.5mm in diamter, and 16 mm long, was inserted into bilateral lateral masses of C3 and C4. 10 mm long screws was inserted at suboccpital area for plate fixation. 343 rods were used for posterior fixation. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head fixed with Mayfield head clamp. We check the C-spine alignment with C-arm, and then disinfected, draped the patient. We made one one midline skin incision from inion to C5 spinous process. We dissected the bilateral paraspinal muscle to expose suboccipital area to bilateral laminae of C5. We performed C1 laminectomy, and inserted bilateral lateral mass screws into biltaeral lateral masses of C3 and C4. We fixed the plate to occpital area, and achieved fixation with rods. The wound was closed in laysers after one CWV inserted. With endotracheal general anaesthesia, the patient was put in prone position with head fixed with Mayfield head clamp. We check the C-spine alignment with C-arm, and then disinfected, draped the patient. We made one one midline skin incision from inion to C5 spinous process. We dissected the bilateral paraspinal muscle to expose suboccipital area to bilateral laminae of C5. We performed C1 laminectomy, and inserted bilateral lateral mass screws into biltaeral lateral masses of C3 and C4. We fixed the plate to occpital area, and achieved fixation with rods. The wound was closed in laysers after one CWV inserted. Operators VS 蕭輔仁 Assistants R4 曾峰毅 R3 王奐之 相關圖片 楊春菊 (F,1952/03/14,60y0m) 手術日期 2011/04/14 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Aneurysm 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 08:23 進入手術室 08:25 麻醉開始 09:00 抗生素給藥 09:13 手術開始 09:30 誘導結束 09:55 手術結束 09:55 麻醉結束 10:03 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt via right Kocher p... 開立醫師: 曾峰毅 開立時間: 2011/04/14 09:53 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunt via right Kocher point (programmable valve) Specimen Count And Types Nil Pathology Nil Operative Findings A Codman programmable valve was used for ventriculoperitoneal shunt (preset to 150 mmH2O). Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to left. After scalp shave, scrubbed, disinfected, and then draped, we made one transverse skin incision at right upper abdomen, and created mini-laparotomy. We created subcutaneous tunnel to right occipital area. We made on curvilinear skin incision at right frontal area, and drilled one burr hole. After durotomy and dura tenting, ventriculostomy was performed once, and then ventricular catheter was inserted. We connected shunt altogether, and checked the function. The wound was closed in layers. Operators VS 王國川 Assistants R4 曾峰毅, R3 王奐之 相關圖片 陳劉乙 (F,1932/06/04,79y9m) 手術日期 2011/04/14 手術主治醫師 蔡翊新 手術區域 東址 005房 01號 診斷 Acquired spondylolisthesis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3 紀錄醫師 陳宣佑, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:10 麻醉開始 08:25 誘導結束 08:50 抗生素給藥 08:52 手術開始 11:50 抗生素給藥 14:35 手術結束 14:35 麻醉結束 14:45 送出病患 14:47 進入恢復室 16:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎間盤切除術-腰椎 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: 1) L5 total laminectomy and partial L4 left h... 開立醫師: 蔡翊新 開立時間: 2011/04/14 14:20 Pre-operative Diagnosis L4-S1 spinal stenosis, L5-S1 grade I spondylolisthesis with degenerative disc disease. Post-operative Diagnosis L4-S1 spinal stenosis, L5-S1 grade I spondylolisthesis with degenerative disc disease. Operative Method 1) L5 total laminectomy and partial L4 left hemilaminectomy ; 2) L4-5 and L5-S1 discectomy and Banana Cage interbody fusion; 3) Transpedical screw with rod fixation, L4~S1, with posterolateral fusion. Specimen Count And Types nil Pathology nil Operative Findings Dissociation of bilateral L5-S1 facet joints, with spondylolisthesis, L5~S1, Grade I. Hypertrophic ligamentum flavum and degenerative herniated discs at L4-5 and L5-S1 levels caused tight compression of thecal sac and L5 and S1 roots, which expanded well after decompression. There was a dural tear while ligamentum flavum was being removed and it was repaired with 5-0 Prolene. The positions of screws and cages were confirmed by intraop C-arm x-ray. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position. The operative field was scrubbed, disinfected and draped as usual. Posterior approach with midline skin incision, 10 cm in length, deepen the incision to the level of spinous processes. L5 total laminectmoy and left L4 hemilaminectomy was performed. The hypertrophied ligamentum flavum was removed. L4-5 and L5-S1 discectomy was done via left side. Two Banana cages (9 mm in height) were inserted to the disc spaces for interbody fusion. Transpedical screws, 45 x 6.5 x 4 at L4,5 levels and 40 x 6.5 x 2 at S1 level, and Rods x 2 (6 cm), were inserted. Posterolateral fusion with autologous bone graft harvested from laminectomy, and 5 c.c. Biocomposites was used. One 1/8" Hemovac drain tube was set at epidural space. After irrigation with N/S and hemostasis was achieved, the wound was closed in layers. Operators VS蔡翊新 Assistants R4李振豪R1陳宣佑 吳龍夫 (M,1944/07/09,67y8m) 手術日期 2011/04/14 手術主治醫師 李苑如 手術區域 東址 008房 05號 診斷 Benign prostatic hypertrophy 器械術式 P.C.N.L. 手術類別 預定手術 手術部位 腹 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 3 紀錄醫師 彭元宏, 時間資訊 11:25 報到 11:30 進入手術室 11:35 麻醉開始 11:40 誘導結束 11:50 手術開始 13:00 抗生素給藥 13:15 手術結束 13:15 麻醉結束 13:37 送出病患 13:40 進入恢復室 16:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 手術 經皮腎結石取石術 1 1 R 記錄__ 手術科部: 泌尿部 套用罐頭: PCNSL 開立醫師: 彭元宏 開立時間: 2011/04/14 13:45 Pre-operative Diagnosis right staghorn stone Post-operative Diagnosis right staghorn stone Operative Method Percutaneous nephrolithotripsy, right side Specimen Count And Types nil Pathology nil Operative Findings 1. a yellowish stones in the right renal calyces Operative Procedures Under satisfactory intubated general anesthesia with the patient in a lithotomy position, prepping and draping were carried out. A 5 Fr. ureteral catheter was inserted into the right ureter smoothly through the 21Fr cystoscope. A 16 Fr. Foley catheter was indwelled. The patient was changed to a prone position. Skin preparation was done. A puncture needle with a hub was inserted into right renal lower calyx under fluoroscope guidence. A 0.035-inch flexible tip guidewire was indwelled through the puncture needle. The tract was dilated with fascial dilators, which was facilitated by passing them over the guidewire, up to 12 Fr. A follower was indwelled by passing it over the guidewire. The tract was further dilated with the following Amplatz dilators by passing them over the follower, up to 30 Fr. A 30 Fr. Amplatz sheath was indwelled and a nephroscope was inserted under adequate visualization at all times. Normal saline was used for irrigation. The instrument was passed to the level of the stone. The stonein the calyx was fragmented with pneumatic device and the stone fragement were removed. A DBJ catheter was inserted from the renal pelvis to the urinary bladder. It was checked by the fluoroscopy. At the same time the previous ureteral catheter was removed. A 20 Fr. percutaneous nephrostomy tube was in place. The patient tolerated the procedure very well and was sent to the recovery room in satisfactory condition. A follower was indwelled by passing it over the guidewire. The tract was further dilated with the following Amplatz dilators by passing them over the follower, up to 30 Fr. A 30 Fr. Amplatz sheath was indwelled and a nephroscope was inserted under adequate visualization at all times. Normal saline was used for irrigation. The instrument was passed to the level of the stone. The stonein the calyx was fragmented with pneumatic device and the stone fragement were removed. A DBJ catheter was inserted from the renal pelvis to the urinary bladder. It was checked by the fluoroscopy. At the same time the previous ureteral catheter was removed. Universa DBJ was inserted via nephroscopy guided. A 20 Fr. percutaneous nephrostomy tube was in place. The patient tolerated the procedure very well and was sent to the recovery room in satisfactory condition. Operators 李苑如, Assistants 彭元宏, 張宇鳴, 朱錦發 (M,1950/09/01,61y6m) 手術日期 2011/04/15 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Cervical myelopathy 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:12 麻醉開始 08:20 誘導結束 09:15 抗生素給藥 09:40 手術開始 13:10 手術結束 13:10 麻醉結束 13:18 送出病患 13:20 進入恢復室 15:23 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-前融合,有固定物)≦四節 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 摘要__ 手術科部: 外科部 套用罐頭: Anterior Cervical Discectomy and Fusion, C3/4 開立醫師: 游健生 開立時間: 2011/04/15 13:37 Pre-operative Diagnosis C3/4 Herniated intervertebral disk with cord compression Post-operative Diagnosis C3/4 Herniated intervertebral disk with cord compression Operative Method Anterior Cervical Discectomy and Fusion, C3/4 Specimen Count And Types nil Pathology Nil Operative Findings Herniated intervertebral disc at C3/4 was noted with cord compression. It compressed more severely on left side. Hypertrophic posterior longitudinal ligament was also noted. A 6# cage was used for fusion. Operative Procedures Under ETGA, patient in supine with neck hyperextended by a air cuff placed beneath the shoulder. After disinfection and draping, a transverse neck incision was made at C3/4 level. The plastysma muscle was transected and mobilized from the underlying superficial cervical fascia which was then opened in vertical direction along the anterior margin of the SCM muscle. The dissection was advanced at the loose plane between SCM muscle and strip muscles until the prevertebral fascia had been reached. The former structure was retracted to the lateral and the later structures with esophagus and trachea to the opposite side by Cloward cervical retractor. The prevertebral fascia was opened vertically, the C3/4 intervertebral space was exposed and identified by intraoperative C-arm. The most medial portion of the longus coli muscles on both sides were detached from the vertebral bodies to provide a wider exposure of the vertebral bodies. The anterior longitudinal ligment was incised transversely at the margins of intervertebral space, the annulus fibrosus was cut too. The degenerated disc and cartilage plate were removed by curette and the anterior-inferior rim of vertebral body was trimed by air-drill for easier approach to the posterior rim of the intervertebral space. The intervertebral spac was widened by a Cloward intervertebral spreader. The spur at posterior margin of vertebral bodies was removed by air-drill and fine curette. The posterior longitudinal ligament was cut from bony edge by curette and then removed. Consequently, the spinal dura expanded into the intervertebral space. The surfaces of vertebral bodies at this intervertebral space were trimed by high speed air drill to creat a biconcave intervertebral space. A 6# cage was packed into the intervertebral space tightly by an impactor. The intervertebral space was widened by pulling the patients head while the impaction of the cage was doing. The air cuff beneath the shoulder was deflated, the Cloward cervical retractor removed. Wound was closed in layers after mini-hemovac placement. Operators Prof 杜永光 Assistants R6 陳睿生 R3 游健生 林宇倢 (F,1984/02/21,28y0m) 手術日期 2011/04/15 手術主治醫師 杜永光 手術區域 東址 003房 02號 診斷 Arteriovenous malformation, brain 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 13:30 進入手術室 13:45 麻醉開始 13:50 誘導結束 14:27 抗生素給藥 14:53 手術開始 17:27 抗生素給藥 18:20 手術結束 18:20 麻醉結束 18:33 送出病患 18:38 進入恢復室 20:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 頭顱成形術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Cranioplasty, left fronto-temporo-parietal 開立醫師: 游健生 開立時間: 2011/04/15 18:46 Pre-operative Diagnosis Left frontoparietal arteriovenous malformation with intracerebral hemorrhage, status post hematoma evacuation and craniectomy Post-operative Diagnosis Left frontoparietal arteriovenous malformation with intracerebral hemorrhage, status post hematoma evacuation and craniectomy Operative Method Cranioplasty, left fronto-temporo-parietal Specimen Count And Types Nil Pathology Nil Operative Findings Large amount of subdural effusion was noted. There was some granulation tissue between scalp and dura. The two original skull plates were assembled and fixed by wires. Operative Procedures Under tracheostomy general anesthesia, patient was in supine position with head rotated to right and left shoulder elevated. After shaving, we disinfected and draped the operation field as usual. Incision was made along previous wound scar and Raney clips were applied to the scalp edge for temporary hemostasis. The scalp flap was elevated and reflected away from dura surface. The margin of skull defect was well exposed. The bleeders on the dissected surfaces were coagulated. The two original skull plates were assembled and fixed by wires. Multiple drill holes were made at the plate to facilitate epidural blood drainage. After 4 central tenting, the skull plate was placed back to the craniectomy window then fixed by 4 mini-plates. After hemostasis and Vancomycin solution irrigation, one epidural CWV and one subgaleal CWV were placed. Wound was closed in layers. Operators Prof. 杜永光 Assistants R6 陳睿生 R3 游健生 林玉鳳 (F,1931/10/08,80y5m) 手術日期 2011/04/15 手術主治醫師 虞希禹 手術區域 東址 017房 01號 診斷 Coronary arterial disease 器械術式 O.P.C.A.B 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 莊民楷, 時間資訊 07:35 報到 08:10 進入手術室 08:15 麻醉開始 09:15 誘導結束 09:35 抗生素給藥 09:40 手術開始 12:35 抗生素給藥 13:45 開始輸血 15:30 手術結束 15:30 抗生素給藥 15:30 麻醉結束 15:35 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 7 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 放置肺動脈導管術 1 0 麻醉 Cardiac out-put 1 0 麻醉 Swan-gang catheterization 1 0 麻醉 T.E.E 1 0 麻醉 Lactic Acid (lactate) 4 0 麻醉 動脈血液檢查全套 4 0 麻醉 Hemoglobin (Hb) 4 0 麻醉 測血糖 4 0 麻醉 Ca (Calcium) 4 0 麻醉 Na (Sodium) 4 0 麻醉 K (Potassium) 4 0 麻醉 Blood gas analysis 4 0 手術 體外心肺循環 1 1 手術 冠狀動脈繞道手術 -三條血管 1 1 摘要__ 手術科部: 外科部 套用罐頭: CABG, under partial CPB 開立醫師: 莊民楷 開立時間: 2011/04/22 21:10 Pre-operative Diagnosis CAD, 3-V-D, with recent MI Post-operative Diagnosis CAD, 3-V-D, with recent MI Operative Method CABG, under partial CPB Specimen Count And Types nil Pathology Nil Operative Findings 1. fair ventricular contractility 2. intraoperative TEE: mild MR 3. coronary angiography: LAD proximal 60% stenosis LCX proximal 70% stenosis RCA mid 80% stenosis, PDA CTO 4. intraoperative dupplex after CABG: SVG1 and SVG2: good flow SVG3 harsh flow sound Operative Procedures 1. ETGA, supine 2. Disinfection and drapping 3. Midline sternotomy 4. Harvest bilateral GSV graft 5. AsAo, RAA cannulation; on partial CPB, under beating heart and normothermia 6. CABG: SVG1: AsAo → LAD SVG2: AsAo → OMx SVG3: AsAo → PDA → PLA 7. Deair, wean off CPB 8. Hemostasis, set three chest tubes over mediastinum and right pleural cavity 9. Close the wound in layers Operators VS 虞希禹 Assistants R5 謝永, R3 莊民楷 江朝源 (M,1953/07/31,58y7m) 手術日期 2011/04/15 手術主治醫師 賴達明 手術區域 東址 002房 01號 診斷 Subarachnoid hemorrhage 器械術式 Craniotomy(Aneurysms) P-DUH 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 曾峰毅, 時間資訊 00:10 臨時手術NPO 00:10 開始NPO 07:11 通知急診手術 08:31 報到 08:31 進入手術室 08:40 麻醉開始 08:50 誘導結束 09:30 抗生素給藥 09:48 手術開始 12:30 抗生素給藥 16:08 麻醉結束 16:08 手術結束 16:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 7 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 開顱術摘除血管病變 - 腦血管瘤 有病徵的 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Aneurysm-frontotemporal approach 開立醫師: 曾峰毅 開立時間: 2011/04/15 16:33 Pre-operative Diagnosis A-com aneurys, ruptured, status post TAE, and left Pcom aneurysm Post-operative Diagnosis A-com aneurys, ruptured, status post TAE, and left Pcom aneurysm, unruptured Operative Method Left pterional craniotomy for Pcom aneurysm clippping Specimen Count And Types Nil Pathology Nil Operative Findings One wide-based aneurysm, about 3mm, located at left ICA, poiting inferiorly and posteriorly, unruptured, was clipped by one clip. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to right and fixed in Mayfield head clamp. After scalp shaved, scrubbed, disinfected, and then draped, we made one cruvilinaer skin incision at right frontotemporal area. We drilled four burr holes, and then created craniotomy. Dura was tented along the craniotomy edge, and was incised in C-shaped. After durotomy, we retracted frontal lobe away from the frontal base and identified optic nerve and left internal carotid artery. We traced ICA from proximal to distal, and clipped the aneurysm with one clip. The dura was closed in water-tight fahsion with 4-0 prolene. Bone graft was fixed back with mini-plate, and one CWV was inserted subgaleally. The wound was closed in layers. Operators VS 賴達明 VS 蔡翊新 Assistants R4 曾峰毅 Ri 蔡佳穎 Indication Of Emergent Operation SAH 王茂 (M,1932/05/11,79y10m) 手術日期 2011/04/15 手術主治醫師 賴達明 手術區域 東址 005房 01號 診斷 Cervical myelopathy 器械術式 OPLL- Anterior Corpectomy 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:10 麻醉開始 08:38 誘導結束 08:40 抗生素給藥 09:37 手術開始 11:40 抗生素給藥 14:38 手術結束 14:38 麻醉結束 14:52 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 手術 椎間盤切除術-頸椎 1 1 摘要__ 手術科部: 外科部 套用罐頭: Anterior approach for odontoidectomy 開立醫師: 林淑雲 開立時間: 2011/04/15 14:41 Pre-operative Diagnosis C1~C2 CPPD C1~C2 calcium pyrophosphate disease Post-operative Diagnosis C1~C2 CPPD C1~C2 calcium pyrophosphate disease Operative Method Anterior approach for odontoidectomy Retropharyngeal approach for odontoidectomy Specimen Count And Types one peice, pieces of C12 ligament Pathology pending Operative Findings 1.Yellowish, chalk like calcification was noted posterior to C2 dens and compressed the spinal cord tightly. 2.After decompression, the spinal cord expanded well 3.Bilateral MEP were poor, and the right side was slightly better then left, through the whole operation, no significant SSEP or MEP change was noted Operative Procedures 1.ETGA, supine 2.Transverse skin incision at right submandiular area 3.Dissect to open preverteral space via the anterior SCM border 4.localization C2 with C-arm 5.Drill C2 dens until hypertrophic CPPD was exposed 6.Remove lesion with curette and kerrison 7.Hemostasis, irrigation 8.Set one CWV, the wound was then closed in layers Operators 賴達明 Assistants 胡朝凱 陳國瑋 相關圖片 賴麗珍 (F,1967/01/01,45y2m) 手術日期 2011/04/15 手術主治醫師 賴達明 手術區域 東址 005房 02號 診斷 Cervical myelopathy 器械術式 OPLL- Anterior Corpectomy 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 14:55 進入手術室 15:00 麻醉開始 15:15 誘導結束 15:30 抗生素給藥 15:53 手術開始 20:00 抗生素給藥 21:15 手術結束 21:15 麻醉結束 21:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 脊椎融合術-前融合,有固定物)≦四節 1 2 手術 椎間盤切除術-頸椎 1 1 摘要__ 手術科部: 外科部 套用罐頭: C3 corpectomy and autologous bone graft inser... 開立醫師: 陳國瑋 開立時間: 2011/04/15 22:58 Pre-operative Diagnosis cervical OPLL cervical Ossification of the posterior longitudinal ligament Post-operative Diagnosis cervical OPLL cervical Ossification of the posterior longitudinal ligament Operative Method C3 corpectomy and autologous bone graft insertion with plate fixation Specimen Count And Types nil Pathology nil Operative Findings 1.Severe hypertrophic and calcified PLL was noted and compressed the spinal cord tightly. 2.The dura was sticked on OPLL 3.No CSF leak 4.Transient mEP decreased was noted during operation, but it recovered after operation. 5.34# plate was chosen and 4 screws were inserted. Operative Procedures 1.ETGA, supine 2.Transverse skin incision at right submandibular area 3.Dissect along the anterior SCM border to enter prevertebral space 4.Localization with C-arm 5.C3 corpectomy with air drill to expose PLL 6.Partial dura was visualized with curette 7.Harvest one autologous bone graft at right iliac crest 8.Insert bone graft 9.Plate fixation 10.Set one hemovac drain 11.Close wound in layers Operators 賴達明 Assistants 胡朝凱, 陳國瑋 相關圖片 李廖阿哖 (F,1926/10/20,85y4m) 手術日期 2011/04/15 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Low back pain 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 陳以幸, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:10 進入手術室 08:15 麻醉開始 08:30 誘導結束 09:00 抗生素給藥 09:33 手術開始 12:05 抗生素給藥 13:50 手術結束 13:50 麻醉結束 14:00 送出病患 14:03 進入恢復室 15:22 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 椎弓切除術(減壓)-二節以內 1 2 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 摘要__ 手術科部: 外科部 套用罐頭: 1.Laminectomy, L4 開立醫師: 陳以幸 開立時間: 2011/04/15 14:04 Pre-operative Diagnosis Spondylolisthesis, L4-5 Post-operative Diagnosis Spondylolisthesis, L4-5 Operative Method 1.Laminectomy, L4 2.Percutaneous transpedicle screw, L4-5, bilateral, with rod fixation Specimen Count And Types nil Pathology nil Operative Findings hypertrophy of ligmentum flavum Operative Procedures 1.under general anesthesia, prone position 2.localize L4 and L5 body under the assistance of C-arm 3.perform percutaneous transpedicle screw to L4 and L5 peidcle, bilateral. Intra-operative C-arm was used to confirm the location 4.mid-line skin incision 5.dissect subcutaneous tissue, midline split the spinous process of L4 6.under the microscope assistance, perform laminectomy of L4, remove ligmentum flavum 7.N/S irrigation, inser one hemovac drainage tube to the epidural space 8.close the wound in layers Operators 賴達明 Assistants 蔡宗良 陳以幸 周守洋 (M,1942/08/30,69y6m) 手術日期 2011/04/15 手術主治醫師 賴達明 手術區域 東址 019房 02號 診斷 Herniation of intervertebral disc (HIVD) 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 陳以幸, 時間資訊 00:00 臨時手術NPO 14:18 進入手術室 14:25 麻醉開始 14:50 誘導結束 15:05 抗生素給藥 15:22 手術開始 17:35 手術結束 17:35 麻醉結束 17:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-頸椎 1 1 手術 脊椎融合術-前融合,有固定物)≦四節 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: anterior cervical decompression and fusion, C3-4 開立醫師: 陳以幸 開立時間: 2011/04/15 17:51 Pre-operative Diagnosis Herniated intervertebral disc, C3-4 Post-operative Diagnosis Herniated intervertebral disc, C3-4 Operative Method anterior cervical decompression and fusion, C3-4 Specimen Count And Types nil Pathology nil Operative Findings herniated intervertebral disc, C3-4 Operative Procedures 1.Under general anethesia, the patient was put as supine position with neck mild htperextension. The incision line was at 2 finger-width, lateral side of thyroid cartiladge. We gradually dissect subcutaneous tissue and identify the SCM and esophagus. The esophagus was retracted to the left side and SCM was retracted to right side. Intra-operative C-arm assistanceto identify C3 and C4 body. Disktectomy of C3-C4 was performed under the assistance of microscope. One 5mm, Synthes, cage was put into C3-4 intervertebral space. One minihemovac was inserted. After checking bleeding, the wound was closed in layers Operators 賴達明 Assistants 蔡宗良 陳以幸 張秀英 (F,1970/10/19,41y4m) 手術日期 2011/04/16 手術主治醫師 蔡瑞章 手術區域 東址 005房 01號 診斷 Lung cancer 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 2 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:17 麻醉開始 08:40 誘導結束 08:40 抗生素給藥 08:47 手術開始 11:40 抗生素給藥 12:35 手術結束 12:35 麻醉結束 13:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for total tumor excision 開立醫師: 陳國瑋 開立時間: 2011/04/16 12:32 Pre-operative Diagnosis Right parietal metastatic tumor Post-operative Diagnosis Right parietal metastatic tumor Operative Method Craniotomy for total tumor excision Specimen Count And Types Tumor mass 5 x 3.5 cm Pathology pending Operative Findings 1.One about 5x3.5 cm firm, yellowish tumor was noted located at right parietal area. It did not attach to the superior sagittal sinus. 2.The tumor border was clear 3.Brain was moderate swelling Operative Procedures Under ETGA, patient was put in prone position with head fixed with Mayfield skull clamp. U shape skin incision was done at right parietal area. Skin flap was dissected and opened. After four burr holes drilled, craniotomy was performed as a 7x7 bone window that one cm cross the midline, followed by dural tenting. U shape dural incision was made with the base left at midline. The tumor was excised by gently dissection through the interface between tumor and brain tissue. Vascular perforation was cauterized. Hemostasis was then performed. After then, dura was closed with prolene. After one CWV drain insertion, wound was closed in layers. Operators P 蔡瑞章 Assistants 胡朝凱, 陳國瑋 相關圖片 孫浚航 (M,2006/07/20,5y7m) 手術日期 2011/04/16 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Hydrocephalus 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 3E 紀錄醫師 胡朝凱, 時間資訊 10:53 通知急診手術 14:59 開始NPO 14:59 臨時手術NPO 20:55 報到 21:08 進入手術室 21:10 麻醉開始 21:20 誘導結束 22:15 抗生素給藥 22:30 手術開始 00:30 麻醉結束 00:30 手術結束 00:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Peripheral arterial line inserti 1 0 手術 立體定位術-抽吸 1 1 R 手術 腦室腹腔分流手術 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 記錄__ 手術科部: 外科部 套用罐頭: Endoscopic cyst fenestration and VP shunt ins... 開立醫師: 胡朝凱 開立時間: 2011/04/17 00:50 Pre-operative Diagnosis Hydrocephalus and infratentorial arachnoid cyst Hydrocephalus due to quadrigeminal arachnoid cyst Post-operative Diagnosis Hydrocephalus and infratentorial arachnoid cyst Hydrocephalus due to quadrigeminal arachnoid cyst Operative Method Endoscopic cyst fenestration and VP shunt insertion Neuroendoscopic cyst fenestration, cystoperitoneal and VP shunts insertion Specimen Count And Types CSF x 3 tubes Pathology nil Operative Findings 1.Opening pressure: around 18 cmH2O 1.Opening pressure: more than 18 cmH2O 2.Clear CSF 3.The cyst wall was identified posterior to mammary body and a fenestration was made. 3.The cyst wall was identified posterior to mammary body and two fenestrations were made. 4.High pressure codman reservior was used for cystic catheter 4.100 mmH2O codman reservior was used for cystic catheter, 12 cm 5.High pressure Medtronic reservior was used for ventricular catheter 5.High pressure Medtronic reservior (110-170 mmH2O) was used for ventricular catheter, 6.7 cm Operative Procedures 1.ETGA, supine 2.Right Kocher point curvature skin incision 3.Reflect skin flap 4.Burr hole drill 5.Open dura after dural tenting 6.Ventricular puncture then inserted the endoscope 6.Ventricular puncture then inserted the endoscope (Handy Oi pro, 2.7 mm rigid endoscopy) 7.Advanced endoscope through foramen Moro and look downward to identified cystic wall 8.A fenestration was made 8.A fenestration was made with bipolar coagulator, then the scope was inserted through the fenestration hole into the cyst 9.Insert a ventricular catheter into cyst 9.Insert the cystic catheter under the direct vision of the scope 10.Connect cyst catheter to Codman reservior 10.Connect cyst catheter to Codman flat bottom typed reservior 11.Insert a ventricular catheter into ventricle that was connected to Medtronic reservior 11.Insert a ventricular catheter into right ventricle that was connected to Medtronic burr hole typed reservior 12.Connect both reservior to Y connector 12.Connect both reservior to Y connector 13.Minilaparotomy was done at RUQ area then pass a subcutaneous catheter then connect to connector 13.Minilaparotomy was done at RUQ area then pass a subcutaneous catheter then connect to connector. A length of 35 cm was inserted into the abdominal cavity 14.Close wound in layers Operators AP 郭夢菲 Assistants 胡朝凱 Indication Of Emergent Operation severe IICP with heart rate below 60/min 江麗珍 (F,1959/12/14,52y3m) 手術日期 2011/04/16 手術主治醫師 李伯皇 手術區域 東址 013房 01號 診斷 Liver tumor 器械術式 S67 Bisegmentectomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 2 紀錄醫師 吳昭瑩, 時間資訊 07:35 報到 07:56 進入手術室 08:00 麻醉開始 08:25 誘導結束 08:35 抗生素給藥 08:41 手術開始 11:37 抗生素給藥 13:00 麻醉結束 13:00 手術結束 13:08 送出病患 13:31 進入恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 右肝葉切除術 1 1 摘要__ 手術科部: 外科部 套用罐頭: Right lobectomy (S6-7 and partial S5-8) 開立醫師: 吳昭瑩 開立時間: 2011/04/16 13:29 Pre-operative Diagnosis Hepatocellular carcinoma at Segment 6-7 Post-operative Diagnosis Hepatocellular carcinoma at Segment 6-7 Operative Method Right lobectomy (S6-7 and partial S5-8) Specimen Count And Types 3 pieces About size:1*1CM Source:right portal vein thrombus About size:18*15cm Source:segment6-7 with Liver tumor About size:4*5cm Source:gallbladder Pathology pending Operative Findings 1. tumor infiltrative type, size about 6*6cm. Location at segment 6-7, whitish in color 3. Satellite nodule(+) 4. Right Portal vein thrombosis(+), removed for pathology 5. Resection segment(S6-7 and partial S5-8) Operative Procedures 1. Under endotracheal general anesthesia, the patient was put in supine position and the whole abdominal skin was disinfected with painting of alcoholic povidon betaiodine. The operation field was then wrapped with surgical towel as usual. 2. Right subcostal incision with cephalic extension was made with electronic tissue cauterizer. The upper operation field was then further pulled upwards and lateral-wards with Kent self-retractor. 3. The ligamentum teres was ligated and divided for traction of the liver. Divided the falciform ligament to the level of IVC. The triangular ligament and coronary ligament were divided with electrocauterizer. 4. The gall bladder was firstly removed to expose the hilar structure of the liver. 5. Intraoperative ultrasonography was performed to locate the tumor. 6. The right hepatic artery and right portal vein was isolated firstly and was looped with different vascular tape. 7. hepatectomy of S6-7 and partial S5-8 including the hepatic tumor was performed with the aid of CUSA and bipolar electrocauterizer. The exposed vascular structure and bile ducts in the resection plane were divided after ligation or clipping with vascular clip. 8. When the resection was completed, detailed hemostasis of the raw surface was performed by electrocauterization and suture ligation of the bleeder. After this, the raw surface of the liver was covered with Surgicel. 9. N/S irrigation of the abdominal cavity. 10. the surgical wound was closed in three layers with two rubber drains left in the wound space. 11.The muscular layer was closed with two layers of continuous suture with one ""O"" Vicryl. The subcutaneous layer was closed with two ""O"" chromic catgut and then the epidermis approximated with Appose. Operators P李伯皇 Assistants R5鄭宗杰 R1吳昭瑩 相關圖片 李勝恩 (M,1930/07/06,81y8m) 手術日期 2011/04/16 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Cerebrovascular accident 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 面罩麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 陳睿生, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:09 進入手術室 08:55 麻醉開始 09:00 抗生素給藥 09:05 誘導結束 09:15 手術開始 09:30 手術結束 09:30 麻醉結束 09:35 送出病患 09:36 進入恢復室 11:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦脊髓液分流管重置 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Semi-opened mask inhalation anes 1 0 摘要__ 手術科部: 外科部 套用罐頭: VP shunt revision 開立醫師: 陳睿生 開立時間: 2011/04/16 09:39 Pre-operative Diagnosis Hydrocephalus status post VP shunt with dysfunction Post-operative Diagnosis Hydrocephalus status post VP shunt with dysfunction Operative Method VP shunt revision Specimen Count And Types nil Pathology Nil Operative Findings The anti-siphon device was removed, and then the CSF was well drained from the catheter. Operative Procedures 1. ETGA, supine position 2. The wound at subclavical region was reopened 3. The anti-siphon device was exposed 4. It was removed and the previous abdominal catheter was connected with a straight connector 5. Close the wound in layers Operators VS 王國川 Assistants R6 陳睿生 吳正雄 (M,1939/07/25,72y7m) 手術日期 2011/04/17 手術主治醫師 蔡翊新 手術區域 東址 001房 01號 診斷 Intracranial hemorrhage 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3E 紀錄醫師 徐展陽, 時間資訊 02:12 開始NPO 02:12 臨時手術NPO 02:12 通知急診手術 02:30 進入手術室 02:35 麻醉開始 02:42 抗生素給藥 02:50 誘導結束 03:20 手術開始 03:50 開始輸血 05:32 麻醉結束 05:32 手術結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 急性硬腦膜下血腫清除術 1 1 R 手術 顱內壓視置入 1 2 R 摘要__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 蔡翊新 開立時間: 2011/04/17 04:42 Pre-operative Diagnosis Right F-T-P acute SDH, right occipital ICH. Post-operative Diagnosis Right F-T-P acute SDH, right occipital ICH, suspected dural AVF rupture. Operative Method Right F-T-P Craniotomy for SDH evacuation and ICP monitoring. Specimen Count And Types nil Pathology Nil. Operative Findings There was no obvious external wound at scalp. Blood clots gushed out upon first burr hole creation at right temporal area, with initial ICP estimated more than 20 mmHg and brain expanded rapidly. ICP after partial evacuation of SDH dropped to 1 mmHg. Prominent branches of right middle meningeal artery with deep indentation on the skull was noted, suspected feeders of a dural AVF leading to the right occipital ICH. There was SDH, 1.8 cm in thickness, at right F-T-P region. The brain became slack after evacuation of the SDH and the cortical surface showed no contusion or SAH. ICP after duroplasty was 0 mmHg. There was no obvious external wound at scalp. Blood clots gushed out upon first burr hole creation at right temporal area, with initial ICP estimated more than 20 mmHg and brain expanded rapidly. ICP after partial evacuation of SDH dropped to 1 mmHg. Prominent branches of right middle meningeal artery with deep indentation on the skull was noted, suspected feeders of a dural AVF leading to the right occipital ICH. There was SDH, 1.8 cm in thickness, at right F-T-P region. The brain became slack after evacuation of the SDH and the cortical surface showed no contusion or SAH. ICP after duroplasty was 0 mmHg and that after skin closure was -8 mmHg. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 6 cm at right anterior-lower temporal area, the skin edge was clipped by Raney clips for temporary hemostasis. The temporalis muscles was incised down to the tempoal squama which was exposed then by applying a self retaining retractor on the muscle. 5. A burr hole was made and the dura was incised for evacuating part of the subdural hematoma, therefore the IICP could be relieved earlier. 6. The incision was extended to a temporal horseshoe, and the temporalis muscle was detached from temporal squama by rasp subsequently. 7. Craniotomy window: 14 x 12 cm, right F-T-P, created by making 6 burr holes then cut by power saw. 8. Dural tenting: by 2/0 silk, 2 cm in interval, distributed along the edge of skull window. 9. Dural incision: curvilinear along the edge of skull window. 10.The subdural clot was removed by sucker. 11.Hemosatasis: the bleeders was stopped by Bovie and oozing surface was covered with Surgicel and Gelfoam. 12.Dural closure: A 12 x 10 cm piece of Durofoam was used for duroplasty. 13.The skull plate was placed back and fixed with 3 miniplates and 6 screws. 14.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 15.Drain: two, epidural, CWV. 16.Blood transfusion: PRBC 4U, Bloos loss: 600 ml. 17.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R6胡朝凱R4曾峰毅R1徐展陽 Indication Of Emergent Operation IICP, uncal herniation. 李美秀 (F,1970/02/03,42y1m) 手術日期 2011/04/18 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Astrocytoma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 08:00 報到 08:08 進入手術室 08:25 麻醉開始 08:45 誘導結束 08:50 抗生素給藥 08:52 手術開始 11:46 手術結束 11:46 麻醉結束 11:50 抗生素給藥 12:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 立體定位術-切片 1 2 手術 腦瘤切除-手術時間在4~8小時 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for stereotactic tumor excision 開立醫師: 陳國瑋 開立時間: 2011/04/18 12:17 Pre-operative Diagnosis Recurrence grade II Astrocytoma Post-operative Diagnosis Recurrence grade II Astrocytoma Operative Method Craniotomy for stereotactic tumor excision Specimen Count And Types 1 piece About size:pieces Source:brain tumor Pathology Frozen: Grade II glioma Operative Findings 1.One about 4x3 cm whitish to greyish soft tumor located at pre-motor gyrus. 2.Tumor border was relative clear 3.Moderate to high vascularity. Operative Procedures The patient was put in supine position with head turned to left and flexion 30 degrees. The skin was scrubbed, disinfected and draped as usual. The skin incision along previous wound was done and the old craniotomy window was opened after removing the screws. Intra-operative ultrasonography and navigation was used to identified the tumor. Brain mapping was used to identify the location of the mortor strip and tumor excision was then performed. Tumor was dissected along the border between brain parenchyma.Hemostasis was then performed. dura was closed with one piece of fascia. Fixed bone back then close wound in layers. Operators 曾漢民 Assistants 胡朝凱 陳國瑋 相關圖片 許文婷 (F,1972/10/26,39y4m) 手術日期 2011/04/18 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Brain Tumor 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 2 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 11:53 報到 12:18 進入手術室 12:25 麻醉開始 12:40 誘導結束 12:52 抗生素給藥 12:58 手術開始 15:52 抗生素給藥 16:25 麻醉結束 16:25 手術結束 16:35 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 手術 腦瘤切除-手術時間在4小時以內 1 1 R 手術 立體定位術-切片 1 2 R 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for stereotactic tumor biopsy 開立醫師: 陳國瑋 開立時間: 2011/04/18 17:08 Pre-operative Diagnosis r/o high grade glioma Post-operative Diagnosis high grade glioma Operative Method Craniotomy for stereotactic tumor biopsy Specimen Count And Types 1 piece About size:pieces Source:brain tumor Pathology the frozen section showed high grade glioma, the formal report was pending Operative Findings 1. Pinkish part near the surface of the brain and some greyish part at deeper with unclear border. Anterior to the pre-motor gyrus, some hard calcification was noted. 2. Moderated vascularity was noted Operative Procedures The patient was put in supine position with head flexion 30 degrees. The skin was scrubbed, disinfected and draped as usual. The skin incision was done alone the midline and then rightward extension. Craniotomy was done as a triangular shape. Intra-operative ultrasonography and navigation was used to identified the tumor. Brain mapping was used to identify the location of the mortor strip and tumor biopsy was then performed. The part of the tumor at pre-motor area was removed. Hemostasis was then performed. dura was closed with one piece of fascia. Fixed bone back then close wound in layers. Operators 曾漢民 Assistants 胡朝凱 陳國瑋 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Craniotomy for stereotactic tumor biopsy 開立醫師: 陳國瑋 開立時間: 2011/12/16 22:48 Pre-operative Diagnosis r/o high grade glioma Post-operative Diagnosis high grade glioma Operative Method Craniotomy for stereotactic tumor biopsy Specimen Count And Types 1 piece About size:pieces Source:brain tumor Pathology the frozen section showed high grade glioma, the formal report was pending Operative Findings 1. Pinkish part near the surface of the brain and some greyish part at deeper with unclear border. Anterior to the pre-motor gyrus, some hard calcification was noted. 2. Moderated vascularity was noted Operative Procedures The patient was put in supine position with head flexion 30 degrees. The skin was scrubbed, disinfected and draped as usual. The skin incision was done alone the midline and then rightward extension. Craniotomy was done as a triangular shape. Intra-operative ultrasonography and navigation was used to identified the tumor. Brain mapping was used to identify the location of the mortor strip and tumor biopsy was then performed. The part of the tumor at pre-motor area was removed. Hemostasis was then performed. dura was closed with one piece of fascia. Fixed bone back then close wound in layers. Operators 曾漢民 Assistants 胡朝凱 陳國瑋 相關圖片 賴建霖 (M,1969/10/09,42y5m) 手術日期 2011/04/18 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Subarachnoid hemorrhage 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 12:10 進入手術室 12:15 麻醉開始 12:20 誘導結束 13:00 抗生素給藥 13:06 手術開始 15:00 手術結束 15:00 麻醉結束 15:10 送出病患 15:12 進入恢復室 16:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 頭顱成形術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 摘要__ 手術科部: 外科部 套用罐頭: Left fronto-temporo-parietal cranioplasty wit... 開立醫師: 游健生 開立時間: 2011/04/18 15:29 Pre-operative Diagnosis Left occipital dura arteriovenous fistula, complicated with SDH, IVH, ICH, status post left occipital craniotomy and ICH removal, status post left fronto-temporo-parietal craniectomy, status post TAE Post-operative Diagnosis Left occipital dura arteriovenous fistula, complicated with SDH, IVH, ICH, status post left occipital craniotomy and ICH removal, status post left fronto-temporo-parietal craniectomy, status post TAE Operative Method Left fronto-temporo-parietal cranioplasty with autologous bone graft Specimen Count And Types nil Pathology Nil Operative Findings Left cerebrum bulged out from left fronto-temporo-parietal craninectomy window slightly. The skull defect was repaired with autologous bone graft. Operative Procedures 1. Under ETGA, supine with head rotated to right and left shoulder elevated. 2. After shaving, disinfected and draped operation field as usual 3. Scalp incision along previous operation scar 4. Elevated scalp flap along plane between dura and granulation tissue 5. Exposed craniectomy window bone edge 6. Created multiple holes on autologous bone graft 7. Central tenting x 3 8. Fixed back bone graft with miniplates 9. Hemostasis and irrigation with gentamycin solution 10.Place one subgaleal CWV 11.Closed wound in layers Operators VS 賴達明 Assistants R6 陳睿生 R3 游健生 吳陳貴菊 (F,1949/03/15,62y11m) 手術日期 2011/04/18 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Lumbar Spondylosis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 08:04 進入手術室 08:10 麻醉開始 08:20 誘導結束 08:50 抗生素給藥 09:26 手術開始 09:50 開始輸血 11:36 手術結束 11:36 麻醉結束 11:42 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 椎弓切除術(減壓)-超過二節 1 1 摘要__ 手術科部: 外科部 套用罐頭: L3-L5 sublaminar decompression 開立醫師: 游健生 開立時間: 2011/04/18 11:56 Pre-operative Diagnosis L3-L5 spinal stenosis Post-operative Diagnosis L3-L5 spinal stenosis Operative Method L3-L5 sublaminar decompression Specimen Count And Types nil Pathology Nil Operative Findings Hypertrophic ligamentum flavum resulted in spinal stenosis from L3 to L5 and indentation on thecal sac. Thecal sac was well decompressed after sublaminar decompression. Operative Procedures 1. Under ETGA, prone position 2 Locate L3 and L5 pedicle level 3. Disinfection and draping 4. Midline incision from L3 to L5 spinous process level 5. Exposed L3-5 spinous processes and splitted them in half with power saw 6. Removed ligamentum flavum 7. Hemostasis and N/S irrigation 8. Wound closed in layers Operators VS 賴達明 Assistants R6 陳睿生 R3 游健生 許惠英 (F,1955/05/30,56y9m) 手術日期 2011/04/19 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Cervical Spondylosis 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 00:08 臨時手術NPO 07:40 報到 08:03 進入手術室 08:05 麻醉開始 08:15 誘導結束 08:28 抗生素給藥 08:51 手術開始 11:22 抗生素給藥 12:02 手術結束 12:02 麻醉結束 12:12 送出病患 12:15 進入恢復室 13:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-頸椎 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 手術 椎間盤切除術-頸椎 1 2 摘要__ 手術科部: 外科部 套用罐頭: C4-5, C5-6 anterior cervical diskectomy and f... 開立醫師: 李振豪 開立時間: 2011/04/19 12:19 Pre-operative Diagnosis Herniation of intervertebral disc with spinal cord compression, C4-5 and C5-6 Post-operative Diagnosis Herniation of intervertebral disc with spinal cord compression, C4-5 and C5-6 Operative Method C4-5, C5-6 anterior cervical diskectomy and fusion with PEEK cage Specimen Count And Types nil Pathology Nil Operative Findings The C4-5, C5-6 disc was degenerative, herniated, and compressed the thecal sac tightly. Marginal spur formation(+). The C4-5 right side ruptured disc was noted and removed. The OPLL also resected and the thecal sac expanded well. C4-5, C5-6 bilateral foraminotomy was performed and the neural foramen was loose after decompression. Anterior fusion was performed with one #6(C4-5 level), one #7(C5-6 level) PEEK cage, and artificial bone. No SSEP change during whole procedure. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with neck extension. The skin was scrubbed, disinfected, and draped as usual. The transverse skin incision was made at left neck and the platysma muscle was transected. The fascia was opened along the anterior margin of the SCM and the prevertebral fascia was approached between thyroid gland and carotid sheath. The prevertebral fascia was opened and two spinal needle was used for localization. The C4-5, C5-6 disc space was identified by portable C-arm X-ray. Anterior cervical diskectomy and foraminotomy were performed with knife, curette, kerrison punches, and Midas air-drived drills. Anterior fusion was done with two PEEK cage filled with artificial bone. Hemostasis was achieved and the wound was then closed in layers with 3-0 Vicryl and 4-0 Dexon. Operators VS曾勝弘 Assistants R4李振豪, Ri洪士鈞 相關圖片 林妍伶 (F,1985/01/29,27y1m) 手術日期 2011/04/19 手術主治醫師 曾勝弘 手術區域 東址 005房 02號 診斷 Hypogonadism female 器械術式 Laminectomy C-Spinal(Posterier 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 李振豪, 時間資訊 00:11 臨時手術NPO 11:40 報到 12:34 進入手術室 12:40 麻醉開始 14:42 抗生素給藥 15:00 誘導結束 15:10 手術開始 15:25 開始輸血 17:42 抗生素給藥 19:00 麻醉結束 19:00 手術結束 19:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 椎弓切除術(減壓)-超過二節 1 1 手術 顱骨切除術,包括異物移除或壓或經切斷 1 2 摘要__ 手術科部: 外科部 套用罐頭: Suboccipital craniectomy and C1-C5 laminectom... 開立醫師: 李振豪 開立時間: 2011/04/19 19:46 Pre-operative Diagnosis 1. Cervical stenosis, C0-C5 with myelopathy 2. Mucopolysaccharidosis, type VI Post-operative Diagnosis 1. Cervical stenosis, C0-C5 with myelopathy 2. Mucopolysaccharidosis, type VI Operative Method Suboccipital craniectomy and C1-C5 laminectomy for decompression Specimen Count And Types nil Pathology Nil Operative Findings Intubation for this patient was very difficult. The thecal sac was compressed tightly from C0 to C4 level, especially C2-3. The thecal sac expanded well after decompression. The lordotic curve was absent. No incidental durotomy was noted after whole procedure. The MEP could not be detected and the SSEP waveform was poor before the operation. The left upper limb MEP was noted during the operation but no SSEP change occurred. Operative Procedures Under nasal endotracheal general anesthesia, the patient was put in prone position with head fixed with Mayfield scalp clamp. The scalp was shaved, scrubbed, and disinfected as usual. The midline skin incision was made from inion to C6 level. The subcutaneous soft tissue and paravertebral muscle groups were detached. to expose the occipital bone and laminae of C1-5. Suboccipital craniectomy and C1-5 laminectomy was performed with Midas air-drived drills, Rongeur, and Kerrison punches. Hemostasis was achieved and one epidural CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS曾勝弘 Assistants R4李振豪, Ri洪士鈞 相關圖片 楊婉君 (F,1991/07/29,20y7m) 手術日期 2011/04/19 手術主治醫師 曾勝弘 手術區域 東址 012房 03號 診斷 Head Injury 器械術式 Debridment-- 5-10cm 手術類別 預定手術 手術部位 頭、頸 傷口分類 污染 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 15:05 進入手術室 15:10 麻醉開始 15:15 誘導結束 15:50 手術開始 17:00 抗生素給藥 17:30 手術結束 17:30 麻醉結束 17:35 送出病患 17:40 進入恢復室 19:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 顱骨切除術,包括異物移除或壓或經切斷 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 外科部 套用罐頭: Right craniectomy and abscess debridement 開立醫師: 陳國瑋 開立時間: 2011/04/19 18:14 Pre-operative Diagnosis Right craniotomy window infection and epidural abscess Post-operative Diagnosis Right craniotomy window infection and epidural abscess Operative Method Right craniectomy and abscess debridement Specimen Count And Types Previous bone graft and necrotic tissue culture tubes x 3 Pathology nil Operative Findings 1.Much granulation and necrotic tissue beneath the galea was noted 2.Frank pus was drained out at epidural space 3.Bone was also necrotic Operative Procedures 1.ETGA, supine 2.Right previous skin incision 3.reflect skin flap downward 4.Remove necrotic tissue with curette 5.Remove previous bone graft 6.Remove pus with irrigation and curette 7.Hemostasis 8.Set one CWV drain 9.Close wound in layers Operators VS 曾勝弘 Assistants 胡朝凱, 陳國瑋 相關圖片 游沛純 (F,2010/05/24,1y9m) 手術日期 2011/04/19 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Apert syndrome 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:05 進入手術室 08:15 麻醉開始 08:50 誘導結束 09:30 抗生素給藥 10:00 手術開始 12:00 開始輸血 12:30 抗生素給藥 15:30 抗生素給藥 17:10 麻醉結束 17:10 手術結束 17:18 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱骨切除術,包括異物移除或壓或經切斷 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 10 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 3 0 麻醉 Hemoglobin (Hb) 3 0 麻醉 測血糖 3 0 麻醉 Ca (Calcium) 3 0 麻醉 Na (Sodium) 3 0 麻醉 K (Potassium) 3 0 麻醉 Blood gas analysis 3 0 麻醉 Peripheral arterial line inserti 1 0 手術 頭顱成形術 1 2 摘要__ 手術科部: 外科部 套用罐頭: Bilateral parietal-temporal and occipital cra... 開立醫師: 許皓淳 開立時間: 2011/04/19 17:49 Pre-operative Diagnosis Craniosynostosis due to Aperts syndrome status post frontal and bilateral parietal craniectomy and expansive reconstructive cranioplasty. Post-operative Diagnosis Craniosynostosis due to Aperts syndrome status post frontal and bilateral parietal craniectomy and expansive reconstructive cranioplasty, status post bilateral parietal-temporal and occipital craniectomy with expansive reconstructive cranioplasty and barrel-stave osteotomy. Operative Method Bilateral parietal-temporal and occipital craniectomy with expansive reconstructive cranioplasty and barrel-stave osteotomy. Specimen Count And Types nil Pathology Nil. Operative Findings 1.Partial ossification of the posterior fontanelle. Severe adhesion was noted at the previous operative site, mainly the vertex region. The adhesions were hard to lysis. The confluence of sinus and bilateral transverse sinus were identified after craniectomy. The sinuses and dura were kept intact during the whole procedure. 2. A butterfly-shaped craniectomy bone plate involving bilateral parietal-temporal, occipital, and the ossified posterior horn was collected for further reconstruction. The bone plates were reconstructed and fixed by absorable-, and micro-plates and screws. 3. Barrel-stave osteotomy was done for the flattened bilateral temporal bones. Operative Procedures Under ETGA, the patient was placed in prone position and fixed on U shaped head-rest with Mayfield. After shaving, disinfection, and draping, the previous scalp incision was re-incised. The scalp was dissected away from the skull bone with only pericranium left. Meticulous dissection of the pericranium from the skull bone was done by dissector. After drilling two small burr holes below the propsed sites of transverse sinus and two at bilateral temporal area, further craniotomy was achieved with 1mm/2mm Kerrison punch and high speed drill. Dissection of the bone plate from the underlying dura mater was obtained with dissectors. Then, the collected craniectomy bone plate was separated to two major pieces and multiple small pieces. The separated bone plates were reconstructed to increase AP diameter and transverse diameter. Multiple absorbable plates and metallic plates was used to fix the bone plates. After well hemostasis, a CWV drain was placed in subgaleal space. The wound was closed in layers. Operators VS 郭夢菲, 謝孟祥 Assistants R5 阮廷倫, 鍾文桂, R1 許皓淳 記錄__ 手術科部: 外科部 套用罐頭: Bilateral parietal-temporal and occipital cra... 開立醫師: 郭夢菲 開立時間: 2011/04/21 17:07 Pre-operative Diagnosis Craniosynostosis due to Aperts syndrome status post frontal and bilateral parietal craniectomy and expansive reconstructive cranioplasty. Post-operative Diagnosis Craniosynostosis due to Aperts syndrome status post frontal and bilateral parietal craniectomy and expansive reconstructive cranioplasty, status post bilateral parietal-temporal and occipital craniectomy with expansive reconstructive cranioplasty and barrel-stave osteotomy. Operative Method Bilateral parietal-temporal and occipital craniectomy with expansive reconstructive cranioplasty and barrel-stave osteotomy. Specimen Count And Types nil Pathology Nil. Operative Findings 1.Partial ossification of the posterior fontanelle. Severe adhesion was noted at the previous operative site, mainly the vertex region. The adhesions were hard to lysis. The confluence of sinus and bilateral transverse sinus were identified after craniectomy. The sinuses and dura were kept intact during the whole procedure. 2. A butterfly-shaped craniectomy bone plate involving bilateral parietal-temporal, occipital, and the ossified posterior horn was collected for further reconstruction. The bone plates were reconstructed and fixed by absorable-, and micro-plates and screws. 3. Barrel-stave osteotomy was done for the flattened bilateral temporal bones. Operative Procedures Under ETGA, the patient was placed in prone position and fixed on U shaped head-rest with Mayfield. After shaving, disinfection, and draping, the previous scalp incision was re-incised. The scalp was dissected away from the skull bone with only pericranium left. Meticulous dissection of the pericranium from the skull bone was done by dissector. After drilling two small burr holes below the propsed sites of transverse sinus and two at bilateral temporal area, further craniotomy was achieved with 1mm/2mm Kerrison punch and high speed drill. Dissection of the bone plate from the underlying dura mater was obtained with dissectors. Then, the collected craniectomy bone plate was separated to two major pieces and multiple small pieces. The separated bone plates were reconstructed to increase AP diameter and transverse diameter. Multiple absorbable plates and metallic plates was used to fix the bone plates. After well hemostasis, a CWV drain was placed in subgaleal space. The wound was closed in layers. Operators VS 郭夢菲, 謝孟祥 Assistants R5 阮廷倫, 鍾文桂, R1 許皓淳 鄭伊廷 (F,1953/07/23,58y7m) 手術日期 2011/04/19 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Malignant neoplasm of frontal lobe 器械術式 Brain tumor Crainotomy(Others) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 蔡宗良, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:15 麻醉開始 08:50 誘導結束 08:50 抗生素給藥 08:55 手術開始 11:55 抗生素給藥 14:25 手術結束 14:25 麻醉結束 14:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除-手術時間在4~8小時 1 1 L 手術 立體定位術-切片 1 2 L 摘要__ 手術科部: 外科部 套用罐頭: 1. Right frontal craniotomy for brain tumor r... 開立醫師: 蔡宗良 開立時間: 2011/04/19 14:49 Pre-operative Diagnosis Oligodendroglioma, right frontal Oligodendroglioma, left frontal Post-operative Diagnosis Oligodendroglioma, right frontal Oligodendroglioma, left frontal Operative Method 1. Right frontal craniotomy for brain tumor removal 1. left frontal craniotomy for brain tumor removal 2. Application of navigation Specimen Count And Types 1 piece About size:小 Source:Brain Pathology Pending Operative Findings 1. The tumor is whitish to greyish, fragile, easily suckable, poorly-demarcated, with involvment of periventricular area and corpus callosum. The tumor margin was unable to seperate clearly from the normal brain parenchyma. 2. Left-sided pericallosal artery and callosmarginal artery were identified and preserved. 3. Left-sided lateral ventricle was breached and packed with Gel-foam. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position with head fixed with Mayfield skull clump. Navigation insturments were being set-up. The lesion was localized. The scalp was shaved, scrubbed, disinfected with alcohol better-iodine then draped. The U- shaped incision was made followed by right frontal craniotomy. The dura was opened around the tumor after tenting along the craniotomy window. The tumor was dissected with dissector and bipolar coagulator. Falx and ACA branches were visible. After meticulous hemostasis, dura was closed with 4-0 Prolene and skull plate was fixed back to the craniotomy window by four mini-plates. The wound was closed in layers after placing a subgaleal CWV drain. Operators 賴達明 Assistants 蔡宗良 陳以幸 翁琴汝 (F,1939/05/03,72y10m) 手術日期 2011/04/19 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Essential hypertension 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳以幸, 時間資訊 00:00 臨時手術NPO 14:05 報到 14:56 進入手術室 15:00 麻醉開始 15:20 誘導結束 15:30 手術開始 15:32 抗生素給藥 17:48 手術結束 17:48 麻醉結束 18:00 送出病患 18:02 進入恢復室 19:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 手術 良性脊髓腫瘤切除術 1 1 摘要__ 手術科部: 外科部 套用罐頭: intraspinal tumor excision 開立醫師: 陳以幸 開立時間: 2011/04/19 18:07 Pre-operative Diagnosis intraspinal tumor, intradural-extramedullary, schwannoma Post-operative Diagnosis intraspinal tumor, intradural-extramedullary, schwannoma Operative Method intraspinal tumor excision Specimen Count And Types 1 piece About size: Source:SCHWANNOMA Pathology pending Operative Findings tumor:grayish, fragile, well-defined vascularity:moderate Operative Procedures 1.Under ETGA, the patient was put as prone position 2.localize the L5 and S1 vertebral body by C-arm 3.midline skin incision about 7cm in length 4.dissect the subtaneous tissue and paraspinal muscle gradually 5.perform L5 laminectomy 6.under the assistance of intra-operative microscope, remove the tumor from foraminal part first. Open the dura, remove intra-dural part totally 7.Dura was closed with 5-0 prolene 8.N/S irrigation, set one CWV drainage tube to extradural space 9.Hemostasis, close the wound in layers Operators 賴達明 Assistants 蔡宗良 陳以幸 林明竹 (M,1948/09/06,63y6m) 手術日期 2011/04/19 手術主治醫師 賴達明 手術區域 東址 003房 03號 診斷 冠狀動脈疾病 CAD, coronary artery disease 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳以幸, 時間資訊 00:00 臨時手術NPO 18:00 報到 18:32 進入手術室 18:40 麻醉開始 18:50 誘導結束 19:00 抗生素給藥 19:20 手術開始 20:49 手術結束 20:49 麻醉結束 20:55 送出病患 21:00 進入恢復室 22:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 椎間盤切除術-腰椎 1 1 摘要__ 手術科部: 外科部 套用罐頭: microdiskectomy, L4-5 開立醫師: 陳以幸 開立時間: 2011/04/19 20:58 Pre-operative Diagnosis Herniated intervertebral disc, L4-L5, right side Post-operative Diagnosis Herniated intervertebral disc, L4-L5, right side Operative Method microdiskectomy, L4-5 Specimen Count And Types nil Pathology nil Operative Findings hypertrophy of ligmentum flavum protruded intervertebral disc, L4-5, without rupture Operative Procedures 1.ETGA, prone position 2.localize L4-5 space under the assistance of C-arm 3.midline skin incision from previous operation scar 4.periosteal dissection from right side 5.perform L4 laminotomy,remove the L4-5 intervertebral disc under the assistance of microscope 6.hemostasis, close the wound in layers Operators 賴達明 Assistants 蔡宗良 陳以幸 李逸華 (F,1983/11/12,28y4m) 手術日期 2011/04/19 手術主治醫師 楊士弘 手術區域 西址 039房 01號 診斷 Malignant neoplasm of nasopharynx, unspecified 器械術式 Scalp tumor 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 09:45 報到 10:25 進入手術室 10:45 麻醉開始 10:50 手術開始 11:45 麻醉結束 11:45 手術結束 11:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 皮下肌肉或深部異物取出術 1 1 R 手術 毛叢移植（每叢） 5 0 R 摘要__ 手術科部: 外科部 套用罐頭: 1. Port-A removal 開立醫師: 游健生 開立時間: 2011/04/19 12:11 Pre-operative Diagnosis NPC status post Port-A implantation Post-operative Diagnosis NPC status post Port-A implantation Operative Method 1. Port-A removal 2. scar removal with W-plasty Specimen Count And Types nil Pathology Nil Operative Findings Severe adhesion between port-A and its surrounding tissue. A scar was noted at previous incision site. Operative Procedures 1. Under local anesthesia, supine position 2. Disinfection and draped 3. Excised scar by W-plasty 4. Dissected in layers and exposed Port-A 5. Removed port-A and ligated the bleeder 6. Hemostasis and irrigation with N/S 7. Closed wound in layers Operators VS 楊士弘 VS 鄭乃禎 Assistants R3 游健生 杜良男 (M,1942/08/07,69y7m) 手術日期 2011/04/19 手術主治醫師 劉殿楨 手術區域 西址 033房 09號 診斷 Malignant neoplasm of other and ill-defined sites of abdomen 器械術式 Benign neck mass excision (sim 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 郭彥麟, 時間資訊 11:30 報到 11:57 進入手術室 12:07 手術開始 12:15 手術結束 醫令資訊 類別 名稱 量 刀 側 手術 頸部良性腫瘤切除,簡單 1 1 L 記錄__ 手術科部: 耳鼻喉部 套用罐頭: Neck mass excision(LA) 開立醫師: 郭彥麟 開立時間: 2011/04/19 16:22 Pre-operative Diagnosis left neck mass Post-operative Diagnosis left neck mass,operated Operative Method incisional biopsy Specimen Count And Types 2 pieces About size:1cm Source:left neck mass About size:1cm Source:left neck mass Pathology Pending Operative Findings neck masses at left level V. incisional biopsy done Operative Procedures 1.The patient was in supine position with neck hyperextended and turned to the right side. 2.Skin was disinfected and draped as usual. 3.Local anesthesia with Bosmin-rinsed Xylocaine was injected into the subcutaneous tissue around the neck mass after marking. 4.A 3 cm horizontal incision parallel to the skin crease was made. 5.The subcutaneous tissue was cut through. 6.2 masses were found, max diameter > 2cm .incisional biopsy was done 7.The specimen was sent to pathology. 8.After hemostasis, the wound was closed and the patient tolerated the procedure well. Operators P劉殿楨 Assistants R4林沛廷R2郭彥麟 盧慶瑞 (M,1962/07/27,49y7m) 手術日期 2011/04/19 手術主治醫師 戴浩志 手術區域 東址 009房 05號 診斷 Skin squamous cell carcinoma 器械術式 Wide excision - soft tissue tu 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 趙崧筌, 時間資訊 15:23 進入手術室 15:35 麻醉開始 15:45 誘導結束 16:00 抗生素給藥 16:05 手術開始 17:20 手術結束 17:20 麻醉結束 17:22 送出病患 17:25 進入恢復室 18:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 頭皮腫瘤 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Wide excison with bone shaving 開立醫師: 趙崧筌 開立時間: 2011/04/19 17:20 Pre-operative Diagnosis Occipital scalp SCC, s/p wide excision with unclear margin from skull Right occipital scalp SCC, s/p wide excision with unclear margin from skull Post-operative Diagnosis Occipital scalp SCC, s/p wide excision with unclear margin from skull Right occipital scalp SCC, s/p wide excision with unclear margin from skull Operative Method Wide excison with bone shaving Specimen Count And Types 3 pieces About size: Source:Scalp wide excision About size: Source:posterior part About size: Source:outer table of skull Pathology Scalp SCC, keratinizing, S1111198 Operative Findings More 0.5cm safe margin was obtained around previous incision. Outer table of the skull was shaved and burred and the specimen was also collected for pathology. Operative Procedures ETGA, supine, disinfected and prepped Fusiform incision with safe margin and deep to skull Excise the scalp tissue Shave and burr the outer table Close woundn in layers after one hemovac placement Operators 戴浩志 Assistants 黃傑慧 趙崧筌 吳正雄 (M,1939/07/25,72y7m) 手術日期 2011/04/19 手術主治醫師 蔡翊新 手術區域 東址 001房 06號 診斷 Intracranial hemorrhage 器械術式 Right craniotomy for SDH, EDH evacuation 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 4E 紀錄醫師 王奐之, 時間資訊 15:35 通知急診手術 16:20 進入手術室 16:20 報到 16:25 麻醉開始 16:30 誘導結束 16:33 抗生素給藥 16:55 手術開始 17:55 開始輸血 18:55 麻醉結束 18:55 手術結束 19:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 硬腦膜外血腫清除術 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 蔡翊新 開立時間: 2011/04/19 18:24 Pre-operative Diagnosis Right frontotemporoparietal EDH and subdural effusion. Post-operative Diagnosis Right frontotemporoparietal EDH. Operative Method Right frontotemporoparietal craniotomy for removal of EDH. Specimen Count And Types nil Pathology Nil. Operative Findings After removal of previous craniotomy plate, epidural hematoma was noted above native dural flap and Durofoam. The subdural space showed no specific hematoma and the effusion was not seen, possibly escaped after scalp incision. The brain was slack and showed good pulsation. The ICP was around 0 mmHg during the whole procedure. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: right frontotemporoparietal area, along previous incision. The skin edge was clipped by Raney clips for temporary hemostasis. The temporalis muscles was reflected anteroinferiorly. 5. The craniotomy plate was removed by removal of screws. 6. The epidural clot was removed by sucker and the Durofoam was also removed. The subdural space was checked for possible bleeder. 7. Dural closure:was closed with a piece of dural graft taking from temporalis fascia (crescent shape 10 cm long, 2 cm wide) along the whole length of the dural incision. 8. The skull plate was fixed back with original miniplates and screws. 9. Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 10.Drain: one subdural rubber drain, two epidural CWV. 11.Blood transfusion: PRBC 3U, Blood loss: 100 ml. 12.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R6陳睿生R3王奐之 Indication Of Emergent Operation Anisocoric pupil, conscious disturbance, CT: new EDH and SDH 相關圖片 黃玥霖 (F,1989/04/29,22y10m) 手術日期 2011/04/20 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 未提及腦梗塞之腦血栓症(CVA) 器械術式 EC-IC by-pass 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:10 麻醉開始 08:30 誘導結束 09:00 手術開始 09:00 抗生素給藥 12:00 抗生素給藥 15:00 抗生素給藥 15:50 手術結束 15:50 麻醉結束 15:57 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 7 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 顱內外血管吻合術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Right STA-MCA (M4) Bypass 開立醫師: 游健生 開立時間: 2011/04/20 16:08 Pre-operative Diagnosis Moyamoya disease, status post left STA-M3 bypass Post-operative Diagnosis Moyamoya disease, status post left STA-M3 bypass Operative Method Right STA-MCA (M4) Bypass Specimen Count And Types nil Pathology Nil Operative Findings Anterior branch of STA was choosen for bypass instead of posterior branch because of small calibar of the latter. Anastomosis time: 50mins. Indocyanine green angiography showed patent anastomsis. Operative Procedures Under ETGA, patient was in supine position with head rotated to left and right shoulder elevated. Head was fixed by headclamp and neck extended. After shaving, the course of superficial temporal artery was marked with multiple light incisions after mapping by doppler. We prepped and draped the operation field as usual. Curvilinear scalp incision was made just anterior to posterior branch of STA. A 10cm-long segment of anterior branch of STA together with its surrounding fat tissue was isolated by sharp dissection. Bleeding from scalp edge was stopped by bipolar coagulator. Isolated STA branch was occluded by temporary clip and divided at distal end. The adventitia at the end was trimmed to expose vascular stump and lumen irrigated with heparin solution. The temporalis muscle was splitted in half and elevated. After 2 burrholes, a 6 x 6cm craniotomy was done followed by dura tenting along window edge. Dura was opened in cruciate fashion. A suitable cortical branch from the MCA was identified at surface of superior temporal gyrus and the arachnoid around the vessel was removed by microscissors. A piece of plastic membrane was placed under the free segment of the artery. Isolated STA branch was shortened to appropriate length. The adventitia at the end was trimmed to expose vascular stump and lumen irrigated with heparin solution. The distal end was dyed by methlene blue. After systemic heparination (1cc heparin iv), two temporary microvascular clips were applied, 1 cm appart, to the isolated segment of the cortical artery. It was then opened to the same size as the diameter of the STA branch and dyed with methlene blue. Heparin solution was used to irrigate the vascular lumen. After two anchoring stitches, the STA was anastomosed end-to-side to the segment of cortical artery with 6 interrupted stitches of 10/0 monofilament nylon. Wraped the anastomsis site with Surgicel and the vascular clips were released in order (distal end of the cortical vessel, the STA, and the proximal end of the cortical artery). The leakage from the anastomosis was successufully stopped by gentle pressure on the Surgicel with a small sucker tip. Patency was checked by intra-operative ICG angiography. Dura was closed with 4/0 nylon with a fascia graft to obtain water-tight closure except the corner where the STA went into subdural space. The loose space there was packed with gelfoam around the STA. Bone flap was fixed back with miniplates while STA went into subdural space via a burrhole. Wound was closed in layers after N/S irrigation. Operators Prof. 杜永光 Assistants R6 陳睿生 R3 游健生 黃吳祿 (M,1970/04/29,41y10m) 手術日期 2011/04/20 手術主治醫師 曾漢民 手術區域 東址 005房 03號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 15:21 進入手術室 15:30 麻醉開始 15:50 誘導結束 16:10 手術開始 16:35 開始輸血 18:45 送出病患 18:45 麻醉結束 18:45 手術結束 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: craniotomy, tumor excision 開立醫師: 陳國瑋 開立時間: 2011/04/20 19:37 Pre-operative Diagnosis left frontal metastatic brain tumor Post-operative Diagnosis left frontal metastatic brain tumor Operative Method craniotomy, tumor excision Specimen Count And Types 1 piece About size:3cm Source:brain tumor Pathology pending Operative Findings 1. One yellowish, well-defined tumor was noted at left frontal lobe. The tumor was elastic in character with cystic component. Some mucinous dark fluid was noted in the cyst. 2. The brain was mild to medorate swelling. Operative Procedures The patient was put in supine position with head tilting about 45 degrees to right. Scrubbing, skin disinfection and dreping was done as usual. One elongated curvicular skin incision was made at left forehead. The skin was reflected downward and circular craniotomy window was made. The tumor location was checked with intra-operative sonography. U-shape dural incision was made and the dura was reflected medially. One small cortical drainage vein was sacrificed for better exposure. Circular corticortomy was done with bipolar. The tumor was dissected off from normal brain. Carful hemostasis was done and the skull bone was put back. The wound was then closed in layers after setting on epidural CWV drainage tube. Operators 曾漢民 Assistants 胡朝凱 陳國瑋 相關圖片 林楊梅 (F,1937/09/08,74y6m) 手術日期 2011/04/20 手術主治醫師 蔡瑞章 手術區域 東址 005房 01號 診斷 Lumbosacral spondylosis without myelopathy 器械術式 Laminectomy for decompression 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 08:06 進入手術室 08:10 麻醉開始 08:15 誘導結束 08:40 抗生素給藥 09:04 手術開始 11:15 手術結束 11:15 麻醉結束 11:27 送出病患 11:30 進入恢復室 13:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術(減壓)-二節以內 1 2 手術 脊椎融合術-後融合,無固定物 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 摘要__ 手術科部: 外科部 套用罐頭: Laminectomy of L4 and L5, Posterolateral fusi... 開立醫師: 陳國瑋 開立時間: 2011/04/20 12:01 Pre-operative Diagnosis Lumbar stenosis, L4-5 Post-operative Diagnosis Lumbar stenosis, L4-5 Operative Method Laminectomy of L4 and L5, Posterolateral fusion of L4-5 Laminectomy of L4 and L5, Posteriolateral fusion of L4-5 Specimen Count And Types nil Pathology nil Operative Findings 1. The dura sac was compressed tightly and expended well after decompression 2. Incidental durotomy was noted and repaired with prolene Operative Procedures The patient was put in prone position. After identification with C-arm, the skin was disinfected and draped as usual. Midline skin incision about 7cm was made and periosteal disection was done. Laminectomy of L4 and L5 was done and prolene was used to repaire the durotomy. Dissection and decorticaton of the L4 and L5 bilateral transverse proscess was done and posterolateral fusion was done with autologus bone and artificial bone. After hemostasis, one CWV drain was placed. The wound was closed in layers. Operators 蔡瑞章 Assistants 胡朝凱 陳國瑋 相關圖片 黃文峰 (M,1975/08/10,36y7m) 手術日期 2011/04/20 手術主治醫師 蔡瑞章 手術區域 東址 005房 02號 診斷 Herniation of intervertebral disc without myelopathy, lumbar 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 11:35 進入手術室 11:40 麻醉開始 11:40 抗生素給藥 11:45 誘導結束 12:36 手術開始 14:15 手術結束 14:15 麻醉結束 14:22 送出病患 14:25 進入恢復室 16:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-腰椎 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 外科部 套用罐頭: Microscopic diskectomy 開立醫師: 陳國瑋 開立時間: 2011/04/20 14:31 Pre-operative Diagnosis L5 S1 herniated intervertebral disc Post-operative Diagnosis L5 S1 herniated intervertebral disc Operative Method Microscopic diskectomy Specimen Count And Types nil Pathology nil Operative Findings 1. The L5S1 intervertebral disc space was narrow and buldging dehydrated disc compressing right side nerve root was noted. 2. The nerve root was injected and it re-expanded well after decompression. Operative Procedures The patient was put in prone position. After localization with C-arm, the skin was disinfected and dreped as usual. Midline skin incision was done and then dissected to the posterior of lamina. The buldging L5 S1 disc was removed under microscope. After hemostasis, the wound was closed in layers. Operators 蔡瑞章 Assistants 胡朝凱 陳國瑋 相關圖片 李語萱 (F,2009/02/02,3y1m) 手術日期 2011/04/20 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Malignant neoplasm of spinal cord 器械術式 Lamino plasty，Malignant intraspinal tumor, e 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 蕭惠壬, 鍾文桂, 時間資訊 00:00 臨時手術NPO 07:48 報到 08:05 進入手術室 08:10 麻醉開始 08:30 誘導結束 09:43 抗生素給藥 09:45 手術開始 11:00 開始輸血 12:43 抗生素給藥 15:43 抗生素給藥 18:50 麻醉結束 18:50 手術結束 18:55 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 13 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 4 0 麻醉 Hemoglobin (Hb) 4 0 麻醉 測血糖 4 0 麻醉 Ca (Calcium) 4 0 麻醉 Na (Sodium) 4 0 麻醉 K (Potassium) 4 0 麻醉 Blood gas analysis 4 0 手術 內頸靜脈切開,永久導管放置術 1 1 手術 脊椎內脊髓內腫瘤切除術 1 1 手術 椎弓整形術 1 3 摘要__ 手術科部: 外科部 套用罐頭: Port-A 開立醫師: 蕭惠壬 開立時間: 2011/04/20 19:01 Pre-operative Diagnosis Intramadullary malignancy tumor Post-operative Diagnosis Intramadullary malignancy tumor Operative Method Port-A insertion Specimen Count And Types nil Pathology Pending Operative Findings Post-operative portable X-ray showed Port-A catheter tip in correct venous branch to SVC. Operative Procedures 1. Under endotracheal general anesthesia with the patient in supine position, prepped and draping were performed in the usual sterile method. 2. An incision was made in left side neck and subclavical area. After identification of the internal jegular vein, Port-A catheter was inserted. 3. Adequate hemostasis was obtained. 4. Then the wound was closed in layers. Post-operative portable X-ray showed catheter tip in correct venous branch to SVC. Operators VS 林文熙 Assistants R6 柯柏瑞 R2 蕭惠壬 摘要__ 手術科部: 外科部 套用罐頭: T8-S2 laminoplasty for gross total tumor exci... 開立醫師: 鍾文桂 開立時間: 2011/04/20 20:38 Pre-operative Diagnosis CNS primitive neuroectodermal tumor, spinal. Post-operative Diagnosis CNS primitive neuroectodermal tumor, spinal. Operative Method T8-S2 laminoplasty for gross total tumor excision. Specimen Count And Types 1 piece About size:Multiple Source:spinal tumor Pathology Pending. Operative Findings 1. Hypervascularized, soft, grayish-red tumor was noted from T8 to the end of spinal dura mater. The tumor encased the cauda equina and conus medullaris. Some of the nerve fibers were encased and sacrafized due to severe fibrotic change with the tumor mass. However, most of the nerves were well preserved as the tumor pushed the nerves of cauda equina bilaterally. 2. A large feeder from the median sacral artery was electrocoagulated and excised along with the filum terminale. 3. The T8-S2 laminoplasty was done smoothly with high speed drill. The laminae were fixed by 2-0 silk. Operative Procedures Under ETGA, the patient was placed in prone position. After disinfection, and draping, a linear vertical incision was made from T8-S2 level. After paraspinal dissection, en bloc T8-S2 laminectomy was obtained by high speed drill. After dissection from the dura mater, a linear durotomy was achieved and the dura was tented bilaterally. The tumor was excised in piecemeal fashion by using CUSA, tumor forceps, bipolar etc. After well hemostasis, the dura mater was closed in water-tight fashion. The laminae were fixed back by 2-0 silk. The wound was closed in layers with one CWV drain above the laminae. Operators V.S. 郭夢菲 Assistants R5 鍾文桂 摘要__ 手術科部: 外科部 套用罐頭: T8-S2 laminoplasty for gross total tumor exci... 開立醫師: 郭夢菲 開立時間: 2011/04/21 15:44 Pre-operative Diagnosis CNS primitive neuroectodermal tumor, spinal, T9-S2. Post-operative Diagnosis CNS primitive neuroectodermal tumor, spinal, T9-S2. Operative Method T8-S2 laminoplasty for gross total tumor excision. Specimen Count And Types 1 piece About size:Multiple Source:spinal tumor Pathology Pending. Operative Findings 1. Hypervascularized, soft, grayish-red tumor was noted from T9 to the end of spinal dura mater. The tumor encased part of the cauda equina and mainly pushed them to bilateral sides. The conus medullaris was bivalved and pished upward. The tumor also extended to the ventral part of the conus medullaris. The tumor seemed to originate from the conus medullaris that some fiber like (fragile, infiltrated nerves?) was noted here. They were removed accompanied with the tumor. 2. Most of the nerves were well preserved. 2. A large feeder from the median sacral artery was electrocoagulated and excised along with the filum terminale. 3. The T8-S2 laminoplasty was done smoothly with high speed drill. The laminae were fixed by 2-0 silk. Operative Procedures Under ETGA, the patient was placed in prone position. After disinfection, and draping, a linear vertical incision was made from T8-S2 level. After paraspinal dissection, en bloc T8-S2 laminectomy was obtained by high speed drill. Operators Assistants 記錄__ 手術科部: 外科部 套用罐頭: T8-S2 laminoplasty for gross total tumor exci... 開立醫師: 郭夢菲 開立時間: 2011/04/21 16:54 Pre-operative Diagnosis CNS primitive neuroectodermal tumor, spinal, T9-S2. Post-operative Diagnosis CNS primitive neuroectodermal tumor, spinal, T9-S2. Operative Method T8-S2 laminoplasty for gross total tumor excision. Specimen Count And Types 1 piece About size:Multiple Source:spinal tumor Pathology Pending. Operative Findings 1. Hypervascularized, soft, grayish-red tumor was noted from T9 to the end of spinal dura mater. The intrathecal pressure was so high that the dura was diffusely bulged and the spinal canal was widely dilatated. The tumor encased part of the cauda equina and mainly pushed them to bilateral sides. The conus medullaris was bivalved and pished upward. The tumor also extended to the ventral part of the conus medullaris. The tumor seemed to originate from the conus medullaris that some fiber like (fragile, infiltrated nerves?) was noted here. They were removed accompanied with the tumor. 2. Most of the nerves were well preserved. 3. A large feeder from the median sacral artery was electrocoagulated and excised along with the filum terminale. 3. The T8-S2 laminoplasty was done smoothly with high speed saw from caudal to cephalad direction. The laminae were fixed by 2-0 silk. Operative Procedures Under ETGA, the patient was placed in prone position. After disinfection, and draping, a linear vertical incision was made from T8-S2 level. After paraspinal dissection, en bloc T8-L4 and L5 to S2 laminectomy were obtained by high speed saw drill. Both of the lamina flaps were reflected upward and downward respectively. Under microscopic view, the dura was opened in the midline. The tumor was debulked with sucker then CUSA till the normal cauda equina was seen. The tumor was then traces upward to free the bivalved conus medullaris. The tumor at the ventral part of the conus were pulled out. The tumor at the cul-de-sac of the thecal sac was then sucked out completely. After meticulous hemostasis, the dura was closed in water tight fashion. The long lamina graft was fixed back with multiple silk sutures The wound was then closed in layeres with out drain left. Under ETGA, the patient was placed in prone position. After disinfection, and draping, a linear vertical incision was made from T8-S2 level. After paraspinal dissection, en bloc T8-L4 and L5 to S2 laminectomy were obtained by high speed saw drill. Both of the lamina flaps were reflected upward and downward respectively. Under microscopic view, the dura was opened in the midline. The tumor was debulked with sucker then CUSA till the normal cauda equina was seen. The tumor was then traces upward to free the bivalved conus medullaris. The tumor at the ventral part of the conus were pulled out. The tumor at the cul-de-sac of the thecal sac was then sucked out completely. After meticulous hemostasis, the dura was closed in water tight fashion. The long lamina graft was fixed back with multiple silk sutures The wound was then closed in layeres with out drain left. Operators VS 郭夢菲 Assistants R5鍾文桂 摘要__ 手術科部: 外科部 套用罐頭: Port-A 開立醫師: 蕭惠壬 開立時間: 2011/04/23 17:13 Pre-operative Diagnosis CNS primitive neuroectodermal tumor, spinal. Post-operative Diagnosis CNS primitive neuroectodermal tumor, spinal. Operative Method Port-A insertion Specimen Count And Types nil Pathology Pending Operative Findings Post-operative portable X-ray showed Port-A catheter tip in correct venous branch to SVC. Operative Procedures 1. Under endotracheal general anesthesia with the patient in supine position, prepped and draping were performed in the usual sterile method. 2. An incision was made in left side neck and subclavical area. After identification of the internal jegular vein, Port-A catheter was inserted. 3. Adequate hemostasis was obtained. 4. Then the wound was closed in layers. Post-operative portable X-ray showed catheter tip in correct venous branch to SVC. Operators VS 林文熙 Assistants R6 柯柏瑞 R2 蕭惠壬 王晨允 (F,2010/10/19,1y4m) 手術日期 2011/04/20 手術主治醫師 郭夢菲 手術區域 兒醫 065房 03號 診斷 Hypoplastic left heart syndrome, congenital 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 15:39 進入手術室 15:39 報到 15:45 麻醉開始 16:05 誘導結束 17:00 抗生素給藥 17:28 手術開始 17:53 開始輸血 19:05 麻醉結束 19:05 手術結束 19:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 手術 慢性硬腦膜下血腫清除術 1 2 R 摘要__ 手術科部: 套用罐頭: 1. Ventriculoperitoneal programmable shunt im... 開立醫師: 鍾文桂 開立時間: 2011/04/20 20:12 Pre-operative Diagnosis 1. Hydrocephalus. 2. Subdural effusion, right frontal-parietal-temporal. Post-operative Diagnosis 1. Hydrocephalus. 2. Subdural effusion, right frontal-parietal-temporal. Operative Method 1. Ventriculoperitoneal programmable shunt implantation, right Kocher. 2. Evacuation of subdural effusion. Specimen Count And Types 2 pieces About size:2cc Source:subdural fluid collection. About size:2cc Source:CSF Pathology Nil. Operative Findings 1. Right Kocher insertion of Codman programmable shunt, set 80mmH20; ventricular catheter: 6cm, peritoneal catheter: 30cm. 2. Clear colorless CSF fluid with low pressure. 3. Clear yellowish subdural effusion with presence of outer memebrane. 4. Easy oozing operative field. 6 units of platelet was transfused. Operative Procedures Under ETGA, the patient was placed in supine position and the head was tilted to the left. After shaving, disinfection, and draping, a curvilinear scalp incision was made at right Kocher point. After scalp dissection, a small craniotomy was made at the right anterior border of anterior fonanelle. After durotomy, the negaton tube was inserted at 3cm level to right Kocher point. The abdominal transverse incision was made and dissection was done until the peritoneal cavity was reached. Subcutanous tunnel was created. The shunt catheter was inserted at peritoneal cavity and passed through the tunnel. The ventricular catheter was implanted into the ventricle. After ensuring the shunt patency, the wounds were closed in layers. Operators V.S. 郭夢菲. Assistants R5 鍾文桂 相關圖片 記錄__ 手術科部: 套用罐頭: 1. Ventriculoperitoneal programmable shunt im... 開立醫師: 郭夢菲 開立時間: 2011/04/21 17:04 Pre-operative Diagnosis 1. Hydrocephalus. 2. Subdural effusion, bilateral frontal-parietal-temporal. Post-operative Diagnosis 1. Hydrocephalus. 2. Subdural effusion, bilateral frontal-parietal-temporal. Operative Method 1. Ventriculoperitoneal programmable shunt implantation, right Kocher. 2. Evacuation of subdural effusion. Specimen Count And Types 2 pieces About size:2cc Source:subdural fluid collection. About size:2cc Source:CSF Pathology Operative Findings 1. Right Kocher insertion of Codman programmable shunt, set 80mmH20; ventricular catheter: 6cm, peritoneal catheter: 30cm. 2. Clear colorless CSF fluid with low pressure. Operative Procedures Under ETGA, the patient was placed in supine position and the head was tilted to the left. After shaving, disinfection, and draping, a curvilinear scalp incision was made at right Kocher point. After scalp dissection, a small craniotomy was made at the right anterior border of anterior fonanelle. After durotomy, the chronic yellowish subdural effusion was drained out gradually. After ventricular tapping with puncture needle, a nelaton tube was inserted at 4cm level to right Kocher point. The abdominal transverse incision was made and dissection was done until the peritoneal cavity was reached. Subcutanous tunnel was created. The shunt catheter was inserted at peritoneal cavity and passed through the tunnel. Another incision was made at the postauricular region, then the peritoneal catheter was passed to the the ventricle wound. All the shunt apparatus were connected together, then the wound was closed in layers. After ensuring the shunt patency, the wounds were closed in layers. Operators V.S. 郭夢菲. Assistants R5 鍾文桂 相關圖片 沈賢圳 (M,1956/11/10,55y4m) 手術日期 2011/04/20 手術主治醫師 蕭輔仁 手術區域 東址 003房 02號 診斷 Esophageal cancer 器械術式 Port-A catheter Removal 手術類別 緊急手術 手術部位 胸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 陳以幸, 時間資訊 10:01 通知急診手術 16:35 報到 16:42 進入手術室 16:55 麻醉開始 17:00 誘導結束 17:02 手術開始 17:10 抗生素給藥 17:25 麻醉結束 17:25 手術結束 17:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 皮下肌肉或深部異物取出術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Removal of port-A 開立醫師: 陳以幸 開立時間: 2011/04/20 17:42 Pre-operative Diagnosis esophageal cancer s/p left side port-A insertion Post-operative Diagnosis esophageal cancer s/p removal of left side port-A Operative Method Port-A catheter Removal Specimen Count And Types nil Pathology Nil Operative Findings The catheter was removed totally and the course was smooth Operative Procedures 1. Local anesthesia, supine position. 2. Skin disinfection. 3. An incision was made over previous scar. 4. Dissect the port-A catheter and port from fascia with eletrocautery knife. 5. Remove port-A set. A suture with 3-0 Dexon was doneto seal the catheter tunnel. 6. Hemostasis. 7. Close wounds in layers with 3-0 Dexon, 3-0 Nylone. Operators 蕭輔仁 Assistants 陳以幸 Indication Of Emergent Operation acute thrombosis 相關圖片 管蔡素貞 (F,1936/11/23,75y3m) 手術日期 2011/04/20 手術主治醫師 謝敦理 手術區域 西址 033房 07號 診斷 Subarachnoid hemorrhage (SAH) 器械術式 Permanent tracheostomy with sk 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 12:52 報到 13:40 進入手術室 13:45 麻醉開始 13:48 手術開始 14:05 手術結束 14:10 送出病患 記錄__ 手術科部: 耳鼻喉部 套用罐頭: debridement and closure 開立醫師: 郭彥麟 開立時間: 2011/04/20 14:09 Pre-operative Diagnosis TRACHOSTOMY WOUND POOR HEALING Post-operative Diagnosis TRACHOSTOMY WOUND POOR HEALING,operated Operative Method debridement and closure Specimen Count And Types nil Pathology nil Operative Findings a 1cm poor healing tracheostomy wound Operative Procedures 1.injecting local anesthesia 2.denuding the tracheostomy wound edge, then approximate the edges 3.patient tolerated well Operators VS謝敦理 Assistants R4林沛廷R2郭彥麟 王徐秋 (F,1943/07/24,68y7m) 手術日期 2011/04/20 手術主治醫師 林晉 手術區域 東址 022房 01號 診斷 Fracture, femoral neck 器械術式 Hemi..Bipolar 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 脊髓麻醉 麻醉主治醫師 林子富 ASA 3 紀錄醫師 葉炳君, 時間資訊 07:55 報到 08:05 進入手術室 08:15 麻醉開始 08:25 誘導結束 08:30 抗生素給藥 08:49 手術開始 09:28 開始輸血 10:20 手術結束 10:20 麻醉結束 10:30 送出病患 10:35 進入恢復室 12:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Spinal anesthesia 1 0 手術 部份關節置換術併整形術–只置換髖臼或股骨或半股關節或半肩關節 1 1 L 摘要__ 手術科部: 骨科部 套用罐頭: Bipolar hemiarthroplasty 開立醫師: 葉炳君 開立時間: 2011/04/20 10:05 Pre-operative Diagnosis Left femoral neck fracture, Garden type 4 Post-operative Diagnosis Left femoral neck fracture, Garden type 4 Operative Method Bipolar hemiarthroplasty Specimen Count And Types nil Pathology Nil Operative Findings Displaced femoral neck fracture, left Operative Procedures 1. Anesthesia induction, right decubitus position. 2. Skin disinfection and draped. 3. Longitudinal skin incision then posterior approach of hip. 4. Remove femoral head then prepare the femur with reamer and broach. 5. Insert United Hip System bipolar prosthesis. 6. Irrigate the wound and repair the capsule and short rotators. 7. Close the wound in layers. Operators P 林晉, Assistants 葉炳君, 黃哲南, 許寬宏, INTAN DELIMA (F,1960/11/16,51y3m) 手術日期 2011/04/21 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Facial spasm 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林子富 ASA 3 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 08:10 進入手術室 08:15 麻醉開始 08:30 誘導結束 09:20 抗生素給藥 09:23 手術開始 12:20 抗生素給藥 13:18 手術結束 13:18 麻醉結束 13:38 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦微血管減壓術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Right retrosigmoid approach for facial nerve ... 開立醫師: 游健生 開立時間: 2011/04/21 13:56 Pre-operative Diagnosis Right hemifacial spasm Post-operative Diagnosis Right hemifacial spasm Operative Method Right retrosigmoid approach for facial nerve decompression Specimen Count And Types nil Pathology Nil Operative Findings A loop of anterior inferior cerebellar artery was seen touching the CN VII/VIII complex superiorly and did not add pressure on the nerve complex. It gave small branches to the nerve complex. When we approached the nerve complex from interior angle, another loop of AICA was seen compressing the nerve complex from inferoposterior aspect near CN VII exit zone. Thus, we thought the latter loop was the offending loop. It was pushed away by teflon to gain adequate decompression of facial nerve. The pre-op ABR was normal and there was no significant ABR changes during the surgery. A 5cm scalp laceration was noted at right parietal region. It was disinfected, sutured, and draped before surgery. Operative Procedures Under ETGA, patient was in supine position with head fixed by headclamp. Her head was rotated to left with neck extension and right shoulder elevated. Right mastoid tip was positioned to the highest point of operation field. A 5cm scalp laceration was noted at right parietal region. It was disinfected, sutured, and draped before surgery. After shaving, operation field was disinfected and draped as usual. A 10cm long incision was made along the retroauricular hair line with center at external acoutic meatus. A fascia was harversted for duroplasty. The asterion was exposed after dissection. A 4 x 2cm suboccipital retromastoid craniotomy was done to expose the lower-posterior margin of the junction of transverse and sigmoid sinus. After K-shape durotomy, the cerebellopontine cistern was opened for CSF drainage. The cerebellum sank and only little retraction on it was needed to expose cranial nerve VII/VIII complex. A loop of anterior inferior cerebellar artery was seen touching the CN VII/VIII complex superiorly. It gave small branches to the nerve complex. When we approached the nerve complex from interior angle, another loop of AICA was seen compressing the nerve complex from inferoposterior aspect near CN VII exit zone. After we freed the AICA loop from arachnoid membrane, we pushed the inferior loop away from CN VII exit zone and filled the space between them with teflon felt cotton. After ensuring no pressure on CN VII, we achieved hemostasis with Surgicel. Dura was repaired with a fascia and sutured with 4-0 prolene to obtain water-tight closure. Muscle was approximated by interrupted silk sutures. Wound was closed with 3-0 vircyl continuous suture for subcutanuous layer and 3-0 nylon continuous suture for the skin. Operators Prof. 杜永光 Assistants R6 陳睿生 R3 游健生 吳佩芸 (F,1974/09/11,37y6m) 手術日期 2011/04/21 手術主治醫師 賴達明 手術區域 東址 005房 02號 診斷 Brain abscess 器械術式 Stereotaxic procedure for aspi 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 林子富 ASA 3 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 12:40 麻醉開始 12:40 進入手術室 13:00 抗生素給藥 13:15 手術開始 15:00 誘導結束 16:43 手術結束 16:43 麻醉結束 16:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 立體定位術-抽吸 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Left frontal burr hole for aspiration of brai... 開立醫師: 李振豪 開立時間: 2011/04/21 17:10 Pre-operative Diagnosis Brain abscess Post-operative Diagnosis Brain abscess Operative Method Left frontal burr hole for aspiration of brain abscess Specimen Count And Types 1 piece About size:5ml Source:brain abscess Pathology Nil Operative Findings Total 5ml brain abscess was aspirated and sent for Gram stain, bacterial, fungal, and mycobacterial culture. The capsule of the brain abscess was thick and hard in character. Some hematoma within the tract was noted before wound closure. The pupil was isocornic with light reflex after the operation. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head fixed with Mayfield skull clamp. The registration of navigation was done. The scalp was shaved, scrubbed, and disinfected as usual. Left frontal linear scalp incision was made followed by one burr hole creation. Two dural tenting was done with cruciform durotomy. Aspiration of brain abscess was performed under navigation guided. Hemostasis was achieved and the wound was then closed in layers. Operators VS蕭輔仁 Assistants R4李振豪, R1陳以幸, R1陳宣佑 相關圖片 陳林專 (F,1933/12/05,78y3m) 手術日期 2011/04/21 手術主治醫師 黃國皓 手術區域 東址 015房 04號 診斷 Intraspinal abscess 器械術式 URS 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 3 紀錄醫師 曾任偉, 時間資訊 14:23 報到 15:03 進入手術室 15:20 麻醉開始 15:25 誘導結束 15:34 手術開始 15:57 手術結束 15:57 麻醉結束 16:00 送出病患 16:05 進入恢復室 17:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 診斷性輸尿管鏡檢，包括輸尿管膀胱接合處，擴張術及膀胱鏡術 1 0 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 泌尿部 套用罐頭: URS-SM 開立醫師: 賴建榮 開立時間: 2011/04/21 16:08 Pre-operative Diagnosis Right hydronephrosis Post-operative Diagnosis Right hydronephrosis Operative Method URS and DBJ insertion Specimen Count And Types nil Pathology nil Operative Findings 1.Turbid urine at bladder and ureter 2.tortous of right ureter with hard consistence 3.Only guide can pass through the ureter,fail to pass URS Operative Procedures Under satisfactory anesthesia with the patient in the lithotomy position, skin preparation was performed. A cystoscope was inserted into the bladder and a guidewire was then introduced into the ureteral orifice. A 6 Fr. ureteroscope was introduced into the ureter. A Fr.6-24cm DBJ catheter was inserted. The patient tolerated the operation well and was sent to the recovery room in stable condition. Operators 黃國皓, Assistants 曾任偉, 黃俊嘉 (M,1971/11/26,40y3m) 手術日期 2011/04/21 手術主治醫師 楊士弘 手術區域 東址 002房 02號 診斷 Bacterial meningitis 器械術式 V-P shunt removal + EVD insertion 手術類別 緊急手術 手術部位 頭、頸 傷口分類 髒 麻醉方式 全身麻醉 麻醉主治醫師 林子富 ASA 3E 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 08:58 通知急診手術 11:50 報到 12:13 進入手術室 12:15 麻醉開始 12:20 誘導結束 12:50 手術開始 13:00 抗生素給藥 13:40 手術結束 13:40 麻醉結束 13:48 送出病患 13:52 進入恢復室 14:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 顱內壓視置入 1 2 R 摘要__ 手術科部: 內科部 套用罐頭: Remove VP shunt 開立醫師: 蔡宗良 開立時間: 2011/04/21 14:07 Pre-operative Diagnosis VP shunt infection Post-operative Diagnosis VP shunt infection Operative Method Remove VP shunt External ventricular drainage, via right-sided Kochers point Specimen Count And Types 2 pieces About size:小 Source:CSF About size:小 Source:Tip culture x2 Pathology None Operative Findings Turbid yellowish CSF ICP: low Operative Procedures 1. ETGA, supine 2. Routine prepping and draping 3. Open previous wound 4. Remove VP shunt, obtain ventricular and peritoneal tip for culture 5. Insert EVD, obtain CSF for culture 6. Fixation of EVD 7. Wound closed in layers after copious saline irrigation. Operators 楊士弘 Assistants 蔡宗良 張哲瑞 Indication Of Emergent Operation increased intracranial pressure 徐惟菁 (F,1968/11/05,43y4m) 手術日期 2011/04/21 手術主治醫師 楊士弘 手術區域 東址 005房 01號 診斷 Brain metastasis 器械術式 Crainotomy Brain Tumor(P-LIN) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林子富 ASA 3 紀錄醫師 陳宣佑, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:20 麻醉開始 09:00 誘導結束 09:00 抗生素給藥 09:22 手術開始 11:43 手術結束 11:43 麻醉結束 12:07 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除-手術時間在4小時以內 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Right frontal craniotomy for total tumor excision 開立醫師: 楊士弘 開立時間: 2011/04/21 11:46 Pre-operative Diagnosis Brain tumor, right frontal lobe, r/o metastasis Post-operative Diagnosis Brain tumor, right frontal lobe, r/o metastasis Operative Method Right frontal craniotomy for total tumor excision Specimen Count And Types 1 piece About size:小 Source:brain tumor Pathology pending Operative Findings A pale yellowish tumor, 2 cm in diameter, was seen just below the pia mater in the middle frontal gyrus. The tumor was soft fragile, and some milky liquid content was found in side the tumor. The tumor wall was quite adherent with the white mater. After tumor excision glistening white surface was seen in the tumor bed, indicating normal white mater. Operative Procedures 1. ETGA, supine, head rotated to left. 2. Linear incision over right frontal scalp. 3. Right frontal craniotomy, 3.5 cm x 3 cm. 4. Cruciate dural opening. 5. Opening of pia surface with bipolar and microscissor. 6. Dissection and removal of tumor from brain parenchyma with bipolar, dissector, and suction. 7. Hemostasis by bipolar coagulation and surgicel strips placed over tumor bed. 8. Dural closure with 4-0 prolene. 9. Fixation of craniotomy flap with miniplates and screws. 10. Wound closure in layers. Operators 楊士弘 Assistants 李振豪, 陳宣佑 相關圖片 李玉仙 (F,1941/06/07,70y9m) 手術日期 2011/04/21 手術主治醫師 蕭輔仁 手術區域 東址 005房 03號 診斷 Low back pain 器械術式 Radiofrequency coagulation 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 17:10 進入手術室 17:20 抗生素給藥 17:36 麻醉開始 17:37 麻醉結束 17:38 手術開始 18:30 手術結束 18:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 高頻熱凝療法 1 1 B 記錄__ 手術科部: 外科部 套用罐頭: Radiofrequency stimulation, bilateral L2 dors... 開立醫師: 陳宣佑 開立時間: 2011/04/21 18:28 Pre-operative Diagnosis Right sciatica Post-operative Diagnosis Right sciatica Operative Method Radiofrequency stimulation, bilateral L2 dorsal root Specimen Count And Types nil Pathology Nil Operative Findings 1. Bilateral L2 dorsal root was identified by portable C-arm X-ray and sensory/motor stimulation test. No acute complication was noted after the procedure. 2. Temp: 42 oC, Time: 180sec x 2 cycles each side Operative Procedures The patient was put in prone position. The location of L2 was identified by portable C-arm X-ray. The skin was disinfected and draped as usual. Local anesthesia was performed with 1% Xylocaine 10ml. Bilateral L2 dorsal root radiofrequency stimulation was performed under portable C-arm guided. The patient stood whole procedure well. Operators VS蕭輔仁 Assistants R4李振豪,R1陳宣佑 相關圖片 摘要__ 手術科部: 外科部 套用罐頭: Radiofrequency stimulation, bilateral L2 dors... 開立醫師: 陳宣佑 開立時間: 2011/04/21 18:28 Pre-operative Diagnosis Right sciatica Post-operative Diagnosis Right sciatica Operative Method Radiofrequency stimulation, bilateral L2 dorsal root Specimen Count And Types nil Pathology Nil Operative Findings 1. Bilateral L2 dorsal root was identified by portable C-arm X-ray and sensory/motor stimulation test. No acute complication was noted after the procedure. 2. Temp: 42 oC, Time: 180sec x 2 cycles each side Operative Procedures The patient was put in prone position. The location of L2 was identified by portable C-arm X-ray. The skin was disinfected and draped as usual. Local anesthesia was performed with 1% Xylocaine 10ml. Bilateral L2 dorsal root radiofrequency stimulation was performed under portable C-arm guided. The patient stood whole procedure well. Operators VS蕭輔仁 Assistants R4李振豪,R1陳宣佑 相關圖片 李劉青 (F,1943/09/13,68y6m) 手術日期 2011/04/21 手術主治醫師 蕭輔仁 手術區域 東址 005房 05號 診斷 Low back pain 器械術式 Radiofrequency coagulation 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 18:47 進入手術室 19:10 麻醉開始 19:15 麻醉結束 19:17 抗生素給藥 19:20 手術開始 19:50 手術結束 19:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 高頻熱凝療法 1 1 B 摘要__ 手術科部: 外科部 套用罐頭: Radiofrequency stimulation, Left L1, L2 and r... 開立醫師: 李振豪 開立時間: 2011/04/21 23:47 Pre-operative Diagnosis Low back pain with bilateral sciatica Post-operative Diagnosis Low back pain with bilateral sciatica Operative Method Radiofrequency stimulation, Left L1, L2 and right L2 dorsal root Specimen Count And Types Nil Pathology Nil Operative Findings 1. Bilateral L2 and left L1 dorsal root was identified by portable C-arm X-ray and sensory/motor stimulation test. No acute complication was noted after the procedure. 2. Temp: 42 oC, Time: 180sec x 2 cycles each side Operative Procedures The patient was put in prone position. The location of L1 and L2 was identified by portable C-arm X-ray. The skin was disinfected and draped as usual. Local anesthesia was performed with 1% Xylocaine 10ml. Bilateral L2 and left L1 dorsal root radiofrequency stimulation was performed under portable C-arm guided. The patient stood whole procedure well. Operators VS蕭輔仁 Assistants R4李振豪, R1陳宣佑 相關圖片 賴綢妹 (F,1929/03/04,83y0m) 手術日期 2011/04/21 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 Cerebral hemorrhage 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林子富 ASA 3 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 13:53 進入手術室 14:00 麻醉開始 14:10 誘導結束 14:15 抗生素給藥 14:28 手術開始 15:12 手術結束 15:12 麻醉結束 15:23 送出病患 15:25 進入恢復室 16:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦脊髓液分流管重置 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt revision, right 開立醫師: 王奐之 開立時間: 2011/04/21 15:31 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunt revision, right Specimen Count And Types Nil Pathology Nil Operative Findings Low pressure was noted on ventricular puncture. Clear & colorless CSF was noted. Smooth CSF refilling was confirmed after assembly of shunt and Y-shaped connector. Operative Procedures After ETGA, the patient was placed in supine position with face turned to left. After scalp shaving, disinfection and draping in sterile fashion, a curvilinear skin incision was made at right frontal area. After identifying the previous burr hole and the ventriculoperitoneal shunt catheter, the burr hole was made larger to the medial-posterior edge. Ventricular puncture was done to the ipsilateral ventricle, followed by insertion of a new ventricular catheter. The new catheter joined the shunt via a Y-shaped connector. After hemostasis, the wound was closed in layers. Operators VS 王國川 Assistants R3 王奐之 相關圖片 賴照輝 (M,1946/05/24,65y9m) 手術日期 2011/04/21 手術主治醫師 王國川 手術區域 東址 003房 03號 診斷 Ossification of posterior longitudinal ligament, cervical (OPLL) 器械術式 Laminectomy for decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林子富 ASA 3 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 15:35 進入手術室 15:40 麻醉開始 15:55 誘導結束 15:55 抗生素給藥 16:05 手術開始 17:56 手術結束 17:56 麻醉結束 18:10 送出病患 18:13 進入恢復室 19:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 椎弓切除術(減壓)-超過二節 1 1 摘要__ 手術科部: 外科部 套用罐頭: Cervical Laminectomy 開立醫師: 曾峰毅 開立時間: 2011/04/21 17:47 Pre-operative Diagnosis Cervical stenosis, C4-6 Post-operative Diagnosis Cervical stenosis, C4-6 Operative Method Cervical Laminectomy, lower C4 to upper C6 Specimen Count And Types Nil Pathology Nil Operative Findings Thecal sac was decompressed well after laminectomy. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position with head fixed with Mayfield head clamp. We disinfected and draped the patient, and made one midline skin incision to dissected bilateral paraspinal muscle from C4 to C6. We performed lameinectomy from lower C4 to upper C6. After hemostasis, the wound was closed with one submuscular CWV. Operators VS 王國川 Assistants R4 曾峰毅 R3 王奐之 相關圖片 劉月麗 (F,1933/07/09,78y8m) 手術日期 2011/04/21 手術主治醫師 蔡清霖 手術區域 東址 027房 03號 診斷 Osteoarthritis, knee 器械術式 TKR -United 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 硬肌麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 黃俊傑, 時間資訊 11:40 報到 12:00 進入手術室 12:05 麻醉開始 12:35 誘導結束 12:42 抗生素給藥 13:05 手術開始 13:55 開始輸血 14:20 抗生素給藥 15:50 麻醉結束 15:50 手術結束 15:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 膝關節全置換術 2 1 B 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Epidural anesthesia 1 0 麻醉 EPIDURAL ANESTHESIA 4 0 記錄__ 手術科部: 骨科部 套用罐頭: Total knee replacement-lateral by 蔡P 開立醫師: 黃俊傑 開立時間: 2011/04/21 16:04 Pre-operative Diagnosis Bilateral knee osteoarthritis Post-operative Diagnosis Ditto Operative Method Total knee replacement with United prosthesis Specimen Count And Types 1 piece About size:culture tip Source:bilatera OA knee for bone bank routine Pathology nil Operative Findings 1.Cartilage wearing and subchondral bone expose 2.osteophyte formation 3.Varus deformity Operative Procedures Under spinal anesthesia, the patient was postioned in supine. The operation field was disinfected and draped as usual. After inflating air tourniquet with 350 mmHg in pressure,left knee skin was incised along midline of knee, and exposusre of the knee jointwas done with lateral approach. Bony preparation of femur, tibia, and patella were performed with ""united"" jigs subsequently. Total knee prosthesis was applied with cement, Tibia: #2, Femur: #2, Patella:22mm, Insert: #2,9mm; Then air tourniquet was deflated, and hemostasis was done. After cleaning surgical wound with normal saline irrigation, the wound was finally closed in layers. After inflating air tourniquet with 350 mmHg in pressure, right knee skin was incised along midline of knee, and exposusre of the knee jointwas done with lateral approach. Bony preparation of femur, tibia, and patella were performed with ""united"" jigs subsequently. Total knee prosthesis was applied with cement, Tibia: #2, Femur: #2, Patella:22mm, Insert: #2,9mm; Then air tourniquet was deflated, and hemostasis was done. After cleaning surgical wound with normal saline irrigation, the wound was finally closed in layers. Operators 蔡清霖, Assistants 黃俊傑, 黃哲南, 李奕辰, 潘以宏 (M,1922/09/24,89y5m) 手術日期 2011/04/21 手術主治醫師 詹志洋 手術區域 東址 001房 01號 診斷 Subdural hemorrhage following injury, with loss of consciousness of unspecified duration 器械術式 Permcath 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 4 紀錄醫師 羅健洺, 時間資訊 14:16 臨時手術NPO 08:30 進入手術室 08:40 麻醉開始 08:45 誘導結束 08:45 抗生素給藥 08:53 手術開始 09:02 手術結束 09:02 麻醉結束 09:10 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 內頸靜脈切開,永久導管放置術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Permcath/port-A 開立醫師: 羅健洺 開立時間: 2011/04/21 09:08 Pre-operative Diagnosis ESRD Post-operative Diagnosis ESRD s/p Permcath insertion Operative Method Permcath implantation via right internal jugular vein Specimen Count And Types nil Pathology nil Operative Findings 1. The Permcath catheter was inserted via right internal jugular vein by echo-guided procedure 2. Patent flow after implantation Operative Procedures -Anesthesia: local, the patient was put on supine position. The operation field was disinfected and draped as usual. -Permcath catheter was implanted on right side upper chest with cut down/puncture method under echo-guided procedure. The catheter was advenced via the peel-away sheath smoothly after tunnelization. -The flow was checked and flushed with heparin solution. The wounds were closure by 2-0 Nylon. Local compression for hemostasis. Operators 詹志洋, Assistants 羅健洺, 楊淑禎 (F,1968/07/24,43y7m) 手術日期 2011/04/22 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Pituitary tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 1 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 08:06 進入手術室 08:10 麻醉開始 08:20 誘導結束 09:18 抗生素給藥 09:55 手術開始 10:50 手術結束 10:50 麻醉結束 11:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 經由蝶竇之腦下垂體瘤切除 1 1 摘要__ 手術科部: 外科部 套用罐頭: Transnasal trans-sphenoid approach for adenom... 開立醫師: 游健生 開立時間: 2011/04/22 11:30 Pre-operative Diagnosis Pituitary macroadenoma with optic chiasm compression Post-operative Diagnosis Pituitary macroadenoma with optic chiasm compression Operative Method Transnasal trans-sphenoid approach for adenomectomy Specimen Count And Types 1 piece About size:a few pieces Source:pituitary tumor Pathology pending Operative Findings Tumor bulged out after durotomy. It was yellowish, soft, and fragile. It pushed normal pituitary gland to left side and extended to suprasellar region and canvernous sinus. Optic chiasm sank back to neurtal position and came into sight after tumor removal. Intra-operative VEP showed no significant changes. Intra-operative CSF leak was noted. Operative Procedures Under ETGA, patient was in supine position with head tilted 30 degree to left. The face and LLQ abdomen were prepared with povidone-iodine alcohol tincture, and the mucosa of oral and nasal cavity with aqueous povidone-iodine tincture. Both were covered by a sterilized adhesive plastic sheet. The nasal submucosa at septum was infiltrated with 1:100 epinephrine solution. The mucosa of nasal septum was dissected away from the septal cartilage after incision and displaced laterally by a long nasal speculum. The septal cartilage was cut at its basal juction by sepatal scissors and then displaced to one side. A Hardys nasal speculum was applied to displace the nasal mucosa laterally and keep the nasal cavity open constantly for the exposure of the vomer bone and the anterior wall of the sphenoid sinus. After removal of anterior wall of sphenoid sinus, the exposed sinus mucosa was coagulated and resected. The sellar floor was penetrated by an osteotome, then widened by Kerrison punch. The sellar floor dura was coagulated with bipolar forceps, then opened in cruciate fashion. The soft tumor parenchyma was removed by curette and suction. Normal pituitary gland was seen pushed by tumor to left side of sellar cavity. After the final piece of the tumor was removed, optic chiasm sank back to neurtal position. The sellar cavity was packed with Surgicel and Gelfoam. CSF leak was sealed by Tissucol Duo. The sphenoid sinus was packed with Gelfoam and sealed by Tissucol Duo. The sphenoid sinus floor was reconstructed by supporting a piece of vomer bone. The Hardys nasal speculum was removed and the nasal mucosa returned to its normal position. Each side of the nasal cavities was tightly packed with Merocel which had been soaked with Better-iodine ointment. Operators Prof. 杜永光 Assistants R6 陳睿生 R3 游健生 詹沛鋆 (F,1988/02/09,24y1m) 手術日期 2011/04/22 手術主治醫師 杜永光 手術區域 東址 003房 02號 診斷 Spinal tumor 器械術式 Intraspinal intramedullary tum 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 1 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 11:28 進入手術室 11:40 麻醉開始 11:50 誘導結束 12:00 抗生素給藥 12:02 手術開始 15:00 抗生素給藥 17:55 手術結束 17:55 麻醉結束 18:08 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 良性脊髓腫瘤切除術 1 1 摘要__ 手術科部: 外科部 套用罐頭: C3-5 laminoplasty for C5 neuroma excision 開立醫師: 游健生 開立時間: 2011/04/22 18:53 Pre-operative Diagnosis Left C5 neuroma with spinal canal extension compressing spinal cord Post-operative Diagnosis Left C5 neuroma with spinal canal extension compressing spinal cord Operative Method C3-5 laminoplasty for C5 neuroma excision Specimen Count And Types 1 piece About size:a few pieces Source:C5 neuroma Pathology Pending Operative Findings An elastic, yellowish, encapsulated extramedullary tumor pushed the cord to right side tightly. It extended along left C5 dorsal root to paravertebral space via C4/5 neural foramen. Three C5 dorsal rootlets were severed to facilitate tumor excision. C5 ventral rootlets were seen after tumor removal and preserved . Patient"s SSEP waveform was poor on both side perioperatively. Her MEP on left side had transient worsening but returned to baseline during surgery. Operative Procedures Under ETGA, patient was in prone position with head fixed by headclamp. After shaving, we disinfected and draped the operation field as usual. Midline incision was made followed by dissection. Spinous process of C2 to C6 were exposed. We drilled C3-5 bilateral laminae near lateral mass till inner cortex became egg-shell thin. Then, we removed the laminae en bloc with spreader. Arachnoid membrane was opened after midline durotomy. An extramedullary tumor arose from C5 dorsal root pushing the cord to right side. The tumor capsule was incised followed by tumor central debulking with tumor forcep and CUSA. Most of the tumor capsule was left in situ. Three C5 dorsal rootlets were transected to facilitate tumor removal. The tumor extended to paravertebral space along C5 dorsal root. We used currette to remove the paravertebral part. C5 ventral rootlets were seen after tumor removal and preserved. The tumor cavity was packed by gelfoam and Surgicel to achieve hemostasis. Dura was closed with 4-0 prolene continuous suture with air-expellation. Gelfoam was placed over the thecal sac. The C3-5 laminae was fixed back with mini-plates. An epilaminar CWV drain was placed on left side after Getamycin solution irrigation. Wound was closed in layers. Operators Prof. 杜永光 Assistants R6 陳睿生 R3 游健生 劉宗禮 (M,1939/11/22,72y3m) 手術日期 2011/04/22 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Esophageal cancer 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 08:07 進入手術室 08:20 麻醉開始 08:58 誘導結束 09:05 抗生素給藥 10:02 手術開始 12:00 抗生素給藥 13:05 手術結束 13:05 麻醉結束 13:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for tumor excision 開立醫師: 陳國瑋 開立時間: 2011/04/22 13:35 Pre-operative Diagnosis Esophageal cancer with brain metastasis Post-operative Diagnosis Esophageal cancer with brain metastasis Operative Method Craniotomy for tumor excision Craniotomy for gross total tumor excision Specimen Count And Types 1 piece About size:3cm Source:brain tumor Pathology pending Operative Findings 1. The tumor was yellowish and elastic in character with relative clear margin. 2. The brain was mild swelling. Operative Procedures The patient was put in supine posistion with head tilting to left. The skin was disinfected and draped as usual. Curvivular skin incision was made from the site before ear to midline, at right frontal area and the skin was retracted downward. Craniotomy was then made. The location of tumor was checked with intra-operative ultraspnography and dural incision was made. Tumor excision was done with the add of bipolar. The dura was closed with prolene in water-tied fasion. The dura overlying the tumor was excised and repaired with muscle fascia. After adequate hemostasis. One epidural CWV was placed and the wound was closed in layers. Operators 曾漢民 Assistants 胡朝凱 陳國瑋 相關圖片 陳睿妤 (F,2003/02/16,9y0m) 手術日期 2011/04/22 手術主治醫師 林文熙 手術區域 兒醫 063房 01號 診斷 Malignant neoplasm of pituitary gland and craniopharyngeal duct 器械術式 Port-A catheter implatation 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 3 紀錄醫師 林昊諭, 時間資訊 07:43 報到 08:10 進入手術室 08:15 麻醉開始 08:20 誘導結束 08:25 抗生素給藥 08:42 手術開始 09:20 手術結束 09:20 麻醉結束 09:25 送出病患 09:28 進入恢復室 11:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 內頸靜脈切開,永久導管放置術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Port-A 開立醫師: 林昊諭 開立時間: 2011/04/22 09:27 Pre-operative Diagnosis Pituitary tumor Post-operative Diagnosis Pituitary tumor Operative Method Port-A insertion (right subclavian vein) Specimen Count And Types nil Pathology nil Operative Findings intra-operative portable X-ray showed Port-A catheter tip in correct venous branch to SVC. Operative Procedures 1. Under GA with the patient in supine position, prepped and draping were performed in the usual sterile method. 2. An incision was made in right subclavical area. After identification of the right subclavian vein, Port-A catheter was inserted. Adequate hemostasis was obtained. Then the wound was closed in layers. Operators 林文熙 Assistants R6林昊諭 Ri徐鶴修 吳政德 (M,1976/10/16,35y4m) 手術日期 2011/04/22 手術主治醫師 賴達明 手術區域 東址 005房 02號 診斷 Cerebrovascular accident (CVA) 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 13:00 報到 13:25 進入手術室 13:30 麻醉開始 13:35 誘導結束 13:55 抗生素給藥 14:23 手術開始 16:55 抗生素給藥 18:15 手術結束 18:15 麻醉結束 18:20 送出病患 18:25 進入恢復室 19:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 頭顱成形術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 摘要__ 手術科部: 外科部 套用罐頭: Cranioplasty 開立醫師: 陳國瑋 開立時間: 2011/04/22 18:03 Pre-operative Diagnosis Head injury status post decompressive craniectomy Post-operative Diagnosis Head injury status post decompressive craniectomy Operative Method Cranioplasty Specimen Count And Types nil Pathology nil Operative Findings 1. mild adhesion of the scalp to the dura. 2. The temporalis was thick Operative Procedures The patient was put in supine position with head turning to right. Ths skin was disinfected and draped as usual. Skin incision along the previous wound was performed and the scalp was detached from the dura and skull bone carefully. The two pieces of skull bones were unioned with wire and six scews were fixed. Central tenting was perfromed. After adequate hemostasis, two CWV were set. The skin was then closed in layers. The patient was put in supine position with head turning to right. Ths skin was disinfected and draped as usual. Skin incision along the previous wound was performed and the scalp was detached from the dura and skull bone carefully. The two pieces of skull bones were unioned with wires, and six miniplates were used to fix the bones. Central tenting was perfromed. After adequate hemostasis, two CWV were set. The skin was then closed in layers. Operators 賴達明 Assistants 王奐之 陳國瑋 相關圖片 王茂 (M,1932/05/11,79y10m) 手術日期 2011/04/22 手術主治醫師 賴達明 手術區域 東址 000房 號 診斷 Cervical myelopathy 器械術式 Spinal fusion posterior (TAS) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 2 紀錄醫師 蔡宗良, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:10 進入手術室 08:35 麻醉開始 09:00 誘導結束 09:10 抗生素給藥 09:17 手術開始 11:55 麻醉結束 11:55 手術結束 12:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 摘要__ 手術科部: 外科部 套用罐頭: Transarticular screw fixation C1-2 with Sonnt... 開立醫師: 蔡宗良 開立時間: 2011/04/22 12:20 Pre-operative Diagnosis Calcium pyrophosphate disease, C1-2 Post-operative Diagnosis Calcium pyrophosphate disease, C1-2 Operative Method Transarticular screw fixation C1-2 with Sonntag autograft fusion Specimen Count And Types None Pathology None Operative Findings Through the whole operation, no significant SSEP or MEP change was noted Operative Procedures 1. ETGA, Mayfield headclamp fixation, prone positioning 2. Midline incision, 2 cm below inion to 2 cm below C3 spinous process 3. Periosteal dissection until C2-3 facet joint were reached 4. Dissect and palpate medial border of spinal cord from C1-2 5. Insert trochar with fluoroscopic confirmation, aiming at C1 anterior tubercle. The sagittal plane is checked by looking from the caudal end. 6. Insertion of transarticular screw (4cm)with fluoroscopic confirmation upon every cm insertion. 7. Harvest autograft from right-sided iliac crest. 8. Sonntag fixation of the autograft after decortication of C1-2 spinous process. 9. Wound closed in layers after placing one CWV drain. Operators VS 賴達明 Assistants R5 蔡宗良, R1 陳以幸 陳玉萍 (F,1972/09/07,39y6m) 手術日期 2011/04/22 手術主治醫師 賴達明 手術區域 東址 002房 02號 診斷 Cerebral aneurysm, nonruptured 器械術式 Craniotomy(Aneurysms) P-DUH 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3E 紀錄醫師 鍾文桂, 時間資訊 00:07 臨時手術NPO 00:07 開始NPO 09:07 通知急診手術 10:15 進入手術室 10:25 麻醉開始 10:50 誘導結束 11:00 抗生素給藥 11:05 手術開始 18:25 手術結束 18:25 麻醉結束 18:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 開顱術摘除血管病變 - 腦血管瘤 有病徵的 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 8 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 摘要__ 手術科部: 外科部 套用罐頭: Dolenc approach for aneurysm wrapping 開立醫師: 鍾文桂 開立時間: 2011/04/22 19:10 Pre-operative Diagnosis Left ICA aneurysm Post-operative Diagnosis Left ICA aneurysm Operative Method Dolenc approach for aneurysm wrapping Specimen Count And Types nil Pathology nil Operative Findings 1.Minimal SAH was noted 2.One saccular aneurysm was noted at left ICA protruding downward and posteriorly. It was opposite to ophthalmic artery. Some part of aneurysm outside the dural ring. Operative Procedures 1.ETGA, supine with head fixed with mayfiel skull clamp 2.Left curvillinear skin incision was done 3.Reflect skin flap then muscle flap anteriorly 4.Craniotomy 5.Anterior clinoidectomy 6.Dural tenting 7.Open dura 8.Open sylvian fissure 9.Open arachnoid membrane at opticocarotid cistern 10.Cut open falciform ligment 11.Identified aneurysm 12.Harvest one piece of fascia 13.Aneurysmal wrapping 14.Close dura 15.Set one CWV drain then close wound in layers Operators 賴達明 Assistants 胡朝凱, 鍾文桂, 洪士鈞 Indication Of Emergent Operation 相關圖片 江東 (M,1980/05/15,31y9m) 手術日期 2011/04/22 手術主治醫師 賴達明 手術區域 東址 019房 03號 診斷 Numbness 器械術式 Spinal fusion posterior 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3E 紀錄醫師 蔡宗良, 時間資訊 00:31 臨時手術NPO 00:31 開始NPO 14:00 通知急診手術 15:00 報到 15:20 進入手術室 15:35 麻醉開始 15:50 誘導結束 15:50 抗生素給藥 16:30 手術開始 18:45 開始輸血 18:50 抗生素給藥 20:55 麻醉結束 20:55 手術結束 21:25 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 良性脊髓腫瘤切除術 1 1 摘要__ 手術科部: 外科部 套用罐頭: Laminectomy from C7 to T2 for removal of intr... 開立醫師: 陳以幸 開立時間: 2011/04/22 21:19 Pre-operative Diagnosis Schwannoma, intradural extramedullary, type 3a, T1 Post-operative Diagnosis Schwannoma, intradural extramedullary, type 3a, T1 Operative Method Laminectomy from C7 to T2 for removal of intraspinal tumor Specimen Count And Types 1 piece About size:小 Source:intradural space, extramedullary Pathology Report pending Operative Findings 1. The intraspinal extramedullary tumor was rounded and well encapsulated; consistency was greyish, soft and elastic. The tumor extended into the T1 foramen (right-sided). Operative Procedures 1. ETGA, Mayfield headclamp, prone positioning. 2. Routine prepping and draping. 3. Midline incision from T6 to T3, followed by periosteal dissection. 4. Laminectomy of T1 and partial laminectomy of lower C7 and upper T2. 5. Open the dura with tack-up suture. 6. Remove the intraspinal tumor with bipolar cautery, CUSA, ring forcep and tumor forcep. 7. Remove the right-sided T1-2 facet. 8. Parallel incision of the extradural part of the tumor, with bipolar cautery, CUSA, ring forcep and tumor forcep. 9. Closed dura with 5-0 Prolene. A small defect was covered by Dura-Form. 10. Hemostasis, closed the wound in layers after placing CWV. Operators 賴達明 Assistants 蔡宗良 陳以幸 Indication Of Emergent Operation cord compression 黃航星 (M,1953/03/24,58y11m) 手術日期 2011/04/22 手術主治醫師 賴達明 手術區域 東址 019房 02號 診斷 HIVD 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 1 紀錄醫師 陳以幸, 時間資訊 00:00 臨時手術NPO 12:00 報到 12:20 進入手術室 12:35 麻醉開始 12:50 誘導結束 13:00 抗生素給藥 13:12 手術開始 14:40 手術結束 14:40 麻醉結束 14:45 送出病患 14:50 進入恢復室 16:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 椎間盤切除術-腰椎 1 1 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: Microdikectomy, L5-S1 開立醫師: 陳以幸 開立時間: 2011/04/22 14:43 Pre-operative Diagnosis Herniated interveterbral disc, L5-S1 Post-operative Diagnosis Herniated interveterbral disc, L5-S1 Operative Method Microdikectomy, L5-S1 Microdiskectomy, L5-S1 Specimen Count And Types nil Pathology nil Operative Findings narrowed L5-S1 space, with protruded disc Operative Procedures 1.Under ETGA, the patient was put as prone position. 2.Under the assistance of C-arm, localize the space between L5 and S1 intervertebral space 3.Skin disinfecion, drapped as usual 4.Midline skin incision, perform left side periosteal dissection 5.Under the assistance of microscope, perform L5 laminotomy. Remove the L5-S1 intervertebral disc 6.normal saline irrigation, hemostasis 7.close the wound in layers Operators 賴達明 Assistants 蔡宗良 陳以幸 廖色珠 (F,1964/02/29,48y0m) 手術日期 2011/04/23 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Parkinson''s disease 器械術式 Stereotaxic procedure for func 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 面罩麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 07:50 報到 07:58 進入手術室 08:25 麻醉開始 08:30 抗生素給藥 08:35 誘導結束 09:00 手術開始 09:10 開始輸血 11:30 抗生素給藥 14:20 麻醉結束 14:20 手術結束 14:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 立體定位術-功能性失調 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Semi-opened mask inhalation anes 1 0 麻醉 Semi-opened INHALATION GENERAL A 4 0 麻醉 SENI-OPENED INHALATION GENERAL A 4 0 手術 立體定位術-功能性失調 1 1 R 手術 深部腦核電生理定位 1 0 B 摘要__ 手術科部: 外科部 套用罐頭: Insertion of DBS wire at bilateral subthalamu... 開立醫師: 鍾文桂 開立時間: 2011/04/23 14:52 Pre-operative Diagnosis Parkisons disease. Post-operative Diagnosis Parkisons disease. Operative Method Insertion of DBS wire at bilateral subthalamus nuclei. Specimen Count And Types nil Pathology Nil. Operative Findings 1. The rigidity decreased after wire inserted at stimulation "on". 2. No EOM limitation or neurologic deficit. Operative Procedures Under IV general anesthesia, the patient was put in supine position. The scalp was shaved, scrubbed and antiseptic with alcohol B-I. Registered the preset localization point to navigator. Bicoronal scalp incision was made with burr hole made at entery point of left frontal region as navigator guided. The DBS wire port was set up and localization of subthalamus nucleus with microelectrode assistance. Inserted the DBS wire and fixed with the port. Waked the patient from the anesthesia and started stimulation from low voltage. Checked the clinical responses while using different voltage for stimulation. Performed the same procedure at right side. After hemostasis, closed the wound in layers. Operators 曾勝弘 Assistants R5 鍾文桂. 相關圖片 周玉英 (F,1946/10/10,65y5m) 手術日期 2011/04/23 手術主治醫師 賴達明 手術區域 東址 001房 06號 診斷 Head Injury 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林至芃 ASA 4E 紀錄醫師 曾峰毅, 時間資訊 08:13 臨時手術NPO 08:13 開始NPO 00:13 通知急診手術 01:45 報到 01:53 進入手術室 01:55 麻醉開始 02:10 誘導結束 02:20 抗生素給藥 02:39 手術開始 03:20 手術結束 03:20 麻醉結束 03:30 送出病患 03:35 進入恢復室 04:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 手術 慢性硬腦膜下血腫清除術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Chronic Subdural Hematoma 開立醫師: 曾峰毅 開立時間: 2011/04/23 03:22 Pre-operative Diagnosis Right chronic subdural hematoma Post-operative Diagnosis Right chronic subdural hematoma Operative Method Right frontal burr hole for subdural drainage Specimen Count And Types Nil Pathology Nil Operative Findings There was outer and inner membrane. After durotomy, clear xanthochromic effusion gushed out, followed by motor-oil-like fluid. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to left. After scalp shaved, scrubbed, disinfected, and then draped, we made one transverse skin incision at right frontal area. We drilled one burr hole, and then created durotomy. We inserted subdural drainage, and irrigated subdural space. The wound was closed in layers, followed by subdural de-air. Operators VS 賴達明 Assistants R4 曾峰毅 Indication Of Emergent Operation IICP 林許雪貞 (F,1945/09/17,66y5m) 手術日期 2011/04/23 手術主治醫師 楊士弘 手術區域 東址 003房 01號 診斷 Lumbar spondylosis 器械術式 Laminectomy for decompression 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:15 麻醉開始 08:45 誘導結束 09:00 抗生素給藥 09:20 手術開始 11:20 開始輸血 12:00 抗生素給藥 13:17 手術結束 13:17 麻醉結束 13:32 送出病患 13:35 進入恢復室 15:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎間盤切除術-腰椎 1 2 摘要__ 手術科部: 外科部 套用罐頭: 1. Transpedicle screws at L3, L4, L5 (6.5*40m... 開立醫師: 陳國瑋 開立時間: 2011/04/23 13:42 Pre-operative Diagnosis Lumbar stenosis, L3-4 L4-5 Post-operative Diagnosis Lumbar stenosis, L3-4 L4-5 Operative Method 1. Transpedicle screws at L3, L4, L5 (6.5*40mm*6) with Banana cage 11mm fusion at L3-4, L4-5 2. Leminectomy at L3 and L4, foraminotomy at right L3-4 Specimen Count And Types nil Pathology nil Operative Findings 1. The thecal sac was and compressed by the hepertrophic flavum ligament and facet joints the right L3 root was compressed by the hypertrophic facet joint 2. L4 on L5 spondylolithesis with L3-4 instability Operative Procedures The patient was put in prone position. After localization with fluoroscopy, the skin was disinfected and draped as usual. Midline skin incision was done and dissection down to the lamina and facet joints was done. Transpedicle screws were implanted. Laminectomy of the L3 and L4 with right L3-4 foraminotomy was done. Banana cage implant was performed after diskectomy of L3-4 and L4-5. Rod connecting L3-4-5 was implanted. After setting one drainage tube, the wound was closed in layers. Operators 楊士弘 Assistants 胡朝凱 陳國瑋 相關圖片 賴清前 (M,1958/01/12,54y2m) 手術日期 2011/04/23 手術主治醫師 蔡翊新 手術區域 東址 002房 01號 診斷 Subdural hemorrhage following injury, with prolonged (more than 24 hours) loss of consciousness w/o return to pre-existing conscious level 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 4E 紀錄醫師 徐紹剛, 時間資訊 08:18 通知急診手術 08:40 報到 08:45 進入手術室 08:50 麻醉開始 09:15 誘導結束 09:25 手術開始 10:46 開始輸血 11:45 麻醉結束 11:45 手術結束 11:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 1 L 手術 顱內壓視置入 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 蔡翊新 開立時間: 2011/04/23 11:29 Pre-operative Diagnosis Head injury with left frontotemporal SDH, left temporal contusion ICH and left parietotemporal EDH. Post-operative Diagnosis Head injury with left frontotemporal SDH, left temporal contusion ICH and left parietotemporal EDH. Operative Method Left F-T-P craniectomy for removal of EDH, SDH and ICH, duroplasty, excision of left temporalis muscle and ICP monitoring. Specimen Count And Types nil Pathology Nil. Operative Findings Epidural hematoma was noted at left parietotemporal area, 6 x 6 x 0.5 cm. The dura was tense upon craniectomy and ICP was 24 mmHg. There was subdural hematoma, 0.8 cm in thickness, over left F-T area. Contusional ICH was noted at left temporal lobe, about 6 x 6 x 5 cm. After removal of SDH and ICH, the brain became soft. ICP after duroplasty was 2 mmHg and ICP after skin closure was mmHg. Epidural hematoma was noted at left parietotemporal area, 6 x 6 x 0.5 cm. The dura was tense upon craniectomy and ICP was 24 mmHg. There was subdural hematoma, 0.8 cm in thickness, over left F-T area. Contusional ICH was noted at left temporal lobe, about 6 x 6 x 5 cm. After removal of SDH and ICH, the brain became soft. ICP after duroplasty was 2 mmHg and ICP after skin closure was 4 mmHg. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: left frontotemporoparietal area, the skin edge was clipped by Raney clips for temporary hemostasis. The temporalis muscle was detached from temporal squama by rasp subsequently. 5. Craniotomy window: 15 x 12 cm, left F-T-P, created by making 5 burr holes then cut by power saw. 6. The epidural hematoma was removed. The epidural space was packed with Gelfoam. 7. Dural tenting: by 2/0 silk, 2 cm in interval, distributed along the edge of skull window. 8. Dural incision: curvilinear along the edge of skull window. 9. The subdural clot was removed by sucker. The left temporal contusion ICH was removed by bipolar coagulator and sucker. 10.Hemosatasis: the bleeders was stopped by Bovie and oozing surface was covered with Surgicel. 11.Duroplasty was performed with a piece of 12 x 10 cm Durofoam in order to create an additional space for the swollen brain. 12.A Codman ICP monitor was placed at subdural space of left temporal area. 13.The skull plate was removed and stored in bone bank for preservation. 14.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 15.Drain: two epidural CWV. 16.Blood transfusion: PRBC 2U; Blood loss: 400 ml. 17.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R4曾峰毅R1徐紹剛 Indication Of Emergent Operation IICP, Conscious deterioration, pupil dilatation 周梨 (F,1924/05/12,87y10m) 手術日期 2011/04/24 手術主治醫師 蔡翊新 手術區域 東址 003房 01號 診斷 Major trauma rated 16 or above on the severity scale ( Injury severity score >=16 ) 器械術式 Right craniectomy for SDH evacuation 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 4E 紀錄醫師 何奕瑢, 時間資訊 17:36 通知急診手術 18:25 報到 18:25 進入手術室 18:30 麻醉開始 18:50 誘導結束 18:55 手術開始 19:05 抗生素給藥 20:40 麻醉結束 20:40 手術結束 20:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 急性硬腦膜下血腫清除術 1 1 R 手術 顱內壓視置入 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 蔡翊新 開立時間: 2011/04/24 20:21 Pre-operative Diagnosis Right frontotemporoparietal acute SDH with brain swelling. Post-operative Diagnosis Right frontotemporoparietal acute SDH with brain swelling. Operative Method Right frontotemporoparietal craniectomy for SDH removal, duroplasty and subdural ICP monitoring. Specimen Count And Types nil Pathology Nil. Operative Findings ICP upon first burr hole creation was 20 mmHg. Dural tear was encountered while craniectomy was performed and SDH gushed out by itself. The dura was tense after craniectomy. SDH, 14 x 10 x 1.5 cm, was evacuated from right F-T-P region. No active bleeder was detected, but bleeding tendency was noted during operation. While we were evacuating the SDH, the brain bulged out gradually, the brain pulsation was weak and cortical surface was pale. ICP after skin closure was mmHg. ICP upon first burr hole creation was 20 mmHg. Dural tear was encountered while craniectomy was performed and SDH gushed out by itself. The dura was tense after craniectomy. SDH, 14 x 10 x 1.5 cm, was evacuated from right F-T-P region. No active bleeder was detected, but bleeding tendency was noted during operation. While we were evacuating the SDH, the brain bulged out gradually, the brain pulsation was weak and cortical surface was pale. ICP after skin closure was 9 mmHg. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 6 cm at anterior-lower temporal area, the skin edge was clipped by Raney clips for temporary hemostasis. The temporalis muscles was incised down to the tempoal squama which was exposed then by applying a self retaining retractor on the muscle. 5. A burr hole was made and the dura was incised for evacuating part of the subdural hematoma, therefore the IICP could be relieved earlier. 6. The incision was extended to a temporal horseshoe, and the temporalis muscle was detached from temporal squama by rasp subsequently. 7. Craniotomy window: 14 x 12 cm, right F-T-P, created by making 5 burr holes then cut by power saw. 8. Dural tenting: by 2/0 silk, 2 cm in interval, distributed along the edge of skull window. 9. Dural incision: curvilinear along the edge of skull window. 10.The subdural clot was removed by sucker. A Codman ICP monitor was placed at subdural space of right temporal region. Reference level: 490. 11.Hemosatasis: the bleeders was stopped by Bovie. 12.Dural closure: was closed with a piece of Durofoam (12 x 10 cm) was used for duroplasty in order to create an additional space for the swollen brain. 13.The skull plate was removed and stored in bone bank for preservation. 14.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 1/0 Vicryl and skin by continuous suture with 3/0 nylon. 15.Drain: two, epidural, CWV. 16.Blood transfusion: FFP 4U, Blood loss: 450 ml. 17.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R6胡朝凱R1何奕瑢 Indication Of Emergent Operation IICP, uncal herniation with brainstem compression. 林芳瑜 (F,1991/06/29,20y8m) 手術日期 2011/04/25 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Headache 器械術式 Right putaminal cavernoma 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 2 紀錄醫師 游健生, 時間資訊 08:00 進入手術室 08:10 麻醉開始 08:30 誘導結束 08:42 手術開始 09:10 抗生素給藥 12:10 抗生素給藥 15:00 手術結束 15:00 麻醉結束 15:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 開顱術摘除血管病變-- 動靜脈畸型小型深部 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Right pterional approach for intracerebral he... 開立醫師: 游健生 開立時間: 2011/04/25 15:21 Pre-operative Diagnosis Right putaminal intracerebral hemorrhage, suspect cavernoma hemorrhage Post-operative Diagnosis Right putaminal intracerebral hemorrhage, suspect cavernoma hemorrhage Operative Method Right pterional approach for intracerebral hematoma and cavernoma removal Specimen Count And Types Size:a few pieces Source: cavernoma Pathology Pending Operative Findings A 0.5cm corticotomy was done at insular cortex. A about 20cc intracerebral hematoma was met about 1cm deep from insular cortex. After hematoma was removed, some raspberry-like vascular sturctures were seen attached to hematoma cavity wall. They were completely removed. Peripheral yellowish hemosiderin deposition was noted at hematoma cavity wall. There was no significant SSEP / MEP changes throughout the surgery. Operative Procedures Under ETGA, patient was in supine position with head fixed by headclamp. Her head was rotated to left with neck extended and right shoulder elevated. After shaving, we disinfected and draped the operation field as usual. A curvilinear scalp incision was made from 1cm anterior to tragus extending upward behind hairline to 2cm cross midline. Scalp flap was elevated with facial nerve preservation technique and reflected anteriorly. Pericranium was elevated and reflected. Temporalis muscle was cut superiorly, leaving a muscle cuff at cranium, and posteriorly followed by downward reflection. Three burrholes were created with one at keyhole followed by craniotomy. After sphenoid ridge was flattened by air-drill, dura tenting along craniotomy border was done. A curvilinear durotomy started from fronto-temporal junction was performed. The Sylvian fissure was opened from proximal to distal exposing the optic nerve, ICA, MCA, and Sylvian vein. The frontal and temporal opercula were gentlely retracted to expose the insular cortex. A 0.5cm corticotomy was done at insular cortex and dissected deep to expose the intracerebral hematoma. The surgical corridor was covered with cottonoid. After hematoma was removed, some raspberry-like vascular sturctures were seen attached to hematoma cavity wall. They were completely removed by bipolar electrocautery and aligator. Hemostasis was achieved by Surgicel coverage. Dura was closed by 4-0 prolene continuous suture to achieve water-tight closure. Bone flap was fixed back with mini-plates and temporalis muscle was approximated to muscle cuff. After epidural CWV placement, wound was closed in layers. Operators Prof. 杜永光 Assistants R6 胡朝凱 R3 游健生 向儀鳳 (F,1957/03/15,54y11m) 手術日期 2011/04/25 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 陳國瑋, 時間資訊 08:00 進入手術室 08:10 麻醉開始 08:35 誘導結束 08:50 手術開始 09:00 抗生素給藥 12:00 抗生素給藥 14:20 開始輸血 15:00 抗生素給藥 15:10 手術結束 15:10 麻醉結束 15:23 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除-手術時間在4~8小時 1 1 摘要__ 手術科部: 外科部 套用罐頭: Suboccipital craniotomy for tumor excision 開立醫師: 陳睿生 開立時間: 2011/04/25 15:45 Pre-operative Diagnosis Cerebellar hemangioblastoma status post, with recurrence Post-operative Diagnosis Cerebellar hemangioblastoma status post, with recurrence Operative Method Suboccipital craniotomy for tumor excision Specimen Count And Types 1 piece About size:pieces Source:brain tumor Pathology pending Operative Findings The tumor was soft, well capsuled and vascularized. It was a reddish one and the diameter was about 3cm. Several drainage veins were noted at the deepest side of the tumor. Easy oozing of the tumor was noted intra-op, and it was removed along the tumor capsule. Previous incision between the vermis and the left cerebellar hemisphere was noted and dissected to remove the tumor. After total remove of the tumor, the ventricular wall was found. Operative Procedures After ETGA, the patient was put in prone position. Head was mild flexion and fixed with Mayfield clump. The skin was disinfected and draped as usual. Skin incision along previous wound was made with right side extension around the inion. The muscle was dissected and previous skull graft was exposed. After removing of the wires, four bur holes were made, and an about 8x8 cm craniotomy window was extended right side. After opening of the posterior rim of the foramen Magnum, the dura was opened curvillinearly. The cerebellar parychema was tightly attached to the dura and was carefully dissected. Dissection between the vermis and left cerebellar hemisphere was done and the tumor was noted subcortically. The plane between the tumor and normal brain was carefully created and several small feeding arteries were electroligated. Some small drainage veins were noted at the deepest side of the tumor. Hemostasis was done with Floceal, and the drainage veins were ligated. The tumor was removed piece by piece. After proper hemostasis, the dura was tightly closed with Gortex, and deair was done, too. The skull flap was fixed back with 4 gages of wires. A subgaleal CWV drain was set, and the wound was closed in layers. Operators VS 曾漢民 Assistants R6 陳睿生; R1 陳國瑋 R6 陳睿生; R2 陳國瑋 相關圖片 陳玉萍 (F,1972/09/07,39y6m) 手術日期 2011/04/25 手術主治醫師 廖漢文 手術區域 東址 000房 號 診斷 Cerebral aneurysm, nonruptured 器械術式 NEURO T.A.E 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 王永彬 ASA 3 時間資訊 12:40 麻醉開始 12:50 誘導結束 15:30 麻醉結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 楊明章 (M,1941/09/07,70y6m) 手術日期 2011/04/25 手術主治醫師 賴達明 手術區域 東址 003房 03號 診斷 Thoracic myelopathy 器械術式 Spinal fusion posterior 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 3E 紀錄醫師 李振豪, 時間資訊 17:38 通知急診手術 18:13 報到 18:25 進入手術室 18:25 麻醉開始 18:35 誘導結束 18:40 抗生素給藥 18:55 手術開始 19:25 開始輸血 21:15 手術結束 21:15 麻醉結束 21:35 送出病患 21:40 進入恢復室 22:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 良性脊髓腫瘤切除術 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: 1. Evacuation of epidural hematoma, 2. T1 lam... 開立醫師: 李振豪 開立時間: 2011/04/25 21:39 Pre-operative Diagnosis Epidural hematoma, T2-4, with acute spinal cord injury Post-operative Diagnosis Epidural hematoma, T2-4, with acute spinal cord injury Operative Method 1. Evacuation of epidural hematoma, 2. T1 laminectomy for epidrual tumor excision Specimen Count And Types nil Pathology Nil Operative Findings The epidural hematoma was mainly below the Gelform packing with tightly compressed the thecal sac. The thickness of the epidural hematoma was about 1cm. After removal of the hematoma and Gelform packing. An active bleeder was noted which radicular artery was favored. The laminectomy was extended and the bleeder was coagulated with bipolar electrocautery. Some residual tumor with active oozing also noted at the cephalic part of the wound and T1 laminectomy was performed for total removal of the epidural mass. Left T3 rhizotomy was performed during the operation due to encasement of the root. The thecal sac expanded well after whole procedure. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position. The skin was scrubbed, disinfected, and draped as usual. The stitches was removed and the wound was opened in layers. The epidural hematoma and Gelform was removed for decompression. The residual tumor was noted at cephalic part of the wound. The T1 laminectomy was performed after wound extension. Tumor excision was performed with Kerrison punches, alligator, and tumor forceps. The left lateral part and ventral part of the thecal sac also checked for tumor excision. Left T3 rhizotomy was performed during removal of the tumor since the root was encased by the tumor. Hemostasis was achieved with Gelform, Surgicel, and bipolar electrocautery. Two Hemovac drain was placed at epidural space. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Blood loss: 1000ml. Operators VS賴達明 Assistants R4李振豪, R1陳宣佑 Indication Of Emergent Operation Acute spinal cord injury with paraplegia and priapism 相關圖片 楊明章 (M,1941/09/07,70y6m) 手術日期 2011/04/25 手術主治醫師 賴達明 手術區域 東址 002房 02號 診斷 Thoracic myelopathy 器械術式 Laminectomy for decompression 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3E 紀錄醫師 蔡宗良, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 08:25 通知急診手術 10:45 進入手術室 10:50 麻醉開始 11:10 抗生素給藥 11:15 誘導結束 11:54 手術開始 14:10 抗生素給藥 14:25 手術結束 14:25 麻醉結束 14:35 送出病患 14:38 進入恢復室 17:02 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 惡性脊髓腫瘤切除術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Laminectomy for removal of metastatic epidura... 開立醫師: 蔡宗良 開立時間: 2011/04/25 14:37 Pre-operative Diagnosis Metastatic epidural spinal cord compression, T2-4 Post-operative Diagnosis Metastatic epidural spinal cord compression, T2-4 Operative Method Laminectomy for removal of metastatic epidural mass, T2-4 Specimen Count And Types 1 piece About size:有 Source:spine Pathology Report pending Operative Findings 1. Reddish, fragile and highly-vascular tumor at T2 lower half to T4 with extension into left-sided T3 foramen. Tumor compressed thecal sac especially to the left. Operative Procedures 1. ETGA, prone 2. Routinely prepped and draped 3. Fluoroscopic confirmation 4. Midline incision from T1 to T5, followed by periosteal dissection 5. Laminectomy from T2 to T4 6. Removal of intraspinal tumor 7. Hemostasis, saline and gentamycin irrigation 8. Wound closed in layers Operators VS賴達明 Assistants R5蔡宗良 Ri蔡佳穎 Indication Of Emergent Operation 許世昌 (M,1964/03/29,47y11m) 手術日期 2011/04/25 手術主治醫師 楊士弘 手術區域 東址 007房 04號 診斷 Malignant neoplasm of connective and other soft tissue of lower limb, including hip 器械術式 Malignant intraspinal tumor, e 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 陳以幸, 時間資訊 13:32 報到 13:50 麻醉開始 14:30 誘導結束 15:30 抗生素給藥 15:38 進入手術室 15:50 手術開始 17:35 抗生素給藥 18:00 開始輸血 20:35 抗生素給藥 20:40 麻醉結束 20:40 手術結束 20:55 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 惡性脊髓腫瘤切除術 1 1 手術 脊椎融合術-後融合,有固定物(<=六節) 1 2 摘要__ 手術科部: 外科部 套用罐頭: 1.intraspinal tumor excision 開立醫師: 陳以幸 開立時間: 2011/04/25 21:24 Pre-operative Diagnosis epitheloid sarcoma with T-spine metastasis Post-operative Diagnosis epitheloid sarcoma with T-spine metastasis Operative Method 1.intraspinal tumor excision 2.transpedicular screw with rod fixation and corsslink 3.partial T10 corpectomy Specimen Count And Types 1 piece About size: Source:intraspinal tumor Pathology epitheloid sarcoma Operative Findings 1.grayish and reddish tumor over T10 post-vertebral area, with rich blood supply and severe adhesion 2.tumor invasion to partial T10 vertebral body 3.bilateral T10 roots are ligated Operative Procedures 1.Under ETGA, put the patient as prone position 2.Localize the T8-T12 vertebral body via the assistance of C-arm 3.Midline skin incision, dissect subcutaneous tissue, perform periosteal dissection from T8~T12 4.Transpedicular screw with rod fixation over T8~T12 4.Transpedicular screw with rod fixation over T8,9,11,12 by A-spine system T8, 9 screws: 5.5 mm x 35 mm T11, 12 screws: 5.5 mm x 40 mm 13 cm long rod on each side One cross link 5.Perform T10 corpectomy, remove the tumor under the assistance of bipolar and electrocoagulator. Ligate bilateral side of T10 root by wake. 5.Perform T10 corpectomy by left costotransversectomy and bilateral pediculectomy, remove the tumor under the assistance of bipolar and electrocoagulator. Ligate bilateral side of T10 roots by Hemoclips. 6.Dissect partial 10th rib to decompress the spinal cord 6.Dissect and remove epidural tumor and PLL away from thecal sac. 7.Set 1 hemovac drainage tube to epidural area 7.Set 2 hemovac drainage tubes to epidural area 8.N/S irrigation, hemostasis, close the wound in layers Operators 賴達明 楊士弘 Assistants 曾峰毅 王奐之 陳以幸 相關圖片 許水濱 (M,1936/05/12,75y10m) 手術日期 2011/04/25 手術主治醫師 王國川 手術區域 東址 002房 03號 診斷 Injury to spine and spinal cord 器械術式 Spinal fusion anterior spinal 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3E 紀錄醫師 蔡宗良, 時間資訊 00:26 臨時手術NPO 00:26 開始NPO 10:26 通知急診手術 15:05 進入手術室 15:11 麻醉開始 15:25 誘導結束 15:55 手術開始 17:00 抗生素給藥 19:15 手術結束 19:15 麻醉結束 19:25 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 脊椎融合術-前融合,有固定物)≦四節 1 2 手術 椎間盤切除術-頸椎 1 1 摘要__ 手術科部: 創傷醫學部 套用罐頭: 1. Anterior cervical discectomy, C3-4 & C4-5 開立醫師: 蔡宗良 開立時間: 2011/04/25 19:36 Pre-operative Diagnosis Herniated cervical disc, C3-4 and C4-5 Post-operative Diagnosis Herniated cervical disc, C3-4 and C4-5 Operative Method 1. Anterior cervical discectomy, C3-4 & C4-5 2. Cage fusion with anterior plate-screw fixation Specimen Count And Types nil Pathology None Operative Findings 1. Disrupted anterior longitudinal at C3-4 2. Hematoma at prevertebral space, at C3-4 and C4-5 Operative Procedures 1. ETGA, supine 2. Routinely prepped and draped 3. Linear skin incision 4. Dissect medial to SCM/common carotid and lateral to streps muscles, and esophagus 5. Set-up autoretractors and Caspar screw 6. Discectomy with cage impacted into disc space 7. Plate fixation 8. Irrigation 9. Wound closed in layers after placement of CWV drain Operators VS 王國川 Assistants R5 蔡宗良 Indication Of Emergent Operation Herniated cervical disc with spinal cord compression 柯耀南 (M,1939/11/10,72y4m) 手術日期 2011/04/25 手術主治醫師 王國川 手術區域 東址 005房 02號 診斷 Dizziness and vertigo 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 4E 紀錄醫師 游健生, 時間資訊 18:59 臨時手術NPO 18:59 開始NPO 19:10 進入手術室 19:15 麻醉開始 19:25 誘導結束 19:30 手術開始 19:40 開始輸血 19:42 抗生素給藥 22:00 手術結束 22:00 麻醉結束 22:10 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 急性硬腦膜下血腫清除術 1 1 R 手術 顱內壓視置入 1 2 R 記錄__ 手術科部: 外科部 套用罐頭: 1. Right F-T-P craniectomy for acute SDH removal 開立醫師: 鍾文桂 開立時間: 2011/04/25 22:17 Pre-operative Diagnosis Right acute SDH Post-operative Diagnosis 1. Right acute SDH 2. Contusional ICH, right frontal base Operative Method 1. Right F-T-P craniectomy for acute SDH removal 2. Subdural ICP monitor placement Specimen Count And Types nil Pathology Nil Operative Findings A about 200cc blood clot was removed from F-T-P subdural space. Two cortical arterial bleeders at temporoparietal surface were noted and coagulated. Codman ICP probe was place at subdural space. The ICP was -8mmHg after wound closure. Codman ICP monitor referance: 470 Pre-op pupil: R/L 5mm/4mm Post-op pupil: R/L 5mm/3mm Operative Procedures 1. Under ETGA, supine position 2. Head rotated to left and right shoulder elevated 3. Shaving, disinfection, and draping 4. A question-mark traumatic incision was made 5. Scalp flap was elevated followed by temporalis muscle flap 6. Multiple burrholes were created 7. One small durotomy was done for decompression 8. F-T-P craniectomy followed by dura tenting 9. Harvest fascia 10.Curvilinear durotomy and removed SDH 11.Coagulated bleeders 12.Duroplasty with fascia 13.Inserted subdural ICP monitor 14.Placed epidural CWV drain 15.Closed wound in layers Operators VS 王國川 Assistants R5 鍾文桂 R3 游健生 Indication Of Emergent Operation Acute deterioration of consciousness 相關圖片 張品品 (F,1947/03/20,64y11m) 手術日期 2011/04/25 手術主治醫師 詹志洋 手術區域 東址 017房 02號 診斷 Secondary cancer of brain and spinal cord 器械術式 Port-A Implatation /WOR 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 16:10 進入手術室 16:40 麻醉開始 16:41 麻醉結束 16:42 手術開始 18:15 手術結束 18:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 內頸靜脈切開,永久導管放置術 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Port-A 開立醫師: 張得一 開立時間: 2011/04/25 18:17 Pre-operative Diagnosis Breast cancer Post-operative Diagnosis Breast cancer s/p Port-A implantation Operative Method Port-A catheter implantation(left), echo guided, right Port-A removal Specimen Count And Types nil Pathology nil Operative Findings 1.After left IJV puncture, guidewire was not smoothly advanced, r/o central vein obstruction 2.Puncture to left subclavian vein under echo guidance The venous blood flow freely in the Port-A catheter after implantation. Operative Procedures The patient was put on supine position. The operation field was disinfected and draped as usual. Under local anesthesia, we puncture to left subclavian vein under echo guidance. After creating subcutaneous pocket, the Port-A catheter was inserted via peel away sheath. We close the wound in layers. Then, the right side Port A was removed and wound closed in layers Operators VS 詹志洋 Assistants R3張得一 錢嘉明 (M,1951/09/14,60y6m) 手術日期 2011/04/25 手術主治醫師 郭文宏 手術區域 兒醫 061房 02號 診斷 Breast cancer, male 器械術式 SM+SLND 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 2 紀錄醫師 陳柏達, 時間資訊 13:05 報到 13:31 進入手術室 13:35 麻醉開始 13:40 誘導結束 13:45 抗生素給藥 13:56 手術開始 15:35 手術結束 15:35 麻醉結束 15:55 進入恢復室 17:03 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 前哨淋巴腺切片術 1 0 R 手術 單純乳房切除術-單側 1 2 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Simple masectomy+SLND 開立醫師: 陳柏達 開立時間: 2011/04/25 15:33 Pre-operative Diagnosis Right breast cancer Post-operative Diagnosis Right breast cancer Operative Method Simple mastectomy+SLND Specimen Count And Types Breast, SLNx1, non-SLNx1 Pathology pending Operative Findings 1. SLND1:13120 imprint cytology:negative 2. Non-SLND: imprint cytology: negative 3. no breast gross tumor was noted Operative Procedures 1. ETGA, supine 2. Skin disinfection and draping 3. Epical skin incision 4. Performed SLND, send for imprint cytology 5. Performed simple masectomy 6. Hemostasis, normal saline irrigation 7. Set CWVx2 and close wound in layers Operators VS郭文宏 Assistants R3陳柏達Ri€翁上硯 相關圖片 廖色珠 (F,1964/02/29,48y0m) 手術日期 2011/04/26 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Parkinson''s disease 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 08:05 進入手術室 08:10 麻醉開始 08:15 誘導結束 08:48 手術開始 10:00 手術結束 10:00 麻醉結束 10:08 送出病患 10:10 進入恢復室 11:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室腹腔分流手術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Implantable pulse generator implantation 開立醫師: 李振豪 開立時間: 2011/04/26 10:14 Pre-operative Diagnosis Parkinson"s disease, status post bilateral subthalamic nucleus deep brain stimulation wire implantation Post-operative Diagnosis Parkinson"s disease, status post bilateral subthalamic nucleus deep brain stimulation wire implantation Operative Method Implantable pulse generator implantation Specimen Count And Types nil Pathology Nil Operative Findings The IPG was place at left forechest and the function of the DBS was ok after connected all compartment together. The operative course was smooth and the patient tolerate whole procedure well. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head rotated to right. The scalp was shaved, scrubbed, and disinfected as usual. The scalp was shaved, scrubbed, and disinfected as usual. The linear scalp incision was made at left parieto-occipital area and the wires were identified. Left forechest transverse skin incision was made and the subcutaneous pocket was created. The subcutaneous tunnel from left parieto-occipital wound to left forechest wound was created and the cable was passed through the tunnel. The wire and cable was connected and and the battery was set up. The function of the deep brain stimulation was checked. Hemostasis was achieved. After fixation of the battery, the wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon at scalp and 3-0 Vicryl and 4-0 Dexon at left forechest. Operators VS曾勝弘 Assistants R4李振豪, Ri蔡佳穎 相關圖片 林玉秀 (F,1957/02/23,55y0m) 手術日期 2011/04/26 手術主治醫師 曾勝弘 手術區域 東址 005房 02號 診斷 Herniation of intervertebral disc (HIVD) 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 10:16 進入手術室 10:20 麻醉開始 10:30 抗生素給藥 10:30 誘導結束 10:46 手術開始 13:30 抗生素給藥 13:45 手術結束 13:45 麻醉結束 13:48 送出病患 13:50 進入恢復室 16:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 手術 椎間盤切除術-頸椎 1 1 L 手術 椎間盤切除術-頸椎 1 2 L 摘要__ 手術科部: 外科部 套用罐頭: C5-6, C6-7 anterior cervical diskectomy and f... 開立醫師: 李振豪 開立時間: 2011/04/26 13:53 Pre-operative Diagnosis Herniation of intervertebral disc, C5-6 and C6-7, with radiculopathy and myelopathy Post-operative Diagnosis Herniation of intervertebral disc, C5-6 and C6-7, with radiculopathy and myelopathy Operative Method C5-6, C6-7 anterior cervical diskectomy and fusion with PEEK cage Specimen Count And Types nil Pathology Nil Operative Findings The C5-6, C6-7 disc was degenerative, herniated, and compressed the thecal sac tightly(more severe on right side). Marginal spur formation(+). The OPLL also resected and the thecal sac expanded well. C5-6, C6-7 bilateral foraminotomy was performed and the neural foramen was loose after decompression. Anterior fusion was performed with one #5(C5-6 level), one #6(C6-7 level) PEEK cage, and artificial bone. No SSEP change during whole procedure. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with neck extension. The skin was scrubbed, disinfected, and draped as usual. The transverse skin incision was made at left neck and the platysma muscle was transected. The fascia was opened along the anterior margin of the SCM and the prevertebral fascia was approached between thyroid gland and carotid sheath. The prevertebral fascia was opened and two spinal needle was used for localization. The C5-6, C6-7 disc space was identified by portable C-arm X-ray. Anterior cervical diskectomy and foraminotomy were performed with knife, curette, kerrison punches, and Midas air-drived drills. Anterior fusion was done with two PEEK cage filled with artificial bone. Hemostasis was achieved and the wound was then closed in layers with 3-0 Vicryl and 4-0 Prolene. Operators VS曾勝弘 Assistants R4李振豪, Ri蔡佳穎 相關圖片 林育蔚 (M,1977/04/11,34y11m) 手術日期 2011/04/26 手術主治醫師 曾勝弘 手術區域 東址 005房 03號 診斷 Atypical face pain 器械術式 Radiofrequency coagulation 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 李振豪, 時間資訊 13:47 報到 14:07 進入手術室 14:12 抗生素給藥 14:13 麻醉開始 14:14 誘導結束 14:15 手術開始 14:24 麻醉結束 14:25 手術結束 14:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 高頻熱凝療法 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Right infraorbital nerve radiofrequency stimu... 開立醫師: 李振豪 開立時間: 2011/04/26 14:42 Pre-operative Diagnosis Right infraorbital neuralgia Post-operative Diagnosis Right infraorbital neuralgia Operative Method Right infraorbital nerve radiofrequency stimulation Specimen Count And Types nil Pathology Nil Operative Findings 1. Radiofrequency stimulation setting: 41 oC, 180sec/cycle, total 2 cycles 2. Acute complication: nil Operative Procedures The skin was disinfected and draped as usual. Local anesthesia with 1% Xylocaine 0.3ml was applied. Right infraorbital nerve was localized under stimulation mode. After localization, radiofrequency stimulation was performed. The second time pulse stimulation was tried but gave up due to motor branch involvement. Active bleeding was noted after removal of the needle. Wound compression was used for hemostasis. The patient stood whole procedure well. Operators VS曾勝弘 Assistants R4李振豪, Ri蔡佳穎 相關圖片 許育安 (F,1997/08/22,14y6m) 手術日期 2011/04/26 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 腦惡性腫瘤 器械術式 Malignant intraspinal tumor, e 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 2 紀錄醫師 鍾文桂, 林昊諭, 時間資訊 00:00 臨時手術NPO 07:36 報到 08:00 進入手術室 08:15 麻醉開始 08:30 誘導結束 08:55 抗生素給藥 09:28 手術開始 11:55 抗生素給藥 13:16 13:50 手術結束 13:50 麻醉結束 13:50 13:57 送出病患 14:00 進入恢復室 15:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓整形術 1 1 手術 脊椎內脊髓內腫瘤切除術 1 1 手術 內頸靜脈切開,永久導管放置術 1 2 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 摘要__ 手術科部: 外科部 套用罐頭: Port-A 開立醫師: 林昊諭 開立時間: 2011/04/26 13:54 Pre-operative Diagnosis Spinal tumor Post-operative Diagnosis Spinal tumor Medulloblastoma with spinal metastasis Operative Method Port-A insertion (right subclavian vein) Specimen Count And Types nil Pathology nil Operative Findings intra-operative portable X-ray showed Port-A catheter tip in correct venous branch to SVC. Operative Procedures 1. Under GA, patient in supine position, prepped and draping were performed in the usual sterile method. 2. An incision was made in right subclavical area. After identification of the right subclavian vein, Port-A catheter was inserted. Adequate hemostasis was obtained. Then the wound was closed in layers. Operators 林文熙 Assistants R6林昊諭 相關圖片 摘要__ 手術科部: 外科部 套用罐頭: 1. En bloc laminectomy for excision of intras... 開立醫師: 鍾文桂 開立時間: 2011/04/26 14:40 Pre-operative Diagnosis Medulloblastoma with spinal metastasis. Post-operative Diagnosis Medulloblastoma with spinal metastasis. Operative Method 1. En bloc laminectomy for excision of intraspinal intramedullary tumor. 2. Laminoplasty, T6/7. Specimen Count And Types 1 piece About size:small fragments Source:medulloblastoma with spinal metastasis. Pathology Frozen pathology: small blue round cells. Operative Findings 1. Pinkish, hypervascularized, fragile tumor with some fibrous tissue in it. The tumor adheres severely to the spinal cord at it posterior and bilateral lateral sides and encases the spinal roots. We biopsied some tumor for permanent and frozen pathology. The CSF was also sent for cytology. 2. The laminae were fixed by mini-plates and screws. Operative Procedures Under ETGA, the patient was placed in prone position. After disinfection and draping, a linear vertical midline incision was made from lower T5 to lower T7 level. After paraspinal dissection, two grooves were created at bilateral T6 and T7 laminae. Then, the laminae were excised in en bloc fashion. After well hemostasis, a vertical durotomy was obtained. The tumor was exposed. The tumor was excised by dissector, tumor forceps, alligator, and ring forceps. After obtaining enough spicemen, the dura mater was closed in water-tight fashion. The lamine were fixed by miniplates and screws. The wound was closed in layers with no drain in situ. Operators 郭夢菲 Assistants R5 鍾文桂 相關圖片 記錄__ 手術科部: 套用罐頭: 1. En bloc laminectomy for excision of intras... 開立醫師: 郭夢菲 開立時間: 2011/04/28 09:37 Pre-operative Diagnosis Medulloblastoma with spinal metastasis. Post-operative Diagnosis Medulloblastoma with spinal metastasis. Operative Method 1. En bloc laminectomy for excision of intraspinal intramedullary tumor. 2. Laminoplasty, T6/7. Specimen Count And Types 1 piece About size:small fragments Source:medulloblastoma with spinal metastasis. Pathology Frozen pathology: small blue round cells. Operative Findings 1. Pinkish, hypervascularized, fragile tumor with some fibrous tissue in it. The tumor adheres severely to the spinal cord at it posterior and bilateral lateral sides and encases the spinal roots. We biopsied some tumor for permanent and frozen pathology. The CSF was also sent for cytology. 2. The laminae were fixed by mini-plates and screws. Operative Procedures Under ETGA, the patient was placed in prone position. After disinfection and draping, a linear vertical midline incision was made from lower T5 to lower T7 level. After paraspinal dissection, two grooves were created at bilateral T6 and T7 laminae with high speed drill and kerrison punches. Then, the laminae were excised in en bloc fashion. After well hemostasis, a vertical durotomy was obtained under microscope. The tumor was exposed. The tumor was excised by dissector, tumor forceps, alligator, and ring forceps. After obtaining enough spicemen, the dura mater was closed in water-tight fashion. The lamine were fixed by miniplates and screws. The wound was closed in layers with no drain in situ. Operators 郭夢菲 Assistants R5 鍾文桂 相關圖片 黃美玲 (F,1968/04/10,43y11m) 手術日期 2011/04/26 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Acoustic neuroma 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 蔡宗良, 時間資訊 08:06 進入手術室 08:10 麻醉開始 09:00 誘導結束 09:15 手術開始 09:20 抗生素給藥 12:20 抗生素給藥 15:20 抗生素給藥 15:40 開始輸血 18:05 手術結束 18:05 麻醉結束 18:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 12 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Suboccipital craniotomy, retrosigmoid approac... 開立醫師: 蔡宗良 開立時間: 2011/04/26 18:33 Pre-operative Diagnosis Vestibular schwannoma, left-sided Post-operative Diagnosis Vestibular schwannoma, left-sided Operative Method Suboccipital craniotomy, retrosigmoid approach for removal of vestibular schwannoma Specimen Count And Types 1 piece About size:小 Source:brain Pathology Report pending Operative Findings 1. Tumor was very rounded and well dermacated, greyish in color, elastic, moderately vascular and hard in consistency. 2. Facial nerve was pushed toward the anterior side. Facial nerve was confirmed by evoked potential stimulation. 3. Low cranial nerves were identified and were intact Operative Procedures ETGA was employed and patient was put in left-sided park-bench position. Scalp was routinely prepped and draped. A S-shaped incision was made. A facial graft was harvested. A 4 x 4 craniotomy was made with a burr hole made just below asterion first. Dura was opened in inverted T-shape. Brain retractor was used to retract the cerebellum. Cisterna magna was opened to release CSF. Cerebello-medullary cistern and cerebello-pontine cistern were opened. Tumor was identified and removed by CUSA, tumor forcep, and bipolar cautery. Confirm facial nerve by EP stimulation. Surgicel packing was performed and dura was closed by 4-0 Prolene in water-tight fashion with a facial graft. Skull plate was fixed back to the craniotomy window. Wound was closed in layers. Operators VS 賴達明 Assistants R5 蔡宗良, R1 陳以幸 賴朝慶 (M,1933/03/11,79y0m) 手術日期 2011/04/26 手術主治醫師 賴達明 手術區域 西址 039房 01號 診斷 Carpal tunnel syndrome 器械術式 Decompression of mediun nerve 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 08:35 報到 09:25 進入手術室 09:50 麻醉開始 09:53 手術開始 10:45 麻醉結束 10:45 手術結束 11:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 正中神經或尺神經腕部減壓術–單側 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Median nerve decompression 開立醫師: 游健生 開立時間: 2011/04/26 11:01 Pre-operative Diagnosis Carpal Tunnel Syndrome, left Post-operative Diagnosis Carpal Tunnel Syndrome, left Operative Method Median nerve decompression Specimen Count And Types nil Pathology Nil Operative Findings Hypertrophic transverse carpal ligament compressed the median nerve tightly. The nerve was pale initially and became pink after complete decompression. Operative Procedures 1.The hand and forearm were sterilized with povidone-iodine tincture, then covered with stockinet. 2.Anesthesia: local injection of Xylocaine 3. Incision: vertical from vertical palmar crease to transverse wrist crease. 4.The palmaris longus tendon was identified, then the plamar aponeurosis was cut longitidinally along the ulnar side of the palmaris longus tendon. 5. The median nerve was identified beneath the palmars longus tendon. Under direct vision, the transverse carpal ligament was divided until no more pressure on the median nerve could be palpated. 6. The skin was closed by interrupted suture with 4/0 nylon. 7.The tourniquet was released. The hand and wrist were draped with fluffy dressing and elastic bandage. Operators VS 賴達明 Assistants R3 游健生 劉面 (F,1933/03/24,78y11m) 手術日期 2011/04/26 手術主治醫師 蕭輔仁 手術區域 東址 005房 04號 診斷 Lumbar Spondylosis 器械術式 Radiofrequency coagulation 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 李振豪, 時間資訊 14:35 報到 14:43 進入手術室 15:27 抗生素給藥 15:28 麻醉開始 15:29 手術開始 15:29 誘導結束 16:05 手術結束 16:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 高頻熱凝療法 1 1 B 摘要__ 手術科部: 外科部 套用罐頭: Radiofrequency stimulation, bilateral L2 dors... 開立醫師: 李振豪 開立時間: 2011/04/26 16:07 Pre-operative Diagnosis Low back pain Post-operative Diagnosis Low back pain Operative Method Radiofrequency stimulation, bilateral L2 dorsal root Specimen Count And Types nil Pathology Nil Operative Findings 1. Bilateral L2 dorsal root was identified by portable C-arm X-ray and sensory/motor stimulation test. No acute complication was noted after the procedure. 2. Temp: 42 oC, Time: 180sec x 2 cycles each side Operative Procedures The patient was put in prone position. The location of L2 was identified by portable C-arm X-ray. The skin was disinfected and draped as usual. Local anesthesia was performed with 1% Xylocaine 10ml. Bilateral L2 dorsal root radiofrequency stimulation was performed under portable C-arm guided. The patient stood whole procedure well. Operators VS蕭輔仁 Assistants R4李振豪 相關圖片 蔡李梅 (F,1940/10/22,71y4m) 手術日期 2011/04/26 手術主治醫師 王國川 手術區域 東址 016房 03號 診斷 Meningitis 器械術式 Crainotomy Brain Tumor(P-LIN) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 髒 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 3E 紀錄醫師 陳睿生, 時間資訊 08:00 開始NPO 08:00 臨時手術NPO 15:21 通知急診手術 16:12 報到 16:41 進入手術室 16:45 麻醉開始 17:05 誘導結束 17:34 手術開始 18:20 開始輸血 18:40 麻醉結束 18:40 手術結束 19:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 顱骨切除術,包括異物移除或壓或經切斷 1 2 R 摘要__ 手術科部: 外科部 套用罐頭: Craniectomy for subgaleal and intracerebellar... 開立醫師: 陳睿生 開立時間: 2011/04/26 19:06 Pre-operative Diagnosis Right side posterior fossa neuroma s/p with infection and abscess formation Post-operative Diagnosis Right side posterior fossa neuroma s/p with infection and abscess formation Operative Method Craniectomy for subgaleal and intracerebellar abscess remove and right Frazier^s EVD insertion Specimen Count And Types 2 pieces About size:3ml Source:pus About size:3ml Source:pus Pathology Nil Operative Findings The CSF was clear and the initial ICP was moderate. A right side Frazier^s EVD was inserted and the EVD was about 10cm in depth. Large amount of subgaleal pus was noted. The pus was red-yellowish, and the surrounded soft tissues were necrotic change. About 5ml intercerebellar abscess was noted and removed. Operative Procedures 1. ETGA, prone position and head fixed with Mayfield clump 2. 3cm linear scalp incision was done at right Frazier^s point 3. Create a bur hole, and the dura was tightly tented 4. The right lateral ventricle was punched, and an EVD was inserted in the depth of 10cm 5. Close the wounds 6. Reopen of the previous wound at right suboccipital region 7. Remove of the subcutaneous pus, and irrigated with gentamicin solution 8. Reopen of the dura and remove the intercerebellar pus 9. After proper hemostasis, the dura was closed with interrupt stitiches 10.The wound was closed with 2-0nylon Operators VS 王國川 Assistants R6 陳睿生 Indication Of Emergent Operation 許水濱 (M,1936/05/12,75y10m) 手術日期 2011/04/26 手術主治醫師 林晉 手術區域 東址 027房 01號 診斷 Injury to spine and spinal cord 器械術式 ORIF -Lockingplate (Leg) 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉漢平 ASA 3 紀錄醫師 葉炳君, 時間資訊 23:59 臨時手術NPO 08:26 報到 08:30 麻醉開始 08:40 進入手術室 08:50 誘導結束 09:16 手術開始 11:00 麻醉結束 11:00 手術結束 11:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 脛骨骨折開放性復位術 1 1 L 手術 橈骨、尺骨骨折開放性復位術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 骨科部 套用罐頭: 1. Open reduction and internal fixation with ... 開立醫師: 葉炳君 開立時間: 2011/04/26 11:18 Pre-operative Diagnosis 1. Right distal radius fracture 2. Left proximal tibial fracture Post-operative Diagnosis 1. Right distal radius fracture 2. Left tibial plateau fracture, Schatzker type 6 Operative Method 1. Open reduction and internal fixation with Zimmer locking plate for distal radius 2. Open reduction and internal fixation with Zimmer locking plate for proximal tibia Specimen Count And Types nil Pathology nil Operative Findings 1. Right distal radius fracture, intraarticular comminution 2. Left proximal tibial fracture, comminution 3. The tip of drill was broken and left in left tibia Operative Procedures 1. Under anesthesia, the patient was positioned in supine. 2. Skin disinfection and drapping as usual 3. Skin incision at right volar wrist, followed by Henrys approach 4. Performed ORIF with locking plate for distal radius under C-arm intensification 5. Skin incision at proximal tibia and periosteal dissection 6. Performed ORIF with locking plate and one interfragmentary under C-arm intensification 7. N/S irrigation and hemostasis 8. Closed the OP wounds in layers 9. Apply a short arm splint for right upper extremity and a long leg splint for left lower extremity Operators 林晉, Assistants 葉炳君, 黃哲南, 許寬宏, 許陳瑟 (F,1930/07/01,81y8m) 手術日期 2011/04/26 手術主治醫師 王國川 手術區域 西址 039房 02號 診斷 Carpal tunnel syndrome 器械術式 Decompression of mediun nerve 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 09:00 報到 11:15 進入手術室 11:25 麻醉開始 11:29 手術開始 11:50 麻醉結束 11:50 手術結束 12:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 正中神經或尺神經腕部減壓術–單側 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Left median nerve decompression 開立醫師: 游健生 開立時間: 2011/04/26 12:00 Pre-operative Diagnosis Carpal Tunnel Syndrome, left Post-operative Diagnosis Carpal Tunnel Syndrome, left Operative Method Left median nerve decompression Specimen Count And Types nil Pathology Nil Operative Findings The transverse carpal ligament was hypertrophic compressing the median nerve. It was well decompressed after opening the ligament. Operative Procedures 1.The hand and forearm were sterilized with povidone-iodine tincture, then covered with stockinet. 2.Anesthesia: local injection Xylocaine 3. Incision: 7 shape from vertical palmar crease to transverse wrist crease. 4.The palmaris longus tendon was identified, then the plamar aponeurosis was cut longitidinally along the ulnar side of the palmaris longus tendon. 5. The median nerve was identified beneath the palmars longus tendon. Under direct vision, the transverse carpal ligament was divided until no more pressure on the median nerve could be palpated. 6. The skin was closed by interrupted suture with 4/0 nylon. 7. The hand and wrist were draped with fluffy dressing and elastic bandage. Operators VS 王國川 Assistants R3 游健生 韓其芳 (M,1965/02/01,47y1m) 手術日期 2011/04/26 手術主治醫師 王一中 手術區域 東址 010房 01號 診斷 Cataract 器械術式 Phaco+PCIOL 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 08:10 進入手術室 09:00 手術開始 09:20 手術結束 09:25 送出病患 記錄__ 手術科部: 眼科部 套用罐頭: Phaco-Superior ( 王一中) 開立醫師: 劉傳方 開立時間: 2011/04/26 09:18 Pre-operative Diagnosis Cataract (os) Post-operative Diagnosis Cataract (os) Operative Method Phacoemulsification and PCIOL implantation (os) Specimen Count And Types nil Pathology nil Operative Findings Cataract (os) Operative Procedures 1. Under retrobulbar anesthesia. 2. Disinfection, irrigation and draping. 3. Application of an eyelid speculum. 4. Made a clear corneal incision and penetrate into AC with 2.5mm trapezoid knife at 10 oclock position. 5. Inject Viscoat into the anterior chamber. 6. Continuous circular capsulorrhexis was done with bent needle and capsular forceps. 7. Made a sideport at 2 oclock position with the MVR blade. 8. Hydrodissection and hydrodelineation were done with BSS.9. Phacoemulsification of the nucleus by standard divide-and-conquer technique. 10. Aspiration of the residual cortical material with I/A tube. 11. Extend the cornea wound to 3.2mm by diamond knife. 12. Foldable PCIOL was implanted into the bag after injection of Viscoat. 13. The residual Viscoat was washed out by Simcoe I/A cannula. 14. Inject BSS into AC and check leakage, and inject Miostat to AC to constrict the pupil 15. Stromal hydrationof the wound with BSS 16. Subconjunctival injection of Rinderon and Garamycin. 17. Maxitrol patching. Operators 王一中, Assistants R3劉傳方 盧世恩 (M,1992/07/24,19y7m) 手術日期 2011/04/27 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Injury to cervical root 器械術式 Spinal fusion anterior spinal 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 游健生, 時間資訊 08:05 進入手術室 08:10 麻醉開始 08:35 誘導結束 09:17 抗生素給藥 09:46 手術開始 12:17 抗生素給藥 13:40 手術結束 13:40 麻醉結束 13:45 送出病患 13:48 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-前融合,有固定物)≦四節 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: Odontoid screw insertion 開立醫師: 游健生 開立時間: 2011/04/27 13:48 Pre-operative Diagnosis C2 type II dens fracture with displacement and non-union Post-operative Diagnosis C2 type II dens fracture with displacement and non-union Operative Method Odontoid screw insertion Specimen Count And Types Nil Pathology nil Operative Findings 1.C2 type II dens fracture with displacement was noted on fluroscopy 2.50 mm compression screw was used. The depth was just cross the cortex of the odontoid apex. Operative Procedures Under ETGA, patient was put in supine position with head extension. Right neck transverse skin incision at C5 level was done. Dissection was made along with the anterior border of SCM muscle. Prevertebral areolar tissue was dissect open to expose prevertebral space. Localization was done with fluoroscopy. C2~3 minimal discectomy was performed. Under fluoroscope guide, K-pin was inserted from the upper rim of C3 vertebral body up to middle part of fractured dens. 50 cm screw was then inserted following the K-pin. Hemostasis was done followed by hemovac drain insertion. Wound was then closed in layers. Operators Prof. 杜永光 Assistants R6 胡朝凱 R3 游健生 邱小豐 (M,1983/02/22,29y0m) 手術日期 2011/04/27 手術主治醫師 杜永光 手術區域 東址 003房 02號 診斷 Herniated intervertebral disc (HIVD) 器械術式 Diskectomy lumbar(Others) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 游健生, 時間資訊 14:00 進入手術室 14:10 麻醉開始 14:15 誘導結束 14:50 抗生素給藥 14:57 手術開始 16:45 手術結束 16:45 麻醉結束 16:55 送出病患 16:57 進入恢復室 18:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-腰椎 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 外科部 套用罐頭: Left microscopic discectomy 開立醫師: 游健生 開立時間: 2011/04/27 17:02 Pre-operative Diagnosis Left L3~4 ruptured disc Post-operative Diagnosis Left L3~4 ruptured disc Operative Method Left microscopic discectomy Specimen Count And Types nil Pathology nil Operative Findings A huge ruptured and downward migration disc fragment from the L3~4 disc space was found and it compressed the left L4 root tightly. The root became injected and swollen. Hypertrophic flavum ligment, sticky peripheral soft tissue were also noted. The root was free after diskectomy. Operative Procedures Under endotracheal general anesthesia, patient was put in prone position. Pre-Op fluoroscopic localization was performed. The back was shaved and scrubbed with povidone-iodine detergent then painted with povidone-iodine tincture and followed by sterilized adhesive plastic sheet covering. Incision was made as 3-cm, between L5~S1 spinous processes. The subcutaneous layer and lumbdorsal fascia were incised then the aponeurosis of the latissimus dorsi and ileocostalis lumborum muscles at spinous processes of L3~4 was incised, the muscles were detached from the interspinous ligament. The multifidus muscles were detached subperiosteally from L3~4 laminae by a rasp. The paravertebral muscles were retracted by a modified narrow Taylor retractor which was retained constantly by a rubbersling to the side rail of the operating table. Under an operating microscope, the ligamentum flavum was cleaned and incised longitudinally at the lateral part.The lateral portion of this ligament was removed with a small angle Kerrison rongeur, the lateral portion of the laminae and the medial border of the facets were removed too until the margin of the facets and a corridor to the disc that ran lateral to the root was reached. The epidural fat was left undisturbed andpreserved. The compressed L5 root and veins overlying the protruded disc were gently pushed away by placing 2 small cottonoid patties, one above and one below the disc at the floor of the epidural canal. The compressed root was gently pushed further away temporarily by sucker tip in order to expose the herniated disc more clearly. The posterior longitudinal ligament and annulus were incised around the protruded disc with a No. 15 blade. The degenerated disc was removed with microdisc forceps until a substantial amount of the nucleus had been loosened with a cone curette and removed. The lumbodorsal fascia was approximated by 3 interruped 2/0 silk stitches. Thesubcutaneous layer was closed by running suture with 4/0 Dexon and skin by adhesive tape. Operators Prof 杜永光 Assistants R6 胡朝凱 R3 游健生 游春美 (F,1968/12/08,43y3m) 手術日期 2011/04/27 手術主治醫師 曾漢民 手術區域 東址 005房 03號 診斷 Pituitary tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳國瑋, 時間資訊 14:43 進入手術室 15:00 麻醉開始 15:20 誘導結束 15:40 抗生素給藥 15:55 手術開始 17:28 手術結束 17:34 送出病患 17:34 麻醉結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 經由蝶竇之腦下垂體瘤切除 1 1 摘要__ 手術科部: 外科部 套用罐頭: Sublabial trans-sphenoid adenomectomy 開立醫師: 陳睿生 開立時間: 2011/04/27 18:11 Pre-operative Diagnosis Pituitary macroadenoma, nonfunctional Post-operative Diagnosis Pituitary macroadenoma, nonfunctional Operative Method Sublabial trans-sphenoid adenomectomy Specimen Count And Types 1 piece About size:pieces Source:pituitary tumor Pathology pending Operative Findings The tumor was soft, fragile, and pink-shitish one. It was about 6cm in height. The tumor was extended into the sphenoid sinus, and the sellar floor was erosive change. Some old hematoma was noted while tumor removing, and apoplexy was impressed. After nearly total remove of the tumor, the arachnoid membrane was falling down, and no obvious normal gland was found. No CSF leakage was noted. Operative Procedures Under ETGA, the patient was put in supine position. Both nostrils and upper lips were disinfected with providine-iodine. The skin was disinfected and draped as usual. About 4cm linear incision was done at upper gingival region. The superior aspect of the hard plate was exposed, and then right side septal mucosa was dissected to expose the bony septum. Hardy spectulum was applied, and the vomer bone was exposed and removed. After remove of the sphenoid sinus mucosa, the tumor was identified, and partial removed. The residual sellar floor, and dura were removed to extend into the sellar region. The tumor inside the sellar region was removed as possible. After tumor remove, the arachnoid membrane fell down. Proper hemostasis was done, and the sellar region was packed with gelfoam. The vomer bone was put back, and the gingiva was suture closed. Mirocel was packed at bilateral nasal cavity. Operators VS 曾漢民 Assistants R6 陳睿生, R2 陳國瑋 相關圖片 張皓翔 (M,1997/12/12,14y3m) 手術日期 2011/04/27 手術主治醫師 郭夢菲 手術區域 兒醫 067房 04號 診斷 Congenital hydrocephalus 器械術式 V-P shunt 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林峰盛 ASA 3E 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 15:31 通知急診手術 16:40 進入手術室 16:45 麻醉開始 17:00 誘導結束 17:43 手術開始 20:53 手術結束 20:53 麻醉結束 21:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Glucose 5 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 手術 腦室腹腔分流手術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Ventriculo-peritoneal shunt implantation via ... 開立醫師: 李振豪 開立時間: 2011/04/27 21:32 Pre-operative Diagnosis 1. Hydrocephalus, 2. Cerebral palsy, 3. Diabetic ketoacidosis Post-operative Diagnosis 1. Hydrocephalus, 2. Cerebral palsy, 3. Diabetic ketoacidosis Operative Method Ventriculo-peritoneal shunt implantation via left Kocher"s point Specimen Count And Types 1 piece About size:5ml Source:CSF Pathology Nil Operative Findings The opening pressure was 25cm H2O and the CSF was clear in appearance. Total 5ml CSF was sampled for routine, BCS, and bacterial culture. High pressure metronic burr hole type reservoir was placed. The ventricular and peritoneal catheter was 6.5cm and 30cm in length. Adhesion around the left side abdomen was noted after entered the peritoneal cavity. We can not passed the tube into the peritoneal cavity. The other wound at subxiphoid area was created in order to placed the shunt into peritoneal cavity. We failed to identify the right side peritoneal catheter during the operation. Right side shunt revision will be scheduled later. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head rotated to right. The scalp was shaved, scrubbed, and disinfected as usual. Curvilinear scalp incision was made along operative scar. The scalp flap was elevated and the burr hole was identified. The burr hole was extended with Kerrison punch. Left lateral ventricle ventriculostomy was performed with ventricular needle. Opening pressure was checked and CSF was sampled for routine, biochemistry, and bacterial culture. Left upper abdomen transverse skin incisionw as made and minilaparotomy was performed. However, adhesion was noted around the wound. Midline skin incision at subxiphoid area was made and minilaparotomy was performed. The peritoneal cavity was entered under direct vision. The subcutaneous tunnel from left abdomen, left forechest, neck, retroauricular area to left occipital area was created. The shunt was passed through the subcutaneous tunnel. The V-P shunt was set up and the ventricular catheter was placed into left lateral ventricle. The peritoneal catheter was placed into the peritoneal cavity. Right abdomen skin incision was made along operative scar in order to identifie the right side peritoneal catheter. However, due to severe fibrosis and possible upward migration of the tube, we failed to expose the peritoneal catheter. The subcutaneous pocket was created at subxiphoid area and another peritoneal catheter was placed. Further revision of right side V-P shunt will be arranged. Hemostasis was achieved and the wound was closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators AP郭夢菲 Assistants R4李振豪, Ri楊依倩 Indication Of Emergent Operation IICP with conscious disturbance 記錄__ 手術科部: 外科部 套用罐頭: Ventriculo-peritoneal shunt implantation via ... 開立醫師: 郭夢菲 開立時間: 2011/04/28 09:45 Pre-operative Diagnosis 1. Multiloculated Hydrocephalus, S/P VP shunt with recurrence 2. Cerebral palsy, 3. Diabetic ketoacidosis Post-operative Diagnosis 1. Multiloculated Hydrocephalus, S/P VP shunt with recurrence 2. Cerebral palsy, 3. Diabetic ketoacidosis Operative Method Ventriculo-peritoneal shunt implantation via left Kocher"s point Specimen Count And Types 1 piece About size:5ml Source:CSF Pathology Nil Operative Findings The opening pressure was 25cm H2O and the CSF was clear in appearance. Total 5ml CSF was sampled for routine, BCS, and bacterial culture. High pressure metronic burr hole type reservoir was placed. The ventricular and peritoneal catheter was 6.5cm and 30cm in length. Adhesion around the left side abdomen was noted after entered the peritoneal cavity. We can not passed the tube into the peritoneal cavity. The other wound at subxiphoid area was created in order to placed the shunt into peritoneal cavity. We failed to identify the right side peritoneal catheter during the operation. Right side shunt revision will be scheduled later. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head rotated to right. The scalp was shaved, scrubbed, and disinfected as usual. Curvilinear scalp incision was made along operative scar. The scalp flap was elevated and the burr hole was identified. The burr hole was extended with Kerrison punch. Left lateral ventricle ventriculostomy was performed with ventricular needle. Opening pressure was checked and CSF was sampled for routine, biochemistry, and bacterial culture. Left upper abdomen transverse skin incisionw as made and minilaparotomy was performed. However, adhesion was noted around the wound. Midline skin incision at subxiphoid area was made and minilaparotomy was performed. The peritoneal cavity was entered under direct vision. The subcutaneous tunnel from left abdomen, left forechest, neck, retroauricular area to left occipital area was created. The shunt was passed through the subcutaneous tunnel. The V-P shunt was set up and the ventricular catheter was placed into left lateral ventricle. The peritoneal catheter was placed into the peritoneal cavity. Right abdomen skin incision was made along operative scar in order to identifie the right side peritoneal catheter. However, due to severe fibrosis and possible upward migration of the tube, we failed to expose the peritoneal catheter. A subcutaneous pocket was created at the subxiphoid wound and another peritoneal catheter was placed into the same minilaparotomy with the peritoneal catheter into it for later use for the right VP shunt. Further revision of right side V-P shunt will be arranged. Hemostasis was achieved and the wound was closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators AP郭夢菲 Assistants R4李振豪, Ri楊依倩 Indication Of Emergent Operation IICP with conscious disturbance 任寶美 (F,1955/10/29,56y4m) 手術日期 2011/04/27 手術主治醫師 賴達明 手術區域 東址 002房 03號 診斷 Subarachnoid hemorrhage (SAH) 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 蔡宗良, 時間資訊 14:25 報到 14:25 進入手術室 14:27 麻醉開始 14:30 誘導結束 14:57 抗生素給藥 15:16 手術開始 16:57 開始輸血 19:18 19:40 麻醉結束 19:40 手術結束 19:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 頭顱成形術 1 1 手術 氣管切開術 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: 1. Cranioplasty 開立醫師: 蔡宗良 開立時間: 2011/04/27 20:01 Pre-operative Diagnosis 1. Cranial defect s/p craniectomy 2. Respiratory failure Post-operative Diagnosis 1. Cranial defect s/p cranioplasty 2. Respiratory failure Operative Method 1. Cranioplasty 2. Tracheostomy Specimen Count And Types nil Pathology None Operative Findings 1. Cranial defect. 2. Previous dura defect, covered by Dura form at left-sided frontal area Operative Procedures 1. ETGA supine 2. Routine prepping and draping 3. Incision on previous wound 4. Dissect the epidural space and reflect the scalp 5. Hemostasis 6. Skull plate fixed back to the cranial defect with mini-plates 7. Central tenting secured 8. CWV drain placed, one at each side 9. Wound closed in layers 10. Prepare prepping and draping for tracheostomy 11. Wound incision and dissect through midline until trachea has been reached 12. Confirm FiO2 and incise the trachea 13. Fixation of 7 Fr low-pressure trachea tube Operators VS 賴達明 Assistants R5 蔡宗良 陳建華 (M,1958/05/19,53y9m) 手術日期 2011/04/27 手術主治醫師 賴達明 手術區域 東址 009房 05號 診斷 Wound, facial 器械術式 Revision of CSF shunt 手術類別 緊急手術 手術部位 頭、頸 傷口分類 髒 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 曾峰毅, 時間資訊 08:00 臨時手術NPO 08:00 開始NPO 08:20 通知急診手術 14:47 進入手術室 14:50 麻醉開始 15:00 誘導結束 15:22 手術開始 16:20 麻醉結束 16:20 手術結束 16:28 送出病患 16:32 進入恢復室 17:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 皮下肌肉或深部異物取出術 1 1 R 手術 深部傷口處理縫合擴創-小 1 0 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 曾峰毅 開立時間: 2011/04/27 16:24 Pre-operative Diagnosis Suspected shunt infection Post-operative Diagnosis Suspected shunt infection Operative Method Ventriculopleural shunt removal and debridment Specimen Count And Types Ventricular catheter and pleural catheter was sent for culture. Pathology Nil Operative Findings Pleural catheter was broken at 10 cm distal to reservoir, but further distal part cannot be localized. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to left. We made one skin incision at right occipital area, and dissected to remove the ventricular catehter, reservoir, and pleural catheter. We made another wound at the infected site, and debrided the wound. The wound was closed in layers. We re-draped the patient, and made one skin incision at right clavicular area to look for the pleural catheter, but in vain. The wound was closed. Operators VS 賴達明 Assistants R4 曾峰毅 Indication Of Emergent Operation Infection control 湯運金 (M,1955/07/05,56y8m) 手術日期 2011/04/27 手術主治醫師 賴達明 手術區域 東址 005房 02號 診斷 Cervical Spondylosis 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳國瑋, 時間資訊 10:35 報到 11:30 進入手術室 11:40 麻醉開始 11:55 誘導結束 12:00 抗生素給藥 12:35 手術開始 14:25 手術結束 14:25 麻醉結束 14:43 送出病患 14:47 進入恢復室 15:47 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 椎間盤切除術-頸椎 1 1 手術 脊椎融合術-前融合,有固定物)≦四節 1 2 摘要__ 手術科部: 外科部 套用罐頭: Microsurgical anterior diskectomy and fusion ... 開立醫師: 陳國瑋 開立時間: 2011/04/27 14:47 Pre-operative Diagnosis Cervical herniated intervertebral disc C4-6 Post-operative Diagnosis Cervical herniated intervertebral disc C4-6 Operative Method Microsurgical anterior diskectomy and fusion with cage C4-5 Microsurgical anterior diskectomy and fusion with cage C4-6 Specimen Count And Types nil Pathology nil Operative Findings dehydrated disk with posterior migration between posterior longitudinal ligament and vertebral body. Spinal fusion with Synthes PEEK cage 8mm at C4-5 and 7mm at C5-6. Spur formation was noted Operative Procedures Under ETGA, the patient was put in supine position with neck mildly extended. Transverse skin incision was made beside thyroid cartlige. Approached the prevertebral space through the anterior border of SCM. Localization of the C4-5 disc space with C-arm. Perforemed diskectomy at C4-5, and the spines were fused with cage 8mm. Diskectomy at C5-6 and fusion with cage 7mm. One hemovac was placed. After careful hemostasis, the wound was closed in layers. Operators 賴達明 Assistants 陳睿生 陳國瑋 相關圖片 陳阿選 (F,1932/12/26,79y2m) 手術日期 2011/04/27 手術主治醫師 賴達明 手術區域 東址 000房 號 診斷 Cerebral aneurysm 器械術式 NEURO T.A.E 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林珍榮 ASA 3E 時間資訊 00:12 臨時手術NPO 00:12 開始NPO 08:12 通知急診手術 08:55 麻醉開始 09:00 誘導結束 10:50 麻醉結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 謝育偉 (M,1969/01/05,43y2m) 手術日期 2011/04/27 手術主治醫師 謝孟祥 手術區域 東址 009房 04號 診斷 Malignant neoplasm of trachea 器械術式 Debridment-- >10cm 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 3 紀錄醫師 周聖哲, 時間資訊 13:03 進入手術室 13:15 麻醉開始 13:25 誘導結束 13:40 手術開始 14:25 手術結束 14:25 麻醉結束 14:32 送出病患 14:36 進入恢復室 15:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 深部傷口處理縫合擴創-大 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 摘要__ 手術科部: 內科部 套用罐頭: Debridement and wound closure 開立醫師: 周聖哲 開立時間: 2011/04/27 14:28 Pre-operative Diagnosis Operation wound infection Post-operative Diagnosis Operation wound infection Operative Method Debridement and wound closure Specimen Count And Types nil Pathology nil Operative Findings little necrotic tissue and granulation tissue in the operation wound, no obvious pus discharge. Exposed TPS was also noted. Operative Procedures 1. ETGA, supine position 2. Disinfect and drape 3. Debridement 4. Place two hemovac drains 5. Hemostasis and close the wound in layers Operators VS謝孟祥 Assistants R5阮廷倫, R1周聖哲 吳雪麗 (F,1956/04/06,55y11m) 手術日期 2011/04/27 手術主治醫師 詹志洋 手術區域 東址 000房 號 診斷 Malignant histiocytosis, extranodal solid organ sites 器械術式 Port-A Implatation /WOR 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 黃俊銘, 時間資訊 16:00 進入手術室 16:05 抗生素給藥 16:18 麻醉開始 16:19 麻醉結束 16:20 手術開始 16:45 手術結束 16:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 內頸靜脈切開,永久導管放置術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Port-A 開立醫師: 黃俊銘 開立時間: 2011/04/27 16:57 Pre-operative Diagnosis Langerhans cell histiocytosis Post-operative Diagnosis Ditto s/p Port-A implantation Operative Method Port-A catheter implantation, echo guided Specimen Count And Types nil Pathology nil Operative Findings Puncture to right IJV under echo guidance The venous blood flow freely in the Port-A catheter after implantation. Operative Procedures The patient was put on supine position. The operation field was disinfected and draped as usual. Under local anesthesia, we puncture to right IJV under echo guidance. After creating subcutaneous pocket, the Port-A catheter was inserted via peel away sheath. We close the wound in layers. Post-op care plan: 1.wound CD QD+PRN2.pain control with tinten 3.prophylatic antibiotics use Operators 詹志洋 Assistants 黃俊銘 周銅城 (M,1933/02/10,79y1m) 手術日期 2011/04/27 手術主治醫師 蕭輔仁 手術區域 東址 005房 01號 診斷 Spondylosis with myelopathy, cervical 器械術式 Laminectomy C-Spinal(Posterier 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳國瑋, 時間資訊 07:55 報到 08:03 進入手術室 08:18 麻醉開始 08:30 誘導結束 08:34 抗生素給藥 09:10 手術開始 11:13 手術結束 11:13 麻醉結束 11:20 送出病患 11:23 進入恢復室 13:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術(減壓)-超過二節 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: C3-6 laminectomy 開立醫師: 陳國瑋 開立時間: 2011/04/27 11:50 Pre-operative Diagnosis Cervical stenosis C3-6 Post-operative Diagnosis Cervical stenosis C3-6 Operative Method C3-6 laminectomy Specimen Count And Types nil Pathology nil Operative Findings The thecal sac expanded well after decompression. No thickened ligmentum flavum was noted. Operative Procedures After ETGA, the patient was put in prone position with head fixed with Mayfield clamp. The skin was disinfected and draped as usual. Midline incision from 3cm below inion to 3cm upper C7 spinal process. The muscle and soft tissue was dissected away to expose the laminae. Performed laminectomy from C3 to C7 with MIDAS. Set one CWV drain. After careful hemostasis, the wound was closed in layers. Operators 蕭輔仁 Assistants 陳睿生 陳國瑋 相關圖片 王再雲 (F,1956/11/10,55y4m) 手術日期 2011/04/27 手術主治醫師 王國川 手術區域 病房 000房 號 診斷 Brain abscess 器械術式 Revision of CSF shunt 手術類別 緊急手術 手術部位 胸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 王奐之, 時間資訊 14:59 通知急診手術 15:50 手術開始 16:10 手術結束 16:15 抗生素給藥 醫令資訊 類別 名稱 量 刀 側 手術 皮下肌肉或深部異物取出術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt ligation 開立醫師: 王奐之 開立時間: 2011/04/27 17:04 Pre-operative Diagnosis Overdrainage of ventriculoperitoneal shunt Post-operative Diagnosis Overdrainage of ventriculoperitoneal shunt Operative Method Ventriculoperitoneal shunt ligation Specimen Count And Types Nil Pathology Nil Operative Findings Difficult CSF flow was observed after shunt ligation. Operative Procedures The patient was placed in supine position. After disinfection & draping in sterile fashion, local anesthesic agent was applied to the right mid-clavicular area. A transverse skin incision was made, and slowly deepened until the shunt catheter was exposed. A short segment (0.5cm) of Nelaton tube was used to cover the shunt catheter. 3 silk were then wrapped around the Nelaton tube (and the catheter inside) and tied tight. The wound was closed with 3-0 Nylon interrupted sutures. Operators VS 王國川 Assistants R3 王奐之 Indication Of Emergent Operation impending herniation 相關圖片 柯勝嚴 (M,1983/01/11,29y2m) 手術日期 2011/04/28 手術主治醫師 廖漢文 手術區域 東址 000房 號 診斷 Arteriovenous malformation, brain 器械術式 NEURO T.A.E 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 2 時間資訊 08:30 麻醉開始 08:40 誘導結束 13:45 麻醉結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 王晨允 (F,2010/10/19,1y4m) 手術日期 2011/04/28 手術主治醫師 黃書健 手術區域 兒醫 067房 01號 診斷 Hypoplastic left heart syndrome, congenital 器械術式 TCPC,JATENE,TAPVR,NORWOOD 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 4 紀錄醫師 莊民楷, 時間資訊 00:38 臨時手術NPO 08:27 報到 08:27 進入手術室 08:32 麻醉開始 09:50 誘導結束 10:14 手術開始 11:15 抗生素給藥 13:00 抗生素給藥 13:08 開始輸血 14:00 麻醉結束 14:00 手術結束 14:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 體外心肺循環 1 1 手術 心房–肺動脈迴路成形術 1 1 手術 腔靜脈回流右心房異常之修補手術 1 2 手術 存開性動脈導管手術 1 4 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 T.E.E 1 0 麻醉 動脈血液檢查全套 3 0 麻醉 Hemoglobin (Hb) 3 0 麻醉 測血糖 3 0 麻醉 Ca (Calcium) 3 0 麻醉 Na (Sodium) 3 0 麻醉 K (Potassium) 3 0 麻醉 Blood gas analysis 3 0 摘要__ 手術科部: 外科部 套用罐頭: BDG shunt creation + RV-PA conduit division +... 開立醫師: 莊民楷 開立時間: 2011/04/28 16:30 Pre-operative Diagnosis HLHS, s/p Norwood procedure, with PV orifice stenosis Post-operative Diagnosis HLHS, s/p Norwood procedure, with PV orifice stenosis Operative Method BDG shunt creation + RV-PA conduit division + PV orifice enlargement Specimen Count And Types nil Pathology Nil Operative Findings 1. severe adhesion over pericardial cavity 2. preoperative TEE: flow acceleration over all PV orifice, PG 25mmhg 3. LA muscle hypertrophy, leading to PV orifice stenosis; postoperative PG 2mmHg 4. SVC 1cm, RPA 6mm 5. postoperative PAP 18~20, SpO2 85% under FiO2 60% 6. exhausted peripheral A-line insertion failed left CFA A-line (2mm in diameter) insertion by cut-down method 7. postoperative AsAo looped by surgical membrane stripe, pericadial cavity covered by surgical membrane Operative Procedures 1. ETGA, supine 2. Disinfection and drapping 3. Left groin incision, dissect to expose LCFA, A-line set-up but failed 4. Midline sternotomy 5. AsAo, SVC/RAA→IVC cannulation; on CPB, cooling to 28 degree 6. Axc, antegrade cardioplegia, cardiac arrest; RV-PA conduit clamp 7. RA incision, PV orifice enlargement by LA muscle incision around PV orifice 8. Rewarm, repair RA, deair 9. SVC transection, close RA side 10. RPA incision, end-to-side anastomosis of SVC to RPA with 7-0 Maxon continueous suture 11. RV-PA conduit division; wean off CPB 12. Hemostasis, set three chest tubes over mediastinum and left pleural cavity 13. Close the wound in layers Operators VS 黃書健 Assistants R5 謝永, R3 莊民楷 記錄__ 手術科部: 外科部 套用罐頭: BDG shunt creation + RV-PA conduit division +... 開立醫師: 黃書健 開立時間: 2011/04/29 11:39 Pre-operative Diagnosis HLHS, s/p Norwood procedure, with PV orifice stenosis Post-operative Diagnosis HLHS, s/p Norwood procedure, with PV orifice stenosis Operative Method BDG shunt creation + RV-PA conduit division + PV orifice enlargement Specimen Count And Types nil Pathology Nil Operative Findings 1. severe adhesion over pericardial cavity 2. preoperative TEE: flow acceleration over all PV orifice, PG 25mmhg 3. PV orifice stenosis at entry into left atrium 4. SVC 1cm, RPA 6mm 5. postoperative PAP 18~20, SpO2 85% under FiO2 60% 6. exhausted peripheral A-line insertion failed left CFA A-line (2mm in diameter) insertion by cut-down method 7. postoperative AsAo looped by surgical membrane stripe, pericadial cavity covered by surgical membrane Operative Procedures 1. ETGA, supine 2. Disinfection and drapping 3. Left groin incision, dissect to expose LCFA, A-line set-up but failed 4. Midline sternotomy 5. AsAo, SVC/RAA→IVC cannulation; on CPB, cooling to 28 degree 6. Axc, antegrade cardioplegia, cardiac arrest; RV-PA conduit clamp 7. RA incision, PV orifice enlargement by excise the pulmonary orifice till the four pulmonary vein orifices were clearly seen 8. Rewarm, repair RA, deair 9. SVC transection, close RA side 10. RPA incision, end-to-side anastomosis of SVC to RPA with 7-0 Maxon continueous suture 11. RV-PA conduit division; wean off CPB 12. Hemostasis, set three chest tubes over mediastinum and left pleural cavity 13. Close the wound in layers Operators VS 黃書健 Assistants R5 謝永, R3 莊民楷 賴明陽 (M,1946/02/10,66y1m) 手術日期 2011/04/28 手術主治醫師 賴達明 手術區域 東址 003房 03號 診斷 Head Injury 器械術式 Brain tumor Crainotomy(Others)，ICP monitoring 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 4E 紀錄醫師 蔡宗良, 時間資訊 06:00 臨時手術NPO 06:00 開始NPO 12:25 進入手術室 12:25 抗生素給藥 12:30 麻醉開始 12:40 誘導結束 13:00 手術開始 14:25 開始輸血 14:55 手術結束 14:55 麻醉結束 15:10 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 急性硬腦膜下血腫清除術 1 1 R 手術 顱內壓視置入 1 2 R 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 創傷醫學部 套用罐頭: 1. Decompressive craniectomy, fronto-temporo-... 開立醫師: 蔡宗良 開立時間: 2011/04/28 15:22 Pre-operative Diagnosis Traumatic brain injury with right-sided subdural hemorrhage and contusional hemorrhage to bilateral temporal base Post-operative Diagnosis Traumatic brain injury with right-sided subdural hemorrhage and contusional hemorrhage to bilateral temporal base Operative Method 1. Decompressive craniectomy, fronto-temporo-parietal, right-sided 2. Intracranial pressure monitoring via subdural space Specimen Count And Types 1 piece About size:小 Source:bone culture Pathology None Operative Findings 1. Subdural hematoma approximately 50 mL 2. Moderate brain swelling, ICP ~ 1 mmHg after wound closure has completed Operative Procedures 1. ETGA, supine, head rotated 60 degrees to the left 2. Routine scalp preparation, disinfection, and drapping 3. Trauma flap performed, followed by craniotomy. Craniectomy was extended further by rongeurs towards the temporal base 4. Dura tenting and U-shaped dura incision 5. Remove subdural hematoma 6. ICP probe placement 7. Dura-form covering 8. Two CWVs placed epidural space 9. Wound closed in layers Operators VS 黃勝堅 Assistants CR 陳睿生, R5 蔡宗良 Indication Of Emergent Operation increased intracranial pressure with uncal herniation 楊春菊 (F,1952/03/14,60y0m) 手術日期 2011/04/28 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Aneurysm 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 08:08 進入手術室 08:10 麻醉開始 08:15 誘導結束 08:30 抗生素給藥 08:49 手術開始 10:00 手術結束 10:00 麻醉結束 10:17 送出病患 10:20 進入恢復室 11:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 顱骨重塑模組 1 0 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 頭顱成形術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Cranioplasty 開立醫師: 曾峰毅 開立時間: 2011/04/28 09:47 Pre-operative Diagnosis Status post craniectomy Post-operative Diagnosis Status post craniectomy Operative Method Cranioplasty Specimen Count And Types Nil Pathology Nil Operative Findings Artificial 3-D reconstructed bone graft fits the skull defect well. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to right. After scalp shaved, scrubbed, disinfected, and then draped, we made skin incision along previous operation wound. We dissected the scalp, and fixed the bone graft with plates and screws. We reconstructed temporalis muscle with bone cement. After one subgaleal CWV, the wound was closed in layers. Operators VS 王國川 Assistants R4 曾峰毅 R3 王奐之 相關圖片 李宸瑄 (F,1956/08/26,55y6m) 手術日期 2011/04/28 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 Subarachnoid hemorrhage 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 2 紀錄醫師 王奐之, 時間資訊 10:27 進入手術室 10:30 麻醉開始 10:40 誘導結束 11:03 手術開始 11:45 抗生素給藥 11:57 手術結束 11:57 麻醉結束 12:05 送出病患 12:08 進入恢復室 13:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 頭顱成形術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Cranioplasty at left 開立醫師: 曾峰毅 開立時間: 2011/04/28 11:48 Pre-operative Diagnosis Status post craniectomy Post-operative Diagnosis Status post craniectomy Operative Method Cranioplasty at left Specimen Count And Types Nil Pathology Nil Operative Findings The bone graft was fixed back with mini-plates and screws. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to right. After scalp shaved, scrubbed, disinfected, and then draped, we made skin incision along previous operation wound. We dissected the scalp, and fixed the bone graft with plates and screws. We reconstructed temporalis muscle with bone cement. After one subgaleal CWV, the wound was closed in layers. Operators VS 王國川 Assistants R4 曾峰毅, R3 王奐之 相關圖片 王再雲 (F,1956/11/10,55y4m) 手術日期 2011/04/28 手術主治醫師 王國川 手術區域 東址 016房 04號 診斷 Brain abscess 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3 紀錄醫師 王國川, 時間資訊 11:32 報到 12:40 進入手術室 12:48 麻醉開始 12:55 誘導結束 13:00 抗生素給藥 13:16 手術開始 14:35 14:40 麻醉結束 14:40 手術結束 14:40 14:45 送出病患 14:50 進入恢復室 15:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 頭顱成形術 1 1 L 手術 顱骨重塑模組 1 0 L 摘要__ 手術科部: 外科部 套用罐頭: Cranioplasty at left with artificial 3-D reco... 開立醫師: 曾峰毅 開立時間: 2011/04/28 13:58 Pre-operative Diagnosis Status post craniectomy Post-operative Diagnosis Status post craniectomy Operative Method Cranioplasty at left with artificial 3-D reconstructed bone graft 1. Cranioplasty at left with artificial 3-D reconstructed bone graft 2. Re-opening of the ligated ventriculoperitoneal shunt Specimen Count And Types nil Pathology Nil Operative Findings Bone graft fits the defect well. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to right. After scalp shaved, scrubbed, disinfected, and then draped, we made skin incision along previous operation wound. We dissected the scalp, and fixed the bone graft with plates and screws. We reconstructed temporalis muscle with bone cement. After one subgaleal CWV, the wound was closed in layers. With endotracheal general anaesthesia, the patient was put in supine position with head rotated to right. After scalp shaved, scrubbed, disinfected, and then draped, we made skin incision along previous operation wound. We dissected the scalp, and fixed the bone graft with plates and screws. We reconstructed temporalis muscle with bone cement. After one subgaleal CWV, the wound was closed in layers. The right mid-clavicular area was disinfected and draped again, the stitches were removed and the shunt catheter was exposed. The ligating sutures were then removed. The wound was closed again with interrupted sutures. Operators VS 王國川 Assistants R4 曾峰毅, R3 王奐之 相關圖片 吳正雄 (M,1939/07/25,72y7m) 手術日期 2011/04/28 手術主治醫師 蔡翊新 手術區域 東址 005房 01號 診斷 Intracranial hemorrhage 器械術式 Craniotomy (A.V.M.) P-DUH 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3 紀錄醫師 陳宣佑, 時間資訊 08:07 進入手術室 08:25 麻醉開始 08:40 誘導結束 09:10 抗生素給藥 09:20 手術開始 10:04 12:10 抗生素給藥 12:55 麻醉結束 12:55 手術結束 13:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 開顱術摘除血管病變-動靜脈畸型小型表淺 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: AVM 開立醫師: 蔡翊新 開立時間: 2011/04/28 11:48 Pre-operative Diagnosis Right occipital dural AV fistula with ICH. Post-operative Diagnosis Right occipital dural AV fistula with ICH. Operative Method Right occipital craniotomy for excision of dural arteriovenous fistula and removal of ICH. Specimen Count And Types 2 pieces About size:2.0 x 1.5 x 1 cm, 1.0 x 0.5 x 0.5 cm Source: venous aneurysms of dural AV fistula. Pathology Two venous aneurysms, sized 2.0 x 1.5 x 1 cm and 1.0 x 0.5 x 0.5 cm. Operative Findings Engorged right occipital artery was coagulated during scalp incision. The periosteum was easy-bleeding. Several engorged meningeal arteries were coagulated before dural incision. Old subdural hematoma was noted upon dural opening. There were several cortical veins draining into the dura which was rich in venous channels. ICH ruptured by itself and a 15 ml ICH was evacuated from right occipital lobe. Medial to the ICH, two venous aneurysms, sized 2.0 x 1.5 x 1 cm and 1.0 x 0.5 x 0.5 cm, were noted, with drainage to cortical veins which drained immediately into superior sagittal sinus. The venous aneurysms were excised by dividing the two draining veins after clipping with hemoclips. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: left decubitus position. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: horse shoe shape, right occipital, centered 6 cm above inion and 3 cm lateral to midline. Raney clips were applied to the scalp edge for temporary hemostasis. The right occipital artery was coagulated. 5. Craniotomy window: 6 x 6 cm, right occipital, created by making 4 burr holes then cut by power saw. 6. Dural tenting: by 2/0 silk, 2.5 cm in interval, distributed along the edge of skull window. 7. Dural incision: curvilinear. The venous channels and connection from cortical veins were coagulated and divided. 8. The occipital cortex at parasagittal region was enlarged by bipolar coagulator from the ruptured site of the ICH. The soft clot of the intracerebral hematoma was removed easily by a sucker. The tough clot was then removed and the venous aneurysms of dural AV fistula were dissected out. The venous drainage to cortical veins were divided after coagulation and clipping by hemoclips. The the venous aneurysm were removed. 9. Hemostasis: The blood oozing point from several locations on the bare surface of the hematoma cavity were packed with Surgicel for complete hemostasis. Finally, the cavity was irrigated with NS several times and it was perfectly water clear before the dural closure. 10.Dural closure: interruped 2/0 silk sutures for key stitches, then continuous suture with 4/0 Prolene to obtain water-tight closure. A piece of pericranium (4 x 3 cm) was used for a perfect dural closure. 11.Closure of skull window: the skull plate was placed back to craniotomy window and fixed by 4 26# wires. The dura was tented to the center of the skull plate by a 2/0 stitch. 12.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 13.Drain: one epidural CWV. 14.Blood transfusion: none. Blood loss: 250 ml. 15.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R4李振豪R1陳宣佑Ri楊依倩 相關圖片 吳瑞琪 (M,1979/08/26,32y6m) 手術日期 2011/04/28 手術主治醫師 蔡翊新 手術區域 東址 005房 02號 診斷 Intracerebral hemorrhage 器械術式 Craniotomy (A.V.M.) P-DUH 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 2 紀錄醫師 李振豪, 時間資訊 13:32 進入手術室 13:35 麻醉開始 13:45 手術開始 13:45 抗生素給藥 13:45 誘導結束 16:45 抗生素給藥 17:05 手術結束 17:05 麻醉結束 17:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 頭皮腫瘤 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 手術 開顱術摘除血管病變-動靜脈畸型小型表淺 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: 1. Left occipital craniotomy for cavernous ma... 開立醫師: 李振豪 開立時間: 2011/04/28 17:43 Pre-operative Diagnosis 1. Left occipital cavernous malformation with intracerebral hemorrhage 2. Left occipital osteoma Post-operative Diagnosis 1. Left occipital cavernous malformation with intracerebral hemorrhage 2. Left occipital osteoma Operative Method 1. Left occipital craniotomy for cavernous malformation excision and hematoma evacuation 2. Removal of left occipital osteoma Specimen Count And Types 1 piece About size:1cm in diameter Source:Left occipital cavernous malformation Pathology Nil Operative Findings Hemosiderin at the surface of the cortex was noted after durotomy. Intra-operative sonography was checked for localization of the ICH and cavernoma. The ICH was encountered first after corticotomy and total 10ml ICH was evacuated. Gliosis and hemosiderin deposition was noted around the hematoma and the cavernoma. The cavernoma was strawberry-like apperance, 1cm in diameter, and adhered with adjacent gliosis tissue. No remarkable brain swelling was noted after removal of the ICH and cavernoma. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position with head fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. Reverse U scalp incision was made at left occipital area and the scalp flap and periosteum flap was elevated. The osteoma was noted and drilled off by Midas air-drived drills. Four burr holes were created followed by one 6x5cm craniotomy window. Dural tenting was performed. C shape durotomy was performed based with midline. Intra-operative sonography was performed and the location of the ICH and cavernoma was identified. Corticotomy was performed and the hematoma was evacuated. The cavernous malformation was encountered medial to the hematoma. Excision of cavernous malformation was performed with bipolar electrocautery, dissector, and sucker. After removal of the cavernous malformation, hemostasis was achieved with bipolar electrocautery and Surgicel lining. Duroplasty was performed with periosteum flap and 4-0 Prolene. The skull plate was fixed back with miniplates and screws after placing one epidural CWV drain. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS蔡翊新 Assistants R4李振豪, R1陳宣佑 相關圖片 楊善新 (F,1927/08/04,84y7m) 手術日期 2011/04/28 手術主治醫師 蔡翊新 手術區域 東址 002房 03號 診斷 Cervical spondylosis with myelopathy 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3 紀錄醫師 曾峰毅, 時間資訊 14:35 進入手術室 14:40 麻醉開始 15:15 抗生素給藥 15:20 誘導結束 15:47 手術開始 18:15 手術結束 18:15 麻醉結束 18:24 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-頸椎 1 1 手術 脊椎融合術-前融合,有固定物)≦四節 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Anterior Discectomy and Fusion, Cervical Spine 開立醫師: 蔡翊新 開立時間: 2011/04/28 18:13 Pre-operative Diagnosis C3-4 and C4-5 HIVD with cord compression. Post-operative Diagnosis C3-4 and C4-5 HIVD with cord compression. Operative Method C3-4 and C4-5 Anterior Discectomy and Fusion with Cages Specimen Count And Types nil Pathology Nil. Operative Findings C3-4 and C4-5 degenerative disc with posterior herniation and cord compression. The thecal sac expanded well after discectomy and bleeding from venous plexus around the roots was noted. Operative Procedures 1. Anesthesia: endotracheal general 2. Position: supine with neck hyperextended by an air cuff placed beneath the shoulder. 3. Skin preparation: the anterior neck was scrubbed with povidone-iodinew detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4.Incision; 5 cm, transverse middle cervical, extended from anterior margin of sternocleidomastoid (SCM) muscle to thyroid cartilage. 5. The plastisma muscle was transected and mobilized from the underlying superficial cervical fascia which was then opened in vertical direction along the anterior margin of the SCM muscle. 6.The dissection was advanced at the loose plane between SCM muscle and strip muscles until the prevertebral fascia had been reached. The former structure was retracted to the lateral and the later structures with esophagus and trachea to the opposite side by Cloward cervical retractor. 7.The prevertebral fascia was opened vertically, the lesion intervertebral space was exposed and identified by intraoperative portable X-ray 8.The most medial portion of the longus coli muscles on both sides were detached from the vertebral bodies to providea wider exposure of the vertebral bodies. 9.The anterior longitudinal ligament was incised transversely at the margins of intervertebral space, the annulus fibrosus was cut too. 10.The degenerated disc and cartilage plate were removed by curette and the anterior-inferior rim of C3,4,5 vertebral bodies was resected by Kerrison punch for easier approach to the posterior rim of the intervertebral space. 11.The intervertebral spac was widened by a Cloward intervertebral spreader. The sclerotic spondylotic bar at the posterior margin of C3,4,5 bodies and the spur at foramen Luscka were removed by high speed air drill and fine curette. The posterior longitudinal ligament was cut from bony edge by curette and then removed. Consequently, the spinal dura expanded into the intervertebral space. 12.The surfaces of vertebral bodies at this intervertebral space was trimmed by high speed air drill to creat a biconcave intervertebral space. 13.Two 6 mm x 12 mm Vigor PEEK Cervical Disc Spacer (Cage) were packed into the intervertebral space tightly by a impactor. The intervertebral space was widened by pulling the patient's head while the impaction of the bone graft was doing. 14.The air cuff beneath the shoulder was deflated, the Cloward cervical retractor removed. 15.Wound closure: continuous suture with 3/0 Vicryl for plastysma and continuous suture with 4/0 Vicryl on the skin. 16.Drain: one mini-hemovac. 17.Blood transfusion: Nil. Blood loss: minimal. 18.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R4曾峰毅 陳玉麵 (F,1957/09/10,54y6m) 手術日期 2011/04/29 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Facial spasm 器械術式 Microvascular decompression 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 游健生, 時間資訊 08:08 進入手術室 08:15 麻醉開始 08:30 誘導結束 09:05 手術開始 09:20 抗生素給藥 11:58 手術結束 11:58 麻醉結束 12:03 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顏面神經減壓術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: Right retrosigmoid approach for facial nerve ... 開立醫師: 游健生 開立時間: 2011/04/29 12:12 Pre-operative Diagnosis Right hemifacial spasm Post-operative Diagnosis Right hemifacial spasm Operative Method Right retrosigmoid approach for facial nerve decompression Specimen Count And Types nil Pathology Nil Operative Findings A loop of anterior inferior cerebellar artery was seen crossing between the CN VII/VIII complex and touched CN VII exit zone. When we approached the nerve complex from inferior angle, AICA was seen compressing CN VII exit zone from inferoposterior aspect. We placed teflon felt cotton between AICA and CN VII. After we freed the AICA loop from arachnoid membrane, we pushed the loop away from CN VII exit zone and filled the space between them with teflon felt cotton. The pre-op ABR was normal and there was no significant ABR changes during the surgery. Operative Procedures Under ETGA, patient was in supine position with head fixed by headclamp. Her head was rotated to left with neck extension and right shoulder elevated. Right mastoid tip was positioned to the highest point of operation field. A 5cm scalp laceration was noted at right parietal region. It was disinfected, sutured, and draped before surgery. After shaving, operation field was disinfected and draped as usual. A 10cm long incision was made along the retroauricular hair line with center at external acoutic meatus. A fascia was harversted for duroplasty. The asterion was exposed after dissection. A 3 x 3cm suboccipital retromastoid craniotomy was done to expose the lower-posterior margin of the junction of transverse and sigmoid sinus. After K-shape durotomy, the cerebellopontine cistern was opened for CSF drainage. The cerebellum sank and only little retraction on it was needed to expose cranial nerve VII/VIII complex and CN XI and X. A loop of anterior inferior cerebellar artery was seen crossing between the CN VII/VIII complex and touched CN VII exit zone. When we approached the nerve complex from interior angle, AICA was seen compressing CN VII exit zone from inferoposterior aspect. We placed teflon felt cotton between AICA and CN VII. After we freed the AICA loop from arachnoid membrane, we pushed the loop away from CN VII exit zone and filled the space between them with teflon felt cotton. After ensuring no pressure on CN VII, we repaired the dura with a fascia and sutured with 4-0 prolene to obtain water-tight closure. Bone flap was fixed back with mini-plates and a gelfoam placed underneath. Muscle was approximated by interrupted silk sutures. Wound was closed with 3-0 vircyl continuous suture for subcutanuous layer and 3-0 nylon continuous suture for the skin. Operators Prof. 杜永光 Assistants R6 胡朝凱 R3 游健生 賴月嬌 (F,1962/08/23,49y6m) 手術日期 2011/04/29 手術主治醫師 詹志洋 手術區域 東址 000房 號 診斷 Non-Hodgkin''s lymphoma 器械術式 Port-A catheter Removal/WOR 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 羅健洺, 時間資訊 16:34 進入手術室 16:48 手術開始 17:00 手術結束 17:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 皮下肌肉或深部異物取出術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: removal of Port-A/Permcath 開立醫師: 羅健洺 開立時間: 2011/04/29 17:03 Pre-operative Diagnosis R/o Port-A infection Post-operative Diagnosis ditto Operative Method Removal of Port-A catheter Specimen Count And Types Port-A tip culture Pathology nil Operative Findings the catheter was removed totally and the course was smooth Operative Procedures The patient was put on supine position. The operation field was disinfected and draped as usual. Under local anesthesia, the Port-A catheter was removed from previous wound smoothly. The wound was irrigated and closed in layers. Operators 詹志洋, Assistants 羅健洺, 李晃 (M,1942/10/19,69y4m) 手術日期 2011/04/29 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Acoustic tumor 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 陳國瑋, 時間資訊 07:52 報到 08:09 進入手術室 08:15 麻醉開始 09:00 誘導結束 09:06 抗生素給藥 09:07 手術開始 12:06 抗生素給藥 12:10 麻醉結束 12:10 手術結束 12:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Right retro-sigmoid approach for nearly total... 開立醫師: 陳國瑋 開立時間: 2011/04/29 12:54 Pre-operative Diagnosis Right CP angle tumor r/o vestibular Schwannoma Post-operative Diagnosis Right CP angle tumor r/o vestibular Schwannoma Operative Method Right retro-sigmoid approach for nearly total tumor removal Specimen Count And Types 1 piece About size:pieces Source:brain tumor Pathology pending Operative Findings Well-defined soft fragile mass with multiple cystic component sized 4.5*3.5*3.5cm at right CP angle arising from acoutic nerve. The trigeminal, facial, and low cranial nerves are preserved. The fluid content was yellowish and clear Operative Procedures Under ETGA, the patient was put in 3/4 prone position. The skin was dis-infected and draped as usual. Skin incision 3cm posterior to ear lobe was made. Craniotomy was made and the cerebellum was retracted with brain retracter. The tumor was identified and central debulking was performed in piecemeal fasion. The CN5, CN7, and low cranial nerves were identified and preserved. The craniotomy window was put back with three mini-plates, and the wound was closed in layers. Operators 曾漢民 Assistants 陳睿生 陳國瑋 相關圖片 原人麒 (M,1965/11/16,46y3m) 手術日期 2011/04/29 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Pituitary tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 陳國瑋, 時間資訊 11:53 報到 12:33 進入手術室 12:40 麻醉開始 13:00 誘導結束 13:15 抗生素給藥 13:30 手術開始 14:25 麻醉結束 14:25 手術結束 14:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經由蝶竇之腦下垂體瘤切除 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: trans-spenoid adenomectomy 開立醫師: 陳國瑋 開立時間: 2011/04/29 14:21 Pre-operative Diagnosis Pituitary macroadenoma Post-operative Diagnosis Pituitary macroadenoma Operative Method trans-spenoid adenomectomy Specimen Count And Types 1 piece About size:pieces Source:pituitary macroadenoma Pathology pending Operative Findings The tumor was soft, reddish. Dark blood was noted r/o apoplexy The tumor was soft, reddish, after removing the tumor arachnoid membrane was noted. Dark blood was noted r/o apoplexy The tumor was soft, white-reddish, and fragile. After removing the tumor, arachnoid membrane was noted. Intra-OP CSF leakage was also noted and the arachnoid membrane was packed with gelfoam and Tissco Duo. Suspect apoplexy with serum like fluid inside the tumor was found. No VEP change peri-op. Operative Procedures After ETGA the patient was in supine position. The nostorils were disinfected. Mucosal lncison at right nostoril was done. Dissection to the vomer bone was done. The floor of the sphenoid sinus was then fractured. Tumor excision was then done. The arachinoid membrane was noted. It was then pushed upward by Gell formn Tissue col du was used. The wound was closed in layers. Operators 曾漢明 Assistants 陳睿生 陳國瑋 相關圖片 傅素娥 (F,1954/02/28,58y0m) 手術日期 2011/04/29 手術主治醫師 曾漢民 手術區域 東址 005房 03號 診斷 Other lymphoma 器械術式 Stereotaxic procedure for biop 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 1 紀錄醫師 陳國瑋, 時間資訊 14:45 報到 15:00 麻醉開始 15:05 誘導結束 15:25 抗生素給藥 15:25 手術開始 15:52 進入手術室 18:05 麻醉結束 18:05 手術結束 18:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 立體定位術-切片 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Stereotaxic brain biopsy 開立醫師: 陳國瑋 開立時間: 2011/04/29 18:36 Pre-operative Diagnosis brain tumor r/o lymphoma Post-operative Diagnosis brain tumor r/o lymphoma Operative Method Stereotaxic brain biopsy Specimen Count And Types 1 piece About size:pieces Source:brain tissue Pathology Pending Operative Findings Pieces of brain tissue showed giosis. Frozen section did not show tumor. Operative Procedures Under ETGA, the patient was put in supine position, with the head fixed with Mayfield clamp. The skin was disinfected and draped as usual. Skin incision about 3cm was made at right fontal area and Burr hole was made. Stereotaxic biopsy was made and pieces of btain tissues were harvested from three sites. The wound was then closed in layers. Operators 曾漢民 Assistants 陳睿生 陳國瑋 相關圖片 魏青暉 (M,1964/06/09,47y9m) 手術日期 2011/04/29 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Cervical spondylosis 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 陳以幸, 時間資訊 08:08 進入手術室 08:15 麻醉開始 08:45 誘導結束 09:05 抗生素給藥 09:29 手術開始 12:07 抗生素給藥 13:40 手術結束 13:40 麻醉結束 13:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-頸椎 1 1 手術 脊椎融合術-前融合,有固定物)≦四節 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: anterior cervical diskectomy and fusion with ... 開立醫師: 陳以幸 開立時間: 2011/04/29 14:00 Pre-operative Diagnosis 1.Herniated intervertebral disc, C5-6 2.spinal stenosis, C4-5, C5-6 Post-operative Diagnosis 1.Herniated intervertebral disc, C5-6 2.spinal stenosis, C4-5, C5-6 Operative Method anterior cervical diskectomy and fusion with artificial disc Specimen Count And Types nil Pathology nil Operative Findings 1.protruded intervertebral disc over C4-5 C5-6 Operative Procedures 1.Under ETGA, put the patient as supine position 2.skin disinfection and drapped as usual, incision line over anterior nick, right side, about 4 finger-width below mandible 3.retracted SCM and esophagus to lateral and medial side, expose the C4-6 vertebral body 4.under the assistance of intra-operative C-arm, locate C4-6 intervertebral area, remove the disk by disk clamp and high speed pneumatic drill 5.put the artificial discs to C4-5, C5-6 intervertenral space, adjust the location. One 6mm height artificial disc was inserted to C5-6 intervertebral space. One 5mm disc was inserted to C4-5 intervertebral space 6.Set one minihemovac to the wound, N/s with gentamycin irrigation 7.hemostasis, close the wound in layers Operators 賴達明 Assistants 蔡宗良 陳以幸 黃陳春卿 (F,1949/02/03,63y1m) 手術日期 2011/04/29 手術主治醫師 賴達明 手術區域 東址 019房 02號 診斷 Lumbar spondylosis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 2 紀錄醫師 陳以幸, 時間資訊 14:08 進入手術室 14:10 麻醉開始 14:45 誘導結束 15:10 抗生素給藥 15:16 手術開始 18:10 抗生素給藥 19:05 手術結束 19:05 麻醉結束 19:15 送出病患 19:17 進入恢復室 22:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎弓切除術(減壓)-二節以內 1 2 摘要__ 手術科部: 外科部 套用罐頭: 1.Laminectomy for decompression, L4-5 開立醫師: 陳以幸 開立時間: 2011/04/29 19:19 Pre-operative Diagnosis spondylolisthesis, grade II, L4-5 Post-operative Diagnosis spondylolisthesis, grade II, L4-5 Operative Method 1.Laminectomy for decompression, L4-5 2.transpedicular screw with rod fixation, and banana cage implantation, L4-5 Specimen Count And Types nil Pathology nil Operative Findings 1.grade II spondylolisthesis, L4-5, with nerve root compression 2.hypertrophic change of ligmentum flavum Operative Procedures 1.Under ETGA, put the patient with prone position. Localize L4-5 level via the assistance of C-arm 2.Midline skin incision, periosteal dissection 3.L4-5 transpedicular screw fixation 4.Laminectomy of L4 5.Transforaminal lumar interbody fusion L4-5 with 9mm cage 6.Rod fixation 7.Insert one hemovac to epidural area 8.normal sline irrigation, close the wound in layers Operators 賴達明 Assistants 蔡宗良 陳以幸 MICHAEL BLAIR MURPHY (M,1978/01/11,34y2m) 手術日期 2011/04/29 手術主治醫師 賴達明 手術區域 東址 003房 03號 診斷 Lumbar spondylosis 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 2 紀錄醫師 游健生, 時間資訊 16:30 進入手術室 16:38 麻醉開始 16:48 誘導結束 17:15 抗生素給藥 17:30 手術開始 18:45 手術結束 18:45 麻醉結束 18:50 送出病患 18:55 進入恢復室 21:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-腰椎 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Microdiskectomy, L4/5 (right) 開立醫師: 游健生 開立時間: 2011/04/29 18:53 Pre-operative Diagnosis L4/5 herniated intervertebral disc Post-operative Diagnosis L4/5 herniated intervertebral disc Operative Method Microdiskectomy, L4/5 (right) Specimen Count And Types nil Pathology Nil Operative Findings L4/5 herniated intervertebral disc compressed right L5 root. Nerve root was free from compression after disc removal. A fat graft for nerve adhesion prevention was noted during surgery. Operative Procedures 1. Under ETGA, prone position 2. Located L4/5 disc space by C-arm 3. Disinfection and draping 4. Incision along previous wound scar 5. Dissected in layers and identified previous laminotomy 6. Removed granulation tissue and a fat graft 7. Right L5 nerve root was identified and protacted by gently retraction 8. Removed henirated intervertebral disc 9. Hemostasis and N/S irrigration 10.Closed wound in layers Operators VS 賴達明 Assistants R6 胡朝凱 R3 游健生 邱創仁 (M,1955/04/10,56y11m) 手術日期 2011/04/29 手術主治醫師 陳敞牧 手術區域 東址 003房 02號 診斷 Cervical myelopathy 器械術式 Laminectomy C-Spinal(Posterier 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 游健生, 時間資訊 12:25 進入手術室 12:30 麻醉開始 13:00 誘導結束 13:00 抗生素給藥 13:05 手術開始 16:00 手術結束 16:00 麻醉結束 16:05 送出病患 16:07 進入恢復室 17:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術(減壓)-超過二節 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: C4-7 laminoplasty (open door method) 開立醫師: 游健生 開立時間: 2011/04/29 16:19 Pre-operative Diagnosis Cervical stenosis with myleopathy Post-operative Diagnosis Cervical stenosis with myleopathy Operative Method C4-7 laminoplasty (open door method) Specimen Count And Types nil Pathology Nil Operative Findings Hypertrophic ligamentum flavum and herniated intervertebral discs resulted in cervical stenosis. The thecal sac was well decompressed after laminoplasty. The pre-operative waveform of right leg and left arm were poor. There was no significant changes of MEP/SSEP perioperatively. Operative Procedures 1. Under ETGA, prone with head fixed by headholder 2. Shaving, disinfection, and draping 3. Midline incision from C3 to T1 4. Dissected in layers to expose C3 to T1 spinous process and lamina 5. Drilled through whole layer of C4-7 lamina on left side 6. Drilled to inner cortex of C4-7 lamina on right side 7. Elevated C4-7 lamina by vertebral spreader 8. Connected C4-7 lamina to left lateral mass with mini-plates 9. Hemostasis and N/S irrigation 10.Placed epilaminar CWV 11.Close wound in layers Operators VS 陳敞牧 Assistants R6 胡朝凱 R3 游健生 杜良男 (M,1942/08/07,69y7m) 手術日期 2011/04/29 手術主治醫師 詹志洋 手術區域 兒醫 068房 03號 診斷 Malignant neoplasm of other and ill-defined sites of abdomen 器械術式 Port-A Implatation /WOR 手術類別 臨時手術 手術部位 胸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 張得一, 時間資訊 17:05 報到 17:08 進入手術室 17:27 麻醉開始 17:28 誘導結束 17:29 手術開始 17:50 麻醉結束 17:50 手術結束 17:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 內頸靜脈切開,永久導管放置術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Port-A 開立醫師: 張得一 開立時間: 2011/04/29 17:50 Pre-operative Diagnosis Metastatic SCC Post-operative Diagnosis Metastatic SCC s/p Port-A implantation Operative Method Port-A catheter implantation, echo guided Specimen Count And Types nil Pathology nil Operative Findings Puncture to right IJV under echo guidance The venous blood flow freely in the Port-A catheter after implantation. Operative Procedures The patient was put on supine position. The operation field was disinfected and draped as usual. Under local anesthesia, we puncture to right IJV under echo guidance. After creating subcutaneous pocket, the Port-A catheter was inserted via peel away sheath. We close the wound in layers. Operators VS 詹志洋 Assistants R3 張得一 沈延誠 (M,1954/07/28,57y7m) 手術日期 2011/04/29 手術主治醫師 李章銘 手術區域 東址 018房 02號 診斷 Secondary cancer of brain and spinal cord 器械術式 Thoracoscopy+Open Chest 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 2 紀錄醫師 吳昭瑩, 時間資訊 16:45 報到 17:10 進入手術室 17:15 麻醉開始 17:25 誘導結束 17:45 抗生素給藥 17:54 手術開始 20:45 抗生素給藥 21:25 麻醉結束 21:25 手術結束 21:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 縱隔腔或腔內淋巴根除術 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 胸腔鏡肺葉切除術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Right upper lobe lobectomy via VATS 開立醫師: 吳昭瑩 開立時間: 2011/04/29 22:01 Pre-operative Diagnosis RUL lung cancer Post-operative Diagnosis RUL lung cancer Operative Method Right upper lobe lobectomy via VATS Specimen Count And Types 3 pieces About size:1*1CM Source:LN group 7 About size:1*1cm Source:LN GROUP 3,4 About size:12*10CM Source:RUL Pathology pending Operative Findings 1.severe adhesion of lobes, The pulmonary vessels were difficult to be identified 2.the inferior ligament was divided Operative Procedures 1. Anesthesia: General anesthesia using double-lumen endotracheal tube. 2. Position: left decubitus position. An axillary roll is placed under the down side. The operative field is well disinfected and draped. 3. Camera port: From the seventh intercostal space in the mid-axillary line away from the lesion. 4. Working ports: First: From the fifth intercostal space in the anterior axillary line. Second: From the fifth intercostal space in the posterior axillary line. 5. The pleural adhesions are separated by grasping forceps and by electrocautery. The RUL lesion was grasp by ring forceps, and then divided for frozen section 6. The fissure between the middle and upper lobes was separated and divided. 7. The pulmonary vessels and the bronchus to the right upper lobe in the hilum were clamped with stapler and then divided. 8. The pleural cavity was irrigated with N/S. 9. Lymph node dissection is done at group 3, 4, 7. 10. After homeostasis, one 28# chest tubes is placed via the camera port. The lung is ventilated under the direct vision. The WOUNDS were closed by layers. Operators P李章銘 Assistants R3郝政鴻 R2賴碩倫 R1吳昭瑩 盧翁素珠 (F,1947/06/29,64y8m) 手術日期 2011/04/30 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 3 紀錄醫師 鍾文桂, 時間資訊 23:02 臨時手術NPO 07:56 報到 08:06 進入手術室 08:15 麻醉開始 08:35 誘導結束 09:25 手術開始 10:00 抗生素給藥 11:18 開始輸血 14:00 抗生素給藥 14:45 麻醉結束 14:45 手術結束 14:53 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 3 0 麻醉 動脈血液檢查全套 3 0 麻醉 Hemoglobin (Hb) 3 0 麻醉 測血糖 3 0 麻醉 Ca (Calcium) 3 0 麻醉 Na (Sodium) 3 0 麻醉 K (Potassium) 3 0 麻醉 Blood gas analysis 3 0 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 手術 顱底瘤手術 1 1 摘要__ 手術科部: 外科部 套用罐頭: Subfrontal approach for Simpson grade IV tumo... 開立醫師: 鍾文桂 開立時間: 2011/04/30 15:32 Pre-operative Diagnosis Olfactory groove meningioma, left with extension to the right frontal base and ethmoid sinus. Post-operative Diagnosis Olfactory groove meningioma, left with extension to the right frontal base and ethmoid sinus. Operative Method Subfrontal approach for Simpson grade IV tumor excision. Specimen Count And Types 1 piece About size:20 cc Source:brain tumor Pathology Pending. Operative Findings 1. Red-grayish, hypervascularized, fragile tumor with severe adhesion to the left frontal base and falx cerebri. It extends to the right frontal region with severe adhesion to the right olfactory nerve. The tumor-brain parenchyma border was not clear. The right olfactory nerve was sacrafized. The tumor that extended into the ethmoid sinus was kept intact. A part of the tumor was en plaque to the tuberculum sella. 2. After tumor excision, the bilateral optic nerves, optic chiasm, lamina terminalis, ICA, A1, A-com, A2 arteries were well preserved and identified. 3. The bilateral frontal sinus was encountered. It was skeletionized and sealed with bonewax. The superior sagital sinus was injuryed during craniotomy. It was sealed and transected with hemoclips. 4. A small bone-pericranium fascia graft was harvested for skull base repair. Due to difficulty in reconstruction and possible infection, we finally decided not to removed the tumor inside the paranasal sinus. So the graft was fixed back by Operative Procedures Under ETGA, the patient was placed in supine position and the head in midline. After shaving, disinfection, and draping, bicoronal scalp incision was made. After scalp dissection, a 10 craniotomy was created by osteotome and high speed drill. After well hemostasis, the durotomy was achieved. The tumor was excised in piecemeal fahsion after devascularization from the frontal skull base. After well hemostasis, the brain surface was covered with surgicel. The dura mater was closed in water-tight fashion and repaired with pericranium. The craniotomy bone plate was fixed back by mini-plates and screws. The wound was closed in layers with one subgaleal CWV drain. Operators V.S. 曾漢民 Assistants R5 鍾文桂 R1 陳以幸 相關圖片 周子文 (M,1967/01/11,45y2m) 手術日期 2011/04/30 手術主治醫師 蔡瑞章 手術區域 東址 003房 02號 診斷 Intracerebral hemorrhage 器械術式 Craniotomy (A.V.M.) P-LIN 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 3 紀錄醫師 胡朝凱, 時間資訊 23:52 臨時手術NPO 12:22 報到 12:22 進入手術室 12:30 麻醉開始 12:50 誘導結束 13:10 手術開始 13:18 抗生素給藥 16:00 開始輸血 16:18 抗生素給藥 18:00 麻醉結束 18:00 手術結束 18:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 開顱術摘除血管病變-動靜脈畸型小型表淺 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Left frontal craniotomy for AVM excision 開立醫師: 胡朝凱 開立時間: 2011/04/30 16:27 Pre-operative Diagnosis Left frontal small AVM with ruptured ICH Post-operative Diagnosis Left frontal small AVM with ruptured ICH Operative Method Left frontal craniotomy for AVM excision Specimen Count And Types Pathology pending Operative Findings 1.One about 1 cm tortuous AVM nidus was noted at left frontal area. two small feeding arteries was noted from a cortical artery and a deeper artery. The artery wall was thin. 2.The drainage vein drained into SSS with reddish color and pulsation before resection of AVM. 3.About 30 ml hematoma was noted in left frontal lobe. 4.The brain was slack after removal of hematoma. Operative Procedures 1.ETGA, supine 2.Bicoronal skin incision 3.Reflect skin flap anteriorly 4.Craniotomy 5. Operators Assistants 摘要__ 手術科部: 外科部 套用罐頭: Left frontal craniotomy for AVM excision 開立醫師: 鍾文桂 開立時間: 2011/05/01 02:28 Pre-operative Diagnosis Left frontal small AVM with ruptured ICH Post-operative Diagnosis Left frontal small AVM with ruptured ICH Operative Method Left frontal craniotomy for AVM excision Specimen Count And Types AVM nidus Pathology pending Operative Findings 1.One about 1 cm tortuous AVM nidus was noted at left frontal area. two small feeding arteries was noted from a cortical artery and a deeper artery. The artery wall was thin. 2.The drainage vein drained into SSS with reddish color and pulsation before resection of AVM. 3.About 30 ml hematoma was noted in left frontal lobe. 4.The brain was slack after removal of hematoma. Operative Procedures 1.ETGA, supine 2.Bicoronal skin incision 3.Reflect skin flap anteriorly 4.Craniotomy 5. 5.dural tenting 6.dural incision with the base left at midline 7.dissect arachnoid plane around AVM nidus 8.remove hematoma 9.Coagulated feeding artery 10.devided drainage vein 11.hemostasis 12.Close dura 13.fixed bone back with miniplate 14.Set one CWV drain then close wound in layers. Operators P 蔡瑞章 Assistants 胡朝凱, 鍾文桂, Ri 黃麗玉 (F,1967/08/08,44y7m) 手術日期 2011/04/30 手術主治醫師 賴達明 手術區域 東址 001房 01號 診斷 Subdural hemorrhage (SDH) 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 2E 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 13:53 通知急診手術 14:42 報到 14:55 進入手術室 15:00 麻醉開始 15:10 誘導結束 15:30 抗生素給藥 15:53 手術開始 18:20 手術結束 18:20 麻醉結束 18:33 送出病患 18:35 進入恢復室 19:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 摘要__ 手術科部: 外科部 套用罐頭: Right burrhole drainage of cSDH 開立醫師: 游健生 開立時間: 2011/04/30 18:31 Pre-operative Diagnosis Right chronic subdural hematoma Post-operative Diagnosis Right chronic subdural hematoma Operative Method Right burrhole drainage of cSDH Specimen Count And Types nil Pathology Nil Operative Findings An soft outer membrane of hematoma was found. After opening the outer membrane, motor-oil like fluid gushed out followed by brownish fluid. During irrigation of subdural space, some dark-red fuild and debris were drained out. A 4cm subdural drain was placed. Operative Procedures 1. Under ETGA, supine position with neck flexed. 2. After shaving, we disinfected and draped the operation field 3. A 5cm verticle incision was made at right frontal region 4. After dissection, we created a burrhole 5. Electrocautery the dura followed by curciate durotomy 6. Opened the outer membrane and irrigated subdural space 7. Inserted subdural drain and expelled air 8. Closed wound in layers Operators VS 賴達明 Assistants R3 游健生 Indication Of Emergent Operation deterioration of left limb muscle power 陳彭金珠 (F,1936/07/11,75y8m) 手術日期 2011/04/30 手術主治醫師 賴達明 手術區域 東址 001房 02號 診斷 Subdural hemorrhage 器械術式 Removal of chronic subdural, left 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 2E 紀錄醫師 鍾文桂, 時間資訊 13:00 開始NPO 15:07 通知急診手術 19:03 報到 19:05 進入手術室 19:15 麻醉開始 19:30 誘導結束 19:34 抗生素給藥 20:00 手術開始 21:15 手術結束 21:15 麻醉結束 21:26 送出病患 21:30 進入恢復室 22:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Burr hole for evacuation of chronic SDH, left. 開立醫師: 鍾文桂 開立時間: 2011/04/30 21:41 Pre-operative Diagnosis Chronic subdural hemorrhage, left. Post-operative Diagnosis Chronic subdural hemorrhage, left. Operative Method Burr hole for evacuation of chronic SDH, left. Specimen Count And Types nil Pathology Nil. Operative Findings Dark red-brown motor-oil like liquified subdural hematoma was noted in left frontal-temporal-parietal subdural space. Presence of inner and outer membrane. Poor brain expansion. Operative Procedures Under ETGA, the patient was placed in supine position and the head was tilted to the right side slightly. After shaving, disinfection, and draping, a linear 3 cm scalp incision was made at left frontal region. After creating a burr hole and durotomy, the cSDH gushed out. Further evaucation of the hematoma was achieved through normal saline irrigation until the evacuated fluid became more clear. The rubber drain was placed in subdural space in situ. The wound was closed in layers. Further subdural air evacuation was obtained through the rubber drain. Finally, the drain was connected to closed drainage system. Operators 賴達明 Assistants 鍾文桂 Indication Of Emergent Operation 相關圖片 摘要__ 手術科部: 外科部 套用罐頭: Burr hole for evacuation of chronic SDH, left. 開立醫師: 鍾文桂 開立時間: 2011/04/30 21:41 Pre-operative Diagnosis Chronic subdural hemorrhage, left. Post-operative Diagnosis Chronic subdural hemorrhage, left. Operative Method Burr hole for evacuation of chronic SDH, left. Specimen Count And Types nil Pathology Nil. Operative Findings Dark red-brown motor-oil like liquified subdural hematoma was noted in left frontal-temporal-parietal subdural space. Presence of inner and outer membrane. Poor brain expansion. Operative Procedures Under ETGA, the patient was placed in supine position and the head was tilted to the right side slightly. After shaving, disinfection, and draping, a linear 3 cm scalp incision was made at left frontal region. After creating a burr hole and durotomy, the cSDH gushed out. Further evaucation of the hematoma was achieved through normal saline irrigation until the evacuated fluid became more clear. The rubber drain was placed in subdural space in situ. The wound was closed in layers. Further subdural air evacuation was obtained through the rubber drain. Finally, the drain was connected to closed drainage system. Operators 賴達明 Assistants 鍾文桂 Indication Of Emergent Operation 相關圖片 摘要__ 手術科部: 外科部 套用罐頭: Burr hole for evacuation of chronic SDH, left. 開立醫師: 鍾文桂 開立時間: 2011/04/30 21:42 Pre-operative Diagnosis Chronic subdural hemorrhage, left. Post-operative Diagnosis Chronic subdural hemorrhage, left. Operative Method Burr hole for evacuation of chronic SDH, left. Specimen Count And Types nil Pathology Nil. Operative Findings Dark red-brown motor-oil like liquified subdural hematoma was noted in left frontal-temporal-parietal subdural space. Presence of inner and outer membrane. Poor brain expansion. Operative Procedures Under ETGA, the patient was placed in supine position and the head was tilted to the right side slightly. After shaving, disinfection, and draping, a linear 3 cm scalp incision was made at left frontal region. After creating a burr hole and durotomy, the cSDH gushed out. Further evaucation of the hematoma was achieved through normal saline irrigation until the evacuated fluid became more clear. The rubber drain was placed in subdural space in situ. The wound was closed in layers. Further subdural air evacuation was obtained through the rubber drain. Finally, the drain was connected to closed drainage system. Operators 賴達明 Assistants 鍾文桂 Indication Of Emergent Operation cSDH 2cm in thickness with mass effect 相關圖片 陳林專 (F,1933/12/05,78y3m) 手術日期 2011/04/30 手術主治醫師 黃國皓 手術區域 東址 015房 04號 診斷 Intraspinal abscess 器械術式 Double-J ureteral stent insert /EOR 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 陳李魁 ASA 3 紀錄醫師 姜秉均, 時間資訊 11:10 報到 11:25 進入手術室 11:27 麻醉開始 11:30 誘導結束 11:42 手術開始 11:53 手術結束 11:53 麻醉結束 12:00 送出病患 12:07 進入恢復室 13:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 雙丁輸尿管導管置入術 1 0 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 記錄__ 手術科部: 泌尿部 套用罐頭: DBJ stent insertion 開立醫師: 姜秉均 開立時間: 2011/04/30 12:08 Pre-operative Diagnosis Right obstructive uropathy Post-operative Diagnosis Right obstructive uropathy Operative Method cystoscopy and DBJ replacement Specimen Count And Types nil Pathology nil Operative Findings blood clots in bladder 6Fr.x24cm DBJ Operative Procedures Under satisfactory anesthesia with the patient in lithotomy position, prepping and drapping was performed in the usual sterile fashion. A Fr 21 Olympus cystoscope was introduced into the bladder cavity under direct vision. Careful inspection was done andDBJ was replaced. Patient tolerated the procedure very well and was sent to recovery room in satisfactory condition. Operators 黃國皓, Assistants 姜秉均, 謝豐達 (M,1960/04/27,51y10m) 手術日期 2011/04/30 手術主治醫師 楊士弘 手術區域 東址 003房 01號 診斷 Cervical spondylosis 器械術式 Diskectomy cervical(Anterier) C5/6 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 3 紀錄醫師 胡朝凱, 時間資訊 23:59 臨時手術NPO 08:05 進入手術室 08:20 麻醉開始 08:30 誘導結束 09:00 抗生素給藥 09:11 手術開始 11:50 手術結束 11:50 麻醉結束 12:00 送出病患 12:02 進入恢復室 13:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-頸椎 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 記錄__ 手術科部: 外科部 套用罐頭: Right C4~5,5~6 foraminotomy 開立醫師: 胡朝凱 開立時間: 2011/04/30 12:07 Pre-operative Diagnosis Right C4~5,5~6 foraminal stenosis Post-operative Diagnosis Right C4~5,5~6 foraminal stenosis Operative Method Right C4~5,5~6 foraminotomy Specimen Count And Types nil Pathology nil Operative Findings 1Right uncinate process hypertrophy and compressed the right nerve root tightly. 2.Hypertrophic and mild adhesion of prevertebral soft tissue. 3.After decompression, root became loose. Operative Procedures 1.ETGA, supine 2.Right neck transverse skin incision 3.Dissec along with the anterior border of SCM muscle 4.Expose prevertebral space 5.Localization 6.Identified right C4~5, and 5~6 disc space then uncinate process 7.Drill of right uncinate process to expose underlying nerve root outlet 8.Hemostasis 9.Set one minihemovac drain 10.close wound in layers Operators VS 楊士弘 Assistants 胡朝凱 周陳阿菊 (F,1945/08/25,66y6m) 手術日期 2011/05/01 手術主治醫師 蔡翊新 手術區域 東址 003房 03號 診斷 Subarachnoid hemorrhage 器械術式 Craniotomy(Aneurysms) P-DUH 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 3E 紀錄醫師 蕭博懷, 時間資訊 22:47 通知急診手術 22:49 開始NPO 22:49 臨時手術NPO 23:32 報到 23:32 進入手術室 23:40 麻醉開始 00:10 誘導結束 00:30 手術開始 01:00 抗生素給藥 05:00 抗生素給藥 06:45 開始輸血 07:45 麻醉結束 07:45 手術結束 07:55 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 8 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 開顱術摘除血管病變 - 腦血管瘤 有病徵的 1 1 R 手術 顱內壓視置入 1 2 R 摘要__ 手術科部: 外科部 套用罐頭: Aneurysm-frontotemporal approach 開立醫師: 蔡翊新 開立時間: 2011/05/01 06:28 Pre-operative Diagnosis A-com artery aneurysm rupture with IVH and acute hydrocephalus. Post-operative Diagnosis A-com artery aneurysm rupture with IVH and acute hydrocephalus. Operative Method Right frontotemporal craniotomy for aneurysm clipping; Right Kocher EVD for ICP monitoring. Specimen Count And Types 3 tubes of CSF, sent for routine, BCS and bacterial culture. Pathology Nil. Operative Findings CSF gushed out upon EVD insertion with initial pressure about 20 cmH2O. The CSF was reddish. The brain was bulging upon dural opening and became slightly slack after CSF release from EVD and by opening the Sylvian fissure and basal cisterns. There was an aneurysm arising from anterior communicating artery, pointing to left and slightly inferiorly, with base 8 mm in width and 6 mm in height. There was a daughter aneurysm arising from the dome of the aneurysm, and it adhered tightly to left A1 artery. The aneurysm was clipped by a fenestrated, straight, 12-mm Sugita clip. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with right back elevated and head rotated to left for 40 degrees and slightly extended then fixed by Mayfield skull clamp. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: right frontotemporal, curvilinear. The skin edge was clipped by Raney clips for temporary hemostasis. After scalp had been lifted, the temporalis muscle was incised and detached from temporal squama and reflected to lower temporal side. 5. Create right Kocher burr hole to insert EVD to right lateral ventricle for CSF release. 6. Craniotomy window: 10 x 6 cm, right frontotemporal, created by making 4 burr holes then cut by power saw. The lower temporal bone and pterionic ridge (esp. the inner table) were cut by rongeur as low as possible for easy approach to the anterior clinoid. 7. Dural tention: by 2/0 silk, 2 cm in interval, distributed along the edge of skull window. 8. Dural incision: curvilinear shape, over-ridding Sylvian fissure and reflected to frontotemporal base. 9. Under operating microscope, the Sylvian fissure was opened. The basal cistern was opened to expose right optic nerve and right ICA, which was traced distally to identify right A1 artery. The thick subarachnoid blood was removed as possible. The right rectal gyrus was excised to expose the dome of aneurysm. The left A1 and bilateral A2 arteries were dissected out. The neck of aneurysm was exposed. 10.A fenestrated, straight, 12-mm Sugita clip was applied to the neck of the aneurysm. 11.After successful clipping of the aneurysm, the patient's BP was brought back to normal, and the exposed field was irrigated with N.S. to make sure no any bleeding. 12.The brain retractors were removed. The dura was closed water-tight by running suture with 4/0 Prolene. 13.Closure of skull window: the skull plate was placed back to craniotomy window and fixed by 3 miniplates and 6 screws. The dura was tented to the center of the skull plate by 3 2/0 stitches. The covering muscle was closed by interrupted stitches with 2/ 0 silk. 14.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 15.Drain: one epidural CWV. EVD was inserted to right lateral ventricle as ICP monitor. 16.Blood transfusion: PRBC 4U, Platelet 12U; Blood loss: 1400 ml. 18.Course of the surgery: hypotension (BP down to 31/26 mmHg) and much blood loss from epidural drain were noted when the skin was being closed. However, when the wound was reopened and skull plate removed, there was no active bleeder. The blood pressure resumed to normal after inotropic agents and blood transfusion were administrated. Operators VS蔡翊新 Assistants R6胡朝凱R5鍾文桂R3游健生R5蕭博懷 Indication Of Emergent Operation aneurysm rupture with SAH, acute hydrocephalus and conscious disturbance. 陳國有 (M,1933/11/15,78y3m) 手術日期 2011/05/01 手術主治醫師 王國川 手術區域 東址 001房 05號 診斷 Subdural hemorrhage 器械術式 Burr hole (trephination) drainage of chronic SDH, right 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 3E 紀錄醫師 林哲光, 時間資訊 14:00 開始NPO 17:21 通知急診手術 21:35 報到 21:45 進入手術室 21:50 麻醉開始 22:00 誘導結束 22:25 抗生素給藥 22:26 手術開始 23:05 手術結束 23:05 麻醉結束 23:15 送出病患 23:18 進入恢復室 00:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Right frontal burr hole drainge of CSDH 開立醫師: 林哲光 開立時間: 2011/05/01 23:12 Pre-operative Diagnosis Right F-T-P chronic SDH Post-operative Diagnosis Right F-T-P chronic SDH Operative Method Right frontal burr hole drainge of CSDH Specimen Count And Types nil Pathology Operative Findings Motor-oil, sand-like fulids gushed out after outer membrane of the hematoma was opened. The brain seemed mildly re-expanded after hematoma removal. Operative Procedures Under ETGA and supine position with head rotated to left side, skin disinfected and drapped were performed as usual. Transverse skin incision was made at right frontal area. A burr hole was created and dura was then opened after dural tenting. The outer membrane was then opened and coagularized. N/S irrigation was performed. The wound was then closed in layers after subdural drain insertion. Operators VS 王國川 Assistants R4 林哲光 Indication Of Emergent Operation limbs weakness, dysarthria 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Right frontal burr hole drainge of CSDH 開立醫師: 林哲光 開立時間: 2011/05/01 23:33 Pre-operative Diagnosis Right F-T-P chronic SDH Post-operative Diagnosis Right F-T-P chronic SDH Operative Method Right frontal burr hole drainge of CSDH Specimen Count And Types nil Pathology Operative Findings Motor-oil, sand-like fulids gushed out after outer membrane of the hematoma was opened. The brain seemed mildly re-expanded after hematoma removal. Operative Procedures Under ETGA and supine position with head rotated to left side, skin disinfected and drapped were performed as usual. Transverse skin incision was made at right frontal area. A burr hole was created and dura was then opened after dural tenting. The outer membrane was then opened and coagularized. N/S irrigation was performed. The wound was then closed in layers after subdural drain insertion. Operators VS 王國川 Assistants R4 林哲光 Indication Of Emergent Operation limbs weakness, dysarthria 相關圖片 方阿運 (M,1932/10/02,79y5m) 手術日期 2011/05/02 手術主治醫師 王國川 手術區域 東址 001房 06號 診斷 Subdural hemorrhage 器械術式 Removal of epidural hematoma，ICP monitoring 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 3E 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 23:40 麻醉開始 00:00 誘導結束 00:15 開始輸血 00:24 抗生素給藥 00:25 手術開始 03:50 手術結束 03:50 麻醉結束 03:55 送出病患 23:36 進入手術室 醫令資訊 類別 名稱 量 刀 側 手術 急性硬腦膜下血腫清除術 1 1 L 手術 顱內壓視置入 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: 1. Left frontal-parietal-temporal craniotomy ... 開立醫師: 林哲光 開立時間: 2011/05/02 03:53 Pre-operative Diagnosis Head injury with acute subdural hemorrhage, left frontal-parietal-temporal. Post-operative Diagnosis Head injury with acute subdural hemorrhage, left frontal-parietal-temporal. Operative Method 1. Left frontal-parietal-temporal craniotomy for evacuation of acute SDH. 2. Insertion of subdural ICP monitor. Specimen Count And Types nil Pathology Nil. Operative Findings 1. organized acute SDH about 1.5cm in thckness. 2. Easy oozing operative field. history of aspirin intake (+). 3. ICP after wound closure: -6 mmHg. 4. Presence of active bleeder at branch of left M3 near the vein of Labbe. Operative Procedures Under ETGA, the patent was placed in supine position and the head was tilted to the right. After shavng, disinfection, and draping, a curvilnear scalp trauma flap was incised. The temporalis muscle and pericranium were dissected away from the skull. Then, a 15cm craniotomy plate was obtained by craniotome and high speed drill. After dural tenting and well hemostasis, the dura mater was incised and opened. The acute subdural hematoma was evacuated by tumor forceps and suction. The dura mater was closed in water-tight fashion. The Codman ICP monitor was placed in subdural spacel. The skull bone plate was fixed by miniplates and screws. The wound was closed in layers with one subgaleal drain in situ. Operators 王國川 Assistants R4 林哲光 R1 李柏穎 Indication Of Emergent Operation 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: 1. Left frontal-parietal-temporal craniotomy ... 開立醫師: 林哲光 開立時間: 2011/05/02 04:28 Pre-operative Diagnosis Head injury with acute subdural hemorrhage, left frontal-parietal-temporal. Post-operative Diagnosis Head injury with acute subdural hemorrhage, left frontal-parietal-temporal. Operative Method 1. Left frontal-parietal-temporal craniotomy for evacuation of acute SDH. 2. Insertion of subdural ICP monitor. Specimen Count And Types nil Pathology Operative Findings 1. organized acute SDH about 1.5cm in thckness. 2. Easy oozing operative field. history of aspirin intake (+). 3. ICP after wound closure: -6 mmHg. 4. Presence of active bleeder at branch of left M3 near the vein of Labbe. Operative Procedures Under ETGA, the patent was placed in supine position and the head was tilted to the right. After shavng, disinfection, and draping, a curvilnear scalp trauma flap was incised. The temporalis muscle and pericranium were dissected away from the skull. Then, a 15cm craniotomy plate was obtained by craniotome and high speed drill. After dural tenting and well hemostasis, the dura mater was incised and opened. The acute subdural hematoma was evacuated by suction. Bleeder of left MCA branch was cauterized. The dura mater was closed in water-tight fashion with autologus fascia. The Codman ICP monitor was placed in subdural spacel. The skull bone plate was fixed by miniplates and screws. The wound was closed in layers with two subgaleal drain in situ. Operators 王國川 Assistants R4 林哲光 R1 李柏穎 Indication Of Emergent Operation acute conscious change, Brain CT revealed acute left F-T-P SDH with midline shift 相關圖片 陳文樹 (M,1945/01/01,67y2m) 手術日期 2011/05/02 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Aneurysm 器械術式 Craniotomy(Aneurysms) P-DUH 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 王奐之, 時間資訊 23:35 臨時手術NPO 08:00 進入手術室 08:05 麻醉開始 08:55 誘導結束 09:20 手術開始 09:20 抗生素給藥 12:20 抗生素給藥 15:20 抗生素給藥 16:00 手術結束 16:00 麻醉結束 16:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 8 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 開顱術摘除血管病變 - 腦血管瘤 無病徵的 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Right Dolenc approach for aneurysm clipping 開立醫師: 王奐之 開立時間: 2011/05/02 16:29 Pre-operative Diagnosis Large right paraclinoid ICA aneurysm, suspected anterior choroidal artery or posterior communicating artery aneurysm Post-operative Diagnosis Large right paraclinoid ICA aneurysm Operative Method Right Dolenc approach for aneurysm clipping Specimen Count And Types Nil Pathology Nil Operative Findings A large aneurysm at right paraclinoid ICA, about 1cm in diameter, incorporating right posterior communicating artery & anterior choroidal artery, was noted. Diffuse calcification of ICA & MCA were noted. 2 straight fenestrated and 1 curved fenestrated Sugita aneurysm clips were applied. Post-clipping ICG angiography showed patent right P-com and anterior choroidal artery, along with small perforators. Operative Procedures After ETGA, the patient was placed in supine position, with head turned to left and fixed in Mayfield skull clamp. After scalp shaving, disinfection & draping in sterile fashion, a preauricular curvilinear skin incision was made at right frontotemporal area. After dissecting the scalp & temporalis muscle, both of them were reflected inferiorly. 3 burr holes were drilled, followed by right pterional craniotomy. After removing the bone flap & performing dural tenting, the sphenoid ridge were made flat with rongeur & air-drills. The dura was dissected from the dural reflections, the temporal base were then detached from middle fossa. Anterior cliniodectomy was then done, exposing the optic nerve & ICA extradurally. The dura was opened in fish-mouth fashion, and the sylvian fissure was opened. ICA, MCA and aneurysm were dissected. After aneurysm dissection, a linear skin incision was made at right mandibular angle, to expose the carotid bifurcation. After Xylocaine injection, purse-string sutures were done, followed by puncture and insertion of Swan-Ganz catheter at right ICA. The catheter was advanced to intracranial portion, the balloon was inflated to provide proximal control. The aneurysm was then clipped with 3 fenestrated Sugita clips. After ICG angiography, Swan-Ganz catheter was removed from ICA and the small incision was closed with previously applied purse-string sutures. After meticulous hemostasis, the dura was closed in water-tight fashion. The bone flap was placed back and fixed with mini-plates, and central tenting stitches were also applied. The wound was closed in layers after placing 1 subgaleal CWV drain. Operators P.杜永光 Assistants R6 胡朝凱, R3 王奐之 相關圖片 莊惠喻 (F,1990/10/07,21y5m) 手術日期 2011/05/02 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Acoustic neuroma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 邱裕淳, 時間資訊 23:37 臨時手術NPO 07:57 進入手術室 08:10 麻醉開始 08:35 誘導結束 08:50 抗生素給藥 08:57 手術開始 11:50 抗生素給藥 13:35 手術結束 13:35 麻醉結束 13:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Left side retrosigmoid approach for total tum... 開立醫師: 陳睿生 開立時間: 2011/05/02 14:11 Pre-operative Diagnosis Left trigeminal neuroma, s/p supratentorial portion remove Post-operative Diagnosis Left trigeminal neuroma, s/p supratentorial portion remove Operative Method Left side retrosigmoid approach for total tumor remove Specimen Count And Types 1 piece About size:pieces Source:tumor Pathology Pending Operative Findings The tumor was whitish, hardish, firm, and well capsuled. The size was about 3.5 cm in diameter. The CN VII, and VIII complex was found and pushed downward by the tumor. After nearly total remove of the tumor, the trigeminal nerve was noted at the deepest side and was compressed to be thin paper like. The tumor inside the meckel^s cave was removed for decompression. Operative Procedures After ETGA, the patient was under 3/4 prone position and head right turn with Mayfield clump fixation. Retroauricular scalp incision was done, and the length was about 10cm. The astron was found and an about 5x5 cm craniotomy window was created. The transverse and sigmoid sinus were exposed, and the dura was opened in a "K" shape. CSF was drained from the cistern magnum for decompression, and then the cerebellar was retracted posteriorly. The tumor was exposed after proper retraction. Then we incised into the arachnoid membrane and tumor capsule. The tumor was firm, and hardish. It was excised piece by piece, and then the residual tumor was removed with CUSA. The tumor inside the meckel^s cave was also removed. After nearly total remove of the tumor, the CN V was found at the deepest side and preserved. After proper hemosatsis, the cerebellum was packed with surgicel, and the dura was tightly closed with fascia graft. The skull graft was fixed back with miniplates x3. The wound was closed in layers Operators VS 曾漢民 Assistants R6 陳睿生, R1 邱郁淳 林良榮 (M,1942/08/04,69y7m) 手術日期 2011/05/02 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Brain Tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 邱裕淳, 時間資訊 23:39 臨時手術NPO 14:00 報到 14:10 進入手術室 14:15 麻醉開始 14:25 誘導結束 14:40 抗生素給藥 14:55 手術開始 16:05 麻醉結束 16:05 手術結束 16:10 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 經由蝶竇之腦下垂體瘤切除 1 1 摘要__ 手術科部: 外科部 套用罐頭: Microscopic trans-sphenoid approach for tumor... 開立醫師: 陳睿生 開立時間: 2011/05/02 16:31 Pre-operative Diagnosis Pituitary macroadenoma Post-operative Diagnosis Pituitary macroadenoma Operative Method Microscopic trans-sphenoid approach for tumor remove Specimen Count And Types 1 piece About size:pieces Source:tumor Pathology Pending Operative Findings The tumor was soft, fragile, solid and whitish one. It mainly located at the intrasellar region, and no chiasma compression was noted. Intra-op CSF leakage was noted and the dura was packed with gelfoam and Tissuco Duo. Operative Procedures After ETGA, the patient was under supine position. After facial and bilateral nastrials disinfection, the left side nasal cavity was exposed. The mucosal septum was incised, and the bony septum was pulled contralaterally. The vomer bone was exposed and then the anterior wall of sphenoid sinus was opened. The sinusal mucosa was removed, and the sellar floor was identified. A small window was opened at the sellar floor, and the dura was opened. Whitish tumor was noted inside the sellar region, and it was removed with ring forceps, and ring curettes. After removing of the tumor, arachnoid membrane and normal gland tissue were noted. CSF leakage was also noted. The sellar floor was packed with gelfoam and bone fragment. Then tissuco Duo was applied. The septum was pushed back and packed with plastic bags. Operators VS 曾漢民 Assistants R6 陳睿生, R1 邱郁淳 黃鎮鎧 (M,1941/01/24,71y1m) 手術日期 2011/05/02 手術主治醫師 郭順文 手術區域 東址 018房 01號 診斷 Tracheostoma stenosis 器械術式 Tracheostoma revision (請用7.0endo) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 郝政鴻, 時間資訊 23:27 臨時手術NPO 07:40 報到 08:09 進入手術室 08:10 麻醉開始 08:15 誘導結束 08:41 手術開始 08:50 抗生素給藥 09:45 手術結束 09:45 麻醉結束 09:50 送出病患 09:53 進入恢復室 11:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 管、支 管、細支 管異物除去術- 管鏡 1 1 手術 深部傷口處理縫合擴創-小 1 0 記錄__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 郝政鴻 開立時間: 2011/05/02 10:07 Pre-operative Diagnosis Tracheostoma granulation and endotracheal granulation Post-operative Diagnosis Tracheostoma granulation and endotracheal granulation Operative Method Tracheostoma closure and remove endotracheal granulation by endobroncheoscopy Specimen Count And Types 1 piece About size:1x1x1 cm Source:tracheostoma and endotracheal granulation Pathology Pending Operative Findings 1. Two small piece endotracheal granulation 0.5 cm in size was removed smoothly. Tracheostomy granulation was total excised and closed with 4-0 Maxon Operative Procedures 1. ETGA and supine position 2. Bronchoscopy for remove endotracheal granulation 3. Excised tracheostoma granulation and closed wound in layers Operators VS郭順文 Assistants R3郝政鴻 Ri釗銘 吳翠英 (F,1955/07/22,56y7m) 手術日期 2011/05/02 手術主治醫師 楊榮森 手術區域 東址 020房 01號 診斷 Other specified transient organic mental disorders 器械術式 L shoulder debridement 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉漢平 ASA 3 紀錄醫師 葉軒, 時間資訊 07:33 報到 08:05 進入手術室 08:25 麻醉開始 08:35 誘導結束 08:50 手術開始 09:00 抗生素給藥 09:55 手術結束 09:55 麻醉結束 10:00 送出病患 10:05 進入恢復室 11:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 急性化膿性關節炎切開術-肩關節、肘關節、腕關節、膝關節、踝關 1 1 L 摘要__ 手術科部: 內科部 套用罐頭: Debridement with arthrotomy 開立醫師: 葉軒 開立時間: 2011/05/02 10:07 Pre-operative Diagnosis Septic arthritis, left shoulder Post-operative Diagnosis Septic arthritis, left shoulder Operative Method Debridement with arthrotomy Specimen Count And Types 3 sets of smear for culture, 1 set of smear for gram stain, and many pieces of debrided necrotic tissue of left shoulder Pathology nil Operative Findings Pus accumination at left shoulder joint space and within left proximal humerus Operative Procedures 1. ETGA, in semi-sitting position 2. Disinfected and draped as uaual 3. Incision over left hip joint, anteriolateral approach 4. Left shoulder capsulotomy, much pus formation; curratage into left proximal humeral head and humeral canal 5. Collect tissue and culture 5. Irrigation with alcohol and massive normal saline 6. Apply hemovac then close the wound Operators 楊榮森, Assistants 葉軒, 陳彥宇, 李奕辰, 洪林伸 (F,1932/11/22,79y3m) 手術日期 2011/05/02 手術主治醫師 林昌平 手術區域 東址 010房 11號 診斷 Cataract 器械術式 Phaco+PCIOL 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 16:10 進入手術室 16:25 手術開始 16:40 手術結束 16:45 送出病患 記錄__ 手術科部: 眼科部 套用罐頭: Phacoemulsification and PCIOL implantation (os) 開立醫師: 蘇乾嘉 開立時間: 2011/05/02 16:38 Pre-operative Diagnosis Cataract (os) Post-operative Diagnosis Cataract (os) Operative Method Phacoemulsification and PCIOL implantation (os) Specimen Count And Types nil Pathology Nil Operative Findings Cataract (os) Operative Procedures 1. Under topical anesthesia 2. Disinfection, irrigation and draping 3. Application of an eyelid speculum 4. Made a clear corneal incision and penetrate into AC with 2.5mm cresent knife at 3 oclock position 5. Inject Viscoat into theanterior chamber 6. Continuous circular capsulorrhexis was done with capsular forceps 7. Made a sideport at 5 oclock position with the MVR blade 8. Hydrodissection and hydrodelineation were done with BSS 9. Phacoemulsification of thenucleus by chopper technique 10. Aspiration of the residual cortical material with I/A cannula 11. One-piece PCIOL was implanted into the bag after injection of Viscoat 12. The residual Viscoat was washed out by I/A cannula 13. Inject BSS into AC and check leakage 14. Subconjunctival injection of Rinderon and Gentamicin 15. Maxitrol patching Operators 林昌平, Assistants 蘇乾嘉, 陳達慶, 王美玲 (F,1973/05/13,38y10m) 手術日期 2011/05/03 手術主治醫師 曾漢民 手術區域 東址 016房 01號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2E 紀錄醫師 胡朝凱, 時間資訊 21:23 臨時手術NPO 21:23 開始NPO 07:23 通知急診手術 08:50 報到 09:04 進入手術室 09:10 麻醉開始 09:30 誘導結束 10:10 抗生素給藥 10:28 手術開始 13:50 麻醉結束 13:50 手術結束 13:55 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 顱底瘤手術 1 1 記錄__ 手術科部: 外科部 套用罐頭: Suboccipital craniotomy for total tumor excision 開立醫師: 胡朝凱 開立時間: 2011/05/03 14:21 Pre-operative Diagnosis Cerebellar tumor, suspect hemangiblastoma Post-operative Diagnosis Cerebellar tumor, suspect hemangiblastoma Operative Method Suboccipital craniotomy for total tumor excision Specimen Count And Types one about 2 cm mural nodule Pathology pending Operative Findings 1.Brain was swelling after dural opening 2.One about 2 cm reddish and easy touch bleeding tumor was noted located at cerebellar midline, 1 cm depth from cerebellar cortex. A large cyst was also noted surrounding the tumor with brown color fluid. 3.No forth ventricle exposure. Operative Procedures 1.ETGA, rpone with head fixed with skull clamp 2.Midline skin incision 3.Dissect along the midline to expose posterior fossa and C1 posterior arch 4.suboccipital craniotomy with exposure of transverse sinus 5.V shape dural incision 6.Right cerebellar corticotomy was done 7.Dissect to drain out cystic content 8.Excised mural nodule via the interface 9.Hemostasis 10.Close dura with Gore artificial dura 11.Fixed bone back with miniplate 12.Close wound in layers after one CWV drain insertion Operators 曾漢民 Assistants 胡朝凱 Indication Of Emergent Operation acute hydrocephalus caused by tumor obstruction 陳宜宿 (M,1952/02/16,60y0m) 手術日期 2011/05/03 手術主治醫師 曾勝弘 手術區域 東址 005房 03號 診斷 Trigeminal neuralgia (Cranial nerve V) 器械術式 Radiofrequency coagulation 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 林哲光, 時間資訊 15:15 進入手術室 15:30 手術開始 15:45 手術結束 15:46 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 高頻熱凝療法 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Radiofrequency rhizotomy for left V2 partial ... 開立醫師: 林哲光 開立時間: 2011/05/03 15:59 Pre-operative Diagnosis Left tirgeminal neuralgia Left infraorbital neuralgia Post-operative Diagnosis Left trigeminal nerualgia Left infraorbital neuralgia Operative Method Radiofrequency rhizotomy for left V2 partial rhizotomy Pulsed radiofrequency stimulation of left infraorbital nerve Specimen Count And Types Pathology Operative Findings Intraoperative localization with voltage was done and total 6-minute-stimulation was done and postoperative pain improvement was noted. Operative Procedures Under supine position, skin disinfected and drapped were performed as usual at left maxillary area. RF needle was introduced around 1cm below the orbital rim to the infraorbital foramen. Voltage stimulation was done for localization to the offending nerve. Further stimulation was then performed after the localization. Operators AP 曾勝弘 Assistants R4 林哲光 秦宗建 (M,1953/10/03,58y5m) 手術日期 2011/05/03 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Lumbar spondylosis 器械術式 Laminectomy for decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 林哲光, 時間資訊 23:02 臨時手術NPO 08:07 進入手術室 08:20 麻醉開始 08:30 誘導結束 08:43 抗生素給藥 09:06 手術開始 11:55 手術結束 11:55 麻醉結束 12:05 送出病患 12:15 進入恢復室 13:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術(減壓)-超過二節 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 記錄__ 手術科部: 外科部 套用罐頭: L3-5 laminectomy for decompression 開立醫師: 林哲光 開立時間: 2011/05/03 12:37 Pre-operative Diagnosis L3-5 lumbar central canal stenosis Post-operative Diagnosis L3-5 lumbar central canal stenosis Operative Method L3-5 laminectomy for decompression Specimen Count And Types nil Pathology Operative Findings Dura seemed re-expanded well after laminectomy. Hypertrophic change of bilateral facet joints and ligamentum flavum were noted. Bilateral roots of L2-S1 were identifed and neural foramen were checked without compression. Operative Procedures Under ETGA and prone position, skin disinfected and drapped were performed as usual. Midline skin incision was made from L2-S1 and bilateral paraspinal muscles were detached. L3-L5 laminectomy was then performed. Hemostasis with Gelfoam packing was done and the wound was then closed in layers after a epidrual drain insertion. Operators AP 曾勝弘 Assistants R4 林哲光, Ri 楊 相關圖片 江美鈴 (F,1945/09/21,66y5m) 手術日期 2011/05/03 手術主治醫師 曾勝弘 手術區域 東址 005房 02號 診斷 Parkinsonism (F02.3) 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 林哲光, 時間資訊 23:06 臨時手術NPO 12:32 進入手術室 12:35 麻醉開始 12:45 誘導結束 13:00 抗生素給藥 13:23 手術開始 14:55 手術結束 14:55 麻醉結束 15:10 送出病患 15:12 進入恢復室 16:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 腦室腹腔分流手術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Right Kocher V-P shunt insertion 開立醫師: 林哲光 開立時間: 2011/05/03 21:00 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Right Kocher V-P shunt insertion Specimen Count And Types 1 piece About size: Source:CSF for CSF cytology, routine, BCS and culture Pathology Operative Findings CSF seemed clear and transparent, medium pressure valve was inserted. Ventricular catheter was 6.5cm long and abdominal catheter was more than 15cm long. Operative Procedures Under ETGA and supnie position with head mild rotated to left side, skin disinfected and drapped were performed as usual. Curvilinear skin incision was made and a burr hole was created at right Kocher point. Ventricular catheter was intorduced along the trajectory composed with two planes pointed to targus and medial canthus. Right abdomen transverse skin incision was made and mini-larparotomy was done. The abdominal catheter was then connected to ventricular catheter with medium pressure valve through the subcutaneous tunneling. The wound was then closed in layers. Operators AP 曾勝弘 Assistants R4 林哲光 相關圖片 許雅婷 (F,1988/09/18,23y5m) 手術日期 2011/05/03 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Epilepsy 器械術式 Vagus nerve stimulation implantation 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 2 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:10 麻醉開始 08:30 誘導結束 08:40 抗生素給藥 09:17 手術開始 12:00 手術結束 12:00 麻醉結束 12:05 送出病患 12:10 進入恢復室 13:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 L 手術 神經分離術–肩,臀關節以上,包括臂神經叢,坐骨神經 1 2 L 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: Implantation of vagus nerve stimulator (Cyber... 開立醫師: 鍾文桂 開立時間: 2011/05/03 13:06 Pre-operative Diagnosis Refractory epilepsy. Post-operative Diagnosis Refractory epilepsy. Operative Method Implantation of vagus nerve stimulator (Cyberronic model 102),left. Specimen Count And Types nil Pathology Nil Operative Findings 1.The left vagus nerve was isolated from carotid sheath. The generator was placed in left upper anterior chest wall. 2. Implantation devices for vagus nerve stimulation therapy: - Cyberonics VNS Therapy Lead Model 302 - Cyberonics VNS Therapy Demipulse Model 102 Generator Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine position with mild neck extension. The skin was scrubbed, disinfected, and draped as usual. One transverse linear skin incision was made at left neck and left forechest with 3 and 4cm in length respectively. The anterior margin of sternocledomastoid muscle was identified after incision of platysma muscle. The deep fascia was opened and the carotid sheath was identified. The carotid sheath was opened and the vagus nerve was isolated under microscope. One left forechest subcutaneous pocket was created for pulse generator. The subcutaneous tunnel was created by tunneler. The electrode was passed throught the subcutaneous tunnel. The three spiral anchor was applied over left vagus nerve for lead placement. The lead was connected with generator and the system was checked with Model 201 programming wand and model 250 programming softward. Hemostasis was checked. Two anchoring sutures were made at left neck for secure the lead. The pulse generator was implanted. The wound was then closed in layers with 4-0 Vicryl and 4-0 Prolene. Operators V.S. 郭夢菲 Assistants R5 鍾文桂 記錄__ 手術科部: 外科部 套用罐頭: Implantation of vagus nerve stimulator (Cyber... 開立醫師: 郭夢菲 開立時間: 2011/05/03 13:19 Pre-operative Diagnosis Refractory epilepsy. Post-operative Diagnosis Refractory epilepsy. Operative Method Implantation of vagus nerve stimulator (Cyberronic model 102),left. Specimen Count And Types nil Pathology Nil Operative Findings 1.The left vagus nerve was isolated from carotid sheath. The generator was placed in left upper anterior chest wall. 2. Implantation devices for vagus nerve stimulation therapy: - Cyberonics VNS Therapy Lead Model 302 - Cyberonics VNS Therapy Demipulse Model 102 Generator Operative Procedures Under endotracheal tube general anesthesia, the patient was put in supine position with mild neck extension. The skin was scrubbed, disinfected, and draped as usual. One transverse linear skin incision was made at left neck and left forechest with 3 and 4cm in length respectively. The anterior margin of sternocledomastoid muscle was identified after incision of platysma muscle. The deep fascia was opened and the carotid sheath was identified. The carotid sheath was opened and the vagus nerve was isolated under microscope. One left forechest subcutaneous pocket was created for pulse generator. The subcutaneous tunnel was created by tunneler. The electrode was passed throught the subcutaneous tunnel. The three spiral anchor was applied over left vagus nerve for lead placement. The lead was connected with generator and the system was checked with Model 201 programming wand and model 250 programming softward. Hemostasis was checked. Two anchoring sutures were made at left neck for secure the lead. The pulse generator was implanted. The wound was then closed in layers with 4-0 Vicryl and 4-0 Prolene. Operators V.S. 郭夢菲 Assistants R5 鍾文桂 郭景貿 (M,1972/08/06,39y7m) 手術日期 2011/05/03 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Cervical myelopathy 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 全賀顯, 時間資訊 23:03 臨時手術NPO 08:05 進入手術室 08:10 麻醉開始 08:15 誘導結束 08:50 抗生素給藥 08:57 手術開始 11:00 手術結束 11:00 麻醉結束 11:10 送出病患 11:14 進入恢復室 12:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 椎間盤切除術-頸椎 1 1 手術 脊椎融合術-前融合,有固定物)≦四節 1 2 摘要__ 手術科部: 外科部 套用罐頭: Anterior Discectomy and Fusion, Cervical Spine 開立醫師: 曾峰毅 開立時間: 2011/05/03 11:06 Pre-operative Diagnosis HIV, C4/5 Post-operative Diagnosis HIV, C4/5 Operative Method Anterior discectomy and fusion with PEEK cage and artificial bone graft. Specimen Count And Types Nil Pathology Nil Operative Findings Herniated disc compressed the thecal sac tightly. The dura was slack after discectomy. Synthes PEEK cage, 7 mm in height, was used. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with neck extended. We made one transverse skin incision at right anterior neck and dissected to expose prevertebral space of C4/5. After C-arm confirmation, we performed C4/5 discectomy. Fusion was achieved with one PEEK cage and artificial bone graft. We placed one mini-hemovac, and closed the wound in layers. Operators VS 賴達明 Assistants R4 曾峰毅 R1 全賀顯 張玉樹 (M,1935/06/22,76y8m) 手術日期 2011/05/03 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Cervical Spondylosis 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 全賀顯, 時間資訊 23:55 臨時手術NPO 11:22 進入手術室 11:30 麻醉開始 11:40 誘導結束 12:00 抗生素給藥 12:17 手術開始 14:35 手術結束 14:35 麻醉結束 14:45 送出病患 14:47 進入恢復室 16:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 椎間盤切除術-頸椎 1 1 手術 脊椎融合術-前融合,有固定物)≦四節 1 2 摘要__ 手術科部: 外科部 套用罐頭: Anterior Discectomy and Fusion, Cervical Spine 開立醫師: 曾峰毅 開立時間: 2011/05/03 14:38 Pre-operative Diagnosis HIVD, C3/4 and C4/5 Post-operative Diagnosis HIVD, C3/4 and C4/5 Operative Method Anterior Discectomy and Fusion with PEEK cages and artificial bone graft, C3/4 and C4/5 Specimen Count And Types Nil Pathology Nil Operative Findings Herniated disc compressed the cord tightly. Thecal sac was slack after discectomy. Two Synthes PEEK cage, 7 mm in height, were used for fusion. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with neck extended. We made one transverse skin incision at right anterior neck and dissected to expose prevertebral space of C3 to C5. After C-arm confirmation, we performed C4/5 discectomy first and then C3/4 discectomy. Fusion was achieved with two PEEK cages and artificial bone graft. We placed one mini-hemovac, and closed the wound in layers. Operators VS 賴達明 Assistants R4 曾峰毅 R1 全賀顯 林宗慶 (M,1982/12/25,29y2m) 手術日期 2011/05/03 手術主治醫師 賴達明 手術區域 東址 003房 03號 診斷 Spondylosis with myelopathy, cervical 器械術式 Neurolysis - Tardy ulnar palsy 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 全賀顯, 時間資訊 14:52 進入手術室 14:55 麻醉開始 15:00 誘導結束 15:10 抗生素給藥 15:16 手術開始 16:05 麻醉結束 16:05 手術結束 16:12 送出病患 16:15 進入恢復室 17:15 離開恢復室 23:00 臨時手術NPO 醫令資訊 類別 名稱 量 刀 側 手術 神經分離術-上臂.前臂.大腿.小腿處之神經 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 摘要__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 曾峰毅 開立時間: 2011/05/03 16:14 Pre-operative Diagnosis Cubital tunnel syndrome, left Post-operative Diagnosis Cubital tunnel syndrome, left Operative Method Neurolysis of left ulnar nerve at left elbow Specimen Count And Types Nil Pathology Nil Operative Findings Left ulnar nerve was compromised just distal to cubital tunnel. The nerve was slack after neurolysis. Operative Procedures With intravenous general anaesthesia, the patient was put in supine position with left arm abducted. We disscted the elbow area to identifed two head of flexor carpi ulnaris, arcuate ligament, and the insertion of triceps. Ulnar nerve was dissected to free, and the wound was closed in layers. Operators VS 賴達明 Assistants R4 曾峰毅 R1 全賀顯 鄭柏涵 (M,1969/06/23,42y8m) 手術日期 2011/05/03 手術主治醫師 賴達明 手術區域 西址 039房 03號 診斷 Carpal tunnel syndrome 器械術式 Neurolysis of the uluar neuve 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 11:22 報到 12:13 進入手術室 12:18 麻醉開始 12:22 手術開始 12:45 手術結束 12:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 正中神經或尺神經腕部減壓術–單側 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Decompression of median nerve 開立醫師: 李振豪 開立時間: 2011/05/03 12:12 Pre-operative Diagnosis Carpal tunnel syndrome, right Post-operative Diagnosis Carpal tunnel syndrome, right Operative Method Decompression of median nerve Specimen Count And Types nil Pathology Nil Operative Findings The right median nerve was compressed by hypertrophic, calcified transverse carpal ligment tightly. The median nerve was decompressed and expanded well after whole procedure. No acute finger weakness was noted after the operation. Operative Procedures The hand and forearm were sterilized with povidone-iodine tincture, then covered with stockinet. Local anesthesia was applied at wrist area with 1% Xylocaine 10ml. Linear skin incision was made at right wrist along the palmar crease. The plamar aponeurosis was identified, then the plamar aponeurosis was cut longitidinally along the ulnar side of the palmaris longus tendon. Under direct vision, the transverse carpal ligment was divided until no more pressure on the median nerve. Hemostasis was achieved and the wound was closed in layers with 4-0 Vicryl and 4-0 Nylon. Operators VS賴達明 Assistants R4李振豪 相關圖片 呂潔 (F,1958/10/29,53y4m) 手術日期 2011/05/03 手術主治醫師 賴達明 手術區域 西址 039房 01號 診斷 Carpal tunnel syndrome 器械術式 Neurolysis of the uluar neuve 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 08:45 報到 09:10 進入手術室 09:24 麻醉開始 09:34 手術開始 10:07 麻醉結束 10:07 手術結束 10:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 正中神經或尺神經腕部減壓術–單側 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Carpal Tunnel Syndrome 開立醫師: 李振豪 開立時間: 2011/05/03 10:20 Pre-operative Diagnosis Carpal tunnel syndrome, right Post-operative Diagnosis Carpal tunnel syndrome, right Operative Method Decompression of right median nerve Specimen Count And Types nil Pathology Nil Operative Findings The right median nerve was compressed by hypertrophic, calcified transverse carpal ligment tightly. The median nerve was decompressed and expanded well after whole procedure. No acute finger weakness was noted after the operation. Operative Procedures The hand and forearm were sterilized with povidone-iodine tincture, then covered with stockinet. Local anesthesia was applied at wrist area with 1% Xylocaine 10ml. Linear skin incision was made at right wrist along the palmar crease. The plamar aponeurosis was identified, then the plamar aponeurosis was cut longitidinally along the ulnar side of the palmaris longus tendon. Under direct vision, the transverse carpal ligment was divided until no more pressure on the median nerve. Hemostasis was achieved and the wound was closed in layers with 4-0 Vicryl and 4-0 Nylon. Operators VS賴達明 Assistants R4李振豪 相關圖片 馬景鵬 (M,1958/12/13,53y3m) 手術日期 2011/05/03 手術主治醫師 王一中 手術區域 東址 010房 01號 診斷 Cataract 器械術式 Phaco+PCIOL 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 08:43 進入手術室 09:03 手術開始 09:20 手術結束 09:25 送出病患 記錄__ 手術科部: 眼科部 套用罐頭: Phacoemulsification and PCIOL implantation (os) 開立醫師: 吳郁芊 開立時間: 2011/05/03 09:21 Pre-operative Diagnosis Cataract (os) Post-operative Diagnosis Cataract (os) Operative Method Phacoemulsification and PCIOL implantation (os) Specimen Count And Types nil Pathology nil Operative Findings Cataract (os) Operative Procedures 1. Under retrobulbar anesthesia. 2. Disinfection, irrigation and draping. 3. Application of an eyelid speculum. 4. Made a clear corneal incision and penetrate into AC with 2.5mm trapezoid knife at 10 oclock position. 5. Inject Viscoat into the anterior chamber. 6. Continuous circular capsulorrhexis was done with bent needle and capsular forceps. 7. Made a sideport at 2 oclock position with the MVR blade. 8. Hydrodissection and hydrodelineation were done with BSS.9. Phacoemulsification of the nucleus by standard divide-and-conquer technique. 10. Aspiration of the residual cortical material with I/A tube. 11. Extend the cornea wound to 3.2mm by diamond knife. 12. Foldable PCIOL was implanted into the bag after injection of Viscoat. 13. The residual Viscoat was washed out by Simcoe I/A cannula. 14. Inject BSS into AC and check leakage, and inject Miostat to AC to constrict the pupil 15. Stromal hydrationof the wound with BSS 16. Subconjunctival injection of Rinderon and Garamycin. 17. Maxitrol patching. Operators 王一中, Assistants R4 陳達慶 R4 吳郁芊 陳國興 (M,1960/07/11,51y8m) 手術日期 2011/05/03 手術主治醫師 陳敞牧 手術區域 東址 005房 04號 診斷 Spinal stenosis, cervical 器械術式 Diskectomy cervical(Anterier) 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 林哲光, 時間資訊 15:48 報到 16:00 進入手術室 16:05 麻醉開始 16:15 誘導結束 16:20 抗生素給藥 16:46 手術開始 19:20 抗生素給藥 19:30 手術結束 19:30 麻醉結束 19:38 進入恢復室 19:40 送出病患 20:40 離開恢復室 18:13 臨時手術NPO 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-頸椎 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 記錄__ 手術科部: 外科部 套用罐頭: C4-5 dicectomy and anterior fusion with Cage ... 開立醫師: 林哲光 開立時間: 2011/05/03 19:48 Pre-operative Diagnosis C4-5 HIVD Post-operative Diagnosis C4-5 HIVD Operative Method C4-5 dicectomy and anterior fusion with Cage (7mm) Specimen Count And Types Pathology Operative Findings A ruptured disc was noted at C4-5 level with direct compressing the dura tightly. Some hematoma was noted inside the disc. 7mm cage was inserted at C4-5 level. Operative Procedures Under ETGA and supine position with neck mild extension, skin disinfected and drapped were performed as usual. Transverse skin incision was made at C4-5 level. Plane dissection between the carotid triangle and esophagus was done and prevertebral fascia was opened. C4-5 discectomy was then performed under microscope. PLL was also dissected and cage was inserted. The wound was then closed in layers after hemostasis. Operators VS 陳敞牧 Assistants R4 林哲光 相關圖片 林素秋 (F,1956/01/20,56y1m) 手術日期 2011/05/03 手術主治醫師 住院醫師 手術區域 西址 039房 02號 診斷 Carpal tunnel syndrome 器械術式 Decompression of mediun nerve 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 10:25 進入手術室 10:43 麻醉開始 10:47 手術開始 11:55 手術結束 11:55 麻醉結束 12:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 正中神經或尺神經腕部減壓術–單側 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Decompression of right median nerve 開立醫師: 李振豪 開立時間: 2011/05/03 12:06 Pre-operative Diagnosis Carpal tunnel syndrome, right Post-operative Diagnosis Carpal tunnel syndrome, right Operative Method Decompression of right median nerve Specimen Count And Types nil Pathology Nil Operative Findings The right median nerve was compressed by hypertrophic, calcified transverse carpal ligment tightly. The median nerve was decompressed and expanded well after whole procedure. No acute finger weakness was noted after the operation. Operative Procedures The hand and forearm were sterilized with povidone-iodine tincture, then covered with stockinet. Local anesthesia was applied at wrist area with 1% Xylocaine 10ml. Linear skin incision was made at right wrist along the palmar crease. The plamar aponeurosis was identified, then the plamar aponeurosis was cut longitidinally along the ulnar side of the palmaris longus tendon. Under direct vision, the transverse carpal ligment was divided until no more pressure on the median nerve. Hemostasis was achieved and the wound was closed in layers with 4-0 Vicryl and 4-0 Nylon. Operators VS曾漢民 Assistants R4李振豪 相關圖片 杜良男 (M,1942/08/07,69y7m) 手術日期 2011/05/03 手術主治醫師 蕭輔仁 手術區域 東址 002房 01號 診斷 Malignant neoplasm of other and ill-defined sites of abdomen 器械術式 Spinal fusion posterior 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 3 紀錄醫師 陳睿生, 時間資訊 01:00 臨時手術NPO 01:00 開始NPO 01:01 通知急診手術 07:20 進入手術室 07:25 麻醉開始 07:50 誘導結束 08:15 抗生素給藥 08:52 手術開始 09:53 開始輸血 11:15 抗生素給藥 12:50 手術結束 12:50 麻醉結束 13:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 惡性脊髓腫瘤切除術 1 1 手術 脊椎融合術-後融合,有固定物(<=六節) 1 2 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 摘要__ 手術科部: 內科部 套用罐頭: T10-L1 laminectomy for cord decompression; T9... 開立醫師: 陳睿生 開立時間: 2011/05/03 13:36 Pre-operative Diagnosis SCC with multiple spinal metastasis, cord compression at T11, L1 level Post-operative Diagnosis SCC with multiple spinal metastasis, cord compression at T11, L1 level Operative Method T10-L1 laminectomy for cord decompression; T9, 10, 12, L2, 3 tranpedicular fixation Specimen Count And Types 2 pieces About size:pieces Source:bone About size:pieces Source:epidural soft tissue Pathology Pending Operative Findings The lamina at T10-L1 level was noted to be involved by the tumor, especially over T11 level. Some epidural metatasis was noted at T11. After proper lamienctomy, the cord was well expanded. TPS fixation was done at T9, 10, 12, L2, 3 level. Screws: A-spine, T9, 10: 5.5 x40mm x4; T12: 6.0 x40mm x2; L2, 3: 6.0 x45mm x4; Rods: 25cm x2; Crosslink x2. Easy oozing was noted intra-op, especially T10-11 level. Intra-op blood loss: 3300ml. Operative Procedures 1. ETGA, prone position, and C-arm localize the T10-L3 level 2. Low back midline incision about 30cm 3. Dissect the paraspinal muscles and expose the T10- L3 lamina 4. Insert transpedicular screws at bilateral T9, 10 , 12, L2, 3 level under C-arm localization 5. Remove T10-L1 spinous process 6. Remove of intra-lamina and epidural metastasis 7. Laminotomy for cord decompression 8. Set bilateral rods and fix the screws 9. Set crosslink x2 10.Set 1/8 hemovac x2 11.Close the wound in layers Operators VS 蕭輔仁 Assistants R6 陳睿生, Ri 嚴愛文 Indication Of Emergent Operation Decrease low limbs muscle power 胡周俊生 (M,1943/09/25,68y5m) 手術日期 2011/05/03 手術主治醫師 王國川 手術區域 東址 016房 02號 診斷 Contusion, scalp 器械術式 Right craniectomy and subdural hematoma evacuation 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 5E 紀錄醫師 鍾文桂, 時間資訊 13:54 通知急診手術 14:25 進入手術室 14:30 麻醉開始 14:52 誘導結束 15:18 開始輸血 15:18 手術開始 16:40 手術結束 16:40 麻醉結束 16:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 顱內壓視置入 1 2 R 手術 顱骨切除術,包括異物移除或壓或經切斷 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: 1. Decompressive craniectomy, right frontal-t... 開立醫師: 王奐之 開立時間: 2011/05/03 17:19 Pre-operative Diagnosis Severe head injury with acute subdural hemorrhage and severe brain swelling. Post-operative Diagnosis Severe head injury with acute subdural hemorrhage and severe brain swelling. Operative Method 1. Decompressive craniectomy, right frontal-temporal-parietal. 2. Insertion of suvdural Codman ICP monitor. 2. Insertion of subdural Codman ICP monitor. ICP after wound closure: 48 mmHg. Specimen Count And Types nil Pathology Nil. Operative Findings 1. Poor vital signs after scalp dissection. Much blood gushed out from the linear skull fracture over midline. Poor brain pulsation. Much liquid subdural hematoma gushed out after the small durotomy. 2. ICP after wound closure: 18mmHg. BP: 101/65mmHg, Levophed: 0.14ug, Bosmin: 0.17ug. Operative Procedures Under ETGA, the patient was placed in supine position and the head was tilted to the left side. After scalp incision and dissection, a 16cm craniectomy bone plate was obtained by using high speed drill and ostoetome. The temporalis muscle was resected. A small durotomy was done for insertion of subdural ICP monitor. After placing one subgaleal CWV drain, the wound was closed in layers. Operators 王國川 Assistants 鍾文桂 王奐之 Indication Of Emergent Operation saving life 相關圖片 吳寶金 (F,1935/04/02,76y11m) 手術日期 2011/05/03 手術主治醫師 林至芃 手術區域 西址 035房 04號 診斷 Cervical spondylosis 器械術式 Nerve block / PC 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 林至芃 ASA 3 時間資訊 11:40 報到 12:15 進入手術室 12:20 麻醉開始 12:25 誘導結束 12:35 手術開始 12:50 麻醉結束 12:50 手術結束 13:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 末稍神經阻斷術 1 0 R 記錄__ 手術科部: 麻醉部 套用罐頭: echo guide nerve block 開立醫師: 葉芷圻 開立時間: 2011/05/03 13:02 Pre-operative Diagnosis cervical spondylosis Post-operative Diagnosis dittol Operative Method echo guide nerve block Specimen Count And Types nil Pathology nil Operative Findings patent neuroforamen Operative Procedures under C-arm and echo guide, levobupivacaine and steroid was inject though the C5 neuroforamen. Operators 林至芃 Assistants 葉芷圻 柯勝嚴 (M,1983/01/11,29y2m) 手術日期 2011/05/04 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Arteriovenous malformation, brain 器械術式 Craniotomy (A.V.M.) P-DUH 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 王奐之, 時間資訊 23:46 臨時手術NPO 08:05 進入手術室 08:10 麻醉開始 08:35 誘導結束 08:50 手術開始 09:10 抗生素給藥 12:10 抗生素給藥 15:00 開始輸血 15:10 抗生素給藥 17:30 手術結束 17:30 麻醉結束 17:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 開顱術摘除血管病變- 動靜脈畸型大型 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 11 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Right temporal craniotomy for total AVM removal 開立醫師: 王奐之 開立時間: 2011/05/04 17:53 Pre-operative Diagnosis Right temporal arteriovenous malformation (AVM), Spetzler-Martin grade III, status post transarterial embolization (twice) Post-operative Diagnosis Right temporal arteriovenous malformation (AVM), Spetzler-Martin grade III, status post transarterial embolization (twice) Operative Method Right temporal craniotomy for total AVM removal Specimen Count And Types 1 piece About size:6*4*3cm Source:right temporal AVM Pathology Pending Operative Findings Significant bleeding from bone and epidural space was encountered during craniotomy. Prominent superficial venous drainage of the AVM was noted, to vein of Labbe, vein of Trolard and Sylvian vein. Numerous arterial feeders came from MCA & PCA branches, and most of them were embolized by previous TAE procedures. A deep draining vein to the tentorium was also noted and was ligated at last. Ventricle was opened and small amount CSF was drained out. Operative Procedures After ETGA, the patient was placed in supine position with head turned to left and fixed in Mayfield skull clamp. After scalp shaving, disinfection and draping in sterile fashion, a reversed-U shape incision was made. After scalp dissection, the temporalis muscle was also detached from the skull and reflected inferiorly. The skull dissection was made down to the level of zygoma. After making 4 burr holes, craniotomy was done, followed by dural tenting. An U-shaped durotomy was done, exposing the engorged vessels. The dissection of AVM began from the anterior-inferior portion and carried out to other edges. Feeding arteries & draining veins were carefully cauterized and divided. After AVM removal in en bloc fashion, the surgical cavity was checked meticulously for hemostasis. The dura was then closed in water-tight fashion. After central tenting, the bone flap was placed back and fixed with mini-plates. The wound was closed in layers after setting 1 subgaleal CWV drain. Operators P. 杜永光 Assistants R6 胡朝凱, R3 王奐之 相關圖片 周敏男 (M,1941/01/05,71y2m) 手術日期 2011/05/04 手術主治醫師 曾漢民 手術區域 東址 005房 03號 診斷 Oligodendroglioma, brain 器械術式 Brain biopsy -Stereotaxic 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 邱裕淳, 時間資訊 23:49 臨時手術NPO 17:15 進入手術室 17:20 麻醉開始 17:25 誘導結束 17:30 抗生素給藥 17:45 手術開始 19:10 手術結束 19:10 麻醉結束 19:21 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦組織活體切片 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Stereotactic tumor biopsy 開立醫師: 陳睿生 開立時間: 2011/05/04 19:19 Pre-operative Diagnosis Left thalamus tumor, suspect glioma, suspect lymphoma Post-operative Diagnosis Left thalamus tumor, suspect glioma, suspect lymphoma Operative Method Stereotactic tumor biopsy Specimen Count And Types 2 pieces About size:1x0.2x0.2 cm x2 Source:tumor About size:1x0.2x0.2 cm x2 Source:tumor Pathology Pending Operative Findings Metronic navigation was used for assist. A bur hole was made at the left frontotemporal region. Two target points were chosen. The first one was at the T1 with contrast enhanced point, and the other one was about 1cm beneath to it. Operative Procedures 1. ETGA, supine position and head fix with Mayfield clump, right turn 2. Registration of the navigation system, and set trajetory 3. A bur hole was made at left temporal region 4. Dura tenting, and we incised into the brain parychema 5. Insert the biopsy needle under navigation assist 6. Extract spicemen 7. Hemostasis, close the wound in layers Operators VS 曾漢民 Assistants R6 陳睿生, R1 邱裕淳 潘孟臣 (M,1952/08/01,59y7m) 手術日期 2011/05/04 手術主治醫師 蔡瑞章 手術區域 東址 005房 01號 診斷 Secondary malignant neoplasm of brain and spinal cord 器械術式 Crainotomy Brain Tumor(P-LIN) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 邱裕淳, 時間資訊 23:30 臨時手術NPO 08:05 進入手術室 08:15 麻醉開始 08:40 誘導結束 08:40 抗生素給藥 09:21 手術開始 11:50 手術結束 11:50 麻醉結束 12:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除-手術時間在4小時以內 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for tumor remove 開立醫師: 陳睿生 開立時間: 2011/05/04 12:12 Pre-operative Diagnosis Lung ca with left cerebellar metastasis Post-operative Diagnosis Lung ca with left cerebellar metastasis Operative Method Craniotomy for tumor remove Specimen Count And Types 1 piece About size:pieces Source:tumor Pathology Pending Operative Findings The tumor was noted at the left superior cerebellar hemisphere. It was about 1.2 cm in diameter. The tumor was soft, grayish, and well capsuled one. The tumor was totally removed. Operative Procedures 1. ETGA, prone position, and head fix with Mayfield clump 2. We incised into the previous linear wound at left paramedian region 3. The muscle was dissected and the bone flap was elevated 4. The tumor was localized with ECHO, and the craniotomy was extended superiorly 5. After dura opening, the tumor was found 6. It was totally removed with electroligated peripehral vein 7. Hemostasis, and the dura was closed with fascia graft 8. The bone graft was fixed back with wires x4 9. The wound was closed in layers Operators P 蔡瑞章 Assistants R6 陳睿生, R1 邱郁淳 謝 (M,1955/09/03,56y6m) 手術日期 2011/05/04 手術主治醫師 蔡瑞章 手術區域 東址 005房 02號 診斷 Skull malignant neoplasm 器械術式 Scalp tumor excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 邱裕淳, 時間資訊 23:52 臨時手術NPO 12:10 進入手術室 12:20 麻醉開始 12:30 誘導結束 13:00 抗生素給藥 13:21 手術開始 13:30 開始輸血 16:00 抗生素給藥 16:45 手術結束 16:45 麻醉結束 17:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 頭皮腫瘤 1 2 L 手術 頭顱成形術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 3 0 麻醉 動脈血液檢查全套 3 0 麻醉 Hemoglobin (Hb) 3 0 麻醉 測血糖 3 0 麻醉 Ca (Calcium) 3 0 麻醉 Na (Sodium) 3 0 麻醉 K (Potassium) 3 0 麻醉 Blood gas analysis 3 0 摘要__ 手術科部: 外科部 套用罐頭: Tumor remove and cranioplasty with artifical ... 開立醫師: 陳睿生 開立時間: 2011/05/04 17:20 Pre-operative Diagnosis Left occipitial skull tumor Post-operative Diagnosis Left occipitial skull tumor Operative Method Tumor remove and cranioplasty with artifical graft Specimen Count And Types 2 pieces About size:pieces Source:tumor About size:pieces Source:bone fragment Pathology Pending Operative Findings The tumor was soft fragile and well vascularized. It was grayish and capsuled. The skull bone was erosed and the dura was not obviously involved. Several feeding arteries was noted from the dura and electroligated. A small rupture of the SSS was noted and suture closed. Intra-op blood loss was about 3600ml. The skull defect was closed with Codman titanium plate. Operative Procedures 1. ETGA, prone position and head fix with Mayfield clump 2. Bilateral occipital inverse "U" scalp incision 3. The tumor was noted after dissection of the periosteum 4. The plane between the tumor and the skull was carefully dissected 5. The tumor was removed carefully with hemostasis 6. Proper dura tenting was done 7. A small superior sagittal sinus leak was noted and was suture closed 8. The skull defect was closed with titanium plate 9. A subgaleal CWV drain was set 10.The wound was closed in layers Operators P 蔡瑞章 Assistants R6 陳睿生, R1 邱郁淳 王玉泉 (M,1941/09/24,70y5m) 手術日期 2011/05/04 手術主治醫師 賴達明 手術區域 東址 002房 05號 診斷 Head Injury 器械術式 Left frontal ICH evacuation + EVD + ICP monitoring 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 3E 紀錄醫師 李振豪, 時間資訊 20:46 通知急診手術 21:20 進入手術室 21:25 麻醉開始 21:45 誘導結束 22:00 抗生素給藥 22:26 手術開始 02:10 手術結束 02:10 麻醉結束 02:22 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 1 L 手術 顱內壓視置入 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: 1. Removal of intracerebral hemorrhage throug... 開立醫師: 鍾文桂 開立時間: 2011/05/05 00:34 Pre-operative Diagnosis 1. Head injury with left frontal base depressed fracture, contusional intracerebral hemorrhage and intraventricular hemorrhage, and pneumocranium. Post-operative Diagnosis 1. Head injury with left frontal base depressed fracture, contusional intracerebral hemorrhage and intraventricular hemorrhage, acute subdural hemorrhage, and pneumocranium. Operative Method 1. Removal of intracerebral hemorrhage through left frontal craniotomy. 2. Insertion of EVD catheter for ICP monitoring and CSF drainage, right Kocher. 3. Reconstruction of left frontal base and orbital roof with pericranium fascia. Specimen Count And Types 1 piece About size:3CC Source:CSF, for routine, culture and BCS. Pathology Nil. Operative Findings 1. A fractured bone chip from left orbital roof was penetrating through the dura mater into the left frontal lobe. The orbital roof was opened and the hematoma inside the orbit was evacuated. The bone chip was placed back. The orbital roof was reconstructed along with dura mater and pericranium. 2. The contusional ICH was evacuated until the left frontal horn was met. No active bleeder was noted. The brain was slack after hematoma evacuation. 3. 長安粗 EVD was inserted to right Kocher point, set 6cm in depth. The CSF was reddish, clear, pressure about 8 cmH2O. 4. The frontal sinus was opened and sealed. 5. ICP after wound closure: 2mmHg. ICP reference: 485 Operative Procedures Under ETGA, the patient was placed in supine position and the head was placed in midline position. After shaving, disinfection, and draping, bicoronal scalp incision was made. After scalp dissection, a burr hole was created at right Kocher point. After durotomy, an EVD was inserted. Then, a 6cm craniotomy window at left frontal region was obtained by osteotome and high speed drill. Dura mater was tented along the edges. After durotomy, the subdural and intracerebral hematoma were evacuated. The orbital roof was reconstructed with pericranium fascia by 4-0 Vicryl. The dura mater was closed in watertight fashion. The craniotomy plate was fixed by miniplates and screws. The wound was closed in layers with one subgaleal drain. Under ETGA, the patient was placed in supine position and the head was placed in midline position. After shaving, disinfection, and draping, bicoronal scalp incision was made. After scalp dissection, a burr hole was created at right Kocher point. After durotomy, an EVD was inserted. Then, a 6cm craniotomy window at left frontal region was obtained by osteotome and high speed drill. Dura mater was tented along the edges. After durotomy, the subdural and intracerebral hematoma were evacuated. The orbital roof was reconstructed with pericranium fascia by 4-0 Vicryl. The dura mater was closed in watertight fashion. One subdural ICP monitor was placed. The craniotomy plate was fixed by miniplates and screws after one epidural CWV drain. The wound was closed in layers. Operators VS 賴達明 Assistants R5 鍾文桂 R4 李振豪 R1 Indication Of Emergent Operation Severe head injury with contusional ICH in progression. 相關圖片 黃雅慧 (F,1977/10/06,34y5m) 手術日期 2011/05/05 手術主治醫師 蔡瑞章 手術區域 東址 005房 04號 診斷 Hydrocephalus 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3 紀錄醫師 李振豪, 時間資訊 23:50 臨時手術NPO 13:57 進入手術室 14:05 麻醉開始 14:10 誘導結束 14:45 抗生素給藥 15:02 手術開始 18:00 抗生素給藥 18:45 手術結束 18:45 麻醉結束 18:55 送出病患 18:58 進入恢復室 22:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 顱骨重塑模組 1 0 手術 頭顱成形術 1 2 R 手術 腦室腹腔分流手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: 1. Cranioplasty with CranioPerfect artificial... 開立醫師: 李振豪 開立時間: 2011/05/06 08:22 Pre-operative Diagnosis 1. Right fronto-temporo-parietal skull defect, 2. Hydrocephalus Post-operative Diagnosis 1. Right fronto-temporo-parietal skull defect, 2. Hydrocephalus Operative Method 1. Cranioplasty with CranioPerfect artificial bone graft, 2. Ventriculoperitoneal shunt via right Kocher"s approach Specimen Count And Types 1 piece About size:10ml Source:CSF Pathology Nil Operative Findings The Codman fixed pressure reservoir with 100mmH2O as pressure setting. The ventricular and peritoneal catheter was 6 and 25cm in length. The CSF was clear in character. CranioPerfect 3D CT reconstructed skull plate was used for cranioplasty. Total 5 miniplates and 10 screws(4mm x V, 6mm x V) were used for cranioplasty. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head rotated to left. The scalp was shaved, scrubbed, and disinfected as usual. Traumatic flap scalp incision was made along the operative scar. The scalp flap was elevated and the bone edge of the craniectomy window was identified. Right upper abdomen transferse skin incision was made and minilaparotomy was done. The subcutaneous tunnel from right upper abdomen, forechest, neck, retroauricular area, and connected to craniectomy window was created. The peritoneal catheter was passed through the tunnel. Ventriculostomy to right lateral ventricle via right Kocher"s approach was performed. The V-P shunt was set up and the ventricular catheter was placed into right lateral ventricle. Cranioplasty was performed with CraniPerfect CT 3D reconstructed artificial skull plate and fixed with 5 miniplates and 10 screws. Hemostasis was achieved and two subgaleal CWV drain was placed. The wound was closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators Prof.蔡瑞章 Assistants R4李振豪, Ri楊國生 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: 1. Cranioplasty with CranioPerfect artificial... 開立醫師: 李振豪 開立時間: 2011/07/11 06:28 Pre-operative Diagnosis 1. Right fronto-temporo-parietal skull defect, 2. Hydrocephalus Post-operative Diagnosis 1. Right fronto-temporo-parietal skull defect, 2. Hydrocephalus Operative Method 1. Cranioplasty with CranioPerfect artificial bone graft, 2. Ventriculoperitoneal shunt via right Kocher"s approach Specimen Count And Types 1 piece About size:10ml Source:CSF Pathology Nil Operative Findings The Codman fixed pressure reservoir with 100mmH2O as pressure setting. The ventricular and peritoneal catheter was 6 and 25cm in length. The CSF was clear in character. CranioPerfect 3D CT reconstructed skull plate was used for cranioplasty. Total 5 miniplates and 10 screws(4mm x V, 6mm x V) were used for cranioplasty. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head rotated to left. The scalp was shaved, scrubbed, and disinfected as usual. Traumatic flap scalp incision was made along the operative scar. The scalp flap was elevated and the bone edge of the craniectomy window was identified. Right upper abdomen transferse skin incision was made and minilaparotomy was done. The subcutaneous tunnel from right upper abdomen, forechest, neck, retroauricular area, and connected to craniectomy window was created. The peritoneal catheter was passed through the tunnel. Ventriculostomy to right lateral ventricle via right Kocher"s approach was performed. The V-P shunt was set up and the ventricular catheter was placed into right lateral ventricle. Cranioplasty was performed with CraniPerfect CT 3D reconstructed artificial skull plate and fixed with 5 miniplates and 10 screws. Hemostasis was achieved and two subgaleal CWV drain was placed. The wound was closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators Prof.蔡瑞章 Assistants R4李振豪, Ri楊國生 相關圖片 江朝源 (M,1953/07/31,58y7m) 手術日期 2011/05/05 手術主治醫師 廖漢文 手術區域 東址 000房 號 診斷 Subarachnoid hemorrhage 器械術式 NEURO T.A.E 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 3 時間資訊 08:45 麻醉開始 09:00 誘導結束 12:20 麻醉結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 陳阿選 (F,1932/12/26,79y2m) 手術日期 2011/05/05 手術主治醫師 賴達明 手術區域 東址 002房 01號 診斷 Cerebral aneurysm 器械術式 Right subdural EVD insertion or right subduro-peritoneal shunt implantation 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3E 紀錄醫師 曾峰毅, 時間資訊 03:20 通知急診手術 08:30 報到 08:30 進入手術室 08:35 麻醉開始 08:40 誘導結束 09:23 手術開始 10:25 麻醉結束 10:25 手術結束 10:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室腹腔分流手術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 曾峰毅 開立時間: 2011/05/05 10:42 Pre-operative Diagnosis Bilateral subdural effusion Post-operative Diagnosis Bilateral subdural effusion Operative Method Right subduro-peritoneal shunt Specimen Count And Types Nil Pathology Nil Operative Findings Xanthochromic, clear, subdural effusion gushed out while durotomy. Codman, fixed-pressure valve, 1 cmH20, was used for subdural peritoneal shunt. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to left. After scalp shaved, scrubbed, disinfected, and then draped, we made one transverse skin incision at right frontal area, and drilled one burr hole. We made another transverse skin incision at right upper abdomen for mini-laparotomy. We created subcutaneous tunnel, inserted subdural catheter, peritoneal catheter, and connected it altogether. The wound was closed in layers. Operators VS 賴達明 Assistants R4 曾峰毅 Indication Of Emergent Operation Consciousness disturbance 林勝焞 (M,1959/10/23,52y4m) 手術日期 2011/05/05 手術主治醫師 陳敞牧 手術區域 東址 005房 02號 診斷 Hypertension 器械術式 Microvascular decompression 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 2 紀錄醫師 林哲光, 時間資訊 23:45 臨時手術NPO 14:15 進入手術室 14:20 麻醉開始 14:40 誘導結束 14:58 抗生素給藥 15:00 手術開始 18:00 抗生素給藥 18:50 手術結束 18:50 麻醉結束 19:02 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 腦微血管減壓術 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Microvascular decompression 開立醫師: 林哲光 開立時間: 2011/05/05 20:57 Pre-operative Diagnosis Left hemifacial spasm Post-operative Diagnosis Left hemifacial spasm Operative Method Microvascular decompression Specimen Count And Types nil Pathology Operative Findings Petrosal vein was noted close to the CN7-8 complex and no obvious other vascular lesion was noted near the root exit zone under Microscope except a small branch of AICA was noted near the relatively distal part of the CN7. Teflon felt was packed surrounding the CN 7-8 complex totally. Operative Procedures Under ETGA and right lateral decubitus position, skin disinfected and drapped were performed as usual. Curvilinear skin incision was made at right posterior auricle area. The temporalis muscle and splenic muscle were dissected and the muscles were detached. A burr hole was created at T-S junction and craniotomy was then performed. Dura was then opened and the cerebellomedullary cistern was opened and CSF drainage was done. CN 7-8 complex was then identified and further arachnoid membrane opening was done surrounding the petrosal vein and CN5. The Teflon felt was then packed surrounding the CN7-8 complex. Duroplasty was then performed with Duragen. The wound was then closed in layers after hemostasis and skull bone fixed with mini-plates. Operators VS 陳敞牧 Assistants R4 林哲光 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Microvascular decompression 開立醫師: 林哲光 開立時間: 2011/05/05 20:57 Pre-operative Diagnosis Left hemifacial spasm Post-operative Diagnosis Left hemifacial spasm Operative Method Microvascular decompression Specimen Count And Types nil Pathology Operative Findings Petrosal vein was noted close to the CN7-8 complex and no obvious other vascular lesion was noted near the root exit zone under Microscope except a small branch of AICA was noted near the relatively distal part of the CN7. Teflon felt was packed surrounding the CN 7-8 complex totally. Operative Procedures Under ETGA and right lateral decubitus position, skin disinfected and drapped were performed as usual. Curvilinear skin incision was made at right posterior auricle area. The temporalis muscle and splenic muscle were dissected and the muscles were detached. A burr hole was created at T-S junction and craniotomy was then performed. Dura was then opened and the cerebellomedullary cistern was opened and CSF drainage was done. CN 7-8 complex was then identified and further arachnoid membrane opening was done surrounding the petrosal vein and CN5. The Teflon felt was then packed surrounding the CN7-8 complex. Duroplasty was then performed with Duragen. The wound was then closed in layers after hemostasis and skull bone fixed with mini-plates. Operators VS 陳敞牧 Assistants R4 林哲光 相關圖片 江淑惠 (F,1965/03/05,47y0m) 手術日期 2011/05/05 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 SAH 器械術式 Decompression of mediun nerve 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 韓吟宜 ASA 2 紀錄醫師 李振豪, 時間資訊 23:52 臨時手術NPO 10:00 進入手術室 10:05 麻醉開始 10:10 誘導結束 10:15 抗生素給藥 10:20 手術開始 10:42 手術結束 10:42 麻醉結束 10:50 送出病患 10:53 進入恢復室 11:53 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 正中神經或尺神經腕部減壓術–單側 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 摘要__ 手術科部: 外科部 套用罐頭: Decompression of right median nerve 開立醫師: 李振豪 開立時間: 2011/05/05 10:03 Pre-operative Diagnosis Bilateral carpal tunnel syndrome, status post left median nerve decompression Post-operative Diagnosis Bilateral carpal tunnel syndrome, status post left median nerve decompression Operative Method Decompression of right median nerve Specimen Count And Types nil Pathology Nil Operative Findings The transverse carpal ligament was hypertrophic and calcified which tightly compressed the median nerve. After transection of the transverse carpal ligament, the median nerve was decompressed well. Operative Procedures Under intravenous general anesthesia with Propofol, the patient was put in supine position. The right hand was scrubbed, disinfected, and draped as usual. The L shape skin incision was made at right wrist. The tendon of palmaris longus superficialis was retracted and the transverse carpal ligment was identified. The transverse carpal ligment was transected by knife and scissor. After decompression of the median nerve, hemostasis was checked. The wound was then closed in layers with 4-0 Vicryl and 5-0 Nylon. Operators VS王國川 Assistants R4李振豪, Ri楊國生 相關圖片 劉昇展 (M,1974/01/06,38y2m) 手術日期 2011/05/05 手術主治醫師 黃國皓 手術區域 東址 015房 06號 診斷 Allergic skin 器械術式 Double-J ureteral stent insert 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 靜脈麻醉 麻醉主治醫師 劉治民 ASA 3 紀錄醫師 蘇彥榮, 時間資訊 15:30 報到 15:40 進入手術室 15:45 麻醉開始 15:50 誘導結束 15:55 抗生素給藥 16:04 手術開始 16:15 手術結束 16:15 麻醉結束 16:20 送出病患 16:22 進入恢復室 17:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 手術 雙丁輸尿管導管置入術 1 0 L 記錄__ 手術科部: 泌尿部 套用罐頭: DBJ stent insertion 開立醫師: 蘇彥榮 開立時間: 2011/05/05 16:24 Pre-operative Diagnosis left obstructive uropathy Post-operative Diagnosis left obstructive uropathy Operative Method DBJ replacement Specimen Count And Types nil Pathology nil Operative Findings 7-26 DBJ inserted to left ureter Operative Procedures Under satisfactory anesthesia with the patient in lithotomy position, prepping and drapping was performed in the usual sterile fashion. A Fr 21 Olympus cystoscope was introduced into the bladder cavity under direct vision. Careful inspection was done and DBJ was inserted. Patient tolerated the procedure very well and was sent to recovery room in satisfactory condition. Operators 黃國皓, Assistants 賴建榮, 蘇彥榮, 盧李金葉 (F,1937/06/11,74y9m) 手術日期 2011/05/05 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Hydrocephalus 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3 紀錄醫師 李振豪, 時間資訊 23:40 臨時手術NPO 08:05 進入手術室 08:10 麻醉開始 08:15 誘導結束 08:17 抗生素給藥 08:58 手術開始 09:40 手術結束 09:40 麻醉結束 09:50 送出病患 09:50 進入恢復室 10:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Ventriculo-peritoneal shunt implantation via ... 開立醫師: 李振豪 開立時間: 2011/05/05 09:41 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculo-peritoneal shunt implantation via right Kocher"s point Specimen Count And Types nil Pathology Nil Operative Findings The CSF was clear in color. The Codman programmable valve reservoir was implanted with initial pressure setting as 150mmH2O. The ventricular catheter and peritoneal catheter was 7 and 30cm in length respectively. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head rotated to left. The scalp was shaved, scrubbed, and disinfected as usual. The scalp incision was made at right frontal area followed by one burr hole creation. Two dural tenting was performed. Right upper abdomen transverse skin incision was made and the minilaparotomy was performed to enter the peritoneal cavity. The subcutaneous tunnel from right abdomen, forechest, neck, and retroauricular area was created. One 1.5cm scalp incision was made at right retroauricular area. The peritoneal catheter was introduced through the subcutaneous tunnel. The ventricular catheter and peritoneal catheter was connected to set up the shunt. Cruciform durotomy was performed and the ventriculostomy was performed by puncture needle. The ventricular catheter was placed into right lateral ventricle. The function of the shunt was checked. The peritoneal catheter was placed into peritoneal cavity under direct vision. Hemostasis was achieved. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS王國川 Assistants R4李振豪, Ri楊國生 相關圖片 蕭周秋偉 (F,1926/08/08,85y7m) 手術日期 2011/05/05 手術主治醫師 王國川 手術區域 東址 003房 03號 診斷 Low back pain 器械術式 Laminectomy for decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3 紀錄醫師 李振豪, 時間資訊 23:53 臨時手術NPO 11:02 進入手術室 11:10 麻醉開始 11:25 誘導結束 11:45 抗生素給藥 11:48 手術開始 13:30 手術結束 13:30 麻醉結束 13:40 送出病患 13:45 進入恢復室 14:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術(減壓)-二節以內 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: L3-4, L4-5 laminotomy for decompression 開立醫師: 李振豪 開立時間: 2011/05/05 13:52 Pre-operative Diagnosis Lumbar spondylosis with left sciatica Post-operative Diagnosis Lumbar spondylosis with left sciatica Operative Method L3-4, L4-5 laminotomy for decompression Specimen Count And Types nil Pathology Nil Operative Findings Lumbar spondylosis was severe with rotation of the vertebrae. The facet was hypertrophic and unstable. The ligmentun flavum was hypertrophic and compressed the thecal sac tightly. Foraminotomy was done during the operation for root decompression. One small incidental durotomy was noted during the operation but no root injury found. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position. The L3-4, L4-5 disc space was localized by portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made and the subcutaneous soft tissue was dissected. Paravertebral muscle group was detached to expose L3-5 laminae. L3-4, L4-5 laminotomy was performed for decompression. Hemostasis was achieved and one epidural CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS王國川 Assistants R4李振豪, Ri楊國生 高彩鳳 (F,1954/12/31,57y2m) 手術日期 2011/05/05 手術主治醫師 蔡翊新 手術區域 東址 005房 01號 診斷 Cerebral hemorrhage 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3 紀錄醫師 林哲光, 時間資訊 23:28 臨時手術NPO 08:05 進入手術室 08:10 麻醉開始 08:55 誘導結束 09:10 抗生素給藥 09:15 手術開始 12:10 抗生素給藥 13:50 手術結束 13:50 麻醉結束 13:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4~8小時 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT 開立醫師: 蔡翊新 開立時間: 2011/05/05 13:46 Pre-operative Diagnosis Left temporal ICH, suspected tumor bleeding. Post-operative Diagnosis Left temporal brain tumor with bleeding. Operative Method Left temporal craniotomy for excision of brain tumor. Specimen Count And Types 1 piece, About size: 4 x 4 x 4 cm, Source: brain tumor. Pathology Forzen section: neuronal tumor. Operative Findings Greyish change of cerebral cortex at left inferior gyrus with adhesion to the dura was noted. The brain was initially bulging out after dural opening. There was a 4 x 4 x 4 cm grey-whitish, elastic tumor at left temporal lobe, with ill-defined margins and moderate vascularity. There were hemosiderin depositions at anterior and medial margins. The brain tissue adjacent to the tumor showed edematous change. The brain became slightly slack after tumor excision. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: Curvilinear at left temporal region, centered at the point 4 cm above EAC. Raney clips were applied to the scalp edge for temporary hemostasis. 5. Craniotomy window: 6 x 5 cm, left temporal, created by making 3 burr holes then cut by power saw. 6. Dural tenting: by 2/0 silk, 2 cm in interval, distributed along the edge of skull window. 7. Dural incision: curvilinear along the edge of skull window. 8. Lobectomy: a cerebral cortical incision was made by Greenwood bipolar forceps at left inferior temporal gyrus. The procedure was then carried out deep into white mater. The tumor was resected by bipolar forceps along its vague discernible junction with normal white mater after central debulking. 9. Hemostasis: The hemostasis during the resection ofthe tumor was obtained satisfactorily by bipolar coagulator and suction on the patties packing on the bleeders. The blood oozing point from several locations on thebare surface after lobectomy were packed with Surgicel for complete hemostasis. Finally, the cavity created after lobectomy was irrigated with NS several times and it was perfectly watery clear before the dural closure. 10.Dural closure: continuous suture with 4/0 Prolene to obtain water-tight closure (a piece of fascia was used as dural graft). 11.Closure of skull window: the skull plate was placed back to craniotomy window and fixed by 3 Gage 26 wires. The dura was tented to the center of the skull plate by a 2/0 stitch. The covering muscle was closed by interrupted 1/0 silk stitches. 12.Scalp closure: hemostasis was done with bipolar coagulator. The muscles were approximated by interrupted sutures with 2/0 silk. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 13.Drain: one, epidural, CWV. 14.Blood transfusion: nil. Blood loss: 400 ml. 15.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R4林哲光 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT 開立醫師: 林哲光 開立時間: 2011/05/05 14:21 Pre-operative Diagnosis Left temporal ICH, suspected tumor bleeding. Post-operative Diagnosis Left temporal brain tumor with bleeding. Operative Method Left temporal craniotomy for excision of brain tumor. Specimen Count And Types 1 piece, About size: 4 x 4 x 4 cm, Source: brain tumor. Pathology Forzen section: neuronal tumor. Operative Findings Greyish change of cerebral cortex at left inferior gyrus with adhesion to the dura was noted. The brain was initially bulging out after dural opening. There was a 4 x 4 x 4 cm grey-whitish, elastic tumor at left temporal lobe, with ill-defined margins and moderate vascularity. There were hemosiderin depositions at anterior and medial margins. The brain tissue adjacent to the tumor showed edematous change. The brain became slightly slack after tumor excision. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: Curvilinear at left temporal region, centered at the point 4 cm above EAC. Raney clips were applied to the scalp edge for temporary hemostasis. 5. Craniotomy window: 6 x 5 cm, left temporal, created by making 3 burr holes then cut by power saw. 6. Dural tenting: by 2/0 silk, 2 cm in interval, distributed along the edge of skull window. 7. Dural incision: curvilinear along the edge of skull window. 8. Lobectomy: a cerebral cortical incision was made by Greenwood bipolar forceps at left inferior temporal gyrus. The procedure was then carried out deep into white mater. The tumor was resected by bipolar forceps along its vague discernible junction with normal white mater after central debulking. 9. Hemostasis: The hemostasis during the resection ofthe tumor was obtained satisfactorily by bipolar coagulator and suction on the patties packing on the bleeders. The blood oozing point from several locations on thebare surface after lobectomy were packed with Surgicel for complete hemostasis. Finally, the cavity created after lobectomy was irrigated with NS several times and it was perfectly watery clear before the dural closure. 10.Dural closure: continuous suture with 4/0 Prolene to obtain water-tight closure (a piece of fascia was used as dural graft). 11.Closure of skull window: the skull plate was placed back to craniotomy window and fixed by 3 Gage 26 wires. The dura was tented to the center of the skull plate by a 2/0 stitch. The covering muscle was closed by interrupted 1/0 silk stitches. 12.Scalp closure: hemostasis was done with bipolar coagulator. The muscles were approximated by interrupted sutures with 2/0 silk. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 13.Drain: one, epidural, CWV. 14.Blood transfusion: nil. Blood loss: 400 ml. 15.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R4林哲光 相關圖片 錢嘉明 (M,1951/09/14,60y6m) 手術日期 2011/05/05 手術主治醫師 郭文宏 手術區域 兒醫 066房 06號 診斷 Breast cancer, male 器械術式 M R M +Port-A 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 3 紀錄醫師 陳建銘, 時間資訊 14:20 進入手術室 14:30 麻醉開始 14:35 誘導結束 14:40 抗生素給藥 14:50 手術開始 17:40 抗生素給藥 18:10 手術結束 18:10 麻醉結束 18:15 送出病患 18:20 進入恢復室 19:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 手術 port–A導管植入術–治療性導管植入術 1 0 L 手術 腋窩淋巴腺清除術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: 1.ALND 開立醫師: 黃凱傑 開立時間: 2011/05/05 18:03 Pre-operative Diagnosis Right breast cancer Post-operative Diagnosis Right breast cancer Operative Method 1.ALND 2.Port-A catheter implantation by Puncture method Specimen Count And Types right axilla lymph node level I and II Pathology pending Operative Findings 1.the tip of Port-A was over RV and SVC 2.right axilla lymph node level I and II were all dissected Operative Procedures 1. ETGA, supine 2. Skin disinfection and draping 3. skin incision 4. Performed ALND, 5. Hemostasis, normal saline irrigation 7. Set CWV and close wound in layers 8. Port-A catheter implantation by Puncture method via left jugular vein 9. check the position of Port-A by CXR 10.close wound in layers Operators 郭文宏 Assistants R4黃凱傑 R2陳建銘 陳佳昕 (F,1968/12/24,43y2m) 手術日期 2011/05/06 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Carotid body tumor 器械術式 Carotid body tumor excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 王奐之, 時間資訊 23:50 臨時手術NPO 08:06 進入手術室 08:10 麻醉開始 08:20 誘導結束 09:35 抗生素給藥 09:38 手術開始 12:35 抗生素給藥 12:45 手術結束 12:45 麻醉結束 12:50 送出病患 12:55 進入恢復室 13:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 臉部腫瘤切除術直徑大於2CM 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: Tumor excision 開立醫師: 王奐之 開立時間: 2011/05/06 13:02 Pre-operative Diagnosis Right neck tumor Post-operative Diagnosis Right neck tumor, suspected neuroma from ansa cervicalis Right neck tumor, suspected neuroma from vagus nerve or ansa cervicalis Operative Method Tumor excision Specimen Count And Types 1 piece About size:3*2*2cm Source:right neck tumor Pathology Pending Operative Findings An elastic purplish tumor was noted at carotid bifurcation, with some adhesion to the carotid artery but easily dissected and was well encapsulated. Several small feeders and draining vessels were noted but the tumor was generally not rich vascularized. Dissection around the tumor revealed some nerve roots entering the tumor, suspect roots from ansa cervicalis. After tumor removal, the tumor capsule was left in place. Hypoglossal nerve was noted intra-operatively and well preserved. An elastic purplish tumor was noted at carotid bifurcation, with some adhesion to the carotid artery but easily dissected and was well encapsulated. Several small feeders and draining vessels were noted but the tumor was generally not rich vascularized. Dissection around the tumor revealed some nerve roots entering the tumor, suspect roots from vagus nerve or ansa cervicalis. After tumor removal, the tumor capsule was left in place. Hypoglossal nerve was noted intra-operatively and well preserved. Operative Procedures After ETGA, the patient was placed in supine position with head turned to left and neck hyperextended. After skin disinfection & draping in sterile fashion, an oblique incision was made below right mandibular angle. The incision was deepened to expose the carotid bifurcation. Dissection around the tumor revealed some nerve roots entering the tumor, the tumor was then removed from intra-capsule in piecemeal fashion with tumor forceps. After tumor removal, meticulous hemostasis was achieved. After setting 1 mini-hemovac, the wound was closed in layers. Operators P.杜永光 Assistants R6 胡朝凱, R3 王奐之 相關圖片 王美玲 (F,1973/05/13,38y10m) 手術日期 2011/05/06 手術主治醫師 曾漢民 手術區域 東址 001房 05號 診斷 Brain tumor 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 王永彬 ASA 3E 紀錄醫師 曾漢民, 時間資訊 14:00 開始NPO 14:00 臨時手術NPO 15:30 通知急診手術 21:40 報到 21:57 進入手術室 22:00 麻醉開始 22:20 誘導結束 22:45 手術開始 23:20 麻醉結束 23:20 手術結束 23:25 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室體外引流 1 2 記錄__ 手術科部: 外科部 套用罐頭: Right Kocher point EVD insertion 開立醫師: 胡朝凱 開立時間: 2011/05/06 23:42 Pre-operative Diagnosis Acute hydrocephalus Post-operative Diagnosis Acute hydrocephalus Operative Method Right Kocher point EVD insertion Specimen Count And Types CSF specimen x 3 tubes Pathology nil Operative Findings 1.Clear CSF 2.Opening pressure : about 20 cmH2O 3.Intraventricular catheter: 6.2 cm Operative Procedures 1.ETGA, supine 2.Right frontal transverse skin incision 3.Dissect to open skin flap 4.Burr hole drill 5.Dural tenting 6.Dural incision 7.Ventricular puncture then catheter insertion 8.Fixed EVD 9.Close wound in layers Operators VS 曾漢民 Assistants 胡朝凱 Indication Of Emergent Operation conscious deterioration 葉順鎮 (M,1938/06/05,73y9m) 手術日期 2011/05/06 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Pituitary tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 邱裕淳, 時間資訊 07:48 報到 08:05 進入手術室 08:10 麻醉開始 08:40 誘導結束 08:45 抗生素給藥 09:08 手術開始 10:10 手術結束 10:10 麻醉結束 10:15 送出病患 22:23 臨時手術NPO 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 經由蝶竇之腦下垂體瘤切除 1 1 L 手術 鼻中膈鼻道成形術-單側 1 2 L 摘要__ 手術科部: 創傷醫學部 套用罐頭: Microscopic trans-sphenoid tumor remove 開立醫師: 陳睿生 開立時間: 2011/05/06 10:30 Pre-operative Diagnosis Pituitary macroadenoma Post-operative Diagnosis Pituitary macroadenoma Operative Method Microscopic trans-sphenoid tumor remove Specimen Count And Types 1 piece About size:pieces Source:tumor Pathology Pending Operative Findings The tumor was whitish, soft, and well capsuled. The right side cavernous sinus was also involved. The normal gland was pushed to the left side. After totally remove of the tumor, the arachnoid membrane fell, and mild CSF leakage was found. The bony sellar floor was found to be erosed by the tumor. Operative Procedures 1. ETGA, supine position and head mild right turn 2. We expand the left side nasal canal, and the mucosal septum was incised 3. The bony septum was pulled to the contralateral side, and the vomer bone was identified 4. The anterior sinusal wall was opened and the sinusal mucosa was removed 5. The sellar floor was found and the dura was opened 6. The tumor was found while dura opening 7. The capsule was carefully dissected from the dura and normal gland 8. It was removed piece by piece 9. Hemostasis, and the sellar cavity was packed with gelfoam and Tissuco Duo 10.The sinusal wall defect was packed with bone graft 11.The mucosa was attached back and the left nasal cavity was packed with plastic bag Operators VS 曾漢民 Assistants R6 陳睿生, R1 邱裕淳 高進儀 (M,1937/12/14,74y3m) 手術日期 2011/05/06 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 邱裕淳, 時間資訊 23:25 臨時手術NPO 09:51 報到 10:35 進入手術室 10:40 麻醉開始 11:20 抗生素給藥 11:20 誘導結束 11:29 手術開始 13:05 開始輸血 14:20 抗生素給藥 16:00 麻醉結束 16:00 手術結束 16:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除-手術時間在4~8小時 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Interhemispheric approach for Simpson grade I... 開立醫師: 陳睿生 開立時間: 2011/05/06 16:50 Pre-operative Diagnosis Left occipital tumor, suspect tentorial meningioma Left occipital tumor, suspect falcine meningioma Post-operative Diagnosis Left occipital tumor, suspect tentorial meningioma Left occipital tumor, suspect falcine meningioma Operative Method Interhemispheric approach for Simpson grade III nearly total tumor remove Specimen Count And Types 1 piece About size:pieces Source:Tumor Pathology Pending Operative Findings The tumor was soft, easy suckable, whitish, and well capsuled. It was a well vascularized one and massive intra-op bleeding was noted. We accessed the tumor via left posterior 1/3 interhemispheric approach. After nearly total tumor remove, the bleeding was stopped. No obvious feeding arteries was noted. Multiple arachnoid ville was noted around the superior sagittal sinus. Operative Procedures 1. ETGA, prone position; head was mild extension and fixed with Mayfield clump 2. Left posterior inverse U scalp incision 3. 6 bur holes were made and an about 10x10 cm craniotomy window was created; the window was across the superior sagittal sinus 4. Hemostasis for sinusal bleeding with gelfoam and Floseal 5. Dura tenting and the dura was opened and we approach the tumor after proper retraction of the left occipital lobe 6. Tumor debulking was done with bipolar, suckion and tumor forceps 7. The tumor capsule was carefully dissected from brain parychema 8. Hemostasis with surgicel and Floseal 9. The dura was tightly closed with fascia graft 10.The skull graft was fixed back with miniplatesx3, and proper central tenting was done 11.A subgaleal CWV drain was set, and the wound was closed in layers Operators VS 曾漢民 Assistants R6 陳睿生, R1 邱裕淳 呂美芳 (F,1932/10/26,79y4m) 手術日期 2011/05/06 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 HIVD 器械術式 Diskectomy cervical(Anterier), C5/6 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 全賀顯, 時間資訊 23:19 臨時手術NPO 08:15 麻醉開始 08:17 進入手術室 08:25 誘導結束 09:00 抗生素給藥 09:09 手術開始 11:31 手術結束 11:31 麻醉結束 11:45 送出病患 11:50 進入恢復室 13:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-頸椎 1 1 手術 脊椎融合術-前融合,有固定物)≦四節 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: Anterior Discectomy and Fusion, Cervical Spine 開立醫師: 曾峰毅 開立時間: 2011/05/06 11:37 Pre-operative Diagnosis C5/6 kyphotic degeneration with cord compression Post-operative Diagnosis C5/6 kyphotic degeneration with cord compression Operative Method C5 corpectomy, fusion with trabecular metal cage and autologous bone graft, anterior fixation with plates and screws. Specimen Count And Types Nil Pathology Nil Operative Findings Cord was decompressed well after corpectomy. Zimmer trabecular metal cage, 18.5 mm in height, was used for fusion. Synthes, plate, 28 mm in length, was used for fixation. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with neck extended. We made one transverse skin incision at right anterior neck and dissected to expose prevertebral space from C4 to C6. We performed C5 corpectomy following C4/5 and C5/6 discectomy. Fusion was achieved with trabecular metal cage, and fixation was done with plate. After one mini-hemovac, the wound was closed in layers. Operators VS 賴達明 Assistants R4 曾峰毅 R1 全賀顯 廖永明 (M,1967/11/15,44y3m) 手術日期 2011/05/06 手術主治醫師 賴達明 手術區域 東址 019房 02號 診斷 Cervical Spondylosis 器械術式 Diskectomy cervical(Anterier) C5/6, C6/7 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 2 紀錄醫師 全賀顯, 時間資訊 12:08 進入手術室 12:15 麻醉開始 12:25 誘導結束 12:30 抗生素給藥 12:54 手術開始 15:45 麻醉結束 15:45 手術結束 15:55 送出病患 15:58 進入恢復室 17:10 離開恢復室 23:21 臨時手術NPO 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 手術 椎間盤切除術-頸椎 1 1 手術 脊椎融合術-前融合,有固定物)≦四節 1 2 摘要__ 手術科部: 外科部 套用罐頭: Anterior Discectomy and Fusion, Cervical Spine 開立醫師: 曾峰毅 開立時間: 2011/05/06 15:45 Pre-operative Diagnosis HIVD, C5/6 and C6/7 Post-operative Diagnosis HIVD, C5/6 and C6/7 Operative Method Anterior discectomy of C5/6 and C6/7, fusion with PEEK cage and artificial bone graft Specimen Count And Types Nil Pathology Nil Operative Findings Synthes PEEK cervical cage, 8 mm in height was inserted into C6/7 intervertebral space, and 7 mm in height, into C5/6. Thecal sac was decompressed well after discectomy. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with neck extended. We made one transverse skin incision at right anterior neck and dissected to expose prevertebral space from C5 to C7. We performed C5/6 and C6/7 discectomy. Fusion was achieved with PEEK cage with artificial bone graft. After one mini-hemovac, the wound was closed in layers. Operators 賴達明 Assistants R4 曾峰毅 R1 全賀顯 李碧珠 (F,1946/08/16,65y6m) 手術日期 2011/05/06 手術主治醫師 陳敞牧 手術區域 東址 002房 01號 診斷 Female breast cancer 器械術式 T5 Laminectomy for decompression, epidural tumor removal and TPS 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 林哲光, 時間資訊 23:09 臨時手術NPO 23:09 開始NPO 23:12 通知急診手術 08:30 報到 08:47 進入手術室 08:55 麻醉開始 09:25 誘導結束 09:45 抗生素給藥 10:25 手術開始 10:58 開始輸血 12:45 抗生素給藥 13:00 手術結束 13:00 麻醉結束 13:10 送出病患 13:20 進入恢復室 15:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 惡性脊髓腫瘤切除術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 椎弓切除術(減壓)-超過二節 1 2 記錄__ 手術科部: 外科部 套用罐頭: T3-6 laminectomy with tumor excision 開立醫師: 林哲光 開立時間: 2011/05/06 13:39 Pre-operative Diagnosis T5 epidural tumor with cord compression Post-operative Diagnosis T3-6 epidural tumor with cord compression Operative Method T3-6 laminectomy with tumor excision Specimen Count And Types 1 piece About size:mutliple pieces Source:tumor Pathology Pending Operative Findings Soft-elastic, reddish, epidural tumor were noted at T3-6 epidural space with cord compression and extending to the bilateral neural foramen. The dura seemed good re-expanded after tumor removal. Easily touch bleeding of the tumor was noted. Operative Procedures Under ETGA and prone position, skin disinfected and drapped were performed as usual. Midline skin incision was made at T3-7 level after C-arm localization. Paraspinal muscles were detached and T3-6 laminectomy was then performed. Epidural tumor was removed along the plane of the healthy dura and grossly total removal was done. Hemostasis was then done with Gelfoam packing. The wound was then closed in layers after epidural drain insertion. Operators VS 陳敞牧 Assistants R4 林哲光 Indication Of Emergent Operation 相關圖片 黃俊嘉 (M,1971/11/26,40y3m) 手術日期 2011/05/06 手術主治醫師 楊士弘 手術區域 東址 003房 02號 診斷 Bacterial meningitis 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 王奐之, 時間資訊 23:52 臨時手術NPO 13:10 進入手術室 13:15 麻醉開始 13:20 誘導結束 13:30 抗生素給藥 14:13 手術開始 15:00 手術結束 15:00 麻醉結束 15:08 進入恢復室 15:10 送出病患 15:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 2 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt insertion via righ... 開立醫師: 王奐之 開立時間: 2011/05/06 15:25 Pre-operative Diagnosis Bacterial meningitis with hydrocephalus Post-operative Diagnosis Bacterial meningitis with hydrocephalus Operative Method Ventriculoperitoneal shunt insertion via right Kocher point Specimen Count And Types Nil Pathology Nil Operative Findings Dirty skin with excessive scaling was noted over scalp, shoulder and chest. Clear CSF was noted after ventricular puncture. Smooth CSF flow through reservoir and to peritoneal catheter was confirmed. A 130mmH2O Codman reservoir was used. Operative Procedures After ETGA, the patient was placed in supine position with head turned to left. After vigorous skin scrubbing, disinfection & draping in sterile fashion, incision along previous scalp & abdominal wound was done. Mini-laparotomy was done, followed by creation of subcutaneous tunnel. After passing the catheter through the subcutaneous tunnel, the catheter and reservoir were assembled. The ventricular catheter was inserted via previous EVD tract, and peritoneal catheter was also inserted after confirmation of smooth CSF flow. After hemostasis, the wounds were closed in layers. Operators VS 楊士弘 Assistants R6 胡朝凱, R3 王奐之 相關圖片 葉永隆 (M,1941/05/21,70y9m) 手術日期 2011/05/06 手術主治醫師 楊士弘 手術區域 東址 005房 03號 診斷 Subdural hemorrhage 器械術式 Removal of subacute subdural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 王永彬 ASA 4 紀錄醫師 胡朝凱, 時間資訊 16:48 通知急診手術 17:53 報到 18:05 進入手術室 18:15 麻醉開始 18:35 誘導結束 18:54 手術開始 19:00 開始輸血 20:45 麻醉結束 20:45 手術結束 20:53 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 麻醉 Glucose 1 0 手術 急性硬腦膜下血腫清除術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 記錄__ 手術科部: 復健部 套用罐頭: Left trephination for hematoma e\removal 開立醫師: 胡朝凱 開立時間: 2011/05/06 21:06 Pre-operative Diagnosis Left acute on chronic SDH Post-operative Diagnosis Left acute on chronic SDH Operative Method Left trephination for hematoma e\removal Specimen Count And Types nil Pathology nil Operative Findings 1. Some motor ol old blood was drained out after dural opening 2. About 1 cm in thick hematoma was also noted at left frontal-temporal-parietal area 3. The brain was compressed by the hematoma. After hematoma removal, it expanded mildly. 4. Outer membrane (+), no inner membrane Operative Procedures 1.ETGA, supine with head rotate to right 2.Linear incision at left temporal to parietal area 3.Dissect skin, muscle flap and periosteum 4.Trephination was made 5.Cruciate form dural incision 6.hematoma removal 7.Insert a rubber drain 8.Close dura 9.Fixed rubber drain then close wound in layers 10.De-air Operators VS 楊士弘 Assistants 胡朝凱 Indication Of Emergent Operation conscious deterioration 蔡崇凱 (M,1932/11/12,79y4m) 手術日期 2011/05/06 手術主治醫師 余宏政 手術區域 西址 039房 10號 診斷 Bladder cancer 器械術式 Fiberocystoscopy /WOR 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 11:30 進入手術室 11:32 麻醉開始 11:34 誘導結束 11:35 手術開始 11:38 手術結束 11:38 麻醉結束 11:40 送出病患 張貴英 (F,1949/11/04,62y4m) 手術日期 2011/05/06 手術主治醫師 吳明勳 手術區域 東址 006房 03號 診斷 Peptic ulcer, acute, with perforation 器械術式 Exploratory laparatomy 手術類別 緊急手術 手術部位 腹 傷口分類 污染 麻醉方式 全身麻醉 麻醉主治醫師 王永彬 ASA 4E 紀錄醫師 吳昭瑩, 時間資訊 08:06 開始NPO 08:06 臨時手術NPO 19:05 通知急診手術 19:05 進入手術室 19:05 報到 19:10 麻醉開始 19:20 誘導結束 19:40 手術開始 21:45 麻醉結束 21:45 手術結束 21:55 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腹腔內膿瘍引流術治療急性穿孔性腹膜炎 1 1 手術 膽囊切除術 1 2 麻醉 Peripheral arterial line inserti 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 外科部 套用罐頭: 1.Repair of duodenal perforation; 2.Cholecyst... 開立醫師: 鄭宗杰 開立時間: 2011/05/06 21:29 Pre-operative Diagnosis Hollow organ perforation, with septic shock Post-operative Diagnosis Perforated duodenal ulcer, with 2nd inflammatory and gangrenous change of gall bladder Operative Method 1.Repair of duodenal perforation; 2.Cholecystectomy; 3.Drainage of intraabdominal abscess; 4.Feeding jejunostomy Specimen Count And Types Gall bladder Pathology Pending Operative Findings 1.Massive turbid ascites, with much fibrin coating bands, accumulated within four quadrants of peritoneal cavity, especially over subhepatic area. 2.One 3 x 1.5 cm longitudinal perforated duodenal ulcer noted over 1st portion of duodenum; chronic inflammatory change and granulation tissue formation was noted 3.The gall bladder was densely adhesed on to duodenal surface and forming a cover layer onto the perforation site. Secondary inflammatory and gangrenous change of gall bladder also identified. 4.On huge hepatic mass also palpable during operation, hemagioma was considered first Operative Procedures 1.ETGA, supine, skin sterize 2.Midline laparotomy 3.Intraabdominal inspection, identify perforation site 4.Cholecystectomy 5.Perform partial Kaukers maneuver to mobilize duodenum 6.Transvere repair for the duodenal perforation in two layer fashion. The transmural whole layer was sutured with 2-0 Silk interrupt stitches, and the seromusculalr layer was running by 2-0 Surgelene 7.Apply omental patch 8.Massive N/S irrigation, set four rubber drain tubes over Right subphrenic space, subhepatic area, left subphrenic space, left Douglas pouch 9.Create feeding jejunostomy with 18# silicon NG tube 10.Wound closure Operators VS吳明勳 Assistants R4廖御佐, R1吳昭瑩, R5鄭宗杰 Indication Of Emergent Operation Peititonitis with septic shock 林慶全 (M,1965/08/27,46y6m) 手術日期 2011/05/07 手術主治醫師 蔡瑞章 手術區域 東址 003房 02號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 3 紀錄醫師 吳昭瑩, 時間資訊 00:00 臨時手術NPO 12:15 報到 12:24 進入手術室 12:30 麻醉開始 12:40 抗生素給藥 12:45 誘導結束 12:58 手術開始 17:15 麻醉結束 17:15 手術結束 17:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除-手術時間在4~8小時 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for Simpson^s grade I tumor remove 開立醫師: 陳睿生 開立時間: 2011/05/07 18:01 Pre-operative Diagnosis Right frontal convexity meningioma Post-operative Diagnosis Right frontal convexity meningioma Operative Method Craniotomy for Simpson^s grade I tumor remove Specimen Count And Types 1 piece About size:pieces Source:tumor Pathology Pending Operative Findings The tumor was soft, mild reddish, and well capsuled. The diameter was about 6.5cm. IT was firmly attached to the high frontal dura, and mild hyperosteosis was alos noted. The dura involved was removed totally, and the dural defect was repaired with artificial graft. Operative Procedures 1. ETGA, supine position and head left turn, fixed with Mayfield clump 2. Inverse U scalp incision 3. Four bur holes made, and then an about 12x15 cm craniotomy window was done 4. The tumor was identified and then the dura was opened along the tumor margin 5. The plane between the tumor capsule and brain parychema was carefully exposed 6. The tumor was then removed piece by piece, and the dura involved was also removed 7. Hemostasis, the dura defect was repaired with artifical graft 8. The skull graft was fixed back with 4 gages of wires, and central tenting was also done 9. Set a subgaleal CWV drain, and the wound was closed in layers Operators P 蔡瑞章 Assistants R6 陳睿生, R1 吳昭瑩 陳麗雲 (F,1950/12/20,61y2m) 手術日期 2011/05/07 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 3 紀錄醫師 陳睿生, 時間資訊 23:01 臨時手術NPO 08:00 進入手術室 08:10 麻醉開始 08:40 誘導結束 08:40 抗生素給藥 08:48 手術開始 10:00 開始輸血 11:40 抗生素給藥 13:35 手術結束 13:35 麻醉結束 13:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4~8小時 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 麻醉 Glucose 2 0 摘要__ 手術科部: 外科部 套用罐頭: Pterional approach for nearly total tumor remove 開立醫師: 陳睿生 開立時間: 2011/05/07 14:07 Pre-operative Diagnosis Left temporal tumor, suspect meningioma, suspect metastasis Post-operative Diagnosis Left temporal tumor, suspect meningioma, suspect metastasis Operative Method Pterional approach for nearly total tumor remove Specimen Count And Types 1 piece About size:pieces Source:tumor Pathology Pending Operative Findings The tumor was grayish, solid, soft and capsulized. It located at the left temporal region and the plane between the temporal and the tumor was not very clear. It was a well vascularized one and the feeding arteries were noted from the dura and the sylvian region. The temporal bone beneath to the tumor was also hypervascularized. A small piece of the tumor attached to the sylvian fissure was left due to the risk. Operative Procedures 1. ETGA, supine position and head right turn, fixed with Mayfield clump 2. Left frontotemporal curvillinear scalp incision 3. After proper facial nerve preservation, the temporalis muscle was dissected 4. Three bur holes made, and an about 10x12 cm craniotomy window was created 5. The temporal bone was removed till the temporal base was achieved 6. The dura was tented and opened curvillinearly; the tumor was noted at the temporal tip region 7. The tumor was carefully dissected from the dura 8. The feeding arteries were electroligated, and cut down 9. The tumor was removed piece by piece with proper hemostasis 10.The dura was tightly closed with fascia graft 11.The skull graft was fixed back with miniplates x3, central tented 12.Set an epidural CWV drain, and the wound was closed in layers Operators VS 曾勝弘 Assistants R6 陳睿生, Ri 許渟珮 (F,1974/12/29,37y2m) 手術日期 2011/05/07 手術主治醫師 楊士弘 手術區域 東址 005房 01號 診斷 Pituitary tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 2 紀錄醫師 吳昭瑩, 時間資訊 23:03 臨時手術NPO 07:50 報到 08:03 進入手術室 08:10 麻醉開始 08:42 抗生素給藥 08:50 誘導結束 09:17 手術開始 11:42 抗生素給藥 11:45 麻醉結束 11:45 手術結束 11:55 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 麻醉 Glucose 1 0 手術 經由蝶竇之腦下垂體瘤切除 1 1 記錄__ 手術科部: 外科部 套用罐頭: Endoscopic trans-sphenoid adenomectomy 開立醫師: 胡朝凱 開立時間: 2011/05/07 12:08 Pre-operative Diagnosis pITUITARY MACROADENOMA Post-operative Diagnosis pITUITARY MACROADENOMA Operative Method Endoscopic trans-sphenoid adenomectomy Specimen Count And Types pituitary tumor pieces Pathology pending Operative Findings 1.One about 2.1 cm yellowish located in sella turcica and push the normal gland to left side. 2.One small part of tumor compressed into right cavernous sinus, but it was removed totally. 3.Arachnoid membrane was identified and intact. No CSF leakage. Operative Procedures 1.ETGA, supine 2.bilateral nostril approach 3.Coagulated the mucosa 4.drill nasal bone and the sphenoid sinus anterior wall 5.remove mucosa 6.Drill of sella floor 7.open dura 8.dissect and remove tumor 9.hemostasis 10.packing with gelfoam Operators VS 楊士弘 Assistants 胡朝凱 翁芷香 (F,1932/12/11,79y3m) 手術日期 2011/05/07 手術主治醫師 蔡清霖 手術區域 東址 022房 01號 診斷 Femoral intertrochanteric fracture, closed 器械術式 ORIF CHS 手術類別 臨時手術 手術部位 四肢 傷口分類 清潔 麻醉方式 脊髓麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 范垂嘉, 時間資訊 22:38 臨時手術NPO 07:35 報到 08:00 進入手術室 08:25 麻醉開始 08:25 抗生素給藥 08:35 誘導結束 09:25 手術開始 09:55 開始輸血 10:35 手術結束 10:35 麻醉結束 10:40 送出病患 10:42 進入恢復室 12:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Spinal anesthesia 1 0 手術 部份關節置換術併整形術–只置換髖臼或股骨或半股關節或半肩關節 1 1 L 摘要__ 手術科部: 骨科部 套用罐頭: Bipolar hemiarthroplasty with United prothesis 開立醫師: 范垂嘉 開立時間: 2011/05/07 10:52 Pre-operative Diagnosis Left femoral neck fracture, Garden IV Post-operative Diagnosis Left femoral neck fracture, Garden IV Operative Method Bipolar hemiarthroplasty with United prothesis Specimen Count And Types nil Pathology nil Operative Findings Left femoralneck fracture, transcervical, completely displaced was shown on traction view Operative Procedures 1.Anesthesia induction, supine on fracture table 2.Apply traction and examination under C-arm 3.Shift to right decubitus position 4.Anterolateral approach to the hip 5.Saw the residual neck and prepare the femoral canal 6.Remove the femoral head and neck 7.Apply the stem (#5/12mm) without cement 8.Assemble the head(45/26mm) and reduce the joint 9.Irrigation and closure Operators 蔡清霖 Assistants 陳勇璋,范垂嘉,傅紹懷 陳榮樹 (M,1939/11/01,72y4m) 手術日期 2011/05/08 手術主治醫師 楊士弘 手術區域 東址 018房 01號 診斷 Subdural hemorrhage 器械術式 Burr hole (trephination) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 3E 紀錄醫師 林哲光, 時間資訊 21:00 臨時手術NPO 21:00 開始NPO 21:43 通知急診手術 08:55 進入手術室 09:00 麻醉開始 09:15 抗生素給藥 09:20 誘導結束 09:55 手術開始 10:50 麻醉結束 10:50 手術結束 10:55 送出病患 11:00 進入恢復室 12:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 慢性硬腦膜下血腫清除術 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Left frontal burr hole drainage of chronic SDH 開立醫師: 林哲光 開立時間: 2011/05/08 11:21 Pre-operative Diagnosis Left F-T-P chronic SDH Post-operative Diagnosis Left F-T-P chronic SDH Operative Method Left frontal burr hole drainage of chronic SDH Specimen Count And Types Nil Pathology Operative Findings Motor-oil like fluids gushed out after outer membrane opened. No obvious inner membrane was noted. The brain seemed no re-expanded well after drainage. Operative Procedures Under ETGA and supine position with head mild rotated to right side, skin disinfected and drapped were performed as usual. Transverse skin incision was made at left frontal area and a burr hole was then done with high-speed driller. The dura was opened after dural tenting and the outer membrane was opened and cauterized. Deair was done. The wound was then closed in layers after a subdural drain was inserted. Operators VS 楊士弘 Assistants R4 林哲光 Indication Of Emergent Operation Chronic SDH with compression sign and left hemiparesis 相關圖片 陳黃明 (M,1983/08/14,28y7m) 手術日期 2011/05/09 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Acromegaly 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 邱裕淳, 時間資訊 23:02 臨時手術NPO 08:00 進入手術室 08:08 麻醉開始 08:18 誘導結束 09:00 抗生素給藥 09:20 手術開始 10:20 手術結束 10:20 麻醉結束 10:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經由蝶竇之腦下垂體瘤切除 1 1 R 手術 鼻中膈鼻道成形術-單側 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Microscopic trans-sphenoid tumor remove 開立醫師: 陳睿生 開立時間: 2011/05/09 10:45 Pre-operative Diagnosis Pituitary macroadenoma Post-operative Diagnosis Pituitary macroadenoma Operative Method Microscopic trans-sphenoid tumor remove Specimen Count And Types 1 piece About size:pieces Source:tumor Pathology Pending Operative Findings The tumor was whitish, soft, and fragile. The left side cavernous sinus was also involved. The normal gland was pushed to the right side. After totally remove of the tumor, the arachnoid membrane fell. Operative Procedures 1. ETGA, supine position and head mild right turn 2. We expand the left side nasal canal, and the mucosal septum was incised 3. The bony septum was pulled to the contralateral side, and the vomer bone was identified 4. The anterior sinusal wall was opened and the sinusal mucosa was removed 5. The sellar floor was found and the dura was opened 6. The tumor was found while dura opening 7. The tumor was carefully dissected from the dura and normal gland 8. It was removed piece by piece 9. Hemostasis, and the sellar cavity was packed with gelfoam and Tissuco Duo 10.The sinusal wall defect was packed with bone graft 11.The mucosa was attached back and the left nasal cavity was packed with plastic bag Operators VS 曾漢民 Assistants R6 陳睿生, R1 邱裕淳 麗青 (F,1972/03/21,39y11m) 手術日期 2011/05/09 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Acoustic tumor 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 邱裕淳, 時間資訊 23:10 臨時手術NPO 10:40 進入手術室 10:50 麻醉開始 11:30 誘導結束 12:10 抗生素給藥 12:21 手術開始 15:10 手術結束 15:10 麻醉結束 15:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 顱底瘤手術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Retrosigmoid approach for subtotal tumor remove 開立醫師: 陳睿生 開立時間: 2011/05/09 15:41 Pre-operative Diagnosis Right CP angle tumor, suspect acoustic neuroma Post-operative Diagnosis Right CP angle tumor, suspect acoustic neuroma Operative Method Retrosigmoid approach for subtotal tumor remove Specimen Count And Types 1 piece About size:pieces Source:tumor Pathology Pending Operative Findings The tumor was yellow-whitish, soft, and moderately vascularized. It was noted to be originated from the lateral aspect of CN VII, VIII complex. The low cranial nerves were compressed inferiorly, and the trigeminal nerve was pushed upward. The facial nerve could not be well identified under stimulation. A small piece of the tumor was left due to firmly attach to the peripheral nerves. Operative Procedures 1. ETGA, prone position and head left turn, fix by Mayfield clump 2. Curvillinear scalp incision was done at right retroauricular region 3. Fascia graft was extracted 4. A bur hole was made at astron, and then an about 6x6 cm craniotomy window was done 5. The transverse sinus and sigmoid sinus were exposed, and the dura was opened in a K shape 6. CSF was drained fromed cistern magnum for decompression 7. The cerebellum was retracted posteriorly and the tumor was identified 8. The arachnoid membrane was dissected and central debulking of the tumor was done 9. We tried to perform facial nerve stimulation but failed 10.A small piece of the tumor was left due to firmly attach to the peripheral nerves 11.Hemostasis, the dura was tightly closed with fascia graft 12.The skull graft was fixed back with miniplates x3 13.The wound was closed in layers Operators VS 曾漢民 Assistants R6 陳睿生, R1 邱裕淳 陳秀華 (F,1957/05/09,54y10m) 手術日期 2011/05/09 手術主治醫師 曾漢民 手術區域 東址 002房 03號 診斷 Benign neoplasm of bones of skull and face 器械術式 Cranioplasty - Skull tumor excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 邱裕淳, 時間資訊 23:13 臨時手術NPO 15:10 報到 15:18 進入手術室 15:25 麻醉開始 15:32 誘導結束 16:30 抗生素給藥 16:39 手術開始 17:15 手術結束 17:15 麻醉結束 17:22 送出病患 17:25 進入恢復室 20:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 頭皮腫瘤 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Tumor excision-Facial 開立醫師: 邱裕淳 開立時間: 2011/05/09 17:26 Pre-operative Diagnosis Right facial subcutaneous tumor Post-operative Diagnosis Right facial subcutaneous tumor Operative Method Facial tumor excision Specimen Count And Types 1 piece About size:0.5*0.5cm Pathology Pending Operative Findings One 0.5 x 0.5 cm yellowish subcutaneous tumor noted over Operative Procedures 1)The patient lied in supine position. 2)Antiseptics applied and drapped as usual. 3)Linear skin incision over border of hair line . 4)Dissection via subcutaneous approach to exposed tumor. 5)Tumor excision performed and normal saline irrigation. 6)Wound closure in layers Operators VS 曾漢民 Assistants R6 陳睿生 R1邱裕淳 陳立軒 (M,1985/06/28,26y8m) 手術日期 2011/05/09 手術主治醫師 賴達明 手術區域 東址 003房 03號 診斷 Intracerebral hemorrhage (ICH) 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 胡朝凱, 時間資訊 23:01 臨時手術NPO 14:18 進入手術室 14:29 麻醉開始 14:45 誘導結束 14:59 抗生素給藥 15:13 手術開始 17:45 手術結束 17:45 麻醉結束 17:50 送出病患 17:52 進入恢復室 19:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 頭顱成形術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Left cranioplasty with autologous bone 開立醫師: 胡朝凱 開立時間: 2011/05/09 17:57 Pre-operative Diagnosis left skull defect Post-operative Diagnosis left skull defect Operative Method Left cranioplasty with autologous bone Specimen Count And Types nil Pathology nil Operative Findings 1.Left skull defect about 20x18 cm 2.Brain was mild swelling Operative Procedures 1.ETGA, supine with head rotate to right 2.Left previous wound incision 3.Dissect skin flap along with the interface between dura and periosteum 4.dissec temporalis muscle 5.Fixed bone back with miniplate 6.set two CWV drain 7.Hemostasis 8.Close wound in layers Operators VS 賴達明 Assistants 胡朝凱, Ri 許文清 (M,1965/04/05,46y11m) 手術日期 2011/05/09 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Herniation of intervertebral disc with myelopathy, cervical (HIVD) 器械術式 Diskectomy cervical(Anterier) C5/6 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 2 紀錄醫師 胡朝凱, 時間資訊 23:55 臨時手術NPO 08:06 進入手術室 08:12 麻醉開始 08:25 誘導結束 08:47 抗生素給藥 09:13 手術開始 11:00 手術結束 11:00 麻醉結束 11:05 送出病患 11:09 進入恢復室 12:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-頸椎 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Microscopic Anteior Cervical Discectomy and F... 開立醫師: 胡朝凱 開立時間: 2011/05/09 11:12 Pre-operative Diagnosis C5~6 HIVD Post-operative Diagnosis C5~6 HIVD Operative Method Microscopic Anteior Cervical Discectomy and Fusion with artificial cage Specimen Count And Types nil Pathology nil Operative Findings 1.One ruptured disc was noted at C5~6 level and compressed the spinal cord and left C6 nerve root tightly. 2.Hypertrophic PLL 3.After decompression, cord expanded well Operative Procedures 1.ETGA, prone 2.Right neck transverse skin incsion 3.Dissect along the anterior border of SCM muscle 4.Expose prevertebral space 5.Detach longus coli muscle 6.Localization C5~6 disc space 7.Discectomy 8.Cage insertion 9.Set one minihemovac drain 10.Close wound in layers Operators VS 賴達明 Assistants 胡朝凱, Ri 黃正義 (M,1944/10/09,67y5m) 手術日期 2011/05/09 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Lumbar Spondylosis 器械術式 Sublaminar decompression L3-5 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 2 紀錄醫師 賴達明, 時間資訊 23:58 臨時手術NPO 10:53 報到 11:18 進入手術室 11:25 麻醉開始 11:35 誘導結束 11:50 抗生素給藥 12:10 手術開始 13:50 手術結束 13:50 麻醉結束 14:04 進入恢復室 14:10 送出病患 15:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 手術 椎弓切除術(減壓)-超過二節 1 1 記錄__ 手術科部: 外科部 套用罐頭: L3~4,4~5 sublaminar decompression 開立醫師: 胡朝凱 開立時間: 2011/05/09 14:09 Pre-operative Diagnosis L3~4,4~5 stenosis Post-operative Diagnosis L3~4,4~5 stenosis Operative Method L3~4,4~5 sublaminar decompression Specimen Count And Types nil Pathology nil Operative Findings 1.Hypertrophic flavum ligment over L3~4,4~5 neural foramen was noted and the nerve roots were compressed tightly. 2.No obvious instability Operative Procedures 1.ETGA, prone 2.Midline skin incision at L3~5 level 3.Split L4 spinous process 4.Detach paravertebral muscle 5.Partial lower L3 and L4 laminectomy 6.Resect flavum ligment 7.release neural foramen 8.Hemostasis 9.Close wound in layers Operators VS 賴達明 Assistants 胡朝凱, Ri 蔣台青 (M,1962/04/05,49y11m) 手術日期 2011/05/09 手術主治醫師 蕭輔仁 手術區域 東址 006房 03號 診斷 Lumbar spondylosis 器械術式 Lamino plasty 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 2 紀錄醫師 鍾文桂, 時間資訊 23:10 臨時手術NPO 14:55 報到 15:07 進入手術室 15:22 麻醉開始 15:30 誘導結束 16:40 手術開始 16:45 抗生素給藥 18:45 抗生素給藥 18:50 開始輸血 19:51 手術結束 19:51 麻醉結束 20:01 送出病患 20:05 進入恢復室 21:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓整形術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Laminoplasty, open-door method, C3-6. 開立醫師: 鍾文桂 開立時間: 2011/05/09 20:22 Pre-operative Diagnosis Cervical stenosis, C3-6. Post-operative Diagnosis Cervical stenosis, C3-6. Operative Method Laminoplasty, open-door method, C3-6. Specimen Count And Types nil Pathology Nil. Operative Findings 1. Easy oozing operative filed. Much oozing from the epidural veins with high pressure. 2. Laminoplasty,open door from left side, C3-6. fixed with miniplates and screws. Intact dura mater. 3. Intraoperative SSEP: less response in left upper extrimity. No change perioperatively. Operative Procedures Under ETGA, the patient was placed in prone position and the head was fixed by 3-pin Mayfield head holder. After shaving, disinfection, and draping, a linear skin incision was made at midline and paraspinal dissection was achieved with monopolar coagulation. After exposing C2-C7 levels, grooving of the bilateral laminae from C3-C6 levels was obtained by high speed cutting drill. The " door" was opened from the left side. The " door" was maintained by miniplates and screws. The epidural oozing was controlled by gelfoam. Then, wound was closed in layer with well hemostasis. One CWV drain was placed lateral to the " door". Operators 蕭輔仁 Assistants R5 鍾文桂 相關圖片 王均斌 (M,1982/09/21,29y5m) 手術日期 2011/05/09 手術主治醫師 蔡翊新 手術區域 東址 002房 02號 診斷 Major trauma rated 16 or above on the severity scale ( Injury severity score >=16 ) 器械術式 bifrontal craniectomy and ICP monitoring 手術類別 緊急手術 手術部位 頭、頸 傷口分類 污染 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 4E 紀錄醫師 黃柏誠, 時間資訊 06:41 開始NPO 06:41 通知急診手術 07:45 進入手術室 07:50 麻醉開始 08:10 誘導結束 08:25 抗生素給藥 08:35 手術開始 10:25 開始輸血 11:25 抗生素給藥 11:35 14:15 麻醉結束 14:15 手術結束 14:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 脫手套法正中顏面手術併顏面骨復位術 1 1 手術 顴骨-封閉性復位 1 2 手術 腦內血腫清除術 1 1 B 手術 頭顱成形術 1 2 B 手術 顱內壓視置入 1 4 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Frontal craniotomy for hematoma evacuation an... 開立醫師: 李振豪 開立時間: 2011/05/09 14:08 Pre-operative Diagnosis Head injury with frontal bone, skull base, and facial bone comminuted fracture and intracerebral hemorrhage Post-operative Diagnosis Head injury with frontal bone, skull base, and facial bone comminuted fracture and intracerebral hemorrhage Operative Method Frontal craniotomy for hematoma evacuation and cranioplasty Specimen Count And Types nil Pathology Nil Operative Findings Comminuted fractures of frontal bone, facial bone, and skull base were noted after elevating scalp flap. Bilateral orbital contents herniated into intracranial space due to fracture of orbital roofs. The ethmoid sinus, frontal sinus, and intracranial space also communicated due to fracture. The superior sagittal sinus was not injured but active oozing with one dural tear was noted at right frontal base adjacent to crista gali. SDH and contusion ICH were evacuated from the dural opening. The dural defect was difficult to repair, so a pedicled periosteal flap was reflected inward and packed the extradural space to prevent CSF leak. The initial ICP was 3~4 mmHg after craniectomy and the dura was not tense by palpation. Active oozing from skull base was noted and much decrease after hemostasis. The right supraorbital bar was reconstructed with microplates by plastic surgeon. ICP was -4 mmHg after wound closure. The ICP reference is 480. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position. The scalp was shaved, scrubbed, and disinfected as usual. Bicoronal scalp incision was made and the scalp flap was elevated. The periosteum was preserved and elevated based on frontal base as a pedicled flap. One burr hole was created at left Kocher"s point with two dural tenting. Cruciate durotomy was done and ventriculostomy was performed with puncture needle. EVD was inserted and fixed at 7cm in depth. Externalization was done and the burr hole was packing with Gelfoam. Three burr holes were created at bilateral frontal area and right side Keyhole. One 12 x 8 cm craniotomy window was performed. Dural tenting was done along the edge of craniotomy window. The fracutred bone was removed and the sinus mucosa was removed until the foramen of frontal sinus. The frontal skull base was exposed and dural tear due to skull base fracture was identified. The fractured bone was removed and intracerebral hemorrhage was evacuated. Due to deep location of the dural tear, the defect was packing with the pedicled periosteal flap, Surgicel, and Gelfoam. The frontal sinus was packed with Gelfoam soaked by better-iodine. The skull base oozing was packed with bone wax and Gelfoam. The orbital contents were pushed back with Gelfoam packing. Right frontal subdural ICP monitor was inserted and the initial pressure was 3~4mmHg. The wound was irrigated with Vancomycin solution. The fractured skull bone was reconstructed with seven #26 wires. The skull plate was fixed back with three miniplates and six screws. One epidural and one subgaleal CWV were placed. The supraorbital bar fracture was reconstructed with microplates by plastic surgeon. Reduction of bilateral zygomatic fractures was done. Hemostasis was achieved and the wound was irrigated with Vancomycin solution again. The wound was closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS蔡翊新 Assistants R4李振豪Ri吳崇丞 Indication Of Emergent Operation open skull fracture, conscious disturbance, suspected IICP 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: 1.ORIF 2.bilateral gillies reduction 3.nasal... 開立醫師: 黃柏誠 開立時間: 2011/05/09 14:58 Pre-operative Diagnosis 1.multiple facial bone fracture, bilateral frontozygomal process and arch fracture, frontal sinus wall fracture, nasal bone fracture, bilateral maxilla wall fracture, suspect infraorbital floor fracture 2.skull bone fracture, frontal base fracture 3.right mandible region laceration wound Post-operative Diagnosis 1.multiple facial bone fracture, bilateral frontozygomal process and arch fracture, frontal sinus wall fracture, nasal bone fracture, bilateral maxilla wall fracture, suspect infraorbital floor fracture 2.skull bone fracture, frontal base fracture 3.right mandible region laceration wound Operative Method 1.ORIF 2.bilateral gillies reduction 3.nasal bone reduction Specimen Count And Types nil Pathology nil Operative Findings 1. multiple facial bone fracture, ORIF with mini plate by H shape wer fixed at upper frontal sinus wall and linearcurve shape was used at right supraorbital and frontol juction 2.bilateral zygomatic archs were reduction by Gillies reduction method 3.right mandible region laceration wound was primary closure after adequate irrigation 4.nasal bone fracture was reduction and occupied with Bosmin Gauze compression Operative Procedures 1.take over from NS doctor 2.ORIF was done with H shape and curvelinear plate, then fixed with 4~6 mm screw 3.Dingman was used for bilateral Gillies reduction 4.right mandible laceration was primary closure after N/S irrigation by 3-0Vicryl and 5-0 Nylon 5.nasal bone reduction was performed Operators P湯月碧 Assistants R4陳建璋 R3黃柏誠 Indication Of Emergent Operation Combine with NS 相關圖片 楊麗珠 (F,1940/01/26,72y1m) 手術日期 2011/05/09 手術主治醫師 王水深 手術區域 東址 016房 01號 診斷 Varicose veins 器械術式 Varicose Vein Stripping 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 面罩麻醉 麻醉主治醫師 趙安怡 ASA 2 紀錄醫師 許皓淳, 時間資訊 09:20 臨時手術NPO 07:45 報到 07:58 進入手術室 08:05 麻醉開始 08:10 誘導結束 08:35 抗生素給藥 08:45 手術開始 10:10 手術結束 10:10 麻醉結束 10:18 送出病患 10:20 進入恢復室 11:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 其他小靜脈曲張之縫合,結紮或剝除 1 2 R 手術 長隱靜脈於隱-股交接處的結紮和分離 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Semi-opened mask inhalation anes 1 0 記錄__ 手術科部: 外科部 套用罐頭: EVRF + Muller’s phlebectomy 開立醫師: 許皓淳 開立時間: 2011/05/09 10:11 Pre-operative Diagnosis Lower limbs varicose vein, Right Post-operative Diagnosis Lower limbs varicose vein, Right, s/p EVRF + Muller’s phlebectomy Operative Method EVRF + Muller’s phlebectomy Specimen Count And Types nil Pathology pending Operative Findings 1. engorged varicose vein over right lower legs, telangiectasia (+) 2. Data: time: 2min 0sec, temperature: 20C, energe: 13W, length: 31cm, 6 cycles. Operative Procedures -Under IVG, the patient was posed in supine position with. adequate skin disinfection and drapping. -EVRF: Echo-guided right GSV catheterization and sheath insertion. EVRF from 2cm distal to GSV/CFV junction to the distal of GSV near to the knee. -Muller phlebectomy: right Muller’s phlebectomy via multiple small stabbing wounds. -Hemostasis, wounds closure. Compression by bandage. Operators 王水深 Assistants 陳政維 黃正富 (M,1943/10/04,68y5m) 手術日期 2011/05/10 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Cervical spondylosis 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 林哲光, 時間資訊 23:58 臨時手術NPO 08:14 進入手術室 08:25 麻醉開始 08:30 誘導結束 09:00 抗生素給藥 09:16 手術開始 12:00 抗生素給藥 13:35 手術結束 13:35 麻醉結束 13:43 送出病患 13:45 進入恢復室 14:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-前融合,有固定物)≦四節 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 記錄__ 手術科部: 外科部 套用罐頭: Discectomy at C5-6, C6-7 and anterior fusion ... 開立醫師: 林哲光 開立時間: 2011/05/10 13:56 Pre-operative Diagnosis C5-6, C6-7 HIVD with right radiculopathy Post-operative Diagnosis C5-6, C6-7 HIVD with right radiculopathy Operative Method Discectomy at C5-6, C6-7 and anterior fusion with Synthes PEEK Specimen Count And Types nil Pathology Operative Findings Decreased height of intervertebral space was noted at C5-6, C6-7 level. Prominent spur formation was notedd with direct compressing the cord and bilateral neural foramens tightly. The dura seemed re-expanded well after discectomy. 7mm and 6mm PEEK were inserted to C6-7 and C5-6 level respectively. Operative Procedures Under ETGA supine position with head mild extension, skin disinfected and drapped were performed as usual. Dissection through the plane between esophagus and carotid artery was done. C5-6, C6-7 disectomy was then performed. The PEEK was inserted into the C5-6 and C6-7 level. The wound was then closed in layers after hemostasis. Operators AP 曾勝弘 Assistants R4 林哲光 相關圖片 李寶祺 (F,1966/01/03,46y2m) 手術日期 2011/05/10 手術主治醫師 曾勝弘 手術區域 西址 039房 02號 診斷 Carpal tunnel syndrome 器械術式 Decompression of mediun nerve 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 08:10 進入手術室 08:35 麻醉開始 08:37 手術開始 09:10 手術結束 09:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 神經分離術-上臂.前臂.大腿.小腿處之神經 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Carpal Tunnel Syndrome 開立醫師: 陳睿生 開立時間: 2011/05/10 09:25 Pre-operative Diagnosis Left side carpal tunnel syndrome Post-operative Diagnosis Left side carpal tunnel syndrome Operative Method Neurolysis Specimen Count And Types nil Pathology Nil Operative Findings The median nerve was reddish in appearance, and the transverse carpal ligamentum was thicken. Operative Procedures 1.The hand and forearm were sterilized with povidone-iodine tincture, then covered with stockinet. 2.Anesthesia: tourniquet was applied at left distal upper arm, then regional block with 15 ml 1% Xylocaine solution was infused through cephalic vein catheter at wrist area. 3. Incision: linear shape from vertical palmar crease to transverse wrist crease. 4.The palmaris longus tendon was identified, then the plamar aponeurosis was cut longitidinally along the ulnar side of the palmaris longus tendon. 5. Themedian nerve was identified beneath the palmars longus tendon. Under direct vision, the transverse carpal ligament was divided until no more pressure on the median nerve could be palpated. 6. The skin was closed by interrupted suture with 4/0 nylon. 7.The tourniquet was released. The hand and wrist were draped with fluffy dressing and elastic bandage. Operators VS 曾勝弘 Assistants R6 陳睿生 洪瑞葉 (F,1956/09/22,55y5m) 手術日期 2011/05/10 手術主治醫師 賴達明 手術區域 東址 019房 02號 診斷 Female breast cancer 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 胡朝凱, 時間資訊 00:22 臨時手術NPO 00:22 開始NPO 07:22 通知急診手術 08:32 報到 09:30 進入手術室 09:35 麻醉開始 10:00 誘導結束 10:40 抗生素給藥 10:53 手術開始 13:50 抗生素給藥 14:50 麻醉結束 14:50 手術結束 15:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除-手術時間在4~8小時 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Posterior fossa craniotomy for tumor excision 開立醫師: 胡朝凱 開立時間: 2011/05/10 15:19 Pre-operative Diagnosis Left cerebellar metastatic tumor Post-operative Diagnosis Left cerebellar metastatic tumor Operative Method Posterior fossa craniotomy for tumor excision Specimen Count And Types pieces of tumor Pathology pending Operative Findings 1.One yellowish to reddish soft tumor located at left cerebellar hemisphere to vermis, measured about 3.5 cm was noted. 2.The border was not clear 3.The tumor adhere to tentorial partially. 4.After tumor excision, brain was slack Operative Procedures 1.ETGA, prone with head fixed with skull clamp 2.Midline skin incision 3.Dissect muscle to expose posterior fossa and C1 posterior arch 4.Craniotomy 5.V shape dural opening 6.corticotomy 7.Dissect tumor border and coagulase 8.Tumor excision piece by piece 9.Hemostasis 10.Close dura with one piece of fascia 11.Close wound in layers Operators VS. 賴達明 Assistants 胡朝凱, Ri 嚴愛文 Indication Of Emergent Operation conscious deterioration 邱靖益 (M,1986/05/05,25y10m) 手術日期 2011/05/10 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Spine tumor 器械術式 Intraspinal intramedullary tumor 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 李振豪, 時間資訊 23:52 臨時手術NPO 08:08 進入手術室 08:15 麻醉開始 08:40 抗生素給藥 08:45 誘導結束 09:16 手術開始 12:04 手術結束 12:04 麻醉結束 12:15 送出病患 12:20 進入恢復室 13:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 手術 脊椎內脊髓內腫瘤切除術 1 1 摘要__ 手術科部: 外科部 套用罐頭: L1 laminectomy and partial L2 laminectomy for... 開立醫師: 李振豪 開立時間: 2011/05/10 12:15 Pre-operative Diagnosis L1 intraspinal, intramedullary tumor, suspect ependymoma Post-operative Diagnosis L1 intraspinal, intramedullary tumor, suspect ependymoma Operative Method L1 laminectomy and partial L2 laminectomy for tumor excision Specimen Count And Types 1 piece About size:multiple small pieces Source:Intraspinal, intramedullary tumor Pathology Pending Operative Findings The tumor was 3.2 x 1 x 1.3 cm in size, well-capsulated, soft to fragile, gray and dark reddish in color. The opening of central canal was noted after total removal of the tumor. The filum terminalis was transected also for removal of the capsule. The roots were preserved well during the operation. No SSEP change after whole procedure. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position. The L1 vertebra was localized by C-arm portable X-ray. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made from T12 to L2. The subcutaneous soft tissue and paraverbetral muscle was divided and detached. The laminae was exposed. Laminectomy was performed with Midas air-drived drills and Rongeur. The thecal sac was identified. Under operative microscope, linear durotomy was performed and the arachnoid membrane was opened. The tumor was identified. The tumor capsule was coagulated and opened. Central debulking was performed with ring curette and CUSA. After central debulking, the tumor was dissected along the capsule. The filum terminalis was noted at the end of the capsule and transected for total removal of the tumor. The upper pole of the tumor was traced along the capsule and connected to central canal of the spinal cord. The roots were well preserved and total removal of the tumor was done. Hemostasis was achieved. The dura was closed with 5-0 Prolene. Posteriolateral fusion was performed with autologous bone graft. Hemostasis was done with bipolar electrocautery and Gelfoam packing. One epidural CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS賴達明 Assistants R4李振豪, R1全賀顯 相關圖片 鄭美月 (F,1951/05/11,60y10m) 手術日期 2011/05/10 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Lumbar spondylosis 器械術式 Spinal fusion posterior, L3/4 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 23:54 臨時手術NPO 12:30 進入手術室 12:40 麻醉開始 12:45 誘導結束 12:45 抗生素給藥 13:15 手術開始 15:45 抗生素給藥 16:35 手術結束 16:35 麻醉結束 16:42 送出病患 16:45 進入恢復室 18:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 骨或軟骨移植術 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 摘要__ 手術科部: 外科部 套用罐頭: 1. L3, L4 transpedicular screws for posterior... 開立醫師: 李振豪 開立時間: 2011/05/10 16:37 Pre-operative Diagnosis L3 on L4 spondylolisthesis with lumbar stenosis Post-operative Diagnosis L3 on L4 spondylolisthesis with lumbar stenosis Operative Method 1. L3, L4 transpedicular screws for posterior instrumentation 2. L3-4 diskectomy and anterior fusion with PEEK cage 3. L3-4 posteriolateral fusion with autologous bone graft 4. L3-4 laminectomy for decompression Specimen Count And Types nil Pathology Nil Operative Findings 1. The facet joint was degenerative and hypertrophic. The ligmentum flavum also hypertrophic which compressed the thecal sac tightly. After laminectomy, the thecal sac expanded well. The right L4 root was well preserved during TLIF. No incidental durotomy of CSF leakage noted. 2. Instrumentation Transpedicular screws: 6.5 x 40 mm x IV (L3 and L4) Rods: 5cm x II Cage: Banana PEEK cage # 11 x I Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position. The L3-4 vertebrae were localized by portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made from L2 to L5 level. The subcutaneous soft tissue and paravertebral muscle were devided and detached. L3, L4 transpedicular screws were performed under C-arm portable X-ray guided. L3-4 laminectomy was done for decompression. Right L3-4 facet joint was removed and TLIF was performed. The location of TPS and cage were confirmed by portable X-ray. Hemostasis was achieved with bipolar electrocautery and gelfoam packing. Posteriolateral fusion with augolotous bone graft was done. One epidural Hemovac was placed. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS賴達明 Assistants R4李振豪, R1全賀顯 相關圖片 陳玉坤 (M,1952/08/01,59y7m) 手術日期 2011/05/10 手術主治醫師 林峰盛 手術區域 西址 035房 09號 診斷 Failed back syndrome 器械術式 DCS implantation / PC 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 林峰盛 ASA 2 時間資訊 17:30 報到 17:35 進入手術室 17:45 麻醉開始 17:46 誘導結束 17:55 手術開始 18:05 麻醉結束 18:05 手術結束 18:10 送出病患 摘要__ 手術科部: 麻醉部 套用罐頭: Pulsed RF 開立醫師: 葉芷圻 開立時間: 2011/05/10 18:13 Pre-operative Diagnosis Failed back syndrome Post-operative Diagnosis Failed back syndrome Operative Method Pulsed RF Specimen Count And Types nil Pathology Nil Operative Findings Operative Procedures 1. IV sedation with midazolam and LA with 1% xylocaine 2. pt in prone position 3. Under fluoroscopic-guidance, insert 22 G SMK RF meedle into bil L5 neuroforamen 4. Neurostimulation with 50 HZ and 2 Hz 0.1-0.5 mV current with positive result 60-80V 2 Hz, 20 ms, 120sec *2 pulsed RF was delivered send pt to POR Operators 林峰盛, Assistants 葉芷圻, 吳雪麗 (F,1956/04/06,55y11m) 手術日期 2011/05/10 手術主治醫師 詹志洋 手術區域 東址 016房 04號 診斷 Malignant histiocytosis, extranodal solid organ sites 器械術式 Remove and Reinsert Port-A 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 11:50 通知急診手術 11:50 開始NPO 14:00 進入手術室 14:24 抗生素給藥 14:30 麻醉開始 14:31 報到 14:32 麻醉結束 14:33 手術開始 15:45 手術結束 醫令資訊 類別 名稱 量 刀 側 手術 內頸靜脈切開,永久導管放置術 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Port-A 開立醫師: 張得一 開立時間: 2011/05/10 15:52 Pre-operative Diagnosis Right side Port-A exposure Post-operative Diagnosis Ditto Operative Method 1.Remove right side Port-A 2.Port-A catheter implantation, echo guided Specimen Count And Types nil Pathology nil Operative Findings Puncture to left IJV under echo guidance The venous blood flow freely in the Port-A catheter after implantation. Operative Procedures The patient was put on supine position. The operation field was disinfected and draped as usual. Under local anesthesia, we puncture to left IJV under echo guidance. After creating subcutaneous pocket, the Port-A catheter was inserted via peel away sheath. We close the wound in layers. Then, right side Port-A was removed. After N/S irrigation, the wound was closed in layers Operators VS詹志洋 Assistants R3張得一 Indication Of Emergent Operation Port A exposure 陳明懿 (M,1956/12/12,55y3m) 手術日期 2011/05/10 手術主治醫師 蕭輔仁 手術區域 東址 003房 03號 診斷 Low back pain 器械術式 Radiofrequency coagulation 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 李振豪, 時間資訊 23:57 臨時手術NPO 16:55 進入手術室 17:16 麻醉開始 17:17 誘導結束 17:17 麻醉結束 17:18 手術開始 17:47 手術結束 17:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 高頻熱凝療法 1 1 B 摘要__ 手術科部: 外科部 套用罐頭: Radiofrequency stimulation, bilateral L2 dors... 開立醫師: 李振豪 開立時間: 2011/05/10 17:56 Pre-operative Diagnosis Low back pain Post-operative Diagnosis Low back pain Operative Method Radiofrequency stimulation, bilateral L2 dorsal root Specimen Count And Types nil Pathology Nil Operative Findings 1. Bilateral L2 dorsal root was identified by portable C-arm X-ray and sensory/motor stimulation test. No acute complication was noted after the procedure. 2. Temp: 42 oC, Time: 180sec x 2 cycles each side Operative Procedures The patient was put in prone position. The location of L2 was identified by portable C-arm X-ray. The skin was disinfected and draped as usual. Local anesthesia was performed with 1% Xylocaine 10ml. Bilateral L2 dorsal root radiofrequency stimulation was performed under portable C-arm guided. The patient stood whole procedure well. Operators VS蕭輔仁 Assistants R4李振豪, R1全賀顯 相關圖片 簡玉霞 (F,1960/03/19,51y11m) 手術日期 2011/05/10 手術主治醫師 蕭輔仁 手術區域 東址 009房 05號 診斷 Disseminated malignant neoplasm 器械術式 Ommaya reservoir implantation 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 王奐之, 時間資訊 23:44 臨時手術NPO 14:00 報到 14:10 進入手術室 14:15 麻醉開始 14:20 抗生素給藥 14:25 誘導結束 14:54 手術開始 15:47 手術結束 15:47 麻醉結束 16:00 送出病患 16:01 進入恢復室 17:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 歐氏貯囊置放手術 1 1 R 摘要__ 手術科部: 腫瘤醫學部 套用罐頭: Ommaya reservoir implantation via right Koche... 開立醫師: 王奐之 開立時間: 2011/05/10 15:53 Pre-operative Diagnosis Breast cancer with leptomeningeal carcinomatosis Post-operative Diagnosis Breast cancer with leptomeningeal carcinomatosis Operative Method Ommaya reservoir implantation via right Kocher point Specimen Count And Types Nil Pathology Nil Operative Findings Clear CSF gushed out after ventricular puncture. Opening pressure: about 10cmH2O. CSF was sent for routine, BCS, bacterial culture and cytology. Easy oozing was encountered during the whole procedure. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position, with head slightly turned to left. After scalp shaving, disinfection and draping in sterile fashion, a curved incision was made at right frontal area. A burr hole was then created at right Kocher point with air-drill. After dural tenting, a cruciate durotomy was done. After hemostasis, ventricular puncture was done. Ommaya reservoir and catheter were then assembled and inserted. After securing the Ommaya reservoir, the wound was closed in layers. Operators VS 蕭輔仁 Assistants R3 王奐之 相關圖片 邱美嬌 (F,1961/02/21,51y0m) 手術日期 2011/05/11 手術主治醫師 杜永光 手術區域 東址 003房 02號 診斷 Aneurysm 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 王奐之, 時間資訊 23:58 臨時手術NPO 12:40 麻醉開始 12:50 誘導結束 13:07 抗生素給藥 13:32 手術開始 13:38 進入手術室 15:50 手術結束 15:50 麻醉結束 16:03 送出病患 16:05 進入恢復室 17:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 頭顱成形術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Right cranioplasty with autologous bone graft 開立醫師: 王奐之 開立時間: 2011/05/11 16:12 Pre-operative Diagnosis Right skull bone defect Post-operative Diagnosis Right skull bone defect Operative Method Right cranioplasty with autologous bone graft Specimen Count And Types nil Pathology nil Operative Findings 1.Two pieces of bone graft was noted, measured about 9x12 cm and 14x5 cm 2.Mild brain swelling was also noted. 3.The dura was sticky to periosteum Operative Procedures Under ETGA, patient was put in supine with head rotated to left Incision was done along the previous operation scar. Raney clips were apllied to the scalp edge for temporary hemostasis. The scalp and temporalis muscle were dissected away from the underlying dura. The dural surface and margin of skull defect were well exposed. The bleeders on the dissected surfaces were coagulated with Bovie painstakingly. The edge of the skull defect was exposed. The original skull plate preserved was placed back to the skull window then fixed by miniplate and a dura tenting at the center of the skull plate. Hemostasis was done with bipolar coagulator Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. Two drains was set with one epidural, and the other subgaleal. Operators P 杜永光 Assistants 胡朝凱, 王奐之 相關圖片 魏鳳輝 (M,1969/10/18,42y4m) 手術日期 2011/05/11 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Pituitary tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 王奐之, 時間資訊 23:56 臨時手術NPO 08:05 進入手術室 08:10 麻醉開始 08:30 誘導結束 09:10 抗生素給藥 09:33 手術開始 12:12 手術結束 12:12 麻醉結束 12:18 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 經由蝶竇之腦下垂體瘤切除 1 1 摘要__ 手術科部: 外科部 套用罐頭: Endoscopic trans-sphenoid adenomectomy 開立醫師: 王奐之 開立時間: 2011/05/11 12:29 Pre-operative Diagnosis Pituitary macroadenoma Post-operative Diagnosis Pituitary macroadenoma Operative Method Endoscopic trans-sphenoid adenomectomy Specimen Count And Types 1 piece About size:pieces Source:pituitary tumor Pathology Pending Operative Findings Fragile purplish tumor was removed in piecemeal fashion with ring currette from sellar area. No CSF leakage was encountered during the operation. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head placed on head-rest. Bilateral nostrils were packed with Bosmin gauze for a period of time and removed after skin scrubbing. After disinfection and draping in sterile fashion, the nasal mucosa was opened under microscopic aid, until the nasal septal cartilage was exposed and deviated. The vomer bone and the anterior wall of sphenoid sinus were then fractured and removed. Sellar floor was then opened, exposing the sellar dura. A small cruciate durotomy was done, the tumor was identified and removed with ring currette. 0 & 30 degrees endoscope were used alternatively for complete tumor removal. After hemostasis and irrigation, the surgical field was packed with gelfoam. The bone flaps were placed back, the cartilage was reduced to midline position, and the nostrils were packed with Marocels. Operators P. 杜永光, VS 楊士弘 Assistants R6 胡朝凱, R3 王奐之 相關圖片 陳鳳蕊 (F,1962/04/05,49y11m) 手術日期 2011/05/11 手術主治醫師 曾漢民 手術區域 東址 005房 03號 診斷 Thyroid cancer 器械術式 Brain biopsy (TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 邱裕淳, 時間資訊 23:01 臨時手術NPO 15:32 報到 15:53 進入手術室 16:00 麻醉開始 16:05 誘導結束 16:15 抗生素給藥 16:30 手術開始 19:20 手術結束 19:20 抗生素給藥 19:20 麻醉結束 19:35 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 手術 腦組織活體切片 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Trephination for tumor biopsy 開立醫師: 陳睿生 開立時間: 2011/05/11 19:48 Pre-operative Diagnosis Left frontal infiltrated tumor, suspect high grade glioma Post-operative Diagnosis Left frontal infiltrated tumor, suspect high grade glioma Operative Method Trephination for tumor biopsy Specimen Count And Types 1 piece About size:pieces Source:tumor Pathology Pending Operative Findings Whitish, hardish, and sticky tumor was noted. No obvious margin was noted between the tumor and normal brain tissue. We localized the tumor with navigation and ECHO, and then an about 1x2x2 cm tumor was extracted for examination. Operative Procedures 1. ETGA, supine position and head fixed with Mayfield clump 2. Set up the navigation system 3. Left frontal curvillinear scalp incision 4. Create a bur hole at inferior frontal region and then an about 6x6 cm craniotomy window was created 5. Dura tenting, and then opened 6. Localize the tumor with ECHO, and then corticotomy was done for tumor extraction 7. Hemostasis, and then the dura was tightly closed with fascia graft 8. The skull graft was fixed back with miniplates x2 9. The wound was closed in layers Operators VS 曾漢民 Assistants R6 陳睿生, R1 邱裕淳 莊李秀華 (F,1950/01/28,62y1m) 手術日期 2011/05/11 手術主治醫師 蔡瑞章 手術區域 東址 005房 01號 診斷 Spinal tumor 器械術式 Intraspinal intramedullary tum 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 邱裕淳, 時間資訊 23:59 臨時手術NPO 07:36 報到 08:06 進入手術室 08:15 麻醉開始 08:45 誘導結束 09:00 抗生素給藥 09:38 手術開始 12:00 抗生素給藥 12:40 手術結束 12:40 麻醉結束 12:48 送出病患 12:50 進入恢復室 13:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎內脊髓內腫瘤切除術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: T10-11 laminectomy for partial tumor remove a... 開立醫師: 陳睿生 開立時間: 2011/05/11 13:03 Pre-operative Diagnosis Intramedullary ependymoma with cord compression at T10-12 level Post-operative Diagnosis Intramedullary ependymoma with cord compression at T10-12 level Operative Method T10-11 laminectomy for partial tumor remove and duroplasty Specimen Count And Types 1 piece About size:pieces Source:tumor Pathology Pending Operative Findings The tumor was grayish, soft and fragile. It adhered with conus and cauda equna tightly, and the plane was unable to expose. We removed the tumor partially for decompression and duroplasty was done with artificial graft. Previous T12 laminectomy was noted. Poor SSEP, MEP over bilateral legs were noted peri-op. The tumor was grayish, soft and fragile. It adhered with conus and cauda equna tightly, and the plane was unable to expose. We removed the tumor partially for decompression and duroplasty was done with Cook artificial graft. Previous T12 laminectomy was noted. Poor SSEP, MEP over bilateral legs were noted peri-op. Operative Procedures 1. ETGA, prone position and the trunk was mild flexion 2. After C-arm localize the T10-12 level, we incised into the previous wound 3. The paraspinal muscle was dissected, and then the T10-11 lamina was exposed 4. T10, 11 laminectomy and the dura was noted 5. The plane between the dura and granulation tissue was carefully dissected during T10-12 level 6. We incised into the dura and the tumor adhered with the conus was noted 7. Partial tumor remove was done and the conus, cauda equna were decompressed 8. After hemostasis, duroplasty was done with artificial graft 9. Set a 1/8 hemovac, and the wound was closed in layers Operators P 蔡瑞章 Assistants R6 陳睿生, R1 邱裕淳 陳正雄 (M,1943/11/26,68y3m) 手術日期 2011/05/11 手術主治醫師 賴達明 手術區域 東址 005房 02號 診斷 Cerebrovascular accident (CVA) 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 邱裕淳, 時間資訊 23:00 臨時手術NPO 12:12 報到 13:05 進入手術室 13:10 麻醉開始 13:15 誘導結束 13:50 抗生素給藥 14:15 手術開始 15:20 手術結束 15:20 麻醉結束 15:25 送出病患 15:30 進入恢復室 16:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: VP shunt insertion via right Kocher^s point 開立醫師: 陳睿生 開立時間: 2011/05/11 15:39 Pre-operative Diagnosis ICH, IVH with hydrocephalus Post-operative Diagnosis ICH, IVH with hydrocephalus Operative Method VP shunt insertion via right Kocher^s point Specimen Count And Types 3 pieces About size:3ml Source:CSF About size:3ml Source:CSF About size:3ml Source:CSF Pathology Nil Operative Findings The ICP was about 5-10cmH2O, and the CSF was clear. A Codman programmable shunt was set from right Kocher^s point to RUQ. The intraventricular catheter was about 6.4cm in length, and the intra-abdominal catheter was about 20cm. The pre-setting of the shunt was 100cmH2O. Operative Procedures 1. ETGA, supine position, and head left turn 2. We incise into right frontal region via previous wound 3. The previous bur hole was exposed 4. An about 3cm skin incision was done at RUQ 5. Minilaparotomy was done 6. A subcutaneous tunnel was created from RUQ to right frontal with one connection wound at right parietal 7. The intra-abdominal catheter was inserted into the tunnel, and the reservior was connected 8. The intraventricular catheter was inserted 9. Hemostasis, and the wounds were closed separately Operators VS 賴達明 Assistants R6 陳睿生, R1 邱裕淳 林維第 (M,1924/06/29,87y8m) 手術日期 2011/05/11 手術主治醫師 洪基翔 手術區域 東址 002房 04號 診斷 Abdominal pain 器械術式 Exploratory laparatomy 手術類別 緊急手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 林子富 ASA 3E 紀錄醫師 陳以幸, 時間資訊 00:00 開始NPO 00:00 臨時手術NPO 18:00 通知急診手術 20:25 報到 20:30 進入手術室 20:35 麻醉開始 21:00 誘導結束 21:20 手術開始 22:40 麻醉結束 22:40 手術結束 22:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腸粘連分離術－併行腸減壓 1 1 摘要__ 手術科部: 外科部 套用罐頭: Exploratory laparotomy --> Adhesiolysis with ... 開立醫師: 鄭宗杰 開立時間: 2011/05/11 22:42 Pre-operative Diagnosis Obstructive ileus, supsect adhesion induced Post-operative Diagnosis Adhesion ileus Operative Method Exploratory laparotomy --> Adhesiolysis with decompression of bowel Specimen Count And Types Nil Pathology Nil Operative Findings 1.Reddish ascites noted on laparotomy 2.Status post subtotal gastrectomy with Roux-en-Y recontruction. Adhesion band formated at the biliary limb and terminal ileum, causing complete encasement of the bowel lumen. collapse of distal ileum was also identified. Congestion and partial venous thombosis was also noted. 3.After adhesiolysis and decompression of bowel content, the perfustion status of small bowel was patent and the pulsation was good. Previous redness color of bowel wall recovered to pink color. Operative Procedures 1.ETGA, supine, skin sterize 2.Midline laparotomy 3.Adhesiolysis 4.Decompression of the bowel content 5.N/S irrigation, set two R/D drain tubes at subphrenic space and Douglas pouch 6.Wound closure Operators VS洪基翔 Assistants R5鄭宗杰, R1陳以幸 Indication Of Emergent Operation Obstructive ileus 李秀珠 (F,1952/08/15,59y6m) 手術日期 2011/05/12 手術主治醫師 楊榮森 手術區域 東址 027房 01號 診斷 Female breast cancer 器械術式 Curettage, cementing, and CHS, left proximal femur 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 脊髓麻醉 麻醉主治醫師 林佩玲 ASA 3 紀錄醫師 葉軒, 時間資訊 00:00 臨時手術NPO 07:35 報到 08:05 進入手術室 08:10 麻醉開始 08:20 誘導結束 08:49 抗生素給藥 08:55 手術開始 10:28 手術結束 10:28 麻醉結束 10:35 送出病患 10:38 進入恢復室 11:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 惡性骨瘤廣泛切除(一次) 1 1 L 手術 股骨頸骨折開放性復位術 1 2 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Spinal anesthesia 1 0 麻醉 SPINAL ANESTHESIA 1 0 摘要__ 手術科部: 骨科部 套用罐頭: Tumor excision, cementing, and open reduction... 開立醫師: 葉軒 開立時間: 2011/05/12 10:41 Pre-operative Diagnosis Left proximal femoral bone tumor, suspected breast cancer metastasis Post-operative Diagnosis Left proximal femoral bone tumor, suspected breast cancer metastasis Operative Method Tumor excision, cementing, and open reduction internal fixation with compression hip screw Specimen Count And Types many pieces of tumor debris curettaged from left proximal femur Pathology pending Operative Findings One 9x2x1cm intramedullary soft tumor was noted over left proximal femur with cortex destruction Operative Procedures 1. Spinal anesthesia, in right decubitus position 2. Skin preaprarion 3. Incision at lateral aspect of left hip above greater trochanter 4. Perfrom tumor excision with alcohol irrigation 5. Perfrom ORIF with compression hip screw (Richard, 140 degrees, 5H5S, lag screw: 85mm) 6. Alcohol and normal saline irrigation, and hemostasis 7. Wound closure with 1/4 hemovac placement Operators 楊榮森, Assistants 廖伯峰, 葉軒, 陳彥宇, 李奕辰, 蔣錦波 (M,1926/09/16,85y5m) 手術日期 2011/05/12 手術主治醫師 蕭輔仁 手術區域 東址 005房 04號 診斷 Fracture, lumbar - spine 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3 紀錄醫師 林哲光, 時間資訊 23:13 臨時手術NPO 14:26 進入手術室 14:35 麻醉開始 14:45 誘導結束 15:00 抗生素給藥 15:25 手術開始 17:45 開始輸血 18:00 抗生素給藥 19:50 手術結束 19:50 麻醉結束 20:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 椎弓切除術(減壓)-二節以內 1 2 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 記錄__ 手術科部: 外科部 套用罐頭: L3 and partial L4 laminectomy and L1/L2/L4/L5... 開立醫師: 林哲光 開立時間: 2011/05/12 21:09 Pre-operative Diagnosis L3 compression fracture Post-operative Diagnosis L3 compression fracture Operative Method L3 and partial L4 laminectomy and L1/L2/L4/L5 posterior fusion with transpedicular screws and rods Specimen Count And Types Nil Pathology Nil Operative Findings Hypertrophic change of bilateral facet joints were noted at L1-L5 level. Severe kyphosis was noted at lumbar level. Osteoporosis change of the whole bony structures was also noted. Dura seemed compressed thightly during lamniectomy and re-expanded well after laminectomy done. Total eight 65mmx45mm TPS were inserted to L1/L2/L4/L5 level and two 13cm rods were inserted with one cross-link use. Operative Procedures Under ETGA and prone position, skin disinfected and drapped were performed as usual. Midline skin incision was made at L1-L5 level and the paraspinal muscles were detached. Eight TPS were inserted to L1/L2/L4/L5 respetively and confirmed with C-arm and two rods and cross-link were also inserted. L3 and partial L4 laminectomy was then performed. Ligamentum flavum were also removed as much as possible. The wound was then closed in layers after hemostasis and two epidural drain inserted. Operators VS 蕭輔仁 Assistants R4 林哲光 相關圖片 張偉明 (M,1948/06/11,63y9m) 手術日期 2011/05/12 手術主治醫師 王國川 手術區域 東址 003房 03號 診斷 Head injury, unspecified 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3 紀錄醫師 李振豪, 時間資訊 23:12 臨時手術NPO 12:40 進入手術室 12:43 麻醉開始 12:45 誘導結束 13:00 抗生素給藥 13:20 手術開始 14:00 手術結束 14:00 麻醉結束 14:10 送出病患 14:12 進入恢復室 15:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Ventriculo-peritoneal shunt implantation via ... 開立醫師: 李振豪 開立時間: 2011/05/12 14:02 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculo-peritoneal shunt implantation via right Kocher"s point Specimen Count And Types 1 piece About size:5ml Source:CSF for routine, biochemistry, and bacterial culture Pathology Nil Operative Findings The CSF was clear in color. The Codman fixed pressure reservoir was implanted with the pressure setting as 40mmH2O. The ventricular catheter and peritoneal catheter was 7 and 30cm in length respectively. Adhesion of peritoneal cavity due to previous infection episode was noted. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head rotated to left. The scalp was shaved, scrubbed, and disinfected as usual. The scalp incision was made at right frontal area along operative scar. Previous burr hole was identified. Right lower abdomen transverse skin incision was made and the minilaparotomy was performed to enter the peritoneal cavity. Under tracheostomy general anesthesia, the patient was put in supine position with head rotated to left. The scalp was shaved, scrubbed, and disinfected as usual. The scalp incision was made at right frontal area along operative scar. Previous burr hole was identified. Right lower abdomen transverse skin incision was made and the minilaparotomy was performed to enter the peritoneal cavity. The subcutaneous tunnel from right abdomen, forechest, neck, and retroauricular area was created. One 1.5cm scalp incision was made at right retroauricular area. The peritoneal catheter was introduced through the subcutaneous tunnel. The ventricular catheter and peritoneal catheter was connected to set up the shunt. The ventriculostomy was performed by puncture needle. The ventricular catheter was placed into right lateral ventricle. The function of the shunt was checked. The peritoneal catheter was placed into peritoneal cavity under direct vision. Hemostasis was achieved. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS王國川 Assistants R4李振豪 相關圖片 許振耀 (M,1935/02/20,77y0m) 手術日期 2011/05/12 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Major trauma rated 16 or above on the severity scale ( Injury severity score >=16 ) 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3 紀錄醫師 李振豪, 時間資訊 23:11 臨時手術NPO 07:48 報到 08:09 進入手術室 08:15 麻醉開始 08:25 誘導結束 08:40 抗生素給藥 09:03 手術開始 10:18 手術結束 10:18 麻醉結束 10:20 送出病患 10:25 進入恢復室 12:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 頭顱成形術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: Cranioplasty with autologous skull plate 開立醫師: 李振豪 開立時間: 2011/05/12 10:29 Pre-operative Diagnosis Left fronto-temporo-parietal skull defect Post-operative Diagnosis Left fronto-temporo-parietal skull defect Operative Method Cranioplasty with autologous skull plate Specimen Count And Types nil Pathology Nil Operative Findings The brain was slacked but well pulsated. The autologous skull plate was fixed back with 3 miniplates and 6 screws. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head rotated to right. The scalp was shaved, scrubbed, and disinfected as usual. The traumatic scalp incision was made along the operative scar. The scalp flap was dissected and elevated. The skull plate was fixed back with miniplates and screws after six central tenting. Bone cement was applied for seal the gap of bone edge. The wound was irrigated with Vancomycin and Gentamicin solutions. Hemostasis was achieved and one subgaleal CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS王國川 Assistants R4李振豪, Ri楊國生 相關圖片 賴章清桂 (F,1930/03/19,81y11m) 手術日期 2011/05/12 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 Hydrocephalus 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3 紀錄醫師 李振豪, 時間資訊 23:10 臨時手術NPO 10:33 進入手術室 10:40 麻醉開始 10:45 誘導結束 10:50 抗生素給藥 11:06 手術開始 11:42 手術結束 11:42 麻醉結束 12:05 送出病患 12:05 進入恢復室 13:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室腹腔分流手術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Ventriculo-peritoneal shunt implantation via ... 開立醫師: 李振豪 開立時間: 2011/05/12 11:39 Pre-operative Diagnosis Normal pressure hydrocephalus Post-operative Diagnosis Normal pressure hydrocephalus Operative Method Ventriculo-peritoneal shunt implantation via right Kocher"s point Specimen Count And Types Nil 5ml CSF for routine, biochemistry, and bacterial culture Pathology Nil Operative Findings The CSF was clear in color. The Codman programmable valve reservoir was implanted with initial pressure setting as 150mmH2O. The ventricular catheter and peritoneal catheter was 6.5 and 30cm in length respectively. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head rotated to left. The scalp was shaved, scrubbed, and disinfected as usual. The scalp incision was made at right frontal area followed by one burr hole creation. Two dural tenting was performed. Right upper abdomen transverse skin incision was made and the minilaparotomy was performed to enter the peritoneal cavity. The subcutaneous tunnel from right abdomen, forechest, neck, and retroauricular area was created. One 1.5cm scalp incision was made at right retroauricular area. The peritoneal catheter was introduced through the subcutaneous tunnel. The ventricular catheter and peritoneal catheter was connected to set up the shunt. Cruciform durotomy was performed and the ventriculostomy was performed by puncture needle. The ventricular catheter was placed into right lateral ventricle. The function of the shunt was checked. The peritoneal catheter was placed into peritoneal cavity under direct vision. Hemostasis was achieved. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS王國川 Assistants R4李振豪, Ri楊國生 相關圖片 鄭國基 (M,1959/07/08,52y8m) 手術日期 2011/05/12 手術主治醫師 蔡翊新 手術區域 東址 005房 01號 診斷 Other and unqualified skull fracture, closed with other and unspecified intracranial hemorrhage, with loss of consciousness of unspecified duration 器械術式 Cranioplasty+VPS 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3 紀錄醫師 林哲光, 時間資訊 23:42 臨時手術NPO 08:15 進入手術室 08:20 麻醉開始 08:28 誘導結束 08:35 抗生素給藥 09:02 手術開始 12:08 抗生素給藥 13:08 15:00 手術結束 15:00 麻醉結束 15:10 送出病患 15:15 進入恢復室 18:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 手術 腦室腹腔分流手術 1 1 R 手術 頭顱成形術 1 2 L 摘要__ 手術科部: 外科部 套用罐頭: Cranioplasty 開立醫師: 蔡翊新 開立時間: 2011/05/12 15:08 Pre-operative Diagnosis Right F-T-P skull defect and hydrocephalus. Post-operative Diagnosis Right F-T-P skull defect and hydrocephalus. Operative Method Cranioplasty with autologous bone graft. Programmable VP shunt via left Kocher point. Specimen Count And Types 3 tubes of CSF, sent for routine, BCS and culture. Pathology Nil. Operative Findings 1. Bulging of scalp over right F-T-P skull defect was noted after general anesthesia. The skull defect was 14 x 12 cm in size. A silastic member placed between dura and galea was removed. CSF was drained via temporary right Kocher EVD for the brain to slack and to facilitate cranioplasty. 2. Intraperitoneal adhesion was encountered at LUQ of abdomen. CSF gushed out after puncture of left frontal horn of lateral ventricle. Ventricular catheter was 6.5 cm in depth. The Codman programmable VP shunt was set at 140 mmH2O. The peritoneal catheter was 20 cm. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation:shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with a sterilized adhesive plastic sheet. 4. Incision: along the previous operation scar at right F-T-P, Raney clips were applied to the scalp edge for temporary hemostasis. 5. The right F-T-P scalp and temporalis muscle were dissected away from the underlying dura. The dural surface and margin of skull defect were well exposed. 6. The bleeders on the dissected surfaces were coagulated with Bovie painstakingly. 7. The original skull plate preserved at bone bank was soaked with Vancomycin solution and placed back to the skull window then fixed by 3 miniplates and 6 screws. Six dural tenting at the center of the skull plate were set. 8. Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by interrupted suture with 3/0 nylon. 9. Drain: two, epidural, CWV. 10.The position was changed to supine with head rotated to right. 11.Skin preparation as usual. 12.Scalp incision at left frontal area. A burr hole was made at left Kocher point. Ventricular catheter was inserted. 13.Minilaparotomy at LUQ of abdomen was created to insert peritoneal catheter. 14.A subcutaneous tunnel was made up to scalp wound. The VP shunt was connected to ventricular and peritoneal catheters. 15.The shunt function was tested. 16.Wounds were closed. 17.Blood transfusion: nil. Blood loss: 300 ml. 18.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R4林哲光Ri嚴愛文 記錄__ 手術科部: 外科部 套用罐頭: Cranioplasty 開立醫師: 林哲光 開立時間: 2011/05/26 15:04 Pre-operative Diagnosis Right F-T-P skull defect and hydrocephalus. Post-operative Diagnosis Right F-T-P skull defect and hydrocephalus. Operative Method Cranioplasty with autologous bone graft. Programmable VP shunt via left Kocher point. Specimen Count And Types 3 tubes of CSF, sent for routine, BCS and culture. Pathology Nil. Operative Findings 1. Bulging of scalp over right F-T-P skull defect was noted after general anesthesia. The skull defect was 14 x 12 cm in size. A silastic member placed between dura and galea was removed. CSF was drained via temporary right Kocher EVD for the brain to slack and to facilitate cranioplasty. 2. Intraperitoneal adhesion was encountered at LUQ of abdomen. CSF gushed out after puncture of left frontal horn of lateral ventricle. Ventricular catheter was 6.5 cm in depth. The Codman programmable VP shunt was set at 140 mmH2O. The peritoneal catheter was 20 cm. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation:shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with a sterilized adhesive plastic sheet. 4. Incision: along the previous operation scar at right F-T-P, Raney clips were applied to the scalp edge for temporary hemostasis. 5. The right F-T-P scalp and temporalis muscle were dissected away from the underlying dura. The dural surface and margin of skull defect were well exposed. 6. The bleeders on the dissected surfaces were coagulated with Bovie painstakingly. 7. The original skull plate preserved at bone bank was soaked with Vancomycin solution and placed back to the skull window then fixed by 3 miniplates and 6 screws. Six dural tenting at the center of the skull plate were set. 8. Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by interrupted suture with 3/0 nylon. 9. Drain: two, epidural, CWV. 10.The position was changed to supine with head rotated to right. 11.Skin preparation as usual. 12.Scalp incision at left frontal area. A burr hole was made at left Kocher point. Ventricular catheter was inserted. 13.Minilaparotomy at LUQ of abdomen was created to insert peritoneal catheter. 14.A subcutaneous tunnel was made up to scalp wound. The VP shunt was connected to ventricular and peritoneal catheters. 15.The shunt function was tested. 16.Wounds were closed. 17.Blood transfusion: nil. Blood loss: 300 ml. 18.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R4林哲光Ri嚴愛文 江志昇 (M,1966/07/14,45y8m) 手術日期 2011/05/12 手術主治醫師 蔡翊新 手術區域 東址 001房 03號 診斷 Intracerebral hemorrhage 器械術式 Brain tumor Crainotomy(Others)，External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3E 紀錄醫師 陳睿生, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 10:35 進入手術室 10:35 報到 10:42 麻醉開始 11:15 抗生素給藥 11:15 誘導結束 11:20 手術開始 14:15 抗生素給藥 15:30 麻醉結束 15:30 手術結束 15:37 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 手術 腦內血腫清除術 1 1 L 手術 顱內壓視置入 1 2 L 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for hematoma evacuation, and EVD i... 開立醫師: 陳睿生 開立時間: 2011/05/12 15:57 Pre-operative Diagnosis Left frontal intracerebral hemorrhage with intraventricular hemorrhage Post-operative Diagnosis Left frontal intracerebral hemorrhage with intraventricular hemorrhage Operative Method Craniotomy for hematoma evacuation, and EVD insertion for ICP monitoring Specimen Count And Types nil Pathology Nil Operative Findings The hematoma was noted subcortically, and it was noted to rupture to the subdural space at lateral aspect. The amount of the hematoma was about 30ml, and severe swelling of the brain was noted initially. After hematoma removal, the lateral ventricle was noted and an EVD was inserted. Initial ICP was low. Easy oozing of the brain parychema was noted intra-op. Operative Procedures 1. ETGA, supine position and head right turn, fix with Mayfield clump 2. Left frontotemporal scalp curvillinear incision 3. Facial nerve preservation, and the temporalis muscle was incised 4. Two bur holes made, and then an about 8x10 cm craniotomy was done 5. Dura tenting, the dura was opened along the craniotomy margin 6. We incised into the frontal cortex, and then hematoma was evacuated for decompression 7. The ventricle was exposed, and the raw surface of the brain parychema was packed with surgicel for hemostasis 8. Insert an EVD into the lateral ventricle 9. Close the dura tightly after deair, and the skull graft was fixed back with miniplates x3 after central tenting 10.Set a subgaleal CWV drain and the wound was closed in layers Operators VS 蔡翊新 Assistants R6 陳睿生, Ri Indication Of Emergent Operation conscious change 林萬益 (M,1933/10/23,78y4m) 手術日期 2011/05/12 手術主治醫師 蔡翊新 手術區域 東址 005房 02號 診斷 Intracerebral hemorrhage 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 4 紀錄醫師 李振豪, 時間資訊 17:16 開始NPO 17:16 通知急診手術 17:45 進入手術室 17:50 麻醉開始 18:20 誘導結束 18:30 開始輸血 18:30 抗生素給藥 18:35 手術開始 19:10 手術結束 19:10 麻醉結束 19:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱內壓視置入 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 神經部 套用罐頭: External ventricular drainage via right Koche... 開立醫師: 李振豪 開立時間: 2011/05/12 19:29 Pre-operative Diagnosis Cerebellar hemorrhage with ruptured into ventricle and hydrocephalus Post-operative Diagnosis Cerebellar hemorrhage with ruptured into ventricle and hydrocephalus Operative Method External ventricular drainage via right Kocher"s point Specimen Count And Types 1 piece About size:5ml Source:CSF for routine, BCS, and bacterial culture Pathology Nil Operative Findings The CSF was reddish with opening pressure 5cmH2O. The ventricular catheter was fixed at 7cm in depth. The pupil was isocornic(2/2) after whole procedure. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position. The scalp was shaved, scrubbed, and disinfected as usual. Linear scalp incision was made at right frontal area followed by one burr hole creation. Two dural tenting was performed. Cruciform durotomy was done and ventriculostomy was performed with ventricular needle. The ventricular catheter was introduced into right lateral ventricle and externalization was done. Hemostasis was achieved and the wound was closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS蔡翊新 Assistants R4李振豪 Indication Of Emergent Operation intraventricular hemorrhage with obstructive hydrocephalus and conscious disturbance 相關圖片 蕭鄭金枝 (F,1943/02/04,69y1m) 手術日期 2011/05/13 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Pituitary tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 王奐之, 時間資訊 23:06 臨時手術NPO 08:07 進入手術室 08:15 麻醉開始 08:30 誘導結束 08:50 抗生素給藥 09:24 手術開始 11:25 手術結束 11:25 麻醉結束 11:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經由蝶竇之腦下垂體瘤切除 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Endoscopic trans-sphenoidal adenomectomy 開立醫師: 王奐之 開立時間: 2011/05/13 11:50 Pre-operative Diagnosis Pituitary macroadenoma Post-operative Diagnosis Pituitary macroadenoma Operative Method Endoscopic trans-sphenoidal adenomectomy Specimen Count And Types 1 piece About size:pieces Source:pituitary tumor Pathology Pending Operative Findings Soft, fragile tumor was noted and removed in piecemeal fashion with ring currette. The tumor eroded the sellar floor. No CSF leakage was noted during the operation. Easy bleeding was encountered during tumor removal, but hemostasis was achieved after tumor removal and packing the tumor bed with gelfoam. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head placed on head-rest. Bilateral nostrils were packed with Bosmin gauze for a period of time and removed after skin scrubbing. After disinfection and draping in sterile fashion, the nasal mucosa was opened under microscopic aid, until the nasal septal cartilage was exposed and deviated. The vomer bone and the anterior wall of sphenoid sinus were then fractured and removed. Sellar floor was then opened, exposing the sellar dura. A small cruciate durotomy was done, the tumor was identified and removed with ring currette. After hemostasis and irrigation, the surgical field was packed with gelfoam. The bone flaps were placed back, the cartilage was reduced to midline position, and the nostrils were packed with Marocels. Operators P.杜永光, VS楊士弘 Assistants R6胡朝凱, R3王奐之 相關圖片 劉柏廷 (M,1990/11/08,21y4m) 手術日期 2011/05/13 手術主治醫師 杜永光 手術區域 東址 003房 02號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 1 紀錄醫師 王奐之, 時間資訊 23:07 臨時手術NPO 11:52 進入手術室 11:57 麻醉開始 12:20 誘導結束 12:30 手術開始 12:30 抗生素給藥 15:30 抗生素給藥 16:20 開始輸血 18:40 抗生素給藥 18:55 手術結束 18:55 麻醉結束 19:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除-手術時間在4~8小時 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Midline craniotomy, left interhemispheric app... 開立醫師: 王奐之 開立時間: 2011/05/13 19:13 Pre-operative Diagnosis Intraventricular tumor, suspected central neurocytoma Post-operative Diagnosis Intraventricular tumor, suspected central neurocytoma Operative Method Midline craniotomy, left interhemispheric approach for tumor removal Midline craniotomy, left interhemispheric transcallosal approach for tumor removal Specimen Count And Types 1 piece About size:pieces Source:intraventricular tumor Pathology Pending Operative Findings Whitish elastic tumor was noted in left lateral ventricle after callosotomy. Clear tumor border was noted, removed in piecemeal fashion completely. Easy bleeding was encountered, estimated blood loss: 1400ml. Operative Procedures After ETGA, the patient was placed in supine position and face turned to left and head fixed in Mayfield skull clamp. A reserved U-shape skin incision was made at frontal area, followed by midline craniotomy creation. A fishmouth durotomy was done, the dural flap was reflected to the midline. Interhemispheric route was taken, and the corpus callosum was noted. A small callosotomy was done (about 2cm in diameter), the ventricle was then entered, exposing the tumor. The tumor was then removed in pieces. After hemostasis and setting 1 EVD, the dura was closed in water-tight fashion. The bone was fixed back with miniplates and screws, the wound was closed in layers after setting 1 subgaleal CWV drain. Operators P. 杜永光 Assistants R6 胡朝凱, R3 王奐之 相關圖片 謝麗珠 (F,1952/09/30,59y5m) 手術日期 2011/05/13 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Sotos'' syndrome 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 邱裕淳, 時間資訊 23:08 臨時手術NPO 08:05 進入手術室 08:10 麻醉開始 08:20 誘導結束 08:43 抗生素給藥 09:13 手術開始 10:00 手術結束 10:00 麻醉結束 10:10 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 經由蝶竇之腦下垂體瘤切除 1 1 R 手術 鼻中膈鼻道成形術-單側 1 2 R 摘要__ 手術科部: 外科部 套用罐頭: Microscopic trans-sphenoid tumor remove 開立醫師: 陳睿生 開立時間: 2011/05/13 10:27 Pre-operative Diagnosis Pituitary macroadenoma Post-operative Diagnosis Pituitary macroadenoma Operative Method Microscopic trans-sphenoid tumor remove Specimen Count And Types 1 piece About size:pieces Source:tumor Pathology Pending Operative Findings The tumor was whitish, soft, and fragile. After totally remove of the tumor, the arachnoid membrane fell. No CSF leakage was noted. Normal gland was found after tumor removed and preserved. Operative Procedures 1. ETGA, supine position and head mild right turn 2. We expand the right side nasal canal, and the mucosal septum was incised 3. The bony septum was pulled to the contralateral side, and the vomer bone was identified 4. The anterior sinusal wall was opened and the sinusal mucosa was removed 5. The sellar floor was found and the dura was opened 6. The tumor was found while dura opening 7. The tumor was carefully dissected from the dura and normal gland 8. It was removed piece by piece 9. Hemostasis, and the sellar cavity was packed with gelfoam 10.The sinusal wall defect was packed with bone graft 11.The mucosa was attached back and the left nasal cavity was packed with plastic bag Operators VS 曾漢民 Assistants R6 陳睿生, R1 邱裕淳 楊和雄 (M,1942/12/24,69y2m) 手術日期 2011/05/13 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Secondary cancer of Brain and spinal cord 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 污染 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 林奎佑, 邱裕淳, 時間資訊 23:09 臨時手術NPO 10:28 進入手術室 10:30 麻醉開始 10:55 誘導結束 11:54 手術開始 12:00 抗生素給藥 16:10 17:00 麻醉結束 17:00 手術結束 17:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 鼻內惡性腫瘤切除術 1 1 手術 顱底瘤手術 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for tumor remove and skull base re... 開立醫師: 陳睿生 開立時間: 2011/05/13 16:57 Pre-operative Diagnosis Nasal sinus SCC with right anterior fossa base and frontal lobe invasion Post-operative Diagnosis Nasal sinus SCC with right anterior fossa base and frontal lobe invasion Operative Method Craniotomy for tumor remove and skull base reconstruction Specimen Count And Types 2 pieces About size:pieces Source:mucosa & bone, tumor invasion About size:pieces Source:Brain tissue, tumor invasion Pathology Pending Operative Findings The tumor was soft, solid and yellowish. The right frontal sinus, ethmoid sinus and the dura at anterior fossa base were noted to be invaded by the tumor. The nasal bony septum was also diminished. The tumor inside the nasal cavity and invaded to the frontal lobe were removed. The anterior fossa base was reconstructed with pedicle flap with outer cortex of frontal bone. Operative Procedures 1. ETGA, supine position and head neutral position 2. Bicoronal scalp incision 3. The frontal scalp was retracted with periosteum preservation 4. The frontal periosteum was extracted as two pedicle flap, the right side one was extracted with an about 4x3 cm bony outer cortex 5. With five bur holes made, an about 10x15 cm craniotomy was created with bilateral frontal region exposion 6. The right frontal sinus was noted to be invaded by the tumor, and the dura at frontal base was also involved 7. The tumor at frontal base and right side frontal sinus, ethmoid sinus and nasal cavity was removed 8. Hemostasis, and the dura defect was repaired with left side periosteum and Tissuco Duo 9. The skull defect was covered with frontal bone outer cortex pedicle flap 10.The skull graft was fixed back with miniplates x6, and then central tenting 11.A subgaleal CWV drain was set, and the wound was closed in layers Operators VS 曾漢民 Assistants R6 陳睿生, R1 邱裕淳 記錄__ 手術科部: 耳鼻喉部 套用罐頭: endoscopic sinus surgery 開立醫師: 林奎佑 開立時間: 2011/05/13 17:22 Pre-operative Diagnosis Sinonasal cacner, right Post-operative Diagnosis Sinonasal cacner, right, operated Operative Method endoscopic sinus surgery Specimen Count And Types 2 pieces About size:0.5x0.5x0.5cm Source:right sinonasal tissue About size:0.2x0.2x0.2cm Source:soft tissue next to lamina papyracea Pathology 1. right sinonasal tissue, 0.5x0.5x0.5cm, pending 2. soft tissue next to lamina papyracea Operative Findings granular tissue noticed at anterior part of right frontal sinus, inter-frontal septum, and right peri-orbital area Operative Procedures 1. After operation by neurosurgeon, we took over the residual endoscopic sinus surgery procedure 2. Re-disinfect and re-drape patient as usual 3. Apply endoscope with 0-degree, 45-degree, and 70-degree to perform endoscopic sinus surgery 4. Remove visibal possible tumor lesion as much as possible. 5. Hemostasis and then pack 2 gelfoam (each 2x2cm) 6. Nasal packing bilaterally (Right: 2 fingerstall and 1 merocel; Left: 1 fingerstall and 1 merocel) 7. Patient tolerated the procedure above well Operators AP 葉德輝 Assistants R4 張睿紘, R2 林奎佑 吳美珍 (F,1993/07/19,18y7m) 手術日期 2011/05/13 手術主治醫師 郭夢菲 手術區域 兒醫 062房 04號 診斷 Malignant neoplasm of vertebral column, excluding sacrum and coccyx 器械術式 Lamino plasty，Malignant intraspinal tumor, e 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 12:32 報到 13:40 進入手術室 13:45 麻醉開始 14:00 誘導結束 15:00 抗生素給藥 15:10 手術開始 16:29 開始輸血 18:00 抗生素給藥 20:36 麻醉結束 20:36 手術結束 20:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術(減壓)-二節以內 1 2 手術 惡性脊髓腫瘤切除術 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: 1. Subtotal tumor excision, C7-T3 level. 開立醫師: 鍾文桂 開立時間: 2011/05/13 21:55 Pre-operative Diagnosis Malignant peripheral nerve sheath tumor with rhabdomyoblastic differentiation,C7-T3 status post tumor excision and chemotherapy, with tumor progression. Post-operative Diagnosis Malignant peripheral nerve sheath tumor with rhabdomyoblastic differentiation,C7-T3 status post tumor excision and chemotherapy, with tumor progression. Operative Method 1. Subtotal tumor excision, C7-T3 level. 2. Laminectomy, T3. Specimen Count And Types 1 piece About size:100cc Source:malignant spinal tumor. Pathology Pending. Operative Findings 1. Whitish, elastic, firm, encapsulated, and hypervascularized tumor from upper T to lower C spine level. The margin of the tumor and the surrounding normal tissue was not clear. It infiltrated into the paraspinal muscle and eroded the spinal laminae and ribs. We first debulked the tumor at the left paraspinal region to reach the epidural tumor mass at T 1-2 level. Then, we did T3 laminectomy to find the tumor-epidural margin. No spinal root was identified during tumor excision. We used CUSA to achieve better tumor excision. The bulging left upper back became flat after tumor excision. 2. The dura mater was thinned with some hypervascularization at its surface. It was intact during tumor excision. It was pushed to the right anterior side by the tumor mass. 3. Blood loss: 1000cc. Operative Procedures Under ETGA, the patient was placed in prone position. After disinfection and draping, a linear 30-cm skin incision was made along the previous operative wound. After meticulous dissection, the posterior margin of the tumor was identifed along its capsule from the paraspinal muscle. The T3 laminae was identified and excised. The tumor was excised in piecemeal fashion by CUSA and monopolar and bipolar electrocoagulation until the dura mater was fully decompressed. Well hemostasis was achieved by bipolar coagulation,surgicel, and gelfoam. The wound was closed in layers with one epidural CWV drain. Operators 郭夢菲 Assistants R5 鍾文桂 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: 1. Subtotal tumor excision, C7-T3 level. 開立醫師: 郭夢菲 開立時間: 2011/05/14 11:55 Pre-operative Diagnosis Malignant peripheral nerve sheath tumor with rhabdomyoblastic differentiation,C7-T3 status post tumor excision and chemotherapy, with tumor progression. Post-operative Diagnosis Malignant peripheral nerve sheath tumor with rhabdomyoblastic differentiation,C7-T3 status post tumor excision and chemotherapy, with tumor progression. Operative Method 1. Subtotal tumor excision, C7-T3 level. 2. Laminectomy, T3. Specimen Count And Types 1 piece About size:100cc Source:malignant spinal tumor. Pathology Pending. Operative Findings 1. Whitish, elastic, firm, encapsulated, and hypervascularized tumor from upper T to lower C spine level. The margin of the tumor and the surrounding normal tissue was not clear. It infiltrated into the paraspinal muscle, interspinal ligment and eroded the spinal laminae and ribs. We first debulked the tumor at the left paraspinal amd interspinal region to reach the epidural tumor mass at T1-2 level. Then, we did T3 laminectomy to find the tumor-epidural margin. No spinal root was identified during tumor excision. We used CUSA to achieve better tumor excision during the whole procedure. The bulging left upper back became flat after tumor excision. 2. The dura mater was thinned with some hypervascularization at its surface. It was intact during tumor excision. It was pushed to the right anterior side by the tumor mass. 3. Blood loss: 1000cc. Operative Procedures Under ETGA, the patient was placed in prone position. After disinfection and draping, a linear 30-cm skin incision was made along the previous operative wound. After meticulous dissection, the posterior margin of the tumor was identifed along its capsule from the paraspinal muscle. the epidural space was not able to reach until the interspinous ligment and paraspinal muwcle which were infiltrated with the muslce was partially removed. The T3 laminae was identified and excised. Then the C7 lamina was identified for better exposure of the tumor and dura interface. The tumor was excised in piecemeal fashion by CUSA and monopolar and bipolar electrocoagulation until the dura mater was fully decompressed. We further removed the tumor at the left paraspinal and the tumor medial to the left sacpula space till the space became falt. The anterior part of the tumor which invaded into the chest cavity was left in space. Well hemostasis was achieved by bipolar coagulation,surgicel, and gelfoam. The wound was closed in layers with one epidural CWV drain. Operators 郭夢菲 Assistants R5 鍾文桂 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: 1. Subtotal tumor excision, C7-T3 level. 開立醫師: 郭夢菲 開立時間: 2011/05/14 11:56 Pre-operative Diagnosis Malignant peripheral nerve sheath tumor with rhabdomyoblastic differentiation,C7-T3 status post tumor excision and chemotherapy, with tumor progression. Post-operative Diagnosis Malignant peripheral nerve sheath tumor with rhabdomyoblastic differentiation,C7-T3 status post tumor excision and chemotherapy, with tumor progression. Operative Method 1. Subtotal tumor excision, C7-T3 level. 2. Laminectomy, T3. Specimen Count And Types 1 piece About size:100cc Source:malignant spinal tumor. Pathology Pending. Operative Findings 1. Whitish, elastic, firm, encapsulated, and hypervascularized tumor from upper T to lower C spine level. The margin of the tumor and the surrounding normal tissue was not clear. It infiltrated into the paraspinal muscle, interspinal ligment and eroded the spinal laminae and ribs. We first debulked the tumor at the left paraspinal amd interspinal region to reach the epidural tumor mass at T1-2 level. Then, we did T3 laminectomy to find the tumor-epidural margin. No spinal root was identified during tumor excision. We used CUSA to achieve better tumor excision during the whole procedure. The bulging left upper back became flat after tumor excision. 2. The dura mater was thinned with some hypervascularization at its surface. It was intact during tumor excision. It was pushed to the right anterior side by the tumor mass. 3. Blood loss: 1000cc. Operative Procedures Under ETGA, the patient was placed in prone position. After disinfection and draping, a linear 30-cm skin incision was made along the previous operative wound. After meticulous dissection, the posterior margin of the tumor was identifed along its capsule from the paraspinal muscle. the epidural space was not able to reach until the interspinous ligment and paraspinal muwcle which were infiltrated with the muslce was partially removed. The T3 laminae was identified and excised. Then the C7 lamina was identified for better exposure of the tumor and dura interface. The tumor was excised in piecemeal fashion by CUSA and monopolar and bipolar electrocoagulation until the dura mater was fully decompressed. We further removed the tumor at the left paraspinal and the tumor medial to the left sacpula space till the space became falt. The anterior part of the tumor which invaded into the chest cavity was left in space. Well hemostasis was achieved by bipolar coagulation,surgicel, and gelfoam. The wound was closed in layers with one epidural CWV drain. Operators 郭夢菲 Assistants R5 鍾文桂 相關圖片 施蔡雪櫻 (F,1939/12/12,72y3m) 手術日期 2011/05/13 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Chronic periodontitis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 1 紀錄醫師 全賀顯, 時間資訊 23:11 臨時手術NPO 08:10 麻醉開始 08:20 誘導結束 08:40 抗生素給藥 08:55 手術開始 08:55 進入手術室 11:40 抗生素給藥 11:50 開始輸血 12:45 手術結束 12:45 麻醉結束 12:50 送出病患 12:55 進入恢復室 14:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎間盤切除術-腰椎 1 2 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 曾峰毅 開立時間: 2011/05/13 12:36 Pre-operative Diagnosis Spondilolisthesis, status post L3/4 transforaminal lumbar interbody fusion, status post right L3 laminotomy for sublaminar decompressin, complicated with adjacent level failure at L2/3 Post-operative Diagnosis Spondilolisthesis, status post L3/4 transforaminal lumbar interbody fusion, status post right L3 laminotomy for sublaminar decompressin, complicated with adjacent level failure at L2/3 Operative Method Transforaminal lumbar interbody fusion with PEEK cage and autologous bone graft at L2/3, removal of previous transpedicular screws at L3 and L4, and posterior fixation with transpedicular scrwes at L2, L3, and L4. Specimen Count And Types Nil Pathology Nil Operative Findings Previuos Stryker transpedicular screws was remvoed. Synthes PEEK cage and transpedicular screws were used. Thecal sac was decompressed well. 6.2 mm x 45 mm screws were inerted into bilateral L2 pedicles and left L3 pedicle. 7.0 mm x 45 mm screws wre inserted into right L3 pedicle and bilateral L4 pedicles. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After back scrubbed, disninfected, and then draped, we made one midline skin incision along previous operation wound. We dissected to expose bilateral laminae from L2 to L4 and previous implant. We removed previous transpedicular screws and rods (Stryker), and inserted transpedicular screws into bilateral pedicles of L2, L3, and L4. We performed L3 laminecomy, and L2/3 diskectomy. Fusion was achieved with PEEk cage and autologous bone graft. Posterio fixation was done with rods fixation. After inserting two hemovasc, the wound was closed in layers. Operators VS 賴達明 Assistants R4 曾峰毅 R1 全賀顯 何阿絨 (F,1941/08/20,70y6m) 手術日期 2011/05/13 手術主治醫師 賴達明 手術區域 東址 019房 02號 診斷 Lumbar Spondylosis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 全賀顯, 時間資訊 23:12 臨時手術NPO 12:15 報到 13:06 進入手術室 13:15 麻醉開始 13:25 誘導結束 13:30 抗生素給藥 13:50 手術開始 16:15 手術結束 16:15 麻醉結束 16:20 送出病患 16:25 進入恢復室 18:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎間盤切除術-腰椎 1 2 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 曾峰毅 開立時間: 2011/05/13 16:12 Pre-operative Diagnosis Lumbar stenosis, L3-5; Spondylolisthesis, L4/5, grade I Post-operative Diagnosis Lumbar stenosis, L3-5; Spondylolisthesis, L4/5, grade I Operative Method Transforaminal lumbar interbody fusion with PEEK cage and autologous bone graft at L4/5, and posterior fixation with transpedicular screws of L4/5; Subalminar decompression of L3/4, and posterolateral fusion with autologous bone graft of L3/4 Specimen Count And Types nil Pathology Nil Operative Findings Thecal sac with bilateral lateral recess of L4/5 were compromised with hypertrophic ligamentum flavum. Neural structure was decompressed well after the procedure. Synthes PEEK cage and transpedicular scres, 6.2 mm x 40 mm, were inserted into bilateral pedicels of L4/5. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After back scrubbed, disinfected, and then draped, we made one midline skin incision to expose bilateral laminae from L3 to L5. We inserted transpedicular screws into bilateral pedicles of L4 and L5. We performed L4 laminectomy and then L4/5 discectomy and L3/4 sublaminar decompression. L4/5 Fusion was achieved with PEEK cage and autologous bone graft in left transforaminal lumbar interbody fusion fashion. Fixation was done with rods set. L3-4 posterolateral fusion with done with autologous bone graft after decortication of outer L3/4 facet. The wound was closed in layers after one hemovac inserted, and gentamycin-saline irrigation. Operators VS 賴達明 Assistants R4 曾峰毅 R1 全賀顯 詹仕宇 (M,1980/08/17,31y6m) 手術日期 2011/05/13 手術主治醫師 賴達明 手術區域 東址 025房 04號 診斷 Hydrocephalus 器械術式 Revision of CSF shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 髒 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 2 紀錄醫師 李振豪, 時間資訊 23:19 臨時手術NPO 13:30 報到 13:40 進入手術室 13:45 麻醉開始 13:45 抗生素給藥 13:50 誘導結束 14:15 手術開始 15:00 手術結束 15:00 麻醉結束 15:10 送出病患 15:15 進入恢復室 16:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦脊髓液分流管重置 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Removal of V-P shunt and wound debridement 開立醫師: 李振豪 開立時間: 2011/05/13 15:28 Pre-operative Diagnosis V-P shunt reservoir exposure Post-operative Diagnosis V-P shunt reservoir exposure Operative Method Removal of V-P shunt and wound debridement Specimen Count And Types 3 pieces About size:tip culture x I Source:Peritoneal catheter tip culture About size:1ml Source:CSF within reservoir About size:culture swab x III Source:debirded tissue Pathology Nil Operative Findings The reservoir of 4th ventricle V-P shunt was exposed with necrotic wound edge. Shunt dysfunction was noted at the begining of the surgery because the CSF sampling from the reservoir was difficult. The ventricular catheter was broken and the proximal part of the ventricular catheter can not be found during the operation. The peritoneal catheter was totally removed and sent for tip culture. Three wound swab and CSF within reservoir were sent for culture. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head rotated to right. The scalp was shaved, scrubbed, and disinfected as usual. CSF sampling from reservoir was tried but failed due to shunt dysfunction. The scalp incision was extended along the exposure wound and the margin of the V-P shunt was dissected. The ventricular catheter was identified but the broken ventricular catheter with missed proximal part was noted during the operation. The fibrotic tract was noted but we still could not found the proximal part of the ventricular catheter. The peritoneal catheter was identified and the connection with left antisiphon device was noted. One 1.5cm left neck transverse skin incision along operative scar was made and the anti-siphon device was identified. The V-P shunt was removed totally except the broken ventricular catheter within 4th ventricle. Hemostasis was achieved. The margin of nuchal wound was trimmed. Gentamicin solution was applied for wound irrigation. The wound was then closed in layers with 3-0 Vicryl and 3-0 Nylon. Operators VS賴達明 Assistants R4李振豪 相關圖片 袁賀耶魯 (F,1932/12/25,79y2m) 手術日期 2011/05/13 手術主治醫師 蔡翊新 手術區域 東址 003房 03號 診斷 Cerebral aneurysm 器械術式 Craniotomy(Aneurysms) P-DUH 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3E 紀錄醫師 胡朝凱, 時間資訊 15:32 臨時手術NPO 15:32 開始NPO 20:32 通知急診手術 22:18 進入手術室 22:30 麻醉開始 23:00 誘導結束 23:30 抗生素給藥 23:37 手術開始 03:55 手術結束 03:55 麻醉結束 04:06 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 開顱術摘除血管病變 - 腦血管瘤 有病徵的 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 摘要__ 手術科部: 外科部 套用罐頭: Aneurysm-frontotemporal approach 開立醫師: 蔡翊新 開立時間: 2011/05/14 05:20 Pre-operative Diagnosis Left p-com arytery aneurysm rupture with diffuse SAH and left temporal ICH. Post-operative Diagnosis Left p-com arytery aneurysm rupture with diffuse SAH and left temporal ICH. Operative Method Left pterional craniotomy for aneurysm clipping. Specimen Count And Types nil Pathology Nil. Operative Findings The dura adhered tightly to the bone and incidental dural tear was created during craniotomy. The brain bulged out after dural opening. Diffuse SAH, esp. in the left Sylvian fissure and basal cisterns, was encountered. Severe atherosclerosis of ICA and MCA was noted. A 1.1 x 0.8 x 0.7 cm saccular aneurysm arose from lateral aspect of left ICA at origin of left p-com artery, pointing inferiolaterally. Left temporal ICH gushed out after cortical incision near the attached point of aneurysmal dome to brain tissue. The aneurysm was clipped by a straight 12 mm Sugita clip. The left temporal ICH was paritally evacuated. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right for 30 degree and slightly extended then fixed by Mayfield skull clamp. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: left frontotemporal, curvilinear. The skin edge was clipped by Raney clips for temporary hemostasis. After scalp had been lifted, the temporalis muscle was incised and detached from temporal squama and reflected to lower temporal side. 5. Craniotomy window: 8 x 6 cm, left frontotemporal, created by making 3 burr holes then cut by power saw. The lower temporal bone and pterionic ridge (esp. the inner table) were cut by rongeur as low as possible for easy approach to the anterior clinoid which was also removed by drilling. 6. Dural tention: by 2/0 silk, 2 cm in interval, distributed along the edge of skull window. 7. Dural incision: V shape, over-ridding Sylvian fissure and reflected to frontotemporal base. 8. Under operating microscope, the Sylvian fissure was opened, then the frontal and temporal opercula were retracted by self-retaining retractor in an opposite direction to expose neck of aneurysm. A 0.7 cm cortical incision was made with a Scarff bipolar forceps at the anterior location of the left superior temporal gyrus, then the intracerebral hematoma was sucked out. A piece of pia membrane was left on the surface of aneurysmal body. 9. The neck of the aneurysm was mobilized gently bya Gage 18 sucker and a microdissector until it was entirely free. 10.A straight 12 mm Sugita clip was applied to the neck of the aneurysm. 11.After successful clipping of the aneurysm, the patient's BP was brought back to normal, and the exposed field was irrigated with N.S. to make sure no any bleeding. 12.The brain retractors were removed. The dura was closed by running suture with 4/0 Prolene and the tore sites were packed with Durofoam. 13.Closure of skull window: the skull plate was placed back to craniotomy window and fixed by 3 miniplates and 6 screws. The dura was tented to the center of the skull plate by a 2/0 stitch. The covering muscle was closed by interrupted stitches with 1/ 0 silk. 14.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 15.Drain: one, epidural, CWV. 16.Blood transfusion: nil. Blood loss: 400 ml. 17.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R6胡朝凱R1游皓鈞 Indication Of Emergent Operation Aneurysm rupture with SAH. 李春美 (F,1950/04/12,61y11m) 手術日期 2011/05/14 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Parkinsonism 器械術式 Deep brain stimulation for Parkinsonism 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 邱裕淳, 時間資訊 23:58 臨時手術NPO 08:00 進入手術室 08:10 麻醉開始 08:20 誘導結束 08:30 抗生素給藥 08:50 手術開始 09:20 開始輸血 11:30 抗生素給藥 14:30 抗生素給藥 14:55 手術結束 14:55 麻醉結束 15:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 立體定位術-功能性失調 1 2 R 手術 立體定位術-功能性失調 1 1 L 手術 深部腦核電生理定位 1 0 B 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 摘要__ 手術科部: 外科部 套用罐頭: Insertion of DBS wire at bilateral subthalamu... 開立醫師: 胡朝凱 開立時間: 2011/05/14 15:10 Pre-operative Diagnosis Parkisons disease Post-operative Diagnosis Parkisons disease Operative Method Insertion of DBS wire at bilateral subthalamus nucleas Specimen Count And Types Nil Pathology Nil Operative Findings 1. final target: left side, lateral 2mm to pre-set target, right side, on the target. 2. The rigidity decreased after wire inserted at stimulation "on". 3. total bilateral trajectory: four times Operative Procedures Under IV general anesthesia, the patient was put in supine position. The scalp was shaved, scrubbed and antiseptic with alcohol B-I. Registered the preset localization point to navigator. Bicoronal scalp incision was made with burr hole made at entery point of left frontal region as navigator guided. The DBS wire port was set up and localization of subthalamus nucleus with microelectrode assistance. Inserted the DBS wire and fixed with the port. Waked the patient from the anesthesia and started stimulation from low voltage. Checked the clinical responses while using different voltage for stimulation. Performed the same procedure at right side. After hemostasis, closed the wound in layers. Operators AP 曾勝弘 Assistants 胡朝凱, 鍾文桂, 邱裕淳 黃政雄 (M,1944/03/25,67y11m) 手術日期 2011/05/15 手術主治醫師 蕭輔仁 手術區域 東址 002房 07號 診斷 Subdural hemorrhage, traumatic 器械術式 Burr hole (trephination) for chronic SDH evacuation 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 胡朝凱, 時間資訊 18:00 臨時手術NPO 18:00 開始NPO 21:00 通知急診手術 01:10 報到 01:15 進入手術室 01:30 麻醉開始 01:40 誘導結束 01:40 抗生素給藥 02:04 手術開始 02:45 手術結束 02:45 麻醉結束 02:52 送出病患 02:55 進入恢復室 03:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 慢性硬腦膜下血腫清除術 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Left burr hole drainage 開立醫師: 胡朝凱 開立時間: 2011/05/15 03:03 Pre-operative Diagnosis Left chronic SDH Post-operative Diagnosis Left chronic SDH Operative Method Left burr hole drainage Specimen Count And Types nil Pathology nil Operative Findings 1.Motor oil like old hematoma was drain out 2.Brain expanded well and quickly 3.Outer membrane was noted Operative Procedures 1.ETGA, supine 2.Left parietal vertical skin incision 3.Dissect to open periosteum 4.Burr hole drill 5.dural tenting 6.open dura and outer membrane 7.insert EVD catheter as subdural drain 8.irrigation 9.Close wound in layers Operators VS 蕭輔仁 Assistants 胡朝凱 Indication Of Emergent Operation acute deterioration of neurologic symptoms 吳莉媺 (F,1987/05/24,24y9m) 手術日期 2011/05/14 手術主治醫師 王國川 手術區域 東址 002房 號 診斷 Contusion, scalp 器械術式 ICP monitoring 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 2E 紀錄醫師 鍾文桂, 時間資訊 01:06 通知急診手術 01:44 進入手術室 01:50 麻醉開始 02:00 誘導結束 02:35 抗生素給藥 02:37 手術開始 03:16 開始輸血 05:00 抗生素給藥 05:50 手術結束 05:50 麻醉結束 06:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 硬腦膜外血腫清除術 1 2 L 手術 腦內血腫清除術 1 1 R 手術 顱內壓視置入 1 4 L 摘要__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 曾峰毅 開立時間: 2011/05/14 05:51 Pre-operative Diagnosis Right frontal contusional ICH, left acute SDH Post-operative Diagnosis Right frontal contusional ICH, left acute EDH and SDH Operative Method Right decompressive craniectomy for ICH removal, and left craniotomy for EDH and SDH removal, and ICP monitor insertion Specimen Count And Types Nil Pathology Nil Operative Findings Before the operation, patient had had bilateral symmetric pupils. Right temporal and frontal contusional ICH was noted by sonography after right craniectomy. The brain was slack initially, but bulging out during duroplasty. The brain remained tense after ICH removal. After right craniecotmy wound closed, the patient had had left dilated and fixed pupil. EDH gushed out while burr hole at left frontotemporal area. Left side EDH was about 2 cm thick, and SDH was about 0.5 cm thick. ICP after the surgery was about 5 mmHg. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to left. After scalp scrubbed, disinfected, and then draped, we made question mark skin incision at right, and relfected the scalp flap inferiorly. We drilled burr holes, and created craniectomy. Dura was incised for augmentation duroplasty with durofoam. We performed sonography in search of ICH, and right frontal and temporal ICH was removed partially. We closed the wound in layers after one subgaleal CWV, and removed the draping. We turned the patient's head to right, and rescrubbed, disinfected, and draped the scalp. We made another smaller question mark skin incision at left, and drilled three burr holes, and performed dura tenting after craniotomy. We removed EDH, and opened the dura to remove SDH. Duroplasty was performed with durofoam, and inserted subdural ICP monitor. We inserted one epidural CWV, and fixed the skull graft back with mini-plates. The wound was closed in layers. Operators VS 王國川 Assistants R5 鍾文桂 R4 曾峰毅 R1 游皓鈞 Indication Of Emergent Operation Life threatening condition 李黃來馨 (F,1927/02/11,85y1m) 手術日期 2011/05/14 手術主治醫師 陳晉興 手術區域 東址 018房 01號 診斷 Patients requiring long-term use of a respirator due to respiratory failure, use respirator 6 hours per day continue 30 days 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 4 紀錄醫師 郝政鴻, 時間資訊 08:17 報到 08:17 進入手術室 08:20 麻醉開始 08:25 誘導結束 08:30 抗生素給藥 08:32 手術開始 08:47 麻醉結束 08:47 手術結束 08:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 氣管切開術 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 郝政鴻 開立時間: 2011/05/14 08:56 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types nil Pathology None Operative Findings Fr . 7 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators VS陳晉興 Assistants R5李佳穎 R3郝政鴻 吳思穎 (F,1981/05/23,30y9m) 手術日期 2011/05/15 手術主治醫師 蕭輔仁 手術區域 東址 001房 01號 診斷 Contusion, chest 器械術式 Spinal fusion posterior 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2E 紀錄醫師 吳昭瑩, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 01:45 通知急診手術 08:25 報到 08:35 進入手術室 08:40 麻醉開始 08:55 誘導結束 09:10 抗生素給藥 09:34 手術開始 12:10 抗生素給藥 12:15 手術結束 12:15 麻醉結束 12:23 送出病患 12:30 進入恢復室 13:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 曾峰毅 開立時間: 2011/05/15 12:21 Pre-operative Diagnosis Fracture dislocation, T6-7 Post-operative Diagnosis Fracture dislocation, T6-7 Operative Method Posterior fixation with transpedicular screws at T5-8 and posterior fusion with autologous and artificial bone graft Specimen Count And Types Nil Pathology Nil Operative Findings Fracture line was noted at T6 laminae. Instability was noted at T6/7 level. A-spine transpedicular screws, crosslink, rods, and artificial bone graft were applied. 5.5 x 40 mm screws were inserted inot bilateral pedicles of T7 and T8. 5.5 x 35 mm screws were inserted inot bilateral pedicles of T6 and T6. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After C-arm localization, we made one midline skin incision to expose bilateral laminae from T5 to T8. We inserted transpedicular screws into bilateral pedicles of T5 to T8. Posterior fixation was achieved after rods set. Posterior fusion was done with autologous and artificial bone graft after laminae decortication. One cross link was used. After one submuscular hemovac set, the wound was closed in layers. Operators VS蕭輔仁 Assistants R4 曾峰毅 R1 吳昭瑩 Indication Of Emergent Operation Unstable traumatic spine injury 陳雪梅 (F,1947/01/20,65y1m) 手術日期 2011/05/15 手術主治醫師 蔡翊新 手術區域 東址 003房 01號 診斷 Subdural hemorrhage, traumatic 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 4E 紀錄醫師 鍾文桂, 時間資訊 15:01 通知急診手術 15:01 臨時手術NPO 15:01 開始NPO 15:35 進入手術室 15:40 麻醉開始 16:00 誘導結束 16:00 抗生素給藥 16:00 開始輸血 16:23 手術開始 19:00 抗生素給藥 20:20 手術結束 20:20 麻醉結束 20:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 急性硬腦膜下血腫清除術 1 1 R 手術 顱內壓視置入 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 蔡翊新 開立時間: 2011/05/15 19:45 Pre-operative Diagnosis Right frontotemporoparietal acute on chronic SDH. Post-operative Diagnosis Right frontotemporoparietal acute on chronic SDH. Operative Method Right frontotemporoparietal craniotomy for removal of SDH and ICP monitoring. Specimen Count And Types nil Pathology Nil. Operative Findings Subgaleal hematoma at right parietal region. The dura adhered tightly to the bone and was torn while we were doing craniotomy. Subdural hematoma with liquified blood and clots, was noted at right frontotemporoparietal area, 15 x 12 cm in area and 2 cm in thickness. An active bleeder from cortical artery at right temporal lobe was coagulated. A small area of contusion was noted at right posterior temporal lobe. There was outer membrane around the whole subdural blood clots. The brain remained slack after removal of SDH. ICP after duroplasty was 0 mmHg and after skin closure was 0 mmHg. ICP reference: 484. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: a temporal horseshoe incision at right frontotemporoparietal area, the skin edge was clipped by Raney clips for temporary hemostasis. The temporalis muscle was detached from temporal squama by rasp subsequently. 7. Craniotomy window: 12 x 10 cm, right F-T-P, created by making 5 burr holes then cut by power saw. 8. Dural tenting: by 2/0 silk, 2-cm in interval, distributed along the edge of skull window. 9. Dural incision: curvilinear along the edge of skull window. 10.The subdural clot was removed by sucker and those located beyond the cranial window was washed out by saline irrigation. 11.Hemosatasis: the bleeders was stopped by Bovie and oozing surface was covered with Surgicel. 12.An Codman ICP monitor was placed at subdural space of right temporal area. Reference level: 484. 13.Dural closure: was closed with a piece of dural graft taking from temporalis fascia, triangular shape, 6 x 5 cm along the whole length of the dural incision in order to create an additional space for the swollen brain. 14.The skull plate was placed back and fixed with 3 miniplates and 6 screws. 15.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 16.Drain: one subdural rubber drain connected to a reservoir bag; on epidural CWV drain. 17.Blood transfusion: nil. Blood loss: 600 ml. 18.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5鍾文桂R1吳昭瑩 Indication Of Emergent Operation Massive SDH, uncal herniation, IICP. 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 鍾文桂 開立時間: 2011/05/15 20:38 Pre-operative Diagnosis Right frontotemporoparietal acute on chronic SDH. Post-operative Diagnosis Right frontotemporoparietal acute on chronic SDH. Operative Method Right frontotemporoparietal craniotomy for removal of SDH and ICP monitoring. Specimen Count And Types nil Pathology Nil. Operative Findings Subgaleal hematoma at right parietal region. The dura adhered tightly to the bone and was torn while we were doing craniotomy. Subdural hematoma with liquified blood and clots, was noted at right frontotemporoparietal area, 15 x 12 cm in area and 2 cm in thickness. An active bleeder from cortical artery at right temporal lobe was coagulated. A small area of contusion was noted at right posterior temporal lobe. There was outer membrane around the whole subdural blood clots. The brain remained slack after removal of SDH. ICP after duroplasty was 0 mmHg and after skin closure was 0 mmHg. ICP reference: 484. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: a temporal horseshoe incision at right frontotemporoparietal area, the skin edge was clipped by Raney clips for temporary hemostasis. The temporalis muscle was detached from temporal squama by rasp subsequently. 7. Craniotomy window: 12 x 10 cm, right F-T-P, created by making 5 burr holes then cut by power saw. 8. Dural tenting: by 2/0 silk, 2-cm in interval, distributed along the edge of skull window. 9. Dural incision: curvilinear along the edge of skull window. 10.The subdural clot was removed by sucker and those located beyond the cranial window was washed out by saline irrigation. 11.Hemosatasis: the bleeders was stopped by Bovie and oozing surface was covered with Surgicel. 12.An Codman ICP monitor was placed at subdural space of right temporal area. Reference level: 484. 13.Dural closure: was closed with a piece of dural graft taking from temporalis fascia, triangular shape, 6 x 5 cm along the whole length of the dural incision in order to create an additional space for the swollen brain. 14.The skull plate was placed back and fixed with 3 miniplates and 6 screws. 15.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 16.Drain: one subdural rubber drain connected to a reservoir bag; on epidural CWV drain. 17.Blood transfusion: nil. Blood loss: 600 ml. 18.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5鍾文桂R1吳昭瑩 Indication Of Emergent Operation Massive SDH, uncal herniation, IICP. 相關圖片 陳文英 (F,1953/10/30,58y4m) 手術日期 2011/05/16 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 王奐之, 時間資訊 23:06 臨時手術NPO 08:05 進入手術室 08:10 麻醉開始 08:55 誘導結束 09:05 抗生素給藥 09:11 手術開始 12:05 抗生素給藥 15:00 手術結束 15:00 麻醉結束 15:05 送出病患 15:05 抗生素給藥 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除-手術時間在4~8小時 1 1 摘要__ 手術科部: 外科部 套用罐頭: Re-do left occipital craniotomy for Simpson g... 開立醫師: 王奐之 開立時間: 2011/05/16 15:11 Pre-operative Diagnosis Right posterior falx meningioma (meningiomatosis) Post-operative Diagnosis Right posterior falx meningioma (meningiomatosis) Operative Method Re-do left occipital craniotomy for Simpson grade 1 tumor removal Re-do left occipital craniotomy for Simpson grade 3 tumor removal Specimen Count And Types 1 piece About size:pieces Source:right occipital tumor Pathology Pending Operative Findings Whitish elastic tumor was noted at occipital area, arising from posterior falx, with extension to both aspects of the falx. Left side tumor was measured about 3 cm, right 1 cm. The great vein of Galen and the straight sinus were spared. Operative Procedures After ETGA, the patient was placed in prone position and head fixed in Mayfield skull clamp. A left occipital reverse U-shape incision along previous wound was made, followed by dissection to remove the bone flaps. A large cyst was noted at left occipital area, which was fenestrated and provided direct access to the meningioma. The tumor left to the falx were removed first, followed by resection of falx, then the tumor right to the falx were removed in pieces also. The tumor down to the falcotentorial junction was also removed from the straight sinus & the great vein of Galen. After meticulous hemostasis, the dura was closed with Durofoam. Bone graft was fixed back with miniplate. Then after one CWV drain insertion, wound was closed in layers. Operators P.杜永光 Assistants R6 胡朝凱, R3 王奐之 相關圖片 陳福川 (M,1976/08/28,35y6m) 手術日期 2011/05/16 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Pituitary Tumor 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 邱裕淳, 時間資訊 23:09 臨時手術NPO 08:02 進入手術室 08:10 麻醉開始 08:45 誘導結束 08:50 手術開始 08:50 抗生素給藥 12:05 抗生素給藥 12:15 手術結束 12:15 麻醉結束 12:25 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除-手術時間在4小時以內 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Transcortical approach for tumor remove 開立醫師: 陳睿生 開立時間: 2011/05/16 12:45 Pre-operative Diagnosis Third ventricle tumor, craniopharyngioma with recurrence Post-operative Diagnosis Third ventricle tumor, craniopharyngioma with recurrence Operative Method Transcortical approach for tumor remove Specimen Count And Types 1 piece About size:PIECES Source:TUMOR Pathology Pending Operative Findings The tumor was yellowish, fragile, and soft. The size was about 1cm in diameter. It located at the anterior part of the optic recess of third ventricle. After total remove of the tumor, endoscope was applied for residual tumor recheck. The fornix, and the brain parychema was preserved intra-op. Operative Procedures 1. ETGA, supine position and head fixed with MAyfield clump 2. After shaving and prepare, and previous wound at left frontal region was opened along the previous wound 3. The skull graft was removed after wires cutting 4. Dura tear was noted at left lateral side, and the dura was opened along the craniotomy window 5. Intra-op ECHO recheck of the previous corticotomy tract and recurrent tumor 6. The previous tract was identified and expanded 7. AFter proper retraction, the lateral ventricle and third one were exoposed 8. The tumor was identified at the anterior aspect of the third ventricle 9. After nearly total tumor remove, endoscope was applied for exanimatiion of residual one 10.Hemostasis, the dura was repaired with fascia graft 11.The skull graft was fixed back with wires x3, and central tenting 12.The wound was closed in layers Operators VS 曾漢民 Assistants R6 陳睿生, R1 邱裕淳 林毅賢 (M,1960/09/17,51y5m) 手術日期 2011/05/16 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Glioblastoma multiforma 器械術式 Brain biopsy (TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 邱裕淳, 時間資訊 23:10 臨時手術NPO 12:00 報到 12:40 進入手術室 12:45 麻醉開始 12:55 誘導結束 13:15 抗生素給藥 13:36 手術開始 15:45 麻醉結束 15:45 手術結束 15:55 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 立體定位術-切片 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Stereotactic biopsy 開立醫師: 陳睿生 開立時間: 2011/05/16 16:10 Pre-operative Diagnosis Left thalamus tumor, suspect glioma Post-operative Diagnosis Left thalamus tumor, suspect glioma Operative Method Stereotactic biopsy Specimen Count And Types 1 piece About size:pieces Source:TUMOR, suspect glioma Pathology Pending Operative Findings Navigation assist stereotactic biopsy was performed smoothly. Three marginal targets were selected for tumor biopsy. The tissue spicemen was whitish and solid. Operative Procedures 1. ETGA, supine position and head flexion, fixed with Mayfield clump 2. Set up navigation and select biopsy targets 3. Left frontal linear scalp incision and create a bur hole 4. Dura tenting, and then opened it 5. Set the biopsy frame, and extract spicemens under navigation guide 6. Hemostasis, and the wound was closed in layers Operators VS 曾漢民 Assistants R6 陳睿生, R1 邱裕淳 黃明珠 (F,1967/11/27,44y3m) 手術日期 2011/05/16 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 Glioblastoma multiforma 器械術式 Crainotomy Brain Tumor(P-LIN) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 胡朝凱, 時間資訊 23:08 臨時手術NPO 14:45 報到 15:25 進入手術室 15:30 麻醉開始 15:50 誘導結束 16:10 手術開始 16:10 抗生素給藥 16:45 17:10 開始輸血 19:25 抗生素給藥 22:25 麻醉結束 22:25 手術結束 22:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除-手術時間在4~8小時 1 1 記錄__ 手術科部: 外科部 套用罐頭: Right frontal craniotomy for tumor excision 開立醫師: 胡朝凱 開立時間: 2011/05/16 22:46 Pre-operative Diagnosis Right frontal metastatic tumor Post-operative Diagnosis Right frontal tumor, suspect metastatic or GBM Operative Method Right frontal craniotomy for tumor excision Specimen Count And Types one piece of tumor Pathology pending Operative Findings 1.One about 7x5 cm extremely hypervascular, reddish, soft tumor with multiple necrosis area was noted at right frontal lobe. 2.The tumor border was not clear 3.One large AV shunting was noted after dural opening 4.Tumor was easy touch bleeding 5.Easy bleeding during opening of skin flap and bone was also noted 6.Tumor was sticky to dura and it was subtotal excision Operative Procedures 1.ETGA, supine 2.Bicoronal skin incision 3.Reflect skin flap downward 4.Right frontal craniotomy one cm away from midline 5.Open dura with base left at midline 6.Tumor was excised along with the suspect border 7.Hemostasis 8.Close dura with Gore artificial dura 9.Fixed bone with miniplate 10.Close wound in layers after drain insertion Operators VS 王國川 Assistants 胡朝凱, 王奐之 丘吳爵 (F,1928/08/31,83y6m) 手術日期 2011/05/17 手術主治醫師 蔡瑞章 手術區域 東址 016房 02號 診斷 Head Injury 器械術式 Right frontal burr hole for chronic SDH drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2E 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 07:31 通知急診手術 10:45 進入手術室 10:50 麻醉開始 10:55 誘導結束 11:15 抗生素給藥 11:43 手術開始 12:35 麻醉結束 12:35 手術結束 12:45 送出病患 12:50 進入恢復室 13:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Right frontal burr hole drainage 開立醫師: 王奐之 開立時間: 2011/05/17 12:33 Pre-operative Diagnosis Right chronic subdural hematoma Post-operative Diagnosis Right chronic subdural hematoma Operative Method Right frontal burr hole drainage Specimen Count And Types Nil Pathology Nil Operative Findings Small amount of motor-oil like old hematoma gushed out after durotomy. The brain re-expanded well after hematoma evacuation. Operative Procedures After ETGA, the patient was placed in supine position with head slightly turned to left. After scalp shaving, disinfection and draping in sterile fashion, a linear incision was made at right frontal area. A burr hole was then created, followed by dural tenting. After hemostasis, a small cruciate durotomy was made, followed by rubber drain insertion for hematoma evacuation. The drain was then secured, and the wound was closed. The operation ended after deairing. Operators P. 蔡瑞章 Assistants R3 王奐之 Indication Of Emergent Operation Mass effect and midline shift 相關圖片 李春美 (F,1950/04/12,61y11m) 手術日期 2011/05/17 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Parkinsonism 器械術式 Implantation of pulse generator (DBS) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 林哲光, 時間資訊 23:15 臨時手術NPO 08:05 進入手術室 08:10 麻醉開始 08:15 誘導結束 08:48 手術開始 10:10 手術結束 10:10 麻醉結束 10:25 送出病患 10:26 進入恢復室 12:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室腹腔分流手術 1 2 L 記錄__ 手術科部: 外科部 套用罐頭: Implantable pulsed generator insertion at lef... 開立醫師: 林哲光 開立時間: 2011/05/17 11:27 Pre-operative Diagnosis Parkinson disease Post-operative Diagnosis Parkinson disease Operative Method Implantable pulsed generator insertion at left prechest area Specimen Count And Types nil Pathology Nil Operative Findings Medtronic IPG was inserted at left prechest area. Easily wound bleeding was noted. Intraoperative IPG function was confirmed. Operative Procedures Under ETGA and supine position with head mild rotated to right side, skin disinfected and drapped were performed as usual. Skin incision was made at left posterior auricle area. The previous two eletroleads were identified and subcutaneous tunneling was made from left prechest area to left neck. The leads were connected to IPG and IPG was inserted into the subcutaneous pocket at left prechest area. The wound was then closed in layers. Operators AP 曾勝弘 Assistants R4 林哲光, R2 陳志軒 相關圖片 黃淇 (M,1944/04/13,67y11m) 手術日期 2011/05/17 手術主治醫師 曾勝弘 手術區域 東址 005房 02號 診斷 Trigeminal neuralgia (Cranial nerve V) 器械術式 Radiofrequency coagulation 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 林哲光, 時間資訊 10:31 進入手術室 10:45 麻醉開始 10:46 麻醉結束 10:47 手術開始 11:08 手術結束 11:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 高頻熱凝療法 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Pulsed radiofrequency stimulation at right su... 開立醫師: 林哲光 開立時間: 2011/05/17 11:18 Pre-operative Diagnosis Right supraorbital neuralgia Post-operative Diagnosis Right supraorbital neuralgia Operative Method Pulsed radiofrequency stimulation at right supraorbital nerve Specimen Count And Types nil Pathology Nil Operative Findings Pulsed radiofrequency stimulation at right supraorbital nerve induced local right forehead pain. Operative Procedures Under supine position, skin disinfected and local anesthesia at right supraorbital noutch was done. Pulsed radiofrequency was then done at right supraorbital nerve for 2 cycle and distal part of the supraorbital noutch for another 2 cycle were done. Operators AP 曾勝弘 Assistants R4 林哲光, R3 陳志軒 R4 林哲光, R2 陳志軒 相關圖片 蘇泓諭 (F,1977/03/05,35y0m) 手術日期 2011/05/17 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Tethered cord syndrome 器械術式 Lamino plasty，Cord untethering -KUO 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 3 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:05 進入手術室 08:10 麻醉開始 08:50 誘導結束 09:05 抗生素給藥 09:35 手術開始 13:00 抗生素給藥 15:50 手術結束 15:50 麻醉結束 16:00 送出病患 16:05 進入恢復室 18:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎內脊髓內腫瘤切除術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 7 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦膜或脊突出修補術 1 2 摘要__ 手術科部: 外科部 套用罐頭: 1. Untethering of spinal cord. 開立醫師: 鍾文桂 開立時間: 2011/05/17 17:07 Pre-operative Diagnosis Tethered cord syndrome caused by lipomyelomeningocele, with re-tethering. Post-operative Diagnosis Tethered cord syndrome caused by lipomyelomeningocele, with re-tethering. Operative Method 1. Untethering of spinal cord. 2. Excision of subcutaneous lipoma. Specimen Count And Types nil Pathology Nil. Operative Findings 1. The L3 laminae was excised partially to identify the normal anatomic plane for further dissection. After durotomy, the left side of the spinal cord was lysed from its surrounding fibrous tissue first. Then, the right side of the spinal cord was lysed from the lipoma by excision of the lipoma. CUSA was used for lipoma excision. After untethering, the spinal cord ascends 1cm upward and positions more ventrally in the dural sac. the Intraoperative SSEP and MEP did not show signigicant change before and after the untethering. 2. The L4/5 ventral roots were identified and kept intact during dissection. The sacral roots were within the lipoma. Only 3 rootlets which adhered severely to the dura mater were sacrafized during dissection. They were proved to be in poor function during intraoperative electro-stimulation. Operative Procedures Under ETGA, the patient was placed in prone position. After disinfection and draping, a vertical incision was made from L3 to S3 ( a dermal sinus tract at this level). After dissection, we first identified the L3 laminae and dissected downward from this plane. After lysis of the epidual fibrous bands, the dura mater was exposed and a linear durotomy was obtained. The cul de sac the dura mater was identified. Then, untethering started from the left side of the spinal cord then to the right side by using dissector, microscissors, and CUSA. Until the cord became unethered, the dura mater was closed primarily with 4-0 prolene in watertight fashion. The wound was closed in layers with one epidural CWV drain. Operators 郭夢菲. Assistants R5 鍾文桂. 記錄__ 手術科部: 外科部 套用罐頭: 1. Untethering of spinal cord. 開立醫師: 郭夢菲 開立時間: 2011/05/18 13:13 Pre-operative Diagnosis Retethered cord syndrome caused by lipomyelomeningocele, S/P untethering Post-operative Diagnosis Retethered cord syndrome caused by lipomyelomeningocele, S/P untethering Operative Method 1. Untethering of spinal cord and repair of dura 2. Excision of subcutaneous lipoma. Specimen Count And Types nil Pathology Nil. Operative Findings The L4 laminae was excised partially at the lower part to identify the normal anatomic plane for further dissection. After durotomy under microscopic view, the left side of the spinal cord was lysed from its surrounding fibrous tissue first. Then, the right side of the lipoduroneural junction was identified and divided from L4 to the cul-de-sac of thecal sac successfully. We then went to the right side. The lipomatous tissue infiltrated into the nerve fiber to the L5 to S3 diffusely, but without sacrifice of the nerve fibers, the placode was lying loosly at the ventral part of the thecal sac. So we decided to preserve these nerves. CUSA was used for lipoma excision. After untethering, the spinal cord ascends 1cm upward and positions more ventrally in the dural sac. The intraoperative SSEP and MEP did not show significant change before and after the untethering. Operative Procedures Under ETGA, the patient was placed in prone position. After disinfection and draping, a vertical incision was made from L3 to S3 along the old scar. After dissection, we first identified the L3 spinous process and dissected downward from this plane and found the L4 lamina. The L4 spinous process has bee3n gone due to previous surgery. After lysis of the epidual fibrous bands, the dura mater was exposed and a linear durotomy was obtained under microscope. We identified the lipoduroneural junction at the left side from L4 level and going down till the cul de sac the thecal sac. We then used CUSA to debulk the lipomatous tissue to facilitate the lipoduroneural junction at the right side. The placode became untethered after complete untethering of the left, dorsal, and the caudal sides and debulking of the lipoma, so we decided to preserve the right side nerves. The dura mater was repaired primarily with the fibrotic dura with some adpose tissue on it with 4-0 prolene in watertight fashion. The wound was closed in layers with one epidural CWV drain. Operators 郭夢菲. Assistants R5 鍾文桂. 任寶美 (F,1955/10/29,56y4m) 手術日期 2011/05/17 手術主治醫師 賴達明 手術區域 東址 016房 01號 診斷 Subarachnoid hemorrhage (SAH) 器械術式 Revision of CSF shunt, left S-P shunt 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2E 紀錄醫師 陳睿生, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 07:29 通知急診手術 08:45 進入手術室 08:50 麻醉開始 08:55 誘導結束 09:15 抗生素給藥 09:43 手術開始 10:18 手術結束 10:18 麻醉結束 10:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦脊髓液分流管重置 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 內科部 套用罐頭: SP shunt revision 開立醫師: 陳睿生 開立時間: 2011/05/17 10:39 Pre-operative Diagnosis A-com aneurysm rupture s/p with post-op subdural effusion s/p left SP shunt with dysfunction Post-operative Diagnosis A-com aneurysm rupture s/p with post-op subdural effusion s/p left SP shunt with dysfunction Operative Method SP shunt revision Subduroperitoneal shunt revision Specimen Count And Types 4 pieces About size:3ml Source:CSF About size:3ml Source:CSF About size:3ml Source:CSF About size:3ml Source:CSF Pathology Nil Operative Findings The reservior was shrinked with poor refilling initially, and intracranial catheter obstruction was impressed. No obvious debris was noted at the catheter tip, and the reservior function was fair after we re-insert the catheter. The subdural fluid was xanthochromic and the pressure was moderate. Operative Procedures 1. After ETGA, the patient was under supine position 2. We reopened the previous wound at left retroauricular and lateral frontal 3. Recheck of the reservior function 4. Remove of the intracranial catheter and drain out subdural fluid about 30ml 5. Re-insert the catheter, and close the wound in layers Operators VS 賴達明 Assistants R6 陳睿生, R1 邱裕淳 Indication Of Emergent Operation poor shunt function with GCS downhill 黃陳春卿 (F,1949/02/03,63y1m) 手術日期 2011/05/17 手術主治醫師 賴達明 手術區域 東址 002房 03號 診斷 Wound infection postoperative 器械術式 Debridment-- >10cm 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 胡朝凱, 時間資訊 23:18 臨時手術NPO 10:54 進入手術室 10:56 麻醉開始 11:10 誘導結束 11:20 抗生素給藥 11:47 手術開始 12:20 手術結束 12:20 麻醉結束 12:32 進入恢復室 14:10 離開恢復室 14:29 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 深部傷口處理縫合擴創-中 1 0 記錄__ 手術科部: 外科部 套用罐頭: Debridement and primary closure 開立醫師: 胡朝凱 開立時間: 2011/05/17 12:25 Pre-operative Diagnosis Wound dehescence Post-operative Diagnosis Wound dehescence Operative Method Debridement and primary closure Specimen Count And Types nil Pathology nil Operative Findings 1.Granulation tissue was noted beneath the dermal layer without fascia layer dehescence 2.No frank pus was noted Operative Procedures 1.ETGA, prone 2.previous wound incision 3.debridement with curette 4.close wound in layers Operators VS 賴達明 Assistants 胡朝凱 莊淑芬 (F,1950/10/20,61y4m) 手術日期 2011/05/17 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Lumbar spondylosis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 全賀顯, 時間資訊 23:11 臨時手術NPO 08:05 進入手術室 08:15 麻醉開始 08:20 誘導結束 08:20 抗生素給藥 08:53 手術開始 11:40 手術結束 11:40 麻醉結束 11:47 送出病患 11:49 進入恢復室 13:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎間盤切除術-腰椎 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 曾峰毅 開立時間: 2011/05/17 11:44 Pre-operative Diagnosis L3/4 spondylolisthesis, grade II Post-operative Diagnosis L3/4 spondylolisthesis, grade II Operative Method Transforaminal lumbar interbody fusion, L3/4; posterior fixation with transpedicular screws, L3/4. Specimen Count And Types Nil Pathology Nil Operative Findings Grade II spondylolisthesis, L3/4, was redused after TLIF of L3/4. Synthes transpedicular screws, 6.2 x 40 mm, were inserted into bilateral pedicles of L3 and L4. Synthes PEEK cage, banaan shape, 11 mm in height, was inserted into L3/4 intervertebral space. Incidental durotomy was made near right L3/4 intervertebral space, and was suture with 7-0 prolene. Grade II spondylolisthesis, L3/4, was redused after TLIF of L3/4. Synthes transpedicular screws, 6.2 x 40 mm, were inserted into bilateral pedicles of L3 and L4. Synthes PEEK cage, banaan shape, 11 mm in height, was inserted into L3/4 intervertebral space. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After C-arm localization, we scrubbed, disinfected, and then draped the patient. We made one midline skin incision and dissected to expose bilateral laminae from L3 to L4. We inserted transpedicular screws into bilateral pedicles of L3 and L4. Right L3 hemilaminectomy was performed, and dura tear was sealed with suture. L3/4 discectomy was performed, and then fused with PEEK banana cage and autologous bone graft via right transforaminal lumbar interbody fusion route. Posterior fixation was done after rods set. The wound was closed in layers after one submuscular CWV inserted. Operators VS 賴達明 Assistants R4 曾峰毅 R1 全賀顯 邱林香妹 (F,1941/07/15,70y7m) 手術日期 2011/05/17 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Lumbar Spondylosis 器械術式 Diskectomy lumbar (sublaminar decompression) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 全賀顯, 時間資訊 23:12 臨時手術NPO 12:06 進入手術室 12:10 麻醉開始 12:20 誘導結束 12:20 抗生素給藥 12:43 手術開始 14:14 手術結束 14:14 麻醉結束 14:20 送出病患 14:22 進入恢復室 15:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術(減壓)-二節以內 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 曾峰毅 開立時間: 2011/05/17 14:16 Pre-operative Diagnosis Lumbar stenosis, L4/5 and L5/S1 Post-operative Diagnosis Lumbar stenosis, L4/5 and L5/S1 Operative Method Bilateral L4/5 and right L5/S1 laminotomy for sublaminar decompression. Specimen Count And Types Nil Pathology nil Operative Findings Lateral recess stenosis was noted at bilateral L4/5 and right L5/S1, compromising neural structure tightly. Roots were decompressed well after the surgery. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After C-arm localization, we scrubbed, disinfected, and then draped the back. We made one midline skin incision to expose bilateral laminae of L4 to L5. We perormed bilateral L4/5 laminotomy, and right L5/S1 laminotomy for sublaminar decompression. The wound was closed in layers after one submuscular CWV inserted. Operators VS 賴達明 Assistants R4 曾峰毅 R1 全賀顯 謝東維 (M,1940/10/04,71y5m) 手術日期 2011/05/17 手術主治醫師 賴達明 手術區域 東址 003房 03號 診斷 Lumbar stenosis 器械術式 Diskectomy lumbar - sublaminar decompression L2/3 3/4 4/5 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾峰毅, 時間資訊 23:01 臨時手術NPO 14:35 進入手術室 14:45 麻醉開始 14:50 誘導結束 14:50 抗生素給藥 15:18 手術開始 16:45 手術結束 16:45 麻醉結束 16:50 送出病患 16:55 進入恢復室 18:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術(減壓)-超過二節 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Glucose 1 0 摘要__ 手術科部: 外科部 套用罐頭: Sublaminar decompression, L2/3, L3/4, and L4/5 開立醫師: 曾峰毅 開立時間: 2011/05/17 16:56 Pre-operative Diagnosis Lumbar stenosis, L2/3, L3/4, and L4/5 Post-operative Diagnosis Lumbar stenosis, L2/3, L3/4, and L4/5 Operative Method Sublaminar decompression, L2/3, L3/4, and L4/5 Specimen Count And Types Nil Pathology Nil Operative Findings Hypertrophic ligamentum flavum compromised neural structure from L2 to L5. Thecal sac and the roots were decompressed well after the surgery. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After C-arm localization, we scrubbed, disinfected, and then draped the patient. We made one midline skin incision to expose spinous process from L2 to L4. We splitted the spinous process, and pefromed sublaminar decompression from L2/3 to L4/5. The wound was closed in layers after one submuscular hemovac inserted. Operators VS 賴達明 Assistants R4 曾峰毅 鍾秀蓮 (F,1937/04/17,74y10m) 手術日期 2011/05/17 手術主治醫師 賴達明 手術區域 東址 025房 05號 診斷 Spondylolisthesis, acquired 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 全賀顯, 時間資訊 23:13 臨時手術NPO 14:10 報到 14:46 進入手術室 15:00 麻醉開始 15:10 誘導結束 15:25 抗生素給藥 16:10 手術開始 17:35 手術結束 17:35 麻醉結束 17:43 送出病患 17:45 進入恢復室 18:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-腰椎 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 外科部 套用罐頭: Microscopic diskectomy 開立醫師: 陳睿生 開立時間: 2011/05/17 17:31 Pre-operative Diagnosis L4/5 HIVD Post-operative Diagnosis L4/5 HIVD Operative Method Microscopic diskectomy Specimen Count And Types nil Pathology Nil Operative Findings Disk rupture was noted at L4/5 level, and the right side L4 root was noted to be compressed tightly by the disk. After diskectomy, the thecal sac and root were well decompressed. Operative Procedures 1. ETGA, prone position, and plain film localized the L4/5 level 2. An about 3cm skin incision was done 3. Expose the L4/5 spinous process and right side lamina 4. Make a small laminotomy at right lower L4 5. Remove of ligamentum flavum, and expose the thecal sac and root 6. Incise into the PLL and diskectomy was done 7. Hemostasis, and the wound was closed in layers Operators VS 賴達明 Assistants R6 陳睿生, R1 全賀顯 林茂桂 (M,1935/01/17,77y1m) 手術日期 2011/05/17 手術主治醫師 賴達明 手術區域 東址 005房 03號 診斷 Spinal stenosis, lumbar region 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 林哲光, 時間資訊 23:13 臨時手術NPO 11:05 報到 11:22 進入手術室 11:25 麻醉開始 11:35 誘導結束 11:55 抗生素給藥 12:17 手術開始 14:50 抗生素給藥 15:25 手術結束 15:25 麻醉結束 15:35 送出病患 15:36 進入恢復室 16:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 手術 脊椎融合術-後融合,有固定物(每增加<=六節) 1 1 記錄__ 手術科部: 外科部 套用罐頭: Partial L3 and L4-L5 laminectomy and TPS post... 開立醫師: 林哲光 開立時間: 2011/05/17 16:01 Pre-operative Diagnosis L3-5 spinal canal stenosis with L4-5 spondylolisthesis Post-operative Diagnosis L3-5 spinal canal stenosis with L4-5 spondylolisthesis Operative Method Partial L3 and L4-L5 laminectomy and TPS posterior fusion at L4, L5 level; posteriolateral fusion at L3 Specimen Count And Types nil Pathology Operative Findings Severe spinal canal stenosis was noted at L3-L5 level with hypertrophic change of bilateral facet joints and ligamentum flavum. Four 45mmx65mm TPS were inserted at L4, L5 level with two rods fixation. Moderate osteoporosis was also noted. Dura seemed re-expanded well after laminectomy. Operative Procedures Under ETGA and prone position, skin disinfected and drapped were performed as usual. Midline skin incision was made from L2-L5 level. THe paraspinal muscles were detached. Four TPS was inserted lateral to bilateral facet joints. Partial L3 and L4-L5 laminectomy were performed. Two rods were then inserted and hemostasis with Gelfoam packing. The wound was then closed in layers after epidural drain insertion. Operators AP 賴達明 Assistants R4 林哲光, R2 陳志軒 相關圖片 陳林專 (F,1933/12/05,78y3m) 手術日期 2011/05/17 手術主治醫師 黃國皓 手術區域 東址 015房 05號 診斷 Intraspinal abscess 器械術式 Removal of double-J 手術類別 緊急手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 無麻醉 麻醉主治醫師 ASA 1 紀錄醫師 黃冠棠, 時間資訊 15:05 進入手術室 15:15 手術開始 15:20 手術結束 15:22 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經膀胱鏡逆行尿管導管 1 0 R 記錄__ 手術科部: 泌尿部 套用罐頭: DBJ stent removal 開立醫師: 蘇彥榮 開立時間: 2011/05/17 15:25 Pre-operative Diagnosis Right hydronephrosis Post-operative Diagnosis Right hydronephrosis Operative Method cystoscopy and removal of DBJ Specimen Count And Types nil Pathology Nil Operative Findings Right DBJ removed smoothly Operative Procedures Under satisfactory anesthesia with the patient in lithotomy position, prepping and drapping was performed in the usual sterile fashion. A Fr 21 Olympus cystoscope was introduced into the bladder cavity under direct vision. Careful inspection was done and right DBJ was removed. Patient tolerated the procedure very well and was sent to recovery room in satisfactory condition. Operators 黃國皓, Assistants 蘇彥榮, 黃冠棠 Indication Of Emergent Operation nil 吳潘雪子 (F,1937/09/07,74y6m) 手術日期 2011/05/17 手術主治醫師 戴槐青 手術區域 東址 008房 01號 診斷 Renal cancer (Transitional cell carcinoma) 器械術式 腹腔鏡腎臟輸尿管切除術 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 3 紀錄醫師 張奕凱, 時間資訊 07:40 報到 08:10 進入手術室 08:25 麻醉開始 08:50 誘導結束 09:20 手術開始 09:30 開始輸血 17:20 麻醉結束 17:20 手術結束 17:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 (後)腹腔鏡腎臟輸尿管切除術 1 1 R 手術 腹腔鏡腸粘連剝離術 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 10 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 泌尿部 套用罐頭: nephroureterectomy + bladder cuff resection 開立醫師: 張奕凱 開立時間: 2011/05/17 17:50 Pre-operative Diagnosis right renal pelvis tumor, Post-operative Diagnosis right renal pelvis tumor, Operative Method 1.Laparoscopic nephroureterectomy and bladder cuff resection,right side 2. adhesiolysis Specimen Count And Types 1 piece About size: Source:right kidney and ureter+ bladder cuff Pathology Pending Operative Findings 1.One lump of cauliflower-like tumor in the right renal pelvis , another mass at renal pelvis, suspected of RCC 2.Severe adhesion between abdominal wall and whole intestines Operative Procedures Under satisfactory endotracheal general anesthesia with the patient in a Lt flank position,prepping and draping was performed. A 7 cm right midline abdominal skin incision was carried out and it was deepened into peritoneal cavity. The ureter was identified and marked with a stay suture. A Hand-port device (Gelport) was placed at this wound. Under satisfactory endotracheal general anesthesia with the patient in a Lt flank position,prepping and draping was performed.Visport was used and 5-12 mm trocar in para umbilical area. Another 2 5-12 Trocars at right lateral abdominal area. Another 2 5-12 Trocars and 2 5mm trocars at right lateral abdominal area. (as picture depicted) A 5-12 mm Versaport was inserted at LLQ of abdomen. Pneumoperitoneum was created by inflation with CO2 to the pressure of 15 mmHg. The second 5-12 mm Versaport forworking was placed subcostally under the optic assistance. After taking the ascending colon down with Ultrashear, Geotas fascia was identified. After isolating the Geotas fascia, A 5-12 mm Versaport was inserted at LLQ of abdomen. Pneumoperitoneum was created by inflation with CO2 to the pressure of 15 mmHg. The second 5-12 mm Versaport forworking was placed subcostally under the optic assistance. After taking the ascending colon down with Ultrashear, Geotas fascia was identified. After isolating the Geotas fascia, Pneumoperitoneum was created by inflation with CO2 to the pressure of 15 mmHg. The second 5-12 mm Versaport forworking was placed subcostally under the optic assistance. After taking the ascending colon down with Ultrashear, Geotas fascia was identified. After isolating the Geotas fascia, The Lt renal pedicle was identified. The gonal and adrenal veins were clipped with Hemolocks and divided. The renal artery and renal vein were also identified, separaated from surrounding tissue. These were doubly clipped with Hemolocks and divided. The adjacent tissue of the Lt kidney was further mobilized, divided. The Gelport and trocars were removed. Wound exposure was obtained with retractors. The Right renal pedicle was identified. The gonal and adrenal veins were clipped with Hemolocks and divided. The renal artery and renal vein were also identified, separaated from surrounding tissue. These were doubly clipped with Hemolocks and divided. The adjacent tissue of the Lt kidney was further mobilized, divided. The ureter was further dissected till the bladder cuff was identified by pulling the mucosa of the bladder upwards. It was clipped with Homolock and divided at the UVJ. The bldder wound was closed with 2-0 vicryl. The kidney and ureter with bladder cuff were removed en bloc via the hand port. The ureter was further dissected till the bladder cuff was identified by pulling the mucosa of the bladder upwards. It was clipped with Homolock and divided at the UVJ. The bldder wound was closed with 2-0 vicryl. The kidney and ureter with bladder cuff were removed en bloc via extended wound at para-median abdomen A #7 CW drain was placed through the upper trocar wound into the Lt lateral border of bladder. We closed the wound of ports with endoclosure device after placing a patch of surgicel at the right renal fossa.The wound was closed by layers with 1-O vicryl on the peritoneum and 1-O silk, figure-of-eight sutures on the fascia. Two #7 CW drain was placed through the right lateral trocar wounds into the right lateral border of bladder and another at right renal fossa.The wound was closed by layers with 1-O vicryl on the peritoneum and 1-O silk, figure-of-eight sutures on the fascia. The skin was closed with 3-O nylon stitches. The patient tolerated theoperation well and was sent to the recovery room with stable condition. The blood loss was estimated to be 50 c.c. The sponge count was correct. The skin was closed with 3-O nylon stitches. The patient tolerated theoperation well and was sent to the recovery room with stable condition. The blood loss was estimated to be 450 c.c. The sponge count was correct. Operators 戴槐青, Assistants 張奕凱, 張宇鳴, 陳進宗 (M,1947/05/29,64y9m) 手術日期 2011/05/17 手術主治醫師 蔡翊新 手術區域 東址 002房 05號 診斷 Intracerebral hemorrhage 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林峰盛 ASA 4E 紀錄醫師 游皓鈞, 時間資訊 14:00 開始NPO 18:33 通知急診手術 19:00 麻醉開始 19:02 進入手術室 19:20 誘導結束 19:30 抗生素給藥 19:35 開始輸血 19:40 手術開始 22:35 手術結束 22:35 麻醉結束 22:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 1 R 手術 顱內壓視置入 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: CVA 開立醫師: 蔡翊新 開立時間: 2011/05/17 22:23 Pre-operative Diagnosis Right putaminal ICH with brainstem extension, IVH and acute hydrocephalus. Post-operative Diagnosis Right putaminal ICH with brainstem extension, IVH and acute hydrocephalus. Operative Method Right frontotemporal craniotomy for ICH evacuation and ICP monitoring. Left Kocher EVD. Specimen Count And Types 3 tubes of CSF: sent for routine, BCS and bacterial culture. Pathology Nil. Operative Findings CSF: bloody, initial pressure: > 30 cmH2O. The dura was fragile and adhered to bone tightly. The brain bulged out upon dural opening. About 100 ml ICH was evacuated from right basal ganglia. Several active bleeders from perforators of right MCA branches were coagulated. Easy oozing from hematoma cavity was encountered, especially at deepest site. The brain became slack, 1 cm away from the dura, after ICH evacuation. The ICP monitor placed in the hematoma cavity showed 10 mmHg after operation. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. EVD was inserted via a burr hole made at left Kocher point to relieve acute hydrocephalus. 5. Incision: right frontotemporal, curvilinear. The skin edge was clipped by Raney clips for temporary hemostasis. After scalp had been lifted, the temporalis muscle was incised and detached from temporal squama and reflected to lower temporal side. 6. Craniotomy: A 8 x 6 cm craniotomy was made at right frontotemporal area with its center 5 cm above extenal ear canal. 7. Dural tenting: by 2/0 silk, 3 cm in interval, distributed along the edge of skull window. 8. Dural incision: curvilinear, reflected anteriorly. 9. A 2 cm cortical incision was made at anterior part of the superior temporal gyrus, the subcortex and white mater was splitted by brain retractor and sucker until the intracerebral hematoma was exposed. The hematoma was sucked out carefully. The cavity was irrigated with NS and the blood oozing was stopped by Surgicel packing. Before closure of the dura, the hematoma caivty was clean and the brain once bulging was very slack. A Codman ICP monitor was inserted into the hematoma cavity (Reference level: 500). 10.Dural closure: continous sutures with 4/0 Prolene to obtain water-tight closure. A piece of Durofoam was used to repair the dural defects created during craniotomy. 11.The craniotomy bone plate was placed back and fixed by 3 #26 wires. 12.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 13.Drain: one epidural CWV drain. 14.Blood transfusion: PRBC 2U, Cryo 12U, Platelet 12U. Blood loss: 100 ml. 15.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5鍾文桂R1游皓鈞 Indication Of Emergent Operation IICP, conscious disturbance 洪翌洧 (M,2010/06/13,1y9m) 手術日期 2011/05/17 手術主治醫師 許文明 手術區域 兒醫 062房 05號 診斷 Complex congenital heart disease 器械術式 gastostomy 手術類別 預定手術 手術部位 腹 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 3 紀錄醫師 施廷翰, 時間資訊 12:14 報到 13:00 進入手術室 13:10 麻醉開始 13:40 誘導結束 14:00 抗生素給藥 14:16 手術開始 17:00 手術結束 17:00 抗生素給藥 17:00 麻醉結束 17:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 橫膈疝 修補術 1 1 手術 腹腔鏡Nissen氏胃摺疊術 1 1 手術 胃造口術 1 3 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 摘要__ 手術科部: 外科部 套用罐頭: 1. Laparoscopic hiatal hernia repair 開立醫師: 施廷翰 開立時間: 2011/05/17 17:26 Pre-operative Diagnosis Suspected gastroesophageal reflux disease Post-operative Diagnosis Hiatal hernia with gastroesophageal reflux disease Operative Method 1. Laparoscopic hiatal hernia repair 2. Laparoscopic Belsey fundoplication 3. Laparoscopic gastrostomy Specimen Count And Types nil Pathology nil Operative Findings A small hiatal hernia was noted Operative Procedures Under ETGA, the patient was placed in supine position with dis-infection performed. infraumbilical incision was made with pneumoperitoneum set up. Another 2 trocars were then advanced under laparoscopic guided. The hiatal hernia and gastroesophageal junction were identified and then freed from surrounding tissue. The hiatal hernia was repaired with 2 stitches. The gastric fundus of the stomach was wrapped around the lower end of the esophagus and sutured with Ticron X 3 stitches at on side and another 3 sititches at the other, according to Belsey method, reinforcing the closing function of the lower esophageal sphincter. After careful hemostasis performed, the wound was closed in layers. Under ETGA, the patient was placed in supine position with dis-infection performed. infraumbilical incision was made with pneumoperitoneum set up. Another 2 trocars were then advanced under laparoscopic guided. The hiatal hernia and gastroesophageal junction were identified and then freed from surrounding tissue. The hiatal hernia was repaired with 2 stitches. The gastric fundus of the stomach was wrapped around the lower end of the esophagus and sutured with Ticron X 3 stitches at on side and another 3 sititches at the other, according to Belsey method, reinforcing the closing function of the lower esophageal sphincter. Horizontal incision was made at left upper quadrant and gastrostomy was done via direct laparoscopic vision. After careful hemostasis performed, the wounds were closed in layers. Operators 許文明 Assistants VS林文熙 CR柯柏瑞 R1施廷翰 Ri王怡人 林秀玉 (F,1954/04/26,57y10m) 手術日期 2011/05/18 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Facial spasm 器械術式 Microvascular decompression 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 王奐之, 時間資訊 23:10 臨時手術NPO 07:40 報到 08:05 進入手術室 08:10 麻醉開始 08:50 誘導結束 09:35 抗生素給藥 09:45 手術開始 12:15 麻醉結束 12:15 手術結束 12:25 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 顏面神經減壓術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Left retrosigmoid suboccipital craniotomy for... 開立醫師: 王奐之 開立時間: 2011/05/18 12:31 Pre-operative Diagnosis Left hemifacial spasm Post-operative Diagnosis Left hemifacial spasm Operative Method Left retrosigmoid suboccipital craniotomy for microvascular decompression Specimen Count And Types Nil Pathology Nil Operative Findings A looping AICA compressed the root exit zone of left CN VII, the CN VII was separated from CN VIII. After inserting Teflon in between AICA and CN VII, no more obvious compression was noted. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to right and fixed in Mayfield skull clamp. After shaving, disinfection and draping in sterile fashion, a curvilinear skin incision in a slight sigmoid shape was made at left retroauricular area. A piece of fascial graft was harvested, followed by retrosigmoid craniotomy. After identifying the sigmoid sinus, the transverse sinus and the transver-sigmoid junction, durotomy was made. After CSF release from the cisterna magna, the cerebellum sank down and CN VII was exposed. After identifying the offending vessel, Teflon was inserted. Meticulous hemostasis was achieved, the dura was then closed in water-tight fashion with fasical graft. The wound was closed in layers after fixing back the bone flap. After identifying the sigmoid sinus, the transverse sinus and the transverse-sigmoid junction, a K-shaped durotomy was made. After CSF release from the cisterna magna, the cerebellum sank down and CN VII was exposed. After identifying the offending vessel, Teflon was inserted. Meticulous hemostasis was achieved, the dura was then closed in water-tight fashion with fasical graft. The wound was closed in layers after fixing back the bone flap. After identifying the sigmoid sinus, the transverse sinus and the transverse-sigmoid junction, a K-shaped durotomy was made. After CSF release from the cisterna magna, the cerebellum sank down and CN VII was exposed. After identifying the offending vessel, Teflon was inserted. Meticulous hemostasis was achieved, the dura was then closed in water-tight fashion with fascial graft. The wound was closed in layers after fixing back the bone flap. Operators P.杜永光 Assistants R6 胡朝凱, R3 王奐之 相關圖片 賴韋翰 (M,2005/11/07,6y4m) 手術日期 2011/05/18 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Arachnoid cyst 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 07:35 報到 08:05 進入手術室 08:15 麻醉開始 08:20 誘導結束 09:00 抗生素給藥 09:38 手術開始 11:22 手術結束 11:22 麻醉結束 11:32 送出病患 11:40 進入恢復室 13:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 腦室腹腔分流手術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Implantation of cystoperitoneal shunt, left t... 開立醫師: 鍾文桂 開立時間: 2011/05/18 11:52 Pre-operative Diagnosis Arachnoid cyst, left temporal. Post-operative Diagnosis Arachnoid cyst, left temporal. Operative Method Implantation of cystoperitoneal shunt, left temporal. Specimen Count And Types nil Pathology Nil. Operative Findings 1. Codman fixed pressure, 10mmH2O, shunt was used. Peritoeal catheter: 30cm, cyst catheter: 4.5cm; it was pointed anteriorly and horizontally in the arachnoid cyst. 2. Cyst content: clear,colorless fluid; presence of cyst wall. Operative Procedures Under ETGA, the patient was place in supine position and the head was tilted to the right. After shaving, disinfection, and draping, a 5-cm linear scalp incision was made at left temporal area. After scalp and temporalis muscle dissection, a burr hole was obtained by using high speed drill. An incision was made at left upper qudrant of abdomen. After dissection, the peritoneal cavity was reached. The shunt catheter was placed into the peritoneal cavity. Subcutaneous tunnel from abdomen to head was created. The shunt catheters and reservoir were connected. After durotomy and incision of the arachnoid cyst wall, the cyst catheter was placed into the cystic cavity. After ensuring the patency of the shunt system, the wounds were closed in layers. Operators 郭夢菲. Assistants R5 鍾文桂 Ri 黃凱懋. 記錄__ 手術科部: 外科部 套用罐頭: Implantation of cystoperitoneal shunt, left t... 開立醫師: 郭夢菲 開立時間: 2011/05/18 13:16 Pre-operative Diagnosis Arachnoid cyst, left temporal tip with frontal convexity extension. Post-operative Diagnosis Arachnoid cyst, left temporal tip with frontal convexity extension. Operative Method Implantation of cystoperitoneal shunt, left temporal. Specimen Count And Types nil Pathology Nil. Operative Findings 1. Codman fixed pressure, 10mmH2O, shunt was used. Peritoeal catheter: 30cm, cyst catheter: 4.5cm; it was pointed anteriorly and horizontally in the arachnoid cyst. 2. Cyst content: clear, colorless fluid; presence of cyst wall. Operative Procedures Under ETGA, the patient was place in supine position and the head was tilted to the right. After shaving, disinfection, and draping, a 4-cm linear scalp incision was made at left temporal area. After scalp and temporalis muscle dissection, a burr hole was obtained by using high speed drill. An incision was made at left upper qudrant of abdomen. After dissection (minilaparotomy), the peritoneal cavity was reached. The shunt catheter was placed into the peritoneal cavity. Subcutaneous tunnel from abdomen to head was created with an additional stabbing wound at the postauricular region. The shunt catheters and reservoir were connected. After durotomy and incision of the arachnoid cyst wall, the cyst catheter was placed into the cystic cavity. After ensuring the patency of the shunt system, the wounds were closed in layers. Operators 郭夢菲. Assistants R5 鍾文桂 Ri 黃凱懋. 周玉英 (F,1946/10/10,65y5m) 手術日期 2011/05/18 手術主治醫師 賴達明 手術區域 東址 002房 04號 診斷 Subdural hemorrhage, traumatic 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3E 紀錄醫師 陳宣佑, 時間資訊 12:43 臨時手術NPO 12:43 開始NPO 20:43 通知急診手術 22:29 進入手術室 22:29 開始輸血 22:33 麻醉開始 22:34 抗生素給藥 22:45 誘導結束 23:08 手術開始 00:00 手術結束 00:00 麻醉結束 00:15 送出病患 00:20 進入恢復室 01:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Burr hole for hematoma drainage 開立醫師: 陳睿生 開立時間: 2011/05/19 00:09 Pre-operative Diagnosis Left frontotemporoparietal chronic subdural hematoma Post-operative Diagnosis Left frontotemporoparietal chronic subdural hematoma Operative Method Burr hole for hematoma drainage Specimen Count And Types nil Pathology Nil Operative Findings The subdural fluid was motor oil like with yellowish clear fluid layer. It gushed out while dura opening. Easy oozing with poor coagulation was noted. The subdural fluid was motor oil like with yellowish clear fluid layer. It gushed out while dura opening. Easy oozing with poor coagulation was noted. No obvious outer or inner membrane was found. Fair brain pulsation was noted after hematoma remove. Operative Procedures 1. ETGA, supine position with head right turn 2. Left frontal linear scalp incision 3. Creat a bur hole, and dura tenting 4. Dura opening, and then drain out the hematoma 5. Set a subgaleal rubber drain 6. Hemostasis, and close the wound in layers Operators VS 賴達明 Assistants R6 陳睿生, R1 陳宣佑 Indication Of Emergent Operation unconscious 陳曾金菊 (F,1931/07/11,80y8m) 手術日期 2011/05/18 手術主治醫師 賴達明 手術區域 東址 005房 01號 診斷 Lumbar Spondylosis 器械術式 Benign intraspinal tumor, exci 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳志軒, 時間資訊 23:11 臨時手術NPO 08:05 進入手術室 08:10 麻醉開始 08:25 誘導結束 09:10 抗生素給藥 09:25 手術開始 12:10 手術結束 12:10 麻醉結束 12:25 送出病患 12:27 進入恢復室 13:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 手術 良性脊髓腫瘤切除術 1 1 摘要__ 手術科部: 外科部 套用罐頭: T11-12 laminectomy for total tumor remove 開立醫師: 陳睿生 開立時間: 2011/05/18 12:33 Pre-operative Diagnosis T12 intraspinal extramedullary tumor, suspect meningioma Post-operative Diagnosis T12 intraspinal extramedullary tumor, suspect meningioma Operative Method T11-12 laminectomy for total tumor remove Specimen Count And Types 1 piece About size:pieces Source:tumor Pathology Pending Operative Findings The tumor was about 2x1.5x1.5 cm in size. It located at the left anterior aspect of T12 level. The tumor was a soft, fragile, well capsule one. It was totally removed with roots and conus medullaris preservation. Operative Procedures 1. ETGA, prone position, and C-arm localized the T11-12 level 2. Low back midline incision about 10cm 3. Expose the T11-12 lamina and spinous process 4. Perform T11-12 laminectomy 5. Opening of the dura and arachnoid membrane 6. Find out the tumor at the left anterior aspect of T12 level 7. Open the tumor capsule and perform tumor debulking 8. Remove of the tumor capsule, and the capsule attached with the dura was also removed 9. Hemostasis, close the dura tightly 10.Set an epidural CWV drain 11.Close the wound in layers Operators VS 賴達明 Assistants R6 陳睿生, R2 陳志軒 陳再松 (M,1941/02/20,71y0m) 手術日期 2011/05/18 手術主治醫師 賴達明 手術區域 東址 005房 02號 診斷 Cervical spondylosis with myelopathy 器械術式 Spinal fusion posterior (C1-2 transarticular screws) 手術類別 臨時手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳志軒, 時間資訊 23:34 臨時手術NPO 12:35 進入手術室 12:45 麻醉開始 12:55 誘導結束 13:05 抗生素給藥 13:22 手術開始 16:05 抗生素給藥 17:15 手術結束 17:15 麻醉結束 17:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎弓切除術(減壓)-二節以內 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: C1-2 transarticular screws fixation and poste... 開立醫師: 陳睿生 開立時間: 2011/05/18 18:09 Pre-operative Diagnosis C1-2 subluxation and C3-4 retrolithesis with cord compression Post-operative Diagnosis C1-2 subluxation and C3-4 retrolithesis with cord compression Operative Method C1-2 transarticular screws fixation and posterior fusion with artifical bone; C3, 4 laminoplasty Specimen Count And Types nil Pathology Nil Operative Findings C1-2 subluxation with increase distance between C1,2 spinous process was noted. Cannulated screws were used for C1-2 fixation. The left side one was 42mm in length, and the right side one was 44mm in length. After proper fixation, we extracted a piece of iliac bone graft for C1-2 posterior fusion (Sonntag fixation). Severe retrolithesis was noted between the C3-4 level, and laminoplasty was done with open book method. The hinge side was over the left. After laminoplasty, the thecal sac was well expanded. No obvious SSEP, MEP change was found peri-op. Operative Procedures 1. ETGA, prone position, head mild extension and fix with Mayfield clump 2. C-arm guide head posture modification for reducing of ADI 3. Posterior neck midline incision, and dissect the trapzius and paraspinal muscle 4. Expose the C1-5 lamina and spinous process 5. Identify the screws insertion points 6. Insert the screws percutaneously under C-arm guide 7. Extract a piece of iliac bone graft from right posterior iliac spine 8. C1, 2 lamina decortication and the bone graft was fixed between the C1-2 lamina with Sonntag fixation 9. Drill grooves bilaterally over C3-4 lamina-facet junction 10.The left C3-4 lamina was elevated and fix with miniplates 11.Hemostasis, and set CWV drain at the C spine and posterior iliac op fields separately 12.Close the wounds in layers Operators VS 賴達明 Assistants R6 陳睿生, R2 陳志軒 丁培勳 (M,1943/10/10,68y5m) 手術日期 2011/05/18 手術主治醫師 吳毅暉 手術區域 東址 017房 03號 診斷 Mitral valve insufficiency and aortic valve stenosis 器械術式 A-V Shunt 手術類別 臨時手術 手術部位 四肢 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 陳政維, 時間資訊 17:00 報到 17:45 進入手術室 17:50 麻醉開始 17:55 誘導結束 18:05 手術開始 20:30 麻醉結束 20:30 手術結束 20:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 末梢血管修補或吻合術併血管移植 1 1 L 記錄__ 手術科部: 內科部 套用罐頭: Arteriovenous fistula creation, Left 開立醫師: 陳政維 開立時間: 2011/05/18 20:36 Pre-operative Diagnosis ESRD Post-operative Diagnosis ESRD s/p AVF creation Operative Method Arteriovenous fistula creation, Left Specimen Count And Types Nil Pathology nil Operative Findings 1. The diameter of the artery was: 2.0 mm; and the diameter of the vein was:3.0mm 2. The anastomosis opening diameter was:10mm. 3. Site: radiocephalic 4. After the fistula created, a continuous thrill was felt over the fistula, bruit (+) Operative Procedures The patient was put on supine position with left hand extended out of the operation table on the arm-board. The operation field was disinfected and draped as usual. Under local anesthesia, a longitudinal skin incision was madebetween the artery and the vein. The vein and then the artery were dissected out from the surrounding tissue. The vein was then transected and the distal end ligated. Heparin solution was used to flush the vein to test the patency and alsoto keep it from thrombosis.A bulldog was applied on the proximal end of the vein to prevent air emboli. After gaining distal and proximal control of the artery by bulldogs, a longitudinal arteriotomy was performed. The end of the vein was then anastomosed to the arteriotomy with 7-0 prolene continuous suture. The bulldogs were released with the order of vein, distal artery, and proximal artery and the air expelled. After meticulous hemeostasis, the wound was closed in layers. Operators VS吳毅暉 Assistants R3陳政維 R5林明賢 Ri吳孟諭 范博修 (M,1993/04/07,18y11m) 手術日期 2011/05/18 手術主治醫師 鄭乃禎 手術區域 東址 009房 09號 診斷 Traumatic brain injury 器械術式 Arch bar removal 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 面罩麻醉 麻醉主治醫師 黃啟祥 ASA 3 紀錄醫師 黃柏誠, 時間資訊 16:06 進入手術室 16:10 麻醉開始 16:11 誘導結束 16:20 手術開始 16:20 抗生素給藥 16:40 手術結束 16:40 麻醉結束 16:45 送出病患 16:48 進入恢復室 17:48 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 去除齒列夾板 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Semi-opened mask inhalation anes 1 0 記錄__ 手術科部: 復健部 套用罐頭: remove arch bar 開立醫師: 黃柏誠 開立時間: 2011/05/18 16:51 Pre-operative Diagnosis Mandible comminuted fracture at right symphysis, parasymphysis and body S/P 1.Open reduction and internal fixation of mandible fracture 2.Intermaxillary fixation Post-operative Diagnosis Mandible comminuted fracture at right symphysis, parasymphysis and body S/P 1.Open reduction and internal fixation of mandible fracture 2.Intermaxillary fixation Operative Method remove arch bar Specimen Count And Types nil Pathology nil Operative Findings 1.occlusion was good 2.remove arch bar smoothly Operative Procedures 1.mask anesthesia 2.local anesthesia for nerve block 3.remove arch bar smoothly Operators VS鄭乃禎 Assistants CR黃傑慧, R3黃柏誠 何色 (F,1940/07/06,71y8m) 手術日期 2011/05/18 手術主治醫師 蔡翊新 手術區域 東址 001房 04號 診斷 Subarachinoid hemorrhage sequelae 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 4E 時間資訊 10:48 通知急診手術 12:05 進入手術室 12:10 麻醉開始 12:20 誘導結束 12:30 抗生素給藥 12:32 手術開始 13:05 手術結束 13:05 麻醉結束 13:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱內壓視置入 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 神經部 套用罐頭: External ventricular drainage via right Koche... 開立醫師: 蔡翊新 開立時間: 2011/05/18 12:51 Pre-operative Diagnosis Subarachnoid hemorrhage with acute hydrocephalus Post-operative Diagnosis Subarachnoid hemorrhage with acute hydrocephalus Operative Method External ventricular drainage via right Kocher"s point Specimen Count And Types 5ml Source:CSF for routine, BCS, and bacterial culture Pathology Nil Operative Findings CSF: clear, pressure: about 10 cmH2O. EVD: 6.5 cm in depth. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position. The scalp was shaved, scrubbed, and disinfected as usual. Linear scalp incision was made at right frontal area followed by one burr hole creation. Two dural tenting was done. Cruciform durotomy was performed. Ventriculostomy was performed with puncture needle and EVD was introduced into right lateral ventricle. The depth of EVD was fixed at 6.5cm in depth. CSF was sampled for study. Externalization of EVD was done. Hemostasis was achieved. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS 蔡翊新 Assistants R4李振豪 Indication Of Emergent Operation Acute hydrocephalus with conscious disturbance 相關圖片 吳宜恒 (M,1975/12/08,36y3m) 手術日期 2011/05/19 手術主治醫師 王國川 手術區域 東址 003房 03號 診斷 Traumatic brain injury 器械術式 V-P shunt 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 3 紀錄醫師 李振豪, 時間資訊 23:13 臨時手術NPO 11:50 報到 12:15 進入手術室 12:20 麻醉開始 12:25 誘導結束 12:33 抗生素給藥 13:00 手術開始 13:50 手術結束 13:50 麻醉結束 14:10 送出病患 14:12 進入恢復室 15:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室腹腔分流手術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Ventriculo-peritoneal shunt implantation via ... 開立醫師: 李振豪 開立時間: 2011/05/19 13:58 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculo-peritoneal shunt implantation via left Kocher"s point Specimen Count And Types 1 piece About size:5ml Source:CSF for routine, biochemistry, and bacterial culture Pathology Nil Operative Findings The CSF was clear in color. The Codman programmable valve reservoir was implanted with initial pressure setting as 140mmH2O. The ventricular catheter and peritoneal catheter was 7 and 30cm in length respectively. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head rotated to right. The scalp was shaved, scrubbed, and disinfected as usual. The scalp incision was made at left frontal area followed by one burr hole creation. Two dural tenting was performed. Left upper abdomen transverse skin incision was made and the minilaparotomy was performed to enter the peritoneal cavity. The subcutaneous tunnel from left abdomen, forechest, neck, and retroauricular area was created. One 1.5cm scalp incision was made at left retroauricular area. The peritoneal catheter was introduced through the subcutaneous tunnel. The ventricular catheter and peritoneal catheter was connected to set up the shunt. Cruciform durotomy was performed and the ventriculostomy was performed by puncture needle. The ventricular catheter was introduced into left lateral ventricle. The function of the shunt was checked. The peritoneal catheter was placed into peritoneal cavity under direct vision. Hemostasis was achieved. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS王國川 Assistants R4李振豪, Ri李伊真 相關圖片 吳莉媺 (F,1987/05/24,24y9m) 手術日期 2011/05/19 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 Contusion, scalp 器械術式 Wound treatment-- >10cm 手術類別 預定手術 手術部位 頭、頸 傷口分類 髒 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 4 紀錄醫師 李振豪, 時間資訊 23:11 臨時手術NPO 10:50 報到 10:52 麻醉開始 10:52 進入手術室 10:55 誘導結束 11:09 手術開始 11:55 麻醉結束 11:55 手術結束 12:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 硬腦膜外血腫清除術 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 創傷醫學部 套用罐頭: Evacuation of epidural hematoma 開立醫師: 李振豪 開立時間: 2011/05/19 12:19 Pre-operative Diagnosis Right fronto-temporo-parietal epidural hematoma Post-operative Diagnosis Right fronto-temporo-parietal epidural hematoma Operative Method Evacuation of epidural hematoma Specimen Count And Types nil Pathology Nil Operative Findings Thin epidural hematoma was evacuated after elevation of the scalp flap. The brain was still swelling but soft by palpation. Pulsation of the brain is fair. Previous Duraform was fragile and partially removed. New Duraform was applied for duroplasty. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head rotated to left. The scalp was shaved, scrubbed, and disinfected as usual. The right traumatic flap wound was opened after removal of the stitches. Epidural hematoma was evacuated and hemostasis was done. Duroplasty was performed with Duraform. The wound was irrigated with Gentamicin and Vancomycin solution. One epidural CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS王國川 Assistants R4李振豪, Ri李伊真 相關圖片 呂泰山 (M,1924/11/14,87y4m) 手術日期 2011/05/19 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Subdural hemorrhage, traumatic 器械術式 Removal of chronic subdural, left 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 3 紀錄醫師 李振豪, 時間資訊 23:10 臨時手術NPO 07:45 報到 08:08 進入手術室 08:25 麻醉開始 08:35 誘導結束 08:50 抗生素給藥 09:02 手術開始 09:40 手術結束 09:40 麻醉結束 10:33 進入恢復室 12:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 頭顱穿洞術(止血引流、穿刺檢查) 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Chronic Subdural Hematoma 開立醫師: 李振豪 開立時間: 2011/05/19 09:48 Pre-operative Diagnosis Left fronto-temporo-parietal chronic subdural hematoma Post-operative Diagnosis Left fronto-temporo-parietal chronic subdural hematoma Operative Method Burr hole drainage Specimen Count And Types nil Pathology Nil Operative Findings The motor oil-like chronic subdural hematoma gushed out after opening the outer membrane of the chronic subdural hematoma. Total around 100ml chronic subdural hematoma was drained out. The inner membrane was noted after evacuation of the hematoma. The brain remained slack after whole procedure. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head rotated to right. The scalp was shaved, scrubbed, and disinfected as usual. One linear scalp incision was made at left temporal area followed by one burr hole creation. Two dural tenting was done. Cruciform durotomy was performed and the outer membrane was identified. The outer membrane was opened and the edge of the outer membrane was coagulated with bipolar electrocautery. The chronic subdural hematoma was drained out and the subdural space was irrigated with 1000ml normal saline. One subdural rubber drain was set up. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Deair was done after wound closure. Operators VS王國川 Assistants R4李振豪, Ri李伊真 相關圖片 鄭國基 (M,1959/07/08,52y8m) 手術日期 2011/05/19 手術主治醫師 蔡翊新 手術區域 東址 003房 號 診斷 Other and unqualified skull fracture, closed with other and unspecified intracranial hemorrhage, with loss of consciousness of unspecified duration 器械術式 V-P shunt revision 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 3 紀錄醫師 李振豪, 時間資訊 23:16 臨時手術NPO 14:10 報到 14:23 進入手術室 14:25 麻醉開始 14:30 誘導結束 14:35 抗生素給藥 14:58 手術開始 16:20 手術結束 16:20 麻醉結束 16:30 送出病患 16:35 進入恢復室 18:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦脊髓液分流管重置 1 2 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Revision of ventriculo-peritoneal shunt 開立醫師: 李振豪 開立時間: 2011/05/19 16:45 Pre-operative Diagnosis Malfunction of ventriculo-peritoneal shunt Post-operative Diagnosis Malfunction of ventriculo-peritoneal shunt Operative Method Revision of ventriculo-peritoneal shunt Specimen Count And Types 1 piece About size:5ml Source:CSF for routine, biochemistry, and bacterial culture Pathology Nil Operative Findings The ventricular catheter was obstructed by blood clot. The reservoir also dysfunction due to blood clot. The ventricular catheter and the reservoir were removed and new ventricular catheter and the programmable valve reservoir was placed with initial setting as 120mmH2O. The depth of the ventricular catheter was 7cm. The CSF was light reddish in character with mild increase in turbidity. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position. The scalp was shaved, scrubbed, and disinfected as usual. Left frontal scalp stitches were removed. The scalp incision was made along previous wound and the burr hole and V-P shunt was identified. The ventricular catheter was pulled out and the function was checked. Obstruction of the reservoir due to blood clot was suspected. Left retroauricular wound was opened and the reservoir was pulled out. Due to blood clot within the reservoir, the ventricular catheter and the reservoir were removed. New programmable valve reservoir and new ventricular catheter were placed and connected with peritoneal catheter. New ventriculostomy was performed with puncture needle. The ventricular catheter was introduced into the left lateral ventricle and the function of the V-P shunt was checked. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS蔡翊新 Assistants R4李振豪, Ri李伊真 相關圖片 曾繁凱 (M,1986/02/16,26y0m) 手術日期 2011/05/19 手術主治醫師 蔡翊新 手術區域 東址 005房 02號 診斷 Major trauma rated 16 or above on the severeity scale ( Injury severeity score >=16 ) 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 3 紀錄醫師 陳志軒, 時間資訊 23:12 臨時手術NPO 12:40 報到 13:20 進入手術室 13:35 麻醉開始 13:35 誘導結束 13:40 抗生素給藥 14:05 手術開始 16:40 抗生素給藥 16:50 手術結束 16:50 麻醉結束 16:55 送出病患 17:00 進入恢復室 19:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 手術 頭顱成形術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Cranioplasty 開立醫師: 蔡翊新 開立時間: 2011/05/19 16:17 Pre-operative Diagnosis Right frontotemporoparietal skull defect. Post-operative Diagnosis Right frontotemporoparietal skull defect. Operative Method Cranioplasty with autologous bone graft. Specimen Count And Types nil Pathology Nil. Operative Findings Subgaleal effusion about 100 ml in amount was drained upon reflection of scalp flap. The silastic membrane placed between dura and galea during last operation was removed. The Durofoam formed a thin layer of dura, so the newly formed granulation layer beneath the galea was taken down as new dura and several perforation sites were repaired with silk and Durafoam. The brain was slightly bulging after drainage of subgaleal effusion, but it was still suitable for cranioplasty. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation:shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with a sterilized adhesive plastic sheet. 4. Incision: along the previous operation scar at right F-T-P area, Raney clips were apllied to the scalp edge for temporary hemostasis. 5. The right F-T-P scalp was dissected away from the underlying newly formed subgaleal granulation tissue which was taken down as new dura layer. The silastic membrane was removed. The dural surface and margin of skull defect were well exposed. 6. The bleeders on the dissected surfaces were coagulated with Bovie painstakingly. 7. The original skull plate preserved at bone bank was placed back to the skull window then fixed by 3 miniplates and 6 screws. Four dural tenting at the center of the skull plate were set. 8. Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by interrupted suture with 3/0 nylon. 9. Drain: one epidural and one subgaleal CWV drains. 10.Blood transfusion: nil. Blood loss: 600 ml. 11.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R4林哲光R2陳志軒 相關圖片 古茗文 (F,1988/08/01,23y7m) 手術日期 2011/05/19 手術主治醫師 蔡翊新 手術區域 東址 005房 01號 診斷 Herniation of intervertebral disc, lumbar (HIVD) 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 2 紀錄醫師 陳志軒, 時間資訊 23:14 臨時手術NPO 08:08 進入手術室 08:10 麻醉開始 08:20 誘導結束 09:10 抗生素給藥 09:15 手術開始 13:00 手術結束 13:00 麻醉結束 13:05 送出病患 13:06 進入恢復室 14:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 手術 椎間盤切除術-腰椎 1 1 摘要__ 手術科部: 外科部 套用罐頭: Microsurgical discectomy, L4/L5, L5/L6, right. 開立醫師: 陳志軒 開立時間: 2011/05/19 12:59 Pre-operative Diagnosis Herniation of intervertebral disc, L4/L5, L5/L6 (Lumborization of S1) Post-operative Diagnosis Herniation of intervertebral disc, L4/L5, L5/L6 (Lumborization of S1) Operative Method Microsurgical discectomy, L4/L5, L5/L6, right. Specimen Count And Types nil Pathology Nil Operative Findings A segment of ruptured disc material at L4-5 causing tight compression of thecal sac and right L5 root, which expanded well and became easy to move after removal of the disc. Bulging disc at L5-6 level caused mild compression of thecal sac. Operative Procedures 1. ETGA with prone position 2. Disinfection as usual procedure 3. Make one midline linear incision about 6cm over lumbo-sacral area. 4. Dissect the aponeurosis of the latissimus dorsi and ileocostalis lumborum muscles at spinous processes of L4-6. 5. Retract paravertebral muscles by a modified narrow Taylor retractor which was retained constantly by a rubbersling. 6. Under microscope, hemilaminotomy of right L4/L5 was performed by Midas drilling to approach thecal sac and right L5 root. 7. Perform L4-5 discectomy. 8. Repeat the procedue over right L5/L6 level. 9. Close the wound in layers Operators 蔡翊新 Assistants 林哲光, 陳志軒 相關圖片 楊石孋淑 (F,1950/06/18,61y8m) 手術日期 2011/05/20 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Pituitary tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 王奐之, 時間資訊 23:09 臨時手術NPO 08:05 進入手術室 08:10 麻醉開始 08:30 誘導結束 08:55 抗生素給藥 09:25 手術開始 11:55 抗生素給藥 12:25 手術結束 12:25 麻醉結束 12:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 經由蝶竇之腦下垂體瘤切除 1 1 摘要__ 手術科部: 外科部 套用罐頭: Endoscopic trans-sphenoidal adenomectomy 開立醫師: 王奐之 開立時間: 2011/05/20 11:36 Pre-operative Diagnosis Pituitary cystic tumor, suspected Rathke cyst Post-operative Diagnosis Pituitary Rathke cyst Operative Method Endoscopic trans-sphenoidal adenomectomy Specimen Count And Types 1 piece About size:pieces Source:pituitary tumor Pathology Pending Operative Findings A small cystic tumor was noted left to the pituitary stalk and superior to the normal pituitary gland. Intra-operative CSF leakage was encountered, Tissucol Duo was applied in addition to gelfoam package at surgical site; lumbar drain was also inserted to release CSF pressure. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head on head-rest and slightly extended. After nostrils packing with Bosmin gauze, skin disinfection & draping in sterile fashion, endoscope was applied to enter the nasal cavity. After coagulating and removing the posterior nasal mucosa, the vomer bone was removed and the anterior wall of sphenoid sinus was drilled open. After entering the sphenoid sinus, the small sellar floor was identified and drilled open. A small durotomy was done, some mucus-like content was sucked out from the left superior aspect of the normal gland, with small amount of fluid. CSF leakage was noted after removing the cystic tumor, packed with gelfoam and Tissucol Duo. The vomer bone was then placed back, followed by Marocel packing in bilateral nostrils. Operators P.杜永光, VS 楊士弘 Assistants R6 胡朝凱, R3 王奐之 相關圖片 陳春蘭 (F,1971/04/18,40y10m) 手術日期 2011/05/20 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Brain Tumor 器械術式 Brain tumor Crainotomy(TZENG) - awake surgery 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 面罩麻醉 麻醉主治醫師 鄭雅蓉 ASA 1 紀錄醫師 邱裕淳, 時間資訊 23:11 臨時手術NPO 07:50 報到 08:05 進入手術室 08:20 麻醉開始 08:25 誘導結束 08:30 抗生素給藥 08:45 手術開始 11:30 抗生素給藥 13:40 麻醉結束 13:40 手術結束 13:48 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 L 手術 立體定位術-切片 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Semi-opened mask inhalation anes 1 0 麻醉 Semi-opened INHALATION GENERAL A 4 0 麻醉 SENI-OPENED INHALATION GENERAL A 3 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: Awake surgery, craniotomy for total tumor remove 開立醫師: 陳睿生 開立時間: 2011/05/20 14:29 Pre-operative Diagnosis Left posterior frontal tumor, suspect low grade glioma Post-operative Diagnosis Left posterior frontal tumor, suspect low grade glioma Operative Method Awake surgery, craniotomy for total tumor remove Specimen Count And Types 2 pieces About size:pieces Source:tumor, whitish, solid and mild firm About size:pieces Source:tumor, grayish, mild elastic Pathology Pending Operative Findings While dura opening, the tumor involved two gyrus at left posterior frontal region was noted. These two gyrus were whitish, mild swelling, and mild firm. The Broca^s area was localized with cortical stimulation intra-operatively, and it located just above the tumor. Two parts of the tumor was identified intra-op. The first one was soft, whitish and mild firm, and it was over the inferior aspect. The second one was mild grayish, elastic, and higher grade was suspected. A small cortical artery was noted across the tumor vertically, and was preserved. Intra-op focal convulsation was noted and was controlled with ice water. After totally remove of the tumor, we applied cortical stimulation again, and the speech function was preserved. Operative Procedures After ETGA, the patient was under supine position and head right turn. The head was fixed with Mayfield clump. The navigation system was applied and the tumor wqas localized roughly. After Xylocaine mixed with Macaine solution was injected for nerve block, curvillinear scalp incision was done at left frontotemporal region. Four bur holes made and then an about 8x8cm craniotomy window was created at frontotemporal region. The dura was well tented and then opened along the craniotomy margin with Xylocaine mixed with Macaine solution injection. Then the tumor was identified with two gyrus swelling. We then let the patient awake, and cortical stimulation was performed to identify the Broca^s area. The tumor was noted just below the Broca^s area. We incised into the gyrus with electroligation. The tumor was totally removed along the gyrus. After total remove of the tumor, cortical stimulation was applied again, and the speech function was preserved. Proper hemostasis was done and the dura was closed tightly with fascia graft. The skull graft was fixed back with miniplates x3 after central tenting. A subgaleal CWV drain was set, and the wound was closed in layers. Operators VS 曾漢民 Assistants R6 陳睿生, R1 邱裕淳 葉黃雪霞 (F,1955/05/10,56y10m) 手術日期 2011/05/20 手術主治醫師 曾漢民 手術區域 東址 003房 02號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 王奐之, 時間資訊 23:12 臨時手術NPO 13:00 進入手術室 13:05 麻醉開始 13:15 誘導結束 13:20 手術開始 13:50 抗生素給藥 15:50 手術結束 15:50 麻醉結束 16:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: Left frontal craniotomy for Simpson grade 1 t... 開立醫師: 王奐之 開立時間: 2011/05/20 16:35 Pre-operative Diagnosis Left frontal meningioma Post-operative Diagnosis Left frontal meningioma Operative Method Left frontal craniotomy for Simpson grade 1 tumor removal Specimen Count And Types 1 piece About size:2*1*1cm Source:left frontal tumor Pathology Pending Operative Findings Severe adhesion between dura and the skull was encountered, resulted in early dura rupture & difficult dura repair. Mild CSF leak was noted after dural closure. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to right. After surface localization with stereotactic probe, the skin was scrubbed, disinfected and draped in sterile fashion. A linear incision was then made at left frontal area, the pericranium was harvested, followed by 1 burr hole creation and subsequent craniotomy. The ruptured dura was removed with the tumor en bloc. After meticulous hemostasis, the dura was closed with pericranial graft. After central tenting, the bone was fixed back with mini-plates and the wound was closed in layers. Operators VS 曾漢民 Assistants R6 胡朝凱, R3 王奐之 相關圖片 翁琴汝 (F,1939/05/03,72y10m) 手術日期 2011/05/20 手術主治醫師 黃國皓 手術區域 東址 015房 02號 診斷 Hydronephrosis 器械術式 Double-J ureteral stent insert 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 靜脈麻醉 麻醉主治醫師 葉惠敏 ASA 3 紀錄醫師 張奕凱, 時間資訊 07:37 報到 09:30 進入手術室 09:35 麻醉開始 09:40 誘導結束 09:40 抗生素給藥 09:45 手術開始 09:52 手術結束 09:52 麻醉結束 09:57 送出病患 10:03 進入恢復室 11:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 手術 診斷性輸尿管鏡檢，包括輸尿管膀胱接合處，擴張術及膀胱鏡術 1 0 L 摘要__ 手術科部: 泌尿部 套用罐頭: DBJ stent insertion 開立醫師: 張奕凱 開立時間: 2011/05/20 10:05 Pre-operative Diagnosis left obstructive uropathy post DBJ Post-operative Diagnosis left obstructive uropathy post DBJ replacement Operative Method ureterorenoscopy and DBJ replacement Specimen Count And Types nil Pathology nil Operative Findings 1. previous DBJ stent encrustration 2. no obvious obstruction at left ureter Operative Procedures Under satisfactory anesthesia with the patient in lithotomy position, prepping and drapping was performed in the usual sterile fashion. A Fr 21 Olympus cystoscope was introduced into the bladder cavity under direct vision. Careful inspection was done and ureterorenoscopy inspection and left optima 6-22 DBJ was inserted. Patient tolerated the procedure very well and was sent to recovery room in satisfactory condition. Operators 黃國皓, Assistants 張奕凱, 曾任偉, 陳阿選 (F,1932/12/26,79y2m) 手術日期 2011/05/20 手術主治醫師 李章銘 手術區域 東址 025房 03號 診斷 Cerebral aneurysm 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 4 紀錄醫師 廖先啟, 時間資訊 15:01 報到 15:01 進入手術室 15:05 麻醉開始 15:10 誘導結束 15:15 手術開始 15:20 麻醉結束 15:20 手術結束 15:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 氣管切開術 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 廖先啟 開立時間: 2011/05/20 15:30 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types Nil Pathology None Operative Findings Fr.7 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators VS李章銘 Assistants R3廖先啟，R5李佳穎 鄭金德 (M,1930/02/09,82y1m) 手術日期 2011/05/20 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Cervical myelopathy 器械術式 Spinal fusion posterior - C1/2 TAS 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 全賀顯, 時間資訊 23:57 臨時手術NPO 08:55 報到 08:56 進入手術室 09:20 麻醉開始 09:20 誘導結束 09:30 抗生素給藥 10:03 手術開始 12:30 抗生素給藥 13:10 麻醉結束 13:10 手術結束 13:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎弓切除術(減壓)-二節以內 1 2 摘要__ 手術科部: 外科部 套用罐頭: Posterior Fusion for Cervical Spine 開立醫師: 曾峰毅 開立時間: 2011/05/20 13:00 Pre-operative Diagnosis Atlantoaxial instability with cervical stenosis at C4/5 Post-operative Diagnosis Atlantoaxial instability with cervical stenosis at C4/5 Operative Method C1 and C4 lamiectomy, posterior fixation with transarticular screws at C1/2, posterior fusion with mini-plates and autologous bone graft at C1-2. Specimen Count And Types nil Pathology Nil Operative Findings C1-2 dislocation was reduced under C-arm guidance. Thecal sac was decompressed well after laminectomy. Operative Procedures With endotracheal general anaethsia, the patient was put in prone position with head fixed by Mayfield head clamp. After occpital area shaved, scrubbed, disinfected, and then draped, we check dislocation reduced under C-arm. One midline skin incision was made from inion to lower cervical area, and we dissected to expose bilateral laminae from C1 to C5. Transarticular screws were inserted under C-arm guidance. C4 laminectomy and C1 laimectomy was done for decompression. C1-2 fusion was achieved with autologous bone graft and mini-plate fixation. The wound was closed in layers after one submuscular CWV placed. Operators VS 賴達明 Assistants R4 曾峰毅 R1 全賀顯 吳瑋萍 (F,1979/11/08,32y4m) 手術日期 2011/05/20 手術主治醫師 林昌平 手術區域 東址 010房 10號 診斷 Acute lymphoid leukemia, without mention of remission 器械術式 IVI 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 蘇乾嘉, 時間資訊 19:00 報到 19:25 手術開始 19:25 進入手術室 19:35 手術結束 19:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 玻璃體空氣液體交換術 1 1 B 記錄__ 手術科部: 眼科部 套用罐頭: IVIA 開立醫師: 蘇乾嘉 開立時間: 2011/05/20 19:35 Pre-operative Diagnosis CMV retinitis(ou) Post-operative Diagnosis CMV retinitis(ou) Operative Method Intravitreal Injection Of ganciclovir 2000ug/0.05ml (ou) Specimen Count And Types nil Pathology nil Operative Findings nil Operative Procedures 1.Under topical anesthesia. 2.Disinfection and draping as usual. 3.Apply an eyelid speculum. 4.Intravitreal injection of ganciclovir 2000ug/0.05ml 5.Check leakage 6.Iop measurement by digit 7.Check bare VA>ND100cm 8.Repeat the same procedure on the opposite eye Operators 林昌平, Assistants 蘇乾嘉, 劉耀臨, 劉振麟 (M,1950/12/20,61y2m) 手術日期 2011/05/20 手術主治醫師 蕭輔仁 手術區域 東址 003房 03號 診斷 Fever 器械術式 Laminectomy for decompression, T9-T10 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 3 紀錄醫師 林哲光, 時間資訊 14:00 臨時手術NPO 14:00 開始NPO 15:17 通知急診手術 17:55 進入手術室 18:00 麻醉開始 18:30 誘導結束 18:55 抗生素給藥 19:00 手術開始 20:00 開始輸血 21:10 手術結束 21:10 麻醉結束 21:20 送出病患 21:25 進入恢復室 22:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 惡性脊髓腫瘤切除術 1 1 記錄__ 手術科部: 腫瘤醫學部 套用罐頭: T9-10 laminectomy for posterior decompression... 開立醫師: 林哲光 開立時間: 2011/05/20 21:45 Pre-operative Diagnosis T9-10 epidural mass with cord compression and myelopathy Post-operative Diagnosis T9-10 epidural mass with cord compression and myelopathy Operative Method T9-10 laminectomy for posterior decompression and partial tumor removal Specimen Count And Types 2 pieces About size:multiple pieces Source:bones About size:multiple pieces Source:tumors Pathology Pending Operative Findings Preopeative bilateral lower limbs hip joint MP was 3-4. Urine retension was also noted. Previous TPS at bilateral T11 facet joints were noted. Some soft tissue was noted inside the T10 lamina and epidural mass lesion was noted at T9-T10 level with yellow-to-grayish in color, soft-to-elastic in consistency. Some tumor was adherent to dura tightly. The tumors were mostly at the right side with compressing the cord to the left side. The dura seemed re-expanded after laminectomy and partial tumor removal. Operative Procedures Under ETGA and prone position, C-arm localization for T9-10 level was done. Midline skin incision was made at T7-T11 level. Paraspinal muscle were detached. T9-10 laminectomy was then performed. Tumor was dissected along the plane of the dura and partial tumor excision was done. Hemostasis was then performed with Gelfoam packing. The wound was then closed in layers after epidural drains x2 were inserted. Operators VS 蕭輔仁 Assistants R4 林哲光, R1 Indication Of Emergent Operation 相關圖片 吳龍夫 (M,1944/07/09,67y8m) 手術日期 2011/05/20 手術主治醫師 李苑如 手術區域 西址 039房 12號 診斷 Calculus of kidney 器械術式 Removal of double-J 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 11:51 進入手術室 11:58 麻醉開始 12:00 手術開始 12:02 手術結束 12:02 麻醉結束 12:05 送出病患 辜陳美月 (F,1957/12/30,54y2m) 手術日期 2011/05/21 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Acoustic neuroma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 3 紀錄醫師 全賀顯, 時間資訊 23:58 臨時手術NPO 07:40 報到 08:00 進入手術室 08:05 麻醉開始 08:40 誘導結束 08:40 抗生素給藥 09:03 手術開始 11:40 抗生素給藥 13:05 麻醉結束 13:05 手術結束 13:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 摘要__ 手術科部: 外科部 套用罐頭: Retrosigmoid approach for tumor remove 開立醫師: 陳睿生 開立時間: 2011/05/21 13:28 Pre-operative Diagnosis Left CP angle cystic tumor, suspect acoustic neuroma Post-operative Diagnosis Left CP angle cystic tumor, suspect acoustic neuroma Operative Method Retrosigmoid approach for tumor remove Specimen Count And Types 1 piece About size:pieces Source:tumor Pathology Pending Operative Findings Both multiple cystic parts and solid parts were noted inside the tumor. The cystic portion was yellowish, clear fluid inside, and the solid portion was yellowish, soft and fragile. The diameter was about 5cm, and the brainstem was tightly compressed. The CN V, VII, parts of VIII were noted to be compressed to the medial aspect, and the low CNs were compressed to the inferior aspect. Severe cerebellar swelling was noted while dura opening. Operative Procedures 1. ETGA, 3/4 prone position and head left turn, fixed with Mayfield clump 2. Retroauricular scalp linear incision about 12cm 3. The fascia was extracted as graft, and then the astron was exposed 4. After four burr holes made, an about 5x6 cm craniotomy window was created posterior to the transverse-sigmoid junction 5. The dura was opened in a K shape, and then the cerebellum was decompressed with CSF drainage from cistern magnum 6. The cerebellum was retracted posteriorly, and then the cystic tumor was exposed 7. The arachnoid membrane covered the tumor was retracted, and then the cystic wall was opened for decompression 8. The solid portion of the tumor was removed, and cysts penestration was also performed 9. The tumor was nearly total removed; the CN V, VII, partial VIII, and low CNS were identified and preserved 10.Hemostasis, and the dura was tightly closed with fascia graft 11.The skull graft was fixed back with miniplates x3 12.The wound was closed in layers Operators VS 曾漢民 Assistants R6 陳睿生, R1 全賀顯 邱顯能 (M,1956/11/05,55y4m) 手術日期 2011/05/21 手術主治醫師 王國川 手術區域 東址 002房 03號 診斷 Contusion, scalp 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 4E 紀錄醫師 陳睿生, 時間資訊 19:38 通知急診手術 20:20 報到 20:20 進入手術室 20:25 麻醉開始 20:30 誘導結束 21:00 開始輸血 21:05 手術開始 21:46 抗生素給藥 22:00 麻醉結束 22:00 手術結束 22:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱內壓視置入 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: ICP monitor insertion 開立醫師: 李俞萱 開立時間: 2011/05/21 22:20 Pre-operative Diagnosis Diffuse traumatic SAH Post-operative Diagnosis Diffuse traumatic SAH Operative Method ICP monitor insertion Specimen Count And Types nil Pathology Nil Operative Findings A Codman ICP monitor was inserted subcortically. The initial ICP was about 4mmHg. Reference: 494 A Codman ICP monitor was inserted subcortically. The initial ICP was about 4mmHg. Massive dural venous bleeding was noted intra-op. Reference: 494 Operative Procedures 1. ETGA, supine position and head left turn 2. Right frontal linear incision and create a bur hole at Kocher^s point 3. Hemostasis, dura tenting, and then dura was opened 4. Insert a subcortical ICP monitor 5. Close the wound in layers Operators VS 王國川 Assistants R6 陳睿生, R1 林瑜婷 Indication Of Emergent Operation suspect brain swelling 吳朝源 (M,1949/10/21,62y4m) 手術日期 2011/05/22 手術主治醫師 蕭輔仁 手術區域 東址 002房 01號 診斷 Subdural hemorrhage 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 3 紀錄醫師 鍾文桂, 時間資訊 22:47 臨時手術NPO 22:47 開始NPO 00:47 通知急診手術 08:52 進入手術室 08:55 麻醉開始 09:00 誘導結束 09:26 抗生素給藥 10:01 手術開始 11:00 麻醉結束 11:00 手術結束 11:10 送出病患 11:15 進入恢復室 13:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Burr hole for evacuation of chronic subdural ... 開立醫師: 鍾文桂 開立時間: 2011/05/22 14:00 Pre-operative Diagnosis Chronic subdural hemorrhage, left frontal-temporal-parietal. Post-operative Diagnosis Chronic subdural hemorrhage, left frontal-temporal-parietal. Operative Method Burr hole for evacuation of chronic subdural hemorrhage. Specimen Count And Types nil Pathology Nil Operative Findings Dark red-brown motor-oil like liquified hematoma at subdural space, about 40 cc. With some blood clots. Presence of inner and outer membrane. Mild brain expansion after hematoma evacuation. Operative Procedures Under ETGA, the patient was placed in supine position and the head was tilted to the right side. After shaving, disinfection, and draping, a linear scalp incision was made at superior temporal line at left frontal area. After dissection, a burr hole was created. After well hemostasis, dural tenting, and durotomy, the liquified hematoma was evacuated. Then, a rubber drain was placed in subdural space. Further normal saline irrigation of the subdural hematoma was done. Then, the subdural rubber drain was placed in situ. The scalp wound was closed in layers. Further evacuation of subdural air was obtained through the rubber drain. Finally, the rubber drain was connected with closed drainage system. Operators 蕭輔仁 Assistants 鍾文桂 Indication Of Emergent Operation Acute neurologic deterioration. 相關圖片 陳文樹 (M,1945/01/01,67y2m) 手術日期 2011/05/23 手術主治醫師 李章銘 手術區域 東址 018房 01號 診斷 Aneurysm 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 趙安怡 ASA 3 紀錄醫師 廖先啟, 時間資訊 23:54 臨時手術NPO 07:45 進入手術室 08:03 麻醉開始 08:05 誘導結束 08:18 手術開始 08:25 手術結束 08:25 麻醉結束 08:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 氣管切開術 1 0 記錄__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 廖先啟 開立時間: 2011/05/23 08:28 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types Nil Pathology None Operative Findings Fr. 8 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators VS李章銘 Assistants R3廖先啟，Ri范釗銘 管瑩如 (F,1981/06/08,30y9m) 手術日期 2011/05/23 手術主治醫師 杜永光 手術區域 東址 003房 號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 王奐之, 時間資訊 23:06 臨時手術NPO 08:06 進入手術室 08:15 麻醉開始 08:40 誘導結束 09:11 抗生素給藥 09:44 手術開始 12:11 抗生素給藥 15:11 抗生素給藥 17:50 手術結束 17:50 麻醉結束 18:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 11 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除-手術時間在4~8小時 1 1 摘要__ 手術科部: 外科部 套用罐頭: Right interhemipheric transcallosal approach ... 開立醫師: 王奐之 開立時間: 2011/05/23 18:00 Pre-operative Diagnosis Large intraventricular tumor, suspected central neurocytoma Post-operative Diagnosis Large intraventricular tumor, suspected central neurocytoma Operative Method Right interhemipheric transcallosal approach for tumor removal Specimen Count And Types 1 piece About size:pieces Source:intraventricular tumor Pathology Frozen section: central neurocytoma (more favored) or glioma Operative Findings Large whitish elastic tumor was located at intraventricular space, with some calcifications within. Inferior ill-defined tumor border with the thalamus was noted, resulted in difficult total tumor removal. No intra-operative SSEP change was observed. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left and fixed in Mayfield skull clamp. After scalp shaving, disinfection & draping in sterile fashion, a bicoronal incision was made, followed by craniotomy. After dural tenting, a fish-mouth durotomy was made and the dura was reflected towards midline. Retractor was set on the falx, the corpus callosum was exposed. A 1.5cm callosotomy was done, the tumor was then identified and removed in piecemeal fashion by tumor forceps & sucker. After tumor removal, an EVD was set to the ventricle, the dura was then closed in water-tight fashion. Central tenting was done, followed by fixing back the bone flap. The wound was closed in layers after setting 1 subgaleal CWV drain. Operators P.杜永光 Assistants R6 胡朝凱, R3 王奐之 相關圖片 張家榆 (F,1979/03/23,32y11m) 手術日期 2011/05/23 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 邱裕淳, 時間資訊 23:07 臨時手術NPO 07:38 報到 07:58 進入手術室 08:08 麻醉開始 08:35 抗生素給藥 08:38 誘導結束 08:43 手術開始 11:35 抗生素給藥 12:00 麻醉結束 12:00 手術結束 12:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Simpson^s grade I total tumor remove 開立醫師: 陳睿生 開立時間: 2011/05/23 12:28 Pre-operative Diagnosis Right frontal convexity meningioma Post-operative Diagnosis Right frontal convexity meningioma Operative Method Simpson^s grade I total tumor remove Specimen Count And Types 2 pieces About size:8x8x8cm Source:tumor About size:6x6cm Source:dura Pathology Pending Operative Findings The tumor was about 8x8x8cm and it was solid, firm, grayish, well margined. The dur was noted to be involved by the tumor, and some large feeding arteries were noted in it. Hyperosteosis was also noted, and was drilled out. The dura defect was repaired with periosteum graft. Operative Procedures 1. ETGA, supine position and head left turn, fixed with Mayfield clump 2. Right frontal curvillinear scalp incision 3. Dissect the temporalis muscle to expose keyhole 4. Make 5 bur holes, and then an about 10x12 cm craniotomy window was created 5. The dura was well tented, and then opened along the tumor margin 6. The tumor was carefully dissected along the arachnoid plane 7. Some small feeding vessels were ligated while dissection, and then the tumor was removed en bloc 8. The dura defect was repaired with periosteum 9. The skull graft was fixed back with miniplates x4, and central tented 10.Set an epidural CWV drain, and the wound was closed in layers Operators VS 曾漢民 Assistants R6 陳睿生, R1 邱裕淳 彭明輝 (M,1960/05/19,51y9m) 手術日期 2011/05/23 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Brain cancer 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 邱裕淳, 時間資訊 18:10 臨時手術NPO 11:45 報到 12:28 進入手術室 12:35 麻醉開始 12:40 誘導結束 12:50 抗生素給藥 12:50 手術開始 15:50 抗生素給藥 16:45 麻醉結束 16:45 手術結束 16:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for tumor remove 開立醫師: 陳睿生 開立時間: 2011/05/23 16:37 Pre-operative Diagnosis Right occipital GBM status post radiotherapy, with radiation necrosis, with recurrence Post-operative Diagnosis Right occipital GBM status post radiotherapy, with radiation necrosis, with recurrence Operative Method Craniotomy for tumor remove Specimen Count And Types 2 pieces About size:pieces Source:whitish, tumor About size:pieces Source:yellowish, radiation necrosis Pathology Pending Operative Findings Both whitish and yellowish mass lesions were noted. The gray-whitish one was solid, fragile, and GBM with recurrence was impressed. It located at the superior aspect of the lesion site. The yellowish one was semi-solid, and fragile. Radiation necrosis was impressed. It mainly located at the inferior aspect. After tumor remove, CSF was drained and eventually opening of the ventricle was impressed. Both whitish and yellowish mass lesions were noted. The gray-whitish one was solid, fragile, and GBM with recurrence was impressed. It located at the superior aspect of the lesion site. The yellowish one was semi-solid, and fragile. Radiation necrosis was impressed. It mainly located at the inferior aspect. After tumor remove, CSF was drained and eventually opening of the ventricle was noted. Operative Procedures 1. ETGA, prone position and head fixed with Mayfield clump 2. We incised into the previous scalp wound and extend laterally, and superiorly 3. The previous skull graft was removed 4. Dura was incised toward the SSS, and then ECHO was applied for tumor localization 5. Corticotomy was done and then the plane between the tumor and normal brain tissue was carefully dissected 6. Gliotic tumor was totally removed 7. The yellowish one suspected radiation necrosis was partially removed 8. Hemostasis, and the dura defect was repaired with Gortex 9. The skull grafts were fixed back with wires x5 10.Hemostasis, close the wound in layers Operators VS 曾漢民 Assistants R6 陳睿生, R1 邱裕淳 吳瑋萍 (F,1979/11/08,32y4m) 手術日期 2011/05/23 手術主治醫師 林昌平 手術區域 東址 010房 06號 診斷 Acute lymphoid leukemia, without mention of remission 器械術式 IVI 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 許詠瑞, 時間資訊 14:15 進入手術室 14:37 手術開始 14:45 手術結束 14:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 玻璃體空氣液體交換術 2 2 B 記錄__ 手術科部: 內科部 套用罐頭: Intravitreal Injection Of Ganciclovir (ou) 開立醫師: 許詠瑞 開立時間: 2011/05/23 14:39 Pre-operative Diagnosis Cytomegalovirus retinitis (ou) Post-operative Diagnosis Ditto Operative Method Intravitreal Injection Of Ganciclovir (ou) Specimen Count And Types nil Pathology nil Operative Findings nil Operative Procedures OD: 1.Under topical anesthesia. 2.Disinfection and draping as usual. 3.Apply an eyelid speculum. 4.Intravitreal injection of Ganciclovir 2000 microgram/0.05ml 5.Check leakage 6.Iop measurement by digit OS: 1.Under topical anesthesia. 2.Disinfection and draping as usual. 3.Apply an eyelid speculum. 4.Intravitreal injection of Ganciclovir 2000 microgram/0.05ml 5.Check leakage 6.Iop measurement by digit Operators VS 林昌平 Assistants R4 劉耀臨 R3 許詠瑞 詹家玲 (F,1972/08/07,39y7m) 手術日期 2011/05/23 手術主治醫師 蕭輔仁 手術區域 東址 002房 01號 診斷 Gastric cancer 器械術式 Metastatic Tumor - Anterior Corpectomy C6 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3E 紀錄醫師 林哲光, 時間資訊 00:17 臨時手術NPO 00:17 開始NPO 07:17 通知急診手術 08:35 報到 09:00 進入手術室 09:05 麻醉開始 09:20 誘導結束 09:48 抗生素給藥 10:00 手術開始 12:48 抗生素給藥 13:15 開始輸血 15:48 抗生素給藥 15:55 手術結束 15:55 麻醉結束 16:05 送出病患 16:10 進入恢復室 17:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 惡性脊髓腫瘤切除術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 脊椎融合術-前融合,有固定物)≦四節 1 2 記錄__ 手術科部: 外科部 套用罐頭: C6 corpectomy and anterior fusion with body c... 開立醫師: 林哲光 開立時間: 2011/05/23 16:49 Pre-operative Diagnosis C6 pathological fracutre, suspected bone metastasis with cord compression Post-operative Diagnosis C6 pathological fracutre, suspected bone metastasis with cord compression Operative Method C6 corpectomy and anterior fusion with body cage and cervial plate fixation (Ulrich, ADD/PLUS); 4-8mm Specimen Count And Types 1 piece About size:Multiple pieces Source:Tumor and surrounding boney structure and disc Pathology Pending Operative Findings Elastic-to-hard mass lesion was noted over prevertebral space at C6 level with severe adherent to surrounding soft tissue, some fragile contents were also noted during the plane dissection to the C6 vertebral body. C6 body is collapsed and C5-6 and C6-7 intervertebral disc seemed also soft and not intact. Some tumor inside the body, intervertebral space and PLL were also noted. The epidural space seemed clear without obvious tumor invasion. The dura was compressed tightly by bulging materials including the tumor and PLL and the dura seemed re-expanded well after removal of the bulging mass. Operative Procedures Under ETGA and supine position with head mild extended, skin disinfected and drapped were performed as usual. Right transverse skin incision was made at C6 level. The platysma was dissected and the plane between the carotid triangle and esophagus was created and the prevertebral fascia was opened. The C6 body was identified with C-arm localization. Corpectomy was then performed and the PLL was opened to survey any tumor invasion to the epidural space, and it seemed free of tumor. The body cage was then inserted into the C6 level and elongated to fill the gap between C5 and C7 level. The position of the body cage was confirmed with C-arm and fixed with the screws. The wound was then closed in layers after prevertebral H/V inserted. Operators VS 蕭輔仁 Assistants R4 林哲光, R1 全賀顯 Indication Of Emergent Operation Acute myeolpathy 相關圖片 莊蔥 (F,1955/04/08,56y11m) 手術日期 2011/05/23 手術主治醫師 蕭輔仁 手術區域 東址 007房 04號 診斷 Nodular lymphoma, extranodal solid organ sites 器械術式 Ommaya reservoir implantation 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 鍾文桂, 時間資訊 23:32 臨時手術NPO 14:05 進入手術室 14:10 麻醉開始 14:17 誘導結束 14:30 抗生素給藥 14:53 手術開始 15:45 手術結束 15:45 麻醉結束 15:55 送出病患 15:58 進入恢復室 17:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 歐氏貯囊置放手術 1 1 R 摘要__ 手術科部: 內科部 套用罐頭: Implantation of Ommaya reservoir, right Kocher. 開立醫師: 鍾文桂 開立時間: 2011/05/23 16:04 Pre-operative Diagnosis Large B cell lymphoma with leptomeningeal carcinomatosis. Post-operative Diagnosis Large B cell lymphoma with leptomeningeal carcinomatosis. Operative Method Implantation of Ommaya reservoir, right Kocher. Specimen Count And Types 1 piece About size:5cc Source:CSF, for routine, culture, BCS and cytology. Pathology Nil. Operative Findings 1. Ommaya reservoir, ventricular catheter: 6.5cm, at right Kocher. 2. Clear colorless CSF with low pressure. Operative Procedures Under ETGA, the patient was placed in supine position and the head in midline. After shaving, disinfection, and draping, a curvilinear scalp incision was made at right Kocher point. Afte scalp dissection, a burr hole was created by using high speed drill. After durotomy, the ventricular puncture needle was inserted to the right Kocher point. The prepared Ommaya reservoir was inserted into the same tract. 5 cc CSF was aspirated through the Ommaya. The Ommaya was fixed on the pericranium. Finally, the wound was closed in layers. Operators 蕭輔仁 Assistants R5 鍾文桂 相關圖片 周美俐 (F,1951/12/10,60y3m) 手術日期 2011/05/23 手術主治醫師 黃俊傑 手術區域 西址 030房 09號 診斷 Malignant neoplasm of female breast, unspecified 器械術式 Port-A catheter Removal 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 13:00 報到 13:28 進入手術室 13:31 麻醉開始 13:36 手術開始 14:10 手術結束 14:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 皮下肌肉或深部異物取出術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Port-A catheter Removal 開立醫師: 黃俊傑 開立時間: 2011/05/23 13:36 Pre-operative Diagnosis left breast cancer s/p port-A insertion Post-operative Diagnosis left breast cancer s/p removal of port-A Operative Method Port-A catheter Removal Specimen Count And Types nil Pathology Nil Operative Findings The catheter was removed totally and the course was smooth Operative Procedures 1. Local anesthesia, supine position. 2. Skin disinfection. 3. An incision was made over previous scar at right subclavical area. 4. Dissect the port-A catheter and port from fascia with eletrocautery knife. 5. Remove port-A set. A suture with 3-0 Dexon was doneto seal the catheter tunnel. 6. Hemostasis. 7. Close wounds in layers with 3-0 Dexon, 4-0 Nylon. Operators V黃俊傑 Assistants R1羅偉誠 相關圖片 余欽麟 (M,1948/03/07,64y0m) 手術日期 2011/05/23 手術主治醫師 蔡翊新 手術區域 東址 005房 03號 診斷 Injury (severity score >=16) 器械術式 ICP monitoring 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3E 紀錄醫師 許皓淳, 時間資訊 17:23 通知急診手術 18:05 報到 18:05 進入手術室 18:10 麻醉開始 18:30 誘導結束 18:48 手術開始 19:15 抗生素給藥 20:30 麻醉結束 20:30 手術結束 20:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 1 R 手術 顱內壓視置入 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 蔡翊新 開立時間: 2011/05/23 20:16 Pre-operative Diagnosis Head injury with bilateral frontal contusion and SDH, brain swelling. Post-operative Diagnosis Head injury with midline frontal skull fracture, bilateral frontal contusion ICH, right F-T-P SDH, severe brain swelling. Operative Method Right frontotemporoparietal craniectomy for removal of ICH and SDH, duroplasty and right frontal intraparenchymal ICP monitoring. Specimen Count And Types nil Pathology Nil. Operative Findings Skull fracture at midline frontal skull bone with subgaleal hematoma. Initial ICP after first burr hole creation was 50 mmHg. The dura was very tense after craniectomy and ICP was 37 mmHg. After dural opening and removal of SDH and ICH, ICP became 7 mmHg. ICP after skin closure was 14 mmHg. Skull fracture at midline frontal skull bone with subgaleal hematoma. Initial ICP after first burr hole creation was 50 mmHg. The dura was very tense after craniectomy and ICP was 37 mmHg. After dural opening and removal of SDH and ICH, ICP became 7 mmHg. ICP after skin closure was 18 mmHg. ICP monitor reference: 492 Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 4 cm at right frontal area, the skin edge was clipped by Raney clips for temporary hemostasis. 5. A burr hole was made at right frontal area and a Codman ICP monitor was inserted to right frontal lobe. 6. The incision was extended to a temporal horseshoe, and the temporalis muscle was detached from temporal squama by rasp subsequently. 7. Craniectomy window: 14 x 13 cm, right frontotemporoparietal, created by making 4 burr holes then cut by power saw. 8. Dural tenting: by 2/0 silk, 2.5 cm in interval, distributed along the edge of skull window. 9. Dural incision: curvilinear along the edge of skull window. 10.The subdural clot and partial right frontal contusion ICH were removed by sucker. The right temporal muscle was excised to prevent future epidural compression. 11.Hemosatasis: the bleeders was stopped by Bovie and oozing surface was covered with gelfoam. 12.Dural closure: A piece of Durofoam was used to do duroplasty in order to create an additional space for the swollen brain. 13.The skull plate was removed and stored at bone bank for preservation. 14.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 1/0 Vicryl and skin by continuous suture with 3/0 nylon. 15.Drain: two epidural CWV. 16.Blood transfusion: nil. Blood loss: 500 ml. 17.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R6胡朝凱R1許皓程 R6胡朝凱 R1許皓淳 Indication Of Emergent Operation IICP 謝夢蘭 (F,1952/09/09,59y6m) 手術日期 2011/05/24 手術主治醫師 杜永光 手術區域 東址 002房 02號 診斷 Obstructive hydrocephalus 器械術式 Revision of CSF shunt 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 胡朝凱, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 03:19 通知急診手術 09:20 報到 09:35 進入手術室 09:40 麻醉開始 09:50 誘導結束 10:15 抗生素給藥 10:40 手術開始 11:30 手術結束 11:30 麻醉結束 11:51 送出病患 11:58 進入恢復室 13:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦脊髓液分流管重置 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Ventricular catheter replacement 開立醫師: 胡朝凱 開立時間: 2011/05/24 11:55 Pre-operative Diagnosis VP shunt dysfunction Post-operative Diagnosis VP shunt dysfunction, ventricular catheter obstruction Operative Method Ventricular catheter replacement Specimen Count And Types CSF x 3 tubes and tip culture Pathology nil Operative Findings 1. some debris was noted on the ventricular catheter tip. 2. The reservior rebound well after replacement of ventricular catheter Operative Procedures Under ETGA, patient was put in supine position. Right frontal previous skin incision was done, followed with skin flap dissection to expose previous ventricular cathter. Cut previous catheter was performed. And a new one waspassed through subcutaneous tunnel. The it was connected to reservior. Insert catheter via previous tract. Then wound was closed in layers. Operators P 杜永光 Assistants 胡朝凱 Indication Of Emergent Operation 傅素娥 (F,1954/02/28,58y0m) 手術日期 2011/05/24 手術主治醫師 吳毅暉 手術區域 東址 001房 08號 診斷 Other lymphoma 器械術式 Port-A Implatation /WOR 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 陳政維, 時間資訊 20:28 進入手術室 20:50 抗生素給藥 20:56 麻醉開始 20:59 手術開始 21:03 麻醉結束 21:03 誘導結束 21:15 手術結束 21:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 內頸靜脈切開,永久導管放置術 1 1 R 記錄__ 手術科部: 內科部 套用罐頭: Port-A catheter implantation, echo guided 開立醫師: 陳政維 開立時間: 2011/05/24 21:20 Pre-operative Diagnosis Lymphoma Post-operative Diagnosis s/p Port-A implantation Operative Method Port-A catheter implantation, echo guided Specimen Count And Types Nil Pathology nil Operative Findings Puncture to right IJV under echo guidance The venous blood flow freely in the Port-A catheter after implantation. Operative Procedures The patient was put on supine position. The operation field was disinfected and draped as usual. Under local anesthesia, we puncture to right IJV under echo guidance. After creating subcutaneous pocket, the Port-A catheter was inserted via peel away sheath. We close the wound in layers. Operators VS吳毅暉 Assistants R3陳政維 陳姿佑 (F,2007/05/07,4y10m) 手術日期 2011/05/24 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Anomalies of spinal cord 器械術式 Cord untethering -KUO 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 3 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 07:43 報到 08:10 進入手術室 08:25 麻醉開始 08:50 誘導結束 09:00 抗生素給藥 09:36 手術開始 12:00 抗生素給藥 15:20 抗生素給藥 17:02 麻醉結束 17:02 手術結束 17:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 9 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 動脈血液檢查全套 4 0 麻醉 Hemoglobin (Hb) 4 0 麻醉 測血糖 4 0 麻醉 Ca (Calcium) 4 0 麻醉 Na (Sodium) 4 0 麻醉 K (Potassium) 4 0 麻醉 Blood gas analysis 4 0 手術 脊椎內脊髓內腫瘤切除術 1 1 手術 腦膜或脊突出修補術 1 2 摘要__ 手術科部: 外科部 套用罐頭: Untethering of spinal cord. 開立醫師: 鍾文桂 開立時間: 2011/05/24 18:33 Pre-operative Diagnosis Tethered cord syndrome caused by lipomyelomeningocele, with re-tethering. Post-operative Diagnosis Tethered cord syndrome caused by lipomyelomeningocele, with re-tethering. Operative Method Untethering of spinal cord. Specimen Count And Types 1 piece About size:1 cm Source:aberrant nerve roots Pathology Pending. Operative Findings 1. The lipodural junction at the left side was not well delineated. Many hard fibrous tissues were encountered and brought difficulty in dissection. The nerve roots were looped within the fibrous tissue. After lysis of the lipodural junction, the untethering was completed with the cord more anteriorwards and upwards. Two nerve roots were found to exit extradurally. They were sacrafized. 2. The lipodural junction at the right side was clear was arachnoid plane. The cul-de-sac of the dura mater was identified after fibrolysis. The nerve roots were more well oriented at the right side. 3. The arachnoid cyst shown in MRI study was identified. Excision of the lipoma extradurally was obtaine by CUSA. The intradural lipoma was debulked for untethering. 4. The dura mater was closed primarily along with the connective fibrous tissue in water-tight fashion. Then, it was covered with Gelfoam and DuraFoam. Operative Procedures Under ETGA, the patient was placed in prone position. After disinfection and draping, the previous operative wound was incised and dissected. After identifying the L2 lamine and dissecting out the normal dural plane, further dural exposure was achieved inferiorly. Then, the dura mater was incised vertically. Lysis of the fibrous tissue was obtained by microscissors and dissector. The nerve roots were lysed from the surrounding fibrous band meticulously. Further dissection was obtained from L3 level to the cul-de-sac of dura mater. The intra- and extra- dural lipoma were excised by using CUSA. Extended undermining of the fibrous tissue and scar was done for well dural and wound closure. The dura mater was closed in water-tight fashion with 5-0 Prolene. The wound was closed in layers with no drain in situ. Operators 郭夢菲 Assistants R5 鍾文桂 記錄__ 手術科部: 外科部 套用罐頭: Untethering of spinal cord. 開立醫師: 郭夢菲 開立時間: 2011/05/25 10:12 Pre-operative Diagnosis Tethered cord syndrome caused by lipomyelomeningocele, s/p with re-tethering. Post-operative Diagnosis Tethered cord syndrome caused by lipomyelomeningocele, s/p with re-tethering. Operative Method 1. Untethering of spinal cord. 2. dural repair Specimen Count And Types 1 piece About size:1 cm Source:aberrant nerve roots Pathology Pending. Operative Findings 1. The lipoduroneural junction at the right side was not well delineated and had marked fibrotic change. Many hard fibrous tissues were encountered and brought difficulty in dissection. The nerve roots were looped within the fibrous tissue. Some of the aberrant nerves mingled into the dorsal lipoma. After lysis of the lipoduroneural tisse as a whole from the presumed extradural sapce, the untethering was completed with the cord more anteriorwards and upwards. Two aberrant nerve roots were found to exit extradurally and dorsally. They were sacrafized for untethering purpose. 2. The lipodural junction at the left side was clear plane though the nerve roots at this side were very short. They went in horizontal direction. The cul-de-sac of the dura mater was identified after fibrolysis. 3. The arachnoid cyst shown in MRI study was identified. Excision of the lipoma extradurally was obtaine by CUSA. The intradural lipoma was debulked for untethering. 4. The dura mater was closed primarily along with the connective fibrous tissue in water-tight fashion. Then, it was covered with Gelfoam and DuraFoam. Operative Procedures Under ETGA, the patient was placed in prone position. After disinfection and draping, the previous operative wound was incised and dissected. After identifying the L3 lamine and dissecting out the normal dural plane, further dural exposure was achieved caudally under microscopic view. Then, the dura mater was incised vertically. Lysis of the fibrous tissue was obtained by microscissors and dissector at left side successfully. The nerve roots were lysed from the surrounding fibrous band meticulously. Further dissection was obtained from L3 level to the cul-de-sac of dura mater. The dissection was then preceeded over the right side. The nerve fibers mingled with the hard fibrotic tissue due to previous surgery. The intra- and extra- dural lipoma were excised by using CUSA. We then dissected the fibrotic lipoduroneural tissue in a created plane to untether the cord and nervous tissue. The aberrant nerve fibers in the dorsal lipoma was excised for untehtering purpose and sent for pathology. Extended undermining of the fibrous dura remnant bilaterally was done for well dural repair. The dura mater was repaired in water-tight fashion with 5-0 Prolene. Durofoan was used to covered the suture line. The wound was closed in layers with no drain in situ. Operators 郭夢菲 Assistants R5 鍾文桂 劉小平 (F,1947/01/02,65y2m) 手術日期 2011/05/24 手術主治醫師 賴達明 手術區域 東址 002房 01號 診斷 Intracranial hemorrhage, trauma 器械術式 Burr hole for chronic SDH drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 1E 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 03:15 通知急診手術 07:10 報到 07:20 進入手術室 07:30 麻醉開始 07:35 誘導結束 07:50 抗生素給藥 08:05 手術開始 08:50 手術結束 08:50 麻醉結束 08:55 送出病患 08:58 進入恢復室 10:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 頭顱穿洞術(止血引流、穿刺檢查) 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Right temporal burr hole for drainage of chro... 開立醫師: 李振豪 開立時間: 2011/05/24 09:03 Pre-operative Diagnosis Right fronto-temporal chronic subdural hematoma Post-operative Diagnosis Right fronto-temporal chronic subdural hematoma Operative Method Right temporal burr hole for drainage of chronic subdural hematoma Specimen Count And Types 1 piece About size:3ml Source:chronic subdural hematoma Pathology Nil Operative Findings Outer membrane was noted after durotomy. Septation of the chronic subdural hematoma also noted during the procedure. Inner membrane showed up after evacuation of the hematoma. The burr hole was at the posterior margin of the chronic subdural hematoma. Total about 50ml subdural hematoma was drained out and sent for bacterial culture. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head rotated to left. The scalp was shaved, scrubbed, and disinfected as usual. One linear scalp incision was made at right fronto-temporal area followed by one burr hole creation. Two dural tenting was done. Cruciform durotomy was performed and the outer membrane was identified. The outer membrane was opened after coagulation. The edge of the opening also coagulated with bipolar electrocautery. Subdural hematoma was drained out and the subdural space was irrigated with 500ml normal saline. One subdural rubber drain was placed toward frontal area and externalization was done. Hemostasis was achieved and the wound was closed in layers with 2-0 Vicryl and 3-0 Nylon. Deair was done after wound closure. Operators VS賴達明 Assistants R4李振豪, R4曾峰毅 Indication Of Emergent Operation Subdural hematoma with new neurological deterioration 相關圖片 謝劍 (M,1934/08/07,77y7m) 手術日期 2011/05/24 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Cervical myelopathy 器械術式 Spinal fusion posterior - cervical 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 全賀顯, 時間資訊 23:59 臨時手術NPO 08:05 進入手術室 08:15 麻醉開始 08:30 誘導結束 08:50 抗生素給藥 09:05 手術開始 09:53 開始輸血 11:20 手術結束 11:20 麻醉結束 11:30 送出病患 11:30 進入恢復室 13:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎弓切除術(減壓)-二節以內 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: C4 laminectomy, posterior fixation and fusion... 開立醫師: 曾峰毅 開立時間: 2011/05/24 11:12 Pre-operative Diagnosis Cervical stenosis, C3-5 Post-operative Diagnosis Cervical stenosis, C3-5 Operative Method C4 laminectomy, posterior fixation and fusion with lateral mass screws at bilateral side of C3 and C5 Specimen Count And Types Nil Pathology Nil Operative Findings Cervical stenosis at C3-5 was decompressed well after laminectomy. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position with head fixed with Mayfield head clamp. We made midline skin incision from C2 to C6. We dissected to expose bilateral laminae from C3 to C5. We performed C4 laminectomy and removed hypertrophic ligamentum flavum. Lateral mass screws were inserted into bilateral lateral mass of C3 and C5. Posterior fixation and fusion was done. The wound was closed in layers after one submuscular CWV set. Operators VS 賴達明 Assistants R4 曾峰毅 R1 全賀顯 宋汝仁 (F,1954/11/26,57y3m) 手術日期 2011/05/24 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Benign neoplasm 器械術式 Benign intraspinal tumor, exci 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 全賀顯, 時間資訊 23:00 臨時手術NPO 11:35 進入手術室 11:43 麻醉開始 12:10 誘導結束 12:20 抗生素給藥 12:45 手術開始 15:20 抗生素給藥 16:00 開始輸血 17:20 手術結束 17:20 麻醉結束 17:35 送出病患 17:40 進入恢復室 19:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 良性脊髓腫瘤切除術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 曾峰毅 開立時間: 2011/05/24 17:18 Pre-operative Diagnosis Nodular lymphoid hyperplasia, complicated with intraspinal mass lesion from T3 to T5 Post-operative Diagnosis Nodular lymphoid hyperplasia, complicated with intraspinal mass lesion from T3 to T5 Operative Method Lower T2 to L5 laminectomy for epidural and subdural tumor excision. Specimen Count And Types Nil Pathology Nil Operative Findings Whitish, normovascular, mass lesion was noted in the epidural space, infiltrating ligamentum flavum. The mass lesion was noted in the subdural space as well, with clear border with spinal cord, but encasing nerve root and the spinal cord. Right T4 root was sacrificed during tumor excision. Whitish, normovascular, mass lesion was noted in the epidural space, infiltrating ligamentum flavum. The mass lesion was noted in the subdural space as well, with clear border with spinal cord, but encasing nerve root and the spinal cord. Right T4 root was sacrificed during tumor excision. MEP and SSEP were affected during the tumor excision, and returned to baseline spontaneously. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After C-arm localization, we made one midline skin incision to expose bilateral laminae from T2 to T5. Laminectomy was performed from lower T2 to T5. Midline durotomy was then made, and tumor excision was performed. The duroplasty was done with Gore-tex artificial graft in water tight sutre. After one CWV set the wound was closed in layers. Operators VS 賴達明 Assistants R4 曾峰毅 R1 全賀顯 許水塗 (M,1956/04/28,55y10m) 手術日期 2011/05/24 手術主治醫師 賴達明 手術區域 東址 003房 03號 診斷 Cervical spondylosis 器械術式 removal of cervical plate 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 全賀顯, 時間資訊 23:01 臨時手術NPO 17:45 進入手術室 17:55 麻醉開始 18:00 誘導結束 18:08 抗生素給藥 18:12 手術開始 19:50 手術結束 19:50 麻醉結束 20:00 送出病患 20:05 進入恢復室 21:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 皮下肌肉或深部異物取出術 1 1 摘要__ 手術科部: 外科部 套用罐頭: Anterior Discectomy and Fusion, Cervical Spine 開立醫師: 曾峰毅 開立時間: 2011/05/24 19:39 Pre-operative Diagnosis Malposition of cervical plate, C3-5 Post-operative Diagnosis Malposition of cervical plate, C3-5 Operative Method Removal of cervical plate Specimen Count And Types nil Pathology Nil Operative Findings Malposition of the plate was noted, and the plate was removed. Spine stability was good after plate removed. Operative Procedures With endtracheal general anaesthesia, the patient was put in supine position. After wound disinfected, and then draped, we made skin incision along previous operation wound. We dissected to expose the plate, and then removed the screws and the plate. The wound was irrigated with gentamycin-saline, and one CWV was put into prevertebral space. The wound was closed in layers. Operators VS 賴達明 Assistants R4 曾峰毅 R1 全賀顯 鍾信吉 (M,1940/02/09,72y1m) 手術日期 2011/05/24 手術主治醫師 賴達明 手術區域 東址 005房 01號 診斷 Ossification of posterior longitudinal ligament (OPLL) 器械術式 Lamino plasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 林哲光, 時間資訊 23:56 臨時手術NPO 07:38 報到 08:06 進入手術室 08:33 麻醉開始 08:43 誘導結束 08:50 抗生素給藥 09:48 手術開始 11:50 抗生素給藥 12:20 手術結束 12:20 麻醉結束 12:27 送出病患 12:30 進入恢復室 14:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術(減壓)-超過二節 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: C4 laminoplasty, C5-6 laminectomy and C7 part... 開立醫師: 林哲光 開立時間: 2011/05/24 13:00 Pre-operative Diagnosis C4-7 spinal canal stenosis with myelopathy Post-operative Diagnosis C4-7 spinal canal stenosis with myelopathy Operative Method C4 laminoplasty, C5-6 laminectomy and C7 partial laminectomy Specimen Count And Types nil Pathology Nil Operative Findings Around 5cm long laceration wound was noted at left frontal scalp due to disoposition of the Mayfield head clump and suture with Nylon. Hypertrophic change of the ligamentum flavum was noted with direct compressing the spinal cord tightly and dura seemed re-expanded well after the laminectomy and ligamentum flavum removal were done. Operative Procedures Under ETGA and prone position with head fixed with Mayfield head clump, skin disinfected and drapped were performed as usual. Midline skin incision was made at C2-C7 level. Laminoplasty of C4, C5-6 and partial C7 laminectomy were then performed. The miniplate was bended as Z shaped and fixed on the C4 lamina. The ligmentum flavum was then removed until the dura was seen. The wound was then closed in layers after epidural CWV insertion. Operators AP 賴達明 Assistants R4 林哲光 相關圖片 王曾蘭 (F,1935/03/13,77y0m) 手術日期 2011/05/24 手術主治醫師 賴達明 手術區域 東址 005房 02號 診斷 Spondylolisthesis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 林哲光, 時間資訊 23:58 臨時手術NPO 11:36 報到 12:38 進入手術室 12:45 麻醉開始 12:55 誘導結束 13:30 抗生素給藥 13:55 手術開始 16:30 抗生素給藥 16:45 開始輸血 18:35 手術結束 18:35 麻醉結束 18:50 送出病患 18:51 進入恢復室 20:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 記錄__ 手術科部: 外科部 套用罐頭: L3-4, L4-5 discectomy, L4-5 laminectomy and L... 開立醫師: 林哲光 開立時間: 2011/05/24 19:32 Pre-operative Diagnosis L3-4-5 spondylosis with L3-4 anterior listhesis and right radiculopathy Post-operative Diagnosis L3-4-5 spondylosis with L3-4 anterior listhesis and right radiculopathy Operative Method L3-4, L4-5 discectomy, L4-5 laminectomy and L3-5 posterior fusion with Cage and TPS at L3, L4, L5 Specimen Count And Types nil Pathology Nil Operative Findings Anterior listhesis of L3-4 level was noted. Bilateral hypertrophy facet joints of L3, L4, L5 were noted. Dura seemed compressed tightly and seemed reexpanded well after laminectomy was done. TPS 40mm x2 were inserted at L5 level and 45mmx4 at L3 and L4 level. 9mm cage was inserted at L4-5 level and 11mm was inserted at L3-4 level. Two 7mm and 8mm rods were used for posterior fusion. Operative Procedures Under ETGA and prone position, skin disinfected and drapped were perfomred as usual. Midline skin incision was made at L2-S1 level and paraspinal muscles were detached. TPS were inserted at L3, L4, L5 level under C-arm localization. L4-5 laminectomy was then performed. L3/4, L4/5 discectomy were then performed and cage was inserted under C-arm guided. Two rods were then inserted for posterior fusion. The wound was then closed in layers after two epidural drains were inserted. Operators AP 賴達明 Assistants R4 林哲光 相關圖片 張武彥 (M,1939/11/22,72y3m) 手術日期 2011/05/24 手術主治醫師 蕭輔仁 手術區域 東址 002房 03號 診斷 Malignant neoplasm of sigmoid colon 器械術式 Spinal fusion posterior 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 邱裕淳, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 03:22 通知急診手術 12:21 報到 12:49 進入手術室 12:55 麻醉開始 13:20 誘導結束 13:39 抗生素給藥 14:10 手術開始 16:15 開始輸血 16:39 抗生素給藥 18:00 手術結束 18:00 麻醉結束 18:15 送出病患 18:18 進入恢復室 20:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 惡性脊髓腫瘤切除術 1 1 手術 脊椎融合術-後融合,有固定物(<=六節) 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 內科部 套用罐頭: T4~5, 7~8 TPS and T6 laminectomy for partial ... 開立醫師: 胡朝凱 開立時間: 2011/05/24 18:28 Pre-operative Diagnosis METASTATIC TUMOR AT T6 WITH cord compression Post-operative Diagnosis METASTATIC TUMOR AT T6 WITH cord compression Operative Method T4~5, 7~8 TPS and T6 laminectomy for partial tumor excision Specimen Count And Types tumor and bone chips Pathology pending Operative Findings 1.T4~5 screws: 30 x 5 , T7~8 : 35 x 5.5 2.Greyish to reddish, hypervascular tumor surround T6 cord with epidural extension was noted at T6 level with bilateral pedicle and body invasion. 3.Kyphosis at T6 level was noted due to compression fracture Operative Procedures 1.ETGA, prone 2.Midline skin incision at T4~8 level 3.Detach paravertebral muscle 4.TPS screws insertion 5.T5~7 laminectomy 6.Resect partial tumor at T5~7 level 7.Remove right T6 pedicle 8.further removal of tumor 9.Fixed rods and cross link 10.Set one hemovac then close wound in layers Operators VS 蕭輔仁 Assistants 胡朝凱, 邱裕淳 Indication Of Emergent Operation repid progress neurologic deficit 柯耀南 (M,1939/11/10,72y4m) 手術日期 2011/05/24 手術主治醫師 李章銘 手術區域 東址 019房 04號 診斷 Dizziness and vertigo 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 廖先啟, 時間資訊 18:34 進入手術室 18:40 麻醉開始 18:45 誘導結束 18:57 手術開始 19:10 手術結束 19:10 麻醉結束 19:17 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 氣管切開術 1 0 記錄__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 廖先啟 開立時間: 2011/05/24 19:14 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types Nil Pathology None Operative Findings Fr. 8 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators VS李章銘 Assistants R3廖先啟，R1陳以幸 王鑫銘 (M,1965/06/15,46y8m) 手術日期 2011/05/25 手術主治醫師 杜永光 手術區域 東址 002房 01號 診斷 Unspecified organic brain syndrome (chronic) 器械術式 Removal of CSF shunt 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2E 紀錄醫師 李振豪, 時間資訊 00:10 臨時手術NPO 00:10 開始NPO 07:10 通知急診手術 08:25 報到 08:55 麻醉開始 08:55 進入手術室 09:05 誘導結束 09:07 抗生素給藥 09:33 手術開始 10:15 手術結束 10:15 麻醉結束 10:25 送出病患 10:28 進入恢復室 11:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦脊髓液分流管重置 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Removal of cysto-peritoneal shunt 開立醫師: 李振豪 開立時間: 2011/05/25 10:36 Pre-operative Diagnosis Cysto-peritoneal shunt dysfunction Post-operative Diagnosis Cysto-peritoneal shunt dysfunction Operative Method Removal of cysto-peritoneal shunt Specimen Count And Types 1 piece About size:tip culture x II Source:Ventricular catheter and peritoneal catheter Pathology Nil Operative Findings The cysto-peritoneal shunt was removed totally with intact ventricular and peritoneal catheter. The tip of ventricular and peritoneal catheter was sent for bacterial culture. The burr hole and durotomy was identified during the operation and clear CSF gushed out after removal of the shunt. The CSF remained clear about 10 minutes later. The durotomy was packing with Gelfoam. No obvious CSF leakage noted during wound closure. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head rotated to right. The scalp was shaved, scrubbed, and disinfected as usual. Linear skin incision was made along operative scar at suboccipital area. The subcutaneous soft tissue was dissected and the reservoir of the shunt was identified. The cysto-peritoneal shunt was removed and the tip of ventricular catheter and peritoneal catheter were sent for bacterial culture. Hemostasis was achieved and the durotomy was packing with Gelfoam. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators Prof.杜永光 Assistants R4李振豪 Indication Of Emergent Operation Progressive left side weakness and persisted headache 相關圖片 陸光亞 (M,1931/06/12,80y9m) 手術日期 2011/05/25 手術主治醫師 杜永光 手術區域 東址 016房 01號 診斷 Hydrocephalus 器械術式 Removal of CSF shunt 手術類別 緊急手術 手術部位 頭、頸 傷口分類 髒 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 林哲光, 時間資訊 00:12 臨時手術NPO 00:12 開始NPO 07:12 通知急診手術 08:32 報到 08:50 進入手術室 08:52 麻醉開始 08:56 誘導結束 09:25 抗生素給藥 09:53 手術開始 10:50 手術結束 10:50 麻醉結束 10:55 送出病患 10:58 進入恢復室 12:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦脊髓液分流管重置 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Removal of V-P shunt (right Kocher point) 開立醫師: 林哲光 開立時間: 2011/05/25 11:17 Pre-operative Diagnosis Exposure of the right reservior of the V-P shunt Post-operative Diagnosis Exposure of the right reservior of the V-P shunt Operative Method Removal of V-P shunt (right Kocher point) Specimen Count And Types 4 pieces About size:2ml CSF Source:from reservior About size:2ml CSF Source:from reservior About size:2ml CSF Source:from reservior About size:V-P shunt tip Source:V-P shunt, ventricular catheter Pathology Nil Operative Findings Exposure of the reservior of the V-P shunt was noted and local erythema and swelling were noted. The subcutaneous area of the reservior seemed no pus accumulation. CSF aspirated from the reservior also seemed clean and transparent. Operative Procedures Under ETGA and supine position with head rotated to left side, skin disinfected and drapped were performed as usual. Fusiform skin incision was made around the reservior exposure site. Another skin incision was made at previous right Kocher incision and the suture of the ventricular catheter was dissected and the ventricular catheter was cut and removed. The skin flap and the reservior was removed together from the right posterior auricle wound and whole abdominal catheter was also removed from the wound. The wound was then closed in layers after N/S with Genta-C irrigation. Operators P 杜永光 Assistants R4 林哲光 Indication Of Emergent Operation V-P shunt infection, for infection control 相關圖片 何佳蓉 (F,1990/05/13,21y10m) 手術日期 2011/05/25 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Arteriovenous malformation, brain 器械術式 Craniotomy (A.V.M.) P-DUH 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 王奐之, 時間資訊 23:52 臨時手術NPO 08:16 進入手術室 08:20 麻醉開始 08:50 誘導結束 09:07 手術開始 09:10 抗生素給藥 12:50 手術結束 12:50 麻醉結束 13:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 開顱術摘除血管病變-動靜脈畸型小型表淺 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Right frontotemporal craniotomy for AVM excis... 開立醫師: 王奐之 開立時間: 2011/05/25 13:05 Pre-operative Diagnosis Right posterior frontal AVM, Spetzler-Martin grade 1, with ICH and SDH Post-operative Diagnosis Right posterior frontal AVM, Spetzler-Martin grade 1, with ICH and SDH Operative Method Right frontotemporal craniotomy for AVM excision, ICH & SDH evacuation Specimen Count And Types 1 piece About size:1*1*1cm Source:AVM nidus Pathology Pending Operative Findings Tortuous tangling vessels deep to the hematoma was noted, about 1cm in size, with 1 main draining vein and 2 small feeding arteries. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left and fixed in Mayfield skull clamp. After scalp scrubbing, disinfection and draping in sterile fashion, a slightly sigmoid curvilinear incision was made at right frontotemporal area. After making 1 burr hole at temporal area, craniotomy was done, followed by dural tenting and a cruciate durotomy. The intracerebral hematoma bulged out after trans-sulcus approach, the AVM nidus was then exposed in the operation field and dissected. After dissecting and ligating all the feeding arteries and the draining vein, the nidus was removed en bloc. After meticulous hemostasis, the subdural hematoma was also evacuated. The dura was then closed in water-tight fashion with 4-0 Prolene continuous sutures. The bone flap was fixed back with mini-plates after central tenting, and the wound was closed in layers after setting 1 subgaleal CWV drain. After endotracheal general anesthesia, the patient was placed in supine position with head turned to left and fixed in Mayfield skull clamp. After scalp scrubbing, disinfection and draping in sterile fashion, a slightly sigmoid curvilinear incision was made at right frontotemporal area. After making 1 burr hole at temporal area, craniotomy was done, followed by dural tenting and a cruciate durotomy. The intracerebral hematoma bulged out after trans-sulcus approach, the AVM nidus was then exposed in the operation field and dissected. After dissecting and ligating all the feeding arteries and the draining vein, the nidus was removed en bloc. After meticulous hemostasis, the subdural hematoma was also evacuated. The dura was then closed in water-tight fashion with 4-0 Prolene continuous sutures. The bone flap was fixed back with mini-plates after central tenting, and the wound was closed in layers. After endotracheal general anesthesia, the patient was placed in supine position with head turned to left and fixed in Mayfield skull clamp. After scalp scrubbing, disinfection and draping in sterile fashion, a slightly sigmoid curvilinear incision was made at right frontotemporal area. After making 1 burr hole at temporal area, craniotomy was done, followed by dural tenting and a cruciate durotomy. The intracerebral hematoma bulged out, the AVM nidus was then exposed in the operation field and dissected. After dissecting and ligating all the feeding arteries and the draining vein, the nidus was removed en bloc. After meticulous hemostasis, the subdural hematoma was also evacuated. The dura was then closed in water-tight fashion with 4-0 Prolene continuous sutures. The bone flap was fixed back with mini-plates after central tenting, and the wound was closed in layers. Operators P.杜永光 Assistants R6 胡朝凱, R3 王奐之 相關圖片 黃慈雯 (F,1953/01/06,59y2m) 手術日期 2011/05/25 手術主治醫師 杜永光 手術區域 東址 003房 02號 診斷 Scalp tumor 器械術式 Scalp tumor 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 王奐之, 時間資訊 23:54 臨時手術NPO 12:40 報到 13:16 進入手術室 13:20 麻醉開始 13:25 誘導結束 14:00 抗生素給藥 14:03 手術開始 14:55 手術結束 14:55 麻醉結束 15:06 送出病患 15:08 進入恢復室 16:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 皮下腫瘤摘除術大於 4CM 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Total tumor excision 開立醫師: 王奐之 開立時間: 2011/05/25 15:18 Pre-operative Diagnosis Right temporal scalp tumor excision Post-operative Diagnosis Right scalp lipoma Operative Method Total tumor excision Specimen Count And Types four tumors 4 pieces About size:7cm Source:right temporal scalp tumor About size:4cm Source:right temporal scalp tumor About size:4cm Source:right temporal scalp tumor About size:1cm Source:right temporal scalp tumor Pathology pending Operative Findings 1.Four yellowish, soft, well encapsulated tumor at right temporal area subcutaneous layers, measured about 7 cm, 4cm,4cm, and 1 cm. 2.The tumor was freely movable without peripheral tissue invasion. Operative Procedures Under ETGA, patient was put in supine position with head rotate to left. Right vertical skin incision was done. After fascia layer opening, tumor buldged out. Dissection was made along with the sreolar tissue between tumor and muscular fascial layer. Tumor was then total excised. Hemostasis was performed. Wound was closed with layers. Operators P 杜永光 Assistants 胡朝凱, 王奐之 相關圖片 黃懷平 (F,1989/05/08,22y10m) 手術日期 2011/05/25 手術主治醫師 蔡瑞章 手術區域 東址 003房 03號 診斷 Brain tumor 器械術式 Crainotomy Brain Tumor 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2E 紀錄醫師 鍾文桂, 時間資訊 08:00 臨時手術NPO 08:00 開始NPO 14:46 通知急診手術 15:52 進入手術室 15:55 麻醉開始 16:20 誘導結束 16:25 抗生素給藥 16:25 手術開始 19:15 手術結束 19:15 麻醉結束 19:25 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 開顱術摘除血管病變-動靜脈畸型小型表淺 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Left suboccipital craniotomy for excision of ... 開立醫師: 鍾文桂 開立時間: 2011/05/25 19:13 Pre-operative Diagnosis 1. Left cerebellar intracerebral hemorrhage. 2. Suspect left cerebellar tumor or vascular malformation. Post-operative Diagnosis Left cerebellar intracerebral hemorrhage caused by suspected cavernoma. Operative Method Left suboccipital craniotomy for excision of cavernoma and hematoma evacuation. Specimen Count And Types 2 pieces About size:5cc Source:ICH About size:5cc Source:suspect cavernoma. Pathology Gross: some motor-oil like liquified hematoma with some organized hematoma. Some hemosiderin deposition was noted at the outer surface of the lesion. The " cavernoma" was a mass of blue purple dilated vessels. Operative Findings 1. Mixture of liquified hematoma and organized hematoma in the left cerebellar hemisphere. 2. The abnormal vessle nest was located in medial superior portion of the left cerebellar hemisphere. It is more likely to be a cavernoma. 3. Moderate cerebellar swelling was noted after craniotomy. The CSF from cisterna magnus was released during the operation. Operative Procedures Under ETGA, the patient was placed in prone position and the head was fixed by Mayfield 3-pin headholder. After shaving, disinfection, and draping, a hockey-stick scalp incision was made at left occipital area. A 6-cm suboccipital craniotomy was created by high speed drill and craniotome. A cruciate durotomy was incised. Then, a 0.5cm corticotomy was done. The liquified hematoma gushed out from the corticotomy. The organized hematoma was evacuated by dissecting the plane between the cerebellar parenchyma and the hematoma. Then, a nest of abnormal vessles was identified and excised in en bloc fashion. After well hemostasis, the dura mater was augmented with pericranium and repaired in watertight fashion. The skull plate was fixed by 4 wires. The wound was closed in layers with one subgaleal CWV drain. Operators 王國川 Assistants R5鍾文桂 R4李振豪 R1陳志軒 Indication Of Emergent Operation Signs of IICP( severe headache, nausea), brainstem compression. 相關圖片 林李阿娥 (F,1943/11/01,68y4m) 手術日期 2011/05/25 手術主治醫師 賴達明 手術區域 東址 005房 01號 診斷 Traumatic spondylopathy 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 邱裕淳, 時間資訊 23:26 臨時手術NPO 07:40 報到 08:06 進入手術室 08:43 麻醉開始 09:00 誘導結束 09:02 抗生素給藥 09:46 手術開始 12:00 抗生素給藥 12:40 手術結束 12:40 麻醉結束 13:02 送出病患 13:05 進入恢復室 14:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術(減壓)-二節以內 1 2 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: T10, 11, L1 transpedicular fixation and lower... 開立醫師: 陳睿生 開立時間: 2011/05/25 12:48 Pre-operative Diagnosis T12 compression fracture with cord compression Post-operative Diagnosis T12 compression fracture with cord compression Operative Method T10, 11, L1 transpedicular fixation and lower T11, T12 laminectomy for decompression Specimen Count And Types nil Pathology Nil Operative Findings T12 compression with mild unstability was noted intra-op. After laminectomy, the thecal sac was well decompressed. Screws: Synthes, 6.2x40mm x6 at T10,11, L1 Rods: Synthes 11cm x2 Crosslink: Synthes x1 Operative Procedures 1. ETGA, prone position and C-arm localize the T10-L1 level 2. Medline skin incision at low back over T10-L1 3. Split the paraspinal muscle over T10-L1, and expose the spinous process and lamina over these levels 4. Under proper wound retraction, the T10, 11 lamina-rib junction, and L1 transverse process were identified 5. Transpedicular screws were inserted at bilateral T10, 11, L1 under C-arm guided 6. Lower T11, and T12 laminectomy was performed 7. The ligamentum flavum was also removed to decompress the thecal sac 8. Set and fix bilateral rods and crosslink 9. Set 1/8 hemovac x2 10.Close the wound in layers Operators VS 賴達明 Assistants R6 陳睿生, R1 邱裕淳 陳莉稜 (F,1979/08/23,32y6m) 手術日期 2011/05/25 手術主治醫師 賴達明 手術區域 東址 005房 02號 診斷 Secondary cancer of brain and spinal cord 器械術式 Brain biopsy -Stereotaxic 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 邱裕淳, 時間資訊 23:25 臨時手術NPO 12:07 報到 13:15 進入手術室 13:20 麻醉開始 13:28 誘導結束 13:34 抗生素給藥 14:13 手術開始 16:30 抗生素給藥 16:35 麻醉結束 16:35 手術結束 16:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 手術 立體定位術-切片 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Stereotactic tumor biopsy and cyst aspiration 開立醫師: 陳睿生 開立時間: 2011/05/25 17:03 Pre-operative Diagnosis Right thalamus cystic lesion, suspecty metastasis, suspect glioma Post-operative Diagnosis Right thalamus cystic lesion, suspecty metastasis, suspect glioma Operative Method Stereotactic tumor biopsy and cyst aspiration Specimen Count And Types 5 pieces About size:pieces Source:tumor About size:3ml Source:cystic fluid About size:3ml Source:cystic fluid About size:3ml Source:cystic fluid About size:10ml Source:cystic fluid Pathology Pending Operative Findings Navigation assist tumor biopsy was done, and the cyst inside was drained about 20ml. The fluid was yellowish and turbid. Four solid specimens were extracted for pathological test. Operative Procedures 1. ETGA, head left turn and fixed with Mayfield clump 2. Right frontal scalp incision about 3cm, and a bur hole was created 3. Dura tenting, ane then opened 4. Set the navigation system, and select target points 5. Extract four pieces of specimen at the lateral aspect of the tumor 6. Aspirate the cystic fluid 7. Hemostasis, close the wound in layers Operators VS 賴達明 Assistants R6 陳睿生, R1 邱裕淳 林傳宗 (M,1936/03/03,76y0m) 手術日期 2011/05/26 手術主治醫師 黃國皓 手術區域 東址 002房 06號 診斷 Lung tumor 器械術式 TUR-P,TUR-BT,TUI-BN,Cystolitho 手術類別 預定手術 手術部位 腹 傷口分類 清潔 麻醉方式 面罩麻醉 麻醉主治醫師 劉治民 ASA 3 紀錄醫師 黃冠棠, 時間資訊 23:59 臨時手術NPO 14:40 抗生素給藥 14:45 麻醉開始 14:50 誘導結束 15:03 手術開始 15:42 手術結束 15:42 麻醉結束 15:47 送出病患 15:49 進入恢復室 15:55 進入手術室 17:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Semi-opened mask inhalation anes 1 0 手術 膀胱腫瘤之切除-內視鏡下 1 1 記錄__ 手術科部: 泌尿部 套用罐頭: TUR-BT 開立醫師: 黃冠棠 開立時間: 2011/05/26 16:02 Pre-operative Diagnosis Bladder tumor Post-operative Diagnosis 1. Cystitis 2. Bleeding from prostate Operative Method TURBT(Transurethral resection of bladder tumor) Specimen Count And Types 2 pieces About size:1 piece Source:trigon About size:1 piece Source:left lateral wall Pathology pending Operative Findings 1. Some polypoid mucosa located at Lt lateral wall and trigon area 2. Erythmatous change of mucosa at trigon area. 3. No definite tumor was found 4. Bleeding from bladder neck and prostate was noticed Operative Procedures 1. Under satisfactory anesthesia with the patient in the lithotomy position, prepping and draping were performed in the usual sterile method. 2. A Fr 22 Olympus Resectoscope was inserted into the urethra and bladder, and the whole bladder was inspected carefully. This revealed presence of some polypoid mucosa located at Lt lateral wall and trigon area. Trigone and bilateral orifices were identified and inspected carefully. Erythmatous change of mucosa at trigon area was found. Inflammation process was suspected. 3. The tissue were resected with resectoscope, piece by piece. 4. The resected tissues were removed. 5. Adequate hemostasis was then obtained. 6. A 22Fr. 3-way Foley catheter was inserted and continuous bladder irrigation with normal saline started. 7. The balloon was inflated to 30 cc. 8. The patient was then sent to the recovery room in a stable condition. Operators 黃國皓 Assistants 周淇業, 黃冠棠 蔡足味 (F,1968/03/13,44y0m) 手術日期 2011/05/26 手術主治醫師 婁培人 手術區域 東址 027房 05號 診斷 Neck mass 器械術式 Incisional biopsy of neck mass,R 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 3 紀錄醫師 黃苔晏, 黃苔晏, 時間資訊 15:00 報到 16:30 進入手術室 16:35 麻醉開始 16:40 抗生素給藥 16:45 誘導結束 16:50 手術開始 18:20 手術結束 18:20 麻醉結束 18:30 進入恢復室 18:30 送出病患 20:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 軟組織良性腫瘤切除術,大或深 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 內頸靜脈切開,永久導管放置術 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Permcath/port-A 開立醫師: 羅健洺 開立時間: 2011/05/26 17:30 Pre-operative Diagnosis Breast cancer Post-operative Diagnosis Breast cancer s/p Port-A insertion Operative Method Port-A implantation via left internal jugular vein Specimen Count And Types nil Pathology nil Operative Findings 1. The Port-A catheter was inserted via left internal jugular vein by echo-guided procedure 2. Patent flow after implantation Operative Procedures -Anesthesia: local, the patient was put on supine position. The operation field was disinfected and draped as usual. -Port-A: After skin disinfection and drapping & local anesthesia, echo-guided LIJV cut down and catheterization was performed. Creation of the subcutaneous pocket at right subclavicular area. Tunneliztion, advanced the catheter into the RIJV via the peel-away sheath smoothly. Wound closure in layers after adequate hemostasis. Operators 吳毅暉, Assistants 羅健洺, 記錄__ 手術科部: 耳鼻喉部 套用罐頭: Neck mass incisional biopsy, right 開立醫師: 黃苔晏 開立時間: 2011/05/26 21:10 Pre-operative Diagnosis Neck mass, Right Post-operative Diagnosis Neck mass, Right Operative Method Neck mass incisional biopsy, right Specimen Count And Types 1 piece About size:0.5x0.5x0.5 Source:right neck mass incisional biopsy Pathology Pending Operative Findings biopsy about 0.5x0.5 cm located at level IV Operative Procedures Anesthesia was set up via ETGA. The patient was in supine position with head extended and turned to left side. Skin was disinfected and draped as usual. Local anesthesia with Bosmin rinsed Xylocaine was injected into the subcutaneous tissue around the mass. After marking an incision parallel to the skin crease, an about 0.5x0.5x0.5 cm incisional biopsy was done over the huge masses at level IV. After hemostasis, the wound was closed with 2 layers. The patient tolerated the procedure well. Operators AP婁培人 Assistants R4林沛廷, R2黃苔晏 吳瑋萍 (F,1979/11/08,32y4m) 手術日期 2011/05/26 手術主治醫師 林昌平 手術區域 西址 031房 06號 診斷 Acute lymphoid leukemia, without mention of remission 器械術式 IVI 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 吳郁芊, 時間資訊 14:55 進入手術室 15:00 麻醉開始 15:03 手術開始 15:12 手術結束 15:12 麻醉結束 15:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 玻璃體空氣液體交換術 1 2 B 記錄__ 手術科部: 眼科部 套用罐頭: IVIA 開立醫師: 林昌平 開立時間: 2011/05/26 15:06 Pre-operative Diagnosis Cytomegalovirus retinitis(OU) Post-operative Diagnosis Ditto Operative Method Intravitreal Injection Of Ganciclovir(OU) Specimen Count And Types nil Pathology nil Operative Findings nil Operative Procedures 1.Under topical anesthesia. 2.Disinfection and draping as usual. 3.Apply an eyelid speculum. 4.Intravitreal injection of Ganciclovir 2000microgram/0.05ml 5.Check leakage 6.Iop measurement by digit Operators 林昌平, Assistants R4吳郁芊 陳臣堪 (M,1934/09/03,77y6m) 手術日期 2011/05/26 手術主治醫師 李苑如 手術區域 東址 008房 02號 診斷 Renal stone 器械術式 P.C.N.L. 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 3 紀錄醫師 胡哲源, 時間資訊 12:45 報到 13:47 進入手術室 13:55 麻醉開始 13:57 抗生素給藥 14:10 誘導結束 14:24 手術開始 17:35 手術結束 17:35 麻醉結束 17:45 送出病患 17:47 進入恢復室 19:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 手術 經皮腎結石取石術 1 1 L 記錄__ 手術科部: 泌尿部 套用罐頭: PCNSL 開立醫師: 胡哲源 開立時間: 2011/05/26 17:56 Pre-operative Diagnosis left staghorn stone Post-operative Diagnosis left staghorn stone Operative Method Percutaneous nephrolithotripsy, left side Specimen Count And Types nil Pathology nil Operative Findings 1. yellowish stones in the left renal calyces 2. cannot insert DBJ into left ureter Operative Procedures Under satisfactory intubated general anesthesia with the patient in a lithotomy position, prepping and draping were carried out. A 5 Fr. ureteral catheter was inserted into the left ureter smoothly through the 21Fr cystoscope. A 16 Fr. Foley catheter was indwelled. The patient was changed to a prone position. Skin preparationwas done. A puncture needle with a hub was inserted into the left renal middle calyx under fluoroscope guidence. A 0.035-inch flexible tip guidewire was indwelled through the puncture needle. The tract was dilated with fascial dilators, which was facilitated by passing them over the guidewire, up to 12 Fr. A follower was indwelled by passing it over the guidewire. The tract was further dilated with the following Amplatz dilators by passing them over the follower, up to 30 Fr. A 30 Fr. Amplatz sheath was indwelled and a nephroscope was inserted under adequate visualization at all times. Normal saline was used for irrigation. The instrument was passed to the level of the stone. The stone was crushed and suctioned by a Lithocrast. We cannot inserted DBJ catheter to the left ureter. The previous ureteral catheter was removed. A 20 Fr. percutaneous nephrostomy tube was left in place. The patient was sent to the recovery room in stable condition. Operators 李苑如, Assistants 胡哲源, 翁文慶, 邱仕堯 (M,1962/11/22,49y3m) 手術日期 2011/05/26 手術主治醫師 蔡翊新 手術區域 東址 005房 01號 診斷 Injury (severity score >=16) 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 3 紀錄醫師 陳志軒, 時間資訊 23:07 臨時手術NPO 07:40 報到 08:05 進入手術室 08:16 麻醉開始 08:25 誘導結束 08:38 抗生素給藥 09:03 手術開始 11:20 手術結束 11:20 麻醉結束 11:25 送出病患 11:33 進入恢復室 12:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 頭顱成形術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Cranioplasty 開立醫師: 蔡翊新 開立時間: 2011/05/26 10:46 Pre-operative Diagnosis Right F-T-P skull defect. Post-operative Diagnosis Right F-T-P skull defect. Operative Method Cranioplasty with autologous bone graft. Specimen Count And Types nil Pathology Nil. Operative Findings A 14 x 12 cm skull defect at right F-T-P area. The brain was slack. The temporalis muscle has been excised during previous operation. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head rotated to left. The scalp was shaved, scrubbed, and disinfected as usual. Right traumatic flap scalp incision was made along operative scar. The scalp flap was elevated and the edge of the craniectomy was skeletonized. Several central tentings were placed. Autologous skull plate was fixed back with 3 miniplates and 6 screws after placing two epidural CWV drains. Hemostasis was achieved and the wound was irrigated with Vancomycin solution. The wound was then closed in layers wit 2-0 Vicryl and 3-0 Nylon. Operators VS蔡翊新 Assistants R4林哲光R2陳志軒 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Cranioplasty 開立醫師: 林哲光 開立時間: 2011/05/26 11:43 Pre-operative Diagnosis Right F-T-P skull defect. Post-operative Diagnosis Right F-T-P skull defect. Operative Method Cranioplasty with autologous bone graft. Specimen Count And Types nil Pathology Nil. Operative Findings A 14 x 12 cm skull defect at right F-T-P area. The brain was slack. The temporalis muscle has been excised during previous operation. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head rotated to left. The scalp was shaved, scrubbed, and disinfected as usual. Right traumatic flap scalp incision was made along operative scar. The scalp flap was elevated and the edge of the craniectomy was skeletonized. Several central tentings were placed. Autologous skull plate was fixed back with 3 miniplates and 6 screws after placing two epidural CWV drains. Hemostasis was achieved and the wound was irrigated with Vancomycin solution. The wound was then closed in layers wit 2-0 Vicryl and 3-0 Nylon. Operators VS蔡翊新 Assistants R4林哲光R2陳志軒 相關圖片 賴清前 (M,1958/01/12,54y2m) 手術日期 2011/05/26 手術主治醫師 蔡翊新 手術區域 東址 003房 01號 診斷 Subdural hemorrhage following injury, with prolonged (more than 24 hours) loss of consciousness w/o return to pre-existing conscious level 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 3 紀錄醫師 李振豪, 時間資訊 23:05 臨時手術NPO 08:08 進入手術室 08:30 麻醉開始 08:40 誘導結束 08:54 抗生素給藥 09:15 手術開始 11:25 手術結束 11:25 麻醉結束 11:35 送出病患 11:38 進入恢復室 13:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 手術 頭顱成形術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Cranioplasty with autologous bone graft. 開立醫師: 蔡翊新 開立時間: 2011/05/26 10:34 Pre-operative Diagnosis Traumatic EDH, SDH, and ICH, status post left F-T-P craniectomy for hematoma evacuation Post-operative Diagnosis Traumatic EDH, SDH, and ICH, status post left F-T-P craniectomy for hematoma evacuation, with left F-T-P skull defect Operative Method Cranioplasty with autologous bone graft. Specimen Count And Types nil Pathology Nil Operative Findings A 14 x 12 skull defect at left F-T-P area. The temporalis muscle has been excised during previous operation. Partial growth of Durofoam at previous dural defect was noted and it was repaired primarily. The brain was slack after dural closure. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head rotated to right. The scalp was shaved, scrubbed, and disinfected as usual. Left traumatic flap scalp incision was made along operative scar. The scalp flap was elevated and the edge of the craniectomy was skeletonized. Seven central tentings were placed. Autologous skull plate was fixed back with 3 miniplates and 6 screws after placing two epidural CWV drains. Hemostasis was achieved and the wound was irrigated with Vancomycin and Gentamicin solution. The wound was then closed in layers wit 2-0 Vicryl and 3-0 Nylon. Operators VS蔡翊新 Assistants R4李振豪Ri 相關圖片 廖浩誠 (M,1982/09/11,29y6m) 手術日期 2011/05/26 手術主治醫師 王廷明 手術區域 東址 022房 03號 診斷 Other specified acquired deformity of head 器械術式 Posterior release with equinus deformity correction with Ilizarov apparatus 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 脊髓麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 黃俊傑, 時間資訊 11:25 報到 12:09 進入手術室 12:20 麻醉開始 12:25 誘導結束 12:30 抗生素給藥 13:00 手術開始 14:19 15:00 麻醉結束 15:00 手術結束 15:00 15:17 送出病患 15:24 進入恢復室 16:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Spinal anesthesia 1 0 麻醉 SPINAL ANESTHESIA 1 0 手術 肌腱放長術 2 1 B 手術 石膏固定－短腿 2 0 B 手術 滑膜切除術或關節囊切除術-肩關節、肘關節、腕關節或踝關節 2 1 B 記錄__ 手術科部: 骨科部 套用罐頭: 1. Bilateral TAL (Achilles tendon lengthening) 開立醫師: 黃俊傑 開立時間: 2011/05/26 15:11 Pre-operative Diagnosis Bilateral equinous feet Post-operative Diagnosis DITTO Operative Method 1. Bilateral TAL (Achilles tendon lengthening) 2. Ankle joint capsulotomy 3. On short leg cast Specimen Count And Types nil Pathology nil Operative Findings 1. Bilateral feet equinous deformity 2. Posterior ankle skin breakage 3. Post TAL ankle : fix at neutral position. Operative Procedures 1. ETGA, prone position, the left lower leg was prepped disinfected and draped 2. longitudinal incision over Achilles tendon, Z shaped tenotomy was performed and tendon graft flipped from proximal portion 3. Deep dissect into the ankle joint , capsulotomy was performed 4. Anastomose the tendon with #1 polysorb 5. Close the wound , on short leg cast 6. The same procedure was performed on the right leg. Operators 王廷明, Assistants 黃俊傑, 陳志偉, 許駿毅, 陳文樹 (M,1945/01/01,67y2m) 手術日期 2011/05/27 手術主治醫師 杜永光 手術區域 東址 003房 02號 診斷 Aneurysm 器械術式 Bilateral subduroperitoneal shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 王奐之, 時間資訊 23:16 臨時手術NPO 09:59 進入手術室 10:05 麻醉開始 10:10 誘導結束 11:08 手術開始 12:30 手術結束 12:30 麻醉結束 12:34 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 2 B 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Bilateral subdural-peritoneal shunt 開立醫師: 王奐之 開立時間: 2011/05/27 12:39 Pre-operative Diagnosis Bilateral subdural effusion Post-operative Diagnosis Bilateral subdural effusion Operative Method Bilateral subdural-peritoneal shunt Specimen Count And Types nil Pathology nil Operative Findings Clear effusion gushed out after dural opening. The brain expanded mildly after effusion drainage. Operative Procedures Under ETGA, patient was put in supine position. Previous wound was incised and extended. Bilateral burr holes was then drilled. RUQ abdominal area transverse skin incision was done. minilaparotomy was then performed to expose intraperitoneal cavity. Subcutaneous tunnel was then made and cathetr was passed through. Bilateral dural opening was done. And catheters were inserted subdurally. After connection by Y connector was complete, the wounds were closed in layers. Operators P 杜永光 Assistants 胡朝凱, 王奐之 相關圖片 張堂明 (M,1968/04/04,43y11m) 手術日期 2011/05/27 手術主治醫師 賴達明 手術區域 東址 005房 02號 診斷 Epilepsy 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 邱裕淳, 時間資訊 23:17 臨時手術NPO 09:54 報到 10:05 進入手術室 10:10 麻醉開始 10:30 抗生素給藥 10:35 誘導結束 10:44 手術開始 13:30 抗生素給藥 15:00 開始輸血 16:30 抗生素給藥 19:30 抗生素給藥 23:05 抗生素給藥 00:15 麻醉結束 00:15 手術結束 00:25 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 20 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 4 0 麻醉 動脈血液檢查全套 4 0 麻醉 Hemoglobin (Hb) 4 0 麻醉 測血糖 4 0 麻醉 Ca (Calcium) 4 0 麻醉 Na (Sodium) 4 0 麻醉 K (Potassium) 4 0 麻醉 Blood gas analysis 4 0 手術 腦瘤切除-手術時間在8小時以上 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Right dolenc approach, Simpson grade IV tumor... 開立醫師: 胡朝凱 開立時間: 2011/05/28 00:43 Pre-operative Diagnosis Right sphenoid ridge inner third meningioma Post-operative Diagnosis Right sphenoid ridge inner third meningioma Operative Method Right dolenc approach, Simpson grade IV tumor excision Specimen Count And Types pieces of tumor Pathology pending Operative Findings 1.A bilobule meningioma arised from sphenoid ridge ineer third area was noted and extended to frontal, measured about 2.5 cm , and temporal, measured about 3 cm. 2.The A1, M1, ICA, and optic nerve were compressed laterally. ICA was partial encased. But they were all preserved well . 3.During operation, MEP wave form decresed over bilateral upper and right lower extremities. 4.Blood supply came from tumor base. 5.Tumor margin was relative clear. Operative Procedures 1.ETGA, supine, head fixed with skull clamp 2.Right curvillinear skin incision was done 3.Reflect skin flap with facial nerve preservation and then muscle flap 4.Craniotomy, followed by dural tenting 5.Anterior clinoidectomy 6.Open dura 7.open sylvian fissure and exposed tumor 8.right temporal tip resection 9.central debulky with CUSA 10.Dissecttion was made along interface between tumor and brain tissue 11.Dissection tumor away from vessels and optic nerve 12.Hemostasis 13.Close dura with prolene 14.Fixed bone back with miniplate 15.Close wound in layers Operators VS 賴達明 Assistants 胡朝凱, 邱裕淳 邱彼信 (M,1929/09/18,82y5m) 手術日期 2011/05/27 手術主治醫師 賴達明 手術區域 東址 019房 02號 診斷 Lumbar spondylosis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 全賀顯, 時間資訊 23:18 臨時手術NPO 09:50 進入手術室 09:55 麻醉開始 10:00 誘導結束 10:30 抗生素給藥 11:00 手術開始 13:30 抗生素給藥 14:30 手術結束 14:30 麻醉結束 14:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎間盤切除術-腰椎 1 2 手術 椎弓切除術(減壓)-二節以內 1 3 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 曾峰毅 開立時間: 2011/05/27 14:29 Pre-operative Diagnosis Lumbar stenosis, L3-6; Spondylolisthesis, L5/6, grade I Post-operative Diagnosis Lumbar stenosis, L3-6; Spondylolisthesis, L5/6, grade I Operative Method Transforaminal lumbar interbody fusion at L5/6 with PEEK cage and autologous bone graft; posterior fixation with transpedicular screws at L5 and L6; L3/4 and L4/5 laminotomy for sublaminar decompression. Specimen Count And Types nil Pathology Nil Operative Findings Hypertrophic ligamentum flvaum compromised neural structure tightly. Spondylolisthesis at L5/6 was reduced after cage inserted. Synthes transpedicular screws, 45 x 6.2 mm, were used with PEEK cage, 9 mm in height. Neural structure was decompressed well after the surgery. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After C-arm localization, we made one midline skin incision to expose bilateral laminae from L3 to L6. We inserted transpedicular screws into bilateral pedicles of L5 and L6. Transforaminal lumbar interbody fusion was performed after disectomy with Synthes PEEK cage at L5/6. L3/4 and L4/5 laminotoy was performed for sublaminar decompression. After hemovac set, the wound was closed in layers. Operators VS 賴達明 Assistants R4 曾峰毅 R1 全賀顯 陳榮銘 (M,1944/03/28,67y11m) 手術日期 2011/05/27 手術主治醫師 蕭輔仁 手術區域 東址 026房 02號 診斷 Malignant neoplasm of hepatic flexure colon 器械術式 Removal of chronic subdural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 3E 紀錄醫師 李振豪, 時間資訊 07:00 臨時手術NPO 07:00 開始NPO 00:13 通知急診手術 01:10 報到 01:10 進入手術室 01:30 麻醉開始 01:50 誘導結束 01:55 抗生素給藥 02:07 手術開始 03:15 麻醉結束 03:15 手術結束 03:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 慢性硬腦膜下血腫清除術 1 1 L 摘要__ 手術科部: 腫瘤醫學部 套用罐頭: Left temporal burr hole for drainage of subdu... 開立醫師: 李振豪 開立時間: 2011/05/27 03:48 Pre-operative Diagnosis Left fronto-temporo-parietal acute on chronic subdural hematoma Post-operative Diagnosis Left fronto-temporo-parietal acute on chronic subdural hematoma Operative Method Left temporal burr hole for drainage of subdural hematoma Specimen Count And Types 2 pieces About size:10ml Source:Chronic subdural hematoma About size:0.5 x 0.5cm Source:Dura Pathology Pending Operative Findings Outer membrane was noted after durotomy. The motor-oil to reddish chronic subdural hematoma gushed out after opening of outer membrane. The inner membrane was not remarkable. Total about 80ml subdural hematoma was drained out. The brain remained slack after evacuation of the hematoma. Pulsation of brain parenchyma was weak but acceptable. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head rotated to right. The scalp was shaved, scrubbed, and disinfected as usual. Linear scalp incision was made at left temporal area followed by one burr hole creation. Two dural tenting was done. The square durotomy was performed and the dura was sent for pathology. The edge of the durotomy was coagulated. The outer membrane was opened and chronic subdural hematoma was drained out. The specimen was sent for cytology and bacterial culture. The edge of the outer membrane was coagulated for hemostasis. The subdural space was irrigated with 500ml normal saline. One subdural rubber drain was placed. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS蕭輔仁 Assistants R4李振豪, R1許皓淳 Indication Of Emergent Operation Rapid deterioration of right side weakness and impending uncal herniation 相關圖片 林燈臺 (M,1931/02/24,81y0m) 手術日期 2011/05/27 手術主治醫師 蕭輔仁 手術區域 東址 003房 04號 診斷 Subdural hemorrhage following injury without mention of open intracranial wound,with no loss of consciousness 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 21:50 進入手術室 22:00 麻醉開始 22:10 誘導結束 22:10 抗生素給藥 22:35 手術開始 23:30 麻醉結束 23:30 手術結束 23:40 送出病患 23:45 進入恢復室 00:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 慢性硬腦膜下血腫清除術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Left side burr hole for chronic subdural hema... 開立醫師: 王奐之 開立時間: 2011/05/27 23:35 Pre-operative Diagnosis Left side frontotemporoparietal chronic subdural hematoma Post-operative Diagnosis Left side frontotemporoparietal chronic subdural hematoma Operative Method Left side burr hole for chronic subdural hematoma evacuation Specimen Count And Types Nil Pathology Nil Operative Findings Motor-oil like fluid gushed out after durotomy. The brain expanded partially after hematoma evacuation. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to right. After scalp shaving, disinfection and draping in sterile fashion, a linear incision was made at left frontal area. A burr hole was then made at left frontal region, a small cruciate durotomy was done after dural tenting. A rubber drain was then inserted into the subdural space to wash and drain the subdural hematoma. After evacuating the hematoma, the rubber drain was set to the frontal subdural space and fixed. The wound was then closed in layers. The operative procedure ended with deairing. Operators VS 蕭輔仁 Assistants R3 王奐之, R1 戴逸昇 Indication Of Emergent Operation Mass effect and midline shift 相關圖片 王均斌 (M,1982/09/21,29y5m) 手術日期 2011/05/27 手術主治醫師 李章銘 手術區域 東址 016房 01號 診斷 Major trauma rated 16 or above on the severity scale ( Injury severity score >=16 ) 器械術式 Tracheostomy+ combine PS 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 鄒冠全, 黃傑慧, 時間資訊 19:50 通知急診手術 00:00 開始NPO 00:00 臨時手術NPO 09:16 報到 09:16 進入手術室 09:18 麻醉開始 09:20 誘導結束 09:45 抗生素給藥 09:56 手術開始 10:20 11:40 麻醉結束 11:40 手術結束 11:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 氣管切開術 1 0 手術 顎間固定法 1 0 記錄__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 鄒冠全 開立時間: 2011/05/27 10:06 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types nil Pathology None Operative Findings Fr . 8 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators 李章銘 Assistants R3鄒冠全 Indication Of Emergent Operation tracheostomy 摘要__ 手術科部: 外科部 套用罐頭: LeFort fracture-IMF 開立醫師: 黃傑慧 開立時間: 2011/05/27 12:06 Pre-operative Diagnosis LeFort III facial fracture, s/p reduction of zygoma, frontal bone ORIF Post-operative Diagnosis LeFort III facial fracture, s/p reduction of zygoma, frontal bone ORIF Operative Method Nasal fracture close reduction; Maxillomandibular fixation Specimen Count And Types nil Pathology Nil Operative Findings Left deviation of nasal septum; Operative Procedures Take over from chest surgeon; the operation field was prepared as usual. Archbar was applied to upper and lower denture, and intermaxillary fixation was performed. Close reduction of nasal fracture was performed, and both nostrils were packed with Merocel and Vaseline gauze. Operators 湯月碧 Assistants 黃傑慧 Indication Of Emergent Operation difficult weaning 趙林芸蘭 (F,1944/10/19,67y4m) 手術日期 2011/05/30 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Pituitary tumor 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 王奐之, 時間資訊 23:09 臨時手術NPO 08:05 進入手術室 08:10 麻醉開始 08:40 誘導結束 08:50 手術開始 09:00 抗生素給藥 12:15 抗生素給藥 12:55 手術結束 12:55 麻醉結束 13:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 顱底瘤手術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Right subfrontal approach for tumor removal 開立醫師: 王奐之 開立時間: 2011/05/30 13:04 Pre-operative Diagnosis Suprasellar cystic tumor, suspected craniopharyngioma Post-operative Diagnosis Suprasellar cystic tumor, suspected Rathke cyst Operative Method Right subfrontal approach for tumor removal Specimen Count And Types 1 piece About size:pieces Source:cyst wall Pathology Pending Operative Findings Bilateral CN II and right CN I were noted intra-operatively and well preserved. The tumor was purplish and cystic, thin cystic wall was noted, and clear fluid was contained inside the cyst. The pituitary stalk was pushed rightward and anteriorly. Some calcification was noted at sellar floor and also sent for pathology. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head fixed in Mayfield skull clamp, and slightly turned to left. A bicoronal incision was made, followed by right frontal craniotomy. The dura was then opened and reflected towards midline. Subfrontal approach was adapted, the cystic tumor was exposed after retracting the right frontal lobe (after opening the Sylvian fissure and dissecting CN I & CN II). The cyst was fenestrated and the cyst wall was removed. After meticulous hemostasis, the dura was closed in water-tight fashion. The bone flap was placed back and fixed with mini-plates, the wound was closed in layers after placement of a subgaleal CWV drain. Operators P.杜永光 Assistants R6 胡朝凱, R3 王奐之 相關圖片 黃中一 (M,1954/05/01,57y10m) 手術日期 2011/05/30 手術主治醫師 曾漢民 手術區域 東址 005房 03號 診斷 Subdural hemorrhage 器械術式 Removal of chronic subdural hematoma, right 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 2E 紀錄醫師 王奐之, 時間資訊 07:00 開始NPO 12:58 通知急診手術 15:13 報到 15:15 進入手術室 15:20 麻醉開始 15:30 誘導結束 15:55 抗生素給藥 16:15 手術開始 17:20 手術結束 17:20 麻醉結束 17:30 送出病患 17:37 進入恢復室 18:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 慢性硬腦膜下血腫清除術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Right frontal burr hole for chronic subdural ... 開立醫師: 王奐之 開立時間: 2011/05/30 17:41 Pre-operative Diagnosis Right side chronic subdural hematoma Post-operative Diagnosis Right side chronic subdural hematoma Operative Method Right frontal burr hole for chronic subdural hematoma evacuation Specimen Count And Types nil Pathology Nil Operative Findings Motor-oil like fluid gushed out after durotomy. The brain expanded partially after hematoma evacuation. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After scalp shaving, disinfection and draping in sterile fashion, a linear incision was made at right frontal area. A burr hole was then made at right frontal region, a small cruciate durotomy was done after dural tenting. A rubber drain was then inserted into the subdural space to wash and drain the subdural hematoma. After evacuating the hematoma, the rubber drain was set to the frontal subdural space and fixed. The wound was then closed in layers. The operative procedure ended with deairing. Operators VS 曾漢民 Assistants R3 王奐之 Indication Of Emergent Operation Mass effect and midline shift 相關圖片 陸慧瑾 (F,1960/06/14,51y9m) 手術日期 2011/05/30 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Pituitary tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 邱裕淳, 時間資訊 23:11 臨時手術NPO 07:38 報到 08:05 進入手術室 08:10 麻醉開始 08:20 誘導結束 08:30 抗生素給藥 09:19 手術開始 10:15 麻醉結束 10:15 手術結束 10:27 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 經由蝶竇之腦下垂體瘤切除 1 1 R 手術 鼻中膈鼻道成形術-單側 1 2 R 摘要__ 手術科部: 外科部 套用罐頭: Trans-sphenoid cyst fenestration, septoplasty 開立醫師: 陳睿生 開立時間: 2011/05/30 10:37 Pre-operative Diagnosis Pituitary cystic tumor, suspect Rathke^s cyst Post-operative Diagnosis Sellar cystic lesion, suspect arachnoid cyst Operative Method Trans-sphenoid cyst fenestration, septoplasty Specimen Count And Types nil Pathology Nil Operative Findings A clear cyst was noted in front of the normal gland. It was formated by the arachnoid membrane. After drainage of the fluid inside, the normal gland behind was well preserved. Operative Procedures 1. ETGA, supine position and head mild right turn 2. Dissect the right side septal mucosa, and expose the vomer bone 3. Remove the anterior sphenoid sinus wall 4. Remove the sinusal mucosa, and bony septum inside 5. The sellar floor was identified 6. The bony floor was opened, and then the dura was exposed 7. We incised into the dura, and the arachnoid cyst was exposed 8. The arachnoid cyst was fenestrated, and the fluid inside was drained for decompression 9. The normal gland was noted behind to the cyst 10.Hemostasis, the dura defect was repaired with gelfoam and Tissuco Duo 11.The vomer bone was set back, and bilateral nasal canals were packed with plastic bags Operators VS 曾漢民 Assistants R6 陳睿生, R1 邱裕淳 林玉鳳 (F,1931/10/08,80y5m) 手術日期 2011/05/30 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 4 紀錄醫師 邱裕淳, 時間資訊 23:12 臨時手術NPO 10:22 報到 10:41 進入手術室 10:45 麻醉開始 11:05 誘導結束 11:20 抗生素給藥 11:44 手術開始 13:30 開始輸血 14:12 麻醉結束 14:12 手術結束 14:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除-手術時間在4小時以內 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for Simpson^s grade.I total tumor ... 開立醫師: 陳睿生 開立時間: 2011/05/30 14:32 Pre-operative Diagnosis Right frontal convexity meningioma Post-operative Diagnosis Right frontal convexity meningioma Operative Method Craniotomy for Simpson^s grade.I total tumor remove Specimen Count And Types 1 piece About size:4x4x4 cm Source:tumor Pathology Pending Operative Findings The tumor was about 4x4x4cm in size. It was soft, well capsuled, and blue-reddish. The tumor was noted to be tightly attached to the dura. Easy oozing was noted around the operation field, and mild brain swelling was noted after tumor remove. Operative Procedures 1. ETGA, supine position, and head left turn 2. Right frontotemporal scalp incision 3. Dissect the temporalis muscle and expose the key hole 4. Create two bur holes, and then an about 8x8 cm craniotomy window was done 5. Proper dura tenting, adn then the tumor was localized with intra-op ECHO 6. The dura was opened along the tumor 7. The arachnoid plane between the tumor and normal brain was carefully dissected 8. The tumor was remvoed en bloc with attached dura 9. Hemostasis, and the dura was repaired with periosteum graft 10.Fix back skull graft with miniplates x3 11.Set a subgaleal CWV drain, and close the woudn in layers Operators VS 曾漢民 Assistants R6 陳睿生, R1 邱裕淳 簡文魁 (M,1958/04/05,53y11m) 手術日期 2011/05/30 手術主治醫師 曾勝弘 手術區域 東址 003房 03號 診斷 Low back pain 器械術式 Laminectomy for decompression, L3-5 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3E 紀錄醫師 林哲光, 時間資訊 12:00 開始NPO 14:21 通知急診手術 15:20 進入手術室 15:40 麻醉開始 16:00 誘導結束 16:38 手術開始 17:00 抗生素給藥 18:30 開始輸血 20:12 麻醉結束 20:12 手術結束 20:25 送出病患 20:30 進入恢復室 22:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 手術 椎弓切除術(減壓)-超過二節 1 1 記錄__ 手術科部: 外科部 套用罐頭: L3-5 laminectomy for posterior decompression 開立醫師: 林哲光 開立時間: 2011/05/30 20:43 Pre-operative Diagnosis Epidural abscess, L3-S2, with acute cauda equina syndrome Epidural abscess, L3-S2, with acute cauda equina syndrome Post-operative Diagnosis Epidural abscess, L3-S2, with acute cauda equina syndrome Operative Method L3-5 laminectomy for posterior decompression L4-5 laminectomy for posterior decompression Specimen Count And Types 1 piece About size:multiple pieces Source:pus for cultures, pathology Pathology Pending Operative Findings Much whitish pus gushed out after laminectomy and some cystic like lesion was tightly adherent to the dura. The dura seemed compressed tightly before the laminectomy and dura seemed re-expanded well after laminectomy. Easily touch bleeding of the surronding soft tissues were noted and easily blood clot trapping of the epidural drains were also noted. Operative Procedures Under ETGA and prone position, skin disinfected and drapped were performed as usual. Midline skin incision at L3-S2 level was done. The paraspinal muslces were detached and laminectomy of L3-5 were then performed. The wound was then closed in layers after two epidural drains were inserted. Under ETGA and prone position, skin disinfected and drapped were performed as usual. Midline skin incision at L3-S2 level was done. The paraspinal muslces were detached and laminectomy of L4-5 were then performed. The wound was then closed in layers after two epidural drains were inserted. Operators P 曾勝弘 Assistants R4 林哲光 Indication Of Emergent Operation acute cauda equina syndrome (acute urine retention and decreased anal tone) 相關圖片 吳瑋萍 (F,1979/11/08,32y4m) 手術日期 2011/05/30 手術主治醫師 林昌平 手術區域 東址 010房 03號 診斷 Acute lymphoid leukemia, without mention of remission 器械術式 IVI ganciclovir (ou) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 蘇乾嘉, 時間資訊 09:58 報到 10:02 進入手術室 10:07 手術開始 10:14 手術結束 10:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 玻璃體空氣液體交換術 1 2 B 記錄__ 手術科部: 內科部 套用罐頭: Intravitreal Injection Of ganciclovir (2000ug... 開立醫師: 蘇乾嘉 開立時間: 2011/05/30 10:16 Pre-operative Diagnosis Cytomegalovirus retinitis(ou) Post-operative Diagnosis Cytomegalovirus retinitis(ou) Operative Method Intravitreal Injection Of ganciclovir (2000ug/0.05ml) (ou) Specimen Count And Types nil Pathology nil Operative Findings nil Operative Procedures 1.Under topical anesthesia. 2.Disinfection and draping as usual. 3.Apply an eyelid speculum. 4.Intravitreal injection of ganciclovir ( 2000ug/0.05ml) 5.Check leakage 6.Iop measurement by digit 7.Repeat the above steps on the other eye Operators 林昌平, Assistants 蘇乾嘉, 劉耀臨 王台生 (M,1951/07/23,60y7m) 手術日期 2011/05/30 手術主治醫師 王國川 手術區域 東址 003房 04號 診斷 Brain concussion 器械術式 Left F-T-P craniectomy and ICP monitoring 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 3E 紀錄醫師 林哲光, 時間資訊 15:00 開始NPO 21:34 通知急診手術 22:00 報到 22:05 進入手術室 22:20 麻醉開始 22:40 誘導結束 22:45 抗生素給藥 22:48 開始輸血 23:29 手術開始 02:30 抗生素給藥 03:00 麻醉結束 03:00 手術結束 03:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: Left F-T-P craniectomy and removal of left fr... 開立醫師: 林哲光 開立時間: 2011/05/31 03:39 Pre-operative Diagnosis Bifrontal contusional and left temporal contusional ICH, left frontal and temporal SAH Post-operative Diagnosis Bifrontal contusional and left temporal contusional ICH, left frontal and temporal SAH Operative Method Left F-T-P craniectomy and removal of left frontal and temporal tip ICH; ICP monitoring; Duroplasty with autologus fasica Specimen Count And Types Nil Pathology Nil Operative Findings Preoperative GCS was poor M6 with isocoric pupils and positive light reflexes. A linear fracture at left frontal bone was noted and oozing from the fracture line was also noted. Brain seemed mild bulging after craniectomy. Contusional frontal lobe and temporal lobe were noted and some subdural hematoma was noted at left temporal area. ICP showed 1 after dural opening and around 5 after the skin closure. ICP reference is 502. Operative Procedures Under ETGA and supine position with head rotated to right side, skin disinfected and drapped were performed as usual. Question mark skin incision was made and the temporalis muscles were detached. Craniectomy was then performed after burr holes created. Dura was opened in C shape and duroplasty with autologus fascia was done. ICH and SDH were removed. Hemostasis was done with Surgecells. The wound was then closed in layers after two epidural CWV drains and subdural ICP insertion. Operators VS 王國川 Assistants R4 林哲光, R1 陳宣佑 Indication Of Emergent Operation 相關圖片 賴書玄 (M,2010/02/22,2y0m) 手術日期 2011/05/30 手術主治醫師 張重義 手術區域 兒醫 067房 02號 診斷 Ventricular septal deffect ( VSD ) 器械術式 VSD repair 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 3 紀錄醫師 周恒文, 時間資訊 11:44 報到 12:05 進入手術室 12:10 麻醉開始 12:45 誘導結束 12:55 抗生素給藥 13:22 手術開始 15:55 抗生素給藥 17:11 開始輸血 18:05 麻醉結束 18:05 手術結束 18:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 四合群症之修補(T.F) 1 1 手術 體外心肺循環 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 T.E.E 1 0 麻醉 動脈血液檢查全套 4 0 麻醉 Hemoglobin (Hb) 4 0 麻醉 測血糖 4 0 麻醉 Ca (Calcium) 4 0 麻醉 Na (Sodium) 4 0 麻醉 K (Potassium) 4 0 麻醉 Blood gas analysis 4 0 手術 A.S.D 修補 1 2 記錄__ 手術科部: 外科部 套用罐頭: Infundibulectomy, VSD patch repair, PFO closure 開立醫師: 周恒文 開立時間: 2011/05/30 20:24 Pre-operative Diagnosis Type 2 VSD, DCRV, PFO Post-operative Diagnosis Type 2 VSD, DCRV, PFO Operative Method Infundibulectomy, VSD patch repair, PFO closure Specimen Count And Types nil Pathology Operative Findings 1. The RV was seperated by hypertrophic infundibulum and modurator band into 2 chambers: inlet chamber and outlet chamber: orifice: 8mm 1. The RV was seperated by hypertrophic infundibulum and modurator band into 2 chambers: inlet chamber and outlet chamber: orifice: 8mm. The orifice was enlarged with modurator band and infundibulum resection. 2. 2.Perimembraneous type VSD sized about 10mm in diameter with conal septum malalignment and aortic overriding. 3.RV hypertrophy with fair contractility 4.After VSD repair, the TV was competent. 5.Bilateral pleura intact, pericardium approximated. Operative Procedures ETGA, supine,disinfection. Midline full stermotomy. Cannulate AsAo, SVC, IVC on CPB and cooling to 28 degree Celsius. AXC and antegrade cardioplegia. Open the RA and venting through PFO. Resect the modurator band and infundibulm. VSD patch repair with Dacron patch and 5-0 pledgetted prolene with interrupted suture. Rewarm, release AXC. Close the PFO. Close the RA and deair. Wean off CPB. Set 2 chest tubes. Close the wound in layers. Operators 張重義 Assistants 林明賢,周恒文 陳仕祥 (M,1972/04/23,39y10m) 手術日期 2011/05/30 手術主治醫師 黃鶴翔 手術區域 東址 008房 05號 診斷 Ureteral stone 器械術式 U.R.S.-S.M. + Meatotomy,URS 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 面罩麻醉 麻醉主治醫師 黃慧薰 ASA 2 紀錄醫師 陳柏誠, 時間資訊 00:00 臨時手術NPO 11:10 報到 11:55 進入手術室 12:00 麻醉開始 12:05 誘導結束 12:16 手術開始 12:35 手術結束 12:35 麻醉結束 12:40 送出病患 12:45 進入恢復室 13:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Semi-opened mask inhalation anes 1 0 手術 輸尿管鏡取石術或碎石術–併用雷射治療方式 1 1 L 記錄__ 手術科部: 泌尿部 套用罐頭: URS-SM 開立醫師: 陳柏誠 開立時間: 2011/05/30 12:48 Pre-operative Diagnosis left ureteral stone with hydronephrosis Post-operative Diagnosis left ureteral stone with hydronephrosis Operative Method URS-SM Specimen Count And Types nil Pathology Operative Findings 1.A yellowish stone obstructed at left upper ureter with hydronephrosis was crushed by Holmium Laser(Energy:1.0J,Frequency:10 /s) 2.urethra stricture Operative Procedures Under satisfactory anesthesia with the patient in the lithotomy position, skin preparation was performed. A 6 Fr. ureteroscope was introduced into the ureter. A yellowish stones was noted at left ureter and crushed by Holmium Laser(Energy:1.0J, Frequency:10 /s) A Fr.7-24cm DBJ catheter was inserted. A 18 Fr.3 way Foley catheter was placed in the urinary bladder. The patient tolerated the operation well and was sent to the recovery room in stable condition. Operators 黃鶴翔, Assistants 陳柏誠, 蘇彥榮, 莊淑芬 (F,1950/10/20,61y4m) 手術日期 2011/05/31 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Lumbar spondylosis 器械術式 Debridment-- 5-10cm 手術類別 預定手術 手術部位 脊椎 傷口分類 污染 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 全賀顯, 時間資訊 23:05 臨時手術NPO 12:31 進入手術室 12:35 麻醉開始 12:45 誘導結束 13:00 抗生素給藥 13:10 手術開始 13:45 手術結束 13:45 麻醉結束 13:50 送出病患 13:51 進入恢復室 15:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 深部傷口處理縫合擴創-中 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 曾峰毅 開立時間: 2011/05/31 13:45 Pre-operative Diagnosis Back wound dehiscence Post-operative Diagnosis Back wound dehiscence Operative Method Debridement Specimen Count And Types Two wound swabs were sent for culture. Pathology Nil Operative Findings Fascia is intact, and the wound is non-purulent. Operative Procedures With enotracheal general anaesthesia, the patient was put in prone position. Aftter skin disinfected and draped, we opened previous surgical wound and debrided the wound. After gentamycin-saline irrigation, the wound was closed in layers with one CWV. Operators VS 賴達明 Assistants R4 曾峰毅 R1 全賀顯 劉陳淑娥 (F,1947/12/01,64y3m) 手術日期 2011/05/31 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 C-Spine fracture ( cervical spine fracture ) 器械術式 Spinal fusion posterior, C1-2 transarticular screws 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 全賀顯, 時間資訊 23:01 臨時手術NPO 08:05 進入手術室 08:25 麻醉開始 08:35 誘導結束 08:40 抗生素給藥 08:45 手術開始 11:42 抗生素給藥 12:05 手術結束 12:05 麻醉結束 12:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Transarticular screws for C1-2 posterior fixa... 開立醫師: 曾峰毅 開立時間: 2011/05/31 12:11 Pre-operative Diagnosis C1-2 sublaxation Post-operative Diagnosis C1-2 sublaxation Operative Method Transarticular screws for C1-2 posterior fixation and posterior fusion with mini-plates and autologous bone graft Specimen Count And Types Nil Pathology Nil Operative Findings C1-2 sublaxation was reduced during the transarticular screws insertion. Operative Procedures With endotracheal general anaesthesia, the patient was pus in prone position with head fixed by Mayfield head clamp. We made one midline skin incision and dissected to expose bilateral laminae from C1 to C3. Under C-arm guidance, we inserted bilateral transarticular screws. We harvested autologous bone graft from left posterior iliac crest, and put the bone graft at C1-2 interlaminar space after decortication. Bone graft was fixed by mini-plates. The wound was closed in layers after one CWV. Operators VS 賴達明 Assistants R4 曾峰毅 R1 全賀顯 王月釵 (F,1952/02/29,60y0m) 手術日期 2011/05/31 手術主治醫師 賴達明 手術區域 東址 003房 03號 診斷 Spondylolisthesis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 全賀顯, 時間資訊 23:33 臨時手術NPO 14:05 麻醉開始 14:10 誘導結束 14:20 抗生素給藥 14:44 手術開始 14:58 進入手術室 17:30 抗生素給藥 18:20 開始輸血 19:30 手術結束 19:30 麻醉結束 19:35 送出病患 19:40 進入恢復室 20:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎間盤切除術-腰椎 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 曾峰毅 開立時間: 2011/05/31 19:26 Pre-operative Diagnosis Spondylolisthesis, at L4/5, grade I; at L5/S1, grade II Post-operative Diagnosis Spondylolisthesis, at L4/5, grade I; at L5/S1, grade II Operative Method Transforaminal lumbar interbody fusion at L4/5 and L5/S1 with PEEK cage and autologous bone graft; posterior decompression with laminectomy L4 and L5; posterior fixation with transpedicular screws at L4-S1. Specimen Count And Types nil Pathology Nil Operative Findings Spondylolisthesis, grade II at L5/S1, and grade I, at L4/5; thecal sac was compromised with hypertrophic ligamentum flavum, and neural structre was decompressed well after the surgery. Operative Procedures With endotracheal general anaethesia, the patient as put in prone position. After C-arm localization, we made one midline skin incision to expose laminae from L3 to S1. We inserted transpedicular screws into bilateral pedicles at L4, L5, and S1. We performed laminectomy at L4 and L5 to achieved decompression. Transforaminal lumbar interbody fusion was done at L4/5 and L5/S1 via right with autologous bone graft and Synthes PEEK Travios cages, 9 mm at L5/S1, and 11 mm at L4/5. Posterior fixation was ahieved with two rods set. We inserted two submuscular hemovac, and the wound was closed in layers. Operators VS 賴達明 Assistants R4 曾峰毅 R1 全賀顯 謝貴枝 (F,1962/02/15,50y0m) 手術日期 2011/05/31 手術主治醫師 賴達明 手術區域 東址 005房 02號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 23:53 臨時手術NPO 13:25 報到 13:50 進入手術室 13:55 麻醉開始 14:20 誘導結束 14:20 抗生素給藥 14:45 手術開始 17:40 抗生素給藥 18:55 麻醉結束 18:55 手術結束 19:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4~8小時 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 摘要__ 手術科部: 外科部 套用罐頭: Left frontal craniotomy for tumor excision 開立醫師: 李振豪 開立時間: 2011/05/31 19:26 Pre-operative Diagnosis Left frontal tumor, suspect high grade glioma Post-operative Diagnosis Left frontal tumor, suspect high grade glioma Operative Method Left frontal craniotomy for tumor excision Specimen Count And Types 1 piece About size:5x5x5cm Source:Left frontal brain tumor Pathology Pending Operative Findings The tumor was gray, dark-reddish, and yellowish in color and 5.8 x 5.5 x 5.5cm in size. One large cystic component was noted with xanthochronic fluid. The character of the tumor was gelatinous in most part but hard in anterior frontal area. The vascularization of the tumor was moderate. The lateral ventricle is not entered during the operation. Mild right upper limb MEP change was noted during manipulation. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head rotated to right. The scalp was shaved, scrubbed, and disinfected as usual. Left question mark scalp incision was made and the scalp flap was elevated. Total four burr hole were created followed by one 10x10cm craniotomy window. Dural tenting was done. Intra-operative sonograph was performed to identified the location of the tumor. The dura was opened with C-shape based with frontal base. Tumor excision was performed with bipolar electrocautery, tumor forceps, and sucker. Hemostasis was achieved with bipolar electrocautery and Surgicel lining. Dura was closed with 4-0 Prolene. The skull plate was fixed back with miniplates and screws after three central tenting. One subgaleal CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS賴達明 Assistants R4李振豪, R2陳志軒 相關圖片 蔡添璧 (M,1930/11/11,81y4m) 手術日期 2011/05/31 手術主治醫師 林峰盛 手術區域 西址 035房 05號 診斷 Spinal stenosis, lumbar 器械術式 Nerve block / PC 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 硬肌麻醉 麻醉主治醫師 林峰盛 ASA 3 時間資訊 15:35 進入手術室 15:43 麻醉開始 15:45 誘導結束 15:46 手術開始 15:57 手術結束 15:57 麻醉結束 16:00 送出病患 記錄__ 手術科部: 麻醉部 套用罐頭: LENB 開立醫師: 葉芷圻 開立時間: 2011/05/31 15:57 Pre-operative Diagnosis 1.spinal stenosis 2. radiculopathy Post-operative Diagnosis 1. spinal stenosis 2. radiculopathy Operative Method LA with 1% xylocaine 5 ml pt in prone position 3. Under fluoroscopic-guiddance, LENB was done to level with 16G Tuohy needle, 60mg Kenaocrt in 0.5% xylocaine 10ml Specimen Count And Types nil Pathology Nil Operative Findings Operative Procedures LENB Operators 林峰盛, Assistants 葉芷圻, 程李玉珍 (F,1924/01/14,88y2m) 手術日期 2011/05/31 手術主治醫師 蕭輔仁 手術區域 東址 001房 03號 診斷 Spondylolisthesis 器械術式 Radiofrequency coagulation 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 李振豪, 時間資訊 18:52 進入手術室 19:20 抗生素給藥 19:31 麻醉開始 19:33 誘導結束 19:35 手術開始 20:07 手術結束 20:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 高頻熱凝療法 1 1 B 摘要__ 手術科部: 外科部 套用罐頭: Bilateral L2 dorsal root radiofrequency stimu... 開立醫師: 李振豪 開立時間: 2011/05/31 19:57 Pre-operative Diagnosis Low back pain Post-operative Diagnosis Low back pain Operative Method Bilateral L2 dorsal root radiofrequency stimulation Specimen Count And Types nil Pathology Nil Operative Findings 1. Bilateral L2 dorsal root was identified by portable C-arm X-ray and sensory/motor stimulation test. No acute complication was noted after the procedure. 2. Temp: 42 oC, Time: 180sec x 2 cycles each side Operative Procedures The patient was put in prone position. The location of L2 was identified by portable C-arm X-ray. The skin was disinfected and draped as usual. Local anesthesia was performed with 1% Xylocaine 10ml. Bilateral L2 dorsal root radiofrequency stimulation was performed under portable C-arm guided. The patient stood whole procedure well. Operators VS蕭輔仁 Assistants R4李振豪, R2陳志軒 相關圖片 沈茂易 (M,1940/11/13,71y4m) 手術日期 2011/05/31 手術主治醫師 蕭輔仁 手術區域 東址 021房 03號 診斷 Spinal cord injury 器械術式 Diskectomy cervical(Anterier)，Anterior Spinal fusion (Others) 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 14:51 進入手術室 15:03 麻醉開始 15:30 誘導結束 15:35 抗生素給藥 16:03 手術開始 18:40 手術結束 18:40 麻醉結束 18:45 抗生素給藥 18:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-前融合,有固定物)≦四節 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: C4-5 discectomy and anterior fusion with cage... 開立醫師: 林哲光 開立時間: 2011/05/31 19:20 Pre-operative Diagnosis C4-5 cervical stenosis and ossfication of PLL Post-operative Diagnosis C4-5 cervical stenosis and ossfication of PLL Operative Method C4-5 discectomy and anterior fusion with cage and fixed with cervical plate Specimen Count And Types Nil Pathology Nil Operative Findings C4-5 instability was noted during the C-arm localization. Dura seemed re-expanded well after discectomy and PLL removal. Severe spur formation was also noted at vertebral body. 8mm Cage and 28mm cervical plate were inserted for anterior fusion. Operative Procedures Under ETGA and supine position with head mild extended, skin disinfected and drapped were performed as usual. Transverse skin incision was made at right neck after C-arm localization. The plane between carotid triangle and esophagus was dissected and prevertebral fascia was opened. C4-5 discectomy was then done and anterior fusion with cage and fixed with cervical plate was done. The wound was then closed in layers after a mini-H/V inserted at prevertebral area. Operators VS 蕭輔仁 Assistants R6 胡朝凱, R4 林哲光 Indication Of Emergent Operation 相關圖片 邱麗娟 (F,1965/08/24,46y6m) 手術日期 2011/05/31 手術主治醫師 蕭輔仁 手術區域 東址 005房 01號 診斷 Ossification of posterior longitudinal ligament 器械術式 OPLL- Anterior Corpectomy 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 23:03 臨時手術NPO 07:45 報到 08:13 進入手術室 08:30 麻醉開始 08:40 誘導結束 09:05 抗生素給藥 09:10 手術開始 12:03 開始輸血 12:09 抗生素給藥 13:25 手術結束 13:25 麻醉結束 13:37 送出病患 13:40 進入恢復室 14:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 脊椎融合術-前融合,有固定物)≦四節 1 2 R 手術 椎間盤切除術-頸椎 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: C4 corpectomy and anterior fusion with expand... 開立醫師: 李振豪 開立時間: 2011/05/31 13:41 Pre-operative Diagnosis Ossification of the posterior longitudinal ligament with cervical stenosis Post-operative Diagnosis Ossification of the posterior longitudinal ligament with cervical stenosis Operative Method C4 corpectomy and anterior fusion with expandable body cage and plating Specimen Count And Types nil Pathology Nil Operative Findings The disc was degenerative with some marginal spur formation. The OPLL was thick and calcified which tight compressed the thecal sac. The Thecal sac expanded well after resection of the OPLL. No CSF leakage was noted during the operation. One expandable body cage with plate(16~27mm) and four screws(14mm) were used for anterior fusion and fixation. No SSEP change was noted after whole procedure. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with neck extension. The skin was scrubbed, disinfected, and draped as usual. Transverse skin incision was made at right neck and dissected along the plan between thyroid gland and carotid sheath. Prevertebral fascia was identified and opened. The C3-4 disc space was localized with portable C-arm X-ray. C3-4 and C4-5 microdiskectomy was performed. C4 corpectomy was done with Midas air-drived drill. The OPLL was removed after corpectomy. Expandable body cage with plate was inserted and the location was checked with portable C-arm X-ray. Four screws were used for anterior fixation and fusion. Hemostasis was achieved and one MiniHemovac was placed. The wound was then closed in layers with 3-0 Vicryl and 4-0 Dexon. Operators VS蕭輔仁 Assistants R4李振豪, R2陳志軒 相關圖片 莊星 (M,1947/08/18,64y6m) 手術日期 2011/05/31 手術主治醫師 王國川 手術區域 東址 001房 01號 診斷 Cerebrovascular accident 器械術式 Burr hole (trephination) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 胡朝凱, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 07:18 通知急診手術 08:35 報到 09:00 進入手術室 09:05 麻醉開始 09:10 誘導結束 09:20 抗生素給藥 09:30 手術開始 10:50 麻醉結束 10:50 手術結束 10:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 急性硬腦膜下血腫清除術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Right trephination for hematoma evacuation 開立醫師: 胡朝凱 開立時間: 2011/05/31 10:58 Pre-operative Diagnosis Right acute on chronic subdural hematoma Post-operative Diagnosis Right acute on chronic subdural hematoma Operative Method Right trephination for hematoma evacuation Specimen Count And Types Nil Pathology nil Operative Findings 1.Hematoma was noted at right subdural space that compressed the brain parenchyma tightly. 2.Outer membrane (+) 3.Opening pressure was high 4.After decompression, brain expanded Operative Procedures 1.ETGA, supine with head rotate to left 2.Right parietal vertical skin incision 3.Dissect to open skin flap and muscle flap 4.trephination 5.Dural tenting 6.Open dura 7.hematoma evacuation 8.set one rubber drain 9.close dura with one piece of fascia 10.fixed bone back with miniplate 11.Close wound in layer 12.De-air Operators VS 王國川 Assistants 胡朝凱 Indication Of Emergent Operation 陳俊升 (M,1961/06/12,50y9m) 手術日期 2011/05/31 手術主治醫師 蔡翊新 手術區域 東址 003房 04號 診斷 Cerebrovascular accident 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3E 紀錄醫師 王奐之, 時間資訊 00:00 抗生素給藥 18:00 開始NPO 18:00 臨時手術NPO 20:26 通知急診手術 20:50 進入手術室 20:55 麻醉開始 21:10 抗生素給藥 21:15 誘導結束 21:27 手術開始 00:45 送出病患 00:45 麻醉結束 00:45 手術結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦內血腫清除術 1 1 R 手術 顱內壓視置入 1 2 R 摘要__ 手術科部: 外科部 套用罐頭: CVA 開立醫師: 蔡翊新 開立時間: 2011/06/01 00:27 Pre-operative Diagnosis Right putaminal ICH and IVH. Post-operative Diagnosis Right putaminal ICH and IVH. Operative Method Right frontotemporal craniotomy for ICH evacuation and ICP monitoring. Specimen Count And Types nil Pathology Nil. Operative Findings The dura was very tense and the brain bulged out rapidly after dural incision. A 8.5 x 7 x 6 cm ICH, about 180 ml in amount, at right basal ganglia was evacuated. Several active bleeders came from perforating arteries of right MCA branch. The brain became slack after ICH removal. Easy oozing from hematoma cavity was encountered. ICP after dural closure was 5 mmHg and that after skin closure was mmHg. The dura was very tense and the brain bulged out rapidly after dural incision. A 8.5 x 7 x 6 cm ICH, about 180 ml in amount, at right basal ganglia was evacuated. Several active bleeders came from perforating arteries of right MCA branch. The brain became slack after ICH removal. Easy oozing from hematoma cavity was encountered. ICP after dural closure was 5 mmHg and that after skin closure was 5 mmHg. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: right frontotemporal, curvilinear. The skin edge was clipped by Raney clips for temporary hemostasis. After scalp had been lifted, the temporalis muscle was incised and detached from temporal squama and reflected to lower temporal side. 5. Craniotomy: A 5 cm trephine was made at right frontotemporal area with its center 8 cm above extenal ear canal. 6. Dural tenting: by 2/0 silk, 2 cm in interval, distributed along the edge of skull window. 7. Dural incision: cruciate. 8. A 2 cm cortical incision was made at anterior part of the inferior frontal gyrus, the subcortex and white mater was splitted by brain retractor and sucker until the intracerebral hematoma was exposed. The hematoma was sucked out carefully. Those tough clot was removed by forceps. The cavity was irrigated with NS and the blood oozing was stopped by Surgicel packing. Before closure of the dura, the hematoma caivty was clean and the brain once bulging was very slack. 9. Dural closure: A fascial graft was used for duroplasty, interrupted 2/0 silk sutures for key stitches, then continous sutures with 4/0 Prolene to obtain water-tight closure. 10.The trephine button was placed back and fixed by 3 miniplates and 6 screws. 11.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 12.Drain: none. 13.Blood transfusion: nil. Blood loss: 250 ml. 14.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R6陳睿生R3王奐之 Indication Of Emergent Operation Conscious disturbance, IICP, massive ICH 相關圖片 管瑩如 (F,1981/06/08,30y9m) 手術日期 2011/06/01 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾偉倫, 時間資訊 23:21 臨時手術NPO 08:15 進入手術室 08:20 麻醉開始 08:30 誘導結束 09:00 手術開始 09:20 抗生素給藥 12:20 抗生素給藥 14:25 開始輸血 15:20 抗生素給藥 17:25 手術結束 17:25 麻醉結束 17:35 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 10 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除-手術時間在4~8小時 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Right interhemipheric transcallosal approach ... 開立醫師: 陳睿生 開立時間: 2011/06/01 17:46 Pre-operative Diagnosis Large intraventricular tumor, central neurocytoma Post-operative Diagnosis Large intraventricular tumor, central neurocytoma Operative Method Right interhemipheric transcallosal approach for tumor removal Specimen Count And Types 1 piece About size:2x2x2 cm Source:Intraventricular tumor Pathology Central neurocytoma, WHO grade I Operative Findings The tumor was soft, grayish, and solid. It was noted to occupy bilateral lateral ventricle, and third ventricle. The tumor was firmly attached to lateral wall of bilateral lateral ventricle, and was removed till the normal ventricle wall exposed. The ipsilateral ICV was noted during tumor remove, and was well preserved. The tumor was soft, grayish, and solid. It was noted to occupy bilateral lateral ventricle, and third ventricle. The tumor was firmly attached to lateral wall of bilateral lateral ventricle, and was removed till the normal ventricle wall exposed. The ipsilateral ICV was noted during tumor remove, and was well preserved. Foramen monro was exposed intra-op. Operative Procedures Under ETGA, we placed the patient in supine position with her head tile slightly to right side. Her head was fixed with Mayfield clamp. After we shaved, scrubbed, disinfected and drapped, we make a cuvilinear skin incision over the previous operation wound. The skull was removed after the previous screws removed. After dural tenting, a fish-mouth durotomy was made and the dura was reflected towards midline. Retractor was set on the falx, the corpus callosum was exposed. A 1.5cm callosotomy was done, the tumor was then identified and removed in piecemeal fashion by tumor forceps & sucker. After tumor removal, an EVD was set to the ventricle, the dura was then closed in water-tight fashion. Central tenting was done, followed by fixing back the bone flap. The wound was closed in layers after setting 1 subgaleal CWV drain. Operators P 杜永光 Assistants R6 陳睿生 R2 曾偉倫 相關圖片 梁維集 (M,1926/10/24,85y4m) 手術日期 2011/06/01 手術主治醫師 梁金銅 手術區域 東址 027房 01號 診斷 Colon cancer 器械術式 L.right hemicolectomy 手術類別 預定手術 手術部位 腹 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林子富 ASA 3 紀錄醫師 楊惠馨, 時間資訊 00:00 臨時手術NPO 08:06 進入手術室 08:15 麻醉開始 08:40 誘導結束 08:45 抗生素給藥 09:15 手術開始 09:35 開始輸血 11:45 抗生素給藥 13:25 手術結束 13:25 麻醉結束 14:15 送出病患 14:20 進入恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 經腹腔鏡右側大腸切除術加吻合術 1 1 手術 肝部份切除術 1 2 記錄__ 手術科部: 外科部 套用罐頭: Laparoscopic right hemicolectomy 開立醫師: 楊惠馨 開立時間: 2011/06/01 13:50 Pre-operative Diagnosis Ascending colon cancer, near hepatic flexure, with liver metastsasis at S4 Post-operative Diagnosis Ascending colon cancer, near hepatic flexure, with liver metastsasis at S4 Operative Method Laparoscopic right hemicolectomy Specimen Count And Types 2 pieces About size:30*25*10cm Source:terminal ileum~T-colon About size:2.5*2.5*2.5cm Source:liver, suspicious colon cancer metastasis Pathology pending Operative Findings 1. One about 4.0*3.0 cm in diameter protruding cauliflower-like tumor over ascending colon, near hepatic flexure, was noted 2. One obvious lymph nodes in the right colic area 3. One about 2.5*2.5*2.5 liver tumor was noted, and liver metastsis was highly suspected 4. Severe adhesion was noted bewteen sigmoid colon and terminal ileum Operative Procedures 1. ETGA, supine position 2. Make 10-10-10-10 ports 3. Mobilize the terminal ileum and ascending colon, ligated ileocecal vessels and right colic vessels 4. Adhesiolysis between sigmoid colon and terminal ileum 5. Departed the T-colon and duodenum 6. Take down the hepatic flexure 7. Performed hepatic wedge resection for the liver metastsis 8. Extend the upper abdomen wound 9. Transection of T-colon and ileum with GIA 50*2 10. Perform side-to-side anastamosis with GIA 50 *2 11. Set three rubber drain in (1)right subhepatic area (2)Douglas pouch (3) left subphrenic area 12. Close the wound in layers Operators P梁金銅 Assistants CR楊惠馨, Ri林維軒 CR楊惠馨, Ri林軒維 相關圖片 陳炳森 (M,1952/05/09,59y10m) 手術日期 2011/06/01 手術主治醫師 曾漢民 手術區域 東址 005房 03號 診斷 Malignant neoplasm of liver, primary 器械術式 Brain biopsy (TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳國瑋, 時間資訊 07:24 臨時手術NPO 07:55 抗生素給藥 14:02 進入手術室 14:10 麻醉開始 14:40 誘導結束 14:40 抗生素給藥 14:50 手術開始 17:55 手術結束 17:55 麻醉結束 18:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy, total tumor excision 開立醫師: 曾偉倫 開立時間: 2011/06/01 18:40 Pre-operative Diagnosis Left parietal brain tumor r/o metastasis Left parietal brain tumor r/o HCC metastasis Post-operative Diagnosis Left parietal brain tumor r/o metastasis Left parietal brain tumor r/o HCC metastasis Operative Method Craniotomy, total tumor excision Specimen Count And Types 1 piece About size:pieces Source:brain tumor Pathology pending Operative Findings 1. The brain was mildly buldging 2. One reddish firm elastic well-defined tumor, measured 1.7*1.5*1.7cm at the subcortical region of motor cortex 3. The cortical drainage veins were preserved Operative Procedures Under ETGA, the patient was put in supine positioina. His head was fixed with Mayfield clamp with neck flexion. Skin disinfection and draping was done in the usual fasion. U-shaped skin incision was made. After the skin was reflected, triangular craniotomy window was made. The tumor location was checked with intra-OP ultrasound. Durotomy was done brain mapping was done. The tumor was reached with trans-culcus apporach. The tumor was removed en bloc. After hemostasis, the dura was closed in water-tied fashion and the craniotomy window was put back. The wound was closed in layers. Operators 曾漢民 Assistants 胡朝凱 陳國瑋 相關圖片 時光 (M,2010/09/08,1y6m) 手術日期 2011/06/01 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Hydrocephalus 器械術式 Revision of CSF shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 07:42 報到 08:03 進入手術室 08:10 麻醉開始 08:30 誘導結束 08:40 抗生素給藥 09:18 手術開始 10:50 手術結束 10:50 麻醉結束 10:55 送出病患 11:05 進入恢復室 12:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦脊髓液分流管重置 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 摘要__ 手術科部: 外科部 套用罐頭: 1.Removal of ventricular catheter and shunt l... 開立醫師: 鍾文桂 開立時間: 2011/06/01 13:39 Pre-operative Diagnosis Hydrocephalus status post implantation of ventriculoperitoneal shunt, with slit ventricle. Post-operative Diagnosis Hydrocephalus status post implantation of ventriculoperitoneal shunt, with slit ventricle. Operative Method 1.Removal of ventricular catheter and shunt ligation. 2.Wound debridement. Specimen Count And Types 1 piece About size:5 cm Source:ventriclar catheter, x II Pathology Nil. Operative Findings 1. Much debris was noted within the reservoir and the programmable valve. 2. Severe adhesion of the ventricular catheter to the brain parenchyma. We were not able to remove the catheter. So we left a portion of the ventricular catheter in situ. The burr hole was sealed with two layers of DuraFoam. 3. The ligated shunt catheter was fixed on retroauricular area for preparation of the shunt revision in the future. 4. We only removed the catheter within the cyst and the programmable valve in this operation. 5. Much granulation formation was noted arround the path of the shunt. We removed some of the granulation tissues. Subgaleal pocket of CSF accumulation was noted at retroauricular area down to submandibular region. We collected the CSF and granulation tissue for culture. Operative Procedures Under ETGA, the patient was placed in supine position and the head was tilted to the left side. After shaving, scrubbing of the head, disinfection, and draping, the previous operative wound was incised and dissected to expose the shunt system. The Y-connector was disconnected from the catheters to the ventricle and cyst.The catheter into the cyst was removed. The catheter into the right occipital horn was cut partially and left some in situ due to severe adhesion. The programmable valve was removed. The proximal part of the shunt catheter was ligated and fixed on pericranium. Debridemnt of the wound was done with currete and dissector. After normal saline irrigation, the wound was closed in layers. Operators 郭夢菲 Assistants R5 鍾文桂 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: 1.Removal of ventricular catheter and shunt l... 開立醫師: 郭夢菲 開立時間: 2011/06/02 09:03 Pre-operative Diagnosis Hydrocephalus status post implantation of ventriculoperitoneal shunt, with slit ventricle and persistent subcutaneous CSF leakage. Post-operative Diagnosis Hydrocephalus status post implantation of ventriculoperitoneal shunt, with slit ventricle and persistent subcutaneous CSF leakage. Operative Method 1.Removal of porencephalic cyst catheter and programmable valve 2.Wound debridement. Specimen Count And Types cultures: swab for 1, porencephalic catheter tip and programmable valve x II Pathology Nil. Operative Findings 1. Much debris was noted within the shunt chamber and the programmable valve. The paritoneal catheter was patent but with some resistance 2. Severe adhesion of the ventricular catheter to the brain parenchyma. We were not able to remove the catheter. So we left a portion of the ventricular catheter in situ. The burr hole was large up to 1.3X1.3 cm in diameter, we then sealed with two layers of DuraFoam. 3. The ligated shunt catheter was fixed on retroauricular area for preparation of the shunt revision in the future. 4. We only removed the catheter within the cyst and the programmable valve in this operation. 5. Much granulation formation was noted arround the path of the shunt. We curretted the granulation tissues. Subgaleal pocket of CSF accumulation was noted at retroauricular area down to submandibular region. We collected the CSF and granulation tissue for culture. Operative Procedures Under ETGA, the patient was placed in supine position and the head was tilted to the left side. After shaving, scrubbing of the head, disinfection, and draping, the previous operative wound over the right retroauricular region up to 6 cm in length wasn incised and dissected to expose the shunt system. The Y-connector was disconnected from the catheters to the ventricle and porencephalic cyst. The catheter into the porencephalic cyst was removed smoothly. The catheter into the right occipital horn was cut partially and left some in situ due to severe adhesion. We had tried to remo0ved by low current coagluation and gentle twisting, but failed. We then dissected the periosteum around the large bony defect for repair of the dural defect. We covered the dural defect with DuroFoam and suture the dural margin in tie-over fashion. We then covered another DuroFoam and suture the periosteum to fix it. The programmable valve was then removed after we made another small incision over the lower end ot it. The proximal part of the peritoneal catheter was ligated and fixed on pericranium in the afterior lower part of the first incision for later use. Debridemnt of the wound was done with currete and dissector. After normal saline irrigation, the wound was closed in layers. Operators 郭夢菲 Assistants R5 鍾文桂 相關圖片 黃莉雅 (F,2009/09/24,2y5m) 手術日期 2011/06/01 手術主治醫師 郭夢菲 手術區域 兒醫 067房 02號 診斷 Hydrocephalus 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 11:14 進入手術室 11:15 麻醉開始 11:20 誘導結束 11:25 抗生素給藥 11:57 手術開始 12:33 手術結束 12:33 麻醉結束 12:45 送出病患 12:50 進入恢復室 13:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦脊髓液分流管重置 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Revision of ventriculoperitoneal shunt by add... 開立醫師: 鍾文桂 開立時間: 2011/06/01 13:46 Pre-operative Diagnosis Slit ventricle caused by overdrainage of ventriculoperitoneal shunt for hydrocephalus. Post-operative Diagnosis Slit ventricle caused by overdrainage of ventriculoperitoneal shunt for hydrocephalus. Operative Method Revision of ventriculoperitoneal shunt by adding on a programmable valve. Specimen Count And Types nil Pathology Nil. Operative Findings Codman programmable valve was added on the previous shunt system. The initial setting was 100 mmH2O. Operative Procedures Under ETGA, the patient was placed in supine position and the head was tilted to the right side. After shaving, disinfection, and draping, the previous operative wound was incised paritially to expose the shunt catheter. We disconnected the shunt catheter from the reservoir and connected the reservoir with the programmable valve. The programmable valve was connected with the shunt catheter at its proximal end. After ensuring the patency of the shung system, the wound was closed in layers. Operators 郭夢菲 Assistants R5 鍾文桂 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Revision of ventriculoperitoneal shunt by add... 開立醫師: 郭夢菲 開立時間: 2011/06/02 09:06 Pre-operative Diagnosis Microcephalus and slit ventricle due to overdrainage of ventriculoperitoneal shunt for hydrocephalus. Post-operative Diagnosis Microcephalus and slit ventricle due to overdrainage of ventriculoperitoneal shunt for hydrocephalus. Operative Method Revision of ventriculoperitoneal shunt by adding on a Codman Hokin programmable valve with pressure setting at 100 mmH2O Specimen Count And Types nil Pathology Nil. Operative Findings Codman programmable valve was added on the previous shunt system. The initial setting was 100 mmH2O. Operative Procedures Under ETGA, the patient was placed in supine position and the head was tilted to the right side. After shaving, disinfection, and draping, the previous operative wound was incised paritially to expose the shunt catheter. We disconnected the distal catheter from the reservoir and connected the reservoir with the programmable valve. The programmable valve was then connected with the shunt catheter at its proximal end after another small incision was made at the retroauricular region. After ensuring the patency of the shung system, the wound was closed in layers. Operators 郭夢菲 Assistants R5 鍾文桂 相關圖片 吳婉秋 (F,1931/04/25,80y10m) 手術日期 2011/06/01 手術主治醫師 賴達明 手術區域 東址 005房 01號 診斷 Hypertension 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 08:03 進入手術室 08:05 麻醉開始 08:10 誘導結束 08:34 抗生素給藥 09:15 手術開始 11:53 手術結束 11:53 麻醉結束 12:02 送出病患 12:05 進入恢復室 13:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎弓切除術(減壓)-二節以內 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 摘要__ 手術科部: 外科部 套用罐頭: L3, L4 laminectomy, L4/5 transpedicle screws ... 開立醫師: 葉軒 開立時間: 2011/06/01 12:27 Pre-operative Diagnosis Lumbar stenosis L3/4, L4/5 Post-operative Diagnosis Lumbar stenosis L3/4, L4/5 Operative Method L3, L4 laminectomy, L4/5 transpedicle screws 6.2*40mm and L4/5 fusion with Synthes bannana cage 11mm, left L4/5 facetomy Specimen Count And Types nil Pathology nil Operative Findings The dural sac was compressed tightly and re-expended well after decompression. Flavum ligment was thickened and compressing the dural sac and nerve roots. L4 over L5 instability was noted. Stenosis of lateral rescess Operative Procedures The patient was ETGA and then put in prone position. After checking position with C-arm. Linear skin incision was done. Dissection was done down to the transverse porscess level. L4/5 transpedicle screws were inserted. Left L4/5 facetomy was done and insertion of bannana cage was performed. L3 and L4 laminectomy was done. After checking position with C-arm the L4/5 was fused with rods. After setting one drain, the wound was closed in layers. Operators 賴達明 Assistants 胡朝凱 陳國瑋 相關圖片 吳莉媺 (F,1987/05/24,24y9m) 手術日期 2011/06/01 手術主治醫師 戴浩志 手術區域 東址 009房 03號 診斷 Contusion, scalp 器械術式 Reduction of mandible;simple 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 3 紀錄醫師 阮廷倫, 時間資訊 11:45 進入手術室 11:50 麻醉開始 11:50 抗生素給藥 12:05 誘導結束 12:30 手術開始 15:05 抗生素給藥 18:15 手術結束 18:15 麻醉結束 18:25 送出病患 18:25 進入恢復室 19:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 手術 下顎骨骨折開放性復位(簡單) 1 1 B 手術 顎間固定法 1 0 B 摘要__ 手術科部: 外科部 套用罐頭: ORIF + MMF 開立醫師: 阮廷倫 開立時間: 2011/06/01 18:38 Pre-operative Diagnosis Mandible fracture Post-operative Diagnosis Mandible fracture Operative Method ORIF + MMF Specimen Count And Types Nil Pathology Nil Operative Findings 1. Mandible fracture line noticed over left subcondyle, left para-symphasis, and right ramus 2. Incision was made over lower gingival sulcus, left pre-auricular region, and left mandibular angle Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position. After skin disinfection and draped, skin and mucosa incision was made. After exploration of fracture lines, adequate reduction was done. left subcondyle was fixed with mini-plate first. Mandible-maxilla fixation was applied to fit proper occlusion. Right ramus and left para-symphasis fracture were fixed with mini-plates. After irrigation and hemostasis, the wounds were closed in layers with 4-0 Dexon, 6-0 Nylon. One mini-hemovac was placed over left pre-auricular space. Operators AP戴浩志 Assistants F1林之昀, R5阮廷倫, R4陳建璋 王台生 (M,1951/07/23,60y7m) 手術日期 2011/06/01 手術主治醫師 王國川 手術區域 東址 016房 03號 診斷 Brain concussion 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 4E 紀錄醫師 王奐之, 時間資訊 14:42 通知急診手術 15:20 報到 15:20 進入手術室 15:25 麻醉開始 15:30 誘導結束 15:50 手術開始 17:00 抗生素給藥 17:45 麻醉結束 17:45 手術結束 17:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 外科部 套用罐頭: Hematoma evacuation 開立醫師: 王奐之 開立時間: 2011/06/01 18:29 Pre-operative Diagnosis Traumatic brain injury status post left side decompressive craniectomy, with delayed frontal contusional hemorrhage Post-operative Diagnosis Traumatic brain injury status post left side decompressive craniectomy, with delayed frontal contusional hemorrhage Operative Method Hematoma evacuation Evacuation of contusional intracerebral hematoma Specimen Count And Types Nil Pathology Nil Operative Findings Brain bulged out after durotomy initially, diffuse contusion was noted at left frontotemporal area. The brain became slack after hematoma evacuation, ICP after the wound closure: 5 mmHg. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to right. After scalp scrubbing, disinfection and draping in sterile fashion, a question-mark incision was made along previous left frontotemporoparietal wound. The dura was opened along previous durotomy, hematoma location was identified via intra-operative sonography. 2 corticotomy were done at left superior and inferior frontal gyrus, followed by hematoma evacuation and hemostasis. The dura was then closed with a small fascial graft in water-tight fashion. After setting 1 epidural CWV drain, the wound was closed in layers. Operators VS 王國川 Assistants R3 王奐之 Indication Of Emergent Operation Mass effect & IICP 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Hematoma evacuation 開立醫師: 王奐之 開立時間: 2011/06/28 18:49 Pre-operative Diagnosis Traumatic brain injury status post left side decompressive craniectomy, with delayed frontal contusional hemorrhage Post-operative Diagnosis Traumatic brain injury status post left side decompressive craniectomy, with delayed frontal contusional hemorrhage Operative Method Evacuation of contusional intracerebral hematoma Specimen Count And Types Nil Pathology Nil Operative Findings Brain bulged out after durotomy initially, diffuse contusion was noted at left frontotemporal area. The brain became slack after hematoma evacuation, ICP after the wound closure: 5 mmHg. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to right. After scalp scrubbing, disinfection and draping in sterile fashion, a question-mark incision was made along previous left frontotemporoparietal wound. The dura was opened along previous durotomy, hematoma location was identified via intra-operative sonography. 2 corticotomy were done at left superior and inferior frontal gyrus, followed by hematoma evacuation and hemostasis. The dura was then closed with a small fascial graft in water-tight fashion. After setting 1 epidural CWV drain, the wound was closed in layers. Operators VS 王國川 Assistants R3 王奐之 Indication Of Emergent Operation Mass effect & IICP 相關圖片 湯釗宇 (M,1972/07/05,39y8m) 手術日期 2011/06/01 手術主治醫師 蔡翊新 手術區域 東址 002房 04號 診斷 Epidural hemorrhage, traumatic 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 4E 紀錄醫師 林哲光, 時間資訊 12:05 通知急診手術 12:05 臨時手術NPO 12:05 開始NPO 12:55 進入手術室 13:00 麻醉開始 13:20 抗生素給藥 13:20 誘導結束 13:30 手術開始 14:33 開始輸血 16:20 抗生素給藥 16:40 手術結束 16:40 麻醉結束 16:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 急性硬腦膜下血腫清除術 1 1 L 手術 顱內壓視置入 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: Right F-T-P craniectomy with removal of EDH a... 開立醫師: 林哲光 開立時間: 2011/06/01 17:50 Pre-operative Diagnosis Right fontal-temporal skull bone fracutre with epidural hematoma and subdural hematoma Post-operative Diagnosis Right fontal-temporal skull bone fracutre with epidural hematoma and subdural hematoma Operative Method Right F-T-P craniectomy with removal of EDH and SDH and subdural ICP monitoring; Duroplasty with autologus fascia Specimen Count And Types nil Pathology Nil Operative Findings Preoperative GCS was E1M5Vt and isocoric pupils were noted. Skull bone fracture at right F-T area was noted with around 5mm gap. Epidural hematom was noted around 1cm thick. The dura seemed bulging before the dura opening and some subdural hematoma was noted. The ICP was around 5 mmHg after skin closure and isocoric small pupils were noted. Operative Procedures Under ETGA and supine position with head rotated to left side, skin disinfected and drapped were performed as usual. A question mark incision was made at right F-T-P area. The skull bone fracture was enforced with mini-plates at right frontal area and total five burr holes were created. Epidural hematoma was removed. Right F-T-p craniectomy was then performed and the dura was then opened after dural tenting. Subdural hematoma was then removed. Duroplasty was then performed with autologus fascia. The ICP monitor was set at right frontal subdural area. The wound was then closed in layers after two epidural CWV drain insertion. Operators VS 王國川 Assistants R4 林哲光, Ri 陳志豪 Indication Of Emergent Operation Acute conscious deterioration with epidural hematoma 相關圖片 王思茹 (F,1980/05/16,31y9m) 手術日期 2011/06/02 手術主治醫師 童寶玲 手術區域 兒醫 063房 號 診斷 Dysmenorrhea 器械術式 LSC cystectomy(single port)+TCR myomectomy 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 李佳潔, 時間資訊 13:00 報到 13:25 進入手術室 13:30 麻醉開始 13:45 誘導結束 13:50 抗生素給藥 14:02 手術開始 16:30 手術結束 16:30 麻醉結束 16:35 送出病患 16:40 進入恢復室 18:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 子宮鏡切除子宮腔隔膜或子宮肌瘤 1 1 手術 腹腔鏡子宮附屬器部份或全部切除術 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 婦產部 套用罐頭: 1. TCR, myomectomy 2. Laparoscopic left salpi... 開立醫師: 李佳潔 開立時間: 2011/06/02 16:45 Pre-operative Diagnosis 1. Left ovarian cyst 2. Submucosal myomas Post-operative Diagnosis 1. Left dermoid cyst 2. Submucosal myomas Operative Method 1. TCR, myomectomy 2. Laparoscopic left salpingoophorectomy Specimen Count And Types 2 pieces About size:multiple pieces Source:uterine myoma About size:10x10 cm Source:left fallopian tube and left ovary Pathology pending Operative Findings < TCR > 1. Several endometrial myomas, occupying diffuse in the uterine cavity. 2. Bilateral ostium: seemed patent. 3. Usage of dextrose water: 6000 ml. 4. uterine myoma: 20 gm < LSC LSO > 1. Uterus: avfl, grossly normal. 2. RAD: grossly normal. 3. LAD: one 10*9 cm cystic lesion in the LOV with sebaseous and hair content. 4. Cul-de-sac: free of adhesion. 5. Estimated blood loss: 100 ml Blood transfusion: nil Complication:nil Operative Procedures < TCR > 1. Put the patient on lithotomy position 2. Skin disinfection and skin draping as usual. 3. Vaginal douching. 4. Insert hysteroscope. 5. Exam the whole uterine cavity and identify the myomas. 6. Resection of the myomas by electrocauterization and ring forcepts. 7. Check bleeding. 8. Insert one piece of vaginal gauze. < LSC LSO > 1. The pneumoperitoneum is induced after inserting a sharp Veress needle through the umbilical incision wound. 2. Perform mini-laparotomy and insert the wound protect into the peritoneal cavity via the subumbilical incision wound and set the grove. 6. 2nd nad 3rd trocars were inserted. 7. Salpingoophorectomy was performed smoothly with electrocoaguation. 8. Put the cysts into the Endobag and take out through the umbilical wound. 9. Irrigate the pelvic space with normal saline. 10. Check bleeding. 11. Remove the wound protect and repair abdominal incision wound. Operators 童寶玲, Assistants 林冠宏, 李佳潔 柳俊豪 (M,1985/06/21,26y8m) 手術日期 2011/06/02 手術主治醫師 陳敞牧 手術區域 東址 003房 01號 診斷 Benign brain tumor 器械術式 Left frontal cavernoma excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 2 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 08:07 進入手術室 08:25 麻醉開始 08:35 誘導結束 08:55 抗生素給藥 09:32 手術開始 11:55 抗生素給藥 14:15 手術結束 14:15 麻醉結束 14:25 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 開顱術摘除血管病變-動靜脈畸型小型表淺 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Left frontal craniotomy with cavernoma excision 開立醫師: 林哲光 開立時間: 2011/06/02 19:58 Pre-operative Diagnosis Left frontal cavernoma Post-operative Diagnosis Left frontal cavernoma Operative Method Left frontal craniotomy with cavernoma excision Specimen Count And Types 1 piece About size:2x2x2cm Source:cavernoma Pathology Pending Operative Findings A 2x2x2 cm sized mass lesion wtih surrounding yellowish hemosiderin was noted at left frontal lobe near the orital roof. Total removal of the mass lesion was done. The frontal sinus was exposed and packed with B-I stinged Gelfoam after muscosa removal and covered wtih periosteum. Intraoperative sonography for mass lesion localization was done before the dura opened. Operative Procedures Under ETGA and supine position, skin disinfected and drapped were performed as usual. Bifrontal skin incision was made and facial nerve preservation was done. Left frontal craniotomy was done and corticotomy at inferior frontal lobe was done. The mass was totally removed and hemostasis with surgecell packing. The duroplasty with autologus fascia was done and Durafoam was covered. The skull bone was then put back and fixed with mini-plates. The wound was then closed in layers after subgaleal drain insertion. Operators VS 陳敞牧 Assistants R4 林哲光 相關圖片 施榮商 (M,1934/11/11,77y4m) 手術日期 2011/06/02 手術主治醫師 陳敞牧 手術區域 東址 003房 02號 診斷 Lumbar spondylosis 器械術式 Sublaminar decompression, L3-4 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 14:38 進入手術室 14:40 麻醉開始 14:50 誘導結束 15:30 抗生素給藥 15:49 手術開始 18:10 手術結束 18:10 麻醉結束 18:20 送出病患 18:22 進入恢復室 19:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術(減壓)-二節以內 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Glucose 1 0 記錄__ 手術科部: 外科部 套用罐頭: L3-4 sublaminal decompression 開立醫師: 林哲光 開立時間: 2011/06/02 18:35 Pre-operative Diagnosis L2-3, L3-4 spinal canal stenosis Post-operative Diagnosis L2-3, L3-4 spinal canal stenosis Operative Method L3-4 sublaminal decompression Specimen Count And Types nil Pathology Nil Operative Findings Hypertrophic change of ligamentum flavum was noted with severe dural compressing. The dura seemed re-expanded well after removal of ligamentum flavum. Operative Procedures Under ETGA and prone position, skin disinfected and drapped were performed as usual. Midline skin incision was made at L3-4 level after C-arm localization. Left paraspinal muscle was detached and laminotomy was performed at left interlaminal space. Sublaminal decompression was then done. The wound was then closed in layers after Gelfoam packing. Operators VS 陳敞牧 Assistants R4 林哲光 相關圖片 林萬益 (M,1933/10/23,78y4m) 手術日期 2011/06/02 手術主治醫師 蔡翊新 手術區域 東址 005房 02號 診斷 Intracerebral hemorrhage 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 污染 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3 紀錄醫師 李振豪, 時間資訊 12:55 進入手術室 12:58 麻醉開始 13:00 誘導結束 13:00 抗生素給藥 13:12 手術開始 13:33 手術結束 13:33 麻醉結束 13:36 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 氣管切開術 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 蔡翊新 開立時間: 2011/06/02 13:35 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types nil Pathology None Operative Findings Fr. 8 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators VS蔡翊新 Assistants R4李振豪 相關圖片 余欽麟 (M,1948/03/07,64y0m) 手術日期 2011/06/02 手術主治醫師 蔡翊新 手術區域 東址 005房 03號 診斷 Injury (severity score >=16) 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3 紀錄醫師 李振豪, 時間資訊 13:50 進入手術室 13:57 麻醉開始 14:00 誘導結束 14:10 手術開始 14:25 手術結束 14:25 麻醉結束 14:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 氣管切開術 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 李振豪 開立時間: 2011/06/02 14:32 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types Nil Pathology Nil Operative Findings Fr. 8 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 1cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators VS蔡翊新 Assistants R4李振豪 相關圖片 許伯丞 (M,1967/04/30,44y10m) 手術日期 2011/06/02 手術主治醫師 蔡翊新 手術區域 東址 005房 01號 診斷 Contusion, Neck 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:30 麻醉開始 08:45 誘導結束 09:00 抗生素給藥 09:07 手術開始 12:00 抗生素給藥 12:20 手術結束 12:20 麻醉結束 12:28 送出病患 12:30 進入恢復室 13:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 椎間盤切除術-頸椎 1 1 手術 椎融合術-前融合,無固定物(≦四節) 1 2 摘要__ 手術科部: 外科部 套用罐頭: Anterior Discectomy and Fusion, Cervical Spine 開立醫師: 蔡翊新 開立時間: 2011/06/02 12:05 Pre-operative Diagnosis C4-5 and C5-6 HIVD with cord compression. Post-operative Diagnosis C4-5 and C5-6 HIVD with cord compression. Operative Method Anterior Discectomy and Fusion with Cages, C4-5 and C5-6. Specimen Count And Types nil Pathology Nil. Operative Findings Degenerative, herniated discs with osteophyte formation at C4-5 and C5-6 levels, causing tight compression of thecal sac, which expanded well after removal of disc. A ruptured segment of C4-5 disc was extracted from behind the C5 vertebral body. Operative Procedures 1. Anesthesia: endotracheal general 2. Position: supine with neck hyperextended by a air cuff placed beneath the shoulder. 3. Skin preparation: the anterior neck was shaved and scrubbed with povidone-iodinew detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4.Incision; 4 cm, transverse middle cervical, extended from anterior margin of sternocleidomastoid (SCM) muscle to thyroid cartilage. 5. The plastisma muscle was transected and mobilized from the underlying superficial cervical fascia which was then opened in vertical direction along the anterior margin of the SCM muscle. 6.The dissection was advanced at the loose plane between SCM muscle and strip muscles until the prevertebral fascia had been reached. The former structure was retracted to the lateral and the later structures with esophagus and trachea to the opposite side by Cloward cervical retractor. 7.The prevertebral fascia was opened vertically, the lesion intervertebral space was exposed and identified by intraoperative portable X-ray. 8.The most medial portion of the longus coli muscles on both sides were detached from the vertebral bodies to provide a wider exposure of the vertebral bodies. 9.The anterior longitudinal ligment was incised transversely at the margins of intervertebral space, the annulus fibrosus was cut too. 10.The degenerated disc and cartilage plate were removed by curette and the anterior-inferior rim of C4,5,6 vertebral body was resected by Kerrison punch for easier approach to the posterior rim of the intervertebral space. 11.The intervertebral spac was widened by a Cloward intervertebral spreader. The sclerotic spondylotic bar at the posterior margin of C-4,5,6 bodies and the spur at foramen Luscka were removed by high speed air drill and fine curette. The posterior longitudinal ligament was cut from bony edge by curette and then removed. Consequently, the spinal dura expanded into the intervertebral space. 12.The surfaces of vertebral bodies at this intervertebral space was trimed by high speed air drill to creat a parallel intervertebral space. 13.Two 6 mm Vigor PEEK Disc spacers (cage) were packed into the intervertebral space tightly by a impactor. The intervertebral space was widened by pulling the patient's head while the impaction of the bone graft was done. 15.The air cuff beneath the shoulder was deflated, the Cloward cervical retractor removed. 16.Wound closure: continuous suture with 3/0 Vicryl for plastisma and continuous suture with 4/0 Vicryl on the skin. 17.Drain: one minihemovac. 18.Blood transfusion: Nil. blood loss: minimal. 19.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R4李振豪 相關圖片 林傳宗 (M,1936/03/03,76y0m) 手術日期 2011/06/03 手術主治醫師 黃培銘 手術區域 東址 025房 02號 診斷 Lung tumor 器械術式 Thoracoscopy+Open Chest 手術類別 預定手術 手術部位 胸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 劉漢平 ASA 3 紀錄醫師 郝政鴻, 時間資訊 10:38 報到 11:20 進入手術室 11:25 麻醉開始 11:55 誘導結束 12:15 抗生素給藥 12:25 手術開始 15:15 抗生素給藥 18:10 麻醉結束 18:10 手術結束 18:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 胸腔鏡肺葉切除術 1 1 L 手術 縱隔腔或腔內淋巴根除術 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Video asssisted thoracoscopic with mini-thoa... 開立醫師: 郝政鴻 開立時間: 2011/06/03 18:38 Pre-operative Diagnosis Lung cancer, left lower lobe, sarcomatoid carcinoma Post-operative Diagnosis Lung cancer, left lower lobe, sarcomatoid carcinoma Operative Method Video asssisted thoracoscopic with mini-thoacotomy left lower lobe lobectomy and group 5/7 lymph node dissection Specimen Count And Types 1 piece About size:15x10x5 cm Source:lung, left lower lobe Pathology Pending Operative Findings 1. One 8 cm in diameter, whitish to yellowish, elastic to firm tumor over left lower lobe 2. Pleural adhesion(+, severe), Pleural retraction(-), Pleural effusion(-) 3. Blood loss: 450 ml Operative Procedures 1. Anesthesia: General anesthesia with single-lumen intubation with blocker under single lung ventilation. 2. Position: Right decubitus position. An axillary roll is placed under the down side. The operative field is well disinfected and draped. 3. VATS camera port setting as usual, then mini-thoracotomy. 4. The pleural adhesions and inferior pulmonary ligament were separated using electrocautery. 5. The fissure between the upper and lober lobes was separated and divided with endo-GIA 7. The pulmonary vein drained from the left lower lobe was identified and divided with endo-GIA. 8. The left lower lobe pulmonary arteries were identified and divided with endo-GIA 9. The bronchus to the Left lower lobe was identified and then divided with endo-GIA. 10.Lymph node dissection group 5/7 and hemostasis. 11.Irrigation with warm normal saline and check air leak. Set one 28# chest tube at posterior aspect, close wound in layers. Operators VS黃培銘 Assistants R3郝政鴻 Ri 梁政翎 (F,2002/09/17,9y5m) 手術日期 2011/06/03 手術主治醫師 許文明 手術區域 兒醫 066房 04號 診斷 Soft tissue tumor 器械術式 Biopsy of subcutaneous tumor 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 1 紀錄醫師 柯柏瑞, 時間資訊 12:44 報到 12:59 進入手術室 13:00 麻醉開始 13:05 誘導結束 13:14 抗生素給藥 13:17 手術開始 14:06 手術結束 14:06 麻醉結束 14:10 送出病患 14:20 進入恢復室 15:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 皮下肌肉或深部異物取出術 1 1 L 摘要__ 手術科部: 套用罐頭: tumor biopsy 開立醫師: 柯柏瑞 開立時間: 2011/06/03 14:26 Pre-operative Diagnosis Soft tissue tumor of left leg, right upper chest and occipital area Post-operative Diagnosis Soft tissue tumor of left leg, right upper chest and occipital area Operative Method tumor biopsy Specimen Count And Types 1 piece About size:1*1 cm Source:left leg tumor Pathology frozen section: small blue round cell Operative Findings 5*5 cm elastic firm tumor located at left lower leg medial side, at muslce layer Operative Procedures 1.ETGA, supine position, skin disinfection 2.Longitudinal skin incision at left lower leg 3.Tumor incisional biopsy 4.Hemostasis and packing the row surface with surgicel 5.Close the wound by layers Operators 許文明 Assistants 林文熙 柯柏瑞 相關圖片 王寶猜 (F,1953/06/10,58y9m) 手術日期 2011/06/03 手術主治醫師 賴達明 手術區域 東址 003房 號 診斷 Lumbar Spondylosis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 陳睿生, 時間資訊 00:00 臨時手術NPO 08:08 進入手術室 08:20 麻醉開始 08:25 誘導結束 09:02 抗生素給藥 09:30 手術開始 12:10 手術結束 12:10 麻醉結束 12:20 送出病患 12:22 進入恢復室 13:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 摘要__ 手術科部: 外科部 套用罐頭: Revision of transpedicular screws 開立醫師: 陳睿生 開立時間: 2011/06/03 12:37 Pre-operative Diagnosis L4/5 spondylolithesis s/p transpedicular fixation with screws malposition Post-operative Diagnosis L4/5 spondylolithesis s/p transpedicular fixation with screws malposition Operative Method Revision of transpedicular screws Specimen Count And Types nil Pathology Nil Operative Findings Malposition of the screws was noted over right L4, L5, and left L5. The screws were revised under C-arm guided. Operative Procedures 1. ETGA, prone position, and mild flexion 2. Reopen of previous wound 3. Dissect the paraspinal muscle and expose the L3-5 lamina 4. Bilateral rods and screws were exposed 5. Remove of right L4,5 screws and reinsertion under C-arm guide 6. Remove of left L5 screw and adjust the trajetory 7. Hemostasis, and set a 1/8 hemovac 8. Close the wound in layers Operators VS 賴達明 Assistants R6 陳睿生, Ri 鄭瓊芠 (F,1971/06/16,40y8m) 手術日期 2011/06/03 手術主治醫師 賴達明 手術區域 東址 005房 01號 診斷 HIVD 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:10 進入手術室 08:15 麻醉開始 08:25 誘導結束 08:40 抗生素給藥 09:15 手術開始 11:40 抗生素給藥 12:10 手術結束 12:10 麻醉結束 12:17 送出病患 12:17 進入恢復室 13:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-頸椎 1 1 R 手術 椎間盤切除術-頸椎 1 2 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Anterior Discectomy and Fusion, Cervical Spine 開立醫師: 李振豪 開立時間: 2011/06/03 12:32 Pre-operative Diagnosis C4/5, C5/6 herniation of intervertebral disc and C4/5 grade I anterior subluxation with myelopathy Post-operative Diagnosis C4/5, C5/6 herniation of intervertebral disc and C4/5 grade I anterior subluxation with myelopathy Operative Method Anterior cervical discectomy and fusion with PEEK cage, C4/5, C5/6 Specimen Count And Types nil Pathology Nil Operative Findings Grade I anterior subluxation over C4/5 was noted. The disc space over C5/6 was severe narrowed. The thecal sac was compressed by the herniated disc at C4/5 and C5/6 level. No ossification of posterior longitudinal ligment was noted. #7 and #5 PEEK cage was placed into C4/5 and C5/6 disc space after diskectomy for anterior fusion. No incidental durotomy or CSF leakage was noted during whole procedure. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with neck extension. The skin was scrubbed, disinfected, and draped as usual. Transverse skin incision was made at right neck and the plastysma was divided. the fascia was opened and the pre-vertebral space was approaced via the plan between thyroid gland and carotid sheath. The pre-vertebral fascia was opened and the disc level was identified by portable C-arm X-ray. The longus colli muscle was detached and Koros retractor was applied. C4/5, C5/6 diskectomy was performed under operative microscope. The marginal spur was removed by Midas air-drived drill and Kerrison punches. The PLL also removed. Two PEEK cage was placed at C4/5, C5/6 level for anterior fusion. Hemostasis was achieved and one MiniHemovac was placed. The wound was then closed in layers with 3-0 Vicryl and 4-0 Dexon. Operators VS賴達明 Assistants R4李振豪, Ri 相關圖片 蕭素花 (F,1957/04/03,54y11m) 手術日期 2011/06/03 手術主治醫師 賴達明 手術區域 東址 005房 02號 診斷 Lumbar Spondylosis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 12:00 報到 12:25 進入手術室 12:35 麻醉開始 12:45 誘導結束 13:20 抗生素給藥 13:24 手術開始 16:20 抗生素給藥 16:40 手術結束 16:40 麻醉結束 16:50 送出病患 16:50 進入恢復室 18:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎間盤切除術-腰椎 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: 1. L4/5 transforminal lumbar interbody fusion... 開立醫師: 李振豪 開立時間: 2011/06/03 17:15 Pre-operative Diagnosis L4 on L5 spondylolisthesis Post-operative Diagnosis L4 on L5 spondylolisthesis Operative Method 1. L4/5 transforminal lumbar interbody fusion with PEEK cage 2. L4, L5 transpedicular screws for posterior instrumentation 3. L4/5 laminotomy for decompression Specimen Count And Types nil Pathology Nil Operative Findings The facet joint was severe hypertrophic. Anterior subluxation of L4 was noted after exposure of laminae. Posterior instrumentation was performed with 6.2 x 40mm screws x IV and 5cm rods x II. Anterior fusion was done with one #11 Banana cage filled with autologous bone graft. No incidental durotomy of CSF leak was noted during the operation. The roots also protected well during the operation. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position. The L4, L5 pedicles were localized with portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made at L4-5 level. The subcutaneous soft tissue and paravertebral muscle groups were detached to expose the laminae and facet joints. Transpedicular screws were implanted at L4 and L5. The location of the screws were confirmed by portable C-arm X-ray. L4-5 laminotomy and left L4-5 facetectomy were performed. L4-5 diskectomy was done followed by fusion with one Banana cage. Decortication was performed followed by posteriolateral fusion with autologous bone graft. Transpedicular screws were set up. Hemostasisw as acheived with bipolar electrocautery and Gelfoam packing. One epidural hemovac was placed and the wound was closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS賴達明 Assistants R4李振豪, Ri 張武彥 (M,1939/11/22,72y3m) 手術日期 2011/06/03 手術主治醫師 劉詩彬 手術區域 東址 027房 04號 診斷 Malignant neoplasm of sigmoid colon 器械術式 TRUS-Biobsy 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 耿俊閎, 時間資訊 12:54 進入手術室 13:17 手術開始 13:28 手術結束 13:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 前列腺切片-控取式 1 1 記錄__ 手術科部: 泌尿部 套用罐頭: TRUS-P-biopsy 開立醫師: 耿俊閎 開立時間: 2011/06/03 13:28 Pre-operative Diagnosis r/o prostate cancer Post-operative Diagnosis highly suspect advanced prostate cancer Operative Method TRUSP biopsy (12 core) Specimen Count And Types 1 piece About size:1cm*12 core Source:prostate Pathology pending Operative Findings systematic 12 cores TRUSP biopsy was performed DRE: marked enlarged prostate, hard consistency, whole prostate hard nodule, irregular surface Operative Procedures Under satisfactory anesthesia with the patient in right flank position, prepping and draping was performed in the usual sterile fashion. TRUSP was performed and echo-guided prostate biopsies were performed smoothly with Biopty gun. The coresof tissue specimen were obtained. The biosy area was compressed for several minutes to ensure adequate hemostasis. The patient tolerated the operation well and was sent to the floor in satisfactory condition. Operators 劉詩彬, Assistants 耿俊閎, 林尊煌 (M,1952/06/05,59y9m) 手術日期 2011/06/03 手術主治醫師 黃培銘 手術區域 東址 025房 01號 診斷 Hepatocellular carcinoma (HCC) 器械術式 Thoracoscopy+Open Chest 手術類別 預定手術 手術部位 胸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 劉漢平 ASA 3 紀錄醫師 郝政鴻, 時間資訊 07:45 報到 08:28 進入手術室 08:35 麻醉開始 09:10 誘導結束 09:20 抗生素給藥 09:35 手術開始 10:45 手術結束 10:45 麻醉結束 10:57 送出病患 11:00 進入恢復室 13:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 胸腔鏡肺楔狀或部分切除術 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: VATS biopsy 開立醫師: 郝政鴻 開立時間: 2011/06/03 10:38 Pre-operative Diagnosis Lung tumor, suspect hepatocellular carcinoma metastasis Post-operative Diagnosis Lung tumor, suspect hepatocellular carcinoma metastasis Operative Method Wedge resection of left upper lobe pulmonary lesion via VATS. Specimen Count And Types 1 piece About size:10X5X5 CM Source:LUNG, LEFT UPPER LOBE Pathology Pending Operative Findings 1. Two soft yellowish without pleural retraction lung mass at left upper lobe, No pleural effusion, no pleural adhesion Operative Procedures 1. Anesthesia: General anesthesia using single-lumen endotracheal tube with blocker under single lung ventilation. 2. Position: right decubitus position. An axillary roll is placed under the down side. The operative field is well disinfected and draped. 3. Camera port: From the seventh intercostal space in the mid-axillary line away from the lesion. 4. Working ports: First: From the fifth intercostal space in the anterior axillary line. Second: From the fifth intercostal space in the posterior axillary line. 5. The pulmonary lesion is visualized and stabilized with the grasping forceps. 6. The Endo-GIA stapler is placed across its base. Wedge resection of the pulmonary lesion is performed. 7. The specimen issent for pathological examination. 8. After meticulous homeostasis, one 28# chest tubes is placed via the camera port. The lung is ventilated under the direct vision. The skin is closed with 4-0 Nylon sutures. Operators VS黃培銘 Assistants R3郝政鴻 R1戴逸昇 湯釗宇 (M,1972/07/05,39y8m) 手術日期 2011/06/03 手術主治醫師 王國川 手術區域 東址 019房 02號 診斷 Epidural hemorrhage, traumatic 器械術式 Left pterional approach hematoma removal (left frontal and temproal) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 4E 紀錄醫師 鍾文桂, 時間資訊 08:38 開始NPO 08:38 臨時手術NPO 08:38 通知急診手術 10:35 進入手術室 10:35 報到 10:45 麻醉開始 10:50 誘導結束 11:17 手術開始 13:00 抗生素給藥 13:18 開始輸血 14:00 麻醉結束 14:00 手術結束 14:10 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 手術 腦內血腫清除術 1 2 L 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 蔡翊新 開立時間: 2011/06/03 13:56 Pre-operative Diagnosis Head injury with right parietal EDH s/p craniectomy, left temporal and frontal contusion ICH. Post-operative Diagnosis Head injury with right parietal EDH s/p craniectomy, left temporal and frontal contusion ICH. Operative Method Left frontotemporal craniectomy for left temporal ICH evacuation and duroplasty. Specimen Count And Types nil Pathology Nil. Operative Findings ICP before craniectomy was 40 mmHg and after dural incision was 18 mmHg. The brain bulged out after dural opening. Contusional ICH about 4 x 4 x 3 cm was evacuated from left temporal tip. Active bleeders from left MCA branch were coagulated. The ICP after ICH evacuation was 10 mmHg and after duroplasty was 16 mmHg. The brain remained bulging out after duroplasty. So temporalis muscle was excised to prevent epidural compression. ICP after skin closure was 16 mmHg. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: left frontotemporal area, the skin edge was clipped by Raney clips for temporary hemostasis. The temporalis muscle was detached from temporal squama by rasp subsequently. 5. Craniotomy window: 12 x 8 cm, left frontotemporal, created by making 3 burr holes then cut by power saw. 6. Dural tenting: by 2/0 silk, 2-cm in interval, distributed along the edge of skull window. 7. Dural incision: curvilinear along the edge of skull window. 8. The left temporal tip contusion ICH was evacuated and the active bleeders from left MCA branches were coagulated. 9. Hemosatasis: the bleeders was stopped by Bovie and oozing surface was covered with Surgicel. 10.Dural closure:was closed with a piece of dural graft taking from temporalis fascia, crescent shape 12 cm long, 2 cm wide, along the whole length of the dural incision in order to create an additional space for the swollen brain. 11.The skull plate was removed and stored at bone bank for preservation. 12.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 13.Drain: one, epidural, CWV. 14.Blood transfusion: PRBC 5U, Blood loss: 900 ml. 15.Course of the surgery: smooth. Operators VS蔡翊新 VS王國川VS蔡翊新 Assistants R5鍾文桂Ri陳映廷 Indication Of Emergent Operation IICP 張阿秀 (F,1943/12/02,68y3m) 手術日期 2011/06/03 手術主治醫師 楊永健 手術區域 西址 030房 01號 診斷 Benign neoplasm of short bones of lower limb 器械術式 Wide excision - soft tissue tu 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 10:00 進入手術室 10:15 手術開始 10:25 手術結束 10:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 臉部以外皮膚及皮下腫瘤摘除術 小於2公分 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Tumor excision 開立醫師: 李維棠 開立時間: 2011/06/03 10:40 Pre-operative Diagnosis Right foot subcutaneous tumor Post-operative Diagnosis Right foot subcutaneous tumor Operative Method Tumor excision Specimen Count And Types 1 piece About size:0.5cmx0.5cm Source: Right foot subcutaneous tumor Pathology Pending Operative Findings One 0.5x0.5 cm white subcutaneous tumor noted over right ankle Operative Procedures Under local anesthesia, the patient lied in prone position. Antiseptics applied and draped as usual. Linear skin incision over right ankle, transverse. Dissection to exposed tumor. Tumor excision performed and normal saline irrigation. Wound closure in layers. Operators VS楊永健 Assistants R2李維棠 林吳阿錫 (M,1934/02/09,78y1m) 手術日期 2011/06/04 手術主治醫師 蔡瑞章 手術區域 東址 019房 號 診斷 Herniation of intervertebral disc, lumbar 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林峰盛 ASA 3 紀錄醫師 陳國瑋, 時間資訊 08:07 進入手術室 08:25 麻醉開始 08:35 誘導結束 09:20 抗生素給藥 09:35 手術開始 11:15 麻醉結束 11:15 手術結束 11:20 送出病患 11:24 進入恢復室 12:00 臨時手術NPO 13:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-腰椎 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Microdiskectomy 開立醫師: 陳睿生 開立時間: 2011/06/04 11:11 Pre-operative Diagnosis Right side L4/5 rupture disk Post-operative Diagnosis Right side L4/5 rupture disk Operative Method Microdiskectomy Specimen Count And Types nil Pathology Nil Operative Findings Disk rupture with thecal sac and right side L4,5 roots compression was noted. After totally remove of the disk, the thecal sac and roots were well-decompressed. Operative Procedures 1. ETGA, prone position, and C-arm localized L4/5 level 2. Low back midline incision about 3cm 3. Split right side paraspinal muscle and expose of the L4,5 lamina 4. Lower L4 and upper L5 right side laminotomy 5. Remove of ligamentum flavum, and identify the L4/5 disk space 6. Incise into the disk and remove of the rupture one 7. Hemostasis, and close the wound in layers Operators P 蔡瑞章 Assistants R6 陳睿生, R2 陳國瑋 相關圖片 許金樹 (M,1948/02/17,64y0m) 手術日期 2011/06/04 手術主治醫師 李章銘 手術區域 東址 002房 02號 診斷 Esophageal tumor 器械術式 Port-A catheter implatation 手術類別 緊急手術 手術部位 胸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 李佳穎, 時間資訊 10:25 通知急診手術 20:52 進入手術室 21:00 抗生素給藥 21:05 麻醉開始 21:10 誘導結束 21:11 手術開始 21:50 手術結束 21:55 送出病患 21:55 麻醉結束 醫令資訊 類別 名稱 量 刀 側 手術 port–A導管植入術–治療性導管植入術 1 0 R 摘要__ 手術科部: 外科部 套用罐頭: Prt-A insertion 開立醫師: 李佳穎 開立時間: 2011/06/04 20:56 Pre-operative Diagnosis esopaheal cancer Post-operative Diagnosis esopaheal cancer Operative Method Prt-A insertion Specimen Count And Types nil Pathology nil. Operative Findings Port-A tip over SVC. Operative Procedures 1.LA. 2.Puncture to Rt subclavicular vein. 3.Port-A was inserted and CxR checck-up. 4.Wound closure by layers. Operators VS李章銘 Assistants R5李佳穎 Indication Of Emergent Operation port-A 劉振麟 (M,1950/12/20,61y2m) 手術日期 2011/06/04 手術主治醫師 楊榮森 手術區域 東址 020房 02號 診斷 Fever 器械術式 ORIF - Large ""A-O"" plate，ORIF - Small ""A-O"" plate, tumor curettage and bone cement 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 2 紀錄醫師 羅婉育, 時間資訊 23:59 臨時手術NPO 09:05 進入手術室 09:10 麻醉開始 09:15 誘導結束 09:20 抗生素給藥 09:38 手術開始 11:10 手術結束 11:15 麻醉結束 11:15 送出病患 11:20 進入恢復室 13:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 惡性骨瘤廣泛切除(一次) 1 1 R 手術 石膏副木固定－長臂 1 0 R 手術 骨或軟骨移植術 1 2 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 腫瘤醫學部 套用罐頭: 1. tumor debulking surgery 開立醫師: 羅婉育 開立時間: 2011/06/04 11:54 Pre-operative Diagnosis 1. Primitive neuroectodermal tumor / Ewing sarcoma, TxNxM1, stage IV, status post C5 corpectomy, C4/5, C5/6 diskectomy and resection of pervertebral and epidural tumor, status post radiotherapy (C spine) and VAdriC-IE alternating protocol (III), with right neck metastasis status post modified radical neck dissection, with bilateral lung metastases status post EDI protocol (IV), with progression of lung metastasis 2. Right distal humerous pathological fracture Post-operative Diagnosis 1. Primitive neuroectodermal tumor / Ewing sarcoma, TxNxM1, stage IV, status post C5 corpectomy, C4/5, C5/6 diskectomy and resection of pervertebral and epidural tumor, status post radiotherapy (C spine) and VAdriC-IE alternating protocol (III), with right neck metastasis status post modified radical neck dissection, with bilateral lung metastases status post EDI protocol (IV), with progression of lung metastasis 2. Right distal humerous pathological fracture Operative Method 1. tumor debulking surgery 2. ORIF with DCP (8H7S) 3. artifical bone graft with osteoset and bone cement Specimen Count And Types 1 piece About size:around 15 mL Source:right humerus Pathology 1. form right humerus medullary cavity, around 15 ml. Operative Findings 1. tumor invaded right humerus medullary cavity and surrounding muscle. 2. well protection of the radial nerve. 3. oblique fracture at distal right humerus. Operative Procedures Anesthetic induction, left decubitous position, skin disinfection, draping. Made a longitudinal incision over the posterior side of right arm. Dissected with caution to the vessels and nerves to the fracture sdie. Perform tumor debulking with curettage. Sent the specimen for cytology and pathology. Irrigated with 95% alcohol. ORIF with DCP (8H7S). Alcohol irrigation followed by N/S irrigation. Set H/V drainage. Close the wound in layers. On long arm splint. Operators 楊榮森, Assistants 羅婉育, 陳彥宇, 吳拓, 江麗珍 (F,1959/12/14,52y3m) 手術日期 2011/06/05 手術主治醫師 陳敞牧 手術區域 東址 019房 01號 診斷 Spinal metastasis 器械術式 Spinal fusion posterior 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林峰盛 ASA 3E 紀錄醫師 李振豪, 時間資訊 02:00 臨時手術NPO 02:00 開始NPO 10:17 通知急診手術 16:20 報到 16:29 進入手術室 17:25 抗生素給藥 17:35 麻醉開始 17:40 手術開始 18:00 誘導結束 19:53 開始輸血 20:50 抗生素給藥 21:00 手術結束 21:00 麻醉結束 21:10 送出病患 21:15 進入恢復室 22:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 手術 惡性脊髓腫瘤切除術 1 1 手術 脊椎融合術-後融合,有固定物(<=六節) 1 2 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: 1. T12 laminectomy and partial tumor excision... 開立醫師: 李振豪 開立時間: 2011/06/05 21:33 Pre-operative Diagnosis T12 spinal tumor with cord compression, suspect metastasis Post-operative Diagnosis T12 spinal tumor with cord compression, suspect metastasis Operative Method 1. T12 laminectomy and partial tumor excision for decompression 2. T10, T11, L1, L2 transpedicular screws for posterior fixation 3. Right T12 rhizotomy Specimen Count And Types 1 piece About size:multiple pieces Source:T12 spinal tumor Pathology Pending Operative Findings The tumor was gray-reddish, moderate vascularized, elastic to firm, ill-defined, and encased the thecal sac tightly. The tumor mainly located at right side pedicle and vertebral body of T12 with paraspinal expansion. The thecal sac expanded well after decompression. No incidental durotomy or CSF leakage noted during the operation. Instrumentation 1. Screws: T10, T11: 6.0 x 40mm x IV L1, L2: 6.5 x 45mm x IV 2. Rods: 15cm x II 3. Cross-link x I Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position. The location of T12 level was identified by portable C-arm X-ray. The skin was scurbbed, disinfected, and draped as usual. Midline skin incision from T10 to L2 level was made. The subcutaneous soft tissue and paravertebral muscle group were detached to expose the laminae and spinous process of T10 to L2 spine. T10, T11, L1, and L2 transpedicular screws were inserted under C-arm X-ray guided. T12 laminectomy for partial tumor excision and decompression was performed. Right T12 rhizotomy also done during tumor excision. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. The rods and cross-link were set up. Two epidural Hemovac was placed and the wound was closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS陳敞牧 Assistants R4李振豪, Ri陳乃綺 Indication Of Emergent Operation Cord compression with urinary retention and lower limbs weakness 郭美惠 (F,1943/10/02,68y5m) 手術日期 2011/06/05 手術主治醫師 蔡翊新 手術區域 東址 018房 03號 診斷 Head Injury 器械術式 Removal of epidural hematoma，ICP monitoring 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林峰盛 ASA 3E 紀錄醫師 吳昭瑩, 時間資訊 12:00 臨時手術NPO 12:00 開始NPO 20:10 報到 20:20 麻醉開始 20:20 進入手術室 20:55 誘導結束 21:10 抗生素給藥 21:22 手術開始 00:10 抗生素給藥 00:54 麻醉結束 00:54 手術結束 01:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 急性硬腦膜下血腫清除術 1 1 R 手術 顱內壓視置入 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 麻醉 Hemoglobin (Hb) 1 0 摘要__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 蔡翊新 開立時間: 2011/06/06 00:32 Pre-operative Diagnosis Right temporoparietal epidural/subdural hematoma. Post-operative Diagnosis Right temporoparietal subdural hematoma. Operative Method Right temporoparietal craniotomy for subdural hematoma evacuation and ICP monitoring. Specimen Count And Types Nil. Pathology Nil. Operative Findings Previous scalp incision at right frontotemporal region and VP shunt at right Kocher point with peritoneal catheter passing through subgaleal space of right temporal region. No skull fracture or epidural hematoma was detected. Subdural hematoma, about 2 cm in maximal thickness, was evacuated from right temporoparietal region, about 14 x 10 cm in area. Multiple adhesions between cerebral cortex and dura were detached. One cortical artery with active bleeding was noted at right temporal lobe. After removal of SDH, the brain remained slack, 1 cm away from the dura. The ICP after dural closure was 5 mmHg. ICP　reference: 468. Previous scalp incision at right frontotemporal region and VP shunt at right Kocher point with peritoneal catheter passing through subgaleal space of right temporal region. No skull fracture or epidural hematoma was detected. Subdural hematoma, about 2 cm in maximal thickness, was evacuated from right temporoparietal region, about 14 x 10 cm in area. Multiple adhesions between cerebral cortex and dura were detached. One cortical artery with active bleeding was noted at right temporal lobe. After removal of SDH, the brain remained slack, 1 cm away from the dura. The ICP after dural closure was 5 mmHg. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left and fixed by Mayfield skull clamp. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: Right frontotemporoparietal, anterior part along previous wound, turning posteriorly and curvilinearly to posterior temporal region. The temporalis muscle was detached from temporal squama by rasp subsequently. The peritoneal catheter was dissected out. The scalp was elevated and periosteum was divided into anterior and posterior parts along the catheter. 5. Craniotomy window: 8 x 7 cm, right temporoparietal, created by making 4 burr holes then cut by power saw. 6. Dural tenting: by 2/0 silk, 2 cm in interval, distributed along the edge of skull window. 7. Dural incision: curvilinear along the edge of skull window and reflected inferiorly. 8. The subdural clot was removed by sucker and those located beyond the cranial window was washed out by saline irrigation. 9. Hemosatasis: the bleeders was stopped by Bovie and oozing surface was covered with Gelfoam and Surgicel. 10.A Codman ICP monitor was inserted into right frontal lobe. 11.Dural closure: The dural was closed by continuous suture with 4-0 Prolene. 12.The skull plate was placed back and fixed with 4 26# wires. 13.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 14.Drain: one subdural rubber drain, one subgaleal CWV drain. 15.Blood transfusion: nil. Blood loss: 150 ml. 16.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5鍾文桂R1吳昭瑩 Indication Of Emergent Operation Head injury with SDH and progressive hemiparesis. 何色 (F,1940/07/06,71y8m) 手術日期 2011/06/06 手術主治醫師 蔡翊新 手術區域 東址 003房 01號 診斷 Subarachinoid hemorrhage sequelae 器械術式 V-P shunt 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 4E 紀錄醫師 吳政達, 時間資訊 00:15 臨時手術NPO 00:15 開始NPO 07:15 通知急診手術 08:47 報到 08:50 進入手術室 09:00 麻醉開始 09:05 誘導結束 09:54 手術開始 11:00 抗生素給藥 11:19 11:50 麻醉結束 11:50 手術結束 11:55 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 腦室腹腔分流手術 1 1 R 手術 氣管切開術 1 0 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 蔡翊新 開立時間: 2011/06/06 10:44 Pre-operative Diagnosis Right occipital dural AVF rupture with SAH and IVH, s/p EVD, with hydrocephalus; Respiratory failure with prolonged intubation. Post-operative Diagnosis Right occipital dural AVF rupture with SAH and IVH, s/p EVD, with hydrocephalus; Respiratory failure with prolonged intubation. Operative Method Right Kocher Ventriculoperitoneal shunt; Tracheostomy. Specimen Count And Types 3 tubes of CSF, sent for routine, BCS and bacterial culture Pathology Nil. Operative Findings 1. CSF: sanguinous, pressure: 5 cmH2O. Ventricular catheter: 6.2 cm in depth, 4 cmH2O in theshold setting. Peritoneal catheter: 30 cm in depth. 2. A Fr.7 Tracheostomy inserted via 2nd tracheal cartilage. Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: supine with head rotated to left. 3.Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 5 cm linear, right frontal, corresponded to the location of right frontal horn. 5. After the scalp flap had been lifted and reflected anteriorly, Rt lateral ventricle was tapped by a ventricular needle, then a 6.2 cm segment of the ventricular catheter was introduced into the ventricle. The outer end of the catheter was connected to a Codman reservoir. 7. A minilaparotomy was made at RUQ of the abdomen, then a trocar was pushed into peritoneal cavity. Subsequently, distal 30 cm segment of the peritoneal catheter was introduced into the peritoneal cavity through the outer tube of the trochar. The proximal end of this catheter was passed through subcutaneous tunnel at forechest, neck, rt retroauricular area and connected the reservoir. The shunt system was checked to make sure its function was working. 8. Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 9. Re-position the patient with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyroid isthmus is also divided. 10.Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tube is fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. 11.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R6胡朝凱R1吳政達 Indication Of Emergent Operation Hydrocephalus; prolonged intubation. 林秀琴 (F,1949/05/30,62y9m) 手術日期 2011/06/07 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Spondylolisthesis, acquired 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 08:02 進入手術室 08:10 麻醉開始 08:20 誘導結束 08:40 抗生素給藥 08:54 手術開始 11:40 抗生素給藥 12:16 手術結束 12:16 麻醉結束 12:25 送出病患 12:28 進入恢復室 13:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎間盤切除術-腰椎 1 2 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 曾峰毅 開立時間: 2011/06/07 12:05 Pre-operative Diagnosis Lumbar spondylolisthesis, L4/5, grade II Post-operative Diagnosis Lumbar spondylolisthesis, L4/5, grade II Operative Method Transforaminal lumbar interbody fusion at L4/5 with PEEK cage and autologous bone graft; posterior fixation with transpedicular screws at L4/5; posterior decompression with L5 laminectomy Transforaminal lumbar interbody fusion at L4/5 with PEEK cage and autologous bone graft; posterior fixation with transpedicular screws at L4/5; posterior decompression with L4-5 laminectomy Specimen Count And Types Nil Pathology Nil Operative Findings Grade II spondylolisthesis at L4/5 was reduced after transforaminal lumbar interbody fusion done. A-spine cage, 10 mm in height, was inserted. Transpedicular screws, 6.0 x 40 mm, were inserted to L4 pedicles, and 6.0 x 45 mm to L5 pedicles. Neural structures were decompressed well after the surgery. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After back scrubbed, disinfected, and then draped, we made one midline skin incision to expose bilateral laminae from L4 to L5. We inserted transpedicular screws into bilateral pedicels of L4 and L5. We performed L5 laminectomy and transforaminal lumbar interbody fusion via right with PEEK cage and autologous bone graft. Posterior fixation was achieved after two 5 cm rods set. The wound was closed in layers after one hemovac inserted. With endotracheal general anaesthesia, the patient was put in prone position. After back scrubbed, disinfected, and then draped, we made one midline skin incision to expose bilateral laminae from L4 to L5. We inserted transpedicular screws into bilateral pedicels of L4 and L5. We performed L4-5 laminectomy and transforaminal lumbar interbody fusion via right with PEEK cage and autologous bone graft. Posterior fixation was achieved after two 5 cm rods set. The wound was closed in layers after one hemovac inserted. Operators VS 曾勝弘 Assistants R4 曾峰毅 R3 王奐之 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 王奐之 開立時間: 2011/06/28 18:49 Pre-operative Diagnosis Lumbar spondylolisthesis, L4/5, grade II Post-operative Diagnosis Lumbar spondylolisthesis, L4/5, grade II Operative Method Transforaminal lumbar interbody fusion at L4/5 with PEEK cage and autologous bone graft; posterior fixation with transpedicular screws at L4/5; posterior decompression with L4-5 laminectomy Specimen Count And Types Nil Pathology Nil Operative Findings Grade II spondylolisthesis at L4/5 was reduced after transforaminal lumbar interbody fusion done. A-spine cage, 10 mm in height, was inserted. Transpedicular screws, 6.0 x 40 mm, were inserted to L4 pedicles, and 6.0 x 45 mm to L5 pedicles. Neural structures were decompressed well after the surgery. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After back scrubbed, disinfected, and then draped, we made one midline skin incision to expose bilateral laminae from L4 to L5. We inserted transpedicular screws into bilateral pedicels of L4 and L5. We performed L4-5 laminectomy and transforaminal lumbar interbody fusion via right with PEEK cage and autologous bone graft. Posterior fixation was achieved after two 5 cm rods set. The wound was closed in layers after one hemovac inserted. Operators VS 曾勝弘 Assistants R4 曾峰毅 R3 王奐之 相關圖片 廖寶雲 (F,1963/12/08,48y3m) 手術日期 2011/06/07 手術主治醫師 曾勝弘 手術區域 東址 005房 02號 診斷 Cervical Spondylosis 器械術式 Laminectomy C-Spinal 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 12:45 進入手術室 12:51 麻醉開始 12:58 誘導結束 13:20 手術開始 13:20 抗生素給藥 16:10 手術結束 16:10 麻醉結束 16:25 送出病患 16:27 進入恢復室 18:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 手術 椎弓切除術(減壓)-超過二節 1 1 摘要__ 手術科部: 外科部 套用罐頭: C3-7 laminectomy 開立醫師: 王奐之 開立時間: 2011/06/07 16:37 Pre-operative Diagnosis Cervical stenosis, C3-6, status post C5-6 anterior discectomy and fusion with cage Post-operative Diagnosis Cervical stenosis, C3-6, status post C5-6 anterior discectomy and fusion with cage Operative Method C3-7 laminectomy Specimen Count And Types Nil Pathology Nil Operative Findings Hypertrophic ligamentum flavum was noted. The thecal sac was free of compression after laminectomy. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position with head fixed in Mayfield skull clamp. After skin disinfection & draping in sterile fashion, a posterior neck midline incision was made. The incision was deepened through the fascia until the spinous processes were exposed. The paraspinal muscles were then detached from the spinous processes and laminae. The C3-7 spinous processes & laminae were removed with rongeur and Kerrison punch. After hemostasis, a gelfoam was packed onto the thecal sac and a drain was set. The wound was closed in layers. Operators VS 曾勝弘 Assistants R3 王奐之 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: C3-7 laminectomy 開立醫師: 王奐之 開立時間: 2011/06/28 18:49 Pre-operative Diagnosis Cervical stenosis, C3-6, status post C5-6 anterior discectomy and fusion with cage Post-operative Diagnosis Cervical stenosis, C3-6, status post C5-6 anterior discectomy and fusion with cage Operative Method C3-7 laminectomy Specimen Count And Types Nil Pathology Nil Operative Findings Hypertrophic ligamentum flavum was noted. The thecal sac was free of compression after laminectomy. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position with head fixed in Mayfield skull clamp. After skin disinfection & draping in sterile fashion, a posterior neck midline incision was made. The incision was deepened through the fascia until the spinous processes were exposed. The paraspinal muscles were then detached from the spinous processes and laminae. The C3-7 spinous processes & laminae were removed with rongeur and Kerrison punch. After hemostasis, a gelfoam was packed onto the thecal sac and a drain was set. The wound was closed in layers. Operators VS 曾勝弘 Assistants R3 王奐之 相關圖片 鄭玉枝 (F,1942/01/10,70y2m) 手術日期 2011/06/07 手術主治醫師 賴達明 手術區域 東址 003房 號 診斷 Spondylolisthesis, acquired 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 08:01 進入手術室 08:05 麻醉開始 08:15 誘導結束 08:55 抗生素給藥 09:03 手術開始 11:50 抗生素給藥 12:35 手術結束 12:35 麻醉結束 12:45 送出病患 12:46 進入恢復室 13:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎間盤切除術-腰椎 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: 1. L4/5 transforaminal lumbar interbody fusio... 開立醫師: 李振豪 開立時間: 2011/06/07 12:47 Pre-operative Diagnosis L4/5 spondylolisthesis with lumbar stenosis Post-operative Diagnosis L4/5 spondylolisthesis with lumbar stenosis Operative Method 1. L4/5 transforaminal lumbar interbody fusion with PEEK cage 2. L3/4 laminectomy for decompression Specimen Count And Types nil Pathology Nil Operative Findings Anterior listhesis of the L4 was noted. The ligmentum flavum was hypertorphic which compressed the thecal sac. The thecal sac expanded well after decompression. No incidental durotomy or CSF leakage was noted during whole procedure. The roots were well preserved during the operation. < Posterior instrumentation > Screws: 6.2 x 40mm x I(L4, right side); 6.2 x 45mm x III Rods: 5cm x II Banana cage: #13 x I Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position. The skin was scrubbed, disinfected and draped as usual. Midline skin incision was made from L3 to L5 level. The subcutaneous soft tissue and paravertebral muscle groups were detached to expose the laminae and facet joints. L4 and L5 transpedicular screws were inserted under C-arm portable X-ray guided. L3 and L4 laminectomy was performed for decompression. Left L4/5 facetectomy was done followed by diskectomy. Transforaminal lumbar interbody fusion with one Banana cage was performed. Decortication was performed followed by posteriolateral fusion with autologous bone graft. The rods were set up. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. One epidural Hemovac was placed. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS賴達明 Assistants R4李振豪, R2陳國瑋 相關圖片 張李美霞 (F,1944/04/24,67y10m) 手術日期 2011/06/07 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Degeneration of intervertebral disc, lumbar or lumbosacral 器械術式 L4-5 microdiskectomy 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 12:57 進入手術室 13:00 麻醉開始 13:15 誘導結束 13:35 抗生素給藥 13:45 手術開始 15:15 手術結束 15:15 麻醉結束 15:25 送出病患 15:27 進入恢復室 16:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-腰椎 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 外科部 套用罐頭: Microdiskectomy 開立醫師: 李振豪 開立時間: 2011/06/07 15:21 Pre-operative Diagnosis Herniation of intervertebral disc, L4/5, left side Post-operative Diagnosis Herniation of intervertebral disc, L4/5, left side Operative Method Microdiskectomy Specimen Count And Types nil Pathology Nil Operative Findings The herniated disc was bulging toward rostral and lateral side which compressed the root. After microdiskectomy, the root became loose. No incidental durotomy or CSF leakage was noted during whole procedure. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position. The L4/5 disc level was localized by portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made at L4/5 disc level with 3cm in length. The subcutaneous soft tissue and paravertebral muscle groups were detached. Modified narrow Taylor retractor was applied. Under an operating microscope, laminotomy was performed followed by resection of ligmentum flavum. The thecal sac was pushed medially and the ruptured disc was identified. Microdiskectomy was done with knife, alligator, and disc clamp. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. The wound was irrigated with Gentamicin solution and closed in layers with 2-0 Vicryl and 4-0 Dexon. Operators VS賴達明 Assistants R4李振豪, R2陳國瑋 相關圖片 張書玲 (F,1926/07/09,85y8m) 手術日期 2011/06/07 手術主治醫師 賴達明 手術區域 東址 003房 03號 診斷 Secondary cancer of brain and spinal cord 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 15:20 報到 15:36 進入手術室 15:45 麻醉開始 16:05 誘導結束 16:20 抗生素給藥 16:38 手術開始 17:00 開始輸血 19:05 麻醉結束 19:05 手術結束 19:13 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 惡性脊髓腫瘤切除術 1 1 手術 脊椎融合術-後融合,有固定物(<=六節) 1 2 摘要__ 手術科部: 外科部 套用罐頭: 1. L2, L4 transpedicular screws for posterior... 開立醫師: 李振豪 開立時間: 2011/06/07 19:38 Pre-operative Diagnosis L3 spinal tumor with thecal sac compression, favor metastasis Post-operative Diagnosis L3 spinal tumor with thecal sac compression, favor metastasis Operative Method 1. L2, L4 transpedicular screws for posterior fixation 2. L3 laminectomy for partial tumor excision Specimen Count And Types 1 piece About size:multiple pieces Source:L3 spinal tumor Pathology Pending Operative Findings Osteoporotic change was noted while TPS insertion. The tumor was mainly located at posterior aspect of thecal sac with tightly compressed the thecal sac. The tumor was grayish, hypovascularized, firm, ill-defined to adjacent soft tissue except clear margin with dura. Bilateral pedicles, especially right side, were eroded by the tumor. After decompression, the thecal sac expanded well. No incidental durotomy or CSF leakage was noted. The roots were encased by the tumor and can not be freed. The paraspinal muscle groups were hypervascularized and easily bleeding. < Posterior Instrumentation > Screws: 6.2 x 40mm x IV Rods: 8cm x II Cross-link x I Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position. L2, L3, and L4 pedicles were localized by portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision from L2 to L4 level was made. The subcutaneous soft tissue and paravertebral muscle groups were detached. L2 and L4 transpedicular screws were inserted under fluoroscopy guided. Rods and cross-link were set up. L3 laminectomy for partial tumor excision was performed. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. The wound was irrigated with Gentamicin solution. One epidural Hemovac was placed and the wound was closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS賴達明 Assistants R4李振豪, R2陳國瑋 相關圖片 林宗德 (M,1949/01/09,63y2m) 手術日期 2011/06/08 手術主治醫師 陳敞牧 手術區域 東址 002房 07號 診斷 Subdural hemorrhage or effusion 器械術式 Burr hole (trephination) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林子富 ASA 3E 紀錄醫師 王奐之, 時間資訊 13:00 開始NPO 22:40 通知急診手術 00:00 進入手術室 00:05 麻醉開始 00:10 誘導結束 00:24 開始輸血 00:40 抗生素給藥 00:55 手術開始 01:45 麻醉結束 01:45 手術結束 02:00 送出病患 02:05 進入恢復室 03:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 慢性硬腦膜下血腫清除術 1 1 摘要__ 手術科部: 內科部 套用罐頭: Left side burr hole for chronic SDH evacuation 開立醫師: 王奐之 開立時間: 2011/06/08 01:51 Pre-operative Diagnosis Left side chronic subdural hematoma Post-operative Diagnosis Left side chronic subdural hematoma Operative Method Left side burr hole for chronic SDH evacuation Specimen Count And Types Nil Pathology Nil Operative Findings Motor-oil like fluid gushed out after durotomy. The brain re-expanded partially after hematoma evacuation. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head slightly turned to right. After skin shaving, disinfection & draping in sterile fashion, a linear incision was made at left frontal area, followed by creation of burr hole. 2 dural tenting stitches were applied, followed by a small cruciate durotomy. A small rubber drain was then inserted into the subdural space for hematoma evacuation. After hematoma evacuation, the wound was closed in layers and the subdural drain was fixed in place. The operation ended with deairing. Operators VS 陳敞牧 Assistants R3 王奐之 Indication Of Emergent Operation Mass effect & midline shift 記錄__ 手術科部: 內科部 套用罐頭: Left side burr hole for chronic SDH evacuation 開立醫師: 王奐之 開立時間: 2011/06/28 18:49 Pre-operative Diagnosis Left side chronic subdural hematoma Post-operative Diagnosis Left side chronic subdural hematoma Operative Method Left side burr hole for chronic SDH evacuation Specimen Count And Types Nil Pathology Nil Operative Findings Motor-oil like fluid gushed out after durotomy. The brain re-expanded partially after hematoma evacuation. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head slightly turned to right. After skin shaving, disinfection & draping in sterile fashion, a linear incision was made at left frontal area, followed by creation of burr hole. 2 dural tenting stitches were applied, followed by a small cruciate durotomy. A small rubber drain was then inserted into the subdural space for hematoma evacuation. After hematoma evacuation, the wound was closed in layers and the subdural drain was fixed in place. The operation ended with deairing. Operators VS 陳敞牧 Assistants R3 王奐之 Indication Of Emergent Operation Mass effect & midline shift 蘇姿妃 (F,1980/10/06,31y5m) 手術日期 2011/06/08 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Pituitary tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:10 麻醉開始 08:30 誘導結束 09:00 抗生素給藥 09:25 手術開始 12:00 抗生素給藥 12:15 手術結束 12:15 麻醉結束 12:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經由蝶竇之腦下垂體瘤切除 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Endoscopic transnasal transsphenoid aladenome... 開立醫師: 曾偉倫 開立時間: 2011/06/08 12:32 Pre-operative Diagnosis Pituitary macroadenoma Post-operative Diagnosis Pituitary macroadenoma Operative Method Endoscopic transnasal transsphenoid aladenomectomy Specimen Count And Types 1 piece About size:4.5x3x2 cm Source:Pituitary tumor Pathology Pending Operative Findings 1. The tumor was yellow-reddish, soft, size 4.5x3x2 cm in diameter. 2. The normal gland was found over right lateral posterior side of the suprasellar cistern after tumor excision. 3. No CSF leakage during the operation 4. The suprasellar cistern descended into the sella turcica and herniated into the sphenoid sinus. It was packed into the sella space by Gelfoam strips and bone fragments. Operative Procedures Under general anethesia and intubation, the patient was put in supine position with head tilted 15 degrees to left. The facial skin was antiseptic with alcohol better-iodine tincture, and the mucosa of oral and nasal cavity with aqueous better-iodine. These areas were covered by sterilized adhesive plastic sheets then draped. Under microscope, the bilateral septal mucosa were incised and dissected from the septal cartilage and bone, and a long nasal speculum inserted to expose the bony wall of sphenoid rostrum. Under endoscope, the nasal mucosa was coagulated at bilateral norstril. Under endoscope, the posterior nasal septum, anterior sphenoid wall and sella floor were removed by osteotome, kerrison, and disk forceps. The sellar floor dura was coagulated then opened in cruciate fashion. The soft tumor parenchyma was removed by curette and alligator. The noraml pituitary and residule tumor was re-checked by microscope. The arachnoid and the opening of diaphragm sellae was enforced by packing with gelform as in the sellar cavity. The nasal septal mucosa returned to its normal position. Both nasal cavities were tightly packed with Merocel tampons soaked with better-iodine ointment. Operators P 杜永光 Assistants VS 楊士弘, R6 胡朝凱, R2 曾偉倫 相關圖片 鍾簡秀時 (F,1942/02/23,70y0m) 手術日期 2011/06/08 手術主治醫師 杜永光 手術區域 東址 003房 02號 診斷 Lumbar spondylosis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 13:00 進入手術室 13:05 麻醉開始 13:15 誘導結束 13:30 抗生素給藥 13:54 手術開始 16:30 抗生素給藥 17:15 手術結束 17:15 麻醉結束 17:25 送出病患 17:28 進入恢復室 18:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎弓切除術(減壓)-二節以內 1 2 L 摘要__ 手術科部: 外科部 套用罐頭: L3~5 TPS with L4~5 left TLIF and L3~4 posteri... 開立醫師: 曾偉倫 開立時間: 2011/06/08 17:43 Pre-operative Diagnosis L3~4, L4-5 spondylolithesis, grade II, with spinal stenosis Post-operative Diagnosis L3~4, L4-5 spondylolithesis, grade II, with spinal stenosis Operative Method L3~5 TPS with L4~5 left TLIF and L3~4 posterior lateral fusion Specimen Count And Types Nil. Pathology Nil Operative Findings 1. Spondylolithesis, L3 on L4, and L4 on L5 2. Calcified bone. and osteoporosis was noted 3. The thecal sac had an acute angle on L4/5 level 4. TPSx6: L3: 6.2x40 mm; L4 and L5 6.2x45mm 5. L4~5 cage: 11# Operative Procedures Under ETGA, patient was put in prone position. Portable X-ray film was used to localize the L3-5 level. After we scrubbed, disinfected and drapped, an incision was made over spinous processes from L3 to L5. The latissimus dorsi, ileocostalis lumborum muscles were detached from spinous processes on both sides. The multifidus muscles were dissected subperiosteally from the laminae with rasper. The paravertebral muscles were retracted by self retaining retractors to expose the spinous processes and laminae. The bleeding from the muscles were stopped by Bovie. The muscular attachment on the lateral aspect of the facets joint and the transverse processes of L4 and L5 were detached. Posterior lateral fusion was done by inserting the TPS screws at L3, L4 and L5 pedicles and checked by C-arm intraoperatively. The spinous processes and laminae of L5 was bitten off with rongeurs and Kerrison punch until the posterior half of the spinal canal was widely opened. The hypertrophic ligamenta flava including those at lateral recesses were excised. After laminectomy, the rods were inserted and fixed with the screws. After one hemovac drain insertion, the paravertebra muscles were closed by interrupted sutures with 2/0 silk, subcutaneous layer by continuous suture with 3/0 Dexon and skin by continuous suture with 3/0 nylon. Operators P 杜永光 Assistants R6 胡朝凱, R2 曾偉倫 相關圖片 陳素禎 (F,1957/08/25,54y6m) 手術日期 2011/06/08 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾峰毅, 時間資訊 00:00 臨時手術NPO 13:25 進入手術室 13:35 麻醉開始 13:45 誘導結束 13:58 手術開始 14:03 抗生素給藥 17:00 手術結束 17:00 麻醉結束 17:03 抗生素給藥 17:05 送出病患 17:10 進入恢復室 19:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for Simpson^s grade.I total tumor ... 開立醫師: 陳睿生 開立時間: 2011/06/08 17:15 Pre-operative Diagnosis Left inferior frontal tumor, suspect meningioma Post-operative Diagnosis Left inferior frontal tumor, suspect meningioma Operative Method Craniotomy for Simpson^s grade.I total tumor remove Specimen Count And Types 1 piece About size:2x2x2cm Source:tumor Pathology Pending Operative Findings The tumor was solid, whitish, and well capsuled. Its size was about 2x2x2cm. The brain parychema was noted to be compressed by the tumor, and was intact after tumor remove. Operative Procedures 1. ETGA, supine position and head fixed with Mayfield clump 2. Set the navigation system and localized the tumor percutaneously 3. Curvillinear scalp incision, and dissect the temporalis muscle 4. An about 6x6cm craniotomy window was created 5. After dura tenting, the dura was opened and the tumor was found 6. It was carefully dissected from peripheral brain tissue, and totally removed 7. Hemostasis, and the dura was tightly closed with fascia graft 8. The skull graft was fixed back with miniplates x3 9. The wound was closed in layers Operators VS 曾漢民 Assistants R6 陳睿生, R4 曾峰毅 王錦蓮 (F,1954/08/14,57y7m) 手術日期 2011/06/08 手術主治醫師 蔡瑞章 手術區域 東址 005房 01號 診斷 Meningioma 器械術式 Crainotomy Brain Tumor(P-LIN) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾峰毅, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:10 麻醉開始 08:40 誘導結束 08:48 手術開始 08:50 抗生素給藥 10:43 開始輸血 11:54 抗生素給藥 12:50 手術結束 12:50 麻醉結束 13:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除-手術時間在4小時以內 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for Simpson^s gr.II tumor remove 開立醫師: 陳睿生 開立時間: 2011/06/08 13:14 Pre-operative Diagnosis Right frontal parasagittal meningioma Post-operative Diagnosis Right frontal parasagittal meningioma Operative Method Craniotomy for Simpson^s gr.II tumor remove Specimen Count And Types 1 piece About size:8x5x4cm Source:tumor Pathology Pending Operative Findings The tumor was soft, solid, and well capsuled. It was dark reddish in appearance and moderately vascularized. It was firmly attached to the falx and lateral wall of SSS. However, no SSS invasion was noted. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head fixed by Mayfield head clamp in neutral positino. After scalp shaved, scrubbed, disinfected, and then draped, we made one bicoronal skin incision and reflected the sclap flap inferiorly. We drilled burr holes at bilateral side of SSS, and created craniotomy at right frontal area. We made C-shape dura incision and dissected the dura-parenchyma plane with cottonoid. Dura attached site at falx and near SSS were cauterized for devascularization. We removed the tumor after central debulking. The duroplasty was done with autologous frontal periosteum. After subdural de-air, we fixed back the bone graft with miniplates and central tengint. Two subgaleal CWV were placed, and the wound was closed in layers. Operators P 蔡瑞章 Assistants VS 王國川 R6 陳睿生 R4 曾峰毅 方阿運 (M,1932/10/02,79y5m) 手術日期 2011/06/08 手術主治醫師 黃培銘 手術區域 東址 002房 01號 診斷 Subdural hemorrhage 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3 紀錄醫師 廖先啟, 時間資訊 23:48 臨時手術NPO 09:02 報到 09:02 進入手術室 09:12 麻醉開始 09:15 誘導結束 09:21 手術開始 09:25 麻醉結束 09:25 手術結束 09:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 氣管切開術 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 廖先啟 開立時間: 2011/06/08 09:34 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types Nil Pathology None Operative Findings Fr. 8 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators VS黃培銘 Assistants R3廖先啟，R3鄒冠全 黃國森 (M,1976/12/21,35y2m) 手術日期 2011/06/08 手術主治醫師 王國川 手術區域 東址 001房 03號 診斷 Cerebral aneurysm 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 林哲光, 時間資訊 23:24 臨時手術NPO 15:05 進入手術室 15:05 報到 15:06 麻醉開始 15:10 誘導結束 15:55 手術開始 17:00 抗生素給藥 17:10 麻醉結束 17:10 手術結束 17:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Right Kocher point Codman programmable V-P sh... 開立醫師: 林哲光 開立時間: 2011/06/08 17:41 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Right Kocher point Codman programmable V-P shunt insertion Specimen Count And Types 1 piece About size:multiple Source:CSF Pathology Nil Operative Findings Opening pressure was more than 10cmH2O after ventirulcar puncture was done. CSF seemed clear and transparent. Valve was set 12cmH2O. Ventricular catheter was 7cm long and abdominal catheter was more than 15cm long. Operative Procedures Under ETGA and supine position with head rotated to left side, skin disinfected and drapped were performed as usual. Transverse skin incision was done at right previous wound. A burr hole was created at right frontal area and ventricular catheter was inserted after ventricular puncture. RUQ abdomen tranverse skin incision was done. Minilarpartomy was then performed. The abdominal catheter was then connected to programmable valve with ventricular catheter along the subcutaneous tunnel. The wounds were then closed in layers. Operators VS 王國川 Assistants R4 林哲光 相關圖片 葉靖涵 (F,1950/07/25,61y7m) 手術日期 2011/06/09 手術主治醫師 陳敞牧 手術區域 東址 005房 01號 診斷 Spinal neuroma 器械術式 T-L neuroma, excision 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 2 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:05 進入手術室 08:10 麻醉開始 08:40 誘導結束 09:00 抗生素給藥 09:28 手術開始 12:00 抗生素給藥 12:51 開始輸血 13:05 手術結束 13:05 麻醉結束 13:07 送出病患 13:08 進入恢復室 14:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 良性脊髓腫瘤切除術 1 1 手術 椎弓切除術(減壓)-二節以內 1 2 摘要__ 手術科部: 外科部 套用罐頭: T11-12 laminoplasty for tumor excision 開立醫師: 王奐之 開立時間: 2011/06/09 13:21 Pre-operative Diagnosis T11-12 intraspinal tumor, suspected neuroma Post-operative Diagnosis T11-12 intraspinal tumor, suspected neuroma Operative Method T11-12 laminoplasty for tumor excision Specimen Count And Types 1 piece About size:3*1*1cm Source:T11-12 intraspinal tumor Pathology Pending Operative Findings Whitish elastic intraspinal extramedullary tumor was noted at T11-12. The tumor bulged out after durotomy, clear margin was noted. 1 nerve root inlet and 1 outlet was identified and both transected. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position. The back was scrubbed, disinfected and draped in sterile fashion. After localization of T11-12 level with C-arm, a midline incision was made at mid-back. The incision was deepened through the fascial layer, the paraspinal muscles were then detached from the spinous process & lamina. After exposing T11-L1 lamina, laminectomy was done with air drill. A linear midline durotomy was done, and exposed the tumor. The tumor was then dissected from surrounding nerve tissue, the inlet & outlet of nerve root was transected and divided from the tumor. The tumor was then removed en bloc. After hemostasis, the dura was closed with 4-0 Prolene continuous suture in water tight fashion. T11-12 laminae and spinous processed were placed back with mini-plates. After setting 1 CWV drain, the wound was closed in layers. Operators VS 陳敞牧 Assistants R3 王奐之, Ri 戴怡芸 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: T11-12 laminoplasty for tumor excision 開立醫師: 王奐之 開立時間: 2011/06/28 18:49 Pre-operative Diagnosis T11-12 intraspinal tumor, suspected neuroma Post-operative Diagnosis T11-12 intraspinal tumor, suspected neuroma Operative Method T11-12 laminoplasty for tumor excision Specimen Count And Types 1 piece About size:3*1*1cm Source:T11-12 intraspinal tumor Pathology Pending Operative Findings Whitish elastic intraspinal extramedullary tumor was noted at T11-12. The tumor bulged out after durotomy, clear margin was noted. 1 nerve root inlet and 1 outlet was identified and both transected. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position. The back was scrubbed, disinfected and draped in sterile fashion. After localization of T11-12 level with C-arm, a midline incision was made at mid-back. The incision was deepened through the fascial layer, the paraspinal muscles were then detached from the spinous process & lamina. After exposing T11-L1 lamina, laminectomy was done with air drill. A linear midline durotomy was done, and exposed the tumor. The tumor was then dissected from surrounding nerve tissue, the inlet & outlet of nerve root was transected and divided from the tumor. The tumor was then removed en bloc. After hemostasis, the dura was closed with 4-0 Prolene continuous suture in water tight fashion. T11-12 laminae and spinous processed were placed back with mini-plates. After setting 1 CWV drain, the wound was closed in layers. Operators VS 陳敞牧 Assistants R3 王奐之, Ri 戴怡芸 相關圖片 曾寶貴 (F,1946/10/18,65y4m) 手術日期 2011/06/09 手術主治醫師 陳敞牧 手術區域 東址 005房 02號 診斷 Malignant neoplasm of female breast 器械術式 Ommaya reservoir implantation 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 13:05 報到 13:20 進入手術室 13:30 麻醉開始 13:35 誘導結束 13:45 抗生素給藥 14:07 手術開始 14:47 手術結束 14:47 麻醉結束 14:56 送出病患 15:00 進入恢復室 16:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 歐氏貯囊置放手術 1 1 R 摘要__ 手術科部: 腫瘤醫學部 套用罐頭: Ommaya reservoir implantation via right Koche... 開立醫師: 王奐之 開立時間: 2011/06/09 15:00 Pre-operative Diagnosis Breast cancer with leptomeningeal carcinomatosis Post-operative Diagnosis Breast cancer with leptomeningeal carcinomatosis Operative Method Ommaya reservoir implantation via right Kocher point Specimen Count And Types Nil Pathology Nil Operative Findings Clear CSF was noted upon ventricular puncture. Opening pressure about 5cmH2O. CSF collected and sent for routine, BCS, cytology and bacterial culture. Smooth CSF flow was confirmed after securing Ommaya reservoir, ventricular catheter length: 6.5cm. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head slightly turned to left. After shaving, scrubbing, disinfection and draping in sterile fashion, a curved incision was made at right frontal area. A burr hole was then created at right Kocher point, a small durotomy was made after dural tenting. Ventricular tapping was smoothly performed, and the Ommaya reservoir was fixed in place. After hemostasis, the wound was closed in layers. Operators VS 陳敞牧 Assistants R3 王奐之, Ri 戴怡芸 相關圖片 記錄__ 手術科部: 腫瘤醫學部 套用罐頭: Ommaya reservoir implantation via right Koche... 開立醫師: 王奐之 開立時間: 2011/06/28 18:49 Pre-operative Diagnosis Breast cancer with leptomeningeal carcinomatosis Post-operative Diagnosis Breast cancer with leptomeningeal carcinomatosis Operative Method Ommaya reservoir implantation via right Kocher point Specimen Count And Types Nil Pathology Nil Operative Findings Clear CSF was noted upon ventricular puncture. Opening pressure about 5cmH2O. CSF collected and sent for routine, BCS, cytology and bacterial culture. Smooth CSF flow was confirmed after securing Ommaya reservoir, ventricular catheter length: 6.5cm. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head slightly turned to left. After shaving, scrubbing, disinfection and draping in sterile fashion, a curved incision was made at right frontal area. A burr hole was then created at right Kocher point, a small durotomy was made after dural tenting. Ventricular tapping was smoothly performed, and the Ommaya reservoir was fixed in place. After hemostasis, the wound was closed in layers. Operators VS 陳敞牧 Assistants R3 王奐之, Ri 戴怡芸 相關圖片 邱豪傑 (M,1984/05/31,27y9m) 手術日期 2011/06/09 手術主治醫師 蕭輔仁 手術區域 東址 001房 01號 診斷 Osteomyelitis 器械術式 Laminectomy for decompression, L3-4, transpedical screws 手術類別 緊急手術 手術部位 脊椎 傷口分類 髒 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 2E 紀錄醫師 陳睿生, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 00:44 通知急診手術 08:56 報到 09:13 進入手術室 09:16 麻醉開始 09:25 誘導結束 10:15 手術開始 11:30 抗生素給藥 12:00 抗生素給藥 13:05 手術結束 13:05 麻醉結束 13:15 送出病患 13:17 進入恢復室 14:17 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎弓切除術(減壓)-二節以內 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: L3/4 transpedicular screws fixation, and L3&u...; 開立醫師: 陳睿生 開立時間: 2011/06/09 13:38 Pre-operative Diagnosis L3/4 osteomyelitis with epidural abscess formation Post-operative Diagnosis L3/4 osteomyelitis with epidural abscess formation Operative Method L3/4 transpedicular screws fixation, and L3&upper; L4 laminectomy for abscess drainage Specimen Count And Types 3 pieces About size:swab Source:pus About size:swab Source:pus About size:swab Source:pus Pathology Nil Operative Findings Few light yellowish pus was noted at the L3/4 ventral epidural space. The thecal sac and roots were tightly compressed. The L3/4 disk space was narrowing, and few abscess was noted inside. An epidural mass lesion was noted while thecal sac retraction, and granulation tissue was noted mainly inside. L3 body erosion was noted superior to the L3/4 disk space, and some pus inside was removed. A-spine transpedicular screws systems were used: 6.5x45mm screws x4 at L3, 4 pedicles 60mm rods x2 Operative Procedures 1. ETGA, prone position and C-arm localized L3, 4 level 2. Low back midline incision, and expose the L3, 4 spinous process 3. The paraspinal musce was dissected and the L3, 4 lamina was exposed 4. Identify L3, 4 transverse process, and transpedicular screws were inserted at L3, 4 level under C-arm guided 5. Perform L3, and upper L4 laminectomy 6. Retract the thecal sac, and the epidural granulation tissue, and pus were drained and removed 7. Hemostasis, and set bilateral rods 8. Perform posteriorlateral fusion with autologus bone graft 9. Set two 1/8 hemovacs, and close the wound in layers Operators VS 蕭輔仁 Assistants R6 陳睿生, Ri 陳 Indication Of Emergent Operation Left lower limb weakness 蔣傳富 (M,1931/09/20,80y5m) 手術日期 2011/06/09 手術主治醫師 蕭輔仁 手術區域 東址 003房 03號 診斷 Neuralgia 器械術式 Decompression of mediun nerve 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 16:10 進入手術室 16:30 麻醉開始 16:32 誘導結束 16:35 手術開始 17:09 手術結束 17:09 麻醉結束 17:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 高頻熱凝療法 1 1 B 記錄__ 手術科部: 外科部 套用罐頭: Pulsed radiofrequency ablation at bilateral L... 開立醫師: 林哲光 開立時間: 2011/06/09 17:24 Pre-operative Diagnosis Low back pain, L4-L5 spinal canal stenosis Post-operative Diagnosis Low back pain, L4-L5 spinal canal stenosis Operative Method Pulsed radiofrequency ablation at bilateral L2 dorsal root ganglion Specimen Count And Types nil Pathology Nil Operative Findings C-arm localization for bilateral L2 pedicles were done. Operative Procedures Under prone position, skin disinfected and drapped were performed as usual. Local anesthesia was done at bilateral 4cm away from the midline and vertical line 4cm below the tranverse line crossing the bilateral pedicles. The needle inserted into the bilateral foramen of L2 and confirmed by C-arm. Pulsed radiofrequency ablation was done with 3-minute cycle for 2 times respectively after chekcing the senosry and motor nerve position. Under prone position, skin disinfected and drapped were performed as usual. Local anesthesia was done at bilateral 4cm away from the midline and vertical line 4cm below the tranverse line crossing the bilateral pedicles. The needle inserted into the bilateral foramen of L2 and confirmed by C-arm. Pulsed radiofrequency ablation was done with 42C, 3-minute cycle for 2 times respectively after chekcing the senosry and motor nerve position. Operators VS 蕭輔仁 Assistants R4 林哲光 黃敏惠 (F,1982/11/05,29y4m) 手術日期 2011/06/09 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Seizures 器械術式 Crainotomy Brain Tumor(P-LIN) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 2 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 08:07 進入手術室 08:10 麻醉開始 08:35 誘導結束 09:10 抗生素給藥 09:30 手術開始 12:10 抗生素給藥 13:30 手術結束 13:30 麻醉結束 13:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 手術 腦瘤切除-手術時間在4~8小時 1 1 L 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: Left frontal craniotomy and partial tumor exc... 開立醫師: 林哲光 開立時間: 2011/06/09 17:51 Pre-operative Diagnosis Left brain tumor, suspected high grade glioma Post-operative Diagnosis Left brain tumor, suspected high grade glioma Operative Method Left frontal craniotomy and partial tumor excision under Navigator and Sonography guided Specimen Count And Types 1 piece About size:around 5cm sized tumor mass Source:tumor Pathology Frozen confirmed glioma, low grade is favored Operative Findings An ill-defined, elastic-hard, whitish-grayish, mass lesion was noted at left frontal base with extended to left basal ganglion and right hemisphere. Some cystic contents without obvious fluids contetns were also noted inside the tumor. Grossly, it was difficult to differentiate from the normal brain tissue, except consistency. Intraopeartive MEP was done and no signal change was noted during the operation. Operative Procedures Under ETGA and supine position with head fixed with Mayfield head clump, skin disinfected and drapped were performed as usual. Bicoronal skin incision was done and left frontal craniotomy was peformed after three burr hole were created. Dura was opened with C-shaped after sonography localization and navigator use. Incision between the inferior frontal gyrus was done and tumor excision was done by debulking and piecemeal removal. Hemostasis was then done with Surgecells packing. The dura was closed with autologus fascia and the skull bone was put back with mini-plates fixation. The wound was then closed in layers after subgaleal drain insertion. Operators VS 王國川 Assistants R4 林哲光 相關圖片 陳駿堯 (M,1982/01/26,30y1m) 手術日期 2011/06/09 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 Arteriovenous malformation, brain 器械術式 Crainotomy Brain Tumor(P-LIN) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 2 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 13:55 進入手術室 14:00 麻醉開始 14:10 誘導結束 14:40 抗生素給藥 14:45 手術開始 15:35 手術結束 15:35 麻醉結束 15:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 麻醉 Lactic Acid (lactate) 1 0 記錄__ 手術科部: 外科部 套用罐頭: Right frontal craniotomy and total tumor exci... 開立醫師: 林哲光 開立時間: 2011/06/09 18:04 Pre-operative Diagnosis Right frontal convexity meningioma Post-operative Diagnosis Right frontal convexity meningioma Operative Method Right frontal craniotomy and total tumor excision, Simpson grade II Specimen Count And Types 1 piece About size:2cm sized Source:tumor Pathology Pending Operative Findings A whitish well defined, soft-elastic, suctionable mass lesion at right frontal area was noted with tightly adherent to adjacent dura. The arachnoid membrane was intact after tumor removal. Operative Procedures Under ETGA and supine position, skin disinfected and drapped were performed as usual. Curvilinear skin incision was made at right frontal area. Two burr holes were created and craniotomy was performed. Dura tear was noted. Tumor excision was then done after dura tenting and dura opened. The dura was reiforced with Duraform. The skull bone was put back and fixed with wires and central tenting was done. The wound was then closed in layers. Operators VS 王國川 Assistants R4 林哲光 相關圖片 劉文彥 (M,1974/12/30,37y2m) 手術日期 2011/06/09 手術主治醫師 王國川 手術區域 東址 005房 03號 診斷 Herniation of intervertebral disc 器械術式 Microdiskectomy, L5/S1, left 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 2 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 15:08 進入手術室 15:15 麻醉開始 15:25 誘導結束 15:35 抗生素給藥 15:51 手術開始 17:12 手術結束 17:12 麻醉結束 17:20 送出病患 17:23 進入恢復室 18:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-腰椎 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Microsurgical discectomy, L5-S1 開立醫師: 王奐之 開立時間: 2011/06/09 17:35 Pre-operative Diagnosis L5-S1 herniated intervertebral disc, ruptured, left Post-operative Diagnosis L5-S1 herniated intervertebral disc, ruptured, left Operative Method Microsurgical discectomy, L5-S1 Specimen Count And Types Nil Pathology Nil Operative Findings A piece of ruptured disc compressed the left S1 tightly. The S1 root became fully decompressed after removal of the ruptured disc fragment. A piece of ruptured disc compressed the left S1 tightly. Some fragments were hard and calcified. The S1 root became fully decompressed after removal of the ruptured disc fragment. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position. After C-arm localization of L5-S1 disc space, a slightly paramedian linear incision was made. The incision was deepened until the fascia was exposed. The fascia was then opened at midline, the left side paraspinal muscles were detached until L5 & S1 laminae were identified. A small laminotomy was done at left L5, the ligamentum flavum was then removed. After identifying the S1 root, the ruptured disc was noted just anterior to the root. The ruptured disc were then removed in pieces. After confirming decompression of the S1 root and achieving meticulous hemostasis, the wound was closed in layers. Operators VS 王國川 Assistants R3 王奐之 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Microsurgical discectomy, L5-S1 開立醫師: 王奐之 開立時間: 2011/06/28 18:49 Pre-operative Diagnosis L5-S1 herniated intervertebral disc, ruptured, left Post-operative Diagnosis L5-S1 herniated intervertebral disc, ruptured, left Operative Method Microsurgical discectomy, L5-S1 Specimen Count And Types Nil Pathology Nil Operative Findings A piece of ruptured disc compressed the left S1 tightly. Some fragments were hard and calcified. The S1 root became fully decompressed after removal of the ruptured disc fragment. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position. After C-arm localization of L5-S1 disc space, a slightly paramedian linear incision was made. The incision was deepened until the fascia was exposed. The fascia was then opened at midline, the left side paraspinal muscles were detached until L5 & S1 laminae were identified. A small laminotomy was done at left L5, the ligamentum flavum was then removed. After identifying the S1 root, the ruptured disc was noted just anterior to the root. The ruptured disc were then removed in pieces. After confirming decompression of the S1 root and achieving meticulous hemostasis, the wound was closed in layers. Operators VS 王國川 Assistants R3 王奐之 相關圖片 劉陳幸子 (F,1944/08/28,67y6m) 手術日期 2011/06/09 手術主治醫師 王堯弘 手術區域 東址 000房 號 診斷 Coma 器械術式 TAE 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 3E 時間資訊 10:08 通知急診手術 13:35 麻醉開始 13:50 誘導結束 17:05 麻醉結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 陳文樹 (M,1945/01/01,67y2m) 手術日期 2011/06/10 手術主治醫師 杜永光 手術區域 東址 001房 03號 診斷 Aneurysm 器械術式 Revision of CSF shunt 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3E 紀錄醫師 鍾文桂, 時間資訊 00:04 臨時手術NPO 00:04 開始NPO 07:04 通知急診手術 11:20 進入手術室 11:26 麻醉開始 11:28 誘導結束 12:30 手術開始 14:10 手術結束 14:10 麻醉結束 14:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦脊髓液分流管重置 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 外科部 套用罐頭: Revision of subdural-peritoneal shunt, bilateral. 開立醫師: 鍾文桂 開立時間: 2011/06/10 14:51 Pre-operative Diagnosis Subdural effusion,bilateral, ( right> left), status post implantation of subdural-peritoneal shunt, with shunt malfunction. Post-operative Diagnosis Subdural effusion,bilateral, ( right> left), status post implantation of subdural-peritoneal shunt, with shunt malfunction. Operative Method Revision of subdural-peritoneal shunt, bilateral. Specimen Count And Types 1 piece About size:5cc Source:subdural effucion, right and left. Pathology Nil. Operative Findings Clear light yellowish subdural effusion at bilateral subdural space. Some debris was noted at the slits of the subdural catheter. High pressure was noted at right subdural effusion. Subgaleal CSF accumulation was noted over the wound site. Operative Procedures Under ETGA, the patient was placed in supine position and the head was slightly tilted to the left side. After shaving, disinfection, and draping, the previous scalp incision was opened and dissected. The two subdural catheters were pulled out and cleaned. The tips of the subdural catheter was excised to gain more drainage of the subdural effusion. ( Medtronic was used.) Then, the subdural drains were repositioned into the subdural space. The distal part of the shunt was checked for its patency. The two durotomies were sealed with DuraFoam. The wound was closed in layers. Operators Prof. 杜永光. Assistants R5 鍾文桂 Indication Of Emergent Operation GCS deterioration. 相關圖片 管瑩如 (F,1981/06/08,30y9m) 手術日期 2011/06/10 手術主治醫師 杜永光 手術區域 東址 002房 02號 診斷 Brain tumor 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3E 紀錄醫師 王奐之, 時間資訊 00:05 臨時手術NPO 00:05 開始NPO 07:05 通知急診手術 10:30 報到 10:30 進入手術室 10:35 麻醉開始 10:45 誘導結束 11:00 抗生素給藥 11:28 手術開始 12:30 麻醉結束 12:30 手術結束 12:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室體外引流 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Extraventricular drain revision via left Koch... 開立醫師: 王奐之 開立時間: 2011/06/10 12:52 Pre-operative Diagnosis Large intraventricular central neurocytoma, status post craniotomy for tumor removal (twice), with obstructive hydrocephalus, status post extraventricular drainage Post-operative Diagnosis Large intraventricular central neurocytoma, status post craniotomy for tumor removal (twice), with obstructive hydrocephalus, status post extraventricular drainage Operative Method Extraventricular drain revision via left Kocher point Specimen Count And Types Nil Pathology Nil Operative Findings Serosanguinous CSF was noted after ventricular puncture. The EVD catheter was fixed at 5cm length before skin closure. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head slightly turned to right. After shaving, scrubbing, disinfection and draping in sterile fashion, sutures along previous wound was removed and the bicoronal incision was opened to expose previous burr hole along the left side of craniotomy window. After removing the bone chip at the burr hole at left Kocher area, a small durotomy was done, followed by ventricular puncture. The EVD catheter was then inserted and fixed. The wound was then closed in layers. Operators P. 杜永光 Assistants R3 王奐之 Indication Of Emergent Operation Hydrocephalus and IICP 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Extraventricular drain revision via left Koch... 開立醫師: 王奐之 開立時間: 2011/06/28 18:48 Pre-operative Diagnosis Large intraventricular central neurocytoma, status post craniotomy for tumor removal (twice), with obstructive hydrocephalus, status post extraventricular drainage Post-operative Diagnosis Large intraventricular central neurocytoma, status post craniotomy for tumor removal (twice), with obstructive hydrocephalus, status post extraventricular drainage Operative Method Extraventricular drain revision via left Kocher point Specimen Count And Types Nil Pathology Nil Operative Findings Serosanguinous CSF was noted after ventricular puncture. The EVD catheter was fixed at 5cm length before skin closure. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head slightly turned to right. After shaving, scrubbing, disinfection and draping in sterile fashion, sutures along previous wound was removed and the bicoronal incision was opened to expose previous burr hole along the left side of craniotomy window. After removing the bone chip at the burr hole at left Kocher area, a small durotomy was done, followed by ventricular puncture. The EVD catheter was then inserted and fixed. The wound was then closed in layers. Operators P. 杜永光 Assistants R3 王奐之 Indication Of Emergent Operation Hydrocephalus and IICP 相關圖片 吳林貴圓 (F,1949/04/16,62y10m) 手術日期 2011/06/10 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 08:10 進入手術室 08:15 麻醉開始 09:00 誘導結束 09:05 手術開始 09:45 抗生素給藥 12:45 抗生素給藥 14:05 手術結束 14:05 麻醉結束 14:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Left pterion approach for Simpson grade II tu... 開立醫師: 曾偉倫 開立時間: 2011/06/10 14:51 Pre-operative Diagnosis Left middle third sphenoid ridge meningioma Post-operative Diagnosis Left middle third sphenoid ridge meningioma Operative Method Left pterion approach for Simpson grade II tumor excisions Specimen Count And Types 1 piece About size:3x3x3 cm Source:Left sphenoid ridge meningioma Pathology Pending Operative Findings 1. The tumor is grey-reddish, soft, hyper-vascularized over the junction of frontal and temporal lobe. The size of the tumor was 5x4x4 cm. The margin between the tumor and normal brain tissue was clear. The feeding vessels were from dura over the sphenoid bone, temporal bone and normal brain tissue. 2. Dural thickening and skull hyperosteosis above the tumor. 3. The major vessels was pushed medial, upward by the tumors. The vessels was well preserved. 4. Blood loss: 200ml Operative Procedures Under ETGA, patient was put on supine position with her face tilt to right. Her head was fixed with Mayfield clamp. After we shaved, scrubbed, disinfected and drapped, a curvilinear skin incision was made over left frontal-temporal area. Left frontal-temporal craniectomy 5x6 cm in size was done and the dura tenting was performed. Part of the temporal bone was removed by Rongour and Kerrison punch and lateral sphenoid ridge was drilled for wider operation field. Bleeders from middle meningeal artery was controled with bipolar forceps. A curvilinear durotomy about 5cm was done and the tumor could be seen. Central debulking was done with bioplar forceps, suction and CUSA. The feeding vesseels was controlled and the the tumor was removed in piece-meal fashion. The dura was cauterized with bipolar forceps. The bleeders were checked and the thickened dura was removed. The dura was closed with 3-0 Prolene continous suture. We placed a CWV drain over sub-galeal area and the wound was closed with 2-0 vicryl and Appose. Operators P 杜永光 Assistants R6 胡朝凱 R2 曾偉倫 相關圖片 邵于純 (F,1977/03/11,35y0m) 手術日期 2011/06/10 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Pituitary tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 曾峰毅, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:06 進入手術室 08:10 麻醉開始 08:25 誘導結束 08:50 抗生素給藥 09:17 手術開始 10:45 麻醉結束 10:45 手術結束 10:58 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 手術 經由蝶竇之腦下垂體瘤切除 1 1 摘要__ 手術科部: 外科部 套用罐頭: Hypophysectomy---Transphenoid 開立醫師: 曾峰毅 開立時間: 2011/06/10 10:36 Pre-operative Diagnosis Cushing disease Post-operative Diagnosis Cushing disease Operative Method Transnasal trans-sphenoidal adenomectomy Specimen Count And Types Several fragments of one tumor was sent for pathology. Pathology pending Operative Findings One hypervascular, soft to elastic, tumor was noted at right part of pituitary gland, which is compatible with functional tumor. CSF leakage was encountered during the operation. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head extended slightly. We made one incision at medial mucosa of left nostril, and deviated the mucosa away from septum. We knocked down the vomer, and removed the sphenoid sinus mucosa. We removed sellar floor, and made x-shape dura incision. We removed the pituitary tumor in piecemeal fashion. We seal the CSF leakage with Tissucol-Duo and gelfoam. We put the vomer graft back, and the packed bilateral nostril. Operators VS 曾漢民 Assistants R6 陳睿生 R4 曾峰毅 相關圖片 潘惠禎 (F,1961/03/16,50y11m) 手術日期 2011/06/10 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Trigeminal neuralgia (Cranial nerve V) 器械術式 Microvascular decompression 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 曾峰毅, 時間資訊 00:00 臨時手術NPO 10:40 報到 11:15 進入手術室 11:30 麻醉開始 11:35 誘導結束 11:40 手術開始 12:05 抗生素給藥 15:05 抗生素給藥 15:30 麻醉結束 15:30 手術結束 15:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦微血管減壓術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Microvascular decompression 開立醫師: 陳睿生 開立時間: 2011/06/10 15:56 Pre-operative Diagnosis Trigeminal neuralgia, right side Post-operative Diagnosis Trigeminal neuralgia, right side Operative Method Microvascular decompression Specimen Count And Types nil Pathology Nil Operative Findings The trigeminal nerve was noted to be compressed by the superior petrosal sinus and a small artery above the trigeminal nerve. Both of the vessels were packed with teflon patch. Operative Procedures 1. ETGA, 3/4 prone position and head right turn, fixed with Mayfield clump 2. Curvillinear scalp incision was done at right retroauricular region 3. Extract a fascia graft, and then the muscles were dissected to expose the astron and right side posterior fossa base 4. Two bur holes was created at astron and posterior fossa base 5. An about 5x5cm craniotomy window was done 6. The dura was opened in a inverse K shape, and CSF was drained from the cistern Magnum for decompression 7. The cerebellum was retracted posteriorly, and the CN VII, VIII complex was identified 8. The trigeminal nerve was identified, and the offending vessels above it was dissected 9. Teflon patch was packed for decompression 10.Hemostasis, and the dura was tightly closed with fascia graft 11.The skull graft was fixed back with miniplates x3 12.The wound was closed in layers Operators VS 曾漢民 Assistants R6 陳睿生, R4 曾峰毅, R2 曾偉倫 相關圖片 蔡員 (F,1936/07/21,75y7m) 手術日期 2011/06/10 手術主治醫師 曾漢民 手術區域 東址 003房 02號 診斷 Brain metastasis 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 曾峰毅, 時間資訊 00:00 臨時手術NPO 14:40 進入手術室 14:45 麻醉開始 15:00 抗生素給藥 15:10 誘導結束 15:30 手術開始 17:55 開始輸血 18:00 抗生素給藥 18:35 手術結束 18:35 麻醉結束 18:46 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除-手術時間在4小時以內 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT 開立醫師: 曾峰毅 開立時間: 2011/06/10 19:08 Pre-operative Diagnosis Left frontal tumor, suspected metastasis Post-operative Diagnosis Left frontal tumor, suspected metastasis Operative Method Left frontal craniotomy for tumor excision Specimen Count And Types One tumor was sent for pahtology. Pathology Pending Operative Findings One capsulated, hypervascular tumor, elastic to firm, solid tumor was noted at left frontal lobe. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to right and fixed with Mayfield head clamp. After scalp shaved, scrubbed, disinfected, and then draped, we made one curvilinear skin incision at left frontal area. We drilled six burr holes, and then created craniotomy. We opened duromtoy in C-shape, and removed the tumor in en bloc. We closed the dura in water-tight fahsion suture and Durafoma. Bone graft was fixed back with mini-plates. The wound was closed in layers. Operators VS 曾漢民 Assistants R4 曾峰毅 相關圖片 林傳宗 (M,1936/03/03,76y0m) 手術日期 2011/06/10 手術主治醫師 黃培銘 手術區域 東址 016房 05號 診斷 Lung tumor 器械術式 Port-A catheter implatation 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 蔡立威, 時間資訊 14:20 報到 14:25 進入手術室 14:30 抗生素給藥 14:50 麻醉開始 14:55 誘導結束 14:56 手術開始 15:59 麻醉結束 15:59 手術結束 16:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 port–A導管植入術–治療性導管植入術 1 0 R 摘要__ 手術科部: 外科部 套用罐頭: Port-A insertion 開立醫師: 蔡立威 開立時間: 2011/06/10 15:56 Pre-operative Diagnosis Lung cancer Post-operative Diagnosis Lung cancer Operative Method Port-A insertion Specimen Count And Types nil Pathology nil Operative Findings The port-A catheter was inserted to right subclavian via puncture method, checked by portable CXR Operative Procedures 1. LA, supine 2. Skin disinfection and draping as usual 3. Insert Port-A via puncture method 4. Checked by portable CXR, close wound in layers Operators VS黃培銘 Assistants R2蔡立威,R1戴逸昇 張皓翔 (M,1997/12/12,14y3m) 手術日期 2011/06/10 手術主治醫師 黃培銘 手術區域 兒醫 068房 01號 診斷 Congenital hydrocephalus 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 3 紀錄醫師 郝政鴻, 時間資訊 00:00 臨時手術NPO 08:40 報到 08:40 進入手術室 08:45 麻醉開始 08:50 誘導結束 09:22 麻醉結束 09:39 手術開始 09:48 手術結束 09:52 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 氣管切開術 1 0 記錄__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 郝政鴻 開立時間: 2011/06/10 10:00 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types nil Pathology None Operative Findings Fr . 8 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators VS黃培銘 Assistants R3郝政鴻 R2蔡立威 任寶美 (F,1955/10/29,56y4m) 手術日期 2011/06/10 手術主治醫師 賴達明 手術區域 東址 027房 04號 診斷 Subarachnoid hemorrhage (SAH) 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 15:02 報到 15:25 進入手術室 15:30 麻醉開始 15:40 誘導結束 16:17 手術開始 17:59 手術結束 17:59 麻醉結束 18:05 送出病患 18:08 進入恢復室 21:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 腦室腹腔分流手術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt insertion via righ... 開立醫師: 王奐之 開立時間: 2011/06/10 17:47 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunt insertion via right Kocher point Specimen Count And Types nil Pathology Nil Operative Findings Clear CSF was noted on ventricular puncture. CSF opening pressure: 5cmH2O. A Codman programmable reservoir shunt was used, preset to 100mmH2O. CSF were collected for routine, BCS & bacterial culture. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After shaving, scrubbing, disinfection and draping in sterile fashion, a curvilinear skin incision was made at right frontal area along previous wound. Mini-laparotomy was also done at right upper quadrant of abdomen. After identifying previous burr hole at right frontal Kocher point, a small durotomy was made, followed by ventricular puncture. A subcutaneous tunnel was then created from abdomen to scalp, followed by passage of peritoneal catheter. The ventricular catheter, reservoir and the peritoneal catheter were then assembled and tested for function. The wounds were then closed in layers. Operators VS 賴達明 Assistants R4 林哲光, R3 王奐之 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt insertion via righ... 開立醫師: 王奐之 開立時間: 2011/06/28 18:48 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunt insertion via right Kocher point Specimen Count And Types nil Pathology Nil Operative Findings Clear CSF was noted on ventricular puncture. CSF opening pressure: 5cmH2O. A Codman programmable reservoir shunt was used, preset to 100mmH2O. CSF were collected for routine, BCS & bacterial culture. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After shaving, scrubbing, disinfection and draping in sterile fashion, a curvilinear skin incision was made at right frontal area along previous wound. Mini-laparotomy was also done at right upper quadrant of abdomen. After identifying previous burr hole at right frontal Kocher point, a small durotomy was made, followed by ventricular puncture. A subcutaneous tunnel was then created from abdomen to scalp, followed by passage of peritoneal catheter. The ventricular catheter, reservoir and the peritoneal catheter were then assembled and tested for function. The wounds were then closed in layers. Operators VS 賴達明 Assistants R4 林哲光, R3 王奐之 相關圖片 黃慕香 (M,1942/10/14,69y5m) 手術日期 2011/06/10 手術主治醫師 賴達明 手術區域 東址 001房 02號 診斷 Intracerebral hemorrhage 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3E 紀錄醫師 鍾文桂, 時間資訊 00:02 臨時手術NPO 00:02 開始NPO 07:02 通知急診手術 08:20 報到 08:50 進入手術室 08:54 麻醉開始 09:03 誘導結束 09:30 抗生素給藥 09:45 手術開始 10:45 手術結束 10:45 麻醉結束 10:55 送出病患 10:58 進入恢復室 11:58 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 慢性硬腦膜下血腫清除術 1 1 L 麻醉 Glucose 1 0 摘要__ 手術科部: 外科部 套用罐頭: Burr hole for evacuation of chronic subdural ... 開立醫師: 鍾文桂 開立時間: 2011/06/10 11:05 Pre-operative Diagnosis Chronic subdural hemorrhage,left frontal-temporal-parietal. Post-operative Diagnosis Chronic subdural hemorrhage,left frontal-temporal-parietal. Operative Method Burr hole for evacuation of chronic subdural hemorrhage. Specimen Count And Types nil Pathology Nil. Operative Findings Dark brown liquified hematoma at subdural space. Presence of inner and outer membrane. Poor brain expansion after hematoma evacuation. Active bleeding from the middle meningeal artery. It was electrocoagulated. Operative Procedures Under ETGA,the patient was placed in supine position and the head was tilted to the right. After shaving, disinfection, and draping, a linear scalp incision was made at left frontal region in front of the V-P shunt. After dissection, a burr hole was obtained by using high speed drill. After well hemostasis, a cruciate durotomy was created. Then, the liquified hematoma was evacuated through a subdural rubber drain. More hematoma was evacuated with normal saline irrigation. Then, we placed the rubber drain in subdural space in situ. The wound was closed in layers. Subdural air accumulation was evacuated through the rubber drian. Finally, the drain was connected with closed drainage system. Operators 賴達明 Assistants R5 鍾文桂 Indication Of Emergent Operation Confused, right hemiparesis. 相關圖片 林文堂 (M,1949/01/01,63y2m) 手術日期 2011/06/10 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Cervical myelopathy 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:05 進入手術室 08:10 麻醉開始 08:30 誘導結束 09:00 抗生素給藥 09:11 手術開始 12:14 抗生素給藥 13:10 手術結束 13:10 麻醉結束 13:18 送出病患 13:22 進入恢復室 14:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 手術 椎間盤切除術-頸椎 1 1 R 手術 椎間盤切除術-頸椎 1 2 R 摘要__ 手術科部: 外科部 套用罐頭: Anterior cervical discectomy and fusion with ... 開立醫師: 李振豪 開立時間: 2011/06/10 13:27 Pre-operative Diagnosis C3-4, C4-5 herniated intervertebral disc with myelopathy Post-operative Diagnosis C3-4, C4-5 herniated intervertebral disc with myelopathy Operative Method Anterior cervical discectomy and fusion with PEEK cage, C3-4, C4-5 Specimen Count And Types nil Pathology Nil Operative Findings C3-4, C4-5 herniated disc was removed during the operation and ossification of the posterior longitudinal ligment was noted at C4-5 segment. The PLL were removed also during the operation. The thecal sac expanded well after the operation. No inciental durotomy, CSF leakage, or evoked potential change noted during whole procedure. One #7(C3-4 level) and one #6(C4-5 level) PEEK cage was used for anterior fusion. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with neck extension. The skin was scrubbed, disinfected, and draped as usual. One transverse skin incision was made at right neck and the platysma was transected. The superficial cervical fascia was opened in vertical direction along the anterior margin of the SCM muscle. The plan between thyroid gland and carotid sheath was entered to expose the pre-vertebral fascia. The fascia was opened and the disc space was identified. Portable C-arm X-ray was used to identify the disc level. C3-4, C4-5 diskectomy was performed with knife, curette, alligator, and Kerrison punches. The PLL also removed after diskectomy. Foraminotomy was done with Kerrison punches. PEEK cages filled with artificial bone graft were inserted into disc space for anterior fusion. Hemostasis was achieved and one MiniHemovac was placed. The wound was then closed in layers with 3-0 Vicryl and 4-0 Dexon. Operators VS賴達明 Assistants R4李振豪, R2陳國瑋 相關圖片 洪桂鶯 (F,1951/04/10,60y11m) 手術日期 2011/06/10 手術主治醫師 賴達明 手術區域 東址 019房 02號 診斷 Lumbar Spondylosis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 12:50 報到 13:30 進入手術室 13:40 麻醉開始 13:50 誘導結束 14:05 抗生素給藥 14:20 手術開始 16:22 開始輸血 17:40 抗生素給藥 18:10 手術結束 18:10 麻醉結束 18:20 送出病患 18:25 進入恢復室 19:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎弓切除術(減壓)-二節以內 1 2 手術 椎間盤切除術-腰椎 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: 1. L3-4 transforaminal lumbar interbody fusio... 開立醫師: 李振豪 開立時間: 2011/06/10 18:46 Pre-operative Diagnosis 1. L3 on L4 spondylolisthesis 2. L1/2 herniated intervertebral disc with radiculopathy 3. L4-5 spondylosis with lumbar stenosis Post-operative Diagnosis 1. L3 on L4 spondylolisthesis 2. L1/2 herniated intervertebral disc with radiculopathy 3. L4-5 spondylosis with lumbar stenosis Operative Method 1. L3-4 transforaminal lumbar interbody fusion with PEEK cage and L3-4 transpedicular screws for posterior fixation 2. L3-4 posterolateral fusion with autologous bone graft 3. L1/2 microdiskectomy, left 4. L4-5 laminotomy for decompression Specimen Count And Types Nil Pathology Nil Operative Findings The facet joint and ligmentum flavum was hypertrophic over L3-5 level. The thecal sac was compressed tightly by the ligmentum flavum and expanded well after decompression. L1-2 ruptured disc was noted with root and thecal sac compression. The root was loose after microdiskectomy No incidental durotomy or CSF leakage was noted after whole procedure. < Posterior Instrumentation > Screws: 6.2 x 40mm x IV Cage: #11 Banana cage x I Rods: 6cm x II Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position. The L1 to L5 level were localized by portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made from L1 to L5 level. The subcutaneous soft tissue and paraspinal muscle groups were detached(Left side paraspinal muscle only over L1-2 level). L3-4 transpedicular screws were inserted under C-arm guided. Laminectomy and left facetectomy was done and Banana cage was used for transforaminal lumbar interbody fusion after diskectomy. L4-5 laminotomy was performed for decompression. L1-2 left side laminotomy was performed and microdiskectomy was done. The rods were set up. Hemostasis was achieved. Two epidural Hemovac was placed. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Under endotracheal general anesthesia, the patient was put in prone position. The L1 to L5 level were localized by portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made from L1 to L5 level. The subcutaneous soft tissue and paraspinal muscle groups were detached(Left side paraspinal muscle only over L1-2 level). L3-4 transpedicular screws were inserted under C-arm guided. Laminectomy and left facetectomy was done and Banana cage was used for transforaminal lumbar interbody fusion after diskectomy. L4-5 laminotomy was performed for decompression. L1-2 left side laminotomy was performed and microdiskectomy was done. The rods were set up. Hemostasis was achieved. Two epidural Hemovac was placed. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS賴達明 Assistants R4李振豪, R2陳國瑋 相關圖片 林李昭娥 (F,1928/08/05,83y7m) 手術日期 2011/06/10 手術主治醫師 陳敞牧 手術區域 東址 003房 03號 診斷 Subdural hemorrhage 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林至芃 ASA 3E 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 19:23 報到 19:33 進入手術室 19:40 麻醉開始 19:45 誘導結束 20:08 抗生素給藥 20:38 手術開始 21:35 手術結束 21:35 麻醉結束 21:47 送出病患 21:50 進入恢復室 22:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: Burr hole for evacuation of chronic subdural ... 開立醫師: 鍾文桂 開立時間: 2011/06/10 21:58 Pre-operative Diagnosis Chronic subdural hemorrhage, right frontal-temporal-parietal. Post-operative Diagnosis Chronic subdural hemorrhage, right frontal-temporal-parietal Operative Method Burr hole for evacuation of chronic subdural hemorrhage. Specimen Count And Types nil Pathology Nil. Operative Findings Dark red-brown liquified hematoma at right subdural space. Presence of inner and outter membrane. Poor brain expansion after hematoma removal. Operative Procedures Under ETGA, the patient was placed in supine position and the head was tilted to the left. After shaving, disinfection, and draping, a linear incision was made at right frontal region. After dissection, a burr hole was obtained by using high speed drill. After durotomy, the liquified hematoma was evacuated. Further hematoma evacuation was achieved through a subdural rubber drain with normal saline irrigation. The subdural drain was placed in situ. Then, the wound was closed in layers. Subdural air accumulation was evacuated through the rubber drain. Finally, the drain was connected with closed drainage system. Operators 蕭輔仁 Assistants R5 鍾文桂 Indication Of Emergent Operation Acute neurologic deterioration in recent 2 days. 相關圖片 張葉阿滿 (F,1942/06/17,69y8m) 手術日期 2011/06/11 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Lymphoma 器械術式 Brain tumor biopsy -Stereotaxic 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 3 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 08:08 進入手術室 08:15 麻醉開始 08:30 誘導結束 08:45 手術開始 08:45 抗生素給藥 11:35 手術結束 11:35 麻醉結束 11:45 送出病患 11:45 抗生素給藥 醫令資訊 類別 名稱 量 刀 側 手術 立體定位術-切片 1 1 R 手術 腦組織活體切片 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: Stereotatic biopsy of brain tumor. 開立醫師: 鍾文桂 開立時間: 2011/06/11 12:07 Pre-operative Diagnosis Right frontal tumor with extension to corpus callosum, suspect lymphoma. Post-operative Diagnosis Right frontal tumor with extension to corpus callosum , suspect lymphoma. Operative Method Stereotatic biopsy of brain tumor. Specimen Count And Types 1 piece About size:Multiple biopsy fragments. Source:right frontal brain tumor Pathology Frozen pathology: lymphoma or high grade glioma. Operative Findings Stereotatic biopsy of brain tumor, the fragments were whitish-gray, and soft. We biopsied 12 sites to obtain good tumor tissue. Operative Procedures Under ETGA, the patient was placed in supine position and the head was fixed on Mayfild. After ensuring the entry point and tract by navigator registration, the preparation of shaving, disinfection, and draping were done. A vertical scalp incision was made at right frontal region. Then, a burr hole was created. After durotomy and setting of the navigation system, the biopsy needle was inserted into the target sites. The tumor was biopsied at several points. After obtaining enough tumor tissue, the wound was closed in layers. Operators 曾漢民. Assistants R5 鍾文桂 R2 陳國瑋 相關圖片 劉慶琴 (F,1952/11/25,59y3m) 手術日期 2011/06/11 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Acoustic tumor 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 3 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 12:00 進入手術室 12:05 麻醉開始 12:55 誘導結束 13:00 抗生素給藥 13:30 手術開始 16:00 抗生素給藥 17:05 手術結束 17:05 麻醉結束 17:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: right retro-sigmoid approach for subtotal tum... 開立醫師: 楊博智 開立時間: 2011/06/11 17:33 Pre-operative Diagnosis right CP angle tumor r/o vestibular Schwannoma Post-operative Diagnosis right CP angle tumor r/o vestibular Schwannoma Operative Method right retro-sigmoid approach for subtotal tumor excision Specimen Count And Types 1 piece About size:pieces Source:brain tumor Pathology pending Operative Findings 1. The brain was buldging through durotomy window 2. Whitish to yellowish tumor with high vascularity was noted with adhesion to surrounding tissue 3. Trigenimal nerve and low cranial nerves were noted and perserved Operative Procedures The patient was put in 3/4 prone position and the head was turned to left side with neck mild flexion. The skin was dis-infected and draped as usual. One vertical linear incision about 10 cm, 4 cm posterior to right ear was made. Craniotomy about 4cm*6cm was made. The Cerebellum was retracted and CSF was drained. The tumor came in sight and central debulking was done with Bipolar. Trigenimal nerve and low cranial nerves were noted and perserved. Duroplasty was performed with galea and Duraform. The skull bone was put back and fixed with miniplate and screws. The wond was then closed in layers. Operators VS曾漢民 Assistants R5鍾文桂 R2陳國瑋 相關圖片 黃榮星 (M,1950/02/02,62y1m) 手術日期 2011/06/11 手術主治醫師 陳韻如 手術區域 東址 011房 09號 診斷 Cataract 器械術式 Phaco+PCIOL 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 球後麻醉 麻醉主治醫師 ASA 1 時間資訊 13:50 進入手術室 13:55 麻醉開始 13:58 誘導結束 14:32 手術開始 15:20 手術結束 15:25 送出病患 記錄__ 手術科部: 眼科部 套用罐頭: Phacoemulsification and PCIOL implantation (oD) 開立醫師: 陳韻如 開立時間: 2011/06/11 15:18 Pre-operative Diagnosis Cataract (oD) Post-operative Diagnosis Cataract (oD) Operative Method Phacoemulsification and PCIOL implantation (oD) Specimen Count And Types nil Pathology Nil Operative Findings Cataract (oD) Operative Procedures 1. Under peribulbar anesthesia 2. Disinfection, irrigation and draping 3. Application of eyelid speculum 4. Made a clear corneal incision and penetrate into AC with 2.5mm trapezoid knife at 11 oclock position 5. Inject Viscoat into the anterior chamber 6. Continuous circular capsulorrhexis was done with bent needle and capsular forceps 7. Made a sideport at 3 oclock position with the MVR blade 8. Hydrodissection and hydrodelineation were done with BSS 9. Phacoemulsification of the nucleus by standard divide-and-conquer technique 10. Aspiration of the residual cortical material with I/A tube 11. Foldable PCIOL was implanted into the bag after injection of Viscoat 12. The residual Viscoat was washed outby Simcoe I/A cannula 13. Inject BSS into AC and check leakage, and inject Miostat to AC to constrict the pupil 14. Stromal hydration of the wound with BSS 16. Subconjunctival injection of Rinderon and Gentamycin 17. Lactycin patching Operators VS黃振宇, Assistants R5陳韻如 時光 (M,2010/09/08,1y6m) 手術日期 2011/06/12 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Hydrocephalus 器械術式 Debridment-- 5-10cm，Brain tumor Crainotomy(P-DUH) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 污染 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3E 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 10:45 進入手術室 10:50 麻醉開始 11:20 誘導結束 12:10 抗生素給藥 12:43 手術開始 14:20 麻醉結束 14:20 手術結束 14:35 送出病患 14:40 進入恢復室 16:14 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 深部傷口處理縫合擴創-中 1 0 R 手術 腦脊髓液分流管重置 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 摘要__ 手術科部: 外科部 套用罐頭: 1. Debridement of subcutaneous abscess. 開立醫師: 鍾文桂 開立時間: 2011/06/12 15:16 Pre-operative Diagnosis Ventriculoperitoneal shunt infection with subcutaneous abscess formation, right retroauricular and submandubular areas. Post-operative Diagnosis Ventriculoperitoneal shunt infection with subcutaneous abscess formation, right retroauricular and submandubular areas. Operative Method 1. Debridement of subcutaneous abscess. 2. Removal of ventriculoperitoneal shunt, ( only the peritoneal shunt). Specimen Count And Types 1 piece About size:20 cc Source:Dirty wound, pus. Pathology Nil. Operative Findings 1. Some granulation tissue was noted around the burr hole. Some CSF leakage was noted from the burr hole. The amount of CSF leakage is much less after dura repair in last operation. We repaire the dura again with DuraGen. No CSF leakage was noted afterwards. 2. Much pus formation was noted in right retroauricular and submandibular areas along the subcutanous shunt path. The pus was evacuated and the mentioned areas were debrided. The shunt catheter was removed. 3. The ventricular catheter into the right occipital horn was not removed as no pus formation is noted in the area and the burr hole is clean. Operative Procedures Under ETGA, the patient was placed in supine position and the head was tilted to the left. After disinfection, removal of the previous operative wound stiches, shaving, disinfection, and draping, the previous operative wound was incised and dissected. The wound was debrided with curretes. The pus were evacuated and collected for cultures. The dural defect on the burr hole was repaired with two layers of DuraGen. Much irrigated of Vancomycin-containing normal saline was done into the subcutanous tunnel. After well hemostasis, the wound was closed in layers with one subcutaneous CWV drain in the subcutanous tunnel in situ. Operators 郭夢菲. Assistants R5 鍾文桂 Indication Of Emergent Operation Wound infection with spiking fever for days, suspect CNS infection. 記錄__ 手術科部: 外科部 套用罐頭: 1. Debridement of subcutaneous abscess. 開立醫師: 郭夢菲 開立時間: 2011/06/13 18:00 Pre-operative Diagnosis Ventriculoperitoneal shunt infection with subcutaneous abscess formation, right retroauricular and submandubular areas. Post-operative Diagnosis Ventriculoperitoneal shunt infection with subcutaneous abscess formation, right retroauricular and submandubular areas. Operative Method 1. Debridement of subcutaneous abscess. 2. Removal of peritoneal part of the ventriculoperitoneal shunt 3. Repair of the dural defect with DuraGen Specimen Count And Types 1 piece About size:20 cc Source:Dirty wound, pus. Pathology Nil. Operative Findings 1. Some granulation tissue was noted around the burr hole. Mild CSF leakage was noted from the burr hole site. The leakage rate is much slower than previous surgery for dural repair. We repaired the dura again with layer of DuraGen. No CSF leakage was noted afterwards. 2. Much pus like fluid was noted in right retroauricular (the lower subcutaneous compartment) and submandibular areas along the subcutanous shunt path. The pus was evacuated and the mentioned areas were debrided. The shunt catheter was removed. The wound was irrigated with corpious vancomycin solution. 3. The ventricular catheter into the right occipital horn was not removed as no pus formation is noted in the area and the burr hole is clean. We were afraid of inducing new infection into the intracranial compartment. Operative Procedures Under ETGA, the patient was placed in supine position and the head was tilted to the left. Neuroendoscope was prepared to removed the intraventricular catheter. After disinfection, removal of the previous operative wound stiches, shaving, disinfection, and draping, the previous upper operative wound was incised and dissected. The fluid in thyei pocket was not dirty, but some pus like fluid came out from the lower subcutaneous compartment. We then irrigated the wound with corpious vancomycin solution and protected the buur hole site with vancomycin soaked gauze along the whole operative procedure. After we moved the prefixed peritoneal catheter, the wound was debrided with curretes. The pus were evacuated and collected for cultures. We dissected the bony margin to expose the dura surface. The dural defect on the burr hole was repaired with two layers of DuraGen. Much irrigated of Vancomycin-containing normal saline was done into the subcutanous tunnel. Since the burr hole region seemed not to be the origin of infection, I decided not to remove the intraventricular catheter to avoid introduction of the infection into the brain compartment. After well hemostasis, the wound was closed in layers with one subcutaneous CWV drain in the subcutanous tunnel in situ. Operators 郭夢菲. Assistants R5 鍾文桂 Indication Of Emergent Operation Wound infection with spiking fever for days, suspect CNS infection. 蕭素娥 (F,1962/06/30,49y8m) 手術日期 2011/06/13 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 08:08 進入手術室 08:20 麻醉開始 08:40 誘導結束 09:00 抗生素給藥 09:25 手術開始 12:13 抗生素給藥 13:15 開始輸血 14:48 手術結束 14:48 麻醉結束 14:53 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 顱底瘤手術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Right pterion approach for Simpson grade IV t... 開立醫師: 曾偉倫 開立時間: 2011/06/13 15:30 Pre-operative Diagnosis Right petroclival meningioma Post-operative Diagnosis Right petroclival meningioma Operative Method Right pterion approach for Simpson grade IV tumor resection Specimen Count And Types 1 piece About size:5x4x4 cm Source:Right petroclival meningioma Pathology Pending Operative Findings 1. The tumor is yellow-reddish, hypervascularized, 5x4x4 cm in size beneath the right frontal and temporal lobe. The border was clear. The tumor invades the cavernous sinous and push the pituitary gland upward. 2. The CN2, CN4 and pituitary gland were identified and well preserved during the operation. 3. The tumor pushed the great vessels medialy and upward. The vessels were preserved. 4. Blood loss: 400 ml. Operative Procedures Under ETGA, patient was put on supine position. We fixed her head with Mayfield clamp and tilt her head to left. After we shaved, scrubbed, disinfected and drapped, a curvilinear skin incision was made over right frontal-temporal area. The Saclp, fascia, and temporalis muscles was detached and retracted. After dural tenting, the outer sphenoid ridge and right anterior clinoid were resected by drills. The optic nerve was visulized and well preserved. The extra-dural part of the tumor could be seen next to the anterior clinoid process. A curvilinear durotomy was made and the tumor resection was performed with bipolar forceps, suction tube and CUSA. The tumor beneath the temporal lobe was resected first, and tumor beneath the frontal lobe was resected. The optic nerve, CN4 and pituitary gland was seen during the operation and well preserved. Complete hemostasis was done. We closed the dura with 3-0 Prolene with water-tight fashion. The skull was fixed back with mini-plate and screw. We placed a CWV drain and closed the scalp in layers. Operators P 杜永光 Assistants R6 胡朝凱 R2 曾偉倫 相關圖片 張信利 (M,1949/04/22,62y10m) 手術日期 2011/06/13 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Ossification of posterior longitudinal ligament, cervical (OPLL) 器械術式 C3-7 Laminoplasty 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 3 紀錄醫師 李柏穎, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:10 麻醉開始 08:25 誘導結束 08:45 抗生素給藥 08:50 手術開始 11:25 手術結束 11:25 麻醉結束 11:35 送出病患 11:40 進入恢復室 12:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓整形術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Laminoplasty 開立醫師: 曾峰毅 開立時間: 2011/06/13 11:36 Pre-operative Diagnosis Ossification of posterior longitudinal ligament, from C3 to C6 Post-operative Diagnosis Ossification of posterior longitudinal ligament, from C3 to C6 Operative Method Laminoplasty, C3-6, Hirabayashi method Specimen Count And Types Nil Pathology Nil Operative Findings Pre-operative SSEP at four limbs are not satisfactory. However, post-decompression SSEP over bilateral upper limbs was decreased, and recoverred a little spontaneously. Thecal sac was decompressed well after the procedure. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position with head fixed with Mayfield head clamp. After skin shaved, scrubbed, disinfected, and then draped, we made one midline skin incision to expose laminaes from C3 to c7. We drilled cortical bone at left laminaes from C3 to C6, and drilled bicortically at right laminaes from C3 to C6. We perfomred C3-6 laminoplasty with hinge at left, and augmentation fixed with mini-plates. After one submuscular CWV, the wound was closed in layers. Operators VS 曾漢民 Assistants R4 曾峰毅 R1 李柏穎 趙乃賢 (F,1945/09/11,66y6m) 手術日期 2011/06/13 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 3 紀錄醫師 李柏穎, 時間資訊 00:00 臨時手術NPO 11:53 進入手術室 12:00 麻醉開始 12:50 誘導結束 12:55 手術開始 13:00 抗生素給藥 16:00 抗生素給藥 18:10 手術結束 18:10 麻醉結束 18:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 顱底瘤手術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT 開立醫師: 曾峰毅 開立時間: 2011/06/13 18:29 Pre-operative Diagnosis Left cerebellopotine angle meningioma Post-operative Diagnosis Left cerebellopotine angle meningioma Operative Method Left retrosigmoidal approach for tumor excision, Simpson grade III Specimen Count And Types Several fragments of one tumor was sent for pathology. Pathology Pending Operative Findings One extra-axial, dura-based, normovascularized, well-defined tumor was noted in left cerebellopontine angle. Lower cranial nerves were identified and preserved well. Left vertebral artery was identified and preserved. One artery encased in the tumor was encountered during tumor removal, and then was further scrificed for hemostasis. Operative Procedures With endotracheal general anaesthsia, the patient was put in 3/4 prone position with head fixed with Mayfield clamp. We made one hockey-stick skin incision at left retroauricular area, and reflected the scalp flap inferiorly. We drilled for burr holes, and created craniotomy. We made durtomy, and released CSF from cistern. Cerebellum was retracted posteriorly, and tumor was removed in piecemeal fashion. After hemostasis, the dura was closed in water-tight fashion with suture and autologus fascia. Bone graft was fixed back with mini-plates, and the wound was closed in layers. Operators VS 曾漢民 Assistants R4 曾峰毅 R1 李柏穎 相關圖片 王麗娟 (F,1968/12/07,43y3m) 手術日期 2011/06/13 手術主治醫師 林至芃 手術區域 西址 034房 08號 診斷 Acute myeloid leukemia 器械術式 Port-A Implatation /WOR 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 林至芃 ASA 3 紀錄醫師 張敬道, 時間資訊 00:00 臨時手術NPO 17:05 報到 17:15 進入手術室 17:20 麻醉開始 17:20 抗生素給藥 17:25 誘導結束 17:35 手術開始 18:35 手術結束 18:35 麻醉結束 18:40 送出病患 18:45 進入恢復室 20:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 內頸靜脈切開,永久導管放置術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 記錄__ 手術科部: 麻醉部 套用罐頭: Port-A implantation, internal jugular 開立醫師: 張敬道 開立時間: 2011/06/13 18:19 Pre-operative Diagnosis AML Post-operative Diagnosis Ditto Operative Method Port-A implantation, echo-guided Specimen Count And Types nil Pathology Nil Operative Findings 1.Site: right internal jugular vein, with cut down & echo-guided procedure 2.Patent flow after implantation 3.Others: nil Operative Procedures 1.The patient was set on supine position and bilateral internal jugular veins were checked by echo. 2.After IVGA and local anesthesia applied, transverse skin incision for 3cm was made at pre-cordial area. 3.Undermine the skin at the layerbetween subcutaneous tissue and deep fascia in lateral direction. 4.Direct cut down method was performed to identify internal jugular vein. An IV catheter was inserted via the neck wound and negatively aspirated until venous blood attainable. 5.J-wire was inserted smoothly in rostral direction. An internal jugular catheter with dilator was inserted through the J-wire, and the dilator was then removed. 6.The catheter for Port-A was threaded into the internal jugular vein until mark 26 cm. Skin tunnel between neck and pre-cordial incision was made by the blunt dissection with Kelly clamp. The catheter was then threaded and adapted into the port and locked with restrictor. The port was inserted into the pouch ofpre-cordial incision. 7.Skin was closed layer by layer. Both catheter and the port were perfused with heparin solutionafter implantation. Operators 林至芃, Assistants 張敬道 林章榮 (M,1954/05/20,57y9m) 手術日期 2011/06/13 手術主治醫師 賴達明 手術區域 東址 016房 01號 診斷 Secondary cancer of brain and spinal cord 器械術式 Crainotomy Brain Tumor(P-LIN) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3E 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 00:16 通知急診手術 08:55 進入手術室 09:05 麻醉開始 09:30 誘導結束 09:40 抗生素給藥 09:45 手術開始 12:35 手術結束 12:35 麻醉結束 12:41 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除-手術時間在4小時以內 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for total tumor removal 開立醫師: 王奐之 開立時間: 2011/06/13 13:04 Pre-operative Diagnosis Right frontal metastatic tumor Post-operative Diagnosis Right frontal metastatic tumor Operative Method Craniotomy for total tumor removal Specimen Count And Types 1 piece About size:1*1*1cm Source:right frontal tumor Pathology Pending Operative Findings Whitish fragile tumor with distinct margin was noted at right frontal area. The cortical veins were well preserved. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head fixed in Mayfield skull clamp and turned to left. After shaving, scrubbing, disinfection & draping in sterile fashion, a curvilinear skin incision was made at right frontal area. A craniotomy was then done, followed by C-shaped durotomy. The tumor was then localized with intra-operative ultrasound. The arachnoid was then cut open, followed by dissection of tumor border. The tumor was then removed totally with tumor forceps. After hemostasis, the dura was closed in water-tight fashion with a small piece of fascial graft. The bone was placed back and fixed with mini-plates and the wound was closed in layers. Operators VS 賴達明 Assistants R6 陳睿生, R3 王奐之 Indication Of Emergent Operation Mass effect & remarkable edema 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Craniotomy for total tumor removal 開立醫師: 王奐之 開立時間: 2011/06/28 18:48 Pre-operative Diagnosis Right frontal metastatic tumor Post-operative Diagnosis Right frontal metastatic tumor Operative Method Craniotomy for total tumor removal Specimen Count And Types 1 piece About size:1*1*1cm Source:right frontal tumor Pathology Pending Operative Findings Whitish fragile tumor with distinct margin was noted at right frontal area. The cortical veins were well preserved. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head fixed in Mayfield skull clamp and turned to left. After shaving, scrubbing, disinfection & draping in sterile fashion, a curvilinear skin incision was made at right frontal area. A craniotomy was then done, followed by C-shaped durotomy. The tumor was then localized with intra-operative ultrasound. The arachnoid was then cut open, followed by dissection of tumor border. The tumor was then removed totally with tumor forceps. After hemostasis, the dura was closed in water-tight fashion with a small piece of fascial graft. The bone was placed back and fixed with mini-plates and the wound was closed in layers. Operators VS 賴達明 Assistants R6 陳睿生, R3 王奐之 Indication Of Emergent Operation Mass effect & remarkable edema 相關圖片 吳瑋萍 (F,1979/11/08,32y4m) 手術日期 2011/06/13 手術主治醫師 林至芃 手術區域 西址 036房 05號 診斷 Acute lymphoid leukemia, without mention of remission 器械術式 Port-A Implatation /WOR 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 林至芃 ASA 3 紀錄醫師 張敬道, 時間資訊 00:00 臨時手術NPO 14:03 報到 15:44 進入手術室 15:47 麻醉開始 15:50 誘導結束 15:57 手術開始 16:20 手術結束 16:25 送出病患 16:25 麻醉結束 16:30 進入恢復室 17:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 port–A導管植入術–治療性導管植入術 1 0 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 記錄__ 手術科部: 麻醉部 套用罐頭: Port-A implantation, subclavian 開立醫師: 張敬道 開立時間: 2011/06/13 16:25 Pre-operative Diagnosis ALL Post-operative Diagnosis Ditto Operative Method Port-A implantation, echo-guided Specimen Count And Types nil Pathology Nil Operative Findings 1.Site: right subclavian vein, with echo-guided procedure 2.Patent flow after implantation 3.Others: nil Operative Procedures 1.The patient was set on supine position and bilateral subclavian veins were checked by echo. 2.After IVGA and local anesthesia applied, transverse skin incision for 3cm was made at pre-cordial area. 3.Undermine the skin at the layer between subcutaneous tissue and deep fascia in lateral direction. 4.An IV catheter was inserted via the subclavian incision and negatively aspirated until venous blood attainable. 5.J-wire was inserted smoothly in rostral direction. A subclavian catheter with dilator was inserted through the J-wire, and the dilator was then removed. 6.The catheter of Port-A was threaded into the subclavian vein until mark 20 cm. The catheter was adapted into the port and locked with restrictor.The Port was inserted into the pouch of pre-cordial incision. 7.Skin was closed layer by layer. Both catheter and port were perfused with heparin solution after implantation. Operators 林至芃, Assistants 張敬道 劉陳幸子 (F,1944/08/28,67y6m) 手術日期 2011/06/13 手術主治醫師 王國川 手術區域 東址 016房 02號 診斷 Coma 器械術式 Revision of CSF shunt 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3E 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 00:23 通知急診手術 13:15 報到 13:15 進入手術室 13:20 麻醉開始 13:25 誘導結束 13:50 抗生素給藥 13:58 手術開始 14:35 麻醉結束 14:35 手術結束 14:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦脊髓液分流管重置 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt revision 開立醫師: 王奐之 開立時間: 2011/06/13 14:50 Pre-operative Diagnosis Ventriculoperitoneal shunt dysfunction with worsening hydrocephalus Post-operative Diagnosis Ventriculoperitoneal shunt dysfunction with worsening hydrocephalus Operative Method Ventriculoperitoneal shunt revision Specimen Count And Types Nil Pathology Nil Operative Findings Easy oozing was encountered during the whole operation. Smooth CSF flow was confirmed after inserting the new ventricular catheter and reservoir. A Codman programmable shunt preset to 100mmH2O was used. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After shaving, scrubbing, disinfection & draping in sterile fashion, a linear skin incision along previous wound was made at right frontal area, another linear incision was made at right retroauricular area. The original ventricular catheter and reservoir were removed, new ventricular catheter and reservoir were assembled and inserted into the burr hole. After hemostasis, the wounds were closed in layers. Operators VS 王國川 Assistants R6 陳睿生, R3 王奐之 Indication Of Emergent Operation Progressive hydrocephalus and IICP 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt revision 開立醫師: 王奐之 開立時間: 2011/06/28 18:48 Pre-operative Diagnosis Ventriculoperitoneal shunt dysfunction with worsening hydrocephalus Post-operative Diagnosis Ventriculoperitoneal shunt dysfunction with worsening hydrocephalus Operative Method Ventriculoperitoneal shunt revision Specimen Count And Types Nil Pathology Nil Operative Findings Easy oozing was encountered during the whole operation. Smooth CSF flow was confirmed after inserting the new ventricular catheter and reservoir. A Codman programmable shunt preset to 100mmH2O was used. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After shaving, scrubbing, disinfection & draping in sterile fashion, a linear skin incision along previous wound was made at right frontal area, another linear incision was made at right retroauricular area. The original ventricular catheter and reservoir were removed, new ventricular catheter and reservoir were assembled and inserted into the burr hole. After hemostasis, the wounds were closed in layers. Operators VS 王國川 Assistants R6 陳睿生, R3 王奐之 Indication Of Emergent Operation Progressive hydrocephalus and IICP 相關圖片 黃桂淼 (F,1954/05/15,57y9m) 手術日期 2011/06/13 手術主治醫師 郭順文 手術區域 東址 018房 02號 診斷 Malignant neoplasm of upper lobe, bronchus or lung 器械術式 Thoracoscopy+Open Chest (LUL) 手術類別 預定手術 手術部位 胸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 趙安怡 ASA 2 紀錄醫師 李佳穎, 時間資訊 23:56 臨時手術NPO 15:00 報到 15:11 進入手術室 15:18 麻醉開始 16:05 誘導結束 16:10 抗生素給藥 16:18 手術開始 18:00 麻醉結束 18:00 手術結束 18:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 胸腔鏡肺葉切除術 1 1 L 手術 根除性淋巴切除術(肺葉切除或全肺切除時) 1 2 L 摘要__ 手術科部: 外科部 套用罐頭: VATS lingular lobectomy + LN dissection 開立醫師: 李佳穎 開立時間: 2011/06/13 18:12 Pre-operative Diagnosis LUL cancer Post-operative Diagnosis LUL cancer Operative Method VATS lingular lobectomy + LN dissection Specimen Count And Types pending. Pathology pending. Operative Findings 1.One 1cm soft tumor with central necrosis noted over lingular lobe. 2.Another 0.5cm whitish nodule noted near it. 3.Gr.5,6,7 LN: soft and small. Operative Procedures 1.DLETGA with Rt decubitus. 2.VATS setting as figure. 3.Loop PA-->PV-->bronchus to lingular lobe and transect by endo-GIA. 4.Gr.5,6,7 LN dissection 5.Set one Fr.28 C/T and wound closure by layers. Operators VS郭順文 Assistants r5李佳穎 r2蔡立威 張亞薇 (F,1968/02/10,44y1m) 手術日期 2011/06/14 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Meningioma 器械術式 Crainotomy Brain Tumor(P-LIN) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 戴依柔, 王奐之, 時間資訊 00:00 臨時手術NPO 07:30 報到 08:05 進入手術室 08:10 麻醉開始 09:00 誘導結束 09:25 手術開始 10:20 抗生素給藥 11:17 12:20 抗生素給藥 15:10 15:20 抗生素給藥 15:50 麻醉結束 15:50 手術結束 15:53 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 7 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腹腔鏡全子宮切除術 1 1 手術 頭顱成形術 1 1 手術 顱底瘤手術 1 1 手術 臉部腫瘤切除術直徑1-2CM 1 3 記錄__ 手術科部: 婦產部 套用罐頭: LAVH 開立醫師: 戴依柔 開立時間: 2011/06/14 10:32 Pre-operative Diagnosis 1.Myoma uteri Post-operative Diagnosis 2.Myoma uteri Operative Method Laparoscopic assisted vaginal hysterectomy Specimen Count And Types 1 piece About size:10*6*5 cm Source:uterus Pathology pending Operative Findings 1. Uterus: multiple uterine myomata. M1: 5*4 cm sybserosal myoma over right anterior fundus M2-M3:3*2 cm,2*2 cm,intramural myoma over posterior wall M4-M5:1*1cm submucosla type myoma 2. Adnexae: grossly normal 3. Cul-de-sac: free Estimated blood loss:minimal Blood transfusion:nil Complication:nil Operative Procedures 1.Put the patient on lithotomy position and vaginal douching. 2.Skin disinfection and draping 3.Insert uterine elevator and on Foley 4.Make a 1cm skin incision below umbilicus 5.Insert Varess needle and make pneumoperitoneum 6.Insert 10 mmtrocar and laparoscopy 7.Submucosal injection of diluted Pitressin (1:100) around the cervix 14.Make incision on the anterior vaginal mucosa and circumcision the cervix. 15.Enter the vesico-cervical space and utero-rectal space with long Kelly. 16.Clamp,cut and suture ligate bilateral utero-sacral ligaments with 1-0 Vicryl 17.Open the peritoneal cavity, anteriorly and posteriorly. 18.Clamp, cut and suture ligate bilateral cardinal ligaments with 1-0 Vicryl 19.Cut the uterus through midline with scissors 20.Morceration of the uterus 21.Clamp,cut and suture ligate bilateral ovarian ligaments and remove uterus 22.Reperitonealization and approximate the vaginal stump. 23.Check bleeding and hemostasis underlaparoscopy 24.Remove trocar and repair skin with 3-0 Vicryl Operators 張道遠, Assistants 戴依柔, 相關圖片 摘要__ 手術科部: 外科部 套用罐頭: 1. Bifrontal craniotomy for tumor resection, ... 開立醫師: 王奐之 開立時間: 2011/06/14 16:50 Pre-operative Diagnosis Recurrent meningioma at bilateral frontal area Post-operative Diagnosis Recurrent meningioma at bilateral frontal area Operative Method 1. Bifrontal craniotomy for tumor resection, left frontal (Simpson grade 1) & right frontal (Simpson grade 4) 2. Soft tissue tumor resection Specimen Count And Types 3 pieces About size:pieces Source:left eyebrow subcutaneous tumor About size:2*1.5*1.5cm Source:left frontal tumor About size:pieces Source:right frontal tumor Pathology Pending Operative Findings 1. Gliotic change of surrounding brain tissue was noted. The left & right frontal tumors were both whitish, elastic in consistency. Right frontal tumor invaded the right anterior frontal base and attached to the periorbital tissue, and invaded through the olfactory groove which was left untouched. 2. The soft tissue tumor at left eyebrow was yellowish with encapsulation, removed in pieces. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position. After shaving, scrubbing, disinfection & draping in sterile fashion, a bicoronal skin incision was made along previous scar. Bifrontal craniotomy was then performed along previous craniotomy. An U-shaped durotomy was done, the dura was then reflected superiorly. The left frontal tumor was removed en bloc, the right frontal tumor was removed in pieces. After meticulous hemostasis, the dura was closed in water-tight fashion. After central tenting, the bone was placed back and fixed with mini-plates. The slits between bone flaps were fitted with bone cements to make even skull surface. An epidural CWV drain was placed. The wound was closed with 2-0 Vicryl continuous sutures & 3-0 Nylon interrupted sutures. After closing the scalp wound, disinfection & draping in sterile fashion over left eyebrow was done. A linear incision was made along skin crease, followed by soft tissue dissection and removal of the tumor. After hemostasis, the wound was closed with 4-0 Vicryl interrupted sutures & 5-0 PDS subcuticular continuous sutures. Operators VS 曾勝弘 Assistants R3 王奐之 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: 1. Bifrontal craniotomy for tumor resection, ... 開立醫師: 王奐之 開立時間: 2011/06/28 18:48 Pre-operative Diagnosis Recurrent meningioma at bilateral frontal area Post-operative Diagnosis Recurrent meningioma at bilateral frontal area Operative Method 1. Bifrontal craniotomy for tumor resection, left frontal (Simpson grade 1) & right frontal (Simpson grade 4) 2. Soft tissue tumor resection Specimen Count And Types 3 pieces About size:pieces Source:left eyebrow subcutaneous tumor About size:2*1.5*1.5cm Source:left frontal tumor About size:pieces Source:right frontal tumor Pathology Pending Operative Findings 1. Gliotic change of surrounding brain tissue was noted. The left & right frontal tumors were both whitish, elastic in consistency. Right frontal tumor invaded the right anterior frontal base and attached to the periorbital tissue, and invaded through the olfactory groove which was left untouched. 2. The soft tissue tumor at left eyebrow was yellowish with encapsulation, removed in pieces. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position. After shaving, scrubbing, disinfection & draping in sterile fashion, a bicoronal skin incision was made along previous scar. Bifrontal craniotomy was then performed along previous craniotomy. An U-shaped durotomy was done, the dura was then reflected superiorly. The left frontal tumor was removed en bloc, the right frontal tumor was removed in pieces. After meticulous hemostasis, the dura was closed in water-tight fashion. After central tenting, the bone was placed back and fixed with mini-plates. The slits between bone flaps were fitted with bone cements to make even skull surface. An epidural CWV drain was placed. The wound was closed with 2-0 Vicryl continuous sutures & 3-0 Nylon interrupted sutures. After closing the scalp wound, disinfection & draping in sterile fashion over left eyebrow was done. A linear incision was made along skin crease, followed by soft tissue dissection and removal of the tumor. After hemostasis, the wound was closed with 4-0 Vicryl interrupted sutures & 5-0 PDS subcuticular continuous sutures. Operators VS 曾勝弘 Assistants R3 王奐之 相關圖片 董子寧 (F,2000/10/30,11y4m) 手術日期 2011/06/14 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Glioma, brain 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:10 進入手術室 08:22 麻醉開始 08:50 誘導結束 09:00 抗生素給藥 09:07 手術開始 12:00 抗生素給藥 14:50 抗生素給藥 15:00 麻醉結束 15:00 手術結束 15:12 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 顱底瘤手術 1 1 摘要__ 手術科部: 外科部 套用罐頭: Telovelar approach for subtotal tumor excision. 開立醫師: 鍾文桂 開立時間: 2011/06/14 17:20 Pre-operative Diagnosis Brainstem glioma. Post-operative Diagnosis Brainstem glioma. Operative Method Telovelar approach for subtotal tumor excision. Specimen Count And Types 1 piece About size:Multiple fragments. Source:brainstem glioma Pathology Pending. Operative Findings Pink-grayish fragile soft tumor with cyst content at its posterior side. The cyst located more on the right side of the brainstem. The tumor mass is more on the left side of the brainstem. Due to the tumors fragile character, it brough difficulty in tumor resection. CSF from the 4th ventricle drained out during tumor resection. We used intraoperative ultrasonography to localize the tumor mass in the brainstem. Grossly, a bulging portion at right posterior part of the medulla with some purplish pigmentation was noted. A thin layer of normal brainstem tissue was covered We used intraoperative ultrasonography to localize the tumor mass in the brainstem. Grossly, a bulging portion at right posterior part of the medulla with some purplish pigmentation was noted. A thin layer of normal brainstem tissue covered the tumor mass. We made a small corticotomy just above the tumor cyst at posterior part of the brainstem to achieve tumor resection. We made a small corticotomy just above the tumor cyst at posterior part of the brainstem to achieve tumor resection. The cystic content of the tumor was clear and colorless. Some venous congestion was noted at superior part of the tumor. Hemostasis was achieved with Surgicel packing. The anterior border of the tumor was not reached due to the nearby brainstem. Intraoperative SSEP and BAEP did not show changes. Intraoperative facial electrophysiologic stimulation over the inferior portion of the corticotomy showed intact bilateral facial response after subtotal tumor resection. Bilateral cerebellar hemispheres and right PICA remained intact through out the operation. Dural repair with DuraFoam and autologous fascia graft was done smoothly. Operative Procedures Under ETGA, the patient was placed in prone position and the head was fixed by 3-pin Mayfield head holder. After shaving, disinfection, and draping, a vertical 10-cm scalp incision was made from 1-cm above inion to C1 level. After midline dissection, the inion and C1 posterior arch were exposed. A 5 cm craniotomy was obtained by high speed drill to expose the posterior fossa. A U shape durotomy was made with electrocoagulation of the occipital sinus. Then, telovelar approach was done by lysis of the arachnoid bands and lateral displacement of bilateral tonsils to expose the floor of 4th ventricle. The medulla was well exposed After midline dissection, the inion and C1 posterior arch were exposed. A 5 cm craniotomy was obtained by high speed drill to expose the posterior fossa. A U shape durotomy was made with electrocoagulation of the occipital sinus. Then, telovelar approach was done by lysis of the arachnoid bands and lateral displacement of bilateral tonsils to expose the floor of 4th ventricle. The medulla was well exposed. After localization of the cystic tumor, a small corticotomy was made. The tumor was excised in piecemeal fashion by tumor forceps, ring forceps, and microdissector. After well hemostasis with Surgicel, the dura mater was repaired with DuraFoam and autologous fascia graft. The craniotomy plate was fixed by wires. The wound was closed in layers with one CWV drain above the craniotomy plate. Operators 郭夢菲 Assistants R5 鍾文桂 Ri 陳映廷 記錄__ 手術科部: 外科部 套用罐頭: bilateral telovelar approach for partial tumo... 開立醫師: 郭夢菲 開立時間: 2011/06/15 10:31 Pre-operative Diagnosis Malignant brainstem (pontine) glioma. Post-operative Diagnosis Malignant brainstem (pontine) glioma. Operative Method bilateral telovelar approach for partial tumor excision. Specimen Count And Types 1 piece About size:Multiple fragments. Source:brainstem glioma Pathology Pending. Operative Findings 1. There is a normal covering of brainstem tissue of the dorsal surface of the tumor, which was located inside the pons and protruded into the 4th ventricle. Pink-grayish fragile hypervascular soft tumor with cyst content at the posterior side of the pons. The cyst located more on the right side of the brainstem. The solid part of the tumor is more on the left side of the brainstem. 2. Due to the tumors fragile character, it brought difficulty in tumor resection. Only suction and grasping piece by piece could be done to get the tumor tissue. 3. We used intraoperative ultrasonography to localize the tumor mass in the brainstem since the tumor surface was covered with a layer of braistem tissue. Grossly, a bulging portion at right posterior part of the pons with some ntation was noted. 4. We made a small incision just above the tumor cyst at posterior part of the brainstem to achieve tumor resection.he cystic content of the tumor was clear and colorless. The anterior border of the tumor was not reached due to the nearby brainstem. 5. Intraoperative SSEP and BAEP did not show changes. Intraoperative facial electrophysiologic stimulation over the inferior portion of the corticotomy showed intact bilateral facial response after subtotal tumor resection. Bilateral cerebellar hemispheres and right PICA remained intact through out the operation. 6. Dural repair with DuraFoam and autologous fascia graft was done smoothly. Operative Procedures Under ETGA, the patient was placed in prone position and the head was fixed by 3-pin Mayfield head holder. After shaving, disinfection, and draping, a vertical 10-cm scalp incision was made from 2.5cm above inion to C1 level. After midline dissection, the inion and C1 posterior arch were exposed. A 5 cm craniotomy was obtained by high speed drill to expose the posterior fossa. A U shape durotomy was made with electrocoagulation of the occipital sinus. Then, telovelar approach was done by lysis of the arachnoid bands and lateral displacement of bilateral tonsils and cerebellar uvula to expose the lower part of floor of 4th ventricle. The pons was well exposed. After localization of the cystic tumor, a small incision was made on the dorsal part of the tumor, a thin layer of pontine tissue. Under microscopic view, the tumor was excised in piecemeal fashion by tumor forceps, ring forceps, and microdissector. The intraoperative BAEP and SSEP did not change. The stimulation of the dorsal surface of the lower part of incision showed both facial nuclei response after operation. After meticulous hemostasis, the sura was closed with a piece of fascial graft. DuroFoan was used to reinforce the dural closure. The bone graft was fixed back with four wires. The wound was then closed in layer with a CWV drain in the subcutaneous space. Operators Meng-Fai Kuo Assistants Wen-Kuei Chung 江東 (M,1980/05/15,31y9m) 手術日期 2011/06/14 手術主治醫師 林峰盛 手術區域 西址 035房 07號 診斷 Benign neoplasm of spinal cord 器械術式 Epi catheter implantation/ PC 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 硬肌麻醉 麻醉主治醫師 林峰盛 ASA 2 時間資訊 16:15 進入手術室 16:20 麻醉開始 16:25 誘導結束 16:25 抗生素給藥 16:30 手術開始 18:00 手術結束 18:00 麻醉結束 18:10 送出病患 18:20 進入恢復室 19:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Epidural anesthesia 1 0 記錄__ 手術科部: 麻醉部 套用罐頭: 1. T2-T3 epidura catheter was inserted, but n... 開立醫師: 張敬道 開立時間: 2011/06/14 18:16 Pre-operative Diagnosis Shwannoma Post-operative Diagnosis Shwannoma Operative Method 1. T2-T3 epidura catheter was inserted, but not smoothly which was considered due to previous operation. 2. C7-T1 under echo, a CSF abscess was noted, and was aspirated. 3. C7-T1 echo-guide blood patch was administrated. Specimen Count And Types nil Pathology nil Operative Findings CSF leakage Operative Procedures Operators 林峰盛 Assistants 張敬道 陳宏睿 (M,1979/12/22,32y2m) 手術日期 2011/06/14 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Hyperhidrosis 器械術式 Endoscopic T2 sympathectomy 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 08:07 進入手術室 08:18 麻醉開始 08:23 誘導結束 08:45 抗生素給藥 08:57 手術開始 09:30 手術結束 09:30 麻醉結束 09:35 送出病患 09:38 進入恢復室 11:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 經內視鏡交感神經切斷術 1 1 B 摘要__ 手術科部: 外科部 套用罐頭: Transendoscopic bilateral T2 sympathectomy 開立醫師: 李振豪 開立時間: 2011/06/14 09:45 Pre-operative Diagnosis Hyperhidrosis, bilateral hand Post-operative Diagnosis Hyperhidrosis, bilateral hand Operative Method Transendoscopic bilateral T2 sympathectomy Specimen Count And Types nil Pathology Nil Operative Findings The palm temperature before T2 sympathectomy was 30.3 degree Celsius over left side and 30.0 degree Celsius over right side. After whole procedure, the palm temperature was 32.8 degree Celsius over left side and 31.8 degree Celsius over right side. Total temperature elevation was 2.5 degree Celsius over left side and 1.8 degree Celsius over right side. No acute complication was noted during the operation. Operative Procedures Under endotracheal general anesthesia, the patient was put in semi-sitting position. The skin was scrubbed, disinfected, and draped as usual. Transverse skin incision was made at bilateral mid-axillary line, T4 level with 1cm in length. Pleural cavity was entered and T2 sympathetic nerve was identified under endoscopic view. Bilateral T2 sympathectomy was done with electrocautery. Deair was done and the wound was closed with 3-0 Nylon. Operators VS賴達明 Assistants R4李振豪 相關圖片 饒春子 (F,1939/03/31,72y11m) 手術日期 2011/06/14 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Lumbar stenosis 器械術式 Laminectomy for decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 09:47 進入手術室 09:52 麻醉開始 10:00 誘導結束 10:20 抗生素給藥 10:42 手術開始 11:35 手術結束 11:35 麻醉結束 11:43 送出病患 11:45 進入恢復室 12:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 椎弓切除術(減壓)-二節以內 1 1 摘要__ 手術科部: 外科部 套用罐頭: Sublaminar decompression, L3 開立醫師: 李振豪 開立時間: 2011/06/14 11:49 Pre-operative Diagnosis Lumbar stenosis, L3 Post-operative Diagnosis Lumbar stenosis, L3 Operative Method Sublaminar decompression, L3 Specimen Count And Types nil Pathology Nil Operative Findings Thecal sac was compressed tightly by the hypertrophic ligmentum flavum. After sublaminar decompression, the thecal sac expanded well. No incidental durotomy or CSF leakage was noted during the operation. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position. The L2-3 disc space was identified by portable C-arm X-ray. The skin was shaved, scrubbed, and disinfected as usual. Midline skin incision was made from L2 to L3 level along previous operative scar. The subcutaneous soft tissue was dissected. The L2 spinous process was splitted by air-drived oscillating saw to exposed the L3 laminae. Under operative microscope, Laminotomy was performed and sublaminar decompression was done with Kerrison punches. Hemostasis was achieved with Gelfoam packin. The wound was then closed in layers with 2-0 Vicryl and 4-0 Dexon. Operators VS賴達明 Assistants R4李振豪, Ri林志豪 張美香 (F,1955/12/05,56y3m) 手術日期 2011/06/14 手術主治醫師 賴達明 手術區域 東址 003房 03號 診斷 Spondylolisthesis, acquired 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 11:50 進入手術室 12:00 麻醉開始 12:15 誘導結束 12:30 抗生素給藥 12:47 手術開始 15:20 麻醉結束 15:20 手術結束 15:25 抗生素給藥 15:25 送出病患 15:30 進入恢復室 16:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎間盤切除術-腰椎 1 2 摘要__ 手術科部: 外科部 套用罐頭: L3-4 transforaminal lumbar interbody fusion w... 開立醫師: 李振豪 開立時間: 2011/06/14 15:40 Pre-operative Diagnosis L3-4 spondylolisthesis with lumbar stenosis Post-operative Diagnosis L3-4 spondylolisthesis with lumbar stenosis Operative Method L3-4 transforaminal lumbar interbody fusion with PEEK cage + L3-4 transpedicular screws for posterior fixation + posterolateral fusion with autologous bone graft Specimen Count And Types nil Pathology Nil Operative Findings Anterior subluxation of L3 was noted. The thecal sac was compressed by hypertrophic ligmentum flavum. The thecal sac expanded well after laminectomy. Degenerative change of L3/4 disc was noted. One #11 PEEK Banana cage was inserted for interbody fusion. Total four transpedicular screws with 6.2 x 40mm in size were used for posterior fixation. The rods were 5cm in length at each side. The left L4 root was preserved well during whole procedure. No incidental durotomy or CSF leakage were found. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position. The L3 and L4 pedicles were localized by portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made from L3 to L4 level. The subcutaneous soft tissue and paravertebral muscle groups were detached. Laminectomy was performed for posterior decompression. L3 and L4 transpedicular screws were inserted under C-arm guided. L3/4 left facetectomy and diskectomy was done. One Banana cage and autologous bone graft was placed for interbody fusion. The location of Cage was confirmed by C-arm. Hemostasis was achieved with Bipolar electrocautery and Gelfoam packing. One epidural Hemovac was placed. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS賴達明 Assistants R4李振豪, Ri林志豪 蔣淑玲 (F,1960/01/08,52y2m) 手術日期 2011/06/14 手術主治醫師 楊士弘 手術區域 東址 016房 01號 診斷 Brain abscess 器械術式 Left frontal craniotomy with tumor excision 手術類別 緊急手術 手術部位 頭、頸 傷口分類 污染 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 曾峰毅, 時間資訊 23:11 通知急診手術 00:00 開始NPO 00:00 臨時手術NPO 08:32 報到 08:50 進入手術室 08:55 麻醉開始 09:20 誘導結束 09:45 抗生素給藥 10:00 手術開始 12:45 抗生素給藥 13:20 麻醉結束 13:20 手術結束 13:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 腦瘤切除-手術時間在4小時以內 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT 開立醫師: 曾峰毅 開立時間: 2011/06/14 13:42 Pre-operative Diagnosis Left frontal tumor, with cystic component, suspected glioma, suspected metastasis, suspected abscess Post-operative Diagnosis Brain abscess Operative Method Right frontal craniotomy for tumor excision Left frontal craniotomy for tumor excision Specimen Count And Types Two bottles of specimens were sent for patholgoy. Two culture swab was sent for culture. Pathology Pending Operative Findings The adhesion between dura and the skull bone was significant, and arachnoid memebrane was thicked. Arachnoiditis was suspected. Two cystic lesion located at left frontal area near frontal base with purulent content. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head fixed with Mayfield head clamp. After scalp shaved, scrubbed, disinfected, and then draped, we made bicoronal skin incision and reflected the scalp inferiorly. We drilled four burr holes, and then created cranitomy. We made X-shape dura incision, and created corticotomy for tumor excision. After hemostasis achieved, we closed the dura in water-tight fashion, and fixed the bone graft back with mini-plates. After one subgaleal CWV, we closed the wound in layers. With endotracheal general anaesthesia, the patient was put in supine position with head fixed with Mayfield head clamp. After scalp shaved, scrubbed, disinfected, and then draped, we made bicoronal skin incision and reflected the scalp inferiorly. We drilled four burr holes, and then created cranitomy. We made X-shape dura incision, and created corticotomy for tumor excision. After hemostasis achieved, we closed the dura in water-tight fashion. After one epidural CWV set, we fixed the bone graft back with mini-plates. We closed the wound in layers. Operators VS 楊士弘 Assistants R4 曾峰毅 Ri 戴怡芸 Indication Of Emergent Operation Intracranial hypertension. 相關圖片 盧美瑾 (F,1977/10/28,34y4m) 手術日期 2011/06/15 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Cerebellar hemorrhage 器械術式 Cerebellar cavernoma excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李柏穎, 時間資訊 00:00 臨時手術NPO 13:20 報到 13:25 進入手術室 13:33 麻醉開始 14:00 誘導結束 14:03 手術開始 14:15 抗生素給藥 17:15 抗生素給藥 18:10 麻醉結束 18:10 手術結束 18:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT 開立醫師: 曾峰毅 開立時間: 2011/06/15 18:31 Pre-operative Diagnosis Cerebellar hemorrhage with venous malformationm, suspected cavernoma Post-operative Diagnosis Cerebellar cavernoma with venous malformation Operative Method Suboccipital craniotomy for cerebellar tumor excision Specimen Count And Types tumor　was sent for pathology Pathology Pending Operative Findings Blood clot with peripheral hemosiderin deposition was noted at right cerebellar hemisphere. Malberry-like lesion was noted near the blood clot with abundant tortuous cappillaries. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position with head fixed by Mayfield head clamp. After scalp shaved, scrubbed, disinfected, and then draped, we made one midline skin incison from 3 cm above inion to upper cervical region. We dissected and drilled burr holes for suboccipital cranitomy. We opened the dura, and identified hemorrhage site. Cavernoma was removed in en bloc, and hemostasis was done. We closed the dura in water-tight fashion with suture and autologous fascia graft. Bone graft was fixed back with mini-plates and wires. One CWV was placed, and the wound was closed in layers. Operators VS 曾漢民 Assistants R4 曾峰毅 R1 李柏穎 相關圖片 洪勝男 (M,1976/06/30,35y8m) 手術日期 2011/06/15 手術主治醫師 曾漢民 手術區域 東址 003房 03號 診斷 Herniation of intervertebral disc (HIVD) 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 14:35 進入手術室 14:50 麻醉開始 14:55 誘導結束 15:00 抗生素給藥 15:32 手術開始 18:00 抗生素給藥 18:10 手術結束 18:10 麻醉結束 18:18 送出病患 18:20 進入恢復室 19:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 手術 椎間盤切除術-頸椎 1 1 手術 椎間盤切除術-頸椎 1 2 摘要__ 手術科部: 外科部 套用罐頭: Anteior discectomy and cage fusion 開立醫師: 曾偉倫 開立時間: 2011/06/15 18:19 Pre-operative Diagnosis c5~6,6~7 HIVD Post-operative Diagnosis c5~6,6~7 HIVD Operative Method Anteior discectomy and cage fusion Specimen Count And Types nil Pathology nil Operative Findings 1.Protruding disc at C5~6,6~7 level that compressed the left roots tightly. 2.Left C6,7 nerve roots were exposed and released. 3.6# cages were inserted at C5~7 disc space 4.Mild hypertrophic PLL was noted Operative Procedures 1.ETGA, supine 2.Right neck transverse skin incision 3.Dissect along the anterior border of SCM muscle to expose prevertebral space 4.Detach longus coli muscle 5.Identified C5~7 disc 6.Disecetemoy C6~7 7.Cage insertion 8.further discectomy of C5~6 level 9.Cage insertion 10.Set one minihemovac 11.Close wound in layers Operators VS 曾漢民 Assistants 胡朝凱, 曾偉倫 相關圖片 張德定 (M,1927/11/12,84y4m) 手術日期 2011/06/15 手術主治醫師 蔡瑞章 手術區域 東址 005房 01號 診斷 Meningioma 器械術式 Right convexity meningioma excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李柏穎, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:10 進入手術室 08:18 麻醉開始 08:35 誘導結束 09:00 抗生素給藥 09:20 手術開始 12:00 抗生素給藥 12:20 麻醉結束 12:20 手術結束 12:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT 開立醫師: 曾峰毅 開立時間: 2011/06/15 12:39 Pre-operative Diagnosis Right frontoparietal convexity meningioma Post-operative Diagnosis Right frontoparietal convexity meningioma Operative Method Right frontoparietal craniotomy for Simpson grade 0 meningioma excision Specimen Count And Types One tumor with its dura attachment was sent for pathology. Pathology Pending Operative Findings One 6x5x5 cm normovacular, elastic to firm, dura-based, extra-axial tumor was noted at right frontoparietal area. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with right shoulder elevated, and head rotated to left and fixed with Mayfield head clamp. Difficulty of Foley catheter insertion was encountered, and urologist was consulted for cystoscope-assisted Foley insertion. We shaved, scrubbed, disinfected, and then draped the patient. Reverse-U-shape skin incsion was made at right frontoparietal area. Four burr holes were drilled for craniotomy. We tented the dura along the craniotomy edge. We removed the tumor with its dura attachment. After hemosatsis, the duroplasty was done in water-tight fashion with autologous fascia graft. Bone graft was fixed back with wires after one epidural CWV set. The wound was closed in layers. Operators P 蔡瑞章 Assistants R4 曾峰毅 R1 李柏穎 相關圖片 黃映棱 (F,1963/11/28,48y3m) 手術日期 2011/06/15 手術主治醫師 蔡瑞章 手術區域 東址 003房 02號 診斷 Spondylolysis, lumbosacral 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 12:00 進入手術室 12:10 麻醉開始 12:15 誘導結束 12:50 抗生素給藥 12:57 手術開始 14:20 手術結束 14:20 麻醉結束 14:25 送出病患 14:29 進入恢復室 15:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-腰椎 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Microscopic discectomy 開立醫師: 曾偉倫 開立時間: 2011/06/15 14:25 Pre-operative Diagnosis Left L5~S1 sequestrated disc Post-operative Diagnosis Left L5~S1 sequestrated disc Operative Method Microscopic discectomy Specimen Count And Types nil Pathology nil Operative Findings 1.One about 1x1.5 cm sequestrated disc without PLL rupture was noted at Left L5~S1 disc level that compressed the root severely. 2.The root was injected and became thin. 3.The rest part of disc was not dehydrated. 4.After decompression, root was loose. Operative Procedures 1.ETGA, prone 2.Midline skin incison at L5~S1 level 3.Detach left paravertebral muscle 4.Resect flavum ligment at left 5~S1 space 5.Identified root and disc 6.open PLL 7.Resect disc 8.Further dissection of disc space 9.local rinderon spary 10.Close wound in layers. Operators P 蔡瑞章 Assistants 胡朝凱, 曾偉倫 相關圖片 梁政翎 (F,2002/09/17,9y5m) 手術日期 2011/06/15 手術主治醫師 許文明 手術區域 兒醫 062房 02號 診斷 Soft tissue tumor 器械術式 Lumbar puncture，BMA+B，Port-A catheter implatation 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 許皓淳, 時間資訊 06:00 臨時手術NPO 10:40 報到 10:48 進入手術室 10:50 麻醉開始 11:00 誘導結束 11:02 抗生素給藥 11:12 手術開始 12:25 13:15 手術結束 13:15 麻醉結束 13:15 13:21 送出病患 13:28 進入恢復室 14:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 內頸靜脈切開,永久導管放置術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 套用罐頭: Port-A implantation by surgical cut down 開立醫師: 許皓淳 開立時間: 2011/06/15 12:20 Pre-operative Diagnosis Rhabdomyosarcoma Post-operative Diagnosis Rhabdomyosarcoma Operative Method Port-A implantation by surgical cut down Specimen Count And Types nil Pathology nil Operative Findings 1. Port-A catheter was inserted into SVC via left cephalic vein 2. Post-operative portable X-ray showed Port-A catheter tip in correct venous branch to SVC. Operative Procedures 1. IVG anesthesia with the patient in supine position, prepped and draping were performed in the usual sterile method. 2. An incision was made in left side neck and subclavical area. After identification of the cephalic vein, Port-A catheter was inserted. 3. Adequate hemostasis was obtained. 4. Post-operative portable X-ray showed catheter tip in correct venous branchto SVC. Then the wound was closed in layers. Operators 許文明 Assistants R1許皓淳, Ri林紀廷 相關圖片 陳昭益 (M,1940/11/05,71y4m) 手術日期 2011/06/15 手術主治醫師 賴達明 手術區域 東址 002房 03號 診斷 Spinal metastasis 器械術式 Spinal tumor excision + TPS 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 01:00 臨時手術NPO 01:00 開始NPO 01:24 通知急診手術 13:30 報到 13:50 進入手術室 13:55 麻醉開始 14:05 誘導結束 14:10 抗生素給藥 14:44 手術開始 15:40 開始輸血 17:10 抗生素給藥 18:30 手術結束 18:30 麻醉結束 18:40 送出病患 18:45 進入恢復室 20:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 惡性脊髓腫瘤切除術 1 1 手術 脊椎融合術-後融合,有固定物(<=六節) 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: T12-L1 laminectomy for tumor excision + T10, ... 開立醫師: 李振豪 開立時間: 2011/06/15 19:19 Pre-operative Diagnosis T12-L1 spinal tumor, suspect metastasis, with thecal sac compression Post-operative Diagnosis T12-L1 spinal tumor, suspect metastasis, with thecal sac compression Operative Method T12-L1 laminectomy for tumor excision + T10, T11, and L2 transpedicular screws for posterior fixation Specimen Count And Types 1 piece About size:Multiple pieces Source:L1 tumor Pathology Pending Operative Findings Tumor was mainly located at L1 with bony destruction of right side facet and pedicle. Paraspinal extension(+). The tumor was gray-pinkish, hypervascularized, elastic, and ill-defined in margin. No intrathecal involvement was noted. No incidental durotomy or CSF leakage was noted during the operation. The thecal sac expanded well after decompression and partial tumor excision. Four 6.2 x 40mm transpedicular screws were inserted to T10 and T11 level. Two 6.2 x 45mm transpedicular screws were inserted to L2 level. Two 13cm rods and one cross link were applied for posterior fixation. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position. T10 to L2 level were localized by portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made from T10 to L2 level. The subcutaneous soft tissue and paravertebral muscle groups were detached. T10, T11, and L2 transpedicular screws were inserted under C-arm guided. T12 and L1 laminectomy was done for intraspinal tumor excision. The tumor located at right side pedicle of L1 also removed. Hemostasis was achieved with bipolar electrocautery, Surgicel lining, Gelfoam packing, and bone cement compaction. Rods and cross-link were applied for posterior fixation. Two 1/8 epidural Hemovac was placed. The wound was irrigated with Gentamicin solution. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Blood loss: 2000ml. Operators VS賴達明 Assistants R4李振豪, Ri林志豪 Indication Of Emergent Operation Spinal tumor with thecal sac compression 葉國保 (M,1955/08/15,56y6m) 手術日期 2011/06/15 手術主治醫師 蔡翊新 手術區域 東址 003房 號 診斷 Glioma, brain 器械術式 Crainotomy Brain Tumor(P-LIN) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 08:07 進入手術室 08:18 麻醉開始 08:55 誘導結束 09:00 手術開始 09:56 抗生素給藥 11:35 手術結束 11:35 麻醉結束 11:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT 開立醫師: 蔡翊新 開立時間: 2011/06/15 11:18 Pre-operative Diagnosis Left frontal brain tumor, suspected high-grade glioma. Post-operative Diagnosis Left frontal brain tumor, suspected high-grade glioma. Operative Method Left frontal craniotomy for partial tumor excision. Specimen Count And Types 1 piece About size:2x2x2 cm Source:Left frontal brain tumor Pathology Frozen section: compatible with high-grade glioma. Operative Findings A 2 x 2 cm grey-reddish change of cortex at left middle frontal gyrus. There was a tortuous vein anterior to the tumor, possible tumor draining vein with AV shunting phenomenon. A 2 x 2 x 2 cm block of tumor was excised and sent for frozen section and pathology. Easy bleeding from the cut surface was noted. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right and fixed by Mayfield skull clamp. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: curvilinear at left frontotemporal region. Raney clips were applied to the scalp edge for temporary hemostasis. 5. Craniotomy window: 8 x 6 cm, left frontal, created by making 2 burr holes then cut by power saw. 6. Dural tenting: by 2/0 silk, 2 cm in interval, distributed along the edge of skull window. 7. Dural incision: curvilinear along the edge of skull window. 8. Lobectomy: a 2 x 2 cm cerebral cortical incision was made by Greenwood bipolar forceps at left middle frontal gyrys. The tumor was resected by bipolar forceps as en-block of 2 x 2 x 2 cm in size. The bleeding during the dissection was stopped by bipolar coagulator or by packing with conttonoid patties. 9. Hemostasis: The hemostasis during the resection ofthe tumor was obtained satisfactorily by bipolar coagulator and suction on the patties packing on the bleeders. The blood oozing point from several locations on the bare surface after tumor excision were packed with Surgicel for complete hemostasis. Finally, the cavity created after tumoe excision was irrigated with NS several times and it was perfectly watery clear before the dural closure. 10.Dural closure: continuous suture with 4/0 Prolene. A piece of Durofoam (7.5 x 2.5 cm ) was used for dura repair because of dural tear at anterior part. 11.Closure of skull window: the skull plate was placed back to craniotomy window and fixed by 3 miniplates and 6 screws. The dura was tented to the center of the skull plate by a 2/0 stitch. 12.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 13.Drain: one, epidural, CWV. 14.Blood transfusion: nil. Blood loss: 150 ml. 15.Course of the surgery: smooth. Operators VS 蔡翊新 Assistants R6胡朝凱R2曾偉倫 相關圖片 錢嘉明 (M,1951/09/14,60y6m) 手術日期 2011/06/15 手術主治醫師 住院醫師 手術區域 西址 038房 06號 診斷 Breast cancer, male 器械術式 Port-A catheter Removal 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 14:48 進入手術室 15:08 麻醉開始 15:10 手術開始 15:50 手術結束 16:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 皮下肌肉或深部異物取出術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Port-A catheter Removal 開立醫師: 徐展陽 開立時間: 2011/06/15 15:54 Pre-operative Diagnosis Breast cancer s/p port-A insertion Post-operative Diagnosis Breast cancer s/p removal of port-A Operative Method Port-A catheter Removal Specimen Count And Types nil Pathology Nil Operative Findings The catheter was removed totally and the course was smooth Operative Procedures The patient lied in supine position. Left upper chest was disinfected and drapped. After the local anesthesia, linear incision line was made along the previous wound scar. We dissected deep to explore the port. We removed port and the catheter. After adequate irrigation with normal saline and hemostasis, we closed the wound in layers. Operators VS陳坤源 Assistants R1徐展陽 張葉阿滿 (F,1942/06/17,69y8m) 手術日期 2011/06/16 手術主治醫師 曾漢民 手術區域 東址 011房 06號 診斷 Lymphoma 器械術式 Port-A catheter Implatation 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 李振豪, 時間資訊 14:05 進入手術室 14:25 抗生素給藥 14:40 手術開始 15:35 手術結束 15:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 port–A導管植入術–治療性導管植入術 1 0 L 摘要__ 手術科部: 外科部 套用罐頭: port-A implantation via percutaneous puncture 開立醫師: 李振豪 開立時間: 2011/06/16 16:18 Pre-operative Diagnosis CNS lymphoma Post-operative Diagnosis CNS lymphoma Operative Method port-A implantation via percutaneous puncture Specimen Count And Types nil Pathology Nil Operative Findings 1. Cellcite Fr. 8.5 Port-A catheter was inserted into SVC via left subclavicular vein. 2. Post-operative portable X-ray showed Port-A catheter tip in correct venous branch to SVC. 3. The catheter was fixed at 17cm in depth. Operative Procedures The patient was put in supine position. Antiseptics and drapping were performed in the usual sterile method. Local anesthesia with 1% Xylocaine was applied over left forechest. An skin incision was made in left subclavicular area. Left subclavicular vein puncture was performed then Port-A catheter was inserted. Intra-operative portable X-ray was performed to make sure the location of catheter tip. The Port-A catheter was set up. Hemostasis was achieved by electrocautery. The Port and catheter were fixed with three stitches. The wound was then closed in layers with 3-0 Vicryl and 4-0 Nylon. The function of the Port-A catheter was checked again with Heparin solution after wound closure. Operators VS曾漢民 Assistants R4李振豪 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: port-A implantation via percutaneous puncture 開立醫師: 李振豪 開立時間: 2011/07/11 06:29 Pre-operative Diagnosis CNS lymphoma Post-operative Diagnosis CNS lymphoma Operative Method port-A implantation via percutaneous puncture Specimen Count And Types nil Pathology Nil Operative Findings 1. Cellcite Fr. 8.5 Port-A catheter was inserted into SVC via left subclavicular vein. 2. Post-operative portable X-ray showed Port-A catheter tip in correct venous branch to SVC. 3. The catheter was fixed at 17cm in depth. Operative Procedures The patient was put in supine position. Antiseptics and drapping were performed in the usual sterile method. Local anesthesia with 1% Xylocaine was applied over left forechest. An skin incision was made in left subclavicular area. Left subclavicular vein puncture was performed then Port-A catheter was inserted. Intra-operative portable X-ray was performed to make sure the location of catheter tip. The Port-A catheter was set up. Hemostasis was achieved by electrocautery. The Port and catheter were fixed with three stitches. The wound was then closed in layers with 3-0 Vicryl and 4-0 Nylon. The function of the Port-A catheter was checked again with Heparin solution after wound closure. Operators VS曾漢民 Assistants R4李振豪 相關圖片 盧美瑾 (F,1977/10/28,34y4m) 手術日期 2011/06/16 手術主治醫師 曾漢民 手術區域 東址 016房 01號 診斷 Cerebellar hemorrhage 器械術式 V-P shunt 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3E 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 07:57 通知急診手術 08:30 進入手術室 08:40 麻醉開始 08:48 誘導結束 09:25 抗生素給藥 09:40 手術開始 11:10 手術結束 11:10 麻醉結束 11:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt through right Kocher`s point 開立醫師: 陳國瑋 開立時間: 2011/06/16 11:40 Pre-operative Diagnosis Cerebellar cavernoma s/p, with acute obstructive hydrocephalus Post-operative Diagnosis Cerebellar cavernoma s/p, with acute obstructive hydrocephalus Operative Method V-P Shunt through right Kocher`s point Specimen Count And Types nil Pathology nil Operative Findings Metronic medium pressure VP shunt, ventricular catheter 6.5cm, peritoneal catheter 30cm The CSF was clear and pinkish, and the opening pressure was around 5 cmH2O Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After shaving, scrubbing, disinfection and draping in sterile fashion, a curvilinear skin incision was made at right frontal area. Mini-laparotomy was also done at right upper quadrant of abdomen. One burr hole at right frontal Kocher point was made, and a small durotomy was made, followed by ventricular puncture. A subcutaneous tunnel was then created from abdomen to scalp, followed by passage of peritoneal catheter. The ventricular catheter, reservoir and the peritoneal catheter were then assembled and tested for function. The wounds were then closed in layers. Operators 曾漢民 Assistants R6鍾文桂 R2陳國瑋 Indication Of Emergent Operation acute obstructive hydrocephalus 相關圖片 陳艷莉 (F,1956/10/13,55y5m) 手術日期 2011/06/16 手術主治醫師 李苑如 手術區域 東址 002房 02號 診斷 Endometrial cancer 器械術式 Double-J ureteral stent insert 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 靜脈麻醉 麻醉主治醫師 劉治民 ASA 3 紀錄醫師 闕舜仁, 時間資訊 09:50 麻醉開始 09:55 誘導結束 10:04 手術開始 10:04 進入手術室 10:15 手術結束 10:15 麻醉結束 10:20 送出病患 10:21 進入恢復室 11:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 雙丁輸尿管導管置入術 1 0 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 記錄__ 手術科部: 泌尿部 套用罐頭: DBJ stent insertion 開立醫師: 闕舜仁 開立時間: 2011/06/16 10:24 Pre-operative Diagnosis Left obstructive uropathy Post-operative Diagnosis Left obstructive uropathy Operative Method cystoscopy and DBJ replacment Specimen Count And Types nil Pathology nil Operative Findings 1. Left 6-24 DBJ was replaced smoothly 2. Turbid urine in the bladder 3. Right Boari flap was intact Operative Procedures Under satisfactory anesthesia with the patient in lithotomy position, prepping and drapping was performed in the usual sterile fashion. A Fr 21 Olympus cystoscope was introduced into the bladder cavity under direct vision. Careful inspection was done and DBJ was replaced. Patient tolerated the procedure very well and was sent to recovery room in satisfactory condition. Operators 李苑如, Assistants 闕舜仁, 陳美蘭 (F,1967/09/14,44y6m) 手術日期 2011/06/16 手術主治醫師 賴達明 手術區域 東址 002房 02號 診斷 Intracerebral hemorrhage 器械術式 Evacuation of ICH 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3E 紀錄醫師 陳國瑋, 時間資訊 07:00 臨時手術NPO 07:00 開始NPO 10:09 通知急診手術 10:44 報到 10:44 進入手術室 10:50 麻醉開始 11:20 誘導結束 11:35 抗生素給藥 12:02 手術開始 14:35 抗生素給藥 15:50 麻醉結束 15:50 手術結束 16:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 1 R 手術 顱內壓視置入 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for hematoma evacuation and ICP mo... 開立醫師: 陳國瑋 開立時間: 2011/06/16 16:03 Pre-operative Diagnosis Right putaminal ICH Post-operative Diagnosis Right putaminal ICH Operative Method Craniotomy for hematoma evacuation and ICP monitor insertion Specimen Count And Types nil Pathology nil Operative Findings 1. The hematoma was located about 2cm deep from cortex and total about 30ml of hematoma was evacuated. 2. The final ICP level was 4mmHg, reference 486mmHg 2. The ICP monitor was put intraparenchymally and the final ICP level was 4mmHg, reference 486mmHg 3. The dural defec was repaired with Duragen 3. The dural defect was repaired with Duragen Operative Procedures The patient was put in supine position with head turning to left. The scalp was scrubed, disinfected and draped as usual. One logitudinal linear skin incision about 8cm was made. Oval craniotomy was then made. The hematoma was checked with intra-operative ultrasonography. Hematoma evacuation was done through trans-sulcus method. ICP monitor was inserted. After adequate hemostasis, 5*3cm duragel was put. The skin was then closed in layers. The patient was put in supine position with head turning to left. The scalp was scrubed, disinfected and draped as usual. One logitudinal linear skin incision about 8cm was made. Oval craniotomy was then made. The hematoma was checked with intra-operative ultrasonography. Hematoma evacuation was done through trans-sulcus method. ICP monitor was inserted. After adequate hemostasis, 5*3cm duragen was put. The skin was then closed in layers. The patient was put in supine position with head turning to left. The scalp was scrubed, disinfected and draped as usual. One logitudinal linear skin incision about 8cm was made. Oval craniotomy was then made. The hematoma was checked with intra-operative ultrasonography. Hematoma evacuation was done through trans-sulcus method. ICP monitor was inserted intraparenchyma. After adequate hemostasis, duroplasty was achieved with 5*3cm duragen. The skin was then closed in layers. Operators VS 賴達明 Assistants R5 鍾文桂 R2 陳國瑋 Indication Of Emergent Operation intracerebral hemorrhage 相關圖片 黃琰宸 (M,1952/05/02,59y10m) 手術日期 2011/06/16 手術主治醫師 陳敞牧 手術區域 東址 005房 01號 診斷 Normal pressure hydrocephalus 器械術式 Removal of shunt ligation 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:08 麻醉開始 08:15 誘導結束 08:54 手術開始 09:07 手術結束 09:07 麻醉結束 09:18 送出病患 09:20 進入恢復室 10:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 皮下肌肉或深部異物取出術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Removal of ventriculoperitoneal shunt ligature 開立醫師: 王奐之 開立時間: 2011/06/16 09:27 Pre-operative Diagnosis Hydrocephalus, status post ventriculoperitoneal shunt insertion, with overdrainage, status post shunt ligation Post-operative Diagnosis Hydrocephalus, status post ventriculoperitoneal shunt insertion, with overdrainage, status post shunt ligation Operative Method Removal of ventriculoperitoneal shunt ligature Specimen Count And Types Nil Pathology Nil Operative Findings The shunt reservoir recoils well after removal of shunt ligature. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position. After scrubbing, disinfection & draping in sterile fashion, a transverse linear incision was made along previous scar at right midclavicular area. The incision was further deepened with electrocautery, until the shunt catheter was exposed. After identifying the ligation suture, the suture was carefully removed without damage to the catheter. After hemostasis, the wound was closed in layers. Operators VS 陳敞牧 Assistants R3 王奐之, Ri 林志豪 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Removal of ventriculoperitoneal shunt ligature 開立醫師: 王奐之 開立時間: 2011/06/28 18:47 Pre-operative Diagnosis Hydrocephalus, status post ventriculoperitoneal shunt insertion, with overdrainage, status post shunt ligation Post-operative Diagnosis Hydrocephalus, status post ventriculoperitoneal shunt insertion, with overdrainage, status post shunt ligation Operative Method Removal of ventriculoperitoneal shunt ligature Specimen Count And Types Nil Pathology Nil Operative Findings The shunt reservoir recoils well after removal of shunt ligature. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position. After scrubbing, disinfection & draping in sterile fashion, a transverse linear incision was made along previous scar at right midclavicular area. The incision was further deepened with electrocautery, until the shunt catheter was exposed. After identifying the ligation suture, the suture was carefully removed without damage to the catheter. After hemostasis, the wound was closed in layers. Operators VS 陳敞牧 Assistants R3 王奐之, Ri 林志豪 相關圖片 王全德 (M,1926/03/03,86y0m) 手術日期 2011/06/16 手術主治醫師 陳敞牧 手術區域 東址 005房 03號 診斷 Spinal stenosis, lumbar 器械術式 L4/5 sublaminar decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 13:55 進入手術室 13:58 麻醉開始 14:10 誘導結束 14:20 抗生素給藥 14:57 手術開始 17:20 手術結束 17:20 麻醉結束 17:25 抗生素給藥 17:30 送出病患 17:30 進入恢復室 18:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 手術 椎弓切除術(減壓)-二節以內 1 1 摘要__ 手術科部: 外科部 套用罐頭: Right L4-5 laminotomy for sublaminar decompre... 開立醫師: 王奐之 開立時間: 2011/06/16 17:25 Pre-operative Diagnosis L4-5 spinal stenosis Post-operative Diagnosis L4-5 spinal stenosis Operative Method Right L4-5 laminotomy for sublaminar decompression Specimen Count And Types Nil Pathology Nil Operative Findings Hypertrophic ligamentum flavum was noted at L4-5 level, causing compression of thecal sac. The thecal sac became slack after decompression. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position. L3-4 & L4-5 disc spaces were localized under C-arm. After scrubbing, disinfection & draping in sterile fashion, a midline incision was made at L3-5. The right side paraspinal muscles were detached from spinous processes and laminae, exposing the L3-5 laminae. L3-4 laminotomy was then done, followed by sublaminar decompression. Same procedure was repeated again at L4-5. After hemostasis, the wound was closed in layers. After endotracheal general anesthesia, the patient was placed in prone position. L4-5 disc spaces were localized under C-arm. After scrubbing, disinfection & draping in sterile fashion, a midline incision was made at L4-5. The right side paraspinal muscles were detached from spinous processes and laminae, exposing the L4-5 laminae. L4-5 laminotomy was then done, followed by sublaminar decompression. After hemostasis, the wound was closed in layers. Operators VS 陳敞牧 Assistants R3 王奐之, Ri 林志豪 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Right L4-5 laminotomy for sublaminar decompre... 開立醫師: 王奐之 開立時間: 2011/06/28 18:47 Pre-operative Diagnosis L4-5 spinal stenosis Post-operative Diagnosis L4-5 spinal stenosis Operative Method Right L4-5 laminotomy for sublaminar decompression Specimen Count And Types Nil Pathology Nil Operative Findings Hypertrophic ligamentum flavum was noted at L4-5 level, causing compression of thecal sac. The thecal sac became slack after decompression. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position. L4-5 disc spaces were localized under C-arm. After scrubbing, disinfection & draping in sterile fashion, a midline incision was made at L4-5. The right side paraspinal muscles were detached from spinous processes and laminae, exposing the L4-5 laminae. L4-5 laminotomy was then done, followed by sublaminar decompression. After hemostasis, the wound was closed in layers. Operators VS 陳敞牧 Assistants R3 王奐之, Ri 林志豪 相關圖片 李汪雪 (F,1942/04/02,69y11m) 手術日期 2011/06/16 手術主治醫師 陳敞牧 手術區域 東址 005房 02號 診斷 Spinal stenosis, lumbar 器械術式 L3-5 sublaminar decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 09:35 報到 09:50 進入手術室 09:56 麻醉開始 10:08 抗生素給藥 10:30 誘導結束 10:52 手術開始 13:08 抗生素給藥 13:30 手術結束 13:30 麻醉結束 13:40 送出病患 13:42 進入恢復室 15:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術(減壓)-超過二節 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: Right L3-4 & L4-5 laminotomy for sublaminar d... 開立醫師: 王奐之 開立時間: 2011/06/16 13:52 Pre-operative Diagnosis L3-5 spinal stenosis Post-operative Diagnosis L3-5 spinal stenosis Operative Method Right L3-4 & L4-5 laminotomy for sublaminar decompression Specimen Count And Types Nil Pathology Nil Operative Findings Hypertrophic ligamentum flavum was noted at L3-4 & L4-5 level, more severe at L4-5, causing compression of thecal sac and thinning of dura. Unintentional durotomy was encountered at L4-5 and packed with Gelfoam. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position. L3-4 & L4-5 disc spaces were localized under C-arm. After scrubbing, disinfection & draping in sterile fashion, a midline incision was made at L3-5. The right side paraspinal muscles were detached from spinous processes and laminae, exposing the L3-5 laminae. L3-4 laminotomy was then done, followed by sublaminar decompression. Same procedure was repeated again at L4-5. After hemostasis, the wound was closed in layers. Operators VS 陳敞牧 Assistants R3 王奐之, Ri 林志豪 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Right L3-4 & L4-5 laminotomy for sublaminar d... 開立醫師: 王奐之 開立時間: 2011/06/28 18:47 Pre-operative Diagnosis L3-5 spinal stenosis Post-operative Diagnosis L3-5 spinal stenosis Operative Method Right L3-4 & L4-5 laminotomy for sublaminar decompression Specimen Count And Types Nil Pathology Nil Operative Findings Hypertrophic ligamentum flavum was noted at L3-4 & L4-5 level, more severe at L4-5, causing compression of thecal sac and thinning of dura. Unintentional durotomy was encountered at L4-5 and packed with Gelfoam. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position. L3-4 & L4-5 disc spaces were localized under C-arm. After scrubbing, disinfection & draping in sterile fashion, a midline incision was made at L3-5. The right side paraspinal muscles were detached from spinous processes and laminae, exposing the L3-5 laminae. L3-4 laminotomy was then done, followed by sublaminar decompression. Same procedure was repeated again at L4-5. After hemostasis, the wound was closed in layers. Operators VS 陳敞牧 Assistants R3 王奐之, Ri 林志豪 相關圖片 陳乙彥 (M,1941/05/10,70y10m) 手術日期 2011/06/16 手術主治醫師 蕭輔仁 手術區域 東址 002房 04號 診斷 Low Back Pain 器械術式 Radiofrequency coagulation 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 李振豪, 時間資訊 17:45 進入手術室 17:57 麻醉開始 17:58 誘導結束 17:59 手術開始 18:38 手術結束 18:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 高頻熱凝療法 1 1 B 摘要__ 手術科部: 外科部 套用罐頭: Bilateral L2 dorsal root radiofrequency stimu... 開立醫師: 李振豪 開立時間: 2011/06/16 17:25 Pre-operative Diagnosis Low back pain Post-operative Diagnosis Low back pain Operative Method Bilateral L2 dorsal root radiofrequency stimulation Specimen Count And Types nil Pathology Nil Operative Findings 1. Bilateral L2 dorsal root was identified by portable C-arm X-ray and sensory/motor stimulation test. No acute complication was noted after the procedure. 2. Temp: 42 oC, Time: 180sec x 2 cycles each side Operative Procedures The patient was put in prone position. The location of L2 was identified by portable C-arm X-ray. The skin was disinfected and draped as usual. Local anesthesia was performed with 1% Xylocaine 10ml. Bilateral L2 dorsal root radiofrequency stimulation was performed under portable C-arm guided. The patient stood whole procedure well. Operators VS蕭輔仁 Assistants R4李振豪 相關圖片 黃桂珍 (F,1935/10/13,76y5m) 手術日期 2011/06/16 手術主治醫師 蕭輔仁 手術區域 東址 002房 02號 診斷 Low back pain 器械術式 Decompression of mediun nerve 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 16:30 進入手術室 16:45 麻醉開始 16:46 誘導結束 16:47 手術開始 17:17 手術結束 17:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 高頻熱凝療法 1 1 B 摘要__ 手術科部: 外科部 套用罐頭: Bilateral L2 dorsal root radiofrequency stimu... 開立醫師: 李振豪 開立時間: 2011/06/16 16:26 Pre-operative Diagnosis Low back pain Post-operative Diagnosis Low back pain Operative Method Bilateral L2 dorsal root radiofrequency stimulation Specimen Count And Types Nil Pathology Nil Operative Findings 1. Bilateral L2 dorsal root was identified by portable C-arm X-ray and sensory/motor stimulation test. No acute complication was noted after the procedure. 2. Temp: 42 oC, Time: 180sec x 2 cycles each side Operative Procedures The patient was put in prone position. The location of L2 was identified by portable C-arm X-ray. The skin was disinfected and draped as usual. Local anesthesia was performed with 1% Xylocaine 10ml. Bilateral L2 dorsal root radiofrequency stimulation was performed under portable C-arm guided. The patient stood whole procedure well. Operators VS蕭輔仁 Assistants R4李振豪 相關圖片 方阿運 (M,1932/10/02,79y5m) 手術日期 2011/06/16 手術主治醫師 王國川 手術區域 東址 003房 03號 診斷 Subdural hemorrhage 器械術式 V-P shunt and S-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 14:32 進入手術室 14:35 麻醉開始 14:40 誘導結束 15:20 抗生素給藥 15:23 手術開始 17:05 手術結束 17:05 麻醉結束 17:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 記錄__ 手術科部: 外科部 套用罐頭: Right Kocher point Codman programmable V-P sh... 開立醫師: 林哲光 開立時間: 2011/06/16 17:47 Pre-operative Diagnosis Subdural effusion and hydrocephalus Post-operative Diagnosis Subdural effusion and hydrocephalus Operative Method Right Kocher point Codman programmable V-P shunt insertion and right subudral-peritoneal shunt insertion Specimen Count And Types nil Pathology Nil Operative Findings Gush of the subdural effusion was noted after dural opening. The intraventricular pressure seemed low after subdural effusion was drained out. Outter membrane and inner membrane formation were noted. The ventricular catheter was 7.5cm long and abdominal catheter was more than 15cm long. The sbudral catheter was around 3cm long. Pre-OP sonography for hepatic cyst was 10cm in diameter. Codman programmable valve was set 120 mmHg and a 10mmHg valve was used for S-P shunt. Operative Procedures Under ETGA and supine position with head rotated to left side, skin disinfected and drapped were performed as usual. Linear skin incision was made at right Kocher point and right temporal area. Burr holes were then created respectively. The dura were then opened after dural tenting. Right abdomen transverse skin incision was made. The ventricular catheter was connected with programmable valve and then connected to Y-connector. The subudral drain was also connected to Y connector with 10mmHg valve. The Y connector was then connected to abdominal catheter via subcutaneous tunneling. The wound was then closed in layers. Operators VS 王國川 Assistants R4 林哲光 相關圖片 吳崇豪 (M,1991/02/10,21y1m) 手術日期 2011/06/16 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Hyperhidrosis 器械術式 Endoscopic T2 sympathectomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 2 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:10 麻醉開始 08:15 誘導結束 08:26 抗生素給藥 08:56 手術開始 09:24 手術結束 09:24 麻醉結束 09:33 送出病患 09:40 進入恢復室 11:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 經內視鏡交感神經切斷術 1 1 B 記錄__ 手術科部: 外科部 套用罐頭: Endoscopic T2 sympathectomy 開立醫師: 林哲光 開立時間: 2011/06/16 09:46 Pre-operative Diagnosis Hyperhidrosis Post-operative Diagnosis Hyperhidrosis Operative Method Endoscopic T2 sympathectomy Specimen Count And Types nil Pathology Nil Operative Findings Pre-OP left hand temperature 32C, right hand 33.4C; Post OP left hand temperature 33C, right hand 34.8C Operative Procedures Under ETGA with IVG and supine position, skin disinfected and drapped were performed as usual. Local skin incision at right T4 level and troca was inserted into the pleural cavity when endotracheal tube was diconnected from the ventilator. Under Endoscopy, T2 sympathetic nerve was identified and coauglation was performed on the medial side the 2nd rib and division was done under endoscopy. The wound was then closed in layers after deair. The same procedure was also performed on the left T4 level. Operators VS 王國川 Assistants R4 林哲光 相關圖片 林宗建 (M,1954/11/28,57y3m) 手術日期 2011/06/16 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 Herniation of intervertebral disc 器械術式 C5 corpectomy 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 2 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 09:45 進入手術室 09:55 麻醉開始 10:10 誘導結束 10:15 抗生素給藥 10:50 手術開始 13:20 抗生素給藥 14:00 手術結束 14:00 麻醉結束 14:06 送出病患 14:10 進入恢復室 15:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 手術 脊椎融合術-前融合,有固定物)≦四節 1 1 記錄__ 手術科部: 外科部 套用罐頭: C5 corpectomy with expandable body cage anter... 開立醫師: 林哲光 開立時間: 2011/06/16 14:23 Pre-operative Diagnosis C4-5, C5-6 ruptured disc with doward migration to C5 level with myelopathy Post-operative Diagnosis C4-5, C5-6 ruptured disc with doward migration to C5 level with myelopathy Operative Method C5 corpectomy with expandable body cage anterior fusion and fixed with cervical plate Specimen Count And Types nil Pathology Nil Operative Findings Prominent spur formation was noted at prevertebral area. Ruptured disc was noted at C4-5 and C5-6 level and calcified PLL was also noted with tightly adherent to the cord. The cord seemed re-expanded well after disc removal totally. Body cage was inserted at C5 level, 16-29mm and 14mm screwsx4 were used for cervical plate, 44mm, fixation Operative Procedures Under ETGA and supine position with head mild extension, skin dinsinfected and drapped were performed as usual. Skin incision was made at C5 body level with C-arm localization. The plane between carotid triangle and esophagus was dissected and the prevertebral fascia was opened. C4-5, C5-6 discectomy were performed after self-retractor was set. C5 corpectomy was then performed and the buging disc was removed totally. The body cage was then inserted and cervical plate was then fixed with screws. The wound was then closed in layers after prevertebral CWV drain was inserted. Operators VS 王國川 Assistants R4 林哲光 相關圖片 陸慧瑾 (F,1960/06/14,51y9m) 手術日期 2011/06/17 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Pituitary tumor 器械術式 Repair of CSF rhinorrhea 手術類別 預定手術 手術部位 頭、頸 傷口分類 污染 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 李柏穎, 時間資訊 09:40 進入手術室 09:43 麻醉開始 09:45 誘導結束 10:20 手術開始 11:00 手術結束 11:00 麻醉結束 11:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 鼻中膈穿孔縫合術 1 1 手術 皮下肌肉或深部異物取出術 1 2 摘要__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 曾峰毅 開立時間: 2011/06/17 11:19 Pre-operative Diagnosis CSF rhinorrhea Post-operative Diagnosis CSF rhinorrhea Operative Method CSF leakage repair with autologous fat graft. Specimen Count And Types 1 piece About size: Source: Pathology Nil Operative Findings CSF leakage was identified well, and was sealed after fat graft packing with Tissucol-Duo. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position. We approach the previuos operation site via right nostril, and removed previous implanted gelfoam. We harvested autologus fat graft from left lower abdomen, and put the fat graft into sphenoid sinus. The leakage was sealed with Tissucol-Duo. The abdominal wound was closed in layers. Operators VS 曾漢民 Assistants R4 曾峰毅 R1 李柏穎 趙乃賢 (F,1945/09/11,66y6m) 手術日期 2011/06/17 手術主治醫師 曾漢民 手術區域 東址 008房 09號 診斷 Meningioma 器械術式 V-P shunt 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3E 紀錄醫師 陳以幸, 時間資訊 11:00 臨時手術NPO 11:00 開始NPO 12:39 通知急診手術 17:27 報到 18:30 進入手術室 18:35 麻醉開始 18:45 誘導結束 19:15 抗生素給藥 19:35 手術開始 20:43 手術結束 20:43 麻醉結束 21:37 送出病患 21:45 進入恢復室 23:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室腹腔分流手術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 陳以幸 開立時間: 2011/06/17 20:55 Pre-operative Diagnosis CP angle tumor status post, with obstructive hydrocephalus Post-operative Diagnosis CP angle tumor status post, with obstructive hydrocephalus Operative Method V-P Shunt via right Kocher^s point Specimen Count And Types 1 piece About size: Source:CSF Pathology Nil Operative Findings A Metronic medium pressure set was inserted via right Kocher^s point. The intraventricular catheter was about 6.4cm in length, and the intra-abdominal catheter was about 20cm in length. The CSF was clear, but the initial ICP was above 15cmH2O. Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: supine with head tilted to left. 3.Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 5 cm curvilinear, right frontal, corresponded to the location of right frontal horn. 5.After the scalp flap had been lifted and reflected anteriorly, a burr hole was made at the Kocher^s point and the dura was tented by 2 stitches. 6.The dura was opened by a nib incision. Rt lateral ventricle was tapped by a ventricular needle, then a 6.4 cm segment of the ventricular catheter was introduced into the ventricle. The outer end of the catheter was connected to a Pudenz reservoir. 7. A 3cm skin incision was made at RUQ of the abdomen. Minilaparotomy was done to expose the intraperitoneal cavity. Subsequently, distal 20 cm segment of the peritoneal catheter (medium pressure) was introduced into the peritoneal cavity through the outer tube of the trochar. The proximal end of this catheter was passed through subcutaneous tunnel at forechest, neck, rt retroauricular area and connected the reservoir. The shunt system was checked to make sure its function was working. 8. The reservoir was fixed to pericranium by 3 stitches. 9. Scalp closure: hemostasis was done with monopolar coagulator touching on the sucker tip. Galea suture was performed by continuous suture with 3/0. Dexon and skin by continuous suture with 3/0 nylon. 10.Course of the surgery: smooth. Operators VS 曾漢民 Assistants R6 陳睿生, R1 陳以幸 Indication Of Emergent Operation acute hydrocephalus 顏仁貴 (M,1939/10/15,72y4m) 手術日期 2011/06/17 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Neuroma, upper limb 器械術式 Left forearm neuroma excision 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 面罩麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 李柏穎, 時間資訊 00:00 臨時手術NPO 08:10 進入手術室 08:20 麻醉開始 08:25 誘導結束 08:35 抗生素給藥 08:40 手術開始 09:10 手術結束 09:10 麻醉結束 09:15 送出病患 09:15 進入恢復室 10:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 軟組織良性腫瘤切除術,大或深 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Semi-opened mask inhalation anes 1 0 摘要__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 曾峰毅 開立時間: 2011/06/17 09:23 Pre-operative Diagnosis Left forearm soft tissue tumor Post-operative Diagnosis Left forearm soft tissue tumor, suspected neuroma Operative Method Tumor excision Specimen Count And Types One tumor was sent for pathology. Pathology Pending Operative Findings One elastic, movable, well defined, capsulated tumor was noted under left forearm muscle. Tumor capsuled arised from one nerve, and was preserved after the subcapsular tumor removal. Operative Procedures With intravenous general anaesthesiat, the patient was put in supine position with left arm abducted. The skin was disinfected, and then draped. We made one longitudinal linear skin incision at left forearm, and dissected through whole layer of muscle to identified the tumor. We made one incision at the tumor capsule and removed the tumor subcapsully. The wound was closed in layers. Operators VS 曾漢民 Assistants R4 曾峰毅 R1 李柏穎 陳煒華 (M,1965/08/22,46y6m) 手術日期 2011/06/17 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Acoustic neuroma 器械術式 Craniotomy for left acoustic neuroma excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 李柏穎, 時間資訊 00:00 臨時手術NPO 11:30 進入手術室 11:40 麻醉開始 11:55 抗生素給藥 12:15 誘導結束 12:20 手術開始 15:25 抗生素給藥 16:50 手術結束 16:50 麻醉結束 16:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: C-P Angle Tumor 開立醫師: 曾峰毅 開立時間: 2011/06/17 17:08 Pre-operative Diagnosis Left acoustic schwannoma Post-operative Diagnosis Left acoustic schwannoma Operative Method Left retrosigmoid approach tumor acoustic schwannoma Specimen Count And Types Several fragments of one tumor was sent for pathology. Pathology Pending Operative Findings One capsulated, hypervascular, elastic, tumor was noted at left cerebellopontine angle involving internal acoustic meatus. BAEP at left was disappeared after tumor excisino, and one nerve discontinuity was noted. Facial nerve stimulation cannot localize the ficial nerve. Operative Procedures With endotracheal general anaesthesia, the patient was put in 3/4 prone postiion. After scalp shaved, scrubbed, disinfected, and draped, we made one curvilinear skin incision at left retroauricular area. We drilled three burr holes, and then created craniotomy. Dura was incised in T-shape, and cerebellar was retracted after CSF drained. We performed tumor excision in piecemeal fashion, and closed the dura in water-tight fashion. The wound was closed in layers after bone graft fixed back with wires. Operators VS 曾漢民 Assistants R4 曾峰毅 R1 李柏穎 相關圖片 諶佳平 (F,1969/12/14,42y3m) 手術日期 2011/06/17 手術主治醫師 黃國皓 手術區域 西址 039房 07號 診斷 Endometriosis of uterus 器械術式 Fiberocystoscopy /WOR 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 10:25 進入手術室 10:27 手術開始 10:30 手術結束 10:32 送出病患 吳美珍 (F,1993/07/19,18y7m) 手術日期 2011/06/17 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Malignant neoplasm of vertebral column, excluding sacrum and coccyx 器械術式 Malignant intraspinal tumor, e 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 3 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:10 進入手術室 08:34 麻醉開始 08:45 抗生素給藥 09:00 誘導結束 09:50 手術開始 10:35 開始輸血 13:10 抗生素給藥 16:52 麻醉結束 16:52 手術結束 18:18 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 9 0 手術 惡性脊髓腫瘤切除術 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 摘要__ 手術科部: 外科部 套用罐頭: Near total tumor excision, C5-T3 levels. 開立醫師: 鍾文桂 開立時間: 2011/06/17 19:11 Pre-operative Diagnosis Malignant peripheral nerve sheath tumor, C6-T3, status post partial tumor excision three time and chemotherapy, with rapid tumor progression. Post-operative Diagnosis Malignant peripheral nerve sheath tumor, C6-T3, status post partial tumor excision three time and chemotherapy, with rapid tumor regrowth to C5-T3 levels. Operative Method Near total tumor excision, C5-T3 levels. Specimen Count And Types 1 piece About size:50cc Source:malignant spinal tumor Pathology Malignant peripheral nerve sheath tumor. Operative Findings 1. A huge hypervascular tumor with fragile, elastic and firm components. It extended to the posterior mediastinum, the extradural space from C7 to T3 levels, and supralaminal space from C5 To T4-5 level. The tumor also occupied the apex of left chest cavity. After tumor debulking, we could feel the expansion of the left lung through respiration. The tumor also compressed the brachial plexus and the left subclavian artery. Yellowish clear cystic content with blood clots was noted over the emptied cavity after the previous tumor resection. 2. The size of the tumor is larger than 10*10*10cm. 3. The tumor adhered to the dura mater and the fibrotic pleura tightly. It also eroded the left 3rd rib and the costotransverse junction from T1-T3 level. 4. Blood loss: 10000cc. 5. Massive blood loss was noted after injurying to left subclavian artery. Asystole occured despite of emergent resuscitation. We explained to the family about her critical condition. The family decided to stop the resuscitation process. Operative Procedures Under ETGA, the patient was placed in prone position. After disinfection, and draping, a vertical linear skin incision was made on the previous operative wound. After midline dissection of the scar tissue, the tumor mass was met and excised by CUSA( both Neuro and GS probe). Well hemostasis was obtained by using bipolar electrocoagulator. Massive bleeding occured during the last piece of tumor resection. Packing was performed into the bleeding point. The resuscitation process began. The wound was closed primarily with gauze packing. CPR started. DNR was signed. The patient was sent home in critical status. Operators 郭夢菲 Assistants R5鍾文桂 Ri陳映廷 記錄__ 手術科部: 外科部 套用罐頭: Near total tumor excision, C5-T3 levels. 開立醫師: 郭夢菲 開立時間: 2011/06/20 10:00 Pre-operative Diagnosis Malignant peripheral nerve sheath tumor, C5-T3, status post partial tumor excision and chemotherapy, with rapid tumor progression. Post-operative Diagnosis Malignant peripheral nerve sheath tumor, C5-T3, status post partial tumor excision and chemotherapy, with rapid tumor regrowth Operative Method Near total tumor excision, C5-T3 levels. Specimen Count And Types 1 piece About size:50cc Source:malignant spinal tumor Pathology Malignant peripheral nerve sheath tumor. Operative Findings 1. A huge hypervascular tumor with fragile, elastic and firm components. It extended from the posterior mediastinum with massive extension to the left extradural space to compress the thecal sac of C7 to T3 levels. The tumor was larger than 10 cm in diameter. It also extended to the paravertebral muscle from C5 To T4-5 level. The tumor also occupied the apex of left chest cavity. After tumor debulking with Neurosurgical and GS typed CUSA, we could feel the expansion of the left lung through respiration. The tumor also compressed the brachial plexus and the left subclavian artery. 2. Yellowish clear cystic content with blood clots was noted over the emptied cavity after the previous tumor resection. 3. The tumor adhered to the dura mater and the fibrotic pleura tightly. It also eroded the left 2nd and 3rd ribs at the previous costotransverse junction from T1-T3 level. 4. Blood loss: 10000cc. 5. Massive blood loss was noted after the anterior margin of the tumor over the the left 2nd eroded rib was removed. Left subclavian artery injury was suspected, but hard to be confirmed due to massive blood loss. We consulted the CVS and they came immediately and suggested ECMO insertion, but the family decided to give up after the explanation of her critical and poor conidtions. Operative Procedures Under ETGA, the patient was placed in prone position. After disinfection, and draping, a vertical linear skin incision was made on the previous operative wound. After midline dissection of the scar tissue, the tumor mass was met and excised by CUSA (fisrt Neurosurgical under microscoic view to decompress the extradural part of the tumor, then shift to the GS probe due to the big bulk of the tumor). Well hemostasis was obtained by using bipolar electrocoagulator. We then debulk the tumor at the parabvertebral and suprsspinous process part, then went to the apex of left lung, which was wxtended to invade the left brachial plexus at its upper margin and the left subclavian arter at its anterior margin. The left 2nd and third ribs was moble and invaded by the tumor, so we tried to remove the tumor between them and when we moved the remnabt of the left 2nd rib, massive bleeding occured during the last piece of tumor resection. Packing was performed into the bleeding point. Since the heart rate deteriorated rapidly, we arragned more blood for her, closed the wound with gauze packing and called the CV surgeon to come, and turned her into supine position for resuscitation. CPR started. ECMO was planned to be inserted and possible thoracotomy to stop the bleeding by CVS doctor but DNR was signed after the critical condition was explained to her family. The patient was sent home in critical status. Operators 郭夢菲 Assistants R5鍾文桂 Ri陳映廷 江東 (M,1980/05/15,31y9m) 手術日期 2011/06/17 手術主治醫師 賴達明 手術區域 東址 008房 08號 診斷 Benign neoplasm of spinal cord 器械術式 Repair of CSF leakage(T-spine) 手術類別 臨時手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 2 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 13:55 報到 14:03 進入手術室 14:10 麻醉開始 14:15 誘導結束 15:00 抗生素給藥 15:11 手術開始 17:40 進入恢復室 19:20 離開恢復室 17:25 麻醉結束 17:25 手術結束 17:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 47 0 手術 腦膜或脊髓膜突出修補術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 記錄__ 手術科部: 外科部 套用罐頭: Dura repair 開立醫師: 林哲光 開立時間: 2011/06/17 18:09 Pre-operative Diagnosis Dura defect with epidural and subcutaneous cyst formation at T2-T3 level Post-operative Diagnosis Dura defect with epidural and subcutaneous cyst formation at T2-T3 level Operative Method Dura repair Specimen Count And Types Cyst fluids Source:swab culture, fluids culture x2 Pathology Nil Operative Findings A well defined capsule around the cyst was noted after skin incision. Much yellowish, transparent fluids gushed out from the cyst was noted. Some granulation tissue with suture inside was also noted at the cyst wall. The cyst seemed originated from a small hole at lamina level with extended into the epidural area. Previous dura defect covered with duragen was noted. Around 10ml hematoma was noted insided the cyst related to previous blood clot packing. The arachonid membrane below the dura defect seemed intact at the previous spinal tumor site. The leakage seemed ceased after soft tissue packing and reinforced with Tissu cul-do. Operative Procedures Under ETGA and prone position, skin disinfected and drapped were performed as usual. Skin incision along the previous operative wound was noted. The cyst wall was opened and much fluids gushed out. After opening the orifice at the bottom of the cyst with curettege. The arachonoid membrane was exposed after duragen was removed. Part of paraspinal muscle was excised for tissue packing at the suspected leakage site and sealed with Tissu cul-do. The wound was then closed in layers with muscle layers, fascia and subcutanoues approximation after a CWV drain inserted at the fascia level. Operators AP 賴達明 Assistants R4 林哲光 相關圖片 林顯明 (M,1979/08/07,32y7m) 手術日期 2011/06/17 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 HIVD 器械術式 C4-5 anterior foraminotomy, right 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:10 麻醉開始 08:15 誘導結束 08:20 抗生素給藥 09:10 手術開始 10:20 手術結束 10:20 麻醉結束 10:25 送出病患 10:28 進入恢復室 11:28 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-頸椎 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: C4-5 anterior foraminotomy, right 開立醫師: 曾偉倫 開立時間: 2011/06/17 10:27 Pre-operative Diagnosis C4-5 right ruptured disc Post-operative Diagnosis C4-5 right ruptured disc Operative Method C4-5 anterior foraminotomy, right Specimen Count And Types nil Pathology Nil. Operative Findings 1.Ruptured disc at right C4~5 disc space that compressed the right nerve root tightly. 2.The rest disc was relative health. Operative Procedures 1.ETGA, supine 2.Right transverse skin incision 3.dissect along the anterior border of SCM muscle to expose prevertebral space 4.right C4~5 foraminotomy with currette and air drill 5.identified ruptured PLL 6.remove ruptured disc 7.set one minihemovac 8.close wound in layers Operators AP 賴達明 Assistants R6 胡朝凱 R2 曾偉倫 相關圖片 許勳捷 (M,1949/12/28,62y2m) 手術日期 2011/06/17 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Ulnar palsy 器械術式 Neurolysis of right uluar neuve 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 面罩麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 10:45 進入手術室 10:50 麻醉開始 10:55 誘導結束 11:00 抗生素給藥 11:15 手術開始 11:55 手術結束 11:55 麻醉結束 12:00 送出病患 12:01 進入恢復室 13:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 神經分離術-上臂.前臂.大腿.小腿處之神經 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Semi-opened mask inhalation anes 1 0 摘要__ 手術科部: 外科部 套用罐頭: Neurolysis 開立醫師: 曾偉倫 開立時間: 2011/06/17 12:02 Pre-operative Diagnosis Tardy ulnar syndrome, right Post-operative Diagnosis Tardy ulnar syndrome, right Operative Method Neurolysis Specimen Count And Types nil Pathology Nil. Operative Findings 1.Right elbow hypertrophic ligment was noted that compressed the right ulnar nerve tightly 2.After decompression, nerve was loose and injected Operative Procedures 1. Under IVG, we scrubbed, disinfected and drapped 2. local anesthesia with Xylocain 3. Right elbow curved skin incision 4. Dissect subcutaneous connective tissue 5. Resect hypertrophic ligment 6. Identified ulnar nerve 7. Release ulnar nerve 8. Close wound in layers Operators AP 賴達明 Assistants R6 胡朝凱 R2 曾偉倫 相關圖片 吳憲漳 (M,1952/09/05,59y6m) 手術日期 2011/06/17 手術主治醫師 賴達明 手術區域 東址 003房 03號 診斷 Spinal stenosis, lumbar 器械術式 L4/5 sublaminar decompression 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 12:17 進入手術室 12:25 麻醉開始 12:35 誘導結束 12:50 抗生素給藥 13:02 手術開始 14:02 手術結束 14:02 麻醉結束 14:10 送出病患 14:12 進入恢復室 15:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓整形術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 記錄__ 手術科部: 外科部 套用罐頭: L4-5 Sub-laminar decompresion 開立醫師: 曾偉倫 開立時間: 2011/06/17 14:15 Pre-operative Diagnosis L4-5 spinal stenosis Post-operative Diagnosis L4-5 spinal stenosis Operative Method L4-5 Sub-laminar decompresion Specimen Count And Types nil Pathology Nil Operative Findings 1.Hypertrophic flavum ligment was noted that compressed the thecal sac and L5 nerve roots tightly. 2.After decompression, roots became loose, and the thecal sac expanded well. 3.No obvious instability Operative Procedures 1. Under ETGA, patient was put on prone position 2. After we locate the operation level with C-arm, we scrubbed, disinfected and drapped as usual 3. A mid-line skin incision was made 4. Split spinous process with drill 5. Detach paraspinal muscle 6. Laminectomy 7. resect flavum ligment 8. identified nerve roots 9. Close wound in layers Operators AP 賴達明 Assistants R6 胡朝凱 R2 曾偉倫 相關圖片 摘要__ 手術科部: 外科部 套用罐頭: L4-5 Sub-laminar decompresion 開立醫師: 曾偉倫 開立時間: 2011/06/17 14:15 Pre-operative Diagnosis L4-5 spinal stenosis Post-operative Diagnosis L4-5 spinal stenosis Operative Method L4-5 Sub-laminar decompresion Specimen Count And Types nil Pathology Nil Operative Findings 1.Hypertrophic flavum ligment was noted that compressed the thecal sac and L5 nerve roots tightly. 2.After decompression, roots became loose, and the thecal sac expanded well. 3.No obvious instability Operative Procedures 1. Under ETGA, patient was put on prone position 2. After we locate the operation level with C-arm, we scrubbed, disinfected and drapped as usual 3. A mid-line skin incision was made 4. Split spinous process with drill 5. Detach paraspinal muscle 6. Laminectomy 7. resect flavum ligment 8. identified nerve roots 9. Close wound in layers Operators AP 賴達明 Assistants R6 胡朝凱 R2 曾偉倫 相關圖片 許輝鴻 (M,1960/10/17,51y4m) 手術日期 2011/06/17 手術主治醫師 賴達明 手術區域 東址 003房 04號 診斷 HIVD 器械術式 Microdiskectomy, L3/4, left 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 14:23 進入手術室 14:30 麻醉開始 14:35 誘導結束 15:00 抗生素給藥 15:06 手術開始 16:35 手術結束 16:35 麻醉結束 16:43 送出病患 16:45 進入恢復室 18:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 椎間盤切除術-腰椎 1 1 摘要__ 手術科部: 外科部 套用罐頭: Microdiskectomy, L3/4 開立醫師: 曾偉倫 開立時間: 2011/06/17 16:53 Pre-operative Diagnosis L3-4 HIVD Post-operative Diagnosis L3-4 HIVD Operative Method Microdiskectomy, L3/4 Specimen Count And Types nil Pathology Nil Operative Findings 1. A ruptured diske over left side of L3-4 level which compressed the L4 root 2. The thecal sac and the root was loose after the diskectomy Operative Procedures 1. Under ETGA, we placed the patient on prone position 2. We locate the L3-4 level with C-arm 3. After we scrubbed, disinfected and drapped a mid-line skin incision was made 4. The para-spinal muscle was detached over the left side of L4 spinous process and the thecal sac was shown after we removed the ligmantum flavum with Kerrison punch and aligator 5. Left-hemilaminectomy was made and a ruptured disk was found and removed 5. A ruptured disk was found and removed. The annulus fibrosis was opened and diskectomy was done 6. The L3-4 disk was removed and the thecal sac was loose 7. The wound was closed in layers after complete hemostasis Operators AP 賴達明 Assistants R6 陳睿生 R2 曾偉倫 相關圖片 李施錦 (F,1948/06/01,63y9m) 手術日期 2011/06/17 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Lumbar Spondylosis 器械術式 L4/5 TLIF 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 2 紀錄醫師 陳國瑋, 李振豪, 時間資訊 00:00 臨時手術NPO 07:38 報到 08:07 進入手術室 08:10 麻醉開始 08:20 誘導結束 08:45 抗生素給藥 08:55 手術開始 11:45 手術結束 11:45 麻醉結束 12:00 送出病患 12:02 進入恢復室 14:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎間盤切除術-腰椎 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: L4-5 transforaminal lumbar interbody fusion w... 開立醫師: 李振豪 開立時間: 2011/06/17 11:47 Pre-operative Diagnosis L4-5 spondylolisthesis with lumbar stenosis Post-operative Diagnosis L4-5 spondylolisthesis with lumbar stenosis Operative Method L4-5 transforaminal lumbar interbody fusion with PEEK cage + L4-5 transpedicular screws for posterior fixation + posterolateral fusion with autologous bone graft Specimen Count And Types nil Pathology Nil Operative Findings Anterior subluxation of L4 was noted. The thecal sac was compressed by hypertrophic ligmentum flavum. The thecal sac expanded well after laminectomy. Degenerative change of L4/5 disc with narrowing of disc space was noted. One #11 PEEK Banana cage was inserted for interbody fusion. Total four transpedicular screws with 6.2 x 40mm in size were used for posterior fixation. The rods were 5cm in length at each side. The left L5 root was preserved well during whole procedure. No incidental durotomy or CSF leakage were found. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position. The L4 and L5 pedicles were localized by portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made from L4 to L5 level. The subcutaneous soft tissue and paravertebral muscle groups were detached. Laminectomy was performed for posterior decompression. L4 and L5 transpedicular screws were inserted under C-arm guided. L4/5 left facetectomy and diskectomy was done. One Banana cage and autologous bone graft was placed for interbody fusion. The location of Cage was confirmed by C-arm. Hemostasis was achieved with Bipolar electrocautery and Gelfoam packing. One epidural Hemovac was placed. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS賴達明 Assistants R4李振豪, R2陳國瑋 相關圖片 顏雅娟 (F,1977/02/26,35y0m) 手術日期 2011/06/17 手術主治醫師 賴達明 手術區域 東址 019房 02號 診斷 Neurilemmoma 器械術式 L1-2 neuroma excision 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 2 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 12:07 進入手術室 12:15 麻醉開始 12:30 誘導結束 12:40 抗生素給藥 12:53 手術開始 16:05 手術結束 16:05 麻醉結束 16:10 送出病患 16:13 進入恢復室 17:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 良性脊髓腫瘤切除術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: Neuroma excision 開立醫師: 李振豪 開立時間: 2011/06/17 16:16 Pre-operative Diagnosis L1-2 neuroma Post-operative Diagnosis L1-2 neuroma Operative Method Neuroma excision Specimen Count And Types 1 piece About size:1.9x1.6x1.3cm Source:Intraspinal tumor Pathology Pending Operative Findings One large cyst with clear fluid content was during dissection. CSF leakage due to last operation was favored. The The cyst was well-capsulated. The margin between the cyst and the dura was mild adhered. After durotomy, the tumor was noted at the right side of spinal canal with severe adhesion to adjacent nerve roots. The tumor was gray-yellowish, elastic but fragile, hypervascularized, well capsulated. One nerve root adhered to the tumor tightly which origin of the tumor was favored. The nerve root was sacrified during tumor excision. Other nerve roots were preserved well during the operation. One large cyst with clear fluid content was during dissection. CSF leakage due to last operation was favored. The The cyst was well-capsulated. The margin between the cyst and the dura was mild adhered. After durotomy, the tumor was noted at the right side of spinal canal with severe adhesion to adjacent nerve roots. The tumor was gray-yellowish, elastic but fragile, hypervascularized, well capsulated. One nerve root adhered to the tumor tightly which origin of the tumor was favored. The nerve root was sacrified during tumor excision. Other nerve roots were preserved well during the operation. Small nerve root without attachment seen continued from neuroma Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made along operative scar at L1-2 level. The subcutaneous soft tissue was devided and thecal sac was dissected. Midline durotomy was performed after removal of previous prolene sutures. Intraspinal tumor was identified. Central debulking was performed with CUSA. The adjacent roots were dissected away from the tumor capsule. After total removal of the tumor, hemostasis was achieved with bipolar electrocautery and Gelfoam packing. The durotomy was closed with 5-0 Prolene with Durafoam packing. One epidural CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS賴達明 Assistants R4 李振豪, R2陳國瑋 相關圖片 柯佩伶 (F,1988/08/13,23y7m) 手術日期 2011/06/17 手術主治醫師 賴達明 手術區域 東址 019房 03號 診斷 Herniation of intervertebral disc (HIVD) 器械術式 Microdiskectomy, L4-5 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 2 紀錄醫師 陳國瑋, 李振豪, 時間資訊 00:00 臨時手術NPO 15:45 報到 16:38 進入手術室 16:45 麻醉開始 17:05 誘導結束 17:10 抗生素給藥 17:25 手術開始 19:45 手術結束 19:45 麻醉結束 19:53 送出病患 19:55 進入恢復室 21:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-腰椎 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 摘要__ 手術科部: 外科部 套用罐頭: Microdiskectomy, L4/5, right 開立醫師: 陳國瑋 開立時間: 2011/06/17 18:44 Pre-operative Diagnosis Herniated intervertebral disc, L4/5 Post-operative Diagnosis Herniated intervertebral disc, L4/5 Operative Method Microdiskectomy, L4/5, right Specimen Count And Types nil Pathology Nil Operative Findings The thecal sac and root were compressed by ruptured disc tightly. The disc was degenerative, ruptured, and migrated to cephalic side. The root was loose after microdiskectomy. No incidental durotomy or CSF leakage were noted during the operation. The thecal sac was compressed by herniated disc tightly. The disc was mild degenerative over central part with cephalic migration at lateral side. The thecal sac was loose after microdiskectomy. No incidental durotomy or CSF leakage were noted during the operation. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position. The L4/5 disc level was localized by portable C-ram X-ray. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made at L4/5 disc level and the subcutaneous soft tissue was devided. The right paravertebral muscle groups were detached to expose the lamina. Under operative microscope, laminotomy was performed. The ruptured disc was identified. Microdiskectomy was done with knife, alligator, and disc clamp. Hemostasis was achieved. The wound was then closed in layers with 2-0 Vicryl and 4-0 Dexon. Under endotracheal general anesthesia, the patient was put in prone position. The L4/5 disc level was localized by portable C-ram X-ray. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made at L4/5 disc level and the subcutaneous soft tissue was devided. The right paravertebral muscle groups were detached to expose the lamina. Under operative microscope, laminotomy was performed. The ruptured disc was identified. Microdiskectomy was done with knife, alligator, and disc clamp. Hemostasis was achieved. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS賴達明 Assistants R4李振豪, R2陳國瑋 相關圖片 張紘彬 (M,2010/02/07,2y1m) 手術日期 2011/06/17 手術主治醫師 謝孟祥 手術區域 東址 012房 01號 診斷 Polydactyly of fingers 器械術式 Reconstruction of polydactyly+Remove VP shunt 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 3 紀錄醫師 陳建璋, 時間資訊 08:25 進入手術室 08:30 麻醉開始 08:40 誘導結束 08:50 抗生素給藥 09:00 手術開始 10:45 手術結束 10:45 麻醉結束 10:53 送出病患 10:55 進入恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦脊髓液分流管重置 1 1 L 手術 併指多指(趾)切除 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 外科部 套用罐頭: Reconstruction of polydactyly 開立醫師: 陳建璋 開立時間: 2011/06/17 11:05 Pre-operative Diagnosis polydactyly Post-operative Diagnosis polydactyly, rudundent rught thumb polydactyly, redundant rght thumb Operative Method Reconstruction of polydactyly Specimen Count And Types 1 piece About size:3x1cm Source:redundent funger Pathology nil Operative Findings 1. redundent and hypoplastic thumb over the radial side of the right thumb. The proximal phalangeal bone was connected to the MCP joint with one fibrous band without involvement of the joint capsule. NO functional tendons were noted during dissection 1. redundant and hypoplastic thumb over the radial side of the right thumb. The proximal phalangeal bone was connected to the MCP joint with one fibrous band without involvement of the joint capsule. NO functional tendons were noted during dissection Operative Procedures Under endotracheal general anestheisa, we took over from the heurosurgeon. The operative field was disinfected and draped as usual. Elliptical incision was made. We dissected and removed the redundent hypoplastic thumb. After irrigation with normal saline and careful hemostasis, the wound was closed with 5-0 Dexon and 5-0 Monosin Under endotracheal general anestheisa, we took over from the heurosurgeon. The operative field was disinfected and draped as usual. Elliptical incision was made. We dissected and removed the redundant hypoplastic thumb. After irrigation with normal saline and careful hemostasis, the wound was closed with 5-0 Dexon and 5-0 Monosin Operators 謝孟祥 Assistants 陳建璋 摘要__ 手術科部: 外科部 套用罐頭: Removal of left subdural-peritoneal shunt. 開立醫師: 鍾文桂 開立時間: 2011/06/17 19:15 Pre-operative Diagnosis Left subdural effusion, status post implantation of left subdural-peritoneal shunt. Post-operative Diagnosis Left subdural effusion, status post implantation of left subdural-peritoneal shunt. Operative Method Removal of left subdural-peritoneal shunt. Specimen Count And Types nil Pathology Nil. Operative Findings Operative Procedures Under ETGA, the patient was placed in supine position and the head was tilted to the right side. After shaving, disinfection, and draping, the previous operative wound was incised and dissected. The shunt catheter was identified. Then, the shunt catheter was removed smoothly. Finally, the wound was closed in layers. Operators 郭夢菲 Assistants R4 陳建璋 記錄__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 郭夢菲 開立時間: 2011/06/23 16:18 Pre-operative Diagnosis Chronic subdural accumulation, S/P SP shunt insertion, left Post-operative Diagnosis Chronic subdural accumulation, S/P SP shunt insertion, left Operative Method Removal of SP shunt, extracranial part Specimen Count And Types nil Pathology nil Operative Findings The subdural catheter was adhered inside the intracranial space, so it was left inside. Operative Procedures Under endotracheal general anesthesia, the patient was placed in supine position with head rotated to right. The skin was prepared by shaving and scrubbing with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. A linear incision was made along the old scar. Then the old catheter was traced till the straight connecter was identified. The fixing sutures were removed then the distal catheter was withdrawal smoothly. The subdural catheter was tried to be removed but failed due to adhesion. After meticulous hemostasis, the wound was closed in layers. Operators VS. 郭夢菲 Assistants nil 邱婉容 (F,1953/10/10,58y5m) 手術日期 2011/06/18 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Parkinson''s disease 器械術式 Deep brain stimulation implantation 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 3 紀錄醫師 曾偉倫, 鍾文桂, 時間資訊 00:00 臨時手術NPO 07:42 報到 07:54 進入手術室 08:00 麻醉開始 08:20 誘導結束 08:38 抗生素給藥 09:10 開始輸血 09:50 手術開始 11:38 抗生素給藥 14:38 抗生素給藥 15:50 麻醉結束 15:50 手術結束 16:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 立體定位術-功能性失調 1 2 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 8 0 麻醉 Peripheral arterial line inserti 1 0 手術 深部腦核電生理定位 1 0 手術 立體定位術-功能性失調 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Insertion of DBS wire at bilateral subthalamu... 開立醫師: 曾偉倫 開立時間: 2011/06/18 16:10 Pre-operative Diagnosis Parkisons disease Post-operative Diagnosis Parkisons disease Operative Method Insertion of DBS wire at bilateral subthalamus nucleas Specimen Count And Types nil Pathology Nil Operative Findings 1. The identified subthalamic nucleus at left side: 3.45 mm in length, right side: 3.5mm in length. 2. The rigidity decreased after wire inserted at stimulation "on". 3. Left eye with left-ward gaze limitation when stimulation "on" over leftsubthalamic nucleus. 4. The final target was 2mm anterior to the planned target. Operative Procedures Under IV general anesthesia, the patient was put in supine position. The scalp was shaved, scrubbed and antiseptic with alcohol B-I. Registered the preset localization point to navigator. Bicoronal scalp incision was made with burr hole made at entery point of left frontal region as navigator guided. The DBS wire port was set up and localization of subthalamus nucleus with microelectrode assistance. Inserted the DBS wire and fixed with the port. Waked the patient from the anesthesia and started stimulation from low voltage. Checked the clinical responses while using different voltage for stimulation. Performed the same procedure at right side. After hemostasis, closed the wound in layers. Operators VS 曾勝弘 Assistants R5 鍾文桂 R2 曾偉倫 相關圖片 王慶泉 (M,1935/11/05,76y4m) 手術日期 2011/06/18 手術主治醫師 陳敞牧 手術區域 東址 002房 04號 診斷 Parkinsonism 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 2E 紀錄醫師 徐紹剛, 時間資訊 14:00 開始NPO 14:00 臨時手術NPO 15:48 通知急診手術 20:30 報到 20:35 進入手術室 20:45 麻醉開始 20:55 誘導結束 20:55 抗生素給藥 21:15 手術開始 22:11 手術結束 22:11 麻醉結束 22:40 送出病患 22:40 進入恢復室 00:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 手術 慢性硬腦膜下血腫清除術 1 1 B 手術 慢性硬腦膜下血腫清除術 1 2 B 摘要__ 手術科部: 外科部 套用罐頭: Chronic Subdural Hematoma 開立醫師: 曾峰毅 開立時間: 2011/06/18 22:15 Pre-operative Diagnosis Bilateral chronic subdural hematoma Post-operative Diagnosis Bilateral chronic subdural hematoma Operative Method Bilateral frontal burr holes for subdural drainage Specimen Count And Types Subdural fluid was sent for cytology. Pathology Nil Operative Findings Dark-reddish subdural effusion was noted, which is compatible with chronic subdural hemorrhage. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position. The scalp was shaved, scrubbed, disinfected, and then draped. We made one transverse skin incision at each side of frontal area, and then drilled burr hole at each side. Dura were sampled for pathology. We inserted subdural rubber drain into bilateral subdural space, and irrigated subdural space with normal saline. The wounds were closed in layers, and subdural space was de-aired. Operators VS 陳敞牧 Assistants R4 曾峰毅 R1 徐紹剛 Indication Of Emergent Operation IICP 相關圖片 摘要__ 手術科部: 外科部 套用罐頭: Bilateral frontal burr holes for subdural dra... 開立醫師: 曾峰毅 開立時間: 2011/06/18 22:21 Pre-operative Diagnosis Bilateral chronic subdural hematoma Post-operative Diagnosis Bilateral chronic subdural hematoma Operative Method Bilateral frontal burr holes for subdural drainage Specimen Count And Types Subdural fluid was sent for cytology. Pathology Nil Operative Findings Dark-reddish subdural effusion was noted, which is compatible with chronic subdural hemorrhage. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position. The scalp was shaved, scrubbed, disinfected, and then draped. We made one transverse skin incision at each side of frontal area, and then drilled burr hole at each side. Dura were sampled for pathology. We inserted subdural rubber drain into bilateral subdural space, and irrigated subdural space with normal saline. The wounds were closed in layers, and subdural space was de-aired. Operators VS 陳敞牧 Assistants R4 曾峰毅 R1 徐紹剛 Indication Of Emergent Operation IICP 相關圖片 陳翊琳 (F,1962/11/18,49y3m) 手術日期 2011/06/18 手術主治醫師 王國川 手術區域 東址 002房 01號 診斷 Subdural hemorrhage, traumatic 器械術式 Bilateral burr hole for chronic subdural hematoma drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 2E 紀錄醫師 曾偉倫, 徐紹剛, 時間資訊 00:00 開始NPO 00:00 臨時手術NPO 00:00 通知急診手術 08:35 報到 08:40 抗生素給藥 08:49 進入手術室 08:55 麻醉開始 09:10 誘導結束 09:47 手術開始 11:15 手術結束 11:15 麻醉結束 11:22 送出病患 11:25 進入恢復室 13:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 B 手術 慢性硬腦膜下血腫清除術 1 2 B 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 外科部 套用罐頭: Chronic Subdural Hematoma 開立醫師: 曾峰毅 開立時間: 2011/06/18 10:58 Pre-operative Diagnosis Bilateral chronic subdural hematoma Post-operative Diagnosis Bilateral chronic subdural hematoma Operative Method Bilateral frontal burr hole for subdural drainage Specimen Count And Types Bilateral dura was sent for pathology, and biltearl subdural fluid was sent for cytology. Pathology Pending Operative Findings Outer membrane was noted at bilatearl side, and dark-reddish motor-oil like fluid gushed out bilaterally while durotomy. The brain expanstion is well after decompression. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position. The scalp was shaved, scrubbed, disinfected, and then draped. We made one transverse skin incision at each side of frontal area, and then drilled burr hole at each side. Dura were sampled for pathology. We inserted subdural rubber drain into bilateral subdural space, and irrigated subdural space with normal saline. The wounds were closed in layers, and subdural space was de-aired. Operators VS 王國川 Assistants R4 曾峰毅 R2 曾偉倫 R1 徐紹剛 Indication Of Emergent Operation IICP 相關圖片 金崇琛 (M,1946/03/19,65y11m) 手術日期 2011/06/19 手術主治醫師 楊士弘 手術區域 東址 002房 02號 診斷 Infection spondylitis 器械術式 Laminectomy for decompression, T3-T4 and posterior fusion of T2-T5 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 3E 紀錄醫師 林哲光, 時間資訊 20:00 開始NPO 19:39 通知急診手術 21:34 進入手術室 21:37 麻醉開始 21:58 誘導結束 23:20 手術開始 04:41 手術結束 04:41 麻醉結束 04:55 送出病患 22:24 開始輸血 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎間盤切除術-椎 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: Bilateral T3-4 laminotomy with T3-4 discectom... 開立醫師: 林哲光 開立時間: 2011/06/20 05:48 Pre-operative Diagnosis T3-4 spondylodiskitis with acute myelopathy Post-operative Diagnosis T3-4 spondylodiskitis with acute myelopathy Operative Method Bilateral T3-4 laminotomy with T3-4 discectomy and sublaminal decompression, T2-T5 posterior fusion with TPS and rods Specimen Count And Types 1 piece About size:multiple pieces Source:pus for bacteria and TB culture Some disk and soft tissue were sent for pathology Pathology Pending Operative Findings Some soft tissue with pus surrounding the T3-T4 spinal cord was noted with direct compressing the spinal cord to the posterior side. Dura seemed bluged during the laminotomy and seemed tension-free after disctomy and removal of some soft tissue. Some ruptured disc was noted with downward migration to T4 level. The pus seemed whitish, milky, stiky and TB infection was impressed. TPS 30mmx 5mm was used for T2 level and 35mmx5mm were used for T5 level. 90mm rods x2 were also used. Operative Procedures Under ETGA and prone position with head fixed wtih Mayfield head clump, skin disinfected and drapped were performed as usual. Midline skin inciison was made at T1-T6 level after C-arm localization. The paraspinal muscles were then detached and T3-4 laminotomy was then performed. T3-4 discetomy was performed and the removal of the surrounding soft tissues was done. TPS at T2 and T5 level was then done and fixed with two rods. The wound was then closed in layers after paravertebral drains insertion. Operators VS 楊士弘 Assistants R4 林哲光, R1 徐展陽 Indication Of Emergent Operation acute myelopathy 相關圖片 陳任和 (M,1953/10/17,58y4m) 手術日期 2011/06/20 手術主治醫師 杜永光 手術區域 東址 003房 02號 診斷 Cerebrovascular accident 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 3E 紀錄醫師 陳國瑋, 時間資訊 12:00 開始NPO 15:02 通知急診手術 16:00 進入手術室 16:10 麻醉開始 16:20 誘導結束 16:35 抗生素給藥 17:02 手術開始 18:15 手術結束 18:15 麻醉結束 18:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室體外引流 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 麻醉 Lactic Acid (lactate) 1 0 摘要__ 手術科部: 外科部 套用罐頭: Left Kocher EVD insertion 開立醫師: 陳國瑋 開立時間: 2011/06/20 18:28 Pre-operative Diagnosis Right thalamic ICH with IVH Post-operative Diagnosis Right thalamic ICH with IVH Operative Method Left Kocher EVD insertion Specimen Count And Types 1 piece About size:3 tubes Source:CSF for routine, culture, BCS Pathology Nil Operative Findings Opening pressure was aournd 5cmH2O and CSF seemed reddish and transparent. Intraventricular catheter was 7cm long. Operative Procedures Under ETGA and supine position, skin disinfected and drapped were performed as usual. Linear skin incision was made at left Kocher point. A burr hole was then created and the dura was opened after dural opening. The EVD was introduced with ventricular puncture along the imaginary line composed with two planes pointing to targus and medial canthus. The wound was then closed in layers after EVD was fixed on the scalp through a subcutaneous tunnel. Operators P 杜永光 Assistants R4 林哲光, R2 陳國瑋, Ri 陳映廷 Indication Of Emergent Operation Hemorrhagic strocke Hemorrhagic stroke 相關圖片 林美英 (F,1964/03/28,47y11m) 手術日期 2011/06/20 手術主治醫師 杜永光 手術區域 東址 003房 號 診斷 Trigeminal neuralgia (Cranial nerve V) 器械術式 Trigeminal neuroma excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:07 進入手術室 08:10 麻醉開始 08:45 誘導結束 08:53 手術開始 08:56 抗生素給藥 11:56 抗生素給藥 14:45 抗生素給藥 15:35 麻醉結束 15:35 手術結束 15:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 顱底瘤手術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 7 0 摘要__ 手術科部: 外科部 套用罐頭: Left Kawase approach for tumor excision 開立醫師: 曾偉倫 開立時間: 2011/06/20 16:54 Pre-operative Diagnosis Trigeminal neuroma, left Post-operative Diagnosis Trigeminal neuroma, left, suspect originated from the CN V-2 or motor branch Operative Method Left Kawase approach for tumor excision Specimen Count And Types 1 piece About size:2x2x2 cm Source:Trigeminal neuroma Pathology Pending Operative Findings After remove of the Kawase^s triangle, the tumor with cystic portion was noted. The tumor composed by two portions. The solid portion was soft, fragile, yellowish and well capsuled. It extended from the lateral aspect of the preganglion CN V, and it mainly located at the inferior aspect of the semicircular ganglion. It was suspected originated from the CN V-2 or motor branch. The cystic portion was mainly at the left CP angle. The fluid inside the cyst was light yellowish. The capsule wall was smooth, and easily detached from peripheral brain tissue. The CN VI and the AICA were compressed inferiorly; the CN VII and VIII were compressed laterally. Operative Procedures Under ETGA, we placed the patient over supine position. After we fixed her head with Mayfield clamp, her head was tilted to right. After we shaved, scrubbed, disinfected and drapped, a question mark like skin incision over frontal-parietal-temporal area was made. The craniotomy was made and the petrosectomy was done with drills, and the Meckels cave was opened. The CN V was identified and the tumor was visualized. The superior petrosal sinus was identified, ligated and divided. The durotomy was made over bilateral side of superior pertosal sinus. The resection of solid part of the tumor was made with bipolar forceps, suction and CUSA. The fluid within cystic part of the tumor was removed and the capsule was dragged with the solid part. After the tumor removal, the CN VI and the AICA were compressed inferiorly; the CN VII and VIII were compressed laterally. All of the abover structiore was preserved. After complete hemostasis, dural tenting was done and the skull was fixed with mini-plate and screws. A CWV drain was placed over sub-cranium and sub-galeal space. The wound was closed within layers. Operators P 杜永光 Assistants R6 陳睿生 R2 曾偉倫 相關圖片 黃吳素卿 (F,1932/08/31,79y6m) 手術日期 2011/06/20 手術主治醫師 杜永光 手術區域 東址 006房 02號 診斷 Herniated intervertebral disc, lumbar 器械術式 Microdiskectomy, L2-3, left 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 14:30 進入手術室 14:35 麻醉開始 14:45 誘導結束 15:15 抗生素給藥 15:26 手術開始 16:55 手術結束 16:55 麻醉結束 17:05 送出病患 17:10 進入恢復室 19:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-腰椎 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: HIVD 開立醫師: 李振豪 開立時間: 2011/06/20 17:25 Pre-operative Diagnosis Herniated intervertebral disc, L2/3, central Post-operative Diagnosis Herniated intervertebral disc, L2/3, central Operative Method Microdiskectomy, L2/3, left Specimen Count And Types nil Pathology Nil Operative Findings The ligmentum flavum was hypertrophic and calcified. The herniated disc was mainly located at central and left part. The disc was degenerated and fragile. After microdiskectomy, the root and thecal sac was decompressed well. No incidental durotomy or CSF leakage was noted during whole procedure. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position. The L2/3 disc space was localized by C-arm portable X-ray. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made from L2 to L3 level with 3cm in length. The subcutaneous soft tissue and left paravertebral muscle were detached. The wound was retracted with modified Taylor retractor. Left side laminotomy was performed and the ligmentum flavum was removed. The thecal sac was identified and the epidural fat was left undisturbed and preserved. The thecal sac was retracted and the herniated disc was noted. Under operative microscope, microdiskectomy was performed with knife, curette, alligator, and disc clamp. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. The wound was irrigated with Gentamicin solution. The wound was then closed in layers with 2-0 Vicryl and 4-0 Dexon. Operators VS賴達明 Prof. 杜永光 Assistants R4李振豪, Ri戴怡芸 陳珮瑜 (F,1979/04/12,32y11m) 手術日期 2011/06/20 手術主治醫師 曾漢民 手術區域 東址 005房 03號 診斷 Brain metastasis 器械術式 Right parieto-occipital brain metastasis excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 3 紀錄醫師 李柏穎, 時間資訊 00:00 臨時手術NPO 14:00 進入手術室 14:10 麻醉開始 14:27 誘導結束 14:28 手術開始 14:40 抗生素給藥 16:13 開始輸血 18:15 手術結束 18:15 麻醉結束 18:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱骨切除術,包括異物移除或壓或經切斷 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy foir total tumor excision 開立醫師: 胡朝凱 開立時間: 2011/06/20 18:41 Pre-operative Diagnosis Right Occipital metastatic tumor Post-operative Diagnosis Right Occipital metastatic tumor Operative Method Craniotomy foir total tumor excision Specimen Count And Types en bloc tumor Pathology pending Operative Findings 1.A 7x6 cm elastic, hypervascular tumor located at right occipital lobe. It attached to falx tightly. The border was clear. It was en-bloc removed. 2.The brain was severe swelling during dural opening 3.transverse sinus partial tear was noted. 4.Blood loss: 2100 ml Operative Procedures 1.ETGA, prone with head fixed with skull clamp 2.Right occipital U shape skin incision 3.Reflect skin flap downward 4.Cranitomy 5.Hemostasis with compression to sinus 6.U shape dural incision with the base left at midline 7.Tumor excision along with the border of tumor and brain tissue 8.Hemostasis 9.Close dura with prolene 10.dural tenting 11.Fixed bone back with miniplate 12.Close wound in layers after CWV drain insertion Operators 曾漢民 Assistants 胡朝凱,李柏穎 陳珮瑜 (F,1979/04/12,32y11m) 手術日期 2011/06/20 手術主治醫師 曾漢民 手術區域 東址 002房 04號 診斷 Brain metastasis 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 4E 紀錄醫師 林瑜婷, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 20:11 通知急診手術 21:11 進入手術室 21:15 麻醉開始 21:20 誘導結束 21:55 開始輸血 22:05 手術開始 23:45 手術結束 23:45 麻醉結束 23:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 硬腦膜外血腫清除術 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Right craniotomy for hematoma evacuation 開立醫師: 胡朝凱 開立時間: 2011/06/21 00:07 Pre-operative Diagnosis Right temporal to parietal epidural hematoma Post-operative Diagnosis Right temporal to parietal epidural hematoma Operative Method Right craniotomy for hematoma evacuation Specimen Count And Types Pathology nil Operative Findings 1.About 6x6x1.5 cm hematoma was noted at right temporal to parietal area with high pressure. 2.After craniotomy, brain expanded fast 3.No obvious bony fracture or bleeder was noted 4.The hematoma extended from previous bone edge Operative Procedures 1.ETGA, supine with head rotate to left 2.Right previous wound incision and extended as reverse U shape 3.Reflect skin and muscular flap downward 4.Craniotomy 5.dural tenting 6.Removal of hematoma 7.Central tenting 8.Fixed bone back with wires 9.Close wound in layers after CWV insertion Operators 曾漢民 Assistants 胡朝凱, Indication Of Emergent Operation conscious change 記錄__ 手術科部: 外科部 套用罐頭: Right craniotomy for hematoma evacuation 開立醫師: 胡朝凱 開立時間: 2011/06/21 00:16 Pre-operative Diagnosis Right temporal to parietal epidural hematoma Post-operative Diagnosis Right temporal to parietal epidural hematoma Operative Method Right craniotomy for hematoma evacuation Specimen Count And Types nil Pathology nil Operative Findings 1.About 6x6x1.5 cm hematoma was noted at right temporal to parietal area with high pressure. 2.After craniotomy, brain expanded fast 3.No obvious bony fracture or bleeder was noted 4.The hematoma extended from previous bone edge Operative Procedures 1.ETGA, supine with head rotate to left 2.Right previous wound incision and extended as reverse U shape 3.Reflect skin and muscular flap downward 4.Craniotomy 5.dural tenting 6.Removal of hematoma 7.Central tenting 8.Fixed bone back with wires 9.Close wound in layers after CWV insertion Operators 曾漢民 Assistants 胡朝凱,林瑜婷 Indication Of Emergent Operation conscious change 林時益 (M,1958/09/13,53y6m) 手術日期 2011/06/20 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Neck mass 器械術式 Neck tumor excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 2 紀錄醫師 李柏穎, 時間資訊 08:10 進入手術室 08:15 麻醉開始 08:20 誘導結束 08:30 抗生素給藥 08:46 手術開始 09:20 手術結束 09:20 麻醉結束 09:30 送出病患 09:31 進入恢復室 10:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 頭皮腫瘤 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 曾峰毅 開立時間: 2011/06/20 09:25 Pre-operative Diagnosis Scalp tumor Post-operative Diagnosis Scalp tumor, lipoma Operative Method Scalp tumor excision Specimen Count And Types One piece of tumor was sent for pathology. Pathology Pending Operative Findings One 4x5x3 cm yellowish, soft, well-defined, tumor was noted at subgaleal space. Operative Procedures With endotracheal general anaethesia, the patient was put in prone positition. After scalp shaved, scrubbed, disinfected, and then draped, we made one longitudinal skin incision. We dissected, and removed the tumor in en bloc. The wound was closed in layers. Operators VS 曾漢民 Assistants R4 曾峰毅 R1 李柏穎 楊如忠 (M,1962/06/09,49y9m) 手術日期 2011/06/20 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Glioblastoma multiforma 器械術式 Right temporal GBM excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 3 紀錄醫師 曾漢民, 時間資訊 00:00 臨時手術NPO 09:39 進入手術室 09:46 麻醉開始 10:10 誘導結束 10:10 抗生素給藥 10:15 手術開始 10:54 抗生素給藥 13:10 抗生素給藥 13:35 手術結束 13:35 麻醉結束 13:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 顱骨切除術,包括異物移除或壓或經切斷 1 1 B 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for subtotal tumor excision 開立醫師: 胡朝凱 開立時間: 2011/06/20 14:03 Pre-operative Diagnosis Right temporal recurrent GBM Post-operative Diagnosis Right temporal recurrent GBM Operative Method Craniotomy for subtotal tumor excision Specimen Count And Types pieces of tumor in one bottle Pathology pending Operative Findings 1.Grayish to yellowish soft tumor located at right superior temporal gyrus was noted. The border was not clear. Some cyst was also noted inside the tumor. 2.The tumor extended to peri-ventricular area. 3.Some MCA branches was also identified during tumor removal and were all preservered well. 4.Small part of tumor was left in situ due to poor border between vessels. Operative Procedures 1.ETGA, supine with head rotate to left and fixed with skull clamp. 2.Previous wound incision and a transverse skin extension were made 3.Dissect to open skin and muscle flap 4.Remove previous bone flap and creat a extended craniotomy 5.Open dura 6.Localized tumor 7.Resect tumor with bipolar by identifying birder between brain tissue and tumor 8.MCA branches were preserved. 9.Close dura 10.Fixed bone back with miniplate 11.Close wound after one CWV drain insertion Operators 曾漢民 Assistants 胡朝凱, 曾峰毅,　李柏穎 王秀琴 (F,1935/12/29,76y2m) 手術日期 2011/06/20 手術主治醫師 蔡清霖 手術區域 東址 027房 02號 診斷 Osteoarthritis, knee 器械術式 Left TKR 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 脊髓麻醉 麻醉主治醫師 劉漢平 ASA 3 紀錄醫師 黃俊傑, 時間資訊 00:00 臨時手術NPO 10:20 報到 10:35 進入手術室 10:45 麻醉開始 10:50 誘導結束 10:53 抗生素給藥 11:16 手術開始 12:00 開始輸血 12:30 手術結束 12:30 麻醉結束 12:35 送出病患 12:38 進入恢復室 14:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Spinal anesthesia 1 0 手術 膝關節全置換術 1 1 L 記錄__ 手術科部: 骨科部 套用罐頭: Total knee replacement-lateral by 蔡P 開立醫師: 黃俊傑 開立時間: 2011/06/20 12:15 Pre-operative Diagnosis Left knee osteoarthritis Post-operative Diagnosis Left knee osteoarthritis Operative Method Total knee replacement with United prosthesis Specimen Count And Types nil Pathology nil Operative Findings 1.Cartilage wearing and subchondral bone expose 2.osteophyte formation 3.Indication for prolonged >24hour antibiotics: poor self hygiene Operative Procedures Under spinal anesthesia, the patient was postioned in supine. The operation field was disinfected and draped as usual. After inflating air tourniquet with 350 mmHg in pressure, skin was incised along midline of knee, and exposusre of the knee jointwas done with lateral approach. Bony preparation of femur, tibia, and patella were performed with ""united"" jigs subsequently.Total knee prosthesis was applied with cement, Tibia: #2_, Femur: #1_, Patella: 22_mm, Insert: #2_,_13_mm; Then air tourniquet was deflated, and hemostasis was done. After cleaning surgical wound with normal saline irrigation, the wound was finally closed in layers. Operators 蔡清霖, Assistants 葉炳君, 黃俊傑, 陳勇璋, 陳起民 (M,1954/02/18,58y0m) 手術日期 2011/06/21 手術主治醫師 杜永光 手術區域 東址 003房 02號 診斷 Lung Tumor 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 4E 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 12:06 進入手術室 12:10 麻醉開始 12:15 誘導結束 12:20 手術開始 12:24 抗生素給藥 14:30 開始輸血 15:24 抗生素給藥 17:05 手術結束 17:05 麻醉結束 17:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 開顱術摘除血管病變-動靜脈畸型小型表淺 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Left craniotomy for hematoma evacuation and A... 開立醫師: 胡朝凱 開立時間: 2011/06/21 16:54 Pre-operative Diagnosis Left parietal AVM ruptured caused ICH and IVH Post-operative Diagnosis Left parietal AVM ruptured caused ICH and IVH Operative Method Left craniotomy for hematoma evacuation and AVm excision, EVD insertion Specimen Count And Types One piece of AVM measured about 1.5x1 cm Pathology pending Operative Findings 1.About 60 ml ICH was evacuated. The brain was severe swelling initially. 2.IVH was also partial removed and an EVD was inserted 3.A 1.5 cm AVM was noted at the edge of hematoma with one feeder and one drainage vein. It located at left parietal lobe, 1 cm indepth from cortex. It was noted bleeding. 4.After hemaotma evacuation, brain became slack. Operative Procedures Under ETGA, patient was put in supine position with head rotate to right and fixed with Mayfield skull clamp. Reverse U shape skin incision was sone at left parietal area. The skin and muscle flap was reflected downward. Crainotomy was made with one cm away from midline. Dura was then opened with the base left at midline. Corticotomy was done and dissection was made to expose hematoma. Hematoma evacuation was performed with sucker. The suspicious lesion of AVM was identifed after partial hematoma removed. After coagulation od feeder and draining vein, AVM was resected. Further evacuation was done for IVH. And one EVD was inserted into ventricle. Hemostasis was performed. Dura was then closed with prolene. Bone was fixed back with miniplate. After one CWV drain insertion, wound was closed in layers. Operators P 杜永光 Assistants 胡朝凱,陳國瑋 Indication Of Emergent Operation Acute conscious change with ICH 相關圖片 邱婉容 (F,1953/10/10,58y5m) 手術日期 2011/06/21 手術主治醫師 曾勝弘 手術區域 東址 000房 01號 診斷 Parkinson''s disease 器械術式 IPG implantation 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 08:07 進入手術室 08:15 麻醉開始 08:20 誘導結束 08:25 手術開始 08:25 抗生素給藥 10:20 手術結束 10:20 麻醉結束 10:30 送出病患 10:32 進入恢復室 11:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室腹腔分流手術 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Implantable pulsed generator insertion at lef... 開立醫師: 林哲光 開立時間: 2011/06/21 10:39 Pre-operative Diagnosis Parkinson disease Post-operative Diagnosis Parkinson disease Operative Method Implantable pulsed generator insertion at left prechest area Specimen Count And Types nil Pathology Nil Operative Findings Medtronic IPG was inserted at left prechest area. Intraoperative IPG function was checked functionally. Operative Procedures Under ETGA and supine position with head mild rotated to right side, skin disinfected and drapped were performed as usual. Skin incision was made at left posterior auricle area. The previous two eletroleads were identified and subcutaneous tunneling was made from left prechest area to left neck. The leads were connected to IPG and IPG was inserted into the subcutaneous pocket at left prechest area. The wound was then closed in layers. Operators P 曾勝弘 Assistants R4 林哲光 相關圖片 許金樹 (M,1948/02/17,64y0m) 手術日期 2011/06/21 手術主治醫師 曾勝弘 手術區域 東址 005房 02號 診斷 Brain metastasis 器械術式 Right parietal brain metastasis excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 10:40 進入手術室 10:45 麻醉開始 11:25 誘導結束 11:30 抗生素給藥 11:30 手術開始 15:10 手術結束 15:10 麻醉結束 15:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Right parietal cranitomy with tumor excision 開立醫師: 林哲光 開立時間: 2011/06/21 15:45 Pre-operative Diagnosis Right parietal brain tumor, suspected brain metastasis Post-operative Diagnosis Right parietal brain tumor, suspected brain metastasis Operative Method Right parietal cranitomy with tumor excision Specimen Count And Types 1 piece About size:Multiple pieces Source:Tumor Pathology Pending Operative Findings A grayish, soft and suctionable tumor mass was noted at right parietal lobe without clear borderline. The arachnoid membrane near the tumor with some grayish discoloration was noted. Some tumor infiltrated into the surrouding gliosis were also noted. The tumor exicision was done as widely until the yellowish relatively healthy brain tissue was exposed. Operative Procedures Under ETGA and supine position with mild left decubitus position, skin disinfected and drapped were performed as usual. A reverse U-shpaed skin incision was made at right parietal part was done. Four burr holes were created and craniotomy was done. The dura was then opened in crossed shaped and the tumor was localized with echo. The tumor was removed with central debulking throuhg the gyrus near the tumor. The wound was then closed in layers after hemostasis. Operators P 曾勝弘 Assistants R4 林哲光 相關圖片 李苡溱 (F,1978/06/16,33y8m) 手術日期 2011/06/21 手術主治醫師 曾勝弘 手術區域 東址 005房 03號 診斷 HIVD 器械術式 Microdiskectomy, L4/5 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 14:44 報到 15:33 進入手術室 15:35 麻醉開始 15:45 誘導結束 15:55 抗生素給藥 16:24 手術開始 18:55 抗生素給藥 19:00 手術結束 19:00 麻醉結束 19:22 送出病患 19:22 進入恢復室 20:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-腰椎 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 記錄__ 手術科部: 外科部 套用罐頭: Microdiscectomy L4-5 開立醫師: 林哲光 開立時間: 2011/06/21 19:23 Pre-operative Diagnosis L4-5 herniated intervertebral disc with bilateral L5 radiculopathy Post-operative Diagnosis L4-5 herniated intervertebral disc with bilateral L5 radiculopathy Operative Method Microdiscectomy L4-5 Microsurgical discectomy, L4-5 Specimen Count And Types nil Pathology Nil Operative Findings Ruptured disc was noted at L4-5 level and removed from the left side microdiscectomy. The erythematous change of the bilaterl L5 root was noted with engorged epidural vessels. Bilateral shoulder and axilla of the L5 root were examed free from the fragment of the disc. Operative Procedures Under ETGA and prone position, skin disinfected and drapped were performed as usual. Midline skin incision at L4-5 level. The paraspinal muscle were detached and bilateral laminotomy at L5 were done. L4-5 microdiscectomy was performed and part of the bulging disc was removed. After checking the bilateral L5 root and covered with Rinderon solution. The wound was closed in layers after Gelfoam packing and subcutaneous Marcaine injection. Operators P 曾勝弘 Assistants R4 林哲光 相關圖片 鄭仰志 (M,1980/04/05,31y11m) 手術日期 2011/06/21 手術主治醫師 曾勝弘 手術區域 西址 039房 01號 診斷 Scalp tumor 器械術式 Excision of neuroma 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 09:00 報到 09:30 進入手術室 09:50 麻醉開始 09:52 誘導結束 09:53 手術開始 10:10 麻醉結束 10:10 手術結束 10:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 頭皮腫瘤 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Tumor remove 開立醫師: 陳睿生 開立時間: 2011/06/21 10:24 Pre-operative Diagnosis Left retroauricular scalp mass Post-operative Diagnosis Left retroauricular scalp mass, suspect lipoma Operative Method Tumor remove Specimen Count And Types 1 piece About size:1.5x1.5cm Source:tumor Pathology Pending Operative Findings An about 1.5x1.5cm yellowish, well capsuled tumor was removed en bloc. Operative Procedures 1. Prone position, local anesthesia 2. Linear scalp incision about 3cm 3. Dissect to expose the tumor 4. Totally remove of the tumor 5. Hemostasis, and close the wound in layers Operators VS 曾勝弘 Assistants R6 陳睿生 黃李秀珠 (F,1941/08/21,70y6m) 手術日期 2011/06/21 手術主治醫師 賴達明 手術區域 東址 003房 03號 診斷 Lumbar spondylosis 器械術式 L5-S1 sublaminar decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 17:20 報到 17:45 麻醉開始 17:45 進入手術室 17:55 誘導結束 18:15 抗生素給藥 18:24 手術開始 19:25 手術結束 19:25 麻醉結束 19:30 送出病患 19:34 進入恢復室 21:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 椎弓切除術(減壓)-二節以內 1 1 摘要__ 手術科部: 外科部 套用罐頭: L5 sublaminar decompression 開立醫師: 陳國瑋 開立時間: 2011/06/21 19:44 Pre-operative Diagnosis Lumbar stenosis Post-operative Diagnosis Lumbar stenosis Operative Method L5 sublaminar decompression Specimen Count And Types nil Pathology nil Operative Findings The thecal sac was compressed tightly by the hypertrophic ligamentum flavum and expanded well after decompression. No incidental durotomy was made during the procedure. Operative Procedures After ETGA, the patient was put in prone position and the L5 pedicle was identified with C-arm. The skin was disinfected and draped as usual. Skin incision was made, and dissection to the level of laminae was made. Under microscopic aid, laminotomy was made at both sides and the hypertrophic ligamentum flavem was removed. After ETGA, the patient was put in prone position and the L5 pedicle was identified with C-arm. The skin was disinfected and draped as usual. Skin incision was made, and dissection to the level of laminae was made. Under microscopic aid, laminotomy was made at both sides and the hypertrophic ligamentum flavem was removed. After hemostasis the wound was closed in layers. Operators VS賴達明 Assistants R5鍾文桂 R2陳國瑋 相關圖片 陳清祥 (M,1953/09/01,58y6m) 手術日期 2011/06/21 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Ossification of posterior longitudinal ligament, cervical (OPLL) 器械術式 C3-7 Laminoplasty 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳國瑋, 李振豪, 時間資訊 00:00 臨時手術NPO 08:07 進入手術室 08:10 麻醉開始 08:20 誘導結束 08:30 抗生素給藥 08:35 手術開始 11:35 手術結束 11:35 麻醉結束 11:45 送出病患 11:48 進入恢復室 13:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 手術 椎弓整形術 1 1 摘要__ 手術科部: 外科部 套用罐頭: C3-6 laminoplasty 開立醫師: 李振豪 開立時間: 2011/06/21 11:48 Pre-operative Diagnosis Cervical ossification of posterior longitudinal ligament with myelopathy Post-operative Diagnosis Cervical ossification of posterior longitudinal ligament with myelopathy Operative Method C3-6 laminoplasty Specimen Count And Types nil Pathology Nil Operative Findings The thecal sac expanded well after laminoplasty. No incidental durotomy or CSF leakage was noted after whole procedure. Poor waveform was noted before the operation, especially left side. No obvious EP change was noted after whole procedure. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position with head fixed wity Mayfield skull clamp. The skin was shaved, scrubbed, and disinfected as usual. Midline skin incision was made from C2 to C7 level. The subcutaneous soft tissue and nuchal muscle groups were devided to expose C2 to C6 laminae. Grooving of bilateral laminae was performed with Midas air-drived drills. The open-door method laminoplasty was performed(open side: left) with miniplates and screws. Hemostasis was achieved and one epidural CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS賴達明 Assistants R4李振豪, R2陳國瑋 相關圖片 葉徐菊梅 (F,1939/10/11,72y5m) 手術日期 2011/06/21 手術主治醫師 賴達明 手術區域 東址 007房 05號 診斷 Herniation of intervertebral disc with myelopathy, cervical 器械術式 C5/6, 6/7 ACDF 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 15:00 報到 15:05 進入手術室 15:15 麻醉開始 15:25 誘導結束 15:45 抗生素給藥 16:00 手術開始 18:25 手術結束 18:25 麻醉結束 18:40 送出病患 18:45 進入恢復室 20:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 手術 椎間盤切除術-頸椎 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Anterior cervical discectomy, foraminotomy, a... 開立醫師: 李振豪 開立時間: 2011/06/21 18:47 Pre-operative Diagnosis Herniated intervertebral disc, C5/6, C6/7 with myelopathy Post-operative Diagnosis Herniated intervertebral disc, C5/6, C6/7 with myelopathy Operative Method Anterior cervical discectomy, foraminotomy, and fusion with PEEK cage Specimen Count And Types nil Pathology Nil Operative Findings Marginal spur formation with narrowing of disc space was noted at C5/6, C6/7 level. The disc was degenerative and fragile in character. Herniated disc, mainly at C5/6 level, compressed the thecal sac tightly. The ossification of posterior longitudinal ligament also noted after diskectomy. The OPLL was resected and the thecal sac expanded well after decompression. No EP change was noted during whole procedure. PEEK cages were placed for anterior fusion(#6 at C5/6 level, #7 at C6/7 level). Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with neck extension. The skin was scrubbed, disinfected, and draped as usual. Transverse skin incision was made at left lower cervical . The platysma muscle was devided and the fascia was opened longitudinally. The pre-vertebral fascia was approached via the plan between carotid sheath and thyroid gland. The pre-vertebral fascia was opened and the longus colis muscle was detached. The disc level was identified by portable C-arm X-ray. Under operative microscope, C5/6, C6/7 microdiskectomy were done with knife, curette, alligator, Kerrison punches, and Midas air-drived drills. Resection of OPLL and foraminotomy were also performed for decompression. Hemostasis was achieved and PEEK cage was implanted for anterior fusion. One MiniHemovac was placed and the wound was closed in layers with 3-0 Vicryl and 4-0 Dexon. Operators VS賴達明 Assistants R4李振豪, Ri洪肇澤 相關圖片 吳盛忠 (M,1957/11/22,54y3m) 手術日期 2011/06/21 手術主治醫師 楊士弘 手術區域 東址 002房 01號 診斷 Spinal metastasis 器械術式 Anterior Spinal fusion (Lateral -Others) 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 曾峰毅, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 06:48 通知急診手術 07:47 報到 08:00 進入手術室 08:10 麻醉開始 08:40 抗生素給藥 09:00 誘導結束 09:40 手術開始 11:40 抗生素給藥 12:25 16:40 開始輸血 16:47 抗生素給藥 18:55 麻醉結束 18:55 手術結束 19:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 惡性脊髓腫瘤切除術 1 1 手術 脊椎融合術-後融合,有固定物(<=六節) 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 14 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Posterior fixatiion of L2 and L4 with transpe... 開立醫師: 曾峰毅 開立時間: 2011/06/21 19:16 Pre-operative Diagnosis L3 metastatic tumor Post-operative Diagnosis L3 metastatic tumor Operative Method Posterior fixatiion of L2 and L4 with transpedicular screws, and posterior fusion with artificial bone graft, L3 corpectomy for tumor excision, and anterior fusion with expandible body cage Specimen Count And Types Several fragments of one tumor was sent for pathology. Pathology Pending Operative Findings A-spine transpedicular screws, 6.5 x 45 mm, were inserted into bilateral pedicles of L2 and L4. 100 mm rods were used for fixation. Artificial bone graft was used for posterior fusion, and A-spine expandible body cage was used for anterior fusion. Hypervascular tumor occupying L3 vertebroal body, supplied by one lumbar artery, was removed in piecemeal. Operative Procedures With endotracheal general anaethesia, the patient was put in prone position. After C-arm localization, we scrubbed, disinfected, and then draped the patient. We made one midline skin incision and dissected paraspinal muscle to expose bilateral laminae from L2 to l4. We inserted transpedicular screws into bilateral pedicles of L2 and L4. We connected the TPS with 100 mm rods, and performed posterior fusion with artificial bone graft. The wound was closed in layers after one submuscular hemovac. The patient was repositioned to supine position, and we made one left paramedian skin incision to dissect along retroperitoneal route, but failed to expose L3 vertebral body well. The wound was closed in layers. The patient was repositioned to right decubitus position, and we made one transverse oblique skin incision from left flank toward to umbilicus. We dissected through external and internal obliques. Tumor was excised in piecemeal fashion, and intervertebral disc of L2/3 and L3/4 was removed. Body cage was inserted. The wound was closed in layers after one submuscular hemovac. Operators VS 楊士弘 Assistants R4 曾峰毅 Indication Of Emergent Operation Acute limb weakness. 林郁喬 (F,2004/04/01,7y11m) 手術日期 2011/06/21 手術主治醫師 楊士弘 手術區域 兒醫 067房 01號 診斷 Benign brain tumor 器械術式 Brain tumor Crainotomy(P-DUH)，External ventricular drainage 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 08:00 報到 08:10 進入手術室 08:15 麻醉開始 08:30 誘導結束 08:50 抗生素給藥 09:25 手術開始 11:00 麻醉結束 11:00 手術結束 11:06 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 歐氏貯囊置放手術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 套用罐頭: Ommaya reservoir implantation to the cyst of ... 開立醫師: 鍾文桂 開立時間: 2011/06/21 12:28 Pre-operative Diagnosis Craniopharyngioma. Post-operative Diagnosis Craniopharyngioma. Operative Method Ommaya reservoir implantation to the cyst of craniopharyngioma. Specimen Count And Types 1 piece About size:3cc Source:Craniopharyngioma cyst content. Pathology Nil. Operative Findings 1. Turbid brownish serous content in the cyst; total of 7 cc was aspirated. 2. Medtronic Ommaya reservoir was implanted 1 cm right lateral to midline and at coronal suture, 7.5cm in length. 3. Intraoperative ultrasonography guidance for Ommaya reservoir implantation into the tumor cyst. Operative Procedures Under ETGA, the patient was placed in supine position and the head was placed in midline. After shaving, disinfection, and draping, a curvilinear scalp incision was made at right frontal area. After dissection, an oval-shaped 2-cm craniotomy was created by high speed drill. Dural tenting was done. After durotomy, the ventricular catheter was inserted into the cyst of craniopharyngioma under the guidance of intraoperative ultrasonography. Then, the Ommaya reservoir was connected with the ventricular catheter. Its patency was checked. Finally, the wound was closed in layers. Operators 楊士弘 Assistants R5 鍾文桂 Ri 陳映廷 相關圖片 李張月桃 (F,1938/07/20,73y7m) 手術日期 2011/06/22 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Hydrocephalus 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李柏穎, 時間資訊 00:00 臨時手術NPO 10:45 進入手術室 10:50 麻醉開始 10:55 誘導結束 11:00 抗生素給藥 11:35 手術開始 12:40 麻醉結束 12:50 手術結束 13:00 送出病患 13:05 進入恢復室 14:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 曾峰毅 開立時間: 2011/06/22 12:59 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunt via right Kocher Specimen Count And Types CSF was sent for routine, culture, and biochemistry. Pathology Nil Operative Findings Colorless, clear CSF, gushed out while ventriculostomy. Codman, programmable shunt, set at 120 mmH20, was used. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to left. We shaved, scrubbed, disinfected,and then draped the skin. We made one transverse skin incision at right frontal area, and then created the burr hole, and another transverse skin incision at right upper abdomen to create mini-laparotomy. Subcutaneous tunnel was created, and shunt catheter was pulled-out. We performed ventriculostomy, and then inserted ventricular catheter, and then connected the shunt together. We checked the function, and thne inserted peritoneal catehter. The wounds were closed in layers. Operators VS 曾漢民 Assistants R4 曾峰毅 R1 李柏穎 相關圖片 趙叔富 (M,1961/04/07,50y11m) 手術日期 2011/06/22 手術主治醫師 蔡瑞章 手術區域 東址 005房 01號 診斷 Lumbar spondylosis 器械術式 Microdiskectomy, L4/5, right 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李柏穎, 時間資訊 00:00 臨時手術NPO 08:00 進入手術室 08:10 麻醉開始 08:15 誘導結束 08:50 抗生素給藥 08:57 手術開始 10:17 手術結束 10:17 麻醉結束 10:28 送出病患 10:30 進入恢復室 11:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-腰椎 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Microsurgical discectomy, L4-L5 開立醫師: 李柏穎 開立時間: 2011/06/22 10:13 Pre-operative Diagnosis Right L4-L5 sequestrated disc Post-operative Diagnosis Right L4-L5 sequestrated disc Operative Method Microsurgical discectomy, L4-L5 Specimen Count And Types nil Pathology nil Operative Findings 1.One about 1x1.5 cm sequestrated disc without PLL rupture was noted at right L4~L1 disc level that compressed the L5 root severely. 1.One about 1x1.5 cm sequestrated disc without PLL rupture was noted at right L4~L5 disc level that compressed the L5 root severely. 2.The root was injected and became thin. 2.The root was congested and became thin. 3.The rest part of disc was not dehydrated. 4.After decompression, root was loose. Operative Procedures 1.Under ETGA, the patient was in prone position 2.Midline skin incison at L4-L5 level 3.Detach Right paravertebral muscle 4.Resect flavum ligment at right L4-L5 space 5.After identified the L5 root and L4-L5 disc, we open the PLL and perform microsurgical discectomy of L4-L5 protruding disc 6.Further dissection of disc space 7.Local rinderon spary was given 8.Hemostasis, irrigation and close wound in layers. Operators 蔡瑞章 Assistants 曾峰毅 李柏穎 駱姵妤 (F,1970/06/20,41y8m) 手術日期 2011/06/22 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Spinal tumor 器械術式 L1 spinal tumor excision + T12-L2 TPS 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 08:08 進入手術室 08:15 麻醉開始 08:25 誘導結束 08:47 抗生素給藥 09:20 手術開始 12:20 手術結束 12:20 麻醉結束 12:25 送出病患 12:27 進入恢復室 14:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 良性脊髓腫瘤切除術 1 1 手術 脊椎融合術-後融合,有固定物(<=六節) 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Laminectomy T12 Tumor rescetion + T11-T12-L1 ... 開立醫師: 曾偉倫 開立時間: 2011/06/22 12:42 Pre-operative Diagnosis T12 Spinal tumor, suspect giant cell tumor Post-operative Diagnosis T12 Spinal tumor, suspect giant cell tumor Operative Method Laminectomy T12 Tumor rescetion + T11-T12-L1 TPS fixation Specimen Count And Types 1 piece About size:5x4x4 cm Source:T12 spinal tumor Pathology Pending Operative Findings 1. A 4x3x3 cm elastic, bluish, hypervascularized tumor over T12 spinous process which pushed the ligmentum flavum and spinal cord anteriorly. 2. The tumor invaded bilateral T12 pedicles 3. The cord expanded well after the tumor removal 4. Synthesis TPS x 5 (6.5 x 40mm)over bilateral T11, L1 and left side T12, Rod x 2 5. Blood loss: 1500ml Operative Procedures Under ETGA, we placed the patient to prone position. We locate the T11-L1 level with C-arm. After we scrubbed, disinfected and drapped, a mid-line skin incision was made from T11 to L1 level. Bilateral paraspinal muscles were detached from the spinous process and lamina. The T12 spinous process and the tumor was removed en-bloc. We removed the ligmentum flavum with Rougour and Kerrison punch. The spinal cord expanded well after then. The tumor below the T12 pedicles were removed with curret. The TPS was placed over bilateral T11, L1 and left side T12 under C-arm guidence. The Rods were fixed. After complete hemostasis, 2 hemovac drain were placed. The wound was closed in layers. Operators AP 賴達明 Assistants R6 陳睿生 R2 曾偉倫 相關圖片 林蔡春歌 (F,1923/12/17,88y2m) 手術日期 2011/06/22 手術主治醫師 王國川 手術區域 東址 018房 05號 診斷 Subarachnoid hemorrhage, trauma 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 4E 紀錄醫師 曾偉倫, 時間資訊 12:00 開始NPO 14:48 通知急診手術 15:15 報到 15:15 進入手術室 15:20 麻醉開始 15:35 誘導結束 15:55 抗生素給藥 16:17 手術開始 16:55 麻醉結束 16:55 手術結束 17:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦室體外引流 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: External ventricular drainage via right Koche... 開立醫師: 曾偉倫 開立時間: 2011/06/22 17:27 Pre-operative Diagnosis Traumatic ICH, IVH and SAH with hydrocephalus Post-operative Diagnosis Traumatic ICH, IVH and SAH with hydrocephalus Operative Method External ventricular drainage via right Kocher point Specimen Count And Types nil Pathology Nil Operative Findings 1. The opening pressure of the ventricle was > 15cm-H2O 2. Bloody CSF was drained 3. Blood loss: 50ml Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: supine with head rotated to left. 3.Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 3 cm linear, abover right Kocher point 5.After the scalp flap had been lifted and reflected anteriorly, a burr hole was made and the dura was tented by 2 stitches. 6.The dura was opened by a nib incision. Rt lateral ventricle was tapped by a ventricular needle, then a 7 cm segment of the ventricular catheter was introduced into the ventricle. The outerend of the catheter was connected to a EVD collecting system 7. The catheter was fixed and the wound was close in layers after hemostasis Operators VS 王國川 Assistants R4 林哲光 R2 曾偉倫 Indication Of Emergent Operation Hydrocephalus, massive hematoma 相關圖片 邱豪傑 (M,1984/05/31,27y9m) 手術日期 2011/06/23 手術主治醫師 蕭輔仁 手術區域 東址 005房 01號 診斷 Osteomyelitis 器械術式 L3/4 epidural abscess debridement 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 08:07 進入手術室 08:15 麻醉開始 08:20 誘導結束 09:00 抗生素給藥 09:08 手術開始 11:05 手術結束 11:05 麻醉結束 11:15 送出病患 11:15 進入恢復室 12:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術(減壓)-二節以內 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 摘要__ 手術科部: 外科部 套用罐頭: Debridement of epidural infectious granulation 開立醫師: 李振豪 開立時間: 2011/06/23 11:29 Pre-operative Diagnosis L3/4 spondylodiskitis with epidural abscess formation Post-operative Diagnosis L3/4 spondylodiskitis with epidural abscess formation Operative Method Debridement of epidural infectious granulation Specimen Count And Types 3 pieces About size:multiple small pieces Source:Posterior epidural granulation tissue About size:multiple small pieces Source:Anterior epidural granulation tissue About size:Swab x 5 Source:Posterior epidural x 2, anterior epidural x 3 Pathology Pending Operative Findings The thecal sac was compressed by granulation tissue both from anterior and posterior epidural space. Moderate adhesion between dura and granulation tissue was noted. The evident caseous necrosis or frank pus was noted during operation. The thecal sac and roots were preserved well and no CSF leakage noted during whole procedure. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made along operative scar. The subcutaneous soft tissue and scar was devided to exposed the epidural space and the posterior instrumentation. The posterior epidural space granulation tissue was removed by curettage and sent for culture and pathology. The laminectomy was extanded both in both direction. Anterior epidural space was checked under operative microscope. The granulation tissue within anterior epidural space was removed by curette, dissector, and kerrison punches. The specimen was sent for culture and pathology also. The whole circumference of epidural space was checked to make sure there was no significant thecal sac compression. Hemostasis was achieved with Gelfoam packing and bipolar electrocautery. The wound was irrigated with Gentamicin solutions. One epidural Hemovac was placed. the wound was then closed in layers with 1-0, 2-0 Vicryl and 3-0 Nylon. Operators VS蕭輔仁 Assistants R4李振豪, Ri陳映廷 林蔡春歌 (F,1923/12/17,88y2m) 手術日期 2011/06/23 手術主治醫師 王國川 手術區域 東址 002房 05號 診斷 Subarachnoid hemorrhage, trauma 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 4E 紀錄醫師 曾峰毅, 時間資訊 23:36 通知急診手術 00:05 進入手術室 00:10 麻醉開始 00:12 誘導結束 00:45 手術開始 01:10 開始輸血 01:45 手術結束 01:45 麻醉結束 01:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦室體外引流 1 2 R 摘要__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 曾峰毅 開立時間: 2011/06/23 01:58 Pre-operative Diagnosis IVH with acute hydrocephalus Post-operative Diagnosis IVH with acute hydrocephalus Operative Method External ventricular drainage via bilateral Kocher point Specimen Count And Types Nil Pathology Nil Operative Findings Bloody CSF gushed out while ventriculostomy. Opening pressure was above 15 cm H20. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position. After scalp shaved, scrubbed, disinfected, and then draped, we made one longitudinal skin incision at left frontal area, and drilled one burr hole. Ventriculostomy was done after durotomy. We inserted ventricular catheter, and closed the wound in layers. We opened previous right frontal wound, and inserted ventricular catheter, and closed the wound in layers. Operators VS 王國川 Assistants R4 曾峰毅 Indication Of Emergent Operation IICP 林昭吟 (F,1974/01/18,38y1m) 手術日期 2011/06/23 手術主治醫師 蔡翊新 手術區域 東址 003房 01號 診斷 Major trauma rated 16 or above on the severity scale ( Injury severity score >=16 ) 器械術式 ICP monitoring 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 蕭柏妮 ASA 3E 紀錄醫師 陳國瑋, 時間資訊 16:40 通知急診手術 17:28 進入手術室 17:35 麻醉開始 17:50 誘導結束 18:00 抗生素給藥 18:10 手術開始 19:30 手術結束 19:30 麻醉結束 19:35 送出病患 19:35 開始輸血 醫令資訊 類別 名稱 量 刀 側 手術 顱內壓視置入 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 蔡翊新 開立時間: 2011/06/23 19:05 Pre-operative Diagnosis Traumatic ICH at left internal and external capsules, left temporal lobe; SDH at left falcotentorium, SAH at right high frontal region; suspected diffuse axon injury. Post-operative Diagnosis Traumatic ICH at left internal and external capsules, left temporal lobe; SDH at left falcotentorium, SAH at right high frontal region; suspected diffuse axon injury. Operative Method Left frontal burr hole for intraparenchymal ICP monitoring. Specimen Count And Types nil Pathology Nil. Operative Findings The brain was not swolloen upon dural incision. Initial ICP was 12 mmHg. ICP after skin closure was mmHg. The brain was not swolloen upon dural incision. Initial ICP was 12 mmHg. ICP after skin closure was 5 mmHg. Reference of ICP monitor: 491. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 4 cm at left frontal area, the skin edge was clipped by Raney clips for temporary hemostasis. 5. A burr hole was made at left Kocher point and the dura was incised cruciately. 6. A Codman ICP monitor was inserted into left frontal lobe. Reference level: 491. 7. Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 8. Drain: nil. 9. Blood transfusion: nil. 10.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5鍾文桂R2陳國瑋 Indication Of Emergent Operation Conscious disturbance, suspected IICP. 相關圖片 朱緯哲 (M,1988/07/21,23y7m) 手術日期 2011/06/24 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Pituitary Tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:10 麻醉開始 08:47 誘導結束 09:05 抗生素給藥 09:35 手術開始 11:55 手術結束 11:55 麻醉結束 12:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經由蝶竇之腦下垂體瘤切除 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Endoscopic transnasal transsphnoid adenomectomy 開立醫師: 曾偉倫 開立時間: 2011/06/24 12:15 Pre-operative Diagnosis Pituitary adenoma Post-operative Diagnosis Pituitary adenoma Operative Method Endoscopic transnasal transsphnoid adenomectomy Specimen Count And Types 2 piece About size:0.5x0.3x0.3 cm Source:Both are pituitary tumor, the one mark as 2 was attached to the normal gland Pathology Pending Operative Findings 1. The tumor was grayish, fragile, soft, and the size was about size 0.8cm in diameter. 2. The yellowish normal gland was found above the tumor, and fell down after tumor remove. 3. No CSF leakage was noted intra-op. Operative Procedures Under general anethesia and intubation, the patient was put in supine position with head tilted 30 degree to left. The facial skin was antiseptic with alcohol better-iodine tincture, and the mucosa of oral and nasal cavity was irrigated with better-iodine solution. The former areas were covered by sterilized adhesive plastic sheets then draped. Under endoscope, bilateral mucosal septum was coagulated and detached from the bone septum. The vomer bone and the anterior wall of the sphenoid sinus were identified and drilled opening. The sinusal mucosa and the septum inside the sinde were removed. The sellar floor was found, and the dura was coagulated then opened in cruciate fashion. The soft tumor parenchyma was removed by curette and aligator. After totally remove of the tumor, the normal gland fell down. Proper hemostasis was done. The sellar floor opening was enforced by packing with gelform. The nasal mucosa and the middle nasal turbinates returned to its normal position. Bilateral sides of the nasal cavities was tightly packed with two segments of rubber glove finger filled with vaseline gauze strips which had been soaked with better-iodine ointment. Operators P 杜永光, VS 楊士弘 Assistants R6 陳睿生, R2 曾偉倫 相關圖片 周子欽 (M,1959/03/08,53y0m) 手術日期 2011/06/24 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Brain metastasis 器械術式 Left frontal tumor excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 李柏穎, 時間資訊 00:00 臨時手術NPO 12:40 進入手術室 12:45 麻醉開始 13:00 誘導結束 13:02 抗生素給藥 13:03 手術開始 16:02 抗生素給藥 16:25 手術結束 16:25 麻醉結束 16:35 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除-手術時間在4小時以內 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Left frontal craniotomy for tumor excision 開立醫師: 曾峰毅 開立時間: 2011/06/24 16:35 Pre-operative Diagnosis Left frontal tumor, suspected metastasis Post-operative Diagnosis Left frontal tumor, suspected metastasis Operative Method Left frontal craniotomy for tumor excision Specimen Count And Types Several fragments of one tumor was sent for pathology. Pathology Pending Operative Findings One capsulated, hypervascular, heterogenous in consistence, tumor was noted at left frontal subcortical area with hemorrhage inside. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head fixed with Mayfield head clamp. We shaved, scrubbed, disinfected, and then draped the patient, and then made one curvilinear scalp incision at left frontal area. We drilled four burr holes, and thne created craniotomy. Dura was tented around the craniotomy window. Tumor excision in piecemeal was performed after durotomy. The dura was closed in water tight fashion with autologous fascia graft. Bone graft was fixed back with wires, and the wound was closed in layers. Operators VS 曾漢民 Assistants R4 曾峰毅 R1 李柏穎 相關圖片 黃日光 (M,1947/10/16,64y4m) 手術日期 2011/06/24 手術主治醫師 賴達明 手術區域 東址 005房 01號 診斷 Pituitary tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 李柏穎, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:04 進入手術室 08:15 麻醉開始 08:35 誘導結束 08:52 抗生素給藥 09:37 手術開始 11:00 開始輸血 11:55 麻醉結束 11:55 手術結束 12:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經由蝶竇之腦下垂體瘤切除 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Trans-sphenoid adenomectomy 開立醫師: 胡朝凱 開立時間: 2011/06/24 12:20 Pre-operative Diagnosis Pituitary macroadenoma Post-operative Diagnosis Pituitary macroadenoma Operative Method Trans-sphenoid adenomectomy Specimen Count And Types pieces of tumor Pathology pending Operative Findings 1.Sellar floor was pushed downward and the sphenoid sinus space was small. 2.Yellowish, soft tumor was noted in the sella turcica. It was hypervascular. 3.After tumor removal, no obvious arachnoid membrane was noted. No CSF leakage. Operative Procedures 1.ETGA, supine 2.Right nostril was exposed 3.Nasal septum mucosa was incised 4.Dissect and fractured septum 5.Remove anterior bone of sphenoid sinus 6.Remove sinus mucosa 7.open sellar floor 8.Open dura as a cruciate form 9.Tumor removal with currette 10.Hemostasis 11.Reconstruct sellar floor with bone chips 12.Close mucosa with merosel packing Operators VS 賴達明 Assistants 胡朝凱, 李柏穎 黃顯臣 (M,1927/09/03,84y6m) 手術日期 2011/06/24 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Cervical Spondylosis 器械術式 C3-6 laminoplasty 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 3 紀錄醫師 李振豪, 陳國瑋, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:20 麻醉開始 09:00 誘導結束 09:20 抗生素給藥 09:35 手術開始 12:00 手術結束 12:00 麻醉結束 12:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 椎弓整形術 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: C3-5 laminoplasty 開立醫師: 李振豪 開立時間: 2011/06/24 12:15 Pre-operative Diagnosis Cervical stenosis with myelopathy Post-operative Diagnosis Cervical stenosis with myelopathy Operative Method C3-5 laminoplasty C3-5 laminoplasty, open-door method Specimen Count And Types nil Pathology Nil Operative Findings calcification of the nuchal ligment was noted and removed during dissection. The thecal sac exapnded well after laminoplasty. No incidental durotomy or CSF leakage was noted during whole procedure. The patient tolerate whole procedure well. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position with head fixed with Mayfield skull clamp. The skin was shaved, scrubbed, and disinfected as usual. Midline skin incision was made from suboccipital area to C5 level. The subcutaneous soft tissue was devided and the paravertebral muscle groups were detached. C3-5 laminae were exposed. Grooving of bilteral laminae were performed with Midas air-drived drills. Laminoplasty was done with Miniplates and screws. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. The wound was irrigated with Gentamicin solution. One epidural CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS賴達明 Assistants R4李振豪, R2陳國瑋 相關圖片 王有忠 (M,1942/06/21,69y8m) 手術日期 2011/06/24 手術主治醫師 賴達明 手術區域 東址 019房 02號 診斷 Lumbar spondylosis 器械術式 C4-6 laminoplasty 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 3 紀錄醫師 李振豪, 陳國瑋, 時間資訊 00:00 臨時手術NPO 11:40 報到 12:25 進入手術室 12:35 麻醉開始 13:05 誘導結束 13:15 抗生素給藥 13:37 手術開始 16:20 手術結束 16:20 麻醉結束 16:40 送出病患 16:42 進入恢復室 17:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓整形術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: C4-6 laminoplasty, open-door method 開立醫師: 李振豪 開立時間: 2011/06/24 16:06 Pre-operative Diagnosis Cervical stenosis with myelopathy Post-operative Diagnosis Cervical stenosis with myelopathy Operative Method C4-6 laminoplasty, open-door method Specimen Count And Types nil Pathology Nil Operative Findings The thecal sac exapnded well after laminoplasty. No incidental durotomy or CSF leakage was noted during whole procedure. Total three miniplates and six screws were used for laminoplasty. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position with head fixed with Mayfield skull clamp. The skin was shaved, scrubbed, and disinfected as usual. Midline skin incision was made from suboccipital area to C6 level. The subcutaneous soft tissue was devided and the paravertebral muscle groups were detached. C4-6 laminae were exposed. Grooving of bilteral laminae were performed with Midas air-drived drills. Laminoplasty was done with Miniplates and screws. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. The wound was irrigated with Gentamicin solution. One epidural CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS賴達明 Assistants R4李振豪, R2陳國瑋 相關圖片 楊靜江 (F,1940/08/28,71y6m) 手術日期 2011/06/24 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Congenital lumbosacral spondylolisthesis 器械術式 L5-S1 TPS + cage 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 3 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 12:35 進入手術室 12:40 麻醉開始 12:50 誘導結束 13:10 抗生素給藥 13:35 手術開始 16:10 抗生素給藥 17:05 手術結束 17:05 麻醉結束 17:15 送出病患 17:18 進入恢復室 19:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎間盤切除術-腰椎 1 2 摘要__ 手術科部: 外科部 套用罐頭: L5-S1 TLIF + L4-5 TPS fixation 開立醫師: 曾偉倫 開立時間: 2011/06/24 17:38 Pre-operative Diagnosis L5-S1 grade 1 spondylolisthesis with L4-S1 spinal stenosis Post-operative Diagnosis L5-S1 grade 1 spondylolisthesis with L4-S1 spinal stenosis Operative Method L5-S1 TLIF + L4-5 TPS fixation Specimen Count And Types nil Pathology Nil. Operative Findings 1. L5-S1 disc protrution with secal sac and root compression 2. L5-S1 grade 1 spondylolisthesis 3. Fixation with TPS x 6 (6.5mmx40mm) + Rod x2 + PEEK cage 11mm x1 4. Right L4 screw cap was stripped during the operation 5. The thecal sac and the roots were loose after the operation Operative Procedures Under ETGA, patient was put on prone position. We localized the L4-S1 level with C-arm. After we scrubbed, disinfected and drapped, a mid-line skin incision was made and we opened the wound in layers. The paraspinal muscle was detatched from the spinous process and the lamina, facet joint and transverse process was detatched. We removed the lower part of L5 lamina, spinous process and the upper part of the S1 spinous process, lamina. The ligmentum flavum was opened and removed. The root and thecal sac was released after then. We perfomred L5-S1 TLIF and L4-5 TPS fixation and a CWV drain was placed. After complete hemostasis, the wound was closed in layers. Operators AP 賴達明 Assistants R6 陳睿生 R2 曾偉倫 相關圖片 陳美珠 (F,1956/03/14,56y0m) 手術日期 2011/06/24 手術主治醫師 黃培銘 手術區域 東址 018房 05號 診斷 Malignant neoplasm of brain, unspecified 器械術式 Port-A catheter implatation 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 廖先啟, 時間資訊 12:40 報到 12:55 進入手術室 13:10 抗生素給藥 13:12 手術開始 13:12 麻醉開始 13:14 誘導結束 13:50 麻醉結束 13:50 手術結束 13:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 port–A導管植入術–治療性導管植入術 1 0 L 記錄__ 手術科部: 外科部 套用罐頭: Port-A implantation 開立醫師: 廖先啟 開立時間: 2011/06/24 13:55 Pre-operative Diagnosis cancer Post-operative Diagnosis cancer Operative Method Port-A implantation by surgical cut down, left Specimen Count And Types Nil Pathology nil Operative Findings 1. Port-A catheter was inserted into SVC via left cephalic vein 2. Post-operative portable X-ray showed Port-A catheter tip in correct venous branch to SVC. Operative Procedures 1. Local anesthesia with the patient in supine position, prepped and draping were performed in the usual sterile method. 2. An incision was made in left side subclavical area. After identification of the cephalic vein, Port-A catheter was inserted. 3. Adequate hemostasis was obtained. 4. Post-operative portable X-ray showed catheter tip in correct venous branchto SVC. Then the wound was closed in layers. Operators VS黃培銘 Assistants R3廖先啟，R1戴逸昇 鍾錦榮 (M,1930/06/02,81y9m) 手術日期 2011/06/25 手術主治醫師 蔡瑞章 手術區域 東址 001房 02號 診斷 Cerebral aneurysm 器械術式 Craniotomy(Aneurysms) VS-TZENG 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 4E 紀錄醫師 胡朝凱, 時間資訊 20:00 臨時手術NPO 20:00 開始NPO 20:45 通知急診手術 21:15 報到 21:23 進入手術室 21:30 麻醉開始 22:00 誘導結束 22:30 抗生素給藥 22:40 手術開始 02:00 抗生素給藥 02:13 開始輸血 03:25 麻醉結束 03:25 手術結束 03:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 開顱術摘除血管病變 - 腦血管瘤 有病徵的 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: Left pterional approach for aneurysm clipping 開立醫師: 胡朝凱 開立時間: 2011/06/26 03:44 Pre-operative Diagnosis Anterior communicating artery aneurysm with spontaneous rupture and subarachnoid hemorrhage and hydrocephalus Post-operative Diagnosis Anterior communicating artery aneurysm with spontaneous rupture and subarachnoid hemorrhage and hydrocephalus Operative Method Left pterional approach for aneurysm clipping Specimen Count And Types Nil Pathology Nil Operative Findings Severe brain swelling was noted upon craniotomy. Severe dural adhesion with overlying skull was also noted. The aneurysm measured about 8mm in size and 6mm in neck width, arising from anterior communicating artery, protruding rightwardly with a small daughter aneurysm noted at anterior direction of the aneurysmal dome. Prominent left A1 was noted. Absent right side A1 segment was noted, and thick blood clot was noted near the aneurysm. Ischemia time less then 5 minutes. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head fixed in Mayfield skull clamp and turned to right. After scalp shaving, scrubbing, disinfection & draping in sterile fashion, a curvilinear incision was made at left frontotemporal area. After dissection of the temporalis muscle flap and reflected inferiorly, a standard left pterional craniotomy was performed. An U-shaped durotomy was made, followed by opening of the Sylvian fissure. The frontal lobe was then retracted, exposing left ICA & A1 segment to allow proximal control. The left A1 was then dissected to the A-com artery and the aneurysm with partial removal of rectus gyrus. After applying the temporary clip, a straight Sugita aneurysm clip was applied to the aneurysm neck; the temporary clip was removed afterwards. After meticulous hemostasis, the dura was closed with 4-0 Prolene continuous suture; the remaining dural defect was fixed with DuraForm. After central tenting, the bone was placed back and fixed with mini-plates. After setting 1 subgaleal CWV drain, the wound was closed with 2-0 Vicryl continuous suture and Appose clips. Operators P.蔡瑞章 Assistants R6 胡朝凱, R1 林瑜婷 Indication Of Emergent Operation prevent rebleeding 鍾錦榮 (M,1930/06/02,81y9m) 手術日期 2011/06/25 手術主治醫師 蔡瑞章 手術區域 東址 006房 02號 診斷 Cerebral aneurysm 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 王永彬 ASA 3E 紀錄醫師 曾峰毅, 時間資訊 03:23 通知急診手術 03:40 報到 03:40 進入手術室 03:45 麻醉開始 03:50 誘導結束 04:05 抗生素給藥 04:26 手術開始 05:00 麻醉結束 05:00 手術結束 05:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱內壓視置入 1 1 R 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: External ventricular drainage via right Koche... 開立醫師: 曾峰毅 開立時間: 2011/06/25 05:33 Pre-operative Diagnosis Acute hydrocephalus Post-operative Diagnosis Acute hydrocephalus Operative Method External ventricular drainage via right Kocher point Specimen Count And Types CSF was sent for routine, BCS, and culture Pathology Nil Operative Findings Light reddish CSF gushed out while ventriculostomy. Opening pressure was above 20 cmH20. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position. We shaved, scrubbed, disinfected, and then draped the patient, and made one transverse skin incision at right frontal area. We drilled one burr hole, and performed ventriculostomy. We inserted ventricular cathter, and closed the wound in layers. Operators P 蔡瑞章 Assistants R4 曾峰毅 Ri 黃楚軒 Indication Of Emergent Operation IICP 蔡昇軒 (M,1976/09/23,35y5m) 手術日期 2011/06/25 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Cerebral aneurysm 器械術式 Craniotomy for aneurysm clipping or excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 3 紀錄醫師 李柏穎, 時間資訊 00:00 臨時手術NPO 08:06 進入手術室 08:15 麻醉開始 08:50 誘導結束 09:18 抗生素給藥 09:20 手術開始 12:18 抗生素給藥 13:00 手術結束 13:00 麻醉結束 13:10 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 開顱術摘除血管病變 - 腦血管瘤 有病徵的 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for distal ACA trapping 開立醫師: 陳睿生 開立時間: 2011/06/25 13:37 Pre-operative Diagnosis Left distal ACA dissecting aneurysm with distal infarction and hemorrhagic transformation Post-operative Diagnosis Left distal ACA thrombosed dissecting aneurysm with distal infarction and hemorrhagic transformation Operative Method Craniotomy for distal ACA trapping Specimen Count And Types nil Pathology Nil Operative Findings An about 1.5cm longitudinal thrombosed dissecting aneurysm was noted at left side distal ACA. It was just beind the ACA to callosomarginal branch junction. The lumen distal to the aneurysm was shrinled, and no obvious flow was noted inside it. The flow inside the callosomarginal artery was also decreased, and it was ligated intra-op. A straight Sugita clip was applied at the distal end of the patent ACA for trapping. Operative Procedures 1. ETGA, the patient was under supine position and the head was fixed with Mayfield clump with mild extension 2. Bicoronal scalp incision, the scalp was dissected and retracted to the anterior aspect 3. Create two bur holes just apart from the SSS at the coronal suture level, and then an about 10x6cm craniotomy window was created with frontal extension 4. Proper dura tenting, and then the dura was opened curvillinearly toward the SSS 5. The plane between the left frontal lobe and falx was dissected to expose bilateral ACA 6. Set self retractor, and then the thrombosed aneurysm was identified 7. Dissect toward the long axis of the aneurysm to expose the proximal and distal side of the ACA 8. A straight Sugita clip was applied at the distal end of the patent ACA for trapping 9. Hemostasis, and the brain surface was packed with surgicel 10.The dura was sutured back tightly with deair 11.The bone graft was fixed back with miniplates x3 after central tenting 12.Set a subgaleal CWV drain, and the wound was closed in layers Operators VS 賴達明 Assistants R6 陳睿生, R1 李柏穎 劉奕輝 (M,1990/09/21,21y5m) 手術日期 2011/06/27 手術主治醫師 王國川 手術區域 東址 025房 01號 診斷 Malignant brain tumor, ventricle 器械術式 Ommaya reservoir implantation 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 3E 紀錄醫師 李振豪, 時間資訊 16:00 臨時手術NPO 16:00 開始NPO 23:14 通知急診手術 00:10 報到 00:20 進入手術室 00:25 麻醉開始 00:30 抗生素給藥 00:40 誘導結束 01:03 手術開始 01:40 手術結束 01:40 麻醉結束 01:50 送出病患 01:55 進入恢復室 03:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 歐氏貯囊置放手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 腫瘤醫學部 套用罐頭: Ommaya reservoir via right Kocher"s approach 開立醫師: 李振豪 開立時間: 2011/06/27 01:56 Pre-operative Diagnosis Germinoma with obstructive hydrocephalus Post-operative Diagnosis Germinoma with obstructive hydrocephalus Operative Method Ommaya reservoir via right Kocher"s approach Specimen Count And Types 1 piece About size:6ml Source:CSF Pathology Nil Operative Findings The opening pressure is more than 15cmH2O. The CSF is xanthochronic with light pinkish in color. Hypercellularity and increase viscosity also noted. CSF seeding was highly suspected. The ventricular catheter was fixed with 6.5 cm in depth. The function of Ommaya reservoir was checked after fixation of the Ommaya reservoir and wound closure. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position. The scalp was shaved, scrubbed, and disinfected as usual. Curvilinear scalp incision was made at right frontal area and previous burr hole were identified. Ventriculostomy was performed with puncture needle and the Ommaya reservoir was inserted. The Ommaya reservoir was fixed with three stitches. CSF sampling was performed. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS王國川 Assistants R4李振豪 Indication Of Emergent Operation IICP with bradycardia and severe headache 相關圖片 李徐昭慧 (F,1947/12/01,64y3m) 手術日期 2011/06/27 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Herniation intervertebral disc without myelopathy, thoracic (HIVD) 器械術式 L4/5 TPS 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 2 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:08 麻醉開始 08:15 誘導結束 08:47 抗生素給藥 09:15 手術開始 12:40 手術結束 12:40 麻醉結束 12:50 送出病患 12:51 進入恢復室 14:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎弓切除術(減壓)-二節以內 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: Laminectomy for scar remove and root decompre... 開立醫師: 陳睿生 開立時間: 2011/06/27 13:01 Pre-operative Diagnosis L4/5 recurrent HIVD s/p twice with scar formation and right side L5 root compression Post-operative Diagnosis L4/5 recurrent HIVD s/p twice with scar formation and right side L5 root compression Operative Method Laminectomy for scar remove and root decompression, L4/5 TPS fixation Specimen Count And Types nil Pathology Nil Operative Findings Thicken scar was noted mainly at right L4/5 level. Previous thecal sac tear with dura repair was noted at this level. The scar compressed the right L5 root from lateral aspect and was removed for decompression. Synthes TPS system: Screws: 6.25x40mm x4 rods: 5cm x2 Operative Procedures After ETGA, the patient was under prone position and mild flexion. C-arm was used to localize the L4/5 leve. We incised into the previous wound and extended to about 8cm. Bilateral paraspinal muscle was dissected to expose the L4/5 spinous process and lamina. Bilateral L4/5, L5/S1 facet joints were indetified, and TPS was inserted under C-arm guidence. L4, and partial L5 laminectomy was done, and the thecal sac was exposed from the upper normal side. The scar was dissected and removed under microscope assist. The thecal sac and right L5 root were exposed and decompressed. After proper hemostasis, the thecal sac was packed with gelfoam, and bilateral rods were set for fixation. The wound was irrigated with gentamicin solution, and a 1/8 hemovac was set. The wound was finally closed in layers. Operators P 杜永光 Assistants R6 陳睿生, R2 曾偉倫 相關圖片 林鳳茹 (F,1968/08/24,43y6m) 手術日期 2011/06/27 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Pituitary tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 污染 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 李柏穎, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:10 麻醉開始 08:15 誘導結束 08:40 抗生素給藥 09:05 手術開始 10:15 手術結束 10:15 麻醉結束 10:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 鼻中膈鼻道成形術-單側 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 經由蝶竇之腦下垂體瘤切除 1 1 摘要__ 手術科部: 外科部 套用罐頭: Hypophysectomy---Transphenoid 開立醫師: 曾峰毅 開立時間: 2011/06/27 10:35 Pre-operative Diagnosis Pituitary macroadenoma with apoplexy Post-operative Diagnosis Pituitary macroadenoma with apoplexy Operative Method Transnasal trans-sphenoidal adenomectomy Specimen Count And Types Several fragments of the tumor was sent for pathology. Pathology Pending Operative Findings Fragile, hypervascular tumor was noted with cyst component, containing xanthochromic and dard-reddish fluild, in the sellae. Arachnoid pouch re-expanded, and there was no CSF leakage. Operative Procedures With endotracheal general anaestehsia, the patient was put in supine position with neck extended. We disinfeted, and then draped the pateint. We made one mucosa incision at medial side of right nostril, and deviated nasal septum to left, and medial turbinate to the lateral. We knocked down the vomer, and removed the mucosa in the sphenoidal sinus. Septum of sphnoidal sinus was removed as well, and sellar floor was knocked down. We made one X-shape dura incision, and then performed tumor excision in piecemeal. We reconstructed the sell floor and vomer after packed sphenoidal sinus with Gelfoam. We packed bilateral nostrils. Operators VS 曾漢民 Assistants R4 曾峰毅 R1 李柏穎 相關圖片 許慧英 (F,1969/08/17,42y6m) 手術日期 2011/06/27 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Glioma, brain 器械術式 Awake surgery for right angular gyrus tumor excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 面罩麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 李柏穎, 時間資訊 00:00 臨時手術NPO 10:45 進入手術室 10:50 麻醉開始 11:09 誘導結束 11:25 抗生素給藥 11:30 手術開始 14:25 抗生素給藥 15:05 手術結束 15:05 麻醉結束 15:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4~8小時 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Semi-opened mask inhalation anes 1 0 麻醉 Semi-opened INHALATION GENERAL A 4 0 麻醉 SENI-OPENED INHALATION GENERAL A 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT 開立醫師: 曾峰毅 開立時間: 2011/06/27 15:24 Pre-operative Diagnosis Suspected glioma, rigth angular gyrus Post-operative Diagnosis Suspected glioma, rigth angular gyrus Operative Method Right temporal craniotomy for tumor biopsy Specimen Count And Types Several fragments of one small piece of tumor, 0.5x0.5x0.5 cm, was sent for pathology. Pathology Nil Operative Findings We identified the pathology area with Naviation, and this area is whiter than surrrouding. Stimluation at posterior part of the tumor, caused the patient mute. Thus, we performed biospy only. Convulsion was noted in the end of speech test, and it stopped spontaneously after seconds. Operative Procedures With intravenous general anaesthesia, the patient was put in left decubitus position with head fixed with Mayfield head clamp. Navigator was set up, and we shaved, scrubbed, disinfected, and then draped the patient's right temporal area. We infiltrated the right temporal area with lidocaine. Then, we made one U-shape skin incision, and then created cranitomy after four burr holes. We open the dura in U-shape, and let the patient woke up from anaethesia. Speech examination was done, and speech area was identified. We performed tumor biospy, and then closed the dura in water-tight fashion. Bone graft was fixed back with wires, and the wound was closed in layers. Operators VS 曾漢民 Assistants R4 曾峰毅 R1 李柏穎 王芬蘭 (F,1935/07/17,76y7m) 手術日期 2011/06/27 手術主治醫師 賴達明 手術區域 東址 002房 01號 診斷 Cerebral aneurysm, nonruptured 器械術式 Left P-com aneurysm clipping 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3E 紀錄醫師 胡朝凱, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 02:00 通知急診手術 08:10 報到 08:21 進入手術室 08:25 麻醉開始 09:10 誘導結束 09:13 抗生素給藥 09:15 手術開始 13:30 抗生素給藥 14:20 麻醉結束 14:20 手術結束 14:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 開顱術摘除血管病變 - 腦血管瘤 有病徵的 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Left Pterional approach for aneurysmal clipping 開立醫師: 胡朝凱 開立時間: 2011/06/27 15:55 Pre-operative Diagnosis Left p-com aneurysm with third nerve compression Post-operative Diagnosis Left p-com aneurysm with third nerve compression Operative Method Left Pterional approach for aneurysmal clipping Specimen Count And Types nil Pathology nil Operative Findings 1.A large P-com aneurysm, measured about 1 cm, protruded downward and posteriorly. 2.Atherosclerosis was also noted at some segment of ICA and aneurysmal neck. 3.One 45 degree stright Sugita clip and a fenestrated,45 degree Sugita clip were applied at aneurysmal neck parallelly. After clipping, aneurysm was punctured without flow inside. 4.Perforators and anterior choroidal artery were all preserved. 5.Proximal control was done twice. The timr period was less then 5 mins. 6.During proximal control, SSEP decreased. But it recovered partially after procedure complete. Operative Procedures 1.ETGA, supine with head rotate to right for 60 degree and fixed with skull clamp 2.Left pterional approach was done 3.Anterior clinoidectomy was further performed 4.open dura 5.Sylvian fissure was opened from distal to proximal 6.open optico-carotid cistern 7.Identified aneurysm, p-com, and perforators 8.proximal control 9.ANeurysmal clipping 10.Close dura with prolene 11.Fixed bone back with miniplate 12.Close wound in layers after one CWV drain insertion. Operators VS 賴達明 Assistants 胡朝凱, Ri Indication Of Emergent Operation acute third nerve palsy. 蔡美露 (F,1946/02/23,66y0m) 手術日期 2011/06/28 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Brain metastasis 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 王奐之, 時間資訊 16:54 臨時手術NPO 08:02 進入手術室 08:08 麻醉開始 08:50 誘導結束 08:56 手術開始 09:00 抗生素給藥 12:00 抗生素給藥 12:50 手術結束 12:50 麻醉結束 13:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 腦瘤切除-手術時間在4小時以內 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Right parieto-occipital craniotomy for tumor ... 開立醫師: 王奐之 開立時間: 2011/06/28 13:22 Pre-operative Diagnosis Thyroid cancer with right parietal and left frontoparietal brain metastases Post-operative Diagnosis Thyroid cancer with right parietal and left frontoparietal brain metastases Operative Method Right parieto-occipital craniotomy for tumor resection Specimen Count And Types 2 pieces About size:3*3*3cm Source:right parietal tumor About size:0.5*0.5*0.5cm Source:right parietal lobe, susp. radionecrosis Pathology Pending Operative Findings A greyish, fragile and hypervascularized tumor was noted at right parietal area, measuring about 3*3*3cm. Some cystic portion was noted at anterior part of the tumor, and some yellowish part was noted adjacent to the tumor, locating anterior to the tumor, suspected to be radionecrosis (also sent for pathologic examination). Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position with head fixed in Mayfield skull clamp and turned to make the right side facing upward. After shaving, scrubbing, disinfection & draping in sterile fashion, a reversed U-shape incision was made at right parieto-occipital area. After dissection and exposure of the skull, 4 burr holes were made and a rectangular craniotomy was done. After removing the bone flap, dural tenting were done at the edges. After localization of the tumor with intra-operative ultrasound, an L-shaped durotomy was made and the dura was reflected superio-medially. The margin between the tumor and normal brain tissue was then dissected, until the tumor was removed en bloc. After meticulous hemostasis, the tumor bed was packed with Surgicel. The dura was closed with a small piece of periosteal graft in water-tight fashion. After central tenting, the bone flap was placed back and fixed with mini-plates. The wound was then closed in layers. Operators VS 曾漢民 Assistants R3 王奐之, Ri 沈維真 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Right parieto-occipital craniotomy for tumor ... 開立醫師: 王奐之 開立時間: 2011/06/28 18:46 Pre-operative Diagnosis Thyroid cancer with right parietal and left frontoparietal brain metastases Post-operative Diagnosis Thyroid cancer with right parietal and left frontoparietal brain metastases Operative Method Right parieto-occipital craniotomy for tumor resection Specimen Count And Types 2 pieces About size:3*3*3cm Source:right parietal tumor About size:0.5*0.5*0.5cm Source:right parietal lobe, susp. radionecrosis Pathology Pending Operative Findings A greyish, fragile and hypervascularized tumor was noted at right parietal area, measuring about 3*3*3cm. Some cystic portion was noted at anterior part of the tumor, and some yellowish part was noted adjacent to the tumor, locating anterior to the tumor, suspected to be radionecrosis (also sent for pathologic examination). Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position with head fixed in Mayfield skull clamp and turned to make the right side facing upward. After shaving, scrubbing, disinfection & draping in sterile fashion, a reversed U-shape incision was made at right parieto-occipital area. After dissection and exposure of the skull, 4 burr holes were made and a rectangular craniotomy was done. After removing the bone flap, dural tenting were done at the edges. After localization of the tumor with intra-operative ultrasound, an L-shaped durotomy was made and the dura was reflected superio-medially. The margin between the tumor and normal brain tissue was then dissected, until the tumor was removed en bloc. After meticulous hemostasis, the tumor bed was packed with Surgicel. The dura was closed with a small piece of periosteal graft in water-tight fashion. After central tenting, the bone flap was placed back and fixed with mini-plates. The wound was then closed in layers. Operators VS 曾漢民 Assistants R3 王奐之, Ri 沈維真 相關圖片 鄭祖倫 (M,2009/06/04,2y9m) 手術日期 2011/06/28 手術主治醫師 曾勝弘 手術區域 兒醫 067房 01號 診斷 Aromatic L-amino acid decarboxylase deficiency 器械術式 Brain biopsy -Stereotaxic 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 4 紀錄醫師 鍾文桂, 時間資訊 04:00 臨時手術NPO 12:10 進入手術室 12:15 麻醉開始 13:05 誘導結束 13:30 抗生素給藥 13:33 手術開始 14:55 手術結束 15:20 送出病患 15:20 麻醉結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 頭皮腫瘤 1 1 L 手術 頭皮腫瘤 1 2 R 摘要__ 手術科部: 套用罐頭: Implantation of fiducial markers for stereotasis. 開立醫師: 鍾文桂 開立時間: 2011/06/28 15:40 Pre-operative Diagnosis Aromatic L-amino acid decarboxylase (AADC) deficiency. Post-operative Diagnosis Aromatic L-amino acid decarboxylase (AADC) deficiency. Operative Method Implantation of fiducial markers for stereotasis. Implantation of fiducial markers for stereotaxis. Specimen Count And Types nil Pathology nil. Operative Findings 1. Total of 8 fiducial marks were implanted on the head of the patients. 2. Follow-up CT of brain without contrast for stereotasis did not show eppidural hematoma over the sites of fiducial marker implantation. Operative Procedures Under ETGA, the patient was placed in supine position and head in midline. After shaving, disinfection, and draping, the fiducial markers were applied on the planned sites ( 4 at bilateral parietal regions and 4 at bilateral frontal regions). Then, 4mm screws were inserted on the fiducial markers. Final fiducial markers were applied onto the screws. The markers were fixed by OP-sites and the head was well draped with dressings. Operators 曾勝弘 Assistants R5 鍾文桂 呂盛成 (M,1985/01/13,27y2m) 手術日期 2011/06/28 手術主治醫師 蕭輔仁 手術區域 東址 003房 01號 診斷 Cervical tumor 器械術式 C3/4 diskectomy + plating 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 陳國瑋, 時間資訊 00:00 臨時手術NPO 08:00 進入手術室 08:15 麻醉開始 08:25 誘導結束 08:50 抗生素給藥 09:08 手術開始 12:00 抗生素給藥 12:35 手術結束 12:35 麻醉結束 12:50 送出病患 12:52 進入恢復室 14:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 脊椎融合術-前融合,有固定物)≦四節 1 2 手術 椎間盤切除術-頸椎 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Anterior cervical diskectomy + fusion with PE... 開立醫師: 李振豪 開立時間: 2011/06/28 12:46 Pre-operative Diagnosis C2 neuroma, status post C1-3 laminectomy for tumor excision, with progressive C3-4 kyphotic change Post-operative Diagnosis C2 neuroma, status post C1-3 laminectomy for tumor excision, with progressive C3-4 kyphotic change Operative Method Anterior cervical diskectomy + fusion with PEEK cage and plating Specimen Count And Types nil Pathology Nil Operative Findings Narrowing of C3/4 disc space was noted and distracted for reduction of kyphotic change. The disc was health in nature. One #6 PEEK cage was placed for anterior fusion. One 28mm plate and four 4.3 x 16mm screws were used for anterior fixation. No incidental durotomy or CSF leakage was noted during whole procedure. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with neck extension. Right upper neck transverse skin incision was made and the subcutaneous soft tissue was devided. The platysma muscle was transected. The fascia was opened and the prevertebral space was entered via the plan between thyroid gland and carotid sheath. The longus colis muscle were detached. The location of C3/4 disc space was identified by portable C-arm X-ray. Under operative microscope, C3/4 diskectomy was performed. One #6 PEEK cage was inserted for anterior fusion. Plate and screws were also applied for anterior fixation. The location of the plate and screws were identified by portable C-arm X-ray. Hemostasis was achieved and the wound was irrigated with gentamicin solution. The wound was then closed in layers with 3-0 Vicryl and 4-0 Dexon. Operators VS蕭輔仁 Assistants R4李振豪, R2陳國瑋 相關圖片 闕寶霞 (F,1961/10/28,50y4m) 手術日期 2011/06/29 手術主治醫師 杜永光 手術區域 東址 003房 05號 診斷 Subarachnoid hemorrhage 器械術式 Craniotomy(Aneurysms) P-DUH right 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 4E 紀錄醫師 曾偉倫, 時間資訊 08:00 臨時手術NPO 08:00 開始NPO 14:39 通知急診手術 15:25 進入手術室 15:45 麻醉開始 15:50 誘導結束 16:00 抗生素給藥 16:00 手術開始 19:00 抗生素給藥 20:55 手術結束 20:55 麻醉結束 21:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 開顱術摘除血管病變 - 腦血管瘤 有病徵的 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Pterional approach for aneurysm clipping 開立醫師: 陳睿生 開立時間: 2011/06/29 21:47 Pre-operative Diagnosis Right MCA bifurcation aneurysm Post-operative Diagnosis Right MCA bifurcation aneurysm Operative Method Pterional approach for aneurysm clipping Specimen Count And Types nil Pathology Nil Operative Findings The aneurysm was about 8mm at dome, and 4mm at neck. It located at M1-M2 junction, and was found between the frontal and temporal branches. The aneurysm protruded superiorly, and the rupture side was noted at temporal side. Intra-op aneurysm rupture was noted, and proximal control was applied for clipping. A straight Sugita clip was applied and no obvious flow was noted inside the aneurysm after clipping. Total ischemic time was about 4mins plus 6mins. Operative Procedures After ETGA, the patient was under supine position, and head left turn, fixed with Mayfield clump. Right frontotemporal scalp curvillinear incision was made, and then the temporalis muscle was dissected with facial nerve preservation. Two bur holes were created at key hole, and below the posterior superior temporal line. Then an about 10x10 cm craniotomy was created. Proper dura tenting was done, and then the outer sphenoid ridge was drilled flattern. The dura was opened, and then CSF was drained from interchaismatic cistern for decompression. Then the sylvian fissure was opened from the distal side. With arachnoid membrane dissection, the proximal M1 was exposed for proximal control. Then we traced the MCA to identify the aneurysm and M2 branches. Aneurysmal wall tear was noted while neck dissection. Under proximal control, the aneurysm neck was well exposed, and then the aneurysm was clipped with straight Sugita clip. Hemostasis was done, and then the dura was tightly closed with deair. The skull graft was fixed back with miniplates x3 with central tenting. An epidural CWV drain was set, and then the wound was closed in layers. Operators P 杜永光 Assistants R6 陳睿生 R2 曾偉倫 Indication Of Emergent Operation 相關圖片 摘要__ 手術科部: 外科部 套用罐頭: Pterional approach for aneurysm clipping 開立醫師: 曾偉倫 開立時間: 2011/06/29 22:06 Pre-operative Diagnosis Right MCA bifurcation aneurysm Post-operative Diagnosis Right MCA bifurcation aneurysm Operative Method Pterional approach for aneurysm clipping Specimen Count And Types nil Pathology Nil Operative Findings The aneurysm was about 8mm at dome, and 4mm at neck. It located at M1-M2 junction, and was found between the frontal and temporal branches. The aneurysm protruded superiorly, and the rupture side was noted at temporal side. Intra-op aneurysm rupture was noted, and proximal control was applied for clipping. A straight Sugita clip was applied and no obvious flow was noted inside the aneurysm after clipping. Total ischemic time was about 4mins plus 6mins. Operative Procedures After ETGA, the patient was under supine position, and head left turn, fixed with Mayfield clump. Right frontotemporal scalp curvillinear incision was made, and then the temporalis muscle was dissected with facial nerve preservation. Two bur holes were created at key hole, and below the posterior superior temporal line. Then an about 10x10 cm craniotomy was created. Proper dura tenting was done, and then the outer sphenoid ridge was drilled flattern. The dura was opened, and then CSF was drained from interchaismatic cistern for decompression. Then the sylvian fissure was opened from the distal side. With arachnoid membrane dissection, the proximal M1 was exposed for proximal control. Then we traced the MCA to identify the aneurysm and M2 branches. Aneurysmal wall tear was noted while neck dissection. Under proximal control, the aneurysm neck was well exposed, and then the aneurysm was clipped with straight Sugita clip. Hemostasis was done, and then the dura was tightly closed with deair. The skull graft was fixed back with miniplates x3 with central tenting. An epidural CWV drain was set, and then the wound was closed in layers. Operators P 杜永光 Assistants R6 陳睿生 R2 曾偉倫 Indication Of Emergent Operation SAH, aneurysm rupture 相關圖片 鄭祖倫 (M,2009/06/04,2y9m) 手術日期 2011/06/29 手術主治醫師 曾勝弘 手術區域 兒醫 067房 01號 診斷 Aromatic L-amino acid decarboxylase deficiency 器械術式 Stereotaxic procedure for func 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 4 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 08:45 進入手術室 08:45 報到 08:55 麻醉開始 09:10 誘導結束 09:20 手術開始 13:00 抗生素給藥 15:38 麻醉結束 15:38 手術結束 15:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 立體定位術-功能性失調 1 1 R 手術 立體定位術-功能性失調 1 2 L 麻醉 動脈血液檢查全套 3 0 麻醉 Hemoglobin (Hb) 3 0 麻醉 測血糖 3 0 麻醉 Ca (Calcium) 3 0 麻醉 Na (Sodium) 3 0 麻醉 K (Potassium) 3 0 麻醉 Blood gas analysis 3 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 摘要__ 手術科部: 套用罐頭: Putaminal AADC gene therapy by bilateral int... 開立醫師: 鍾文桂 開立時間: 2011/06/29 16:50 Pre-operative Diagnosis Aromatic L-amino acid decarboxylase (AADC) deficiency. Post-operative Diagnosis Aromatic L-amino acid decarboxylase (AADC) deficiency. Operative Method Putaminal AADC gene therapy by bilateral intraputaminal infusion of adeno-associated virus vector containing the human AADC gene. Specimen Count And Types nil Pathology Nil. Operative Findings 1. A total of four tracts at bilateral anterior and posterior lateral half of the putamen at bilateral sides were aimed for implantation of adeno-associated virus vector containing the human AADC gene.At each tract, 80 ul was injected( 20ul at each point, 4 points at each tract, each point is 2 mm apart.) Operative Procedures Under ETGA, the patient was put in supine position. The scalp was shaved, scrubbed and antiseptic with alcohol B-I. Registered the preset localization point to navigator. Bicoronal scalp incision was made with burr hole made at entery point of left frontal region as navigator guided. The port was set up. Injected needle was inserted. The virus was then injected with each 2 mm for 5 minutes. Performed the same procedure at right side. After hemostasis, closed the wound in layers. Operators 曾勝弘 Assistants R5 鍾文桂 相關圖片 陳起民 (M,1954/02/18,58y0m) 手術日期 2011/06/30 手術主治醫師 杜永光 手術區域 東址 016房 05號 診斷 Lung Tumor 器械術式 EVD revision 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 4E 紀錄醫師 李振豪, 時間資訊 09:04 通知急診手術 14:25 進入手術室 14:40 麻醉開始 14:45 誘導結束 15:26 手術開始 16:10 手術結束 16:10 麻醉結束 16:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室體外引流 1 1 記錄__ 手術科部: 外科部 套用罐頭: External ventricular drainage via right Koche... 開立醫師: 李振豪 開立時間: 2011/09/07 14:47 Pre-operative Diagnosis 1. Hydrocephalus, 2. AVM rupture with ICH, IVH Post-operative Diagnosis 1. Hydrocephalus, 2. AVM rupture with ICH, IVH Operative Method External ventricular drainage via right Kocher"s approach Specimen Count And Types 1 piece About size:10ml Source:CSF Pathology Nil Operative Findings The opening pressure is more than 20cmH2O. The CSF was xanthochromic with light pinkish in color. Total 10ml CSF was sampled for CSF study. The external ventricular catheter was fixed at 6.5cm in depth. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position. The scalp was shaved, scrubbed, and disinfected as usual. One linear scalp incision was made over right frontal area followed by one burr hole creation at right Kocher"s point. Two dural tenting was done. Cruciform durotomy was performed and ventriculostomy was performed with puncture needle. The external ventricular catheter was inserted into right lateral ventricle and fixed at 6.5cm in depth from brain surface. Externalization was done. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators Prof.杜永光 Assistants R5李振豪 Indication Of Emergent Operation Hydrocephalus with IICP 相關圖片 周土郎 (M,1943/05/03,68y10m) 手術日期 2011/06/30 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Back pain 器械術式 T6-7, T8-9 intraspinal tumor excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 2 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:20 麻醉開始 08:50 誘導結束 09:30 抗生素給藥 09:40 手術開始 11:00 開始輸血 12:21 抗生素給藥 15:21 抗生素給藥 15:25 手術結束 15:25 麻醉結束 15:40 送出病患 15:42 進入恢復室 17:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 良性脊髓腫瘤切除術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: T6-9 laminectomy for tumor resection 開立醫師: 王奐之 開立時間: 2011/06/30 15:44 Pre-operative Diagnosis Multiple T6-9 intradural extramedullary tumors, suspected neuroma Post-operative Diagnosis Multiple T6-9 intradural extramedullary tumors, suspected neuroma Operative Method T6-9 laminectomy for tumor resection Specimen Count And Types Nil 4 pieces About size:0.7*0.7*0.7cm Source:intraspinal tumor, in pieces About size:1.5*1.5*1.5cm Source:intraspinal tumor About size:0.7*0.7*0.7cm Source:intraspinal tumor About size:2*1.5*1.5cm Source:intraspinal tumor Pathology Pending Operative Findings The tumors were mobile, elastic-firm and hypervascularized, located at T6-9 intrathecal area (anterolateral to the cord). No obvious entering or exiting nerve root was noted. 4 various size tumors interconnected to each other with small band of soft tissue. Intra-operatively the right leg MEP disappeared for a short period of time, and re-appeared after tumor removal. The left leg MEP decreased in amplitude after tumor dissection. Easy oozing was encountered throughout the whole operative procedure. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position. After scrubbing, disinfection & draping in sterile fashion, the T6-9 level was localized with C-arm. A midline incision was then made, and the incision was further deepend to the fascia. The paraspinal muscles were detached from spinous processes & laminae, T6-9 laminectomy was then done. After exposing the thecal sac from T6-9 level, a linear durotomy was made. The cord was slightly & gently retracted to the left side, exposing the tumors. The tumors were then removed in several pieces. After hemostasis, the dura was closed with 4-0 Prolene continuous suture in water-tight fashion. After setting 1 CWV drain, the wound was closed in layers. Operators VS 曾勝弘 Assistants R3 王奐之, Ri 李宜潔 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: T6-9 laminectomy for tumor resection 開立醫師: 王奐之 開立時間: 2011/07/04 19:46 Pre-operative Diagnosis Multiple T6-9 intradural extramedullary tumors, suspected neuroma Post-operative Diagnosis Multiple T6-9 intradural extramedullary tumors, suspected neuroma Operative Method T6-9 laminectomy for tumor resection Specimen Count And Types 4 pieces About size:0.7*0.7*0.7cm Source:intraspinal tumor, in pieces About size:1.5*1.5*1.5cm Source:intraspinal tumor About size:0.7*0.7*0.7cm Source:intraspinal tumor About size:2*1.5*1.5cm Source:intraspinal tumor Pathology Pending Operative Findings The tumors were mobile, elastic-firm and hypervascularized, located at T6-9 intrathecal area (anterolateral to the cord). No obvious entering or exiting nerve root was noted. 4 various size tumors interconnected to each other with small band of soft tissue. Intra-operatively the right leg MEP disappeared for a short period of time, and re-appeared after tumor removal. The left leg MEP decreased in amplitude after tumor dissection. Easy oozing was encountered throughout the whole operative procedure. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position. After scrubbing, disinfection & draping in sterile fashion, the T6-9 level was localized with C-arm. A midline incision was then made, and the incision was further deepend to the fascia. The paraspinal muscles were detached from spinous processes & laminae, T6-9 laminectomy was then done. After exposing the thecal sac from T6-9 level, a linear durotomy was made. The cord was slightly & gently retracted to the left side, exposing the tumors. The tumors were then removed in several pieces. After hemostasis, the dura was closed with 4-0 Prolene continuous suture in water-tight fashion. After setting 1 CWV drain, the wound was closed in layers. Operators VS 曾勝弘 Assistants R3 王奐之, Ri 李宜潔 相關圖片 陳松柏 (M,1937/10/02,74y5m) 手術日期 2011/06/30 手術主治醫師 李苑如 手術區域 東址 008房 05號 診斷 Benign prostatic hypertrophy 器械術式 TRUS-Biobsy 手術類別 預定手術 手術部位 腹 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 劉治民 ASA 3 紀錄醫師 胡哲源, 時間資訊 13:35 報到 13:50 進入手術室 13:55 麻醉開始 14:00 誘導結束 14:05 手術開始 14:10 手術結束 14:10 麻醉結束 14:15 送出病患 14:18 進入恢復室 16:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 手術 前列腺切片-控取式 1 1 記錄__ 手術科部: 泌尿部 套用罐頭: TRUS-P-biopsy 開立醫師: 胡哲源 開立時間: 2011/06/30 14:09 Pre-operative Diagnosis r/o prostate cancer Post-operative Diagnosis r/o prostate cancer Operative Method TRUSP biopsy Specimen Count And Types 4 pieces About size:0.2*2cm*3 Source:left midial lobe About size:0.2*2cm*3 Source:left lateal lobe About size:0.2*2cm*3 Source:right medial lobe About size:0.2*2cm*3 Source:right lateral lobe Pathology pending Operative Findings 1.systematic 12 cores TRUSP biopsy was performed 2.prostate size: 5.34cm x 3.32cm x 5.83cm= 54.2g Operative Procedures Under satisfactory anesthesia with the patient in right flank position, prepping and draping was performed in the usual sterile fashion. TRUSP was performed and echo-guided prostate biopsies were performed smoothly with Biopty gun. The coresof tissue specimen were obtained. The biosy area was compressed for several minutes to ensure adequate hemostasis. The patient tolerated the operation well and was sent to the floor in satisfactory condition. Operators 李苑如, Assistants 胡哲源, 張宇鳴, 陳鄭幸連 (F,1945/04/12,66y11m) 手術日期 2011/06/30 手術主治醫師 陳敞牧 手術區域 東址 003房 02號 診斷 Malignant neoplasm of ethmoidal sinus 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 12:10 報到 13:10 進入手術室 13:15 麻醉開始 13:25 誘導結束 13:45 抗生素給藥 14:25 手術開始 16:35 手術結束 16:35 麻醉結束 16:45 送出病患 16:47 進入恢復室 17:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 記錄__ 手術科部: 外科部 套用罐頭: Right Kocher Codman programmable V-P shunt in... 開立醫師: 林哲光 開立時間: 2011/06/30 16:57 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Right Kocher Codman programmable V-P shunt insertion Specimen Count And Types 1 piece About size:CSF Source:CSF sent for cytology, routine, BCS, culture Pathology Nil Operative Findings Opening pressure was around 15cmH2O after ventricular puncture. Valve was set 120 mmHg. CSF seemed clear and transparent. Ventricular catheter was 7cm long and abdominal catheter was more than 15cm long. Operative Procedures Under ETGA and supine position, skin disinfected and drapped were performed as usual. SKin incision along the previous bicoronal skin incision was made. THe right Kocher point was exposed and a burr hole was created. The dura was opened after dural tenting. The ventricular catheter was then introduced via ventricular puncture. RUQ abdomen transverse skin incision was made. Minilarparotomy was performed. Subcutaneous tunneling was then done. The abdominal catheter was then connected to ventricular catheter with programmable valve. The wound was then closed in layers after hemostasis. Operators VS 陳敞牧 Assistants R4 林哲光, Ri 沈維真 相關圖片 吳惠 (F,1953/05/31,58y9m) 手術日期 2011/06/30 手術主治醫師 陳敞牧 手術區域 東址 003房 03號 診斷 Malignant neoplasm of trachea 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 16:18 報到 16:50 進入手術室 17:05 麻醉開始 17:15 誘導結束 17:20 抗生素給藥 17:55 手術開始 19:10 手術結束 19:10 麻醉結束 19:20 送出病患 19:28 進入恢復室 20:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Right Kocher V-P Codman HAKIM fixed pressure ... 開立醫師: 林哲光 開立時間: 2011/06/30 19:47 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Right Kocher V-P Codman HAKIM fixed pressure valve shunt insertion Specimen Count And Types 1 piece About size:CSF Source:CSF sent for BCS, routine, cytology, culture Pathology Nil Operative Findings Opening pressure of ventricle was more than 15cmH2O. CSF seemed clear and transparent. 100mmH2O +- 10mmH2O Medium high range valve was used. Ventricular catheter was 7cm long and abdominal catheter was around 15cm long. Operative Procedures Under ETGA and supine position, skin disinfected and drapped were performed as usual. Skin incision was made at right Kocher point and a burr hole was created. The dura was opened after dural tenting. The ventricular catheter was then introduced via ventricular puncture. RUQ abdomen transverse skin incision was made. Minilarparotomy was performed. Subcutaneous tunneling was then done. The abdominal catheter was then connected to ventricular catheter with valve. The wound was then closed in layers after hemostasis. Operators VS 陳敞牧 Assistants R4 林哲光 相關圖片 黃啟東 (M,1959/03/11,53y0m) 手術日期 2011/06/30 手術主治醫師 蕭輔仁 手術區域 東址 003房 號 診斷 Major trauma rated 16 or above on the severeity scale ( Injury severeity score >=16 ) 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 07:37 報到 08:03 進入手術室 08:20 麻醉開始 08:40 誘導結束 08:47 抗生素給藥 09:32 手術開始 11:49 抗生素給藥 12:38 手術結束 12:38 麻醉結束 12:50 送出病患 12:54 進入恢復室 15:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 頭顱成形術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Cranioplasty with Codman Bioplate titanium mesh 開立醫師: 林哲光 開立時間: 2011/06/30 13:07 Pre-operative Diagnosis Right frontotemporal skull bone defect Post-operative Diagnosis Right frontotemporal skull bone defect Operative Method Cranioplasty with Codman Bioplate titanium mesh Specimen Count And Types nil Pathology Nil Operative Findings Right F-T skull bone defect was noted. The dura was left untouched. The mesh (127mmx131mm) and six 4mm screws were used for cranioplasty. Operative Procedures Under ETGA and supine position, skin disinfected and drapped were performed as usual. Skin incision was performed along the previous operative wound. The plane between the dura and galea was dissceted until the bone edge was exposed well. The mesh was then reshaped to fit the size of the skull defect and fixed on the skull bone with screws after two epidural drains were inserted. The wound was then closed in layers. Operators VS 蕭輔仁 Assistants R4 林哲光 相關圖片 張林彩鳳 (F,1925/03/10,87y0m) 手術日期 2011/06/30 手術主治醫師 蕭輔仁 手術區域 東址 020房 05號 診斷 Low back pain 器械術式 Radiofrequency coagulation(P-G 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 17:00 進入手術室 17:32 麻醉開始 17:33 誘導結束 17:35 手術開始 18:13 手術結束 18:18 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 高頻熱凝療法 1 1 B 摘要__ 手術科部: 外科部 套用罐頭: Bilateral L2 dorsal root ganglion radiofreque... 開立醫師: 王奐之 開立時間: 2011/06/30 18:14 Pre-operative Diagnosis Low back pain Post-operative Diagnosis Low back pain Operative Method Bilateral L2 dorsal root ganglion radiofrequency stimulation Specimen Count And Types nil Pathology Nil Operative Findings 1. Bilateral L2 dorsal root was identified by portable C-arm X-ray and sensory/motor stimulation test. No acute complication was noted after the procedure. 2. Temp: 42 oC, Time: 180sec x 2 cycles each side. Operative Procedures The patient was put in prone position. The location of L2 was identified by portable C-arm X-ray. The skin was disinfected and draped as usual. Local anesthesia was performed with 1% Xylocaine 10ml. Bilateral L2 dorsal root radiofrequency stimulation was performed under portable C-arm guided. The patient stood whole procedure well. Operators VS 蕭輔仁 Assistants R3 王奐之 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Bilateral L2 dorsal root ganglion radiofreque... 開立醫師: 王奐之 開立時間: 2011/09/08 18:48 Pre-operative Diagnosis Low back pain Post-operative Diagnosis Low back pain Operative Method Bilateral L2 dorsal root ganglion radiofrequency stimulation Specimen Count And Types nil Pathology Nil Operative Findings 1. Bilateral L2 dorsal root was identified by portable C-arm X-ray and sensory/motor stimulation test. No acute complication was noted after the procedure. 2. Temp: 42 oC, Time: 180sec x 2 cycles each side. Operative Procedures The patient was put in prone position. The location of L2 was identified by portable C-arm X-ray. The skin was disinfected and draped as usual. Local anesthesia was performed with 1% Xylocaine 10ml. Bilateral L2 dorsal root radiofrequency stimulation was performed under portable C-arm guided. The patient stood whole procedure well. Operators VS 蕭輔仁 Assistants R3 王奐之 相關圖片 鄭凱騰 (M,1980/10/06,31y5m) 手術日期 2011/06/30 手術主治醫師 蕭輔仁 手術區域 東址 020房 06號 診斷 Low back pain 器械術式 Radiofrequency coagulation(P-G 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 18:23 進入手術室 18:37 麻醉開始 18:38 麻醉結束 18:38 誘導結束 18:39 手術開始 19:41 手術結束 19:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 高頻熱凝療法 1 1 B 摘要__ 手術科部: 外科部 套用罐頭: Bilateral L2 dorsal root ganglion radiofreque... 開立醫師: 王奐之 開立時間: 2011/06/30 19:50 Pre-operative Diagnosis Low back pain Post-operative Diagnosis Low back pain Operative Method Bilateral L2 dorsal root ganglion radiofrequency stimulation Specimen Count And Types Nil Pathology Nil Operative Findings 1. Bilateral L2 dorsal root was identified by portable C-arm X-ray and sensory/motor stimulation test. No acute complication was noted after the procedure. 2. Temp: 42 oC, Time: 180sec x 2 cycles each side. Operative Procedures The patient was put in prone position. The location of L2 was identified by portable C-arm X-ray. The skin was disinfected and draped as usual. Local anesthesia was performed with 1% Xylocaine 10ml. Bilateral L2 dorsal root radiofrequency stimulation was performed under portable C-arm guided. The patient stood whole procedure well. Operators VS 蕭輔仁 Assistants R3 王奐之 相關圖片 鮑威 (M,1930/11/21,81y3m) 手術日期 2011/06/30 手術主治醫師 蕭輔仁 手術區域 東址 003房 04號 診斷 Low back pain 器械術式 Radiofrequency coagulation(P-G 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 ASA 1 時間資訊 19:40 進入手術室 20:17 手術開始 21:10 手術結束 21:15 送出病患 摘要__ 手術科部: 外科部 套用罐頭: Bilateral L2 dorsal root ganglion and right L... 開立醫師: 王奐之 開立時間: 2011/06/30 21:14 Pre-operative Diagnosis Low back pain Post-operative Diagnosis Low back pain Operative Method Bilateral L2 dorsal root ganglion and right L4 facet joint radiofrequency stimulation Specimen Count And Types nil Pathology Nil Operative Findings 1. Bilateral L2 dorsal root was identified by portable C-arm X-ray and sensory/motor stimulation test. No acute complication was noted after the procedure. 2. Temp: 42 oC, Time: 180sec x 2 cycles each side. Operative Procedures The patient was put in prone position. The location of L2 was identified by portable C-arm X-ray. The skin was disinfected and draped as usual. Local anesthesia was performed with 1% Xylocaine 10ml. Bilateral L2 dorsal root ganglion & right L4 facet joint radiofrequency stimulation was performed under portable C-arm guided. The patient stood whole procedure well. Operators VS 蕭輔仁 Assistants R3 王奐之 相關圖片 林鴻吉 (M,1942/02/03,70y1m) 手術日期 2011/06/30 手術主治醫師 王國川 手術區域 東址 002房 02號 診斷 Spinal cord injury 器械術式 C3/4, 4/5, 5/6 cervical diskectomy + plating 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 2E 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 08:46 通知急診手術 11:25 報到 11:25 進入手術室 11:30 麻醉開始 11:50 誘導結束 12:00 抗生素給藥 12:27 手術開始 15:00 抗生素給藥 15:35 麻醉結束 15:35 手術結束 15:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 脊椎融合術-前融合,有固定物)≦四節 1 1 手術 椎間盤切除術-頸椎 1 2 摘要__ 手術科部: 外科部 套用罐頭: Anterior Cervical Diskectomy with Fusion over... 開立醫師: 曾偉倫 開立時間: 2011/06/30 15:59 Pre-operative Diagnosis Cervical stenosis with OPLL over C3-4, C4-5, C5-6 Post-operative Diagnosis Cervical stenosis with OPLL over C3-4, C4-5, C5-6 Operative Method Anterior Cervical Diskectomy with Fusion over C3-4, C4-5, C5-6 with plate and cage x 3 Specimen Count And Types nil Pathology Nil. Operative Findings 1. Ruptured ALL over C5-6 disk with disk destruction 2. The spinal cord became loose after the disks removed Operative Procedures Under ETGA, patient was put on supine position. The C3-4, C4-5, C5-6 level was located with intra-operative C-arm. A 8cm horizontal skin incision was made over right neck of C4 level. The platysma was divided and the SCM muscle was retracted laterally. The trachea and esophagus was pushed over the left side. The vetebral body over C3,4,5,6 was exposed and diskectomy was done over C3-4, C4-5, C5-6 levels. Cage x 3 (8mm,m6mm,7mm) insertion and plate fusion were done. The cage and plates location was checked with C-arm. After complete hemostasis, a CWV drain was placed and th wound was closed in layers. Operators VS 王國川 Assistants R2 曾偉倫 R1 李柏穎 Indication Of Emergent Operation Prevent further injury 相關圖片 王文歆 (F,1987/02/16,25y0m) 手術日期 2011/07/01 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Moyamoya disease 器械術式 Right STA-MCA bypass 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 08:00 進入手術室 08:10 麻醉開始 08:40 誘導結束 09:00 抗生素給藥 09:10 手術開始 10:35 開始輸血 12:00 抗生素給藥 15:30 抗生素給藥 16:15 手術結束 16:15 麻醉結束 16:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 8 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 顱內外血管吻合術 1 1 R 摘要__ 手術科部: 復健部 套用罐頭: right EC-IC Bypass 開立醫師: 陳國瑋 開立時間: 2011/07/01 12:32 Pre-operative Diagnosis Moyamoya disease status post left EC-IC bypass Post-operative Diagnosis Moyamoya disease status post bilateral EC-IC bypass Operative Method right EC-IC Bypass Right superficial temporal artery to M3 bypass Right superficial temporal artery to opercular artery bypass Specimen Count And Types nil Pathology nil Operative Findings Increased collateral vessels were noted at right frontal area, and collateral vessels were significantly less at right temporal lobe. Superficial temporal artery flow was satisfactory, and anastomosis was made to the opercular artetry at right frontal lobe. Anastomosis was patent, and flow direction was from the STA graft to the right opercular artery under microscopic ICG flow exam. The parietal branch of STA was used t Operative Procedures After ETGA, the patient was put in supine position with the head tilting to left. The right superficial tempotal artery with frontal and parietal branches were identified by sonography. The skin was disinfected with providine-iodine and then drapped as usual. Skin incision was made ahead of the ear and the superficial temporal artery was dissected out with great care. Dissection along the parietal branch was done and the frontal branch was clipped. The lumen was then rinced with heparin. The galea and temporalis muscle muscle was inscied into two parts and then retracted downwards. Craniotomy was done and the dura was incised into three parts after dura tenting. The superficial cortical vessels were identified and Diagonogreen was used to confirm the artery. The overlying arachnoid membrane was cut open and the artery was dissected free. The STA was trimmed and End-to-side anastomosis was done with 10-0 nylone. After ETGA, the patient was put in supine position with the head tilting to left. The right superficial tempotal artery with frontal and parietal branches were identified by sonography. The skin was disinfected with providine-iodine and then drapped as usual. Skin incision was made ahead of the ear and the superficial temporal artery was dissected out with great care. Dissection along the parietal branch was done and the frontal branch was clipped. The lumen was then rinced with heparin. The galea and temporalis muscle muscle was inscied into two parts and then retracted downwards. Craniotomy was done and the dura was incised into three parts after dura tenting. The superficial cortical vessels were identified and Diagonogreen was used to confirm the artery. The overlying arachnoid membrane was cut open and the artery was dissected free. The STA was trimmed and End-to-side anastomosis was done with 10-0 nylone. After carful hemostasis the dura was closed in water-tied fasion and the craniotomy window was put back. The skin was closed in layers. The galea and temporalis muscle muscle was inscied into two parts and then retracted downwards. Craniotomy was done and the dura was incised into three parts after dura tenting. The superficial cortical vessels were identified and Diagonogreen was used to confirm the artery. The overlying arachnoid membrane was cut open and the artery was dissected free. The STA was trimmed and End-to-side anastomosis was done with 10-0 nylone. After carful hemostasis the dura was closed in water-tied fasion and the bone graft was put back. The skin was closed in layers. After ETGA, the patient was put in supine position with the head tilting to left. The right superficial tempotal artery with frontal and parietal branches were identified by sonography. The skin was disinfected with providine-iodine and then drapped as usual. Skin incision was made ahead of the ear and the superficial temporal artery was dissected out with great care. Dissection along the parietal branch was done and the frontal branch was clipped. The lumen was then rinced with heparin. The galea and temporalis muscle muscle was inscied into two parts and then retracted downwards. Operators Prof. 杜永光 Assistants R5曾峰毅 R2陳國瑋 相關圖片 黃亞九 (M,1951/03/15,60y11m) 手術日期 2011/07/01 手術主治醫師 杜永光 手術區域 東址 003房 02號 診斷 Hydrocephalus 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 15:58 報到 16:45 進入手術室 16:50 麻醉開始 17:00 誘導結束 17:10 抗生素給藥 17:44 手術開始 19:00 手術結束 19:00 麻醉結束 19:05 送出病患 19:06 進入恢復室 20:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Ventriculo-peritoneal shunt insertion through... 開立醫師: 陳國瑋 開立時間: 2011/07/01 19:16 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculo-peritoneal shunt insertion through right Kocher`s point Specimen Count And Types nil Pathology nil Operative Findings The opening pressure was about 10-15 cmH20. Medtronic, fixed medium pressure, shunt was inserted via right Kocher point. Colorless, clear, CSF gushed out while ventriculostomy. Ventriculostomy was performed once. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After shaving, scrubbing, disinfection and draping in sterile fashion, a curvilinear skin incision was made at right frontal area. Mini-laparotomy was also done at right upper quadrant of abdomen. One burr hole at right frontal Kocher point was made, and a small durotomy was made, followed by ventricular puncture. A subcutaneous tunnel was then created from abdomen to scalp, followed by passage of peritoneal catheter. The ventricular catheter and the peritoneal catheter were then assembled and tested for function. The wounds were then closed in layers. Operators Prof. 杜永光 Assistants R5曾峰毅 R3陳國瑋 相關圖片 陳英招 (F,1954/09/26,57y5m) 手術日期 2011/07/01 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Lumbar Spondylosis 器械術式 L3-4 TPS + cage 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:15 麻醉開始 08:25 誘導結束 09:10 抗生素給藥 09:20 手術開始 12:10 抗生素給藥 13:31 手術結束 13:35 麻醉結束 13:36 送出病患 13:40 進入恢復室 14:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎弓切除術(減壓)-二節以內 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: 1. L3/4 transforaminal lumbar interbody fusio... 開立醫師: 李振豪 開立時間: 2011/07/01 13:52 Pre-operative Diagnosis L3/4 grade I spondylolisthesis and L4/5 retrolisthesis with spinal stenosis Post-operative Diagnosis L3/4 grade I spondylolisthesis and L4/5 retrolisthesis with spinal stenosis Operative Method 1. L3/4 transforaminal lumbar interbody fusion with PEEK cage, right side 2. L3 to L5 posterior instrumentation with transpedicular screws and posteriolateral fusion with autologous bone graft 3. L4/5 laminotomy for decompression Specimen Count And Types nil Pathology Nil Operative Findings The L3/4 facet joint was severe hypertrophic with unstable spine. The L3/4 disc was degenerative and fragile in character. The ligmentum flavum also hypertrophic which compressed the thecal sac tightly. One #12 PEEK Banana cage was inserted for interbody fusion. Total six 6.5 x 45mm transpedicle screws were used for posterior instrumentation. The rods were 9cm in length. The cross-link was 7cm in length. The roots were all protected well during whole procedure. No incidental durotomy or CSF leakage was noted before wound closure. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position. The L3 to L5 pedicles were localized by portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made from L3 to L5 level. The subcutaneous soft tissue was devided and paravertebral muscle groups were detached. L3, L4 and L5 bilateral transpedicular screws were implanted and the location was confirmed by portable C-arm X-ray. L3/4 laminectomy and right side facetectomy was done for decompression. L3/4 diskectomy was done and transforaminal lumbar interbody fusion was performed with one Banana PEEK cage. L4/5 laminotomy for decompression also performed for lumbar stenosis. Decortication was done and posterolateral fusion with autologous bone graft. The transpedicular screws were set up with two rods and one cross-link. Hemostasis was achieved and one 1/8 Hemovac was placed. The wound was then closed in layers with 1-0, 2-0 Vicryl and 3-0 Nylon. Operators VS曾漢民 Assistants R5李振豪, R2許皓淳 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: 1. L3/4 transforaminal lumbar interbody fusio... 開立醫師: 李振豪 開立時間: 2011/07/01 14:12 Pre-operative Diagnosis L3/4 grade I spondylolisthesis and L4/5 retrolisthesis with spinal stenosis Post-operative Diagnosis L3/4 grade I spondylolisthesis and L4/5 retrolisthesis with spinal stenosis Operative Method 1. L3/4 transforaminal lumbar interbody fusion with PEEK cage, right side 2. L3 to L5 posterior instrumentation with transpedicular screws and posteriolateral fusion with autologous bone graft 3. L4/5 laminotomy for decompression Specimen Count And Types nil Pathology Nil Operative Findings The L3/4 facet joint was severe hypertrophic with unstable spine. The L3/4 disc was degenerative and fragile in character. The ligmentum flavum also hypertrophic which compressed the thecal sac tightly. One #12 PEEK Banana cage was inserted for interbody fusion. Total six 6.5 x 45mm transpedicle screws were used for posterior instrumentation. The rods were 9cm in length. The cross-link was 7cm in length. The roots were all protected well during whole procedure. No incidental durotomy or CSF leakage was noted before wound closure. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position. The L3 to L5 pedicles were localized by portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made from L3 to L5 level. The subcutaneous soft tissue was devided and paravertebral muscle groups were detached. L3, L4 and L5 bilateral transpedicular screws were implanted and the location was confirmed by portable C-arm X-ray. L3/4 laminectomy and right side facetectomy was done for decompression. L3/4 diskectomy was done and transforaminal lumbar interbody fusion was performed with one Banana PEEK cage. L4/5 laminotomy for decompression also performed for lumbar stenosis. Decortication was done and posterolateral fusion with autologous bone graft. The transpedicular screws were set up with two rods and one cross-link. Hemostasis was achieved and one 1/8 Hemovac was placed. The wound was then closed in layers with 1-0, 2-0 Vicryl and 3-0 Nylon. Operators VS曾漢民 Assistants R5李振豪, R2許皓淳 相關圖片 游沛純 (F,2010/05/24,1y9m) 手術日期 2011/07/01 手術主治醫師 謝孟祥 手術區域 東址 012房 01號 診斷 Apert syndrome 器械術式 Reconstruction of syndactyly 手術類別 預定手術 手術部位 四肢 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 3 紀錄醫師 陳志軒, 時間資訊 08:05 進入手術室 08:10 麻醉開始 08:20 誘導結束 08:30 抗生素給藥 09:30 手術開始 11:35 抗生素給藥 14:40 手術結束 14:40 麻醉結束 15:08 進入恢復室 16:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 手術 多指(趾)切除每多加一個 1 3 B 手術 皮膚全層植補術-FTSG 1 1 B 手術 石膏副木固定－短臂 2 0 B 手術 併指多指(趾)切除 1 1 B 摘要__ 手術科部: 外科部 套用罐頭: Reconstruction with syndactyly of bilateral r... 開立醫師: 游彥辰 開立時間: 2011/07/01 15:31 Pre-operative Diagnosis Apert syndrome with bilateral hands syndactyly Post-operative Diagnosis Apert syndrome with bilateral hands syndactyly Operative Method Reconstruction with syndactyly of bilateral ring-little fingers webspace, with FTSG coverage Specimen Count And Types nil Pathology Nil Operative Findings Apert syndrome with bilateral hands syndactyly was noted. The four fingers of both hands were fused. Both hands ring and little fingers were fused till finger tip, without phalanx fusion. The syndactyly of both ring-little finger was seperated. Residual skin defect after seperation was about 6cm square for each hand. The skin defect was reconstructed with FTSG, harvested from left inguinal area. The FTSG donor site was closed primarily. The left hand 4th and 5ht metatarcal bones were fused at proximal end, and was seperated by osteotome and the seperation space was filled with bone wax. Operative Procedures Under ETGA, the patient was placed in supine position. Anti-septic preparation was performed. Zig-zag incision and a local flap for webspace reconstruction at dorsal side were designed. Incision was then made to left hand under pneumatic tornique. Dissection was then performed to seperate the ring and little fingers. After hemostasis, the skin flap was inset for webspace reconstruction and digit skin defect coverage. Another linear incision was made at left hand dorsum above proximal 4th and 5th metacarpal area. Dissection was performed deep to periosteum and osteotomy of proximal 4th and 5th metacarpal fused bone was done. The same procedure was performed to the right hand except the osteotomy. FTSG was then harvested from left inguinal area and applied to both hands skin defects. Tie-over was then performed. The FTSG donor site was primarily closed in layers after hemostasis. Short arm splint was applied for both hands fixation. Operators VS謝孟祥 Assistants R5游彥辰, R3陳志軒, Int陳乃綺 丘美容 (F,1953/12/26,58y2m) 手術日期 2011/07/01 手術主治醫師 賴達明 手術區域 東址 005房 02號 診斷 Pituitary tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 13:52 進入手術室 14:00 麻醉開始 14:40 誘導結束 15:00 抗生素給藥 15:08 手術開始 17:20 手術結束 17:20 麻醉結束 17:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經由蝶竇之腦下垂體瘤切除 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: Trans-sphenoidal adenomectomy 開立醫師: 李振豪 開立時間: 2011/07/01 17:51 Pre-operative Diagnosis Acromegaly Post-operative Diagnosis Acromegaly Operative Method Trans-sphenoidal adenomectomy Specimen Count And Types 1 piece About size:multiple small pieces Source:Pituitary adenoma Pathology Pending Operative Findings Left lateral wall of sphenois sinus was eroded and entered initially. Left side cavernous sinus was entered after through the eroded lateral wall and packing with Surgicel for hemostasis. The sellar floor was localized by C-arm portable X-ray. The tumor was whithsy, soft, hypovascularized and 1.8 x 1.4 x 1.2cm in size. After total removal of the tumor, arachnoid pouch was noted. The normal gland was not well visualized from the operative field. Mild CSF leakage was suspected and Tissucol Duo was used to avoid CSF rhinorrhea. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position. The nasal cavity was packing with 1:100 epinephrine solution for 10 minutes. The face and anterior right thigh were prepared with povidone-iodine alcohol tincture, and the mucosa of oral and nasal cavity with aqueous povidone-iodine tincture. The former areas were covered by a sterilized adhesive plastic sheet. The nasal submucosa at septum and floor and the subperiostium at upper alveola were infiltrated with 1:100 epinephrine solution. One 1cm incision was made at septum of right nostrium and the mucosa of nasal septum and floor was dissected away from the septal cartilage and the bony floor on both sides from anterior to posterior and displaced laterally by a long nasal speculum. The perpendicular plate of Vomer bone was fractured and removed. The opening of sphenoid sinus was identified and the floor of sphenoid sinus was opened. The mucosa of the sphenoid sinus was partially removed and coagulated for hemostasis. The septum and floor of sphenoid sinus were identified. The sellar floor was entered after fracture of the sellar floor. The location of sellar floor was confirmed by intra-operative portable X-ray. The dura was coagulated and opened in cruciform. The tumor was removed by curette and suction. The pseudocapsule and the arachnoid pouch sank into the sella spontaneously after removal of the tumor. Hemostasis was achieved. The sella was packing with Surgicel and Gelfoam for hemostasis. Tissucol Duo was applied after placement of bone fragment. The sphenoid sinus also packing with Gelfoam and the fractured part of Vomer bone was placed back and covered with Tissucol Duo. The nasal septum and mucosa was pushed back into the neutral position. And two Merocel was placed into nasal cavity for packing. Operators VS賴達明 Assistants R5李振豪, R2許皓淳 魏鈺錡 (M,1988/01/10,24y2m) 手術日期 2011/07/01 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Cervical fracture 器械術式 C1-2 TAS(transarticular screws) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:14 進入手術室 08:20 麻醉開始 08:45 誘導結束 09:10 抗生素給藥 09:40 手術開始 12:56 抗生素給藥 14:00 麻醉結束 14:00 手術結束 14:12 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Transarticular screw fixation at C1/2 with bo... 開立醫師: 曾偉倫 開立時間: 2011/07/01 14:30 Pre-operative Diagnosis C1-2 subluxation Post-operative Diagnosis C1-2 subluxation Operative Method Transarticular screw fixation at C1/2 with bone grafting fixed with wiring Specimen Count And Types nil Pathology Nil Operative Findings Retrolisthesis of C1 was noted. Two TAS 34mm and 32mm were used. A bone graft was harvested from left iliac crest and fixed to C1-C2 intraspinous area after decortication. Intraoperative MEP was intact without signal change. Operative Procedures Under ETGA and prone position and head fixed with Mayfield head clump, skin disinfected and drapped were performed as usual. Midline skin incision was made at C0-C3 level. The paraspinal muscles were detached and C0-C1 lamina were dissected carefully. Under C-arm localization, TAS was inserted through C1-C2 articular joints via K-pin introduced after medial and lateral border were identified for VA and dura sac. A bone graft was then harvested from left iliac crest and fixed to interspinous area of C1-C2 level with wiring. The wound was then closed in layers after a paravertebral CWV drain was inserted. Operators AP 賴達明 Assistants R5 林哲光, R3 曾偉倫 相關圖片 陳宏臣 (M,1944/04/10,67y11m) 手術日期 2011/07/01 手術主治醫師 賴達明 手術區域 東址 019房 02號 診斷 Herniated intervertebral disc (HIVD) 器械術式 C3/4 cervical diskectomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 13:53 報到 14:30 進入手術室 14:35 麻醉開始 14:45 誘導結束 15:00 抗生素給藥 15:23 手術開始 18:06 手術結束 18:06 麻醉結束 18:11 送出病患 18:15 進入恢復室 19:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-前融合,有固定物)≦四節 1 2 手術 椎間盤切除術-頸椎 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: Anterior cervical diskectomy with cage (7mm) ... 開立醫師: 曾偉倫 開立時間: 2011/07/01 18:31 Pre-operative Diagnosis Herniated intervetebral disk C3-4 Post-operative Diagnosis Herniated intervetebral disk C3-4 Operative Method Anterior cervical diskectomy with cage (7mm) fusion Specimen Count And Types nil Pathology Nil. Operative Findings 1. OPLL with osteophyte formation over C3-4, C4-5, C5-6. C3-4 with central budging disk, mild compressed to left root 2. The thecal sac became loose after the PLL was removed 3. A PEEK cage (7mm in size)was placed Operative Procedures Under ETGA, patient put on supint position. The C3-4 level was located by intra-operative C-arm. After we scrubbed, disinfected and drapped a horizontal skin incision was made above the C3-4 junction level. The platysma was dissected and the SCM, carotid sheath, treachea and esophagus was pushed seperately for exposing the body of spine. We opened the annulus fibrosis of C3-4 disk and diskectomy was done with curret and aligator. The thickened PLL and osteophyte was removed with Kerrison punch. The thecal sac was well preserved. The cage was placed in C3-4 disk space. After complete hemostasis, we placed a mini-hemovac and closed the wound in layers. Operators AP 賴達明 Assistants R5 林哲光 R2 曾偉倫 相關圖片 劉逸閩 (M,1935/07/16,76y7m) 手術日期 2011/07/01 手術主治醫師 賴達明 手術區域 東址 005房 03號 診斷 Thoracic spine fracture 器械術式 Removal of TPS 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 17:45 進入手術室 17:50 麻醉開始 18:05 誘導結束 18:17 手術開始 20:00 手術結束 20:00 麻醉結束 20:18 送出病患 20:20 進入恢復室 22:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術(減壓)-二節以內 1 1 B 麻醉 Peripheral arterial line inserti 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Removal of posterior instrumentation 開立醫師: 李振豪 開立時間: 2011/07/01 20:24 Pre-operative Diagnosis Displacement of transpedicular screws Post-operative Diagnosis Displacement of transpedicular screws Operative Method Removal of posterior instrumentation Specimen Count And Types nil Pathology Nil Operative Findings Total eight transpedicular screws, two rods, and one cross-link were removed smoothly. The wound was filled with scar tissue. The thecal sac was not exposed during the operation. Displacement of right side T6, T7 and left side T9, T10 transpedicular screws was noted during the operation. The bone union was well. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made along operative scar. The subcutaneous soft tissue was devided. The location of transpedicular screws were identified by palpation. The transpedicular screws, rods, and cross-link were all removed. Hemostasis was achieved and two 1/8 Hemovac was placed. The wound was then closed in layers with 1-0, 2-0 Vicryl and 3-0 Nylon. Operators VS賴達明 Assistants R5李振豪, R2許皓淳 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Removal of posterior instrumentation 開立醫師: 李振豪 開立時間: 2011/07/01 20:24 Pre-operative Diagnosis Displacement of transpedicular screws Post-operative Diagnosis Displacement of transpedicular screws Operative Method Removal of posterior instrumentation Specimen Count And Types nil Pathology Nil Operative Findings Total eight transpedicular screws, two rods, and one cross-link were removed smoothly. The wound was filled with scar tissue. The thecal sac was not exposed during the operation. Displacement of right side T6, T7 and left side T9, T10 transpedicular screws was noted during the operation. The bone union was well. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made along operative scar. The subcutaneous soft tissue was devided. The location of transpedicular screws were identified by palpation. The transpedicular screws, rods, and cross-link were all removed. Hemostasis was achieved and two 1/8 Hemovac was placed. The wound was then closed in layers with 1-0, 2-0 Vicryl and 3-0 Nylon. Operators VS賴達明 Assistants R5李振豪, R2許皓淳 相關圖片 吳盛忠 (M,1957/11/22,54y3m) 手術日期 2011/07/01 手術主治醫師 黃培銘 手術區域 東址 021房 03號 診斷 Spinal metastasis 器械術式 L.Gastrostomy 手術類別 預定手術 手術部位 胸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 蕭柏妮 ASA 3 紀錄醫師 郝政鴻, 時間資訊 15:10 報到 15:28 進入手術室 15:30 麻醉開始 15:40 誘導結束 15:50 抗生素給藥 16:00 手術開始 18:00 18:40 手術結束 18:40 麻醉結束 18:50 送出病患 19:00 進入恢復室 20:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 胃造口術 1 1 手術 port–A導管植入術–治療性導管植入術 1 0 記錄__ 手術科部: 外科部 套用罐頭: Port-A 開立醫師: 郝政鴻 開立時間: 2011/07/01 19:11 Pre-operative Diagnosis Esophageal cancer with bone metastasis Post-operative Diagnosis Esophageal cancer with bone metastasis Operative Method GAstrostomy and Port-A insertion Gastrostomy and Port-A insertion Specimen Count And Types nil Pathology nil Operative Findings 24Fr gastrostomy tube was inserted smoothly The port-A catheter was inserted to left/right subclavian via puncture method, checked by portable CXR Operative Procedures 1. ETGA, supine 2. Skin disinfection and draping as usual 3. Skin incision via previous surgical wound. 4. Creat gastrostomy and inserted 24Fr gastrostomy tube smoothly 5. Closed wound in layers 6. Redisinfection and draped 7. Insert Port-A via puncture method 8. Checked by portable CXR, close wound in layers Operators VS黃培銘 Assistants R3郝政鴻 Ri 王均斌 (M,1982/09/21,29y5m) 手術日期 2011/07/01 手術主治醫師 湯月碧 手術區域 東址 012房 02號 診斷 Major trauma rated 16 or above on the severity scale ( Injury severity score >=16 ) 器械術式 Debridment-- <5cm 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 趙崧筌, 時間資訊 15:13 報到 15:15 進入手術室 15:25 麻醉開始 15:32 手術開始 15:47 麻醉結束 15:47 手術結束 15:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 深部傷口處理縫合擴創-中 1 0 摘要__ 手術科部: 外科部 套用罐頭: Removal of arch bar 開立醫師: 趙崧筌 開立時間: 2011/07/01 15:52 Pre-operative Diagnosis Multiple facial bone fracture, bilateral frontozygomal process and arch fracture, frontal sinus wall fracture, nasal bone fracture, bilateral maxilla wall fracture status post ORIF and MMF Post-operative Diagnosis Multiple facial bone fracture, bilateral frontozygomal process and arch fracture, frontal sinus wall fracture, nasal bone fracture, bilateral maxilla wall fracture status post ORIF and MMF Operative Method Removal of arch bar Specimen Count And Types nil Pathology Nil Operative Findings The arch bars were removed smoothly after cutting wires. Candidiasis was noted over his tongue. Operative Procedures LA, supine, prepped Cut the wires and removed the arch bars Obtained oral hygiene Operators 戴浩志 Assistants 趙崧筌 陳乃綺 林昭吟 (F,1974/01/18,38y1m) 手術日期 2011/07/01 手術主治醫師 黃培銘 手術區域 東址 018房 04號 診斷 Major trauma rated 16 or above on the severity scale ( Injury severity score >=16 ) 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 蕭柏妮 ASA 3 紀錄醫師 高明蔚, 時間資訊 23:35 臨時手術NPO 16:50 進入手術室 16:53 麻醉開始 16:55 手術開始 16:55 誘導結束 17:00 抗生素給藥 17:10 手術結束 17:10 麻醉結束 17:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 氣管切開術 1 0 摘要__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 高明蔚 開立時間: 2011/07/01 17:19 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types nil Pathology None Operative Findings OD.7 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators 黃培銘 Assistants R4高明蔚,Ri陳柔合 吳秀玲 (F,1959/02/08,53y1m) 手術日期 2011/07/01 手術主治醫師 何子昌 手術區域 東址 010房 04號 診斷 Macular pucker, Epiretinal membrane 器械術式 P.P.V.- complicated 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 吳廷郁, 時間資訊 16:35 進入手術室 17:00 手術開始 18:17 手術結束 18:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 眼坦部玻璃體切除術-複雜 1 1 L 手術 玻璃體內注射 1 2 L 記錄__ 手術科部: 眼科部 套用罐頭: Complicated PPV + ICG-assisted internal limit... 開立醫師: 吳廷郁 開立時間: 2011/07/02 07:25 Pre-operative Diagnosis Foveoshisis (os) Post-operative Diagnosis Foveoshisis (os) Operative Method Complicated PPV + ICG-assisted internal limiting membrane peeling + Intravitreal injection of Silicone Oil 6 ml (os) Specimen Count And Types nil Pathology nil Operative Findings Foveoshisis (os) Operative Procedures 1. Under retrobulbar anesthesia 2. Disinfection and draping as usual, apply an eyelid speculum. 3. Partial peritomy and hemostasis with cautery. 3. Three sclerotomy were made then apply light probe, microvit, and infusion line throughthe sclerotomy wounds. 4. Vitrectomy was performed with Microvit 5. Removal of posterior hyaloid 6. Internal membrane peeling was done with ICG staining. 7. Air-fluid exchange with Charle’s needle and air pump 8. Intravitreal injection of Silicone Oil 6 ml 9. Close sclerotomy wound with 9-0 Nylon 10. Close conjunctival wound with 6-0 Vicryl. 11. Subconjunctival injection of Rinderon and Gentamicin. 12. Atropine and Latycinpatching. Operators 何子昌, Assistants R4蘇乾嘉, R3吳廷郁 吳瑋萍 (F,1979/11/08,32y4m) 手術日期 2011/07/02 手術主治醫師 楊士弘 手術區域 東址 002房 08號 診斷 Acute lymphoid leukemia, without mention of remission 器械術式 Bilateral subdural drain 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林子富 ASA 3E 紀錄醫師 李振豪, 時間資訊 20:00 臨時手術NPO 20:00 開始NPO 04:03 通知急診手術 05:15 進入手術室 05:20 麻醉開始 05:30 誘導結束 06:06 手術開始 07:35 手術結束 07:35 麻醉結束 07:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 慢性硬腦膜下血腫清除術 1 1 B 手術 慢性硬腦膜下血腫清除術 1 2 B 摘要__ 手術科部: 內科部 套用罐頭: Bilateral burr hole drainage 開立醫師: 楊士弘 開立時間: 2011/07/02 07:44 Pre-operative Diagnosis Bilateral subdural collection, nature? Post-operative Diagnosis Bilateral subdural hemorrhagic effusion, r/o infection, malignacy, or coagulopathy related Operative Method Bilateral burr hole drainage Bilateral burr hole drainage for removal of subudral hematoma Specimen Count And Types size:30ml Source:Subdural collection Pathology Pending Operative Findings Easy wound oozing and bleeding were encountered during the whole procedure. No inner membrane was seen after dura opening. Clear liquid gushed out from the subdural space initially, followed by blood-mixed effusion on each side. No obvious brain expansion was noted. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position. The scalp was shaved, scrubbed, and disinfected as usual. Bilateral temporal skin incision were made followed by one burr hole creation at each side. Dural tenting was done. The dura was opened. The subdural collection gushed out after durotomy. The EVD catheter was placed into subdural space and externalization was done. Hemostasis was achieved with bipolar electrocautery and gelfoam packing. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS楊士弘 Assistants R5李振豪 Indication Of Emergent Operation acute change of consciousness 相關圖片 鄭程耀 (M,1973/12/15,38y2m) 手術日期 2011/07/02 手術主治醫師 楊士弘 手術區域 東址 003房 01號 診斷 Cervical myelopathy 器械術式 C5/6 cervical diskectomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林子富 ASA 2 紀錄醫師 張倍慈, 時間資訊 00:00 臨時手術NPO 12:35 報到 12:50 進入手術室 12:55 麻醉開始 13:05 誘導結束 13:53 抗生素給藥 14:05 手術開始 16:35 手術結束 16:35 麻醉結束 16:42 送出病患 16:45 進入恢復室 18:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-頸椎 1 1 R 手術 椎融合術-前融合,無固定物(≦四節) 1 2 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 記錄__ 手術科部: 外科部 套用罐頭: Anterior Discectomy and Fusion, Cervical Spine 開立醫師: 楊士弘 開立時間: 2011/07/02 16:42 Pre-operative Diagnosis Cervical intervertebral herniated disc, C5-6, with myelopathy Post-operative Diagnosis Cervical intervertebral herniated disc, C5-6, with myelopathy Operative Method Anterior Discectomy and interbody cage fusion, Cervical Spine Specimen Count And Types nil Pathology Nil Operative Findings The C5-6 disc was found to bulge posteriorly, and the posterior longitudinal ligament was rather thick. The thecal sac was compressed by the herniated disc and PLL, and reexpanded well after decompression. A 7 mm high PEEK cage was inserted into the C5-6 disc space. Proper position of the PEEK cage was verified by intraop. fluoroscopy. Operative Procedures 1. Anesthesia: endotracheal general 2.Position: supine with neck hyperextended by a air cuff placed beneath the shoulder. 3. Skin preparation: the anterior neck and rt iliac crest was shaved and scrubbed with povidone-iodinew detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4.Incision; 4 cm, transverse middle cervical, extended from anterior margin of sternocleidomastoid (SCM) muscle to thyroid cartilage. 5. The plastisma muscle was transected and mobilized from the underlying superficial cervical fascia which was then opened in vertical direction along the anterior margin of the SCM muscle. 6.The dissection was advanced at the loose plane between SCM muscle and strip muscles until the prevertebral fascia had been reached. The former structure was retracted to the lateral and the later structures with esophagus and trachea to the opposite side by Cloward cervical retractor. 7.The prevertebral fascia was opened vertically, the lesion intervertebral space was exposed and identified by intraoperative portable X-ray 8.The most medial portion of the longus coli muscles on both sides were detached from the vertebral bodies to providea wider exposure of the vertebral bodies. 9.The anterior longitudinal ligment was incised transversely at the margins of intervertebral space, the annulus fibrosus was cut too. 10.The degenerated disc and cartilage plate were removed by curette andthe anterior-inferior rim of C5 vertebral body was resected by Kerrison punch for easier approach to the posterior rim of the intervertebral space. 11.The intervertebral spac was widened by a Cloward interveetebral spreader. The sclerotic spondylotic bar at the posterior margin of C5-6 bodies and the spur at foramen Luscka were removed by high speed air drill and fine curette. The posterior longitudinal ligament was cut from bony edge by curette and then removed. Consequently, the spinal dura expanded into the intervertebral space. 12.The surfaces of vertebral bodies at this intervertebral space was trimed by high speed air drill to creat a biconcave intervertebral space. 13.A 7 mm PEEK cage was filled with hydroxyappatite bone graft particles and autologous blood. 14.The cage graft was packed into the intervertebral space tightly by a impactor. 15.The air cuff beneath the shoulder was deflated, the Cloward cervical retractor removed. 16.Wound closure: continuous suture with 4/0 Dexon for plastisma and continuous suture with 4/0 nylon on the skin. 17.Drain: onr, mini-HV. 18.Blood transfusion: nil 19.Course of the surgery: smooth. Operators 楊士弘 Assistants 林哲光, 張倍慈 相關圖片 黃榮星 (M,1950/02/02,62y1m) 手術日期 2011/07/02 手術主治醫師 王國川 手術區域 東址 019房 02號 診斷 Chronic renal failure 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林子富 ASA 4E 紀錄醫師 林哲光, 時間資訊 12:41 開始NPO 12:41 臨時手術NPO 12:41 通知急診手術 20:35 進入手術室 20:35 報到 20:40 麻醉開始 20:55 誘導結束 21:35 手術開始 22:35 麻醉結束 22:35 手術結束 22:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室體外引流 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Left Kocher EVD insertion 開立醫師: 林哲光 開立時間: 2011/07/02 23:08 Pre-operative Diagnosis Right thalamus ICH with IVH and hydrocephalus Post-operative Diagnosis Right thalamus ICH with IVH and hydrocephalus Operative Method Left Kocher EVD insertion Specimen Count And Types nil Pathology Nil Operative Findings CSF seemed bloody with blood clot formation was noted after ventricular puncture. Inital intraventricular pressure was less than 10cmH2O. Ventricular catheter was 7cm long. Operative Procedures Under ETGA and supine position, skin disinfected and drapped were performed as usual. Linear skin incision was made at left Kocher point and a burr hole was created. Ventricular catheter was insserted into the lateral ventricle via ventricular puncture along the imaginary line composed with two planes pointing to targus and medial canthus. The ventricular was then fixed on the skin through the subcutaneous tunneling. The wound was then closed in layers. Operators VS 王國川 Assistants R4 林哲光 Indication Of Emergent Operation Acute hydrocephalus with conscious drowsy 相關圖片 孫錫華 (F,1935/06/14,76y9m) 手術日期 2011/07/03 手術主治醫師 曾漢民 手術區域 東址 001房 01號 診斷 Glioblastoma multiforma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林子富 ASA 3E 紀錄醫師 曾峰毅, 時間資訊 01:14 通知急診手術 01:14 臨時手術NPO 01:14 開始NPO 08:40 報到 08:55 進入手術室 09:00 麻醉開始 09:30 誘導結束 09:30 抗生素給藥 09:50 開始輸血 09:54 手術開始 12:30 抗生素給藥 13:50 麻醉結束 13:50 手術結束 14:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除-手術時間在4~8小時 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT 開立醫師: 曾峰毅 開立時間: 2011/07/03 14:13 Pre-operative Diagnosis Left temoral tumor, susepcted high-grade glioma Post-operative Diagnosis Left temoral glioma, grade to be determined Operative Method Left frontotemporal craniotomy for tumor excision Specimen Count And Types Several fragment of one tumor was sent for pathology. Pathology Pending Operative Findings Ill-defined, hypervascular, soft-fragile tumor was noted at left temporal lobe with necrotic component. High grade glioma was suspected. Left MCA(M1 segment), left anterior chroidal artery, were preserved well. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head fixed with Mayfield head clamp, and rotated to right. We shaved, scrubbed, disinfected, and then draped the scalp, and made one curvilinear skin incision at left frontotemporal area. We reflected the scalp, and drilled four burr holes, and then created craniotomy. Dura was tented around the craniotomy window. Dura was then incised in C-shape, and tumor excision was performed in piecemeal fashion. The dura was closed in water-tight fashion suture, and bone graft was fixed back with mini-plates. The wound was closed in layers after one subgaleal CWV inserted. Operators VS 曾漢民 Assistants R5 曾峰毅 Indication Of Emergent Operation Uncal herniation. 相關圖片 黃榮星 (M,1950/02/02,62y1m) 手術日期 2011/07/03 手術主治醫師 王國川 手術區域 東址 009房 04號 診斷 Chronic renal failure 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林子富 ASA 4E 紀錄醫師 林哲光, 時間資訊 08:00 臨時手術NPO 08:00 開始NPO 12:44 通知急診手術 20:15 進入手術室 20:20 麻醉開始 20:25 誘導結束 20:50 手術開始 21:45 手術結束 21:45 麻醉結束 21:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室體外引流 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Left Kocher EVD insertion 開立醫師: 林哲光 開立時間: 2011/07/03 22:13 Pre-operative Diagnosis Right thalamus ICH with IVH and acute hydrocephalus Post-operative Diagnosis Right thalamus ICH with IVH and acute hydrocephalus Operative Method Left Kocher EVD insertion Specimen Count And Types nil Pathology Nil Operative Findings Intravnetricular pressure seemed less than 10cmH2O. CSF seemed reddish and transparent. Ventricular puncture was checked patent at 4cm and 6cm level and ventricular catheter 6cm was inserted. Operative Procedures Under ETGA and supine position, skin disinfected and drapped were performed as usual. Skin incision was made at previous operative wound. The burr hole was extended to lateral side. Another corticotomy was done. The ventricular catheter was then inserted via ventricular puncture. The wound was then closed in layers after EVD was fixed through subcutaneous tunneling and fixed on the skin. Operators VS 王國川 Assistants R5 曾峰毅, R5 林哲光 Indication Of Emergent Operation Conscious deterioation 相關圖片 楊陳月桃 (F,1936/05/26,75y9m) 手術日期 2011/07/04 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Meningioma 器械術式 Left F-T craniotomy for left sphenoidal ridge (outter 1/3) meningioma excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 07:30 報到 08:05 進入手術室 08:10 麻醉開始 08:40 誘導結束 08:45 抗生素給藥 08:50 手術開始 11:15 開始輸血 11:45 抗生素給藥 14:45 麻醉結束 14:45 手術結束 14:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4~8小時 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Left pterion approach for tumor excision, Sim... 開立醫師: 曾峰毅 開立時間: 2011/07/04 15:03 Pre-operative Diagnosis Left outer third sphenoid ridge meningioma Post-operative Diagnosis Left outer third sphenoid ridge meningioma Operative Method Left pterion approach for tumor excision, Simpson grade I Specimen Count And Types 1 piece About size:5x5x4.5cm Source:brain tumor Pathology pending Operative Findings One flesh, well-defined, extra-axial, dura-based tumor was noted at outer third of sphenoid ridge. Operative Procedures After endotracheal intubation and general anesthesia, the patient was put in supine position with head turing to right. One question mark skin incision was made with extension 2cm behine ear canal. The skin was reflected downward. The Yasagil fat pad was dissected to preserve facial nerve. The Temporalis muscle was detatched from superior temporal line. Four burr holes was created and craniotomy was done. Left anterior clinoid proscess was remvoed partially. The U shape dura incision was made after dural tenting. The tumor was retracted by sutures. The vessels surrounding the tumor were dissected away. The tumor was removed en bloc. The dura was repaired with duraform, and bone graft was fixed with mini-plates. The wound was closed in layers after one hemovac inserted. Operators 杜永光 Assistants 曾峰毅 陳國瑋 相關圖片 張志能 (M,1956/09/07,55y6m) 手術日期 2011/07/04 手術主治醫師 杜永光 手術區域 東址 003房 02號 診斷 Arachnoid cyst 器械術式 Cysto-peritoneal shunt, posterior fossa arachnoid cyst 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 14:40 報到 15:15 進入手術室 15:20 麻醉開始 15:25 誘導結束 15:35 抗生素給藥 15:45 手術開始 17:35 手術結束 17:35 麻醉結束 17:54 送出病患 17:56 進入恢復室 19:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 曾峰毅 開立時間: 2011/07/04 17:44 Pre-operative Diagnosis Posterior fossa arachnoid cyst Post-operative Diagnosis Posterior fossa arachnoid cyst Operative Method Cystoperitoneal shunt. Specimen Count And Types Nil Pathology Nil Operative Findings Clear, colorless, fluid gushed out while durotomy and cyst fenestration. Clear, colorless, fluid gushed out while durotomy and cyst fenestration. Metronic low pressure valve was used. Operative Procedures With endotracheal general anaesthesia, the patient was put in right decubitus position and head rotated to right (facing ground) fixed with Mayfield head clamp. We made one midline skin incision at occipital area, and drilled one burr hole at midline beneath inion. We made another skin incision at left upper abdomen to performe laparotomy. We created subcutaneous tunnel to connect left upper abdoemn to occipital area. We performed durotomy, and inserted cathter into the cyst. We inserted peritoneal catheter, and connected the shunt altogether. We checked the shunt function, and then closed the wound in layers. Operators P 杜永光 Assistants R5 曾峰毅 R3 陳國瑋 相關圖片 吳宛君 (F,1966/06/12,45y9m) 手術日期 2011/07/04 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Meningioma 器械術式 Left C-P angle tumor, petrous meningioma 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 08:06 進入手術室 08:20 麻醉開始 08:35 誘導結束 08:50 手術開始 09:00 抗生素給藥 12:00 抗生素給藥 14:15 手術結束 14:15 麻醉結束 14:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Left retrosigmoid, suboccipital approach for ... 開立醫師: 李振豪 開立時間: 2011/07/04 14:57 Pre-operative Diagnosis Left petroclival meningioma Post-operative Diagnosis Left petroclival meningioma Operative Method Left retrosigmoid, suboccipital approach for Simpson grade IV tumor excision Specimen Count And Types 1 piece About size:Multiple pieces Source:left CP angle tumor Pathology Nil Operative Findings The tumor was 4.3 x 3.4 x 4cm in size, red-yellowish, extreme hypervascularized, elastic to firm, and capsulated in character. The tumor was adhered with adjacent cerebellum with much feeding artery and engorged venous drainage. The CN 5, 7, 8 were pushed superioanteriorly and the low cranial nerve were pushed inferioanteriorly. The all cranial nerve were all preserved well except one branch of low cranial nerve. Thin layer of tumor was left due to tightly adhered around the low cranial nerve. The dural base was coagulated with bipolar electrocautery during devascularization. The vessels of cerebellum and brainstem were well preserved also. The cerebellum became slack after nearly total removal of the tumor. Waveform of left side BAEP was poor before the operation and no change during the operation. No SSEP change was noted after whole procedure. Thin layer of tumor was left due to tightly adhered around the low cranial nerve with extension into foramen. The dural base was coagulated with bipolar electrocautery during devascularization. The vessels of cerebellum and brainstem were well preserved also. The cerebellum became slack after nearly total removal of the tumor. Waveform of left side BAEP was poor before the operation and no change during the operation. No SSEP change was noted after whole procedure. Operative Procedures Under endotracheal general anesthesia, the patient was put in right 3/4 prone position with head fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. Hokey-stick scalp incision was made at left suboccipital area and the scalp flap was elevated. Five burr holes were created followed by one 6x4cm craniotomy over left retrosigmoid, suboccipital area. The foramen magnum also opened during craniotomy. After dural opening, CSF was diversed from foramen magnum. The tumor was identified after retracted the cerebellum. The arachnoid membrane was pulled away from the tumor and devascularization was performed. The tumor was removed piece by piece by bipolar electrocautery and scissor. Hemostasis was achieved with bipolar electrocautery and Surgicel lining. Duroplasty was performed with autologous fascia. One epidural CWV drain was placed. The skull plate was fixed back with three miniplates and six screws. The wound was then closed in layers with 2-0 Vicryl and Appose staples. Operators VS曾漢民 Assistants R5李振豪, R2許皓淳 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Left retrosigmoid, suboccipital approach for ... 開立醫師: 李振豪 開立時間: 2011/07/04 15:03 Pre-operative Diagnosis Left petroclival meningioma Post-operative Diagnosis Left petroclival meningioma Operative Method Left retrosigmoid, suboccipital approach for Simpson grade IV tumor excision Specimen Count And Types 1 piece About size:Multiple pieces Source:left CP angle tumor Pathology Nil Operative Findings The tumor was 4.3 x 3.4 x 4cm in size, red-yellowish, extreme hypervascularized, elastic to firm, and capsulated in character. The tumor was adhered with adjacent cerebellum with much feeding artery and engorged venous drainage. The CN 5, 7, 8 were pushed superioanteriorly and the low cranial nerve were pushed inferioanteriorly. The all cranial nerve were all preserved well except one branch of low cranial nerve. Thin layer of tumor was left due to tightly adhered around the low cranial nerve with extension into foramen. The dural base was coagulated with bipolar electrocautery during devascularization. The vessels of cerebellum and brainstem were well preserved also. The cerebellum became slack after nearly total removal of the tumor. Waveform of left side BAEP was poor before the operation and no change during the operation. No SSEP change was noted after whole procedure. Operative Procedures Under endotracheal general anesthesia, the patient was put in right 3/4 prone position with head fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. Hokey-stick scalp incision was made at left suboccipital area and the scalp flap was elevated. Five burr holes were created followed by one 6x4cm craniotomy over left retrosigmoid, suboccipital area. The foramen magnum also opened during craniotomy. After dural opening, CSF was diversed from foramen magnum. The tumor was identified after retracted the cerebellum. The arachnoid membrane was pulled away from the tumor and devascularization was performed. The tumor was removed piece by piece by bipolar electrocautery and scissor. Hemostasis was achieved with bipolar electrocautery and Surgicel lining. Duroplasty was performed with autologous fascia. One epidural CWV drain was placed. The skull plate was fixed back with three miniplates and six screws. The wound was then closed in layers with 2-0 Vicryl and Appose staples. Operators VS曾漢民 Assistants R5李振豪, R2許皓淳 相關圖片 黃于瑄 (F,1987/06/03,24y9m) 手術日期 2011/07/05 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Numbness 器械術式 C1 laminectomy, C0-3 fixation and fusion with sublaminal wiring 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 吳奕緯, 時間資訊 00:00 臨時手術NPO 08:02 進入手術室 08:10 麻醉開始 08:20 誘導結束 09:00 抗生素給藥 09:09 手術開始 12:35 手術結束 12:35 麻醉結束 12:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎弓切除術(減壓)-二節以內 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Cervical Laminectomy 開立醫師: 曾峰毅 開立時間: 2011/07/05 12:46 Pre-operative Diagnosis C2 odontoid fracture Post-operative Diagnosis C2 odontoid fracture Operative Method C1 laminectomy, and posterior fixation with sublaminar wiring at C0, C2, and C3 Specimen Count And Types Nil Pathology Nil Operative Findings Reduction of C1-2 deformaity is not feasibly under C-arm guidance and neurophysiology monitor. However, SSEP of four limbs diminished during the paraspinal muscle dissection. We woke up the patient during the operation, and then the patient was noted with spontaneous limb movement. Codman titanium Sof-wires were used for sublaminar and epidural wiring. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position with head fixed with Mayfield head clamp. We made one midline skin incision to expose suboccipital area to C5 level. We performed C1 laminectomy, and then sublaminar wiring at C2 and C3. We drilled furr burr holes at suboccipital area, and then inserted epidural wiring. We bending 3 mm K-pin as an omega loop, and fixed the omega loop with the wires. The wound was closed in layers after one epidural CWV. Operators 曾勝弘 Assistants 曾峰毅 吳奕緯 相關圖片 黃于瑄 (F,1987/06/03,24y9m) 手術日期 2011/07/05 手術主治醫師 曾勝弘 手術區域 東址 003房 04號 診斷 Numbness 器械術式 Spinal fusion posterior 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林峰盛 ASA 2E 紀錄醫師 吳奕緯, 時間資訊 17:08 通知急診手術 18:18 報到 18:18 進入手術室 18:30 麻醉開始 18:40 誘導結束 18:45 抗生素給藥 19:15 手術開始 21:05 麻醉結束 21:05 手術結束 21:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 顱骨切除術,包括異物移除或壓或經切斷 1 2 摘要__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 曾峰毅 開立時間: 2011/07/05 21:31 Pre-operative Diagnosis Odontoid fracture, status post posterior fixation at C0-C3, complicated with Brown-Sequard syndrome Post-operative Diagnosis Odontoid fracture, status post posterior fixation at C0-C3, complicated with Brown-Sequard syndrome Operative Method Revision of C0-C3 wiriing, and subocciptal partial craniectomy Specimen Count And Types Nil Pathology Nil Operative Findings Discontinuity of left C2 sublaminar wires was noted. Prominent dura pulsation was noted after posture adjustment. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position with head fixed by Mayfield head clamp. We reopened the wound, and revised the sublaminar wiring of C2 and C3, and epidural wiring of C0. Laminectomy of C1 was enlargted, and foramen magnum was opened for decompression. The wound was irrigated with gentamycin-saline. The wound was closed in layers after epidural CWV. Operators VS 曾勝弘 Assistants R5 曾峰毅 PGY 吳奕緯 Indication Of Emergent Operation Brown-Sequard syndrome 洪慧子 (F,1967/07/20,44y7m) 手術日期 2011/07/05 手術主治醫師 曾勝弘 手術區域 東址 005房 02號 診斷 Herniation of intervertebral disc, lumbar (HIVD) 器械術式 Microsurgical lumbar discectomy, left L5/S1 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 吳奕緯, 時間資訊 00:00 臨時手術NPO 13:02 進入手術室 13:07 麻醉開始 13:15 誘導結束 13:25 抗生素給藥 13:45 手術開始 15:10 手術結束 15:10 麻醉結束 15:15 送出病患 15:22 進入恢復室 17:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 椎間盤切除術-腰椎 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: HIVD 開立醫師: 曾峰毅 開立時間: 2011/07/05 15:15 Pre-operative Diagnosis L5/S1 HIVD Post-operative Diagnosis L5/S1 HIVD Operative Method Microdiskectomy of L5/S1 Specimen Count And Types nil Pathology Nil Operative Findings Ruptured disc at L5/S1 compromised left S1 root tightly. Neural structure was decompressed well after diskectomy. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After back scrubbed, disinfected, and then draped, we made one midline skin incision, and dissected to expose left lamina of L5. We created L5/S1 laminotomy, and performed microdiskectomy. The wound was closed in layers. Operators VS 曾勝弘 Assistants R5 曾峰毅 PGY 吳弈緯 相關圖片 趙致瓴 (M,1966/01/03,46y2m) 手術日期 2011/07/05 手術主治醫師 曾勝弘 手術區域 東址 005房 03號 診斷 Brain metastasis 器械術式 Left F-P craniotomy with tumor excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 吳奕緯, 時間資訊 00:00 臨時手術NPO 15:25 進入手術室 15:40 麻醉開始 15:55 抗生素給藥 16:00 誘導結束 16:10 手術開始 18:10 手術結束 18:10 麻醉結束 18:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 手術 腦瘤切除-手術時間在4小時以內 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Left frontal craniotomy for cyst drainage and... 開立醫師: 曾峰毅 開立時間: 2011/07/05 18:33 Pre-operative Diagnosis Left frontal lesion, suspected metastasis, suspected abscess Post-operative Diagnosis Left frontal lesion, suspected metastasis, suspected abscess Operative Method Left frontal craniotomy for cyst drainage and biopsy Specimen Count And Types Cystic content was sent for cytology and culture. Cyst wall was sent for pathology. Pathology Pending Operative Findings One cystic lesion was noted at left frontal lobe. The lesion was delineated well under sonongraphy, and the compoent was mainly cystic. Neurophysiology study showed the lesion location was left motor cortex. Cystic content was yelloish, turbid, with some debris. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head fixed with Mayfield head clamp and rotated to right. After scalp shaved, scrubbed, disinfected, and then draped, we made one U-shape scalp incision at left frontal area. We drilled four burr holes, and then performed U-shape durotomy. Neurophysiology study was doen to locat motor cortex. We performed aspiration of the cyst, and biopsy of the cyst wall. Dura was closed in water-tight suture, and the bone graft was fixed back with wires. The wound was closed in layers. Operators VS 曾勝弘 Assistants R5 曾峰毅 PGY 吳奕緯 相關圖片 王曜銘 (M,1997/05/08,14y10m) 手術日期 2011/07/05 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Moyamoya disease 器械術式 Moyamoya /EDAS Dr.郭 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 07:35 報到 08:05 進入手術室 08:20 麻醉開始 09:10 誘導結束 09:30 抗生素給藥 09:47 手術開始 12:30 抗生素給藥 12:45 麻醉結束 12:45 手術結束 12:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱內外血管吻合術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 朴卜勒氏血流測定（週邊血管） 1 0 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 摘要__ 手術科部: 外科部 套用罐頭: Right side encephaloduroarteriosynangiosis fr... 開立醫師: 王奐之 開立時間: 2011/07/05 13:28 Pre-operative Diagnosis Moyamora disease, status post left EDAS Post-operative Diagnosis Moyamora disease, status post left EDAS Operative Method Right side encephaloduroarteriosynangiosis from posterior branch of STA Specimen Count And Types nil Pathology Nil Operative Findings Numerous small collateral vessel were noted at brain surface. The posterior branch of right STA was used, with about 7cm of mobilized segment; the surrounding galeal tissue were left with STA (about 1cm in width). Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After tracing and marking of the superficial temporal artery, the scalp was scrubbed, disinfected, and draped in sterile fashion. A small reversed hockey stick incision was made at right temporal area, followed dissection of the galea and careful preserving the STA. 1 segment of STA along with surrounding galeal tissue were mobilized and gently retracted to the side. An ovoid craniotomy was then done with its long axis along the STA course. A linear durotomy was made, followed opening of the arachnoid membrane at the surface artery. 4 anchoring sutures were applied to the proximal & distal end of STA, and one more stitch was applied at the middle segment to fix the STA graft to the exposed pia. The dura was then closed with 4-0 Prolene continuous sutures. The bone flap edge was rongeured off to allow patent entry & exit points of the STA. After central tenting, the bone flap was fixed back with wires. The wound was then closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之, Ri 謝明秀 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Right side encephaloduroarteriosynangiosis fr... 開立醫師: 王奐之 開立時間: 2011/07/05 13:30 Pre-operative Diagnosis Moyamora disease, status post left EDAS Post-operative Diagnosis Moyamora disease, status post left EDAS Operative Method Right side encephaloduroarteriosynangiosis from posterior branch of STA Specimen Count And Types nil Pathology Nil Operative Findings Numerous small collateral vessel were noted at brain surface. The posterior branch of right STA was used, with about 7cm of mobilized segment; the surrounding galeal tissue were left with STA (about 1cm in width). Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After tracing and marking of the superficial temporal artery, the scalp was scrubbed, disinfected, and draped in sterile fashion. A small reversed hockey stick incision was made at right temporal area, followed dissection of the galea and careful preserving the STA. 1 segment of STA along with surrounding galeal tissue were mobilized and gently retracted to the side. An ovoid craniotomy was then done with its long axis along the STA course. A linear durotomy was made, followed opening of the arachnoid membrane at the surface artery. 4 anchoring sutures were applied to the proximal & distal end of STA, and one more stitch was applied at the middle segment to fix the STA graft to the exposed pia. The dura was then closed with 4-0 Prolene continuous sutures. The bone flap edge was rongeured off to allow patent entry & exit points of the STA. After central tenting, the bone flap was fixed back with wires. The wound was then closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之, Ri 謝明秀 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Right side encephaloduroarteriosynangiosis (i... 開立醫師: 郭夢菲 開立時間: 2011/07/05 15:50 Pre-operative Diagnosis Moyamora disease, status post left EDAS Post-operative Diagnosis Moyamora disease, status post left EDAS Operative Method Right side encephaloduroarteriosynangiosis (indirect EC IC bypass) from posterior branch of STA to MCA territory Specimen Count And Types nil Pathology Nil Operative Findings Numerous small collateral vessel were noted at brain surface. The posterior branch of right STA was used, with about 7cm of mobilized segment; the surrounding galeal tissue were left with STA (about 1cm in width). Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After tracing and marking of the superficial temporal artery with Duplex, the scalp was scrubbed, disinfected, and draped in sterile fashion. Under microscopic view, a small reversed hockey stick incision was made at right temporal area, followed dissection of the galea and careful preserving the STA. One segment of STA along with surrounding galeal tissue were mobilized and gently retracted to the side. After linear incision of the temporalis muscle, an ovoid craniotomy was then done with its long axis along the STA course. A linear durotomy was made, followed opening of the arachnoid membrane at the surface artery. 4 anchoring sutures were applied to the proximal & distal end of STA to the dural edges, and one more stitch was applied at the middle segment to fix the STA graft to the exposed pia. The dura was then closed with 4-0 Prolene continuous sutures. a piece of DuroFoam was used to covered the dural surface to prevent CSF leakage. The bone flap edge was rongeured off to allow patent entry & exit points of the STA. After central tenting, the bone flap was fixed back with 3 wires. The wound was then closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之, Ri 謝明秀 相關圖片 黃春男 (M,1939/04/08,72y11m) 手術日期 2011/07/05 手術主治醫師 賴達明 手術區域 東址 002房 03號 診斷 Subarachnoid hemorrhage 器械術式 Craniectomy for aneurysm clipping 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林峰盛 ASA 4E 紀錄醫師 李振豪, 時間資訊 13:52 通知急診手術 16:20 報到 16:20 進入手術室 16:25 麻醉開始 16:30 誘導結束 16:51 抗生素給藥 17:00 手術開始 19:30 開始輸血 19:53 抗生素給藥 22:53 抗生素給藥 23:30 麻醉結束 23:30 手術結束 23:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 開顱術摘除血管病變 - 腦血管瘤 有病徵的 1 1 L 手術 腦室體外引流 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: 1. Left Kocher"s external ventricular drainag... 開立醫師: 李振豪 開立時間: 2011/07/06 00:10 Pre-operative Diagnosis Anterior communicating artery aneurysm ruptured with diffuse subarachnoid hemorrhage and hydrocephalus Post-operative Diagnosis Anterior communicating artery aneurysm ruptured with diffuse subarachnoid hemorrhage and hydrocephalus Operative Method 1. Left Kocher"s external ventricular drainage insertion 2. Left fronto-temporal craniectomy and pterional approach for aneurysm clipping Specimen Count And Types 1 piece About size:10ml Source:CSF Pathology Nil Operative Findings The opening pressure is more than 20cmH2O. The CSF was reddish in character. After 15ml CSF drainage, the brain was not severe swelled while dura opening. The pulsation of the brain also good. Thick subarachnoid hemorrhage was noted in brain surface and sylvian fissure. After dissection, the left side A1, A2, recurrent artery and fronto-polar artery were all exposed well. One bayonet and one fenestrated Sugita clips were used for aneurysm clipping. Right A2 segment was noted after aneurysm clipping. Proximal control: 5minutes x II. After aneurysm clipping, the wall of aneurysm was cut and no active bleeding was noted. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. Left fronto-temporal curvilinear scalp incision was made and the scalp flap was elevated. One burr hole were created at left Kocher"s point. One dural tenting was performed cruciform durotomy was done. Left lateral ventriculostomy was done with ventricular needle and the ventricular catheter was inserted with 7cm in depth. Externalization was done. Three burr hole were created followed by one 12 x 10cm craniectomy window. Dural tenting was done. C-shape dura incision was performed based with skull base. The sylvian fissure was opened and the optic nerve was identified. After localization of internal carotid artery, the A1 segment was traced for proximal control. The rectus gyrus was removed and the aneurysm was identified. The A2 segment, recurrent artery, and fronto-polar artery were all identified. The aneurysm was clipped with one bayonet and one fenestrated Sugita"s clip. Hemostasis was achieved with bipolar electrocautery and Surgicel lining. Duroplasty was performed with temporalis muscle fascia. One epidural CWV drain was placed and the wound was closed in layers with 2-0 Vicryl and Appose staples. Operators VS賴達明 Assistants R5李振豪, Ri Indication Of Emergent Operation Aneurysmal subarachnoid hemorrhage 記錄__ 手術科部: 外科部 套用罐頭: 1. Left Kocher"s external ventricular drainag... 開立醫師: 李振豪 開立時間: 2011/07/06 00:10 Pre-operative Diagnosis Anterior communicating artery aneurysm ruptured with diffuse subarachnoid hemorrhage and hydrocephalus Post-operative Diagnosis Anterior communicating artery aneurysm ruptured with diffuse subarachnoid hemorrhage and hydrocephalus Operative Method 1. Left Kocher"s external ventricular drainage insertion 2. Left fronto-temporal craniectomy and pterional approach for aneurysm clipping Specimen Count And Types 1 piece About size:10ml Source:CSF Pathology Nil Operative Findings The opening pressure is more than 20cmH2O. The CSF was reddish in character. After 15ml CSF drainage, the brain was not severe swelled while dura opening. The pulsation of the brain also good. Thick subarachnoid hemorrhage was noted in brain surface and sylvian fissure. After dissection, the left side A1, A2, recurrent artery and fronto-polar artery were all exposed well. One bayonet and one fenestrated Sugita clips were used for aneurysm clipping. Right A2 segment was noted after aneurysm clipping. Proximal control: 5minutes x II. After aneurysm clipping, the wall of aneurysm was cut and no active bleeding was noted. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. Left fronto-temporal curvilinear scalp incision was made and the scalp flap was elevated. One burr hole were created at left Kocher"s point. One dural tenting was performed cruciform durotomy was done. Left lateral ventriculostomy was done with ventricular needle and the ventricular catheter was inserted with 7cm in depth. Externalization was done. Three burr hole were created followed by one 12 x 10cm craniectomy window. Dural tenting was done. C-shape dura incision was performed based with skull base. The sylvian fissure was opened and the optic nerve was identified. After localization of internal carotid artery, the A1 segment was traced for proximal control. The rectus gyrus was removed and the aneurysm was identified. The A2 segment, recurrent artery, and fronto-polar artery were all identified. The aneurysm was clipped with one bayonet and one fenestrated Sugita"s clip. Hemostasis was achieved with bipolar electrocautery and Surgicel lining. Duroplasty was performed with temporalis muscle fascia. One epidural CWV drain was placed and the wound was closed in layers with 2-0 Vicryl and Appose staples. Operators VS賴達明 Assistants R5李振豪, Ri Indication Of Emergent Operation Aneurysmal subarachnoid hemorrhage 高萲芠 (F,1954/08/28,57y6m) 手術日期 2011/07/05 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Lumbar spondylosis 器械術式 L2/3, L4/5 TPS and L4/5 cage interbody fusion 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 10:17 報到 10:35 進入手術室 10:40 麻醉開始 10:50 誘導結束 10:55 抗生素給藥 11:32 手術開始 13:55 抗生素給藥 14:40 手術結束 14:40 麻醉結束 14:50 送出病患 14:51 進入恢復室 16:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 摘要__ 手術科部: 外科部 套用罐頭: Laminectomy over L4 with TPS and cage interbo... 開立醫師: 曾偉倫 開立時間: 2011/07/05 15:09 Pre-operative Diagnosis Spondylolisthesis over L4-5 and L2-3 Post-operative Diagnosis Spondylolisthesis over L4-5 and L2-3 Operative Method Laminectomy over L4 with TPS and cage interbody fusion of L4-5 Specimen Count And Types nil Pathology Nil Operative Findings 1. Spondylolisthesis over L4-5 2. The fixation was done with TPS (6mm x 40 mm) x4 + Rod 50mm x 2 2. The fixation was done with TPS (6mm x 40 mm) x4 + Rod 50mm x 2 + Cage 11mm x 1 3. A Dura defect was made during the laminectomy and the defect was sealed with Gel-foam. No CSF leak after then 4. The facet joints over L4-5 were hypertrophy bilaterally 5. Post-operatively, the thecal sac became loose Operative Procedures Under ETGA, patient was put on prone position. The spine L4-5 level was locate with C-arm. after we scrubbed, disinfected and drapped, a mid-line skin incision was made over L4-5 level. The paraspinal muscles were divided and the spinous process and pedicles was seen. We fixed the TPS over L4 and L5 pedicles under intra-operative C-arm guidence. The L4 spinous process and lamina was removed with Rongour and Kerrison punch. After the thecal sac became loose, the interbody and lateral fusion was done with cage and rods. After complete hemostasis, a CWV drain was placed and the wound was close in layers. Operators AP 賴達明 Assistants R5 林哲光 R3 曾偉倫 相關圖片 任士平 (M,1964/11/14,47y4m) 手術日期 2011/07/05 手術主治醫師 賴達明 手術區域 東址 003房 03號 診斷 Lung cancer 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 14:35 報到 15:00 進入手術室 15:08 麻醉開始 15:13 誘導結束 15:15 抗生素給藥 16:02 手術開始 17:45 手術結束 17:45 麻醉結束 17:50 送出病患 17:55 進入恢復室 18:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 腫瘤醫學部 套用罐頭: V-P Shunt 開立醫師: 曾偉倫 開立時間: 2011/07/05 18:18 Pre-operative Diagnosis Lung cancer with leptomeningeal metastasis with hydrocephalus Post-operative Diagnosis Lung cancer with leptomeningeal metastasis with hydrocephalus Operative Method V-P Shunt Specimen Count And Types nil Pathology Nil. Operative Findings 1. Clear CSF drained from the left lateral ventricle 2. The opening presure is 10-11 cm-H2O 3. Codman 10 cm-H2O shunt was placed via left Kocher point 4. The resovior expand well after the shunt was placed Operative Procedures Under ETGA, we placed the patient on supine position with left shoulder lifted. After we scrubbed, disinfected and drapped, we made a skin incision over left Kocher point and left lower abdominal area. Craniectomy was done and the laterl ventricle was reached with ventricular needle and the abdominal cavity was opened in layers. The subcutaneous tunnel was made with a trochar and the shunt was placed smoothly. The resovoir was placed over the left post-auricular area. After complete hemostasis, we closed the wound in layers. Operators AP 賴達明 Assistants R5 林哲光 R3 曾偉倫 相關圖片 洪淑真 (F,1958/03/05,54y0m) 手術日期 2011/07/05 手術主治醫師 賴達明 手術區域 西址 039房 02號 診斷 Carpal tunnel syndrome 器械術式 Decompression of mediun nerve 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 09:30 進入手術室 09:45 麻醉開始 09:50 手術開始 10:15 手術結束 10:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 正中神經或尺神經腕部減壓術–單側 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Carpal Tunnel Syndrome 開立醫師: 李振豪 開立時間: 2011/07/05 10:29 Pre-operative Diagnosis Carpal tunnel syndrome, right Post-operative Diagnosis Carpal tunnel syndrome, right Operative Method Decompression of median nerve, right Specimen Count And Types nil Pathology Nil Operative Findings The transverse carpal ligment was hypertrophic which compressed the right median nerve tightly. The calcification is not significant. The right median nerve expanded well after transection of the ligment. The nerve was preserved well during whole procedure. Operative Procedures The patient was put in supine position. The right hand and forearm were sterilized with povidone-iodine tincture and draped as usual. Local anesthesia with 5ml 1% Xylocaine solution was applied over right wrist. One 1.5cm linear skin incision was made at right wrist and the subcutaneous soft tissue and tendon was devided and splitted. The transverse carpal ligment was identified and trensected with knife. The right median nerve was noted and the transverse carpal ligment was devided along the tract of median nerve. After well decompression of right median nerve, hemostasis was achieved. The wound was then closed in layers with 3-0 Vicryl and 4-0 Nylon. Operators VS賴達明 Assistants R5李振豪 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Carpal Tunnel Syndrome 開立醫師: 李振豪 開立時間: 2011/07/05 10:29 Pre-operative Diagnosis Carpal tunnel syndrome, right Post-operative Diagnosis Carpal tunnel syndrome, right Operative Method Decompression of median nerve, right Specimen Count And Types nil Pathology Nil Operative Findings The transverse carpal ligment was hypertrophic which compressed the right median nerve tightly. The calcification is not significant. The right median nerve expanded well after transection of the ligment. The nerve was preserved well during whole procedure. Operative Procedures The patient was put in supine position. The right hand and forearm were sterilized with povidone-iodine tincture and draped as usual. Local anesthesia with 5ml 1% Xylocaine solution was applied over right wrist. One 1.5cm linear skin incision was made at right wrist and the subcutaneous soft tissue and tendon was devided and splitted. The transverse carpal ligment was identified and trensected with knife. The right median nerve was noted and the transverse carpal ligment was devided along the tract of median nerve. After well decompression of right median nerve, hemostasis was achieved. The wound was then closed in layers with 3-0 Vicryl and 4-0 Nylon. Operators VS賴達明 Assistants R5李振豪 相關圖片 方新正 (M,1925/08/08,86y7m) 手術日期 2011/07/05 手術主治醫師 楊士弘 手術區域 東址 003房 01號 診斷 Head Injury 器械術式 Burr hole drainage of left F-T-P CSDH 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 07:30 報到 08:00 進入手術室 08:10 麻醉開始 08:15 誘導結束 08:35 抗生素給藥 08:50 手術開始 10:00 手術結束 10:00 麻醉結束 10:05 送出病患 10:08 進入恢復室 11:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Burr-hole drainage of sub-dural hematoma 開立醫師: 曾偉倫 開立時間: 2011/07/05 10:19 Pre-operative Diagnosis Chronic Subdural Hematoma, left Post-operative Diagnosis Chronic Subdural Hematoma, left Operative Method Burr-hole drainage of sub-dural hematoma Specimen Count And Types nil Pathology Nil. Operative Findings 1. Chronic sub-dural hematoma over left frontal-parietal area, thick whitish hapervascularized outer membrane (+) 2. Some dark red, motor oil like hematoma was drained 3. The brain was slack after the operation Operative Procedures Under ETGA, we placed the patient over supine position with his head tilt to right. After we locate the mid-line and the hematoma location, a horizontal skin incision was made. The scalp was opened and the periostium was divided. The burr-hole was made with the drill and the dura tenting was done. We open the dura in layers with knife and bioplar forceps, and the outer membrane was seen. The hematoma evacuation with rubber drain was done after we opened the outer membrane. Repetitive irrigation over the drain was done. De-air was done after we closed the wound in layers. The rubber drain was connected to a collecting bag. Operators VS 楊士弘 Assistants R5 林哲光 R2 曾偉倫 相關圖片 林昱維 (M,1999/02/20,13y0m) 手術日期 2011/07/05 手術主治醫師 楊士弘 手術區域 兒醫 067房 02號 診斷 Diabetes insipidus 器械術式 Brain tumor Crainotomy(Others) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 王奐之, 時間資訊 04:00 臨時手術NPO 13:05 報到 13:15 進入手術室 13:30 麻醉開始 14:00 誘導結束 14:30 抗生素給藥 14:38 手術開始 19:00 麻醉結束 19:00 手術結束 19:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除-手術時間在4~8小時 1 1 R 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 摘要__ 手術科部: 套用罐頭: Right pterional craniotomy for partial tumor ... 開立醫師: 王奐之 開立時間: 2011/07/05 19:21 Pre-operative Diagnosis Pituitary stalk tumor Post-operative Diagnosis Pituitary stalk tumor Operative Method Right pterional craniotomy for partial tumor resection Specimen Count And Types 1 piece About size:小 Source:pituitary stalk tumor Pathology Frozen: fibrotic tissue Operative Findings Pituitary stalk was noted at right optic-chiasmatic space. The tumor was elastic firm, whitish, and located totally on the pituitary stalk. The pituitary gland was not exposed during the operative procedure. After partial tumor removal, the pituitary stalk was not severed. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head fixed in Mayfield skull clamp and turned to left (about 45 degrees). After scalp shaving, scrubbing, disinfection & draping in sterile fashion, a curvilinear skin incision was made at right frontotemporal area to make standard pterional craniotomy. After careful facial nerve preservation, the temporalis muscle was reflected inferiorly. Right pterional craniotomy was done after drilling of 3 burr holes. The sphenoid ridge was rongeur off to expose more inferior portion of skull base. A fish-mouth durotomy was then made, followed by frontal lobe retraction. Bilateral optic nerves were then identified, along with optic chiasm. The pituitary stalk was further identified, along with the tumor. Partial tumor resection was then done with micro-scissors & alligator. After tumor removal, meticulous hemostasis was achieved. The dura was closed with 4-0 Prolene continuous suture in water-tight fashion. After central tenting, the bone flap was fixed back with mini-plates. After placement of 1 epidural CWV drain, the wound was closed in layers. Operators VS 楊士弘 Assistants R4 王奐之 相關圖片 記錄__ 手術科部: 套用罐頭: Right pterional craniotomy for partial tumor ... 開立醫師: 王奐之 開立時間: 2011/07/07 10:54 Pre-operative Diagnosis Pituitary stalk tumor Post-operative Diagnosis Pituitary stalk tumor Operative Method Right pterional craniotomy for partial tumor resection Specimen Count And Types 1 piece About size:小 Source:pituitary stalk tumor Pathology Frozen: fibrotic tissue Operative Findings Pituitary stalk was noted at right optic-chiasmatic space. The tumor was elastic firm, whitish, and located totally on the pituitary stalk. The pituitary gland was not exposed during the operative procedure. After partial tumor removal, the pituitary stalk was not severed. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head fixed in Mayfield skull clamp and turned to left (about 45 degrees). After scalp shaving, scrubbing, disinfection & draping in sterile fashion, a curvilinear skin incision was made at right frontotemporal area to make standard pterional craniotomy. After careful facial nerve preservation, the temporalis muscle was reflected inferiorly. Right pterional craniotomy was done after drilling of 3 burr holes. The sphenoid ridge was rongeur off to expose more inferior portion of skull base. A fish-mouth durotomy was then made, followed by frontal lobe retraction. Bilateral optic nerves were then identified, along with optic chiasm. The pituitary stalk was further identified, along with the tumor. Partial tumor resection was then done with micro-scissors & alligator. After tumor removal, meticulous hemostasis was achieved. The dura was closed with 4-0 Prolene continuous suture in water-tight fashion. After central tenting, the bone flap was fixed back with mini-plates. After placement of 1 epidural CWV drain, the wound was closed in layers. Operators VS 楊士弘 Assistants R4 王奐之 相關圖片 白淑芬 (F,1971/09/05,40y6m) 手術日期 2011/07/06 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Meningioma 器械術式 Left craniotomy for tumor excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:10 進入手術室 08:15 麻醉開始 08:35 誘導結束 08:45 抗生素給藥 08:50 手術開始 11:45 抗生素給藥 14:45 抗生素給藥 16:45 麻醉結束 16:45 手術結束 17:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 9 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Left Kawase approach for tumor excision, Simp... 開立醫師: 陳國瑋 開立時間: 2011/07/07 01:23 Pre-operative Diagnosis Left petroclival meningioma Post-operative Diagnosis Left petroclival meningioma Operative Method Left Kawase approach for tumor excision, Simpson grade II Specimen Count And Types 1 piece About size:pieces Source:brain tumor Pathology pending Operative Findings Soft, moderately-vascularied, lobulated, tumor was noted at posterior fossa with dura base at inferior aspect of tentorial, with extention to Mekels cave. Trigeminal nerve was pushed by tumor laterally, trochlear nerve medially, and facial and cochlear-vestibulat nerve inferiorly. There was no SSEP, BAEP change during the operation. Tumor was removed totally, and based-dura was cauterized. Operative Procedures Under ETGA, we placed the patient over supine position. After we fixed her head with Mayfield clamp, her head was tilted to right. After we shaved, scrubbed, disinfected and drapped, a question mark like skin incision over frontal-parietal-temporal area was made. The craniotomy was made after four burr holes. Dura was tented around the craniotomy winodw. The temporal lobe was reached and retracted upward. Foramen Spinosum, foramen Ovale and Foramen Rotundum were identified. The middle meningeal artery was electrocautrized. Superficial greater petrosal nerve was identified and preserved. The dura of the Second and Third branch of Trigeminal nerve was pealed with knife. The petrosectomy was done with drills at Kawase triangle. Petrosal segment of internal carotid artery was identified, and preserved. The superior petrosal sinus was transected after clipping. The tentorium was cut open. The Meckels cave was opened. The CN V was identified and the tumor was visualized medial to the nerve. The durotomy was made over bilateral side of superior pertosal sinus. The tumor was removed with bipolar forceps, suction and CUSA in piecemea. After the tumor removal, the CN VII VIII complex was noted inferior to tumor. The trochlear nerve was pushed medially. All of the abover structiore was preserved. After complete hemostasis, duroplasty was done with Durofoam. Dural tenting was done and the skull graft was fixed back with mini-plate and screws. A CWV drain was placed over sub-cranium and sub-galeal space. The wound was closed within layers. Operators P杜永光 Assistants R5曾峰毅 R3陳國瑋 相關圖片 周子欽 (M,1959/03/08,53y0m) 手術日期 2011/07/06 手術主治醫師 曾漢民 手術區域 東址 005房 03號 診斷 Brain metastasis 器械術式 Port-A catheter Implatation 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 許皓淳, 時間資訊 12:05 進入手術室 12:10 抗生素給藥 12:20 手術開始 13:15 手術結束 13:17 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 port–A導管植入術–治療性導管植入術 1 0 L 摘要__ 手術科部: 外科部 套用罐頭: Port-A catheter implantation via percutaneous... 開立醫師: 李振豪 開立時間: 2011/07/06 13:03 Pre-operative Diagnosis Brain metastasis, status post craniotomy for tumor excision Post-operative Diagnosis Brain metastasis, status post craniotomy for tumor excision Operative Method Port-A catheter implantation via percutaneous puncture Specimen Count And Types Nil Pathology nil Operative Findings 1. Port-A catheter was inserted into SVC via left subclavicular vein and fixed at 18cm in depth. 2. Intra-operative portable X-ray showed Port-A catheter tip in correct venous branch to SVC. Operative Procedures The patient was put in supine position. The skin was disinfected and draped as usual. Local anesthesia with 10ml 1% Xylocaine was applied. Linear skin incision was made at left subclavical area and percutaneous puncture of left subclavicular vein was performed. The Port-A catheter was inserted. The location of tip of port-A catheter was checked by intra-operative portable X-ray. The port-A catheter was set up and the function was checked. Hemostasis was achieved and the wound was closed in layers with 3-0 Vicryl and 4-0 Nylon. After wound closure, the function of port-A catheter was checked agin and it work well. Operators VS曾漢民 Assistants R5李振豪, R2許皓淳 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Port-A catheter implantation via percutaneous... 開立醫師: 李振豪 開立時間: 2011/07/06 13:03 Pre-operative Diagnosis Brain metastasis, status post craniotomy for tumor excision Post-operative Diagnosis Brain metastasis, status post craniotomy for tumor excision Operative Method Port-A catheter implantation via percutaneous puncture Specimen Count And Types Nil Pathology nil Operative Findings 1. Port-A catheter was inserted into SVC via left subclavicular vein and fixed at 18cm in depth. 2. Intra-operative portable X-ray showed Port-A catheter tip in correct venous branch to SVC. Operative Procedures The patient was put in supine position. The skin was disinfected and draped as usual. Local anesthesia with 10ml 1% Xylocaine was applied. Linear skin incision was made at left subclavical area and percutaneous puncture of left subclavicular vein was performed. The Port-A catheter was inserted. The location of tip of port-A catheter was checked by intra-operative portable X-ray. The port-A catheter was set up and the function was checked. Hemostasis was achieved and the wound was closed in layers with 3-0 Vicryl and 4-0 Nylon. After wound closure, the function of port-A catheter was checked agin and it work well. Operators VS曾漢民 Assistants R5李振豪, R2許皓淳 相關圖片 嚴招富 (M,1954/11/20,57y3m) 手術日期 2011/07/06 手術主治醫師 曾漢民 手術區域 東址 005房 04號 診斷 Glioma, brain 器械術式 stereostatic biopsy for right temporal and parietal tumor 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 13:54 報到 14:00 進入手術室 14:05 麻醉開始 14:10 誘導結束 14:13 抗生素給藥 14:55 手術開始 17:40 麻醉結束 17:40 手術結束 17:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 手術 立體定位術-切片 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: stereotactic for right temporal lesion biopsy 開立醫師: 李振豪 開立時間: 2011/07/06 18:25 Pre-operative Diagnosis Multiple brain lesion, Suspect gliomatosis cerebri Post-operative Diagnosis Multiple brain lesion, Suspect gliomatosis cerebri Operative Method stereotactic for right temporal lesion biopsy Specimen Count And Types 1 piece About size:multiple Source:brain tumor biopsy Pathology pending Operative Findings Navigation was used for stereotactic biopsy. Total four small pieces of right temporal lesion was sampled and sent for pathology exam. No obvious hematoma noted in the last time of biopsy. The specimen was grey-yellowish and fragile in character. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. A 3cm linear incision was made over right frontal area followed by one burr hole creation. Two dural tenting was done and cruciform durotomy was performed. The Navigation was used for frameless stereotactic biopsy. After biopsy, hemostasis was achieved and the wound was closed in layers with 2-0 Vicryl and Appose staples. Operators VS曾漢民 Assistants R5李振豪, R2許皓淳 相關圖片 李紫汶 (F,1998/02/15,14y0m) 手術日期 2011/07/06 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Chiari malformation 器械術式 Laminectomy C-Spinal(Posterier 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 07:59 報到 08:05 進入手術室 08:15 麻醉開始 08:30 誘導結束 08:40 抗生素給藥 08:41 手術開始 12:55 麻醉結束 12:55 手術結束 12:58 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術(減壓)-二節以內 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦膜或脊髓膜突出修補術 1 1 手術 超音波診查機–腦神經外科術中特殊儀器使用費 1 0 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 摘要__ 手術科部: 外科部 套用罐頭: Suboccipital craniectomy, C1 laminectomy and ... 開立醫師: 王奐之 開立時間: 2011/07/06 13:32 Pre-operative Diagnosis Chiari malformation Post-operative Diagnosis Chiari malformation Operative Method Suboccipital craniectomy, C1 laminectomy and duroplasty Specimen Count And Types Nil Pathology Nil Operative Findings Obvious tonsil herniation was noted at foramen magnum and C1 level, with left side more severe then right side. Intra-operative ultrasonography showed loosening of CSF space. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position with head fixed in Mayfield skull clamp. A midline incision was made from below inion to C2 level, the incision was further deepened to expose the suboccipital skull and C1 lamina. Suboccipital craniectomy and C1 laminectomy were done with rongeur, air-drill & Kerrison punch. C1 level dura was opened, the arachnoid membrane was also opened. Bilateral tonsils were electrocauterized and shrinkage was resulted. The dura was then closed with Goretex graft with 5-0 Prolene continuous sutures. After meticulous hemostasis, the wound was closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之, Ri 謝明秀 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Suboccipital craniectomy, C1 laminectomy and ... 開立醫師: 王奐之 開立時間: 2011/07/07 10:54 Pre-operative Diagnosis Chiari malformation Post-operative Diagnosis Chiari malformation Operative Method Suboccipital craniectomy, C1 laminectomy and duroplasty Specimen Count And Types Nil Pathology Nil Operative Findings Obvious tonsil herniation was noted at foramen magnum and C1 level, with left side more severe then right side. Intra-operative ultrasonography showed loosening of CSF space. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position with head fixed in Mayfield skull clamp. A midline incision was made from below inion to C2 level, the incision was further deepened to expose the suboccipital skull and C1 lamina. Suboccipital craniectomy and C1 laminectomy were done with rongeur, air-drill & Kerrison punch. C1 level dura was opened, the arachnoid membrane was also opened. Bilateral tonsils were electrocauterized and shrinkage was resulted. The dura was then closed with Goretex graft with 5-0 Prolene continuous sutures. After meticulous hemostasis, the wound was closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之, Ri 謝明秀 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: 1. Posterior decompression by Suboccipital cr... 開立醫師: 郭夢菲 開立時間: 2011/07/08 12:36 Pre-operative Diagnosis Chiari malformation with syringomyelia formation from cervical to thoracic cord Post-operative Diagnosis Chiari malformation with syringomyelia formation from cervical to thoracic cord Operative Method 1. Posterior decompression by Suboccipital craniectomy and C1 laminectomy 2. Expansive duroplasty 3. Shrinkage of bilateral tonsils Specimen Count And Types Nil Pathology Nil Operative Findings 1. Obvious tonsil herniation was noted at foramen magnum and C1 level, with left side more severe than right side. 2. The occidpital bone was markedly depressed at the midline that resulted in severe compression to the posterior fossa. The soft tissue surrounding the foramen magnum was not thick, and the arachnoid was not severely fibrotic. 3. Intra-operative ultrasonography showed loosening of CSF space but poor brain pulsation before dural opening. The bain pulsation improved after decompression and shrinkage of tonsils Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position with head fixed in Mayfield skull clamp. A midline incision was made from below inion to C2 level, the incision was further deepened to expose the suboccipital skull and C1 lamina. Suboccipital craniectomy for 2.5 cm and C1 laminectomy were done with rongeur, air-drill & Kerrison punch. Under microscopic view, the dura over the C1 and foramen magnum level was opened, the arachnoid membrane was also opened. Bilateral tonsils were electrocauterized and shrinkage was resulted. The dura was then closed with Goretex graft with 5-0 Prolene continuous sutures. After meticulous hemostasis, and application of Tissue-col-duo to the surface of dura, the wound was closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之, Ri 謝明秀 相關圖片 梁一云 (F,1999/01/09,13y2m) 手術日期 2011/07/06 手術主治醫師 郭夢菲 手術區域 兒醫 067房 02號 診斷 Brain concussion 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3E 紀錄醫師 王奐之, 時間資訊 01:00 開始NPO 13:13 通知急診手術 14:20 報到 14:30 進入手術室 14:35 麻醉開始 14:50 誘導結束 15:20 抗生素給藥 15:30 手術開始 17:15 麻醉結束 17:15 手術結束 17:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 硬腦膜外血腫清除術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 外科部 套用罐頭: Right frontoparietal craniotomy for epidural ... 開立醫師: 王奐之 開立時間: 2011/07/06 17:52 Pre-operative Diagnosis Right frontoparietal acute epidural hematoma Post-operative Diagnosis Right frontoparietal acute epidural hematoma Operative Method Right frontoparietal craniotomy for epidural hematoma evacuation Specimen Count And Types Nil Pathology Nil Operative Findings About 30ml of epidural hematoma was noted at right frontoparietal area, without obvious epidural bleeder. A linear fracture was noted superio-anterior to the bone flap. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After hair shaving, scalp scrubbing, disinfection & draping in sterile fashion, a linear skin incision was made at right frontoparietal area. A round craniotomy was then made (about 5*6cm in size), exposing the epidural hematoma. After removal of the epidural hematoma, tenting stitches were made along the edge of craniotomy. After confirmation of hemostasis, central tenting was made, and the bone flap was placed back and fixed with mini-plates. The wound was then closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之, Ri 謝明秀 Indication Of Emergent Operation 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Right frontoparietal craniotomy for epidural ... 開立醫師: 王奐之 開立時間: 2011/07/07 10:55 Pre-operative Diagnosis Right frontoparietal acute epidural hematoma Post-operative Diagnosis Right frontoparietal acute epidural hematoma Operative Method Right frontoparietal craniotomy for epidural hematoma evacuation Specimen Count And Types Nil Pathology Nil Operative Findings About 30ml of epidural hematoma was noted at right frontoparietal area, without obvious epidural bleeder. A linear fracture was noted superio-anterior to the bone flap. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After hair shaving, scalp scrubbing, disinfection & draping in sterile fashion, a linear skin incision was made at right frontoparietal area. A round craniotomy was then made (about 5*6cm in size), exposing the epidural hematoma. After removal of the epidural hematoma, tenting stitches were made along the edge of craniotomy. After confirmation of hemostasis, central tenting was made, and the bone flap was placed back and fixed with mini-plates. The wound was then closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之, Ri 謝明秀 Indication Of Emergent Operation IICP 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Right frontoparietal craniotomy for epidural ... 開立醫師: 郭夢菲 開立時間: 2011/07/11 17:07 Pre-operative Diagnosis Right frontoparietal acute epidural hematoma Post-operative Diagnosis Right frontoparietal acute epidural hematoma Operative Method Right frontoparietal craniotomy for epidural hematoma evacuation Specimen Count And Types Nil Pathology Nil Operative Findings About 30ml of epidural hematoma clot was noted at right frontoparietal area, without obvious epidural bleeder. A linear fracture was noted superio-anterior to the bone flap. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After hair shaving, scalp scrubbing, disinfection & draping in sterile fashion, a linear skin incision was made at right frontoparietal area. A round craniotomy was then made (about 5*6cm in size), exposing the epidural hematoma. After removal of the epidural hematoma, tenting stitches were made along the edge of craniotomy. After confirmation of hemostasis, central tenting was made, and the bone flap was placed back and fixed with 3 sets of mini-plates. The wound was then closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之, Ri 謝明秀 Indication Of Emergent Operation 相關圖片 鄒秀貞 (F,1954/05/10,57y10m) 手術日期 2011/07/07 手術主治醫師 陳敞牧 手術區域 東址 013房 01號 診斷 Herniation of intervertebral disc with myelopathy, cervical 器械術式 Laminectomy for decompression 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 1E 紀錄醫師 林哲光, 時間資訊 17:30 開始NPO 23:06 通知急診手術 00:20 進入手術室 00:40 麻醉開始 01:00 誘導結束 01:50 手術開始 01:55 抗生素給藥 03:32 開始輸血 04:50 麻醉結束 04:50 手術結束 05:09 送出病患 05:15 進入恢復室 06:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 椎弓切除術(減壓)-超過二節 1 1 記錄__ 手術科部: 外科部 套用罐頭: C5-7 laminectomy for decompression, pus drain... 開立醫師: 林哲光 開立時間: 2011/07/07 05:24 Pre-operative Diagnosis Cervical stenosis with hypertrophic PLL at C5, C6, C7 and acute myelopathy; paraspinal abscess at C5-6 level Post-operative Diagnosis Cervical stenosis with hypertrophic PLL at C5, C6, C7 and acute myelopathy; ; paraspinal abscess at C5-6 level Operative Method C5-7 laminectomy for decompression, pus drainage at left C5-6 level Specimen Count And Types 1 piece About size:pus culture Source: Pathology Nil Operative Findings Pus gushed out during the paraspinal muscle detachment. A thin pus coating at the epidural area was noted. Hypertrophic change of the ligamentum flavum was also noted. The dura seemed compressed tightly during the laminectomy and the the dura seemed slack and re-expanded well after laminectomy. The dura sac seemed bulging prominently after the procedure was done. Operative Procedures Under ETGA and prone posiition with head fixed with Mayfield head clump, skin disinfected and drapped were performed as usual. MIdline skin incision was made at C3-C7 level. The paraspinal muscles were then detached. C5-7 laminectomy was performed. Hemostasis was then done with Gelfoam packing. The wound was then closed in layers after epidural drains x2 inserted. Operators VS 陳敞牧 Assistants R5 林哲光, R1 胡敏冰 Indication Of Emergent Operation 相關圖片 謝吳金定 (F,1951/09/02,60y6m) 手術日期 2011/07/06 手術主治醫師 戴浩志 手術區域 東址 009房 03號 診斷 Malignant neoplasm of connective and other soft tissue 器械術式 Lymph nodes biopsy, Bil. inguinal 手術類別 預定手術 手術部位 腹 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 3 紀錄醫師 陳志軒, 時間資訊 00:00 臨時手術NPO 13:05 報到 13:27 進入手術室 13:35 麻醉開始 13:40 誘導結束 13:45 抗生素給藥 13:53 手術開始 18:40 手術結束 18:40 麻醉結束 18:50 送出病患 18:58 進入恢復室 20:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 手術 腹股溝淋巴腺腫切除術 1 1 摘要__ 手術科部: 內科部 套用罐頭: Deep tumors excision 開立醫師: 陳志軒 開立時間: 2011/07/06 19:15 Pre-operative Diagnosis Bilateral inguinal lymphadenopathy Post-operative Diagnosis Bilateral inguinal cystic tumors, suspected left side schwannoma and suspected right side lymph node or schwannoma Operative Method Deep tumors excision Specimen Count And Types 3 pieces About size:1cm Source:left inguinal lymph node About size:2-3cm Source:Left inguinal mass About size:7cm Source:Right inguinal mass Pathology Pending Operative Findings There was one 1cm lynph node found at left inguinal area. There was one 2~3cm cystic tumor found located at left inguinal area, next to femoral vessels, with nerve fibers surrounding attaching to it. Schwannoma was suspected. There was one 7x4cm cystic mass found located at right inguinal area, with chocolate-like thick mucous fluid inside. The mass was adhered to surrounding tissue. Some nerve fibers were found attached to the mass. Operative Procedures Under LMAGA, the patient was placed in supine position. Anti-septic preparation was performed. Linear incision was made at both inguinal area. Dissection was performed to explore the mass. The tumor was then excised with preservation of the femoral nerve. After hemostasis and N/S irrigation, one CWV drainage tubr was inserted to each side.The wound was then closed in alyers. Operators AP戴浩志 Assistants R5游彥辰, R3陳志軒, Int陳乃綺 相關圖片 黃明崑 (M,1959/01/06,53y2m) 手術日期 2011/07/06 手術主治醫師 黃培銘 手術區域 東址 025房 01號 診斷 Lung cancer, non-small cell 器械術式 Thoracoscopy+Open Chest 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 鄒冠全, 時間資訊 07:50 報到 08:10 進入手術室 08:20 麻醉開始 08:40 誘導結束 09:10 抗生素給藥 09:21 手術開始 12:00 12:10 抗生素給藥 15:50 抗生素給藥 18:10 麻醉結束 18:10 手術結束 18:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 胸腔鏡肺葉切除術 1 1 R 手術 根除性淋巴切除術(肺葉切除或全肺切除時) 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 12 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 3 0 麻醉 動脈血液檢查全套 3 0 麻醉 Hemoglobin (Hb) 3 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 3 0 手術 惡性脊髓腫瘤切除術 1 1 R 麻醉 Na (Sodium) 3 0 麻醉 K (Potassium) 3 0 麻醉 Blood gas analysis 3 0 記錄__ 手術科部: 外科部 套用罐頭: Video-assisted thoracotomy for RUL lobectomy ... 開立醫師: 鄒冠全 開立時間: 2011/07/06 12:44 Pre-operative Diagnosis RUL lung cancer with chest wall and vertibral body invasion s/p CCRT Post-operative Diagnosis RUL lung cancer with chest wall and vertibral body invasion s/p CCRT Operative Method Video-assisted thoracotomy for RUL lobectomy and lymph node dissection Specimen Count And Types 2 pieces About size:8*12cm Source:RUL About size:0.5*0.5cm Source:Gr.3A Pathology pending Operative Findings 1. The tumor was severe adhesion to chest wall with thickened pleura. 2. No obvious lymph node was noted at Gr.3,4,7, only mild lymph node noted at Gr.3A Operative Procedures 1. ETGA with bronchial blocker, left decubitus 2. Set camara at previous camara port 3. Thoracotomy at 4th ICS, adhesionolysis, take down RUL from chest wall adhesion, dissect PA, PV and bronchus with harmonic 4. Due to severe adhesion, the hilum strcture was ligated with GIA75*1 and Ethicon endo-GIA45*2 5. Hemostasis, perform lymph node dissection of Gr.7, 3+4 and 3A 6. N/S irrigation, let wound open and hand over to NS Operators 黃培銘 Assistants R4鄒冠全, Ri 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: T3, T4 corpectomy with cage insertion and pla... 開立醫師: 林哲光 開立時間: 2011/07/07 05:50 Pre-operative Diagnosis RUL lung cancer with direct invasion to T3, T4 level Post-operative Diagnosis RUL lung cancer with direct invasion to T3, T4 level Operative Method T3, T4 corpectomy with cage insertion and plate fixation Specimen Count And Types 1 piece About size:multiple pieces Source:tumor Pathology Pending Operative Findings Lung tumor was removed and some pleural thickening with directly invading into the T3, T4 vertebral body with T4 rib involvement. Two segment cage was inserted and a plate fixation was done. T3, T4, T5 right side segmental artery were divided during the tumor excision. Operative Procedures After thoractomy was done, T3, T4 corpectomy was done. The tumor was excised picemeal method. The cage was the inserted and the plat was fixed with screws. The wound was then closed in layers after chest tube insertion. Operators VS 蕭輔仁 Assistants R5 林哲光 相關圖片 湯張秋霞 (F,1948/11/10,63y4m) 手術日期 2011/07/06 手術主治醫師 王國川 手術區域 東址 005房 01號 診斷 Hemiplegia affecting unspecified side, late effects of cerebrovascular disease 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:15 麻醉開始 08:25 誘導結束 08:40 抗生素給藥 08:58 手術開始 09:30 手術結束 09:30 麻醉結束 09:37 送出病患 09:38 進入恢復室 10:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦脊髓液分流管重置 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Revision of ventriculoperitoneal shunt 開立醫師: 李振豪 開立時間: 2011/07/06 09:44 Pre-operative Diagnosis Malfunction of ventriculoperitoneal shunt Post-operative Diagnosis Malfunction of ventriculoperitoneal shunt Operative Method Revision of ventriculoperitoneal shunt Specimen Count And Types nil Pathology Nil Operative Findings The shunt function was checked after wound opening and the ventricular catheter and peritoneal catheter were all patent. The CSF is clear in character. Codman programmable valve reservoir with initial setting as 100mmH2O was used for shunt revision. The ventricular catheter was 7cm in depth. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head rotated to left. The scalp was shaved, scrubbed, and disinfected as usual. The right frontal scalp incision was made along operative scar and the reservoir was exposed. Right temporal linear scalp incision was made along the tract of shunt and the peritoneal catheter was exposed. The shunt was trnsected at right temporal area and the function of ventricular and peritoneal catheter were checked. The old reservoir was removed and the Codman programmable valve reservoir was placed. After connection with peritoneal catheter, the function of new shunt was checked. Hemostasis was achieved with bipolar electrocautery and the wound was closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS王國川 Assistants R5李振豪, R2許皓淳 相關圖片 徐榮意 (M,1939/01/28,73y1m) 手術日期 2011/07/06 手術主治醫師 王國川 手術區域 東址 005房 02號 診斷 Intracranial hemorrhage 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 09:50 進入手術室 10:00 麻醉開始 10:05 誘導結束 10:38 手術開始 11:16 手術結束 11:16 麻醉結束 11:30 送出病患 11:35 進入恢復室 12:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt via left Kocher"s ... 開立醫師: 李振豪 開立時間: 2011/07/06 11:41 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunt via left Kocher"s approach Specimen Count And Types 1 piece About size:5ml Source:CSF Pathology Nil Operative Findings The opening pressure is 10cmH2O. The CSF is xanthochromic in character and 5ml CSF is sampled for routine, BCS, and bacterial culture. Codman fixed pressure reservoir(100mmH2O) is used. The depth of ventricular and peritoneal catheter are 7.5 and 25cm respectively. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head rotated to right. The scalp was shaved, scrubbed, and disinfected as usual. Left frontal scalp incision was made along operative scar and previous left frontal burr hole were identified. Left upper abdomen transverse skin incision was made and minilaparotomy was performed. The subcutaneous tunnel was created from left upper abdomen, forechest, neck, to left retroauricular area. One small skin incision was made at left retroauricular area and the peritoneal catheter was passed through the subcutaneous tunnel. Left lateral ventricle puncture was performed with puncture needle. The ventricular catheter was placed into the left lateral ventricle and the V-P shunt was set. The function of the shunt was checked. The peritoneal catheter was placed into peritoneal cavity under direct vision. Hemostasis was achieved and the wound was closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS王國川 Assistants R5李振豪, R2許皓淳 相關圖片 黃琰宸 (M,1952/05/02,59y10m) 手術日期 2011/07/07 手術主治醫師 陳敞牧 手術區域 東址 005房 02號 診斷 Epidural hematoma, traumatic 器械術式 Revision of CSF shunt, right 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 13:25 報到 13:55 進入手術室 14:12 麻醉開始 14:17 誘導結束 14:55 抗生素給藥 15:00 手術開始 16:08 手術結束 16:08 麻醉結束 16:20 送出病患 16:23 進入恢復室 17:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦脊髓液分流管重置 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Revision of ventriculoperitoneal shunt 開立醫師: 李振豪 開立時間: 2011/07/07 16:36 Pre-operative Diagnosis Malfunction of ventriculoperitoneal shunt Post-operative Diagnosis Malfunction of ventriculoperitoneal shunt Operative Method Revision of ventriculoperitoneal shunt Specimen Count And Types 1 piece About size:5ml Source:CSF Pathology Nil Operative Findings The old ventriculoperitoneal shunt was obstructed at the level of shunt ligation. The ventricular catheter and the distal peritoneal catheter were all patent. No obvious adhesion was noted at right upper abdomen while we entered the peritoneal cavity. The CSF was clear in character and sampled for routine, biochemistry, and bacterial culture. Metronic high pressure reservoir was used for new shunt. The depth of ventricular and peritoneal catheter were 7cm and 25cm respectively. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head rotated to left. The scalp was shaved, scrubbed, and disinfected as usual. Right upper abdomen skin incision was made along operative scar and the subcutaneous soft tissue was devided. The peritoneal catheter was found and the peritoneal cavity was entered along the catheter. The peritoneal catheter was pulled out. The peritoneal cavity was examed and no obvious adhesion was noted. Right frontal scalp incision was made along operative scar. The reservoir was identified and free from the scalp. The connection between reservoir and peritoneal catheter was cut off and the function of ventricular catheter was checked. The old peritoneal catheter was connected to the new peritoneal catheter with 2-0 silk. The old peritoneal catheter was removed and the new peritoneal catheter was passed through the subcutaneous tunnel at the same time. The new peritoneal catheter was connected to new high pressure reservoir. The old reservoir was removed and the new reservoir and ventricular catheter was placed into right lateral ventricle. The function of shunt was checked. Hemostasis was achieved. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS陳敞牧 Assistants R5李振豪, R1張倍慈 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Revision of ventriculoperitoneal shunt 開立醫師: 李振豪 開立時間: 2011/07/07 16:36 Pre-operative Diagnosis Malfunction of ventriculoperitoneal shunt Post-operative Diagnosis Malfunction of ventriculoperitoneal shunt Operative Method Revision of ventriculoperitoneal shunt Specimen Count And Types 1 piece About size:5ml Source:CSF Pathology Nil Operative Findings The old ventriculoperitoneal shunt was obstructed at the level of shunt ligation. The ventricular catheter and the distal peritoneal catheter were all patent. No obvious adhesion was noted at right upper abdomen while we entered the peritoneal cavity. The CSF was clear in character and sampled for routine, biochemistry, and bacterial culture. Metronic high pressure reservoir was used for new shunt. The depth of ventricular and peritoneal catheter were 7cm and 25cm respectively. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head rotated to left. The scalp was shaved, scrubbed, and disinfected as usual. Right upper abdomen skin incision was made along operative scar and the subcutaneous soft tissue was devided. The peritoneal catheter was found and the peritoneal cavity was entered along the catheter. The peritoneal catheter was pulled out. The peritoneal cavity was examed and no obvious adhesion was noted. Right frontal scalp incision was made along operative scar. The reservoir was identified and free from the scalp. The connection between reservoir and peritoneal catheter was cut off and the function of ventricular catheter was checked. The old peritoneal catheter was connected to the new peritoneal catheter with 2-0 silk. The old peritoneal catheter was removed and the new peritoneal catheter was passed through the subcutaneous tunnel at the same time. The new peritoneal catheter was connected to new high pressure reservoir. The old reservoir was removed and the new reservoir and ventricular catheter was placed into right lateral ventricle. The function of shunt was checked. Hemostasis was achieved. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS陳敞牧 Assistants R5李振豪, R1張倍慈 相關圖片 傅月梅 (F,1961/10/06,50y5m) 手術日期 2011/07/07 手術主治醫師 陳敞牧 手術區域 東址 005房 01號 診斷 Liver replaced by transplant 器械術式 Laminectomy for decompression, T12 partial tumor removal and TPS for T10, T11, L1, L2 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 07:42 報到 08:00 進入手術室 08:25 麻醉開始 08:45 誘導結束 08:50 抗生素給藥 09:26 手術開始 11:50 抗生素給藥 12:00 開始輸血 13:10 麻醉結束 13:10 手術結束 13:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 惡性脊髓腫瘤切除術 1 1 手術 脊椎融合術-後融合,有固定物(<=六節) 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 內科部 套用罐頭: 1. T12 laminectomy and right facetectomy for ... 開立醫師: 李振豪 開立時間: 2011/07/07 13:56 Pre-operative Diagnosis T12 spinal tumor with cord compression, favor metastatic tumor Post-operative Diagnosis T12 metastatic tumor with cord compression Operative Method 1. T12 laminectomy and right facetectomy for transpedicular tumor excision 2. T10, T11, L1, and L2 transpedicular screws for posterior instrumentation Specimen Count And Types 1 piece About size:Multiple small pieces Source:T12 spinal tumor Pathology Pending Operative Findings The tumor was gray-reddish, fragile, hypervascularized, and ill-demarcated in character. The tumor was mainly located at right side pedicle, anterior epidural space, posterior part of vertebral body, and paraspinal area. The roots and thecal sac was protected well during the operation. Bleeding tendancy also noted during the operation. Total blood loss was 4500ml. Total eight transpedicular screws were used for posterior instrumentation(T10 and T11: 6.0 x 40mm; L1 and L2: 6.5 x 45mm). The size of rods and cross-link were 17cm and 7cm respectively. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position. The T10 to L2 level were localized by portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision from T10 to L2 were made. The subcutaneous soft tissue was devided and the paravertebral muscle groups were detached. T10, T11, L1, and L2 transpedicular screws were inserted under C-arm guided. T12 laminectomy was performed and partial tumor excision for decompression was done. The right side pedicle of T12 was destructed by the tumor. Tumor excision was performed via right side pedicle of T12 to posterior part of the vertebral body. The space was packing with Gelfoam. Two rods and one cross-link were used for posterior instrumentation. Two epidural 1/8 hemovac was placed. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS陳敞牧 Assistants R5李振豪, R1張倍慈 記錄__ 手術科部: 內科部 套用罐頭: 1. T12 laminectomy and right facetectomy for ... 開立醫師: 李振豪 開立時間: 2011/07/07 13:56 Pre-operative Diagnosis T12 spinal tumor with cord compression, favor metastatic tumor Post-operative Diagnosis T12 metastatic tumor with cord compression Operative Method 1. T12 laminectomy and right facetectomy for transpedicular tumor excision 2. T10, T11, L1, and L2 transpedicular screws for posterior instrumentation Specimen Count And Types 1 piece About size:Multiple small pieces Source:T12 spinal tumor Pathology Pending Operative Findings The tumor was gray-reddish, fragile, hypervascularized, and ill-demarcated in character. The tumor was mainly located at right side pedicle, anterior epidural space, posterior part of vertebral body, and paraspinal area. The roots and thecal sac was protected well during the operation. Bleeding tendancy also noted during the operation. Total blood loss was 4500ml. Total eight transpedicular screws were used for posterior instrumentation(T10 and T11: 6.0 x 40mm; L1 and L2: 6.5 x 45mm). The size of rods and cross-link were 17cm and 7cm respectively. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position. The T10 to L2 level were localized by portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision from T10 to L2 were made. The subcutaneous soft tissue was devided and the paravertebral muscle groups were detached. T10, T11, L1, and L2 transpedicular screws were inserted under C-arm guided. T12 laminectomy was performed and partial tumor excision for decompression was done. The right side pedicle of T12 was destructed by the tumor. Tumor excision was performed via right side pedicle of T12 to posterior part of the vertebral body. The space was packing with Gelfoam. Two rods and one cross-link were used for posterior instrumentation. Two epidural 1/8 hemovac was placed. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS陳敞牧 Assistants R5李振豪, R1張倍慈 蔡秀鳳 (F,1968/06/02,43y9m) 手術日期 2011/07/07 手術主治醫師 蕭輔仁 手術區域 東址 003房 02號 診斷 Hyperhidrosis 器械術式 Endoscopic T2 sympathectomy, bilateral 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 2 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 12:00 進入手術室 12:03 麻醉開始 12:10 誘導結束 12:47 手術開始 13:25 手術結束 13:25 麻醉結束 13:30 抗生素給藥 13:35 送出病患 13:38 進入恢復室 15:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 經內視鏡交感神經切斷術 1 1 B 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Bilateral T2-T3 sympathectomy 開立醫師: 王奐之 開立時間: 2011/07/07 13:33 Pre-operative Diagnosis Hyperhidrosis Post-operative Diagnosis Hyperhidrosis Operative Method Bilateral T2-T3 sympathectomy Specimen Count And Types Nil Pathology Nil Operative Findings Temperature change of left hand before & after sympathectomy: 33.7 to 35.2. Temperature change of right hand before & after sympathectomy: 31.5 to 33.2. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with bilateral arms stretched out. After skin disinfection & draping in sterile fashion, 1 small linear incision was made at right axillary area (about 3th ICS & mid-axillary line intersection). After inserting the trocar into left pleural space, endoscope was inserted until the T2 rib was identified. Electrocauterization was then applied to left T2 & T3 sympathetic ganglion. The same procedure was repeated again at right side. The 2 wounds were closed with 3-0 Nylon. After endotracheal general anesthesia, the patient was placed in supine position with bilateral arms stretched out. After skin disinfection & draping in sterile fashion, 1 small linear incision was made at right axillary area (about 4th ICS & mid-axillary line intersection). After inserting the trocar into left pleural space, endoscope was inserted until the T2 rib was identified. Electrocauterization was then applied to left T2 & T3 sympathetic ganglion. The same procedure was repeated again at right side. The 2 wounds were closed with 3-0 Nylon. Operators VS 蕭輔仁 Assistants R4 王奐之, Ri 李宜潔 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Bilateral T2-T3 sympathectomy 開立醫師: 王奐之 開立時間: 2011/07/07 14:06 Pre-operative Diagnosis Hyperhidrosis Post-operative Diagnosis Hyperhidrosis Operative Method Bilateral T2-T3 sympathectomy Specimen Count And Types Nil Pathology Nil Operative Findings Temperature change of left hand before & after sympathectomy: 33.7 to 35.2. Temperature change of right hand before & after sympathectomy: 31.5 to 33.2. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with bilateral arms stretched out. After skin disinfection & draping in sterile fashion, 1 small linear incision was made at right axillary area (about 4th ICS & mid-axillary line intersection). After inserting the trocar into left pleural space, endoscope was inserted until the T2 rib was identified. Electrocauterization was then applied to left T2 & T3 sympathetic ganglion. The same procedure was repeated again at right side. The 2 wounds were closed with 3-0 Nylon. Operators VS 蕭輔仁 Assistants R4 王奐之, Ri 李宜潔 相關圖片 吳莉媺 (F,1987/05/24,24y9m) 手術日期 2011/07/07 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Gastrointestinal upset 器械術式 Cranioplasty, right skull bone 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 08:00 進入手術室 08:20 麻醉開始 08:25 誘導結束 09:00 抗生素給藥 09:17 手術開始 11:23 手術結束 11:23 麻醉結束 11:35 送出病患 11:40 進入恢復室 12:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 頭顱成形術 1 1 R 手術 去除齒列夾板 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 摘要__ 手術科部: 外科部 套用罐頭: Right side frontotemporoparietal cranioplasty... 開立醫師: 王奐之 開立時間: 2011/07/07 10:43 Pre-operative Diagnosis Right side frontotemporoparietal skull defect Post-operative Diagnosis Right side frontotemporoparietal skull defect Operative Method Right side frontotemporoparietal cranioplasty with autologous bone graft Specimen Count And Types Nil Pathology Nil Operative Findings Only mild adhesion was noted between galea and dura surface. 6 central tenting stitches were applied to the dura. Bone cement was used to fill-up the bony gaps. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After shaving, scrubbing, disinfection & draping in sterile fashion, a quesion mark incision was made along previous wound scar. The plane between galea & dura was then dissected with blunt scissors, and the bony edge was exposed by electrocautery. After central tentings, the bone graft was fixed in place with mini-plates. After setting 1 subgaleal CWV drain, the wound was closed in layers. Operators VS 王國川 Assistants R4 王奐之, Ri 李宜潔 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Right side frontotemporoparietal cranioplasty... 開立醫師: 王奐之 開立時間: 2011/07/07 10:55 Pre-operative Diagnosis Right side frontotemporoparietal skull defect Post-operative Diagnosis Right side frontotemporoparietal skull defect Operative Method Right side frontotemporoparietal cranioplasty with autologous bone graft Specimen Count And Types Nil Pathology Nil Operative Findings Only mild adhesion was noted between galea and dura surface. 6 central tenting stitches were applied to the dura. Bone cement was used to fill-up the bony gaps. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After shaving, scrubbing, disinfection & draping in sterile fashion, a quesion mark incision was made along previous wound scar. The plane between galea & dura was then dissected with blunt scissors, and the bony edge was exposed by electrocautery. After central tentings, the bone graft was fixed in place with mini-plates. After setting 1 subgaleal CWV drain, the wound was closed in layers. Operators VS 王國川 Assistants R4 王奐之, Ri 李宜潔 相關圖片 摘要__ 手術科部: 外科部 套用罐頭: removal of Arch bars and lingual splint 開立醫師: 李維棠 開立時間: 2011/07/07 11:29 Pre-operative Diagnosis Mandible fracture s/p ORIF + MMF Post-operative Diagnosis Mandible fracture s/p ORIF + MMF Operative Method removal of Arch bars and lingual splint Specimen Count And Types nil Pathology nil Operative Findings all arch bars and lingual splint were removed Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position. The operative field was disinfected and draped as usual. All arch bars and lingual splint were removed. The pateint tolerated the procedure well. Operators VS戴浩志 Assistants R3李維棠 Ri李宜潔 相關圖片 張鈞凱 (M,1986/01/30,26y1m) 手術日期 2011/07/07 手術主治醫師 王國川 手術區域 東址 001房 04號 診斷 Epidural hematoma, traumatic 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 4E 紀錄醫師 陳國瑋, 時間資訊 10:00 開始NPO 15:04 通知急診手術 15:50 進入手術室 16:00 麻醉開始 16:15 抗生素給藥 16:20 誘導結束 16:35 手術開始 17:30 開始輸血 18:55 手術結束 18:55 麻醉結束 19:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 硬腦膜外血腫清除術 1 1 L 手術 顱內壓視置入 1 2 L 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 摘要__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 曾峰毅 開立時間: 2011/07/07 18:25 Pre-operative Diagnosis Left temporoparietal epidural hematoma with skull fracture Post-operative Diagnosis Left temporoparietal epidural hematoma with skull fracture Operative Method Left temporoparietal craniotomy for epidural hematoma removal and ICP monitor insertion Specimen Count And Types Nil Pathology Pending Operative Findings Epidural hematoma was about 2 cm. ICP after wound closed was 6. Codman ICP monitor reference is 503. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to right. After Scalp shaved, scrubbed, disinfected, and then draped, we made one reverted-U shape scalp incision at left temporoparietal area. We drilled four burr holes, and then created craniotomy, about 8x10 cm. We removed epidural hematoma, and tented the dura along the craniotomy window. Weopened the dura, and irrigated subdural space with saline. ICP monitor was inserted into subdural space. We fixed the bone graft back with wires after dura central tenting and inserting epidural CWV. The wound was closed in layers. Operators VS 王國川 Assistants R5 曾峰毅 R3 陳國瑋 R1 許皓淳 R5 曾峰毅 R3 陳國瑋 R2 許皓淳 Indication Of Emergent Operation Head injury 相關圖片 張煜杰 (M,1990/12/18,21y2m) 手術日期 2011/07/08 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Brain tumor 器械術式 Left frontal craniotomty for cavernoma excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 1 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:12 麻醉開始 08:58 誘導結束 09:05 抗生素給藥 09:15 手術開始 12:05 抗生素給藥 14:55 手術結束 14:55 麻醉結束 15:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 手術 腦瘤切除-手術時間在4~8小時 1 1 L 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Left frontoparietal craniotomy, trans-sulcus ... 開立醫師: 曾峰毅 開立時間: 2011/07/08 14:30 Pre-operative Diagnosis Cavernoma at left sensory cortex Post-operative Diagnosis Cavernoma at left sensory cortex Operative Method Left frontoparietal craniotomy, trans-sulcus approach for tumor excision Specimen Count And Types 1 piece About size:3cm Source:brain tumor Pathology Pending Operative Findings Sensory cortex was confirmed by neurophysiology meeting. The lesion was located 1m beneath sensory cortex with peripheral hemosiderin deposition. The mass lesion is dark-brownish, malberry-like. One cortical artery was injured, and was repaired by 10-0 prolene suture. Sensory cortex was confirmed by neurophysiology mappingg. The lesion was located 1m beneath sensory cortex with peripheral hemosiderin deposition. The mass lesion is dark-brownish, mulberry-like. One cortical artery was injured, and was repaired by 10-0 prolene suture. Operative Procedures After intubation and general anesthesia, the patient was put in supine position with head turing to right. The skin was disinfected and draped as usual. One U shape skin incision was done and the skin was retracted downward with temporalis. Craniotomy was done after four burr holes. Durotomy was then done after dura tenting. The tumor was identified with sonography and the junction of sensory and motor cortex was checked with mapping. Trans-sulcus tumor excision was performed with sucker and bipolar. One cortical artery was injuried accidentally and then repaired by 10-0 prolene suture. The bone graft was fixed with wires. After adequate hemostasis, the wound was closed in layers with one subgaleal CWV. After intubation and general anesthesia, the patient was put in supine position with head turing to right. The skin was disinfected and draped as usual. One U shape skin incision was done and the skin was retracted downward with temporalis. Craniotomy was done after four burr holes. Durotomy was then done after dura tenting. The tumor was identified with sonography and the junction of sensory and motor cortex was checked with mapping. Trans-sulcus tumor excision was performed with sucker and bipolar. One cortical artery was injuried accidentally and then repaired by 10-0 prolene suture. The bone graft was fixed with wires. After adequate hemostasis, the wound was closed in layers with one CWV beneath temporalis muscle. Operators P 杜永光 Assistants R5 曾峰毅 R3 陳國瑋 Ri 林怡均 相關圖片 陳崧渶 (M,1927/08/05,84y7m) 手術日期 2011/07/08 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Glioblastoma multiforma 器械術式 Excision of right frontal glioma 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:05 進入手術室 08:10 麻醉開始 08:40 誘導結束 08:44 手術開始 09:00 抗生素給藥 11:50 抗生素給藥 12:10 麻醉結束 12:10 手術結束 12:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Right frontal craniotomy for tumor excision 開立醫師: 李振豪 開立時間: 2011/07/08 12:23 Pre-operative Diagnosis Right frontal tumor, suspect metastasis Post-operative Diagnosis Right frontal glioma Operative Method Right frontal craniotomy for tumor excision Specimen Count And Types 1 piece About size:multiple small pieces Source:right frontal tumor Pathology Frozen section: glioma Operative Findings The tumor was grayish, ill-defined, moderate vascularized, and 2.5 x 2.4 x 3cm in size. Glioma was suspected and frozen section was sent. The report of frozen section also favored glioma but no evident microvascular proliferation or focal necrosis. Perifocal edema was remarkable with brain swelling. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. Right fronto-temporal scalp curvilinear incision was made and the scalp flap was elevated. Two burr hole were created followed by one 6 x 5cm craniotomy window. Dural tenting was done. C-shape durotomy based with superior sagittal sinus was performed. Intra-operative sonography was used for localization of the tumor. one 2cm corticotomy was made and the tumor was excised by tumor forceps, bipolar electrocautery, and suction. Frozen section was sent for suspect glioma. Hemostasis was achieved with bipolar electrocautery and Surgicel lining. The dura was closed with 4-0 Prolene and duroplasty was done with one small pieces of periosteum. The skull plate was fixed back with miniplates, screws, and two central tenting. One subgaleal CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and Appose staples. Operators VS曾漢民 Assistants R5李振豪, R2許皓淳 謝秉洋 (M,1975/04/04,36y11m) 手術日期 2011/07/08 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Brain Tumor 器械術式 Brain tumor Crainotomy(TZENG) for right frontal horn glioma (intraventricular) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 11:30 報到 12:22 進入手術室 12:30 麻醉開始 12:45 誘導結束 13:00 抗生素給藥 13:00 手術開始 16:00 手術結束 16:00 抗生素給藥 16:00 麻醉結束 16:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 記錄__ 手術科部: 外科部 套用罐頭: Right frontal craniotomy for tumor excision 開立醫師: 李振豪 開立時間: 2011/07/08 16:36 Pre-operative Diagnosis Right intraventricular tumor, suspect glioma Post-operative Diagnosis Right intraventricular and hypothalamic tumor, favor glioma Operative Method Right frontal craniotomy for tumor excision Specimen Count And Types 1 piece About size:multiple small pieces Source:Right intraventricular tumor Pathology Pending Operative Findings Brain surface was adhered to the dura due to previous surgery. Fibrotic change over previous operative tract was noted and the right lateral ventricle was entered along the tract. The tumor was encountered after we entered the lateral ventricle. One firm, yellow-whitish, hypovascularized, 1cm in diameter, and well-demarcated tumor was noted at medial side of frontal horn. The other part of the tumor was gelatinous and low grade glioma was favored. The tumor was mainly located lateral side of ventricle and extended to hypothalamus. 3rd ventricle was entered after tumor excision. The cystic portion of the tumor was filled with some brown-yellowish fluid which old hemorrhage was favored. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. Bicoronal scalp incision was made along operative scar and the scalp flap was elevated. Previous craniotomy window was identified and removed again. The craniotomy window was extended laterally and anteriorly. Durotomy was performed with lumda shape. The previous operative tract was noted and the right lateral ventricle was entered along the tract. Tumor excision was performed with bipolar electrocautery and suction. Hemostasis was achieved with bipolar electrocautery. Duroplasty with periostium was done and the skull plate was fixed back with miniplates and screws. One subgaleal CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS曾漢民 Assistants R5李振豪, R2許皓淳 相關圖片 曾家榆 (F,1967/04/27,44y10m) 手術日期 2011/07/08 手術主治醫師 曾漢民 手術區域 東址 003房 02號 診斷 Meningioma 器械術式 Left frontal craniotomy for cavernoma removal 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 14:18 報到 15:10 進入手術室 15:15 麻醉開始 15:25 誘導結束 15:30 抗生素給藥 15:35 手術開始 18:30 麻醉結束 18:30 手術結束 18:35 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 手術 腦瘤切除-手術時間在4小時以內 1 1 L 手術 立體定位術-切片 1 2 L 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for Simpson grade I tumor excision... 開立醫師: 陳國瑋 開立時間: 2011/07/08 19:12 Pre-operative Diagnosis Left convexity meningioma Post-operative Diagnosis Left convexity meningioma Operative Method Craniotomy for Simpson grade I tumor excision, with stereotactic guidance Specimen Count And Types 1 piece About size:2cm Source:brain tumor Pathology pending Operative Findings One firm elastic, extra-axial, 2cm in size brain tumor was noted at left high convextity. Operative Procedures The patient was put in supine position. After intubation and general anesthesia, we use Navigation to locate the site of tumor. Skin was disinfected and draped as usual. Curve skin incision was made from left occipital to frontal, along the midline. Craniotomy was made. Ultrasonography was used to identified the tumor. The dura was incised around the tumor. The cortical vessels were preserved. Duraplasty was done with periosteum. The wound was closed in layers. Operators VS曾漢民 Assistants R5曾峰毅 R2陳國瑋 Ri林怡均 相關圖片 陳艷莉 (F,1956/10/13,55y5m) 手術日期 2011/07/08 手術主治醫師 李苑如 手術區域 西址 039房 13號 診斷 Endometric cancer 器械術式 Removal of double-J 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 無麻醉 麻醉主治醫師 ASA 1 時間資訊 12:10 進入手術室 12:12 手術開始 12:14 手術結束 12:16 送出病患 游沛純 (F,2010/05/24,1y9m) 手術日期 2011/07/08 手術主治醫師 謝孟祥 手術區域 東址 012房 01號 診斷 Apert syndrome 器械術式 Debridment-- >10cm 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 蔡奉芳 ASA 2 紀錄醫師 陳志軒, 時間資訊 07:45 報到 08:05 進入手術室 08:25 麻醉開始 08:30 誘導結束 08:30 抗生素給藥 08:32 手術開始 08:55 手術結束 08:55 麻醉結束 09:21 送出病患 09:24 進入恢復室 10:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 拆線大於10CM 1 0 B 手術 拆線大於10CM 1 0 B 摘要__ 手術科部: 外科部 套用罐頭: Removal of bilateral hand splint and tie-over 開立醫師: 陳志軒 開立時間: 2011/07/08 09:17 Pre-operative Diagnosis Apert syndrome with bilateral hands syndactyly s/p reconstruction with syndactyly of bilateral ring-little fingers webspace, with FTSG coverage Post-operative Diagnosis Apert syndrome with bilateral hands syndactyly s/p reconstruction with syndactyly of bilateral ring-little fingers webspace, with FTSG coverage Operative Method Removal of bilateral hand splint and tie-over Specimen Count And Types nil Pathology Nil Operative Findings Bilateral hand FTSG take fair. The wound healing process is good. Operative Procedures Under general anathesia with endotracheal tube, patient was put in supine position. We remove the bilateral splint, flexible bandage, gauze, and tie-over step by step. Then we check the wounds. Normal saline irrigation was performed. We covered the wounds by iodine-guaze. Operators VS謝孟祥 Assistants R5游彥辰 R3陳志軒 Ri陳乃綺 相關圖片 陳莉稜 (F,1979/08/23,32y6m) 手術日期 2011/07/08 手術主治醫師 賴達明 手術區域 東址 002房 03號 診斷 Malignant neoplasm of female breast, nipple and areola 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3E 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 09:36 通知急診手術 12:30 報到 13:10 進入手術室 13:15 麻醉開始 13:20 誘導結束 13:25 抗生素給藥 14:10 手術開始 16:25 抗生素給藥 17:50 手術結束 17:50 麻醉結束 18:00 送出病患 18:05 進入恢復室 19:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室腹腔分流手術 1 1 L 手術 歐氏貯囊置放手術 1 2 R 摘要__ 手術科部: 外科部 套用罐頭: 1. Ventriculoperitoneal shunt implantation vi... 開立醫師: 王奐之 開立時間: 2011/07/08 18:35 Pre-operative Diagnosis Right breast cancer with right thalamus cystic metastasis, status post stereotactic biopsy & cyst aspiration, with cyst re-accumulation and acute hydrocephalus Post-operative Diagnosis Right breast cancer with right thalamus cystic metastasis, status post stereotactic biopsy & cyst aspiration, with cyst re-accumulation and acute hydrocephalus Operative Method 1. Ventriculoperitoneal shunt implantation via left Kocher point 2. Ommaya reservoir implantation via prior right frontal burr hole to the cystic tumor cavity Specimen Count And Types Nil Pathology Nil Operative Findings Medium pressure Medtronic ventriculoperionteal shunt reservoir was used, opening pressure was about 10cmH2O. Ventricular catheter length: 6.5cm. Peritoneal catheter length: 30cm. Ommaya catheter length: about 6cm. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to right. After scalp shaving, scrubbing, disinfection & draping in sterile fashion, a curved incision was made at left frontal area. A burr hole was made at left Kocher point. A transverse incision was then made at LUQ area of abdomen, followed by mini-laparotomy. After creating a subcutaneous tunnel from abdominal incision to left retroauricular area, another small incision was made, and the peritoneal catheter was passed through. The shunt were then assembled, and ventricular tapping was done. The ventricular catheter was inserted and confirmed smooth flow & function. After securing the shunt reservoir in place and inserting the peritoneal catheter into the peritoneal cavity, the wounds were closed in layers. The patient was then placed in supine position with head turned to left. After scalp shaving, scrubbing, disinfection & draping in sterile fashion, a curvilinear incision was made at left frontotemporal area. After identifying the previous burr hole, a larger trephination was done. After tenting stitches, the Ommaya catheter was inserted to the cystic tumor cavity under real-time ultrasonographic guidance. The bone was then placed back and fixed with mini-plates, the Ommaya reservoir was also secured. The wound was closed in layers. Operators VS 賴達明 Assistants R4 王奐之, Ri 李宜潔 Indication Of Emergent Operation IICP 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: 1. Ventriculoperitoneal shunt implantation vi... 開立醫師: 王奐之 開立時間: 2011/07/08 18:35 Pre-operative Diagnosis Right breast cancer with right thalamus cystic metastasis, status post stereotactic biopsy & cyst aspiration, with cyst re-accumulation and acute hydrocephalus Post-operative Diagnosis Right breast cancer with right thalamus cystic metastasis, status post stereotactic biopsy & cyst aspiration, with cyst re-accumulation and acute hydrocephalus Operative Method 1. Ventriculoperitoneal shunt implantation via left Kocher point 2. Ommaya reservoir implantation via prior right frontal burr hole to the cystic tumor cavity Specimen Count And Types Nil Pathology Nil Operative Findings Medium pressure Medtronic ventriculoperionteal shunt reservoir was used, opening pressure was about 10cmH2O. Ventricular catheter length: 6.5cm. Peritoneal catheter length: 30cm. Ommaya catheter length: about 6cm. Medium pressure Medtronic ventriculoperionteal shunt reservoir was used, opening pressure was about 10cmH2O. Ventricular catheter length: 6.5cm. Peritoneal catheter length: 30cm. Ommaya catheter length: about 6cm. About 30ml of yellowish mucoid fluid was aspirated through Ommaya. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to right. After scalp shaving, scrubbing, disinfection & draping in sterile fashion, a curved incision was made at left frontal area. A burr hole was made at left Kocher point. A transverse incision was then made at LUQ area of abdomen, followed by mini-laparotomy. After creating a subcutaneous tunnel from abdominal incision to left retroauricular area, another small incision was made, and the peritoneal catheter was passed through. The shunt were then assembled, and ventricular tapping was done. The ventricular catheter was inserted and confirmed smooth flow & function. After securing the shunt reservoir in place and inserting the peritoneal catheter into the peritoneal cavity, the wounds were closed in layers. The patient was then placed in supine position with head turned to left. After scalp shaving, scrubbing, disinfection & draping in sterile fashion, a curvilinear incision was made at left frontotemporal area. After identifying the previous burr hole, a larger trephination was done. After tenting stitches, the Ommaya catheter was inserted to the cystic tumor cavity under real-time ultrasonographic guidance. The bone was then placed back and fixed with mini-plates, the Ommaya reservoir was also secured. The wound was closed in layers. Operators VS 賴達明 Assistants R4 王奐之, Ri 李宜潔 Indication Of Emergent Operation IICP 相關圖片 郭美瑛 (F,1962/12/16,49y2m) 手術日期 2011/07/08 手術主治醫師 賴達明 手術區域 東址 005房 04號 診斷 Cerebral aneurysm, nonruptured 器械術式 Craniotomy(Aneurysms) Others 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 2E 紀錄醫師 陳國瑋, 時間資訊 03:00 臨時手術NPO 03:00 開始NPO 13:45 通知急診手術 20:30 進入手術室 20:35 麻醉開始 20:45 誘導結束 21:00 抗生素給藥 21:05 手術開始 00:00 抗生素給藥 00:05 開始輸血 02:00 手術結束 02:00 麻醉結束 02:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 開顱術摘除血管病變 - 腦血管瘤 有病徵的 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Left petrion approach for aneurysm clipping 開立醫師: 曾峰毅 開立時間: 2011/07/09 01:51 Pre-operative Diagnosis Left P-com aneurysm Post-operative Diagnosis Left P-com aneurysm Operative Method Left petrion approach for aneurysm clipping Specimen Count And Types nil Pathology nil Operative Findings One saccular aneurysm, arising from left posterior communicating artery, about 8 mm in largest diameter, about 3 mm in neck, pointing laterally and inferiorl, compromised left oculomotor nerve. One bayonet clip was applied to aneurysm. The aneurysm was obliaterated totally by the clipping. Left ICA was clipped temporarily for proximal control for 3 minutes. Left posterior communicating artery, and two left anterior choroidal arteries were identified and preserved after aneurysm clipped. Operative Procedures After intubation and general anesthesia, the patient was put in supine position with head tilting to right. Skin was prepared as usual. Curve skin incision was made from ahead of ear to forhead. The posterior branch of STA was electrocaugried. The skin was retracted downward after Yasargil fat pad dissected. The temporalis muscle was detached from superior temporal line. Four burr holes were made at keyhole, bilateral sides of superior temporal line, and temporal bone. Craniotomy window was then made. Sylvian fissure was opened at frontal side. Left internal carotid artery was identified, and traced from the proximal to identified the aneurysm. One bayonet clip was applied for aneurysm obilateration. After hemostasis, the dura was closed in water-tight fahsion. Bone graft was fixed back with mini-plates. One subgaleal CWV was placed, and the wound was closed in layers. Operators VS 賴達明 Assistants R5 曾峰毅 R3 陳國瑋 Indication Of Emergent Operation Aneurysm 相關圖片 蔡足味 (F,1968/03/13,44y0m) 手術日期 2011/07/08 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Malignant neoplasm of female breast, nipple and areola 器械術式 C6 laminoplasty for tumor excision 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 3 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:05 進入手術室 08:10 麻醉開始 08:25 誘導結束 09:10 抗生素給藥 09:46 手術開始 12:10 抗生素給藥 14:00 手術結束 14:00 麻醉結束 14:15 送出病患 14:20 進入恢復室 15:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 良性脊髓腫瘤切除術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 記錄__ 手術科部: 外科部 套用罐頭: Right C6-7 laminotomy with partial tumor excision 開立醫師: 林哲光 開立時間: 2011/07/08 14:47 Pre-operative Diagnosis Right C6 intraspinal tumor Post-operative Diagnosis Right C6 intraspinal tumor Operative Method Right C6-7 laminotomy with partial tumor excision Specimen Count And Types 1 piece About size:3cm sized Source:neuroma Pathology Pending Operative Findings One multilobulated, witish, well demarcated, elastic-firm intradural mass lesion was noted at C7 root with direct compressing the root tightly. One rootlet was excised during the tumor excision and intraoperative SEP was not changed. Operative Procedures Under ETGA and prone position wiht head fixed with Mayfield head clump, skin disinfected and drapped were performed as usual. Midline skin incision was made and paraspinal muscles were detached. RIght C6-7 laminotomy was then performed and the dura was opened with exposure of the C7 root. Tumor excision was then performed as much as possible. The dura was then closed with Prolene and covered with Durafoam. THe wound was then closed in layers after an epidural CWV drain was inserted. Operators AP 賴達明 Assistants R5 林哲光 相關圖片 鄭淑華 (F,1961/02/18,51y0m) 手術日期 2011/07/08 手術主治醫師 賴達明 手術區域 東址 019房 02號 診斷 Lumbar spondylosis 器械術式 L4/5 TPS 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 2 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 14:30 進入手術室 14:35 麻醉開始 14:40 誘導結束 14:55 抗生素給藥 15:35 手術開始 17:55 抗生素給藥 19:25 手術結束 19:25 麻醉結束 19:42 送出病患 19:45 進入恢復室 21:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎間盤切除術-腰椎 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 記錄__ 手術科部: 外科部 套用罐頭: L4 right laminotomy with L4-5 discectomy and ... 開立醫師: 林哲光 開立時間: 2011/07/08 20:23 Pre-operative Diagnosis L4-5 grade II spondylolisthesis Post-operative Diagnosis L4-5 grade II spondylolisthesis Operative Method L4 right laminotomy with L4-5 discectomy and PEEK cage insertion; Sublaminal decompression; Posterior fusion with TPS at L4, L5 Specimen Count And Types nil Pathology Nil Operative Findings Hypertrophic change of ligamentum flavum and L5 facet joints was noted. The dura seemed re-expanded well after sublaminal decompression. PEEK cage 9mm, TPS 40mm x4 at L4, L5 pedicle and 5cm rods x2 were used. Operative Procedures Under ETGA and prone position, skin disinfected and drapped were performed as usual. Midline skin incision was made and paraspinal muscles were detached. TPS were inserted at L4, L5 pedicle respectively. Right L4 laminotomy was done and discectomy was done. PEEK cage was then inserted. Sublaminal decompression was then performed. The wound was then closed in layers after epidural hemovac insertion. Operators AP 賴達明 Assistants R5 林哲光, R1 張倍慈 相關圖片 SAE CHIAO SUPHAPHON (F,1969/01/01,43y2m) 手術日期 2011/07/08 手術主治醫師 楊士弘 手術區域 東址 002房 02號 診斷 Tuberculosis meningitis 器械術式 V-P shunt 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3E 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 07:21 通知急診手術 10:00 報到 10:10 進入手術室 10:15 麻醉開始 10:20 誘導結束 10:35 抗生素給藥 11:17 手術開始 12:20 手術結束 12:20 麻醉結束 12:38 送出病患 12:42 進入恢復室 14:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 曾偉倫 開立時間: 2011/07/08 12:34 Pre-operative Diagnosis Hydrocephalus; meningitis, r/o tuberculous meningitis Post-operative Diagnosis Hydrocephalus; meningitis, r/o tuberculous meningitis Operative Method Ventriculoperitoneal shunt, medium pressure control Specimen Count And Types 5 pieces About size:小 Source:CSF About size:小 Source:CSF About size:小 Source:CSF About size:小 Source:CSF About size:小 Source:CSF Pathology Nil Operative Findings Clear CSF drained out after ventricular tapping. The opening pressure was around 15 cm H2O. Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: supine with head rotated to left. 3.Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 5 cm curvilinear, right frontal, corresponded. Raney clips were applied to the scalp edge for temporary hemostasis. 5.After the scalp flap had been lifted and reflected anteriorly, a burr hole was made and the dura was tented by 2 stitches. 6.The dura was opened by a nib incision. Rt lateral ventricle was tapped by a ventricular needle, then a 6 cm segment of the ventricular catheter was introduced into the ventricle. The outer end of the catheter was connected to a medium pressure Metronic reservoir. 7. A 4 cm transverse incision was made at RUQ of the abdomen , then a trocar was inserted into peritoneal cavity after opening of pertioneum. Subsequently, distal 30 cm segment of the peritoneal catheter was introduced into the peritoneal cavity through the outer tube of the trochar. The proximal end of this catheter was passed through subcutaneous tunnel at forechest, neck, rt retroauricular area and connected the reservoir. The shunt systemwas checked to make sure its function was working. 8. The reservoir was fixed to pericranium by 3 stitches. 9. Scalp closure: hemostasis was done with monopolar coagulator touching on the sucker tip. Galea suture was performed by continuous suture with 3/0. Dexon and skin by continuous suture with 3/0 nylon. 10.Course of the surgery: smooth. Operators 楊士弘 Assistants 王奐之 Indication Of Emergent Operation IICP, drowsy consciousness 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 王奐之 開立時間: 2011/07/08 12:47 Pre-operative Diagnosis Hydrocephalus; meningitis, r/o tuberculous meningitis Post-operative Diagnosis Hydrocephalus; meningitis, r/o tuberculous meningitis Operative Method Ventriculoperitoneal shunt, medium pressure control Specimen Count And Types 5 pieces About size:小 Source:CSF About size:小 Source:CSF About size:小 Source:CSF About size:小 Source:CSF About size:小 Source:CSF Pathology Nil Operative Findings Clear CSF drained out after ventricular tapping. The opening pressure was around 15 cm H2O. Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: supine with head rotated to left. 3.Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 5 cm curvilinear, right frontal, corresponded. Raney clips were applied to the scalp edge for temporary hemostasis. 5.After the scalp flap had been lifted and reflected anteriorly, a burr hole was made and the dura was tented by 2 stitches. 6.The dura was opened by a nib incision. Rt lateral ventricle was tapped by a ventricular needle, then a 6 cm segment of the ventricular catheter was introduced into the ventricle. The outer end of the catheter was connected to a medium pressure Metronic reservoir. 7. A 4 cm transverse incision was made at RUQ of the abdomen , then a trocar was inserted into peritoneal cavity after opening of pertioneum. Subsequently, distal 30 cm segment of the peritoneal catheter was introduced into the peritoneal cavity through the outer tube of the trochar. The proximal end of this catheter was passed through subcutaneous tunnel at forechest, neck, rt retroauricular area and connected the reservoir. The shunt systemwas checked to make sure its function was working. 8. The reservoir was fixed to pericranium by 3 stitches. 9. Scalp closure: hemostasis was done with monopolar coagulator touching on the sucker tip. Galea suture was performed by continuous suture with 3/0. Dexon and skin by continuous suture with 3/0 nylon. 10.Course of the surgery: smooth. Operators 楊士弘 Assistants 王奐之 Indication Of Emergent Operation IICP, drowsy consciousness 相關圖片 陳仕祥 (M,1972/04/23,39y10m) 手術日期 2011/07/08 手術主治醫師 黃鶴翔 手術區域 西址 039房 05號 診斷 Hydronephrosis 器械術式 Removal of double-J 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 10:05 進入手術室 10:10 麻醉開始 10:12 手術開始 10:15 手術結束 10:15 麻醉結束 10:18 送出病患 孫錫華 (F,1935/06/14,76y9m) 手術日期 2011/07/09 手術主治醫師 王至弘 手術區域 東址 021房 01號 診斷 Glioblastoma multiforma 器械術式 Bipolar hemiarthroplasty, right 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 脊髓麻醉 麻醉主治醫師 詹光政 ASA 3 紀錄醫師 洪嘉鴻, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:15 麻醉開始 08:30 誘導結束 09:15 報到 09:15 抗生素給藥 09:15 手術開始 09:22 開始輸血 09:40 手術結束 09:40 麻醉結束 09:45 送出病患 09:50 進入恢復室 10:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Spinal anesthesia 1 0 手術 部份關節置換術併整形術–只置換股骨踝或脛骨高丘或半膝關節或只 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Bipolar hemiarthroplasty with Zimmer prosthe... 開立醫師: 洪嘉鴻 開立時間: 2011/07/09 09:31 Pre-operative Diagnosis Right femoral neck fracture Post-operative Diagnosis Right femoral neck fracture Operative Method Bipolar hemiarthroplasty with Zimmer prosthesis( Head 45mm, Stem 12mm ) Specimen Count And Types nil Pathology nil Operative Findings Right femoral neck fracture Operative Procedures 1. Anesthesia induction, left decubitus position. 2. Skin disinfection and draped. 3. Longitudinal skin incision at greater trochanter level then posterior approach of hip. 4. Identify the joint capsule then incised to the joint 5. Remove femoral head then prepare the femur with reamer and broach. 5. Insert Zimmer bipolar prosthesis. 6. Irrigate the wound and repair the capsule and short rotators. 7. Close the wound in layers. Operators 王至弘, Assistants 洪嘉鴻, 王政為, 許寬宏, 王至言 (M,1975/05/16,36y9m) 手術日期 2011/07/09 手術主治醫師 曾漢民 手術區域 東址 003房 01號 診斷 HIVD 器械術式 Lumbar HIVD, L5-S1, microsurgical lumbar discectomy 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 2 紀錄醫師 許皓淳, 時間資訊 00:00 臨時手術NPO 08:00 進入手術室 08:05 麻醉開始 08:10 誘導結束 08:30 抗生素給藥 09:00 手術開始 10:30 手術結束 10:30 麻醉結束 10:35 送出病患 10:40 進入恢復室 11:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 椎間盤切除術-腰椎 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: HIVD 開立醫師: 曾峰毅 開立時間: 2011/07/09 10:18 Pre-operative Diagnosis L5/S1, sequestrated disc Post-operative Diagnosis L5/S1, sequestrated disc` Operative Method Microdiscetomy Specimen Count And Types Nil Pathology Nil Operative Findings One ruptured disc was noted compromising left S1 root. The neural structure was decompressed well after microdiscectomy. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After C-arm localization, we scrubbed, disinfected, and then draped the patient's back. We made one midline skin incision, and dissected left paraspinal muscle to expose L5/S1 interlaminar space. We created laminotomy, and removed sequestrated disc. We performed discectomy, and hemostasis was achieved. We packed left S1 root with Rinderon-gelfoam, and irrigated the wound. The wound was closed in layers. Operators VS 曾漢民 Assistants R5 曾峰毅 R2 許皓淳 相關圖片 陳子鈞 (M,1949/11/09,62y4m) 手術日期 2011/07/09 手術主治醫師 王國川 手術區域 東址 002房 02號 診斷 Hand Injury 器械術式 Left subdural peritoneal shunt 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 2E 紀錄醫師 曾偉倫, 時間資訊 18:00 臨時手術NPO 18:00 開始NPO 06:40 進入手術室 06:45 麻醉開始 06:50 誘導結束 07:48 手術開始 08:35 手術結束 08:35 麻醉結束 08:45 送出病患 08:46 進入恢復室 10:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Left subdural peritoneal shunt 開立醫師: 曾偉倫 開立時間: 2011/07/09 08:53 Pre-operative Diagnosis Left subdural effusion Post-operative Diagnosis Left subdural effusion Operative Method Left subdural peritoneal shunt Specimen Count And Types nil Pathology Nil Operative Findings 1. Serosangious clear fluid was drained from the subdural space 2. The opening pressure was high 3. A 10mm-H2O Codman resevoir was placed Operative Procedures Under ETGA, we placed th patient to supine position with his face mild tilt to right. After shaving his hair, we scrubbed, disinfected and drapped as usual. linear skin incision was made over left frontal area and left upper abdominal area. After we open the wound, the skull was opened with drill. After dural tenting, the dura was opened with cruciate fashion. The sub-cutaneous tunnel was made and the resevoir was plased over post-auricular area. The distal part of the drain was put into peritoneal cavity. The subdural drain was inserted. The shunt function was tested and the wound was closed in layers. Operators VS 王國川 Assistants R5 林哲光 R3 曾偉倫 Indication Of Emergent Operation Progressive IICP 相關圖片 陳起民 (M,1954/02/18,58y0m) 手術日期 2011/07/11 手術主治醫師 陳晉興 手術區域 東址 018房 01號 診斷 Lung Tumor 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 趙安怡 ASA 4 紀錄醫師 高明蔚, 時間資訊 23:50 臨時手術NPO 08:19 進入手術室 08:19 報到 08:20 麻醉開始 08:23 誘導結束 08:25 抗生素給藥 08:31 手術開始 08:46 麻醉結束 08:46 手術結束 08:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 氣管切開術 1 0 摘要__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 高明蔚 開立時間: 2011/07/11 08:53 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types nil Pathology None Operative Findings OD.8 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators 陳晉興 Assistants R4高明蔚 顧慧琴 (F,1938/01/08,74y2m) 手術日期 2011/07/11 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG), tuberculum sellar meninigoma 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 許皓淳, 時間資訊 00:00 臨時手術NPO 08:00 報到 08:10 進入手術室 08:27 麻醉開始 08:42 誘導結束 08:45 手術開始 08:45 抗生素給藥 11:45 麻醉結束 11:45 手術結束 11:53 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Right frontal craniotomy for Simpson grade II... 開立醫師: 李振豪 開立時間: 2011/07/11 12:09 Pre-operative Diagnosis Planum sphenoidale meningioma Post-operative Diagnosis Planum sphenoidale meningioma Operative Method Right frontal craniotomy for Simpson grade II tumor excision Specimen Count And Types 1 piece About size:Multiple small pieces Source:frontal base tumor Pathology Pending Operative Findings The tumor was 1.9 x 1.0 x 1.8cm in size, soft, fragile, gray-reddish, hypervascularized, and well-capsulated in character. Thickness of the arachnoid membrane with pseudocapsule formation around the tumor was noted. Superior hypophyseal artery was encased by the tumor and preserved well during the operation. The arachnoid membrane was left intact after total removal of the tumor. The right olfactory nerve was lysis during retraction of the frontal lobe and preserved well during whole procedure. Small cortical injury over right frontal base was noted during brain retraction. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. Bicoronal scalp incision was made and the scalp flap was elevated. Three burr holes were created followed by one 8x6cm craniotomy window over right frontal area. Dural tenting was performed. C-shape durotomy was performed based with skull base. The frontal lobe was retracted and neurolysis of the right olfactory nerve was conducted. After identification of the tumor, the pseudocapsule of the tumor was opened and subcapsule removal of the tumor was performed with suction, bipolar electrocautery, ring curette, and tumor forceps. Hemostasis was achieved with electrocautery and Surgicel lining. Dura was closed with 4-0 prolene. The skull base was fixed back with miniplates and screws. One subgaleal CWV drain was placed and the wound was closed in layers with 2-0 Vicryl and Appose staples. Operators VS曾漢民 Assistants R5李振豪, R2許皓淳 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Right frontal craniotomy for Simpson grade II... 開立醫師: 李振豪 開立時間: 2011/07/11 12:09 Pre-operative Diagnosis Planum sphenoidale meningioma Post-operative Diagnosis Planum sphenoidale meningioma Operative Method Right frontal craniotomy for Simpson grade II tumor excision Specimen Count And Types 1 piece About size:Multiple small pieces Source:frontal base tumor Pathology Pending Operative Findings The tumor was 1.9 x 1.0 x 1.8cm in size, soft, fragile, gray-reddish, hypervascularized, and well-capsulated in character. Thickness of the arachnoid membrane with pseudocapsule formation around the tumor was noted. Superior hypophyseal artery was encased by the tumor and preserved well during the operation. The arachnoid membrane was left intact after total removal of the tumor. The right olfactory nerve was lysis during retraction of the frontal lobe and preserved well during whole procedure. Small cortical injury over right frontal base was noted during brain retraction. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. Bicoronal scalp incision was made and the scalp flap was elevated. Three burr holes were created followed by one 8x6cm craniotomy window over right frontal area. Dural tenting was performed. C-shape durotomy was performed based with skull base. Under endotracheal general anesthesia, the patient was put in supine position with head fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. Bicoronal scalp incision was made and the scalp flap was elevated. Three burr holes were created followed by one 8x6cm craniotomy window over right frontal area. Frontal sinus was opened with sealed with bone wax. The mucosa in skull plate was removed. Dural tenting was performed. C-shape durotomy was performed based with skull base. The frontal lobe was retracted and neurolysis of the right olfactory nerve was conducted. After identification of the tumor, the pseudocapsule of the tumor was opened and subcapsule removal of the tumor was performed with suction, bipolar electrocautery, ring curette, and tumor forceps. Hemostasis was achieved with electrocautery and Surgicel lining. Dura was closed with 4-0 prolene. The skull base was fixed back with miniplates and screws. One subgaleal CWV drain was placed and the wound was closed in layers with 2-0 Vicryl and Appose staples. Operators VS曾漢民 Assistants R5李振豪, R2許皓淳 相關圖片 李凱翰 (M,1989/12/31,22y2m) 手術日期 2011/07/11 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Glioblastoma multiforma 器械術式 Brain tumor Crainotomy(TZENG), right F-P craniotomy for tumor excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 2 紀錄醫師 許皓淳, 時間資訊 00:00 臨時手術NPO 11:38 報到 12:20 進入手術室 12:25 麻醉開始 12:52 誘導結束 12:55 手術開始 12:55 抗生素給藥 15:49 麻醉結束 16:00 手術結束 16:10 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除-手術時間在4小時以內 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Right temporo-parietal craniotomy for subtota... 開立醫師: 李振豪 開立時間: 2011/07/11 16:44 Pre-operative Diagnosis Right parietal tumor, suspect glioblastoma Post-operative Diagnosis Right parietal tumor, suspect glioblastoma Operative Method Right temporo-parietal craniotomy for subtotal tumor excision Specimen Count And Types 1 piece About size:Multiple small pieces Source:right parietal tumor Pathology Frozen section: high grade glioma Operative Findings The tumor was mainly located parietal lobe with sensory cortex involvement. Motor cortex involvement was suspected by intra-operative sonography and mapping. The tumor was green-yellowish, gelatinous, fragile, hypervascularized, and 4.8 x 4.5 x 4.9cm in size. Tumor bleeding with old hematoma was noted during tumor resection and the hematoma was drained out. Under the consideration of function preservation, subtotal tumor excision was performed. The Frozen section confirmed the diagnosis of high grade glioma. Total four pieces of Gliadel Wafer was placed in the tumor bed. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head rotated to left and fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. The reverse U scalp incision was made at right temporo-parietal area and the scalp flap was elevated. Four burr holes were created followed by one 7x7cm craniotomy window. Dural tenting was done and C-shape durotomy based with superior sagittal sinus were performed. Intra-operative sonography was used for localization of the tumor. Intra-operative mapping was also used for identification of motor and sensory cortex. One 1cm corticotomy was performed behind the sensory cortex and tumor excision was performed with bipolar electrocautery, tumor forceps, and suction. Hemostasis was achieved with bipolar electrocautery and Surgicel lining. Four pieces of Gliadel Wafer was placed in the tumor bed. The cavity was filled with Tissuecol Duo. Duroplasty with periosteum was done. The skull plate was fixed back with seven #26 wires and two central tenting. The wound was then closed in layers with 2-0 Vicryl and Appose staples. Operators VS曾漢民 Assistants R5李振豪, R2許皓淳 相關圖片 趙玉琦 (M,1963/08/01,48y7m) 手術日期 2011/07/11 手術主治醫師 賴達明 手術區域 東址 003房 05號 診斷 Intraventricular hemorrhage 器械術式 Craniotomy ICH hematoma evacuation 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 4E 紀錄醫師 李振豪, 時間資訊 13:00 臨時手術NPO 13:00 開始NPO 17:37 通知急診手術 18:15 報到 18:15 進入手術室 18:18 麻醉開始 18:40 誘導結束 18:40 抗生素給藥 19:15 開始輸血 19:19 手術開始 21:40 抗生素給藥 23:10 麻醉結束 23:10 手術結束 23:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室體外引流 1 2 R 手術 腦內血腫清除術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: Right occipital craniotomy for intraventricul... 開立醫師: 李振豪 開立時間: 2011/07/12 00:13 Pre-operative Diagnosis Intraventricular hemorrhage with acute hydrocephalus Post-operative Diagnosis Intraventricular hemorrhage with acute hydrocephalus Operative Method Right occipital craniotomy for intraventricular hematoma evacuation + external ventricular drainage insertion Specimen Count And Types nil Pathology Nil Operative Findings The brain was bulging out with spontaneous rupture of the hematoma after dura opening. The hematoma was mainly located at right lateral ventricle. After evacuation of the hematoma, the brain was mild slack. Bleeding tendancy was noted during the operation. Total blood loss: 1000ml. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position with head fixed with mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. Right occipital linear scalp incision was made followed by one burr hole creation. One 5 x 4 cm craniotomy window was made and dural tenting was done. The dura was opened with cruciform in fashion. The brain bulging out with spontaneous rupture of the hematoma. Under operative microscope, the hematoma was evacuated and the right lateral ventricle was entered along the tract of hematoma. The intraventricular hematoma was evacuated with suction and tumor forceps. Hemostasis was achieved with bipolar electrocautery and Surgicel lining. The EVD was placed into right frontal horn during the operation and fixed at 10cm in depth. Duroplasty was performed with Duraform. The skull plate was fixed back with miniplates, screws, and two dural tenting. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS賴達明 Assistants R5李振豪, R1張倍慈 Indication Of Emergent Operation Acute intracranial hemorrhage with conscious deterioration(E1M3Vt) 相關圖片 葉簡淑英 (F,1946/08/01,65y7m) 手術日期 2011/07/11 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Lumbar spondylosis 器械術式 Laminectomy for decompression, L4/5 TPS, cage, L3-4 sublaminal decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 07:42 報到 08:05 進入手術室 08:10 麻醉開始 08:20 誘導結束 08:58 手術開始 11:35 手術結束 11:35 麻醉結束 12:08 送出病患 12:10 進入恢復室 13:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎間盤切除術-腰椎 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Transforaminal lumbar interbody fusion with P... 開立醫師: 曾峰毅 開立時間: 2011/07/11 11:50 Pre-operative Diagnosis L4/5 spondylolisthesis, grade I; spinal stenosis, L3/4 Post-operative Diagnosis L4/5 spondylolisthesis, grade I; spinal stenosis, L3/4 Operative Method Transforaminal lumbar interbody fusion with PEEK cage and autologous bone graft at L4/5; posterior fixation with transpedicular screws at L4/5; sublaminar decompression at L3/4 Specimen Count And Types nil Pathology Nil. Operative Findings Grade I spondylolisthesis was reduced after cage insertion. Synthes transpedicular screws, 6.2 x 45 mm, were inserted into bilateral pedicles of L4 and L5 for posterior fixation with two 5 cm rods. Synthes PEEK cage with autologous bone graft, 9 mm in height, was used for fusion. Hypertrophic ligamentum flavum compromised thecal sac tightly, and neural structures were decompressed well after the surgery. Blood loss was 400 ml. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After C-arm localization, we made one midline skin incision to expose bilateral laminae from L3 to L5. We inserted transpedicular screws into bilateral pedicles of L4 and L5. L4 laminectomy was performed, and L4/5 diskectomy was done. We performed transforaminal lumbar interbody fusion via right L4/5 neural foramen, and PEEK cage with autologous bone graft was used for fusion. We achieved posterior fixation after fixed two 5 cm rods to transpedicular screws. After inserting two submuscular hemovac, the wound was closed in layers. Operators VS 賴達明 Assistants R5 曾峰毅 R3 曾偉倫 相關圖片 江美絨 (F,1955/06/29,56y8m) 手術日期 2011/07/11 手術主治醫師 楊士弘 手術區域 東址 003房 02號 診斷 Malignant neoplasm of trachea 器械術式 Ommaya reservoir implantation 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 面罩麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 12:25 進入手術室 12:30 麻醉開始 12:35 誘導結束 12:57 手術開始 13:17 手術結束 13:17 麻醉結束 13:20 送出病患 13:22 進入恢復室 14:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 歐氏貯囊置放手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Semi-opened mask inhalation anes 1 0 摘要__ 手術科部: 腫瘤醫學部 套用罐頭: Ommaya reservoir implantation 開立醫師: 曾峰毅 開立時間: 2011/07/11 13:10 Pre-operative Diagnosis Cancerous meningitis Post-operative Diagnosis Cancerous meningitis Operative Method Ommaya reservoir implantation Specimen Count And Types Nil Pathology Nil Operative Findings Whitis, turbid, high viscosity CSF gushed out while ventriculostomy. Operative Procedures With intravenous general anaesthesia, the patient was put in supine position with head rotated to left. We shaved, scrubbed, disinfected, and then draped the patient, and then one curvilinear skin incision was made at right frontal area. We drilled one burr hole, and performed ventriculostomy. We impalnted ommaya reservoir, and closed the wound in layers. Operators VS 楊士弘 Assistants R5 曾峰毅 R3 曾偉倫 相關圖片 莊武雄 (M,1941/03/05,71y0m) 手術日期 2011/07/11 手術主治醫師 王國川 手術區域 東址 001房 01號 診斷 Scalp Laceration wound 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 5E 紀錄醫師 王奐之, 時間資訊 00:04 開始NPO 00:04 通知急診手術 00:32 進入手術室 00:35 麻醉開始 00:40 誘導結束 00:50 抗生素給藥 01:07 手術開始 01:40 開始輸血 02:11 手術結束 02:11 麻醉結束 02:23 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 急性硬腦膜下血腫清除術 1 1 L 手術 顱內壓視置入 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 創傷醫學部 套用罐頭: Left craniectomy and ICP monitor insertion 開立醫師: 曾峰毅 開立時間: 2011/07/11 02:14 Pre-operative Diagnosis Bilateral acute subdural hematoma, more at left, with skull fracture Post-operative Diagnosis Bilateral acute subdural hematoma, more at left, with skull fracture Operative Method Left craniectomy and ICP monitor insertion Specimen Count And Types Nil Pathology Nil Operative Findings One transverse skull fracture was noted at left temporal area. Massive bleeding from medial side of subdural space after durotomy. Sinus rupture was suspected. Brain parenchyma is stony-hard without pulsation after decompressive craniectomy. ICP after wound closure was 50 mmHg. ICP reference is 503. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to right. After scalp shaved, scrubbed, disinfected, and then draped, we made one question-mark scalp incision at left side. We drilled 7 burr holes, and then created craniectomy. Duroplasty was performed with Durofoam. Subdural hematoma was removed. We inserted ICP monitor into subdural space, and two CWV to epidural space. The wound was closed in layers. Operators VS 王國川 Assistants R5 曾峰毅 R4 王奐之 R0 柯嘉怡 Indication Of Emergent Operation Trauma 相關圖片 記錄__ 手術科部: 創傷醫學部 套用罐頭: Left craniectomy and ICP monitor insertion 開立醫師: 王奐之 開立時間: 2011/07/11 13:08 Pre-operative Diagnosis Bilateral acute subdural hematoma, more at left, with skull fracture Post-operative Diagnosis Bilateral acute subdural hematoma, more at left, with skull fracture Operative Method Left craniectomy and ICP monitor insertion Specimen Count And Types Nil Pathology Nil Operative Findings One transverse skull fracture was noted at left temporal area. Massive bleeding from medial side of subdural space after durotomy. Sinus rupture was suspected. Brain parenchyma is stony-hard without pulsation after decompressive craniectomy. ICP after wound closure was 50 mmHg. ICP reference is 503. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to right. After scalp shaved, scrubbed, disinfected, and then draped, we made one question-mark scalp incision at left side. We drilled 7 burr holes, and then created craniectomy. Duroplasty was performed with Durofoam. Subdural hematoma was removed. We inserted ICP monitor into subdural space, and two CWV to epidural space. The wound was closed in layers. Operators VS 王國川 Assistants R5 曾峰毅 R4 王奐之 R0 柯嘉怡 Indication Of Emergent Operation Trauma 相關圖片 李黃來馨 (F,1927/02/11,85y1m) 手術日期 2011/07/11 手術主治醫師 林峰盛 手術區域 西址 036房 04號 診斷 Patients requiring long-term use of a respirator due to respiratory failure, use respirator 6 hours per day continue 30 days 器械術式 Nerve block / PC 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 林峰盛 ASA 3 紀錄醫師 林峰盛, 時間資訊 00:00 臨時手術NPO 13:55 進入手術室 14:05 麻醉開始 14:08 誘導結束 14:20 手術開始 14:45 手術結束 14:45 麻醉結束 14:57 進入恢復室 16:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 高頻熱凝療法 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 摘要__ 手術科部: 麻醉部 套用罐頭: Pulsed RF 開立醫師: 林至芃 開立時間: 2011/07/11 15:18 Pre-operative Diagnosis postherpetic neuralgia Post-operative Diagnosis postherpetic neuralgia Operative Method 1. IV sedation with midazolam and LA with 1% xylocaine 2. pt in prone position 3. Under sonographic-guidance, insert 22 G SMK RF meedle into left C4-5 nerve root 4. Neurostimulation with 50 HZ and 2 Hz 0.1-0.5 mV current with positive result 60-80V 2 Hz, 20 ms, 120sec *2 pulsed RF was delivered 5.inject 2.5mg Rinderon for block send pt to POR Specimen Count And Types nil Pathology Nil Operative Findings Operative Procedures Pulsed RF Operators 林峰盛, Assistants 謝承原 林暖 (F,1961/06/10,50y9m) 手術日期 2011/07/11 手術主治醫師 廖漢文 手術區域 東址 000房 號 診斷 Cerebral aneurysm 器械術式 NEURO T.A.E 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 王永彬 ASA 2 時間資訊 10:50 麻醉開始 11:05 誘導結束 14:40 麻醉結束 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 李月霞 (F,1952/03/21,59y11m) 手術日期 2011/07/12 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Spinal stenosis, cervical 器械術式 Laminectomy for decompression, C3-7 stenosis, C4/5, C5/6 HIVD 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 吳奕緯, 時間資訊 00:00 臨時手術NPO 08:00 報到 08:05 進入手術室 08:23 麻醉開始 08:35 誘導結束 08:45 抗生素給藥 08:47 手術開始 11:00 手術結束 11:00 麻醉結束 11:08 進入恢復室 11:10 送出病患 14:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 椎弓切除術(減壓)-超過二節 1 1 摘要__ 手術科部: 外科部 套用罐頭: Cervical Laminectomy, C3-7 開立醫師: 曾峰毅 開立時間: 2011/07/12 11:11 Pre-operative Diagnosis Cervical stenosis Post-operative Diagnosis Cervical stenosis Operative Method Cervical Laminectomy, C3-7 Specimen Count And Types Nil Pathology Nil Operative Findings Hypertrohpic ligamentum flavum compromised spinal canal, which is decompressed well after laminectomy. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After scalp shaved, scrubbd, disinfected, and then draped, we made one midline skin incision to expose spinous process from C3 to C7. We dissected bilateral paraspinal muscle to expose bilateral laminae from C3 to C7, and then performed laminectomy from C3 to C7 with Karrison and rongeurs. After placing one epidural CWV, the wound was closed in layers. Operators VS 曾勝弘 Assistants R5 曾峰毅 R0 吳奕緯 相關圖片 李美煉 (F,1949/09/29,62y5m) 手術日期 2011/07/12 手術主治醫師 曾勝弘 手術區域 東址 005房 02號 診斷 Lumbar spondylosis 器械術式 Laminectomy for decompression L3-5 and lateral fusion 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 吳奕緯, 時間資訊 00:00 臨時手術NPO 11:20 進入手術室 11:30 麻醉開始 11:45 誘導結束 12:00 抗生素給藥 12:10 手術開始 14:25 手術結束 14:25 麻醉結束 14:32 進入恢復室 14:35 送出病患 16:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術(減壓)-超過二節 1 1 手術 脊椎融合術-後融合,無固定物 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 摘要__ 手術科部: 外科部 套用罐頭: L3-5, laminectomy for decompression, posterol... 開立醫師: 曾峰毅 開立時間: 2011/07/12 14:34 Pre-operative Diagnosis Lumbar stenosis, L3-5, status post L3/4 and L4/5 laminotomy for decompression Post-operative Diagnosis Lumbar stenosis, L3-5, status post L3/4 and L4/5 laminotomy for decompression Operative Method L3-5, laminectomy for decompression, posterolateral fusion with artificial and autologous bone graft Specimen Count And Types Nil Pathology Nil Operative Findings Severe scarring over previous operation site was noted from L3 to L5. Incidental durotomy was noted at right aspect of thecal sac at L5 level, and left aspect of thecal sac at left L5 root level. Durotomy were all sutured with 5-0 prolene. Thecal sac and bilateral roots from L2 to L5 were compromised with scarring tissue and hypetrophic ligamentum flavum. Neural structures were decompressed well after the surgery. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After C-arm localization, we made one midline skin incision to expose bilateral laminae from L3 to L5. Laminectomy was perfomred from L3 to L5, and posterolateral fusion was done with autologous bone graft and artificial bone graft, Simbone HT. Incidental durotomy was sutured with 5-0 prolene. After irrigation, we placed one epidural CWV. The wound was closed in layers. Operators VS 曾勝弘 Assistants R5 曾峰毅 R0 吳奕緯 相關圖片 李玫 (F,1998/07/08,13y8m) 手術日期 2011/07/12 手術主治醫師 曾勝弘 手術區域 東址 005房 03號 診斷 Dystonia 器械術式 intrathecal baclofen therapy (ITB) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 吳奕緯, 時間資訊 00:00 臨時手術NPO 14:31 報到 14:50 進入手術室 14:55 麻醉開始 15:05 誘導結束 15:30 抗生素給藥 15:40 手術開始 18:03 手術結束 18:03 麻醉結束 18:20 進入恢復室 20:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 腦室腹腔分流手術 1 1 R 摘要__ 手術科部: 神經部 套用罐頭: Intrathecal baclofen infuser implantation 開立醫師: 曾峰毅 開立時間: 2011/07/12 18:36 Pre-operative Diagnosis Dystonia Post-operative Diagnosis Dystonia Operative Method Intrathecal baclofen infuser implantation Specimen Count And Types Nil Pathology nil Operative Findings Cathter tip was located at T4/5. About 30 mg baclofen in 30 ml distilled water was injected into the infuser pump. Operative Procedures With endotracheal general anaesthesia, the patient was put right decubitus position. After back scrubbed, disinfected, and then draped, we perfromed lumbar puncture in right paramedian approach to L2/3 interlaminar space. We inserted infusion catheter into thecal sac to T4/5 level. We made another skin incision at right upper abdomen, and created subcutaneous pouch. We created subcutaneous tunnel, and pulled the catheter to the abdominal pouch. We implanted the baclofen infuser and connected it to the catheter. The wound was closed in layers. Operators VS 曾勝弘 Assistants R5 曾峰毅 R0 吳奕緯 相關圖片 鄭里芊 (F,2009/07/04,2y8m) 手術日期 2011/07/12 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Craniosynostosis 器械術式 Cranioplasty for scaphocephaly 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:08 進入手術室 08:25 麻醉開始 08:40 誘導結束 09:00 抗生素給藥 09:30 手術開始 11:50 手術結束 11:50 麻醉結束 12:05 送出病患 12:10 進入恢復室 13:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 手術 頭顱成形術 1 1 摘要__ 手術科部: 外科部 套用罐頭: Drilling of metopic ridge 開立醫師: 王奐之 開立時間: 2011/07/12 12:04 Pre-operative Diagnosis Scaphocephaly with metopic ridge Post-operative Diagnosis Scaphocephaly with metopic ridge Operative Method Drilling of metopic ridge Specimen Count And Types Nil Pathology Nil Operative Findings Bulging metopic ridge was noted. Flattening of the bony surface was confirmed under palpation. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head placed on a horseshoe rest. After shaving, scrubbing, disinfection & draping in sterile fashion, a midline transverse linear incision (about 2cm in length) was made at forehead. The incision was deepened and the periosteum was dissected off the the bone. Drilling of the metopic ridge was then done with Midas air-drill. After hemostasis, the wound was closed with 3-0 Vicryl & 5-0 Nylon continuous sutures. Operators AP 郭夢菲 Assistants R4 王奐之, Ri 謝明秀 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Drilling of metopic ridge 開立醫師: 王奐之 開立時間: 2011/07/12 12:04 Pre-operative Diagnosis Scaphocephaly with metopic ridge Post-operative Diagnosis Scaphocephaly with metopic ridge Operative Method Drilling of metopic ridge Specimen Count And Types Nil Pathology Nil Operative Findings Bulging metopic ridge was noted. Flattening of the bony surface was confirmed under palpation. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head placed on a horseshoe rest. After shaving, scrubbing, disinfection & draping in sterile fashion, a midline transverse linear incision (about 2cm in length) was made at forehead. The incision was deepened and the periosteum was dissected off the the bone. Drilling of the metopic ridge was then done with Midas air-drill. After hemostasis, the wound was closed with 3-0 Vicryl & 5-0 Nylon continuous sutures. Operators AP 郭夢菲 Assistants R4 王奐之, Ri 謝明秀 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Drilling of metopic ridge 開立醫師: 郭夢菲 開立時間: 2011/07/12 18:08 Pre-operative Diagnosis Scaphocephaly, S/P suturectomy, with metopic ridge Post-operative Diagnosis Scaphocephaly, S/P suturectomy, with metopic ridge Operative Method Drilling of metopic ridge Specimen Count And Types Nil Pathology Nil Operative Findings Bulging metopic ridge was noted from nasion to Bregma. Flattening of the bony surface was confirmed under palpation. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head placed on a horseshoe rest. After shaving, scrubbing, disinfection & draping in sterile fashion, a midline transverse linear incision (about 2cm in length) was made at forehead. The incision was deepened and the periosteum was dissected off the the bone. Drilling of the metopic ridge was then done with Midas air-drill from the wound toward bregma then from wound to nasion. After hemostasis, the wound was closed with 3-0 Vicryl & 5-0 Nylon continuous sutures. Operators AP 郭夢菲 Assistants R4 王奐之, Ri 謝明秀 相關圖片 鄭羽翔 (M,2001/06/06,10y9m) 手術日期 2011/07/12 手術主治醫師 郭夢菲 手術區域 兒醫 067房 02號 診斷 Wound infection postoperative 器械術式 Posterior fossa craniectomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 髒 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 12:30 進入手術室 12:35 麻醉開始 12:45 誘導結束 12:45 抗生素給藥 13:20 手術開始 14:40 手術結束 14:40 麻醉結束 14:52 送出病患 14:55 進入恢復室 16:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 皮下肌肉或深部異物取出術 1 1 摘要__ 手術科部: 外科部 套用罐頭: Foreign body removal & debridement 開立醫師: 王奐之 開立時間: 2011/07/12 15:04 Pre-operative Diagnosis Poor healing of suboccipital with retaining foreign body Post-operative Diagnosis Poor healing of suboccipital with retaining foreign body Operative Method Foreign body removal & debridement Specimen Count And Types 3 pieces About size:pieces Source:suboccipital soft tissue About size:pieces Source:suboccipital soft tissue About size:pieces Source:suboccipital soft tissue Pathology Nil Operative Findings 1 3-hole mini-plate was noted at suboccipital area, near the left occipital condyle, attached to the surrounding fibrotic tissue. 1 devitalized subcutaneous tissue tract to the poorly healed wound was noted, originated from the place where the mini-plate lied. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position with head placed on a horseshoe rest. After shaving, scrubbing, disinfection & draping in sterile fashion, a midline linear incision was made at suboccital area to upper neck along previous scar. The incision was deepened until the bone and dura was exposed. The soft tissue was then dissected until the retaining mini-plate was exposed, and the mini-plate was removed en bloc. After hemostasis, 1 CWV drain was placed. The wound was then closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之, Ri 謝明秀 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Foreign body removal & debridement 開立醫師: 王奐之 開立時間: 2011/07/12 15:04 Pre-operative Diagnosis Poor healing of suboccipital with retaining foreign body Post-operative Diagnosis Poor healing of suboccipital with retaining foreign body Operative Method Foreign body removal & debridement Specimen Count And Types 3 pieces About size:pieces Source:suboccipital soft tissue About size:pieces Source:suboccipital soft tissue About size:pieces Source:suboccipital soft tissue Pathology Nil Operative Findings 1 3-hole mini-plate was noted at suboccipital area, near the left occipital condyle, attached to the surrounding fibrotic tissue. 1 devitalized subcutaneous tissue tract to the poorly healed wound was noted, originated from the place where the mini-plate lied. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position with head placed on a horseshoe rest. After shaving, scrubbing, disinfection & draping in sterile fashion, a midline linear incision was made at suboccital area to upper neck along previous scar. The incision was deepened until the bone and dura was exposed. The soft tissue was then dissected until the retaining mini-plate was exposed, and the mini-plate was removed en bloc. After hemostasis, 1 CWV drain was placed. The wound was then closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之, Ri 謝明秀 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Foreign body (miniplates and screws) removal ... 開立醫師: 郭夢菲 開立時間: 2011/07/12 18:13 Pre-operative Diagnosis Poor healing and granuloma formation of the previous suboccipital wound with retaining foreign body Post-operative Diagnosis Poor healing and granuloma formation of the previous suboccipital wound with retaining foreign body Operative Method Foreign body (miniplates and screws) removal & debridement Specimen Count And Types 3 pieces About size:pieces Source:suboccipital soft tissue About size:pieces Source:suboccipital soft tissue About size:pieces Source:suboccipital soft tissue Pathology Nil Operative Findings 1 3-hole mini-plate was noted at suboccipital area, near the left occipital condyle at the left margin of the previous right occipital craniectomy, attached to the surrounding fibrotic tissue. One devitalized subcutaneous tissue tract with granuloma formation at the poorly healed wound was noted, originated from the place where the mini-plate lied. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position with head placed on a horseshoe rest. After shaving, scrubbing, disinfection & draping in sterile fashion, a midline linear incision was made at suboccital area to upper neck along previous scar. The incision was deepened until the bone and dura was exposed. The soft tissue was then dissected until the retaining mini-plate was exposed, and the mini-plate was removed en bloc. After hemostasis, 1 CWV drain was placed. The wound was then closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之, Ri 謝明秀 相關圖片 竇斌峰 (M,1996/09/10,15y6m) 手術日期 2011/07/12 手術主治醫師 郭夢菲 手術區域 兒醫 067房 03號 診斷 Cerebral Palsy 器械術式 Revision of CSF shunt 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3E 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 14:25 報到 14:41 通知急診手術 15:05 進入手術室 15:10 麻醉開始 15:20 誘導結束 15:20 抗生素給藥 15:58 手術開始 17:20 手術結束 17:20 麻醉結束 17:30 送出病患 17:35 進入恢復室 18:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦脊髓液分流管重置 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: V-P shunt revision 開立醫師: 王奐之 開立時間: 2011/07/12 17:47 Pre-operative Diagnosis Hydrocephalus status post V-P shunt insertion, with suspected shunt dysfunction Post-operative Diagnosis Hydrocephalus status post V-P shunt insertion, with suspected shunt dysfunction Operative Method V-P shunt revision Specimen Count And Types 1 piece About size:3ml Source:CSF Pathology Nil Operative Findings Medtronic medium pressure valve was used, with ventricular catheter set at 6cm. The old shunt reservoir was left in place and ligated. 3ml of clear CSF was collected, sent for CSF routine, BCS & bacterial culture. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After shaving, scrubbing, disinfection & draping in sterile fashion, a curvilinear incision was made at right frontal area along previous scar. Dissection was done carefully to expose the original shunt reservoir & catheter. A new burr hole was made at right Kocher point, followed by 2 tenting stitches. Ventricular puncture was then done. After assembly of shunt reservoir, ventricular catheter and connection to the old peritoneal catheter, the ventricular catheter was inserted. Smooth CSF flow was confirmed. After hemostasis, the wound was closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之 Indication Of Emergent Operation IICP 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: V-P shunt revision 開立醫師: 王奐之 開立時間: 2011/07/12 17:47 Pre-operative Diagnosis Hydrocephalus status post V-P shunt insertion, with suspected shunt dysfunction Post-operative Diagnosis Hydrocephalus status post V-P shunt insertion, with suspected shunt dysfunction Operative Method V-P shunt revision Specimen Count And Types 1 piece About size:3ml Source:CSF Pathology Nil Operative Findings Medtronic medium pressure valve was used, with ventricular catheter set at 6cm. The old shunt reservoir was left in place and ligated. 3ml of clear CSF was collected, sent for CSF routine, BCS & bacterial culture. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After shaving, scrubbing, disinfection & draping in sterile fashion, a curvilinear incision was made at right frontal area along previous scar. Dissection was done carefully to expose the original shunt reservoir & catheter. A new burr hole was made at right Kocher point, followed by 2 tenting stitches. Ventricular puncture was then done. After assembly of shunt reservoir, ventricular catheter and connection to the old peritoneal catheter, the ventricular catheter was inserted. Smooth CSF flow was confirmed. After hemostasis, the wound was closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之 Indication Of Emergent Operation IICP 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: V-P shunt revision 開立醫師: 郭夢菲 開立時間: 2011/07/13 17:22 Pre-operative Diagnosis Hydrocephalus status post V-P shunt insertion, with suspected shunt dysfunction Post-operative Diagnosis Hydrocephalus status post V-P shunt insertion, with intermittent shunt dysfunction Operative Method V-P shunt revision Specimen Count And Types 1 piece About size:3ml Source:CSF Pathology Nil Operative Findings 1. This time, Medtronic medium pressure valve was used, with ventricular catheter set at 6.3cm. 2. The old shunt was patent, however, it was tightly stretched laterally by the peritoneal catheter that made the trajectory of the ventricular catheter toward the septum pellucidum, and possbile freqhent dysfunction. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After shaving, scrubbing, disinfection & draping in sterile fashion, a curvilinear incision was made at right frontal area along previous scar. Dissection was done carefully to expose the original shunt reservoir & catheter. A new burr hole was made at right Kocher point, followed by 2 tenting stitches. The ventricular cather was inserted smoothly and connected to the old peritoneal catheter after an extension tube, about 10 cm was connected onto the previous peritoneal one. The old reservoir was disconnected and ligated. The wound was then closed in layers after meticulous hemostasis. Operators AP 郭夢菲 Assistants R4 王奐之 Indication Of Emergent Operation 相關圖片 謝宗凱 (M,1998/11/29,13y3m) 手術日期 2011/07/12 手術主治醫師 郭夢菲 手術區域 兒醫 067房 04號 診斷 Meningitis, unspecified 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 髒 麻醉方式 全身麻醉 麻醉主治醫師 林子富 ASA 3E 紀錄醫師 曾峰毅, 時間資訊 18:00 臨時手術NPO 18:00 開始NPO 18:20 通知急診手術 21:05 進入手術室 21:10 麻醉開始 21:15 誘導結束 21:36 手術開始 22:10 手術結束 22:10 麻醉結束 22:18 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 顱內壓視置入 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 曾峰毅 開立時間: 2011/07/12 22:25 Pre-operative Diagnosis Ventriculitis Post-operative Diagnosis Ventriculitis Operative Method External ventricular drainage via right Kocher Specimen Count And Types CSF was sent for culture. Pathology Nil Operative Findings Turbid, yellowish to whitish, CSF with much witish debris was drained while ventriculostomy. Opening pressure of ventriculostomy was about 10-15 cmH20. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position. After scalp shaved, scurbbed, disinfected, and then draped, we made one transverse skin incision at right frontal area. We drilled one burr hole, and then created durotomy. Ventriculostomy was performed once, and then ventricular catheter was inserted. The wound was closed in layers after ventricular catheter fixed. Operators VS 郭夢菲 Assistants R5 曾峰毅 Indication Of Emergent Operation Acute hydrocephalus 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 郭夢菲 開立時間: 2011/07/13 17:23 Pre-operative Diagnosis Ventriculitis Post-operative Diagnosis Ventriculitis Operative Method External ventricular drainage via right Kocher Specimen Count And Types CSF was sent for culture. Pathology Nil Operative Findings Turbid, yellowish to whitish, CSF with much witish debris was drained while ventriculostomy. Opening pressure of ventriculostomy was about 10-15 cmH20. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position. After scalp shaved, scurbbed, disinfected, and then draped, we made one transverse skin incision at right frontal area. We drilled one burr hole, and then created durotomy. Ventriculostomy was performed once, and then ventricular catheter was inserted. After saline irrigation, the wound was closed in layers after ventricular catheter fixed. Operators VS 郭夢菲 Assistants R5 曾峰毅 Indication Of Emergent Operation Acute hydrocephalus 相關圖片 莊貴龍 (M,1946/10/15,65y4m) 手術日期 2011/07/12 手術主治醫師 賴達明 手術區域 東址 003房 03號 診斷 Secondary cancer of brain and spinal cord 器械術式 Anterior Spinal fusion; C7 corpectomy with autologus bone fusion, plate (cash?) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 16:05 報到 16:50 進入手術室 16:55 麻醉開始 17:30 誘導結束 17:45 抗生素給藥 18:07 手術開始 21:00 抗生素給藥 21:30 手術結束 21:30 麻醉結束 21:45 送出病患 21:50 進入恢復室 23:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 脊椎融合術-前融合,有固定物(每增加<=四節) 1 1 記錄__ 手術科部: 外科部 套用罐頭: C7 corpectomy with autologus bone fusion, fix... 開立醫師: 林哲光 開立時間: 2011/07/12 22:00 Pre-operative Diagnosis C7 pathological fracture, spine metastasis, suspected HCC metastasis Post-operative Diagnosis C7 pathological fracture, spine metastasis, suspected HCC metastasis Operative Method C7 corpectomy with autologus bone fusion, fixed with cervical plate Specimen Count And Types 1 piece About size:Multiple pieces Source:C7 body, bone metastasis Pathology Pending Operative Findings Decreased vertebral body height was noted at C7 level. Some soft tissue inside the body was also noted and it was grayish with less vascularity. Autologus bone graft was harvested from left iliac crest. A cervical plate was used to fix at C6/T1 body. Operative Procedures Under ETGA and supine position, skin disinfected and drapped were performed as usual. Transverse skin incision was made at left neck below the circoid cartilage. The platysma muscle was dissected and the dissection was done at the plane between the carotid triangle and esophagus. THe longus coli was dissected and C7 corpectomy was then performed after C-arm localization. Another skin inciison was made at left iliac crest and bone graft as harvested. The bone graft was fixed at C7 body level with cervical plate fixation. The wound was then closed in layers after a prevertebral CWV drain insertion. Operators 賴達明 Assistants 林哲光, 張倍慈 相關圖片 簡才揮 (M,1973/08/22,38y6m) 手術日期 2011/07/12 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Spine tumor 器械術式 Laminectomy for decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 10:10 報到 10:26 進入手術室 10:30 麻醉開始 10:40 誘導結束 10:50 抗生素給藥 11:40 手術開始 13:50 抗生素給藥 16:25 手術結束 16:25 麻醉結束 16:35 送出病患 16:36 進入恢復室 17:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 手術 良性脊髓腫瘤切除術 1 1 記錄__ 手術科部: 外科部 套用罐頭: L2 laminectomy and tumor excision, partial re... 開立醫師: 林哲光 開立時間: 2011/07/12 16:51 Pre-operative Diagnosis L2 intraspinal tumor Post-operative Diagnosis L2 intraspinal tumor, intradural extramedullary tumor, suspected neuroma Operative Method L2 laminectomy and tumor excision, partial removal Specimen Count And Types 1 piece About size:Multiple pieces Source:intraspinal tumor Pathology Pending Operative Findings A grayish-withish, fragile, encapsulated, intradural mass lesion was noted at L2 level with high cellularity, deeply inside the anterior part of the cauda equina. Intraoperative SSEP of right lower limb was vanished during tumor excision. Operative Procedures Under ETGA and prone position, skin disnifected and drapped were performed as usual. Midline skin incision was made at L1-L3 level. The paraspinal muscles of L2 were detached and L2 laminectomy was then performed. The dura was then opened. Tumor excision was then done with CUSA. The dura was then closed in water-tie method with 5-0 Prolene. The wound was then closed in layers after epidural CWV drain was inserted. Operators 賴達明 Assistants 林哲光,張倍慈 相關圖片 鄒秀貞 (F,1954/05/10,57y10m) 手術日期 2011/07/12 手術主治醫師 楊庭華 手術區域 西址 033房 06號 診斷 Herniation of intervertebral disc with myelopathy, cervical 器械術式 Biopsy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 林奎佑, 時間資訊 11:30 進入手術室 11:41 麻醉開始 11:43 手術開始 12:05 手術結束 12:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 口腔黏膜切片 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Incisional biopsy of tongue ulcer 開立醫師: 林奎佑 開立時間: 2011/07/12 12:16 Pre-operative Diagnosis Tongue ulcer, right border Post-operative Diagnosis Tongue ulcer, right border, operated Operative Method Incisional biopsy of tongue ulcer Specimen Count And Types 1 piece About size:1.5x1.0x0.2cm Source:tongue ulcerative lesion Pathology 1. tongue ulcer, 1.5x1.0x0.2cm, pending Operative Findings tongue ulcer, status post incisional biopsy Operative Procedures 1.The patient was put in a supine position. 2.Local anesthesia was set up under local Bosmin-Xylocane injection. 3.The operative field was disinfected and draped as usual. 4.A lesion about 1.5x1.0cm in size was noted in tongue 5.Incisional biopsy was then done carefully. 6.Not much bleeding was noted. 7.Hemostasis was done carefully. The patient tolerated the entire procedure well. Operators Asp 楊庭華 Assistants R4 許軍偉, R3 林奎佑 帥宗統 (M,1975/11/25,36y3m) 手術日期 2011/07/12 手術主治醫師 陳敞牧 手術區域 東址 002房 04號 診斷 Herniated intervertebral disc, lumbar 器械術式 Diskectomy lumbar(Others) 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3E 紀錄醫師 許皓淳, 時間資訊 00:30 臨時手術NPO 00:30 開始NPO 11:31 通知急診手術 16:53 報到 17:15 進入手術室 17:18 麻醉開始 17:25 誘導結束 18:21 手術開始 20:20 手術結束 20:20 麻醉結束 20:30 送出病患 20:35 進入恢復室 21:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 椎間盤切除術-腰椎 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Right L5-S1 laminotomy for removal of scar tissue 開立醫師: 許皓淳 開立時間: 2011/07/12 20:55 Pre-operative Diagnosis Herniated intervertebral disc, L5-S1 Post-operative Diagnosis L5-S1 scar formation, right Operative Method Right L5-S1 laminotomy for removal of scar tissue Specimen Count And Types nil Pathology nil Operative Findings The thecal sac and right S1 root were mainly surrounded by scar tissue. Tight adhesion was noted during the operation. The laminotomy was extended and the scar tissue was removed. The annulus of the disc was intact and no obvious bulging was noted during the operation. The disc was left intact since the root and thecal sac became loose after adhesionlysis. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After C-arm localization, the skin of back was scrubbed, disinfected, and then draped. One midline skin incision was made, and right paraspinal muscle was dissected to expose L5/S1 interlaminar space. Laminotomy was performed, and scar tissue was removed. Adhesiolysis was performed, and hemostasis was achieved. The wound was irrigated and closed in layers. Operators 陳敞牧 Assistants R5李振豪, R2許皓淳 Indication Of Emergent Operation 相關圖片 謝吳金定 (F,1951/09/02,60y6m) 手術日期 2011/07/12 手術主治醫師 陳敞牧 手術區域 東址 003房 01號 診斷 Malignant neoplasm of connective and other soft tissue 器械術式 Laminectomy for decompression, T1 tumor excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 無麻醉 麻醉主治醫師 李宗勳 ASA 2 時間資訊 00:00 臨時手術NPO 07:20 報到 08:08 進入手術室 08:10 麻醉開始 08:20 誘導結束 10:00 送出病患 10:00 麻醉結束 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 楊湯玉松 (F,1943/09/14,68y6m) 手術日期 2011/07/12 手術主治醫師 楊士弘 手術區域 西址 039房 01號 診斷 Carpal tunnel syndrome 器械術式 Decompression of mediun nerve 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 08:55 進入手術室 09:25 麻醉開始 09:29 誘導結束 09:30 手術開始 10:15 手術結束 10:15 麻醉結束 10:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 正中神經或尺神經腕部減壓術–單側 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Carpal Tunnel Syndrome 開立醫師: 黃川倩 開立時間: 2011/07/12 10:25 Pre-operative Diagnosis Left carpal tunnel syndrome Post-operative Diagnosis Left carpal tunnel syndrome Operative Method Neurolysis Specimen Count And Types nil Pathology nil Operative Findings The transvers capal ligment compressed the median nerve tightly. The transvers carpal ligment compressed the median nerve tightly. The median nerve was injected and returned to light-yellow after decompression Operative Procedures 1.The hand and forearm were sterilized with povidone-iodine tincture, then covered with stockine. 2.Anesthesia: tourniquet was applied at distal upper arm, then regional block with 15 ml 1% Xylocaine solution was infused through cephalic vein catheter at wrist area. 2. Local anesthesia 3. Incision: S shape from vertical palmar crease to transverse wrist crease. 4.The palmaris longus tendon was identified, then the plamar aponeurosis was cut longitidinally along the ulnar side of the palmaris longus tendon. 5. The median nerve was identified beneath the palmars longus tendon. Under direct vision, the transverse carpal ligament was divided until no more pressure on the median nerve could be palpated. 6. The skin was closed by interrupted suture with 4/0 nylon. 7.The hand and wrist were draped with fluffy dressing and elastic bandage. Operators VS 楊士弘 Assistants R3 陳國瑋 相關圖片 張秀霞 (F,1967/08/28,44y6m) 手術日期 2011/07/13 手術主治醫師 王國川 手術區域 東址 003房 04號 診斷 Glioblastoma multiforma 器械術式 Brain tumor Crainotomy(Others) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 2E 紀錄醫師 黃怡嘉, 時間資訊 13:30 臨時手術NPO 13:30 開始NPO 21:27 通知急診手術 22:50 麻醉開始 23:50 誘導結束 00:00 抗生素給藥 00:30 手術開始 03:00 手術結束 03:00 麻醉結束 03:05 送出病患 23:35 進入手術室 23:35 報到 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT 開立醫師: 曾峰毅 開立時間: 2011/07/13 03:30 Pre-operative Diagnosis Right frontal tumor with extension to left frontal, suspected high grade glioma Post-operative Diagnosis Right frontal tumor with extension to left frontal, suspected high grade glioma Operative Method Right frontal craniotomy for tumor excision Specimen Count And Types Several fragments of one tumor was sent for pathology. Pathology Pending Operative Findings One intra-axial, hypervascular, greyish, fragile, gelatinous tumor was noted at right frontal lobe with extension to left frontal lobe via corpus callosum. One right ACA brach was sacrificed during tumor excision. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head fixed with Mayfield head clamp. We shaved, scrubbed, disinfected, and then draped the patient. We made one bicoronal skin incision, and then right frontal craniotomy. After C-shape durotomy, we performed tumor excision via right frontal corticotomy. Hemostasis was achieved, followed by duroplasty in water-tight fashion sutre with 5-0 prolene and autologous fascia graft. Bone graft was fixed back with mini-plates, and one subgaleal CWV was placed. The wound was closed in layers. Operators VS 王國川 Assistants R5 曾峰毅 R0 黃怡嘉 Indication Of Emergent Operation Acute consciousness disturbance 相關圖片 郭月鳳 (F,1961/06/28,50y8m) 手術日期 2011/07/12 手術主治醫師 王國川 手術區域 西址 039房 02號 診斷 Carpal tunnel syndrome 器械術式 Neurolysis of the uluar neuve 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 10:45 進入手術室 11:00 麻醉開始 11:02 誘導結束 11:03 手術開始 11:25 手術結束 11:25 麻醉結束 11:30 送出病患 摘要__ 手術科部: 外科部 套用罐頭: Carpal Tunnel Syndrome 開立醫師: 陳國瑋 開立時間: 2011/07/12 11:42 Pre-operative Diagnosis Carpal tunnel syndrome Post-operative Diagnosis Carpal tunnel syndrome Operative Method Neurolysis Specimen Count And Types nil Pathology nil Operative Findings Thickened flexor reticulum and transverse carpal ligament were noted Operative Procedures 1.The hand and forearm were sterilized with povidone-iodine tincture, then covered with stockinet. 2. Local anesthesia 3. Incision: L shape along transverse wrist crease. 4.The palmaris longus and superficial fexor digitorum tendon were identified and pull aside . 5. The median nerve was identified. Under direct vision, the transverse carpal ligament was divided until no more pressure on the median nerve could be palpated. 6. The skin was closed by interrupted suture with 4/0 nylon.7.The tourniquet was released. The hand and wrist were draped with fluffy dressing and elastic bandage. Operators 王國川 Assistants 陳國瑋 相關圖片 陳張美珠 (F,1948/10/02,63y5m) 手術日期 2011/07/12 手術主治醫師 張志豪 手術區域 西址 036房 03號 診斷 Late effect of fracture of upper extremities 器械術式 TER 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 王永彬 ASA 2 紀錄醫師 李嘉哲, 時間資訊 12:40 進入手術室 12:50 麻醉開始 13:00 誘導結束 13:25 抗生素給藥 13:34 手術開始 16:30 抗生素給藥 16:55 手術結束 16:55 麻醉結束 17:00 送出病患 17:10 進入恢復室 18:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 手術 肘關節全置換術 1 1 L 手術 石膏副木固定－長臂 1 0 L 手術 骨內固定物拔除術-骨盆,髖骨,肱骨,股骨,尺骨,橈骨,脛骨 1 2 L 摘要__ 手術科部: 骨科部 套用罐頭: Remove of implants and Total Elbow Replacement 開立醫師: 黃鼎鈞 開立時間: 2011/07/14 00:19 Pre-operative Diagnosis Left elbow osteoarthritis, secondary change Post-operative Diagnosis Left elbow osteoarthritis, secondary change Operative Method Remove of implants and Total Elbow Replacement Specimen Count And Types nil Pathology nil Operative Findings 1. Left elbow joint degenerative change with effusion and adhesion 2. two screws Operative Procedures 1. ETGA with supine position 2. disinfect the skin and drapping as usualm then set air tourniquet 200 mmhg 3. incision along previous surgical scar and dissect to expose the two screws. Then remove them 4. Shape distal humerus and proximal ulna to fit in the humeral and ulnar part TER implant, then hinge them, fixed with bone cement, air tourniquet had been deflated and inflated once. 5. irrigation, deflate air tourniquet and hemostasis 6. close wound in layers 7. apply long arm splint Operators 張志豪, Assistants 黃偉程, 李嘉哲 張志能 (M,1956/09/07,55y6m) 手術日期 2011/07/13 手術主治醫師 杜永光 手術區域 東址 005房 04號 診斷 Arachnoid cyst 器械術式 Revision of CSF shunt 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 許皓淳, 時間資訊 00:00 臨時手術NPO 15:18 進入手術室 15:25 麻醉開始 15:30 誘導結束 15:35 抗生素給藥 15:40 手術開始 17:00 手術結束 17:00 麻醉結束 17:15 送出病患 17:17 進入恢復室 18:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦脊髓液分流管重置 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Revision of cystoperitoneal shunt 開立醫師: 李振豪 開立時間: 2011/07/13 17:25 Pre-operative Diagnosis Malposition of cystoperitoneal shunt Post-operative Diagnosis Malposition of cystoperitoneal shunt Operative Method Revision of cystoperitoneal shunt Specimen Count And Types nil Pathology Nil Operative Findings CSF gushed out after opening of the wound. The function of the shunt was good and the CSF was clear in character. The ventricular catheter was cut short to 3cm in length. The reservoir was repositioned below the nuchal muscle to make less angulation of the catheter. The function of the shunt was checked again after reposition and it work well. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position with head fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. The scalp incision was made along previous wound and opened in layers. The reservoir and vantricular catheter was identified. The ventricular catheter was pulled out and cut short to 3cm in length. The left nuchal muscle was splitted and the reservoir was placed below the nuchal muscle. The ventricular catheter was placed back into the arachnoid cyst and packing with Gelfoam. Hemostasis was achieved with bipolar electrocautery. The nuchal muscle was repaired. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators Prof.杜永光 Assistants R5李振豪, R2許皓淳 相關圖片 黃火盛 (M,1948/09/10,63y6m) 手術日期 2011/07/13 手術主治醫師 蔡瑞章 手術區域 東址 005房 01號 診斷 Herniation of intervertebral disc 器械術式 microsurgical lumbar discectomy 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 許皓淳, 時間資訊 00:00 臨時手術NPO 07:38 報到 08:03 進入手術室 08:05 麻醉開始 08:15 誘導結束 08:35 抗生素給藥 09:09 手術開始 11:10 手術結束 11:10 麻醉結束 11:20 送出病患 11:25 進入恢復室 12:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 椎間盤切除術-腰椎 1 1 L 手術 椎弓切除術(減壓)-二節以內 1 2 L 摘要__ 手術科部: 外科部 套用罐頭: 1. L4/5 laminotomy for sublaminar decompression 開立醫師: 李振豪 開立時間: 2011/07/13 11:15 Pre-operative Diagnosis L4/5 spondylosis and herniation of intervertebral disc with spinal stenosis Post-operative Diagnosis L4/5 spondylosis and herniation of intervertebral disc with spinal stenosis Operative Method 1. L4/5 laminotomy for sublaminar decompression 2. L4/5 microdiskectomy, left Specimen Count And Types nil Pathology Nil Operative Findings The ligmentum flavum was hypertrophic which compressed the thecal sac tightly. After sublaminar decompression, the thecal sac expanded well. Bulging disc was noted after retraction of the thecal sac and left L5 root. The root was compressed by the disc and became much loose after microdiskectomy. One small incidental durotomy over left side was noted but the arachnoid membrane was intact. The durotomy was repaired with 5-0 prolene. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position. L4/5 disc space was localized by portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made at L4/5 disc space level and the subcutaneous soft tissue was devided. The L4 spinous process was splitted by ooscillating saw. The spinous process was fracture and laminae was exposed. L4/5 laminotomy was performed and bilateral sublaminar decompression was done with Kerrison puncues. Microdiskectomy was approached from left side with curette, alligator, and disc clamp. One small incidental durotomy was noted during the operation but the arachnoid membrane was intact. The durotomy was repaired with 5-0 prolene. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. The wound was then closed in layers with 2-0 Vicryl and 4-0 Dexon. Operators Prof.蔡瑞章 Assistants R5李振豪, R2許皓淳 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: 1. L4/5 laminotomy for sublaminar decompression 開立醫師: 李振豪 開立時間: 2011/07/13 11:15 Pre-operative Diagnosis L4/5 spondylosis and herniation of intervertebral disc with spinal stenosis Post-operative Diagnosis L4/5 spondylosis and herniation of intervertebral disc with spinal stenosis Operative Method 1. L4/5 laminotomy for sublaminar decompression 2. L4/5 microdiskectomy, left Specimen Count And Types nil Pathology Nil Operative Findings The ligmentum flavum was hypertrophic which compressed the thecal sac tightly. After sublaminar decompression, the thecal sac expanded well. Bulging disc was noted after retraction of the thecal sac and left L5 root. The root was compressed by the disc and became much loose after microdiskectomy. One small incidental durotomy over left side was noted but the arachnoid membrane was intact. The durotomy was repaired with 5-0 prolene. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position. L4/5 disc space was localized by portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made at L4/5 disc space level and the subcutaneous soft tissue was devided. The L4 spinous process was splitted by ooscillating saw. The spinous process was fracture and laminae was exposed. L4/5 laminotomy was performed and bilateral sublaminar decompression was done with Kerrison puncues. Microdiskectomy was approached from left side with curette, alligator, and disc clamp. One small incidental durotomy was noted during the operation but the arachnoid membrane was intact. The durotomy was repaired with 5-0 prolene. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. The wound was then closed in layers with 2-0 Vicryl and 4-0 Dexon. Operators Prof.蔡瑞章 Assistants R5李振豪, R2許皓淳 相關圖片 辜秋香 (F,1959/11/20,52y3m) 手術日期 2011/07/13 手術主治醫師 蔡瑞章 手術區域 東址 005房 02號 診斷 Herniation of intervertebral disc (HIVD) 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 李振豪, 時間資訊 23:36 臨時手術NPO 11:05 報到 11:30 進入手術室 11:40 麻醉開始 11:50 誘導結束 12:08 抗生素給藥 12:25 手術開始 13:50 手術結束 13:50 麻醉結束 14:00 送出病患 14:01 進入恢復室 15:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 椎間盤切除術-腰椎 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: L3/4 microscopic diskectomy, right 開立醫師: 李振豪 開立時間: 2011/07/13 14:02 Pre-operative Diagnosis L3/4 sequestrated disc, right paramedian Post-operative Diagnosis L3/4 sequestrated disc, right paramedian Operative Method L3/4 microscopic diskectomy, right Specimen Count And Types nil Pathology Nil Operative Findings Large sequestrated disc was noted at right L3/4 paramedian location which compressed the thecal sac tightly. The thecal sac was expanded well after removal of the ruptured disc. No incidental durotomy or CSF leakage was noted during whole procedure. The annulus of L3/4 disc was checked but no obvious rupture site was noted. The disc was left intact because no obvious bulging out and compression of thecal sac. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position. The L3/4 disc space was localized by portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision at L3/4 disc space level was made. The subcutaneous soft tissue was devided and right paravertebral muscle groups were detached. Modified narrow Taylor retractor was used to exposed the right side lamina. Laminotomy was performed and the ligmentum flavum was removed to expose the thecal sca. The thecal was retracted and the sequestrated disc was noted. The sequestrated disc was removed by alligator gentally. The L3/4 disc was checked and no obvious bulging or compression of root was noted. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. Rinderon suspension was applied around the root. The wound was then closed in layers with 2-0 Vicryl and 4-0 Dexon. Operators Prof.蔡瑞章 Assistants R5李振豪, R2許皓淳 相關圖片 楊雅云 (F,1970/09/21,41y5m) 手術日期 2011/07/13 手術主治醫師 曾勝弘 手術區域 東址 002房 01號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(Others) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 07:31 通知急診手術 08:50 報到 09:09 進入手術室 09:10 麻醉開始 09:40 誘導結束 09:43 抗生素給藥 10:19 手術開始 12:48 抗生素給藥 14:10 麻醉結束 14:10 手術結束 14:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: Right frontal craniotomy for tumor excision, ... 開立醫師: 林哲光 開立時間: 2011/07/13 15:13 Pre-operative Diagnosis Right frontal brain tumor, suspected glioma Post-operative Diagnosis Right frontal brain tumor, suspected glioma Operative Method Right frontal craniotomy for tumor excision, partial removal Specimen Count And Types 1 piece About size:Multiple pieces Source:Brain tumor Pathology Frozen pathology showed glioma Operative Findings Infiltrative brain tumor between normal brain tissue without clear border was noted with cystic component and some solid part. The tumor seemed high cellularity and grayish with moderate vascularity. The cyst content was yellowish, transparent fluid and the cystic wall was thin with some gliosis. Operative Procedures Under ETGA and supine position, skin disinfected and drapped were performed as usual. Bicoronal skin incision was made and right frontal craniotomy was then made after four burr holes were created. The dura was then opened in reversed U shape after dural tenting. Corticotomy was done at right superior frontal lobe and partial middle frontal lobe was also excised. The skull bone graft was put back and fixed with mini-plates. The wound was then closed in layers after hemostasis with Surgecells. Operators 曾勝弘 Assistants 林哲光 Indication Of Emergent Operation severe perifocal edema 相關圖片 李官馨 (F,1997/07/28,14y7m) 手術日期 2011/07/13 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Moyamoya disease 器械術式 Right side STA-MCA EDAS 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 07:35 報到 08:08 進入手術室 08:15 麻醉開始 08:35 誘導結束 08:43 抗生素給藥 09:45 手術開始 11:43 抗生素給藥 13:05 麻醉結束 13:05 手術結束 13:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 顱內外血管吻合術 1 1 R 手術 朴卜勒氏血流測定（週邊血管） 1 0 R 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 R 摘要__ 手術科部: 外科部 套用罐頭: Right side encephaloduroarteriosynangiosis (i... 開立醫師: 王奐之 開立時間: 2011/07/13 13:32 Pre-operative Diagnosis Moyamoya disease, status post left encephaloduroarteriosynangiosis Post-operative Diagnosis Moyamoya disease, status post left encephaloduroarteriosynangiosis Operative Method Right side encephaloduroarteriosynangiosis (indirect EC-IC bypass) from posterior branch of STA to MCA territory Specimen Count And Types Nil Pathology Nil Operative Findings Numerous small collateral vessel were noted at brain surface. The posterior branch of right STA was used, with about 6cm of mobilized segment; the surrounding galeal tissue were left with STA (about 1cm in width). Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After tracing and marking of the superficial temporal artery with Duplex, the scalp was scrubbed, disinfected, and draped in sterile fashion. Under microscopic view, a small reversed hockey stick incision was made at right temporal area, followed dissection of the galea and careful preserving the STA. One segment of STA along with surrounding galeal tissue were mobilized and gently retracted to the side. After linear incision of the temporalis muscle, an ovoid craniotomy was then done with its long axis along the STA course. A linear durotomy was made, followed opening of the arachnoid membrane at the surface artery. 4 anchoring sutures were applied to the proximal & distal end of STA to the dural edges, and 2 more stitches were applied at the proximal & distal segment to fix the STA graft to the exposed pia. The dura was then closed with 4-0 Prolene continuous sutures. A piece of DuroFoam was used to covered the dural surface to prevent CSF leakage. The bone flap edge was rongeured off to allow patent entry & exit points of the STA. After central tenting, the bone flap was fixed back with 4 wires. The wound was then closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Right side encephaloduroarteriosynangiosis (i... 開立醫師: 王奐之 開立時間: 2011/07/13 13:34 Pre-operative Diagnosis Moyamoya disease, status post left encephaloduroarteriosynangiosis Post-operative Diagnosis Moyamoya disease, status post left encephaloduroarteriosynangiosis Operative Method Right side encephaloduroarteriosynangiosis (indirect EC-IC bypass) from posterior branch of STA to MCA territory Specimen Count And Types Nil Pathology Nil Operative Findings Numerous small collateral vessel were noted at brain surface. The posterior branch of right STA was used, with about 6cm of mobilized segment; the surrounding galeal tissue were left with STA (about 1cm in width). Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After tracing and marking of the superficial temporal artery with Duplex, the scalp was scrubbed, disinfected, and draped in sterile fashion. Under microscopic view, a small reversed hockey stick incision was made at right temporal area, followed dissection of the galea and careful preserving the STA. One segment of STA along with surrounding galeal tissue were mobilized and gently retracted to the side. After linear incision of the temporalis muscle, an ovoid craniotomy was then done with its long axis along the STA course. A linear durotomy was made, followed opening of the arachnoid membrane at the surface artery. 4 anchoring sutures were applied to the proximal & distal end of STA to the dural edges, and 2 more stitches were applied at the proximal & distal segment to fix the STA graft to the exposed pia. The dura was then closed with 4-0 Prolene continuous sutures. A piece of DuroFoam was used to covered the dural surface to prevent CSF leakage. The bone flap edge was rongeured off to allow patent entry & exit points of the STA. After central tenting, the bone flap was fixed back with 4 wires. The wound was then closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之 相關圖片 陳昭益 (M,1940/11/05,71y4m) 手術日期 2011/07/13 手術主治醫師 陳炯年 手術區域 東址 007房 02號 診斷 Spinal metastasis 器械術式 Port-A catheter Implatation 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 3 紀錄醫師 陳柏達, 時間資訊 12:00 進入手術室 12:10 麻醉開始 12:20 誘導結束 12:30 手術開始 13:17 手術結束 13:17 麻醉結束 13:25 送出病患 13:30 進入恢復室 14:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 port–A導管植入術–治療性導管植入術 1 0 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: port-A implantation 開立醫師: 陳柏達 開立時間: 2011/07/13 13:27 Pre-operative Diagnosis Gastric cancer Post-operative Diagnosis Gastric cancer Operative Method port-A implantation Specimen Count And Types nil Pathology nil Operative Findings Intravenous catheter tip at SVC/RA junction Operative Procedures Under IV general anethesia, the patient lied at supine position. With cut down procedure, intravenous catheter was inserted to right cephalic vein. The catheter tip was identified with intra-op CXR. The wound was closed in layers after hemostasis Operators P陳炯年 Assistants R3陳柏達 簡金蓮 (F,1975/08/20,36y6m) 手術日期 2011/07/13 手術主治醫師 楊士弘 手術區域 東址 003房 01號 診斷 Lumbar spondylosis 器械術式 Diskectomy lumbar, L5-S1, bilateral (?) microsurgical decompression 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 08:10 進入手術室 08:15 麻醉開始 08:20 誘導結束 08:30 抗生素給藥 09:05 手術開始 11:35 手術結束 11:35 麻醉結束 11:40 送出病患 11:41 進入恢復室 12:41 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 手術 椎間盤切除術-腰椎 1 1 B 摘要__ 手術科部: 外科部 套用罐頭: Bilateral L5-S1 laminotomy and disecktomy 開立醫師: 陳國瑋 開立時間: 2011/07/13 11:36 Pre-operative Diagnosis L5-S1 HIVD Sequestrated intervertebral disc at L5/S1 Post-operative Diagnosis L5-S1 HIVD Sequestrated intervertebral disc at L5/S1 Operative Method Bilateral L5-S1 laminotomy and disecktomy Bilateral L5-S1 laminotomy for L5/S1 discectomy Specimen Count And Types nil Pathology nil Operative Findings Hypertrophic ligamentum flavum and protruding of intervertebral disc were noted. The thecal sac was compressed tightly and became loose after decompression. Hypertrophic ligamentum flavum and protruding of intervertebral disc compromised bilateral L5/S1 neural foramen. Bilateral S1 roots were compressed tightly and became loose after decompression. Operative Procedures The patient was put in prone position after ETGA. The level of L5-S1 was identified with C-arm. Skin was prepared as usual. Midline skin incision was done and the paraspinal muscle and soft tissue was dissected away. Under microscope, left side foraminotomy and disecktomy was done. So did on the right side. Afeter careful hemostasis, the wound was closed in layers. The patient was put in prone position after ETGA. The level of L5-S1 was identified with C-arm. Skin was prepared as usual. Midline skin incision was done and the paraspinal muscle and soft tissue was dissected away. Under microscope, left side L5/S1 lamintomy for discectomy was done. So did on the right side. Afeter careful hemostasis, the wound was closed in layers. Operators VS 楊士弘 Assistants 曾峰毅 陳國瑋 相關圖片 李佳宜 (F,1997/11/23,14y3m) 手術日期 2011/07/13 手術主治醫師 楊士弘 手術區域 兒醫 067房 02號 診斷 Dislocations of second cervical vertebra, closed 器械術式 occipitocervical fusion 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 王奐之, 時間資訊 00:00 開始NPO 00:00 臨時手術NPO 15:14 通知急診手術 14:15 報到 14:20 進入手術室 14:35 麻醉開始 15:05 誘導結束 15:30 抗生素給藥 16:03 手術開始 17:20 開始輸血 21:05 麻醉結束 21:05 手術結束 21:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 脊椎骨、盆骨骨折徒手復位術 1 3 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 骨或軟骨移植術 1 1 摘要__ 手術科部: 外科部 套用罐頭: Occipitocervical fixation and fusion, posterior 開立醫師: 王奐之 開立時間: 2011/07/13 21:37 Pre-operative Diagnosis Occipitoatlantoaxial subluxation; spondyloepiphyseal dysplasia Post-operative Diagnosis Occipitoatlantoaxial subluxation; spondyloepiphyseal dysplasia Operative Method Occipitocervical fixation and fusion, posterior Specimen Count And Types nil Pathology Nil Operative Findings The atlantoaxial subluxation was reduced back in normal position by close reduction, after verification by C-arm fluorscopy. The wound bled easily throughout the procedure. The spinous processes of C2-5 was hypoplastic. A T-shaped occipital plate was fixed to the occipital bone by 2 screws (10 mm and 14 mm respectivey). Four lateral mass screws were inserted into the C3, and C4 (14-18 mm long, 3.5 mm in diameter). The occipital plate and lateral mass screws were bridged by two rods. A segment of 6 cm rib was harvested from the left 7th rib, and bihalved to placed between occipital bone, C1 and C2 lamina by a Sof-Wire (Codman) fixation. Hydroxyappatite artificial bone graft were placed over decorticated surfaces of C2-4 lamina. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position with head fixed on the previously applied Halo ring. After shaving, disinfection & draping in sterile fashion, a midline incision was made from the inion to C6 level. The incision was further deepened until the spinous processes were exposed. The paraspinal muscles were dissected off from C2-C5 laminae, the muscles attached to suboccipital area were also detached. Lateral mass screws were then inserted at bilateral C3 & C4. Occipital plate was fixed onto suboccipital area. Another oblique linear incision was made at left upper back, along the course of left 7th rib. After careful dissection of surrounding tissues off the rib, a segment of rib was harvested. The harvested rib was cut in half and placed over C0-C2 laminae. Rods were then fixed to the occipital plate & the lateral mass screws. The rib grafts were fixed to the C2 spinous process with Sof-Wire. Bone fragments & Synbone were placed over the decorticated surfaces of C2-4 laminae. After hemostasis, 1 CWV drain was set, and both wounds were then closed in layers. Operators VS 楊士弘 Assistants R4 王奐之, Ri 謝明秀 Indication Of Emergent Operation Myelopathy 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Occipitocervical fixation and fusion, posterior 開立醫師: 王奐之 開立時間: 2011/07/13 21:37 Pre-operative Diagnosis Occipitoatlantoaxial subluxation; spondyloepiphyseal dysplasia Post-operative Diagnosis Occipitoatlantoaxial subluxation; spondyloepiphyseal dysplasia Operative Method Occipitocervical fixation and fusion, posterior Specimen Count And Types nil Pathology Nil Operative Findings The atlantoaxial subluxation was reduced back in normal position by close reduction, after verification by C-arm fluorscopy. The wound bled easily throughout the procedure. The spinous processes of C2-5 was hypoplastic. A T-shaped occipital plate was fixed to the occipital bone by 2 screws (10 mm and 14 mm respectivey). Four lateral mass screws were inserted into the C3, and C4 (14-18 mm long, 3.5 mm in diameter). The occipital plate and lateral mass screws were bridged by two rods. A segment of 6 cm rib was harvested from the left 7th rib, and bihalved to placed between occipital bone, C1 and C2 lamina by a Sof-Wire (Codman) fixation. Hydroxyappatite artificial bone graft were placed over decorticated surfaces of C2-4 lamina. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position with head fixed on the previously applied Halo ring. After shaving, disinfection & draping in sterile fashion, a midline incision was made from the inion to C6 level. The incision was further deepened until the spinous processes were exposed. The paraspinal muscles were dissected off from C2-C5 laminae, the muscles attached to suboccipital area were also detached. Lateral mass screws were then inserted at bilateral C3 & C4. Occipital plate was fixed onto suboccipital area. Another oblique linear incision was made at left upper back, along the course of left 7th rib. After careful dissection of surrounding tissues off the rib, a segment of rib was harvested. The harvested rib was cut in half and placed over C0-C2 laminae. Rods were then fixed to the occipital plate & the lateral mass screws. The rib grafts were fixed to the C2 spinous process with Sof-Wire. Bone fragments & Synbone were placed over the decorticated surfaces of C2-4 laminae. After hemostasis, 1 CWV drain was set, and both wounds were then closed in layers. Operators VS 楊士弘 Assistants R4 王奐之, Ri 謝明秀 Indication Of Emergent Operation Myelopathy 相關圖片 陳羅惠美 (F,1940/12/20,71y2m) 手術日期 2011/07/13 手術主治醫師 蕭輔仁 手術區域 東址 005房 03號 診斷 Patients requiring long-term use of a respirator due to respiratory failure, use respirator 6 hours per day continue 30 days 器械術式 Tracheostomy 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 許皓淳, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 12:00 通知急診手術 14:15 進入手術室 14:16 麻醉開始 14:19 手術開始 14:20 誘導結束 14:55 手術結束 14:55 麻醉結束 15:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 氣管切開術 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 許皓淳 開立時間: 2011/07/13 15:03 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types nil Pathology Nil Operative Findings Fr. 8 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tube is fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Operators VS蕭輔仁 Assistants R5李振豪, R2許皓淳 Indication Of Emergent Operation 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 李振豪 開立時間: 2011/07/13 15:05 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types nil Pathology Nil Operative Findings Fr. 8 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tube is fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Operators VS蕭輔仁 Assistants R5李振豪, R2許皓淳 Indication Of Emergent Operation Prolonged endotracheal intubation with repeat pneumonia 相關圖片 陳自文 (M,1945/01/08,67y2m) 手術日期 2011/07/14 手術主治醫師 陳敞牧 手術區域 東址 005房 01號 診斷 Herniation of intervertebral disc, lumbar 器械術式 Microsurgical discectomy, L5-S1 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 1 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 08:04 進入手術室 08:15 麻醉開始 08:24 誘導結束 08:35 抗生素給藥 09:01 手術開始 10:20 手術結束 10:20 麻醉結束 10:28 送出病患 10:30 進入恢復室 11:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術(減壓)-二節以內 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: L4/5 left laminotomy for decompression 開立醫師: 李振豪 開立時間: 2011/07/14 10:23 Pre-operative Diagnosis Left sciatica, suspect L4/5 herniated intervertebral disc Post-operative Diagnosis Left sciatica Operative Method L4/5 left laminotomy for decompression Specimen Count And Types nil Pathology Nil Operative Findings Degenerative change and unstable facet joint was noted during the operation. After decompression, the thecal sac expanded well. The L4/5 disc was left intact since no remarkable bulging disc with root compression. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position. L4/5 disc space was localized by portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made at L4/5 disc space and left paravertebral muscle groups were detached. The laminae was exposed and laminotomy with decompression was performed. The disc space was checked but no remarkable bulging disc noted. Hemostasis was achieved and the wound was closed in layers with 2-0 Vicryl and 4-0 Dexon. Operators VS陳敞牧 Assistants R5李振豪, R3曾偉倫 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: L4/5 left laminotomy for decompression 開立醫師: 李振豪 開立時間: 2011/07/14 10:23 Pre-operative Diagnosis Left sciatica, suspect L4/5 herniated intervertebral disc Post-operative Diagnosis Left sciatica Operative Method L4/5 left laminotomy for decompression Specimen Count And Types nil Pathology Nil Operative Findings Degenerative change and unstable facet joint was noted during the operation. After decompression, the thecal sac expanded well. The L4/5 disc was left intact since no remarkable bulging disc with root compression. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position. L4/5 disc space was localized by portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made at L4/5 disc space and left paravertebral muscle groups were detached. The laminae was exposed and laminotomy with decompression was performed. The disc space was checked but no remarkable bulging disc noted. Hemostasis was achieved and the wound was closed in layers with 2-0 Vicryl and 4-0 Dexon. Operators VS陳敞牧 Assistants R5李振豪, R3曾偉倫 相關圖片 蔡聲國 (M,1950/07/25,61y7m) 手術日期 2011/07/14 手術主治醫師 陳敞牧 手術區域 東址 005房 02號 診斷 Back sprain 器械術式 Right Kocher V-P shunt insertion 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 2 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 10:43 進入手術室 10:48 麻醉開始 10:55 誘導結束 11:10 抗生素給藥 11:29 手術開始 12:32 手術結束 12:32 麻醉結束 12:42 送出病患 12:45 進入恢復室 14:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: V-P shunt insertion via right Kocher point 開立醫師: 曾偉倫 開立時間: 2011/07/14 12:55 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method V-P shunt insertion via right Kocher point Specimen Count And Types nil Pathology Nil. Operative Findings 1. The CSF was clear in character. The pressure was not evelated 2. A Codman Programmable shunt was inserted with initial presure 100mm-H2O Ventricular catheter 7 cm, Peritoneal catheter: 30 cm 3. The shunt function was tested with fair flow Operative Procedures Under ETGA, patient was put on supine position with his head tilt to left. After we shaved, scrubbed, disinfected and drapped, a linear skin incision was made over right kocher point. After the burr hole and durotomy were made, right lateral ventricle was reached with ventricular puncture needle. A horizintal skin incision was made over right abdominal area and the peritonium was reached after we opened the wound in layers. The sub-cutaneous tunnel was made with trochar. The venntricular catheter and peritoneal catheter were inserted after the shunt function was tested. The resovoir was placed over right post-auricular area. The wound was closed in layers after complete hemostasis. Operators VS 陳敞牧 Assistants R5 李振豪 R3 曾偉倫 相關圖片 丁培勳 (M,1943/10/10,68y5m) 手術日期 2011/07/14 手術主治醫師 劉嘉銘 手術區域 東址 003房 04號 診斷 Mitral valve insufficiency and aortic valve stenosis 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 蕭柏妮 ASA 3 紀錄醫師 林冠良, 時間資訊 19:35 報到 19:35 進入手術室 19:40 麻醉開始 19:42 誘導結束 19:45 手術開始 20:00 麻醉結束 20:00 手術結束 20:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 氣管切開術 1 0 記錄__ 手術科部: 耳鼻喉部 套用罐頭: Tracheostomy 開立醫師: 林冠良 開立時間: 2011/07/15 15:20 Pre-operative Diagnosis Respiratory failure with prolonged intubation Post-operative Diagnosis Respiratory failure with prolonged intubation, operated Operative Method Tracheostomy Specimen Count And Types nil Pathology Nil Operative Findings Deep trachea position Operative Procedures The patient was in supine position with neck hyperextended. Skin was disinfected and draped as usual. Local anesthesia with Bosmin-rinsed Xylocaine was injected into the subcutaneous tissue and the pretracheal area layer by layer. A verticalskin incision was made in the midline of lower neck. Subcutaneous tissue, fascia and strap muscles were separated, then the thyroid gland was seen and hooked upwards with thyroid hooks. The tracheal rings were cut in longitudinal direction.An oval-shaped window was made at the 2 nd to 3 rd rings. A 8# low pressure tracheostomy tube was inserted. The patient tolerated the above procedure well. Operators P劉嘉銘 Assistants R3林冠良/ R4周承翰 郭黃靜妹 (F,1941/11/10,70y4m) 手術日期 2011/07/14 手術主治醫師 蕭輔仁 手術區域 東址 005房 03號 診斷 Parkinson''s disease 器械術式 L5-S1 TPS 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 3 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 13:03 進入手術室 13:10 麻醉開始 14:00 誘導結束 14:00 抗生素給藥 14:15 手術開始 17:15 手術結束 17:15 麻醉結束 17:22 送出病患 17:25 進入恢復室 21:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎弓切除術(減壓)-二節以內 1 2 摘要__ 手術科部: 外科部 套用罐頭: L5 laminectomy + TPS with posterior-lateral f... 開立醫師: 曾偉倫 開立時間: 2011/07/14 17:29 Pre-operative Diagnosis Spondylolisthesis, L5-S1 Post-operative Diagnosis Spondylolisthesis, L5-S1 Operative Method L5 laminectomy + TPS with posterior-lateral fusion L5-S1 Specimen Count And Types nil Pathology Nil. Operative Findings 1. Spondylolisthesis over L5-S1 level with spinal stenosis. Scoliosis (+) 2. The thecal sac expand well after laminectomy 3. Instrumentation: A-spine Screws: L5: 6.0 x 45mm x II; S1: 6.5 x 40mm x II Rods: 5cm x II Operative Procedures Under ETGA, we placed the patient over prone position. We locate the L5-S1 level with C-arm. After we scrubbed, disinfected and drapped, a mid-line skin incision was made. The para spinal muscle was divided and retracted. Bilateral L5, S1 lamina and L5-S1 facet joint was exposed. We rmoved the spinous process of L5 and laminectomy with Rongour and Kerrison punch. The TPS was inserted over L5 and S1 pedicles. L5 laminectomy was performed and the poaterior-lateral fusion was done with rods. After complete hemostasis, a hemovac drain was inserted. We closed the wound in layers. Operators VS 蕭輔仁 Assistants R5 李振豪 R3 曾偉倫 相關圖片 沈常山 (M,1925/01/13,87y2m) 手術日期 2011/07/14 手術主治醫師 蕭輔仁 手術區域 東址 005房 04號 診斷 Low back pain 器械術式 Radiofrequency coagulation(P-G 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 17:55 進入手術室 18:05 麻醉開始 18:10 誘導結束 18:15 手術開始 18:50 麻醉結束 18:55 送出病患 18:55 手術結束 醫令資訊 類別 名稱 量 刀 側 手術 高頻熱凝療法 1 1 B 記錄__ 手術科部: 外科部 套用罐頭: Radiofrequency stimulation, bilateral L2 dors... 開立醫師: 李振豪 開立時間: 2011/07/14 18:44 Pre-operative Diagnosis Low back pain Post-operative Diagnosis Low back pain Operative Method Radiofrequency stimulation, bilateral L2 dorsal root Specimen Count And Types nil Pathology Nil Operative Findings 1. Bilateral L2 dorsal root was identified by portable C-arm X-ray and sensory/motor stimulation test. No acute complication was noted after the procedure. 2. Temp: 42 oC, Time: 180sec x 2 cycles each side Operative Procedures The patient was put in prone position. The location of L2 was identified by portable C-arm X-ray. The skin was disinfected and draped as usual. Local anesthesia was performed with 1% Xylocaine 10ml. Bilateral L2 dorsal root radiofrequency stimulation was performed under portable C-arm guided. The patient stood whole procedure well. Operators VS 蕭輔仁 Assistants R5 李振豪 R3 曾偉倫 相關圖片 張峻國 (M,1992/07/17,19y7m) 手術日期 2011/07/14 手術主治醫師 蕭輔仁 手術區域 東址 006房 03號 診斷 Benign neoplasm of subcutaneous tissue 器械術式 Excision of neuroma 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 17:15 進入手術室 17:24 麻醉開始 17:25 誘導結束 17:27 手術開始 17:45 手術結束 17:45 麻醉結束 17:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 皮下腫瘤摘除術中2-4 CM 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Tumor excision 開立醫師: 李振豪 開立時間: 2011/07/14 17:51 Pre-operative Diagnosis Right thigh subcutaneous tumor, r/o lipoma Post-operative Diagnosis Right thigh subcutaneous tumor, favor lipoma Operative Method Tumor excision Specimen Count And Types 1 piece About size:2.1cm in diameter Source:right thigh subcutaneous neuroma Pathology Pending Operative Findings The tumor is yellowish, well-capsulated, subcutaneous in depth, hypovascularized, and 2.1cm in diameter. No obvious adhesion or invasion to adjacent soft tissue. Lipoma is most likely clinically. Operative Procedures The patient was put in supine position. The skin was disinfected and draped as usual. Local anesthesia with 5ml 1% Xylocaine was applied. One linear skin incision was made at right thigh and the subcutaneous tumor was identified. The tumor was dissected along the margin and removed totally. Hemostasis was achieved and the wound was closed in layers with 3-0 Vicryl and 4-0 Nylon. Operators VS蕭輔仁 Assistants R5李振豪 相關圖片 李白燕 (F,1926/07/10,85y8m) 手術日期 2011/07/14 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Head Injury 器械術式 Cranioplasty, autologus bone graft 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 4 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 08:00 進入手術室 08:10 麻醉開始 08:15 誘導結束 09:00 抗生素給藥 09:25 手術開始 10:53 11:30 手術結束 11:30 麻醉結束 11:45 送出病患 11:48 進入恢復室 13:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 頭顱成形術 1 2 L 手術 腦室腹腔分流手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: 1. Left side cranioplasty with autologous bon... 開立醫師: 王奐之 開立時間: 2011/07/14 11:55 Pre-operative Diagnosis Left side skull defect with hydrocephalus Post-operative Diagnosis Left side skull defect with hydrocephalus Operative Method 1. Left side cranioplasty with autologous bone graft 2. Ventriculoperitoneal shunt insertion via right Kocher point Specimen Count And Types Nil Pathology Nil Operative Findings Only mild adhesion was noted at left skull defect. Codman programmable shunt was used, preset to 150mmH2O. Ventricular catheter length: 7cm, peritoneal catheter length: 30cm. Opening pressure: about 5cmH2O. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to right. After shaving, disinfection & draping in sterile fashion, a curved incision along previous wound at left frontotemporal area was done. The plane between dura and galea was then dissected, and the bony defect edge was exposed. After 7 central tenting stitches, the bone graft was fixed in place with mini-plates. The wound was closed in layers after hemostasis and setting 1 subgaleal CWV drain. The patient was then placed in supine position with head turned to left. After shaving, disinfection & draping in sterile fashion, a transverse linear incision was made at right frontal area. A burr hole was made at right Kocher point. Another incision was made at right upper quadrant of abdomen, followed by mini-laparotomy. After creation of subcutaneous tunnel from the abdominal wound to the right frontal wound, the shunt catheter was assembled and inserted. A small durotomy was done after 2 tenting stitches. Ventricular tapping was done, followed by insertion of ventricular catheter. The wounds were then closed in layers. Operators VS 王國川 Assistants R4 王奐之, Ri 沈維真 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: 1. Left side cranioplasty with autologous bon... 開立醫師: 王奐之 開立時間: 2011/07/14 11:57 Pre-operative Diagnosis Left side skull defect with hydrocephalus Post-operative Diagnosis Left side skull defect with hydrocephalus Operative Method 1. Left side cranioplasty with autologous bone graft 2. Ventriculoperitoneal shunt insertion via right Kocher point Specimen Count And Types Nil Pathology Nil Operative Findings Only mild adhesion was noted at left skull defect. Codman programmable shunt was used, preset to 150mmH2O. Ventricular catheter length: 7cm, peritoneal catheter length: 30cm. Opening pressure: about 5cmH2O. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to right. After shaving, disinfection & draping in sterile fashion, a curved incision along previous wound at left frontotemporal area was done. The plane between dura and galea was then dissected, and the bony defect edge was exposed. After 7 central tenting stitches, the bone graft was fixed in place with mini-plates. The wound was closed in layers after hemostasis and setting 1 subgaleal CWV drain. The patient was then placed in supine position with head turned to left. After shaving, disinfection & draping in sterile fashion, a transverse linear incision was made at right frontal area. A burr hole was made at right Kocher point. Another incision was made at right upper quadrant of abdomen, followed by mini-laparotomy. After creation of subcutaneous tunnel from the abdominal wound to the right frontal wound, the shunt catheter was assembled and inserted. A small durotomy was done after 2 tenting stitches. Ventricular tapping was done, followed by insertion of ventricular catheter. The wounds were then closed in layers. Operators VS 王國川 Assistants R4 王奐之, Ri 沈維真 相關圖片 劉林阿好 (F,1928/01/02,84y2m) 手術日期 2011/07/14 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 Malignant neoplasm of kidney, except pelvis 器械術式 Right frontal craniotomy for tumor excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 3 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 12:00 進入手術室 12:05 麻醉開始 12:30 誘導結束 12:30 抗生素給藥 12:58 手術開始 15:15 手術結束 15:15 麻醉結束 15:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除-手術時間在4小時以內 1 1 R 手術 超音波診查機–腦神經外科術中特殊儀器使用費 1 0 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for total tumor removal 開立醫師: 王奐之 開立時間: 2011/07/14 15:25 Pre-operative Diagnosis Right frontal metastatic tumor Post-operative Diagnosis Right frontal metastatic tumor Operative Method Craniotomy for total tumor removal Specimen Count And Types 1 piece About size:1*1*1cm Source:right frontal lobe Pathology Pending Operative Findings One elastic-firm fragile yellowish round tumor was noted at right frontal area, measuring about 1cm in diameter, just beneath the coronal suture. No obvious cystic component was noted. Easy oozing was encountered while dissecting the tumor border. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After shaving, scrubbing, disinfection & draping in sterile fashion, a slightly sigmoid-shaped linear incision was made at right frontal area. After drilling of 3 burr holes, a round craniotomy was made. A C-shaped durotomy was done, and the tumor location was confirmed under intra-operative ultrasound. After opening the arachnoid membrane, the tumor was dissected from surrounding brain tissue and was removed totally. After meticulous hemostasis, the dura was closed with a piece of temporalis fascia in water fashion with 4-0 Prolene continuous suture. After 2 central tenting stitches, the bone flap was placed back and fixed with 4 wires. The wound was closed in layers. Operators VS 王國川 Assistants R4 王奐之, Ri 沈維真 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Craniotomy for total tumor removal 開立醫師: 王奐之 開立時間: 2011/07/14 15:25 Pre-operative Diagnosis Right frontal metastatic tumor Post-operative Diagnosis Right frontal metastatic tumor Operative Method Craniotomy for total tumor removal Specimen Count And Types 1 piece About size:1*1*1cm Source:right frontal lobe Pathology Pending Operative Findings One elastic-firm fragile yellowish round tumor was noted at right frontal area, measuring about 1cm in diameter, just beneath the coronal suture. No obvious cystic component was noted. Easy oozing was encountered while dissecting the tumor border. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After shaving, scrubbing, disinfection & draping in sterile fashion, a slightly sigmoid-shaped linear incision was made at right frontal area. After drilling of 3 burr holes, a round craniotomy was made. A C-shaped durotomy was done, and the tumor location was confirmed under intra-operative ultrasound. After opening the arachnoid membrane, the tumor was dissected from surrounding brain tissue and was removed totally. After meticulous hemostasis, the dura was closed with a piece of temporalis fascia in water fashion with 4-0 Prolene continuous suture. After 2 central tenting stitches, the bone flap was placed back and fixed with 4 wires. The wound was closed in layers. Operators VS 王國川 Assistants R4 王奐之, Ri 沈維真 相關圖片 吳潘雪子 (F,1937/09/07,74y6m) 手術日期 2011/07/14 手術主治醫師 王國川 手術區域 東址 003房 03號 診斷 Secondary malignant neoplasm of brain and spinal cord 器械術式 Left T-O craniotomy for tumor excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 3 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 14:40 報到 15:40 進入手術室 15:45 麻醉開始 16:00 誘導結束 16:28 手術開始 18:40 麻醉結束 18:40 手術結束 18:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 L 手術 超音波診查機–腦神經外科術中特殊儀器使用費 1 0 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Left temporo-occipital craniotomy for tumor r... 開立醫師: 王奐之 開立時間: 2011/07/14 19:24 Pre-operative Diagnosis Left temporo-occipital metastatic tumor Post-operative Diagnosis Left temporo-occipital metastatic tumor Operative Method Left temporo-occipital craniotomy for tumor removal Specimen Count And Types 1 piece About size:5*3*3cm Source:left temporo-occipital lobe Pathology Nil Operative Findings Brain tissue bulged out after durotomy, and sank down after tumor removal. Yellowish fragile tumor was noted at left temporo-occipital area, thin ventricular wall (temporal horn of left lateral ventricle) was noted after tumor removal. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to right. After shaving, scrubbing, disinfection & draping in sterile fashion, a reverse U-shaped incision was made at left temporo-occipital area. After dissection of skin flap, 5 burr holes were made, followed by craniotomy. A C-shaped durotomy was made, and the dura was reflected inferiorly. After intra-operative localization of tumor with ultrasonography, the tumor border was dissected. The tumor was then removed en bloc. After meticulous hemostasis, the dura was closed with a piece of periosteal graft in water-tight fashion with 4-0 Prolene continuous sutures. Three central tenting stitches were applied, the bone flap was fixed back with 5 wires. After setting 1 subgaleal CWV drain, the wound was closed in layers. Operators VS 王國川 Assistants R4 王奐之, Ri 沈維真 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Left temporo-occipital craniotomy for tumor r... 開立醫師: 王奐之 開立時間: 2011/07/14 19:24 Pre-operative Diagnosis Left temporo-occipital metastatic tumor Post-operative Diagnosis Left temporo-occipital metastatic tumor Operative Method Left temporo-occipital craniotomy for tumor removal Specimen Count And Types 1 piece About size:5*3*3cm Source:left temporo-occipital lobe Pathology Nil Operative Findings Brain tissue bulged out after durotomy, and sank down after tumor removal. Yellowish fragile tumor was noted at left temporo-occipital area, thin ventricular wall (temporal horn of left lateral ventricle) was noted after tumor removal. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to right. After shaving, scrubbing, disinfection & draping in sterile fashion, a reverse U-shaped incision was made at left temporo-occipital area. After dissection of skin flap, 5 burr holes were made, followed by craniotomy. A C-shaped durotomy was made, and the dura was reflected inferiorly. After intra-operative localization of tumor with ultrasonography, the tumor border was dissected. The tumor was then removed en bloc. After meticulous hemostasis, the dura was closed with a piece of periosteal graft in water-tight fashion with 4-0 Prolene continuous sutures. Three central tenting stitches were applied, the bone flap was fixed back with 5 wires. After setting 1 subgaleal CWV drain, the wound was closed in layers. Operators VS 王國川 Assistants R4 王奐之, Ri 沈維真 相關圖片 張貴美 (F,1953/06/16,58y8m) 手術日期 2011/07/14 手術主治醫師 謝敦理 手術區域 西址 033房 04號 診斷 Otitis media with effusion 器械術式 Gromment placement (ntuh made) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 09:55 進入手術室 09:55 報到 09:57 麻醉開始 10:00 手術開始 10:10 麻醉結束 10:10 手術結束 10:12 送出病患 記錄__ 手術科部: 耳鼻喉部 套用罐頭: Grommet tube insertion, left 開立醫師: 廖怡茹 開立時間: 2011/07/14 10:00 Pre-operative Diagnosis OME, left Post-operative Diagnosis OME, left,operated Operative Method Grommet tube insertion, left Specimen Count And Types nil Pathology Nil Operative Findings left MEE(+) with glue-like discharge. Operative Procedures 1.The patient was put in supine position. 2.After local anestehsia of external auditory canal, the face was disinfected and draped as usual. 3.Her head was turned to the right side. 4.Radial incision was made over the anterio-inferior quadrant of the left eardrum and middle ear effusion was sucked out. 5.Then one 1.27mm Grommet tube was inserted smoothly. . 6.The patient tolerated the whole procedure well. Operators 謝敦理, Assistants R4許軍偉,R3廖怡茹, 黃淑珍 (F,1962/04/20,49y10m) 手術日期 2011/07/15 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Spinal tumor 器械術式 Right L2 neuroma excision 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 1 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:10 麻醉開始 08:20 誘導結束 08:50 抗生素給藥 09:30 手術開始 11:50 抗生素給藥 12:35 手術結束 12:35 麻醉結束 12:41 進入恢復室 12:50 送出病患 14:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 良性脊髓腫瘤切除術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 曾峰毅 開立時間: 2011/07/15 12:26 Pre-operative Diagnosis Right L2 root neurilemmoma Post-operative Diagnosis Right L2 root neurilemmoma Operative Method Right L2/3 foraminotomy for right L2 neurilemmoma tumor excision Specimen Count And Types Several fragments of one tumor was sent for pathology. Pathology Nil Operative Findings One well capsulated, hypervascular, soft to fragile, yellowish tumor arised from right L2 root. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After C-arm localization, we scrubbed, disinfected, and then draped the patient's back. We made midline skin incision along previous skin incision. We dissected right paraspinal muscle to expose right L2 laminae. We performed right L2 partial hemilaminectomy and right L2/3 foraminotomy. The tumor was removed subcapsularly in piecemeal with tumor forceps, CUSA, and suction. The dura was sutured in water-tight fashion. After hemostasis, the wound was closed in layers. Operators P 杜永光 Assistants R5 曾峰毅 R3 陳國瑋 相關圖片 劉廷豐 (M,1955/09/22,56y5m) 手術日期 2011/07/15 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 許皓淳, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:10 麻醉開始 08:20 誘導結束 08:40 手術開始 08:50 抗生素給藥 10:35 開始輸血 11:50 抗生素給藥 13:25 手術結束 13:25 麻醉結束 13:35 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 顱底瘤手術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 記錄__ 手術科部: 外科部 套用罐頭: Bifrontal craniotomy for Simpson grade II tum... 開立醫師: 李振豪 開立時間: 2011/07/15 14:00 Pre-operative Diagnosis Frontal base huge tumor, favor olfactory groove meningioma Post-operative Diagnosis Olfactory groove meningioma Operative Method Bifrontal craniotomy for Simpson grade II tumor excision Specimen Count And Types 1 piece About size:7.9 x 7.1 x 5.8cm Source:Frontal base tumor Pathology Pending Operative Findings The tumor was 7.9 x 7.1 x 5.8cm in size, hypervascularized, well-capsulated, firm to hard in character. The tumor was mainly attached at frontal base with much small feeding arteries. After devascularization from skull base, the tumor became hypovascularized. Some calcification was noted within the tumor. Left olfactory nerve was sacrified during the operation. Bilateral optic nerve, optic chiasma, bilateral internal carotid artery, bilateral anterior cerebral artery, A-com artery, and left MCA were all well preserved and visualized after total resection of the tumor. The vascular structure over brain surface also preserved during dissection. The brain became slack after total removal of the tumor. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. Bicoronal scalp incision was made and the scalp flap was elevated. Five burr holes were created followed by one 15 x 7cm craniotomy. The frontal sinus was opened and sealed with bone wax. Dural tenting was performed. C-shape durotomy based with frontal base was performed over left frontal area. The tumor was identified. Devascularization was performed and the tumor was dissected along the capsule. Debulking was performed during dissection of the tumor. After total removal of the tumor, the dura over frontal base was coagulated. Hemostasis was achieved with bipolar electrocautery and Surgicel lining. Dura was closed with 4-0 Prolene. The skull plate was fixed back with miniplates and two central tenting. One subgaleal CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and Appose staples. Operators VS曾漢民 Assistants R5李振豪, R2許皓淳 相關圖片 林鈺芳 (F,1951/11/09,60y4m) 手術日期 2011/07/15 手術主治醫師 賴達明 手術區域 東址 003房 03號 診斷 Intracerebral hemorrhage 器械術式 Left craniectomy with hematomaevacuation 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 4E 紀錄醫師 陳國瑋, 時間資訊 13:46 開始NPO 13:46 通知急診手術 15:16 麻醉開始 15:16 進入手術室 15:30 誘導結束 15:35 抗生素給藥 15:40 手術開始 18:50 抗生素給藥 18:55 手術結束 18:55 麻醉結束 19:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦內血腫清除術 1 1 L 手術 顱內壓視置入 1 2 L 摘要__ 手術科部: 外科部 套用罐頭: CVA 開立醫師: 曾峰毅 開立時間: 2011/07/15 18:55 Pre-operative Diagnosis Subcortical intracerebral hemorrhage at left frontoparietal Post-operative Diagnosis Subcortical intracerebral hemorrhage at left frontoparietal Operative Method Left craniectomy for intracerebral hematoma evacuation and ICP monitor insertion Specimen Count And Types Nil Pathology Nil Operative Findings Subcortical ICH was noted at left frontoparietal area. ICH gushed out spontaneously via a corticotomy at left parietal area while durotomy. Codman ICP monitor reference was 491. ICP after wound closure was 8 mmHg. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to right. After scalp shaved, scrubebd, disinfected, and then draped, we made one question-mark scalp incision at left frontotemporoparietal area. We created craniectomy about 10 x 12 cm, and performed dura incision. ICH was removed. After hemostasis, duroplasty was done with durafoam. ICP monitor was inserted into subdural space. The wound was closed in layers after two subgaleal CWV placed. Operators VS 賴達明 Assistants R5 曾峰毅 R3 陳國瑋 Indication Of Emergent Operation Uncal herniation 相關圖片 徐振東 (M,1948/05/24,63y9m) 手術日期 2011/07/15 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Epigastralgia 器械術式 L3-5 sublaminal decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:05 進入手術室 08:10 麻醉開始 08:25 誘導結束 08:45 抗生素給藥 09:22 手術開始 11:30 手術結束 11:30 麻醉結束 11:42 送出病患 11:45 進入恢復室 12:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術(減壓)-二節以內 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 記錄__ 手術科部: 外科部 套用罐頭: L3, L4 partial laminectomy with sublaminal de... 開立醫師: 林哲光 開立時間: 2011/07/15 11:55 Pre-operative Diagnosis L3-5 spinal canal stenosis Post-operative Diagnosis L3-5 spinal canal stenosis Operative Method L3, L4 partial laminectomy with sublaminal decompression Specimen Count And Types nil Pathology Nil Operative Findings Hypertrophic change of the ligamentum flavum was noted at L3, L4 level with tightly compressing spinal cord at L3/4 level. The dura seemed reexpanded well after removal of the ligamentum flavum. Operative Procedures Under ETGA and prone position, skin disinfected and drapped were performed as usual. Midline skin incision was made at L3-L5 level after C-arm localization. The paraspinal muscles were detached and partial L3 and L4 laminectomy were done. Sublaminal decompression was then performed. The wound was then closed in layers after hemostasis with Gelfoam packing and a epidural drain insertion. Operators 賴達明 Assistants 林哲光 相關圖片 柯佳媛 (F,1950/11/17,61y3m) 手術日期 2011/07/15 手術主治醫師 賴達明 手術區域 東址 019房 02號 診斷 Brain tumor 器械術式 Left retrosigmoid approach acoustic neuroma excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 11:10 報到 12:03 進入手術室 12:05 麻醉開始 12:25 誘導結束 12:25 抗生素給藥 12:35 手術開始 15:50 抗生素給藥 18:00 麻醉結束 18:00 手術結束 18:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 顱底瘤手術 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Left retrosigmoid approach tumor excision, su... 開立醫師: 林哲光 開立時間: 2011/07/15 18:58 Pre-operative Diagnosis Left cerebellopontine tumor, suspected vestibular schwannoma Post-operative Diagnosis Left cerebellopontine tumor, suspected vestibular schwannoma Operative Method Left retrosigmoid approach tumor excision, subtotal removal Specimen Count And Types 1 piece About size:multiple pieces Source:Tumor Pathology Pending Operative Findings A cerebellopontine mass lesion was noted with tightly adherent to left CN 7/8 complex. The mass was fragile, grayish-to-whitish, encapsulated with some yellowish dicoloration. Cystic and solid component were noted. Grossly the tumor was removed extensively expected some attachment was left on the nerve sheath at CN 8. Intraoperative BAEP and SSEP were not changed and facial nerve stimulation was done after tumor removal and good response was noted. Operative Procedures Under ETGA and park bench position, skin disinfected and drapped were perofmred as usual. A S shaped skin incision at left posterior auricle area. The muscles were detached and a burr hole was created at right T-S junction, asterion. Craniotomy was then done. The dura was opened pia incision. Cerebellopontine cistern was opened for CSF drainage and the tumor was identified at CN 7/8 complex. Tumor excision was then performed. The dura was closed in water-tie method. The skull bone was put back and fixed with mini-plates. The wound was then closed in layers after a subgalaeal drain insertion. Operators AP 賴達明 Assistants R5 林哲光 相關圖片 SAE CHIAO SUPHAPHON (F,1969/01/01,43y2m) 手術日期 2011/07/15 手術主治醫師 楊士弘 手術區域 東址 003房 02號 診斷 Tuberculosis meningitis 器械術式 V-P shunt removal, EVD insertion 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 13:20 進入手術室 13:25 麻醉開始 13:32 誘導結束 14:00 手術開始 14:40 手術結束 14:40 麻醉結束 14:50 送出病患 14:51 進入恢復室 15:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 頭顱穿洞術(止血引流、穿刺檢查) 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 內科部 套用罐頭: Removal of ventriculoperitoneal shunt, and ex... 開立醫師: 曾峰毅 開立時間: 2011/07/15 14:27 Pre-operative Diagnosis Tuberculosis meningitis, status post ventriculoperitoneal shunt, complicated with shunt infection Post-operative Diagnosis Tuberculosis meningitis, status post ventriculoperitoneal shunt, complicated with shunt infection Operative Method Removal of ventriculoperitoneal shunt, and external ventricular drainage via right Kocher point Specimen Count And Types Nil Pathology Nil Operative Findings Turbid CSF drained via the external ventricular drainage. Opening pressure was about 5 cmH20. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to left. We made skin incision along previous operation wound, and removed previous ventriculoperitoneal shunt. We inserted external ventricular drain catheter via previuos ventriculostomy, and pulled out the catheter at right post-auricular area. We closed the wound in layers. Operators VS 楊士弘 Assistants R5 曾峰毅 R3 陳國瑋 Ri 李宜潔 相關圖片 李白燕 (F,1926/07/10,85y8m) 手術日期 2011/07/15 手術主治醫師 王國川 手術區域 東址 002房 03號 診斷 Head Injury 器械術式 Removal of subdural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 4E 紀錄醫師 林哲光, 時間資訊 01:08 開始NPO 01:08 臨時手術NPO 01:08 通知急診手術 01:35 進入手術室 01:35 報到 01:40 麻醉開始 02:00 誘導結束 02:10 手術開始 02:45 開始輸血 03:55 麻醉結束 03:55 手術結束 04:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 急性硬腦膜下血腫清除術 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Right F-T-P craniotomy with hematoma evacuati... 開立醫師: 林哲光 開立時間: 2011/07/15 04:20 Pre-operative Diagnosis Right F-T-P acute SDH Post-operative Diagnosis Right F-T-P acute SDH Operative Method Right F-T-P craniotomy with hematoma evacuation with subdural drain insertion Specimen Count And Types nil Pathology Nil Operative Findings Around 2cm thick hematoma was noted at right F-T-P area. The brain seemed slack after hematoma removal. V-P shunt was left unexposed during the procedure. Operative Procedures Under ETGA and supine position with head rotated to left side, skin disinfected and drapped were performed as usual. A reverse U shaped skin incision was made at right F-T-P area. Craniotomy was then done after four burr holes created. The dura was then opened after dural tenting. Hematoma removal was done and the dura was closed in water-tie way with autologus fascia augmentation. The skull bone was then put back and fixed with mini-plates. The wound was then closed in layers after subdural drain and subgaleal drain insertion. Operators VS 王國川 Assistants R5 林哲光 Indication Of Emergent Operation Conscious disturbance 相關圖片 黃榮星 (M,1950/02/02,62y1m) 手術日期 2011/07/15 手術主治醫師 林孟暐 手術區域 東址 025房 03號 診斷 Chronic renal failure 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 蕭柏妮 ASA 3 紀錄醫師 郝政鴻, 時間資訊 23:24 臨時手術NPO 12:50 報到 12:50 進入手術室 12:55 麻醉開始 13:00 誘導結束 13:05 手術開始 13:10 麻醉結束 13:10 手術結束 13:17 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 氣管切開術 1 0 記錄__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 廖先啟 開立時間: 2011/07/15 13:19 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types nil Pathology None Operative Findings Fr. 8 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators VS林孟暐 Assistants R4郝政鴻，Ri陳柔和 吳國華 (M,1981/09/06,30y6m) 手術日期 2011/07/15 手術主治醫師 王國川 手術區域 東址 002房 01號 診斷 Major trauma rated 16 or above on the severity scale ( Injury severity score >=16 ) 器械術式 ICP monitoring 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 2E 紀錄醫師 曾偉倫, 時間資訊 03:00 臨時手術NPO 03:00 開始NPO 05:01 通知急診手術 05:30 進入手術室 05:40 麻醉開始 05:50 誘導結束 06:30 手術開始 07:45 08:50 抗生素給藥 09:08 麻醉結束 09:08 手術結束 09:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 骨骼外固定器裝置術 1 1 L 手術 顱內壓視置入 1 1 記錄__ 手術科部: 外科部 套用罐頭: Right frontal subdural ICP monitoring, Codman 開立醫師: 林哲光 開立時間: 2011/07/15 07:14 Pre-operative Diagnosis Head injury with conscious change Post-operative Diagnosis Head injury with conscious change Operative Method Right frontal subdural ICP monitoring, Codman Specimen Count And Types nil Pathology Nil Operative Findings Pre-OP GCS E1M5Vt. Initial ICP was 7 mmHg. (Reference is 478) Operative Procedures Under ETGA and prone position, skin disinfected and drapped were performed as usual. Linear skin incision was made at right frontal area and a burr hole was created. The dura was then opened after dural tenting. ICP catheter was then introduced into the subdural area through subcutaneous tunneling. The catheter was then fixed on the skin. The wound was then closed in layers. Operators VS 王國川 Assistants R5 林哲光, R3 曾偉倫 Indication Of Emergent Operation conscious change 摘要__ 手術科部: 骨科部 套用罐頭: Reduction and external skeletal fixation 開立醫師: 葉炳君 開立時間: 2011/07/15 16:07 Pre-operative Diagnosis Left distal femoral shaft fracture Post-operative Diagnosis Left distal femoral shaft fracture Operative Method Reduction and external skeletal fixation Specimen Count And Types nil Pathology nil Operative Findings Left distal femoral shaft comminuted fracture Operative Procedures 1. Under anesthesia, the patient was positioned in supine. 2. Skin disinfection and drapping as usual 3. Inserted two Swan screws on the distal fragment and another two on prpximal fragments 4. Set Trauma-Fix device to bind the screws after reduction 5. Covered the wound with B-I gauze. Operators 王廷明, Assistants 葉炳君, 黃偉程, 林家聖, Indication Of Emergent Operation Trauma 黃能忠 (M,1954/09/12,57y6m) 手術日期 2011/07/16 手術主治醫師 李章銘 手術區域 東址 018房 01號 診斷 Esophageal cancer 器械術式 Port-A catheter implatation 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 高明蔚, 時間資訊 08:03 進入手術室 08:30 抗生素給藥 09:03 手術開始 09:40 手術結束 09:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 port–A導管植入術–治療性導管植入術 1 0 R 摘要__ 手術科部: 外科部 套用罐頭: Port-A implantation, puncutre method 開立醫師: 高明蔚 開立時間: 2011/07/16 10:23 Pre-operative Diagnosis Advanced esophageal cancer Post-operative Diagnosis Advanced esophageal cancer Operative Method Port-A implantation, puncutre method Specimen Count And Types nil Pathology Nil Operative Findings Port-A catheter was inserted via right subclavian vein. The position was confirmed by inra-op chest roentgenography. No immediate complications encountered. Operative Procedures LA, supine, skin disinfection and draping as usual. Insert guidewire then cather via Sheldinger method Fix the port Check bleeding, hemostasis. Close the wound in layers. Operators 李章銘 Assistants R4高明蔚,R1劉欣瑜 林德泉 (M,1957/04/17,54y10m) 手術日期 2011/07/16 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Parkinson''s disease 器械術式 Stereotaxic procedure for DBS 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:03 進入手術室 08:20 麻醉開始 08:25 誘導結束 08:35 抗生素給藥 08:40 手術開始 11:50 抗生素給藥 15:10 抗生素給藥 17:00 麻醉結束 17:00 手術結束 17:10 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 9 0 手術 立體定位術-功能性失調 1 1 B 手術 立體定位術-功能性失調 1 2 B 手術 深部腦核電生理定位 1 0 B 記錄__ 手術科部: 外科部 套用罐頭: Insertion of DBS wire at bilateral subthalamu... 開立醫師: 林哲光 開立時間: 2011/07/16 17:27 Pre-operative Diagnosis Parkisons disease Post-operative Diagnosis Parkisons disease Operative Method Insertion of DBS wire at bilateral subthalamus nucleas Specimen Count And Types nil Pathology Nil Operative Findings 1. The rigidity decreased after wire inserted at stimulation "on". 2. Left eye with left-ward gaze limitation when stimulation "on" over leftsubthalamic nucleus. 3. The final target was 2mm anterior to the planned target. Operative Procedures Under IV general anesthesia, the patient was put in supine position. The scalp was shaved, scrubbed and antiseptic with alcohol B-I. Registered the preset localization point to navigator. Bicoronal scalp incision was made with burr hole made at entery point of left frontal region as navigator guided. The DBS wire port was set up and localization of subthalamus nucleus with microelectrode assistance. Inserted the DBS wire and fixed with the port. Waked the patient from the anesthesia and started stimulation from low voltage. Checked the clinical responses while using different voltage for stimulation. Performed the same procedure at right side. After hemostasis, closed the wound in layers. Operators P 曾勝弘 Assistants R5 林哲光 相關圖片 翁琴汝 (F,1939/05/03,72y10m) 手術日期 2011/07/16 手術主治醫師 黃國皓 手術區域 東址 008房 01號 診斷 Benign neoplasm of connective and other soft tissue of other specified sites 器械術式 腹腔鏡腎臟輸尿管切除術 手術類別 預定手術 手術部位 腹 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 戴逸昇, 時間資訊 07:45 報到 08:05 進入手術室 08:10 麻醉開始 08:30 誘導結束 08:35 抗生素給藥 08:38 手術開始 09:05 11:35 手術結束 11:35 麻醉結束 11:45 送出病患 11:45 11:50 進入恢復室 14:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 輸尿管剝離術-單側 1 1 L 手術 腹腔鏡檢查 1 0 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 泌尿部 套用罐頭: nephrectomy, radical 開立醫師: 戴逸昇 開立時間: 2011/07/16 12:08 Pre-operative Diagnosis Lefy hydronephrosis Post-operative Diagnosis Lefy hydronephrosis Operative Method 1. Laparocopic ureterolysis and pelvic wall repair 2. URS and left DBJ insertion Specimen Count And Types nil Pathology nil Operative Findings 1. Pelvic ureter was stuck between the left ischial bone and piriformis muscle with severe adhesion. 2. The ureter was approximated with psoas muscle 3. Pelvic fossa was stuffed with Surgicels wand covered by mesh. 4. A Fr.7-24cm DBJ catheter was inserted into left ureter Operative Procedures Under satisfactory endotracheal general anesthesia with the patient in lithotomy position position,prepping and draping was performed. A cystoscope was inserted into the bladder and a guidewire was then introduced into the left ureteral orifice. A 6 Fr. ureteroscope was introduced into the ureter, tortuous lower ureter with multiple polypoid lesions was noted. No obvious stricture was noted. A Fr.7-24cm DBJ catheter was inserted. A 16 Fr. Foley catheter was placed in the urinary bladder. Patient was changed to right decubitus position. Prepping and draping was performed again in the usual sterile fashion. A 5-12 Versaport was inserted at the left paraumbilicus area as well as Pneumoperitoneum was created by inflation with CO2 to thepressure of 15 mmHg. Then another 5-12 and 5 Versaport were placed at the left flank under direct vision. After taking the descending colon down by Harmonic , Left gonada vein and ureter were identified, careful dissection was carried out along the gonadal vein downward and pelvic ureter was stuck between the left ischial bone and piriformis muscle with severe adhesion. The ureter were isolated from the surrounding tissuecarefully and made no tension as well as gonada vein was ligation. The ureter was approximated with psoas muscle to keep the ureter straight and stuck site away from the pelvic fossa. Pelvic fossa was stuffed with Surgicels wand covered by mesh. The abdominal incision was closed with continuous 1-O vicryl on the peritoneum and 1-O silk, figure of eight sutures on the fascia. The skin was closed with interrupted 3-O nylon stitches. The patient tolerated the procedure well andwas send to recovery room in satisfactory condition. Operators 黃國皓, Assistants 姜秉均, 戴逸昇, 蔡足味 (F,1968/03/13,44y0m) 手術日期 2011/07/16 手術主治醫師 林志峰 手術區域 東址 023房 02號 診斷 Malignant neoplasm of female breast, nipple and areola 器械術式 WE 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 林峰盛 ASA 3 紀錄醫師 陳姵妤, 時間資訊 10:50 進入手術室 10:55 麻醉開始 11:15 誘導結束 11:20 抗生素給藥 11:30 手術開始 12:30 手術結束 12:35 麻醉結束 12:45 送出病患 12:47 進入恢復室 14:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 C.V.P. catheter in ubation 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 軟組織良性腫瘤切除術,大或深 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Neck mass debulking, right 開立醫師: 陳姵妤 開立時間: 2011/07/16 12:52 Pre-operative Diagnosis Neck mass, Right Post-operative Diagnosis Neck mass, Right, operated Operative Method Neck mass debulking, right Specimen Count And Types 1 piece About size: 3*3cm, Source:neck mass, right Pathology Pending Operative Findings a mass about 3 x 3 cm located at supraclavicular area was removed. Operative Procedures Anesthesia was set up via ETGA. The patient was in supine position with head extended and turned to (left) side. Skin was disinfected and draped as usual. Local anesthesia with Bosmin rinsed Xylocaine was injected into the subcutaneous tissue around the mass. After marking an incision parallel to the skin crease, an about (3*3) cm masses were noted behind the right SCM muscle (below the level of thyroid cartilage). Debulking of right neck mass was performed. After hemostasis, a CWV was inserted and then the wound was closed with 2 layers. The patient tolerated the procedure well. Operators VS林志峰, Assistants R3蘇家弘, R2陳姵妤, 陳滄源 (M,1950/10/10,61y5m) 手術日期 2011/07/16 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Subarachnoid hemorrhage 器械術式 Craniotomy(Aneurysms) a-com aneurysm 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 4E 紀錄醫師 曾峰毅, 時間資訊 12:25 開始NPO 12:25 臨時手術NPO 08:30 進入手術室 08:30 報到 08:35 麻醉開始 08:40 抗生素給藥 08:45 手術開始 08:45 誘導結束 11:40 抗生素給藥 14:47 麻醉結束 14:47 手術結束 14:55 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 開顱術摘除血管病變 - 腦血管瘤 有病徵的 1 1 L 摘要__ 手術科部: 套用罐頭: Left petrional approach for aneurysm clipping 開立醫師: 曾峰毅 開立時間: 2011/07/16 15:30 Pre-operative Diagnosis Anterior communicating artery aneurysm, ruptured Post-operative Diagnosis Anterior communicating artery aneurysm, ruptured Operative Method Left petrional approach for aneurysm clipping Specimen Count And Types Nil Pathology Nil Operative Findings One wide-neck, about 2-3 mm, saccular aneurysm, arised from anterior communicating artery, pointing to right, inferior, and posterior. Proximal control time at left anterior cerebral artery was about 4 minutes once. One curvilinear clip, 4-mm-long blade, was used for obliteration. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to right and fixed with Mayfield head clamp. We shaved, scrubbbed, disinfected, and then draped the patient as usual. We made one curvilinear scalp incision at left frontotemporal area, and disseted along Yasagil fat pad to preserve the facial nerve. We drilled four burr hoels, and created craniotomy. Dura was tented along the craniotomy window, and performed durotomy. Sylvian fissure was opened, and basal cistern was opened. We traced right interncal carotid artery from proximal to bifurcation. Frontal lobe was retracted slightly away from frontal base, and left rectal gyrus was removed partially. We dissected around the anterior communicating artery complex, and identified the aneurysm. Aneuryms was clipped under proximal control. Dura was closed in water-tight fashion, and bone graft was fixed back with mini-plates. After placing one subgaleal CWV, the wound was closed in layers. Operators VS 賴達明 Assistants R5 曾峰毅 R0 柯嘉怡 Indication Of Emergent Operation Ruptured aneurysm 相關圖片 葉雪淳 (M,1930/01/18,82y1m) 手術日期 2011/07/16 手術主治醫師 王國川 手術區域 東址 002房 號 診斷 Hematoma contusion 器械術式 Removal of intra-cerebral hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 4E 紀錄醫師 陳國瑋, 時間資訊 14:00 開始NPO 07:32 通知急診手術 08:34 進入手術室 08:34 報到 08:35 麻醉開始 09:15 誘導結束 09:20 抗生素給藥 09:21 開始輸血 09:34 手術開始 12:05 麻醉結束 12:05 手術結束 12:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 1 R 手術 顱內壓視置入 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Right craniotomy for hematomoa evacuation and... 開立醫師: 陳國瑋 開立時間: 2011/07/16 12:51 Pre-operative Diagnosis Right intracerebral hemorrhage, left subdural hematoma Post-operative Diagnosis Right intracerebral hemorrhage, left subdural hematoma Operative Method Right craniotomy for hematomoa evacuation and ICP monitor insertion Specimen Count And Types nil Pathology nil Operative Findings The brain buldged through durotomy window, and bruise at the brain surface was noted. Some serum-like clear fluid gushed out and then reddish blood was noted. After hematoma evacuation, the ventricle was entered. The ICP monitor reference level was 500 and the inital ICP was 15mmHg and then rised to over 30mmHg after skin closure. Operative Procedures After ETGA, the paitent was put in supine position with the head tilting to left. The skin was prepared as usual. One curvilinear was made at right temporal area. The temporalis muscle was cut into two parts with inverted T shape. The periostium was refected. Oval craniotomy was made after four burr holes made. Hematoma evacuation was done. ICP monitor insertion was done. The bone graft was put back and fixed with wire. The wound was closed in layers. Operators VS王國川 Assistants R3陳國瑋 R0 Indication Of Emergent Operation hemiplegia and conscious disturbance 相關圖片 葉雪淳 (M,1930/01/18,82y1m) 手術日期 2011/07/16 手術主治醫師 王國川 手術區域 東址 007房 05號 診斷 Hematoma contusion 器械術式 Removal of intracerebral hematoma, craniectomy 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 4E 紀錄醫師 陳國瑋, 時間資訊 13:30 臨時手術NPO 13:30 開始NPO 13:30 通知急診手術 14:13 進入手術室 14:15 麻醉開始 14:30 誘導結束 14:57 手術開始 15:03 開始輸血 15:05 抗生素給藥 17:20 手術結束 17:20 麻醉結束 17:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱骨切除術,包括異物移除或壓或經切斷 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Right craniectomy and hematoma evacuation 開立醫師: 陳國瑋 開立時間: 2011/07/16 18:24 Pre-operative Diagnosis Traumatic ICH, SAH, SDH status post hematoma evacuation and ICP monitor insertion Post-operative Diagnosis Traumatic ICH, SAH, SDH status post hematoma evacuation and ICP monitor insertion Operative Method Right craniectomy and hematoma evacuation Specimen Count And Types nil Pathology nil Operative Findings The brain swell through durotomy window. SDH was noted. Some hematoma was noted after we entered the sylvian fissure. The final ICP was 14mmHg. Operative Procedures After ETGA, the patient was put in supine position with his head tilting to left. The CWV was removed. The skin was disinfected as usual. The wound was extended in three ways, and the skin flap was detached further. The previous craniotomy window was The temporalis fascia was harvested, and the muscle was transected away. The wires were cut and previous craniotomy window was taken out. After burr hole creation, craniectomy was done. Durotomy was done after dura tenting. The subdural hematoma was evacuated and the hematoma in the sylvian fissure was evacuated. After careful hemostasis, the wound was closed in layers. Operators 王國川 Assistants 陳國瑋 R0 Indication Of Emergent Operation IHC 相關圖片 賴何芙蓉 (F,1948/11/08,63y4m) 手術日期 2011/07/16 手術主治醫師 王國川 手術區域 東址 001房 01號 診斷 Malignant neoplasm of other specified sites of female breast 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 4E 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 09:41 通知急診手術 10:40 報到 11:00 進入手術室 11:10 麻醉開始 11:25 誘導結束 11:38 抗生素給藥 12:06 手術開始 14:38 抗生素給藥 17:31 抗生素給藥 18:00 麻醉結束 18:00 手術結束 18:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 1 R 手術 顱內壓視置入 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 神經部 套用罐頭: Right frontoparietal craniotomy for hematoma ... 開立醫師: 王奐之 開立時間: 2011/07/16 18:35 Pre-operative Diagnosis Right MCA territory infarction with massive hemorrhagic transformation Post-operative Diagnosis Right MCA territory infarction with massive hemorrhagic transformation Operative Method Right frontoparietal craniotomy for hematoma evacuation & ICP monitoring Specimen Count And Types Nil Pathology Nil Operative Findings The brain bulged out after durotomy. About 40-50ml of blood clot was evacuated, some residual hematoma was noted under ultrasonography, but the residual hematoma did not interconnect with the main evacuated hematoma cavity. The brain became slack after hematoma evacuation. ICP monitor reference value: 505. ICP after skin closure: 4mmHg. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After shaving, scrubbing, disinfection & draping in sterile fashion, a reverse U-shaped incision was made at right frontoparietal area. After creation of 5 burr holes, right frontoparietal craniotomy was done. After durotomy, hematoma evacuation was then made. Surgicel were applied to the cavity after hemostasis. The dura was then closed with 4-0 Prolene continuous suture with pericranial graft. ICP monitor was inserted the hematoma cavity and secured. After central tenting, the bone was fixed back with mini-plates. After setting 1 subgaleal CWV drain, the wound was closed in layers. Operators VS 王國川 Assistants R4 王奐之 Indication Of Emergent Operation IICP 相關圖片 記錄__ 手術科部: 神經部 套用罐頭: Right frontoparietal craniotomy for hematoma ... 開立醫師: 王奐之 開立時間: 2011/07/16 21:47 Pre-operative Diagnosis Right MCA territory infarction with massive hemorrhagic transformation Post-operative Diagnosis Right MCA territory infarction with massive hemorrhagic transformation Operative Method Right frontoparietal craniotomy for hematoma evacuation & ICP monitoring Specimen Count And Types Nil Pathology Nil Operative Findings The brain bulged out after durotomy. About 40-50ml of blood clot was evacuated, some residual hematoma was noted under ultrasonography, but the residual hematoma did not interconnect with the main evacuated hematoma cavity. The brain became slack after hematoma evacuation. ICP monitor reference value: 505. ICP after skin closure: 4mmHg. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After shaving, scrubbing, disinfection & draping in sterile fashion, a reverse U-shaped incision was made at right frontoparietal area. After creation of 5 burr holes, right frontoparietal craniotomy was done. After durotomy, hematoma evacuation was then made. Surgicel were applied to the cavity after hemostasis. The dura was then closed with 4-0 Prolene continuous suture with pericranial graft. ICP monitor was inserted the hematoma cavity and secured. After central tenting, the bone was fixed back with mini-plates. After setting 1 subgaleal CWV drain, the wound was closed in layers. Operators VS 王國川 Assistants R4 王奐之 Indication Of Emergent Operation IICP 相關圖片 黃錦珠 (F,1954/09/12,57y6m) 手術日期 2011/07/18 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Meningioma 器械術式 Left Pcom aneurysm clipping and left frontal craniotomy for meningioma excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 07:30 報到 08:05 進入手術室 08:10 麻醉開始 08:50 誘導結束 08:55 抗生素給藥 09:31 手術開始 10:38 開始輸血 12:10 抗生素給藥 15:10 抗生素給藥 15:50 麻醉結束 15:50 手術結束 16:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 開顱術摘除血管病變 - 腦血管瘤 無病徵的 1 1 L 手術 腦瘤切除-手術時間在4~8小時 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 7 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Left frontotemporal craniotomy, pterional app... 開立醫師: 曾峰毅 開立時間: 2011/07/18 16:25 Pre-operative Diagnosis Left P-com aneurysm and left convexity meningioma Post-operative Diagnosis Left superior hypophyseal artery aneurysm, ventral type, and left frontal convexity meningioma Operative Method Left frontotemporal craniotomy, pterional approach for aneurysm clipping, for tumor excision, Simpson grade I Specimen Count And Types 1 piece About size:2cm Source:brain tumor Pathology pending Operative Findings One wide-based aneurysm arised from knuckle of left superior hypophyseal artery, pointing inferiorly. Post-clipping ICG fluoroangiography showed total obliteration of the aneurysm and patency of left internal carotid artery, left ophthalmic artery, and left superior hypophyseal artery. One soft, dura-based tumor, supplied of engorged middle meningeal artery, was noted at left frontal area, about 3x2x2 cm. There was no SSEP change before and after the operation. Operative Procedures After intubation and general anesthesia, the patient was put in supine position with head tilting to right. The head was fix with Mayfield head clamp. The skin was prepared as usual. One curve skin incision was made from 1cm ahead of ear to 1.5cm left to midline and extended to the opposite side. The sclap flap was reflected inferiorly with preservation of the left frontal branch of facial nerve. The temporalis muscle was reflected anteriorly and downward. One piece of pericranium was havested. Four burr holes were made, and the bone flap was elevated. Anterior clinoidectomy was performed. Durotomy was made at low temporal area. The dura was reflected and the Sylvian fissure was opened. The Optic nerve and internal carotid artery were identified. The Falciform ligament along with the optic sheath was opened and the dura was further opened to distal dura ring. The aneurysm was identified and clipped with one fenestrated clip. After checking with fluoroangiogram, we closed the dura in water-tight fashion. We performed circumscrbided durotomy along the left frontal dura-based tumor, and the dura was removed totally. Duroplasty was performed with autologous fascia graft and water-tight fashion. Bone graft was fixed back with mini-plates after one epidural CWV placed. Temporalis muscle was sutured back, and The wound was closed in layers. Operators Prof. 杜永光 Assistants 曾峰毅 陳國瑋 相關圖片 趙笛詠 (M,1999/01/10,13y2m) 手術日期 2011/07/18 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Pituitary tumor 器械術式 right fontal craniotomy for tumor excison, pituitary 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 2 紀錄醫師 許皓淳, 時間資訊 00:00 臨時手術NPO 08:03 進入手術室 08:05 麻醉開始 09:00 誘導結束 09:00 抗生素給藥 09:22 手術開始 10:40 手術結束 10:40 麻醉結束 10:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經由蝶竇之腦下垂體瘤切除 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Trans-nasal trans-sphenoidal adenomectomy 開立醫師: 李振豪 開立時間: 2011/07/18 11:05 Pre-operative Diagnosis Pituitary tumor with hypopituitarism Post-operative Diagnosis Rathke cleft cyst Operative Method Trans-nasal trans-sphenoidal adenomectomy Specimen Count And Types 1 piece About size:one small piece Source:Pituitary tumor Pathology Pending Operative Findings The Rathke cleft cyst was 5 x 5.3 x 6.7 mm in size with whitish and gelatinous content. The cyst was well-demarcated and hypovascularized. The cyst was covered by thin normal gland. The gland was preserved well and the Rathke cleft cyst was removed in en block method. CSF leakage was noted after total removal of the tumor and repaired with Gelfoam packing and Tissucol Duo. Sinus bleeding was encountered during dura opening and hemostasis with bipolar electrocautery and Gelfoam packing. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head tilted 30 degree to left. The face and left lower abdomen were prepared with povidone-iodine alcohol tincture, and the mucosa of oral and nasal cavity with aqueous povidone-iodine tincture. The former areas were covered by a sterilized adhesive plastic sheet. The nasal submucosa at septum were infiltrated with 1:100 epinephrine solution. Incision was made at nasal mucosa of septum and the submucosal dissection was performed. The septum and vomer bone were fracture to exposed the sellar floor. The sellar floor was opened by Nomi and Kerrison punches. Cruciform durotomy was done and the tumor was removed by suction and alligator. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. The sphenoid sinus and sellar area was pcking with Gelfoam and fixed with Tissucol Duo and fractured bone fragment. The vomer was placed back to original location. The mucosa was pushed back and reduction of middle turbinate was also performed. The nasal cavity was packing with finger part of glove soacked with Better-iodine ointment in each side. Operators VS曾漢民 Assistants R5李振豪, R2許皓淳 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Trans-nasal trans-sphenoidal adenomectomy 開立醫師: 李振豪 開立時間: 2011/07/18 11:05 Pre-operative Diagnosis Pituitary tumor with hypopituitarism Post-operative Diagnosis Rathke cleft cyst Operative Method Trans-nasal trans-sphenoidal Rathke cleft cyst excision Specimen Count And Types 1 piece About size:one small piece Source:Pituitary tumor Pathology Pending Operative Findings The Rathke cleft cyst was 5 x 5.3 x 6.7 mm in size with whitish and gelatinous content. The cyst was well-demarcated and hypovascularized. The cyst was covered by thin normal gland. The gland was preserved well and the Rathke cleft cyst was removed in en block method. CSF leakage was noted after total removal of the tumor and repaired with Gelfoam packing and Tissucol Duo. Sinus bleeding was encountered during dura opening and hemostasis with bipolar electrocautery and Gelfoam packing. The Rathke cleft cyst was 5 x 5.3 x 6.7 mm in size with whitish and gelatinous content. The cyst was well-demarcated and hypovascularized. The cyst was covered by thin normal gland. The gland was preserved well and the Rathke cleft cyst was removed in en block method. CSF leakage was noted after total removal of the tumor and repaired with Gelfoam packing and Tissucol Duo. Cavernous sinus bleeding was encountered during dura opening and hemostasis with bipolar electrocautery and Gelfoam packing. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head tilted 30 degree to left. The face and left lower abdomen were prepared with povidone-iodine alcohol tincture, and the mucosa of oral and nasal cavity with aqueous povidone-iodine tincture. The former areas were covered by a sterilized adhesive plastic sheet. The nasal submucosa at septum were infiltrated with 1:100 epinephrine solution. Incision was made at nasal mucosa of septum and the submucosal dissection was performed. The septum and vomer bone were fracture to exposed the sellar floor. The sellar floor was opened by Nomi and Kerrison punches. Cruciform durotomy was done and the tumor was removed by suction and alligator. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. The sphenoid sinus and sellar area was pcking with Gelfoam and fixed with Tissucol Duo and fractured bone fragment. The vomer was placed back to original location. The mucosa was pushed back and reduction of middle turbinate was also performed. The nasal cavity was packing with finger part of glove soacked with Better-iodine ointment in each side. Operators VS曾漢民 Assistants R5李振豪, R2許皓淳 相關圖片 胡照雄 (M,1955/02/11,57y1m) 手術日期 2011/07/18 手術主治醫師 黃培銘 手術區域 東址 018房 03號 診斷 Esophageal cancer 器械術式 Port-A catheter implatation 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 郝政鴻, 時間資訊 15:45 進入手術室 16:00 抗生素給藥 16:05 手術開始 16:50 手術結束 16:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 port–A導管植入術–治療性導管植入術 1 0 R 記錄__ 手術科部: 外科部 套用罐頭: Port-A 開立醫師: 郝政鴻 開立時間: 2011/07/18 16:55 Pre-operative Diagnosis Esophageal cancer Post-operative Diagnosis Esophageal cancer Operative Method Port-A insertion Specimen Count And Types nil Pathology nil Operative Findings The port-A catheter was inserted to right subclavian via puncture method, checked by portable CXR Operative Procedures 1. LA, supine 2. Skin disinfection and draping as usual 3. Insert Port-A via puncture method 4. Checked by portable CXR, close wound in layers Operators VS李章銘 Assistants R4郝政鴻 R0柯嘉怡 許輝鴻 (M,1960/10/17,51y4m) 手術日期 2011/07/18 手術主治醫師 王碩盟 手術區域 西址 039房 07號 診斷 Hematuria 器械術式 Fiberocystoscopy /WOR 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 14:28 進入手術室 14:30 麻醉開始 14:32 手術開始 14:34 手術結束 14:34 麻醉結束 14:35 送出病患 羅家猷 (M,1919/07/20,92y7m) 手術日期 2011/07/18 手術主治醫師 楊士弘 手術區域 東址 019房 02號 診斷 Subdural hemorrhage 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 陳國瑋, 時間資訊 07:00 開始NPO 07:00 臨時手術NPO 16:24 通知急診手術 23:10 進入手術室 23:20 抗生素給藥 23:25 麻醉開始 23:29 誘導結束 23:30 手術開始 23:57 手術結束 00:03 送出病患 23:57 麻醉結束 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Chronic Subdural Hematoma 開立醫師: 曾峰毅 開立時間: 2011/07/19 00:12 Pre-operative Diagnosis Chronic subdural hematoma at left Chronic subdural hematoma, left frontotemporoparietal Post-operative Diagnosis Chronic subdural hematoma at left Chronic subdural hematoma, left frontotemporoparietal Operative Method Left frontal burr hole for subdural drain Left frontal burr hole for hematoma drainage and insertion of a subdural drain Specimen Count And Types Nil Pathology Nil Operative Findings Xanthochromic fluid gushed out while durotomy, then followed by dark-brownish non-coagulated blood. There was outer and inner membrane. Operative Procedures The patient was put in supine position with head in neutral position. We infiltrated the scalp with lidocaine, and made one transverse scalp incision. We drilled one burr hole, and created durotomy. One subdural drain was inserted, and subdural space was irrigated and de-air-ed. The wound was closed in layers. The patient was put in supine position with head in neutral position. Local anesthesia was adopted for the whole procedure. We infiltrated the scalp with lidocaine, and made one transverse scalp incision. We drilled one burr hole, and created durotomy. One subdural drain was inserted, and subdural space was irrigated with saline and de-air-ed. The wound was closed in layers. Operators VS 楊士弘 Assistants R5 曾峰毅 R3 陳國瑋 Indication Of Emergent Operation Intracranial hypertension 吳國華 (M,1981/09/06,30y6m) 手術日期 2011/07/18 手術主治醫師 王廷明 手術區域 東址 002房 03號 診斷 Major trauma rated 16 or above on the severity scale ( Injury severity score >=16 ) 器械術式 ORIF -Zimmer distal femur locking plate 手術類別 緊急手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉漢平 ASA 3E 紀錄醫師 吳俊毅, 時間資訊 13:32 通知急診手術 12:31 進入手術室 12:35 麻醉開始 12:37 誘導結束 13:18 手術開始 15:20 開始輸血 15:45 手術結束 15:45 麻醉結束 15:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 股骨幹骨折開放性復位術 1 1 L 摘要__ 手術科部: 骨科部 套用罐頭: 1. Removal of ESF 開立醫師: 吳俊毅 開立時間: 2011/07/18 14:38 Pre-operative Diagnosis Left distal femoral shaft fracture status post ESF fixation Post-operative Diagnosis Left distal femoral shaft fracture status post MIPO-locking plate Left distal femoral shaft fracture status post periarticular locking plate Operative Method 1. Removal of ESF 2. CRIF with MIPO locking plate 2. CRIF with Zimmer periarticular locking plate by MIPO 2. CRIF with Zimmer periarticular locking plate by MIPO ( total 15 screws: 2 cannulated screws + 3 cortical screws + 10 locking screws) Specimen Count And Types nil Pathology nil Operative Findings Distal femoral shaft fracture Operative Procedures 1. ETGA. supine position 2. Removed ESF 3. Skin prepare and drapped 4. Longitudinal skin incision 5. Closed reduction under fluoroscopy 6. Applied locking plate by MIPO technique 7. Fixed locking screws 8. Checked aligment 9. NS irrigation and closed wound Operators 王廷明, Assistants 徐鎮平, 林家聖, Indication Of Emergent Operation distal femoral fracture 林德泉 (M,1957/04/17,54y10m) 手術日期 2011/07/19 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Parkinson''s disease 器械術式 implantable pulsed generator insertion 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 張倍慈, 時間資訊 00:00 臨時手術NPO 08:02 進入手術室 08:05 麻醉開始 08:15 誘導結束 08:50 抗生素給藥 09:06 手術開始 10:03 手術結束 10:03 麻醉結束 10:12 送出病患 10:15 進入恢復室 11:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 2 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 曾峰毅 開立時間: 2011/07/19 10:13 Pre-operative Diagnosis Parkinsonism Post-operative Diagnosis Parkinsonism Operative Method Implantation of pulse generator Specimen Count And Types Nil Pathology Nil Operative Findings Medtronic pulse generator was implanted. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to right. We made one linear scalp incision at left occipital area to retrieve the wires. We made one transverse skin incision at left upper chest, and created subcutaneous pouch. We created subcutaneous tunnel from chest to left occipital area and pulled the wires through. We connected the wires together with the pulse generator, and checked the function of generator. We put the generator to the chest subcutaneous pouch. The wound was closed in layers. Operators VS 曾勝弘 Assistants R5 曾峰毅 R0 張倍慈 相關圖片 須藤裕美 (F,1971/08/27,40y6m) 手術日期 2011/07/19 手術主治醫師 曾勝弘 手術區域 東址 005房 02號 診斷 Malignant neoplasm of cerebrum, except lobes and ventricles 器械術式 right F-P cranitomy for tumor excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 張倍慈, 時間資訊 00:00 臨時手術NPO 10:25 進入手術室 10:30 麻醉開始 10:53 抗生素給藥 11:20 誘導結束 11:23 手術開始 14:53 抗生素給藥 16:10 手術結束 16:10 麻醉結束 16:14 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4~8小時 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT 開立醫師: 曾峰毅 開立時間: 2011/07/19 16:32 Pre-operative Diagnosis Right frontal low-grade glioma, status post excision, recurrence Post-operative Diagnosis Right frontal low-grade glioma, status post excision, recurrence Operative Method Right frontal craniotomy for tumor excision Specimen Count And Types Several fragments of the tumor was sent for pathology. Pathology Pending Operative Findings Motor stimulation localized the motor cortex of left face, causing facial twitching. Ill-defined, hypovascular, whitish tumor was located in the surrouding area of previous tumor excised cavity. Operative Procedures With endonasal intubation and intravenous general anaesthesia, the patient was put in supine position with head rotated to left and fixed with Mayfield head clamp. After scalp shaved, scrubbed, disinfected, and then draped, we made scalp incision along previous curvilinear right frontal incision. We removed previous craniotomy bone graft, and extented craniotomy posteriorly. We infiltrated the dura with lidocaine, and wake the patient up. We opened the dura, and localize motor crotex with neurophysicology study. We performed motor stimuation with patient awake, and performed tumor excision in piecemeal. The dura was closed in water-tight suture with autologous fascia graft. Bone graft was fixed back with mini-plates. The wound was closed in layers. Operators VS 曾勝弘 Assistants R5 曾峰毅 R0 張倍慈 相關圖片 鄭仲廷 (M,1995/01/19,17y1m) 手術日期 2011/07/19 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Brain tumor 器械術式 craniotomy for 3rd ventricular tumor resection 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 07:34 報到 08:08 進入手術室 08:20 麻醉開始 08:35 誘導結束 09:10 抗生素給藥 09:50 手術開始 12:03 開始輸血 12:10 抗生素給藥 15:10 抗生素給藥 16:35 麻醉結束 16:35 手術結束 16:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱內壓視置入 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 8 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除-手術時間在4~8小時 1 1 L 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 摘要__ 手術科部: 外科部 套用罐頭: 1. EVD insertion via right Kocher point and e... 開立醫師: 王奐之 開立時間: 2011/07/19 17:04 Pre-operative Diagnosis Intraventricular tumor with both cystic & solid portions, suspected subependymal giant cell astrocytoma Post-operative Diagnosis Intraventricular tumor with both cystic & solid portions, suspected subependymal giant cell astrocytoma Operative Method 1. EVD insertion via right Kocher point and endoscopic cyst fenestration 2. Left frontal craniotomy for transcortical intraventricular tumor resection and EVD insertion via left Kocher point Specimen Count And Types 1 piece About size:pieces Source:intraventricular tumor Pathology Pending Operative Findings A small portion of tumor was left in place due to ill-defined margin. The foramen of Monroe was identified after tumor resection. The tumor was purplish in color, elastic-firm, and attached to the septum pellucidum. Some cystic wall from the cystic portion of tumor was also obtained for pathology. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head fixed in Mayfield skull clamp. After shaving, scrubbing, disinfection & draping in sterile fashion, a curvilinear bicoronal incision was made at frontal area. After splitting and dissection of pericranium, 2 burr holes were made at bilateral Kocher point, followed by EVD insertion. Endoscope was inserted to the right lateral ventricle via right EVD tract, and the cyst was fenestrated. Left frontal craniotomy was then made around the left Kocher burr hole. A cruciate durotomy was done, followed by performing a 2cm corticotomy. The corticotomy was deepened until the left lateral ventricle was reached. The tumor was then dissected off the septum pellucidum and removed in several pieces. After hemostasis, bilateral EVD were secured, the wound was then closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: 1. EVD insertion via right Kocher point and e... 開立醫師: 王奐之 開立時間: 2011/07/19 17:04 Pre-operative Diagnosis Intraventricular tumor with both cystic & solid portions, suspected subependymal giant cell astrocytoma Post-operative Diagnosis Intraventricular tumor with both cystic & solid portions, suspected subependymal giant cell astrocytoma Operative Method 1. EVD insertion via right Kocher point and endoscopic cyst fenestration 2. Left frontal craniotomy for transcortical intraventricular tumor resection and EVD insertion via left Kocher point Specimen Count And Types 1 piece About size:pieces Source:intraventricular tumor Pathology Pending Operative Findings A small portion of tumor was left in place due to ill-defined margin. The foramen of Monroe was identified after tumor resection. The tumor was purplish in color, elastic-firm, and attached to the septum pellucidum. Some cystic wall from the cystic portion of tumor was also obtained for pathology. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head fixed in Mayfield skull clamp. After shaving, scrubbing, disinfection & draping in sterile fashion, a curvilinear bicoronal incision was made at frontal area. After splitting and dissection of pericranium, 2 burr holes were made at bilateral Kocher point, followed by EVD insertion. Endoscope was inserted to the right lateral ventricle via right EVD tract, and the cyst was fenestrated. Left frontal craniotomy was then made around the left Kocher burr hole. A cruciate durotomy was done, followed by performing a 2cm corticotomy. The corticotomy was deepened until the left lateral ventricle was reached. The tumor was then dissected off the septum pellucidum and removed in several pieces. After hemostasis, bilateral EVD were secured, the wound was then closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: 1. EVD insertion via right Kocher point after... 開立醫師: 郭夢菲 開立時間: 2011/07/21 11:04 Pre-operative Diagnosis Left frontal intraventricular tumor with both cystic & solid portions, suspected subependymal giant cell astrocytoma Post-operative Diagnosis Left frontal intraventricular tumor with both cystic & solid portions, suspected subependymal giant cell astrocytoma Operative Method 1. EVD insertion via right Kocher point after endoscopic cyst fenestration of the right wall of the cyst 2. Left frontal craniotomy for transcortical intraventricular tumor resection and EVD insertion via left Kocher point Specimen Count And Types 1 piece About size:pieces Source:intraventricular tumor Pathology Pending Operative Findings 1. The cystic portion of the tumor was located at the same place of septum pellucidum. IOt contain sosme arachnoid membrane like thin membrane, which was sent for pathology. 2. The tumor was purplish in color, elastic-firm, and attached to the left side of the cyst and based wide to the left caudate nucleus. Some cystic wall from the cystic portion of tumor was also obtained for pathology. A small portion of tumor was left in place due to ill-defined margin. The left foramen of Monroe was identified after tumor resection. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head fixed in Mayfield skull clamp. After shaving, scrubbing, disinfection & draping in sterile fashion, a curvilinear bicoronal incision was made at bifrontal area. After splitting and dissection of pericranium, 2 burr holes were made at bilateral Kocher point, followed by EVD insertion. Endoscope was inserted to the right lateral ventricle via right EVD tract, and the right cystic wall was fenestrated then dilated with 3-Fr. Fogarty catheter. Left frontal craniotomy was then made around the left Kocher burr hole, 4 cm infrontal of coronal suture and 1 cm behind coronal suture. Under microscpic view, a cruciate durotomy was done, followed by performing a 2cm corticotomy. The corticotomy was deepened until the left lateral ventricle was reached. The tumor was then dissected off the septum pellucidum and removed in several pieces. After hemostasis, bilateral EVD were secured, the wound was then closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: 1. Endoscopic fenestration of the right cysti... 開立醫師: 郭夢菲 開立時間: 2011/07/21 11:19 Pre-operative Diagnosis Intraventricular tumor with both cystic & solid portions, suspected subependymal giant cell astrocytoma Post-operative Diagnosis Intraventricular tumor with both cystic & solid portions, suspected subependymal giant cell astrocytoma Operative Method 1. Endoscopic fenestration of the right cystic wall, and ICP monitoring by EVD insertion via right Kocher point 2. Left frontal craniotomy for transcortical intraventricular tumor resection and EVD insertion via left Kocher point Specimen Count And Types 1 piece About size:pieces Source:intraventricular tumor Pathology Pending Operative Findings A small portion of tumor was left in place due to ill-defined margin. The foramen of Monroe was identified after tumor resection. The tumor was purplish in color, elastic-firm, and attached to the septum pellucidum. Some cystic wall from the cystic portion of tumor was also obtained for pathology. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head fixed in Mayfield skull clamp. After shaving, scrubbing, disinfection & draping in sterile fashion, a curvilinear bicoronal incision was made at frontal area. After splitting and dissection of pericranium, 2 burr holes were made at bilateral Kocher point, followed by EVD insertion. Endoscope was inserted to the right lateral ventricle via right EVD tract, and the cyst was fenestrated. Left frontal craniotomy was then made around the left Kocher burr hole. A cruciate durotomy was done, followed by performing a 2cm corticotomy. The corticotomy was deepened until the left lateral ventricle was reached. The tumor was then dissected off the septum pellucidum and removed in several pieces. After hemostasis, bilateral EVD were secured, the wound was then closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之 相關圖片 鄒沁彤 (F,2010/12/02,1y3m) 手術日期 2011/07/19 手術主治醫師 郭夢菲 手術區域 兒醫 067房 02號 診斷 Psychomotor retardation 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 蕭柏妮 ASA 3E 紀錄醫師 王奐之, 時間資訊 00:00 開始NPO 00:00 臨時手術NPO 08:00 通知急診手術 19:40 報到 19:40 進入手術室 19:50 麻醉開始 20:50 誘導結束 21:21 手術開始 22:03 開始輸血 23:00 抗生素給藥 02:00 抗生素給藥 05:00 抗生素給藥 08:00 抗生素給藥 09:50 麻醉結束 09:50 手術結束 09:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱內壓視置入 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 20 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 4 0 麻醉 Hemoglobin (Hb) 4 0 麻醉 測血糖 4 0 麻醉 Ca (Calcium) 4 0 麻醉 Na (Sodium) 4 0 麻醉 K (Potassium) 4 0 麻醉 Blood gas analysis 4 0 手術 腦瘤切除-手術時間在8小時以上 1 1 R 摘要__ 手術科部: 套用罐頭: Right temporal craniotomy for transcortical s... 開立醫師: 王奐之 開立時間: 2011/07/20 10:33 Pre-operative Diagnosis Right intraventricular tumor, suspected choroid plexus papilloma, with hydrocephalus Post-operative Diagnosis Right intraventricular tumor, suspected choroid plexus papilloma, with hydrocephalus Operative Method Right temporal craniotomy for transcortical subtotal tumor resection Specimen Count And Types 1 piece About size:pieces Source:right intraventricular tumor Pathology Pending Operative Findings About 100ml of light yellowish CSF was evacuated prior to dural opening, and sent for CSF routine, BCS, bacterial culture & cytology. The skull was about 2mm thin and easily fractured. Enlarged suture gap & fontanels were noted with bulging dural surface. Thin cerebral cortex was also noted. After entering the right lateral ventricle, papillomatous appearance of tumor was noted, with yellowish & reddish colors. Only a small portion of tumor has clear margin against normal brain tissue, while other parts adhered to brain tissue without distinct border. After tumor resection & CSF release, the brain became slack. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After shaving, scrubbing, disinfection & draping in sterile fashion, a reverse U-shaped incision was made at right temporal area. After splitting & dissection of pericranium, a rectangular craniotomy was done with Kerrison punch. An U shaped durotomy was made, a 3cm corticotomy was created at right middle temporal gyrus. After deepening of corticotomy, the right lateral ventricle was entered. After identifying the intraventricular tumor, the tumor was removed in several pieces. After meticulous hemostasis, the dura was closed with 4-0 Prolene continuous suture in water-tight fashion. One EVD drain was inserted to the subdural space to function as a subdural drain. After central tenting, the bone was fixed back with 3-0 silk. The wound was then closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之 Indication Of Emergent Operation IICP 相關圖片 記錄__ 手術科部: 套用罐頭: Right temporal craniotomy for transcortical s... 開立醫師: 王奐之 開立時間: 2011/07/20 10:33 Pre-operative Diagnosis Right intraventricular tumor, suspected choroid plexus papilloma, with hydrocephalus Post-operative Diagnosis Right intraventricular tumor, suspected choroid plexus papilloma, with hydrocephalus Operative Method Right temporal craniotomy for transcortical subtotal tumor resection Specimen Count And Types 1 piece About size:pieces Source:right intraventricular tumor Pathology Pending Operative Findings About 100ml of light yellowish CSF was evacuated prior to dural opening, and sent for CSF routine, BCS, bacterial culture & cytology. The skull was about 2mm thin and easily fractured. Enlarged suture gap & fontanels were noted with bulging dural surface. Thin cerebral cortex was also noted. After entering the right lateral ventricle, papillomatous appearance of tumor was noted, with yellowish & reddish colors. Only a small portion of tumor has clear margin against normal brain tissue, while other parts adhered to brain tissue without distinct border. After tumor resection & CSF release, the brain became slack. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After shaving, scrubbing, disinfection & draping in sterile fashion, a reverse U-shaped incision was made at right temporal area. After splitting & dissection of pericranium, a rectangular craniotomy was done with Kerrison punch. An U shaped durotomy was made, a 3cm corticotomy was created at right middle temporal gyrus. After deepening of corticotomy, the right lateral ventricle was entered. After identifying the intraventricular tumor, the tumor was removed in several pieces. After meticulous hemostasis, the dura was closed with 4-0 Prolene continuous suture in water-tight fashion. One EVD drain was inserted to the subdural space to function as a subdural drain. After central tenting, the bone was fixed back with 3-0 silk. The wound was then closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之 Indication Of Emergent Operation IICP 相關圖片 記錄__ 手術科部: 套用罐頭: Right temporal craniotomy for transcortical s... 開立醫師: 郭夢菲 開立時間: 2011/07/21 11:17 Pre-operative Diagnosis Right intraventricular tumor, suspected choroid plexus papilloma, with hydrocephalus Post-operative Diagnosis Right intraventricular tumor, suspected choroid plexus papilloma, with hydrocephalus Operative Method Right temporal craniotomy for transcortical subtotal tumor resection and ICP monitoring by subdural catherter insertion Specimen Count And Types 1 piece About size:pieces Source:right intraventricular tumor Pathology Pending Operative Findings 1. The ICP was estremely high that several sites of sural was eroded. The anterior was fully bulging and tense. The posterior fontanel was widely opened, too. 2. More then 120ml of light yellowish CSF was aspirated slowly from the dilated ventricle before the dura was opened, but the brain was still bulged out while dura was opened, that we needed another aspiration of the SCF from the occipital hoen. The CSF routine, BCS, bacterial culture & cytology. 3. The skull was about 1-2mm thin due to chronic IICP. Thin cerebral cortex was also noted. 4. After entering the right lateral ventricle, papillomatous appearance of tumor was noted, with yellowish & reddish colors. Only a small portion of tumor has clear margin against normal brain tissue, while other parts adhered to brain tissue without distinct border. After tumor resection & CSF release, the brain became slack and more than7 cm away from the skull bone. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After shaving, scrubbing, disinfection & draping in sterile fashion, a reverse U-shaped incision was made at right temporal area. After splitting & dissection of pericranium, a rectangular craniotomy was done with Kerrison punch. We aspirated the CSF by fine needle tapping of the temporal horn for about 120 cc slowly to balance the intracrianl pressure before opening hte dura. We then opened the dura by U-shape, howerver, the brain still bulged out, so we tapped the CSF from the occipital horn for 20 cdc more again. Undewr mcroscopic view, An U shaped durotomy was made, a 3cm corticotomy was created at right middle temporal gyrus. After deepening of corticotomy, the right lateral ventricle was entered. We coagulated the tumor surface then identified the right anterior choroidal artery at the inferior anterior margin of the tumor. The tumor was tried to be removed in en bloc, but failed due severe adhesion between the lrumor and ventricular wal in many portions, so we removed the tumor in several pieces. After meticulous hemostasis, the dura was closed with 4-0 Prolene continuous suture in water-tight fashion. One EVD drain was inserted to the subdural space to function as a subdural drain and ICP monitor. After central tenting, the bone was fixed back with 3-0 silk. The wound was then closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之 Indication Of Emergent Operation 相關圖片 楊建勛 (M,1965/05/01,46y10m) 手術日期 2011/07/19 手術主治醫師 賴達明 手術區域 東址 002房 04號 診斷 Herniated intervertebral disc (HIVD) 器械術式 Diskectomy lumbar 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2E 紀錄醫師 李振豪, 時間資訊 07:18 通知急診手術 15:30 報到 15:40 進入手術室 15:50 麻醉開始 15:55 誘導結束 16:19 抗生素給藥 16:42 手術開始 17:25 手術結束 17:25 麻醉結束 17:35 送出病患 17:37 進入恢復室 19:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-腰椎 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: L5-S1 microdiskectomy, left 開立醫師: 李振豪 開立時間: 2011/07/19 17:46 Pre-operative Diagnosis Herniated intervertebral disc, L5-S1, left Post-operative Diagnosis Herniated intervertebral disc, L5-S1, left Operative Method L5-S1 microdiskectomy, left Specimen Count And Types nil Pathology Nil Operative Findings One 2.5 x 1 x 0.5cm sequestrated disc was removed which compressed the left S1 root tightly. No obvious bulging of L5-S1 disc was noted. The root was decompressed well after removal of the ruptured disc. No incidental durotomy or CSF leakage noted during whole procedure. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position. L5-S1 disc space was identified by portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision with 4cm in length was made at L5-S1 disc space level and the subcutaneous soft tissue was devided. The left paravertebral muscle groups were detached and retracted by a modified narrow Taylor retractor. Laminotomy was performed and the ligmentum flavum was removed. The thecal sac was retracted and the ruptured disc was identified. The ruptured disc was removed with alligator. The L5-S1 microdiskectomy was performed with alligator and disc clamp. Hemostasis was achieved with Gelfoam packing. The wound was then closed in layers with 2-0 Vicryl and 4-0 Dexon. Operators VS 賴達明 Assistants R5李振豪 Indication Of Emergent Operation L5-S1 HIVD with severe sciatica and weakness 相關圖片 李柯金定 (F,1936/11/20,75y3m) 手術日期 2011/07/19 手術主治醫師 賴達明 手術區域 東址 002房 05號 診斷 Cerebral aneurysm 器械術式 Craniotomy for aneurysm clipping 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 4E 紀錄醫師 曾峰毅, 時間資訊 22:00 臨時手術NPO 22:00 開始NPO 14:13 通知急診手術 18:05 進入手術室 18:10 麻醉開始 18:15 誘導結束 18:45 抗生素給藥 19:05 手術開始 20:30 開始輸血 21:45 抗生素給藥 23:50 手術結束 23:50 麻醉結束 00:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 開顱術摘除血管病變 - 腦血管瘤 有病徵的 1 1 R 手術 顱內壓視置入 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Aneurysm-frontotemporal approach 開立醫師: 曾峰毅 開立時間: 2011/07/20 00:15 Pre-operative Diagnosis Right posterior communicating artery aneurysm, status post wrapping, re-ruptured Post-operative Diagnosis Right posterior communicating artery aneurysm, status post wrapping, re-ruptured Operative Method Right frontotemporal craniectomy for aneurysm clipping; right Kocher external ventricular drainage Specimen Count And Types Nil Pathology Nil Operative Findings Opening pressure of external ventricular drainage was above 20 cmH20, and intracranial hypertensio was release after 20 ml CSF drained. Right internal carotid artery is atherosclerotic and tortuous. One wide-base, about 6-7 mm in neck, saccular aneurysm was noted arising from right internal carotid artery just distal to the orifice of right posterior communicating artery, pointing inferiorly and posteriorly. One Sugita, curvilinear clip was used for aneurysm obliteration. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to left. After scalp shaved, scrubbed, disinfected, and then draped, we made scalp incision along previous operation wound. We inserted ventricular drainage via right Kocher point. We removed previous craniotomy bone graft, and extended craniotomy posteriorly as decompressive craniectomy. We performed dura incision in U-shape, and retracted frontal lobe away from frontal base. We drained CSF from external ventricular drainage, and cisterns. Right temporal lobe tip was excised, and right temporal ICH, small amount was removed. We traced internal carotid artery from proximal to distal. Aneurysm was clipped with one curvilinear clip under proximal control with temporary clipping. Duroplasty was done with Durofoam and suture. After setting two epidural CWV, the wound was closed in layers. Operators VS 賴達明 Assistants R5 李振豪 R5 曾峰毅 R1 顏 Indication Of Emergent Operation Aneurysmal subarachnoid hemorrhage and acute hydrocephalus 相關圖片 林加苳 (M,1939/09/07,72y6m) 手術日期 2011/07/19 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Lumbar Spondylosis 器械術式 L3/4 listehsis, TPS + cage 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 08:02 進入手術室 08:05 麻醉開始 08:15 誘導結束 08:26 抗生素給藥 08:59 手術開始 11:35 抗生素給藥 12:05 開始輸血 12:55 手術結束 12:55 麻醉結束 13:00 送出病患 13:05 進入恢復室 14:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 記錄__ 手術科部: 外科部 套用罐頭: L3/4 discectomy and posterior fusion at L3, L... 開立醫師: 林哲光 開立時間: 2011/07/19 13:11 Pre-operative Diagnosis L3/4 spondylolisthesis Post-operative Diagnosis L3/4 spondylolisthesis Operative Method L3/4 discectomy and posterior fusion at L3, L4 level with TPS and cage insertion Specimen Count And Types nil Pathology Nil Operative Findings Hypertrophic change of ligamentum flavum was noted. Inflammatory change of the left L4 root and large epidural vessels were noted. The dura seemed re-expanded well after sublaminal decompression. TPS 65mmx45mm were inserted at L3, L4 pedicles and two rods 6cm long were used for posterior fusion. 11mm PEEK cage was inserted at L3/4 level. Operative Procedures Under ETGA and prone position, skin disinfected and drapped were performed as usual. Midline skin incision was made at L2-L5 level after C-arm localization. The paraspinal muscles were detached and bilateral L3, L4 facet joints were exposed well. TPS were then inserted under C-arm localization. Left hemilaminectomy was then performed and L3/4 discectomy was done. The cage was inserted. Sublaminal decompression was then performed. The wound was then closed in layers after rods were set and epidural hemovac was inserted. Operators 賴達明 Assistants 林哲光, 吳奕緯 相關圖片 李吳富玉 (F,1940/11/15,71y3m) 手術日期 2011/07/19 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Radiculopathy 器械術式 L4/5 TPS and discectomy with cage 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 13:00 報到 13:08 進入手術室 13:20 麻醉開始 13:30 誘導結束 13:30 抗生素給藥 13:59 手術開始 16:30 抗生素給藥 17:20 手術結束 17:20 麻醉結束 17:25 送出病患 17:26 進入恢復室 18:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 記錄__ 手術科部: 外科部 套用罐頭: L4/5 discectomy and posterior fusion at L4, L... 開立醫師: 林哲光 開立時間: 2011/07/19 17:41 Pre-operative Diagnosis L4/5 spondylolisthesis Post-operative Diagnosis L4/5 spondylolisthesis Operative Method L4/5 discectomy and posterior fusion at L4, L5 with TPS and PEEK cage Specimen Count And Types nil Pathology Nil Operative Findings Hypertrophic change of the ligamentum flavum was noted and the dura seemed re-expanded well after sublaminal decompression. Depressed vertebral body was noted at L4. Four TPS 65mmx40mm inserted at L4, L5 level. Rod 5cm and 6cm were used at right side and left side respectively. Operative Procedures Under ETGA and prone position, skin disinfected and drapped were performed as usual. Midline skin incision was made at L3-S1 level and the paraspinal muscles were detached. TPS were inserted at L4, L5 pedicle under C-arm localizatin. Right hemilaminectomy was then done and L4/5 discectomy was then done. PEEK cage was inserted at L4/5 intervertebral space. The wound was then closed in layers after rods were set and epidural hemovac were inserted. Operators 賴達明 Assistants 林哲光, 吳奕緯 相關圖片 李信義 (M,1946/10/10,65y5m) 手術日期 2011/07/19 手術主治醫師 賴達明 手術區域 東址 005房 03號 診斷 Lumbar spondylosis 器械術式 L4/5 TPS and discectomy with cage 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 15:57 報到 16:20 麻醉開始 16:29 進入手術室 16:30 誘導結束 17:00 抗生素給藥 17:18 手術開始 19:20 手術結束 19:20 麻醉結束 19:25 送出病患 19:30 進入恢復室 20:33 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 記錄__ 手術科部: 外科部 套用罐頭: L4/5 discectomy and posterior fusion at L4, L... 開立醫師: 林哲光 開立時間: 2011/07/19 19:37 Pre-operative Diagnosis L4/5 spondylolisthesis Post-operative Diagnosis L4/5 spondylolisthesis Operative Method L4/5 discectomy and posterior fusion at L4, L5 with TPS and PEEK cage Specimen Count And Types nil Pathology Nil Operative Findings Hypertrophic change of the ligamentum flavum was noted and the dura seemed re-expanded well after sublaminal decompression. Depressed vertebral body was noted at L4. Four TPS 65mmx45mm inserted at L4, L5 level. Rods 5cm were inserted. Operative Procedures Under ETGA and prone position, skin disinfected and drapped were performed as usual. Midline skin incision was made at L3-S1 level and the paraspinal muscles were detached. TPS were inserted at L4, L5 pedicle under C-arm localizatin. Right hemilaminectomy was then done and L4/5 discectomy was then done. PEEK cage was inserted at L4/5 intervertebral space. The wound was then closed in layers after rods were set and epidural hemovac were inserted. Operators 賴達明 Assistants 曾峰毅, 林哲光, 張倍慈 相關圖片 蔡彬 (M,1951/08/02,60y7m) 手術日期 2011/07/19 手術主治醫師 陳敞牧 手術區域 東址 002房 03號 診斷 Spine bone metastasis 器械術式 Spinal fusion posterior, T spine 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 李振豪, 時間資訊 07:15 通知急診手術 10:20 報到 10:35 進入手術室 10:40 麻醉開始 11:00 誘導結束 11:31 抗生素給藥 11:44 手術開始 12:02 開始輸血 14:30 抗生素給藥 14:48 麻醉結束 14:48 手術結束 15:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 惡性脊髓腫瘤切除術 1 1 B 手術 脊椎融合術-後融合,有固定物(<=六節) 1 2 B 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: 1. T10, T11, L1, and L2 transpedicular screws... 開立醫師: 李振豪 開立時間: 2011/07/19 15:30 Pre-operative Diagnosis T12 metastatic spinal tumor with cord compression Post-operative Diagnosis T12 metastatic spinal tumor with cord compression Operative Method 1. T10, T11, L1, and L2 transpedicular screws for posterior fixation 2. T12 laminectomy for decompression and partial tumor excision 3. Left T12 rhizotomy Specimen Count And Types 1 piece About size:multiple pieces Source:spinal tumor Pathology Pending Operative Findings The tumor was soft to elastic, hypervascularized, and ill-defined with adjacent soft tissue. The tumor was mainly located at left T12 pedicle with extension to paraspinal muscle and vertebral body. The thecal sac was compressed from left side and anterior epidural space tightly and expanded well after decompression. Massive blood loss was noted during tumor excision. Total blood loss: 3600ml. Posterior instrumentation: Screws: 6.0 x 40mm x IV(T10, T11); 6.5 x 45mm x IV(L1, L2) Rods: 15cm x II; Cross-link: 7cm x I Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position. T10 to L2 pedicle level was localized by portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made from T10 to L2 level. The subcutaneous soft tissue and paravertebral muscle groups were detached. T10, T11, L1, and L2 transpedicular screws were implanted under C-arm guided. T12 laminectomy for decompression and partial tumor excision was performed. The left T12 rhizotomy was done during tumor excision. Hemostasis was achieved and two epidural Hemovac was placed. The wound was closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS陳敞牧 Assistants R5李振豪, Ri Indication Of Emergent Operation Metastatic tumor with acute myelopathy 林素秋 (F,1956/01/20,56y1m) 手術日期 2011/07/19 手術主治醫師 楊士弘 手術區域 西址 039房 01號 診斷 Carpal tunnel syndrome 器械術式 Decompression of mediun nerve 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 09:10 進入手術室 09:35 麻醉開始 09:36 手術開始 10:10 手術結束 10:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 正中神經或尺神經腕部減壓術–單側 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Decompression of median nerve, left 開立醫師: 許皓淳 開立時間: 2011/07/19 10:16 Pre-operative Diagnosis Carpal Tunnel Syndrome, left Post-operative Diagnosis Carpal Tunnel Syndrome, left Operative Method Decompression of median nerve, left Specimen Count And Types nil Pathology nil Operative Findings Left median nerve was compressed by transverse carpal ligament Operative Procedures 1.The hand and forearm were sterilized with povidone-iodine tincture, then covered with stockinet. 2.Anesthesia: tourniquet was applied at distal upper arm, then regional block with 15 ml 1% Xylocaine solution was infused through cephalic vein catheter at wrist area. 3. Incision: S shape from vertical palmar crease to transverse wrist crease. 4.The palmaris longus tendon was identified, then the plamar aponeurosis was cut longitidinally along the ulnar side of the palmaris longus tendon. 5. The median nerve was identified beneath the palmars longus tendon. Under direct vision, the transverse carpal ligament was divided until no more pressure on the median nerve could be palpated. 6. The skin was closed by interrupted suture with 4/0 nylon. 7.The tourniquet was released. The hand and wrist were draped with fluffy dressing and elastic bandage. Operators VS楊士弘 Assistants R2許皓淳 相關圖片 林崇德 (M,2011/07/16,8m2d) 手術日期 2011/07/19 手術主治醫師 邱英世 手術區域 兒醫 068房 03號 診斷 Interruption of aortic arch 器械術式 TCPC,JATENE,TAPVR,NORWOOD 手術類別 緊急手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 蕭柏妮 ASA 4E 紀錄醫師 陳政維, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 15:00 通知急診手術 16:30 進入手術室 16:40 麻醉開始 17:10 誘導結束 17:30 抗生素給藥 17:40 手術開始 20:30 開始輸血 20:30 抗生素給藥 21:25 手術結束 21:25 麻醉結束 21:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 主動脈轉位症手術 1 1 手術 存開性動脈導管手術 1 2 手術 體外心肺循環 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 3 0 麻醉 Hemoglobin (Hb) 3 0 麻醉 測血糖 3 0 麻醉 Ca (Calcium) 3 0 麻醉 Na (Sodium) 3 0 麻醉 K (Potassium) 3 0 麻醉 Blood gas analysis 3 0 記錄__ 手術科部: 外科部 套用罐頭: Norwood stage I with RV-PA conduit 開立醫師: 陳政維 開立時間: 2011/07/22 17:56 Pre-operative Diagnosis IAA, type A, LVOTO, VSD, PDA Post-operative Diagnosis IAA, type A, LVOTO, VSD, PDA Operative Method Norwood stage I with RV-PA conduit Specimen Count And Types nil Pathology Nil Operative Findings 1.Situs solitus, levocardia, left side arch 2.Sano shunt(RV-PA conduit: 6mm gortex conduit) 3.Neo-Ao reconstruction with autologus pericardial patch 4.Post-OP: No PG between lower and upper limbs 5.Post-OP bilateral pleural opened. Sternum unapproximation Operative Procedures ETGA, supine position, midline full sternotomy Mobilized AsAo, arch vessels, bilateral PA, MPA and PDA Cannulate IA(through 3.5mm Gortex graft) and RAA, On CPB Ligate PDA and anastomose 6mm Gortex graft to MPA stump. After MPA transection, AXC and antegrade cardioplegia infusion Circulatory arrest with selective cerebral perfusion(1000cc/min) Neo-Ao reconstruction with connection of AsAo, MPA and DsAo and augmentation with autologus pericardial patch. Rewarm, resume CPB, anastomose 6mm Gortex graft to RV Deair, wean off CPB, Hemostasis and set three chest tubes Left the sternum unapproximation Operators P邱英世 VS黃書健 Assistants R5周恒文 R4陳政維 Indication Of Emergent Operation 劉奕輝 (M,1990/09/21,21y5m) 手術日期 2011/07/19 手術主治醫師 石博元 手術區域 西址 037房 02號 診斷 Malignant brain tumor, ventricle 器械術式 Port-A Implatation /WOR 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 石博元 ASA 3 紀錄醫師 謝承原, 時間資訊 00:00 臨時手術NPO 09:12 報到 09:25 進入手術室 09:40 抗生素給藥 10:00 麻醉開始 10:05 誘導結束 10:30 手術開始 10:43 手術結束 10:43 麻醉結束 10:50 送出病患 10:55 進入恢復室 12:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 手術 port–A導管植入術–治療性導管植入術 1 0 R 記錄__ 手術科部: 麻醉部 套用罐頭: Port-A implantation, subclavian 開立醫師: 謝承原 開立時間: 2011/07/19 10:48 Pre-operative Diagnosis brain tumor Post-operative Diagnosis Ditto Operative Method Port-A implantation, echo-guided Specimen Count And Types Pathology Nil Operative Findings 1.Site: right subclavian vein, with echo-guided procedure 2.Patent flow after implantation 3.Others: nil Operative Procedures 1.The patient was set on supine position and bilateral subclavian veins were checked by echo. 2.After IVGA and local anesthesia applied, transverse skin incision for 3cm was made at pre-cordial area. 3.Undermine the skin at the layer between subcutaneous tissue and deep fascia in lateral direction. 4.An IV catheter was inserted via the subclavian incision and negatively aspirated until venous blood attainable. 5.J-wire was inserted smoothly in rostral direction. A subclavian catheter with dilator was inserted through the J-wire, and the dilator was then removed. 6.The catheter of Port-A was threaded into the subclavian vein until mark 21 cm. The catheter was adapted into the port and locked with restrictor.The Port was inserted into the pouch of pre-cordial incision. 7.Skin was closed layer by layer. Both catheter and port were perfused with heparin solution after implantation. Operators 石博元 Assistants 謝承原 管瑩如 (F,1981/06/08,30y9m) 手術日期 2011/07/20 手術主治醫師 陳欽德 手術區域 產房 090房 06號 診斷 Brain tumor 器械術式 D & C for diagnostic 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 靜脈麻醉 麻醉主治醫師 鍾乙諄 ASA 2 紀錄醫師 楊博凱, 時間資訊 00:00 臨時手術NPO 12:11 報到 12:50 進入手術室 12:55 麻醉開始 13:00 誘導結束 13:04 抗生素給藥 13:05 手術開始 13:15 手術結束 13:15 麻醉結束 13:20 送出病患 13:30 進入恢復室 15:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 妊娠前十二週流產刮宮術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 記錄__ 手術科部: 婦產部 套用罐頭: Therapeutic D&C; 開立醫師: 楊博凱 開立時間: 2011/07/20 13:35 Pre-operative Diagnosis Pregnancy for 13 weeks with blighted ovum. Post-operative Diagnosis Pregnancy for 13 weeks with blighted ovum. Operative Method Therapeutic dilatation and curettage. Specimen Count And Types 1 piece About size: Source:blighted ovum Pathology Pending. Operative Findings 1. Uterus: anteversion, sounding: 9.5 cm, dilatation to Hegar No. 10. 2. Some villus-like tissus was curetted from endometrial cavity. 3. Estimated blood loss: 30 mL, Blood transfusion: nil, Complication: nil. Operative Procedures 1. Put the patient in lithotomy position. 2. Vaginal douching, skin preparation and drapping as usual. 3. Sounding of the uterine cavity: 9.5 cm. 4. Dilatation: Hegar No. 10. 5. Suction curettage of the uterine cavity. Operators 陳欽德 Assistants 楊博凱. 梁麗俐 (F,1952/11/07,59y4m) 手術日期 2011/07/20 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Brain Tumor 器械術式 left frontal craniotomy for tumor excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:10 麻醉開始 09:00 誘導結束 09:35 抗生素給藥 09:39 手術開始 10:55 開始輸血 15:25 手術結束 15:25 麻醉結束 15:35 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 7 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 顱底瘤手術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Left frontal craniotomy for Simpson grade II ... 開立醫師: 曾峰毅 開立時間: 2011/07/20 15:27 Pre-operative Diagnosis Meningioma, outer-third of left sphenoid ridge Post-operative Diagnosis Meningioma, outer-third of left sphenoid ridge Operative Method Left frontal craniotomy for Simpson grade II tumor excision Specimen Count And Types 1 piece About size:6cm Source:brain tumor Pathology pending Operative Findings Abundant bleeding from engorged left superficial temporal artery while scalp incision. Abundant emissary veins and venous poors were encounterred during craniotomy. One firm, elastic, well-defined, and hypervascular, dura-based, tumor was noted arising from outer-thrid of left sphenoid ridge. It masured 7*5*4cm. Blood loss: 6000ml. Transfusion: 6 units of whole blood, 16 units of packed RBC, 10 units of FFP, and 46 units of platelets. Operative Procedures After intubation and general anesthesia, the patient was put in supine position. Her head was fixed with Mayfield head clamp and the skin was prepared as usual. One bicoronal skin incision was made from 1cm before left ear, to 5cm across the midline. The superficial temporal artery was sacrificed for hemostasis. The skin flap was reflected downward and one piece of 5*8 cm pericranium was harvested. Four burr holes were made at keyhole, temporal bone, and both sides of midline. Craniotomy was made. Vertical dural incision was made and the tumor was pulled up. The tumor was dissected by bipolar and CUSA, and was removed in en-bloc. Hemostasis was done with alcohol injection into tumor, and H202 irrigation at tumor-based dura. The dura was repaired with pericranium and prolene in water-tight fashion. Opened frontal sinus was sealed with pericranium and packed with beta-iodine gelfoam. The bone flap was fixed back with miniplates after two epidural CWV placed. The wound was closed in layers. Operators Prof. 杜永光 Assistants R5 曾峰毅 R3 陳國瑋 相關圖片 李書儀 (F,1978/10/28,33y4m) 手術日期 2011/07/20 手術主治醫師 蔡瑞章 手術區域 東址 005房 01號 診斷 Herniation of intervertebral disc without myelopathy, lumbar (HIVD) 器械術式 right L4-5 microsurgical discectomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 許皓淳, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:03 進入手術室 08:05 麻醉開始 08:10 誘導結束 08:50 抗生素給藥 09:06 手術開始 10:45 手術結束 10:45 麻醉結束 10:57 送出病患 11:00 進入恢復室 12:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 椎間盤切除術-腰椎 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: L4/5 Microdiskectomy, right 開立醫師: 李振豪 開立時間: 2011/07/20 11:01 Pre-operative Diagnosis L4/5 herniated intervertebral disc, right Post-operative Diagnosis L4/5 herniated intervertebral disc, right Operative Method L4/5 Microdiskectomy, right Specimen Count And Types nil Pathology Nil Operative Findings Bulging disc with ruptured disc was noted after retraction of the thecal sac and right L5 root. The sequestrated disc was removed and the root became loose after microdiskectomy. No incidental durotomy or CSF leakage was noted during whole procedure. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position. L4/5 disc space was localized by portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made at L4/5 disc level and the subcutaneous soft tissue was devided. The right paravertebral muscle groups were detached and retracted by a modified narrow Taylor retractor. L4/5 right side laminotomy was performed and the ligmentum flavum was resected. The thecal sac and right L5 root were retracted and the ruptured disc was identified. The sequestrated disc was removed followed by microdiskectomy with curette, alligator, and disc clamp. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. Rinderon suspension was applied and the wound was closed in layers with 2-0 Vicryl and 4-0 Dexon. Operators Prof.蔡瑞章 Assistants R5李振豪, R2許皓淳 相關圖片 劉啟恩 (M,2010/11/23,1y3m) 手術日期 2011/07/20 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Lipoma 器械術式 anterior fontanel dermoid cyst resection 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 2 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 09:50 報到 10:18 進入手術室 10:20 麻醉開始 10:30 誘導結束 10:35 抗生素給藥 11:04 手術開始 11:45 手術結束 11:45 麻醉結束 12:30 送出病患 12:30 進入恢復室 12:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 手術 頭皮腫瘤 1 1 摘要__ 手術科部: 外科部 套用罐頭: Tumor excision 開立醫師: 王奐之 開立時間: 2011/07/20 11:39 Pre-operative Diagnosis Anterior fontanel epidermoid cyst Post-operative Diagnosis Anterior fontanel epidermoid cyst Operative Method Tumor excision Specimen Count And Types 1 piece About size:1*1*1cm Source:scalp tumor Pathology Pending Operative Findings An elastic-firm tumor, about 1cm in diameter, with well encapsulation was noted over anterior fontanel, compressed the anterior fontanel. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position. After shaving, scrubbing, disinfection & draping in sterile fashion, a tranverse linear incision was made over the tumor. The subcutaneous plane was then carefully dissected to remove the tumor en bloc without rupture. After tumor removal, hemostasis was achieved. The wound was then closed with 3-0 Vicryl & 4-0 Nylon continuous sutures. Operators AP 郭夢菲 Assistants R4 王奐之, Ri 陳滄堯 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Tumor excision 開立醫師: 王奐之 開立時間: 2011/07/20 11:39 Pre-operative Diagnosis Anterior fontanel epidermoid cyst Post-operative Diagnosis Anterior fontanel epidermoid cyst Operative Method Tumor excision Specimen Count And Types 1 piece About size:1*1*1cm Source:scalp tumor Pathology Pending Operative Findings An elastic-firm tumor, about 1cm in diameter, with well encapsulation was noted over anterior fontanel, compressed the anterior fontanel. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position. After shaving, scrubbing, disinfection & draping in sterile fashion, a tranverse linear incision was made over the tumor. The subcutaneous plane was then carefully dissected to remove the tumor en bloc without rupture. After tumor removal, hemostasis was achieved. The wound was then closed with 3-0 Vicryl & 4-0 Nylon continuous sutures. Operators AP 郭夢菲 Assistants R4 王奐之, Ri 陳滄堯 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Tumor excision 開立醫師: 柯柏瑞 開立時間: 2011/07/21 10:36 Pre-operative Diagnosis Anterior fontanel epidermoid or dermoid cytst Post-operative Diagnosis Anterior fontanel epidermoid or dermoid cytst Operative Method Tumor excision Specimen Count And Types 1 piece About size:1*1*1cm Source:scalp tumor Pathology Pending Operative Findings An elastic-firm tumor, about 1cm in diameter, with well encapsulation was noted over anterior fontanel, compressed the anterior fontanel. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position. After shaving, scrubbing, disinfection & draping in sterile fashion, a tranverse linear incision was made over the tumor. The subcutaneous plane was then carefully dissected to remove the tumor en bloc without rupture. After tumor removal, hemostasis was achieved. The wound was then closed with 3-0 Vicryl & 4-0 Nylon continuous sutures. Operators AP 郭夢菲 Assistants R4 王奐之, Ri 陳滄堯 相關圖片 簡明珠 (F,1954/09/21,57y5m) 手術日期 2011/07/20 手術主治醫師 賴達明 手術區域 東址 002房 04號 診斷 Cerebral aneurysm 器械術式 left Pcom aneurysmal clipping 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 09:40 通知急診手術 12:16 進入手術室 12:16 報到 12:20 麻醉開始 12:40 誘導結束 13:20 抗生素給藥 13:28 手術開始 16:20 抗生素給藥 18:30 開始輸血 19:20 抗生素給藥 20:40 麻醉結束 20:40 手術結束 20:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 開顱術摘除血管病變 - 腦血管瘤 有病徵的 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 9 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: Left pterional approach aneurysmal clipping 開立醫師: 林哲光 開立時間: 2011/07/20 21:38 Pre-operative Diagnosis Left posterior communicating aneurysm and left anterior choroidal artery aneurysm Post-operative Diagnosis Left posterior communicating aneurysm and left anterior choroidal artery aneurysm Operative Method Left pterional approach aneurysmal clipping Specimen Count And Types Pathology Nil Operative Findings One 1cm long left Pcom aneurysm was noted with daughter aneurysm and tightly compressing left 3rd nerve. A curved Sugita clip was applied. Another small aneurysm was noted at left anterior choroidal artery and another curve Sugita clip was applied. Operative Procedures Under ETGA and supine position with head fixed with Mayfield head clump around 15 degree, skin disinfected and drapped were performed as usual. Curvilinear skin incision was made at left frototemporal area. The muscle falp was dissected and reflected to expose keyhole. Craniotomy was then done after four burr holes were created. The spheonid ridge was dissected until ACP was expsed. THe dura was then opened in C shaped. Sylvian fissure was opened at frontal side and arachnoid membrane of the optic nerve and ICA were opened. THe aneurysm was then exopsed well after brain retractor was set. Aneurysmal clipping was then performed at left Pcom aneurysm and left anterior choroidal artery. The dura was then closed in water-tie method. THe skull bone was put back and fixed with mini-plates. THe wound was then closed in layers after a subgaleal CWV drain insertion. Operators 賴達明 Assistants 林哲光 Indication Of Emergent Operation 相關圖片 劉庭妤 (F,1989/09/20,22y5m) 手術日期 2011/07/20 手術主治醫師 賴達明 手術區域 東址 005房 02號 診斷 HIVD 器械術式 Left L4-5 microsurgical discectomy 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 許皓淳, 時間資訊 00:00 臨時手術NPO 10:55 報到 11:05 進入手術室 11:10 麻醉開始 11:15 誘導結束 11:38 抗生素給藥 12:00 手術開始 13:33 手術結束 13:33 麻醉結束 13:40 送出病患 13:45 進入恢復室 14:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 椎間盤切除術-腰椎 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: L4/5 Microdiskectomy, left 開立醫師: 李振豪 開立時間: 2011/07/20 13:38 Pre-operative Diagnosis L4/5 herniated intervertebral disc, left Post-operative Diagnosis L4/5 herniated intervertebral disc, left Operative Method L4/5 Microdiskectomy, left Specimen Count And Types nil Pathology Nil Operative Findings Bulging disc was noted at L4/5 level which compressed the left L5 root tightly. The PLL was intact. After opening of the PLL, the herniated disc was noted. Microdiskectomy was performed and the left L5 root became much loose. The disc within disc space was remain healthy. No incidental durotomy or CSF leakage was noted during whole procedure. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position. L4/5 disc space was localized by portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made at L4/5 disc level and the subcutaneous soft tissue was devided. The left paravertebral muscle groups were detached and retracted by a modified narrow Taylor retractor. L4/5 left side laminotomy was performed and the ligmentum flavum was resected. The thecal sac and left L5 root were retracted and the bulging disc was identified. Microdiskectomy was performed with alligator, disc clamp, and curette. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. The wound was closed in layers with 2-0 Vicryl and 4-0 Dexon. Operators VS賴達明 Assistants R5李振豪, R2許皓淳 相關圖片 李佳宜 (F,1997/11/23,14y3m) 手術日期 2011/07/20 手術主治醫師 楊士弘 手術區域 兒醫 067房 02號 診斷 Dislocations of second cervical vertebra, closed 器械術式 Re-adjustment of O-C instrumentation & C1 laminectomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 11:35 報到 12:35 進入手術室 12:45 麻醉開始 13:30 誘導結束 13:35 抗生素給藥 13:51 手術開始 16:35 抗生素給藥 17:00 麻醉結束 17:00 手術結束 17:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術(減壓)-二節以內 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: C1 Laminectomy + Re-adjustment of instrumentation 開立醫師: 曾偉倫 開立時間: 2011/07/20 17:15 Pre-operative Diagnosis Occipitoatlantoaxial subluxation; spondyloepiphyseal dysplasia status post Occipitocervical fixation and fusion Post-operative Diagnosis Occipitoatlantoaxial subluxation; spondyloepiphyseal dysplasia status post Occipitocervical fixation and fusion Operative Method C1 Laminectomy + Re-adjustment of instrumentation Specimen Count And Types nil Pathology Nil Operative Findings 1. Persisted C1-2 sublauxation in intra-operative x-ray 2. The thecal sac expanded well after the operation 3. Intra-operative SSEP showed no latency or amplify change Operative Procedures Under ETGA, patient was put on prone position. After we shaved, scrubbed, disinfected and drapped, A mid-line skin incision was made over the previous operation wound. The wound was opened in layers and the previous screws and rods was exposed. The rod was removed after we make the screws loose. We extend her neck intra-operatively and we fixed the screws with rods. C1 lamincetomy was done after then and posterior fusion was done with bone graft. A CWV drain was placed after complete hemostasis. The wound was closed in layers. Operators VS 楊士弘 Assistants R3 曾偉倫 相關圖片 陳臣堪 (M,1934/09/03,77y6m) 手術日期 2011/07/20 手術主治醫師 李苑如 手術區域 西址 039房 02號 診斷 Calculus of kidney 器械術式 Removal of double-J 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 13:28 進入手術室 13:30 麻醉開始 13:31 誘導結束 13:32 手術開始 13:35 手術結束 13:40 送出病患 13:40 麻醉結束 林育蔚 (M,1977/04/11,34y11m) 手術日期 2011/07/21 手術主治醫師 林峰盛 手術區域 西址 034房 02號 診斷 Major depression disorder 器械術式 Nerve block / PC 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 林峰盛 ASA 2 時間資訊 08:35 報到 10:05 進入手術室 10:07 麻醉開始 10:10 誘導結束 10:15 手術開始 10:40 麻醉結束 10:40 手術結束 10:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 高頻熱凝療法 1 1 R 摘要__ 手術科部: 麻醉部 套用罐頭: Pulsed RF 開立醫師: 林峰盛 開立時間: 2011/07/21 10:44 Pre-operative Diagnosis atypical facial pain Post-operative Diagnosis atypical facial pain Operative Method Pulsed RF Specimen Count And Types nil Pathology Nil Operative Findings Operative Procedures 1. IV sedation with midazolam and LA with 1% xylocaine 2. pt in supine position 3. Under fluoroscopic-guidance, insert 22 G SMK RF meedle via pterygopalatine fissure to sphenopalatine ganglion 4. Neurostimulation with 50 HZ and 2 Hz 0.1-0.5 mV current with positive result 60-80V 2 Hz, 20 ms, 120sec *3 pulsed RF was delivered send pt to POR Operators 林峰盛, Assistants 謝承原, 陳艷莉 (F,1956/10/13,55y5m) 手術日期 2011/07/21 手術主治醫師 李苑如 手術區域 東址 008房 02號 診斷 Ureteral stricture 器械術式 Double-J ureteral stent insert 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 靜脈麻醉 麻醉主治醫師 劉治民 ASA 3 紀錄醫師 戴逸昇, 時間資訊 08:44 報到 08:48 進入手術室 08:55 麻醉開始 09:00 誘導結束 09:10 手術開始 09:22 手術結束 09:22 麻醉結束 09:25 送出病患 09:30 進入恢復室 10:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 手術 雙丁輸尿管導管置入術 1 0 L 記錄__ 手術科部: 泌尿部 套用罐頭: URS (biopsy) 開立醫師: 戴逸昇 開立時間: 2011/07/21 09:34 Pre-operative Diagnosis Left hydronephrosis Post-operative Diagnosis 1. Left lower ureteral stricture 2. Left hydronephrosis Operative Method 1. Left DBJ insertion 2. URS Specimen Count And Types nil Pathology nil Operative Findings 1. Left lower ureteral stricture 2. Polyps at left orifice and intact right ureteroneocystostomy orifice 3. A Fr.7-24cm DBJ catheter was inserted. Operative Procedures Under satisfactory anesthesia with the patient in the lithotomy position, skin preparation was performed. A cystoscope was inserted into the bladder and a guidewire was then introduced into the ureteral orifice. Right ureteroneocystostomy orifice and left orifice with polyps were intact. A 6 Fr. ureteroscope was introduced into the ureter. Left lower ureteral stricture was noted. A Fr.7-24cm DBJ catheter was inserted. The patient tolerated the operation well and was sent to the recovery room in stablecondition. Operators 李苑如, Assistants 姜秉均, 戴逸昇, 相關圖片 潘佳杰 (M,1977/10/03,34y5m) 手術日期 2011/07/21 手術主治醫師 李崇維 手術區域 東址 000房 號 診斷 Arteriovenous malformation, brain 器械術式 NEURO T.A.E 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 2 時間資訊 08:27 麻醉開始 08:45 誘導結束 13:00 麻醉結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 文龍萍 (M,1971/07/07,40y8m) 手術日期 2011/07/21 手術主治醫師 陳敞牧 手術區域 東址 005房 01號 診斷 Central cord syndrome injury 器械術式 ACDF with cage 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:09 進入手術室 08:15 麻醉開始 09:00 誘導結束 09:05 抗生素給藥 09:33 手術開始 12:05 手術結束 12:05 麻醉結束 12:05 抗生素給藥 12:20 送出病患 12:20 進入恢復室 13:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-前融合,有固定物)≦四節 1 2 手術 椎間盤切除術-頸椎 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 記錄__ 手術科部: 外科部 套用罐頭: C3/4 anterior cervical discectomy and fusion ... 開立醫師: 李振豪 開立時間: 2011/07/21 12:11 Pre-operative Diagnosis C-spine injury with C3/4 herniated intervertebral disc and myelopathy Post-operative Diagnosis C-spine injury with C3/4 transdiscal fracture and myelopathy Operative Method C3/4 anterior cervical discectomy and fusion with PEEK cage Specimen Count And Types nil Pathology Nil Operative Findings The anterior longitudinal ligment was discontinued at C3/4 level. Transdiscal fracture was favored. The marginal spur was removed. The disc was degenerative in character. Hypertrophic posterior longitudinal ligment was resected and the thecal sac expanded well. No incidental durotomy or CSF leakage noted during the operation. One #8 PEEK cage was inserted for anterior cervical fusion. The anterior longitudinal ligment was discontinued at C3/4 level. Transdiscal fracture was favored. The marginal spur was removed. The disc was degenerative in character. Hypertrophic posterior longitudinal ligment was resected and the thecal sac expanded well. No incidental durotomy or CSF leakage noted during the operation. One #8 PEEK cage was inserted for anterior cervical fusion. Poor SSEP waveform over right side was noted before the operation. No obvious SSEP change during whole procedure. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position. The skin was scrubbed, disinfected, and draped as usual. Transverse skin incision was made at right upper neck. The subcutaneous soft tissue was devided and the platysma muscle was retracted laterally. Dissection along the plane between thyroid gland and SCM muscle/carotid sheath was performed until prevertebral fascia was approached. C3/4 disc space was localized by intra-operative portable C-arm X-ray. The prevertebral fascia was opened and the longus collis muscle was detached. Under operative microscope, microdiskectomy was performed with curette, alligator, and Midas air-drived drills. Resection of PLL and bilateral foraminotomy also performed. One #8 PEEK cage was inserted for anterior cervical fusion. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. The wound was then closed in layers with 3-0 Vicryl and 4-0 Dexon. Operators VS陳敞牧 Assistants R5李振豪, R1張倍慈 相關圖片 王正祿 (M,1969/10/30,42y4m) 手術日期 2011/07/21 手術主治醫師 陳敞牧 手術區域 東址 005房 02號 診斷 Herniated intervertebral disc (HIVD) 器械術式 ACDF, C3/4 with cage 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 12:07 報到 12:30 進入手術室 12:35 麻醉開始 12:50 誘導結束 13:10 抗生素給藥 13:20 手術開始 15:23 手術結束 15:23 麻醉結束 15:38 送出病患 15:42 進入恢復室 16:42 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-頸椎 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 手術 脊椎融合術-前融合,有固定物)≦四節 1 2 記錄__ 手術科部: 外科部 套用罐頭: C3/4 anterior cervical discectomy and fusion ... 開立醫師: 李振豪 開立時間: 2011/07/21 15:26 Pre-operative Diagnosis C3/4 herniated intervertebral disc with myelopathy Post-operative Diagnosis C3/4 herniated intervertebral disc with myelopathy Operative Method C3/4 anterior cervical discectomy and fusion with PEEK cage Specimen Count And Types nil Pathology Nil Operative Findings The disc was degenerative in character. The thecal sac expanded well after resection of the posterior longitudinal ligment. One #7 PEEK cage was used for anterior cervical fusion. The lower extremities SSEP was unsatisficated before the operation. No significant SSEP change during whole procedure. No incidental durotomy or CSF leakage found also. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position. The skin was scrubbed, disinfected, and draped as usual. Transverse skin incision was made at right upper neck. The subcutaneous soft tissue was devided and the platysma muscle was retracted laterally. Dissection along the plane between thyroid gland and SCM muscle/carotid sheath was performed until prevertebral fascia was approached. C3/4 disc space was localized by intra-operative portable C-arm X-ray. The prevertebral fascia was opened and the longus collis muscle was detached. Under operative microscope, microdiskectomy was performed with curette, alligator, and Midas air-drived drills. Resection of PLL and bilateral foraminotomy also performed. One #7 PEEK cage was inserted for anterior cervical fusion. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. The wound was then closed in layers with 3-0 Vicryl and 4-0 Dexon. Operators VS陳敞牧 Assistants R5李振豪, R1張倍慈 相關圖片 李建郎 (M,1976/05/13,35y10m) 手術日期 2011/07/21 手術主治醫師 楊士弘 手術區域 東址 003房 03號 診斷 Hyperhidrosis 器械術式 Endoscopic T2 sympathectomy 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 1 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 16:19 進入手術室 16:25 麻醉開始 16:30 誘導結束 16:40 抗生素給藥 16:58 手術開始 17:55 手術結束 17:55 麻醉結束 18:05 送出病患 18:10 進入恢復室 19:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 經內視鏡交感神經切斷術 1 1 B 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Endoscopic Bilateral T2-T3 sympathectomy 開立醫師: 曾偉倫 開立時間: 2011/07/21 18:01 Pre-operative Diagnosis Hyperhidrosis Post-operative Diagnosis Hyperhidrosis Operative Method Endoscopic Bilateral T2-T3 sympathectomy Specimen Count And Types nil Pathology Nil. Operative Findings 1. Temperature change of right hand before & after sympathectomy: 30.2 to 34.5 2. Temperature change of left hand before & after sympathectomy: 28.8 to 32.2. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with bilateral arms stretched out. After skin disinfection & draping in sterile fashion, 1 small linear incision was made at right axillary area (about 4th ICS & mid-axillary line intersection). After inserting the trocar into left pleural space, endoscope was inserted until the T2 rib was identified. Electrocauterization was then applied to left T2 & T3 sympathetic ganglion. The same procedure was repeated again at right side. The 2 wounds were closed with 3-0 Nylon. After endotracheal general anesthesia, the patient was placed in supine position with bilateral arms stretched out. After skin disinfection & draping in sterile fashion, 1 small linear incision was made at left axillary area (about 4th ICS & anterior axillary line intersection). After inserting the trocar into left pleural space, endoscope was inserted until the T2 rib was identified. Electrocauterization was then applied to left T2 & T3 sympathetic ganglion. The same procedure was repeated again at right side. The 2 wounds were closed with 3-0 Nylon. Operators VS 楊士弘 Assistants R4 王奐之 R3 曾偉倫 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Endoscopic Bilateral T2-T3 sympathectomy 開立醫師: 王奐之 開立時間: 2011/07/23 06:43 Pre-operative Diagnosis Hyperhidrosis Post-operative Diagnosis Hyperhidrosis Operative Method Endoscopic Bilateral T2-T3 sympathectomy Specimen Count And Types nil Pathology Nil. Operative Findings 1. Temperature change of right hand before & after sympathectomy: 30.2 to 34.5 2. Temperature change of left hand before & after sympathectomy: 28.8 to 32.2. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with bilateral arms stretched out. After skin disinfection & draping in sterile fashion, 1 small linear incision was made at left axillary area (about 4th ICS & anterior axillary line intersection). After inserting the trocar into left pleural space, endoscope was inserted until the T2 rib was identified. Electrocauterization was then applied to left T2 & T3 sympathetic ganglion. The same procedure was repeated again at right side. The 2 wounds were closed with 3-0 Nylon. Operators VS 楊士弘 Assistants R4 王奐之 R3 曾偉倫 相關圖片 林崇德 (M,2011/07/16,8m2d) 手術日期 2011/07/21 手術主治醫師 黃書健 手術區域 ICU 00-房 01號 診斷 Interruption of aortic arch 器械術式 bedside sternal closure 手術類別 預定手術 手術部位 胸 傷口分類 清潔污染 麻醉方式 靜脈麻醉 麻醉主治醫師 ASA 1 紀錄醫師 黃俊銘, 時間資訊 00:43 臨時手術NPO 13:15 麻醉開始 13:15 進入恢復室 13:20 手術開始 14:00 麻醉結束 14:05 手術結束 18:04 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 IV or IM anesthesia 1 0 手術 探查性心包膜切開術 1 2 摘要__ 手術科部: 外科部 套用罐頭: Sternal closure 開立醫師: 黃俊銘 開立時間: 2011/07/21 14:22 Pre-operative Diagnosis IAA type A, LVOTO, VSD, PDA s/p Norwood stage I + RV-PA conduit with sternum unapproximated Post-operative Diagnosis Ditto Operative Method Sternal closure Specimen Count And Types nil Pathology Nil Operative Findings Few hematoma Surgical membrane strip loop neo-Ao and RV-PA conduit Surgical membrane cover heart Operative Procedures ETGA, supine Skin disinfect, draping Remove silicon membrane Remove hematoma N/S irrigation Wound closed in layers Operators 邱英世 黃書健 Assistants 黃俊銘 黃美鳳 (F,1953/12/10,58y3m) 手術日期 2011/07/21 手術主治醫師 蕭輔仁 手術區域 東址 005房 03號 診斷 Low back pain 器械術式 Radiofrequency coagulation(P-G 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 16:26 進入手術室 16:42 麻醉開始 16:43 誘導結束 16:45 手術開始 17:10 手術結束 17:12 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 高頻熱凝療法 1 1 B 記錄__ 手術科部: 外科部 套用罐頭: Radiofrequency stimulation, bilateral L2 dors... 開立醫師: 李振豪 開立時間: 2011/07/21 17:09 Pre-operative Diagnosis Low back pain Post-operative Diagnosis Low back pain Operative Method Radiofrequency stimulation, bilateral L2 dorsal root Specimen Count And Types nil Pathology Nil Operative Findings 1. Bilateral L2 dorsal root was identified by portable C-arm X-ray and sensory/motor stimulation test. No acute complication was noted after the procedure. 2. Temp: 42 oC, Time: 180sec x 2 cycles each side Operative Procedures The patient was put in prone position. The location of L2 was identified by portable C-arm X-ray. The skin was disinfected and draped as usual. Local anesthesia was performed with 1% Xylocaine 10ml. Bilateral L2 dorsal root radiofrequency stimulation was performed under portable C-arm guided. The patient stood whole procedure well. Operators VS 蕭輔仁 Assistants R5 李振豪 相關圖片 謝秀月 (F,1946/09/08,65y6m) 手術日期 2011/07/21 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Brain tumor 器械術式 right frontal craniotomy for tumor excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3 紀錄醫師 吳奕緯, 曾偉倫, 時間資訊 00:00 臨時手術NPO 08:04 進入手術室 08:15 麻醉開始 09:06 抗生素給藥 09:15 誘導結束 09:25 手術開始 12:06 抗生素給藥 12:10 手術結束 12:10 麻醉結束 12:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Right frontal craniectomy for tumor excision 開立醫師: 曾偉倫 開立時間: 2011/07/21 12:25 Pre-operative Diagnosis Right frontal brain tumor, suspect glioma or oligodendroglioma Post-operative Diagnosis Right frontal brain tumor, suspect glioma or oligodendroglioma Operative Method Right frontal craniectomy for tumor excision Specimen Count And Types 1 piece About size:2x2x2 cm Source:Right frontal brain tumor Pathology Frozen section:glioma Operative Findings 1. A 2x2x2 cm mild-hypervescularized, geryish, soft, ill-defined tumor over right frontal lobe next to a cortical drainage vein 2. The pericallosal artery could be seen after the tumor removed Operative Procedures Under ETGA, we placed the patient on supine position with her face tilt to left. After we shaved, scrubbed, disinfected and drapped, we made a cuvilinear bi-cronal skin incision. A right frontal craniectomy was made followed by dural tenting. A curivinear dural incision was made above the tumor after intra-operative echo localization. Tumor resection done with bipolar forceps, bumot forceps, and micro-scissors. The tumor margin was defined with echo and maximal tumor resection was done. After complete hemostasis, we placed a CWV drain. The skull was fixed with mini-plate and screw. The wound was closed in layers. Operators VS 王國川 Assistants R4 王奐之 R3 曾偉倫 R1 吳奕緯 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Right frontal craniectomy for tumor excision 開立醫師: 王奐之 開立時間: 2011/07/23 06:44 Pre-operative Diagnosis Right frontal brain tumor, suspect glioma or oligodendroglioma Post-operative Diagnosis Right frontal brain tumor, suspect glioma or oligodendroglioma Operative Method Right frontal craniectomy for tumor excision Specimen Count And Types 1 piece About size:2x2x2 cm Source:Right frontal brain tumor Pathology Frozen section:glioma Operative Findings 1. A 2x2x2 cm mild-hypervescularized, geryish, soft, ill-defined tumor over right frontal lobe next to a cortical drainage vein 2. The pericallosal artery could be seen after the tumor removed Operative Procedures Under ETGA, we placed the patient on supine position with her face tilt to left. After we shaved, scrubbed, disinfected and drapped, we made a cuvilinear bi-cronal skin incision. A right frontal craniectomy was made followed by dural tenting. A curivinear dural incision was made above the tumor after intra-operative echo localization. Tumor resection done with bipolar forceps, bumot forceps, and micro-scissors. The tumor margin was defined with echo and maximal tumor resection was done. After complete hemostasis, we placed a CWV drain. The skull was fixed with mini-plate and screw. The wound was closed in layers. Operators VS 王國川 Assistants R4 王奐之 R3 曾偉倫 R1 吳奕緯 相關圖片 楊明墩 (M,1931/09/30,80y5m) 手術日期 2011/07/21 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 Cervical myelopathy 器械術式 C3-6 laminectomy and Lateral mass screws posterior fusion 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 12:27 進入手術室 12:30 麻醉開始 12:50 誘導結束 12:56 抗生素給藥 12:58 手術開始 16:00 手術結束 16:00 麻醉結束 16:10 送出病患 16:15 進入恢復室 17:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: C3-C5 laminectomy + C3-5 lateral mass screw p... 開立醫師: 曾偉倫 開立時間: 2011/07/21 16:24 Pre-operative Diagnosis Spondylotic cervical canal stenosis, C3-6, with myelopathy Post-operative Diagnosis Spondylotic cervical canal stenosis, C3-6, with myelopathy Operative Method C3-C5 laminectomy + C3-5 lateral mass screw posterior fixation Specimen Count And Types Nil Pathology Nil Operative Findings 1. Stenosis over C3-6 level, C3 is not stable during the manuver 2. Intra-operative SSEP and MEP showed no change during the operation, but his right hand SSEP and MEP are worse then the others during the whole course 3. Blood loss: 400ml 4. Instrument: DePuy Summit SI lateral mass screw 14mm, ROD: 5cm, Cross link: 5 cm 4. Instrument: DePuy Summit SI lateral mass screw 14mm x 6 , ROD: 5cm x 2, Cross link: 5 cm Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position with head fixed in Mayfield skull clamp. After shaving, scrubbing, disinfection & draping in sterile fashion, a midline linear incision was made at posterior neck. We dissect the para-spinal muscle and expose C3-C6 lamina and lateral mass. C3-C5 laminectomy was done with drill and kerrison punch. Lateral mass screw was inserted and we fixed them with RODs. The cross link was placed. After complete hemostasis, a CWV rain was placed and the wound was closed in layers. Operators VS 王國川 Assistants R4 王奐之, R3 曾偉倫 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: C3-C5 laminectomy + C3-5 lateral mass screw p... 開立醫師: 王奐之 開立時間: 2011/07/23 06:44 Pre-operative Diagnosis Spondylotic cervical canal stenosis, C3-6, with myelopathy Post-operative Diagnosis Spondylotic cervical canal stenosis, C3-6, with myelopathy Operative Method C3-C5 laminectomy + C3-5 lateral mass screw posterior fixation Specimen Count And Types Nil Pathology Nil Operative Findings 1. Stenosis over C3-6 level, C3 is not stable during the manuver 2. Intra-operative SSEP and MEP showed no change during the operation, but his right hand SSEP and MEP are worse then the others during the whole course 3. Blood loss: 400ml 4. Instrument: DePuy Summit SI lateral mass screw 14mm x 6 , ROD: 5cm x 2, Cross link: 5 cm Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position with head fixed in Mayfield skull clamp. After shaving, scrubbing, disinfection & draping in sterile fashion, a midline linear incision was made at posterior neck. We dissect the para-spinal muscle and expose C3-C6 lamina and lateral mass. C3-C5 laminectomy was done with drill and kerrison punch. Lateral mass screw was inserted and we fixed them with RODs. The cross link was placed. After complete hemostasis, a CWV rain was placed and the wound was closed in layers. Operators VS 王國川 Assistants R4 王奐之, R3 曾偉倫 相關圖片 陳林蘭香 (F,1952/04/15,59y10m) 手術日期 2011/07/22 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Glioblastoma multiforma 器械術式 Right craniotomy for tumor excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 許皓淳, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:10 麻醉開始 08:25 誘導結束 08:30 抗生素給藥 08:40 手術開始 10:50 開始輸血 11:30 抗生素給藥 13:50 手術結束 13:50 麻醉結束 13:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4~8小時 1 1 R 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 記錄__ 手術科部: 外科部 套用罐頭: Right parieto-occipital craniotomy for tumor ... 開立醫師: 李振豪 開立時間: 2011/07/22 14:20 Pre-operative Diagnosis Right medial fronto-parietal tumor, suspect high grade glioma Post-operative Diagnosis Right medial fronto-parietal tumor, suspect high grade glioma Operative Method Right parieto-occipital craniotomy for tumor excision Specimen Count And Types 1 piece About size:Multiple pieces Source:Brain tumor Pathology Pending Operative Findings The brain bulging out while dural opening. Bleeding from cortical vein and superior sagittal sinus was encountered. Previous tumor bleeding with old hematoma was noted. Hemosiderin deposition around the tumor and hematoma also noted. The tumor was gelatinous, gray-yellowish, hypervascularized, ill-defined, and 3.8 x 3.6 x 2cm in size. Right lateral ventricle was entered during tumor excision. Intra-operative sonography was checked again after total tumor excision and no obvious residual tumor was noted. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position with head fixed wity Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. Right parieto-occipital reverse V scalp incision was made and the scalp flap was elevated. Five burr holes were created followed by one 8x8cm craniotomy window. Dural tenting was performed. Intra-operative sonography was used for localization of the tumor. C-shape durotomy based with superior sagittal sinus were done. Bleeding from cortical vein and superior sagittal sinus was encountered and Floseal was applied for hemostasis. One 1.5 x 2cm corticotomy was performed and tumor excision was done with suction, bipolar electrocautery, and tumor forceps. Right lateral ventricle was entered during the operation. Hemostasis was achieved with bipolar electrocautery and Surgicel lining. Intra-operative sonography was checked again after total removal of the tumor. Duroplasty with periosteum was performed. The skull plate was fixed back with six #26 wires. One subgaleal CWV drain was placed and the wound was closed in layers with 2-0 Vicryl, 3-0 Nylon, and Appose staples. Operators VS曾漢民 Assistants R5李振豪, R2許皓淳 相關圖片 林鈺芳 (F,1951/11/09,60y4m) 手術日期 2011/07/22 手術主治醫師 賴達明 手術區域 東址 005房 02號 診斷 Intracerebral hemorrhage 器械術式 tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 許皓淳, 時間資訊 00:00 臨時手術NPO 14:22 進入手術室 14:23 麻醉開始 14:30 誘導結束 14:30 抗生素給藥 14:40 手術開始 15:02 手術結束 15:02 麻醉結束 15:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 氣管切開術 1 0 摘要__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 許皓淳 開立時間: 2011/07/22 15:06 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types nil Pathology None Operative Findings Fr. 8 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators VS賴達明 Assistants R5李振豪, R2許皓淳 相關圖片 葉檉淦 (F,1956/09/18,55y5m) 手術日期 2011/07/22 手術主治醫師 賴達明 手術區域 東址 007房 03號 診斷 Intracerebral hemorrhage 器械術式 Removal of intracerabral hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 蕭柏妮 ASA 4E 紀錄醫師 曾峰毅, 時間資訊 08:00 臨時手術NPO 08:00 開始NPO 17:13 通知急診手術 18:00 進入手術室 18:10 麻醉開始 18:30 誘導結束 19:00 抗生素給藥 19:00 開始輸血 19:10 手術開始 21:55 手術結束 21:55 麻醉結束 22:00 抗生素給藥 22:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦內血腫清除術 1 1 L 手術 顱內壓視置入 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 摘要__ 手術科部: 外科部 套用罐頭: CVA 開立醫師: 曾峰毅 開立時間: 2011/07/22 22:17 Pre-operative Diagnosis Left frontal intracerebral hemorrhage Post-operative Diagnosis Left frontal intracerebral hemorrhage Operative Method Craniotomy for hemotoma evacuation and ICP monitor insertion. Specimen Count And Types Nil Pathology Nil Operative Findings Subcorticol hematoma was noted at left frontal lobe. No obvious bleeder, neoplasm, vascular lesion was noted. Post-op ICP was 8 mmHg, and Codman ICP reference is 491. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to right. We shaved, scrubbed, disinfected, and then draped the patient as usual, and then made one linear scalp incision at left frontal area, about 3 cm behind the coronal suture. We made two burr holes, and then created craniotomy. Dura was tented along the craniotomy window, and dura was incised in X-shape. Hematoma was removed via corticotomy, and hemostasis was performed. One subdural ICP monitor was inserted. Duroplasty was done with water-tight suture. Bone graft was fixed back with mini-plates, and the wound was closed in layers. Operators VS 賴達明 Assistants R5 曾峰毅 Ri 俞 Indication Of Emergent Operation IICP 相關圖片 柳鋼輝 (M,1934/05/28,77y9m) 手術日期 2011/07/22 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Herniated intervertebral disc (HIVD) 器械術式 C6-7 discectomy with cage 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 吳奕緯, 時間資訊 00:00 臨時手術NPO 07:58 進入手術室 08:00 麻醉開始 08:30 誘導結束 08:50 抗生素給藥 08:57 手術開始 11:00 手術結束 11:00 麻醉結束 11:05 送出病患 11:10 進入恢復室 12:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-頸椎 1 1 手術 脊椎融合術-前融合,有固定物)≦四節 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Anterior Discectomy and Fusion, Cervical Spine 開立醫師: 曾峰毅 開立時間: 2011/07/22 11:01 Pre-operative Diagnosis HIVD, C6/7 Post-operative Diagnosis HIVD, C6/7 Operative Method C6/7, anterior discectomy, and anterior fusion with PEEK cage and artificial bone graft. Specimen Count And Types Nil Pathology Nil Operative Findings Thecal sac was compressed by herniated disc, and was decompressed well after disectomy. Synthes PEEK cage, 8 mm in height, was inserted into C6/7 intervertebral space for fusion. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with neck extended. We made one transverse skin incision at right aspect of the neck, and dissected along medial side of platysma to expose prevertebral space. We performed anterior diskectomy and fused with PEEK cage and artificial bone graft. The wound was closed in layers. Operators VS 賴達明 Assistants R5 曾峰毅 R0 吳奕瑋 相關圖片 謝吳金定 (F,1951/09/02,60y6m) 手術日期 2011/07/22 手術主治醫師 陳敞牧 手術區域 東址 019房 01號 診斷 Malignant neoplasm of connective and other soft tissue 器械術式 T1 laminectomy with tumor excision, L2-3 laminectomy with tumor excision 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 07:15 報到 08:05 進入手術室 08:10 麻醉開始 08:20 誘導結束 09:20 抗生素給藥 09:40 手術開始 12:30 抗生素給藥 15:20 開始輸血 15:40 手術結束 15:40 麻醉結束 15:50 送出病患 15:52 進入恢復室 17:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 7 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 脊椎內脊髓內腫瘤切除術 1 1 手術 椎弓切除術(減壓)-二節以內 1 2 摘要__ 手術科部: 內科部 套用罐頭: T1 laminectomy for posterior decompression an... 開立醫師: 曾偉倫 開立時間: 2011/07/22 16:17 Pre-operative Diagnosis Intrapsinal tumor, T-spine and L-spine Post-operative Diagnosis Lumbar intrapsinal intramedullary tumor, suspected neuroma Operative Method T1 laminectomy for posterior decompression and L2-3 laminectomy for intraspinal tumor excision Specimen Count And Types 1 piece About size:Two 2cm sized Source:intraspinal tumor Pathology Pending Operative Findings The dura seemed bulging to the posterior side after lamniectomy. The dura seemed tension free after dura was opened and CSF drainage was done. No visible lesion was noted at T spine level. Intraspinal intramedullary tumor was noted at L2-3 level with cystic component. It was tightly adherenet to two roots and the roots were divided for tumor excision. The tumor was yellowish, elastic, hypovascular with 2x1x1 cm in size. The SSEP and MEP showed no change during the operation. Operative Procedures Under ETGA, we placed the patient on prone position. The T1 and L2-3 level was located with C-arm. After scrubbed, disinfected and drapped, we made a skin incision over T1 level and the wound was open layer by layer. The para spinal muscle was resected and T1 laminectomy was done. We opened the dura and there was no tumor found within the thecal sac. The dura was closed with water-tight fasion. There was no tumor found around the T1 area and the thecal sac was loose. We closed the wound in layers after placing a CWV drain. A mid-line skin incision was made over L2-36 level and L2-3 laminoplasty was done. The dura was opened and tumor resection was done with bioplar forceps and tumor forceps. The dura was closed and a CWV drain was placed. We closed the wound in layers. Operators VS 陳敞牧 Assistants R5 林哲光 R3 曾偉倫 相關圖片 康夏華 (F,1970/05/05,41y10m) 手術日期 2011/07/23 手術主治醫師 楊士弘 手術區域 東址 019房 03號 診斷 Headache 器械術式 Burr hole (trephination) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 蕭柏妮 ASA 2E 紀錄醫師 陳國瑋, 時間資訊 16:00 開始NPO 20:15 通知急診手術 01:35 報到 01:50 麻醉開始 01:50 進入手術室 01:55 誘導結束 02:10 抗生素給藥 02:27 手術開始 03:25 手術結束 03:25 麻醉結束 03:32 送出病患 03:40 進入恢復室 04:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 慢性硬腦膜下血腫清除術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Chronic Subdural Hematoma 開立醫師: 曾峰毅 開立時間: 2011/07/23 03:22 Pre-operative Diagnosis Left chronic subdural hematoma Post-operative Diagnosis Left chronic subdural hematoma Operative Method Left frontal burr hole for subdural drainage Specimen Count And Types Nil Pathology Nil Operative Findings Dark-brownish non-coagulated blood gushed out while durotomy. There was outer and inner membrane. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position. After scalp shaved, scrubbed, disinfected, and then draped as usual, we made one transverse scalp incision at left frontal area. We drilled one burr hole, and created durotomy. We insertes subdural drain for draiange and irrigation. The wound was closed in layers. Subdural space was de-air-ed. Operators VS 楊士弘 Assistants R5 曾峰毅 R3 陳國瑋 Indication Of Emergent Operation IICP 相關圖片 偕登荏 (M,1985/12/08,26y3m) 手術日期 2011/07/22 手術主治醫師 楊士弘 手術區域 東址 003房 02號 診斷 Lumbar spondylosis 器械術式 L5-S1 microsurgical discectomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 吳奕緯, 時間資訊 00:00 臨時手術NPO 11:00 報到 11:26 進入手術室 11:30 麻醉開始 11:35 誘導結束 12:08 抗生素給藥 12:09 手術開始 13:55 手術結束 13:55 麻醉結束 14:02 送出病患 14:05 進入恢復室 15:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 手術 椎間盤切除術-腰椎 1 1 B 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 外科部 套用罐頭: Microsurgical diskectomy 開立醫師: 曾峰毅 開立時間: 2011/07/22 14:07 Pre-operative Diagnosis Herniated intervertebral disc, L5-S1, bilateral Post-operative Diagnosis Herniated intervertebral disc, L5-S1, bilateral Operative Method Microsurgical diskectomy Specimen Count And Types nil Pathology Nil Operative Findings The ligamentum flavum between L5-S1 was thick, and facet joints were hypertrophic. TheL5-S1 was rather bulging and caused compression of the bilateral S1 roots, which became free of tension after excision of hypertrophic ligament and protruding disk. Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: prone with a bolster beneath both sides and flexed at the waist and knees. 3. Skin preparation: the back was shaved and scrubbed with povidone-iodine detergent then painted with povidone-iodine tincture and followed by sterilized adhesive plastic sheet covering. 4.A spinal needle was inserted between spinous processes of L5- S1 and a portable X-ray film was taken to locate the correct interspace. 5.Incision: 4 cm, between L5-S1 spinous processes. The subcutaneous layer and lumbdorsal fascia were incised then. 6.The aponeurosis of the latissimus dorsi and ileocostalis lumborum muscles at spinous processes of L5-S1 was incised, the left muscles were detached from the interspinous ligament. The multifidus muscles were detached subperiosteally from L5-S1 laminae by a rasp. 7.The paravertebral muscles were retracted by a modified narrow Taylor retractor which was retained constantly by a rubbersling to the side rail of the operating table. 8.Under an operating microscope, the ligamentum flavum was cleaned and incised longitudinally at the lateral part with a No. 11 blade. The lateral portion of this ligament was removed with a small angle Kerrison rongeur, the lateral portion of the laminae and the medial border of the facets were removed too until the margin of the facets and a corridor to the disc that ran lateral to the root was reached. 9. The epidural fat was left undisturbed andpreserved. 10.The compressed left S1 root and veins overlying the protruded disc were gently pushed away by placing 2 small cottonoid patties, one above and one below the disc at the floor of the epidural canal. 11.The compressed root was gently pushed further away temporarily by sucker tip in order to expose the herniated disc more clearly. The posterior longitudinal ligament and annulus were incised around the protruded disc with a No. 15 blade. The degenerated disc was removed with microdisc forcepsuntil a substantial amount of the nucleus had been loosened with a cone curette and removed. 12.Pieces of Gelfoam strips covered on left S1 root. 13.The same procedures from 6 to 12 were repeated on the right side for right L5-S1 diskectomy. 14. Irrigation of both S1 roots with Rinderon suspension was done. 15. The lumbodorsal fascia was approximated by 3 interruped 2/0 silk stitches. 16.Thesubcutaneous layer was closed by running suture with 4/0 Dexon and skin by adhesive tape. 17.Course of the surgery: smooth. Operators VS 楊士弘 Assistants R5 曾峰毅 相關圖片 余欽麟 (M,1948/03/07,64y0m) 手術日期 2011/07/22 手術主治醫師 蔡翊新 手術區域 東址 019房 02號 診斷 Patients requiring long-term use of a respirator due to respiratory failure use respirator 6 hours per day continue 30 days 器械術式 Cranioplasty & subdural effusion evacuation 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 蕭柏妮 ASA 4E 紀錄醫師 曾峰毅, 時間資訊 21:03 開始NPO 21:03 通知急診手術 22:40 進入手術室 22:50 麻醉開始 23:00 誘導結束 23:05 抗生素給藥 23:30 手術開始 01:15 手術結束 01:15 麻醉結束 01:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 急性硬腦膜下血腫清除術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Cranioplasty 開立醫師: 蔡翊新 開立時間: 2011/07/23 00:47 Pre-operative Diagnosis Right frontotemporoparietal skull defect with massive subdural effusion causing brain compression. Post-operative Diagnosis Right frontotemporoparietal skull defect with massive subdural effusion causing brain compression. Operative Method Removal of subdural effusion and cranioplasty with autologous bone graft. Specimen Count And Types nil Pathology Nil. Operative Findings Tense and bulging craniectomy window at right F-T-P area. The subdural effusion gushed out upon wound incision and elevation of scalp flap. The brain was slack after removal of the subdural effusion. A skull defect, about 14 x 12 cm, was identified at right F-T-P area. There was poor healing of the Duroform with native dura. A thick transparent membrane was noted to entrap some effusion at subdural space. There were several sites of brain adhesion with the dura. Operative Procedures Under general anesthesia via tracheostomy and supine position with head rotated to left side, the skin was prepped and drapped as usual. The scalp incision was made along previous scar at right F-T-P area and the scalp flap was elevated. The subdural effusion was evacuated. The edge of bone window was exposed. The dura was repaired with 4-0 Prolene in a water-tight fashion. The autologous bone graft was placed back and fixed with 3 miniplates and 6 screws. Four central tentings were set. An epidural CWV and a subgaleal CWV drains were placed. The wound was then closed in layers. The patient tolerated the procedure well. Operators VS蔡翊新 Assistants R5曾峰毅Ri俞鈞仁 Indication Of Emergent Operation Massive subdural effusion with IICP. 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Cranioplasty 開立醫師: 曾峰毅 開立時間: 2011/07/23 01:30 Pre-operative Diagnosis Right frontotemporoparietal skull defect with massive subdural effusion causing brain compression. Post-operative Diagnosis Right frontotemporoparietal skull defect with massive subdural effusion causing brain compression. Operative Method Removal of subdural effusion and cranioplasty with autologous bone graft. Specimen Count And Types nil Pathology Nil. Operative Findings Tense and bulging craniectomy window at right F-T-P area. The subdural effusion gushed out upon wound incision and elevation of scalp flap. The brain was slack after removal of the subdural effusion. A skull defect, about 14 x 12 cm, was identified at right F-T-P area. There was poor healing of the Duroform with native dura. A thick transparent membrane was noted to entrap some effusion at subdural space. There were several sites of brain adhesion with the dura. Operative Procedures Under general anesthesia via tracheostomy and supine position with head rotated to left side, the skin was prepped and drapped as usual. The scalp incision was made along previous scar at right F-T-P area and the scalp flap was elevated. The subdural effusion was evacuated. The edge of bone window was exposed. The dura was repaired with 4-0 Prolene in a water-tight fashion. The autologous bone graft was placed back and fixed with 3 miniplates and 6 screws. Four central tentings were set. An epidural CWV and a subgaleal CWV drains were placed. The wound was then closed in layers. The patient tolerated the procedure well. Operators VS蔡翊新 Assistants R5曾峰毅Ri俞鈞仁 Indication Of Emergent Operation Massive subdural effusion with IICP. 相關圖片 周月梅 (F,1954/05/01,57y10m) 手術日期 2011/07/22 手術主治醫師 陳祈安 手術區域 產房 093房 02號 診斷 Postmenopausal bleeding 器械術式 D & C for diagnostic /WOR 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 石博元 ASA 1 時間資訊 08:00 報到 08:45 進入手術室 08:47 麻醉開始 08:50 誘導結束 08:55 抗生素給藥 09:00 手術開始 09:05 手術結束 09:05 麻醉結束 09:10 送出病患 09:15 進入恢復室 10:25 離開恢復室 記錄__ 手術科部: 婦產部 套用罐頭: Fractional D&C; 開立醫師: 周佳謙 開立時間: 2011/07/22 09:15 Pre-operative Diagnosis Endometrial leision Post-operative Diagnosis Endometrial leision Operative Method Fractional dilatation and curettage Specimen Count And Types 2 pieces About size: Source:Ecx About size: Source:EM Pathology Pending. Operative Findings 1. Uterus: Anteversion, 8 cm. 2. Scanty endocervical and some endometrial tissue were curetted out. 3. Hypertrophic cervix 3. Estimated blood loss: 15 mL, Blood transfusion: nil, complication: nil. Operative Procedures 1. Put the patient on lithotomy position. 2. Douching, skin disinfection and skin draping as usual. 3. Sounding: Anteversion, 9 cm. 4. Cervical dilatation to Hegar No. 7. 5. Curette endocervical canal and uterine cavity. Operators 陳祈安, Assistants 周佳謙, 劉仲翔 (M,1985/05/31,26y9m) 手術日期 2011/07/23 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Spinal stenosis 器械術式 C2-C6 laminoplasty 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 3 紀錄醫師 許皓淳, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:10 麻醉開始 08:20 誘導結束 08:22 手術開始 09:00 抗生素給藥 11:25 手術結束 11:25 麻醉結束 11:40 送出病患 11:45 進入恢復室 13:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓整形術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: Laminoplasty 開立醫師: 曾峰毅 開立時間: 2011/07/23 11:15 Pre-operative Diagnosis Cervical stenosis, congenital Post-operative Diagnosis Cervical stenosis, congenital Operative Method Laminoplasty, C3-6, Hirobayashi, hinge at left Specimen Count And Types Nil Pathology Nil Operative Findings Thecal sac was decompressed well after laminoplasty. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position with head fixed with Mayfield head clamp. Scalp was shaved, scrubbed, disinfected, and then draped as usual. We made one midline skin incision from inion to lower cervical area to expose bilateral laminae from C2 to C7. We drilled bicortically at right laminae from C3 to C6, and half layer of left laminae from C3 to C6, with air-drills. Lower C2 and upper C7 laminectomy was performed as well. Laminae, C3-6, were elevated as hinge at left, and fixed with miniplates. The wound was irrigated with saline and gentamycin. One submuscular CWV was placed, and the wound was closed in layers. Operators VS 賴達明 Assistants R5 曾峰毅 R2 許皓淳 相關圖片 徐陳桂領 (F,1932/04/09,79y11m) 手術日期 2011/07/23 手術主治醫師 陳敞牧 手術區域 東址 003房 04號 診斷 Spinal tumor 器械術式 Benign intraspinal tumor, excision, T1-2 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 2E 紀錄醫師 李振豪, 時間資訊 10:00 開始NPO 11:47 通知急診手術 18:45 報到 19:01 進入手術室 19:05 麻醉開始 19:30 抗生素給藥 19:30 誘導結束 20:22 手術開始 22:10 手術結束 22:10 麻醉結束 22:23 送出病患 22:25 進入恢復室 00:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 良性脊髓腫瘤切除術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 記錄__ 手術科部: 外科部 套用罐頭: T1 laminotomy for tumor excision 開立醫師: 李振豪 開立時間: 2011/07/23 22:51 Pre-operative Diagnosis T1 spinal tumor, suspect synovial cyst Post-operative Diagnosis T1 intraspinal extradural cystic tumor, suspect synovial cyst Operative Method T1 laminotomy for tumor excision Specimen Count And Types 1 piece About size:Multiple small pieces Source:Intraspinal tumor Pathology Pending Operative Findings The cystic tumor was mainly located at T1 level with x x x in size and extended to neural foramen. The thecal sac was pushed to right side and compressed tightly. The content of the cystic tumor was gelatinous and green-yellowish in color. Three swab was checked for bacterial, fungal, and mycobacterial culture. Adhesion of cytic wall to adjacent ligmentum flavum was noted. After removal of the tumor and ligmentum falvum, the thecal sac expanded well. No incidental durotomy or CSF leakage was noted. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position with head fixed wity Mayfield skull clamp. T1-T2 interspinous space was localized by portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision from C7 to T2 was made and the subcutaneous soft tissue was devided. The paravertebral muscle groups were detached to exposed the T1 laminae. Laminotomy was performed and the tumor was identified after resection of the ligmentum flavum. Culture swab was performed for bacterial, fungal, and mycobacterial culture. The tumor was dissected along the junction between the thecal sac. After total removal of the tumor, the thecal sac expanded well. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. One epidural CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS陳敞牧, VS楊士弘 Assistants R5李振豪, R1韋凌亦 Indication Of Emergent Operation Urinary retention with left lower limb weakness 相關圖片 孫實勇 (M,1968/03/05,44y0m) 手術日期 2011/07/24 手術主治醫師 曾漢民 手術區域 東址 002房 01號 診斷 Bronchus and lung cancer 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 3E 紀錄醫師 許皓淳, 時間資訊 06:51 通知急診手術 08:05 報到 08:23 進入手術室 08:25 麻醉開始 08:35 抗生素給藥 08:50 誘導結束 09:15 手術開始 11:35 抗生素給藥 12:00 麻醉結束 12:00 手術結束 12:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT 開立醫師: 曾峰毅 開立時間: 2011/07/24 12:06 Pre-operative Diagnosis Left frontal metastatic tumor with tumor bleeding Post-operative Diagnosis Left frontal metastatic tumor with tumor bleeding Operative Method Left frontal craniotomy for tumor excision Specimen Count And Types One tumor was sent for pathology Pathology pending Operative Findings One hypervascular, capsulated mass lesion was noted at left frontal lobe with bleeding. Ventricle was opened after tumor removed. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position. We shaved, scrubbed, disinfected, and then draped the patient as usual. We made one bicoronal scalp incision, and reflected scalp flap inferiorly. We drilled three burr holes, and then created left frontal craniotomy. Dura was tented along the craniotomy window, and was incised in U-shape. Tumor was removed in en bloc via corticotomy. Tumor cavity was paved with surgicel for hemostasis. Duroplasty was performed in water-tight suture with autologous fascia graft. Bone graft was fixed back with mini-plates. After one subgaleal CWV placed, the wound was closed in layers. Operators VS 曾漢民 Assistants R5 曾峰毅 R2 許皓淳 Indication Of Emergent Operation Tumor bleeding 相關圖片 李子良 (M,1966/07/04,45y8m) 手術日期 2011/07/25 手術主治醫師 杜永光 手術區域 東址 003房 02號 診斷 Meningioma 器械術式 Evacuation of pneumoventricle 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 蔡奉芳 ASA 3E 紀錄醫師 李振豪, 時間資訊 18:00 開始NPO 19:45 通知急診手術 22:30 進入手術室 22:30 報到 22:35 麻醉開始 22:46 誘導結束 23:23 手術開始 00:05 手術結束 00:05 麻醉結束 00:23 送出病患 00:30 進入恢復室 01:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室體外引流 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Left external ventricular drainage for pneumo... 開立醫師: 李振豪 開立時間: 2011/07/26 00:20 Pre-operative Diagnosis Massive pneumocephalus, suspect CSF leakage Post-operative Diagnosis Massive pneumocephalus, suspect CSF leakage Operative Method Left external ventricular drainage for pneumocephalus Specimen Count And Types 1 piece About size:15ml Source:CSF Pathology Nil Operative Findings The CSF was sampled from right side V-P shunt with total 7ml for CSF study and culture. The CSF was xanthochromic and mild hypercellularity in character. The air gushed out after puncture of left lateral ventricle. The CSF was sampled again after placing the ventricular catheter. The compliance of the brain parenchyma was poor. Deair was done and the external ventricular drainage was left in situ for further drainage. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head rotated to right. The scalp was shaved, scrubbed, and disinfected as usual. 4cm left frontal scalp incision was made along operative scar. Previous burr hole were identified. Ventricular puncture was performed with puncture needle and the air gushed out after ventriculostomy. The ventricular catheter was placed into left lateral ventricle and fixed with 6cm in depth. Externalization was done. The Burr hole were packing with Gelfoam and deair was done. Hemostasis was achieved with bipolar electrocautery. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators Prof.杜永光 Assistants R5李振豪 Indication Of Emergent Operation Massive pneumoventricle with conscious disturbance and right side weakness 相關圖片 熊劉嵩華 (F,1942/10/03,69y5m) 手術日期 2011/07/25 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Brain tumor 器械術式 Right craniotomy for aneurysmal clipping 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 08:02 進入手術室 08:05 麻醉開始 08:35 誘導結束 08:45 手術開始 09:00 抗生素給藥 12:22 抗生素給藥 15:30 抗生素給藥 16:25 手術結束 16:25 麻醉結束 16:38 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 9 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 開顱術摘除血管病變 - 腦血管瘤 有病徵的 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Right pterion craniotomy, trans-Sylvian combi... 開立醫師: 陳國瑋 開立時間: 2011/07/25 19:37 Pre-operative Diagnosis Basilar tip aneurysm Post-operative Diagnosis Basilar tip aneurysm Operative Method Right pterion craniotomy, trans-Sylvian combined with subtemporal approach for aneurysm clipping Specimen Count And Types nil Pathology nil Operative Findings First proximal control 3 minutes 35 seconds, reperfusion 8 minutes Second proximal control 3 minutes 41 seconds, reperfusion 10 minutes Third proximal control 3 minuts 33 seconds, reperfusion 5 minutes 23 seconds Fourth proximal control 3 minutes 23 seconds, SSEP change at right hand and foot, and then recovered spontaneously after refperfusion. Fluoroangiography showed total obliteration of the basilar tip aneurysm and preservation of the perforators after clipping. Operative Procedures The patient was put in supine position. After intubation and general anesthesia, her head was tilt to left. The skin was prepared as usual. On bi-coronal skin incision was made from ahead of the ear to 7 cm across the midline. The skin was reflected anteriorly. The temporalis muscle was insiced and reflected downward along with the Yasargil fat pad. Five burr holes were made at keyhole, squamous bone, frontal bone. Craniotomy window was made dura tenting was done. The spenoid ridge was drilled. The dura was inscied at low temoral area and reflected. The distal sylvian fissure was opened and the temporal tip was retracted backward. The optic nerve, internal carotid artery, ACA, MCA, oculomotor nerve, and basilar tip were checked. The sylvian fissure was splitted wide and the optic nerve and the ICA were identified. The frontal lobe was retracted until the opposit optic nerve came out. We tracted from right posterior communicating artery, posterior cerebral artery, and then the basilar bifurcation. The aeurysm was then identified. Aneurym was clipped with one curved Sugita clip. Fluoroangiography was performed for check of parent artery patency. Duroplasty was performed in water-tight suture with 4-0 prolene. Bone graft was fixed back with miniplates, and bone defect was filled with bone cement. We placed one submuscluar CWV, and temporalis muscle was sutured back. The wound was closed in layers. Operators P 杜永光 Assistants R5 曾峰毅 R3 陳國瑋 相關圖片 吳孟哲 (M,1988/02/22,24y0m) 手術日期 2011/07/25 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 許皓淳, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:03 進入手術室 08:10 麻醉開始 08:35 抗生素給藥 08:35 誘導結束 08:44 手術開始 12:00 麻醉結束 12:00 手術結束 12:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Left frontal craniotomy for tumor excision 開立醫師: 李振豪 開立時間: 2011/07/25 12:26 Pre-operative Diagnosis Left frontal tumor, suspect glioma Post-operative Diagnosis Left frontal tumor, suspect glioma Operative Method Left frontal craniotomy for tumor excision Specimen Count And Types 1 piece About size:Multiple small pieces Source:Left frontal brain tumor Pathology Pending Operative Findings The fluid content was green-yellowish in color. After release the fluid content, the brain became slack. The solid part mainly located at anteriomedial side of the cystic part which was gray-reddish, gelatinous, and hypervascularized in character. The capsule was green-yellowish in color which hemosiderin deposition was favored. Left lateral ventricle was entered and packing with Gelfoam. The solid component and capsule was sent for pathology. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. Bicoronal scalp incision was made and the scalp flap was elevated. Four burr hole were created followed by one 8 x 6cm craniotomy window over left frontal area. Dural tenting was done. Intra-operative sonography was used for localization of the tumor. C-shape durotomy was performed based with superior sagittal sinus. 1.5 x 2.5cm corticotomy was performed followed by tumor excision. The fluid content was released and tumor excision was performed along the capsule of the tumor. Hemostasis was achieved with bipolar electrocautery and Surgicel lining. Duroplasty with periosteum was done. The skull plate was fixed back with miniplates and screws. One epidural CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and Appose staples. Operators VS曾漢民 Assistants R5李振豪, R2許皓淳 相關圖片 褚月寧 (F,1971/04/19,40y10m) 手術日期 2011/07/25 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Acoustic tumor 器械術式 Left retrosigomid tumor excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 許皓淳, 時間資訊 00:00 臨時手術NPO 11:55 報到 12:30 進入手術室 12:35 麻醉開始 13:25 誘導結束 13:38 抗生素給藥 13:40 手術開始 15:00 開始輸血 16:20 麻醉結束 16:20 手術結束 16:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 顱骨切除術,包括異物移除或壓或經切斷 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Left retrosigmoid craniotomy for tumor excision 開立醫師: 李振豪 開立時間: 2011/07/25 16:55 Pre-operative Diagnosis Left acoustic neuroma Post-operative Diagnosis Left acoustic neuroma Operative Method Left retrosigmoid craniotomy for tumor excision Specimen Count And Types nil Pathology Nil Operative Findings One 2cm left sigmoid sinus laceration was noted with massive blood loss(1300ml). The laceration was packing with Gelfoam due to difficult repair of sinus. The condition was discussed with her family and the operation was withheld. The vital signs was stable after component therapy. No obvious bleeding was noted after wound closure. Operative Procedures Under endotracheal general anesthesia, the patient was put in 3/4 prone position to right with head fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. One curvilinear scalp incision over left retroauricular area was made and one 3x3cm fascia was harvested. The muscle was devided to exposed the asterion. Four burr hole were created followed by one 4x3 cm craniotomy. Left sigmoid sinus laceration with 2cm in length was noted during craniotomy. The laceration was packing with Gelfoam for hemostasis. The skull plate was fixed back with miniplates. The wound was then closed in layers with 2-0 Vicryl and Appose staple after placing one CWV drain. Operators VS曾漢民 Assistants R5李振豪, R2許皓淳 相關圖片 許綺華 (F,1960/02/12,52y1m) 手術日期 2011/07/25 手術主治醫師 楊士弘 手術區域 東址 002房 02號 診斷 Headache 器械術式 V-P shunt 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 王奐之, 時間資訊 00:00 開始NPO 00:00 臨時手術NPO 12:12 報到 12:55 進入手術室 13:10 麻醉開始 13:20 抗生素給藥 13:25 誘導結束 13:55 手術開始 15:05 麻醉結束 15:05 手術結束 15:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦室腹腔分流手術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 內科部 套用罐頭: Ventriculoperitoneal shunt insertion via righ... 開立醫師: 王奐之 開立時間: 2011/07/25 14:59 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunt insertion via right Kocher point Specimen Count And Types Nil Pathology Nil Operative Findings Opening pressure: about 5cmH2O. Clear CSF was noted after ventricular puncture. Medtronic medium pressure shunt valve was used, ventricular catheter length: 6.5cm. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After shaving, scrubbing, disinfection & draping in sterile fashion, a curved incision was made at right frontal area, followed by burr hole creation at right Kocher point. Another linear incision was made at right upper quadrant of abdomen, followed by mini-laparotomy. A subcutaneous tunnel was then done from abdominal wound to occipital area, another tunnel was made from right frontal wound to occipital area and the catheter was passed through the tunnels. A small cruciate durotomy was performed, followed by ventricular puncture. The ventricular catheter was then inserted after assembly of the shunt. After confirmation of smooth CSF flow, the peritoneal catheter was also inserted. After meticulous hemostasis, the wounds were closed in layers. Operators VS 楊士弘 Assistants R5 林哲光, R4 王奐之, Ri Indication Of Emergent Operation IICP 相關圖片 記錄__ 手術科部: 內科部 套用罐頭: Ventriculoperitoneal shunt insertion via righ... 開立醫師: 王奐之 開立時間: 2011/07/25 15:00 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunt insertion via right Kocher point Specimen Count And Types Nil Pathology Nil Operative Findings Opening pressure: about 5cmH2O. Clear CSF was noted after ventricular puncture. Medtronic medium pressure shunt valve was used, ventricular catheter length: 6.5cm. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After shaving, scrubbing, disinfection & draping in sterile fashion, a curved incision was made at right frontal area, followed by burr hole creation at right Kocher point. Another linear incision was made at right upper quadrant of abdomen, followed by mini-laparotomy. A subcutaneous tunnel was then done from abdominal wound to occipital area, another tunnel was made from right frontal wound to occipital area and the catheter was passed through the tunnels. A small cruciate durotomy was performed, followed by ventricular puncture. The ventricular catheter was then inserted after assembly of the shunt. After confirmation of smooth CSF flow, the peritoneal catheter was also inserted. After meticulous hemostasis, the wounds were closed in layers. Operators VS 楊士弘 Assistants R5 林哲光, R4 王奐之, Ri Indication Of Emergent Operation IICP 相關圖片 李晃 (M,1942/10/19,69y4m) 手術日期 2011/07/26 手術主治醫師 戴槐青 手術區域 東址 007房 03號 診斷 Inguinal hernia, adult 器械術式 Herniorrhaphy 手術類別 預定手術 手術部位 腹 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 3 紀錄醫師 張奕凱, 時間資訊 14:00 進入手術室 14:05 麻醉開始 14:10 誘導結束 14:32 手術開始 17:18 手術結束 17:18 麻醉結束 17:25 送出病患 17:30 進入恢復室 19:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腹腔鏡疝氣修補術 1 2 B 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 腹腔鏡疝氣修補術 1 1 B 摘要__ 手術科部: 泌尿部 套用罐頭: herniorrhaphy 開立醫師: 張奕凱 開立時間: 2011/07/26 17:33 Pre-operative Diagnosis bilateral inguinal hernia Post-operative Diagnosis bilateral inguinal hernia, direct type and right femoral hernia Operative Method total extraperitoneal laparoscopic herniorrhaphy Specimen Count And Types nil Pathology pending Operative Findings 1. right femoral hernia 2. Sac from posterior wall, direct sac at bilateral side 3. bilateral Posterior wall weakness. Operative Procedures Under satisfactory endotracheal general anesthesia with the patient in a supine position, prepping and draping was performed. A 16 Fr Foley was inserted with sterile method. A balloon trocar was placed at periumbilical area. The wound was deepened into pre-peritoneum. The balloon was inflated and a pre-peritoneal space was created. Two 5 mm port were placed at bilateral lower abdomen. Dissection were perfomed along the right spermatic cord and hernia sac was dissected out. The sac was ligated and transected. The posterior wall weakness was repaired with Mesh. The same procedure was performed at left side. We closed the 5-12 mm port wound with 1-0 Vicryl and skin with 3-0 Nylon. The patient tolerated the procedure very well, and was sent to the recovery room in satisfactory condition. Operators 戴槐青, Assistants 張奕凱, 伍嘉偉, 傅慧屏 (F,1963/10/30,48y4m) 手術日期 2011/07/26 手術主治醫師 曾漢民 手術區域 西址 039房 02號 診斷 Benign neoplasm of subcutaneous tissue 器械術式 Excision of neuroma 手術類別 預定手術 手術部位 腹 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 10:08 進入手術室 10:15 麻醉結束 10:15 麻醉開始 10:17 手術開始 10:50 手術結束 10:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 皮下腫瘤摘除術小於2CM 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Tumor excision 開立醫師: 蔡翊新 開立時間: 2011/07/26 10:55 Pre-operative Diagnosis Abdominal subcutaneous tumor Post-operative Diagnosis Abdominal subcutaneous tumor Operative Method Tumor excision Specimen Count And Types 1 piece About size:1.5cm Source:abdomen subcutaneous tumor Pathology pending Operative Findings One 1.5cm well defined, firm, subcutaneous tumor at left lower quadrent Operative Procedures 1. Supine, skin prepare 2. Local anesthesia 3. One 3cm transverse skin incision 4. Tumor excision 5. Skin closure with Dexon and Nylon Operators 曾漢民 Assistants 蔡翊新 陳國瑋 相關圖片 陳毅 (M,2011/07/25,7m23d) 手術日期 2011/07/26 手術主治醫師 郭夢菲 手術區域 兒醫 066房 03號 診斷 Subdural hemorrhage 器械術式 Removal of right acute SDH 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 4E 紀錄醫師 林哲光, 時間資訊 13:00 開始NPO 13:00 臨時手術NPO 14:47 通知急診手術 19:26 報到 19:26 進入手術室 19:30 麻醉開始 19:35 抗生素給藥 20:30 誘導結束 21:30 開始輸血 22:19 手術開始 23:13 麻醉結束 23:13 手術結束 23:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 急性硬腦膜下血腫清除術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: Right F-T-P craniectomy with removal of subdu... 開立醫師: 林哲光 開立時間: 2011/07/26 23:56 Pre-operative Diagnosis Right F-T-P subacute SDH with acute hemorrhage Right F-T-P acute subdural hematoma Post-operative Diagnosis Right F-T-P subacute SDH with acute hemorrhage Right F-T-P acute subdural hematoma Operative Method Right F-T-P craniectomy with removal of subdural hematoma Right F-T-P decompressive craniectomy with removal of subdural hematoma Specimen Count And Types nil Pathology Nil Operative Findings Preoperative bilateral pupils were isocoric, 3.0/3.0. Bulging of the frontanell was noted before the surgery. Gush of the dark-reddish subdural contents were noted after dural opened at right frontal area initially. The brain seemed re-expanded rapidly after the hematoma removal, but the brain parenchyma seemed withtish without good vascularity and no obvious visble pulsation. Unstable hemodynamics was also noted during the surgery. Preoperative bilateral pupils were isocoric, 3.0/3.0. Bulging of the frontanell was noted before the surgery. Gush of the dark-reddish subdural contents were noted after dural opened at right frontal area initially. The brain seemed re-expanded rapidly after the hematoma removal, but the brain parenchyma seemed withtish without good vascularity and no obvious visble pulsation. About 50-60 ml hematoma was removed. Unstable hemodynamics was also noted during the surgery. Preoperative bilateral pupils were isocoric, 3.0/3.0. Bulging of the fontanelle was noted before the surgery. Gush of the dark-reddish subdural contents were noted after dural opened at right frontal area initially. The brain seemed re-expanded rapidly after the hematoma removal, but the brain parenchyma seemed withtish without good vascularity and no obvious visble pulsation. About 50-60 ml hematoma was removed. Unstable hemodynamics was also noted during the surgery. 1. Preoperative bilateral pupils were isocoric, 3.0/3.0. Bulging of the fontanelle was noted before the surgery. Gush of the dark-reddish subdural contents were noted after a small dural opened for slowly release of IICP at right frontal area initially. The brain seemed re-expanded progressively after hematoma removal, but the brain parenchyma seemed to be relatively hypovascular due to poor perfusion. There was no obvious pulsation after decompression. 2. About 50-60 ml hematoma was removed. Unstable hemodynamics was also noted during the surgery with the systolic afterial pressure down to 27 to 35 mmHg for about 1-2 minutes, which soon resumed to 60 mmHg after continuous blood trasfusion. 3. The last preop. coagulation profile showed the platelet count was slightly higher than 60000, and the INR was around 1.9. The intraoperative findings showed that the oozing could be controlled under continuosuly platelet trasfusion. The FFP was sent to the OR when we began to closed the skin. Operative Procedures Under ETGA and supine position with head rotated to left side, skin disinfected and drapped were performed as usual. A small piece of frontal bone was removed along the coronal suture and dura was opened for removal of some SDH. Right F-T-P craniectomy was then done and subdural hematoma was removed. The dura was then covered with Duragen and the fascia and periosteum were covered to the skull bone defect. The wound was then closed in layers after a subgaleal CWV drain insertion. Under ETGA and supine position with head rotated to left side, skin disinfected and drapped were performed as usual. A F-T-P reverse horse shoe skin flap was performed and reflected downward. A small piece of parietal bone posterior to the right coronal suture was removed as a burr hole. The dura was opened here to release the IICP by removal of some SDH before the craniotomy could be accomplished. Right F-T-P craniectomy was then done by Kerrison punches, and subdural hematoma was removed by suction after the dural was opened. After the hematoma was mostly removed, the brain expanded gradually and progressively, and the vital sign was not stable for 1-2 minutes, we decided to covered the dura with a piece of Duragen and the dura was closed loosely for possible postop brain swelling. The fascia and periosteum were covered to the skull bone defect. The wound was then closed in layers after a subgaleal CWV drain insertion. The removed skull bone plate was stored in deep freezer. Operators 郭？菲 郭夢菲 Assistants R5 林哲光 Indication Of Emergent Operation acute conscious deterioration 相關圖片 蔡添璧 (M,1930/11/11,81y4m) 手術日期 2011/07/26 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Lumbar spondylosis 器械術式 L3/4/5 TPS and L4/5 discectomy with cage 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:00 進入手術室 08:10 麻醉開始 08:20 誘導結束 09:32 抗生素給藥 09:35 手術開始 11:15 開始輸血 12:32 抗生素給藥 13:05 手術結束 13:05 麻醉結束 13:18 送出病患 13:25 進入恢復室 14:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎間盤切除術-腰椎 1 2 記錄__ 手術科部: 外科部 套用罐頭: L3/4, L4/5 discectomy and posterior fusion wi... 開立醫師: 林哲光 開立時間: 2011/07/26 13:38 Pre-operative Diagnosis L3/4 herniated intervertebral disc and L4/5 grade I spondylolisthesis Post-operative Diagnosis L3/4 herniated intervertebral disc and L4/5 grade I spondylolisthesis Operative Method L3/4, L4/5 discectomy and posterior fusion with TPS at L3/L4/L5 level with PEEK cage at L3/4 and L4/5 level Specimen Count And Types nil Pathology Nil Operative Findings Decreased height of intervertebral space was noted at L3/4 level with severe disc bulging direct comrpessing the dura sac from the right side. Hypertrophic change of the ligamentum flavum was also noted. TPS 45mm were inserted at L3/L4/L5 pedicles and two 11mm PEEK cage were inserted at L3/4, L4/5 level. Two rods 7cm were inserted after rods were bending in kyphotic way. Operative Procedures Under ETGA and prone position, skin dinsinfected and drapped were performed as usual. Midline skin incision was made at L2-S1 level. THe paraspainal muscles were detached and TPS were inserted at L3/L4/L5 level. Laminectomy was then perfomred at right L3/4, left L4/5 level. L3/4, L4/5 disectomy were done and cages were inserted at L3/4, L4/5 level and rods were inserted and fixed. The wound was then closed in layers after epidural hemovac insertion. Operators AP 賴達明 Assistants R5 林哲光, Ri 林千又 相關圖片 林鳳蘭 (F,1937/02/13,75y1m) 手術日期 2011/07/26 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Lumbar Spondylosis 器械術式 L3/4/5 TPS and L3/4/5 discectomy with cage 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 13:00 報到 13:40 進入手術室 13:41 麻醉開始 13:50 誘導結束 14:00 開始輸血 14:30 抗生素給藥 14:40 手術開始 17:30 抗生素給藥 19:10 手術結束 19:10 麻醉結束 19:25 送出病患 19:27 進入恢復室 21:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎間盤切除術-腰椎 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 記錄__ 手術科部: 外科部 套用罐頭: L4/5 discectomy and posterior fusion with PEE... 開立醫師: 林哲光 開立時間: 2011/07/26 19:34 Pre-operative Diagnosis L4/5 grade I spondylolisthesis Post-operative Diagnosis L4/5 grade I spondylolisthesis Operative Method L4/5 discectomy and posterior fusion with PEEK cage insertion and TPS at L4/5 level Specimen Count And Types nil Pathology Nil Operative Findings Depressed vertebral body was noted at L5 body and hypertrophic change of ligamentum flavum and bilateral facet joints were noted. TPS 40mm were inserted at L4, L5 pedicles and PEEK cage 11mm was inserted at L4/5 intervetebral space. Operative Procedures Under ETGA and prone position, skin dinsinfected and drapped were performed as usual. Midline skin incision was made at L2-L5 level. THe paraspainal muscles were detached and TPS were inserted at L4/L5 level. Laminectomy was then perfomred at right L4/5 level. L4/5 disectomy were done and cages were inserted at L4/5 level and rods were inserted and fixed. The wound was then closed in layers after epidural hemovac insertion. Operators AP 賴達明 Assistants R5 林哲光, Ri 林千又 相關圖片 潘佳杰 (M,1977/10/03,34y5m) 手術日期 2011/07/26 手術主治醫師 賴達明 手術區域 東址 005房 02號 診斷 Arteriovenous malformation, brain 器械術式 Right P-O craniotomy for AVM excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾峰毅, 時間資訊 00:00 臨時手術NPO 12:06 進入手術室 12:10 麻醉開始 12:45 誘導結束 13:00 手術開始 13:00 抗生素給藥 16:00 抗生素給藥 19:00 抗生素給藥 22:29 抗生素給藥 01:03 開始輸血 01:55 抗生素給藥 02:45 手術結束 02:45 麻醉結束 03:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 開顱術摘除血管病變 - 動靜脈畸型中型表淺 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 21 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: AVM 開立醫師: 曾峰毅 開立時間: 2011/07/27 03:27 Pre-operative Diagnosis Right parietal arteriovenous malformation, Martin-Spetzeler grade II, status post partial embolization Post-operative Diagnosis Right parietal arteriovenous malformation, Martin-Spetzeler grade II, status post partial embolization Operative Method Right parietal craniectomy for partial AVM excision Specimen Count And Types Several fragments of the lesion was sent for pathology. Pathology Pending Operative Findings One AVM, about 3-4 cm, with feeder from right ACA, MCA, and PCA, and drainage to superior saggital sinus, was noted at right parietal lobe. Right PCA feeders were embolized preveiously. Partial AVM excision was done due to prolonged operation time. Bone graft was stored at bone bank. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position with head fixed with Mayfield head clamp. We shaved, scrubbed, disinfected, and then draped the patient's head as usual. One U-shape scalp incision was made at right pareital area, and five burr holes was made, followed by craniotomy. U-shape dura incision was done, and meticulous dissection around the arteriovenous malformation was done. Feeders from right middle and anterior cerebral artery were cauterized. Partial excision of the AVM was done. Duroplasty with Duragem was performed. The wound was closed in layers after two CWV insertion. Operators VS 賴達明 Assistants R5 曾峰毅 Ri 林 相關圖片 陳文令 (M,1929/09/11,82y6m) 手術日期 2011/07/26 手術主治醫師 林峰盛 手術區域 西址 035房 05號 診斷 Low back pain 器械術式 Nerve block / PC 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 硬肌麻醉 麻醉主治醫師 林峰盛 ASA 3 時間資訊 17:45 進入手術室 17:48 麻醉開始 17:50 誘導結束 17:55 手術開始 18:35 麻醉結束 醫令資訊 類別 名稱 量 刀 側 手術 硬脊膜外麻醉 1 0 B 記錄__ 手術科部: 麻醉部 套用罐頭: LENB 開立醫師: 謝承原 開立時間: 2011/07/26 18:34 Pre-operative Diagnosis 1.spinal stenosis 2. radiculopathy Post-operative Diagnosis 1. spinal stenosis 2. radiculopathy Operative Method LENB Specimen Count And Types Pathology Nil Operative Findings Operative Procedures LA with 1% xylocaine 5 ml pt in prone position 3. Under fluoroscopic-guidance, LENB was done to L5-S1 level with 17G Tuohy needle, 5mg Rinderon in 0.5% xylocaine 6ml Operators 林峰盛, Assistants 謝承原, 梁益誠 (M,1979/01/16,33y1m) 手術日期 2011/07/26 手術主治醫師 陳敞牧 手術區域 東址 005房 01號 診斷 Cervical Spondylosis 器械術式 C5-6 discectomy with cage 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾峰毅, 時間資訊 00:00 臨時手術NPO 07:30 報到 08:00 進入手術室 08:10 麻醉開始 08:30 誘導結束 09:00 抗生素給藥 09:27 手術開始 11:25 手術結束 11:25 麻醉結束 11:30 送出病患 11:37 進入恢復室 12:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 手術 椎間盤切除術-頸椎 1 1 手術 脊椎融合術-前融合,有固定物)≦四節 1 2 摘要__ 手術科部: 外科部 套用罐頭: Anterior Discectomy and Fusion, Cervical Spine 開立醫師: 曾峰毅 開立時間: 2011/07/26 11:40 Pre-operative Diagnosis HIVD, C5/6 Post-operative Diagnosis HIVD, C5/6 Operative Method Anterior cervical discectomy and anterior fusion with PEEK cage and artificial bone graft, C6/7 Specimen Count And Types Nil Pathology Nil Operative Findings Thecal sac and bilateral neural foramens were decompressed well after diskectomy. Synthes PEEK cage, 7 mm in height, was inserted for fusion. Thecal sac and bilateral neural foramens were decompressed well after diskectomy. A-spine PEEK cage, 7 mm in height, was inserted for fusion. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position. We made one transverse skin incision at right aspect of the neck, and dissected along medial side of Plastysma, and lateral side of thyroid gland capsule to prevertebral space. C5/6 intervertebral space was localized by C-arm, and diskectomy was done. Fusion was achieved with one PEEK cage and artificial bone graft. The wound was closed in layers. Operators VS 陳敞牧 Assistants R5 曾峰毅 相關圖片 李宜純 (F,1976/05/17,35y9m) 手術日期 2011/07/26 手術主治醫師 楊士弘 手術區域 東址 009房 08號 診斷 Breast cancer, female 器械術式 Right Kocher Ommaya implantation 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 19:40 進入手術室 19:45 麻醉開始 19:55 誘導結束 20:32 手術開始 21:30 手術結束 21:30 麻醉結束 21:38 送出病患 21:45 進入恢復室 22:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 歐氏貯囊置放手術 1 1 R 摘要__ 手術科部: 腫瘤醫學部 套用罐頭: Right Kocher Ommaya implantation 開立醫師: 王奐之 開立時間: 2011/07/26 21:37 Pre-operative Diagnosis Leptomeningeal metastasis Post-operative Diagnosis Leptomeningeal metastasis Operative Method Right Kocher Ommaya implantation Specimen Count And Types 1 piece About size:CSF Source:culture, BCS, routine Pathology Pending Operative Findings CSF seemed, opnening pressure was Operative Procedures Under ETGA and supine position, skin disinfected and drapped were perofrmed as usual. Curvilinear skin incision was made at right Kocher point and a burr hole was created. The dura was then opened after dural tetning. Ventricular catheter was then introduced into the lateral horn of right frontal horn along the imaginary line composed with two planes pointing to right medial canthus and right targus. Ommaya implantation was done and the wound was then closed in layers after hemostasis. Operators VS 楊士弘 Assistants R4 王奐之, R3 陳國瑋 相關圖片 記錄__ 手術科部: 腫瘤醫學部 套用罐頭: Right Kocher Ommaya implantation 開立醫師: 王奐之 開立時間: 2011/07/26 21:37 Pre-operative Diagnosis Leptomeningeal metastasis Post-operative Diagnosis Leptomeningeal metastasis Operative Method Right Kocher Ommaya implantation Specimen Count And Types 1 piece About size:CSF Source:culture, BCS, routine Pathology Pending Operative Findings CSF seemed, opnening pressure was Operative Procedures Under ETGA and supine position, skin disinfected and drapped were perofrmed as usual. Curvilinear skin incision was made at right Kocher point and a burr hole was created. The dura was then opened after dural tetning. Ventricular catheter was then introduced into the lateral horn of right frontal horn along the imaginary line composed with two planes pointing to right medial canthus and right targus. Ommaya implantation was done and the wound was then closed in layers after hemostasis. Operators VS 楊士弘 Assistants R4 王奐之, R3 陳國瑋 相關圖片 摘要__ 手術科部: 腫瘤醫學部 套用罐頭: Right Kocher Ommaya implantation 開立醫師: 陳國瑋 開立時間: 2011/07/26 21:47 Pre-operative Diagnosis Leptomeningeal metastasis Leptomeningeal carcinomatosis Post-operative Diagnosis Leptomeningeal metastasis Leptomeningeal carcinomatosis Operative Method Right Kocher Ommaya implantation Ommaya reservoir implantation via right Kocher point Specimen Count And Types 1 piece About size:CSF Source:culture, BCS, routine Pathology Pending Operative Findings CSF seemed, opnening pressure was CSF seemed clear, opnening pressure was 10~15 cmH2O Operative Procedures Under ETGA and supine position, skin disinfected and drapped were perofrmed as usual. Curvilinear skin incision was made at right Kocher point and a burr hole was created. The dura was then opened after dural tetning. Ventricular catheter was then introduced into the lateral horn of right frontal horn along the imaginary line composed with two planes pointing to right medial canthus and right targus. Ommaya implantation was done and the wound was then closed in layers after hemostasis. Under ETGA and supine position, skin disinfection and draping were perofrmed as usual. Curvilinear skin incision was made at right Kocher point and a burr hole was created. The dura was then opened after dural tetning. Ventricular catheter, 6.5 cm long, was then introduced into the frontal horn of right lateral ventricle, after ventricular tapping along the imaginary line composed with two planes pointing to right medial canthus and right targus. Ommaya implantation was done and the wound was then closed in layers after hemostasis. Operators VS 楊士弘 Assistants R4 王奐之, R3 陳國瑋 相關圖片 劉美華 (F,1951/05/30,60y9m) 手術日期 2011/07/26 手術主治醫師 楊士弘 手術區域 西址 030房 02號 診斷 Carpal tunnel syndrome 器械術式 Decompression of mediun nerve 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 12:15 進入手術室 12:35 麻醉結束 12:35 麻醉開始 12:36 手術開始 13:10 手術結束 13:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 正中神經或尺神經腕部減壓術–單側 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Neurolysis of left median nerve 開立醫師: 陳國瑋 開立時間: 2011/07/26 13:27 Pre-operative Diagnosis Carpal tunnel syndrome, left Post-operative Diagnosis Carpal tunnel syndrome, left Operative Method Neurolysis of left median nerve Specimen Count And Types nil Pathology Nil Operative Findings Mild thickening of left transverse carpal ligament compressing the median nerve. The compression was released after neurolysis Operative Procedures 1. Supine, left hand extension 2. Skin prepare 3. Midline skin incision 2.5cm at the junction of wrist and palm 4. Dissection open the palmar aponeurosis 5. Cut open the transverse carpal ligament 6. Hemostasis 7. Wound closure in layers Operators 楊士弘 Assistants 陳國瑋 相關圖片 林張琴 (F,1934/10/25,77y4m) 手術日期 2011/07/26 手術主治醫師 蔡翊新 手術區域 西址 039房 01號 診斷 Carpal tunnel syndrome 器械術式 Decompression of mediun nerve 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 09:00 進入手術室 09:18 麻醉結束 09:18 麻醉開始 09:20 手術開始 09:52 手術結束 09:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 正中神經或尺神經腕部減壓術–單側 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Carpal Tunnel Syndrome 開立醫師: 蔡翊新 開立時間: 2011/07/26 09:56 Pre-operative Diagnosis Left carpal tunnel syndrome Post-operative Diagnosis Left carpal tunnel syndrome Operative Method Left median nerve decompression at wrist. Specimen Count And Types nil Pathology Nil. Operative Findings Thickening of transverse carpal ligament causing compression of left median nerve which expanded well after decompression. Operative Procedures 1.The left hand and forearm were sterilized with povidone-iodine tincture, then covered with stockinet. 2.Anesthesia: local anesthesia with 2 ml 1% Xylocaine solution was injected at subcutaneous layer at wrist area. 3. Incision: linear at left palm near the wrist. 4.The plamar aponeurosis was cut longitidinally along the ulnar side of the palmaris longus tendon. 5. The median nerve was identified beneath the palmars longus tendon. Under direct vision, the transverse carpal ligament was divided until no more pressure on the median nerve could be palpated. 6. The skin was closed by interrupted suture with 4/0 nylon. 7. The hand and wrist were draped with fluffy dressing and elastic bandage. Operators VS蔡翊新 Assistants R3陳國瑋 記錄__ 手術科部: 外科部 套用罐頭: Carpal Tunnel Syndrome 開立醫師: 蔡翊新 開立時間: 2011/07/26 10:02 Pre-operative Diagnosis Left carpal tunnel syndrome Post-operative Diagnosis Left carpal tunnel syndrome Operative Method Left median nerve decompression at wrist. Specimen Count And Types nil Pathology Nil. Operative Findings Thickening of transverse carpal ligament causing compression of left median nerve which expanded well after decompression. Operative Procedures 1.The left hand and forearm were sterilized with povidone-iodine tincture, then covered with stockinet. 2.Anesthesia: local anesthesia with 2 ml 1% Xylocaine solution was injected at subcutaneous layer at wrist area. 3. Incision: linear at left palm near the wrist. 4.The plamar aponeurosis was cut longitidinally along the ulnar side of the palmaris longus tendon. 5. The median nerve was identified beneath the palmars longus tendon. Under direct vision, the transverse carpal ligament was divided until no more pressure on the median nerve could be palpated. 6. The skin was closed by interrupted suture with 4/0 nylon. 7. The hand and wrist were draped with fluffy dressing and elastic bandage. Operators VS蔡翊新 Assistants R3陳國瑋 涂正漢 (M,1979/01/03,33y2m) 手術日期 2011/07/26 手術主治醫師 蔡翊新 手術區域 西址 030房 01號 診斷 Benign neoplasm of subcutaneous tissue 器械術式 Scalp tumor 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 09:10 報到 10:50 進入手術室 11:12 麻醉開始 11:15 手術開始 11:50 手術結束 11:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 頭皮腫瘤 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Tumor excision 開立醫師: 陳國瑋 開立時間: 2011/07/26 11:54 Pre-operative Diagnosis Scalp tumor Post-operative Diagnosis Scalp tumor Operative Method Tumor excision Specimen Count And Types 1 piece About size:3cm Source:scalp tumor Pathology pending Operative Findings One soft, 3cm, fungating tumor was noted at scalp Operative Procedures 1. Supine, skin prepare 2. Local anesthesia 3. Fusiform skin incision aroud tumor 4. Tumor excision 5. Hemostasis 6. Skin closure in layers Operators 蔡翊新 Assistants 陳國瑋 相關圖片 陳文英 (F,1953/10/30,58y4m) 手術日期 2011/07/27 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 08:00 報到 08:08 進入手術室 08:20 麻醉開始 08:30 抗生素給藥 08:40 誘導結束 08:53 手術開始 11:15 開始輸血 11:30 抗生素給藥 14:30 抗生素給藥 15:10 麻醉結束 15:10 手術結束 15:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Left pterion craniotomy for tumor excision, S... 開立醫師: 曾峰毅 開立時間: 2011/07/27 15:00 Pre-operative Diagnosis Meningiomatosis, status post repeated surgery, recurrence Post-operative Diagnosis Meningiomatosis, status post repeated surgery, recurrence Operative Method Left pterion craniotomy for tumor excision, Simpson II Specimen Count And Types 1 piece About size:pieces Source:brain tumor Pathology Pending Operative Findings The skull bone was in pieces and reconstructed with multiple wires and bone cement in the previous operation. The dura was shattered and incomplete. Multiple soft, dura-based, extra-axial tumors were noted along left sphenoid ridge, left anterior clinoid process, right anterior clinoid process, and planum sphenoidale. The biggest one, about 3x3 cm, was locatd at left anterior clinoid process. Simpson grade II tumor excision was achieved. Operative Procedures After intubation and general anesthesia, the patient was put in supine position with head turned to right and fixed with Mayfield head clamp. The skin was incised along previous wound from ahead of the ear to 5cm across midline. The skin was reflected anteriorly. After making on burr hole at keyhole, the bone graft was elevated along previous fracture line. The sphenoid ridge was drilled flat extradurally, and anterior clinoidectomy was done with opening of left optic canal for decomrpession. The tumor along the sphenoid ridge was removed. The tumor at left anterior clinoid process was in sight and then removed with bipolar and tumor forceps. One tumor at planum sphenoidale, and one at right anteior clinoid process were both removed. The left oculomotor nerve, internal carotid artery, bilateral optic nerve and optic chiasm were all identified. Duroplasty was done with Durofoam. Bone graft was fixed back with mini-plates, and bone cement, after one epidural CWV placed. The wound was closed in layers. The tumor along the sphenoid ridge was removed. The tumor at left anterior clinoid process was in sight and then removed with bipolar and tumor forceps. Residual tumor in the left optic canal, just beneath falciform ligament was removed by nerve hook. One tumor at planum sphenoidale, and one at right anteior clinoid process were both removed. The left oculomotor nerve, internal carotid artery, bilateral optic nerve and optic chiasm were all identified. Duroplasty was done with Durofoam. Bone graft was fixed back with mini-plates, and bone cement, after one epidural CWV placed. The wound was closed in layers. Operators Prof. 杜永光 Assistants R5 曾峰毅 R3 陳國瑋 相關圖片 陳文英 (F,1953/10/30,58y4m) 手術日期 2011/07/28 手術主治醫師 杜永光 手術區域 東址 025房 03號 診斷 Meningioma 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3E 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 22:47 通知急診手術 23:40 進入手術室 23:45 麻醉開始 23:50 誘導結束 00:22 手術開始 01:10 手術結束 01:10 麻醉結束 01:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室體外引流 1 2 R 記錄__ 手術科部: 外科部 套用罐頭: External ventricular drainage via right Koche... 開立醫師: 李振豪 開立時間: 2011/07/28 01:33 Pre-operative Diagnosis Left frontal intracerebral hemorrhage and intraventricular hemorrhage with acute hydrocephalus Post-operative Diagnosis Left frontal intracerebral hemorrhage and intraventricular hemorrhage with acute hydrocephalus Operative Method External ventricular drainage via right Kocher"s approach Specimen Count And Types 1 piece About size:5ml Source:CSF Pathology Nil Operative Findings Thick subgaleal fluid accumulation was noted at left fronto-temporo-pareital area and CWV drain showed bloody in character. After durotomy, the brain bulging out. The opening pressure was more than 25cmH2O. The ventricular catheter was fixed at 7cm in depth from cortex. The CSF was reddish in character and sent for routine, BCS, and bacterial culture. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position. The scalp was shaved, scrubbed, and disinfected as usual. Scalp incision was made along operative scar. One burr hole were created and two dural tenting was done. The dura was opened with cruciform fashion. Ventriculostomy was performed with puncture needle and ventricular catheter was inserted into right lateral ventricle. Externalization was done and the EVD was fixed at 7cm in depth. CSF was sampled. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators Prof.杜永光 Assistants R5李振豪 Indication Of Emergent Operation 相關圖片 鄭洪美雪 (F,1940/07/22,71y7m) 手術日期 2011/07/27 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Lymphoma 器械術式 Stereostatic biopsy for lymphoma 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 許皓淳, 時間資訊 00:00 臨時手術NPO 11:30 進入手術室 11:34 麻醉開始 11:38 誘導結束 11:55 抗生素給藥 12:10 手術開始 14:12 手術結束 14:12 麻醉結束 14:25 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 立體定位術-切片 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Stereotactic biopsy for right frontal brain tumor 開立醫師: 李振豪 開立時間: 2011/07/27 14:38 Pre-operative Diagnosis Multiple brain lesion, suspect CNS lymphoma Post-operative Diagnosis CNS lymphoma Operative Method Stereotactic biopsy for right frontal brain tumor Specimen Count And Types 1 piece About size:multiple Source:right frontal tumor biopsy Pathology Frozen section: CNS lymphoma Operative Findings Navigation was used for stereotactic biopsy. Total eight pieces specimens were obtained and sent for pathology exam. Small hematoma was noted in the last time of biopsy. The specimen was whitish and elastic to firm in character. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head fixed with Mayfield skull clamp. Navigation was set up and registrated. The entry point was decided under navigation guided. The scalp was shaved, scrubbed, and disinfected as usual. A 3cm linear incision was made over right frontal area followed by one burr hole creation. Two dural tenting was done and cruciform durotomy was performed. Stereotactic biopsy was performed and the specimen was sent for frozen section. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. The wound was then closed in layers with 2-0 Vicryl and Appose staples. Operators VS曾漢民 Assistants R5李振豪, R2許皓淳 相關圖片 謝梨昭 (F,1953/09/24,58y5m) 手術日期 2011/07/27 手術主治醫師 曾漢民 手術區域 東址 005房 03號 診斷 Intracerebral hemorrhage 器械術式 Left craniotomy for glioma excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 許皓淳, 時間資訊 00:00 臨時手術NPO 14:39 進入手術室 14:45 麻醉開始 15:05 抗生素給藥 15:10 誘導結束 15:18 手術開始 17:35 手術結束 17:35 麻醉結束 17:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除-手術時間在4小時以內 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 記錄__ 手術科部: 外科部 套用罐頭: Left fronto-temporal craniotomy for tumor exc... 開立醫師: 李振豪 開立時間: 2011/07/27 18:20 Pre-operative Diagnosis Left frontal lesion, suspect malignancy or hemorrhagic infarction Post-operative Diagnosis Left frontal lesion, suspect malignancy or hemorrhagic infarction Operative Method Left fronto-temporal craniotomy for tumor excision Specimen Count And Types 1 piece About size:Multiple small pieces Source:left frontal lesion Pathology Frozen section: reactive process Operative Findings One thrombosed vessel was noted at the brain surface before corticotomy. The tumor was 2.5 x 2 x 2.2cm in size, black-reddish, soft, fragile, hypovascularized, ill-defined and located at frontal lobe just adjacent to angular gyrus. No obviuos brain swelling was noted during the operation. The specimen was sent for frozen section and reactive process with hemorrhage was favored. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head rotated to right and fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. One curvilinear scalp incision was made at left fronto-temporal area. The scalp flap was elevated till exposure of the Keyhole. Facial nerve preservation was performed. Four burr holes were created followed by one 10 x 8cm craniotomy. Dural tenting was done. Intra-operative sonography was used for localization of the tumor. C-shape durotomy was performed based with skull base. One 1cm corticotomy was performed and tumor excision was conducted with tumor forceps and suction. The specimen was sent for frozen section. Hemostasis was achieved with bipolar electrocautery and Surgicel lining. Dura was closed with 4-0 Prolene. The skull plate was fixed back with miniplates/screws, and two dural tenting. One subgaleal CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and Appose staples. Operators VS曾漢民 Assistants R5李振豪, R2許皓淳 相關圖片 陳五萬 (M,1934/01/22,78y1m) 手術日期 2011/07/27 手術主治醫師 蔡瑞章 手術區域 東址 005房 01號 診斷 Lumbar spondylosis 器械術式 C5-6 discectomy with cage 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 許皓淳, 時間資訊 00:00 臨時手術NPO 07:33 報到 08:04 進入手術室 08:15 麻醉開始 08:30 誘導結束 08:35 抗生素給藥 08:57 手術開始 10:55 手術結束 10:55 麻醉結束 11:05 送出病患 11:08 進入恢復室 12:08 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-頸椎 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 記錄__ 手術科部: 外科部 套用罐頭: C5/6 anterior cervical diskectomy and fusion ... 開立醫師: 李振豪 開立時間: 2011/07/27 10:58 Pre-operative Diagnosis Herniated intervertebral disc, C5/6 with myelopathy Post-operative Diagnosis Herniated intervertebral disc, C5/6 with myelopathy Operative Method C5/6 anterior cervical diskectomy and fusion with PEEK cage Specimen Count And Types nil Pathology Nil Operative Findings Degenerative and ruptured disc was noted at C5/6 level with marginal spur formation. Hypertrophic posterior longitudinal ligment also noted. After diskectomy, the thecal sac expanded well and no incidental durotomy was noted during whole procedure. One #8 PEEK cage was inserted for anterior cervical fusion. Poor SSEP waveform, especially bilateral lower limbs were noted before the operation. The SSEP was stationary after whole procedure. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with neck extension. The skin was scrubbed, disinfected, and draped as usual. Transverse skin incision was made at right mid-neck. The subcutaneous soft tissue was devided and the margin of right platysma muscle and strip muscle were identified. The plane between muscle and thyroid gland was entered to exposed pre-vertebral fascia. The C5/6 disc space was identified by portable C-arm X-ray. the prevertebral fascia was opened and the longus collis muscle were detached. Koros retractor was applied. Under operative microscope, diskectomy was performed with curette, alligator, kerrison punches, and Midas air-drived drills. Resection of posterior longitudinal ligment and bilateral foraminotomy also performed. One #8 PEEK cage was inserted for anterior fusion. The wound was irrigated with Gentamicin solution. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. The wound was then closed in layers with 3-0 Vicryl and 4-0 Dexon. Operators Prof.蔡瑞章 Assistants R5李振豪, R2許皓淳 相關圖片 葉雲淇 (F,1998/06/16,13y8m) 手術日期 2011/07/27 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Moyamoya disease 器械術式 Right side EC-IC bypass (EDAS) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 07:51 報到 08:08 進入手術室 08:18 麻醉開始 08:35 誘導結束 09:05 抗生素給藥 09:25 手術開始 12:01 抗生素給藥 12:20 麻醉結束 12:20 手術結束 12:28 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 顱內外血管吻合術 1 1 R 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 手術 朴卜勒氏血流測定（週邊血管） 1 0 摘要__ 手術科部: 外科部 套用罐頭: Right side encephaloduroarteriosynangiosis (i... 開立醫師: 王奐之 開立時間: 2011/07/27 12:37 Pre-operative Diagnosis Moyamoya disease, status post left encephaloduroarteriosynangiosis Post-operative Diagnosis Moyamoya disease, status post left encephaloduroarteriosynangiosis Operative Method Right side encephaloduroarteriosynangiosis (indirect EC-IC bypass) from posterior branch of STA to MCA territory Specimen Count And Types Nil Pathology Nil Operative Findings Numerous small collateral vessel were noted at brain surface. The posterior branch of right STA was used, with about 5cm of mobilized segment; the surrounding galeal tissue were left with STA (about 1cm in width). Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After tracing and marking of the superficial temporal artery with Duplex, the scalp was scrubbed, disinfected, and draped in sterile fashion. Under microscopic view, a small reversed hockey stick incision was made at right temporal area, followed dissection of the galea and careful preserving the STA. One segment of STA along with surrounding galeal tissue were mobilized and gently retracted to the side. After linear incision of the temporalis muscle, an ovoid craniotomy was then done with its long axis along the STA course. A linear durotomy was made, followed by opening of the arachnoid membrane at the surface artery. 4 anchoring sutures were applied to the proximal & distal end of STA to the dural edges. The dura was then closed with 4-0 Prolene continuous sutures. A piece of DuroFoam was used to covered the dural surface to prevent CSF leakage. The bone flap edge was rongeured off to allow patent entry & exit points of the STA. After central tenting, the bone flap was fixed back with 4 wires. The wound was then closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Right side encephaloduroarteriosynangiosis (i... 開立醫師: 王奐之 開立時間: 2011/07/27 12:37 Pre-operative Diagnosis Moyamoya disease, status post left encephaloduroarteriosynangiosis Post-operative Diagnosis Moyamoya disease, status post left encephaloduroarteriosynangiosis Operative Method Right side encephaloduroarteriosynangiosis (indirect EC-IC bypass) from posterior branch of STA to MCA territory Specimen Count And Types Nil Pathology Nil Operative Findings Numerous small collateral vessel were noted at brain surface. The posterior branch of right STA was used, with about 5cm of mobilized segment; the surrounding galeal tissue were left with STA (about 1cm in width). 1. Numerous small collateral vessel were noted at brain surface. The posterior branch of right STA was used, with about 5cm of mobilized segment; the surrounding galeal tissue were left with STA (about 1cm in width). 2. The STA flap could contact with three parts of the cerebral arteries Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After tracing and marking of the superficial temporal artery with Duplex, the scalp was scrubbed, disinfected, and draped in sterile fashion. Under microscopic view, a small reversed hockey stick incision was made at right temporal area, followed dissection of the galea and careful preserving the STA. One segment of STA along with surrounding galeal tissue were mobilized and gently retracted to the side. After linear incision of the temporalis muscle, an ovoid craniotomy was then done with its long axis along the STA course. Under microscopic view, a elongated reversed hockey stick incision was made along the right STA, followed dissection of the galea and careful preserving the STA. One segment of STA along with surrounding galeal tissue were mobilized and gently retracted to the side. After linear incision of the temporalis muscle, an ovoid craniotomy was then done with its long axis along the STA course. A linear durotomy was made, followed by opening of the arachnoid membrane at the surface artery. 4 anchoring sutures were applied to the proximal & distal end of STA to the dural edges. The dura was then closed with 4-0 Prolene continuous sutures. A piece of DuroFoam was used to covered the dural surface to prevent CSF leakage. The bone flap edge was rongeured off to allow patent entry & exit points of the STA. After central tenting, the bone flap was fixed back with 4 wires. The wound was then closed in layers. Under microscopic view, a linear durotomy was made, followed by opening of the arachnoid membrane at the surface artery. 4 anchoring sutures were applied to the proximal & distal end of STA to the dural edges. The dura was then closed with 4-0 Prolene continuous sutures. A piece of DuroFoam was used to covered the dural surface to prevent CSF leakage. The bone flap edge was rongeured off to allow patent entry & exit points of the STA. After central tenting, the bone flap was fixed back with 4 wires. The wound was then closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之 相關圖片 黃彩詩 (M,1931/09/29,80y5m) 手術日期 2011/07/27 手術主治醫師 蔡翊新 手術區域 東址 025房 03號 診斷 Injury (severity score >=16) 器械術式 Craniotomy for right SDH removal 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 2E 紀錄醫師 李振豪, 時間資訊 19:15 通知急診手術 19:40 進入手術室 19:45 麻醉開始 20:00 誘導結束 20:19 抗生素給藥 20:33 手術開始 23:10 手術結束 23:10 麻醉結束 23:17 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 C.V.P. catheter in ubation 1 0 手術 急性硬腦膜下血腫清除術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Right fronto-temporo-parietal craniotomy for ... 開立醫師: 李振豪 開立時間: 2011/07/27 23:30 Pre-operative Diagnosis Right fronto-temporo-parietal acute on chronic subdural hematoma Post-operative Diagnosis Right fronto-temporo-parietal acute on chronic subdural hematoma Operative Method Right fronto-temporo-parietal craniotomy for subdural hematoma evacuation Specimen Count And Types nil Pathology Nil Operative Findings Large dura laceration was noted during craniotomy due to adhesion. Duroplasty with fascia was used for repair of dural laceration. Outer membrane and inner membrane formation were noted. The hematoma was septated and all compartment were opened. Total 150ml subdural hematoma was evacuated. The brain was slack and poor pulsatile after hematoma evacuation. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head rotated to left. the scalp was shaved, scrubbed, and disinfected as usual. Traumatic flap scalp incision was made and the scalp flap was elevated. Three burr holes were created followed by one 10 x 8cm craniotomy window. C-shape durotomy was performed and the outer membrane of the subdural hematoma was coagulated. The outer membrane of the chronic subdural was opened and hematoma evacuation was performed. Septation was noted and all compartment were opened. The subdural space was irrigated with normal saline. Duroplasty was performed with fascia. One subdural rubber drain and one epidural CWV drain was placed. The skull plate was fixed back with miniplates and screws. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS蔡翊新 Assistants R5李振豪 Indication Of Emergent Operation Acute conscious deterioration 相關圖片 陳文英 (F,1953/10/30,58y4m) 手術日期 2011/07/28 手術主治醫師 杜永光 手術區域 東址 016房 01號 診斷 Meningioma 器械術式 Left side craniectomy & ICH evacuation 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 4E 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 05:11 通知急診手術 05:42 進入手術室 05:45 麻醉開始 05:50 誘導結束 06:25 手術開始 07:00 開始輸血 10:05 手術結束 10:05 麻醉結束 10:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: 1. Left fronto-temporal craniectomy for ICH a... 開立醫師: 李振豪 開立時間: 2011/07/28 11:10 Pre-operative Diagnosis Left frontal intracerebral hemorrhage and intraventricular hemorrhage Post-operative Diagnosis Left frontal intracerebral hemorrhage and intraventricular hemorrhage Operative Method 1. Left fronto-temporal craniectomy for ICH and IVH evacuation Left fronto-temporal craniectomy for ICH and IVH evacuation Specimen Count And Types nil Pathology Nil Operative Findings The brain was bulging with poor pulsatile while dura opening. Active oozing from frontal skull base was noted. After expose the frontal base, hematoma was encountered and which mainly located at subdural space with ruptured into parenchyma at posterior part. The intraventricular hematoma was evacuated and one EVD was placed under direct vision. The right side EVD was kept open with 10cm above tragus. But the brain still bulging after hematoma evacuation. Her blood pressure was unstable before wound closure and inotropic agent was given. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head fixed with Mayfield skull clamp. The CWV drain was removed. The scalp was scrubbed, disinfected, and draped as usual. The stitches were removed and the scalp flap was elevated. The miniplates, screws, and skull plates were removed for decompression. The Duraform and prolene was removed. Ventriculostomy was performed via direct puncture and intraventricular hemorrhage was evacuated. The frontal base hematoma was removed piece by piece to preserve the optic nerve. Hemostasis was achieved with bipolar electrocautery, Floseal, Surgicel, and Gelfoam. Ventricular catheter was placed into right lateral ventricle under direct vision. New Duraform was used for duroplasty. One epidural CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators Prof.杜永光 Assistants R5李振豪, R2許皓淳, R1陸惠宗 Indication Of Emergent Operation Severe IICP with rapid deterioration of GCS 相關圖片 吳曼琳 (F,1960/02/14,52y1m) 手術日期 2011/07/28 手術主治醫師 陳敞牧 手術區域 東址 005房 01號 診斷 Acoustic tumor 器械術式 Left retrosigmoid approach tumor excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 石博元 ASA 2 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 07:32 報到 08:05 進入手術室 08:10 麻醉開始 08:45 誘導結束 09:10 抗生素給藥 09:10 手術開始 12:10 抗生素給藥 15:50 麻醉結束 15:50 手術結束 16:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 7 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 顱底瘤手術 1 1 摘要__ 手術科部: 外科部 套用罐頭: Left retrosigmoid approach for tumor resection 開立醫師: 曾偉倫 開立時間: 2011/07/28 16:04 Pre-operative Diagnosis Left cerebellum-pontine angle tumor, suspect acoustic neuroma Post-operative Diagnosis Left cerebellum-pontine angle tumor, suspect acoustic neuroma Operative Method Left retrosigmoid approach for tumor resection Specimen Count And Types 1 piece About size:4x4x2 cm Source:Left CP angle tumor, suspect acoustic neuroma Pathology Pending Operative Findings 1. A 4x3x3 elastic, greyish, hypervascularized tumor over left CP angle with cystic and solid part. The fluid within the cyst was clear light-yellowish. The tumor pushed the CN VII and VIII upward, anterior-medially, the CN V superiorly and the low crnial nerve downward. 2. The brain stem was pushed medialy and it became loose after the tumor removed 3. The intra-operative BAEP showed poor amplify over the left ear during the whole operation. 4. Facial nerve stimulation was performed for identifying the facial nerve, but there was no obvious response while touching different part of the tissue 5. The cystic wall of the tumor was left due to severe adhesion with surrounding tissue, most of the solid part of tumor was removed 6. Blood loss: 250ml Operative Procedures Under ETGA, we placed the patient over right 3/4 prone position. Her head was fixed with Mayfield head clamp. After we shaved, scrubbed, disinfected and drapped, a curvilinear skin incision was made over left posterior auricular area. Craniectomy was made and cisterna magna was reached after the durotomy. CSF fluid was drained and the cerebellum was sunk. The cystic portion of the tumor was reach and the fluid within was drained for wider space. Facial nerve stimulation was done for identifying the normal nerve tissue. Tumor resection was performed with bipolar forceps, scissors, sucker and tumor forceps. After complete hemostasis, a CWV drain was placed. The skull was fixed back with mini-plate and screw. The wound was closed in layers. Operators VS 陳敞牧 Assistants R5 林哲光 R3 曾偉倫 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Left retrosigmoid approach for tumor resection 開立醫師: 曾偉倫 開立時間: 2011/07/28 16:41 Pre-operative Diagnosis Left cerebellum-pontine angle tumor, suspect acoustic neuroma Post-operative Diagnosis Left cerebellum-pontine angle tumor, suspect acoustic neuroma Operative Method Left retrosigmoid approach for tumor resection Specimen Count And Types 1 piece About size:4x4x2 cm Source:Left CP angle tumor, suspect acoustic neuroma Pathology Pending Operative Findings 1. A 4x3x3 elastic, greyish, hypervascularized tumor over left CP angle with cystic and solid part. The fluid within the cyst was clear light-yellowish. The tumor pushed the CN VII and VIII upward, anterior-medially, the CN V superiorly and the low crnial nerve downward. 2. The brain stem was pushed medialy and it became loose after the tumor removed 3. The intra-operative BAEP showed poor amplify over the left ear during the whole operation. 4. Facial nerve stimulation was performed for identifying the facial nerve, but there was no obvious response while touching different part of the tissue 5. The cystic wall of the tumor was left due to severe adhesion with surrounding tissue, most of the solid part of tumor was removed 6. Blood loss: 250ml Operative Procedures Under ETGA, we placed the patient over right 3/4 prone position. Her head was fixed with Mayfield head clamp. After we shaved, scrubbed, disinfected and drapped, a curvilinear skin incision was made over left posterior auricular area. Craniectomy was made and cisterna magna was reached after the durotomy. CSF fluid was drained and the cerebellum was sunk. The cystic portion of the tumor was reach and the fluid within was drained for wider space. Facial nerve stimulation was done for identifying the normal nerve tissue. Tumor resection was performed with bipolar forceps, scissors, sucker and tumor forceps. After complete hemostasis, a CWV drain was placed. The skull was fixed back with mini-plate and screw. The wound was closed in layers. Operators VS 陳敞牧 Assistants R5 林哲光 R3 曾偉倫 相關圖片 林大舜 (M,1972/05/11,39y10m) 手術日期 2011/07/28 手術主治醫師 陳敞牧 手術區域 東址 003房 04號 診斷 Herniation of intervertebral disc 器械術式 C5-6 discectomy with cage 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 石博元 ASA 2 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 15:10 進入手術室 15:15 麻醉開始 15:25 誘導結束 15:30 抗生素給藥 15:52 手術開始 19:00 抗生素給藥 19:20 手術結束 19:20 麻醉結束 19:25 送出病患 19:27 進入恢復室 21:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 手術 椎間盤切除術-頸椎 1 1 手術 脊椎融合術-前融合,有固定物)≦四節 1 2 摘要__ 手術科部: 外科部 套用罐頭: C5-6 anterior diskectomy with cage fusion 開立醫師: 曾偉倫 開立時間: 2011/07/28 19:20 Pre-operative Diagnosis Herniated intervetebral disc, C5-6 Post-operative Diagnosis Herniated intervetebral disc, C5-6 Operative Method C5-6 anterior diskectomy with cage fusion Specimen Count And Types nil Pathology Nil Operative Findings 1. Protruding C5-6 disk in pre-operative C-spine MRI 2. Instrumentation: Vigor PEEK Disc Spacer 7 x 12 mm with artificial bone graft 3. Blood loss: minimal Operative Procedures Under ETGA, we placed the patient over supine position. After we scrubbed, disinfected and drapped, a horizontal skin incision was made over the C5-6 level. The wound was opened in layers. The trachea, esophagus and thyroid was puched laterally for exposion the cervical vetebral body. The C5-6 level was located tith intra-operative C-arm. C5-6 Diskectomy was done with Kerrison punch, Aligator and Disk clamp. The PEEK cage was placed and the location was checked with intra-operaitve C-arm. After complete hemostasis, the wound was closed in layers. Operators VS 陳敞牧 Assistants R5 林哲光 R4 王奐之 R3 曾偉倫 Ri 林千又 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: C5-6 anterior diskectomy with cage fusion 開立醫師: 曾偉倫 開立時間: 2011/07/28 19:27 Pre-operative Diagnosis Herniated intervetebral disc, C5-6 Post-operative Diagnosis Herniated intervetebral disc, C5-6 Operative Method C5-6 anterior diskectomy with cage fusion Specimen Count And Types nil Pathology Nil Operative Findings 1. Protruding C5-6 disk in pre-operative C-spine MRI 2. Instrumentation: Vigor PEEK Disc Spacer 7 x 12 mm with artificial bone graft 3. Blood loss: minimal Operative Procedures Under ETGA, we placed the patient over supine position. After we scrubbed, disinfected and drapped, a horizontal skin incision was made over the C5-6 level. The wound was opened in layers. The trachea, esophagus and thyroid was puched laterally for exposion the cervical vetebral body. The C5-6 level was located tith intra-operative C-arm. C5-6 Diskectomy was done with Kerrison punch, Aligator and Disk clamp. The PEEK cage was placed and the location was checked with intra-operaitve C-arm. After complete hemostasis, the wound was closed in layers. Operators VS 陳敞牧 Assistants R5 林哲光 R4 王奐之 R3 曾偉倫 Ri 林千又 相關圖片 蔡輝雄 (M,1943/03/02,69y0m) 手術日期 2011/07/28 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Pituitary tumor 器械術式 Endonasal tras-sphenoidal pituitary adenomectomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 石博元 ASA 3 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 08:10 進入手術室 08:15 麻醉開始 09:00 誘導結束 09:10 抗生素給藥 09:16 手術開始 09:45 開始輸血 10:20 手術結束 10:20 麻醉結束 10:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經由蝶竇之腦下垂體瘤切除 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Microscopic endonasal trans-sphenoid adenomectomy 開立醫師: 王奐之 開立時間: 2011/07/28 10:52 Pre-operative Diagnosis Pituitary macroadenoma Post-operative Diagnosis Pituitary macroadenoma Operative Method Microscopic endonasal trans-sphenoid adenomectomy Specimen Count And Types 1 piece About size:pieces Source:pituitary tumor Pathology Pending Operative Findings Yellowish fragile tumor was noted in sellar area, the dura was eroded by the tumor. A small part of tumor adhered to arachnoid membrane tightly and was left in place. Minor CSF leakage was encountered, and was stopped by packing of bone chips, gelfoam and application of Tissucol Duo. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head put on head rest and neck extended. After Bosmin gauze packing of bilateral nostrils, the operation field was disinfection & draped in sterile fashion. The nasal mucosa was detached, and the nasal septum was deviated to left. The vomer bone and anterior wall of sphenoid sinus were then fractured and removed. The septum within the sphenoid sinus was removed, and the sellar floor was opened. Dura at sellar floor was cut open, and the tumor was removed in pieces by ring curettage & suction. After tumor removal, the dural defect was packed with bone chip, gelfoam & Tissucol Duo. The vomer bone was placed back, and the nasal septum was reduced back. The operation ended after placement of nasal packings. Operators VS 王國川 Assistants R4 王奐之 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Microscopic endonasal trans-sphenoid adenomectomy 開立醫師: 王奐之 開立時間: 2011/07/28 10:52 Pre-operative Diagnosis Pituitary macroadenoma Post-operative Diagnosis Pituitary macroadenoma Operative Method Microscopic endonasal trans-sphenoid adenomectomy Specimen Count And Types 1 piece About size:pieces Source:pituitary tumor Pathology Pending Operative Findings Yellowish fragile tumor was noted in sellar area, the dura was eroded by the tumor. A small part of tumor adhered to arachnoid membrane tightly and was left in place. Minor CSF leakage was encountered, and was stopped by packing of bone chips, gelfoam and application of Tissucol Duo. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head put on head rest and neck extended. After Bosmin gauze packing of bilateral nostrils, the operation field was disinfection & draped in sterile fashion. The nasal mucosa was detached, and the nasal septum was deviated to left. The vomer bone and anterior wall of sphenoid sinus were then fractured and removed. The septum within the sphenoid sinus was removed, and the sellar floor was opened. Dura at sellar floor was cut open, and the tumor was removed in pieces by ring curettage & suction. After tumor removal, the dural defect was packed with bone chip, gelfoam & Tissucol Duo. The vomer bone was placed back, and the nasal septum was reduced back. The operation ended after placement of nasal packings. Operators VS 王國川 Assistants R4 王奐之 相關圖片 許玉聘 (F,1935/02/07,77y1m) 手術日期 2011/07/28 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 Hydrocephalus 器械術式 Right Kocher V-P shunt insertion 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 石博元 ASA 2 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 10:52 進入手術室 10:55 麻醉開始 11:05 誘導結束 11:25 抗生素給藥 11:30 手術開始 12:15 手術結束 12:15 麻醉結束 12:20 送出病患 12:30 進入恢復室 13:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt insertion via righ... 開立醫師: 王奐之 開立時間: 2011/07/28 12:30 Pre-operative Diagnosis Normal pressure hydrocephalus Post-operative Diagnosis Normal pressure hydrocephalus Operative Method Ventriculoperitoneal shunt insertion via right Kocher point Specimen Count And Types Nil Pathology Nil Operative Findings Codman medium pressure valve was used, with ventricular catheter set at 7cm & peritoneal catheter set at 30cm. Clear CSF was noted after ventricular puncture, and smooth CSF flow was confirmed. Opening pressure: about 5-10cmH2O. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After shaving, scrubbing, disinfection & draping in sterile fashion, a linear incision was made at right frontal area. A burr hole was created at right Kocher point. Another linear incision was made at righ upper quadrant of abdomen, followed by mini-laparotomy. A subcutaneous tunnel was then created from abdominal wound to retroauricular area. Anpther subcutaneous tunnel was created from the right frontal wound to retroauricular area, the catheters were then assembled and passed throught the subcutaneous tunnels. A small cruciate durotomy was performed after 2 tenting stitches. Ventricular puncture was done, followed by insertion of ventricular catheter. After confirmation of smooth CSF flow, the peritoneal catheter was also inserted. The wounds were closed in layers after hemostasis. Operators VS 王國川 Assistants R4 王奐之, Ri 林千又 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt insertion via righ... 開立醫師: 王奐之 開立時間: 2011/07/28 12:30 Pre-operative Diagnosis Normal pressure hydrocephalus Post-operative Diagnosis Normal pressure hydrocephalus Operative Method Ventriculoperitoneal shunt insertion via right Kocher point Specimen Count And Types Nil Pathology Nil Operative Findings Codman medium pressure valve was used, with ventricular catheter set at 7cm & peritoneal catheter set at 30cm. Clear CSF was noted after ventricular puncture, and smooth CSF flow was confirmed. Opening pressure: about 5-10cmH2O. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After shaving, scrubbing, disinfection & draping in sterile fashion, a linear incision was made at right frontal area. A burr hole was created at right Kocher point. Another linear incision was made at righ upper quadrant of abdomen, followed by mini-laparotomy. A subcutaneous tunnel was then created from abdominal wound to retroauricular area. Anpther subcutaneous tunnel was created from the right frontal wound to retroauricular area, the catheters were then assembled and passed throught the subcutaneous tunnels. A small cruciate durotomy was performed after 2 tenting stitches. Ventricular puncture was done, followed by insertion of ventricular catheter. After confirmation of smooth CSF flow, the peritoneal catheter was also inserted. The wounds were closed in layers after hemostasis. Operators VS 王國川 Assistants R4 王奐之, Ri 林千又 相關圖片 林連喜 (M,1934/10/25,77y4m) 手術日期 2011/07/28 手術主治醫師 王國川 手術區域 東址 003房 03號 診斷 Cerebrovascular accident 器械術式 Cranioplasty, left F-T 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 石博元 ASA 3 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 13:00 進入手術室 13:05 麻醉開始 13:15 誘導結束 13:30 抗生素給藥 13:35 手術開始 14:35 手術結束 14:35 麻醉結束 15:00 送出病患 15:02 進入恢復室 16:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 頭顱成形術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Left side cranioplasty with autologous bone graft 開立醫師: 王奐之 開立時間: 2011/07/28 14:51 Pre-operative Diagnosis Left side frontotemporal skull defect Post-operative Diagnosis Left side frontotemporal skull defect Operative Method Left side cranioplasty with autologous bone graft Specimen Count And Types Nil Pathology Nil Operative Findings Previous ventriculoperitoneal shunt catheter acrossed operation field and entered the left hemisphere through left Kocher point. Mild adhesion was noted between dura & galea. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to right. After shaving, scrubbing, disinfection & draping in sterile fashion, a question mark incision was made along previous scar. After dissection of the plane between dura & galea, the skin flap was reflected inferiorly. The bony edge was exposed completely, and 5 central tenting stitches were done. The bone flap was then fixed back with mini-plates. After setting 1 subgaleal CWV drain, the wound was closed in layers. Operators VS 王國川 Assistants R4 王奐之, Ri 林千又 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Left side cranioplasty with autologous bone graft 開立醫師: 王奐之 開立時間: 2011/07/28 14:52 Pre-operative Diagnosis Left side frontotemporal skull defect Post-operative Diagnosis Left side frontotemporal skull defect Operative Method Left side cranioplasty with autologous bone graft Specimen Count And Types Nil Pathology Nil Operative Findings Previous ventriculoperitoneal shunt catheter acrossed operation field and entered the left hemisphere through left Kocher point. Mild adhesion was noted between dura & galea. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to right. After shaving, scrubbing, disinfection & draping in sterile fashion, a question mark incision was made along previous scar. After dissection of the plane between dura & galea, the skin flap was reflected inferiorly. The bony edge was exposed completely, and 5 central tenting stitches were done. The bone flap was then fixed back with mini-plates. After setting 1 subgaleal CWV drain, the wound was closed in layers. Operators VS 王國川 Assistants R4 王奐之, Ri 林千又 相關圖片 摘要__ 手術科部: 外科部 套用罐頭: Left side cranioplasty with autologous bone graft 開立醫師: 王奐之 開立時間: 2011/07/28 15:07 Pre-operative Diagnosis Left side frontotemporal skull defect Post-operative Diagnosis Left side frontotemporal skull defect Operative Method Left side cranioplasty with autologous bone graft Specimen Count And Types Nil Pathology Nil Operative Findings Previous ventriculoperitoneal shunt catheter crossed operation field and entered the left hemisphere through left Kocher point. Mild adhesion was noted between dura & galea. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to right. After shaving, scrubbing, disinfection & draping in sterile fashion, a question mark incision was made along previous scar. After dissection of the plane between dura & galea, the skin flap was reflected inferiorly. The bony edge was exposed completely, and 5 central tenting stitches were done. The bone flap was then fixed back with mini-plates. After setting 1 subgaleal CWV drain, the wound was closed in layers. Operators VS 王國川 Assistants R4 王奐之, Ri 林千又 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Left side cranioplasty with autologous bone graft 開立醫師: 王奐之 開立時間: 2011/07/28 15:07 Pre-operative Diagnosis Left side frontotemporal skull defect Post-operative Diagnosis Left side frontotemporal skull defect Operative Method Left side cranioplasty with autologous bone graft Specimen Count And Types Nil Pathology Nil Operative Findings Previous ventriculoperitoneal shunt catheter crossed operation field and entered the left hemisphere through left Kocher point. Mild adhesion was noted between dura & galea. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to right. After shaving, scrubbing, disinfection & draping in sterile fashion, a question mark incision was made along previous scar. After dissection of the plane between dura & galea, the skin flap was reflected inferiorly. The bony edge was exposed completely, and 5 central tenting stitches were done. The bone flap was then fixed back with mini-plates. After setting 1 subgaleal CWV drain, the wound was closed in layers. Operators VS 王國川 Assistants R4 王奐之, Ri 林千又 相關圖片 陳寰穎 (M,2003/07/05,8y8m) 手術日期 2011/07/28 手術主治醫師 廖漢文 手術區域 東址 000房 號 診斷 Moyamoya disease 器械術式 Common Carotid Angiography 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 2 時間資訊 08:20 麻醉開始 08:30 誘導結束 09:35 麻醉結束 10:00 進入恢復室 11:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 童鈺翔 (M,1988/09/05,23y6m) 手術日期 2011/07/28 手術主治醫師 張志豪 手術區域 西址 036房 02號 診斷 Posterior interosseous nerve syndrome 器械術式 (註)osteotomy of radioulnar synostosis 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林峰盛 ASA 2 紀錄醫師 李嘉哲, 時間資訊 09:25 報到 09:40 進入手術室 09:50 麻醉開始 09:55 誘導結束 10:10 抗生素給藥 10:22 手術開始 12:50 手術結束 12:50 麻醉結束 13:05 進入恢復室 13:57 送出病患 14:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 肘關節整型術 1 1 L 手術 石膏副木固定－長臂 1 0 L 記錄__ 手術科部: 骨科部 套用罐頭: 1.excision of the heterotrophic bone 2. fix D... 開立醫師: 李嘉哲 開立時間: 2011/07/28 13:09 Pre-operative Diagnosis left proximal radial-ulna osteosynthesis left proximal radial-ulna osteosynostosis Post-operative Diagnosis left proximal radial-ulna osteosynthesis left proximal radial-ulna osteosynostosis Operative Method 1.excision of the heterotrophic bone 2. fix DRUJ with c-wire Specimen Count And Types nil Pathology nil Operative Findings 1.osteosynthesis between proximal radial and ulna 1.osteosynostosis between proximal radial and ulna 2.radial head malunion Operative Procedures 1.LMA , supine 2.sterilize the skin and drap 3.skin incsino ,anterior approach 4.remove the HO and debridement of the elbow joint and R-U joint 4.remove the hypertrophic synostosis and perform debridement over the elbow joint and R-U joint 5.fix DRUJ with C-wire 6.appll long arm splint 6.close wound in layers and apply long arm splint Operators 張志豪, Assistants 黃偉程, 駱檠 (M,1968/06/21,43y8m) 手術日期 2011/07/29 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Spine tumor 器械術式 Benign intraspinal tumor excision C1-2 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉育彰 ASA 3 紀錄醫師 陳國瑋, 時間資訊 00:28 臨時手術NPO 07:40 報到 08:05 進入手術室 08:10 麻醉開始 09:00 誘導結束 09:00 抗生素給藥 09:04 手術開始 12:00 抗生素給藥 12:35 麻醉結束 12:35 手術結束 12:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 良性脊髓腫瘤切除術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: C1 hemilaminectomy, C2 laminotomy for tumor e... 開立醫師: 曾峰毅 開立時間: 2011/07/29 12:22 Pre-operative Diagnosis Intraspinal extradural tumor, neurilemmoma, from left C2 root Post-operative Diagnosis Intraspinal extradural tumor, neurilemmoma, from left C2 root Operative Method C1 hemilaminectomy, C2 laminotomy for tumor excision C1 hemilaminectomy, C2 upper partial hemilaminectomy for tumor excision Specimen Count And Types 1 piece About size:pieces Source:spine tumor Pathology pending Operative Findings One capsulated, intraspinal, extradural, well defined, hypervasculized tumor arising from left C2 root are noted at left C1-2 level, occupying left C1/2 neural foramen, thinning left C1-2 laminae. One capsulated, intraspinal, extradural, well defined, hypervasculized tumor arising from left C2 root are noted at left C1-2 level, occupying left C1/2 neural foramen, thinning left C1-2 laminae. The SSEP and MEP remained unchanged during the whole procedure. Operative Procedures The patient was intubated and under general anesthesia. His head was fixed with Mayfield clamp. He was turned to prone position. The skin was prepared as usual. Midline skin incision about 8cm was made from inion. The paraspinal muscles was retracted aside and the C1 C2 spinal process was identified. Left C1 hemilaminectomy and left C2 upper partial hemilaminectomy was done. The tumor was removed in piecemeal intra-capsularly with CUSA and tumor forceps. After hemostasis, we placed one submuscular CWV, and closed the wound in layers. Operators Prof. 杜永光 Assistants R5 曾峰毅 R3 陳國瑋 相關圖片 黃阿蝦 (F,1931/02/06,81y1m) 手術日期 2011/07/29 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Subdural hemorrhage (SDH) 器械術式 Removal of chronic subdural 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 3 紀錄醫師 許皓淳, 時間資訊 23:33 臨時手術NPO 07:45 報到 08:10 進入手術室 08:20 麻醉開始 08:30 誘導結束 08:32 抗生素給藥 08:53 手術開始 09:50 手術結束 09:50 麻醉結束 10:00 送出病患 10:02 進入恢復室 12:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 B 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Bilateral burr hole drainage 開立醫師: 李振豪 開立時間: 2011/07/29 10:05 Pre-operative Diagnosis Bilateral subdural effusion Post-operative Diagnosis Bilateral subdural effusion Operative Method Bilateral burr hole drainage Specimen Count And Types 1 piece About size:10ml Source:subdural effusion Pathology Nil Operative Findings Bilateral subdural effusion was noted after duraotomy. The effusion was xanthochromic and clear in character. The opening pressure is very low. The catheter was fixed at 4cm in depth from durotomy. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position. The scalp was shaved, scrubbed, and disinfected as usual. Bilateral frontal scalp incision was made followed by one burr hole creation at each side. Dural tenting was performed. A small durotomy was performed and ventricular catheter was placed into bilateral subdural space. The subdural effusion was sampled for study. Externalization was done. Hemostasis was performed with bipolar electrocautery and Gelfoam packing. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS曾漢民 Assistants R5李振豪, R2許皓淳 相關圖片 方英鑾 (F,1938/08/17,73y6m) 手術日期 2011/07/29 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Meningioma 器械術式 Right retrosigmoid approach for tumor resection 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 3 紀錄醫師 許皓淳, 時間資訊 23:35 臨時手術NPO 10:00 報到 10:25 進入手術室 10:30 麻醉開始 11:05 誘導結束 11:06 抗生素給藥 11:11 手術開始 14:00 抗生素給藥 16:00 麻醉結束 16:00 手術結束 16:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 顱底瘤手術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Right retrosigmoid approach for tumor excision 開立醫師: 李振豪 開立時間: 2011/07/29 16:18 Pre-operative Diagnosis Right petroclival meningioma Post-operative Diagnosis Right petroclival meningioma Operative Method Right retrosigmoid approach for tumor excision Specimen Count And Types 1 piece About size:Multiple pieces Source:Right petroclival meningioma Pathology Nil Operative Findings The CN VII, VIII, and low cranial nerve were pushed posteriorlly by the tumor. The CNV was pushed upward by the tumor. The tumor attachment was mainly located between The internal acustic meatus and CN VI. The tumor was 2.4 x 1.5 x 2.2cm in size, well-capsulated, elastic to firm, hypervascularized, and red-yellowish in color. All cranial nerve(5,6,7,8, and low cranial nerve), labyrinth artery, AICA, and bascular artery were all well preserved during the operation. Small pieces of the tumor within internal acustic canal was left in situ for functional preservation. No obvious cerebellum injury was noted after tumor resection. Operative Procedures Under endotracheal general anesthesia, the patient was put in 3/4 prone position with head fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. One curvilinear scalp incision over right retroauricular area was made. The subcutaneous soft tissue and nuchal muscle was devided. One 3x3cm fascia was harvested during soft tissue dissection. Four burr hole were created followed by one 5x3cm craniotomy window. 兀 shape durotomy was performed. CSF was released from cisterna magna. The cerebellum was retracted and CN VII, VIII, and low cranial nerve were identified. The CN VII, VIII complex was lysis from the tumor. Devascularization of the tumor was performed. Subcapsule decompression with CUSA was used. The tumor was removed piece by piece. After total resection of the tumor, hemostasis was achieved with bipolar electrocautery and Surgicel lining. Duroplasty with fascia was done. The skull plate was fixed back with four #26 wires. The wound was then closed in layers with 2-0 Vicryl and Appose staples. Operators VS曾漢民 Assistants R5李振豪, R2許皓淳 相關圖片 顏守信 (M,1937/04/16,74y10m) 手術日期 2011/07/29 手術主治醫師 周介仁 手術區域 西址 031房 01號 診斷 Blepharochalasia 器械術式 Cosmatic Lower Lid Blepharopla 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 08:40 報到 09:05 進入手術室 09:35 麻醉開始 09:41 手術開始 09:55 誘導結束 09:55 麻醉結束 10:40 手術結束 10:45 送出病患 記錄__ 手術科部: 眼科部 套用罐頭: Fat removal (ou) 開立醫師: 麥珮怡 開立時間: 2011/07/29 10:46 Pre-operative Diagnosis Lid bag (ou) Post-operative Diagnosis Lid bag (ou) Operative Method Fat removal (ou) Specimen Count And Types nil Pathology Nil Operative Findings Lid bag (ou) Operative Procedures 1.Injected local anesthetic + vasoconstrictor 2.Disinfection and draping as usual 3.Bridle suture over lower eyelid (od) 4.Open the palpebral conjunctiva with scissors 5.Expose the lid bag fat with scissors and hemostasis with cautery 6.remove the lid bag fat ( central, medial, lateral part) 7.Close conjunctival wound with 6-0 Vicryl 8.Repeat the previous procedures on Os 9.Tetracyclin patching. Operators 周介仁, Assistants R4麥珮怡 謝宗凱 (M,1998/11/29,13y3m) 手術日期 2011/07/29 手術主治醫師 郭夢菲 手術區域 兒醫 067房 03號 診斷 Meningitis, unspecified 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 3E 紀錄醫師 王奐之, 時間資訊 16:49 通知急診手術 00:00 開始NPO 00:00 臨時手術NPO 12:45 進入手術室 12:45 報到 12:50 麻醉開始 13:10 誘導結束 14:05 手術開始 14:50 麻醉結束 14:50 手術結束 15:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱內壓視置入 1 1 L 麻醉 C.V.P. catheter in ubation 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 套用罐頭: External ventricular drainage as ICP monitor,... 開立醫師: 王奐之 開立時間: 2011/07/29 15:33 Pre-operative Diagnosis CNS infection, ventriculitis with hydrocephalus Post-operative Diagnosis CNS infection, ventriculitis with hydrocephalus Operative Method External ventricular drainage as ICP monitor, via left Kocher point Specimen Count And Types 1 piece About size:10ml Source:CSF Pathology Nil Operative Findings Turbid CSF was noted, opening pressure of ventriulostomy was 10~15 cmH2O, and dropped to 3-5 cmH2O after gushing out 1~2 ml of CSF. EVD catheter set at 6.5 cm length intracranially. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position. After shaving, scrubbing, disinfection & draping in sterile fashion, a linear incision was made at left frontal area. A burr hole was then created with perforator at left Kocher point, 2 tenting stitches were applied. A small cruciate durotomy was done, and meticulous hemostasis was achieved. Ventricular puncture was then performed, followed by insertion of EVD catheter. After securing the EVD catheter, the wound was closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之 Indication Of Emergent Operation IICP 相關圖片 記錄__ 手術科部: 套用罐頭: External ventricular drainage as ICP monitor,... 開立醫師: 王奐之 開立時間: 2011/07/29 15:33 Pre-operative Diagnosis CNS infection, ventriculitis with hydrocephalus Post-operative Diagnosis CNS infection, ventriculitis with hydrocephalus Operative Method External ventricular drainage as ICP monitor, via left Kocher point Specimen Count And Types 1 piece About size:10ml Source:CSF Pathology Nil Operative Findings Turbid CSF was noted, opening pressure of ventriulostomy was 10~15 cmH2O, and dropped to 3-5 cmH2O after gushing out 1~2 ml of CSF. EVD catheter set at 6.5 cm length intracranially. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position. After shaving, scrubbing, disinfection & draping in sterile fashion, a linear incision was made at left frontal area. A burr hole was then created with perforator at left Kocher point, 2 tenting stitches were applied. A small cruciate durotomy was done, and meticulous hemostasis was achieved. Ventricular puncture was then performed, followed by insertion of EVD catheter. After securing the EVD catheter, the wound was closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之 Indication Of Emergent Operation IICP 相關圖片 摘要__ 手術科部: 套用罐頭: External ventricular drainage as ICP monitor,... 開立醫師: 王奐之 開立時間: 2011/07/29 15:36 Pre-operative Diagnosis CNS infection, ventriculitis with hydrocephalus Post-operative Diagnosis CNS infection, ventriculitis with hydrocephalus Operative Method External ventricular drainage as ICP monitor, via left Kocher point Specimen Count And Types 1 piece About size:10ml Source:CSF Pathology Nil Operative Findings Slightly turbid CSF was noted, with small amount of whitish debris (musch less then previous procedure); opening pressure of ventriulostomy was 10~15 cmH2O, and dropped to 3-5 cmH2O after gushing out 1~2 ml of CSF. EVD catheter set at 6.5 cm length intracranially. Intraventricular irrigation was performed for several times. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position. After shaving, scrubbing, disinfection & draping in sterile fashion, a linear incision was made at left frontal area. A burr hole was then created with perforator at left Kocher point, 2 tenting stitches were applied. A small cruciate durotomy was done, and meticulous hemostasis was achieved. Ventricular puncture was then performed, followed by insertion of EVD catheter. After securing the EVD catheter, the wound was closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之 Indication Of Emergent Operation IICP 相關圖片 記錄__ 手術科部: 套用罐頭: External ventricular drainage as ICP monitor,... 開立醫師: 王奐之 開立時間: 2011/07/29 15:36 Pre-operative Diagnosis CNS infection, ventriculitis with hydrocephalus Post-operative Diagnosis CNS infection, ventriculitis with hydrocephalus Operative Method External ventricular drainage as ICP monitor, via left Kocher point Specimen Count And Types 1 piece About size:10ml Source:CSF Pathology Nil Operative Findings Slightly turbid CSF was noted, with small amount of whitish debris (musch less then previous procedure); opening pressure of ventriulostomy was 10~15 cmH2O, and dropped to 3-5 cmH2O after gushing out 1~2 ml of CSF. EVD catheter set at 6.5 cm length intracranially. Intraventricular irrigation was performed for several times. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position. After shaving, scrubbing, disinfection & draping in sterile fashion, a linear incision was made at left frontal area. A burr hole was then created with perforator at left Kocher point, 2 tenting stitches were applied. A small cruciate durotomy was done, and meticulous hemostasis was achieved. Ventricular puncture was then performed, followed by insertion of EVD catheter. After securing the EVD catheter, the wound was closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之 Indication Of Emergent Operation IICP 相關圖片 記錄__ 手術科部: 套用罐頭: External ventricular drainage as ICP monitor,... 開立醫師: 郭夢菲 開立時間: 2011/08/01 09:47 Pre-operative Diagnosis CNS infection, ventriculitis with hydrocephalus Post-operative Diagnosis CNS infection, ventriculitis with hydrocephalus Operative Method External ventricular drainage as ICP monitor, via left Kocher point Specimen Count And Types 1 piece About size:10ml Source:CSF Pathology Nil Operative Findings Turbid CSF was noted, opening pressure of ventriulostomy was 10~15 cmH2O, and dropped to 3-5 cmH2O after gushing out 1~2 ml of CSF. EVD catheter set at 6.5 cm length intracranially. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position. After shaving, scrubbing, disinfection & draping in sterile fashion, a linear incision was made at left frontal area. A burr hole was then created with perforator at left Kocher point, 2 tenting stitches were applied. A small cruciate durotomy was done, and meticulous hemostasis was achieved. Ventricular puncture was then performed, followed by insertion of EVD catheter. After securing the EVD catheter, the wound was closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之 Indication Of Emergent Operation 相關圖片 李柯金定 (F,1936/11/20,75y3m) 手術日期 2011/07/29 手術主治醫師 賴達明 手術區域 東址 003房 03號 診斷 Cerebral aneurysm 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 3E 紀錄醫師 陳國瑋, 時間資訊 16:15 報到 16:15 進入手術室 16:16 麻醉開始 16:20 誘導結束 16:26 手術開始 17:10 麻醉結束 17:10 手術結束 17:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 氣管切開術 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 李振豪 開立時間: 2011/07/29 17:20 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types Nil Pathology None Operative Findings Fr. 7 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 1cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Operators VS賴達明 Assistants R5李振豪, R3陳國瑋 相關圖片 吳天送 (M,1928/04/09,83y11m) 手術日期 2011/07/29 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Meningioma 器械術式 Spine tumor resection, T2 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉育彰 ASA 2 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 13:00 進入手術室 13:05 麻醉開始 13:30 誘導結束 13:40 手術開始 14:40 抗生素給藥 15:45 手術結束 15:45 麻醉結束 15:52 送出病患 15:57 進入恢復室 17:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 良性脊髓腫瘤切除術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Left T2 hemilaminectomy for tumor excision, S... 開立醫師: 陳國瑋 開立時間: 2011/07/29 16:02 Pre-operative Diagnosis Spinal intradural, extramedullar tumor, suspected meningioma Post-operative Diagnosis Intraspinal meningioma, at T2 level Operative Method Left T2 hemilaminectomy for tumor excision, Simpson grade II Specimen Count And Types 1 piece About size:2cm Source:spine tumor Pathology pending Operative Findings One well-defined, soft to elastic, intra-dural, extra-medullary, dura-based tumor at T2 level. The SSEP and MEP remained unchanged during the whole procedure. Operative Procedures The patient was intubated and under general anesthesia. His head was fixed with Mayfield clamp, and then turned into prone position. The level of T2 was identified with C-arm. The skin was prepared as usual. One linear skin incision was made and the soft tissue and para-spinal muscle was splited aside. Left hemilaminectomy of T2 was done and the durotomy was made longitudinally at left paramedian. The tumor was removed en bloc. The dura was sutured with prolene. The wound was closed in layers after setting on CWV. Operators 賴達明 Assistants 曾峰毅 陳國瑋 相關圖片 陳素熾 (F,1956/11/11,55y4m) 手術日期 2011/07/29 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Herniation of intervertebral disc, lumbar 器械術式 Diskectomy lumbar, L4-5 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 2 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 07:35 報到 08:05 進入手術室 08:08 麻醉開始 08:10 誘導結束 09:05 抗生素給藥 09:12 手術開始 11:07 手術結束 11:07 麻醉結束 11:20 送出病患 11:25 進入恢復室 12:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-腰椎 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 記錄__ 手術科部: 外科部 套用罐頭: L4/5 microsurgical discectomy 開立醫師: 林哲光 開立時間: 2011/07/29 11:27 Pre-operative Diagnosis L4-5 HIVD with left L5 radiculopathy Post-operative Diagnosis L4-5 HIVD with left L5 radiculopathy Operative Method L4/5 microsurgical discectomy Specimen Count And Types nil Pathology Nil Operative Findings Ruptured disc was noted at L5 root and hypertrophic change of the ligamentum flavum was noted. Hyperemic change of the left L5 root was also noted. Operative Procedures Under ETGA and prone position, skin disinfected and drapped were performed as usual. Midline skin incsiion was made at L4/5 level after L4/5 disc level was idenetified. Left paraspinal muscle was detached and L4, L5 lamina were exposed well. Lamniotomy was done at L4 level and ligamentum flavum was removed and the root was exposed. The disc was then exposed by pushing the root from the lateral side. L4/5 discectomy was then done. Hemostasis was then performed and the wound was then closed in layers. Operators AP 賴達明 Assistants R5 林哲光, Ri 沈宛臻 相關圖片 張傅金蘭 (F,1951/06/09,60y9m) 手術日期 2011/07/29 手術主治醫師 賴達明 手術區域 東址 019房 02號 診斷 Lumbar Spondylosis 器械術式 Spinal fusion posterior, L4/5 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 2 紀錄醫師 林哲光, 時間資訊 23:42 臨時手術NPO 11:00 報到 11:32 進入手術室 11:38 麻醉開始 11:45 誘導結束 12:07 抗生素給藥 12:30 手術開始 15:07 抗生素給藥 15:48 手術結束 15:48 麻醉結束 15:53 送出病患 15:58 進入恢復室 17:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎間盤切除術-腰椎 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 記錄__ 手術科部: 外科部 套用罐頭: L4/5 discectomy and posterior fusion with PEE... 開立醫師: 林哲光 開立時間: 2011/07/29 16:04 Pre-operative Diagnosis L4/5 grade I spondylolisthesis Post-operative Diagnosis L4/5 grade I spondylolisthesis Operative Method L4/5 discectomy and posterior fusion with PEEK cage insertion and TPS at L4/5 level Specimen Count And Types nil Pathology Nil Operative Findings Depressed vertebral body was noted at L5 body and hypertrophic change of ligamentum flavum and bilateral facet joints were noted. TPS 40mm were inserted at L4, L5 pedicles and PEEK cage 13mm was inserted at L4/5 intervetebral space, Rods 5cm and 6cm at right and left side respectively. Operative Procedures Under ETGA and prone position, skin dinsinfected and drapped were performed as usual. Midline skin incision was made at L2-L5 level. THe paraspainal muscles were detached and TPS were inserted at L4/L5 level. Laminectomy was then perfomred at right L4/5 level. L4/5 disectomy were done and cages were inserted at L4/5 level and rods were inserted and fixed. The wound was then closed in layers after epidural hemovac insertion. Operators AP 賴達明 Assistants R5 林哲光, Ri 沈宛臻 相關圖片 林重藤 (M,1946/11/11,65y4m) 手術日期 2011/07/29 手術主治醫師 賴達明 手術區域 東址 019房 03號 診斷 Spinal Stenosis 器械術式 Diskectomy cervical(Anterier), C3/4, C4/5 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 林哲光, 時間資訊 23:40 臨時手術NPO 15:45 報到 16:05 進入手術室 16:10 麻醉開始 16:20 誘導結束 16:35 抗生素給藥 16:55 手術開始 19:30 抗生素給藥 19:45 手術結束 19:45 麻醉結束 19:50 送出病患 20:00 進入恢復室 21:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-頸椎 1 1 手術 脊椎融合術-前融合,有固定物)≦四節 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 記錄__ 手術科部: 外科部 套用罐頭: C3-4, C4-5 discectomy and anterior fusion wit... 開立醫師: 林哲光 開立時間: 2011/07/29 20:05 Pre-operative Diagnosis C3-4, C4-5 HIVD with myelopathy Post-operative Diagnosis C3-4, C4-5 HIVD with myelopathy Operative Method C3-4, C4-5 discectomy and anterior fusion with cage and cervical plate Specimen Count And Types nil Pathology Nil Operative Findings Osteophyte formation at prevertebral area at C4-5 level was noted. The intervertebral disc height was decreased at C3-4, C4-5 level. Hypertrophic change of PLL was also noted. 7mm and 6mm PEEK cage were inserted at C4-5 and C3-4 level. Operative Procedures Under ETGA, we placed the patient over supine position. After we scrubbed, disinfected and drapped, a horizontal skin incision was made over the C5-6 level. The wound was opened in layers. The trachea, esophagus and thyroid was puched laterally for exposion the cervical vetebral body. The C5-6 level was located tith intra-operative C-arm. C5-6 Diskectomy was done with Kerrison punch, Aligator and Disk clamp. The PEEK cage was placed and the location was checked with intra-operaitve C-arm. After complete hemostasis, the wound was closed in layers. Operators AP 賴達明 Assistants R5 曾峰毅, R5 林哲光, Ri 沈宛臻 相關圖片 陳國樹 (M,1921/09/22,90y5m) 手術日期 2011/07/29 手術主治醫師 蔡翊新 手術區域 東址 003房 04號 診斷 Intracerebral hemorrhage 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 5E 紀錄醫師 范姜鈞, 時間資訊 21:24 開始NPO 21:24 通知急診手術 21:55 進入手術室 22:00 麻醉開始 22:40 誘導結束 22:50 抗生素給藥 23:10 手術開始 01:50 抗生素給藥 02:30 手術結束 02:30 麻醉結束 02:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦內血腫清除術 1 1 R 手術 顱內壓視置入 1 2 R 摘要__ 手術科部: 外科部 套用罐頭: CVA 開立醫師: 蔡翊新 開立時間: 2011/07/30 02:24 Pre-operative Diagnosis Head injury with right cerebellar ICH, IVH and acute hydrocephalus. Post-operative Diagnosis Head injury with right cerebellar ICH, IVH and acute hydrocephalus. Operative Method Suboccipital craniectomy for ICH evacuation, right Frazier point EVD for ICP monitoring. Specimen Count And Types nil Pathology Nil. Operative Findings CSF: bloody, pressure: higher than 30 cmH2O. The dura was tense after craniectomy. The brain bulged out after dural opening. About 15 ml ICH was evacuated from right cerebellar hemisphere. The cerebellum became slack after ICH evacuation. There was easy touch bleeding at brain tissue. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: prone position with head fixed by a Mayfield skull clamp. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. A burr hole was made at right Frazier point for EVD insertion for ICP monitoring. 5. Incision: linear, from 2 cm above inion downward to C3 spinous process. 6. Suboccipital craniectomy was performed by air drill and Rongeurs. 7. Dural incision: V-shaped, reflected superiorly toward Inion 8. A 1 cm cortical incision was made at right cerebellar hemisphere. The subcortex and white mater was splitted by bipolar coagulator and sucker until the intracerebral hematoma was exposed. The hematoma was sucked out carefully. The cavity was irrigated with NS and the blood oozing was stopped by Surgicel packing. Before closure of the dura, the hematoma caivty was clean and the brain once bulging was very slack. 9. Dural closure: A piece of Duroform was used for duroplasty because the dura was severely tored during craniectomy. 10.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 11.Drain: one epidural CWV. 12.Blood transfusion: nil. Operators VS蔡翊新 Assistants R5曾峰毅R1范姜鈞 Indication Of Emergent Operation Cerebellar ICH, IVH with acute hydrocephalus and brainstem compression. 相關圖片 張勝雄 (M,1941/02/19,71y0m) 手術日期 2011/07/29 手術主治醫師 楊宗霖 手術區域 西址 032房 01號 診斷 Aspiration pneumonia 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 蔡奉芳 ASA 3 紀錄醫師 曾家承, 時間資訊 08:40 進入手術室 08:45 麻醉開始 08:50 誘導結束 08:52 手術開始 09:45 10:10 麻醉結束 10:10 手術結束 10:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 氣管切開術 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 內科部 套用罐頭: Tracheostomy 開立醫師: 曾家承 開立時間: 2011/07/30 12:14 Pre-operative Diagnosis prolonged intubation Post-operative Diagnosis prolonged intubation,operated Operative Method Tracheostomy Specimen Count And Types nil Pathology Nil Operative Findings A No.6 shiley tube cuffed tracheostomy tube was inserted Operative Procedures (1)The patient was in supine position with neck hyperextended. (2)Skin was disinfected and draped as usual. Local anesthesia with Bosmin-rinsed Xylocaine was injected into the subcutaneous tissue and the pretracheal area. (3)A vertical skin incision was made in the midline of lower neck. (4)Subcutaneous tissue, fascia and strap muscles were seperated, then the thyroid gland was seen and hooked upwards with thyroid hooks. (5)The tracheal rings were cut in longitudinal direction. A oval-shaped window was made at the 2 nd to 3 rd tracheal rings. (6)A No.6 shiley tube cuffed tracheostomy tube was inserted. (7)The patient tolerated the above procedure well. Operators 楊宗霖, Assistants 曾家承, 許軍偉, 陳世雄 (M,1960/07/23,51y7m) 手術日期 2011/07/30 手術主治醫師 陳敞牧 手術區域 東址 005房 01號 診斷 spinal cord injury 器械術式 C-laminoplasty, C4-7 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 2 紀錄醫師 曾峰毅, 時間資訊 00:00 臨時手術NPO 07:48 報到 08:05 進入手術室 08:15 麻醉開始 08:20 誘導結束 08:30 抗生素給藥 09:13 手術開始 10:50 手術結束 10:50 麻醉結束 11:05 送出病患 11:10 進入恢復室 12:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 椎弓整形術 1 1 摘要__ 手術科部: 外科部 套用罐頭: Laminoplasty 開立醫師: 曾峰毅 開立時間: 2011/07/30 11:00 Pre-operative Diagnosis Cervical stenosis Post-operative Diagnosis Cervical stenosis Operative Method Laminoplasty, Hirobayashi method, C4 to C6 Specimen Count And Types Nil Pathology Nil Operative Findings Thecal sac was decompressed well after laminoplasty. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position with head fixed with Mayfield head clamp. The scalp was shaved, scrubbed, disinfected, and then draped as ususal . We made one midline skin incision to expose bilateral laminae from C3 to C7. We performed laminoplasty from C4 to C6, hinge at right with miniplates. The wound was closed in layers after one submuscular CWV. Operators VS 陳敞牧 Assistants R5 曾峰毅 Ri 簡 相關圖片 SAE CHIAO SUPHAPHON (F,1969/01/01,43y2m) 手術日期 2011/07/30 手術主治醫師 楊士弘 手術區域 東址 003房 02號 診斷 Tuberculosis meningitis 器械術式 EVD changed to V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 2 紀錄醫師 許皓淳, 時間資訊 00:00 臨時手術NPO 09:40 報到 09:45 進入手術室 09:50 麻醉開始 09:55 誘導結束 10:46 手術開始 11:00 抗生素給藥 11:43 麻醉結束 11:43 手術結束 11:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦脊髓液分流管重置 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Ventriculo-peritoneal shunt implantation via ... 開立醫師: 李振豪 開立時間: 2011/07/30 12:05 Pre-operative Diagnosis TB meningitis with hydrocephalus Post-operative Diagnosis TB meningitis with hydrocephalus Operative Method Ventriculo-peritoneal shunt implantation via right Kocher"s point Specimen Count And Types 1 piece About size:6ml Source:CSF Pathology Nil Operative Findings The CSF is clear in character and total 6ml CSF was sampled for routine, BCS, and bacterial culture. Active bleeding was noted after insertion of ventricular catheter. The reservoir was obstructed by the blood clot. After hemostasis, the nelaton catheter was placed into right lateral ventricle again and light reddish CSF was noted. Bleeding from subdural space was suspected. The new Metronid fixed high pressure reservoir was used and the ventricular catheter was inserted into right lateral ventricle again. The function of the shunt was checked again and much satisficated this time. The ventricular and peritoneal catheter was 6 and 25cm in length. The CSF is clear in character and total 6ml CSF was sampled for routine, BCS, and bacterial culture. Active bleeding was noted after insertion of ventricular catheter. The reservoir was obstructed by the blood clot. After hemostasis, the nelaton catheter was placed into right lateral ventricle again and light reddish CSF was noted. Bleeding from subdural space was suspected. The new Metronid fixed high pressure reservoir was used and the ventricular catheter was inserted into right lateral ventricle again. The function of the shunt was checked again and much satisficated this time. The ventricular and peritoneal catheter was 6 and 25cm in length. Mild adhesion over lower abdomen was noted during placement of peritoneal catheter. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head rotated to left. The scalp and skin were shaved, scrubbed, and disinfected as usual. Right frontal scalp and right upper abdomen skin incision were made along operative scar. The scalp flap was elevated and previous burr hole were identified. Nelaton catheter was inserted into right lateral ventricle for CSF sampling. Minilaparotomy was performed to enter peritoneal cavity. Subcutaneous tunnel from right upper abdomen, chest, right neck, to right retroauricular area was created and the peritoneal catheter was passed through the subcutaneous tunnel. The ventricular catheter, reservoir, and peritoneal catheter was connected. The ventricular catheter was placed into right lateral ventricle. Poor recoiling of the reservoir was noted initially followed by active bleeding. The reservoir and ventricular catheter were removed and hemostasis was performed with bipolar electrocautery. New reservoir was used due to blood clot within the old one. The ventricular catheter was inserted again and the function of the V-P shunt was checked. Peritoneal catheter was placed into peritoneal cavity under direct vision. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS楊士弘 Assistants R5李振豪, R2許皓淳 相關圖片 摘要__ 手術科部: 外科部 套用罐頭: Ventriculo-peritoneal shunt implantation via ... 開立醫師: 李振豪 開立時間: 2011/07/30 12:09 Pre-operative Diagnosis TB meningitis with hydrocephalus Post-operative Diagnosis TB meningitis with hydrocephalus Operative Method Ventriculo-peritoneal shunt implantation via right Kocher"s point Specimen Count And Types 1 piece About size:6ml Source:CSF Pathology Nil Operative Findings The CSF is clear in character and total 6ml CSF was sampled for routine, BCS, and bacterial culture. Active bleeding was noted after insertion of ventricular catheter. The reservoir was obstructed by the blood clot. After hemostasis, the nelaton catheter was placed into right lateral ventricle again and light reddish CSF was noted. Bleeding from subdural space was suspected. The new Metronid fixed high pressure reservoir was used and the ventricular catheter was inserted into right lateral ventricle again. The function of the shunt was checked again and much satisficated this time. The ventricular and peritoneal catheter was 6 and 25cm in length. Mild adhesion over lower abdomen was noted during placement of peritoneal catheter. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head rotated to left. The scalp and skin were shaved, scrubbed, and disinfected as usual. Right frontal scalp and right upper abdomen skin incision were made along operative scar. The scalp flap was elevated and previous burr hole were identified. Nelaton catheter was inserted into right lateral ventricle for CSF sampling. Minilaparotomy was performed to enter peritoneal cavity. Subcutaneous tunnel from right upper abdomen, chest, right neck, to right retroauricular area was created and the peritoneal catheter was passed through the subcutaneous tunnel. The ventricular catheter, reservoir, and peritoneal catheter was connected. The ventricular catheter was placed into right lateral ventricle. Poor recoiling of the reservoir was noted initially followed by active bleeding. The reservoir and ventricular catheter were removed and hemostasis was performed with bipolar electrocautery. New reservoir was used due to blood clot within the old one. The ventricular catheter was inserted again and the function of the V-P shunt was checked. Peritoneal catheter was placed into peritoneal cavity under direct vision. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS楊士弘 Assistants R5李振豪, R2許皓淳 相關圖片 蔡世豪 (M,1974/06/26,37y8m) 手術日期 2011/07/30 手術主治醫師 楊士弘 手術區域 東址 003房 01號 診斷 Acute myeloid leukemia 器械術式 Ommaya reservoir implantation 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 2 紀錄醫師 許皓淳, 時間資訊 23:16 臨時手術NPO 07:40 報到 08:05 進入手術室 08:10 麻醉開始 08:20 誘導結束 08:23 抗生素給藥 08:45 手術開始 09:25 手術結束 09:25 麻醉結束 09:30 送出病患 09:33 進入恢復室 12:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 歐氏貯囊置放手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 內科部 套用罐頭: Ommaya reservoir implantation via right Koche... 開立醫師: 李振豪 開立時間: 2011/07/30 09:22 Pre-operative Diagnosis Acute myeloid leukemia Post-operative Diagnosis Acute myeloid leukemia Operative Method Ommaya reservoir implantation via right Kocher"s point Specimen Count And Types 1 piece About size:3ml Source:CSF Pathology Nil Operative Findings The CSF is clear in character. Total 3ml CSF was sampled for routine, BCS, and bacterial culture. The ventricular catheter was 6.5cm in length. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position. The scalp was shaved, scrubbed, and disinfected as usual. One C shape scalp incision was made at right frontal area followed by one burr hole creation. Two dural tenting was done. Cruciform dural opening was performed and ventriculostomy with puncture needle was conducted. The Ommaya reservoir was inserted into right lateral ventricle and fixed with three stitches. Hemostasis was achieved and the wound was closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS楊士弘 Assistants R5李振豪, R2許皓淳 相關圖片 記錄__ 手術科部: 內科部 套用罐頭: Ommaya reservoir implantation via right Koche... 開立醫師: 李振豪 開立時間: 2011/07/30 09:22 Pre-operative Diagnosis Acute myeloid leukemia Post-operative Diagnosis Acute myeloid leukemia Operative Method Ommaya reservoir implantation via right Kocher"s point Specimen Count And Types 1 piece About size:3ml Source:CSF Pathology Nil Operative Findings The CSF is clear in character. Total 3ml CSF was sampled for routine, BCS, and bacterial culture. The ventricular catheter was 6.5cm in length. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position. The scalp was shaved, scrubbed, and disinfected as usual. One C shape scalp incision was made at right frontal area followed by one burr hole creation. Two dural tenting was done. Cruciform dural opening was performed and ventriculostomy with puncture needle was conducted. The Ommaya reservoir was inserted into right lateral ventricle and fixed with three stitches. Hemostasis was achieved and the wound was closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS楊士弘 Assistants R5李振豪, R2許皓淳 相關圖片 羅月娟 (F,1948/02/08,64y1m) 手術日期 2011/07/30 手術主治醫師 楊士弘 手術區域 東址 003房 03號 診斷 Tuberculosis meningitis 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 2 紀錄醫師 許皓淳, 時間資訊 00:00 臨時手術NPO 12:05 進入手術室 12:10 麻醉開始 12:15 誘導結束 12:25 抗生素給藥 12:49 手術開始 13:40 手術結束 13:40 麻醉結束 13:45 送出病患 13:50 進入恢復室 15:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室腹腔分流手術 1 1 R 摘要__ 手術科部: 內科部 套用罐頭: Ventriculo-peritoneal shunt implantation via ... 開立醫師: 許皓淳 開立時間: 2011/07/30 14:07 Pre-operative Diagnosis Tuberculosis meningitis with hydrocephalus Post-operative Diagnosis Tuberculosis meningitis with hydrocephalus Operative Method Ventriculo-peritoneal shunt implantation via left Kocher"s point Specimen Count And Types 3 pieces About size:小 Source:CSF About size:小 Source:CSF About size:小 Source:CSF Pathology Nil Operative Findings The CSF is clear in character and total 6ml CSF was sampled for routine, BCS, and bacterial culture. The function of the shunt was checked. The ventricular and peritoneal catheter was 6 and 25cm in length. The CSF is clear in character and total 6ml CSF was sampled for routine, BCS, and bacterial culture. The function of the shunt was checked. The ventricular and peritoneal catheter was 6 and 25cm in length. The pressure of VP shunt is 100mmH2O. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head rotated to right. The scalp and skin were shaved, scrubbed, and disinfected as usual. Left frontal scalp and left upper abdomen skin incision were made along operative scar. The scalp flap was elevated and a burr hole was created. Minilaparotomy was performed to enter peritoneal cavity. Subcutaneous tunnel from left upper abdomen, chest, left neck, to left retroauricular area was created and the peritoneal catheter was passed through the subcutaneous tunnel. The ventricular catheter, reservoir, and peritoneal catheter was connected. The ventricular catheter was placed into left lateral ventricle. The function of the V-P shunt was checked. Peritoneal catheter was placed into peritoneal cavity under direct vision. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators 楊士弘 Assistants 李振豪, 許皓淳 相關圖片 陳國棟 (M,1950/11/29,61y3m) 手術日期 2011/07/30 手術主治醫師 楊榮森 手術區域 東址 020房 02號 診斷 Lung cancer 器械術式 Hemi..Bipolar 手術類別 緊急手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 蕭柏妮 ASA 3E 紀錄醫師 范垂嘉, 時間資訊 23:44 臨時手術NPO 23:44 開始NPO 09:12 報到 09:30 進入手術室 09:35 麻醉開始 09:40 誘導結束 09:50 抗生素給藥 10:02 手術開始 10:30 開始輸血 11:05 手術結束 11:05 麻醉結束 11:13 送出病患 11:20 進入恢復室 12:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 部份關節置換術併整形術–只置換髖臼或股骨或半股關節或半肩關節 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 骨科部 套用罐頭: Bipolar hemiarthroplasty with United prothesi... 開立醫師: 范垂嘉 開立時間: 2011/07/30 11:01 Pre-operative Diagnosis 1.Non-small cell lung cancer 2.Left femoral neck fracture, Garden IV 2.Left femoral neck fracture, Garden IV, suspected pathologic Post-operative Diagnosis 1.Non-small cell lung cancer 2.Left femoral neck fracture, Garden IV 2.Left femoral neck fracture, Garden IV, suspected pathologic Operative Method Bipolar hemiarthroplasty with United prothesis, left Specimen Count And Types Pieces of the proximal femoral bone for pathology Pathology Pieces of the proximal femoral bone and the femoral head Operative Findings 1.Left femoral neck fracture, displaced 2.Hemarthrosis 3.No marked bony destruction or fleshy tumor 4.United protheses- stem:11mm/#4, head:26/+0mm, cup:54mm Operative Procedures 1.SA, right decubitus 2.Prep and drape 3.Lateral longitudinal incision, posterior approach to the hip 4.Retrieve the femoral head, saw the neck 5.Ream and broach the proximal femur 6.Apply the stem with cementless technique 7.Assemble the head and cup to the stem 8.Reduce the hip, repair the capsule 9.Close the wound over an 1/8" Hemovac Operators 楊榮森 Assistants 陳志偉,范垂嘉,張書豪 Indication Of Emergent Operation severe pain 記錄__ 手術科部: 骨科部 套用罐頭: Bipolar hemiarthroplasty with United prothesi... 開立醫師: 范垂嘉 開立時間: 2011/07/30 11:22 Pre-operative Diagnosis 1.Non-small cell lung cancer 2.Left femoral neck fracture, Garden IV, suspected pathologic Post-operative Diagnosis 1.Non-small cell lung cancer 2.Left femoral neck fracture, Garden IV, suspected pathologic Operative Method Bipolar hemiarthroplasty with United prothesis, left Specimen Count And Types Pieces of the proximal femoral bone for pathology Pathology Pieces of the proximal femoral bone and the femoral head Operative Findings 1.Left femoral neck fracture, displaced 2.Hemarthrosis 3.No marked bony destruction or fleshy tumor 4.United protheses- stem:11mm/#4, head:26/+0mm, cup:54mm Operative Procedures 1.SA, right decubitus 2.Prep and drape 3.Lateral longitudinal incision, posterior approach to the hip 4.Retrieve the femoral head, saw the neck 5.Ream and broach the proximal femur 6.Apply the stem with cementless technique 7.Assemble the head and cup to the stem 8.Reduce the hip, repair the capsule 9.Close the wound over an 1/8" Hemovac Operators 楊榮森 Assistants 陳志偉,范垂嘉,張書豪 Indication Of Emergent Operation severe pain 黃思菁 (F,1989/08/17,22y6m) 手術日期 2011/07/31 手術主治醫師 蔡翊新 手術區域 東址 001房 01號 診斷 Subdural hemorrhage following injury, with loss of consciousness of unspecified duration 器械術式 craniectomy right side 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 3E 紀錄醫師 許皓淳, 時間資訊 23:10 開始NPO 23:49 通知急診手術 00:30 進入手術室 00:35 麻醉開始 00:40 誘導結束 00:40 抗生素給藥 00:48 手術開始 03:10 手術結束 03:10 麻醉結束 03:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 頭皮腫瘤 1 4 L 手術 急性硬腦膜下血腫清除術 1 1 R 手術 顱內壓視置入 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 蔡翊新 開立時間: 2011/07/31 02:49 Pre-operative Diagnosis Head injury with right frontotemporoparietal acute SDH and brain swelling. Left occipital scalp laceration. Post-operative Diagnosis Head injury with right frontotemporoparietal acute SDH and brain swelling. Left occipital scalp laceration. Operative Method Right frontotemporoparietal craniectomy for SDH removal and intraparenchymal ICP monitoring. Suture of left occipital scalp laceration. Specimen Count And Types nil Pathology Nil. Operative Findings A 3 cm scalp laceration with active bleeding was noted at left occipital area. Tense dura was noted after craniectomy. Upon dural opening via first burr hole, SDH gushed out rapidly. Initial ICP was estimated more than 25 mmHg, but the measured value was 5 mmHg. A 0.8 cm layer of blood clot was noted at right F-T-P area. Contusion of right frontal and temporal lobes was noted, at both sides of right Sylvian fissure. There was extensive traumatic SAH at right frontotemporal lobes and brain swelling was marked. The right temporalis muscle was excised to prevent postop epidural compression. ICP after skin closure was 13 mmHg. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right and suture of left occipital wound was performed. Then, the head was turned to left. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: right frontotemporoparietal as a trauma flap. The skin edge was clipped by Raney clips for temporary hemostasis. The temporalis muscles was incised down to the tempoal squama. The incision was extended to a temporal horseshoe, and the temporalis muscle was detached from temporal squama by rasp subsequently. 5. Craniotomy window: 14 x 12 cm, right F-T-P, created by making 4 burr holes then cut by power saw. 6. Dural tenting: by 2/0 silk, 2-cm in interval, distributed along the edge of skull window. 7. Dural incision: curvilinear along the edge of skull window. 8. The subdural clot was removed by sucker. 9. Hemosatasis: the bleeders was stopped by Bovie and oozing surface was covered with gelfoam and Surgicel. 10.Dural closure: was closed with a piece of dural graft taking from temporalis fascia, crescent shape 12 cm long, 1.5 cm wide along the whole length of the dural incision in order to create an additional space for the swollen brain. 11.The skull plate was removed and stored at bone bank for preservation. 12.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 13.Drain: two epidural CWV. 14.Blood transfusion: nil. Blood loss: 650 ml. 15.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5李振豪R2許皓淳 Indication Of Emergent Operation IICP, pupil dilatation due to uncal herniation. 相關圖片 李欣瑩 (F,1990/12/27,21y2m) 手術日期 2011/08/01 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Brain Tumor 器械術式 Left frontal craniotomy for tumor excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 1 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 08:00 進入手術室 08:10 麻醉開始 08:40 抗生素給藥 08:45 誘導結束 08:50 手術開始 11:40 抗生素給藥 14:30 手術結束 14:30 麻醉結束 14:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4~8小時 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: left frontal craniotomy for tumor excision 開立醫師: 李振豪 開立時間: 2011/08/01 14:45 Pre-operative Diagnosis Left frontal tumor, suspect low grade glioma Post-operative Diagnosis Left frontal tumor, suspect low grade glioma Operative Method left frontal craniotomy for tumor excision Specimen Count And Types 1 piece About size:Multiple small pieces Source:Left frontal tumor Pathology Pending Operative Findings The tumor was 6 x 5 x 5.5cm in size with large cystic portion. The content of cystic part was CSF-like with light xanthochromic in appearance. The solid part of the tumor was grayish, gelatinous, fragile, hypervascularized, and ill-defined in character. The location of solid part was mainly located at anteriomedial and posteriolateral of the tumor. Total removal of the tumor was not feasible due to extension into corpus callosum and basal ganglion. No obvious EP change was noted during the operation. The ventricle was not entered during tumor resection. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. bicoronal scalp incision was made and the scalp flap was elevated. Three burr hole were created followed by one 9 x 9 cm craniotomy window. Dural tenting was performed. Intra-operative sonography was used for localization of the tumor. C-shape durotomy based with superior sagittal sinus was used. One 2 x 1cm corticotomy was performed and the tumor was removed by suction, tumor forceps, and bipolar electrocautery. The cystic portion was drained off. Hemostasis was achieved with bipolar electrocautery and Surgicel lining. Duroplasty with periosteum and 4-0 Prolene was done. The skull plate was fixed back with miniplates, screws, and two central tenting. The wound was then closed in layers with 2-0 vicryl and 3-0 Nylon. Operators Prof. 杜永光 Assistants R5李振豪, R3曾偉倫 相關圖片 林福雄 (M,1954/04/17,57y10m) 手術日期 2011/08/01 手術主治醫師 杜永光 手術區域 東址 003房 02號 診斷 Subdural and cerebral hemorrhage 器械術式 Left trepination for drainage of CSDH 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 14:50 進入手術室 14:55 麻醉開始 15:10 誘導結束 15:20 抗生素給藥 15:30 手術開始 17:30 手術結束 17:30 麻醉結束 17:35 送出病患 17:50 進入恢復室 18:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 記錄__ 手術科部: 外科部 套用罐頭: Trephination for subdural hematoma evacuation 開立醫師: 李振豪 開立時間: 2011/08/01 17:46 Pre-operative Diagnosis Chronic subdural hematoma, left fronto-temporo-parietal Post-operative Diagnosis Subacute and chronic subdural hematoma, left fronto-temporo-parietal Operative Method Trephination for subdural hematoma evacuation Specimen Count And Types nil Pathology Nil Operative Findings Subacute and chronic subdural hematoma with multiple septation was noted. The septation were all opened. The outer and inner membrane were noted during hematoma evacuation. No active bleeder noted during the operation. The pulsatile of brain parenchyma was fair but the brain remain slack after hematoma evacuation. The inner membrane was kept intact during whole procedure. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head rotated to right. The scalp was shaved, scrubbed, and disinfected as usual. Linear scalp incision was made at left fronto-temporal area and the temporalis muscle was splitted. One burr hole was created followed by one 3x3cm trephination window. Dural tenting was done. C-shape durotomy was performed and the outer membrane was left intact. The outer membrane was coagulated and opened for subdural hematoma evacuation. The septation was all opened and the subdural space was irrigated with normal saline. The dura was closed with 4-0 Prolene with one subdural rubber drain. The skull plate was fixed back with miniplates and screws. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators Prof.杜永光 Assistants R5李振豪, R3曾偉倫 相關圖片 柯智惠 (F,1940/05/18,71y9m) 手術日期 2011/08/01 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Glioma 器械術式 right frontal craniotomy for tumor excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:00 進入手術室 08:05 麻醉開始 08:30 誘導結束 08:58 抗生素給藥 09:00 手術開始 11:58 抗生素給藥 13:05 麻醉結束 13:05 手術結束 13:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Right F-P craniotomy with tumor excision 開立醫師: 林哲光 開立時間: 2011/08/01 13:41 Pre-operative Diagnosis Right motor cortex brain tumor, suspected metastasis Post-operative Diagnosis Right motor cortex brain tumor, high grade glioma Operative Method Right F-P craniotomy with tumor excision Specimen Count And Types 1 piece About size:multiple pieces Source:Tumor Pathology Frozen biopsy showed glioma, suspected anaplastic astrocytoma Operative Findings Echo localization for tumor was performed and showed no obvious heterogenous echogenicity. The motor cortex mapping was performed intraoperatively. The tumor was yellowish, not well-demarcated, soft-elastic mass lesion with moderate vascularity. Operative Procedures Under ETGA and supine position with head mild rotated to left side and fixed with Mayfield head clamp, skin disinfected and drapped were performed as usual. A C-shaped skin incision was made and the craniotomy was done after four burr holes were created. The dura was then opened after echo localization and dural tenting. Corticotomy was done at the gyrus anterior and posterior to the motor cortex which was identified with motor cortex mapping. Tumor excision was then done. Hemostasis wtih Surgecells was performed. The skull bone was then put back and fixed with miniplates. The wound was then closed in layers after central tenting and subgaleal drain CWV drain insertion. Operators 曾漢民 Assistants R5 林哲光, R1 蕭智楊, Ri 林千又 相關圖片 謝王秋香 (F,1931/11/05,80y4m) 手術日期 2011/08/01 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Lung cancer, non-small cell 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 12:58 報到 13:22 進入手術室 13:25 麻醉開始 13:35 抗生素給藥 13:39 誘導結束 13:40 手術開始 16:35 抗生素給藥 17:10 麻醉結束 17:10 手術結束 17:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除-手術時間在4小時以內 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Right F-P craniotomy for total tumor excision 開立醫師: 林哲光 開立時間: 2011/08/01 18:26 Pre-operative Diagnosis Right parietal lobe (sensory cortex) metastatic brain tumor Post-operative Diagnosis Right parietal lobe (sensory cortex) metastatic brain tumor Operative Method Right F-P craniotomy for total tumor excision Specimen Count And Types 1 piece About size:multiple pieces Source:tumor Pathology Frozen biopsy showed adenocarcinoma Operative Findings Motor cortex mapping was done for sensory cortex idenification. The tumor was grayish-yellowish, well demarcated, soft-elastic mass lesion with moderate hypervascularity at right sensory cortex. Sudden onset of hypotension was noted when skin closure and it had good response to Ephedrine 12mg IV push. Postoperative bilateral iscoric small fixed pupils were noted. Operative Procedures Under ETGA and supine position with head rotated to left side and fixed with Mayfield head clamp, skin disinfected and drapped were performed as usual. A C-shaped skin incision was made at right F-P area and craniotomy was done after four burr holes were created. The dura was then opened after echo localization and dural tenting. Intraoperative motor cortex mapping was done and corticotomy was done at a gyrus behind the motor cortex. Tumor excision was then performed. Hemostasis with surgecells packing was done and the dura was closed in water-tie method with autologus fascia augmentation. The wound was then closed in layers after skull bone was put back and fixed with mini-plates and a subgaleal CWV drain was inserted. Operators 曾漢民 Assistants R5 林哲光, R1 蕭智陽, Ri 林千又 相關圖片 許輝鴻 (M,1960/10/17,51y4m) 手術日期 2011/08/01 手術主治醫師 王碩盟 手術區域 西址 039房 04號 診斷 Hematuria 器械術式 Retrograde pyelography (single 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 13:26 進入手術室 13:28 麻醉開始 13:32 誘導結束 13:35 手術開始 13:40 手術結束 13:40 麻醉結束 13:42 送出病患 溫昭智 (M,1935/01/06,77y2m) 手術日期 2011/08/01 手術主治醫師 王國川 手術區域 東址 019房 02號 診斷 Cerebrovascular accident 器械術式 Burr hole (trephination) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 4E 紀錄醫師 陳國瑋, 時間資訊 06:30 開始NPO 09:58 通知急診手術 11:45 報到 12:10 進入手術室 12:15 麻醉開始 12:20 抗生素給藥 12:20 誘導結束 12:55 手術開始 13:45 手術結束 13:45 麻醉結束 13:50 送出病患 13:55 進入恢復室 14:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Chronic Subdural Hematoma 開立醫師: 曾峰毅 開立時間: 2011/08/01 13:31 Pre-operative Diagnosis Chronic subdural hematoma, at left Post-operative Diagnosis Chronic subdural hematoma, at left Operative Method Left frontal burr hole for subdural drain Specimen Count And Types Nil Pathology Nil Operative Findings Dark-reddish non-coagulated blood was drained after durotomy. There was outer and inner membrane. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine positin. After scalp shaved, scrubbed, disinfected, and then draped, we made one transverse skin incision at left frontal area. We drilled one burr hole, and created durotomy. We inserted subdural rubber drain, and irrigated subdural space. The wound was closed in layers, and subdural was de-air-ed. Operators VS 王國川 Assistants R5 曾峰毅 R3 陳國瑋 R0 王怡人 Indication Of Emergent Operation IICP 相關圖片 摘要__ 手術科部: 外科部 套用罐頭: Left frontal burr hole for subdural drain 開立醫師: 曾峰毅 開立時間: 2011/08/01 14:04 Pre-operative Diagnosis Chronic subdural hematoma, at left Post-operative Diagnosis Chronic subdural hematoma, at left Operative Method Left frontal burr hole for subdural drain Specimen Count And Types Nil Pathology Nil Operative Findings Dark-reddish non-coagulated blood was drained after durotomy. There was outer and inner membrane. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine positin. After scalp shaved, scrubbed, disinfected, and then draped, we made one transverse skin incision at left frontal area. We drilled one burr hole, and created durotomy. We inserted subdural rubber drain, and irrigated subdural space. The wound was closed in layers, and subdural was de-air-ed. Operators VS 王國川 Assistants R5 曾峰毅 R3 陳國瑋 R0 王怡人 Indication Of Emergent Operation IICP 相關圖片 鄒沁彤 (F,2010/12/02,1y3m) 手術日期 2011/08/02 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Psychomotor retardation 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 石博元 ASA 3 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:00 進入手術室 08:10 麻醉開始 08:20 誘導結束 09:36 手術開始 10:35 麻醉結束 10:35 手術結束 10:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 腦室腹腔分流手術 1 1 L 摘要__ 手術科部: 套用罐頭: Ventriculoperitoneal shunt insertion via left... 開立醫師: 王奐之 開立時間: 2011/08/02 10:59 Pre-operative Diagnosis Right side atypical choroid plexus papilloma with severe hydrocephalus Post-operative Diagnosis Right side atypical choroid plexus papilloma with severe hydrocephalus Operative Method Ventriculoperitoneal shunt insertion via left Kocher point Specimen Count And Types 1 piece About size:6ml Source:CSF Pathology Nil Operative Findings Opening pressure: about 10~15 cmH2O. Ventricular catheter length: 6.2cm. Peritoneal catheter length: 35cm. A Codman programmable valve (burr hole type) was used, preset to 130 mmH2O. Clear CSF was collected, and sent for routine, BCS, cytology & bacterial culture. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to right. After shaving, scrubbing, disinfection & draping in sterile fashion, a curved incision was made at left frontal area. A burr hole was created at left Kocher point with rongeur. Another linear incision was made at left upper quadrant of abdomen, followed by mini-laparotomy. A subcutaneous tunnel was then created from abdominal wound to retroauricular area. Anpther subcutaneous tunnel was created from the left frontal wound to retroauricular area, the catheters were then assembled and passed throught the subcutaneous tunnels. A small cruciate durotomy was performed. Ventricular puncture was done, followed by insertion of ventricular catheter. After confirmation of smooth CSF flow, the peritoneal catheter was also inserted. The wounds were closed in layers after hemostasis. Operators AP 郭夢菲 Assistants R4 王奐之, Ri 陳滄堯 相關圖片 記錄__ 手術科部: 套用罐頭: Ventriculoperitoneal shunt insertion via left... 開立醫師: 王奐之 開立時間: 2011/08/02 10:59 Pre-operative Diagnosis Right side atypical choroid plexus papilloma with severe hydrocephalus Post-operative Diagnosis Right side atypical choroid plexus papilloma with severe hydrocephalus Operative Method Ventriculoperitoneal shunt insertion via left Kocher point Specimen Count And Types 1 piece About size:6ml Source:CSF Pathology Nil Operative Findings Opening pressure: about 10~15 cmH2O. Ventricular catheter length: 6.2cm. Peritoneal catheter length: 35cm. A Codman programmable valve (burr hole type) was used, preset to 130 mmH2O. Clear CSF was collected, and sent for routine, BCS, cytology & bacterial culture. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to right. After shaving, scrubbing, disinfection & draping in sterile fashion, a curved incision was made at left frontal area. A burr hole was created at left Kocher point with rongeur. Another linear incision was made at left upper quadrant of abdomen, followed by mini-laparotomy. A subcutaneous tunnel was then created from abdominal wound to retroauricular area. Anpther subcutaneous tunnel was created from the left frontal wound to retroauricular area, the catheters were then assembled and passed throught the subcutaneous tunnels. A small cruciate durotomy was performed. Ventricular puncture was done, followed by insertion of ventricular catheter. After confirmation of smooth CSF flow, the peritoneal catheter was also inserted. The wounds were closed in layers after hemostasis. Operators AP 郭夢菲 Assistants R4 王奐之, Ri 陳滄堯 相關圖片 咼承安 (M,2010/08/04,1y7m) 手術日期 2011/08/02 手術主治醫師 郭夢菲 手術區域 兒醫 067房 02號 診斷 Craniosynostosis 器械術式 Cranial reconstruction 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 石博元 ASA 3 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 10:36 報到 11:00 進入手術室 11:05 麻醉開始 11:40 誘導結束 12:00 抗生素給藥 12:24 手術開始 13:10 開始輸血 15:00 抗生素給藥 17:55 麻醉結束 17:55 手術結束 18:10 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 3 0 麻醉 Hemoglobin (Hb) 3 0 麻醉 測血糖 3 0 麻醉 Ca (Calcium) 3 0 麻醉 Na (Sodium) 3 0 麻醉 K (Potassium) 3 0 麻醉 Blood gas analysis 3 0 手術 頭顱成形術 1 2 手術 顱骨切除術,包括異物移除或壓或經切斷 1 1 摘要__ 手術科部: 外科部 套用罐頭: Cranial reconstruction 開立醫師: 王奐之 開立時間: 2011/08/02 19:00 Pre-operative Diagnosis Scaphocephaly Post-operative Diagnosis Scaphocephaly Operative Method Cranial reconstruction Specimen Count And Types Nil Pathology Nil Operative Findings An acute angle was noted at forehead skull, and flattening of forehead curve was resulted after cranial reconstruction. Most of the bone flaps were fixed in floating fashion except for the 2 forehead flaps (which were fixed with micro-plates in rigid fashion). Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head put on a horseshoe rest. After shaving, scrubbing, disinfection & draping in sterile fashion, a bicoronal curvilinear incision was made. After dissection and reflecting the periosteum inferiorly, 5 burr holes were created each side, followed by craniectomy, 3 pieces of skull were removed. Cranial reconstruction were then performed by placing back the skull and fixing them with micro-plates & Vicryl sutures. After approximation of periosteum and insertion of a subgaleal CWV drain, the wound was closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Cranial reconstruction 開立醫師: 王奐之 開立時間: 2011/08/02 19:00 Pre-operative Diagnosis Scaphocephaly Post-operative Diagnosis Scaphocephaly Operative Method Cranial reconstruction Specimen Count And Types Nil Pathology Nil Operative Findings An acute angle was noted at forehead skull, and flattening of forehead curve was resulted after cranial reconstruction. Most of the bone flaps were fixed in floating fashion except for the 2 forehead flaps (which were fixed with micro-plates in rigid fashion). Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head put on a horseshoe rest. After shaving, scrubbing, disinfection & draping in sterile fashion, a bicoronal curvilinear incision was made. After dissection and reflecting the periosteum inferiorly, 5 burr holes were created each side, followed by craniectomy, 3 pieces of skull were removed. Cranial reconstruction were then performed by placing back the skull and fixing them with micro-plates & Vicryl sutures. After approximation of periosteum and insertion of a subgaleal CWV drain, the wound was closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Anterior cranial reconstruction 開立醫師: 郭夢菲 開立時間: 2011/08/04 09:41 Pre-operative Diagnosis Scaphocephaly Post-operative Diagnosis Scaphocephaly Operative Method Anterior cranial reconstruction Specimen Count And Types Nil Pathology Nil Operative Findings 1.Severe frontal bossing caused acute angles forehead. Flattening of forehead curve was resulted after cranial reconstruction with the bone posterior to the coronal suture. 2.Most of the bone flaps were fixed in floating fashion except for the 2 forehead flaps (which were fixed with micro-plates in rigid fashion). Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head put on a horseshoe rest. After shaving, scrubbing, disinfection & draping in sterile fashion, a bicoronal curvilinear incision was made. After dissection and reflecting the periosteum inferiorly, 5 burr holes were created each side at keyholes, and 1.2 cm beside the sagittal suture, followed by craniectomy, 3 pieces of skull of frontal and biparietal bones were removed. The forehead was reconstructed with the bone posterior to the coronal suture and fixed wiht microplated at the bilateral pterional regions and midline, then the other defects was reconstructed with the remnant of the bone plate to make the previously indentation over the coronal suture corrected. The bone plates were fixed back floatingly with Vicryl sutures. After approximation of periosteum and insertion of a subgaleal CWV drain, the wound was closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之 相關圖片 林承輝 (M,1965/12/12,46y3m) 手術日期 2011/08/02 手術主治醫師 賴達明 手術區域 東址 003房 03號 診斷 HIVD 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 周聖哲, 時間資訊 23:01 臨時手術NPO 15:50 進入手術室 15:55 麻醉開始 16:00 誘導結束 16:00 抗生素給藥 16:20 手術開始 18:00 手術結束 18:00 麻醉結束 18:10 送出病患 18:12 進入恢復室 19:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 椎間盤切除術-腰椎 1 1 摘要__ 手術科部: 外科部 套用罐頭: HIVD 開立醫師: 曾峰毅 開立時間: 2011/08/02 18:00 Pre-operative Diagnosis HIVD, L5/S1, status post diskectomy, recurred Post-operative Diagnosis HIVD, L5/S1, status post diskectomy, recurred Operative Method Microdiskectomy, L5/S1 Specimen Count And Types Nil Pathology Nil Operative Findings Severe scarring connective tissue was noted at previous right L5/S1 laminotomy. Right S1 root was decompressed well after diskectomy. Operative Procedures With endotracheal general anaesthesia, the patient was ptu in prone position. After C-arm localization, we made one midline skin incision along previous operation wound, and dissected right paraspinal muscle to expose L5/S1 interlaminar space. We performed adhesiolysis, and identified right S1 root. Diskectomy was performed. The wound was closed in layers. Operators VS 賴達明 Assistants R5 曾峰毅 R2 周聖哲 Ri 沈 相關圖片 高月裡 (F,1932/10/17,79y4m) 手術日期 2011/08/02 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Compression fracture, pathological, spontaneous 器械術式 Spinal fusion posterior, L2/3 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 周聖哲, 時間資訊 23:12 臨時手術NPO 07:43 報到 08:00 進入手術室 08:10 麻醉開始 08:30 誘導結束 08:35 抗生素給藥 08:48 手術開始 10:38 開始輸血 11:05 手術結束 11:05 麻醉結束 11:15 送出病患 11:18 進入恢復室 13:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎間盤切除術-腰椎 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 曾峰毅 開立時間: 2011/08/02 10:58 Pre-operative Diagnosis Spinal stenosis, L1/2 and L2/3 Post-operative Diagnosis Spinal stenosis, L1/2 and L2/3 Operative Method Transforaminal lumbar interbody fusion at L2/3 with PEEK cage and autologous bone graft, posterior fixation with transpedicular screws at L2 and L3, sublaminar decompression at L1/2 Specimen Count And Types Nil Pathology Nil Operative Findings Thecal sac was decompressed well after diskectomy. Synthes transpedicular screws, 6.2 x 40 mm were inserted into bilateral pedicles of L2, and L3. PEEK cage 11 mm in height was used for fuison. Operative Procedures WIth endotracheal general anaesthesia, the patient was put in prone position. After C-arm localization, the back was scrubbed, disinfected, and then draped as usual. We made one midline skin incision and dissected bilateral paraspinal muscle to expose bilateral laminae from L1 to L4. We instrumented bilateral pedicles of L2 and L3 with transpedicular screws, and performed L2 laminectomy for L2/3 diskectomy. Fusion with achieved with PEEK cage and autologous bone graft. Posterior fixation with achieved after two 5-cm rods set. Sublaminar decompression was done at L1/2. The wound was irrigated with gentamycin-saline. After setting one hemovac, the wound was closed in layers. Operators VS 賴達明 Assistants R5 曾峰毅 R2 周聖哲 Ri 沈 相關圖片 李有利 (M,1959/12/04,52y3m) 手術日期 2011/08/02 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Brain cancer 器械術式 Crainotomy Brain Tumor(P-LIN) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 周聖哲, 時間資訊 11:40 麻醉開始 11:40 進入手術室 12:20 抗生素給藥 12:25 誘導結束 12:45 手術開始 15:20 抗生素給藥 15:23 手術結束 15:23 麻醉結束 15:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 R 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 摘要__ 手術科部: 外科部 套用罐頭: Right frontal craniotomy for tumor excision 開立醫師: 曾峰毅 開立時間: 2011/08/02 15:16 Pre-operative Diagnosis Oligodendoastrocytoms, WHO grade III, status post craniotomy for tumor excision, three times, status post radiation therapy Post-operative Diagnosis Oligodendoastrocytoms, WHO grade III, status post craniotomy for tumor excision, three times, status post radiation therapy Operative Method Right frontal craniotomy for tumor excision Specimen Count And Types Several fragments of one tumor was sent for pathology. Pathology Pending Operative Findings Two moderately vascularized, greyish to pinkish, soft to fragile tumors were noted near the medial side of right lateral ventricles. One of them extended beneath the falx to the opposite side. Operative Procedures Withe endotracheal general anaesthesiat, the patient was put in supne position with head fixed with Mayfield head clamp. We shaved, scrubbed, disinfected, and draped the scalp as usual. We made one curvilinear saclp incision along previous operation wound, and removed previous implanted mini-plates. Bone graft was removed. Dura was opened in C-shape. Tumor was removed in piece-meal with suction and tumor forceps. Dura was closed in water-tight fashion suture, and bone graft was fixed back with miniplates. The wound was closed in layers. Operators VS 賴達明 Assistants R5 曾峰毅 R2 周聖哲 Ri 沈 相關圖片 陳玉坤 (M,1952/08/01,59y7m) 手術日期 2011/08/02 手術主治醫師 林峰盛 手術區域 西址 035房 06號 診斷 Failed back syndrome 器械術式 DCS implantation / PC 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 林峰盛 ASA 1 時間資訊 14:15 報到 15:23 進入手術室 15:25 麻醉開始 15:26 誘導結束 15:37 手術開始 16:25 麻醉結束 16:25 手術結束 16:35 送出病患 摘要__ 手術科部: 麻醉部 套用罐頭: Pulsed RF 開立醫師: 林峰盛 開立時間: 2011/08/02 16:00 Pre-operative Diagnosis Radiculopathy Failed back syndrome Post-operative Diagnosis Radiculopathy Failed back syndrome Operative Method Pulsed RF transforaminal epidural steroid injection Specimen Count And Types nil Pathology Nil Operative Findings Operative Procedures 1. IV sedation with midazolam and LA with 1% xylocaine 2. pt in prone position 3. Under fluoroscopic-guidance, insert 22 G SMK RF meedle into right L5 and S1 neuroforamen 4. Neurostimulation with 50 HZ and 2 Hz 0.1-0.5 mV current with positive result 60-80V 2 Hz, 20 ms, 120sec *2 pulsed RF was delivered 5. TFESI with rinderon 5 mg to right L5 and S1 root send pt to PRO Operators 林峰盛, Assistants 楊仁廷, 林鈺翔 (M,1990/08/09,21y7m) 手術日期 2011/08/02 手術主治醫師 陳敞牧 手術區域 東址 002房 01號 診斷 spinal cord injury 器械術式 Spinal fusion posterior 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 林哲光, 時間資訊 07:00 通知急診手術 08:23 進入手術室 08:30 麻醉開始 08:40 誘導結束 08:50 抗生素給藥 08:55 手術開始 11:50 抗生素給藥 13:00 手術結束 13:00 麻醉結束 13:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: C3-4 reduction and lateral mass screws fixati... 開立醫師: 林哲光 開立時間: 2011/08/02 13:53 Pre-operative Diagnosis C3-4 lock facet with myelopathy Post-operative Diagnosis C3-4 lock facet with myelopathy Operative Method C3-4 reduction and lateral mass screws fixation at C3-5 level Specimen Count And Types nil Pathology Nil Operative Findings C4 lamina posterior dislocation was noted and C3 spinous process was rotated to left side. Muscle contusion was also noted at paraspinal muscles. 14mm lateral mass screws were inserted at bilateral C3 and left C4, and 16mm lateral mass screws were applied to C4 and C5 level. Two rods, 7cm, were inserted in lordosis way. C3, C4 aligament seemed reduction well with normal anatomical position. Operative Procedures Under ETGA and prone position, skin disinfected and drapped were performed as usual. Midline skin incision was made at C2-C6 level and the paraspinal muscles were detached. C4 facet joint was drilled off until the C3-4 lamina could be redcuted to the normal anatomical position. Lateral mass screws were then applied to C3, C4, C5 level and rods were inserted and fixed in lordosis way. The wound was then closed in layers after hemostasis and a paraspinal area CWV drain insertion. Operators 陳敞牧 Assistants R5 林哲光, R1 吳 Indication Of Emergent Operation C3-4 lock facet with myelopathy 相關圖片 許武助 (M,1939/09/28,72y5m) 手術日期 2011/08/02 手術主治醫師 王國川 手術區域 東址 005房 01號 診斷 Lung tumor 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 09:15 臨時手術NPO 08:05 報到 08:10 進入手術室 08:15 麻醉開始 08:35 誘導結束 08:50 抗生素給藥 09:40 手術開始 12:15 麻醉結束 12:15 手術結束 12:16 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 腦瘤切除-手術時間在4小時以內 1 1 R 手術 腦室體外引流 1 2 R 記錄__ 手術科部: 外科部 套用罐頭: 1. External ventricular drainage via right Fr... 開立醫師: 李振豪 開立時間: 2011/08/02 12:45 Pre-operative Diagnosis 1. Cerebellar tumor, right hemisphere, favor metastasis 2. Aqueduct tumor with obstructive hydrocephalus, favor metastasis Post-operative Diagnosis 1. Cerebellar tumor, right hemisphere, favor metastasis 2. Aqueduct tumor with obstructive hydrocephalus, favor metastasis Operative Method 1. External ventricular drainage via right Frazier"s point 2. Right suboccipital craniotomy for cerebellar tumor excision Specimen Count And Types 1 piece About size:Multiple small pieces Source:Cerebellar tumor Pathology Pending Operative Findings The opening pressure is high while ventricular puncture. The CSF was clear in character without increase viscosity or turbidity. Total 10ml CSF was sampled for routine, BCS, bacterial culture, and cytology. The ventricular catheter was fixed 10cm in depth from brain surface. The tumor was grey-whitish with some pus-like content, 4x3x2.6cm in size, relative well-demarcated, moderate vascularized, and attach to tentorium. After total removal of the tumor, the cerebellum became slack. Intra-operative sonography was checked after total removal of the tumor. No obvious EP change during whole procedure. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position with head fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. Linear scalp incision was made at right occipital area followed by one burr hole creation. Dural tenting was performed and a small durotomy was done. Ventriculostomy from right Frazier"s point was performed and external ventricular catheter was inserted with 10cm depth from brain surface. Externalization was done. Hemostasis was achieved and the wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Hockey-stick scalp incision was made over right suboccipital area and the scalp flap was elevated. One 4 x 2cm fascia was harvested for duroplasty. Three burr holes were created and one 3x3 craniotomy window was performed. Intra-operative sonography was used for localization of the tumor. The dura was opened and 2x1 cm corticotomy was performed for tumor excision. The tumor was removed by suction, bipolar electrocautery, and tumor forceps. Hemostasis was achieved with bipolar electrocautery and Surgicel lining. Duroplasty with fascia and 4-0 Prolene was conducted. The skull plate was fixed back with three #26 wire. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Hockey-stick scalp incision was made over right suboccipital area and the scalp flap was elevated. One 4 x 2cm fascia was harvested for duroplasty. Three burr holes were created and one 3x3 craniotomy window was performed. Intra-operative sonography was used for localization of the tumor. The dura was opened and 2x1 cm corticotomy was performed for tumor excision. The tumor was removed by suction, bipolar electrocautery, and tumor forceps. Hemostasis was achieved with bipolar electrocautery and Surgicel lining. Duroplasty with fascia and 4-0 Prolene was conducted. The skull plate was fixed back with three #26 wire. One subgaleal CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS王國川 Assistants R5李振豪, R1王怡人 相關圖片 簡若觀 (F,1953/11/01,58y4m) 手術日期 2011/08/02 手術主治醫師 王國川 手術區域 東址 005房 02號 診斷 Brain metastasis 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 11:52 報到 12:33 進入手術室 12:35 麻醉開始 13:00 誘導結束 13:05 抗生素給藥 13:07 手術開始 16:05 抗生素給藥 16:36 開始輸血 18:05 麻醉結束 18:05 手術結束 18:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 R 手術 腦瘤切除-手術時間在4小時以內 1 2 L 麻醉 Peripheral arterial line inserti 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Right suboccipital and left parietal cranioto... 開立醫師: 李振豪 開立時間: 2011/08/02 18:46 Pre-operative Diagnosis Multiple brain metastasis Post-operative Diagnosis Multiple brain metastasis Operative Method Right suboccipital and left parietal craniotomy for tumor excision Specimen Count And Types 2 pieces About size:1.4x1.6x1.5cm Source:Right cerebellar tumor About size:3.1 x 2.5 x 2.3cm Source:Left parietal tumor Pathology Pending Operative Findings The right cerebellar tumor was x x xcm and left parietal tumor was x xx cm in size. Tumor bleeding was noted in both site and hematoma was evacuated during the operation. The tumor was firm, well-demarcated, reddish, and hypervascularized with remarkable edematous change over adjacent brain parenchyma. Left lateral ventricle was entered during the operation due to ventricular wall involvement. We tried to remove the small one cerebellar metastasis but failed because difficult to localize the tumor. Bleeding diathesis(+). Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position with head fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. Reverse V scalp incision was made at right suboccipital area and the scalp flap was elevated. Periosteum was harvested for duroplasty. Three burr holes were created followed by one 3x3cm craniotomy window. The foramen magnum was opened during craniotomy. Dural tenting was done. Intra-operative sonography was used for localization of the tumor. After durotomy, CSF was released from foramen magnum first. One 2 x 1cm corticotomy was performed. Under operative microscope, the tumor was removed by tumor forceps, suction, and bipolar electrocautery. The hematoma also removed during the operation. Hemostasis was achieved with bipolar electrocautery and Surgicel lining. Duroplasty was done and the skull plate was fixed back with three #26 wire. One subgaleal CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Reverse U scalp incision was made over left parietal area. The scalp flap was elevated and periosteum was harvested for duroplasty. Three burr hole were created followed by one 4x4cm craniotomy window. Dural tenting was done. Intra-operative sonography was used for localization of the tumor. C-shape durotomy was performed. Under operative microscope, one 2x1cm corticotomy was performed. The tumor was removed by bipolar electrocautery, tumor forcep, and suction. Left lateral ventricle was entered and packing with Gelfoam. Hemostasis was performed with bipolar electrocautery, Surgicel lining, and Gelfoam packing. Duroplasty was done. The skull plate was fixed back with four #26 wires. One subgaleal CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS王國川 Assistants R5李振豪, R1王怡人 相關圖片 鄭榮仁 (M,1961/08/06,50y7m) 手術日期 2011/08/03 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Spine tumor 器械術式 Intraspinal intramedullary tumor C2-7 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 曾偉倫, 時間資訊 23:49 臨時手術NPO 08:05 進入手術室 08:10 麻醉開始 09:00 抗生素給藥 09:05 誘導結束 09:38 手術開始 12:00 抗生素給藥 14:30 手術結束 14:30 麻醉結束 14:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 脊椎內脊髓內腫瘤切除術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: C1-C2 laminoplasty with intramedullary tumor ... 開立醫師: 李振豪 開立時間: 2011/08/03 15:04 Pre-operative Diagnosis C2 intraspinal intramedullary tumor, suspect ependymoma Post-operative Diagnosis C2 intraspinal intramedullary tumor, suspect hemangioblastoma Operative Method C1-C2 laminoplasty with intramedullary tumor excision Specimen Count And Types 1 piece About size:2x2x1 cm Source:C2 intraspinal tumor Pathology Pending Operative Findings The tumor was 1.2 x 0.6 x 0.8cm in size, well-demarcated, hypervascularized, and red-yellowish in color. There were two major feeding artery and one large engorged drainage vein on the surface of spinal cord which confirmed by ICG test. Fibrotic change was noted over pia surface and the tumor adhered to spinal cord at left and anterior side. Gliosis between the tumor and spinal cord was noted which can be dissected for tumor excision. The central canal and syrinx was entered after resection of the tumor. Flatening of left side SSEP was noted during dissection of the tumor. The SSEP did not recovered well after warm saline irrigation. No obvious MEP change noted after whole procedure. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position with head fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. Midline skin incision was made at C1-C2 level and the subcutaneous soft tissue was devided. Paraspinal muscle groups were detached. Under operative microscope, grooving of C1-C2 laminae was performed and the laminae was removed. After midline durotomy, the arachnoid membrane was opened. The intramedullary tumor was noted with much tortuous vessels. ICG was applied to identified the feeding artery and drainage vein. The feeding artery was transected first for devascularization. The tumor was dissected along the margin for en block tumor excision. Flatening of left side SSEP was noted during manipulation and warm saline was used. Hemostasis was achieved with bipolar electrocautery after total removal of the tumor. The pia was closed with 7-0 prolene. Dura was closed with 5-0 prolene. Laminoplasty with miniplates and screws were conducted. One CWV drain was placed and the wound was closed in layers with 2-0 vicryl and 3-0 Nylon. Operators Prof. 杜永光 Assistants R5 李振豪 R3 曾偉倫 相關圖片 徐玉嬌 (F,1953/02/15,59y0m) 手術日期 2011/08/03 手術主治醫師 廖漢文 手術區域 東址 000房 號 診斷 器械術式 Other RAD exam/intervention 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 蔡奉芳 ASA 3 時間資訊 11:35 麻醉開始 11:40 誘導結束 11:54 麻醉結束 12:20 進入恢復室 13:20 離開恢復室 邱連旺 (M,1936/09/02,75y6m) 手術日期 2011/08/03 手術主治醫師 蔡瑞章 手術區域 東址 005房 01號 診斷 Brain metastasis 器械術式 Crainotomy Brain Tumor 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 林哲光, 時間資訊 23:57 臨時手術NPO 07:20 報到 08:05 進入手術室 08:15 麻醉開始 08:55 誘導結束 09:00 抗生素給藥 09:05 手術開始 11:09 開始輸血 12:00 抗生素給藥 14:40 麻醉結束 14:40 手術結束 14:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4~8小時 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: Right occipital craniotomy for tumor excision 開立醫師: 林哲光 開立時間: 2011/08/03 15:21 Pre-operative Diagnosis Right occipital tumor, suspected brain metastasis Post-operative Diagnosis Right occipital tumor, suspected brain metastasis Operative Method Right occipital craniotomy for tumor excision Specimen Count And Types 1 piece About size:multiple pieces Source:Tumor at right occipital area Pathology Pending Operative Findings Brain parenchyma bulging after the dural opening was noted. Around 4cm sized, grayish, soft-elastic, well-defined mass lesion was noted at subcortical area of right occipital part. Operative Procedures Under ETGA and prone position, skin disinfected and drapped were performed as usual. Reversed U-shaped skin incision was made at right occipital area. Craniotomy was performed after four burr holes were created. The dura was opened in cruciated way and tumor was localized with echo. Tumor excision was then done. The skull bone was then put back with wire fixation and the wound was then closed in layers after a subgaleal drain insertion. Operators P 蔡瑞章 Assistants R5 林哲光, R1 蕭智陽, Ri 林千又 相關圖片 李語萱 (F,2009/02/02,3y1m) 手術日期 2011/08/03 手術主治醫師 彭信逢 手術區域 東址 000房 號 診斷 Malignant neoplasm of spinal cord 器械術式 For MRI 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 面罩麻醉 麻醉主治醫師 蔡奉芳 ASA 3 時間資訊 00:00 臨時手術NPO 09:15 麻醉開始 09:20 誘導結束 10:34 麻醉結束 10:45 進入恢復室 11:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Semi-opened mask inhalation anes 1 0 謝宗凱 (M,1998/11/29,13y3m) 手術日期 2011/08/03 手術主治醫師 郭夢菲 手術區域 兒醫 067房 02號 診斷 Meningitis, unspecified 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 4E 紀錄醫師 王奐之, 時間資訊 12:16 開始NPO 12:16 臨時手術NPO 12:16 通知急診手術 12:50 進入手術室 12:55 麻醉開始 13:00 誘導結束 13:10 手術開始 13:40 手術結束 13:40 麻醉結束 13:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 顱內壓視置入 1 1 摘要__ 手術科部: 套用罐頭: EVD insertion via right Kocher point 開立醫師: 王奐之 開立時間: 2011/08/03 14:16 Pre-operative Diagnosis CNS infection, ventriculitis with hydrocephalus, s/p left side EVD Post-operative Diagnosis CNS infection, ventriculitis with hydrocephalus, s/p left side EVD Operative Method EVD insertion via right Kocher point Specimen Count And Types 1 piece About size:20ml Source:CSF Pathology Nil Operative Findings Turbid CSF was noted (much worse than previous procedure), with opening pressure > 40 cmH2O. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position. After shaving, scrubbing, disinfection & draping in sterile fashion, a linear incision was made at right frontal area. Ventricular puncture was then performed via previously created burr hole at right Kocher point, followed by insertion of EVD catheter. After securing the EVD catheter, the wound was closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之 Indication Of Emergent Operation Pupil dilatation & IICP. 相關圖片 記錄__ 手術科部: 套用罐頭: EVD insertion via right Kocher point 開立醫師: 王奐之 開立時間: 2011/08/03 14:16 Pre-operative Diagnosis CNS infection, ventriculitis with hydrocephalus, s/p left side EVD Post-operative Diagnosis CNS infection, ventriculitis with hydrocephalus, s/p left side EVD Operative Method EVD insertion via right Kocher point Specimen Count And Types 1 piece About size:20ml Source:CSF Pathology Nil Operative Findings Turbid CSF was noted (much worse than previous procedure), with opening pressure > 40 cmH2O. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position. After shaving, scrubbing, disinfection & draping in sterile fashion, a linear incision was made at right frontal area. Ventricular puncture was then performed via previously created burr hole at right Kocher point, followed by insertion of EVD catheter. After securing the EVD catheter, the wound was closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之 Indication Of Emergent Operation Pupil dilatation & IICP. 相關圖片 記錄__ 手術科部: 套用罐頭: EVD insertion via right Kocher point 開立醫師: 郭夢菲 開立時間: 2011/08/04 10:35 Pre-operative Diagnosis CNS infection, ventriculitis with hydrocephalus, s/p left side EVD with isolated right lateral ventricle Post-operative Diagnosis CNS infection, ventriculitis with hydrocephalus, s/p left side EVD with isolated right lateral ventricle Operative Method EVD insertion via right Kocher point Specimen Count And Types 1 piece About size:20ml Source:CSF Pathology Nil Operative Findings Turbid CSF was noted (much worse than previous procedure), with opening pressure > 40 cmH2O. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position. After shaving, scrubbing, disinfection & draping in sterile fashion, a linear incision was made at previous right frontal area. Ventricular puncture was then performed via previously created burr hole at right Kocher point, followed by insertion of EVD catheter. After securing the EVD catheter, the wound was closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之 Indication Of Emergent Operation 相關圖片 鐘仁傑 (M,2005/01/12,7y2m) 手術日期 2011/08/03 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Anomalies of spinal cord 器械術式 Cord untethering 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 2 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:05 進入手術室 08:20 麻醉開始 08:25 誘導結束 08:45 抗生素給藥 09:12 手術開始 11:45 抗生素給藥 12:33 手術結束 12:33 麻醉結束 12:38 送出病患 12:40 進入恢復室 13:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 手術 良性脊髓腫瘤切除術 1 1 摘要__ 手術科部: 外科部 套用罐頭: Spinal cord untethering 開立醫師: 王奐之 開立時間: 2011/08/03 14:33 Pre-operative Diagnosis Tethered cord syndrome due to lipomyelomeningocele, status post untethering by tumor excision, with retethering Post-operative Diagnosis Tethered cord syndrome due to lipomyelomeningocele, status post untethering by tumor excision, with retethering Operative Method Spinal cord untethering Specimen Count And Types Nil Pathology Nil Operative Findings The silicon plate inserted previously did not adhere to the intrathecal structures, surrounding tissue showed severe adhesions, however. The adhesion mainly limited the nerve roots, and indirectly tethered the spinal cord itself. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position. After scrubbing, disinfection & draping in sterile fashion, a midline linear incision was made along previous scar (at lower back). The incision was deepened until the sacral spine was exposed. Lower sacral lamina was identified and removed, exposing the dura. The dura was then opened in linear fashion, the terminal spinal cord and previously inserted silicon plate was seen. After removing the silicon plate, adhesiolysis was done to the intrathecal adhesions. After confirming the mobilization of spinal cord and meticulous hemostasis, the dura was closed in water-tight fashion. The wound was closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之, Ri 陳滄堯 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Spinal cord untethering 開立醫師: 王奐之 開立時間: 2011/08/03 14:33 Pre-operative Diagnosis Tethered cord syndrome due to lipomyelomeningocele, status post untethering by tumor excision, with retethering Post-operative Diagnosis Tethered cord syndrome due to lipomyelomeningocele, status post untethering by tumor excision, with retethering Operative Method Spinal cord untethering Specimen Count And Types Nil Pathology Nil Operative Findings The silicon plate inserted previously did not adhere to the intrathecal structures, surrounding tissue showed severe adhesions, however. The adhesion mainly limited the nerve roots, and indirectly tethered the spinal cord itself. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position. After scrubbing, disinfection & draping in sterile fashion, a midline linear incision was made along previous scar (at lower back). The incision was deepened until the sacral spine was exposed. Lower sacral lamina was identified and removed, exposing the dura. The dura was then opened in linear fashion, the terminal spinal cord and previously inserted silicon plate was seen. After removing the silicon plate, adhesiolysis was done to the intrathecal adhesions. After confirming the mobilization of spinal cord and meticulous hemostasis, the dura was closed in water-tight fashion. The wound was closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之, Ri 陳滄堯 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Spinal cord untethering 開立醫師: 郭夢菲 開立時間: 2011/08/04 10:15 Pre-operative Diagnosis Retethered cord syndrome due to lipomyelomeningocele, status post untethering Post-operative Diagnosis Retethered cord syndrome due to lipomyelomeningocele, status post untethering Operative Method Spinal cord untethering Specimen Count And Types Nil Pathology Nil Operative Findings 1. The silastic membrane inserted previously did not adhere to the intrathecal structures, however the surrounding tissue showed severe adhesions. The adhesion mainly limited the nerve roots, and indirectly tethered the spinal cord itself, which was tethered but not very tight. 2. the spinal cord end was divided into two parts, the right one extended to the cul-de-sac of the end of thecal sac, the left one extended to the left sacral nerves. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position. After scrubbing, disinfection & draping in sterile fashion, a midline linear incision was made along previous scar (at lower back). The incision was deepened until the sacral spine was exposed. Lower part of the S2 or S3 lamina was identified and removed, exposing the dura. The dura was then opened in linear fashion under microscope aid, the terminal spinal cord and previously inserted silicon plate was seen. the silastic membrane located at the right side of the cord was removed, adhesiolysis was done to the intrathecal adhesions. After confirming the complete mobilization of spinal cord and meticulous hemostasis, the dura was closed in water-tight fashion. The wound was closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之, Ri 陳滄堯 相關圖片 吳柏宏 (M,1998/11/04,13y4m) 手術日期 2011/08/03 手術主治醫師 郭夢菲 手術區域 兒醫 067房 03號 診斷 Brain tumor 器械術式 Scalp tumor excision & cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 2 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 13:50 報到 14:07 進入手術室 14:20 麻醉開始 14:30 誘導結束 15:00 抗生素給藥 15:09 手術開始 16:55 麻醉結束 16:55 手術結束 17:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 腦瘤切除-手術時間在4小時以內 1 1 手術 頭顱成形術 1 2 R 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: Tumor excision and cranioplasty 開立醫師: 王奐之 開立時間: 2011/08/03 17:19 Pre-operative Diagnosis Right occipital bone tumor, suspected metastasis Post-operative Diagnosis Right occipital bone tumor, suspected Langerhans histiocytosis Operative Method Tumor excision and cranioplasty Specimen Count And Types 1 piece About size:3*3*3cm Source:right occipital bone tumor Pathology Frozen section: Langerhans histiocytosis Operative Findings The tumor was reddish, elastic-firm, measuring about 3*3*3cm, with well-circumscribed encapsulation, located at right occipital-suboccipital area, with bony erosion & a small portion of epidural extension. About 3mm bony margin was removed with Kerrison punch. The epidural tumor was removed by currettage. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position. After shaving, scrubbing, disinfection & draping in sterile fashion, a reverse-U shaped incision was made at right occipital area. After dissecting the galea and reflecing the scalp flap inferiorly, the tumor was exposed and dissected around its margin. The tumor was then removed in several pieces. The bony edge was removed with Kerrison punch. After tumor removal and hemostasis, the bony defect was replaced with bone cement. The wound was then closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Tumor excision and cranioplasty 開立醫師: 王奐之 開立時間: 2011/08/03 17:19 Pre-operative Diagnosis Right occipital bone tumor, suspected metastasis Post-operative Diagnosis Right occipital bone tumor, suspected Langerhans histiocytosis Operative Method Tumor excision and cranioplasty Specimen Count And Types 1 piece About size:3*3*3cm Source:right occipital bone tumor Pathology Frozen section: Langerhans histiocytosis Operative Findings The tumor was reddish, elastic-firm, measuring about 3*3*3cm, with well-circumscribed encapsulation, located at right occipital-suboccipital area, with bony erosion & a small portion of epidural extension. About 3mm bony margin was removed with Kerrison punch. The epidural tumor was removed by currettage. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position. After shaving, scrubbing, disinfection & draping in sterile fashion, a reverse-U shaped incision was made at right occipital area. After dissecting the galea and reflecing the scalp flap inferiorly, the tumor was exposed and dissected around its margin. The tumor was then removed in several pieces. The bony edge was removed with Kerrison punch. After tumor removal and hemostasis, the bony defect was replaced with bone cement. The wound was then closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之 相關圖片 摘要__ 手術科部: 外科部 套用罐頭: Tumor excision and cranioplasty 開立醫師: 王奐之 開立時間: 2011/08/03 17:22 Pre-operative Diagnosis Right occipital bone tumor, suspected metastasis Post-operative Diagnosis Right occipital bone tumor, suspected Langerhans histiocytosis Operative Method Tumor excision and cranioplasty Specimen Count And Types 1 piece About size:3*3*3cm Source:right occipital bone tumor Pathology Frozen section: Langerhans histiocytosis Operative Findings The tumor was reddish, elastic-firm, measuring about 3*3*3cm, with well-circumscribed encapsulation, located at right occipital-suboccipital area, with bony erosion & a small portion of epidural extension. About 3mm bony margin was removed with Kerrison punch. The epidural tumor was removed by currettage. Some necrotic portion was noted and easy bleeding was encountered in that portion. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position. After shaving, scrubbing, disinfection & draping in sterile fashion, a reverse-U shaped incision was made at right occipital area. After dissecting the galea and reflecing the scalp flap inferiorly, the tumor was exposed and dissected around its margin. The tumor was then removed in several pieces. The bony edge was removed with Kerrison punch. After tumor removal and hemostasis, the bony defect was replaced with bone cement. The wound was then closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Tumor excision and cranioplasty 開立醫師: 王奐之 開立時間: 2011/08/03 17:22 Pre-operative Diagnosis Right occipital bone tumor, suspected metastasis Post-operative Diagnosis Right occipital bone tumor, suspected Langerhans histiocytosis Operative Method Tumor excision and cranioplasty Specimen Count And Types 1 piece About size:3*3*3cm Source:right occipital bone tumor Pathology Frozen section: Langerhans histiocytosis Operative Findings The tumor was reddish, elastic-firm, measuring about 3*3*3cm, with well-circumscribed encapsulation, located at right occipital-suboccipital area, with bony erosion & a small portion of epidural extension. About 3mm bony margin was removed with Kerrison punch. The epidural tumor was removed by currettage. Some necrotic portion was noted and easy bleeding was encountered in that portion. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position. After shaving, scrubbing, disinfection & draping in sterile fashion, a reverse-U shaped incision was made at right occipital area. After dissecting the galea and reflecing the scalp flap inferiorly, the tumor was exposed and dissected around its margin. The tumor was then removed in several pieces. The bony edge was removed with Kerrison punch. After tumor removal and hemostasis, the bony defect was replaced with bone cement. The wound was then closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之 相關圖片 摘要__ 手術科部: 外科部 套用罐頭: Tumor excision and cranioplasty 開立醫師: 郭夢菲 開立時間: 2011/08/04 09:51 Pre-operative Diagnosis Right occipital bone tumor, suspected metastasis Post-operative Diagnosis Right occipital bone tumor, suspected Langerhans histiocytosis Operative Method Tumor excision and cranioplasty Specimen Count And Types 1 piece About size:3*3*3cm Source:right occipital bone tumor Pathology Frozen section: Langerhans histiocytosis Operative Findings 1. The tumor originated inside the bone marrow with expansion to both the inner and outer tables of the occipital bone. The tumor was reddish, elastic at its outer part, measuring about 3*3*3cm, and was fragile at the innner part. There was some tumor necrosis at the outer portion of the tumor. 2. There was epidural extension. 3. About 3mm bony margin was removed with Kerrison punch. The epidural tumor was removed by currettage. The dura and the right transverse sinus were intact. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position. After shaving, scrubbing, disinfection & draping in sterile fashion, a reverse-U shaped incision was made at right occipital area. After dissecting the galea and reflecing the scalp flap inferiorly, the tumor was exposed and dissected around its margin. The Operators AP 郭夢菲 Assistants R4 王奐之 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Tumor excision and cranioplasty 開立醫師: 郭夢菲 開立時間: 2011/08/04 10:07 Pre-operative Diagnosis Right occipital bone tumor, suspected metastasis Post-operative Diagnosis Right occipital bone tumor, suspected Langerhans histiocytosis Operative Method Tumor excision and cranioplasty Specimen Count And Types 1 piece About size:3*3*3cm Source:right occipital bone tumor Pathology Frozen section: Langerhans histiocytosis Operative Findings 1. The tumor originated inside the bone marrow with expansion to both the inner and outer tables of the occipital bone. The tumor was reddish, elastic at its outer part, measuring about 3*3*3cm, and was fragile at the innner part. There was some tumor necrosis at the outer portion of the tumor. 2. There was epidural extension. 3. About 3mm bony margin was removed with Kerrison punch. The epidural tumor was removed by currettage. The dura and the right transverse sinus were intact. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position. After shaving, scrubbing, disinfection & draping in sterile fashion, a reverse-U shaped incision was made at right occipital area. After dissecting the galea and reflecing the scalp flap inferiorly, the tumor was exposed and dissected around its margin. The tumor bulged out slowly by itself. We then rhongeured off the bone surrounding the tumor, then removed the tumor by curret till the dura was exposed. The dural surface was coagulated with bipolar coagulator. We then reconstruced the boney defect with bone cement. The wound was then closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之 相關圖片 林阿菊 (F,1951/04/23,60y10m) 手術日期 2011/08/03 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Brain metastasis 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 林哲光, 時間資訊 23:11 臨時手術NPO 14:10 報到 15:00 進入手術室 15:05 麻醉開始 15:45 誘導結束 16:00 抗生素給藥 16:02 手術開始 19:02 抗生素給藥 19:15 麻醉結束 19:15 手術結束 19:25 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除-手術時間在4小時以內 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Left P-T craniotomy for tumor excision 開立醫師: 林哲光 開立時間: 2011/08/03 20:00 Pre-operative Diagnosis Left temporoparietal lobe tumor, suspected metastasis Post-operative Diagnosis Left temporoparietal lobe tumor, suspected metastasis Operative Method Left P-T craniotomy for tumor excision Specimen Count And Types 1 piece About size:multiple pieces Source:tumor Pathology Pending Operative Findings 4cm sized grayish, soft-elastic mass lesion was noted at left temporopareital lobe with temporal part predominant and hypercellularity. The tumor was well-defined and perifocal gliosis was also noted. The tumor was removed totally. Operative Procedures Under ETGA and supine position with head rotated to right side and fixed with Mayfield head clamp, skin disinfected and drapped were performed as usual. A reversed U-shaped skin incision was made at left P-T region and four burr holes were created for craniotomy. The dura was opened after echo localization and dural tetning. Tumor excision was then done with picemeal removal. Hemostasis was then performed with Surgecell packing. The wound was then closed in layers after skull bone was put back and fixed with miniplates and a subgaleal drain insertion. Operators AP 賴達明 Assistants R5 林哲光, R1 蕭智陽, Ri 林千又 相關圖片 張哲華 (M,1989/08/21,22y6m) 手術日期 2011/08/03 手術主治醫師 蔡翊新 手術區域 東址 002房 05號 診斷 Head Injury 器械術式 Left frontal depression fracture reduction, ICP monitoring, Laceration wound debridment 手術類別 緊急手術 手術部位 頭、頸 傷口分類 污染 麻醉方式 全身麻醉 麻醉主治醫師 林峰盛 ASA 3E 紀錄醫師 曾偉倫, 時間資訊 23:00 臨時手術NPO 23:00 開始NPO 00:32 通知急診手術 01:20 進入手術室 01:30 麻醉開始 01:50 誘導結束 02:26 手術開始 02:30 開始輸血 03:30 抗生素給藥 06:30 抗生素給藥 08:40 09:50 麻醉結束 09:50 手術結束 10:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 眼窩成形術 1 1 L 手術 深部傷口處理縫合擴創-大 1 0 L 手術 顱內壓視置入 1 2 L 手術 腦內血腫清除術 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 9 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: 1. Left frontal craniotomy with debridement, ... 開立醫師: 蔡翊新 開立時間: 2011/08/03 10:08 Pre-operative Diagnosis Head injury with left frontal open, depressed fracture and orbital rim fracture, with dural tear, subdural hematoma and left frontal contusional ICH. Post-operative Diagnosis Head injury with left frontal open, depressed fracture and orbital rim fracture, with dural tear, subdural hematoma and left frontal contusional ICH. Operative Method 1. Left frontal craniotomy with debridement, removal of bone chips, subdural hematoma and contusional brain tissues, dural repair and cranioplasty with miniplates, screws and autologous bone flaps. 2. Left frontal subdural ICP monitoring. Specimen Count And Types nil Pathology Nil Operative Findings A 10 cm laceration wound at left forehead, with 6 x 5 cm depressed skull fracture and extrusion of necrotic brain tissues. Comminuted fracture of the superior orbital rim into multiple fragments was also noted. After craniotomy with removal of the bone fragments, a 5 cm dural defect was noted just beneath the scalp laceration and skull fracture. Subdural hematoma and 5 x 5 cm contusional ICH were evacuated from left frontal lobe. The brain became slack after evacuation of hematomas. ICP after dural repair was 5 mmHg. The fragments were difficult to assemble back to a whole piece, so the cranioplasty was performed with two long miniplates across the bony defect and the bone chips were fixed under the miniplates with screws. Operative Procedures Under ETGA, the patient was placed in a supine position and the skin was disinfected and drapped as usual. A bicoronal scalp incision was made to expose the left frontal bone and the fractured sites. A burr hole was made at left temporal bone to create a craniotomy, 7 x 6 cm. The bony fragments were removed. Curvilinear dural incision was performed and subdural and contusional hematomas were evacuated. Hemostasis was achieved by bipolar coagulator and Surgicel packing. The dural defect was repaired with a piece of pericranium. Cranioplasty was performed with two long miniplates across the bony defect and the bone chips were fixed under the miniplates with screws. The fractures of orbital rim and roof were reconstructed by plastic surgeon with miniplates and screws. A subgaleal CWV drain was set. The scalp laceration was repaired and the scalp wound was closed in layers. Operators VS 蔡翊新 Assistants R5 林哲光 R3 曾偉倫 Indication Of Emergent Operation open, depressed skull fracture, with intracranial hemorrhage 相關圖片 摘要__ 手術科部: 外科部 套用罐頭: 1. Left frontal craniotomy with debridement, ... 開立醫師: 蔡翊新 開立時間: 2011/08/03 10:08 Pre-operative Diagnosis Head injury with left frontal open, depressed fracture and orbital rim fracture, with dural tear, subdural hematoma and left frontal contusional ICH. Post-operative Diagnosis Head injury with left frontal open, depressed fracture and orbital rim fracture, with dural tear, subdural hematoma and left frontal contusional ICH. Operative Method 1. Left frontal craniotomy with debridement, removal of bone chips, subdural hematoma and contusional brain tissues, dural repair and cranioplasty with miniplates, screws and autologous bone flaps. 2. Left frontal subdural ICP monitoring. Specimen Count And Types nil Pathology Nil Operative Findings A 10 cm laceration wound at left forehead, with 6 x 5 cm depressed skull fracture and extrusion of necrotic brain tissues. Comminuted fracture of the superior orbital rim into multiple fragments was also noted. After craniotomy with removal of the bone fragments, a 5 cm dural defect was noted just beneath the scalp laceration and skull fracture. Subdural hematoma and 5 x 5 cm contusional ICH were evacuated from left frontal lobe. The brain became slack after evacuation of hematomas. ICP after dural repair was 5 mmHg. The fragments were difficult to assemble back to a whole piece, so the cranioplasty was performed with two long miniplates across the bony defect and the bone chips were fixed under the miniplates with screws. Operative Procedures Under ETGA, the patient was placed in a supine position and the skin was disinfected and drapped as usual. A bicoronal scalp incision was made to expose the left frontal bone and the fractured sites. A burr hole was made at left temporal bone to create a craniotomy, 7 x 6 cm. The bony fragments were removed. Curvilinear dural incision was performed and subdural and contusional hematomas were evacuated. Hemostasis was achieved by bipolar coagulator and Surgicel packing. The dural defect was repaired with a piece of pericranium. Cranioplasty was performed with two long miniplates across the bony defect and the bone chips were fixed under the miniplates with screws. The fractures of orbital rim and roof were reconstructed by plastic surgeon with miniplates and screws. A subgaleal CWV drain was set. The scalp laceration was repaired and the scalp wound was closed in layers. Operators VS 蔡翊新 Assistants R5 林哲光 R3 曾偉倫 Indication Of Emergent Operation open, depressed skull fracture, with intracranial hemorrhage 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: ORIF to left superior orbital rim and bone gr... 開立醫師: 蕭智陽 開立時間: 2011/08/09 20:11 Pre-operative Diagnosis Head injury with left frontal compression fracture, left superior orbital rim fracture, and left orbital roof fracture; Lower Lip through and through laceration Post-operative Diagnosis Head injury with left frontal compression fracture, left superior orbital rim fracture, and left orbital roof fracture; Lower Lip through and through laceration Operative Method ORIF to left superior orbital rim and bone grafting to orbital roof; Lower lip repairment Specimen Count And Types nil Pathology Nil Operative Findings Left superior orbital rim and orbital roof cominuted fracture was noted with several bone fragments. The fronto-zygomatic junction was fixed to left tempral area and to superior orbital rim bone fracments. Bone graft was applied to reconstruct orbital roof. The bone graft was taken from the fractured skull bone. The lower lip was through-through lacerated and was repaired in layers. Operative Procedures We did the operation with neurosurgeon. The front-zygomatic junction was fixed to temproal area with one mini-plate. The superior orbital rim was fixed with the fractured fragments with a mini-plate. Bone graft taken from the fractured bone was applied to reconstruct the orbital roof. Operators VS楊永健 Assistants R5游彥辰, R4黃柏誠 Indication Of Emergent Operation 相關圖片 陳文英 (F,1953/10/30,58y4m) 手術日期 2011/08/04 手術主治醫師 杜永光 手術區域 東址 016房 01號 診斷 Meningioma 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 07:35 通知急診手術 08:20 報到 08:20 進入手術室 08:25 麻醉開始 08:30 誘導結束 09:00 抗生素給藥 09:17 手術開始 10:00 麻醉結束 10:00 手術結束 10:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室體外引流 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: 1. Right Kochers approach for extraventricula... 開立醫師: 曾偉倫 開立時間: 2011/08/04 10:22 Pre-operative Diagnosis Left frontal intracerebral hemorrhage and intraventricular hemorrhage with acute hydrocephalus Post-operative Diagnosis Left frontal intracerebral hemorrhage and intraventricular hemorrhage with acute hydrocephalus Operative Method 1. Right Kochers approach for extraventricular drainage 2. Left sub-galeal effusion drainage Specimen Count And Types nil Pathology Nil Operative Findings 1. Dense bloody CSF was drained after the venticular catheter inserted, the open pressure was high 2. Right sub-galea effusion, light bloody, with 65ml drainage Operative Procedures Under ETGA, we placed the patient on supine position. After we shaved, scrubbed, disonfected and drappes, a curvilinear skin incision was made over right frontal area on the previous operation wound. The EVD was inserted via the previous EVD tract and it was connected with the previous tract. The wound was closed in layers after the EVD was fixed. Left sub-galeal effusion was tappered with 22G cath for 65 ml. Operators Prof. 杜永光 Assistants R3 曾偉倫 Indication Of Emergent Operation Acute hydrocephalus 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: 1. Right Kochers approach for extraventricula... 開立醫師: 曾偉倫 開立時間: 2011/08/04 10:23 Pre-operative Diagnosis Left frontal intracerebral hemorrhage and intraventricular hemorrhage with acute hydrocephalus Post-operative Diagnosis Left frontal intracerebral hemorrhage and intraventricular hemorrhage with acute hydrocephalus Operative Method 1. Right Kochers approach for extraventricular drainage 2. Left sub-galeal effusion drainage Specimen Count And Types nil Pathology Nil Operative Findings 1. Dense bloody CSF was drained after the venticular catheter inserted, the open pressure was high 2. Right sub-galea effusion, light bloody, with 65ml drainage Operative Procedures Under ETGA, we placed the patient on supine position. After we shaved, scrubbed, disonfected and drappes, a curvilinear skin incision was made over right frontal area on the previous operation wound. The EVD was inserted via the previous EVD tract and it was connected with the previous tract. The wound was closed in layers after the EVD was fixed. Left sub-galeal effusion was tappered with 22G cath for 65 ml. Operators Prof. 杜永光 Assistants R3 曾偉倫 Indication Of Emergent Operation Acute hydrocephalus 相關圖片 鄭榮仁 (M,1961/08/06,50y7m) 手術日期 2011/08/04 手術主治醫師 杜永光 手術區域 東址 002房 02號 診斷 Spine tumor 器械術式 Suboccipital decompression + EVD 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 4E 紀錄醫師 曾偉倫, 時間資訊 14:40 通知急診手術 15:25 報到 15:25 進入手術室 15:30 麻醉開始 15:50 誘導結束 16:05 手術開始 17:40 抗生素給藥 21:05 麻醉結束 21:05 手術結束 21:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 1 手術 腦室體外引流 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: 1. Suboccipital craniectomy for decompression... 開立醫師: 李振豪 開立時間: 2011/08/04 21:41 Pre-operative Diagnosis Cerebellar hemorrhage with intraventricular hemorrhage and subarachnoid hemorrhage, suspect hemorrhagic infarction Post-operative Diagnosis Cerebellar hemorrhage with intraventricular hemorrhage and subarachnoid hemorrhage, suspect hemorrhagic infarction Operative Method 1. Suboccipital craniectomy for decompression and left cerebellar hematoma evacuation 2. External ventricular drainage via right Frazier"s point Specimen Count And Types nil Pathology Nil Operative Findings The opening pressure is high and the CSF was bloody in character. The EVD was fixed at 10cm in depth from brain surface. Dural tear was noted during craniectomy. The cerebellum was swelling and hemorrhagic infarction was noted over left upper cerebellum. Part of infarcted cerebellum was removed for hemostasis. The cerebellum remain swelling with poor pulsation over left side. The surface of right cerebellum was relative intact but still swelling. CSF gushed out from cisterna magnum after decompression and dural opening. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position with head fixed with mayfield skull clamp. CWV drain was removed and the scalp was shaved, scrubbed, and disinfected as usual. Right parietal linear scalp incision was made followed by one burr hole creation. Dural tenting was done. Small durotomy was performed and ventriculostomy was done with puncture needle. The ventricular catheter wa sinserted and fixed at 10cm in depth. Externalization was done and the wound was closed in layers with 2-0 Vicryl and 3-0 Nylon. The C1-2 operative wound was opened and extended to occipital area. The nuchal muscle group were detached. Four burr hole were created followed by suboccipital craniectomy. The C1 laminae also removed for decompression. Left cerebellar hemorrhagic infarction was noted and evacuated for hemostasis. Duroplasty with fascia was tried but failed due to dural tear and swelling of cerebellum. Duraform was applied for part of duroplasty. One epidural CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators Prof.杜永光, VS賴達明 Assistants R5李振豪, R3曾偉倫 Indication Of Emergent Operation 相關圖片 張葉阿滿 (F,1942/06/17,69y8m) 手術日期 2011/08/04 手術主治醫師 吳耀銘 手術區域 東址 013房 04號 診斷 CBD stone 器械術式 Cholecystectomy & choledocholithotomy with T-tube 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 林珍榮 ASA 3 紀錄醫師 蕭惠壬, 時間資訊 00:00 臨時手術NPO 16:20 進入手術室 16:22 麻醉開始 16:30 誘導結束 16:30 抗生素給藥 16:42 手術開始 17:04 開始輸血 17:05 送出病患 18:55 麻醉結束 18:55 手術結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 總膽管切開石術及T形管引流 1 1 R 手術 膽囊切除術 1 2 R 摘要__ 手術科部: 外科部 套用罐頭: Open cholecystectomy and choledocholithotomy ... 開立醫師: 蕭惠壬 開立時間: 2011/08/04 19:20 Pre-operative Diagnosis GB stones with CBD stone s/p PTCD Post-operative Diagnosis GB stones with CBD stone s/p PTCD Operative Method Open cholecystectomy and choledocholithotomy with T-tube drainage Specimen Count And Types 1 piece About size: Source:Gallbaldder Pathology Pending Operative Findings 1. Gallstone: 2, mixed type; about 1 cm in diameter 2. Gallbladder contracture (2.5*2.5cm) and wall thickness (4~5mm); GB adhesion with duodenum 3. CBD diameter: 0.3 cm. A big CBD stone was found at distal CBD and causes obsturction Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position and the whole abdominal skin was disinfected with painting of alcoholic povidon betaiodine. The operation field was then wrapped with surgical towel as usual. Right subcostal incision was made with electronic tissue cauterizer. The upper operation field was then further pulled upwards and lateral-wards with Kent self-retractor. The cystic duct and cystic artery were firstly ligated and divided and then the gall bladder was removed. The soft tissue covering the CBD was then dissected out to expose the mid-portion of the CBD. After confirming the position of the CBD by aspiration with fine needle and syringe, the CBD was opened longitudinally with two anchoring suture on each side of the opening. The CBD stone was removed by forceps. The remained stones in both proximal and distal CBD were further cleaned. After these, a T-tube of size 16 was put into the CBD and the opening closed with interrupted sutures. After hemostasis and wound irrigation, the long arm of the T-tube was pulled out of the abdominal wall through a stab wound on the abdomen. A rubber drain was left in the wound space for further drainagehe surgical wound was then closed in three layers. Operators VS吳耀銘, Assistants R5 廖御佐, R3 蕭惠壬, 相關圖片 鄭洪美雪 (F,1940/07/22,71y7m) 手術日期 2011/08/04 手術主治醫師 吳毅暉 手術區域 東址 001房 02號 診斷 Lymphoma 器械術式 Port-A Implatation /WOR 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 陳政維, 時間資訊 09:35 進入手術室 09:40 抗生素給藥 09:48 麻醉開始 09:49 誘導結束 09:50 手術開始 09:50 麻醉結束 10:10 手術結束 10:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 內頸靜脈切開,永久導管放置術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Port-A 開立醫師: 陳政維 開立時間: 2011/08/04 09:24 Pre-operative Diagnosis Lymphoma Post-operative Diagnosis s/p Port-A implantation Operative Method Port-A catheter implantation, echo guided Specimen Count And Types nil Pathology Nil Operative Findings 1.Puncture to right IJV under echo guidance 2.The venous blood flow freely in the Port-A catheter after implantation. Operative Procedures 1. The patient was put on supine position. The operation field was disinfected and draped as usual. 2. Under local anesthesia, we puncture to right IJV under echo guidance. 3. After creating subcutaneous pocket, the Port-A catheter was inserted via peel away sheath. 4. We close the wound in layers. Operators VS吳毅暉 Assistants R4陳政維 蔡吳里 (F,1930/10/20,81y4m) 手術日期 2011/08/04 手術主治醫師 蔡清霖 手術區域 東址 027房 02號 診斷 Femoral neck fracture, closed 器械術式 Hemi..Bipolar 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 脊髓麻醉 麻醉主治醫師 劉治民 ASA 3 紀錄醫師 黃全敬, 時間資訊 00:00 臨時手術NPO 11:15 報到 11:47 進入手術室 11:47 麻醉開始 12:05 誘導結束 12:30 抗生素給藥 12:45 手術開始 12:50 抗生素給藥 14:05 手術結束 14:05 麻醉結束 14:10 送出病患 14:15 進入恢復室 15:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Spinal anesthesia 1 0 麻醉 SPINAL ANESTHESIA 1 0 手術 部份關節置換術併整形術–只置換髖臼或股骨或半股關節或半肩關節 1 1 L 摘要__ 手術科部: 骨科部 套用罐頭: cemented bipolar hemiarthroplasty with United... 開立醫師: 黃全敬 開立時間: 2011/08/04 14:00 Pre-operative Diagnosis left femoral neck fracture, displaced Post-operative Diagnosis left femoral neck fracture, displaced Operative Method cemented bipolar hemiarthroplasty with United prosthesis Specimen Count And Types nil Pathology nil Operative Findings 1. left femoral neck fracture, displaced 2. United prosthesis: shell 40 mm; head 26 mm neck +0 mm; femoral stem proximal #2 distal 10 mm Operative Procedures 1. SA, lateral decubitus position 2. skin disinfection, draped 3. skin incision over left hip, anterolateral approach to hip joint 4. remove femoral head, cut femoral neck as guide 5. ream femoral canal, prepare with broach 6. set bipolar prosthesis using cemented technique 7. reduce hip joint, check alignment and stability 8. N/S irrigation, hemostasis, close the wound in layers Operators 蔡清霖, Assistants 黃全敬, 董正仁, 廖翊廷, 記錄__ 手術科部: 骨科部 套用罐頭: cemented bipolar hemiarthroplasty with United... 開立醫師: 黃全敬 開立時間: 2011/08/04 14:00 Pre-operative Diagnosis left femoral neck fracture, displaced Post-operative Diagnosis left femoral neck fracture, displaced Operative Method cemented bipolar hemiarthroplasty with United prosthesis Specimen Count And Types nil Pathology nil Operative Findings 1. left femoral neck fracture, displaced 2. United prosthesis: shell 40 mm; head 26 mm neck +0 mm; femoral stem proximal #2 distal 10 mm Operative Procedures 1. SA, lateral decubitus position 2. skin disinfection, draped 3. skin incision over left hip, anterolateral approach to hip joint 4. remove femoral head, cut femoral neck as guide 5. ream femoral canal, prepare with broach 6. set bipolar prosthesis using cemented technique 7. reduce hip joint, check alignment and stability 8. N/S irrigation, hemostasis, close the wound in layers Operators 蔡清霖, Assistants 黃全敬, 董正仁, 廖翊廷, 李碧珠 (F,1946/08/16,65y6m) 手術日期 2011/08/04 手術主治醫師 陳敞牧 手術區域 東址 013房 06號 診斷 Secondary cancer of brain and spinal cord 器械術式 T4-6 tumor excision & T3-7 TPS posterior fixation 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 蕭柏妮 ASA 3E 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 07:38 通知急診手術 22:35 進入手術室 22:37 麻醉開始 22:45 誘導結束 23:22 抗生素給藥 23:40 手術開始 01:30 開始輸血 02:45 手術結束 02:45 麻醉結束 03:00 送出病患 03:05 進入恢復室 04:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 惡性脊髓腫瘤切除術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Extended laminectomy for subtotal tumor excis... 開立醫師: 林哲光 開立時間: 2011/08/05 03:32 Pre-operative Diagnosis T4-6 epidural tumor with cord compression Post-operative Diagnosis T4-6 epidural tumor with cord compression Operative Method Extended laminectomy for subtotal tumor excision, partial T2 and T7 Specimen Count And Types 1 piece About size:multiple pieces Source:tumor Pathology Pending Operative Findings Severe adhesion of paraspinal muscles were noted with obvious fibrotic change and the layers could not be identified well. The tumor was located mostly at T5 level with cord encasement and tightly adherent to the dura. The tumor was elastic-firm, grayish epidural mass without obvious vascularity, directly compressing the dura tighly. The dura seemed re-expanded well after the tumor was removed as extended as possible. Operative Procedures Under ETGA and prone position, skin disinfected and drapped were performed as usual. SKin incision was made at previous midline incision and extended to expose T2 and T7 spinous process. The paraspinal muscles were then opened after the dura and lamina level were identified from the normal structure. Tumor excision was then performed. Hemostasis with Gelfoam packing and the wound was closed in layers after a epidural hemovac drain was inserted. Operators 陳敞牧 Assistants R5 林哲光 Indication Of Emergent Operation Acute myelopathy 相關圖片 楊景宗 (M,1991/01/22,21y1m) 手術日期 2011/08/04 手術主治醫師 陳敞牧 手術區域 東址 005房 01號 診斷 Spine tumor 器械術式 Benign intraspinal tumor, exci 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 周聖哲, 時間資訊 23:14 臨時手術NPO 07:40 報到 07:57 進入手術室 08:00 麻醉開始 08:30 誘導結束 08:34 抗生素給藥 09:25 手術開始 11:35 抗生素給藥 13:20 麻醉結束 13:20 手術結束 13:22 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 良性脊髓腫瘤切除術 1 1 手術 脊椎融合術-後融合,有固定物(<=六節) 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 摘要__ 手術科部: 外科部 套用罐頭: Posterior Fusion for Cervical Spine 開立醫師: 曾峰毅 開立時間: 2011/08/04 13:40 Pre-operative Diagnosis Neurilemomma right left C3 root, status post C3-4 laminectomy for tumor excision, recurrence Neurilemomma right left C3 root, status post C3-4 laminectomy for tumor excision, recurrence, with kyphotic change Post-operative Diagnosis Neurilemomma right left C3 root, status post C3-4 laminectomy for tumor excision, recurrence Neurilemomma right left C3 root, status post C3-4 laminectomy for tumor excision, recurrence with kyphotic change Operative Method Tumor excision via C3-4 laminectomy, posterior fixation with lateral mass screws at C3-4-5, and posterior fusion with artificial bone graft. Specimen Count And Types Several fragments of one tumor was sent for pathology. Pathology Pending Operative Findings One intradural, extramedullary, well-capsulated, firm to elastic, was noted arised from left C3 root. Synthes Axon screws were inserted into bilatearl lateral masses of C3-5 for posterior fixation. SimBone HT 5 ml were used for posterior fusion. One intradural, extramedullary, well-capsulated, firm to elastic, was noted arised from left C3 root. Synthes Axon screws were inserted into bilatearl lateral masses of C3-5 for posterior fixation. SimBone HT 5 ml were used for posterior fusion. Kphotic chagne was reduced after posterior fixation. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position with head fixed with Mayfield head clamp. We made one midlins skin incision along previous operation wound, and dissected to exposed previous C3/4 laminectomy window, and C2 and C5 laminae. We made one paramedian durotomy and performed tumor excision with CUSA and dissector. The dura was closed in water-tight suture, and seal with durofoam. Lateral mass screws were inserted into bialteral latearl massed of C3-4-5 for posterior fixation. Posterior fusion was achieved after decrotication over lateral mass and placement of artificial bone graft. The wound was closed in layers after one epidural CWV placed. With endotracheal general anaesthesia, the patient was put in prone position with head fixed with Mayfield head clamp. We made one midlins skin incision along previous operation wound, and dissected to exposed previous C3/4 laminectomy window, and C2 and C5 laminae. We made one paramedian durotomy and performed tumor excision with CUSA and dissector. The dura was closed in water-tight suture, and seal with durofoam. Lateral mass screws were inserted into bialteral latearl massed of C3-4-5 for posterior fixation. Reduction of kyphotic change was done. Posterior fusion was achieved after decrotication over lateral mass and placement of artificial bone graft. The wound was closed in layers after one epidural CWV placed. Operators VS 陳敞牧 Assistants R5 曾峰毅 R2 周聖哲 相關圖片 臧傳平 (M,1964/05/10,47y10m) 手術日期 2011/08/04 手術主治醫師 楊士弘 手術區域 東址 005房 02號 診斷 Cervical spondylosis 器械術式 Diskectomy cervical (後開加前開) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 周聖哲, 時間資訊 23:16 臨時手術NPO 13:45 進入手術室 13:55 麻醉開始 14:00 抗生素給藥 14:05 誘導結束 14:11 手術開始 17:00 抗生素給藥 17:09 開始輸血 20:15 手術結束 20:28 送出病患 20:28 麻醉結束 21:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-頸椎 1 1 手術 椎弓整形術 1 1 手術 椎融合術-前融合,無固定物(≦四節) 1 3 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Laminoplasty, Hirabayashi method, C3-6; lamin... 開立醫師: 曾峰毅 開立時間: 2011/08/04 20:43 Pre-operative Diagnosis Congenital stenosis, C3-T2; cervical herniated intervertebral disc, C5/6 Post-operative Diagnosis Congenital stenosis, C3-T2; cervical herniated intervertebral disc, C5/6 Operative Method Laminoplasty, Hirabayashi method, C3-6; laminectomy, upper C7, T1, and upper T2, for sublaminar decompression; anterior cervical discectomy, C5/6, with anterior fusion with PEEK cage and artificial bone graft Specimen Count And Types Nil Pathology Nil Operative Findings Thecal sac was compromised by stenotic spinal canal and hypertrophic ligamentum flavum, and was decompressed well after the surgery. SSEP and MEP did not change during the surgery. Zimmer PEEK cage was used for anterior fusion. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position with headh fixed with Mayfield head clamp. We shaved, scrubbed, disinfected, and then draped the patient. One midline skin incision was made from 2 cm below the inion to upper back. We dissected to expose bilatearl laminae from C2 to T2, and drilled left laminae from C3 to C6 bicortically, and drilled half layer of right laminae from C3 to C6. Laminoplasty was achieved with hinge at right, and fixation with mini-plate at left. Upper C7, T1, and upper T2 laminectomy was peformed for suhblaminar decompression. We placed one epidural CWV, and closed the wound in layers. We turned the patient to supine position, and re-draped the neck. We made one transverse skin incision at right aspect of the neck, and dissected to expose prevertebral space of C5/6. After C-arm confirmation, we performed C5/6 diskectomy. Fusion with PEEK cage and artificial bone graft was done. The wound was closed in layers. Operators VS 楊士弘 Assistants R5 曾峰毅 R2 周聖哲 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Laminoplasty, Hirabayashi method, C3-6; lamin... 開立醫師: 周聖哲 開立時間: 2011/08/17 08:50 Pre-operative Diagnosis Developmental stenosis, C3-T2; cervical herniated intervertebral disc, C5/6 Post-operative Diagnosis Developmental stenosis, C3-T2; cervical herniated intervertebral disc, C5/6 Operative Method Laminoplasty, Hirabayashi method, C3-6; laminectomy, upper C7, T1, and upper T2, for sublaminar decompression; anterior cervical discectomy, C5/6, with anterior fusion with PEEK cage and artificial bone graft Specimen Count And Types Nil Pathology Nil Operative Findings Thecal sac was compromised by stenotic spinal canal and hypertrophic ligamentum flavum, and was decompressed well after the surgery. SSEP and MEP did not change during the surgery. Zimmer PEEK cage was used for anterior fusion. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position with headh fixed with Mayfield head clamp. We shaved, scrubbed, disinfected, and then draped the patient. One midline skin incision was made from 2 cm below the inion to upper back. We dissected to expose bilatearl laminae from C2 to T2, and drilled left laminae from C3 to C6 bicortically, and drilled half layer of right laminae from C3 to C6. Laminoplasty was achieved with hinge at right, and fixation with mini-plate at left. Upper C7, T1, and upper T2 laminectomy was peformed for suhblaminar decompression. We placed one epidural CWV, and closed the wound in layers. We turned the patient to supine position, and re-draped the neck. We made one transverse skin incision at right aspect of the neck, and dissected to expose prevertebral space of C5/6. After C-arm confirmation, we performed C5/6 diskectomy. Fusion with PEEK cage and artificial bone graft was done. The wound was closed in layers. Operators VS 楊士弘 Assistants R5 曾峰毅 R2 周聖哲 相關圖片 柯耀南 (M,1939/11/10,72y4m) 手術日期 2011/08/04 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 Dizziness and vertigo 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 王奐之, 時間資訊 23:12 臨時手術NPO 12:55 進入手術室 13:00 麻醉開始 13:10 誘導結束 13:20 抗生素給藥 13:38 手術開始 14:46 手術結束 14:46 麻醉結束 14:55 送出病患 14:56 進入恢復室 15:56 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 頭顱成形術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Right side cranioplasty with autologous bone ... 開立醫師: 王奐之 開立時間: 2011/08/04 14:50 Pre-operative Diagnosis Right side skull defect Post-operative Diagnosis Right side skull defect Operative Method Right side cranioplasty with autologous bone graft Specimen Count And Types nil Pathology nil Operative Findings Easy oozing was encountered during the whole procedure. Mild adhesion was noted between the galea & the dura. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position. After shaving, scrubbing, disinfection & draping in sterile fashion, a question mark incision was made along previous craniectomy scar. The plane between galea and dura was dissected, the bony edge was then exposed. After central tenting, the bone graft was fixed back with mini-plates. The wound was then closed in layers after hemostasis & setting up of 2 subgaleal CWV drains. Operators VS 王國川 Assistants R4 王奐之 R1 吳欣翰 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Right side cranioplasty with autologous bone ... 開立醫師: 王奐之 開立時間: 2011/08/04 14:50 Pre-operative Diagnosis Right side skull defect Post-operative Diagnosis Right side skull defect Operative Method Right side cranioplasty with autologous bone graft Specimen Count And Types nil Pathology nil Operative Findings Easy oozing was encountered during the whole procedure. Mild adhesion was noted between the galea & the dura. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position. After shaving, scrubbing, disinfection & draping in sterile fashion, a question mark incision was made along previous craniectomy scar. The plane between galea and dura was dissected, the bony edge was then exposed. After central tenting, the bone graft was fixed back with mini-plates. The wound was then closed in layers after hemostasis & setting up of 2 subgaleal CWV drains. Operators VS 王國川 Assistants R4 王奐之 R1 吳欣翰 相關圖片 許美柑 (F,1951/04/22,60y10m) 手術日期 2011/08/04 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Brain metastasis 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 王奐之, 時間資訊 23:08 臨時手術NPO 08:05 進入手術室 08:10 麻醉開始 08:50 誘導結束 09:00 抗生素給藥 09:25 手術開始 12:30 手術結束 12:30 麻醉結束 12:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Left occipital craniotomy for tumor resection 開立醫師: 王奐之 開立時間: 2011/08/04 12:49 Pre-operative Diagnosis Left occipital tumor, suspected metastasis Post-operative Diagnosis Left occipital tumor, suspected metastasis Operative Method Left occipital craniotomy for tumor resection Specimen Count And Types 1 piece About size:pieces Source:left occipital tumor Pathology Nil Operative Findings A soft, fragile, purplish hypervascular tumor was noted at left occipital area, with dural involvement, measuring about 3*2*2cm. The tumor was irregular in shape and appeared to have indistinct border, gross total tumor resection was achieved. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position with head fixed in Mayfield skull clamp. After shaving, scrubbing, disinfection & draping in sterile fashion, a reverse-U shaped incision was made at left occipital area. After reflecting the periosteum inferiorly, 3 burr holes were drilled, followed by craniotomy. After ultrasonographic confirmation of tumor location, an U-shape durotomy was done. Tumor was then dissected and removed in pieces. After meticulous hemostasis, the tumor bed was packed with Surgicel. The overlying involved dura was also excised. Dura was then closed with periosteal graft in water-tight fashion. The bone flap was fixed back with 5 wires after central tenting. The wound was closed in layers after setting 1 subgaleal CWV drain. Operators VS 王國川 Assistants R4 王奐之, R3 陳國瑋 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Left occipital craniotomy for tumor resection 開立醫師: 王奐之 開立時間: 2011/08/04 12:49 Pre-operative Diagnosis Left occipital tumor, suspected metastasis Post-operative Diagnosis Left occipital tumor, suspected metastasis Operative Method Left occipital craniotomy for tumor resection Specimen Count And Types 1 piece About size:pieces Source:left occipital tumor Pathology Nil Operative Findings A soft, fragile, purplish hypervascular tumor was noted at left occipital area, with dural involvement, measuring about 3*2*2cm. The tumor was irregular in shape and appeared to have indistinct border, gross total tumor resection was achieved. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position with head fixed in Mayfield skull clamp. After shaving, scrubbing, disinfection & draping in sterile fashion, a reverse-U shaped incision was made at left occipital area. After reflecting the periosteum inferiorly, 3 burr holes were drilled, followed by craniotomy. After ultrasonographic confirmation of tumor location, an U-shape durotomy was done. Tumor was then dissected and removed in pieces. After meticulous hemostasis, the tumor bed was packed with Surgicel. The overlying involved dura was also excised. Dura was then closed with periosteal graft in water-tight fashion. The bone flap was fixed back with 5 wires after central tenting. The wound was closed in layers after setting 1 subgaleal CWV drain. Operators VS 王國川 Assistants R4 王奐之, R3 陳國瑋 相關圖片 杜張玉真 (F,1951/11/21,60y3m) 手術日期 2011/08/04 手術主治醫師 王國川 手術區域 東址 003房 03號 診斷 Lymphoma 器械術式 Ommaya reservoir implantation 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 王奐之, 時間資訊 23:14 臨時手術NPO 15:20 進入手術室 15:25 麻醉開始 15:35 誘導結束 15:48 抗生素給藥 15:55 手術開始 16:36 手術結束 16:36 麻醉結束 16:40 送出病患 16:45 進入恢復室 18:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 歐氏貯囊置放手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Ommaya reservoir implantation via right Koche... 開立醫師: 王奐之 開立時間: 2011/08/04 16:47 Pre-operative Diagnosis Diffuse large B cell lymphoma with CNS involvement Post-operative Diagnosis Diffuse large B cell lymphoma with CNS involvement Operative Method Ommaya reservoir implantation via right Kocher point Specimen Count And Types Nil Pathology Nil Operative Findings Clear CSF was noted, opening pressure: 5~10 cmH2O. Ventricular catheter length set at 6.5 cm. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position. After shaving, scrubbing, disinfection & draping in sterile fashion, a curved incision was made at right frontal area. A burr hole was then created at right Kocher point, followed by 2 tenting stitches. A small cruciate durotomy was then performed, ventricular puncture was done after hemostasis. The Ommaya reservoir was then assembled and inserted. The wound was closed in layers. Operators VS 王國川 Assistants R4 王奐之 相關圖片 記錄__ 手術科部: 內科部 套用罐頭: Ommaya reservoir implantation via right Koche... 開立醫師: 王奐之 開立時間: 2011/08/04 16:47 Pre-operative Diagnosis Diffuse large B cell lymphoma with CNS involvement Post-operative Diagnosis Diffuse large B cell lymphoma with CNS involvement Operative Method Ommaya reservoir implantation via right Kocher point Specimen Count And Types Nil Pathology Nil Operative Findings Clear CSF was noted, opening pressure: 5~10 cmH2O. Ventricular catheter length set at 6.5 cm. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position. After shaving, scrubbing, disinfection & draping in sterile fashion, a curved incision was made at right frontal area. A burr hole was then created at right Kocher point, followed by 2 tenting stitches. A small cruciate durotomy was then performed, ventricular puncture was done after hemostasis. The Ommaya reservoir was then assembled and inserted. The wound was closed in layers. Operators VS 王國川 Assistants R4 王奐之 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Ommaya reservoir implantation via right Koche... 開立醫師: 王奐之 開立時間: 2011/08/04 16:49 Pre-operative Diagnosis Diffuse large B cell lymphoma with CNS involvement Post-operative Diagnosis Diffuse large B cell lymphoma with CNS involvement Operative Method Ommaya reservoir implantation via right Kocher point Specimen Count And Types Nil Pathology Nil Operative Findings Clear CSF was noted, opening pressure: 5~10 cmH2O. Ventricular catheter length set at 6.5 cm. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position. After shaving, scrubbing, disinfection & draping in sterile fashion, a curved incision was made at right frontal area. A burr hole was then created at right Kocher point, followed by 2 tenting stitches. A small cruciate durotomy was then performed, ventricular puncture was done after hemostasis. The Ommaya reservoir was then assembled and inserted. The wound was closed in layers. Operators VS 王國川 Assistants R4 王奐之 相關圖片 涂春陽 (M,1960/01/26,52y1m) 手術日期 2011/08/04 手術主治醫師 蔡翊新 手術區域 東址 016房 03號 診斷 Arteriovenous malformation, brain 器械術式 Right craniectomy for decompression and SDH evacuation 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 4E 紀錄醫師 吳欣翰, 時間資訊 13:42 通知急診手術 13:42 臨時手術NPO 13:42 開始NPO 14:30 報到 14:30 進入手術室 14:35 麻醉開始 14:50 誘導結束 15:10 抗生素給藥 15:30 手術開始 18:10 抗生素給藥 19:55 開始輸血 21:05 麻醉結束 21:05 手術結束 21:10 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 開顱術摘除血管病變-動靜脈畸型小型表淺 1 1 R 手術 顱內壓視置入 1 2 R 摘要__ 手術科部: 外科部 套用罐頭: AVM 開立醫師: 蔡翊新 開立時間: 2011/08/04 20:39 Pre-operative Diagnosis Right frontotemporoparietal SDH, suspicious vascular lesion at right parietal lobe. Post-operative Diagnosis Right frontotemporoparietal SDH, suspected traumatic origin. Right frontoparietal superficial AVM. Operative Method Right F-T-P craniotomy for SDH evacuation, ICP monitoring and AVM excision. Specimen Count And Types 1 piece About size: 2 x 0.5 cm Source:brain, AVM Pathology Pending. Operative Findings The dura was tense when craniotomy was made. Initial ICP after craniotomy was 26 mmHg. Subdural blood clot, 18 x 16 x 1 cm, was evacuated from right F-T-P region. There was a 4 x 4 cm contusion at right temporoparietal area, with a cortical artery as the bleeder. Two engorged venous structure were noted at right frontoparietal area, with several tiny tortuous feeding arteries coming from anterior and inferior aspects as distal branches of right MCA. The nidus of the AVM was about 2 x 1 cm. After SDH evacuation, the brain was slack. ICP after skin closure was 1 mmHg. The dura was tense when craniotomy was made. Initial ICP after craniotomy was 26 mmHg. Subdural blood clot, 18 x 16 x 1 cm, was evacuated from right F-T-P region. There was a 4 x 4 cm contusion at right temporoparietal area, with a cortical artery as the bleeder. Two engorged venous structure were noted at right frontoparietal area, with several tiny tortuous feeding arteries coming from anterior and inferior aspects as distal branches of right MCA. The nidus of the AVM was about 2 x 1 cm. The vein was drained into the superior sagittal sinus. After SDH evacuation, the brain was slack. ICP after skin closure was 1 mmHg. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: trauma flap at right F-T-P area. Raney clips were applied to the scalp edge for temporary hemostasis. 5. Craniotomy window: 14 x 12 cm, right fronto-temporo-parietal, created by making 5 burr holes then cut by power saw. 6. Dural tenting: by 2/0 silk, 2.5 cm in interval, distributed along the edge of skull window. 7. Dural incision: curvilinear. 8. The subdural blood clots were evacuated by sucker and normal saline irrigation. The bleeder was coagulated by bipolar coagulator. 9. The feeding arteries of the AVM were coagulated. The nidus of the AVM was dissected from the adjacent brain tissue. The vein drained into the superior sagittal sinus was clipped and divided and the nidus was removed. 10.Hemostasis: The blood oozing point from several locations on the bare surface were packed with surgicel for complete hemostasis. A Codman ICP monitor was placed at subdural space of right frontal area. Reference level: 494. 10.Dural closure: interruped 2/0 silk sutures for key stitches, then continuous suture with 4/0 prolene to obtain water-tight closure. A piece of pericranium (12x2 cm) was used for a perfect dural closure. 11.Closure of skull window: the skull plate was placed back to craniotomy window and fixed by 3 miniplates and 6 screws. The dura was tented to the center of the skull plate by several 2/0 stitches. 12.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Dexon and skin by continuous suture with 3/0 nylon. 13.Drain: two epidural CWV. 14.Blood transfusion: PRBC 2U. Blood loss: 600 ml. 15.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5林哲光R1吳欣翰 Indication Of Emergent Operation SDH, midline shift, conscious disturbance, pupil anisocoria 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: AVM 開立醫師: 林哲光 開立時間: 2011/08/04 21:37 Pre-operative Diagnosis Right frontotemporoparietal SDH, suspicious vascular lesion at right parietal lobe. Post-operative Diagnosis Right frontotemporoparietal SDH, suspected traumatic origin. Right frontoparietal superficial AVM. Operative Method Right F-T-P craniotomy for SDH evacuation, ICP monitoring and AVM excision. Specimen Count And Types 1 piece About size: 2 x 0.5 cm Source:brain, AVM Pathology Pending. Operative Findings The dura was tense when craniotomy was made. Initial ICP after craniotomy was 26 mmHg. Subdural blood clot, 18 x 16 x 1 cm, was evacuated from right F-T-P region. There was a 4 x 4 cm contusion at right temporoparietal area, with a cortical artery as the bleeder. Two engorged venous structure were noted at right frontoparietal area, with several tiny tortuous feeding arteries coming from anterior and inferior aspects as distal branches of right MCA. The nidus of the AVM was about 2 x 1 cm. The vein was drained into the superior sagittal sinus. After SDH evacuation, the brain was slack. ICP after skin closure was 1 mmHg. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: trauma flap at right F-T-P area. Raney clips were applied to the scalp edge for temporary hemostasis. 5. Craniotomy window: 14 x 12 cm, right fronto-temporo-parietal, created by making 5 burr holes then cut by power saw. 6. Dural tenting: by 2/0 silk, 2.5 cm in interval, distributed along the edge of skull window. 7. Dural incision: curvilinear. 8. The subdural blood clots were evacuated by sucker and normal saline irrigation. The bleeder was coagulated by bipolar coagulator. 9. The feeding arteries of the AVM were coagulated. The nidus of the AVM was dissected from the adjacent brain tissue. The vein drained into the superior sagittal sinus was clipped and divided and the nidus was removed. 10.Hemostasis: The blood oozing point from several locations on the bare surface were packed with surgicel for complete hemostasis. A Codman ICP monitor was placed at subdural space of right frontal area. Reference level: 494. 10.Dural closure: interruped 2/0 silk sutures for key stitches, then continuous suture with 4/0 prolene to obtain water-tight closure. A piece of pericranium (12x2 cm) was used for a perfect dural closure. 11.Closure of skull window: the skull plate was placed back to craniotomy window and fixed by 3 miniplates and 6 screws. The dura was tented to the center of the skull plate by several 2/0 stitches. 12.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Dexon and skin by continuous suture with 3/0 nylon. 13.Drain: two epidural CWV. 14.Blood transfusion: PRBC 2U. Blood loss: 600 ml. 15.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5林哲光R1吳欣翰 Indication Of Emergent Operation SDH, midline shift, conscious disturbance, pupil anisocoria 相關圖片 楊陳月桃 (F,1936/05/26,75y9m) 手術日期 2011/08/05 手術主治醫師 郭順文 手術區域 東址 025房 02號 診斷 Meningioma 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 蕭柏妮 ASA 3 紀錄醫師 郝政鴻, 時間資訊 10:33 報到 10:33 進入手術室 10:50 麻醉開始 10:50 抗生素給藥 10:55 誘導結束 10:56 手術開始 11:18 麻醉結束 11:18 手術結束 11:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 氣管切開術 1 0 記錄__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 郝政鴻 開立時間: 2011/08/05 11:23 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types nil Pathology None Operative Findings Fr . 7 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators VS郭順文 Assistants R4高明蔚 R4郝政鴻 曾振添 (M,1971/07/15,40y7m) 手術日期 2011/08/05 手術主治醫師 李章銘 手術區域 東址 018房 02號 診斷 Stridor 器械術式 Stent insertion 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 4E 紀錄醫師 蔡東明, 時間資訊 09:02 開始NPO 20:02 通知急診手術 22:00 進入手術室 22:10 麻醉開始 22:40 誘導結束 22:50 手術開始 00:20 手術結束 00:20 麻醉結束 00:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 管內腔置管術 1 1 記錄__ 手術科部: 外科部 套用罐頭: Trachea stent insertion 開立醫師: 蔡東明 開立時間: 2011/08/06 00:38 Pre-operative Diagnosis 1.Tracheal invasion by esophageal cancer 2.Airway obstruction Post-operative Diagnosis 1.Tracheal invasion by esophageal cancer 2.Airway obstruction Operative Method Trachea stent insertion Specimen Count And Types nil Pathology None Operative Findings Trachea obstruction by lobulated mass is noted at middle part of trachea (4cm to 6cm above carina). The airway is partially obstructed. One 20mm*40mm (25mm cover) trachea stent is inserted to bypass the stenosis site. Operative Procedures 1.ETGA, supine 2.Skin disinfection and drapping 3.Set up of rigid bronchoscopic setting 4.Insertion of trachea stent Operators VS李章銘 VS郭順文 Assistants R5蔡東明 Indication Of Emergent Operation Airway obstruction 竇斌峰 (M,1996/09/10,15y6m) 手術日期 2011/08/05 手術主治醫師 郭夢菲 手術區域 東址 000房 號 診斷 Cerebral Palsy 器械術式 Revision of CSF shunt 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3E 紀錄醫師 王奐之, 時間資訊 11:00 臨時手術NPO 11:00 開始NPO 11:37 通知急診手術 17:23 進入手術室 17:30 麻醉開始 17:40 誘導結束 18:00 抗生素給藥 18:13 手術開始 19:10 麻醉結束 19:10 手術結束 19:20 送出病患 19:28 進入恢復室 20:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦脊髓液分流管重置 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: V-P shunt revision 開立醫師: 王奐之 開立時間: 2011/08/05 19:32 Pre-operative Diagnosis Cerebral palsy with hydrocephalus, status post V-P shunt insertion & revision, with suspected V-P shunt dysfunction Post-operative Diagnosis Cerebral palsy with hydrocephalus, status post V-P shunt insertion & revision, with suspected V-P shunt dysfunction Operative Method V-P shunt revision Specimen Count And Types Peritoneal catheter tip & CSF, sent for bacterial/fungal/mycobacterial culture. Pathology Nil Operative Findings Whitish debris clotting at the tip of peritoneal catheter was noted. The catheter seemed to stuck at the level of chest, where the straight connector lied. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After shaving, scrubbing, disinfection & draping in sterile fashion, a linear incision was made at right upper quadrant (along one of the previous wound). A small wound was made at right frontal scalp along previous scar. Previous shunt catheter was exposed, the new peritoneal catheter was then inserted via original path. After removal of the old peritoneal catheter, a new subcutaneous tunnel was created from the abdominal wound to the scalp wound, with 2 new wounds in between for easier passage. The ventricular catheter was disconnected from the old shunt and connected to the new peritoneal catheter. The old shunt was then removed. After hemostasis, the wounds were closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之 Indication Of Emergent Operation Persistent hydrocephalus & IICP. 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: V-P shunt revision 開立醫師: 王奐之 開立時間: 2011/08/05 19:32 Pre-operative Diagnosis Cerebral palsy with hydrocephalus, status post V-P shunt insertion & revision, with suspected V-P shunt dysfunction Post-operative Diagnosis Cerebral palsy with hydrocephalus, status post V-P shunt insertion & revision, with suspected V-P shunt dysfunction Operative Method V-P shunt revision Specimen Count And Types Peritoneal catheter tip & CSF, sent for bacterial/fungal/mycobacterial culture. Pathology Nil Operative Findings Whitish debris clotting at the tip of peritoneal catheter was noted. The catheter seemed to stuck at the level of chest, where the straight connector lied. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After shaving, scrubbing, disinfection & draping in sterile fashion, a linear incision was made at right upper quadrant (along one of the previous wound). A small wound was made at right frontal scalp along previous scar. Previous shunt catheter was exposed, the new peritoneal catheter was then inserted via original path. After removal of the old peritoneal catheter, a new subcutaneous tunnel was created from the abdominal wound to the scalp wound, with 2 new wounds in between for easier passage. The ventricular catheter was disconnected from the old shunt and connected to the new peritoneal catheter. The old shunt was then removed. After hemostasis, the wounds were closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之 Indication Of Emergent Operation Persistent hydrocephalus & IICP. 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: V-P shunt revision 開立醫師: 郭夢菲 開立時間: 2011/08/08 11:18 Pre-operative Diagnosis Cerebral palsy with hydrocephalus, status post V-P shunt insertion & revision, with suspected V-P shunt dysfunction Post-operative Diagnosis Cerebral palsy with hydrocephalus, status post V-P shunt insertion & revision, with suspected V-P shunt dysfunction Operative Method V-P shunt revision Specimen Count And Types Peritoneal catheter tip & CSF, sent for bacterial/fungal/mycobacterial culture. Pathology Nil Operative Findings 1. Whitish debris clotting at the tip of peritoneal catheter was noted though it was patent. 2. The catheter stucked at the level of chest, where the straight connector lied. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After shaving, scrubbing, disinfection & draping in sterile fashion, a linear incision was made at right upper quadrant (along one of the previous wound). A small wound was made at right frontal scalp along previous scar. Previous shunt catheter was exposed, the new peritoneal catheter was then inserted via original path. After removal of the old peritoneal catheter, a new subcutaneous tunnel was created from the abdominal wound to the scalp wound due to adhesion of the old peritoneal catheter, with 2 new wounds in between for easier passage. The new peritoneal catheter was connected to the previous short proximal catheter, then the old peritoneal catheter was removed. After hemostasis, the four wounds were closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之 Indication Of Emergent Operation 相關圖片 蔡美金 (F,1958/01/02,54y2m) 手術日期 2011/08/05 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Dislocations of second cervical vertebra, closed 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 2 紀錄醫師 周聖哲, 時間資訊 23:00 臨時手術NPO 07:43 報到 08:03 進入手術室 08:10 麻醉開始 08:25 誘導結束 08:30 抗生素給藥 09:05 手術開始 11:05 手術結束 11:05 麻醉結束 11:15 送出病患 11:20 進入恢復室 13:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 脊椎融合術-後融合,無固定物 1 1 摘要__ 手術科部: 外科部 套用罐頭: Re-adjustment & fixation of bone graft for C1... 開立醫師: 王奐之 開立時間: 2011/08/05 10:57 Pre-operative Diagnosis C1-2 subluxation s/p TAS & C1-2 posterior fusion, with malposition of bone graft & non-union Post-operative Diagnosis C1-2 subluxation s/p TAS & C1-2 posterior fusion, with malposition of bone graft & non-union Operative Method Re-adjustment & fixation of bone graft for C1-2 posterior fusion Specimen Count And Types Nil Pathology Nil Operative Findings The bone graft splitted into 3 fragments, the 2 posterior segments were easily detached and showed non-union, while the remaining bone graft fragment already united with C2 lamina; non-union was noted between the bone graft and the C1 posterior arch. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position with head fixed in Mayfield skull clamp. After shaving, scrubbing, disinfection & draping in sterile fashion, a midline linear incision was made along previous scar at posterior upper neck. The incision was deepened until the C2 spinous process & the bone graft exposed. After removal of the mobilized fragments of bone graft, the C2 spinous process & C1 posterior arch were decorticated. The longest mobilized fragment of bone graft was re-fixed to the remaining graft & C1 posterior arch with mini-plates & screws. After meticulous hemostasis, the wound was closed in layers. After endotracheal general anesthesia, the patient was placed in prone position with head fixed in Mayfield skull clamp. After shaving, scrubbing, disinfection & draping in sterile fashion, a midline linear incision was made along previous scar at posterior upper neck. The incision was deepened until the C2 spinous process & the bone graft exposed. After removal of the mobilized fragments of bone graft, the C2 spinous process & C1 posterior arch were decorticated. The longest mobilized fragment of bone graft was re-fixed to the remaining graft & C1 posterior arch with mini-plates & screws. After meticulous hemostasis, the operative field was irriagated with diluted Gentamicin. The wound was then closed in layers. Operators VS 賴達明 Assistants R4 王奐之, R2 周聖哲, Ri 沈宛臻 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Re-adjustment & fixation of bone graft for C1... 開立醫師: 王奐之 開立時間: 2011/08/05 10:58 Pre-operative Diagnosis C1-2 subluxation s/p TAS & C1-2 posterior fusion, with malposition of bone graft & non-union Post-operative Diagnosis C1-2 subluxation s/p TAS & C1-2 posterior fusion, with malposition of bone graft & non-union Operative Method Re-adjustment & fixation of bone graft for C1-2 posterior fusion Specimen Count And Types Nil Pathology Nil Operative Findings The bone graft splitted into 3 fragments, the 2 posterior segments were easily detached and showed non-union, while the remaining bone graft fragment already united with C2 lamina; non-union was noted between the bone graft and the C1 posterior arch. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position with head fixed in Mayfield skull clamp. After shaving, scrubbing, disinfection & draping in sterile fashion, a midline linear incision was made along previous scar at posterior upper neck. The incision was deepened until the C2 spinous process & the bone graft exposed. After removal of the mobilized fragments of bone graft, the C2 spinous process & C1 posterior arch were decorticated. The longest mobilized fragment of bone graft was re-fixed to the remaining graft & C1 posterior arch with mini-plates & screws. After meticulous hemostasis, the operative field was irriagated with diluted Gentamicin. The wound was then closed in layers. Operators VS 賴達明 Assistants R4 王奐之, R2 周聖哲, Ri 沈宛臻 相關圖片 李柯金定 (F,1936/11/20,75y3m) 手術日期 2011/08/05 手術主治醫師 賴達明 手術區域 東址 005房 02號 診斷 Cerebral aneurysm 器械術式 External ventricular drainage 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 林哲光, 時間資訊 23:59 臨時手術NPO 13:00 進入手術室 13:05 麻醉開始 13:10 誘導結束 13:38 手術開始 14:20 手術結束 14:20 麻醉結束 14:26 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室體外引流 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Right Kocher point EVD insertion 開立醫師: 林哲光 開立時間: 2011/08/05 14:57 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Right Kocher point EVD insertion Specimen Count And Types nil Pathology Nil Operative Findings CSF seemed clear and mild xanthochromic. Gush of CSF was noted after ventriculostomy along the previous trajectory of right Kocher point. Intraventricular catheter was 6.5 cm long. Operative Procedures Under ETGA and supine position, skin disinfected and drapped were performed as usual. Skin incision was made at previous operative wound. The previous burr hole was exposed well and EVD was introduced into the ventricle along the previous tract of EVD. The wound was then closed in layers after EVD was fixed on the skin through subcutaneous tunnel. Operators 賴達明 Assistants R5 林哲光, Ri 林千又 相關圖片 林淑端 (F,1964/04/09,47y11m) 手術日期 2011/08/05 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 HIVD 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾偉倫, 時間資訊 23:56 臨時手術NPO 08:00 進入手術室 08:05 麻醉開始 08:20 誘導結束 08:40 抗生素給藥 09:02 手術開始 11:40 抗生素給藥 12:18 抗生素給藥 12:20 手術結束 12:20 麻醉結束 12:20 進入恢復室 12:38 送出病患 13:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎融合術-前融合,無固定物(≦四節) 1 2 手術 椎間盤切除術-頸椎 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Anterior cervical diskectomy and fusion with ... 開立醫師: 李振豪 開立時間: 2011/08/05 12:24 Pre-operative Diagnosis Herniated intervertebral disc, C5/6, with myelopathy Post-operative Diagnosis Herniated intervertebral disc, C5/6, with myelopathy Ossification of posterior longitudinal ligment Operative Method Anterior cervical diskectomy and fusion with PEEK cage Specimen Count And Types nil Pathology Nil Operative Findings Marginal spur formation with herniated disc was noted over C5/6 level. The disc was degenerative in character. The posterior longitudinal ligment was hypertrophic and calcified(left side) which compressed the thecal sac tightly. The PLL adhered to dura at calcified site. After resection of the posterior longitudinal ligment, the thecal sac expanded well. One #8 PEEK cage was inserted for anterior cervical fusion. No CSF leakage or incidental durotomy was noted. The EP was stationary during whole procedure. Marginal spur formation with herniated disc was noted over C5/6 level. The disc was degenerative in character. The posterior longitudinal ligment was hypertrophic and calcified which compressed the thecal sac tightly. After resection of the posterior longitudinal ligment, the thecal sac expanded well. One #8 PEEK cage was inserted for anterior cervical fusion. No CSF leakage or incidental durotomy was noted. The EP was stationary during whole procedure. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with neck extension. The skin was scrubbed, disinfected, and draped as usual. Transverse skin incision was made at right middle cervical level and the subcutaneous soft tissue was devided. The plan between thyroid gland and carotid sheath was entered to expose prevertebral fascia. The disc level was localized by portable C-arm X-ray. prevertebral muscle were opened and the longus collis muscle were detached. Microdiskectomy was performed with knife, curette, Midas high speed air-drived drills, Kerrison punches, and alligator. Resection of PLL and bilateral foraminotomy also conducted for decompression. Hemostasis was achieved and one #8 PEEK cage was inserted for anterior fusion. One minihemovac was placed. The wound was then closed in layers with 3-0 Vicryl and 4-0 Dexon. Operators VS賴達明 Assistants R5李振豪, R3曾偉倫 相關圖片 李賢良 (M,1952/01/04,60y2m) 手術日期 2011/08/05 手術主治醫師 賴達明 手術區域 東址 005房 01號 診斷 Cervical spondylosis 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 林哲光, 時間資訊 23:58 臨時手術NPO 07:45 報到 08:01 進入手術室 08:05 麻醉開始 08:10 誘導結束 09:00 抗生素給藥 09:09 手術開始 12:00 抗生素給藥 12:20 手術結束 12:20 麻醉結束 12:38 送出病患 12:40 進入恢復室 13:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 椎間盤切除術-頸椎 1 1 手術 脊椎融合術-前融合,有固定物)≦四節 1 2 記錄__ 手術科部: 外科部 套用罐頭: C5-6 discectomy with PEEK cage anterior fixation 開立醫師: 林哲光 開立時間: 2011/08/05 12:53 Pre-operative Diagnosis C5-6 HIVD with central canal stenosis Post-operative Diagnosis C5-6 HIVD with central canal stenosis Operative Method C5-6 discectomy with PEEK cage anterior fixation Specimen Count And Types nil Pathology Nil Operative Findings Spur formation was noted at C5-6 level with decreased intervertebral disc height. 7mm PEEK cage was inserted. Operative Procedures Under ETGA and supine position, skin disinfected and drapped were performed as usual. Transverse skin incision was made at inferior border of thyroid cartilage. The platysma was identified and the plane between carotid triangle and esophagus was dissected. C5-6 discectomy was then performed after C-arm localization and cage was then inserted. The wound was then closed in layers after a mini-H/V was inserted. Operators 賴達明 Assistants R5 林哲光, R1 蕭智陽, Ri 林千又 相關圖片 張寶治 (F,1954/10/29,57y4m) 手術日期 2011/08/05 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 Unspecified disorder of muscle, ligament, and fascia 器械術式 Spinal fusion posterior 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 蕭智陽, 時間資訊 10:05 通知急診手術 12:40 進入手術室 12:45 麻醉開始 13:20 誘導結束 14:14 抗生素給藥 14:15 開始輸血 14:15 手術開始 15:38 手術結束 15:38 麻醉結束 15:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術(減壓)-超過二節 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: T11-L1 laminectomy for hematoma removal 開立醫師: 蕭智陽 開立時間: 2011/08/09 16:58 Pre-operative Diagnosis T9-L1 epidural hematoma Post-operative Diagnosis T9-L1 epidural hematoma Operative Method T11-L1 laminectomy for hematoma removal Specimen Count And Types Nil Pathology Nil Operative Findings Epidural hematoma was noted after laminectomy, compressing spinal cord tightly. No obvious vascular lesion was noted during the operation. Operative Procedures Under ETGA and prone position, skin disinfected and drapped were perofmred as usual. Midline skin incision was made at T10-L2 level. The paraspinal muscles were detached and the spinous process and bilateral facet joints were exposed well. T11-L1 laminectomy was then performed. Hematoma was then evacuated. Hemostasis was done. The wound was then closed in layers after a epidural CWV drain insertion. Operators 王國川 Assistants 蕭智陽 Indication Of Emergent Operation Acute myelopathy with paraplegia 相關圖片 涂春陽 (M,1960/01/26,52y1m) 手術日期 2011/08/06 手術主治醫師 蔡翊新 手術區域 東址 002房 02號 診斷 Arteriovenous malformation, brain 器械術式 Right craniectomy 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 蕭柏妮 ASA 4E 紀錄醫師 吳健暉, 時間資訊 14:52 通知急診手術 15:16 進入手術室 15:16 報到 15:20 麻醉開始 15:25 誘導結束 15:36 抗生素給藥 15:50 手術開始 16:10 開始輸血 17:10 麻醉結束 17:10 手術結束 17:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱骨切除術,包括異物移除或壓或經切斷 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 蔡翊新 開立時間: 2011/08/06 16:51 Pre-operative Diagnosis Right F-T-P SDH and right frontoparietal AVM s/p craniotomy, with brain swelling and IICP. Post-operative Diagnosis Right F-T-P SDH and right frontoparietal AVM s/p craniotomy, with brain swelling and IICP. Operative Method Right F-T-P Craniectomy and excision of right temporal muscle for decompression. Specimen Count And Types nil Pathology Nil. Operative Findings There was intramural hematoma in the right temporalis muscle causing thickening of the muscle bulk to 2.5 cm in thickness. ICP before craniectomy was 24 mmHg, after craniectomy 2 mmHg and after skin closure mmHg. There was intramural hematoma in the right temporalis muscle causing thickening of the muscle bulk to 2.5 cm in thickness. ICP before craniectomy was 24 mmHg, after craniectomy 2 mmHg and after skin closure 8 mmHg. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: a right frontotemporoparietal horseshoe, and the temporalis muscle was excised. 5. Craniectomy window: 14 x 10 cm, right frontotemporoparietal, by removal of previous miniplates and screws. 6. Hemosatasis: the bleeders was stopped by Bovie and oozing surface was covered with gelfoam. 7. The skull plate was removed and stored at bone bank for preservation. 8. Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 9. Drain: two epidural CWV. 10.Blood transfusion: PRBC 2U. Bloos loss: 250 ml. 11.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5李振豪R1吳健暉 Indication Of Emergent Operation brain edema and IICP 相關圖片 何有義 (M,1931/10/10,80y5m) 手術日期 2011/08/06 手術主治醫師 劉詩彬 手術區域 東址 008房 01號 診斷 Benign prostatic hypertrophy ( BPH ) 器械術式 TRUS-Biobsy 手術類別 預定手術 手術部位 腹 傷口分類 污染 麻醉方式 靜脈麻醉 麻醉主治醫師 蕭柏妮 ASA 3 紀錄醫師 周博敏, 時間資訊 07:40 報到 07:57 進入手術室 08:20 麻醉開始 08:25 誘導結束 08:26 手術開始 08:36 手術結束 08:36 麻醉結束 08:40 送出病患 08:43 進入恢復室 09:43 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 手術 前列腺切片-控取式 1 1 記錄__ 手術科部: 泌尿部 套用罐頭: TRUS-P-biopsy 開立醫師: 林威佑 開立時間: 2011/08/06 08:34 Pre-operative Diagnosis r/o prostate cancer Post-operative Diagnosis r/o prostate cancer Operative Method TRUSP biopsy Specimen Count And Types 6 pieces About size:1.7*0.1*0.1*3 Source:Left lateral About size:1.7*0.1*0.1*3 Source:Left medial About size:1.7*0.1*0.1*3 Source:Left medial deep About size:1.7*0.1*0.1*3 Source:Right medial deep About size:1.7*0.1*0.1*3 Source:Right medial About size:1.7*0.1*0.1*3 Source:Right lateral Pathology pending Operative Findings 1.systematic 18 cores TRUSP biopsy was performed 2.prostate size: 2.54cm x 5.44cm x 4.52cm= 31.6ml Operative Procedures Under satisfactory anesthesia with the patient in right flank position, prepping and draping was performed in the usual sterile fashion. TRUSP was performed and echo-guided prostate biopsies were performed smoothly with Biopty gun. The coresof tissue specimen were obtained. The biosy area was compressed for several minutes to ensure adequate hemostasis. The patient tolerated the operation well and was sent to the floor in satisfactory condition. Operators 劉詩彬, Assistants 周博敏, 李子良 (M,1966/07/04,45y8m) 手術日期 2011/08/08 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(P-DUH) for CSF leakage repair 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 曾偉倫, 時間資訊 23:11 臨時手術NPO 08:03 進入手術室 08:10 麻醉開始 08:55 誘導結束 09:07 手術開始 09:07 抗生素給藥 12:00 抗生素給藥 13:45 手術結束 13:45 麻醉結束 13:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除-手術時間在4小時以內 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Left pterional craniotomy for repair of CSF l... 開立醫師: 李振豪 開立時間: 2011/08/08 14:15 Pre-operative Diagnosis 1. Left inner third sphenoid ridge meningioma ststus post tumor resection with recurrence 2. Repeat pneumocephalus and pneumoventricle, suspect CSF leakage Post-operative Diagnosis 1. Left inner third sphenoid ridge meningioma ststus post tumor resection with recurrence 2. Repeat pneumocephalus and pneumoventricle, suspect CSF leakage Operative Method Left pterional craniotomy for repair of CSF leakage and partial tumor excision Specimen Count And Types nil Pathology Pending Operative Findings The anterior frontal skull base was intact and there was no evident defect that communicating with paranasal sinus. After dural opening, the left lateral ventricle was entered via thin layer of cortex. Again, there was no obvious defect noted. The thin layer of cortex over the frontal base was opened for searching of the leakage site. But only small bubble arising around the olfactory groove was noted. The dura was intact from midline to sphenoid ridge. The tumor was encountered during exploration of anterior skull base and the tumor was well-capsulated, soft to elastic, gray-reddish in color. The skull base was repaired with periosteum and Surgicel lining. No obvious air bubble noted again after repair of skull base. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head fixed with Mayfield skull clamp. The stitches were removed. The scalp was shaved, scrubbed, and disinfected as usual. Bicoronal scalp incision was made and the scalp flap was elevated. The periosteum was dissected and preserved and harvested for repairment of CSF leakage. The previous craniotomy was identified and the miniplates/screws were removed. Midas high speed air-drived drills were used for craniotomy. Curvilinear durotomy was made and the ventricle was entered through thin layer of brain. The pneumoventricle was drained out. Due to no obvious leakage site, the skull base was approached via corticotomy from left lateral ventricle. Unfortunately, there was not obvious defect of dura. But small air bubble was noted during deair. The tumor was encountered during exploration of skull base and partial tumor excision was done. The harvested periosteum was placed at skull base(intradural) with several layers of Surgicel lining. Hemostasis was achieved. The dura was closed with 4-0 Prolene. One epidural CWV drain was set up. The skull plate was fixed back with miniplates/screws, and 2 central tenting. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators Prof. 杜永光 Assistants R5 李振豪 R3 曾偉倫 Ri 許淑嫻 相關圖片 陳秀鳳 (F,1956/11/10,55y4m) 手術日期 2011/08/08 手術主治醫師 杜永光 手術區域 東址 003房 02號 診斷 Lymphoma 器械術式 Brain biopsy (TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 曾偉倫, 時間資訊 23:14 臨時手術NPO 14:15 進入手術室 14:20 麻醉開始 15:00 誘導結束 15:00 抗生素給藥 15:05 手術開始 17:10 手術結束 17:10 麻醉結束 17:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 立體定位術-切片 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Sterotactic tumor biopsy 開立醫師: 曾偉倫 開立時間: 2011/08/08 17:26 Pre-operative Diagnosis Left basal ganglion tumor, suspect high grade glioma Post-operative Diagnosis Left basal ganglion tumor, suspect high grade glioma Operative Method Sterotactic tumor biopsy Specimen Count And Types 2 pieces About size:1.0x0.1x0.1 cm Source:Brain tumor for Frozen About size:1.0x0.1x0.1 cm Source:Brain tumor for final Pathology Pathology Frozen section: Operative Findings 1. A 4.7cm multilobulated lesion in the left basal ganglia-thalmic region with focal edema and transtentorial herniation 2. The tumor tisue was greyish 2. The tumor tissue was greyish, the necrotic part of the tumor was orange 3. The frozen section showed neuron cell over the margin of the tumor and necrosis over the central part of the tumor Operative Procedures Under ETGA, we placed the patient over supine position with her head face to right. After the tumor location was locate with Medtronic Navigator. After we shaved, scrubbed, disinfected and drapped, a linear skin incision was made over left frontal area anterior to the coronal suture. The A burr-hole was made with air-drived drill and the dura was opened. The needle was placed into the lesion under Navigator guide and tumor biopsy was done. Under ETGA, we placed the patient over supine position with her head face to right. After the tumor location was locate with Medtronic Navigator. After we shaved, scrubbed, disinfected and drapped, a linear skin incision was made over left frontal area anterior to the coronal suture. The A burr-hole was made with air-drived drill and the dura was opened. The needle was placed into the lesion under Navigator guide and tumor biopsy was done. After complete hemostasis, the wound was closed in layers. Operators Prof. 杜永光 Assistants R5 李振豪 R3 曾偉倫 Ri 林淑嫻 R5 李振豪 R3 曾偉倫 Ri 許淑嫻 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Sterotactic tumor biopsy 開立醫師: 曾偉倫 開立時間: 2011/08/08 17:57 Pre-operative Diagnosis Left basal ganglion tumor, suspect high grade glioma Post-operative Diagnosis Left basal ganglion tumor, suspect high grade glioma Operative Method Sterotactic tumor biopsy Specimen Count And Types 2 pieces About size:1.0x0.1x0.1 cm Source:Brain tumor for Frozen About size:1.0x0.1x0.1 cm Source:Brain tumor for final Pathology Pathology Frozen section: Operative Findings 1. A 4.7cm multilobulated lesion in the left basal ganglia-thalmic region with focal edema and transtentorial herniation 2. The tumor tissue was greyish, the necrotic part of the tumor was orange 3. The frozen section showed neuron cell over the margin of the tumor and necrosis over the central part of the tumor Operative Procedures Under ETGA, we placed the patient over supine position with her head face to right. After the tumor location was locate with Medtronic Navigator. After we shaved, scrubbed, disinfected and drapped, a linear skin incision was made over left frontal area anterior to the coronal suture. The A burr-hole was made with air-drived drill and the dura was opened. The needle was placed into the lesion under Navigator guide and tumor biopsy was done. After complete hemostasis, the wound was closed in layers. Operators Prof. 杜永光 Assistants R5 李振豪 R3 曾偉倫 Ri 許淑嫻 相關圖片 陳林梅玉 (F,1947/07/15,64y7m) 手術日期 2011/08/08 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Cerebrovascular accident 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 林哲光, 時間資訊 23:16 臨時手術NPO 08:10 進入手術室 08:13 麻醉開始 08:25 誘導結束 08:40 手術開始 08:40 抗生素給藥 10:32 開始輸血 11:40 抗生素給藥 12:45 手術結束 12:45 麻醉結束 12:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 手術 腦瘤切除-手術時間在4小時以內 1 1 L 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Left F-T-P craniectomy for tumor excision and... 開立醫師: 林哲光 開立時間: 2011/08/08 14:08 Pre-operative Diagnosis Left temporal tumor, suspected metastasis Post-operative Diagnosis Left temporal tumor, suspected metastasis Operative Method Left F-T-P craniectomy for tumor excision and duroplasty with Durafoam Specimen Count And Types 1 piece About size:multiple pieces Source:tumor Pathology Frozen pathology revealed inflammatory cells and no obvious tumor cell was noted. Further specimen for pathology was given. Operative Findings Brain parechyma bulging was noted after left F-T-P craniectomy. The surface of brain parenchyma near the proximal site of left sylvian vein was noted, supsected little branch of the sylvain vein tear with bleeding. Diffuse oozing was noted during hemostasis and tumor excision. Bleeding seemed controlled after blood transfusion with platelet, FFP. The tumor was grayish, well-defined, soft-elastic, mass lesion at left middle gyrus with cystic and solid component. Mucus like materials inside the cyst was noted. The brain parechyma seemed bulging after tumor excision and the skull bone was not put back and dura defect was covered with Durafoam. Postoperative pupils were 2.5/2.5 without light reflex. Operative Procedures Under ETGA and supine position with head rotated to right side and fixed with Mayfield head clamp, skin disinfected and drapped were performed as usual. A question mark skin incision was made at left F-T-P area and five burr holes were create. Left F-T-P craniectomy was then done. Corticotomy was done at left middle temporal gyrus and tumor excision was done. Hemostasis was done with Floseal and Surgecell packing under blood transfusion. Duroplasty was then done with Durafoam. The wound was then closed in layers after a epidural CWV drain insertion. Operators 曾漢民 Assistants R5 林哲光, R1 蕭智陽 相關圖片 陳林梅玉 (F,1947/07/15,64y7m) 手術日期 2011/08/08 手術主治醫師 曾漢民 手術區域 東址 001房 03號 診斷 Cerebrovascular accident 器械術式 Craniectomy, Removal of hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3E 紀錄醫師 周聖哲, 時間資訊 14:34 通知急診手術 15:13 進入手術室 15:15 麻醉開始 15:20 誘導結束 15:25 手術開始 16:00 抗生素給藥 17:35 手術結束 17:35 麻醉結束 17:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 曾峰毅 開立時間: 2011/08/08 17:42 Pre-operative Diagnosis Left temporal intracerebral hemorrhage Post-operative Diagnosis Left temporal intracerebral hemorrhage Operative Method ICH evacuation. Specimen Count And Types Nil Pathology Nil Operative Findings Left temporal ICH was removed. Fresh-reddish bleeder from Sylvian vein was noted, and brain was slack after ICH removed. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to right. We scrubbed, disinfected, and then draped the patient, and made scalp incision along previous operation wound. We removed previuos placed durofoam, and evacuated the intracerebral hemorrhage. Hemostasis was performed meticulously. Durofoam was put back for duroplasty. After one subgaleal CWV inserted, the wound was closed in layers. Operators VS 曾漢民 Assistants 周聖哲, 曾峰毅 曾峰毅, 周聖哲 Indication Of Emergent Operation Uncal herniation 相關圖片 許育安 (F,1997/08/22,14y6m) 手術日期 2011/08/08 手術主治醫師 周獻堂 手術區域 兒醫 061房 01號 診斷 Medulloblastoma 器械術式 BM HARVEST,BMA+B 手術類別 預定手術 手術部位 腹 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 蔡奉芳 ASA 3 紀錄醫師 池宛玲, 時間資訊 07:30 報到 08:04 進入手術室 08:15 麻醉開始 08:25 誘導結束 09:05 手術開始 09:15 開始輸血 11:25 手術結束 11:25 麻醉結束 11:35 進入恢復室 13:23 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 骨髓移植－抽髓（自體或異體） 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 記錄__ 手術科部: 套用罐頭: BMSCH 開立醫師: 陳麒年 開立時間: 2011/08/08 11:50 Pre-operative Diagnosis Healthy bone marrow donor 1. medulloblastoma, recurrence 2. bone marrow donor, autologous Post-operative Diagnosis Healthy bone marrow donor, auto 1. medulloblastoma, recurrence 2. bone marrow donor, autologous Operative Method Bone marrow stem cell harvest Specimen Count And Types 2 pieces About size:B/C and F/C Source:stem cell Pathology Nil Operative Findings The total volume of bone marrow was approximately 800 mL, devided to 500ml and 472 ml 2 pack stem cell. B/C and F/C was send. Operative Procedures The patient was taken to the operating room where general anesthesia was induced in the supine position. The patient was placed in the supine position and the anterior iliac crest was prepared and draped in a sterile fashion with Beta iodine. 5 mL aliquots of bone marrow were seriously obtained from different depth of approximately 200 sites over bilateral ant. iliac crest using Jamshidis bone marrow aspiration needle. The bone marrow was treated with preservative free heparin. A total volume of 800 ml was obtained and the anticoagulated bone marrow was then processed in a sterile fashion by passing through 300 micron and then 200 micron sterile iron mesh filters. The total nucleated marrow cells were numerated. The harvested marrow was sent for (frozen preservation ). Pressure dressings were applied over the anterior iliac crest aspiration site. The harvested bone marrow was sent for bacterial, fungal culture. Operators VS 周獻堂 Assistants R2 池宛玲, R3陳麒年, R3 林俊言 吳天送 (M,1928/04/09,83y11m) 手術日期 2011/08/08 手術主治醫師 賴達明 手術區域 東址 005房 02號 診斷 Meningioma 器械術式 Debridment-- 5-10cm 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 蕭智陽, 時間資訊 23:18 臨時手術NPO 12:35 報到 13:30 進入手術室 13:35 麻醉開始 13:50 誘導結束 14:00 抗生素給藥 14:35 手術開始 16:00 手術結束 16:00 麻醉結束 16:15 送出病患 16:20 進入恢復室 17:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 深部傷口處理縫合擴創-中 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 記錄__ 手術科部: 外科部 套用罐頭: Debridement 開立醫師: 林哲光 開立時間: 2011/08/08 16:16 Pre-operative Diagnosis T2 meningeoma status post tumor excision, complicated with poor wound healing Post-operative Diagnosis T2 meningeoma status post tumor excision, complicated with poor wound healing Operative Method Debridement Specimen Count And Types nil Pathology Nil Operative Findings poor wound healing Operative Procedures Under general anesthesia, the patient lied in prone position. Antiseptics applied and draped as usual. Normal saline irrigation. Wound underwent wet dressing. One CWV drain was placed upon the fascia. Wound has been closed by layers. Operators VS賴達明 Assistants CR林哲光, R1蕭智陽 相關圖片 陳林專 (F,1933/12/05,78y3m) 手術日期 2011/08/08 手術主治醫師 黃國皓 手術區域 東址 015房 03號 診斷 Malignant neoplasm of cervix uteri, unspecified 器械術式 P.C.N. dilation 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 3 紀錄醫師 黃旭澤, 時間資訊 00:00 臨時手術NPO 09:45 報到 09:50 進入手術室 10:02 麻醉開始 10:15 誘導結束 10:20 抗生素給藥 10:25 手術開始 10:55 麻醉結束 10:55 手術結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腎臟造廔術(手術) 1 1 R 麻醉 Peripheral arterial line inserti 1 0 記錄__ 手術科部: 泌尿部 套用罐頭: PCN (Percutaneous nephrostomy) 開立醫師: 黃旭澤 開立時間: 2011/08/08 11:17 Pre-operative Diagnosis Rt hydronephrosis Post-operative Diagnosis Same Operative Method Rt percutneous nephrostomy-PCN dilitation Specimen Count And Types nil Pathology Nil. Operative Findings Dilated Rt renal pelvis and collecting system Operative Procedures The patient was placed in Rt flank position. Prepping and drapping was performed in the usual sterile fashion. After general anesthesia, guidewire was inserted through the previous pigtail into the pelvis and the pigtail was removed then. The tract was dilated with fascial dilators, which was facilitated by passing them over the guidewire, up to 12 Fr. A follower was indwelled by passing it over the guidewire. The tract was further dilated with the following Amplatz dilators by passing them over the follower, up to 24 Fr. The 20Fr PCN tube was passed over the guidewire into the renal pelvis according to the previously measured depth(7cm). The guidewire was removed and the PCN tube was fixed to the skin, the ballon size is 3CC. Patient tolerated the procedure well and was sent to recovery in satisfactory condition. Operators 黃國皓, Assistants 陳聖復, 黃旭澤 林清秀 (M,1951/07/27,60y7m) 手術日期 2011/08/09 手術主治醫師 蔡翊新 手術區域 東址 001房 04號 診斷 Cerebral aneurysm 器械術式 Right ACA aneurysm clipping and EVD placement 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 蕭柏妮 ASA 4E 紀錄醫師 曾偉倫, 時間資訊 18:30 臨時手術NPO 18:30 開始NPO 22:55 通知急診手術 23:35 報到 23:35 進入手術室 23:40 麻醉開始 00:05 誘導結束 00:35 抗生素給藥 00:45 手術開始 03:00 開始輸血 03:35 抗生素給藥 06:15 麻醉結束 06:15 手術結束 06:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 手術 開顱術摘除血管病變 - 腦血管瘤 有病徵的 1 1 R 手術 顱內壓視置入 1 2 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Right pterional craniotomy for aneurysm clipp... 開立醫師: 蔡翊新 開立時間: 2011/08/09 06:09 Pre-operative Diagnosis Right A1 aneurysm rupture with SAH, IVH and ICH Post-operative Diagnosis Right A1 aneurysm rupture with SAH, IVH and ICH Operative Method Right pterional craniotomy for aneurysm clipping and right Kocher point EVD for ICP monitoring. Specimen Count And Types nil Pathology Nil Operative Findings 1. CSF: bloody, pressure: > 25 cmH2O. 2. There were subarachnoid blood clots at basal cistern and deep Sylvian fissure causing adhesion between right optic nerve and right ICA. There was an elongated, saccular aneurysm arising from proximal A1 segment of right ACA just adjacent to the ICA bifurcation, pointing medially and posteriorly. The neck was narrow, about 2.7 mm in width. The dome was masked by the ACA from the view of operator. It was clipped by a 10-mm, curved Sugita clip. Operative Procedures Under ETGA, we placed the patient over supine position. After we shaved, we fixed his head with Mayfield clamp and tilt his head to left. After we scrubbed, disinfected and drapped, a curvilinear skin incision above right Kocher point was made. The wound was open in layers and a burr hole was made. The durotomy was made and the ventricular needle was inserted. After the ventricle was reached, the EVD tube was placed. The wound was extended to right frontotemporal skin incision and the wound was opened. The facial nerve was preserved and the temporalis muscle was elevated. A 8 x 6 cm craniotomy was created by making 3 burr holes. Curvilinear dural incision was done to reflect the dura inferiorly. The right Sylvian fissure was opened under microscope, so as the preoptic cistern. The subarachnoid blood clots were removed by sucker and normal saline irrigation. The right frontal lobe was retracted backwardly to dissect the right ICA, ACA and aneurysm neck out. The aneurysm was clipped by a 10-mm, curved Sugita clip. After hemostasis, the dura was closed by 4-0 Prolene in a water-tight fashion. The bone plate was fixed back by 3 miniplates and 6 screws after setting an epidural CWV drain. The wound was then closed in layers. Operators VS 蔡翊新 Assistants R5 李振豪 R3 曾偉倫 Indication Of Emergent Operation Aneurysm rupture, acute hydrocephalus 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Right pterional craniotomy for aneurysm clipp... 開立醫師: 曾偉倫 開立時間: 2011/12/10 11:47 Pre-operative Diagnosis Right A1 aneurysm rupture with SAH, IVH and ICH Post-operative Diagnosis Right A1 aneurysm rupture with SAH, IVH and ICH Operative Method Right pterional craniotomy for aneurysm clipping and right Kocher point EVD for ICP monitoring. Specimen Count And Types nil Pathology Nil Operative Findings 1. CSF: bloody, pressure: > 25 cmH2O. 2. There were subarachnoid blood clots at basal cistern and deep Sylvian fissure causing adhesion between right optic nerve and right ICA. There was an elongated, saccular aneurysm arising from proximal A1 segment of right ACA just adjacent to the ICA bifurcation, pointing medially and posteriorly. The neck was narrow, about 2.7 mm in width. The dome was masked by the ACA from the view of operator. It was clipped by a 10-mm, curved Sugita clip. Operative Procedures Under ETGA, we placed the patient over supine position. After we shaved, we fixed his head with Mayfield clamp and tilt his head to left. After we scrubbed, disinfected and drapped, a curvilinear skin incision above right Kocher point was made. The wound was open in layers and a burr hole was made. The durotomy was made and the ventricular needle was inserted. After the ventricle was reached, the EVD tube was placed. The wound was extended to right frontotemporal skin incision and the wound was opened. The facial nerve was preserved and the temporalis muscle was elevated. A 8 x 6 cm craniotomy was created by making 3 burr holes. Curvilinear dural incision was done to reflect the dura inferiorly. The right Sylvian fissure was opened under microscope, so as the preoptic cistern. The subarachnoid blood clots were removed by sucker and normal saline irrigation. The right frontal lobe was retracted backwardly to dissect the right ICA, ACA and aneurysm neck out. The aneurysm was clipped by a 10-mm, curved Sugita clip. After hemostasis, the dura was closed by 4-0 Prolene in a water-tight fashion. The bone plate was fixed back by 3 miniplates and 6 screws after setting an epidural CWV drain. The wound was then closed in layers. Operators VS 蔡翊新 Assistants R5 李振豪 R3 曾偉倫 Indication Of Emergent Operation Aneurysm rupture, acute hydrocephalus 相關圖片 李黃來馨 (F,1927/02/11,85y1m) 手術日期 2011/08/08 手術主治醫師 林峰盛 手術區域 西址 034房 06號 診斷 Patients requiring long-term use of a respirator due to respiratory failure, use respirator 6 hours per day continue 30 days 器械術式 Nerve block / PC 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 林峰盛 ASA 3 紀錄醫師 楊仁廷, 時間資訊 12:15 進入手術室 12:20 麻醉開始 12:25 誘導結束 12:26 手術開始 12:45 手術結束 12:45 麻醉結束 12:50 送出病患 12:58 進入恢復室 14:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 高頻熱凝療法 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 記錄__ 手術科部: 麻醉部 套用罐頭: Pulsed RF 開立醫師: 楊仁廷 開立時間: 2011/08/08 12:43 Pre-operative Diagnosis Post-herpetic neuralgia Post-operative Diagnosis Post-herpetic neuralgia Operative Method Pulsed RF Specimen Count And Types nil Pathology Nil Operative Findings Operative Procedures 1. IV sedation with midazolam and LA with 1% xylocaine 2. pt in supine position 3. Under sonography-guidance, insert 22 G SMK RF meedle into C5 and C6 roots 4. Neurostimulation with 50 HZ and 2 Hz 0.1-0.5 mV current with positive result 60-80V 2 Hz, 20 ms, 120sec *2 pulsed RF was delivered send pt to POR Operators 林峰盛 Assistants 林文瑛 摘要__ 手術科部: 麻醉部 套用罐頭: Pulsed RF 開立醫師: 楊仁廷 開立時間: 2011/08/08 12:48 Pre-operative Diagnosis Post-herpetic neuralgia Post-operative Diagnosis Post-herpetic neuralgia Operative Method 1.right C5, C6 root block 2.Pulsed RF Specimen Count And Types nil Pathology Nil Operative Findings Operative Procedures 1. IV sedation with midazolam and LA with 1% xylocaine 2. pt in supine position 3. Under sonography-guidance, insert 22 G SMK RF meedle into C5 and C6 roots 4. Neurostimulation with 50 HZ and 2 Hz 0.1-0.5 mV current with positive result 60-80V 2 Hz, 20 ms, 120sec *2 pulsed RF was delivered send pt to POR Operators 林峰盛 Assistants 林文瑛 陳文宗 (M,1945/12/20,66y2m) 手術日期 2011/08/09 手術主治醫師 曾勝弘 手術區域 東址 005房 03號 診斷 Back mass 器械術式 Excision, back tumor 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 李振豪, 時間資訊 08:00 臨時手術NPO 15:00 進入手術室 15:05 抗生素給藥 15:22 麻醉開始 15:24 誘導結束 15:25 麻醉結束 15:26 手術開始 16:45 手術結束 16:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 軟組織良性腫瘤切除術,大或深 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Tumor excision 開立醫師: 李振豪 開立時間: 2011/08/09 16:43 Pre-operative Diagnosis Right back tumor, suspect lipoma Post-operative Diagnosis Right back tumor, suspect lipoma Operative Method Tumor excision Specimen Count And Types 1 piece About size:7x6x2.5cm Source:Right scapular soft tissue tumor Pathology pending Operative Findings The tumor was 7x6x2.5cm in size, deep located(below the muscle group and above the thoracic cage), well-demarcated, movable, and lipoma-like in character. The feeding artery was mainly from base of the tumor. No significant adjacent soft tissue invasion was noted during dissection. The pleural cavity was not entered after total resection of the tumor. The patient tolerate well during whole procedure. Operative Procedures The patient was put in prone position. The skin was scrubbed, disinfected, and draped as usual. Local anesthesia with total 20ml 1% Xylocaine was applied. Linear skin incision was made and the subcutaneous soft tissue was devided layer by layer. The fascia was opened and the muscle was splitted to iednetified the subcutaneous tumor. The tumor was dissecting along the margin and total excision was done. Hemostasis was achieved and the wound was then closed in layers with 2-0, 3-0 Vicryl and 4-0 Nylon. Operators VS曾勝弘 Assistants R5李振豪, R1王怡人 相關圖片 汪文忠 (M,1962/11/13,49y4m) 手術日期 2011/08/09 手術主治醫師 曾勝弘 手術區域 西址 039房 01號 診斷 Carpal tunnel syndrome 器械術式 Neurolysis of the uluar neuve 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 08:17 報到 08:28 進入手術室 08:35 麻醉開始 08:45 手術開始 09:10 手術結束 09:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 正中神經或尺神經腕部減壓術–單側 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Left median nerve decompression 開立醫師: 林哲光 開立時間: 2011/08/09 09:30 Pre-operative Diagnosis Carpal tunnel syndrome, left Post-operative Diagnosis Carpal tunnel syndrome, left Operative Method Left median nerve decompression Specimen Count And Types nil Pathology Nil Operative Findings Hypertrophic change of flexor reticulum and soft tissue were noted. Erythematous change of median nerve was noted and re-expanded well after soft tissue excision. Operative Procedures Under supine position, skin disinfected and drapped were performed as usual. Skin incision was made between the thenar and hypothenar muscle. Division of the flexor reticulum was done and hemostasis was done. The wound was then closed in 4-0 Nylon closely. Operators 曾勝弘 Assistants 林哲光 相關圖片 陳金鳳 (F,1952/01/12,60y2m) 手術日期 2011/08/09 手術主治醫師 曾勝弘 手術區域 西址 039房 02號 診斷 Tardy ulnar palsy 器械術式 Decompression of mediun nerve 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 09:01 報到 09:35 進入手術室 09:45 麻醉開始 09:50 手術開始 10:40 手術結束 10:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 神經分離術-上臂.前臂.大腿.小腿處之神經 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Neurolysis, left ulnar nerve decompression 開立醫師: 林哲光 開立時間: 2011/08/09 10:59 Pre-operative Diagnosis Tardy ulnar palsy, left Post-operative Diagnosis Tardy ulnar palsy, left Operative Method Neurolysis, left ulnar nerve decompression Specimen Count And Types nil Pathology Nil Operative Findings Entrapement of the left ulnar nerve was noted and seemed re-expanded well after neurolysis was done. Operative Procedures 1. The entire-arm was disinfected with povidone-iodine tincture then covered with stockinet. 2. Anesthesia: the forearm was squeezed by tourniquet, then regional block with 20 cc 1% xylocaine solution was infused through a cubital vein catheter. 2. Anesthesia: local anesthesia 1% Xylocaine at incision site. 3. Incision: 6 cm, longitudinal in direction, crossed over the medial epicondyle. 4. The brachial fascia and medial intermusclular septum were opened longitudinally to exposed the ulnar nerve at supracondylar region, a 5 cm segment of this nerve and its mesoneurium were isolated. The fibrous tissue which entraped the nerve at ulnar groove of medial epicondyle was opened and the nerve was released. The nerve was isolated futher distally to the location 1 inch distal to the medial epicondyle. 5. The ulnar nerve was transposed to cubital fossa and anchored there by subcutaneous fat flap. 6. The tourniquet was released for hemostasis. 6. Hemostasis with Bipolar cauterization. 7. The wound was closed with 4/0 nylon. 8. The arm was draped with elastic bandage dressing. Operators 曾勝弘 Assistants 林哲光 相關圖片 李秀芳 (F,1974/08/30,37y6m) 手術日期 2011/08/09 手術主治醫師 曾勝弘 手術區域 西址 039房 03號 診斷 Tardy ulnar palsy 器械術式 Decompression of mediun nerve 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 10:22 報到 11:00 進入手術室 11:08 麻醉開始 11:12 手術開始 12:05 手術結束 12:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 神經分離術-上臂.前臂.大腿.小腿處之神經 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Neurolysis, left ulnar nerve decompression 開立醫師: 林哲光 開立時間: 2011/08/09 12:15 Pre-operative Diagnosis Left tardy ulnar palsy Post-operative Diagnosis Left tardy ulnar palsy Operative Method Neurolysis, left ulnar nerve decompression Specimen Count And Types nil Pathology Nil Operative Findings Entrapement of left ulnar nerve was noted with surrounding soft tissue and fascia. The nerve seemed re-expanded well. Operative Procedures 1.The entire arm was disinfected with povidone-iodine tincture then covered with stockinet. 2.Anesthesia: local anesthesia at incision site. 3.Incision: 10 cm, longitudinal in direction, crossed over the medial epicondyle. 4.The brachial fascia and medial intermusclular septum were opened longitudinally to exposed the ulnar nerve at supracondylar region, a 5 cm segment of this nerve and its mesoneurium were isolated. The fibrous tissue which entraped the nerve at ulnar groove of medial epicondyle was opened and the nerve was released. The nerve was isolated futher distally to the location 1 inch distal to the medial epicondyle. 5.The ulnar nerve was transposed to cubital fossa and anchored there by subcutaneous fat flap. 6.Hemostasis was then performed. 7.The wound was closed by running suture with 3/0 nylon. 8.The arm was draped with elastic bandage dressing. Operators 曾勝弘 Assistants 林哲光 相關圖片 陳毅 (M,2011/07/25,7m23d) 手術日期 2011/08/09 手術主治醫師 郭夢菲 手術區域 兒醫 067房 02號 診斷 Subdural hemorrhage 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 石博元 ASA 3 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 12:15 進入手術室 12:20 麻醉開始 12:37 抗生素給藥 12:40 誘導結束 13:16 手術開始 13:30 開始輸血 14:55 手術結束 14:55 麻醉結束 15:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 頭顱成形術 1 1 R 摘要__ 手術科部: 套用罐頭: Right side cranioplasty with autologous bone ... 開立醫師: 王奐之 開立時間: 2011/08/09 15:18 Pre-operative Diagnosis Right side skull defect Post-operative Diagnosis Right side skull defect Operative Method Right side cranioplasty with autologous bone graft Specimen Count And Types Nil Pathology Nil Operative Findings Small dural defect was noted at posterior edge of craniectomy window. Some bony formation was noted at posteroinferior the border. Subgaleal hematoma accumulation at the anterior portion was noted after wound closure, along with some air in the subgaleal space as well. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After shaving, scrubbing, disinfection & draping in sterile fashion, a reverse-U shaped incision was made at right frontotemporoparietal area along previous wound scar. The plane between galea & dura was then dissected, and the skin flap was reflected inferiorly. The dura was then dissected off the bony edge. After 2 central tenting stitches, the bone graft was fixed back with silk ties. A thin membrane of periosteum was approximated and covered onto the bone graft. After hemostasis, the wound was closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之 相關圖片 記錄__ 手術科部: 套用罐頭: Right side cranioplasty with autologous bone ... 開立醫師: 王奐之 開立時間: 2011/08/09 15:18 Pre-operative Diagnosis Right side skull defect Post-operative Diagnosis Right side skull defect Operative Method Right side cranioplasty with autologous bone graft Specimen Count And Types Nil Pathology Nil Operative Findings Small dural defect was noted at posterior edge of craniectomy window. Some bony formation was noted at posteroinferior the border. Subgaleal hematoma accumulation at the anterior portion was noted after wound closure, along with some air in the subgaleal space as well. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After shaving, scrubbing, disinfection & draping in sterile fashion, a reverse-U shaped incision was made at right frontotemporoparietal area along previous wound scar. The plane between galea & dura was then dissected, and the skin flap was reflected inferiorly. The dura was then dissected off the bony edge. After 2 central tenting stitches, the bone graft was fixed back with silk ties. A thin membrane of periosteum was approximated and covered onto the bone graft. After hemostasis, the wound was closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之 相關圖片 記錄__ 手術科部: 套用罐頭: Right side cranioplasty with autologous bone ... 開立醫師: 郭夢菲 開立時間: 2011/08/09 16:22 Pre-operative Diagnosis Right side skull defect Post-operative Diagnosis Right side skull defect Operative Method Right side cranioplasty with autologous bone graft Specimen Count And Types Nil Pathology Nil Operative Findings Small dural defect was noted at posterior edge of craniectomy window. Some bony formation was noted at posteroinferior the border. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After shaving, scrubbing, disinfection & draping in sterile fashion, a reverse-U shaped incision was made at right frontotemporoparietal area along previous wound scar. The plane between galea & dura was then dissected, and the skin flap was reflected inferiorly. The dura was then dissected off the bony edge. After 2 central tenting stitches, the bone graft was fixed back with silk ties. A thin membrane of periosteum was approximated and covered onto the bone graft. After hemostasis, the wound was closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之 相關圖片 陳仲璿 (M,1998/03/26,13y11m) 手術日期 2011/08/09 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Head Injury 器械術式 S-P shunt removal 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 石博元 ASA 2 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:05 進入手術室 08:10 麻醉開始 08:16 誘導結束 08:33 抗生素給藥 09:22 手術開始 11:30 手術結束 11:30 麻醉結束 11:38 抗生素給藥 11:40 送出病患 11:45 進入恢復室 12:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦脊髓液分流管重置 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 摘要__ 手術科部: 外科部 套用罐頭: Subduro-peritoneal shunt removal 開立醫師: 王奐之 開立時間: 2011/08/09 11:54 Pre-operative Diagnosis Subdural effusion, status post subduro-peritoneal shunt insertion Post-operative Diagnosis Subdural effusion, status post subduro-peritoneal shunt insertion Operative Method Subduro-peritoneal shunt removal Specimen Count And Types 1 piece About size:60*0.3*0.3cm Source:subduro-peritoneal shunt & calcified tissue Pathology Pending Operative Findings Severe adhesion of the shunt with surrounding soft tissue was noted. A long segment of calcified coating was present from retroauricular area to right chest, resulted in difficult shunt removal. The calcified coating was removed as much as possible. The remaining peritoneal shunt was easily removed below the level of right chest. The shunt became fragile and rough in surface, and broke into several pieces during removal. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After shaving, scrubbing, disinfection & draping in sterile fashion, 3 linear incisions were made along previous frontal scalp. After dissection, the Y-connector was removed; the 2 cathters entering the subdural space were transected at burr holes & removed. Four more small linear incisions were made from retroauricular area to right chest for removal of the shunt catheter and the calcified coating. The wounds were then closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Subduro-peritoneal shunt removal 開立醫師: 王奐之 開立時間: 2011/08/09 11:54 Pre-operative Diagnosis Subdural effusion, status post subduro-peritoneal shunt insertion Post-operative Diagnosis Subdural effusion, status post subduro-peritoneal shunt insertion Operative Method Subduro-peritoneal shunt removal Specimen Count And Types 1 piece About size:60*0.3*0.3cm Source:subduro-peritoneal shunt & calcified tissue Pathology Pending Operative Findings Severe adhesion of the shunt with surrounding soft tissue was noted. A long segment of calcified coating was present from retroauricular area to right chest, resulted in difficult shunt removal. The calcified coating was removed as much as possible. The remaining peritoneal shunt was easily removed below the level of right chest. The shunt became fragile and rough in surface, and broke into several pieces during removal. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After shaving, scrubbing, disinfection & draping in sterile fashion, 3 linear incisions were made along previous frontal scalp. After dissection, the Y-connector was removed; the 2 cathters entering the subdural space were transected at burr holes & removed. Four more small linear incisions were made from retroauricular area to right chest for removal of the shunt catheter and the calcified coating. The wounds were then closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Subduro-peritoneal shunt removal 開立醫師: 郭夢菲 開立時間: 2011/08/09 16:20 Pre-operative Diagnosis Subdural effusion, status post subduro-peritoneal shunt insertion Post-operative Diagnosis Subdural effusion, status post subduro-peritoneal shunt insertion Operative Method Subduro-peritoneal shunt removal Specimen Count And Types 1 piece About size:60*0.3*0.3cm Source:subduro-peritoneal shunt & calcified tissue Pathology Pending Operative Findings 1. SP shunt into bifrontal region with Y-connector interposited between the both subdural catheter and the peritoneal catheter. 2. Severe adhesion of the shunt with surrounding soft tissue was noted. A long segment of calcified coating was present from retroauricular area to right chest, resulted in difficult shunt removal. The calcified coating was removed as much as possible. The remaining peritoneal shunt was easily removed below the level of right chest. The shunt became fragile and rough in surface, and broke into several pieces during removal. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After shaving, scrubbing, disinfection & draping in sterile fashion, 3 linear incisions were made along previous incisions on frontal scalp. After dissection, the Y-connector was removed; the 2 cathters entering the subdural space were transected at burr holes & removed. Four more small linear incisions were made from retroauricular area to right chest for removal of the shunt catheter and the calcified coating. The wounds were then closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之 相關圖片 余智暘 (M,1988/08/08,23y7m) 手術日期 2011/08/09 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Neuroma, upper limb 器械術式 Right brachial plexus neurmoa excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 周聖哲, 時間資訊 23:01 臨時手術NPO 09:32 進入手術室 09:40 麻醉開始 09:50 誘導結束 09:50 抗生素給藥 10:08 手術開始 11:20 手術結束 11:20 麻醉結束 11:24 送出病患 11:30 進入恢復室 12:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 神經分離術–肩,臀關節以上,包括臂神經叢,坐骨神經 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 曾峰毅 開立時間: 2011/08/09 11:12 Pre-operative Diagnosis Two neurilemmoma, at right brachial plexus Post-operative Diagnosis Two neurilemmoma, at right brachial plexus Operative Method Tumor excision Specimen Count And Types Two tumor was sent for pathology. Pathology Pending Operative Findings Two well-defined, capsulated, movable, firm to elastic, moderately-vascularized, yellowish, lobuated tumor, about 2x2x3 and 3x3x4 cm, arised from right brachial pelxus. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to left. We scrubbed, disinfected, and then draped the patient as usual, and made one 5-cm transverse skin incision, about 4 cm above the right clavicle. We dissected to expose the first tumor, and dissected the tumor intracapsularly. The tumor capsule, proximal, and distal nerve were preserved well. Another tumor was located deeper, more proximal to the first tumor. We dissected to expose the second tumor, and dissected the tumor intracapsularly. The tumor capsule, proximal, and distal nerve were preserved as well. The wound was closed in layers. Operators VS 賴達明 Assistants R5 曾峰毅 R2 周聖哲 Ri 陳乃綺 相關圖片 張碧龍 (M,1951/08/28,60y6m) 手術日期 2011/08/09 手術主治醫師 賴達明 手術區域 東址 005房 01號 診斷 Cervical spondylosis 器械術式 Laminoplasty 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 23:03 臨時手術NPO 07:45 報到 07:55 進入手術室 08:00 麻醉開始 08:20 誘導結束 08:35 抗生素給藥 08:37 手術開始 11:40 手術結束 11:40 麻醉結束 11:50 送出病患 11:55 進入恢復室 13:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓整形術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 記錄__ 手術科部: 外科部 套用罐頭: C3-6 open-door laminoplasty 開立醫師: 李振豪 開立時間: 2011/08/09 11:21 Pre-operative Diagnosis Cervical stenosis, C3-6, with myelopathy Post-operative Diagnosis Cervical stenosis, C3-6, with myelopathy Operative Method C3-6 open-door laminoplasty Specimen Count And Types nil Pathology Nil Operative Findings The thecal sac expanded well after laminoplasty. No incidental durotomy or CSF leakage was found during whole procedure. Total four pieces of miniplates and eight screws(5mm x 4, 7mm x 4) were implanted for laminoplasty. The patient tolerate well during the operation. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position with head fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. Midline skin incision from C2 to C7 was made and the subcutaneous soft tissue was devided. C3-6 paravertebral muscle group were detached. C3-6 spinous process was removed. Grooving over bilateral laminae was performed with Midas air-drived drills. The left side was opened and laminoplast was performed with miniplates and screws. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. One epidural CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS賴達明 Assistants R5李振豪, R1王怡人 相關圖片 林瓊玉 (F,1941/09/25,70y5m) 手術日期 2011/08/09 手術主治醫師 賴達明 手術區域 東址 005房 02號 診斷 Degeneration of intervertebral disc, lumbar or lumbosacral 器械術式 Diskectomy lumbar, L4/5 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 23:05 臨時手術NPO 11:15 報到 12:00 進入手術室 12:05 麻醉開始 12:15 誘導結束 12:30 抗生素給藥 12:50 手術開始 14:35 手術結束 14:35 麻醉結束 14:45 進入恢復室 15:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-腰椎 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 記錄__ 手術科部: 外科部 套用罐頭: Microdiskectomy, L4/5, left 開立醫師: 李振豪 開立時間: 2011/08/09 14:50 Pre-operative Diagnosis Herniated intervertebral disc, L4/5, left Post-operative Diagnosis Herniated intervertebral disc, L4/5, left Operative Method Microdiskectomy, L4/5, left Specimen Count And Types nil Pathology Nil Operative Findings Hypertorphic ligmentum flavum and degenerative change of left L4/5 facet joint was noted during the operation. After removal of the ligmentum flavum, the thecal sac became loose. Herniated intervertebral disc also noted at L4/5 disc space. No ruptured disc was noted. Microdiskectomy was performed for decompression and the thecal sac and root were all protected well during whole procedure. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position. L4/5 disc level was localized by portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made at L4/5 disc level and the subcutaneous soft tissue was devided. Left paravertebral muscle group were detached and modified Taylor retractor was used. Laminotomy was performed and ligmentum flavum was removed. The thecal sac and left L5 root were identified and retracted to expose the L4/5 intervertebral disc. The annulus was opened and microdiskecotmy was done with curetted, alligator, and disc clamp. After decompression, hemostasis was achieved with bipolar electrocautery and Gelfoam packing. The wound was then closed in layers with 2-0 Vicryl and 4-0 Dexon. Operators VS賴達明 Assistants R5李振豪, R1王怡人 相關圖片 陳文令 (M,1929/09/11,82y6m) 手術日期 2011/08/09 手術主治醫師 林峰盛 手術區域 西址 035房 09號 診斷 Failed back syndrome 器械術式 Nerve block / PC 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 林峰盛 ASA 3 時間資訊 18:00 進入手術室 18:05 麻醉開始 18:06 誘導結束 18:10 手術開始 18:30 手術結束 18:30 麻醉結束 18:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 高頻熱凝療法 1 1 R 記錄__ 手術科部: 麻醉部 套用罐頭: Pulsed RF 開立醫師: 楊仁廷 開立時間: 2011/08/09 18:36 Pre-operative Diagnosis failed back syndrome Post-operative Diagnosis failed back syndrome Operative Method Pulsed RF Specimen Count And Types nil Pathology Nil Operative Findings Operative Procedures 1. IV sedation with midazolam and LA with 1% xylocaine 2. pt in prone position 3. Under fluoroscopic-guidance, insert 22 G SMK RF meedle into neuroforamen 4. Neurostimulation with 50 HZ and 2 Hz 0.1-0.5 mV current with positive result 60-80V 2 Hz, 20 ms, 120sec *2 pulsed RF was delivered send pt to PRO Operators 林豐盛 Assistants 楊仁廷 陳乙彥 (M,1941/05/10,70y10m) 手術日期 2011/08/09 手術主治醫師 余宏政 手術區域 東址 008房 06號 診斷 Benign prostatic hypertrophy ( BPH ) 器械術式 T U R - P 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 脊髓麻醉 麻醉主治醫師 葉惠敏 ASA 3 紀錄醫師 彭元宏, 時間資訊 13:15 報到 13:19 進入手術室 13:20 麻醉開始 13:30 誘導結束 13:30 抗生素給藥 13:47 手術開始 14:50 手術結束 14:50 麻醉結束 14:55 送出病患 14:58 進入恢復室 17:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Spinal anesthesia 1 0 手術 KTP Green Light Laser Evaporization of the Prostate 1 0 B 記錄__ 手術科部: 泌尿部 套用罐頭: TUR-P 開立醫師: 彭元宏 開立時間: 2011/08/09 15:04 Pre-operative Diagnosis benign prostate hyperplasia Post-operative Diagnosis benign prostate hyperplasia Operative Method 1. KTP laser therapy for BPH Specimen Count And Types 1 piece About size:2g Source:prostate tissue Pathology pending Operative Findings 1. 2 g of prostatic tissue was resected 2. bilateral lobes of the prostate kiss together 2. bladder trabeculation grade II 3. a bladder diverticulum at the posterior wall 4. marked intravesical growth of medial lobe of the prostate 5. KTP Greenlight laser therapy was done smoothly(80W-120W) 6. Balloon inflated to 60cc Operative Procedures Under satisfactory spinal anesthesia, the patient was placed in lithotomy position. Prepping and draping were performed in the usual sterile method. A Fr 27. Olympus resectoscope sheath was inserted into the urethra with adequate lubrication. Then the resectoscope was inserted. Bilateral lobes of prostate were vaporated with KTP Greenlight laser therapy(80W-120W). Hemostasis was done. 2g of tissue was resected. A 22 Fr. 3-way Foley catheter was inserted and its balloon was inflated to 60c.c. Continuous N/S irrigation started. The patient tolerated the operation well and was sent to the recovery room with stable condition. Operators 余宏政, Assistants 彭元宏, 張宇鳴, 張水萍 (M,1957/06/28,54y8m) 手術日期 2011/08/09 手術主治醫師 蕭輔仁 手術區域 東址 003房 03號 診斷 Cellulitis 器械術式 Debridment-- >10cm 手術類別 預定手術 手術部位 脊椎 傷口分類 髒 麻醉方式 無麻醉 麻醉主治醫師 ASA 1 紀錄醫師 周聖哲, 時間資訊 23:39 臨時手術NPO 14:05 進入手術室 14:21 手術開始 15:06 手術結束 15:12 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 深部傷口處理縫合擴創-大 1 0 摘要__ 手術科部: 外科部 套用罐頭: Debridement 開立醫師: 周聖哲 開立時間: 2011/08/09 15:24 Pre-operative Diagnosis Ankylosing soondylitis s/p thoracolumbar posterior fusion, complicated with wound infection Post-operative Diagnosis Ankylosing soondylitis s/p thoracolumbar posterior fusion, complicated with wound infection Operative Method Debridement Specimen Count And Types nil Pathology Nil Operative Findings Wound dehiscence with necrotic tissue between paraspinal muscle and implants Operative Procedures The patient was put in prone position. We disinfected and drapped the operation field as usual. Linear skin incision was made to extended the dehiscence wound. The necrotic tissue was removed with Rongeur an curette. After irrigation with Gentamicin solution and hemostasis. One CWV drain was placed and the wound was closed in layers. Operators VS蕭輔仁 Assistants R5曾峰毅, R2周聖哲, Ri陳 相關圖片 陳國樹 (M,1921/09/22,90y5m) 手術日期 2011/08/09 手術主治醫師 蔡翊新 手術區域 東址 003房 02號 診斷 Intracerebral hemorrhage 器械術式 Tracheostomy + EVD revision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 周聖哲, 時間資訊 23:30 臨時手術NPO 11:45 進入手術室 11:48 麻醉開始 11:50 誘導結束 12:22 手術開始 13:15 13:35 手術結束 13:40 送出病患 13:40 麻醉結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室體外引流 1 1 R 手術 氣管切開術 1 0 R 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 蔡翊新 開立時間: 2011/08/09 13:24 Pre-operative Diagnosis Head injury with IVH and hydrocephalus, s/p EVD; Prolonged intubation with respiratory failure. Post-operative Diagnosis Head injury with IVH and hydrocephalus, s/p EVD; Prolonged intubation with respiratory failure. Operative Method Right Kocher EVD revision; Tracheostomy Specimen Count And Types 3 tubes of CSF, sent for routine, BCS and bacterial culture Pathology Nil. Operative Findings 1. CSF: bloody, pressure: 15 cmH2O. EVD tube 6.5 cm in depth. 2. 8# Tracheostomy was inserted via 2nd tracheal ring. Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: supine. Previous EVD at right Frazier point was removed first. 3.Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 5 cm linear, right frontal, corresponded to the location of right frontal horn. Raney clips were applied to the scalp edge for temporary hemostasis. 5.After the scalp flap had been lifted and reflected anteriorly, a burr hole was made and the dura was tented by 2 stitches. 6.The dura was opened by a nib incision. Rt lateral ventricle was tapped by a ventricular needle, then a 6.5 cm segment of the ventricular catheter was introduced into the ventricle. 7.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 8.Redrapping and disinfection for tracheostomy. 9.A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyroid isthmus is also divided. 10.Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tube is fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. 11.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5曾峰毅R2周聖哲Ri 相關圖片 李再興 (M,1958/12/01,53y3m) 手術日期 2011/08/09 手術主治醫師 蔡翊新 手術區域 東址 003房 06號 診斷 Major trauma rated 16 or above on the severity scale ( Injury severity score >=16 ) 器械術式 Craniectomy for acute SDH removal 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3E 紀錄醫師 陳國瑋, 時間資訊 07:30 臨時手術NPO 07:30 開始NPO 17:35 通知急診手術 18:25 報到 18:29 進入手術室 18:35 麻醉開始 19:00 誘導結束 19:01 抗生素給藥 19:24 手術開始 21:40 麻醉結束 21:40 手術結束 21:55 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 急性硬腦膜下血腫清除術 1 1 L 手術 顱內壓視置入 1 2 L 摘要__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 蔡翊新 開立時間: 2011/08/09 21:24 Pre-operative Diagnosis Left frontotemporoparietal acute SDH, SAH and brain swelling. Post-operative Diagnosis Left frontotemporoparietal acute SDH, SAH and brain swelling. Operative Method Left frontotemporoparietal craniectomy for SDH evacuation and subdural ICP monitoring. Specimen Count And Types nil Pathology Nil. Operative Findings Intramural hematoma at left temporalis muscle and Linear skull fracture at left temporal bone were noted. ICP upon first burr hole creation was 24 mmHg. The dura was tense upon craniectomy. Before dural opening, the ICP climbed up to 46 mmHg. Blood clots gushed out upon dural incision and subdural hematoma, 18 x 14 cm in area and 1.5 cm in thickness, was evacuated from left F-T-P area. Diffuse SAH and several contusion sites were noted at left F-T-P area. There were several active bleeders from cortical arteries and veins, also from bridging veins. Adhesions between cortical surface and dura were encountered at left frontotemporal region, possibly due to previous head injury. The ICP after skin closure was mmHg. Intramural hematoma at left temporalis muscle and Linear skull fracture at left temporal bone were noted. ICP upon first burr hole creation was 24 mmHg. The dura was tense upon craniectomy. Before dural opening, the ICP climbed up to 46 mmHg. Blood clots gushed out upon dural incision and subdural hematoma, 18 x 14 cm in area and 1.5 cm in thickness, was evacuated from left F-T-P area. Diffuse SAH and several contusion sites were noted at left F-T-P area. There were several active bleeders from cortical arteries and veins, also from bridging veins. Adhesions between cortical surface and dura were encountered at left frontotemporal region, possibly due to previous head injury. The ICP after skin closure was 1 mmHg. Intramural hematoma at left temporalis muscle and Linear skull fracture at left temporal bone were noted. ICP upon first burr hole creation was 24 mmHg. The dura was tense upon craniectomy. Before dural opening, the ICP climbed up to 46 mmHg. Blood clots gushed out upon dural incision and subdural hematoma, 18 x 14 cm in area and 1.5 cm in thickness, was evacuated from left F-T-P area. Diffuse SAH and several contusion sites were noted at left F-T-P area. There were several active bleeders from cortical arteries and veins, also from bridging veins. Adhesions between cortical surface and dura were encountered at left frontotemporal region, possibly due to previous head injury. The ICP after skin closure was 1 mmHg. The ICP monitor reference was 469. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: left temporal horseshoe, the skin edge was clipped by Raney clips for temporary hemostasis. The temporalis muscles was incised down to the tempoal squama. 5. Craniectomy window: 14 x 12 cm, left F-T-P, created by making 5 burr holes then cut by power saw. ICP monitor was inserted to left temporal subdural space. 6. Dural tenting: by 2/0 silk, 2-cm in interval, distributed along the edge of skull window. 7. Dural incision: curvilinear along the edge of skull window. 8. The subdural clot was removed by sucker. 9. Hemosatasis: the bleeders was stopped by Bovie and oozing surface was covered with Gelfoam. 10.Dural closure: was closed with a piece of Duroform in order to create an additional space for the swollen brain. 11.The skull plate was removed and stored at bone bank for preservation. 12.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 3/0 Dexon and skin by continuous suture with 3/0 nylon. 13.Drain: two epidural CWV drains. 14.Blood transfusion: PRBC 2U. Blood loss: 1100 ml. 15.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5林哲光R3陳國瑋 Indication Of Emergent Operation conscious deterioration, IICP, midline shift, brainstem compression. 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 蔡翊新 開立時間: 2011/08/09 21:34 Pre-operative Diagnosis Left frontotemporoparietal acute SDH, SAH and brain swelling. Post-operative Diagnosis Left frontotemporoparietal acute SDH, SAH and brain swelling. Operative Method Left frontotemporoparietal craniectomy for SDH evacuation and subdural ICP monitoring. Specimen Count And Types nil Pathology Nil. Operative Findings Intramural hematoma at left temporalis muscle and Linear skull fracture at left temporal bone were noted. ICP upon first burr hole creation was 24 mmHg. The dura was tense upon craniectomy. Before dural opening, the ICP climbed up to 46 mmHg. Blood clots gushed out upon dural incision and subdural hematoma, 18 x 14 cm in area and 1.5 cm in thickness, was evacuated from left F-T-P area. Diffuse SAH and several contusion sites were noted at left F-T-P area. There were several active bleeders from cortical arteries and veins, also from bridging veins. Adhesions between cortical surface and dura were encountered at left frontotemporal region, possibly due to previous head injury. The ICP after skin closure was 1 mmHg. Intramural hematoma at left temporalis muscle and Linear skull fracture at left temporal bone were noted. ICP upon first burr hole creation was 24 mmHg. The dura was tense upon craniectomy. Before dural opening, the ICP climbed up to 46 mmHg. Blood clots gushed out upon dural incision and subdural hematoma, 18 x 14 cm in area and 1.5 cm in thickness, was evacuated from left F-T-P area. Diffuse SAH and several contusion sites were noted at left F-T-P area. There were several active bleeders from cortical arteries and veins, also from bridging veins. Adhesions between cortical surface and dura were encountered at left frontotemporal region, possibly due to previous head injury. The ICP after skin closure was 1 mmHg. The reference of ICP monitor was 469. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: left temporal horseshoe, the skin edge was clipped by Raney clips for temporary hemostasis. The temporalis muscles was incised down to the tempoal squama. 5. Craniectomy window: 14 x 12 cm, left F-T-P, created by making 5 burr holes then cut by power saw. ICP monitor was inserted to left temporal subdural space. 6. Dural tenting: by 2/0 silk, 2-cm in interval, distributed along the edge of skull window. 7. Dural incision: curvilinear along the edge of skull window. 8. The subdural clot was removed by sucker. 9. Hemosatasis: the bleeders was stopped by Bovie and oozing surface was covered with Gelfoam. 10.Dural closure: was closed with a piece of Duroform in order to create an additional space for the swollen brain. 11.The skull plate was removed and stored at bone bank for preservation. 12.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 3/0 Dexon and skin by continuous suture with 3/0 nylon. 13.Drain: two epidural CWV drains. 14.Blood transfusion: PRBC 2U. Blood loss: 1100 ml. 15.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5林哲光R3陳國瑋 Indication Of Emergent Operation conscious deterioration, IICP, midline shift, brainstem compression. 相關圖片 蔡仁根 (M,1936/04/30,75y10m) 手術日期 2011/08/09 手術主治醫師 紀乃新 手術區域 東址 001房 03號 診斷 Dissection of aorta, thoracic 器械術式 D.A.A (Bentells or Grafting) 手術類別 緊急手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 4E 紀錄醫師 陳建銘, 時間資訊 10:54 開始NPO 10:54 通知急診手術 13:00 報到 13:13 進入手術室 13:15 麻醉開始 13:40 誘導結束 14:00 抗生素給藥 14:10 手術開始 17:00 抗生素給藥 20:00 開始輸血 20:00 抗生素給藥 20:56 麻醉結束 20:56 手術結束 21:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 7 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 4 0 麻醉 動脈血液檢查全套 4 0 麻醉 Hemoglobin (Hb) 4 0 麻醉 測血糖 4 0 麻醉 Ca (Calcium) 4 0 麻醉 Na (Sodium) 4 0 麻醉 K (Potassium) 4 0 麻醉 Blood gas analysis 4 0 麻醉 T.E.E 1 0 手術 瓣膜成形術 1 2 手術 體外心肺循環 1 1 手術 胸(腹)部動靜廔管之切除移植或直接修補手術–主動脈弓 1 1 記錄__ 手術科部: 外科部 套用罐頭: 1.AVP, 2.total arch replacement (Hybrid proce... 開立醫師: 陳建銘 開立時間: 2011/08/13 11:07 Pre-operative Diagnosis 1.DAA,type I with cardiac temponade, 2.moderate AR Post-operative Diagnosis 1.DAA,type I with cardiac temponade, 2.moderate AR Operative Method 1.AVP, 2.total arch replacement (Hybrid procedure), 3.TEVAR over arch and decending thoracic aorta Specimen Count And Types 1 piece About size: Source:ascending aorta Pathology pending Operative Findings 1.AR due to NCC prolapse and chordae displacement Operative Procedures 1.SCA,FA;FV,RA cannulate on CPB, cooling to 18C 2.AVP with compression suture over NCC 3.Proximal aortic root reconstruction with Sandwich method using 4-branch,30mm Hemasheld 4.left carotid artery anastomose to 4 branch graft with continus suture to right carotid and left subclavilce artery 5.right brachiocephalic truck anastomose to graft 6.perfuse brachiocephalic truck and LCA from 4-branch graft 7.open aortic arch and place Gore Endovascular graft(40mm;15cm) ; low body arrest time 24min (left subclavicle artery closed from inside) 8.finish distal anatomosis Operators VS紀乃新 VS詹志洋 Assistants F林明賢 R5周恒文 R3陳建銘 Indication Of Emergent Operation DAA with pericardial effusion 陳如春 (F,1974/11/16,37y3m) 手術日期 2011/08/10 手術主治醫師 杜永光 手術區域 東址 003房 號 診斷 Spine tumor 器械術式 Intraspinal intramedullary tum 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 曾偉倫, 時間資訊 23:46 臨時手術NPO 08:05 進入手術室 08:30 麻醉開始 09:30 誘導結束 09:36 抗生素給藥 10:05 手術開始 12:40 抗生素給藥 15:30 手術結束 15:30 麻醉結束 15:40 抗生素給藥 15:55 送出病患 16:00 進入恢復室 17:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 脊椎內脊髓內腫瘤切除術 1 1 摘要__ 手術科部: 外科部 套用罐頭: T2 and T3 laminoplasty + T4 hemi-laminectomy ... 開立醫師: 曾偉倫 開立時間: 2011/08/10 16:03 Pre-operative Diagnosis T2-3 Intradural intramedullary spinal tumor, suspect hemangioblastoma Post-operative Diagnosis T2-3 Intradural intramedullary spinal tumor, suspect hemangioblastoma Operative Method T2 and T3 laminoplasty + T4 hemi-laminectomy for tumor excision Specimen Count And Types 1 piece About size:3x1x1 cm Source:Intra-medullary spine tumor, T2-3, suspect hemangioblastoma Pathology Pending Operative Findings A 3x2x2 cm orange to reddish, soft, haypervascularized, intramedullary tumor over posterior part of T2-3 level. Three feeding artery and engourged drainage vein was identified with intra-operative ICG. Syringomyelia anterior to the tumor and it was entered during the dissection of the tumor. The pia was thickened with fibrotic change around the tumor. The nerve roots stays around the tumorwith out attachment. The SSEP and MEP showed no latency or amplitude change during the operation. The blood loss was 200ml. Operative Procedures Under ETGA, the patient was put on prone position with her head fixed with Mayfield clamp. The T2-3 level was located with C-arm. After we scrubbed, disinfected and drapped, a mid-line skin incision was made over T1-T4 level. After opening the wound in layers, T2-3 laminectomy was done and the dura was exposed. The hemi-laminectomy over T4 was done for better operation exposure. The mid-line durotomy was done and the tumor was dissected. The feeding artery and drainage vein was identified with intra-operative ICG. After cauterized the feeding artery, tumor excision was initiated with bipolar forceps, dissector, needle and suction tube. After the tumor was removed, the pia was closed with 3-0 prolene. After complete hemostasis, a CWV drain was placed. The wound was closed in layers. Operators Prof. 杜永光 Assistants R5 李振豪 R3 曾偉倫 Ri 許淑嫻 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: T2 and T3 laminoplasty + T4 hemi-laminectomy ... 開立醫師: 曾偉倫 開立時間: 2011/08/10 16:03 Pre-operative Diagnosis T2-3 Intradural intramedullary spinal tumor, suspect hemangioblastoma Post-operative Diagnosis T2-3 Intradural intramedullary spinal tumor, suspect hemangioblastoma Operative Method T2 and T3 laminoplasty + T4 hemi-laminectomy for tumor excision Specimen Count And Types 1 piece About size:3x1x1 cm Source:Intra-medullary spine tumor, T2-3, suspect hemangioblastoma Pathology Pending Operative Findings A 3x2x2 cm orange to reddish, soft, haypervascularized, intramedullary tumor over posterior part of T2-3 level. Three feeding artery and engourged drainage vein was identified with intra-operative ICG. Syringomyelia anterior to the tumor and it was entered during the dissection of the tumor. The pia was thickened with fibrotic change around the tumor. The nerve roots stays around the tumorwith out attachment. The SSEP and MEP showed no latency or amplitude change during the operation. The blood loss was 200ml. Operative Procedures Under ETGA, the patient was put on prone position with her head fixed with Mayfield clamp. The T2-3 level was located with C-arm. After we scrubbed, disinfected and drapped, a mid-line skin incision was made over T1-T4 level. After opening the wound in layers, T2-3 laminectomy was done and the dura was exposed. The hemi-laminectomy over T4 was done for better operation exposure. The mid-line durotomy was done and the tumor was dissected. The feeding artery and drainage vein was identified with intra-operative ICG. After cauterized the feeding artery, tumor excision was initiated with bipolar forceps, dissector, needle and suction tube. After the tumor was removed, the pia was closed with 3-0 prolene. After complete hemostasis, a CWV drain was placed. The wound was closed in layers. Operators Prof. 杜永光 Assistants R5 李振豪 R3 曾偉倫 Ri 許淑嫻 相關圖片 蔡子靖 (M,1944/01/27,68y1m) 手術日期 2011/08/10 手術主治醫師 杜永光 手術區域 東址 005房 01號 診斷 Lumbar spondylosis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 林哲光, 時間資訊 23:48 臨時手術NPO 07:40 報到 08:05 進入手術室 08:10 麻醉開始 08:35 誘導結束 09:10 抗生素給藥 09:10 手術開始 13:00 抗生素給藥 14:20 開始輸血 16:00 抗生素給藥 18:35 麻醉結束 18:35 手術結束 18:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(每增加<=六節) 1 1 手術 椎間盤切除術-腰椎 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 13 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: Removal of TPS at L3, L4, L5; L2 left partial... 開立醫師: 林哲光 開立時間: 2011/08/10 18:40 Pre-operative Diagnosis Failed back syndrome Post-operative Diagnosis Failed back syndrome Operative Method Removal of TPS at L3, L4, L5; L2 left partial laminectomy and sublaminal decompression; TPS at L2, L3, L5 and L2/3 discectomy and posterior fusion with PEEK cage Specimen Count And Types nil Pathology Nil Operative Findings status post laminectomy and TPS, severe adhesion was noted with not well recognized plane between the dura and surrounding soft tissue. TPS were all removed and 6.2x45mmx6 were applied to L2, L3, L5 pedicles. 11mm PEEK cage was inserted into the L2/3 intervertebral disc level. Dura sac seemed compressed tightly by surrounding soft tissue including ligamentum flavum and it seemed re-expanded slightly after sublaminal decompression was done. Some soft tissue limitation was divided as extensively as possible. Two rods, 9cm and 10cm, were inserted for posterior fusion at right and left side respectively. A cross-link was then applied. Operative Procedures Under ETGA and prone position, skin disinfected and drapped were performed as usual. Midline skin incision was made at previous operative wound. The paraspinal muscles at L2 level were detached. Previous TPS were then exposed well along the lamina plane. TPS were then removed and other TPS were then inserted at L2, L3, L5 level and confirmed with C-arm. L2/3 discetomy was then performed and PEEK cage was then inserted. Sublaminal decompression at L2 and L3 level was done. Rods and cross link were then inserted and the wound was then closed in layers after epidural H/V insertion. Operators 杜永光, 賴達明 Assistants 林哲光, 蕭智陽, 龔柏榕 相關圖片 王嘉緗 (F,1965/11/24,46y3m) 手術日期 2011/08/10 手術主治醫師 賴達明 手術區域 東址 016房 03號 診斷 Brain cancer 器械術式 External ventricular drainage, right side 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 4E 紀錄醫師 周聖哲, 時間資訊 08:00 開始NPO 11:35 通知急診手術 12:25 進入手術室 12:30 麻醉開始 12:50 誘導結束 13:00 抗生素給藥 13:19 手術開始 13:57 手術結束 13:57 麻醉結束 14:03 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 顱內壓視置入 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 曾峰毅 開立時間: 2011/08/10 13:57 Pre-operative Diagnosis Acute obstructive hydrocephalus Post-operative Diagnosis Acute obstructive hydrocephalus Operative Method External ventricular draiange via right Kocher point Specimen Count And Types Nil Pathology Nil Operative Findings Opening pressure was about 10cm H20. Colorless, clear CSF was drained. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position. We shaved, scrubbed, disinfected, and then draped the patient's scalp as usual. We made one transverse scalp incision at right frontal area, and drilled one burr hole. After durotomy, ventriculosotomy was performed. External ventricular drainage was inserted, and the wound was closed in layers. Operators VS 賴達明 Assistants R5 曾峰毅 R2 周聖哲 Indication Of Emergent Operation Acute hydrocephalus. 相關圖片 林鈺翔 (M,1990/08/09,21y7m) 手術日期 2011/08/10 手術主治醫師 郭順文 手術區域 東址 016房 02號 診斷 spinal cord injury 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 污染 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 3 紀錄醫師 高明蔚, 時間資訊 10:55 送出病患 11:23 進入手術室 11:25 麻醉開始 11:28 誘導結束 11:39 手術開始 11:50 麻醉結束 11:50 手術結束 醫令資訊 類別 名稱 量 刀 側 手術 氣管切開術 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 高明蔚 開立時間: 2011/08/10 12:06 Pre-operative Diagnosis C-spine injury, respiratory failure Post-operative Diagnosis C-spine injury, respiratory failure Operative Method Tracheostomy Specimen Count And Types nil Pathology Nil Operative Findings Via 2nd cartiladge. ID 8 low-pressure cuffed tracheostomy tube was inserted. Operative Procedures ETGA, supine, skin disinfection and draping. Skin incision. Dissect in layers. Hemostasis. Insert tube. Close the wound. Operators 郭順文 Assistants R4高明蔚,R1陸惠宗 何東鏘 (M,1935/10/20,76y4m) 手術日期 2011/08/11 手術主治醫師 陳敞牧 手術區域 東址 005房 01號 診斷 Diabetes mellitus 器械術式 Laminectomy for decompression, L4/5 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 林哲光, 時間資訊 23:56 臨時手術NPO 07:55 報到 08:00 進入手術室 08:10 麻醉開始 08:40 誘導結束 09:05 抗生素給藥 09:28 手術開始 11:23 手術結束 11:23 麻醉結束 11:30 送出病患 11:35 進入恢復室 13:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 手術 椎弓切除術(減壓)-二節以內 1 1 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: L4/5 laminotomy with sublaminal decompression 開立醫師: 林哲光 開立時間: 2011/08/11 11:34 Pre-operative Diagnosis L4/5 spinal canal stenosis Post-operative Diagnosis L4/5 spinal canal stenosis Operative Method L4/5 laminotomy with sublaminal decompression Specimen Count And Types nil Pathology Nil Operative Findings Hypertrophic change of ligamentum flavum with direct compressing dura sac tightly. The dura sac seemed re-expanded well after sublaminal decompression. A small dura tear was noted and CSF gush out was noted, covered with Gelfoam. Operative Procedures Under ETGA and prone position, skin disinfected and drapped were performed as usual. Midline skin incision was made L4/5 level. The left paraspinal muscle was detached and L4, L5 lamina were exposed well and L4 laminotomy was done. Sublaminal decompression was done. The wound was then closed in layers after hemostasis. Operators 陳敞牧 Assistants 林哲光, 吳欣翰 相關圖片 程紹淳 (M,1965/07/10,46y8m) 手術日期 2011/08/11 手術主治醫師 陳敞牧 手術區域 東址 005房 02號 診斷 Cervical Spondylosis 器械術式 Lamino plasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 林哲光, 時間資訊 23:02 臨時手術NPO 11:58 進入手術室 12:03 麻醉開始 12:10 誘導結束 12:15 抗生素給藥 12:20 手術開始 15:00 手術結束 15:00 麻醉結束 15:05 送出病患 15:06 進入恢復室 16:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 椎弓整形術 1 1 記錄__ 手術科部: 外科部 套用罐頭: C3-5 laminoplasty with C6 sublaminal decompre... 開立醫師: 林哲光 開立時間: 2011/08/11 15:27 Pre-operative Diagnosis C3-5 cervical canal stenosis Post-operative Diagnosis C3-5 cervical canal stenosis Operative Method C3-5 laminoplasty with C6 sublaminal decompression Specimen Count And Types nil Pathology Nil Operative Findings Dura sac seemed compressed tightly by ligamentum flavum. Dura sac seemed re-expanded well after laminoplasty. Operative Procedures Under ETGA and prone position, skin disinfected and drapped were performed as usual. Midline skin incision was made at C3-C6 level. Paraspinal muscles were detached and C3-5 lamina were exposed well. C3-5 laminoplasty was then performed and fixed with miniplates. The wound was then closed in layers after hemostasis and a epidural CWV drain insertion. Operators 陳昶牧 Assistants 林哲光, 龔柏榕 相關圖片 蕭純華 (F,1954/01/21,58y1m) 手術日期 2011/08/11 手術主治醫師 陳敞牧 手術區域 東址 005房 03號 診斷 Numbness 器械術式 Lamino plasty, C3-6 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 林哲光, 時間資訊 23:53 臨時手術NPO 15:20 進入手術室 15:30 麻醉開始 15:38 誘導結束 15:40 抗生素給藥 15:44 手術開始 18:05 手術結束 18:05 麻醉結束 18:10 送出病患 18:15 進入恢復室 20:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術(減壓)-超過二節 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 記錄__ 手術科部: 外科部 套用罐頭: C4-6 laminoplasty and C3 sublaminal decompression 開立醫師: 林哲光 開立時間: 2011/08/11 18:02 Pre-operative Diagnosis C3-6 cervical canal stenosis Post-operative Diagnosis C3-6 cervical canal stenosis Operative Method C4-6 laminoplasty and C3 sublaminal decompression Specimen Count And Types nil Pathology Nil Operative Findings Dura sac seemed compressed tightly by surrounding soft tissue and ligamentum flavum. Dura sac seemed re-expanded well after laminoplasty. Operative Procedures Under ETGA and prone position, skin disinfected and drapped were performed as usual. Midline skin incision was made at C3-6 level and paraspinal muscles were detached. C4-6 laminoplasty was then perfomred and fixed with miniplates. C3 sublaminal decompression was done. The wound was then closed in layers after hemostasis and epidural CWV drain insertion. Operators 陳敞牧 Assistants 林哲光, 吳欣翰 相關圖片 許武助 (M,1939/09/28,72y5m) 手術日期 2011/08/11 手術主治醫師 王國川 手術區域 東址 003房 03號 診斷 Lung tumor 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 15:03 報到 15:17 進入手術室 15:23 麻醉開始 15:30 誘導結束 15:50 抗生素給藥 15:55 手術開始 16:30 手術結束 16:30 麻醉結束 16:38 送出病患 16:40 進入恢復室 17:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室腹腔分流手術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt insertion via left... 開立醫師: 王奐之 開立時間: 2011/08/11 16:28 Pre-operative Diagnosis Obstructive hydrocephalus Post-operative Diagnosis Obstructive hydrocephalus Operative Method Ventriculoperitoneal shunt insertion via left Kocher point Specimen Count And Types Nil Pathology Nil Operative Findings Clear CSF was noted upon ventricular puncture, opening pressure: 15~20cmH2O. Codman 100mmH2O reservoir was used. Difficult subcutaneous passage was encountered at retroauricular area. Ventricular catheter length: 6.5cm, peritoneal catheter length: 30cm. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to right. After shaving, scrubbing, disinfection and draping in sterile fashion, a linear incision was made at left frontal area. A bur hole was created at left Kocher point, followed by 2 tenting stitches. Another linear incision was made at left upper quadrant of abdomen. A subcutaneous tunnel was created from the abdominal wound to left frontal wound, 1 more wound in between were created for easier passage. After passing throught the peritoneal catheter, ventricular puncture was performed once. The shunt was then assembled and inserted. After hemostasis, the wounds were closed in layers. Operators VS 王國川 Assistants R4 王奐之, PGY 王怡人 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt insertion via left... 開立醫師: 王奐之 開立時間: 2011/08/11 16:28 Pre-operative Diagnosis Obstructive hydrocephalus Post-operative Diagnosis Obstructive hydrocephalus Operative Method Ventriculoperitoneal shunt insertion via left Kocher point Specimen Count And Types Nil Pathology Nil Operative Findings Clear CSF was noted upon ventricular puncture, opening pressure: 15~20cmH2O. Codman 100mmH2O reservoir was used. Difficult subcutaneous passage was encountered at retroauricular area. Ventricular catheter length: 6.5cm, peritoneal catheter length: 30cm. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to right. After shaving, scrubbing, disinfection and draping in sterile fashion, a linear incision was made at left frontal area. A bur hole was created at left Kocher point, followed by 2 tenting stitches. Another linear incision was made at left upper quadrant of abdomen. A subcutaneous tunnel was created from the abdominal wound to left frontal wound, 1 more wound in between were created for easier passage. After passing throught the peritoneal catheter, ventricular puncture was performed once. The shunt was then assembled and inserted. After hemostasis, the wounds were closed in layers. Operators VS 王國川 Assistants R4 王奐之, PGY 王怡人 相關圖片 摘要__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt insertion via left... 開立醫師: 王奐之 開立時間: 2011/08/11 16:41 Pre-operative Diagnosis Obstructive hydrocephalus Post-operative Diagnosis Obstructive hydrocephalus Operative Method Ventriculoperitoneal shunt insertion via left Kocher point Specimen Count And Types Nil Pathology Nil Operative Findings Clear CSF was noted upon ventricular puncture, opening pressure: 15~20cmH2O. Codman 100mmH2O reservoir was used. Ventricular catheter length: 6.5cm, peritoneal catheter length: 30cm. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to right. After shaving, scrubbing, disinfection and draping in sterile fashion, a linear incision was made at left frontal area. A bur hole was created at left Kocher point, followed by 2 tenting stitches. Another linear incision was made at left upper quadrant of abdomen. A subcutaneous tunnel was created from the abdominal wound to left frontal wound, 1 more wound in between were created for easier passage. After passing throught the peritoneal catheter, ventricular puncture was performed once. The shunt was then assembled and inserted. After hemostasis, the wounds were closed in layers. Operators VS 王國川 Assistants R4 王奐之, PGY 王怡人 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt insertion via left... 開立醫師: 王奐之 開立時間: 2011/08/11 16:41 Pre-operative Diagnosis Obstructive hydrocephalus Post-operative Diagnosis Obstructive hydrocephalus Operative Method Ventriculoperitoneal shunt insertion via left Kocher point Specimen Count And Types Nil Pathology Nil Operative Findings Clear CSF was noted upon ventricular puncture, opening pressure: 15~20cmH2O. Codman 100mmH2O reservoir was used. Ventricular catheter length: 6.5cm, peritoneal catheter length: 30cm. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to right. After shaving, scrubbing, disinfection and draping in sterile fashion, a linear incision was made at left frontal area. A bur hole was created at left Kocher point, followed by 2 tenting stitches. Another linear incision was made at left upper quadrant of abdomen. A subcutaneous tunnel was created from the abdominal wound to left frontal wound, 1 more wound in between were created for easier passage. After passing throught the peritoneal catheter, ventricular puncture was performed once. The shunt was then assembled and inserted. After hemostasis, the wounds were closed in layers. Operators VS 王國川 Assistants R4 王奐之, PGY 王怡人 相關圖片 張林月梅 (F,1930/11/21,81y3m) 手術日期 2011/08/11 手術主治醫師 王國川 手術區域 東址 002房 04號 診斷 Subdural hemorrhage 器械術式 Removal of chronic subdural hematoma, Bilateral 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 3E 紀錄醫師 周聖哲, 時間資訊 09:00 臨時手術NPO 09:00 開始NPO 13:10 通知急診手術 18:40 進入手術室 18:45 麻醉開始 19:00 誘導結束 19:05 抗生素給藥 19:25 手術開始 20:20 麻醉結束 20:20 手術結束 20:50 送出病患 20:55 進入恢復室 22:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 B 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Bilateral frontal burr holes for subdural drain 開立醫師: 周聖哲 開立時間: 2011/08/11 20:38 Pre-operative Diagnosis Bilateral subdural hematoma Bilateral chronic subdural hematoma Post-operative Diagnosis Bilateral subdural hematoma Bilateral chronic subdural hematoma Operative Method Bilateral frontal burr holes for subdural drain Specimen Count And Types Nil Pathology Nil Operative Findings Dark-reddish non-coagulated blood was drained after durotomy. There was outer and inner membrane. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine positin. After scalp shaved, scrubbed, disinfected, and then draped, we made one transverse skin incision at left frontal area. We drilled one burr hole, and created durotomy. We inserted subdural rubber drain, and irrigated subdural space. The wound was closed in layers, and subdural was de-air-ed. Operators VS王國川 Assistants R2周聖哲 Indication Of Emergent Operation Chronic SDH 相關圖片 吳安元 (M,1944/10/20,67y4m) 手術日期 2011/08/11 手術主治醫師 王國川 手術區域 東址 003房 04號 診斷 Cerebral vascular disease 器械術式 Right decompressive craniectomy + ICP mornitoring 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 3E 紀錄醫師 王奐之, 曾偉倫, 時間資訊 08:00 開始NPO 14:09 通知急診手術 17:07 進入手術室 17:26 麻醉開始 18:00 抗生素給藥 18:02 誘導結束 18:23 手術開始 20:36 開始輸血 21:00 抗生素給藥 21:20 抗生素給藥 22:10 手術結束 22:10 麻醉結束 22:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 神經部 套用罐頭: Right frontotemporoparietal decompressive cra... 開立醫師: 王奐之 開立時間: 2011/08/11 22:42 Pre-operative Diagnosis Right MCA infarction with hemorrhagic transformation Post-operative Diagnosis Right MCA infarction with hemorrhagic transformation Operative Method Right frontotemporoparietal decompressive craniectomy, hematoma evacuation, partial right temporal lobectomy, duroplasty & subdural ICP monitoring Specimen Count And Types Nil Pathology Nil Operative Findings The brain bulged out immediately after durotomy, scattered hemorrhage with diffuse brain swelling was noted. After removal of superior temporal gyrus, temporal tip & a small portion at right parietal lobe, the brain pulsation became better and more slacked. ICP after dural closure was 0~1 mmHg. ICP monitor reference: 478. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After shaving, scrubbing, disinfection & draping in sterile fashion, a question-mark incision was made at right frontotemporoparietal area was done to create a standard trauma flap. The skin flap was then reflected anteroinferiorly, followed by dissection of the temporalis muscle subperiosteally. The temporalis fascia was harvested and craniectomy was done after drilling of 6 bur holes. After tenting, the dura was opened in C-shape and reflected inferiorly. The fascial graft was fixed onto the outer dural edge first, followed by partial right temporal lobectomy along with hematoma evacuation. After hemostasis, the dura was closed in water-tight fashion. The ICP monitor was inserted subdurally then. The wound was closed in layers after placement of 2 epidural CWV drain & securing the ICP monitor. Operators VS 王國川 Assistants R4 王奐之 Indication Of Emergent Operation 相關圖片 記錄__ 手術科部: 神經部 套用罐頭: Right frontotemporoparietal decompressive cra... 開立醫師: 王奐之 開立時間: 2011/08/11 22:42 Pre-operative Diagnosis Right MCA infarction with hemorrhagic transformation Post-operative Diagnosis Right MCA infarction with hemorrhagic transformation Operative Method Right frontotemporoparietal decompressive craniectomy, hematoma evacuation, partial right temporal lobectomy, duroplasty & subdural ICP monitoring Specimen Count And Types Nil Pathology Nil Operative Findings The brain bulged out immediately after durotomy, scattered hemorrhage with diffuse brain swelling was noted. After removal of superior temporal gyrus, temporal tip & a small portion at right parietal lobe, the brain pulsation became better and more slacked. ICP after dural closure was 0~1 mmHg. ICP monitor reference: 478. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After shaving, scrubbing, disinfection & draping in sterile fashion, a question-mark incision was made at right frontotemporoparietal area was done to create a standard trauma flap. The skin flap was then reflected anteroinferiorly, followed by dissection of the temporalis muscle subperiosteally. The temporalis fascia was harvested and craniectomy was done after drilling of 6 bur holes. After tenting, the dura was opened in C-shape and reflected inferiorly. The fascial graft was fixed onto the outer dural edge first, followed by partial right temporal lobectomy along with hematoma evacuation. After hemostasis, the dura was closed in water-tight fashion. The ICP monitor was inserted subdurally then. The wound was closed in layers after placement of 2 epidural CWV drain & securing the ICP monitor. Operators VS 王國川 Assistants R4 王奐之 Indication Of Emergent Operation IICP 相關圖片 摘要__ 手術科部: 神經部 套用罐頭: Right frontotemporoparietal decompressive cra... 開立醫師: 王奐之 開立時間: 2011/08/12 07:16 Pre-operative Diagnosis Right MCA infarction with hemorrhagic transformation Post-operative Diagnosis Right MCA infarction with hemorrhagic transformation Operative Method Right frontotemporoparietal decompressive craniectomy, hematoma evacuation, partial right temporal lobectomy, duroplasty & subdural ICP monitoring Specimen Count And Types Nil Pathology Nil Operative Findings The brain bulged out immediately after durotomy, scattered hemorrhage with diffuse brain swelling was noted. After removal of superior temporal gyrus, temporal tip & a small portion at right parietal lobe, the brain pulsation became better and more slacked. ICP after dural closure was 0~1 mmHg. ICP monitor reference: 478. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After shaving, scrubbing, disinfection & draping in sterile fashion, a question-mark incision was made at right frontotemporoparietal area was done to create a standard trauma flap. The skin flap was then reflected anteroinferiorly, followed by dissection of the temporalis muscle subperiosteally. The temporalis fascia was harvested and craniectomy was done after drilling of 6 bur holes. After tenting, the dura was opened in C-shape and reflected inferiorly. The fascial graft was fixed onto the outer dural edge first, followed by partial right temporal lobectomy along with hematoma evacuation. After hemostasis, the dura was closed in water-tight fashion. The ICP monitor was inserted subdurally then. The wound was closed in layers after placement of 2 epidural CWV drain & securing the ICP monitor. Operators VS 王國川 Assistants R4 王奐之, R3 曾偉倫 Indication Of Emergent Operation 相關圖片 記錄__ 手術科部: 神經部 套用罐頭: Right frontotemporoparietal decompressive cra... 開立醫師: 王奐之 開立時間: 2011/08/12 07:17 Pre-operative Diagnosis Right MCA infarction with hemorrhagic transformation Post-operative Diagnosis Right MCA infarction with hemorrhagic transformation Operative Method Right frontotemporoparietal decompressive craniectomy, hematoma evacuation, partial right temporal lobectomy, duroplasty & subdural ICP monitoring Specimen Count And Types Nil Pathology Nil Operative Findings The brain bulged out immediately after durotomy, scattered hemorrhage with diffuse brain swelling was noted. After removal of superior temporal gyrus, temporal tip & a small portion at right parietal lobe, the brain pulsation became better and more slacked. ICP after dural closure was 0~1 mmHg. ICP monitor reference: 478. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After shaving, scrubbing, disinfection & draping in sterile fashion, a question-mark incision was made at right frontotemporoparietal area was done to create a standard trauma flap. The skin flap was then reflected anteroinferiorly, followed by dissection of the temporalis muscle subperiosteally. The temporalis fascia was harvested and craniectomy was done after drilling of 6 bur holes. After tenting, the dura was opened in C-shape and reflected inferiorly. The fascial graft was fixed onto the outer dural edge first, followed by partial right temporal lobectomy along with hematoma evacuation. After hemostasis, the dura was closed in water-tight fashion. The ICP monitor was inserted subdurally then. The wound was closed in layers after placement of 2 epidural CWV drain & securing the ICP monitor. Operators VS 王國川 Assistants R4 王奐之, R3 曾偉倫 Indication Of Emergent Operation IICP 相關圖片 黃國書 (M,1963/09/10,48y6m) 手術日期 2011/08/11 手術主治醫師 王國川 手術區域 東址 001房 04號 診斷 Ischemic stroke 器械術式 Sub-occipital craniectomy + EVD insertion 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 3E 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 20:51 通知急診手術 21:58 報到 21:58 進入手術室 22:08 麻醉開始 22:20 誘導結束 22:20 抗生素給藥 23:16 手術開始 23:30 開始輸血 01:20 抗生素給藥 02:20 麻醉結束 02:20 手術結束 02:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱骨切除術,包括異物移除或壓或經切斷 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Right Frazier EVD insertion and suboccipital ... 開立醫師: 林哲光 開立時間: 2011/08/12 03:04 Pre-operative Diagnosis Cerebellar infarction, left hemisphere Post-operative Diagnosis Cerebellar infarction, left hemisphere Operative Method Right Frazier EVD insertion and suboccipital craniectomy with removal of part of left cerebellum and duroplasty with autologus fascia for posterior fossa decompression Specimen Count And Types nil Pathology Nil Operative Findings Pre-operative GCS was M4. Gush of CSF was noted after ventricular puncture and intraventricular catheter was around 9cm long. Sharp angle and small posteior fossa was noted. C1 subluxation was noted before the operation from CT image. Bulging left cerebellar hemisphere was noted with ischemic change was noted. Tonsilar herniation with medulla oblongata compression was noted. Duroplasty with autologus fascia was done and the dura seemed slack after craniectomy and partial cerebellum removal was done. Operative Procedures Under ETGA and prone position with head fixed with Mayfield head clamp, skin disinfected and drapped were performed as usual. A paramedian skin incision was made at right Frazier point and EVD was inserted after a burr hole was created and dural tenting. Midline skin incision was made at inion to C2 level. A fascia flap was excised and nuchal muscles were divided from the midline and occipital bone was exposed well until foramn magnum was palpable. Four burr holes were created for suboccipital craniectomy and cerebellum and brainstem were exposed well by removal of bony structure with Karrison. The dura was then opened in V-shpaed and partial left hemisphere removal was done and tonil was removed totally until brainstem was no more compressed. Hemostasis with Surgecell was done. Duroplasty with autologus fascia was then performed and the wound was then closed in layers after a epidural CWV drain was inserted. Operators 王國川 Assistants 林哲光 Indication Of Emergent Operation Acute conscious change 相關圖片 卓郡祺 (F,1975/01/07,37y2m) 手術日期 2011/08/11 手術主治醫師 王國川 手術區域 東址 003房 號 診斷 Tension headache 器械術式 Microvascular decompression 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 王奐之, 時間資訊 23:52 臨時手術NPO 08:00 進入手術室 08:05 麻醉開始 08:15 誘導結束 09:25 抗生素給藥 09:25 手術開始 12:25 手術結束 12:25 麻醉結束 12:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦微血管減壓術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: Left retrosigmoid craniotomy for microvascula... 開立醫師: 王奐之 開立時間: 2011/08/11 13:21 Pre-operative Diagnosis Left hemifacial spasm Post-operative Diagnosis Left hemifacial spasm Operative Method Left retrosigmoid craniotomy for microvascular decompression of facial nerve Specimen Count And Types Nil Pathology Nil Operative Findings Easy oozing was encountered during craniotomy. Prominent mastoid air cells were noted, and sealed off with bone wax. A prominent loop of left AICA was noted near the superior margin of CN VII/VIII complex; another smaller looping artery passed in between CN VII/VIII were easily detached peripherally, but difficult to be pealed off from CN VII/VIII near the root exit zone. Operative Procedures After endotracheal general anesthesia, the patient was placed in left lateral oblique position ("park bench") with head fixed in Mayfield skull clamp. After shaving, scrubbing, disinfection & draping in sterile fashion, a lazy S-shaped incision was made at left retroauricular area. The incision was deepened, and a piece of fascia was harvested. The suboccipital muscles were then dissected subperiosteally. Retrosigmoid craniotomy was then performed, followed by durotomy in a K-shape. CSF release was done from the cisterna magna. After sinking of cerebellum, the cerebellum was gently retracted to expose the CN VII/VIII complex to the level of root exit zone. A loop of left AICA was noted to compress the CN VII/VIII at superior margin, and another smaller looping artery passed in between CN VII & CN VIII. Teflon were then inserted into the offending arteries and CN VII. After meticulous hemostasis, the CSF space was re-filled with normal saline, and the dura was closed in water-tight fashion with fascial graft. The bone was fixed back with mini-plates after central tenting. The bone defect was fixed with bone cement. After placement of 1 subgaleal CWV drain, the wound was closed in layers. Operators VS 王國川 Assistants R4 王奐之, R1 蕭智陽 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Left retrosigmoid craniotomy for microvascula... 開立醫師: 王奐之 開立時間: 2011/08/11 13:22 Pre-operative Diagnosis Left hemifacial spasm Post-operative Diagnosis Left hemifacial spasm Operative Method Left retrosigmoid craniotomy for microvascular decompression of facial nerve Specimen Count And Types Nil Pathology Nil Operative Findings Easy oozing was encountered during craniotomy. Prominent mastoid air cells were noted, and sealed off with bone wax. A prominent loop of left AICA was noted near the superior margin of CN VII/VIII complex; another smaller looping artery passed in between CN VII/VIII were easily detached peripherally, but difficult to be pealed off from CN VII/VIII near the root exit zone. Operative Procedures After endotracheal general anesthesia, the patient was placed in left lateral oblique position ("park bench") with head fixed in Mayfield skull clamp. After shaving, scrubbing, disinfection & draping in sterile fashion, a lazy S-shaped incision was made at left retroauricular area. The incision was deepened, and a piece of fascia was harvested. The suboccipital muscles were then dissected subperiosteally. Retrosigmoid craniotomy was then performed, followed by durotomy in a K-shape. CSF release was done from the cisterna magna. After sinking of cerebellum, the cerebellum was gently retracted to expose the CN VII/VIII complex to the level of root exit zone. A loop of left AICA was noted to compress the CN VII/VIII at superior margin, and another smaller looping artery passed in between CN VII & CN VIII. Teflon were then inserted into the offending arteries and CN VII. After meticulous hemostasis, the CSF space was re-filled with normal saline, and the dura was closed in water-tight fashion with fascial graft. The bone was fixed back with mini-plates after central tenting. The bone defect was fixed with bone cement. After placement of 1 subgaleal CWV drain, the wound was closed in layers. Operators VS 王國川 Assistants R4 王奐之, R1 蕭智陽 相關圖片 梁伊圻 (F,1988/02/05,24y1m) 手術日期 2011/08/11 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 Epilepsy 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 王奐之, 時間資訊 11:07 臨時手術NPO 13:05 進入手術室 13:10 麻醉開始 13:20 誘導結束 13:20 抗生素給藥 13:52 手術開始 14:55 手術結束 14:55 麻醉結束 15:08 送出病患 15:10 進入恢復室 15:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt insertion via left... 開立醫師: 王奐之 開立時間: 2011/08/11 15:20 Pre-operative Diagnosis Congenital aqueductal agenesis with non-communicating hydrocephalus, status post ventriculoperitoneal shunt insertion via right Kocher point, with shunt dysfunction Post-operative Diagnosis Congenital aqueductal agenesis with non-communicating hydrocephalus, status post ventriculoperitoneal shunt insertion via right Kocher point, with shunt dysfunction Operative Method Ventriculoperitoneal shunt insertion via left Kocher point Specimen Count And Types Nil Pathology Nil Operative Findings Clear CSF was noted upon ventricular puncture, opening pressure: 15~20cmH2O. Codman programmable shunt reservoir was used, preset to 120mmH2O. Difficult subcutaneous passage was encountered at retroauricular area. Ventricular catheter length: 6.5cm, peritoneal catheter length: 30cm. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to right. After shaving, scrubbing, disinfection and draping in sterile fashion, a linear incision was made at left frontal area. A bur hole was created at left Kocher point, followed by 2 tenting stitches. Another linear incision was made at left upper quadrant of abdomen. A subcutaneous tunnel was created from the abdominal wound to left frontal wound, 3 more wounds in between were created for easier passage. After passing throught the peritoneal catheter, ventricular puncture was performed once. The shunt was then assembled and inserted. After hemostasis, the wounds were closed in layers. Operators VS 王國川 Assistants R4 王奐之, PGY 王怡人 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt insertion via left... 開立醫師: 王奐之 開立時間: 2011/08/11 15:21 Pre-operative Diagnosis Congenital aqueductal agenesis with non-communicating hydrocephalus, status post ventriculoperitoneal shunt insertion via right Kocher point, with shunt dysfunction Post-operative Diagnosis Congenital aqueductal agenesis with non-communicating hydrocephalus, status post ventriculoperitoneal shunt insertion via right Kocher point, with shunt dysfunction Operative Method Ventriculoperitoneal shunt insertion via left Kocher point Specimen Count And Types Nil Pathology Nil Operative Findings Clear CSF was noted upon ventricular puncture, opening pressure: 15~20cmH2O. Codman programmable shunt reservoir was used, preset to 120mmH2O. Difficult subcutaneous passage was encountered at retroauricular area. Ventricular catheter length: 6.5cm, peritoneal catheter length: 30cm. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to right. After shaving, scrubbing, disinfection and draping in sterile fashion, a linear incision was made at left frontal area. A bur hole was created at left Kocher point, followed by 2 tenting stitches. Another linear incision was made at left upper quadrant of abdomen. A subcutaneous tunnel was created from the abdominal wound to left frontal wound, 3 more wounds in between were created for easier passage. After passing throught the peritoneal catheter, ventricular puncture was performed once. The shunt was then assembled and inserted. After hemostasis, the wounds were closed in layers. Operators VS 王國川 Assistants R4 王奐之, PGY 王怡人 相關圖片 戴金蘭 (F,1936/08/18,75y6m) 手術日期 2011/08/11 手術主治醫師 蔡翊新 手術區域 東址 001房 01號 診斷 Subarachnoid hemorrhage 器械術式 Craniotomy(Aneurysms) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 3E 紀錄醫師 曾峰毅, 時間資訊 20:00 臨時手術NPO 20:00 開始NPO 02:00 通知急診手術 04:39 進入手術室 04:55 麻醉開始 05:25 誘導結束 06:00 抗生素給藥 06:30 手術開始 09:00 抗生素給藥 09:10 開始輸血 11:10 手術結束 11:10 麻醉結束 11:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 開顱術摘除血管病變 - 腦血管瘤 有病徵的 1 1 R 手術 顱內壓視置入 1 2 R 摘要__ 手術科部: 外科部 套用罐頭: Aneurysm-frontotemporal approach 開立醫師: 蔡翊新 開立時間: 2011/08/11 10:23 Pre-operative Diagnosis Right p-com artery aneurysm rupture with SAH and IVH; right ICA bifurcation unruptured blister aneurysm. Post-operative Diagnosis Right p-com artery aneurysm rupture with SAH and IVH; right ICA bifurcation unruptured blister aneurysm. Operative Method Right frontotemporal craniotomy for clipping of both aneurysms and right Kocher point EVD for ICP monitoring. Specimen Count And Types 3 tubes of CSF, sent for routine, BCS and bacterial culture. Pathology Nil. Operative Findings CSF was sanguinous and initial pressure was about 8 cmH2O. There were some blood in prechiasmatic cistern. Calcification of right ICA wall was noted. A blister aneurysm at p-com-ICA junction pointed laterally was noted, with a wide (4-mm) base and a tiny daughter aneurysm on it. It was clipped with a 6-mm straight Sugita clip. A blister aneurysm was noted at bifurcation of right ICA, pointed superiorly, with wide (3-mm) base. It was round in shape. The ICA aneurysm was clipped with a 4-mm straight Sugita clip. There was not much SAH around both aneurysms. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with right back elevated and head rotated to left for 40 degree and slightly extended then fixed by Mayfield skull clamp. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: right frontotemporal, curvilinear. The skin edge was clipped by Raney clips for temporary hemostasis. After scalp had been lifted, the temporalis muscle was incised and detached from temporal squama and reflected to lower temporal side. 5. A burr hole was made at right Kocher point. An EVD tube was inserted to right frontal horn of lateral ventricle for CSF release and as an ICP monitor. 6. Craniotomy window: 8 x 6 cm, right frontotemporal, created by making 3 burr holes then cut by power saw. The lower temporal bone and pterionic ridge (esp.the inner table) were cut by rongeur and drill as low as possible for easy approach to the anterior clinoid. 7. Dural tention: by 2/0 silk, 2-cm in interval, distributed along the edge of skull window. 8. Dural incision: curvilinear, over-ridding Sylvian fissure and reflected to frontotemporal base. 9. Under operating microscope, the Sylvian fissure was opened, then the frontal and temporal opercula were retracted by self-retaining retractor in an opposite direction to expose the right ICA. When the dissectio was carried out more proximally, the aneurysms soon came into view. From that moment on, the patinet's blood pressure was brought down to 80 mHg. The neck of the aneurysm was mobilized gently by a Gage 18 sucker and a fine tip bipolar forceps until it was entirely free. 10.A 6-mm straight Sugita clip was applied to the neck of the aneurysm at p-com artery and ICA junction. A 4-mm straight Sugita clip was applied to the neck of the aneurysm at right ICA bifurcation. 11.After successful clipping of the aneurysm, the patient's BP was brought back to normal, and the exposed field was irrigated with N.S. to make sure no any bleeding. 12.The brain retractors were removed. The dura was closed water-tight by 2 2/0 silk for key stitches followed by running suture with 4/0 Prolene. 13.Closure of skull window: the skull plate was placed back to craniotomy window and fixed by 3 miniplates and 6 screws. The dura was tented to the center of the skull plate by several 2/0 stitches. The covering muscle was closed by interrupted stitches with 1/ 0 silk. 14.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Dexon and skin by continuous suture with 3/0 nylon. 15.Drain: one, epidural, CWV. 16.Blood transfusion: PRBC 2U. Blood loss: 16.Blood transfusion: PRBC 2U. Blood loss: 450 ml. 17.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5曾峰毅R0王怡人 Indication Of Emergent Operation aneurysm rupture with SAH, IVH, acute hydrocephalus; conscious disturbance 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Aneurysm-frontotemporal approach 開立醫師: 蔡翊新 開立時間: 2011/08/11 10:44 Pre-operative Diagnosis Right p-com artery aneurysm rupture with SAH and IVH; right ICA bifurcation unruptured blister aneurysm. Post-operative Diagnosis Right p-com artery aneurysm rupture with SAH and IVH; right ICA bifurcation unruptured blister aneurysm. Operative Method Right frontotemporal craniotomy for clipping of both aneurysms and right Kocher point EVD for ICP monitoring. Specimen Count And Types 3 tubes of CSF, sent for routine, BCS and bacterial culture. Pathology Nil. Operative Findings CSF was sanguinous and initial pressure was about 8 cmH2O. There were some blood in prechiasmatic cistern. Calcification of right ICA wall was noted. A blister aneurysm at p-com-ICA junction pointed laterally was noted, with a wide (4-mm) base and a tiny daughter aneurysm on it. It was clipped with a 6-mm straight Sugita clip. A blister aneurysm was noted at bifurcation of right ICA, pointed superiorly, with wide (3-mm) base. It was round in shape. The ICA aneurysm was clipped with a 4-mm straight Sugita clip. There was not much SAH around both aneurysms. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with right back elevated and head rotated to left for 40 degree and slightly extended then fixed by Mayfield skull clamp. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: right frontotemporal, curvilinear. The skin edge was clipped by Raney clips for temporary hemostasis. After scalp had been lifted, the temporalis muscle was incised and detached from temporal squama and reflected to lower temporal side. 5. A burr hole was made at right Kocher point. An EVD tube was inserted to right frontal horn of lateral ventricle for CSF release and as an ICP monitor. 6. Craniotomy window: 8 x 6 cm, right frontotemporal, created by making 3 burr holes then cut by power saw. The lower temporal bone and pterionic ridge (esp.the inner table) were cut by rongeur and drill as low as possible for easy approach to the anterior clinoid. 7. Dural tention: by 2/0 silk, 2-cm in interval, distributed along the edge of skull window. 8. Dural incision: curvilinear, over-ridding Sylvian fissure and reflected to frontotemporal base. 9. Under operating microscope, the Sylvian fissure was opened, then the frontal and temporal opercula were retracted by self-retaining retractor in an opposite direction to expose the right ICA. When the dissectio was carried out more proximally, the aneurysms soon came into view. From that moment on, the patinet's blood pressure was brought down to 80 mHg. The neck of the aneurysm was mobilized gently by a Gage 18 sucker and a fine tip bipolar forceps until it was entirely free. 10.A 6-mm straight Sugita clip was applied to the neck of the aneurysm at p-com artery and ICA junction. A 4-mm straight Sugita clip was applied to the neck of the aneurysm at right ICA bifurcation. 11.After successful clipping of the aneurysm, the patient's BP was brought back to normal, and the exposed field was irrigated with N.S. to make sure no any bleeding. 12.The brain retractors were removed. The dura was closed water-tight by 2 2/0 silk for key stitches followed by running suture with 4/0 Prolene. 13.Closure of skull window: the skull plate was placed back to craniotomy window and fixed by 3 miniplates and 6 screws. The dura was tented to the center of the skull plate by several 2/0 stitches. The covering muscle was closed by interrupted stitches with 1/ 0 silk. 14.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Dexon and skin by continuous suture with 3/0 nylon. 15.Drain: one, epidural, CWV. 16.Blood transfusion: PRBC 2U. Blood loss: 450 ml. 17.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5曾峰毅R0王怡人 Indication Of Emergent Operation aneurysm rupture with SAH, IVH, acute hydrocephalus; conscious disturbance 相關圖片 陳文英 (F,1953/10/30,58y4m) 手術日期 2011/08/12 手術主治醫師 杜永光 手術區域 東址 005房 02號 診斷 Meningioma 器械術式 External ventricular drainage 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 林哲光, 時間資訊 23:12 臨時手術NPO 15:27 進入手術室 15:30 麻醉開始 15:35 誘導結束 16:20 手術開始 17:35 麻醉結束 17:40 手術結束 17:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室體外引流 1 2 R 記錄__ 手術科部: 外科部 套用罐頭: Right frontal EVD insertion 開立醫師: 林哲光 開立時間: 2011/08/12 17:33 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Right frontal EVD insertion Specimen Count And Types 1 piece About size: Source:CSF for BCS, routine, culture Pathology Nil Operative Findings CSF seemed xanthochromic and initial intraventricular pressure was less then 10cmH2O. Intraventricular catheter was 7cm long. Much subgaleal effusion was noted. Operative Procedures Under ETGA and supine position with head mild rotated to left side, skin disinfected and drapped were performed as usual. Skin incision was made along the previous operative wound. The previous burr hole at right frontal area. EVD was then inserted as the previous trajectory and packed with Gelfoam. The wound was then closed in layers after EVD was fixed on the skin through the subcutaneous tunneling. Operators P 杜永光 Assistants R5 林哲光, R1 蕭智陽 相關圖片 鄭榮仁 (M,1961/08/06,50y7m) 手術日期 2011/08/12 手術主治醫師 杜永光 手術區域 東址 006房 02號 診斷 Spine tumor 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 4E 紀錄醫師 陳國瑋, 時間資訊 00:00 開始NPO 00:00 臨時手術NPO 08:59 通知急診手術 12:18 進入手術室 12:18 報到 12:20 麻醉開始 12:25 誘導結束 13:16 手術開始 14:05 麻醉結束 14:05 手術結束 14:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室體外引流 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: left Kocher point external ventricular draina... 開立醫師: 陳國瑋 開立時間: 2011/08/12 14:30 Pre-operative Diagnosis Cerebellar infarction and hydrocephalus Post-operative Diagnosis Cerebellar infarction and hydrocephalus Operative Method left Kocher point external ventricular drainage insertion Specimen Count And Types 1 piece About size:CSF 7ml Source:CSF Pathology nil Operative Findings The CSF was transparent with mild pinkish. The opening pressure was around 15mmHg. Operative Procedures The paitent was put in supine position. The previous EVD was removed. Under ETGA and supine position, skin disinfected and drapped were performed as usual. Skin incision was made at 1cm before coronal suture. The one burr hole was made and EVD was introduced into the ventricle after ventriculostomy with puncture needle. The wound was then closed in layers after EVD was fixed on the skin through subcutaneous tunnel. Operators Prof. 杜永光 Assistants R4 王奐之 R3 陳國瑋 Indication Of Emergent Operation Hydrocephalus, 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: left Kocher point external ventricular draina... 開立醫師: 王奐之 開立時間: 2011/08/12 21:29 Pre-operative Diagnosis Cerebellar infarction and hydrocephalus Post-operative Diagnosis Cerebellar infarction and hydrocephalus Operative Method left Kocher point external ventricular drainage insertion Specimen Count And Types 1 piece About size:CSF 7ml Source:CSF Pathology nil Operative Findings The CSF was transparent with mild pinkish. The opening pressure was around 15mmHg. Operative Procedures The paitent was put in supine position. The previous EVD was removed. Under ETGA and supine position, skin disinfected and drapped were performed as usual. Skin incision was made at 1cm before coronal suture. The one burr hole was made and EVD was introduced into the ventricle after ventriculostomy with puncture needle. The wound was then closed in layers after EVD was fixed on the skin through subcutaneous tunnel. Operators Prof. 杜永光 Assistants R4 王奐之 R3 陳國瑋 Indication Of Emergent Operation Hydrocephalus, 相關圖片 蔡水燕 (F,1966/12/08,45y3m) 手術日期 2011/08/12 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Brain Tumor 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 曾偉倫, 時間資訊 12:09 臨時手術NPO 07:56 進入手術室 08:05 麻醉開始 08:45 誘導結束 08:50 抗生素給藥 09:04 手術開始 13:00 抗生素給藥 13:07 開始輸血 16:00 抗生素給藥 17:40 手術結束 17:40 麻醉結束 17:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 L 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 11 0 摘要__ 手術科部: 外科部 套用罐頭: Far-lateral approach for tumor excision 開立醫師: 李振豪 開立時間: 2011/08/12 18:06 Pre-operative Diagnosis Left low cranial nerve neuroma with extension into left jugular foramen Post-operative Diagnosis Left low cranial nerve neuroma with extension into left jugular foramen Operative Method Far-lateral approach for tumor excision Specimen Count And Types 1 piece About size:3x3x2 cm Source:Left low cranial nerve tumor, suspect neuroma Pathology Pending Operative Findings The tumor was gray-yellowish, soft, well-capsulated, hypervascularized, and 2.7 x 2.9 x 3cm in size. The spinal accessory nerve was pushed posteriorlly and the vertebral artery was pushed upward. The brainstem and cerebellum was pushed to right side and compressed tightly. Enlarging of the opening of jugular foramen was noted due to tumor extension. The left condyle was also eroded by the drainage vein of the tumor. The jugular foramen was opened extra-cranially for total removal of the tumor. After total removal of the tumor, the brainstem and cerebellum were decompressed well after tumor excision. The low cranial nerve, intracranial vessels, sigmoid sinus, and internal jugular vein were all preserved well during the operation. No significant latency or decrease amplitude of the EP was noted. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with left shoulder elevation and head rotated to right. The skull was fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. Reverse U shape skin incision was made over left suboccipital area and the scalp flap was elevated. The nuchal muscle was devided from nuchal line layer by layre to expose the occipital bone, foramen magnum, and left posterior arch of C1. The left vertebral artery was encountered during dissection of the C1 and the vertebral artery was free from adjacent soft tissue. The left transverse process and left jugular foramen also exposed. Left C1 hemilaminectomy and left suboccipital craniotomy was performed. The posterior third of left condyle and jugular foramen was drilled off. Curvilinear duraotomy was done and CSF was released from cisterna magna. The Tumor was identified and the adjacent low cranial nerve and vessels were dissected away from the tumor. Subcapsule debulking was conducted with CUSA, ring curette, tumor forceps, and bipolar electrocautery. After central debulking, the tumor was dissected along the capsule. The capsule was transected at the opening of jugular foramen. The tumor within jugular foramen was removed by ring curette. The operation field was shifted to jugular foramen which we drilled off. The capsule was opened and subcapsule removal of the tumor was done with ring curetten, CUSA, and tumor forceps. After total removal of the tumor, hemostasis was achieved with bipolar electorcautery and Surgicel lining. Duroplasty was performed with autologous fascia. The skull plate and posterior arch of C1 was fixed back with miniplates and screws. One subgaleal CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators Prof. 杜永光 Assistants R5 李振豪 R3 曾偉倫 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Far-lateral approach for tumor excision 開立醫師: 李振豪 開立時間: 2011/08/12 18:06 Pre-operative Diagnosis Left low cranial nerve neuroma with extension into left jugular foramen Post-operative Diagnosis Left low cranial nerve neuroma with extension into left jugular foramen Operative Method Far-lateral approach for tumor excision Specimen Count And Types 1 piece About size:3x3x2 cm Source:Left low cranial nerve tumor, suspect neuroma Pathology Pending Operative Findings The tumor was gray-yellowish, soft, well-capsulated, hypervascularized, and 2.7 x 2.9 x 3cm in size. The spinal accessory nerve was pushed posteriorlly and the vertebral artery was pushed upward. The brainstem and cerebellum was pushed to right side and compressed tightly. Enlarging of the opening of jugular foramen was noted due to tumor extension. The left condyle was also eroded by the drainage vein of the tumor. The jugular foramen was opened extra-cranially for total removal of the tumor. After total removal of the tumor, the brainstem and cerebellum were decompressed well after tumor excision. The low cranial nerve, intracranial vessels, sigmoid sinus, and internal jugular vein were all preserved well during the operation. No significant latency or decrease amplitude of the EP was noted. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with left shoulder elevation and head rotated to right. The skull was fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. Reverse U shape skin incision was made over left suboccipital area and the scalp flap was elevated. The nuchal muscle was devided from nuchal line layer by layre to expose the occipital bone, foramen magnum, and left posterior arch of C1. The left vertebral artery was encountered during dissection of the C1 and the vertebral artery was free from adjacent soft tissue. The left transverse process and left jugular foramen also exposed. Left C1 hemilaminectomy and left suboccipital craniotomy was performed. The posterior third of left condyle and jugular foramen was drilled off. Curvilinear duraotomy was done and CSF was released from cisterna magna. The Tumor was identified and the adjacent low cranial nerve and vessels were dissected away from the tumor. Subcapsule debulking was conducted with CUSA, ring curette, tumor forceps, and bipolar electrocautery. After central debulking, the tumor was dissected along the capsule. The capsule was transected at the opening of jugular foramen. The tumor within jugular foramen was removed by ring curette. The operation field was shifted to jugular foramen which we drilled off. The capsule was opened and subcapsule removal of the tumor was done with ring curetten, CUSA, and tumor forceps. After total removal of the tumor, hemostasis was achieved with bipolar electorcautery and Surgicel lining. Duroplasty was performed with autologous fascia. The skull plate and posterior arch of C1 was fixed back with miniplates and screws. One subgaleal CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators Prof. 杜永光 Assistants R5 李振豪 R3 曾偉倫 相關圖片 陳炳森 (M,1952/05/09,59y10m) 手術日期 2011/08/12 手術主治醫師 許巍鐘 手術區域 西址 031房 01號 診斷 Malignant neoplasm of liver, primary 器械術式 vescular repair + neck mass excision 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 蔡奉芳 ASA 4E 紀錄醫師 林珮璇, 時間資訊 08:44 報到 08:48 進入手術室 08:48 麻醉開始 09:13 抗生素給藥 09:19 手術開始 10:26 通知急診手術 10:45 誘導結束 13:45 手術結束 13:45 麻醉結束 13:55 送出病患 14:03 進入恢復室 15:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 頸部良性腫瘤切除,簡單 1 1 L 手術 末稍血管修補及吻合術 1 1 L 麻醉 Peripheral arterial line inserti 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 摘要__ 手術科部: 耳鼻喉部 套用罐頭: Incisional biopsy of left neck mass with vasc... 開立醫師: 林珮璇 開立時間: 2011/08/14 11:33 Pre-operative Diagnosis Neck mass, left Post-operative Diagnosis Neck mass, left, operated Operative Method Incisional biopsy of left neck mass with vascular repair Specimen Count And Types 1 piece About size:0.5*0.5cm Source:left neck mass Pathology Pending Operative Findings a mass about 2 x 2 cm located at level IV was noted and incisional biopsy was done. IJV ruprute was noted and was ligated partially. The thoracic duct was ruptured and ligated Operative Procedures The patient was in supine position with neck hyperextended and turned to the right side. Skin was disinfected and draped as usual. Local anesthesia with Bosmin-rinsed Xylocaine was injected into the subcutaneous tissue around the neck mass after marking. A 3 cm horizontal incision parallel to the skin crease was made. The subcutaneous tissue was cut through. One 2 x 2 cm mass was found and dissected from its surrounding tissue with blunt and sharp dissection. CHylous leakage was noted and thracic duct rupture was noted. Also, massive bleeding was noted and IJV rupture was impressed. Skin wound extention to expose the bleeder was done but failed to stopped the bleeding. Then, the operation was change into general anesthesia, wich was set up via ETGA. Skin was disinfected again. Hemostasis was tried with hemoclip and ligation. The bleeding subsided after partial ligation of the IJV. Incisional biopsy was done to the neck mass and chylous leakage from the mass was also noted. After hemostasis and check bleeding, a mini hemovac was inserted and then the wound was closed with 2 layers. The patient tolerated the procedure well. Operators Asp 許巍鐘, VS 林志峰, Assistants R5孟繁宇, R4邱義霖, R2林珮璇, Indication Of Emergent Operation Massive bleeding and IJV rupture was noted during operation 陳雪玉 (F,1984/10/25,27y4m) 手術日期 2011/08/12 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Acoustic tumor 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 1 紀錄醫師 林哲光, 時間資訊 23:17 臨時手術NPO 07:40 報到 07:57 進入手術室 08:10 麻醉開始 08:30 誘導結束 08:45 抗生素給藥 09:00 手術開始 11:45 抗生素給藥 14:55 麻醉結束 14:55 手術結束 15:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 顱底瘤手術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Right retrosigmoid approach for total tumor e... 開立醫師: 林哲光 開立時間: 2011/08/12 20:47 Pre-operative Diagnosis Right acoustic tumor Post-operative Diagnosis Right acoustic tumor Operative Method Right retrosigmoid approach for total tumor excision Specimen Count And Types 1 piece About size:3cm sized Source:tumor 1 piece About size:4.6cm sized Source:tumor Pathology Pending Operative Findings A well defined yellowish, soft-elastic, 4cm sized tumor with invading into the internal auditory canal and tightly compressing the brainstem. Low cranial nerves and trigeminal nerve were pushed away by the tumor. Hypervascularity of the tumor was noted and main feeders were originated from AICA. CN7-8 complex was not identified during the operation. A well defined yellowish, soft-elastic, 4.6cm sized tumor with invading into the internal auditory canal and tightly compressing the brainstem. Low cranial nerves and trigeminal nerve were pushed away by the tumor. Hypervascularity of the tumor was noted and main feeders were originated from AICA. CN7-8 complex was not identified during the operation. Operative Procedures Under ETGA and prone position with head fixed with Mayfield head clamp, skin disinfected and drapped were performed as usual. A curved skin incision was made at right posterior auricle area at 4cm posterior to the auricle and the wound was extended until the mastoid groove was exposed. A craniotomy was performed after four burr holes were created to expose transverse and sigmoid sinus. Dura was then opened in C-shaped with sinus as base. Cisterna Magna was opened for CSF drainage. Cerebellum was retracted with brain retractor less than 1.5cm to expose the tumor well. Central debulking of the tumor was done and the tumor capsule was then removed meticulously. Tumor removal inside the IAC was done with Ring currettege. Hemostasis with surgecells packing was done. The skull bone was fixed with miniplates. The wound was then closed in layers after a subgaleal CWV drain insertion. Operators 曾漢民 Assistants 林哲光, 蕭智陽 相關圖片 林玲珍 (F,1951/02/28,61y0m) 手術日期 2011/08/12 手術主治醫師 蔡瑞章 手術區域 東址 000房 號 診斷 Meningitis due to Gram-negative bacteria 器械術式 Externalization of V-P shunt 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 ASA 1 紀錄醫師 蔡瑞章, 時間資訊 16:45 手術開始 16:45 麻醉開始 17:20 麻醉結束 17:20 手術結束 醫令資訊 類別 名稱 量 刀 側 手術 腦脊髓液分流管重置 1 1 麻醉 IV or IM anesthesia 1 0 記錄__ 手術科部: 外科部 套用罐頭: Externalization of Ventriculo-peritoneal shunt 開立醫師: 蔡瑞章 開立時間: 2011/09/07 15:29 Pre-operative Diagnosis Ventriculitis, Ventriculo-peritoneal shunt infection Post-operative Diagnosis Ditto Operative Method Externalization of Ventriculo-peritoneal shunt Specimen Count And Types CSF (pus) 3 tubes Source:from Ventriculo-peritoneal shunt Pathology Pending Operative Findings Pus in V-P shunt system, a lot, yelloish turbid, no odor. Operative Procedures The patient was on endotracheal tube with ventilator in ICU. Her consciousness was E2M4Vt. Under local anesthesia, a nib incision was done near right clavicle at the site where the tube of V-P shunt pass through. Blunt dissection to find the tube by palpation. The tube was then pulled out carefully and connected to a ICP monoitor set. Pus like substance was noted in the tube. The wound was then closed in layers. The patient stood the procedure well. Operators VS 王國川/P. 蔡瑞章 Assistants Indication Of Emergent Operation Ventriculitis, V-P shunt infection 相關圖片 董子寧 (F,2000/10/30,11y4m) 手術日期 2011/08/12 手術主治醫師 王國川 手術區域 兒醫 067房 01號 診斷 Headache 器械術式 V-P shunt 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 石博元 ASA 3E 紀錄醫師 王奐之, 時間資訊 03:00 臨時手術NPO 03:00 開始NPO 10:30 通知急診手術 13:10 進入手術室 13:15 麻醉開始 13:20 誘導結束 14:38 抗生素給藥 14:52 手術開始 15:45 手術結束 15:45 麻醉結束 16:00 送出病患 16:00 進入恢復室 17:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 腦室腹腔分流手術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt insertion via righ... 開立醫師: 王奐之 開立時間: 2011/08/12 21:30 Pre-operative Diagnosis Obstructive hydrocephalus Post-operative Diagnosis Obstructive hydrocephalus Operative Method Ventriculoperitoneal shunt insertion via right Kocher point Specimen Count And Types Nil Pathology Nil Operative Findings Clear CSF was noted, opening pressure about 10~15 cmH2O. Medtronic medium pressure bur hole type reservoir was used, with ventricular catheter length: 6.5cm & peritoneal catheter length: 40cm. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After shaving, scrubbing, disinfection and draping in sterile fashion, a linear incision was made at right frontal area. A bur hole was created at right Kocher point, followed by 2 tenting stitches. Another linear incision was made at right upper quadrant of abdomen. A subcutaneous tunnel was created from the abdominal wound to right frontal wound, 2 more wounds in between were created for easier passage. After passing through the peritoneal catheter, ventricular puncture was performed once. The shunt was then assembled and inserted. After hemostasis, the wounds were closed in layers. Operators VS 王國川 Assistants R4 王奐之 Indication Of Emergent Operation 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt insertion via righ... 開立醫師: 王奐之 開立時間: 2011/08/12 21:30 Pre-operative Diagnosis Obstructive hydrocephalus Post-operative Diagnosis Obstructive hydrocephalus Operative Method Ventriculoperitoneal shunt insertion via right Kocher point Specimen Count And Types Nil Pathology Nil Operative Findings Clear CSF was noted, opening pressure about 10~15 cmH2O. Medtronic medium pressure bur hole type reservoir was used, with ventricular catheter length: 6.5cm & peritoneal catheter length: 40cm. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After shaving, scrubbing, disinfection and draping in sterile fashion, a linear incision was made at right frontal area. A bur hole was created at right Kocher point, followed by 2 tenting stitches. Another linear incision was made at right upper quadrant of abdomen. A subcutaneous tunnel was created from the abdominal wound to right frontal wound, 2 more wounds in between were created for easier passage. After passing through the peritoneal catheter, ventricular puncture was performed once. The shunt was then assembled and inserted. After hemostasis, the wounds were closed in layers. Operators VS 王國川 Assistants R4 王奐之 Indication Of Emergent Operation IICP 相關圖片 李柯金定 (F,1936/11/20,75y3m) 手術日期 2011/08/12 手術主治醫師 李崇維 手術區域 東址 000房 號 診斷 Cerebral aneurysm 器械術式 TAE 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 王永彬 ASA 4E 時間資訊 13:33 通知急診手術 13:33 臨時手術NPO 13:33 開始NPO 14:00 麻醉開始 14:05 誘導結束 15:25 麻醉結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 潘佳杰 (M,1977/10/03,34y5m) 手術日期 2011/08/12 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Arteriovenous malformation, brain 器械術式 Craniotomy (A.V.M.) P-DUH 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 3 紀錄醫師 周聖哲, 時間資訊 23:20 臨時手術NPO 07:30 報到 08:00 進入手術室 08:10 麻醉開始 08:30 抗生素給藥 08:40 誘導結束 08:49 手術開始 11:30 抗生素給藥 15:00 抗生素給藥 18:00 抗生素給藥 18:35 麻醉結束 18:35 手術結束 18:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 開顱術摘除血管病變- 動靜脈畸型大型 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 13 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Total excision of arteriovenous malformation ... 開立醫師: 曾峰毅 開立時間: 2011/08/12 18:40 Pre-operative Diagnosis Right parietal arteriovenous malforamtion, Martin-Spetzelar grade II, status post crainectomy for partial excision Post-operative Diagnosis Right parietal arteriovenous malforamtion, Martin-Spetzelar grade II, status post crainectomy for partial excision Operative Method Total excision of arteriovenous malformation and cranioplasty Specimen Count And Types One piece of AVM, about 2x6x3 cm, was sent for pathology. Pathology Pending Operative Findings There is still abundant blood flow in previous dissected AVM, and the venous lake became cyanosis after all feeding artery from ACA, MCA, and PCA, ligated. Venous drainage into superior saggital sinus in the middle part of arteriovenous malformation. Blood loss is 450 ml. There is still abundant blood flow in previous dissected AVM, and the venous lake became cyanostic after all feeding arteries from ACA and PCA were ligated. Venous drainage into superior sagittal sinus in the middle part of arteriovenous malformation. Blood loss is 450 ml. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head fixed with Mayfield head clamp. The scalp was shaved, scrubbed, disinfected, and then draped as usual. Previuos operation wounds suture was removed. We made skin incision along previious operation wound, and previous artifical dura graft was removed. We dissected along arteriovenous malformation, and mobilized it along the anterior, posterior, and right side. After ligated all feeding artery, we dissected the medial side (venous side) of the malformation. The arteriovenous malformation was excised totally. With endotracheal general anaesthesia, the patient was put in supine position with head fixed with Mayfield head clamp. The scalp was shaved, scrubbed, disinfected, and then draped as usual. Previuos operation wounds suture was removed. We made skin incision along previious operation wound, and previous artifical dura graft was removed. We dissected along arteriovenous malformation, and mobilized it along the anterior, posterior, and right side. After ligated all feeding artery, we dissected the medial side (venous side) of the malformation. The arteriovenous malformation was excised totally. The dura was closed with Durafrom. The skull was placed back and fixed with mini-plate. The wound was closed in layers after placing one subgaleal CWV drain. Operators VS 賴達明 Assistants R5 曾峰毅 R2 周聖哲 Ri 陳乃綺 相關圖片 簡朝欽 (M,1954/07/12,57y8m) 手術日期 2011/08/12 手術主治醫師 賴達明 手術區域 東址 022房 03號 診斷 HIVD 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 2 紀錄醫師 曾峰毅, 時間資訊 23:22 臨時手術NPO 13:37 報到 13:50 進入手術室 13:55 麻醉開始 14:00 誘導結束 14:50 抗生素給藥 14:51 手術開始 17:10 手術結束 17:10 麻醉結束 17:20 送出病患 17:22 進入恢復室 18:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-腰椎 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 摘要__ 手術科部: 外科部 套用罐頭: HIVD 開立醫師: 曾峰毅 開立時間: 2011/08/12 17:27 Pre-operative Diagnosis Sequestrated disc, L5/S1 Post-operative Diagnosis Sequestrated disc, L5/S1 Operative Method Microdiskectomy of L5/S1 Specimen Count And Types Nil Pathology Nil Operative Findings Sequestrated disc was noted below the L5/S1 disc level, compromising right S1 root tightly. Thecal sac and right S1 root was decompressed well after the diskectomy. Blood loss: <5 ml. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After C-arm localization, we made one midline skin incision and dissected to expose right interlaminar space of L5/S1. We performed right laminotomy of L5/S1, and removed ligamentum flavum. We removed sequestrated disc, and L5/S1 diskectomy was performed. After hemostasis, we closed the wound layers. Operators VS 賴達明 Assistants R5 曾峰毅 徐士堯 (M,1992/07/01,19y8m) 手術日期 2011/08/12 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 For certification 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 無麻醉 麻醉主治醫師 ASA 1 紀錄醫師 林哲光, 時間資訊 23:23 臨時手術NPO 18:05 進入手術室 18:38 抗生素給藥 18:55 手術開始 20:15 手術結束 20:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-腰椎 1 1 記錄__ 手術科部: 外科部 套用罐頭: L5-6 discectomy with HydorCision SpineJet 開立醫師: 林哲光 開立時間: 2011/08/12 19:56 Pre-operative Diagnosis L5-6 HIVD with left L5 radiculopathy Post-operative Diagnosis L5-6 HIVD with left L5 radiculopathy Operative Method L5-6 discectomy with HydorCision SpineJet Specimen Count And Types nil Pathology Nil Operative Findings Sacral lumbarization was noted. Total 6 segments were noted. The lesion was at L5-6 level. Operative Procedures Under prone position, skin disinfected and drapped were performed as usual. C-arm localization at L5/6 level was done. L5/6 spinal needle insertion was then performed around 14cm lateral to midline. The Spinjet system was then introduced by K-pin guided and L5/6 discectomuy was done. The wound was then closed with Nylon. Operators 賴達明 Assistants 林哲光 相關圖片 李再興 (M,1958/12/01,53y3m) 手術日期 2011/08/14 手術主治醫師 蔡翊新 手術區域 東址 002房 01號 診斷 Major trauma rated 16 or above on the severity scale ( Injury severity score >=16 ) 器械術式 Removal of epidural hematoma, left 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 林峰盛 ASA 4E 紀錄醫師 周聖哲, 時間資訊 00:00 開始NPO 00:00 臨時手術NPO 02:58 通知急診手術 03:30 報到 03:32 進入手術室 03:35 麻醉開始 03:40 誘導結束 03:55 手術開始 05:00 抗生素給藥 05:20 開始輸血 05:55 麻醉結束 05:55 手術結束 06:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 急性硬腦膜下血腫清除術 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 蔡翊新 開立時間: 2011/08/14 05:57 Pre-operative Diagnosis Left frontotemporoparietal epidural and subdural hematoma with severe IICP. Post-operative Diagnosis Left frontotemporoparietal epidural and subdural hematoma with severe IICP. Operative Method Evacuation of EDH and SDH. Specimen Count And Types nil Pathology Nil. Operative Findings Stony-hard craniectomy window was noted before wound opening and the highest preop ICP was 93 mmHg. Epidural hematoma about 2 cm in thickness and subdural hematoma about 3 cm in maximal thickness were noted all over the craniectomy window, estimating 200 ml in total amount. A cortical artery and a bridging vein draining to superior sagittal sinus were active bleeders. The brain showed mild pulsation after evacuation of the hematoma. The ICP after skin closure was mmHg. Stony-hard craniectomy window was noted before wound opening and the highest preop ICP was 93 mmHg. Epidural hematoma about 2 cm in thickness and subdural hematoma about 3 cm in maximal thickness were noted all over the craniectomy window, estimating 200 ml in total amount. A cortical artery and a bridging vein draining to superior sagittal sinus were active bleeders. The brain showed mild pulsation after evacuation of the hematoma. The ICP after skin closure was 2 mmHg. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right. 3. Skin preparation: previous epidural CWV drain was removed. The skin was shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: left F-T-P along previous wound. 5. The epidural and subdural clots were removed by sucker and currettes. 6. Hemosatasis: the bleeders was stopped by Bovie and oozing surface was covered with Surgicel and Gelfoam. 7. The ICP monitor was placed back to subdural space at left temporal region. 8. Dural closure: A piece of 12 x 10 cm Durofoam was used for duroplasty. 9. Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 10.Drain: two epidural CWV drains. 11.Blood transfusion: PRBC 2U. Blood loss: 1000 ml. 12.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5曾峰毅R2周聖哲 Indication Of Emergent Operation severe IICP, midline shift, brainstem compression. 相關圖片 陳永明 (M,1949/11/30,62y3m) 手術日期 2011/08/15 手術主治醫師 蔡翊新 手術區域 東址 003房 02號 診斷 Extradural hemorrhage following injury, with concussion 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林峰盛 ASA 3E 紀錄醫師 陳國瑋, 時間資訊 19:30 臨時手術NPO 19:30 開始NPO 23:35 通知急診手術 00:07 進入手術室 00:10 麻醉開始 00:30 誘導結束 00:31 抗生素給藥 00:50 手術開始 02:20 手術結束 02:20 麻醉結束 02:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 硬腦膜外血腫清除術 1 1 L 手術 顱內壓視置入 1 2 L 記錄__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 蔡翊新 開立時間: 2011/08/15 02:18 Pre-operative Diagnosis Left frontotemporal skull fracture with frontotemporoparietal acute EDH; right frontotemporal SAH. Post-operative Diagnosis Left frontotemporal skull fracture with frontotemporoparietal acute EDH; right frontotemporal SAH. Operative Method Left frontotemporoparietal craniotomy for EDH evacuation and ICP monitoring. Specimen Count And Types nil Pathology Nil. Operative Findings Swelling of left temporal scalp was noted. A linear skull fracture led from parietal region obliquely to frontotemporal area. Acute EDH, 7.56 x 8.52 cm in area, 2.7 cm in maximal thickness, about 87 ml in amount, was evacuated from left F-T-P area. Active bleeding from meningeal vessels were noted. The dura expanded after evacuation of the EDH. Subdural effusion was noted, with a thin layer of outer membrane. ICP was 2 mmHg. The reference of Codman ICP monitor was 472. Swelling of left temporal scalp was noted. A linear skull fracture led from parietal region obliquely to frontotemporal area. Acute EDH, 7.56 x 8.52 cm in area, 2.7 cm in maximal thickness, about 87 ml in amount, was evacuated from left F-T-P area. Active bleeding from meningeal vessels were noted. The dura expanded after evacuation of the EDH. Subdural effusion was noted, with a thin layer of outer membrane. ICP was 2 mmHg. The reference of Codman ICP monitor was 472. ICP after skin closure was 4 mmHg. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: curvilinear, left frontotemporoparietal area. The temporalis muscle was detached from temporal squama by rasp subsequently. 5. Craniotomy window: 10 x 7 cm, left F-T-P, created by making 3 burr holes then cut by power saw. 6. Dural tenting: by 2/0 silk, 1.5-cm in interval, distributed along the edge of skull window. 7. The epidural clot was removed by sucker. 8. Hemosatasis: the bleeders was stopped by Bovie and oozing surface was covered with gelfoam. 9. A Codman ICP monitor was inserted to subdural space of left temporal area. 10.The skull plate was fixed back with 3 miniplates and 6 screws. 11.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 12.Drain: one, epidural, CWV. 13.Blood transfusion: nil. Blood loss: 1200 ml. 14.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5曾峰毅R3陳國瑋 Indication Of Emergent Operation conscious deterioration, Thick EDH 相關圖片 蔡松澤 (M,1937/06/12,74y9m) 手術日期 2011/08/15 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3 紀錄醫師 林哲光, 時間資訊 23:30 臨時手術NPO 08:05 進入手術室 08:15 麻醉開始 08:50 抗生素給藥 08:55 誘導結束 08:56 手術開始 11:50 抗生素給藥 13:10 手術結束 13:10 麻醉結束 13:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除-手術時間在4~8小時 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Right frontal craniotomy for tumor excision, ... 開立醫師: 林哲光 開立時間: 2011/08/15 14:10 Pre-operative Diagnosis Right frontal convexity meningioma Post-operative Diagnosis Right frontal convexity meningioma Operative Method Right frontal craniotomy for tumor excision, Simpson grade II Right frontal craniotomy for tumor excision, Simpson grade I Specimen Count And Types 1 piece About size:5cm sized Source:tumor Pathology Pending Operative Findings A 5cm sized, soft-elastic, graysih-yellowish mass lesion was noted at right frontal area with tightly adherent to the dura and dura thickening was noted. The adjacent skull bone hypertrophic chanage was also noted and bony lesion was removed by high-speed drill. The tumor seemed infiltrative into the surrounding parenchyma and some border is not well-defined under Microsopcy. Grossly, total tumor removal was done, including skull bony lesion and dural attachement and the edge of the dura was cauterized with Bipolar. Gore-Tex aritifical dura was used for duroplasty. Operative Procedures Under ETGA and supine position with head fixed with Mayfield head clamp, skin disinfected and drapped were performed as usual. Bicoronal incision was made for right frontal craniotomy after five burr holes were created. The dura was cuaterized by Bioplar and then opened in C-shaped after dural tenting as frontal base as base. The dura was divided from the tumor meticulously and tumor excision was then done. The dura was also excised and duroplasty with Gore-Tex was done after hemostasis in water-tie method. The skull bone was put back and fixed with miniplates. The wound was then closed in layers after a epidural CWV drain and a subgaleal drain insertion. Operators 曾漢民 Assistants 林哲光, 曾偉倫, 蕭智陽 相關圖片 陳柏彰 (M,1979/07/04,32y8m) 手術日期 2011/08/15 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 1 紀錄醫師 林哲光, 時間資訊 23:31 臨時手術NPO 13:37 進入手術室 13:40 麻醉開始 14:15 誘導結束 14:17 抗生素給藥 14:19 手術開始 17:17 抗生素給藥 19:15 手術結束 19:15 麻醉結束 19:25 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 顱底瘤手術 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Posterior interhemispheric approach for totoa... 開立醫師: 林哲光 開立時間: 2011/08/15 20:13 Pre-operative Diagnosis Left tentorial edge meningioma Post-operative Diagnosis Left tentorial edge meningioma Operative Method Posterior interhemispheric approach for totoal tumor excision, Simpson grade II Posterior interhemispheric approach for totoal tumor excision, Simpson grade I Specimen Count And Types 1 piece About size:4cm sized Source:tumor Pathology Pending Operative Findings A 4cm sized well-defined, soft-elastic, yellowish mass lesion was noted at left tentorial edge, with direct compressing the brainstem tightly. Hypertrohpic change of the tentorium was noted at the tumor site. Intraoperative EVD insertion for CSF drainage was done and CSF seemed clear and transparent. Operative Procedures Under ETGA and prone position with head fixed with Mayfield head clamp, skin disinfected and drapped were performed as usual. Hockey-stick skin incision was made at left occipital part and six burr holes were created for craniotomy and the superior sagittal sinus was exposed. EVD was inserted into the left occipital horn under echo guided and CSF drainage was done. The dura was then opened in C-shaped with sinus as base after dural tenting. The occipital lobe was then retracted until the tumor was exposed. Tumor excision at supratentorial part with picemeal excision was done and the tentorium was incised and opened. The infratentorial tumor was then removed also. The tentorium was then cauterized with bipolar. The dura was then closed in water-tie method and the skull bone was put back with mini-plates. The wound was then closed in layers after a subgaleal drain insertion. Operators 曾漢民 Assistants 林哲光, 蕭智陽 相關圖片 謝吳金定 (F,1951/09/02,60y6m) 手術日期 2011/08/15 手術主治醫師 郭順文 手術區域 東址 007房 02號 診斷 Malignant neoplasm of connective and other soft tissue 器械術式 Thoracoscopy (right wedge for biopsy) 手術類別 預定手術 手術部位 胸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 4 紀錄醫師 郝政鴻, 時間資訊 23:07 臨時手術NPO 14:00 報到 14:50 進入手術室 14:55 麻醉開始 15:20 誘導結束 15:51 手術開始 17:00 麻醉結束 17:00 手術結束 17:10 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 胸腔鏡肺楔狀或部分切除術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: VATS biopsy 開立醫師: 郝政鴻 開立時間: 2011/08/15 17:27 Pre-operative Diagnosis Diffuse pulmonary lesion, ground glass opacity, cause unknown, suspect infection related Post-operative Diagnosis Diffuse pulmonary lesion, ground glass opacity, cause unknown, suspect infection related Operative Method Wedge resection of right lower lobe pulmonary lesion via VATS. Specimen Count And Types 1 piece About size:3X2X1 CM Source:LUNG, right lower lobe Pathology Pending Operative Findings Sever to moderate adhesion between lung and chest wall Lung nodule, grey, elastic at lower lobe was excised Hypotension was noted after anesthesia induction Operative Procedures 1. Anesthesia: General anesthesia using single-lumen endotracheal tube with blocker under single lung ventilation. 2. Position: left decubitus position. An axillary roll is placed under the down side. The operative field is well disinfected and draped. 3. Camera port: From the seventh intercostal space in the mid-axillary line away from the lesion. 4. Working ports: First: From the fifth intercostal space in the anterior axillary line. Second: From the fifth intercostal space in the posterior axillary line. 5. The pleural adhesions are separated by grasping forceps and by electrocautery. 6. The pulmonary lesion is visualized and stabilized with the grasping forceps. 7. The Endo-GIA stapler is placed across its base. Wedge resection of the pulmonary lesion is performed. 8. The specimen issent for pathological examination and TB, fungus, and bacteria cultures. 9. After meticulous homeostasis, one 28# chest tubes is placed via the camera port. The lung is ventilated under the direct vision. The skin is closed with 4-0 Nylon sutures. Operators VS郭順文 Assistants R4郝政鴻 Ri陳滄堯 蔣錦波 (M,1926/09/16,85y5m) 手術日期 2011/08/15 手術主治醫師 戴槐青 手術區域 東址 015房 01號 診斷 Benign prostatic hypertrophy 器械術式 T U R - P + trocar cystostomy 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 脊髓麻醉 麻醉主治醫師 詹光政 ASA 3 紀錄醫師 彭元宏, 時間資訊 23:59 臨時手術NPO 08:01 報到 08:10 進入手術室 08:20 麻醉開始 08:30 誘導結束 08:55 手術開始 09:45 手術結束 09:45 麻醉結束 09:50 送出病患 09:55 進入恢復室 11:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 經尿道攝護腺切除術-切除之攝護腺重量15至50公克 1 1 手術 膀胱造口術 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Spinal anesthesia 1 0 記錄__ 手術科部: 泌尿部 套用罐頭: TUR-P 開立醫師: 彭元宏 開立時間: 2011/08/15 10:01 Pre-operative Diagnosis 1. benign prostate hyperplasia 2. neurogenic bladder Post-operative Diagnosis 1. benign prostate hyperplasia 2. neurogenic bladder Operative Method 1. Transurethral resection of the prostate 2. Cystostomy Specimen Count And Types 1 piece About size:20g Source:prostate gland Pathology pending Operative Findings 1. 20 g of prostatic tissue was resected 2. bilateral lobes of the prostate kiss together 2. bladder trabeculation grade III 3. a bladder diverticulum at the posterior wall 4. marked intravesical growth of medial lobe of the prostate 6. Trocar cystostomy was done smoothly Operative Procedures Under satisfactory spinal anesthesia, the patient was placed in lithotomy position. Prepping and draping were performed in the usual sterile method. Olympus resectoscope sheath was inserted into the urethra with adequate lubrication. Then the resectoscope was inserted. Bilateral lobes of prostate were resected with cutting loop piece after piece. The chips were washed out with a Ellik evacuator. Hemostasis was done. Trocar cystostomy was done via urethroscopy guided. A 22 Fr. 3-way Foley catheter was inserted and its balloon was inflated to 40c.c. Continuous N/S irrigation started. The patient tolerated the operation well and was sent to the recovery room with stable condition. Operators 戴槐青, Assistants 彭元宏, 陳聖復, 胡天賜 (M,1952/03/15,59y11m) 手術日期 2011/08/15 手術主治醫師 蕭輔仁 手術區域 東址 003房 01號 診斷 Thoracic myelopathy 器械術式 Benign intraspinal tumor, exci 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 曾偉倫, 時間資訊 23:44 臨時手術NPO 08:25 報到 08:27 進入手術室 08:30 麻醉開始 08:45 誘導結束 08:53 抗生素給藥 08:53 手術開始 11:53 抗生素給藥 14:53 抗生素給藥 16:10 手術結束 16:10 麻醉結束 16:32 送出病患 16:38 進入恢復室 17:38 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 良性脊髓腫瘤切除術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 7 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 神經部 套用罐頭: C7-T2 laminoplasty for subtotal tumor excision 開立醫師: 李振豪 開立時間: 2011/08/15 16:20 Pre-operative Diagnosis Left C7-T1 spinal intradural extramedullary tumor, suspect neuroma Post-operative Diagnosis Left C7-T1 spinal intradural extramedullary tumor, suspect neuroma Operative Method C7-T2 laminoplasty for subtotal tumor excision Specimen Count And Types 1 piece About size:4x3x3 cm Source:C7-T1 tumor Pathology Pending Operative Findings The tumor was 4x3x3cm in size, elastic to firm, white-yellowish, and well-demarcated in character which mainly located at left side of intrathecal space and large extradural part extending into left C7-T1 neural foramen. The tumor was arized from ventral root and the adjacent ventral root were adhered to the tumor tightly. We tried to preserved the ventral root but failed in some roots. The intrathecal part was all removed and the spinal cord was preserved well. But part of the tumor within neural foramen was left due to difficult to identify the root. Left lower limb MEP change was noted during the operation and recovered during skin closure. No SSEP change(but stationary of poor waveform over left lower limb) was noted during whole procedure. Operative Procedures Under ETGA, we placed the patient over prone position after fixing his head with Mayfield skull clamp. The C7-T1 level was located with C-arm portable X-ray. After we scrubbed, disinfected and drapped,a mid-line skin incision was made over the C7-T2 level. Subcutaneous soft tissue was devided and bilatera paraspinal muscle were detached to expose the laminae. Grooving of bilateral laminae with Midas air-drived drills were performed and the laminae was removed. Left C7-T1 facetectomy also performed to expose left C8 root. Midline durotomy was performed and the tumor was identified. The tumor was debulking with CUSA and removed piece by piece. The extradural part also removed piece by piece after root identified. After partial removal of the extradural part, we turned back to intradural part. The sleeve of the root was identified and the durotomy was extended along the root. Partial removal of the intraforaminal part of the tumor was done under the consideration of functional preserved. Hemostasis was achieved and the dura was closed with 5-0 Prolene. Duraform was covered for dura repair. C7-T2 laminoplasty was done with miniplates and screws. One autologous bone was place at left C7-T1 facetectomy site for fusion. One CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS 蕭輔仁 Assistants R5 李振豪 R3 曾偉倫 Ri 許淑嫻 相關圖片 黃宥霖 (F,1962/08/26,49y6m) 手術日期 2011/08/15 手術主治醫師 廖漢文 手術區域 東址 000房 號 診斷 Arteriovenous malformation 器械術式 Right parietal AVM for TAE 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 王永彬 ASA 2 時間資訊 23:59 臨時手術NPO 08:30 麻醉開始 08:45 誘導結束 14:00 麻醉結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 劉仕傑 (M,1976/01/21,36y1m) 手術日期 2011/08/15 手術主治醫師 蔡翊新 手術區域 東址 016房 02號 診斷 Subarachnoid hemorrhage 器械術式 Craniotomy(Aneurysms) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 4E 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 08:54 通知急診手術 09:30 進入手術室 09:40 麻醉開始 09:55 誘導結束 10:00 抗生素給藥 10:19 手術開始 11:53 手術結束 11:53 麻醉結束 12:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦內血腫清除術 1 1 R 手術 顱內壓視置入 1 2 R 摘要__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 蔡翊新 開立時間: 2011/08/15 11:50 Pre-operative Diagnosis Massive SAH and IVH, left frontal ICH, suspected aneurysm rupture; severe brain swelling and IICP. Post-operative Diagnosis Massive SAH and IVH, left frontal ICH, suspected aneurysm rupture; severe brain swelling and IICP. Operative Method Right F-T-P craniectomy for removal of ICH, duroplasty, and ICP monitoring. Right Kocher point EVD. Specimen Count And Types nil Pathology Nil. Operative Findings CSF was bloody and initial pressure was very high (> 30 cmH2O). The dura was tense upon craniectomy. Diffuse SAH and severe brain swelling were encountered upon dural opening and the brain bulged out rapidly. ICH even ruptured while we were closing the scalp. Reference of ICP monitor was 481. ICP after skin closure was 64 mmHg. CSF was bloody and initial pressure was very high (> 30 cmH2O). The dura was tense upon craniectomy. Diffuse SAH and severe brain swelling were encountered upon dural opening and the brain bulged out rapidly. ICH even ruptured while we were closing the scalp. Reference of ICP monitor was 481. ICP after skin closure was 64 mmHg and climbed rapidly to 104 mmHg. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left and fixed with Mayfield skull clamp. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 4 cm at right frontal area, the skin edge was clipped by Raney clips for temporary hemostasis. 5. A burr hole was made at right Kocher point. EVD was inserted to right frontal horn. 6. The incision was extended to a temporal horseshoe, and the temporalis muscle was detached from temporal squama by rasp subsequently. 7. Craniotomy window: 14 x 12 cm, right F-T-P, created by making 5 burr holes then cut by power saw. 8. Dural tenting: by 2/0 silk, 3-cm in interval, distributed along the edge of skull window. 9. Dural incision: curvilinear along the edge of skull window. 10.Dural closure: a piece of Durofoam was used for duroplasty in order to create an additional space for the swollen brain. 11.The skull plate was removed stored at bone bank for preservation. 12.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 2/0 nylon. 13.Drain: two epidural CWV drains. 14.Blood transfusion: PRBC 2U. Blood loss: 800 ml. 15.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5曾峰毅R3陳國瑋 Indication Of Emergent Operation Severe IICP, pupil dilatation. 相關圖片 林怡君 (F,1982/04/21,29y10m) 手術日期 2011/08/16 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Secondary malignant neoplasm of brain and spinal cord 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 07:32 報到 08:02 進入手術室 08:10 麻醉開始 08:30 誘導結束 08:35 抗生素給藥 09:03 手術開始 11:35 抗生素給藥 13:25 麻醉結束 13:25 手術結束 13:35 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除-手術時間在4小時以內 1 1 記錄__ 手術科部: 外科部 套用罐頭: Suboccipital craniotomy for trans-vermis cere... 開立醫師: 李振豪 開立時間: 2011/08/16 13:19 Pre-operative Diagnosis Cerebellar tumor, suspect metastasis Post-operative Diagnosis Cerebellar tumor, suspect metastasis Operative Method Suboccipital craniotomy for trans-vermis cerebellar tumor excision Specimen Count And Types 1 piece About size:Multiple small pieces Source:Cerebellar tumor Pathology Pending Operative Findings The tumor was covered with one thin layer of cortex. The tumor was ill-defined, white-yellowish, 3.4x3.3x3.8cm in size, and hypervascularized. The upper part of the tumor was soft but relative hard in lower part. The fourth ventricle was entered after total resection of the tumor. The cerebellum became slack after tumor resection. Venous bleeding from right supracerebellar area was noted due to slack of the cerebellum. The hemostasis was achieved with Gelfoam packing. No obvious EP change during whole procedure. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position with head fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. Midline scalp incision was made at suboccipital area and the subcutaneous soft tissue was devided. One 4x4cm fascia was harvested for duroplasty. The nuchal muscle groups were devided from midline to expose the suboccipital area and posterior arch of C1. Four burr hole were created followed by one 5x4cm craniotomy window. The dura was opened with V-shape. Trans-vermis tumor excision was performed with bipolar electrocautery, suction, and tumor forceps. Hemostasis was achieved with bipolar electrocautery, Surgicel lining, and Gelfoam packing. Duroplasty with autologous fascia was done with 4-0 Prolene. the skull plate was fixed back with four #26 wires and one central tenting. One subgaleal CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS 曾漢民 Assistants R5 李振豪, R1王怡人 相關圖片 方明鋒 (M,1921/11/18,90y3m) 手術日期 2011/08/16 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Compression fracture pathological Spontaneous fracture 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 周聖哲, 時間資訊 23:50 臨時手術NPO 08:05 進入手術室 08:10 麻醉開始 08:30 誘導結束 08:30 抗生素給藥 09:10 手術開始 11:30 抗生素給藥 11:43 手術結束 11:43 麻醉結束 11:50 送出病患 12:00 進入恢復室 13:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎弓切除術(減壓)-二節以內 1 2 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 曾峰毅 開立時間: 2011/08/16 11:43 Pre-operative Diagnosis L3 compression fracture with stenosis, status post vertebroplasty, unstable Post-operative Diagnosis L3 compression fracture with stenosis, status post vertebroplasty, unstable Operative Method Posterior fixation with percutaneous transpedicular screw sysytem at L2 and L4; L3 laminectomy for decompression. Specimen Count And Types Nil Pathology Nil Operative Findings Depuy Viper percutaneous transpedicular screws, 6.0 x 45 mm, were instrumented into bilateral pedicles of L2 and L4. Two 8.5 mm long rods were used for fixation. Hypertrophic ligamentum flavum , compromising thecal sac and biltearl neural foramen at L2/3 and L3/4 tightly, was removed for decompression. Neural structure was decompressed well after the surgery. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. Under C-arm guidance, instrumentation with Depy Viper percutaneous transpedicular screws was done at bialteral pedicles of L2 and L4. Posterior fixation was achieved with two 8.5-cm-long rods. We made another midline skin incision and dissected to expose the tip of L3 spinous process. L3 spinous process was splitted by oscilating saw, and L3 laminectomy for decompression was performed. After hemostasis, the wound was closed in layers. Operators VS 賴達明 Assistants R5 曾峰毅 R2 周聖哲 Ri 連一潔 相關圖片 林瑞雲 (F,1962/05/23,49y9m) 手術日期 2011/08/16 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Facial spasm 器械術式 Microvascular decompression 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 周聖哲, 時間資訊 23:49 臨時手術NPO 11:27 報到 12:10 進入手術室 12:15 麻醉開始 12:25 抗生素給藥 12:35 誘導結束 12:50 手術開始 15:25 抗生素給藥 16:45 麻醉結束 16:45 手術結束 16:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦微血管減壓術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Microvascular Decompression 開立醫師: 曾峰毅 開立時間: 2011/08/16 16:37 Pre-operative Diagnosis Right hemifacial spasm Post-operative Diagnosis Right hemifacial spasm Operative Method Microvascular Decompression via Right Retrosigmoid Approach for Hemifacial Spasm Specimen Count And Types Nil Pathology Nil Operative Findings One offending AICA loop was noted just medial to the facial nerve exiting zone. The offending vessel was pushed away from the right facial nerve with teflon cotton. Operative Procedures With endotracheal general anaesthesia, the patient was put in 3/4 prone position with head fixed by Mayfield head clamp. We made one curvilinear skin incision at right retroauricular area, and drilled an craniotomy about 3x5 cm. We made durotomy, and retracted cerebellum posteriorly. CSF was drained from right ambient cistern. We dissected, and identified offending vessel. We put the teflon cotton between the offending vessel and the facial nerve. Dura was closed in water-tight suture with autologous fascia graft and Duraform. Bone graft was fixed back with mini-plate. The wound was closed in layers. Operators VS 賴達明 Assistants R5 曾峰毅 R2 周聖哲 Ri 連一潔 相關圖片 黃鈺翔 (M,1997/11/30,14y3m) 手術日期 2011/08/16 手術主治醫師 林文瑛 手術區域 西址 035房 09號 診斷 Primitive neuroectodermal tumor 器械術式 Nerve block / PC 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 林文瑛 ASA 3 紀錄醫師 楊仁廷, 時間資訊 17:20 進入手術室 17:25 麻醉開始 17:30 誘導結束 17:35 手術開始 18:05 手術結束 18:05 麻醉結束 18:15 進入恢復室 18:15 送出病患 19:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 手術 神經分離術–肩,臀關節以上,包括臂神經叢,坐骨神經 1 1 R 記錄__ 手術科部: 麻醉部 套用罐頭: serial intercostal neurolysis 開立醫師: 楊仁廷 開立時間: 2011/08/16 18:13 Pre-operative Diagnosis Primitive neuroectodermal tumor Post-operative Diagnosis Primitive neuroectodermal tumor Operative Method neurolysis with rinderon injection Specimen Count And Types nil Pathology nil Operative Findings 1. Good contrast medium location Operative Procedures 1.Put patient in supine position 2.IV general anesthesia propofol TCI titration 3.Locate c7 root by fluroscpe and C-arm. 4.insert 22G RF needle toward target site under realtime ultrasound guidance 6. Inject contrast medium to locate desired space 7. Inject rinderon 8. Check vital signs and send patient to PACU. Operators 林文瑛 Assistants 楊仁廷 施藝璇 (F,1998/05/19,13y9m) 手術日期 2011/08/16 手術主治醫師 蕭輔仁 手術區域 東址 005房 02號 診斷 Contusion, scalp 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 23:55 臨時手術NPO 14:06 進入手術室 14:10 麻醉開始 14:50 誘導結束 15:25 手術開始 19:05 手術結束 19:05 麻醉結束 19:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 B 手術 椎弓切除術(減壓)-二節以內 1 2 B 記錄__ 手術科部: 外科部 套用罐頭: 1. T12, L1, L3, and L4 transpedicular screws ... 開立醫師: 李振豪 開立時間: 2011/08/16 19:33 Pre-operative Diagnosis L2 burst fracture with kyphotic change and thecal sac compression Post-operative Diagnosis L2 burst fracture with kyphotic change and thecal sac compression Operative Method 1. T12, L1, L3, and L4 transpedicular screws for posterior fixation 2. L2 laminectomy for decompression Specimen Count And Types nil Pathology Nil Operative Findings 1. Soft tissue contusion with hematoma formation at L2 level was noted during soft tissue dissection. The L1/2 interspinous ligment was disrupted with kyphotic change of spine. Linear fracture of L2 and L3 laminae was noted during laminectomy. The thecal sac was pushed posterior and compressed tightly by the compression fracture. Part of the bony fragment was removed and the rest part was pushed back with impactor for decompression. Active oozing from burst fracture site was noted and hard to hemostasis from posterior approach. The thecal sac was intact without evident CSF leakage. The thecal sac was decompressed well after whole procedure. 2. Posterior instrumentation T12: 5.0 x 35mm x II L1: 5.5 x 35mm x II L3, L4: 5.5 x 40mm x IV Rods: 17cm x I Cross-link: 7cm x I Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position. The T12 to L4 pedicle level were localized by portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. The Midline skin incision was made from T12 to L4 level. the subcutaneous soft tissue was devided and paravertebral muscle groups were detached. T12, L1, L3, and L4 transpedicular screws insertion was performed under fluoroscope guided. L2 laminectomy for decompression was performed and the bony fragment that compressed the thecal sac was pushed back by impactor. Part of the bony fragment was removed for decompression. Hemostasis with bipolar electrocautery and Gelfoam packing was done. The rods and cross-link were set up. Two Hemovac was placed. The wound was irrigated with Gentamicin solution and closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS 蕭輔仁 Assistants R5李振豪, R1王怡人 相關圖片 吳秋源 (M,1948/08/01,63y7m) 手術日期 2011/08/16 手術主治醫師 許榮彬 手術區域 東址 017房 01號 診斷 Anemia, unspecified 器械術式 Redo-M.V.R., A.V.R. 請排二位刷手 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 莊民楷, 時間資訊 08:00 報到 08:09 進入手術室 08:15 麻醉開始 08:55 誘導結束 09:30 抗生素給藥 09:55 手術開始 12:30 抗生素給藥 15:30 抗生素給藥 18:00 麻醉結束 18:00 手術結束 18:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Ca (Calcium) 4 0 麻醉 Na (Sodium) 4 0 麻醉 K (Potassium) 4 0 麻醉 Blood gas analysis 4 0 手術 兩個瓣膜換置 1 1 手術 體外心肺循環 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 12 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 放置肺動脈導管術 1 0 麻醉 Cardiac out-put 1 0 麻醉 Swan-gang catheterization 1 0 麻醉 T.E.E 1 0 麻醉 Lactic Acid (lactate) 4 0 麻醉 動脈血液檢查全套 4 0 麻醉 Hemoglobin (Hb) 4 0 麻醉 測血糖 4 0 摘要__ 手術科部: 外科部 套用罐頭: redo-DVR with mechanical valve 開立醫師: 莊民楷 開立時間: 2011/08/18 13:52 Pre-operative Diagnosis RHD, s/p DVR with mechanical valve, with AS and mitral paraprosthetic leakage related hemolytic anemia Post-operative Diagnosis RHD, s/p DVR with mechanical valve, with AS and mitral paraprosthetic leakage related hemolytic anemia Operative Method redo-DVR with mechanical valve Specimen Count And Types 1 piece About size:2x2cm Source:subvalvular pennus (aortic valve) Pathology pending Operative Findings 1. severe adhesion over mediastinum, especially between sternum and RV/aorta 2. fair contractility, dilated RA/RV 3. aortic valve: good prosthesis opening, subvalvular pennus(+), leading to AS 4. mitral valve: good prosthesis opening, one stitch dehiscence related paraprosthetic leakage was found over P3 (leakage area 8x2mm), partial pennus formation 5. previous aortic prosthesis: 23mm → redo-AVR with 21mm St. Jude mechanical valve previous mitral prosthesis: 29mm → redo-MVR with 27mm Sorin mechanical valve 6. intraoperative oliguria 7. postoperative urine color more light 8. postoperative right pleura opened, junctional rhythm Operative Procedures 1. ETGA, supine 2. Disinfection and drapping 3. Midline resternotomy, adhesionlysis 4. AsAo, RAA→SVC/IVC cannulation; on CPB, cooling to 28 degree 5. Axc, transverse aortotomy, direct antegrade cardioplegia, cardia arrest 6. RA incision, set retrograde cardioplegia 7. Check aortic pathology, excise previous prosthesis and subvalvular pennus 8. LA incision, check mitral pathology, excise previous prosthesis and pennus 9. MVR with 27mm Sorin mechanical valve and eighteen pledgetted 2-0 Ticron suture, repair LA 10. AVR with 21mm St. Jude mechanical valve and sixteen pledgetted 2-0 Ticron suture, repair AsAo 11. Rewarm, repair RA, deair, wean off CPB 12. Hemostasis, set three chest tubes over mediastinum and right pleural cavity 13. Close the wound in layers Operators VS 許榮彬 Assistants R5 周恒文, R4 莊民楷 陳明鑑 (M,1956/01/06,56y2m) 手術日期 2011/08/16 手術主治醫師 蔡翊新 手術區域 東址 016房 05號 診斷 Cerebral aneurysm 器械術式 Left pterion approach for A-com aneurysm clipping 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2E 紀錄醫師 吳欣翰, 時間資訊 12:00 開始NPO 15:45 通知急診手術 17:15 進入手術室 17:20 麻醉開始 17:40 誘導結束 18:00 抗生素給藥 18:45 手術開始 20:25 開始輸血 21:00 抗生素給藥 00:00 抗生素給藥 01:55 手術結束 01:55 麻醉結束 02:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 9 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 開顱術摘除血管病變 - 腦血管瘤 有病徵的 1 1 L 手術 顱內壓視置入 1 2 L 記錄__ 手術科部: 外科部 套用罐頭: Aneurysm-frontotemporal approach 開立醫師: 蔡翊新 開立時間: 2011/08/17 01:34 Pre-operative Diagnosis Anterior communicating artery aneurysm rupture with SAH. Post-operative Diagnosis Anterior communicating artery aneurysm rupture with SAH. Operative Method Left pterional craniotomy for aneurysm clipping. Left Kocher EVD for ICP monitoring. Specimen Count And Types 3 tubes of CSF, sent for routine, BCS, and bacterial culture. Pathology Nil. Operative Findings CSF was bloody and initial pressure was about 20 cmH2O. The brain was swollen despite CSF release from EVD and basal cistern. Thick SAH was encoutered at left Sylvian fissure, prechiasmatic cistern and around A-com complex. The A1 segment of left ACA was longer and more prominent than right A1. A saccular aneurysm arose from anterior communicating artery, pointing to right, with the neck about 4 mm in width. There was a daughter blister aneurysm at the neck, pointing superiorly. The main aneurysm was clipped with a 7.7 mm, curved Sugita clip, with a small residual neck, which was clipped together with the daughter aneurysm with a 4 mm, curved Sugita clip. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right for 45 degrees and slightly extended then fixed by Mayfield skull clamp. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: left frontotemporal, curvilinear. The skin edge was clipped by Raney clips for temporary hemostasis. After scalp had been lifted, the temporalis muscle was incised and detached from temporal squama and reflected to lower temporal side. 5. A burr hole was made at left Kocher point. EVD was inserted after ventricular puncture to left frontal horn. 6. Craniotomy window: 10 x 8 cm, left frontotemporal, created by making 3 burr holes then cut by power saw. The lower temporal bone and pterionic ridge (esp. the inner table) were cut by rongeur as low as possible for easy approach to the anterior clinoid. 7. Dural tenting: by 2/0 silk, 2 cm in interval, distributed along the edge of skull window. 8. Dural incision: curvilinear shape, over-ridding Sylvian fissure and reflected to frontotemporal base. 9. Under operating microscope, the suprasellar cistern was opened. The left optic nerve and ICA came into view. The left rectal gyrus was excised to facilitate exposure of the aneurysm. A1 and A2 segments of bilateral ACAs and anterior communicating artery were identified. The neck of the aneurysm was mobilized gently by a Gage 18 sucker and a fine tip bipolar forceps until it was entirely free. l0.A 7.7-mm curved Sugita clip was applied to the neck of the aneurysm. The residual neck and the daughter aneurysm were clipped with a 4-mm curved Sugita clip. 11.The brain retractors were removed. The dura was closed water-tight by running suture with 4/0 Prolene. 12.Closure of skull window: the skull plate was placed back to craniotomy window and fixed by 3 miniplates and 6 screws. The dura was tented to the center of the skull plate by 4 2/0 stitches. The covering muscle was closed by interrupted stitches with 1/ 0 silk. 13.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Dexon and skin by continuous suture with 3/0 nylon. 14.Drain: one, epidural, CWV. 15.Blood transfusion: PRBC 4U. Blood loss: 1350 ml. 16.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5林哲光R1吳欣翰 Indication Of Emergent Operation aneurysm rupture, to prevent rebleeding 相關圖片 徐自修 (M,1950/11/15,61y3m) 手術日期 2011/08/16 手術主治醫師 張志豪 手術區域 西址 031房 04號 診斷 Cubital tunnel syndrome 器械術式 Ulnar nerve anterior transposition 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 張之嚴, 時間資訊 10:35 進入手術室 10:39 麻醉開始 10:45 誘導結束 10:45 抗生素給藥 11:11 手術開始 11:45 手術結束 11:45 麻醉結束 11:57 送出病患 12:03 進入恢復室 13:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 神經分離術-手.足之經 1 1 L 摘要__ 手術科部: 骨科部 套用罐頭: Anterior transposition of left ulnar nerve 開立醫師: 張之嚴 開立時間: 2011/08/16 12:13 Pre-operative Diagnosis Cubital tunnel syndrome, left Post-operative Diagnosis Cubital tunnel syndrome, left Operative Method Anterior transposition of left ulnar nerve Specimen Count And Types nil Pathology nil Operative Findings Increased tension of left ulnar nerve during elbow extension Operative Procedures 1. GA, supine. 2. Aseptic, draping, on tourniquet 3. Skin incision via medial approach of elbow 4. Explored left ulnar nerve and secure it 4. Explored left ulnar nerve and secured it 5. Dissected the fascia of commom flexor m., incised it. 6. Put left ulnar n. beneath the fascia of commom flexor m., then closed the fascia. 7. Made sure that left ulnar nerve was free in the new tunnel. 8. Off tourniquet. Irrigation. Check bleeding. 8. Off tourniquet. Irrigation. Checked bleeding. 9. Close wound in layers. Operators 張志豪, Assistants 張之嚴, 簡錦慧 記錄__ 手術科部: 骨科部 套用罐頭: Anterior transposition of left ulnar nerve 開立醫師: 張之嚴 開立時間: 2011/08/16 12:14 Pre-operative Diagnosis Cubital tunnel syndrome, left Post-operative Diagnosis Cubital tunnel syndrome, left Operative Method Anterior transposition of left ulnar nerve Specimen Count And Types nil Pathology nil Operative Findings Increased tension of left ulnar nerve during elbow extension Operative Procedures 1. GA, supine. 2. Aseptic, draping, on tourniquet 3. Skin incision via medial approach of elbow 4. Explored left ulnar nerve and secured it 5. Dissected the fascia of commom flexor m., incised it. 6. Put left ulnar n. beneath the fascia of commom flexor m., then closed the fascia. 7. Made sure that left ulnar nerve was free in the new tunnel. 8. Off tourniquet. Irrigation. Checked bleeding. 9. Close wound in layers. Operators 張志豪, Assistants 張之嚴, 簡錦慧 劉廷豐 (M,1955/09/22,56y5m) 手術日期 2011/08/17 手術主治醫師 曾漢民 手術區域 東址 003房 01號 診斷 Cerebrospinal fluid rhinorrhea 器械術式 Cranioplasty for CSF leakage 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 曾偉倫, 時間資訊 23:31 臨時手術NPO 07:32 報到 08:02 進入手術室 08:05 麻醉開始 08:30 誘導結束 09:15 手術開始 11:55 麻醉結束 11:55 手術結束 12:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 頭顱成形術 1 1 B 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: Repair of CSF leakage 開立醫師: 李振豪 開立時間: 2011/08/17 11:27 Pre-operative Diagnosis CSF rhinorrhea Post-operative Diagnosis CSF rhinorrhea Operative Method Repair of CSF leakage Specimen Count And Types nil Pathology Nil Operative Findings The CSF leakage was mainly from left frontal base near the crista galli. Previous durotomy that covered with Gelfoam healed well without evident CSF leakage. Thickening of mucosa within frontal sinus was noted and active inflammation was favored. The frontal sinus was extreme prominent with large opening connecting into nasal cavity. The mucosa was removed and the sinus was packing with aqua Better-iodine soaked Geoflam and bone wax again. Primary closure of dura defect was used followed by Durafoam and Tissuecol Duo coverage. After dura repair, no evident CSF leakage was noted. The periosteum pedicle flap was reflected into frontal base to cevered the dura defect and sinus. Lumbar drain was inserted for CSF diversion after whole procedure. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position. The scalp was shaved, scrubbed, and disinfected as usual. Bicoronal scalp incision was made along operative scar. The scalp flap was elevated and the periosteum was dissected as pedicle flap. the skull plate was removed and the granulation tissue was removed. The bone wax at the opening of the sinus also removed. The mucosa of the sinus was removed and the wound was irrigated with Gentamicin solution. The frontal sinus was packing with aqua Better-iodine soaked Gelfoam and sealed again with bone wax. Dura defect over left frontal base was sutured with 4-0 Prolene. Tissuecol Duo and Duraform was applied over the dura defect site. The periosteum flap was reflected into frontal base and sutured with 4-0 Prolene. Tissuecol Duo was applied again. The skull plate was fixed back with miniplates, screws, and two central tenting. One subgaleal CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and Appose staples. Operators VS曾漢民 Assistants R5李振豪, R3曾偉倫, Ri許淑嫻 相關圖片 柯智惠 (F,1940/05/18,71y9m) 手術日期 2011/08/17 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Glioma 器械術式 Craniectomy for subdural empyema 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 林哲光, 時間資訊 23:29 臨時手術NPO 15:25 報到 15:28 進入手術室 15:32 麻醉開始 15:50 誘導結束 15:55 抗生素給藥 16:00 手術開始 16:53 開始輸血 18:45 麻醉結束 18:45 手術結束 18:55 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 腦內血腫清除術 1 2 R 記錄__ 手術科部: 外科部 套用罐頭: Right frontal craniotomy for abscess removal ... 開立醫師: 林哲光 開立時間: 2011/08/17 19:25 Pre-operative Diagnosis Right frontal brain abscess, subcutaneous abscess Post-operative Diagnosis Right frontal brain abscess, subcutaneous abscess Operative Method Right frontal craniotomy for abscess removal and debridement Specimen Count And Types nil Pathology Nil Operative Findings Gush of pus was noted from a unhealing operative wound. The fascia and temporalis muscle which were covered over previous skull bone graft seemed necrotic change and removed as extensively as possible. Epidural hematoma with some granulation tissue was noted after craniotomy. A small pus accumulation was noted at the subdural space near the edge of dura after dural opening. Two previous corticotomy were opened to survey. Anterior one showed some local hematoma and it was removed. Posterior one had pus inside and it was removed as extensively as possible. The skull bone was soaked with B-I solution and put back and fixed with miniplates. Operative Procedures Under ETGA and supine position with head rotated to left side and fixed with Mayfield head clamp, skin disinfected and drapped were performed as usual. Skin incision along the previous operative wound was done. The skull bone graft was removed and soaked in the B-I solution. Dura was then opened and the two previous corticotomy were opened for survey. Pus and hematoma removal were done. Hemostasis was then performed. The wound was irrigated with large amount N/S and B-I solution. The skull bone was then put back and fixed with mini-plates. The wound was then closed in layers after epidural drain and subgaleal drain insertion. Operators 曾漢民 Assistants 林哲光, 蕭智陽 相關圖片 廖武森 (M,1941/11/30,70y3m) 手術日期 2011/08/17 手術主治醫師 蔡瑞章 手術區域 東址 005房 01號 診斷 Glioma, brain 器械術式 Brain tumor Crainotomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 林哲光, 時間資訊 23:31 臨時手術NPO 07:40 報到 08:02 進入手術室 08:10 麻醉開始 08:47 誘導結束 09:00 抗生素給藥 09:07 手術開始 15:10 麻醉結束 15:10 手術結束 15:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除-手術時間在4~8小時 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Right frontal craniotomy for tumor excision; ... 開立醫師: 蔡瑞章 開立時間: 2011/08/17 15:51 Pre-operative Diagnosis Right frontal cystic lesion, suspected brain abscess Post-operative Diagnosis Right frontal cystic tumor, glioma Operative Method Right frontal craniotomy for tumor excision; duroplasty with aoutologus fascia Specimen Count And Types 1 piece About size:multiple pieces Source:tumor Pathology Frozen revealed high grade glioma Operative Findings A 5.8cm sized cystic lesion was noted at right frontal lobe and some yellowish, clear and transparent fluid contents inside the cystic lesion was noted. The tumor seemed grayish, not well-defined, soft-elastic in consistency. Part of cystic wall was not removed. Operative Procedures Under ETGA the patient was put in a supine position, skin was disinfected and drapped as usual. Curvilinear skin incision was made at right F-T area and a burr hole was created at right inferior frontal area. Cystic component fluid was aspirated under echo-guided for decompression and for rule-out brain abscess. The wound was then extended to perform right frontal craniotomy. The dura was opened in C-shaped and corticotomy was done at right middle frontal lobe. The residual cystic lesion was then identified under echo guided. Cystic wall was then seperated from normal brain with some difficulty due to the poor demarcation between cystic wall and brain. After tumor excision, meticulous hemostasis was performed. No residual cystic content was confirmed by ultrasound examination. The skull bone was then put back with mini-plates fixation after central tenting. The wound was then closed in layers with a subgaleal CWV drain. Operators 蔡瑞章 Assistants 林哲光, 蕭智陽 相關圖片 黃也芬 (F,1949/11/12,62y4m) 手術日期 2011/08/17 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Cervical spondylosis 器械術式 Diskectomy cervical(Anterier) C2/3 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 曾偉倫, 時間資訊 07:27 臨時手術NPO 12:18 進入手術室 12:20 麻醉開始 13:00 誘導結束 13:22 手術開始 14:22 抗生素給藥 15:42 手術結束 15:42 麻醉結束 15:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 椎間盤切除術-頸椎 1 1 記錄__ 手術科部: 外科部 套用罐頭: C2-3 anterior cervical diskectomy and fusion ... 開立醫師: 李振豪 開立時間: 2011/08/17 15:44 Pre-operative Diagnosis C2-3 anterior subluxation with myelopathy Post-operative Diagnosis C2-3 anterior subluxation with myelopathy Operative Method C2-3 anterior cervical diskectomy and fusion with PEEK cage Specimen Count And Types nil Pathology Nil Operative Findings C2-3 anterior subluxation with herniated intervertebral disc and hypertrophic anterior longitudinal ligment was noted. Narrowing of C2-3 disc space was noted with degenerative disc. CSF leakage was noted during resection of posterior longitudinal ligment but no obvious durotomy was noted. Reduction of C2-3 subluxation and anterior plating was tried but failed due to osteoporosis. One #8 PEEK cage with Sinbone was used for anterior cervical fusion. Poor MEP over all limbs were noted before the operation. No significant SSEP or MEP change noted after whole procedure. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with neck extension. The skin was scrubbed, disinfected, and draped as usual. Transverse skin incision was made at right submandibular area and the subcutaneous soft tissue was devided. The platysma was devided and the fascia was opened. Finger dissection was used along the plan between carotid sheath and thyroid cartilage. Prevertebral fascia was approach and Korros retractor was applied. Intra-operative portable C-arm X-ray was used for localization of C2/3 disc space. Under operative microscope, the prevertebral fascia was opened and the longus collis muscle were detached bilaterally. Microdiskectomy was performed with knife, curette, alligator, disc clamp, and Kerrison punches. The OPLL also resected during microdiskectomy. Hemostasis was achieved with Geofoam packing. One #8 PEEK cage filled with Sinbone was placed for anterior fusion. Plating was tried but failed due to osteoporosis and difficult to reduction of anterior subluxation. One minihemovac was placed and the wound was irrigated with Gentamicin solution. The wound was then closed in layers with 3-0 Vicryl and 4-0 Dexon. Operators VS 賴達明 Assistants R5 李振豪 R3 曾偉倫 Ri 許淑嫻 相關圖片 張智恩 (M,1996/09/24,15y5m) 手術日期 2011/08/17 手術主治醫師 楊士弘 手術區域 兒醫 067房 01號 診斷 Germinoma brain 器械術式 Craniotomy for tumor resection 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 07:34 報到 08:05 進入手術室 08:20 麻醉開始 08:50 誘導結束 08:55 抗生素給藥 09:02 手術開始 12:10 抗生素給藥 15:10 抗生素給藥 16:10 麻醉結束 16:10 手術結束 16:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 8 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 4 0 麻醉 Hemoglobin (Hb) 4 0 麻醉 測血糖 4 0 麻醉 Ca (Calcium) 4 0 麻醉 Na (Sodium) 4 0 麻醉 K (Potassium) 4 0 麻醉 Blood gas analysis 4 0 手術 腦瘤切除-手術時間在4~8小時 1 1 R 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 R 摘要__ 手術科部: 套用罐頭: Right frontal craniotomy, combined right subf... 開立醫師: 王奐之 開立時間: 2011/08/17 16:46 Pre-operative Diagnosis Suprasellar mass, suspected germ cell tumor Post-operative Diagnosis Suprasellar mass, suspected germ cell tumor Operative Method Right frontal craniotomy, combined right subfrontal & interhemispheric approach for partial tumor resection Specimen Count And Types 1 piece About size:pieces Source:suprasellar mass Pathology Frozen section showed small blue round cell, germinoma is more favored. Final pathology is pending. Operative Findings Whitish elastic-firm tumor was noted at suprasellar area, involving hypothalamus to pituitary stalk. Thick and firm capsule was noted, with increased vasculature in the vicinity. Moderate adhesion was encountered at the interhemispheric fissure. Preservation of right olfactory nerve was attempted at first but was sacrificed during tumor resection (probably due to retraction of frontal lobe). 5ml of CSF was collected, sent for cytology & tumor markers (alpha-fetoprotein & beta-hCG). Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head fixed in Mayfield skull clamp. After shaving, scrubbing, disinfection & draping in sterile fashion, a bicoronal skin incision was made, followed by creation of 3 burr holes and right frontal craniotomy. Durotomy was then done after dural tenting, the dural flap was reflected inferiorly & medially. Subfrontal approach was adapted first until exposure of the right olfactory nerve & optic chiasma. The interhemispheric fissure was then dissected and bilateral frontal lobes divided, until the A1/A2 & A-com arteries exposed. The lamina terminalis was identified posterosuperiorly to the A-com, and was opened to allow access to the tumor. Some tumor was removed in pieces. After meticulous hemostasis of the removed tumor bed and surrounding brain tissue, the dura was closed in water-tight fashion. 4 central tenting stitches were done, followed by fixing back the bone flap with mini-plates and setting of 1 epidural CWV drain. After re-approximation of periosteum & temporalis muscle, the wound was closed in layers. Operators VS 楊士弘 Assistants R4 王奐之, Ri 吳祐新 相關圖片 記錄__ 手術科部: 套用罐頭: Right frontal craniotomy, combined right subf... 開立醫師: 王奐之 開立時間: 2011/08/17 16:46 Pre-operative Diagnosis Suprasellar mass, suspected germ cell tumor Post-operative Diagnosis Suprasellar mass, suspected germ cell tumor Operative Method Right frontal craniotomy, combined right subfrontal & interhemispheric approach for partial tumor resection Specimen Count And Types 1 piece About size:pieces Source:suprasellar mass Pathology Frozen section showed small blue round cell, germinoma is more favored. Final pathology is pending. Operative Findings Whitish elastic-firm tumor was noted at suprasellar area, involving hypothalamus to pituitary stalk. Thick and firm capsule was noted, with increased vasculature in the vicinity. Moderate adhesion was encountered at the interhemispheric fissure. Preservation of right olfactory nerve was attempted at first but was sacrificed during tumor resection (probably due to retraction of frontal lobe). 5ml of CSF was collected, sent for cytology & tumor markers (alpha-fetoprotein & beta-hCG). Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head fixed in Mayfield skull clamp. After shaving, scrubbing, disinfection & draping in sterile fashion, a bicoronal skin incision was made, followed by creation of 3 burr holes and right frontal craniotomy. Durotomy was then done after dural tenting, the dural flap was reflected inferiorly & medially. Subfrontal approach was adapted first until exposure of the right olfactory nerve & optic chiasma. The interhemispheric fissure was then dissected and bilateral frontal lobes divided, until the A1/A2 & A-com arteries exposed. The lamina terminalis was identified posterosuperiorly to the A-com, and was opened to allow access to the tumor. Some tumor was removed in pieces. After meticulous hemostasis of the removed tumor bed and surrounding brain tissue, the dura was closed in water-tight fashion. 4 central tenting stitches were done, followed by fixing back the bone flap with mini-plates and setting of 1 epidural CWV drain. After re-approximation of periosteum & temporalis muscle, the wound was closed in layers. Operators VS 楊士弘 Assistants R4 王奐之, Ri 吳祐新 相關圖片 吳逸樺 (F,1973/04/14,38y11m) 手術日期 2011/08/18 手術主治醫師 楊士弘 手術區域 東址 005房 01號 診斷 Herniation of intervertebral disc, lumbar (HIVD) 器械術式 Diskectomy lumbar (endoscope) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 王怡人, 時間資訊 23:08 臨時手術NPO 07:50 報到 08:05 進入手術室 08:10 麻醉開始 08:20 誘導結束 08:50 抗生素給藥 09:22 手術開始 10:55 手術結束 10:55 麻醉結束 11:05 送出病患 11:07 進入恢復室 12:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 椎間盤切除術-腰椎 1 1 摘要__ 手術科部: 外科部 套用罐頭: Microsurgical diskectomy 開立醫師: 林哲光 開立時間: 2011/08/18 11:18 Pre-operative Diagnosis Herniated intervertebral disc, left L5-S1 Post-operative Diagnosis Herniated intervertebral disc, left L5-S1 Operative Method Microsurgical diskectomy Specimen Count And Types nil Pathology Nil Operative Findings A ruptured disc fragement was found under the left S1 root. The fragment was protruded via a defect in the annulus fibrosus and connected with the nucleus propulsus. The root became slack and free from tension after removal of the disc fragment. Operative Procedures Under ETG and prone position, skin disinfected and drapped were performed as usual. Midline skin incision was made at L5-S1 level after C-arm localization. Paraspinal muscles were detached and the left laminia was exposed well. L5 laminotomy was then performed until the ligamentum flavum was exposed. The left L5 root was then exposed and discectomy was done. Hemostasis was then performed and the wound was then closed in layers. Operators 楊士弘 Assistants 林哲光,王怡人 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Microsurgical diskectomy 開立醫師: 林哲光 開立時間: 2011/08/18 11:18 Pre-operative Diagnosis Herniated intervertebral disc, left L5-S1 Post-operative Diagnosis Herniated intervertebral disc, left L5-S1 Operative Method Microsurgical diskectomy Specimen Count And Types nil Pathology Nil Operative Findings A ruptured disc fragement was found under the left S1 root. The fragment was protruded via a defect in the annulus fibrosus and connected with the nucleus propulsus. The root became slack and free from tension after removal of the disc fragment. Operative Procedures Under ETG and prone position, skin disinfected and drapped were performed as usual. Midline skin incision was made at L5-S1 level after C-arm localization. Paraspinal muscles were detached and the left laminia was exposed well. L5 laminotomy was then performed until the ligamentum flavum was exposed. The left L5 root was then exposed and discectomy was done. Hemostasis was then performed and the wound was then closed in layers. Operators 楊士弘 Assistants 林哲光,王怡人 相關圖片 摘要__ 手術科部: 外科部 套用罐頭: Microsurgical diskectomy 開立醫師: 楊士弘 開立時間: 2011/08/22 13:49 Pre-operative Diagnosis Herniated intervertebral disc, left L5-S1 Post-operative Diagnosis Herniated intervertebral disc, left L5-S1 Operative Method Microsurgical diskectomy Specimen Count And Types nil Pathology Nil Operative Findings A ruptured disc fragement was found under the left S1 root. The fragment was protruded via a defect in the annulus fibrosus and connected with the nucleus propulsus. The root became slack and free from tension after removal of the disc fragment. Operative Procedures Under ETG and prone position, skin disinfected and drapped were performed as usual. Midline skin incision was made at L5-S1 level after C-arm localization. Paraspinal muscles were detached and the left laminia was exposed well. L5 laminotomy was then performed until the ligamentum flavum was exposed. The left S1 root was then exposed and discectomy was done. Hemostasis was then performed and the wound was then closed in layers. Operators 楊士弘 Assistants 林哲光,王怡人 相關圖片 王盛泰 (M,1954/09/11,57y6m) 手術日期 2011/08/18 手術主治醫師 蕭輔仁 手術區域 東址 003房 03號 診斷 Low back pain 器械術式 Radiofrequency coagulation(P-G 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 16:20 進入手術室 17:04 麻醉開始 17:05 手術開始 17:05 麻醉結束 17:46 手術結束 17:56 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 高頻熱凝療法 1 1 B 摘要__ 手術科部: 外科部 套用罐頭: Pulsed radiofrequency stimulation, bilateral ... 開立醫師: 林哲光 開立時間: 2011/08/18 17:58 Pre-operative Diagnosis Low back pain Post-operative Diagnosis Low back pain Operative Method Pulsed radiofrequency stimulation, bilateral L2 dorsal root Specimen Count And Types nil Pathology Nil Operative Findings 1. Bilateral L2 dorsal root was identified by portable C-arm X-ray and sensory/motor stimulation test. No acute complication was noted after the procedure. 2. Temp: 42 oC, Time: 180sec x 2 cycles each side Operative Procedures The patient was put in prone position. The location of L2 was identified by portable C-arm X-ray. The skin was disinfected and draped as usual. Local anesthesia was performed with 1% Xylocaine at 4cm below, 4cm away from the midline of L2 interspinous process and pedicle. Bilateral L2 dorsal root radiofrequency stimulation was performed under portable C-arm guided. The patient stood whole procedure well. Operators 蕭輔仁 Assistants 林哲光 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Pulsed radiofrequency stimulation, bilateral ... 開立醫師: 林哲光 開立時間: 2011/08/18 17:59 Pre-operative Diagnosis Low back pain Post-operative Diagnosis Low back pain Operative Method Pulsed radiofrequency stimulation, bilateral L2 dorsal root Specimen Count And Types nil Pathology Nil Operative Findings 1. Bilateral L2 dorsal root was identified by portable C-arm X-ray and sensory/motor stimulation test. No acute complication was noted after the procedure. 2. Temp: 42 oC, Time: 180sec x 2 cycles each side Operative Procedures The patient was put in prone position. The location of L2 was identified by portable C-arm X-ray. The skin was disinfected and draped as usual. Local anesthesia was performed with 1% Xylocaine at 4cm below, 4cm away from the midline of L2 interspinous process and pedicle. Bilateral L2 dorsal root radiofrequency stimulation was performed under portable C-arm guided. The patient stood whole procedure well. Operators 蕭輔仁 Assistants 林哲光 相關圖片 傅南榮 (M,1940/03/27,71y11m) 手術日期 2011/08/18 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Herniated intervertebral disc (HIVD) 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 王奐之, 時間資訊 23:06 臨時手術NPO 08:05 進入手術室 08:15 麻醉開始 08:20 誘導結束 08:45 抗生素給藥 09:13 手術開始 11:05 手術結束 11:05 麻醉結束 11:10 送出病患 11:13 進入恢復室 12:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-腰椎 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 摘要__ 手術科部: 外科部 套用罐頭: Microsurgical discectomy, L4-5 開立醫師: 王奐之 開立時間: 2011/08/18 11:15 Pre-operative Diagnosis L4-5 sequestrated disc, right Post-operative Diagnosis L4-5 sequestrated disc, right Operative Method Microsurgical discectomy, L4-5 Specimen Count And Types Nil Pathology Nil Operative Findings A piece of sequestrated disc was noted at right L4 level, compressing the thecal sac & L4 root. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position. After localizing the L4-5 space with C-arm, the back was scrubbed, disinfected & draped in sterile fashion. A linear incision was made at right lower back over L4-5 level, and the incision was further deepened through the fascia. The right side paraspinal muscle was detached from the spinous process & lamina, followed by setting up of Taylor retractor. A laminotomy was then done at right L4 lamina, and the ligamentum flavum was removed, exposing the thecal sac. The thecal sac was then gently retracted to the left, and the sequestrated disc was removed by alligator clamp. The PLL was then incised, and the right side intervertebral disc was removed in pieces. After hemostasis, the wound was closed in layers. Operators VS 王國川 Assistants R4 王奐之, R1 吳欣翰 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Microsurgical discectomy, L4-5 開立醫師: 王奐之 開立時間: 2011/08/18 11:15 Pre-operative Diagnosis L4-5 sequestrated disc, right Post-operative Diagnosis L4-5 sequestrated disc, right Operative Method Microsurgical discectomy, L4-5 Specimen Count And Types Nil Pathology Nil Operative Findings A piece of sequestrated disc was noted at right L4 level, compressing the thecal sac & L4 root. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position. After localizing the L4-5 space with C-arm, the back was scrubbed, disinfected & draped in sterile fashion. A linear incision was made at right lower back over L4-5 level, and the incision was further deepened through the fascia. The right side paraspinal muscle was detached from the spinous process & lamina, followed by setting up of Taylor retractor. A laminotomy was then done at right L4 lamina, and the ligamentum flavum was removed, exposing the thecal sac. The thecal sac was then gently retracted to the left, and the sequestrated disc was removed by alligator clamp. The PLL was then incised, and the right side intervertebral disc was removed in pieces. After hemostasis, the wound was closed in layers. Operators VS 王國川 Assistants R4 王奐之, R1 吳欣翰 相關圖片 何秀霞 (F,1954/04/30,57y10m) 手術日期 2011/08/18 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 Ankylosing spondylitis 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 王奐之, 時間資訊 23:04 臨時手術NPO 11:25 進入手術室 11:30 麻醉開始 11:35 誘導結束 12:05 抗生素給藥 12:41 手術開始 14:32 手術結束 14:32 麻醉結束 14:40 送出病患 14:45 進入恢復室 16:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-腰椎 1 1 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 手術 椎弓切除術(減壓)-二節以內 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 摘要__ 手術科部: 外科部 套用罐頭: Microsurgical discectomy, L4-5 開立醫師: 王奐之 開立時間: 2011/08/18 14:55 Pre-operative Diagnosis L4-5 herniated intervertebral disc Post-operative Diagnosis L4-5 herniated intervertebral disc Operative Method Microsurgical discectomy, L4-5 Specimen Count And Types Nil Pathology Nil Operative Findings Several engorged epidural veins were noted, resulted in easy oozing after exposure of thecal sac, and the veins were electrocauterized. A small piece of rupture disc was noted at right side of L4-5 level, compressed the thecal sac, but not very severe. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position. The L4-5 disc level was localized by C-arm. After scrubbing, disinfection & draping in sterile fashion, a midline linear incision was made at L4-5 level. The incision was further deepened until the fascia was exposed. The right side paraspinal muscles were detached from the spinous process & lamina. After setting up of Taylor retractor, a laminotomy was made at L4. The ligamentum flavum was removed in pieces, exposing the thecal sac. After gentle retraction of the thecal sac, the PLL was incised & discectomy was performed with disc clamp. The left side ligamentum flavum was also removed to achieve sublaminar decompression. After hemostasis, the wound was closed in layers. Operators VS 王國川 Assistants R4 王奐之 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Microsurgical discectomy, L4-5 開立醫師: 王奐之 開立時間: 2011/08/18 14:55 Pre-operative Diagnosis L4-5 herniated intervertebral disc Post-operative Diagnosis L4-5 herniated intervertebral disc Operative Method Microsurgical discectomy, L4-5 Specimen Count And Types Nil Pathology Nil Operative Findings Several engorged epidural veins were noted, resulted in easy oozing after exposure of thecal sac, and the veins were electrocauterized. A small piece of rupture disc was noted at right side of L4-5 level, compressed the thecal sac, but not very severe. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position. The L4-5 disc level was localized by C-arm. After scrubbing, disinfection & draping in sterile fashion, a midline linear incision was made at L4-5 level. The incision was further deepened until the fascia was exposed. The right side paraspinal muscles were detached from the spinous process & lamina. After setting up of Taylor retractor, a laminotomy was made at L4. The ligamentum flavum was removed in pieces, exposing the thecal sac. After gentle retraction of the thecal sac, the PLL was incised & discectomy was performed with disc clamp. The left side ligamentum flavum was also removed to achieve sublaminar decompression. After hemostasis, the wound was closed in layers. Operators VS 王國川 Assistants R4 王奐之 相關圖片 王嘉緗 (F,1965/11/24,46y3m) 手術日期 2011/08/19 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Brain cancer 器械術式 Crainotomy Brain Tumor(P-LIN) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 4 紀錄醫師 林哲光, 時間資訊 23:09 臨時手術NPO 08:20 進入手術室 08:25 麻醉開始 08:30 誘導結束 09:25 手術開始 12:52 抗生素給藥 13:15 手術結束 13:15 麻醉結束 13:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Subocciptial approach tumor excision 開立醫師: 林哲光 開立時間: 2011/08/19 14:28 Pre-operative Diagnosis Cerebellar cystic tumor, suspected recurrent ependymoma Post-operative Diagnosis Cerebellar cystic tumor, suspected recurrent ependymoma Operative Method Subocciptial approach tumor excision Specimen Count And Types 1 piece About size:multiple pieces Source:tumor Pathology Pending Operative Findings Preopeartive conscious was E4M6Vt. Previous suboccipital craniectomy was done. Severe adhesion between the dura and cerebellar hemisphere was noted and adhesionolysis was failed to identify the normal structure. Tumor excision was done via corticotomy under echo localization for dilated 4th ventricle. CSF was gushed out after corticotomy was done. The tumor was grayish, soft, fragile, suctionable mass lesion lying over the 4th ventricle. Grossly total tumor excision was done. Some blood clot was noted at the aqueduct after tumor excision and removal of blood clot was done and 3rd ventricle was visble under microscopy. Operative Procedures Under ETGA and prone position with head fixed with Mayfield head clamp, skin disinfected and drapped were performed as usual. Adhesionolysis was done until the previous craniectomy window was exposed and the dura with fibrosis band was opened in V-shaped. Adhesionolysis between the dura and the cerebellum was failed. Corticotomy was done after echo localization. Tumor excision was then performed and hemostasis was then performed. Aqueduct was checked and blood clot was removed. Dura was then closed in Prolene. The wound was then closed in layers after epidural CWV drain was inserted. Operators 曾漢民 Assistants 林哲光, 蕭智陽, 龔柏榕 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Subocciptial approach tumor excision 開立醫師: 林哲光 開立時間: 2011/08/19 14:28 Pre-operative Diagnosis Cerebellar cystic tumor, suspected recurrent ependymoma Post-operative Diagnosis Cerebellar cystic tumor, suspected recurrent ependymoma Operative Method Subocciptial approach tumor excision Specimen Count And Types 1 piece About size:multiple pieces Source:tumor Pathology Pending Operative Findings Preopeartive conscious was E4M6Vt. Previous suboccipital craniectomy was done. Severe adhesion between the dura and cerebellar hemisphere was noted and adhesionolysis was failed to identify the normal structure. Tumor excision was done via corticotomy under echo localization for dilated 4th ventricle. CSF was gushed out after corticotomy was done. The tumor was grayish, soft, fragile, suctionable mass lesion lying over the 4th ventricle. Grossly total tumor excision was done. Some blood clot was noted at the aqueduct after tumor excision and removal of blood clot was done and 3rd ventricle was visble under microscopy. Operative Procedures Under ETGA and prone position with head fixed with Mayfield head clamp, skin disinfected and drapped were performed as usual. Adhesionolysis was done until the previous craniectomy window was exposed and the dura with fibrosis band was opened in V-shaped. Adhesionolysis between the dura and the cerebellum was failed. Corticotomy was done after echo localization. Tumor excision was then performed and hemostasis was then performed. Aqueduct was checked and blood clot was removed. Dura was then closed in Prolene. The wound was then closed in layers after epidural CWV drain was inserted. Operators 曾漢民 Assistants 林哲光, 蕭智陽, 龔柏榕 相關圖片 臧傳平 (M,1964/05/10,47y10m) 手術日期 2011/08/19 手術主治醫師 楊士弘 手術區域 東址 003房 02號 診斷 Cervical spondylosis 器械術式 Debridment-- 5-10cm 手術類別 預定手術 手術部位 脊椎 傷口分類 污染 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 曾偉倫, 時間資訊 23:32 臨時手術NPO 10:00 進入手術室 10:05 麻醉開始 10:10 誘導結束 10:15 抗生素給藥 10:20 手術開始 12:05 手術結束 12:05 麻醉結束 12:10 送出病患 12:15 進入恢復室 13:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 深部傷口處理縫合擴創-大 1 0 記錄__ 手術科部: 外科部 套用罐頭: Debridement and primary closure of the wound 開立醫師: 李振豪 開立時間: 2011/08/19 11:57 Pre-operative Diagnosis Nuchal wound dehiscence Post-operative Diagnosis Nuchal wound dehiscence Operative Method Debridement and primary closure of the wound Specimen Count And Types 1 piece About size:Swab x I Source:Granulation tissue Pathology Nil Operative Findings Some healthy granulation formation and thin hyaline-like tissue were noted within the wound. Previous stitches were removed. The wound was relative clear without evident active infection. Elevation of skin edge was noted and the skin edge was trimmed off. The muscle and fascia layers were closed in 2 layers with 1-0 Vicryl. The fat and subcutaneous soft tissue were closed in 2 layers with 2-0 Vicryl. The skin was closed with 3-0 Nylon. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position with head fixed with Mayfield skull clamp. The skin was scrubbed, disinfected, and draped as usual. Wound debridement was performed with currete and scissor. The wound was irrigated with copious normal saline and Gentamicin solution. One CWV drain was placed. The wound was then closed in layers with 1-0 Vicry, 2-0 Vicryl, and 3-0 Nylon. Operators VS楊士弘 Assistants R5李振豪, R3曾偉倫 相關圖片 劉敏華 (F,1969/07/12,42y8m) 手術日期 2011/08/19 手術主治醫師 楊士弘 手術區域 東址 003房 01號 診斷 Hyperhidrosis 器械術式 Dorsal sympathectomy 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 曾偉倫, 時間資訊 23:26 臨時手術NPO 08:10 進入手術室 08:15 麻醉開始 08:25 誘導結束 08:30 抗生素給藥 08:48 手術開始 09:35 手術結束 09:35 麻醉結束 09:43 送出病患 09:45 進入恢復室 10:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 經內視鏡交感神經切斷術 1 1 B 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Endoscopic dorsal sympathectomy, Bilateral T2 開立醫師: 李振豪 開立時間: 2011/08/19 09:48 Pre-operative Diagnosis Hyperhidrosis Post-operative Diagnosis Hyperhidrosis Operative Method Endoscopic dorsal sympathectomy, Bilateral T2 Specimen Count And Types nil Pathology Nil Operative Findings Bilateral T2 was identified under endoscopic view which accompanied with a collateral vein. Bilateral T2 dorsal sympathectomy was performed smoothly and the vein were coagulated at the same time. The palm temperature elevated from 26.5 to 31.1 oC at right side and from 27.7 to 32.8 oC at left side. No acute complication was noted during whole procedure. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with semi-sitting position. The skin was disinfected, and draped as usual. One 1cm transverse skin incision over left anterior axillary line, 4th intercostal space was made. The vnetilator was disconnected and the pleural cavity was entered with direct trocar puncture. Under endoscopic view, T2 dorsal sympathetic trunk was identified. Sympathectomy was performed with coagulation. Deair was performed and the wound was closed in layers with 3-0 Nylon. One 1cm transverse skin incision over right anterior axillary line, 4th intercostal space was made. The vnetilator was disconnected and the pleural cavity was entered with direct trocar puncture. Under endoscopic view, T2 dorsal sympathetic trunk was identified. Sympathectomy was performed with coagulation. Deair was performed and the wound was closed in layers with 3-0 Nylon. Operators VS楊士弘 Assistants R5李振豪, R3曾偉倫 相關圖片 林鳳嬌 (F,1953/08/16,58y6m) 手術日期 2011/08/19 手術主治醫師 蕭輔仁 手術區域 東址 000房 號 診斷 Other inflammatory spondylopathies 器械術式 Spinal fusion posterior, L5/S1 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 無麻醉 麻醉主治醫師 洪明輝 ASA 2 時間資訊 23:12 臨時手術NPO 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 麻醉 T.E.E 1 0 吳秋源 (M,1948/08/01,63y7m) 手術日期 2011/08/19 手術主治醫師 王國川 手術區域 東址 005房 03號 診斷 Anemia, unspecified 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 蔡奉芳 ASA 4E 紀錄醫師 周聖哲, 時間資訊 12:21 臨時手術NPO 12:21 開始NPO 22:50 進入手術室 22:52 麻醉開始 22:55 誘導結束 23:11 手術開始 23:45 手術結束 23:45 麻醉結束 23:47 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 慢性硬腦膜下血腫清除術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Burr hole for hematoma evacuation 開立醫師: 陳國瑋 開立時間: 2011/08/19 23:39 Pre-operative Diagnosis Left chronic subdural hemorrhage Post-operative Diagnosis Left chornic subdural hemorrhage Operative Method Burr hole for hematoma evacuation Specimen Count And Types nil Pathology nil Operative Findings Hematoma was gushed out after opening the outer menbrane. The SDH was clear in upper part and dark-reddish in the depandent part. The brain expended well after decompression. Inner and outer menbrane were identified. Operative Procedures The patient was put in supine position. One transverse skin incision was made at left frontal area. One burr hole was made and the dura was opened after dural tenting. The hematoma was drained out. One drain was placed. The wound was closed in layers after hemostasis. De-air was then done. Operators VS 王國川 Assistants 曾峰毅 周聖哲 Indication Of Emergent Operation IICP 相關圖片 陳林梅玉 (F,1947/07/15,64y7m) 手術日期 2011/08/20 手術主治醫師 曾漢民 手術區域 東址 003房 01號 診斷 Cerebrovascular accident 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 周聖哲, 時間資訊 23:28 臨時手術NPO 09:03 進入手術室 09:05 麻醉開始 09:07 誘導結束 09:10 抗生素給藥 09:25 手術開始 09:50 手術結束 09:50 麻醉結束 09:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 氣管切開術 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 周聖哲 開立時間: 2011/08/20 10:02 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types nil Pathology None Operative Findings Fr. 7 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 1 cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and fix the tracheostomy tube with 3-0 nylon. Operators VS曾漢民 Assistants R5李振豪, R2周聖哲 相關圖片 王嘉緗 (F,1965/11/24,46y3m) 手術日期 2011/08/20 手術主治醫師 曾漢民 手術區域 東址 003房 02號 診斷 Brain cancer 器械術式 V-P shunt 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 4E 紀錄醫師 王奐之, 時間資訊 09:00 臨時手術NPO 09:00 開始NPO 12:17 通知急診手術 12:53 進入手術室 13:00 麻醉開始 13:10 誘導結束 13:53 手術開始 15:06 手術結束 15:06 麻醉結束 15:17 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Left Kocher point Codman programmable V-P shu... 開立醫師: 林哲光 開立時間: 2011/08/20 15:14 Pre-operative Diagnosis Obstructive hydrocephalus Post-operative Diagnosis Obstructive hydrocephalus Operative Method Left Kocher point Codman programmable V-P shunt insertion Specimen Count And Types 1 piece About size: Source:CSF for culture, BCS and routine Pathology Nil Operative Findings Intraventriuclar opening pressure was around 5cm H2O. CSF seemed clear, mild xanthochromic, and transparent. The valve was set 10cmH2O. Intraventricular catheter was 6cm long and abdominal cathteter was 15cm long. Operative Procedures Under ETGA and supine position with head rotated to right side, skin disinfected and drapped were perfomred as usual. Linear skin incision was made at left Kocher point. A burr hole was then created. Transverse skin incision was made at left upper abdomen. Minilaparotomy was then performed and the peritoneum was opened. Subcutaneous tunneling was then done with Stylate and abdominal catheter was set and connected to ventricular catheter with valve through the subcutaneous tunnel. Ventricular puncture was then performed and ventriuclar catehter was inserted. The abdominal catheter was then inserted into the peritoneal space. The wound was then closed in layers. Operators 曾漢民 Assistants 林哲光, 王奐之, 陳浩慧 Indication Of Emergent Operation acute obstructive hydrocephalus with consciuos change 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Left Kocher point Codman programmable V-P shu... 開立醫師: 林哲光 開立時間: 2011/08/20 15:14 Pre-operative Diagnosis Obstructive hydrocephalus Post-operative Diagnosis Obstructive hydrocephalus Operative Method Left Kocher point Codman programmable V-P shunt insertion Specimen Count And Types 1 piece About size: Source:CSF for culture, BCS and routine Pathology Nil Operative Findings Intraventriuclar opening pressure was around 5cm H2O. CSF seemed clear, mild xanthochromic, and transparent. The valve was set 10cmH2O. Intraventricular catheter was 6cm long and abdominal cathteter was 15cm long. Operative Procedures Under ETGA and supine position with head rotated to right side, skin disinfected and drapped were perfomred as usual. Linear skin incision was made at left Kocher point. A burr hole was then created. Transverse skin incision was made at left upper abdomen. Minilaparotomy was then performed and the peritoneum was opened. Subcutaneous tunneling was then done with Stylate and abdominal catheter was set and connected to ventricular catheter with valve through the subcutaneous tunnel. Ventricular puncture was then performed and ventriuclar catehter was inserted. The abdominal catheter was then inserted into the peritoneal space. The wound was then closed in layers. Operators 曾漢民 Assistants 林哲光, 王奐之, 陳浩慧 Indication Of Emergent Operation acute obstructive hydrocephalus with consciuos change 相關圖片 黃麗華 (F,1956/10/06,55y5m) 手術日期 2011/08/20 手術主治醫師 王國川 手術區域 東址 001房 01號 診斷 Intracranial hemorrhage 器械術式 craniectomy, right 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 蔡奉芳 ASA 4E 紀錄醫師 周聖哲, 時間資訊 18:00 臨時手術NPO 18:00 開始NPO 01:39 通知急診手術 02:05 進入手術室 02:18 麻醉開始 02:30 誘導結束 02:40 抗生素給藥 02:45 手術開始 03:21 開始輸血 05:05 手術結束 05:05 麻醉結束 05:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 1 R 手術 顱內壓視置入 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: CVA 開立醫師: 曾峰毅 開立時間: 2011/08/20 05:18 Pre-operative Diagnosis Right putaminal intracerebral hemorrhage Post-operative Diagnosis Right putaminal intracerebral hemorrhage Operative Method CVA Craniotomy for hematoma evacuation and ICP monitor insertion Specimen Count And Types Nil Pathology nil Operative Findings Hematoma, about 60 ml, was noted at right frontal lobe. Codman ICP reference is 499. ICP after wound closure was -2 mmHg. Blood loss was 50 ml. Operative Procedures With endotracheal general anaesthesiat, the patient was put in supine position with head rotated to left. The scalp was shaved, scrubbed, disinfected, and then draped as usual. We made on curvilinear skin incision at right frontotemporal area, and drilled three burr holes to create one 6x8 cm craniotomy. Dura was tented along the carniotomy window, and was incised in U shape. We made corticotomy at right inferior frontal gyrus, and hematoma was evacuated. Hematoma cavity was paved with Surgicel for hemostasis. Dura was closed in water tight fashion. Subdural space was de-air, and one ICP monitor was inserted into subdural space. Bone graft was fixed back with mini-plates. We placed one subgaleal CWV, and closed the wound in layers. Operators VS 王國川 Assistants R5 曾峰毅 R2 周聖哲 Indication Of Emergent Operation Uncal herniation 相關圖片 李再興 (M,1958/12/01,53y3m) 手術日期 2011/08/20 手術主治醫師 蔡翊新 手術區域 東址 002房 03號 診斷 Major trauma rated 16 or above on the severity scale ( Injury severity score >=16 ) 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 4E 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 16:42 通知急診手術 18:10 進入手術室 18:15 麻醉開始 18:18 誘導結束 18:58 手術開始 20:25 手術結束 20:25 麻醉結束 20:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室體外引流 1 1 R 手術 慢性硬腦膜下血腫清除術 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: 1. External ventricular drainage via right Ko... 開立醫師: 李振豪 開立時間: 2011/08/20 21:39 Pre-operative Diagnosis 1. Ventriculitis, 2. Left subgaleal collection, suspect abscess formation Post-operative Diagnosis 1. Ventriculitis, 2. Left subgaleal collection, suspect abscess formation Operative Method 1. External ventricular drainage via right Kocher"s approach 2. Evacuation of left subgaleal collection Specimen Count And Types 2 pieces About size:30ml Source:CSF About size:swab x III Source:left subgaleal collection Pathology Nil Operative Findings CSF leakage from scalp wound was noted before the operation. Ischemic change with eschar formation over previous craniectomy wound also noted. The wound healing was poor. The CSF leakage site was mainly from ICP monitor wound. The ICP before the operation was 18mmHg. The CSF was turbid and xanthochromic in character with high opening pressure(more than 20cmH2O). The ventricular wall was hard. The ventricular catheter was fixed at 6.5cm in depth from brain surface. Total 40ml CSF was drained for release of pressure and CSF study. Normal saline irrigation also performed several times. The fluid accumulation over left frontal subgaleal area was CSF like with some necrotic tissue(Durafoam?). Three culture swabs were done for suspect abscess formation. The brain was swelling after evacuation of subgaleal collection. The ICP monitor was left in situ. The ICP after wound closure was 11mmHg. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position. The scalp was shaved, scrubbed, and disinfected as usual. Right frontal scalp incision was made followed by one burr hole creation. Two dural tenting was done and cruciform durotomy was made. Ventricular puncture was performed with puncture needle and the ventricular catheter was placed into right lateral ventricle. Externalization was done. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. The wound was the closed in layers with 1-0 Vicryl and 3-0 Nylon. Left frontal wound was opened after removal of stitches. The subgaleal collection was evacuated and the wound was irrigated with Gentamicin solution. Hemostasis was achieved and the necrotic skin edge was trimmed off. One subgaleal CWV drain was placed and the wound was closed in layers with 1-0 Vicryl and 3-0 Nylon. The stitches for fixation of ICP monitor was removed for antiseptics and the ICP monitor was fixed again with 2 stitches. Operators VS蔡翊新 Assistants R5李振豪 Indication Of Emergent Operation Acute hydrocephalus with deterioration of consciousness 相關圖片 鄭榮仁 (M,1961/08/06,50y7m) 手術日期 2011/08/22 手術主治醫師 杜永光 手術區域 東址 005房 02號 診斷 Spine tumor 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 4 紀錄醫師 林哲光, 時間資訊 23:44 臨時手術NPO 14:40 進入手術室 14:42 麻醉開始 14:50 誘導結束 15:38 手術開始 17:30 手術結束 17:30 麻醉結束 17:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 記錄__ 手術科部: 外科部 套用罐頭: Right Kocher point Codman V-P shunt insertion... 開立醫師: 林哲光 開立時間: 2011/08/22 17:58 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Right Kocher point Codman V-P shunt insertion, 100mmHg Specimen Count And Types 1 piece About size: Source:CSF for culture, BCS, routine Pathology Nil Operative Findings CSF seemed clear and transparent. Gush of CSF was noted when ventricular puncture. Fixed pressure 100mmHg was inserted. Intraventricular catheter was 6.5cm long and abdominal catheter was around 15cm long. CSF seemed clear and transparent. Gush of CSF was noted when ventricular puncture. Fixed pressure 100mmH2O was inserted. Intraventricular catheter was 6.5cm long and abdominal catheter was around 15cm long. Operative Procedures Under ETGA and supine position with head rotated to left side, skin disinfected and drapped were performed as usual. Linear skin incision was made at right Kocher point and a burr hole was created. Transverse skin incision was made at right upper abdomen. Minilarparotomy was done and the peritoneum was opened. Subcutaneous tunneling was done with Stylate through right abdomen, right chest, right neck to right posterior auricle area. The ventricular catheter was then connected to abdominal catheter with abdominal catheter through subcutaneous tunnel. The dura was then opened after dural tenting and ventricular catheter was inserted via ventricular puncture. The abdominal catheter was then inserted into peritoneal cavity. The wound was then closed in layrs. Operators 杜永光 Assistants 林哲光, 蕭智陽 相關圖片 摘要__ 手術科部: 外科部 套用罐頭: Right Kocher point Codman V-P shunt insertion... 開立醫師: 林哲光 開立時間: 2011/08/22 18:00 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Right Kocher point Codman V-P shunt insertion, 100mmHg Specimen Count And Types 1 piece About size: Source:CSF for culture, BCS, routine Pathology Nil Operative Findings CSF seemed clear and transparent. Gush of CSF was noted when ventricular puncture. Fixed pressure 100mmH2O was inserted. Intraventricular catheter was 6.5cm long and abdominal catheter was around 15cm long. Operative Procedures Under ETGA and supine position with head rotated to left side, skin disinfected and drapped were performed as usual. Linear skin incision was made at right Kocher point and a burr hole was created. Transverse skin incision was made at right upper abdomen. Minilarparotomy was done and the peritoneum was opened. Subcutaneous tunneling was done with Stylate through right abdomen, right chest, right neck to right posterior auricle area. The ventricular catheter was then connected to abdominal catheter with abdominal catheter through subcutaneous tunnel. The dura was then opened after dural tenting and ventricular catheter was inserted via ventricular puncture. The abdominal catheter was then inserted into peritoneal cavity. The wound was then closed in layrs. Operators 杜永光 Assistants 林哲光, 蕭智陽 相關圖片 張賜福 (M,1964/04/25,47y10m) 手術日期 2011/08/22 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Brain Tumor 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 曾偉倫, 時間資訊 23:42 臨時手術NPO 07:55 報到 08:01 進入手術室 08:30 麻醉開始 08:50 誘導結束 09:00 手術開始 13:00 抗生素給藥 17:15 麻醉結束 17:15 手術結束 17:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 10 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 顱底瘤手術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Right far-lateral approach for total tumor ex... 開立醫師: 李振豪 開立時間: 2011/08/22 17:48 Pre-operative Diagnosis Right foramen magnum tumor, suspect meningioma Post-operative Diagnosis Right foramen of Luschka tumor, suspect papilloma Operative Method Right far-lateral approach for total tumor excision Specimen Count And Types 1 piece About size:3x2x2 cm Source:Right foramen magnum tumor, suspect meningioma Pathology Pending Operative Findings The right vertebral artery passed the C1 via a foramen rather a groove. The venous plexus was enriched and easily touch bleeding. The tumor attachment was located at right foramen of Luschka with only small portion in the fourth ventricle. The tumor was well-capsulated, soft, hypervascularized, white-pinkish(choroid plexus-like), and 2.3 x 1.6 x 2.9cm in size. The tumor did not adhere to adjacent structure tightly. Some small calcification within the tumor was suspected grossly. The brainstem was pushed to left side by the tumor was decompressed well after total removal of the tumor. The right vertebral artery passed the C1 via a foramen rather a groove. The venous plexus was enriched and easily touch bleeding. The tumor attachment was located at right foramen of Luschka with only small portion in the fourth ventricle. The tumor was well-capsulated, soft, hypervascularized, white-pinkish(choroid plexus-like), and 2.3 x 1.6 x 2.9cm in size. The tumor did not adhere to adjacent structure tightly. Some small calcification within the tumor was suspected grossly. The brainstem was pushed to left side by the tumor was decompressed well after total removal of the tumor. No significant SSEP or MEP change noted during whole procedure except right BAEP flatening after craniectomy. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position head fixed with Mayfield skull clamp and rotated to left. The scalp was shaved, scrubbed, and disinfected as usual. Reverse U scalp incision was made at right suboccipital area. The scalp flap was elevated and the nuchal muscle were detached. The foramen magnum, right posterior arch of C1, and right vertebral artery were exposed. Right C1 hemilaminectomy and right suboccipital tear-drop shape craniotomy was performed with Midas air-drived drills. Curvilinear durotomy was performed and CSF was released from foramen magnum. The tumor was identified at the junction between brainstem and cerebellum. The cerebellum was retracted for better exposure of the tumor. Subcapsule decompression was done with bipolar electrocautery, suction, and tumor forceps. The tumor was dissected along the capsule. The tumor within fourth ventricle was removed via right foramen of Luschka. After total removal of the tumor, hemostasis was achieved with bipolar electrocautery and Surgicel lining. Dura was closed with 4-0 Prolene. The skull plate was fixed back with miniplates and screws. One subgaleal CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators Prof. 杜永光 Assistants R5 李振豪 R3 曾偉倫 Ri 許淑嫻 相關圖片 劉添妹 (F,1934/12/10,77y3m) 手術日期 2011/08/22 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Acoustic tumor 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 林哲光, 時間資訊 21:45 臨時手術NPO 07:45 報到 08:02 進入手術室 08:05 麻醉開始 08:30 誘導結束 08:50 抗生素給藥 09:35 手術開始 11:50 抗生素給藥 13:55 麻醉結束 13:55 手術結束 14:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Right retrosigmoid approach subtotal tumor ex... 開立醫師: 林哲光 開立時間: 2011/08/22 18:35 Pre-operative Diagnosis Right cerebellopontine tumor, acoustic neuroma Post-operative Diagnosis Right cerebellopontine tumor, acoustic neuroma Operative Method Right retrosigmoid approach subtotal tumor excision Specimen Count And Types 1 piece About size:multiple pieces Source:tumor Pathology Pending Operative Findings A 4.4cm sized, yellowish, soft, well-demarcated, cystic lesion was noted at right cerebellopontine angle with adherent to CN7 and compressing the CN5 to medial side. CN7 was checked with stimulator during the operation and function was preserved. Part of the tumor was left on the CN7-8 complex. Operative Procedures Under ETGA and 3/4 prone position and fixed with Mayfield head clamp, skin disinfected and drapped were performed as usual. A curvilinear skin incision was made and a fasica flap was excised for duroplasty. Four burr holes were then created and a craniotomy was then done to expose the S-T junction. A C-shaped dura opening was done. CSF drainage was done via cisterna Magnum and the brain retractor was applied on the cerebellum to expose the tumor well. Tumor excision was done with central debulking and part of the tumor was left on the CN7-8 complex and left untouched. Intraopeartive CN7 stimulation was done. Duroplasty was done and the skull bone was put back with miniplates fixation. The wound was then closed in layers after a subgaleal drain insertion. Operators 曾漢民 Assistants 林哲光, 蕭智陽 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Right retrosigmoid approach subtotal tumor ex... 開立醫師: 林哲光 開立時間: 2011/08/22 18:35 Pre-operative Diagnosis Right cerebellopontine tumor, acoustic neuroma Post-operative Diagnosis Right cerebellopontine tumor, acoustic neuroma Operative Method Right retrosigmoid approach subtotal tumor excision Specimen Count And Types 1 piece About size:multiple pieces Source:tumor Pathology Pending Operative Findings A 4.4cm sized, yellowish, soft, well-demarcated, cystic lesion was noted at right cerebellopontine angle with adherent to CN7 and compressing the CN5 to medial side. CN7 was checked with stimulator during the operation and function was preserved. Part of the tumor was left on the CN7-8 complex. Operative Procedures Under ETGA and 3/4 prone position and fixed with Mayfield head clamp, skin disinfected and drapped were performed as usual. A curvilinear skin incision was made and a fasica flap was excised for duroplasty. Four burr holes were then created and a craniotomy was then done to expose the S-T junction. A C-shaped dura opening was done. CSF drainage was done via cisterna Magnum and the brain retractor was applied on the cerebellum to expose the tumor well. Tumor excision was done with central debulking and part of the tumor was left on the CN7-8 complex and left untouched. Intraopeartive CN7 stimulation was done. Duroplasty was done and the skull bone was put back with miniplates fixation. The wound was then closed in layers after a subgaleal drain insertion. Operators 曾漢民 Assistants 林哲光, 蕭智陽 相關圖片 唐美蓉 (F,1951/01/01,61y2m) 手術日期 2011/08/22 手術主治醫師 戴浩志 手術區域 東址 009房 04號 診斷 Parkinsonism (F02.3) 器械術式 debriment +rotation Flap 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 顏玄, 時間資訊 17:10 進入手術室 17:15 麻醉開始 17:20 誘導結束 17:35 抗生素給藥 17:38 手術開始 18:45 手術結束 18:45 麻醉結束 18:56 送出病患 19:00 進入恢復室 22:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 皮腱膜移位術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Fascia and skin rotation flap and debridement 開立醫師: 顏玄 開立時間: 2011/08/22 19:11 Pre-operative Diagnosis Deep brain stimulation device related right head unhealing wound and left neck abscess Post-operative Diagnosis Deep brain stimulation device related right head unhealing wound and left neck abscess Operative Method Fascia and skin rotation flap and debridement Specimen Count And Types nil Pathology nil Operative Findings Exposured deep brain stimulation without fascia and skin covered on right parietal bone. There were two absecess on left neck. Operative Procedures Under ETGA, the patient was put in supine position. Local anathesia was performed. A linar excision was performed. The skin and the fascia was seperated. Frontalis fascia was used as rotator fascia to cover the DBS. The fascia was closed by 4-0 dexon. And skin incsion was closed by 4-0 nylon. The left neck abscess debridement was performed. Wet dressing was given. Operators VS戴浩志 Assistants R5游彥辰,R1顏玄,Int黃敬文 記錄__ 手術科部: 外科部 套用罐頭: Fascia and skin rotation flap and debridement 開立醫師: 顏玄 開立時間: 2011/08/23 18:46 Pre-operative Diagnosis Deep brain stimulation device related right head unhealing wound and left neck abscess Post-operative Diagnosis Deep brain stimulation device related right head unhealing wound and left neck abscess Operative Method Fascia and skin rotation flap and debridement Specimen Count And Types nil Pathology nil Operative Findings Exposured deep brain stimulation without fascia and skin covered on right parietal bone. There were two absecess on left neck. Operative Procedures Under ETGA, the patient was put in supine position. Local anathesia was performed. A linar excision was performed. The skin and the fascia was seperated. Frontalis fascia was used as rotator fascia to cover the DBS. The fascia was closed by 4-0 dexon. And skin incsion was closed by 4-0 nylon. The left neck abscess debridement was performed. Wet dressing was given. Operators VS戴浩志 Assistants R5游彥辰,R1顏玄,Int黃敬文 唐美蓉 (F,1951/01/01,61y2m) 手術日期 2011/08/22 手術主治醫師 戴浩志 手術區域 東址 009房 07號 診斷 Parkinsonism (F02.3) 器械術式 Debridment-- >10cm 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 顏玄, 時間資訊 22:25 進入手術室 22:32 麻醉開始 22:34 麻醉結束 22:35 手術開始 23:05 手術結束 23:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 深部傷口處理縫合擴創-小 1 0 R 摘要__ 手術科部: 外科部 套用罐頭: Debridement 開立醫師: 阮廷倫 開立時間: 2011/08/22 23:27 Pre-operative Diagnosis Right scalp hematoma Post-operative Diagnosis Right scalp hematoma Operative Method Debridement Specimen Count And Types nil Pathology nil Operative Findings Blood clots in right scalp space Operative Procedures Under local anathesia, the patient was put in supine position. Anti-septic preparation was done. 7 stitches was removed. Blood clots was removed. N/S irrigation and hemostasis was perfomred. A CWV drain was placed in front of the ear. Wound was closed by 4-0 nylon. Operators VS戴浩志 Assistants R5游彥辰,R1顏？玄 記錄__ 手術科部: 外科部 套用罐頭: Debridement 開立醫師: 顏玄 開立時間: 2011/08/23 18:53 Pre-operative Diagnosis Right scalp hematoma Post-operative Diagnosis Right scalp hematoma Operative Method Debridement Specimen Count And Types nil Pathology nil Operative Findings Blood clots in right scalp space Operative Procedures Under local anathesia, the patient was put in supine position. Anti-septic preparation was done. 7 stitches was removed. Blood clots was removed. N/S irrigation and hemostasis was perfomred. A CWV drain was placed in front of the ear. Wound was closed by 4-0 nylon. Operators VS戴浩志 Assistants R5游彥辰,R1顏？玄 官勝茂 (M,1947/02/18,65y0m) 手術日期 2011/08/22 手術主治醫師 蔡翊新 手術區域 東址 016房 03號 診斷 Subdural hemorrhage 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 4E 紀錄醫師 周聖哲, 時間資訊 10:30 臨時手術NPO 10:30 開始NPO 14:23 通知急診手術 14:45 進入手術室 14:50 麻醉開始 15:00 誘導結束 15:05 抗生素給藥 15:10 手術開始 15:50 開始輸血 16:20 手術結束 16:20 麻醉結束 16:28 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 急性硬腦膜下血腫清除術 1 1 R 手術 顱內壓視置入 1 2 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 蔡翊新 開立時間: 2011/08/22 16:20 Pre-operative Diagnosis Right F-T-P acute SDH and severe brain swelling. Post-operative Diagnosis Right F-T-P acute SDH and severe brain swelling, suspected aneurysm rupture. Operative Method Right F-T-P craniectomy for SDH evacuation, duroplasty and subdural ICP monitoring. Specimen Count And Types nil Pathology Nil. Operative Findings Right temporal muscle contusion was noted, but there was no skull fracture. ICP after first burr hole creation was 51 mmHg. The dura was very tense after craniectomy. SDH gushed out upon dural opening. The brain showed hyperemic change and bulged out rapidly. There was fresh blood gushing out from right Sylvian fissure, but the bleeder could not be approached due to severe brain swelling. The brain tissue ruptured during closure of scalp wound. ICP after skin closure was 60 mmHg, then dropped to 51 mmHg. Right temporal muscle contusion was noted, but there was no skull fracture. ICP after first burr hole creation was 51 mmHg. The dura was very tense after craniectomy. SDH gushed out upon dural opening. The brain showed hyperemic change and bulged out rapidly. There was fresh blood gushing out from right Sylvian fissure, but the bleeder could not be approached due to severe brain swelling. The brain tissue ruptured during closure of scalp wound. ICP after skin closure was 60 mmHg, then dropped to 51 mmHg. ICP monitor reference is 484. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 4 cm at anterior-lower temporal area, the skin edge was clipped by Raney clips for temporary hemostasis. The temporalis muscles was incised down to the tempoal squama which was exposed then by applying a self retaining retractor on the muscle. 5. A burr hole was made and the dura was incised for evacuating part of the subdural hematoma, therefore the IICP could be relieved earlier. 6. The incision was extended to a temporal horseshoe, and the temporalis muscle was excised to prevent further epidural compression. 7. Craniectomy window: 14 x 12 cm, right F-T-P, created by making 4 burr holes then cut by power saw. 8. Dural incision: curvilinear along the edge of skull window. 9. The subdural clot was removed by sucker. 10.Hemosatasis: the bleeders was stopped by Bovie and oozing surface was covered with gelfoam. 11.Dural closure: a piece of 12 x 10 cm Durofoam was used for duroplasty. 12.The skull plate was removed and stored at bone bank for preservation. 13.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 3/0 Dexon and skin by continuous suture with 3/0 nylon. 14.Drain: two epidural CWV. 15.Blood transfusion: PRBC 4U. Blood loss: 2000 ml. 16.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5曾峰毅R2周聖哲 Indication Of Emergent Operation Coma, pupil dilatation, severe brain swelling. 相關圖片 姚素貞 (F,1949/09/02,62y6m) 手術日期 2011/08/22 手術主治醫師 蔡翊新 手術區域 東址 005房 03號 診斷 Subdural hemorrhage following injury without mention of open intracranial wound,unspecified state of consciousness 器械術式 Burr hole (trephination) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 3E 紀錄醫師 李振豪, 時間資訊 12:00 臨時手術NPO 12:00 開始NPO 17:01 通知急診手術 19:05 進入手術室 19:15 麻醉開始 19:20 誘導結束 19:40 抗生素給藥 19:57 手術開始 20:40 麻醉結束 20:40 手術結束 20:53 送出病患 20:55 進入恢復室 22:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Left temporal burr hole for drainage of chron... 開立醫師: 蔡翊新 開立時間: 2011/08/22 20:28 Pre-operative Diagnosis Chronic subdural hematoma, left Post-operative Diagnosis Chronic subdural hematoma, left Operative Method Left temporal burr hole for drainage of chronic subdural hematoma Specimen Count And Types nil. Pathology Nil Operative Findings Dark reddish, liquified old blood gushed out slightly after opening the dura and outer membrane. The pressure was not high. Some fibrin debris were washed out from subdural space. A thin layer of inner membrane was seen. The brain remained slack after removal of the chronic SDH. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head rotated to right. The scalp was shaved, scrubbed, and disinfected as usual. One linear scalp incision was made at left frontal area followed by one burr hole creation. Two dural tentings were done. Cruciate durotomy was performed and the outer membrane was opened for evacuation of subdural hematoma. The edge of the outer membrane and durotomy was coagulated with bipolar electrocautery. The subdural space was irrigated with copious normal saline. One subdural rubber drain was placed. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS 蔡翊新 Assistants R5李振豪 Indication Of Emergent Operation 相關圖片 惲煒立 (M,1936/01/09,76y2m) 手術日期 2011/08/22 手術主治醫師 戴槐青 手術區域 東址 015房 02號 診斷 Bladder cancer 器械術式 Herniorrhaphy , Hydrocelectomy 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3 紀錄醫師 胡哲源, 時間資訊 00:00 臨時手術NPO 09:08 麻醉開始 09:09 進入手術室 09:10 誘導結束 09:20 抗生素給藥 09:28 手術開始 11:35 手術結束 11:35 麻醉結束 11:40 送出病患 11:45 進入恢復室 13:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 鼠蹊疝氣修補術-無腸切除 1 1 R 手術 碎石取出術,簡單(在膀胱內壓碎並除去)結石<1cm 1 2 R 記錄__ 手術科部: 泌尿部 套用罐頭: herniorrhaphy, inguinal 開立醫師: 胡哲源 開立時間: 2011/08/22 11:54 Pre-operative Diagnosis right side inguinal hernia Post-operative Diagnosis right side indirect inguinal hernia Operative Method 1. right herniorrhaphy and posterior repair with Mesh 2. cystolithotripsy Specimen Count And Types 1 piece About size:3*3cm Source:hernia sac Pathology pending Operative Findings 1. Sac from internal inguinal ring, indirect sac. 2. Posterior wall weakness. 3. two yellowish bladder stone at dome Operative Procedures 1. Under satisfactory spinal anesthesia with the patient in supine position. 2. Prepping and draping was performed in the usual sterile fashion. 3. An inguinal oblique incision was made in the right inguinal area. 4. The wound was deepened through layers into inguinal canal. 5. The spermatic cord was mobilized, and an indirect sac was noted. 6. The hernia sac was isolated from spermatic cord. 7. Ligation and transection of the hernia sac near the the internal inguinal ring was performed. 8. Posterior wall repair with interrupted 1-O surgilon was performed to approximate the conjoin ligment, transverse abdominal fascia and the shelfing portion of the inguinal ligament. (Mesh). 9. After adequate hemostasis was obtained, the wound was closed in layers with 1-O vicryl on the external oblique fascia and 2-O chromic on the Scarpas fascia. Skin was closed with interrupted 3-O nylon mattress stitches. 10.change the patient to the lithotomy position, skin preparation was performed. A 21Fr. Resectoscope was inserted under adequate lubrication. 11. Two yellowish bladder stones was noted at dome. The stones were then crushed by lithoclast. Finally, a Fr.22 3-way Foley catheter was placed. 12. The patient tolerated the procedure very well, and was sent to the recovery room insatisfactory condition. Operators 戴槐青, Assistants 胡哲源, 陳聖復, 王玉泉 (M,1941/09/24,70y5m) 手術日期 2011/08/23 手術主治醫師 周介仁 手術區域 東址 011房 02號 診斷 Cataract 器械術式 Corrective for ectropion 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鄭琪睿, 時間資訊 09:15 報到 09:35 進入手術室 09:40 麻醉開始 09:46 誘導結束 10:00 手術開始 10:30 手術結束 10:30 麻醉結束 10:45 送出病患 10:50 進入恢復室 11:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 眼瞼外翻矯正手術 1 1 L 記錄__ 手術科部: 眼科部 套用罐頭: Correction of entropion + lateral tarsal strip 開立醫師: 鄭琪睿 開立時間: 2011/08/23 10:35 Pre-operative Diagnosis Lid Ectropion (OS) Post-operative Diagnosis Lid Ectropion (OS) Operative Method Correction of ectropion: Medial spindle procedure + lateral tarsal strip (OS) Medial spindle procedure + lateral tarsal strip (OS) Specimen Count And Types Nil. Pathology Nil Operative Findings Ectropion (OS) Operative Procedures 1.Under endotracheal general anesthesia 2.Disinfection and draping 3.Make a spindle shape conjunctival excision lateral to lower punctum 4. Suture the conjunctival wound with 6-0 Vicryl 5.Make lateral canthotomy and inferior cantholysis 6.Eyelid is separated horizontally at the gray line intoanterior and posterior lamellae 7.Excise 2-3mm of tarsal strip 7.Excise 4-5 mmof tarsal strip 8.Lateral tarsal fixation with 4-0 Prolene 9.Skin edge re-approximate with 6-0 Vicryl 10. Left eye patching with Tetracycline ointment. Operators VS 周介仁, Assistants R3 鄭琪睿 張傅金蘭 (F,1951/06/09,60y9m) 手術日期 2011/08/23 手術主治醫師 賴達明 手術區域 東址 005房 02號 診斷 Cellulitis 器械術式 Debridment-- >10cm 手術類別 預定手術 手術部位 脊椎 傷口分類 髒 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 林哲光, 時間資訊 23:02 臨時手術NPO 10:45 進入手術室 10:50 麻醉開始 11:00 誘導結束 11:25 手術開始 12:27 12:41 手術結束 12:41 麻醉結束 12:50 送出病患 12:52 進入恢復室 14:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 深部傷口處理縫合擴創-大 1 0 摘要__ 手術科部: 外科部 套用罐頭: Wound debridement and primary closure 開立醫師: 林哲光 開立時間: 2011/08/23 13:07 Pre-operative Diagnosis Wound dehiscence of lumbar wound Post-operative Diagnosis Wound dehiscence of lumbar wound Operative Method Wound debridement and primary closure Specimen Count And Types nil Pathology Nil Operative Findings Paraspinal muscle and fasica seemed intact without obvious pus accumulation. Local skin necrosis was noted and subcutaneous fat tissue necrosis was also noted. Operative Procedures Under ETGA and prone position, skin disinfected and drapped were performed as usual. Skin incision was made along the previous wound and the subcutaneous area was exposed well. The fascia was palpated for any dehiscence or any fluid accumulation. Fusiform incision to remove the skin necrosis was done. The wound was then closed in layers and skin approximation with 3-0 Nylon interruptly. Operators 蕭輔仁 Assistants 林哲光, 王怡人 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Wound debridement and primary closure 開立醫師: 林哲光 開立時間: 2011/08/23 13:08 Pre-operative Diagnosis Wound dehiscence of lumbar wound Post-operative Diagnosis Wound dehiscence of lumbar wound Operative Method Wound debridement and primary closure Specimen Count And Types nil Pathology Nil Operative Findings Paraspinal muscle and fasica seemed intact without obvious pus accumulation. Local skin necrosis was noted and subcutaneous fat tissue necrosis was also noted. Operative Procedures Under ETGA and prone position, skin disinfected and drapped were performed as usual. Skin incision was made along the previous wound and the subcutaneous area was exposed well. The fascia was palpated for any dehiscence or any fluid accumulation. Fusiform incision to remove the skin necrosis was done. The wound was then closed in layers and skin approximation with 3-0 Nylon interruptly. Operators 蕭輔仁 Assistants 林哲光, 王怡人 相關圖片 王則興 (M,1941/10/23,70y4m) 手術日期 2011/08/23 手術主治醫師 林文瑛 手術區域 西址 035房 02號 診斷 Bronchus and lung cancer 器械術式 Port-A Implatation /WOR 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 林文瑛, 時間資訊 08:37 報到 09:12 進入手術室 09:13 麻醉開始 09:20 誘導結束 09:25 手術開始 09:45 手術結束 09:45 麻醉結束 09:55 送出病患 09:57 進入恢復室 11:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 port–A導管植入術–治療性導管植入術 1 0 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 記錄__ 手術科部: 麻醉部 套用罐頭: Port-A implantation, subclavian 開立醫師: 楊仁廷 開立時間: 2011/08/23 09:50 Pre-operative Diagnosis Bronchus and lung cancer Post-operative Diagnosis Bronchus and lung cancer Operative Method Port-A implantation, echo-guided Specimen Count And Types nil Pathology Nil Operative Findings 1.Site: right subclavian vein, with echo-guided procedure 2.Patent flow after implantation 3.Others: nil Operative Procedures 1.The patient was set on supine position and bilateral subclavian veins were checked by echo. 2.After IVGA and local anesthesia applied, transverse skin incision for 3cm was made at pre-cordial area. 3.Undermine the skin at the layer between subcutaneous tissue and deep fascia in lateral direction. 4.An IV catheter was inserted via the subclavian incision and negatively aspirated until venous blood attainable. 5.J-wire was inserted smoothly in rostral direction. A subclavian catheter with dilator was inserted through the J-wire, and the dilator was then removed. 6.The catheter of Port-A was threaded into the subclavian vein until mark 21 cm. The catheter was adapted into the port and locked with restrictor.The Port was inserted into the pouch of pre-cordial incision. 7.Skin was closed layer by layer. Both catheter and port were perfused with heparin solution after implantation. Operators 林文瑛 Assistants 楊仁廷, 李佳蓉 (F,1978/11/21,33y3m) 手術日期 2011/08/23 手術主治醫師 楊士弘 手術區域 東址 003房 01號 診斷 Spine tumor 器械術式 Tumor excision 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 周聖哲, 時間資訊 23:57 臨時手術NPO 08:00 進入手術室 08:05 麻醉開始 08:15 誘導結束 08:30 抗生素給藥 08:48 手術開始 10:08 手術結束 10:08 麻醉結束 10:15 送出病患 10:20 進入恢復室 11:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 軟組織良性腫瘤切除術,大或深 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 曾峰毅 開立時間: 2011/08/23 10:14 Pre-operative Diagnosis Soft tissue tumor, at paraspinal region, at T2-4 level Post-operative Diagnosis Hemangioma, at paraspinal region, at T2-4 level Operative Method Tumor excision Specimen Count And Types Two major parts of the tumor was sent for pathology. Pathology Pending Operative Findings Tortuous vascular lesion was noted at midline just above the T4 spinous process and beneath the subcutaneous fat, and was noted with vascular connection to another part of tumor at T3 level. The second part of tumor, which was characterized with tortuous vascular-like, was located between right trapezius and right rhomboid muscle. Abundant venous lake was noted at right T3 paraspinal muslce. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. The back was scrubbed, disinfected, and then draped as usual. We made one midline skin incision at T2-4 level, and dissected beneath subcutaneous fat, and above the fascia of trapezius. First part of tumor was identified at midline just above the T4 spinous process, and was removed en bloc. We traced the tumor upward, and dissected between right trapezius and right rhomboid muscle to identified the second part of tumor. The tumor was removed en bloc as well. We dissected right paraspinal muscle at T3 level, and venous bleeding was encounter, and was cauterized by bipolar for hemostasis. The wound was closed in layers. Operators VS 楊士弘 Assistants R5 曾峰毅 R2 周聖哲 Ri 連一潔 相關圖片 何秀霞 (F,1954/04/30,57y10m) 手術日期 2011/08/23 手術主治醫師 林峰盛 手術區域 西址 035房 05號 診斷 Ankylosing spondylitis 器械術式 Nerve block / PC 手術類別 臨時手術 手術部位 四肢 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 楊仁廷, 時間資訊 12:55 進入手術室 13:20 麻醉開始 13:22 手術開始 13:30 手術結束 13:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 末稍神經阻斷術 1 0 R 記錄__ 手術科部: 麻醉部 套用罐頭: terminal nerve block 開立醫師: 林文瑛 開立時間: 2011/08/23 13:40 Pre-operative Diagnosis Sciatica Post-operative Diagnosis Sciatica Operative Method terminal nerve block Specimen Count And Types nil Pathology Nil Operative Findings nil Operative Procedures 1.pt in prone position 2. Under sonography-guidance, sciatic nerve block was done by injecting 1% xylocaine 20 ml to the sciatic nerve and 10 ml to the right lateral hip tender point. 3. Check vital sign and send p't to POR Operators 林峰盛 Assistants 楊仁廷 羅台清 (M,1958/04/04,53y11m) 手術日期 2011/08/23 手術主治醫師 王國川 手術區域 東址 001房 04號 診斷 Disseminated malignant neoplasm 器械術式 Burr hole (trephination) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 3E 紀錄醫師 周聖哲, 時間資訊 00:41 開始NPO 00:41 臨時手術NPO 00:41 通知急診手術 01:45 報到 01:55 進入手術室 01:58 麻醉開始 02:35 誘導結束 02:48 手術開始 03:13 開始輸血 03:35 麻醉結束 03:35 手術結束 03:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 2 B 手術 慢性硬腦膜下血腫清除術 1 1 B 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 腫瘤醫學部 套用罐頭: Bilateral burr hole for drainage of subdural ... 開立醫師: 李振豪 開立時間: 2011/08/23 04:16 Pre-operative Diagnosis Bilateral chronic subdural hematoma, suspect coagulopathy or cancer related Post-operative Diagnosis Bilateral chronic subdural hematoma, suspect coagulopathy or cancer related Operative Method Bilateral burr hole for drainage of subdural collection Specimen Count And Types 2 pieces About size:0.3 x 0.3cm Source:Dura About size:5ml Source:Subdural collection for cytology Pathology Pending Operative Findings Both outer and inner membrane was noted bilaterally. The opening pressure over left subdural space was not high. The subdural collection was xanthochronic with some reddish sediment. Hypercellularity appearance was noted at left side subdural collection. Cancer-related subdural hematoma was highly suspected. One small piece of dura and subdural collection was sampled for pathology and cytology. The brain expanded after evacuation of the subdural collection. Bleeding tendancy(+). Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position. The scalp was shaved, scrubbed, and disinfected as usual. Bilateral temporal linear scalp incision was made followed by one burr hole creation in each side. Two dural tenting was done. One small piece of dura was sampled for pathology. After durotomy, the outer membrane of the subdural collection was opened and external ventricular catheter was placed into subdural space for drainage. The subdural space was irrigated with normal saline solution. Externalization of the subdural drain was done. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. The wound was closed with 1-0 Vicryl and 3-0 Nylon. Deair was conducted again after wound closure. Operators VS王國川 Assistants R5李振豪, R2周聖哲 Indication Of Emergent Operation Acute conscious disturbance 相關圖片 何鋒明 (M,1950/05/14,61y10m) 手術日期 2011/08/23 手術主治醫師 王國川 手術區域 東址 005房 01號 診斷 Intracerebral hemorrhage (ICH) 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 林哲光, 時間資訊 23:01 臨時手術NPO 08:02 進入手術室 08:05 麻醉開始 08:25 誘導結束 09:15 手術開始 10:00 手術結束 10:00 麻醉結束 10:15 送出病患 10:20 進入恢復室 11:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Revision of V-P shunt, Left Kocher point prog... 開立醫師: 林哲光 開立時間: 2011/08/23 10:30 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Revision of V-P shunt, Left Kocher point programmable V-P shunt insertion Specimen Count And Types nil Pathology Nil Operative Findings Pre-operative trachestomy changing to low pressure type was done, 6#, and it was changed back to Shelly after the operation. Previous burr hole type Medtronic valve was inserted. The abdominal catheter was checked functionally during the operation with N/S infusion. Intraventricular catheter was 7cm long and the valve was set 100mmH2O. CSF seemed clear and transparent. No gush of CSF was noted after valve removal. Operative Procedures Under ETGA and supine position with head rotated to right side, skin disinfected and drapped were performed as usual. Skin incision was made at previous operative wound until the valve was well-exposed. Another skin incision was made at right posteiror auricle area and the catheter was divided and connected to the Codman programmable valve through subcutaneous tunnel. The ventricular catheter was inserted along the previous trajectory to lateral horn. The wound was then closed in layers after a Gelfoam packing. Operators 王國川 Assistants 林哲光, 王怡人 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Revision of V-P shunt, Left Kocher point prog... 開立醫師: 林哲光 開立時間: 2011/08/23 10:30 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Revision of V-P shunt, Left Kocher point programmable V-P shunt insertion Specimen Count And Types nil Pathology Nil Operative Findings Pre-operative trachestomy changing to low pressure type was done, 6#, and it was changed back to Shelly after the operation. Previous burr hole type Medtronic valve was inserted. The abdominal catheter was checked functionally during the operation with N/S infusion. Intraventricular catheter was 7cm long and the valve was set 100mmH2O. CSF seemed clear and transparent. No gush of CSF was noted after valve removal. Operative Procedures Under ETGA and supine position with head rotated to right side, skin disinfected and drapped were performed as usual. Skin incision was made at previous operative wound until the valve was well-exposed. Another skin incision was made at right posteiror auricle area and the catheter was divided and connected to the Codman programmable valve through subcutaneous tunnel. The ventricular catheter was inserted along the previous trajectory to lateral horn. The wound was then closed in layers after a Gelfoam packing. Operators 王國川 Assistants 林哲光, 王怡人 相關圖片 楊美香 (F,1959/09/25,52y5m) 手術日期 2011/08/23 手術主治醫師 蔡翊新 手術區域 東址 003房 03號 診斷 Subarachnoid hemorrhage 器械術式 Craniotomy(Aneurysms) left 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3E 紀錄醫師 韋凌亦, 時間資訊 08:00 臨時手術NPO 08:00 開始NPO 16:00 通知急診手術 17:55 進入手術室 18:10 麻醉開始 18:30 誘導結束 18:50 抗生素給藥 18:50 手術開始 22:05 抗生素給藥 00:50 開始輸血 01:05 抗生素給藥 02:05 手術結束 02:05 麻醉結束 02:12 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 8 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 手術 開顱術摘除血管病變 - 腦血管瘤 有病徵的 1 1 L 手術 顱內壓視置入 1 2 L 記錄__ 手術科部: 外科部 套用罐頭: Aneurysm-frontotemporal approach 開立醫師: 蔡翊新 開立時間: 2011/08/24 00:51 Pre-operative Diagnosis Left p-com artery and anterior choroidal artery aneurysms rupture with SAH and hydrocephalus. Post-operative Diagnosis Left p-com artery and anterior choroidal artery aneurysms rupture with SAH and hydrocephalus. Operative Method Left pterional craniotomy for aneurysms clipping and left Kocher EVD for ICP monitoring. Specimen Count And Types nil Pathology Nil. Operative Findings CSF was clean and initial pressure was about 5~6 cmH2O. Blood clots and fibrin adhesion were noted at subarachnoid space of left Sylvian fissure and prechiasmatic cistern. The left ICA showed atherosclerotic change. A saccular aneurysm was noted at left ICA and p-com artery junction, pointing posteriorly and adhering to dura overlying the skull base, with its neck about 4 mm in width. It was clipped by a 10-mm straight Sugita clip. Another saccular aneurysm was noted arising from the junction of left ICA and anterior choroidal artery, pointing laterally and adhering to left temporal lobe, with its neck about 4 mm in width. It was clipped by a 7-mm byonet-shaped Sugita clip. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right for 40 degree and slightly extended then fixed by Mayfield skull clamp. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: left frontotemporal, curvilinear. The skin edge was clipped by Raney clips for temporary hemostasis. After scalp had been lifted, the temporalis muscle was incised and detached from temporal squama and reflected to lower temporal side. 5. A burr hole was made at left Kocher point for EVD insertion for CSF release and ICP monitor. 6. Craniotomy window: 10 x 6 cm, left frontotemporal, created by making 3 burr holes then cut by power saw. The lower temporalbone and pterionic ridge (esp.the inner table) were cut by rongeur and airdrill as low as possible for easy approach to the anterior clinoid. 7. Dural tention: by 2/0 silk, 2-cm in interval, distributed along the edge of skull window. 8. Dural incision: V shape, over-ridding Sylvian fissure and reflected to frontotemporal base. 9. Under operating microscope, the Sylvian fissure was opened, then the frontal operculum was retracted by self-retaining retractor. The suprasellar cistern was opened, the left optic nerve and ICA came into view. The arachnoid trabeculi and the fibrin (or blood clot) were cleaned out to expose the necks of the aneurysms, which were mobilized gently by a Gage 18 sucker and a fine tip bipolar forceps until it was entirely free. 10.A 10-mm straight Sugita clip was applied to the neck of the p-com artery aneurysm, and a 7-mm bayonet-shaped Sugita clip was applied to the neck of the anterior choroidal artery aneurysm. 11.The brain retractor was removed. The dura was closed water-tight by running suture with 4/0 Prolene. 12.Closure of skull window: the skull plate was placed back to craniotomy window and fixed by 3 miniplates and 6 screws. The dura was tented to the center of the skull plate by several 2/0 stitches. The covering muscle was closed by interrupted stitches with 1/ 0 silk. 13.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 14.Drain: one, epidural, CWV. 15.Blood transfusion: PRBC 2U. Blood loss: 500 ml. 16.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5林哲光R1韋凌亦 Indication Of Emergent Operation Aneurysm rupture, to prevent rebleeding 相關圖片 廖永盛 (M,1955/02/07,57y1m) 手術日期 2011/08/23 手術主治醫師 蔡翊新 手術區域 西址 034房 01號 診斷 Back atheroma 器械術式 Scalp tumor 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 09:25 進入手術室 09:33 麻醉開始 09:35 手術開始 10:10 手術結束 10:10 麻醉結束 10:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 皮下腫瘤摘除術大於 4CM 1 1 記錄__ 手術科部: 外科部 套用罐頭: Tumor excision 開立醫師: 蔡翊新 開立時間: 2011/08/23 10:06 Pre-operative Diagnosis Mid upper back subcutaneous tumor, suspected atheroma Post-operative Diagnosis Mid upper back subcutaneous tumor, suspected atheroma Operative Method Tumor excision Specimen Count And Types 1 piece About size:5*4*3cm Source:mid-upper back tumor Pathology Pending Operative Findings A 5 x 4 x 3 cm cystic tumor, with cheese-like, greyish content, at subcutaneous layer of midline upper back. Operative Procedures The patient was placed in prone position. After palpation of the tumor, the skin was disinfected and draped in usual sterile fashion. After local infiltration of lidocaine for anesthesia, a fusiform incision was made around the tumor. The tumor was then carefully dissected around its border and removed en bloc. After hemostasis, the wound was closed. Operators VS 蔡翊新 Assistants R4 王奐之 相關圖片 陳文英 (F,1953/10/30,58y4m) 手術日期 2011/08/24 手術主治醫師 杜永光 手術區域 東址 005房 02號 診斷 Meningioma 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 林哲光, 時間資訊 23:07 臨時手術NPO 11:00 進入手術室 11:00 抗生素給藥 11:02 麻醉開始 11:05 誘導結束 11:25 手術開始 11:50 手術結束 11:50 麻醉結束 11:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 氣管切開術 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 內科部 套用罐頭: Tracheostomy 開立醫師: 林哲光 開立時間: 2011/08/24 12:05 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types nil Pathology None Operative Findings Fr . 7 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators 杜永光 Assistants 林哲光, 蕭智陽, 陳乃綺 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 林哲光 開立時間: 2011/08/24 12:05 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types nil Pathology None Operative Findings Fr . 7 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators 杜永光 Assistants 林哲光, 蕭智陽, 陳乃綺 相關圖片 林慶堂 (M,1959/10/29,52y4m) 手術日期 2011/08/24 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Brain Tumor 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 2 紀錄醫師 曾偉倫, 時間資訊 23:05 臨時手術NPO 08:00 進入手術室 08:05 麻醉開始 08:50 誘導結束 09:00 抗生素給藥 09:13 手術開始 12:00 抗生素給藥 14:10 手術結束 14:10 麻醉結束 14:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Right retrosigmoid approach for tumor biopsy 開立醫師: 曾峰毅 開立時間: 2011/08/24 13:56 Pre-operative Diagnosis Right brian stem lesion with extension to cerebellum, suspect glioma Post-operative Diagnosis Right brian stem lesion with extension to cerebellum, suspect glioma Operative Method Right retrosigmoid approach for tumor biopsy Specimen Count And Types 1 piece About size:1x1x1 cm Source:Right cerebellar-pontine junction tumor Pathology Frozen: normal cerebellar tissue Operative Findings Whitish, normal vascularized, ill-defined lesion was noted at rigth middle cerebellar peduncle, just above and lateral to the exit zone of facial nerve. There was no interval change of SSEP and BAEP. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with right shoulder elevated, and head rotated to left. The retroauricular area was shaved, scrubbed, disinfected, and then draped as usual. We made one curvlinear skin incision at right retroauricular area, about 4 cm posterior to right external auditory canal. We harvested pericranium for autologous fascia graft. We drilled first burr hole at right asterion, and created craniotomy. We extended the craniotomy to the posterior edege of sigmoid sinus, and inferior edge of transverse sinus. Dura was incised in E-shape, and cerebellum was retracted posteriorly. CSF was drained from cistern, and tumor biopsy was performed. Frozen biopsy was sent, but the results were normal cerebellum parenchyma. We closed the dura in water-tight fashion with autologous fascia graft. Bone graft was fixed back with mini-plate, and the wound was closed in layers. Operators Prof. 杜永光 Assistants R5 曾峰毅 R3 曾偉倫 Ri 許淑嫻 相關圖片 張木榮 (M,1966/02/15,46y0m) 手術日期 2011/08/24 手術主治醫師 蔡瑞章 手術區域 東址 005房 01號 診斷 Scalp tumor 器械術式 Scalp tumor excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 1 紀錄醫師 林哲光, 時間資訊 23:15 臨時手術NPO 08:02 進入手術室 08:15 麻醉開始 08:20 誘導結束 08:40 抗生素給藥 09:08 手術開始 10:23 手術結束 10:23 麻醉結束 10:30 送出病患 10:35 進入恢復室 11:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 皮下腫瘤摘除術大於 4CM 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Nearly total tumor excision 開立醫師: 林哲光 開立時間: 2011/08/24 10:16 Pre-operative Diagnosis Left scalp mass, at left mastoid process Post-operative Diagnosis Left scalp mass, at left mastoid process, lipoma Operative Method Nearly total tumor excision Specimen Count And Types 1 piece About size:4cm sized Source:subcutaneous mass Pathology Pending Operative Findings A 4cm sized yellowish, not well demarcated, soft-elastic, mass lesion was noted at subcutaneous area without fascia layer invasion. Part of tumor was left at the lateral border of the tumor. Operative Procedures Under ETGA and prone position, skin disinfected and drapped were performed as usual. A linear skin incision was done inside the hairline. Blunt dissection along the plane between tumor and subcutaneous tissue was done and tumor excision was done in Enbloc way. Hemostasis was done and the wound was then closed in layers after N/S irrigation. Operators 蔡瑞章 Assistants 林哲光, 蕭智陽, 陳乃綺 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Nearly total tumor excision 開立醫師: 林哲光 開立時間: 2011/08/24 10:16 Pre-operative Diagnosis Left scalp mass, at left mastoid process Post-operative Diagnosis Left scalp mass, at left mastoid process, lipoma Operative Method Nearly total tumor excision Specimen Count And Types 1 piece About size:4cm sized Source:subcutaneous mass Pathology Pending Operative Findings A 4cm sized yellowish, not well demarcated, soft-elastic, mass lesion was noted at subcutaneous area without fascia layer invasion. Part of tumor was left at the lateral border of the tumor. Operative Procedures Under ETGA and prone position, skin disinfected and drapped were performed as usual. A linear skin incision was done inside the hairline. Blunt dissection along the plane between tumor and subcutaneous tissue was done and tumor excision was done in Enbloc way. Hemostasis was done and the wound was then closed in layers after N/S irrigation. Operators 蔡瑞章 Assistants 林哲光, 蕭智陽, 陳乃綺 相關圖片 曾國烈 (M,1950/07/07,61y8m) 手術日期 2011/08/24 手術主治醫師 王國川 手術區域 東址 005房 04號 診斷 Brain tumor 器械術式 Craniotomy for brain abscess drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 3E 紀錄醫師 曾峰毅, 時間資訊 15:00 臨時手術NPO 15:00 開始NPO 18:32 通知急診手術 19:40 報到 20:00 進入手術室 20:05 麻醉開始 20:30 誘導結束 20:36 抗生素給藥 21:15 手術開始 23:40 麻醉結束 23:40 手術結束 23:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除-手術時間在4小時以內 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Right parietal craniotomy for abscess drainage 開立醫師: 曾峰毅 開立時間: 2011/08/25 00:00 Pre-operative Diagnosis Right parietal lobe abscess Post-operative Diagnosis Right parietal lobe abscess Operative Method Right parietal craniotomy for abscess drainage Specimen Count And Types Pus was sent for cultures. Pathology Nil Operative Findings One 4x4x4 cm cystic lesion was located at subcortical area of right parietal lobe. Purulent fluid gushed out while corticotomy. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to left and fixed with Mayfield head clamp. We shaved, scrubbed, disinfected, and then draped the scalp, and made one U-shape scalp incision at right parietal area. We created 6x6 cm craniotomy window after four burr holes, and dura was incised in C-shape. Corticotomy was done under C-arm guidance, and abscess was drained. Hemostasis was done, and one drianage catheter was placed in the abscess cavity. Dura was closed in water-tight closure with one vascularized fascia. Bone graft was fixed back with mini-plates, and the wound was closed in layers with one subgaleal CWV. Operators VS 王國川 Assistants R5 曾峰毅 Ri 許淑嫻 Indication Of Emergent Operation 相關圖片 林清秀 (M,1951/07/27,60y7m) 手術日期 2011/08/24 手術主治醫師 廖漢文 手術區域 東址 000房 號 診斷 Cerebral aneurysm 器械術式 Right ACA aneurysm for TAE 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林珍榮 ASA 3 時間資訊 16:36 通知急診手術 23:59 開始NPO 23:59 臨時手術NPO 12:25 麻醉開始 12:40 誘導結束 14:20 麻醉結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 陳明鑑 (M,1956/01/06,56y2m) 手術日期 2011/08/24 手術主治醫師 廖漢文 手術區域 東址 000房 號 診斷 Cerebral aneurysm 器械術式 ACom aneurysm TAE 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林珍榮 ASA 3 時間資訊 16:35 通知急診手術 23:59 開始NPO 23:59 臨時手術NPO 10:45 麻醉開始 10:50 誘導結束 11:35 麻醉結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 陳哲雄 (M,1962/02/20,50y0m) 手術日期 2011/08/25 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Malignant neoplasm of temporal lobe 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 王奐之, 時間資訊 23:10 臨時手術NPO 08:55 進入手術室 08:58 麻醉開始 09:45 誘導結束 09:50 抗生素給藥 09:55 手術開始 12:50 抗生素給藥 14:20 手術結束 14:20 麻醉結束 14:25 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 手術 腦瘤切除-手術時間在4~8小時 1 1 L 手術 超音波診查機–腦神經外科術中特殊儀器使用費 1 0 L 手術 誘發電位手術監視機–腦神經外科術中特殊儀器使用費 1 0 L 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 L 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 摘要__ 手術科部: 外科部 套用罐頭: Left temporal craniotomy for tumor resection ... 開立醫師: 王奐之 開立時間: 2011/08/25 14:49 Pre-operative Diagnosis Left temporal anaplastic astrocytoma status post tumor resection, with recurrence Post-operative Diagnosis Left temporal anaplastic astrocytoma status post tumor resection, with recurrence Operative Method Left temporal craniotomy for tumor resection under intra-operative navigation Specimen Count And Types 1 piece About size:pieces Source:left temporal tumor Pathology Pending. Frozen section: low cellularity tissue, not diagnostic for glioma. Operative Findings Cystic portion of tumor was located at anterior temporal area. The anterior temporal part of the tumor was indistinct under ultrasound and not typical in appearance, necrotic change was noted, and frozen section reported low cellularity tissue, not diagnostic for glioma. The other portion of tumor at posterior portion of the medial temporal was also removed, which was whitish & elastic-firm. After tumor resection, the temporal horn was opened, and later packed with Gelfoam to prevent direct contact of CSF space with Gliadel wafers. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to right and fixed in Mayfield skull clamp. Navigation system was then set. After scrubbing, disinfection & draping in sterile fashion, a question mark incision along previous scar was made. After reflecting the skin flap anteroinferiorly, burr holes were drilled again along previous burr holes. The bone flap was then removed. Tumor location was then confirmed with navigation system & intra-operative ultrasound. A small durotomy was performed at temporal area under microscopic view. Tumor resection was then performed in piecemeal fashion by tumor forceps & suction. After confirming completion of tumor resection with navigation, tumor bed hemostasis was achieved and packed with Gelfoam. Eight Gliadel wafer was applied to the tumor cavity. The dura was then closed with Surgisis dural graft in water-tight fashion. After 6 central tenting stitches, the bone was fixed back with mini-plates. The wound was closed in layers after placement of 1 subgaleal CWV drain. Operators VS 王國川 Assistants R4 王奐之, R1 吳欣翰 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Left temporal craniotomy for tumor resection ... 開立醫師: 王奐之 開立時間: 2011/08/25 14:49 Pre-operative Diagnosis Left temporal anaplastic astrocytoma status post tumor resection, with recurrence Post-operative Diagnosis Left temporal anaplastic astrocytoma status post tumor resection, with recurrence Operative Method Left temporal craniotomy for tumor resection under intra-operative navigation Specimen Count And Types 1 piece About size:pieces Source:left temporal tumor Pathology Pending. Frozen section: low cellularity tissue, not diagnostic for glioma. Operative Findings Cystic portion of tumor was located at anterior temporal area. The anterior temporal part of the tumor was indistinct under ultrasound and not typical in appearance, necrotic change was noted, and frozen section reported low cellularity tissue, not diagnostic for glioma. The other portion of tumor at posterior portion of the medial temporal was also removed, which was whitish & elastic-firm. After tumor resection, the temporal horn was opened, and later packed with Gelfoam to prevent direct contact of CSF space with Gliadel wafers. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to right and fixed in Mayfield skull clamp. Navigation system was then set. After scrubbing, disinfection & draping in sterile fashion, a question mark incision along previous scar was made. After reflecting the skin flap anteroinferiorly, burr holes were drilled again along previous burr holes. The bone flap was then removed. Tumor location was then confirmed with navigation system & intra-operative ultrasound. A small durotomy was performed at temporal area under microscopic view. Tumor resection was then performed in piecemeal fashion by tumor forceps & suction. After confirming completion of tumor resection with navigation, tumor bed hemostasis was achieved and packed with Gelfoam. Eight Gliadel wafer was applied to the tumor cavity. The dura was then closed with Surgisis dural graft in water-tight fashion. After 6 central tenting stitches, the bone was fixed back with mini-plates. The wound was closed in layers after placement of 1 subgaleal CWV drain. Operators VS 王國川 Assistants R4 王奐之, R1 吳欣翰 相關圖片 黃久珊 (F,1978/07/23,33y7m) 手術日期 2011/08/25 手術主治醫師 王國川 手術區域 東址 005房 04號 診斷 Glioma 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 王奐之, 時間資訊 23:09 臨時手術NPO 13:47 進入手術室 13:50 麻醉開始 14:15 誘導結束 14:30 抗生素給藥 14:50 手術開始 17:35 抗生素給藥 18:35 手術結束 18:35 麻醉結束 18:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除-手術時間在4小時以內 1 1 L 手術 超音波診查機–腦神經外科術中特殊儀器使用費 1 0 L 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 摘要__ 手術科部: 外科部 套用罐頭: Left frontal craniotomy for tumor resection u... 開立醫師: 王奐之 開立時間: 2011/08/25 19:41 Pre-operative Diagnosis Left frontal anaplastic astrocytoma status post tumor resection, with suspected recurrence Post-operative Diagnosis Left frontal anaplastic astrocytoma status post tumor resection, with suspected recurrence Operative Method Left frontal craniotomy for tumor resection under intra-operative navigation Specimen Count And Types 1 piece About size:pieces Source:left frontal tumor Pathology Pending. Frozen section: anaplastic astrocytoma. Operative Findings Some gliotic change of brain tissue was noted along previous resection margin, which was sent for frozen section and reported anaplastic astrocytoma. More tissue was obtained but grossly they did not exhibit tumor-like appearance even though signal change was noted on the contrast T1 MR image. The left frontal horn was not entered after tumor resection. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position and head fixed in Mayfield skull clamp. After shaving, scrubbing, disinfection & draping in sterile fashion, a bicoronal incision was made along previous wound scar. Left frontal bone flap was removed after removing the mini-plates. After localizing the tumor location under intra-operative navigation, durotomy was done, followed by tumor resection in piecemeal fashion. After tumor removal and meticulous hemostasis, the dura was closed with Surgisis dural graft in water-tight fashion. After 4 central tenting stitches, the bone flap was fixed back with mini-plates. The wound was closed in layers after setting 1 subgaleal CWV drain. Operators VS 王國川 Assistants R4 王奐之, R1 吳欣翰 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Left frontal craniotomy for tumor resection u... 開立醫師: 王奐之 開立時間: 2011/08/25 19:41 Pre-operative Diagnosis Left frontal anaplastic astrocytoma status post tumor resection, with suspected recurrence Post-operative Diagnosis Left frontal anaplastic astrocytoma status post tumor resection, with suspected recurrence Operative Method Left frontal craniotomy for tumor resection under intra-operative navigation Specimen Count And Types 1 piece About size:pieces Source:left frontal tumor Pathology Pending. Frozen section: anaplastic astrocytoma. Operative Findings Some gliotic change of brain tissue was noted along previous resection margin, which was sent for frozen section and reported anaplastic astrocytoma. More tissue was obtained but grossly they did not exhibit tumor-like appearance even though signal change was noted on the contrast T1 MR image. The left frontal horn was not entered after tumor resection. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position and head fixed in Mayfield skull clamp. After shaving, scrubbing, disinfection & draping in sterile fashion, a bicoronal incision was made along previous wound scar. Left frontal bone flap was removed after removing the mini-plates. After localizing the tumor location under intra-operative navigation, durotomy was done, followed by tumor resection in piecemeal fashion. After tumor removal and meticulous hemostasis, the dura was closed with Surgisis dural graft in water-tight fashion. After 4 central tenting stitches, the bone flap was fixed back with mini-plates. The wound was closed in layers after setting 1 subgaleal CWV drain. Operators VS 王國川 Assistants R4 王奐之, R1 吳欣翰 相關圖片 黃宥霖 (F,1962/08/26,49y6m) 手術日期 2011/08/25 手術主治醫師 廖漢文 手術區域 東址 000房 號 診斷 Arteriovenous malformation 器械術式 Right parietal AVM for TAE. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 2 時間資訊 23:59 臨時手術NPO 08:35 麻醉開始 09:00 誘導結束 11:30 麻醉結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 呂雪 (F,1946/05/04,65y10m) 手術日期 2011/08/26 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Acoustic tumor 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 林哲光, 時間資訊 23:58 臨時手術NPO 08:05 進入手術室 08:10 麻醉開始 08:50 誘導結束 09:10 抗生素給藥 09:20 手術開始 10:37 開始輸血 12:00 抗生素給藥 15:15 手術結束 15:15 麻醉結束 15:25 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 顱底瘤手術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Right retrosigmoid approach nearly total tumo... 開立醫師: 林哲光 開立時間: 2011/08/26 16:24 Pre-operative Diagnosis Right cerebellopontine angle tumor, suspected acoustic neuroma Post-operative Diagnosis Right cerebellopontine angle tumor, suspected acoustic neuroma Operative Method Right retrosigmoid approach nearly total tumor excision Specimen Count And Types 1 piece About size:multiple pieces Source:tumor Pathology Pending Operative Findings A 5.7cm sized, yellowish, well-demarcated, soft-elastic mass lesion was noted at right C-P angle with directly compressing the CN7-8 complex, low cranial nerves tightly. CN7 was identified during the operation and stimulation at proximal site revealed intact. The tumor was nearly total removed and only part of the tumor was left on the CN7-8 complex. Operative Procedures Under ETGA and 3/4 prone position, skin disinfected and drapped were performed as usual. Hockey-stick skin incision was made at right neck including the midline and mastoid process. The craniotomy was then performed until the T-S junction was exposed. Dura was then opened in C-shaped and CSF drainage via cisterna magnum. Brain retractor was applied and tumor excision was done with central debulking. Intraoperative facial nerve stimulation was done. Hemostasis with surgecell packing was done and the dura was closed in water-tie method. The skull bone was put back and fixed with miniplates. The wound was then closed in layers after a subgaleal drain insertion. Operators 曾漢民 Assistants 林哲光, 蕭智陽, 陳乃綺 相關圖片 摘要__ 手術科部: 外科部 套用罐頭: Right retrosigmoid approach nearly total tumo... 開立醫師: 林哲光 開立時間: 2011/08/26 16:24 Pre-operative Diagnosis Right cerebellopontine angle tumor, suspected acoustic neuroma Post-operative Diagnosis Right cerebellopontine angle tumor, suspected acoustic neuroma Operative Method Right retrosigmoid approach nearly total tumor excision Specimen Count And Types 1 piece About size:multiple pieces Source:tumor Pathology Pending Operative Findings A 5.7cm sized, yellowish, well-demarcated, soft-elastic mass lesion was noted at right C-P angle with directly compressing the CN7-8 complex, low cranial nerves tightly. CN7 was identified during the operation and stimulation at proximal site revealed intact. The tumor was nearly total removed and only part of the tumor was left on the CN7-8 complex. Operative Procedures Under ETGA and 3/4 prone position, skin disinfected and drapped were performed as usual. Hockey-stick skin incision was made at right neck including the midline and mastoid process. The craniotomy was then performed until the T-S junction was exposed. Dura was then opened in C-shaped and CSF drainage via cisterna magnum. Brain retractor was applied and tumor excision was done with central debulking. Intraoperative facial nerve stimulation was done. Hemostasis with surgecell packing was done and the dura was closed in water-tie method. The skull bone was put back and fixed with miniplates. The wound was then closed in layers after a subgaleal drain insertion. Operators 曾漢民 Assistants 林哲光, 蕭智陽, 陳乃綺 相關圖片 林玲珍 (F,1951/02/28,61y0m) 手術日期 2011/08/26 手術主治醫師 蔡瑞章 手術區域 東址 009房 05號 診斷 Meningitis due to Gram-negative bacteria 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 4 紀錄醫師 王奐之, 時間資訊 23:13 臨時手術NPO 15:23 進入手術室 15:25 麻醉開始 15:30 誘導結束 15:50 手術開始 16:25 手術結束 16:25 麻醉結束 16:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 氣管切開術 1 0 摘要__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 王奐之 開立時間: 2011/08/26 16:48 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types Nil Pathology Nil Operative Findings A Fr.7 low-pressure tracheostomy tube was inserted into the trachea through the 2nd-3rd tracheal cartilage. Operative Procedures After ETGA, the patient was placed in supine position with neck hyperextended. A 1cm midline skin incision was made 2 finger breadth above the sternal notch, the incision was further deepened through dissection. After exposing the 2nd and 3rd tracheal rings, a round trachea opening was made by scalpal. The low-pressure tracheostomy tube was then inserted into the trachea. After confirmation of ventilation, the endotracheal tube was removed and the tracheostomy wound was approximated with 3-0 Nylon sutures. Operators P.蔡瑞章 Assistants R4 王奐之, PGY 王怡人 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 王奐之 開立時間: 2011/08/26 16:48 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types Nil Pathology Nil Operative Findings A Fr.7 low-pressure tracheostomy tube was inserted into the trachea through the 2nd-3rd tracheal cartilage. Operative Procedures After ETGA, the patient was placed in supine position with neck hyperextended. A 1cm midline skin incision was made 2 finger breadth above the sternal notch, the incision was further deepened through dissection. After exposing the 2nd and 3rd tracheal rings, a round trachea opening was made by scalpal. The low-pressure tracheostomy tube was then inserted into the trachea. After confirmation of ventilation, the endotracheal tube was removed and the tracheostomy wound was approximated with 3-0 Nylon sutures. Operators P.蔡瑞章 Assistants R4 王奐之, PGY 王怡人 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 蔡瑞章 開立時間: 2011/08/27 08:58 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types Nil Pathology Nil Operative Findings A Fr.7 low-pressure tracheostomy tube was inserted into the trachea through the 2nd-3rd tracheal cartilage. Operative Procedures After ETGA, the patient was placed in supine position with neck hyperextended. A 1cm midline skin incision was made 2 finger breadth above the sternal notch, the incision was further deepened through dissection. After exposing the 2nd and 3rd tracheal rings, a round trachea opening was made by scalpal. The low-pressure tracheostomy tube was then inserted into the trachea. After confirmation of ventilation, the endotracheal tube was removed and the tracheostomy wound was approximated with 3-0 Nylon sutures. Operators P.蔡瑞章 Assistants R4 王奐之, PGY 王怡人 相關圖片 陳進龍 (M,1953/04/01,58y11m) 手術日期 2011/08/26 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Lumbar Spondylosis 器械術式 Spinal fusion posterior, L4/5, (+L5/S1) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 2 紀錄醫師 周聖哲, 時間資訊 23:59 臨時手術NPO 08:02 進入手術室 08:05 麻醉開始 08:20 誘導結束 08:30 抗生素給藥 08:45 手術開始 11:30 抗生素給藥 12:10 手術結束 12:10 麻醉結束 12:15 送出病患 12:20 進入恢復室 13:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎間盤切除術-腰椎 1 2 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 曾峰毅 開立時間: 2011/08/26 11:56 Pre-operative Diagnosis Lumbar stenosis, status post L4/5 and L5/S1 laminotomy for decompression, complicated with re-stenosis and spondylolisthesis, grade II, at L4/5 Post-operative Diagnosis Lumbar stenosis, status post L4/5 and L5/S1 laminotomy for decompression, complicated with re-stenosis and spondylolisthesis, grade II, at L4/5 Operative Method L4 and L5 laminectomy for decompression, posterior instrumentation at bilateral pedicle of L4 and L5 for posterior fixation, transforaminol lumbar interbody fusino at L4/5 L4 and L5 laminectomy for decompression, posterior instrumentation at bilateral pedicle of L4 and L5 for posterior fixation, transforaminal lumbar interbody fusion at L4/5 Specimen Count And Types nil Pathology nil Operative Findings Synthes transpedicular screws, 6.2 x 45 mm, were inserted into bilateral pedicles of L4-5 for posterior instrumentation. Two 5 cm rods was used for posterior fixation. Transforaminal lumbar interbody fusion at L4/5 was done with one 13 mm high PEEK cage and autologous bone graft. Hypertrophic ligamentum flavum, firm post-operative adhesion, and fibrotic tissue compromised neural foramens at L4/5 and L5/S1, and spinal canal tightly. Neural structures were decompressed well after the surgery. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After C-arm localization, we made one midline back incision along previous operation wound. We dissected paraspinal muscle and post-operative fibrosis to expose bilateral laminae from L4 to S1. We inserted transpedicular screws into bilateral pedicles of L4 and L5, and L4 laminectomy was performed for decompression. Hypertrophic ligamentum flavum and fibrotic tissue were removed to decompress the spinal canal and neural foramen. L4/5 diskecotmy was performed, and transforaminal lumbar interbody fusion with done with one 13 mm PEEK cage and autologous bone graft. Posterior fixation was ahieved after two 5 cm rods ste. L5 laminectomy was performed, and decompression was done at bilateral L5/S1 neural foramen. Wound was irrigated with gentamycin-saline, and we placed two epidural hemovac. The wound was closed in layers. Operators VS 賴達明 Assistants R5 曾峰毅 R2 周聖哲 Ri 連一潔 相關圖片 喬致傑 (M,1986/11/18,25y3m) 手術日期 2011/08/26 手術主治醫師 賴達明 手術區域 東址 019房 02號 診斷 HIVD 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 2 紀錄醫師 周聖哲, 時間資訊 23:00 臨時手術NPO 12:25 進入手術室 12:30 麻醉開始 12:40 誘導結束 13:00 抗生素給藥 13:17 手術開始 16:00 抗生素給藥 16:30 手術結束 16:30 麻醉結束 16:35 送出病患 16:36 進入恢復室 17:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 手術 椎間盤切除術-腰椎 1 1 摘要__ 手術科部: 外科部 套用罐頭: HIVD 開立醫師: 曾峰毅 開立時間: 2011/08/26 16:19 Pre-operative Diagnosis HIVD, L4/5 Post-operative Diagnosis HIVD, L4/5 Operative Method Microdiskectomy, L4/5, and dynamic stablization device implantation. Specimen Count And Types nil Pathology Nil Operative Findings Central cuptured intervertebral disc compromised thecal sac tightly, and neural structure was decompressed well after the surgery. Coflex, 10 mm high, was implanted into L4/5 interspinous space. Central ruptured intervertebral disc compromised thecal sac tightly, and neural structure was decompressed well after the surgery. Coflex, 10 mm high, was implanted into L4/5 interspinous space. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After C-arm localziation, we scrubbed, disinfected, and then draped the skin. We made one midline skin incision and dissected to expose bilateral laminae of L4/5. Right L4/5 laminotomy was performed, and microdiskectomy was done. Coflex, 10 mm high, was placed into L4/5 interspinous space. Wound was irrigated with gentamycin saline, and was closed in layers. Operators VS 賴達明 Assistants R5 曾峰毅 R2 周聖哲 Ri 連一潔 相關圖片 張智恩 (M,1996/09/24,15y5m) 手術日期 2011/08/26 手術主治醫師 林文熙 手術區域 兒醫 062房 05號 診斷 Germinoma brain 器械術式 Port-A catheter implatation 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 林昊諭, 時間資訊 12:25 報到 12:40 進入手術室 12:46 麻醉開始 12:50 誘導結束 12:50 抗生素給藥 13:04 手術開始 15:02 手術結束 15:02 麻醉結束 15:10 進入恢復室 15:10 送出病患 16:11 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 內頸靜脈切開,永久導管放置術 1 1 R 摘要__ 手術科部: 套用罐頭: Port-A implantation (right internal jugular vein) 開立醫師: 林昊諭 開立時間: 2011/08/26 14:44 Pre-operative Diagnosis Germinoma, suprasellar region Post-operative Diagnosis Germinoma, suprasellar region Operative Method Port-A implantation (right internal jugular vein) Specimen Count And Types nil Pathology nil Operative Findings catheter in SVC. Operative Procedures 1.Under ETGA and supine position 2.Transverse skin incision was done at right suprasternal area, between SCM 3.Looping of internal jugular vein 4.Purse string suture for fixation of catheter 5.Portable x-ray for confirmation of the position 6.Wound closure in layers. Operators 林文熙 Assistants F2林昊諭 Ri莊再庚 記錄__ 手術科部: 套用罐頭: Port-A implantation (right internal jugular vein) 開立醫師: 林昊諭 開立時間: 2011/09/13 14:24 Pre-operative Diagnosis Germinoma, suprasellar region Post-operative Diagnosis Germinoma, suprasellar region Operative Method Port-A implantation (right internal jugular vein) Specimen Count And Types nil Pathology nil Operative Findings catheter in SVC. Operative Procedures 1.Under ETGA and supine position 2.Transverse skin incision was done at right suprasternal area, between SCM 3.Looping of internal jugular vein 4.Purse string suture for fixation of catheter 5.Portable x-ray for confirmation of the position 6.Wound closure in layers. Operators 林文熙 Assistants F2林昊諭 Ri莊再庚 李金源 (M,1948/11/09,63y4m) 手術日期 2011/08/26 手術主治醫師 楊士弘 手術區域 東址 003房 01號 診斷 Lumbar spondylosis 器械術式 Anterior Spinal fusion(TZENG) 前開加後開 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 曾偉倫, 時間資訊 23:54 臨時手術NPO 08:02 進入手術室 08:10 麻醉開始 08:40 誘導結束 09:00 抗生素給藥 09:30 手術開始 12:17 開始輸血 15:18 18:10 麻醉結束 18:10 手術結束 18:16 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎融合術-前融合,無固定物(≦四節) 1 1 手術 椎間盤切除術-腰椎 1 3 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 12 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: (1) Lumbar anterolateral retroperitoneal appr... 開立醫師: 李振豪 開立時間: 2011/08/26 18:43 Pre-operative Diagnosis Lumbar spondylodiskitis, L2-3 Post-operative Diagnosis Lumbar spondylodiskitis, L2-3 Operative Method (1) Lumbar anterolateral retroperitoneal approach for L2-3 diskectomy, lower L2/upper L3 corpectomy, and mesh cage fusion (filled with autologous iliac bone graft and Stimulan graft) (2) Posterior spinal fixation with transpedicle screws/rods from T12 to L4, and posterior bone fusion with SinboneHT bone graft Specimen Count And Types 1 piece About size:小 Source:lumbar disc and vertebral body Pathology pending Operative Findings The medial part of psoas muscle became fibrotic and adherent with the L2-3 disk. Gray yellowish, soft elastic granulation tissue , about 3.5 cm x 3.5 cm x 3 cm in size, were found inside the L2-3 disk space and the adjacent L2-3 vertebral bodies. Healthy bone of the upper L2 and lower L3 was encountered after thorough curretage of the granulation tissue. A titanium mesh cage, 2.5 cm in diameter and 3.5 cm in height, was filled with multiple pieces of autologous iliac bone and calcium phosphate (Stimulan) graft, then impacted into the space between upper L2 and lower L3 endplates. Proper position of cage was confirmed by intraoperative fluoroscopy. Position of posterior instrumentation was also verified by intraoperative fluoroscopy. Six pedicle screws, 6.5 mm x 40 mm, were inserted into the T12, L1, and L4 pedicles. Two rods, 15 cm long each, were used to link screws on each side. A transverse cross link was placed across the rods. Onlay hydroxyappatite and tricalcium phosphate graft was placed over decorticated surface of T12 to L4 lamina. Operative Procedures Under endotracheal general anesthesia, the patient was put in right decubitus position and lateral bending to right. Curvilinear skin incision was made over left flank from posterior axillary line(at the level of the 12th rib) to lateral edge of the left rectus(at the level of umbilicus). The external abdominal oblique, internal abdominal oblique, and transverse abdominalis muscles were transected along the skin incision. The peritoneum and retroperitoneal fat was noted. Retroperitoneal approach was used and the left psoas muscle were splitted. The L2/3 disc space was noted with thick capsule and adhered to adjacent soft tissue. The capsule was opened and debridement was done with knife, curette, Kerrison punches, and high speed air-drived drills. One transverse skin incision was made along left iliac crest and the autologous bone graft(3x2x1.5cm in size)was harvested. Fragmentation of the autologous bone graft was performed and the titanium mesh cage was filled with autologous bone graft and calcium phosphate graft. The mesh cage was inserted to the L2/3 disc and interbody space. Hemostasis was achieved and the wound was irrigated with Gentamicin solution. One CWV drain was placed from retroperitoneal cavity to L2/3 interbody space. The wound was closed in layers with 1-0 , 2-0 Vicryl and 3-0 Nylon. The patient was put in prone position. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made from T12 to L4 level. The subcutaneous soft tissue and paravertebral muscle group were detached. T12, L1, and L4 bilateral transpedicular screws were inserted under C-arm portable X-ray guided. The rods were set up with left side compression since scoliosis to right side was noted. One cross-link was placed. Decortication from T12 to L4 laminae was performed with high speed air-drived drills. Onlay hydroxyappatite and tricalcium phosphate graft was placed over decorticated surface. Hemostasis was achieved with bipolar electrocautery. The wound was irrigated with Gentamicin solution. Two Hemovac drain was placed. The wound was then closed in layers with 1-0, 2-0 Vicryl, and 3-0 Nylon. Operators VS楊士弘 Assistants R5李振豪,R3曾偉倫 相關圖片 鄭宇先 (F,1988/09/04,23y6m) 手術日期 2011/08/26 手術主治醫師 王國川 手術區域 東址 005房 02號 診斷 Hyperhidrosis 器械術式 Endoscopic T2 sympathectomy 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 1 紀錄醫師 蕭智陽, 時間資訊 23:24 臨時手術NPO 15:40 進入手術室 15:45 麻醉開始 15:50 誘導結束 15:50 抗生素給藥 16:00 手術開始 16:30 手術結束 16:30 麻醉結束 16:35 送出病患 16:35 進入恢復室 17:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 經內視鏡交感神經切斷術 1 1 B 手術 經內視鏡交感神經切斷術 1 2 B 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Bilateral thoracoscopic T2 sympathectomy 開立醫師: 林哲光 開立時間: 2011/08/26 16:42 Pre-operative Diagnosis Hyperhidrosis Post-operative Diagnosis Hyperhidrosis Operative Method Bilateral thoracoscopic T2 sympathectomy Specimen Count And Types nil Pathology Nil Operative Findings Temperature Right hand Preop 32.0 Lowest 26.8 Postop 32.5 Left hand Preop 31.3 Lowest 28.3 Postop 34.2 Operative Procedures 1. Anesthesia : single lumen endotracheal general anesthesia 2. Position : supine, with both arms put on the arm tables, 90 degrees abduction and external rotation at the shoulders, and mild flexion at the elbows to expose both axillary areas. 3. Skin preparation : both axilla and chest were scrubbed with povidone-iodine detergent, painted with povidone-iodine tincture and draped as usual. 4. Made a 1.0 cm incision at the anterior axillary line, 3nd intercostal space, just under the lateral margin of Pectoralis major muscle. After the arterial oxygen saturation kept at 100%, the ventilator was disconnected, with the lung to a relatively mild atelectatic state. Then the trocar was inserted into the right pleural space carefully, followed by the thoracoscope. Then we identified the sympathetic chain and electrocauterized the sympathetic trunk over T2 and T3 level completely with a electrocauterization probe. 4. Made a 1.0 cm incision at the anterior axillary line, 3nd intercostal space, just under the lateral margin of Pectoralis major muscle. After the arterial oxygen saturation kept at 100%, the ventilator was disconnected, with the lung to a relatively mild atelectatic state. Then the trocar was inserted into the right pleural space carefully, followed by the thoracoscope. Then we identified the sympathetic chain and electrocauterized the sympathetic trunk over T2 level completely with a electrocauterization probe. 5. The effect was monitored by the finger temperature probes connected to the thumb of the patients hand. Before the oxygen saturation falling down to 80%, we removed the probe and thoracoscope gentlely, followed with a suction tube to drain the air in pleural space. 6. The ventilator was reconnected with forced positive ventilation to expand the lung tissue. The drain tube was removed after the expansion of the lung and the skin was closed with 3/0 nylon suture. Operators VS王國川 Assistants R1蕭智陽 相關圖片 王嘉緗 (F,1965/11/24,46y3m) 手術日期 2011/08/27 手術主治醫師 曾漢民 手術區域 東址 003房 01號 診斷 Brain cancer 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 4 紀錄醫師 曾峰毅, 時間資訊 23:08 臨時手術NPO 08:20 進入手術室 08:22 麻醉開始 08:25 誘導結束 08:30 抗生素給藥 08:35 手術開始 08:55 手術結束 08:55 麻醉結束 09:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 氣管切開術 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 曾峰毅 開立時間: 2011/08/27 09:07 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types Nil Pathology Nil Operative Findings Low pressure tracheostomy tube, size 7, was inserted. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with neck extended. We scrubbed, disinfected, and then draped the patient. One midline skin incision was performed at lower neck. We dissected to expose tracheal ring, and tracheotomy was done. Low pressure tracheostomy tube was inserted. Operators VS 曾漢民 Assistants R5 曾峰毅 R0 王怡人 相關圖片 林崇德 (M,2011/07/16,8m2d) 手術日期 2011/08/27 手術主治醫師 楊士弘 手術區域 兒醫 067房 01號 診斷 Interruption of aortic arch (IAA) 器械術式 V-P shunt 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 4E 紀錄醫師 曾峰毅, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 12:02 通知急診手術 15:34 進入手術室 15:40 麻醉開始 16:00 誘導結束 16:30 抗生素給藥 16:40 手術開始 17:45 手術結束 17:45 麻醉結束 17:52 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 套用罐頭: Ventriculoperitoneal shunt via right Kocher point 開立醫師: 曾峰毅 開立時間: 2011/08/27 18:02 Pre-operative Diagnosis Acute communicating hydrocephalus Post-operative Diagnosis Acute communicating hydrocephalus Operative Method Ventriculoperitoneal shunt via right Kocher point Specimen Count And Types CSF was sent for routine, culture, and BCS. Pathology Nil Operative Findings Opening pressure of ventriculostomy is more than 15 cm H20. Mild turbid, yellowish CSF gushed out. Codman, programmable, burr-hole-type shunt was used, and valve set at 10 cm H20. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to left. After scalp shaved, scrubbed, disinfeced, and then draped, we made one curvilinear skin incision at right frontal saclp. We created durotomy via anterior margin of anterior fontanelle. We made another transverse skin incision at right upper abdomen. Mini-laparotomy was performed, and subcutaneous tunnel was created. We performed ventriculosotmy, and inserted ventricular catehter with the valve. We connected the valve to the peritoneal catehter, and checked the funciton. The wound was closed in layers. Operators VS 楊士弘 Assistants R5 曾峰毅 Indication Of Emergent Operation IICP 相關圖片 張基應 (M,1929/12/26,82y2m) 手術日期 2011/08/27 手術主治醫師 楊長豪 手術區域 東址 010房 01號 診斷 Cataract 器械術式 Phaco+PCIOL 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 08:20 進入手術室 08:40 手術開始 09:07 手術結束 09:10 送出病患 記錄__ 手術科部: 眼科部 套用罐頭: ECCE and PCIOL implantation 開立醫師: 高姿芸 開立時間: 2011/08/27 09:11 Pre-operative Diagnosis Cataract (OS) Post-operative Diagnosis Cataract (OS) Operative Method ECCE and PCIOL implantation Specimen Count And Types nil Pathology Nil Operative Findings Cataract (OS) Operative Procedures 1.Under RBGB 2.Disinfection, irrigation and draping. 3.Apply an eyelid speculum. 4.Bridle suture over SRM. 5.Superior 150-degree peritomy and hemostasis with cautery. 6.1st and 2nd planes of limbal incision with a No.64 blade. 7.Penetrate into the anterior chamber inject Healon into the anterior chamber. 8.Anterior capsulotomy with can-opening technique. 9.Extend limbal wound with scissors. 10.Two 10-0 Nylon preplace limbal sutures were made. 11.Hydrodissection with BSS solution. 12.Deliver the nucleus. 13.Tighten the preplaced suture. 14.Irrigation and aspiration of cortical material with Simcoe I/A cannula. 15.PCIOL was implanted. 16.Close limbal wound with 10-0 Nylon ( stitches). 17.Wash out residual Healon with Simcoe I/A cannula. 18.Inject Miostat into AC. 19.Subconjunctival injection of Gentamicin & Rinderon. 20.Maxitrol patching. Operators 楊長豪, Assistants 高姿芸, 陳清松 (M,1941/10/27,70y4m) 手術日期 2011/08/29 手術主治醫師 曾漢民 手術區域 東址 003房 02號 診斷 Malignant brain tumor and its complication 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3 紀錄醫師 曾偉倫, 時間資訊 23:34 臨時手術NPO 09:55 報到 10:08 進入手術室 10:15 麻醉開始 11:00 抗生素給藥 11:27 手術開始 11:40 誘導結束 17:00 抗生素給藥 17:19 麻醉結束 17:19 手術結束 17:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 內視鏡功能鼻竇手術-雙側 1 1 B 手術 顱底瘤手術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Bifrontal craniotomy for total tumor excision... 開立醫師: 李振豪 開立時間: 2011/08/29 16:54 Pre-operative Diagnosis Right ethmoid sinus tumor with intracranial invasion Post-operative Diagnosis Right ethmoid sinus tumor with intracranial invasion, suspect neuroblastoma Operative Method Bifrontal craniotomy for total tumor excision and skull reconstruction with autologous pedicle flap Specimen Count And Types 2 pieces About size:Multiple small pieces Source:Intracranial tumor About size:Multiple small pieces Source:Nasal tumor Pathology Frozen section: small blue round cells, compatible with neuroblastoma Operative Findings The dura was adhered to the skull plate tightly and multiple dural laceration was noted during craniotomy. The incidental durotomy was repaired with 4-0 prolene. The dura was tense even after 150ml Mannitol use and hyperventilation(EtCO2: 26). After durotomy, about 1 x 2cm cortex over right mesial frontal base was removed and the tumor was encountered. The tumor was fragile to soft, pink-reddish, ill-defined, hypervascularized, and 6.4 x 4.1 x 7.1cm in size. The brain parenchyma adjacent to the tumor was yellowish with edematous change. The tumor seem larger than MRI study both on left side extension and suprasellar extension. The right optic nerve was noted after total removal of the tumor. The arachnoid membrane covered the optic nerve was not opened. The skull defect was 1.5 x 0.5cm which connected to right ethmoid sinus. The tumor within the ethmoid sinus was removed after extension of the skull defect. The intranasal part of the tumor was checked by ENT doctor after we close the wound and only small part of the tissue was suspected as residual tumor. The frontal base dural defect was repaired with pedicle periosteum flap. The skull base defect was repaired with pedicle galea flap and pedicle flap with periosteum and outer table of skull plate. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position. The scalp and nasal cavity was shaved, scrubbed, and disinfected as usual. Bicoronal scalp incision was made and the scalp flap was elevated. The periosteum was harvested as two pedicle flap and the left side pedicle flap was attached with one 3.6 x 3cm outer table of skull bone. Six burr holes were created followed by one 15 x 8cm craniotomy window. The mucosa within frontal sinus was removed and the opening of the sinus was sealed with bonewax. Dural tenting was done. C-shape durotomy based with frontal base was made over right frontal area. The right frontal lobe was retracted and the tumor was identified. Devascularization from skull base was conducted followed by subcapsule debulking with bipolar electrocautery and suction. The tumor was then removed along the border between the normal brain parenchyma. After total removal of the intracranial part, hemostasis was achieved with bipolar electrocautery and Surgicel lining. The skull base defect that connected to the right ethmoid sinus was extended by Midas air-drived drills. The tumor within ethmoid sinus was removed by curette, dissector, tumor forceps, and suction. Hemostasis was achieved with bipolar electrocautery. The dura laceration was repaired by 4-0 Prolene. The frontal base dural defect was repaired with pedicle flap from right side periosteum and 5-0 Prolene. The galeal layer of scalp flap was harvested as pedicle flap and placed into the skull base defect extradurally. The left side pedicle flap of periosteum and skull plate was then put in the defect for skull base reconstruction. The skull plate was fixed back with total four miniplates and 8 screws. One subgaleal CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and Appose staples. The procedure was followed by ENT doctor for evaluation of any residual tumor. Operators VS曾漢民 Assistants R5李振豪, R3曾偉倫, Ri何孟穎 記錄__ 手術科部: 外科部 套用罐頭: Endoscopic sinus surgery, bilateral 開立醫師: 許雅晴 開立時間: 2011/08/29 18:09 Pre-operative Diagnosis Right nasal tumor with intracranial invasion Post-operative Diagnosis Right nasal tumor with intracranial invasion, operated Operative Method Endoscopic sinus surgery, bilateral Specimen Count And Types 1 piece About size:0.5*0.5cm Source:nasal tumor Pathology pending Operative Findings 1. Some residual tumor at right middle turbinate 2. Septal perforation at upper part of septum 3. Right middle turbinate was resected. Operative Procedures We took over after neurosurgeon. The patient was in supine position. The operative field was disinfected and draped as usual. The sinoscope was applied. Granular tumor at remaining right middle turbinate was seen and removed. Nasal packing with VG*2 and Merocel*1 at right side, and VG*1 to the left side. The patient tolerated the whole procedure well. Operators P 劉嘉銘 Assistants R4 許雅晴 王顯寅 (M,1962/11/20,49y3m) 手術日期 2011/08/29 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Pituitary tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 3 紀錄醫師 林哲光, 時間資訊 23:31 臨時手術NPO 08:03 進入手術室 08:10 麻醉開始 08:30 誘導結束 09:00 抗生素給藥 09:20 手術開始 10:10 開始輸血 11:15 手術結束 11:15 麻醉結束 11:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 經由蝶竇之腦下垂體瘤切除 1 1 摘要__ 手術科部: 外科部 套用罐頭: Translabial trans-sphenoidal pituitary tumor ... 開立醫師: 林哲光 開立時間: 2011/08/29 13:03 Pre-operative Diagnosis Pituitary macroadenoma Post-operative Diagnosis Pituitary macroadenoma Operative Method Translabial trans-sphenoidal pituitary tumor partial excision Specimen Count And Types 1 piece About size:multiple pieces Source:tumor Pathology Frozen pathology revealed adenoma Operative Findings A soft-elastic, yellowish-greyish, capsulated mass lesion was noted at pituitary fossa with extending into the sphenoid sinus. Easily touch bleeing was noted during the operation and the normal structure of sellar floor was not identified. Total blood loss was around 500ml and CSF leakage was noted during the operation. Operative Procedures Under ETGA and supine position, the face and left abdomen were prepared with povidone-iodine alcohol tincture, and the mucosa of oral and nasal cavity with aqueous povidone-iodine tincture. The former areas were covered by a sterilized adhesive plastic sheet. The nasal submucosa at septum and floor and the subperiostium at upper alveola were infiltrated with 1:100 epinephrine solution. An incision was made at labial mucosa, 3 mm away from its gingival junction and corresponding to 4 upper incisors. The inferior margin of the nasal septum and floor was exposed after the upper lip had been dissected subperiosteallly and lifted. The mucosa of nasal septum and floor was dissected away from the septal cartilage and the bony floor on both sides from anterior to posterior and displaced laterally by a long nasal speculum. The septal cartilage was cut at its basal juction by sepatal scissors and then displaced to one side. A Hardys nasal speculum was applied to displace the nasal mucosa laterally and keep the nasal cavity open constantly for the exposure of the vomer bone and the anterior wall of the sphenoid sinus. The tumor was noted after the wall of sphenoid sinus was opened when the vomer bone was fractured. The sellar floor was hard to be identified and the soft tumor parenchyma was removed by curette and suction. Hemostasis was done by Gelfoam packing after partial tumor removal. The vomer bone was then put back at the wall of sphenoid sinus after Gelfoam packing. The Hardys nasal speculum was removed and the nasal mucosa returned to its normal position after Merocel nasal packing at each side of the nasal cavities which had been soacked with Better-iodine ointment. The labial wound was then closed continuously with 4/0 Catgut. Operators 曾漢民 Assistants 林哲光, 蕭智陽 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Translabial trans-sphenoidal pituitary tumor ... 開立醫師: 林哲光 開立時間: 2011/08/29 13:03 Pre-operative Diagnosis Pituitary macroadenoma Post-operative Diagnosis Pituitary macroadenoma Operative Method Translabial trans-sphenoidal pituitary tumor partial excision Specimen Count And Types 1 piece About size:multiple pieces Source:tumor Pathology Frozen pathology revealed adenoma Operative Findings A soft-elastic, yellowish-greyish, capsulated mass lesion was noted at pituitary fossa with extending into the sphenoid sinus. Easily touch bleeing was noted during the operation and the normal structure of sellar floor was not identified. Total blood loss was around 500ml and CSF leakage was noted during the operation. Operative Procedures Under ETGA and supine position, the face and left abdomen were prepared with povidone-iodine alcohol tincture, and the mucosa of oral and nasal cavity with aqueous povidone-iodine tincture. The former areas were covered by a sterilized adhesive plastic sheet. The nasal submucosa at septum and floor and the subperiostium at upper alveola were infiltrated with 1:100 epinephrine solution. An incision was made at labial mucosa, 3 mm away from its gingival junction and corresponding to 4 upper incisors. The inferior margin of the nasal septum and floor was exposed after the upper lip had been dissected subperiosteallly and lifted. The mucosa of nasal septum and floor was dissected away from the septal cartilage and the bony floor on both sides from anterior to posterior and displaced laterally by a long nasal speculum. The septal cartilage was cut at its basal juction by sepatal scissors and then displaced to one side. A Hardys nasal speculum was applied to displace the nasal mucosa laterally and keep the nasal cavity open constantly for the exposure of the vomer bone and the anterior wall of the sphenoid sinus. The tumor was noted after the wall of sphenoid sinus was opened when the vomer bone was fractured. The sellar floor was hard to be identified and the soft tumor parenchyma was removed by curette and suction. Hemostasis was done by Gelfoam packing after partial tumor removal. The vomer bone was then put back at the wall of sphenoid sinus after Gelfoam packing. The Hardys nasal speculum was removed and the nasal mucosa returned to its normal position after Merocel nasal packing at each side of the nasal cavities which had been soacked with Better-iodine ointment. The labial wound was then closed continuously with 4/0 Catgut. Operators 曾漢民 Assistants 林哲光, 蕭智陽 相關圖片 黃羅秀雲 (F,1932/01/04,80y2m) 手術日期 2011/08/30 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Spinal stenosis, lumbar 器械術式 L3-5 laminectomy 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 李振豪, 時間資訊 23:07 臨時手術NPO 08:06 進入手術室 08:10 麻醉開始 08:45 誘導結束 09:00 抗生素給藥 09:20 手術開始 11:25 手術結束 11:25 麻醉結束 11:35 送出病患 11:40 進入恢復室 12:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 手術 椎弓切除術(減壓)-超過二節 1 1 記錄__ 手術科部: 外科部 套用罐頭: L3-5 laminectomy for decompression 開立醫師: 李振豪 開立時間: 2011/08/30 11:23 Pre-operative Diagnosis L3-5 lumbar spondylosis Post-operative Diagnosis L3-5 lumbar spondylosis Operative Method L3-5 laminectomy for decompression Specimen Count And Types nil Pathology Nil Operative Findings The thecal sac expanded well after decompression. Bilateral lateral recess stenosis with root compression was noted. L2 to S1 foraminotomy was done for decompression. No incidental durotomy or CSF leakage was noted after whole procedure. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position. L3 to L5 space was localized by portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made from L3 to L5 level. The subcutaneous soft tissue and paravertebral muscle group were detached. L3-5 laminectomy was performed with bone cutter, Ronguer, and Kerrison punches. Bilateral foraminotomy also done after laminectomy. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. One epidural Hemovac was placed. The wound was then closed in layers with 1-0, 2-0 Vicryl and 3-0 Nylon. Operators VS曾勝弘 Assistants R5李振豪, R1吳欣翰 相關圖片 郭謝傃琛 (F,1952/07/22,59y7m) 手術日期 2011/08/30 手術主治醫師 曾勝弘 手術區域 東址 005房 02號 診斷 Spinal stenosis, lumbar 器械術式 L3-5 laminectomy 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 23:09 臨時手術NPO 12:10 進入手術室 12:15 麻醉開始 12:20 抗生素給藥 12:30 誘導結束 12:43 手術開始 14:25 開始輸血 15:20 抗生素給藥 15:50 手術結束 15:50 麻醉結束 16:00 送出病患 16:03 進入恢復室 17:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術(減壓)-超過二節 1 1 B 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 手術 脊椎融合術-後融合,無固定物 1 2 記錄__ 手術科部: 外科部 套用罐頭: L3-5 laminectomy for decompression + posterol... 開立醫師: 李振豪 開立時間: 2011/08/30 16:11 Pre-operative Diagnosis L3-5 lumbar stenosis Post-operative Diagnosis L3-5 lumbar stenosis Operative Method L3-5 laminectomy for decompression + posterolateral fusion with autologous bone and Sinbone graft Specimen Count And Types nil Pathology Nil Operative Findings Facet and ligmentum flavum was hypertrophic over L3 to L5 level, especially L4/5 level. The thecal sac was compressed tightly by the ligmentum flavum and expanded well after laminectomy. Bilateral foraminotomy was done during the decompression. No incidental durotomy or CSf leakage was noted during whole procedure. The thecal sac expanded well before wound closure. Posterolateral fusion was performed with autologous bone graft mixed with Sinbone. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position. L3 to L5 space was localized by portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made from L3 to L5 level. The subcutaneous soft tissue and paravertebral muscle group were detached. L3-5 laminectomy was performed with bone cutter, Ronguer, and Kerrison punches. Bilateral foraminotomy also done after laminectomy. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. Decortication was performed followed by posterolateral fusion with autologous bone mixed with Sinbone. One epidural Hemovac was placed. The wound was then closed in layers with 1-0, 2-0 Vicryl and 3-0 Nylon. Operators VS曾勝弘 Assistants R5李振豪, R1吳欣翰, Ri張凱評 相關圖片 陳春木 (M,1948/10/15,63y4m) 手術日期 2011/08/30 手術主治醫師 陳敞牧 手術區域 東址 003房 01號 診斷 Spinal stenosis, cervical 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 周聖哲, 時間資訊 23:06 臨時手術NPO 08:05 進入手術室 08:10 麻醉開始 08:25 誘導結束 08:50 抗生素給藥 09:02 手術開始 11:50 抗生素給藥 12:10 手術結束 12:10 麻醉結束 12:15 送出病患 12:20 進入恢復室 13:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 手術 椎間盤切除術-頸椎 1 1 手術 脊椎融合術-前融合,有固定物)≦四節 1 2 摘要__ 手術科部: 外科部 套用罐頭: Anterior cervical diskectomy 開立醫師: 曾峰毅 開立時間: 2011/08/30 11:48 Pre-operative Diagnosis HIVD, C5/6, C6/7 Post-operative Diagnosis HIVD, C5/6, C6/7` Operative Method Anterior cervical diskectomy Specimen Count And Types nil Pathology Nil Operative Findings Thecal sac and bilateral neural foramen at C5/6 and C6/7 were decompressed well after diskectomy. A-spine, PEEK cage, 7 mm, was inserted into C5/6 disc space with artificial bone garft, and 8 mm, at C6/7. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with neck extended. We made one transverse skin incision at right aspect of the neck, and dissected along medial side of platysma and lateral side of thyroid gland to expose prevertebral space. We dissected longus coli, and locailzed the C5/6 and C6/7 under C-arm. Anterior diskectomy of C5/6 was performed, and anterior fusion with PEEK cage and artificial bone graft was done. Then, anterior diskectomy of C6/7 was performed, and anterior fusion with PEEK cage and artificial bone graft was done. The wound was irrigated with gentamycin-saline, and closed in layers. Operators VS 陳敞牧 Assistants R5 曾峰毅 R2 周聖哲 相關圖片 陳天佑 (M,1997/09/18,14y5m) 手術日期 2011/08/30 手術主治醫師 楊士弘 手術區域 兒醫 067房 01號 診斷 Spine tumor 器械術式 C6-7 intraspinal tumor excision 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 石博元 ASA 3 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 07:38 報到 08:30 進入手術室 08:32 麻醉開始 08:50 誘導結束 09:06 抗生素給藥 09:10 手術開始 12:12 抗生素給藥 15:12 抗生素給藥 18:12 抗生素給藥 18:15 麻醉結束 18:15 手術結束 18:17 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 脊椎內脊髓內腫瘤切除術 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 11 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 4 0 麻醉 Hemoglobin (Hb) 4 0 麻醉 測血糖 4 0 麻醉 Ca (Calcium) 4 0 麻醉 Na (Sodium) 4 0 麻醉 K (Potassium) 4 0 麻醉 Blood gas analysis 4 0 摘要__ 手術科部: 外科部 套用罐頭: C4-6 en bloc laminectomy + upper C7 laminecto... 開立醫師: 王奐之 開立時間: 2011/08/30 18:54 Pre-operative Diagnosis Spinal cord tumor, cervical spine Post-operative Diagnosis Spinal cord tumor, cervical spine Operative Method C4-6 en bloc laminectomy + upper C7 laminectomy for tumor excision; C4-6 laminoplasty Specimen Count And Types 2 pieces About size:小 Source:C5-7 intramedullary tumor About size:小 Source:C4-5 intramedullary tumor Pathology Pending. Frozen section: inflammation. Operative Findings After laminectomy, sonography showed two hyperechoic tumors in the midline spinal cord at C5-7 and right spinal cord at C4-5. Easy bleeding from epidural venous plexus was encountered at C4-5, which were electrocauterized and packed with Gelfoam. Most of the tumor at C5-7, which was hypervascular, elastic & greyish, was removed while and only a small portion of tumor was removed at C4-5. The right lower limb MEP was absent since the beginning of surgery, while the left lower limb MEP disappeared in the middle of the surgery; right upper limb MEP decreased in amplitude toward the end of operation. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position with head fixed in Mayfield skull clamp. After shaving, scrubbing, disinfection & draping in sterile fashion, a midline linear incision was made from C2-C7. The incision was further deepened until the spinal processes were identified. The paraspinal muscles were detached from the spine until the lateral masses were exposed. C4-6 en bloc laminectomy were performed with Midas air-drill, followed by intra-operative localization of tumor with ultrasonography. A linear durotomy was first made at C5-7 level, followed by a linear incision on the spinal cord. The incision was deepened until the tumor was noted, and the tumor was removed in piecemeal fashion. After hemostasis, the pia was closed with 6-0 Prolene & the dura was closed with 4-0 Prolene in water-tight fashion. Another durotomy was made at right paramedian C4-5 level, followed by a linear incision on the spinal cord, and the tumor was removed in piecemeal fashion. After hemostasis, the dura was closed with 4-0 Prolene in water-tight fashion. After placing back the lamina with mini-plates, 1 CWV drain was set. The wound was closed in layers after Gentamicin irrigation. Operators VS 楊士弘 Assistants R4 王奐之 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: C4-6 en bloc laminectomy + upper C7 laminecto... 開立醫師: 王奐之 開立時間: 2011/08/30 18:54 Pre-operative Diagnosis Spinal cord tumor, cervical spine Post-operative Diagnosis Spinal cord tumor, cervical spine Operative Method C4-6 en bloc laminectomy + upper C7 laminectomy for tumor excision; C4-6 laminoplasty Specimen Count And Types 2 pieces About size:小 Source:C5-7 intramedullary tumor About size:小 Source:C4-5 intramedullary tumor Pathology Pending. Frozen section: inflammation. Operative Findings After laminectomy, sonography showed two hyperechoic tumors in the midline spinal cord at C5-7 and right spinal cord at C4-5. Easy bleeding from epidural venous plexus was encountered at C4-5, which were electrocauterized and packed with Gelfoam. Most of the tumor at C5-7, which was hypervascular, elastic & greyish, was removed while and only a small portion of tumor was removed at C4-5. The right lower limb MEP was absent since the beginning of surgery, while the left lower limb MEP disappeared in the middle of the surgery; right upper limb MEP decreased in amplitude toward the end of operation. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position with head fixed in Mayfield skull clamp. After shaving, scrubbing, disinfection & draping in sterile fashion, a midline linear incision was made from C2-C7. The incision was further deepened until the spinal processes were identified. The paraspinal muscles were detached from the spine until the lateral masses were exposed. C4-6 en bloc laminectomy were performed with Midas air-drill, followed by intra-operative localization of tumor with ultrasonography. A linear durotomy was first made at C5-7 level, followed by a linear incision on the spinal cord. The incision was deepened until the tumor was noted, and the tumor was removed in piecemeal fashion. After hemostasis, the pia was closed with 6-0 Prolene & the dura was closed with 4-0 Prolene in water-tight fashion. Another durotomy was made at right paramedian C4-5 level, followed by a linear incision on the spinal cord, and the tumor was removed in piecemeal fashion. After hemostasis, the dura was closed with 4-0 Prolene in water-tight fashion. After placing back the lamina with mini-plates, 1 CWV drain was set. The wound was closed in layers after Gentamicin irrigation. Operators VS 楊士弘 Assistants R4 王奐之 相關圖片 摘要__ 手術科部: 外科部 套用罐頭: C4-6 en bloc laminectomy + right C4-5 medial ... 開立醫師: 楊士弘 開立時間: 2011/09/01 16:35 Pre-operative Diagnosis Spinal cord tumor, cervical spine Post-operative Diagnosis Spinal cord tumor, cervical spine Operative Method C4-6 en bloc laminectomy + right C4-5 medial facetomy + upper C7 laminectomy for tumor excision; C4-6 laminoplasty Specimen Count And Types 2 pieces About size:小 Source:C5-7 intramedullary tumor About size:小 Source:C4-5 intramedullary tumor Pathology Pending. Frozen section: inflammation. Operative Findings After laminectomy, sonography showed two hyperechoic tumors in the midline spinal cord at C5-7 and right spinal cord at C4-5. Easy bleeding from epidural venous plexus was encountered at C4-5, which were electrocauterized and packed with Gelfoam. Most of the tumor at C5-7, which was hypervascular, soft fragile & greyish, was removed after midline myelopathy (2 cm long) and traction pial suture. A small portion of tumor, which was subpial, soft elastic, yellowish white in character, was removed from right lateral spinal cord at C4-5 level, after division and traction suture of dentate ligament between right C5 and C6 dorsal roots and 1 xm long pial incision at right laterl anterior cord surface. The right lower limb MEP was absent since the beginning of surgery, while the left lower limb MEP disappeared in the middle of the surgery; right upper limb MEP decreased in amplitude toward the end of operation. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position with head fixed in Mayfield skull clamp. After shaving, scrubbing, disinfection & draping in sterile fashion, a midline linear incision was made from C2-C7. The incision was further deepened until the spinal processes were identified. The paraspinal muscles were detached from the spine until the lateral masses were exposed. C4-6 en bloc laminectomy were performed with Midas air-drill, followed by intra-operative localization of tumor with ultrasonography. A linear durotomy was first made at C5-7 level, followed by a linear incision on the midline raphe of dorsal spinal cord. The incision was deepened until the tumor was noted, and the tumor was removed in piecemeal fashion by tumor forceps, suction, and dissectors. After hemostasis, the pia was closed with 6-0 Prolene & the dura was closed with 4-0 Prolene in water-tight fashion. Another durotomy was made at right paramedian C4-5 level, followed by a linear incision on the lateral spinal cord anterior to the dentate ligament, and the tumor was removed in piecemeal fashion by tumor forceps, suction, and CUSA. After hemostasis, the dura was closed with 4-0 Prolene in water-tight fashion. A piece of Duragen, 1 inch x 3 inch, was placed on the dural surface. After placing back the lamina with mini-plates and screws, 1 CWV drain was set. The wound was closed in layers after Gentamicin irrigation. Operators VS 楊士弘 Assistants R4 王奐之 相關圖片 王雅頌 (M,1949/01/24,63y1m) 手術日期 2011/08/30 手術主治醫師 蕭輔仁 手術區域 東址 003房 02號 診斷 Spinal cord lesion 器械術式 Spinal fusion posterior T1, T2, T4, T5 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 周聖哲, 時間資訊 23:49 臨時手術NPO 12:30 進入手術室 12:35 麻醉開始 13:03 誘導結束 13:45 手術開始 15:02 開始輸血 16:30 手術結束 16:30 麻醉結束 16:44 送出病患 16:47 進入恢復室 18:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 惡性脊髓腫瘤切除術 1 1 摘要__ 手術科部: 外科部 套用罐頭: Cervical Laminectomy 開立醫師: 曾峰毅 開立時間: 2011/08/30 16:26 Pre-operative Diagnosis T3 tumor, extradural, suspected metastatic or lymphoma Post-operative Diagnosis T3 tumor, extradural, suspected metastatic or lymphoma Operative Method T2-T4 laminectomy for epidural tumor excision Specimen Count And Types Several fragments of tumor was sent for pathology. Pathology Frozen: suspected metastasis, but lymphoma can not be ruled out Operative Findings Hypervascular, elastic to firm, greyish, tumor was noted at epidural space from T2 to T4 with extension to bialteral neural foramen. Cortical bone of bilateral pedicle at T2-4 is intact. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After C-arm localization, we made one midline skin incision and dissected to expose bilatearl laminae from T1 to T5. We performed T2 to T4 laminectomy, and removed epidural tumor in piecemeal. Specimens was sent for pathology, and the wound was closed in layers after two epidural hemovac set. Operators VS 蕭輔仁 Assistants R5 曾峰毅 R2 周聖哲 相關圖片 陳王勉 (F,1939/04/12,72y11m) 手術日期 2011/08/30 手術主治醫師 蔡翊新 手術區域 西址 039房 01號 診斷 Carpal tunnel syndrome 器械術式 Neurolysis of median nerve 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 09:14 報到 09:50 進入手術室 09:55 麻醉開始 09:57 誘導結束 09:59 手術開始 10:38 手術結束 10:42 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 正中神經或尺神經腕部減壓術–單側 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Carpal Tunnel Syndrome 開立醫師: 蔡翊新 開立時間: 2011/08/30 10:41 Pre-operative Diagnosis Left carpal tunnel syndrome. Post-operative Diagnosis Left carpal tunnel syndrome. Operative Method Left median nerve decompression at wrist. Specimen Count And Types nil Pathology Nil. Operative Findings Thickening of transverse carpal ligament causing tight compression of left median nerve which expanded well after decompression. Operative Procedures 1.The hand and forearm were sterilized with povidone-iodine tincture, then covered with stockinet. 2.Anesthesia: 5 ml 1% Xylocaine solution was injected to subcutaneous layer of left hand near the wrist. 3.Incision: linear, along vertical palmar crease to transverse wrist crease. 4.The palmaris longus tendon was identified, then the plamar aponeurosis was cut longitidinally along the ulnar side of the palmaris longus tendon. 5.The median nerve was identified beneath the palmars longus tendon. Under direct vision, the transverse carpal ligament was divided until no more pressure on the median nerve could be palpated. 6.The skin was closed by interrupted suture with 4/0 nylon. The hand and wrist were draped with fluffy dressing and elastic bandage. Operators VS蔡翊新 Assistants R5林哲光 林茂守 (M,1927/02/02,85y1m) 手術日期 2011/08/31 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Brain Tumor 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 曾偉倫, 時間資訊 23:08 臨時手術NPO 08:05 進入手術室 08:10 麻醉開始 09:05 誘導結束 09:07 手術開始 09:10 抗生素給藥 12:10 抗生素給藥 14:20 手術結束 14:20 麻醉結束 14:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4~8小時 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: Left forntal craniotomy for tumor excision 開立醫師: 李振豪 開立時間: 2011/08/31 14:47 Pre-operative Diagnosis Left frontal brain tumor, suspect high grade glioma Post-operative Diagnosis Left frontal brain tumor, suspect high grade glioma Operative Method Left forntal craniotomy for tumor excision Specimen Count And Types 1 piece About size:3x2x2 cm Source:Left frontal brain tumor Pathology Frozen section: high grade glioma Operative Findings The tumor was hypervascularized, soft to elastic, ill-defined, gray-reddish, and 3x3x5cm in size. The central part of the tumor was firm in character and calcification was suspected. CUSA was used in this part of the tumor. Left callosal marginal and pericallosal artery was encased by the tumor and one large branch from left callosal marginal was sacrified during tumor excision. The main trunk of left ACA, left callosal marginal, and bilateral pericallosal arteries were all preserved during the operation. Small opening of left lateral ventricle was noted after total tumor excision and the opening was sealed with Surgicel and Gelfoam packing. No obvious EP change was noted during whole procedure. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. Bicoronal scalp incision was made and the scalp flap was elevated. Periosteum was elevated based with anterior frontal base. Four burr holes were created followed by one 8 x 6cm craniotomy window. Dural tenting was done. Intra-operative sonography was performed for localization of the tumor. C-shape durotomy based with superior sagittal sinus was done. One 1 x 2cm corticotomy was performed over anterior mesial frontal area. The tumor was encountered about 1.5cm from brain surface. The tumor was removed by bipolar electrocautery, suction, tumor forceps, and CUSA. Hemostasis was achieved with bipolar electrocautery and Surgicel lining. Dura was closed with 4-0 Prolene and one small piece of periosteum for duroplasty. The skull plate was fixed back with miniplates and screws. One subgaleal CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators Prof. 杜永光 Assistants R5 李振豪 R3 曾偉倫 Ri 何孟穎 相關圖片 林怡君 (F,1982/04/21,29y10m) 手術日期 2011/08/31 手術主治醫師 梁金銅 手術區域 東址 027房 03號 診斷 Abdominal pain 器械術式 Pelvic tumor excision 手術類別 預定手術 手術部位 腹 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3 紀錄醫師 楊順貿, 時間資訊 12:15 報到 12:43 進入手術室 12:45 麻醉開始 13:10 誘導結束 13:15 抗生素給藥 13:30 手術開始 15:30 麻醉結束 15:30 手術結束 15:38 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 剖腹探查術 1 1 手術 子宮附屬器部份或全部切除術 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 婦產部 套用罐頭: Debulking 開立醫師: 楊順貿 開立時間: 2011/08/31 16:10 Pre-operative Diagnosis Pelvic tumor Post-operative Diagnosis Left side ovarian cancer Operative Method Pelvic tumor excision Specimen Count And Types 1 piece About size:10*10*7 cm Source:left ovarian tumor Pathology pending Operative Findings 1. One huge pelvic mass(10*10*7cm), growing from the left ovary with intect capsule(+) 2. Intra-abdominal adhesion(+) 3. No evidence of intra-peritoneal seeding 4. Liver metastasis(-) Operative Procedures 1. Put the patient on the lithotomy position 2. Skin disinfection with beta-iodine, and skin draping. 3. Make midline vertical skin incision and open the abdominal wall layer by layer. 4. Adhesiolysis of upper abdomen 5. Apply self-retractor and expose the pelvic tumor 7. Clamp, ligate and cut the pedicle of the tumor, and removed it 8. Insert two right rubber drain in subphrenic space and cul-de-sac, and insert left rubber drain in cul-de-sac 8. Covered the intraperitoneal organ with Surgirap 9. Close the abdomen layer by layer. Operators P梁金銅 Assistants CR楊惠馨 R1楊順貿 Ri葉品宏 廖溱家 (F,2008/12/29,3y2m) 手術日期 2011/08/31 手術主治醫師 彭信逢 手術區域 東址 000房 號 診斷 Aromatic L-amino acid decarboxylase deficiency 器械術式 Brain MRI 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 蔡奉芳 ASA 3 時間資訊 11:35 麻醉開始 11:45 誘導結束 12:35 麻醉結束 12:50 進入恢復室 14:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 湯釗宇 (M,1972/07/05,39y8m) 手術日期 2011/08/31 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 Subarachnoid hemorrhage 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 曾偉倫, 時間資訊 23:11 臨時手術NPO 14:07 報到 14:52 進入手術室 14:55 麻醉開始 15:10 抗生素給藥 15:25 手術開始 16:05 誘導結束 16:50 手術結束 16:50 麻醉結束 17:05 送出病患 17:07 進入恢復室 18:07 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 頭顱成形術 1 1 L 手術 頭皮腫瘤 1 2 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Left cranioplasty + Right drain wound debridm... 開立醫師: 曾偉倫 開立時間: 2011/08/31 17:00 Pre-operative Diagnosis Traumatic brain injury with bilateral frontal, left temporal, right parietal lobes, epidural hematoma, subdural hematoma and skull bone fracture status post right fronto-parieto-temporal craniectomy and left frontotemporal craniectomy Post-operative Diagnosis Traumatic brain injury with bilateral frontal, left temporal, right parietal lobes, epidural hematoma, subdural hematoma and skull bone fracture status post right fronto-parieto-temporal craniectomy and left frontotemporal craniectomy Operative Method Left cranioplasty + Right drain wound debridment and granulation tissue excision Specimen Count And Types nil Pathology Right drain wound granulation Operative Findings 1. Skull defect over bilateral F-T-P area 2. Right drain wound granulation formation without pus formation Operative Procedures Under ETGA, we placed the patient over supine position. After we shaved, disinfected and drapped, the right drain wound was debrided and the granulation tissue was resected. The wound was closed with 1-0 Nylon primarily. We tile his face to right and the skin incision was made over the pervious operation wound. The wound was opened and the dura-galea border was divided. The skull was fixed with mini-plate and screw. The dura tenting was made. A CWV drain was placed and the wound was closed in layers. Operators VS 王國川 Assistants R3 曾偉倫 Ri 何孟穎 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Left cranioplasty + Right drain wound debridm... 開立醫師: 曾偉倫 開立時間: 2011/08/31 17:00 Pre-operative Diagnosis Traumatic brain injury with bilateral frontal, left temporal, right parietal lobes, epidural hematoma, subdural hematoma and skull bone fracture status post right fronto-parieto-temporal craniectomy and left frontotemporal craniectomy Post-operative Diagnosis Traumatic brain injury with bilateral frontal, left temporal, right parietal lobes, epidural hematoma, subdural hematoma and skull bone fracture status post right fronto-parieto-temporal craniectomy and left frontotemporal craniectomy Operative Method Left cranioplasty + Right drain wound debridment and granulation tissue excision Specimen Count And Types nil Pathology Right drain wound granulation Operative Findings 1. Skull defect over bilateral F-T-P area 2. Right drain wound granulation formation without pus formation Operative Procedures Under ETGA, we placed the patient over supine position. After we shaved, disinfected and drapped, the right drain wound was debrided and the granulation tissue was resected. The wound was closed with 1-0 Nylon primarily. We tile his face to right and the skin incision was made over the pervious operation wound. The wound was opened and the dura-galea border was divided. The skull was fixed with mini-plate and screw. The dura tenting was made. A CWV drain was placed and the wound was closed in layers. Operators VS 王國川 Assistants R3 曾偉倫 Ri 何孟穎 相關圖片 蔡輝雄 (M,1943/03/02,69y0m) 手術日期 2011/08/31 手術主治醫師 紀乃新 手術區域 東址 001房 02號 診斷 End stage renal disease (ESRD) 器械術式 AVF revision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 08:15 報到 10:29 進入手術室 10:52 麻醉開始 10:54 誘導結束 10:55 手術開始 13:55 手術結束 14:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 末梢血管修補或吻合術併血管移植 1 1 B 記錄__ 手術科部: 外科部 套用罐頭: Right AVF ligation, Left brachial-cephalic AV... 開立醫師: 陳政維 開立時間: 2011/08/31 13:56 Pre-operative Diagnosis Right AVF dysfunction Post-operative Diagnosis Ditto Operative Method Right AVF ligation, Left brachial-cephalic AVF creation Specimen Count And Types Nil Pathology Nil Operative Findings 1.Right fore arm straight AVG total oclusion, Forgaty could not pass-by 2.The left new AVF a.The diameter of the artery was: 3.0 mm; and the diameter of the vein was:3.0mm b.The anastomosis opening diameter was: 6 mm. c.Site: brachiocephalic AVF d.After the fistula created, a continuous thrill was felt over the fistula, bruit (+) Operative Procedures 1.SKin disinfection and well draped 2.Left forearm skin incision, identify previous AVF, loop and control it 3.Perform thrombectomy with forgaty 0.75ml, but the tip could not pass-by the proximal anastomosis site 4.Left elbow skin disinfection, mobilize and identify the A and V 5.Create AVF with 7-0 prolene 6.Hemostasis and close the wound in layers Operators VS紀乃新 Assistants R4陳政維 巫佳珍 (F,1986/01/08,26y2m) 手術日期 2011/08/31 手術主治醫師 王國川 手術區域 東址 005房 01號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 2 紀錄醫師 林哲光, 時間資訊 23:13 臨時手術NPO 08:06 進入手術室 08:15 麻醉開始 08:40 誘導結束 09:10 抗生素給藥 09:18 手術開始 12:10 抗生素給藥 12:35 手術結束 12:35 麻醉結束 12:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Right pterional approach for total tumor excision 開立醫師: 林哲光 開立時間: 2011/08/31 13:00 Pre-operative Diagnosis Right temporal tumor, suspected low grade glioma Post-operative Diagnosis Right temporal tumor, suspected low grade glioma Operative Method Right pterional approach for total tumor excision Specimen Count And Types 1 piece About size:multiple pieces, around 2.5cm Source:right temporal tumor Pathology Pending Operative Findings One 2.5cm, not well defined, greyish, gelatinous, soft mass was noted at right temporal tip. Total tumor excision was done under echo localization. The MCA was left untouched during the operation. Operative Procedures Under ETGA and supine position with head rotated to left side and fixed wtih Mayfield head clamp, skin disinfected and drapped were performed as usual. A curvilinear skin incision was made at right F-T area and craniotomy was performed after three burr holes were created. The dura was then opened in C-shaped after dural tenting. The sylvian fissure was opened and the tumor was localized with echo. Tumor excision was then performed after the margin was identified meticulously under echo and bipolar cauterization. Hemostasis was then perfomred with surgecell packing. The dura was then closed in water-tie method and the skull bone was put and fixed with miniplates. The burr holes were covered with bone cemen and the wound was then closed in layers after a subgaleal drain inserted. Operators 王國川 Assistants 林哲光, 蕭智陽 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Right pterional approach for total tumor excision 開立醫師: 林哲光 開立時間: 2011/08/31 13:00 Pre-operative Diagnosis Right temporal tumor, suspected low grade glioma Post-operative Diagnosis Right temporal tumor, suspected low grade glioma Operative Method Right pterional approach for total tumor excision Specimen Count And Types 1 piece About size:multiple pieces, around 2.5cm Source:right temporal tumor Pathology Pending Operative Findings One 2.5cm, not well defined, greyish, gelatinous, soft mass was noted at right temporal tip. Total tumor excision was done under echo localization. The MCA was left untouched during the operation. Operative Procedures Under ETGA and supine position with head rotated to left side and fixed wtih Mayfield head clamp, skin disinfected and drapped were performed as usual. A curvilinear skin incision was made at right F-T area and craniotomy was performed after three burr holes were created. The dura was then opened in C-shaped after dural tenting. The sylvian fissure was opened and the tumor was localized with echo. Tumor excision was then performed after the margin was identified meticulously under echo and bipolar cauterization. Hemostasis was then perfomred with surgecell packing. The dura was then closed in water-tie method and the skull bone was put and fixed with miniplates. The burr holes were covered with bone cemen and the wound was then closed in layers after a subgaleal drain inserted. Operators 王國川 Assistants 林哲光, 蕭智陽 相關圖片 廖晟凱 (M,1991/02/03,21y1m) 手術日期 2011/08/31 手術主治醫師 王國川 手術區域 東址 005房 02號 診斷 Skull benign neoplasm 器械術式 Crainotomy Brain Tumor(P-LIN) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 2 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 13:05 進入手術室 13:15 麻醉開始 13:27 誘導結束 13:30 抗生素給藥 13:45 手術開始 15:10 手術結束 15:10 麻醉結束 15:20 送出病患 15:25 進入恢復室 17:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 手術 頭顱成形術 1 1 摘要__ 手術科部: 外科部 套用罐頭: Bone tumor excision 開立醫師: 林哲光 開立時間: 2011/08/31 14:49 Pre-operative Diagnosis Skull bone tumor, suboccipital area Post-operative Diagnosis Skull bone tumor, suboccipital area Operative Method Bone tumor excision Specimen Count And Types 1 piece About size:4cm sized Source:tumor Pathology Pending Operative Findings Around 5cm long bulging mass was noted at posterior neck and a skull bone tumor was noted at suboccipital area, bulging posteriorly, inferiorly without obvious margin between the surrounding skull bone tissue. The consistency of the tumor was stone-hard. The inner layer of the skull bone was left untouched and the outter layer was removed as extensively as possible. Operative Procedures Under ETGA and prone position, skin disinfected and drapped were performed as usual. Midline skin incision was made and the skull bone tumor was then exposed well. The margin of the skull bone tumor was drilled with high speed drill and tumor was removed along the plane of normal skull bone. The outter layer of the skull bone including the tumor was drilled off. The wound was then closed in layers after a subgaleal CWV drain was inserted. Operators 王國川 Assistants 林哲光, 蕭智陽 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Bone tumor excision 開立醫師: 林哲光 開立時間: 2011/08/31 14:49 Pre-operative Diagnosis Skull bone tumor, suboccipital area Skull bone tumor, occipital area Post-operative Diagnosis Skull bone tumor, suboccipital area Skull bone tumor, occipital area Operative Method Bone tumor excision Specimen Count And Types 1 piece About size:4cm sized Source:tumor Pathology Pending Operative Findings Around 5cm long bulging mass was noted at posterior neck and a skull bone tumor was noted at suboccipital area, bulging posteriorly, inferiorly without obvious margin between the surrounding skull bone tissue. The consistency of the tumor was stone-hard. The inner layer of the skull bone was left untouched and the outter layer was removed as extensively as possible. Around 5cm long bulging mass was noted at posterior neck and a skull bone tumor was noted at occipital area near the inion, bulging posteriorly, inferiorly without obvious margin between the surrounding skull bone tissue. The consistency of the tumor was stone-hard. The inner layer of the skull bone was left untouched and the outter layer was removed as extensively as possible. Operative Procedures Under ETGA and prone position, skin disinfected and drapped were performed as usual. Midline skin incision was made and the skull bone tumor was then exposed well. The margin of the skull bone tumor was drilled with high speed drill and tumor was removed along the plane of normal skull bone. The outter layer of the skull bone including the tumor was drilled off. The wound was then closed in layers after a subgaleal CWV drain was inserted. Operators 王國川 Assistants 林哲光, 蕭智陽 相關圖片 涂茂森 (M,1977/08/21,34y6m) 手術日期 2011/09/01 手術主治醫師 王國川 手術區域 東址 001房 03號 診斷 Epidural hematoma 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 王奐之, 時間資訊 23:42 臨時手術NPO 13:37 報到 14:15 進入手術室 14:20 麻醉開始 14:25 誘導結束 14:35 抗生素給藥 14:58 手術開始 18:55 手術結束 18:55 麻醉結束 19:05 送出病患 19:10 進入恢復室 20:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 頭顱成形術 1 1 L 手術 顱骨重塑模組 1 0 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Left side cranioplasty with artificial bone graft 開立醫師: 王奐之 開立時間: 2011/09/01 19:12 Pre-operative Diagnosis Left side skull defect Post-operative Diagnosis Left side skull defect Operative Method Left side cranioplasty with artificial bone graft Specimen Count And Types Nil Pathology Nil Operative Findings Severe adhesion was noted between galea & dura. Thickening of scalp flap was noted, along with some hard portion (suspected dislodged bone cement). The skin was undermined for advancement (for difficult wound closure). Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to right. After shaving, scrubbing, disinfection & draping in sterile fashion, a question mark incision along previous wound scar was made at left frontotemporoparietal area. After application of Raney clips, the skin flap was reflected anteroinferiorly, and the plane between galea and dura was dissected. The artificial bone graft was trimmed to fit the skull defect, and was then placed and fixed with mini-plates after central tenting stitches. Bone cement was used for reconstructing the temporalis defect. After hemostasis and setting up of 2 subgaleal CWV drain, the wound was closed in layers. Operators VS 王國川 Assistants R4 王奐之, PGY 李思慧 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Left side cranioplasty with artificial bone graft 開立醫師: 王奐之 開立時間: 2011/09/01 19:12 Pre-operative Diagnosis Left side skull defect Post-operative Diagnosis Left side skull defect Operative Method Left side cranioplasty with artificial bone graft Specimen Count And Types Nil Pathology Nil Operative Findings Severe adhesion was noted between galea & dura. Thickening of scalp flap was noted, along with some hard portion (suspected dislodged bone cement). The skin was undermined for advancement (for difficult wound closure). Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to right. After shaving, scrubbing, disinfection & draping in sterile fashion, a question mark incision along previous wound scar was made at left frontotemporoparietal area. After application of Raney clips, the skin flap was reflected anteroinferiorly, and the plane between galea and dura was dissected. The artificial bone graft was trimmed to fit the skull defect, and was then placed and fixed with mini-plates after central tenting stitches. Bone cement was used for reconstructing the temporalis defect. After hemostasis and setting up of 2 subgaleal CWV drain, the wound was closed in layers. Operators VS 王國川 Assistants R4 王奐之, PGY 李思慧 相關圖片 王台生 (M,1951/07/23,60y7m) 手術日期 2011/09/01 手術主治醫師 王國川 手術區域 東址 001房 02號 診斷 Traumatic brain injury 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 王奐之, 時間資訊 23:40 臨時手術NPO 10:35 報到 10:50 進入手術室 11:00 麻醉開始 11:05 誘導結束 11:10 抗生素給藥 11:45 手術開始 14:00 手術結束 14:00 麻醉結束 14:03 送出病患 14:05 進入恢復室 15:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 頭顱成形術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Left side cranioplasty with autologous bone graft 開立醫師: 王奐之 開立時間: 2011/09/01 14:10 Pre-operative Diagnosis Left side skull defect Post-operative Diagnosis Left side skull defect Operative Method Left side cranioplasty with autologous bone graft Specimen Count And Types Nil Pathology Nil Operative Findings Mild adhesion was noted between galea & dura. 2 pieces of bone graft were put together with 2 wires & fixed back to the skull with mini-plates. Vancomycin solution was used for bone graft immersion & wound irrigation. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to right. After shaving, scrubbing, disinfection & draping in sterile fashion, a question mark incision along previous wound scar was made at left frontotemporoparietal area. After application of Raney clips, the skin flap was reflected anteroinferiorly, and the plane between galea and dura was dissected. The bone graft was then placed and fixed with mini-plates after central tenting stitches. Bone cement was used for reconstructing the temporalis defect. After hemostasis and setting up of 2 subgaleal CWV drain, the wound was closed in layers. Operators VS 王國川 Assistants R4 王奐之, PGY 李思慧 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Left side cranioplasty with autologous bone graft 開立醫師: 王奐之 開立時間: 2011/09/01 14:10 Pre-operative Diagnosis Left side skull defect Post-operative Diagnosis Left side skull defect Operative Method Left side cranioplasty with autologous bone graft Specimen Count And Types Nil Pathology Nil Operative Findings Mild adhesion was noted between galea & dura. 2 pieces of bone graft were put together with 2 wires & fixed back to the skull with mini-plates. Vancomycin solution was used for bone graft immersion & wound irrigation. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to right. After shaving, scrubbing, disinfection & draping in sterile fashion, a question mark incision along previous wound scar was made at left frontotemporoparietal area. After application of Raney clips, the skin flap was reflected anteroinferiorly, and the plane between galea and dura was dissected. The bone graft was then placed and fixed with mini-plates after central tenting stitches. Bone cement was used for reconstructing the temporalis defect. After hemostasis and setting up of 2 subgaleal CWV drain, the wound was closed in layers. Operators VS 王國川 Assistants R4 王奐之, PGY 李思慧 相關圖片 黃宥霖 (F,1962/08/26,49y6m) 手術日期 2011/09/01 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Arteriovenous malformation 器械術式 Craniotomy (A.V.M.) P-LIN 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 游健生, 時間資訊 23:36 臨時手術NPO 07:52 報到 08:00 進入手術室 08:15 麻醉開始 08:55 誘導結束 08:56 抗生素給藥 09:00 手術開始 10:30 開始輸血 11:56 抗生素給藥 14:56 抗生素給藥 17:56 抗生素給藥 19:15 麻醉結束 19:15 手術結束 19:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 14 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 開顱術摘除血管病變- 動靜脈畸型大型 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Right parietal craniotomy for total AVM excision 開立醫師: 游健生 開立時間: 2011/09/01 20:47 Pre-operative Diagnosis Right parietal AVM, Spetzler-Martin grade III Post-operative Diagnosis Right parietal AVM, Spetzler-Martin grade III Operative Method Right parietal craniotomy for total AVM excision Specimen Count And Types 1 piece About size:6cm Source:AVM Pathology Pending Operative Findings After durotomy, a large drainage vein was seen at right parietal cortex arising from inside. The some feeders from MCA were embolized by previous TAE. The feeders from PCA were small and assembled as bundles while feeders from MCA were larger and ran individually. The nidus was about 6cm in diameter and located beneath parietal cortex. Operative Procedures Under ETGA, patient was in prone position with head fixed by headclamp. After shaving, we disinfected and draped the operation field as usual. A reversed U-shape scalp incision was made at right parietal region starting from 3cm above inion at midline. The scalp flap was elevated followed by pericranium. Total 5 burhole were created with 3 over superior sagittal sinus. A craniotomy was done followed by dura tenting. The dura was opened in U-shape with base at SSS. After durotomy, a large drainage vein was seen at right parietal cortex arising from inside. Then, we traced the drainage vein into parenchyma and dissected the nidus from brain parenchyma circumferentially. The feeders from MCA were coagulated, clipped, and transected. The feeders from PCA were coagulated and transected. After complete dissection, we ligated the drainage vein by clips and transected it. We covered the rough surface with Surgicel. Dura was repaired with artifical dura graft and 3-0 Prolene continuous sutures. Bone flap was fixed back with 5 wires after 2 central tentings. Pericranium was approximated and a CWV was placed at subgaleal space. Wound was closed in layers. Operators VS 王國川 Assistants R4 游健生 PGY 涂怡安 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Right parietal craniotomy for total AVM excision 開立醫師: 游健生 開立時間: 2011/09/01 20:48 Pre-operative Diagnosis Right parietal AVM, Spetzler-Martin grade III Post-operative Diagnosis Right parietal AVM, Spetzler-Martin grade III Operative Method Right parietal craniotomy for total AVM excision Specimen Count And Types 1 piece About size:6cm Source:AVM Pathology Pending Operative Findings After durotomy, a large drainage vein was seen at right parietal cortex arising from inside. The some feeders from MCA were embolized by previous TAE. The feeders from PCA were small and assembled as bundles while feeders from MCA were larger and ran individually. The nidus was about 6cm in diameter and located beneath parietal cortex. Operative Procedures Under ETGA, patient was in prone position with head fixed by headclamp. After shaving, we disinfected and draped the operation field as usual. A reversed U-shape scalp incision was made at right parietal region starting from 3cm above inion at midline. The scalp flap was elevated followed by pericranium. Total 5 burhole were created with 3 over superior sagittal sinus. A craniotomy was done followed by dura tenting. The dura was opened in U-shape with base at SSS. After durotomy, a large drainage vein was seen at right parietal cortex arising from inside. Then, we traced the drainage vein into parenchyma and dissected the nidus from brain parenchyma circumferentially. The feeders from MCA were coagulated, clipped, and transected. The feeders from PCA were coagulated and transected. After complete dissection, we ligated the drainage vein by clips and transected it. We covered the rough surface with Surgicel. Dura was repaired with artifical dura graft and 3-0 Prolene continuous sutures. Bone flap was fixed back with 5 wires after 2 central tentings. Pericranium was approximated and a CWV was placed at subgaleal space. Wound was closed in layers. Operators VS 王國川 Assistants R4 游健生 PGY 涂怡安 相關圖片 陳勤程 (M,1980/03/03,32y0m) 手術日期 2011/09/01 手術主治醫師 王國川 手術區域 東址 005房 01號 診斷 Acute lymphoid leukemia, without mention of remission 器械術式 Ommaya reservoir implantation 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 王奐之, 時間資訊 23:51 臨時手術NPO 08:05 進入手術室 08:10 麻醉開始 08:30 誘導結束 08:38 抗生素給藥 09:30 手術開始 09:30 開始輸血 10:12 手術結束 10:12 麻醉結束 10:20 送出病患 10:22 進入恢復室 11:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 歐氏貯囊置放手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 內科部 套用罐頭: Ommaya reservoir implantation via right Koche... 開立醫師: 王奐之 開立時間: 2011/09/01 10:26 Pre-operative Diagnosis Pre-B cell lymphoblastic leukemia, with CNS involvement Post-operative Diagnosis Pre-B cell lymphoblastic leukemia, with CNS involvement Operative Method Ommaya reservoir implantation via right Kocher point Specimen Count And Types Nil Pathology Nil Operative Findings Clear CSF was noted, opening pressure: 5~10cmH2O upon ventricular puncture. Ventricular catheter length: 6.5cm. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position. After shaving, scrubbing, disinfection & draping in sterile fashion, a curved incision was made at right frontal area. A burr hole was then made at right Kocher point, followed by 2 dural tenting stitches. After hemostasis, a small cruciform durotomy was done, followed by ventricular puncture. The Ommaya reservoir along with ventricular catheter was assembled and inserted, and fixed in place after confirmation of smooth CSF flow. The wound was then closed in layers after hemostasis. Operators VS 王國川 Assistants R4 王奐之, PGY 李思慧 相關圖片 記錄__ 手術科部: 內科部 套用罐頭: Ommaya reservoir implantation via right Koche... 開立醫師: 王奐之 開立時間: 2011/09/01 10:26 Pre-operative Diagnosis Pre-B cell lymphoblastic leukemia, with CNS involvement Post-operative Diagnosis Pre-B cell lymphoblastic leukemia, with CNS involvement Operative Method Ommaya reservoir implantation via right Kocher point Specimen Count And Types Nil Pathology Nil Operative Findings Clear CSF was noted, opening pressure: 5~10cmH2O upon ventricular puncture. Ventricular catheter length: 6.5cm. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position. After shaving, scrubbing, disinfection & draping in sterile fashion, a curved incision was made at right frontal area. A burr hole was then made at right Kocher point, followed by 2 dural tenting stitches. After hemostasis, a small cruciform durotomy was done, followed by ventricular puncture. The Ommaya reservoir along with ventricular catheter was assembled and inserted, and fixed in place after confirmation of smooth CSF flow. The wound was then closed in layers after hemostasis. Operators VS 王國川 Assistants R4 王奐之, PGY 李思慧 相關圖片 陳韋廷 (M,1986/02/14,26y1m) 手術日期 2011/09/01 手術主治醫師 蔡翊新 手術區域 東址 005房 02號 診斷 Head Injury 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 陸惠宗, 時間資訊 07:30 開始NPO 08:57 通知急診手術 10:28 進入手術室 10:30 麻醉開始 10:50 誘導結束 11:00 抗生素給藥 11:22 手術開始 14:00 抗生素給藥 15:10 手術結束 15:10 麻醉結束 15:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 急性硬腦膜下血腫清除術 1 1 L 手術 顱內壓視置入 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 蔡翊新 開立時間: 2011/09/01 15:10 Pre-operative Diagnosis Head injury with left frontotemporoparietal acute SDH and contusional ICH. Post-operative Diagnosis Head injury with left frontotemporoparietal acute SDH and contusional ICH. Operative Method Left frontotemporoparietal craniectomy, resection of left temporalis muscle, removal of SDH and contusional ICH, duroplasty and ICP monitoring. Specimen Count And Types nil Pathology Nil. Operative Findings Initial ICP after first burr hole creation was 26 mmHg. The dura felt slightly tense after craniectomy. SDH, about 1.5 cm in thickness, 15 x 12 cm in area, was noted at left F-T-P region. Several contusion ICHs were evacuated from left temporal lobe, near the base. The temporalis muscle was swollen and it was resected to prevent future epidural compression. The ICP after skin closure was 3 mmHg. Reference level of Codman ICP monitor was 495. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 4 cm at left frontal area, the skin edge was clipped by Raney clips for temporary hemostasis. 5. A burr hole was made at left frontal area and the dura was incised for evacuating part of the subdural hematoma, therefore the IICP could be relieved earlier. A Codman ICP monitor was inserted to check initial ICP. 6. The incision was extended to a temporal horseshoe, and the temporalis muscle was detached from temporal squama by rasp subsequently. 7. Craniotomy window: 15 x 12 cm, left F-T-P, created by making 5 burr holes then cut by power saw. 8. Dural tenting: by 2/0 silk, 2-cm in interval, distributed along the edge of skull window. 9. Dural incision: curvilinear along the edge of skull window. 10.The subdural clot and contusional ICHs were removed by sucker. 11.Hemosatasis: the bleeders was stopped by Bovie and oozing surface was covered with Surgicel. 12.Dural closure: was closed with a piece of dural graft taking from temporalis fascia (crescent shape 15 cm long, 2 cm wide) along the whole length of the dural incision in order to create an additional space for the swollen brain. 13.The skull plate was removed and stored at bone bank for preservation. 14.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 15.Drain: two epidural CWVs. 16.Blood transfusion: nil. Blood loss: 600 ml. 17.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5李振豪R1陸惠宗 Indication Of Emergent Operation conscious disturbance, IICP 相關圖片 蕭錦龍 (M,1946/11/01,65y4m) 手術日期 2011/09/02 手術主治醫師 杜永光 手術區域 東址 003房 03號 診斷 Hydrocephalus 器械術式 Revision of CSF shunt 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 陳國瑋, 時間資訊 09:36 臨時手術NPO 12:15 報到 13:00 進入手術室 13:05 抗生素給藥 13:20 麻醉開始 13:22 誘導結束 13:23 手術開始 13:41 手術結束 13:43 送出病患 13:43 麻醉結束 醫令資訊 類別 名稱 量 刀 側 手術 腦脊髓液分流管重置 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: VP shunt revision 開立醫師: 陳國瑋 開立時間: 2011/09/02 14:03 Pre-operative Diagnosis AVM with hydrocephalus status post VP shunt insertion status post ligation Post-operative Diagnosis AVM with hydrocephalus status post VP shunt insertion status post ligation status post revision with anti-siphon Operative Method VP shunt revision Specimen Count And Types nil Pathology nil Operative Findings Two silk ligation nodes were noted at right clavicular area. The CSF drained smoothly after revision. Operative Procedures The patient was put in supine position. The skin was prepared as usual. One 3 cm transverse skin incision was made. Dissection was done and the shunt tube was identified. One segment of tube was excised and anti-siphon device was implanted. The skin was closed in layers with 4-0 nylon after hemostasis. Operators Prof. 杜永光 Assistants R5 曾峰毅 R3 陳國瑋 相關圖片 胡火亮 (M,1954/03/28,57y11m) 手術日期 2011/09/02 手術主治醫師 杜永光 手術區域 東址 003房 02號 診斷 Unspecified condition of brain 器械術式 Revision of CSF shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 陳國瑋, 時間資訊 23:13 臨時手術NPO 10:47 進入手術室 10:50 麻醉開始 11:00 誘導結束 11:20 抗生素給藥 11:23 手術開始 12:22 手術結束 12:22 麻醉結束 12:37 送出病患 12:40 進入恢復室 15:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 歐氏貯囊置放手術 1 1 摘要__ 手術科部: 外科部 套用罐頭: Ommaya reservoir implantation 開立醫師: 曾峰毅 開立時間: 2011/09/02 12:23 Pre-operative Diagnosis Craniopharyngioma Post-operative Diagnosis Craniopharyngioma Operative Method Ommaya reservoir revision Specimen Count And Types Nil Pathology Nil Operative Findings Yellowish, high viscosity, fluid was drained via the Ommaya after adjustment. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position. After scalp shaved, scrubbed, disinfected, and then draped, we made one curvilinear skin incision along previous operation wound at right frontal area. We transected previous shunt at right Kocher point, and reconnected it with one straight connector. We pulled the Ommaya reservoir out, and cutailed the Ommaya catheter by 2.5 cm, changed the Ommaya reservoir. The wound was closed in layers. Operators P 杜永光 Assistants R5 曾峰毅 R2 陳國瑋 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Ommaya reservoir implantation 開立醫師: 陳國瑋 開立時間: 2011/09/02 12:45 Pre-operative Diagnosis Craniopharyngioma Post-operative Diagnosis Craniopharyngioma Operative Method Ommaya reservoir revision Specimen Count And Types Nil Pathology Nil Operative Findings Yellowish, high viscosity, fluid was drained via the Ommaya after adjustment. Yellowish, high viscosity, fluid was drained via the Ommaya after adjustment. The VP shunt was injured and repaired with straight connector. Yellowish, high viscosity, fluid was drained via the Ommaya after adjustment. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position. After scalp shaved, scrubbed, disinfected, and then draped, we made one curvilinear skin incision along previous operation wound at right frontal area. We transected previous shunt at right Kocher point, and reconnected it with one straight connector. We pulled the Ommaya reservoir out, and cutailed the Ommaya catheter by 2.5 cm, changed the Ommaya reservoir. The wound was closed in layers. Operators P 杜永光 Assistants R5 曾峰毅 R3 陳國瑋 相關圖片 蔡珊珊 (F,1943/09/08,68y6m) 手術日期 2011/09/02 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Acromegaly and gigantism 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 李振豪, 時間資訊 23:41 臨時手術NPO 08:35 報到 08:45 進入手術室 08:50 麻醉開始 09:00 誘導結束 09:31 抗生素給藥 10:20 手術開始 11:30 麻醉結束 11:30 手術結束 11:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經由蝶竇之腦下垂體瘤切除 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: Trans-nasal Trans-sphenoidal adenomectomy 開立醫師: 李振豪 開立時間: 2011/09/02 12:06 Pre-operative Diagnosis Growth hormone-secreting pituitary adenoma Post-operative Diagnosis Growth hormone-secreting pituitary adenoma Operative Method Trans-nasal Trans-sphenoidal adenomectomy Specimen Count And Types 1 piece About size:Multiple small pieces Source:Pituitary adenoma Pathology Pending Operative Findings The tumor was white-yellowish in color, soft to elastic, well-defined, hypervascularized, and 1.4 x 0.7 x 1.3cm in size. Bleeding from cavernous sinus was encountered initially and hemostasis with Gelfoam packing before dura opening. After tumor excision, one vessel was noted at left side of operative field. Arachnoid defect was suspected. But no obvious CSF gushed out during the operation. Tissucol Duo was used for prevent further CSF leakage. The normal gland was not well visualized during the operation. Operative Procedures Under endotracheal general anesthesia, the patient was putin supine position with head tilted 30 degree to left. The nasal cavity was packing with epinephrine soaked gauze for 10 minutes. The face and left lower abdomen were prepared with povidone-iodine alcohol tincture, and the mucosa of oral and nasal cavity with aqueous povidone-iodine tincture. The nasal submucosa at septum and floor were infiltrated with 1:100 epinephrine solution. One 1.5cm incision was made at nasal mucosa of right nasal septum and the musoca was dissected away from the septum. The nasal septum was fractured and the vomer was removed. The sphenoid sinus was entered and the mucosa within the sphenoid sinus was removed. The sellar floor was identified and opened. The bleeding from cavernous sinus was encountered and hemostasis was achieved with Gelfoam packing. Cruciform durotomy was done and the tumor showed up after dura opening. The margin of the tumor was dissected by microdissector. The tumor was then removed by alligator. Hemostasis was achieved and the space was packing with Gelfoam, Tissucol Duo, autologous bone fragment, Tissucol Duo, and Gelfoam. The vomer bone was placed back and the nasal mucosa was pushed back to the neutral position. Tissucol Duo was applied between the nasal mucosa and the vomer bone. The nasal septum and the middle turbinate was pushed back to neutral position. Bilateral nasal cavities were packed with a segment of rubber glove finger which had been soaked with better-iodine ointment. Total blood loss was 200ml. The course of the operation was smooth. Operators VS曾漢民 Assistants R5李振豪, R1陸惠宗 林清香 (F,1955/10/23,56y4m) 手術日期 2011/09/02 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Arteriovenous malformation, brain (AVM) 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 李振豪, 時間資訊 23:42 臨時手術NPO 12:17 進入手術室 12:20 麻醉開始 12:45 誘導結束 12:50 抗生素給藥 13:00 手術開始 15:50 抗生素給藥 17:36 手術結束 17:36 麻醉結束 17:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 開顱術摘除血管病變- 動靜脈畸型大型 1 1 R 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 記錄__ 手術科部: 外科部 套用罐頭: Right temporal craniotomy for cavernous malfo... 開立醫師: 李振豪 開立時間: 2011/09/02 18:22 Pre-operative Diagnosis Right temporal cavernous malformation with repeat bleeding Post-operative Diagnosis Right temporal cavernous malformation with repeat bleeding Operative Method Right temporal craniotomy for cavernous malformation excision Specimen Count And Types 1 piece About size:Multiple pieces Source:Right temporal cavernous malformation Pathology pending Operative Findings Much subacute and chronic hematoma was noted around and within the tumor. The tumor was surrounded by gliotic and siderotic tissue. The tumor was 7x5x3.5cm in size, strawberry-like, well-demarcated, and feeding from the branch of the PCA which mainly located at right temporal area extended into infra-tentorial area. The main trunk of PCA, CN IV, and anterior choroidal artery were preserved during the operation. The SSEP and MEP was monitored during whole procedure and flatening of left upper limb SSEP was noted after total excision of the tumor. The MEP were stationary after tumor excision. The tentorium was not incised. The infra-tentorial part of the tumor was pulled out and removed. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head rotated to left. The scalp was shaved, scrubbed, and disinfected as usual. Reverse U scalp incision was made over right temporal area followed by five burr holes creation. One 7x6cm craniotomy was performed and dural tenting was done. Intra-operative sonography was used for localization of the tumor. The dura was opened with U-shape based with right temporal base. One 2x1cm craniotomy was performed over right inferior temporal area and the tumor was identified. The tumor was excised with bipolar electrocautery, suction, tumor forceps, and microscissor. The hematoma also evacuated during tumor excision. The gliotic and some siderosis was removed also. Hemostasis was achieved with bipolar electrocautery and Surgicel lining. Dura was closed with 4-0 Prolene. The skull plate was fixed back with miniplates/screws, and two central tenting. One subgaleal CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and Appose staples. Operators VS曾漢民 Assistants R5李振豪, R1陸惠宗 相關圖片 李柯金定 (F,1936/11/20,75y3m) 手術日期 2011/09/02 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Cerebral aneurysm 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 4 紀錄醫師 陳以幸, 時間資訊 23:40 臨時手術NPO 08:40 進入手術室 08:40 報到 08:45 麻醉開始 08:50 抗生素給藥 08:50 誘導結束 09:46 手術開始 10:55 麻醉結束 10:55 手術結束 11:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 2 L 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 摘要__ 手術科部: 外科部 套用罐頭: Ventriuloperitoneal shunt via left Kocher point 開立醫師: 王奐之 開立時間: 2011/09/02 10:53 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriuloperitoneal shunt via left Kocher point Specimen Count And Types 1 piece About size:5ml Source:CSF Pathology Nil Operative Findings Clear CSF was noted after ventriculostomy, opening pressure 5~10cmH2O. A fixed medium pressure Medtronic burr hole type reservoir was used. 5ml CSF was collected and sent for CSF routine, BCS & bacterial culture. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to right. After securing the tracheostomy tube, the scalp was shaved, scrubbed, disinfected and draped in sterile fashion. A curved incision was made at left frontal area, followed by burr hole creation at left Kocher point. Two dural tenting stitches were applied, followed by a small cruciate durotomy. A linear incision was then done at right upper quadrant of abdomen, followed by mini-laparatomy. A subcutaneous tunnel was created from the abdominal wound to the left frontal wound, with another small wound in between (near left post-auricular area) for easier passage. After ventricular puncture, the shunt was inserted after its assembly. The wounds were closed in layers after hemostasis and confirmation of smooth CSF flow. Operators VS 賴達明 Assistants R4 王奐之, R2 陳以幸 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Ventriuloperitoneal shunt via left Kocher point 開立醫師: 王奐之 開立時間: 2011/09/02 10:53 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriuloperitoneal shunt via left Kocher point Specimen Count And Types 1 piece About size:5ml Source:CSF Pathology Nil Operative Findings Clear CSF was noted after ventriculostomy, opening pressure 5~10cmH2O. A fixed medium pressure Medtronic burr hole type reservoir was used. 5ml CSF was collected and sent for CSF routine, BCS & bacterial culture. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to right. After securing the tracheostomy tube, the scalp was shaved, scrubbed, disinfected and draped in sterile fashion. A curved incision was made at left frontal area, followed by burr hole creation at left Kocher point. Two dural tenting stitches were applied, followed by a small cruciate durotomy. A linear incision was then done at right upper quadrant of abdomen, followed by mini-laparatomy. A subcutaneous tunnel was created from the abdominal wound to the left frontal wound, with another small wound in between (near left post-auricular area) for easier passage. After ventricular puncture, the shunt was inserted after its assembly. The wounds were closed in layers after hemostasis and confirmation of smooth CSF flow. Operators VS 賴達明 Assistants R4 王奐之, R2 陳以幸 相關圖片 蔡麗美 (F,1955/07/20,56y7m) 手術日期 2011/09/02 手術主治醫師 賴達明 手術區域 東址 019房 02號 診斷 Herniated intervertebral disc (HIVD) 器械術式 Sublaminar decompression , L3/4 and L4/5 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 2 紀錄醫師 陳以幸, 時間資訊 23:46 臨時手術NPO 11:00 報到 11:20 進入手術室 11:25 麻醉開始 11:45 誘導結束 12:30 抗生素給藥 12:45 手術開始 13:50 手術結束 13:50 麻醉結束 14:00 送出病患 14:00 進入恢復室 15:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術(減壓)-二節以內 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: L3 partial laminectomy for sublaminar decompr... 開立醫師: 柯安達 開立時間: 2011/09/02 14:06 Pre-operative Diagnosis L3-4 spinal canal stenosis Post-operative Diagnosis L3-4 spinal canal stenosis Operative Method L3 partial laminectomy for sublaminar decompression Specimen Count And Types Nil Pathology Nil Operative Findings Hypertrophic ligamentum flavum was noted. About 1/2 of L3 lamina was removed to achieve sublaminar decompression. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position. The lower end of L3 spinous process was localized with C-arm. After scrubbing, disinfection & draping in sterile fashion, a midline linear incision was made at L3-4 level. The incision was further deepened until the spinous process was exposed. The paraspinal muscles were detached from the spinous process and lamina. Partial L3 laminectomy & partial left L3-4 facetectomy were performed with rongeur. After endotracheal general anesthesia, the patient was placed in prone position. The lower end of L3 spinous process was localized with C-arm. After scrubbing, disinfection & draping in sterile fashion, a midline linear incision was made at L3-4 level. The incision was further deepened until the spinous process was exposed. The paraspinal muscles were detached from the spinous process and lamina. Partial L3 laminectomy & partial left L3-4 facetectomy were performed with rongeur. The left side ligamentum flavum was then removed in pieces. After hemostasis, the wound was closed in layers. Operators VS 賴達明 Assistants R4 王奐之, R2 陳以幸 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: L3 partial laminectomy for sublaminar decompr... 開立醫師: 王奐之 開立時間: 2011/09/02 14:16 Pre-operative Diagnosis L3-4 spinal canal stenosis Post-operative Diagnosis L3-4 spinal canal stenosis Operative Method L3 partial laminectomy for sublaminar decompression Specimen Count And Types Nil Pathology Nil Operative Findings Hypertrophic ligamentum flavum was noted. About 1/2 of L3 lamina was removed to achieve sublaminar decompression. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position. The lower end of L3 spinous process was localized with C-arm. After scrubbing, disinfection & draping in sterile fashion, a midline linear incision was made at L3-4 level. The incision was further deepened until the spinous process was exposed. The paraspinal muscles were detached from the spinous process and lamina. Partial L3 laminectomy & partial left L3-4 facetectomy were performed with rongeur. The left side ligamentum flavum was then removed in pieces. After hemostasis, the wound was closed in layers. Operators VS 賴達明 Assistants R4 王奐之, R2 陳以幸 相關圖片 陳聰義 (M,1928/12/06,83y3m) 手術日期 2011/09/02 手術主治醫師 賴達明 手術區域 東址 019房 03號 診斷 Disseminated superficial actinic porokeratosis 器械術式 Sublaminar decompression, L4/5 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 2 紀錄醫師 陳以幸, 時間資訊 23:48 臨時手術NPO 14:13 進入手術室 14:15 麻醉開始 14:35 誘導結束 14:40 抗生素給藥 15:13 手術開始 17:10 手術結束 17:10 麻醉結束 17:28 送出病患 17:30 進入恢復室 18:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術(減壓)-二節以內 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Partial L4 laminectomy for sublaminar decompr... 開立醫師: 陳以幸 開立時間: 2011/09/02 17:22 Pre-operative Diagnosis L4-5 spinal canal stenosis Post-operative Diagnosis L4-5 spinal canal stenosis Operative Method Partial L4 laminectomy for sublaminar decompression Specimen Count And Types Nil Pathology Nil Operative Findings Hypertrophic ligamentum flavum was noted. About 1/2 of L4 lamina was removed to achieve sublaminar decompression. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position. The lower end of L4 spinous process was localized with C-arm. After scrubbing, disinfection & draping in sterile fashion, a midline linear incision was made at L4-5 level. The incision was further deepened until the spinous process was exposed. The paraspinal muscles were detached from the spinous process and lamina. Partial L4 laminectomy was performed with rongeur. The ligamentum flavum was then removed in pieces. After hemostasis, the wound was closed in layers. Operators VS 賴達明 Assistants R4 王奐之, R2 陳以幸 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Partial L4 laminectomy for sublaminar decompr... 開立醫師: 王奐之 開立時間: 2011/09/04 11:10 Pre-operative Diagnosis L4-5 spinal canal stenosis Post-operative Diagnosis L4-5 spinal canal stenosis Operative Method Partial L4 laminectomy for sublaminar decompression Specimen Count And Types Nil Pathology Nil Operative Findings Hypertrophic ligamentum flavum was noted. About 1/2 of L4 lamina was removed to achieve sublaminar decompression. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position. The lower end of L4 spinous process was localized with C-arm. After scrubbing, disinfection & draping in sterile fashion, a midline linear incision was made at L4-5 level. The incision was further deepened until the spinous process was exposed. The paraspinal muscles were detached from the spinous process and lamina. Partial L4 laminectomy was performed with rongeur. The ligamentum flavum was then removed in pieces. After hemostasis, the wound was closed in layers. Operators VS 賴達明 Assistants R4 王奐之, R2 陳以幸 相關圖片 李金源 (M,1948/11/09,63y4m) 手術日期 2011/09/02 手術主治醫師 楊士弘 手術區域 東址 002房 02號 診斷 Lumbar spondylosis 器械術式 Debridment-- >10cm 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 陸惠宗, 時間資訊 23:39 臨時手術NPO 11:23 進入手術室 11:30 麻醉開始 11:35 誘導結束 12:20 手術開始 13:20 手術結束 13:20 麻醉結束 13:35 送出病患 13:40 進入恢復室 15:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 深部傷口處理縫合擴創-中 1 0 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: sequestrectomy 開立醫師: 楊士弘 開立時間: 2011/09/02 13:29 Pre-operative Diagnosis Left anterior superior iliac spine avulsion fracture; s/p bone harvest from left anterior iliac crest Post-operative Diagnosis Left anterior superior iliac spine avulsion fracture; s/p bone harvest from left anterior iliac crest Operative Method sequestrectomy Specimen Count And Types nil Pathology nil Operative Findings The left anterior superior iliac spine was separated from the iliac crest. The bone fragment measured about 2.5 cm x 2 cm x 1 cm. Previous bone graft harvest site over iliac crest was filled with some seroseguious fluid. No active bleeder was seen. Operative Procedures 1. ETGA, supine. 2. Incision over previous wound over left anterior iliac crest. 3. Opening of superficial and deep fascia. 4. Detachment of bone fragment from fascia and muscle attachment by monopolar cautery. 5. Saline irrigation of wound. 6. Wound closure in layers. Operators 楊士弘 Assistants 陸惠宗 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: sequestrectomy 開立醫師: 楊士弘 開立時間: 2011/09/02 13:35 Pre-operative Diagnosis Left anterior superior iliac spine avulsion fracture; s/p bone harvest from left anterior iliac crest Post-operative Diagnosis Left anterior superior iliac spine avulsion fracture; s/p bone harvest from left anterior iliac crest Operative Method sequestrectomy Specimen Count And Types nil Pathology nil Operative Findings The left anterior superior iliac spine was separated from the iliac crest. The bone fragment measured about 2.5 cm x 2 cm x 1 cm. Previous bone graft harvest site over iliac crest was filled with some seroseguious fluid. No active bleeder was seen. Operative Procedures 1. ETGA, supine. 2. Incision over previous wound over left anterior iliac crest. 3. Opening of superficial and deep fascia. 4. Detachment of bone fragment from fascia and muscle attachment by monopolar cautery. 5. Saline irrigation of wound. 6. Wound closure in layers. Operators 楊士弘 Assistants 陸惠宗 相關圖片 SHANNON-ALLAN FREDERICK (M,1970/03/24,41y11m) 手術日期 2011/09/02 手術主治醫師 蕭輔仁 手術區域 東址 003房 01號 診斷 Herniated intervertebral disc (HIVD) 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 陳國瑋, 時間資訊 23:37 臨時手術NPO 08:10 進入手術室 08:15 麻醉開始 08:15 抗生素給藥 08:25 誘導結束 09:17 手術開始 10:28 手術結束 10:28 麻醉結束 10:32 送出病患 10:35 進入恢復室 11:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-腰椎 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Microscopic diskectomy, L5-S1 開立醫師: 曾峰毅 開立時間: 2011/09/02 10:31 Pre-operative Diagnosis L5-S1 herniated intervertebral disc Post-operative Diagnosis L5-S1 herniated intervertebral disc Operative Method Microscopic diskectomy, L5-S1 Specimen Count And Types 1 piece About size:pieces Source:L5-S1 posterior element Pathology pending Operative Findings The flavum ligamentum was hypertrophic. The thecal sac and S1 root was compressed tightly by the herniated disc. Neural structures were decompressed well after the surgery. Operative Procedures After ETGA and localization with C-arm, the patient was put in prone position. One midline skin incision was made, and we dissected left paraspinal muscle to expose left L5 lamina. We performed left L5/S1 laminotomy, and removed ligamentum flavum. Diskectomy was performed in piecemeal under microscope. Hemostasis was done, and the wound was closed in layers. Operators VS 蕭輔仁 Assistants R5 曾峰毅 R2 周聖哲 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Microscopic diskectomy, L5-S1 開立醫師: 陳國瑋 開立時間: 2011/09/02 10:38 Pre-operative Diagnosis L5-S1 herniated intervertebral disc Post-operative Diagnosis L5-S1 herniated intervertebral disc Operative Method Microscopic diskectomy, L5-S1 Specimen Count And Types 1 piece About size:pieces Source:L5-S1 ruptured disc Pathology pending Operative Findings The flavum ligamentum was hypertrophic. The thecal sac and S1 root was compressed tightly by the herniated disc. Neural structures were decompressed well after the surgery. Operative Procedures After ETGA and localization with C-arm, the patient was put in prone position. One midline skin incision was made, and we dissected left paraspinal muscle to expose left L5 lamina. We performed left L5/S1 laminotomy, and removed ligamentum flavum. Diskectomy was performed in piecemeal under microscope. Hemostasis was done, and the wound was closed in layers. Operators VS 蕭輔仁 Assistants R5 曾峰毅 R3 陳國瑋 相關圖片 黃偉銘 (M,1964/05/23,47y9m) 手術日期 2011/09/04 手術主治醫師 蔡翊新 手術區域 東址 025房 02號 診斷 Subdural hemorrhage 器械術式 Removal of chronic subdural, bilateral 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 2E 紀錄醫師 劉昌杰, 時間資訊 04:30 臨時手術NPO 04:30 開始NPO 07:16 通知急診手術 11:10 報到 11:25 進入手術室 11:30 麻醉開始 11:35 誘導結束 11:55 抗生素給藥 12:14 手術開始 13:30 手術結束 13:30 麻醉結束 13:35 送出病患 13:40 進入恢復室 14:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 慢性硬腦膜下血腫清除術 1 1 L 手術 慢性硬腦膜下血腫清除術 1 2 R 記錄__ 手術科部: 外科部 套用罐頭: Chronic Subdural Hematoma 開立醫師: 蔡翊新 開立時間: 2011/09/04 13:23 Pre-operative Diagnosis Bilateral frontotemporoparietal chronic subdural hematoma. Post-operative Diagnosis Bilateral frontotemporoparietal chronic subdural hematoma. Operative Method Bilateral frontotemporal burr holes for removal of chronic SDH. Specimen Count And Types nil Pathology Nil. Operative Findings Dark reddish liquified blood gushed out upon opening the dura and outer membranes. The brain remained slack after evacuation of the SDH. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: linear, 4 cm, at bilateral frontotemporal regions. Raney clips were applied to the scalp edge for temporary hemostasis. 5. Two burr holes were made at bilateral frontotemporal region. 6. Dural tenting: by two 2/0 silk. 7. Dural incision: cruciate. 8. The outer membrane of the hematoma was coagulated by Bovie along the edge of dural incision, then incised. 9. The liquified old blood in the subdural space was evacuated by sucker, then thoroughly irrigated with N.S. through a rubber tube until the return was clean. 10.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous sutures with 3/0 Dexon and skin by continuouss suture with 3/0 nylon. 11.Drain: one subdural rubber drain at each side. 12.Blood transfusion: Nil. Blood loss: 200 ml (including chronic SDH). 13.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5曾峰毅R2劉昌杰 Indication Of Emergent Operation Bilateral chronic SDH with brain compression 相關圖片 李正勇 (M,1939/02/23,73y0m) 手術日期 2011/09/05 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Malignant neoplasm of brain, unspecified 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 李振豪, 時間資訊 23:51 臨時手術NPO 08:04 進入手術室 08:15 麻醉開始 08:30 誘導結束 09:00 抗生素給藥 09:10 手術開始 11:35 手術結束 11:35 麻醉結束 11:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Left temporo-parietal craniotomy for tumor ex... 開立醫師: 李振豪 開立時間: 2011/09/05 12:04 Pre-operative Diagnosis Left parietal gliosarcoma, suspect recurrence Post-operative Diagnosis Left parietal gliosarcoma, favor post-irradiation change Operative Method Left temporo-parietal craniotomy for tumor excision Specimen Count And Types 1 piece About size:Multiple small pieces Source:Left parietal tumor Pathology Frozen section: mainly post-irradiation change with small amount residual tumor. No evident recurrence noted. Operative Findings Eschar formation was noted around the scalp wound and post-irradiation change was favored. The dura was adhered to the brain parenchyma with fibrotic change. No obvious brain swelling was noted after durotomy. The cystic part of the tumor was covered with one thick layer of fibrotic tissue. The cystic part was connecting to the ventricle. The tissue within the tumor was fibrotic, yellowish, and hypovascularized in character. Radiation necrosis was favored. The frozen section was checked and the result showed mainly post-irradiation change with few residual tumor. Recurrence was not revealed by the frozen section. The fibrotic part was removed till the normal brain parenchyma was seen. Three pieces of Gliadel was implanted since some residual tumor was reported. Eschar formation was noted around the scalp wound and post-irradiation change was favored. Intra-operative sonography was used for localization of the tumor but no remarkable tumor margin but diffuse hyperechogenesity noted. The dura was adhered to the brain parenchyma with fibrotic change. No obvious brain swelling was noted after durotomy. The cystic part of the tumor was covered with one thick layer of fibrotic tissue. The cystic part was connecting to the ventricle. The tissue within the tumor was fibrotic, yellowish, and hypovascularized in character. Radiation necrosis was favored. The frozen section was checked and the result showed mainly post-irradiation change with few residual tumor. Recurrence was not revealed by the frozen section. The fibrotic part was removed till the normal brain parenchyma was seen. Three pieces of Gliadel was implanted since some residual tumor was reported. No obvious MEP or SSEP change was noted after whole procedure. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head rotated to right. The scalp was shaved, scrubbed, and disinfected as usual. Reverse U scalp incision was made along operative scar. The scalp flap was elevated and the miniplates/screws were identified. The skull plate was removed. Intra-operative sonography was used for localization of the tumor. C-shape durotomy based with temporal base was performed. Tumor excision was performed with bipolar electrocautery, suction, and tumor forceps. Frozen section was checked and post-irradiation change was favored. Small amountn of residual tumor cell was noted by frozen section. After hemostasis, the space connection to left lateral ventricle was sealed off with Gelfoam and Tissucol Duo. Total three pieces of Gliadel was implanted into the tumor bed and sealed with Tissucol Duo. Dura was closed with 4-0 Prolene and sealed with Tissucol Duo + Gelfoam packing. The skull plate was fixed back with miniplates and screws. One subgaleal CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and Appose staples. Operators VS 曾漢民 Assistants R5李振豪, R1陸惠宗 相關圖片 鄭洪美雪 (F,1940/07/22,71y7m) 手術日期 2011/09/05 手術主治醫師 郭順文 手術區域 東址 007房 01號 診斷 Lung cancer 器械術式 Thoracoscopy+Open Chest 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3 紀錄醫師 廖先啟, 劉昌杰, 時間資訊 07:45 報到 08:03 進入手術室 08:15 麻醉開始 08:30 誘導結束 08:40 抗生素給藥 09:10 手術開始 10:39 麻醉結束 10:39 手術結束 10:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 胸腔鏡肺楔狀或部分切除術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: VATS biopsy 開立醫師: 廖先啟 開立時間: 2011/09/05 11:08 Pre-operative Diagnosis LLL lung tumor, adenocarcinoma Post-operative Diagnosis LLL lung tumor, adenocarcinoma Operative Method VATS LLL wedge resection of pulmonary lesion + Gr.5,6,7 LNs dissection. Specimen Count And Types 1 piece about size: 6*5cm; Source: LLL lung with tumor inside Pathology Pending Operative Findings 1. One 2.5*2.0cm, grayish, elastic tumor over LLL. 2. Pleural retraction(+), pleural effusion(-) Operative Procedures 1. Anesthesia: General anesthesia using endotracheal tube with blocker. 2. Position: right decubitus position. An axillary roll is placed under the down side. The operative field is well disinfected and draped. 3. Three VATS working ports setting as usual. 4. The pulmonary lesion is visualized and stabilized with the grasping forceps. 5. The Endo-GIA stapler is placed across its base. Wedge resection of the pulmonary lesion is performed. 6. The specimen issent for pathological examination. 7. Gr.5,6,7 LNs dissection 8. After meticulous homeostasis, one 28# chest tubes is placed via the camera port. 9. N/S irrigation, cloe wound in layers. Operators VS郭順文 Assistants R4廖先啟，R2劉昌杰 諶佳平 (F,1969/12/14,42y3m) 手術日期 2011/09/05 手術主治醫師 曾漢民 手術區域 東址 003房 02號 診斷 Skull benign neoplasm 器械術式 Cranioplasty (remove wire) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 陳國瑋, 時間資訊 15:55 臨時手術NPO 10:18 進入手術室 10:25 麻醉開始 10:30 誘導結束 10:35 抗生素給藥 10:57 手術開始 11:09 手術結束 11:09 麻醉結束 11:21 送出病患 11:25 進入恢復室 12:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 頭顱成形術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Cranioplasty 開立醫師: 陳國瑋 開立時間: 2011/09/05 11:30 Pre-operative Diagnosis osteoma status post resection Post-operative Diagnosis osteoma status post resection status post cranioplasty Operative Method Cranioplasty Specimen Count And Types nil Pathology nil Operative Findings Two wires were noted in proper position and then removed. The bone growth is well, and the skull is steady. Operative Procedures After ETGA, the patient was put in prone position. The hair was shaved along previous wound. The skin was prepared as usual. Skin incision was made along previous wound. After dissection to the skull, two wires were noted and removed. The wound was closed in layers. Operators VS 曾漢民 Assistants R5 曾峰毅 R3 陳國瑋 相關圖片 呂芳燻 (M,1932/01/11,80y2m) 手術日期 2011/09/05 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Brain metastasis 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3 紀錄醫師 李振豪, 時間資訊 12:05 進入手術室 12:05 麻醉開始 12:20 誘導結束 12:30 抗生素給藥 12:53 手術開始 15:25 手術結束 15:25 麻醉結束 15:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Right temporo-parietal craniotomy for tumor e... 開立醫師: 李振豪 開立時間: 2011/09/05 16:04 Pre-operative Diagnosis Right temporal tumor with tumor bleeding, suspect metastasis Post-operative Diagnosis Right temporal tumor with tumor bleeding, favor metastasis Operative Method Right temporo-parietal craniotomy for tumor excision Specimen Count And Types 1 piece About size:1.5 x 2 x 2cm Source:Right temporal tumor Pathology Nil Operative Findings The tumor was 1.5 x 2 x 2cm in size, well-demarcated, hypervascularized, soft to elastic, and gray-reddish in color. The tumor and hematoma was well-visualized under sonography. The hematoma was mainly located at anterior, medial, and inferior direction of the tumor. The brain was swelling and fragile around the tumor. Siderosis around the hematoma also noted. Total tumor excision with en block method was done. No obvious MEP or SSEP change was noted during whole procedure. One 2cm dural laceration was noted at the inferior margin of the craniotomy window and repaired with Durafoam. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head rotated to left. The scalp was shaved, scrubbed, and disinfected as usual. Reverse U scalp incision was made at right temporo-parietal area and the scalp flap was elevated. Four burr holes were created followed by one 6x6cm craniotomy window. Dural tenting was done. Intra-operative sonography was used for localization of the tumor. C-shape durotomy was performed based with temporal base. One 1.5 x 1.5cm corticotomy was created and and the tumor was identified. The tumor was excised en block . The hematoma also evacuated during tumor excision. Hemostasis was achieved with bipolar electrocautery and Surgicel lining. Dura was closed with 4-0 Prolene and Duraform. The skull plate was fixed back with miniplates/screws, and one central tenting. One subgaleal CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS曾漢民 Assistants R5李振豪, R1陸惠宗 相關圖片 蘇惠卿 (F,1948/04/25,63y10m) 手術日期 2011/09/05 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Spondylolisthesis 器械術式 Spinal fusion posterior (remove TPS) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 陳國瑋, 時間資訊 15:55 臨時手術NPO 07:30 報到 08:05 進入手術室 08:15 麻醉開始 08:20 誘導結束 08:30 抗生素給藥 08:47 手術開始 09:55 手術結束 09:55 麻醉結束 10:07 進入恢復室 10:10 送出病患 11:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 骨內固定物拔除術-脊椎 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: L4/5 TPS removal 開立醫師: 陳國瑋 開立時間: 2011/09/05 10:25 Pre-operative Diagnosis Spondylolisthesis status post L4/5 TPS, L4/5 diskectomy, cage insertion and L4 laminectomy Post-operative Diagnosis Spondylolisthesis status post L4/5 TPS, L4/5 diskectomy, cage insertion and L4 laminectomy Operative Method L4/5 TPS removal Specimen Count And Types nil Pathology nil Operative Findings The L4/5 TPS were removed and malposition of left L4 TPS was noted. It was pointing outward. Operative Procedures After ETGA, the patient was put in prone position and the skin was prepared as usual. Skin incision along the previous wound was made and paravertebral muscle groups were then detached. The screws were identified and removed. The wound was irrigated with normal saline and one hemovac was placed. The wound was closed in layers. Operators VS賴達明 Assistants R5曾峰毅 R3陳國瑋 相關圖片 林鳳嬌 (F,1953/08/16,58y6m) 手術日期 2011/09/05 手術主治醫師 蕭輔仁 手術區域 東址 003房 03號 診斷 Other inflammatory spondylopathies 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3 紀錄醫師 陳國瑋, 時間資訊 23:57 臨時手術NPO 11:35 進入手術室 11:40 麻醉開始 12:30 誘導結束 12:35 抗生素給藥 12:51 手術開始 15:15 手術結束 15:15 麻醉結束 15:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎弓切除術(減壓)-二節以內 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 曾峰毅 開立時間: 2011/09/05 15:19 Pre-operative Diagnosis Spondylodiskitis, L5/S1 Post-operative Diagnosis Spondylodiskitis, L5/S1 Operative Method Posterior instrumentation with tranpedicular screws at L5 and S1, posterior decompression with L5 laminectomy, posterolateral fusion with autologous bone graft. Specimen Count And Types Cultures were sent for pathology. Pathology Nil Operative Findings A-spine, 6.5x40 mm transpedicular screws were inserted at L5 pedicles, and 6.5x45 mm, at S1. Easily-touched-bleeding granulation tissue was encountered while L5/S1 diskectomy. No obvious pus or purulent discharge was noted. Operative Procedures With endotrachela general anaesthesia, the patient was put in prone position. We scrubbed, disinfected, and then draped the back, and localized the lesion with C-arm. We made one midlins skin incision and dissected to expose bilateral laminae of L4 to S1. We performed posterior instrumentation with transpedicular screws into bilateral pedicles of L5 and S1. Posterior decompression was done after L5 laminectomy. We tried to performed partial L5/S1 diskectomy, and cultrue was obtained. Posterior fixation was achieved after two 5-cm rods set, and posterolateral fusion with done with autologous bone graft. We set two hemovac, and the wound was closed in layers. Operators VS 蕭輔仁 Assistants R5 曾峰毅 R3 陳國瑋 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 陳國瑋 開立時間: 2011/09/05 15:52 Pre-operative Diagnosis Spondylodiskitis, L5/S1 Post-operative Diagnosis Spondylodiskitis, L5/S1 Operative Method Posterior instrumentation with tranpedicular screws at L5 and S1, posterior decompression with L5 laminectomy, posterolateral fusion with autologous bone graft. Specimen Count And Types Cultures were sent for pathology. Pathology Nil Operative Findings A-spine, 6.5x40 mm transpedicular screws were inserted at L5 pedicles, and 6.5x45 mm, at S1. Easily-touched-bleeding granulation tissue was encountered while L5/S1 diskectomy. No obvious pus or purulent discharge was noted. Operative Procedures With endotrachela general anaesthesia, the patient was put in prone position. We scrubbed, disinfected, and then draped the back, and localized the lesion with C-arm. We made one midlins skin incision and dissected to expose bilateral laminae of L4 to S1. We performed posterior instrumentation with transpedicular screws into bilateral pedicles of L5 and S1. Posterior decompression was done after L5 laminectomy. We tried to performed partial L5/S1 diskectomy, and cultrue was obtained. Posterior fixation was achieved after two 5-cm rods set, and posterolateral fusion with done with autologous bone graft. We set two hemovac, and the wound was closed in layers. Operators VS 蕭輔仁 Assistants R5 曾峰毅 R3 陳國瑋 相關圖片 李進財 (M,1954/01/01,58y2m) 手術日期 2011/09/05 手術主治醫師 王國川 手術區域 東址 003房 04號 診斷 Subdural hemorrhage or effusion 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3 紀錄醫師 陳國瑋, 時間資訊 15:35 報到 15:50 進入手術室 15:53 麻醉開始 16:00 誘導結束 16:10 抗生素給藥 16:28 手術開始 17:25 手術結束 17:25 麻醉結束 18:25 送出病患 18:30 進入恢復室 19:45 離開恢復室 23:03 臨時手術NPO 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦脊髓液分流管重置 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 曾峰毅 開立時間: 2011/09/05 17:19 Pre-operative Diagnosis Hydrocephalus, status post ventriculoperitoneal shunt, complicated with bilatearl subdural effusion Post-operative Diagnosis Hydrocephalus, status post ventriculoperitoneal shunt, complicated with bilatearl subdural effusion Operative Method Left frotal subduroperitoneal shunt Specimen Count And Types Nil Pathology Nil Operative Findings Subdural effusion was clear, and opening pressure at durotomy was little. Codman fixed pressure valve at 1 cmH20, was used for subduroperitoneal shunt. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to right. We shaved, scrubbed, disinfected, and then draped the patient, and one curvilinear scalp incision at left retroauricular area to dissect preveious programmable valve. We made one transverse scalp incision at left frontral area, and drilled one burr hole. Durotomy was made, and we inserted catheter into subdural space. Catheter was pulled out to left retroauricular area, and connected to one Y-shaped connector and to previous programmable ventriculoperitoneal shunt. The wound was closed in layers. Operators VS 王國川 Assistants R5 曾峰毅 R3 陳國瑋 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 陳國瑋 開立時間: 2011/09/05 17:49 Pre-operative Diagnosis Hydrocephalus, status post ventriculoperitoneal shunt, complicated with bilatearl subdural effusion Post-operative Diagnosis Hydrocephalus, status post ventriculoperitoneal shunt, complicated with bilatearl subdural effusion Operative Method Left frotal subduroperitoneal shunt Specimen Count And Types Nil Pathology Nil Operative Findings Subdural effusion was clear, and opening pressure at durotomy was little. Codman fixed pressure valve at 1 cmH20, was used for subduroperitoneal shunt. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to right. We shaved, scrubbed, disinfected, and then draped the patient, and one curvilinear scalp incision at left retroauricular area to dissect preveious programmable valve. We made one transverse scalp incision at left frontral area, and drilled one burr hole. Durotomy was made, and we inserted catheter into subdural space. Catheter was pulled out to left retroauricular area, and connected to one Y-shaped connector and to previous programmable ventriculoperitoneal shunt. The wound was closed in layers. Operators VS 王國川 Assistants R5 曾峰毅 R3 陳國瑋 相關圖片 嚴秀鳳 (F,1962/10/02,49y5m) 手術日期 2011/09/06 手術主治醫師 杜永光 手術區域 東址 002房 01號 診斷 Cerebral aneurysm 器械術式 Left pterion approach for P-com aneurysm clipping 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 05:49 通知急診手術 08:50 進入手術室 09:00 麻醉開始 09:30 誘導結束 10:20 抗生素給藥 10:25 手術開始 13:20 開始輸血 13:20 抗生素給藥 16:25 手術結束 16:30 送出病患 16:30 麻醉結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 7 0 麻醉 C.V.P. catheter in ubation 1 0 手術 開顱術摘除血管病變 - 腦血管瘤 有病徵的 1 1 L 手術 顱內壓視置入 1 2 L 記錄__ 手術科部: 外科部 套用罐頭: Left pterional approach for aneurysm clipping... 開立醫師: 李振豪 開立時間: 2011/09/06 17:19 Pre-operative Diagnosis Left posterior communicating artery aneurysm ruptured with diffuse subarachnoid hemorrhage Post-operative Diagnosis Left posterior communicating artery aneurysm ruptured with diffuse subarachnoid hemorrhage Operative Method Left pterional approach for aneurysm clipping and external ventricular drainage for intracerebral pressure monitoring via left Kocher"s approach Specimen Count And Types 1 piece About size:20ml Source:CSF Pathology Nil Operative Findings Reddish CSF gushed out after durotomy for EVD insertion. The opening pressure of the left lateral ventricle was more than 20cmH2O. The CSF was reddish and mild turbid in character. The CSF was sampled for routine, BCS, and bacterial culture. The EVD was fixed at 6.5cm in depth from brain surface. The aneurysm arised from the origin of left posterior communicating artery and pointing posterior and inferiorly. Pre-mature rupture was encountered during dissection and the first time proximal control was 7~8minutes. The backward flow was still strong after proximal control of ICA and the aneurysm was clipped with one bayonet Sugita clip initially. The bleeding stopped after aneurysm clipping. After resting for 15 minutes, the second time proximal contrl was applied for 5 minutes and the Sugita clip was shifted from bayonet shape to curvilinear shape. The posterior communicating artery was checked again after hemostasis and the pulsation of the P-com artery was well. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head rotated to right and fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. Curvilinear scalp incision was made over left fronto-temporal area and the scalp flap was elevated with facial nerve preservation. One burr hole were created at left Kocher"s point followed by dural tenting. Cruciform durotomy was made and external ventricular drainage was placed for ICP monitoring. The EVD was fixed 6.5cm in depth from brain surface. Externalization was done and the burr hole was packing with Gelfoam. The temporalis muscle and the periosteum was elevated. Three burr holes were created followed by one 8x6cm craniotomy window. Dural tenting was done. The sphenoid ridge was drilled off till superior orbital fissure was exposed. The temporal base was packing with Gelfoam for hemostasis. Curvilinear durotomy was made based with left frontal and temporal base. The Sylvian fissure was opened and the retractor was applied on frontal and temporal lobe for better exposure. The left optic nerve and left internal carotid artery was identified after opening of the arachnoid membrane. Pre-mature rupture was encountered while further exposure of the internal carotid artery. Temporary clip of proximal ICA was applied and the aneurysm was clipped after exposing the neck of the aneurysm. One bayonet Sugita clip was used for aneurysm clipping. Temporary clip was removed and the neck of aneurysm, left P-com artery, and ICA were exposed more clearly. The bayonet Sugita clip was shifted to one curvilinear Sugita clip. Hemostasis was achieved with bipolar electrocautery and Surgicel lining. The dura was closed with small autologous fascia graft. One epidural CWV drain was placed. The skull plate was fixed back with miniplates/screws, and two central tenting. The temporalis muscle was fixed back to the neutral position. The wound was then closed in layers with 2-0 Vicryl and Appose staples. Operators Prof.杜永光, VS蔡翊新 Assistants R5李振豪, PGY李思慧 Indication Of Emergent Operation Cerebral aneurysm rupture with diffuse subarachnoid hemorrhage 相關圖片 鄺雪玲 (F,1939/07/09,72y8m) 手術日期 2011/09/06 手術主治醫師 曾勝弘 手術區域 西址 039房 01號 診斷 Carpal tunnel syndrome 器械術式 Decompression of mediun nerve 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 08:00 報到 08:25 進入手術室 08:25 麻醉開始 08:40 手術開始 09:35 手術結束 09:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 正中神經或尺神經腕部減壓術–單側 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Carpal Tunnel Syndrome 開立醫師: 陳以幸 開立時間: 2011/09/06 09:37 Pre-operative Diagnosis Carpal Tunnel Syndrome Post-operative Diagnosis Carpal Tunnel Syndrome Operative Method median nerve decompression, left hand Specimen Count And Types nil Pathology nil Operative Findings moderate adhesion of transverse carpal ligament Operative Procedures 1.The left hand and forearm were sterilized with povidone-iodinetincture, then covered with stockinet. 2.Anesthesia: regional block with 7 ml 2% Xylocaine solution was infused at wrist area. 3. Incision: vertical palmar crease to transverse wrist crease. 4.The palmaris longus tendon was identified, then the plamar aponeurosis was cut longitidinally along the ulnar side of the palmaris longus tendon. 5. The median nerve was identified beneath the palmars longus tendon. Under direct vision, the transverse carpal ligament was ivided until no more pressure on the median nerve could be palpated. 6. The skin was closed by interrupted suture with 4/0 nylon. 7. The hand and wrist were draped with fluffy dressing and elastic bandage. Operators VS曾勝弘 Assistants R5曾峰毅 R2陳以幸 相關圖片 廖溱家 (F,2008/12/29,3y2m) 手術日期 2011/09/06 手術主治醫師 曾勝弘 手術區域 兒醫 067房 01號 診斷 Aromatic L-amino acid decarboxylase deficiency 器械術式 釘頭 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 石博元 ASA 3 紀錄醫師 王奐之, 時間資訊 23:16 臨時手術NPO 12:20 報到 12:25 進入手術室 12:30 麻醉開始 13:20 誘導結束 13:55 抗生素給藥 14:00 手術開始 14:30 麻醉結束 14:30 手術結束 14:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 頭皮腫瘤 2 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 摘要__ 手術科部: 外科部 套用罐頭: Pin insertion for localization of stereotacti... 開立醫師: 王奐之 開立時間: 2011/09/06 15:08 Pre-operative Diagnosis Aromatic L-amino acid decarboxylase deficiency Post-operative Diagnosis Aromatic L-amino acid decarboxylase deficiency Operative Method Pin insertion for localization of stereotactic procedure Specimen Count And Types Nil Pathology Nil Operative Findings 4 pins were placed at anterior frontal area, while the other 4 pins were placed at bilateral parietal area in symmetric fashion. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position. After shaving, scrubbing, disinfection & draping in sterile fashion, 8 pins were inserted onto the skull. The localization metallic ball were then sticked onto the pins, covered with Op Site. The whole scalp was covered with cotton role. Operators VS 曾勝弘 Assistants R4 王奐之, Ri 何孟穎 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Pin insertion for localization of stereotacti... 開立醫師: 王奐之 開立時間: 2011/09/06 15:08 Pre-operative Diagnosis Aromatic L-amino acid decarboxylase deficiency Post-operative Diagnosis Aromatic L-amino acid decarboxylase deficiency Operative Method Pin insertion for localization of stereotactic procedure Specimen Count And Types Nil Pathology Nil Operative Findings 4 pins were placed at anterior frontal area, while the other 4 pins were placed at bilateral parietal area in symmetric fashion. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position. After shaving, scrubbing, disinfection & draping in sterile fashion, 8 pins were inserted onto the skull. The localization metallic ball were then sticked onto the pins, covered with Op Site. The whole scalp was covered with cotton role. Operators VS 曾勝弘 Assistants R4 王奐之, Ri 何孟穎 相關圖片 黃睿恩 (M,2005/03/07,7y0m) 手術日期 2011/09/06 手術主治醫師 許巍鐘 手術區域 兒醫 062房 01號 診斷 Aromatic L-amino acid decarboxylase deficiency 器械術式 BRONCHOSCOPY 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 3 紀錄醫師 曾家承, 時間資訊 08:18 報到 08:19 進入手術室 08:20 麻醉開始 08:25 誘導結束 08:26 手術開始 08:42 麻醉結束 08:42 手術結束 08:52 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 支氣管鏡檢查 1 0 手術 管、支 管、細支 管異物除去術- 管鏡 1 1 記錄__ 手術科部: 套用罐頭: Flexible bronchoscope,Rigid bronchoscope 開立醫師: 曾家承 開立時間: 2011/09/06 14:46 Pre-operative Diagnosis Obstructive sleep apnea syndrome, laryngomalacia Post-operative Diagnosis Obstructive sleep apnea syndrome, laryngomalacia, saliva aspiration Obstructive sleep apnea syndrome, laryngomalacia, saliva aspiration, subglottic erosion Operative Method Flexible bronchoscope,Rigid bronchoscope Specimen Count And Types one 0.2x0.2 cm interarytenoid soft tissue, one 0.2x0.2 cm upper esophagus Pathology nil Operative Findings Nose______patent______Choana_________patent________ Pharynx: Nasopharynx___________patent______________ Tongue base___________tongue drop_________ Vallecula_____________patent _____________ Hypopharynx___________patent______________ Larynx: Epiglottis____________patent_______________ Aryepiglottic fold_________laryngomalacia___ Arytenoid cartilage________laryngomalacia___ Accesory cartilage_________laryngomalacia____ True vocal fold___________normal___________ False vocal folds___________normal___________ Subglotttis____________some erosion____________ Trachea:____________deviated _______________ Carina: ______________saliva aspiration_____________ Right main bronchus:________saliva aspiration________ Left main bronchus__________saliva aspiration______ Others:___________saliva aspiration___________ Operative Procedures The patient was put in supine position with neck hyperextended. After IVF was setup, flexible bronchoscope was applied into the nostril. From the nasal cavity and nasopharynx till bilateral bronchi were examed. Adenoid vegetation and bilateral tonsillar hypertrophy were noted under the bronchoscopy. The pharynx, larynx, trachea, carina and bilateral bronchi were patent. The patient was put in supine position with neck hyperextended. After IVF was setup, flexible bronchoscope was applied into the nostril. From the nasal cavity and nasopharynx till bilateral bronchi were examed. Laryngomalacia, saliva aspiration and subglottic erosion were noted under the bronchoscopy. The pharynx, larynx, trachea, carina and bilateral bronchi were patent. Then the patient was in supine position. Jet ventilation was used for impending airway obstruction. Rigid bronchoscopy was set and larynx, subglottis, trachea, carina, bilateral main bronchus, and right upper, middle, lower; left upper and lowerbronchus were checked. Operators ASP 許巍鐘, Assistants R2曾家承, R3 林奎佑 陳毓芳 (M,2009/12/21,2y2m) 手術日期 2011/09/06 手術主治醫師 郭夢菲 手術區域 東址 005房 02號 診斷 Subdural hemorrhage, traumatic 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 4E 紀錄醫師 曾峰毅, 時間資訊 20:02 通知急診手術 20:03 開始NPO 20:03 臨時手術NPO 20:25 進入手術室 20:30 麻醉開始 21:00 抗生素給藥 21:00 誘導結束 21:15 手術開始 22:05 開始輸血 22:30 手術結束 22:30 麻醉結束 22:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 急性硬腦膜下血腫清除術 1 1 R 手術 顱內壓視置入 1 2 R 摘要__ 手術科部: 外科部 套用罐頭: Right frontotemporoparietal craniectomy for S... 開立醫師: 曾峰毅 開立時間: 2011/09/06 22:53 Pre-operative Diagnosis Right traumatic acute SDH Post-operative Diagnosis Right traumatic acute SDH Operative Method Right frontotemporoparietal craniectomy for SDH evacuation and subdural ICP monitoring. Specimen Count And Types nil Pathology nil Operative Findings Fracture line was noted over right frontal area. The dura was tense after craniectomy. Acute subdural hematoma was noted. Slight brain pulsation was noted after decompression. The ICP was 7 mmHg after skin closure. The ICP, Codman, referance is 499. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: right temporal horseshoe, the skin edge was clipped by Raney clips for temporary hemostasis. 5. Craniectomy window: 10 x 8 cm, right F-T-P, created by making burr holes then cut by power saw. ICP monitor was inserted to left subdural space. 6. Dural tenting: by 4/0 silk, 2-cm in interval, distributed along the edge of skull window. 7. Dural incision: curvilinear along the edge of skull window. 8. The subdural clot was removed by sucker. 9. Hemosatasis: the bleeders was stopped by Bovie and oozing surface was covered with Gelfoam. 10.Dural closure: was closed with a piece of Duroform in order to create an additional space for the swollen brain. 11.The skull plate was removed and stored at bone bank for preservation. 12.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 3/0 Dexon and skin by continuous suture with 3/0 nylon. 13.Drain: one epidural CWV drain. 14.Blood transfusion: PRBC 1U. 15.Course of the surgery: smooth. Operators VS 郭夢菲 Assistants R5 曾峰毅 Ri 何孟穎 Indication Of Emergent Operation 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Right frontotemporoparietal craniectomy for S... 開立醫師: 郭夢菲 開立時間: 2011/09/07 17:46 Pre-operative Diagnosis Right traumatic acute SDH Post-operative Diagnosis Right traumatic acute SDH Operative Method Right frontotemporoparietal decompressive craniectomy for SDH evacuation and subdural ICP monitoring. Specimen Count And Types nil Pathology nil Operative Findings Fracture line was noted over right frontal area. The dura was tense after craniectomy. Acute subdural hematoma was noted scattering on the surface of brain and temporal region. Slight brain pulsation was noted after decompression. The ICP was 7 mmHg after skin closure. The ICP, Codman, referance is 499. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: right temporal horseshoe, the skin edge was clipped by Raney clips for temporary hemostasis. 5. Craniectomy window: 10 x 8 cm, right F-T-P, created by making burr holes then cut by power saw. ICP monitor was inserted to left subdural space. 6. Dural tenting: by 4/0 silk, 2-cm in interval, distributed along the edge of skull window. 7. Dural incision: curvilinear along the edge of skull window. 8. The subdural clot was removed by sucker. 9. Hemosatasis: the bleeders was stopped by Bovie and oozing surface was covered with Gelfoam. 10.Dural closure: was closed with a piece of Duroform in order to create an additional space for the swollen brain. 11.The skull plate was removed and stored at bone bank for preservation. 12.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 3/0 Dexon and skin by continuous suture with 3/0 nylon. 13.Drain: one epidural CWV drain. 14.Blood transfusion: PRBC 1U. 15.Course of the surgery: smooth. Operators VS 郭夢菲 Assistants R5 曾峰毅 Ri 何孟穎 Indication Of Emergent Operation brain herniation with fixed and asymmetric pupils 相關圖片 賴言瑄 (F,2011/05/13,10m6d) 手術日期 2011/09/06 手術主治醫師 郭夢菲 手術區域 東址 005房 01號 診斷 Lipoma 器械術式 Cord untethering and tumor excision 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:15 麻醉開始 08:25 誘導結束 09:05 抗生素給藥 09:30 手術開始 12:05 抗生素給藥 15:05 抗生素給藥 15:50 手術結束 15:50 麻醉結束 16:00 送出病患 16:05 進入恢復室 17:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 良性脊髓腫瘤切除術 1 1 手術 腦膜或脊突出修補術 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 7 0 摘要__ 手術科部: 外科部 套用罐頭: 1. Cord untethering and myelomeningocele repair 開立醫師: 游健生 開立時間: 2011/09/06 17:25 Pre-operative Diagnosis Lipomyelomeningocele Post-operative Diagnosis Lipomyelomeningocele Operative Method 1. Cord untethering and myelomeningocele repair 2. Lipoma excision Specimen Count And Types 2 piece About size:10x6cm Source:back soft tissue tumor and intraspinal fibrosis band Pathology Pending Operative Findings A soft adipose-tissue like tumor was noted at subcutaneous layer of lumbo-sacral area at the back. It was about 10x6cm in size and extended into spinal canal without capsule. It attached to myelomeningocele tightly and was difficult to separate from it. The L3 right lamina was absent as well as the lamina below L3. The thecal sac herniated from spinal canal forming a myelomeningocele. After opening the dura, the spinal cord was found twisted to left. Its end splitted in half and fused to the myelomeningocele. Nerve stimulation was used to check for nerve function before nerve transection. Operative Procedures Under ETGA, patient was in prone position. After disinfection and draping, we made a fusiform skin incision over the soft tumor. We dissected along the tumor border until we reached its bottom. During dissection, the L2 and L3 spinous process were exposed followed by paraspinal muscle detachment. L2-3 lamina were cut off bilaterally and elevated at the junction of L1/2. The thecal sac was exposed and opened at midline. After CSF drainage, we traced and opened along the dura to define the myelomeningocele. The spinal cord was exposed clearly except its end due to fusion with myelomeningocele. Some atrophic nerve roots were transected for mobilizing spinal cord after nerve stimulation showing no active conduction. The soft tumor was excised in pieces with the help of CUSA to further mobilizing the spinal cord and myelomeningocele. Finally, we freed the end of spinal cord from myelomeningocele and put it back into spinal canal. The dura was closed with part of myelomeningocele after its reduction in size. After hemostasis, we fixed the lamina back to its origin position with silk. The wound was closed in layers with Vircyl and Nylon. Operators VS 郭夢菲 Assistants R4 游健生 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: 1. Cord untethering and myelomeningocele repair 開立醫師: 游健生 開立時間: 2011/09/06 17:25 Pre-operative Diagnosis Lipomyelomeningocele Post-operative Diagnosis Lipomyelomeningocele Operative Method 1. Cord untethering and myelomeningocele repair 2. Lipoma excision Specimen Count And Types 2 piece About size:10x6cm Source:back soft tissue tumor and intraspinal fibrosis band Pathology Pending Operative Findings A soft adipose-tissue like tumor was noted at subcutaneous layer of lumbo-sacral area at the back. It was about 10x6cm in size and extended into spinal canal without capsule. It attached to myelomeningocele tightly and was difficult to separate from it. The L3 right lamina was absent as well as the lamina below L3. The thecal sac herniated from spinal canal forming a myelomeningocele. After opening the dura, the spinal cord was found twisted to left. Its end splitted in half and fused to the myelomeningocele. Nerve stimulation was used to check for nerve function before nerve transection. Operative Procedures Under ETGA, patient was in prone position. After disinfection and draping, we made a fusiform skin incision over the soft tumor. We dissected along the tumor border until we reached its bottom. During dissection, the L2 and L3 spinous process were exposed followed by paraspinal muscle detachment. L2-3 lamina were cut off bilaterally and elevated at the junction of L1/2. The thecal sac was exposed and opened at midline. After CSF drainage, we traced and opened along the dura to define the myelomeningocele. The spinal cord was exposed clearly except its end due to fusion with myelomeningocele. Some atrophic nerve roots were transected for mobilizing spinal cord after nerve stimulation showing no active conduction. The soft tumor was excised in pieces with the help of CUSA to further mobilizing the spinal cord and myelomeningocele. Finally, we freed the end of spinal cord from myelomeningocele and put it back into spinal canal. The dura was closed with part of myelomeningocele after its reduction in size. After hemostasis, we fixed the lamina back to its origin position with silk. The wound was closed in layers with Vircyl and Nylon. Operators VS 郭夢菲 Assistants R4 游健生 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: 1. Cord untethering by excision of the intram... 開立醫師: 郭夢菲 開立時間: 2011/09/07 17:59 Pre-operative Diagnosis Lipomyelocystocele, lumbosacral region with cord herniation and tethered Post-operative Diagnosis Lipomyelocystocele, lumbosacral region with cord herniation and tethered Operative Method 1. Cord untethering by excision of the intramedullary part of lipoma 2. myelomeningocele repair 2. subcutaneous lipoma excision Specimen Count And Types 2 piece About size:10x6cm Source:back soft tissue tumor and intraspinal fibrosis band Pathology Pending Operative Findings A soft adipose-tissue like tumor was noted at subcutaneous layer of lumbo-sacral area at the back. It was about 10x6cm in size and extended into spinal canal without capsule. It attached to myelomeningocele tightly and was difficult to separate from it. The L3 right lamina was absent due to partial bifid, and total bifid (loss of ) lamina below L3. The thecal sac herniated from spinal canal at L3-4 level and formed a myelomeningocele. After opening the dura, the spinal cord was found twisted to left (from caudal view, the cord was clockwise rotated). Its end, the placode was splitted and formed a small terminal ventricle and then fused to the herniated thecal sac. The number of right side nerves was much less than left side. 2. Nerve stimulation was used to check for nerve function before lysis of the tissue. Operative Procedures Under ETGA, patient was in prone position. Intraoperative nerve monitoring was set up. After disinfection and draping, we made a fusiform skin incision over the soft tumor. Under microscopic view, we dissected along the tumor border until we reached its bottom. During dissection, the L2 and L3 spinous process were exposed followed by paraspinal muscle detachment. L2-3 lamina were cut off bilaterally and elevated at the junction of L1/2. The thecal sac was exposed and opened at midline. After CSF drainage, we traced and opened along the dura to define the myelomeningocele. The splitted and deformed placode was exposed clearly except its end due to fusion with the surrounding lipoma The placode was dissected from the surrounding thecal sac after nerve stimulation showing no active conduction. The soft tumor was further excised in pieces with the help of CUSA. Finally, we freed the end of placode from myelomeningocele sac and put it back into spinal canal. The dura was closed with part of hernniated thecal sac after its reduction in size. After hemostasis, we fixed the lamina back to its origin position with silk. The wound was closed in layers with Vicryl and Nylon. Operators VS 郭夢菲 Assistants R4 游健生 相關圖片 趙曉琳 (F,1955/04/10,56y11m) 手術日期 2011/09/06 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Lumbar spondylosis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 23:11 臨時手術NPO 08:05 進入手術室 08:10 麻醉開始 08:20 誘導結束 09:00 抗生素給藥 09:22 手術開始 12:00 抗生素給藥 12:30 開始輸血 12:50 手術結束 12:50 麻醉結束 13:00 送出病患 13:05 進入恢復室 14:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 椎弓切除術(減壓)-二節以內 1 2 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 摘要__ 手術科部: 外科部 套用罐頭: 1. Spinal fixation with transpedicle screws, ... 開立醫師: 鍾文桂 開立時間: 2011/09/06 13:18 Pre-operative Diagnosis Lumbar spondylolisthesis, L4/5. Post-operative Diagnosis Lumbar spondylolisthesis, L4/5. Operative Method 1. Spinal fixation with transpedicle screws, L4/5, and fusion with banna cage. 2. L4 decompressive laminectomy and L4/5 discectomy. Specimen Count And Types nil Pathology Nil. Operative Findings 1. The left superior facet of L5 was removed for discectomy and decompression. 2. Hypertrophic ligamentum flavum; intact dura mater. 3. Internal fixation apparatus: 6.2* 40 mm, rods: 5cm; fusion: banna cage: 11mm. Operative Procedures Under ETGA, the patient was placed in prone position. After ensuring the L4/5 level with intraoperative fluoroscopy, the skin was disinfected and drapped. A vertical midline skin incision was made then paraspinal dissection was obtained. The fixation apparatus was implanted. Ensuring their position was obtained through intraoperative fluoroscopy. L4 decompressive laminectomy was done along with L4/5 discectomy. The banna cage was inserted at L4/5 disc space. After ensuring the cage position, the wound was closed in layers with one 1/8 hemovac in situ. Operators 賴達明 Assistants R6鍾文桂 林蘇月雲 (F,1948/12/15,63y2m) 手術日期 2011/09/06 手術主治醫師 賴達明 手術區域 東址 003房 03號 診斷 Lumbar spondylosis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 23:12 臨時手術NPO 15:55 進入手術室 16:05 麻醉開始 16:15 誘導結束 16:23 抗生素給藥 16:50 手術開始 19:40 手術結束 19:40 麻醉結束 19:50 送出病患 19:55 進入恢復室 21:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術(減壓)-二節以內 1 2 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 摘要__ 手術科部: 外科部 套用罐頭: 1. Internal fixation with transpedicle screws... 開立醫師: 鍾文桂 開立時間: 2011/09/06 20:03 Pre-operative Diagnosis Lumbar spondylolisthesis, L4/5. Post-operative Diagnosis Lumbar spondylolisthesis, L4/5. Operative Method 1. Internal fixation with transpedicle screws, L4/5, and interbody fusion of banana PEEK cage. 2. Decompressive laminectomy, L4. Specimen Count And Types nil Pathology Nil. Operative Findings 1. A small incidental durotomy while implanting the PEEK cage. 2. Internal fixation: screws: 40x 6.2mm ; rods: 5mm, right, 6mm, left; banana PEEK cage: 11mm. Operative Procedures Under ETGA, the patient was placed in prone position. After disinfection and draping, a midline skin incision was made. After paraspinal dissection, L4 and L5 facet jounts were identified. The pedicle screws were inserted. Decompressive L4 laminectomy was done later. Then, the L4/5 disc were removed piece by piece. The banana cage was inserted into the disc space. The internal fixation apparatus was set. The cage position and the screws position were ensured by intraoperative fluoroscopy. After a 1/8 hemovac at epidural space, the wound was closed in layers. Operators 賴達明 Assistants R5 鍾文桂 陳坤 (M,1930/11/06,81y4m) 手術日期 2011/09/06 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Lumbar Spondylosis 器械術式 Sublaminar decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 23:13 臨時手術NPO 13:10 進入手術室 13:10 麻醉開始 13:15 誘導結束 13:30 抗生素給藥 13:57 手術開始 15:30 手術結束 15:30 麻醉結束 15:40 送出病患 15:40 進入恢復室 16:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 椎弓切除術(減壓)-二節以內 1 1 摘要__ 手術科部: 外科部 套用罐頭: Sublaminar decompression, L3-5. 開立醫師: 鍾文桂 開立時間: 2011/09/06 15:37 Pre-operative Diagnosis Lumbar stenosis, L3-5. Post-operative Diagnosis Lumbar stenosis, L3-5. Operative Method Sublaminar decompression, L3-5. Specimen Count And Types nil Pathology Nil. Operative Findings 1. Hypertrophic ligamentum flavum. 2. Approached through right hemilaminectomy from L3 to L5 levels. 2. Approached through right hemilaminectomy from lower margin of L3 and L4. 3. The roots were slack after decompression. Intact dura mater. Operative Procedures Under ETGA, the patient was placed in prone position. The L3-5 levels were checked by intraoperative dluoroscopy. After disinfection and draping, midline skin incision was made. Splitting of the spinous process was done by oscillating saw. The hemilaminectomy was achieved by kerrison and rongeur. The ligamentum flavum was removed. As the roots were slack after decompression, the wound was closed in layers. Operators 賴達明 Assistants R5 曾峰毅 R6 鍾文桂 郭榮富 (M,1957/12/03,54y3m) 手術日期 2011/09/06 手術主治醫師 蕭輔仁 手術區域 西址 039房 02號 診斷 Lipoma 器械術式 Excision of neuroma 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 09:55 進入手術室 10:00 麻醉開始 10:08 誘導結束 10:09 手術開始 10:50 手術結束 10:50 麻醉結束 11:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 皮下腫瘤摘除術中2-4 CM 1 1 摘要__ 手術科部: 外科部 套用罐頭: Tumor excision 開立醫師: 陳以幸 開立時間: 2011/09/06 10:53 Pre-operative Diagnosis subcutaneous tumor Post-operative Diagnosis subcutaneous tumor Operative Method Excision of subcutaneous tumor Specimen Count And Types 1 piece About size: Source:subcutaneous tumor Pathology pending Operative Findings 1. A　2x2 cm well-capsulated, round, soft tumor was remvoed. Operative Procedures 1. Local anesthesia, supine position 2. Skin disinfection. 3. Skin incision at tumor site. 4. Tumor excision was done with electrocautery knife. 5. Wound irrigation, hemostasis. 6. Close wounds in layers with 2-0 Vicryl, 4-0 Nylon. Operators VS蕭輔仁 Assistants R5曾峰毅 R2陳以幸 周耀東 (M,1963/07/11,48y8m) 手術日期 2011/09/06 手術主治醫師 紀乃新 手術區域 東址 016房 01號 診斷 Coronary atherosclerosis, coronary artery disease 器械術式 C.A.B.G.(Dr.- LIN P) 手術類別 緊急手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 4E 紀錄醫師 陳建銘, 時間資訊 20:45 臨時手術NPO 20:45 開始NPO 05:00 通知急診手術 08:45 報到 08:45 進入手術室 08:50 麻醉開始 09:35 誘導結束 09:40 抗生素給藥 10:04 手術開始 12:40 抗生素給藥 13:15 開始輸血 14:25 麻醉結束 14:25 手術結束 14:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 放置肺動脈導管術 1 0 麻醉 Cardiac out-put 1 0 麻醉 Swan-gang catheterization 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 冠狀動脈繞道手術-二條血管 1 1 記錄__ 手術科部: 外科部 套用罐頭: OPCAB 開立醫師: 陳建銘 開立時間: 2011/09/09 18:28 Pre-operative Diagnosis CAD,2VD s/p POBAS with ISRS, unstable angina Post-operative Diagnosis CAD,2VD s/p POBAS with ISRS, unstable angina Operative Method OPCAB Specimen Count And Types nil Pathology nil Operative Findings cardiomegaly(-),fair contractility CAG: LAD 50% Lcx hypoplasia RCA distal total occlusion-->POBAS with ISRS Revascularization:SVG:AsAo-->PLA(1.5)-->PDA(2.0) LIMA harvested but abandoned due to poor flow pericardium closure(+) Operative Procedures ETGA,supine midline sternotomy harvest LIMA and left GSV Connect SVG to AsAo Connect SVG to AsAo then,PLA,PDA sequentially hemostasis, set two chest tubes wound closure in layer Operators VS紀乃新 Assistants R5黃俊銘 R3陳建銘 Indication Of Emergent Operation unstable angina 蘇靖淳 (F,1998/03/15,13y11m) 手術日期 2011/09/06 手術主治醫師 華筱玲 手術區域 兒醫 063房 02號 診斷 Urinary tract infection (UTI) 器械術式 TAH 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 2 紀錄醫師 蔡可欣, 時間資訊 09:42 報到 10:00 進入手術室 10:05 麻醉開始 10:10 誘導結束 10:25 抗生素給藥 10:34 手術開始 12:30 手術結束 12:30 麻醉結束 12:53 送出病患 12:55 進入恢復室 14:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 一般全子宮切除術,經腹部 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 婦產部 套用罐頭: TAH 開立醫師: 蔡可欣 開立時間: 2011/09/06 12:21 Pre-operative Diagnosis Down syndrome Post-operative Diagnosis Down syndrome Operative Method Total abdominal hysterectomy and bilateral tubal ligation Specimen Count And Types 1 piece About size:6x4x2cm Source:uterus Pathology Pending Operative Findings 1. Uterus: avfl, 6x4x2cm, grossly normal 2. RAD: grossly normal 3. LAD: grossly normal 4. CDS: free of adhesion 5. Estimated blood loss:30ml Blood transfusion:nil Complication:nil Operative Procedures 1. Under ETGA, put the patient on the lithotomy position, and on Foley. 2. Skin disinfection with beta-iodine and skin draping. 3. Make a Pfannenstiel skin incision and open the abdominal wall layer by layer. 4. Apply autoretractorand pack up the intestines to expose uterus. 5. Clamp, cut and ligate the bilateral round ligaments & open the broad ligaments anteriorly along the side of uterus downward to vesicouterine fold bilaterally. 6. Clamp, cut and ligate bilateral ovarian ligaments and tubes. 7. Dissect the densely adherent posterior leaf of broad ligaments overlying the uterosacral ligaments bilaterally. 8. Dissect and reflect the bladder downwards and off the uterus. 9. Clamp, cut and ligate the ascending branches of uterine arteries bilaterally at the level of isthmus of cervix. 10. Clamp, cut and ligate the paracervical vessels along lateral borders of cervix step by step downward bilaterally till the level of lateral vaginal fornix. 11. Cut the uterus and grasp the vaginal stump by Kockers. 12. Suture the vaginal stump with 1-0 vicryl sutures. 13. Fix the stumps of bilateral adnexa with the angles of vaginal stump. 14. Check bleeding and reperitonealization 15. Closethe abdomen layer by layer. 16. Skin approximation with 4-0 Dexon. Operators 華筱玲, Assistants 吳晉睿, 蔡可欣, 吳昱霄 (M,1986/07/12,25y8m) 手術日期 2011/09/07 手術主治醫師 曾漢民 手術區域 東址 003房 01號 診斷 Leg mass 器械術式 Leg neuroma excision 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 詹偉弘 ASA 1 紀錄醫師 陳以幸, 時間資訊 19:42 臨時手術NPO 07:32 報到 08:05 進入手術室 08:15 麻醉開始 08:20 抗生素給藥 08:20 誘導結束 08:30 手術開始 09:15 手術結束 09:15 麻醉結束 09:20 送出病患 09:25 進入恢復室 10:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 皮下肌肉或深部異物取出術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 摘要__ 手術科部: 外科部 套用罐頭: tumor excision 開立醫師: 陳以幸 開立時間: 2011/09/07 09:14 Pre-operative Diagnosis right foot neuroma Post-operative Diagnosis right foot neuroma Operative Method tumor excision Specimen Count And Types 1 piece About size: Source:neuroma Pathology pending Operative Findings one firm, elastic, , well-defined, yellowish soft tumor was noted over right foot, medial side Operative Procedures under intravascular anesthesia, the patient was put as supine position. Skin incision from medial side of right foot, ankle area. After dissecting the subcutaneous tissue and tendon sheath, the tumor was noted over the posterior tibial nerve. Via the assistence of dissector and knife, the tumor was removed totally without injury to adjesent tissue. After adequate hemostasis, the wound was closed in layers. Operators VS曾漢民 Assistants R5曾峰毅 R2陳以幸 相關圖片 徐萬玉如 (F,1939/10/11,72y5m) 手術日期 2011/09/07 手術主治醫師 曾漢民 手術區域 東址 005房 03號 診斷 Pituitary tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 李振豪, 時間資訊 23:44 臨時手術NPO 15:08 進入手術室 15:15 麻醉開始 15:45 誘導結束 15:48 抗生素給藥 16:13 手術開始 17:10 手術結束 17:10 麻醉結束 17:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經由蝶竇之腦下垂體瘤切除 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Trans-nasal, trahs-sphenoidal adenomectomy 開立醫師: 李振豪 開立時間: 2011/09/07 17:21 Pre-operative Diagnosis Pituitary macroadenoma Post-operative Diagnosis Pituitary macroadenoma Operative Method Trans-nasal, trahs-sphenoidal adenomectomy Specimen Count And Types 1 piece About size:Multiple small pieces Source:pituitary tumor Pathology Pending Operative Findings The tumor was white-yellowish in color, soft and fragile, well-defined, hypervascularized, and 3 x 2 x 2.2cm in size. Small cystic component with some clear content was noted during tumor excision. After total removal of the tumor, the normal gland was noted over upper part of the cavity. The arachnoid pouch was intact. No evident CSF leakage was noted after whole procedure. The tumor was white-reddish in color, soft and fragile, well-defined, hypervascularized, and 3 x 2 x 2.2cm in size. Small cystic component with some clear content was noted during tumor excision. After total removal of the tumor, the normal gland was noted over upper part of the cavity. The arachnoid pouch was intact. No evident CSF leakage was noted after whole procedure. Operative Procedures Under endotracheal general anesthesia, the patient was putin supine position with head tilted 30 degree to left. The nasal cavity was packing with epinephrine soaked gauze for 10 minutes. The face and left lower abdomen were prepared with povidone-iodine alcohol tincture, and the mucosa of oral and nasal cavity with aqueous povidone-iodine tincture. The nasal submucosa at septum and floor were infiltrated with 1:100 epinephrine solution. One 1.5cm incision was made at nasal mucosa of right nasal septum and the musoca was dissected away from the septum. The nasal septum was fractured and the vomer was removed. The sphenoid sinus was entered and the mucosa within the sphenoid sinus was removed. The sellar floor was identified and opened. Cruciform durotomy was done and the tumor showed up after dura opening. Tumor excision was performed with ring curette, tumor forceps, and suction. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. The bony fragment and vomer was placed back. The nasal mucosa was pushed back and bilateral nasal cavity were packing with a segment of rubber glove finger which had been soaked with better-iodine ointment. Operators VS曾漢民 Assistants R5 李振豪, R1陸惠宗 陳碧珠 (F,1958/07/26,53y7m) 手術日期 2011/09/07 手術主治醫師 蔡瑞章 手術區域 東址 005房 01號 診斷 Cervical spondylosis 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 李振豪, 時間資訊 23:40 臨時手術NPO 07:45 報到 08:03 進入手術室 08:10 麻醉開始 08:30 誘導結束 08:50 抗生素給藥 08:58 手術開始 11:50 抗生素給藥 12:30 手術結束 12:30 麻醉結束 12:45 送出病患 12:48 進入恢復室 14:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-頸椎 1 1 R 手術 椎間盤切除術-頸椎 1 2 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: C5/6, C6/7 anterior cervical diskectomy, fora... 開立醫師: 李振豪 開立時間: 2011/09/07 12:43 Pre-operative Diagnosis Cervical stenosis with radiculopathy, C5/6, C6/7 Post-operative Diagnosis Cervical stenosis with radiculopathy, C5/6, C6/7 Operative Method C5/6, C6/7 anterior cervical diskectomy, foraminotomy, and fusion and PEEK cage Specimen Count And Types nil Pathology Nil Operative Findings Anterior marginal spur formation was noted over C5/6 and C6/7 disc level. The disc was relative health in character. Herniated disc, posterior marginal spur, and hypertrophic posterior longitudinal ligment was noted which compressed the thecal sac and root. The thecal sac expanded well after whole procedure. The neural foramen also wide opened for decompression. No CSF leakage, incidental durotomy, or EP change noted during whole procedure. Easily bleeding from epidural space was noted after decompression and packing with Gelfoam for hemostasis. Anterior marginal spur formation was noted over C5/6 and C6/7 disc level. The disc was relative health in character. Herniated disc, posterior marginal spur, and hypertrophic posterior longitudinal ligment was noted which compressed the thecal sac and root. The thecal sac expanded well after whole procedure. The neural foramen also wide opened for decompression. One #6 and one #7 PEEK cage filled with artificial bone graft was implanted into C5/6 and C6/7 disc space respectively for anterior fusion. No CSF leakage, incidental durotomy, or EP change noted during whole procedure. Easily bleeding from epidural space was noted after decompression and packing with Gelfoam for hemostasis. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with neck extension. The skin was scrubbed, disinfected, and draped as usual. Transverse skin incision was made at right lower neck and the subcutaneous tissue was devided to expose the platysma muscle. The fascia between bilateral platysma and strip muscle was opened and thyroid gland was identified. Dissection was performed along the plan between thyroid gland and carotid sheath. The thyroid gland, trachea, and esophagus was retracted to left side and the prevertebral fascia was exposed. After oepning the prevertebral fascia, two spinal needle was used for localization of the disc level. Portable C-arm X-ray was used and the C5/6, C6/7 disc level were confirmed. Under operative microscope, anterior cervical diskectomy was performed with knife, curette, kerrison punches, and Midas air-drived drills. The posterior longitudinal ligment also resected for decompression. Bilateral foraminotomy, especially right side was performed for radiculopathy. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. One #6 and one #7 PEEK cage filled with artificial bone graft were inserted to C5/6, and C6/7 disc level for anterior fusion. The location of the cage was checked by C-arm X-ray. One MiniHemovac was placed. The wound was then closed in layers with 3-0 Vicryl and 4-0 Dexon. Operators Prof.蔡瑞章 Assistants R5李振豪, R1陸惠宗 相關圖片 廖溱家 (F,2008/12/29,3y2m) 手術日期 2011/09/07 手術主治醫師 曾勝弘 手術區域 兒醫 061房 01號 診斷 Aromatic L-amino acid decarboxylase deficiency 器械術式 Stereotaxic procedure for impl 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 王奐之, 時間資訊 23:50 臨時手術NPO 08:45 報到 08:50 進入手術室 08:52 麻醉開始 09:05 誘導結束 09:18 手術開始 13:00 抗生素給藥 15:20 麻醉結束 15:20 手術結束 15:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 立體定位術-功能性失調 1 1 B 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 動脈血液檢查全套 3 0 麻醉 Hemoglobin (Hb) 3 0 麻醉 測血糖 3 0 麻醉 Ca (Calcium) 3 0 麻醉 Na (Sodium) 3 0 麻醉 K (Potassium) 3 0 麻醉 Blood gas analysis 3 0 手術 顱骨切除術,包括異物移除或壓或經切斷 1 2 B 摘要__ 手術科部: 套用罐頭: Stereotactic viral vectors delivery to bilate... 開立醫師: 王奐之 開立時間: 2011/09/07 15:51 Pre-operative Diagnosis Aromatic L-amino acid decarboxylase deficiency Post-operative Diagnosis Aromatic L-amino acid decarboxylase deficiency Operative Method Stereotactic viral vectors delivery to bilateral putamen (for gene therapy) Specimen Count And Types 0.5*0.5*0.5cm 1 piece About size:0.5*0.5*0.5cm Source:right frontal bone tumor Pathology Nil Operative Findings A small yellowish bone tumor was noted at right frontal area near the right frontal entry point, suspected epidermoid cyst; the tumor was removed en bloc and sent for pathology. Adeno-associated virus was used as vector to deliver the AADC gene, 80 microliters/each were infused to 4 pre-planned spots (at anterior & posterior putamen). Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head fixed in Mayfield skull clamp. After scrubbing, disinfection & draping with large Op Site, bilateral frontal entry points were marked with K-pin under navigation. A bicoronal incision was made across the 2 entry points, followed by creation of 2 burr holes around the entry points. After tenting stitches, small durotomies were done, and Tissucol Duo were applied to the pial surface for hemostasis. After setting up of the navigation system, puncture needle was inserted to the desired depth according to the calculation from CT images. Viral vectors were then infused via the puncture needle. The wound was then closed in layers. Operators VS 曾勝弘 Assistants R4 王奐之, Ri 何孟穎 相關圖片 記錄__ 手術科部: 套用罐頭: Stereotactic viral vectors delivery to bilate... 開立醫師: 王奐之 開立時間: 2011/09/07 15:52 Pre-operative Diagnosis Aromatic L-amino acid decarboxylase deficiency Post-operative Diagnosis Aromatic L-amino acid decarboxylase deficiency Operative Method Stereotactic viral vectors delivery to bilateral putamen (for gene therapy) Specimen Count And Types 1 piece About size:0.5*0.5*0.5cm Source:right frontal bone tumor Pathology Nil Operative Findings A small yellowish bone tumor was noted at right frontal area near the right frontal entry point, suspected epidermoid cyst; the tumor was removed en bloc and sent for pathology. Adeno-associated virus was used as vector to deliver the AADC gene, 80 microliters/each were infused to 4 pre-planned spots (at anterior & posterior putamen). Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head fixed in Mayfield skull clamp. After scrubbing, disinfection & draping with large Op Site, bilateral frontal entry points were marked with K-pin under navigation. A bicoronal incision was made across the 2 entry points, followed by creation of 2 burr holes around the entry points. After tenting stitches, small durotomies were done, and Tissucol Duo were applied to the pial surface for hemostasis. After setting up of the navigation system, puncture needle was inserted to the desired depth according to the calculation from CT images. Viral vectors were then infused via the puncture needle. The wound was then closed in layers. Operators VS 曾勝弘 Assistants R4 王奐之, Ri 何孟穎 相關圖片 摘要__ 手術科部: 套用罐頭: 1. Craniectomy to excise skull tumor 開立醫師: 王奐之 開立時間: 2011/09/08 17:16 Pre-operative Diagnosis Aromatic L-amino acid decarboxylase deficiency Post-operative Diagnosis Aromatic L-amino acid decarboxylase deficiency Operative Method 1. Craniectomy to excise skull tumor 2. Stereotactic viral vectors delivery to bilateral putamen (for gene therapy) Specimen Count And Types 1 piece About size:0.5*0.5*0.5cm Source:right frontal bone tumor Pathology Nil Operative Findings A small yellowish bone tumor was noted at right frontal area near the right frontal entry point, suspected epidermoid cyst; the tumor was removed en bloc and sent for pathology. Adeno-associated virus was used as vector to deliver the AADC gene, 80 microliters/each were infused to 4 pre-planned spots (at anterior & posterior putamen). Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head fixed in Mayfield skull clamp. After scrubbing, disinfection & draping with large Op Site, bilateral frontal entry points were marked with K-pin under navigation. A bicoronal incision was made across the 2 entry points, followed by creation of 2 burr holes around the entry points. After tenting stitches, small durotomies were done, and Tissucol Duo were applied to the pial surface for hemostasis. After setting up of the navigation system, puncture needle was inserted to the desired depth according to the calculation from CT images. Viral vectors were then infused via the puncture needle. The wound was then closed in layers. Operators VS 曾勝弘 Assistants R4 王奐之, Ri 何孟穎 相關圖片 記錄__ 手術科部: 套用罐頭: 1. Craniectomy to excise skull tumor 開立醫師: 王奐之 開立時間: 2011/09/08 17:16 Pre-operative Diagnosis Aromatic L-amino acid decarboxylase deficiency Post-operative Diagnosis Aromatic L-amino acid decarboxylase deficiency Operative Method 1. Craniectomy to excise skull tumor 2. Stereotactic viral vectors delivery to bilateral putamen (for gene therapy) Specimen Count And Types 1 piece About size:0.5*0.5*0.5cm Source:right frontal bone tumor Pathology Nil Operative Findings A small yellowish bone tumor was noted at right frontal area near the right frontal entry point, suspected epidermoid cyst; the tumor was removed en bloc and sent for pathology. Adeno-associated virus was used as vector to deliver the AADC gene, 80 microliters/each were infused to 4 pre-planned spots (at anterior & posterior putamen). Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head fixed in Mayfield skull clamp. After scrubbing, disinfection & draping with large Op Site, bilateral frontal entry points were marked with K-pin under navigation. A bicoronal incision was made across the 2 entry points, followed by creation of 2 burr holes around the entry points. After tenting stitches, small durotomies were done, and Tissucol Duo were applied to the pial surface for hemostasis. After setting up of the navigation system, puncture needle was inserted to the desired depth according to the calculation from CT images. Viral vectors were then infused via the puncture needle. The wound was then closed in layers. Operators VS 曾勝弘 Assistants R4 王奐之, Ri 何孟穎 相關圖片 楊婷儒 (F,1994/07/29,17y7m) 手術日期 2011/09/07 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Moyamoya disease 器械術式 EDAS for Moyamoya 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 08:06 進入手術室 08:15 麻醉開始 08:30 抗生素給藥 08:50 誘導結束 09:34 手術開始 11:30 抗生素給藥 13:15 手術結束 13:15 麻醉結束 13:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱內外血管吻合術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 朴卜勒氏血流測定（週邊血管） 1 0 摘要__ 手術科部: 外科部 套用罐頭: Right fronto-temporal craniotomy for encephal... 開立醫師: 游健生 開立時間: 2011/09/07 14:38 Pre-operative Diagnosis Moyamoya disease Post-operative Diagnosis Moyamoya disease Operative Method Right fronto-temporal craniotomy for encephalo-duro-arteriosynangiosis (EDAS) Specimen Count And Types nil Pathology Nil Operative Findings The posterior branch of superficial temporal artery was used for EDAS. Its lenght was about 7cm and diameter was 1.3mm. It was placed on fronto-temporal pia surface and had direct contact to three cortical arteries. Operative Procedures Under ETGA, patient was in supine position with head rotated to left and right shoulder elevated. We mapped the route of posterior branch of STA by doppler. After shavning, we disinfected and draped the operation field as usual. A reversed L-shape scalp incision was made just anterior to main STA from tragus, extented along post. branch of STA and crossed it at its bifurcation. The scalp flap was elevated without galea leaving post. branch of STA in situ. Then, a segment of post. branch of STA was isolated together with some galea. The temporalis muscle was splitted in half vertically and retracted to expose cranium. A burhole was created at superior and inferior end followed by craniotomy. Dura tenting along craniotomy window border was done. Dura was opened vertically and retracted. The arachnoid membrane over cortical artery was torn open for direct contact to the STA segment. Total three cortical arteries were chosen at fronto-temporal lobe surface for arteriosynangiosis. The isoloated STA segment was fixed by interrupted sutures to dura and covered by Surgicel. Dura was approximated by 3-0 Prolene continuous suture and covered by DuraForm. The bone flap was fixed back by 4 wires after central tenting. The temporalis muscle was approximated by interrupted silk sutures. Skin was closed by 2-0 Vicryl and 3-0 Nylon. Operators VS 郭夢菲 Assistants R4 游健生 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Right fronto-temporal craniotomy for encephal... 開立醫師: 郭夢菲 開立時間: 2011/09/07 17:43 Pre-operative Diagnosis Moyamoya disease Post-operative Diagnosis Moyamoya disease Operative Method Right fronto-temporal craniotomy for encephalo-duro-arteriosynangiosis (EDAS) Specimen Count And Types nil Pathology Nil Operative Findings The posterior branch of right superficial temporal artery was used for EDAS. Its lenght was about 7cm and diameter was 1.3mm. It was placed on fronto-temporal pia surface and had direct contact to three cortical arteries of right MCA Operative Procedures Under ETGA, patient was in supine position with head rotated to left and right shoulder elevated. We mapped the route of posterior branch of STA by doppler. After shavning, we disinfected and draped the operation field as usual. A reversed L-shape scalp incision was made just posterior to main STA from tragus, extented along post. branch of STA and crossed it at its bifurcation. Under microscopic view, the scalp flap was elevated without galea leaving post. branch of STA in situ. Then, a segment of post. branch of STA was isolated together with surrounding galea. The temporalis muscle was splitted in half vertically and retracted to expose cranium. A burhole was created at superior and inferior end followed by craniotomy. Dura tenting along craniotomy window border was done. Dura was opened vertically and retracted. The arachnoid membrane over cortical artery was torn open for direct contact to the STA segment. Total three cortical arteries were chosen at fronto-temporal lobe surface for arteriosynangiosis. The isoloated STA segment was fixed by 4 anchring sutures to dura and covered by gelfoam. Dura was approximated by 3-0 Prolene continuous suture and covered by DuraForm. The bone flap was fixed back by 4 wires after central tenting. The temporalis muscle was approximated by interrupted silk sutures. Skin was closed by 2-0 Vicryl and 3-0 Nylon. Operators VS 郭夢菲 Assistants R4 游健生 相關圖片 丁培勳 (M,1943/10/10,68y5m) 手術日期 2011/09/07 手術主治醫師 許榮彬 手術區域 東址 018房 01號 診斷 Mitral valve insufficiency and aortic valve stenosis 器械術式 A.V.R.，M.V.R. 請排二位刷手 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 4 紀錄醫師 陳建銘, 時間資訊 09:25 報到 09:25 進入手術室 09:30 麻醉開始 10:20 誘導結束 10:30 抗生素給藥 10:56 手術開始 13:30 抗生素給藥 15:05 麻醉結束 15:05 手術結束 15:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 體外心肺循環 1 1 手術 瓣膜成形術 1 2 手術 主動脈瓣或二尖瓣或三尖瓣之置換手術 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 放置肺動脈導管術 1 0 麻醉 Cardiac out-put 1 0 麻醉 Swan-gang catheterization 1 0 麻醉 T.E.E 1 0 麻醉 Lactic Acid (lactate) 4 0 麻醉 動脈血液檢查全套 4 0 麻醉 Hemoglobin (Hb) 4 0 麻醉 測血糖 4 0 麻醉 Ca (Calcium) 4 0 麻醉 Na (Sodium) 4 0 麻醉 K (Potassium) 4 0 麻醉 Blood gas analysis 4 0 記錄__ 手術科部: 外科部 套用罐頭: AVR and MVP 開立醫師: 羅健洺 開立時間: 2011/09/07 15:50 Pre-operative Diagnosis Moderate to severe AS, IE with moderate MR, CHF, ESRD Post-operative Diagnosis Moderate to severe AS, moderate MR, CHF, ESRD Operative Method AVR and MVP Specimen Count And Types aortic valve leaflets Pathology Pending Operative Findings 1. Cardioemgaly, fair heart contractility 2. No obvious vegetation was found over mitral valve and aortic valve, no evidence of IE 3. Severe calcification at aortic valve leaflets, leads to limited opening, moderate to severe AS 4. Mitral valve: no obvious pathology was found and mild central ject was noted, suspect functional MR 5. One calcified plaque was noted over RCA territory by hand touching 6. Post op rhythm was NSR, and TEE showed trivial MR and good aortic mechanical valve was found Remark: pericardium was closed. Operative Procedures ETGA, supine, skin sterization, drapping. Midline sternotomy and AsAo, RAA, IVC cannulation. On CPB and cooling to 28 degrees. AXC, aortotomy was done and antegrade cardiopelgia was done. Retrograde cardioplegia was infused via C.S. Venting from LA. LA atriotomy and checked mitral valve pathology. Posterior wooler annuloplication was performed. Closed LA atriotomy. AVR with 23mm Sorin mechanical valve. Closed aorotomy with 4-0 prolene. Weaning from CPB and rewarm. Deair from AsAo Bungus needle. After hemostasis, set two chest tubes at mediasternal cavity. Close wound in layers. Operators 許榮彬 Assistants 羅健洺,陳建銘 藍萬貴 (M,1962/01/02,50y2m) 手術日期 2011/09/07 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 Compression fracture 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 2 紀錄醫師 陳以幸, 時間資訊 23:35 臨時手術NPO 09:31 進入手術室 09:40 麻醉開始 09:55 誘導結束 10:15 抗生素給藥 10:35 手術開始 12:50 手術結束 12:50 麻醉結束 13:00 送出病患 13:03 進入恢復室 14:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎弓切除術(減壓)-二節以內 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 曾峰毅 開立時間: 2011/09/07 12:49 Pre-operative Diagnosis Burst fracture of T10 Post-operative Diagnosis Burst fracture of T10 Operative Method Posterior instrumentation and fixation with tranpediculars screws at T9, T11, and T12; posterior decompression with T10 laminectomy; posterior fusion with autologous and artificial bone graft Specimen Count And Types Nil Pathology Nil Operative Findings Submuscular hemorrhage with contusion was noted after skin incision. Rupture of supraspinous ligament at T10/11, and rupture of interspinous ligament at T9/10 and T10/11. Fracture of left laminae at T10 involved left T10 costotransverse joint. Epidural hematoma was noted after laminecotmy. A-spine transpedicular screws, 6.0 x 40 mm, were inserted into bilateral pedicles of T9 and T11, 6.5 x 45 mm at T12. Two 11-cm rods was used for posterior fixation. Simbone HT was used for posterior fusion. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After C-arm localization, we scrubbed, disinfected, and then draped the back. One midline skin incision was made to expose bilateral laminae from T9 to T12. We inserted transpedicular screws into bilateral pedicles of T9, T11, and T12. Posterior decompression was done with T10 laminectomy. Posterior fixation was achieved with two 11-cm rods set. Posterior fusion was done with autologous and artificial bone graft. Cross-link was set. Two submuscular hemovac was placed, and the wound was closed in layers. Operators VS 王國川 Assistants R5 曾峰毅 R2 陳以幸 相關圖片 蔡珊珊 (F,1943/09/08,68y6m) 手術日期 2011/09/08 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Acromegaly and gigantism 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 王奐之, 時間資訊 23:07 臨時手術NPO 12:08 報到 12:48 進入手術室 12:52 麻醉開始 13:00 誘導結束 13:30 抗生素給藥 13:32 手術開始 13:56 手術結束 13:56 麻醉結束 14:12 送出病患 14:15 進入恢復室 15:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 經由蝶竇之腦下垂體瘤切除 1 2 摘要__ 手術科部: 外科部 套用罐頭: CSF leakage repair with packing of abdominal fat 開立醫師: 王奐之 開立時間: 2011/09/08 14:25 Pre-operative Diagnosis Acromegaly due to pituitary microadenoma, status post trans-sphenoid adenomectomy, with CSF leakage Post-operative Diagnosis Acromegaly due to pituitary microadenoma, status post trans-sphenoid adenomectomy, with CSF leakage Operative Method CSF leakage repair with packing of abdominal fat Specimen Count And Types Nil Pathology Nil Operative Findings CSF leakage was noted noted after removal of previously packed gelfoam; no more CSF leak was noted after packing of abdominal fat. A piece of abdominal fat measuring about 1cm in diameter was obtained for CSF leakage repair. Operative Procedures After endotracheal general anethesia, the patient was placed in supine position, with her head put on a head rest. After skin disinfection & draping, a small transverse incision was made at left upper quadrant of abdomen. After retrival of a piece of abdominal fat, the abdominal wound was then closed with 3-0 Vicryl & 4-0 Nylon. The left nostril was entered, the nasal mucosa was detached from previous incision and the bone fragments were removed. After removal of gelfoam, the fat was packed and stuck at the edge durotomy; Tissucol Duo was applied onto the fat to facilitate sealing. The bone fragments were placed back, and packed with gelfoam. After reduction of nasal mucosa, nasal packings were inserted for compression. Operators VS 曾漢民 Assistants R4 王奐之, PGY 李思慧 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: CSF leakage repair with packing of abdominal fat 開立醫師: 王奐之 開立時間: 2011/09/08 14:25 Pre-operative Diagnosis Acromegaly due to pituitary microadenoma, status post trans-sphenoid adenomectomy, with CSF leakage Post-operative Diagnosis Acromegaly due to pituitary microadenoma, status post trans-sphenoid adenomectomy, with CSF leakage Operative Method CSF leakage repair with packing of abdominal fat Specimen Count And Types Nil Pathology Nil Operative Findings CSF leakage was noted noted after removal of previously packed gelfoam; no more CSF leak was noted after packing of abdominal fat. A piece of abdominal fat measuring about 1cm in diameter was obtained for CSF leakage repair. Operative Procedures After endotracheal general anethesia, the patient was placed in supine position, with her head put on a head rest. After skin disinfection & draping, a small transverse incision was made at left upper quadrant of abdomen. After retrival of a piece of abdominal fat, the abdominal wound was then closed with 3-0 Vicryl & 4-0 Nylon. The left nostril was entered, the nasal mucosa was detached from previous incision and the bone fragments were removed. After removal of gelfoam, the fat was packed and stuck at the edge durotomy; Tissucol Duo was applied onto the fat to facilitate sealing. The bone fragments were placed back, and packed with gelfoam. After reduction of nasal mucosa, nasal packings were inserted for compression. Operators VS 曾漢民 Assistants R4 王奐之, PGY 李思慧 相關圖片 摘要__ 手術科部: 外科部 套用罐頭: CSF leakage repair with packing of abdominal fat 開立醫師: 王奐之 開立時間: 2011/09/08 14:30 Pre-operative Diagnosis Acromegaly due to pituitary microadenoma, status post trans-sphenoid adenomectomy, with CSF leakage Post-operative Diagnosis Acromegaly due to pituitary microadenoma, status post trans-sphenoid adenomectomy, with CSF leakage Operative Method CSF leakage repair with packing of abdominal fat Specimen Count And Types Nil Pathology Nil Operative Findings CSF leakage was noted noted after removal of previously packed gelfoam; no more CSF leak was noted after packing of abdominal fat. A piece of abdominal fat measuring about 1cm in diameter was obtained for CSF leakage repair. Operative Procedures After endotracheal general anethesia, the patient was placed in supine position, with her head put on a head rest. After skin disinfection & draping, a small transverse incision was made at left upper quadrant of abdomen. After retrival of a piece of abdominal fat, the abdominal wound was then closed with 3-0 Vicryl & 4-0 Nylon. The right nostril was entered, the nasal mucosa was detached from previous incision and the bone fragments were removed. After removal of gelfoam, the fat was packed and stuck at the edge durotomy; Tissucol Duo was applied onto the fat to facilitate sealing. The bone fragments were placed back, and packed with gelfoam. After reduction of nasal mucosa, nasal packings were inserted for compression. Operators VS 曾漢民 Assistants R4 王奐之, PGY 李思慧 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: CSF leakage repair with packing of abdominal fat 開立醫師: 王奐之 開立時間: 2011/09/08 14:30 Pre-operative Diagnosis Acromegaly due to pituitary microadenoma, status post trans-sphenoid adenomectomy, with CSF leakage Post-operative Diagnosis Acromegaly due to pituitary microadenoma, status post trans-sphenoid adenomectomy, with CSF leakage Operative Method CSF leakage repair with packing of abdominal fat Specimen Count And Types Nil Pathology Nil Operative Findings CSF leakage was noted noted after removal of previously packed gelfoam; no more CSF leak was noted after packing of abdominal fat. A piece of abdominal fat measuring about 1cm in diameter was obtained for CSF leakage repair. Operative Procedures After endotracheal general anethesia, the patient was placed in supine position, with her head put on a head rest. After skin disinfection & draping, a small transverse incision was made at left upper quadrant of abdomen. After retrival of a piece of abdominal fat, the abdominal wound was then closed with 3-0 Vicryl & 4-0 Nylon. The right nostril was entered, the nasal mucosa was detached from previous incision and the bone fragments were removed. After removal of gelfoam, the fat was packed and stuck at the edge durotomy; Tissucol Duo was applied onto the fat to facilitate sealing. The bone fragments were placed back, and packed with gelfoam. After reduction of nasal mucosa, nasal packings were inserted for compression. Operators VS 曾漢民 Assistants R4 王奐之, PGY 李思慧 相關圖片 范姜陳玉榮 (F,1929/12/20,82y2m) 手術日期 2011/09/08 手術主治醫師 蕭輔仁 手術區域 東址 005房 04號 診斷 Low back pain 器械術式 Radiofrequency coagulation(P-G 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 17:35 進入手術室 17:58 麻醉開始 17:59 麻醉結束 17:59 誘導結束 18:00 手術開始 18:50 手術結束 19:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 高頻熱凝療法 1 1 B 摘要__ 手術科部: 外科部 套用罐頭: Bilateral L2 dorsal root ganglion radiofreque... 開立醫師: 王奐之 開立時間: 2011/09/08 18:50 Pre-operative Diagnosis Low back pain Post-operative Diagnosis Low back pain Operative Method Bilateral L2 dorsal root ganglion radiofrequency stimulation Specimen Count And Types Nil Pathology Nil Operative Findings 1. Bilateral L2 dorsal root was identified by portable C-arm X-ray and sensory/motor stimulation test. No acute complication was noted after the procedure. 2. Temp: 42 oC, Time: 180sec x 2 cycles each side. Operative Procedures The patient was put in prone position. The location of L2 was identified by portable C-arm X-ray. The skin was disinfected and draped as usual. Local anesthesia was performed with 1% Xylocaine 10ml. Bilateral L2 dorsal root ganglion radiofrequency stimulation was performed under portable C-arm guided. The patient stood whole procedure well. Operators VS 蕭輔仁 Assistants R4 王奐之 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Bilateral L2 dorsal root ganglion radiofreque... 開立醫師: 王奐之 開立時間: 2011/09/08 18:50 Pre-operative Diagnosis Low back pain Post-operative Diagnosis Low back pain Operative Method Bilateral L2 dorsal root ganglion radiofrequency stimulation Specimen Count And Types Nil Pathology Nil Operative Findings 1. Bilateral L2 dorsal root was identified by portable C-arm X-ray and sensory/motor stimulation test. No acute complication was noted after the procedure. 2. Temp: 42 oC, Time: 180sec x 2 cycles each side. Operative Procedures The patient was put in prone position. The location of L2 was identified by portable C-arm X-ray. The skin was disinfected and draped as usual. Local anesthesia was performed with 1% Xylocaine 10ml. Bilateral L2 dorsal root ganglion radiofrequency stimulation was performed under portable C-arm guided. The patient stood whole procedure well. Operators VS 蕭輔仁 Assistants R4 王奐之 相關圖片 張可盈 (F,1974/10/20,37y4m) 手術日期 2011/09/08 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Facial spasm 器械術式 Microvascular decompression 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 游健生, 時間資訊 12:17 臨時手術NPO 08:00 進入手術室 08:10 麻醉開始 08:35 誘導結束 09:00 手術開始 09:08 抗生素給藥 12:05 手術結束 12:05 麻醉結束 12:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦微血管減壓術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Right retrosigmoid approach for facial nerve ... 開立醫師: 游健生 開立時間: 2011/09/08 12:52 Pre-operative Diagnosis Right hemifacial spasm Post-operative Diagnosis Right hemifacial spasm Operative Method Right retrosigmoid approach for facial nerve decompression Specimen Count And Types nil Pathology Nil Operative Findings A bridging vein was encountered and ligated during surgical exposure. A loop of posterior inferior cerebellar artery compressed on the exit zone of CN VII. A Teflon felt cotton was padded between the CN VII and PICA loop for decompression. Operative Procedures Under ETGA, patient was in park-bench position (left decubitus) with head fixed by Mayfield headclamp. After shaving, we disinfected and draped the operation field as usual. A lazy-S scalp incision was made centered at 4cm behind external acoustic meatus along imaginary line extending from zygomatic arch. Scalp flap was retracted and pericranium of superior portion was harvested for later duroplasty. The neck muscle attached at inferior portion of wound was transected vertically to expose cranium. A burhole was done at Asterion and another two at mastoid and suboccipital region. After craniotomy, the dura was tented at craniotomy border and opened in T-shape. Mannitol and CO2 wash out were applied to relax the cerebellum followed by CSF drainage from cerebropontine cistern. Gentle retraction was applied to cerebellum to expose floculus and CN VIII/VII complex. A bridging vein was encountered and ligated during surgical exposure. There was a loop of posterior inferior cerebellar artery compressing on the exit zone of CN VII. After mobilizing the loop, Teflon felt cotton was padded between the CN VII and PICA loop for decompression. After hemostasis and irrigation, dura was repaired with pericranium graft. A Gelfoam was placed over the dura. Bone flap was fixed back by wires after central tenting. Neck muscles were approximated and wound closed in layers with 2-o Vicryl and 3-0 Nylon. Operators VS 王國川 Assistants R4 游健生 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Right retrosigmoid approach for facial nerve ... 開立醫師: 游健生 開立時間: 2011/09/08 12:53 Pre-operative Diagnosis Right hemifacial spasm Post-operative Diagnosis Right hemifacial spasm Operative Method Right retrosigmoid approach for facial nerve decompression Specimen Count And Types nil Pathology Nil Operative Findings A bridging vein was encountered and ligated during surgical exposure. A loop of posterior inferior cerebellar artery compressed on the exit zone of CN VII. A Teflon felt cotton was padded between the CN VII and PICA loop for decompression. Operative Procedures Under ETGA, patient was in park-bench position (left decubitus) with head fixed by Mayfield headclamp. After shaving, we disinfected and draped the operation field as usual. A lazy-S scalp incision was made centered at 4cm behind external acoustic meatus along imaginary line extending from zygomatic arch. Scalp flap was retracted and pericranium of superior portion was harvested for later duroplasty. The neck muscle attached at inferior portion of wound was transected vertically to expose cranium. A burhole was done at Asterion and another two at mastoid and suboccipital region. After craniotomy, the dura was tented at craniotomy border and opened in T-shape. Mannitol and CO2 wash out were applied to relax the cerebellum followed by CSF drainage from cerebropontine cistern. Gentle retraction was applied to cerebellum to expose floculus and CN VIII/VII complex. A bridging vein was encountered and ligated during surgical exposure. There was a loop of posterior inferior cerebellar artery compressing on the exit zone of CN VII. After mobilizing the loop, Teflon felt cotton was padded between the CN VII and PICA loop for decompression. After hemostasis and irrigation, dura was repaired with pericranium graft. A Gelfoam was placed over the dura. Bone flap was fixed back by wires after central tenting. Neck muscles were approximated and wound closed in layers with 2-o Vicryl and 3-0 Nylon. Operators VS 王國川 Assistants R4 游健生 相關圖片 張蓬玉 (M,1951/01/03,61y2m) 手術日期 2011/09/08 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 Spondylosis,cervical 器械術式 Diskectomy cervical(Anterier) x2 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 游健生, 時間資訊 23:59 臨時手術NPO 12:26 進入手術室 12:35 麻醉開始 12:50 誘導結束 13:05 抗生素給藥 13:22 手術開始 16:05 抗生素給藥 17:45 手術結束 17:45 麻醉結束 17:55 送出病患 17:56 進入恢復室 19:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-前融合,有固定物)≦四節 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 摘要__ 手術科部: 外科部 套用罐頭: Anterior Discectomy and Fusion, Cervical Spine 開立醫師: 游健生 開立時間: 2011/09/08 18:14 Pre-operative Diagnosis C4-7 HIVD with myelopathy and radiculopathy Post-operative Diagnosis C4-7 HIVD with myelopathy and radiculopathy Operative Method Anterior Discectomy and Fusion, Cervical Spine Specimen Count And Types nil Pathology Nil Operative Findings C4-7 herniated disc resulted in thecal sac compression and neural foramin stenosis. After diskectomy, neural element were free of compression. Cage used as spacer was 6#, 6#, and 5# at C4/5, C5/6, and C6/7 respectively. A 60mm anterior cervical plate was fixed at C4-7 with 7 screws (only one screw at C7 body). Operative Procedures 1. Under ETGA, patient was in supine position with neck mildly extended 2. After locating C4/5 by C-arm, we disinfected and draped the operation field 3. A transverse 7cm incision was made on right neck 4. Platysmus was transected and undermined for mobilization 5. Dissected along avascular plane to reach prevertebral space 6. After locating C6/7 level by C-arm, we inserted Caspar retraction screws at C4 and C5 7. Vessels were retracted laterally and trachea/esophagus medially 8. Diskectomy was done till exposure of PLL and neural element free of compression 9. Inserted cage into intervertebral disc space and removed Caspar screws 10.Repeat similar procedure at C5/6 and C6/7 level 11.Placed anterior cervical plate and fixed it with 7 screws after position checked by C-arm 12.After hemostasis and irrigation, a CWV was placed 13.Wound was closed in layers Operators VS 王國川 Assistants R4 游健生 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Anterior Discectomy and Fusion, Cervical Spine 開立醫師: 游健生 開立時間: 2011/09/08 18:15 Pre-operative Diagnosis C4-7 HIVD with myelopathy and radiculopathy Post-operative Diagnosis C4-7 HIVD with myelopathy and radiculopathy Operative Method Anterior Discectomy and Fusion, Cervical Spine Specimen Count And Types nil Pathology Nil Operative Findings C4-7 herniated disc resulted in thecal sac compression and neural foramin stenosis. After diskectomy, neural element were free of compression. Cage used as spacer was 6#, 6#, and 5# at C4/5, C5/6, and C6/7 respectively. A 60mm anterior cervical plate was fixed at C4-7 with 7 screws (only one screw at C7 body). Operative Procedures 1. Under ETGA, patient was in supine position with neck mildly extended 2. After locating C4/5 by C-arm, we disinfected and draped the operation field 3. A transverse 7cm incision was made on right neck 4. Platysmus was transected and undermined for mobilization 5. Dissected along avascular plane to reach prevertebral space 6. After locating C6/7 level by C-arm, we inserted Caspar retraction screws at C4 and C5 7. Vessels were retracted laterally and trachea/esophagus medially 8. Diskectomy was done till exposure of PLL and neural element free of compression 9. Inserted cage into intervertebral disc space and removed Caspar screws 10.Repeat similar procedure at C5/6 and C6/7 level 11.Placed anterior cervical plate and fixed it with 7 screws after position checked by C-arm 12.After hemostasis and irrigation, a CWV was placed 13.Wound was closed in layers Operators VS 王國川 Assistants R4 游健生 相關圖片 陳臣堪 (M,1934/09/03,77y6m) 手術日期 2011/09/08 手術主治醫師 王國川 手術區域 東址 010房 05號 診斷 Hydrocephalus 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳以幸, 時間資訊 23:01 臨時手術NPO 13:00 進入手術室 13:05 麻醉開始 13:15 誘導結束 13:30 抗生素給藥 13:45 手術開始 14:55 手術結束 14:55 麻醉結束 15:00 送出病患 15:05 進入恢復室 16:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室腹腔分流手術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 曾峰毅 開立時間: 2011/09/08 14:51 Pre-operative Diagnosis Normal pressure hydrocephalus Post-operative Diagnosis Normal pressure hydrocephalus Operative Method Ventriculoperitoneal shunt via right Kocher Specimen Count And Types CSF was sent for routine, culture, and BCS. Pathology NIL Operative Findings Medtronic, fixed pressure, medium pressure valve was used. Opening pressure of ventriculostomy was about 5-8 cm H20. Colorless, clear CSF was drained. Ventricular catheter is 6.5 cm long. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to left. We scrubbed, disinfected, and then draped the patient's skin. We made one transverse skin incision at right upper abdomen and to performed mini-laparotomy. We made one curvilinear skin incision at right frontal area, and drilled one burr hole. We created subcutaenous tunnel from right upper abdomen to right frontal, and pulled the catheter through. We performed ventriculostomy, and inserted ventricular catheter. We connected the shunt altogether, and checked the function. We inserted peritoneal catheter into peritoneal cavity, and closed the wound in layers. Operators VS 王國川 Assistants R5 曾峰毅 R2 陳以幸 相關圖片 李再興 (M,1958/12/01,53y3m) 手術日期 2011/09/08 手術主治醫師 蔡翊新 手術區域 東址 005房 02號 診斷 Major trauma rated 16 or above on the severity scale ( Injury severity score >=16 ) 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 污染 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 李思慧, 時間資訊 23:05 臨時手術NPO 11:18 進入手術室 11:19 麻醉開始 11:22 誘導結束 11:35 抗生素給藥 11:39 手術開始 11:58 手術結束 11:58 麻醉結束 12:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 氣管切開術 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 王奐之 開立時間: 2011/09/08 12:12 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types nil Pathology Nil Operative Findings A Fr.8 low-pressure tracheostomy tube was inserted into the trachea through the 2nd-3rd tracheal cartilage. Operative Procedures After ETGA, the patient was placed in supine position with neck hyperextended. A 1cm midline skin incision was made 2 finger breadth above the sternal notch, the incision was further deepened through dissection. After exposing the 2nd and 3rd tracheal rings, a round trachea opening was made by scalpal. The low-pressure tracheostomy tube was then inserted into the trachea. After confirmation of ventilation, the endotracheal tube was removed and the tracheostomy wound was approximated with 3-0 Nylon sutures. Operators VS 蔡翊新 Assistants R4 王奐之, PGY 李思慧 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 王奐之 開立時間: 2011/09/08 12:12 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types nil Pathology Nil Operative Findings A Fr.8 low-pressure tracheostomy tube was inserted into the trachea through the 2nd-3rd tracheal cartilage. Operative Procedures After ETGA, the patient was placed in supine position with neck hyperextended. A 1cm midline skin incision was made 2 finger breadth above the sternal notch, the incision was further deepened through dissection. After exposing the 2nd and 3rd tracheal rings, a round trachea opening was made by scalpal. The low-pressure tracheostomy tube was then inserted into the trachea. After confirmation of ventilation, the endotracheal tube was removed and the tracheostomy wound was approximated with 3-0 Nylon sutures. Operators VS 蔡翊新 Assistants R4 王奐之, PGY 李思慧 相關圖片 張美玲 (F,1968/08/04,43y7m) 手術日期 2011/09/08 手術主治醫師 蔡翊新 手術區域 東址 003房 03號 診斷 Cerebral aneurysm 器械術式 Left pterion approach for aneurysm clipping 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 3E 紀錄醫師 陸惠宗, 時間資訊 11:00 臨時手術NPO 11:00 開始NPO 20:48 通知急診手術 23:10 進入手術室 23:10 報到 23:15 麻醉開始 23:30 誘導結束 23:40 抗生素給藥 23:53 手術開始 02:45 抗生素給藥 05:45 抗生素給藥 06:00 麻醉結束 06:00 手術結束 06:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 開顱術摘除血管病變 - 腦血管瘤 有病徵的 1 1 L 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Aneurysm-frontotemporal approach 開立醫師: 蔡翊新 開立時間: 2011/09/09 06:01 Pre-operative Diagnosis Left ICA ophthalmic segment aneurysm with optic nerve compression. Post-operative Diagnosis Left ICA ophthalmic segment aneurysm with optic nerve compression. Operative Method Left pterional craniotomy with excision of anterior clinoid process for aneurysm clipping and optic nerve decompression. Specimen Count And Types nil Pathology Nil. Operative Findings The left optic nerve became thin and curved due to compression from inferior aspect by a saccular aneurysm at left paraclinoid region arising from left ICA and pointing superior and medially. The aneurysm neck was about 8 mm in width and the dome was 9 mm in height. The aneurysm was clipped by a 15-mm straight Sugita aneurysm clip. The left ophthalmic artery was spared. After clipping, the aneurysm sac was opened and shrank, so that the optic nerve was decompressed. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with left back elevated and head rotated to right for 45 degrees and slightly extended then fixed by Mayfield skull clamp. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: left frontotemporal, curvilinear. The skin edge was clipped by Raney clips for temporary hemostasis. After scalp had been lifted, the temporalis muscle was incised and detached from temporal squama and reflected to lower temporal side. 5. Craniotomy window: 8 x 6 cm, left frontotemporal, created by making 3 burr holes then cut by power saw. The lower temporalbone and pterionic ridge (esp. the inner table) were cut by rongeur as low as possible for easy approach to the anterior clinoid process, which was drilled off and removed. 6. Dural tention: by 2/0 silk, 2 cm in interval, distributed along the edge of skull window. 7. Dural incision: curvilinear, over-ridding Sylvian fissure and reflected to frontotemporal base. 8. Under operating microscope, the suprasellar cistern was opened. The left optic nerve and ICA came into view. The dural ring was divided after intradual resection of the medial wall of optic canal. The arachnoid trabeculi were cleaned out to expose the neck of the aneurysm which located just distal to the orifice of left ophthalmic artery. 9. A 15-mm straight Sugita clip was applied to the neck of the aneurysm. 10.Tissue Co-duo was applied to the dural defect covering the anterior clinoid process to prevent CSF leak. 11.The brain retractors were removed. The dura was closed water-tight by running suture with 4/0 Prolene. 12.Closure of skull window: the skull plate was placed back to craniotomy window and fixed by 3 miniplates and 6 screws. The covering muscle was closed by interrupted stitches with 1/ 0 silk. 13.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 14.Drain: one, epidural, CWV. 15.Blood transfusion: nil. Blood loss: 150 ml. 16.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R6鍾文桂R1陸惠宗 Indication Of Emergent Operation Optic nerve compression by an impending rupture aneurysm 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Aneurysm-frontotemporal approach 開立醫師: 蔡翊新 開立時間: 2011/09/09 06:01 Pre-operative Diagnosis Left ICA ophthalmic segment aneurysm with optic nerve compression. Post-operative Diagnosis Left ICA ophthalmic segment aneurysm with optic nerve compression. Operative Method Left pterional craniotomy with excision of anterior clinoid process for aneurysm clipping and optic nerve decompression. Specimen Count And Types nil Pathology Nil. Operative Findings The left optic nerve became thin and curved due to compression from inferior aspect by a saccular aneurysm at left paraclinoid region arising from left ICA and pointing superior and medially. The aneurysm neck was about 8 mm in width and the dome was 9 mm in height. The aneurysm was clipped by a 15-mm straight Sugita aneurysm clip. The left ophthalmic artery was spared. After clipping, the aneurysm sac was opened and shrank, so that the optic nerve was decompressed. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with left back elevated and head rotated to right for 45 degrees and slightly extended then fixed by Mayfield skull clamp. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: left frontotemporal, curvilinear. The skin edge was clipped by Raney clips for temporary hemostasis. After scalp had been lifted, the temporalis muscle was incised and detached from temporal squama and reflected to lower temporal side. 5. Craniotomy window: 8 x 6 cm, left frontotemporal, created by making 3 burr holes then cut by power saw. The lower temporalbone and pterionic ridge (esp. the inner table) were cut by rongeur as low as possible for easy approach to the anterior clinoid process, which was drilled off and removed. 6. Dural tention: by 2/0 silk, 2 cm in interval, distributed along the edge of skull window. 7. Dural incision: curvilinear, over-ridding Sylvian fissure and reflected to frontotemporal base. 8. Under operating microscope, the suprasellar cistern was opened. The left optic nerve and ICA came into view. The dural ring was divided after intradual resection of the medial wall of optic canal. The arachnoid trabeculi were cleaned out to expose the neck of the aneurysm which located just distal to the orifice of left ophthalmic artery. 9. A 15-mm straight Sugita clip was applied to the neck of the aneurysm. 10.Tissue Co-duo was applied to the dural defect covering the anterior clinoid process to prevent CSF leak. 11.The brain retractors were removed. The dura was closed water-tight by running suture with 4/0 Prolene. 12.Closure of skull window: the skull plate was placed back to craniotomy window and fixed by 3 miniplates and 6 screws. The covering muscle was closed by interrupted stitches with 1/ 0 silk. 13.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 14.Drain: one, epidural, CWV. 15.Blood transfusion: nil. Blood loss: 150 ml. 16.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R6鍾文桂R1陸惠宗 Indication Of Emergent Operation Optic nerve compression by an impending rupture aneurysm 相關圖片 林智森 (M,1941/07/07,70y8m) 手術日期 2011/09/08 手術主治醫師 蔡翊新 手術區域 東址 005房 01號 診斷 Brain abscess 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 髒 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李思慧, 時間資訊 23:04 臨時手術NPO 08:03 進入手術室 08:12 麻醉開始 08:50 誘導結束 09:00 抗生素給藥 09:06 手術開始 10:40 手術結束 10:40 麻醉結束 10:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT 開立醫師: 蔡翊新 開立時間: 2011/09/08 10:41 Pre-operative Diagnosis Left occipital brain abscess. Post-operative Diagnosis Left occipital brain abscess. Operative Method Left occipital trephination for ehco-guided brain abscess drainage. Specimen Count And Types 3 tubes of pus, sent for gram stain, bacterial and fungus cultures. Pathology Nil. Operative Findings A 3.76 x 3.23 x 3.11 cm (measured from MRI) brain abscess with greyish pus content at left occipital region. The center of the abscess was 6.6 cm above inion, 2.9 cm lateral to midline, 3 cm beneath the skin. After drainage and irrigation, the abscess cavity was obscure under ultrasound. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: prone with neck flexed and head fixed by Mayfield skull clamp. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: linear, 5 cm, at left occipital region, with its center 6.6 cm above inion, 3.8 cm lateral to midline. Raney clips were applied to the scalp edge for temporary hemostasis. 5. Craniotomy window: 2 x 2 cm, left occipital, created by making 1 burr hole and enlarged by Kerrison rongeur. 6. Dural tenting: by 2/0 silk, 2 cm in interval, distributed along the edge of skull window. 7. Dural incision: crusade fashion 8. Under echo guidance, the abscess was punctured by a ventricular needle. The abscess content was drained, about 10 ml pus was withdrawn by syringe. The abscess cavity was irrigated with some normal saline. 9. Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 1/0 Vicryl and skin by continuoussuture with 3/0 nylon. 10.Drain: one Fr 6 Nelaton tube was set at abscess cavity and connected to a minihemovac bag. 11.Blood transfusion: Nil. Blood loss: minimal. 12.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R4王奐之R1李思慧 相關圖片 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT 開立醫師: 蔡翊新 開立時間: 2011/09/08 10:55 Pre-operative Diagnosis Left occipital brain abscess. Post-operative Diagnosis Left occipital brain abscess. Operative Method Left occipital trephination for ehco-guided brain abscess drainage. Specimen Count And Types 3 tubes of pus, sent for gram stain, bacterial and fungus cultures. Pathology Nil. Operative Findings A 3.76 x 3.23 x 3.11 cm (measured from MRI) brain abscess with greyish pus content at left occipital region. The center of the abscess was 6.6 cm above inion, 2.9 cm lateral to midline, 3 cm beneath the skin. After drainage and irrigation, the abscess cavity was obscure under ultrasound. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: prone with neck flexed and head fixed by Mayfield skull clamp. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: linear, 5 cm, at left occipital region, with its center 6.6 cm above inion, 3.8 cm lateral to midline. Raney clips were applied to the scalp edge for temporary hemostasis. 5. Craniotomy window: 2 x 2 cm, left occipital, created by making 1 burr hole and enlarged by Kerrison rongeur. 6. Dural tenting: by 2/0 silk, 2 cm in interval, distributed along the edge of skull window. 7. Dural incision: crusade fashion 8. Under echo guidance, the abscess was punctured by a ventricular needle. The abscess content was drained, about 10 ml pus was withdrawn by syringe. The abscess cavity was irrigated with some normal saline. 9. Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 1/0 Vicryl and skin by continuoussuture with 3/0 nylon. 10.Drain: one Fr 6 Nelaton tube was set at abscess cavity and connected to a minihemovac bag. 11.Blood transfusion: Nil. Blood loss: minimal. 12.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R4王奐之R1李思慧 相關圖片 王智 (M,1944/04/02,67y11m) 手術日期 2011/09/09 手術主治醫師 曾漢民 手術區域 東址 006房 01號 診斷 Subdural hemorrhage, traumatic 器械術式 bilateral cSDH burhole drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3E 紀錄醫師 李思慧, 時間資訊 01:00 臨時手術NPO 01:00 開始NPO 07:28 通知急診手術 09:00 報到 09:28 進入手術室 09:30 麻醉開始 09:40 誘導結束 10:00 抗生素給藥 10:20 手術開始 13:00 抗生素給藥 13:05 手術結束 13:05 麻醉結束 13:18 送出病患 13:20 進入恢復室 14:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 B 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 摘要__ 手術科部: 外科部 套用罐頭: 1. Left frontal trephination for chronic subd... 開立醫師: 王奐之 開立時間: 2011/09/09 13:29 Pre-operative Diagnosis Bilateral chronic subdural hematoma Post-operative Diagnosis Bilateral chronic subdural hematoma Operative Method 1. Left frontal trephination for chronic subdural hematoma evacuation 2. Right frontal burr hole for chronic subdural hematoma evacuation Specimen Count And Types Nil Pathology Nil Operative Findings Motor oil like fluid gushed out after opening of the outer membrane of chronic subdural hematoma. Multiple septums were noted inside the left side hematoma, no active bleeder was identified after hematoma evacuation. Easy bleeding with diffuse soft tissue oozing was encountered throught the whole operation procedure, estimated blood loss: 400ml. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position. After shaving, scrubbing, disinfection & draping in sterile fashion, a curvilinear incision was made at left frontal area. 2 burr holes were made, followed by a small round craniotomy. After tenting stitches, the dura was opened in cruciate fashion. The outer membrane of chronic subdural hematoma was then incised, and the hematoma was evacuated; the septation within the hematoma was also lysed. After securing 1 subdural rubber drain, the dura was closed with a small piece of fascial graft in water-tight fashion. The bone flap was fixed back with wires after central tenting. The wound was then closed in layers after hemostasis. Another linear incision was made at right frontal area, followed by a single burr hole creation. After tenting, a small cruciate durotomy was created, and the outer membrane was incised. After evacuating most of the hematoma, 1 subdural rubber drain was set in place and the wound was closed in layers. Bilateral deairing was then performed to end the operation. Operators VS 曾漢民 Assistants R4 王奐之, PGY 李思慧 Indication Of Emergent Operation Hematoma with mass effect 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: 1. Left frontal trephination for chronic subd... 開立醫師: 王奐之 開立時間: 2011/09/09 13:29 Pre-operative Diagnosis Bilateral chronic subdural hematoma Post-operative Diagnosis Bilateral chronic subdural hematoma Operative Method 1. Left frontal trephination for chronic subdural hematoma evacuation 2. Right frontal burr hole for chronic subdural hematoma evacuation Specimen Count And Types Nil Pathology Nil Operative Findings Motor oil like fluid gushed out after opening of the outer membrane of chronic subdural hematoma. Multiple septums were noted inside the left side hematoma, no active bleeder was identified after hematoma evacuation. Easy bleeding with diffuse soft tissue oozing was encountered throught the whole operation procedure, estimated blood loss: 400ml. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position. After shaving, scrubbing, disinfection & draping in sterile fashion, a curvilinear incision was made at left frontal area. 2 burr holes were made, followed by a small round craniotomy. After tenting stitches, the dura was opened in cruciate fashion. The outer membrane of chronic subdural hematoma was then incised, and the hematoma was evacuated; the septation within the hematoma was also lysed. After securing 1 subdural rubber drain, the dura was closed with a small piece of fascial graft in water-tight fashion. The bone flap was fixed back with wires after central tenting. The wound was then closed in layers after hemostasis. Another linear incision was made at right frontal area, followed by a single burr hole creation. After tenting, a small cruciate durotomy was created, and the outer membrane was incised. After evacuating most of the hematoma, 1 subdural rubber drain was set in place and the wound was closed in layers. Bilateral deairing was then performed to end the operation. Operators VS 曾漢民 Assistants R4 王奐之, PGY 李思慧 Indication Of Emergent Operation Hematoma with mass effect 相關圖片 張銀銘 (M,1974/02/01,38y1m) 手術日期 2011/09/09 手術主治醫師 曾漢民 手術區域 東址 002房 03號 診斷 Brain Tumor 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 陳國瑋, 時間資訊 23:39 臨時手術NPO 14:10 報到 14:35 進入手術室 14:37 麻醉開始 15:05 誘導結束 15:23 手術開始 15:30 抗生素給藥 18:30 抗生素給藥 19:30 麻醉結束 19:30 手術結束 19:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 手術 顱底瘤手術 1 1 摘要__ 手術科部: 外科部 套用罐頭: Suboccipital craniotomy for tumor excision 開立醫師: 曾峰毅 開立時間: 2011/09/09 19:38 Pre-operative Diagnosis Cerebellar tumor, suspected hemangiolastoma Post-operative Diagnosis Cerebellar hemangiolastoma Operative Method Suboccipital craniotomy for tumor excision Specimen Count And Types 1 piece About size:pieces Source:cerebellar tumor Pathology Pending Operative Findings A 3x2x2 cm cystic lesion with xanthochromic fluid accumulation was noted at right cerebellar hemisphere, and mural nodular part is am orange to reddish, soft, haypervascularized, tumor. The SSEP and MEP showed no latency or amplitude change during the operation. The blood loss was 400ml. Operative Procedures After ETGA, the patient was put in prone position with head fixed with Mayfield clamp. The skin was prepared as usual. One midline incision was made from inion to C1 level. The bilateral trapezius, capitis muscles were dissected away. Fives hurr holes were made and suboccipital craniotomy was done. The bone window was extended to foramen maganen with Rongeur. The location of tumor was checked with sonography. The cerebellum was retracted downward and corticotomy at tentorial surface of cerebellum was done. Cystic portion of the tumor was drained first, and the tumor excision was done after feeder cauterized. Hemostasis was done, and the tumor cavity was paved with Surgicel. Duroplasty was performed with artificial fascia graft and water-tight suture. Bone graft was fixed back with mini-plates. After setting one subgaleal CWV, the wound was closed in layers. Operators VS 曾漢民 Assistants 曾峰毅 陳國瑋 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Suboccipital craniotomy for tumor excision 開立醫師: 陳國瑋 開立時間: 2011/09/09 20:11 Pre-operative Diagnosis Cerebellar tumor, suspected hemangiolastoma Post-operative Diagnosis Cerebellar hemangiolastoma Operative Method Suboccipital craniotomy for tumor excision Specimen Count And Types 1 piece About size:pieces Source:cerebellar tumor Pathology Pending Operative Findings A 3x2x2 cm cystic lesion with xanthochromic fluid accumulation was noted at right cerebellar hemisphere, and mural nodular part is am orange to reddish, soft, haypervascularized, tumor. The SSEP and MEP showed no latency or amplitude change during the operation. The blood loss was 400ml. Operative Procedures After ETGA, the patient was put in prone position with head fixed with Mayfield clamp. The skin was prepared as usual. One midline incision was made from inion to C1 level. The bilateral trapezius, capitis muscles were dissected away. Fives hurr holes were made and suboccipital craniotomy was done. The bone window was extended to foramen maganen with Rongeur. The location of tumor was checked with sonography. The cerebellum was retracted downward and corticotomy at tentorial surface of cerebellum was done. Cystic portion of the tumor was drained first, and the tumor excision was done after feeder cauterized. Hemostasis was done, and the tumor cavity was paved with Surgicel. Duroplasty was performed with artificial fascia graft and water-tight suture. Bone graft was fixed back with mini-plates. After setting one subgaleal CWV, the wound was closed in layers. Operators VS 曾漢民 Assistants 曾峰毅 陳國瑋 相關圖片 黃淑華 (F,1966/04/24,45y10m) 手術日期 2011/09/09 手術主治醫師 曾漢民 手術區域 東址 007房 01號 診斷 Acoustic neuroma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 李振豪, 時間資訊 23:27 臨時手術NPO 08:05 進入手術室 08:13 麻醉開始 08:40 誘導結束 09:00 抗生素給藥 09:11 手術開始 12:00 抗生素給藥 15:00 抗生素給藥 15:15 手術結束 15:15 麻醉結束 15:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 顱底瘤手術 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Left retrosigmoid approach for tumor excision 開立醫師: 李振豪 開立時間: 2011/09/09 16:00 Pre-operative Diagnosis Left trigeminal neuroma Post-operative Diagnosis Left trigeminal neuroma Operative Method Left retrosigmoid approach for tumor excision Specimen Count And Types 1 piece About size:multiple small pieces Source:Left trigeminal neuroma Pathology Pending Operative Findings The tumor was well-capsulated, yellow-grayish, hypervascularized, soft, and 5.3 x 5 x 4cm in size. The tumor was mainly originated from trigeminal nerve and the fascicle of the trigeminal nerve was encased within the tumor. The adjacent cranial nerves were pushed away from the tumor. The CN VII, VIII, and low cranial nerve was pushed posteroinferiorly. The CN III, IV, and VI were pushed anteriorly. Meckle"s cave was expanded by the tumor widely. After total removal of the tumor, the basilar artery, PCA, CN III, VII, VIII, and low cranial nerve were all visualized. The facial nerve stimulation was used after total tumor excision but failed to identify the location of the tumor. The left mastoid air cell was exposed during craniotomy and sealed with bonewax. Operative Procedures Under endotracheal general anesthesia, the patient was put in 3/4 prone position with head fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, disinfected as usual. Hokeystick scalp incision was made over left suboccipital area and scalp flap was elevated. Five burr holes were created follwed by one 5x3cm craniotomy window. The craniotomy window was extended to expose the transverse and sigmoid sinus. The foramen magnum also opened. The CSF was released from the foramen magnum. After dural opening, the cerebellum was retracted and the tumor was identified. The arachnoid membrane covered the tumor was opened and the tumor was dissected along the subarachnoid plan. Subcapsule debulking was performed by suction. The tumor was then total removed with bipolar electrocatuery, suction, and tumor forceps. Hemostasis was achieved with bipolar electrocautery and Surgicel lining. The dura was closed with one autologous fascia and 4-0 Prolene. The skull plate was fixed back with three wires and miniplates/screws. One CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and Appose staples. Operators VS曾漢民 Assistants R5李振豪, R1陸惠宗 相關圖片 唐美蓉 (F,1951/01/01,61y2m) 手術日期 2011/09/09 手術主治醫師 戴浩志 手術區域 東址 009房 04號 診斷 Cellulitis 器械術式 Debridment-- >10cm 手術類別 預定手術 手術部位 頭、頸 傷口分類 污染 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 3 紀錄醫師 趙崧筌, 時間資訊 15:20 報到 15:55 進入手術室 16:00 麻醉開始 16:05 誘導結束 16:18 手術開始 16:35 手術結束 16:35 麻醉結束 16:40 送出病患 17:00 進入恢復室 18:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 深部傷口處理縫合擴創-小 1 0 L 摘要__ 手術科部: 外科部 套用罐頭: Debridement 開立醫師: 趙崧筌 開立時間: 2011/09/09 16:47 Pre-operative Diagnosis Left neck two poor healing wounds with wire exposure Post-operative Diagnosis Left neck two poor healing wounds with wire exposure Operative Method Debridement Specimen Count And Types 1 piece About size: Source:wound culture x2 Pathology Nil Operative Findings Left neck two poor healing wounds with wire exposure was noted after fragile granulation curetted. The wounds were packed with Bosmin wet gauze. No electrocautery was applied due to DBS machine. Operative Procedures ETGA, supine, disinfected and prepped Debrided the wound by curettage and obtained wound cultures Packed the wounds with Bosmin wet gauze Operators 戴浩志 Assistants 趙崧筌 曾振添 (M,1971/07/15,40y7m) 手術日期 2011/09/09 手術主治醫師 李章銘 手術區域 東址 016房 03號 診斷 Malignant neoplasm of lower third of esophagus 器械術式 Tracheal stent insertion 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 蕭柏妮 ASA 4E 紀錄醫師 郝政鴻, 時間資訊 23:05 開始NPO 23:05 臨時手術NPO 23:06 通知急診手術 13:35 報到 13:42 進入手術室 13:50 麻醉開始 14:30 誘導結束 14:40 手術開始 15:27 16:05 麻醉結束 16:05 手術結束 16:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 管內腔置管術 1 1 手術 氣管切開術 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 記錄__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 郝政鴻 開立時間: 2011/09/09 16:37 Pre-operative Diagnosis Esophageal cancer with tracheal invasion, status post tracheal stent insertion, complicated with tracheal stenosis Post-operative Diagnosis Esophageal cancer with tracheal invasion, status post tracheal stent insertion, complicated with tracheal stenosis Operative Method Tracheostomy adn tracheal stent insertion Tracheostomy and tracheal stent insertion Specimen Count And Types nil Pathology None Operative Findings Fr . 6.5 hand made low pressure cuffed tube marked about 10 cm in length inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Zebra guide wir was inserted via endotracheal tube adn Ultraflex tracheal stent try to deployed but failed. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure hand made cuffed tracheotomy tube as tracheal stent was inserted under bronchoscopy survillence. Tube was fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators VS李章銘 Assistants R4郝政鴻 R1柯人玄 Indication Of Emergent Operation Desaturation and severe airway obstruction 游沛純 (F,2010/05/24,1y9m) 手術日期 2011/09/09 手術主治醫師 謝孟祥 手術區域 東址 012房 01號 診斷 Apert syndrome 器械術式 Syndactyly division 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 3 紀錄醫師 陳建璋, 時間資訊 07:30 報到 08:05 進入手術室 08:10 麻醉開始 08:20 誘導結束 09:10 抗生素給藥 09:15 手術開始 13:10 抗生素給藥 15:20 手術結束 15:20 麻醉結束 15:25 送出病患 15:30 進入恢復室 16:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 併指多指(趾)切除 1 2 B 手術 多指(趾)切除每多加一個 1 2 B 手術 局部皮瓣(2公分以上) 1 1 B 手術 皮膚全層植補術 1 2 B 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 摘要__ 手術科部: 外科部 套用罐頭: Syndactyly division, Bruner incision with dor... 開立醫師: 柯安達 開立時間: 2011/09/09 15:48 Pre-operative Diagnosis Apert syndrome Post-operative Diagnosis Apert syndrome Operative Method Syndactyly division, Bruner incision with dorsal rectangular flap for web space Specimen Count And Types nil Pathology nil Operative Findings bilateral hand syndactyly(index finger, middle finger and ring finger) Operative Procedures 1. Supine position, ETGA 2. Disinfected bilateral hands and inguinal area 3. Design the rectangular flap and zigzag incision 4. Make incisions between the index finger and middle finger 5. Preserve the neurovascular bundle 6. Fixed the rectangular flap to web space 7. Suture the zigzag skin close to each other 8. Bilateral inguinal graft were obtained and applied to the uncover skin surface 9. Close the finger wound and bilateral inguinal wound 10. Immobilization with cast Operators 謝孟祥 Assistants R5 陳建璋 R2柯安達 Ri 相關圖片 洪麗玲 (F,1964/02/20,48y0m) 手術日期 2011/09/09 手術主治醫師 賴達明 手術區域 東址 017房 09號 診斷 Intracranial hemorrhage 器械術式 Removal of intracerebral hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 4E 紀錄醫師 曾峰毅, 時間資訊 21:14 開始NPO 21:14 通知急診手術 21:56 進入手術室 22:00 麻醉開始 22:26 誘導結束 22:30 抗生素給藥 22:58 手術開始 01:30 手術結束 01:30 麻醉結束 01:35 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦內血腫清除術 1 1 L 手術 顱內壓視置入 1 2 L 摘要__ 手術科部: 外科部 套用罐頭: CVA 開立醫師: 曾峰毅 開立時間: 2011/09/10 01:50 Pre-operative Diagnosis Left putaminal intracerebral hemorrhage Post-operative Diagnosis Left putaminal intracerebral hemorrhage Operative Method CVA Specimen Count And Types Nil Pathology Nil Operative Findings Brain bulged after durotomy. Acute hematoma was noted at left basal ganaglion. Brain parenchyma was slack and pulsation was satisfactory after hematoma evacuation. Codman ICP reference is 480. ICP after wound closure was 3 mmHg. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to right. After scalp shaved, scrubbed, disinfected, and then draped, we made one linear skin incision at left frontotemporal area. We dissected the temporalis muscle, and drilled four burr holes. One 6x6 cm craniotoy was made, and then dura was tented along the craniotomy winodw. Dura was incised in X-shape, and Sylvian fissure was opened by 1 cm. Hematoma was removed, and hemastasis was achieved. Hematoma cavity was paved with Surgicels. Dura was closed in water-tight suture and one subdural ICP was placed. Bone graft was fixed back with mini-plates, and the wound was closed in layers with one subgaleal CWV. Operators VS 賴達明 Assistants R5 曾峰毅 Ri 吳伯軒 Indication Of Emergent Operation Stroke 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: CVA 開立醫師: 曾峰毅 開立時間: 2011/09/10 01:57 Pre-operative Diagnosis Left putaminal intracerebral hemorrhage Post-operative Diagnosis Left putaminal intracerebral hemorrhage Operative Method Left frontotemporal craniotomy, trans-Sylvian, for hematoma evcuation; ICP monitor insertion Specimen Count And Types Nil Pathology Nil Operative Findings Brain bulged after durotomy. Acute hematoma was noted at left basal ganaglion. Brain parenchyma was slack and pulsation was satisfactory after hematoma evacuation. Codman ICP reference is 480. ICP after wound closure was 3 mmHg. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to right. After scalp shaved, scrubbed, disinfected, and then draped, we made one linear skin incision at left frontotemporal area. We dissected the temporalis muscle, and drilled four burr holes. One 6x6 cm craniotoy was made, and then dura was tented along the craniotomy winodw. Dura was incised in X-shape, and Sylvian fissure was opened by 1 cm. Hematoma was removed, and hemastasis was achieved. Hematoma cavity was paved with Surgicels. Dura was closed in water-tight suture and one subdural ICP was placed. Bone graft was fixed back with mini-plates, and the wound was closed in layers with one subgaleal CWV. Operators VS 賴達明 Assistants R5 曾峰毅 Ri 吳伯軒 Indication Of Emergent Operation Stroke 相關圖片 黃光治 (M,1941/12/26,70y2m) 手術日期 2011/09/09 手術主治醫師 賴達明 手術區域 東址 001房 01號 診斷 Spondylolisthesis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 陳國瑋, 時間資訊 23:31 臨時手術NPO 07:50 報到 08:02 進入手術室 08:17 麻醉開始 08:27 誘導結束 09:00 抗生素給藥 09:17 手術開始 12:10 抗生素給藥 12:25 手術結束 12:25 麻醉結束 12:38 送出病患 12:40 進入恢復室 13:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎間盤切除術-腰椎 1 2 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 曾峰毅 開立時間: 2011/09/09 12:19 Pre-operative Diagnosis Spondylolisthesis, L4/5, grade I Post-operative Diagnosis Spondylolisthesis, L4/5, grade I Operative Method Transforaminal lumbar interbody fusion at L4/5 with PEEK cage and autologous bone graft; posterior instrumentation and fixation with transpedicular screws and rods at L4/5 Specimen Count And Types Nil Pathology Nil Operative Findings Thecal sac was compromised by hypertrophic ligamentum flavum. Thecal was decompressed well after the surgery. Synthes, transpedicular screws,6.2 x 45 mm, were instrumented into bilateral pedicles of L4 and L5. Synthes PEEK cage, 13 mm high, was used for TLIF. Incidental durotomy was sutured with 5-0 prolene. Operative Procedures WIth endotracheal general anaesthesia, the patient was put in prone position. After C-arm localization, the back was scrubbed, disinfected, and then draped as usual. We made one midline skin incision and dissected bilateral paraspinal muscle to expose bilateral laminae from L3 to L5. We instrumented bilateral pedicles of L4 and L5 with transpedicular screws, and performed L4 laminectomy for L4/5 diskectomy. Fusion with achieved with PEEK cage and autologous bone graft. Posterior fixation with achieved after two 5-cm rods set. The wound was irrigated with gentamycin-saline. After setting one hemovac, the wound was closed in layers. Operators VS 賴達明 Assistants R5 曾峰毅 R2 陳國瑋 相關圖片 林薛雲 (F,1945/08/26,66y6m) 手術日期 2011/09/09 手術主治醫師 賴達明 手術區域 東址 001房 02號 診斷 Ulnar nerve lesion 器械術式 Decompression of ulnar nerve, tardy ulnar palsy 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 陳國瑋, 時間資訊 16:36 臨時手術NPO 12:16 報到 12:50 進入手術室 12:55 麻醉開始 13:00 抗生素給藥 13:00 誘導結束 13:14 手術開始 14:20 手術結束 14:20 麻醉結束 14:22 送出病患 14:25 進入恢復室 15:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 神經分離術-上臂.前臂.大腿.小腿處之神經 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 曾峰毅 開立時間: 2011/09/09 13:58 Pre-operative Diagnosis Bilateral tardy ulnar palsy, status post left ulnar nerve neurolysis Post-operative Diagnosis Bilateral tardy ulnar palsy, status post left ulnar nerve neurolysis Operative Method Ulnar nerve neurolysis at right cubital tunnel Specimen Count And Types Nil Pathology Nil Operative Findings Ulnar nerve was compressed by hard ligament tightly. Ulnar nerve was decompressed well after the surgery. Operative Procedures With LMA general anaesthesia, the patient was put in supine position with right arm abduction. We disinfected right elbow, and draped the elbow. We made one curvilinear skin incision at right elbow, and dissected to expose ulnar nerve. Nerve was decompressed well. The wound was closed in layers. Operators VS 賴達明 Assistants R5 曾峰毅 R2 陳國瑋 R5 曾峰毅 R3 陳國瑋 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 張政傑 開立時間: 2011/09/09 14:32 Pre-operative Diagnosis Bilateral tardy ulnar palsy, status post left ulnar nerve neurolysis Post-operative Diagnosis Bilateral tardy ulnar palsy, status post left ulnar nerve neurolysis Operative Method Ulnar nerve neurolysis at right cubital tunnel Specimen Count And Types Nil Pathology Nil Operative Findings Ulnar nerve was compressed by hard ligament tightly. Ulnar nerve was decompressed well after the surgery. Operative Procedures With LMA general anaesthesia, the patient was put in supine position with right arm abduction. We disinfected right elbow, and draped the elbow. We made one curvilinear skin incision at right elbow, and dissected to expose ulnar nerve. Nerve was decompressed well. The wound was closed in layers. Operators VS 賴達明 Assistants R5 曾峰毅 R3 陳國瑋 相關圖片 江建成 (M,1976/02/24,36y0m) 手術日期 2011/09/09 手術主治醫師 賴達明 手術區域 東址 027房 05號 診斷 Herniation of intervertebral disc with myelopathy, cervical (HIVD) 器械術式 Diskectomy cervical(Anterier), C3/4 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 李振豪, 時間資訊 23:49 臨時手術NPO 17:45 進入手術室 17:50 麻醉開始 18:00 誘導結束 18:10 抗生素給藥 18:30 手術開始 21:05 手術結束 21:05 麻醉結束 21:22 送出病患 21:25 進入恢復室 22:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-頸椎 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 記錄__ 手術科部: 外科部 套用罐頭: C3/4 anterior cervical diskectomy, foraminoto... 開立醫師: 李振豪 開立時間: 2011/09/09 21:17 Pre-operative Diagnosis C3/4 cervical stenosis with myelopathy Post-operative Diagnosis C3/4 cervical stenosis with myelopathy Operative Method C3/4 anterior cervical diskectomy, foraminotomy, and fusion with PEEK cage Specimen Count And Types nil Pathology Nil Operative Findings Mild degenerative disc at C3/4 level was noted. The thecal sac was compressed by herniated disc and posterior marginal spur tightly and expanded well after decompression. No incidental durotomy or CSF leakage was noted during whole procedure. One #8 PEEK cage filled with artificial bone graft was inserted for anterior fusion. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with neck extension. The skin was scrubbed, disinfected, and draped as usual. Right upper neck transverse skin incision was made and the subcutaneous soft tissue was devided. The platysma muscle was transected and the fascia was opened in order to enter the plan between thyroid gland and carotid sheath. The pre-vertebral fascia was exposed and the C3/4 disc level was localized by portable C-arm X-ray. The pre-vertebral fascia was opened and bilateral longus collis muscle were detached. Anterior cervical diskectomy and foraminotomy was performed with curette, Kerrison punches, and alligator. The posterior longitudinal ligment and posterior marginal spur also removed. The thecal sac expanded well after well decompression. Hemostasis was achieved with bipolar electrocautery. One #8 PEEK cage filled with artificial bone was inserted for anterior fusion. The wound was irrigated with Gentamicin solution. One MiniHemovac was placed. The wound was then closed in layers with 3-0 Vicryl and 4-0 Dexon. Operators VS賴達明 Assistants R5李振豪, R1陸惠宗 相關圖片 杜夷波 (M,1952/05/15,59y9m) 手術日期 2011/09/09 手術主治醫師 賴達明 手術區域 東址 007房 02號 診斷 Neuroma, upper limb 器械術式 Excision of subcutaneous tumor, left brachial plexus 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 李振豪, 時間資訊 23:45 臨時手術NPO 15:50 進入手術室 15:55 麻醉開始 16:00 誘導結束 16:01 抗生素給藥 16:15 手術開始 17:30 手術結束 17:30 麻醉結束 17:34 送出病患 17:35 進入恢復室 19:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 軟組織良性腫瘤切除術,大或深 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Tumor excision 開立醫師: 李振豪 開立時間: 2011/09/09 17:52 Pre-operative Diagnosis Left brachial plexus tumor, suspect neuroma Post-operative Diagnosis Left brachial plexus neuroma Operative Method Tumor excision Specimen Count And Types 1 piece About size:5 x 4.9 x 3.5cm Source:Left brachial plexus tumor Pathology Pending Operative Findings The tumor was 5 x 4.9 x 3.5cm in size, gray-yellowish, hypervascularzied, well-demarcated, and elastic in character. The tumor was originated from left brachial plexus and dissected after opening of the capsule. Total tumor excision was performed after transection of the stump between the tumor and the nerve. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position. The skin was scrubbed, disinfected, and draped as usual. Linear skin incision was made over left forechest and the subcutaneous soft tissue was devided. The fascia was opened and the pectoralis major was splitted. The tumor was exposed after splitting of two muscle layers. The capsule of the tumor was opened along the tract of the nerve. Subcapsule dissection was performed. Debulking was performed during tumor dissection and the tumor was removed totally after transection the stump between the tumor and the nerve. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. The wound was then closed in layers with 3-0 Vicryl and 4-0 Dexon. Operators VS賴達明 Assistants R5李振豪, R1陸惠宗 相關圖片 任可克 (M,1951/07/28,60y7m) 手術日期 2011/09/09 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Herniated intervertebral disc (HIVD) 器械術式 Diskectomy cervical(Anterier), C3/4 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 2 紀錄醫師 鍾文桂, 時間資訊 23:47 臨時手術NPO 07:50 報到 08:05 進入手術室 08:10 麻醉開始 08:25 誘導結束 09:10 抗生素給藥 09:36 手術開始 12:35 手術結束 12:35 麻醉結束 12:45 送出病患 12:50 進入恢復室 13:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 椎間盤切除術-頸椎 1 1 手術 椎融合術-前融合,無固定物(≦四節) 1 2 摘要__ 手術科部: 外科部 套用罐頭: 1. Diskectomy, C3/4, anterior approach. 開立醫師: 鍾文桂 開立時間: 2011/09/09 12:26 Pre-operative Diagnosis Herniated intervertebral disc, C3/4. Post-operative Diagnosis Herniated intervertebral disc, C3/4. Operative Method 1. Diskectomy, C3/4, anterior approach. 2. Interbody fusion, C3/4. Specimen Count And Types nil Pathology Nil. Operative Findings 1. Posterior spur formation is present. Intact dura mater. 2. 7mm PEEK cage with allogragt bone was used for fusion. 3. A piece of ruptured disc was noted. Operative Procedures Under ETGA, the patient was placed in supine position and the head was in extension position. After disinfection and draping, a linear transverse skin incision was made a hyoid bone level. Dissection was made meticulously. The submandibular gland was retracted superiorly. After ensuring C3/4 disc level with intraoperative fluoroscopy, retractor was set. The intervertebral disc was resected piece by piece by using currete and alligator. Then, the spur was drilled out by high speed drill. A PEEK cage was implanted into the C3/4 disc space. The wound was closed in layers with one CWV drain. Operators 賴達明 Assistants 鍾文桂 陳以幸 相關圖片 黃亮昇 (M,1969/08/20,42y6m) 手術日期 2011/09/09 手術主治醫師 賴達明 手術區域 東址 019房 02號 診斷 Spondylosis with myelopathy, cervical 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 2 紀錄醫師 陳以幸, 時間資訊 23:50 臨時手術NPO 12:25 報到 13:05 進入手術室 13:10 麻醉開始 13:25 誘導結束 13:50 抗生素給藥 14:05 手術開始 19:10 手術結束 19:10 麻醉結束 19:15 送出病患 19:25 進入恢復室 21:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 手術 椎間盤切除術-頸椎 1 1 摘要__ 手術科部: 外科部 套用罐頭: 1. Diskectomy, anterior approach, C4/5, and C... 開立醫師: 鍾文桂 開立時間: 2011/09/09 18:58 Pre-operative Diagnosis Spinal stenosis and herniated intervertebral disc, C4/5 and C6/7. Post-operative Diagnosis Spinal stenosis and herniated intervertebral disc, C4/5 and C6/7. Operative Method 1. Diskectomy, anterior approach, C4/5, and C6/7. 2. Spinal fusion and fixaion with PEEK cage and plate/screws, C4/5, C6/7. Specimen Count And Types nil Pathology Nil. Operative Findings 1. Ruptured disc at C4/5 levels. Intact dura mater at both C4/5 and C6/7 levels. 2. C4/5: 8mm PEEK cage, plate 20mm, 4 screws: 4.0x1.6, 4 C6/7: 6mm PEEK cage, plate 16mm, 4 screws: 4.0x1.6 Operative Procedures Under ETGA, the patient was placed in supine position and the head was extended. After intraoperative fluoroscopy to ensure the C4/5 C6/7 levels, disinfection and draping were done. A liner horozontal incision was made at right neck. After meticulous dissection, the prevertebral space was reached. The C4-C7 levels were well exposed. The C4/5 and C6/7 intervertebral discs were resected piece by piece. The cage was placed for spinal fusion and the plate/screws were inserted for fixation. Finally, their positions were ensured by intraoperative fluoroscopy. The wound was closed in layers with one prevertebral minihemovac drain. Operators 賴達明 Assistants 鍾文桂 陳以幸 相關圖片 蔡宜真 (F,1981/10/03,30y5m) 手術日期 2011/09/09 手術主治醫師 蔡翊新 手術區域 東址 017房 08號 診斷 Obstructive hydrocephalus 器械術式 V-P shunt 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3E 紀錄醫師 陳以幸, 時間資訊 15:00 臨時手術NPO 15:00 開始NPO 17:51 通知急診手術 19:30 進入手術室 19:35 麻醉開始 19:40 誘導結束 20:00 抗生素給藥 20:27 手術開始 21:35 手術結束 21:35 麻醉結束 21:45 送出病患 21:50 進入恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室腹腔分流手術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt, left Kocher. 開立醫師: 蔡翊新 開立時間: 2011/09/09 21:32 Pre-operative Diagnosis Obstructive hydrocephalus status post V-P shunt insertion, with shunt dysfunction Post-operative Diagnosis Obstructive hydrocephalus status post V-P shunt insertion, with shunt dysfunction Operative Method Ventriculoperitoneal shunt, left Kocher. Specimen Count And Types 3 tubes of CSF, sent for routine, BCS and culture. Pathology Nil Operative Findings CSF: clear, pressure: 15 cmH2O. Ventricular catheter: 6.5 cm in depth, medium-pressure. Peritoneal catheter: 30 cm in depth, open. Intraperitoneal adhesion was noted. Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: supine with head rotated to right. 3.Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 7 cm curvilinear, right occipital, corresponded to the location of right occipital horn. Raney clips were applied to the scalp edge for temporary hemostasis. 5.After the scalp flap had been lifted and reflected anteriorly, a burr hole was made and the dura was tented by 2 stitches. 6.The dura was opened by a nib incision. Left lateral ventricle was tapped by a ventricular needle, then a 6.5 cm segment of the ventricular catheter was introduced into the ventricle. The outer end of the catheter was connected to a Pudenz reservoir. 7. A minilaparotomy was made at LUQ of the abdomen, then a trocar was pushed into peritoneal cavity. Subsequently, distal 30 cm segment of the peritoneal catheter (low-pressure) was introduced into the peritoneal cavity through the outer tube of the trochar. The proximal end of this catheter was passed through subcutaneous tunnel at forechest, neck, left retroauricular area and connected the reservoir. The shunt system was checked to make sure its function was working. 8. The reservoir was fixed to pericranium by 3 stitches. 9. Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 1/0 Vicryl and skin by continuous suture with 3/0 nylon. 10.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5曾峰毅R4王奐之R2陳以幸 Indication Of Emergent Operation IICP 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt, left Kocher. 開立醫師: 蔡翊新 開立時間: 2011/09/09 21:32 Pre-operative Diagnosis Obstructive hydrocephalus status post V-P shunt insertion, with shunt dysfunction Post-operative Diagnosis Obstructive hydrocephalus status post V-P shunt insertion, with shunt dysfunction Operative Method Ventriculoperitoneal shunt, left Kocher. Specimen Count And Types 3 tubes of CSF, sent for routine, BCS and culture. Pathology Nil Operative Findings CSF: clear, pressure: 15 cmH2O. Ventricular catheter: 6.5 cm in depth, medium-pressure. Peritoneal catheter: 30 cm in depth, open. Intraperitoneal adhesion was noted. Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: supine with head rotated to right. 3.Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 7 cm curvilinear, right occipital, corresponded to the location of right occipital horn. Raney clips were applied to the scalp edge for temporary hemostasis. 5.After the scalp flap had been lifted and reflected anteriorly, a burr hole was made and the dura was tented by 2 stitches. 6.The dura was opened by a nib incision. Left lateral ventricle was tapped by a ventricular needle, then a 6.5 cm segment of the ventricular catheter was introduced into the ventricle. The outer end of the catheter was connected to a Pudenz reservoir. 7. A minilaparotomy was made at LUQ of the abdomen, then a trocar was pushed into peritoneal cavity. Subsequently, distal 30 cm segment of the peritoneal catheter (low-pressure) was introduced into the peritoneal cavity through the outer tube of the trochar. The proximal end of this catheter was passed through subcutaneous tunnel at forechest, neck, left retroauricular area and connected the reservoir. The shunt system was checked to make sure its function was working. 8. The reservoir was fixed to pericranium by 3 stitches. 9. Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 1/0 Vicryl and skin by continuous suture with 3/0 nylon. 10.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5曾峰毅R4王奐之R2陳以幸 Indication Of Emergent Operation IICP 相關圖片 林助 (M,1928/01/15,84y1m) 手術日期 2011/09/09 手術主治醫師 何子昌 手術區域 東址 010房 07號 診斷 Lens dislocation 器械術式 P.P.V.- complicated 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 林暄婕, 時間資訊 13:45 進入手術室 13:50 麻醉開始 13:55 誘導結束 14:09 手術開始 14:50 手術結束 14:52 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 移位晶體除合併玻璃體切除術 1 1 R 記錄__ 手術科部: 眼科部 套用罐頭: PPV (simple / peeling) 開立醫師: 林暄婕 開立時間: 2011/09/09 14:48 Pre-operative Diagnosis Epiretinal membrane (o ) Lens dislocation (od) Post-operative Diagnosis Epiretinal membrane (o ) Lens dislocation (od) Operative Method Complicated PPV + Kenacort-assisted epiretinal menbrane removal + ICG-assisted internal limiting membrane removal (o ) pars plana vitrectomy + lensectomy (od) Specimen Count And Types nil Pathology nil Operative Findings Epiretinal membrane at macular area Lens dislocation (od) Operative Procedures 1. Under retrobulbar anesthesia 2. Disinfection and draping as usual, apply an eyelid speculum. 3. 360-degree peritomy and hemostasis with cautery. 3. Three sclerotomy were made then apply light probe, microvit, and infusion line throughthe sclerotomy wounds. 4. Vitrectomy was performed with Microvit 5. Remove dislocated lens with Framentome 6. Close sclerotomy wound with 9-0 Nylon 7. Close conjunctival wound with 8-0 Vicryl. 8. Subconjunctival injection of Rinderon and Gentamicin. 9. Atropine and Latycinpatching. Operators 何子昌, Assistants 林暄婕, 劉耀臨, 林玲珍 (F,1951/02/28,61y0m) 手術日期 2011/09/10 手術主治醫師 蔡瑞章 手術區域 東址 019房 01號 診斷 Meningitis due to Gram-negative bacteria 器械術式 Ommaya reservoir implantation 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 李振豪, 時間資訊 23:11 臨時手術NPO 08:20 進入手術室 08:22 麻醉開始 08:23 誘導結束 08:50 手術開始 09:40 手術結束 09:40 麻醉結束 09:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 歐氏貯囊置放手術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 內科部 套用罐頭: 1. Removal of ventriculo-peritoneal shunt 開立醫師: 李振豪 開立時間: 2011/09/10 09:44 Pre-operative Diagnosis Meningitis Post-operative Diagnosis Meningitis Operative Method 1. Removal of ventriculo-peritoneal shunt 2. Ommaya reservoir implantation Specimen Count And Types 2 pieces About size:one tip culture Source:ventricular catheter About size:5ml Source:CSF Pathology Nil Operative Findings The CSF was clear in character. The opening pressure is around 5cmH2O. The ventricular catheter of Ommaya reservoir was 6.5cm in depth. No acute complication was noted during whole procedure. The CSF was sent for routine, BCS, and bacterial culture. The ventricular catheter of V-P shunt was sent for tip culture. Operative Procedures Under tracheal general anesthesia, the patient was put in supine position. The scalp was shaved, scrubbed, and disinfected as usual. The scalp incision was made along operative scar. The ventricular catheter was identified. The ventricular catheter was cut off and CSF was sampled for study. The ventricular catheter was removed with tip culture. New ventriculostomy was performed with puncture needle from right Kocher"s burr hole. Nelaton was inserted and the ventricle was irrigated with normal saline. The Ommaya reservoir was implanted and fixed with three stitches. The function of Ommaya reservoir was checked. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. The wound was then closed in layers with 1-0 Vicryl and 3-0 Nylon. Right retroauricular small skin incision was made and the reservoir of the shunt was removed. The peritoneal catheter was cut off. The wound was closed with 3-0 Nylon. The peritoneal catheter was then removed from forechest wound. Operators Prof.蔡瑞章 Assistants R5李振豪, R2陳以幸 相關圖片 褚月寧 (F,1971/04/19,40y10m) 手術日期 2011/09/11 手術主治醫師 曾漢民 手術區域 東址 019房 01號 診斷 Acoustic tumor 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 3E 紀錄醫師 鍾文桂, 時間資訊 00:00 開始NPO 00:00 臨時手術NPO 06:54 通知急診手術 15:45 報到 15:45 進入手術室 15:50 麻醉開始 16:20 抗生素給藥 16:25 誘導結束 16:30 手術開始 19:50 麻醉結束 19:50 手術結束 20:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 顱底瘤手術 1 1 L 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 摘要__ 手術科部: 外科部 套用罐頭: Retrosigmoid approach for near total tumor ex... 開立醫師: 鍾文桂 開立時間: 2011/09/11 20:30 Pre-operative Diagnosis Acoustic neuroma, left. Post-operative Diagnosis Acoustic neuroma, left. Operative Method Retrosigmoid approach for near total tumor excision. Specimen Count And Types 1 piece About size:5cc Source:acoustic neuroma Pathology Pending. Operative Findings 1. Very firm, elastic,and whitish tumor in moderate vascularity.Clear yellowish fluid content in the cyst. The cyst wall was removed totally with intact arachnoid plane. 2. Intact sigmoid sinus. 3. The CN V, VI, VII/VIII, and lower cranial nerves were identified and left intact. 4. The intracanalicular portion of the tumor was left. Operative Procedures Under ETGA, the patient was placed in 3/4 prone position and the head was fixed by Mayfield. After shaving, disinfection, and draping, the previous craniotomy wound was incised and dissected. The craniotomy plate was taken out. A cruciate durotomy was made. The CSF was drained from cerebellopontine cistern for further brain retraction. The tumor was resected in piecemeal fashion along the tumor capsule. After tumor resection with the intracanalicular portion left, meticulous hemostasis was done. The dura mater was repaired with dura allograft. The bone plate was fixed back by miniplate. Under ETGA, the patient was placed in 3/4 prone position and the head was fixed by Mayfield. After shaving, disinfection, and draping, the previous craniotomy wound was incised and dissected. The craniotomy plate was taken out. A cruciate durotomy was made. The CSF was drained from cerebellopontine cistern for further brain retraction. The tumor was resected in piecemeal fashion along the tumor capsule. After tumor resection with the intracanalicular portion left, meticulous hemostasis was done. The dura mater was repaired with dura allograft. The bone plate was fixed back by miniplate. The wound was closed in layers with one CWV drain. Operators 曾漢民 Assistants R6 鍾文桂 R4 游健生 Indication Of Emergent Operation Recent neurologic deterioration: unsteady gait. 相關圖片 方民儒 (M,1954/07/11,57y8m) 手術日期 2011/09/12 手術主治醫師 賴達明 手術區域 東址 001房 03號 診斷 Intracranial hemorrhage 器械術式 suboccipital craniecotmy for hemotma evacuation and EVD 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 4E 紀錄醫師 游健生, 時間資訊 05:20 通知急診手術 05:40 進入手術室 05:45 麻醉開始 06:15 誘導結束 06:20 抗生素給藥 06:40 手術開始 09:20 抗生素給藥 10:50 手術結束 10:50 麻醉結束 11:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Bilateral suboccipital craniectomy with hemat... 開立醫師: 游健生 開立時間: 2011/09/12 12:15 Pre-operative Diagnosis Left cerebellar intracerebral hemorrhage with brainstem compression Post-operative Diagnosis Left cerebellar intracerebral hemorrhage with brainstem compression Operative Method Bilateral suboccipital craniectomy with hematoma evacuation Specimen Count And Types nil Pathology Nil Operative Findings A 2.5x2cm previous suboccipital craniectomy window with dura defect was noted at left side. The hematoma with some necrotic cerebellar tissue herniated from that craniectomy window after neck muscles were detached. The foramen magnum was opened during surgery. After bilateral suboccipital craniectomy and durotomy, subarachnoid space at right cerebellar was initally filled with CSF and bulged out. Gradually, the space collapsed and cerebellum became slack. Duraplasty was done with artificial dura (Cook). Diffuse oozing was noted during surgery and coagulopathy was suspected. Poor SpO2 during operation was noted probably due to lung edema and poor heart function was suspected. Operative Procedures Under ETGA, patient was in prone position with head fixed by headclamp. After shaving, we disinfected and draped the operation field as usual. A midline incision was made from 2cm above inion down to C2 spinous process. After dissection and neck muscle detachment, the suboccipital cranium and C1, C2 spinous process were exposed. The hematoma with some necrotic cerebellar tissue herniated from previous craniectomy window at left suboccipital region. We removed the hematoma and necrotic brain tissue with tumor forcep and suction. Hemostasis was achieved with bipolar and Surgicel covering. Two burholes were done at nuchal line, one at inion, and one at right suboccipital region. Craniectomy was done by connecting burholes with drill and Kerrison. Dura oozing was controlled by Gelfoam packing. The foramen magnum was opened followed by a V-shape durotomy. Subarachnoid space at right cerebellar was initally filled with CSF and bulged out. Gradually, the space collapsed and cerebellum became slack. We meticulously checked bleeding again and repaired the dura with artificial dura by water-tight continuous 3-0 prolene suture. A CWV drain was placed at epidural space. Neck muscles were approximated by interrupted sutures. Wound was closed by 2-0 Vicryl and 3-0 Nylon. Operators VS 賴達明 Assistants R6 鍾文桂 R4 游健生 Indication Of Emergent Operation brainstem compression 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Bilateral suboccipital craniectomy with hemat... 開立醫師: 游健生 開立時間: 2011/09/12 12:15 Pre-operative Diagnosis Left cerebellar intracerebral hemorrhage with brainstem compression Post-operative Diagnosis Left cerebellar intracerebral hemorrhage with brainstem compression Operative Method Bilateral suboccipital craniectomy with hematoma evacuation Specimen Count And Types nil Pathology Nil Operative Findings A 2.5x2cm previous suboccipital craniectomy window with dura defect was noted at left side. The hematoma with some necrotic cerebellar tissue herniated from that craniectomy window after neck muscles were detached. The foramen magnum was opened during surgery. After bilateral suboccipital craniectomy and durotomy, subarachnoid space at right cerebellar was initally filled with CSF and bulged out. Gradually, the space collapsed and cerebellum became slack. Duraplasty was done with artificial dura (Cook). Diffuse oozing was noted during surgery and coagulopathy was suspected. Poor SpO2 during operation was noted probably due to lung edema and poor heart function was suspected. Operative Procedures Under ETGA, patient was in prone position with head fixed by headclamp. After shaving, we disinfected and draped the operation field as usual. A midline incision was made from 2cm above inion down to C2 spinous process. After dissection and neck muscle detachment, the suboccipital cranium and C1, C2 spinous process were exposed. The hematoma with some necrotic cerebellar tissue herniated from previous craniectomy window at left suboccipital region. We removed the hematoma and necrotic brain tissue with tumor forcep and suction. Hemostasis was achieved with bipolar and Surgicel covering. Two burholes were done at nuchal line, one at inion, and one at right suboccipital region. Craniectomy was done by connecting burholes with drill and Kerrison. Dura oozing was controlled by Gelfoam packing. The foramen magnum was opened followed by a V-shape durotomy. Subarachnoid space at right cerebellar was initally filled with CSF and bulged out. Gradually, the space collapsed and cerebellum became slack. We meticulously checked bleeding again and repaired the dura with artificial dura by water-tight continuous 3-0 prolene suture. A CWV drain was placed at epidural space. Neck muscles were approximated by interrupted sutures. Wound was closed by 2-0 Vicryl and 3-0 Nylon. Operators VS 賴達明 Assistants R6 鍾文桂 R4 游健生 Indication Of Emergent Operation brainstem compression 相關圖片 黃壽廷 (M,1969/09/17,42y5m) 手術日期 2011/09/13 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 王奐之, 時間資訊 23:19 臨時手術NPO 11:00 進入手術室 11:06 麻醉開始 11:25 誘導結束 11:41 手術開始 12:18 抗生素給藥 15:00 手術結束 15:00 麻醉結束 15:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦組織活體切片 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: Right frontal burr hole for stereotactic biopsy 開立醫師: 王奐之 開立時間: 2011/09/13 15:38 Pre-operative Diagnosis Suprasellar tumor, suspected craniopharyngioma or germ cell tumor Post-operative Diagnosis Suprasellar tumor, suspected craniopharyngioma Operative Method Right frontal burr hole for stereotactic biopsy Specimen Count And Types Nil Pathology Frozen section: craniopharyngioma Operative Findings Biopsy trajectory was planned to avoid penetration of right sylvian fissure, right lateral ventricle and the visible major vessels. Biopsy was performed for 6 times, showing white-yellowish tissue. Some blood clots were noted from the biopsy needle, but no obvious blood extravasating from the corticotomy at the end of procedure. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head fixed in Mayfield skull clamp. After planning of biopsy trajectory, the hair around the entry point was shaved and the scalp was scrubbed, disinfected & draped in sterile fashion. A linear incision was then made at right frontal area, followed by burr creation. After 2 tenting stitches, a small cruciate durotomy was performed. A small corticotomy was made, followed by meticulous hemostasis. Stereotactic biopsy was then performed with biopsy needle for 6 times. The wound was then closed in layers after hemostasis. Operators VS 曾漢民 Assistants R4 王奐之 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Right frontal burr hole for stereotactic biopsy 開立醫師: 王奐之 開立時間: 2011/09/13 15:38 Pre-operative Diagnosis Suprasellar tumor, suspected craniopharyngioma or germ cell tumor Post-operative Diagnosis Suprasellar tumor, suspected craniopharyngioma Operative Method Right frontal burr hole for stereotactic biopsy Specimen Count And Types Nil Pathology Frozen section: craniopharyngioma Operative Findings Biopsy trajectory was planned to avoid penetration of right sylvian fissure, right lateral ventricle and the visible major vessels. Biopsy was performed for 6 times, showing white-yellowish tissue. Some blood clots were noted from the biopsy needle, but no obvious blood extravasating from the corticotomy at the end of procedure. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head fixed in Mayfield skull clamp. After planning of biopsy trajectory, the hair around the entry point was shaved and the scalp was scrubbed, disinfected & draped in sterile fashion. A linear incision was then made at right frontal area, followed by burr creation. After 2 tenting stitches, a small cruciate durotomy was performed. A small corticotomy was made, followed by meticulous hemostasis. Stereotactic biopsy was then performed with biopsy needle for 6 times. The wound was then closed in layers after hemostasis. Operators VS 曾漢民 Assistants R4 王奐之 相關圖片 摘要__ 手術科部: 外科部 套用罐頭: Right frontal burr hole for stereotactic biopsy 開立醫師: 王奐之 開立時間: 2011/09/13 15:39 Pre-operative Diagnosis Suprasellar tumor, suspected craniopharyngioma or germ cell tumor Post-operative Diagnosis Suprasellar tumor, suspected craniopharyngioma Operative Method Right frontal burr hole for stereotactic biopsy Specimen Count And Types 1 piece About size:pieces Source:suprasellar tumor Pathology Frozen section: craniopharyngioma Operative Findings Biopsy trajectory was planned to avoid penetration of right sylvian fissure, right lateral ventricle and the visible major vessels. Biopsy was performed for 6 times, showing white-yellowish tissue. Some blood clots were noted from the biopsy needle, but no obvious blood extravasating from the corticotomy at the end of procedure. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head fixed in Mayfield skull clamp. After planning of biopsy trajectory, the hair around the entry point was shaved and the scalp was scrubbed, disinfected & draped in sterile fashion. A linear incision was then made at right frontal area, followed by burr creation. After 2 tenting stitches, a small cruciate durotomy was performed. A small corticotomy was made, followed by meticulous hemostasis. Stereotactic biopsy was then performed with biopsy needle for 6 times. The wound was then closed in layers after hemostasis. Operators VS 曾漢民 Assistants R4 王奐之 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Right frontal burr hole for stereotactic biopsy 開立醫師: 王奐之 開立時間: 2011/09/13 15:39 Pre-operative Diagnosis Suprasellar tumor, suspected craniopharyngioma or germ cell tumor Post-operative Diagnosis Suprasellar tumor, suspected craniopharyngioma Operative Method Right frontal burr hole for stereotactic biopsy Specimen Count And Types 1 piece About size:pieces Source:suprasellar tumor Pathology Frozen section: craniopharyngioma Operative Findings Biopsy trajectory was planned to avoid penetration of right sylvian fissure, right lateral ventricle and the visible major vessels. Biopsy was performed for 6 times, showing white-yellowish tissue. Some blood clots were noted from the biopsy needle, but no obvious blood extravasating from the corticotomy at the end of procedure. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head fixed in Mayfield skull clamp. After planning of biopsy trajectory, the hair around the entry point was shaved and the scalp was scrubbed, disinfected & draped in sterile fashion. A linear incision was then made at right frontal area, followed by burr creation. After 2 tenting stitches, a small cruciate durotomy was performed. A small corticotomy was made, followed by meticulous hemostasis. Stereotactic biopsy was then performed with biopsy needle for 6 times. The wound was then closed in layers after hemostasis. Operators VS 曾漢民 Assistants R4 王奐之 相關圖片 張境軒 (M,1967/08/24,44y6m) 手術日期 2011/09/13 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Herniated intervertebral disc (HIVD) 器械術式 Diskectomy lumbar, L5/S1 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 王奐之, 時間資訊 23:17 臨時手術NPO 08:00 進入手術室 08:05 麻醉開始 08:10 誘導結束 08:30 抗生素給藥 08:53 手術開始 10:35 手術結束 10:35 麻醉結束 10:45 送出病患 10:50 進入恢復室 11:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-腰椎 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 外科部 套用罐頭: Microsurgical discectomy, L5-S1 開立醫師: 王奐之 開立時間: 2011/09/13 10:57 Pre-operative Diagnosis Herniated intervertebral disc, L5-S1, left Post-operative Diagnosis Herniated intervertebral disc, L5-S1, left Operative Method Microsurgical discectomy, L5-S1 Specimen Count And Types Nil Pathology Nil Operative Findings Bulging disc at left L5-S1 was noted, compressing the left S1 nerve root tightly. Some central calcification of the L5-S1 disc was noted, which was difficult to remove. After discectomy, the S1 root was decompressed thoroughly. An engorged vein was noted at the axilla of left S1 root, with some bleeding encountered, which was electrocauterized and packed with gelfoam. A small unintentional durotomy was noted on left S1 root, and was repaired with a single stitch of 5-0 Prolene. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position. After localization of L5-S1 level with C-arm, the skin was scrubbed, disinfected & draped in sterile fashion. A midline incision was made at L5-S1 level, the incision was deepened through fascial layer. The left side paraspinal muscles were detached from the L5 spinous process and lamina. Taylor hook was then applied, exposing the L5-S1 lamina & interlaminary space. Lower L5 & upper S1 laminotomy was done, the left S1 nerve root was identified and gently retracted to the medial side. A squared incision was made at left L5-S1 disc, followed by discectomy in piecemeal fashion. After hemostasis, the wound was closed in layers. Operators VS 曾勝弘 Assistants R4 王奐之 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Microsurgical discectomy, L5-S1 開立醫師: 王奐之 開立時間: 2011/09/13 10:58 Pre-operative Diagnosis Herniated intervertebral disc, L5-S1, left Post-operative Diagnosis Herniated intervertebral disc, L5-S1, left Operative Method Microsurgical discectomy, L5-S1 Specimen Count And Types Nil Pathology Nil Operative Findings Bulging disc at left L5-S1 was noted, compressing the left S1 nerve root tightly. Some central calcification of the L5-S1 disc was noted, which was difficult to remove. After discectomy, the S1 root was decompressed thoroughly. An engorged vein was noted at the axilla of left S1 root, with some bleeding encountered, which was electrocauterized and packed with gelfoam. A small unintentional durotomy was noted on left S1 root, and was repaired with a single stitch of 5-0 Prolene. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position. After localization of L5-S1 level with C-arm, the skin was scrubbed, disinfected & draped in sterile fashion. A midline incision was made at L5-S1 level, the incision was deepened through fascial layer. The left side paraspinal muscles were detached from the L5 spinous process and lamina. Taylor hook was then applied, exposing the L5-S1 lamina & interlaminary space. Lower L5 & upper S1 laminotomy was done, the left S1 nerve root was identified and gently retracted to the medial side. A squared incision was made at left L5-S1 disc, followed by discectomy in piecemeal fashion. After hemostasis, the wound was closed in layers. Operators VS 曾勝弘 Assistants R4 王奐之 相關圖片 陳定谷 (M,2009/07/26,2y7m) 手術日期 2011/09/13 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Anomalies of spinal cord 器械術式 Cord untethering 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 石博元 ASA 1 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 07:43 報到 08:02 進入手術室 08:10 麻醉開始 08:35 誘導結束 08:54 抗生素給藥 09:16 手術開始 11:54 抗生素給藥 12:57 手術結束 12:57 麻醉結束 13:03 送出病患 13:12 進入恢復室 14:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 手術 良性脊髓腫瘤切除術 1 1 手術 皮下肌肉或深部異物取出術 1 2 摘要__ 手術科部: 外科部 套用罐頭: 1. S3 laminectomy for sacral Intradural spina... 開立醫師: 游健生 開立時間: 2011/09/13 14:16 Pre-operative Diagnosis 1. Sacral Intradural spinal tumor with cord tethering 2. Dermocutaneous sinus tract Post-operative Diagnosis 1. Sacral intradural spinal lipoma with cord tethering 2. Dermocutaneous sinus tract Operative Method 1. S3 laminectomy for sacral Intradural spinal lipoma excision and cord untethering 2. Excision of dermocutaneous sinus tract Specimen Count And Types 2 piece About size:a)2 x 1.5cm b) 0.5x3cm Source: a)intradural spinal tumor b) dermis & subcutaneous tissue Pathology Pending Operative Findings The S4 laminae were absent with a intradural soft tumor herniated from it. The proximal of tumor was covered with dura and its distal became a sinus tract. The tumor was adipose-tissue like and a few small nerve roots arising from the ventral aspect. Thus, we suspected the cord blended with its ventral site. There were severe adhesion between arachnoid and pia/nerve root. The cord was free from tethering after surgery. Operative Procedures Under ETGA, patient was in prone position. After disinfection and draping, a midline linear incision was made and changed to an elliptic incision to include the sinus tract orifice. We dissected along the right aspect of sinus tract. The paraspinal muscles were detached and S2,3 laminae were exposed. We removed S3 laminae and reflected S2 laminae upward after cutting bilateral lamina. We opened the dura at S2 level and a normal cord was seen. We traced the cord caudally and a intraspinal soft tumor was met. We freed the cord, nerve roots, and tumor from arachnoid adhesion. There were a few small nerve roots arising from the ventral aspect of tumor. Thus, we suspected the cord blended with its ventral site. The tumor was transected at the junction of dura and the cord was freed from tethering at its caudal aspect. The sinus tract and some intradural part of tumor were excised. Hemostasis was achieved with bipolar. We closed the pia with 7-0 prolene and the dura with 5-0 prolene continuous suture. We placed a Duraform on the thecal sac. The S2 laminae and paraspinal muscles were approximated with interrupted silk sutures. Wound was closed in layers with 3-0 Vicryl and 3-0 Nylon. Operators VS 郭夢菲 Assistants R4 游健生 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: 1. S3 laminectomy for sacral Intradural spina... 開立醫師: 游健生 開立時間: 2011/09/16 11:43 Pre-operative Diagnosis 1. Sacral Intradural spinal tumor with cord tethering 2. Dermocutaneous sinus tract Post-operative Diagnosis 1. Sacral intradural spinal lipoma with cord tethering 2. Dermocutaneous sinus tract Operative Method 1. S3 laminectomy for sacral Intradural spinal lipoma excision and cord untethering 2. Excision of dermocutaneous sinus tract Specimen Count And Types 2 piece About size:a)2 x 1.5cm b) 0.5x3cm Source: a)intradural spinal tumor b) dermis & subcutaneous tissue Pathology Pending Operative Findings The S4 laminae were absent with a intradural soft tumor herniated from it. The proximal of tumor was covered with dura and its distal became a sinus tract. The tumor was adipose-tissue like and a few small nerve roots arising from the ventral aspect. Thus, we suspected the cord blended with its ventral site. There were severe adhesion between arachnoid and pia/nerve root. The cord was free from tethering after surgery. Operative Procedures Under ETGA, patient was in prone position. After disinfection and draping, a midline linear incision was made and changed to an elliptic incision to include the sinus tract orifice. We dissected along the right aspect of sinus tract. The paraspinal muscles were detached and S2,3 laminae were exposed. We removed S3 laminae and reflected S2 laminae upward after cutting bilateral lamina. We opened the dura at S2 level and a normal cord was seen. We traced the cord caudally and a intraspinal soft tumor was met. We freed the cord, nerve roots, and tumor from arachnoid adhesion. There were a few small nerve roots arising from the ventral aspect of tumor. Thus, we suspected the cord blended with its ventral site. The tumor was transected at the junction of dura and the cord was freed from tethering at its caudal aspect. The sinus tract and some intradural part of tumor were excised. Hemostasis was achieved with bipolar. We closed the pia with 7-0 prolene and the dura with 5-0 prolene continuous suture. We placed a Duraform on the thecal sac. The S2 laminae and paraspinal muscles were approximated with interrupted silk sutures. Wound was closed in layers with 3-0 Vicryl and 3-0 Nylon. Operators VS 郭夢菲 Assistants R4 游健生 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: 1. S3 laminectomy for intradural lipoma subto... 開立醫師: 郭夢菲 開立時間: 2011/09/16 12:49 Pre-operative Diagnosis 1. Sacral Intradural lipoma with cord tethering, caudal type 2. Dermocutaneous sinus tract with tethered spinal cord Post-operative Diagnosis 1. Sacral Intradural lipoma with cord tethering, caudal type 2. Dermocutaneous sinus tract with tethered spinal cord Operative Method 1. S3 laminectomy for intradural lipoma subtotal excision and cord untethering 2. Excision of dermocutaneous sinus tract and primary repair of dura Specimen Count And Types 2 piece About size:a)2 x 1.5cm b) 0.5x3cm Source: a)intradural spinal tumor b) dermis & subcutaneous tissue Pathology Pending Operative Findings 1. There a skin depression overlying the dermal sinus tract and a deep dimple just above the coccyx. They were excised and repaired. 2. The S4 laminae were absent with an intradural lipoma herniated from it. The placode was tethered both by the intradural intramedullary lipoma at its ventral and cuadal part and also tethered by a lipomatous dermal sinus tract at its dorsal side. 3. The ventral roots was scanty but could be traced to S3 level. All the nerve roots at the ventral side were preserved. 4. There were severe adhesion between arachnoid and pia/nerve root around the whold placoed, which indicate a high possibility of retethering in the cuture though the cord was free from tethering after surgery. Operative Procedures Under ETGA, patient was in prone position. After disinfection and draping, a midline linear incision was made and changed to an elliptic incision to include the sinus tract orifice and the deep coccygeal dimple. We dissected along the right aspect of sinus tract. The paraspinal muscles were detached and the bifid and deformed S2,3 laminae were exposed. We removed S3 laminae and reflected S2 laminae upward after cutting bilateral lamina. We opened the dura at S2 level and a normal cord was seen under microscope. We traced the cord caudally and a intraspinal soft tumor was met. We freed the cord, nerve roots, and tumor from arachnoid adhesion. There were a few small nerve roots arising from the ventral aspect of tumor. Thus, we suspected the cord blended with its ventral site. The tumor was transected at the junction of dura and the cord was freed from tethering at its caudal aspect. The sinus tract and some intradural part of tumor were excised. Hemostasis was achieved with bipolar. We closed the pia with 7-0 prolene after further debulking of the lipoma to reconstruct the placoed, then the dural repair with 5-0 prolene continuous suture. We placed a Duraform on the thecal sac. The S2 laminae and paraspinal muscles were approximated with interrupted silk sutures. Wound was closed in layers with 3-0 Vicryl and 3-0 Nylon. Operators VS 郭夢菲 Assistants R4 游健生 相關圖片 戴佳惠 (F,1976/03/01,36y0m) 手術日期 2011/09/13 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Facial spasm 器械術式 Microvascular decompression (right) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 鍾文桂, 時間資訊 23:11 臨時手術NPO 07:30 報到 08:05 進入手術室 08:10 麻醉開始 08:30 誘導結束 08:41 抗生素給藥 09:00 手術開始 11:41 抗生素給藥 12:55 麻醉結束 12:55 手術結束 13:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦微血管減壓術 1 1 R 手術 精密手術顯微鏡–腦神經外科術中儀器使用費微鏡 1 0 R 摘要__ 手術科部: 外科部 套用罐頭: Microvascular decompression of facial nerve,r... 開立醫師: 鍾文桂 開立時間: 2011/09/13 13:20 Pre-operative Diagnosis Hemifacial spasm, right. Post-operative Diagnosis Hemifacial spasm, right. Operative Method Microvascular decompression of facial nerve,right. Specimen Count And Types nil Pathology Nil. Operative Findings 1. A loop of AICA branch was noted offending the CN VII. 2. No offending vessle on the trigeminal nerve is noted. Operative Procedures Under ETGA, the patient was placed in 3/4 prone position and the head was fixed by Mayfield. After shaving, disinfection, and draping, a linear incision was made at retroauricular area. After dissection and harvesting fascia graft, a retrosigmoid craniotomy was obtained. After identifying the sigmoid sinus, the durotomy was done. CSF drainage from cerebellopontine cister was obtained followed by cerebellar retraction. After arachnoid dissection, Teflon pad was placed between the offending AICA and CNVII. After well hemostasis, the wound was closed in layers and the craniotomy plate was fixed by miniplates and screws. Operators 賴達明 Assistants R6鍾文桂 相關圖片 陳寶釵 (F,1950/02/04,62y1m) 手術日期 2011/09/13 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Sciatica 器械術式 Spinal fusion posterior (L5/S1) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 23:14 臨時手術NPO 12:55 報到 13:20 進入手術室 13:30 麻醉開始 13:35 誘導結束 13:45 抗生素給藥 14:33 手術開始 16:50 抗生素給藥 17:55 開始輸血 18:30 手術結束 18:30 麻醉結束 18:40 送出病患 18:42 進入恢復室 19:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎弓切除術(減壓)-二節以內 1 2 摘要__ 手術科部: 外科部 套用罐頭: 1. Transforaminal lumbar interbody fusion at ... 開立醫師: 鍾文桂 開立時間: 2011/09/13 19:03 Pre-operative Diagnosis Spondylolisthesis, L4/5, grade I Spondylolisthesis, L5/S1, grade I Post-operative Diagnosis Spondylolisthesis, L4/5, grade I Spondylolisthesis, L5/S1, grade I Operative Method 1. Transforaminal lumbar interbody fusion at L5/S1PEEK cage and autologous bone graft 2. Posterior instrumentation and fixation with transpedicular screws and rods at L5/S1. 3. L5 laminectomy. Specimen Count And Types nil Pathology Nil. Operative Findings Thecal sac was compromised by hypertrophic ligamentum flavum. Thecal sac was intact after the surgery. Synthes, transpedicular screws,6.2 x 40 mm at right L5 and bilateral S1 pedicles, 6.2x40mm at left L5 were instrumented. Synthes PEEK banana cage, 11 mm in height, and rods 5cm were used for TLIF. Operative Procedures WIth endotracheal general anaesthesia, the patient was put in prone position. After C-arm localization, the back was scrubbed, disinfected, and then draped as usual. We made one midline skin incision and dissected bilateral paraspinal muscle to expose bilateral laminae from L3 to L5. We instrumented bilateral pedicles of L5 and S1 with transpedicular screws, and performed L5 laminectomy for L4/5 diskectomy. Fusion with achieved with PEEK cage and autologous bone graft. Posterior fixation with achieved after two 5-cm rods set. The wound was irrigated with gentamycin-saline. After setting one hemovac, the wound was closed in layers. Operators VS 賴達明 Assistants R6 鍾文桂 陳玉坤 (M,1952/08/01,59y7m) 手術日期 2011/09/13 手術主治醫師 賴達明 手術區域 東址 005房 03號 診斷 Lumbar Spondylosis 器械術式 Laminectomy for decompression (sublaminar decompression) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 王奐之, 時間資訊 23:15 臨時手術NPO 15:27 進入手術室 15:35 麻醉開始 15:45 誘導結束 16:10 抗生素給藥 16:45 手術開始 18:35 手術結束 18:35 麻醉結束 18:45 送出病患 18:46 進入恢復室 19:46 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 椎弓切除術(減壓)-二節以內 1 1 摘要__ 手術科部: 外科部 套用罐頭: Partial L4 laminectomy for L3-4 sublaminar de... 開立醫師: 王奐之 開立時間: 2011/09/13 18:55 Pre-operative Diagnosis L3-4 spinal canal stenosis Post-operative Diagnosis L3-4 spinal canal stenosis Operative Method Partial L4 laminectomy for L3-4 sublaminar decompression Specimen Count And Types Nil Pathology Nil Operative Findings Hypertrophic ligamentum flavum was noted and the thecal sac was compressed tightly. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position. After localization of L3-4 level with C-arm, the skin was scrubbed, disinfected & draped in sterile fashion. A midline incision was made at L3-4, and the incision was deepened through fascial layer. The paraspinal muscles were then detached from L3-4 spinous processes & L4 lamina. Partial L4 laminectomy was then performed under microscope. The ligamentum flavum was also removed with Kerrison punch. After hemostasis, the wound was closed in layers. Operators VS 賴達明 Assistants R4 王奐之 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Partial L4 laminectomy for L3-4 sublaminar de... 開立醫師: 王奐之 開立時間: 2011/09/13 18:55 Pre-operative Diagnosis L3-4 spinal canal stenosis Post-operative Diagnosis L3-4 spinal canal stenosis Operative Method Partial L4 laminectomy for L3-4 sublaminar decompression Specimen Count And Types Nil Pathology Nil Operative Findings Hypertrophic ligamentum flavum was noted and the thecal sac was compressed tightly. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position. After localization of L3-4 level with C-arm, the skin was scrubbed, disinfected & draped in sterile fashion. A midline incision was made at L3-4, and the incision was deepened through fascial layer. The paraspinal muscles were then detached from L3-4 spinous processes & L4 lamina. Partial L4 laminectomy was then performed under microscope. The ligamentum flavum was also removed with Kerrison punch. After hemostasis, the wound was closed in layers. Operators VS 賴達明 Assistants R4 王奐之 相關圖片 林茂榮 (M,1934/06/23,77y8m) 手術日期 2011/09/13 手術主治醫師 蔡翊新 手術區域 東址 001房 06號 診斷 Subdural hemorrhage, traumatic 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 石博元 ASA 4E 紀錄醫師 陳以幸, 時間資訊 07:00 開始NPO 15:55 通知急診手術 18:05 進入手術室 18:08 麻醉開始 18:18 誘導結束 18:21 開始輸血 18:30 抗生素給藥 18:50 手術開始 20:35 手術結束 20:35 麻醉結束 20:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 慢性硬腦膜下血腫清除術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Chronic Subdural Hematoma 開立醫師: 蔡翊新 開立時間: 2011/09/13 19:32 Pre-operative Diagnosis Right F-T-P chronic SDH. Post-operative Diagnosis Right F-T-P chronic SDH. Operative Method Right frontotemporal burr hole for removal of chronic SDH. Specimen Count And Types 1 piece of dura, 0.5 cm in diameter, sent for pathology. 1 tube of chronic SDH, sent for cytology. Pathology Pending. Operative Findings Dark reddish liquified blood gushed out upon opening the dura and outer membrane. The brain remained slack after drainage of the chronic SDH. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: linear at right frontotemporal area, 5 cm. Raney clips were applied to the scalp edge for temporary hemostasis. 5. A burr hole was made at right F-T area. 6. Dural tenting: by two 2/0 silk. 7. Dural incision: circular, and the dura was sent for pathology. 8. The outer membrane of the hematoma was coagulated by Bovie along the edge of dural incision, then exicsed. 9. The liquified old blood in the subdural space was evacuated by sucker, some sent for cytology, then thoroughly irrigated with N.S. through a rubber tube until the return was clean. 10.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous sutures with 2/0 Vicryl and skin by continuouss suture with 3/0 nylon. 11.Drain: one, subdural, rubber drain. 12.Blood transfusion: PRBC 2U (for anemia). Blood loss: minimal. 13.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5李振豪R2陳以幸 Indication Of Emergent Operation IICP, left side weakness. 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Chronic Subdural Hematoma 開立醫師: 蔡翊新 開立時間: 2011/09/13 19:32 Pre-operative Diagnosis Right F-T-P chronic SDH. Post-operative Diagnosis Right F-T-P chronic SDH. Operative Method Right frontotemporal burr hole for removal of chronic SDH. Specimen Count And Types 1 piece of dura, 0.5 cm in diameter, sent for pathology. 1 tube of chronic SDH, sent for cytology. Pathology Pending. Operative Findings Dark reddish liquified blood gushed out upon opening the dura and outer membrane. The brain remained slack after drainage of the chronic SDH. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: linear at right frontotemporal area, 5 cm. Raney clips were applied to the scalp edge for temporary hemostasis. 5. A burr hole was made at right F-T area. 6. Dural tenting: by two 2/0 silk. 7. Dural incision: circular, and the dura was sent for pathology. 8. The outer membrane of the hematoma was coagulated by Bovie along the edge of dural incision, then exicsed. 9. The liquified old blood in the subdural space was evacuated by sucker, some sent for cytology, then thoroughly irrigated with N.S. through a rubber tube until the return was clean. 10.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous sutures with 2/0 Vicryl and skin by continuouss suture with 3/0 nylon. 11.Drain: one, subdural, rubber drain. 12.Blood transfusion: PRBC 2U (for anemia). Blood loss: minimal. 13.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5李振豪R2陳以幸 Indication Of Emergent Operation IICP, left side weakness. 相關圖片 俞綏國 (M,1927/04/20,84y10m) 手術日期 2011/09/13 手術主治醫師 蔡翊新 手術區域 東址 001房 07號 診斷 Subdural hemorrhage 器械術式 left burhole for cSDH 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 石博元 ASA 3E 紀錄醫師 蕭智陽, 時間資訊 16:00 臨時手術NPO 16:00 開始NPO 20:23 通知急診手術 21:25 進入手術室 21:30 麻醉開始 21:40 誘導結束 21:55 抗生素給藥 22:06 手術開始 23:05 麻醉結束 23:05 手術結束 23:15 送出病患 23:20 進入恢復室 00:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 手術 慢性硬腦膜下血腫清除術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Chronic Subdural Hematoma 開立醫師: 蔡翊新 開立時間: 2011/09/13 22:35 Pre-operative Diagnosis Left frontoparietal chronic SDH. Post-operative Diagnosis Left frontoparietal chronic SDH. Operative Method Left frontal burr hole for removal of chronic SDH. Specimen Count And Types nil Pathology Nil. Operative Findings Dark reddish liquified blood gushed out upon opening the dura and outer membrane. The brain remained slack after removal of SDH. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: linear at left frontal area. Raney clips were applied to the scalp edge for temporary hemostasis. 5. A burr hole was made at left frontal area. 6. Dural tenting: by two 2/0 silk. 7. Dural incision: cruciate. 8. The outer membrane of the hematoma was coagulated by Bovie along the edge of dural incision, then excised. 9. The liquified old blood in the subdural space was evacuated by sucker, then thoroughly irrigated with N.S. through a rubber tube until the return was clean. 10.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous sutures with 1/0 Vicryl and skin by continuouss suture with 3/0 nylon. 11.Drain: one, subdural, rubber drain. 12.Blood transfusion: Nil. Blood loss: minimal. 13.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5李振豪R1蕭智陽 Indication Of Emergent Operation right side weakness, brain compression 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Chronic Subdural Hematoma 開立醫師: 蔡翊新 開立時間: 2011/09/13 22:35 Pre-operative Diagnosis Left frontoparietal chronic SDH. Post-operative Diagnosis Left frontoparietal chronic SDH. Operative Method Left frontal burr hole for removal of chronic SDH. Specimen Count And Types nil Pathology Nil. Operative Findings Dark reddish liquified blood gushed out upon opening the dura and outer membrane. The brain remained slack after removal of SDH. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: linear at left frontal area. Raney clips were applied to the scalp edge for temporary hemostasis. 5. A burr hole was made at left frontal area. 6. Dural tenting: by two 2/0 silk. 7. Dural incision: cruciate. 8. The outer membrane of the hematoma was coagulated by Bovie along the edge of dural incision, then excised. 9. The liquified old blood in the subdural space was evacuated by sucker, then thoroughly irrigated with N.S. through a rubber tube until the return was clean. 10.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous sutures with 1/0 Vicryl and skin by continuouss suture with 3/0 nylon. 11.Drain: one, subdural, rubber drain. 12.Blood transfusion: Nil. Blood loss: minimal. 13.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5李振豪R1蕭智陽 Indication Of Emergent Operation right side weakness, brain compression 相關圖片 孫錫華 (F,1935/06/14,76y9m) 手術日期 2011/09/14 手術主治醫師 張金池 手術區域 東址 025房 02號 診斷 Glioblastoma multiforma 器械術式 Tracheostomy 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 3 紀錄醫師 郝政鴻, 時間資訊 06:00 臨時手術NPO 11:45 報到 12:30 進入手術室 12:35 麻醉開始 12:40 誘導結束 12:55 手術開始 13:00 手術結束 13:00 麻醉結束 13:58 送出病患 14:00 進入恢復室 15:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 氣管切開術 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 郝政鴻 開立時間: 2011/09/14 13:08 Pre-operative Diagnosis Vocal cord plasy with impending respiratory failure Post-operative Diagnosis Vocal cord plasy with impending respiratory failure Operative Method Tracheostomy Specimen Count And Types nil Pathology None Operative Findings Fr . 6 shily low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding. Operators VS張金池 Assistants R4郝政鴻 R1柯人玄 蔡珊珊 (F,1943/09/08,68y6m) 手術日期 2011/09/14 手術主治醫師 曾漢民 手術區域 東址 003房 03號 診斷 Acromegaly and gigantism 器械術式 CSF leakage repair 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 陳國瑋, 時間資訊 23:06 臨時手術NPO 14:05 報到 14:13 進入手術室 14:15 麻醉開始 14:25 誘導結束 14:45 抗生素給藥 15:07 手術開始 17:00 手術結束 17:00 麻醉結束 17:10 送出病患 17:13 進入恢復室 18:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 經由蝶竇之腦下垂體瘤切除 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 摘要__ 手術科部: 外科部 套用罐頭: CSF leakage repair with packing of abdominal fat 開立醫師: 陸惠宗 開立時間: 2011/09/14 15:48 Pre-operative Diagnosis Pituitary microadenoma status post trans-sphenoid adenomectomy with CSF leakage status post repair Post-operative Diagnosis Pituitary microadenoma status post trans-sphenoid adenomectomy with CSF leakage status post repair twice Operative Method CSF leakage repair with packing of abdominal fat Specimen Count And Types nil Pathology nil Operative Findings CSF leakage was noted noted after removal of previously packed gelfoam; no more CSF leak was noted after packing of abdominal fat. A piece of abdominal fat measuring about 2.5cm in diameter was obtained for CSF leakage repair. Operative Procedures After endotracheal general anethesia, the patient was placed in supine position, with her head put on a head rest. After skin disinfection & draping, a small transverse incision was made at left upper quadrant of abdomen. After retrival of a piece of abdominal fat, the abdominal wound was then closed with 3-0 Vicryl & 4-0 Nylon. The right nostril was entered, the nasal mucosa was detached from previous incision and the bone fragments were removed. After removal of gelfoam, the fat was packed and stuck at the edge durotomy; Tissucol Duo was applied onto the fat to facilitate sealing. The bone fragments were placed back, and packed with gelfoam. After reduction of nasal mucosa, nasal packings were inserted for compression. Operators VS曾漢民 Assistants R6鍾文桂 R3陳國瑋 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: CSF leakage repair with packing of abdominal fat 開立醫師: 陳國瑋 開立時間: 2011/09/14 17:13 Pre-operative Diagnosis Pituitary microadenoma status post trans-sphenoid adenomectomy with CSF leakage status post repair Post-operative Diagnosis Pituitary microadenoma status post trans-sphenoid adenomectomy with CSF leakage status post repair twice Operative Method CSF leakage repair with packing of abdominal fat Specimen Count And Types nil Pathology nil Operative Findings CSF leakage was noted noted after removal of previously packed gelfoam; no more CSF leak was noted after packing of abdominal fat. A piece of abdominal fat measuring about 2.5cm in diameter was obtained for CSF leakage repair. CSF leakage was noted noted after removal of previously packed abdominal fat; no more CSF leak was noted after packing of abdominal fat. A piece of abdominal fat measuring about 2.5cm in diameter was obtained for CSF leakage repair. Operative Procedures After endotracheal general anethesia, the patient was placed in supine position, with her head put on a head rest. After skin disinfection & draping, a small transverse incision was made at left upper quadrant of abdomen. After retrival of a piece of abdominal fat, the abdominal wound was then closed with 3-0 Vicryl & 4-0 Nylon. The right nostril was entered, the nasal mucosa was detached from previous incision and the bone fragments were removed. After removal of gelfoam, the fat was packed and stuck at the edge durotomy; Tissucol Duo was applied onto the fat to facilitate sealing. The bone fragments were placed back, and packed with gelfoam. After reduction of nasal mucosa, nasal packings were inserted for compression. Operators VS曾漢民 Assistants R6鍾文桂 R3陳國瑋 相關圖片 林孟詮 (M,1990/10/08,21y5m) 手術日期 2011/09/14 手術主治醫師 曾漢民 手術區域 東址 005房 03號 診斷 Prolactinoma (Pituitary benign neoplasm) 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 李振豪, 時間資訊 22:30 臨時手術NPO 13:51 報到 14:05 麻醉開始 14:05 進入手術室 14:20 誘導結束 14:40 抗生素給藥 15:45 手術開始 17:00 麻醉結束 17:00 手術結束 17:23 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 手術 經由蝶竇之腦下垂體瘤切除 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Trans-nasal trans-sphenoidal adenomectomy 開立醫師: 李振豪 開立時間: 2011/09/14 17:19 Pre-operative Diagnosis Pituitary macroadenoma Post-operative Diagnosis Pituitary macroadenoma Operative Method Trans-nasal trans-sphenoidal adenomectomy Specimen Count And Types 1 piece About size:Multiple small pieces Source:Pituitary macroadenoma Pathology Nil Operative Findings The tumor was gray-reddish in color, soft and fragile, well-defined with pseudocapsule formation, hypervascularized, and 2.8 x 1.7 x 2.1 cm in size. After total removal of the tumor, the arachnoid pouch was intact. Easily bleeding from nasal mucosa and bleeding from cavernous sinus was noted during operation. The bleeding from cavernous sinus was packing with Gelfoam. No evident CSF leakage was noted after whole procedure. Operative Procedures Under endotracheal general anesthesia, the patient was putin supine position with head tilted 30 degree to left. The nasal cavity was packing with epinephrine soaked gauze for 10 minutes. The face and left lower abdomen were prepared with povidone-iodine alcohol tincture, and the mucosa of oral and nasal cavity with aqueous povidone-iodine tincture. The nasal submucosa at septum and floor were infiltrated with 1:100 epinephrine solution. One 1.5cm incision was made at nasal mucosa of right nasal septum and the musoca was dissected away from the septum. The nasal septum was fractured and the vomer was removed. The sphenoid sinus was entered and the mucosa within the sphenoid sinus was removed. The sellar floor was identified and opened. Cruciform durotomy was done and the tumor showed up after dura opening. Tumor excision was performed with ring curette, tumor forceps, and suction. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. The bony fragment and vomer was placed back. The nasal mucosa was pushed back and bilateral nasal cavity were packing with two segment of rubber glove finger which had been soaked with better-iodine ointment. Operators VS曾漢民 Assistants R5李振豪, R1陸惠宗 陳昆山 (M,1948/02/16,64y0m) 手術日期 2011/09/14 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Fever 器械術式 Revision of CSF shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 髒 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 陳國瑋, 時間資訊 22:31 臨時手術NPO 12:10 進入手術室 12:12 麻醉開始 12:15 誘導結束 12:35 手術開始 13:00 抗生素給藥 13:10 手術結束 13:10 麻醉結束 13:15 送出病患 13:20 進入恢復室 14:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 皮下肌肉或深部異物取出術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 內科部 套用罐頭: Shunt removal 開立醫師: 曾峰毅 開立時間: 2011/09/14 12:45 Pre-operative Diagnosis Ventriculoperitoneal shunt wound dehiscence Post-operative Diagnosis Ventriculoperitoneal shunt wound dehiscence Operative Method Shunt removal Specimen Count And Types Ventricular cathter, and shunt reservoir was sent for culture. Pathology Nil Operative Findings Shunt reservoir exposure at right retroauricular area. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position. We shaved, scrubbed, disinfected, and then draped the patient as usual. We made one transverse scalp incision at right frontal area, and removed ventricular catheter. We made another skin incision along shunt at right auricular area, and removed shunt reservoir with peritoneal catheter. The wound was closed in layers after getamycin irrigation. Operators VS 賴達明 Assistants R5 曾峰毅 R3 陳國瑋 相關圖片 江致佑 (M,1982/07/24,29y7m) 手術日期 2011/09/14 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Pituitary tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 陳國瑋, 時間資訊 23:19 臨時手術NPO 07:30 報到 08:05 進入手術室 08:20 麻醉開始 08:30 誘導結束 08:50 抗生素給藥 09:22 手術開始 11:22 麻醉結束 11:22 手術結束 11:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經由蝶竇之腦下垂體瘤切除 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Trans-nasal, trans-sphenoid adenomectomy 開立醫師: 陳國瑋 開立時間: 2011/09/14 12:02 Pre-operative Diagnosis Pituitary macroadenoma, acromegaly Post-operative Diagnosis Pituitary macroadenoma, acromegaly Operative Method Trans-nasal, trans-sphenoid adenomectomy Specimen Count And Types 1 piece About size:2cm Source:pituitary tumor Pathology pending Operative Findings The tumor was yellow to red in color, soft, fragile, well-defined, hypervascularized, and 1.5 x 0.7 x 1.3cm in size. After tumor removal, the normal gland was encountered. Operative Procedures Under endotracheal general anesthesia, the patient was putin supine position with head tilted 30 degree to left. The nasal cavity was packing with epinephrine soaked gauze for 10 minutes. The face and left lower abdomen were prepared with povidone-iodine alcohol tincture, and the mucosa of oral and nasal cavity with aqueous povidone-iodine tincture. The nasal submucosa at septum and floor were infiltrated with 1:100 epinephrine solution. One 1.5cm incision was made at nasal mucosa of right nasal septum and the musoca was dissected away from the septum. The nasal septum was fractured and the vomer was removed. The sphenoid sinus was entered and the mucosa within the sphenoid sinus was removed. The sellar floor was identified and opened. Cruciform durotomy was done and the tumor showed up after dura opening. The margin of the tumor was dissected by microdissector. The tumor was then removed by alligator. Hemostasis was achieved and the space was packing with Gelfoam, Tissucol Duo, autologous bone fragment, and Gelfoam. The vomer bone was placed back and the nasal mucosa was pushed back to the neutral position. Tissucol Duo was applied between the nasal mucosa and the vomer bone. The nasal septum and the middle turbinate was pushed back to neutral position. Bilateral nasal cavities were packed with merocel which had been soaked with better-iodine ointment. Operators 賴達明 Assistants 曾峰毅 陳國瑋 相關圖片 陳文進 (M,1943/03/17,68y11m) 手術日期 2011/09/14 手術主治醫師 蕭輔仁 手術區域 東址 005房 02號 診斷 Spinal stenosis, lumbar 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 李振豪, 時間資訊 23:22 臨時手術NPO 09:15 麻醉開始 09:48 進入手術室 10:05 抗生素給藥 10:15 誘導結束 10:38 手術開始 13:40 手術結束 13:40 麻醉結束 13:45 送出病患 13:45 進入恢復室 14:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎間盤切除術-腰椎 1 2 記錄__ 手術科部: 外科部 套用罐頭: L4/5 transforaminal lumbar interbody fusion w... 開立醫師: 李振豪 開立時間: 2011/09/14 13:57 Pre-operative Diagnosis L4-5 grade I spondylolisthesis with lumbar stenosis Post-operative Diagnosis L4-5 grade I spondylolisthesis with lumbar stenosis Operative Method L4/5 transforaminal lumbar interbody fusion with PEEK cage and L4/5 transpedicular screws for posterior instrumentation Specimen Count And Types nil Pathology Nil Operative Findings Anterior subluxation of L4 was noted. The L4/5 facet joint was hypertrophic and mild deformed. The ligmantum flavum also hypertrophic which compressed the thecal sac and bilateral nerve roots tightly. After decompression, the thecal sac and the nerve roots expanded well. The L4/5 disc was bulging out posteriorly. The disc was mild degenerative in character. After diskectomy, one #11 Banana PEEK cage filled with autologous bone graft was implanted for interbody fusion. Four 6.5 x 45mm transpedicular screws were implanted at L4 and L5 level. The rods were 5cm in length. No obvious CSF leakage was noted during whole procedure. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position. The L4 and L5 pedicles were localized by portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made and the subcutaneous soft tissue was devided. The paravertebral muscle groups were detached. L4 and L5 transpedicular screws were inserted under C-arm guided. L4/5 laminectomy was performed for posterior decompression. Left side foraminotomy and right side facetectomy were also done during laminectomy for lateral recess stenosis. The disc was identified and diskectomy was conducted. One #11 Banana PEEK cage filled with autologous bone graft was inserted for interbody fusion. Hemostasis was achieved. The rods were set up. One Hemovac was placed. The wound was irrigated with Gentamicin solution and then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS蕭輔仁 Assistants R5李振豪, R1陸惠宗 相關圖片 林清秀 (M,1951/07/27,60y7m) 手術日期 2011/09/14 手術主治醫師 蔡翊新 手術區域 東址 005房 01號 診斷 Cerebral aneurysm 器械術式 EVD 手術類別 預定手術 手術部位 頭、頸 傷口分類 髒 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 陸惠宗, 時間資訊 23:23 臨時手術NPO 08:05 進入手術室 08:10 麻醉開始 08:15 誘導結束 08:50 手術開始 09:20 手術結束 09:20 麻醉結束 09:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室體外引流 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Right Kocher EVD. 開立醫師: 蔡翊新 開立時間: 2011/09/14 09:07 Pre-operative Diagnosis Hydrocephalus, suspected ventriculitis. Post-operative Diagnosis Hydrocephalus, suspected ventriculitis. Operative Method Right Kocher EVD. Specimen Count And Types 4 tubes of CSF, sent for routine, BCS, bacterial and fungus culture. Pathology Nil. Operative Findings CSF: clear, pressure: 8 cmH2O. Operative Procedures Under general anesthesia via endotracheal intubation, the patient was placed in supine position. The skin was disinfected and drapped as usual. Scalp incision was made at right frontal area along previous wound. The frontal horn of right lateral ventricle was punctured by a ventricular needle. An EVD tube with 3.5 mm in outer diameter was inserted via the tract. CSF was collected for routine, BCS, bacterial and fungus culture. The wound was irrigated with large amount of saline and Gentamycin solution, then it was closed in layers. Operators VS蔡翊新 Assistants R5李振豪R1陸惠宗 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Right Kocher EVD. 開立醫師: 蔡翊新 開立時間: 2011/09/14 09:07 Pre-operative Diagnosis Hydrocephalus, suspected ventriculitis. Post-operative Diagnosis Hydrocephalus, suspected ventriculitis. Operative Method Right Kocher EVD. Specimen Count And Types 4 tubes of CSF, sent for routine, BCS, bacterial and fungus culture. Pathology Nil. Operative Findings CSF: clear, pressure: 8 cmH2O. Operative Procedures Under general anesthesia via endotracheal intubation, the patient was placed in supine position. The skin was disinfected and drapped as usual. Scalp incision was made at right frontal area along previous wound. The frontal horn of right lateral ventricle was punctured by a ventricular needle. An EVD tube with 3.5 mm in outer diameter was inserted via the tract. CSF was collected for routine, BCS, bacterial and fungus culture. The wound was irrigated with large amount of saline and Gentamycin solution, then it was closed in layers. Operators VS蔡翊新 Assistants R5李振豪R1陸惠宗 相關圖片 潘坤福 (M,1944/02/15,68y0m) 手術日期 2011/09/14 手術主治醫師 王碩盟 手術區域 東址 002房 04號 診斷 Urinary tract infection 器械術式 U.R.S.-S.M. 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 靜脈麻醉 麻醉主治醫師 林佩玲 ASA 3 紀錄醫師 周淇業, 時間資訊 13:10 麻醉開始 13:12 進入手術室 13:20 誘導結束 13:33 手術開始 14:17 手術結束 14:17 麻醉結束 14:25 送出病患 14:30 進入恢復室 15:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 輸尿管鏡取石術或碎石術–併用超音波或電擊方式 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 摘要__ 手術科部: 泌尿部 套用罐頭: URS-SM 開立醫師: 周淇業 開立時間: 2011/09/14 14:31 Pre-operative Diagnosis Right ureteral stone with hydronephrosis Post-operative Diagnosis Right ureteral stone with hydronephrosis Operative Method URS-SM Specimen Count And Types nil Pathology Nil. Operative Findings A yellowish stone obstructed at right upper ureter with hydronephrosis Crushed by Holmium Laser(Energy:1.2J,Frequency:12 /s) Operative Procedures Under satisfactory anesthesia with the patient in the lithotomy position, skin preparation was performed. A cystoscope was inserted into the bladder and a guidewire was then introduced into the ureteral orifice. A 6 Fr. ureteroscope was introduced into the ureter. A yellowish stones was noted at right ureter and crushed by Holmium Laser(Energy:1.0J, Frequency:10 /s). A Fr.6-24cm DBJ catheter was inserted. A 16 Fr. Foley catheter was placed in the urinary bladder. The patient tolerated the operation well and was sent to the recovery room in stable condition. Operators 王碩盟 Assistants 周淇業 記錄__ 手術科部: 泌尿部 套用罐頭: URS-SM 開立醫師: 周淇業 開立時間: 2011/09/14 17:46 Pre-operative Diagnosis Right ureteral stone with hydronephrosis Post-operative Diagnosis Right ureteral stone with hydronephrosis Operative Method URS-SM Specimen Count And Types nil Pathology Nil. Operative Findings A yellowish stone obstructed at right upper ureter with hydronephrosis Crushed by Holmium Laser(Energy:1.2J,Frequency:12 /s) Operative Procedures Under satisfactory anesthesia with the patient in the lithotomy position, skin preparation was performed. A cystoscope was inserted into the bladder and a guidewire was then introduced into the ureteral orifice. A 6 Fr. ureteroscope was introduced into the ureter. A yellowish stones was noted at right ureter and crushed by Holmium Laser(Energy:1.0J, Frequency:10 /s). A Fr.6-24cm DBJ catheter was inserted. A 16 Fr. Foley catheter was placed in the urinary bladder. The patient tolerated the operation well and was sent to the recovery room in stable condition. Operators 王碩盟 Assistants 周淇業 王玉燕 (F,1952/01/03,60y2m) 手術日期 2011/09/15 手術主治醫師 葉德輝 手術區域 東址 023房 03號 診斷 Chronic paranasal sinusitis 器械術式 ESS, bil 手術類別 預定手術 手術部位 頭、頸 傷口分類 污染 麻醉方式 全身麻醉 麻醉主治醫師 林珍榮 ASA 2 紀錄醫師 林珮璇, 時間資訊 13:05 進入手術室 13:10 麻醉開始 13:15 誘導結束 13:20 抗生素給藥 13:30 手術開始 14:30 手術結束 14:30 麻醉結束 14:45 送出病患 14:50 進入恢復室 15:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 多竇副鼻竇手術 1 1 L 手術 多竇副鼻竇手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 耳鼻喉部 套用罐頭: Endoscopic sinus surgery, bilateral 開立醫師: 林珮璇 開立時間: 2011/09/15 20:05 Pre-operative Diagnosis Chronic paranasal sinusitis, bilateral Post-operative Diagnosis Chronic paranasal sinusitis, bilateral, operated Operative Method Endoscopic sinus surgery, bilateral Specimen Count And Types 2 pieces About size:0.5x0.5cm Source:right nasal cavity About size:1x0.5cm Source:left nasal cavity Pathology pending Operative Findings Right infun.: OK( ) edematous(V) polypoid( ) polyp( ) mucopus( ) fungus( ) cyst( ) A.Eth.: OK( ) edematous(V) polypoid( ) polyp( ) mucopus( ) fungus( ) cyst( ) P.Eth: OK( ) edematous(V) polypoid( ) polyp( ) mucopus( ) fungus( ) cyst( ) Maxi.: OK( ) edematous( ) polypoid( ) polyp( ) mucopus( ) fungus( ) cyst( ) --> NA Fron.: OK(V) edematous( ) polypoid( ) polyp( ) mucopus( ) fungus( ) cyst( ) Sph.: OK( ) edematous( ) polypoid( ) polyp( ) mucopus( ) fungus( ) cyst( ) --> NA Left infun.: OK( ) edematous( ) polypoid( ) polyp(V) mucopus( ) fungus( ) cyst( ) A.Eth.: OK( ) edematous( ) polypoid( ) polyp(V) mucopus( ) fungus( ) cyst( ) P.Eth: OK( ) edematous( ) polypoid( ) polyp(V) mucopus(V) fungus( ) cyst( ) Maxi.: OK( ) edematous( ) polypoid( ) polyp( ) mucopus( ) fungus( ) cyst( ) --> NA Fron.: OK( ) edematous( ) polypoid( ) polyp( ) mucopus(V) fungus( ) cyst( ) Sph.: OK( ) edematous( ) polypoid( ) polyp( ) mucopus( ) fungus( ) cyst( ) --> NA septal deviation (-) bony variation of uncinate process :R(NA)L(NA) enlarged ethmoid bulla :R(-)L(-) prominent agger nasi :R(-)L(-) concha bullosa :R(+)L(-) others : Operative Procedures (1) Infundibulotomy :R(+)L(+) (2) Opening/trimming of ethmoid bulla :R(-)L(-) anterior ethmoid :R(+)L(+) agger nasi :R(-)L(-) frontal recess :R(+)L(+) middle turbinate :R(+)L(+) (3) Opening/trimming of ground lamella :R(-)L(-) posterior ethmoid :R(+)L(+) sphenoid sinus :R(-)L(-) (4) Widening of maxillary ostium :R(-)L(-) aspiration :R(-)L(-) irrigation :R(-)L(-) (5) Packing with Merocel :R(X1)L(X1) Vaseline gauze :R( )L( ) Betta-iodine gauze :R( )L( ) Fingerstall :R(X2)L(X2) Operators AP葉德輝, Assistants R2林珮璇, R4李嘉欣, 常守榮 (M,1933/05/13,78y10m) 手術日期 2011/09/15 手術主治醫師 陳敞牧 手術區域 東址 005房 01號 診斷 Herniation of intervertebral disc with myelopathy, cervical 器械術式 Lamino plasty 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李思慧, 時間資訊 07:16 臨時手術NPO 08:00 進入手術室 08:05 麻醉開始 08:25 誘導結束 08:40 抗生素給藥 09:33 手術開始 11:20 開始輸血 11:48 抗生素給藥 12:25 手術結束 12:25 麻醉結束 12:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 椎弓整形術 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: C4-6 Hirabayashi (open-door) laminoplasty 開立醫師: 王奐之 開立時間: 2011/09/16 09:25 Pre-operative Diagnosis C3-7 spinal canal stenosis with cord compression Post-operative Diagnosis C3-7 spinal canal stenosis with cord compression Operative Method C4-6 Hirabayashi (open-door) laminoplasty Specimen Count And Types Nil Pathology Nil Operative Findings The thecal sac was compressed tightly, decompression and thecal sac expansion was achieved after the procedure. Easy bleeding was noted throughout the operation, and oozing came out from epidural venous plexus significantly; estimated blood loss: 1600 ml. Intra-operatively bilateral upper extremities MEP flattened, but no unintentional durotomy or root injury was encountered; bilateral upper extremities MEP recovered with prolonged latency upon wound closure. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position with head fixed in Mayfield skull clamp. After shaving, scrubbing, disinfection and draping in sterile fashion, a midline incision was made at posterior neck. The incision was deepened through fascial layer until the spinous processes were exposed. The paraspinal muscles were detached from the spinous processes & laminae. After exposure of C3-7 lamina & lateral masses, a groove was drilled through left C4-6 laminae. Another groove was drilled at right C4-6 laminae to make thinning of lamina-lateral mass junction. The C4-6 laminae were then opened from the left side with its hinge at the right. Mini-plates were used for fixation of the conformation. After hemostasis and setting up of 1 CWV drain, the wound was closed in layers. Operators VS 陳敞牧 Assistants R4 王奐之, PGY 李思慧 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: C4-6 Hirabayashi (open-door) laminoplasty 開立醫師: 王奐之 開立時間: 2011/09/16 09:25 Pre-operative Diagnosis C3-7 spinal canal stenosis with cord compression Post-operative Diagnosis C3-7 spinal canal stenosis with cord compression Operative Method C4-6 Hirabayashi (open-door) laminoplasty Specimen Count And Types Nil Pathology Nil Operative Findings The thecal sac was compressed tightly, decompression and thecal sac expansion was achieved after the procedure. Easy bleeding was noted throughout the operation, and oozing came out from epidural venous plexus significantly; estimated blood loss: 1600 ml. Intra-operatively bilateral upper extremities MEP flattened, but no unintentional durotomy or root injury was encountered; bilateral upper extremities MEP recovered with prolonged latency upon wound closure. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position with head fixed in Mayfield skull clamp. After shaving, scrubbing, disinfection and draping in sterile fashion, a midline incision was made at posterior neck. The incision was deepened through fascial layer until the spinous processes were exposed. The paraspinal muscles were detached from the spinous processes & laminae. After exposure of C3-7 lamina & lateral masses, a groove was drilled through left C4-6 laminae. Another groove was drilled at right C4-6 laminae to make thinning of lamina-lateral mass junction. The C4-6 laminae were then opened from the left side with its hinge at the right. Mini-plates were used for fixation of the conformation. After hemostasis and setting up of 1 CWV drain, the wound was closed in layers. Operators VS 陳敞牧 Assistants R4 王奐之, PGY 李思慧 相關圖片 康文正 (M,1973/05/17,38y9m) 手術日期 2011/09/15 手術主治醫師 陳敞牧 手術區域 東址 003房 03號 診斷 Malignant neoplasm of cerebrum, except lobes and ventricles 器械術式 Excision of subcutaneous tumor 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 15:20 報到 16:04 進入手術室 16:40 麻醉開始 16:41 誘導結束 16:42 手術開始 18:55 麻醉結束 18:55 手術結束 19:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 皮下腫瘤摘除術中2-4 CM 7 1 摘要__ 手術科部: 外科部 套用罐頭: Tumor excision 開立醫師: 游健生 開立時間: 2011/09/15 19:03 Pre-operative Diagnosis Lower back and right arm subcutaneous tumors, suspected lipomas Post-operative Diagnosis Lower back and right arm subcutaneous tumors, suspected lipomas Operative Method Tumor excision Specimen Count And Types 7 pieces About size: The largest one 2.5*2*3cm Source: subcutaneous tumor Pathology Pending Operative Findings Yellowish subcutaneous soft tumors were noted and removed. Operative Procedures The patient was placed in prone position. After palpation for confirmation of tumor location, the skin was disinfected & draped as usual. Six linear incisions were made at bilateral lower back, followed by soft tissue dissection to remove the tumors en bloc. After hemostasis, the wounds were closed in layers. Repeat similar procedure at right arm. Operators VS 陳敞牧 Assistants R4 游健生 PGY 涂怡安 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Tumor excision 開立醫師: 游健生 開立時間: 2011/09/15 19:18 Pre-operative Diagnosis Lower back and right arm subcutaneous tumors, suspected lipomas Post-operative Diagnosis Lower back and right arm subcutaneous tumors, suspected lipomas Operative Method Tumor excision Specimen Count And Types 7 pieces About size: The largest one 2.5*2*3cm Source: subcutaneous tumor Pathology Pending Operative Findings Yellowish subcutaneous soft tumors were noted and removed. Operative Procedures The patient was placed in prone position. After palpation for confirmation of tumor location, the skin was disinfected & draped as usual. Six linear incisions were made at bilateral lower back, followed by soft tissue dissection to remove the tumors en bloc. After hemostasis, the wounds were closed in layers. Repeat similar procedure at right arm. Operators VS 陳敞牧 Assistants R4 游健生 PGY 涂怡安 相關圖片 陳滿 (F,1940/03/25,71y11m) 手術日期 2011/09/15 手術主治醫師 蕭輔仁 手術區域 東址 005房 03號 診斷 Low back pain 器械術式 Radiofrequency coagulation(P-G 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 16:26 進入手術室 16:43 麻醉開始 16:44 誘導結束 16:45 手術開始 17:45 手術結束 17:45 麻醉結束 17:52 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 高頻熱凝療法 1 1 B 摘要__ 手術科部: 外科部 套用罐頭: Bilateral L2 dorsal root ganglion radiofreque... 開立醫師: 王奐之 開立時間: 2011/09/15 16:45 Pre-operative Diagnosis Low back pain Post-operative Diagnosis Low back pain Operative Method Bilateral L2 dorsal root ganglion radiofrequency stimulation Specimen Count And Types Nil Pathology Nil Operative Findings 1. Bilateral L2 dorsal root was identified by portable C-arm X-ray and sensory/motor stimulation test. No acute complication was noted after the procedure. 2. Temp: 42 oC, Time: 180sec x 2 cycles each side. Operative Procedures The patient was placed in prone position. The location of bilateral L2 pedicles were identified by portable C-arm X-ray. The skin was disinfected and draped as usual. Local anesthesia was performed with 10ml of 1% Xylocaine at the entry points. Bilateral L2 dorsal root ganglion radiofrequency stimulation was performed under portable C-arm guidance. The patient stood the whole procedure well. Operators VS 蕭輔仁 Assistants R4 王奐之 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Bilateral L2 dorsal root ganglion radiofreque... 開立醫師: 王奐之 開立時間: 2011/09/15 16:45 Pre-operative Diagnosis Low back pain Post-operative Diagnosis Low back pain Operative Method Bilateral L2 dorsal root ganglion radiofrequency stimulation Specimen Count And Types Nil Pathology Nil Operative Findings 1. Bilateral L2 dorsal root was identified by portable C-arm X-ray and sensory/motor stimulation test. No acute complication was noted after the procedure. 2. Temp: 42 oC, Time: 180sec x 2 cycles each side. Operative Procedures The patient was placed in prone position. The location of bilateral L2 pedicles were identified by portable C-arm X-ray. The skin was disinfected and draped as usual. Local anesthesia was performed with 10ml of 1% Xylocaine at the entry points. Bilateral L2 dorsal root ganglion radiofrequency stimulation was performed under portable C-arm guidance. The patient stood the whole procedure well. Operators VS 蕭輔仁 Assistants R4 王奐之 相關圖片 陳旺城 (M,1949/04/10,62y11m) 手術日期 2011/09/15 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 Communicating hydrocephalus 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 游健生, 時間資訊 23:23 臨時手術NPO 13:50 進入手術室 13:55 麻醉開始 14:05 誘導結束 14:39 手術開始 15:30 手術結束 15:30 麻醉結束 15:48 送出病患 15:53 進入恢復室 17:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt insertion via righ... 開立醫師: 游健生 開立時間: 2011/09/15 15:50 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunt insertion via right Kocher point Specimen Count And Types nil Pathology Nil Operative Findings Initially, some whitish turbid CSF was drained after ventriculostomy. But soon, clear CSF was drained. The opening pressure was modrate low. A Codman HAKIM fixed pressure (70mmH2O) valve was used. The ventricle catheter was 7cm. Operative Procedures Under tracheostomy general anesthesia, patient was in supine position with right shoulder elevated and head rotated to left. After shaving, we disinfected and draped the operation field as usual. A transverse scalp incision was made below SP shunt reservoir. After dissection, the SP shunt reservoir was exposed. The shunt was ligated and transected distal to reservior. A scalp stab wound was created followed by introduction of Codman VP shunt valve to subcutaneous layer after connection to ventricle catheter. The previous SP shunt peritoneal catheter was then connected to the VP shunt reservoir. A transverse scalp incision was made at right Kocher region. After dissection, a burhole was done followed by dura tenting. The dura was coaguated and opened in cruciated fashion. The pia was coaguated and cut open. Ventricuolostomy was done followed by insertion of ventricle catheter. After hemostasis, wounds were closed in layers. Operators VS 王國川 Assistants R4 游健生 PGY 涂怡安 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt insertion via righ... 開立醫師: 游健生 開立時間: 2011/09/15 16:02 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunt insertion via right Kocher point Specimen Count And Types nil Pathology Nil Operative Findings Initially, some whitish turbid CSF was drained after ventriculostomy. But soon, clear CSF was drained. The opening pressure was modrate low. A Codman HAKIM fixed pressure (70mmH2O) valve was used. The ventricle catheter was 7cm. Operative Procedures Under tracheostomy general anesthesia, patient was in supine position with right shoulder elevated and head rotated to left. After shaving, we disinfected and draped the operation field as usual. A transverse scalp incision was made below SP shunt reservoir. After dissection, the SP shunt reservoir was exposed. The shunt was ligated and transected distal to reservior. A scalp stab wound was created followed by introduction of Codman VP shunt valve to subcutaneous layer after connection to ventricle catheter. The previous SP shunt peritoneal catheter was then connected to the VP shunt reservoir. A transverse scalp incision was made at right Kocher region. After dissection, a burhole was done followed by dura tenting. The dura was coaguated and opened in cruciated fashion. The pia was coaguated and cut open. Ventricuolostomy was done followed by insertion of ventricle catheter. After hemostasis, wounds were closed in layers. Operators VS 王國川 Assistants R4 游健生 PGY 涂怡安 相關圖片 張美玲 (F,1956/06/05,55y9m) 手術日期 2011/09/15 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Brain tumor 器械術式 Crainotomy Brain Tumor(P-LIN) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 游健生, 時間資訊 23:10 臨時手術NPO 07:30 報到 08:05 進入手術室 08:08 麻醉開始 08:30 誘導結束 08:40 抗生素給藥 08:58 手術開始 11:40 抗生素給藥 12:15 麻醉結束 12:15 手術結束 12:25 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 顱底瘤手術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Left retrosigmoid approach for Simpson grade ... 開立醫師: 游健生 開立時間: 2011/09/15 13:02 Pre-operative Diagnosis Left cerebellopontine angle meningioma Post-operative Diagnosis Left cerebellopontine angle meningioma Operative Method Left retrosigmoid approach for Simpson grade II meningioma excision Specimen Count And Types 1 piece About size:2.2 x 1.5 x 2cm Source:left CP angle tumor Pathology Pending Operative Findings A pinkish soft tumor, 2.2 x 1.5 x 2cm, attached at the junction of petrous and tentorium, with petrous side more tight. There was an arachnoid membrane encapsulating the tumor with numberous tiny white spots (calcification?) on it. It pushed the CN VII/VIII infero-medially, CN V supero-medially, and superior petrosal vein medially. There were no changes of SSEP and BAEP during the surgery. We failed to induce CN VII response by nerve stimulation. Operative Procedures Under ETGA, patient was in park-bench position (right decubitus) with head fixed by Mayfield headclamp. Her head was rotated to right and vertex tilted downward resulted in mastoid tip at the top of operation field. After shaving, we disinfected and draped the operation field. A lazy-S scalp incision was made along the hairline centered at 4cm behind external acoustic meatus. We harvested the pericranium at the superior part. The neck muscles were splitted at the middle and elevated to expose mastoid and suboccipital cranium. A burhole was done at asterion and three more burholes were done. After craniotomy, we tented the dura along the craniotomy edge. A T-shape durotomy was done followed by gentle cerebellum retraction. The cerebellomedullary cistern was opened for CSF drainage to relax cerebellum. CN IX, X, and XI were seen at jugular foramen. We moved upward and the tumor was seen attached at petrous dura. We opened the arachnoid membrane covering the tumor and pushed it away from tumor. In this way, we gradually saw the CN VII/VIII and internal acoustic meatus and separating the nerves from the tumor. Then, we detached the tumor from petrous dura. Part of the tumor also attached to the tentorium and we detached tumor from it too. The feeders from petrous bone were coagulated. After complete detachment, the tumor was removed en bloc. The CN III, CN V, and superior petrosal vein were then seen. Hemostasis was achieved by bipolar and Surgicel. Dura was repaired with pericranium by 3-0 prolene continuous sutures after CSF replacement by normal saline. After central tenting and Gelfoam covering, bone flap was fixed back by 3 wires. Artificial bone cement was used to modify the contour of cranium. Neck muscles were approximated by interrupted Vicryl. Wound was closed by 2-0 Vicryl and 3-0 Nylon. Operators VS 王國川 Assistants R4 游健生 PGY1 涂怡安 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Left retrosigmoid approach for Simpson grade ... 開立醫師: 游健生 開立時間: 2011/09/15 13:51 Pre-operative Diagnosis Left cerebellopontine angle meningioma Post-operative Diagnosis Left cerebellopontine angle meningioma Operative Method Left retrosigmoid approach for Simpson grade II meningioma excision Specimen Count And Types 1 piece About size:2.2 x 1.5 x 2cm Source:left CP angle tumor Pathology Pending Operative Findings A pinkish soft tumor, 2.2 x 1.5 x 2cm, attached at the junction of petrous and tentorium, with petrous side more tight. There was an arachnoid membrane encapsulating the tumor with numberous tiny white spots (calcification?) on it. It pushed the CN VII/VIII infero-medially, CN V supero-medially, and superior petrosal vein medially. There were no changes of SSEP and BAEP during the surgery. We failed to induce CN VII response by nerve stimulation. Operative Procedures Under ETGA, patient was in park-bench position (right decubitus) with head fixed by Mayfield headclamp. Her head was rotated to right and vertex tilted downward resulted in mastoid tip at the top of operation field. After shaving, we disinfected and draped the operation field. A lazy-S scalp incision was made along the hairline centered at 4cm behind external acoustic meatus. We harvested the pericranium at the superior part. The neck muscles were splitted at the middle and elevated to expose mastoid and suboccipital cranium. A burhole was done at asterion and three more burholes were done. After craniotomy, we tented the dura along the craniotomy edge. A T-shape durotomy was done followed by gentle cerebellum retraction. The cerebellomedullary cistern was opened for CSF drainage to relax cerebellum. CN IX, X, and XI were seen at jugular foramen. We moved upward and the tumor was seen attached at petrous dura. We opened the arachnoid membrane covering the tumor and pushed it away from tumor. In this way, we gradually saw the CN VII/VIII and internal acoustic meatus and separating the nerves from the tumor. Then, we detached the tumor from petrous dura. Part of the tumor also attached to the tentorium and we detached tumor from it too. The feeders from petrous bone were coagulated. After complete detachment, the tumor was removed en bloc. The CN III, CN V, and superior petrosal vein were then seen. Hemostasis was achieved by bipolar and Surgicel. Dura was repaired with pericranium by 3-0 prolene continuous sutures after CSF replacement by normal saline. After central tenting and Gelfoam covering, bone flap was fixed back by 3 wires. Artificial bone cement was used to modify the contour of cranium. Neck muscles were approximated by interrupted Vicryl. Wound was closed by 2-0 Vicryl and 3-0 Nylon. Operators VS 王國川 Assistants R4 游健生 PGY1 涂怡安 相關圖片 鄭國基 (M,1959/07/08,52y8m) 手術日期 2011/09/15 手術主治醫師 蔡翊新 手術區域 東址 005房 02號 診斷 Injury (severity score >=16) 器械術式 Burr hole (trephination) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李思慧, 時間資訊 00:00 臨時手術NPO 12:50 進入手術室 12:55 麻醉開始 13:15 誘導結束 13:25 抗生素給藥 13:38 手術開始 15:35 手術結束 15:35 麻醉結束 15:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 手術 腦組織活體切片 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Right F-T-P craniotomy for dural biopsy. 開立醫師: 蔡翊新 開立時間: 2011/09/15 14:57 Pre-operative Diagnosis Right side subdural fluid collection, suspected subdural empyema Post-operative Diagnosis Right frontotemporoparietal dural thickening. Operative Method Right F-T-P craniotomy for dural biopsy. Specimen Count And Types A piece of thickened dura, 0.5 x 0.5 cm. Pathology Pending. Operative Findings The dura under previous cranioplasty window became very thick, 0.6 cm in thickness. There was no subdural fluid or pus collection. Operative Procedures Under general anesthesia via endotracheal intubation, the patient was placed in supine position with head rotated to left. The skin was prepped and drapped as usual. The scalp incision was made at right F-T-P area along previous wound. The craniotomy was performed by removal of the screws and miniplates. The dura was opened to check subdural space. A piece of thickened dura was excised for pathology. The dura was closed in water-tight fashion with 4-0 Prolene. The bone graft was fixed back by 3 miniplates and 6 screws. An epidural CWV drain was placed. The skin was closed in layers. Operators VS 蔡翊新 Assistants R4 王奐之, PGY 李思慧 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Right F-T-P craniotomy for dural biopsy. 開立醫師: 蔡翊新 開立時間: 2011/09/15 14:57 Pre-operative Diagnosis Right side subdural fluid collection, suspected subdural empyema Post-operative Diagnosis Right frontotemporoparietal dural thickening. Operative Method Right F-T-P craniotomy for dural biopsy. Specimen Count And Types A piece of thickened dura, 0.5 x 0.5 cm. Pathology Pending. Operative Findings The dura under previous cranioplasty window became very thick, 0.6 cm in thickness. There was no subdural fluid or pus collection. Operative Procedures Under general anesthesia via endotracheal intubation, the patient was placed in supine position with head rotated to left. The skin was prepped and drapped as usual. The scalp incision was made at right F-T-P area along previous wound. The craniotomy was performed by removal of the screws and miniplates. The dura was opened to check subdural space. A piece of thickened dura was excised for pathology. The dura was closed in water-tight fashion with 4-0 Prolene. The bone graft was fixed back by 3 miniplates and 6 screws. An epidural CWV drain was placed. The skin was closed in layers. Operators VS 蔡翊新 Assistants R4 王奐之, PGY 李思慧 相關圖片 黃啟瑞 (M,1972/03/29,39y11m) 手術日期 2011/09/15 手術主治醫師 蔡翊新 手術區域 東址 002房 04號 診斷 Subarachnoid hemorrhage, trauma 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 石博元 ASA 3E 紀錄醫師 林妤芳, 時間資訊 06:00 臨時手術NPO 06:00 開始NPO 16:38 通知急診手術 17:00 抗生素給藥 17:13 報到 17:13 進入手術室 17:18 麻醉開始 17:25 誘導結束 17:55 手術開始 20:50 開始輸血 22:30 麻醉結束 22:30 手術結束 22:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 1 R 手術 顱內壓視置入 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 蔡翊新 開立時間: 2011/09/15 21:54 Pre-operative Diagnosis Head injury with right frontotemporal SDH, contusion ICH, and brain swelling. Post-operative Diagnosis Head injury with right frontal and temporal contusion ICH and brain swelling. Operative Method Right F-T-P craniectomy for ICH evacuation and ICP monitoring. Specimen Count And Types nil Pathology Nil. Operative Findings Initial ICP after first burr hole creation was 26 mmHg. The dura was tense after craniectomy and the ICP climbed to 33 mmHg before dural opening. Thin SDH and diffuse SAH were noted at right frontotemporal lobes. Contusions at right frontal and right temporal base and tips were evacuated. ICP after dural augmentation was 9 mmHg and that after skin closure was mmHg. The reference level of ICP monitor was 512. Initial ICP after first burr hole creation was 26 mmHg. The dura was tense after craniectomy and the ICP climbed to 33 mmHg before dural opening. Thin SDH and diffuse SAH were noted at right frontotemporal lobes. Contusions at right frontal and right temporal base and tips were evacuated. ICP after dural augmentation was 9 mmHg and that after skin closure was 15 mmHg. The reference level of ICP monitor was 512. Initial ICP after first burr hole creation was 26 mmHg. The dura was tense after craniectomy and the ICP climbed to 33 mmHg before dural opening. Thin SDH and diffuse SAH were noted at right frontotemporal lobes. Contusions at right frontal and right temporal base and tips were evacuated. ICP after dural augmentation was 9 mmHg and that after skin closure was 15 mmHg. The reference level of ICP monitor was 501. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 4 cm at right frontal area, the skin edge was clipped by Raney clips for temporary hemostasis. 5. A burr hole was made and the dura was incised. A Codman ICP monitor was inserted to measure the ICP. 6. The incision was extended to a temporal horseshoe, and the temporalis muscle was detached from temporal squama by rasp subsequently. 7. Craniotomy window: 14 x 12 cm, right F-T-P, created by making 4 burr holes then cut by power saw. 8. Dural tenting: by 2/0 silk, 2-cm in interval, distributed along the edge of skull window. 9. Dural incision: curvilinear along the edge of skull window. 10.The subdural clot was removed by sucker. The contused brain and ICH at right frontal and temporal lobes were evacuated. 11.Hemosatasis: the bleeders was stopped by Bovie and oozing surface was covered with Surgicel. 12.Dural closure: was closed with a piece of dural graft taking from temporalis fascia (crescent shape 15 cm long, 2 cm wide) along the whole length of the duralincision in order to create an additional space for the swollen brain. 13.The skull plate was removed and stored at bone bank for preservation. 14.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 15.Drain: two epidural CWV drains. 16.Blood transfusion: PRBC 2U. Blood loss: 500 ml. 17.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5李振豪R0林妤芳 Indication Of Emergent Operation IICP, conscious disturbance 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 蔡翊新 開立時間: 2011/09/15 22:38 Pre-operative Diagnosis Head injury with right frontotemporal SDH, contusion ICH, and brain swelling. Post-operative Diagnosis Head injury with right frontal and temporal contusion ICH and brain swelling. Operative Method Right F-T-P craniectomy for ICH evacuation and ICP monitoring. Specimen Count And Types nil Pathology Nil. Operative Findings Initial ICP after first burr hole creation was 26 mmHg. The dura was tense after craniectomy and the ICP climbed to 33 mmHg before dural opening. Thin SDH and diffuse SAH were noted at right frontotemporal lobes. Contusions at right frontal and right temporal base and tips were evacuated. ICP after dural augmentation was 9 mmHg and that after skin closure was 15 mmHg. The reference level of ICP monitor was 501. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 4 cm at right frontal area, the skin edge was clipped by Raney clips for temporary hemostasis. 5. A burr hole was made and the dura was incised. A Codman ICP monitor was inserted to measure the ICP. 6. The incision was extended to a temporal horseshoe, and the temporalis muscle was detached from temporal squama by rasp subsequently. 7. Craniotomy window: 14 x 12 cm, right F-T-P, created by making 4 burr holes then cut by power saw. 8. Dural tenting: by 2/0 silk, 2-cm in interval, distributed along the edge of skull window. 9. Dural incision: curvilinear along the edge of skull window. 10.The subdural clot was removed by sucker. The contused brain and ICH at right frontal and temporal lobes were evacuated. 11.Hemosatasis: the bleeders was stopped by Bovie and oozing surface was covered with Surgicel. 12.Dural closure: was closed with a piece of dural graft taking from temporalis fascia (crescent shape 15 cm long, 2 cm wide) along the whole length of the duralincision in order to create an additional space for the swollen brain. 13.The skull plate was removed and stored at bone bank for preservation. 14.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 15.Drain: two epidural CWV drains. 16.Blood transfusion: PRBC 2U. Blood loss: 500 ml. 17.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5李振豪R0林妤芳 Indication Of Emergent Operation IICP, conscious disturbance 相關圖片 洪秀蘭 (F,1943/05/06,68y10m) 手術日期 2011/09/15 手術主治醫師 林峰盛 手術區域 西址 034房 02號 診斷 Failed back syndrome 器械術式 Nerve block / PC 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 林峰盛 ASA 3 時間資訊 09:15 進入手術室 09:17 麻醉開始 09:20 誘導結束 09:25 手術開始 09:50 手術結束 09:50 麻醉結束 09:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 高頻熱凝療法 1 1 L 記錄__ 手術科部: 麻醉部 套用罐頭: Pulsed RF 開立醫師: 歐陽霓 開立時間: 2011/09/15 09:52 Pre-operative Diagnosis Radiculopathy Post-operative Diagnosis radiculopathy Operative Method Pulsed RF Specimen Count And Types nil Pathology Nil Operative Findings Operative Procedures 1. IV sedation with midazolam and LA with 1% xylocaine 2. pt in prone position 3. Under fluoroscopic-guidance, insert 22 G SMK RF meedle into left L4. Neurostimulation with 50 HZ and 2 Hz 0.1-0.5 mV current with positive result 60-80V 2 Hz, 20 ms, 120sec *2 pulsed RF was delivered 5.Rinderon 2.5mg was injected to left L4 send pt to PRO Operators 林峰盛, Assistants 歐陽霓, 黃睿恩 (M,2005/03/07,7y0m) 手術日期 2011/09/16 手術主治醫師 許巍鐘 手術區域 兒醫 067房 02號 診斷 Aromatic L-amino acid decarboxylase deficiency 器械術式 bronchoscopy+tracheosotmy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 陳姵妤, 時間資訊 11:45 報到 11:45 進入手術室 11:52 麻醉開始 11:55 誘導結束 11:56 手術開始 12:35 麻醉結束 12:35 手術結束 12:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 管、支 管、細支 管異物除去術- 管鏡 1 2 手術 氣管永久造孔術 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 耳鼻喉部 套用罐頭: Rigid bronchoscope 開立醫師: 陳姵妤 開立時間: 2011/09/16 14:17 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Rigid bronchoscope Specimen Count And Types nil Pathology Nil Operative Findings RIGID BRONCHOSCOPE (1)Pharynx: ....Tongue base: OK ....Vallecula: OK ....Hypopharynx: OK (2)Larynx: ....Epiglottis: OK ....Aryepiglottic fold: OK ....Arytenoid: edematous change of interarytenoid area ....Accesory cartilage: OK ....True vocal fold: contact granuloma, bilateral ....False vocal folds: no lesion ....Subglotttis: patent (3)Trachea: ....patent above carina level (4)Bronchus: ....Left main bronchus: OK ....Right main bronchus: OK Operative Procedures (1) The patient was put in supine position with neck hyperextended. (2) General anesthesia was setup via endotracheal tube. (3) The endotracheal tube was removed and the ventilation was shifted to the rigid bronchoscopy. (5) Examination with rigid bronchoscope was done (to bilateral bronchi) (6) The patient tolerated the procedure well (7) A #4 endotracheal tube was inserted back. Operators 許巍鐘, Assistants R3廖怡茹,R2陳姵妤 記錄__ 手術科部: 耳鼻喉部 套用罐頭: Tracheostomy 開立醫師: 陳姵妤 開立時間: 2011/09/16 14:20 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure, operated Operative Method Tracheostomy Tracheostomy, permanent Specimen Count And Types nil Pathology Nil Operative Findings A No.4.5 Shiley tracheostomy tube was inserted into the permenant tracheostoma Operative Procedures (1)The patient was in supine position with neck hyperextended. (2)Skin was disinfected and draped as usual. Local anesthesia with Bosmin-rinsed Xylocaine was injected into the subcutaneous tissue and the pretracheal area. (3)A horizontal skin incision was made in the midline of lower neck. (4)Subcutaneous tissue, fascia and strap muscles were seperated, then the thyroid gland was seen and hooked upwards with thyroid hooks. (5)The tracheal rings were cut in longitudinal direction. A oval-shaped window was made at the 2 nd to 3 rd tracheal rings. (6)The tracheostoma was sutured to the surrounding skin. (7)A No.4.5 Shiley tracheostomy tube was inserted under the vision of rigid bronchoscopy. (8)The patient tolerated the above procedure well. Operators AsP許巍鐘 Assistants R3廖怡茹,R2陳姵妤 游沛純 (F,2010/05/24,1y9m) 手術日期 2011/09/16 手術主治醫師 謝孟祥 手術區域 東址 012房 01號 診斷 Apert syndrome 器械術式 Debridment-- >10cm 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 3 紀錄醫師 柯安達, 時間資訊 08:05 麻醉開始 08:05 進入手術室 08:10 誘導結束 08:23 手術開始 08:58 手術結束 08:58 麻醉結束 09:08 送出病患 09:12 進入恢復室 10:12 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 ketamine線術 1 0 B 摘要__ 手術科部: 外科部 套用罐頭: remove tieover 開立醫師: 柯安達 開立時間: 2011/09/16 08:48 Pre-operative Diagnosis Sydactyly s/p bilateral index fingers reconstruction Post-operative Diagnosis Sydactyly s/p bilateral index fingers reconstruction Operative Method remove tieover Specimen Count And Types nil Pathology nil Operative Findings 1. The index fingers was separated from middle fingers 2. The wound was clear and the skin was intact Operative Procedures 1. Supine postion, ETGA 2. Remove the tieover carefully 3. wrap it with cast fixation Operators 謝孟祥 Assistants R5陳建璋 R2柯安達 Ri林秉毅 陳毓芳 (M,2009/12/21,2y2m) 手術日期 2011/09/16 手術主治醫師 郭夢菲 手術區域 兒醫 067房 03號 診斷 Subdural hemorrhage, traumatic 器械術式 left EVD 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 石博元 ASA 3E 紀錄醫師 游健生, 時間資訊 13:00 臨時手術NPO 13:00 開始NPO 13:23 通知急診手術 13:55 進入手術室 13:56 麻醉開始 14:00 誘導結束 14:36 手術開始 15:20 手術結束 15:20 麻醉結束 15:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室體外引流 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: External ventricular drainage, left Kocher 開立醫師: 游健生 開立時間: 2011/09/16 15:58 Pre-operative Diagnosis 1. Hydrocephalus 2. Right traumatic acute SDH, status post right frontotemporoparietal decompressive craniectomy for SDH evacuation and subdural ICP monitoring. Post-operative Diagnosis 1. Hydrocephalus 2. Right traumatic acute SDH, status post right frontotemporoparietal decompressive craniectomy for SDH evacuation and subdural ICP monitoring. Operative Method External ventricular drainage, left Kocher Specimen Count And Types 1 piece About size:10cc Source:CSF Pathology Nil Operative Findings Clear CSF gashed out after ventriculostomy. The opening pressure >15cmH2O. Some was sent for biochem, routine, and culture. The ventricle catheter was about 6cm. Operative Procedures Under ETGA, patient was in supine position. After shaving, we disinfected and draped the operation field as usual. A transverse scalp incision was made at left Kocher region. We created a small craniectomy by Kerrison from coronal suture. After dura tenting, a cruciate durotomy was done. A ventriculostomy from Kocher point was done followed by ventricle catheter insertion. After hemostasis, wound was closed in layers. Operators VS 郭夢菲 Assistants R4 游健生 Ri 潘建廷 Indication Of Emergent Operation Hydrocephalus with high ICP 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: External ventricular drainage, left Kocher 開立醫師: 游健生 開立時間: 2011/09/16 15:59 Pre-operative Diagnosis 1. Hydrocephalus 2. Right traumatic acute SDH, status post right frontotemporoparietal decompressive craniectomy for SDH evacuation and subdural ICP monitoring. Post-operative Diagnosis 1. Hydrocephalus 2. Right traumatic acute SDH, status post right frontotemporoparietal decompressive craniectomy for SDH evacuation and subdural ICP monitoring. Operative Method External ventricular drainage, left Kocher Specimen Count And Types 1 piece About size:10cc Source:CSF Pathology Nil Operative Findings Clear CSF gashed out after ventriculostomy. The opening pressure >15cmH2O. Some was sent for biochem, routine, and culture. The ventricle catheter was about 6cm. Operative Procedures Under ETGA, patient was in supine position. After shaving, we disinfected and draped the operation field as usual. A transverse scalp incision was made at left Kocher region. We created a small craniectomy by Kerrison from coronal suture. After dura tenting, a cruciate durotomy was done. A ventriculostomy from Kocher point was done followed by ventricle catheter insertion. After hemostasis, wound was closed in layers. Operators VS 郭夢菲 Assistants R4 游健生 Ri 潘建廷 Indication Of Emergent Operation Hydrocephalus with high ICP 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: External ventricular drainage, left Kocher 開立醫師: 郭夢菲 開立時間: 2011/09/21 13:04 Pre-operative Diagnosis 1. Hydrocephalus 2. Right traumatic acute SDH, status post right frontotemporoparietal decompressive craniectomy for SDH evacuation and subdural ICP monitoring. Post-operative Diagnosis 1. Hydrocephalus 2. Right traumatic acute SDH, status post right frontotemporoparietal decompressive craniectomy for SDH evacuation and subdural ICP monitoring. Operative Method External ventricular drainage, left Kocher Specimen Count And Types 1 piece About size:10cc Source:CSF Pathology Nil Operative Findings Clear CSF gashed out after ventriculostomy. The opening pressure >15cmH2O. Some was sent for biochem, routine, and culture. The ventricle catheter was about 6cm. Operative Procedures Under ETGA, patient was in supine position. After shaving, we disinfected and draped the operation field as usual. A transverse scalp incision was made at left Kocher region. We created a small craniectomy by Kerrison from coronal suture. After dura tenting, a cruciate durotomy was done. A ventriculostomy from Kocher point was done followed by ventricle catheter insertion. After hemostasis, wound was closed in layers. Operators VS 郭夢菲 Assistants R4 游健生 Ri 潘建廷 Indication Of Emergent Operation 相關圖片 林廖素卿 (F,1955/06/26,56y8m) 手術日期 2011/09/16 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Cervical Spondylosis 器械術式 Spinal fusion posterior, TAS-C1/2 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 陳國瑋, 時間資訊 23:01 臨時手術NPO 07:30 報到 08:05 進入手術室 08:15 麻醉開始 08:55 誘導結束 09:00 抗生素給藥 09:15 手術開始 12:00 抗生素給藥 12:55 手術結束 13:00 送出病患 13:00 麻醉結束 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎弓切除術(減壓)-二節以內 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Cervical Laminectomy 開立醫師: 曾峰毅 開立時間: 2011/09/16 12:34 Pre-operative Diagnosis Atlantoaxial sublaxation Post-operative Diagnosis Atlantoaxial sublaxation Operative Method Posterior decompression with C1 laminectomy, posterior fixation of C1/2 with transarticular screw at right, posterior fusion with autologous bone graft and mini-plates Specimen Count And Types Nil Pathology Nil Operative Findings Thecal sac was compromised by anterior-dislocated C1, and was decompressed well after C1 laminectomy. Cannulated screws, 4 cm long, was inserted for posterior transarticular fixation. There was no latency or amplitude change of SSEP during the operation. Operative Procedures With endotracheal general anaesthesia,the patient was put in prone position with neck extended, head flexed, and head fixed by Mayfield head clamp. We made one midline skin incision and dissected paraspinal muscle to expose bilateral laminae from C0 to C4. We inserted transarticular screws into right lateral mass of C1/2 for posterior fixation under C-arm guidance. C1 laminectomy was performed for decompression. We harvest autologous bone graft from right iliac crest, and fixed the bone graft at C1/2 with mini-plates. After one epidural CWV inserted, the wounds were closed in layers. Operators VS 賴達明 Assistants R5 曾峰毅 R2 陳國瑋 Ri 何孟穎 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Cervical Laminectomy 開立醫師: 陳國瑋 開立時間: 2011/09/16 13:14 Pre-operative Diagnosis Atlantoaxial sublaxation Post-operative Diagnosis Atlantoaxial sublaxation Operative Method Posterior decompression with C1 laminectomy, posterior fixation of C1/2 with transarticular screw at right, posterior fusion with autologous bone graft and mini-plates Specimen Count And Types Nil Pathology Nil Operative Findings Thecal sac was compromised by anterior-dislocated C1, and was decompressed well after C1 laminectomy. Cannulated screws, 4 cm long, was inserted for posterior transarticular fixation. There was no latency or amplitude change of SSEP during the operation. Operative Procedures With endotracheal general anaesthesia,the patient was put in prone position with neck extended, head flexed, and head fixed by Mayfield head clamp. We made one midline skin incision and dissected paraspinal muscle to expose bilateral laminae from C0 to C4. We inserted transarticular screws into right lateral mass of C1/2 for posterior fixation under C-arm guidance. C1 laminectomy was performed for decompression. We harvest autologous bone graft from right iliac crest, and fixed the bone graft at C1/2 with mini-plates. After one epidural CWV inserted, the wounds were closed in layers. Operators VS 賴達明 Assistants R5 曾峰毅 R2 陳國瑋 Ri 何孟穎 相關圖片 吳秋慧 (F,1965/09/18,46y5m) 手術日期 2011/09/16 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Secondary cancer of brain and spinal cord 器械術式 Malignant intraspinal tumor, e 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 陳國瑋, 時間資訊 23:27 臨時手術NPO 12:35 報到 13:28 進入手術室 13:35 麻醉開始 14:00 誘導結束 14:00 抗生素給藥 14:10 手術開始 17:00 抗生素給藥 18:30 麻醉結束 18:30 手術結束 18:55 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 脊椎內脊髓內腫瘤切除術 1 1 摘要__ 手術科部: 外科部 套用罐頭: Cervical Laminectomy 開立醫師: 曾峰毅 開立時間: 2011/09/16 18:25 Pre-operative Diagnosis Intraspinal intramedullar tumor, C6, suspected metastasis Post-operative Diagnosis Intraspinal intramedullar tumor, C6, suspected metastasis Operative Method Laminectomy, C6 to T1, for intraspinal intramedullar tumor excision Specimen Count And Types Several fragments of one tumor was sent for pathology. Pathology Pending Operative Findings One hypervascular, well defined, greyish, fragile mass lesion was noted intramedullarly at C6/7 level. Amplitude of left lower extremity MEP decreased during the tumor excision, and returned to baseline spontaneously. SSEP and MEP of other extremities remained unchanged during the operation. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position with head fixed with Mayfield head clamp. We made one midline skin incision and dissected to expose bilateral lamniae from C6 to T1. We performed C6 to T1 laminectomy, and midline durotomy was performed. Midline myelotomy was performed at C6/7 level, and tumor excision was performed in enbloc. After hemostasis, dura was closed in layers with 5-0 prolene in water-tight fashion. After one epidural CWV, the wound was closed in layers. Operators 賴達明 Assistants R5 曾峰毅 R2 陳國瑋 R5 曾峰毅 R3 陳國瑋 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Cervical Laminectomy 開立醫師: 陳國瑋 開立時間: 2011/09/16 19:19 Pre-operative Diagnosis Intraspinal intramedullar tumor, C6, suspected metastasis Post-operative Diagnosis Intraspinal intramedullar tumor, C6, suspected metastasis Operative Method Laminectomy, C6 to T1, for intraspinal intramedullar tumor excision Specimen Count And Types Several fragments of one tumor was sent for pathology. Pathology Pending Operative Findings One hypervascular, well defined, greyish, fragile mass lesion was noted intramedullarly at C6/7 level. Amplitude of left lower extremity MEP decreased during the tumor excision, and returned to baseline spontaneously. SSEP and MEP of other extremities remained unchanged during the operation. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position with head fixed with Mayfield head clamp. We made one midline skin incision and dissected to expose bilateral lamniae from C6 to T1. We performed C6 to T1 laminectomy, and midline durotomy was performed. Midline myelotomy was performed at C6/7 level, and tumor excision was performed in enbloc. After hemostasis, dura was closed in layers with 5-0 prolene in water-tight fashion. After one epidural CWV, the wound was closed in layers. Operators 賴達明 Assistants R5 曾峰毅 R3 陳國瑋 相關圖片 傅振江 (M,1952/10/04,59y5m) 手術日期 2011/09/16 手術主治醫師 賴達明 手術區域 東址 005房 01號 診斷 C1-C4 level fracture with unspecified spinal cord injury, closed 器械術式 Spinal fusion posterior, occipito-cervical fusion 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 陳以幸, 時間資訊 09:08 臨時手術NPO 08:02 進入手術室 09:05 麻醉開始 10:30 誘導結束 10:45 手術開始 11:00 抗生素給藥 15:00 開始輸血 18:00 手術結束 18:00 麻醉結束 18:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎弓切除術(減壓)-二節以內 1 2 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 10 0 記錄__ 手術科部: 外科部 套用罐頭: 1. Occipito-cervical fusion with plating and ... 開立醫師: 李振豪 開立時間: 2011/09/16 18:29 Pre-operative Diagnosis 1. C1/2 subluxation with myelopathy, 2. C5/6 transdiscal fracture Post-operative Diagnosis 1. C1/2 subluxation with myelopathy, 2. C5/6 transdiscal fracture Operative Method 1. Occipito-cervical fusion with plating and lateral mass screws 2. C2 laminectomy for decompression 3. C5/6 wiring for posterior fixation Specimen Count And Types nil Pathology Nil Operative Findings C1/2 subluxation with cord compression was noted. After C2 laminectomy, the thecal sac expanded well. No incidental durotomy was noted after whole procedure. The OC fusion was performed with 31mm occipital plate(fixed with two occipital screws, 16mm and 11mm in size), four lateral mass screws(18mm on left C3 lateral mass, 14mm on right C3 and bilateral C4 lateral mass). The autologous bone graft was harvested from right PSIS. Posterior fusion with autologous bone graft was performed from C1 to C6. Wiring of C5/6 spinous process was performed with #16 wire. C1/2 subluxation with cord compression was noted. The C1 was unstable before the operation. After C2 laminectomy, the thecal sac expanded well. No incidental durotomy was noted after whole procedure. The OC fusion was performed with 31mm occipital plate(fixed with two occipital screws, 16mm and 11mm in size), four lateral mass screws(18mm on left C3 lateral mass, 14mm on right C3 and bilateral C4 lateral mass). The autologous bone graft was harvested from right PSIS. Posterior fusion with autologous bone graft was performed from C1 to C6. Wiring of C5/6 spinous process was performed with #16 wire. No obvious EP change was noted during whole procedure. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position with head fixed with Halo-Vest. The scalp was shaved, scrubbed, and disinfected as usual. Midline skin incision was made from 1cm above inion to C7 level. the subcutaneous soft tissue awas devided and the paravertebral muscle group were detached. Occipital, foramen magnum, C1 to C6 laminae were all exposed. C2 laminectomy was performed with Midas air-drived drills for decompression. C3 and C4 lateral mass was exposed and lateral mass screws were implanted. The occipital plate was applied with two occipital screws. The rods were applied according to the curve of C0 to C4. One transverse skin incision was made at right lower back along the posterior superior iliac crest. A 6x5x2cm bone graft was harvested from PSIS. Hemostasis was achieved with bone wax, bipolar electrocautery, and Gelfoam packing. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Decortication was performed over C1, C3, C4, C5, and C6 laminae. The bone graft was applied for posterior fusion. Wiring of C5/6 spinous process was performed for posterior fixation. One Hemovac was placed. The wound was then closed in layers with 1-0, 2-0 Vicryl and 3-0 Nylon. Operators VS賴達明 Assistants R5李振豪, R2陳以幸, Ri劉子弘 相關圖片 黃榮秋 (F,1950/11/19,61y3m) 手術日期 2011/09/16 手術主治醫師 賴達明 手術區域 東址 005房 02號 診斷 Herniation of intervertebral disc without myelopathy, cervical 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 陳以幸, 時間資訊 23:05 臨時手術NPO 18:38 進入手術室 18:40 麻醉開始 18:45 誘導結束 19:00 抗生素給藥 19:18 手術開始 21:05 手術結束 21:05 麻醉結束 21:15 送出病患 21:20 進入恢復室 22:22 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 手術 椎間盤切除術-頸椎 1 1 手術 脊椎融合術-前融合,有固定物)≦四節 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 外科部 套用罐頭: Anterior Discectomy and Fusion, Cervical Spine 開立醫師: 曾峰毅 開立時間: 2011/09/16 21:07 Pre-operative Diagnosis Herniated intervertebral disc, C4/5 Post-operative Diagnosis Herniated intervertebral disc, C4/5 Operative Method Anterior cervical diskectomy at C4/5, fusion with PEEK cage and artificial bone graft Specimen Count And Types Nil Pathology Nil Operative Findings Degenrated disc at C4/5 compromised thecal sac and right neural foramen. Neural structures were decompressed well after the surgery. Synthes PEEK cage, 7 mm high, was used for anterior fusion with artificial bone graft. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with neck extended. We made one transverse skin incision at right anterior aspect of the neck, and dissected along the medial side of platysma and lateral side of thyroid gland to prevertebral space. We localized the C4/5 intervertebral disc space under C-arm, and performed anterior cervical diskectomy. Disc space was filled with PEEK cage and artificial bone graft. We placed one mini-hemovac, and closed the wound in layers. Operators VS 賴達明 Assistants R5 曾峰毅 R2 陳以幸 相關圖片 祝魯其璧 (F,1934/08/20,77y6m) 手術日期 2011/09/16 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Spinal stenosis, lumbar 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 鍾文桂, 時間資訊 23:26 臨時手術NPO 08:05 進入手術室 08:20 麻醉開始 08:30 誘導結束 08:45 抗生素給藥 09:39 手術開始 11:50 抗生素給藥 12:30 開始輸血 13:35 手術結束 13:35 麻醉結束 13:40 送出病患 13:41 進入恢復室 15:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎弓切除術(減壓)-二節以內 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: 1. Internal fixation with transpedicle screws... 開立醫師: 鍾文桂 開立時間: 2011/09/16 13:56 Pre-operative Diagnosis Lumbar spondylolisthesis, L3-5. Post-operative Diagnosis Lumbar spondylolisthesis, L3-5. Operative Method 1. Internal fixation with transpedicle screws, L3 and L5; with transforaminal lumbar interbody fusion, L3/4. 2. Decompressive laminectomy, L3/4 and diskectomy, L3/4. Specimen Count And Types nil Pathology Nil. Operative Findings PEEK cage: 11mm, rods: 8cm, screws: 6.2*40mm. Intact dura mater. Operative Procedures Under ETGA, the patient was placed in prone position. After disinfection and draping, a linear vertical incision was made from L3-L5 level. After paraspinal dissection, the transpedical screws were implanted and their positions were ensured by intraoperative fluoroscopy. Then, laminectomy was done at L3 and L4 levels. L3/4 diskectomy was obtained. The banana PEEK cage was placed into the disc space. Posterolateral fusion was achieved with autologous bone graft. The internal fixation apparatus was completed with rods. The wound was closed in layers with one 1/8 hemovac drain. The wound was closed in layers. Operators 賴達明 Assistants 鍾文桂 陸惠宗 蘇清松 (M,1937/09/04,74y6m) 手術日期 2011/09/16 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Spinal stenosis, lumbar 器械術式 Laminectomy for decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 陸惠宗, 時間資訊 23:25 臨時手術NPO 14:00 進入手術室 14:05 麻醉開始 14:15 誘導結束 14:30 抗生素給藥 14:56 手術開始 18:05 手術結束 18:05 麻醉結束 18:05 送出病患 18:20 進入恢復室 20:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術(減壓)-二節以內 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: Sublaminar decompression, L5/S1. 開立醫師: 鍾文桂 開立時間: 2011/09/16 18:27 Pre-operative Diagnosis Spinal stenosis, L4/5, and L5/S1, status post Wallis implantation at L4/5. Post-operative Diagnosis Spinal stenosis, L4/5, and L5/S1, status post Wallis implantation at L4/5. Operative Method Sublaminar decompression, L5/S1. Specimen Count And Types nil Pathology nil Operative Findings 1. The Wallis was kept intact during dissection. 2. Intact dura mater. The ligamentum flavum at L5/S1 level was removed to achieve slack thecal sac. We tried to decompress the L4/5 level. However, because of Wallis, we only could approach the lateral part of the laminae.Intermlaminar space of L4/5 was not reached. Operative Procedures Under ETGA, the patient was placed in prone position. After intraoperative ensurance of L5/S1 level, a linear incision was obtained in continuity with the previous operative wound. After paraspinal dissection, the L5/S1 interlaminar space was exposed and dissected. The hypertrophic ligamentum flavum was removed by Kerrison punch and disc clamp. After well hemostasis, the wound was closed in layers. Operators VS 賴達明 Assistants R6 鍾文桂, R1 陸惠宗 記錄__ 手術科部: 外科部 套用罐頭: Sublaminar decompression, L5/S1. 開立醫師: 陸惠宗 開立時間: 2011/09/28 08:12 Pre-operative Diagnosis Spinal stenosis, L4/5, and L5/S1, status post Wallis implantation at L4/5. Post-operative Diagnosis Spinal stenosis, L4/5, and L5/S1, status post Wallis implantation at L4/5. Operative Method Sublaminar decompression, L5/S1. Specimen Count And Types nil Pathology nil Operative Findings 1. The Wallis was kept intact during dissection. 2. Intact dura mater. The ligamentum flavum at L5/S1 level was removed to achieve slack thecal sac. We tried to decompress the L4/5 level. However, because of Wallis, we only could approach the lateral part of the laminae.Intermlaminar space of L4/5 was not reached. Operative Procedures Under ETGA, the patient was placed in prone position. After intraoperative ensurance of L5/S1 level, a linear incision was obtained in continuity with the previous operative wound. After paraspinal dissection, the L5/S1 interlaminar space was exposed and dissected. The hypertrophic ligamentum flavum was removed by Kerrison punch and disc clamp. After well hemostasis, the wound was closed in layers. Operators VS 賴達明 Assistants R6 鍾文桂, R1 陸惠宗 張圳 (M,1928/01/15,84y1m) 手術日期 2011/09/16 手術主治醫師 蕭輔仁 手術區域 東址 003房 03號 診斷 Sprain, back 器械術式 T1-3 epidural tumor exicison 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林峰盛 ASA 3E 紀錄醫師 游健生, 時間資訊 19:04 通知急診手術 19:05 開始NPO 19:05 臨時手術NPO 21:00 報到 21:01 進入手術室 21:08 麻醉開始 21:35 誘導結束 21:40 抗生素給藥 22:13 手術開始 23:10 開始輸血 00:10 麻醉結束 00:10 手術結束 00:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 惡性脊髓腫瘤切除術 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 摘要__ 手術科部: 外科部 套用罐頭: Cervical Laminectomy 開立醫師: 曾峰毅 開立時間: 2011/09/16 23:58 Pre-operative Diagnosis Prostate cancer, with T2 metastasis, status post T1-3 laminectomy for tumor excision, recurrence Post-operative Diagnosis Prostate cancer, with T2 metastasis, status post T1-3 laminectomy for tumor excision, recurrence Operative Method T4 laminectomy; epdidural tumor revomal T1-4; removal of left T2 pedicle Specimen Count And Types Several fragments of epidural tumor was sent for pathology. Pathology Pending Operative Findings Hypervascular, greyish tumor was noted in the epidural space from T1 to T4. Tight connective tissue was found at previous operation route with severe adhesion. Cord was pushsed posteriorly by the tumor at T2 level. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. We made upper back midline skin incision along previous operation wound and extended caudally and rostrally. We dissected to exposed previous laminectomy winodw and bilateral laminae of T4. Epidural tumor was removed, and left T2 pedicle was drilled off with air-drill. Tumor at T2 vertebral body, in front of thecal sac, was removed partially for decompression. After hemostasis, we placed one epidural CWV, and closed the wound in layers. Operators VS 蕭輔仁 Assistants R5 曾峰毅 R4 游健生 Indication Of Emergent Operation Spinal cord compression 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: T4 laminectomy; epdidural tumor revomal T1-4;... 開立醫師: 游健生 開立時間: 2011/09/17 00:47 Pre-operative Diagnosis Prostate cancer, with T2 metastasis, status post T1-3 laminectomy for tumor excision, recurrence Post-operative Diagnosis Prostate cancer, with T2 metastasis, status post T1-3 laminectomy for tumor excision, recurrence Operative Method T4 laminectomy; epdidural tumor revomal T1-4; removal of left T2 pedicle Specimen Count And Types Several fragments of epidural tumor was sent for pathology. Pathology Pending Operative Findings Hypervascular, greyish tumor was noted in the epidural space from T1 to T4. Tight connective tissue was found at previous operation route with severe adhesion. Cord was pushsed posteriorly by the tumor at T2 level. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. We made upper back midline skin incision along previous operation wound and extended caudally and rostrally. We dissected to exposed previous laminectomy winodw and bilateral laminae of T4. Epidural tumor was removed, and left T2 pedicle was drilled off with air-drill. Tumor at T2 vertebral body, in front of thecal sac, was removed partially for decompression. After hemostasis, we placed one epidural CWV, and closed the wound in layers. Operators VS 蕭輔仁 Assistants R5 曾峰毅 R4 游健生 Indication Of Emergent Operation Spinal cord compression 相關圖片 黃敏銘 (M,1936/05/09,75y10m) 手術日期 2011/09/16 手術主治醫師 王國川 手術區域 東址 002房 05號 診斷 Scalp Laceration wound 器械術式 Burr hole (trephination) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林峰盛 ASA 4E 紀錄醫師 王奐之, 時間資訊 10:00 開始NPO 16:10 通知急診手術 18:05 進入手術室 18:15 麻醉開始 18:30 誘導結束 18:47 抗生素給藥 19:10 手術開始 20:40 手術結束 20:40 麻醉結束 20:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 B 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 C.V.P. catheter in ubation 1 0 摘要__ 手術科部: 外科部 套用罐頭: Bilateral frontal burr hole for hematoma evac... 開立醫師: 王奐之 開立時間: 2011/09/16 20:48 Pre-operative Diagnosis Bilateral acute on chronic subdural hematoma Post-operative Diagnosis Bilateral Operative Method Bilateral frontal burr hole for hematoma evacuation Specimen Count And Types Nil Pathology Nil Operative Findings Motor-oil like fluid gushed out after opening of outer membrane. The brain did not re-expand after evacuation of subdural hematoma. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position. After shaving, scrubbing, disinfection & draping in sterile fashion, a linear incision was made at right frontal area. After creation of burr hole, tenting stitches were applied. A small cruciate durotomy was done, followed by penetration of outer membrane of the subdural hematoma. A small rubber drain was then inserted into the subdural space. After evacuation of subdural hematoma, the subdural drain was set to the frontal area. The wound was then closed in layers. The same procedure was repeated at left side. The operation ended with deairing. Operators VS 王國川 Assistants R4 王奐之, PGY 怡安 Indication Of Emergent Operation IICP 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Bilateral frontal burr hole for hematoma evac... 開立醫師: 王奐之 開立時間: 2011/09/16 20:48 Pre-operative Diagnosis Bilateral acute on chronic subdural hematoma Post-operative Diagnosis Bilateral Operative Method Bilateral frontal burr hole for hematoma evacuation Specimen Count And Types Nil Pathology Nil Operative Findings Motor-oil like fluid gushed out after opening of outer membrane. The brain did not re-expand after evacuation of subdural hematoma. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position. After shaving, scrubbing, disinfection & draping in sterile fashion, a linear incision was made at right frontal area. After creation of burr hole, tenting stitches were applied. A small cruciate durotomy was done, followed by penetration of outer membrane of the subdural hematoma. A small rubber drain was then inserted into the subdural space. After evacuation of subdural hematoma, the subdural drain was set to the frontal area. The wound was then closed in layers. The same procedure was repeated at left side. The operation ended with deairing. Operators VS 王國川 Assistants R4 王奐之, PGY 怡安 Indication Of Emergent Operation IICP 相關圖片 摘要__ 手術科部: 外科部 套用罐頭: Bilateral frontal burr hole for hematoma evac... 開立醫師: 王奐之 開立時間: 2011/09/17 10:00 Pre-operative Diagnosis Bilateral acute on chronic subdural hematoma Post-operative Diagnosis Bilateral acute on chronic subdural hematoma Operative Method Bilateral frontal burr hole for hematoma evacuation Specimen Count And Types Nil Pathology Nil Operative Findings Motor-oil like fluid gushed out after opening of outer membrane. The brain did not re-expand after evacuation of subdural hematoma. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position. After shaving, scrubbing, disinfection & draping in sterile fashion, a linear incision was made at right frontal area. After creation of burr hole, tenting stitches were applied. A small cruciate durotomy was done, followed by penetration of outer membrane of the subdural hematoma. A small rubber drain was then inserted into the subdural space. After evacuation of subdural hematoma, the subdural drain was set to the frontal area. The wound was then closed in layers. The same procedure was repeated at left side. The operation ended with deairing. Operators VS 王國川 Assistants R4 王奐之, PGY 怡安 Indication Of Emergent Operation 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Bilateral frontal burr hole for hematoma evac... 開立醫師: 王奐之 開立時間: 2011/09/17 10:00 Pre-operative Diagnosis Bilateral acute on chronic subdural hematoma Post-operative Diagnosis Bilateral acute on chronic subdural hematoma Operative Method Bilateral frontal burr hole for hematoma evacuation Specimen Count And Types Nil Pathology Nil Operative Findings Motor-oil like fluid gushed out after opening of outer membrane. The brain did not re-expand after evacuation of subdural hematoma. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position. After shaving, scrubbing, disinfection & draping in sterile fashion, a linear incision was made at right frontal area. After creation of burr hole, tenting stitches were applied. A small cruciate durotomy was done, followed by penetration of outer membrane of the subdural hematoma. A small rubber drain was then inserted into the subdural space. After evacuation of subdural hematoma, the subdural drain was set to the frontal area. The wound was then closed in layers. The same procedure was repeated at left side. The operation ended with deairing. Operators VS 王國川 Assistants R4 王奐之, PGY 怡安 Indication Of Emergent Operation IICP 相關圖片 賴禹鈞 (M,1996/09/24,15y5m) 手術日期 2011/09/16 手術主治醫師 林晉 手術區域 東址 020房 02號 診斷 Major trauma rated 16 or above on the severity scale ( Injury severity score >=16 ) 器械術式 Left proximal tibia fx, Zimmer locking plate 手術類別 緊急手術 手術部位 四肢 傷口分類 清潔 麻醉方式 脊髓麻醉 麻醉主治醫師 劉漢平 ASA 4E 紀錄醫師 張允亮, 時間資訊 12:05 報到 12:05 進入手術室 12:08 麻醉開始 12:15 誘導結束 12:52 手術開始 15:20 麻醉結束 15:39 送出病患 15:39 手術結束 醫令資訊 類別 名稱 量 刀 側 手術 脛骨骨折開放性復位術 1 1 L 手術 石膏副木固定－長腿 1 0 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Spinal anesthesia 1 0 麻醉 SPINAL ANESTHESIA 2 0 記錄__ 手術科部: 骨科部 套用罐頭: ORIF with Zimmer periarticular locking plate ... 開立醫師: 張允亮 開立時間: 2011/09/16 15:39 Pre-operative Diagnosis Left proximal tibial open comminuted fracture, Gustilo type II Post-operative Diagnosis Left proximal tibial open comminuted fracture, Gustilo type II Operative Method ORIF with Zimmer periarticular locking plate 1P21S Specimen Count And Types nil Pathology nil Operative Findings 1. Left proximal tibial open comminuted fracture, with 2cm wound around tibial tubercle s/p suture, healed 2. One 3x5cm pressure sore was noted over left heel Operative Procedures 1. SA, supine, prep & drape 2. Skin incision along left lower leg, lateral approach 3. ORIF with Zimmer locking plate & screws via MIPPO technique 4. NS irrigation, hemostasis 5. Close wound in layers 6. Apply long leg splint Operators 林晉, Assistants 洪誌鍵, 張允亮, 陳志偉, Indication Of Emergent Operation nil 何冠毅 (M,2009/10/09,2y5m) 手術日期 2011/09/16 手術主治醫師 謝孟祥 手術區域 東址 012房 03號 診斷 Acrocephlosyndactyly 器械術式 Reconstruction of syndactyly 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 3 紀錄醫師 柯安達, 時間資訊 11:35 進入手術室 11:40 麻醉開始 11:45 誘導結束 12:20 抗生素給藥 12:30 手術開始 16:27 抗生素給藥 18:20 手術結束 18:20 麻醉結束 18:25 送出病患 18:30 進入恢復室 19:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 皮膚全層植補術 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 手術 局部皮瓣(2公分以上) 1 1 B 手術 併指多指(趾)切除 1 2 B 手術 多指(趾)切除每多加一個 1 2 B 摘要__ 手術科部: 外科部 套用罐頭: Syndactyly division, Bruner incision with dor... 開立醫師: 柯安達 開立時間: 2011/09/16 18:33 Pre-operative Diagnosis Apert syndrome Post-operative Diagnosis Apert syndrome Operative Method Syndactyly division, Bruner incision with dorsal rectangular flap for web space Specimen Count And Types nil Pathology nil Operative Findings bilateral hand syndactyly(index finger, middle finger and ring finger) Operative Procedures 1. Supine position, ETGA 2. Disinfected bilateral hands and inguinal area 3. Design the rectangular flap and zigzag incision 4. Make incisions between the index finger and middle finger 5. Preserve the neurovascular bundle 6. Fixed the rectangular flap to web space 7. Suture the zigzag skin close to each other 8. Bilateral inguinal graft were obtained and applied to the uncover skin surface 9. Close the finger wound and bilateral inguinal wound 10. Immobilization with cast Operators 謝孟祥 Assistants R5 陳建璋 R2柯安達 Ri林秉毅 相關圖片 吳美麗 (F,1969/10/23,42y4m) 手術日期 2011/09/17 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Cerebral aneurysm 器械術式 Right pterion approach for aneurysm clipping 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2E 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 15:55 通知急診手術 18:00 進入手術室 18:05 麻醉開始 18:30 誘導結束 19:00 抗生素給藥 19:02 手術開始 22:00 抗生素給藥 23:20 開始輸血 01:00 抗生素給藥 04:00 抗生素給藥 04:35 手術結束 04:35 麻醉結束 04:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 13 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 開顱術摘除血管病變 - 腦血管瘤 有病徵的 1 1 R 手術 腦室體外引流 1 2 R 摘要__ 手術科部: 外科部 套用罐頭: Pterional approach for clipping of aneurysm. 開立醫師: 鍾文桂 開立時間: 2011/09/18 05:20 Pre-operative Diagnosis Ruptured anterior choroidal aneurysm, right. Post-operative Diagnosis Ruptured anterior choroidal aneurysm, right. Operative Method Pterional approach for clipping of aneurysm. Specimen Count And Types 1 piece About size:3cc Source:CSF. Pathology Nil. Operative Findings 1. A sacular aneurysm arising from right anterior choroidal artery pointing posterolaterally. It was clipped by an 45 degree angled Sugita clip. After clipping, the aneurysmal sac was electrocoagulated. 2. Moderate brain swelling. EVD was inserted at Kings point, ICP was about 5cmH2O. Operative Procedures Under ETGA, the patient was placed in supine position and the head was tilted to the left side. After shaving, disinfection, and draping, a curvilinear scalp incision was made. After pericranium dissection and facial nerve preservation, craniotomy was created by using high speed drill and craniotome. The dura was tented. After durotomy, the slivian fissure was opened. The frontal lobe was retracted to identify the optic nerve and ophthalmic artery. Then, the ICA, A1, and MCA were identified with meticulous dissection and some temporal lobe resection. The aneurysm arising from anterior choroidal artery was clipped. After well hemostasis, the wound was closed in layers. Operators 賴達明 Assistants 鍾文桂 王奐之 Indication Of Emergent Operation rupture of aneurysm. 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Pterional approach for clipping of aneurysm. 開立醫師: 鍾文桂 開立時間: 2011/11/01 20:23 Pre-operative Diagnosis Ruptured anterior choroidal aneurysm, right. Post-operative Diagnosis Ruptured anterior choroidal aneurysm, right. Operative Method Pterional approach for clipping of aneurysm. Specimen Count And Types 1 piece About size:3cc Source:CSF. Pathology Nil. Operative Findings 1. A sacular aneurysm arising from right anterior choroidal artery pointing posterolaterally. It was clipped by an 45 degree angled Sugita clip. After clipping, the aneurysmal sac was electrocoagulated. 2. Moderate brain swelling. EVD was inserted at Kings point, ICP was about 5cmH2O. Operative Procedures Under ETGA, the patient was placed in supine position and the head was tilted to the left side. After shaving, disinfection, and draping, a curvilinear scalp incision was made. After pericranium dissection and facial nerve preservation, craniotomy was created by using high speed drill and craniotome. The dura was tented. After durotomy, the slivian fissure was opened. The frontal lobe was retracted to identify the optic nerve and ophthalmic artery. Then, the ICA, A1, and MCA were identified with meticulous dissection and some temporal lobe resection. The aneurysm arising from anterior choroidal artery was clipped. After well hemostasis, the wound was closed in layers. Operators 賴達明 Assistants 鍾文桂 王奐之 Indication Of Emergent Operation rupture of aneurysm. 相關圖片 葉益男 (M,1943/11/13,68y4m) 手術日期 2011/09/17 手術主治醫師 蕭輔仁 手術區域 東址 002房 01號 診斷 Malignant neoplasm of prostate 器械術式 T1-3 laminectomy for epidural tumor excision 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 鍾文桂, 時間資訊 00:00 開始NPO 00:00 臨時手術NPO 07:00 通知急診手術 08:55 報到 09:15 進入手術室 09:20 麻醉開始 09:50 誘導結束 09:50 抗生素給藥 10:00 手術開始 10:55 開始輸血 14:00 麻醉結束 14:00 手術結束 14:16 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 惡性脊髓腫瘤切除術 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: T1-3 laminectomy for removal of epidural meta... 開立醫師: 鍾文桂 開立時間: 2011/09/17 15:05 Pre-operative Diagnosis Prostate cancer with spinal metastasis. Post-operative Diagnosis Epidural spinal metastasis, T1-3 with cord comression. Operative Method T1-3 laminectomy for removal of epidural metastatic tumor. Specimen Count And Types 2 pieces About size:5cc Source:spinal tumor. About size:50cc Source:metastatic bony lesions. Pathology Pending. Operative Findings 1. dark red- grayish soft tumor with very high vascularity.It surrounded the left T2 root and compressed the spinal cord to the right side. Engorged epidural vein over the lesion site was noted. Intact dura mater after laminectomy and tumor resection. The tumor located at anterior part 2. Total blood loss: 1500cc. 3. A scalp laceration wound at left parietal region was made due to slip of Mayfield head pin. Operative Procedures Under ETGA, the patient was placed in prone position and the head was fixed by Mayfield head holder. After disinfection and draping, a vertical midline incision was made from T1 to T3 level. After paraspinal dissection, T1-3 laminectomy was achieved by using rongeur and 2mm Kerrison punch. Tumor resection was done with tumor forceps and currete. After well hemostasis, the wound was closed in layers with two epidural 1/8 hemovac drains. Operators 蕭輔仁 Assistants 鍾文桂 陸惠宗 Indication Of Emergent Operation acute lower extrimity weakness. 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: T1-3 laminectomy for removal of epidural meta... 開立醫師: 陸惠宗 開立時間: 2011/10/06 10:26 Pre-operative Diagnosis Prostate cancer with spinal metastasis. Post-operative Diagnosis Epidural spinal metastasis, T1-3 with cord comression. Operative Method T1-3 laminectomy for removal of epidural metastatic tumor. Specimen Count And Types 2 pieces About size:5cc Source:spinal tumor. About size:50cc Source:metastatic bony lesions. Pathology Pending. Operative Findings 1. dark red- grayish soft tumor with very high vascularity.It surrounded the left T2 root and compressed the spinal cord to the right side. Engorged epidural vein over the lesion site was noted. Intact dura mater after laminectomy and tumor resection. The tumor located at anterior part 2. Total blood loss: 1500cc. 3. A scalp laceration wound at left parietal region was made due to slip of Mayfield head pin. Operative Procedures Under ETGA, the patient was placed in prone position and the head was fixed by Mayfield head holder. After disinfection and draping, a vertical midline incision was made from T1 to T3 level. After paraspinal dissection, T1-3 laminectomy was achieved by using rongeur and 2mm Kerrison punch. Tumor resection was done with tumor forceps and currete. After well hemostasis, the wound was closed in layers with two epidural 1/8 hemovac drains. Operators 蕭輔仁 Assistants 鍾文桂 陸惠宗 Indication Of Emergent Operation acute lower extrimity weakness. 相關圖片 潘坤福 (M,1944/02/15,68y0m) 手術日期 2011/09/17 手術主治醫師 王碩盟 手術區域 東址 015房 07號 診斷 Urinary tract infection 器械術式 Double-J ureteral stent insert 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 面罩麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 黃冠棠, 時間資訊 23:59 臨時手術NPO 11:20 報到 11:40 進入手術室 11:43 麻醉開始 11:45 誘導結束 12:00 手術開始 12:45 手術結束 12:45 麻醉結束 12:50 送出病患 13:00 進入恢復室 14:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Semi-opened mask inhalation anes 1 0 手術 經皮腎臟造廔術-單側(豬尾巴) 1 1 R 手術 診斷性輸尿管鏡檢，包括輸尿管膀胱接合處，擴張術及膀胱鏡術 1 0 R 摘要__ 手術科部: 泌尿部 套用罐頭: Pigtail PCN 開立醫師: 黃冠棠 開立時間: 2011/09/17 13:04 Pre-operative Diagnosis Right hydronephrosis Post-operative Diagnosis Right hydronephrosis Operative Method Right pigtail PCN and ureteroscopy Specimen Count And Types nil Pathology nil Operative Findings 1. Dilated right renal pelvis and collecting system 2. Middle ureteral stricture with suspected false lumen or perforation Operative Procedures 1. Under satisfactory anesthesia with the patient in the lithotomy position, skin preparation was performed. 2. A cystoscope was inserted into the bladder. The previous DBJ was removed and a guidewire was then introduced into the right ureteral orifice. 3. A 6 Fr. ureteroscope was introduced into the ureter. Middle ureteral stricture with suspected false lumen or perforation was noted. 4. Prepping and draping were performed in the usual sterile method. 5. Dilated renal collecting system was identified under ultrasound. Adequate puncture path was chosen. The puncture needle was introduced into the collecting system under ultrasonographic guidance. 6. The guide-wire was inserted into right renal pelvis under sono-guidedance. 7. The tract was dilated with dilators, and the pigtail catheter was introduced into the renal pelvis smoothly through the guidewire. 8. The guidewire was removed. 9. After the fluid was drained out, the tube was fixed on the skin. 10.The patient tolerated the operation well, and was sent back to ward in stable condition. Operators 王碩盟, Assistants 黃冠棠, 姜秉均, 記錄__ 手術科部: 泌尿部 套用罐頭: Pigtail PCN 開立醫師: 黃冠棠 開立時間: 2011/09/17 13:04 Pre-operative Diagnosis Right hydronephrosis Post-operative Diagnosis Right hydronephrosis Operative Method Right pigtail PCN and ureteroscopy Specimen Count And Types nil Pathology nil Operative Findings 1. Dilated right renal pelvis and collecting system 2. Middle ureteral stricture with suspected false lumen or perforation Operative Procedures 1. Under satisfactory anesthesia with the patient in the lithotomy position, skin preparation was performed. 2. A cystoscope was inserted into the bladder. The previous DBJ was removed and a guidewire was then introduced into the right ureteral orifice. 3. A 6 Fr. ureteroscope was introduced into the ureter. Middle ureteral stricture with suspected false lumen or perforation was noted. 4. Prepping and draping were performed in the usual sterile method. 5. Dilated renal collecting system was identified under ultrasound. Adequate puncture path was chosen. The puncture needle was introduced into the collecting system under ultrasonographic guidance. 6. The guide-wire was inserted into right renal pelvis under sono-guidedance. 7. The tract was dilated with dilators, and the pigtail catheter was introduced into the renal pelvis smoothly through the guidewire. 8. The guidewire was removed. 9. After the fluid was drained out, the tube was fixed on the skin. 10.The patient tolerated the operation well, and was sent back to ward in stable condition. Operators 王碩盟, Assistants 黃冠棠, 姜秉均, 藍永順 (M,1936/09/06,75y6m) 手術日期 2011/09/17 手術主治醫師 陳晉興 手術區域 東址 018房 01號 診斷 Empyema 器械術式 Thoracoscopy 手術類別 預定手術 手術部位 胸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 3 紀錄醫師 高明蔚, 時間資訊 08:03 進入手術室 08:15 麻醉開始 08:30 誘導結束 09:10 手術開始 10:55 手術結束 10:55 麻醉結束 11:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 胸腔鏡肺膜剝脫術 1 1 R 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 外科部 套用罐頭: VATS decortication, right 開立醫師: 高明蔚 開立時間: 2011/09/17 11:04 Pre-operative Diagnosis Right empyema thoracis Post-operative Diagnosis Right empyema thoracis Operative Method VATS decortication, right Specimen Count And Types 1 piece About size:multiple Source:pleural peal and fibrin Pathology Pending Operative Findings Moderate adhesion was noted, esp. lung base. Several lobulated effusion with fibrin deposit noted, esp, apex, fissures and the lung base. One abscess with yellowish~greenish purulent discharge was noted near posterior CP angle. Blood loss 10ml. Effusion 600ml, straw color. Operative Procedures DLETGA, left decubitus, skin disinfection and draping as usual. VATS setting after echo guidance. Pneumolysis and decortication. Check bleeding, hemostasis, saline irrigation. set Fr.28 / 32 chest tubes. Close the wounds. Operators 陳晉興 Assistants R4高明蔚,R1柯人玄 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: VATS decortication, right 開立醫師: 高明蔚 開立時間: 2011/09/17 11:21 Pre-operative Diagnosis Right empyema thoracis Post-operative Diagnosis Right empyema thoracis Operative Method VATS decortication, right Specimen Count And Types 1 piece About size:multiple Source:pleural peal and fibrin Pathology Pending Operative Findings Moderate adhesion was noted, esp. lung base. Several lobulated effusion with fibrin deposit noted, esp, apex, fissures and the lung base. One abscess with yellowish~greenish purulent discharge was noted near posterior CP angle. Blood loss 10ml. Effusion 600ml, straw color. Operative Procedures DLETGA, left decubitus, skin disinfection and draping as usual. VATS setting after echo guidance. Pneumolysis and decortication. Check bleeding, hemostasis, saline irrigation. set Fr.28 / 32 chest tubes. Close the wounds. Operators 陳晉興 Assistants R4高明蔚,R1柯人玄 相關圖片 賴言瑄 (F,2011/05/13,10m6d) 手術日期 2011/09/18 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Lipoma 器械術式 Wound debridement, suspect CSF leak 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 2E 紀錄醫師 曾峰毅, 時間資訊 16:38 通知急診手術 17:00 開始NPO 17:00 臨時手術NPO 22:37 進入手術室 22:42 麻醉開始 22:48 誘導結束 23:25 手術開始 00:10 麻醉結束 00:10 手術結束 00:15 送出病患 00:20 進入恢復室 01:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 深部傷口處理縫合擴創-大 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 曾峰毅 開立時間: 2011/09/19 00:13 Pre-operative Diagnosis Lipomyelomeningocele, status post myelomeningocele repair, cord untethering, and lipoma excision, complicated with wound dehiscence Post-operative Diagnosis Lipomyelomeningocele, status post myelomeningocele repair, cord untethering, and lipoma excision, complicated with wound dehiscence Operative Method Debridement and primary closure Specimen Count And Types Nil Pathology Nil Operative Findings Wound dehiscence over mid-portion of previous operation wound. There was no purulent discharged, and there was no obvious CSF leakage site under scrutizing. Subcutaneous fat necrosis was suspected, and debridement was performed. Wound edge was trimmed for primary closure. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. We opened dehiscenced wound, and performed debridement. Wound was irrigated with 1000 ml of normal saline. The wound was closed primarily in layers. With endotracheal general anaesthesia, the patient was put in prone position. We opened dehiscenced wound, and performed debridement. Wound edge granulation was trimmed. Wound was irrigated with 1000 ml of normal saline. One epidural CWV drain was palced. The wound was closed primarily in layers. Operators AP 郭夢菲 Assistants R5 曾峰毅 Indication Of Emergent Operation Wound dehiscence 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 郭夢菲 開立時間: 2011/09/19 10:38 Pre-operative Diagnosis Lipomyelomeningocele, status post myelomeningocele repair, cord untethering, and lipoma excision, complicated with wound dehiscence Post-operative Diagnosis Lipomyelomeningocele, status post myelomeningocele repair, cord untethering, and lipoma excision, complicated with wound dehiscence Operative Method Debridement and primary closure Specimen Count And Types Nil Pathology Nil Operative Findings Wound dehiscence over mid-portion of previous operation wound. The pther part of wound healed well. There was no purulent discharged, and there was no CSF leakage site under scrutizing. Subcutaneous fat necrosis was suspected, and debridement was performed. Wound edge was trimmed for primary closure. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. We opened dehiscenced wound, and performed debridement. Wound edge granulation was trimmed. Wound was irrigated with 1000 ml of normal saline. One epidural CWV drain was palced. The wound was closed primarily in layers with interrupted stitches. Operators AP 郭夢菲 Assistants R5 曾峰毅 Indication Of Emergent Operation Wound dehiscence 相關圖片 摘要__ 手術科部: 外科部 套用罐頭: Debridement and primary closure 開立醫師: 郭夢菲 開立時間: 2011/09/23 08:51 Pre-operative Diagnosis Lipomyelomeningocele, status post myelomeningocele repair, cord untethering, and lipoma excision, complicated with wound dehiscence Post-operative Diagnosis Lipomyelomeningocele, status post myelomeningocele repair, cord untethering, and lipoma excision, complicated with wound dehiscence Operative Method Debridement and primary closure Specimen Count And Types Nil Pathology Nil Operative Findings Wound dehiscence over mid-portion of previous operation wound. The pther part of wound healed well. There was no purulent discharged, and there was no CSF leakage site under scrutizing. Subcutaneous fat necrosis was suspected, and debridement was performed. Wound edge was trimmed for primary closure. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. We opened dehiscenced wound, and performed debridement. Wound edge granulation was trimmed. Wound was irrigated with 1000 ml of normal saline. One epidural CWV drain was palced. The wound was closed primarily in layers with interrupted stitches. Operators AP 郭夢菲 Assistants R5 曾峰毅 Indication Of Emergent Operation Wound dehiscence 相關圖片 鄧旭煜 (M,1983/12/18,28y2m) 手術日期 2011/09/19 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Malignant neoplasm of brain, unspecified 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 李振豪, 時間資訊 23:47 臨時手術NPO 08:09 進入手術室 08:15 麻醉開始 08:45 誘導結束 09:00 抗生素給藥 09:21 手術開始 12:00 抗生素給藥 13:50 手術結束 13:50 麻醉結束 14:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4~8小時 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Right frontal craniotomy for tumor excision 開立醫師: 李振豪 開立時間: 2011/09/19 14:43 Pre-operative Diagnosis Right frontal tumor, suspect recurrent germinoma Post-operative Diagnosis Right frontal recurrent germinoma Operative Method Right frontal craniotomy for tumor excision Specimen Count And Types 1 piece About size:Multiple pieces Source:Right frontal brain tumor Pathology Frozen section: recurrent germinoma Operative Findings The tumor was 6.7 x 6.5 x 5cm in size, hypervascularized, and relative well-demarcated but not capsulated. The outter part of the tumor was soft and fragile, gray-reddish in color. The central part of the tumor was whittish and hard with remarkable calcification. Both right lateral ventricle and 3rd ventricle was entered during tumor excision. External ventricular drainage of right lateral ventricle was placed under direct vision. The caudate nucleus and corpus callosum also invaded by the tumor. After tumro excision, the brain was slack with good pulsation. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position. The scalp was shaved, scrubbed, and disinfected as usual. Bicoronal scalp incision was made and the scalp flap was elevated. Three burr hole were created followed by one 8x6cm craniotomy window. Dural tenting was done. Intra-operative sonography was performed for localization of the tumor. C-shape durotomy was performed based with superior sagittal sinus. One 1x2cm corticotomy was performed and the tumor was removed by bipolar electrocautery, suction, and tumor forceps. The specimen was sent for frozen section during tumor excision. Hemostasis was achieved with bipolar electrocautery and Surgicel lining. External ventricular drainage was placed into right lateral ventricle under direct vision. Dura was closed with 4-0 Prolene. A small dural laceration was noted near the crista galli and repaired with 4-0 prolene. The skull plate was fixed back with miniplates, screws, and central tenting. One subgaleal CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and Appose staples. Operators VS曾漢民 Assistants R5李振豪, R1陸惠宗 相關圖片 歐玉環 (F,1953/10/30,58y4m) 手術日期 2011/09/19 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Lumbar Spondylosis 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 陳國瑋, 時間資訊 23:43 臨時手術NPO 08:03 進入手術室 08:10 麻醉開始 08:20 誘導結束 08:58 手術開始 11:10 手術結束 11:10 麻醉結束 11:15 送出病患 11:22 進入恢復室 12:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-腰椎 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 記錄__ 手術科部: 外科部 套用罐頭: L5-S1 microscopic diskectomy 開立醫師: 陳國瑋 開立時間: 2011/09/19 11:25 Pre-operative Diagnosis L5-S1 ruptured disc Post-operative Diagnosis L5-S1 ruptured disc Operative Method L5-S1 microscopic diskectomy Specimen Count And Types nil Pathology nil Operative Findings The S1 root was compressed tightly by the ruptured disc, and expened well after decompression. The right L5 root was compressed tightly by the ruptured disc. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position. The L5 S1 intervertebral space was localized by portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made and the subcutaneous soft tissue was devided. The paravertebral muscle groups were detached. Right L5-S1 laminotomy was performed. The ruptured disc was identified and diskectomy was conducted. Hemostasis was achieved. The wound was closed in layers with 2-0 Vicryl and 4-0 Vicryl. Operators 賴達明 Assistants 鍾文桂 陳國瑋 相關圖片 宗志殷 (M,1967/03/31,44y11m) 手術日期 2011/09/19 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Radiculopathy 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 陳國瑋, 時間資訊 23:44 臨時手術NPO 11:03 報到 11:20 進入手術室 11:35 麻醉開始 11:40 誘導結束 12:10 抗生素給藥 12:18 手術開始 15:10 抗生素給藥 15:18 手術結束 15:18 麻醉結束 15:25 送出病患 15:29 進入恢復室 16:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 手術 椎間盤切除術-腰椎 1 1 記錄__ 手術科部: 外科部 套用罐頭: Microscopic diskectomy 開立醫師: 陳國瑋 開立時間: 2011/09/19 15:31 Pre-operative Diagnosis L5-S1 herniated disc Post-operative Diagnosis L5-S1 herniated disc Operative Method Microscopic diskectomy Specimen Count And Types nil Pathology nil Operative Findings The left S1 root was compressed tightly by the buldging disc, and it expended well after decompression. Incidental durotomy was noted and covered with Durafoam. Thick ligamentum flavum was noted also. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position. The L5 S1 intervertebral space was localized by portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made and the subcutaneous soft tissue was devided. The left side paravertebral muscle groups were detached. Left L5-S1 laminotomy was performed. The buldging disc was identified and diskectomy was conducted. Hemostasis was achieved. The wound was closed in layers with 2-0 Vicryl and 4-0 Vicryl. Operators 賴達明 Assistants 鍾文桂 陳國瑋 相關圖片 王興華 (M,1929/11/04,82y4m) 手術日期 2011/09/19 手術主治醫師 王國川 手術區域 東址 001房 02號 診斷 Subdural hemorrhage, traumatic 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3E 紀錄醫師 游健生, 時間資訊 08:36 通知急診手術 08:36 臨時手術NPO 08:36 開始NPO 09:03 進入手術室 09:08 麻醉開始 09:30 誘導結束 09:35 抗生素給藥 10:00 開始輸血 10:00 手術開始 12:35 抗生素給藥 12:58 手術結束 12:58 麻醉結束 13:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 1 L 手術 顱內壓視置入 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: 1. Left fronto-temporo-parietal craniectomy f... 開立醫師: 游健生 開立時間: 2011/09/19 14:12 Pre-operative Diagnosis Left acute subdural hemorrhage Post-operative Diagnosis 1. Left acute subdural hemorrhage 2. Left temporal and frontal contusional intracerebral hemorrhage 3. Left temporo-parietal skull fracture Operative Method 1. Left fronto-temporo-parietal craniectomy for aSDH and ICH removal 2. Left subdural ICP monitor placement Specimen Count And Types nil Pathology Nil Operative Findings There was a linear fracture at left temporo-parietal skull. Severe dura adhesion to cranium was noted. There was about 20cc acute subdural hematoma at left temporo-frontal region. There was contusional ICH at left temporal tip, angular gyrus, frontal operculum, and frontal base. The ICH and contusional brain parenchyma at temporal tip and frontal base were removed due to significant mass effect. Immediate post-op ICP was 2mmHg with isocroic pupil (3mm). Operative Procedures Under ETGA, patient was in supine position with left shoulder elevated and head rotated to right. After shaving, we disinfected and draped the operation field as usual. A question-mark scalp incision was made, started from 1cm anterior to tragus extending to 3cm crossed midline just behind right forehead hairline. The scalp flap was elevated without pericranium followed by temporalis muscle flap elevation. The temporalis fasica with pericranium was harvested for later duroplasty. We made several burholes including at keyhole followed by craniectomy. After dura tenting along craniectomy border, a C-shape durotomy was done. The aSDH was removed followed by ICH and contusional brain parenchyma at temporal tip and frontal base. The rough surface was covered with Surgicel. After hemostasis, we repaired the dura with previously harvested fascia and pericranium by 3-0 prolene continuous suture. An ICP monitor probe was placed at subdural space via a small durotomy. After a subgaleal CWV was placed, wound was closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS 王國川 Assistants R4 游健生 PGY 李思慧 Indication Of Emergent Operation Pending uncal herniation 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: 1. Left fronto-temporo-parietal craniectomy f... 開立醫師: 游健生 開立時間: 2011/09/19 14:14 Pre-operative Diagnosis Left acute subdural hemorrhage Post-operative Diagnosis 1. Left acute subdural hemorrhage 2. Left temporal and frontal contusional intracerebral hemorrhage 3. Left temporo-parietal skull fracture Operative Method 1. Left fronto-temporo-parietal craniectomy for aSDH and ICH removal 2. Left subdural ICP monitor placement Specimen Count And Types nil Pathology Nil Operative Findings There was a linear fracture at left temporo-parietal skull. Severe dura adhesion to cranium was noted. There was about 20cc acute subdural hematoma at left temporo-frontal region. There was contusional ICH at left temporal tip, angular gyrus, frontal operculum, and frontal base. The ICH and contusional brain parenchyma at temporal tip and frontal base were removed due to significant mass effect. Immediate post-op ICP was 2mmHg with isocroic pupil (3mm). Operative Procedures Under ETGA, patient was in supine position with left shoulder elevated and head rotated to right. After shaving, we disinfected and draped the operation field as usual. A question-mark scalp incision was made, started from 1cm anterior to tragus extending to 3cm crossed midline just behind right forehead hairline. The scalp flap was elevated without pericranium followed by temporalis muscle flap elevation. The temporalis fasica with pericranium was harvested for later duroplasty. We made several burholes including at keyhole followed by craniectomy. After dura tenting along craniectomy border, a C-shape durotomy was done. The aSDH was removed followed by ICH and contusional brain parenchyma at temporal tip and frontal base. The rough surface was covered with Surgicel. After hemostasis, we repaired the dura with previously harvested fascia and pericranium by 3-0 prolene continuous suture. An ICP monitor probe was placed at subdural space via a small durotomy. After a subgaleal CWV was placed, wound was closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS 王國川 Assistants R4 游健生 PGY 李思慧 Indication Of Emergent Operation Pending uncal herniation 相關圖片 丁竺原 (F,1969/05/30,42y9m) 手術日期 2011/09/19 手術主治醫師 廖漢文 手術區域 東址 000房 號 診斷 Vascular malformation 器械術式 Cerebellar AVM TAE 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 3 時間資訊 23:59 臨時手術NPO 08:22 麻醉開始 08:40 誘導結束 13:40 麻醉結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 黃碧玉 (F,1945/12/12,66y3m) 手術日期 2011/09/19 手術主治醫師 蔡清霖 手術區域 東址 020房 01號 診斷 Osteoarthritis, knee 器械術式 TKR -United 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 脊髓麻醉 麻醉主治醫師 劉漢平 ASA 3 紀錄醫師 羅婉育, 時間資訊 07:55 報到 08:10 進入手術室 08:30 麻醉開始 08:40 誘導結束 08:58 手術開始 09:32 抗生素給藥 09:35 開始輸血 09:38 抗生素給藥 10:20 手術結束 10:20 麻醉結束 10:25 送出病患 10:26 進入恢復室 11:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Spinal anesthesia 1 0 手術 膝關節全置換術 1 1 L 摘要__ 手術科部: 骨科部 套用罐頭: Total knee replacement-lateral by 蔡P 開立醫師: 羅婉育 開立時間: 2011/09/19 10:19 Pre-operative Diagnosis Left knee osteoarthritis Post-operative Diagnosis Left knee osteoarthritis Operative Method Total knee replacement with United prosthesis Specimen Count And Types nil Pathology nil Operative Findings 1.Cartilage wearing and subchondral bone expose 2.osteophyte formation 3.Varus deformity Operative Procedures Under spinal anesthesia, the patient was postioned in supine. The operation field was disinfected and draped as usual. After inflating air tourniquet with 350 mmHg in pressure, skin was incised along midline of knee, and exposusre of the knee jointwas done with lateral approach. Bony preparation of femur, tibia, and patella were performed with ""united"" jigs subsequently.Total knee prosthesis was applied with cement, Tibia: #_1__, Femur: #__1_, Patella: __22__mm, Insert: #___1__,__9__mm; Then air tourniquet was deflated, and hemostasis was done. After cleaning surgical wound with normal saline irrigation, the wound was finally closed in layers. Operators 蔡清霖, Assistants 葉炳君, 羅婉育, 黃哲南, 簡錦慧, 李梅蘭 (F,1955/12/12,56y3m) 手術日期 2011/09/20 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Spondylosis 器械術式 Laminectomy for decompression, L5 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 王奐之, 時間資訊 23:57 臨時手術NPO 07:08 報到 08:02 進入手術室 08:08 麻醉開始 08:12 誘導結束 08:36 抗生素給藥 08:56 手術開始 10:30 手術結束 10:30 麻醉結束 10:38 送出病患 10:40 進入恢復室 12:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術(減壓)-二節以內 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 外科部 套用罐頭: L5 laminectomy 開立醫師: 王奐之 開立時間: 2011/09/20 10:37 Pre-operative Diagnosis L4-5 spinal stenosis & L5-S1 HIVD Post-operative Diagnosis L4-5 spinal stenosis & L5-S1 central HIVD Operative Method L5 laminectomy Specimen Count And Types Nil Pathology Nil Operative Findings Hypertrophic ligamentum flavum was noted, the thecal sac & left side L5 root was compressed tightly. The thecal sac expanded well after decompression. Bilateral L5 roots & S1 roots were identified, left side S2 root was also exposed. No CSF leakage was encountered during the surgery. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position. After localization of L5 level with C-arm, a midline linear incision was made. The incision was deepened through the fascia, and the paraspinal muscles were detached from spinous process & lamina. L5 laminectomy was then performed with rongeus & Kerrison punch. The ligamentum flavum was also removed in pieces. After full decompression & hemostasis, the wound was closed in layers. Operators VS 曾勝弘 Assistants R4 王奐之 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: L5 laminectomy 開立醫師: 王奐之 開立時間: 2011/09/20 10:37 Pre-operative Diagnosis L4-5 spinal stenosis & L5-S1 HIVD Post-operative Diagnosis L4-5 spinal stenosis & L5-S1 central HIVD Operative Method L5 laminectomy Specimen Count And Types Nil Pathology Nil Operative Findings Hypertrophic ligamentum flavum was noted, the thecal sac & left side L5 root was compressed tightly. The thecal sac expanded well after decompression. Bilateral L5 roots & S1 roots were identified, left side S2 root was also exposed. No CSF leakage was encountered during the surgery. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position. After localization of L5 level with C-arm, a midline linear incision was made. The incision was deepened through the fascia, and the paraspinal muscles were detached from spinous process & lamina. L5 laminectomy was then performed with rongeus & Kerrison punch. The ligamentum flavum was also removed in pieces. After full decompression & hemostasis, the wound was closed in layers. Operators VS 曾勝弘 Assistants R4 王奐之 相關圖片 王嘉源 (M,1991/04/23,20y10m) 手術日期 2011/09/20 手術主治醫師 曾勝弘 手術區域 東址 005房 02號 診斷 Injury to peroneal nerve 器械術式 Peroneal nerve repair 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 王奐之, 時間資訊 23:58 臨時手術NPO 10:47 進入手術室 10:55 麻醉開始 11:00 誘導結束 11:58 抗生素給藥 12:15 手術開始 15:00 抗生素給藥 19:00 抗生素給藥 21:00 手術結束 21:00 麻醉結束 21:05 送出病患 21:10 進入恢復室 22:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 12 0 手術 神經切斷術 1 2 R 手術 神經切斷術－每加一條 1 4 L 手術 神經移植-上臂.前臂.大腿.小腿處之經 1 1 摘要__ 手術科部: 外科部 套用罐頭: Nerve transfer to left superficial peroneal n... 開立醫師: 王奐之 開立時間: 2011/09/20 20:37 Pre-operative Diagnosis Left common peroneal nerve neuropathy Post-operative Diagnosis Left common peroneal nerve neuropathy Operative Method Nerve transfer to left superficial peroneal nerve & left deep peroneal nerve with bilateral sural nerve grafts Specimen Count And Types 1 piece About size:8*1*1cm Source:left side peroneal nerves Pathology Pending Operative Findings Length of transected superficial peroneal nerve & deep peroneal nerve: 8cm. Diameter of common peroneal nerve: 1cm. Diameter of superficial peroneal nerve: 5mm. Diameter of deep peroneal nerve: 4mm. Diameter of sural nerve grafts: 2mm. 4 segments of nerve grafts were anastomosed to the distal common peroneal nerve end in end-to-end fashion, 3 of the grafts were anastomosed to the proximal superficial peroneal nerve, while 1 of the graft was anastomosed to the proximal deep peroneal nerve. The tibial nerve function is well. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position. After scrubbing, disinfection & draping in sterile fashion, a curvilinear incision was made at left popliteal area. The soft tissue was dissected carefully until the left side sciatic nerve, tibial nerve, common peroneal nerve, superficial peroneal nerve, & deep peroneal nerve were exposed. Intra-operative EMG and SSEP were checked to evaluate the function of the nerves. Two linear incision were made at bilateral calves for sural nerve harvesting. The left superficial peroneal nerve & deep peroneal nerve were then transected, and anastomosed to the sural nerve grafts under microscope. After hemostasis, the wounds were closed in layers and the left leg was immobilized with splint. Operators VS 曾勝弘 Assistants R4 王奐之, Ri 黃威勝 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Nerve transfer to left superficial peroneal n... 開立醫師: 王奐之 開立時間: 2011/09/20 20:37 Pre-operative Diagnosis Left common peroneal nerve neuropathy Post-operative Diagnosis Left common peroneal nerve neuropathy Operative Method Nerve transfer to left superficial peroneal nerve & left deep peroneal nerve with bilateral sural nerve grafts Specimen Count And Types 1 piece About size:8*1*1cm Source:left side peroneal nerves Pathology Pending Operative Findings Length of transected superficial peroneal nerve & deep peroneal nerve: 8cm. Diameter of common peroneal nerve: 1cm. Diameter of superficial peroneal nerve: 5mm. Diameter of deep peroneal nerve: 4mm. Diameter of sural nerve grafts: 2mm. 4 segments of nerve grafts were anastomosed to the distal common peroneal nerve end in end-to-end fashion, 3 of the grafts were anastomosed to the proximal superficial peroneal nerve, while 1 of the graft was anastomosed to the proximal deep peroneal nerve. The tibial nerve function is well. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position. After scrubbing, disinfection & draping in sterile fashion, a curvilinear incision was made at left popliteal area. The soft tissue was dissected carefully until the left side sciatic nerve, tibial nerve, common peroneal nerve, superficial peroneal nerve, & deep peroneal nerve were exposed. Intra-operative EMG and SSEP were checked to evaluate the function of the nerves. Two linear incision were made at bilateral calves for sural nerve harvesting. The left superficial peroneal nerve & deep peroneal nerve were then transected, and anastomosed to the sural nerve grafts under microscope. After hemostasis, the wounds were closed in layers and the left leg was immobilized with splint. Operators VS 曾勝弘 Assistants R4 王奐之, Ri 黃威勝 相關圖片 楊映彤 (F,2010/12/08,1y3m) 手術日期 2011/09/20 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Lipoma 器械術式 Cord untethering -KUO 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 石博元 ASA 3 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 07:44 報到 08:05 進入手術室 08:15 麻醉開始 08:25 誘導結束 08:50 抗生素給藥 09:16 手術開始 11:55 手術結束 11:55 麻醉結束 12:03 送出病患 12:10 進入恢復室 15:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓整形術 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 手術 良性脊髓腫瘤切除術 1 1 摘要__ 手術科部: 外科部 套用罐頭: L4-5 laminoplasty for intraspinal lipoma exci... 開立醫師: 游健生 開立時間: 2011/09/20 13:08 Pre-operative Diagnosis Intraspinal lipoma with tethered cord Post-operative Diagnosis Intraspinal lipoma with tethered cord Operative Method L4-5 laminoplasty for intraspinal lipoma excision and cord untethering Specimen Count And Types 2 pieces About size:4x3 cm Source:subcutaneous soft tumor About size:2x1cm Source:intraspinal soft tumor Pathology pending Operative Findings There was a cutaneous hemangioma over the low back soft tumor. The lamina of S1&2 were absent. The caudal aspect of spinal cord splitted into ventral and dorsal part. The ventral part became conus medullaris giving out nerve roots. The dorsal part blended with a poor-defined adipose-tissue like tumor. The tumor fused with dura and herniated through the lamina defect at S1 level to become a well-demarcated subcutaneous adipose-tissue like tumor. There was adhesion between arachnoid membrane and tumor. The filum terminale seemed to tethering the cord and thus was transected. Operative Procedures Under ETGA, patient was in prone position. After disinfection and draping, an elliptical incision was made at midline over the soft tumor at lower back. We dissected along the tumor margin until it converged to a muscle fascia defect. The tumor was transected at this level leaving the stump in situ. The paraspinal muscle was detached and L4/5 lamina was exposed. We cut off the L4&5 lamina bilaterally and flapped them up. The stump of tumor was found continued with thecal sac and the rest of tumor was inside it. The dura over the tumor was opened at midline. After we lysed the adhesion between arachnoid and tumor, the conus medullaris, cauda equina, and filum terminale were seen. The tumor was then excised by microscissors and bipolar. The pia was closed with 7-0 Prolene continuous suture. The filum terminale was transected. The dura was closed with 5-0 Prolene continuous suture followed by DuraForm coverage. The lamina and paraspinal muscle were approximated with interrupted silk sutures. Wound was closed in layers with 3-0 Vicryl and 4-0 Nylon. Operators VS 郭夢菲 Assistants R4 游健生 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: L4-5 laminoplasty for intraspinal lipoma exci... 開立醫師: 游健生 開立時間: 2011/09/20 13:08 Pre-operative Diagnosis Intraspinal lipoma with tethered cord Post-operative Diagnosis Intraspinal lipoma with tethered cord Operative Method L4-5 laminoplasty for intraspinal lipoma excision and cord untethering Specimen Count And Types 2 pieces About size:4x3 cm Source:subcutaneous soft tumor About size:2x1cm Source:intraspinal soft tumor Pathology pending Operative Findings There was a cutaneous hemangioma over the low back soft tumor. The lamina of S1&2 were absent. The caudal aspect of spinal cord splitted into ventral and dorsal part. The ventral part became conus medullaris giving out nerve roots. The dorsal part blended with a poor-defined adipose-tissue like tumor. The tumor fused with dura and herniated through the lamina defect at S1 level to become a well-demarcated subcutaneous adipose-tissue like tumor. There was adhesion between arachnoid membrane and tumor. The filum terminale seemed to tethering the cord and thus was transected. Operative Procedures Under ETGA, patient was in prone position. After disinfection and draping, an elliptical incision was made at midline over the soft tumor at lower back. We dissected along the tumor margin until it converged to a muscle fascia defect. The tumor was transected at this level leaving the stump in situ. The paraspinal muscle was detached and L4/5 lamina was exposed. We cut off the L4&5 lamina bilaterally and flapped them up. The stump of tumor was found continued with thecal sac and the rest of tumor was inside it. The dura over the tumor was opened at midline. After we lysed the adhesion between arachnoid and tumor, the conus medullaris, cauda equina, and filum terminale were seen. The tumor was then excised by microscissors and bipolar. The pia was closed with 7-0 Prolene continuous suture. The filum terminale was transected. The dura was closed with 5-0 Prolene continuous suture followed by DuraForm coverage. The lamina and paraspinal muscle were approximated with interrupted silk sutures. Wound was closed in layers with 3-0 Vicryl and 4-0 Nylon. Operators VS 郭夢菲 Assistants R4 游健生 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: 1. L4-5 laminoplasty for intraspinal lipoma e... 開立醫師: 郭夢菲 開立時間: 2011/09/20 17:45 Pre-operative Diagnosis Intraspinal lipoma with tethered lumbosacral spinal cord to the subcutaneous lipoma Post-operative Diagnosis Intraspinal lipoma with tethered clumbosacral spinal cord to the subcutaneous lipoma Operative Method 1. L4-5 laminoplasty for intraspinal lipoma excision and cord untethering 2. Dural repair 3. Excision of the subcutaneous lipoma Specimen Count And Types 2 pieces About size:4x3 cm Source:subcutaneous soft tumor About size:2x1cm Source:intraspinal soft tumor Pathology pending Operative Findings 1. There was a cutaneous hemangioma overlying the lumbosacral lipoma. The size was about 3x3 cm in diameter. 2. The lamina of S1&2 were absent. 3. The caudal part of the spinal cord splitted into ventral and dorsal parts. The ventral part became conus medullaris giving out cauda equina nerve roots at the S1-S2 level. The dorsal part blended with a poor-defined adipose-tissue like tumor. The tumor fused with dura and herniated through the lamina defect at S1 level to become a well-demarcated subcutaneous adipose-tissue like tumor. There was adhesion between arachnoid membrane and tumor. 4. The filum terminale seemed to tether the cord and thus was transected. Operative Procedures Under ETGA, patient was in prone position. After disinfection and draping, an elliptical incision was made at midline over the soft tumor at lower back. We dissected along the tumor margin until it converged to a muscle fascia defect. The tumor was transected at this level leaving the stump in situ. The paraspinal muscle was detached and L4/5 lamina was exposed. We cut off the L4&5 lamina bilaterally and flapped them up. The stump of tumor was found continued with thecal sac and the rest of tumor was inside it. Under microscopic view, the dura over the tumor was opened at midline. After we lysed the adhesion between arachnoid and tumor toward the caudal side, the conus medullaris, cauda equina, and filum terminale were seen. The tumor was then excised by microscissors and bipolar. The lipoma at the L4-5 level was debilked after its pia was carefully opened and preserved. After the lipoma was excised subtotally, the pia was closed with 7-0 Prolene continuous suture. The filum terminale was transected after coagluation. The dura was closed with 5-0 Prolene continuous suture followed by DuraForm coverage. The lamina and paraspinal muscle were approximated (laminoplasty) with interrupted silk sutures. Wound was closed in layers with 3-0 Vicryl and 4-0 Nylon. Operators VS 郭夢菲 Assistants R4 游健生 相關圖片 鄭淑璧 (F,1952/07/05,59y8m) 手術日期 2011/09/20 手術主治醫師 賴達明 手術區域 東址 016房 01號 診斷 Spine tumor 器械術式 Spinal fusion posterior 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 00:45 通知急診手術 09:13 進入手術室 09:18 麻醉開始 09:45 誘導結束 09:50 抗生素給藥 09:56 手術開始 12:50 抗生素給藥 13:30 開始輸血 15:50 抗生素給藥 16:50 手術結束 16:50 麻醉結束 17:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 7 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 惡性脊髓腫瘤切除術 1 1 B 手術 脊椎融合術-後融合,有固定物(<=六節) 1 2 B 記錄__ 手術科部: 外科部 套用罐頭: 1. T2~T4 laminectomy and T3 transpedicular co... 開立醫師: 李振豪 開立時間: 2011/09/20 17:34 Pre-operative Diagnosis T3 extradural tumor with myelopathy, suspect metastasis Post-operative Diagnosis T3 extradural tumor with myelopathy, suspect metastasis Operative Method 1. T2~T4 laminectomy and T3 transpedicular corpectomy for tumor excision 2. Bilateral T3 rhozitomy 3. T1, T2, T5, and T6 transpedicular screws for posterior fixation 4. T2~T4 anterior fusion with titanium mesh cage Specimen Count And Types 1 piece About size:Multipel pieces Source:Spine tumor and bony fragment Pathology Pending Operative Findings The tumor was gray-reddish in color, elastic, and hypervascularized(blood supply from bilateral intercostal arteries) which mainly located at T3 vertebral body, pedicles, and T4 pedicles. T3 pathological compression fracture with severe thecal sac compression was noted. After decompression, the thecal sac expanded and pulsatile well. Incidental durotomy over left T3 root was noted and primary repair with 5-0 Prolene was done after rhizotomy. Osteoporosis(or tumor involvement?) was noted from T1 to T4 level. Posterior fixation was performed with three 4.5 x 25mm(T1 and right T2) and five 5.0 x 30mm(left T2, T5, and T6) transpedicular screws. The rods were 13cm x II and one cross-link was applied. Anterior fusion was performed with one titanium wire mesh with 1cm in diameter and 3cm in length. Total blood loss: 2000ml. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position with head fixed with Mayfield skull clamp. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made from C7 to T6. The subcutaneous soft tissue was devided and paravertebral muscle group were detached. T1, T2, T4 and T5 transpedicular screws were implanted under C-arm guided. T4 transpedicular screws were gave up due to tumor infiltration. So we performed T6 transpedicular screws for posterior fixation. T2 to T4 laminectomy and T3 transpedicular corpectomy was performed for tumor excision. The T2/3 and T3/4 disc also removed during corpectomy. Bilateral T3 rhizotomy was done during tumor excision and incidental durotomy was noted at left T3 root. Primary closure of durotomy with 5-0 Prolene was done. One titanium wire mech filled with autologous bone graft and artificial bone graft was implanted for anterior fusion. The rods and cross-link was set up for posterior fixation. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. Two epidural hemovac drain was placed. The wound was then closed in layers with 1-0, 2-0 Vicryl and 3-0 Nylon. Operators VS賴達明, VS蕭輔仁 Assistants R5李振豪, PGY涂安怡 Indication Of Emergent Operation Acute urinary retention and deterioration of lower limb weakness 相關圖片 陳泓運 (M,1990/09/29,21y5m) 手術日期 2011/09/20 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Spinal cord disease, others 器械術式 Intraspinal intramedullary tum 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 23:54 臨時手術NPO 08:02 進入手術室 08:10 麻醉開始 08:20 誘導結束 08:50 抗生素給藥 09:15 手術開始 11:50 抗生素給藥 14:50 抗生素給藥 15:15 手術結束 15:15 麻醉結束 15:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 Peripheral arterial line inserti 1 0 手術 脊椎腔內動靜脈畸型切除術-過二節 1 1 摘要__ 手術科部: 外科部 套用罐頭: Total excision of spinal cavernoma. 開立醫師: 鍾文桂 開立時間: 2011/09/20 15:47 Pre-operative Diagnosis Spinal cavernous malformation, T5-7. Post-operative Diagnosis Spinal cavernous malformation, T5-7. Operative Method Total excision of spinal cavernoma. Specimen Count And Types 1 piece About size:5cc Source:spinal cavernoma. Pathology Pending. Operative Findings 1. Purplish-red grape-like cavernoma in the spinal cord; presence of microcalcification and cysts. Liquified hematoma and surrounding hemosiderin deposition are noted. 2. Intraoperative MEP and SSEP were not detectable. 3. Further T4 laminectomy was done for wider exposure. 4. Presence of large keloid formation on the previous scar. we resected the keloid and closed the wound primarily. Operative Procedures Under ETGA,the patient was placed in prone position. After disinfection and draping, the previous operative wound was incised and dissected from T4 level. With meticulous dissection, the dura mater was exposed. Vertical linear durotomy was performed. The cavernoma was identified and dissected away from the normal spinal cord tissue by using dissector. After completion excision of the cavernoma, the dura mater was closed in water-tight fashion. The wound was closed in layers with one epidural CWV drain. Operators 賴達明 Assistants 鍾文桂 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Total excision of spinal cavernoma. 開立醫師: 鍾文桂 開立時間: 2011/10/05 20:09 Pre-operative Diagnosis Spinal cavernous malformation, T5-7. Post-operative Diagnosis Spinal cavernous malformation, T5-7. Operative Method Total excision of spinal cavernoma. Specimen Count And Types 1 piece About size:5cc Source:spinal cavernoma. Pathology Pending. Operative Findings 1. Purplish-red grape-like cavernoma in the spinal cord; presence of microcalcification and cysts. Liquified hematoma and surrounding hemosiderin deposition are noted. 2. Intraoperative MEP and SSEP were not detectable. 3. Further T4 laminectomy was done for wider exposure. 4. Presence of large keloid formation on the previous scar. we resected the keloid and closed the wound primarily. Operative Procedures Under ETGA,the patient was placed in prone position. After disinfection and draping, the previous operative wound was incised and dissected from T4 level. With meticulous dissection, the dura mater was exposed. Vertical linear durotomy was performed. The cavernoma was identified and dissected away from the normal spinal cord tissue by using dissector. After completion excision of the cavernoma, the dura mater was closed in water-tight fashion. The wound was closed in layers with one epidural CWV drain. Operators 賴達明 Assistants 鍾文桂 相關圖片 黃蘭英 (F,1945/11/17,66y3m) 手術日期 2011/09/20 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 23:55 臨時手術NPO 14:20 報到 15:35 進入手術室 15:40 麻醉開始 15:55 誘導結束 16:05 抗生素給藥 16:10 手術開始 20:00 抗生素給藥 22:35 麻醉結束 22:35 手術結束 22:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Retrosigmoid approach for Simpson grade II tu... 開立醫師: 鍾文桂 開立時間: 2011/09/20 23:19 Pre-operative Diagnosis Middle 1/3 petrous ridge meningioma,left. Petrous apex meningioma,left. Post-operative Diagnosis Middle 1/3 petrous ridge meningioma,left. Petrous apex meningioma,left. Operative Method Retrosigmoid approach for Simpson grade II tumor excision.. Retrosigmoid approach for Simpson grade I tumor excision.. Retrosigmoid approach for Simpson grade II tumor excision.. Specimen Count And Types 1 piece About size:3cc Source:meningioma Pathology Pending. Operative Findings Well delineated, grayish-red, hard, and elastic tumor based on left middle 1/3 of sphenoid ridge; just anterior to CN VII/VII complex and low cranial nerve. The CN VII/VII were intact. However, lower cranial nerves were partially injured. No intraoperative BAEP change. Operative Procedures Under ETGA, the patient was placed in 3/4 prone position and the head was fixed by Mayfield. After disinfection, a linear incision was made at retroauricular area. After dissection, a 5 cm craniotomy was obtained by high speed drill. After identifying the sigmoid sinus, durotomy was done. The cerebellum was retracted. Then, the tumor mass was identified. The tumor was resected by bipolar and CUSA. The dural base was electrocoagulated. After well hemostasis, the wound was closed in layers and the craniotomy plate was fixed by miniplates and screws. Operators 賴達明 Assistants 鍾文桂 陳以幸 李思惠 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Retrosigmoid approach for Simpson grade II tu... 開立醫師: 鍾文桂 開立時間: 2011/10/05 20:10 Pre-operative Diagnosis Petrous apex meningioma,left. Post-operative Diagnosis Petrous apex meningioma,left. Operative Method Retrosigmoid approach for Simpson grade II tumor excision.. Specimen Count And Types 1 piece About size:3cc Source:meningioma Pathology Pending. Operative Findings Well delineated, grayish-red, hard, and elastic tumor based on left middle 1/3 of sphenoid ridge; just anterior to CN VII/VII complex and low cranial nerve. The CN VII/VII were intact. However, lower cranial nerves were partially injured. No intraoperative BAEP change. Operative Procedures Under ETGA, the patient was placed in 3/4 prone position and the head was fixed by Mayfield. After disinfection, a linear incision was made at retroauricular area. After dissection, a 5 cm craniotomy was obtained by high speed drill. After identifying the sigmoid sinus, durotomy was done. The cerebellum was retracted. Then, the tumor mass was identified. The tumor was resected by bipolar and CUSA. The dural base was electrocoagulated. After well hemostasis, the wound was closed in layers and the craniotomy plate was fixed by miniplates and screws. Operators 賴達明 Assistants 鍾文桂 陳以幸 李思惠 相關圖片 林茂榮 (M,1934/06/23,77y8m) 手術日期 2011/09/20 手術主治醫師 蔡翊新 手術區域 東址 002房 02號 診斷 Subdural hemorrhage, traumatic 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 陳以幸, 時間資訊 09:00 臨時手術NPO 09:00 開始NPO 09:41 通知急診手術 11:20 報到 11:35 進入手術室 11:40 麻醉開始 11:45 誘導結束 12:00 抗生素給藥 12:15 手術開始 13:13 手術結束 13:13 麻醉結束 13:18 送出病患 13:25 進入恢復室 14:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Left fronto burr hole for removal of SDE. 開立醫師: 陳以幸 開立時間: 2011/09/20 13:29 Pre-operative Diagnosis left F-T subdural effusion Post-operative Diagnosis left F-T subdural effusion Operative Method Left fronto burr hole for removal of SDE. Specimen Count And Types nil Pathology nil Operative Findings Dark reddish liquified blood gushed out upon opening the dura. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: linear at left frontal area, 5 cm. Raney clips were applied to the scalp edge for temporary hemostasis. 5. A burr hole was made at right frontal area. 6. Dural tenting: by two 2/0 silk. 7. Dural incision: circular, and the dura was sent for pathology. 8. The outer membrane of the hematoma was coagulated by Bovie along the edge of dural incision, then exicsed. 9. The liquified old blood in the subdural space was evacuated by sucker, then thoroughly irrigated with N.S. through a rubber tube until the return was clean. 10.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous sutures with 2/0 Vicryl and skin by continuouss suture with 3/0 nylon. 11.Drain: one, subdural, rubber drain. 12.Blood transfusion: platelet 12U, due to coagulopathy, Blood loss: minimal. 13.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R2陳以幸 Indication Of Emergent Operation muscle power loss and acute consciousness disturbance 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Left fronto burr hole for removal of SDE. 開立醫師: 蔡翊新 開立時間: 2011/10/21 09:35 Pre-operative Diagnosis left F-T subdural effusion Post-operative Diagnosis left F-T subdural effusion Operative Method Left fronto burr hole for removal of SDE. Specimen Count And Types nil Pathology nil Operative Findings Dark reddish liquified blood gushed out upon opening the dura. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: linear at left frontal area, 5 cm. Raney clips were applied to the scalp edge for temporary hemostasis. 5. A burr hole was made at right frontal area. 6. Dural tenting: by two 2/0 silk. 7. Dural incision: circular, and the dura was sent for pathology. 8. The outer membrane of the hematoma was coagulated by Bovie along the edge of dural incision, then exicsed. 9. The liquified old blood in the subdural space was evacuated by sucker, then thoroughly irrigated with N.S. through a rubber tube until the return was clean. 10.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous sutures with 2/0 Vicryl and skin by continuouss suture with 3/0 nylon. 11.Drain: one, subdural, rubber drain. 12.Blood transfusion: platelet 12U, due to coagulopathy, Blood loss: minimal. 13.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R2陳以幸 Indication Of Emergent Operation muscle power loss and acute consciousness disturbance 相關圖片 孫錦昌 (M,1959/02/07,53y1m) 手術日期 2011/09/20 手術主治醫師 蔡翊新 手術區域 東址 002房 05號 診斷 Major trauma rated 16 or above on the severity scale ( Injury severity score >=16 ) 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 5E 紀錄醫師 李宗儒, 時間資訊 21:31 通知急診手術 21:42 進入手術室 21:45 誘導結束 21:45 麻醉開始 22:05 手術開始 23:10 手術結束 23:10 麻醉結束 23:17 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 硬腦膜外血腫清除術 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 蔡翊新 開立時間: 2011/09/20 23:05 Pre-operative Diagnosis Left frontotemporoparietal EDH. Post-operative Diagnosis Left frontotemporoparietal EDH. Operative Method Evacuation of left F-T-P epidural hematoma. Specimen Count And Types nil Pathology Nil. Operative Findings Bulging of previous craniectomy window was noted and preop ICP was 33 mmHg. Blood gushed out upon opening the wound at left temporal area. There was EDH, 2 cm in thickness, all over the left F-T-P craniectomy window. Bleeding from left temporal base was noted and the source was left temporal base skull fracture. Massive bleeding from the draining vein into the sinus, which was torn by the fracture line, was encountered upon removal of the EDH at temporal base. Oozing from epidural space was noted. ICP after skin closure was 2 mmHg. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 6 cm at anterior-lower left temporal area. The EDH was removed partially to lower the ICP first. 6. The incision was extended to a temporal horseshoe. 7. The epidural clot was removed by sucker. 8. Hemosatasis: the bleeders from skull base fracture was packed by bone wax, Surgicel and Gelfoam. The epidural bleeding was stopped by Gelfoam packing and dural tenting. 9. Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 10.Drain: two epidural CWV drains. 11.Blood transfusion: PRBC 2U, Whole blood 4U. Blood loss: 1100 ml. 12.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5曾峰毅PGY李宗儒 Indication Of Emergent Operation IICP, tense craniectomy window 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 蔡翊新 開立時間: 2011/09/20 23:05 Pre-operative Diagnosis Left frontotemporoparietal EDH. Post-operative Diagnosis Left frontotemporoparietal EDH. Operative Method Evacuation of left F-T-P epidural hematoma. Specimen Count And Types nil Pathology Nil. Operative Findings Bulging of previous craniectomy window was noted and preop ICP was 33 mmHg. Blood gushed out upon opening the wound at left temporal area. There was EDH, 2 cm in thickness, all over the left F-T-P craniectomy window. Bleeding from left temporal base was noted and the source was left temporal base skull fracture. Massive bleeding from the draining vein into the sinus, which was torn by the fracture line, was encountered upon removal of the EDH at temporal base. Oozing from epidural space was noted. ICP after skin closure was 2 mmHg. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 6 cm at anterior-lower left temporal area. The EDH was removed partially to lower the ICP first. 6. The incision was extended to a temporal horseshoe. 7. The epidural clot was removed by sucker. 8. Hemosatasis: the bleeders from skull base fracture was packed by bone wax, Surgicel and Gelfoam. The epidural bleeding was stopped by Gelfoam packing and dural tenting. 9. Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 10.Drain: two epidural CWV drains. 11.Blood transfusion: PRBC 2U, Whole blood 4U. Blood loss: 1100 ml. 12.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5曾峰毅PGY李宗儒 Indication Of Emergent Operation IICP, tense craniectomy window 相關圖片 孫錦昌 (M,1959/02/07,53y1m) 手術日期 2011/09/20 手術主治醫師 蔡翊新 手術區域 東址 006房 03號 診斷 Major trauma rated 16 or above on the severity scale ( Injury severity score >=16 ) 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 5E 紀錄醫師 李宗儒, 時間資訊 18:25 通知急診手術 18:50 進入手術室 18:52 麻醉開始 19:10 誘導結束 19:15 抗生素給藥 19:20 手術開始 19:45 開始輸血 21:05 手術結束 21:05 麻醉結束 21:10 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 急性硬腦膜下血腫清除術 1 1 L 手術 顱內壓視置入 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 摘要__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 蔡翊新 開立時間: 2011/09/20 20:49 Pre-operative Diagnosis Head injury with left temporal skull fracture with EDH, left frontotemporoparietal acute SDH and contusion. Post-operative Diagnosis Head injury with left temporal skull fracture with EDH, left frontotemporoparietal acute SDH and contusion. Operative Method Left frontotemporoparietal craniectomy for removal of acute SDH and left temporal subdural ICP monitoring. Specimen Count And Types nil Pathology Nil. Operative Findings A scalp laceration, 5 cm, at left parietal region, with marked subgaleal hematoma. Skull fracture at left temporal base with active bleeding. Initial ICP after first burr hole creation was 44 mmHg. EDH, 5 x 4 x 1 cm at left temporal area was noted. The dura was tense after craniectomy. Subdural blood clots, about 2 cm in thickness, was noted at left F-T-P area, 16 x 14 cm. There were several contusions at cortical surface of left frontal and temporal lobes. The brain became gradually swollen after removal of SDH. ICP after skin closure was 3 mmHg. Reference of ICP monitor: 494. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 6 cm at anterior-lower left temporal area, the skin edge was clipped by Raney clips for temporary hemostasis. The temporalis muscles was incised down to the tempoal squama which was exposed then by applying a self retaining retractor on the muscle. 5. A burr hole was made and the dura was incised for evacuating part of the subdural hematoma, therefore the IICP could be relieved earlier. 6. The incision was extended to a temporal horseshoe, and the temporalis muscle was detached from temporal squama by rasp subsequently. 7. Craniotomy window: 16 x 13 cm, left frontotemporoparietal, created by making 5 burr holes then cut by power saw. 8. Dural tenting: by 2/0 silk, 2-cm in interval, distributed along the edge of skull window. 9. Dural incision: curvilinear along the edge of skull window. 10.The subdural clot was removed by sucker. A Codman ICP monitor was placed at subdural space at left temporal area. 11.Hemosatasis: the bleeders was stopped by Bovie and oozing surface was covered with gelfoam. 12.Dural closure: duroplasty was performedwith a piece of Durofoam, 12 x 10 cm in order to create an additional space for the swollen brain. 13.The skull plate was removed and stored at bone bank for preservation. 14.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 15.Drain: two, epidural, CWV. 16.Blood transfusion: PRBC 2U; Blood loss: 800 ml. 17.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5曾峰毅R1李宗儒 Indication Of Emergent Operation IICP, coma, pupil dilatation 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 蔡翊新 開立時間: 2011/09/20 20:49 Pre-operative Diagnosis Head injury with left temporal skull fracture with EDH, left frontotemporoparietal acute SDH and contusion. Post-operative Diagnosis Head injury with left temporal skull fracture with EDH, left frontotemporoparietal acute SDH and contusion. Operative Method Left frontotemporoparietal craniectomy for removal of acute SDH and left temporal subdural ICP monitoring. Specimen Count And Types nil Pathology Nil. Operative Findings A scalp laceration, 5 cm, at left parietal region, with marked subgaleal hematoma. Skull fracture at left temporal base with active bleeding. Initial ICP after first burr hole creation was 44 mmHg. EDH, 5 x 4 x 1 cm at left temporal area was noted. The dura was tense after craniectomy. Subdural blood clots, about 2 cm in thickness, was noted at left F-T-P area, 16 x 14 cm. There were several contusions at cortical surface of left frontal and temporal lobes. The brain became gradually swollen after removal of SDH. ICP after skin closure was 3 mmHg. Reference of ICP monitor: 494. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 6 cm at anterior-lower left temporal area, the skin edge was clipped by Raney clips for temporary hemostasis. The temporalis muscles was incised down to the tempoal squama which was exposed then by applying a self retaining retractor on the muscle. 5. A burr hole was made and the dura was incised for evacuating part of the subdural hematoma, therefore the IICP could be relieved earlier. 6. The incision was extended to a temporal horseshoe, and the temporalis muscle was detached from temporal squama by rasp subsequently. 7. Craniotomy window: 16 x 13 cm, left frontotemporoparietal, created by making 5 burr holes then cut by power saw. 8. Dural tenting: by 2/0 silk, 2-cm in interval, distributed along the edge of skull window. 9. Dural incision: curvilinear along the edge of skull window. 10.The subdural clot was removed by sucker. A Codman ICP monitor was placed at subdural space at left temporal area. 11.Hemosatasis: the bleeders was stopped by Bovie and oozing surface was covered with gelfoam. 12.Dural closure: duroplasty was performedwith a piece of Durofoam, 12 x 10 cm in order to create an additional space for the swollen brain. 13.The skull plate was removed and stored at bone bank for preservation. 14.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 15.Drain: two, epidural, CWV. 16.Blood transfusion: PRBC 2U; Blood loss: 800 ml. 17.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5曾峰毅R1李宗儒 Indication Of Emergent Operation IICP, coma, pupil dilatation 相關圖片 吳永桂 (M,1939/08/31,72y6m) 手術日期 2011/09/21 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Lung cancer, non-small cell 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 鍾文桂, 時間資訊 23:35 臨時手術NPO 15:00 進入手術室 15:03 麻醉開始 15:30 誘導結束 15:45 抗生素給藥 15:58 手術開始 18:10 手術結束 18:10 麻醉結束 18:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除-手術時間在4小時以內 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Left frontal craniotomy for gross total tumor... 開立醫師: 鍾文桂 開立時間: 2011/09/21 19:39 Pre-operative Diagnosis Left frontal metastatic tumor. Post-operative Diagnosis Left frontal metastatic tumor. Operative Method Left frontal craniotomy for gross total tumor excision. Specimen Count And Types 1 piece About size:5cc Source:brain tumor. Pathology Pending. Operative Findings Red-grayish soft tumor with moderate vascularity. Intraoperative ultrasonography was used for tumor localization. Dural defect at anterior border of cranitomy was repaired with pericranium. Operative Procedures Under ETGA, the patient was placed in supine position and the head was in midline position. After shaving,disinfection, and draping, a curvilinear scalp incision at left frontal region was made. Then, craniotomy plate was obtained. After dural tenting, the tumor was located by using intraoperative ultrasonography. After a small corticotomy, the tumor was excised by using dipolar electrocoagulation. With well hemostasis, the dura was repaired and closed in water-tight fashion. The craniotomy plate was fixed by mini-screws and plates. The wound was closed in layers with one subgaleal CWV drain. Operators 曾漢民 Assistants 鍾文桂 陸惠宗 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Left frontal craniotomy for gross total tumor... 開立醫師: 陸惠宗 開立時間: 2011/09/28 10:39 Pre-operative Diagnosis Left frontal metastatic tumor. Post-operative Diagnosis Left frontal metastatic tumor. Operative Method Left frontal craniotomy for gross total tumor excision. Specimen Count And Types 1 piece About size:5cc Source:brain tumor. Pathology Pending. Operative Findings Red-grayish soft tumor with moderate vascularity. Intraoperative ultrasonography was used for tumor localization. Dural defect at anterior border of cranitomy was repaired with pericranium. Operative Procedures Under ETGA, the patient was placed in supine position and the head was in midline position. After shaving,disinfection, and draping, a curvilinear scalp incision at left frontal region was made. Then, craniotomy plate was obtained. After dural tenting, the tumor was located by using intraoperative ultrasonography. After a small corticotomy, the tumor was excised by using dipolar electrocoagulation. With well hemostasis, the dura was repaired and closed in water-tight fashion. The craniotomy plate was fixed by mini-screws and plates. The wound was closed in layers with one subgaleal CWV drain. Operators 曾漢民 Assistants 鍾文桂 陸惠宗 相關圖片 丁勝凡 (M,1929/06/24,82y8m) 手術日期 2011/09/21 手術主治醫師 蔡瑞章 手術區域 東址 003房 01號 診斷 Malignant neoplasm of brain 器械術式 Brain biopsy -Stereotaxic 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 陳國瑋, 時間資訊 23:31 臨時手術NPO 08:05 進入手術室 08:10 麻醉開始 08:17 誘導結束 08:36 抗生素給藥 08:40 手術開始 11:15 手術結束 11:15 麻醉結束 11:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 手術 立體定位術-切片 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Stereotactic biopsy 開立醫師: 陳國瑋 開立時間: 2011/09/21 11:25 Pre-operative Diagnosis Brain tumor r/o high grade glioma Post-operative Diagnosis Brain tumor r/o high grade glioma Operative Method Stereotactic biopsy Specimen Count And Types 1 piece About size:pieces Source:brain tumor Pathology pending Operative Findings Fragments of tumor tissues were harvested. They were white and soft in character. Operative Procedures The patient was put in supine position with head tilting to right. The navigation was set up, and entry point was decided at the left frontal aside coronal suture. The skin was shaved and scrubbed as usual. Skin incision was made and one burr hole was created. Stereotactic biopsy was performed. Fronzen secton showed suspect high grade glioma. The wound was then closed in layers after hemostasis. Operators P 蔡瑞章 Assistants 曾峰毅 陳國瑋 相關圖片 吳秀英 (F,1963/07/29,48y7m) 手術日期 2011/09/21 手術主治醫師 蔡瑞章 手術區域 東址 005房 01號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 2 紀錄醫師 陸惠宗, 時間資訊 23:40 臨時手術NPO 08:05 進入手術室 08:08 麻醉開始 08:55 誘導結束 08:56 抗生素給藥 08:58 手術開始 11:56 抗生素給藥 14:10 手術結束 14:10 麻醉結束 14:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4~8小時 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Right frontal-parietal craniotomy for Simpson... 開立醫師: 鍾文桂 開立時間: 2011/09/21 14:52 Pre-operative Diagnosis Meningiomatosis at right frontal-parietal and left parietal regions. Meningiomatosis at right parietal and left parietal regions. Post-operative Diagnosis Meningiomatosis at right frontal-parietal and left parietal regions. Meningiomatosis at right parietal and left parietal regions. Operative Method Right frontal-parietal craniotomy for Simpson grade IV tumor excision. Specimen Count And Types 1 piece About size:30cc Source:meningioma Pathology Pending. Operative Findings Total of 6 tumors were excised through the same craniotomy. Tumor: status post TAE, whitish, soft, in low vascularity, invaded into the the inner table of skull bone and dura mater, well delineated. presence of superior sagital sinus invasion.Two engorged drainage veins were noted posterior to the tumor mass. They were kept intact. Blood loss: 200cc. Operative Procedures Under ETGA, the patient was placed in supine position and the head was tilted to the left side and fixed by Mayfield. After shaving, disinfection, and draping, a reverse U shape incision was made. A 10 cm craniotomy window was obtained through craniotome and high speed drill. After dural tenting and durotomy, the tumor was excised in piecemeal fashion. The tumor near the superior sagital sinus was electrocoagulated. The dural defect was repaired by pericranium. After fixing the craniotomy plate by wires, the wound was closed in layers with one subgaleal CWV drain. Operators 蔡瑞章 王國川 Assistants 鍾文桂 陸惠宗 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Right frontal-parietal craniotomy for Simpson... 開立醫師: 陸惠宗 開立時間: 2011/09/28 08:14 Pre-operative Diagnosis Meningiomatosis at right parietal and left parietal regions. Post-operative Diagnosis Meningiomatosis at right parietal and left parietal regions. Operative Method Right frontal-parietal craniotomy for Simpson grade IV tumor excision. Specimen Count And Types 1 piece About size:30cc Source:meningioma Pathology Pending. Operative Findings Total of 6 tumors were excised through the same craniotomy. Tumor: status post TAE, whitish, soft, in low vascularity, invaded into the the inner table of skull bone and dura mater, well delineated. presence of superior sagital sinus invasion.Two engorged drainage veins were noted posterior to the tumor mass. They were kept intact. Blood loss: 200cc. Operative Procedures Under ETGA, the patient was placed in supine position and the head was tilted to the left side and fixed by Mayfield. After shaving, disinfection, and draping, a reverse U shape incision was made. A 10 cm craniotomy window was obtained through craniotome and high speed drill. After dural tenting and durotomy, the tumor was excised in piecemeal fashion. The tumor near the superior sagital sinus was electrocoagulated. The dural defect was repaired by pericranium. After fixing the craniotomy plate by wires, the wound was closed in layers with one subgaleal CWV drain. Operators 蔡瑞章 王國川 Assistants 鍾文桂 陸惠宗 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Right frontal-parietal craniotomy for Simpson... 開立醫師: 陸惠宗 開立時間: 2011/10/03 10:55 Pre-operative Diagnosis Meningiomatosis at right parietal and left parietal regions. Post-operative Diagnosis Meningiomatosis at right parietal and left parietal regions. Operative Method Right frontal-parietal craniotomy for Simpson grade IV tumor excision. Specimen Count And Types 1 piece About size:30cc Source:meningioma Pathology Pending. Operative Findings Total of 6 tumors were excised through the same craniotomy. Tumor: status post TAE, whitish, soft, in low vascularity, invaded into the the inner table of skull bone and dura mater, well delineated. presence of superior sagital sinus invasion.Two engorged drainage veins were noted posterior to the tumor mass. They were kept intact. Blood loss: 200cc. Operative Procedures Under ETGA, the patient was placed in supine position and the head was tilted to the left side and fixed by Mayfield. After shaving, disinfection, and draping, a reverse U shape incision was made. A 10 cm craniotomy window was obtained through craniotome and high speed drill. After dural tenting and durotomy, the tumor was excised in piecemeal fashion. The tumor near the superior sagital sinus was electrocoagulated. The dural defect was repaired by pericranium. After fixing the craniotomy plate by wires, the wound was closed in layers with one subgaleal CWV drain. Operators 蔡瑞章 王國川 Assistants 鍾文桂 陸惠宗 相關圖片 徐恩典 (M,2011/09/01,6m15d) 手術日期 2011/09/21 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Hydrocephalus 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 07:35 報到 08:10 進入手術室 08:21 麻醉開始 08:31 誘導結束 09:00 抗生素給藥 09:14 手術開始 10:20 麻醉結束 10:20 手術結束 10:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室腹腔分流手術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Cyst-peritoneal shunt via right suboccipital ... 開立醫師: 游健生 開立時間: 2011/09/21 11:19 Pre-operative Diagnosis 1. Posterior fossa arachnoid cyst 2. Hydrocephalus Post-operative Diagnosis 1. Posterior fossa arachnoid cyst 2. Hydrocephalus Operative Method Cyst-peritoneal shunt via right suboccipital burhole Specimen Count And Types 1 piece About size:4cc Source:Cyst fluid Pathology Nil Operative Findings Xanthochromic mild turbid fluid gashed out after arachnoid cyst was opened. Some was sent for routine, biochem, and culture. The cyst catheter was 4cm in lenght. A Codman HAKIM Precision fixed pressure(4cmH2O) valve was used as CP shunt valve. The peritoneal catheter was 25cm. Operative Procedures Under ETGA, patient was in supine position with head rotated to left and right shoulder elevated. After shaving, we disinfected and draped the operation field as usual. A transverse RLQ abdominal incision was made. After blunt dissection, the peritonium was opened and peritoneal catheter was inserted. Another transverse incision was made at right clavicle and created a subcutaneous pocket for Codman valve. A verticle scalp incision was made at right suboccipital region followed by neck muscle detachment. We removed the suboccipital cranium by Kerrison punch to create a small burhole. The dura was coagulated and opened in cruciate fashion. We connected the cyst catheter to Codman valve and passed upward from clavicle to scalp wound via subcutaneous tunnel. Then, the cyst catheter was inserted after cyst membrane was opened. The peritoneal catheter was passed upward via subcutaneous tunnel and connected to Codman valve. After hemostasis and adjustment of shunt system, wounds were closed in layers by 3-0 Vicryl and 4-0 Nylon. Operators VS 郭夢菲 Assistants R4 游健生 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Cyst-peritoneal shunt via right suboccipital ... 開立醫師: 游健生 開立時間: 2011/09/21 11:22 Pre-operative Diagnosis 1. Posterior fossa arachnoid cyst 2. Hydrocephalus Post-operative Diagnosis 1. Posterior fossa arachnoid cyst 2. Hydrocephalus Operative Method Cyst-peritoneal shunt via right suboccipital burhole Specimen Count And Types 1 piece About size:4cc Source:Cyst fluid Pathology Nil Operative Findings Xanthochromic mild turbid fluid gashed out after arachnoid cyst was opened. Some was sent for routine, biochem, and culture. The cyst catheter was 4cm in lenght. A Codman HAKIM Precision fixed pressure(4cmH2O) valve was used as CP shunt valve. The peritoneal catheter was 25cm. Operative Procedures Under ETGA, patient was in supine position with head rotated to left and right shoulder elevated. After shaving, we disinfected and draped the operation field as usual. A transverse RLQ abdominal incision was made. After blunt dissection, the peritonium was opened and peritoneal catheter was inserted. Another transverse incision was made at right clavicle and created a subcutaneous pocket for Codman valve. A verticle scalp incision was made at right suboccipital region followed by neck muscle detachment. We removed the suboccipital cranium by Kerrison punch to create a small burhole. The dura was coagulated and opened in cruciate fashion. We connected the cyst catheter to Codman valve and passed upward from clavicle to scalp wound via subcutaneous tunnel. Then, the cyst catheter was inserted after cyst membrane was opened. The peritoneal catheter was passed upward via subcutaneous tunnel and connected to Codman valve. After hemostasis and adjustment of shunt system, wounds were closed in layers by 3-0 Vicryl and 4-0 Nylon. Operators VS 郭夢菲 Assistants R4 游健生 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Cyst-peritoneal shunt via right suboccipital ... 開立醫師: 郭夢菲 開立時間: 2011/09/21 13:00 Pre-operative Diagnosis 1. Posterior fossa arachnoid cyst 2. Hydrocephalus Post-operative Diagnosis 1. Posterior fossa arachnoid cyst 2. Hydrocephalus Operative Method Cyst-peritoneal shunt via right suboccipital burrhole Specimen Count And Types 1 piece About size:4cc Source:Cyst fluid Pathology Nil Operative Findings Xanthochromic fluid gashed out after arachnoid cyst was opened. Some was sent for routine, biochem, and culture. The cyst catheter was 4cm in lenght. A Codman HAKIM Precision fixed pressure(4cmH2O) valve was used as CP shunt valve. The peritoneal catheter was 25cm. Operative Procedures Under ETGA, patient was in supine position with head rotated to left and right shoulder elevated. After shaving, we disinfected and draped the operation field as usual. A transverse RLQ abdominal incision was made. After blunt dissection, the peritonium was opened and peritoneal catheter was inserted. Another transverse incision was made below right clavicle and created a subcutaneous pocket for Codman valve. A verticle scalp incision was made at right suboccipital region 2 cm lateral and below the inion, followed by neck muscle detachment. We removed the suboccipital cranium by Kerrison punch to create a small burhole. The dura was coagulated and opened in cruciate fashion. We connected the cyst catheter to Codman valve and passed upward from clavicle to scalp wound via subcutaneous tunnel. Then, the cyst catheter was inserted after cyst membrane was opened. The peritoneal catheter was passed upward via subcutaneous tunnel and connected to Codman valve. After hemostasis and adjustment of shunt system, wounds were closed in layers by 3-0 Vicryl and 4-0 Nylon. Operators VS 郭夢菲 Assistants R4 游健生 相關圖片 鍾秀蓮 (F,1937/04/17,74y10m) 手術日期 2011/09/21 手術主治醫師 陳慕師 手術區域 東址 010房 08號 診斷 Macular edema 器械術式 Aspiration of vitreous 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 14:15 進入手術室 14:30 手術開始 14:33 手術結束 14:35 送出病患 記錄__ 手術科部: 眼科部 套用罐頭: Subtenon injection of Traimcinolone 開立醫師: 鄭琪睿 開立時間: 2011/09/21 14:36 Pre-operative Diagnosis Macular edema (OS) Post-operative Diagnosis Macular edema (OS) Operative Method Subtenon injection of Traimcinolone Specimen Count And Types Nil. Pathology Nil. Operative Findings Nil. Operative Procedures 1.Under topical anesthesia. 2.Disinfection and draping as usual. 3.Apply an eyelid speculum. 4.Subtenon injection of Triamcinolone 20mg/ 0.5 mL. 5. Check VA > Counting finger 100cm. Operators VS 陳慕師, Assistants R5 劉耀臨, 簡志宏 (M,1988/02/29,24y0m) 手術日期 2011/09/22 手術主治醫師 蔡紫薰 手術區域 西址 031房 03號 診斷 Esotropia 器械術式 Rc + Rs / Dr.Tsai 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 高姿芸, 時間資訊 12:05 進入手術室 12:07 麻醉開始 12:10 誘導結束 12:15 手術開始 13:10 手術結束 13:10 麻醉結束 13:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 眼肌移植術 1 1 R 手術 斜視矯正手術-放鬆及切除-一條 1 4 R 手術 眼肌移植術 1 2 R 記錄__ 手術科部: 眼科部 套用罐頭: Right medial rectus muscle recession 6mm + Hu... 開立醫師: 高姿芸 開立時間: 2011/09/23 07:35 Pre-operative Diagnosis RET+RH Post-operative Diagnosis RET+RH Operative Method Right medial rectus muscle recession 6mm + Hummelsheim procedure (lateral transposition of half of RSR and RIR) Specimen Count And Types Pathology Nil Operative Findings Operative Procedures 1.Under RBGB 2.Disinfection, irrigation and draping as usual 3.Apply an eyelid speculum 4.Superior and inferior limbal traction suture 5.360 degree peritomy with extension 6.Identify RMR and RMR recession 6 mm was done 7.Identify RSR and half of RSR lateral transposition was done (to the level of RLR) 8.Identify RIR and half of RIR lateral transposition was done (to the level of RLR) 9.Close conjunctival wound with 8-0 Nylon 10.Maxitrol patching Operators 蔡紫薰, Assistants 高姿芸, 許家豪 (M,1982/11/09,29y4m) 手術日期 2011/09/22 手術主治醫師 陳敞牧 手術區域 東址 009房 02號 診斷 Hyperhidrosis 器械術式 Endoscopic T2 sympathectomy 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾峰毅, 時間資訊 07:00 臨時手術NPO 11:55 進入手術室 12:00 麻醉開始 12:05 誘導結束 12:15 抗生素給藥 12:20 手術開始 12:59 手術結束 12:59 麻醉結束 13:15 送出病患 13:30 進入恢復室 15:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 經內視鏡交感神經切斷術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Dorsal Sympathectomy 開立醫師: 曾峰毅 開立時間: 2011/09/22 13:11 Pre-operative Diagnosis Hyperhidrosis Post-operative Diagnosis Hyperhidrosis Operative Method Bilateral endoscopic T2 dorsal Sympathectomy Specimen Count And Types nil Pathology nil Operative Findings Right hand temperature increased from 33.6 dgrees Celsius to 34.4, and left fromt 33.8 to 34.2. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with bilateral upper arm abducted. We made one transverse skin incision at right T3/4 intercostal spacem, about 2 cm behind anterior axillar line. We inserted trochar, and inserted endoscpe. T2 dorsal sympathectomy was performed. Wound was closed in layers after de-air. We made one transverse skin incision at left T3/4 intercostal spacem, about 2 cm behind anterior axillar line. We inserted trochar, and inserted endoscpe. T2 dorsal sympathectomy was performed. Wound was closed in layers after de-air. Operators VS 陳敞牧 Assistants R5 曾峰毅 張蘭桂 (F,1961/01/07,51y2m) 手術日期 2011/09/22 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 游健生, 時間資訊 23:31 臨時手術NPO 08:02 進入手術室 08:10 麻醉開始 08:20 誘導結束 08:40 抗生素給藥 08:59 手術開始 11:40 抗生素給藥 13:00 手術結束 13:00 麻醉結束 13:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 腦瘤切除-手術時間在4~8小時 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Left fronto-temporal craniotomy for Simpson g... 開立醫師: 游健生 開立時間: 2011/09/22 13:36 Pre-operative Diagnosis Left temporal convexity meningioma Post-operative Diagnosis Left temporal convexity meningioma Operative Method Left fronto-temporal craniotomy for Simpson grade II meningioma excision Specimen Count And Types 1 piece About size:5 x 4 x 2.2cm Source:Tumor arose from dura Pathology Pending Operative Findings A 5x 4x 2.2cm yellowish elastic-firm tumor arose from temporal dura. It invaded the squamous portion of temporal bone. We achieved Simpson grade II excision because the tumor invaded to the temporal base dura. There was a clear arachnoid plane between temporal lobe and tumor overall. But the plane became blurred at some region of middle and inferior temporal gyrus suggesting possible brain invasion. All cortical vessels attaching to the tumor were preserved and detached from it. Operative Procedures Under ETGA, patient was in supine position with left shoulder elevated. Her head was fixed by Mayfield headclamp and rotated to right. After shaving, we disinfected and draped the opeartion field as usual. A reversed U-shape scalp incision was made at left fronto-temporal region. The scalp flap and temporalis muscle flap were elevated separately. The temporalis muscle fascia was harvested for later duroplasty. After five burholes, a craniotomy was done. The tumor was detached from bone flap by skull elevator. After dura tenting along craniotomy window, the dura was cut around the tumor border. The tumor was dissected away from temporal lobe along arachnoid plane. Cortical vessels attaching to tumor were detached and preserved. Tumor debulking was done with scissors. After complete dissection, the convexity dura attached by tumor were removed together with tumor. The temporal base dura invaded by tumor was coagulated throughoutly. After hemostasis, the tumor bed was covered with Surgicel. Dura was repaired with fascia by 3-0 prolene continuous suture. Bone flap was fixed back with 3 miniplates after dura tenting. A CWV drain was placed at epidural space. Temporalis muscle was approximated and wound was closed by 2-0 Vicryl and 3-0 Nylon. Operators VS 王國川 Assistants R4 游健生 PGY 涂怡安 相關圖片 摘要__ 手術科部: 外科部 套用罐頭: Left fronto-temporal craniotomy for Simpson g... 開立醫師: 游健生 開立時間: 2011/09/22 18:54 Pre-operative Diagnosis Left temporal convexity meningioma Post-operative Diagnosis Left temporal convexity meningioma Operative Method Left fronto-temporal craniotomy for Simpson grade II meningioma excision Specimen Count And Types 1 piece About size:5 x 4 x 2.2cm Source:Tumor arose from dura Pathology Pending Operative Findings A 5x 4x 2.2cm yellowish elastic-firm tumor arose from temporal dura. It invaded the squamous portion of temporal bone. We achieved Simpson grade II excision because the tumor invaded to the temporal base dura. There was a clear arachnoid plane between temporal lobe and tumor overall. But the plane became blurred at some region of middle and inferior temporal gyrus suggesting possible brain invasion. All cortical vessels attaching to the tumor were preserved and detached from it. Operative Procedures Under ETGA, patient was in supine position with left shoulder elevated. Her head was fixed by Mayfield headclamp and rotated to right. After shaving, we disinfected and draped the opeartion field as usual. A reversed U-shape scalp incision was made at left fronto-temporal region. The scalp flap and temporalis muscle flap were elevated separately. The temporalis muscle fascia was harvested for later duroplasty. After five burholes, a craniotomy was done. The tumor was detached from bone flap by skull elevator. After dura tenting along craniotomy window, the dura was cut around the tumor border. The tumor was dissected away from temporal lobe along arachnoid plane. Cortical vessels attaching to tumor were detached and preserved. Tumor debulking was done with scissors. After complete dissection, the convexity dura attached by tumor were removed together with tumor. The temporal base dura invaded by tumor was coagulated throughoutly. After hemostasis, the tumor bed was covered with Surgicel. Dura was repaired with fascia by 3-0 prolene continuous suture. Bone flap was fixed back with 3 miniplates after dura tenting. A CWV drain was placed at epidural space. Temporalis muscle was approximated and wound was closed by 2-0 Vicryl and 3-0 Nylon. Operators VS 王國川 Assistants R4 游健生 PGY 涂怡安 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Left fronto-temporal craniotomy for Simpson g... 開立醫師: 游健生 開立時間: 2011/09/22 18:54 Pre-operative Diagnosis Left temporal convexity meningioma Post-operative Diagnosis Left temporal convexity meningioma Operative Method Left fronto-temporal craniotomy for Simpson grade II meningioma excision Specimen Count And Types 1 piece About size:5 x 4 x 2.2cm Source:Tumor arose from dura Pathology Pending Operative Findings A 5x 4x 2.2cm yellowish elastic-firm tumor arose from temporal dura. It invaded the squamous portion of temporal bone. We achieved Simpson grade II excision because the tumor invaded to the temporal base dura. There was a clear arachnoid plane between temporal lobe and tumor overall. But the plane became blurred at some region of middle and inferior temporal gyrus suggesting possible brain invasion. All cortical vessels attaching to the tumor were preserved and detached from it. Operative Procedures Under ETGA, patient was in supine position with left shoulder elevated. Her head was fixed by Mayfield headclamp and rotated to right. After shaving, we disinfected and draped the opeartion field as usual. A reversed U-shape scalp incision was made at left fronto-temporal region. The scalp flap and temporalis muscle flap were elevated separately. The temporalis muscle fascia was harvested for later duroplasty. After five burholes, a craniotomy was done. The tumor was detached from bone flap by skull elevator. After dura tenting along craniotomy window, the dura was cut around the tumor border. The tumor was dissected away from temporal lobe along arachnoid plane. Cortical vessels attaching to tumor were detached and preserved. Tumor debulking was done with scissors. After complete dissection, the convexity dura attached by tumor were removed together with tumor. The temporal base dura invaded by tumor was coagulated throughoutly. After hemostasis, the tumor bed was covered with Surgicel. Dura was repaired with fascia by 3-0 prolene continuous suture. Bone flap was fixed back with 3 miniplates after dura tenting. A CWV drain was placed at epidural space. Temporalis muscle was approximated and wound was closed by 2-0 Vicryl and 3-0 Nylon. Operators VS 王國川 Assistants R4 游健生 PGY 涂怡安 相關圖片 黃思菁 (F,1989/08/17,22y6m) 手術日期 2011/09/22 手術主治醫師 蔡翊新 手術區域 東址 005房 01號 診斷 Injury (severity score >=16) 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李思慧, 時間資訊 23:34 臨時手術NPO 08:30 進入手術室 08:35 麻醉開始 08:40 誘導結束 08:50 抗生素給藥 09:20 手術開始 11:40 手術結束 11:40 麻醉結束 11:50 抗生素給藥 11:50 送出病患 11:55 進入恢復室 13:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 頭顱成形術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 摘要__ 手術科部: 外科部 套用罐頭: Cranioplasty 開立醫師: 蔡翊新 開立時間: 2011/09/22 11:21 Pre-operative Diagnosis Right F-T-P skull defect. Post-operative Diagnosis Right F-T-P skull defect. Operative Method Cranioplasty with autologous bone graft. Specimen Count And Types nil Pathology Nil. Operative Findings A 14 x 12 cm skull defect at right F-T-P area. The temporalis muscle has been excised during previous craniectomy. There was a dural defect at parietal region along the bone edge, 8 cm in length. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with a sterilized adhesive plastic sheet. 4. Incision: along the previous operation scar at right F-T-P area, Raney clips were applied to the scalp edge for temporary hemostasis. 5. The right F-T-P scalp was dissected away from the underlying dura. 6. The bleeders on the dissected surfaces were coagulated with Bovie painstakingly. 7. The edge of the skull defect was exposed. The dural defect was repaired with 4-0 Prolene. 8. The original skull plate preserved at bone bank was placed back to the skull window then fixed by 3 miniplates and 6 screws. Six dural tentings at the center of the skull plate were placed. 9. Bone cement paste was applied to the temporal area to replace the bulk of temporalis muscle. 10.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by interrupted mattressed suture with 3/0 nylon. 11.Drain: two epidural CWV drains. 12.Blood transfusion: nil. Blood loss: 100 ml. 13.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R4王奐之R0李思慧 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Cranioplasty 開立醫師: 蔡翊新 開立時間: 2011/09/22 11:21 Pre-operative Diagnosis Right F-T-P skull defect. Post-operative Diagnosis Right F-T-P skull defect. Operative Method Cranioplasty with autologous bone graft. Specimen Count And Types nil Pathology Nil. Operative Findings A 14 x 12 cm skull defect at right F-T-P area. The temporalis muscle has been excised during previous craniectomy. There was a dural defect at parietal region along the bone edge, 8 cm in length. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with a sterilized adhesive plastic sheet. 4. Incision: along the previous operation scar at right F-T-P area, Raney clips were applied to the scalp edge for temporary hemostasis. 5. The right F-T-P scalp was dissected away from the underlying dura. 6. The bleeders on the dissected surfaces were coagulated with Bovie painstakingly. 7. The edge of the skull defect was exposed. The dural defect was repaired with 4-0 Prolene. 8. The original skull plate preserved at bone bank was placed back to the skull window then fixed by 3 miniplates and 6 screws. Six dural tentings at the center of the skull plate were placed. 9. Bone cement paste was applied to the temporal area to replace the bulk of temporalis muscle. 10.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by interrupted mattressed suture with 3/0 nylon. 11.Drain: two epidural CWV drains. 12.Blood transfusion: nil. Blood loss: 100 ml. 13.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R4王奐之R0李思慧 相關圖片 林智森 (M,1941/07/07,70y8m) 手術日期 2011/09/22 手術主治醫師 蔡翊新 手術區域 東址 003房 02號 診斷 Brain abscess 器械術式 Crainotomy Brain Tumor(P-LIN) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 游健生, 時間資訊 23:36 臨時手術NPO 13:26 進入手術室 13:30 麻醉開始 13:40 誘導結束 13:43 手術開始 17:07 手術結束 17:07 麻醉結束 17:10 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除-手術時間在4小時以內 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Left parieto-occipital craniotomy for abscess... 開立醫師: 游健生 開立時間: 2011/09/22 18:11 Pre-operative Diagnosis Left parieto-occipital abscess Post-operative Diagnosis Left parieto-occipital abscess Operative Method Left parieto-occipital craniotomy for abscess excision Specimen Count And Types 1 piece About size:2.5 x 2.5x 2cm Source:tumor Pathology Pending Operative Findings Previous trephination was at the center of craniotomy. A 2.5x 2.5x 2cm abscess with thick capsule was found at left parieto-occipital region. We encountered the abscess about 7mm beneath cortex. There was clear yellowish fluid inside the abscess. There was severe adhesion between brain parenchyma and capsule. Operative Procedures Under ETGA, patient was in prone position with head fixed by headclamp. After shaving, we disinfected and draped the operation field as usual. The previous wound was opened and extended caudally and rostrally into a lazy-S wound. After debrided, we harvested the pericranium for later duraplasty. A burhole was created followed by craniotomy. We tented the dura along craniotomy window and opened the dura in cruciate fashion. The abscess was located by intra-operative ultrasound. We extended previous corticotomy into 2cm and dissected to abscess wall. The capsule was dissected away from brain parenchyma. We facilitated dissection by opening the capsule to drain the fluid inside. After hemostasis, the rough surface was covered by Surgicel. Dura was repaired with pericranium by 3-0 prolene. Bone flap was fixed back with 3 wires after central tenting. Muscles were approximated and wound closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS 蔡翊新 VS 王國川 Assistants R4 游健生 PGY 涂怡安 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Left parieto-occipital craniotomy for abscess... 開立醫師: 游健生 開立時間: 2011/09/22 18:29 Pre-operative Diagnosis Left parieto-occipital abscess Post-operative Diagnosis Left parieto-occipital abscess Operative Method Left parieto-occipital craniotomy for abscess excision Specimen Count And Types 1 piece About size:2.5 x 2.5x 2cm Source:tumor Pathology Pending Operative Findings Previous trephination was at the center of craniotomy. A 2.5x 2.5x 2cm abscess with thick capsule was found at left parieto-occipital region. We encountered the abscess about 7mm beneath cortex. There was clear yellowish fluid inside the abscess. There was severe adhesion between brain parenchyma and capsule. Operative Procedures Under ETGA, patient was in prone position with head fixed by headclamp. After shaving, we disinfected and draped the operation field as usual. The previous wound was opened and extended caudally and rostrally into a lazy-S wound. After debrided, we harvested the pericranium for later duraplasty. A burhole was created followed by craniotomy. We tented the dura along craniotomy window and opened the dura in cruciate fashion. The abscess was located by intra-operative ultrasound. We extended previous corticotomy into 2cm and dissected to abscess wall. The capsule was dissected away from brain parenchyma. We facilitated dissection by opening the capsule to drain the fluid inside. After hemostasis, the rough surface was covered by Surgicel. Dura was repaired with pericranium by 3-0 prolene. Bone flap was fixed back with 3 wires after central tenting. Muscles were approximated and wound closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS 蔡翊新 VS 王國川 Assistants R4 游健生 PGY 涂怡安 相關圖片 丁竺原 (F,1969/05/30,42y9m) 手術日期 2011/09/22 手術主治醫師 蔡翊新 手術區域 東址 005房 02號 診斷 Vascular malformation 器械術式 Craniotomy (A.V.M.) P-DUH 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李思慧, 時間資訊 23:38 臨時手術NPO 12:13 進入手術室 12:15 麻醉開始 12:40 誘導結束 12:40 抗生素給藥 12:45 手術開始 15:30 開始輸血 17:20 抗生素給藥 20:20 抗生素給藥 23:25 抗生素給藥 02:20 抗生素給藥 03:30 手術結束 03:30 麻醉結束 03:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 23 0 手術 開顱術摘除血管病變 - 動靜脈畸型中型表淺 1 1 L 手術 顱內壓視置入 1 2 L 摘要__ 手術科部: 外科部 套用罐頭: AVM 開立醫師: 蔡翊新 開立時間: 2011/09/23 03:23 Pre-operative Diagnosis Left cerebellar AVM rupture with ICH and hydrocephalus. Post-operative Diagnosis Left cerebellar AVM rupture with ICH and hydrocephalus. Operative Method Suboccipital craniotomy for AVM excision, ICH evacuation and left Frazier EVD for ICP monitoring. Specimen Count And Types 1 piece About size:2.8 x 2.3 x 2 cm Source:AVM Pathology Pending. Operative Findings CSF: clean; There were tortuous vessels at cortical surface of left cerebellar hemisphere. As dissection went on, the feeding arteries coming from left PICA, AICA and SCA were identified, some of which showed grey-purplish change due to TAE effect. The nidus of the AVM was about 2.8 cm in depth, 2.3 x 2 cm in area. The draining vein went to occipital sinus. During dissection of left anterior aspect of the nidus, massive bleeding was encountered because of difficulty in finding the feeding artery. Feeding arteries coming from right VA system were identified when the AVM was retracted to left side. Some old ICH was evacuated from superioanterior aspect of the nidus, about 5 ml in amount. The cerebellum was a little swollen, though soft, after AVM excision. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: prone with head fixed by a Mayfield skull clamp. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. A burr hole was made at left Frazier point for EVD insertion as an ICP monitor. 5. Incision: suboccipital scalp incision to expose the inion and suboccipital bone. Raney clips were applied to the scalp edge for temporary hemostasis. 6. Craniotomy window: 8 x 5 cm, suboccipital, created by making 5 burr holes then cut by power saw. The craniotomy was extended to foramen magnum by Rongeur. 7. Dural incision: V-shaped and reflected upward. 8. Under operating microscope, the arachnoid membrane around the abnormal vessels was opened to expose the feeding artery of AVM. The feeding artery was traced to the nidus then divided. The nidus of the AVM was isolated from the surrounding brain tissue by microbipolar coagulator with great precaution to minimize the chance of rupture. After the entire mass of the nidus had been dissected free, the drainage vein was occluded by hemoclips and divided. 9. Hemostasis: The blood oozing point from several locations on the bare surface of the hematoma cavity were coagulated and packed with Surgicel for complete hemostasis. Finally, the cavity was irrigated with NS several times and it was perfectly water clear before the dural closure. 10.Dural closure: interruped 2/0 silk sutures for key stitches. A piece of Durofoam, 7 x 7 cm, was used for duroplasty since the dura shrank severely after operation and could not be closed in a water-tight fashion. 11.Closure of skull window: the skull plate was placed back to craniotomy window without fixation. 12.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl (1/0 Vicryl for burr hole wound) and skin by continuous suture with 3/0 nylon. 13.Drain: one subgaleal CWV. 14.Blood transfusion: PRBC 5U, FFP 3U, Platelet 12U. Blood loss: 1900 ml. 15.Course of the surgery: massive bleeding was encountered during dissection of the AVM. Operators VS蔡翊新 Assistants R4王奐之R2柯安達R0李思慧 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: AVM 開立醫師: 蔡翊新 開立時間: 2011/09/23 03:23 Pre-operative Diagnosis Left cerebellar AVM rupture with ICH and hydrocephalus. Post-operative Diagnosis Left cerebellar AVM rupture with ICH and hydrocephalus. Operative Method Suboccipital craniotomy for AVM excision, ICH evacuation and left Frazier EVD for ICP monitoring. Specimen Count And Types 1 piece About size:2.8 x 2.3 x 2 cm Source:AVM Pathology Pending. Operative Findings CSF: clean; There were tortuous vessels at cortical surface of left cerebellar hemisphere. As dissection went on, the feeding arteries coming from left PICA, AICA and SCA were identified, some of which showed grey-purplish change due to TAE effect. The nidus of the AVM was about 2.8 cm in depth, 2.3 x 2 cm in area. The draining vein went to occipital sinus. During dissection of left anterior aspect of the nidus, massive bleeding was encountered because of difficulty in finding the feeding artery. Feeding arteries coming from right VA system were identified when the AVM was retracted to left side. Some old ICH was evacuated from superioanterior aspect of the nidus, about 5 ml in amount. The cerebellum was a little swollen, though soft, after AVM excision. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: prone with head fixed by a Mayfield skull clamp. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. A burr hole was made at left Frazier point for EVD insertion as an ICP monitor. 5. Incision: suboccipital scalp incision to expose the inion and suboccipital bone. Raney clips were applied to the scalp edge for temporary hemostasis. 6. Craniotomy window: 8 x 5 cm, suboccipital, created by making 5 burr holes then cut by power saw. The craniotomy was extended to foramen magnum by Rongeur. 7. Dural incision: V-shaped and reflected upward. 8. Under operating microscope, the arachnoid membrane around the abnormal vessels was opened to expose the feeding artery of AVM. The feeding artery was traced to the nidus then divided. The nidus of the AVM was isolated from the surrounding brain tissue by microbipolar coagulator with great precaution to minimize the chance of rupture. After the entire mass of the nidus had been dissected free, the drainage vein was occluded by hemoclips and divided. 9. Hemostasis: The blood oozing point from several locations on the bare surface of the hematoma cavity were coagulated and packed with Surgicel for complete hemostasis. Finally, the cavity was irrigated with NS several times and it was perfectly water clear before the dural closure. 10.Dural closure: interruped 2/0 silk sutures for key stitches. A piece of Durofoam, 7 x 7 cm, was used for duroplasty since the dura shrank severely after operation and could not be closed in a water-tight fashion. 11.Closure of skull window: the skull plate was placed back to craniotomy window without fixation. 12.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl (1/0 Vicryl for burr hole wound) and skin by continuous suture with 3/0 nylon. 13.Drain: one subgaleal CWV. 14.Blood transfusion: PRBC 5U, FFP 3U, Platelet 12U. Blood loss: 1900 ml. 15.Course of the surgery: massive bleeding was encountered during dissection of the AVM. Operators VS蔡翊新 Assistants R4王奐之R2柯安達R0李思慧 相關圖片 賴禹鈞 (M,1996/09/24,15y5m) 手術日期 2011/09/22 手術主治醫師 洪學義 手術區域 東址 009房 01號 診斷 Major trauma rated 16 or above on the severity scale ( Injury severity score >=16 ) 器械術式 Reduction of mandible;simple 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 黃柏誠, 時間資訊 08:10 進入手術室 08:15 麻醉開始 08:25 誘導結束 08:35 手術開始 11:10 手術結束 11:10 麻醉結束 11:15 送出病患 11:20 進入恢復室 12:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 上下顎間鋼絲固定 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 記錄__ 手術科部: 外科部 套用罐頭: close reduction and IMF 開立醫師: 黃柏誠 開立時間: 2011/09/22 11:22 Pre-operative Diagnosis left maxillary sinus and palate fracture Post-operative Diagnosis left maxillary sinus and palate fracture Operative Method close reduction and IMF Specimen Count And Types nil Pathology nil Operative Findings 1.close reduction and IMF was done smoothly, fixation with elastic band and OG tube insertion was performed. Operative Procedures 1.ETGA supine position 2.disinfection and drape 3.performed IMF 4.fix occulsal plate 5.fix IMF and occulsal plate with elastic band after OG insertion Operators VS洪學義 Assistants R5陳建良 R4黃柏誠 魏陳秀鑾 (F,1938/12/17,73y2m) 手術日期 2011/09/22 手術主治醫師 林鶴雄 手術區域 兒醫 061房 01號 診斷 Stress urinary incontinence 器械術式 TOT 手術類別 預定手術 手術部位 腹 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 蕭柏妮 ASA 2 紀錄醫師 蔡可欣, 時間資訊 07:36 報到 08:05 進入手術室 08:25 麻醉開始 08:30 誘導結束 08:35 抗生素給藥 08:46 手術開始 09:05 麻醉結束 09:05 手術結束 09:10 送出病患 09:13 進入恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 手術 腹式會陰尿道懸吊術 1 1 記錄__ 手術科部: 婦產部 套用罐頭: TOT 開立醫師: 蔡可欣 開立時間: 2011/09/22 09:20 Pre-operative Diagnosis Urodynamic stress incontinence Post-operative Diagnosis ditto Operative Method TOT (Trans-obturator tape) operation Specimen Count And Types nil Pathology nil Operative Findings 1. Grade I cystocele 2. Estimated blood loss:20ml Blood transfusion:nil Complication:nil Operative Procedures 1. Under IVGA, put the patient on lithotomy position 2. Douching, urine catheterization, disinfecting with beta-iodine and skin drapping as usual 3. Inject diluted Pitressin (1:50) into anterior vaginal submucosa. 4. Make a vertical skin incision 1cm beneath the midurethra. 5. Make a blind tunnel from the incision wound to reach obturator space bilaterally 6. Make two small skin incisions of 0.5 cm on lower abdominal area. 7. Insert TOT into the skin incision to support the urethra9. Adjust the tension of the TOT 10. Remove the sheath of the TOT and cut the end of the TOT. 11. Repair the cut vaginal wall and lower abdominal wound. 12. Pack the vagina with one piece of gauze and on Foley Operators 張廷禎, 林鶴雄, Assistants 蔡可欣, 梁啟文 (M,1935/09/01,76y6m) 手術日期 2011/09/23 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Lumbar Spondylosis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 陳國瑋, 時間資訊 23:33 臨時手術NPO 08:10 進入手術室 08:20 麻醉開始 08:50 誘導結束 09:20 抗生素給藥 09:38 手術開始 10:00 開始輸血 12:20 抗生素給藥 14:35 手術結束 14:35 麻醉結束 14:48 送出病患 14:48 抗生素給藥 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 3 0 麻醉 動脈血液檢查全套 3 0 麻醉 Hemoglobin (Hb) 3 0 麻醉 測血糖 3 0 麻醉 Ca (Calcium) 3 0 麻醉 Na (Sodium) 3 0 麻醉 K (Potassium) 3 0 麻醉 Blood gas analysis 3 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎間盤切除術-腰椎 1 2 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 曾峰毅 開立時間: 2011/09/23 14:37 Pre-operative Diagnosis Lumbar sponydlosis with canal stenosis at L2-4 Post-operative Diagnosis Lumbar sponydlosis with canal stenosis at L2-4 Operative Method Transforaminal lumbar interbody with PEEK cage and autologous bone graft at L2/3 and L3/4 Specimen Count And Types Nil Pathology Nil Operative Findings Reborn (寶億) transpedicular screws, 6.25 x 45mm, were inserted into bilateral pedicles of L2-4. Size 10 PEEK cage, was inserted into L2/3, and Size 12 into L3/4. Blood loss is about 3000ml. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After C-arm localization, we made one midline skin incision to dissect bilatearl laminae from L1 to L4. Posterior instrumentation was performed with transpedicular screws at bilateral pedicles of L2-4. L3-4 laminectomy was performed for decompression. Transforaminal lumbar interbody fusion was done with PEEK cage and autologous bone graft at L2/3 and L3/4. After hemostasis with Floseal, the wound was closed in layers after two submuscular hemovac. Operators VS 賴達明 Assistants R5 曾峰毅 R2 陳國瑋 R5 曾峰毅 R3 陳國瑋 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 陳國瑋 開立時間: 2011/10/07 17:12 Pre-operative Diagnosis Lumbar sponydlosis with canal stenosis at L2-4 Post-operative Diagnosis Lumbar sponydlosis with canal stenosis at L2-4 Operative Method Transforaminal lumbar interbody with PEEK cage and autologous bone graft at L2/3 and L3/4 Specimen Count And Types Nil Pathology Nil Operative Findings Reborn (寶億) transpedicular screws, 6.25 x 45mm, were inserted into bilateral pedicles of L2-4. Size 10 PEEK cage, was inserted into L2/3, and Size 12 into L3/4. Blood loss is about 3000ml. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After C-arm localization, we made one midline skin incision to dissect bilatearl laminae from L1 to L4. Posterior instrumentation was performed with transpedicular screws at bilateral pedicles of L2-4. L3-4 laminectomy was performed for decompression. Transforaminal lumbar interbody fusion was done with PEEK cage and autologous bone graft at L2/3 and L3/4. After hemostasis with Floseal, the wound was closed in layers after two submuscular hemovac. Operators VS 賴達明 Assistants R5 曾峰毅 R3 陳國瑋 相關圖片 王美蓮 (F,1951/02/12,61y1m) 手術日期 2011/09/23 手術主治醫師 賴達明 手術區域 東址 005房 01號 診斷 Spondylolisthesis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 陳以幸, 時間資訊 23:34 臨時手術NPO 07:50 報到 08:04 進入手術室 08:10 麻醉開始 08:25 誘導結束 09:00 抗生素給藥 09:20 手術開始 12:00 抗生素給藥 12:50 開始輸血 14:10 手術結束 14:10 麻醉結束 14:15 送出病患 14:23 進入恢復室 17:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 手術 椎間盤切除術-腰椎 1 2 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 陳以幸 開立時間: 2011/09/23 14:33 Pre-operative Diagnosis Spondylolisthesis , L4-5 Post-operative Diagnosis Spondylolisthesis , L4-5 Operative Method L4 laminectomy and transpedicle screw with rod fixation L4-5, banana peek cage insertion, 11mm, L4-5 Specimen Count And Types nil Pathology nil Operative Findings anterior spondylolisthesis, L4-5, with severe spinal stenosis hypertrophic ligmentum flavum was removed via rongeur and Kerrison Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: prone. 3. Skin preparation: the back was shaved and scrubbed with povidone-iodine detergent then painted with povidone-iodine tincture and followed by sterilized adhesive plastic sheet covering. 4. A spinal needle was inserted between spinous processes of L4-5 and a portable X-ray film was taken to locate the correct interspace. 5. Incision: 10 cm, over spinous processes from L3 to L5 6. The paravertebral muscles were retracted by gel-pea to expose the spinous processes and laminae of L4-L5. The bleeding from the muscles were stopped by Bovie. 7. Four 4mm transpedicular screw were placed into bilateral L4-L5 pedical under the assistance of intra-operative C-arm 8. The spinous processes and laminae of L4were bitten off with rongeurs and Kerrison punch until the posterior half of the spinal canal was widely opened. The hypertrophic ligamenta flava including those at lateral recesses were excised. 9. Two rods were put into bilateral screw 10.After hemostasis, the paravertebral muscles were closed by interrupted sutures with 1/0 silk, subcutaneous layer by continuous suture with 2/0 Dexon and skin by continuous suture with 3/0 nylon. 13.Drain: one, epilaminal, hemovac. 14.Blood transfusion: 4U 15.Course ofthesurgery: smooth. Operators VS賴達明 Assistants R6鍾文桂 R2陳以幸 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 陳以幸 開立時間: 2011/10/03 09:44 Pre-operative Diagnosis Spondylolisthesis , L4-5 Post-operative Diagnosis Spondylolisthesis , L4-5 Operative Method L4 laminectomy and transpedicle screw with rod fixation L4-5, banana peek cage insertion, 11mm, L4-5 Specimen Count And Types nil Pathology nil Operative Findings anterior spondylolisthesis, L4-5, with severe spinal stenosis hypertrophic ligmentum flavum was removed via rongeur and Kerrison Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: prone. 3. Skin preparation: the back was shaved and scrubbed with povidone-iodine detergent then painted with povidone-iodine tincture and followed by sterilized adhesive plastic sheet covering. 4. A spinal needle was inserted between spinous processes of L4-5 and a portable X-ray film was taken to locate the correct interspace. 5. Incision: 10 cm, over spinous processes from L3 to L5 6. The paravertebral muscles were retracted by gel-pea to expose the spinous processes and laminae of L4-L5. The bleeding from the muscles were stopped by Bovie. 7. Four 4mm transpedicular screw were placed into bilateral L4-L5 pedical under the assistance of intra-operative C-arm 8. The spinous processes and laminae of L4were bitten off with rongeurs and Kerrison punch until the posterior half of the spinal canal was widely opened. The hypertrophic ligamenta flava including those at lateral recesses were excised. 9. Two rods were put into bilateral screw 10.After hemostasis, the paravertebral muscles were closed by interrupted sutures with 1/0 silk, subcutaneous layer by continuous suture with 2/0 Dexon and skin by continuous suture with 3/0 nylon. 13.Drain: one, epilaminal, hemovac. 14.Blood transfusion: 4U 15.Course ofthesurgery: smooth. Operators VS賴達明 Assistants R6鍾文桂 R2陳以幸 相關圖片 許莊貴妹 (F,1928/04/16,83y10m) 手術日期 2011/09/23 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Low Back Pain 器械術式 Laminectomy for decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3 紀錄醫師 王奐之, 時間資訊 23:35 臨時手術NPO 08:05 進入手術室 08:20 麻醉開始 08:25 誘導結束 08:50 抗生素給藥 09:26 手術開始 11:25 手術結束 11:25 麻醉結束 11:35 送出病患 11:40 進入恢復室 13:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術(減壓)-二節以內 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: Partial L4 & L5 laminectomy for L4-5 sublamin... 開立醫師: 王奐之 開立時間: 2011/09/23 11:50 Pre-operative Diagnosis L4-5 spinal stenosis Post-operative Diagnosis L4-5 spinal stenosis Operative Method Partial L4 & L5 laminectomy for L4-5 sublaminar decompression Specimen Count And Types Nil Pathology Nil Operative Findings Hypertrophic ligamentum flavum was noted at L4-5 level, with decreased L4-5 & L5-S1 interlaminary space as well. Thecal sac expanded well after decompression. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position. After localization of L4-5 level with C-arm, the skin was scrubbed, disinfected & draped. A midline linear incision was made at lower back, and further deepened through fascial layer. After exposure of L5 spinous process, the paraspinal muscles were detached from the spinous process & lamina. Partial L4 & L5 laminectomy was then performed after identifying the L4-5 interlaminary space. After complete removal of the ligamentum flavum to achieve adequate decompression, hemostasis was obtained, and the wound was closed in layers. Operators VS 賴達明 Assistants R4 王奐之, PGY 涂怡安 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Partial L4 & L5 laminectomy for L4-5 sublamin... 開立醫師: 王奐之 開立時間: 2011/09/23 11:51 Pre-operative Diagnosis L4-5 spinal stenosis Post-operative Diagnosis L4-5 spinal stenosis Operative Method Partial L4 & L5 laminectomy for L4-5 sublaminar decompression Specimen Count And Types Nil Pathology Nil Operative Findings Hypertrophic ligamentum flavum was noted at L4-5 level, with decreased L4-5 & L5-S1 interlaminary space as well. Thecal sac expanded well after decompression. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position. After localization of L4-5 level with C-arm, the skin was scrubbed, disinfected & draped. A midline linear incision was made at lower back, and further deepened through fascial layer. After exposure of L5 spinous process, the paraspinal muscles were detached from the spinous process & lamina. Partial L4 & L5 laminectomy was then performed after identifying the L4-5 interlaminary space. After complete removal of the ligamentum flavum to achieve adequate decompression, hemostasis was obtained, and the wound was closed in layers. Operators VS 賴達明 Assistants R4 王奐之, PGY 涂怡安 相關圖片 謝添福 (M,1955/12/25,56y2m) 手術日期 2011/09/23 手術主治醫師 蔡翊新 手術區域 東址 019房 02號 診斷 Subdural hemorrhage 器械術式 Removal of subdural hematoma and craniectomy, left 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 4E 紀錄醫師 怡安, 時間資訊 00:00 開始NPO 00:00 臨時手術NPO 11:10 通知急診手術 12:23 進入手術室 12:23 報到 12:30 麻醉開始 13:15 手術開始 13:50 誘導結束 15:50 麻醉結束 15:50 手術結束 15:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 急性硬腦膜下血腫清除術 1 1 L 手術 顱內壓視置入 1 2 L 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 摘要__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 蔡翊新 開立時間: 2011/09/23 15:24 Pre-operative Diagnosis Left frontoparietal acute SDH. Post-operative Diagnosis Left frontoparietal acute SDH. Operative Method Left F-T-P craniotomy for removal of SDH and subdural ICP monitoring. Specimen Count And Types nil Pathology Nil. Operative Findings There was easy bleeding from bone marrow and epidural space. The dura was tense after craniotomy. Initial ICP after subdural blood gushed out was 9 mmHg. Semiliquified, dark reddish blood was noted at subdural space of left frontoparietal region. There was no active bleeder. The brain remained slack after removal of subdural hematoma. ICP after skin closure was -1 mmHg. Reference of ICP monitor was 480. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: curvilinear at left frontotemporoparietal area, the skin edge was clipped by Raney clips for temporary hemostasis. The temporalis muscle was detached from temporal squama by rasp subsequently. 7. Craniotomy window: 8 x 8 cm, left frontotemporoparietal, created by making 3 burr holes then cut by power saw. 8. Dural tenting: by 2/0 silk, 2-cm in interval, distributed along the edge of skull window. 9. Dural incision: curvilinear along the edge of skull window. 10.The subdural clot was removed by sucker and those located beyond the cranial window was washed out by saline irrigation through a Nelaton tube introduced into subdural space. 11.A Codman ICP monitor was placed at subdural space of left temporal area. 12.Dural closure: water-tight by 4-0 Prolene. 13.The skull plate was fixed back with 3 miniplates and 6 screws. 14.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 15.Drain: one, epidural, CWV. 16.Blood transfusion: Platelet 12U. Blood loss: 200 ml. 17.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R4王奐之R0怡安 Indication Of Emergent Operation conscious disturbacne, IICP. 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 蔡翊新 開立時間: 2011/09/23 15:24 Pre-operative Diagnosis Left frontoparietal acute SDH. Post-operative Diagnosis Left frontoparietal acute SDH. Operative Method Left F-T-P craniotomy for removal of SDH and subdural ICP monitoring. Specimen Count And Types nil Pathology Nil. Operative Findings There was easy bleeding from bone marrow and epidural space. The dura was tense after craniotomy. Initial ICP after subdural blood gushed out was 9 mmHg. Semiliquified, dark reddish blood was noted at subdural space of left frontoparietal region. There was no active bleeder. The brain remained slack after removal of subdural hematoma. ICP after skin closure was -1 mmHg. Reference of ICP monitor was 480. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: curvilinear at left frontotemporoparietal area, the skin edge was clipped by Raney clips for temporary hemostasis. The temporalis muscle was detached from temporal squama by rasp subsequently. 7. Craniotomy window: 8 x 8 cm, left frontotemporoparietal, created by making 3 burr holes then cut by power saw. 8. Dural tenting: by 2/0 silk, 2-cm in interval, distributed along the edge of skull window. 9. Dural incision: curvilinear along the edge of skull window. 10.The subdural clot was removed by sucker and those located beyond the cranial window was washed out by saline irrigation through a Nelaton tube introduced into subdural space. 11.A Codman ICP monitor was placed at subdural space of left temporal area. 12.Dural closure: water-tight by 4-0 Prolene. 13.The skull plate was fixed back with 3 miniplates and 6 screws. 14.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 15.Drain: one, epidural, CWV. 16.Blood transfusion: Platelet 12U. Blood loss: 200 ml. 17.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R4王奐之R0怡安 Indication Of Emergent Operation conscious disturbacne, IICP. 相關圖片 何冠毅 (M,2009/10/09,2y5m) 手術日期 2011/09/23 手術主治醫師 謝孟祥 手術區域 東址 012房 02號 診斷 Acrocephlosyndactyly 器械術式 Debridment-- >10cm 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 3 紀錄醫師 柯安達, 時間資訊 09:15 進入手術室 09:20 麻醉開始 09:25 誘導結束 09:26 手術開始 09:54 手術結束 09:54 麻醉結束 10:07 送出病患 10:10 進入恢復室 11:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 ketamine線術 1 0 B 摘要__ 手術科部: 外科部 套用罐頭: remove tieover 開立醫師: 柯安達 開立時間: 2011/09/23 09:58 Pre-operative Diagnosis Sydactyly s/p bilateral index fingers reconstruction Post-operative Diagnosis Sydactyly s/p bilateral index fingers reconstruction Operative Method remove tieover Specimen Count And Types nil Pathology nil Operative Findings 1. The index fingers was separated from middle fingers 2. The wound was clear and the skin graft was intact Operative Procedures 1. Supine postion, ETGA 2. Remove the tieover carefully 3. wrap it with guze Operators 謝孟祥 Assistants R4游彥辰 R2柯安達 Ri李伊真 林鳳嬌 (F,1953/08/16,58y6m) 手術日期 2011/09/24 手術主治醫師 蕭輔仁 手術區域 東址 005房 01號 診斷 Other inflammatory spondylopathies 器械術式 Wound treatment-- 5-10cm 手術類別 預定手術 手術部位 脊椎 傷口分類 髒 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 3 紀錄醫師 鍾文桂, 時間資訊 08:00 臨時手術NPO 08:00 進入手術室 08:10 麻醉開始 08:30 誘導結束 09:06 手術開始 10:10 手術結束 10:10 麻醉結束 10:11 送出病患 10:15 進入恢復室 11:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 深部傷口處理縫合擴創-中 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: Debridement of infected wound. 開立醫師: 鍾文桂 開立時間: 2011/09/24 10:21 Pre-operative Diagnosis Lumbar operative wound infection. Post-operative Diagnosis Lumbar operative wound infection. Operative Method Debridement of infected wound. Specimen Count And Types 1 piece About size:1cc Source:wound culture. Pathology Nil. Operative Findings 1. infected wound about 8cm in length. Intact fascia layer. Operative Procedures Under ETGA, the patient was placed in prone position. After disinfection and draping, the wound was opened and debrided with currete. After 500cc normal saline irrigation, the wound was closed primarily with one CWV drain in situ. Operators 蕭輔仁 Assistants 鍾文桂 陳以幸 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Debridement of infected wound. 開立醫師: 鍾文桂 開立時間: 2011/10/05 20:11 Pre-operative Diagnosis Lumbar operative wound infection. Post-operative Diagnosis Lumbar operative wound infection. Operative Method Debridement of infected wound. Specimen Count And Types 1 piece About size:1cc Source:wound culture. Pathology Nil. Operative Findings 1. infected wound about 8cm in length. Intact fascia layer. Operative Procedures Under ETGA, the patient was placed in prone position. After disinfection and draping, the wound was opened and debrided with currete. After 500cc normal saline irrigation, the wound was closed primarily with one CWV drain in situ. Operators 蕭輔仁 Assistants 鍾文桂 陳以幸 相關圖片 梁啟修 (M,1951/05/01,60y10m) 手術日期 2011/09/24 手術主治醫師 蕭輔仁 手術區域 東址 005房 02號 診斷 C5-C7 level with unspecified spinal cord injury 器械術式 Laminectomy C-Spinal(Posterier 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 3E 紀錄醫師 韋凌亦, 時間資訊 03:00 臨時手術NPO 03:00 開始NPO 10:33 進入手術室 10:40 麻醉開始 11:00 誘導結束 11:20 抗生素給藥 11:37 手術開始 12:20 開始輸血 14:20 抗生素給藥 14:23 手術結束 14:23 麻醉結束 14:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術(減壓)-超過二節 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Cervical Laminectomy 開立醫師: 韋凌亦 開立時間: 2011/09/24 15:11 Pre-operative Diagnosis spinal cord ingury Post-operative Diagnosis spinal cord ingury Operative Method Cervical Laminectomy Specimen Count And Types nil Pathology nil Operative Findings 1.Spinal cord was severely compressed 2.Spinal cord poor pulsatle after decompression 3.Blood lose: 1500ml Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: prone with neck flexed and head fixed by a Mayfield skull clamp 3. Skin preparation: occipital and neck areas were shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: medline nape, from suboccipital to lower neck. 5. The trapezius, semispinalis capitis, splenius capitis muscles on both sides were splitted at itsorigin of ligamentum nuchae, then, together with serratus posterior superior, rectus capitis posterior, obliqus capitis inferior and multifidus were detached from the spinous processes of C2-C7 by Bovie, followed by subperiosteal dissection on the laminae. 6. The paravertebral muscles were kept open by self retaining retractors to expose spinous processes and laminae of C2-C7. The bleeding from the muscles was stopped by Bovie. 7. The spinous processes and laminae of C2-C7 were bitten off by different type of rongeurs and Kerrison punch until posterior half of the spinal canal was widely opened and the cord had been well decompressed. The epidural venous bleeding was stopped by gelfoam packing. 8.The paravertebral muscles were closed by interrupted sutures with 2/0 silk, subcutaneous layer by continuous suture with 3/0 Dexon and skin by continuous suture with 3/0 nylon. 9.Drain: one, epilaminal, hemovac. 10.Blood transfusion: pRBC 2U 11.Course of the surgery: smooth. Operators VS 蕭輔仁 Assistants CR鍾文桂 R1韋凌亦 Indication Of Emergent Operation spinal cord ingury 相關圖片 黃慧忠 (M,1955/08/22,56y6m) 手術日期 2011/09/24 手術主治醫師 蕭輔仁 手術區域 東址 002房 05號 診斷 Malignant neoplasm of thyroid gland 器械術式 Spinal fusion posterior 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 3E 紀錄醫師 李振豪, 時間資訊 16:00 臨時手術NPO 16:00 開始NPO 22:26 進入手術室 22:28 麻醉開始 23:00 誘導結束 23:15 抗生素給藥 23:40 手術開始 00:42 開始輸血 01:55 麻醉結束 01:55 手術結束 02:10 送出病患 02:15 進入恢復室 03:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 惡性脊髓腫瘤切除術 1 1 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: T2, T3, and partial T4 laminectomy for decomp... 開立醫師: 李振豪 開立時間: 2011/09/25 02:30 Pre-operative Diagnosis T2-4 spinal metastasis with myelopathy Post-operative Diagnosis T2-4 spinal metastasis with myelopathy Operative Method T2, T3, and partial T4 laminectomy for decompression and tumor excision Specimen Count And Types 1 piece About size:Multiple pieces Source:spinal tumor Pathology Pending Operative Findings The tumor was mainly located at T2 to T4 spine and right posterior chest wall. The tumor was soft to elastic, hypervascularized, and gray-reddish in character. The thecal sac was compressed and encased by the tumor. Due to remarkable compression from ventral side of the tumor, the thecal sac did not expanded very well after posterior decompression. However, significant blood loss up to 2500ml was encountered after posterior decompression. So anterior decompression is not performed for difficult to control bleeding. No incidental durotomy or CSF leakage was noted during whole procedure. Blood transfusion: 6U pRBC. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position with head fixed with Mayfield skull clamp. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made along operative scar and the subcutaneous soft tissue was devided. The paravertebral muscle group were detached. The tumor was noted at T2 and T3 laminae with easily touch bleeding. T2, T3, and partial T4 laminectomy was performed and tumor excision was done for posterior decompression. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. One epidural Hemovac was placed. The wound was then closed in layers with 1-0, 2-0 Vicryl and 3-0 Nylon. Operators VS蕭輔仁 Assistants R5李振豪, R1吳欣翰 Indication Of Emergent Operation Acute deterioration of lower limb muscle power 相關圖片 耿杰 (M,1976/09/04,35y6m) 手術日期 2011/09/24 手術主治醫師 蕭輔仁 手術區域 東址 003房 01號 診斷 Herniated intervertebral disc, lumbar 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 3 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:10 麻醉開始 08:20 誘導結束 09:00 抗生素給藥 09:06 手術開始 12:00 抗生素給藥 14:13 手術結束 14:13 麻醉結束 14:20 送出病患 14:25 進入恢復室 15:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-腰椎 1 2 B 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 B 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 記錄__ 手術科部: 外科部 套用罐頭: L4/5 transforaminal interbody fusion with PEE... 開立醫師: 李振豪 開立時間: 2011/09/24 14:28 Pre-operative Diagnosis L4-5 degenerative disc disease with low back pain Post-operative Diagnosis L4-5 degenerative disc disease with low back pain Operative Method L4/5 transforaminal interbody fusion with PEEK cage Specimen Count And Types nil Pathology Nil Operative Findings The L4/5 facet joint was mild hypertrophic. The L4/5 disc was bulging posteriorly with mild thecal sac and root compression. The disc was degenerative with mild edematous change. One #12 banana PEEK cage filled with autologous bone graft was implanted for interbody fusion. The thecal sac and left L5 root were protected well during whole procedure. Four 6.5 x 50mm transpedicular screws were inserted with two 5cm rods as posterior instrumentation. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position. L4 and L5 pedicle level was localized by portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made at L4-L5 level. The subcutaneous soft tissue and paravertebral muscle groups were detached. L4 and L5 transpedicular screws were inserted under C-arm guided. L4/5 left facetectomy was performed and left L5 roots were identified. L4/5 diskectomy was done and one #12 banana PEEK cage was inserted for interbody fusion. The rods were applied and hemostasis was achieved with bipolar electrocautery and Gelfoam packing. One Hemovac was placed. The wound was then closed in layers with 1-0, 2-0 Vicryl, and 3-0 Nylon. Operators VS蕭輔仁 Assistants R5李振豪, Ri 相關圖片 林茂榮 (M,1934/06/23,77y8m) 手術日期 2011/09/25 手術主治醫師 蔡翊新 手術區域 東址 018房 01號 診斷 Subdural hemorrhage, traumatic 器械術式 Burr hole (trephination) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 3E 紀錄醫師 曾穎凡, 時間資訊 14:00 臨時手術NPO 14:00 開始NPO 18:08 通知急診手術 19:20 麻醉開始 19:22 進入手術室 19:25 誘導結束 19:30 開始輸血 19:37 抗生素給藥 19:57 手術開始 20:55 手術結束 20:55 麻醉結束 21:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Chronic Subdural Hematoma 開立醫師: 蔡翊新 開立時間: 2011/09/25 20:49 Pre-operative Diagnosis Left frontotemporoparietal chronic SDH, recurrent. Post-operative Diagnosis Left frontotemporoparietal chronic SDH, recurrent. Operative Method Left frontotemporal burr hole for removal of chronic SDH. Specimen Count And Types nil Pathology Nil. Operative Findings Dark reddish liquified blood gushed out upon opening the dura. There was no definite outer membrane, but inner membrane was seen. The return after large amount of normal saline irrigation at subdural space still showed sanguinous, suggestive of bleeding tendency. The brain remained slack after removal of SDH. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: linear scalp incision, 5 cm in length, left frontotemporal area, parallel and posteriolaterally to the previous incision. 5. Burr hole: a new one created at left frontotemporal skull, 3 cm away from previous one. 6. Dural tenting: 3 stitches of 2/0 silk, distributed along the edge of the burr hole. 7. Dural incision: cruciate. 8. The liquified old blood and clot in the subdural space was evacuated by sucker, then thoroughly irrigated with N.S. through a rubber tube until the return was much cleaner than initial status (still sanguinous). 9. Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous sutures with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 10.Drain: one, subdural, connected to a reservoir bag. 11.Blood transfusion: Platelet 24U. Blood loss: minimal. 12.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5鍾文桂R0曾穎凡 Indication Of Emergent Operation progressive aphasia, right side weakness 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Chronic Subdural Hematoma 開立醫師: 蔡翊新 開立時間: 2011/09/25 20:49 Pre-operative Diagnosis Left frontotemporoparietal chronic SDH, recurrent. Post-operative Diagnosis Left frontotemporoparietal chronic SDH, recurrent. Operative Method Left frontotemporal burr hole for removal of chronic SDH. Specimen Count And Types nil Pathology Nil. Operative Findings Dark reddish liquified blood gushed out upon opening the dura. There was no definite outer membrane, but inner membrane was seen. The return after large amount of normal saline irrigation at subdural space still showed sanguinous, suggestive of bleeding tendency. The brain remained slack after removal of SDH. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: linear scalp incision, 5 cm in length, left frontotemporal area, parallel and posteriolaterally to the previous incision. 5. Burr hole: a new one created at left frontotemporal skull, 3 cm away from previous one. 6. Dural tenting: 3 stitches of 2/0 silk, distributed along the edge of the burr hole. 7. Dural incision: cruciate. 8. The liquified old blood and clot in the subdural space was evacuated by sucker, then thoroughly irrigated with N.S. through a rubber tube until the return was much cleaner than initial status (still sanguinous). 9. Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous sutures with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 10.Drain: one, subdural, connected to a reservoir bag. 11.Blood transfusion: Platelet 24U. Blood loss: minimal. 12.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5鍾文桂R0曾穎凡 Indication Of Emergent Operation progressive aphasia, right side weakness 相關圖片 謝夢蘭 (F,1952/09/09,59y6m) 手術日期 2011/09/26 手術主治醫師 杜永光 手術區域 東址 003房 03號 診斷 Obstructive hydrocephalus 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3 紀錄醫師 陳國瑋, 時間資訊 23:46 臨時手術NPO 16:45 報到 17:30 進入手術室 17:35 麻醉開始 17:40 誘導結束 17:55 抗生素給藥 18:12 手術開始 19:12 手術結束 19:12 麻醉結束 19:26 送出病患 19:30 進入恢復室 21:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦脊髓液分流管重置 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 曾峰毅 開立時間: 2011/09/26 19:02 Pre-operative Diagnosis Hydrocephalus, status post ventriculoperitoneal shunt, complicated with under drainage Post-operative Diagnosis Hydrocephalus, status post ventriculoperitoneal shunt, complicated with under drainage Operative Method Ventriculoperitoneal shunt revision with Codman programmable shunt Specimen Count And Types CSF was sent for routine, BCS, culture. Pathology Nil Operative Findings Codman programmable shunt, pre-set at 100 mmH20, was used for revision. Colorless, clear, CSF was drained. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to left. We made skin incision at right frontal area, and right retroauricular area along previous operation wound. We transected previoud Codman, fixed-pressure, valve, and reconnected programmable valve. The wound was closed in layers. Operators P 杜永光 Assistants R5 曾峰毅 R3 陳國瑋 相關圖片 沈炎昌 (M,1964/11/12,47y4m) 手術日期 2011/09/26 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Brain Tumor 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 陳國瑋, 時間資訊 07:35 報到 08:00 進入手術室 08:10 麻醉開始 08:45 誘導結束 08:55 抗生素給藥 09:00 手術開始 13:05 麻醉結束 13:15 手術結束 13:25 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除-手術時間在4~8小時 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Left craniotomy for tumor excision 開立醫師: 曾峰毅 開立時間: 2011/09/26 13:10 Pre-operative Diagnosis Anaplastic astrocytomy status post tumor excision with recurrence, suspected glioblastoma multuforme Post-operative Diagnosis Anaplastic astrocytomy status post tumor excision with recurrence, suspected glioblastoma multuforme Operative Method Left craniotomy for tumor excision Specimen Count And Types 1 piece About size:pieces Source:brain tumor Pathology Pending Operative Findings One 4x4.5x4.5 cm, ill-defiend, hypervascular, soft, greyish tu mor with gelatin-like content, necrosis portion, and suspected intra-tumor hemorrhage, was noted at left frontal lobe. Previous dura graft was invaded by recurrent tumor. Intra-operative mapping for motor cortex localization is not able to be performed due to adhesion. Operative Procedures Under endotracheal general anaesthesia, the patient was put in supine position with head rotated to right and fixed with Mayfield head clamp. We made one curvilinear incision along previuos operation wound. We removed previous fixation wires, and removed boen graft. Dura incision was done along previous durotomy. Tumor excision was performed, and hemostatsis was done with H202 irrigation and Suricel paving. Duroplasty with Durafoam was done. Bone graft was fixed back with mini-plates. The wound was closed in layers. Operators P 杜永光 Assistants R5 曾峰毅 R3 陳國瑋 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Left craniotomy for tumor excision 開立醫師: 陳國瑋 開立時間: 2011/09/26 13:39 Pre-operative Diagnosis Anaplastic astrocytomy status post tumor excision with recurrence, suspected glioblastoma multuforme Anaplastic astrocytoma status post tumor excision with recurrence, suspected glioblastoma multuforme Post-operative Diagnosis Anaplastic astrocytomy status post tumor excision with recurrence, suspected glioblastoma multuforme Anaplastic astrocytoma status post tumor excision with recurrence, suspected glioblastoma multuforme Operative Method Left craniotomy for tumor excision Specimen Count And Types 1 piece About size:pieces Source:brain tumor Pathology Pending Operative Findings One 4x4.5x4.5 cm, ill-defiend, hypervascular, soft, greyish tu mor with gelatin-like content, necrosis portion, and suspected intra-tumor hemorrhage, was noted at left frontal lobe. Previous dura graft was invaded by recurrent tumor. Intra-operative mapping for motor cortex localization is not able to be performed due to adhesion. Operative Procedures Under endotracheal general anaesthesia, the patient was put in supine position with head rotated to right and fixed with Mayfield head clamp. We made one curvilinear incision along previuos operation wound. We removed previous fixation wires, and removed boen graft. Dura incision was done along previous durotomy. Tumor excision was performed, and hemostatsis was done with H202 irrigation and Suricel paving. Duroplasty with Durafoam was done. Bone graft was fixed back with mini-plates. The wound was closed in layers. Operators P 杜永光 Assistants R5 曾峰毅 R3 陳國瑋 相關圖片 王啟霖 (M,1934/05/03,77y10m) 手術日期 2011/09/26 手術主治醫師 杜永光 手術區域 東址 003房 02號 診斷 Pituitary Tumor 器械術式 TSH 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3 紀錄醫師 陳國瑋, 時間資訊 23:40 臨時手術NPO 13:40 進入手術室 13:45 麻醉開始 14:25 誘導結束 14:38 抗生素給藥 14:58 手術開始 16:55 手術結束 16:55 麻醉結束 17:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經由蝶竇之腦下垂體瘤切除 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Hypophysectomy---Transphenoid 開立醫師: 曾峰毅 開立時間: 2011/09/26 17:21 Pre-operative Diagnosis Pituitary tumor, status post trans-nasal trans-sphenoidal tumor excision, failed twice Post-operative Diagnosis Suspected craniopharyngioma Operative Method Trans-nasal trans-sphenoidal tumor excision Specimen Count And Types Several fragments of the tumor was sent for pathology. Pathology Frozen section: Squamous-cell-like epithelium with keratin and calcification, craniopharyngioma is more likley. Operative Findings Previously perforated nasal septum, opened sphenoidal sinus, and right inferior turbinate synechia was noted. One cystic tumor with xanthochromic deposition, suspected calcification, ont cystic wall was noted at sellar area. CSF leakage was encountered after tumor removal. There was no latency or amplitude change of VEP during the operation. Operative Procedures With endotracheal generala anaesthesia, the patient was put in supine position with neck extended. We entered sphenoid sinus via right nostril. Previous packing in the sphenoid sinus was removed. Sell floor opening, made at previous operation, was enlarged with Karrison rongeur. Tumor was removed in piecemeal with ring-currette and alligator. CSF leakage was sealed by packings with autologus fat graft, gelfoam, surgicels, and Tissucol-Duo. Bilateral nostrils were packed with Merocels. Operators P 杜永光 Assistants R5 曾峰毅 R3 陳國瑋 相關圖片 陳美川 (F,1962/12/13,49y3m) 手術日期 2011/09/26 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 李振豪, 時間資訊 10:51 臨時手術NPO 07:42 報到 08:01 進入手術室 08:05 麻醉開始 08:30 誘導結束 08:45 抗生素給藥 08:48 手術開始 11:45 抗生素給藥 12:45 麻醉結束 12:45 手術結束 12:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除-手術時間在4小時以內 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Left parietal craniotomy for tumor excision 開立醫師: 李振豪 開立時間: 2011/09/26 13:06 Pre-operative Diagnosis Left fronto-parietal parasagittal meningioma Post-operative Diagnosis Left fronto-parietal parasagittal meningioma Operative Method Left parietal craniotomy for tumor excision Specimen Count And Types 1 piece About size:Multiple pieces Source:Left parasagittal meningioma Pathology Pending Operative Findings The tumor was 4.2 x 3.5 x 3cm in size, hypervascularized with much engorged venous drainage, well-demarcated in most arachnoid plan, and firm with central necrosis in character. Some part of the tumor adhered with brain parenchyma tightly. The tumor was based at parasagittal area so the dura excision was not possible. The dura base was coagulated after total removal of the tumor. No obvious skull involvement was noted. Total blood loss: 500ml. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. V-shape scalp incision was made at left parietal area and the scalp flap was elevated. The periosteum was elevated also. Six burr holes were created followed by one 8 x 7cm craniotomy window. Dural tenting was done and the bleeding from arachnoid granule was packing with Gelfoam. Intra-operative sonography was used for localization of the tumor. C-shape durotomy was performed based with superior sagittal sinus. The tumor was detached from the dura with bipolar electrocautery and microscissor. Central debulking was conducted and the tumor was dissected along the arachnoid plan between brain parenchyma and tumor. After total tumor excision, hemostasis was achieved with bipolar electrocautery and Surgicel lining. The dura where tumor originated was coagulated. Periosteum was harvested for duroplasty. The skull plate was fixed back with miniplates, screws, and two central tenting. One subgaleal CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and Appose staples. Operators VS曾漢民 Assistants R5李振豪, R1陸惠宗 相關圖片 劉松標 (M,1958/09/14,53y6m) 手術日期 2011/09/26 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Astrocytoma, brain 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 李振豪, 時間資訊 23:52 臨時手術NPO 11:55 報到 13:10 麻醉開始 13:10 進入手術室 13:30 誘導結束 13:33 抗生素給藥 13:33 手術開始 16:55 抗生素給藥 18:10 麻醉結束 18:10 手術結束 18:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4~8小時 1 1 L 手術 顱內壓視置入 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Left occipital craniotomy for tumor excision ... 開立醫師: 李振豪 開立時間: 2011/09/26 18:32 Pre-operative Diagnosis Left temporo-parietal peri-ventricular tumor, suspect high grade glioma Post-operative Diagnosis Left temporo-parietal peri-ventricular tumor, favor high grade glioma Operative Method Left occipital craniotomy for tumor excision and external ventricular drainage Specimen Count And Types 1 piece About size:Multiple pieces Source:Left periventricular tumor Pathology Frozen section: high grade glioma Operative Findings The tumor was gray-yellowish, soft and fragile, hypervascularized, 3x3x4.2cm in size, and ill-demarcated in character. The tumor was located around the left ventricular trigone and the left lateral ventricle was opened after tumor excision. The specimen was sent for frozen section and high grade glioma was favored. Numerous feeding artery was noted during tumor excision and hemostasis was not satisficated by bipolar electrocautery and Surgicel lining. Floseal was used for both tumor bed and superior sagittal sinus bleeding. The brain was bulging out after dural opening and became slack after tumor removal. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position with head fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. Hokeystick scalp incision was made and the scalp flap was elevated. The periosteum was elevated. Three burr holes were created followed by one 7x7cm craniotomy window. Dural tenting was done. Intra-operative sonography was used for localization of the tumor. C-shape durotomy was made based with superior sagittal sinus. One 1x1.5cm corticotomy was performed and tumor was encountered 2~3cm in depth. Tumor excision was performed with tumor forceps, bipolar electrocautery, and suction. The tumor was sent for frozen section. The left lateral ventricle was entered during tumor excision and one external ventricular drainage was placed under direct vision. Due to difficult to stop bleeding with bipolar electrocautery and Surgicel lining, Floseal was applied for hemostasis. One 1 x 5cm periosteum was harvested for duroplasty. Externalization of the ventricular drain was performed. The skull plate was fixed back with miniplates, screws, and two central tenting. One subgaleal CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and Appose staples. Operators VS曾漢民 Assistants R5李振豪, R1陸惠宗 相關圖片 陳義德 (M,1948/09/05,63y6m) 手術日期 2011/09/26 手術主治醫師 曾漢民 手術區域 東址 005房 03號 診斷 Maxillary tumor 器械術式 Brachial plexus neuroma excision 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 面罩麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 李振豪, 時間資訊 23:55 臨時手術NPO 17:22 報到 18:31 進入手術室 18:35 麻醉開始 18:40 抗生素給藥 18:40 誘導結束 18:56 手術開始 19:23 手術結束 19:23 麻醉結束 19:28 送出病患 19:29 進入恢復室 20:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 軟組織良性腫瘤切除術,大或深 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Semi-opened mask inhalation anes 1 0 記錄__ 手術科部: 外科部 套用罐頭: Tumor excision 開立醫師: 李振豪 開立時間: 2011/09/26 19:40 Pre-operative Diagnosis Right arm soft tissue tumor, suspect neuroma Post-operative Diagnosis Right arm neuroma, suspect median nerve origin Operative Method Tumor excision Specimen Count And Types 1 piece About size:1.2 X 1.3 X 1.7cm Source:right arm soft tissue tumor Pathology Pending Operative Findings The tumor was 1.2 x 1.3 x 1.7cm in size, well-demarcated, elastic to firm, hypervascularized, and originated from the nerve fascicle(median nerve?). The tumor was removed by en block method and the fascicle attached to the nerve was sacrified for total removal of the tumor. Cystic transformation was noted within the tumor. The patient stood whole procedure well. Operative Procedures Under intravenous general anesthesia, the patient was put in supine position. The skin was scrubbed, disinfected, and draped as usual. Linear skin incision with 2cm was made at medial side of right upper arm. The subcutanoues soft tissue was devided and dissected. The tumor was encountered and dissected along the margin of the tumor. Hemostasis was achieved by manual compression for 5 minutes. The wound was then closed in layers with 3-0 Vicryl and 4-0 Nylon. Operators VS 曾漢民 Assistants R5李振豪, R1陸惠宗 相關圖片 翁琴汝 (F,1939/05/03,72y10m) 手術日期 2011/09/26 手術主治醫師 王碩盟 手術區域 西址 039房 10號 診斷 Hydronephrosis 器械術式 Removal of double-J 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 14:11 報到 15:08 進入手術室 15:12 手術開始 15:20 手術結束 15:22 送出病患 王興華 (M,1929/11/04,82y4m) 手術日期 2011/09/26 手術主治醫師 王國川 手術區域 東址 016房 02號 診斷 Subdural hemorrhage, traumatic 器械術式 Burr hole (trephination) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3E 紀錄醫師 鍾文桂, 時間資訊 12:16 通知急診手術 12:55 進入手術室 12:58 麻醉開始 13:05 誘導結束 13:38 手術開始 14:25 手術結束 14:25 麻醉結束 14:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦內血腫清除術 1 1 手術 顱內壓視置入 1 2 摘要__ 手術科部: 外科部 套用罐頭: Burr hole for evacuation of subdural effusion. 開立醫師: 鍾文桂 開立時間: 2011/09/27 19:31 Pre-operative Diagnosis Subdural effusion, right frontal-parietal. Post-operative Diagnosis Subdural effusion, right frontal-parietal. Operative Method Burr hole for evacuation of subdural effusion. Specimen Count And Types nil. Pathology Nil. Operative Findings 1. pinkish clear fluid in subdural space. Low pressure. 2. No outer or inner membrane noted. Poor brain expansion after effusion evacuation. Operative Procedures Under ETGA, the patient was placed in supine position and the head was tilted to the left side. After shaving, disinfection, and draping, a linear incision was made at right frontal region. After dissection, a burr hole was obtained by using high speed drill. The effusion was drained through EVD tube after durotomy. The wound was closed in layers after placing the EVD tube into the subdural space in situ. Then, the air was evacuated through the tube with normal saline. The tube was connected with EVD set finally. Operators 王國川 Assistants 鍾文桂 Indication Of Emergent Operation change of consciousness 相關圖片 黃火盛 (M,1948/09/10,63y6m) 手術日期 2011/09/27 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Herniation of intervertebral disc 器械術式 Laminectomy for decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 王奐之, 時間資訊 23:46 臨時手術NPO 08:00 進入手術室 08:05 麻醉開始 08:15 誘導結束 08:30 抗生素給藥 09:00 手術開始 11:09 開始輸血 11:30 抗生素給藥 13:10 手術結束 13:10 麻醉結束 13:20 送出病患 13:25 進入恢復室 14:32 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 手術 椎弓切除術(減壓)-超過二節 1 1 手術 脊椎融合術-後融合,無固定物 1 2 摘要__ 手術科部: 外科部 套用罐頭: L3-5 laminectomy & L3-5 posterolateral fusion... 開立醫師: 王奐之 開立時間: 2011/09/27 13:40 Pre-operative Diagnosis Lumbar spinal stenosis, L3-5, status post L4-5 microsurgical discectomy, with failed back syndrome Post-operative Diagnosis Lumbar spinal stenosis, L3-5, status post L4-5 microsurgical discectomy, with failed back syndrome Operative Method L3-5 laminectomy & L3-5 posterolateral fusion with autologous bone grafts & artificial bone grafts (Sinbone) Specimen Count And Types Nil Pathology Nil Operative Findings Easy bleeding was encountered throughout the operative proceudre. Three small unintentional durotomies were noted after laminectomy, close to the previous operation location; the largest one at midline was repaired with 5-0 Prolene. Bilateral L3, L4, & L5 roots were identified and well preserved. Estimated blood loss: 1400ml. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position. After localization of L3-5 level under C-arm, a midline linear incision was made. The incision was further deepened through fascial layer until the spinous processes were exposed. The paraspinal muscles were then detached from L3-5 spinous processes & laminae, and further dissected laterally to expose the facets. L3-5 laminectomy was performed with bone cutter, rongeur, & Kerrison punch. After completion of decompression, the removed bone grafts were placed outside the facets along with Sinbone for posterolateral fusion. After setting 1 CWV drain & hemostasis, the wound was closed in layers. Operators VS 曾勝弘 Assistants R4 王奐之, Ri 黃威勝 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: L3-5 laminectomy & L3-5 posterolateral fusion... 開立醫師: 王奐之 開立時間: 2011/09/27 13:40 Pre-operative Diagnosis Lumbar spinal stenosis, L3-5, status post L4-5 microsurgical discectomy, with failed back syndrome Post-operative Diagnosis Lumbar spinal stenosis, L3-5, status post L4-5 microsurgical discectomy, with failed back syndrome Operative Method L3-5 laminectomy & L3-5 posterolateral fusion with autologous bone grafts & artificial bone grafts (Sinbone) Specimen Count And Types Nil Pathology Nil Operative Findings Easy bleeding was encountered throughout the operative proceudre. Three small unintentional durotomies were noted after laminectomy, close to the previous operation location; the largest one at midline was repaired with 5-0 Prolene. Bilateral L3, L4, & L5 roots were identified and well preserved. Estimated blood loss: 1400ml. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position. After localization of L3-5 level under C-arm, a midline linear incision was made. The incision was further deepened through fascial layer until the spinous processes were exposed. The paraspinal muscles were then detached from L3-5 spinous processes & laminae, and further dissected laterally to expose the facets. L3-5 laminectomy was performed with bone cutter, rongeur, & Kerrison punch. After completion of decompression, the removed bone grafts were placed outside the facets along with Sinbone for posterolateral fusion. After setting 1 CWV drain & hemostasis, the wound was closed in layers. Operators VS 曾勝弘 Assistants R4 王奐之, Ri 黃威勝 相關圖片 蔡吳里 (F,1930/10/20,81y4m) 手術日期 2011/09/27 手術主治醫師 曾勝弘 手術區域 東址 005房 02號 診斷 Hydrocephalus 器械術式 Revision of CSF shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 王奐之, 時間資訊 23:47 臨時手術NPO 13:40 進入手術室 13:45 麻醉開始 13:50 誘導結束 14:00 抗生素給藥 14:28 手術開始 15:35 手術結束 15:35 麻醉結束 15:45 送出病患 15:46 進入恢復室 17:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦脊髓液分流管重置 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt revision (via righ... 開立醫師: 王奐之 開立時間: 2011/09/27 18:40 Pre-operative Diagnosis Hydrocephalus, status post ventriculoperitoneal shunt, with shunt dysfunction Post-operative Diagnosis Hydrocephalus, status post ventriculoperitoneal shunt, with shunt dysfunction Operative Method Ventriculoperitoneal shunt revision (via right Kocher point) Specimen Count And Types 2 pieces About size:3ml Source:CSF About size:8*0.2*0.2cm Source:ventricular catheter Pathology Nil Operative Findings Clear CSF was noted upon ventricular puncture. A tear was noticed on the ventricular catheter over the straight connector, and so the ventricular catheter was replaced; length of the new ventricular catheter: 6.5cm intracranially. The old ventricular catheter was sent for tip culture, and 3ml of clear CSF was also collected for routine analysis, BCS & bacterial culture. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After shaving, scrubbing, disinfection & draping in sterile fashion, a curvilinear incision was made at right frontal area along previous wound. The ventricular catheter was carefully dissected from surrounding soft tissue and mobilized. The previous burr hole at right Kocher point was enlarged laterally with Kerrison punch to allow a more lateral entry point of the catheter. After removal of old ventricular catheter and assembly of the new catheter, ventriculostomy was performed via a new corticotomy (lateral to the previous tract). The ventricular catheter was then inserted, and secured in place with silk sutures. After hemostasis, the wound was closed in layers. Operators VS 曾勝弘 Assistants R4 王奐之, Ri 黃威勝 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt revision (via righ... 開立醫師: 王奐之 開立時間: 2011/09/27 18:40 Pre-operative Diagnosis Hydrocephalus, status post ventriculoperitoneal shunt, with shunt dysfunction Post-operative Diagnosis Hydrocephalus, status post ventriculoperitoneal shunt, with shunt dysfunction Operative Method Ventriculoperitoneal shunt revision (via right Kocher point) Specimen Count And Types 2 pieces About size:3ml Source:CSF About size:8*0.2*0.2cm Source:ventricular catheter Pathology Nil Operative Findings Clear CSF was noted upon ventricular puncture. A tear was noticed on the ventricular catheter over the straight connector, and so the ventricular catheter was replaced; length of the new ventricular catheter: 6.5cm intracranially. The old ventricular catheter was sent for tip culture, and 3ml of clear CSF was also collected for routine analysis, BCS & bacterial culture. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After shaving, scrubbing, disinfection & draping in sterile fashion, a curvilinear incision was made at right frontal area along previous wound. The ventricular catheter was carefully dissected from surrounding soft tissue and mobilized. The previous burr hole at right Kocher point was enlarged laterally with Kerrison punch to allow a more lateral entry point of the catheter. After removal of old ventricular catheter and assembly of the new catheter, ventriculostomy was performed via a new corticotomy (lateral to the previous tract). The ventricular catheter was then inserted, and secured in place with silk sutures. After hemostasis, the wound was closed in layers. Operators VS 曾勝弘 Assistants R4 王奐之, Ri 黃威勝 相關圖片 鄒沁彤 (F,2010/12/02,1y3m) 手術日期 2011/09/27 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Inverted papilloma 器械術式 right temporal crainotomy for tumor excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 石博元 ASA 2 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:07 進入手術室 08:10 麻醉開始 08:30 誘導結束 09:20 抗生素給藥 09:42 手術開始 10:30 開始輸血 12:20 抗生素給藥 15:05 麻醉結束 15:05 手術結束 15:10 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除-手術時間在4~8小時 1 1 R 手術 顱內壓視置入 1 2 R 摘要__ 手術科部: 外科部 套用罐頭: 1. Right parietal craniotomy for total tumor ... 開立醫師: 游健生 開立時間: 2011/09/27 16:58 Pre-operative Diagnosis 1. Atypical choroid plexus papilloma, status post right temporal craniotomy for subtotal tumor excision 2. Hydrocephalus, status post programmable VP shunt insertion via left Kocher point Post-operative Diagnosis 1. Atypical choroid plexus papilloma, status post right temporal craniotomy for subtotal tumor excision 2. Hydrocephalus, status post programmable VP shunt insertion via left Kocher point Operative Method 1. Right parietal craniotomy for total tumor excision 2. EVD insertion as ICP monitor Specimen Count And Types 1 piece About size:4x 3.5x 5cm Source:Intraventicular tumor Pathology Pending Operative Findings There were 3 small cranial defected at right parietal region which were resulted from previously severe intracranial hypertension. The brain was bulging after craniotomy and became slack after CSF drainage. There was severe adhesion between pia/arachnoid membrane and dura. The parietal cortex was very thin(about 1.5mm) and no obvious gyri / sulci seen except one. The right lateral ventricle was divided into multiple non-communicating compartment by semi-transparent septa which were radiated from the tumor. Initial fluid gashed out after ventriculostomy at junction of occipital horn and body of lateral ventricle was light-yellowish and mild turbid. After we opened a septum, the fluid inside was clear green-yellowish. When we entered the temporal horn, the fluid was clear and transparent. A multi-lobulated elastic-firm pink tumor arose from the choroid plexus at the posterior body of lateral ventricle. It was about 4x 3.5x 5cm in size and moderately vascularized. It had a poor-defined margin between brain parenchyma at pedicle. A small part of the tumor was cauliflower-like with flesh color. The EVD was placed at the body of lateral ventricle after we opened all septa in ventricle. The foramen Monro was seen and the corticotomy was covered by Duraform. Operative Procedures Under ETGA, patient was in supine position with right shoulder elevated and head rotated to left. After shaving, we disinfected and draped the operation field as usual. A reverse U-shape scalp incision was made at right parietal region with the lateral border connected to previous operation wound. After we reflexted the scalp flap downward followed by pericranium reflection. The cranial defects at right parietal region were seen. We separated the dura from cranium at these defects and performed craniotomy. The durotomy was along the craniotomy window with base at midline after dura tenting. We identified a sulcus at right parietal lobe and opened it. After a 3cm corticotomy, we entered an compartment of right lateral ventricle at junction of occipital horn and body. We traced the septum and led us to the tumor. We dissected the tumor at its pedicle away from brain parenchyma. All septa encountered were transected. The pedicle was coagulated and transected followed by en bloc tumor removal. Hemostasis was achieved with bipolar. All compartment of right lateral ventricle were opened. Choroid plexus was seen at temoporal horn and coagulated. The foramen Monro was seen and an EVD was placed at the body of lateral ventricle. A Duraform was used to covered the corticotomy. After re-filling the CSF space with normal saline, dura was closed with 3-0 prolene continuous suture. Bone flap was fixed back with silk sutures after central tenting and Duraform coverage. Pericranium was approximated and wound closed in layers with 3-0 Vircyl and 3-0 Nylon. Operators VS 郭夢菲 Assistants R4 游健生 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: 1. Right parietal craniotomy for total tumor ... 開立醫師: 郭夢菲 開立時間: 2011/09/27 18:19 Pre-operative Diagnosis 1. Atypical choroid plexus papilloma, status post right temporal craniotomy for subtotal tumor excision 2. Hydrocephalus, status post programmable VP shunt insertion via left Kocher point Post-operative Diagnosis 1. Atypical choroid plexus papilloma, status post right temporal craniotomy for subtotal tumor excision 2. Hydrocephalus, status post programmable VP shunt insertion via left Kocher point Operative Method 1. Right parietal craniotomy for total tumor excision 2. EVD insertion as ICP monitor Specimen Count And Types 1 piece About size:4x 3.5x 5cm Source:Intraventicular tumor Pathology Pending Operative Findings There were 3 small cranial defected at right parietal region which were resulted from previously severe intracranial hypertension. The brain was bulging after craniotomy and became slack after CSF drainage (needle aspiration from the right lateral ventricle for 40cc). There was adhesion between pia/arachnoid membrane and dura due to previous surgery and subdural space. The parietal cortex was very thin(about 1.5mm) and no obvious gyri/sulci seen except one. The right lateral ventricle was divided into multiple non-communicating compartment by semi-transparent septa which were radiated from the tumor. Initial fluid gashed out after ventriculostomy at junction of occipital horn and body of lateral ventricle was light-yellowish and mild turbid. After we opened a septum, the fluid inside was clear and yellowish. When we entered the temporal horn, the fluid was clear and transparent. The temporal horn was entrapped due to septum formation from previous surgery and the septum of the tumor per se. A multi-lobulated elastic-firm pink tumor arose from the choroid plexus at the posterior body of lateral ventricle. It was about 4x 3.5x 5cm in size and moderately vascularized. It had a poor-defined margin between brain parenchyma at its pedicle along the base of the right ventricular body. A small part of the tumor located at the lowest part of the tumor was pinkish and cauliflower-like with flesh color. The EVD was placed at the body of lateral ventricle after we opened all septa in ventricle. The foramen Monro was seen and the corticotomy was covered by Duraform. Operative Procedures Under ETGA, patient was in supine position with right shoulder elevated and head rotated to left. After shaving, we disinfected and draped the operation field as usual. A reverse U-shape scalp incision was made at right parietal region with the lateral border connected to previous operation wound. After we reflexted the scalp flap downward followed by pericranium reflection. The cranial defects at right parietal region were seen. We separated the dura from cranium at these defects and performed craniotomy. After needle aspiration of the CSF from the right lateral ventricle to decompress the brain, durotomy was along the craniotomy window with base at midline after dura tenting. We identified a sulcus at right parietal lobe and opened it. Under microscopic view, a 2cm corticotomy was performed, we then entered an compartment of right lateral ventricle at junction of occipital horn and body. We traced the septum and led us to the tumor. We dissected the tumor at its pedicle away from brain parenchyma. All septa encountered were transected. The pedicle was coagulated and transected followed by en bloc tumor removal. Hemostasis was achieved with bipolar. All compartment of right lateral ventricle were opened. Normal choroid plexus was seen at temoporal horn and coagulated. The foramen Monro was seen and an EVD was placed at the body of lateral ventricle. A Duraform was used to covered the corticotomy. After re-filling the CSF space with normal saline, dura was closed with 5-0 prolene continuous suture. Bone flap was fixed back with silk sutures after central tenting and Duraform coverage. Pericranium was approximated and wound closed in layers with 3-0 Vircyl and 3-0 Nylon. Operators VS 郭夢菲 Assistants R4 游健生 相關圖片 摘要__ 手術科部: 外科部 套用罐頭: 1. Right parietal craniotomy for total tumor ... 開立醫師: 游健生 開立時間: 2011/09/27 19:11 Pre-operative Diagnosis 1. Atypical choroid plexus papilloma, status post right temporal craniotomy for subtotal tumor excision 2. Hydrocephalus, status post programmable VP shunt insertion via left Kocher point Post-operative Diagnosis 1. Atypical choroid plexus papilloma, status post right temporal craniotomy for subtotal tumor excision 2. Hydrocephalus, status post programmable VP shunt insertion via left Kocher point Operative Method 1. Right parietal craniotomy for total tumor excision 2. EVD insertion as ICP monitor Specimen Count And Types 1 piece About size:4x 3.5x 5cm Source:Intraventicular tumor Pathology Pending Operative Findings There were 3 small cranial defected at right parietal region which were resulted from previously severe intracranial hypertension. The brain was bulging after craniotomy and became slack after CSF drainage. There was severe adhesion between pia/arachnoid membrane and dura. The parietal cortex was very thin(about 1.5mm) and no obvious gyri / sulci seen except one. The right lateral ventricle was divided into multiple non-communicating compartment by semi-transparent septa which were radiated from the tumor. Initial fluid gashed out after ventriculostomy at junction of occipital horn and body of lateral ventricle was light-yellowish and mild turbid. After we opened a septum, the fluid inside was clear green-yellowish. When we entered the temporal horn, the fluid was clear and transparent. A multi-lobulated elastic-firm pink tumor arose from the choroid plexus at the posterior body of lateral ventricle. It was about 4x 3.5x 5cm in size and moderately vascularized. It had a poor-defined margin between brain parenchyma at pedicle. A small part of the tumor was cauliflower-like with flesh color. The EVD was placed at the body of lateral ventricle after we opened all septa in ventricle. The foramen Monro was seen and the corticotomy was covered by Duraform. Operative Procedures Under ETGA, patient was in supine position with right shoulder elevated and head rotated to left. After shaving, we disinfected and draped the operation field as usual. A reverse U-shape scalp incision was made at right parietal region with the lateral border connected to previous operation wound. After we reflexted the scalp flap downward followed by pericranium reflection. The cranial defects at right parietal region were seen. We separated the dura from cranium at these defects and performed craniotomy. The durotomy was along the craniotomy window with base at midline after dura tenting. We identified a sulcus at right parietal lobe and opened it. After a 3cm corticotomy, we entered an compartment of right lateral ventricle at junction of occipital horn and body. We traced the septum and led us to the tumor. We dissected the tumor at its pedicle away from brain parenchyma. All septa encountered were transected. The pedicle was coagulated and transected followed by en bloc tumor removal. Hemostasis was achieved with bipolar. All compartment of right lateral ventricle were opened. Choroid plexus was seen at temoporal horn and coagulated. The foramen Monro was seen and an EVD was placed at the body of lateral ventricle. A Duraform was used to covered the corticotomy. After re-filling the CSF space with normal saline, dura was closed with 3-0 prolene continuous suture. Bone flap was fixed back with silk sutures after central tenting and Duraform coverage. Pericranium was approximated and wound closed in layers with 3-0 Vircyl and 3-0 Nylon. Operators VS 郭夢菲 Assistants R4 游健生 相關圖片 范姜群義 (M,1962/04/02,49y11m) 手術日期 2011/09/27 手術主治醫師 賴達明 手術區域 東址 001房 02號 診斷 Brain tumors, malignant 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 李振豪, 時間資訊 00:08 臨時手術NPO 00:08 開始NPO 07:09 通知急診手術 07:50 報到 08:02 進入手術室 08:05 麻醉開始 08:35 誘導結束 08:40 抗生素給藥 09:20 手術開始 11:40 抗生素給藥 14:45 麻醉結束 14:45 手術結束 14:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 手術 腦瘤切除-手術時間在4~8小時 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Left frontal craniotomy for tumor excision 開立醫師: 李振豪 開立時間: 2011/09/27 15:54 Pre-operative Diagnosis Left frontal tumor, suspect glioblastoma Post-operative Diagnosis Left frontal tumor, favor glioblastoma Operative Method Left frontal craniotomy for tumor excision Specimen Count And Types 1 piece About size:Multiple pieces Source:Left frontal tumor Pathology Pending Operative Findings The tumor was 5.6 x 4.5 x 5cm in size, hypervascularized, gelatinous appearance, ill-demarcated, and gray-reddish in color. Glioblastoma was favored according to gross pathology. The tumor was mainly located at anterior frontal lobe. Gross total excision was achieved during the operation. Large dura laceration was noted after elevation of the skull plate and duroplasty was performed with one 5x1cm periosteum and one periosteum pedicle flap to avoid further CSF leakage. The frontal sinus and left lateral ventricle are not entered during the operation. The tumor was 5.6 x 4.5 x 5cm in size, hypervascularized, gelatinous appearance, ill-demarcated, and gray-reddish in color. Tumor bleeding was noted within the anterior part of the tumor. The tumor was mainly located at anterior frontal lobe. Brain bulging out after dura opening and became slack after tumor excision. Glioblastoma was favored according to gross pathology. Gross total excision was achieved during the operation. Large dura laceration was noted after elevation of the skull plate and duroplasty was performed with one 5x1cm periosteum and one periosteum pedicle flap to avoid further CSF leakage. The frontal sinus and left lateral ventricle are not entered during the operation. The tumor was 5.6 x 4.5 x 5cm in size, hypervascularized, gelatinous appearance, ill-demarcated, and gray-reddish in color. Glioblastoma was favored according to gross pathology. The tumor was mainly located at anterior frontal lobe. Gross total excision was achieved during the operation. Large dura laceration was noted after elevation of the skull plate and duroplasty was performed with one 5x1cm periosteum and one periosteum pedicle flap to avoid further CSF leakage. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position. The scalp was shaved, scrubbed, and disinfected as usual. Bicoronal scalp incision was made and the periosteum was elevated as pedicle flap. Three burr holes were created followed by one 8x8cm craniotomy. Dural laceration was noted after elevation of the skull plate. Dural tenting was done. Intra-operative sonography was used for localization of the tumor. C-shape durotomy was performed based with superior sagittal sinus. Corticotomy over left lower frontal pole was performed and tumor excision was conducted with bipolar electrocautery, tumor forceps, and suction. After gross total tumor excision, hemostasis was achieved with bipolar electrocautery and Surgicel lining. Dura was closed with periosteum pedicle flap. The skull plate was fixed back with miniplates, screws, and two central tenting. One subgaleal CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS賴達明 Assistants R5李振豪, PGY涂安怡 Indication Of Emergent Operation Left frontal tumor bleeding with deteriortion of neurological status 相關圖片 杜金川 (M,1950/10/09,61y5m) 手術日期 2011/09/27 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Herniated intervertebral disc (HIVD) 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李思慧, 時間資訊 23:42 臨時手術NPO 08:02 進入手術室 08:10 麻醉開始 08:20 誘導結束 08:30 抗生素給藥 08:46 手術開始 11:30 抗生素給藥 12:45 開始輸血 13:03 手術結束 13:03 麻醉結束 13:10 送出病患 13:12 進入恢復室 14:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎間盤切除術-腰椎 1 2 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 曾峰毅 開立時間: 2011/09/27 13:20 Pre-operative Diagnosis Spondylolisthesis, grade I, at L4/5 and L5/S1 Post-operative Diagnosis Spondylolisthesis, grade I, at L4/5 and L5/S1 Operative Method Lumbar Laminectomy (and/or Posterior Fusion) Transforaminal lumbar interbody fusion at L4/5 and L5/S1 Specimen Count And Types Nil Pathology Nil Operative Findings Hypertophic ligamentum flavum compromised thecal sac and biateral lateral recess from L4/5 to S1 tightly. Neural structure was decompressed well after the surgery. Synthes transpedicular screws, 6.2 x 45 mm, were used for instrumentation at bilateral pedicles of L4, L5, and S1. Two 8-cm rods were used for posterior fixation. One 11-mm PEEK cage was used for TILF at L4/5, and 13 mm at L5/S1. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After C-arm localization, we scrubbed, disinfected, and then draped the patient as usual. We made one midline skin incision and dissected bialteral paraspinal muscle to expose bilateral laminae from L3 to S1. We performed instrumentation with transpedicular screws into bilateral pedicles of L4 to S1. L4 and L5 left hemi-laminectomy was performed for decompression. Diskectomy was done at L4/5 and L5/S1, and transforaminal lumbar interbody fusion was done with PEEK cage and autologous bone graft at L4/5 and L5/S1. Two 8-cm rods were set for posterior fixation. After hemostasis, two epidural hemovac was set. The wound was closed in layers. Operators VS 賴達明 Assistants R5 曾峰毅 PGY 李思慧 相關圖片 陳欽恒 (M,1962/02/08,50y1m) 手術日期 2011/09/27 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 HIVD 器械術式 Diskectomy cervical(Anterier), C6/7 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 23:58 臨時手術NPO 13:27 進入手術室 13:31 麻醉開始 13:40 誘導結束 14:00 抗生素給藥 14:18 手術開始 16:44 手術結束 16:44 麻醉結束 16:52 送出病患 16:55 進入恢復室 18:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎融合術-前融合,無固定物(≦四節) 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 摘要__ 手術科部: 外科部 套用罐頭: Right anterior approach for diskectomy and in... 開立醫師: 鍾文桂 開立時間: 2011/09/27 17:05 Pre-operative Diagnosis Herniated intervertebral disc, C6-7. Post-operative Diagnosis Herniated intervertebral disc, C6-7. Operative Method Right anterior approach for diskectomy and interbody fusion, C6/7. Specimen Count And Types nil Pathology Nil. Operative Findings Presence of spur formation mainly at left side. Intact dura mater. Slack cord after decompression. 8mm PEEK cage was implanted at C6/7 level. Operative Procedures Under ETGA, the patient was placed in supine position. After disinfection and draping, a linear skin incision was made at right anterior neck. After dissection along the anterior border of sternocledomastoid muscle, the pervertebral space was reached. After dissection of longus collis muscle and setting the retractors, the C6/7 disc level was ensured by intraoperative fluoroscopy. The disc was removed by currete and kerrison punch. Spurs were removed by high speed drill and kerrison punch. The PEEK cage was implanted after filling with allograft bone materials. The wound was closed in layers with one prevertebral mini-hemovac. Operators 賴達明 Assistants R6鍾文桂 R1李思惠 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Right anterior approach for diskectomy and in... 開立醫師: 鍾文桂 開立時間: 2011/10/05 20:11 Pre-operative Diagnosis Herniated intervertebral disc, C6-7. Post-operative Diagnosis Herniated intervertebral disc, C6-7. Operative Method Right anterior approach for diskectomy and interbody fusion, C6/7. Specimen Count And Types nil Pathology Nil. Operative Findings Presence of spur formation mainly at left side. Intact dura mater. Slack cord after decompression. 8mm PEEK cage was implanted at C6/7 level. Operative Procedures Under ETGA, the patient was placed in supine position. After disinfection and draping, a linear skin incision was made at right anterior neck. After dissection along the anterior border of sternocledomastoid muscle, the pervertebral space was reached. After dissection of longus collis muscle and setting the retractors, the C6/7 disc level was ensured by intraoperative fluoroscopy. The disc was removed by currete and kerrison punch. Spurs were removed by high speed drill and kerrison punch. The PEEK cage was implanted after filling with allograft bone materials. The wound was closed in layers with one prevertebral mini-hemovac. Operators 賴達明 Assistants R6鍾文桂 R1李思惠 相關圖片 陳文令 (M,1929/09/11,82y6m) 手術日期 2011/09/27 手術主治醫師 賴達明 手術區域 東址 005房 03號 診斷 Lumbar Spondylosis 器械術式 Laminectomy for decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 王奐之, 時間資訊 23:40 臨時手術NPO 16:00 進入手術室 16:05 麻醉開始 16:23 抗生素給藥 16:25 誘導結束 16:53 手術開始 18:10 手術結束 18:10 麻醉結束 18:15 送出病患 18:20 進入恢復室 19:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術(減壓)-二節以內 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Partial L4-5 & right L5-S1 laminectomy for su... 開立醫師: 王奐之 開立時間: 2011/09/27 18:37 Pre-operative Diagnosis Lumbar spinal stenosis, L3-S1, status post partial L4 laminectomy Post-operative Diagnosis Lumbar spinal stenosis, L3-S1, status post partial L4 laminectomy Operative Method Partial L4-5 & right L5-S1 laminectomy for sublaminar decompression Specimen Count And Types Nil Pathology Nil Operative Findings An unintentional durotomy was observed during the procedure at L4-5 level, without tearing of the arachnoid membrane (no CSF leakage was noted intra-operatively). The dural defect was packed with DuraFoam. Hypertrophic ligamentum flavum were noted at L4-5 & L5-S1 level, and the thecal sac expanded well after decompression. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position. After localization of the L5 spinous process, the skin was scrubbed, disinfected & draped in sterile fashion. A midline linear incision was then made at lower back, the incision was deepened through fascial layer until exposure of the spinous processes. The paraspinal muscles were detached from the spinous process & lamina. The L4-5 & L5-S1 interlaminary spaces were identified, followed by lower L4, upper L5 & lower right L5 partial laminectomy. The ligamentum flavum of these 2 levels were also removed to achieve adequate decompression. After hemostasis and placement of DuraFoam, the wound was closed in layers. Operators VS 賴達明 Assistants R4 王奐之, Ri 黃威勝 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Partial L4-5 & right L5-S1 laminectomy for su... 開立醫師: 王奐之 開立時間: 2011/09/27 18:37 Pre-operative Diagnosis Lumbar spinal stenosis, L3-S1, status post partial L4 laminectomy Post-operative Diagnosis Lumbar spinal stenosis, L3-S1, status post partial L4 laminectomy Operative Method Partial L4-5 & right L5-S1 laminectomy for sublaminar decompression Specimen Count And Types Nil Pathology Nil Operative Findings An unintentional durotomy was observed during the procedure at L4-5 level, without tearing of the arachnoid membrane (no CSF leakage was noted intra-operatively). The dural defect was packed with DuraFoam. Hypertrophic ligamentum flavum were noted at L4-5 & L5-S1 level, and the thecal sac expanded well after decompression. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position. After localization of the L5 spinous process, the skin was scrubbed, disinfected & draped in sterile fashion. A midline linear incision was then made at lower back, the incision was deepened through fascial layer until exposure of the spinous processes. The paraspinal muscles were detached from the spinous process & lamina. The L4-5 & L5-S1 interlaminary spaces were identified, followed by lower L4, upper L5 & lower right L5 partial laminectomy. The ligamentum flavum of these 2 levels were also removed to achieve adequate decompression. After hemostasis and placement of DuraFoam, the wound was closed in layers. Operators VS 賴達明 Assistants R4 王奐之, Ri 黃威勝 相關圖片 吳元生 (M,1959/02/28,53y0m) 手術日期 2011/09/28 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Lung cancer 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 07:30 報到 08:05 進入手術室 08:10 麻醉開始 08:30 誘導結束 08:35 抗生素給藥 08:53 手術開始 11:35 抗生素給藥 12:40 麻醉結束 12:40 手術結束 12:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Right posterior frotnal craniotomy for tumor ... 開立醫師: 曾峰毅 開立時間: 2011/09/28 12:40 Pre-operative Diagnosis Suspected lung cancer with cerebral and cerebellar metastasis Post-operative Diagnosis Suspected lung cancer with cerebral and cerebellar metastasis Operative Method Right posterior frotnal craniotomy for tumor excision Specimen Count And Types 1 piece About size:3cm Source:brain tumor Pathology pending Operative Findings One capsulated, hypervascular, grayish, intra-axial solid tumor was noted at right posterior frontal lobe, at motor cortex, adjacent to superior sagittal sinus. One capsulated, hypervascular, grayish, intra-axial solid tumor was noted at right posterior frontal lobe, at motor cortex, adjacent to superior sagittal sinus. Some turbid, whitish to yellowish discharged was noted at the bottom of the tumor. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with neck flexed and head fixed with Mayfield head clamp. We made one U-shape scalp incision, and drilled four burr holes. 6x6 cm craniotomy was performed, and sonography was used to locate the tumor. U-shape durotomy was done, and tumor excision for central deubulkin was done first. Tumor border was dissected meticulously. Tumor was removed totally, and tumor cavity was paved with Surgicel for hemostasis. Bone graft was fixed back with wires and mini-plates. We placed one subgaleal CWV, and the wound was closed in layers. With endotracheal general anaesthesia, the patient was put in supine position with neck flexed and head fixed with Mayfield head clamp. We made one U-shape scalp incision, and drilled four burr holes. 6x6 cm craniotomy was performed, and sonography was used to locate the tumor. U-shape durotomy was done, and tumor excision for central deubulking was done first. Tumor border was dissected meticulously. Tumor was removed totally, and tumor cavity was paved with Surgicel for hemostasis. Bone graft was fixed back with wires and mini-plates. We placed one subgaleal CWV, and the wound was closed in layers. Operators P 杜永光 Assistants R5 曾峰毅 R3 陳國瑋 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Right posterior frotnal craniotomy for tumor ... 開立醫師: 陳國瑋 開立時間: 2011/11/16 10:33 Pre-operative Diagnosis Suspected lung cancer with cerebral and cerebellar metastasis Post-operative Diagnosis Suspected lung cancer with cerebral and cerebellar metastasis Operative Method Right posterior frotnal craniotomy for tumor excision Specimen Count And Types 1 piece About size:3cm Source:brain tumor Pathology pending Operative Findings One capsulated, hypervascular, grayish, intra-axial solid tumor was noted at right posterior frontal lobe, at motor cortex, adjacent to superior sagittal sinus. Some turbid, whitish to yellowish discharged was noted at the bottom of the tumor. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with neck flexed and head fixed with Mayfield head clamp. We made one U-shape scalp incision, and drilled four burr holes. 6x6 cm craniotomy was performed, and sonography was used to locate the tumor. U-shape durotomy was done, and tumor excision for central deubulking was done first. Tumor border was dissected meticulously. Tumor was removed totally, and tumor cavity was paved with Surgicel for hemostasis. Bone graft was fixed back with wires and mini-plates. We placed one subgaleal CWV, and the wound was closed in layers. Operators P 杜永光 Assistants R5 曾峰毅 R3 陳國瑋 相關圖片 陳時炤 (M,1948/12/25,63y2m) 手術日期 2011/09/28 手術主治醫師 杜永光 手術區域 東址 003房 02號 診斷 Acoustic tumor 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 13:30 進入手術室 13:35 麻醉開始 14:05 誘導結束 14:10 抗生素給藥 14:14 手術開始 17:10 抗生素給藥 19:40 手術結束 19:40 麻醉結束 19:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Left retrosigmoid approach for hearing preser... 開立醫師: 曾峰毅 開立時間: 2011/09/28 19:14 Pre-operative Diagnosis Left vestibular neurilemmoma Post-operative Diagnosis Left vestibular neurilemmoma Operative Method Left retrosigmoid approach for hearing preservation vestibular neurilemmoma surgery Specimen Count And Types 1 piece About size:PIECES Source:BRAIN TUMOR Pathology pending Operative Findings One capsulated, hypervascular, grayish tumor, about 2.6x2x1.8 cm, located at left cerebellopontine angle, extending into left internal acoutic canal. Canal orifice was enlarged by the tumor. Left facial nerve and cochlear nerve were identified during the surgery, and were preserved well. There was no latency or amplitude change of BAEP and SSEP during the surgery. Facial nerve stimulation localized the left facial nerve precisely. Operative Procedures After intubation and general anesthesia, the patient was put in supine position with left shoulder elevated and head tilting to right. One 8cm curvlinear skin incision was made. One bur hole was made at asterion and the craniotomy window was 5cm in diameter with extesion with driller to the posterior margin of sigmoid sinus. The dura was incised. Cerebellum was retracted slightly posteriorly, and CSF was drained. The tumor and low cranial nerves were identified after cerebellum retraction. Central debulking of the tumor with CUSA was performed. The internal acustic meatus was then drilled open. The intracannalicular portion of the tumor was removed with CUSA and nerve hook. The CN VII VIII was identified after tumor removal in the internal acoustic meatus, and can be tranced back to the nerve existing site of the pons after total tumor removal. Opened internal acoustic canal was packed with Surgicels and Tissucol-Duo. After hemostasis, the dura was closed in water-tight fahsion. Epidural space was packed with Surigcels, Gelfoam, and Tissucol-Duo. Bone graft was fixed back with mini-plates. The wound was closed in lyaers. Operators Prof. 杜永光 Assistants R5 曾峰毅 R3 陳國瑋 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Left retrosigmoid approach for hearing preser... 開立醫師: 陳國瑋 開立時間: 2011/09/29 02:52 Pre-operative Diagnosis Left vestibular neurilemmoma Post-operative Diagnosis Left vestibular neurilemmoma Operative Method Left retrosigmoid approach for hearing preservation vestibular neurilemmoma surgery Specimen Count And Types 1 piece About size:PIECES Source:BRAIN TUMOR Pathology pending Operative Findings One capsulated, hypervascular, grayish tumor, about 2.6x2x1.8 cm, located at left cerebellopontine angle, extending into left internal acoutic canal. Canal orifice was enlarged by the tumor. Left facial nerve and cochlear nerve were identified during the surgery, and were preserved well. There was no latency or amplitude change of BAEP and SSEP during the surgery. Facial nerve stimulation localized the left facial nerve precisely. Operative Procedures After intubation and general anesthesia, the patient was put in supine position with left shoulder elevated and head tilting to right. One 8cm curvlinear skin incision was made. One bur hole was made at asterion and the craniotomy window was 5cm in diameter with extesion with driller to the posterior margin of sigmoid sinus. The dura was incised. Cerebellum was retracted slightly posteriorly, and CSF was drained. The tumor and low cranial nerves were identified after cerebellum retraction. Central debulking of the tumor with CUSA was performed. The internal acustic meatus was then drilled open. The intracannalicular portion of the tumor was removed with CUSA and nerve hook. The CN VII VIII was identified after tumor removal in the internal acoustic meatus, and can be tranced back to the nerve existing site of the pons after total tumor removal. Opened internal acoustic canal was packed with Surgicels and Tissucol-Duo. After hemostasis, the dura was closed in water-tight fahsion. Epidural space was packed with Surigcels, Gelfoam, and Tissucol-Duo. Bone graft was fixed back with mini-plates. The wound was closed in lyaers. Operators Prof. 杜永光 Assistants R5 曾峰毅 R3 陳國瑋 相關圖片 黃壽廷 (M,1969/09/17,42y5m) 手術日期 2011/09/28 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Benign neoplasm of craniopharyngeal duct (pouch) 器械術式 Brain tumor Crainotomy(TZENG)，Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 13:20 進入手術室 13:25 麻醉開始 13:50 誘導結束 14:10 抗生素給藥 14:40 手術開始 17:10 抗生素給藥 19:30 手術結束 19:30 麻醉結束 19:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除-手術時間在4~8小時 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Right frontal craniotomy for tumor excision 開立醫師: 李振豪 開立時間: 2011/09/28 20:34 Pre-operative Diagnosis Craniopharyngioma Post-operative Diagnosis Craniopharyngioma Operative Method Right frontal craniotomy for tumor excision Specimen Count And Types 1 piece About size:Multiple pieces Source:3rd ventricle tumor Pathology Pending Operative Findings Bilateral frontal sinus was opened during craniotomy. The frontal sinus was sealed with bone wax and covered with pedicle flap of periosteum after dura closure. Right side olfactory nerve was sacrified during interhemispheric approach. The optic chiasma was located anterior and inferior to the tumor. The tumor was 3.2 x 3.3 x 3.2cm in size, white-yellowish in color, well-demarcated and capsulated, elastic to firm, and hypovascularized in character. The tumor was mainly located within third ventricle and we encountered the tumor after opening the lamina terminalis. Microcalcification was noted withint the tumor. After subcapsule decompression, the capsule of the tumor was tried to remove but failed due to adhere to adjacent brain parenchyma. The pituitary stalk was not identified during tumor excision. Bleeding from superior sagittal sinus occurred during the operation and hemostasis was achieved with Floseal and bipolar electrocautery. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position. The scalp was shaved, scrubbed, and disinfected as usual. Bicoronal scalp incision was made and the periosteum was elevated as pedicle flap. Three burr holes were created followed by one 10x7cm craniotomy window. Dural tenting was done. C-shape durotomy was performed based with superior sagittal sinus. Interhemispheric approach was used and the tumor was noted posterior to optic chiasma. After opening of the lamina terminalis, the tumor was identified. Tumor excision was performed piece by piece. After central debulking, the capsule of the tumor was tried to remove also. Hemostasis was achieved with bipolar electrocautery, Floseal, Gelfoam packing, and Surgicel lining. Dura was closed with 4-0 Prolene. The frontal sinus was sealed with bone wax and covered with pedicle flap of periosteum. The skull plate was fixed back with miniplates, screws, and two central tenting. One subgaleal CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and Appose staples. Operators VS曾漢民 Assistants R5李振豪, R1陸惠宗 相關圖片 許績淵 (M,1954/08/16,57y6m) 手術日期 2011/09/28 手術主治醫師 蔡瑞章 手術區域 東址 005房 01號 診斷 Brain cancer 器械術式 Brain tumor Crainotomy(Others) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 1 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 08:04 進入手術室 08:10 麻醉開始 08:35 誘導結束 08:40 抗生素給藥 09:10 手術開始 11:40 抗生素給藥 12:55 手術結束 12:55 麻醉結束 13:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Left temporo-parietal craniotomy for tumor ex... 開立醫師: 李振豪 開立時間: 2011/09/28 12:53 Pre-operative Diagnosis Left temporal recurrent glioblastoma Post-operative Diagnosis Left temporal recurrent glioblastoma Operative Method Left temporo-parietal craniotomy for tumor excision and implantation of Gliadel Wafer Specimen Count And Types 1 piece About size:Multiple pieces Source:Left temporal tumor Pathology Pending Operative Findings The dura was thickened and adhered to the brain parenchyma, especially previous corticotomy location. The brain was yellowish in color which post-irradiation effect was favored. The tumor was gray-reddish, gelatinous, hypervascularized, ill-defined, and 5x3.5x4cm in size which mainly located at periventricular area and extended into left temporal lobe. Cystic formation at posterior part of the tumor was noted which compatible with MRI finding. The left lateral ventricle was opened during tumor excision and the opening was sealed with Gelfoam packing. Total eight pieces of Gliadel Wafer was implanted into the tumor bed and covered with Surgicel and Gelfoam. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head rotated to right. The scalp was shaved, scrubbed, and disinfected as usual. Reverse U scalp incision was made along operative scar. The scalp flap was elevated. The skull plate was removed after dissection along the margin of previous craniotomy window. Intra-operative sonography was checked for localization of the tumor. C-shape durotomy was performed based with left temporal base. Tumor excision was performed with tumor forceps, bipolar electrocautery, and suction via previous corticotomy. The left lateral ventricle was opened during tumor excision. After tumor excision, the opening of left lateral ventricle was sealed with Gelfoam packing. Total eight pieces of Gliadel Wafer was implanted into tumor bed. The tumor capsule was covered with one large pieces of Gelfoam. The dura was closed with 4-0 prolene. The skull plate was fixed back with miniplates and screws. One subgaleal CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators Prof. 蔡瑞章 Assistants R5李振豪, R1陸惠宗 相關圖片 陳毓芳 (M,2009/12/21,2y2m) 手術日期 2011/09/28 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Subdural hemorrhage, traumatic 器械術式 Cranioplasty and VP shunt, right 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 1 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 08:34 進入手術室 08:34 報到 08:35 麻醉開始 08:40 誘導結束 09:30 手術開始 13:00 開始輸血 13:00 抗生素給藥 16:01 麻醉結束 16:01 手術結束 16:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 頭顱成形術 1 2 R 手術 腦室腹腔分流手術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 7 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: 1. Right fronto-temporo-parietal cranioplasty... 開立醫師: 游健生 開立時間: 2011/09/28 14:50 Pre-operative Diagnosis 1. Right aSDH, status post right fronto-temporo-parietal craniectomy 2. Hydrocephalus, status post EVD insertion via left Kocher point Post-operative Diagnosis 1. Right aSDH, status post right fronto-temporo-parietal craniectomy, status post cranioplasty with autologous bone graft 2. Hydrocephalus, status post EVD insertion via left Kocher point, status post VP shunt implantation Operative Method 1. Right fronto-temporo-parietal cranioplasty with autologous bone graft 2. VP shunt implantation Specimen Count And Types 1 piece About size:3cc Source:CSF Pathology Nil Operative Findings Minor tear of dura at right parietal region because of mild bulging brain and moderate adhesion between dura and galea. The right ventricle was slack. Clear CSF drained out at low pressure after ventriculostomy. Some was sent for routine, biochem, and culture. The ventricle catheter was inserted under intra-operative echo guidance to frontal horn of left lateral ventricle. It was about 8.5cm in length. The peritoneal catheter was about 30cm in length. A medium-pressure Medtronic valve was used as VP shunt valve. Operative Procedures Under ETGA, patient was in supine position with head rotated to left and right shoulder elevated. His abdomen was elevated by towel row. After shaving, we disinfected and draped the operation field as usual. We incised along previous operation wound and elevated the scalp flap. moderate adhesion between dura and galea was noted. A minor tear of dura at right parietal region was covered by DuraGen. A transverse RLQ abdominal incision was made followed by dissection. The peritonium was exposed and opened. The peritoneal catheter was inserted and peritonium closed with purse-string suture. The proximal end of catheter was then passed upwawrd to scalp wound via a subcutaneous tunnel with a relay point at neck. After we confirmed the trajectory of ventricle catheter by intra-operative echo, we created a linear durotomy followed by ventriculostomy and ventricle catheter insertion. Total six dura tenting were done. The autologous bone graft, previously immersed in Gentamycin solution, was fixed back by 5 microplates. The VP shunt was assembled to Medtronic fixed pressure (medium) valve. A subgaleal CWV was placed and wounds were closed in layers with 3-0 Vicryl and 4-0 Nylon. Operators VS 郭夢菲 Assistants R6 鍾文桂 R4 游健生 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: 1. Right fronto-temporo-parietal cranioplasty... 開立醫師: 郭夢菲 開立時間: 2011/09/29 10:54 Pre-operative Diagnosis 1. Right ASDH, status post right fronto-temporo-parietal decompressive craniectomy 2. Hydrocephalus, status post EVD insertion via left Kocher point Post-operative Diagnosis 1. Right ASDH, status post right fronto-temporo-parietal decompressive craniectomy 2. Hydrocephalus, status post EVD insertion via left Kocher point Operative Method 1. Right fronto-temporo-parietal cranioplasty with autologous bone graft 2. VP shunt implantation Specimen Count And Types 1 piece About size:3cc Source:CSF Pathology Nil Operative Findings Minor tear of dura at right parietal region because of mild bulging brain and moderate adhesion between dura and galea. The right ventricle was slack and deviated due to slacken brian during operation. Clear CSF drained out at low pressure after ventriculostomy. Some was sent for routine, biochem, and culture. The ventricle catheter was inserted under intra-operative echo guidance from right lateral toward septum pellucidum and into left frontal horn due to deviated anatomy. It was about 8.5cm in length. The peritoneal catheter was about 30cm in length. A medium-pressure Medtronic valve was used as VP shunt valve. Operative Procedures Under ETGA, patient was in supine position with head rotated to left and right shoulder elevated. His abdomen was elevated by towel row. First, we removed the intracranil pressure monitor kit. After shaving, we disinfected and draped the operation field as usual. We incised along previous operation wound and elevated the scalp flap. Moderate adhesion between dura and galea was noted. A minor tear of dura at right parietal region was covered by DuraGen. A transverse RLQ abdominal incision was made followed by dissection. The peritonium was exposed and opened. The peritoneal catheter was inserted and peritonium closed with purse-string suture. The proximal end of catheter was then passed upwawrd to scalp wound via a subcutaneous tunnel with a relay point at neck. After we confirmed the trajectory of ventricle catheter by intra-operative echo, we created a linear durotomy followed by ventriculostomy and ventricle catheter insertion. The ventricular catheter was advanced from right lateral ventricle into the left frontal horn under echo guidance because the midline deviated toward the left side that made the insertion of ventricular catheter alightly difficult. After echo documentation of the shunt tip position and the flow of CSF, we connected the ventricular catheter to the medium pressure reservoir and then to he peritoneal catheter. A total of six dura tenting were done. The autologous bone graft, previously immersed in Gentamycin solution, was fixed back by 5 microplates. A subgaleal CWV was placed and wounds were closed in layers with 3-0 Vicryl and 4-0 Nylon. Operators VS 郭夢菲 Assistants R6 鍾文桂 R4 游健生 相關圖片 黃昱潔 (F,2011/09/07,6m9d) 手術日期 2011/09/29 手術主治醫師 郭夢菲 手術區域 兒醫 067房 03號 診斷 Prematurity, 1000-1249g 器械術式 Ommaya reservoir implantation 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 3E 紀錄醫師 游健生, 時間資訊 07:00 臨時手術NPO 07:00 開始NPO 11:35 通知急診手術 15:25 報到 15:25 進入手術室 15:30 麻醉開始 15:35 誘導結束 15:50 抗生素給藥 15:56 手術開始 16:30 麻醉結束 16:30 手術結束 16:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 歐氏貯囊置放手術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 套用罐頭: CSF reservoir implantation, right side 開立醫師: 游健生 開立時間: 2011/09/29 17:20 Pre-operative Diagnosis Post-hemorrhagic hydrocephalus Post-operative Diagnosis Post-hemorrhagic hydrocephalus Operative Method CSF reservoir implantation, right side Specimen Count And Types 1 piece About size:4cc Source:CSF Pathology Nil Operative Findings Deep yellowish clear CSF was drained out after ventriculostomy. Some was sent for biochem, routine, and culture. A Medtronic CSF reservoir was implanted at right frontal region. The ventricle catheter was 3.5cm in lenght. A large anterior fontenelle was noted (>6cm in diameter). Operative Procedures Under ETGA, patient was in supine position. After shaving, we disinfected and draped the operation field as usual. A transverse scalp incision was made at right frontal region near anterior border of anterior fontenelle. After dissection, the cranium and anterior fontenelle were exposed. A subgaleal pocket was created for CSF reservoir. Some bone was removed from anterior border of fontenelle by Kerrison and Rongeur. The dura was coagulated and opened transeversely. After coagulation of pia, ventriculostomy was done followed by ventricle catheter insertion. The reservoir was placed in the pocket. Wound was closed in layers with 4-0 Vircyl and 5-0 Nylon. Operators VS 郭夢菲 Assistants R4 游健生 Indication Of Emergent Operation Severe hydrocephalus with intracranial hypertension 相關圖片 記錄__ 手術科部: 套用罐頭: CSF reservoir implantation, right side 開立醫師: 游健生 開立時間: 2011/09/29 17:20 Pre-operative Diagnosis Post-hemorrhagic hydrocephalus Post-operative Diagnosis Post-hemorrhagic hydrocephalus Operative Method CSF reservoir implantation, right side Specimen Count And Types 1 piece About size:4cc Source:CSF Pathology Nil Operative Findings Deep yellowish clear CSF was drained out after ventriculostomy. Some was sent for biochem, routine, and culture. A Medtronic CSF reservoir was implanted at right frontal region. The ventricle catheter was 3.5cm in lenght. A large anterior fontenelle was noted (>6cm in diameter). Operative Procedures Under ETGA, patient was in supine position. After shaving, we disinfected and draped the operation field as usual. A transverse scalp incision was made at right frontal region near anterior border of anterior fontenelle. After dissection, the cranium and anterior fontenelle were exposed. A subgaleal pocket was created for CSF reservoir. Some bone was removed from anterior border of fontenelle by Kerrison and Rongeur. The dura was coagulated and opened transeversely. After coagulation of pia, ventriculostomy was done followed by ventricle catheter insertion. The reservoir was placed in the pocket. Wound was closed in layers with 4-0 Vircyl and 5-0 Nylon. Operators VS 郭夢菲 Assistants R4 游健生 Indication Of Emergent Operation Severe hydrocephalus with intracranial hypertension 相關圖片 記錄__ 手術科部: 套用罐頭: Ommaya reservoir implantation, right side 開立醫師: 郭夢菲 開立時間: 2011/10/04 09:49 Pre-operative Diagnosis Post-hemorrhagic hydrocephalus Post-operative Diagnosis Post-hemorrhagic hydrocephalus Operative Method Ommaya reservoir implantation, right side Specimen Count And Types 1 piece About size:4cc Source:CSF Pathology Nil Operative Findings Deep straw colored CSF was drained out after ventriculostomy. Some was sent for biochem, routine, and culture. A Medtronic CSF reservoir was implanted at right frontal region. The ventricle catheter was 3.5cm in lenght. Operative Procedures Under ETGA, patient was in supine position. After shaving, we disinfected and draped the operation field as usual. A transverse scalp incision was made at right frontal region near anterior border of anterior fontenelle. After dissection, the cranium and anterior fontenelle were exposed. A subgaleal pocket was created for CSF reservoir. Some bone was removed from anterior border of fontenelle by Kerrison and Rongeur. The dura was coagulated and opened transeversely. After coagulation of pia, ventriculostomy was done followed by ventricle catheter insertion. The reservoir was placed in the pocket. Wound was closed in layers with 4-0 Vircyl and 5-0 Nylon. Operators VS 郭夢菲 Assistants R4 游健生 Indication Of Emergent Operation 相關圖片 張玉君 (F,1983/07/29,28y7m) 手術日期 2011/09/29 手術主治醫師 林佳慧 手術區域 東址 001房 03號 診斷 Normal spontaneous delivery with 2° perineal laceration 器械術式 EVD right 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3E 紀錄醫師 陳國瑋, 時間資訊 04:20 臨時手術NPO 04:20 開始NPO 04:23 通知急診手術 04:45 報到 04:50 進入手術室 05:00 麻醉開始 05:30 抗生素給藥 05:30 誘導結束 05:40 手術開始 06:30 麻醉結束 06:30 手術結束 06:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室體外引流 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 記錄__ 手術科部: 外科部 套用罐頭: Right external ventricular drainage 開立醫師: 陳國瑋 開立時間: 2011/09/29 06:58 Pre-operative Diagnosis Right caudate neucleus ICH with IVH, acute hydrocephalus Right caudate nucleus ICH with IVH, acute hydrocephalus Post-operative Diagnosis Right caudate neucleus ICH with IVH, acute hydrocephalus Right caudate nucleus ICH with IVH, acute hydrocephalus Operative Method Right external ventricular drainage Specimen Count And Types 1 piece About size:CSF 5ml Source:CSF Pathology nil Operative Findings The CSF pressure was around 10cmH2O. One metronic external EVD drain was put smoothly through right Kocher point. The CSF was pink. The ventricular catheter was 6.5cm. Operative Procedures After ETGA, the patient was put in supine position. The skin was scrubbed, disinfected and drapped as usual. The right Kocher point was identified and two imaginary lines to right medial canthus and right external meatus were checked. One bur hole was then made. The ventricule was punctured with ventricular needle. CSF was harvested and sent lab test. The wound was then closed in layers after hemostasis. Operators VS賴達明 Assistants R5李振豪 R2陳國瑋 R5李振豪 R3陳國瑋 Indication Of Emergent Operation Acute hydrocephalus, conscious change 相關圖片 郗更陵 (M,1926/05/27,85y9m) 手術日期 2011/09/29 手術主治醫師 蕭輔仁 手術區域 東址 008房 08號 診斷 Low back pain 器械術式 Radiofrequency coagulation(P-G 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 17:45 進入手術室 18:10 麻醉開始 18:14 誘導結束 18:15 手術開始 19:15 手術結束 醫令資訊 類別 名稱 量 刀 側 手術 高頻熱凝療法 1 1 B 記錄__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 蕭輔仁 開立時間: 2011/09/29 19:42 Pre-operative Diagnosis Low back pain Post-operative Diagnosis Ditto Operative Method Pulsed radiofrequency of bilateral L2 dorsal root ganglia Specimen Count And Types nil Pathology Nil Operative Findings 1. Good electrode postion bilaterally 2. Slightly worse reaction to stimulation on left side Operative Procedures 1. Anesthesia : local 2. Position : sprone 3. Skin preparation : after locating L2, back skin were painted with povidone-iodine tincture and draped as usual. 4. Puncture of right L2 DRG 4 cm from midline and 3 cm below pedicle, confirmed with C-arm 5. Stimulation with 2 Hz and 50 Hz to ensure good postiion 6. PRF with 42C 180s x 2 course 7. Same procedure on left side 8. cover puncture site with Band-Aid Operators 蕭輔仁 Assistants 林金枝 (F,1939/09/15,72y5m) 手術日期 2011/09/29 手術主治醫師 王國川 手術區域 東址 003房 03號 診斷 Contusion, scalp 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 15:30 進入手術室 15:35 麻醉開始 15:40 誘導結束 15:52 抗生素給藥 16:27 手術開始 18:30 手術結束 18:30 麻醉結束 18:43 送出病患 18:45 進入恢復室 22:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 頭顱成形術 1 1 R 手術 顱骨重塑模組 1 0 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 摘要__ 手術科部: 外科部 套用罐頭: Cranioplasty with allograft bone. 開立醫師: 鍾文桂 開立時間: 2011/09/29 20:14 Pre-operative Diagnosis Skull defect, right frontal-temporal-parietal. Post-operative Diagnosis Skull defect, right frontal-temporal-parietal. Operative Method Cranioplasty with allograft bone. Specimen Count And Types nil Pathology Nil. Operative Findings Due to bone resorption, multiple skull bone fragments were noted over the epidural space. They were encased by the granulation tissues. The bone cement allografts were also in fragments. They were removed totally. The computer designed allograft bone was implanted at the bony defect.The V-P shunt was left in situ. Operative Procedures Under ETGA, patient was in supine position with right shoulder elevated. His head was rotated to left and shaven. After disinfection and draping, we incised along previous operation wound at scalp. The scalp flap was elevated along plane between galea and dura. The bone edge was exposed and 7 dura tenting were done.The bony defect was repaired with Codman allograft skull bone and fixed by plates and screws. Cranial contour was modified with bone cement. A subgaleal CWV was placed and wound closed in layers with 2-0 Vircyl and 3-0 Nylon. Operators 王國川 Assistants R6 鍾文桂 R3 陳國瑋 R0 怡安. 相關圖片 湯釗宇 (M,1972/07/05,39y8m) 手術日期 2011/09/29 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Subarachnoid hemorrhage 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 游健生, 時間資訊 07:47 報到 08:05 進入手術室 08:10 麻醉開始 08:20 誘導結束 08:35 抗生素給藥 09:05 手術開始 10:40 手術結束 10:40 麻醉結束 10:45 送出病患 10:47 進入恢復室 11:45 離開恢復室 23:49 臨時手術NPO 醫令資訊 類別 名稱 量 刀 側 手術 頭顱成形術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 外科部 套用罐頭: Right Right fronto-temporo-parietal craniopla... 開立醫師: 游健生 開立時間: 2011/09/29 11:05 Pre-operative Diagnosis Right fronto-temporo-parietal cranial defect Post-operative Diagnosis Right fronto-temporo-parietal cranial defect Operative Method Right Right fronto-temporo-parietal cranioplasty with autologous bone flap Specimen Count And Types nil Pathology Nil Operative Findings A large cranial defect at right fronto-temporo-parietal region was noted. The brain was mild slack before cranioplasty. There was clear plane between dura and galea. There was no accidental durotomy during surgery. Two autologous bone flaps were fixed together with 3 wires and back to cranium with 3 miniplates. Cranial contour was modified with bone cement. Operative Procedures Under ETGA, patient was in supine position with right shoulder elevated. His head was rotated to left and shaven. After disinfection and draping, we incised along previous operation wound at scalp. The scalp flap was elevated along plane between galea and dura. The bone edge was exposed and 7 dura tenting were done. Two autologous bone flaps were fixed together with 3 wires and back to cranium with 3 miniplates. Six small holes were created at bone flap for epidural drainage. Cranial contour was modified with bone cement. A subgaleal CWV was placed and wound closed in layers with 2-0 Vircyl and 3-0 Nylon. Operators VS 王國川 Assistants R4 游健生 PGY 涂怡安 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Right Right fronto-temporo-parietal craniopla... 開立醫師: 游健生 開立時間: 2011/09/29 11:07 Pre-operative Diagnosis Right fronto-temporo-parietal cranial defect Post-operative Diagnosis Right fronto-temporo-parietal cranial defect Operative Method Right Right fronto-temporo-parietal cranioplasty with autologous bone flap Specimen Count And Types nil Pathology Nil Operative Findings A large cranial defect at right fronto-temporo-parietal region was noted. The brain was mild slack before cranioplasty. There was clear plane between dura and galea. There was no accidental durotomy during surgery. Two autologous bone flaps were fixed together with 3 wires and back to cranium with 3 miniplates. Cranial contour was modified with bone cement. Operative Procedures Under ETGA, patient was in supine position with right shoulder elevated. His head was rotated to left and shaven. After disinfection and draping, we incised along previous operation wound at scalp. The scalp flap was elevated along plane between galea and dura. The bone edge was exposed and 7 dura tenting were done. Two autologous bone flaps were fixed together with 3 wires and back to cranium with 3 miniplates. Six small holes were created at bone flap for epidural drainage. Cranial contour was modified with bone cement. A subgaleal CWV was placed and wound closed in layers with 2-0 Vircyl and 3-0 Nylon. Operators VS 王國川 Assistants R4 游健生 PGY 涂怡安 相關圖片 李金田 (M,1943/05/20,68y9m) 手術日期 2011/09/29 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 Hydrocephalus 器械術式 Cranioplasty + VPS 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 游健生, 時間資訊 20:50 臨時手術NPO 10:20 報到 11:05 進入手術室 11:10 麻醉開始 11:25 誘導結束 11:30 抗生素給藥 12:01 手術開始 14:30 抗生素給藥 14:55 手術結束 14:55 麻醉結束 15:05 送出病患 15:13 進入恢復室 16:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 手術 顱骨重塑模組 1 0 R 手術 頭顱成形術 1 2 R 手術 腦室腹腔分流手術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: 1. Right fronto-temporo-parietal cranioplasty... 開立醫師: 游健生 開立時間: 2011/09/29 15:23 Pre-operative Diagnosis 1. Right fronto-temporo-parietal cranial defect 2. Isolated ventricles with hydrocephalus Post-operative Diagnosis 1. Right fronto-temporo-parietal cranial defect 2. Isolated ventricles with hydrocephalus Operative Method 1. Right fronto-temporo-parietal cranioplasty with artificial bone graft 2. VP shunt, 3rd ventricle and temporal horn of right lateral ventricle. Specimen Count And Types Nil Pathology Nil Operative Findings A large cranial defect was noted at right fronto-temporo-parietal region. The plane between galea and dura was unclear probably due to artificial dura usage. There was an incidental durotomy at parietal region and was repaired by artificial dura (Cook) with 3-0 prolene. Dilated 3rd ventricle and temporal horn of right lateral ventricle were noted by intra-operative echo. The body and frontal horn of bilateral ventricles were small. Clear CSF gashed out after ventriculostomy at 3rd ventricle and drained slowly at temporal horn. The ventricle catheter at 3rd ventricle was 8cm and at temporal horn was 5cm. Codman programmable valve was used and pressure set at 120mmH2O. Operative Procedures Under ETGA, patient was in supine position with head rotated to left and right shoulder elevated. After shaving, we disinfected and draped the operation field as usual. We incised the scalp along previous operation scar and elevated the scalp flap. An incidental durotomy at parietal region was made and repaired by artificial dura (Cook) with 3-0 prolene. We made 3rd ventriculostomy under inra-operative echo guidance and inserted the ventricle catheter. Temoporal horn was punctured by same method followed by ventricle catheter insertion. After six dura tentings were made, the artificial bone graft was fixed back with 4 plates. The ventricle catheters passed out via burholes at bone graft and connected to Codman programmable valve via a Y-connector. A transverse abdominal incision was made at RUQ region followed by dissection. The peritonium was opened and peritoneal catheter inserted. The peritoneal catheter was passed upward via subcutaneous tunnel and connected to VP shunt. After hemostasis and irrigation, wounds were closed in layers. Operators VS 王國川 Assistants R4 游健生 PGY 涂怡安 Ri 黃威勝 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: 1. Right fronto-temporo-parietal cranioplasty... 開立醫師: 游健生 開立時間: 2011/09/29 15:24 Pre-operative Diagnosis 1. Right fronto-temporo-parietal cranial defect 2. Isolated ventricles with hydrocephalus Post-operative Diagnosis 1. Right fronto-temporo-parietal cranial defect 2. Isolated ventricles with hydrocephalus Operative Method 1. Right fronto-temporo-parietal cranioplasty with artificial bone graft 2. VP shunt, 3rd ventricle and temporal horn of right lateral ventricle. Specimen Count And Types Nil Pathology Nil Operative Findings A large cranial defect was noted at right fronto-temporo-parietal region. The plane between galea and dura was unclear probably due to artificial dura usage. There was an incidental durotomy at parietal region and was repaired by artificial dura (Cook) with 3-0 prolene. Dilated 3rd ventricle and temporal horn of right lateral ventricle were noted by intra-operative echo. The body and frontal horn of bilateral ventricles were small. Clear CSF gashed out after ventriculostomy at 3rd ventricle and drained slowly at temporal horn. The ventricle catheter at 3rd ventricle was 8cm and at temporal horn was 5cm. Codman programmable valve was used and pressure set at 120mmH2O. Operative Procedures Under ETGA, patient was in supine position with head rotated to left and right shoulder elevated. After shaving, we disinfected and draped the operation field as usual. We incised the scalp along previous operation scar and elevated the scalp flap. An incidental durotomy at parietal region was made and repaired by artificial dura (Cook) with 3-0 prolene. We made 3rd ventriculostomy under inra-operative echo guidance and inserted the ventricle catheter. Temoporal horn was punctured by same method followed by ventricle catheter insertion. After six dura tentings were made, the artificial bone graft was fixed back with 4 plates. The ventricle catheters passed out via burholes at bone graft and connected to Codman programmable valve via a Y-connector. A transverse abdominal incision was made at RUQ region followed by dissection. The peritonium was opened and peritoneal catheter inserted. The peritoneal catheter was passed upward via subcutaneous tunnel and connected to VP shunt. After hemostasis and irrigation, wounds were closed in layers. Operators VS 王國川 Assistants R4 游健生 PGY 涂怡安 Ri 黃威勝 相關圖片 方慧雯 (F,1977/07/06,34y8m) 手術日期 2011/09/29 手術主治醫師 王國川 手術區域 東址 003房 04號 診斷 Scalp tumor 器械術式 Scalp tumor Suture 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 鍾文桂, 時間資訊 23:52 臨時手術NPO 18:55 進入手術室 19:08 麻醉開始 19:09 誘導結束 19:09 麻醉結束 19:10 手術開始 19:10 抗生素給藥 19:45 手術結束 19:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 頭皮腫瘤 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Total excision of scalp tumor. 開立醫師: 鍾文桂 開立時間: 2011/09/29 20:05 Pre-operative Diagnosis Retroauricular scalp tumor, left. Post-operative Diagnosis Retroauricular scalp tumor, left. Operative Method Total excision of scalp tumor. Specimen Count And Types 1 piece About size:3.5cm Source:Retroauricular scalp tumor. Pathology Pending. Operative Findings 1. A hard, well-delineated, yellowish tumor with moderate vascularity at left retroauricular area. Operative Procedures Under local anesthesia, the patient was lying on the bed and in lateral decubitus position. After shaving, disinfection, and draping of the left retroauricular area, an ellipse skin incision was made over the top of the bulging mass. After dissecting out the capsule plane, the tumor was excised en bloc. After well hemostasis, the wound was closed in layers. Operators 王國川 Assistants R6 鍾文桂 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Total excision of scalp tumor. 開立醫師: 鍾文桂 開立時間: 2011/10/05 20:13 Pre-operative Diagnosis Retroauricular scalp tumor, left. Post-operative Diagnosis Retroauricular scalp tumor, left. Operative Method Total excision of scalp tumor. Specimen Count And Types 1 piece About size:3.5cm Source:Retroauricular scalp tumor. Pathology Pending. Operative Findings 1. A hard, well-delineated, yellowish tumor with moderate vascularity at left retroauricular area. Operative Procedures Under local anesthesia, the patient was lying on the bed and in lateral decubitus position. After shaving, disinfection, and draping of the left retroauricular area, an ellipse skin incision was made over the top of the bulging mass. After dissecting out the capsule plane, the tumor was excised en bloc. After well hemostasis, the wound was closed in layers. Operators 王國川 Assistants R6 鍾文桂 相關圖片 林清秀 (M,1951/07/27,60y7m) 手術日期 2011/09/29 手術主治醫師 蔡翊新 手術區域 東址 005房 01號 診斷 Cerebral aneurysm 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 李思慧, 時間資訊 23:53 臨時手術NPO 08:14 進入手術室 08:20 麻醉開始 08:25 誘導結束 09:30 手術開始 10:30 手術結束 10:30 麻醉結束 10:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室腹腔分流手術 1 2 R 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 蔡翊新 開立時間: 2011/09/29 09:51 Pre-operative Diagnosis Right A1 aneurysm s/p clipping; Hydrocephalus. Post-operative Diagnosis Right A1 aneurysm s/p clipping; Hydrocephalus. Operative Method Ventriculoperitoneal Shunt, right Kocher. Specimen Count And Types 3 tubes of CSF, sent for routine, BCS and bacterial culture. Pathology Nil. Operative Findings Clean CSF gushed out upon opening the previous burr hole. Ventricular catheter: 6.5 cm in depth, medium-pressure; Peritoneal catheter: 25 cm in depth, low-pressure. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 5 cm curvilinear, right frontal, corresponded to the location of right frontal horn. The burr hole at right Kocher point was opened. 5. Rt lateral ventricle was tapped by a ventricular needle, then a 6.5 cm segment of the ventricular catheter was introduced into the ventricle. The outer end of the catheter was connected to a Pudenz reservoir. 6. A minilaparotomy was made at RUQ of the abdomen, then a trocar was pushed into peritoneal cavity. Subsequently, distal 25 cm segment of the peritoneal catheter (low pressure) was introduced into the peritoneal cavity through the outer tube of the trochar. The proximal end of this catheter was passed through subcutaneous tunnel at forechest, neck, right retroauricular area and connected the reservoir. The shunt system was checked to make sure its function was working. 7. The reservoir was fixed to pericranium by 3 stitches. 8. Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 9. Course of the surgery: smooth. Operators VS蔡翊新 Assistants R4王奐之R0李思慧 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 蔡翊新 開立時間: 2011/09/29 09:51 Pre-operative Diagnosis Right A1 aneurysm s/p clipping; Hydrocephalus. Post-operative Diagnosis Right A1 aneurysm s/p clipping; Hydrocephalus. Operative Method Ventriculoperitoneal Shunt, right Kocher. Specimen Count And Types 3 tubes of CSF, sent for routine, BCS and bacterial culture. Pathology Nil. Operative Findings Clean CSF gushed out upon opening the previous burr hole. Ventricular catheter: 6.5 cm in depth, medium-pressure; Peritoneal catheter: 25 cm in depth, low-pressure. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 5 cm curvilinear, right frontal, corresponded to the location of right frontal horn. The burr hole at right Kocher point was opened. 5. Rt lateral ventricle was tapped by a ventricular needle, then a 6.5 cm segment of the ventricular catheter was introduced into the ventricle. The outer end of the catheter was connected to a Pudenz reservoir. 6. A minilaparotomy was made at RUQ of the abdomen, then a trocar was pushed into peritoneal cavity. Subsequently, distal 25 cm segment of the peritoneal catheter (low pressure) was introduced into the peritoneal cavity through the outer tube of the trochar. The proximal end of this catheter was passed through subcutaneous tunnel at forechest, neck, right retroauricular area and connected the reservoir. The shunt system was checked to make sure its function was working. 7. The reservoir was fixed to pericranium by 3 stitches. 8. Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 9. Course of the surgery: smooth. Operators VS蔡翊新 Assistants R4王奐之R0李思慧 相關圖片 黃宇智 (M,1977/09/21,34y5m) 手術日期 2011/09/29 手術主治醫師 蔡翊新 手術區域 東址 002房 05號 診斷 Intracranial hemorrhage 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 陸惠宗, 時間資訊 15:15 通知急診手術 15:25 進入手術室 15:27 麻醉開始 15:45 誘導結束 15:55 抗生素給藥 16:16 手術開始 16:55 手術結束 16:55 麻醉結束 17:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱內壓視置入 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Bilateral thoracoscopic T2 sympathectomy 開立醫師: 曾峰毅 開立時間: 2011/09/29 17:10 Pre-operative Diagnosis Head injury Post-operative Diagnosis Head injury Operative Method Bilateral thoracoscopic T2 sympathectomy Left frontal burr hole for ICP monitor insertion. Specimen Count And Types nil Pathology Nil Operative Findings Codman ICP reference is 467. ICP after durotomy was 9 mmHg. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to right. We shaved, scrubbed, disinfected, and then draped the patient as usual, and made one longitudinal scalp incision at left frontal area. We drilled one burr hole, and made durotomy. We inserted ICP monitor, and closed the wound in layers. Operators VS 蔡翊新 Assistants R5 曾峰毅 R1 陸惠宗 Indication Of Emergent Operation Head injury 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Bilateral thoracoscopic T2 sympathectomy 開立醫師: 陸惠宗 開立時間: 2011/09/30 01:40 Pre-operative Diagnosis Head injury Post-operative Diagnosis Head injury Operative Method Left frontal burr hole for ICP monitor insertion. Specimen Count And Types nil Pathology Nil Operative Findings Codman ICP reference is 467. ICP after durotomy was 9 mmHg. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to right. We shaved, scrubbed, disinfected, and then draped the patient as usual, and made one longitudinal scalp incision at left frontal area. We drilled one burr hole, and made durotomy. We inserted ICP monitor, and closed the wound in layers. Operators VS 蔡翊新 Assistants R5 曾峰毅 R1 陸惠宗 Indication Of Emergent Operation Head injury 相關圖片 詹宏建 (M,1961/11/02,50y4m) 手術日期 2011/09/29 手術主治醫師 蔡翊新 手術區域 東址 005房 02號 診斷 Extradural hemorrhage following injury with mention of open intracranial wound, with prolonged (more than 24 hours) loss of consciousness without return to pre-existing conscious level 器械術式 OPLL- Anterior Corpectomy 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 李思慧, 時間資訊 20:55 臨時手術NPO 11:37 進入手術室 11:40 麻醉開始 12:05 誘導結束 12:38 手術開始 13:00 抗生素給藥 17:00 手術結束 17:00 麻醉結束 17:18 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 椎間盤切除術-頸椎 1 1 手術 脊椎融合術-前融合,有固定物)≦四節 1 2 摘要__ 手術科部: 外科部 套用罐頭: Anterior Discectomy and Fusion, Cervical Spine 開立醫師: 蔡翊新 開立時間: 2011/09/29 17:03 Pre-operative Diagnosis C4 fracture-dislocation with cord compression Post-operative Diagnosis C4 fracture-dislocation with cord compression Operative Method C4 corpectomy + C3-4, C4-5 discectomy + C3-5 mesh-cage fusion + C3-5 plate fixation C4 corpectomy + C3-4, C4-5 discectomy + C3-5 PYRAMESH-cage fusion + C3-5 plate fixation Specimen Count And Types nil Pathology Nil. Operative Findings A fractured segment of vertebral body at C4 was noted. The C3-4 and C4-5 discs showed degenerative change. The C4 body was posteriorly displaced causing thecal sac compression, which expanded well after C4 corpectomy. Postop C-arm x-ray showed good positions of mesh cage, plate and screws. Operative Procedures 1. Anesthesia: endotracheal general 2. Position: supine with neck hyperextended by a air cuff placed beneath the shoulder. 3. Skin preparation: the anterior neck was shaved and scrubbed with povidone-iodinew detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4.Incision; 5 cm, transverse middle cervical, extended from anterior margin of sternocleidomastoid (SCM) muscle to thyroid cartilage. 5. The plastysma muscle was transected and mobilized from the underlying superficial cervical fascia which was then opened in vertical direction along the anterior margin of the SCM muscle. 6.The dissection was advanced at the loose plane between SCM muscle and strip muscles until the prevertebral fascia had been reached. The former structure was retracted to the lateral and the later structures with esophagus and trachea to the opposite side by Cloward cervical retractor. 7.The prevertebral fascia was opened vertically, the lesion intervertebral space was exposed and identified by intraoperative portable X-ray. 8.The most medial portion of the longus coli muscles on both sides were detached from the vertebral bodies to provide a wider exposure of the vertebral bodies. 9.The anterior longitudinal ligment was incised transversely at the margins of intervertebral space, the annulus fibrosus was cut too. 10.The C4 vertebral body was excised by high-speed airdrill and Kerrison Rongeur. The degenerated disc and cartilage plate were removed by curette and the anterior-inferior rim of C3,5 vertebral body was resected by Kerrison punch for easier approach to the posterior rim of the intervertebral space. 11.The surfaces of vertebral bodies at this intervertebral space was trimed by high-speed air drill. 12.A 2 cm mesh cage was filled up with Stimulan Calcium Sulfate pellets and packed into the intervertebral space tightly by an impactor. The intervertebral space was widened by pulling the patients head while the impaction of the mesh cage was doing. 12.A 2 cm PYRAMESH cage was filled up with Stimulan Calcium Sulfate pellets and packed into the intervertebral space tightly by an impactor. The intervertebral space was widened by pulling the patients head while the impaction of the mesh cage was doing. 13.A 40-mm plate and 4 14x4mm screws were applied for C3-5 fixation. The position of the instruments was checked by C-arm x-ray. 14.The air cuff beneath the shoulder was deflated, the Cloward cervical retractor removed. 15.Wound closure: continuous suture with 3/0 Vicryl for plastisma and continuous suture with 4/0 Vicryl on the subcutaneous layer. Adhesive tapes were applied to approximate the skin. 16.Drain: a minihemovac was placed. 17.Blood transfusion: nil. Blood loss: 100 ml. 18.Course of the surgery: smooth. Operators 蔡翊新 Assistants R4王奐之R0李思慧 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Anterior Discectomy and Fusion, Cervical Spine 開立醫師: 蔡翊新 開立時間: 2011/09/29 17:09 Pre-operative Diagnosis C4 fracture-dislocation with cord compression Post-operative Diagnosis C4 fracture-dislocation with cord compression Operative Method C4 corpectomy + C3-4, C4-5 discectomy + C3-5 PYRAMESH-cage fusion + C3-5 plate fixation Specimen Count And Types nil Pathology Nil. Operative Findings A fractured segment of vertebral body at C4 was noted. The C3-4 and C4-5 discs showed degenerative change. The C4 body was posteriorly displaced causing thecal sac compression, which expanded well after C4 corpectomy. Postop C-arm x-ray showed good positions of mesh cage, plate and screws. Operative Procedures 1. Anesthesia: endotracheal general 2. Position: supine with neck hyperextended by a air cuff placed beneath the shoulder. 3. Skin preparation: the anterior neck was shaved and scrubbed with povidone-iodinew detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4.Incision; 5 cm, transverse middle cervical, extended from anterior margin of sternocleidomastoid (SCM) muscle to thyroid cartilage. 5. The plastysma muscle was transected and mobilized from the underlying superficial cervical fascia which was then opened in vertical direction along the anterior margin of the SCM muscle. 6.The dissection was advanced at the loose plane between SCM muscle and strip muscles until the prevertebral fascia had been reached. The former structure was retracted to the lateral and the later structures with esophagus and trachea to the opposite side by Cloward cervical retractor. 7.The prevertebral fascia was opened vertically, the lesion intervertebral space was exposed and identified by intraoperative portable X-ray. 8.The most medial portion of the longus coli muscles on both sides were detached from the vertebral bodies to provide a wider exposure of the vertebral bodies. 9.The anterior longitudinal ligment was incised transversely at the margins of intervertebral space, the annulus fibrosus was cut too. 10.The C4 vertebral body was excised by high-speed airdrill and Kerrison Rongeur. The degenerated disc and cartilage plate were removed by curette and the anterior-inferior rim of C3,5 vertebral body was resected by Kerrison punch for easier approach to the posterior rim of the intervertebral space. 11.The surfaces of vertebral bodies at this intervertebral space was trimed by high-speed air drill. 12.A 2 cm PYRAMESH cage was filled up with Stimulan Calcium Sulfate pellets and packed into the intervertebral space tightly by an impactor. The intervertebral space was widened by pulling the patients head while the impaction of the mesh cage was doing. 13.A 40-mm plate and 4 14x4mm screws were applied for C3-5 fixation. The position of the instruments was checked by C-arm x-ray. 14.The air cuff beneath the shoulder was deflated, the Cloward cervical retractor removed. 15.Wound closure: continuous suture with 3/0 Vicryl for plastisma and continuous suture with 4/0 Vicryl on the subcutaneous layer. Adhesive tapes were applied to approximate the skin. 16.Drain: a minihemovac was placed. 17.Blood transfusion: nil. Blood loss: 100 ml. 18.Course of the surgery: smooth. Operators 蔡翊新 Assistants R4王奐之R0李思慧 相關圖片 高崇武 (M,1941/02/24,71y0m) 手術日期 2011/09/29 手術主治醫師 蔡翊新 手術區域 東址 005房 03號 診斷 Chronic renal failure 器械術式 Burr hole (trephination) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 李思慧, 時間資訊 00:00 臨時手術NPO 17:55 進入手術室 18:00 麻醉開始 18:03 誘導結束 18:28 手術開始 19:05 手術結束 19:05 麻醉結束 19:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Chronic Subdural Hematoma 開立醫師: 蔡翊新 開立時間: 2011/09/29 19:02 Pre-operative Diagnosis Right frontoparietal subdural fluid collection, suspected empyema. Post-operative Diagnosis Right frontoparietal subdural effusion. Operative Method Right frontoparietal burr hole for subdural effusion drainage. Specimen Count And Types 3 tubes of subdural fluid, 1 ml each. Pathology Nil. Operative Findings Outer membrane was noted after opening the dura. Sanginous fluid was noted at the subdural space, and the pressure was low. The brain expanded well after removal of the fluid. There was no pus detected. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: linear, 5 cm, at right frontoparietal region. Raney clips were applied to the scalp edge for temporary hemostasis. 5. Burr hole: at right frontoparietal region. 6. Dural tenting: by 2 stitches of 2/0 silk, distributed along the edge of the trephine. 7. Dural incision: cruciate. 8. The outer membrane was coagulated by Bovie along the edge of dural incision, then exicsed. 9. The effusion in the subdural space was evacuated by sucker, then thoroughly irrigated with N.S. through a rubber tube until the return was clean. 10.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous sutures with 2/0 Vicryl and skin by continuouss suture with 3/0 nylon. 11.Drain: none. 12.Blood transfusion: nil. Blood loss: minimal. 13.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R4王奐之R0李思慧 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Chronic Subdural Hematoma 開立醫師: 蔡翊新 開立時間: 2011/09/29 19:02 Pre-operative Diagnosis Right frontoparietal subdural fluid collection, suspected empyema. Post-operative Diagnosis Right frontoparietal subdural effusion. Operative Method Right frontoparietal burr hole for subdural effusion drainage. Specimen Count And Types 3 tubes of subdural fluid, 1 ml each. Pathology Nil. Operative Findings Outer membrane was noted after opening the dura. Sanginous fluid was noted at the subdural space, and the pressure was low. The brain expanded well after removal of the fluid. There was no pus detected. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: linear, 5 cm, at right frontoparietal region. Raney clips were applied to the scalp edge for temporary hemostasis. 5. Burr hole: at right frontoparietal region. 6. Dural tenting: by 2 stitches of 2/0 silk, distributed along the edge of the trephine. 7. Dural incision: cruciate. 8. The outer membrane was coagulated by Bovie along the edge of dural incision, then exicsed. 9. The effusion in the subdural space was evacuated by sucker, then thoroughly irrigated with N.S. through a rubber tube until the return was clean. 10.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous sutures with 2/0 Vicryl and skin by continuouss suture with 3/0 nylon. 11.Drain: none. 12.Blood transfusion: nil. Blood loss: minimal. 13.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R4王奐之R0李思慧 相關圖片 楊義忠 (M,1936/09/27,75y5m) 手術日期 2011/09/30 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 陳國瑋, 時間資訊 21:00 臨時手術NPO 07:30 報到 08:10 進入手術室 08:20 麻醉開始 08:50 誘導結束 08:50 抗生素給藥 09:00 手術開始 11:50 抗生素給藥 14:50 開始輸血 15:27 抗生素給藥 15:35 麻醉結束 15:35 手術結束 15:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 7 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 顱底瘤手術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Right pterion approach for optic nerve decomp... 開立醫師: 陳國瑋 開立時間: 2011/09/30 13:58 Pre-operative Diagnosis Tuberculum sellae meningioma Post-operative Diagnosis Tuberculum sellae meningioma Operative Method Right pterion approach for optic nerve decompression Specimen Count And Types 1 piece About size:fragments Source:brain tumor Pathology pending Operative Findings Operative Procedures After intubation and general anesthesia, the patient was put in supine position. The head was scrubbion Operators Assistants 相關圖片 摘要__ 手術科部: 外科部 套用罐頭: Right pterion approach for optic nerve decomp... 開立醫師: 陳國瑋 開立時間: 2011/09/30 14:02 Pre-operative Diagnosis Tuberculum sellae meningioma Post-operative Diagnosis Tuberculum sellae meningioma Operative Method Right pterion approach for optic nerve decompression Specimen Count And Types 1 piece About size:fragments Source:brain tumor Pathology pending Operative Findings Operative Procedures After intubation and general anesthesia, the patient was put in supine position. The head was scrubbion After intubation and general anesthesia, the patient was put in supine position. The head was scrubbed and prepared as ususal and was fixed with Mayfield clamp. One curve skine began anterior the ear and extended to the contralateral frontal scalp. The skin was then reflaced. Three burr holes were made and craniotomy window Operators Assistants 相關圖片 摘要__ 手術科部: 外科部 套用罐頭: Right pterion approach for meningioma excisio... 開立醫師: 曾峰毅 開立時間: 2011/09/30 15:25 Pre-operative Diagnosis Meningioma arising from tuberculum sellae and posterior portion of planum sphenoidale Post-operative Diagnosis Meningioma arising from tuberculum sellae and posterior portion of planum sphenoidale Operative Method Right pterion approach for meningioma excision, Simpson grade II, and right optic nerve decompression Specimen Count And Types 1 piece About size:fragments Source:brain tumor Pathology Pending Operative Findings Sphenoid sinus development is prominent in this patient, and was opened during the anterior choroidectomy. The sphenoid sinus mucosa was left intact in situ. One dura-based, 4.8x4x3 cm, soft to elastic, grayish, capsulated, moderately-vascularized tumor was noted at posetrior portion of frontal base, more at left, arising from tuberculum sellae and posterior portion of planum sphenoidale. The tumor encased bilateral carotid artery without obvious invasion, pushed bilateral optic nerve upward and laterally, and deviated the pituitary stalk to the right. Left otpic nerve is more atrophic than the right one. There was no latency or amplitude change of SSEP during the operation. Blood loss was 850 ml. Operative Procedures After intubation and general anesthesia, the patient was put in supine position with head rotated to the right and fixed with Mayfield head clamp. The scalp was shaved, scrubbed, disinfected, and then draped as usual. We made one curvilinear skin incision at right frontal area, and reflected the scalp flap inferiorly. Yasagil fat pad was diseccted for facial nerve preservation. We transected right temporalis muscle along the superior temporal line, and retracted it inferiorly. We drilled three burr holes, and crerated one 6x10 cm craniotomy with air-drill. Temporal base was drilled to flat, and anterior chroidectomy was performed as Dolenc approach. Right temporal dura reflection was disseected to expose first two braches of trigeminal nerves. Cavernous sinus bleeding was stopped by Gelfoam packing. Sphenoid sinus was packed with Gelfoam as well. Right optic canal was opened with diamond burr. One Curvilinear durotomy was made, and right frontal lobe was retrated slighly away from the frontal base. Devascularization of the tumor was performed with bipolar cauterization, and bilateral optic nerve, oculomotor nerve, internal carotid artery, and pituitary stalk was preserved well during the tumor removal. Tumor was removed totally, and tumor-based dura was cauterized with bipolar cauterization. Duroplasty was performed with water-tie suture with 4-0 prolene. Central tenting was done, adn the boen graft was fixed back with mini-plates. One sugaleal CWV was placed, following by wound closure. Operators Prof. 杜永光 Assistants R5 曾峰毅 R3 陳國瑋 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Right pterion approach for meningioma excisio... 開立醫師: 陳國瑋 開立時間: 2011/09/30 16:04 Pre-operative Diagnosis Meningioma arising from tuberculum sellae and posterior portion of planum sphenoidale Post-operative Diagnosis Meningioma arising from tuberculum sellae and posterior portion of planum sphenoidale Operative Method Right pterion approach for meningioma excision, Simpson grade II, and right optic nerve decompression Specimen Count And Types 1 piece About size:fragments Source:brain tumor Pathology Pending Operative Findings Sphenoid sinus development is prominent in this patient, and was opened during the anterior choroidectomy. The sphenoid sinus mucosa was left intact in situ. One dura-based, 4.8x4x3 cm, soft to elastic, grayish, capsulated, moderately-vascularized tumor was noted at posetrior portion of frontal base, more at left, arising from tuberculum sellae and posterior portion of planum sphenoidale. The tumor encased bilateral carotid artery without obvious invasion, pushed bilateral optic nerve upward and laterally, and deviated the pituitary stalk to the right. Left otpic nerve is more atrophic than the right one. There was no latency or amplitude change of SSEP during the operation. Blood loss was 850 ml. Operative Procedures After intubation and general anesthesia, the patient was put in supine position with head rotated to the left and fixed with Mayfield head clamp. The scalp was shaved, scrubbed, disinfected, and then draped as usual. We made one curvilinear skin incision at right frontal area, and reflected the scalp flap inferiorly. Yasagil fat pad was diseccted for facial nerve preservation. We transected right temporalis muscle along the superior temporal line, and retracted it inferiorly. We drilled three burr holes, and crerated one 6x10 cm craniotomy with air-drill. Temporal base was drilled to flat, and anterior chroidectomy was performed as Dolenc approach. Right temporal dura reflection was disseected to expose first two braches of trigeminal nerves. Cavernous sinus bleeding was stopped by Gelfoam packing. Sphenoid sinus was packed with Gelfoam as well. Right optic canal was opened with diamond burr. One Curvilinear durotomy was made, and right frontal lobe was retrated slighly away from the frontal base. Devascularization of the tumor was performed with bipolar cauterization, and bilateral optic nerve, oculomotor nerve, internal carotid artery, and pituitary stalk was preserved well during the tumor removal. Tumor was removed totally, and tumor-based dura was cauterized with bipolar cauterization. Duroplasty was performed with water-tie suture with 4-0 prolene. Central tenting was done, adn the boen graft was fixed back with mini-plates. One sugaleal CWV was placed, following by wound closure. Operators Prof. 杜永光 Assistants R5 曾峰毅 R3 陳國瑋 相關圖片 陳柯月嬌 (F,1949/03/01,63y0m) 手術日期 2011/09/30 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Secondary cancer of Brain and spinal cord 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 李振豪, 時間資訊 21:03 臨時手術NPO 08:02 進入手術室 08:15 麻醉開始 08:50 誘導結束 08:51 抗生素給藥 09:15 手術開始 11:51 抗生素給藥 12:10 手術結束 12:10 麻醉結束 12:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除-手術時間在4小時以內 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Left fronto-temporal craniotomy for tumor exc... 開立醫師: 李振豪 開立時間: 2011/09/30 12:39 Pre-operative Diagnosis Left temporal tumor, suspect metastasis Post-operative Diagnosis Left temporal tumor, suspect metastasis Operative Method Left fronto-temporal craniotomy for tumor excision Specimen Count And Types 1 piece About size:Multiple pieces Source:left temporal tumor Pathology Pending Operative Findings The cystic component was filled with xanthochromic and clear fluid. The wall of the cystic tumor was removed and temporal horn of left lateral ventricle was entered. The solid part of the tumor was gray-yellowish, glandular and nodular in character, and moderate vascularized. The margin between the tumor and brain parenchyma was difficult to dissect due to thin tumor wall. The tumor size was 5.4 x 4.0 x 4.1cm in size. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head rotated to right. The scalp was shaved, scrubbed, and disinfected as usual. Reverse U scalp incision was made and the scalp flap was elevated. The temporalis muscle was elevated with periosteum. Four burr holes were created followed by one 7x5cm craniotomy window. Dural tenting was done. Intra-operative sonography was used for localization of the tumor. C-shape durotomy based with temporal skull base was performed. Left inferior temporal gyrus corticotomy was conducted for tumor excision. The fluid within the cystic tumor gushed out and the brain became slack soon. The tumor was removed with bipolar electrocautery, tumor forceps, and suction. The left temporal horn was entered during tumor excision. Hemostasis was achieved with bipolar electrocautery and Surgicel lining. The dura was closed with 4-0 Prolene and one 1x3 inch Duraform. The skull plate was fixed back with miniplates, screws, and two central tenting. The temporalis muscle was fixed back. One subgaleal CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and Appose staples. Operators VS曾漢民 Assistants R5李振豪, R1陸惠宗 相關圖片 陳淑莉 (F,1967/03/11,45y0m) 手術日期 2011/09/30 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 李振豪, 時間資訊 21:06 臨時手術NPO 12:20 報到 12:30 進入手術室 12:40 麻醉開始 12:45 抗生素給藥 13:10 誘導結束 13:15 手術開始 15:05 開始輸血 15:45 抗生素給藥 18:30 麻醉結束 18:30 手術結束 18:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Right frontal craniotomy for tumor excision 開立醫師: 李振豪 開立時間: 2011/09/30 19:20 Pre-operative Diagnosis Tuberculum sella meningioma Post-operative Diagnosis Tuberculum sella meningioma Operative Method Right frontal craniotomy for tumor excision Specimen Count And Types 1 piece About size:Multiple pieces Source:Suprasellar tumor Pathology Pending Operative Findings The tumor was 3.1 x 2.5 x 1.7cm in size, gray-reddish in color, soft, well-capsulated, and hypervascularized. Right optic nerve was pushed upward by the tumor and compressed tightly. The right internal carotid artery also encased by the tumor. During tumor excision, iatrogenic injury of right internal carotid artery was noted when we cut off the feeding artery. Hemostasis was tried with bipolar electrocautery and aneurysm clip but failed. Floseal with manual compression of right common carotid artery was tried for several tims and finally the bleeding stop. The rest of the tumor was removed except the tumor adjacent to the right ICA. Right olfactory nerve was sacrified during the operation. Large dural laceration(anterior, medial, and posterior margin of craniotomy window) was noted after craniotomy and duroplasty was conducted with COOK artificial dura. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. Bicoronal scalp incision was made and the scalp flap was elevated. Three burr holes were created and one 6x5cm craniotomy window was performed. The right frontal skull base was drilled more flatening before we enter the intra-dural space. Laceration of the dura was noted and we entered the frontal base via the laceration of the dura. The frontal lobe was retracted upward and the tumor was encountered. Devascularization was performed followed by central debulking. Unfortunately, right ICA injury during resection of the feeding artery was noted and massive bleeding occurred. Hemostasis was achieved finally with Floseal under manual compression of right neck common carotid artery. The tumor was nearly total removed except the tumor adjacent to the ICA. The pituitary stalk was noted after tumor excision and left intact. Duroplasty was performed with COOK artificial dura. The skull plate was fixed back with miniplates, screws, and two central tenting. One subgaleal CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and Appose staples. Operators VS曾漢民 Assistants R5李振豪, R1陸惠宗 相關圖片 羅玉梅 (F,1955/04/25,56y10m) 手術日期 2011/09/30 手術主治醫師 曾勝弘 手術區域 東址 005房 03號 診斷 Brain tumors, malignant 器械術式 remove port-A 手術類別 緊急手術 手術部位 胸 傷口分類 污染 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 陳國瑋, 時間資訊 08:51 通知急診手術 18:59 報到 19:00 進入手術室 19:19 麻醉開始 19:20 手術開始 19:58 手術結束 20:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 肌肉或深部組織腫瘤切除術及異物取出術 1 1 R 記錄__ 手術科部: 內科部 套用罐頭: Port-A removal 開立醫師: 陳國瑋 開立時間: 2011/09/30 20:02 Pre-operative Diagnosis Port-A infection Post-operative Diagnosis Port-A infection Operative Method Port-A removal Specimen Count And Types 2 pieces About size:wound swab Source:port-A pocket About size:3cm Source:catheter tip Pathology nil Operative Findings Erythematous change of the skin. Pus was noted in the port-A pocket. Operative Procedures 1. Supine local anesthesia with 1% lidocaine 2. Skin incision along previous wound 3. Dissection was done to reveal the port 4. The port was removed 5. Do swab and catheter tip culture 6. The wound and pocket was irrigated with normal saline 500ml 6. The wound was closed in layers after hemostasis 7. The wound was closed in layers after hemostasis Operators VS 曾勝宏 VS 曾勝弘 Assistants R3 陳國瑋 Indication Of Emergent Operation Infection 相關圖片 吳泰忠 (M,1980/09/13,31y6m) 手術日期 2011/09/30 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Lumbar Spondylosis 器械術式 Spinal fusion posterior, L5/S1 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 陳以幸, 時間資訊 23:28 臨時手術NPO 07:45 報到 08:05 進入手術室 08:15 麻醉開始 08:30 誘導結束 09:20 抗生素給藥 09:30 手術開始 12:50 抗生素給藥 13:42 手術結束 13:42 麻醉結束 13:46 送出病患 13:50 進入恢復室 14:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎間盤切除術-腰椎 1 2 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Transforaminal interbody fusion and internal ... 開立醫師: 鍾文桂 開立時間: 2011/09/30 14:21 Pre-operative Diagnosis Spinal stenosis and herniated intervertebral disc, L5-S1. Post-operative Diagnosis Spinal stenosis and herniated intervertebral disc, L5-S1. Operative Method Transforaminal interbody fusion and internal fixation, L5/S1. Specimen Count And Types nil Pathology nil Operative Findings 1. transpedicle screws: 6.2x45 at bilateral L5, 6.2x35 mm at bilateral S1, banana cage: 13mm( from left side, rods: 5cm. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After C-arm localization, we made one midline skin incision to dissect bilatearl laminae, L5 and S1. Posterior instrumentation was performed with transpedicular screws at bilateral pedicles of L5 and S1. L5 hemilaminectomy and L5/S1 diskectomy was performed for decompression. Transforaminal lumbar interbody fusion was done with PEEK cage and autologous bone graft at L5/S1. After hemostasis with Floseal, the wound was closed in layers after one submuscular hemovac. With endotracheal general anaesthesia, the patient was put in prone position. After C-arm localization, we made one midline skin incision to dissect bilatearl laminae, L5 and S1. Posterior instrumentation was performed with transpedicular screws at bilateral pedicles of L5 and S1. L5 hemilaminectomy and L5/S1 diskectomy was performed for decompression. Transforaminal lumbar interbody fusion was done with PEEK cage and autologous bone graft at L5/S1. After hemostasis , the wound was closed in layers after one submuscular hemovac. Operators 賴達明 Assistants R6鍾文桂 R2陳以幸 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Transforaminal interbody fusion and internal ... 開立醫師: 陳以幸 開立時間: 2011/10/18 13:10 Pre-operative Diagnosis Spinal stenosis and herniated intervertebral disc, L5-S1. Post-operative Diagnosis Spinal stenosis and herniated intervertebral disc, L5-S1. Operative Method Transforaminal interbody fusion and internal fixation, L5/S1. Specimen Count And Types nil Pathology nil Operative Findings 1. transpedicle screws: 6.2x45 at bilateral L5, 6.2x35 mm at bilateral S1, banana cage: 13mm( from left side, rods: 5cm. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After C-arm localization, we made one midline skin incision to dissect bilatearl laminae, L5 and S1. Posterior instrumentation was performed with transpedicular screws at bilateral pedicles of L5 and S1. L5 hemilaminectomy and L5/S1 diskectomy was performed for decompression. Transforaminal lumbar interbody fusion was done with PEEK cage and autologous bone graft at L5/S1. After hemostasis , the wound was closed in layers after one submuscular hemovac. Operators 賴達明 Assistants R6鍾文桂 R2陳以幸 相關圖片 湯黃秋雲 (F,1943/08/31,68y6m) 手術日期 2011/09/30 手術主治醫師 賴達明 手術區域 東址 019房 02號 診斷 HIVD 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 陳以幸, 時間資訊 23:29 臨時手術NPO 13:12 報到 14:05 進入手術室 14:10 麻醉開始 14:15 誘導結束 14:15 抗生素給藥 14:55 手術開始 16:50 抗生素給藥 17:20 手術結束 17:20 麻醉結束 17:30 送出病患 17:32 進入恢復室 18:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-前融合,有固定物)≦四節 1 2 手術 椎間盤切除術-頸椎 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: Right anterior approach for diskectomy and in... 開立醫師: 陳以幸 開立時間: 2011/09/30 17:39 Pre-operative Diagnosis Herniated intervertebral disc, C6-7 Post-operative Diagnosis Herniated intervertebral disc, C6-7 Operative Method Right anterior approach for diskectomy and interbody fusion, C6/7. Specimen Count And Types nil Pathology nil Operative Findings Presence of spur formation mainly at left side. Intact dura mater. Slack cord after decompression. 7mm PEEK cage was implanted at C6/7 level. Operative Procedures Under ETGA, the patient was placed in supine position. After disinfection and draping, a linear skin incision was made at right anterior neck. After dissection along the anterior border of sternocledomastoid muscle, the pervertebral space was reached. After dissection of longus collis muscle and setting the retractors, the C6/7 disc level was ensured by intraoperative fluoroscopy. The disc was removed by currete and kerrison punch. Spurs were removed by high speed drill and kerrison punch. The PEEK cage was implanted after filling with allograft bone materials. The wound was closed in layers with one prevertebral mini-hemovac. Operators VS賴達明 Assistants R6鍾文桂 R2陳以幸 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Right anterior approach for diskectomy and in... 開立醫師: 陳以幸 開立時間: 2011/10/18 13:10 Pre-operative Diagnosis Herniated intervertebral disc, C6-7 Post-operative Diagnosis Herniated intervertebral disc, C6-7 Operative Method Right anterior approach for diskectomy and interbody fusion, C6/7. Specimen Count And Types nil Pathology nil Operative Findings Presence of spur formation mainly at left side. Intact dura mater. Slack cord after decompression. 7mm PEEK cage was implanted at C6/7 level. Operative Procedures Under ETGA, the patient was placed in supine position. After disinfection and draping, a linear skin incision was made at right anterior neck. After dissection along the anterior border of sternocledomastoid muscle, the pervertebral space was reached. After dissection of longus collis muscle and setting the retractors, the C6/7 disc level was ensured by intraoperative fluoroscopy. The disc was removed by currete and kerrison punch. Spurs were removed by high speed drill and kerrison punch. The PEEK cage was implanted after filling with allograft bone materials. The wound was closed in layers with one prevertebral mini-hemovac. Operators VS賴達明 Assistants R6鍾文桂 R2陳以幸 相關圖片 顧善隆 (M,1962/01/06,50y2m) 手術日期 2011/09/30 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Herniation of intervertebral disc with myelopathy, cervical (HIVD) 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 陳國瑋, 時間資訊 23:31 臨時手術NPO 15:57 報到 16:15 進入手術室 16:20 麻醉開始 16:30 誘導結束 16:35 抗生素給藥 16:58 手術開始 18:40 手術結束 18:40 麻醉結束 18:50 送出病患 18:55 進入恢復室 19:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-頸椎 1 1 手術 脊椎融合術-前融合,有固定物)≦四節 1 2 麻醉 Peripheral arterial line inserti 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 外科部 套用罐頭: Anterior Discectomy and Fusion, Cervical Spine 開立醫師: 曾峰毅 開立時間: 2011/09/30 18:43 Pre-operative Diagnosis HIVD, C5/6 Post-operative Diagnosis HIVD, C5/6 Operative Method Anterior cervical diskectomy of C5/6 and anterior fusion with PEEK cage and artificial bone graft. Specimen Count And Types Nil Pathology Nil Operative Findings Degenrated disc at C5/6 with severe spur formation. Thecal sac and bilateral nerve exiting sites were decompressed well after the surgery. Degenrated disc at C5/6 with severe spur formation. Thecal sac and bilateral nerve exiting sites were decompressed well after the surgery. Synthes, cervical PEEK cage, 7 mm high, was used for anterior fusion. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with neck extended. We made one transverse skin incision at right anterior aspect of the neck, and dissected to expose the prevertebral space. We performed diskectomy of C5/6 after localized by C-arm. Anterior fusion was performed with PEEK cage and artificial bone graft. The wound was closed in layers. Operators VS 賴達明 Assistants R5 曾峰毅 R3 陳國瑋 相關圖片 徐榮意 (M,1939/01/28,73y1m) 手術日期 2011/09/30 手術主治醫師 許巍鐘 手術區域 西址 034房 04號 診斷 Pneumonia 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 蔡奉芳 ASA 3 紀錄醫師 陳姵妤, 時間資訊 11:34 報到 11:34 進入手術室 11:35 麻醉開始 11:45 誘導結束 12:13 手術開始 12:40 手術結束 12:40 麻醉結束 12:50 送出病患 12:55 進入恢復室 14:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 氣管切開術 1 0 記錄__ 手術科部: 耳鼻喉部 套用罐頭: Tracheostomy 開立醫師: 陳姵妤 開立時間: 2011/09/30 12:45 Pre-operative Diagnosis Bilateral vocal palsy Post-operative Diagnosis Bilateral vocal palsy,operated Operative Method Tracheostomy Specimen Count And Types nil Pathology Nil Operative Findings A No.6 Shiley cuffed tracheostomy tube was inserted Operative Procedures (1)The patient was in supine position with neck hyperextended. (2)Skin was disinfected and draped as usual. Local anesthesia with Bosmin-rinsed Xylocaine was injected into the subcutaneous tissue and the pretracheal area. (3)A vertical skin incision was made in the midline of lower neck. (4)Subcutaneous tissue, fascia and strap muscles were seperated, then the thyroid gland was seen and hooked upwards with thyroid hooks. (5)The tracheal rings were cut in longitudinal direction. A oval-shaped window was made at the 2 nd to 3 rd tracheal rings. (6)A No.6 Shiley cuffed tracheostomy tube was inserted. (7)The patient tolerated the above procedure well. Operators AsP許巍鐘 Assistants R4周承翰,R2陳姵妤 黃國恩 (M,1989/10/23,22y4m) 手術日期 2011/09/30 手術主治醫師 謝孟祥 手術區域 東址 009房 01號 診斷 Fracture of other facial bones, closed 器械術式 medpore implantation 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 2 紀錄醫師 李維棠, 時間資訊 08:10 麻醉開始 08:15 誘導結束 08:55 手術開始 08:57 進入手術室 10:25 手術結束 10:25 麻醉結束 10:34 送出病患 10:35 進入恢復室 11:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 眼窩成形術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 記錄__ 手術科部: 外科部 套用罐頭: Reconstruction of orbital floor with Medpor i... 開立醫師: 李維棠 開立時間: 2011/09/30 11:00 Pre-operative Diagnosis Left zygomatic bone fracture s/p ORIF with absorbable plate system s/p cranioplasty with bone source remodeling Post-operative Diagnosis Left zygomatic bone fracture s/p ORIF with absorbable plate system s/p cranioplasty with bone source remodeling Operative Method Reconstruction of orbital floor with Medpor implanataiton Specimen Count And Types nil Pathology Nil Operative Findings 1. Frontal hallowing with left frontal bone depression 2. Mild atrophy of soft tissue over left temporal-frontal area 3. Medpor was impanted over inferior and lateral orbital ring Operative Procedures Under general anesthesia, the patient lied in supine position. Antiseptics applied and draped as usual. Linear incision was made over left lower eyelid. Dissection to the orbital floor and Medpor was implanted over inferior and lateral orbital ring then fixation with 6-0 Monocryl. After hemostasis and normal saline irrigation, the wound was closed in layers. Operators VS謝孟祥 Assistants R6官振翔 R3李維棠 Ri蘇騰葳 相關圖片 許雪峰 (F,1951/01/02,61y2m) 手術日期 2011/10/01 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Parkinson''s Disease 器械術式 Stereotaxic procedure for implantation 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 面罩麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 鍾文桂, 時間資訊 23:09 臨時手術NPO 08:05 進入手術室 08:10 麻醉開始 08:20 誘導結束 08:35 抗生素給藥 09:25 手術開始 12:18 抗生素給藥 14:00 手術結束 14:00 麻醉結束 14:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Semi-opened mask inhalation anes 1 0 麻醉 Semi-opened INHALATION GENERAL A 4 0 麻醉 SENI-OPENED INHALATION GENERAL A 4 0 麻醉 Peripheral arterial line inserti 1 0 手術 立體定位術-功能性失調 1 1 L 手術 立體定位術-功能性失調 1 2 R 手術 深部腦核電生理定位 1 0 摘要__ 手術科部: 外科部 套用罐頭: Insertion of DBS wire at bilateral subthalami... 開立醫師: 鍾文桂 開立時間: 2011/10/01 14:34 Pre-operative Diagnosis Parkisons disease Post-operative Diagnosis Parkisons disease Operative Method Insertion of DBS wire at bilateral subthalamic nuclei. Specimen Count And Types nil Pathology Nil. Operative Findings The rigidity decreased after wire inserted at stimulation "on". The planned tracts were used with no change . Operative Procedures Under IV general anesthesia, the patient was put in supine position. The scalp was shaved, scrubbed and antiseptic with alcohol B-I. Registered the preset localization point to navigator. Bicoronal scalp incision was made with burr hole made at entery point of left frontal region as navigator guided. The DBS wire port was set up and localization of subthalamus nucleus with microelectrode assistance. Inserted the DBS wire and fixed with the port. Waked the patient from the anesthesia and started stimulation from low voltage. Checked the clinical responses while using different voltage for stimulation. Performed the same procedure at right side. After hemostasis, we closed the wound in layers. Operators VS 曾勝弘 Assistants R5 鍾文桂 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Insertion of DBS wire at bilateral subthalami... 開立醫師: 鍾文桂 開立時間: 2011/10/05 19:02 Pre-operative Diagnosis Parkisons disease Post-operative Diagnosis Parkisons disease Operative Method Insertion of DBS wire at bilateral subthalamic nuclei. Specimen Count And Types nil Pathology Nil. Operative Findings The rigidity decreased after wire inserted at stimulation "on". The planned tracts were used with no change . Operative Procedures Under IV general anesthesia, the patient was put in supine position. The scalp was shaved, scrubbed and antiseptic with alcohol B-I. Registered the preset localization point to navigator. Bicoronal scalp incision was made with burr hole made at entery point of left frontal region as navigator guided. The DBS wire port was set up and localization of subthalamus nucleus with microelectrode assistance. Inserted the DBS wire and fixed with the port. Waked the patient from the anesthesia and started stimulation from low voltage. Checked the clinical responses while using different voltage for stimulation. Performed the same procedure at right side. After hemostasis, we closed the wound in layers. Operators VS 曾勝弘 Assistants R5 鍾文桂 相關圖片 任士平 (M,1964/11/14,47y4m) 手術日期 2011/10/01 手術主治醫師 詹志洋 手術區域 東址 016房 04號 診斷 Lung cancer 器械術式 Port-A catheter Removal 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 陳建銘, 時間資訊 01:50 報到 11:55 進入手術室 12:21 麻醉開始 12:22 手術開始 12:22 誘導結束 12:50 手術結束 12:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 皮下肌肉或深部異物取出術 1 1 R 記錄__ 手術科部: 腫瘤醫學部 套用罐頭: Port-A catheter removal and debridement 開立醫師: 陳建銘 開立時間: 2011/10/01 12:52 Pre-operative Diagnosis Port-A catheter infection Post-operative Diagnosis Port-A catheter infection Operative Method Port-A catheter removal and debridement Specimen Count And Types 1 piece About size: Source:tip culture Pathology nil Operative Findings 1.yellowish debris inside 2.abscess formation(-) Operative Procedures The patient was put on supine position. The operation field was disinfected and draped as usual. Under local anesthesia, the Port-A catheter was removed from previous wound smoothly. The wound was irrigated and closed in layers. Operators VS詹志洋 Assistants R3陳建銘 李宜純 (F,1976/05/17,35y9m) 手術日期 2011/10/01 手術主治醫師 楊士弘 手術區域 東址 003房 02號 診斷 Breast cancer, female 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 王奐之, 時間資訊 23:11 臨時手術NPO 10:35 進入手術室 10:45 麻醉開始 11:00 誘導結束 11:07 抗生素給藥 11:25 手術開始 12:10 手術結束 12:10 麻醉結束 12:25 送出病患 12:30 進入恢復室 13:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室腹腔分流手術 1 1 R 摘要__ 手術科部: 腫瘤醫學部 套用罐頭: Ventriculoperitoneal shunt insertion via righ... 開立醫師: 王奐之 開立時間: 2011/10/01 12:10 Pre-operative Diagnosis Breast cancer with leptomeningeal carcinomatosis with hydrocephalus Post-operative Diagnosis Breast cancer with leptomeningeal carcinomatosis with hydrocephalus Operative Method Ventriculoperitoneal shunt insertion via right Kocher point Specimen Count And Types Nil Pathology Nil Operative Findings Opening pressure was about 5 cmH2O. A Medtronic medium pressure reservoir was used. Ventricular catheter length: 6.5cm. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After shaving, scrubbing, disinfection & draping in sterile fashion, a curvilinear incision along previous wound scar was made at right frontal area. Another linear incision was made at right upper quadrant of abdomen, followed by mini-laparotomy. A subcutaneous tunnel from the abdominal wound to the right frontal wound was created, followed by passage of peritoneal catheter. After assembly of the ventricular catheter, the previously inserted Ommaya reservoir was removed, and the ventricular catheter was inserted through the original ventriculostomy tract. After hemostasis and confirmation of smooth CSF flow, the peritoneal catheter was inserted into the peritoneal cavity. The wounds were then closed in layers. Operators VS 楊士弘 Assistants R4 王奐之, PGY 鄭宇軒 相關圖片 記錄__ 手術科部: 腫瘤醫學部 套用罐頭: Ventriculoperitoneal shunt insertion via righ... 開立醫師: 王奐之 開立時間: 2011/10/01 12:10 Pre-operative Diagnosis Breast cancer with leptomeningeal carcinomatosis with hydrocephalus Post-operative Diagnosis Breast cancer with leptomeningeal carcinomatosis with hydrocephalus Operative Method Ventriculoperitoneal shunt insertion via right Kocher point Specimen Count And Types Nil Pathology Nil Operative Findings Opening pressure was about 5 cmH2O. A Medtronic medium pressure reservoir was used. Ventricular catheter length: 6.5cm. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After shaving, scrubbing, disinfection & draping in sterile fashion, a curvilinear incision along previous wound scar was made at right frontal area. Another linear incision was made at right upper quadrant of abdomen, followed by mini-laparotomy. A subcutaneous tunnel from the abdominal wound to the right frontal wound was created, followed by passage of peritoneal catheter. After assembly of the ventricular catheter, the previously inserted Ommaya reservoir was removed, and the ventricular catheter was inserted through the original ventriculostomy tract. After hemostasis and confirmation of smooth CSF flow, the peritoneal catheter was inserted into the peritoneal cavity. The wounds were then closed in layers. Operators VS 楊士弘 Assistants R4 王奐之, PGY 鄭宇軒 相關圖片 陳子鈞 (M,1949/11/09,62y4m) 手術日期 2011/10/01 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Fever 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 王奐之, 時間資訊 23:10 臨時手術NPO 08:05 進入手術室 08:20 麻醉開始 08:40 誘導結束 09:03 手術開始 09:41 手術結束 09:41 麻醉結束 09:50 送出病患 09:55 進入恢復室 12:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt insertion via left... 開立醫師: 王奐之 開立時間: 2011/10/01 10:00 Pre-operative Diagnosis Left side subdural effusion, status post left subduroperitoneal shunt insertion, with hydrocephalu Post-operative Diagnosis Left side subdural effusion, status post left subduroperitoneal shunt insertion, with hydrocephalu Operative Method Ventriculoperitoneal shunt insertion via left Kocher point (with connection to previous subduroperitoneal shunt) Specimen Count And Types Nil Pathology Nil Operative Findings The reservoir of previously inserted subduroperitoneal shunt was already obstructed due to collapse of subdural space. This old reservoir was removed, while the subdural catheter was left in place. New catheter for ventriculoperitoneal shunt was inserted to the left lateral ventricle via left Kocher point, smooth CSF flow was noted. Opening pressure upon ventriculostomy was about 5-10 cmH2O, clear & colorless CSF was noted. Ventricular catheter length: 7cm. A programmable pressure Codman reservoir was used, preset to 120mmH2O. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to right. After shaving, scrubbing, disinfection & draping in sterile fashion, a linear incision was made at left frontal area, another incision was made at left supra-auricular area along previous wound scar. A burr hole was made at left frontal area (Kocher point). After removal of the previous reservoir and creation of subcutaneous tunnel, assembly of the ventricular catheter was done. A small cruciate durotomy was then made at the burr hole after 2 tenting stitches. Ventriculostomy was performed, followed by ventricular catheter insertion. After securing the catheter and meticulous hemostasis, the wounds were closed in layers. Operators VS 王國川 Assistants R4 王奐之, PGY 鄭宇軒 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt insertion via left... 開立醫師: 王奐之 開立時間: 2011/10/01 10:00 Pre-operative Diagnosis Left side subdural effusion, status post left subduroperitoneal shunt insertion, with hydrocephalu Post-operative Diagnosis Left side subdural effusion, status post left subduroperitoneal shunt insertion, with hydrocephalu Operative Method Ventriculoperitoneal shunt insertion via left Kocher point (with connection to previous subduroperitoneal shunt) Specimen Count And Types Nil Pathology Nil Operative Findings The reservoir of previously inserted subduroperitoneal shunt was already obstructed due to collapse of subdural space. This old reservoir was removed, while the subdural catheter was left in place. New catheter for ventriculoperitoneal shunt was inserted to the left lateral ventricle via left Kocher point, smooth CSF flow was noted. Opening pressure upon ventriculostomy was about 5-10 cmH2O, clear & colorless CSF was noted. Ventricular catheter length: 7cm. A programmable pressure Codman reservoir was used, preset to 120mmH2O. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to right. After shaving, scrubbing, disinfection & draping in sterile fashion, a linear incision was made at left frontal area, another incision was made at left supra-auricular area along previous wound scar. A burr hole was made at left frontal area (Kocher point). After removal of the previous reservoir and creation of subcutaneous tunnel, assembly of the ventricular catheter was done. A small cruciate durotomy was then made at the burr hole after 2 tenting stitches. Ventriculostomy was performed, followed by ventricular catheter insertion. After securing the catheter and meticulous hemostasis, the wounds were closed in layers. Operators VS 王國川 Assistants R4 王奐之, PGY 鄭宇軒 相關圖片 陳永靖 (M,1961/07/21,50y7m) 手術日期 2011/10/02 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Cerebral aneurysm 器械術式 Craniotomy(Aneurysms) P-DUH 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3E 紀錄醫師 鍾文桂, 曾偉倫, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 07:53 通知急診手術 11:10 麻醉開始 11:30 誘導結束 12:00 抗生素給藥 12:08 報到 12:10 進入手術室 12:10 手術開始 15:00 抗生素給藥 18:00 抗生素給藥 18:42 抗生素給藥 19:12 麻醉結束 19:12 手術結束 19:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 開顱術摘除血管病變 - 腦血管瘤 有病徵的 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 8 0 摘要__ 手術科部: 外科部 套用罐頭: Left pterion approach for Acom aneurysm clipping 開立醫師: 鍾文桂 開立時間: 2011/10/02 19:53 Pre-operative Diagnosis Anterior communicating artery aneurysm, ruptured with subarachnoid hemorrhage Post-operative Diagnosis Anterior communicating artery aneurysm, ruptured with subarachnoid hemorrhage Operative Method Left pterion approach for Acom aneurysm clipping Specimen Count And Types nil Pathology Nil. Operative Findings 1. The a-com aneurysm is 10 mm in size which projecting superiorly at A-com, with small daughter sacs. 2. Left A1 temporary clip 2min 30sec x 2 3. Intraoperative ICG was used for identify the perforator over A1 and A2 pre- and post- clipping. There was no obvious residule aneurysm found in post-clipping ICG 4. Blood loss:250cc Operative Procedures Under ETGA, we placed the patient over supine position and his head was fixed with Mayfield clamp. We tilt his face to right about 45 degree and extend her neck. After we scrubbed, disinfected and drapped, A curvilinear skin incision was made over left frontal-temporal area and the wound was open in layers. The superficial tmeporalis fascia was dissected meticulously for facial nerve preservation. The temporalis muscle was detached and the burr holes were made. Frontal-temporal craniectomy was done and the superior orbital fissure was opened with drill for optic nerve mobilization. A curvilinear durotomy was made and the arachnoid was opened with micro-dissector. The frontal lobe was retracted and the pre-chiasmatic cistern was exposed. The CSF was drained via the cistern and the brain sunk afterward. Bilateral A1, A2, Acom and recurrent artery of Hubener were identified after dissection. Left A1 temporary clip were applied for proximal control and the aneurysm was clipped with Surgita clip x 2. The post-clipping ICG examination was done and there was no obvious residule aneurysm. We closed the dura after complete hemostasis and the skull was fixed with mini-plate and mini-screw. The temporalis muscle was fixed and a sub-galeal CWV drain was placed. The wound was closed in layers. Operators Prof. 杜永光 Assistants R6 鍾文桂 R3 曾偉倫 R2 陳以幸 R1 吳健暉 Indication Of Emergent Operation 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Left pterion approach for Acom aneurysm clipping 開立醫師: 鍾文桂 開立時間: 2011/10/05 20:14 Pre-operative Diagnosis Anterior communicating artery aneurysm, ruptured with subarachnoid hemorrhage Post-operative Diagnosis Anterior communicating artery aneurysm, ruptured with subarachnoid hemorrhage Operative Method Left pterion approach for Acom aneurysm clipping Specimen Count And Types nil Pathology Nil. Operative Findings 1. The a-com aneurysm is 10 mm in size which projecting superiorly at A-com, with small daughter sacs. 2. Left A1 temporary clip 2min 30sec x 2 3. Intraoperative ICG was used for identify the perforator over A1 and A2 pre- and post- clipping. There was no obvious residule aneurysm found in post-clipping ICG 4. Blood loss:250cc Operative Procedures Under ETGA, we placed the patient over supine position and his head was fixed with Mayfield clamp. We tilt his face to right about 45 degree and extend her neck. After we scrubbed, disinfected and drapped, A curvilinear skin incision was made over left frontal-temporal area and the wound was open in layers. The superficial tmeporalis fascia was dissected meticulously for facial nerve preservation. The temporalis muscle was detached and the burr holes were made. Frontal-temporal craniectomy was done and the superior orbital fissure was opened with drill for optic nerve mobilization. A curvilinear durotomy was made and the arachnoid was opened with micro-dissector. The frontal lobe was retracted and the pre-chiasmatic cistern was exposed. The CSF was drained via the cistern and the brain sunk afterward. Bilateral A1, A2, Acom and recurrent artery of Hubener were identified after dissection. Left A1 temporary clip were applied for proximal control and the aneurysm was clipped with Surgita clip x 2. The post-clipping ICG examination was done and there was no obvious residule aneurysm. We closed the dura after complete hemostasis and the skull was fixed with mini-plate and mini-screw. The temporalis muscle was fixed and a sub-galeal CWV drain was placed. The wound was closed in layers. Operators Prof. 杜永光 Assistants R6 鍾文桂 R3 曾偉倫 R2 陳以幸 R1 吳健暉 Indication Of Emergent Operation Ruptured cerebral aneurysm. 相關圖片 陳文英 (F,1953/10/30,58y4m) 手術日期 2011/10/03 手術主治醫師 杜永光 手術區域 東址 007房 03號 診斷 Meningioma 器械術式 SP shunt, right 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3E 紀錄醫師 姜士中, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 08:00 通知急診手術 14:50 進入手術室 14:53 麻醉開始 15:00 誘導結束 15:28 手術開始 16:20 麻醉結束 16:20 手術結束 16:30 送出病患 16:35 進入恢復室 18:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室腹腔分流手術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Right frontal burr hole for subduroperitoneal... 開立醫師: 曾峰毅 開立時間: 2011/10/03 16:25 Pre-operative Diagnosis Subdural effusion Post-operative Diagnosis Subdural effusion Operative Method Right frontal burr hole for subduroperitoneal shunt Specimen Count And Types Nil Pathology Nil Operative Findings Colorless, clear CSF gushed out while durotomy. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to left. We shaved, scrubbed, disinfected, and then draped the patient as usual. We made one transverse skin incision at right frontal area, and drilled one burr hole. We created durotomy, and made one transverse skin incision at right upper abdomen. Mini-laparotomy was performed. We inserted peritoneal catheter, and pulled the catheter through the subcutaneous tunnel. We inserted subdural catheter, and connceted the shunt altogether. The wound was closed in layers. Operators P 杜永光 Assistants R5 曾峰毅 R1 姜士中 Indication Of Emergent Operation IICP 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Right frontal burr hole for subduroperitoneal... 開立醫師: 黃薇諭 開立時間: 2011/10/28 00:31 Pre-operative Diagnosis Subdural effusion Post-operative Diagnosis Subdural effusion Operative Method Right frontal burr hole for subduroperitoneal shunt Specimen Count And Types Nil Pathology Nil Operative Findings Colorless, clear CSF gushed out while durotomy. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to left. We shaved, scrubbed, disinfected, and then draped the patient as usual. We made one transverse skin incision at right frontal area, and drilled one burr hole. We created durotomy, and made one transverse skin incision at right upper abdomen. Mini-laparotomy was performed. We inserted peritoneal catheter, and pulled the catheter through the subcutaneous tunnel. We inserted subdural catheter, and connceted the shunt altogether. The wound was closed in layers. Operators P 杜永光 Assistants R5 曾峰毅 R1 姜士中 Indication Of Emergent Operation IICP 相關圖片 梁維集 (M,1926/10/24,85y4m) 手術日期 2011/10/03 手術主治醫師 杜永光 手術區域 東址 002房 06號 診斷 Malignant neoplasm of hepatic flexure colon 器械術式 Burr hole (trephination) for right CSDH 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 4E 紀錄醫師 李振豪, 時間資訊 11:30 開始NPO 17:41 通知急診手術 18:45 報到 18:55 進入手術室 19:00 麻醉開始 19:20 誘導結束 19:25 抗生素給藥 19:50 手術開始 20:48 手術結束 20:48 麻醉結束 21:00 送出病患 21:05 進入恢復室 22:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 頭顱穿洞術(止血引流、穿刺檢查) 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Right frontal burr hole for drainage of chron... 開立醫師: 李振豪 開立時間: 2011/10/03 20:59 Pre-operative Diagnosis Chronic subdural hematoma, right Post-operative Diagnosis Chronic subdural hematoma, right Operative Method Right frontal burr hole for drainage of chronic subdural hematoma Specimen Count And Types 1 piece About size:15ml Source:subdural hematoma for cytology Pathology Nil Operative Findings Massive motor-oil like right chronic subdural hematoma was drained out with total about 200ml in volume. The outer membrane and inner membrane were noted during the operation. The brain was extreme slack initially and expanded slightly before wound closure. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head rotated to left. The scalp was shaved, scrubbed, and disinfected as usual. Right frontal linear scalp incision was made followed by one burr hole creation. Two dural tenting was done. Cruciform durotomy was made and the outer membrane was exposed. The edge of the dura was coagulated. The outer membrane was opened and the edge of the outer membrane was coagulated for hemostasis. After drainage of the chronic subdural hematoma, the subdural space was irrigated with copious normal saline. One subdural rubber drain was placed and the wound was closed in layers with 2-0 Vicryl and 3-0 Nylon. Deair was performed after wound closure. The patient stood whole procedure well. Operators Prof.杜永光 Assistants R5李振豪, R1吳健暉 Indication Of Emergent Operation Acute deterioration of left side muscle power 相關圖片 李寶堂 (M,1970/07/26,41y7m) 手術日期 2011/10/03 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Malignant neoplasm of brain, unspecified 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 李振豪, 曾偉倫, 時間資訊 00:00 臨時手術NPO 08:01 進入手術室 08:05 麻醉開始 08:20 誘導結束 08:35 抗生素給藥 08:36 手術開始 11:30 抗生素給藥 13:00 手術結束 13:00 麻醉結束 13:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除-手術時間在4~8小時 1 1 記錄__ 手術科部: 外科部 套用罐頭: Right frontal craniotomy for tumor excision 開立醫師: 李振豪 開立時間: 2011/10/03 12:56 Pre-operative Diagnosis Recurrent anaplastic oligodendroglioma Post-operative Diagnosis Recurrent anaplastic oligodendroglioma Operative Method Right frontal craniotomy for tumor excision Specimen Count And Types 1 piece About size:Multiple pieces Source:Right frontal tumor Pathology Frozen section: fibrotic back ground with much calcification Operative Findings The brain was adhered with the dura at previous corticotomy site. Intra-operative sonography was used for localization of the tumor. The tumor was hyperechogenecity which located anterior to the frontal horn. The tumor firm which fibrosis and calcification was favored. The recurrent tumor was mainly located at medially and posteriorly. The falx was resected during last operation. One of the callosal marginal artery was thrombosed and the other one was patent. A small opening of right lateral ventricle was noted during the operation and no obvious CSF leak after covering with Surgicel. The frozen section was sent and fibrotic back ground with much calcification was reported. The brain was adhered with the dura at previous corticotomy site. Intra-operative sonography was used for localization of the tumor. The tumor was hyperechogenecity which located anterior to the frontal horn. The tumor was firm which fibrosis and calcification was favored, 2.0 x 2.1 x 2.3 in size, gray-yellowish in color, and ill-defined in character. The recurrent tumor was mainly located at medially and posteriorly. The surrounding brain tissue was yellowish in color due to previous irradiation. The falx was resected during last operation. One of the callosal marginal artery was thrombosed and the other one was patent. A small opening of right lateral ventricle was noted during the operation and no obvious CSF leak after covering with Surgicel. The frozen section was sent and fibrotic back ground with much calcification was reported. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head fixed with Mayfield skull clamp. the scalp was shaved, scrubbed, and disinfected as usual. Bicoronal scalp incision was made along operative scar. The scalp flap was elevated. Previous craniotomy was identified and the screws/miniplates were removed. The skull plate was elevated. Intra-operative sonography was used for localization of the tumor. C-shape durotomy was performed based with superior sagittal sinus. The scar tissue was noted after dura opening. Tumor excision was performed along the scar tissue and the specimen was sent for frozen section. After tumor excision, hemostasis was achieved with bipolar electrocautery and Surgicel lining. Dura was closed with 4-0 Prolene. The skull plate was fixed back with miniplates, screws, and two central tenting. The wound was then closed in layers with 2-0 vicryl and 3-0 Nylon. Operators Prof.杜永光 Assistants R5李振豪, R3曾偉倫, Ri王瑩軒 相關圖片 謝明 (M,1974/06/14,37y9m) 手術日期 2011/10/03 手術主治醫師 杜永光 手術區域 東址 003房 02號 診斷 Arterovenous malformation brain / ( AVM brain ) 器械術式 Brain tumor Crainotomy(P-DUH)，Craniotomy (A.V.M.) P-DUH 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 曾偉倫, 李振豪, 時間資訊 00:00 臨時手術NPO 12:15 報到 13:22 進入手術室 13:25 麻醉開始 13:56 抗生素給藥 14:35 誘導結束 14:52 手術開始 16:56 抗生素給藥 19:00 麻醉結束 19:00 手術結束 19:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 開顱術摘除血管病變-- 動靜脈畸型小型深部 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Left subtemporal approach for arteriovenous m... 開立醫師: 李振豪 開立時間: 2011/10/03 19:25 Pre-operative Diagnosis Left temporal arteriovenous malformation Post-operative Diagnosis Left temporal arteriovenous malformation Operative Method Left subtemporal approach for arteriovenous malformation excision Specimen Count And Types 1 piece About size:0.5 x 0.5 x 0.5 Source:Left temporal AVM Pathology Pending Operative Findings The left mastoid air cell was opened during burr hole creation. The mastoid air cell was sealed with Gelfoam and bonewax. The vein of Labbe was noted at posterior margin of the durotomy. Oozing from temporal base was noted and hemostasis was achieved with Surgicel and Gelfoam packing. The vein of Labbe was protected well during whole procedure. The organized hematoma was noted at inferior temporal lobe and the AVM was surrounded by firm organized hematoma. The feeding artery was mainly from lateral posterior choroidal artery. There are some small feeder from medial side of the AVM. One large drainage vein was noted during AVM excision was transected at the end of dissection. The AVM was 0.5~1cm in diameter. The left lateral ventricle was entered during the hematoma evacuation. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with left shoulder elevation and head rotated to right. The scalp was shaved, scrubbed, and disinfected as usual. Curvilinear scalp incision was made at left temporal and retroauricular area and the the temporalis muscle was splitted. One burr hole was created at asterion for identification of the sigmoid sinus. One 4x4cm craniotomy window was made at left temporal base. The mastoid air cell was opened during craniotomy and sealed with Gelfoam and bonewax. Dural tenting was done. The C-shape durotomy based with left temporal base was done and CSF was released from ambient cistern. The vein of Labbe was noted at posterior margin of the durotomy and protected with Surgicel and Gelfoam. The left temporal lobe was retracted and one 1x1cm corticotomy was made at left temporal base. The hematoma was encountered about 1.5cm in depth. After hematoma evacuation, left lateral ventricle was entered. The AVM was noted at posterior and lateral to lateral ventricle. The feeding artery from lateral posterior choroidal artery was ligated and the drainage vein was transected later. Some small feeding artery was also noted at medial side of the AVM. After total removal of the AVM, hemostasis was achieved with bipolar electrocautery and Surgicel lining. No obvious IVH was noted within the left lateral ventricle and we did not place external ventricular drainage. The dura was closed with 4-0 prolene and one 1 x 3cm COOK artificial dura. The skull plate was fixed back with miniplates, screws, and two central tenting. One subgaleal CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators Prof.杜永光 Assistants R5李振豪, R3曾偉倫 相關圖片 楊秀月 (F,1952/08/02,59y7m) 手術日期 2011/10/03 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Glioblastoma multiforma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 08:04 進入手術室 08:10 麻醉開始 08:12 抗生素給藥 08:40 誘導結束 08:41 手術開始 11:12 抗生素給藥 12:23 手術結束 12:23 麻醉結束 12:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除-手術時間在4小時以內 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Right T-P craniotomy for tumor excision 開立醫師: 林哲光 開立時間: 2011/10/03 13:34 Pre-operative Diagnosis Right T-P tumor, suspected glioma Post-operative Diagnosis Right T-P high grade glioma Operative Method Right T-P craniotomy for tumor excision Specimen Count And Types 1 piece About size: 4.3 cm sized Source:tumor Pathology Frozen pathology revealed high grade glioma Operative Findings The previous craniotomy at right parietal part with wire fixation was noted. About 4.3 cm sized, ill-defined, yellowish-to-whitish, soft-to-elastic mass lesion was located at right middle temporal lobe. The mass lesion was difficult to differentiate from the normal brain parechyma expect its consitency. Tumor excision was done as widely as possible until the normal brain parechyma could be identified in all directions. Right temporal horn of lateral ventricle was opened during tumor excision. Operative Procedures Under ETGA and supine position with head rotated to left side, skin disinfected and drapped were performed as usual. Skin incision was made along the previous operative wound and the wound was extended to expose the temporal part. Another T-P craniotomy was done with previous two burr holes and another two burr holes were created at temporal area. Echo localization for the tumor was then performed and the dura was then opened after dural tenting in reversed U shape. Corticotomy was done at middle temporal lobe anterior to the vein of Labbe. Tumor excision was then done and hemostasis was done meticulously with bipolar cauterization and surgecell packing. The temporal horn of the lateral ventricle was covered with Gelfoam. Dura was then closed in water-tie method and the skull bone was put back and fixed with mini-plates. The wound was then closed in layers after a subgaleal drain insertion. Operators 曾漢民 Assistants 林哲光 相關圖片 林雪雲 (F,1946/11/10,65y4m) 手術日期 2011/10/03 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 12:50 進入手術室 12:55 麻醉開始 13:20 誘導結束 13:30 抗生素給藥 13:55 手術開始 16:30 抗生素給藥 16:48 開始輸血 19:20 手術結束 19:20 麻醉結束 19:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 顱底瘤手術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Left suboccipital craniectomy and C1 laminect... 開立醫師: 曾偉倫 開立時間: 2011/10/03 19:57 Pre-operative Diagnosis Foramen magnum meningioma Post-operative Diagnosis Foramen magnum meningioma Operative Method Left suboccipital craniectomy and C1 laminectomy for tumor excision, Simpson grade IV Specimen Count And Types 1 piece About size:fragments Source:foramen meganum tumor Pathology pending Operative Findings One well-defined, elastic to hard, highly vasculized tumor was noted at left anterior aspect of foramen meganum with compression to medulla oblonggata. The CN XII was pushed posterior laterally and low cranial nerves were partially encased by the tumor mass. CN XII was left intact after tumor resection. We did not resect the tumor which locates anterior to and encasing the low cranial nerves. The tumor was excised in piecemeal fasion and the part lateral to the vertebral artery was remained. Operative Procedures After intubation and general anesthesia, the patient was log-rolled with three and fourth prone position. The skin was shaved, disinfected and drapped as usual. One hokey stick skin incision was made from C4 level across inion to left ear. The skin was then retrated downward. C1 laminectomy was performed. The dura was incised in U-shape fasion and opened to left side. Tumor excision was done. The dura was repaired with Surgisis artificial dura in water-tie fashion. The wound was closed in layers with one epidural CWV drain. Operators 曾漢民 Assistants 鍾文桂 陳國瑋 相關圖片 摘要__ 手術科部: 外科部 套用罐頭: Left suboccipital craniectomy and C1 laminect... 開立醫師: 曾偉倫 開立時間: 2011/10/03 19:59 Pre-operative Diagnosis Foramen magnum meningioma Post-operative Diagnosis Foramen magnum meningioma Operative Method Left suboccipital craniectomy and C1 laminectomy for tumor excision, Simpson grade IV Specimen Count And Types 1 piece About size:fragments Source:foramen meganum tumor Pathology pending Operative Findings One well-defined, elastic to hard, highly vasculized tumor was noted at left anterior aspect of foramen meganum with compression to medulla oblonggata. The CN XII was pushed posterior laterally and low cranial nerves were partially encased by the tumor mass. CN XII was left intact after tumor resection. We did not resect the tumor which locates anterior to and encasing the low cranial nerves. The tumor was excised in piecemeal fasion and the part lateral to the vertebral artery was remained. Operative Procedures After intubation and general anesthesia, the patient was log-rolled with three and fourth prone position. The skin was shaved, disinfected and drapped as usual. One hokey stick skin incision was made from C4 level across inion to left ear. The skin was then retrated downward. C1 laminectomy was performed. The dura was incised in U-shape fasion and opened to left side. Tumor excision was done. The dura was repaired with Surgisis artificial dura in water-tie fashion. The wound was closed in layers with one epidural CWV drain. After intubation and general anesthesia, the patient was log-rolled with three quater prone position. The skin was shaved, disinfected and drapped as usual. One hokey stick skin incision was made from C2 level across inion to left ear. The skin was then retrated downward. C1 laminectomy was performed. The dura was incised in U-shape fasion and opened to left side. Tumor excision was done. The dura was repaired with Surgisis artificial dura in water-tie fashion. The wound was closed in layers with one epidural CWV drain. Operators 曾漢民 Assistants 鍾文桂 陳國瑋 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Left suboccipital craniectomy and C1 laminect... 開立醫師: 陳國瑋 開立時間: 2011/10/03 20:34 Pre-operative Diagnosis Foramen magnum meningioma Post-operative Diagnosis Foramen magnum meningioma Operative Method Left suboccipital craniectomy and C1 laminectomy for tumor excision, Simpson grade IV Left suboccipital craniectomy and C1 laminectomy for tumor excision, Simpson grade III Specimen Count And Types 1 piece About size:fragments Source:foramen meganum tumor Pathology pending Operative Findings One well-defined, elastic to hard, highly vasculized tumor was noted at left anterior aspect of foramen meganum with compression to medulla oblonggata. The CN XII was pushed posterior laterally and low cranial nerves were partially encased by the tumor mass. CN XII was left intact after tumor resection. We did not resect the tumor which locates anterior to and encasing the low cranial nerves. One well-defined, elastic to hard, highly vasculized tumor was noted at left anterior aspect of foramen meganum with compression to medulla oblonggata. The CN XI was pushed posterior laterally and low cranial nerves were partially encased by the tumor mass. CN XI was left intact after tumor resection. We did not resect the tumor which locates anterior to and encasing the low cranial nerves. The tumor was excised in piecemeal fasion and the part lateral to the vertebral artery was remained. The tumor was excised in piecemeal fashion and the part lateral to the vertebral artery was remained. Operative Procedures After intubation and general anesthesia, the patient was log-rolled with three and fourth prone position. The skin was shaved, disinfected and drapped as usual. One hokey stick skin incision was made from C2 level across inion to left ear. The skin was then retrated downward. C1 laminectomy was performed. The dura was incised in U-shape fasion and opened to left side. Tumor excision was done. The dura was repaired with Surgisis artificial dura in water-tie fashion. The wound was closed in layers with one epidural CWV drain. Operators 曾漢民 Assistants 鍾文桂 陳國瑋 相關圖片 張亞薇 (F,1968/02/10,44y1m) 手術日期 2011/10/03 手術主治醫師 廖述朗 手術區域 西址 031房 02號 診斷 Eyelid tumor 器械術式 Remove orbital tumor-anterior 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 石博元 ASA 2 紀錄醫師 林暄婕, 時間資訊 10:40 報到 10:55 進入手術室 11:05 麻醉開始 11:10 誘導結束 11:20 抗生素給藥 11:25 手術開始 12:00 手術結束 12:00 麻醉結束 12:15 送出病患 12:25 進入恢復室 13:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 眼窩腫瘤切除術-經前方途徑 1 1 L 記錄__ 手術科部: 眼科部 套用罐頭: tumor exicision from anterior approach (os) 開立醫師: 林暄婕 開立時間: 2011/10/03 11:56 Pre-operative Diagnosis orbital tumor(os) Post-operative Diagnosis orbital tumor(os) Operative Method tumor exicision from anterior approach (os) Specimen Count And Types nil Pathology number: 1 size: 3x2x2cm Operative Findings orbital tumor(os) Operative Procedures 1. Under endotracheal general anesthesia 2. Injected local anesthetic + vasoconstrictor 3. Disinfection & draping 4. Skin incision along previously marked line with No. 10 blade 5. Dissected along the skin insicion and exposed the tumor 6. Excised the tumor & sent specimen for pathology 7. Electrocauterization for hemostasis 8. Close subcutaneous wound with 5-0 Vicryl 9. Close skin wound with 6-0 Nylon 10.Latycin patching Operators 廖述朗, Assistants 謝旻瑾, 趙致瓴 (M,1966/01/03,46y2m) 手術日期 2011/10/03 手術主治醫師 吳政翰 手術區域 東址 000房 號 診斷 Brain tumor 器械術式 大腸鏡/PES, in 治療室 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 王永彬 ASA 3 時間資訊 10:45 麻醉開始 11:20 麻醉結束 徐鵬鎮 (M,2003/07/05,8y8m) 手術日期 2011/10/03 手術主治醫師 廖漢文 手術區域 東址 000房 號 診斷 Moyamoya disease 器械術式 Moyamoya disease for diagnostic angiography 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 1 時間資訊 23:59 臨時手術NPO 08:55 麻醉開始 09:05 誘導結束 10:40 麻醉結束 10:53 進入恢復室 12:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 吳美麗 (F,1969/10/23,42y4m) 手術日期 2011/10/03 手術主治醫師 賴達明 手術區域 東址 002房 05號 診斷 Cerebral aneurysm 器械術式 V-P shunt 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 黃薇諭, 時間資訊 00:00 開始NPO 00:00 臨時手術NPO 08:38 通知急診手術 15:55 進入手術室 15:55 報到 16:05 麻醉開始 16:15 誘導結束 17:00 手術開始 18:02 麻醉結束 18:02 手術結束 18:10 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室腹腔分流手術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Ventriculopertoneal shunt insertion via left ... 開立醫師: 王奐之 開立時間: 2011/10/03 18:08 Pre-operative Diagnosis Right anterior choroidal artery aneurysm with subarachnoid hemorrhage, hydrocephalus Post-operative Diagnosis Right anterior choroidal artery aneurysm with subarachnoid hemorrhage, hydrocephalus Operative Method Ventriculopertoneal shunt insertion via left Kocher point (Codman programmable shunt) Specimen Count And Types nil Pathology Nil Operative Findings Opening pressure: 10-15 cmH2O, pinkish CSF gushed out after ventricular puncture. A Codman programmable shunt was used, preset to 100 mmH2O. Ventricular catheter length: 6.5cm. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to right. After shaving, scrubbing, disinfection & draping in sterile fashion, a linear incision was made at left frontal area. A burr hole was created at left Kocher point. Another linear incision was made at left upper quadrant of abdomen, followed by mini-laparotomy. A subcutaneous tunnel was then created from the abdominal wound to left frontal wound, with 1 wound in between for better passage; the peritoneal catheter was then passed through the subcutaneous tunnel. After assembly of the catheters & the reservoir, a small cruciate durotomy was done, followed by ventriculostomy & insertion of ventricular catheter. After securing the shunt and confirmation of smooth CSF flow, the wounds were closed in layers. Operators VS 賴達明 Assistants R5 曾峰毅, R4 王奐之, PGY 黃薇諭 Indication Of Emergent Operation IICP 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Ventriculopertoneal shunt insertion via left ... 開立醫師: 王奐之 開立時間: 2011/10/03 18:08 Pre-operative Diagnosis Right anterior choroidal artery aneurysm with subarachnoid hemorrhage, hydrocephalus Post-operative Diagnosis Right anterior choroidal artery aneurysm with subarachnoid hemorrhage, hydrocephalus Operative Method Ventriculopertoneal shunt insertion via left Kocher point (Codman programmable shunt) Specimen Count And Types nil Pathology Nil Operative Findings Opening pressure: 10-15 cmH2O, pinkish CSF gushed out after ventricular puncture. A Codman programmable shunt was used, preset to 100 mmH2O. Ventricular catheter length: 6.5cm. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to right. After shaving, scrubbing, disinfection & draping in sterile fashion, a linear incision was made at left frontal area. A burr hole was created at left Kocher point. Another linear incision was made at left upper quadrant of abdomen, followed by mini-laparotomy. A subcutaneous tunnel was then created from the abdominal wound to left frontal wound, with 1 wound in between for better passage; the peritoneal catheter was then passed through the subcutaneous tunnel. After assembly of the catheters & the reservoir, a small cruciate durotomy was done, followed by ventriculostomy & insertion of ventricular catheter. After securing the shunt and confirmation of smooth CSF flow, the wounds were closed in layers. Operators VS 賴達明 Assistants R5 曾峰毅, R4 王奐之, PGY 黃薇諭 Indication Of Emergent Operation IICP 相關圖片 李金田 (M,1943/05/20,68y9m) 手術日期 2011/10/03 手術主治醫師 王國川 手術區域 東址 007房 02號 診斷 Hydrocephalus 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3E 紀錄醫師 黃薇諭, 時間資訊 11:19 通知急診手術 11:23 開始NPO 11:23 臨時手術NPO 12:13 進入手術室 12:15 麻醉開始 12:40 誘導結束 12:54 手術開始 13:05 抗生素給藥 13:10 開始輸血 14:28 手術結束 14:28 麻醉結束 14:33 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 手術 急性硬腦膜下血腫清除術 1 2 R 摘要__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 曾峰毅 開立時間: 2011/10/03 13:51 Pre-operative Diagnosis Head injury, status post left craniectomy, status post ventriculoperitoneal shunt and cranioplasty, complicated with acute subdural and epidural hemorrahge Post-operative Diagnosis Head injury, status post left craniectomy, status post ventriculoperitoneal shunt and cranioplasty, complicated with acute epidural and subdural hemorrahge Operative Method Removal of acute subdural hematoma, and ventricular catheter to right temporal horn revision Specimen Count And Types Pathology Nil Operative Findings There were epidural hematoma and acute subdural hematoma. Ventricular catheter to right temporal horn did not function well. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to left. We shaved, scrubbed, disinfected, and then draped the patients scalp as usual. We made skin incision along previous operation wound, and disconncected two previous inserted ventricular catehter from the Y-connector. Artificial bone graft was removed. Epidural hematoma was removed, and then dura was opened. Subdural hematoma was removed, and right temporal horn catheter was rivised due to blood clot obstruction. Duroplasty was done with 4-0 prolene suture, and two ventricular catehters were connected back to Y-connector. The wound was irrigated with vancomycin-saline solution. One subgaleal and one epidural CWV were placed, and the wound was closed in layers. Operators VS 王國川 Assistants R4 王奐之 R1 Indication Of Emergent Operation Intracranial hypertension 相關圖片 摘要__ 手術科部: 外科部 套用罐頭: Removal of acute subdural hematoma, and ventr... 開立醫師: 王奐之 開立時間: 2011/10/03 14:31 Pre-operative Diagnosis Head injury, status post left craniectomy, status post ventriculoperitoneal shunt and cranioplasty, complicated with acute subdural and epidural hemorrahge Post-operative Diagnosis Head injury, status post left craniectomy, status post ventriculoperitoneal shunt and cranioplasty, complicated with acute epidural and subdural hemorrahge Operative Method Removal of acute subdural hematoma, and ventricular catheter to right temporal horn revision Specimen Count And Types Nil Pathology Nil Operative Findings There were epidural hematoma and acute subdural hematoma. Ventricular catheter to right temporal horn did not function well. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to left. We shaved, scrubbed, disinfected, and then draped the patients scalp as usual. We made skin incision along previous operation wound, and disconncected two previous inserted ventricular catehter from the Y-connector. Artificial bone graft was removed. Epidural hematoma was removed, and then dura was opened. Subdural hematoma was removed, and right temporal horn catheter was rivised due to blood clot obstruction. Duroplasty was done with 4-0 prolene suture, and two ventricular catehters were connected back to Y-connector. The wound was irrigated with vancomycin-saline solution. One subgaleal and one epidural CWV were placed, and the wound was closed in layers. Operators VS 王國川 Assistants R4 王奐之 PGY 黃薇諭 Indication Of Emergent Operation Intracranial hypertension 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Removal of acute subdural hematoma, and ventr... 開立醫師: 王奐之 開立時間: 2011/10/04 08:28 Pre-operative Diagnosis Head injury, status post left craniectomy, status post ventriculoperitoneal shunt and cranioplasty, complicated with acute subdural and epidural hemorrahge Post-operative Diagnosis Head injury, status post left craniectomy, status post ventriculoperitoneal shunt and cranioplasty, complicated with acute epidural and subdural hemorrahge Operative Method Removal of acute subdural hematoma, and ventricular catheter to right temporal horn revision Specimen Count And Types Nil Pathology Nil Operative Findings There were epidural hematoma and acute subdural hematoma. Ventricular catheter to right temporal horn did not function well. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to left. We shaved, scrubbed, disinfected, and then draped the patients scalp as usual. We made skin incision along previous operation wound, and disconncected two previous inserted ventricular catehter from the Y-connector. Artificial bone graft was removed. Epidural hematoma was removed, and then dura was opened. Subdural hematoma was removed, and right temporal horn catheter was rivised due to blood clot obstruction. Duroplasty was done with 4-0 prolene suture, and two ventricular catehters were connected back to Y-connector. The wound was irrigated with vancomycin-saline solution. One subgaleal and one epidural CWV were placed, and the wound was closed in layers. Operators VS 王國川 Assistants R4 王奐之 PGY 黃薇諭 Indication Of Emergent Operation Intracranial hypertension 相關圖片 吳秀玲 (F,1959/02/08,53y1m) 手術日期 2011/10/03 手術主治醫師 何子昌 手術區域 西址 032房 05號 診斷 Macular degeneration (senile), unspecified 器械術式 IVI 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 13:19 誘導結束 13:24 進入手術室 13:25 麻醉開始 13:26 手術開始 13:27 手術結束 13:27 麻醉結束 13:28 送出病患 記錄__ 手術科部: 眼科部 套用罐頭: IVIA 開立醫師: 楊中美 開立時間: 2011/10/03 13:29 Pre-operative Diagnosis macular edema Post-operative Diagnosis Ditto Operative Method Intravitreal Injection Of Avastin(OS) Specimen Count And Types nil Pathology nil Operative Findings nil Operative Procedures 1.Under topical anesthesia. 2.Disinfection and draping as usual. 3.Apply an eyelid speculum. 4.Intravitreal injection of Avastin 0.05ml 5.Check leakage 6.Iop measurement by digit 7.Check bare VA>ND100cm Operators 何子昌, Assistants 蘇乾嘉, 林美英 (F,1969/07/25,42y7m) 手術日期 2011/10/03 手術主治醫師 童寶玲 手術區域 兒醫 062房 03號 診斷 Tubo-ovarian abscess 器械術式 LSC drainage 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 蔡奉芳 ASA 2 紀錄醫師 楊博凱, 時間資訊 10:40 報到 11:25 進入手術室 11:30 麻醉開始 11:35 誘導結束 11:58 手術開始 13:00 抗生素給藥 13:25 手術結束 13:25 麻醉結束 13:35 進入恢復室 13:35 送出病患 14:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腹腔鏡子宮附屬器部份或全部切除術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 婦產部 套用罐頭: LSC Rt cystectomy(single port) 開立醫師: 楊博凱 開立時間: 2011/10/03 13:45 Pre-operative Diagnosis Right pyrosalpinx Post-operative Diagnosis Right pyrosalpinx Left hydrosalpinx Pelvic adhesion Operative Method Laparoscopic right salpingectomy + adhesionalysis Specimen Count And Types 1 piece About size: Source:right fallopian tube Pathology pending Operative Findings 1. Uterus: Avfl, normal size, grossly normal. 2. ROV: grossly normal. 3. RAD: Right fallopian tube dilated and swollen at 10 x 5cm, with pus-like content, severe adhesion to pelvic side wall, right ovary, and cul-de-sac. 4. LOV: grossly normal. 5. LAD: hydrosalpinx with adhesion to pelvic side wall. 6. CDS: Adhesion to right and left adnexa. 7. Estimated blood loss: 10ml Blood transfusion: Nil Complication: Nil Operative Procedures 1. Put the patient on the lithotomy position. 2. Vaginal douching with beta-iodine. 3. Skin disinfection with beta-iodine and skin draping as usual, then insert the Foley catheter and uterus elevator. 4. Make a 2cm skin incision at the umbilicus 5. Open the abdominal wall layer by layer 6. Insert single port equipment and 1st(5mm), 2nd (5mm) and 3rd (5mm) trocar 7. Make pneumoperitoneum 8. Dissect and remove the right fallopian tube. 9. Irrigate the pelvic space with normal saline. 10. Check bleeding and hemostasis. 11. Remove trocars and repair abdominal incision wounds. Operators 童寶玲 Assistants 劉惠珊, 楊博凱 陳文英 (F,1953/10/30,58y4m) 手術日期 2011/10/04 手術主治醫師 杜永光 手術區域 東址 002房 03號 診斷 Meningioma 器械術式 Removal of subdural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 3E 紀錄醫師 張書豪, 時間資訊 17:25 開始NPO 17:25 臨時手術NPO 17:25 通知急診手術 17:57 進入手術室 18:00 麻醉開始 18:10 誘導結束 18:37 手術開始 19:11 開始輸血 21:15 手術結束 21:15 麻醉結束 21:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 急性硬腦膜下血腫清除術 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 曾峰毅 開立時間: 2011/10/04 21:40 Pre-operative Diagnosis Right acute subdural hematoma after subduroperitoneal shunt Post-operative Diagnosis Right acute subdural hematoma after subduroperitoneal shunt Operative Method Right frontoparietal craniotomy for subdudral hematoma removal, ligation of subduroperitoneal shunt, and subdural drainage Specimen Count And Types Nil Pathology Nil Operative Findings Acute subdural hematoma was noted in the subdural space. one bridging vein near right temporal area was oozing, and was then cauterized for hemostasis. Brain parenchyma expasion was little after hematoma evacuation. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with ehad rotated to left. The scalp was shaved, scrubbed, disinfected, and then draped as usual. We made scalp incision along previous operation wound. We removed ventricular catheter of right subduroperitoneal shunt, ligated, and transected it near the burr holes. We drilled another burr hole, and performed 6x6 cm craniotomy. Dura was tented along the craniotomy window. Durotomy was done in C-shape. Subdural hematoma was removed, and one subdural drainage was placed. Dura was closed in water-tight suture. Bone graft was fixed back with mini-plates. After placing two subgaleal CWV, the wound was closed in layers. Operators Prof. 杜永光 Assistants R5 曾峰毅 R1 張書豪 Indication Of Emergent Operation Acute subdural hematoma 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 張書豪 開立時間: 2011/10/05 17:22 Pre-operative Diagnosis Right acute subdural hematoma after subduroperitoneal shunt Post-operative Diagnosis Right acute subdural hematoma after subduroperitoneal shunt Operative Method Right frontoparietal craniotomy for subdudral hematoma removal, ligation of subduroperitoneal shunt, and subdural drainage Specimen Count And Types Nil Pathology Nil Operative Findings Acute subdural hematoma was noted in the subdural space. one bridging vein near right temporal area was oozing, and was then cauterized for hemostasis. Brain parenchyma expasion was little after hematoma evacuation. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with ehad rotated to left. The scalp was shaved, scrubbed, disinfected, and then draped as usual. We made scalp incision along previous operation wound. We removed ventricular catheter of right subduroperitoneal shunt, ligated, and transected it near the burr holes. We drilled another burr hole, and performed 6x6 cm craniotomy. Dura was tented along the craniotomy window. Durotomy was done in C-shape. Subdural hematoma was removed, and one subdural drainage was placed. Dura was closed in water-tight suture. Bone graft was fixed back with mini-plates. After placing two subgaleal CWV, the wound was closed in layers. Operators Prof. 杜永光 Assistants R5 曾峰毅 R1 張書豪 Indication Of Emergent Operation Acute subdural hematoma 相關圖片 吳秀貞 (F,1973/11/27,38y3m) 手術日期 2011/10/04 手術主治醫師 曾漢民 手術區域 西址 039房 01號 診斷 Carpal tunnel syndrome 器械術式 Decompression of mediun nerve 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 09:20 進入手術室 09:40 麻醉開始 09:45 手術開始 10:30 手術結束 10:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 正中神經或尺神經腕部減壓術–單側 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Carpal Tunnel Syndrome 開立醫師: 余正苓 開立時間: 2011/10/04 10:44 Pre-operative Diagnosis Bilateral carpal tunnel syndrome Post-operative Diagnosis Bilateral carpal tunnel syndrome status post right neurolysis Operative Method Carpal Tunnel Syndrome Specimen Count And Types nil Pathology nil Operative Findings The median nerve was compressed tightly by the hypertrophic transverse carpal ligament Operative Procedures 1.The hand and forearm were sterilized with povidone-iodine tincture, then covered with stockinet. 2.Anesthesia: tourniquet was applied at distal upper arm, then 2.Anesthesia: 2% Xylocaine solution regional block with 15 ml 1% Xylocaine solution was infused through cephalic vein catheter at wrist area. 3. Incision: from vertical palmar crease to transverse wrist crease. 4.The palmaris longus tendon was identified, then the plamar aponeurosis was cut longitidinally along the ulnar side of the palmaris longus tendon. 5. The median nerve was identified beneath the palmars longus tendon. Under direct vision, the transverse carpal ligament was divided until no more pressure on the median nerve could be palpated. 6. The skin was closed by interrupted suture with 4/0 nylon.7.The tourniquet was released. The hand and wrist were draped with 6. The skin was closed by interrupted suture with 4/0 nylon. fluffy dressing and elastic bandage. Operators 曾漢民 Assistants 鍾文桂 陳國瑋 相關圖片 許雪峰 (F,1951/01/02,61y2m) 手術日期 2011/10/04 手術主治醫師 曾勝弘 手術區域 東址 005房 02號 診斷 Parkinson''s Disease 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 08:17 進入手術室 08:25 麻醉開始 08:30 誘導結束 08:30 抗生素給藥 09:07 手術開始 10:16 手術結束 10:16 麻醉結束 10:25 送出病患 10:30 進入恢復室 11:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室腹腔分流手術 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Implantable pulsed generator insertion at lef... 開立醫師: 林哲光 開立時間: 2011/10/04 10:39 Pre-operative Diagnosis Parkinson disease Post-operative Diagnosis Parkinson disease Operative Method Implantable pulsed generator insertion at left prechest area Specimen Count And Types nil Pathology Nil Operative Findings Medtronic IPG was inserted at left prechest area. Intraoperative IPG function was checked functionally. Operative Procedures Under ETGA and supine position with head mild rotated to right side, skin disinfected and drapped were performed as usual. Skin incision was made at left posterior auricle area. The previous two eletroleads were identified and subcutaneous tunneling was made from left prechest area to left neck. The leads were connected to IPG and IPG was inserted into the subcutaneous pocket at left prechest area. The wound was then closed in layers. Operators 曾勝弘 Assistants 林哲光, 姜士中 相關圖片 陳秀蘭 (F,1947/07/20,64y7m) 手術日期 2011/10/04 手術主治醫師 曾勝弘 手術區域 東址 005房 03號 診斷 Secondary Parkinsonism 器械術式 Port-A Implatation /WOR 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 10:38 進入手術室 10:42 麻醉開始 10:50 誘導結束 11:08 抗生素給藥 11:13 手術開始 11:53 手術結束 11:53 麻醉結束 11:58 送出病患 12:00 進入恢復室 13:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦脊髓液分流管重置 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Exchange of implantable pulsed generator at l... 開立醫師: 林哲光 開立時間: 2011/10/04 12:07 Pre-operative Diagnosis Parkinson disease Post-operative Diagnosis Parkinson disease Operative Method Exchange of implantable pulsed generator at left prechest area Specimen Count And Types nil Pathology Nil Operative Findings Medtronic IPG was inserted at left prechest area. Intraoperative IPG function was checked functionally. Operative Procedures Under ETGA and supine position with head mild rotated to right side, skin disinfected and drapped were performed as usual. Skin incision was made at left posterior auricle area. The previous two eletroleads were identified and subcutaneous tunneling was made from left prechest area to left neck. The leads were connected to IPG and IPG was inserted into the subcutaneous pocket at left prechest area. The wound was then closed in layers. Operators 曾勝弘 Assistants 林哲光, 姜士中 相關圖片 摘要__ 手術科部: 外科部 套用罐頭: Exchange of implantable pulsed generator at l... 開立醫師: 林哲光 開立時間: 2011/10/04 12:08 Pre-operative Diagnosis Parkinson disease Post-operative Diagnosis Parkinson disease Operative Method Exchange of implantable pulsed generator at left prechest area Specimen Count And Types nil Pathology Nil Operative Findings Medtronic IPG was inserted at left prechest area. Intraoperative IPG function was checked functionally. Operative Procedures Under ETGA and supine position with head mild rotated to right side, skin disinfected and drapped were performed as usual. Skin incision was made at left posterior auricle area. The previous two eletroleads were identified and subcutaneous tunneling was made from left prechest area to left neck. The leads were connected to IPG and IPG was inserted into the subcutaneous pocket at left prechest area. The wound was then closed in layers. Operators 曾勝弘 Assistants 林哲光, 姜士中 相關圖片 張雅嵐 (F,1982/12/29,29y2m) 手術日期 2011/10/04 手術主治醫師 曾勝弘 手術區域 東址 005房 04號 診斷 Soft tissue tumor 器械術式 Excision of subcutaneous tumor 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 12:07 進入手術室 12:10 麻醉開始 12:20 誘導結束 12:21 抗生素給藥 12:38 手術開始 13:30 手術結束 13:30 麻醉結束 13:40 送出病患 13:45 進入恢復室 14:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 頭皮腫瘤 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Scalp mass excision, nearly total excision 開立醫師: 林哲光 開立時間: 2011/10/04 13:55 Pre-operative Diagnosis Scalp mass Post-operative Diagnosis Scalp mass near the apex, suspected lipoma Operative Method Scalp mass excision, nearly total excision Specimen Count And Types 1 piece About size:4cm sized Source:subcutaneous tumor Pathology Pending Operative Findings Around 4cm sized, ill defined, yellowish, soft subcutaneous mass was noted. The galea seemed intact. Some residual mass was still palpable near the margin of the previous mass lesion. Whole thikness skin flap was also partially excised for pathology. Operative Procedures Under ETGA and prone position, skin disinfected and drapped were performed as usual. A linear skin incision was made at the center of the mass until the galea was exposed. The undermining was done for tumor excision and hemostasis was then performed. Part of the skin edge was incised for wound approximation. The wound was then closed in layers. Operators 曾勝弘 Assistants 林哲光, 姜士中 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Scalp mass excision, nearly total excision 開立醫師: 林哲光 開立時間: 2011/10/04 13:55 Pre-operative Diagnosis Scalp mass Post-operative Diagnosis Scalp mass near the apex, suspected lipoma Operative Method Scalp mass excision, nearly total excision Specimen Count And Types 1 piece About size:4cm sized Source:subcutaneous tumor Pathology Pending Operative Findings Around 4cm sized, ill defined, yellowish, soft subcutaneous mass was noted. The galea seemed intact. Some residual mass was still palpable near the margin of the previous mass lesion. Whole thikness skin flap was also partially excised for pathology. Operative Procedures Under ETGA and prone position, skin disinfected and drapped were performed as usual. A linear skin incision was made at the center of the mass until the galea was exposed. The undermining was done for tumor excision and hemostasis was then performed. Part of the skin edge was incised for wound approximation. The wound was then closed in layers. Operators 曾勝弘 Assistants 林哲光, 姜士中 相關圖片 鄭慈竹 (F,1956/02/20,56y0m) 手術日期 2011/10/04 手術主治醫師 曾勝弘 手術區域 東址 005房 05號 診斷 Lumbar spondylosis 器械術式 Laminectomy for decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 13:55 進入手術室 14:00 手術開始 14:00 誘導結束 14:00 麻醉開始 14:30 抗生素給藥 16:20 開始輸血 17:30 抗生素給藥 18:30 手術結束 18:30 麻醉結束 18:45 送出病患 18:50 進入恢復室 20:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術(減壓)-超過二節 1 1 手術 脊椎融合術-後融合,無固定物 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: L3-5 and partial L2 laminectomy, sublaminal d... 開立醫師: 林哲光 開立時間: 2011/10/04 19:14 Pre-operative Diagnosis L3-5 spinal canal stenosis Post-operative Diagnosis L3-5 spinal canal stenosis Operative Method L3-5 and partial L2 laminectomy, sublaminal decompression and posterolateral fusion with autologus bone and Sinbone Specimen Count And Types nil Pathology Nil Operative Findings Hypertrophic change of ligamentum flavum was noted with tightly compressing the spinal cord. Th dura seemed re-expanded well after laminectomy for posterior decompression and removal of ligamentum flavum. Dura tear was noted during the operation status post suture with 5-0 Prolene. Stenosis of bilateral L3-5 neural foamens were also noted and decompression was done under the vision with Karyson. Operative Procedures Under ETGA and prone position, skin disinfected and drapped were performed as usual. Midline skin incision was made at L2-S1 after C-arm localization. The paraspinal muscles were detached and the laminectomy was then performed. Sublaminal decompression was also performed meticulously. The dura tear was repaired with 5-0 Prolene. Posterolateral fusion was done with decortication by Nomi and bone graft (autologus bone and Sinbone) were put over the decortication area at bilateral lamina and transverse process, which were fixed as a multiple pockets to avoid the bone graft disposition. The wound was then closed in layers after epidural H/V were inserted. Operators 曾勝弘 Assistants 林哲光, 姜士中 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: L3-5 and partial L2 laminectomy, sublaminal d... 開立醫師: 林哲光 開立時間: 2011/10/04 19:14 Pre-operative Diagnosis L3-5 spinal canal stenosis Post-operative Diagnosis L3-5 spinal canal stenosis Operative Method L3-5 and partial L2 laminectomy, sublaminal decompression and posterolateral fusion with autologus bone and Sinbone Specimen Count And Types nil Pathology Nil Operative Findings Hypertrophic change of ligamentum flavum was noted with tightly compressing the spinal cord. Th dura seemed re-expanded well after laminectomy for posterior decompression and removal of ligamentum flavum. Dura tear was noted during the operation status post suture with 5-0 Prolene. Stenosis of bilateral L3-5 neural foamens were also noted and decompression was done under the vision with Karyson. Operative Procedures Under ETGA and prone position, skin disinfected and drapped were performed as usual. Midline skin incision was made at L2-S1 after C-arm localization. The paraspinal muscles were detached and the laminectomy was then performed. Sublaminal decompression was also performed meticulously. The dura tear was repaired with 5-0 Prolene. Posterolateral fusion was done with decortication by Nomi and bone graft (autologus bone and Sinbone) were put over the decortication area at bilateral lamina and transverse process, which were fixed as a multiple pockets to avoid the bone graft disposition. The wound was then closed in layers after epidural H/V were inserted. Operators 曾勝弘 Assistants 林哲光, 姜士中 相關圖片 鄭恩進 (M,1933/05/20,78y9m) 手術日期 2011/10/04 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 HIVD 器械術式 Laminectomy for decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 吳健暉, 時間資訊 00:00 臨時手術NPO 08:01 進入手術室 08:05 麻醉開始 08:10 誘導結束 08:50 抗生素給藥 08:58 手術開始 10:23 手術結束 10:23 麻醉結束 10:30 送出病患 10:33 進入恢復室 11:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-腰椎 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 外科部 套用罐頭: HIVD 開立醫師: 曾峰毅 開立時間: 2011/10/04 10:30 Pre-operative Diagnosis Sequestrated disc, L4/5 Post-operative Diagnosis Sequestrated disc, L4/5 Operative Method Microdiskecotmy of L4/5 via right L4/5 laminotomy Specimen Count And Types Nil Pathology Nil Operative Findings Sequestrated disc from L4/5 compromised right L5 root tightly. Hypertrophic ligamentum flavum compressed the thecal sac. Neural sctructure was decompressed well after the surgery. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After C-arm localization, we made one midline skin incision and dissected paraspinal muscle to expose right L4/5 interlaminar space. Right L4/5 laminotomy was performed with air-drill, and microdiskectomy was done. The wound was closed in layers. Operators VS 賴達明 Assistants R5 曾峰毅 R1 吳健暉 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: HIVD 開立醫師: 吳健暉 開立時間: 2011/10/04 10:33 Pre-operative Diagnosis Sequestrated disc, L4/5 Post-operative Diagnosis Sequestrated disc, L4/5 Operative Method Microdiskecotmy of L4/5 via right L4/5 laminotomy Specimen Count And Types Nil Pathology Nil Operative Findings Sequestrated disc from L4/5 compromised right L5 root tightly. Hypertrophic ligamentum flavum compressed the thecal sac. Neural sctructure was decompressed well after the surgery. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After C-arm localization, we made one midline skin incision and dissected paraspinal muscle to expose right L4/5 interlaminar space. Right L4/5 laminotomy was performed with air-drill, and microdiskectomy was done. The wound was closed in layers. Operators VS 賴達明 Assistants R5 曾峰毅 R1 吳健暉 相關圖片 洪淑霞 (F,1968/10/11,43y5m) 手術日期 2011/10/04 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Herniation of intervertebral disc 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 吳健暉, 時間資訊 00:00 臨時手術NPO 10:41 進入手術室 10:45 麻醉開始 10:55 誘導結束 11:25 抗生素給藥 11:31 手術開始 14:15 手術結束 14:15 麻醉結束 14:25 送出病患 14:26 進入恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 手術 椎間盤切除術-頸椎 1 1 手術 脊椎融合術-前融合,有固定物)≦四節 1 2 摘要__ 手術科部: 外科部 套用罐頭: Anterior cervical diskectomy at C4/5 with art... 開立醫師: 曾峰毅 開立時間: 2011/10/04 14:18 Pre-operative Diagnosis Cervical herniated intervertebral disc, C4/5 Post-operative Diagnosis Cervical herniated intervertebral disc, C4/5 Operative Method Anterior cervical diskectomy at C4/5 with arthroplasty Specimen Count And Types Nil Pathology Nil Operative Findings Herniated cervical intervertebral disc compromised thecal sac, and was removed after the surgery. Syhtnes prodisc-C was used for arthroplasty. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with neck extended. We check the midline, and made one transverse skin incison at right upper aspect of the neck. We dissected throught medial border of the platysma to the prevertebral space. We confirmed the level with C-arm, and performed anterior cervical diskecotmy at C4/5. Arthroplasty with Prodisc-C was done. The wound was irrigated with gentamycin saline, and the wound was closed in layers. Operators VS 賴達明 Assistants R5 曾峰毅 R1 吳健暉 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Anterior cervical diskectomy at C4/5 with art... 開立醫師: 吳健暉 開立時間: 2011/10/05 16:01 Pre-operative Diagnosis Cervical herniated intervertebral disc, C4/5 Post-operative Diagnosis Cervical herniated intervertebral disc, C4/5 Operative Method Anterior cervical diskectomy at C4/5 with arthroplasty Specimen Count And Types Nil Pathology Nil Operative Findings Herniated cervical intervertebral disc compromised thecal sac, and was removed after the surgery. Syhtnes prodisc-C was used for arthroplasty. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with neck extended. We check the midline, and made one transverse skin incison at right upper aspect of the neck. We dissected throught medial border of the platysma to the prevertebral space. We confirmed the level with C-arm, and performed anterior cervical diskecotmy at C4/5. Arthroplasty with Prodisc-C was done. The wound was irrigated with gentamycin saline, and the wound was closed in layers. Operators VS 賴達明 Assistants R5 曾峰毅 R1 吳健暉 相關圖片 林純敏 (F,1948/09/19,63y5m) 手術日期 2011/10/04 手術主治醫師 賴達明 手術區域 東址 003房 03號 診斷 Lumbar Spondylosis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 吳健暉, 時間資訊 23:09 臨時手術NPO 14:40 進入手術室 14:55 麻醉開始 15:10 誘導結束 15:30 抗生素給藥 15:41 手術開始 17:35 手術結束 17:35 麻醉結束 17:46 送出病患 17:50 進入恢復室 18:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎間盤切除術-腰椎 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 曾峰毅 開立時間: 2011/10/04 17:46 Pre-operative Diagnosis Spondylolisthesis, L4/5, grade I Post-operative Diagnosis Spondylolisthesis, L4/5, grade I Operative Method Transforaminal lumbar interbody fusion at L4/5 Specimen Count And Types Nil Pathology Nil Operative Findings Hypertrophic ligamentum flavum compromised thecal sac and nerve roots tightly. Neural structure was decmopressed well after the surgery. Synthes transpedicular screws systems with PEEK cage was used for TLIF. Operative Procedures With endotracheal general anaethesia, the patient was put in prone position. After C-arm localization, we made one midline skin incision at back, and dissected bilateral paraspinal muscle to expose bilateral lamiae from L3 to L5. Posterior instrumentation was done with transpedicular screws at bialteral pedicles of L4 and L5. Posterior decompression was done with laminectomy at L4. L4/5 diskectomy was done, and transforaminal lumbar interbody fusion was done via right neural foramen with PEEK cage and autologous bone graft. Posterior fixation was done with two 6-cm rods. The wound was closed in layers after two epidural hemovacs and gentamycin irrigation. Operators VS 賴達明 Assistants R5 曾峰毅 R1 吳健暉 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 吳健暉 開立時間: 2011/10/05 16:01 Pre-operative Diagnosis Spondylolisthesis, L4/5, grade I Post-operative Diagnosis Spondylolisthesis, L4/5, grade I Operative Method Transforaminal lumbar interbody fusion at L4/5 Specimen Count And Types Nil Pathology Nil Operative Findings Hypertrophic ligamentum flavum compromised thecal sac and nerve roots tightly. Neural structure was decmopressed well after the surgery. Synthes transpedicular screws systems with PEEK cage was used for TLIF. Operative Procedures With endotracheal general anaethesia, the patient was put in prone position. After C-arm localization, we made one midline skin incision at back, and dissected bilateral paraspinal muscle to expose bilateral lamiae from L3 to L5. Posterior instrumentation was done with transpedicular screws at bialteral pedicles of L4 and L5. Posterior decompression was done with laminectomy at L4. L4/5 diskectomy was done, and transforaminal lumbar interbody fusion was done via right neural foramen with PEEK cage and autologous bone graft. Posterior fixation was done with two 6-cm rods. The wound was closed in layers after two epidural hemovacs and gentamycin irrigation. Operators VS 賴達明 Assistants R5 曾峰毅 R1 吳健暉 相關圖片 徐平和 (M,1945/05/05,66y10m) 手術日期 2011/10/04 手術主治醫師 蕭輔仁 手術區域 西址 039房 03號 診斷 Carpal tunnel syndrome 器械術式 Decompression of mediun nerve 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 12:45 進入手術室 13:00 麻醉開始 13:03 手術開始 13:03 誘導結束 13:50 手術結束 13:50 麻醉結束 13:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 正中神經或尺神經腕部減壓術–單側 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Median nerve neurolysis 開立醫師: 陳國瑋 開立時間: 2011/10/04 14:03 Pre-operative Diagnosis Carpal Tunnel Syndrome Post-operative Diagnosis Carpal Tunnel Syndrome Operative Method Median nerve neurolysis Specimen Count And Types nil Pathology nil Operative Findings The median was compressed tightly by the transvers carpal ligament. Operative Procedures 1.The hand and forearm were sterilized with povidone-iodine tincture, then covered with stockinet. 2.Anesthesia: regional block with 15 ml 1% Xylocaine 3. Incision: S shape from vertical palmar crease to transverse wrist crease. 4.The palmaris longus tendon was identified, then the plamar aponeurosis was cut longitidinally along the ulnar side of the palmaris longus tendon. 5. The median nerve was identified beneath the palmars longus tendon. Under direct vision, the transverse carpal ligament was divided until no more pressure on the median nerve could be palpated. 6. The skin was closed by interrupted suture with 4/0 nylon. Operators 蕭輔仁 Assistants 鍾文桂 陳國瑋 相關圖片 張智傑 (M,1979/10/14,32y5m) 手術日期 2011/10/04 手術主治醫師 蔡翊新 手術區域 東址 023房 04號 診斷 Hydrocephalus 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 14:35 報到 14:55 進入手術室 15:00 麻醉開始 15:05 誘導結束 16:05 手術開始 18:35 抗生素給藥 19:25 麻醉結束 19:25 手術結束 19:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 蔡翊新 開立時間: 2011/10/04 19:25 Pre-operative Diagnosis Hydrocephalus s/p VP shunt with slit ventricle. Post-operative Diagnosis Hydrocephalus s/p VP shunt with slit ventricle. Operative Method V-P Shunt via right Kocher point. Removal of previous shunt. Specimen Count And Types peritoneal catheter, sent for bacterial culture. Pathology Nil. Operative Findings Previous VP shunt reservoir was medium-pressure and located at right Frazier point. The ventricular catheter was adhered tightly to the brain tissue and could not be removed. The peritoneal catheter had been amputated at right anterior chest wound, but a segment of the stump retained at subcutaneous layer at right anterior chest wall. CSF was clear and the pressure was about 5 cmH2O. However, the reservoir was changed to high-pressure because of over-drainage with previous pressure setting. There was severe adhesion and fibrosis around the wound at the RUQ of abdomen. General surgeon was consulted to open the peritoneum for us to insert the peritoneal catheter. The ventricular catheter was 6.5 cm in depth and peritoneal catheter 20 cm. Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: supine with head rotated to left. 3.Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 5 cm curvilinear, right occipital, along previous wound. The old VP shunt was removed. Because of retention of ventricular catheter in brain tissue, we could not puncture the ventricle via old tract. So we change the site to right Kocher point. Another curvilinear scalp incision was made at right frontal area. 5.After the scalp flap had been lifted and reflected anteriorly, a burr hole was made at right Kocher point and the dura was tented by 2 stitches. 6.The dura was opened by a nib incision. Rt lateral ventricle was tapped by a ventricular needle, then a 6.5 cm segment of the ventricular catheter was introduced into the ventricle. The outer end of the catheter was connected to a high-pressure Pudenz reservoir. 7. A laparotomy, 8 cm in length, was made at RUQ of the abdomen, along previous wound. General surgeon was consulted to open the peritoneum because of severe adhesion around the preperitoneal space. Subsequently, distal 20 cm segment of the peritoneal catheter (low pressure) was introduced into the peritoneal cavity. The proximal end of this catheter was passed through subcutaneous tunnel at forechest, neck, right retroauricular area and connected the reservoir. The shunt system was checked to make sure its function was working. 8. The reservoir was fixed to pericranium by 3 stitches. 9. Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by interrupted suture with 3/0 nylon. The laparotomy was closed in layers. 10.Blood transfusion: nil. Blood loss: 150 ml. 11.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5鍾文桂R4楊惠馨R3陳國瑋 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 蔡翊新 開立時間: 2011/10/04 19:25 Pre-operative Diagnosis Hydrocephalus s/p VP shunt with slit ventricle. Post-operative Diagnosis Hydrocephalus s/p VP shunt with slit ventricle. Operative Method V-P Shunt via right Kocher point. Removal of previous shunt. Specimen Count And Types peritoneal catheter, sent for bacterial culture. Pathology Nil. Operative Findings Previous VP shunt reservoir was medium-pressure and located at right Frazier point. The ventricular catheter was adhered tightly to the brain tissue and could not be removed. The peritoneal catheter had been amputated at right anterior chest wound, but a segment of the stump retained at subcutaneous layer at right anterior chest wall. CSF was clear and the pressure was about 5 cmH2O. However, the reservoir was changed to high-pressure because of over-drainage with previous pressure setting. There was severe adhesion and fibrosis around the wound at the RUQ of abdomen. General surgeon was consulted to open the peritoneum for us to insert the peritoneal catheter. The ventricular catheter was 6.5 cm in depth and peritoneal catheter 20 cm. Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: supine with head rotated to left. 3.Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 5 cm curvilinear, right occipital, along previous wound. The old VP shunt was removed. Because of retention of ventricular catheter in brain tissue, we could not puncture the ventricle via old tract. So we change the site to right Kocher point. Another curvilinear scalp incision was made at right frontal area. 5.After the scalp flap had been lifted and reflected anteriorly, a burr hole was made at right Kocher point and the dura was tented by 2 stitches. 6.The dura was opened by a nib incision. Rt lateral ventricle was tapped by a ventricular needle, then a 6.5 cm segment of the ventricular catheter was introduced into the ventricle. The outer end of the catheter was connected to a high-pressure Pudenz reservoir. 7. A laparotomy, 8 cm in length, was made at RUQ of the abdomen, along previous wound. General surgeon was consulted to open the peritoneum because of severe adhesion around the preperitoneal space. Subsequently, distal 20 cm segment of the peritoneal catheter (low pressure) was introduced into the peritoneal cavity. The proximal end of this catheter was passed through subcutaneous tunnel at forechest, neck, right retroauricular area and connected the reservoir. The shunt system was checked to make sure its function was working. 8. The reservoir was fixed to pericranium by 3 stitches. 9. Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by interrupted suture with 3/0 nylon. The laparotomy was closed in layers. 10.Blood transfusion: nil. Blood loss: 150 ml. 11.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5鍾文桂R4楊惠馨R3陳國瑋 相關圖片 張智傑 (M,1979/10/14,32y5m) 手術日期 2011/10/04 手術主治醫師 蔡翊新 手術區域 東址 005房 01號 診斷 Hydrocephalus 器械術式 V-P shunt ligation 手術類別 緊急手術 手術部位 胸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 李振豪, 時間資訊 06:41 通知急診手術 07:05 進入手術室 07:15 抗生素給藥 07:33 麻醉開始 07:34 麻醉結束 07:35 手術開始 08:00 手術結束 08:05 送出病患 19:35 進入恢復室 20:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 皮下肌肉或深部異物取出術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Ligation of the ventriculo-peritoneal shunt 開立醫師: 李振豪 開立時間: 2011/10/04 08:14 Pre-operative Diagnosis Slit ventricle syndrome Post-operative Diagnosis Slit ventricle syndrome Operative Method Ligation of the ventriculo-peritoneal shunt Specimen Count And Types 1 piece About size:tip culture x I Source:peritoneal catheter Pathology Nil Operative Findings Eschar formation over the wound was noted and removed during the operation. Much granulation formation at subcutaneous soft tissue was noted. The shunt was identified at right side of the wound. After ligation with three 3-0 silk, the peritoneal catheter was pulled out and transected. No acute complication was noted. The patient stood whole procedure well. Operative Procedures The patient was put in supine position. The stitches over right forechest was removed. The skin was scrubbed, disinfected, and draped as usual. Local anesthesia was applied over right forechest wound. The right forechest wound was opened and dissected to identify the shunt. The peritoneal catheter was pulled out and ligated with three 3-0 silk. The peritoneal catheter was transected and sent for bacterial culture. The wound was irrigated and hemostasis was achieved. the wound was then closed in layers with 3-0 Vicryl and 4-0 Nylon. Operators VS蔡翊新 Assistants R5李振豪 Indication Of Emergent Operation Headache with diplopia 相關圖片 吳元生 (M,1959/02/28,53y0m) 手術日期 2011/10/05 手術主治醫師 杜永光 手術區域 東址 016房 03號 診斷 Lung cancer 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 鄭宇軒, 時間資訊 19:27 臨時手術NPO 14:50 報到 15:06 進入手術室 15:15 麻醉開始 15:35 誘導結束 16:00 抗生素給藥 16:35 手術開始 19:00 抗生素給藥 20:35 麻醉結束 20:35 手術結束 20:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除-手術時間在4小時以內 1 2 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT 開立醫師: 曾峰毅 開立時間: 2011/10/05 20:54 Pre-operative Diagnosis Cerebellar metastasis Post-operative Diagnosis Cerebellar metastasis Operative Method Right suboccipital craniotomy fro tumor excision Specimen Count And Types Several fragments of one tumor was sent for pathology. Pathology Pending Operative Findings One intra-axial, hypervascular, well-defined tumor was noted at right cerebellar hemisphere was adhesion to tentorial. Operative Procedures With endotracheal general anaesthesia, the patient was put prone position with head fixed with Mayfield head clamp. We made one right paramidan longitudinal skin incision 3 cam away from the midline. We dissected the muscle from the nuchal line, and harvested one 4x4 cm autologous fascia graft. We drilled three burr holes, and created one 6x6 cm craniotomy. Dura incision was made in T-shape, and CSF was drainaed from cistern. Tumor excision was done in piece-meal, and hemostasis was performed. Dura-attachment was cauterized. Duroplasty was performed in water-tight suture with autologous fascia graft. Bone graft was fixed back with mini-plates, and the wound was closed in layers after one subgaleal CWV. Operators Prof. 杜永光 Assistants R5 曾峰毅 R1 鄭宇軒 相關圖片 丁慧賢 (M,1973/08/02,38y7m) 手術日期 2011/10/05 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 曾偉倫, 李振豪, 時間資訊 19:24 臨時手術NPO 07:35 報到 08:00 進入手術室 08:10 麻醉開始 08:30 誘導結束 08:35 抗生素給藥 08:40 手術開始 11:35 抗生素給藥 14:35 麻醉結束 14:35 手術結束 14:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4~8小時 1 1 L 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 記錄__ 手術科部: 外科部 套用罐頭: Left pterional approach for Simpson grade I t... 開立醫師: 李振豪 開立時間: 2011/10/05 14:24 Pre-operative Diagnosis Tuberculum sellae meningioma Post-operative Diagnosis Tuberculum sellae meningioma Operative Method Left pterional approach for Simpson grade I tumor excision Specimen Count And Types 1 piece About size:Few small pieces Source:Suprasellar tumor Pathology Pending Operative Findings The tumor was 1x0.5x0.6 cm in size, hypervascularized, well-demarcated, gray-reddish, and soft in character. The tumor was located between two optic nerve and originated from the tuberculum sellae with mild extension into left optic canal. The left optic sheath was opened for total removal of the tumor. In order to achieve Simpson grade I tumor excision, the dura covered the tubercullum sellae was resected and thin layer of bony structure was drilled off. The optic nerve, optic chiasma, laminae terminalis, pituitary gland, and bilateral internal carotid arteries were protected well during whole procedure. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with left shoulder elevation and head rotated to right. The head was fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. One curvilinear scalp incision was made at left frontotemporal area and the scalp flap was elevated with facial nerve preservation. The temporalis muscle was detached from skull bone and reflected posterioinferiorly. Three burr holes were created followed by one 8x8cm craniotomy window. Dural tenting was done. The left sphenoid ridge was drilled off and the temporal ligment was devided in order to expose left anterior clinoid process.Anterior clinoidectomy was done. The active oozing from skull base was controlled with bipolar electrocautery and Gelfoam packing. Curvilinear durotomy was made at fronto-temporal base cross the Sylvian fissure. After dura opening, frontal lobe was retracted. The Sylvian fissure was opened and the tumor was encountered just medial to the left optic nerve. The arachnoid membrane covered the tumor was dissected. The tumor was removed by bipolar electrocautery, tumor forceps, ring curette, dissector, and suction. The left optic sheath was opened for total removal of the tumor. The dura covered the tubercullum sellae was resected and thin layer of bone was drilled off. After hemostasis, the dura was closed with 4-0 prolene. The skull plate was fixed back with miniplates, screws, and three central tenting. The temporalis muscle was fixed back to its neutral position. One subgaleal CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators Prof.杜永光 Assistants R5李振豪, R3曾偉倫, Ri王瑩軒 相關圖片 廖新凱 (M,1972/10/31,39y4m) 手術日期 2011/10/05 手術主治醫師 杜永光 手術區域 東址 003房 02號 診斷 Malignant neoplasm of cerebrum, except lobes and ventricles 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 2 紀錄醫師 曾偉倫, 時間資訊 23:26 臨時手術NPO 15:00 進入手術室 15:10 麻醉開始 15:35 誘導結束 15:40 手術開始 15:40 抗生素給藥 18:40 抗生素給藥 20:55 手術結束 20:55 麻醉結束 21:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除-手術時間在4~8小時 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 記錄__ 手術科部: 外科部 套用罐頭: Left suboccipital craniotomy for tumor excision 開立醫師: 李振豪 開立時間: 2011/10/05 21:26 Pre-operative Diagnosis Multiple brain tumor, suspect multicentric glioblastoma Post-operative Diagnosis Multiple brain tumor, suspect multicentric glioblastoma Operative Method Left suboccipital craniotomy for tumor excision Specimen Count And Types 1 piece About size:Multiple small pieces Source:left cerebellar tumor Pathology Pending Operative Findings The tumor was 3.3 x 3.8 x 2.2cm in size, hypervascularized, gelatinous, ill-defined, and gray-reddish in color. There was two different component noted within the tumor, high grade glioma was favored at posterosuperior part and relative low grade appearance was favored at anteroinferior area. Intra-operative sonography was checked before and during tumor excision. The cerebellum was still mild bulging after tumor excision and release of CSF. Mastoid aircell was entered during craniotomy and sealed with Gelfoam and bonewax. Operative Procedures Under endotracheal general anesthesia, the patient was put in 3/4 prone position with head fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. Left retroauricular curvilinear scalp incision was made and one 3x2cm fascia was harvested for duroplasty. The Nuchal muscle was devided along the wound and the suboccipital area was exposed. Two burr holes were created followed by one 5x3cm craniotomy window. The craniotomy window was extended superiorly and anteriorly to expose the transverse and sigmoid sinus. Intra-operative sonography was used for localization of the tumor. Pi shape durotomy was done and CSF was released from cisterna magna. One 2 x 1cm corticotomy was performed for tumor excision. The tumor was encountered about 1.5cm in depth. Sonography was checked again during tumor excision. After removal of the tumor, hemostasis was achieved with bipolar electrocautery and Surgicel lining. Duroplasty was performed with autologous fascia graft. the skull plate was fixed back with wires, miniplates, and screws. One CWV drain was placed and the wound was closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators Prof.杜永光 Assistants R5李振豪, R3曾偉倫 相關圖片 陳素真 (F,1956/12/11,55y3m) 手術日期 2011/10/05 手術主治醫師 曾漢民 手術區域 東址 006房 03號 診斷 Pituitary tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 陳國瑋, 時間資訊 19:51 臨時手術NPO 15:50 報到 16:05 進入手術室 16:15 麻醉開始 16:30 誘導結束 16:40 抗生素給藥 16:50 手術開始 18:45 麻醉結束 18:45 手術結束 18:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 經由蝶竇之腦下垂體瘤切除 1 1 摘要__ 手術科部: 外科部 套用罐頭: Transnasal transsphenoidal adenomectomy. 開立醫師: 鍾文桂 開立時間: 2011/10/05 23:00 Pre-operative Diagnosis Pituitary macroadenoma. Post-operative Diagnosis Pituitary macroadenoma. Operative Method Transnasal transsphenoidal adenomectomy. Specimen Count And Types 1 piece About size:2cc Source:pituitary adenoma Pathology Pending. Operative Findings 1. 2. Due to CSF leakage, autologous fat graft from abdomen was implanted into the sphenoid sinus and TissueColDup was applied on it. 3. Lumbar drain was placed for CSF drainage. Operative Procedures Under endotracheal general anesthesia, the patient was putin supine position with head tilted 30 degree to left. The nasal cavity was packing with epinephrine soaked gauze for 10 minutes. The face and left lower abdomen were prepared with povidone-iodine alcohol tincture, and the mucosa of oral and nasal cavity with aqueous povidone-iodine tincture. The nasal submucosa at septum and floor were infiltrated with 1:100 epinephrine solution. One 1.5cm incision was made at nasal mucosa of right nasal septum and the musoca , Tissucol Duo, autologous bone fragment, Tissucol Duo, and Gelfoam. The vomer bone was plawas dissected away from the septum. The nasal septum was fractured and the vomer was removed. The sphenoid sinus was entered and the mucosa within the sphenoid sinus was removed. The sellar floor was identified and opened. The bleeding from cavernous sinus was encountered and hemostasis was achieved with Gelfoam packing. Cruciform durotomy was done and the tumor showed up after dura opening. The margin of the tumor was dissected by microdissector. The tumor was then removed by alligator. Hemostasis was achieved and the space was packing with Gelfoamced back and the nasal mucosa was pushed back to the neutral position. Tissucol Duo was applied between the nasal mucosa and the vomer bone. The nasal septum and the middle turbinate was pushed back to neutral position. Bilateral nasal cavities were packed with a segment of rubber glove finger which had been soaked with better-iodine ointment. Total blood loss was 50 ml. The course of the operation was smooth. Operators 曾漢民 Assistants 鍾文桂 陳國偉 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Transnasal transsphenoidal adenomectomy. 開立醫師: 陳國瑋 開立時間: 2011/10/06 06:58 Pre-operative Diagnosis Pituitary macroadenoma. Post-operative Diagnosis Pituitary macroadenoma. Operative Method Transnasal transsphenoidal adenomectomy. Specimen Count And Types 1 piece About size:2cc Source:pituitary adenoma Pathology Pending. Operative Findings 1. The tumor invaded through the sellae floor. It was soft and red in character. Normal gland came in sight after tumor removal 2. Due to CSF leakage, autologous fat graft from abdomen was implanted into the sphenoid sinus and TissueColDup was applied on it. 3. Lumbar drain was placed for CSF drainage. Operative Procedures Under endotracheal general anesthesia, the patient was putin supine position with head tilted 30 degree to left. The nasal cavity was packing with epinephrine soaked gauze for 10 minutes. The face and left lower abdomen were prepared with povidone-iodine alcohol tincture, and the mucosa of oral and nasal cavity with aqueous povidone-iodine tincture. The nasal submucosa at septum and floor were infiltrated with 1:100 epinephrine solution. One 1.5cm incision was made at nasal mucosa of right nasal septum and the musoca , Tissucol Duo, autologous bone fragment, Tissucol Duo, and Gelfoam. The vomer bone was plawas dissected away from the septum. The nasal septum was fractured and the vomer was removed. The sphenoid sinus was entered and the mucosa within the sphenoid sinus was removed. The sellar floor was identified and opened. The bleeding from cavernous sinus was encountered and hemostasis was achieved with Gelfoam packing. Cruciform durotomy was done and the tumor showed up after dura opening. The margin of the tumor was dissected by microdissector. The tumor was then removed by alligator. Hemostasis was achieved and the space was packing with Gelfoamced back and the nasal mucosa was pushed back to the neutral position. Tissucol Duo was applied between the nasal mucosa and the vomer bone. The nasal septum and the middle turbinate was pushed back to neutral position. Bilateral nasal cavities were packed with a segment of rubber glove finger which had been soaked with better-iodine ointment. Total blood loss was 50 ml. The course of the operation was smooth. Operators 曾漢民 Assistants 陳國瑋, 鍾文桂, 相關圖片 林玲珍 (F,1951/02/28,61y0m) 手術日期 2011/10/05 手術主治醫師 蔡瑞章 手術區域 東址 005房 02號 診斷 Meningitis due to Gram-negative bacteria 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 2 紀錄醫師 鍾文桂, 時間資訊 19:50 臨時手術NPO 14:05 進入手術室 14:10 麻醉開始 14:15 誘導結束 15:13 手術開始 16:45 手術結束 16:45 麻醉結束 16:50 送出病患 16:55 進入恢復室 17:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 外科部 套用罐頭: Implantation of ventriculoperitoneal shunt, left. 開立醫師: 鍾文桂 開立時間: 2011/10/05 17:09 Pre-operative Diagnosis Hydrocephalus. Post-operative Diagnosis Hydrocephalus. Operative Method Implantation of ventriculoperitoneal shunt, left. Specimen Count And Types 1 piece About size:3cc Source:CSF for routine,BCS, and bacterial culture. Pathology Nil. Operative Findings Clear colorless CSF gushed out after ventriculostomy. Medtronic medium pressure Hakim fixed pressure shunt was implanted to left Kocher point. Operative Procedures Under ETGA, the patient was placed in supine position and the head was tilted to the right side. After shaving, disinfection, and draping, a curvilinear scalp incision and a linear incision at left upper quadrant were incised and dissected. A burr hole was made at left Kocher point. The peritoneal cavity was reached after dissection. A subcutaneous tunnel was created from left upper quadrant of abdomen to left frontal region. After ventriculostomy, the ventricle catheter was implanted through the same tract. The shunt patency was checked. The peritoneal catheter was placed into the peritoneal cavity. The wound was closed in layers. The right Kocher Ommaya reservoir was left in situ. Operators Prof. 蔡瑞章 Assistants 鍾文桂 陳國瑋 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Implantation of ventriculoperitoneal shunt, left. 開立醫師: 鍾文桂 開立時間: 2011/10/05 20:14 Pre-operative Diagnosis Hydrocephalus. Post-operative Diagnosis Hydrocephalus. Operative Method Implantation of ventriculoperitoneal shunt, left. Specimen Count And Types 1 piece About size:3cc Source:CSF for routine,BCS, and bacterial culture. Pathology Nil. Operative Findings Clear colorless CSF gushed out after ventriculostomy. Medtronic medium pressure Hakim fixed pressure shunt was implanted to left Kocher point. Operative Procedures Under ETGA, the patient was placed in supine position and the head was tilted to the right side. After shaving, disinfection, and draping, a curvilinear scalp incision and a linear incision at left upper quadrant were incised and dissected. A burr hole was made at left Kocher point. The peritoneal cavity was reached after dissection. A subcutaneous tunnel was created from left upper quadrant of abdomen to left frontal region. After ventriculostomy, the ventricle catheter was implanted through the same tract. The shunt patency was checked. The peritoneal catheter was placed into the peritoneal cavity. The wound was closed in layers. The right Kocher Ommaya reservoir was left in situ. Operators Prof. 蔡瑞章 Assistants 鍾文桂 陳國瑋 相關圖片 林淑萱 (F,1963/06/21,48y8m) 手術日期 2011/10/05 手術主治醫師 蔡瑞章 手術區域 東址 005房 01號 診斷 Brain tumors, malignant 器械術式 Crainotomy Brain Tumor(P-LIN) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 2 紀錄醫師 陳國瑋, 時間資訊 19:48 臨時手術NPO 08:05 進入手術室 08:10 麻醉開始 08:30 誘導結束 08:31 抗生素給藥 08:45 手術開始 11:31 抗生素給藥 13:45 手術結束 13:45 麻醉結束 13:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦瘤切除-手術時間在4~8小時 1 1 R 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 記錄__ 手術科部: 外科部 套用罐頭: Right frontal craniotomy for tumor excision 開立醫師: 陳國瑋 開立時間: 2011/10/05 14:18 Pre-operative Diagnosis Right frontal brain tumor, suspected high grade glioma Post-operative Diagnosis Right frontal brain tumor, suspected lymphoma Operative Method Right frontal craniotomy for tumor excision Specimen Count And Types 1 piece About size:fragments Source:brain tumor Pathology Frozen section suspected lymphoma Operative Findings The tumor was red-greyish, hypervasvular, ill-defined, without clear margin. Multiple cysts were noted with turbid red-yellowish content. Upon durotomy, the brain buldged through the dura opening. One opening to ventricule was encountered. Operative Procedures After intubation and general anesthesia, the paitent was put in supine position. The skin was shaved, disinfected and drapped as usual. One skin incision was made from zygomatic arch 3c across midline. The skin was reflected downward and three burr holes were made. Craniotomy of 8*6 cm was made. After checking the tumor location with sonography. One X shape durotomy was made and the cystic part was aspirated. Tumor excison was performed in piecemeal fashion by using sucktion and bipolar coagulation. After well hemostasis, the dura mater was closed in watertight fashion and the dura defect was sealed with pericranium. The skull bone was fixed by miniplates and screws. The wound was closed in layers with one subgaleal drain. Operators 蔡瑞章 Assistants 鍾文桂 陳國瑋 相關圖片 徐鵬鎮 (M,2003/07/05,8y8m) 手術日期 2011/10/05 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Moyamoya disease 器械術式 Moyamoya /EDAS Dr.郭 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:15 麻醉開始 08:40 抗生素給藥 08:42 報到 08:50 誘導結束 09:30 手術開始 11:40 抗生素給藥 13:35 麻醉結束 13:35 手術結束 13:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱內外血管吻合術 1 1 L 手術 朴卜勒氏血流測定（週邊血管） 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Left side encephaloduroarteriosynangiosis (in... 開立醫師: 王奐之 開立時間: 2011/10/05 13:46 Pre-operative Diagnosis Moyamora disease, status post right side encephaloduromyosynangiosis, with post-op subdural effusion, status post right side subduroperitoneal shunt insertion Post-operative Diagnosis Moyamora disease, status post right side encephaloduromyosynangiosis, with post-op subdural effusion, status post right side subduroperitoneal shunt insertion Operative Method Left side encephaloduroarteriosynangiosis (indirect EC-IC bypass) from posterior branch of STA to MCA territory Specimen Count And Types Nil Pathology Nil Operative Findings Numerous small collateral vessel were noted at brain surface. The posterior branch of left STA was used, with about 6cm of mobilized segment; the surrounding galeal tissue were left with STA (about 1cm in width). Easy oozing was encountered during the whole operation, suspected to be relating to the rich collateral vessels (especially from the branch of middle meningeal artery). Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to right. After tracing and marking of the superficial temporal artery (STA) with Duplex, the scalp was scrubbed, disinfected, and draped in sterile fashion. Under microscopic view, a small reversed hockey stick incision was made at left temporal area, followed by dissection of galea and careful preservation of STA. One segment of STA along with surrounding galeal tissue were mobilized and gently retracted to the side. After a linear incision over the temporalis muscle, an ovoid craniotomy was then done with its long axis along the STA course. A linear durotomy was made, followed by opening of the arachnoid membrane covering the surface artery. 4 anchoring sutures were applied to the proximal & distal end of STA to the dural edges, and one more stitch was applied at the middle segment to fix the STA graft to the exposed pia. The dura was then approximated with 4-0 Prolene continuous sutures. a piece of DuroForm was used to covered the dural surface to prevent CSF leakage. The bone flap edge was rongeured off to allow patent entry & exit points of STA. After central tenting, the bone flap was fixed back with 3 wires. The wound was then closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之, Ri 林秉毅 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Left side encephaloduroarteriosynangiosis (in... 開立醫師: 王奐之 開立時間: 2011/10/05 13:46 Pre-operative Diagnosis Moyamora disease, status post right side encephaloduromyosynangiosis, with post-op subdural effusion, status post right side subduroperitoneal shunt insertion Post-operative Diagnosis Moyamora disease, status post right side encephaloduromyosynangiosis, with post-op subdural effusion, status post right side subduroperitoneal shunt insertion Operative Method Left side encephaloduroarteriosynangiosis (indirect EC-IC bypass) from posterior branch of STA to MCA territory Specimen Count And Types Nil Pathology Nil Operative Findings Numerous small collateral vessel were noted at brain surface. The posterior branch of left STA was used, with about 6cm of mobilized segment; the surrounding galeal tissue were left with STA (about 1cm in width). Easy oozing was encountered during the whole operation, suspected to be relating to the rich collateral vessels (especially from the branch of middle meningeal artery). 1. Numerous small abnormal collateral vessels were noted at meninges and brain surface. 1. Numerous small abnormal collateral vessels were noted at meninges and brain surface. The caliber of branches of MCA was abnormally small. 2. There was diffuse thickening of the arachnoic membrane, that may be due to previous multiple brain insults. 3. The posterior branch of left STA was used, with about 6cm of mobilized segment; the surrounding galeal tissue were left with STA (about 1cm in width). Easy oozing was encountered during the whole operation, suspected to be relating to the rich collateral vessels (especially from the branch of middle meningeal artery). Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to right. After tracing and marking of the superficial temporal artery (STA) with Duplex, the scalp was scrubbed, disinfected, and draped in sterile fashion. Under microscopic view, a small reversed hockey stick incision was made at left temporal area, followed by dissection of galea and careful preservation of STA. One segment of STA along with surrounding galeal tissue were mobilized and gently retracted to the side. After a linear incision over the temporalis muscle, an ovoid craniotomy was then done with its long axis along the STA course. A linear durotomy was made, followed by opening of the arachnoid membrane covering the surface artery. 4 anchoring sutures were applied to the proximal & distal end of STA to the dural edges, and one more stitch was applied at the middle segment to fix the STA graft to the exposed pia. A linear durotomy was made, followed by opening of the arachnoid membrane covering the surface artery. 4 anchoring sutures were applied to the proximal & distal end of STA to the dural edges. The dura was then approximated with 4-0 Prolene continuous sutures. a piece of DuroForm was used to covered the dural surface to prevent CSF leakage. The bone flap edge was rongeured off to allow patent entry & exit points of STA. After central tenting, the bone flap was fixed back with 3 wires. The wound was then closed in layers. The dura was then approximated with 4-0 Prolene continuous sutures. a piece of DuroForm was used to covered the dural surface both inside and outside to prevent CSF leakage. The bone flap edge was rongeured off to allow patent entry & exit points of STA. After central tenting, the bone flap was fixed back with 4 wires. The wound was then closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之, Ri 林秉毅 相關圖片 王興華 (M,1929/11/04,82y4m) 手術日期 2011/10/05 手術主治醫師 黃培銘 手術區域 東址 025房 01號 診斷 Subdural hemorrhage, traumatic 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 3 紀錄醫師 郝政鴻, 時間資訊 08:30 報到 08:30 進入手術室 08:35 麻醉開始 08:37 手術開始 08:40 誘導結束 08:55 麻醉結束 08:55 手術結束 09:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 氣管切開術 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 郝政鴻 開立時間: 2011/10/05 09:06 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types nil Pathology None Operative Findings Fr . 8 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators VS黃培銘 Assistants R4郝政鴻 R0王維理 陳艷莉 (F,1956/10/13,55y5m) 手術日期 2011/10/06 手術主治醫師 李苑如 手術區域 東址 008房 04號 診斷 Endometrial cancer 器械術式 Removal of double-J 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 靜脈麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 葉亭均, 時間資訊 11:20 報到 11:35 進入手術室 11:40 麻醉開始 11:45 誘導結束 11:55 抗生素給藥 11:58 手術開始 12:12 手術結束 12:12 麻醉結束 12:15 送出病患 12:20 進入恢復室 13:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 手術 雙丁輸尿管導管置入術 1 0 L 記錄__ 手術科部: 泌尿部 套用罐頭: cystoscopy（ureteral catheter) 開立醫師: 葉亭均 開立時間: 2011/10/06 12:24 Pre-operative Diagnosis Left hydronephrosis Left hydronephrosis s/p DBJ insertion Post-operative Diagnosis Left hydronephrosis Left hydronephrosis s/p DBJ replacement Operative Method cystoscopy and left double J catheter insertion cystoscopy and left double J catheter replacement Specimen Count And Types nil Pathology nil Operative Findings 1. Left side ureteral DBJ Fr.7x24 cm catheter inserion Operative Procedures Under satisfactory anesthesia with the patient in lithotomy position, prepping and drapping was performed in the usual sterile fashion. A Fr 21 Olympus cystoscope was introduced into the bladder cavity under direct vision. Careful inspection was done. A Fr 7x24 cm DBJ catheter was inserted into left ureter. Patient tolerated the procedure very well and was sent to recovery room in satisfactory condition. Under satisfactory anesthesia with the patient in lithotomy position, prepping and drapping was performed in the usual sterile fashion. A Fr 21 Olympus cystoscope was introduced into the bladder cavity under direct vision. Careful inspection was done. The previous DBJ was noted at the left ureterla orifice. A new Fr 7x24 cm DBJ catheter was replaced and inserted into left ureter. Patient tolerated the procedure very well and was sent to recovery room in satisfactory condition. Operators 李苑如, Assistants 陳聖復, 葉亭均, 陳艷莉 (F,1956/10/13,55y5m) 手術日期 2011/10/06 手術主治醫師 曾勝弘 手術區域 東址 005房 04號 診斷 Endometrial cancer 器械術式 Right craniotomy for tumor resection 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林峰盛 ASA 3E 紀錄醫師 林哲光, 時間資訊 13:00 臨時手術NPO 13:00 開始NPO 17:05 通知急診手術 19:42 報到 19:42 進入手術室 19:50 麻醉開始 20:05 誘導結束 20:30 抗生素給藥 21:25 手術開始 23:05 開始輸血 23:30 抗生素給藥 00:25 麻醉結束 00:25 手術結束 00:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Right F-T craniotomy for tumor excision, gros... 開立醫師: 林哲光 開立時間: 2011/10/07 01:07 Pre-operative Diagnosis Right temporal cystic tumor Post-operative Diagnosis Right temporal cystic tumor, suspected metastasis Operative Method Right F-T craniotomy for tumor excision, grossly total excision Specimen Count And Types 1 piece About size:5cm sized Source:tumor Pathology Pending Operative Findings The dura seemed bulging after craniotomy was done. A 5cm sized, soft, fragile, well-demarcated mass lesion was noted at right temporal lobe with cystic component without obvious contents. A tumor capsule was also noted. The overlying cortical vessels became AV-shunting and easily touch bleeding was noted. The brain parechyma seemed no more swelling after tumor removal. Operative Procedures Under ETGA and supine position with head rotated to left side, skin disinfected and drapped were performed as usual. A reverse U-shaped skin incision was made at right F-T area and facial nerve preservation was done. The temporalis muscle was dissected and deflected. Four burr holes were then created and craniotomy was then done. The dura was then opened in reverse U-shape after dural tenting and confirmation of tumor localization. Corticotomy was done at middle and inferior temporal gyrus. Grossly total tumor excision was removed and hemostasis was done with bipolar cauterization and packed with Surgecells. Bleeders were checked with elevated BP up to 140 mmHg. The dura was then closed in water-tie method and the skull bone was put back and fiexed with miniplates. The wound was then closed in layers. Operators 曾勝弘 Assistants 林哲光 Indication Of Emergent Operation Uncal herniation 相關圖片 摘要__ 手術科部: 外科部 套用罐頭: Right F-T craniotomy for tumor excision, gros... 開立醫師: 林哲光 開立時間: 2011/10/07 01:07 Pre-operative Diagnosis Right temporal cystic tumor Post-operative Diagnosis Right temporal cystic tumor, suspected metastasis Operative Method Right F-T craniotomy for tumor excision, grossly total excision Specimen Count And Types 1 piece About size:5cm sized Source:tumor Pathology Pending Operative Findings The dura seemed bulging after craniotomy was done. A 5cm sized, soft, fragile, well-demarcated mass lesion was noted at right temporal lobe with cystic component without obvious contents. A tumor capsule was also noted. The overlying cortical vessels became AV-shunting and easily touch bleeding was noted. The brain parechyma seemed no more swelling after tumor removal. Operative Procedures Under ETGA and supine position with head rotated to left side, skin disinfected and drapped were performed as usual. A reverse U-shaped skin incision was made at right F-T area and facial nerve preservation was done. The temporalis muscle was dissected and deflected. Four burr holes were then created and craniotomy was then done. The dura was then opened in reverse U-shape after dural tenting and confirmation of tumor localization. Corticotomy was done at middle and inferior temporal gyrus. Grossly total tumor excision was removed and hemostasis was done with bipolar cauterization and packed with Surgecells. Bleeders were checked with elevated BP up to 140 mmHg. The dura was then closed in water-tie method and the skull bone was put back and fiexed with miniplates. The wound was then closed in layers. Operators 曾勝弘 Assistants 林哲光 Indication Of Emergent Operation Uncal herniation 相關圖片 徐鵬鎮 (M,2003/07/05,8y8m) 手術日期 2011/10/06 手術主治醫師 戴槐青 手術區域 東址 002房 04號 診斷 Moyamoya disease 器械術式 Cystoscopy 手術類別 緊急手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 靜脈麻醉 麻醉主治醫師 林峰盛 ASA 2E 紀錄醫師 周博敏, 時間資訊 13:32 通知急診手術 19:15 報到 19:20 進入手術室 19:24 麻醉開始 19:30 誘導結束 19:33 手術開始 20:04 手術結束 20:04 麻醉結束 20:10 送出病患 20:15 進入恢復室 21:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 手術 尿道結石-異物除去術 1 1 記錄__ 手術科部: 泌尿部 套用罐頭: cystoscopy（biopsy ) 開立醫師: 周博敏 開立時間: 2011/10/06 20:27 Pre-operative Diagnosis Uretrhal foreign body (Foley catheter) Post-operative Diagnosis Uretrhal foreign body (Foley catheter) Operative Method cystoscopy and foreign body removal Specimen Count And Types nil Pathology pending Operative Findings inflated Foley balloon, penetrated with laser Operative Procedures Under satisfactory anesthesia with the patient in lithotomy position, prepping and drapping was performed in the usual sterile fashion. A 8 Fr ureteroscope was introduced into the bladder cavity under direct vision. The balloon of the Foley was penetrated with laser. The Foley was retrieved with forceps. Patient tolerated the procedure very well and was sent to recovery room in satisfactory condition. Operators 戴槐青, Assistants 陳聖復, 周博敏, Indication Of Emergent Operation difficult Foley removal 李柯金定 (F,1936/11/20,75y3m) 手術日期 2011/10/06 手術主治醫師 賴達明 手術區域 東址 005房 03號 診斷 Cerebral aneurysm 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 林哲光, 時間資訊 23:09 臨時手術NPO 15:22 進入手術室 15:30 麻醉開始 15:32 誘導結束 16:00 抗生素給藥 16:23 手術開始 18:55 手術結束 18:55 麻醉結束 19:00 送出病患 19:07 進入恢復室 20:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 手術 頭顱成形術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Right F-T-P cranioplasty with autologus bone ... 開立醫師: 林哲光 開立時間: 2011/10/06 19:25 Pre-operative Diagnosis Right F-T-P skull bone defect Post-operative Diagnosis Right F-T-P skull bone defect Operative Method Right F-T-P cranioplasty with autologus bone and fixed with miniplates Specimen Count And Types nil Pathology Nil Operative Findings A Y-shaped old skin incision was noted and a right F-T-P skull bone defect was also noted. A temporalis muscle stump was also noted. Operative Procedures Under ETGA and supine position with head rotated to left side, skin disinfected and drapped were performed as usual. Skin incision along the previous operative wound was done as Y-shaped and the plane between the soft tissue and skin flap was dissected until the skull bone edge was exposed. The skull bone graft was then put back and fixed with miniplates. The wound was then closed in layers after two subgaleal drain insertion. Operators 賴達明 Assistants 林哲光 相關圖片 摘要__ 手術科部: 外科部 套用罐頭: Right F-T-P cranioplasty with autologus bone ... 開立醫師: 林哲光 開立時間: 2011/10/06 19:26 Pre-operative Diagnosis Right F-T-P skull bone defect Post-operative Diagnosis Right F-T-P skull bone defect Operative Method Right F-T-P cranioplasty with autologus bone and fixed with miniplates Specimen Count And Types nil Pathology Nil Operative Findings A Y-shaped old skin incision was noted and a right F-T-P skull bone defect was also noted. A temporalis muscle stump was also noted. Operative Procedures Under ETGA and supine position with head rotated to left side, skin disinfected and drapped were performed as usual. Skin incision along the previous operative wound was done as Y-shaped and the plane between the soft tissue and skin flap was dissected until the skull bone edge was exposed. The skull bone graft was then put back and fixed with miniplates. The wound was then closed in layers after two subgaleal drain insertion. Operators 賴達明 Assistants 林哲光 相關圖片 黃淑敏 (F,1961/08/18,50y6m) 手術日期 2011/10/06 手術主治醫師 陳敞牧 手術區域 東址 005房 02號 診斷 Brain metastasis 器械術式 Crainotomy Brain Tumor(P-LIN) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 林哲光, 時間資訊 23:03 臨時手術NPO 09:24 進入手術室 09:30 麻醉開始 10:10 誘導結束 10:15 抗生素給藥 10:39 手術開始 12:50 開始輸血 13:15 抗生素給藥 14:55 手術結束 14:55 麻醉結束 15:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 頭顱成形術 1 4 手術 腦瘤切除-手術時間在4~8小時 1 1 手術 皮腱膜移位術 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Right craniectomy for skull bone tumor excisi... 開立醫師: 林哲光 開立時間: 2011/10/06 20:04 Pre-operative Diagnosis Right P-T skull bone tumor, suspected metastasis Post-operative Diagnosis Right P-T skull bone tumor, suspected metastasis Operative Method Right craniectomy for skull bone tumor excision and cranioplasty with Titanium plate and autologus temporalis fascia flap Specimen Count And Types 1 piece About size:7cm sized Source:skull bone tumor Pathology Pending Operative Findings A 7cm sized soft-elastic, well demarcated mass lesion with tightly adherent to the right P-T area and bony loss at right temporal bone was noted. The right zygomatic arch seemed fractured and tumor erosion was also noted and part of zygomatic arch was removed. Dura was left intact and the skull bone lesion was covered with Tiatnium plate and the autologus temporalis fasica flap divided by plastic surgen was packed over the right temporal area. Operative Procedures Under ETGA and supine position with head rotated to left side, skin disinfected and drapped were performed as usual. A Y-shaped skin incision was made at right F-T-P area and the temporalis facia flap was created by plastic surgeon. The right temporalis muscle was divided and excised. The mass lesion was removed as extensively as possible and the skull defect was drilled off with Midas along the edge of the tumor. The dura was left intact and bipolar cauterization was performed at some residual tumor at the epidural surface. The skull bone defect was covered with Titanium plate and fixed with screws after the fascia flap was deflected to cover the temporal lesion. Bone cemet to modify the shape of the temporal area was done. The wound was then closed in layers after a subgaleal drain insertion. Operators 陳敞牧 Assistants 林哲光 相關圖片 摘要__ 手術科部: 外科部 套用罐頭: Right craniectomy for skull bone tumor excisi... 開立醫師: 林哲光 開立時間: 2011/10/06 20:04 Pre-operative Diagnosis Right P-T skull bone tumor, suspected metastasis Post-operative Diagnosis Right P-T skull bone tumor, suspected metastasis Operative Method Right craniectomy for skull bone tumor excision and cranioplasty with Titanium plate and autologus temporalis fascia flap Specimen Count And Types 1 piece About size:7cm sized Source:skull bone tumor Pathology Pending Operative Findings A 7cm sized soft-elastic, well demarcated mass lesion with tightly adherent to the right P-T area and bony loss at right temporal bone was noted. The right zygomatic arch seemed fractured and tumor erosion was also noted and part of zygomatic arch was removed. Dura was left intact and the skull bone lesion was covered with Tiatnium plate and the autologus temporalis fasica flap divided by plastic surgen was packed over the right temporal area. Operative Procedures Under ETGA and supine position with head rotated to left side, skin disinfected and drapped were performed as usual. A Y-shaped skin incision was made at right F-T-P area and the temporalis facia flap was created by plastic surgeon. The right temporalis muscle was divided and excised. The mass lesion was removed as extensively as possible and the skull defect was drilled off with Midas along the edge of the tumor. The dura was left intact and bipolar cauterization was performed at some residual tumor at the epidural surface. The skull bone defect was covered with Titanium plate and fixed with screws after the fascia flap was deflected to cover the temporal lesion. Bone cemet to modify the shape of the temporal area was done. The wound was then closed in layers after a subgaleal drain insertion. Operators 陳敞牧 Assistants 林哲光 相關圖片 林嘉誠 (M,1998/10/05,13y5m) 手術日期 2011/10/06 手術主治醫師 黃書健 手術區域 兒醫 067房 06號 診斷 Mediastinum, malignant 器械術式 TCPC,JATENE,TAPVR,NORWOOD 手術類別 緊急手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 蕭柏妮 ASA 4E 紀錄醫師 黃世銘, 時間資訊 16:29 通知急診手術 19:27 進入手術室 19:30 麻醉開始 19:45 誘導結束 19:50 手術開始 20:10 開始輸血 21:50 手術結束 21:50 麻醉結束 22:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 體外循環維生系統(ECMO)建立(第一次) 1 1 手術 惡性腫瘤胸壁切除 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 T.E.E 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 蕭銘炎 (M,1935/03/08,77y0m) 手術日期 2011/10/06 手術主治醫師 蕭輔仁 手術區域 東址 003房 02號 診斷 Cerebrovascular accident 器械術式 Lamino plasty 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 陳國瑋, 時間資訊 23:06 臨時手術NPO 13:12 報到 14:30 進入手術室 14:40 麻醉開始 14:55 誘導結束 15:05 抗生素給藥 15:05 手術開始 17:40 手術結束 17:40 麻醉結束 17:50 送出病患 17:55 進入恢復室 19:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術(減壓)-超過二節 1 1 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 記錄__ 手術科部: 外科部 套用罐頭: C3-7 laminectomy 開立醫師: 陳國瑋 開立時間: 2011/10/06 17:56 Pre-operative Diagnosis Cervical stenosis Post-operative Diagnosis Cervical stenosis Operative Method C3-7 laminectomy Specimen Count And Types nil Pathology nil Operative Findings The thecal sac was compresssed tightly by the hypertrophic ligament and herniated disc. Ie expended well after decompression. Instability of C3 over C4 was noted. Operative Procedures After intubation and general anesthesia, the head was fixed with Mayfield clamp. He was turned into prone position. Linear skin incision was made and the soft tissue was detached to bilateral laminae. Laminectomy C3 to C7 was done. After hemostasis and setting on CWV, the wound was closed in layers. Operators 蕭輔仁 Assistants 陳國瑋 黃葳諭 相關圖片 謝麗霞 (F,1949/04/28,62y10m) 手術日期 2011/10/06 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Brain tumor 器械術式 Crainotomy Brain Tumor(P-LIN) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳國瑋, 時間資訊 23:28 臨時手術NPO 08:03 進入手術室 08:10 麻醉開始 08:35 誘導結束 08:50 抗生素給藥 08:53 手術開始 11:43 抗生素給藥 13:45 手術結束 13:45 麻醉結束 13:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4~8小時 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: Occipital craniotomy for tumor excision, Simp... 開立醫師: 陳國瑋 開立時間: 2011/10/06 18:52 Pre-operative Diagnosis Left tentorial meningioma Post-operative Diagnosis Left tentorial meningioma Operative Method Occipital craniotomy for tumor excision, Simpson grade III Specimen Count And Types 1 piece About size:fragments Source:brain tumor Pathology Pending Operative Findings One well defined, extra-axial tumor attached to the left tentorium with extension mainly downard. The tumor was soft to elastic in character. During central debluking, the straight sinus was injuried and packed with Gelfoam and Floseal. One vein was encountered as we did debulking. Incidental injury of superior saggital sinus was noted while doing durotomy. It was repaired with prolene 6-0. Operative Procedures After intubation and general anesthesia, the head was fixed with Mayfield clamp and the skin was prepared as usual. One U shape skin incision was made at left occipital area. The skin was retrated downward and one 8*5cm craniotomy window was made. We identified the superior saggital sinus and left transverse sinus. Incidental injury of superior saggital sinus was noted while doing durotomy. It was repaired with prolene 6-0. The craniotomy window was extended upward. Durotomy was done and the tumor base was found after retracting left occipital lobe. Devasculization was achieved with bipolar electrocaugry of the tentorial base. Central debulking was done. The straight sinus was injured and packed with Gelfoam and Floseal. The part of tumor adhearing to it was left. After hemostasis and setting one CWV, the wound was closed in layers. Operators 王國川 Assistants 陳國瑋 黃葳諭 相關圖片 詹宏建 (M,1961/11/02,50y4m) 手術日期 2011/10/06 手術主治醫師 蔡翊新 手術區域 東址 005房 01號 診斷 Extradural hemorrhage following injury with mention of open intracranial wound, with prolonged (more than 24 hours) loss of consciousness without return to pre-existing conscious level 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 林哲光, 時間資訊 23:09 臨時手術NPO 08:20 進入手術室 08:23 麻醉開始 08:25 誘導結束 08:26 抗生素給藥 08:39 手術開始 09:00 手術結束 09:00 麻醉結束 09:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 氣管切開術 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 林哲光 開立時間: 2011/10/06 09:18 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types nil Pathology None Operative Findings Fr . 8 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators 蔡翊新 Assistants 林哲光 相關圖片 摘要__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 林哲光 開立時間: 2011/10/06 09:18 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types nil Pathology None Operative Findings Fr . 8 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators 蔡翊新 Assistants 林哲光 相關圖片 李長熹 (M,1944/11/25,67y3m) 手術日期 2011/10/06 手術主治醫師 蔡翊新 手術區域 東址 001房 02號 診斷 Spinal stenosis, lumbar region 器械術式 Laminectomy, L4-5 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 姜士中, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 07:52 通知急診手術 09:53 進入手術室 10:00 麻醉開始 10:10 誘導結束 10:20 抗生素給藥 10:33 手術開始 11:50 麻醉結束 11:50 手術結束 12:00 送出病患 12:05 進入恢復室 13:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 椎弓切除術(減壓)-二節以內 1 1 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 蔡翊新 開立時間: 2011/10/06 11:51 Pre-operative Diagnosis Lumbar stenosis, L4-5. Post-operative Diagnosis Lumbar stenosis, L4-5. Operative Method Lumbar Laminectomy, L4-5. Specimen Count And Types nil Pathology Nil. Operative Findings Hypertrophy of ligamentum flavum caused tight compression of thecal sac and lateral recess stenosis at lower L3 to Upper S1 levels, more severe at L4-5. After laminectomy and removal of the ligaments, the thecal sac expanded well and bilateral L4,L5,S1 roots were loosened. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: prone. 3. Skin preparation: the back was shaved and scrubbed with povidone-iodine detergent then painted with povidone-iodine tincture and followed by sterilized adhesive plastic sheet covering. 4. A needle was attached to the skin between spinous processes of L4-5 and a portable X-ray film was taken to locate the correct interspace. 5. Incision: 10 cm, over spinous processes from L3 to S1. 6. The paraspinal muscles were detached from spinous processes of L4,5 on both sides by Bovie, then multifidus muscles were dissected subperiosteally from the laminae with rasp. 7. The paravertebral muscles were retracted by self retaining retractors to expose the spinous processes and laminae of L4,5. The bleeding from the muscles were stopped by Bovie. 8. The spinous processes and laminae of L4,5 were bitten off with rongeurs and Kerrison punch until the posterior half of the spinal canal was widely opened. The hypertrophic ligamenta flava including those at lateral recesses were excised. The epidural venous bleeding was stopped by gelfoam packing. 9. The paravertebral muscles were closed by interrupted sutures with 1/0 Vicryl, subcutaneous layer by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 10.Drain: one, epilaminal, hemovac. 11.Blood transfusion: nil. Blood loss: 100 ml. 12.Course ofthesurgery: smooth. Operators VS蔡翊新 Assistants R5曾峰毅R0姜士中 Indication Of Emergent Operation cauda equina syndrome with lower limb weakness and urine and stool retention. 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 蔡翊新 開立時間: 2011/10/06 11:51 Pre-operative Diagnosis Lumbar stenosis, L4-5. Post-operative Diagnosis Lumbar stenosis, L4-5. Operative Method Lumbar Laminectomy, L4-5. Specimen Count And Types nil Pathology Nil. Operative Findings Hypertrophy of ligamentum flavum caused tight compression of thecal sac and lateral recess stenosis at lower L3 to Upper S1 levels, more severe at L4-5. After laminectomy and removal of the ligaments, the thecal sac expanded well and bilateral L4,L5,S1 roots were loosened. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: prone. 3. Skin preparation: the back was shaved and scrubbed with povidone-iodine detergent then painted with povidone-iodine tincture and followed by sterilized adhesive plastic sheet covering. 4. A needle was attached to the skin between spinous processes of L4-5 and a portable X-ray film was taken to locate the correct interspace. 5. Incision: 10 cm, over spinous processes from L3 to S1. 6. The paraspinal muscles were detached from spinous processes of L4,5 on both sides by Bovie, then multifidus muscles were dissected subperiosteally from the laminae with rasp. 7. The paravertebral muscles were retracted by self retaining retractors to expose the spinous processes and laminae of L4,5. The bleeding from the muscles were stopped by Bovie. 8. The spinous processes and laminae of L4,5 were bitten off with rongeurs and Kerrison punch until the posterior half of the spinal canal was widely opened. The hypertrophic ligamenta flava including those at lateral recesses were excised. The epidural venous bleeding was stopped by gelfoam packing. 9. The paravertebral muscles were closed by interrupted sutures with 1/0 Vicryl, subcutaneous layer by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 10.Drain: one, epilaminal, hemovac. 11.Blood transfusion: nil. Blood loss: 100 ml. 12.Course ofthesurgery: smooth. Operators VS蔡翊新 Assistants R5曾峰毅R0姜士中 Indication Of Emergent Operation cauda equina syndrome with lower limb weakness and urine and stool retention. 相關圖片 高阿周 (M,1945/04/05,66y11m) 手術日期 2011/10/07 手術主治醫師 曾漢民 手術區域 東址 003房 01號 診斷 Glioblastoma multiforma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 曾偉倫, 李振豪, 時間資訊 08:59 臨時手術NPO 08:05 進入手術室 08:14 麻醉開始 08:30 誘導結束 09:20 抗生素給藥 09:22 手術開始 12:20 抗生素給藥 15:00 手術結束 15:00 麻醉結束 15:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 手術 腦瘤切除-手術時間在4~8小時 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Left pterional, trans-sylvian approach for tu... 開立醫師: 李振豪 開立時間: 2011/10/07 15:30 Pre-operative Diagnosis Left insula tumor, suspect high grade glioma Post-operative Diagnosis Left insula tumor, suspect high grade glioma Operative Method Left pterional, trans-sylvian approach for tumor excision Specimen Count And Types 1 piece About size:Multiple pieces Source:Left insula tumor Pathology Pending Operative Findings The tumor was 4 x 4.5 x 5.4cm in size, gray-reddish, gelatinous appearance, well-demarcated, and hypervascularized in character. The tumor was mainly located at left insula and putamen with few large cystic part. The solid part became larger compared with MRI study. The frontal and temporal opeculum was protected well during the operation. One large drainage vein was noted along the sylvian fissue and angular gyrus and also preserved well during tumor excision. No SSEP or MEP change was noted during whole procedure. Small opening of left mastoid air cell was noted at temporal area of craniotomy and sealed with Bonewax. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with left shoulder elevation and head rotated to right. The head was fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. One small question mark scalp incision was made at left fronto-temporo-parietal area and the scalp flap was elevated. Facial nerve preservation was conducted during scalp elevation. The temporalis muscle was detached from the skull and pulled posteroinferiorly. Four burrholes were created followed by one 12 x 10cm craniotomy window. Dural tenting was done. Active oozing from skull base was hemostasis with Gelfoam packing and tenting. C-shape durotomy based with left skull base was conducted. Intra-operative sonography was used for localization of the tumor. The sylvian fissue was opened and the tumor was noted within the insula. One 1 x 2cm corticotomy was performed and tumor was excised with bipolar electrocautery, suction, and tumor forceps. After gross total tumor excision, hemostasis was achieved with bipolar electrocautery, Floseal, and Surgicel lining. The dura was closed with 4-0 Prolene. The skull plate was fixed back with miniplates, screws, and five central tenting. The temporalis muscle was fixed back to its neutral position. One subgaleal CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and Appose staples. Operators VS曾漢民 Assistants R5李振豪, R3曾偉倫 相關圖片 顏守信 (M,1937/04/16,74y10m) 手術日期 2011/10/07 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Bone metastasis 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 陳國瑋, 時間資訊 23:03 臨時手術NPO 08:05 進入手術室 08:10 麻醉開始 08:20 誘導結束 08:45 抗生素給藥 09:22 手術開始 10:44 手術結束 10:44 麻醉結束 10:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 癌前病變硬組織切片 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: Trans-nasal, trans-sphenoid tumor biopsy. 開立醫師: 鍾文桂 開立時間: 2011/10/07 11:15 Pre-operative Diagnosis Intra-cavernous sinus tumor,left. Post-operative Diagnosis Intra-cavernous sinus tumor,left,favored metastatic tumor. Operative Method Trans-nasal, trans-sphenoid tumor biopsy. Specimen Count And Types 1 piece About size:fragments Source:brain tumor Pathology pending. Operative Findings An arterial bleeding at upper anteror margin of the durotomy was encountered. It was controlled by Flosseal and gelfoam. The tumor was hard, elastic, and red-brown. The cavernous sinus was not entered. Operative Procedures Under endotracheal general anesthesia, the patient was putin supine position with head tilted 30 degree to left. The nasal cavity was packing with epinephrine soaked gauze for 10 minutes. The face and left lower abdomen were prepared with povidone-iodine alcohol tincture, and the mucosa of oral and nasal cavity with aqueous povidone-iodine tincture. The nasal submucosa at septum and floor were infiltrated with 1:100 epinephrine solution. One 1.5cm incision was made at nasal mucosa of right nasal septum and the musoca , Tissucol Duo, autologous bone fragment, Tissucol Duo, and Gelfoam. The vomer bone was plawas dissected away from the septum. The nasal septum was fractured and the vomer was removed. The sphenoid sinus was entered and the mucosa within the sphenoid sinus was removed. The sellar floor was identified and opened. Arterial bleeding was encountered and hemostasis was achieved with Gelfoam packing and Floseal. Cruciform durotomy was done and the tumor showed up after dura opening. Tumor biopsy was done with alligator. Hemostasis was achieved and the space was packing with Gelfoamced back and the nasal mucosa was pushed back to the neutral position. The nasal septum and the middle turbinate was pushed back to neutral position. Bilateral nasal cavities were packed with a segment of rubber glove finger which had been soaked with better-iodine ointment. Total blood loss was 50 ml. The course of the operation was smooth. Operators 曾漢民 Assistants 鍾文桂 陳國瑋 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Trans-nasal, trans-sphenoid tumor biopsy. 開立醫師: 曾偉倫 開立時間: 2011/10/11 04:56 Pre-operative Diagnosis Intra-cavernous sinus tumor,left. Post-operative Diagnosis Intra-cavernous sinus tumor,left,favored metastatic tumor. Operative Method Trans-nasal, trans-sphenoid tumor biopsy. Specimen Count And Types 1 piece About size:fragments Source:brain tumor Pathology pending. Operative Findings An arterial bleeding at upper anteror margin of the durotomy was encountered. It was controlled by Flosseal and gelfoam. The tumor was hard, elastic, and red-brown. The cavernous sinus was not entered. Operative Procedures Under endotracheal general anesthesia, the patient was putin supine position with head tilted 30 degree to left. The nasal cavity was packing with epinephrine soaked gauze for 10 minutes. The face and left lower abdomen were prepared with povidone-iodine alcohol tincture, and the mucosa of oral and nasal cavity with aqueous povidone-iodine tincture. The nasal submucosa at septum and floor were infiltrated with 1:100 epinephrine solution. One 1.5cm incision was made at nasal mucosa of right nasal septum and the musoca , Tissucol Duo, autologous bone fragment, Tissucol Duo, and Gelfoam. The vomer bone was plawas dissected away from the septum. The nasal septum was fractured and the vomer was removed. The sphenoid sinus was entered and the mucosa within the sphenoid sinus was removed. The sellar floor was identified and opened. Arterial bleeding was encountered and hemostasis was achieved with Gelfoam packing and Floseal. Cruciform durotomy was done and the tumor showed up after dura opening. Tumor biopsy was done with alligator. Hemostasis was achieved and the space was packing with Gelfoamced back and the nasal mucosa was pushed back to the neutral position. The nasal septum and the middle turbinate was pushed back to neutral position. Bilateral nasal cavities were packed with a segment of rubber glove finger which had been soaked with better-iodine ointment. Total blood loss was 50 ml. The course of the operation was smooth. Operators 曾漢民 Assistants 鍾文桂 陳國瑋 相關圖片 程如意 (F,1958/07/27,53y7m) 手術日期 2011/10/07 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 陳國瑋, 時間資訊 23:58 臨時手術NPO 11:30 麻醉開始 11:34 進入手術室 11:38 誘導結束 12:00 抗生素給藥 12:30 手術開始 15:00 抗生素給藥 16:20 手術結束 16:20 麻醉結束 16:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 記錄__ 手術科部: 外科部 套用罐頭: Left parietal craniotomy for tumor excision, ... 開立醫師: 陳國瑋 開立時間: 2011/10/07 17:10 Pre-operative Diagnosis Left convexity meningioma Post-operative Diagnosis Left convexity meningioma Operative Method Left parietal craniotomy for tumor excision, Simpson grade I Specimen Count And Types 1 piece About size:6*5*5 cm Source:brain tumor Pathology Pending Operative Findings One greyish to yellowish, extra-axial, soft, dura-based tumor located at brain surface, size 6*5*5cm. One bone eminence was noted. The attached dura was removed and the defect was repaired COOK. Vein of Trolard was noted at the anterior surface of tumor and was remained intact during the whole procedure. Operative Procedures After intubation and general anesthesia, the patient was put in right decubitus position. The neck was slightly flexed. The skin was prepared as usual. U shape skin incision was made at left parietal area and the skin was retracted downward. Craniotomy 9*7cm was made. The location of tumor was checked with ultrasonograpy. Electrocougry of the dural surface was done and durotomy was made around the tumor. The attachment and vessels from dura was electrocoaguated and devided. The arachnoid membrane was pushed toward brain surface. Central debulking was done. Tumor was elevated with great care. The dura was repaired with COOK. After setting one CWV, the wound was closed in layers. Operators 曾漢民 Assistants 鍾文桂 陳國瑋 相關圖片 張玉君 (F,1983/07/29,28y7m) 手術日期 2011/10/07 手術主治醫師 賴達明 手術區域 東址 016房 01號 診斷 Intraventricular hemorrhage 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 蕭柏妮 ASA 3E 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 07:42 通知急診手術 08:40 進入手術室 08:45 麻醉開始 08:55 誘導結束 09:35 手術開始 10:06 手術結束 10:06 麻醉結束 10:18 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室體外引流 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Right Kocher point EVD revision 開立醫師: 林哲光 開立時間: 2011/10/07 11:10 Pre-operative Diagnosis Right caudate nucleus ICH with intraventricular hemorrhage Post-operative Diagnosis Right caudate nucleus ICH with intraventricular hemorrhage Operative Method Right Kocher point EVD revision Specimen Count And Types 1 piece About size: Source:EVD tip culture, CSF study Pathology Nil Operative Findings Gush of CSF with some blot clot was noted. The intraventricular catheter was inserted along the previous tract of EVD, ventricular catheter was 7cm long. Operative Procedures Under ETGA and supine position, skin incision was done along the previuos operative wound and the previous Kocher point was exposed. The intraventricular catheter was inserted along the previous tract. The wound was then closed in layers after the EVD was fixed through the subcutaneous tunneling and fixed on the skin. Operators 賴達明 Assistants 林哲光 Indication Of Emergent Operation Conscious deterioration 相關圖片 摘要__ 手術科部: 外科部 套用罐頭: Right Kocher point EVD revision 開立醫師: 林哲光 開立時間: 2011/10/07 11:11 Pre-operative Diagnosis Right caudate nucleus ICH with intraventricular hemorrhage Post-operative Diagnosis Right caudate nucleus ICH with intraventricular hemorrhage Operative Method Right Kocher point EVD revision Specimen Count And Types 1 piece About size: Source:EVD tip culture, CSF study Pathology Nil Operative Findings Gush of CSF with some blot clot was noted. The intraventricular catheter was inserted along the previous tract of EVD, ventricular catheter was 7cm long. Operative Procedures Under ETGA and supine position, skin incision was done along the previuos operative wound and the previous Kocher point was exposed. The intraventricular catheter was inserted along the previous tract. The wound was then closed in layers after the EVD was fixed through the subcutaneous tunneling and fixed on the skin. Operators 賴達明 Assistants 林哲光 Indication Of Emergent Operation Conscious deterioration 相關圖片 廖淑婷 (F,1978/06/10,33y9m) 手術日期 2011/10/07 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Pituitary tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 2 紀錄醫師 吳健暉, 時間資訊 23:07 臨時手術NPO 08:08 進入手術室 08:15 麻醉開始 08:25 誘導結束 08:45 抗生素給藥 09:14 手術開始 11:25 手術結束 11:25 麻醉結束 11:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經由蝶竇之腦下垂體瘤切除 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Trans-sphenoidal adenomectomy 開立醫師: 曾峰毅 開立時間: 2011/10/07 11:41 Pre-operative Diagnosis Acromegaly Post-operative Diagnosis Acromegaly Operative Method Trans-sphenoidal adenomectomy Specimen Count And Types Several fragments of one tumor was sent for pathology. Pathology Nil Operative Findings Yellowish, hypervascular, firm to elastic tumor was noted at sellar region. CSF leakage was noted, and was sealed with Tissucol-Duo. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with neck extended. We made mucosa incision at the medial side of right nostril. We deviated right middle turbinate to lateral and nasal setpum to the left. Vomer was knocked down, and sphenoid sinus mucosa was removed. Sellar floor was knocked down, and adenomectomy was performed in piecemeal with ring currette, and alligator. Durotomy and CSF leakage were packed with autolougs fat from left lower abdomen, gelfoam, and Tissucol-Duo. Nasal cavity was packed with Merocels. Operators VS 賴達明 Assistants R5 曾峰毅 R1 吳健暉 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Trans-sphenoidal adenomectomy 開立醫師: 吳健暉 開立時間: 2011/10/07 15:07 Pre-operative Diagnosis Acromegaly Post-operative Diagnosis Acromegaly Operative Method Trans-sphenoidal adenomectomy Specimen Count And Types Several fragments of one tumor was sent for pathology. Pathology Nil Operative Findings Yellowish, hypervascular, firm to elastic tumor was noted at sellar region. CSF leakage was noted, and was sealed with Tissucol-Duo. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with neck extended. We made mucosa incision at the medial side of right nostril. We deviated right middle turbinate to lateral and nasal setpum to the left. Vomer was knocked down, and sphenoid sinus mucosa was removed. Sellar floor was knocked down, and adenomectomy was performed in piecemeal with ring currette, and alligator. Durotomy and CSF leakage were packed with autolougs fat from left lower abdomen, gelfoam, and Tissucol-Duo. Nasal cavity was packed with Merocels. Operators VS 賴達明 Assistants R5 曾峰毅 R1 吳健暉 相關圖片 摘要__ 手術科部: 外科部 套用罐頭: Trans-sphenoidal adenomectomy 開立醫師: 曾峰毅 開立時間: 2011/10/09 14:52 Pre-operative Diagnosis Acromegaly Post-operative Diagnosis Acromegaly Operative Method Trans-sphenoidal adenomectomy Specimen Count And Types Several fragments of one tumor was sent for pathology. Pathology Nil Operative Findings Yellowish, hypervascular, firm to elastic tumor was noted at sellar region. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with neck extended. We made mucosa incision at the medial side of right nostril. We deviated right middle turbinate to lateral and nasal setpum to the left. Vomer was knocked down, and sphenoid sinus mucosa was removed. Sellar floor was knocked down, and adenomectomy was performed in piecemeal with ring currette, and alligator. Durotomy and CSF leakage were packed with autolougs fat from left lower abdomen, gelfoam, and Tissucol-Duo. Nasal cavity was packed with Merocels. Operators VS 賴達明 Assistants R5 曾峰毅 R1 吳健暉 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Trans-sphenoidal adenomectomy 開立醫師: 吳健暉 開立時間: 2011/10/13 17:40 Pre-operative Diagnosis Acromegaly Post-operative Diagnosis Acromegaly Operative Method Trans-sphenoidal adenomectomy Specimen Count And Types Several fragments of one tumor was sent for pathology. Pathology Nil Operative Findings Yellowish, hypervascular, firm to elastic tumor was noted at sellar region. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with neck extended. We made mucosa incision at the medial side of right nostril. We deviated right middle turbinate to lateral and nasal setpum to the left. Vomer was knocked down, and sphenoid sinus mucosa was removed. Sellar floor was knocked down, and adenomectomy was performed in piecemeal with ring currette, and alligator. Durotomy and CSF leakage were packed with autolougs fat from left lower abdomen, gelfoam, and Tissucol-Duo. Nasal cavity was packed with Merocels. Operators VS 賴達明 Assistants R5 曾峰毅 R1 吳健暉 相關圖片 陳林香青 (F,1950/05/22,61y9m) 手術日期 2011/10/07 手術主治醫師 賴達明 手術區域 東址 019房 02號 診斷 Cervical spondylosis 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 2 紀錄醫師 吳健暉, 時間資訊 23:04 臨時手術NPO 11:55 進入手術室 12:00 麻醉開始 12:00 抗生素給藥 12:10 誘導結束 12:37 手術開始 14:45 手術結束 14:45 麻醉結束 15:00 送出病患 15:05 進入恢復室 16:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-頸椎 1 1 手術 椎間盤切除術-頸椎 1 2 手術 脊椎融合術-前融合,有固定物)≦四節 1 4 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: Anterior Discectomy and Fusion, Cervical Spine 開立醫師: 曾峰毅 開立時間: 2011/10/07 14:52 Pre-operative Diagnosis HIVD, C4/5 and C5/6 Post-operative Diagnosis HIVD, C4/5 and C5/6 Operative Method Anterior cervical diskectomy and fusion with PEEK cage and artificial bone graft C4/5 and C5/6. Specimen Count And Types Nil Pathology Nil Operative Findings Degenrated disc with herniated component compromising spinal cord was noted at C4/5 and C5/6. Anterior fusion with Synthes PEEK cages and artificial bone graft. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with neck extended. We scrubbed, disinfected, and then draped the patient as usual. We made one transverse skin incision at right anterior aspect of the neck, and dissected to expose prevertebral space. Anterior diskectomy was done at C4/5 after C-arm confirmation. Anterior fusion with PEEK cage and artificial bone graft was performed. Then, anterior diskectomy was done at C5/6 with anterior fusion with PEEK cage and artificial bone graft. The wound was closed in layers. Operators VS 賴達明 Assistants R5 曾峰毅 R1 吳健暉 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Anterior Discectomy and Fusion, Cervical Spine 開立醫師: 吳健暉 開立時間: 2011/10/07 15:07 Pre-operative Diagnosis HIVD, C4/5 and C5/6 Post-operative Diagnosis HIVD, C4/5 and C5/6 Operative Method Anterior cervical diskectomy and fusion with PEEK cage and artificial bone graft C4/5 and C5/6. Specimen Count And Types Nil Pathology Nil Operative Findings Degenrated disc with herniated component compromising spinal cord was noted at C4/5 and C5/6. Anterior fusion with Synthes PEEK cages and artificial bone graft. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with neck extended. We scrubbed, disinfected, and then draped the patient as usual. We made one transverse skin incision at right anterior aspect of the neck, and dissected to expose prevertebral space. Anterior diskectomy was done at C4/5 after C-arm confirmation. Anterior fusion with PEEK cage and artificial bone graft was performed. Then, anterior diskectomy was done at C5/6 with anterior fusion with PEEK cage and artificial bone graft. The wound was closed in layers. Operators VS 賴達明 Assistants R5 曾峰毅 R1 吳健暉 相關圖片 陳林瑞月 (F,1936/09/01,75y6m) 手術日期 2011/10/07 手術主治醫師 賴達明 手術區域 東址 019房 03號 診斷 Spinal tumor 器械術式 Benign intraspinal tumor, exci 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 2 紀錄醫師 吳健暉, 時間資訊 23:11 臨時手術NPO 14:32 報到 15:15 進入手術室 15:20 麻醉開始 15:30 誘導結束 15:58 抗生素給藥 16:16 手術開始 17:30 開始輸血 17:50 手術結束 17:50 麻醉結束 18:00 送出病患 18:02 進入恢復室 19:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 良性脊髓腫瘤切除術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 曾峰毅 開立時間: 2011/10/07 17:58 Pre-operative Diagnosis Left T12 extraforaminal schwannoma Post-operative Diagnosis Left T12 extraforaminal schwannoma Operative Method Left retroperitoneal approach for left T12 extraforaminal schwannoma excision Specimen Count And Types Several fragments of one tumor was sent for pathology. Pathology Pending Operative Findings One 5x4x5cm capsulated, well-defined, hypervascular, yellowish tumor was noted just left to L1 vertebral body, arising from left T12 intercostal nerve, erosing the L1 vertebral body. One 5x4x5cm capsulated, well-defined, hypervascular, soft to elasitc yellowish tumor was noted just adjacent to the left side of L1 vertebral body, arising from left T12 intercostal nerve, erosing the L1 vertebral body partilly. Blood loss was about 400 ml. Blood tranfusion: pRBC 2u. Pleura was opened at left costopeural angle, and was sutured. Operative Procedures With endotracheal general anaestehsia, the patient was put in right decubitus position. We scrubbed, disinfected, and then draped the patient as usual, and made one oblique transverse skin incision at left T11 intercostal space. We dissected along retroperitoneal space to the tumor. Tumor was dissected, and removed subcapsularly for central debulking. The tumor capsule was removed totally. The pleura was closed, and the wound was closed in layers after one submuscular CWV set. Operators VS 賴達明 Assistants R5 曾峰毅 R1 吳健暉 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 吳健暉 開立時間: 2011/10/07 19:30 Pre-operative Diagnosis Left T12 extraforaminal schwannoma Post-operative Diagnosis Left T12 extraforaminal schwannoma Operative Method Left retroperitoneal approach for left T12 extraforaminal schwannoma excision Specimen Count And Types Several fragments of one tumor was sent for pathology. Pathology Pending Operative Findings One 5x4x5cm capsulated, well-defined, hypervascular, soft to elasitc yellowish tumor was noted just adjacent to the left side of L1 vertebral body, arising from left T12 intercostal nerve, erosing the L1 vertebral body partilly. Blood loss was about 400 ml. Blood tranfusion: pRBC 2u. Pleura was opened at left costopeural angle, and was sutured. Operative Procedures With endotracheal general anaestehsia, the patient was put in right decubitus position. We scrubbed, disinfected, and then draped the patient as usual, and made one oblique transverse skin incision at left T11 intercostal space. We dissected along retroperitoneal space to the tumor. Tumor was dissected, and removed subcapsularly for central debulking. The tumor capsule was removed totally. The pleura was closed, and the wound was closed in layers after one submuscular CWV set. Operators VS 賴達明 Assistants R5 曾峰毅 R1 吳健暉 相關圖片 劉昇展 (M,1974/01/06,38y2m) 手術日期 2011/10/07 手術主治醫師 楊士弘 手術區域 東址 027房 03號 診斷 Malignant neoplasm of sigmoid colon 器械術式 T3-5 metastatic tumor resection, T1.2.6.7 TPS fixation 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 林哲光, 時間資訊 00:00 開始NPO 07:44 通知急診手術 15:20 報到 16:00 進入手術室 16:05 麻醉開始 16:30 誘導結束 17:05 手術開始 21:00 抗生素給藥 21:15 開始輸血 23:00 手術結束 23:00 麻醉結束 23:12 送出病患 23:20 進入恢復室 01:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 惡性脊髓腫瘤切除術 1 1 手術 脊椎融合術-後融合,有固定物(<=六節) 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 摘要__ 手術科部: 外科部 套用罐頭: (1) Posterior transpedicular tumor excision; ... 開立醫師: 楊士弘 開立時間: 2011/10/07 22:19 Pre-operative Diagnosis 1. Metastatic spinal tumor, thoracic spine, T3-5; 2. Colon cancer Post-operative Diagnosis 1. Metastatic spinal tumor, thoracic spine, T3-5; 2. Colon cancer Operative Method (1) Posterior transpedicular tumor excision; (2) transpedicular screws and rods fixation from T2-T7 Specimen Count And Types 1 piece About size:小 Source:T3-5 intraspinal tumor Pathology Nil Operative Findings A previous op. scar was noted in the midline back from T2 to T7, and the spinous processes and lamina from T3 to T6 were absent and filled with thick scar tissue. After removal of posterior epidural scar, soft fragile, moderately vascularized, greyish white tumor and scar tissue was found around the latter gutters of spinal canal, compressing the thecal sac and nerve roots from T3 to T5. The thecal sac reexpanded well after tumor excision. Neurectomy of right T4,5 and left T5,6 roots were done to facilitate tumor excision. Six pedicle screws, two rods, and one cross link were placed for posterior spinal fixation: T2 screws: 4.5 mm in diameter, 30 mm long T6,7 screws: 5.5 mm in diamter, 40 mm long Rods: 15 cm long on both sides Operative Procedures 1. ETGA, prone, head fixed with Mayfield skull clamp. 2. Midline incision over upper back along previous scar. 3. Dissection of paravertebral muscles off spinous processes and lamina from T2, lower T6, and T7. 4. Insertion of titanium screws into bilateral T2, T6, and T7 levels. 5. Removal of posterior epidural scar. 6. Resection of T3,4,5 pedicles and medial facets. 7. Dissection and excision of epidural tumor and scar tissue from the lateral gutters of spinal canal. 8. Hemostasis and placement of Gelfoam over posterior dural surface. 9. Bridging of screws with a rod on each side; bridging of rods with one transverse link. 10. Two hemovac drains. 11. Wound closure in layers. Operators 楊士弘 Assistants 李振豪,林哲光 Indication Of Emergent Operation paraplegia due to spinal cord compression 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: (1) Posterior transpedicular tumor excision; ... 開立醫師: 游健生 開立時間: 2011/11/16 14:07 Pre-operative Diagnosis 1. Metastatic spinal tumor, thoracic spine, T3-5; 2. Colon cancer Post-operative Diagnosis 1. Metastatic spinal tumor, thoracic spine, T3-5; 2. Colon cancer Operative Method (1) Posterior transpedicular tumor excision; (2) transpedicular screws and rods fixation from T2-T7 Specimen Count And Types 1 piece About size:小 Source:T3-5 intraspinal tumor Pathology Nil Operative Findings A previous op. scar was noted in the midline back from T2 to T7, and the spinous processes and lamina from T3 to T6 were absent and filled with thick scar tissue. After removal of posterior epidural scar, soft fragile, moderately vascularized, greyish white tumor and scar tissue was found around the latter gutters of spinal canal, compressing the thecal sac and nerve roots from T3 to T5. The thecal sac reexpanded well after tumor excision. Neurectomy of right T4,5 and left T5,6 roots were done to facilitate tumor excision. Six pedicle screws, two rods, and one cross link were placed for posterior spinal fixation: T2 screws: 4.5 mm in diameter, 30 mm long T6,7 screws: 5.5 mm in diamter, 40 mm long Rods: 15 cm long on both sides Operative Procedures 1. ETGA, prone, head fixed with Mayfield skull clamp. 2. Midline incision over upper back along previous scar. 3. Dissection of paravertebral muscles off spinous processes and lamina from T2, lower T6, and T7. 4. Insertion of titanium screws into bilateral T2, T6, and T7 levels. 5. Removal of posterior epidural scar. 6. Resection of T3,4,5 pedicles and medial facets. 7. Dissection and excision of epidural tumor and scar tissue from the lateral gutters of spinal canal. 8. Hemostasis and placement of Gelfoam over posterior dural surface. 9. Bridging of screws with a rod on each side; bridging of rods with one transverse link. 10. Two hemovac drains. 11. Wound closure in layers. Operators 楊士弘 Assistants 李振豪,林哲光 Indication Of Emergent Operation paraplegia due to spinal cord compression 相關圖片 鄭國基 (M,1959/07/08,52y8m) 手術日期 2011/10/07 手術主治醫師 謝榮賢 手術區域 東址 009房 02號 診斷 Injury (severity score >=16) 器械術式 Debridement 手術類別 預定手術 手術部位 四肢 傷口分類 清潔污染 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 陳志軒, 時間資訊 15:55 進入手術室 16:00 抗生素給藥 16:14 麻醉開始 16:15 誘導結束 16:16 手術開始 17:10 手術結束 17:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 移前皮瓣移植術 1 1 L 記錄__ 手術科部: 復健部 套用罐頭: advancement flap 開立醫師: 黃柏誠 開立時間: 2011/10/07 17:09 Pre-operative Diagnosis left lower leg chronic ulcer x2 Post-operative Diagnosis left lower leg chronic ulcer x2 Operative Method advancement flap Specimen Count And Types 1 piece About size:5x5 cm Source:left lower leg chronic ulcer Pathology pending Operative Findings 1. a 3x3 cm and a 2x2 cm chronic ulcer was noted at left calf and lateral malleolus region, advancement flap was done for primary wound closure Operative Procedures 1.supine position 2.disinfeciton and drape 3.performed advcement flap 4.cover BI gauze Operators VS謝榮賢 Assistants R3陳志軒 R4黃柏誠 相關圖片 劉國陽 (M,1966/11/05,45y4m) 手術日期 2011/10/07 手術主治醫師 蔡翊新 手術區域 東址 005房 04號 診斷 Epidural hemorrhage 器械術式 Removal of epidural hematoma，ICP monitoring 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 4E 紀錄醫師 曾偉倫, 黃薇諭, 時間資訊 00:00 開始NPO 00:00 臨時手術NPO 22:38 報到 22:38 進入手術室 22:42 麻醉開始 23:00 抗生素給藥 23:00 誘導結束 23:15 手術開始 01:45 麻醉結束 01:45 手術結束 01:55 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 硬腦膜外血腫清除術 1 1 L 手術 顱內壓視置入 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 摘要__ 手術科部: 外科部 套用罐頭: Left temporal craniotomy for EDH evacuation a... 開立醫師: 蔡翊新 開立時間: 2011/10/08 01:30 Pre-operative Diagnosis Left temporal bone fracture with epidural hemorrhage. Post-operative Diagnosis Left temporal bone fracture with epidural hemorrhage. Operative Method Left temporal craniotomy for EDH evacuation and ICP monitoring. Specimen Count And Types nil Pathology Nil. Operative Findings A linear skull fracture leading from left parietal area to temporal area, just above the petrous bone. There was epidural hematoma, 3 cm in maximal thickness, 8 x 6 cm in area, at left temporal area. The dura was slack after EDH evacuation. Bleeders came from venous sinus at temporal base. The Zero reference of ICP monitor was 487. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: reverse U-shaped at lower temporal area, the skin edge was clipped by Raney clips for temporary hemostasis. The temporalis muscles was incised down to the tempoal squama which was exposed then by applying a self retaining retractor on the muscle. 5. A burr hole was made at left temporal area for evacuating part of the epidural hematoma, therefore the IICP could be relieved earlier. 6. Craniotomy window: 8 x 5 cm, left temporal, created by making 4 burr holes then cut by power saw. 7. Dural tenting: by 2/0 silk, 1.5-cm in interval, distributed along the edge of skull window. 8. The epidural clot was removed by sucker. 9. Hemostasis: the bleeders was stopped by Gelfoam packing and dural tenting. 10.A nib opening of the dura was made to check subdural space and a Codman ICP monitor was inserted to subdural space. 11.The skull plate was fixed back with 4 26# wires. 12.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 13.Drain: one, epidural, CWV. 14.Blood transfusion: PRBC 2U. Blood loss: 500 ml. 15.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R6鍾文桂R3曾偉倫R0黃薇諭 Indication Of Emergent Operation large EDH with uncal herniation 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Left temporal craniotomy for EDH evacuation a... 開立醫師: 蔡翊新 開立時間: 2011/10/08 01:30 Pre-operative Diagnosis Left temporal bone fracture with epidural hemorrhage. Post-operative Diagnosis Left temporal bone fracture with epidural hemorrhage. Operative Method Left temporal craniotomy for EDH evacuation and ICP monitoring. Specimen Count And Types nil Pathology Nil. Operative Findings A linear skull fracture leading from left parietal area to temporal area, just above the petrous bone. There was epidural hematoma, 3 cm in maximal thickness, 8 x 6 cm in area, at left temporal area. The dura was slack after EDH evacuation. Bleeders came from venous sinus at temporal base. The Zero reference of ICP monitor was 487. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: reverse U-shaped at lower temporal area, the skin edge was clipped by Raney clips for temporary hemostasis. The temporalis muscles was incised down to the tempoal squama which was exposed then by applying a self retaining retractor on the muscle. 5. A burr hole was made at left temporal area for evacuating part of the epidural hematoma, therefore the IICP could be relieved earlier. 6. Craniotomy window: 8 x 5 cm, left temporal, created by making 4 burr holes then cut by power saw. 7. Dural tenting: by 2/0 silk, 1.5-cm in interval, distributed along the edge of skull window. 8. The epidural clot was removed by sucker. 9. Hemostasis: the bleeders was stopped by Gelfoam packing and dural tenting. 10.A nib opening of the dura was made to check subdural space and a Codman ICP monitor was inserted to subdural space. 11.The skull plate was fixed back with 4 26# wires. 12.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 13.Drain: one, epidural, CWV. 14.Blood transfusion: PRBC 2U. Blood loss: 500 ml. 15.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R6鍾文桂R3曾偉倫R0黃薇諭 Indication Of Emergent Operation large EDH with uncal herniation 相關圖片 莊燦雄 (M,1950/03/01,62y0m) 手術日期 2011/10/08 手術主治醫師 杜永光 手術區域 東址 003房 02號 診斷 Headache 器械術式 Removal of right chronic SDH 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林峰盛 ASA 2E 紀錄醫師 林哲光, 時間資訊 09:00 開始NPO 13:04 通知急診手術 14:35 報到 14:40 進入手術室 14:45 麻醉開始 14:50 誘導結束 15:19 抗生素給藥 15:48 手術開始 16:45 手術結束 16:45 麻醉結束 17:00 送出病患 17:05 進入恢復室 18:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 手術 慢性硬腦膜下血腫清除術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Right frontal burr hole drainage for chronic ... 開立醫師: 林哲光 開立時間: 2011/10/08 16:58 Pre-operative Diagnosis Right F-T-P chronic subdural hematoma Post-operative Diagnosis Right F-T-P chronic subdural hematoma Operative Method Right frontal burr hole drainage for chronic subudral hematoma Specimen Count And Types nil Pathology Nil Operative Findings Gush of yellowish fluids contents were noted when dura and outer membrane of CSDH was opened. Motor-oil like fluids contents from right subdural space was also noted in the dependent part. Outer membrane of CSDH formation was noted but no obvious inner membrane formation was noted. The brain parechyma seemed re-expanded slowly after drainage. Operative Procedures Under ETGA and supine position and head rotated to left side, skin disinfected and drapped were performed as usual. A transverse skin incision was made at right frontal area. A burr hole was then created and the dura was opened after dural tenting. The outer membrane was opened and subdural hematoma was drained out. Subdural drain was fixed through the subcutaneous tunneling after N/S irrigation. The burr hole was packed with Gelfoam and the wound was then closed in layers after hemostasis and deair. Operators 杜永光 Assistants 林哲光 Indication Of Emergent Operation Mass effect of CSDH 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Right frontal burr hole drainage for chronic ... 開立醫師: 林哲光 開立時間: 2011/10/08 16:58 Pre-operative Diagnosis Right F-T-P chronic subdural hematoma Post-operative Diagnosis Right F-T-P chronic subdural hematoma Operative Method Right frontal burr hole drainage for chronic subudral hematoma Specimen Count And Types nil Pathology Nil Operative Findings Gush of yellowish fluids contents were noted when dura and outer membrane of CSDH was opened. Motor-oil like fluids contents from right subdural space was also noted in the dependent part. Outer membrane of CSDH formation was noted but no obvious inner membrane formation was noted. The brain parechyma seemed re-expanded slowly after drainage. Operative Procedures Under ETGA and supine position and head rotated to left side, skin disinfected and drapped were performed as usual. A transverse skin incision was made at right frontal area. A burr hole was then created and the dura was opened after dural tenting. The outer membrane was opened and subdural hematoma was drained out. Subdural drain was fixed through the subcutaneous tunneling after N/S irrigation. The burr hole was packed with Gelfoam and the wound was then closed in layers after hemostasis and deair. Operators 杜永光 Assistants 林哲光 Indication Of Emergent Operation Mass effect of CSDH 相關圖片 甘中宜 (F,1967/12/29,44y2m) 手術日期 2011/10/08 手術主治醫師 曾漢民 手術區域 東址 003房 01號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林峰盛 ASA 3 紀錄醫師 林哲光, 時間資訊 23:18 臨時手術NPO 08:01 進入手術室 08:15 麻醉開始 08:40 誘導結束 08:50 抗生素給藥 08:51 手術開始 11:50 抗生素給藥 14:00 手術結束 14:00 麻醉結束 14:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4~8小時 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Left F-T craniotomy with total tumor excision 開立醫師: 林哲光 開立時間: 2011/10/08 18:09 Pre-operative Diagnosis Left temporal mass Post-operative Diagnosis Left temporal mass, suspected covexity meningioma Operative Method Left F-T craniotomy with total tumor excision Specimen Count And Types 1 piece About size:4.2cm sized Source:tumor Pathology Pending Operative Findings A 4.2cm sized, well demarcated, elastic-firm, whitish mass lesion was noted at left temporal lobe with dural attachment at left temporal base. A drainage vein of the tumor from the sylvian vein was noted. Total tumor removal was done and cuaterization of the dural attachment was also done. Operative Procedures Under ETGA and supine position with head roated to right side and fixed with head clamp, skin disinfected and drapped were performed as usual. Curvilinear skin incision was made at right F-T area. Skin flap was deflected and facial nerve perservation was done. The muscle falp was detached and deflected. Four burr holes were created and craniotomy was done. Further temporal bone was removed by Rongeur until the brain base was exposed. Central debulking was done by piecemeal removal. The whole tumor was then removed gradually. Hemostasis was done with surgcells covering. The dura was closed in water-tie method with artifical dura. The skull bone was put back and fixed with miniplates. The wound was then closed in layers after a subgaleal drain insertion. Operators 曾漢民 Assistants 林哲光 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Left F-T craniotomy with total tumor excision 開立醫師: 林哲光 開立時間: 2011/10/08 18:09 Pre-operative Diagnosis Left temporal mass Post-operative Diagnosis Left temporal mass, suspected covexity meningioma Operative Method Left F-T craniotomy with total tumor excision Specimen Count And Types 1 piece About size:4.2cm sized Source:tumor Pathology Pending Operative Findings A 4.2cm sized, well demarcated, elastic-firm, whitish mass lesion was noted at left temporal lobe with dural attachment at left temporal base. A drainage vein of the tumor from the sylvian vein was noted. Total tumor removal was done and cuaterization of the dural attachment was also done. Operative Procedures Under ETGA and supine position with head roated to right side and fixed with head clamp, skin disinfected and drapped were performed as usual. Curvilinear skin incision was made at right F-T area. Skin flap was deflected and facial nerve perservation was done. The muscle falp was detached and deflected. Four burr holes were created and craniotomy was done. Further temporal bone was removed by Rongeur until the brain base was exposed. Central debulking was done by piecemeal removal. The whole tumor was then removed gradually. Hemostasis was done with surgcells covering. The dura was closed in water-tie method with artifical dura. The skull bone was put back and fixed with miniplates. The wound was then closed in layers after a subgaleal drain insertion. Operators 曾漢民 Assistants 林哲光 相關圖片 崔延泰 (M,1956/10/29,55y4m) 手術日期 2011/10/08 手術主治醫師 賴達明 手術區域 東址 005房 01號 診斷 Subarachnoid hemorrhage 器械術式 Left pterion approach for aneurysm clipping 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林峰盛 ASA 3 紀錄醫師 李振豪, 時間資訊 21:03 通知急診手術 00:00 開始NPO 00:00 臨時手術NPO 08:40 報到 08:40 進入手術室 08:55 麻醉開始 09:20 抗生素給藥 09:20 誘導結束 09:30 手術開始 12:20 抗生素給藥 16:00 麻醉結束 16:00 手術結束 16:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 開顱術摘除血管病變 - 腦血管瘤 有病徵的 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Left pterional approach for aneurysm clipping 開立醫師: 李振豪 開立時間: 2011/10/08 16:28 Pre-operative Diagnosis Anterior communicating artery aneurysm rupture with subarachnoid hemorrhage Post-operative Diagnosis Anterior communicating artery aneurysm rupture with subarachnoid hemorrhage Operative Method Left pterional approach for aneurysm clipping Specimen Count And Types nil Pathology Nil Operative Findings The brain was not swelling during dura opening. After release of CSF, the brain became slack. Minimal subarachnoid hemorrhage was noted during the operation, especially from skull base. The anterior communicating artery aneurysm was abound 5mm in size which projected to medial and inferior. Total two Sugita clips(one bayonet and one fenestrated) were used for aneurysm clipping. No pre-mature rupture was noted during manipulation. Temporary clipping of left A1 was used twice for proximal control with 5 minutes each time. Left recurren artery was preserved well during whole procedure. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with left shoulder elevation and head rotated to right. The head was fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. Curvilinear scalp incision was made at left fronto-temporal area and the scalp flap was elevated with facial nerve preservation. The temporalis muscle was detached from the skull and reflected toward posteroinferiorly. Four burrholes were created and one 12 x 10cm craniotomy window was made. Dural tenting was done. C-shape durotomy based with left skull base was conducted. The Sylvian fissure was opened and left optic nerve was identified after retraction of the frontal lobe. After wide opening of the arachnoid membrane, left rectal gyrus was resected to identified the ACA. The aneurysm was encountered while we dissect along the ACA. The of the aneurysm was idenfitied. One bayonet and one fenestrated Sugita clip were used for aneurysm clipping. Hemostasis was achieved with bipolar electrocautery and Surgicel lining. Dura was closed with 4-0 prolene. The skull plate was fixed back with miniplates, screws, and five central tenting. The temporalis muscle was fixed back to neutral position. One subgaleal CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and Appose staples. Operators VS賴達明 Assistants R5李振豪 Indication Of Emergent Operation Aneurysmal SAH 相關圖片 張怡蓁 (F,2011/09/23,5m23d) 手術日期 2011/10/09 手術主治醫師 黃書健 手術區域 東址 000房 號 診斷 Ebstein anomaly 器械術式 TCPC,JATENE,TAPVR,NORWOOD 手術類別 緊急手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 ASA 1 紀錄醫師 陳建銘, 時間資訊 10:51 開始NPO 10:51 臨時手術NPO 10:51 通知急診手術 11:25 手術開始 11:25 麻醉開始 12:25 麻醉結束 12:30 手術結束 醫令資訊 類別 名稱 量 刀 側 手術 存開性動脈導管手術 1 1 麻醉 IV or IM anesthesia 1 0 記錄__ 手術科部: 套用罐頭: PDA ligation 開立醫師: 陳建銘 開立時間: 2011/10/09 12:47 Pre-operative Diagnosis Ebstein anomaly with severe TR and large PDA Ebstein anomaly with severe TR and large PDA, HEART FAILURE AND PULMONARY HEMORRHAGE Post-operative Diagnosis Ditto Operative Method PDA ligation Specimen Count And Types nil Pathology nil Operative Findings 1.cardiomegaly(+), fair contractility 2.pulmonary congestion(+), PDA size around 6mm 3.pre-op: pCO2 82.2,pH:7.01,Lac:16 ; post-op:SBP87/55,HR153,SpO2:100,pH 7.24, pCO2:42 4.sternum unapproximated Operative Procedures 1.ETGA,supine,skin disinfection 2.set two way a-line and two-way CVP over right femoral 2.set two way a-line and THREE-way CVP over right femoral, CUT-DOWN METHOD 3.midline sternotomy 4.PDA ligation with silk 4.PDA ligation with 2-0 silk 5.set two chest tube(pleural) and one chest tube(mediastinum) 6.pericardium with surgical membrane covered and keep sternum unapproximated 6. keep sternum unapproximated FOR POOR HEART/LUNG CONDITION Operators VS黃書健 Assistants F徐綱宏,R3陳建銘 Indication Of Emergent Operation desaturation, hypotension 陳俊宏 (M,1962/08/03,49y7m) 手術日期 2011/10/10 手術主治醫師 曾漢民 手術區域 東址 003房 02號 診斷 Brain Tumor 器械術式 T.S.H. 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 3E 紀錄醫師 李振豪, 時間資訊 00:03 開始NPO 00:03 臨時手術NPO 00:03 通知急診手術 12:27 報到 12:40 進入手術室 13:00 麻醉開始 13:10 誘導結束 13:30 抗生素給藥 13:50 手術開始 15:40 麻醉結束 15:40 手術結束 15:56 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經由蝶竇之腦下垂體瘤切除 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 記錄__ 手術科部: 外科部 套用罐頭: Trans-nasal Trans-sphenoidal adenomectomy 開立醫師: 李振豪 開立時間: 2011/10/10 16:25 Pre-operative Diagnosis Pituitary macroadenoma Post-operative Diagnosis Pituitary macroadenoma Operative Method Trans-nasal Trans-sphenoidal adenomectomy Specimen Count And Types 1 piece About size:Multiple small pieces Source:pituitary tumor Pathology Pending Operative Findings The tumor was reddish in color, elastic to firm, well-capsulated, hypervascularized, and 3.1 x 2.8 x 2.2cm in size. A large cystic component with xanthochrmoic content was noted within the central part of the tumor. The capsule was adhered to adjacent tissue tightly and CSF leakage was noted during dissection along the capsule. The normal gland was not well visualized after tumor excision. Autologous fat graft was harvested from left abdomen. The sellar regions was packing with Gelfoam, autologous fat, and Tissucol Duo to avoid further CSF leakage. The patient stood whole procedure well. Operative Procedures Under endotracheal general anesthesia, the patient was putin supine position with head tilted 30 degree to left. The nasal cavity was packing with epinephrine soaked gauze for 10 minutes. The face and left lower abdomen were prepared with povidone-iodine alcohol tincture, and the mucosa of oral and nasal cavity with aqueous povidone-iodine tincture. The nasal submucosa at septum and floor were infiltrated with 1:100 epinephrine solution. One 1.5cm incision was made at nasal mucosa of right nasal septum and the musoca was dissected away from the septum. The nasal septum was fractured and the vomer was removed. The sphenoid sinus was entered and the mucosa within the sphenoid sinus was removed. The sellar floor was identified and opened. Cruciform durotomy was done and the xanthochromic fluid within the cystic part gushed out. The tumor was dissected along the capsule and removed by alligator, ring curette, and suction. CSF leakage was noted during dissection along the capsule. Hemostasis was achieved with Gelfoam packing. One transverse skin incision with 3cm in length was made at left abdomen and one 2 x 2 x 3cm autologous fat graft was harvested. The wound was closed in layers with 2-0 Vicryl and 3-0 Nylon. The sellar region was packing with Gelfoam, autologous fat graft and Tissucol Duo to avoid further CSF leakage. The vomer bone was placed back and the nasal mucosa was pushed back to the neutral position. Tissucol Duo was applied between the nasal mucosa and the vomer bone. The nasal septum and the middle turbinate was pushed back to neutral position. Bilateral nasal cavities were packed with a segment of rubber glove finger which had been soaked with better-iodine ointment. Total blood loss was 50ml. Operators VS曾漢民 Assistants R5李振豪 Indication Of Emergent Operation Pituitary tumor with apoplexy and Pituitary tumor with apoplexy and visual acuity impairment 蘇桂香 (F,1927/01/04,85y2m) 手術日期 2011/10/10 手術主治醫師 蔡翊新 手術區域 東址 001房 04號 診斷 Cerebrovascular accident 器械術式 Removal of ICH 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 4E 紀錄醫師 范姜鈞, 時間資訊 12:59 通知急診手術 14:30 進入手術室 14:35 麻醉開始 14:45 誘導結束 15:00 抗生素給藥 15:22 手術開始 18:00 抗生素給藥 21:20 手術結束 21:20 麻醉結束 21:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦內血腫清除術 1 1 R 手術 顱內壓視置入 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 摘要__ 手術科部: 外科部 套用罐頭: CVA 開立醫師: 蔡翊新 開立時間: 2011/10/10 21:15 Pre-operative Diagnosis Right frontal ICH. Post-operative Diagnosis Right frontal ICH, amyloid angiopathy. Operative Method Right frontal craniotomy for ICH evacuation and subdural ICP monitoring. Specimen Count And Types 1 piece About size:3 X 3 X 2 cm Source:blood clot, suspected vascular tuft Pathology Pending. Operative Findings The dura was tense after craniotomy and the brain bulged out upon dural opening. Serum-like fluid, followed by dark reddish blood gushed out spontaneously from a ruptured site of right frontal cortex. Tracing via the ruptured site, a huge ICH was evacuated from right frontal lobe. The brain adjacent to the ICH was very fragile and the bleeders were very difficult to coagulate. The ICH was estimated 120 ml. A vascular tuft was encountered at posteromedial aspect of the ICH. After ICH evacuation, the brain was initially very slack, but it bulged gradually during the course of hemostasis. ICP after skin closure was -9 mmHg. Reference of ICP monitor was 490. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: right frontotemporal, curvilinear. The skin edge was clipped by Raney clips for temporary hemostasis. 5. Craniotomy: A 7 x 4 cm craniotomy was made at right frontal area via 3 burr holes. 6. Dural tenting: by 2/0 silk, 2 cm in interval, distributed along the edge of skull window. 7. Dural incision: curvilinear along the craniotomy margin, reflected toward superior sagittal sinus. 8. We used the ruptured site at right frontal lobe as cortical incision. The subcortex and white mater was splitted by brain retractor and sucker until the intracerebral hematoma was exposed. The hematoma was sucked out carefully. Those tough clots were removed by forceps. The cavity was irrigated with NS and the blood oozing was stopped by Surgicel and Gelfoam packing. 9. Dural closure: interrupted 2/0 silk sutures for key stitches, then continous sutures with 4/0 Prolene to obtain water-tight closure. A 3 x 0.5 cm piece of fascial graft was used for duroplasty. 10.A Codman ICP monitor was set at subdural space of right frontal area. 11.The bone graft was fixed back with 3 miniplates and 6 screws. 12.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 13.Drain: one epidural CWV drain. 14.Blood transfusion: PRBC 4U, Platelet 12U, FFP 2U. Blood loss: 750 ml. 15.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R3陳國瑋R1范姜鈞 Indication Of Emergent Operation conscious disturbance, pupil anisocoria, huge ICH 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: CVA 開立醫師: 蔡翊新 開立時間: 2011/10/10 21:15 Pre-operative Diagnosis Right frontal ICH. Post-operative Diagnosis Right frontal ICH, amyloid angiopathy. Operative Method Right frontal craniotomy for ICH evacuation and subdural ICP monitoring. Specimen Count And Types 1 piece About size:3 X 3 X 2 cm Source:blood clot, suspected vascular tuft Pathology Pending. Operative Findings The dura was tense after craniotomy and the brain bulged out upon dural opening. Serum-like fluid, followed by dark reddish blood gushed out spontaneously from a ruptured site of right frontal cortex. Tracing via the ruptured site, a huge ICH was evacuated from right frontal lobe. The brain adjacent to the ICH was very fragile and the bleeders were very difficult to coagulate. The ICH was estimated 120 ml. A vascular tuft was encountered at posteromedial aspect of the ICH. After ICH evacuation, the brain was initially very slack, but it bulged gradually during the course of hemostasis. ICP after skin closure was -9 mmHg. Reference of ICP monitor was 490. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: right frontotemporal, curvilinear. The skin edge was clipped by Raney clips for temporary hemostasis. 5. Craniotomy: A 7 x 4 cm craniotomy was made at right frontal area via 3 burr holes. 6. Dural tenting: by 2/0 silk, 2 cm in interval, distributed along the edge of skull window. 7. Dural incision: curvilinear along the craniotomy margin, reflected toward superior sagittal sinus. 8. We used the ruptured site at right frontal lobe as cortical incision. The subcortex and white mater was splitted by brain retractor and sucker until the intracerebral hematoma was exposed. The hematoma was sucked out carefully. Those tough clots were removed by forceps. The cavity was irrigated with NS and the blood oozing was stopped by Surgicel and Gelfoam packing. 9. Dural closure: interrupted 2/0 silk sutures for key stitches, then continous sutures with 4/0 Prolene to obtain water-tight closure. A 3 x 0.5 cm piece of fascial graft was used for duroplasty. 10.A Codman ICP monitor was set at subdural space of right frontal area. 11.The bone graft was fixed back with 3 miniplates and 6 screws. 12.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 13.Drain: one epidural CWV drain. 14.Blood transfusion: PRBC 4U, Platelet 12U, FFP 2U. Blood loss: 750 ml. 15.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R3陳國瑋R1范姜鈞 Indication Of Emergent Operation conscious disturbance, pupil anisocoria, huge ICH 相關圖片 張蓮童 (M,1971/11/18,40y3m) 手術日期 2011/10/11 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Brachial plexopathy 器械術式 brachial plexus repair 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 林哲光, 時間資訊 23:18 臨時手術NPO 08:08 進入手術室 08:15 麻醉開始 08:20 誘導結束 08:58 抗生素給藥 09:48 手術開始 11:58 抗生素給藥 12:50 手術結束 12:50 麻醉結束 13:08 送出病患 13:15 進入恢復室 15:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 神經分離術–肩,臀關節以上,包括臂神經叢,坐骨神經 1 1 L 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 摘要__ 手術科部: 外科部 套用罐頭: Neurolysis at C5, C6 root and superior trunk 開立醫師: 林哲光 開立時間: 2011/10/11 13:45 Pre-operative Diagnosis Left brachial plexus injury Post-operative Diagnosis Left middle cervical myelpathy and severe muscle fibrosis Operative Method Neurolysis at C5, C6 root and superior trunk Specimen Count And Types nil Pathology Nil Operative Findings Left C5, C6 root, superior trunck and suprascapular nerve were identified and electrostimulation were done. The innervated muscle groups showed good signal transduction but MEP showed no wave formation. Muscle weakness or severe muscle fibrosis is suspected. Operative Procedures Under ETGA and supine postiion with head rotated to right side, skin disinfected and drapped were performed as usual. A curvilinear skin incision was made at left neck from submandibular area to left retroclavicle area. The dissection was done through the plane posterior to SCM after platysma was opened. The anterior and middle scalene muscles were identified and phrenic nerves were then identified. Further dissection was done lateral to anterior scalene muscle and the superior trunk was then found and C5, C6 roots were then identified. Further traction to left suprascapular nerve was done. Intraoperative electrostimulation was done and all nerves conduction seemed well but MEP showed no obvious wave formation. The wound was then closed in layers. Operators 曾勝弘, 楊士弘 Assistants 林哲光 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Neurolysis at C5, C6 root and superior trunk 開立醫師: 林哲光 開立時間: 2011/10/11 13:46 Pre-operative Diagnosis Left brachial plexus injury Post-operative Diagnosis Left middle cervical myelpathy and severe muscle fibrosis Operative Method Neurolysis at C5, C6 root and superior trunk Specimen Count And Types nil Pathology Nil Operative Findings Left C5, C6 root, superior trunck and suprascapular nerve were identified and electrostimulation were done. The innervated muscle groups showed good signal transduction but MEP showed no wave formation. Muscle weakness or severe muscle fibrosis is suspected. Operative Procedures Under ETGA and supine postiion with head rotated to right side, skin disinfected and drapped were performed as usual. A curvilinear skin incision was made at left neck from submandibular area to left retroclavicle area. The dissection was done through the plane posterior to SCM after platysma was opened. The anterior and middle scalene muscles were identified and phrenic nerves were then identified. Further dissection was done lateral to anterior scalene muscle and the superior trunk was then found and C5, C6 roots were then identified. Further traction to left suprascapular nerve was done. Intraoperative electrostimulation was done and all nerves conduction seemed well but MEP showed no obvious wave formation. The wound was then closed in layers. Operators 曾勝弘, 楊士弘 Assistants 林哲光 相關圖片 梁政翎 (F,2002/09/17,9y5m) 手術日期 2011/10/11 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Malignant neoplasm of connective and other soft tissue of lower limb, including hip 器械術式 Removal of parietal skull & left thigh tumor 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 石博元 ASA 3 紀錄醫師 曾穎凡, 王奐之, 時間資訊 00:00 臨時手術NPO 07:42 報到 08:01 進入手術室 08:10 麻醉開始 08:30 誘導結束 09:00 抗生素給藥 09:23 手術開始 09:46 開始輸血 10:35 12:05 抗生素給藥 13:45 麻醉結束 13:45 手術結束 13:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 軟組織惡性腫瘤廣泛切除 1 1 L 手術 顱骨切除術,包括異物移除或壓或經切斷 1 1 手術 頭顱成形術 1 2 記錄__ 手術科部: 外科部 套用罐頭: Left lower leg tumor excision 開立醫師: 柯柏瑞 開立時間: 2011/10/11 12:36 Pre-operative Diagnosis Left lower leg rhabdomyosarcoma Post-operative Diagnosis Left lower leg rhabdomyosarcoma Operative Method Excision of subcutaneous tumor Specimen Count And Types 1, a 5 x 3 x 2.5 cm tumor excised from left lower leg Pathology pending Operative Findings 1. A　5 x 3 x 2.5 cm whitish, capsulated, oval, solid tumor was removed from left lower leg, posterior compartment 2. Adhesion between tumor and adjacent muscle, infiltration was suspected Operative Procedures 1. ETGA, supine position 2. Skin disinfection and draping 3. Fusiform skin incision at tumor site, left lower leg 4. Tumor excision was done with electrocautery knife 5. Wound irrigation, hemostasis 6. Set one CWV drain 7. Close wounds in layers with 3-0, 4-0 Monocryl, 3-0 Nylon 8. Wound packing Operators VS 許文明 Assistants F2 柯柏瑞; PGY 曾穎凡; Ri 林秉毅 相關圖片 摘要__ 手術科部: 外科部 套用罐頭: Craniectomy for gross total tumor resection a... 開立醫師: 王奐之 開立時間: 2011/10/11 14:34 Pre-operative Diagnosis Rhabdomyosarcoma of left parietal skull Post-operative Diagnosis Rhabdomyosarcoma of left parietal skull Operative Method Craniectomy for gross total tumor resection and cranioplasty with titanium mesh Specimen Count And Types 1 piece About size:9*9*1.5cm in total size Source:parietal skull tumor Pathology Pending Operative Findings 1. The tumor mainly involved midline skull, causing bony erosion and severe dural adhesion. Some small blackish nodules with unknown nature were noted throughout the soft part of tumor and the resected skull as well. 2. The craniectomy window was about 11*10cm in size, a 13*13cm titanium mesh was used for cranioplasty (trimmed for appropriate size & shape). 3. Easy oozing over the surgical field was encountered. Estimated blood loss (take the left leg operation into account also) was 950ml, a total of 3 units of packed RBC were transfused. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position. After shaving, scrubbing, disinfection & draping in sterile fashion, a bicoronal linear incision was made at parietal area. After application of Raney clips, 5 burr holes were made for craniectomy. Bone flaps off the midline were removed first, while the remaining bone flap over midline was left in place. After thinning of the midline bone edges with airdrill, the hard bony portion was debulked with rongeur & Kerrison punches. A more fragile portion adhered to the midline dura tightly with small bone chips in between, which was dissected off the dura carefully and removed in pieces. The dura was cauterized with bipolar electrocautery for the suspected remaining epidural tumor cells. Dural tenting was then performed. Titanium mesh was trimmed to a appropriate size & shape, and bent to fit the curve of skull defect. It was fixed onto the skull edge with screws. The sharp edges of titanium mesh was smoothened with bone cement. After placement of 1 subgaleal CWV drain & meticulous hemostasis, the wound was closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之, Ri 陳勇仁 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Craniectomy for gross total tumor resection a... 開立醫師: 王奐之 開立時間: 2011/10/11 14:34 Pre-operative Diagnosis Rhabdomyosarcoma of left parietal skull Post-operative Diagnosis Rhabdomyosarcoma of left parietal skull Operative Method Craniectomy for gross total tumor resection and cranioplasty with titanium mesh Specimen Count And Types 1 piece About size:9*9*1.5cm in total size Source:parietal skull tumor Pathology Pending Operative Findings 1. The tumor mainly involved midline skull, causing bony erosion and severe dural adhesion. Some small blackish nodules with unknown nature were noted throughout the soft part of tumor and the resected skull as well. 2. The craniectomy window was about 11*10cm in size, a 13*13cm titanium mesh was used for cranioplasty (trimmed for appropriate size & shape). 3. Easy oozing over the surgical field was encountered. Estimated blood loss (take the left leg operation into account also) was 950ml, a total of 3 units of packed RBC were transfused. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position. After shaving, scrubbing, disinfection & draping in sterile fashion, a bicoronal linear incision was made at parietal area. After application of Raney clips, 5 burr holes were made for craniectomy. Bone flaps off the midline were removed first, while the remaining bone flap over midline was left in place. After thinning of the midline bone edges with airdrill, the hard bony portion was debulked with rongeur & Kerrison punches. A more fragile portion adhered to the midline dura tightly with small bone chips in between, which was dissected off the dura carefully and removed in pieces. The dura was cauterized with bipolar electrocautery for the suspected remaining epidural tumor cells. Dural tenting was then performed. Titanium mesh was trimmed to a appropriate size & shape, and bent to fit the curve of skull defect. It was fixed onto the skull edge with screws. The sharp edges of titanium mesh was smoothened with bone cement. After placement of 1 subgaleal CWV drain & meticulous hemostasis, the wound was closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之, Ri 陳勇仁 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Craniectomy for gross total tumor resection a... 開立醫師: 郭夢菲 開立時間: 2011/10/11 15:43 Pre-operative Diagnosis Rhabdomyosarcoma of parietal skull, more on left side, with epidural extension Post-operative Diagnosis Rhabdomyosarcoma of parietal skull, more on left side, with epidural extension Operative Method Craniectomy for gross total tumor resection and cranioplasty with titanium mesh, 13X13 cm in size Specimen Count And Types 1 piece About size:9*9*1.5cm in total size Source:parietal skull tumor Pathology Pending Operative Findings 1. The tumor mainly involved midline and left parietal skull, causing bony erosion, expansion and severe dural adhesion, which may be due to previous extradural extension of the tumor after chemotherapy effect. Some small blackish nodules with unknown nature were noted throughout the soft part of tumor and the resected skull marrow as well. 2. The craniectomy window was about 11*10cm in size, a 13*13cm titanium mesh was used for cranioplasty (trimmed for appropriate size & shape). 3. Easy oozing over the surgical field was encountered. Estimated blood loss (take the left leg operation into account also) was 950ml, a total of 3 units of packed RBC were transfused. After grossly total excision of the tumor, the oozing stopped. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position. After shaving, scrubbing, disinfection & draping in sterile fashion, a bicoronal linear incision was made at parietal area. After application of Raney clips, 5 burr holes were made for craniectomy. Bone flaps left off the midline were removed first, while the remaining bone flap over midline was left in place. After thinning of the midline bone edges with airdrill, the hard bony portion was debulked with rongeur & Kerrison punches. A more fragile portion adhered to the midline dura tightly with small bone chips in between, which was dissected off the dura carefully and removed in pieces. The dura was cauterized with bipolar electrocautery for the suspected remaining epidural tumor cells. Dural tenting was then performed. Titanium mesh was trimmed to a appropriate size & shape, and bent to fit the curve of skull defect. It was fixed onto the skull edge with screws. The sharp edges of titanium mesh was smoothened with bone cement. After placement of 1 subgaleal CWV drain & meticulous hemostasis, the wound was closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之, Ri 陳勇仁 相關圖片 黃富敏 (F,1952/10/22,59y4m) 手術日期 2011/10/11 手術主治醫師 賴達明 手術區域 東址 003房 號 診斷 Spondylolisthesis 器械術式 Spinal fusion posterior, L4/5 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 吳健暉, 時間資訊 23:12 臨時手術NPO 08:01 進入手術室 08:10 麻醉開始 08:20 誘導結束 08:20 抗生素給藥 08:45 手術開始 10:20 手術結束 10:20 麻醉結束 10:30 送出病患 10:31 進入恢復室 14:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎間盤切除術-腰椎 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 曾峰毅 開立時間: 2011/10/11 10:29 Pre-operative Diagnosis Spondylolisthesis, grade I, L4/5 Post-operative Diagnosis Spondylolisthesis, grade I, L4/5 Operative Method Transforaminal lumbar interbody fusion, L4/5 Specimen Count And Types Nil Pathology Nil Operative Findings Hypertrophic ligamentum flavum compromsed thecal sac and right neural foramne at L4/5 tightly. Neural structure was decompressed well after the surgery. Synthes transpedicular screws system and PEEK cage were used for TLIF. Operative Procedures With endotracheal general anaestheis, the patient was put in prone position. After C-arm localization, we scrubbed, disinfected, and then draped the patient's back. We made one midline skin incision and dissected paraspinal muscle to expose bialteral laminae from lower L3 to upper L5. Posterior instrumentation was done with transpedicular screws into bilateral pedicles of L4 and L5. L4 laminectomy was done for posterior decompression with bilatearl L4/5 foraminotomy. Transforaminal lumbar interbody fusion at L4/5 via right L4/5 neural foramen was done with PEEK cage and autologous bone graft after diskectomy. The wound was irrigated with gentamycin saline. After two hemovac inserted, the wound was closed in layers. Operators VS 賴達明 Assistants R5 曾峰毅 R1 吳健暉 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 吳健暉 開立時間: 2011/10/26 13:53 Pre-operative Diagnosis Spondylolisthesis, grade I, L4/5 Post-operative Diagnosis Spondylolisthesis, grade I, L4/5 Operative Method Transforaminal lumbar interbody fusion, L4/5 Specimen Count And Types Nil Pathology Nil Operative Findings Hypertrophic ligamentum flavum compromsed thecal sac and right neural foramne at L4/5 tightly. Neural structure was decompressed well after the surgery. Synthes transpedicular screws system and PEEK cage were used for TLIF. Operative Procedures With endotracheal general anaestheis, the patient was put in prone position. After C-arm localization, we scrubbed, disinfected, and then draped the patient's back. We made one midline skin incision and dissected paraspinal muscle to expose bialteral laminae from lower L3 to upper L5. Posterior instrumentation was done with transpedicular screws into bilateral pedicles of L4 and L5. L4 laminectomy was done for posterior decompression with bilatearl L4/5 foraminotomy. Transforaminal lumbar interbody fusion at L4/5 via right L4/5 neural foramen was done with PEEK cage and autologous bone graft after diskectomy. The wound was irrigated with gentamycin saline. After two hemovac inserted, the wound was closed in layers. Operators VS 賴達明 Assistants R5 曾峰毅 R1 吳健暉 相關圖片 游水木 (M,1941/01/21,71y1m) 手術日期 2011/10/11 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Spondylolisthesis 器械術式 Spinal fusion posterior, L4/5 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 吳健暉, 時間資訊 23:14 臨時手術NPO 10:41 進入手術室 10:50 麻醉開始 11:00 誘導結束 11:05 抗生素給藥 11:21 手術開始 13:40 手術結束 13:40 麻醉結束 13:50 送出病患 13:55 進入恢復室 14:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎間盤切除術-腰椎 1 2 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 曾峰毅 開立時間: 2011/10/11 13:37 Pre-operative Diagnosis Spondylolisthesis, L4/5, grade I Post-operative Diagnosis Spondylolisthesis, L4/5, grade I Operative Method Transforaminal lumbar interbody fusion, L4/5 Specimen Count And Types Nil Pathology Nil Operative Findings Hyptrophic ligamentum flavum compromised thecal sac and bilateral neural foramen. Nueral structures were decompressed well after the surgery. Synthes transpedicular screws system and PEEK cage were used for TLIF. Operative Procedures With endotracheal general anaestheis, the patient was put in prone position. After C-arm localization, we scrubbed, disinfected, and then draped the patient's back. We made one midline skin incision and dissected paraspinal muscle to expose bialteral laminae from lower L3 to upper L5. Posterior instrumentation was done with transpedicular screws into bilateral pedicles of L4 and L5. L4 laminectomy was done for posterior decompression with bilatearl L4/5 foraminotomy. Transforaminal lumbar interbody fusion at L4/5 via right L4/5 neural foramen was done with PEEK cage and autologous bone graft after diskectomy. The wound was irrigated with gentamycin saline. After two hemovac inserted, the wound was closed in layers. Operators VS 賴達明 Assistants R5 曾峰毅 R1 吳健暉 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 吳健暉 開立時間: 2011/10/20 17:57 Pre-operative Diagnosis Spondylolisthesis, L4/5, grade I Post-operative Diagnosis Spondylolisthesis, L4/5, grade I Operative Method Transforaminal lumbar interbody fusion, L4/5 Specimen Count And Types Nil Pathology Nil Operative Findings Hyptrophic ligamentum flavum compromised thecal sac and bilateral neural foramen. Nueral structures were decompressed well after the surgery. Synthes transpedicular screws system and PEEK cage were used for TLIF. Operative Procedures With endotracheal general anaestheis, the patient was put in prone position. After C-arm localization, we scrubbed, disinfected, and then draped the patient's back. We made one midline skin incision and dissected paraspinal muscle to expose bialteral laminae from lower L3 to upper L5. Posterior instrumentation was done with transpedicular screws into bilateral pedicles of L4 and L5. L4 laminectomy was done for posterior decompression with bilatearl L4/5 foraminotomy. Transforaminal lumbar interbody fusion at L4/5 via right L4/5 neural foramen was done with PEEK cage and autologous bone graft after diskectomy. The wound was irrigated with gentamycin saline. After two hemovac inserted, the wound was closed in layers. Operators VS 賴達明 Assistants R5 曾峰毅 R1 吳健暉 相關圖片 陳依萍 (F,1978/06/24,33y8m) 手術日期 2011/10/11 手術主治醫師 楊士弘 手術區域 東址 005房 02號 診斷 Back mass 器械術式 back lipoma excision 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 林哲光, 時間資訊 23:17 臨時手術NPO 13:23 進入手術室 13:35 麻醉開始 14:00 抗生素給藥 14:07 手術開始 14:17 誘導結束 14:50 手術結束 14:50 麻醉結束 15:05 送出病患 15:10 進入恢復室 16:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 軟組織良性腫瘤切除術,大或深 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Totoal tumor excision 開立醫師: 林哲光 開立時間: 2011/10/11 15:05 Pre-operative Diagnosis Subfascial soft tissue tumor Post-operative Diagnosis Subfascial soft tissue tumor Operative Method Totoal tumor excision Specimen Count And Types 1 piece About size:6cm sized Source:subfascial tumor Pathology Pending Operative Findings A 6cm sized soft-elastic, well-demarcated, grayish mass lesion was noted at subfacial area of lumbosacral region with cystic component and some hematoma and necrotic tissue inside the cyst was noted. Operative Procedures Under ETGA and prone position, skin disinfected and drapped were performed as usual. Transverse skin incision was made at the soft tissue tumor and tumor excision was done by cicumferential dissection. Total tumor excision was done. The wound was then closed in layers after hemostasis. Operators 楊士弘 Assistants 林哲光 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Totoal tumor excision 開立醫師: 林哲光 開立時間: 2011/10/11 15:05 Pre-operative Diagnosis Subfascial soft tissue tumor Post-operative Diagnosis Subfascial soft tissue tumor Operative Method Totoal tumor excision Specimen Count And Types 1 piece About size:6cm sized Source:subfascial tumor Pathology Pending Operative Findings A 6cm sized soft-elastic, well-demarcated, grayish mass lesion was noted at subfacial area of lumbosacral region with cystic component and some hematoma and necrotic tissue inside the cyst was noted. Operative Procedures Under ETGA and prone position, skin disinfected and drapped were performed as usual. Transverse skin incision was made at the soft tissue tumor and tumor excision was done by cicumferential dissection. Total tumor excision was done. The wound was then closed in layers after hemostasis. Operators 楊士弘 Assistants 林哲光 相關圖片 摘要__ 手術科部: 外科部 套用罐頭: Totoal tumor excision 開立醫師: 楊士弘 開立時間: 2011/10/11 18:14 Pre-operative Diagnosis Subfascial soft tissue tumor, sacral area Post-operative Diagnosis Subfascial soft tissue tumor, sacral area Operative Method Totoal tumor excision Specimen Count And Types 1 piece About size:6cm sized Source:subfascial tumor Pathology Pending Operative Findings A 6cm sized soft-elastic, well-demarcated, encapsulated, grayish mass lesion was noted at subfacial area of lumbosacral region with cystic component and some hematoma and necrotic tissue inside the tumor was noted. Operative Procedures Under ETGA and prone position, skin disinfected and drapped were performed as usual. Transverse skin incision was made at the soft tissue tumor and tumor excision was done by cicumferential dissection. Total tumor excision was done. The wound was then closed in layers after hemostasis. Operators 楊士弘 Assistants 林哲光 相關圖片 張怡蓁 (F,2011/09/23,5m23d) 手術日期 2011/10/11 手術主治醫師 黃書健 手術區域 ICU 00-房 02號 診斷 Ebstein anomaly 器械術式 Bedside Re-op 手術類別 緊急手術 手術部位 胸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 黃書健 ASA 4 紀錄醫師 周恒文, 時間資訊 10:24 通知急診手術 12:20 手術開始 12:20 麻醉開始 12:55 麻醉結束 12:55 手術結束 醫令資訊 類別 名稱 量 刀 側 手術 探查性心包膜切開術 1 2 麻醉 IV or IM anesthesia 1 0 記錄__ 手術科部: 外科部 套用罐頭: Close the sternum 開立醫師: 周恒文 開立時間: 2011/10/11 14:55 Pre-operative Diagnosis Ebstein anomaly and large PDA s/p PDA ligation Post-operative Diagnosis Ebstein anomaly and large PDA s/p PDA ligation Operative Method Close the sternum Specimen Count And Types nil Pathology Operative Findings No hematoma inside the pericardial cavity Operative Procedures ETGA, supine, remove the silicon membrane. Irrigation. Close the sternum and the wound in layers Operators 黃書健 Assistants 周恒文 Indication Of Emergent Operation sternal unapproximation 林嘉誠 (M,1998/10/05,13y5m) 手術日期 2011/10/11 手術主治醫師 黃書健 手術區域 東址 000房 號 診斷 Mediastinum, malignant 器械術式 Remove ECMO;Femoral artery repair; Reperfusion cath 手術類別 緊急手術 手術部位 四肢 傷口分類 清潔污染 麻醉方式 靜脈麻醉 麻醉主治醫師 黃書健 ASA 4 紀錄醫師 黃書健, 時間資訊 00:00 開始NPO 00:00 臨時手術NPO 12:30 通知急診手術 13:10 手術開始 13:10 麻醉開始 13:40 麻醉結束 13:40 手術結束 醫令資訊 類別 名稱 量 刀 側 手術 末稍血管修補及吻合術 1 2 L 麻醉 IV or IM anesthesia 1 0 記錄__ 手術科部: 套用罐頭: Removal of ECMO and repair the femoral vessels 開立醫師: 周恒文 開立時間: 2011/10/11 14:58 Pre-operative Diagnosis Mediastinal tumor s/p VA ECMO Post-operative Diagnosis Mediastinal tumor s/p VA ECMO Operative Method Removal of ECMO and repair the femoral vessels Specimen Count And Types nil Pathology Operative Findings Post-repair distal pulsation: intact Operative Procedures ETGA, disinfection. Left inguinal re-open. Remvoe the ECMO cannula and repair the femoral artery and femoral vein. Close the wound in layers. Operators 黃書健 Assistants 周恒文 Indication Of Emergent Operation Remove ECMO 許美柑 (F,1951/04/22,60y10m) 手術日期 2011/10/11 手術主治醫師 林文瑛 手術區域 西址 034房 02號 診斷 Lung cancer 器械術式 Insertion of hichman or port a 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 ASA 1 時間資訊 09:39 進入手術室 09:55 抗生素給藥 10:02 手術開始 10:10 手術結束 10:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 port–A導管植入術–治療性導管植入術 1 0 R 記錄__ 手術科部: 麻醉部 套用罐頭: Port-A implantation, subclavian 開立醫師: 林文瑛 開立時間: 2011/10/11 10:17 Pre-operative Diagnosis Lung cancer Post-operative Diagnosis Lung cancer Operative Method Port-A implantation, echo-guided Specimen Count And Types nil Pathology Nil Operative Findings 1.Site: right subclavian vein, with echo-guided procedure 2.Patent flow after implantation 3.Others: nil Operative Procedures 1.The patient was set on supine position and bilateral subclavian veins were checked by echo. 2.After IVGA and local anesthesia applied, transverse skin incision for 3cm was made at pre-cordial area. 3.Undermine the skin at the layer between subcutaneous tissue and deep fascia in lateral direction. 4.An IV catheter was inserted via the subclavian incision and negatively aspirated until venous blood attainable. 5.J-wire was inserted smoothly in rostral direction. A subclavian catheter with dilator was inserted through the J-wire, and the dilator was then removed. 6.The catheter of Port-A was threaded into the subclavian vein until mark 21 cm. The catheter was adapted into the port and locked with restrictor.The Port was inserted into the pouch of pre-cordial incision. 7.Skin was closed layer by layer. Both catheter and port were perfused with heparin solution after implantation. Operators 林文瑛, Assistants 劉映汝, 王興華 (M,1929/11/04,82y4m) 手術日期 2011/10/11 手術主治醫師 王國川 手術區域 東址 001房 04號 診斷 Subdural hemorrhage, traumatic 器械術式 Right subdural peritoneal shunt 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 3E 紀錄醫師 姜士中, 時間資訊 12:00 臨時手術NPO 12:00 開始NPO 15:17 通知急診手術 16:20 報到 16:20 進入手術室 16:25 麻醉開始 16:30 誘導結束 16:55 抗生素給藥 17:03 手術開始 17:29 麻醉結束 17:29 手術結束 17:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Right subduroperitoneal shunt 開立醫師: 曾峰毅 開立時間: 2011/10/11 17:26 Pre-operative Diagnosis Right subdural effusion Post-operative Diagnosis Right subdural effusion Operative Method Right subduroperitoneal shunt Specimen Count And Types Nil Pathology nil Operative Findings Xanthocrhomic, clear, CSF gushed out while durotomy. Codman, fixed-pressure, 10 mmH20, shunt was used. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to left. We made one transverse skin incision at right upper abdomen, and performed mini-laparotmy. We created subcutaneous tunnel, and made one transverse incision at right frontal area along previous operation wound. We inserted ventricular cathter, and pulled the subcutaneous catheter through to right upper abdomen. we check the function, and inserted peritoneal catheter into peritoneal cavity. The wound was closed in layers. Operators VS 王國川 Assistants R5 曾峰毅 R1 姜士中 Indication Of Emergent Operation Subdural effusion with midline shift 相關圖片 丁竺原 (F,1969/05/30,42y9m) 手術日期 2011/10/11 手術主治醫師 蔡翊新 手術區域 東址 003房 03號 診斷 Vascular malformation 器械術式 Scalp wound debridment and CSF leak repair, occipital wound 手術類別 緊急手術 手術部位 頭、頸 傷口分類 髒 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2E 紀錄醫師 吳健暉, 時間資訊 08:00 臨時手術NPO 08:00 開始NPO 09:53 通知急診手術 14:15 進入手術室 14:20 麻醉開始 14:50 誘導結束 15:00 手術開始 17:00 抗生素給藥 20:10 手術結束 20:10 麻醉結束 20:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 顱骨切除術,包括異物移除或壓或經切斷 1 1 手術 腦室體外引流 1 2 L 摘要__ 手術科部: 外科部 套用罐頭: Cervical Laminectomy 開立醫師: 蔡翊新 開立時間: 2011/10/11 19:34 Pre-operative Diagnosis Cerebellar AVM s/p suboccipital craniotomy for AVM excision, with CSF leak and wound infection involving epidural space and bone. Post-operative Diagnosis Cerebellar AVM s/p suboccipital craniotomy for AVM excision, with CSF leak and wound infection involving epidural space and bone. Operative Method Suboccipital craniectomy, wound debridement, dural repair and left Frazier EVD insertion. Specimen Count And Types Two culture swabs for pus. Pathology Nil. Operative Findings Frank pus accummulated at subcutaneous layer, subgaleal space, and epidural space over occipital wound. CSF leak persisted from previous dural defect at lower part of posterior fossa where Duroform was used for duroplasty during previous operation. After dural repair with several pieces of fascial grafts, CSF leakage was no more detected. CSF from EVD was mildly sanguinous and with low pressure. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: prone with neck flexed and head fixed by a Mayfield skull clamp. 3. Skin preparation: occipital and neck areas were shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. EVD insertion via previous burr hole at left Frazier point. 5. Incision: suboccipital, along previous wound, with extension transversely to right side at upper end. 6. The pus and necrotic tissues were debrided with currettes and large amount of normal saline and Vancomycin solution were used for wound irrigation. 7. The dural defect was closed in three layers with several fascial grafts obtained from right occipital area. 8. The paravertebral muscles were closed by interrupted sutures with 1/0 Vicryl, subcutaneous layer by continuous suture with 2/0 Vicryl and skin by interrupted suture with 3/0 nylon. 9. Drain: one epidural CWV. 10.Blood transfusion: nil. Blood loss: 350 ml. 11.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R6鍾文桂R1吳健暉 Indication Of Emergent Operation CNS wound infection 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Cervical Laminectomy 開立醫師: 蔡翊新 開立時間: 2011/10/11 19:35 Pre-operative Diagnosis Cerebellar AVM s/p suboccipital craniotomy for AVM excision, with CSF leak and wound infection involving epidural space and bone. Post-operative Diagnosis Cerebellar AVM s/p suboccipital craniotomy for AVM excision, with CSF leak and wound infection involving epidural space and bone. Operative Method Suboccipital craniectomy, wound debridement, dural repair and left Frazier EVD insertion. Specimen Count And Types Two culture swabs for pus. Pathology Nil. Operative Findings Frank pus accummulated at subcutaneous layer, subgaleal space, and epidural space over occipital wound. CSF leak persisted from previous dural defect at lower part of posterior fossa where Duroform was used for duroplasty during previous operation. After dural repair with several pieces of fascial grafts, CSF leakage was no more detected. CSF from EVD was mildly sanguinous and with low pressure. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: prone with neck flexed and head fixed by a Mayfield skull clamp. 3. Skin preparation: occipital and neck areas were shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. EVD insertion via previous burr hole at left Frazier point. 5. Incision: suboccipital, along previous wound, with extension transversely to right side at upper end. 6. The pus and necrotic tissues were debrided with currettes and large amount of normal saline and Vancomycin solution were used for wound irrigation. 7. The dural defect was closed in three layers with several fascial grafts obtained from right occipital area. 8. The paravertebral muscles were closed by interrupted sutures with 1/0 Vicryl, subcutaneous layer by continuous suture with 2/0 Vicryl and skin by interrupted suture with 3/0 nylon. 9. Drain: one epidural CWV. 10.Blood transfusion: nil. Blood loss: 350 ml. 11.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R6鍾文桂R1吳健暉 Indication Of Emergent Operation CNS wound infection 相關圖片 童鈺翔 (M,1988/09/05,23y6m) 手術日期 2011/10/11 手術主治醫師 張志豪 手術區域 西址 036房 01號 診斷 Injury (severity score >=16) 器械術式 Remove of inplant (mini ""A.O + screw) + radial head excision 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 吳欣翰, 時間資訊 23:14 臨時手術NPO 07:53 進入手術室 08:00 麻醉開始 08:05 誘導結束 08:28 抗生素給藥 08:42 手術開始 09:40 手術結束 09:40 麻醉結束 09:57 進入恢復室 11:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 骨內固定物拔除術-其他部位 1 2 L 手術 肘關節整型術 1 1 摘要__ 手術科部: 骨科部 套用罐頭: 1. Removal of implants 2.left elbow arthroplasty 開立醫師: 吳欣翰 開立時間: 2011/10/11 09:58 Pre-operative Diagnosis left radial head s/p ORIF, bony union with pronation contracture Post-operative Diagnosis left radial head s/p ORIF, bony union with pronation contracture Operative Method 1. Removal of implants 2.left elbow arthroplasty Specimen Count And Types nil Pathology Nil Operative Findings left radial head s/p ORIF, bony union, intact implants pronation contracture: pre-op supination ROM 0 degree radial head osteophyte formation and periarticular fibrosis Operative Procedures 1. Anesthetic induction, supine position, arm board, tourniquet. 2. Skin disinfected and draped. 3. Skin incision over previous operation scar. 4. Dissected and exposed old implants (5H5S and 1 headless screw); then removed. 5. left elbow contracture release 6. incision dorsal side of wrist and release DRUJ 7. Irrigated with normal saline and hemostasis. 8. Closed the wound by layers. Operators 張志豪, Assistants 江明弘, 吳欣翰, 林家聖 記錄__ 手術科部: 骨科部 套用罐頭: 1. Removal of implants 2.left elbow arthroplasty 開立醫師: 吳欣翰 開立時間: 2011/10/11 09:58 Pre-operative Diagnosis left radial head s/p ORIF, bony union with pronation contracture Post-operative Diagnosis left radial head s/p ORIF, bony union with pronation contracture Operative Method 1. Removal of implants 2.left elbow arthroplasty Specimen Count And Types nil Pathology Nil Operative Findings left radial head s/p ORIF, bony union, intact implants pronation contracture: pre-op supination ROM 0 degree radial head osteophyte formation and periarticular fibrosis Operative Procedures 1. Anesthetic induction, supine position, arm board, tourniquet. 2. Skin disinfected and draped. 3. Skin incision over previous operation scar. 4. Dissected and exposed old implants (5H5S and 1 headless screw); then removed. 5. left elbow contracture release 6. incision dorsal side of wrist and release DRUJ 7. Irrigated with normal saline and hemostasis. 8. Closed the wound by layers. Operators 張志豪, Assistants 江明弘, 吳欣翰, 林家聖 陳俐岑 (F,1975/07/02,36y8m) 手術日期 2011/10/12 手術主治醫師 曾漢民 手術區域 東址 003房 03號 診斷 Hyperprolactinemia 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 2 紀錄醫師 李振豪, 時間資訊 23:30 臨時手術NPO 15:30 進入手術室 15:35 麻醉開始 15:50 誘導結束 15:55 抗生素給藥 16:36 手術開始 18:20 手術結束 18:20 麻醉結束 18:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 經由蝶竇之腦下垂體瘤切除 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Trans-nasal, trans-sphenoidal adenomectomy 開立醫師: 李振豪 開立時間: 2011/10/12 18:56 Pre-operative Diagnosis Pituitary adenoma Post-operative Diagnosis Pituitary adenoma Operative Method Trans-nasal, trans-sphenoidal adenomectomy Specimen Count And Types 1 piece About size:Multiple small pieces Source:pituitary tumor Pathology Pending Operative Findings There was two component of the tumor, the left side(hypointensity in T1+C image) was white-reddish, soft and fragile. The right side component was yellowish in color and elastic. The tumor was hypervascularized, well-capsulated, and 1.5 x 0.9 x 1.1cm in size. The tumor was left to the normal glane. During dissection along the tumor, small arachnoid membrane defect with CSF leakage was noted. The defect was packing with Gelfoam, autologous bone fragment, and sealed with Tissucol Duo. Bleeding from cavernous sinus was also encountered during the operation and hemostasis was achieved with bipolar electrocautery and Gelfoam packing. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head tilted 30 degree to left. The nasal cavity was packing with epinephrine soaked gauze for 10 minutes. The face and left lower abdomen were prepared with povidone-iodine alcohol tincture, and the mucosa of oral and nasal cavity with aqueous povidone-iodine tincture. The nasal submucosa at septum and floor were infiltrated with 1:100 epinephrine solution. One 1.5cm incision was made at nasal mucosa of right nasal septum and the musoca was dissected away from the septum. The nasal septum was fractured and the vomer was removed. The sphenoid sinus was entered and the mucosa within the sphenoid sinus was removed. The sellar floor was identified and opened. Cruciform durotomy was done and bleeding from dura and cavernous sinus was encountered. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. The tumor was removed by suction, microdissector, ring curette, and alligator. After total removal of the tumor, the arachnoid defect was sealed with Gelfoam, autologous bone fragment, and Tissucol Duo. The vomer bone was placed back and the nasal mucosa was pushed back to the neutral position. Tissucol Duo was applied between the nasal mucosa and the vomer bone. The nasal septum and the middle turbinate was pushed back to neutral position. Bilateral nasal cavities were packed with a segment of rubber glove finger(two on right side and one on left side) which had been soaked with better-iodine ointment. Operators VS曾漢民 Assistants R5李振豪, PGY鄭宇軒 陳玫蓉 (F,1963/10/24,48y4m) 手術日期 2011/10/12 手術主治醫師 蔡瑞章 手術區域 東址 005房 01號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 2 紀錄醫師 陳國瑋, 時間資訊 23:28 臨時手術NPO 08:05 進入手術室 08:10 麻醉開始 08:30 誘導結束 08:43 抗生素給藥 08:48 手術開始 11:43 抗生素給藥 14:43 抗生素給藥 17:43 抗生素給藥 20:10 手術結束 20:10 麻醉結束 20:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 16 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: Left parieto-occipital craniotomy for tumor e... 開立醫師: 陳國瑋 開立時間: 2011/10/12 21:01 Pre-operative Diagnosis Falcotentorial meningioma Post-operative Diagnosis Falcotentorial meningioma Operative Method Left parieto-occipital craniotomy for tumor excision Left parieto-occipital craniotomy for tumor excision, Simpson grade III Specimen Count And Types 1 piece About size:fragments Source:brain tumor Pathology pending Operative Findings One 7*5*6cm, moderately-vascularized, elastic-to-firm tumor with attachment to falx and tentorium. The brain buldged through durotomy window. After removal of the tumor, the inner side of left occipital lobe came in sight. The left tentorium was cut and one piece of tumor was left over midbrain and cerebellum. The deep cerebral venous system was not seen during the whole procedure. The brain was slack after tumor removal. Operative Procedures After intubation and general anesthesia, the patients head was fixed with Mayfield clamp. The patient was then turned into prone position. The skin was shaved, scrubbed and prepared as usual. One U shape skin incision was made and retraced downward. The craniotomy window was made after making four burr holes. durotomy was made and reflected toward midline. The left occipital lobe was retracted and the tumor came in sight. Tumor debulking was performed. The left tentorium was cut to facilitate tumor excision. The other side of tumor was reached below flax. After tumor removal, the bleeding was checked with Floseal and surgicel. Duroplasty was done with fascia. After setting one CWV, the wound was closed in layers. Operators 蔡瑞章 王國川 Prof. 蔡瑞章 VS 王國川 Assistants 鍾文桂 陳國瑋 相關圖片 徐裴欣 (F,1980/08/15,31y6m) 手術日期 2011/10/12 手術主治醫師 林本仁 手術區域 西址 037房 01號 診斷 Colon cancer of transverse colon 器械術式 Rt hemicolectomy 手術類別 預定手術 手術部位 腹 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 雷秋文, 時間資訊 07:40 報到 07:53 進入手術室 08:05 麻醉開始 08:25 誘導結束 08:30 抗生素給藥 08:42 手術開始 10:05 手術結束 10:20 送出病患 10:20 麻醉結束 10:22 進入恢復室 12:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 根治性半結腸切除術加吻合術,升結腸 1 1 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Right hemi 開立醫師: 雷秋文 開立時間: 2011/10/12 10:11 Pre-operative Diagnosis T colon cancer, with neck lymph node metastasis Post-operative Diagnosis Ditto Operative Method Right hemicolectomy Specimen Count And Types 1 piece About size:20X 8 CM2 Source:ASCENDING COLON Pathology pending Operative Findings 1. A 3.5 X 3 cm, fungating, ulcerative mass was noted over t colon of hepatic flexure. 2. Serosa involvement (+). 3. Ascites (-). 4. Regional lymph nodes (+). Operative Procedures 1. Under general anesthesia, the patient was placed in supine position. The skin was disinfected with alcohol better-iodine from the level of symphysis pubis to nipple area. 2. The abdomen was opened and explored through a midline incision from epigastrium to the umbilicus. 3. The ascending colon was mobilized by dividing its peritoneal attachments upwards toward the hepatic flexure. 4. The underlying right ureter and gonadal vessels were kept posteriorly in the retroperitoneum. 5. By applying gently anterior retraction on the mobilized right colon, the surgeon exposes the duodenum, which was left unharmed in the retroperitoneum by dividing any remaining tissue tethering the colon to the retroperitoneum. 6. Adhesion between colon and gallbladder were divided under direct view. 7. The gastrocolic ligaments were divided between clamps with preservation of the gastroepiploic vessels along the greater curvature of the stomach. 8. The right branch of middle colic artery was identified and ligated. 9. The right colic artery and ileocolic vessels were identified and ligated. 10. The mesentery of right half of the T-colon, ascending colon and terminal ileum were incised piece by piece. 11. The terminal ileum was transected at 10 cm proximal to the ileocecal junction. 12. Ileocolic side to side anastomosis was done by two-layer sutures with silk 3-0. 13. One rubber drain was indwelled at subhepatic area. 14. The wound was closed by layers. Operators VS 林本仁 Assistants R3 雷秋文, Ri 相關圖片 蔡楊玉絲 (F,1935/08/08,76y7m) 手術日期 2011/10/12 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Thoracic myelopathy 器械術式 Benign intraspinal tumor, exci 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 李振豪, 時間資訊 23:24 臨時手術NPO 08:08 進入手術室 08:15 麻醉開始 08:35 誘導結束 08:35 抗生素給藥 09:15 手術開始 11:35 抗生素給藥 11:40 手術結束 11:40 麻醉結束 11:50 送出病患 11:52 進入恢復室 13:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 手術 良性脊髓腫瘤切除術 1 1 記錄__ 手術科部: 神經部 套用罐頭: T10, partial T9, T11 laminectoy for tumor exc... 開立醫師: 李振豪 開立時間: 2011/10/12 11:43 Pre-operative Diagnosis T10 intradural extramedullary tumor, suspect meningioma Post-operative Diagnosis T10 intradural extramedullary tumor, favor meningioma Operative Method T10, partial T9, T11 laminectoy for tumor excision Specimen Count And Types 1 piece About size:Multiple pieces Source:T10 intraspinal tumor Pathology Pending Operative Findings The tumor was white-pinkish, well-demarcated, 1.3 x 1.35 x 1.8cm in size, hypovascularized, and soft to elastic in character. The tumor attached to left posterolateral side of dura tightly and the tumor base was dissected with thin layer of the dura for complete tumor excision. The spinal cord and nerve roots were protected well and dissection was performed along the arachnoid plan. Some arachnoid plan at the lateral side was transected due to adhesion. One small incidental durotomy was noted at left lateral side of the thecal sac and packing with Gelfoam. Poor SSEP and absent left lower limb MEP was noted before the operation. The left lower limb MEP was detectable after laminectomy. No significant SSEP or right lower limb MEP change during whole procedure. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position. T10 level was localized with portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made from T9 to T11 level. The subcutaneous soft tissue was dissected and the paraspinal muscle was detached to expose the laminae. T10 and partial T9, T11 lamninectomy was performed. Midline durotomy was performed and the tumor was encountered. The tumor was dissected away from the dura and followed by arachnoid plan between the spinal cord and tumor. The tumro adhered to the left posterolateral aspect dura was removed with thin layer of dura. After total removal of the tumor, hemostasis was achieved with bipolar electrocautery and Gelfoam packing. The dura was closed with 5-0 Prolene. One large piece of Gelfoam was put on epidural space and one CWV drain was placed. The wound was then closed in layers with 1-0, 2-0 Vicryl and 3-0 Nylon. Operators VS賴達明 Assistants R5李振豪, R1鄭宇軒 相關圖片 許著棟 (M,1937/09/03,74y6m) 手術日期 2011/10/12 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Lymphoma 器械術式 Stereotaxic procedure for aspi 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 李振豪, 時間資訊 23:47 臨時手術NPO 12:05 進入手術室 12:10 麻醉開始 12:30 誘導結束 12:35 抗生素給藥 12:45 手術開始 14:55 手術結束 14:55 麻醉結束 15:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 立體定位術-切片 1 1 R 麻醉 Peripheral arterial line inserti 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 記錄__ 手術科部: 外科部 套用罐頭: Right frontal burr hole for stereotactic tumo... 開立醫師: 李振豪 開立時間: 2011/10/12 15:27 Pre-operative Diagnosis Right frontal and right thalamus tumor, suspect lymphoma Post-operative Diagnosis Right frontal and right thalamus tumor, suspect lymphoma Operative Method Right frontal burr hole for stereotactic tumor biopsy Specimen Count And Types 1 piece About size:8 small pieces Source:Right frontal tumor Pathology Frozen section: much lymphocyte infiltration was noted within the specimen Operative Findings Total eight pieces of tumor tissue was sampled under framless navigation guided. Gross pathology showed gray-reddish in color and soft in character. The frozen section showed much lymphocyte infiltration. The patient stood whole procedure well. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head fixed with Mayfield skull clamp. Navigation was set up and registration was done. The scalp was shaved, scrubbed, and disinfected as usual. One transverse scalp incision with 3cm in length was made at right frontal area followed by one burr hole creation. Two dural tenting was done. Cruciform durotomy was made and the arachnoid membrane was opened. Under framless navigation, right frontal tumor stereotactic biopsy was performed with biopsy needle. Total eight pieces of specimen were sampled and the frozen section showed much lymphocyte infiltration. Hemostasis was achieved with bipolar electrocautery. The burr hole was packing with Gelfoam and bone dust. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS賴達明 Assistants R5李振豪, R1鄭宇軒 相關圖片 黃菊妹 (F,1940/01/03,72y2m) 手術日期 2011/10/12 手術主治醫師 黃昭淵 手術區域 西址 039房 04號 診斷 Malignant neoplasm of bladder 器械術式 Fiberocystoscopy /WOR 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 無麻醉 麻醉主治醫師 ASA 1 時間資訊 14:10 進入手術室 14:15 手術開始 14:26 手術結束 14:28 送出病患 葉子誠 (M,2008/12/13,3y3m) 手術日期 2011/10/12 手術主治醫師 楊士弘 手術區域 兒醫 067房 01號 診斷 Scalp mass 器械術式 Right temporal scalp tumor excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 2 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:06 進入手術室 08:10 麻醉開始 08:15 誘導結束 08:29 抗生素給藥 08:57 手術開始 09:25 手術結束 09:25 麻醉結束 09:30 送出病患 09:37 進入恢復室 11:08 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 頭皮腫瘤 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Tumor excision 開立醫師: 王奐之 開立時間: 2011/10/12 09:30 Pre-operative Diagnosis Right temporal scalp tumor, suspected atheroma Post-operative Diagnosis Right temporal scalp tumor, suspected atheroma Operative Method Tumor excision Specimen Count And Types 1 piece About size:1*1*1cm Source:right temporal scalp tumor Pathology Pending Operative Findings A movable soft tumor could be palpated at right temporal area (about 1.5 cm above the right ear). The tumor was yellowish, soft & elastic, measuring about 1*1*1cm in size. It was located beneath the temporalis fascia but above the temporalis muscle. No rupture of the tumor capsule occurred during the operation. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After shaving, scrubbing, disinfection & draping in sterile fashion, a linear incision was made over the tumor. Careful dissection was then performed to remove the tumor en bloc. After tumor removal & meticulous hemostasis, the wound was closed in layers. Operators VS 楊士弘 Assistants R4 王奐之, Ri 陳勇仁 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Tumor excision 開立醫師: 王奐之 開立時間: 2011/10/12 09:30 Pre-operative Diagnosis Right temporal scalp tumor, suspected atheroma Post-operative Diagnosis Right temporal scalp tumor, suspected atheroma Operative Method Tumor excision Specimen Count And Types 1 piece About size:1*1*1cm Source:right temporal scalp tumor Pathology Pending Operative Findings A movable soft tumor could be palpated at right temporal area (about 1.5 cm above the right ear). The tumor was yellowish, soft & elastic, measuring about 1*1*1cm in size. It was located beneath the temporalis fascia but above the temporalis muscle. No rupture of the tumor capsule occurred during the operation. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After shaving, scrubbing, disinfection & draping in sterile fashion, a linear incision was made over the tumor. Careful dissection was then performed to remove the tumor en bloc. After tumor removal & meticulous hemostasis, the wound was closed in layers. Operators VS 楊士弘 Assistants R4 王奐之, Ri 陳勇仁 相關圖片 呂瑞濤 (M,1951/12/08,60y3m) 手術日期 2011/10/13 手術主治醫師 蔡瑞章 手術區域 東址 000房 號 診斷 Lymphoma 器械術式 Stereotaxic procedure for aspi 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 時間資訊 23:44 臨時手術NPO 13:12 進入手術室 13:15 麻醉開始 13:20 誘導結束 14:20 送出病患 14:20 麻醉結束 14:22 進入恢復室 15:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 林傳宗 (M,1936/03/03,76y0m) 手術日期 2011/10/13 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Brain metastasis 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 林哲光, 時間資訊 23:27 臨時手術NPO 07:30 報到 08:05 進入手術室 08:07 麻醉開始 08:35 誘導結束 08:40 抗生素給藥 08:47 手術開始 11:40 抗生素給藥 14:25 麻醉結束 14:25 手術結束 14:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4~8小時 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Left frontal craniotomy and right parietal cr... 開立醫師: 林哲光 開立時間: 2011/10/13 17:56 Pre-operative Diagnosis Multiple brain tumors, right parietal, left frontal and right cerebellum, suspected metastasis Post-operative Diagnosis Multiple brain tumors, right parietal, left frontal and right cerebellum, suspected metastasis Operative Method Left frontal craniotomy and right parietal craniotomy for total tumor excision Specimen Count And Types 2 pieces About size:3.2cm sized Source:left frontal tumor About size:3cm sized Source:right parietal tumor Pathology Pending Operative Findings A 3.2cm sized, well-demarcated, elastic-firm, whitish-grayish mass lesion was noted at left frontal area and another 3cm sized, well-demarcated, elastic-firm, whitish-grayish mass lesion was noted at right parietal area. The left sylvian vein was left untouched and the motor cortex was not exposed during the operation. Total tumor excision was performed. Dura tear was noted at bilateral sites during craniotomy and Gelfoam packing was done. Operative Procedures Under ETGA and supine position with head rotated to left side and fixed with Mayfield head clamp, skin disinfected and drapped were performed as usual. A reverse U-shpaed skin incision was made at right parietal area and craniotomy was done after four burr holes were created. The tumor was localized by the echo and the dura was then opened in cross shaped after dural tenting. Corticotomy was done and tumor excision was then done in piecemeal initially and then enbloc excision. The dura was closed in water-tie method and the skull bone was put back and fixed with miniplates. The wound was then closed in layers after hemostasis meticulously. Another curvilinear skin incison was made at left frontal area and craniotomy was done after three burr holes were created. Tumor localization by echo was done and dura was then opened in cross shaped after dural tenting. Corticotomy was then performed and tumor excision was then done in piecemeal method and then enbloc tumor excision. Hemostasis was then done with surgecells and Gelfoam pakcing. The dura was then closed in water-tie method and the skull bone was put back and fixed with miniplates. The wound was then closed in layers. Operators 曾勝弘 Assistants 林哲光 相關圖片 摘要__ 手術科部: 外科部 套用罐頭: Left frontal craniotomy and right parietal cr... 開立醫師: 林哲光 開立時間: 2011/10/13 17:56 Pre-operative Diagnosis Multiple brain tumors, right parietal, left frontal and right cerebellum, suspected metastasis Post-operative Diagnosis Multiple brain tumors, right parietal, left frontal and right cerebellum, suspected metastasis Operative Method Left frontal craniotomy and right parietal craniotomy for total tumor excision Specimen Count And Types 2 pieces About size:3.2cm sized Source:left frontal tumor About size:3cm sized Source:right parietal tumor Pathology Pending Operative Findings A 3.2cm sized, well-demarcated, elastic-firm, whitish-grayish mass lesion was noted at left frontal area and another 3cm sized, well-demarcated, elastic-firm, whitish-grayish mass lesion was noted at right parietal area. The left sylvian vein was left untouched and the motor cortex was not exposed during the operation. Total tumor excision was performed. Dura tear was noted at bilateral sites during craniotomy and Gelfoam packing was done. Operative Procedures Under ETGA and supine position with head rotated to left side and fixed with Mayfield head clamp, skin disinfected and drapped were performed as usual. A reverse U-shpaed skin incision was made at right parietal area and craniotomy was done after four burr holes were created. The tumor was localized by the echo and the dura was then opened in cross shaped after dural tenting. Corticotomy was done and tumor excision was then done in piecemeal initially and then enbloc excision. The dura was closed in water-tie method and the skull bone was put back and fixed with miniplates. The wound was then closed in layers after hemostasis meticulously. Another curvilinear skin incison was made at left frontal area and craniotomy was done after three burr holes were created. Tumor localization by echo was done and dura was then opened in cross shaped after dural tenting. Corticotomy was then performed and tumor excision was then done in piecemeal method and then enbloc tumor excision. Hemostasis was then done with surgecells and Gelfoam pakcing. The dura was then closed in water-tie method and the skull bone was put back and fixed with miniplates. The wound was then closed in layers. Operators 曾勝弘 Assistants 林哲光 相關圖片 陳毓芳 (M,2009/12/21,2y2m) 手術日期 2011/10/13 手術主治醫師 黃培銘 手術區域 兒醫 062房 01號 診斷 Subdural hemorrhage, traumatic 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 蕭柏妮 ASA 3 紀錄醫師 鄒冠全, 時間資訊 00:00 臨時手術NPO 08:28 進入手術室 08:30 麻醉開始 08:35 誘導結束 09:00 手術開始 09:15 手術結束 09:15 麻醉結束 09:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 氣管切開術 1 0 記錄__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 鄒冠全 開立時間: 2011/10/13 09:30 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types nil Pathology None Operative Findings Fr . 5 shirly uncuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a shirly uncuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators 黃培銘 Assistants R4鄒冠全 周靜 (F,1949/04/12,62y11m) 手術日期 2011/10/13 手術主治醫師 楊榮森 手術區域 東址 027房 02號 診斷 Bone metastasis 器械術式 THR or bipolar hemiarthroplasty 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 3 紀錄醫師 范垂嘉, 時間資訊 09:20 進入手術室 09:25 麻醉開始 09:50 誘導結束 09:50 開始輸血 09:55 抗生素給藥 10:05 手術開始 11:13 手術結束 11:13 麻醉結束 11:20 送出病患 11:25 進入恢復室 12:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 惡性骨瘤廣泛切除(一次) 1 1 R 手術 部份關節置換術併整形術–只置換髖臼或股骨或半股關節或半肩關節 1 2 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 骨科部 套用罐頭: Tumor currettage and bipolar hemiarthroplasty... 開立醫師: 范垂嘉 開立時間: 2011/10/13 11:38 Pre-operative Diagnosis NSCLC, adenocarcinoma, with right proximal femoral mets and pathological fracture of the femoral neck Post-operative Diagnosis NSCLC, adenocarcinoma, with right proximal femoral mets and pathological fracture of the femoral neck Operative Method Tumor currettage and bipolar hemiarthroplasty with United prostheses, right Specimen Count And Types Femoral head and proximal femoral bone tumor for pathology Pathology Femoral head and proximal femoral bone tumor Operative Findings 1.Pathological fracture of the femoral neck, subcapital 2.Fleshy, red-whitish and hypervascular tumor infiltrates the proximal femur with bony destruction 3.The acetabulum was grossly intact 4.United prostheses- cup:43mm, head:26mm/+0mm, stem:11mm/#2 Operative Procedures 1.GA, left decubitus position 2.Prep and drape 3.Lateral longitudinal incision, posterior approach to the hip 4.Capsulotomy, saw the neck and remove the head 6.Debride the acetabulum 7.Curettage the proximal femur tumor 8.Irrigate and canal and operative field with 95% alcohol 9.Ream and broach the femur 10.Apply the stem with vancomycin-impregnanted cement 11.Assemble the head and reduce the hip 12.Repair the capsule with Merilene strap and repair the short rotators 13.Irrigate and close the wound over an 1/8" Hemovac Operators 楊榮森 Assistants 陳勇璋,范垂嘉,許寬宏 記錄__ 手術科部: 骨科部 套用罐頭: Tumor currettage and bipolar hemiarthroplasty... 開立醫師: 范垂嘉 開立時間: 2011/10/13 11:38 Pre-operative Diagnosis NSCLC, adenocarcinoma, with right proximal femoral mets and pathological fracture of the femoral neck Post-operative Diagnosis NSCLC, adenocarcinoma, with right proximal femoral mets and pathological fracture of the femoral neck Operative Method Tumor currettage and bipolar hemiarthroplasty with United prostheses, right Specimen Count And Types Femoral head and proximal femoral bone tumor for pathology Pathology Femoral head and proximal femoral bone tumor Operative Findings 1.Pathological fracture of the femoral neck, subcapital 2.Fleshy, red-whitish and hypervascular tumor infiltrates the proximal femur with bony destruction 3.The acetabulum was grossly intact 4.United prostheses- cup:43mm, head:26mm/+0mm, stem:11mm/#2 Operative Procedures 1.GA, left decubitus position 2.Prep and drape 3.Lateral longitudinal incision, posterior approach to the hip 4.Capsulotomy, saw the neck and remove the head 6.Debride the acetabulum 7.Curettage the proximal femur tumor 8.Irrigate and canal and operative field with 95% alcohol 9.Ream and broach the femur 10.Apply the stem with vancomycin-impregnanted cement 11.Assemble the head and reduce the hip 12.Repair the capsule with Merilene strap and repair the short rotators 13.Irrigate and close the wound over an 1/8" Hemovac Operators 楊榮森 Assistants 陳勇璋,范垂嘉,許寬宏 王詳喻 (M,2003/06/28,8y8m) 手術日期 2011/10/13 手術主治醫師 張重義 手術區域 兒醫 068房 01號 診斷 Complex congenital heart disease ( Complex CHD ) 器械術式 TCPC,JATENE,TAPVR,NORWOOD 請排兩位刷手 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 4 紀錄醫師 黃世銘, 時間資訊 07:50 報到 08:10 進入手術室 08:20 麻醉開始 08:50 誘導結束 09:10 抗生素給藥 09:40 手術開始 12:30 抗生素給藥 14:30 開始輸血 15:30 手術結束 15:30 麻醉結束 15:33 抗生素給藥 15:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 體外心肺循環 1 1 手術 腔靜脈回流右心房異常之修補手術 1 1 手術 瓣膜成形術 1 2 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 T.E.E 1 0 麻醉 動脈血液檢查全套 4 0 麻醉 Hemoglobin (Hb) 4 0 麻醉 測血糖 4 0 麻醉 Ca (Calcium) 4 0 麻醉 Na (Sodium) 4 0 麻醉 K (Potassium) 4 0 麻醉 Blood gas analysis 4 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 手術 二尖瓣擴張術 1 4 記錄__ 手術科部: 外科部 套用罐頭: AVVP+ right PV rerouting 開立醫師: 黃世銘 開立時間: 2011/10/28 10:05 Pre-operative Diagnosis RAI, EC, PA s/p bilateral BDG, AVVP, PA patch augmentation, with moderate AVVR, left PA stenosis, right PV obstruction Post-operative Diagnosis Ditto Operative Method AVVP+ right PV rerouting Specimen Count And Types Nil Pathology Nil Operative Findings 1. Situs ambigus, dextrocardia, Left arch 2. LPA stenosis due to surrounding tissue adhesion, thus imroved after adhesiolysis 3. Three right PVs drained to right side atrium through one small opening 4. AVV: Alferi stitch x4 (over left side AV valve) 5. Surgical membrane loop AsAo and IVC, then cover heart Operative Procedures 1. Under ETGA with supine position 2. Disinfected and well drapped 3. Re-sternotomy 4. Cannulation via AsAo/RA/IVC, on CPB, Cooling to 20 degree Celsius 5. AXC and antegrade cardioplegia infusion 6. RA incision, identify and enlarge right PVs opening under DHCA 15min 7. AVVP with Alferi stitches x4 8. Close RA. Rewarm, Deair, Weaning off CB 9. Hemostasis. Set 2 chest tubes 10. Wound closure in layers Operators VS張重議 Assistants R5黃俊銘, R3黃世銘 相關圖片 陳美惠 (F,1952/09/08,59y6m) 手術日期 2011/10/13 手術主治醫師 蕭輔仁 手術區域 東址 005房 02號 診斷 Low back pain 器械術式 Radiofrequency coagulation(P-G 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 15:05 報到 15:40 進入手術室 16:08 麻醉開始 16:10 麻醉結束 16:12 手術開始 16:45 手術結束 16:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 高頻熱凝療法 1 1 B 摘要__ 手術科部: 外科部 套用罐頭: Pulsed radiofrequency stimulation, bilateral ... 開立醫師: 林哲光 開立時間: 2011/10/13 16:59 Pre-operative Diagnosis Low back pain Post-operative Diagnosis Low back pain Operative Method Pulsed radiofrequency stimulation, bilateral L2 dorsal root Specimen Count And Types Pathology Nil Operative Findings 1. Bilateral L2 dorsal root was identified by portable C-arm X-ray and sensory/motor stimulation test. No acute complication was noted after the procedure. 2. Temp: 42 oC, Time: 180sec x 2 cycles each side Operative Procedures The patient was put in prone position. The location of L2 was identified by portable C-arm X-ray. The skin was disinfected and draped as usual. Local anesthesia was performed with 1% Xylocaine at 4cm below, 4cm away from the midline of L2 interspinous process and pedicle. Bilateral L2 dorsal root radiofrequency stimulation was performed under portable C-arm guided. The patient stood whole procedure well. Operators 蕭輔仁 Assistants 林哲光 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Pulsed radiofrequency stimulation, bilateral ... 開立醫師: 林哲光 開立時間: 2011/10/13 16:59 Pre-operative Diagnosis Low back pain Post-operative Diagnosis Low back pain Operative Method Pulsed radiofrequency stimulation, bilateral L2 dorsal root Specimen Count And Types Pathology Nil Operative Findings 1. Bilateral L2 dorsal root was identified by portable C-arm X-ray and sensory/motor stimulation test. No acute complication was noted after the procedure. 2. Temp: 42 oC, Time: 180sec x 2 cycles each side Operative Procedures The patient was put in prone position. The location of L2 was identified by portable C-arm X-ray. The skin was disinfected and draped as usual. Local anesthesia was performed with 1% Xylocaine at 4cm below, 4cm away from the midline of L2 interspinous process and pedicle. Bilateral L2 dorsal root radiofrequency stimulation was performed under portable C-arm guided. The patient stood whole procedure well. Operators 蕭輔仁 Assistants 林哲光 相關圖片 陳智英 (F,1952/12/28,59y2m) 手術日期 2011/10/13 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Aneurysm 器械術式 EC-IC bypass + aneurysm clipping 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳國瑋, 時間資訊 23:42 臨時手術NPO 07:50 報到 08:00 進入手術室 08:10 麻醉開始 08:45 抗生素給藥 08:45 誘導結束 09:27 手術開始 11:45 抗生素給藥 14:45 抗生素給藥 16:05 麻醉結束 16:05 手術結束 16:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱內外血管吻合術 1 2 R 手術 開顱術摘除血管病變- 腦血管瘤 .巨大的 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 8 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: High flow EC-IC bypass from right external ca... 開立醫師: 陳國瑋 開立時間: 2011/10/13 17:01 Pre-operative Diagnosis Right ICA-MCA giant aneurysm. Post-operative Diagnosis Right ICA-MCA giant aneurysm. Operative Method High flow EC-IC bypass from right external carotid artery to M2 with great saphenous vein graft Specimen Count And Types nil Pathology nil Operative Findings One giant aneurysm about 4.5*3 cm was noted at ICA bifercation pointing upward was noted. The MCA was pushed posterior to the aneurysm. The wall of the aneurysm was calcified. The right saphenous vein about 45cm was harvested for bypass. The bypass was from right ECA to M2. The pulsation of the vessesl graft was good. Operative Procedures After intubation and general anesthesia, the patient was put in supine position with head turning to left and right leg rotated outward. The right pterion craniotomy was done. The ECA was dissected out and looped. The great saphanous vein was harvested and anastomosis to right ECA was done. Durotomy was done. The sylvian fissure was opened and the aneurysm came in sight. Bypass to the right M2 was done. The flow pattern was good. After setting on CWV the wounds were closed in layers. After intubation and general anesthesia, the patient was put in supine position with head turning to left and right leg rotated outward. The right pterion craniotomy was done. The ECA was dissected out and looped. The great saphanous vein was harvested and anastomosis to right ECA was done. Durotomy was done. The sylvian fissure was opened and the aneurysm came in sight. End-to-side anastomosis to M2 was achieved with 8-0 prolene continously. Oozing from anastomosis was noted and we tried to repaired it with 8-0 prolene. However, break of M2 was noted and hemostasis was achieved with Tissucol duo. The flow pattern was good. After setting on CWV the wounds were closed in layers. Operators 王國川 紀乃新 Assistants 莊民凱 陳國瑋 黃薇諭 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: High flow EC-IC bypass from right external ca... 開立醫師: 王慈惠 開立時間: 2011/10/26 08:31 Pre-operative Diagnosis Right MCA bifurcation giant aneurysm. Post-operative Diagnosis Right MCA bifurcation giant aneurysm. Operative Method High flow EC-IC bypass from right external carotid artery to M2 with great saphenous vein graft Specimen Count And Types nil Pathology nil Operative Findings One giant aneurysm about 4.5*3 cm was noted at ICA bifercation pointing upward was noted. The MCA was pushed posterior to the aneurysm. The wall of the aneurysm was calcified. The right saphenous vein about 45cm was harvested for bypass. The bypass was from right ECA to M2. The pulsation of the vessesl graft was good. Operative Procedures After intubation and general anesthesia, the patient was put in supine position with head turning to left and right leg rotated outward. The right pterion craniotomy was done. The ECA was dissected out and looped. The great saphanous vein was harvested and anastomosis to right ECA was done. Durotomy was done. The sylvian fissure was opened and the aneurysm came in sight. End-to-side anastomosis to M2 was achieved with 8-0 prolene continously. Oozing from anastomosis was noted and we tried to repaired it with 8-0 prolene. However, break of M2 was noted and hemostasis was achieved with Tissucol duo. The flow pattern was good. After setting on CWV the wounds were closed in layers. Operators 王國川 紀乃新 Assistants 莊民凱 陳國瑋 黃薇諭 相關圖片 王祥宏 (M,1963/12/23,48y2m) 手術日期 2011/10/13 手術主治醫師 蔡翊新 手術區域 東址 002房 01號 診斷 Cerebrovascular accident 器械術式 Brain tumor Crainotomy(TZENG)，ICP monitoring 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3E 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 05:25 進入手術室 05:35 麻醉開始 05:50 誘導結束 06:00 手術開始 06:40 抗生素給藥 09:40 抗生素給藥 12:10 手術結束 12:10 麻醉結束 12:16 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 1 手術 顱內壓視置入 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Cervical Laminectomy 開立醫師: 蔡翊新 開立時間: 2011/10/13 11:40 Pre-operative Diagnosis Cerebellar infarction with tonsillar herniation, brainstem compression and hydrocephalus. Post-operative Diagnosis Cerebellar infarction with tonsillar herniation, brainstem compression and hydrocephalus. Operative Method Suboccipital craniectomy and C1 laminectomy for resection of infarcted cerebellar hemispheres and duroplasty. Right Frazier EVD for ICP monitoring. Specimen Count And Types nil Pathology Nil. Operative Findings The CSF was clear and initial pressure was 5 cmH2O. The dura was tense upon craniectomy and C1 laminectomy. After dural opening, the cerebellum bulged out rapidly. Both cerebellar tonsils were displaced into foramen magnum. The bilateral cerebellar hemispheres were pale and fragile and some dark reddish blood was evacuated during cerebellar resection. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: prone with neck flexed and head fixed by a Mayfield skull clamp 3. Skin preparation: occipital and neck areas were shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. A burr hole was made at right Frazier point for EVD insertion and for ICP monitoring. 5. Incision: medline nape, from suboccipital to upper neck. 6. The semispinalis capitis, splenius capitis muscles on both sides were splitted at its origin of ligamentum nuchae, then, together with serratus posterior superior, rectus capitis posterior, obliqus capitis inferior and multifidus were detached from the spinous processes of C1-2 by Bovie, followed by subperiosteal dissection on the C1 laminae. 7. The scalp and paravertebral muscles were kept open by self retaining retractors to expose spinous processes and laminae of C1. The bleeding from the muscles was stopped by Bovie. 8. Craniectomy: 8 x 5.5 cm, suboccipital, with foramen magnum bitten off to occipital condyles by rongeurs and Kerrison punch. C1 laminectomy was done. 9. The dura was opened in a Y-shape with extension to C1 cervical cord. 10.The bilateral cerebellar hemispheres were resection to gain more space and to prevent further edema. Hemostasis was obtained by bipolar coagulator and Surgicel packing. 11.The dura was closed with a piece of 7 x 4 cm Biodesign Surgisis Dural Graft for dural augmentation by continuous suture with 4/0 Prolene. 12.The paravertebral muscles were closed by interrupted sutures with 1/0 Vicryl, subcutaneous layer by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 13.Drain: one, epidural CWV. 14.Blood transfusion: PRBC 2U. Blood loss: 600 ml. 15.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R6鍾文桂R3陳國瑋R0鄭宇軒 Indication Of Emergent Operation tonsillar herniation and brainstem compression 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Cervical Laminectomy 開立醫師: 蔡翊新 開立時間: 2011/10/13 11:40 Pre-operative Diagnosis Cerebellar infarction with tonsillar herniation, brainstem compression and hydrocephalus. Post-operative Diagnosis Cerebellar infarction with tonsillar herniation, brainstem compression and hydrocephalus. Operative Method Suboccipital craniectomy and C1 laminectomy for resection of infarcted cerebellar hemispheres and duroplasty. Right Frazier EVD for ICP monitoring. Specimen Count And Types nil Pathology Nil. Operative Findings The CSF was clear and initial pressure was 5 cmH2O. The dura was tense upon craniectomy and C1 laminectomy. After dural opening, the cerebellum bulged out rapidly. Both cerebellar tonsils were displaced into foramen magnum. The bilateral cerebellar hemispheres were pale and fragile and some dark reddish blood was evacuated during cerebellar resection. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: prone with neck flexed and head fixed by a Mayfield skull clamp 3. Skin preparation: occipital and neck areas were shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. A burr hole was made at right Frazier point for EVD insertion and for ICP monitoring. 5. Incision: medline nape, from suboccipital to upper neck. 6. The semispinalis capitis, splenius capitis muscles on both sides were splitted at its origin of ligamentum nuchae, then, together with serratus posterior superior, rectus capitis posterior, obliqus capitis inferior and multifidus were detached from the spinous processes of C1-2 by Bovie, followed by subperiosteal dissection on the C1 laminae. 7. The scalp and paravertebral muscles were kept open by self retaining retractors to expose spinous processes and laminae of C1. The bleeding from the muscles was stopped by Bovie. 8. Craniectomy: 8 x 5.5 cm, suboccipital, with foramen magnum bitten off to occipital condyles by rongeurs and Kerrison punch. C1 laminectomy was done. 9. The dura was opened in a Y-shape with extension to C1 cervical cord. 10.The bilateral cerebellar hemispheres were resection to gain more space and to prevent further edema. Hemostasis was obtained by bipolar coagulator and Surgicel packing. 11.The dura was closed with a piece of 7 x 4 cm Biodesign Surgisis Dural Graft for dural augmentation by continuous suture with 4/0 Prolene. 12.The paravertebral muscles were closed by interrupted sutures with 1/0 Vicryl, subcutaneous layer by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 13.Drain: one, epidural CWV. 14.Blood transfusion: PRBC 2U. Blood loss: 600 ml. 15.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R6鍾文桂R3陳國瑋R0鄭宇軒 Indication Of Emergent Operation tonsillar herniation and brainstem compression 相關圖片 郭金琳 (F,1963/08/27,48y6m) 手術日期 2011/10/14 手術主治醫師 杜永光 手術區域 東址 003房 02號 診斷 Carotid stenosis 器械術式 EC-IC by-pass 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 曾偉倫, 時間資訊 23:13 臨時手術NPO 12:13 進入手術室 12:20 麻醉開始 12:40 誘導結束 13:10 抗生素給藥 13:20 手術開始 16:10 抗生素給藥 19:30 抗生素給藥 21:30 手術結束 21:30 麻醉結束 21:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 10 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 顱內外血管吻合術 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Extracranial-intracranial bypass surgery(left... 開立醫師: 李振豪 開立時間: 2011/10/14 22:36 Pre-operative Diagnosis Left internal carotid artery stenosis with left middle cerebral artery territory hypoperfusion Post-operative Diagnosis Left internal carotid artery stenosis with left middle cerebral artery territory hypoperfusion Operative Method Extracranial-intracranial bypass surgery(left superficial temporal artery to left middle cerebral artery) Specimen Count And Types nil Pathology Nil Operative Findings Left anterior and posterior branche of superficial temporal artery was dissected for at least 10cm in length. The diameter of anterior branch was larger then posterior branch. So we harvested anterior branch for EC-IC bypass. The pulsation was good but the flow was fair after heparin irrigation. During dissection along the superficial temporal artery, right limbs SSEP flatened due to relative hypotension. The systolic blood pressure was keep around 110~120mmHg and the SSEP returned to baseline waveform. After craniotomy and durotomy, one largest cortical artery within the operative field was choose for similar diameter with anterior branch of superficial temporal artery. End-to-side anastomosis was performed with total 12 interrupted stitches. Fish-mouth appearance was achieved after complete anastomosis. Oozing from anastomotic site was noted and hemostasis was achieved with Surgicel lining. The systolic blood pressure was elevated to 160mmHg and no active oozing was noted. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with left shoulder elevation. The course of left superficial temporal artery(both anterior and posterior branch) was traced by duplex. The head was rotated to right and the head was fixed with Mayfield skull clamp. Under operative microscope, one curvilinear scalp incision was made at left fronto-temporal area. The main trunk of left superficial temporal artery was identified and the anterior/posterior branch were dissected carefully. About 10cm anterior and posterior branch were exposed and the small branches were ligated with hemoclip or bipolar electrocautery. Anterior branch was harvested for larger diameter. The harvested vessel was prepared with heparin and clamp with temporary clip. The temporalis muscle was transected with T-shape and reflected laterally. Two burr holes were created at left temporal and parietal area followed by one 4x4cm craniotomy window. Dural tenting was done. T-shape durotomy was performed. The largest cortical artery within the operative field was exposed. Extracranial to intracranial bypass surgery was performed with 10-0 Nylon. Two anchoring stitches were conducted initially. Total 10 interrupted stitches were applied for end-to side anastomosis. Hemostasis was achieved with Surgicel lining. Dura was closed with 4-0 prolene. The skull plate was fixed back with miniplates and scerws. One CWV drain was placed. The temporalis muscle was fixed back. The wound was then closed in layers with 4-0 Vicryl and 3-0 Nylon. Operators Prof. 杜永光 Assistants R5 李振豪, R3 曾偉倫, Ri王美婷 相關圖片 林哲仁 (M,1965/05/29,46y9m) 手術日期 2011/10/14 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Acoustic neuroma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 陳國瑋, 時間資訊 23:16 臨時手術NPO 08:15 進入手術室 08:20 麻醉開始 08:45 誘導結束 08:50 抗生素給藥 08:57 手術開始 11:50 抗生素給藥 14:00 手術結束 14:00 麻醉結束 14:10 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 顱底瘤手術 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Left retrosigmoid approach for tumor excision 開立醫師: 陳國瑋 開立時間: 2011/10/14 14:50 Pre-operative Diagnosis Left vestibular schwannoma Post-operative Diagnosis Left vestibular schwannoma Operative Method Left retrosigmoid approach for tumor excision Left retrosigmoid approach for tumor excision Specimen Count And Types 1 piece About size:fragments Source:brain tumor, CSF Pathology Pending Operative Findings The dura was intense after bone window elevated. The opening pressure was about 15cm H2O after ventriculostomy. The tumor was yellowish to greyish, elastic in character measured 5.2*3.7*4.8 with invasion into internal acoustic meatus. Large cystic component was encountered after cerebellar retraction. The cystic content was clear and straw-colored. The CNVII and CN VI were identified and preserved well. The CNVII was pushed paper-thin. The part of tumor entering IAC was remained. Pons and basilar artery was noted after tumor removal. Facial stimulation was done but no response. The dura was intense after bone window elevated. The opening pressure was about 15cm H2O after ventriculostomy. The tumor was yellowish to greyish, elastic in character measured 5.2*3.7*4.8 with invasion into internal acoustic meatus. Large cystic component was encountered after cerebellar retraction. The cystic content was clear and straw-colored. The CNVII and low cranial nerve were identified and preserved well. The CNVII was pushed paper-thin. The part of tumor entering IAC was remained. Pons and basilar artery was noted after tumor removal. Facial stimulation was done but no response. Operative Procedures After intubation and general anesthesia, the patient was put in 3/4 prone position. The skin was shaved, scrubbed and prepared as usual. Hockystick skin incision was made from retroauricular cross midline to cervical level. The skin was retrated downward. Bone window created to the border of left transverse sinus and sigmoid sinus. Ventriculostomy was done through left Frazier point. The dura was incised, and the cerebellum was retracted downward. The cystic part was encountered and cut open. Tumor removal was performed. CNVII and CNIX were noted. Facial stimulation was done. After careful hemostasis, duroplasty was done with fascia. The ventricular drain tube was removed. The bone graft was fixed back with mini-plate. One subgaleal CWV was placed. The wound was then closed in layers. After intubation and general anesthesia, the patient was put in 3/4 prone position. The skin was shaved, scrubbed and prepared as usual. Hockystick skin incision was made from retroauricular cross midline to cervical level. The skin was retrated downward. Bone window created to the border of left transverse sinus and sigmoid sinus. Ventriculostomy was done through left Frazier point. The dura was incised, and the cerebellum was retracted downward. The cystic part was encountered and cut open. Tumor removal was performed. CNVI and CNVII were noted. Facial stimulation was done. After careful hemostasis, duroplasty was done with fascia. The ventricular drain tube was removed. The bone graft was fixed back with mini-plate. One subgaleal CWV was placed. The wound was then closed in layers. Operators 曾漢民 Assistants 鍾文桂 陳國瑋 相關圖片 石昇弘 (M,1979/10/28,32y4m) 手術日期 2011/10/14 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Oligodendroglioma, brain 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 1 紀錄醫師 陳國瑋, 時間資訊 23:15 臨時手術NPO 13:10 報到 14:45 進入手術室 14:50 麻醉開始 15:00 誘導結束 15:00 抗生素給藥 15:04 手術開始 18:00 抗生素給藥 20:02 麻醉結束 20:02 手術結束 20:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4~8小時 1 1 R 手術 立體定位術-切片 1 2 R 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 摘要__ 手術科部: 外科部 套用罐頭: Right frontal craniotomy for tumor excision u... 開立醫師: 陳國瑋 開立時間: 2011/10/14 20:30 Pre-operative Diagnosis Oligodendroglioma Post-operative Diagnosis Oligodendroglioma Operative Method Right frontal craniotomy for tumor excision under stereotactic guidance Specimen Count And Types 2 pieces About size:fragments Source:brain tumor About size:fragments Source:brain tumor medial side Pathology Pending Operative Findings One ill-defined tumor at right fontal lobe. The tumor was hard and elastic in character with petichiae hemorrhage over the medial frontal portion. The tumor at more lateral side is gray-pinksih and also hard elastic. Two pathologic specimens were sent for each. According to the tractography, the neuronal fibers are integrated into the lateral and posterior parts of the tumor. Hence, the tumor in the mentioned area was remained. Operative Procedures After intubation and general anesthesia, the patient was put in supine position. The skin was shaved, scrubbed and prepared as usual. The navigation was settled. Bi-coronal skin incision was done and the skin was retracted forward. One 8*6cm bone window was elevated. After checking with Navigator and sonography. The dura was refleced medially. Tumo excision was performed in piecemeal fashion. With well hemostasis, the cortical surface was coverved with surgicel. The dura mater was closed in watertight fashion. The wound was closed in layers after fixing the craniotomy plate with miniplates and screws with one subgaleal CWV drain. Operators 曾漢民 Assistants 鍾文桂 陳國瑋 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Right frontal craniotomy for tumor excision u... 開立醫師: 陳國瑋 開立時間: 2011/10/28 01:33 Pre-operative Diagnosis Oligodendroglioma Post-operative Diagnosis Oligodendroglioma Operative Method Right frontal craniotomy for tumor excision under stereotactic guidance Specimen Count And Types 2 pieces About size:fragments Source:brain tumor About size:fragments Source:brain tumor medial side Pathology Pending Operative Findings One ill-defined tumor at right fontal lobe. The tumor was hard and elastic in character with petichiae hemorrhage over the medial frontal portion. The tumor at more lateral side is gray-pinksih and also hard elastic. Two pathologic specimens were sent for each. According to the tractography, the neuronal fibers are integrated into the lateral and posterior parts of the tumor. Hence, the tumor in the mentioned area was remained. Operative Procedures After intubation and general anesthesia, the patient was put in supine position. The skin was shaved, scrubbed and prepared as usual. The navigation was settled. Bi-coronal skin incision was done and the skin was retracted forward. One 8*6cm bone window was elevated. After checking with Navigator and sonography. The dura was refleced medially. Tumo excision was performed in piecemeal fashion. With well hemostasis, the cortical surface was coverved with surgicel. The dura mater was closed in watertight fashion. The wound was closed in layers after fixing the craniotomy plate with miniplates and screws with one subgaleal CWV drain. Operators 曾漢民 Assistants 鍾文桂 陳國瑋 相關圖片 張玉君 (F,1983/07/29,28y7m) 手術日期 2011/10/14 手術主治醫師 賴達明 手術區域 東址 002房 01號 診斷 Intraventricular hemorrhage 器械術式 Change external ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3E 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 07:24 通知急診手術 08:32 進入手術室 08:40 麻醉開始 08:45 誘導結束 09:44 手術開始 10:20 手術結束 10:20 麻醉結束 10:25 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室體外引流 1 2 R 摘要__ 手術科部: 外科部 套用罐頭: Right Kocher point EVD revision 開立醫師: 曾偉倫 開立時間: 2011/10/14 10:30 Pre-operative Diagnosis Right caudate nucleus ICH with intraventricular hemorrhage Post-operative Diagnosis Right caudate nucleus ICH with intraventricular hemorrhage Operative Method Right Kocher point EVD revision Specimen Count And Types nil Pathology Nil. Operative Findings Gush of reddish CSF was noted, and the opening pressure was about 8cm-H2O. The intraventricular catheter was inserted along the previous tract of EVD, ventricular catheter was 7cm long. Operative Procedures Under ETGA and supine position, skin incision was done along the previuos operative wound and the previous Kocher point was exposed. The intraventricular catheter was inserted along the previous tract. The wound was then closed in layers after the EVD was fixed through the subcutaneous tunneling and fixed on the skin. Operators VS 賴達明 Assistants R5 林哲光 R3 曾偉倫 Indication Of Emergent Operation Persisted massive CSF drainage 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Right Kocher point EVD revision 開立醫師: 曾偉倫 開立時間: 2011/10/14 10:30 Pre-operative Diagnosis Right caudate nucleus ICH with intraventricular hemorrhage Post-operative Diagnosis Right caudate nucleus ICH with intraventricular hemorrhage Operative Method Right Kocher point EVD revision Specimen Count And Types nil Pathology Nil. Operative Findings Gush of reddish CSF was noted, and the opening pressure was about 8cm-H2O. The intraventricular catheter was inserted along the previous tract of EVD, ventricular catheter was 7cm long. Operative Procedures Under ETGA and supine position, skin incision was done along the previuos operative wound and the previous Kocher point was exposed. The intraventricular catheter was inserted along the previous tract. The wound was then closed in layers after the EVD was fixed through the subcutaneous tunneling and fixed on the skin. Operators VS 賴達明 Assistants R5 林哲光 R3 曾偉倫 Indication Of Emergent Operation Persisted massive CSF drainage 相關圖片 鍾朝龍 (M,1948/07/18,63y7m) 手術日期 2011/10/14 手術主治醫師 賴達明 手術區域 東址 002房 03號 診斷 Malignant neoplasm of liver, primary 器械術式 T5 corpectomy and fixation 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3E 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 07:27 通知急診手術 16:45 報到 17:08 進入手術室 17:15 麻醉開始 17:45 誘導結束 18:00 抗生素給藥 18:18 手術開始 20:15 開始輸血 21:00 抗生素給藥 00:05 麻醉結束 00:05 手術結束 00:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 惡性脊髓腫瘤切除術 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 3 0 麻醉 動脈血液檢查全套 3 0 麻醉 Hemoglobin (Hb) 3 0 麻醉 測血糖 3 0 麻醉 Ca (Calcium) 3 0 麻醉 Na (Sodium) 3 0 麻醉 K (Potassium) 3 0 麻醉 Blood gas analysis 3 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 手術 脊椎融合術-前融合,有固定物)≦四節 1 2 摘要__ 手術科部: 外科部 套用罐頭: T5 corpectomy and anterior fusion with Medtro... 開立醫師: 林哲光 開立時間: 2011/10/15 00:51 Pre-operative Diagnosis T5 spine metastasis, suspected HCC origin Post-operative Diagnosis T5 spine metastasis, suspected HCC origin Operative Method T5 corpectomy and anterior fusion with Medtronic cage and Z-plate Specimen Count And Types 1 piece About size:3cm sized Source:tumor and T5 body Pathology Pending Operative Findings Bulging mass was noted at T5 level covered by pleura and T5 body was invaded by the grayish tumor mass, which was easily touch bleeding and hypercellularity with cord compression. The dura sac seemed re-expanded well after tumor excision. Screws for Z-plate fixation were 40x35mm. Operative Procedures Under ETGA and left decubitus position, skin disinfected and drapped were performed as usual. Thoracotomy was done at 4th intercostal space by chest surgeon and the T5 body was exposed well. T5 corpectomy was then done after T4-5 and T5-6 discectomy. The tumor was excised as extensively as possible with Currettege. Cage insertion was then done at T5 level and fixed with screws. N/S irrigation was done and the wound was then closed in layers after a chest tube insertion. Operators 蕭輔仁, 黃培銘 Assistants 林哲光, 郝紹鴻, 廖先啟 Indication Of Emergent Operation T5 cord compression with myelopathy and bilateral lower limbs weakness 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: T5 corpectomy and anterior fusion with Medtro... 開立醫師: 林哲光 開立時間: 2011/10/15 00:51 Pre-operative Diagnosis T5 spine metastasis, suspected HCC origin Post-operative Diagnosis T5 spine metastasis, suspected HCC origin Operative Method T5 corpectomy and anterior fusion with Medtronic cage and Z-plate Specimen Count And Types 1 piece About size:3cm sized Source:tumor and T5 body Pathology Pending Operative Findings Bulging mass was noted at T5 level covered by pleura and T5 body was invaded by the grayish tumor mass, which was easily touch bleeding and hypercellularity with cord compression. The dura sac seemed re-expanded well after tumor excision. Screws for Z-plate fixation were 40x35mm. Operative Procedures Under ETGA and left decubitus position, skin disinfected and drapped were performed as usual. Thoracotomy was done at 4th intercostal space by chest surgeon and the T5 body was exposed well. T5 corpectomy was then done after T4-5 and T5-6 discectomy. The tumor was excised as extensively as possible with Currettege. Cage insertion was then done at T5 level and fixed with screws. N/S irrigation was done and the wound was then closed in layers after a chest tube insertion. Operators 蕭輔仁, 黃培銘 Assistants 林哲光, 郝紹鴻, 廖先啟 Indication Of Emergent Operation T5 cord compression with myelopathy and bilateral lower limbs weakness 相關圖片 謝余彰 (M,1953/07/28,58y7m) 手術日期 2011/10/14 手術主治醫師 賴達明 手術區域 東址 002房 02號 診斷 Cerebrovascular accident 器械術式 Removal of ICH 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 4E 紀錄醫師 曾偉倫, 林哲光, 時間資訊 10:23 開始NPO 10:23 通知急診手術 11:10 進入手術室 11:20 麻醉開始 12:00 抗生素給藥 12:00 誘導結束 12:23 手術開始 15:00 抗生素給藥 16:20 手術結束 16:20 麻醉結束 16:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Right F-T craniotomy for ICH removal 開立醫師: 林哲光 開立時間: 2011/10/14 16:58 Pre-operative Diagnosis Right putaminal ICH Post-operative Diagnosis Right putaminal ICH Operative Method Right F-T craniotomy for ICH removal Specimen Count And Types nil Pathology Nil Operative Findings About 60ml intracerebral hematoma without obvious bleeders was noted. The brain parenchyma seemed slack well after hematoma removal. Main trunk of STA was presreved and anterior branch was sacrificed. Operative Procedures Under ETGA and supine position with head rotated to left side, skin disinfected and drapped were performed as usual. S-shaped skin incision was made at right F-T area and temporalis muscle was dissected. Craniotomy was then performed after two burr holes were created. The dura was then opened in cross shaped after dural tenting. Corticotomy was done at middle temporal lobe and hematoma removal was done. Hemostasis was done with bipolar cauterization without injury to the vessles and packed with Surgecells. Duroplasty was done with Surgisis dural graft (COOK) after deair. The skull bone was put back and fixed with miniplates. The wound was then closed in layers after subgaleal drain insertion. Operators 賴達明 Assistants 林哲光, 曾偉倫 Indication Of Emergent Operation 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Right F-T craniotomy for ICH removal 開立醫師: 林哲光 開立時間: 2011/10/14 17:01 Pre-operative Diagnosis Right putaminal ICH Post-operative Diagnosis Right putaminal ICH Operative Method Right F-T craniotomy for ICH removal Specimen Count And Types nil Pathology Nil Operative Findings About 60ml intracerebral hematoma without obvious bleeders was noted. The brain parenchyma seemed slack well after hematoma removal. Main trunk of STA was presreved and anterior branch was sacrificed. Operative Procedures Under ETGA and supine position with head rotated to left side, skin disinfected and drapped were performed as usual. S-shaped skin incision was made at right F-T area and temporalis muscle was dissected. Craniotomy was then performed after two burr holes were created. The dura was then opened in cross shaped after dural tenting. Corticotomy was done at middle temporal lobe and hematoma removal was done. Hemostasis was done with bipolar cauterization without injury to the vessles and packed with Surgecells. Duroplasty was done with Surgisis dural graft (COOK) after deair. The skull bone was put back and fixed with miniplates. The wound was then closed in layers after subgaleal drain insertion. Operators 賴達明 Assistants 林哲光, 曾偉倫 Indication Of Emergent Operation 60ml ICH with mass effect and left hemiparesis 相關圖片 朱益賦 (M,1976/02/16,36y0m) 手術日期 2011/10/14 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Spinal metastasis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 3 紀錄醫師 吳健暉, 時間資訊 23:17 臨時手術NPO 07:42 報到 08:00 進入手術室 08:15 麻醉開始 08:30 誘導結束 09:00 抗生素給藥 09:18 手術開始 12:10 開始輸血 12:12 抗生素給藥 12:45 手術結束 12:45 麻醉結束 12:50 送出病患 13:00 進入恢復室 14:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 惡性脊髓腫瘤切除術 1 1 R 手術 脊椎融合術-後融合,有固定物(<=六節) 1 2 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 曾峰毅 開立時間: 2011/10/14 12:57 Pre-operative Diagnosis Lumbar metastatic tumor, L3 Post-operative Diagnosis Lumbar metastatic tumor, L3 Operative Method L2 laminectomy for tumor excision, posterior fixation from L2 to L4, and posterolateral fusion, L2 to L4 Specimen Count And Types Several fragments of one tumor was sent for pathology. Pathology Pending Operative Findings Elastic, fragile, hypervascular, greyish, mass lesion was noted occupying right pedicle of L3, erosing cortical bone of the pedicle, involving right posterolateral portion of L3 vertebral body, encasing right L3 roots. Synthes, transpedicluar screws, 6.2x50 mm, were inserted into biateral pedicles of L2 and L4, left pedicles of L3. Simbone HT, 5ml, was used for posterolateral fusion, L2 to L4. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone positin. After C-arm localization, we scrubbed, disinfected, and then draped the patient's back as usual. We made one midline incision and dissected bilateral paraspinal muscle to expose bilateral laminae from L1 to L4. Posterior instrumentation was performed with transpedicular scres into bilateral pedicles of L2 and L4, and left pedicles of L3. Posterior decompression was done with L2 laminectomy. Intraspinal tumor was removed, and right pedicle of L3 and right L2/3 facet was removed for total tumor excision. Right partial L3 corpectomy was done via right pedicle. Hemostasis was performed, and posterior fixation was with two rods set. Posterolateral fusion was performed with artificial bone graft. After gentamycin-saline irrigation, we inserted two submuscular hemovac. The wound was closed in layers. Operators VS 賴達明 Assistants R5 曾峰毅 R1 吳健暉 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 吳健暉 開立時間: 2011/10/17 23:24 Pre-operative Diagnosis Lumbar metastatic tumor, L3 Post-operative Diagnosis Lumbar metastatic tumor, L3 Operative Method L2 laminectomy for tumor excision, posterior fixation from L2 to L4, and posterolateral fusion, L2 to L4 Specimen Count And Types Several fragments of one tumor was sent for pathology. Pathology Pending Operative Findings Elastic, fragile, hypervascular, greyish, mass lesion was noted occupying right pedicle of L3, erosing cortical bone of the pedicle, involving right posterolateral portion of L3 vertebral body, encasing right L3 roots. Synthes, transpedicluar screws, 6.2x50 mm, were inserted into biateral pedicles of L2 and L4, left pedicles of L3. Simbone HT, 5ml, was used for posterolateral fusion, L2 to L4. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone positin. After C-arm localization, we scrubbed, disinfected, and then draped the patient's back as usual. We made one midline incision and dissected bilateral paraspinal muscle to expose bilateral laminae from L1 to L4. Posterior instrumentation was performed with transpedicular scres into bilateral pedicles of L2 and L4, and left pedicles of L3. Posterior decompression was done with L2 laminectomy. Intraspinal tumor was removed, and right pedicle of L3 and right L2/3 facet was removed for total tumor excision. Right partial L3 corpectomy was done via right pedicle. Hemostasis was performed, and posterior fixation was with two rods set. Posterolateral fusion was performed with artificial bone graft. After gentamycin-saline irrigation, we inserted two submuscular hemovac. The wound was closed in layers. Operators VS 賴達明 Assistants R5 曾峰毅 R1 吳健暉 相關圖片 游定信 (M,1951/04/25,60y10m) 手術日期 2011/10/14 手術主治醫師 楊士弘 手術區域 東址 003房 01號 診斷 Spondylosis with myelopathy, cervical 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 李振豪, 時間資訊 23:11 臨時手術NPO 08:05 進入手術室 08:15 麻醉開始 08:25 誘導結束 08:35 抗生素給藥 09:18 手術開始 11:30 抗生素給藥 11:47 手術結束 11:47 麻醉結束 11:50 送出病患 11:55 進入恢復室 13:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 椎間盤切除術-頸椎 1 1 手術 椎融合術-前融合,無固定物(≦四節) 1 2 記錄__ 手術科部: 外科部 套用罐頭: Anterior microsurgical diskectomy + interbody... 開立醫師: 李振豪 開立時間: 2011/10/14 12:02 Pre-operative Diagnosis Cervical herniated intervertebral disk, C5-6 Post-operative Diagnosis Cervical herniated intervertebral disk, C5-6 Operative Method Anterior microsurgical diskectomy + interbody cage fusion Specimen Count And Types nil Pathology Nil Operative Findings Anterior marginal spur were found in the C5-6 vertebral bodies. The disk space was narrow, and the disk became dehydrated. The thecal sac was compressed tightly by posterior marginal spurs and posteriorly bulging disk, and reexpanded well after decompression. The C5-6 disk space was rather immobile even after decompression. A 5 mm high x 12 mm deep PEEK cage was impacted into the C5-6 disk space. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with neck extension. The skin was scrubbed, disinfected, and draped as usual. Transverse skin incision with 3cm in length was made over middle anterior neck. The subcutaneous soft tissue was devided and the margin of right platysma muscle was identified. The fascia was opened along the margin of the platysma muscle till the plane between thyroid gland and right anterior strap muscles. Blunt dissection was performed along the plane to reach the prevertebral space. Prevertebral fascia was opened and the C5-6 disc level was confirmed by portable C-arm X-ray. Bilateral longus collis muscle were detached and Koros retractor was applied. Caspar retractor was inserted into C5 and C6 body. Under operative microscope, diskectomy was performed with curette, Kerrison punches, alligator, and Midas air-drived drill. Posterior longitudinal ligment was transected during microdiskectomy. Bilateral foraminotomy also conducted for decompression. One #5 PEEK cage filled with artificial bone graft was implanted into C5/6 disc space for interbody fusion. Hemostasis was achieved. The wound was then closed in layers with 3-0 Vicryl and 4-0 Dexon. Operators VS楊士弘 Assistants R5李振豪 相關圖片 駱世強 (M,1968/12/31,43y2m) 手術日期 2011/10/14 手術主治醫師 楊士弘 手術區域 東址 019房 02號 診斷 Spinal injury with spinal bone injury 器械術式 Spinal fusion posterior-REMOVAL OF TPS 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 2 紀錄醫師 吳健暉, 時間資訊 23:22 臨時手術NPO 13:10 進入手術室 13:20 麻醉開始 13:30 誘導結束 13:40 抗生素給藥 13:54 手術開始 16:50 手術結束 16:50 麻醉結束 17:00 送出病患 17:05 進入恢復室 18:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 手術 脊椎融合術-後融合,無固定物 1 1 手術 骨內固定物拔除術-脊椎 1 2 摘要__ 手術科部: 外科部 套用罐頭: 1. Removal of spinal implant; 2. Posterior fu... 開立醫師: 楊士弘 開立時間: 2011/10/14 16:56 Pre-operative Diagnosis 1. Spinal implant loosening; 2. T12 compression fracture s/p internal fixation and fusion with T11-L1 transpedicle screws, rods, and wires Post-operative Diagnosis 1. Spinal implant loosening; 2. T12 compression fracture s/p internal fixation and fusion with T11-L1 transpedicle screws, rods, and wires Operative Method 1. Removal of spinal implant; 2. Posterior fusion from T12 to L1 with Simbone graft Specimen Count And Types nil Pathology Nil Operative Findings 1. The right T11 screw became loosening and displaced posteriorly. The screw cap dislodged and migrated into the paraspinal muscle. 2. The wires were embedded in the posterior fusion bone construnct. The fused bone graft needed to be removed for removal of the wires. Therefore Simbone grafts were placed between the T12 to L1 spinous processes and lamina. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. We drilled part of previous fused bone to expose the wires, and removed the wires in segments. We put artificial bone graft at the site where the fusion we drilled off to expose wires. After gentamycin irrigation, the wound was closed in layers after submuscular hemovac placed. Operators 楊士弘 Assistants 曾峰毅,吳健暉 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: 1. Removal of spinal implant; 2. Posterior fu... 開立醫師: 吳健暉 開立時間: 2011/10/17 23:24 Pre-operative Diagnosis 1. Spinal implant loosening; 2. T12 compression fracture s/p internal fixation and fusion with T11-L1 transpedicle screws, rods, and wires Post-operative Diagnosis 1. Spinal implant loosening; 2. T12 compression fracture s/p internal fixation and fusion with T11-L1 transpedicle screws, rods, and wires Operative Method 1. Removal of spinal implant; 2. Posterior fusion from T12 to L1 with Simbone graft Specimen Count And Types nil Pathology Nil Operative Findings 1. The right T11 screw became loosening and displaced posteriorly. The screw cap dislodged and migrated into the paraspinal muscle. 2. The wires were embedded in the posterior fusion bone construnct. The fused bone graft needed to be removed for removal of the wires. Therefore Simbone grafts were placed between the T12 to L1 spinous processes and lamina. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. We drilled part of previous fused bone to expose the wires, and removed the wires in segments. We put artificial bone graft at the site where the fusion we drilled off to expose wires. After gentamycin irrigation, the wound was closed in layers after submuscular hemovac placed. Operators 楊士弘 Assistants 曾峰毅,吳健暉 相關圖片 陳深淵 (M,1953/01/25,59y1m) 手術日期 2011/10/15 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3E 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 11:59 通知急診手術 16:52 進入手術室 17:00 麻醉開始 17:20 誘導結束 17:40 抗生素給藥 17:54 手術開始 20:38 抗生素給藥 20:45 手術結束 20:45 麻醉結束 20:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 手術 腦瘤切除-手術時間在4小時以內 1 1 R 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Right frontal craniotomy for tumor excision 開立醫師: 李振豪 開立時間: 2011/10/15 21:14 Pre-operative Diagnosis Multiple right frontal tumor with tumor bleeding, suspect metastasis Post-operative Diagnosis Multiple right frontal tumor with tumor bleeding, suspect metastasis Operative Method Right frontal craniotomy for tumor excision Specimen Count And Types 1 piece About size:Multiple pieces Source:Right frontal brain tumor Pathology Pending Operative Findings Total two solid tumor was noted under ultrasound guided. The tumor most anteriorly was 1.3cm in diameter and the other one at posterior frontal was 1.8cm in diameter. Tumor bleeding with large hematoma formation was noted in two different part. The largest part was 5.5cm in diameter. The other one was 1.5cm in diameter. The cystic wall around the hematoma was removed also. Left lateral ventricle was opened during hematoma evacuation. The tumor was reddish, soft, well-demarcated, hypovascularized in character. The brain parenchyma adjacent to the tumor was yellowish and fragile in character. Malignant disease related condition was favored. The brain became slack after tumor removal and hematoma evacuation. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position. The scalp was shaved, scrubbed, and disinfected as usual. Bicoronal scalp incision was made and the scalp flap was elevated. Five burrholes were created followed by one 12 x 6cm craniotomy window. Dural tenting was done. Intra-operative sonography was used for localization of the tumor. C-shape durotomy was made based with superior sagittal sinus. Tumor excision was conducted with bipolar electrocautery, and suction. Right lateral ventricle was opened during tumor excision. The opening of the ventricle was sealed with Gelfoam packing and Surgicel lining. Hemostasis was achieved with bipolar electrocautery and Surgicel. Dura was closed with 4-0 Prolene. The skull plate was fixed back with miniplates, screws, and three central tenting. One subgaleal CWV drain was placed. The wound was then close in layers with 2-0 Vicryl and Appose staples. Operators VS曾漢民 Assistants R5李振豪, PGY陳怡穎 Indication Of Emergent Operation Tumor bleeding with midline shift and impending herniation 相關圖片 蘇昱丞 (M,1994/01/12,18y2m) 手術日期 2011/10/15 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Brain tumors, malignant 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 2 紀錄醫師 李振豪, 時間資訊 23:25 臨時手術NPO 07:40 報到 08:10 進入手術室 08:20 麻醉開始 08:40 誘導結束 08:42 抗生素給藥 08:55 手術開始 11:42 抗生素給藥 12:00 開始輸血 14:42 抗生素給藥 16:10 麻醉結束 16:10 手術結束 16:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 8 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 4 0 麻醉 動脈血液檢查全套 4 0 麻醉 Hemoglobin (Hb) 4 0 麻醉 測血糖 4 0 麻醉 Ca (Calcium) 4 0 麻醉 Na (Sodium) 4 0 麻醉 K (Potassium) 4 0 麻醉 Blood gas analysis 4 0 手術 腦瘤切除-手術時間在4~8小時 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Right parietal craniotomy for Simpson grade I... 開立醫師: 李振豪 開立時間: 2011/10/15 16:59 Pre-operative Diagnosis Right parietal falcial meningioma Post-operative Diagnosis Right parietal falcial meningioma, suspect malignancy Operative Method Right parietal craniotomy for Simpson grade II tumor excision Specimen Count And Types 1 piece About size:Multiple pieces Source:Right parietal tumor Pathology Frozen section: typical meningioma was favored over medial part. However, the lateral part of the tumor showed atypical cell with high mitotic rate. WHO grade III meningioma or high grade glioma was suspected. Operative Findings Intra-operative sonography showed one well-defined part over medial part of the tumor and hyperechogenecity area over lateral part of the tumor(subcortical distribution?). The brain bulging out rapidly after durotomy. The tumor has two different component. The medial part of the tumor was mainly stony hard in character, white-yellowish, moderate vascularized, and relative well-defined in character which attached to falx with much small feeding artery from inferior part of the tumor. Direct invasion into superior sagittal sinus was not observed during the operation. Frozen section in this part of the tumor favor typical meningioma. The lateral part of the tumor was gelatinous, gray-reddish, hypervascularized, and ill-defined. Tumor bleeding within this part of the tumor was noted and evacuated during the operation. Frozen section in this part of the tumor showed atypical cell with high mitotic rate. WHO grade III meningioma or glioma was suspected. The total tumor size was 4.3 x 4 x 3.9cm. Large cortical vein and artery between tumor and the brain parenchyma was preserved during tumor excision. The falx was not excised but coagulated with bipolar electrocautery. The brain remain bulging after tumor excision but much soft by palpation. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position with neck extension and head fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. Reverse U shape scalp incision was made at right parietal area and the scalp flap was elevated as usual. Total six burrholes were created followed by one 8x6cm craniotomy window. Dural tenting was done. Intra-operative sonography was used for localization of the tumor. C-shape durotomy was made based with superior sagittal sinus. Debulking of the tumor was conducted with bipolar electrocautery, scissor, tumor forceps, and suction. The hard part of the tumor was dissected along the margin and removed piece by piece. The attachement of the tumor was mainly at falx and the falx was coagulated after tumor excision. The gelatinous part of the tumor was removed by suction but the border between normal brain and the tumor was not clear. Frozen section was checked for unusual appearance. After total removal of the tumor, hemostasis was achieved with bipolar electrocautery and Surgicel lining. Duroplasty with periosteum was performed with 4-0 prolene. The skull plate was fixed back with miniplates, screws, and five central tenting. One subgaleal CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Debulking of the tumor was conducted with bipolar electrocautery, scissor, tumor forceps, and suction. The hard part of the tumor was dissected along the margin and removed piece by piece. The attachement of the tumor was mainly at falx and the falx was coagulated after tumor excision. The gelatinous part of the tumor was removed by suction but the border between normal brain and the tumor was not clear. Frozen section was checked for unusual appearance. After total removal of the tumor, hemostasis was achieved with bipolar electrocautery and Surgicel lining. Duroplasty with periosteum was performed with 4-0 prolene. The skull plate was fixed back with miniplates, screws, and five central tenting. One subgaleal CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and Appose staples. Operators VS曾漢民 Assistants R5李振豪, PGY黃薇諭 相關圖片 謝榮哲 (M,1957/02/02,55y1m) 手術日期 2011/10/17 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 陳國瑋, 時間資訊 23:41 臨時手術NPO 08:09 進入手術室 08:20 麻醉開始 08:25 抗生素給藥 08:35 誘導結束 08:50 手術開始 10:05 手術結束 10:05 麻醉結束 10:10 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除-手術時間在4小時以內 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for tumor exicion, Simpson Grade I 開立醫師: 陳國瑋 開立時間: 2011/10/17 09:46 Pre-operative Diagnosis Left high convexcity meningioma Post-operative Diagnosis Left high convexcity meningioma Operative Method Craniotomy for tumor exicion, Simpson Grade I Specimen Count And Types 1 piece About size:2cm Source:meningioma Pathology pending Operative Findings One extra-axial, soft to elastic tumor about 3 cm at left high convexitity just under the marking site. Operative Procedures After intubation and general anesthttia, the patient was put in supine postition. The marker was identifined. One longitudinal skin incisiona 5cm was made. The tumor came in sight. Tumor exisin was performed. The dura was repaired with fasia. After careful hemostasis the wound was closed in layers. Operators 曾漢民 Assistants 鍾文桂 陳國瑋 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Craniotomy for tumor exicion, Simpson Grade I 開立醫師: 陳國瑋 開立時間: 2011/10/17 09:55 Pre-operative Diagnosis Left high convexcity meningioma Post-operative Diagnosis Left high convexcity meningioma Operative Method Craniotomy for tumor exicion, Simpson Grade I Specimen Count And Types 1 piece About size:2cm Source:meningioma Pathology pending Operative Findings One extra-axial, soft to elastic tumor about 2.1 cm at left high convexitity just under the marking site. Simpson grade I tumor excision was achieved and the dura defect was repaired with fascia. Operative Procedures After intubation and general anesthttia, the patient was put in supine postition. The marker was identifined. One longitudinal skin incisiona 5cm was made. The tumor came in sight. Tumor exisin was performed. The dura was repaired with fasia. After careful hemostasis the wound was closed in layers. Operators 曾漢民 Assistants 鍾文桂 陳國瑋 相關圖片 李賜海 (M,1955/05/09,56y10m) 手術日期 2011/10/17 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Acoustic tumor 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 陳國瑋, 時間資訊 23:43 臨時手術NPO 10:00 報到 10:30 進入手術室 10:35 麻醉開始 11:00 抗生素給藥 11:05 誘導結束 11:30 手術開始 14:00 抗生素給藥 17:00 抗生素給藥 19:05 麻醉結束 19:05 手術結束 19:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4~8小時 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 9 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Right retro-sigmoid approach for tumor excision 開立醫師: 許皓淳 開立時間: 2011/10/17 19:36 Pre-operative Diagnosis Right vestibullar schwannoma Right vestibular schwannoma Post-operative Diagnosis Right vestibullar schwannoma Right vestibular schwannoma Operative Method Right retro-sigmoid approach for tumor excision Specimen Count And Types 1 piece About size:fragments Source:brain tumor Pathology pending Operative Findings The dura was tense after bone window elevated. The tumor was yellowish to greyish, elastic firm in character measured 4.8*3.6 cm with invasion into internal acoustic meatus. The CN VI, CNVII, low cranial nerve, and SCA were identified and preserved well. The CNVII was pushed paper-thin. The part of tumor entering IAC was also removed. Pons and basilar artery was noted after tumor removal. Facial stimulation was done but only orbicualris oculi was responsive. BEP remained unchanged. Operative Procedures After intubation and general anesthesia, the patient was put in 3/4 prone position. The skin was shaved, scrubbed and prepared as usual. Hockystick skin incision was made from retroauricular along midline to cervical level. The skin was retrated downward. Bone window created to the border of left transverse sinus and sigmoid sinus and then exteneded to the right side of foramen maganum. The dura was incised, and CSF was drained through foramen maganum. The cerebullum was retrated downward. Tumor removal was performed. CN VI, CNVII, low cranial nerves, and SCA were identified. Facial stimulation was done. After careful hemostasis, duroplasty was done with COOK artificial dura. The bone graft was fixed back with mini-plate. One subgaleal CWV was placed. The wound was then closed in layers. Operators 曾漢民 Assistants 鍾文桂 陳國瑋 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Right retro-sigmoid approach for tumor excision 開立醫師: 陳國瑋 開立時間: 2011/10/28 01:32 Pre-operative Diagnosis Right vestibular schwannoma Post-operative Diagnosis Right vestibular schwannoma Operative Method Right retro-sigmoid approach for tumor excision Specimen Count And Types 1 piece About size:fragments Source:brain tumor Pathology pending Operative Findings The dura was tense after bone window elevated. The tumor was yellowish to greyish, elastic firm in character measured 4.8*3.6 cm with invasion into internal acoustic meatus. The CN VI, CNVII, low cranial nerve, and SCA were identified and preserved well. The CNVII was pushed paper-thin. The part of tumor entering IAC was also removed. Pons and basilar artery was noted after tumor removal. Facial stimulation was done but only orbicualris oculi was responsive. BEP remained unchanged. Operative Procedures After intubation and general anesthesia, the patient was put in 3/4 prone position. The skin was shaved, scrubbed and prepared as usual. Hockystick skin incision was made from retroauricular along midline to cervical level. The skin was retrated downward. Bone window created to the border of left transverse sinus and sigmoid sinus and then exteneded to the right side of foramen maganum. The dura was incised, and CSF was drained through foramen maganum. The cerebullum was retrated downward. Tumor removal was performed. CN VI, CNVII, low cranial nerves, and SCA were identified. Facial stimulation was done. After careful hemostasis, duroplasty was done with COOK artificial dura. The bone graft was fixed back with mini-plate. One subgaleal CWV was placed. The wound was then closed in layers. Operators 曾漢民 Assistants 鍾文桂 陳國瑋 相關圖片 呂瑞濤 (M,1951/12/08,60y3m) 手術日期 2011/10/17 手術主治醫師 蔡瑞章 手術區域 東址 003房 03號 診斷 Lymphoma 器械術式 Stereotaxic procedure for biop 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 曾偉倫, 時間資訊 23:46 臨時手術NPO 13:30 進入手術室 13:40 抗生素給藥 13:45 麻醉開始 13:50 誘導結束 14:00 手術開始 16:25 手術結束 16:25 麻醉結束 16:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 立體定位術-切片 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: left frontal burr hole for stereotactic tumor... 開立醫師: 李振豪 開立時間: 2011/10/17 16:34 Pre-operative Diagnosis Left basal ganglion tumor, suspect lymphoma Post-operative Diagnosis Left basal ganglion tumor, suspect lymphoma Operative Method left frontal burr hole for stereotactic tumor biopsy Left frontal burr hole for stereotactic tumor biopsy Specimen Count And Types 8 piece About size:0.5x0.1x0.1 cm each one Source:Left basal ganglia tumor Pathology Frozen section:Atypical large lymphocyte was noted within the specimen. Severe artifact was noted by frozen section. Operative Findings Total eight pieces of tumor tissue was sampled under framless navigation guided. Gross pathology showed yellow-grayish in color. Atypical large lymphocyte was noted by the frozen section though severe artifact. The patient stood whole procedure well. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head fixed with Mayfield skull clamp. Navigation was set up and registration was done. The scalp was shaved, scrubbed, and disinfected as usual. One transverse scalp incision with 3cm in length was made at left frontal area followed by one burr hole creation. Two dural tenting was done. Cruciform durotomy was made and the arachnoid membrane was opened. Under framless navigation, left basal ganglion tumor stereotactic biopsy was performed with biopsy needle. Total eight pieces of specimen were sampled and the frozen section showed much lymphocyte infiltration. Hemostasis was achieved with bipolar electrocautery. The burr hole was packing with Gelfoam and bone dust. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators P 蔡瑞章 Assistants R5 李振豪 R3 曾偉倫 相關圖片 吳黃光政 (M,1937/12/12,74y3m) 手術日期 2011/10/17 手術主治醫師 陳敞牧 手術區域 東址 003房 01號 診斷 Herniation of intervertebral disc 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 曾偉倫, 時間資訊 23:45 臨時手術NPO 08:03 進入手術室 08:10 麻醉開始 08:28 誘導結束 08:35 抗生素給藥 09:00 手術開始 10:50 手術結束 10:50 麻醉結束 10:55 送出病患 11:00 進入恢復室 13:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-腰椎 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 記錄__ 手術科部: 外科部 套用罐頭: Microdiskectomy and sequestrectomy, L5-S1, left 開立醫師: 李振豪 開立時間: 2011/10/17 11:01 Pre-operative Diagnosis Ruptured intervertebral disc, L5-S1, left Post-operative Diagnosis Ruptured intervertebral disc, L5-S1, left Operative Method Microdiskectomy and sequestrectomy, L5-S1, left Specimen Count And Types nil Pathology Nil Operative Findings Sequestration of ruptured disc was noted with thecal sac and left S1 root compression. The disc space was narrowing with herniated disc and marginal spur formation. The L5-S1 disc was degenerative in character. The ruptured disc was fragmented and fragile. After microdiskectomy and sequestrectomy, the thecal sac and root expanded well. No incidental durotomy or CSF leakage noted during whole procedure. Rinderon suspension was applied around the root after decompression. The patient stood whole procedure well. Operative Procedures Under endotracheal general anesthesia, The patient was put in prone position. The L5-S1 disc level was localized by portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made at L5-S1 level. Subcutaneous soft tissue and left paravertebral muscle groups were detached. The paravertebral muscles were retracted by a modified narrow Taylor retractor which was retained constantly by a rubbersling to the side rail of the operating table. Under operating microscope, left side laminotomy was performed with Kerrison punches. The ligmentum flavum was removed during laminotomy. The epidural fat was left in situ for protection of the thecal sac. The ruptured disc was noted after retraction of the thecal. the ruptured disc was removed and the herniated disc was encountered. Microdiskectomy was performed with knife, curette, alligator, and Kerrison punches. The thecal sac and left S1 root became much loose after microdiskectomy and sequestrectomy. Hemostasis was acheived with bipolar electrocautery and Gelfoam packing. Rinderon suspension was applied around the root. The wound was then closed in layers with 2-0 vicryl and 4-0 Dexon. Operators VS陳敞牧 Assistants R5李振豪, R3曾偉倫 相關圖片 楊春菊 (F,1952/03/14,60y0m) 手術日期 2011/10/17 手術主治醫師 李崇維 手術區域 東址 000房 號 診斷 Aneurysm 器械術式 ACom aneurysm, for TAE 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 3 時間資訊 08:25 麻醉開始 08:45 誘導結束 11:40 麻醉結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 賴朝獻 (M,1924/08/20,87y6m) 手術日期 2011/10/17 手術主治醫師 王水深 手術區域 東址 017房 03號 診斷 Subdural hemorrhage or effusion 器械術式 AV shunt + Permcath 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 陳建銘, 時間資訊 17:45 報到 18:08 進入手術室 18:20 抗生素給藥 18:32 手術開始 19:47 抗生素給藥 21:00 手術結束 21:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 末稍血管修補及吻合術 1 2 B 手術 內頸靜脈切開,永久導管放置術 1 1 B 記錄__ 手術科部: 外科部 套用罐頭: AVF 開立醫師: 陳建銘 開立時間: 2011/10/17 20:54 Pre-operative Diagnosis ESRD Post-operative Diagnosis ESRD, s/p AVF creation Operative Method Arteriovenous fistula creation, Left + Permcath catheter implantation Specimen Count And Types nil Pathology Nil Operative Findings 1. The diameter of the artery was: 3 mm; and the diameter of the vein was: 3 mm 2. The anastomosis opening diameter was: 10 mm. 3. Site: radiocephalic, AVG 4. After the fistula created, a continuous thrill was felt over the fistula, bruit (+ ) Operative Procedures 1.The patient was put on supine position with left hand extended out of the operation table on the arm-board. 2.The operation field was disinfected and draped as usual. 3.Under local anesthesia, a longitudinal skin incision was madebetween the artery and the vein. 4.The vein and then the artery were dissected out from the surrounding tissue. 5.The vein was then transected and the distal end ligated. Heparin solution was used to flush the vein to test thepatency and alsoto keep it from thrombosis. 6.A bulldog was applied on the proximal end of the vein to prevent air emboli. 7.After gaining distal and proximal control of the artery by bulldogs, a longitudinal arteriotomy was performed. 8.The end of the vein was then anastomosed to the arteriotomy with 7-0 prolene continuous suture. 9.The bulldogs were released with the order of vein, distal artery, and proximal artery and the air expelled. 10.After meticulous hemeostasis,the wound was closed in layers. Operators P王水深 Assistants R4張得一,R3陳建銘 黃立身 (M,1956/05/22,55y9m) 手術日期 2011/10/18 手術主治醫師 曾漢民 手術區域 東址 003房 01號 診斷 Numbness 器械術式 Neurolysis of the uluar neuve 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 吳健暉, 時間資訊 23:57 臨時手術NPO 08:00 進入手術室 08:05 麻醉開始 08:10 誘導結束 08:25 抗生素給藥 08:33 手術開始 09:52 手術結束 09:52 麻醉結束 09:56 送出病患 10:00 進入恢復室 11:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 神經分離術-上臂.前臂.大腿.小腿處之神經 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 曾峰毅 開立時間: 2011/10/18 09:49 Pre-operative Diagnosis Tardy ulnar palsy at right Post-operative Diagnosis Tardy ulnar palsy at right Operative Method Ulnar nerve neurolysis Specimen Count And Types Nil Pathology Nil Operative Findings Adhesion was noted just 1 to 2 cm proximal to the right cubital tunnel. Compromised nerve was decompressed well. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with right arm abducted and elbow flexed. After scrubbed, disinfected, and then draped the patient's right upper limb, we made one curvilinear skin incision at right elbow. We dissected to expose ulnar nerve between olecranon and medial epiphysis. We traced the nerve to the distal part, and entry site beneath flexor carpi ulnaris was opened as well. We traced the nerve to the proximal. Adhesion site just proximal to cubital tunnel was found, and was released. The wound was closed in layers. Operators VS 曾漢民 Assistants R5 曾峰毅 R1 吳健暉 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 吳健暉 開立時間: 2011/10/18 10:01 Pre-operative Diagnosis Tardy ulnar palsy at right Post-operative Diagnosis Tardy ulnar palsy at right Operative Method Ulnar nerve neurolysis Specimen Count And Types Nil Pathology Nil Operative Findings Adhesion was noted just 1 to 2 cm proximal to the right cubital tunnel. Compromised nerve was decompressed well. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with right arm abducted and elbow flexed. After scrubbed, disinfected, and then draped the patient's right upper limb, we made one curvilinear skin incision at right elbow. We dissected to expose ulnar nerve between olecranon and medial epiphysis. We traced the nerve to the distal part, and entry site beneath flexor carpi ulnaris was opened as well. We traced the nerve to the proximal. Adhesion site just proximal to cubital tunnel was found, and was released. The wound was closed in layers. Operators VS 曾漢民 Assistants R5 曾峰毅 R1 吳健暉 相關圖片 曾秀鳳 (F,1957/11/27,54y3m) 手術日期 2011/10/18 手術主治醫師 曾漢民 手術區域 西址 039房 01號 診斷 Carpal tunnel syndrome 器械術式 Decompression of mediun nerve 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 09:00 進入手術室 09:12 麻醉開始 09:15 手術開始 09:52 手術結束 09:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 正中神經或尺神經腕部減壓術–單側 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Carpal tunnel release, left 開立醫師: 王奐之 開立時間: 2011/10/18 09:52 Pre-operative Diagnosis Carpal tunnel syndrome, left Post-operative Diagnosis Carpal tunnel syndrome, left Operative Method Carpal tunnel release, left Specimen Count And Types Nil Pathology Nil Operative Findings Hypertrophic flexor retinaculum was noted, the nerve sheath expanded well after decompression. Operative Procedures The patient was placed in supine position with right arm stretched out. After skin disinfection and draping in sterile fashion, a linear skin incision was made at left wrist, and the incision was deepened until visualization of flexor retinaculum. The retinaculum was then cut by scissors until full release. After hemostasis, the wound was closed with 4-0 Dexon and 3-0 Nylon in interrupted sutures. Operators VS 曾漢民 Assistants R4 王奐之, Ri 陳勇仁 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Carpal tunnel release, left 開立醫師: 王奐之 開立時間: 2011/10/18 09:52 Pre-operative Diagnosis Carpal tunnel syndrome, left Post-operative Diagnosis Carpal tunnel syndrome, left Operative Method Carpal tunnel release, left Specimen Count And Types Nil Pathology Nil Operative Findings Hypertrophic flexor retinaculum was noted, the nerve sheath expanded well after decompression. Operative Procedures The patient was placed in supine position with right arm stretched out. After skin disinfection and draping in sterile fashion, a linear skin incision was made at left wrist, and the incision was deepened until visualization of flexor retinaculum. The retinaculum was then cut by scissors until full release. After hemostasis, the wound was closed with 4-0 Dexon and 3-0 Nylon in interrupted sutures. Operators VS 曾漢民 Assistants R4 王奐之, Ri 陳勇仁 相關圖片 曾振添 (M,1971/07/15,40y7m) 手術日期 2011/10/18 手術主治醫師 曾勝弘 手術區域 東址 003房 03號 診斷 Malignant neoplasm of lower third of esophagus 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 吳健暉, 時間資訊 23:44 臨時手術NPO 10:35 報到 11:05 進入手術室 11:10 麻醉開始 11:20 抗生素給藥 11:40 誘導結束 11:43 手術開始 14:20 抗生素給藥 14:55 麻醉結束 14:55 手術結束 15:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT 開立醫師: 曾峰毅 開立時間: 2011/10/18 13:59 Pre-operative Diagnosis Left parietal lobe tumor, suspected metastasis Post-operative Diagnosis Left parietal lobe tumor, suspected metastasis Operative Method Left parietal craniotomy for tumor excision Specimen Count And Types Several fragments of one tumor was sent for pathology. Pathology Pending Operative Findings One normovascularied, capsulated, soft to elastic, fragile, cystic tumor was noted at left pareital lobe, just behind the sensory cortex. Operative Procedures With endotracheal general anaesthesiat, the patient was put in prone position with head fixed with Mayfield head clamp. We shaved, scrubbed, disinfected, and then draped the patient's scalp. We made one curvilinear skin incsion at left parietal area. We drilled four burr holes, and then created craniotomy. Dura incision was made in Benz-shape, and electrophysiology mapping was performed to localize motor cortex and sensory cortex. Corticotomy was performed for tumor excision. We dissected around the tumor, and removed the tumor in en-bloc. After hemostasis, dura was closed in water-tight fashion. The bone graft was fixed back with mini-plates. The wound was closed in layers. Operators VS 曾勝弘 Assistants R6 鍾文桂 R5 曾峰毅 R1 吳健暉 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT 開立醫師: 吳健暉 開立時間: 2011/10/18 15:04 Pre-operative Diagnosis Left parietal lobe tumor, suspected metastasis Post-operative Diagnosis Left parietal lobe tumor, suspected metastasis Operative Method Left parietal craniotomy for tumor excision Specimen Count And Types Several fragments of one tumor was sent for pathology. Pathology Pending Operative Findings One normovascularied, capsulated, soft to elastic, fragile, cystic tumor was noted at left pareital lobe, just behind the sensory cortex. Operative Procedures With endotracheal general anaesthesiat, the patient was put in prone position with head fixed with Mayfield head clamp. We shaved, scrubbed, disinfected, and then draped the patient's scalp. We made one curvilinear skin incsion at left parietal area. We drilled four burr holes, and then created craniotomy. Dura incision was made in Benz-shape, and electrophysiology mapping was performed to localize motor cortex and sensory cortex. Corticotomy was performed for tumor excision. We dissected around the tumor, and removed the tumor in en-bloc. After hemostasis, dura was closed in water-tight fashion. The bone graft was fixed back with mini-plates. The wound was closed in layers. Operators VS 曾勝弘 Assistants R6 鍾文桂 R5 曾峰毅 R1 吳健暉 相關圖片 林月娥 (F,1953/01/04,59y2m) 手術日期 2011/10/18 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Lumbar stenosis 器械術式 Laminectomy for decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 林哲光, 時間資訊 23:05 臨時手術NPO 08:00 進入手術室 08:10 麻醉開始 08:12 報到 08:15 誘導結束 08:30 抗生素給藥 09:03 手術開始 11:30 抗生素給藥 13:27 手術結束 13:27 麻醉結束 13:37 送出病患 13:40 進入恢復室 15:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術(減壓)-二節以內 1 4 手術 椎間盤切除術-腰椎 1 2 手術 椎融合術-前融合,無固定物(≦四節) 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 記錄__ 手術科部: 外科部 套用罐頭: L1-2 discectomy and L4-5 laminectomy with sub... 開立醫師: 林哲光 開立時間: 2011/10/18 14:08 Pre-operative Diagnosis L1-2 HIVD and L4-5 spinal canal stenosis and spondylosis Post-operative Diagnosis L1-2 HIVD and L4-5 spinal canal stenosis and spondylosis Operative Method L1-2 discectomy and L4-5 laminectomy with sublaminal decompression, neural foranotomy and posterolateral fusion with autologus bone and Sinbone Specimen Count And Types nil Pathology Nil Operative Findings Right L1-2 laminotomy was done and engorged epidural veins were noted. The L1/2 disc seemed not bulging obviously and the dura sac seemed expanded well without tension. Hypertrophic change of ligamentum flavum, bilateral facet joints and neural foramen stenosis were noted at L4, L5 level with direct compressing the cord tightly to wedge shaped and the fluid contents were few initially. Bilateral L4-S1 roots were identified and the surrounding tissue were removed. Operative Procedures Under ETGA and prone position, skin disinfected and drapped were performed as usual. Midline skin incision was made at L1-S1 level and the paraspinal muscles were detached. The right L1 and L2 laminotomy was done and the L2 root was exposed. The disc seemed not bulging obviously and engorged epidural vessels were noted. The disc was left untouched. L4-L5 laminectomy was then performed and sublaminal decompression was done. Hemostasis was done with Gelfoam packing. Posterolateral fusion was then performed after decortication along the bilateral L4, L5 facet joints to transverse process and covered with autologus bone and Sinbone. The wound was then closed in layers after epidural H/V was inserted. Operators 曾勝弘 Assistants 林哲光 相關圖片 摘要__ 手術科部: 外科部 套用罐頭: L1-2 discectomy and L4-5 laminectomy with sub... 開立醫師: 林哲光 開立時間: 2011/10/18 14:08 Pre-operative Diagnosis L1-2 HIVD and L4-5 spinal canal stenosis and spondylosis Post-operative Diagnosis L1-2 HIVD and L4-5 spinal canal stenosis and spondylosis Operative Method L1-2 discectomy and L4-5 laminectomy with sublaminal decompression, neural foranotomy and posterolateral fusion with autologus bone and Sinbone Specimen Count And Types nil Pathology Nil Operative Findings Right L1-2 laminotomy was done and engorged epidural veins were noted. The L1/2 disc seemed not bulging obviously and the dura sac seemed expanded well without tension. Hypertrophic change of ligamentum flavum, bilateral facet joints and neural foramen stenosis were noted at L4, L5 level with direct compressing the cord tightly to wedge shaped and the fluid contents were few initially. Bilateral L4-S1 roots were identified and the surrounding tissue were removed. Operative Procedures Under ETGA and prone position, skin disinfected and drapped were performed as usual. Midline skin incision was made at L1-S1 level and the paraspinal muscles were detached. The right L1 and L2 laminotomy was done and the L2 root was exposed. The disc seemed not bulging obviously and engorged epidural vessels were noted. The disc was left untouched. L4-L5 laminectomy was then performed and sublaminal decompression was done. Hemostasis was done with Gelfoam packing. Posterolateral fusion was then performed after decortication along the bilateral L4, L5 facet joints to transverse process and covered with autologus bone and Sinbone. The wound was then closed in layers after epidural H/V was inserted. Operators 曾勝弘 Assistants 林哲光 相關圖片 蔡瑞君 (F,1979/06/16,32y8m) 手術日期 2011/10/18 手術主治醫師 曾勝弘 手術區域 東址 005房 02號 診斷 Pituitary tumor 器械術式 T.S.H. (ENDOSCOPE) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 林哲光, 時間資訊 23:06 臨時手術NPO 13:50 進入手術室 13:55 麻醉開始 14:15 誘導結束 14:20 抗生素給藥 14:51 手術開始 17:15 手術結束 17:15 麻醉結束 17:25 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 經由蝶竇之腦下垂體瘤切除 1 1 摘要__ 手術科部: 外科部 套用罐頭: Endoscopic transsphnoid adenomectomy 開立醫師: 林哲光 開立時間: 2011/10/18 18:05 Pre-operative Diagnosis Pituitary macroadenoma Post-operative Diagnosis Pituitary macroadenoma Operative Method Endoscopic transsphnoid adenomectomy Specimen Count And Types 1 piece About size:7mm Source:tumor Pathology Pending Operative Findings Large spheonid sinus was noted with multiple septum formation was noted. The tumor was grayish-to-whitish, soft, 7mm in diameter, just adjacent to right ICA. The normal gland was found after tumor excision. No obvious CSF leakage was noted during the operation. Operative Procedures Under general anethesia and intubation, the patient was put in supine position with head tilted 30 degree to left. The facial skin was antiseptic with alcohol better-iodine tincture, and the mucosa of oral and nasal cavity with aqueous better-iodine . The former areas were covered by sterilized adhesive plastic sheets then draped. Under endoscope, the nasal mucosa was coagulated at right norstril. A nasal speculum was applied to displace the nasal mucosa laterally and keep the nasal cavity open constantly for the exposure of the vomer bone and the anterior wall of the sphenoid sinus. The anterior sphenoid wall and posterior sphenoid wall was remove by high speed air drill and Kerrison punch. The sellar floor dura was coagulated then opened in cruciate fashion. The soft tumor parenchyma was removed by curette and aligator. The arachnoid and the opening of diaphragm sellae was enforced by packing with gelform as in the sellar cavity. The nasal mucosa returned to its normal position. Both sides of the nasal cavities was tightly packed with two segments of rubber glove finger filled with vaseline gauze strips which had been soaked with better-iodine ointment respectively. Operators 曾勝弘,楊士弘 Assistants 林哲光 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Endoscopic transsphnoid adenomectomy 開立醫師: 林哲光 開立時間: 2011/10/18 18:05 Pre-operative Diagnosis Pituitary macroadenoma Post-operative Diagnosis Pituitary macroadenoma Operative Method Endoscopic transsphnoid adenomectomy Specimen Count And Types 1 piece About size:7mm Source:tumor Pathology Pending Operative Findings Large spheonid sinus was noted with multiple septum formation was noted. The tumor was grayish-to-whitish, soft, 7mm in diameter, just adjacent to right ICA. The normal gland was found after tumor excision. No obvious CSF leakage was noted during the operation. Operative Procedures Under general anethesia and intubation, the patient was put in supine position with head tilted 30 degree to left. The facial skin was antiseptic with alcohol better-iodine tincture, and the mucosa of oral and nasal cavity with aqueous better-iodine . The former areas were covered by sterilized adhesive plastic sheets then draped. Under endoscope, the nasal mucosa was coagulated at right norstril. A nasal speculum was applied to displace the nasal mucosa laterally and keep the nasal cavity open constantly for the exposure of the vomer bone and the anterior wall of the sphenoid sinus. The anterior sphenoid wall and posterior sphenoid wall was remove by high speed air drill and Kerrison punch. The sellar floor dura was coagulated then opened in cruciate fashion. The soft tumor parenchyma was removed by curette and aligator. The arachnoid and the opening of diaphragm sellae was enforced by packing with gelform as in the sellar cavity. The nasal mucosa returned to its normal position. Both sides of the nasal cavities was tightly packed with two segments of rubber glove finger filled with vaseline gauze strips which had been soaked with better-iodine ointment respectively. Operators 曾勝弘,楊士弘 Assistants 林哲光 相關圖片 許火龍 (M,1956/09/08,55y6m) 手術日期 2011/10/18 手術主治醫師 楊士弘 手術區域 東址 002房 01號 診斷 C5-C7 level fracture with unspecified spinal cord injury, closed 器械術式 OPLL- Anterior Corpectomy，Diskectomy cervical(Anterier) 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 07:38 通知急診手術 08:15 報到 08:23 進入手術室 08:28 麻醉開始 08:45 誘導結束 09:15 抗生素給藥 09:43 手術開始 12:10 抗生素給藥 14:15 手術結束 14:15 麻醉結束 14:25 送出病患 14:28 進入恢復室 15:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 椎間盤切除術-頸椎 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 手術 骨或軟骨移植術 1 1 手術 脊椎融合術-前融合,有固定物)≦四節 1 3 記錄__ 手術科部: 外科部 套用罐頭: Anterior Discectomy and Fusion, Cervical Spine 開立醫師: 李振豪 開立時間: 2011/10/18 14:44 Pre-operative Diagnosis 1. Ossification of posterior longitudinal ligment, C5-6, with spinal stenosis 2. C5/6 transdiscal fracture with acute spinal injury Post-operative Diagnosis 1. Ossification of posterior longitudinal ligment, C5-6, with spinal stenosis 2. C5/6 transdiscal fracture with acute spinal injury Operative Method C5 corpectomy and anterior fusion with autologous bone graft + anterior fixation with cervical plate Specimen Count And Types Nil Pathology Nil Operative Findings Hematoma within the prevertebral space and ecchymosis of longus collis muscle was noted after opening of prevertebral fascia. C5/6 transdiscal fracture was also noted which compatible with MRI study. The C5/6 intervertebral disc was calcified and marginal spur formation was noted at C4/5, C5/6 level. The C4/5 disc was healthy in character. After C5 corpectomy, the ossification of posterior longitudinal ligment was noted at lower 2/3 of the vertebral body which compressed the thecal sac tightly. The OPLL was not adhered to the dura tightly and dissection was performed with nerve hook. The OPLL was extended into upper C6 and also removed during the operation. After decompression, the thecal sac expanded well with good pulsation. No incidental durotomy or CSF leakage was noted during whole procedure. One 2.5 x 1.2 x 1.5cm autologous bone graft harvested from left anterior iliac crest was used for anterior cervical fusion. Anterior cervical fixation from C4 to C6 was performed with one 46mm cervical plate and four 4 x 14mm screws. Total blood loss: 150ml. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with neck hyperextension. Left side pelvis was elevated. The skin was scrubbed, disinfected, and draped as usual. One 5cm transverse skin incision was made at right middle neck. The platysma muscle was transected and mobilized from the underlying superficial cervical fascia which was then opened in vertical direction along the anterior margin of the SCM muscle. The dissection was advanced at the loose plane between SCM muscle and strip muscles until the prevertebral fascia had veen reached. the former structure was retracted to the lateral and the later structures with esophagus and trachea to the opposite side by Koros retractor. The prevertebral fascia was opened vertically, the lesion intervertebral space was exposed and identified by intraoperative portable X-ray. The most medial portion of the longus coli muscles on both sides were detached from the vertebral bodies to providea wider exposure of the vertebral bodies. C4/5 and C5/6 microdiskectomy was performed with curette, kerrison punches, and alligator. C5 corpectomy was done with Midas air-drived drills, rongue, and kerrison punches. The ossification of posterior longitudinal ligment and herniated disc was dissected away from the thecal sac and removed by Kerrison punches. One 5cm transverse skin incision was made at left lower flank along the anterior iliac crest. The subcutaneous soft tissue was devided. The fascia covered the anterior iliac crest was opened and the muscle was detached from the iliac bone. One 1.5 x 2.5 x 1.5cm in size tricortical bone was harvested from left anterior iliac bone. Hemostasis was achieved with bonewax, bipolar electrocautery, and Gelfoam packing. The wound was irrigated with Gentamicin and closed in layers with 1-0, 2-0 Vicryl, and 3-0 Nylon. The autologous bone graft was tailed to fit the space between C4 and C6. The bone graft was packed into the space by impactor. Anterior fixation with cervical plate and four screws were conducted. The location of the graft and cervical plate was checked by intra-operative X-ray. One CWV drain was placed into prevertebral space. The wound was irrigated with Gentamicin solution. The wound was then closed in layers with 3-0 vicryl and 4-0 Dexon. Operators VS 楊士弘 Assistants R5 李振豪, PGY 姜士中 Indication Of Emergent Operation Acute spinal cord injury with quadriplegia 相關圖片 鄭淑惠 (F,1958/05/09,53y10m) 手術日期 2011/10/18 手術主治醫師 蕭輔仁 手術區域 西址 039房 02號 診斷 Carpal tunnel syndrome 器械術式 Decompression of mediun nerve 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 09:55 進入手術室 10:17 麻醉開始 10:19 手術開始 10:50 手術結束 10:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 正中神經或尺神經腕部減壓術–單側 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Carpal tunnel release, right 開立醫師: 王奐之 開立時間: 2011/10/18 09:58 Pre-operative Diagnosis Carpal tunnel syndrome, right Post-operative Diagnosis Carpal tunnel syndrome, right Operative Method Carpal tunnel release, right Specimen Count And Types Nil Pathology Nil Operative Findings Hypertrophic flexor retinaculum was noted, the nerve sheath expanded well after decompression. Operative Procedures The patient was placed in supine position with right arm stretched out. After skin disinfection and draping in sterile fashion, a linear skin incision was made at right wrist, and the incision was deepened until visualization of flexor retinaculum. The retinaculum was then cut by scissors until full release. After hemostasis, the wound was closed with 4-0 Dexon and 3-0 Nylon in interrupted sutures. Operators VS 蕭輔仁 Assistants R4 王奐之, Ri 陳勇仁 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Carpal tunnel release, right 開立醫師: 王奐之 開立時間: 2011/10/18 09:59 Pre-operative Diagnosis Carpal tunnel syndrome, right Post-operative Diagnosis Carpal tunnel syndrome, right Operative Method Carpal tunnel release, right Specimen Count And Types Nil Pathology Nil Operative Findings Hypertrophic flexor retinaculum was noted, the nerve sheath expanded well after decompression. Operative Procedures The patient was placed in supine position with right arm stretched out. After skin disinfection and draping in sterile fashion, a linear skin incision was made at right wrist, and the incision was deepened until visualization of flexor retinaculum. The retinaculum was then cut by scissors until full release. After hemostasis, the wound was closed with 4-0 Dexon and 3-0 Nylon in interrupted sutures. Operators VS 蕭輔仁 Assistants R4 王奐之, Ri 陳勇仁 相關圖片 賴章清桂 (F,1930/03/19,81y11m) 手術日期 2011/10/18 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 Hydrocephalus 器械術式 Revision of CSF shunt 手術類別 預定手術 手術部位 腹 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 吳健暉, 時間資訊 23:57 臨時手術NPO 10:05 進入手術室 10:10 麻醉開始 10:15 誘導結束 10:15 抗生素給藥 10:26 手術開始 10:48 手術結束 10:48 麻醉結束 10:50 送出病患 10:53 進入恢復室 12:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦脊髓液分流管重置 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 曾峰毅 開立時間: 2011/10/18 10:44 Pre-operative Diagnosis Hydrocephalus, status post ventriculoperitoneal shunt via right Kocher, complicated with peritoneal shunt dislodge Post-operative Diagnosis Hydrocephalus, status post ventriculoperitoneal shunt via right Kocher, complicated with peritoneal shunt dislodge Operative Method VP Shunt revision Specimen Count And Types Nil Pathology Nil Operative Findings Subutaneous hygroma was noted at right upper abdomen. Operative Procedures With intravenous general anaesthesia, the patient was put in supine position. We scrubebd, disinfected, and then draped the patient. One transverse skin incision was made at right upper abdomen along previous operation wound. We dissected to expose peritoneal shunt, and peformed mini-laparotomy. We re-inserted peritoneal catheter into peritoneal cavity. The wound was closed in layers. Operators VS 王國川 Assistants R5 曾峰毅 R1 吳健暉 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 曾峰毅 開立時間: 2011/10/18 20:27 Pre-operative Diagnosis Hydrocephalus, status post ventriculoperitoneal shunt via right Kocher, complicated with peritoneal shunt dislodge Post-operative Diagnosis Hydrocephalus, status post ventriculoperitoneal shunt via right Kocher, complicated with peritoneal shunt dislodge Operative Method VP Shunt revision Specimen Count And Types Nil Pathology Nil Operative Findings Subutaneous hygroma was noted at right upper abdomen. Operative Procedures With intravenous general anaesthesia, the patient was put in supine position. We scrubebd, disinfected, and then draped the patient. One transverse skin incision was made at right upper abdomen along previous operation wound. We dissected to expose peritoneal shunt, and peformed mini-laparotomy. We re-inserted peritoneal catheter into peritoneal cavity. The wound was closed in layers. Operators VS 王國川 Assistants R5 曾峰毅 R1 吳健暉 相關圖片 林燕玉 (F,1960/05/17,51y9m) 手術日期 2011/10/18 手術主治醫師 王國川 手術區域 東址 003房 05號 診斷 Subarachnoid hemorrhage 器械術式 Craniotomy(Aneurysms) Others 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 4E 紀錄醫師 陳以幸, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 15:30 通知急診手術 18:35 進入手術室 18:40 麻醉開始 19:00 誘導結束 19:10 抗生素給藥 19:21 手術開始 22:20 抗生素給藥 23:30 開始輸血 01:35 手術結束 01:35 麻醉結束 01:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 開顱術摘除血管病變- 腦血管瘤 .巨大的 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Right pterional approach for aneurysm clipping 開立醫師: 曾峰毅 開立時間: 2011/10/19 02:08 Pre-operative Diagnosis Right anteriro choroidal artery aneurysm, giant Post-operative Diagnosis Right anteriro choroidal artery aneurysm, giant Operative Method Right pterional approach for aneurysm clipping Specimen Count And Types Nil Pathology Nil Operative Findings Thick subarachoid hemorrhage was noted in the basal cistern and subarachnoid hemorrhage. One wide-based giant aneurysm (largest diameter 2.7cm) arised right distal ICA, pointing posteriorly. Premature rupture at neck was encountered, and was stopped by packing. One straight, fenestrated, clip was applied to the aneurysm. Operative Procedures With endotracheal general anaesthesiat, the patient was put in supine position with head rotated to left. We shaved, scrubbed, disinfected, and then draped the patients head as usual. One curvilinear scalp incision was made at right frontotemporal area. We dissected Yasagils fat pad to preserve frontal branch of facial nerve, and reflected scalp flap inferiorly. We transected the temporalis muscle along superior temporal line. We drilled three burr holes, and created craniotomy. Sphenoidal ridge and frontal base were drilled to flat. Dura was tented along the craniotomy window, and dura incision was made in U-shape. Sylvian fissure was opened, and we traced the right ICA from the proximal. Under temporal clipping at ICA for proximal control, we clipped the aneurysm with one straight fenestrated clip. One EVD was inserted via right Paines point. Dura was closed in water tight suture. Bone graft was fixed back with mini-plates. The wound was closed in layers after one subgaleal CWV placed. Operators VS 王國川 Assistants R5 曾峰毅 R3 曾偉倫 R2 陳以幸 Indication Of Emergent Operation Aneurysmal subarachnoid hemorrhage 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Right pterional approach for aneurysm clipping 開立醫師: 陳以幸 開立時間: 2011/11/15 12:12 Pre-operative Diagnosis Right anteriro choroidal artery aneurysm, giant Post-operative Diagnosis Right anteriro choroidal artery aneurysm, giant Operative Method Right pterional approach for aneurysm clipping Specimen Count And Types Nil Pathology Nil Operative Findings Thick subarachoid hemorrhage was noted in the basal cistern and subarachnoid hemorrhage. One wide-based giant aneurysm (largest diameter 2.7cm) arised right distal ICA, pointing posteriorly. Premature rupture at neck was encountered, and was stopped by packing. One straight, fenestrated, clip was applied to the aneurysm. Operative Procedures With endotracheal general anaesthesiat, the patient was put in supine position with head rotated to left. We shaved, scrubbed, disinfected, and then draped the patients head as usual. One curvilinear scalp incision was made at right frontotemporal area. We dissected Yasagils fat pad to preserve frontal branch of facial nerve, and reflected scalp flap inferiorly. We transected the temporalis muscle along superior temporal line. We drilled three burr holes, and created craniotomy. Sphenoidal ridge and frontal base were drilled to flat. Dura was tented along the craniotomy window, and dura incision was made in U-shape. Sylvian fissure was opened, and we traced the right ICA from the proximal. Under temporal clipping at ICA for proximal control, we clipped the aneurysm with one straight fenestrated clip. One EVD was inserted via right Paines point. Dura was closed in water tight suture. Bone graft was fixed back with mini-plates. The wound was closed in layers after one subgaleal CWV placed. Operators VS 王國川 Assistants R5 曾峰毅 R3 曾偉倫 R2 陳以幸 Indication Of Emergent Operation Aneurysmal subarachnoid hemorrhage 相關圖片 吳呂綿 (F,1948/02/20,64y0m) 手術日期 2011/10/18 手術主治醫師 王國川 手術區域 西址 039房 03號 診斷 Carpal tunnel syndrome (CTS) 器械術式 Decompression of mediun nerve 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 11:05 進入手術室 11:18 麻醉開始 11:20 手術開始 11:42 手術結束 11:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 正中神經或尺神經腕部減壓術–單側 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Carpal tunnel release, left 開立醫師: 王奐之 開立時間: 2011/10/18 11:05 Pre-operative Diagnosis Carpal tunnel syndrome, left Post-operative Diagnosis Carpal tunnel syndrome, left Operative Method Carpal tunnel release, left Specimen Count And Types Nil Pathology Nil Operative Findings Hypertrophic flexor retinaculum was noted, the nerve sheath expanded well after decompression. Operative Procedures The patient was placed in supine position with right arm stretched out. After skin disinfection and draping in sterile fashion, a linear skin incision was made at left wrist, and the incision was deepened until visualization of flexor retinaculum. The retinaculum was then cut by scissors until full release. After hemostasis, the wound was closed with 3-0 Dexon and 4-0 Nylon in interrupted sutures. Operators VS 王國川 Assistants R4 王奐之, Ri 陳勇仁 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Carpal tunnel release, left 開立醫師: 王奐之 開立時間: 2011/10/18 11:05 Pre-operative Diagnosis Carpal tunnel syndrome, left Post-operative Diagnosis Carpal tunnel syndrome, left Operative Method Carpal tunnel release, left Specimen Count And Types Nil Pathology Nil Operative Findings Hypertrophic flexor retinaculum was noted, the nerve sheath expanded well after decompression. Operative Procedures The patient was placed in supine position with right arm stretched out. After skin disinfection and draping in sterile fashion, a linear skin incision was made at left wrist, and the incision was deepened until visualization of flexor retinaculum. The retinaculum was then cut by scissors until full release. After hemostasis, the wound was closed with 3-0 Dexon and 4-0 Nylon in interrupted sutures. Operators VS 王國川 Assistants R4 王奐之, Ri 陳勇仁 相關圖片 摘要__ 手術科部: 外科部 套用罐頭: Carpal tunnel release, left 開立醫師: 王奐之 開立時間: 2011/10/18 11:06 Pre-operative Diagnosis Carpal tunnel syndrome, left Post-operative Diagnosis Carpal tunnel syndrome, left Operative Method Carpal tunnel release, left Specimen Count And Types Nil Pathology Nil Operative Findings Hypertrophic flexor retinaculum was noted, the nerve sheath expanded well after decompression. Operative Procedures The patient was placed in supine position with right arm stretched out. After skin disinfection and draping in sterile fashion, a reversed L-shaped skin incision was made at left wrist, and the incision was deepened until visualization of flexor retinaculum. The retinaculum was then cut by scissors until full release. After hemostasis, the wound was closed with 3-0 Dexon and 4-0 Nylon in interrupted sutures. Operators VS 王國川 Assistants R4 王奐之, Ri 陳勇仁 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Carpal tunnel release, left 開立醫師: 王奐之 開立時間: 2011/10/18 11:06 Pre-operative Diagnosis Carpal tunnel syndrome, left Post-operative Diagnosis Carpal tunnel syndrome, left Operative Method Carpal tunnel release, left Specimen Count And Types Nil Pathology Nil Operative Findings Hypertrophic flexor retinaculum was noted, the nerve sheath expanded well after decompression. Operative Procedures The patient was placed in supine position with right arm stretched out. After skin disinfection and draping in sterile fashion, a reversed L-shaped skin incision was made at left wrist, and the incision was deepened until visualization of flexor retinaculum. The retinaculum was then cut by scissors until full release. After hemostasis, the wound was closed with 3-0 Dexon and 4-0 Nylon in interrupted sutures. Operators VS 王國川 Assistants R4 王奐之, Ri 陳勇仁 相關圖片 高崇武 (M,1941/02/24,71y0m) 手術日期 2011/10/18 手術主治醫師 吳振吉 手術區域 東址 021房 05號 診斷 Chronic renal failure 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3 紀錄醫師 黃彥傑, 時間資訊 17:20 進入手術室 17:25 麻醉開始 17:30 誘導結束 17:36 手術開始 17:55 手術結束 17:55 麻醉結束 18:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 氣管切開術 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 耳鼻喉部 套用罐頭: Tracheostomy 開立醫師: 黃彥傑 開立時間: 2011/10/19 02:28 Pre-operative Diagnosis Respiratory distress Post-operative Diagnosis Respiratory distress, operated Operative Method Tracheostomy Specimen Count And Types nil Pathology Nil Operative Findings tracheostomy in place Operative Procedures The patient was in supine position with neck hyperextended. Skin was disinfected and draped as usual. Local anesthesia with Bosmin-rinsed Xylocaine was injected into the subcutaneous tissue and the pretracheal area layer by layer. A vertical skin incision was made in the midline of lower neck. Subcutaneous tissue, fascia and strap muscles were separated, then the thyroid gland was seen and hooked upwards with thyroid hooks. The tracheal rings were cut in longitudinal direction. An oval-shaped window was made at the 2 nd to 3 rd rings. A 6# shiley tracheostomy tube was inserted. The patient tolerated the above procedure well. Operators Asp吳振吉, Assistants R2黃彥傑, R2曾文萱, R2陳姵妤, R4李建賢, 徐銘夆 (M,1982/12/05,29y3m) 手術日期 2011/10/18 手術主治醫師 林峰盛 手術區域 西址 035房 09號 診斷 Failed back syndrome 器械術式 Epi' catheter implantation/ PC 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 林峰盛 ASA 2 時間資訊 15:25 進入手術室 15:30 麻醉開始 15:35 誘導結束 15:40 手術開始 15:50 手術結束 15:50 麻醉結束 15:55 送出病患 摘要__ 手術科部: 麻醉部 套用罐頭: RF lesioning 開立醫師: 劉映汝 開立時間: 2011/10/18 15:58 Pre-operative Diagnosis low back pain R/O SI joint pain Post-operative Diagnosis low back pain favored SI joint pain Operative Method diagnostic SI joint injection diagnostic bil S1-S3 lat branch block Specimen Count And Types nil Pathology Nil Operative Findings Operative Procedures 1.LA with 1%xylocaine. 2.patient in prone position 3. Under fluoroscopic-guidance, bil SI joint injection 0.5% Marcaine 1ml+kenacort 5 per joint 4. diagnostic bil S1-S3 lateral branch block with 1% xylocaine per branch Operators 林峰盛, Assistants 劉映汝, 楊陳月桃 (F,1936/05/26,75y9m) 手術日期 2011/10/19 手術主治醫師 杜永光 手術區域 東址 003房 03號 診斷 Meningioma 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 曾偉倫, 時間資訊 23:17 臨時手術NPO 15:40 報到 15:55 進入手術室 16:00 麻醉開始 16:10 抗生素給藥 16:10 誘導結束 16:40 手術開始 17:35 手術結束 17:35 麻醉結束 17:47 送出病患 17:50 進入恢復室 19:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 記錄__ 手術科部: 外科部 套用罐頭: Ventriculo-peritoneal shunt via right Kocher"... 開立醫師: 李振豪 開立時間: 2011/10/19 17:59 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculo-peritoneal shunt via right Kocher"s approach Specimen Count And Types nil Pathology Nil Operative Findings The opening pressure was about 7~8 cmH2O. The CSF was clear in character with slightly xanthochromic. total 15ml CSF was sampled for routine, biochemistry, and bacterial culture. Codman 10cmH2O fixed pressure reservoir was implanted. The ventricular and peritoneal catheter was 7cm and 30cm in depth respectively. The shunt function was checked before wound closure. No acute complication was noted during whole procedure. Operative Procedures Under tracheostomy general anesthesia, the patient was put in supine position with head rotated to left and right shoulder elevation. The skin was scrubbed, disinfected, and draped as usual. Right frontal linear scalp incision was made followed by one burr hole creation at Kocher"s point. Two dural tenting was done. Cruciform durotomy was performed and ventriculostomy was created with puncture needle. Nelaton was inserted for evaluation of opening pressure and CSF sampling. One transverse skin incision was made at right lower abdomen and the subcutaneous soft tissue was devided. The rectus abdominis muscle was splitted and minilaparotomy was conducted. Subcutaneous tunnel from right lower abdomen, right forechest(near midline), right neck, to right retroauricular area was created. One small skin incision at right temporal area was made at the end of the subcutaneous tunnel. The peritoneal catheter was passed through the subcutaneous tunnel. The reservoir was passed through subgaleal space and connected with the peritoneal and ventricular catheter. The function of the shunt was checked. The ventricular catheter was then inserted into right lateral ventricle. The function of the shunt was checked again and CSF was sampled for total 15ml in amount. The peritoneal catheter was placed into peritoneal cavity under direct vision. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators Prof. 杜永光 Assistants R5 李振豪 R3 曾偉倫 相關圖片 黃于恩 (F,2002/09/22,9y5m) 手術日期 2011/10/19 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Pituitary tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 2 紀錄醫師 曾偉倫, 時間資訊 07:14 臨時手術NPO 08:02 進入手術室 08:05 麻醉開始 08:40 誘導結束 08:51 抗生素給藥 09:27 手術開始 11:20 手術結束 11:20 麻醉結束 11:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經由蝶竇之腦下垂體瘤切除 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Trans-nasal trans-sphenoidal adenomectomy 開立醫師: 李振豪 開立時間: 2011/10/19 12:07 Pre-operative Diagnosis Pituitary tumor Post-operative Diagnosis Pituitary tumor Operative Method Trans-nasal trans-sphenoidal adenomectomy Specimen Count And Types 1 piece About size:0.5x0.5x0.5 cm Source:Pituitary tumor Pathology Pending Operative Findings The tumor was whitish, soft and fragile, well-capsulated, hypovascularized, and 9 x 6 x7mm in size. The normal gland was pushed superoposteriorly. CSF leakage due to arachnoid membrane defect was noted after tumor excision. The defect was sealed with Gelfoam, Surgicel, and Tissucol Duo. The sphenoid sinus also packing with Gelfoam, Surgicel, and Tissucol Duo to avoid further CSF leakage. Lumbar drain was placed via L3/4 level for CSF diversion after whole procedure. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head tilted 30 degree to left and mild neck extension. The face and right lower abdomen were prepared with povidone-iodine alcohol tincture, and the mucosa of oral and nasal cavity with aqueous povidone- iodine tincture. The operative field were covered by a sterilized adhesive plastic sheet and draped as usual. The nasal submucosa at septum was infiltrated with 1:1000 epinephrine + Xylocaine solution. A 2cm mucosa incision was made at right side nasal septum and the mucosa was dissected away from the septum and vomer bone. The nasal septum was fractured to left side along the junction between cartilage and vomer bone. The left side mucosa covered the vomer bone was dissected away. A Hardys nasal speculum was applied to displace the nasal mucosa laterally and keep the nasal cavity open constantly for the exposure of the vomer bone and the anterior wall of the sphenoid sinus. The floor of sphenoid sinus was opened with Nomi and the sinus mucosa was removed. The sellar floor was identified and opened with Nomi and Kerrison punches. The dura was coagulated with bipolar forceps and then opened in cruciate fashion. The soft tumor parenchyma was removed by ring curette, tumor forceps, and alligator. The normal gland was noted superoposterior to the tumor. Diaphragm sellae was seen after tumor excision. CSF leakage was noted and the sellar region was sealed with Gelfoam, Surgicel, and Tissucol Duo. The sphenoid sinus also packing with Gelfoam, Surgicel, and Tissucol Duo. The bony fragment was placed back for skull base and vomer bone reconstruction. The nasal mucosa and nasal septum were pushed back to neutral position. Merocel soaked with Better-iodine ointment was placed into bilateral nasal cavity for nasal packing. Lumbar drain via L3/4 level was placed and fixed at 10cm in depth for CSF diversion. Operators Prof. 杜永光 Assistants R5 李振豪, R3 曾偉倫 相關圖片 鄭安盛 (M,1970/05/06,41y10m) 手術日期 2011/10/19 手術主治醫師 杜永光 手術區域 東址 003房 02號 診斷 Pituitary Tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 2 紀錄醫師 曾偉倫, 時間資訊 07:16 臨時手術NPO 11:43 進入手術室 11:45 麻醉開始 11:49 報到 12:20 誘導結束 12:45 抗生素給藥 13:06 手術開始 15:20 麻醉結束 15:20 手術結束 15:27 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經由蝶竇之腦下垂體瘤切除 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Trans-nasal trans-sphenoidal adenomectomy 開立醫師: 李振豪 開立時間: 2011/10/19 15:50 Pre-operative Diagnosis Recurrent pituitary adenoma Post-operative Diagnosis Recurrent pituitary adenoma Operative Method Trans-nasal trans-sphenoidal adenomectomy Specimen Count And Types 1 piece About size:1x0.5x0.5 cm Source:Pituitary tumor Pathology pending Operative Findings The sphenoid sinus was entered directly during dissection between mucosa and cartilage of the nasal septum. Calcification of nasal septum cartilage was noted also. The septum within the sphenoid sinus was thickening. The dura of the sellar region was visualized directly via the defect of sellar floor. After durotomy, the tumor could not be found initially. After dissection with ring curette, the tumor was discovered anterior to the durotomy. The tumor was red-grayish, soft with some elastic part, well-capsulated, hypovascularized, and 1.2 x 1.0 x 1.1 cm in size. Normal gland was noted after tumor excision. Large arachnoid defect was found after durotomy with active CSF leakage. The defect was sealed with Gelfoam, Surgicel, and Tissucol Duo. The sphenoid sinus also packing with Gelfoam, Surgicel, and Tissucol Duo to avoid further CSF leakage. Lumbar drain was placed via L4/5 level for CSF diversion after whole procedure. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head tilted 30 degree to left and mild neck extension. The face and right lower abdomen were prepared with povidone-iodine alcohol tincture, and the mucosa of oral and nasal cavity with aqueous povidone-iodine tincture. The operative field were covered by a sterilized adhesive plastic sheet and draped as usual. The nasal submucosa at septum was infiltrated with 1:1000 epinephrine + Xylocaine solution. A 2cm mucosa incision was made at right side nasal septum and the mucosa was dissected away from the septum and vomer bone. The nasal septum was fractured to left side. A Hardys nasal speculum was applied to displace the nasal mucosa laterally and keep the nasal cavity open constantly for the exposure of the vomer bone. When we trace along the submucosa plane, one large bony defect was exposed and sphenoid sinus was entered. The mucosa within the sphenoid sinus was dissected and the bony defect and dura of sellar floor were identified. The dura was coagulated with bipolar forceps and then opened in cruciate fashion. After identification of the tumor location, the tumor was removed by ring curette, tumor forceps, and alligator. The normal gland was noted after tumor excision. Large arachnoid defect with CSF leakage was noted and the sellar region was sealed with Gelfoam, Surgicel, and Tissucol Duo. The sphenoid sinus also packing with Gelfoam, Surgicel, and Tissucol Duo. The bony fragment was placed back for skull base and vomer bone reconstruction. The nasal mucosa and nasal septum were pushed back to neutral position. Merocel soaked with Better-iodine ointment was placed into bilateral nasal cavity for nasal packing. Lumbar drain via L4/5 level was placed and fixed at 10cm in depth for CSF diversion. Operators Prof.杜永光 Assistants R5李振豪, R3曾偉倫 相關圖片 鄧旭煜 (M,1983/12/18,28y2m) 手術日期 2011/10/19 手術主治醫師 林文瑛 手術區域 西址 036房 06號 診斷 Malignant neoplasm of brain, unspecified 器械術式 Port-A Implatation /WOR 手術類別 臨時手術 手術部位 胸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 林文瑛 ASA 2 紀錄醫師 劉映汝, 時間資訊 13:30 報到 13:40 進入手術室 13:45 麻醉開始 13:47 誘導結束 13:50 抗生素給藥 14:05 手術開始 14:30 手術結束 14:30 麻醉結束 14:43 送出病患 14:48 進入恢復室 15:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 手術 port–A導管植入術–治療性導管植入術 1 0 R 記錄__ 手術科部: 麻醉部 套用罐頭: Port-A implantation, subclavian 開立醫師: 劉映汝 開立時間: 2011/10/19 14:19 Pre-operative Diagnosis Brain tumor Post-operative Diagnosis Ditto Operative Method Port-A implantation, echo-guided Specimen Count And Types nil Pathology Nil Operative Findings 1.Site: right subclavian vein, with echo-guided procedure 2.Patent flow after implantation 3.Others: nil Operative Procedures 1.The patient was set on supine position and bilateral subclavian veins were checked by echo. 2.After IVGA and local anesthesia applied, transverse skin incision for 3cm was made at pre-cordial area. 3.Undermine the skin at the layer between subcutaneous tissue and deep fascia in lateral direction. 4.An IV catheter was inserted via the subclavian incision and negatively aspirated until venous blood attainable. 5.J-wire was inserted smoothly in rostral direction. A subclavian catheter with dilator was inserted through the J-wire, and the dilator was then removed. 6.The catheter of Port-A was threaded into the subclavian vein until mark 23 cm. The catheter was adapted into the port and locked with restrictor.The Port was inserted into the pouch of pre-cordial incision. 6.The catheter of Port-A was threaded into the subclavian vein until mark 22 cm. The catheter was adapted into the port and locked with restrictor.The Port was inserted into the pouch of pre-cordial incision. 7.Skin was closed layer by layer. Both catheter and port were perfused with heparin solution after implantation. Operators 林文瑛 Assistants 劉映汝 姚邦仁 (M,1951/10/20,60y4m) 手術日期 2011/10/19 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Meningioma 器械術式 Benign intraspinal tumor, exci 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 2 紀錄醫師 陳國瑋, 時間資訊 23:20 臨時手術NPO 15:18 進入手術室 15:25 麻醉開始 15:40 誘導結束 15:45 抗生素給藥 16:31 手術開始 19:30 手術結束 19:30 麻醉結束 19:40 送出病患 19:42 進入恢復室 21:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 良性脊髓腫瘤切除術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: L1 laminoplasty for intradural extramedullay ... 開立醫師: 鍾文桂 開立時間: 2011/10/19 19:27 Pre-operative Diagnosis Intradural extramedullay spinal tumor, L1-L2. Post-operative Diagnosis Multiple intradural extramedullay spinal tumors, L1-L2. Operative Method L1 laminoplasty for intradural extramedullay spinal tumor excision. Specimen Count And Types 1 piece About size:5 pieces Source:Intraspinal tumor Pathology Pending. Operative Findings Total of 5 neuromas were excised. The tumors arised from the spinal roots. They are whitish, well-delineated with moderate vascularity. The spinal roots were kept intact. L1 laminoplasty was done with fixation by miniplates and screws. Operative Procedures Under ETGA, the patient was placed in prone position. After intraoperative fluoroscopy for localization of L1 level, the operative field was disinfection, and draped. A vertical linear skin incision was made at L1 level. With paraspinal dissection, the L1 lamina was exposed. Grooving of the L1 lamina was done with high speed drill. After removal of the ligamentum flavum, a vertical durotomy was done. The spinal tumor was excised by using ring forceps and dissector. The dural was closed in watertight fashion by 5-0 prolene. L1 lamina was fixed by miniplates and screws. The wound was closed in layers with one 1/8 hemovac. Operators 曾漢民 Assistants 鍾文桂 陳國瑋 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: L1 laminoplasty for intradural extramedullay ... 開立醫師: 陳國瑋 開立時間: 2011/10/19 19:54 Pre-operative Diagnosis Intradural extramedullay spinal tumor, L1-L2. Post-operative Diagnosis Multiple intradural extramedullay spinal tumors, L1-L2. Operative Method L1 laminoplasty for intradural extramedullary spinal tumor excision. Specimen Count And Types 1 piece About size:5 pieces Source:Intraspinal tumor Pathology Pending. Operative Findings Total of 5 neuromas were excised. The tumors arised from the spinal roots. They are whitish, well-delineated with moderate vascularity. The spinal roots were kept intact. L1 laminoplasty was done with fixation by miniplates and screws. Operative Procedures Under ETGA, the patient was placed in prone position. After intraoperative fluoroscopy for localization of L1 level, the operative field was disinfection, and draped. A vertical linear skin incision was made at L1 level. With paraspinal dissection, the L1 lamina was exposed. Grooving of the L1 lamina was done with high speed drill. After removal of the ligamentum flavum, a vertical durotomy was done. The spinal tumor was excised by using ring forceps and dissector. The dural was closed in watertight fashion by 5-0 prolene. L1 lamina was fixed by miniplates and screws. The wound was closed in layers with one 1/8 hemovac. Operators 曾漢民 Assistants 鍾文桂 陳國瑋 相關圖片 趙晟宇 (M,1962/08/09,49y7m) 手術日期 2011/10/19 手術主治醫師 蔡瑞章 手術區域 東址 005房 01號 診斷 Brain metastasis 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 2 紀錄醫師 陳國瑋, 時間資訊 23:18 臨時手術NPO 08:05 進入手術室 08:16 麻醉開始 08:30 抗生素給藥 08:35 誘導結束 08:55 手術開始 11:30 抗生素給藥 14:30 抗生素給藥 14:55 手術結束 14:55 麻醉結束 15:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除-手術時間在4~8小時 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Frontal craniotomy for tumor excision 開立醫師: 陳國瑋 開立時間: 2011/10/19 12:40 Pre-operative Diagnosis Lung cancer with brain metastasis Post-operative Diagnosis Lung cancer with brain metastasis Lung cancer with brain metastasis, right frontal. Operative Method Frontal craniotomy for tumor excision Specimen Count And Types 1 piece About size:fragments Source:brain tumor Pathology pending Operative Findings Pink-grayish, soft, elastic tumor at frontal pole and high frontal areas. Intraoperative mapping of the motor cortex revealed the corticotomy is 3 cm anterior to the motor cortex. The frontal sinus was entered and skeletonized. It was sealed with bone wax and pericranium. The olfactory nerve,right was exposed and left intact. The falx cerebri and right frontal base were noted after tumor resection. Operative Procedures After intubation and general anesthesia, the patient was put in supine position. The head was fixed with Mayfield clamp. The skin was scrubbed, disinfected and drapped as usual. Bicoronal skin incision was made and the skin was pushed forward. One 12*5 cm craniotomy was made and the dura was incised and reflected medially. Sonography was used for tumor localization and tumor excision was done. After intubation and general anesthesia, the patient was put in supine position. The head was fixed with Mayfield clamp. The skin was scrubbed, disinfected and drapped as usual. Bicoronal skin incision was made and the skin was pushed forward. One 12*5 cm craniotomy was made and the dura was incised and reflected medially. Sonography was used for tumor localization and tumor excision was done. After well hemostasis, the dura mater was closed in water tight fashion. The craniotomy plate was fixed by miniplates and screws. The wound was closed in layers with one subgaleal drain. Operators Prof. 蔡瑞章 Assistants 鍾文桂 陳國瑋 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Frontal craniotomy for tumor excision 開立醫師: 陳國瑋 開立時間: 2011/10/19 15:12 Pre-operative Diagnosis Lung cancer with brain metastasis Post-operative Diagnosis Lung cancer with brain metastasis, right frontal. Operative Method Frontal craniotomy for tumor excision Specimen Count And Types 1 piece About size:fragments Source:brain tumor Pathology pending Operative Findings Pink-grayish, soft, elastic tumor at frontal pole and high frontal areas. Intraoperative mapping of the motor cortex revealed the corticotomy is 3 cm anterior to the motor cortex. The frontal sinus was entered and skeletonized. It was sealed with bone wax and pericranium. The olfactory nerve,right was exposed and left intact. The falx cerebri and right frontal base were noted after tumor resection. Operative Procedures After intubation and general anesthesia, the patient was put in supine position. The head was fixed with Mayfield clamp. The skin was scrubbed, disinfected and drapped as usual. Bicoronal skin incision was made and the skin was pushed forward. One 12*5 cm craniotomy was made and the dura was incised and reflected medially. Sonography was used for tumor localization and tumor excision was done. The frontal sinus opening was sealed with bone wax and pericranium. After well hemostasis, the dura mater was closed in water tight fashion. The craniotomy plate was fixed by miniplates and screws. The wound was closed in layers with one subgaleal drain. Operators Prof. 蔡瑞章 Assistants 鍾文桂 陳國瑋 相關圖片 陳艷莉 (F,1956/10/13,55y5m) 手術日期 2011/10/19 手術主治醫師 王水深 手術區域 兒醫 068房 02號 診斷 Endometrial cancer 器械術式 Port-A implantation 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 黃世銘, 時間資訊 11:00 進入手術室 11:10 抗生素給藥 11:15 麻醉開始 11:17 誘導結束 11:20 手術開始 11:45 手術結束 11:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 內頸靜脈切開,永久導管放置術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Port-A 開立醫師: 黃世銘 開立時間: 2011/10/19 11:45 Pre-operative Diagnosis Endometrial cancer Post-operative Diagnosis Endometrial cancer s/p Port-A implantation Operative Method Port-A catheter implantation, echo guided Specimen Count And Types Nil Pathology Nil Operative Findings 1.Puncture to right IJV under echo guidance 2.The venous blood flow freely in the Port-A catheter after implantation. Operative Procedures 1. The patient was put on supine position. The operation field was disinfected and draped as usual. 2. Under local anesthesia, we puncture to right IJV under echo guidance. 3. After creating subcutaneous pocket, the Port-A catheter was inserted via peel away sheath. 4. We close the wound in layers. Operators VS王水深 Assistants R3黃世銘 相關圖片 黃俊嘉 (M,1971/11/26,40y3m) 手術日期 2011/10/19 手術主治醫師 王碩盟 手術區域 東址 015房 07號 診斷 Malignant neoplasm of trachea 器械術式 Cystoscopy 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 靜脈麻醉 麻醉主治醫師 林佩玲 ASA 3 紀錄醫師 胡哲源, 時間資訊 18:17 報到 18:20 進入手術室 18:25 麻醉開始 18:30 誘導結束 18:40 手術開始 18:50 手術結束 18:50 麻醉結束 18:55 送出病患 18:56 進入恢復室 20:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 膀胱鏡檢查 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 記錄__ 手術科部: 泌尿部 套用罐頭: cystoscopy（biopsy ) 開立醫師: 胡哲源 開立時間: 2011/10/19 18:58 Pre-operative Diagnosis hematuria Post-operative Diagnosis hematuria Operative Method cystoscopy Specimen Count And Types nil Pathology nil Operative Findings 1. prostate vessel engorgement 2. no obvious bladder tumor 3. bilateral clear efflux Operative Procedures Under satisfactory anesthesia with the patient in lithotomy position, prepping and drapping was performed in the usual sterile fashion. A Fr 21 Olympus cystoscope was introduced into the bladder cavity under direct vision. Careful inspection revealed no obvious bladder tumor. A Fr 18 Foley catheter was inserted. Patient tolerated the procedure very well and was sent to recovery room in satisfactory condition. Operators 王碩盟, Assistants 胡哲源, 曾任偉, 單定寰 (M,1965/12/20,46y2m) 手術日期 2011/10/19 手術主治醫師 楊士弘 手術區域 東址 002房 05號 診斷 Low back pain 器械術式 Diskectomy lumbar 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 1E 紀錄醫師 鄭宇軒, 時間資訊 00:24 臨時手術NPO 00:24 開始NPO 12:24 通知急診手術 14:18 進入手術室 14:22 麻醉開始 14:28 誘導結束 14:35 抗生素給藥 15:25 手術開始 17:10 麻醉結束 17:10 手術結束 17:22 送出病患 17:25 進入恢復室 18:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 椎間盤切除術-腰椎 1 1 摘要__ 手術科部: 外科部 套用罐頭: Microsurgical diskectomy 開立醫師: 楊士弘 開立時間: 2011/10/19 17:12 Pre-operative Diagnosis Lumbosacral herniated intervertebral disc, left L5-S1 Post-operative Diagnosis Lumbosacral herniated intervertebral disc, left L5-S1 Operative Method Microsurgical diskectomy Specimen Count And Types nil Pathology Nil Operative Findings The left S1 root was compressed tightly by herniated disc. The disc was subligamental (PLL) and ruptured through a defect of the annulus. The fragment measured about 2 cm x 2 cm x 2 cm in size. The left S1 root became slack after decompression. Operative Procedures 1. ETGA, prone. 2. C-arm localization of L5-S1 level. 3. Left paramedian incision. 4. Insertion of K-pin and sequential dilators for insertion of a 2.3 cm diametered tubular retractor, which was fixed by a holder. 5. Visualization of left L5-S1 interlaminar space under microscope. 6. Left lower L5 laminotomy by Kerrison punches and a high speed drill. 7. Excision of ligamentum flavum. 8. Medial retraction of left S1 root to expose the ruptured disc and L5-S1 disc space. 9. Excision of ruptured disc by knife, disc forceps, and currets/ 10. Irrigation of the epidural space with Rinderon solution. 11. Wound closure in layers. Operators 楊士弘 Assistants 曾峰毅, 鄭宇軒 Indication Of Emergent Operation Severe sciatica and left leg numbness 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Microsurgical diskectomy 開立醫師: 鄭宇軒 開立時間: 2011/10/21 12:01 Pre-operative Diagnosis Lumbosacral herniated intervertebral disc, left L5-S1 Post-operative Diagnosis Lumbosacral herniated intervertebral disc, left L5-S1 Operative Method Microsurgical diskectomy Specimen Count And Types nil Pathology Nil Operative Findings The left S1 root was compressed tightly by herniated disc. The disc was subligamental (PLL) and ruptured through a defect of the annulus. The fragment measured about 2 cm x 2 cm x 2 cm in size. The left S1 root became slack after decompression. Operative Procedures 1. ETGA, prone. 2. C-arm localization of L5-S1 level. 3. Left paramedian incision. 4. Insertion of K-pin and sequential dilators for insertion of a 2.3 cm diametered tubular retractor, which was fixed by a holder. 5. Visualization of left L5-S1 interlaminar space under microscope. 6. Left lower L5 laminotomy by Kerrison punches and a high speed drill. 7. Excision of ligamentum flavum. 8. Medial retraction of left S1 root to expose the ruptured disc and L5-S1 disc space. 9. Excision of ruptured disc by knife, disc forceps, and currets/ 10. Irrigation of the epidural space with Rinderon solution. 11. Wound closure in layers. Operators 楊士弘 Assistants 曾峰毅, 鄭宇軒 Indication Of Emergent Operation Severe sciatica and left leg numbness 相關圖片 謝苡臻 (F,2011/10/06,5m10d) 手術日期 2011/10/19 手術主治醫師 楊士弘 手術區域 兒醫 067房 01號 診斷 Hydrocephalus 器械術式 Ommaya reservoir implantation 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 5 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 08:35 進入手術室 08:36 麻醉開始 08:45 誘導結束 09:00 抗生素給藥 09:30 手術開始 10:00 手術結束 10:00 麻醉結束 10:07 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 歐氏貯囊置放手術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 套用罐頭: Ommaya reservoir implantation via right Koche... 開立醫師: 王奐之 開立時間: 2011/10/19 10:21 Pre-operative Diagnosis Prematurity with extremely low birth weight, complicated with intraventricular hemorrhage and hydrocephalus Post-operative Diagnosis Prematurity with extremely low birth weight, complicated with intraventricular hemorrhage and hydrocephalus Operative Method Ommaya reservoir implantation via right Kocher point Specimen Count And Types 1 piece About size:5ml Source:CSF Pathology Nil Operative Findings Bulging anterior fontanelle was noted, along with widening of coronal suture. Brownish CSF (implying previous hemorrhage) gushed out after durotomy. A neonate Ommaya reservoir was implanted smoothly, smooth CSF flow was confirmed after insertion of the reservoir. The fontanelle became less tense after evacuation of 5ml CSF. Opening pressure upon ventriculostomy: 5~10 cmH2O. Estimated blood loss: minimal. Operative Procedures Under endotracheal general anesthesia, the patient was placed in supine position. After shaving, scrubbing, disinfection & draping in sterile fashion, a linear incision was made at right frontal area, followed by subgaleal dissection posterior to the incision for the reservoir pocket. A linear incision was made over the periosteum, then a small cruciate durotomy was done. After careful hemostasis, a small corticotomy was performed with bipolar electrocautery. Ventriculostomy was performed once, and the Ommaya reservoir was inserted. After confirmation of smooth CSF flow and meticulous hemostasis, the wound was closed in 5-0 Maxon & 6-0 Nylon continuous sutures. Operators VS 楊士弘 Assistants R4 王奐之, Ri 陳勇仁 相關圖片 記錄__ 手術科部: 套用罐頭: Ommaya reservoir implantation via right Koche... 開立醫師: 王奐之 開立時間: 2011/10/19 10:21 Pre-operative Diagnosis Prematurity with extremely low birth weight, complicated with intraventricular hemorrhage and hydrocephalus Post-operative Diagnosis Prematurity with extremely low birth weight, complicated with intraventricular hemorrhage and hydrocephalus Operative Method Ommaya reservoir implantation via right Kocher point Specimen Count And Types 1 piece About size:5ml Source:CSF Pathology Nil Operative Findings Bulging anterior fontanelle was noted, along with widening of coronal suture. Brownish CSF (implying previous hemorrhage) gushed out after durotomy. A neonate Ommaya reservoir was implanted smoothly, smooth CSF flow was confirmed after insertion of the reservoir. The fontanelle became less tense after evacuation of 5ml CSF. Opening pressure upon ventriculostomy: 5~10 cmH2O. Estimated blood loss: minimal. Operative Procedures Under endotracheal general anesthesia, the patient was placed in supine position. After shaving, scrubbing, disinfection & draping in sterile fashion, a linear incision was made at right frontal area, followed by subgaleal dissection posterior to the incision for the reservoir pocket. A linear incision was made over the periosteum, then a small cruciate durotomy was done. After careful hemostasis, a small corticotomy was performed with bipolar electrocautery. Ventriculostomy was performed once, and the Ommaya reservoir was inserted. After confirmation of smooth CSF flow and meticulous hemostasis, the wound was closed in 5-0 Maxon & 6-0 Nylon continuous sutures. Operators VS 楊士弘 Assistants R4 王奐之, Ri 陳勇仁 相關圖片 許翁素貞 (F,1962/01/10,50y2m) 手術日期 2011/10/20 手術主治醫師 蔡翊新 手術區域 東址 002房 06號 診斷 Subarachnoid hemorrhage 器械術式 Craniotomy(Aneurysms) P-DUH; A-comanuerysm rupture for clipping 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林峰盛 ASA 3E 紀錄醫師 怡安, 時間資訊 09:00 開始NPO 17:16 通知急診手術 23:50 報到 23:50 進入手術室 00:05 麻醉開始 00:10 抗生素給藥 00:10 誘導結束 00:20 手術開始 04:57 抗生素給藥 06:25 麻醉結束 06:25 手術結束 06:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 開顱術摘除血管病變 - 腦血管瘤 有病徵的 1 1 L 手術 顱內壓視置入 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 記錄__ 手術科部: 外科部 套用罐頭: Aneurysm-frontotemporal approach 開立醫師: 蔡翊新 開立時間: 2011/10/20 06:11 Pre-operative Diagnosis A-com artery aneurysm rupture with SAH. Post-operative Diagnosis A-com artery aneurysm rupture with SAH. Operative Method Left pterional craniotomy for aneurysm clipping and left Kocher point EVD for ICP monitoring. Specimen Count And Types nil Pathology Nil. Operative Findings CSF was clean initially and then sanguinous. The pressure was 5 cmH2O. Subarachnoid blood clots and adhesions were noted at prechiasmatic cistern and around the A-com complex. There was a saccular aneurysm arising from the junction of left A1 and anterior communicating artery, pointing to right and superiorly. The neck of the aneurysm was 6 mm and the dome was 10 mm with a daughter aneurysm arising from its dome and adhered to right frontal lobe. The aneurysm was clipped by a 135-degree angled, 8 mm Sugita clip and a small residual neck was clipped by a straight, 4-mm Sugita clip. After clipping, the dome of the aneurysm shrank following puncture of its body. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with left back elevated and head rotated to right for 40 degree and slightly extended then fixed by Mayfield skull clamp. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: left frontotemporal, curvilinear. The skin edge was clipped by Raney clips for temporary hemostasis. After scalp had been lifted, the temporalis muscle was incised and detached from temporal squama and reflected to lower temporal side. 5. Craniotomy window: 10 x 6 cm, left frontotemporal, created by making 3 burr holes then cut by power saw. The lower temporalbone and pterionic ridge (esp. the inner table) were cut by rongeur and high-speed airdrill as low as possible for easy approach to the anterior clinoid. 6. Dural tention: by 2/0 silk, 2.5 cm in interval, distributed along the edge of skull window. 7. Dural incision: V shape, over-ridding Sylvian fissure and reflected to frontotemporal base. 8. Ventricular tapping and drainage of CSF was made via a burr hole at left Kocher point to slacken down the brain for easy approach to anterior clinoid without undue traction on the brain. 9. Under operating microscope, the suprasellar cistern was opened. The left optic nerve and ICA came into view. The arachnoid trabeculi and the fibrin (or blood clot) were cleaned out and left rectal gyrus was excised to expose the neck of the aneurysm. The neck of the aneurysm was mobilized gently by a Gage 18 sucker and a fine tip bipolar forceps until it was entirely free. 10.The aneurysm was clipped by a 135-degree angled, 8 mm Sugita clip and a small residual neck was clipped by a straight, 4-mm Sugita clip. After clipping, the dome of the aneurysm shrank following puncture of its body. 11.After successful clipping of the aneurysm, the exposed field was irrigated with N.S. to make sure no any bleeding. 12.The brain retractors were removed. The dura was closed water-tight by running suture with 4/0 Prolene. 13.Closure of skull window: the skull plate was placed back to craniotomy window and fixed by 3 miniplates and 6 screws. The dura was tented to the center of the skull plate by a 2/0 stitch. The covering muscle was closed by interrupted stitches with 1/ 0 silk. 14.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 15.Drain: one subgaleal CWV. 16.Blood transfusion: nil. Blood loss: 300 ml. 17.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R6鍾文桂R0怡安 Indication Of Emergent Operation ANEURYSM RUPTURE, TO PREVENT REBLEEDING. 相關圖片 林雪鳳 (F,1967/08/02,44y7m) 手術日期 2011/10/19 手術主治醫師 蔡翊新 手術區域 東址 002房 05號 診斷 Intracerebral hemorrhage 器械術式 Removal of ICH 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林峰盛 ASA 4E 紀錄醫師 怡安, 時間資訊 17:34 通知急診手術 17:34 臨時手術NPO 17:34 開始NPO 18:07 進入手術室 18:10 麻醉開始 18:30 誘導結束 19:07 手術開始 19:15 開始輸血 21:00 抗生素給藥 22:43 手術結束 22:43 麻醉結束 22:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 開顱術摘除血管病變 - 腦血管瘤 有病徵的 1 1 R 手術 顱內壓視置入 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: CVA 開立醫師: 蔡翊新 開立時間: 2011/10/19 22:43 Pre-operative Diagnosis Right frontal ICH, suspected mycotic aneurysm rupture. Post-operative Diagnosis Right frontal mycotic aneurysm rupture with ICH, brain abscess and meningitis. Operative Method Right frontotemporoparietal craniectomy for excision of mycotic aneurysm, removal of ICH and abscess, and intraparenchymal ICP monitoring. Specimen Count And Types 2 culture swabs; several pieces of brain abscess tissue and one mycotic aneurysm Pathology Pending. Operative Findings The dura was tense upon craniectomy. Initial ICP was 64 mmHg and the brain was pale. The brain bulged out rapidly after dural opening. There was pus gushed out from a ruptured site of right posterior frontal cortex. An active bleeding mycotic aneurysm at surface of right middle frontal gyrus was noted, adjacent to which subarachnoid hemorrhage and pus accumulation at subarachnoid space were noted. Beneath the cortical surface around the mycotic aneurysm, there was a large ICH, measured about 60 ml, in the right frontal lobe. At the posterior aspect of the ICH, brain abscess with fragile brain tissue was evacuated, leading to the ruptured site at right posterior frontal area. After ICH and brain abscess removal, the brain was less bulged. The ICP after duroplasty was 2 mmHg and after skin closure was 8 mmHg. The dura was tense upon craniectomy. Initial ICP was 64 mmHg and the brain was pale. The brain bulged out rapidly after dural opening. There was pus gushed out from a ruptured site of right posterior frontal cortex. An active bleeding mycotic aneurysm at surface of right middle frontal gyrus was noted, adjacent to which subarachnoid hemorrhage and pus accumulation at subarachnoid space were noted. Beneath the cortical surface around the mycotic aneurysm, there was a large ICH, measured about 60 ml, in the right frontal lobe. At the posterior aspect of the ICH, brain abscess with fragile brain tissue was evacuated, leading to the ruptured site at right posterior frontal area. After ICH and brain abscess removal, the brain was less bulged. The ICP after duroplasty was 2 mmHg and after skin closure was 8 mmHg. The reference of Codman ICP monitor: 526. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: right frontotemporoparietal, curvilinear. The skin edge was clipped by Raney clips for temporary hemostasis. After scalp had been lifted, the temporalis muscle was incised and detached from temporalsquama and reflected to lower temporal side. 5. Craniectomy: 10 x 10 cm, right frontotemporoparietal area, by making 4 burr holes. 6. Dural tenting: by 2/0 silk, 3 cm in interval, distributed along the edge of skull window. 7. Dural incision: curvilinear along the craniectomy window. 8. The mycotic aneurysm was coagulated and excised. The ICH was evacuated and the brain abscess was removed. Hemostasis was achieved by bipolar coagulator and Surgicel packing. Before closure of the dura, the hematoma caivty was clean and the brain once bulging was slightly slack. 9. Dural closure: interrupted 2/0 silk sutures for key stitches, then continous sutures with 4/0 Vicryl with a fascial graft. A dural defect at bone edge was repaired by a piece of DuroGen to obtain water-tight closure. 10.The craniectomy bone graft was removed and preserved at bone bank. 11.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Dexon and skin by continuous suture with 3/0 nylon. 12.Drain: two epidural CWV. 13.Blood transfusion: PRBC 6U. Blood loss: 800 ml. 14.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R6鍾文桂R5林哲光R0怡安 Indication Of Emergent Operation IICP, conscious deterioration. 相關圖片 林進吉 (M,1966/02/11,46y1m) 手術日期 2011/10/20 手術主治醫師 陳敞牧 手術區域 東址 005房 02號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 林哲光, 時間資訊 23:07 臨時手術NPO 10:40 報到 10:49 進入手術室 10:55 麻醉開始 11:20 誘導結束 11:30 抗生素給藥 11:35 手術開始 14:30 抗生素給藥 17:30 抗生素給藥 18:05 開始輸血 20:05 麻醉結束 20:05 手術結束 20:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 10 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 顱底瘤手術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Right retrosigmoid approach for subtotal tumo... 開立醫師: 林哲光 開立時間: 2011/10/20 20:56 Pre-operative Diagnosis Right cerebellopontine angle tumor, acoustic neuroma Post-operative Diagnosis Right cerebellopontine angle tumor, acoustic neuroma Operative Method Right retrosigmoid approach for subtotal tumor excision Specimen Count And Types 1 piece About size:4cm sized Source:tumor Pathology Pending Operative Findings One yellowish, soft-to-elastic, well-demarcated mass lesion was noted at right cerebellopontine angle with direct compressing the low cranial nerves downward and CN5 tightly. Right CN7-8 complex was not exposed during the operation. The tumor attached to acoustic meatus was left untouched. Part of the tumor was tightly adherent to the pons and easily touch bleeding during the dissection and it was left there. Intraoperative CN7 stimulation for localization was done but there was no finding. Upper and inferior part of the tumor were removed and the low cranial nerves, CN5 and petrosal vein were identified and left intact. Operative Procedures Under ETGA and 3/4 prone position and fixed with Mayfield head clamp, skin disinfected and drapped were performed as usual. A curvilinear skin incision was made and a fasica flap was excised for duroplasty. Two burr holes were then created and a craniotomy was then done to expose the S-T junction. A C-shaped dura opening was done. CSF drainage was done via cisterna Magnum and the brain retractor was applied on the cerebellum to expose the tumor well. Tumor excision was done with central debulking and part of the tumor was left near the acoustic meatus and left untouched; another part of the tumor adherent to pons was easily touch bleeding during the dissection and left untouched there. Dura was then closed in water-tie method after hemostasis and the skull bone was put back with miniplates fixation. The wound was then closed in layers. Operators 陳昶牧 Assistants 林哲光 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Right retrosigmoid approach for subtotal tumo... 開立醫師: 林哲光 開立時間: 2011/10/20 20:56 Pre-operative Diagnosis Right cerebellopontine angle tumor, acoustic neuroma Post-operative Diagnosis Right cerebellopontine angle tumor, acoustic neuroma Operative Method Right retrosigmoid approach for subtotal tumor excision Specimen Count And Types 1 piece About size:4cm sized Source:tumor Pathology Pending Operative Findings One yellowish, soft-to-elastic, well-demarcated mass lesion was noted at right cerebellopontine angle with direct compressing the low cranial nerves downward and CN5 tightly. Right CN7-8 complex was not exposed during the operation. The tumor attached to acoustic meatus was left untouched. Part of the tumor was tightly adherent to the pons and easily touch bleeding during the dissection and it was left there. Intraoperative CN7 stimulation for localization was done but there was no finding. Upper and inferior part of the tumor were removed and the low cranial nerves, CN5 and petrosal vein were identified and left intact. Operative Procedures Under ETGA and 3/4 prone position and fixed with Mayfield head clamp, skin disinfected and drapped were performed as usual. A curvilinear skin incision was made and a fasica flap was excised for duroplasty. Two burr holes were then created and a craniotomy was then done to expose the S-T junction. A C-shaped dura opening was done. CSF drainage was done via cisterna Magnum and the brain retractor was applied on the cerebellum to expose the tumor well. Tumor excision was done with central debulking and part of the tumor was left near the acoustic meatus and left untouched; another part of the tumor adherent to pons was easily touch bleeding during the dissection and left untouched there. Dura was then closed in water-tie method after hemostasis and the skull bone was put back with miniplates fixation. The wound was then closed in layers. Operators 陳昶牧 Assistants 林哲光 相關圖片 吳安元 (M,1944/10/20,67y4m) 手術日期 2011/10/20 手術主治醫師 王國川 手術區域 東址 005房 01號 診斷 Cerebral infarction 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 林哲光, 時間資訊 23:03 臨時手術NPO 08:02 進入手術室 08:05 麻醉開始 08:15 誘導結束 08:30 抗生素給藥 09:10 手術開始 10:30 麻醉結束 10:31 手術結束 10:38 送出病患 10:40 進入恢復室 12:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 頭顱成形術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Craniplasty with autologus bone graft, right ... 開立醫師: 林哲光 開立時間: 2011/10/20 10:23 Pre-operative Diagnosis Right F-T-P skull bone defect Post-operative Diagnosis Right F-T-P skull bone defect Operative Method Craniplasty with autologus bone graft, right F-T-P Specimen Count And Types nil Pathology Nil Operative Findings Right F-T-P skull bone defect was noted. The dura seemed intact without obvious tear. Burr holes were packed with bone cement. Operative Procedures Under ETGA and supine position, skin disinfected and drapped were performed as usual. Skin incison along the previous operative wound was done. The plane between galea and dura was dissceted and until the bone edge was all exposed well. The skull bone tinged with Gentamycin solution was put back and fixed with miniplates after central tenting was done. The bone cement was covered at burr holes and temporal part for cosmetic reason. The wound was then closed in layers after a subgaleal drain insertion. Operators 王國川 Assistants 林哲光 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Craniplasty with autologus bone graft, right ... 開立醫師: 林哲光 開立時間: 2011/10/20 10:23 Pre-operative Diagnosis Right F-T-P skull bone defect Post-operative Diagnosis Right F-T-P skull bone defect Operative Method Craniplasty with autologus bone graft, right F-T-P Specimen Count And Types nil Pathology Nil Operative Findings Right F-T-P skull bone defect was noted. The dura seemed intact without obvious tear. Burr holes were packed with bone cement. Operative Procedures Under ETGA and supine position, skin disinfected and drapped were performed as usual. Skin incison along the previous operative wound was done. The plane between galea and dura was dissceted and until the bone edge was all exposed well. The skull bone tinged with Gentamycin solution was put back and fixed with miniplates after central tenting was done. The bone cement was covered at burr holes and temporal part for cosmetic reason. The wound was then closed in layers after a subgaleal drain insertion. Operators 王國川 Assistants 林哲光 相關圖片 王治 (F,1940/04/08,71y11m) 手術日期 2011/10/20 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 Lumbar spondylosis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鄭宇軒, 時間資訊 23:01 臨時手術NPO 13:10 報到 13:44 進入手術室 13:50 麻醉開始 14:00 誘導結束 14:20 抗生素給藥 14:35 手術開始 16:30 開始輸血 17:20 抗生素給藥 19:40 手術結束 19:40 麻醉結束 19:55 送出病患 19:57 進入恢復室 21:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 摘要__ 手術科部: 外科部 套用罐頭: 1. Lower L3 to upper L5 laminectomy for subla... 開立醫師: 王奐之 開立時間: 2011/10/20 20:17 Pre-operative Diagnosis 1. L3/4 spondylolisthesis, grade I 2. L4-5 spinal canal stenosis Post-operative Diagnosis 1. L3/4 spondylolisthesis, grade I 2. L4-5 spinal canal stenosis Operative Method 1. Lower L3 to upper L5 laminectomy for sublaminar decompression, with L3-5 trans-pedicle screws insertion for posterior fixation 2. L3-4, L4-5 microsurgical discectomy, L3-4 & L4-5 cage insertion for interbody fusion Specimen Count And Types Nil Pathology Nil Operative Findings 1. Easy oozing was noted and significant bleeding was encountered, especially from the venous plexus posterior to the PLL. Estimated blood loss: 2000ml. 2. Two banana cage (PEEK cage) were used, 10mm for C3-4 level & 9mm for C4-5 level. 3. Six trans-pedicle screws were inserted to bilateral C3/4/5 pedicles, with location & trajectory confirmed with intra-operative C-arm. Two rods & 1 cross-link bar were used. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position. The level of C3/4/5 pedicles were marked under C-arm guidance. After scrubbing, disinfection & draping in sterile fashion, a midline linear incision was made at lower back. The incision was deepened through fascial layer, until the spinous processes were exposed. The paraspinal muscles were detached from the spinous processes, until the facets were exposed. Lower L3 to upper L5 laminectomy were then performed for decompression under microscopic view, followed by L3-4 & L4-5 cage insertion. 6 trans-pedicle screws were inserted, rods & cross-link bar were subsequently set. After hemostasis and setting up one hemovac drain, the wound was closed in layers. Operators VS 王國川 Assistants R4 王奐之, PGY 鄭宇軒 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: 1. Lower L3 to upper L5 laminectomy for subla... 開立醫師: 王奐之 開立時間: 2011/10/20 20:17 Pre-operative Diagnosis 1. L3/4 spondylolisthesis, grade I 2. L4-5 spinal canal stenosis Post-operative Diagnosis 1. L3/4 spondylolisthesis, grade I 2. L4-5 spinal canal stenosis Operative Method 1. Lower L3 to upper L5 laminectomy for sublaminar decompression, with L3-5 trans-pedicle screws insertion for posterior fixation 2. L3-4, L4-5 microsurgical discectomy, L3-4 & L4-5 cage insertion for interbody fusion Specimen Count And Types Nil Pathology Nil Operative Findings 1. Easy oozing was noted and significant bleeding was encountered, especially from the venous plexus posterior to the PLL. Estimated blood loss: 2000ml. 2. Two banana cage (PEEK cage) were used, 10mm for C3-4 level & 9mm for C4-5 level. 3. Six trans-pedicle screws were inserted to bilateral C3/4/5 pedicles, with location & trajectory confirmed with intra-operative C-arm. Two rods & 1 cross-link bar were used. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position. The level of C3/4/5 pedicles were marked under C-arm guidance. After scrubbing, disinfection & draping in sterile fashion, a midline linear incision was made at lower back. The incision was deepened through fascial layer, until the spinous processes were exposed. The paraspinal muscles were detached from the spinous processes, until the facets were exposed. Lower L3 to upper L5 laminectomy were then performed for decompression under microscopic view, followed by L3-4 & L4-5 cage insertion. 6 trans-pedicle screws were inserted, rods & cross-link bar were subsequently set. After hemostasis and setting up one hemovac drain, the wound was closed in layers. Operators VS 王國川 Assistants R4 王奐之, PGY 鄭宇軒 相關圖片 賴禹鈞 (M,1996/09/24,15y5m) 手術日期 2011/10/20 手術主治醫師 蔡翊新 手術區域 東址 003房 01號 診斷 Major trauma rated 16 or above on the severity scale ( Injury severity score >=16 ) 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鄭宇軒, 時間資訊 23:06 臨時手術NPO 08:08 進入手術室 08:22 麻醉開始 08:28 誘導結束 09:00 抗生素給藥 09:16 手術開始 12:00 抗生素給藥 13:15 手術結束 13:15 麻醉結束 13:30 送出病患 13:33 進入恢復室 15:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 頭顱成形術 1 2 L 手術 深部傷口處理縫合擴創-大 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 手術 頭顱成形術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Cranioplasty 開立醫師: 蔡翊新 開立時間: 2011/10/20 11:04 Pre-operative Diagnosis Bilateral frontotemporoparietal skull defects. Post-operative Diagnosis Bilateral frontotemporoparietal skull defects. Operative Method Bilateral cranioplasty with autologous bone grafts preserved at abdominal wall. Specimen Count And Types nil Pathology Nil. Operative Findings Skull defects at bilateral F-T-P areas, 12 x 10 cm at right side and 10 x 8 cm at left side. The original bone plates were preserved at lower abdominal wall. The margins of bone plates showed some absorption by his own body. The dura was slack after elevation of scalp flap. The temporalis muscle was possibly resected during previous craniectomy. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation:shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with a sterilized adhesive plastic sheet. 4. Incision: along the previous operation scar at right F-T-P area, Raney clips were applied to the scalp edge for temporary hemostasis. 5. The right F-T-P scalp was dissected away from the underlying dura. 6. The bleeders on the dissected surfaces were coagulated with Bovie painstakingly. 7. The edge of the skull defect was exposed. 8. The original skull plate preserved at subcutanuous layer of lower abdominal wall was removed and placed back to the skull window then fixed by 3 miniplates and 6 screws and several dura tentings at the center of the skull plate. 9. Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 3/0 Vicryl and skin by continuous suture with 3/0 nylon. 10.Drain: two epidural CWV drains. One subcutaneous CWV drain at abdominal wound. 11.The same procedure was performed at left side. 12.Blood transfusion: nil. 13.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R4王奐之R0鄭宇軒Ri陳勇仁 相關圖片 倪甜麗 (F,1992/05/25,19y9m) 手術日期 2011/10/21 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Pineal gland cancer 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 1 紀錄醫師 曾偉倫, 時間資訊 07:48 臨時手術NPO 08:10 進入手術室 08:17 麻醉開始 08:56 誘導結束 09:00 抗生素給藥 09:05 手術開始 12:05 抗生素給藥 14:40 手術結束 14:40 麻醉結束 14:55 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除-手術時間在4小時以內 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Interhemispheric, transcallosal approach for ... 開立醫師: 李振豪 開立時間: 2011/10/21 14:32 Pre-operative Diagnosis Pineal gland tumor, suspect germinoma Post-operative Diagnosis Pineal gland tumor, favor germinoma Operative Method Interhemispheric, transcallosal approach for tumor biopsy Specimen Count And Types 1 piece About size:0.5 x 0.5 x 0.5 cm Source:Pineal tumor Pathology Frozen section: Germinoma Operative Findings One small cortical vein was sacrified during interhemispheric approach. The other larger one cortical vein was preserved well. The brain bulging out and interhemispheric approach was difficult to conduct. So right Frazier"s external ventricular drainage was placed for CSF diversion. Total 20~30ml CSF was released and the brain became flat. About less than 2cm callosotomy was performed at genu of corpus callosum and left lateral ventricle was entered. Choroid plexus and posterior choroidal artery was noted. We opened the medial part of the ventricle and internal cerebral vein was identified. The third ventricle was entered through the space between bilateral internal cerebral vein. The tumor was well-capsulated(very thick and hard capsule), hypervascularized, gray-reddish in color, and soft in character. Red-brownish color fluid was noted within the tumor. The tumor was mainly located at posterior part of the third ventricle which just below the internal cerebral vein. The Frozen section was sent and germinoma was favored. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position with head fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. C-shape scalp incision was made at right occipital area and the scalp flap was elevated. Four burrholes were created followed by one 7x5cm craniotomy window. Dural tenting was done. Bleeding from superior sagittal sinus was packing with Gelfoam. C-shape durotomy was conducted based with superior sagittal sinus. Right Frazier"s external ventricular drainage was placed and fixed at 8cm in depth for CSF diversion. Intra-operative sonography was used for localization of the tumor. Interhemispheric approach was used for tumor biopsy. Left lateral ventricle was entered after callosotomy. The internal cerebral vein was identified after opened the roof of third ventricle. The tumor was noted at posterior part of the 3rd ventricle. Tumor biopsy was performed with alligator. Hemostasis was achieved with bipolar electrocautery and Surgicel lining. Dura was closed with 4-0 Prolene. The skull plate was fixed back with miniplates, screws, and two central tenting. One subgaleal CWV drain was placed. Externalization of the ventricular drainage was done. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators Prof. 杜永光 Assistants R5 李振豪 R3 曾偉倫 Ri 王美婷 相關圖片 黃素華 (F,1932/11/27,79y3m) 手術日期 2011/10/21 手術主治醫師 杜永光 手術區域 東址 003房 02號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 曾偉倫, 時間資訊 23:50 臨時手術NPO 15:20 進入手術室 15:25 麻醉開始 15:42 抗生素給藥 15:50 誘導結束 16:00 手術開始 18:00 開始輸血 18:42 抗生素給藥 20:20 手術結束 20:20 麻醉結束 21:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除-手術時間在4小時以內 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Right frontal craniotomy for Simpson grade II... 開立醫師: 曾偉倫 開立時間: 2011/10/21 20:45 Pre-operative Diagnosis Right frontal pole meningioma Post-operative Diagnosis Right frontal pole meningioma Operative Method Right frontal craniotomy for Simpson grade II tumor excision Specimen Count And Types 1 piece About size:3.5 x 3.6 x 6cm Source:Right frontal meningioma Pathology Pending Operative Findings Remarkable adhesion of epidural space and thin dura over frontal area was noted during craniotomy. One 2cm dura laceration was noted at left frontal area. Much feeding artery of tumor was noted at dura with diffuse active oozing. Bleeding from superior sagittal sinus also noted. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. Cranialization of bilateral frontal sinus was performed(packing with better-iodine soaked Gelfoam and sealed with Bonewax). The tumor was 3.5 x 3.6 x 6cm in size, soft, hypervascularized, well-demarcated, and gray-reddish in color. The attachment was mainly around the crista galli and anterior frontal convexity. After total removal of the tumor, the dura was coagulated for Simpson grade II tumor excision. Mild swelling of the brain was noted after tumor excision. The dura was repaired with periosteum and Durafoam. The pedicle periosteum flap was reflected into epidural space to avoid CSF leakage. An episode of hypotension with desaturation was noted during the wound closure. CVC was inserted and the follow up TEE showed no decreased contractility or air embolism sign. Hypovolemia was considered and fluid were given. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. Bicoronal scalp incision was made along previous operative scar. The scalp flap was elevated and the periosteum was elevated as pedicle flap. Three burrholes were created followed by one 9x8cm craniotomy window. Dural tenting was done. Bleeding from superior sagittal sinus and feeding artery of the tumor was coagulated with bipolar electrocautery. C-shape durotomy was made based with superior sagittal sinus. The tumor was detached from the dura and dissected away from frontal lobe along the arachnoid plane. En block tumor excision was performed. Hemostasis was achieved with bipolar electrocautery, Surgicel, and Gelfoam packing. One dura laceration was noted at left frontal area. Dura was repaired with periosteum. Right frontal duroplasty was conducted with dural foam. The pedicle periosteum flap was reflected into epidural space to avoid further CSF leakage. The skull plate was fixed back with miniplates, screws, and central tenting. One subgaleal CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators Prof.杜永光 Assistants R5李振豪, R5曾峰毅, R3曾偉倫 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Right frontal craniotomy for Simpson grade II... 開立醫師: 曾偉倫 開立時間: 2011/10/21 20:45 Pre-operative Diagnosis Right frontal pole meningioma Post-operative Diagnosis Right frontal pole meningioma Operative Method Right frontal craniotomy for Simpson grade II tumor excision Specimen Count And Types 1 piece About size:3.5 x 3.6 x 6cm Source:Right frontal meningioma Pathology Pending Operative Findings Remarkable adhesion of epidural space and thin dura over frontal area was noted during craniotomy. One 2cm dura laceration was noted at left frontal area. Much feeding artery of tumor was noted at dura with diffuse active oozing. Bleeding from superior sagittal sinus also noted. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. Cranialization of bilateral frontal sinus was performed(packing with better-iodine soaked Gelfoam and sealed with Bonewax). The tumor was 3.5 x 3.6 x 6cm in size, soft, hypervascularized, well-demarcated, and gray-reddish in color. The attachment was mainly around the crista galli and anterior frontal convexity. After total removal of the tumor, the dura was coagulated for Simpson grade II tumor excision. Mild swelling of the brain was noted after tumor excision. The dura was repaired with periosteum and Durafoam. The pedicle periosteum flap was reflected into epidural space to avoid CSF leakage. An episode of hypotension with desaturation was noted during the wound closure. CVC was inserted and the follow up TEE showed no decreased contractility or air embolism sign. Hypovolemia was considered and fluid were given. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. Bicoronal scalp incision was made along previous operative scar. The scalp flap was elevated and the periosteum was elevated as pedicle flap. Three burrholes were created followed by one 9x8cm craniotomy window. Dural tenting was done. Bleeding from superior sagittal sinus and feeding artery of the tumor was coagulated with bipolar electrocautery. C-shape durotomy was made based with superior sagittal sinus. The tumor was detached from the dura and dissected away from frontal lobe along the arachnoid plane. En block tumor excision was performed. Hemostasis was achieved with bipolar electrocautery, Surgicel, and Gelfoam packing. One dura laceration was noted at left frontal area. Dura was repaired with periosteum. Right frontal duroplasty was conducted with dural foam. The pedicle periosteum flap was reflected into epidural space to avoid further CSF leakage. The skull plate was fixed back with miniplates, screws, and central tenting. One subgaleal CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators Prof.杜永光 Assistants R5李振豪, R5曾峰毅, R3曾偉倫 相關圖片 劉芸琪 (F,1982/06/27,29y8m) 手術日期 2011/10/21 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 陳國瑋, 時間資訊 23:51 臨時手術NPO 08:05 進入手術室 08:15 麻醉開始 08:50 誘導結束 09:00 抗生素給藥 09:34 手術開始 12:00 抗生素給藥 14:35 手術結束 14:35 麻醉結束 14:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Right retrosigmoid approach for total tumor e... 開立醫師: 鍾文桂 開立時間: 2011/10/21 15:05 Pre-operative Diagnosis Right vestibullar schwannoma Post-operative Diagnosis Right vestibullar schwannoma Operative Method Right retrosigmoid approach for total tumor excision. Specimen Count And Types 1 piece About size:fragments Source:brain tumor Pathology Pending. Operative Findings Soft, yellowish-gray, well-delineated tumor was removed totally. The tumor inside the internal acoustic meatus was removed totally. The emptied meatus was sealed with muscle graft and TissuColDuo. CN VII was kept intact and its function was ensured with intraoperative facial nerve stimulation. The CN IV,V,VI,VII, and low cranial nerves were kept intact. Some injury to right cerebellar hemisphere was noted due to diffucult tumor resection on the cerebellar part( soft tissue character -> hard to find arachnoid plane.) Operative Procedures After intubation and general anesthesia, the patient was put in 3/4 prone position. The skin was shaved, scrubbed and prepared as usual. A vertical linear skin incision was made from retroauricular cross midline to cervical level. The skin was retrated downward. Bone window created to the border of right transverse sinus and sigmoid sinus. The dura was incised, and the cerebellum was retracted medially. Tumor removal was performed in piecemeal fashion by using dissector, bipolar electrocoagulation, and suction. The internal acoustic meatus was drilled for further tumor resection. Facial stimulation was performed. After careful hemostasis, duroplasty was done with fascia. The bone graft was fixed back with mini-plate and screws. The wound was closed in layers. Operators 曾漢民 Assistants 鍾文桂 陳國瑋 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Right retrosigmoid approach for total tumor e... 開立醫師: 陳國瑋 開立時間: 2011/10/21 15:10 Pre-operative Diagnosis Right vestibular schwannoma Post-operative Diagnosis Right vestibular schwannoma Operative Method Right retrosigmoid approach for total tumor excision. Specimen Count And Types 1 piece About size:fragments Source:brain tumor Pathology Pending. Operative Findings Soft, yellowish-gray, well-delineated tumor was removed totally. The tumor inside the internal acoustic meatus was removed totally. The emptied meatus was sealed with muscle graft and TissuCol Duo. CN VII was kept intact and its function was ensured with intraoperative facial nerve stimulation. The CN IV,V,VI,VII, and low cranial nerves were kept intact. Some injury to right cerebellar hemisphere was noted due to diffucult tumor resection on the cerebellar part( soft tissue character -> hard to find arachnoid plane.) Operative Procedures After intubation and general anesthesia, the patient was put in 3/4 prone position. The skin was shaved, scrubbed and prepared as usual. A vertical linear skin incision was made at retroauricular area. The skin was retraced aside. Bone window created to the border of right transverse sinus and sigmoid sinus. The dura was incised, and the cerebellum was retracted medially. Tumor removal was performed in piecemeal fashion by using dissector, bipolar electrocoagulation, and suction. The internal acoustic meatus was drilled for further tumor resection. Facial stimulation was performed. After careful hemostasis, duroplasty was done with fascia. The bone graft was fixed back with mini-plate and screws. The wound was closed in layers. Operators 曾漢民 Assistants 鍾文桂 陳國瑋 相關圖片 石田玉梅 (F,1944/04/20,67y10m) 手術日期 2011/10/21 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Brain Tumor 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 陳國瑋, 時間資訊 23:52 臨時手術NPO 14:55 進入手術室 14:58 麻醉開始 15:35 誘導結束 15:40 抗生素給藥 16:05 手術開始 16:50 開始輸血 18:40 手術結束 18:40 抗生素給藥 18:40 麻醉結束 18:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 顱底瘤手術 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Left fronto-orbital craniotomy for tumor exci... 開立醫師: 陳國瑋 開立時間: 2011/10/21 20:13 Pre-operative Diagnosis Left middle third sphenoid ridge tumor with bone involvment Post-operative Diagnosis Left middle third sphenoid ridge tumor with bone involvment suspected meningioma Operative Method Left fronto-orbital craniotomy for tumor excision, Simpson grade II Specimen Count And Types 1 piece About size:3 Source:meningioma. Pathology Pending Operative Findings Soft, grayish, tumor arising from dura was noted at left sphenoid ridge. Some part of the overlying bone was fragile and was trimmed off with air-drill. The dura was also thickened too. The lateral wall and roof of the orbital cavity were opened. One extraocular muscle came in sight after opening into the orbital cavity. Operative Procedures After intubation and general anesthesia, the patient was put in supine position with left shoulder elevated and head turning to right. The skin was shaved, scrubbed and disinfected as usual. The skin incision was made from forhead to preauricular area. The skin was retrated downward to the level of upper margin of orbital ring. The temporalis muscle muscle was detached along superior temroral line and retracted backward. Four burr holes were made. Fronto-orbital craniotomy was done. The orbital roof was further opened with Rongeur and the sphenoid ridge was drilled. The dura was opened and the tumor excision was done. The overlying bone graft was drilled and Rongeured. After careful hemostasis, the dura was repaired with temporalis fascia. The bone graft was fixed back with mini-plates and crews. One CWV was set and the wound was closed in layers. Operators VS 曾漢民 Assistants 鍾文桂 陳國瑋 相關圖片 江淑芬 (F,1954/04/22,57y10m) 手術日期 2011/10/21 手術主治醫師 曾漢民 手術區域 東址 019房 01號 診斷 Herniation of intervertebral disc without myelopathy, cervical (HIVD) 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 2 紀錄醫師 吳健暉, 時間資訊 23:54 臨時手術NPO 08:05 進入手術室 08:15 麻醉開始 08:22 抗生素給藥 08:30 誘導結束 09:05 手術開始 11:25 抗生素給藥 12:20 手術結束 12:20 麻醉結束 12:30 送出病患 12:31 進入恢復室 14:31 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 椎間盤切除術-頸椎 1 1 手術 脊椎融合術-前融合,有固定物)≦四節 1 2 摘要__ 手術科部: 外科部 套用罐頭: Anterior Discectomy and Fusion, Cervical Spine 開立醫師: 曾峰毅 開立時間: 2011/10/21 12:15 Pre-operative Diagnosis Cervical stenosis at C4/5 and C5/6 Post-operative Diagnosis Cervical stenosis with degenerative disc and ossification of posterior logitudinal ligament at C4/5 and C5/6 Operative Method Anterior cervical diskectomy and fusion with PEEK cage and artificial bone graft. Specimen Count And Types Nil Pathology Nil Operative Findings Ossification of posterior longitudinal ligament at C4/5 and C5/6 compromised the thecal sac thightly, and was decompressed well after the surgery. Medtronic PEEK cage and artificial bone graft was used for ACDF. Operative Procedures With endotracheal general anaesthesiat, the patient was put in supine position with neck extended. We disinfected, and then draped the patietn as usual, and made one transverse skin incision at right aspect of the neck. We dissected along the medial side of platysma muscle to the prevertebral space. C4/5 diskectomy was performed and anterior fusion with PEEK cage and artificial bone graft was done. C5/6 diskectomy was performed and anterior fusion with PEEK cage and artificial bone graft was done. The wound was closed in layers. Operators VS 曾漢民 Assistants R5 曾峰毅 R1 吳健暉 Ri 王鈺維 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Anterior Discectomy and Fusion, Cervical Spine 開立醫師: 吳健暉 開立時間: 2011/10/21 12:34 Pre-operative Diagnosis Cervical stenosis at C4/5 and C5/6 Post-operative Diagnosis Cervical stenosis with degenerative disc and ossification of posterior logitudinal ligament at C4/5 and C5/6 Operative Method Anterior cervical diskectomy and fusion with PEEK cage and artificial bone graft. Specimen Count And Types Nil Pathology Nil Operative Findings Ossification of posterior longitudinal ligament at C4/5 and C5/6 compromised the thecal sac thightly, and was decompressed well after the surgery. Medtronic PEEK cage and artificial bone graft was used for ACDF. Operative Procedures With endotracheal general anaesthesiat, the patient was put in supine position with neck extended. We disinfected, and then draped the patietn as usual, and made one transverse skin incision at right aspect of the neck. We dissected along the medial side of platysma muscle to the prevertebral space. C4/5 diskectomy was performed and anterior fusion with PEEK cage and artificial bone graft was done. C5/6 diskectomy was performed and anterior fusion with PEEK cage and artificial bone graft was done. The wound was closed in layers. Operators VS 曾漢民 Assistants R5 曾峰毅 R1 吳健暉 Ri 王鈺維 相關圖片 黃威諭 (M,1976/11/14,35y4m) 手術日期 2011/10/21 手術主治醫師 曾勝弘 手術區域 東址 019房 02號 診斷 Glioblastoma, brain 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 2 紀錄醫師 吳健暉, 時間資訊 23:14 臨時手術NPO 12:45 進入手術室 12:49 麻醉開始 13:00 抗生素給藥 13:25 誘導結束 13:36 手術開始 16:05 手術結束 16:05 麻醉結束 16:10 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除-手術時間在4小時以內 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Left frontal craniotomy for tumor excision 開立醫師: 曾峰毅 開立時間: 2011/10/21 16:23 Pre-operative Diagnosis Left frontal tumor, suspected low grade glioma with high grade transformation Post-operative Diagnosis Left frontal tumor, suspected low grade glioma with high grade transformation Operative Method Left frontal craniotomy for tumor excision Specimen Count And Types Several fragments of the tumor was sent for pathology. Pathology Frozen: gliosis enoplasm, suspected grade II to III, no necrosis noted Operative Findings One hypervascular, intra-axial, whitish, elastic tumor was noted at left frontal lobe, about 4x3.5x3.5 cm. Frontal sinus was opened, and sealed with bone wax and Gelfoam. Ventricle was opened as well, and gelfoam was packed for sealing. Operative Procedures With endotracheal general anaesthesia, we put the patient in supine position with head fixed by Mayfield head clamp. We shaved, scrubbed, disinfected, and then draped the patient. Bicoronal scalp incision was done, and three burr holes were drilled. Left frontal craniotomy was done, durass was tented along the craniotomy window. Frontal sinus was sealed with bone wax and beta-iodine Gelfoam. C-shape durotomy was done. Tumor was removed piece by piece. Frozen section was done, and tumor was removed totall. Tumor cavity was paved with Surgicels. Dura was closed in water-tighy fashion. Bone graft was fixed back with mini-plates. The wound was closed in layers. Operators VS 曾勝弘 Assistants R5 曾峰毅 R1 吳健暉 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Left frontal craniotomy for tumor excision 開立醫師: 吳健暉 開立時間: 2011/10/22 14:42 Pre-operative Diagnosis Left frontal tumor, suspected low grade glioma with high grade transformation Post-operative Diagnosis Left frontal tumor, suspected low grade glioma with high grade transformation Operative Method Left frontal craniotomy for tumor excision Specimen Count And Types Several fragments of the tumor was sent for pathology. Pathology Frozen: gliosis enoplasm, suspected grade II to III, no necrosis noted Operative Findings One hypervascular, intra-axial, whitish, elastic tumor was noted at left frontal lobe, about 4x3.5x3.5 cm. Frontal sinus was opened, and sealed with bone wax and Gelfoam. Ventricle was opened as well, and gelfoam was packed for sealing. Operative Procedures With endotracheal general anaesthesia, we put the patient in supine position with head fixed by Mayfield head clamp. We shaved, scrubbed, disinfected, and then draped the patient. Bicoronal scalp incision was done, and three burr holes were drilled. Left frontal craniotomy was done, durass was tented along the craniotomy window. Frontal sinus was sealed with bone wax and beta-iodine Gelfoam. C-shape durotomy was done. Tumor was removed piece by piece. Frozen section was done, and tumor was removed totall. Tumor cavity was paved with Surgicels. Dura was closed in water-tighy fashion. Bone graft was fixed back with mini-plates. The wound was closed in layers. Operators VS 曾勝弘 Assistants R5 曾峰毅 R1 吳健暉 相關圖片 王春風 (M,1939/05/13,72y10m) 手術日期 2011/10/21 手術主治醫師 曾勝弘 手術區域 東址 019房 04號 診斷 Neuralgia, neuritis and radiculitis 器械術式 Decompression of mediun nerve 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 吳健暉, 時間資訊 09:15 臨時手術NPO 15:30 報到 16:35 進入手術室 16:40 抗生素給藥 16:48 麻醉開始 16:49 手術開始 16:49 誘導結束 17:35 麻醉結束 17:35 手術結束 17:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 正中神經或尺神經腕部減壓術–單側 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 曾峰毅 開立時間: 2011/10/21 17:41 Pre-operative Diagnosis 1. Left carpal tunnel syndrome, status post median nerve decompression, recurrence 2. Gout Post-operative Diagnosis 1. Left carpal tunnel syndrome, status post median nerve decompression, recurrence 2. Gout Operative Method Left median nerve decompression Specimen Count And Types Nil Pathology Nil Operative Findings Previous post-operative scar compromised left median nerve tightly. The nerve was decompressed well after the surgery. There was no tophi noted. Operative Procedures The patient was put in supine position with left arm abducted. Under local anaesthesia, we made one linear skin incision at left wrist. We retracted palmaris longus to radial side, and dissected to expose median nerve. We trace median nerve to distal part, and opened previous post-operative scar. The wound was closed in layers. Operators VS 曾勝弘 Assistants R5 曾峰毅 R1 吳健暉 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 吳健暉 開立時間: 2011/10/21 17:44 Pre-operative Diagnosis 1. Left carpal tunnel syndrome, status post median nerve decompression, recurrence 2. Gout Post-operative Diagnosis 1. Left carpal tunnel syndrome, status post median nerve decompression, recurrence 2. Gout Operative Method Left median nerve decompression Specimen Count And Types Nil Pathology Nil Operative Findings Previous post-operative scar compromised left median nerve tightly. The nerve was decompressed well after the surgery. There was no tophi noted. Operative Procedures The patient was put in supine position with left arm abducted. Under local anaesthesia, we made one linear skin incision at left wrist. We retracted palmaris longus to radial side, and dissected to expose median nerve. We trace median nerve to distal part, and opened previous post-operative scar. The wound was closed in layers. Operators VS 曾勝弘 Assistants R5 曾峰毅 R1 吳健暉 相關圖片 許著棟 (M,1937/09/03,74y6m) 手術日期 2011/10/21 手術主治醫師 蕭輔仁 手術區域 東址 019房 04號 診斷 Lymphoma 器械術式 Port-A Implatation 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 吳健暉, 時間資訊 16:36 臨時手術NPO 17:25 報到 18:00 進入手術室 18:10 抗生素給藥 18:23 手術開始 19:05 手術結束 19:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 port–A導管植入術–治療性導管植入術 1 0 L 記錄__ 手術科部: 外科部 套用罐頭: Port-A cut down 開立醫師: 吳健暉 開立時間: 2011/10/21 19:27 Pre-operative Diagnosis brain lymphoma Post-operative Diagnosis brain lymphoma Operative Method Port-A implantation by surgical cut down Specimen Count And Types nil Pathology nil Operative Findings 1. Port-A catheter was inserted into SVC via left cephalic vein 2. intra-operative portable X-ray showed Port-A catheter tip in correct venous branch to SVC. Operative Procedures 1. Local anesthesia with the patient in supine position, prepped and draping were performed in the usual sterile method. 2. An incision was made in side subclavical area. After identification of the cephalic vein, Port-A catheter was inserted. 3. Adequate hemostasis was obtained. 4. intra-operative portable X-ray showed catheter tip in correct venous branchto SVC. Then the wound was closed in layers. Operators 蕭輔仁 Assistants 吳健暉 相關圖片 陳鄭幸連 (F,1945/04/12,66y11m) 手術日期 2011/10/21 手術主治醫師 葉德輝 手術區域 東址 023房 05號 診斷 Malignant neoplasm of ethmoidal sinus 器械術式 Endoscopic functional sinus exam for CSF leak 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 陳姵妤, 時間資訊 15:00 進入手術室 15:13 麻醉開始 15:20 誘導結束 15:48 手術開始 16:45 手術結束 16:45 麻醉結束 16:57 送出病患 17:00 進入恢復室 18:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 內視鏡功能鼻竇手術-單側 1 4 手術 立體定位術-切片 1 1 L 手術 經外側篩竇切除修補腦髓液鼻 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: External ethmoidectomy for repairment of CSF ... 開立醫師: 陳姵妤 開立時間: 2011/10/21 23:26 Pre-operative Diagnosis Cerebrospinal fluid leakage, left Post-operative Diagnosis Cerebrospinal fluid leakage, left, operated Operative Method External ethmoidectomy for repairment of CSF rhiorrhea with endoscopic sinus surgery under navigation system, left Specimen Count And Types several pieces About size:0.2*0.3cm fragments Source:nasal cavity, left Pathology pending Operative Findings Left nasal cavity: pulsatile watery discharge from the base of frontal sinus, just below the anterior ethmoid artery bony variation of uncinate process :no enlarged ethmoid bulla :no prominent agger nasi :no concha bullosa : yes Operative Procedures Left nasal cavity (1) Infundibulotomy :+ (2) Opening/trimming of ethmoid bulla :+ anterior ethmoid :- agger nasi :+ frontal recess :+ middle turbinate :+ (3) Opening/trimming of ground lamella :+ posterior ethmoid :+ sphenoid sinus :- (4) Widening of maxillary ostium :- aspiration :- irrigation :- (5) Packing with Merocele :R(0)L(1) Fingerstall :R(0)L(2) 1. The patient in supine position. ETGA done. 2. The operative field was disinfected as usual. 3. The navigator system was set up. 4. Middle turbinate trimming done. 5. The frontal sinus, frontoethmoid cell were opened. 6. Watery, pulsatile discharge from the base of frontal sinus was noted. 7. The mucosa and chips of bone of middle turbinate was cut and inserted to the defect of frontal sinus as tissue plug. 8. The defect was then covered with the mucosa flap of middle turbinate, then with gelfoam and tissue glue. 9. Left nasal cavity was packed with merocele (1) and fingerstall (2). 10.The patient tolerated the procedure well. Operators AP葉德輝 Assistants R4李建賢, R2陳姵妤 詹宏建 (M,1961/11/02,50y4m) 手術日期 2011/10/21 手術主治醫師 謝汝敦 手術區域 病房 000房 號 診斷 Extradural hemorrhage following injury with mention of open intracranial wound, with prolonged (more than 24 hours) loss of consciousness without return to pre-existing conscious level 器械術式 Cystostomy -- Trocar method 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 葉亭均, 時間資訊 16:30 手術開始 16:30 進入手術室 16:50 送出病患 16:50 手術結束 醫令資訊 類別 名稱 量 刀 側 手術 膀胱造口術 1 1 記錄__ 手術科部: 泌尿部 套用罐頭: cystostomy, trocar 開立醫師: 葉亭均 開立時間: 2011/10/21 17:05 Pre-operative Diagnosis Neurogenic bladder Post-operative Diagnosis Neurogenic bladder Operative Method Trocar cystostomy Specimen Count And Types nil Pathology nil Operative Findings 1. Hydrodistension by 300ml normal saline bladder instillation. Bladder echo was checked. 2. A Fr. 16 catheter was inserted to the bladder. Operative Procedures Put the patient in supine position. Prepping and drapping was performed in the usual sterile fashion. The Foley was clamped. After hydrodistention of bladder was done, a test needle was inserted to the bladder from suprapubic area. Then, trocar cystostomy was performed under echo guidance. A Fr 16 catheter was inserted. Patient tolerated the procedure well. Operators 謝汝敦, Assistants 楊智凱, 葉亭均, 陳佑嘉 (M,2009/10/28,2y4m) 手術日期 2011/10/21 手術主治醫師 許巍鐘 手術區域 兒醫 065房 01號 診斷 Tetralogy of Fallot 器械術式 BRONCHOSCOPY 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 曾文萱, 時間資訊 14:55 通知急診手術 00:00 開始NPO 00:00 臨時手術NPO 08:48 報到 09:03 進入手術室 09:05 麻醉開始 09:10 誘導結束 09:11 手術開始 09:24 手術結束 09:24 麻醉結束 09:30 送出病患 09:35 進入恢復室 11:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 管、支 管、細支 管異物除去術- 管鏡 1 1 手術 經內視鏡切片（每一診次） 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 套用罐頭: 1. Flexible bronchoscope 2. rigid bronchoscop... 開立醫師: 曾文萱 開立時間: 2011/10/21 11:27 Pre-operative Diagnosis Tetralogy of Fallot Post-operative Diagnosis Tetralogy of Fallot, operated Operative Method 1. Flexible bronchoscope 2. rigid bronchoscopic biopsy Specimen Count And Types 2 pieces About size:0.3 cm Source:inter-arytenoid About size:0.3 cm Source:inter-arytenoid Pathology nil Operative Findings 1.Flexible bronchoscopy Nose____________ok__________Choana____ok________________ Nose____________ok__________Choana____high-arch palate Pharynx: Nasopharynx__________ok__________________ Tongue base___________ok___________________ Vallecula_____________ok__________________ Hypopharynx__________ok___________________ Larynx: Epiglottis_____________ok___________________ Aryepiglottic fold______ok__________________ Arytenoid cartilage_____ok___________________ Accesory cartilage_______ok___________________ True vocal fold__________ok___________________ False vocal folds_________ok_________________ Subglotttis_________________ok__________________ Trachea:___________________granulation tissue beneth stroma site___________________ Trachea:____tracheomalacia__________granulation tissue above stoma site and mid-tracdhea (tip of tracheostomy tube)(supra-stomal granulation)___________________ Carina: _________cystic lesion at left side__________________________ Right main bronchus:_______ok________________ Left main bronchus_______ok___________________ Others:__________________adenoid vegetation____________________ 2.Rigid bronchoscopy Pharynx: Nasopharynx_________ok____________________ Tongue base__________ok____________________ Vallecula____________ok____________________ Hypopharynx__________ok___________________ Larynx: Epiglottis____________ok_____________________ Aryepiglottic fold_____ok____________________ Arytenoid cartilage_____ok__________________ Accesory cartilage________ok________________ True vocal fold____________ok________________ False vocal folds___________ok_____________ Subglotttis______________ok____________________ Trachea:_____________granulation tissue beneth stroma site_____________________ Carina: __________cystic lesion at left side______________________ Right main bronchus:_______ok________________ Right main bronchus:_______mild malacia________________ Left main bronchus________ok_____________ Left main bronchus: mild malacia Others:______________________________________ Operative Procedures The patient was put in supine position with neck hyperextended. After IVF was setup, flexible bronchoscope was applied into the nostril. From the nasal cavity and nasopharynx till bilateral bronchi were examed. Adenoid vegetation and bilateral tonsillar hypertrophy were noted under the bronchoscopy. The pharynx, larynx, trachea, carina and bilateral bronchi were smooth and patent.Rigid bronchoscopy was set and larynx, subglottis, trachea, carina, bilateral main bronchus, and right upper, middle, lower; left upper and lowerbronchus were checked. Operators AsP許巍鐘, Assistants R2曾文萱,R3 黃苔晏, Indication Of Emergent Operation nil 賴上錦 (F,1952/03/01,60y0m) 手術日期 2011/10/22 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Lung cancer 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 蔡奉芳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 23:06 臨時手術NPO 07:40 報到 07:52 進入手術室 08:20 麻醉開始 08:40 誘導結束 08:45 抗生素給藥 09:00 手術開始 11:45 抗生素給藥 13:00 麻醉結束 13:00 手術結束 13:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 腦瘤切除-手術時間在4小時以內 1 1 記錄__ 手術科部: 外科部 套用罐頭: Suboccipital cranitomy for tumor excision. 開立醫師: 鍾文桂 開立時間: 2011/10/22 13:36 Pre-operative Diagnosis Left cerebellar tumor, suspect metastasis. Post-operative Diagnosis Left cerebellar tumor, suspect metastasis. Operative Method Suboccipital cranitomy for tumor excision. Specimen Count And Types 1 piece About size:2cc Source:cerebellar tumor Pathology Pending. Operative Findings 1. Red- yellowish, gelatinous, ill-defined tumor at left cerebellar hemisphere. Presence of old hematoma. Difficult to dissect the tumor-cerebellar border. 2.intraoperative sonography guidance for localization of tumor mass. Operative Procedures Under ETGA, the patient was placed in prone position and the head was fixed by Mayfield. After shaving, disinfection, and draping, a linear vertical incision was made with paraspinal dissection. After suboccipital craniotomy by using high speed drill, durotomy was made. After localizing the tumor with sonography, a 1-cm corticotomy was made and tumor was excised in piecemeal fashion. With well hemostasis, the dura mater was closed and augmented with Surgisis. The craniotomy plate was fixed by miniplates and screws. The wound was closed in layers with one submuscular CWV drain. Operators 曾漢民 Assistants 鍾文桂 相關圖片 邱幸福 (F,1964/07/12,47y8m) 手術日期 2011/10/22 手術主治醫師 楊士弘 手術區域 東址 005房 02號 診斷 Fracture of lumbar with spinal cord injury, closed 器械術式 Spinal fusion posterior 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 蔡奉芳 ASA 3E 紀錄醫師 吳健暉, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 16:13 通知急診手術 18:10 進入手術室 18:20 麻醉開始 18:40 誘導結束 18:50 抗生素給藥 19:32 手術開始 20:15 開始輸血 21:50 抗生素給藥 01:25 抗生素給藥 01:50 手術結束 01:50 麻醉結束 02:08 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 2 手術 硬腦膜外血腫清除術 1 1 手術 椎弓切除術(減壓)-二節以內 1 4 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 7 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: 1. T7 laminectomy for removal of EDH; 2. L2 l... 開立醫師: 楊士弘 開立時間: 2011/10/23 02:52 Pre-operative Diagnosis 1. Lumbar spine fracture dislocation, L1-2; 2. Thoracic spine epidural hematoma, T7 Post-operative Diagnosis 1. Lumbar spine fracture dislocation, L1-2; 2. Thoracic spine epidural hematoma, T7 Operative Method 1. T7 laminectomy for removal of EDH; 2. L2 laminectomy + T12-L1-L3-L4 posterior fixation with transpedicle screws and rods, and posterior bone fusion Specimen Count And Types 1 piece About size:小 Source:T7 epidural hematoma Pathology pending Operative Findings 1. There was fracture of the T6 and T7 spinous process. 2. Epidural hematoma was seen under the T7 lamina, causing spinal cord compression. Thecal sac reexpanded well after decompression. 3. Subcutaneous and intramuscular hematoma was seen in the low back area, from L1-L4. 4. The interspinous ligament, ligamentum flavum and left facet of L1-2 were disrupted, with transverse subluxation of L1-L2 vertebrae. 5. A long dura tear was found from L1-2. Part of the dura mater was absent on the right side. Several nerve roots were found incarcerated and severed in the disrupted L1-2 ligamentum flavum, and extruded following removal of the lamina. A piece of 7 cm x 7 cm Durafoam (cut in two pieces) were used to repair the dural defect. 6. Posterior fixation system: T12, L1 pedicle screws: 6 mm x 40 mm L3, L4 pedicle screws: 6 mm x 45 mm Rods: 15 cm on each side one cross link Operative Procedures 1. ETGA, prone. 2. Midback midline incision, T6-7. 3. T7 laminectomy for removal of EDH. 4. One CWV drain. 5. Wound closure. 6. Lowback midline incision, T12 ro L4. 7. Insertion of pedicle screws to bilateral T12, L1, L3, and L4. 8. L2 laminectomy for thecal sac decompression. 9. Durafoam for dural defect repair. 10. Application of rods and a cross link to complete fixation. 11. Decortication of T12-L4 facet and lamina. 12. Placement of autologous bone graft (from resected lamina) and Simbone graft over decorticated surface. 13. Two HV drain. 14. Wound closure in layers. Operators 楊士弘 Assistants 林哲光, 吳健暉 Indication Of Emergent Operation Spinal injury with leg weakness 相關圖片 摘要__ 手術科部: 外科部 套用罐頭: 1. T7 laminectomy for removal of EDH; 2. L2 l... 開立醫師: 楊士弘 開立時間: 2011/10/23 02:53 Pre-operative Diagnosis 1. Lumbar spine fracture dislocation, L1-2; 2. Thoracic spine epidural hematoma, T7 Post-operative Diagnosis 1. Lumbar spine fracture dislocation, L1-2; 2. Thoracic spine epidural hematoma, T7 Operative Method 1. T7 laminectomy for removal of EDH; 2. L2 laminectomy + T12-L1-L3-L4 posterior fixation with transpedicle screws and rods, and posterior bone fusion Specimen Count And Types 1 piece About size:小 Source:T7 epidural hematoma Pathology pending Operative Findings 1. There was fracture of the T6 and T7 spinous process. 2. Epidural hematoma was seen under the T7 lamina, causing spinal cord compression. Thecal sac reexpanded well after decompression. 3. Subcutaneous and intramuscular hematoma was seen in the low back area, from L1-L4. 4. The interspinous ligament, ligamentum flavum and left facet of L1-2 were disrupted, with transverse subluxation of L1-L2 vertebrae. 5. A long dura tear was found from L1-2. Part of the dura mater was absent on the right side. Several nerve roots were found incarcerated and severed in the disrupted L1-2 ligamentum flavum, and extruded following removal of the lamina. A piece of 7 cm x 7 cm Durafoam (cut in two pieces) were used to repair the dural defect. 6. Posterior fixation system: T12, L1 pedicle screws: 6 mm x 40 mm L3, L4 pedicle screws: 6 mm x 45 mm Rods: 15 cm on each side one cross link Operative Procedures 1. ETGA, prone. 2. Midback midline incision, T6-7. 3. T7 laminectomy for removal of EDH. 4. One CWV drain. 5. Wound closure. 6. Lowback midline incision, T12 ro L4. 7. Insertion of pedicle screws to bilateral T12, L1, L3, and L4. 8. L2 laminectomy for thecal sac decompression. 9. Durafoam for dural defect repair. 10. Application of rods and a cross link to complete fixation. 11. Decortication of T12-L4 facet and lamina. 12. Placement of autologous bone graft (from resected lamina) and Simbone graft over decorticated surface. 13. Two HV drain. 14. Wound closure in layers. Operators 楊士弘 Assistants 林哲光, 吳健暉 Indication Of Emergent Operation Spinal injury with leg weakness 相關圖片 摘要__ 手術科部: 外科部 套用罐頭: 1. T7 laminectomy for removal of EDH; 2. L2 l... 開立醫師: 楊士弘 開立時間: 2011/10/23 20:46 Pre-operative Diagnosis 1. Lumbar spine fracture dislocation, L1-2; 2. Thoracic spine epidural hematoma, T7 Post-operative Diagnosis 1. Lumbar spine fracture dislocation, L1-2; 2. Thoracic spine epidural hematoma, T7 1. Lumbar spine fracture dislocation associated with nerve roots (right side of cauda equina) disruption , L1-2; 2. Thoracic spine epidural hematoma, T7 Operative Method 1. T7 laminectomy for removal of EDH; 2. L2 laminectomy + T12-L1-L3-L4 posterior fixation with transpedicle screws and rods, and posterior bone fusion Specimen Count And Types 1 piece About size:小 Source:T7 epidural hematoma Pathology pending Operative Findings 1. There was fracture of the T6 and T7 spinous process. 2. Epidural hematoma was seen under the T7 lamina, causing spinal cord compression. Thecal sac reexpanded well after decompression. 3. Subcutaneous and intramuscular hematoma was seen in the low back area, from L1-L4. 4. The interspinous ligament, ligamentum flavum and left facet of L1-2 were disrupted, with transverse subluxation of L1-L2 vertebrae. 5. A long dura tear was found at L1-2 level. Part of the dura mater was absent on the right side. Several nerve roots in the right side of thecal sac were found incarcerated and some roots were severed in the disrupted L1-2 ligamentum flavum and fractured lamina. These roots were carefully separated from the bony and soft tissue compression and reduced back to the thecal sac. Burst fracture of the L2 vertebral body was seen anterior to the thecal sac. A piece of 7 cm x 7 cm Durafoam (cut in two pieces) were used to repair the dural defect on the right side. 5. A long dura tear was found at L1-2 level. Part of the dura mater was absent on the right side. Several nerve roots in the right side of thecal sac were incarcerated and some roots were found severed in the disrupted L1-2 ligamentum flavum and fractured lamina. These roots were carefully separated from the bony and soft tissue compression and reduced back to the thecal sac. Burst fracture of the L2 vertebral body was seen anterior to the thecal sac. A piece of 7 cm x 7 cm Durafoam (cut in two pieces) were used to repair the dural defect on the right side. 6. Posterior fixation system: 6. Posterior fixation system: (A-spine system) T12, L1 pedicle screws: 6 mm x 40 mm L3, L4 pedicle screws: 6 mm x 45 mm Rods: 15 cm on each side Rods: 15 cm long on each side one cross link Operative Procedures 1. ETGA, prone. 2. Midback midline incision, T6-7. 3. T7 laminectomy for removal of EDH. Placement of Gelfoam strips in the epidural space. 4. One CWV drain. 5. Wound closure. 6. Lowback midline incision, T12 ro L4. 7. Insertion of pedicle screws to bilateral T12, L1, L3, and L4. 8. Lower L1, whole L2 laminectomy, and bilateral L2 superior facectomy for nerve roots and thecal sac decompression. 9. Durafoam for dural defect repair. 10. Application of rods and a cross link to complete fixation. 11. Decortication of T12-L4 facet and lamina. Placement of autologous bone graft (from resected lamina) and Simbone graft over decorticated surface. 12. Hemostasis with bipolar cautery, bone wax, and Gelfoam strips. 13. Two HV drain in the epilaminal space. 14. Wound closure in layers. Operators 楊士弘 Assistants 林哲光, 吳健暉 Indication Of Emergent Operation Spinal injury with leg weakness 相關圖片 王興華 (M,1929/11/04,82y4m) 手術日期 2011/10/22 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 Subdural hemorrhage, traumatic 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 蔡奉芳 ASA 3 紀錄醫師 林哲光, 時間資訊 07:06 臨時手術NPO 10:15 進入手術室 10:15 報到 10:20 麻醉開始 10:22 誘導結束 10:25 抗生素給藥 10:39 手術開始 12:35 麻醉結束 12:35 手術結束 12:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 頭顱成形術 1 1 L 手術 腦脊髓液分流管重置 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 外科部 套用罐頭: Cranioplasty with aoutologus bone graft; revi... 開立醫師: 林哲光 開立時間: 2011/10/22 12:58 Pre-operative Diagnosis Left F-T-P skull bone defect; malposition of right S-P shunt Post-operative Diagnosis Left F-T-P skull bone defect; malposition of right S-P shunt Operative Method Cranioplasty with aoutologus bone graft; revision of right S-P shunt Specimen Count And Types nil Pathology Nil Operative Findings Left F-T-P skull bone defect was noted and a fractured part was noted at left F-P area. Some hematoma was noted below the fascia flap. The bone graft was fixed with miniplates. Right S-P shunt catheter tip was at right temporal area. Operative Procedures Under ETGA and supine position with head rotated to right side, skin disinfected and drapped were performed as usual. Skin incison was made along the previous operative wound. The plane between the galea and dura was dissected. Hemostasis was done and N/S irrigation was performed. The bone edge was exposed well. The skull bone was put back with miniplates fixation after central tenting was done. The wound was then closed in layers after a subgaleal drain insertion. The head position was rotated to left side and skin disinfected and drapped were then repeated as usual. Two skin incisions were made near the valve of S-P shunt. The abdominal catheter connected to valve was put 2cm downward after subcutaneous dissection along the catheter. The subdural catheter was fixed and the wounds were then closed in layers after checking shunt function. Operators 王國川 Assistants 林哲光, 姜士中 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Cranioplasty with aoutologus bone graft; revi... 開立醫師: 林哲光 開立時間: 2011/10/22 13:00 Pre-operative Diagnosis Left F-T-P skull bone defect; malposition of right S-P shunt Post-operative Diagnosis Left F-T-P skull bone defect; malposition of right S-P shunt Operative Method Cranioplasty with aoutologus bone graft; revision of right S-P shunt Specimen Count And Types nil Pathology Nil Operative Findings Left F-T-P skull bone defect was noted and a fractured part was noted at left F-P area. Some hematoma was noted below the fascia flap. The bone graft was fixed with miniplates. Right S-P shunt catheter tip was at right temporal area. Operative Procedures Under ETGA and supine position with head rotated to right side, skin disinfected and drapped were performed as usual. Skin incison was made along the previous operative wound. The plane between the galea and dura was dissected. Hemostasis was done and N/S irrigation was performed. The bone edge was exposed well. The skull bone was put back with miniplates fixation after central tenting was done. The wound was then closed in layers after a subgaleal drain insertion. The head position was rotated to left side and skin disinfected and drapped were then repeated as usual. Two skin incisions were made near the valve of S-P shunt. The abdominal catheter connected to valve was put 2cm downward after subcutaneous dissection along the catheter. The subdural catheter was fixed and the wounds were then closed in layers after checking shunt function. Operators 王國川 Assistants 林哲光, 姜士中 相關圖片 羅煥鳳 (M,1928/01/16,84y1m) 手術日期 2011/10/22 手術主治醫師 王國川 手術區域 東址 003房 03號 診斷 Cerebrovascular accident 器械術式 Removal of epidural hematoma，ICP monitoring 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 蔡奉芳 ASA 4E 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 19:36 通知急診手術 20:35 報到 20:35 進入手術室 20:50 麻醉開始 21:05 誘導結束 21:41 手術開始 23:00 抗生素給藥 23:50 麻醉結束 23:50 手術結束 23:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 1 L 手術 顱內壓視置入 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Craniotomy for hematoma evacuation and ICP mo... 開立醫師: 陳國瑋 開立時間: 2011/10/22 23:38 Pre-operative Diagnosis Left frontal ICH Post-operative Diagnosis Left frontal ICH Operative Method Craniotomy for hematoma evacuation and ICP monitor insertion Specimen Count And Types nil Pathology Nil Operative Findings Subdural hematoma was noted. About 40ml of hematoma was evacuated and some part of it was uncoagualted. Vessels were noted in the hematoma. Subdural hematoma was noted. About 40ml of hematoma was evacuated and some part of it was uncoagualted. Vessels were noted in the hematoma. ICP monitor reference was 502. The ICP was 1 after skin closure. Subdural hematoma and subarachnoid hemorrhage was noted. About 40ml of hematoma was evacuated and some part of it was uncoagualted. Vessels were noted in the hematoma. ICP monitor reference was 502. The ICP was 1 after skin closure. Operative Procedures The patient was put in supine position with head turning to right. The Skin was prepared as usual. One U-shape skin incision was made and the bone window 7*6cm was elevated. The dura was cut open in X shape. Corticortomy was made 2.5cm. The subdural hematoma and intracerebral hematoma was evacuated. The brain was slack after the procedure. Duroplasty was done with muscle fascia. After setting CWV and ICP monitor, the wound was closed in layers. Operators 王國川 Assistants 陳國瑋 劉昌杰 Indication Of Emergent Operation Enlarging hematoma with unclear consciousness 相關圖片 鄭皇 (M,1932/09/12,79y6m) 手術日期 2011/10/22 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Hydrocephalus 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 蔡奉芳 ASA 3 紀錄醫師 林哲光, 時間資訊 07:05 臨時手術NPO 07:37 報到 08:00 進入手術室 08:09 麻醉開始 08:16 誘導結束 08:45 抗生素給藥 09:02 手術開始 09:45 手術結束 09:45 麻醉結束 09:50 送出病患 09:55 進入恢復室 10:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室腹腔分流手術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Right Kocher point Codman programmable V-P sh... 開立醫師: 林哲光 開立時間: 2011/10/22 10:03 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Right Kocher point Codman programmable V-P shunt insertion Specimen Count And Types nil Pathology Nil Operative Findings CSF seemed clear and transparent. Intraventricular catheter was 7cm long and abdominal catheter 25cm long. Valve was set 13 cmH2O. Operative Procedures Under ETGA and supine position, skin disinfected and drapped were performed as usual. A transverse skin incision was made at right Kocher point and a burr hole was then created. The dura was the opened after dural tenting. Meanwhile, minilaparotomy was done at RUQ abdomen and peritoneal cavity was opened. The ventricular catheter was connected to the valve with abdominal catheter through the subcutaneous tunnleing which was made by Stylate through RUQ abdomen, right chest, right neck to right posterior auricle. Right Kocher point was connected by the stylate also. The ventricular catheter was then inserted via ventricular puncture. The burr hole was covered with Gelfoam and the abdominal catheter was inserted into the peritoneal cavity after peritoneum was opened. The wound was then closed in layers after hemostasis. Operators 王國川 Assistants 林哲光, 姜士中 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Right Kocher point Codman programmable V-P sh... 開立醫師: 林哲光 開立時間: 2011/10/22 10:03 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Right Kocher point Codman programmable V-P shunt insertion Specimen Count And Types nil Pathology Nil Operative Findings CSF seemed clear and transparent. Intraventricular catheter was 7cm long and abdominal catheter 25cm long. Valve was set 13 cmH2O. Operative Procedures Under ETGA and supine position, skin disinfected and drapped were performed as usual. A transverse skin incision was made at right Kocher point and a burr hole was then created. The dura was the opened after dural tenting. Meanwhile, minilaparotomy was done at RUQ abdomen and peritoneal cavity was opened. The ventricular catheter was connected to the valve with abdominal catheter through the subcutaneous tunnleing which was made by Stylate through RUQ abdomen, right chest, right neck to right posterior auricle. Right Kocher point was connected by the stylate also. The ventricular catheter was then inserted via ventricular puncture. The burr hole was covered with Gelfoam and the abdominal catheter was inserted into the peritoneal cavity after peritoneum was opened. The wound was then closed in layers after hemostasis. Operators 王國川 Assistants 林哲光, 姜士中 相關圖片 翁連彩琴 (F,1938/07/25,73y7m) 手術日期 2011/10/24 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 曾偉倫, 時間資訊 23:36 臨時手術NPO 07:35 報到 08:00 進入手術室 08:05 麻醉開始 08:20 誘導結束 08:35 抗生素給藥 08:40 手術開始 10:55 開始輸血 11:35 抗生素給藥 14:20 麻醉結束 14:20 手術結束 14:25 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除-手術時間在4~8小時 1 1 記錄__ 手術科部: 外科部 套用罐頭: Right pterional approach for Simpson Grade II... 開立醫師: 李振豪 開立時間: 2011/10/24 14:35 Pre-operative Diagnosis Right middle 3rd sphenoid ridge meningioma Post-operative Diagnosis Right middle 3rd sphenoid ridge meningioma Operative Method Right pterional approach for Simpson Grade II tumor excision Specimen Count And Types 1 piece About size:3x3x3 cm Source:Right middle 3rd sphenoid ridge meningioma Pathology Pending Operative Findings A 3.4x3.2x3.6 cm soft, yellow-whitish, hypervascularizd, well-capsulated tumor was noted which origin from right middle 3rd sphenoid ridge. The main tumor part was within middle fossa which covered by a thin layer of brain parenchyma. The feeding artery was mainly from the middle meningeal artery. The middle cerebral artery was pushed anterosuperiorly. The M2 segment was adhered to the tumor and few feeding artery arising from M2 was noted. A samll laceration of right M2 segment occurred during tumor dissection and primary repair with 10-0 Nylon was done. The ischemic time during primary repair was less than 5 minutes. Operative Procedures Under endotracheal general anesthesia, we placed the patient over supine position with right shoulder elevation. After we shaved, we fixed her head with Mayfield skull clamp. Her head was tilted to left with neck mild flexed. After we scrubbed, disinfected and drapped, a curvilinear skin incision was made over right frontal-temporal area. The wound was opened in layers and the superficial temporal artery was identified and preserved. The facial nerve preservation was done during the wound opening and the temporalis muscle was detached from skull bone. Three burrholes were created followed by one 8x6cm craniotomy window. Dural tenting was done. The dura over right temporal base was detached for devascularization and the sphenoid ridge and temporal bone were drilled for better exposure. Curvilinear durotomy was made. The tumor was identified. Sylvian fissure was opened and the tumor was dissected along the arachnoid plane. The tumor was detached from dura attachement. The tumor was then removed. A small piece of tumor adhered to the right M2 segment tightly and small laceration over the right M2 segment was noted after tumor excision. The small laceration was repaired with 10-0 Nylon directly. Temporary clip was applied during primary repair. The tumor adhered to the M2 artery was removed carefully. Hemostasis was achieved with bipolar electrocautery and Surgicel. Duroplasty with fascia of temporalis muscle was performed with 4-0 Prolene. The skull plate was fixed back with miniplates, screws, and two central tenting. The temporalis muscle was fixed back to its neutral position. One subgaleal CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators Prof. 杜永光 Assistants R5 李振豪 R3 曾偉倫 Ri 相關圖片 沈源杏 (M,1948/03/20,63y11m) 手術日期 2011/10/24 手術主治醫師 杜永光 手術區域 東址 003房 02號 診斷 Glioblastoma multiforma 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 曾偉倫, 時間資訊 23:37 臨時手術NPO 13:50 報到 14:40 進入手術室 14:45 麻醉開始 15:00 誘導結束 15:25 手術開始 15:30 抗生素給藥 18:36 抗生素給藥 20:35 麻醉結束 20:35 手術結束 20:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4~8小時 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: Left fronto-parietal craniotomy inter-hemisph... 開立醫師: 李振豪 開立時間: 2011/10/24 21:00 Pre-operative Diagnosis Left frontal brain tumor, suspect high grade glioma Post-operative Diagnosis Left frontal brain tumor, suspect high grade glioma Operative Method Left fronto-parietal craniotomy inter-hemisphere approach for subtotal tumor excision Specimen Count And Types Multiple small pieces, Source:Left frontal brain tumor Pathology Pending Operative Findings The tumor was hypervascularized, ill-defined, gelatinous and fragile, red-yellowish, and 7.8 x 2.7 x 3.3cm in size. The tumor was located at left mesial frontal (about 3cm in depth from superior sagittal sinus). Before tumor excision, motor cortex mapping was performed and which was located at posterior margin of the craniotomy. The brain bulging out after durotomy and still mild swelling after tumor excision. Left lateral ventricle was opened during tumor excision and sealed with Gelfoam. The tumor beneath the motor cortex was left for functional preservation. Operative Procedures Under endotracheal general anesthesia, we placed the patient over supine position. After we shaved, his head was fixed with Mayfield skull clamp. His right sholder was elevated and his face was turned to left with neck flexed. After we scrubbed, disinfected and drapped, a cuvilinear bi-crownal skin incision was made. The wound was opened in layers and a 7x4 cm craniotomy was made. Dural tenting was done. The brain tumor was located with intra-operative sonography. C-shape durotomy was made based with superior sagittal sinus. We retracted the falx and a 4x2 cm corticotomy was made over the left mesial frontal which 3cm depth from superior sagittal sinus. The tumor was removed by tumor forceps, bipolar electrocautery, and suction. Hemostasis was achieved with bipolar electrocautery and Surgicel lining. Dura was closed with 4-0 prolene. Bleeding from superior sagittal sinus and arachnoid granule was stopped by Gelfoam and Surgicel packing. The skull plate was fixed back with miniplates, screws, and one central tenting. One subgaleal CWV drain was placed. The wound was then closed in layers with 2-0 vicryl and 3-0 Nylon. Operators Prof. 杜永光 Assistants R5 李振豪, R3 曾偉倫 相關圖片 施永和 (M,1957/04/06,54y11m) 手術日期 2011/10/24 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 鍾文桂, 時間資訊 23:41 臨時手術NPO 07:35 報到 08:02 進入手術室 08:02 麻醉開始 08:30 抗生素給藥 08:45 誘導結束 08:55 手術開始 11:30 抗生素給藥 12:20 麻醉結束 12:20 手術結束 12:25 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除-手術時間在4小時以內 1 1 R 手術 顱內壓視置入 1 2 R 摘要__ 手術科部: 外科部 套用罐頭: 1. Right frontal craniotomy for total tumor e... 開立醫師: 鍾文桂 開立時間: 2011/10/24 12:57 Pre-operative Diagnosis Intraventricular tumor, right lateral ventricle. Post-operative Diagnosis Intraventricular tumor, right lateral ventricle. Operative Method 1. Right frontal craniotomy for total tumor excision. 2. Ventriculostomy for ICP monitoring and CSF drainage. Specimen Count And Types 1 piece About size:2cc Source:Right intraventricular tumor. Pathology Frozen pathology: the specimen showed low cellularity. Operative Findings 1. Transcortical approach for tumor exicion. A 1 cm corticotomy was done after dissection through a sulcus 1 cm anterior to coronal suture and 3 cm lateral to midline. Intraoperative ultrasonography was obtained for tumor localization. The tumor is soft, yellowish-red, with fair delineation to normal brain tissue. 2. The frontal horn of right lateral ventricle was entered and an EVD tube was placed in situ( 6cm in depth). Foramen of Monro, internal cerebral vein, thalamostriae vein, and septum pellucidum were identified during tumor resection. Operative Procedures Under ETGA, the patient was placed in supine position and the head was flexed and fixed on Mayfield. After shaving, disinfection, and draping, a curvilinear scalp incision was made. After dissection, a 5 cm craniotomy was obtained. After a U shape durotomy based on superior sagital sinus, the tumor was localized by intraoperative ultrasonography. The arachnoid membrane was lysed along the sulcus. Then, a 1 cm corticotomy was performed. Dissection was done to reach the tumor intraventricularly. The tumor was resected in piecemeal fashion. After well hemostasis, the EVD tube was inserted intraventricularly. The dura mater was closed in water-tight fashion. Craniotomy plate was fixed by miniplates and screws. The wound was closed in layers with one subgaleal drain. Operators 曾漢民 Assistants 鍾文桂 陳國瑋 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: 1. Right frontal craniotomy for total tumor e... 開立醫師: 鍾文桂 開立時間: 2011/11/01 20:27 Pre-operative Diagnosis Intraventricular tumor, right lateral ventricle. Post-operative Diagnosis Intraventricular tumor, right lateral ventricle. Operative Method 1. Right frontal craniotomy for total tumor excision. 2. Ventriculostomy for ICP monitoring and CSF drainage. Specimen Count And Types 1 piece About size:2cc Source:Right intraventricular tumor. Pathology Frozen pathology: the specimen showed low cellularity. Operative Findings 1. Transcortical approach for tumor exicion. A 1 cm corticotomy was done after dissection through a sulcus 1 cm anterior to coronal suture and 3 cm lateral to midline. Intraoperative ultrasonography was obtained for tumor localization. The tumor is soft, yellowish-red, with fair delineation to normal brain tissue. 2. The frontal horn of right lateral ventricle was entered and an EVD tube was placed in situ( 6cm in depth). Foramen of Monro, internal cerebral vein, thalamostriae vein, and septum pellucidum were identified during tumor resection. Operative Procedures Under ETGA, the patient was placed in supine position and the head was flexed and fixed on Mayfield. After shaving, disinfection, and draping, a curvilinear scalp incision was made. After dissection, a 5 cm craniotomy was obtained. After a U shape durotomy based on superior sagital sinus, the tumor was localized by intraoperative ultrasonography. The arachnoid membrane was lysed along the sulcus. Then, a 1 cm corticotomy was performed. Dissection was done to reach the tumor intraventricularly. The tumor was resected in piecemeal fashion. After well hemostasis, the EVD tube was inserted intraventricularly. The dura mater was closed in water-tight fashion. Craniotomy plate was fixed by miniplates and screws. The wound was closed in layers with one subgaleal drain. Operators 曾漢民 Assistants 鍾文桂 陳國瑋 相關圖片 李明惠 (M,1946/05/16,65y9m) 手術日期 2011/10/24 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Acoustic tumor 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 陳國瑋, 時間資訊 23:42 臨時手術NPO 11:25 報到 12:45 進入手術室 12:55 麻醉開始 13:20 抗生素給藥 13:35 誘導結束 13:48 手術開始 16:30 抗生素給藥 18:25 麻醉結束 18:25 手術結束 18:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 摘要__ 手術科部: 外科部 套用罐頭: Left retrosigmoid approach for total tumor ex... 開立醫師: 鍾文桂 開立時間: 2011/10/24 18:50 Pre-operative Diagnosis Left vestibular schwannoma Post-operative Diagnosis Left vestibular schwannoma Operative Method Left retrosigmoid approach for total tumor excision Specimen Count And Types 1 piece About size:fragments Source:brain tumor Pathology pending Operative Findings The tumro was soft, yellowish-red, hypervascularized,and well-delineated. The internal acoustic meatus was widened by the tumor mass. The tumor inside the IAC was resected. The cystic content of the tumor was clear yellowish in color. The cystic wall was noted right after durotomy. Intraoperative facial nerve stimulation showed good response after total tumor excision. Operative Procedures After intubation and general anesthesia, the patient was put in 3/4 prone position. The skin was shaved, scrubbed and prepared as usual. A vertical linear skin incision was made at retroauricular area. The skin was retraced aside. Bone window created to the border of left transverse sinus and sigmoid sinus. The dura was incised, and the cerebellum was retracted medially. The cystic part of the tumor came in sight. CSF drainage and cystomy was performed. Tumor removal was performed in piecemeal fashion by using dissector, bipolar electrocoagulation, and suction. The CNV,VI, CNVII were noted and preserved. Facial stimulation was done. The internal acoustic meatus was drilled for further tumor resection. After careful hemostasis, duroplasty was done with fascia. The bone graft was fixed back with mini-plate and screws. The wound was closed in layers. Operators 曾漢民 Assistants 鍾文桂 陳國瑋 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Left retrosigmoid approach for total tumor ex... 開立醫師: 陳國瑋 開立時間: 2011/11/02 15:35 Pre-operative Diagnosis Left vestibular schwannoma Post-operative Diagnosis Left vestibular schwannoma Operative Method Left retrosigmoid approach for total tumor excision Specimen Count And Types 1 piece About size:fragments Source:brain tumor Pathology pending Operative Findings The tumro was soft, yellowish-red, hypervascularized,and well-delineated. The internal acoustic meatus was widened by the tumor mass. The tumor inside the IAC was resected. The cystic content of the tumor was clear yellowish in color. The cystic wall was noted right after durotomy. Intraoperative facial nerve stimulation showed good response after total tumor excision. Operative Procedures After intubation and general anesthesia, the patient was put in 3/4 prone position. The skin was shaved, scrubbed and prepared as usual. A vertical linear skin incision was made at retroauricular area. The skin was retraced aside. Bone window created to the border of left transverse sinus and sigmoid sinus. The dura was incised, and the cerebellum was retracted medially. The cystic part of the tumor came in sight. CSF drainage and cystomy was performed. Tumor removal was performed in piecemeal fashion by using dissector, bipolar electrocoagulation, and suction. The CNV,VI, CNVII were noted and preserved. Facial stimulation was done. The internal acoustic meatus was drilled for further tumor resection. After careful hemostasis, duroplasty was done with fascia. The bone graft was fixed back with mini-plate and screws. The wound was closed in layers. Operators 曾漢民 Assistants 鍾文桂 陳國瑋 相關圖片 陳智英 (F,1952/12/28,59y2m) 手術日期 2011/10/24 手術主治醫師 廖漢文 手術區域 東址 000房 號 診斷 Aneurysm 器械術式 Right ICA aneurysm, For TAE 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 2 時間資訊 12:00 麻醉開始 12:20 誘導結束 15:15 麻醉結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 蔡小平 (F,1954/04/02,57y11m) 手術日期 2011/10/25 手術主治醫師 曾漢民 手術區域 西址 039房 01號 診斷 Carpal tunnel syndrome 器械術式 Decompression of mediun nerve 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 09:00 報到 09:30 進入手術室 09:45 麻醉開始 10:02 手術開始 10:55 手術結束 11:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 正中神經腕部減壓術-雙側 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Neurolysis 開立醫師: 陳國瑋 開立時間: 2011/10/25 11:09 Pre-operative Diagnosis Carpal tunnel syndrome, left Post-operative Diagnosis Carpal tunnel syndrome, left Operative Method Neurolysis Specimen Count And Types nil Pathology nil Operative Findings The medium nerve was compressed tightly by the hypertrophic transverse carpal ligament, with erythematous change. Operative Procedures 1. Skin prepare, Local anesthesia. 2. Skin incision 3. Neurolysis 4. hemostasis 5. wound closure in layers Operators 曾漢民 Assistants 鍾文桂 陳國瑋 相關圖片 洪文楷 (M,1940/04/26,71y10m) 手術日期 2011/10/25 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Lumbar Spondylosis 器械術式 Laminectomy for decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 林哲光, 時間資訊 23:19 臨時手術NPO 07:35 報到 08:05 進入手術室 08:10 麻醉開始 08:15 誘導結束 08:30 抗生素給藥 09:05 手術開始 10:35 開始輸血 11:30 抗生素給藥 13:20 手術結束 13:20 麻醉結束 13:28 送出病患 13:30 進入恢復室 15:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術(減壓)-超過二節 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 手術 脊椎融合術-後融合,無固定物 1 2 摘要__ 手術科部: 外科部 套用罐頭: T11-12 laminectomy for posteior decompression... 開立醫師: 林哲光 開立時間: 2011/10/25 14:00 Pre-operative Diagnosis T-L spinal canal stenosis Post-operative Diagnosis T-L spinal canal stenosis Operative Method T11-12 laminectomy for posteior decompression, L2-5 laminectomy and posterolateral fusion with autologus bone and Sinbone Specimen Count And Types nil Pathology Nil Operative Findings Severe hypertrophic change of bilateral facet joints were noted. Thicken hypertrophic ligamentum flavum was also noted with direct compressing the dura sac tightly. The dura sac seemed re-expanded well. A ruptured calcified disc was noted at left L4-5 level above the shoulder of left L5 root with direct compressing the root. Bilateral L2-S1 roots were identified and decompressed well during the operation. Operative Procedures Under ETGA and prone position with head fixed with head clamp, skin disinfected and drapped were performed as usual. Midline skin incision was made from T10 to S1 and the paraspinal muscles were detached. T12 laminectomy was done to expose T11-T12 junction and sublaminal decompression was done. L2-L5 laminectomy was then performed and bilateral sublaminal decompression was done until bilateral L2-S1 roots were identified and decompressed well. Posterolateral fusion was then performed after decortication and covered with autologus bone and Sinbone at bilateral inferior facet joints and transverse processes. The wound was then closed in layers after hemostasis and one epidural H/V insertion. Operators 曾勝宏 Assistants 林哲光 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: T11-12 laminectomy for posteior decompression... 開立醫師: 林哲光 開立時間: 2011/10/25 17:10 Pre-operative Diagnosis T-L spinal canal stenosis Post-operative Diagnosis T-L spinal canal stenosis Operative Method T11-12 laminectomy for posteior decompression, L2-5 laminectomy and posterolateral fusion with autologus bone and Sinbone Specimen Count And Types nil Pathology Nil Operative Findings Severe hypertrophic change of bilateral facet joints were noted. Thicken hypertrophic ligamentum flavum was also noted with direct compressing the dura sac tightly. The dura sac seemed re-expanded well. A ruptured calcified disc was noted at left L4-5 level above the shoulder of left L5 root with direct compressing the root. Bilateral L2-S1 roots were identified and decompressed well during the operation. Operative Procedures Under ETGA and prone position with head fixed with head clamp, skin disinfected and drapped were performed as usual. Midline skin incision was made from T10 to S1 and the paraspinal muscles were detached. T12 laminectomy was done to expose T11-T12 junction and sublaminal decompression was done. L2-L5 laminectomy was then performed and bilateral sublaminal decompression was done until bilateral L2-S1 roots were identified and decompressed well. Posterolateral fusion was then performed after decortication and covered with autologus bone and Sinbone at bilateral inferior facet joints and transverse processes. The wound was then closed in layers after hemostasis and one epidural H/V insertion. Operators 曾勝弘 Assistants 林哲光 相關圖片 王以安 (F,1987/04/14,24y11m) 手術日期 2011/10/25 手術主治醫師 曾勝弘 手術區域 東址 005房 02號 診斷 Bone tumor 器械術式 Benign intraspinal tumor, exci 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 林哲光, 時間資訊 23:20 臨時手術NPO 13:45 進入手術室 13:48 麻醉開始 13:55 誘導結束 13:55 抗生素給藥 13:57 手術開始 15:02 手術結束 15:02 麻醉結束 15:12 送出病患 15:15 進入恢復室 16:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術(減壓)-二節以內 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Excision of tumor and C5 spinous process 開立醫師: 林哲光 開立時間: 2011/10/25 15:27 Pre-operative Diagnosis C5 posterior mass Post-operative Diagnosis C5 posterior mass, suspected osteochondroma Operative Method Excision of tumor and C5 spinous process Specimen Count And Types 1 piece About size:C5 spinous process and bony tumor Source: Pathology Pending Operative Findings A 2.5 cm sized grayish-whitish, well-demarcated, paraspinal tumor was noted with suspected direct invasion into the C5 spinous process. Wide excision of the C5 spinous process was also done. Operative Procedures Under ETGA and prone position with head fixed with head clamp, skin disinfected and drapped were performed as usual. Midline skin incision was done at the tumor site (C4-5 level) and the tumor was exposed well after paraspinal muscle were detached. Tumor excision was done and spinous process of C5 was also removed at lamina level. The wound was then closed in layers after hemostasis. Operators 曾勝弘 Assistants 林哲光 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Excision of tumor and C5 spinous process 開立醫師: 林哲光 開立時間: 2011/10/25 15:27 Pre-operative Diagnosis C5 posterior mass Post-operative Diagnosis C5 posterior mass, suspected osteochondroma Operative Method Excision of tumor and C5 spinous process Specimen Count And Types 1 piece About size:C5 spinous process and bony tumor Source: Pathology Pending Operative Findings A 2.5 cm sized grayish-whitish, well-demarcated, paraspinal tumor was noted with suspected direct invasion into the C5 spinous process. Wide excision of the C5 spinous process was also done. Operative Procedures Under ETGA and prone position with head fixed with head clamp, skin disinfected and drapped were performed as usual. Midline skin incision was done at the tumor site (C4-5 level) and the tumor was exposed well after paraspinal muscle were detached. Tumor excision was done and spinous process of C5 was also removed at lamina level. The wound was then closed in layers after hemostasis. Operators 曾勝弘 Assistants 林哲光 相關圖片 張安民 (M,1932/07/01,79y8m) 手術日期 2011/10/25 手術主治醫師 曾勝弘 手術區域 東址 005房 03號 診斷 Subdural hemorrhage (SDH) 器械術式 Removal of chronic subdural 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 林哲光, 時間資訊 23:21 臨時手術NPO 15:30 進入手術室 15:35 麻醉開始 15:40 抗生素給藥 15:45 誘導結束 16:00 手術開始 16:58 手術結束 16:58 麻醉結束 17:11 送出病患 17:15 進入恢復室 18:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 慢性硬腦膜下血腫清除術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Left burr hole drainage for CSDH 開立醫師: 林哲光 開立時間: 2011/10/25 17:17 Pre-operative Diagnosis Left F-T-P chronic SDH Post-operative Diagnosis Left F-T-P chronic SDH Operative Method Left burr hole drainage for CSDH Specimen Count And Types nil Pathology Nil Operative Findings Dark-reddish, sand-like fluid contents gushed out after the dural opening. Outer and inner membrane formation were noted. The brain seemed re-expanded well after drainage. Operative Procedures Under ETGA and supine position with head rotated to right side, skin disinfected and drapped were performed as usual. A linear skin incision was made at left temporal area and the incision was avoided from the DBS catheter. Two burr holes were created after muscle dissection. Dura was widely opened after dural tenting and bipolar cauterization on the outer membrane was done. N/S irrigation from the drainage tube was done. The wound was then closed in layers after deair and the drainage tube was removed. Operators 曾勝弘 Assistants 林哲光 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Left burr hole drainage for CSDH 開立醫師: 林哲光 開立時間: 2011/10/25 17:17 Pre-operative Diagnosis Left F-T-P chronic SDH Post-operative Diagnosis Left F-T-P chronic SDH Operative Method Left burr hole drainage for CSDH Specimen Count And Types nil Pathology Nil Operative Findings Dark-reddish, sand-like fluid contents gushed out after the dural opening. Outer and inner membrane formation were noted. The brain seemed re-expanded well after drainage. Operative Procedures Under ETGA and supine position with head rotated to right side, skin disinfected and drapped were performed as usual. A linear skin incision was made at left temporal area and the incision was avoided from the DBS catheter. Two burr holes were created after muscle dissection. Dura was widely opened after dural tenting and bipolar cauterization on the outer membrane was done. N/S irrigation from the drainage tube was done. The wound was then closed in layers after deair and the drainage tube was removed. Operators 曾勝弘 Assistants 林哲光 相關圖片 曾子嫣 (F,2010/06/10,1y9m) 手術日期 2011/10/25 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Malignant neoplasm of spinal cord 器械術式 T4-sacral intramedullary tumor excision 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 石博元 ASA 3 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 07:46 報到 08:10 進入手術室 08:15 麻醉開始 09:30 誘導結束 09:50 抗生素給藥 10:10 手術開始 12:50 抗生素給藥 13:50 開始輸血 15:50 抗生素給藥 18:20 麻醉結束 18:20 手術結束 18:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 脊椎內脊髓內腫瘤切除術 1 1 手術 腦膜或脊髓膜突出修補術 1 2 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 12 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Long segment (T8-S3) laminoplasty for gross t... 開立醫師: 王奐之 開立時間: 2011/10/25 18:51 Pre-operative Diagnosis Intraspinal intramedullary tumor, from mid-thoracic level to sacrococcygeal region with intra-pelvic extraspinal extension via S2 level, status post sacral tumor biopsy Post-operative Diagnosis Intraspinal intramedullary tumor, from mid-thoracic level to sacrococcygeal region with intra-pelvic extraspinal extension via S2 level, status post sacral tumor biopsy Operative Method Long segment (T8-S3) laminoplasty for gross total intraspinal tumor resection Specimen Count And Types 3 pieces About size:1.5*1.5*6cm Source:intraspinal tumor About size:0.5*0.4*0.2cm Source:arachnoid membrane About size:pieces Source:intraspinal tumor Pathology Pending. Frozen section: gliosis or grade II astrocytoma Operative Findings 1. Scoliosis was noted. 2. A long segment of tumor extending from about T8 to S3-4 was noted, seemed to be arising near conus medullaris, tangled with the cauda equina and exiting nerve roots. Left S2 neural foramen was enlarged, and tumor extended beyond spinal canal to extraspinal area through this route. This foramen was sealed with DuraGene & Tissucol Duo to prevent future extraspinal tumor growth. 3. Careful identification & preservation of the sacral nerve roots were done via intra-operative nerve stimulation. 4. No intra-operative SSEP or MEP change was noted. 4. Specimen labeled as "A" is the tumor mainly located at the dorsal aspect of the cauda equina. Specimen labeled as "B" is the thickened arachnoid membrane with some suspicious granule coatings (suspected seeding of the tumor cells). Specimen labeled as "C" is the tumor located at the ventral aspect of cauda equina. 5. No intra-operative SSEP or MEP change was noted. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position. After scrubbing, disinfection & draping in sterile fashion, a curvilinear incision was made along the course of the spinous process (from about T8 to sacrum). The laminae was then removed en bloc with saw, Kerrison punch and scissors. A midline linear durotomy was then performed under microscopic view. Tumor resection was then performed with bipolar electrocautery, scissors & CUSA. After meticulous hemostasis, the left S2 neural foramen was sealed with DuraGene & Tissucol Duo. The dura was then closed in water-tight fashion with 5-0 Prolene continuous suture, and augmented with Tissucol Duo. The wound was then closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之, Ri 陳勇仁 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Long segment (T8-S3) laminoplasty for gross t... 開立醫師: 王奐之 開立時間: 2011/10/25 18:54 Pre-operative Diagnosis Intraspinal intramedullary tumor, from mid-thoracic level to sacrococcygeal region with intra-pelvic extraspinal extension via S2 level, status post sacral tumor biopsy Post-operative Diagnosis Intraspinal intramedullary tumor, from mid-thoracic level to sacrococcygeal region with intra-pelvic extraspinal extension via S2 level, status post sacral tumor biopsy Operative Method Long segment (T8-S3) laminoplasty for gross total intraspinal tumor resection Specimen Count And Types 3 pieces About size:1.5*1.5*6cm Source:intraspinal tumor About size:0.5*0.4*0.2cm Source:arachnoid membrane About size:pieces Source:intraspinal tumor Pathology Pending. Frozen section: gliosis or grade II astrocytoma Operative Findings 1. Scoliosis was noted. 2. A long segment of tumor extending from about T8 to S3-4 was noted, seemed to be arising near conus medullaris, tangled with the cauda equina and exiting nerve roots. Left S2 neural foramen was enlarged, and tumor extended beyond spinal canal to extraspinal area through this route. This foramen was sealed with DuraGene & Tissucol Duo to prevent future extraspinal tumor growth. 3. Careful identification & preservation of the sacral nerve roots were done via intra-operative nerve stimulation. 4. Specimen labeled as "A" is the tumor mainly located at the dorsal aspect of the cauda equina. Specimen labeled as "B" is the thickened arachnoid membrane with some suspicious granule coatings (suspected seeding of the tumor cells). Specimen labeled as "C" is the tumor located at the ventral aspect of cauda equina. 5. No intra-operative SSEP or MEP change was noted. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position. After scrubbing, disinfection & draping in sterile fashion, a curvilinear incision was made along the course of the spinous process (from about T8 to sacrum). The laminae was then removed en bloc with saw, Kerrison punch and scissors. A midline linear durotomy was then performed under microscopic view. Tumor resection was then performed with bipolar electrocautery, scissors & CUSA. After meticulous hemostasis, the left S2 neural foramen was sealed with DuraGene & Tissucol Duo. The dura was then closed in water-tight fashion with 5-0 Prolene continuous suture, and augmented with Tissucol Duo. The wound was then closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之, Ri 陳勇仁 相關圖片 劉陳淑娥 (F,1947/12/01,64y3m) 手術日期 2011/10/25 手術主治醫師 侯育致 手術區域 東址 026房 04號 診斷 Cataract 器械術式 Phaco+PCIOL 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 10:55 進入手術室 11:15 手術開始 11:35 手術結束 11:40 送出病患 記錄__ 手術科部: 眼科部 套用罐頭: Phacoemulsification and PCIOL implantation (od ) 開立醫師: 吳立理 開立時間: 2011/10/25 11:32 Pre-operative Diagnosis Cataract (od ) Post-operative Diagnosis Cataract (od ) Operative Method Phacoemulsification and PCIOL implantation (od ) Specimen Count And Types Pathology Nil Operative Findings Cataract (od ) Operative Procedures 1. Under topical anesthesia. 2. Disinfection, irrigation and draping. 3. Application of an eyelid speculum. 4. Made a clear corneal incision and penetrate into AC with 2.5mm trapezoid knife at 10 oclock position. 5. Inject Healon into the anterior chamber. 6. Continuous circular capsulorrhexis was done with bent needle and capsular forceps. 7. Made a sideport at 2 oclock position with the MVR blade. 8. Hydrodissection and hydrodelineation were done with BSS. 9. Phacoemulsification of the nucleus by standard divide-and-conquer technique. 10. Aspiration of the residual cortical material with I/A tube. 11. Foldable PCIOL was implanted into the bag after injection of Viscoat. 12. The residual Healon was washed out by I/A device. 13. Inject BSS into AC and check leakage 14. Stromal hydration of the wound with BSS 16. Topical irrigation of Rinderon and Gentamycin. 17. Maxitrol patching. Operators 侯育致, Assistants 吳立理, 麥珮怡, 邱福地 (M,1955/01/15,57y1m) 手術日期 2011/10/25 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 HIVD 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 吳健暉, 時間資訊 23:14 臨時手術NPO 07:38 報到 08:05 進入手術室 08:10 麻醉開始 08:15 誘導結束 08:20 抗生素給藥 08:35 手術開始 11:00 手術結束 11:00 麻醉結束 11:15 送出病患 11:20 進入恢復室 12:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 椎間盤切除術-頸椎 1 1 手術 脊椎融合術-前融合,有固定物)≦四節 1 2 摘要__ 手術科部: 外科部 套用罐頭: Anterior Discectomy and Fusion, Cervical Spine 開立醫師: 曾峰毅 開立時間: 2011/10/25 10:48 Pre-operative Diagnosis 1. Diffuse idiopathic skeletal hyperostosis 2. Hernivated intervertebral disc, C5/6 Post-operative Diagnosis 1. Diffuse idiopathic skeletal hyperostosis 2. Hernivated intervertebral disc, C5/6 Operative Method Anterior cervical diskectomy at C5/6 and fusion with trabecular metal cage and artificial bone graft Specimen Count And Types Nil Pathology Nil Operative Findings Diffuse idiopathic skeletal hyperostosis was noted at C5/6 and C6/7. Buldgind disc compromised thecal sac tightly, and spinal cord was decompressed well after the surgery. Zimmer trabecular metal cage and Simbone HT were used for fusion. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with neck extended. We scrubbed, disinfected, and then draped the patient's neck. We made one transverse skin incision at right aspect of the neck, and dissected along the medial side of platysma to preverterbral space. WE drilled off the spurs, and performed anterior diskectomy at C5/6. Anterior fusion was performed with cage and artificial bone graft. The wound was closed in layers. Operators VS 賴達明 Assistants R5 曾峰毅 R1 吳健暉 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Anterior Discectomy and Fusion, Cervical Spine 開立醫師: 吳健暉 開立時間: 2011/10/25 11:18 Pre-operative Diagnosis 1. Diffuse idiopathic skeletal hyperostosis 2. Hernivated intervertebral disc, C5/6 Post-operative Diagnosis 1. Diffuse idiopathic skeletal hyperostosis 2. Hernivated intervertebral disc, C5/6 Operative Method Anterior cervical diskectomy at C5/6 and fusion with trabecular metal cage and artificial bone graft Specimen Count And Types Nil Pathology Nil Operative Findings Diffuse idiopathic skeletal hyperostosis was noted at C5/6 and C6/7. Buldgind disc compromised thecal sac tightly, and spinal cord was decompressed well after the surgery. Zimmer trabecular metal cage and Simbone HT were used for fusion. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with neck extended. We scrubbed, disinfected, and then draped the patient's neck. We made one transverse skin incision at right aspect of the neck, and dissected along the medial side of platysma to preverterbral space. WE drilled off the spurs, and performed anterior diskectomy at C5/6. Anterior fusion was performed with cage and artificial bone graft. The wound was closed in layers. Operators VS 賴達明 Assistants R5 曾峰毅 R1 吳健暉 相關圖片 余登元 (M,1951/12/01,60y3m) 手術日期 2011/10/25 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Ossification of posterior longitudinal ligament, cervical 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 吳健暉, 時間資訊 23:18 臨時手術NPO 11:23 進入手術室 11:25 麻醉開始 11:30 誘導結束 11:31 抗生素給藥 12:00 手術開始 14:30 抗生素給藥 14:55 手術結束 14:55 麻醉結束 15:00 送出病患 15:05 進入恢復室 17:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-頸椎 1 1 手術 椎間盤切除術-頸椎 1 2 手術 脊椎融合術-前融合,有固定物)≦四節 1 4 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 摘要__ 手術科部: 外科部 套用罐頭: Anterior Discectomy and Fusion, Cervical Spine 開立醫師: 曾峰毅 開立時間: 2011/10/25 14:48 Pre-operative Diagnosis Cervical stenosis, status laminoplasty, complicated with adjacent degenration at C3/4 and C4/5 Post-operative Diagnosis Cervical stenosis, status laminoplasty, complicated with adjacent degenration at C3/4 and C4/5 Operative Method Anterior cervical diskectomy and fusion with PEEK cage and artificial bone graft at C3/4 and C4/5 Specimen Count And Types Nil Pathology Nil Operative Findings Herniated disc compromised thecal sac and bilateral neural foramen at C3/4 and C4/5. Neural structures were decompressed well after the surgery. Synthes PEEK cage and artificial bone graft were used for fusion at C3/4 and C4/5. CSF leakage was noted during C3/4 diskectomy, and was sealed by Gelfoam packing. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with neck extended. We scrubbed, disinfected, and then draped the patient. We made one transverse skin incision at right aspect of the neck, and dissected to expose prevertebral space. Anterior diskectomy was performed at C4/5, and fusion with PEEK cage and aritificial bone graft was done. Anterior diskectomy was performed at C3/4, and fusion with PEEK cage and aritificial bone graft was done. After inserting one submuscuarl mini-hemovac, the wound was closed in layers. Operators VS 賴達明 Assistants R5 曾峰毅 R1 吳健暉 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Anterior Discectomy and Fusion, Cervical Spine 開立醫師: 吳健暉 開立時間: 2011/10/25 15:08 Pre-operative Diagnosis Cervical stenosis, status laminoplasty, complicated with adjacent degenration at C3/4 and C4/5 Post-operative Diagnosis Cervical stenosis, status laminoplasty, complicated with adjacent degenration at C3/4 and C4/5 Operative Method Anterior cervical diskectomy and fusion with PEEK cage and artificial bone graft at C3/4 and C4/5 Specimen Count And Types Nil Pathology Nil Operative Findings Herniated disc compromised thecal sac and bilateral neural foramen at C3/4 and C4/5. Neural structures were decompressed well after the surgery. Synthes PEEK cage and artificial bone graft were used for fusion at C3/4 and C4/5. CSF leakage was noted during C3/4 diskectomy, and was sealed by Gelfoam packing. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with neck extended. We scrubbed, disinfected, and then draped the patient. We made one transverse skin incision at right aspect of the neck, and dissected to expose prevertebral space. Anterior diskectomy was performed at C4/5, and fusion with PEEK cage and aritificial bone graft was done. Anterior diskectomy was performed at C3/4, and fusion with PEEK cage and aritificial bone graft was done. After inserting one submuscuarl mini-hemovac, the wound was closed in layers. Operators VS 賴達明 Assistants R5 曾峰毅 R1 吳健暉 相關圖片 黃榮長 (M,1950/03/04,62y0m) 手術日期 2011/10/25 手術主治醫師 賴達明 手術區域 東址 003房 03號 診斷 Cervical spondylosis 器械術式 Spinal fusion posterior-TAS C1-2 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 吳健暉, 時間資訊 23:16 臨時手術NPO 15:12 進入手術室 15:25 抗生素給藥 15:25 麻醉開始 15:30 誘導結束 15:35 報到 16:20 手術開始 18:25 抗生素給藥 19:15 麻醉結束 19:15 手術結束 19:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎弓切除術(減壓)-二節以內 1 2 手術 骨或軟骨移植術 1 4 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 曾峰毅 開立時間: 2011/10/25 19:01 Pre-operative Diagnosis C1/2 sublaxation Post-operative Diagnosis C1/2 sublaxation Operative Method Posterior fixation of C1/2 with trans-articular screws, posterior decompression with C1 lamienctomy, posterior fusion with autologous iliac crest bone graft and mini-plates. Specimen Count And Types Nil Pathology Nil Operative Findings Compromised thecal sac expanded well after C1-laminectomy. Two 3.6-cm-long screws were used for C1/2 fixation. Compromised thecal sac expanded well after C1-laminectomy. Two 3.6-cm-long screws were used for C1/2 fixation. There is no amplitude or latency change of SSEP during the operation. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position with head fixed with Mayfield head clamp. We shaved, scrubbed, disinfected, and then draped the patient's skin. We made midline skin incision and dissected paraspinal muscle to expose bilateral laminae from C1 to C3. C1 laminectomy was done, and bone graft was harvested from right iliac crest. Trans-articular screws were inserted from C2 lateral mass under C-arm guidance. Posterior fusion was done with autologous bone graft and mini-plates. After one submuscular CWV, the wound was closed in layers. Operators VS 賴達明 Assistants R5 曾峰毅 R1 吳健暉 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 吳健暉 開立時間: 2011/10/25 19:20 Pre-operative Diagnosis C1/2 sublaxation Post-operative Diagnosis C1/2 sublaxation Operative Method Posterior fixation of C1/2 with trans-articular screws, posterior decompression with C1 lamienctomy, posterior fusion with autologous iliac crest bone graft and mini-plates. Specimen Count And Types Nil Pathology Nil Operative Findings Compromised thecal sac expanded well after C1-laminectomy. Two 3.6-cm-long screws were used for C1/2 fixation. There is no amplitude or latency change of SSEP during the operation. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position with head fixed with Mayfield head clamp. We shaved, scrubbed, disinfected, and then draped the patient's skin. We made midline skin incision and dissected paraspinal muscle to expose bilateral laminae from C1 to C3. C1 laminectomy was done, and bone graft was harvested from right iliac crest. Trans-articular screws were inserted from C2 lateral mass under C-arm guidance. Posterior fusion was done with autologous bone graft and mini-plates. After one submuscular CWV, the wound was closed in layers. Operators VS 賴達明 Assistants R5 曾峰毅 R1 吳健暉 相關圖片 徐光沐 (M,1958/05/15,53y9m) 手術日期 2011/10/26 手術主治醫師 杜永光 手術區域 東址 003房 號 診斷 Cerebral aneurysm 器械術式 Craniotomy(Aneurysms) P-DUH 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 李振豪, 曾偉倫, 時間資訊 23:34 臨時手術NPO 07:43 報到 08:05 進入手術室 08:15 麻醉開始 09:00 誘導結束 09:20 抗生素給藥 09:30 手術開始 12:40 抗生素給藥 14:10 麻醉結束 14:10 手術結束 14:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 2 0 手術 開顱術摘除血管病變 - 腦血管瘤 無病徵的 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Right pterional approach for aneurysm clipping 開立醫師: 李振豪 開立時間: 2011/10/26 14:15 Pre-operative Diagnosis Right posterior communicating artery aneurysm Post-operative Diagnosis Right posterior communicating artery aneurysm Operative Method Right pterional approach for aneurysm clipping Specimen Count And Types nil Pathology Nil Operative Findings The right posterior communicating artery was 5.5mm in largest diameter and 3.5mm in neck which pointing posterolaterally. The dome was adhered to temporal lobe. A 130 degree angled Sugita clip was used for aneurysm clipping. ICG test was performed which confirmed the patency of right posterior communicating artery. The aneurysm was not bright up under IR800 view. The aneurysm was opened with 27G needle and no active bleeding found. The brain was slack after the operation. A small incidental durotomy was noted at posterior margin of craniotomy and packing with Gelfoam. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with right shoulder elevation. The head was rotated to left and fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. Curvilinear scalp incision was made at right fronto-temporal area. The scalp flap was elevated with facial nerve preservation. The temporalis muscle was detached from skull bone and retracted posteroinferiorly. Three burrholes were created followed by one 8x4cm craniotomy window. Dural tenting was done. The sphenoid ridge was drilled for better expose of skull base. Curvilinear durotomy was made at fronto-temporal area. The frontal lobe was retracted and optic nerve was identified. The arachnoid membrane was opened along the optic nerve and internal carotid artery. We trace along the internal carotid artery and posterior communicating artery aneurysm was identified. The neck of aneurysm was dissected and one 130 degree angled aneurysm clip was applied for aneurysm clipping. ICG test was performed and the patency of the posterior communicating artery was confirmed. The aneurysm was opened with 27G needle and no active bleeding was noted. Hemostasis was achieved with bipolar electrocautery. Dura was closed with 4-0 Prolene. The skull plate was fixed back with miniplates, screws, and three central tenting. The temporalis muscle was fixed back to its neutral position. One subgaleal CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators Prof. 杜永光 Assistants R5 李振豪, R3 曾偉倫 相關圖片 林怡君 (F,1982/04/21,29y10m) 手術日期 2011/10/26 手術主治醫師 曾漢民 手術區域 東址 002房 04號 診斷 Germ cell tumor, ovary 器械術式 Ommaya reservoir implantation 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 曾峰毅, 時間資訊 23:40 臨時手術NPO 12:50 報到 12:55 進入手術室 13:10 麻醉開始 13:15 誘導結束 13:30 抗生素給藥 13:38 手術開始 14:27 手術結束 14:27 麻醉結束 14:38 送出病患 14:40 進入恢復室 15:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 歐氏貯囊置放手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Ommaya reservoir implantation 開立醫師: 曾峰毅 開立時間: 2011/10/26 13:09 Pre-operative Diagnosis Brain metastasis Post-operative Diagnosis Brain metastasis Operative Method Right Kocher point ommaya reservoir implantation Specimen Count And Types Nil Pathology Nil Operative Findings Clear CSF drained out after ventricular puncture. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position. The scalp was shaved, scrubbed, antiseptic with alcohol B-I then draped. A curvilinear skin incision was made at right frontal region followed by burr hole creation. The dura was incised after tenting with 3-0 silk. A ventricular puncture needle was used to puncture then shifted to the ommaya reservoir. After checked the reservoir function, the wound was closed in layers. Operators VS 曾漢民 Assistants R5 曾峰毅 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Ommaya reservoir implantation 開立醫師: 曾峰毅 開立時間: 2011/10/26 14:28 Pre-operative Diagnosis Brain metastasis Post-operative Diagnosis Brain metastasis Operative Method Right Kocher point ommaya reservoir implantation, failed Specimen Count And Types Nil Pathology Nil Operative Findings Failed ventriculostomy 6 times. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position. The scalp was shaved, scrubbed, antiseptic with alcohol B-I then draped. A curvilinear skin incision was made at right frontal region followed by burr hole creation. The dura was incised after tenting with 3-0 silk. A ventricular puncture needle was used to puncture. Ventriculostomy failed. The wound was closed in layers. Operators VS 曾漢民 Assistants R5 曾峰毅 相關圖片 水殿 (M,1946/08/26,65y6m) 手術日期 2011/10/26 手術主治醫師 曾漢民 手術區域 東址 003房 02號 診斷 Brain Tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 2 紀錄醫師 曾偉倫, 時間資訊 23:42 臨時手術NPO 13:55 報到 14:35 進入手術室 14:40 麻醉開始 14:50 誘導結束 15:15 抗生素給藥 15:30 手術開始 17:00 麻醉結束 17:00 手術結束 17:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 手術 經由蝶竇之腦下垂體瘤切除 1 1 記錄__ 手術科部: 外科部 套用罐頭: Trans-nasal trans-sphenoidal adenomectomy 開立醫師: 李振豪 開立時間: 2011/10/26 17:26 Pre-operative Diagnosis Pituitary macroadenoma Post-operative Diagnosis Pituitary macroadenoma Operative Method Trans-nasal trans-sphenoidal adenomectomy Specimen Count And Types Multiple small pieces, Source:Pituitary tumor Pathology Pending Operative Findings The tumor was white-reddish in color, soft and fragile, well-defined with pseudocapsule formation, hypervascularized, and 3 x 2.5 x 4 cm in size. After total removal of the tumor, paper thin normal gland was coated at pseudocapsule. The arachnoid pouch was intact without evident CSF leakage. The nasal mucosa was easily bleeding. The septal mucosa was hard to repair and packing with Gelfoam. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head tilted 30 degree to left. The nasal cavity was packing with epinephrine soaked gauze for 10 minutes. The face and left lower abdomen were prepared with povidone-iodine alcohol tincture, and the mucosa of oral and nasal cavity with aqueous povidone-iodine tincture. The nasal submucosa at septum and floor were infiltrated with 1:100 epinephrine solution. One 2cm incision was made at nasal mucosa of right nasal septum and the musoca was dissected away from the septum. The nasal septum was fractured and the vomer was removed. The sphenoid sinus was entered and the mucosa within the sphenoid sinus was removed. The sellar floor was identified and opened. Cruciform durotomy was done and the tumor showed up after dura opening. Tumor excision was performed with ring curette, tumor forceps, and suction. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. The bony fragment and vomer was placed back. The nasal mucosa was pushed back and middle turbinate was reducted. Bilateral nasal cavity were packing with total three segment of rubber glove finger which had been soaked with better-iodine ointment(two on right and one on left). Operators VS 曾漢民 Assistants R5 李振豪, R3 曾偉倫 相關圖片 鄭兆閎 (M,2002/04/26,9y10m) 手術日期 2011/10/26 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Headache 器械術式 V-P shunt revision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:05 進入手術室 08:10 麻醉開始 08:30 抗生素給藥 08:30 誘導結束 09:09 手術開始 10:00 手術結束 10:00 麻醉結束 10:23 送出病患 10:25 進入恢復室 11:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦脊髓液分流管重置 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt revision with addi... 開立醫師: 王奐之 開立時間: 2011/10/26 10:11 Pre-operative Diagnosis Suspected slit ventricle syndrome Post-operative Diagnosis Suspected slit ventricle syndrome Operative Method Ventriculoperitoneal shunt revision with addition of Codman programmable reservoir Specimen Count And Types Nil Pathology Nil Operative Findings Thick soft tissue with ingrowth to the space between the bone and the burr hole reservoir was noted, and removed to reduce the distance between the reservoir and the bone. A Codman programmable reservoir was connected to the burr hole reservoir, preset to 100 mmH2O. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After shaving, scrubbing, disinfection & draping in sterile fashion, a curved incision along previous scar was made at right frontal area. Another small linear incision was made at right retroauricular area. After mobilization of the shunt catheter, the shunt was transected at the retroauricular wound. The programmable reservoir was passed throught the subcutaneous tunnel and connected to the distal shunt, followed by connection of the reservoir to the burr hole reservoir. After confirmation of smooth CSF flow, the wound was closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之, Ri 陳勇仁 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt revision with addi... 開立醫師: 王奐之 開立時間: 2011/10/26 10:11 Pre-operative Diagnosis Suspected slit ventricle syndrome Post-operative Diagnosis Suspected slit ventricle syndrome Operative Method Ventriculoperitoneal shunt revision with addition of Codman programmable reservoir Specimen Count And Types Nil Pathology Nil Operative Findings Thick soft tissue with ingrowth to the space between the bone and the burr hole reservoir was noted, and removed to reduce the distance between the reservoir and the bone. A Codman programmable reservoir was connected to the burr hole reservoir, preset to 100 mmH2O. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After shaving, scrubbing, disinfection & draping in sterile fashion, a curved incision along previous scar was made at right frontal area. Another small linear incision was made at right retroauricular area. After mobilization of the shunt catheter, the shunt was transected at the retroauricular wound. The programmable reservoir was passed throught the subcutaneous tunnel and connected to the distal shunt, followed by connection of the reservoir to the burr hole reservoir. After confirmation of smooth CSF flow, the wound was closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之, Ri 陳勇仁 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt revision with addi... 開立醫師: 郭夢菲 開立時間: 2011/10/26 10:53 Pre-operative Diagnosis Slit ventricle syndrome Post-operative Diagnosis Slit ventricle syndrome Operative Method Ventriculoperitoneal shunt revision with addition of a Codman programmable reservoir (pressure setting 100mm H2O) Specimen Count And Types Nil Pathology Nil Operative Findings Thick soft tissue with ingrowth to the space between the bone and the burr hole reservoir was noted, and removed to reduce the distance between the reservoir and the bone. A Codman programmable reservoir was connected to the burr hole reservoir, preset to 100 mmH2O. When the old shunt was disconnected between the reservoir and the peritoneal catheter, the CSF flew out slowly, continuously, and amoothly. It showed that the shunt was patent though the ventricular catheter might be a little shorter. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After shaving, scrubbing, disinfection & draping in sterile fashion, a curved incision along previous scar was made at right frontal area. Another small linear incision was made at right retroauricular area. After mobilization (disconnection between the valve and the peritoneal catheter) of the shunt catheter, the shunt was transected at the retroauricular wound. The programmable reservoir was passed throught the subcutaneous tunnel and connected to the distal shunt, followed by connection of the reservoir to the burr hole reservoir. After confirmation of smooth CSF flow, the fibrosis tissue underlying the pervious reservior was removed and the valve was fixed back again for two stitches. The wound was closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之, Ri 陳勇仁 相關圖片 蔡東諺 (M,2008/04/26,3y10m) 手術日期 2011/10/26 手術主治醫師 郭夢菲 手術區域 兒醫 067房 02號 診斷 Brain tumor 器械術式 S-P shunt removal 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 1 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 09:51 報到 10:35 進入手術室 10:40 麻醉開始 10:50 誘導結束 11:04 抗生素給藥 11:23 手術開始 11:40 手術結束 11:40 麻醉結束 11:48 送出病患 12:00 進入恢復室 13:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 皮下肌肉或深部異物取出術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Right side subduroperitoneal shunt removal 開立醫師: 王奐之 開立時間: 2011/10/26 11:53 Pre-operative Diagnosis Subdural effusion, status post right subduroperioneal shunt insertion Post-operative Diagnosis Subdural effusion, status post right subduroperioneal shunt insertion Operative Method Right side subduroperitoneal shunt removal Specimen Count And Types 1 piece About size:10cm Source:shunt catheter Pathology Nil Operative Findings Only minimal adhesion was encountered. Estimated blood loss: minimal. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position. After shaving, scrubbing, disinfection & draping in sterile fashion, a linear incision along previous wound was made at right temporal area. Dissection of surrounding tissue to expose the shunt catheter was done, the peritoneal catheter was extracted, and the catheter was transected at the entry site of burr hole. The wound was then closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Right side subduroperitoneal shunt removal 開立醫師: 王奐之 開立時間: 2011/10/26 11:53 Pre-operative Diagnosis Subdural effusion, status post right subduroperioneal shunt insertion Post-operative Diagnosis Subdural effusion, status post right subduroperioneal shunt insertion Operative Method Right side subduroperitoneal shunt removal Specimen Count And Types 1 piece About size:10cm Source:shunt catheter Pathology Nil Operative Findings Only minimal adhesion was encountered. Estimated blood loss: minimal. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position. After shaving, scrubbing, disinfection & draping in sterile fashion, a linear incision along previous wound was made at right temporal area. Dissection of surrounding tissue to expose the shunt catheter was done, the peritoneal catheter was extracted, and the catheter was transected at the entry site of burr hole. The wound was then closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Right side subduroperitoneal shunt removal 開立醫師: 郭夢菲 開立時間: 2011/10/27 08:56 Pre-operative Diagnosis Subdural effusion, status post right subduroperioneal shunt insertion Post-operative Diagnosis Subdural effusion, status post right subduroperioneal shunt insertion Operative Method Right side subduroperitoneal shunt removal Specimen Count And Types 1 piece About size:10cm Source:shunt catheter Pathology Nil Operative Findings The old sP shunt was a Codman very low pressure differential valve. Only minimal adhesion was encountered. Estimated blood loss: minimal. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position. After shaving, scrubbing, disinfection & draping in sterile fashion, a linear incision along previous wound was made at right temporal area. Dissection of surrounding tissue to expose the shunt catheter was done, the peritoneal catheter was extracted, and the catheter was transected at the entry site of burr hole. The wound was then closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之 相關圖片 王則興 (M,1941/10/23,70y4m) 手術日期 2011/10/27 手術主治醫師 賴達明 手術區域 東址 002房 06號 診斷 Subdural hemorrhage or effusion 器械術式 Removal of chronic subdural hematoma, Left 手術類別 緊急手術 手術部位 頭、頸 傷口分類 髒 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 3E 紀錄醫師 林哲光, 時間資訊 10:00 開始NPO 10:00 臨時手術NPO 19:19 通知急診手術 00:45 報到 00:50 進入手術室 01:00 麻醉開始 01:05 誘導結束 01:52 手術開始 03:25 麻醉結束 03:25 手術結束 03:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 慢性硬腦膜下血腫清除術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Left frontal burr hole drainage 開立醫師: 林哲光 開立時間: 2011/10/27 04:09 Pre-operative Diagnosis Left F-T-P chronic subdural hematoma Post-operative Diagnosis Left F-T-P subdural abscess with effusion Operative Method Left frontal burr hole drainage Specimen Count And Types 1 piece About size: Source:Outer membrane of subdural abscess and part of dura, Swab culture of pus x2, pus routine, culture, BCS and LDH, cytology were sent Pathology Pending Operative Findings Preoperative GCS was E2M3-4V1. Pus gushed out after dura and outer membrane opened. Outer and inner membrane formation was noted. Some dark-reddish fluid contents were also noted after pus drained out. Operative Procedures Under ETGA and supine position with head rotated to right side, skin disinfected and drapped were performed as usual. A transverse skin incison was made and the muscle was split. A 2cm sized burr hole was created and the dura was opened after dural tenting. The outer membrane was excised and sent for pathology. Pus gushed out and rubber drain was inserted for further drainage. N/S irrigation was then done and the subdural drain was fixed through the subcutaneous tunneling. The burr hole was packed with Gelfoam and the wound was then closed in layers and Deair was performed. Operators 賴達明 Assistants 林哲光 Indication Of Emergent Operation Conscious change and high fever with right side weakness 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Left frontal burr hole drainage 開立醫師: 林哲光 開立時間: 2011/10/27 04:09 Pre-operative Diagnosis Left F-T-P chronic subdural hematoma Post-operative Diagnosis Left F-T-P subdural abscess with effusion Operative Method Left frontal burr hole drainage Specimen Count And Types 1 piece About size: Source:Outer membrane of subdural abscess and part of dura, Swab culture of pus x2, pus routine, culture, BCS and LDH, cytology were sent Pathology Pending Operative Findings Preoperative GCS was E2M3-4V1. Pus gushed out after dura and outer membrane opened. Outer and inner membrane formation was noted. Some dark-reddish fluid contents were also noted after pus drained out. Operative Procedures Under ETGA and supine position with head rotated to right side, skin disinfected and drapped were performed as usual. A transverse skin incison was made and the muscle was split. A 2cm sized burr hole was created and the dura was opened after dural tenting. The outer membrane was excised and sent for pathology. Pus gushed out and rubber drain was inserted for further drainage. N/S irrigation was then done and the subdural drain was fixed through the subcutaneous tunneling. The burr hole was packed with Gelfoam and the wound was then closed in layers and Deair was performed. Operators 賴達明 Assistants 林哲光 Indication Of Emergent Operation Conscious change and high fever with right side weakness 相關圖片 莊永川 (M,1934/07/01,77y8m) 手術日期 2011/10/26 手術主治醫師 賴達明 手術區域 東址 005房 02號 診斷 Pulmonary tuberculosis 器械術式 Spinal fusion anterior spinal 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 陳國瑋, 鍾文桂, 時間資訊 23:36 臨時手術NPO 14:20 進入手術室 14:30 麻醉開始 14:50 誘導結束 15:30 抗生素給藥 15:40 手術開始 17:53 開始輸血 18:30 抗生素給藥 18:50 手術結束 18:50 麻醉結束 19:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 脊椎融合術-前融合,有固定物(每增加<=四節) 1 2 L 手術 椎間盤切除術-腰椎 1 1 記錄__ 手術科部: 內科部 套用罐頭: 1. L1 corpectomy and fusion with body mesh ca... 開立醫師: 陳國瑋 開立時間: 2011/10/26 19:32 Pre-operative Diagnosis L1 TB spine Post-operative Diagnosis L1 TB spine Operative Method 1. L1 corpectomy and fusion with body mesh cage 3.5cm, Z plate 40mm Screws*II 1. L1 corpectomy and fusion with body mesh cage and Z plate 2. Diskectomy T12-L1, L1-2 Specimen Count And Types 2 pieces About size:fragments Source:L1 body, upper and lower disc and paraspinal soft tissue About size:Swab *III Source:L1 Pathology Pending Operative Findings The L1 vertebral body had been eroded and became soft and fragile. Granulation at bilateral paraspinal soft tissue and epidural space was noted. The end-plates and disces were not eroded. The L1 vertebral body had been eroded and became soft and fragile. Granulation at bilateral paraspinal soft tissue and epidural space was noted. The end-plates and disces were not eroded. The body mesh cage 3.5cm, Z plate 40mm Screws*II were implanted Operative Procedures Under intubation and general anesthesia, the patient was put in right decubitus position. One 10cm curvelinear skin incision was made over the left 11th rib. The rib was then fractured and harvested for bone graft. Dissection between the parietal and visceral pleura was done to the level of vertebral body. The diaphram cruz was dissected. L1 corpectomy, T12-L1, L1-2 diskectomy was done along with debridement of paraspinal and epidural granulation. One mesh body cage 3.5cm heigh was placed between T12-L2 vertebral body with autologus bone graft and allograft. One Z plate was fixed and four screws were placed. Careful hemastasis was done. After placing one CWV the wound was closed in layers. Operators 賴達明 Assistants 鍾文桂 陳國瑋 相關圖片 林天中 (M,1975/01/17,37y1m) 手術日期 2011/10/26 手術主治醫師 楊士弘 手術區域 東址 005房 01號 診斷 Herniated Intervertebral Disc ( HIVD ) 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 面罩麻醉 麻醉主治醫師 詹偉弘 ASA 2 紀錄醫師 鍾文桂, 時間資訊 23:38 臨時手術NPO 08:05 進入手術室 08:15 麻醉開始 09:10 誘導結束 09:15 抗生素給藥 09:35 手術開始 12:15 抗生素給藥 13:35 手術結束 13:35 麻醉結束 13:40 送出病患 13:50 進入恢復室 15:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-腰椎 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Semi-opened mask inhalation anes 1 0 麻醉 Semi-opened INHALATION GENERAL A 4 0 麻醉 SENI-OPENED INHALATION GENERAL A 3 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: Endoscopic diskectomy. 開立醫師: 張政傑 開立時間: 2011/10/26 14:07 Pre-operative Diagnosis Far lateral herniated intervertebral disc, L4/5. Post-operative Diagnosis Far lateral herniated intervertebral disc, L4/5. Operative Method Endoscopic diskectomy. Specimen Count And Types nil Pathology Nil. Operative Findings Extreme lateral disc with soft and hard consistency. Intraoperative fluoroscopy was done for localization of the disc space. Removal of the ruptured disc and the disc inside the intervertebral space were done under endoscope. We did not visualize the root directly. However, it was close to our operative field as the patient experienced electric shock sensation of right lower back? during bipolar electrocoagulation. Operative Procedures Under local anesthesia, the patient was placed in prone position. After disinfection and draping, a 1cm skin incision was made at left lower back. A guiding needle was inserted 15 cm off midline and 30 degree above the horizon at L4/5 level. Its tip reached the foramen under intraoperative fluoroscopy guidance. Then, the endoscope was inserted through the same tract. The endoscopes location was ensured by intraoperative fluoroscopy again. The disc was removed in piecemeal fashion by punch and bipolar electrocoagulation. The operative field was cleaned by normal saline irrigation. With well hemostasis, the wound was closed primarily. Operators 蔡瑞章 楊士弘 Assistants 鍾文桂 陳國瑋 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Endoscopic diskectomy. 開立醫師: 陳政維 開立時間: 2011/10/26 14:16 Pre-operative Diagnosis Far lateral herniated intervertebral disc, L4/5. Post-operative Diagnosis Far lateral herniated intervertebral disc, L4/5. Operative Method Endoscopic diskectomy. Specimen Count And Types nil Pathology Nil. Operative Findings Extreme lateral disc with soft and hard consistency. Intraoperative fluoroscopy was done for localization of the disc space. Removal of the ruptured disc and the disc inside the intervertebral space were done under endoscope. We did not visualize the root directly. However, it was close to our operative field as the patient experienced electric shock sensation of right lower back? during bipolar electrocoagulation. Operative Procedures Under local anesthesia, the patient was placed in prone position. After disinfection and draping, a 1cm skin incision was made at left lower back. A guiding needle was inserted 15 cm off midline and 30 degree above the horizon at L4/5 level. Its tip reached the foramen under intraoperative fluoroscopy guidance. Then, the endoscope was inserted through the same tract. The endoscopes location was ensured by intraoperative fluoroscopy again. The disc was removed in piecemeal fashion by punch and bipolar electrocoagulation. The operative field was cleaned by normal saline irrigation. With well hemostasis, the wound was closed primarily. Operators 蔡瑞章 楊士弘 Assistants 鍾文桂 陳國瑋 相關圖片 王徐秋 (F,1943/07/24,68y7m) 手術日期 2011/10/26 手術主治醫師 王碩盟 手術區域 東址 008房 04號 診斷 Adrenal tumor 器械術式 Adrenalectomy, /Laparscopy 手術類別 預定手術 手術部位 腹 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 楊智凱, 時間資訊 11:03 報到 11:13 進入手術室 11:17 麻醉開始 11:50 誘導結束 12:10 抗生素給藥 12:17 手術開始 14:25 手術結束 14:25 麻醉結束 14:40 送出病患 14:45 進入恢復室 16:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腹腔鏡腎上腺切除 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 記錄__ 手術科部: 泌尿部 套用罐頭: adrenalectomy, left 開立醫師: 楊智凱 開立時間: 2011/10/26 14:47 Pre-operative Diagnosis Left adrenal tumor Post-operative Diagnosis Left adrenal tumor Operative Method Left laparoscopic adrenalectomy Specimen Count And Types left adrenal tumor Pathology pending Operative Findings 4 x 3.5 cm-sized adenoma in left adrenal gland Operative Procedures Under satisfactory anesthesia with the patient in right flank position, prepping and draping were performed in the usual sterile fashion. A 16Fr. Foley was inserted into the bladder before the positioning. A 5-12 mm visiport was created at paraumbilicalarea with CO2 inflation up to 15 mmHg. Two 5-mm ports were furtherly placed at LUQ along mid-clavicular line and anterior axillary line. The descending colon was taken down, and the Gerota's fascia was opened. The left adrenal gland was exposed aftercareful dissection. The adrenal vessels were clipped with Hemoloc and divided. The left adrenal gland was delivered and removed after being entrapped into the finger of surgical glove as retrieval bag. Adequate hemostasis was obtained. The wound was closed with 5/8 dexon and skin was closed with 3-0 nylon. The patient tolerated the procedure well and was sent to post-operative room in stable condition. Operators 王碩盟, Assistants 楊智凱, 姜秉均, 郭冠宏 (M,1977/11/08,34y4m) 手術日期 2011/10/27 手術主治醫師 蔡瑞章 手術區域 東址 003房 02號 診斷 Hydrocephalus 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 黃薇諭, 時間資訊 23:12 臨時手術NPO 10:00 報到 10:25 進入手術室 10:30 麻醉開始 10:35 誘導結束 11:10 抗生素給藥 11:35 手術開始 12:35 手術結束 12:35 麻醉結束 12:45 送出病患 12:50 進入恢復室 14:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 歐氏貯囊置放手術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Ommaya reservoir implantation via left Kocher... 開立醫師: 王奐之 開立時間: 2011/10/27 12:41 Pre-operative Diagnosis Hydrocephalus status post ventriculoperitoneal shunt insertion, with shunt dysfunction Post-operative Diagnosis Hydrocephalus status post ventriculoperitoneal shunt insertion, with shunt dysfunction Operative Method Ommaya reservoir implantation via left Kocher point Specimen Count And Types 1 piece About size:5ml Source:CSF Pathology Nil Operative Findings Severe adhesion was encountered, the distal shunt was transected during dissection and could not be retrieved. Minimal adhesion was noted around the ventricular catheter, and could be easily removed. The Ommaya reservoir was inserted into the ventricle through the original tract. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to right. After shaving, scrubbing, disinfection & draping in sterile fashion, a curved incision along previous scar was made at left frontal area. Dissection was made to expose the ventriculoperitoneal shunt reservoir. After mobilization of the reservoir and assembly of the Ommaya reservoir, the shunt reservoir was removed and Ommaya was inserted. After hemostasis, the wound was closed in layers. Operators P 蔡瑞章 Assistants R4 王奐之, R0 黃薇諭 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Ommaya reservoir implantation via left Kocher... 開立醫師: 王奐之 開立時間: 2011/10/27 12:41 Pre-operative Diagnosis Hydrocephalus status post ventriculoperitoneal shunt insertion, with shunt dysfunction Post-operative Diagnosis Hydrocephalus status post ventriculoperitoneal shunt insertion, with shunt dysfunction Operative Method Ommaya reservoir implantation via left Kocher point Specimen Count And Types 1 piece About size:5ml Source:CSF Pathology Nil Operative Findings Severe adhesion was encountered, the distal shunt was transected during dissection and could not be retrieved. Minimal adhesion was noted around the ventricular catheter, and could be easily removed. The Ommaya reservoir was inserted into the ventricle through the original tract. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to right. After shaving, scrubbing, disinfection & draping in sterile fashion, a curved incision along previous scar was made at left frontal area. Dissection was made to expose the ventriculoperitoneal shunt reservoir. After mobilization of the reservoir and assembly of the Ommaya reservoir, the shunt reservoir was removed and Ommaya was inserted. After hemostasis, the wound was closed in layers. Operators P 蔡瑞章 Assistants R4 王奐之, R0 黃薇諭 相關圖片 楊靜江 (F,1940/08/28,71y6m) 手術日期 2011/10/27 手術主治醫師 洪基翔 手術區域 東址 002房 02號 診斷 Urosepsis 器械術式 Suture ligation of rectal bleeding 手術類別 緊急手術 手術部位 腹 傷口分類 髒 麻醉方式 面罩麻醉 麻醉主治醫師 林珍榮 ASA 3E 紀錄醫師 蔡立威, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 09:55 通知急診手術 12:40 進入手術室 12:55 麻醉開始 13:00 誘導結束 13:07 手術開始 13:15 抗生素給藥 13:25 手術結束 13:25 麻醉結束 13:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 結腸肛門止血術 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Semi-opened mask inhalation anes 1 0 記錄__ 手術科部: 內科部 套用罐頭: suture ligation of rectal ulcer 開立醫師: 施廷翰 開立時間: 2011/10/27 13:54 Pre-operative Diagnosis Rectal ulcer bleeding Post-operative Diagnosis Rectal ulcer bleeding Operative Method suture ligation of rectal ulcer Specimen Count And Types nil Pathology nil Operative Findings multiple ulcer bleeding site was noted, above anal verge< 10cm, 1, 3, 6 oclock-direction Operative Procedures 1.IVG, supine 2.disinfection and drapping 3.anal retraction 4.suture ligation of rectal ulcer 5.Bosmin gauze compression Operators 洪基翔 Assistants 黃凱傑,蔡立威 Indication Of Emergent Operation active bleeding 蔡足味 (F,1968/03/13,44y0m) 手術日期 2011/10/27 手術主治醫師 婁培人 手術區域 東址 025房 05號 診斷 Neck mass 器械術式 excisionof right neck mass 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 1 紀錄醫師 黃彥傑, 時間資訊 15:56 進入手術室 16:05 麻醉開始 16:10 誘導結束 16:22 手術開始 18:40 手術結束 18:40 麻醉結束 18:45 送出病患 18:47 進入恢復室 20:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 軟組織惡性腫瘤廣泛切除 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 記錄__ 手術科部: 耳鼻喉部 套用罐頭: Neck mass excision, right 開立醫師: 黃彥傑 開立時間: 2011/10/27 18:30 Pre-operative Diagnosis Malignant peripheral nerve sheath tumor, Right Post-operative Diagnosis Malignant peripheral nerve sheath tumor, Right, operated Operative Method Neck mass excision, right Specimen Count And Types 1 piece About size:7x6cm Source:right supraclavicular fossa tumor Pathology Pending Operative Findings 1. a very hard heterogenous mass about 7x6 cm located at supraclavicular fossa was removed partially. 2. Severe adhesion and fibrosis was noted around the tumor Operative Procedures Anesthesia was set up via ETGA. The patient was in supine position with head extended and turned to left side. Skin was disinfected and draped as usual. Local anesthesia with Bosmin rinsed Xylocaine was injected into the subcutaneous tissue around the mass. After marking an incision parallel to the skin crease, an about 7x6 cm mass was noted behind the right SCM muscle at supraclavicular fossa. The mass was dissecting from the surrounding tissue with residual tumor below thoracic inlet. After hemostasis, a CWV was inserted and then the wound was closed with 2 layers. The patient tolerated the procedure well. Operators P婁培人, Assistants R2黃彥傑, R4李嘉欣, 羅李鳳蘭 (F,1939/01/22,73y1m) 手術日期 2011/10/27 手術主治醫師 林峰盛 手術區域 西址 034房 05號 診斷 Radiculopathy 器械術式 Nerve block / PC 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 林峰盛 ASA 2 時間資訊 12:05 進入手術室 12:16 麻醉開始 12:17 誘導結束 12:18 手術開始 13:00 手術結束 13:00 麻醉結束 13:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 神經分離術–肩,臀關節以上,包括臂神經叢,坐骨神經 1 1 B 手術 靜脈或肌肉麻醉 1 0 B 記錄__ 手術科部: 麻醉部 套用罐頭: Pulsed RF 開立醫師: 劉映汝 開立時間: 2011/10/27 13:02 Pre-operative Diagnosis Radiculopathy Post-operative Diagnosis radiculopathy Operative Method nil Specimen Count And Types nil Pathology Nil Operative Findings nil Operative Procedures 1. IV sedation with midazolam and LA with 1% xylocaine 2. pt in prone position 3. Under fluoroscopic-guidance, insert 23 G spinal needle into bilateral L2 and L5 neuroforamen 4. Root block with rinderon 2.5mg+0.5% lidocaine 3ml 5. send pt to PRO Operators 林峰盛, Assistants 劉映汝, 林文瑛, 陳鄭幸連 (F,1945/04/12,66y11m) 手術日期 2011/10/27 手術主治醫師 陳敞牧 手術區域 東址 001房 04號 診斷 Malignant neoplasm of ethmoidal sinus 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 4E 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 18:28 通知急診手術 19:20 進入手術室 19:25 麻醉開始 20:00 抗生素給藥 20:00 誘導結束 20:22 手術開始 20:47 手術結束 20:47 麻醉結束 20:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室體外引流 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 曾峰毅 開立時間: 2011/10/27 20:36 Pre-operative Diagnosis Hydrocephalust, status post ventriculoperitoneal shunt via right Kocher, complicated with shunt infection and dysfunction Post-operative Diagnosis Hydrocephalust, status post ventriculoperitoneal shunt via right Kocher, complicated with shunt infection and dysfunction Operative Method Removal of VP shunt, and insertion of external ventricular drianage via right Kocher. Specimen Count And Types CSF was sent for routine, BCS, and culture. Ventricular catheter tip was sent for culture. Pathology Nil Operative Findings Turbid CSF gushed out via ventriculostomy while shunt removed. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position. We shaved, scrubbed, disinfected, and then draped the patient, and made scalp incision along previous frontal incision, and another incision at right retroaurcular region just above shunt reservoir. We removed previous shunt, and inserted external ventricular drainage. The wound was closed in layers. Operators VS 陳敞牧 Assistants R5 曾峰毅 R3 陳國瑋 Ri 黃晨祐 Indication Of Emergent Operation Acute hydrocephalus 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 陳國瑋 開立時間: 2011/11/02 15:09 Pre-operative Diagnosis Hydrocephalust, status post ventriculoperitoneal shunt via right Kocher, complicated with shunt infection and dysfunction Post-operative Diagnosis Hydrocephalust, status post ventriculoperitoneal shunt via right Kocher, complicated with shunt infection and dysfunction Operative Method Removal of VP shunt, and insertion of external ventricular drianage via right Kocher. Specimen Count And Types CSF was sent for routine, BCS, and culture. Ventricular catheter tip was sent for culture. Pathology Nil Operative Findings Turbid CSF gushed out via ventriculostomy while shunt removed. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position. We shaved, scrubbed, disinfected, and then draped the patient, and made scalp incision along previous frontal incision, and another incision at right retroaurcular region just above shunt reservoir. We removed previous shunt, and inserted external ventricular drainage. The wound was closed in layers. Operators VS 陳敞牧 Assistants R5 曾峰毅 R3 陳國瑋 Ri 黃晨祐 Indication Of Emergent Operation Acute hydrocephalus 相關圖片 徐正發 (M,1956/05/24,55y9m) 手術日期 2011/10/27 手術主治醫師 楊士弘 手術區域 東址 005房 02號 診斷 Herniation of intervertebral disc with myelopathy, cervical (HIVD) 器械術式 Laminoplasty 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 林哲光, 時間資訊 23:15 臨時手術NPO 10:55 報到 11:20 進入手術室 11:30 麻醉開始 11:40 誘導結束 11:45 手術開始 11:50 抗生素給藥 14:50 手術結束 14:50 麻醉結束 14:55 送出病患 15:00 進入恢復室 16:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓整形術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 摘要__ 手術科部: 外科部 套用罐頭: Laminoplasty C3-5 and sublaminal decompressio... 開立醫師: 林哲光 開立時間: 2011/10/27 15:15 Pre-operative Diagnosis OPLL with C3-5 spinal canal stenosis Post-operative Diagnosis OPLL with C3-5 spinal canal stenosis Operative Method Laminoplasty C3-5 and sublaminal decompression at C2 level Specimen Count And Types nil Pathology Nil Operative Findings Hypertrophic change of bilateral facet joints were noted and decreased interlaminal space was noted at C3-4 level. The hypertrophic change of ligamentum flavum was also noted and the dura sac seemed re-expanded after laminoplasty was done. Operative Procedures Under ETGA and prone position with neck flexed and head fixed by a Mayfield skull clamp. Skin disinfected and drapped were performed as usual. Midline skin incison from suboccipital to lower neck was done. The trapezius, semispinalis capitis, splenius capitis muscles on both sides were splitted at its origin of ligamentum nuchae, then, together with serratus posterior superior, rectus capitis posterior, obliqus capitis inferior and multifidus were detached from the spinous processes of C2-5 by Bovie, followed by subperiosteal dissection on the laminae. The paravertebral muscles were kept open by self retaining retractors to expose spinous processes and laminae of C2-5. The bleeding from the muscles was stopped by Bovie. The laminal arches were cut through right whole thickness at its midline by a 2 mm head size high speed air drill. The base of the laminae at its laminopedicle juction was cut into a depth of left half thickness by a 1mm head size high speed cutting burr. The lamina on each side was bent to the lateral side by opening a book like action of a Cloward intervertebral spreader. Consequently, the posterior half of the spinal canal was enlarged. The hypertrophic ligmenta flava, esp. at posterior central region were resected. Each gap newly created between the lt and rt leminae at C3-5 after splitting was bridged by the reserved spinous process which was fixed to the laminae by a miniplate on each end. The new epidural empty space was loosely packed with Gelfoam. Around 3 mm width partial laminectomy was done with Kerrison punch at the lower margin of C2 lamina and the upper margin of C6 lamina. The paravertebral muscles were closed by interrupted sutures with 2/0 silk, subcutaneous layer by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon after a epilaminal drain insertion. Operators 楊士弘 Assistants 林哲光, 鄭宇軒 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Laminoplasty C3-5 and sublaminal decompressio... 開立醫師: 林哲光 開立時間: 2011/10/27 15:15 Pre-operative Diagnosis OPLL with C3-5 spinal canal stenosis Post-operative Diagnosis OPLL with C3-5 spinal canal stenosis Operative Method Laminoplasty C3-5 and sublaminal decompression at C2 level Specimen Count And Types nil Pathology Nil Operative Findings Hypertrophic change of bilateral facet joints were noted and decreased interlaminal space was noted at C3-4 level. The hypertrophic change of ligamentum flavum was also noted and the dura sac seemed re-expanded after laminoplasty was done. Operative Procedures Under ETGA and prone position with neck flexed and head fixed by a Mayfield skull clamp. Skin disinfected and drapped were performed as usual. Midline skin incison from suboccipital to lower neck was done. The trapezius, semispinalis capitis, splenius capitis muscles on both sides were splitted at its origin of ligamentum nuchae, then, together with serratus posterior superior, rectus capitis posterior, obliqus capitis inferior and multifidus were detached from the spinous processes of C2-5 by Bovie, followed by subperiosteal dissection on the laminae. The paravertebral muscles were kept open by self retaining retractors to expose spinous processes and laminae of C2-5. The bleeding from the muscles was stopped by Bovie. The laminal arches were cut through right whole thickness at its midline by a 2 mm head size high speed air drill. The base of the laminae at its laminopedicle juction was cut into a depth of left half thickness by a 1mm head size high speed cutting burr. The lamina on each side was bent to the lateral side by opening a book like action of a Cloward intervertebral spreader. Consequently, the posterior half of the spinal canal was enlarged. The hypertrophic ligmenta flava, esp. at posterior central region were resected. Each gap newly created between the lt and rt leminae at C3-5 after splitting was bridged by the reserved spinous process which was fixed to the laminae by a miniplate on each end. The new epidural empty space was loosely packed with Gelfoam. Around 3 mm width partial laminectomy was done with Kerrison punch at the lower margin of C2 lamina and the upper margin of C6 lamina. The paravertebral muscles were closed by interrupted sutures with 2/0 silk, subcutaneous layer by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon after a epilaminal drain insertion. Operators 楊士弘 Assistants 林哲光, 鄭宇軒 相關圖片 陳洪金英 (F,1931/12/21,80y2m) 手術日期 2011/10/27 手術主治醫師 蕭輔仁 手術區域 東址 003房 03號 診斷 Lumbar spondylosis 器械術式 Radiofrequency coagulation 手術類別 臨時手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 王奐之, 時間資訊 13:25 進入手術室 13:46 麻醉開始 13:47 手術開始 14:25 手術結束 14:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 高頻熱凝療法 1 1 B 摘要__ 手術科部: 外科部 套用罐頭: Bilateral L2 dorsal root ganglion radiofreque... 開立醫師: 王奐之 開立時間: 2011/10/27 14:31 Pre-operative Diagnosis Low back pain Post-operative Diagnosis Low back pain Operative Method Bilateral L2 dorsal root ganglion radiofrequency stimulation Specimen Count And Types Nil Pathology Nil Operative Findings 1. Bilateral L2 dorsal root was identified by portable C-arm X-ray and sensory/motor stimulation test. No acute complication was noted after the procedure. 2. Temperature setting: 42 degrees Celsius, time: 180sec for 2 cycles (each side). Operative Procedures The patient was put in prone position. The location of L2 was identified by portable C-arm X-ray. The skin was disinfected and draped as usual. Local anesthesia was performed with 1% Xylocaine 10ml. Bilateral L2 dorsal root radiofrequency stimulation was performed under portable C-arm guidance. The patient stood whole procedure well. Operators VS 蕭輔仁 Assistants R4 王奐之 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Bilateral L2 dorsal root ganglion radiofreque... 開立醫師: 王奐之 開立時間: 2011/10/27 14:31 Pre-operative Diagnosis Low back pain Post-operative Diagnosis Low back pain Operative Method Bilateral L2 dorsal root ganglion radiofrequency stimulation Specimen Count And Types Nil Pathology Nil Operative Findings 1. Bilateral L2 dorsal root was identified by portable C-arm X-ray and sensory/motor stimulation test. No acute complication was noted after the procedure. 2. Temperature setting: 42 degrees Celsius, time: 180sec for 2 cycles (each side). Operative Procedures The patient was put in prone position. The location of L2 was identified by portable C-arm X-ray. The skin was disinfected and draped as usual. Local anesthesia was performed with 1% Xylocaine 10ml. Bilateral L2 dorsal root radiofrequency stimulation was performed under portable C-arm guidance. The patient stood whole procedure well. Operators VS 蕭輔仁 Assistants R4 王奐之 相關圖片 江秀玉 (F,1934/04/16,77y10m) 手術日期 2011/10/27 手術主治醫師 蕭輔仁 手術區域 東址 003房 05號 診斷 Low back pain 器械術式 Radiofrequency coagulation(P-G 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 16:14 進入手術室 16:40 麻醉開始 16:43 手術開始 17:27 手術結束 17:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 高頻熱凝療法 1 1 B 摘要__ 手術科部: 外科部 套用罐頭: Pulsed radiofrequency stimulation, bilateral ... 開立醫師: 林哲光 開立時間: 2011/10/27 17:35 Pre-operative Diagnosis Low back pain Post-operative Diagnosis Low back pain Operative Method Pulsed radiofrequency stimulation, bilateral L2 dorsal root Specimen Count And Types nil Pathology Nil Operative Findings 1. Bilateral L2 dorsal root was identified by portable C-arm X-ray and sensory/motor stimulation test. No acute complication was noted after the procedure. Right trigger pain was noted. 2. Temp: 42 oC, Time: 180sec x 2 cycles each side Operative Procedures The patient was put in prone position. The location of L2 was identified by portable C-arm X-ray. The skin was disinfected and draped as usual. Local anesthesia was performed with 1% Xylocaine at 4cm below, 4cm away from the midline of L2 interspinous process and pedicle. Bilateral L2 dorsal root radiofrequency stimulation was performed under portable C-arm guided. The patient stood whole procedure well. Operators 蕭輔仁 Assistants 林哲光 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Pulsed radiofrequency stimulation, bilateral ... 開立醫師: 林哲光 開立時間: 2011/10/27 17:35 Pre-operative Diagnosis Low back pain Post-operative Diagnosis Low back pain Operative Method Pulsed radiofrequency stimulation, bilateral L2 dorsal root Specimen Count And Types nil Pathology Nil Operative Findings 1. Bilateral L2 dorsal root was identified by portable C-arm X-ray and sensory/motor stimulation test. No acute complication was noted after the procedure. Right trigger pain was noted. 2. Temp: 42 oC, Time: 180sec x 2 cycles each side Operative Procedures The patient was put in prone position. The location of L2 was identified by portable C-arm X-ray. The skin was disinfected and draped as usual. Local anesthesia was performed with 1% Xylocaine at 4cm below, 4cm away from the midline of L2 interspinous process and pedicle. Bilateral L2 dorsal root radiofrequency stimulation was performed under portable C-arm guided. The patient stood whole procedure well. Operators 蕭輔仁 Assistants 林哲光 相關圖片 黃敏銘 (M,1936/05/09,75y10m) 手術日期 2011/10/27 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Subdural hemorrhage (SDH) 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 黃薇諭, 時間資訊 23:10 臨時手術NPO 07:30 報到 08:00 進入手術室 08:05 麻醉開始 08:10 誘導結束 08:40 抗生素給藥 09:05 手術開始 10:00 手術結束 10:00 麻醉結束 10:10 送出病患 10:15 進入恢復室 11:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室腹腔分流手術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Right side subduroperionteal shunt insertion 開立醫師: 王奐之 開立時間: 2011/10/27 10:18 Pre-operative Diagnosis Right side subdural effusion and chronic subdural hemorrhage, status post burr hole drainage Post-operative Diagnosis Right side subdural effusion and chronic subdural hemorrhage, status post burr hole drainage Operative Method Right side subduroperionteal shunt insertion Specimen Count And Types Nil Pathology Nil Operative Findings A Codman fixed-pressure reservoir was used, 10 mmH2O. Light brownish fluid gushed out after incision of the thin outer membrane, indicating some recurrence of previous chronic subdural hemorrhage. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After shaving, scrubbing, disinfection & draping in sterile fashion, a linear incision was made along previous incision for burr hole procedure. Another incision was made at right upper quadrant of abdomen, followed by mini-laparotomy. A subcutaneous tunnel was created from the abdominal wound to right frontal wound, with a small incision at right retroauricular area in between for passage of the reservoir. After through irrigation of the subdural space, the shunt was assembled and the catheter was inserted to the subdural space. After confirmation of patency, the peritoneal catheter was also inserted. The wounds were then closed in layers after meticulous hemostasis. Operators VS 王國川 Assistants R4 王奐之, R0 黃薇諭 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Right side subduroperionteal shunt insertion 開立醫師: 王奐之 開立時間: 2011/10/27 10:18 Pre-operative Diagnosis Right side subdural effusion and chronic subdural hemorrhage, status post burr hole drainage Post-operative Diagnosis Right side subdural effusion and chronic subdural hemorrhage, status post burr hole drainage Operative Method Right side subduroperionteal shunt insertion Specimen Count And Types Nil Pathology Nil Operative Findings A Codman fixed-pressure reservoir was used, 10 mmH2O. Light brownish fluid gushed out after incision of the thin outer membrane, indicating some recurrence of previous chronic subdural hemorrhage. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After shaving, scrubbing, disinfection & draping in sterile fashion, a linear incision was made along previous incision for burr hole procedure. Another incision was made at right upper quadrant of abdomen, followed by mini-laparotomy. A subcutaneous tunnel was created from the abdominal wound to right frontal wound, with a small incision at right retroauricular area in between for passage of the reservoir. After through irrigation of the subdural space, the shunt was assembled and the catheter was inserted to the subdural space. After confirmation of patency, the peritoneal catheter was also inserted. The wounds were then closed in layers after meticulous hemostasis. Operators VS 王國川 Assistants R4 王奐之, R0 黃薇諭 相關圖片 丁竺原 (F,1969/05/30,42y9m) 手術日期 2011/10/27 手術主治醫師 蔡翊新 手術區域 東址 005房 01號 診斷 Vascular malformation 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鄭宇軒, 時間資訊 23:14 臨時手術NPO 08:05 進入手術室 08:10 麻醉開始 08:15 誘導結束 09:26 手術開始 11:00 手術結束 11:00 抗生素給藥 11:00 麻醉結束 11:02 送出病患 11:05 進入恢復室 12:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 腦室腹腔分流手術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 蔡翊新 開立時間: 2011/10/27 10:49 Pre-operative Diagnosis Cerebellar AVM with ICH, s/p AVM excision, with hydrocephalus. Post-operative Diagnosis Cerebellar AVM with ICH, s/p AVM excision, with hydrocephalus. Operative Method Right Kocher ventriculoperitoneal shunt. Specimen Count And Types 3 tubes of CSF: sent for bacterial culture, routine, BCS. Pathology Nil. Operative Findings CSF: clean, pressure: 15 cmH2O. Ventricular catheter: 6.5 cm, medium pressure. Peritoneal catheter: 25 cm, low pressure. Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: supine with head rotated to left. 3.Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 5 cm curvilinear, right frontal, corresponded to the location of right frontal horn. Raney clips were applied to the scalp edge for temporary hemostasis. 5.After the scalp flap had been lifted and reflected anteriorly, a burr hole was made and the dura was tented by 2 stitches. 6.The dura was opened by a nib incision. Rt lateral ventricle was tapped by a ventricular needle, then a 6.5 cm segment of the ventricular catheter was introduced into the ventricle. The outer end of the catheter was connected to a Pudenz reservoir. 7. A minilaparotomy was made at RUQ of the abdomen, then a trocar was pushed into peritoneal cavity. Subsequently, distal 25 cm segment of the peritoneal catheter (low pressure) was introduced into the peritoneal cavity through the outer tube of the trochar. The proximal end of this catheter was passed through subcutaneous tunnel at forechest, neck, right retroauricular area and connected the reservoir. The shunt system was checked to make sure its function was working. 8. The reservoir was fixed to pericranium by 3 stitches. 9. Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 10.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5林哲光R0鄭宇軒 相關圖片 姚邦仁 (M,1951/10/20,60y4m) 手術日期 2011/10/28 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 陳國瑋, 時間資訊 23:10 臨時手術NPO 11:10 進入手術室 11:15 麻醉開始 11:45 誘導結束 11:50 抗生素給藥 11:52 手術開始 14:00 開始輸血 14:50 抗生素給藥 18:15 抗生素給藥 18:50 手術結束 18:50 麻醉結束 18:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4~8小時 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 7 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: Craniotomy for tumor excision, Simpson grade ... 開立醫師: 陳國瑋 開立時間: 2011/10/28 19:51 Pre-operative Diagnosis Falx and falcotentorial meningioma Falx and falcotentorial meningiomas Post-operative Diagnosis Falx and falcotentorial meningioma Falx and falcotentorial meningiomas Operative Method Craniotomy for tumor excision, Simpson grade II for the falx meningioma and grade III for the falcotentorial meningioma Craniotomy for multiple tumor excision, Simpson grade II for the falx meningioma and grade III for the falcotentorial meningioma Specimen Count And Types 1 piece About size:fragments Source:brain tumor Pathology pending Operative Findings The bain was buldging even after mannitol 200ml and CO2 washout. Two large cortical drainage veins drained into the superior saggital sinus were noted and the corticotomy was done in between. The anterior one was sacrificed. The tumor with attachement to the falx was soft and hypervascular 6.1*5.0*3.8 cm in size. After tumor removal, corpus callosum was noted. The second one attached to the tentorium was hard with central calcification, and 2.8*2.9*2.8cm in size. Entering into the ambient cistern was noted during tumor removal. Several vessels with tight adhesion at the right and upper aspect of the tumor were noted and preserved. The anterior and inferior part of tumor was remained. Operative Procedures After intubation and general anesthesia, the patient was put in prone position. The head was fixed with mayfield clamp. The skin was shaved, scrubbed and drapped as usual. One U shaped skin incision was made at left parietal area. Craniotomy of 12*7cm was made. The durotomy was made and the dura was reflected medially. The left parietal lobe was retraced laterally and the tumor was noted. Interhemispheric approach for tumor excision was done. Hemostasis was achieved with Floseal. The tumor cavity was paved with Surgicel. After setting on CWV, the wound was closed in layers. Operators 曾漢民 Assistants 鍾文桂 陳國瑋 相關圖片 彭勤妹 (F,1937/10/04,74y5m) 手術日期 2011/10/28 手術主治醫師 曾漢民 手術區域 東址 003房 02號 診斷 Lumbar Spondylosis 器械術式 Diskectomy lumbar(Others) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 李振豪, 曾偉倫, 時間資訊 23:06 臨時手術NPO 14:55 進入手術室 15:05 麻醉開始 15:15 誘導結束 15:30 抗生素給藥 15:48 手術開始 18:00 手術結束 18:00 麻醉結束 18:05 送出病患 18:08 進入恢復室 19:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 椎間盤切除術-腰椎 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Microdiskectomy and sequestrectomy, L3/4, left 開立醫師: 李振豪 開立時間: 2011/10/28 18:09 Pre-operative Diagnosis Ruptured intervertebral disc, L3/4, left Post-operative Diagnosis Ruptured intervertebral disc, L3/4, left Operative Method Microdiskectomy and sequestrectomy, L3/4, left Specimen Count And Types nil Pathology Nil Operative Findings Sequestration of ruptured disc was noted with thecal sac and left L4 root compression. The disc space was narrowing with herniated disc. The L3/4 disc was degenerative in character. The ruptured disc was fragmented and fragile. After microdiskectomy and sequestrectomy, the thecal sac and root expanded well. No incidental durotomy or CSF leakage noted during whole procedure. Rinderon suspension was applied around the root after decompression. Bupivacaine was applied as local anesthesia. The patient stood whole procedure well. Operative Procedures Under endotracheal general anesthesia, The patient was put in prone position. The L3/4 disc level was localized by portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made at L3/4 level. Subcutaneous soft tissue and left paravertebral muscle groups were detached. The paravertebral muscles were retracted by a modified narrow Taylor retractor which was retained constantly by a rubbersling to the side rail of the operating table. Under operating microscope, left side laminotomy was performed with Kerrison punches. The ligmentum flavum was removed during laminotomy. The epidural fat was left in situ for protection of the thecal sac. The ruptured disc was noted after retraction of the thecal. the ruptured disc was removed and the herniated disc was encountered. Microdiskectomy was performed with knife, curette, alligator, and Kerrison punches. The thecal sac and left L4 root became much loose after microdiskectomy and sequestrectomy. Hemostasis was acheived with bipolar electrocautery and Gelfoam packing. Rinderon suspension was applied around the root. Bupivacaine was applied over the wound. The wound was then closed in layers with 2-0 vicryl and 4-0 Dexon. Operators VS曾漢民 Assistants R5李振豪, R3曾偉倫 相關圖片 羅愛湄 (F,1977/01/14,35y2m) 手術日期 2011/10/28 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Pituitary tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 陳國瑋, 時間資訊 23:08 臨時手術NPO 07:40 報到 08:05 進入手術室 08:10 麻醉開始 08:20 誘導結束 08:30 抗生素給藥 09:30 手術開始 10:40 麻醉結束 10:40 手術結束 10:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經由蝶竇之腦下垂體瘤切除 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: Trans-nasal trans-sphenoidal adenomectomy 開立醫師: 陳國瑋 開立時間: 2011/10/28 11:26 Pre-operative Diagnosis Pituitary macroadenoma Post-operative Diagnosis Pituitary macroadenoma Operative Method Trans-nasal trans-sphenoidal adenomectomy Specimen Count And Types 1 piece About size:fragments Source:pituitary tumor Pathology Pending Operative Findings One soft reddish hypervascular tumor size 4.5x2.3x2.4cm was noted. The normal gland came in sight after tumor removal. The arachnoid pouch was intact without evident CSF leakage. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head tilted 30 degree to left. The nasal cavity was packing with epinephrine soaked gauze for 10 minutes. The face and left lower abdomen were prepared with povidone-iodine alcohol tincture, and the mucosa of oral and nasal cavity with aqueous povidone-iodine tincture. The nasal submucosa at septum and floor were infiltrated with 1:100 epinephrine solution. One 2cm incision was made at nasal mucosa of right nasal septum and the musoca was dissected away from the septum. The nasal septum was fractured and the vomer was removed. The sphenoid sinus was entered and the mucosa within the sphenoid sinus was removed. The sellar floor was identified and opened. Durotomy was done and the tumor showed up after dura opening. Tumor excision was performed with ring curette, tumor forceps, and suction. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. The bony fragment and vomer was placed back. The nasal mucosa was pushed back and middle turbinate was reducted. Bilateral nasal cavity were packing with two segment of rubber glove finger which had been soaked with better-iodine ointment. Operators 曾漢民 Assistants 鍾文桂 陳國瑋 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Trans-nasal trans-sphenoidal adenomectomy 開立醫師: 陳國瑋 開立時間: 2011/10/28 15:33 Pre-operative Diagnosis Pituitary macroadenoma Recurrent pituitary macroadenoma Post-operative Diagnosis Pituitary macroadenoma Recurrent pituitary macroadenoma Operative Method Trans-nasal trans-sphenoidal adenomectomy Specimen Count And Types 1 piece About size:fragments Source:pituitary tumor Pathology Pending Operative Findings One soft reddish hypervascular tumor size 4.5x2.3x2.4cm was noted. The normal gland came in sight after tumor removal. The arachnoid pouch was intact without evident CSF leakage. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head tilted 30 degree to left. The nasal cavity was packing with epinephrine soaked gauze for 10 minutes. The face and left lower abdomen were prepared with povidone-iodine alcohol tincture, and the mucosa of oral and nasal cavity with aqueous povidone-iodine tincture. The nasal submucosa at septum and floor were infiltrated with 1:100 epinephrine solution. One 2cm incision was made at nasal mucosa of right nasal septum and the musoca was dissected away from the septum. The nasal septum was fractured and the vomer was removed. The sphenoid sinus was entered and the mucosa within the sphenoid sinus was removed. The sellar floor was identified and opened. Durotomy was done and the tumor showed up after dura opening. Tumor excision was performed with ring curette, tumor forceps, and suction. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. The bony fragment and vomer was placed back. The nasal mucosa was pushed back and middle turbinate was reducted. Bilateral nasal cavity were packing with two segment of rubber glove finger which had been soaked with better-iodine ointment. Operators 曾漢民 Assistants 鍾文桂 陳國瑋 相關圖片 程李玉珍 (F,1924/01/14,88y2m) 手術日期 2011/10/28 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Spondylolisthesis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 3 紀錄醫師 吳健暉, 時間資訊 23:14 臨時手術NPO 07:45 報到 08:06 進入手術室 08:10 麻醉開始 08:30 誘導結束 08:30 抗生素給藥 09:05 手術開始 09:49 開始輸血 11:40 抗生素給藥 13:42 手術結束 13:42 麻醉結束 14:00 送出病患 14:03 進入恢復室 16:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎間盤切除術-腰椎 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 曾峰毅 開立時間: 2011/10/28 13:54 Pre-operative Diagnosis Spinal stenosis, L3 to S1 Post-operative Diagnosis Spinal stenosis, L3 to S1 Operative Method Posterior fixation with percutaneous transpedicular screws system at L4 and L5, transforaminal lumbar interbody fusion at L4/5, and L3-4 laminectomy for posterior decompression Specimen Count And Types nil Pathology Nil Operative Findings Hypertrophic ligamentum flavum compromised thecal sac tightly. Incidental durotomy was made. Osteporosis caused S1 screws loosening, and thus posterior instrumnetation is not performed to sacrum. Depuy percutaneous transpedicular screws system were used with 40 x 6.0 mm screws and two 3.5 cm rods. Synthes PEEK cage with autologous bone graft was used for fusion. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. We disinfected, and draped the back as usual. We made left para-median skin incision, and performed posterior instrumentation with percutaneous transpedicular screws into left pedicles of L4, L5, and S1. Posterior fixation was set with a rod after S1 screws removed. We made one midline skin incision and dissected paraspinal muscle. L4 and L5 laminectomy was performed for decompression. Indicental durotomy was sutured. L4/5 diskectomy was done, and fusion was perforemd via right neural foramen with PEEK cage and autologous bone graft. Posterior instrumentation to right pedicles of L4 and L5 was done, and posterior fixation with done with one rod. The wound was irrigated with gentamycin-saline, and one submuscular CWV was inserted. The wound was closed in layers. Operators VS 賴達民 Assistants R5 曾峰毅 R1 吳健暉 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 吳健暉 開立時間: 2011/10/28 14:05 Pre-operative Diagnosis Spinal stenosis, L3 to S1 Post-operative Diagnosis Spinal stenosis, L3 to S1 Operative Method Posterior fixation with percutaneous transpedicular screws system at L4 and L5, transforaminal lumbar interbody fusion at L4/5, and L3-4 laminectomy for posterior decompression Specimen Count And Types nil Pathology Nil Operative Findings Hypertrophic ligamentum flavum compromised thecal sac tightly. Incidental durotomy was made. Osteporosis caused S1 screws loosening, and thus posterior instrumnetation is not performed to sacrum. Depuy percutaneous transpedicular screws system were used with 40 x 6.0 mm screws and two 3.5 cm rods. Synthes PEEK cage with autologous bone graft was used for fusion. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. We disinfected, and draped the back as usual. We made left para-median skin incision, and performed posterior instrumentation with percutaneous transpedicular screws into left pedicles of L4, L5, and S1. Posterior fixation was set with a rod after S1 screws removed. We made one midline skin incision and dissected paraspinal muscle. L4 and L5 laminectomy was performed for decompression. Indicental durotomy was sutured. L4/5 diskectomy was done, and fusion was perforemd via right neural foramen with PEEK cage and autologous bone graft. Posterior instrumentation to right pedicles of L4 and L5 was done, and posterior fixation with done with one rod. The wound was irrigated with gentamycin-saline, and one submuscular CWV was inserted. The wound was closed in layers. Operators VS 賴達民 Assistants R5 曾峰毅 R1 吳健暉 相關圖片 馬景鵬 (M,1958/12/13,53y3m) 手術日期 2011/10/28 手術主治醫師 賴達明 手術區域 東址 019房 02號 診斷 Lumbar Spondylosis 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 3 紀錄醫師 吳健暉, 時間資訊 23:15 臨時手術NPO 14:15 進入手術室 14:20 麻醉開始 14:30 誘導結束 14:40 抗生素給藥 14:55 手術開始 16:45 手術結束 16:45 麻醉結束 16:50 送出病患 16:53 進入恢復室 17:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎間盤切除術-腰椎 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 曾峰毅 開立時間: 2011/10/28 16:31 Pre-operative Diagnosis Buldgind disc, L4/5 Post-operative Diagnosis Buldgind disc, L4/5 Operative Method Microdiskectomy at L4/5, and interspinous stabilization with Coflex. Specimen Count And Types Nil Pathology nil Operative Findings Bulding disc and hypertrophic ligamentum flavum compromised neural structure tightly, and was decompressed well after the surgery. Coflex was placed for stablization. Operative Procedures With endotracheal general anaestehsia, the patient was put in prone position. After C-arm localization, we made one midline skin incision and dissected paraspinal muscle to expose bilateral laminae from L4 to L5. Left L4/5 laminotomy was done for diskectomy. Interspinous stablization device was placed. The wound was closed in layers. Operators VS 賴達民 Assistants R5 曾峰毅 R1 吳健暉 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 吳健暉 開立時間: 2011/10/28 16:54 Pre-operative Diagnosis Buldgind disc, L4/5 Post-operative Diagnosis Buldgind disc, L4/5 Operative Method Microdiskectomy at L4/5, and interspinous stabilization with Coflex. Specimen Count And Types Nil Pathology nil Operative Findings Bulding disc and hypertrophic ligamentum flavum compromised neural structure tightly, and was decompressed well after the surgery. Coflex was placed for stablization. Operative Procedures With endotracheal general anaestehsia, the patient was put in prone position. After C-arm localization, we made one midline skin incision and dissected paraspinal muscle to expose bilateral laminae from L4 to L5. Left L4/5 laminotomy was done for diskectomy. Interspinous stablization device was placed. The wound was closed in layers. Operators VS 賴達民 Assistants R5 曾峰毅 R1 吳健暉 相關圖片 翁陳珠 (F,1942/05/10,69y10m) 手術日期 2011/10/28 手術主治醫師 陳敞牧 手術區域 東址 003房 01號 診斷 Cervical Spondylosis 器械術式 Occipito-cervical Fusion 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 曾偉倫, 時間資訊 23:04 臨時手術NPO 08:05 進入手術室 08:10 麻醉開始 08:20 誘導結束 09:20 抗生素給藥 09:34 手術開始 12:20 抗生素給藥 14:35 手術結束 14:35 麻醉結束 14:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎弓切除術(減壓)-二節以內 1 2 記錄__ 手術科部: 外科部 套用罐頭: 1. C1 posterior arch laminectomy for decompre... 開立醫師: 李振豪 開立時間: 2011/10/28 14:54 Pre-operative Diagnosis C1-2 subluxation with cord compression Post-operative Diagnosis C1-2 subluxation with cord compression Operative Method 1. C1 posterior arch laminectomy for decompression 2. Occipito-cervical fusion with occipital plate, C2 transpedicular screws, and C3 lateral mass screws and fusion with autologous bone graft Specimen Count And Types nil Pathology Nil Operative Findings Subluxation of C1-2 with unstable spine was noted. After removal of posterior arch of C1 ring, the thecal sac expanded well. The atlanto-occipital ligment also removed. Bilateral vertebral artery groove was identified and the vertebral artery was protected well during whole procedure. Occipital plate(31mm, occipital screws: 5.2 x 12mm + 5.2 x 8mm), C2 transpedicular screws(3.5 x 24mm), and C3 lateral mass screws(3.5 x 16mm) were implanted as usual method. Two 8cm rods and one cross-link was used for set up of O-C fusion. Incidental durotomy with CSF leakage was noted during drilled of occipital bone. The durotomy was packing with Gelfoam. One of the occipital screws was applied with bone cement due to loosening of the screws. No significant SSEP latency or flatening was noted after whole procedure. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone positino with head fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. Midline skin incision was made at nuchal area and the subcutaneous soft tissue was devided. The nuchal muscle and paravertebral muscle groups were detached. Occipital, foramen magnum, C1~C3 laminae was exposed. Bilateral vertebral groove also identified during dissection along posterior arch of C1 ring. C1 laminectomy was performed with Midas air-drived drills with 2cm in width. Bilateral C2 transpedicular screws and C3 lateral mass screws were implanted. Occipital plate was fixed with two occipital screws. Loosening of the 5.2 x 8mm occipital screws was noted and bone cement was used for augmentation. Decortication of C1 and C2 laminae was performed with air-drived drills. The posterior arch of the C1 ring was devided and used as autologous bone graft. Two rods and one cross-link were applied. The wound was irrigated with Gentamicin solution. One CWV drain was placed. The wound was then closed in layers with 1-0, 2-0 Vicryl and 3-0 Nylon. Operators VS陳敞牧 Assistants R5李振豪, R3曾偉倫 相關圖片 徐禮文 (M,1944/12/26,67y2m) 手術日期 2011/10/28 手術主治醫師 蔡翊新 手術區域 東址 027房 04號 診斷 Cellulitis 器械術式 SP shunt removal 手術類別 緊急手術 手術部位 頭、頸 傷口分類 污染 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3E 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 07:23 通知急診手術 14:20 報到 14:40 進入手術室 14:45 麻醉開始 14:50 誘導結束 15:00 抗生素給藥 15:23 手術開始 15:55 手術結束 16:00 麻醉結束 16:00 送出病患 16:10 進入恢復室 17:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 深部傷口處理縫合擴創-小 1 0 R 手術 皮下肌肉或深部異物取出術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Subduroperitoneal shunt removal and debrideme... 開立醫師: 蔡翊新 開立時間: 2011/10/28 16:14 Pre-operative Diagnosis Subduroperitoneal shunt exposure at abdominal wall. Post-operative Diagnosis Subduroperitoneal shunt exposure at abdominal wall. Operative Method Subduroperitoneal shunt removal and debridement of abdominal wound. Specimen Count And Types 2 pieces About size:4 x 1 cm Source:debrided tissue About size: Source:tip culture of SP shunt Pathology Pending. Operative Findings A 1.5 cm granulation tissue at RUQ of abdominal wall, with peritoneal catheter exposed. There was traction of subcutaneous tissue adjacent to the exposure site. The subdural catheter adhered tightly and was not removed to prevent intracranial bleeding. Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: supine with head rotated to left. 3.Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4.Incision: 4 x 1 cm, fusiform, at RUQ of abdomen to include the exposure site. 5.Distal part of peritoneal catheter was removed, tip culture sent. 6.Scalp incision along previous wound at right frontal area. The peritoneal catheter was disconnected from the straight connector and removed from the abdominal wound. The subdural catheter was left unremoved. 7.The wounds were closed in layers. Operators VS蔡翊新 Assistants R5林哲光 Indication Of Emergent Operation shunt exposure, infection 相關圖片 邱子瑀 (F,1981/09/09,30y6m) 手術日期 2011/10/28 手術主治醫師 華筱玲 手術區域 產房 092房 04號 診斷 Breech presentation, delivered 器械術式 Cesarean section 手術類別 臨時手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 脊髓麻醉 麻醉主治醫師 葉惠敏 ASA 2 紀錄醫師 林明緯, 時間資訊 16:00 報到 21:00 進入手術室 21:10 麻醉開始 21:15 誘導結束 21:30 手術開始 22:00 抗生素給藥 22:15 麻醉結束 22:15 手術結束 22:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 剖腹產術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Spinal anesthesia 1 0 記錄__ 手術科部: 婦產部 套用罐頭: CS 開立醫師: 林明緯 開立時間: 2011/10/28 22:48 Pre-operative Diagnosis Pregnancy for 36 weeks, with breech presentation. Post-operative Diagnosis Pregnancy for 36 weeks, with breech presentation, status post Cesarean section. Operative Method Cesarean section. Specimen Count And Types nil Pathology Nil. Operative Findings 1. A live immature female baby was delivered by breech extraction. (1) Birth weight: 2824 gm, (2) Apgar score: 9 to 9. 2. Meconium stain (-), extension of uterine wound (-), fetal anomaly (-). 3. Estimated blood loss: 400 mL; Bloodtransfusion: nil; Complication: nil. 4. Preoperative cervical condition: (1) OS: close, (2) Station: high, (3) Effacement: poor. Operative Procedures 1. Put the patient on the lithotomy position. 2. Vaginal douching and insert foley. 3. Skin disinfection with beta iodine and skin draping. 4. Lower abdominal Pfannenstiel skin incision was made to open the abdominal wall layer by layer. 5. Low segment transverse cesarean section was performed to deliver a baby and removed the placenta manually. 6. Closed bilateral incision angle with 1-0 Vicryl and sutured the myometrium with 2-0 Vicryl continuously for two layers, andthenclose the serosa. 7. Check bleeding and hemostasis. 8. Reperitonization and close the abdomen in layers. 9. Skin approximation with Appose. Operators 華筱玲, Assistants 林明緯, 郭喜文 (M,1941/12/27,70y2m) 手術日期 2011/10/29 手術主治醫師 賴達明 手術區域 東址 005房 03號 診斷 Subdural hemorrhage or effusion 器械術式 S-P shunt, bilateral 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 3E 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 14:28 進入手術室 14:35 麻醉開始 14:45 誘導結束 15:00 抗生素給藥 15:47 手術開始 16:55 麻醉結束 16:55 手術結束 17:25 送出病患 17:30 進入恢復室 18:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦室腹腔分流手術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Right sudural shunt implant 開立醫師: 曾峰毅 開立時間: 2011/10/29 17:21 Pre-operative Diagnosis Bilateral subdural effusion Post-operative Diagnosis Bilateral subdural effusion Operative Method Right sudural shunt implant Specimen Count And Types nil Pathology Nil Operative Findings Outer menbrane was noted and clear, slightly straw-color fluid gushed out upound dura opening. One Codman S-P shunt with valve pressure 1cmH2O was implanted. The shunt function was good. The abdominal catheter was 20cm long. The sbudral catheter was around 3cm long. Operative Procedures The patient was put in supine position with head turning to left after intubation and general anesthesia. The skin was shaved, disinfected, and prepared as usual. One linear skin incision was made at right frontal area. Burr hole was made. Transverse skin incision was made at right upper quadrant. Dissection to peritonium was done. Subcutaneous tunnel was made and the shunt system was assembled. The subdral catheter was inserted after dura opening. The wound was then closed in layers. Operators 賴達明 Assistants 曾峰毅 陳國瑋 陳以幸 Indication Of Emergent Operation Increased intra-cranial pressure 相關圖片 林溪圳 (M,1948/02/01,64y1m) 手術日期 2011/10/29 手術主治醫師 楊士弘 手術區域 東址 003房 03號 診斷 Spine bone metastasis 器械術式 Spinal fusion posterior T7 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 3E 紀錄醫師 陳以幸, 時間資訊 15:00 臨時手術NPO 15:00 開始NPO 11:27 通知急診手術 16:30 進入手術室 16:40 麻醉開始 16:50 誘導結束 16:55 抗生素給藥 17:33 手術開始 18:30 開始輸血 20:10 抗生素給藥 20:20 手術結束 20:20 麻醉結束 20:26 送出病患 22:32 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 惡性脊髓腫瘤切除術 1 1 手術 脊椎融合術-後融合,有固定物(<=六節) 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: 1. Posterior approach for transpedicular tumo... 開立醫師: 楊士弘 開立時間: 2011/10/29 20:17 Pre-operative Diagnosis Spinal epidural metastasis, T6-7, with spinal cord compression Post-operative Diagnosis Spinal epidural metastasis, T6-7, with spinal cord compression Operative Method 1. Posterior approach for transpedicular tumor excision; 2. Spinal fixation with transpedicle screws and rods fixation, T6-T8-T9, and posterior fusion with Simbone graft Specimen Count And Types 1 piece About size:小 Source:vertebral tumor Pathology pending Operative Findings An epidural tumor was found around posteriorly and left laterally around the thecal sac at T6-7 level. It was soft fragile, greyish red, mildly vascularized, and also wrapping around the left T7 root. The thecal sac reexpanded well after decompression. Posterior fixation was done with A-spine TPS system: T6 pedicle screws: 5.0 mm x 35 mm T8, T9 pedicle screws: 5.5 mm x 35 mm rods: 11 cm on each side one cross link Blood loss: 500ml Transfusion: pRBC 2u Operative Procedures 1. ETGA, prone. 2. C-arm localization of T6-9 3. Midline incison over back, T6-9 4. Dissection and retraction of paraspinal muscles off spinous processes, lamina, and transverse processes 5. T6-7 laminectomy, bilateral facetomy, and left T7 pediculectomy 6. Dissection and excision of epidural tumor from thecal sac and left T7 root with tumor forceps, dissector, and bipolar cautery 7. Hemostasis with Gelfoam, bone was, and bipolar 8. Application of TPS-rods system for posterior fixation from T6-T8-T9 9. Decortication of lamina and transverse processes of T6-9 10. Onlay Simbone grafts over decorticated surfaces 11. Two HV drain 12. Wound closure in layers Operators VS 楊士弘 Assistants R5 曾峰毅 R2 陳以幸 Indication Of Emergent Operation Acute myelopathy 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: 1. Posterior approach for transpedicular tumo... 開立醫師: 陳以幸 開立時間: 2011/10/29 20:31 Pre-operative Diagnosis Spinal epidural metastasis, T6-7, with spinal cord compression Post-operative Diagnosis Spinal epidural metastasis, T6-7, with spinal cord compression Operative Method 1. Posterior approach for transpedicular tumor excision; 2. Spinal fixation with transpedicle screws and rods fixation, T6-T8-T9, and posterior fusion with Simbone graft Specimen Count And Types 1 piece About size:小 Source:vertebral tumor Pathology pending Operative Findings An epidural tumor was found around posteriorly and left laterally around the thecal sac at T6-7 level. It was soft fragile, greyish red, mildly vascularized, and also wrapping around the left T7 root. The thecal sac reexpanded well after decompression. Posterior fixation was done with A-spine TPS system: T6 pedicle screws: 5.0 mm x 35 mm T8, T9 pedicle screws: 5.5 mm x 35 mm rods: 11 cm on each side one cross link Blood loss: 500ml Transfusion: pRBC 2u Operative Procedures 1. ETGA, prone. 2. C-arm localization of T6-9 3. Midline incison over back, T6-9 4. Dissection and retraction of paraspinal muscles off spinous processes, lamina, and transverse processes 5. T6-7 laminectomy, bilateral facetomy, and left T7 pediculectomy 6. Dissection and excision of epidural tumor from thecal sac and left T7 root with tumor forceps, dissector, and bipolar cautery 7. Hemostasis with Gelfoam, bone was, and bipolar 8. Application of TPS-rods system for posterior fixation from T6-T8-T9 9. Decortication of lamina and transverse processes of T6-9 10. Onlay Simbone grafts over decorticated surfaces 11. Two HV drain 12. Wound closure in layers Operators VS 楊士弘 Assistants R5 曾峰毅 R2 陳以幸 Indication Of Emergent Operation Acute myelopathy 相關圖片 陳貝豐 (M,1950/05/21,61y9m) 手術日期 2011/10/29 手術主治醫師 楊士弘 手術區域 東址 003房 01號 診斷 Spondylosis with myelopathy, thoracic 器械術式 Intraspinal intramedullary tum 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 2 紀錄醫師 黃薇諭, 時間資訊 23:25 臨時手術NPO 07:35 報到 08:02 進入手術室 08:10 麻醉開始 08:20 誘導結束 08:40 抗生素給藥 09:07 手術開始 11:40 抗生素給藥 12:40 手術結束 12:40 麻醉結束 12:50 送出病患 12:51 進入恢復室 13:51 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎腔內動靜脈畸型切除術-二節以內 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 3 0 麻醉 動脈血液檢查全套 3 0 麻醉 Hemoglobin (Hb) 3 0 麻醉 測血糖 3 0 麻醉 Ca (Calcium) 3 0 麻醉 Na (Sodium) 3 0 麻醉 K (Potassium) 3 0 麻醉 Blood gas analysis 3 0 摘要__ 手術科部: 外科部 套用罐頭: Lower T4 To T6 laminoplasty for intraspinal a... 開立醫師: 曾峰毅 開立時間: 2011/10/29 12:56 Pre-operative Diagnosis Spinal arteriovenous fistula, T5 Post-operative Diagnosis Spinal arteriovenous fistula, T5 Operative Method Lower T4 To T6 laminoplasty for intraspinal arteriorvenous fistula ligation Specimen Count And Types nil Pathology Nil Operative Findings Abudant diploic vein bleeding was encountered while laminecotmy. Epidural venous bleeding was mass as well, and two engorged epidural vein crossed over dura at dorsal site was found and cauterized. Left T5 radicular artery shunted the arterial blood to tortuous, engorged, and arterized vein. The arterized vein became more cyanotic after fistula ligation. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After C-arm localization, we made one midline skin incision and dissected paraspinal muscle to expose bilateral laminae from lower T4 to T6. Laminectomy was done from lower T4 to T6. Epidural bleeding was packed with Gelfoam, and one epidurla vein was cauterized and transected. Midline durotomy was done. Intraoperative ICG angiography was performed to evaluate fistula condition. Fistula site was clipped, and cauterized by bipolar. Duroplasty was performed in water-tight suture. Laminoplasty was done with mini-plates and autologous bone graft. The wound was closed in layers after one submuscular CWV placed. Operators VS 楊士弘 Assistants R5 曾峰毅 R1 黃薇諭 相關圖片 摘要__ 手術科部: 外科部 套用罐頭: Lower T4 To T6 laminoplasty for intraspinal a... 開立醫師: 曾峰毅 開立時間: 2011/10/31 11:21 Pre-operative Diagnosis Spinal arteriovenous fistula, T5 Post-operative Diagnosis Spinal arteriovenous fistula, T5 Operative Method Lower T4 To T6 laminoplasty for intraspinal arteriorvenous fistula ligation Specimen Count And Types Nil Pathology Nil Operative Findings Abudant diploic vein bleeding was encountered while laminecotmy. Epidural venous bleeding was mass as well, and two engorged epidural vein crossed over dura at dorsal site was found and cauterized. Left T5 radicular artery shunted the arterial blood to tortuous, engorged, and arterized vein. The arterized vein became more cyanotic after fistula ligation. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After C-arm localization, we made one midline skin incision and dissected paraspinal muscle to expose bilateral laminae from lower T4 to T6. Laminectomy was done from lower T4 to T6. Epidural bleeding was packed with Gelfoam, and one epidurla vein was cauterized and transected. Midline durotomy was done. Intraoperative ICG angiography was performed to evaluate fistula condition. Fistula site was clipped, and cauterized by bipolar. Duroplasty was performed in water-tight suture. Laminoplasty was done with mini-plates and autologous bone graft. The wound was closed in layers after one submuscular CWV placed. Operators VS 楊士弘 Assistants R5 曾峰毅 R1 黃 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Lower T4 To T6 laminoplasty for intraspinal a... 開立醫師: 黃薇諭 開立時間: 2011/10/31 11:37 Pre-operative Diagnosis Spinal arteriovenous fistula, T5 Post-operative Diagnosis Spinal arteriovenous fistula, T5 Operative Method Lower T4 To T6 laminoplasty for intraspinal arteriorvenous fistula ligation Specimen Count And Types Nil Pathology Nil Operative Findings Abudant diploic vein bleeding was encountered while laminecotmy. Epidural venous bleeding was mass as well, and two engorged epidural vein crossed over dura at dorsal site was found and cauterized. Left T5 radicular artery shunted the arterial blood to tortuous, engorged, and arterized vein. The arterized vein became more cyanotic after fistula ligation. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After C-arm localization, we made one midline skin incision and dissected paraspinal muscle to expose bilateral laminae from lower T4 to T6. Laminectomy was done from lower T4 to T6. Epidural bleeding was packed with Gelfoam, and one epidurla vein was cauterized and transected. Midline durotomy was done. Intraoperative ICG angiography was performed to evaluate fistula condition. Fistula site was clipped, and cauterized by bipolar. Duroplasty was performed in water-tight suture. Laminoplasty was done with mini-plates and autologous bone graft. The wound was closed in layers after one submuscular CWV placed. Operators VS 楊士弘 Assistants R5 曾峰毅 R1 黃 相關圖片 吳順卿 (M,1950/09/05,61y6m) 手術日期 2011/10/29 手術主治醫師 楊士弘 手術區域 東址 003房 02號 診斷 Displacement of lumbar intervertebral disc whthout myelopathy 器械術式 Diskectomy lumbar, L4-5, left 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 1 紀錄醫師 黃薇諭, 時間資訊 00:00 臨時手術NPO 13:10 進入手術室 13:15 麻醉開始 13:20 誘導結束 13:40 抗生素給藥 13:45 手術開始 15:40 手術結束 15:40 麻醉結束 15:50 送出病患 15:50 進入恢復室 16:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 椎間盤切除術-腰椎 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Microsurgical diskectomy 開立醫師: 楊士弘 開立時間: 2011/10/29 15:55 Pre-operative Diagnosis Lumbar herniated intervertebral disc, L4-5, left Post-operative Diagnosis Lumbar herniated intervertebral disc, L4-5, left Operative Method Microsurgical diskectomy Specimen Count And Types nil Pathology Nil Operative Findings The left L4-5 spinous process, lamina, and facets were rather thick. The ligamentum flavum was also hypertrophic, causing compression of the thecal sac. The left L4-5 disc bulged out posteriorly with compression of the left L5 nerve root, which became slack after decompression. Operative Procedures 1. ETGA, prone. 2. Paramedian skin incision, left L4-5. 3. Sequential dilatation of paraspinal muscles with various dilators, for insertion of tubal retractor (23 mm in diameter). 4. Application of microscopy for further surgery. 5. Laminotomy of left lower L4 and upper L5. 6. Removal of hypertrophic ligamentum flavum. 7. Medial retraction of left L5 root. 8. Knife incision of annulus for excision of nucleus propulsus. 9. Hemostasis; irrigitation of epidural space with Rinderon solution. 10. Wound closure in layers. Operators 楊士弘 Assistants 曾峰毅, 曾峰毅,黃薇諭 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Microsurgical diskectomy 開立醫師: 黃薇諭 開立時間: 2011/10/31 10:31 Pre-operative Diagnosis Lumbar herniated intervertebral disc, L4-5, left Post-operative Diagnosis Lumbar herniated intervertebral disc, L4-5, left Operative Method Microsurgical diskectomy Specimen Count And Types nil Pathology Nil Operative Findings The left L4-5 spinous process, lamina, and facets were rather thick. The ligamentum flavum was also hypertrophic, causing compression of the thecal sac. The left L4-5 disc bulged out posteriorly with compression of the left L5 nerve root, which became slack after decompression. Operative Procedures 1. ETGA, prone. 2. Paramedian skin incision, left L4-5. 3. Sequential dilatation of paraspinal muscles with various dilators, for insertion of tubal retractor (23 mm in diameter). 4. Application of microscopy for further surgery. 5. Laminotomy of left lower L4 and upper L5. 6. Removal of hypertrophic ligamentum flavum. 7. Medial retraction of left L5 root. 8. Knife incision of annulus for excision of nucleus propulsus. 9. Hemostasis; irrigitation of epidural space with Rinderon solution. 10. Wound closure in layers. Operators 楊士弘 Assistants 曾峰毅,黃薇諭 相關圖片 黃明崑 (M,1959/01/06,53y2m) 手術日期 2011/10/29 手術主治醫師 蕭輔仁 手術區域 東址 003房 04號 診斷 Malignant neoplasm of trachea 器械術式 Spinal fusion posterior 手術類別 緊急手術 手術部位 脊椎 傷口分類 污染 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 3E 紀錄醫師 陳以幸, 時間資訊 14:00 臨時手術NPO 14:00 開始NPO 19:58 通知急診手術 21:16 進入手術室 21:26 麻醉開始 21:46 誘導結束 21:50 抗生素給藥 22:21 手術開始 23:00 開始輸血 01:36 手術結束 01:36 送出病患 01:50 麻醉結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 惡性脊髓腫瘤切除術 1 1 手術 脊椎融合術-後融合,有固定物(<=六節) 1 2 摘要__ 手術科部: 外科部 套用罐頭: 1. T3-5 laminectomy, for umor excision and ri... 開立醫師: 曾峰毅 開立時間: 2011/10/30 02:04 Pre-operative Diagnosis Lung cancer with direct invation to the chest wall and T3-5 vertebral bodies status post T3, T4 corpectomy, anterior fusion with body cage, right T4 rhizotomy, and anterior plating for fixation at T2-5, complicated with recurrence with spinal cord encasement at T3-5 Post-operative Diagnosis Lung cancer with direct invation to the chest wall and T3-5 vertebral bodies status post T3, T4 corpectomy, anterior fusion with body cage, right T4 rhizotomy, and anterior plating for fixation at T2-5, complicated with recurrence with spinal cord encasement at T3-5 Operative Method 1. T3-5 laminectomy, for umor excision and right T3 rhizotomy 2. Posterior fixation with transpedicle screws at T1-2 and T6-7 3. Posterior fusion with artificial bone graft Specimen Count And Types 1 piece About size:fragments Source:spine tumor Pathology pending Operative Findings The tumor encasing the spinal cord from the right, posterior and anterior aspect and the cord being compressed tightly. The Spinal cord expanded well after the surgery. A-spine transpedicular screws fixation system was used for posterior fixation. 35 x 5.0 mm screws were inserted into bilateral pedicles of T6 and T7. 30 x 4.5 mm screws were inserted into bilateral pedicles of T1 and T2. Simbone HT was used for posterior fusion. Tumor invasion to pleural cavity was noted with air leakage from lung parencyma after tumor removal. Operative Procedures The patient was put in prone position after intubation and general anesthesia. The skin was scrubed, disifnected and draped as usual. After localization with C-arm, one linear skin incision was made. Dissection down to the laminae was done. Bilateral transpedicle screws were implanted at T1-2, T6-7. Laminectomy T3-5 with right side extension was achieved. Right T3 rhizotomy and tumor excision was done with removal right pedicles of T3 and T4. Two 20-cm rods and one corss link were used for fixation. The wound was irrigated with gentamycin-saline. Two submuscular hemovac was inserted, and the wound was closed in layers. Operators 蕭輔仁 Assistants 曾峰毅 陳以幸 Indication Of Emergent Operation Acute myelopathy 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: 1. T3-5 laminectomy, for umor excision and ri... 開立醫師: 陳以幸 開立時間: 2011/11/15 12:13 Pre-operative Diagnosis Lung cancer with direct invation to the chest wall and T3-5 vertebral bodies status post T3, T4 corpectomy, anterior fusion with body cage, right T4 rhizotomy, and anterior plating for fixation at T2-5, complicated with recurrence with spinal cord encasement at T3-5 Post-operative Diagnosis Lung cancer with direct invation to the chest wall and T3-5 vertebral bodies status post T3, T4 corpectomy, anterior fusion with body cage, right T4 rhizotomy, and anterior plating for fixation at T2-5, complicated with recurrence with spinal cord encasement at T3-5 Operative Method 1. T3-5 laminectomy, for umor excision and right T3 rhizotomy 2. Posterior fixation with transpedicle screws at T1-2 and T6-7 3. Posterior fusion with artificial bone graft Specimen Count And Types 1 piece About size:fragments Source:spine tumor Pathology pending Operative Findings The tumor encasing the spinal cord from the right, posterior and anterior aspect and the cord being compressed tightly. The Spinal cord expanded well after the surgery. A-spine transpedicular screws fixation system was used for posterior fixation. 35 x 5.0 mm screws were inserted into bilateral pedicles of T6 and T7. 30 x 4.5 mm screws were inserted into bilateral pedicles of T1 and T2. Simbone HT was used for posterior fusion. Tumor invasion to pleural cavity was noted with air leakage from lung parencyma after tumor removal. Operative Procedures The patient was put in prone position after intubation and general anesthesia. The skin was scrubed, disifnected and draped as usual. After localization with C-arm, one linear skin incision was made. Dissection down to the laminae was done. Bilateral transpedicle screws were implanted at T1-2, T6-7. Laminectomy T3-5 with right side extension was achieved. Right T3 rhizotomy and tumor excision was done with removal right pedicles of T3 and T4. Two 20-cm rods and one corss link were used for fixation. The wound was irrigated with gentamycin-saline. Two submuscular hemovac was inserted, and the wound was closed in layers. Operators 蕭輔仁 Assistants 曾峰毅 陳以幸 Indication Of Emergent Operation Acute myelopathy 相關圖片 陳錦亞 (F,1962/10/08,49y5m) 手術日期 2011/10/31 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Cerebral Aneurysm 器械術式 Craniotomy(Aneurysms) P-DUH 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3 紀錄醫師 曾偉倫, 時間資訊 23:32 臨時手術NPO 08:04 進入手術室 08:15 麻醉開始 08:35 誘導結束 08:40 抗生素給藥 08:40 手術開始 11:24 開始輸血 11:40 抗生素給藥 14:40 抗生素給藥 15:10 抗生素給藥 17:05 手術結束 17:05 麻醉結束 17:13 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 開顱術摘除血管病變 - 腦血管瘤 無病徵的 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 10 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: Left pterional approach for aneurysm clipping 開立醫師: 李振豪 開立時間: 2011/10/31 18:13 Pre-operative Diagnosis Left hypophyseal artery aneurysm Post-operative Diagnosis Left paraclinoid carotid artery aneurysm Operative Method Left pterional approach for aneurysm clipping Specimen Count And Types nil Pathology Nil Operative Findings A small opening connecting to sphenoid sinus was noted after left anterior clinoidectomy. The opening was packing with Better-iodine soaked Gelfoam, a small piece of muscle, and Tissucol Duo. The optic canal was opened for mobilization of the optic nerve. After durotomy, the optic sheath was opened. The proximal and distal dural ring of left internal carotid artery also opened. Bleeding from left cavernous sinus was packing with Gelfoam. The neck of the aneurysm was around 7mm in width and the largest diameter was around 1cm. The aneurysm was pointing to medial, posterior, and inferior directions. The main part of the aneurysm was intradural with small part within carotid cave. After well demarcated of the aneurysm, two fenestrated, right-angled, curved Sugita clip was applied. ICG test was used after aneurysm clipping. No obvious bright up of aneurysm was noted. The left ICA and its branches(left ophthalmic artery, left hypophyseal artery, and left posterior communicating artery) were all patent. The dura defect after dural closure was packing with Gelfoam and augmentation with Tissucol Duo. Poor left eye VEP was noted before the operation and no interval change noted during whole procedure. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with left shoulder elevation. The head was turned to right and fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. Curvilinear scalp incision was made at left fronto-temporal area. The scalp flap was elevated with facial nerve preservation. The temporalis muscle was detached from the skull bone. Three burrholes were created followed by one 12x8cm craniotomy window. Dural tenting was done. The sphenoid ridge was drilled and temporal ligment was transected. The dural reflection was opened and anterior clinoidectomy was done with Midas air-drived drill. A small opening connecting to sphenoid sinus was noted after anterior clinoidectomy. The defect was packing with Better-iodine soaked Gelfoam, a small piece of muscle, and Tissucol Duo. Curvilinear durotomy was opened initially and turned to T-shape in order to open optic sheath and dural ring of internal carotid artery. The arachnoid membrane was opened until well visualization of bilateral optic nerve and optic chiasma. The frontal lobe was retracted with Sugita retractor. The Sylvian fissure also opened for larger operative field. After opening of the optic sheath, the dura incision was extended along the proximal and distal dural ring of the internal carotid artery. Bleeding from cavernous sinus was packing with Gelfoam. The left ophthalmic artery, left hypophyseal artery, and left posterior communicating artery were exposed well. The aneurysm was dissected after mobilization of left optic nerve. The neck of the aneurysm was well-demarcated. Two fenestrated, right angled, and curved Sugita clips(1cm and 0.5cm in length respectively) were applied for aneurysm clipping. ICG test was used and no bright up of aneurysm was noted. The left internal carotid artery, left ophthalmic artery, left hypophyseal artery, and left posterior communicating artery were all patent after aneurysm clipping. Hemostasis was achieved with Surgicel lining and bipolar electrocautery. Dura was closed with 4-0 prolene. The dura defect within left skull base was packing with Gelfoam and sealed with Tissucol Duo. The skull plate was fixed back with miniplates, screws, and four central tenting. The temporalis muscle was fixed back to its neutral position. One subgaleal CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and Appose staples. Operators Prof. 杜永光 Assistants R5 李振豪 R3 曾偉倫 相關圖片 林榮祥 (M,1960/02/15,52y0m) 手術日期 2011/10/31 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Pituitary tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 3 紀錄醫師 陳國瑋, 時間資訊 23:36 臨時手術NPO 08:10 進入手術室 08:20 麻醉開始 08:45 誘導結束 08:55 抗生素給藥 09:15 手術開始 10:35 手術結束 10:35 麻醉結束 10:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經由蝶竇之腦下垂體瘤切除 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Trans-nasal, trans-sphenoid adenomectomy 開立醫師: 陳國瑋 開立時間: 2011/10/31 11:03 Pre-operative Diagnosis Pituitary microadenoma Post-operative Diagnosis Operative Method Trans-nasal, trans-sphenoid adenomectomy Specimen Count And Types 1 piece About size:fragments Source:pituitary tumor Pathology pending Operative Findings After dura incision, the tumor came in sight. The tumor is hard, yellowish with fibrotic change about 5mm in size. CSF leakage was noted during tumor excision, and was packed with Gelfoam and Tissucol duo. No more CSF leakage was noted. Normal gland was noted high above after tumor removal. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head tilted 30 degree to left. The nasal cavity was packing with epinephrine soaked gauze for 10 minutes. The face and left lower abdomen were prepared with povidone-iodine alcohol tincture, and the mucosa of oral and nasal cavity with aqueous povidone-iodine tincture. The nasal submucosa at septum and floor were infiltrated with 1:100 epinephrine solution. One 2cm incision was made at nasal mucosa of right nasal septum and the musoca was dissected away from the septum. The nasal septum was fractured and the vomer was removed. The sphenoid sinus was entered and the mucosa within the sphenoid sinus was removed. The sellar floor was identified and opened. Cruciform durotomy was done and the tumor showed up after dura opening. Tumor excision was performed with alligator, and suction. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. The bony fragment and vomer was placed back. The nasal mucosa was pushed back and middle turbinate was reducted. Bilateral nasal cavity were packing with of rubber glove finger which had been soaked with better-iodine ointment. Operators 曾漢民 Assistants 鍾文桂 陳國瑋 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Trans-nasal, trans-sphenoid adenomectomy 開立醫師: 陳國瑋 開立時間: 2011/10/31 11:32 Pre-operative Diagnosis Pituitary microadenoma Post-operative Diagnosis Pituitary tumor Operative Method Trans-nasal, trans-sphenoid adenomectomy Specimen Count And Types 1 piece About size:fragments Source:pituitary tumor Pathology pending Operative Findings After dura incision, the tumor came in sight. The tumor is hard, yellowish with fibrotic change largest diameter about 5mm in size. The dura was thickened. CSF leakage was noted during tumor excision, and was packed with Gelfoam and Tissucol duo and No more CSF leakage was noted. Normal gland was noted high above after tumor removal. Old organized hematoma was noted. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head tilted 30 degree to left. The nasal cavity was packing with epinephrine soaked gauze for 10 minutes. The face and left lower abdomen were prepared with povidone-iodine alcohol tincture, and the mucosa of oral and nasal cavity with aqueous povidone-iodine tincture. The nasal submucosa at septum and floor were infiltrated with 1:100 epinephrine solution. One 2cm incision was made at nasal mucosa of right nasal septum and the musoca was dissected away from the septum. The nasal septum was fractured and the vomer was removed. The sphenoid sinus was entered and the mucosa within the sphenoid sinus was removed. The sellar floor was identified and opened. Cruciform durotomy was done and the tumor showed up after dura opening. Tumor excision was performed with alligator, and suction. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. The bony fragment and vomer was placed back. The nasal mucosa was pushed back and middle turbinate was reducted. Bilateral nasal cavity were packing with of rubber glove finger which had been soaked with better-iodine ointment. Operators 曾漢民 Assistants 鍾文桂 陳國瑋 相關圖片 摘要__ 手術科部: 外科部 套用罐頭: Trans-nasal, trans-sphenoid adenomectomy 開立醫師: 陳國瑋 開立時間: 2011/10/31 11:40 Pre-operative Diagnosis Pituitary microadenoma Post-operative Diagnosis Pituitary tumor Operative Method Trans-nasal, trans-sphenoid adenomectomy Specimen Count And Types 1 piece About size:fragments Source:pituitary tumor Pathology pending Operative Findings There was hard yellowish organized hematoma with interwinding fibrotic change with largest diameter about 5mm in size. The dura was thickened. CSF leakage was noted after hematoma removal, and was packed with Gelfoam and Tissucol duo. Normal gland was noted high above after tumor removal. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head tilted 30 degree to left. The nasal cavity was packing with epinephrine soaked gauze for 10 minutes. The face and left lower abdomen were prepared with povidone-iodine alcohol tincture, and the mucosa of oral and nasal cavity with aqueous povidone-iodine tincture. The nasal submucosa at septum and floor were infiltrated with 1:100 epinephrine solution. One 2cm incision was made at nasal mucosa of right nasal septum and the musoca was dissected away from the septum. The nasal septum was fractured and the vomer was removed. The sphenoid sinus was entered and the mucosa within the sphenoid sinus was removed. The sellar floor was identified and opened. Cruciform durotomy was done and the tumor showed up after dura opening. Tumor excision was performed with alligator, and suction. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. The bony fragment and vomer was placed back. The nasal mucosa was pushed back and middle turbinate was reducted. Bilateral nasal cavity were packing with of rubber glove finger which had been soaked with better-iodine ointment. Operators 曾漢民 Assistants 鍾文桂 陳國瑋 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Trans-nasal, trans-sphenoid adenomectomy 開立醫師: 陳國瑋 開立時間: 2011/10/31 11:40 Pre-operative Diagnosis Pituitary microadenoma Post-operative Diagnosis Pituitary tumor Pituitary microadenoma Operative Method Trans-nasal, trans-sphenoid adenomectomy Specimen Count And Types 1 piece About size:fragments Source:pituitary tumor Pathology pending Operative Findings There was hard yellowish organized hematoma with interwinding fibrotic change with largest diameter about 5mm in size. The dura was thickened. CSF leakage was noted after hematoma removal, and was packed with Gelfoam and Tissucol duo. Normal gland was noted high above after tumor removal. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head tilted 30 degree to left. The nasal cavity was packing with epinephrine soaked gauze for 10 minutes. The face and left lower abdomen were prepared with povidone-iodine alcohol tincture, and the mucosa of oral and nasal cavity with aqueous povidone-iodine tincture. The nasal submucosa at septum and floor were infiltrated with 1:100 epinephrine solution. One 2cm incision was made at nasal mucosa of right nasal septum and the musoca was dissected away from the septum. The nasal septum was fractured and the vomer was removed. The sphenoid sinus was entered and the mucosa within the sphenoid sinus was removed. The sellar floor was identified and opened. Cruciform durotomy was done and the tumor showed up after dura opening. Tumor excision was performed with alligator, and suction. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. The bony fragment and vomer was placed back. The nasal mucosa was pushed back and middle turbinate was reducted. Bilateral nasal cavity were packing with of rubber glove finger which had been soaked with better-iodine ointment. Operators 曾漢民 Assistants 鍾文桂 陳國瑋 相關圖片 蘇芳雄 (M,1933/03/28,78y11m) 手術日期 2011/10/31 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Pituitary tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 3 紀錄醫師 鍾文桂, 時間資訊 23:37 臨時手術NPO 10:30 報到 11:05 進入手術室 11:12 麻醉開始 11:45 誘導結束 12:15 抗生素給藥 12:27 手術開始 13:30 開始輸血 14:00 麻醉結束 14:00 手術結束 14:10 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 經由蝶竇之腦下垂體瘤切除 1 1 R 手術 鼻中膈鼻道成形術-單側 1 2 R 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Transnasal transsphenoidal adenomectomy 開立醫師: 陳國瑋 開立時間: 2011/10/31 14:36 Pre-operative Diagnosis Pituitary macroadenoma Post-operative Diagnosis Pituitary macroadenoma Operative Method Transnasal transsphenoidal adenomectomy Specimen Count And Types 1 piece About size:fragments Source:pituitary tumor Pathology pending Operative Findings The tumor was soft, hypervasculized, well-defined, and measured 4.0*2.7*2.8cm. One vessel coursing along the left side of sphenoid sinus roof and was injured during the tumor removal and was stopped with Floseal, Gelfoam, and Surgicel packing. Arachinoid membrane dropped after tumor removal. Blood loss was 1200ml. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head tilted 30 degree to left. The nasal cavity was packing with epinephrine soaked gauze for 10 minutes. The face and left lower abdomen were prepared with povidone-iodine alcohol tincture, and the mucosa of oral and nasal cavity with aqueous povidone-iodine tincture. The nasal submucosa at septum and floor were infiltrated with 1:100 epinephrine solution. One 2cm incision was made at nasal mucosa of right nasal septum and the musoca was dissected away from the septum. The nasal septum was fractured and the vomer was removed. The sphenoid sinus was entered and the mucosa within the sphenoid sinus was removed. The sellar floor was identified and opened. Cruciform durotomy was done and the tumor showed up after dura opening. Tumor excision was performed with ring curette, tumor forceps, and suction. Vessel bleeding was stopped with Floseal, Gelfoam, and Surgicel packing. The bony fragment and vomer was placed back. The nasal mucosa was pushed back and middle turbinate was reducted. Bilateral nasal cavity were packing with of rubber glove finger which had been soaked with better-iodine ointment. Operators 曾漢民 Assistants 鍾文桂 陳國瑋 相關圖片 黃能忠 (M,1954/09/12,57y6m) 手術日期 2011/10/31 手術主治醫師 曾漢民 手術區域 東址 005房 03號 診斷 Pituitary tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 3 紀錄醫師 鍾文桂, 時間資訊 23:38 臨時手術NPO 14:32 進入手術室 14:38 麻醉開始 15:10 誘導結束 15:20 抗生素給藥 15:35 手術開始 17:05 手術結束 17:05 麻醉結束 17:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經由蝶竇之腦下垂體瘤切除 1 1 R 手術 鼻中膈鼻道成形術-單側 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Transnasal trans-sphenoidal adenomectomy 開立醫師: 陳國瑋 開立時間: 2011/10/31 17:59 Pre-operative Diagnosis Pituitary macroadenoma Post-operative Diagnosis Pituitary macroadenoma Operative Method Transnasal trans-sphenoidal adenomectomy Specimen Count And Types 1 piece About size:fragments Source:pituitary tumor Pathology Pending Operative Findings One soft, hypervasculized, measured 2*1.2*0.9cm tumor. The mucosa was easy-bleeding. No CSF leakage was noted during the procedure. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head tilted 30 degree to left. The nasal cavity was packing with epinephrine soaked gauze for 10 minutes. The face and left lower abdomen were prepared with povidone-iodine alcohol tincture, and the mucosa of oral and nasal cavity with aqueous povidone-iodine tincture. The nasal submucosa at septum and floor were infiltrated with 1:100 epinephrine solution. One 2cm incision was made at nasal mucosa of right nasal septum and the musoca was dissected away from the septum. The nasal septum was fractured and the vomer was removed. The sphenoid sinus was entered and the mucosa within the sphenoid sinus was removed. Portable C-arm X-ray was used to check the position localtion of sellae. The sellar floor was identified and opened. Cruciform durotomy was done and the tumor showed up after dura opening. Tumor excision was performed with ring curette, tumor forceps, and suction. The hemostasis was achieved with Gelfoam. The bony fragment and vomer was placed back. The nasal mucosa was pushed back and middle turbinate was reducted. Bilateral nasal cavity were packing with of rubber glove finger which had been soaked with better-iodine ointment. Operators 曾漢民 Assistants 鍾文桂 陳國瑋 相關圖片 黃偉銘 (M,1964/05/23,47y9m) 手術日期 2011/10/31 手術主治醫師 蔡翊新 手術區域 東址 002房 02號 診斷 Subdural hemorrhage following injury without mention of open intracranial wound,unspecified state of consciousness 器械術式 Bilateral chronic SDH evacuation 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2E 紀錄醫師 林哲光, 時間資訊 08:00 開始NPO 11:48 通知急診手術 13:30 報到 13:50 進入手術室 13:52 麻醉開始 14:00 抗生素給藥 14:00 誘導結束 14:40 手術開始 15:55 手術結束 15:55 麻醉結束 16:05 送出病患 16:08 進入恢復室 17:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 L 手術 慢性硬腦膜下血腫清除術 1 2 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Bilateral frontal burr hole drainage of CSDH 開立醫師: 林哲光 開立時間: 2011/10/31 16:43 Pre-operative Diagnosis Recurrent bilateral chronic subdural hematoma Post-operative Diagnosis Recurrent bilateral chronic subdural hematoma Operative Method Bilateral frontal burr hole drainage of CSDH Specimen Count And Types 1 piece About size: Source:Bilateral subdural hematoma sent for cytology, culture, BCS and routine; Piece of right outer membrane for pathology Pathology Pending Operative Findings Gush of motor-oil, sand-like, drak-reddish fluid contents were noted after the dura and outer membrane was opened. Outer and inner membrane formation was noted at bilateral side. The brain parechyma seemed re-expanded after drainage and EtCO2 40 mmHg. Operative Procedures Under ETGA and supine position, skin disinfected and drapped were performed as usual. Two linear skin incison was made at previous operative wounds at bilateral frontal area. The burr hole was exposed well and the dura was then opened after cauterization. Outer membrane was then opened and the subdural contents were drained out via rubber drain. The edge of outer membrane was cauterized by bipolar and well opened. N/S irrigation for subdural space was then done. The subdural drain was then fixed through the subcutaneous tunneling and the wound was then closed in layers after Gelfoam packing. Operators 蔡翊新 Assistants 林哲光 Indication Of Emergent Operation Severe headache refractory to medical treatment and drowsy consciousness 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Bilateral frontal burr hole drainage of CSDH 開立醫師: 林哲光 開立時間: 2011/10/31 16:43 Pre-operative Diagnosis Recurrent bilateral chronic subdural hematoma Post-operative Diagnosis Recurrent bilateral chronic subdural hematoma Operative Method Bilateral frontal burr hole drainage of CSDH Specimen Count And Types 1 piece About size: Source:Bilateral subdural hematoma sent for cytology, culture, BCS and routine; Piece of right outer membrane for pathology Pathology Pending Operative Findings Gush of motor-oil, sand-like, drak-reddish fluid contents were noted after the dura and outer membrane was opened. Outer and inner membrane formation was noted at bilateral side. The brain parechyma seemed re-expanded after drainage and EtCO2 40 mmHg. Operative Procedures Under ETGA and supine position, skin disinfected and drapped were performed as usual. Two linear skin incison was made at previous operative wounds at bilateral frontal area. The burr hole was exposed well and the dura was then opened after cauterization. Outer membrane was then opened and the subdural contents were drained out via rubber drain. The edge of outer membrane was cauterized by bipolar and well opened. N/S irrigation for subdural space was then done. The subdural drain was then fixed through the subcutaneous tunneling and the wound was then closed in layers after Gelfoam packing. Operators 蔡翊新 Assistants 林哲光 Indication Of Emergent Operation Severe headache refractory to medical treatment and drowsy consciousness 相關圖片 張光澤 (M,1949/01/13,63y2m) 手術日期 2011/11/01 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Lumbar spondylosis 器械術式 Laminectomy for decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 07:16 臨時手術NPO 08:00 進入手術室 08:10 麻醉開始 08:20 誘導結束 08:40 抗生素給藥 09:10 手術開始 11:42 抗生素給藥 12:10 手術結束 12:10 麻醉結束 12:18 進入恢復室 12:20 送出病患 13:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 手術 椎間盤切除術-腰椎 1 2 手術 椎弓切除術(減壓)-超過二節 1 1 摘要__ 手術科部: 外科部 套用罐頭: Decompressive laminectomy, L4-S1. 開立醫師: 鍾文桂 開立時間: 2011/11/01 10:52 Pre-operative Diagnosis Lumbar stenosis, L4/L5 and L5/S1. Post-operative Diagnosis Lumbar stenosis, L4/L5 and L5/S1. Operative Method Decompressive laminectomy, L4-S1. Specimen Count And Types nil Pathology Nil. Operative Findings 1. Hypertrophic ligamentum flavum, L4-S1. 2. Thining of dura mater, very fragile. Incidental durotomy occured during decompression. The roots were slack after decompression. Operative Procedures Under ETGA, the patient was placed in prone position. After localization of L4/5 and L5/S1 levels with intraoperative fluoroscopy, the operative area was marked, disinfected, and draped. A linear skin incision was made and paraspinal dissection was obtained. The L4-S1 laminae were removed by bone cutter and rougeur. The ligamentum flavum was removed by Kerrison rougeur. The incidental durotomy was repaired primarily with 5-0 Prolene. With one submuscular 1/8 hemovac drain, the wound was closed in layer with well hemostasis. Operators 曾勝弘 Assistants 蔡宗良 鍾文桂 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Decompressive laminectomy, L4-S1. 開立醫師: 鍾文桂 開立時間: 2011/11/02 20:12 Pre-operative Diagnosis Lumbar stenosis, L4/L5 and L5/S1. Post-operative Diagnosis 1. Herniated intervertebral disc, L4/5. 2. Lumbar stenosis, L4/L5 and L5/S1. Operative Method 1. Diskectomy, L4/5. 2. Decompressive laminectomy, L4-S1. Specimen Count And Types nil Pathology Nil. Operative Findings 1. Hypertrophic ligamentum flavum, L4-S1. 2. Thining of dura mater, very fragile. Incidental durotomy occured during decompression. The roots were slack after decompression. 3. Herniated intervertebral disc at right side with root compression. Operative Procedures Under ETGA, the patient was placed in prone position. After localization of L4/5 and L5/S1 levels with intraoperative fluoroscopy, the operative area was marked, disinfected, and draped. A linear skin incision was made and paraspinal dissection was obtained. The L4-S1 laminae were removed by bone cutter and rougeur. The ligamentum flavum was removed by Kerrison rougeur. The incidental durotomy was repaired primarily with 5-0 Prolene.The L4/5 herniated disc was removed with alligator and disc clamp. With one submuscular 1/8 hemovac drain, the wound was closed in layer with well hemostasis. Operators 曾勝弘 Assistants 蔡宗良 鍾文桂 相關圖片 黃亮昇 (M,1969/08/20,42y6m) 手術日期 2011/11/01 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Spondylosis with myelopathy, cervical 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 23:48 臨時手術NPO 13:15 進入手術室 13:20 麻醉開始 13:30 誘導結束 13:30 抗生素給藥 14:05 手術開始 16:40 手術結束 16:40 麻醉結束 16:50 送出病患 16:55 進入恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 手術 椎間盤切除術-頸椎 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Removal of C4-5 cervical plate and cage 開立醫師: 李嘉哲 開立時間: 2011/11/01 16:57 Pre-operative Diagnosis C4/5 cervical stenosis, status post microdiskectomy and anterior plating, with displacement of the plate and cage Post-operative Diagnosis C4/5 cervical stenosis, status post microdiskectomy and anterior plating, with displacement of the plate and cage Operative Method Removal of C4-5 cervical plate and cage Specimen Count And Types nil Pathology Nil Operative Findings Severe adhesion was noted during neck dissection. The C4/5 plate was difficult to approach via previous wound level. Another transverse skin incision was made at right upper neck . After we dissection along the granulation tissue, the right side longus collis muscle was exposed. The prevertebral space and the anterior cervical plate was identified after transection of the longus collis muscle. Loosening of C5 screws were noted due to fracture of vertebral body. After removal of the plate, Operative Procedures 1. Under endotracheal general anesthesia, the patient was put in supine position with neck extension. The skin was scrubbed, disinfected, and draped as usual. 2. Transverse skin incision was made along operative scar over right lower neck. The subcutaneous soft tissue and platysma muscle were devided. 3. The fascia was opened along inner margin of the SCM muscle. 4. The prevertebral fascia was tried to approach but failed due to severe adhesion. 5. Due to difficult to approach of C4-5 cervical plate, another transverse skin incision was made at right upper neck. The subcutaneous soft tissue and platysma muscle were devided. The dissection was tried again. 6. Right side longus collis muscle was identified. The longus collis muscle was transected and prevertebral space was entered. 7. The C4-5 cervical plate was identified, exposed, and removed. 8. The C4/5 PEEK cage also removed. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. 9. The C4/5 disc space also packing with Gelfoam. One CWV drain was placed. The wound was then closed in layers with 3-0 Vicryl and 4-0 Dexon. Operators VS賴達明 Assistants R5李振豪, PGY李嘉哲 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Removal of C4-5 cervical plate and cage 開立醫師: 李振豪 開立時間: 2011/11/01 17:05 Pre-operative Diagnosis C4/5 cervical stenosis, status post microdiskectomy and anterior plating, with displacement of the plate and cage Post-operative Diagnosis C4/5 cervical stenosis, status post microdiskectomy and anterior plating, with displacement of the plate and cage Operative Method Removal of C4-5 cervical plate and cage Specimen Count And Types nil Pathology Nil Operative Findings Severe adhesion was noted during neck dissection. The C4/5 plate was difficult to approach via previous wound level. Another transverse skin incision was made at right upper neck . After we dissection along the granulation tissue, the right side longus collis muscle was exposed. The prevertebral space and the anterior cervical plate was identified after transection of the longus collis muscle. Loosening of C5 screws were noted due to fracture of vertebral body. After removal of the plate, C4/5 PEEK cage was exposed. The C4 end plate was fracture and the cage sank into C4 body with posterior migration. The cage was removed for suspect cord compression. Anterior instrumentation was considered but difficult to perform due to fracture of C4 and C5 body. Posterior instrumentation may be considered if condition feasible. Operative Procedures 1. Under endotracheal general anesthesia, the patient was put in supine position with neck extension. The skin was scrubbed, disinfected, and draped as usual. 2. Transverse skin incision was made along operative scar over right lower neck. The subcutaneous soft tissue and platysma muscle were devided. 3. The fascia was opened along inner margin of the SCM muscle. 4. The prevertebral fascia was tried to approach but failed due to severe adhesion. 5. Due to difficult to approach of C4-5 cervical plate, another transverse skin incision was made at right upper neck. The subcutaneous soft tissue and platysma muscle were devided. The dissection was tried again. 6. Right side longus collis muscle was identified. The longus collis muscle was transected and prevertebral space was entered. 7. The C4-5 cervical plate was identified, exposed, and removed. 8. The C4/5 PEEK cage also removed. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. 9. The C4/5 disc space also packing with Gelfoam. One CWV drain was placed. The wound was then closed in layers with 3-0 Vicryl and 4-0 Dexon. Operators VS賴達明 Assistants R5李振豪, PGY李嘉哲 相關圖片 黃敏杼 (F,1956/11/04,55y4m) 手術日期 2011/11/01 手術主治醫師 賴達明 手術區域 東址 003房 03號 診斷 Herniation of intervertebral disc 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 23:13 臨時手術NPO 17:00 進入手術室 17:05 麻醉開始 17:10 誘導結束 17:27 抗生素給藥 17:45 手術開始 18:47 手術結束 18:47 麻醉結束 18:53 送出病患 18:55 進入恢復室 20:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 椎間盤切除術-腰椎 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Sequestrectomy, L3/4, left 開立醫師: 李振豪 開立時間: 2011/11/01 19:05 Pre-operative Diagnosis Ruptured intervertebral disc, L3/4, left Post-operative Diagnosis Ruptured intervertebral disc, L3/4, left Operative Method Sequestrectomy, L3/4, left Specimen Count And Types nil Pathology Nil Operative Findings Sequestration of ruptured disc was noted with thecal sac and left L4 root compression. Degeneration of L3/4 disc was not significant and microdiskectomy was not performed. The ruptured disc was fragmented and fragile. After sequestrectomy, the thecal sac and root expanded well. No incidental durotomy or CSF leakage noted during whole procedure. The patient stood whole procedure well. Operative Procedures Under endotracheal general anesthesia, The patient was put in prone position. The L3/4 disc level was localized by portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made at L3/4 level. Subcutaneous soft tissue and left paravertebral muscle groups were detached. The paravertebral muscles were retracted by a modified narrow Taylor retractor which was retained constantly by a rubbersling to the side rail of the operating table. Under operating microscope, left side laminotomy was performed with Kerrison punches. The ligmentum flavum was removed during laminotomy. The epidural fat was left in situ for protection of the thecal sac. The ruptured disc was noted after retraction of the thecal. Sequestrectomy was performed for decompression. The thecal sac and left L4 root became much loose after sequestrectomy. The L3/4 disc was checked and microdiskectomy was not performed due to no significant degenerative change of the disc. Hemostasis was acheived with bipolar electrocautery and Gelfoam packing. The wound was then closed in layers with 2-0 vicryl and 4-0 Dexon. Operators VS賴達明 Assistants R5李振豪, PGY李嘉哲 相關圖片 陳真男 (M,1940/11/24,71y3m) 手術日期 2011/11/01 手術主治醫師 賴達明 手術區域 東址 009房 04號 診斷 Spondylolysis, lumbar-sacral 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 23:06 臨時手術NPO 13:55 進入手術室 14:00 麻醉開始 14:10 誘導結束 14:25 抗生素給藥 15:00 手術開始 17:25 手術結束 17:25 麻醉結束 17:30 送出病患 17:35 進入恢復室 18:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 手術 椎間盤切除術-腰椎 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: 1. Bilateral laminotomy, L4/5. 開立醫師: 鍾文桂 開立時間: 2011/11/01 18:04 Pre-operative Diagnosis 1.Ruptured of left synovial joint,L4/5. 2.Herniated intervertebral disc,right side, L4/5. Post-operative Diagnosis 1.Ruptured of left synovial joint,L4/5. 2.Herniated intervertebral disc,right side, L4/5. Operative Method 1. Bilateral laminotomy, L4/5. 2. Removal of ruptured synovial joint. Specimen Count And Types nil Pathology Nil. Operative Findings 1. Right side laminotomy and removal of hypertrophic ligamentum flavum were done for nerve decompression. We did not remove the herniated disc over the right side. 2. A large piece of ruptured synoval joint was noted after laminotomy. The L4/5 joint is unstable due to the disrupted synovial joint. Operative Procedures Under ETGA, the patient was placed in prone position. After ensuring L4/5 intervertebral space with intraoperative fluoroscopy, the operative area was disinfected and drapped. A 3 cm skin incision was made and paraspinal dissection was obtained. After muscle retraction, bilateral laminotomy was achieved. The ruptured synovial joint was removed for decompression. With well hemostasis, the wound was closed in layers with no drain. Operators 賴達明 Assistants 鍾文桂 相關圖片 林貴美 (F,1953/02/08,59y1m) 手術日期 2011/11/01 手術主治醫師 陳敞牧 手術區域 東址 005房 02號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 蔡宗良, 時間資訊 23:27 臨時手術NPO 11:52 報到 12:34 進入手術室 12:40 麻醉開始 13:10 抗生素給藥 13:10 誘導結束 13:30 手術開始 16:10 抗生素給藥 16:30 開始輸血 17:55 麻醉結束 17:55 手術結束 18:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4~8小時 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Fronto-parietal craniotomy for brain tumor re... 開立醫師: 陳國瑋 開立時間: 2011/11/01 18:38 Pre-operative Diagnosis Intra-axial brain tumor, frontal and parietal, right-sided Post-operative Diagnosis Suspect high grade glioma Operative Method Fronto-parietal craniotomy for brain tumor removal, right-sided Specimen Count And Types 1 piece About size:小 Source:Brain Pathology Frozen section: high grade glioma, either grade III or IV Operative Findings Both frontal and parietal tumor were greyish in color, not very well demarcated, slight soft in consistency, moderately vascular. Both tumor were evident after durotomy. Part of frontal tumor near to the motor strip was left behind. Operative Procedures General anesthesia with endotracheal intubation was employed. Patient was put in supine position with head rotated 90 degrees to the left with right-sided shoulder elevated with towels. After routine disinfection and preparation, a inverted U-shaped scalp incision including both tumor was applied, followed by craniotomy. Ultrasonography was used to confirm the position before durotomy. Tumor was removed partly and sent for frozen section. Tumor was removed by bi-polar cautery and tumor forceps. Hemostasiswith surgicel was applied before dura closure. Skull plated was fixed back to the craniotomy window. Wound was closed in layers after placement of 7-mm CWV drain. General anesthesia with endotracheal intubation was employed. Patient was put in supine position with head rotated 90 degrees to the left with right-sided shoulder elevated with towels. After routine disinfection and preparation, a inverted U-shaped scalp incision including both tumor was applied, followed by craniotomy. Ultrasonography was used to confirm the position before durotomy. Intraoperative mapping was performed and the central sulcus was identified. Tumor was removed partly and sent for frozen section. Tumor was removed by bi-polar cautery and tumor forceps. Hemostasiswith surgicel was applied before dura closure. Skull plated was fixed back to the craniotomy window. Wound was closed in layers after placement of 7-mm CWV drain. Operators VS 陳敞牧 Assistants R6 蔡宗良 朱粵川 (M,1947/06/26,64y8m) 手術日期 2011/11/02 手術主治醫師 蔡翊新 手術區域 東址 002房 05號 診斷 Subdural hemorrhage, traumatic 器械術式 Removal of epidural hematoma，ICP monitoring 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 王永彬 ASA 4E 紀錄醫師 鍾文桂, 時間資訊 00:00 開始NPO 10:58 通知急診手術 23:25 進入手術室 23:30 麻醉開始 23:45 開始輸血 00:05 抗生素給藥 00:10 抗生素給藥 00:10 誘導結束 00:28 手術開始 03:00 抗生素給藥 03:05 抗生素給藥 03:20 手術結束 03:20 麻醉結束 03:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 急性硬腦膜下血腫清除術 1 1 L 手術 顱內壓視置入 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for evacuation of acute SDH, Inser... 開立醫師: 鍾文桂 開立時間: 2011/11/02 03:58 Pre-operative Diagnosis Head injury with acute subdural hemorrhage, left fronto-parieto-temporal. Post-operative Diagnosis Head injury with acute subdural hemorrhage, left fronto-parieto-temporal. Operative Method Craniotomy for evacuation of acute SDH, Insertion ICP monitor. Specimen Count And Types nil Pathology Nil. Operative Findings 1. The amount of hematoma seems to be larger comparing to pre-op CT. The two bleeders over the cortica surface was electrocoagulated. 2. The patient skull bone is thiner comparing to others. Operative Procedures Under ETGA, the patient was placed in supine postiona and the head was tilted to the right. After shaving, disinfection, and draping, a trauma flap was obtained. Craniotomy was obtained by high speed drills. The dura mater was incised. The hematoma was evacuated. The bleeders were electrocoagulated. The dura mater was augmented with fascia. The craniotomy bone plate was fixed by plates and screws. The ICP monitor was inserted into subdural space. The wound was closed in layers. Operators 王國川 Assistants 鍾文桂 Indication Of Emergent Operation Acute GCS deterioreation. 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Craniotomy for evacuation of acute SDH, Inser... 開立醫師: 鍾文桂 開立時間: 2011/11/04 15:52 Pre-operative Diagnosis Head injury with acute subdural hemorrhage, left fronto-parieto-temporal. Post-operative Diagnosis Head injury with acute subdural hemorrhage, left fronto-parieto-temporal. Operative Method Craniotomy for evacuation of acute SDH, Insertion ICP monitor. Specimen Count And Types nil Pathology Nil. Operative Findings 1. The amount of hematoma seems to be larger comparing to pre-op CT. The two bleeders over the cortica surface was electrocoagulated. 2. The patient skull bone is thiner comparing to others. Operative Procedures Under ETGA, the patient was placed in supine postiona and the head was tilted to the right. After shaving, disinfection, and draping, a trauma flap was obtained. Craniotomy was obtained by high speed drills. The dura mater was incised. The hematoma was evacuated. The bleeders were electrocoagulated. The dura mater was augmented with fascia. The craniotomy bone plate was fixed by plates and screws. The ICP monitor was inserted into subdural space. The wound was closed in layers. Operators 王國川 Assistants 鍾文桂 Indication Of Emergent Operation Acute GCS deterioreation. 相關圖片 陳惠真 (F,1977/09/11,34y6m) 手術日期 2011/11/02 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Brain Tumor 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 2 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 08:07 進入手術室 08:25 麻醉開始 09:00 誘導結束 09:00 抗生素給藥 09:05 手術開始 12:00 抗生素給藥 13:30 手術結束 13:30 麻醉結束 13:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4~8小時 1 1 L 手術 腦室體外引流 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 摘要__ 手術科部: 外科部 套用罐頭: Left occipital craniotomy with tumor resectio... 開立醫師: 曾偉倫 開立時間: 2011/11/02 14:11 Pre-operative Diagnosis Left occipital horn intraventricular tumor, suspect choroid plexus papilloma Post-operative Diagnosis Left occipital horn intraventricular tumor, suspect choroid plexus papilloma Operative Method Left occipital craniotomy with tumor resection and EVD insertion Specimen Count And Types 1 piece About size:2x2x2 cm Source:Left occipital horn tumor, suspect choroid plexus papilloma Pathology Pending Operative Findings A 3 cm pinkish, hard, elastic, and well delineated tumor is located in left occipital horn of lateral ventricle. The feeders from choroidal arteries from anterior inferor aspect of the tumor and a large drainage vein were electrocoagulated. The tenia choroidia was identified. Some cyst formation was noted. The septations were lysed. The cyst content was clear and colorless. The tumor was dissected along the ventricular wall. The tumor was excised in en bloc fashion. The normal choroid plexus and the tumor mass were removed in one large piece. The cranitotomy was 5 cm in diameter, 5 cm above and posterior to external auditory canal. The cortex 0.05 mm Operative Procedures Under ETGA, we placed her on prone position. We fixed her head with mayfield clamp. After we shaved, scrubbed and disinfected, a S-chape skin incision was made behind the external acoustic canal. A 5x5 cm craniotomy was made with a hand- and an air-drived drill. A cruciate durotomy was made and an 1x1 cm corticotomy was made. The left lateral ventricle was entered after the durotomy and the cystic part of tumor was found. The solid part of the tumor was devascularized with bipolar forceps and micro-scissors. The main feeder was also found via the choroidal artery. The border between ventricle wall and the tumor was clear. The tumor was removed smoothly. An EVD was placed via the corticotomy and the durotomy was closed with 3-0 prolene and a autologus fascia flap. The wound was clised in layers with 2-0 Vicryl and 3-0 Nylon. The EVD was also fixed during the wound closure. Operators Prof. 杜永光 Assistants R6 鍾文桂 R3 曾偉倫 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Left occipital craniotomy with tumor resectio... 開立醫師: 曾偉倫 開立時間: 2011/11/05 07:01 Pre-operative Diagnosis Left occipital horn intraventricular tumor, suspect choroid plexus papilloma Post-operative Diagnosis Left occipital horn intraventricular tumor, suspect choroid plexus papilloma Operative Method Left occipital craniotomy with tumor resection and EVD insertion Specimen Count And Types 1 piece About size:2x2x2 cm Source:Left occipital horn tumor, suspect choroid plexus papilloma Pathology Pending Operative Findings A 3 cm pinkish, hard, elastic, and well delineated tumor is located in left occipital horn of lateral ventricle. The feeders from choroidal arteries from anterior inferor aspect of the tumor and a large drainage vein were electrocoagulated. The tenia choroidia was identified. Some cyst formation was noted. The septations were lysed. The cyst content was clear and colorless. The tumor was dissected along the ventricular wall. The tumor was excised in en bloc fashion. The normal choroid plexus and the tumor mass were removed in one large piece. The cranitotomy was 5 cm in diameter, 5 cm above and posterior to external auditory canal. The cortex 0.05 mm Operative Procedures Under ETGA, we placed her on prone position. We fixed her head with mayfield clamp. After we shaved, scrubbed and disinfected, a S-chape skin incision was made behind the external acoustic canal. A 5x5 cm craniotomy was made with a hand- and an air-drived drill. A cruciate durotomy was made and an 1x1 cm corticotomy was made. The left lateral ventricle was entered after the durotomy and the cystic part of tumor was found. The solid part of the tumor was devascularized with bipolar forceps and micro-scissors. The main feeder was also found via the choroidal artery. The border between ventricle wall and the tumor was clear. The tumor was removed smoothly. An EVD was placed via the corticotomy and the durotomy was closed with 3-0 prolene and a autologus fascia flap. The wound was clised in layers with 2-0 Vicryl and 3-0 Nylon. The EVD was also fixed during the wound closure. Operators Prof. 杜永光 Assistants R6 鍾文桂 R3 曾偉倫 相關圖片 蔡宗道 (M,1957/06/20,54y8m) 手術日期 2011/11/02 手術主治醫師 蔡瑞章 手術區域 東址 002房 02號 診斷 Hydrocephalus 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 2 紀錄醫師 蔡宗良, 時間資訊 00:00 臨時手術NPO 10:48 報到 11:10 進入手術室 11:15 麻醉開始 11:25 誘導結束 11:30 抗生素給藥 12:06 手術開始 13:30 手術結束 13:30 麻醉結束 13:35 送出病患 13:38 進入恢復室 15:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunting, medium pressur... 開立醫師: 蔡宗良 開立時間: 2011/11/02 13:39 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunting, medium pressure, via right-sided Kocher point Specimen Count And Types nil Pathology None Operative Findings ICP approximately 2 cmH2O Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: supine with head rotated (tilted) to right (left). 3.Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 5 cm curvilinear, right occipital, corresponded to the location of right occipital horn. Raney clips were applied to the scalp edge for temporary hemostasis. 5.After the scalp flap had been lifted and reflected anteriorly, a burr hole was made and the dura was tented by 1 stitches. 6.The dura was opened by a nib incision. Rt lateral ventricle was tapped by a ventricular needle, then a 6.5 cm segment of the ventricular catheter was introduced into the ventricle. The outer end of the catheter was connected to a reservoir. 7. A nib incision was made at RUQ of the abdomen , then a trocar was pushed into peritoneal cavity. Subsequently, distal 25 cm segment of the peritoneal catheter (zero pressure) was introduced into the peritoneal cavity through the outer tube of the trochar. The proximal end of this catheter was passed through subcutaneous tunnel at forechest, neck, rt retroauricular area and connected the reservoir. The shunt systemwas checked to make sure its function was working. 8. The reservoir was fixed to pericranium by 3 stitches. 9. Scalp closure: hemostasis was done with monopolar coagulator touching on the sucker tip. Galea suture was performed by continuous suture with 1/0 Dexon and skin by continuous suture with 3/0 nylon. 10.Course of the surgery: smooth. Operators prof. 蔡瑞章 Assistants R6 蔡宗良 R1 李嘉哲 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunting, medium pressur... 開立醫師: 蔡瑞章 開立時間: 2011/11/11 10:34 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunting, medium pressure, via right-sided Kocher point Specimen Count And Types nil Pathology None Operative Findings ICP approximately 2 cmH2O Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: supine with head rotated (tilted) to right left. 3.Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 5 cm curvilinear, right occipital, corresponded to the location of right occipital horn. Raney clips were applied to the scalp edge for temporary hemostasis. 5.After the scalp flap had been lifted and reflected anteriorly, a burr hole was made and the dura was tented by 1 stitches. 6.The dura was opened by a nib incision. Rt lateral ventricle was tapped by a ventricular needle, then a 6.5 cm segment of the ventricular catheter was introduced into the ventricle. The outer end of the catheter was connected to a reservoir. 7. A nib incision was made at RUQ of the abdomen , then a trocar was pushed into peritoneal cavity. Subsequently, distal 25 cm segment of the peritoneal catheter (zero pressure) was introduced into the peritoneal cavity through the outer tube of the trochar. The proximal end of this catheter was passed through subcutaneous tunnel at forechest, neck, rt retroauricular area and connected the reservoir. The shunt system was checked to make sure its function was working. 8. The reservoir was fixed to pericranium by 3 stitches. 9. Scalp closure: hemostasis was done with monopolar coagulator touching on the sucker tip. Galea suture was performed by continuous suture with 1/0 Dexon and skin by continuous suture with 3/0 nylon. 10.Course of the surgery: smooth. Operators prof. 蔡瑞章 Assistants R6 蔡宗良 R1 李嘉哲 相關圖片 李怡瑱 (F,1969/10/16,42y4m) 手術日期 2011/11/02 手術主治醫師 蔡瑞章 手術區域 東址 005房 01號 診斷 Lymphoma 器械術式 Skull bone metastasis excision + cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 張哲瑋, 時間資訊 00:00 臨時手術NPO 08:10 進入手術室 08:15 麻醉開始 08:40 誘導結束 08:40 抗生素給藥 08:43 手術開始 10:20 開始輸血 11:43 抗生素給藥 11:45 手術結束 11:45 麻醉結束 11:55 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除-手術時間在4小時以內 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Craniectomy for skull and epidural tumor exci... 開立醫師: 曾峰毅 開立時間: 2011/11/02 11:41 Pre-operative Diagnosis Vaginal cancer with skull metastasis Post-operative Diagnosis Vaginal cancer with skull metastasis with epdirual extension and dura invovlement Operative Method Craniectomy for skull and epidural tumor excision, cranioplasty with titanium mesh Specimen Count And Types Several fragments of one tumor with invaded skull bone was sent for pathology. Pathology Pending Operative Findings Two hypervascular tumor involved skull bone at parietal area at midline and right paremedian area. Tumor was invaded scalp through galeal and invaded dura. Superior sagittal sinus was depressed inferiorly, and was remained intact during the surgery. Codman titanium mesh was used for carnioplasty. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position with head fixed by Mayfield head clamp. We made one C-shape skin incision and reflect scalp flap. We drilled 8 burr holes, and created craniectomy. Epidural tumor was removed, and hemostasis was ahieved. Cranioplasty was performed with titanium mesh, and wound was closed in layers after one epidural and one subgaleal CWV. Operators Prof. 蔡瑞章 Assistants R5 曾峰毅 R1 張哲瑋 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Craniectomy for skull and epidural tumor exci... 開立醫師: 張哲瑋 開立時間: 2011/11/04 16:29 Pre-operative Diagnosis Vaginal cancer with skull metastasis Post-operative Diagnosis Vaginal cancer with skull metastasis with epdirual extension and dura invovlement Operative Method Craniectomy for skull and epidural tumor excision, cranioplasty with titanium mesh Specimen Count And Types Several fragments of one tumor with invaded skull bone was sent for pathology. Pathology Pending Operative Findings Two hypervascular tumor involved skull bone at parietal area at midline and right paremedian area. Tumor was invaded scalp through galeal and invaded dura. Superior sagittal sinus was depressed inferiorly, and was remained intact during the surgery. Codman titanium mesh was used for carnioplasty. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position with head fixed by Mayfield head clamp. We made one C-shape skin incision and reflect scalp flap. We drilled 8 burr holes, and created craniectomy. Epidural tumor was removed, and hemostasis was ahieved. Cranioplasty was performed with titanium mesh, and wound was closed in layers after one epidural and one subgaleal CWV. Operators Prof. 蔡瑞章 Assistants R5 曾峰毅 R1 張哲瑋 相關圖片 鐘余素蘭 (F,1942/12/26,69y2m) 手術日期 2011/11/02 手術主治醫師 蔡瑞章 手術區域 東址 005房 02號 診斷 Lumbar spondylosis 器械術式 L4-5 transpedicular screws 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 張哲瑋, 時間資訊 00:00 臨時手術NPO 11:35 報到 12:25 麻醉開始 12:30 抗生素給藥 12:35 誘導結束 12:39 進入手術室 13:02 手術開始 15:30 手術結束 15:30 麻醉結束 15:38 送出病患 15:40 進入恢復室 18:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎間盤切除術-腰椎 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 張哲瑋 開立時間: 2011/11/02 15:37 Pre-operative Diagnosis Spondylolisthesis, grade I, L4/5 Post-operative Diagnosis Spondylolisthesis, grade I, L4/5 Operative Method Transformainal lumbar interbody fusion with PEEK cage and autologous bone graft at L4/5; posterior fixation with transpedicular screws at L4 and L5 Specimen Count And Types Nil Pathology Nil Operative Findings Hypertrophic ligamentum flavum compromised bilateral lateral recess of L4/5 and thecal sac tightly. Neural structures were decompressed well after the surgery. Baui posterior fixation system and PEEK cage were used for TLIF. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After C-arm localization, we made one midline skin incision and dissected bilateral paraspinal muscle to expose bilateral laminae from L3 to L5. Posterior instrumentation with transpedicular screws into bilateral pedicles of L4 and L5. Posterior decompression was done with L4 laminectomy. L4/5 diskectomy was done, and transforaminal lumbar interbody fusion with done with PEEK cage and augologous bone graft. Posterior fixation with achieved after two 5-cm rods set. After gentamycin-saline irrigation, the wound was closed in layers with two submuscular hemovac. Operators Prof. 蔡瑞章 Assistants R5 曾峰毅 R1 張哲瑋 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 張哲瑋 開立時間: 2011/11/04 16:30 Pre-operative Diagnosis Spondylolisthesis, grade I, L4/5 Post-operative Diagnosis Spondylolisthesis, grade I, L4/5 Operative Method Transformainal lumbar interbody fusion with PEEK cage and autologous bone graft at L4/5; posterior fixation with transpedicular screws at L4 and L5 Specimen Count And Types Nil Pathology Nil Operative Findings Hypertrophic ligamentum flavum compromised bilateral lateral recess of L4/5 and thecal sac tightly. Neural structures were decompressed well after the surgery. Baui posterior fixation system and PEEK cage were used for TLIF. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After C-arm localization, we made one midline skin incision and dissected bilateral paraspinal muscle to expose bilateral laminae from L3 to L5. Posterior instrumentation with transpedicular screws into bilateral pedicles of L4 and L5. Posterior decompression was done with L4 laminectomy. L4/5 diskectomy was done, and transforaminal lumbar interbody fusion with done with PEEK cage and augologous bone graft. Posterior fixation with achieved after two 5-cm rods set. After gentamycin-saline irrigation, the wound was closed in layers with two submuscular hemovac. Operators Prof. 蔡瑞章 Assistants R5 曾峰毅 R1 張哲瑋 相關圖片 賴國春 (M,1935/02/13,77y1m) 手術日期 2011/11/02 手術主治醫師 陳敞牧 手術區域 東址 003房 02號 診斷 Back pain 器械術式 L4-5 Laminectomy for decompression 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3E 紀錄醫師 李振豪, 時間資訊 01:00 開始NPO 11:57 通知急診手術 13:50 報到 14:05 進入手術室 14:25 麻醉開始 14:40 誘導結束 14:45 開始輸血 14:45 抗生素給藥 15:15 手術開始 17:35 手術結束 17:35 麻醉結束 17:43 送出病患 17:45 進入恢復室 19:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 良性脊髓腫瘤切除術 1 1 手術 椎弓切除術(減壓)-二節以內 1 2 記錄__ 手術科部: 外科部 套用罐頭: L4 and partial L5 laminectomy for epidural le... 開立醫師: 李振豪 開立時間: 2011/11/02 17:31 Pre-operative Diagnosis L4 epidural lesion, suspect abscess Post-operative Diagnosis L4 epidural mass, suspect infectious granulation formation, ruled out malignancy Operative Method L4 and partial L5 laminectomy for epidural lesion excision Specimen Count And Types 1 piece About size:Multiple pieces Source:L4 intra-spinal lesion Pathology Pending Operative Findings Upper part of L5 spinous process was fragile with some bony destruction extended into upper part of L5 lamina. After L4 and partial L5 laminectomy, the hypertrophic ligmentum flavum was encountered. the ligmentum flavum was removed and epidural mass was disclosed. The epidural fat was unhealthy and green-yellowish in color. The epidural mass was 1 x 1.1 x 2cm in size with thin layer epidural extension(especially right side) which compressed the thecal sac tightly. The mass was mainly located at L4-5 level and adhered to the thecal sac tightly. The mass was dissected away from thecal sac from normal dura toward the lesion. The epidural extension also removed. No incidental durotomy or CSF leakage was noted during whole procedure. After decompression, the thecal sac expanded well. Gelfoam was not used under the consideration of infection. The patient stood whole procedure well. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position. L4 level was localized with portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made at L4-5 level. The subcutaneous soft tissue and paravertebral muscle groups were detached. L4 and partial L5 laminectomy was performed. The ligmentum flavum was excised. The epidural mass was identified and dissected away from the thecal sac. Three culture swab and pathology was sampled for further study. Hemostasis was achieved with bipolar electrocautery. One Hemovac was placed. The wound was then closed in layers with 1-0, 2-0 Vicryl and 3-0 Nylon. Operators VS陳敞牧 Assistants R5李振豪, R1李嘉哲 Indication Of Emergent Operation Cauda equina syndrome 相關圖片 林添 (M,1935/01/11,77y2m) 手術日期 2011/11/02 手術主治醫師 王碩盟 手術區域 東址 008房 02號 診斷 Benign prostatic hypertrophy 器械術式 Cystostomy -- Trocar method 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 靜脈麻醉 麻醉主治醫師 林佩玲 ASA 3 紀錄醫師 蔡博超, 時間資訊 08:35 進入手術室 08:50 麻醉開始 08:53 誘導結束 08:55 抗生素給藥 09:05 手術開始 09:15 手術結束 09:15 麻醉結束 09:20 送出病患 09:22 進入恢復室 10:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 膀胱造口術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 摘要__ 手術科部: 泌尿部 套用罐頭: cystostomy, trocar 開立醫師: 蔡博超 開立時間: 2011/11/02 09:24 Pre-operative Diagnosis Neurogenic bladder Post-operative Diagnosis Neurogenic bladder Operative Method Trocar cystostomy Specimen Count And Types nil Pathology nil Operative Findings 1. Prostate lobes kissing together 2. Severe trabeculation of bladder wall 3. A Fr 16 Cystostomy inserted Operative Procedures Under satisfactory anesthesia with the patient in lithotomy position, prepping and drapping was performed in the usual sterile fashion. A Fr 21 Olympus cystoscope was introduced into the bladder cavity under direct vision. Careful inspectionrevealed bilateral ureteral orifice was normal. posterior wall mucosa irritation change was noted. After hydrodistention of bladder was done, trocar cystostomy was performed under optic guidance. A Fr 16 catheter was inserted. Patient tolerated the procedure very well and was sent to recovery room in satisfactory condition. Operators 王碩盟, Assistants 蔡博超, 周淇業, 記錄__ 手術科部: 泌尿部 套用罐頭: cystostomy, trocar 開立醫師: 蔡博超 開立時間: 2011/11/02 09:24 Pre-operative Diagnosis Neurogenic bladder Post-operative Diagnosis Neurogenic bladder Operative Method Trocar cystostomy Specimen Count And Types nil Pathology nil Operative Findings 1. Prostate lobes kissing together 2. Severe trabeculation of bladder wall 3. A Fr 16 Cystostomy inserted Operative Procedures Under satisfactory anesthesia with the patient in lithotomy position, prepping and drapping was performed in the usual sterile fashion. A Fr 21 Olympus cystoscope was introduced into the bladder cavity under direct vision. Careful inspectionrevealed bilateral ureteral orifice was normal. posterior wall mucosa irritation change was noted. After hydrodistention of bladder was done, trocar cystostomy was performed under optic guidance. A Fr 16 catheter was inserted. Patient tolerated the procedure very well and was sent to recovery room in satisfactory condition. Operators 王碩盟, Assistants 蔡博超, 周淇業, 朱粵川 (M,1947/06/26,64y8m) 手術日期 2011/11/02 手術主治醫師 王國川 手術區域 東址 016房 05號 診斷 Subdural hemorrhage, traumatic 器械術式 Removal of left acute SDH 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 4E 紀錄醫師 王奐之, 時間資訊 15:25 開始NPO 15:25 臨時手術NPO 15:25 通知急診手術 15:42 進入手術室 15:50 麻醉開始 15:55 誘導結束 16:07 手術開始 17:00 抗生素給藥 17:05 手術結束 17:05 麻醉結束 17:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 急性硬腦膜下血腫清除術 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Left side craniotomy for epidural & subdural ... 開立醫師: 王奐之 開立時間: 2011/11/02 17:26 Pre-operative Diagnosis Left side acute subdural hematoma, status post craniotomy for hematoma evacuation, with recurrent subdural hematoma Post-operative Diagnosis Left side acute subdural hematoma, status post craniotomy for hematoma evacuation, with recurrent subdural hematoma and acute epidural hematoma Operative Method Left side craniotomy for epidural & subdural hematoma evacuation Specimen Count And Types Nil Pathology Nil Operative Findings Bilaterally dilated pupils were noted on entering the operation room. The majority of hematoma located at the epidural space, subgaleal & subdural hematoma also accompanied, along with diffuse oozing. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to right. After scrubbing, disinfection & draping in sterile fashion, the previous wound was opened after removal of stitches. The subgaleal hematoma was removed after application of Raney clips, followed removal of the bone flap. Epidural hematoma was then removed with 12-Fr. & 10-Fr. suction tip. A 2cm durotomy was done over the insertion site of ICP monitor, and small amount of subdural hemorrhage was also removed. The dura was closed with silk in water-tight fashion. After setting up 1 epidural CWV drain & 1 subgeal CWV drain, 8 central tenting stitches were applied, the bone flap was fixed back with mini-plates. The wound was closed in layers after hemostasis. Operators VS 王國川 Assistants R4 王奐之 Indication Of Emergent Operation IICP & pupil dilatation 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Left side craniotomy for epidural & subdural ... 開立醫師: 王奐之 開立時間: 2011/11/02 17:27 Pre-operative Diagnosis Left side acute subdural hematoma, status post craniotomy for hematoma evacuation, with recurrent subdural hematoma Post-operative Diagnosis Left side acute subdural hematoma, status post craniotomy for hematoma evacuation, with recurrent subdural hematoma and acute epidural hematoma Operative Method Left side craniotomy for epidural & subdural hematoma evacuation Specimen Count And Types Nil Pathology Nil Operative Findings Bilaterally dilated pupils were noted on entering the operation room. The majority of hematoma located at the epidural space, subgaleal & subdural hematoma also accompanied, along with diffuse oozing. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to right. After scrubbing, disinfection & draping in sterile fashion, the previous wound was opened after removal of stitches. The subgaleal hematoma was removed after application of Raney clips, followed removal of the bone flap. Epidural hematoma was then removed with 12-Fr. & 10-Fr. suction tip. A 2cm durotomy was done over the insertion site of ICP monitor, and small amount of subdural hemorrhage was also removed. The dura was closed with silk in water-tight fashion. After setting up 1 epidural CWV drain & 1 subgeal CWV drain, 8 central tenting stitches were applied, the bone flap was fixed back with mini-plates. The wound was closed in layers after hemostasis. Operators VS 王國川 Assistants R4 王奐之 Indication Of Emergent Operation IICP & pupil dilatation 相關圖片 何李秋菊 (F,1937/10/16,74y4m) 手術日期 2011/11/02 手術主治醫師 蔡翊新 手術區域 東址 001房 01號 診斷 Out of hospital cardiac arrest 器械術式 Tracheostomy 手術類別 緊急手術 手術部位 頭、頸 傷口分類 污染 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3E 紀錄醫師 李振豪, 時間資訊 21:31 通知急診手術 00:00 開始NPO 00:00 臨時手術NPO 08:23 進入手術室 08:30 麻醉開始 08:35 誘導結束 08:49 手術開始 09:05 手術結束 09:05 麻醉結束 09:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 氣管切開術 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 李振豪 開立時間: 2011/11/02 09:12 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types nil Pathology None Operative Findings Fr. 7 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 1cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators VS蔡翊新 Assistants R5李振豪 Indication Of Emergent Operation 相關圖片 賈傑 (M,1972/02/22,40y0m) 手術日期 2011/11/03 手術主治醫師 陳敞牧 手術區域 東址 003房 03號 診斷 Herniation of intervertebral disc with myelopathy, cervical (HIVD) 器械術式 C4/5 anterior cervical diskectomy 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 施培艾, 時間資訊 00:00 臨時手術NPO 13:05 報到 13:35 進入手術室 13:40 麻醉開始 13:45 誘導結束 14:00 抗生素給藥 14:36 手術開始 17:00 抗生素給藥 17:45 手術結束 17:45 麻醉結束 18:03 送出病患 18:05 進入恢復室 19:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-頸椎 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 手術 脊椎融合術-前融合,有固定物)≦四節 1 2 摘要__ 手術科部: 外科部 套用罐頭: Anterior C4-5 discectomy and fusion with PEEK... 開立醫師: 王奐之 開立時間: 2011/11/03 18:12 Pre-operative Diagnosis C4-5 hernitated intervertebral disc Post-operative Diagnosis C4-5 hernitated intervertebral disc Operative Method Anterior C4-5 discectomy and fusion with PEEK cage & artificial bone grafts Specimen Count And Types Nil Pathology Nil Operative Findings Thick neck with bulky soft tissue resulted in difficult access. A 8 mm PEEK cage was inserted into C4-5 disc space after discectomy. The thecal sac was compressed tightly and fully decompressed after discectomy. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with neck hyper-extended. After scrubbing, disinfection and draping in sterile fashion, a transverse skin incision was made at right neck. After subplastysmal dissection of skin flap superior & inferior to the incision, the medial border of sternocleidomastoid muscle was identified. Dissection was performed through this plane, with trachea, esophagus & thyroid retracted to the medial aspect. After identifying the longus colli muscle, the muscles were splitted and retracted to sides. Confirmation of C4-5 disc space was done under C-arm. After application of Caspar retractorm, discectomy was then performed under microscopic view with curette, disc clamp & air drill. A cage stuffed with artifical bone grafts was inserted into the C4-5 disc space. After meticulous hemostasis and setting up of an mini-hemovac drain, the wound was closed in layers. Operators VS 陳敞牧 Assistants R4 王奐之, R0 施培艾 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Anterior C4-5 discectomy and fusion with PEEK... 開立醫師: 王奐之 開立時間: 2011/11/03 18:12 Pre-operative Diagnosis C4-5 hernitated intervertebral disc Post-operative Diagnosis C4-5 hernitated intervertebral disc Operative Method Anterior C4-5 discectomy and fusion with PEEK cage & artificial bone grafts Specimen Count And Types Nil Pathology Nil Operative Findings Thick neck with bulky soft tissue resulted in difficult access. A 8 mm PEEK cage was inserted into C4-5 disc space after discectomy. The thecal sac was compressed tightly and fully decompressed after discectomy. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with neck hyper-extended. After scrubbing, disinfection and draping in sterile fashion, a transverse skin incision was made at right neck. After subplastysmal dissection of skin flap superior & inferior to the incision, the medial border of sternocleidomastoid muscle was identified. Dissection was performed through this plane, with trachea, esophagus & thyroid retracted to the medial aspect. After identifying the longus colli muscle, the muscles were splitted and retracted to sides. Confirmation of C4-5 disc space was done under C-arm. After application of Caspar retractorm, discectomy was then performed under microscopic view with curette, disc clamp & air drill. A cage stuffed with artifical bone grafts was inserted into the C4-5 disc space. After meticulous hemostasis and setting up of an mini-hemovac drain, the wound was closed in layers. Operators VS 陳敞牧 Assistants R4 王奐之, R0 施培艾 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Anterior C4-5 discectomy and fusion with PEEK... 開立醫師: 施培艾 開立時間: 2011/11/04 14:29 Pre-operative Diagnosis C4-5 hernitated intervertebral disc Post-operative Diagnosis C4-5 hernitated intervertebral disc Operative Method Anterior C4-5 discectomy and fusion with PEEK cage & artificial bone grafts Specimen Count And Types Nil Pathology Nil Operative Findings Thick neck with bulky soft tissue resulted in difficult access. A 8 mm PEEK cage was inserted into C4-5 disc space after discectomy. The thecal sac was compressed tightly and fully decompressed after discectomy. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with neck hyper-extended. After scrubbing, disinfection and draping in sterile fashion, a transverse skin incision was made at right neck. After subplastysmal dissection of skin flap superior & inferior to the incision, the medial border of sternocleidomastoid muscle was identified. Dissection was performed through this plane, with trachea, esophagus & thyroid retracted to the medial aspect. After identifying the longus colli muscle, the muscles were splitted and retracted to sides. Confirmation of C4-5 disc space was done under C-arm. After application of Caspar retractorm, discectomy was then performed under microscopic view with curette, disc clamp & air drill. A cage stuffed with artifical bone grafts was inserted into the C4-5 disc space. After meticulous hemostasis and setting up of an mini-hemovac drain, the wound was closed in layers. Operators VS 陳敞牧 Assistants R4 王奐之, R0 施培艾 相關圖片 邱豪傑 (M,1984/05/31,27y9m) 手術日期 2011/11/03 手術主治醫師 蕭輔仁 手術區域 東址 005房 02號 診斷 Lumbar Spondylosis 器械術式 L-spine wound debridement 手術類別 預定手術 手術部位 脊椎 傷口分類 污染 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 張書豪, 時間資訊 00:00 臨時手術NPO 09:18 進入手術室 09:30 麻醉開始 09:40 誘導結束 09:55 抗生素給藥 10:06 手術開始 10:35 手術結束 10:35 麻醉結束 10:50 送出病患 10:52 進入恢復室 12:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 深部傷口處理縫合擴創-小 1 0 記錄__ 手術科部: 外科部 套用罐頭: Debridement 開立醫師: 張書豪 開立時間: 2011/11/03 10:56 Pre-operative Diagnosis Lumbar operative scar dehiscence Post-operative Diagnosis Lumbar operative scar dehiscence Operative Method Debridement Specimen Count And Types culture: TB x1, common pahtogen x1; pathology x1 Pathology nil Operative Findings 1.Wound dehiscence, about 3x1cm in size, about 2.5cm in depth after debridement 2.Whitish necrotic tissue found in the dehiscence wound, pathology sent Operative Procedures 1.ETGA, prone 2.Skin scrubbed, disinfected, drapped 3.Perform debridement, obtain culture x2, pathology x1 4.Corpious normal saline irrigation 5.Gentamycin + normal saline irrigation 6.Apply CWV drain 7.Close the wound in layers Operators VS蕭輔仁 Assistants R6蔡宗良 PGYR1張書豪 蕭銘炎 (M,1935/03/08,77y0m) 手術日期 2011/11/03 手術主治醫師 蕭輔仁 手術區域 東址 005房 03號 診斷 Cerebrovascular accident 器械術式 C3/4 anterior cervical diskectomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 張書豪, 時間資訊 00:00 臨時手術NPO 10:45 報到 11:05 進入手術室 11:10 麻醉開始 11:15 誘導結束 11:25 抗生素給藥 11:54 手術開始 14:15 麻醉結束 14:25 手術結束 14:40 送出病患 14:45 進入恢復室 16:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-頸椎 1 1 手術 椎融合術-前融合,無固定物(≦四節) 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Anterior Discectomy and Fusion, Cervical Spine 開立醫師: 張書豪 開立時間: 2011/11/03 14:50 Pre-operative Diagnosis Herniated cervical disc, C3-4 Post-operative Diagnosis Herniated cervical disc, C3-4 Operative Method Anterior Discectomy and Fusion, Cervical Spine Specimen Count And Types 1 piece About size:小 Source:intervertebral disc Pathology Report pending Operative Findings 1.Herniated cervical disc, C3-4 2.Posterior longitudinal ligament redundant 3.Nucleus pulposus herniated to annulus fibrosus Operative Procedures 1. Anesthesia: endotracheal general 2.Position: supine with neck hyperextended by a air cuff placed beneath the shoulder. Rt side pelvis was elevated too. 3. Skin preparation: the anterior neck and rt iliac crest was shaved and scrubbed with povidone-iodinew detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4.Incision; 5 cm, transverse middle cervical, extended from anterior margin of sternocleidomastoid (SCM) muscle to thyroid cartilage. 5. The plastisma muscle was transected and mobilized from the underlying superficial cervical fascia which was then opened in vertical direction along the anterior margin of the SCM muscle. 6.The dissection was advanced at the loose plane between SCM muscle and strip muscles until the prevertebral fascia had been reached. The former structure was retracted to the lateral and the later structures with esophagus and trachea to the opposite side by Cloward cervical retractor. 7.The prevertebral fascia was opened vertically, the lesion intervertebral space was exposed and identified by intraoperative portable X-ray 8.The most medial portion of the longus coli muscles on both sides were detached from the vertebral bodies to providea wider exposure of the vertebral bodies. 9.The anterior longitudinal ligment was incised transversely at the margins of intervertebral space, the annulus fibrosus was cut too. 10.The degenerated disc and cartilage plate were removed by curette. 11.The intervertebral spac was widened by a Cloward interveetebral spreader. The posterior longitudinal ligament was cut from bony edge by curette and then removed. Consequently, the spinal dura expanded into the intervertebral space. 12.The surfaces of vertebral bodies at this intervertebral space was trimed by high speed air drill to creat a biconcave intervertebral space. 13.A 7mm height cage was packed into the intervertebral space tightly by a impactor. The intervertebral space was widened by pulling the patients head while the impaction of the bone graft (Stimulan) was doing. 15.The air cuff beneath the shoulder was deflated, the Cloward cervical retractor removed. 16.Wound closure: continuous suture with 4/0 Dexon for plastisma and continuous subcutaneous suture with 4/0 Vicryl on the skin. 17.Drain: one CWV 18.Blood transfusion: nil 19.Course of the surgery: smooth. Operators VS蕭輔仁 Assistants R6蔡宗良 PGYR1張書豪 相關圖片 張添椿 (M,1921/02/12,91y1m) 手術日期 2011/11/03 手術主治醫師 蕭輔仁 手術區域 東址 005房 05號 診斷 Low back pain 器械術式 Radiofrequency coagulation(P-G 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 16:00 報到 17:15 進入手術室 17:34 麻醉開始 17:35 麻醉結束 17:35 誘導結束 17:36 手術開始 18:20 手術結束 18:23 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 高頻熱凝療法 1 1 B 摘要__ 手術科部: 外科部 套用罐頭: L2 dorsal root ganglion radiofrequency ablati... 開立醫師: 蔡宗良 開立時間: 2011/11/03 18:25 Pre-operative Diagnosis Low back pain Post-operative Diagnosis Low back pain Operative Method L2 dorsal root ganglion radiofrequency ablation, bilateral Specimen Count And Types nil Pathology Operative Findings Operative Procedures 1. Disinfection 2. Local anesthesia 3. Confirmation of L2 root 4. Needle insertion and radiofrequency ablation 5. Wound covered by adhesive tapes Operators VS 蕭輔仁 Assistants R6 蔡宗良 廖陳靜枝 (F,1941/01/04,71y2m) 手術日期 2011/11/03 手術主治醫師 王國川 手術區域 東址 005房 04號 診斷 Subdural hemorrhage 器械術式 Removal of chronic subdural, right 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 蔡宗良, 時間資訊 00:00 開始NPO 00:00 臨時手術NPO 10:03 通知急診手術 14:25 報到 15:00 進入手術室 15:05 麻醉開始 15:10 誘導結束 15:30 抗生素給藥 15:46 手術開始 16:45 麻醉結束 16:45 手術結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 慢性硬腦膜下血腫清除術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Chronic Subdural Hematoma 開立醫師: 張哲瑋 開立時間: 2011/11/03 17:20 Pre-operative Diagnosis Chronic Subdural Hematoma Post-operative Diagnosis Chronic Subdural Hematoma Operative Method Chronic Subdural Hematoma Specimen Count And Types nil Pathology None Operative Findings Motor-oil like fluid gushed out after durotomy Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated (tilted) to right (left). 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: horse shoe shape at --parietal area. Raney clips were applied to the scalp edge for temporary hemostasis. 5. Craniotomy: 4 cm trephine at --parietal area. 6. Dural tenting: by 2/0 silk at --cm interval, distributed along the edge of the trephine. 7. Dural incision: 3/4 circle along the trephine margin. 8. The outer membrane of the hematoma was coagulated by Bovie along the edge of dural incision, then exicsed. 9. The liquified old blood and clot in the subdural space was evacuated by sucker, then thoroughly irrigated with N.S. through a rubber tube until the return was clean. The inner membrane of the hematoma was opened by a nib incision when the membrane had beenlifted away from its underlying arachnoid by a sucker, then the membrane was cut in 4 different directions as far as possible under direct vision with head light for subdural illumination. 10.Dural closure:interruped 2/0 silk sutures for key stitches, then continuous sutures with 4/0 Dexon to obtain water-tight closure (Dural graft?) 11.Closure of skull window: the trephine button was placed back simply after one coner of its edge had been rongeured out for the drain. 12.Scalp closure:hemostasis was done with monopolar coagulator touching on the sucker tip. Galea suture was performed by continuous sutures with 3/0 Dexon and skin by continuouss suture with 3/0 nylon. 13.Drain: one, subdural, collected in a surgeon's glove. 14.Blood transfusion: 15.Course of the surgery: smooth. Operators 王國川 Assistants R6蔡宗良 R1張哲瑋 Indication Of Emergent Operation 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Chronic Subdural Hematoma 開立醫師: 張哲瑋 開立時間: 2011/11/03 17:20 Pre-operative Diagnosis Chronic Subdural Hematoma Post-operative Diagnosis Chronic Subdural Hematoma Operative Method Chronic Subdural Hematoma Specimen Count And Types nil Pathology None Operative Findings Motor-oil like fluid gushed out after durotomy Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated (tilted) to right (left). 2. Position: supine with head rotated to the left. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: horse shoe shape at --parietal area. Raney clips were applied to 4. Incision: linear scalp incision. the scalp edge for temporary hemostasis. 5. Craniotomy: 4 cm trephine at --parietal area. 5. Craniostomy by high speed pneumatic burr 6. Dural tenting: by 2/0 silk at --cm interval, distributed along the edge of 6. Dural tenting the trephine. 7. Dural incision: 3/4 circle along the trephine margin. 7. Dural incision: cruciate 8. The outer membrane of the hematoma was coagulated by Bovie along the edge of dural incision, then exicsed. 9. The liquified old blood and clot in the subdural space was evacuated by sucker, then thoroughly irrigated with N.S. through a rubber tube until the return was clean. The inner membrane of the hematoma was opened by a nib return was clean. incision when the membrane had beenlifted away from its underlying arachnoid by a sucker, then the membrane was cut in 4 different directions as far as possible under direct vision with head light for subdural illumination. 10.Dural closure:interruped 2/0 silk sutures for key stitches, then continuous sutures with 4/0 Dexon to obtain water-tight closure (Dural graft?) 11.Closure of skull window: the trephine button was placed back simply after one coner of its edge had been rongeured out for the drain. 12.Scalp closure:hemostasis was done with monopolar coagulator touching on the 10. Wound was closed in layers after fixation of the subdural drain. sucker tip. Galea suture was performed by continuous sutures with 3/0 Dexon 11. The subdural space was filled with saline. and skin by continuouss suture with 3/0 nylon. 13.Drain: one, subdural, collected in a surgeon's glove. 14.Blood transfusion: 15.Course of the surgery: smooth. Operators 王國川 Assistants R6蔡宗良 R1張哲瑋 Indication Of Emergent Operation IICP 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Chronic Subdural Hematoma 開立醫師: 蔡宗良 開立時間: 2011/12/02 16:51 Pre-operative Diagnosis Chronic Subdural Hematoma Post-operative Diagnosis Chronic Subdural Hematoma Operative Method Craniostomy with subdural placement for removal of chronic subdural hematoma, right-sided Specimen Count And Types nil Pathology None Operative Findings Motor-oil like fluid gushed out after durotomy Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated (tilted) to right (left). 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: horse shoe shape at --parietal area. Raney clips were applied to the scalp edge for temporary hemostasis. 5. Craniotomy: 4 cm trephine at --parietal area. 6. Dural tenting: by 2/0 silk at --cm interval, distributed along the edge of the trephine. 7. Dural incision: 3/4 circle along the trephine margin. 8. The outer membrane of the hematoma was coagulated by Bovie along the edge of dural incision, then exicsed. 9. The liquified old blood and clot in the subdural space was evacuated by sucker, then thoroughly irrigated with N.S. through a rubber tube until the return was clean. The inner membrane of the hematoma was opened by a nib incision when the membrane had beenlifted away from its underlying arachnoid by a sucker, then the membrane was cut in 4 different directions as far as possible under direct vision with head light for subdural illumination. 10.Dural closure:interruped 2/0 silk sutures for key stitches, then continuous sutures with 4/0 Dexon to obtain water-tight closure (Dural graft?) 11.Closure of skull window: the trephine button was placed back simply after one coner of its edge had been rongeured out for the drain. 12.Scalp closure:hemostasis was done with monopolar coagulator touching on the sucker tip. Galea suture was performed by continuous sutures with 3/0 Dexon and skin by continuouss suture with 3/0 nylon. 13.Drain: one, subdural, collected in a surgeon''s glove. 14.Blood transfusion: 15.Course of the surgery: smooth. Operators 王國川 Assistants R6蔡宗良 R1張哲瑋 Indication Of Emergent Operation Increased intracranial pressure 相關圖片 摘要__ 手術科部: 外科部 套用罐頭: Craniostomy with subdural drain placement for... 開立醫師: 蔡宗良 開立時間: 2011/12/02 17:05 Pre-operative Diagnosis Chronic subdural hematoma, right-sided Post-operative Diagnosis Chronic subdural hematoma, right-sided Operative Method Craniostomy with subdural drain placement for removal of chronic subdural hematoma, right-sided Specimen Count And Types nil Pathology None Operative Findings Motor-oil like fluid gushed out upon durotomy. Presence of outer membrane. Operative Procedures 1. ETGA, supine, head rotated towards the left 2. Routine preparation 3. Linear wound incision, followed by burr hole drilling, tenting, and durotomy. 4. EVD drain tube was used to irrigate the subdural fluids until the fluild return clear. 5. Wound was closed in layers after fixation of the subdural drain tube. 6. The subdural space was filled with clear saline. Operators VS 王國川 Assistants R6 蔡宗良, R1 張哲瑋 Indication Of Emergent Operation Increased intracranial pressure 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Craniostomy with subdural drain placement for... 開立醫師: 蔡宗良 開立時間: 2011/12/02 17:05 Pre-operative Diagnosis Chronic subdural hematoma, right-sided Post-operative Diagnosis Chronic subdural hematoma, right-sided Operative Method Craniostomy with subdural drain placement for removal of chronic subdural hematoma, right-sided Specimen Count And Types nil Pathology None Operative Findings Motor-oil like fluid gushed out upon durotomy. Presence of outer membrane. Operative Procedures 1. ETGA, supine, head rotated towards the left 2. Routine preparation 3. Linear wound incision, followed by burr hole drilling, tenting, and durotomy. 4. EVD drain tube was used to irrigate the subdural fluids until the fluild return clear. 5. Wound was closed in layers after fixation of the subdural drain tube. 6. The subdural space was filled with clear saline. Operators VS 王國川 Assistants R6 蔡宗良, R1 張哲瑋 Indication Of Emergent Operation Increased intracranial pressure 相關圖片 袁芳傳 (M,1953/06/29,58y8m) 手術日期 2011/11/03 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Spondylosis with myelopathy, cervical 器械術式 C4/5 anterior cervical diskectomy 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 施培艾, 時間資訊 00:00 臨時手術NPO 08:02 進入手術室 08:08 麻醉開始 08:15 誘導結束 09:00 抗生素給藥 09:17 手術開始 11:08 手術結束 11:08 麻醉結束 11:15 送出病患 11:18 進入恢復室 12:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-頸椎 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 摘要__ 手術科部: 外科部 套用罐頭: Anterior C4-5 discectomy and fusion with cage... 開立醫師: 王奐之 開立時間: 2011/11/03 11:29 Pre-operative Diagnosis C4-5 hernitated intervertebral disc with myelopathy Post-operative Diagnosis C4-5 hernitated intervertebral disc with myelopathy Operative Method Anterior C4-5 discectomy and fusion with cage & artificial bone grafts Specimen Count And Types Nil Pathology Nil Operative Findings A 7*12 mm Vigor PEEK cage was inserted into C4-5 disc space after discectomy. Marginal spur formation was noted at anterior lower C4 body & posterior upper C5 body, and was removed with air drill. The thecal sac was compressed tightly and fully decompressed after discectomy. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with neck hyper-extended. After scrubbing, disinfection and draping in sterile fashion, a transverse skin incision was made at right neck. After subplastysmal dissection of skin flap superior & inferior to the incision, the medial border of sternocleidomastoid muscle was identified. Dissection was performed through this plane, with trachea, esophagus & thyroid retracted to the medial aspect. After identifying the longus colli muscle, the muscles were splitted and retracted to sides. Confirmation of C4-5 disc space was done under C-arm. After application of Caspar retractorm, discectomy was then performed under microscopic view with curette, disc clamp & air drill. A cage stuffed with artifical bone grafts was inserted into the C4-5 disc space. After meticulous hemostasis and setting up of an mini-hemovac drain, the wound was closed in layers. Operators VS 王國川 Assistants R4 王奐之, R0 施培艾 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Anterior C4-5 discectomy and fusion with cage... 開立醫師: 王奐之 開立時間: 2011/11/03 11:29 Pre-operative Diagnosis C4-5 hernitated intervertebral disc with myelopathy Post-operative Diagnosis C4-5 hernitated intervertebral disc with myelopathy Operative Method Anterior C4-5 discectomy and fusion with cage & artificial bone grafts Specimen Count And Types Nil Pathology Nil Operative Findings A 7*12 mm Vigor PEEK cage was inserted into C4-5 disc space after discectomy. Marginal spur formation was noted at anterior lower C4 body & posterior upper C5 body, and was removed with air drill. The thecal sac was compressed tightly and fully decompressed after discectomy. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with neck hyper-extended. After scrubbing, disinfection and draping in sterile fashion, a transverse skin incision was made at right neck. After subplastysmal dissection of skin flap superior & inferior to the incision, the medial border of sternocleidomastoid muscle was identified. Dissection was performed through this plane, with trachea, esophagus & thyroid retracted to the medial aspect. After identifying the longus colli muscle, the muscles were splitted and retracted to sides. Confirmation of C4-5 disc space was done under C-arm. After application of Caspar retractorm, discectomy was then performed under microscopic view with curette, disc clamp & air drill. A cage stuffed with artifical bone grafts was inserted into the C4-5 disc space. After meticulous hemostasis and setting up of an mini-hemovac drain, the wound was closed in layers. Operators VS 王國川 Assistants R4 王奐之, R0 施培艾 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Anterior C4-5 discectomy and fusion with cage... 開立醫師: 施培艾 開立時間: 2011/11/03 19:42 Pre-operative Diagnosis C4-5 hernitated intervertebral disc with myelopathy Post-operative Diagnosis C4-5 hernitated intervertebral disc with myelopathy Operative Method Anterior C4-5 discectomy and fusion with cage & artificial bone grafts Specimen Count And Types Nil Pathology Nil Operative Findings A 7*12 mm Vigor PEEK cage was inserted into C4-5 disc space after discectomy. Marginal spur formation was noted at anterior lower C4 body & posterior upper C5 body, and was removed with air drill. The thecal sac was compressed tightly and fully decompressed after discectomy. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with neck hyper-extended. After scrubbing, disinfection and draping in sterile fashion, a transverse skin incision was made at right neck. After subplastysmal dissection of skin flap superior & inferior to the incision, the medial border of sternocleidomastoid muscle was identified. Dissection was performed through this plane, with trachea, esophagus & thyroid retracted to the medial aspect. After identifying the longus colli muscle, the muscles were splitted and retracted to sides. Confirmation of C4-5 disc space was done under C-arm. After application of Caspar retractorm, discectomy was then performed under microscopic view with curette, disc clamp & air drill. A cage stuffed with artifical bone grafts was inserted into the C4-5 disc space. After meticulous hemostasis and setting up of an mini-hemovac drain, the wound was closed in layers. Operators VS 王國川 Assistants R4 王奐之, R0 施培艾 相關圖片 唐林英 (F,1929/02/05,83y1m) 手術日期 2011/11/03 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 Hydrocephalus 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 施培艾, 時間資訊 00:00 臨時手術NPO 11:41 進入手術室 11:48 麻醉開始 11:55 誘導結束 11:56 抗生素給藥 12:20 手術開始 13:05 手術結束 13:05 麻醉結束 13:10 送出病患 13:18 進入恢復室 14:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt via right Kocher point 開立醫師: 王奐之 開立時間: 2011/11/03 13:18 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunt via right Kocher point Specimen Count And Types Nil Pathology Nil Operative Findings A Codman fixed pressure reservoir was used (100 mmH2O). Opening pressure was about 5 cmH2O upon ventriculostomy, clear CSF was noted. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After shaving, scrubbing, disinfection and draping in sterile fashion, a linear incision was made at right frontal area. Another linear incision was made at right upper quadrant of abdomen, followed by mini-laparotomy. A subcutaneous tunnel was then created from the abdominal wound to right frontal wound, followed by passage of peritoneal catheter. A burr hole was created at right Kocher point, followed by 2 tenting stitches and a small cruciate durotomy. Ventriculostomy was performed, the ventricular catheter was then inserted after assembly of the shunt. After meticulous hemostasis, the wound was closed in layers. Operators VS 王國川 Assistants R4 王奐之, R0 施培艾 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt via right Kocher point 開立醫師: 王奐之 開立時間: 2011/11/03 13:18 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunt via right Kocher point Specimen Count And Types Nil Pathology Nil Operative Findings A Codman fixed pressure reservoir was used (100 mmH2O). Opening pressure was about 5 cmH2O upon ventriculostomy, clear CSF was noted. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After shaving, scrubbing, disinfection and draping in sterile fashion, a linear incision was made at right frontal area. Another linear incision was made at right upper quadrant of abdomen, followed by mini-laparotomy. A subcutaneous tunnel was then created from the abdominal wound to right frontal wound, followed by passage of peritoneal catheter. A burr hole was created at right Kocher point, followed by 2 tenting stitches and a small cruciate durotomy. Ventriculostomy was performed, the ventricular catheter was then inserted after assembly of the shunt. After meticulous hemostasis, the wound was closed in layers. Operators VS 王國川 Assistants R4 王奐之, R0 施培艾 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt via right Kocher point 開立醫師: 施培艾 開立時間: 2011/11/04 11:43 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunt via right Kocher point Specimen Count And Types Nil Pathology Nil Operative Findings A Codman fixed pressure reservoir was used (100 mmH2O). Opening pressure was about 5 cmH2O upon ventriculostomy, clear CSF was noted. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After shaving, scrubbing, disinfection and draping in sterile fashion, a linear incision was made at right frontal area. Another linear incision was made at right upper quadrant of abdomen, followed by mini-laparotomy. A subcutaneous tunnel was then created from the abdominal wound to right frontal wound, followed by passage of peritoneal catheter. A burr hole was created at right Kocher point, followed by 2 tenting stitches and a small cruciate durotomy. Ventriculostomy was performed, the ventricular catheter was then inserted after assembly of the shunt. After meticulous hemostasis, the wound was closed in layers. Operators VS 王國川 Assistants R4 王奐之, R0 施培艾 相關圖片 林雪鳳 (F,1967/08/02,44y7m) 手術日期 2011/11/03 手術主治醫師 蔡翊新 手術區域 東址 005房 01號 診斷 Intracerebral hemorrhage 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 污染 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 張書豪, 時間資訊 00:00 臨時手術NPO 08:15 進入手術室 08:20 麻醉開始 08:25 誘導結束 08:30 手術開始 08:57 手術結束 08:57 麻醉結束 09:03 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 氣管切開術 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 創傷醫學部 套用罐頭: Tracheostomy 開立醫師: 張書豪 開立時間: 2011/11/03 09:08 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types 1 piece About size: Source: Pathology None Operative Findings Fr . 8 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators VS蔡翊新 Assistants R6蔡宗良 PGYR1張書豪 高信謙 (M,1955/03/15,56y11m) 手術日期 2011/11/03 手術主治醫師 楊宗霖 手術區域 西址 033房 11號 診斷 Nasal tumor 器械術式 Sinoscopy with biopsy-- bilate 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 15:34 進入手術室 15:37 麻醉開始 15:40 手術開始 16:05 手術結束 16:15 送出病患 記錄__ 手術科部: 耳鼻喉部 套用罐頭: Incitional biopsy of bilateral nasal tumor 開立醫師: 林珮璇 開立時間: 2011/11/03 16:12 Pre-operative Diagnosis Nasal tumor, bilateral Post-operative Diagnosis Nasal tumor, bilateral, operated Operative Method Incitional biopsy of bilateral nasal tumor Specimen Count And Types 2 pieces About size:1x1cm Source:left nose About size:1x1cm Source:right nose Pathology Pending Operative Findings Polipoid nasal tumor, bilateral, s/p incisional biopsy Operative Procedures 1. Sinoscope surgery, bilateral 2. Nasal packing remove, bilateral 3. Tumor mass over right nasal cavity, incisional biopsy done with FNA 4. Hemostasis 5. Patient tolerate will during the procedure. Operators Asp楊宗霖, Assistants R2林珮璇, R4林其懋, 陳洪抄 (F,1945/01/26,67y1m) 手術日期 2011/11/03 手術主治醫師 林峰盛 手術區域 西址 034房 03號 診斷 Spinal stenosis, lumbar 器械術式 Nerve block / PC 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 林峰盛 ASA 3 時間資訊 09:06 報到 09:50 進入手術室 09:53 麻醉開始 09:54 誘導結束 09:55 手術開始 10:08 手術結束 10:12 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 末稍神經阻斷術 1 0 L 手術 超音波導引（為組織切片，抽吸及注射等） 1 0 L 記錄__ 手術科部: 麻醉部 套用罐頭: RF lesioning 開立醫師: 陳盈曦 開立時間: 2011/11/03 10:15 Pre-operative Diagnosis Fail back syndrome Post-operative Diagnosis Fail back syndrome Operative Method Diagnostic medial branch block, Facet joint injection Specimen Count And Types nil Pathology Nil Operative Findings Operative Procedures 1.LA with 1%xylocaine. 2.patient in prone position 3. Under fluoroscopic-guidance, left L5-S1 facet block with 0.5% Marcaine 1ml+Rinerdon 2.5mg per joint 4.Diagnostic medial branch block with 0.5% Marcaine left L5 Operators 林峰盛, Assistants 陳盈曦, 林文瑛 陳淑梅 (F,1960/06/21,51y8m) 手術日期 2011/11/04 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Carotid body tumor 器械術式 Left carotid body tumor excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 鍾文桂, 曾偉倫, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:15 麻醉開始 08:30 誘導結束 08:50 抗生素給藥 08:57 手術開始 11:50 抗生素給藥 14:45 手術結束 14:45 麻醉結束 14:50 抗生素給藥 15:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 頸動脈體瘤切除術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Carotid body tumor excision, left 開立醫師: 鍾文桂 開立時間: 2011/11/04 14:40 Pre-operative Diagnosis Left carotid body tumor Post-operative Diagnosis Left carotid body tumor Operative Method Carotid body tumor excision, left Specimen Count And Types 3x3x3 cm Left carotid body tumor Pathology Pending Operative Findings The tumor is elastic, hard,reddish in color, and located at the bifurcation of common carotid artery.The tumor located more posteriorly is softer due to preoperative embolization. It encased the distal part of common carotid artery, proximal parts of internal and external carotid artery, and superior thyroid artery, and ascending pharyngeal artery. The ascending pharyngeal artery was ligated and divided. The recurrent laryngeal nerve was well preserved during tumor dissection and resection. The posterior belly of digastric muscle, hypoglossal nerve, and vagus nerve were identified and preserved. The tumor was excised totally along the adventitia of the arteries. No intraoperative MEP change. The Operative Procedures Under ETGA, we placed the patient on supine position with her face tilt to right. Her left shoulder was elevated and her neck was extended. A linear horizontal skin incision was made over the neck skin crese below the mandible ~ 2cm. Meticulus dissection was performed after the skin incision under the microscope. The platysma was divided and the wound extended. The tumor was reached after dissection and the tumor around ECA was resected with bipolar forceps, scissors and dissector. The left superior thyroid artery was identified and divided. A branch of anca cervicalis was preserved and the tumor border was dissected gradually. The tumor was removed piece by piece and the ECA and ICA were well preserved. After totally removed the tumor, complete hemostasis was achived. The wound was closed in layers with 2-0 Vicryl and 3-0 Nylon after placing a CWV drain. Operators Prof. 杜永光 Assistants R6 鍾文桂 R3 曾偉倫 相關圖片 摘要__ 手術科部: 外科部 套用罐頭: Carotid body tumor excision, left 開立醫師: 曾偉倫 開立時間: 2011/11/04 15:18 Pre-operative Diagnosis Left carotid body tumor Post-operative Diagnosis Left carotid body tumor Operative Method Carotid body tumor excision, left Specimen Count And Types 3x3x3 cm Left carotid body tumor Pathology Pending Operative Findings The tumor is elastic, hard,reddish in color, and located at the bifurcation of common carotid artery.The tumor located more posteriorly is softer due to preoperative embolization. It encased the distal part of common carotid artery, proximal parts of internal and external carotid artery, and superior thyroid artery, and ascending pharyngeal artery. The anterior thyroid was ligated and divided. The branch of vagus nerve was well preserved during tumor dissection and resection. The posterior belly of digastric muscle, hypoglossal nerve, and vagus nerve were identified and preserved. The tumor was excised totally along the adventitia of the arteries. No intraoperative MEP change. Operative Procedures Under ETGA, we placed the patient on supine position with her face tilt to right. Her left shoulder was elevated and her neck was extended. A linear horizontal skin incision was made over the neck skin crese below the mandible ~ 2cm. Meticulus dissection was performed after the skin incision under the microscope. The platysma was divided and the wound extended. The tumor was reached after dissection and the tumor around ECA was resected with bipolar forceps, scissors and dissector. The left superior thyroid artery was identified and divided. A branch of anca cervicalis was preserved and the tumor border was dissected gradually. The tumor was removed piece by piece and the ECA and ICA were well preserved. After totally removed the tumor, complete hemostasis was achived. The wound was closed in layers with 2-0 Vicryl and 3-0 Nylon after placing a mini-hemovac drain. Operators Prof. 杜永光 Assistants R6 鍾文桂 R3 曾偉倫 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Carotid body tumor excision, left 開立醫師: 曾偉倫 開立時間: 2011/11/04 15:18 Pre-operative Diagnosis Left carotid body tumor Post-operative Diagnosis Left carotid body tumor Operative Method Carotid body tumor excision, left Specimen Count And Types 3x3x3 cm Left carotid body tumor Pathology Pending Operative Findings The tumor is elastic, hard,reddish in color, and located at the bifurcation of common carotid artery.The tumor located more posteriorly is softer due to preoperative embolization. It encased the distal part of common carotid artery, proximal parts of internal and external carotid artery, and superior thyroid artery, and ascending pharyngeal artery. The anterior thyroid was ligated and divided. The branch of vagus nerve was well preserved during tumor dissection and resection. The posterior belly of digastric muscle, hypoglossal nerve, and vagus nerve were identified and preserved. The tumor was excised totally along the adventitia of the arteries. No intraoperative MEP change. Operative Procedures Under ETGA, we placed the patient on supine position with her face tilt to right. Her left shoulder was elevated and her neck was extended. A linear horizontal skin incision was made over the neck skin crese below the mandible ~ 2cm. Meticulus dissection was performed after the skin incision under the microscope. The platysma was divided and the wound extended. The tumor was reached after dissection and the tumor around ECA was resected with bipolar forceps, scissors and dissector. The left superior thyroid artery was identified and divided. A branch of anca cervicalis was preserved and the tumor border was dissected gradually. The tumor was removed piece by piece and the ECA and ICA were well preserved. After totally removed the tumor, complete hemostasis was achived. The wound was closed in layers with 2-0 Vicryl and 3-0 Nylon after placing a mini-hemovac drain. Operators Prof. 杜永光 Assistants R6 鍾文桂 R3 曾偉倫 相關圖片 江楊絹 (F,1943/10/16,68y4m) 手術日期 2011/11/04 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Meningioma 器械術式 Left frontal convexity meningioma excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 張哲瑋, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:02 進入手術室 08:05 麻醉開始 08:30 誘導結束 08:44 抗生素給藥 08:50 手術開始 11:44 抗生素給藥 13:05 麻醉結束 13:05 手術結束 13:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除-手術時間在4~8小時 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT 開立醫師: 曾峰毅 開立時間: 2011/11/04 13:13 Pre-operative Diagnosis Left frontoparietal convexity meningioma with bone invasion Post-operative Diagnosis Left frontoparietal convexity meningioma with bone invasion Operative Method Left frontoparietal craniotomy for meningioma excision, Simpson grade I Specimen Count And Types Tumor with based-bone was sent for pathology. Pathology Nil Operative Findings One dura-based tumor was noted at left frontoparietal arae, adjacent to superior sagittal sinus. One dura-based tumor was noted at left frontoparietal arae, adjacent to superior sagittal sinus. Tumor, based-dura, and invaded bone graft were removed totally. One subdural dura-based tumor. 4x4.5x5.5 cm, was noted at left frontoparietal arae, adjacent to superior sagittal sinus, with extention to epidural space. The tumor invaded and eroded the covering sckull bone and extended to the midline. Tumor, based-dura, and invaded bone graft were removed totally. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with neck flexed and head fixed by Mayfield head clamp. After the head shaved, scrubbed, disinfected, and then draped, we made one U-shape scalp incision at left frontoparietal area. We reflected the scalp flap, and drilled four burr holes, Craniotomy window was then made, and dura was tented along the craniotomy edge. Dura was incised along the tumor base, and tumor-brain interface was dissected meticulously. Tumor cavity was paved with Srugicels for hemostasis after tumor totally removed. Duroplasty was performed with water-tight suture and artificial dura. Cranioplasty was done with titanium mesh and screws. The wound was closed in layers after one subgaleal CWV. Operators VS 曾漢民 Assistants R5 曾峰毅 R1 張哲瑋 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT 開立醫師: 張哲瑋 開立時間: 2011/11/04 16:27 Pre-operative Diagnosis Left frontoparietal convexity meningioma with bone invasion Post-operative Diagnosis Left frontoparietal convexity meningioma with bone invasion Operative Method Left frontoparietal craniotomy for meningioma excision, Simpson grade I Specimen Count And Types Tumor with based-bone was sent for pathology. Pathology Nil Operative Findings One subdural dura-based tumor. 4x4.5x5.5 cm, was noted at left frontoparietal arae, adjacent to superior sagittal sinus, with extention to epidural space. The tumor invaded and eroded the covering sckull bone and extended to the midline. Tumor, based-dura, and invaded bone graft were removed totally. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with neck flexed and head fixed by Mayfield head clamp. After the head shaved, scrubbed, disinfected, and then draped, we made one U-shape scalp incision at left frontoparietal area. We reflected the scalp flap, and drilled four burr holes, Craniotomy window was then made, and dura was tented along the craniotomy edge. Dura was incised along the tumor base, and tumor-brain interface was dissected meticulously. Tumor cavity was paved with Srugicels for hemostasis after tumor totally removed. Duroplasty was performed with water-tight suture and artificial dura. Cranioplasty was done with titanium mesh and screws. The wound was closed in layers after one subgaleal CWV. Operators VS 曾漢民 Assistants R5 曾峰毅 R1 張哲瑋 相關圖片 王志維 (M,1968/12/01,43y3m) 手術日期 2011/11/04 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Scalp mass 器械術式 Forehead lipoma excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 張哲瑋, 時間資訊 00:00 臨時手術NPO 13:27 進入手術室 13:35 抗生素給藥 13:48 手術開始 14:02 手術結束 14:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 頭皮腫瘤 1 1 摘要__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 曾峰毅 開立時間: 2011/11/04 14:06 Pre-operative Diagnosis Scalp tumor Post-operative Diagnosis Scalp tumor Operative Method Scalp tumor exicision Specimen Count And Types One tumor was sent for pathology. Pathology Pending Operative Findings One soft, yellowish, well-defined tumor was noted in the subgaleal space. Lipoma is likely. Operative Procedures The patient was put in supine position. We injected lidocaine into patient's forehead around the tumor for local anaesthesia. We performed one transverse skin incision and dissected for tumor excision. The wound was closed in layers. Operators VS 曾漢民 Assistants R5 曾峰毅 R1 張哲瑋 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 張哲瑋 開立時間: 2011/11/04 16:28 Pre-operative Diagnosis Scalp tumor Post-operative Diagnosis Scalp tumor Operative Method Scalp tumor exicision Specimen Count And Types One tumor was sent for pathology. Pathology Pending Operative Findings One soft, yellowish, well-defined tumor was noted in the subgaleal space. Lipoma is likely. Operative Procedures The patient was put in supine position. We injected lidocaine into patient's forehead around the tumor for local anaesthesia. We performed one transverse skin incision and dissected for tumor excision. The wound was closed in layers. Operators VS 曾漢民 Assistants R5 曾峰毅 R1 張哲瑋 相關圖片 倪啟華 (M,1947/08/11,64y7m) 手術日期 2011/11/04 手術主治醫師 曾漢民 手術區域 東址 005房 03號 診斷 Hydrocephalus 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 張哲瑋, 時間資訊 00:00 臨時手術NPO 14:12 報到 14:15 進入手術室 14:20 麻醉開始 14:30 誘導結束 14:35 抗生素給藥 15:00 手術開始 16:00 手術結束 16:00 麻醉結束 16:17 送出病患 16:20 進入恢復室 17:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 曾峰毅 開立時間: 2011/11/04 16:00 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunt insertion via left Kocher point with Codman Hakin programmable valve. Specimen Count And Types CSF was sent for routine, culture, and BCS Pathology Nil Operative Findings Mild xanthcrhomic CSF drained out while durotomy. Opening pressure was about 10 cm H20. Codman promgrammable valve, Hakin valve, preset at 120 mmH20, was used. Operative Procedures With endotracheal geneeral anaesthesia, the patient was put in supine position with head rotated to right. We made one transverse skin incision at left frontal area, and drilled one burr hole. Durotomy was done. We made another transeverse skin incision at left upper abdomen, and performed mini-laparotomy. We created subcutaneous tunnel to connected two wound. Peritoneal catheter was pulled through the subcutaneous tunnel. Ventriculostomy was performed once, and ventricular cathter was inserted. We connected the catheter with the reservoir, and checked the shunt function. The wounds were closed in layers. Operators VS 曾漢民 Assistants R5 曾峰毅 R1 張哲瑋 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 張哲瑋 開立時間: 2011/11/04 16:24 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunt insertion via left Kocher point with Codman Hakin programmable valve. Specimen Count And Types CSF was sent for routine, culture, and BCS Pathology Nil Operative Findings Mild xanthcrhomic CSF drained out while durotomy. Opening pressure was about 10 cm H20. Codman promgrammable valve, Hakin valve, preset at 120 mmH20, was used. Operative Procedures With endotracheal geneeral anaesthesia, the patient was put in supine position with head rotated to right. We made one transverse skin incision at left frontal area, and drilled one burr hole. Durotomy was done. We made another transeverse skin incision at left upper abdomen, and performed mini-laparotomy. We created subcutaneous tunnel to connected two wound. Peritoneal catheter was pulled through the subcutaneous tunnel. Ventriculostomy was performed once, and ventricular cathter was inserted. We connected the catheter with the reservoir, and checked the shunt function. The wounds were closed in layers. Operators VS 曾漢民 Assistants R5 曾峰毅 R1 張哲瑋 相關圖片 蔡吳阿秀 (F,1935/03/17,76y11m) 手術日期 2011/11/04 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Lumbar spondylosis 器械術式 L4/5 TPS 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:08 進入手術室 08:20 麻醉開始 08:35 誘導結束 08:40 抗生素給藥 09:03 手術開始 11:40 抗生素給藥 12:05 手術結束 12:05 麻醉結束 12:15 送出病患 12:18 進入恢復室 13:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎間盤切除術-腰椎 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: L4-5 transforaminal lumbar interbody fusion +... 開立醫師: 李振豪 開立時間: 2011/11/04 12:18 Pre-operative Diagnosis L4-5 spondylolisthesis with spinal stenosis Post-operative Diagnosis L4-5 spondylolisthesis with spinal stenosis Operative Method L4-5 transforaminal lumbar interbody fusion + posterior decompression Specimen Count And Types nil Pathology Nil Operative Findings L4 on L5 spondylolisthesis was noted with destructive and hypertrophic facet joint. The ligmentum flavum also hypertrophic which compressed the thecal sac tightly. After laminectomy and right facetectomy, the thecal sac and right L5 root was decompressed well. the right L4 root was not exposed during the operation. Lumbar diskectomy was performed followed by transforaminal lumbar interbody fusion with one #13 PEEK banana cage. Four 6.2 x 40mm transpedicular screws were implanted at L4 and L5 level. Two 5cm rods were applied for posterior fixation. Blood loss: 450ml. The patient stood whole procedure well. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position. The L4, L5 pedicle level were localized by portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made and the subcutaneous soft tissue was devided. The paravertebral muscle groups were detached. L4 and L5 transpedicular screws were implanted under C-arm guided. L4 laminectomy and right facetectomy was performed for decompression. L4/5 diskectomy was done. One #13 PEEK banana cage was inserted for transforaminal lumbar interbody fusion. Rods were applied for posterior instrumentation. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. One 1/8 Hemovac was placed. The wound was then closed in layers with 1-0, 2-0 Vicryl and 3-0 Nylon. Operators VS賴達明 Assistants R5李振豪, R1李嘉哲 相關圖片 吳國光 (M,1948/02/15,64y0m) 手術日期 2011/11/04 手術主治醫師 賴達明 手術區域 東址 019房 02號 診斷 Lumbar Spondylosis 器械術式 L2/4 TPS 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 11:40 報到 12:25 進入手術室 12:30 麻醉開始 12:45 誘導結束 12:52 抗生素給藥 13:18 手術開始 15:52 抗生素給藥 16:40 手術結束 16:40 麻醉結束 16:45 送出病患 16:50 進入恢復室 17:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎間盤切除術-腰椎 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: 1. L2-4 posterior instrumentation with transp... 開立醫師: 李振豪 開立時間: 2011/11/04 17:00 Pre-operative Diagnosis L2-4 spondylolisthesis with lumbar stenosis Post-operative Diagnosis L2-4 spondylolisthesis with lumbar stenosis Operative Method 1. L2-4 posterior instrumentation with transpedicular screws 2. L2-3 transforaminal lumbar interbody fusion 2. L2-3 transforaminal lumbar interbody fusion with PEEK cage+ L3-4 posterolateral fusion with autologous bone graft 3. L2-4 Partial laminectomy for posterior decompression Specimen Count And Types nil Pathology Nil Operative Findings L2 on L3 spondylolisthesis and pseudoarthrosis of facet joint was noted. The L3-4 facet joint also hypertrophic. The ligmentum flavum was thick which compressed the thecal sac and removed for posterior decompression. Six 6.2 x 40mm transpedicular screws and two 9cm rods were implanted for L2-4 posterior instrumentation. L2/3 right facetectomy was performed and transforaminal lumbar interbody fusion was conducted with one #9 PEEK banana cage. The thecal sac and right L3 root were decomrpessed well after whole procedure. No incidental durotomy or CSF leakage was noted. Total blood loss: 500ml. The patient stood whole procedure well. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position. L2 to L4 pedicle level were localized by portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made and the subcutaneous soft tissue was devided. The paravertebral muscle groups were detached. L2, L3, and L4 transpedicular screws were implanted under C-arm X-ray guided. L2-3 partial laminectomy and right facetectomy was performed for decompression. L2-3 diskectomy was done followed by transforaminal lumbar interbody fusion with one #9 PEEK banana cage. L3-4 laminotomy was conducted for posterior decompression. Two rods were applied for set up posterior fixation. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. One 1/8 hemovac was placed. The wound was then closed in layers with 1-0, 2-0 Vicryl and 3-0 Nylon. Under endotracheal general anesthesia, the patient was put in prone position. L2 to L4 pedicle level were localized by portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made and the subcutaneous soft tissue was devided. The paravertebral muscle groups were detached. L2, L3, and L4 transpedicular screws were implanted under C-arm X-ray guided. L2-3 partial laminectomy and right facetectomy was performed for decompression. L2-3 diskectomy was done followed by transforaminal lumbar interbody fusion with one #9 PEEK banana cage. L3-4 laminotomy was conducted for posterior decompression. Two rods were applied for set up posterior fixation. L3-4 poasterolateral fusion with autologous bone graft was performed. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. One 1/8 hemovac was placed. The wound was then closed in layers with 1-0, 2-0 Vicryl and 3-0 Nylon. Operators VS賴達明 Assistants R5李振豪, R1李嘉哲 相關圖片 Phong Tuan Pham (M,2006/03/13,6y0m) 手術日期 2011/11/04 手術主治醫師 楊士弘 手術區域 兒醫 067房 01號 診斷 Brain tumor 器械術式 Crainotomy for tumor excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:10 進入手術室 08:40 麻醉開始 09:00 誘導結束 09:30 抗生素給藥 09:54 手術開始 12:30 抗生素給藥 14:20 麻醉結束 14:20 手術結束 14:25 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 手術 腦瘤切除-手術時間在4~8小時 1 1 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Occipital-suboccipital craniotomy for total t... 開立醫師: 游健生 開立時間: 2011/11/04 15:21 Pre-operative Diagnosis Vermis tumor Post-operative Diagnosis Vermis low-grade glioma Operative Method Occipital-suboccipital craniotomy for total tumor excision Specimen Count And Types 1 piece About size:2x3x2 cm Source:Vermis tumor Pathology Pending Frozen section: pilocytic astrocytoma Operative Findings Larger right transverse sinus was noted. There was a small slit at midline of the superior part of vermis. Through the slit, a grayish, gelatin-like tumor could be seen. The tumor was 3 x 2.3 x2.6cm in size. The cranial and dorsal part of the tumor was encapsulated by a whitish semi-transparent membrane. Gliosis was noted around the tumor. The caudal and ventral part of the tumor infiltrated into normal parenchyma of vermis. A few vessels supplying the tumor were seen at the caudal and ventral aspect of the tumor. Operative Procedures Under ETGA, patient was in prone position with head fixed by Mayfield headclamp. The neck was flexed. After shaving, we disinfected and draped the operation field as usual. A 8cm midline scalp incision was made from 2cm above the inion. The neck muscle was detached as well as periosteum. Two burholes were created on both side of the position where transverse sinus was presumed. Then, a suboccipital-occipital craniotomy was done by saw. The dura was opened in U-shape with sinus as base and dura flap was tented. The arachnoid membrane was opened for CSF drainage and cerebellum became slack. We performed midline corticotomy by enlarging the slit at the superior part of vermis. Central debulking of the tumor was done followed by circumferential dissection of the tumor. Some specimen was sent for fronzen section. Vessels supplying the tumor from caudal and ventral aspect were coagulated and transected. Minor injury to left transverse sinus was noted and bleeding stopped by Gelfoam packing. After meticulous hemostasis, the tumor bed was covered with Surgicel. Dura was closed with 5-0 prolene continuous suture and covered by DuraForm. The bone flap was fixed back with mini-plates. Neck muscle and periosteum were approximated. Wound was closed in layers with 3-0 Vircyl and 4-0 Nylon. Operators VS 楊士弘 Assistants R4 游健生 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Occipital-suboccipital craniotomy for total t... 開立醫師: 曾峰毅 開立時間: 2011/11/07 08:17 Pre-operative Diagnosis Vermis tumor Post-operative Diagnosis Vermis low-grade glioma Operative Method Occipital-suboccipital craniotomy for total tumor excision Specimen Count And Types 1 piece About size:2x3x2 cm Source:Vermis tumor Pathology Pending Frozen section: pilocytic astrocytoma Operative Findings Larger right transverse sinus was noted. There was a small slit at midline of the superior part of vermis. Through the slit, a grayish, gelatin-like tumor could be seen. The tumor was 3 x 2.3 x2.6cm in size. The cranial and dorsal part of the tumor was encapsulated by a whitish semi-transparent membrane. Gliosis was noted around the tumor. The caudal and ventral part of the tumor infiltrated into normal parenchyma of vermis. A few vessels supplying the tumor were seen at the caudal and ventral aspect of the tumor. Operative Procedures Under ETGA, patient was in prone position with head fixed by Mayfield headclamp. The neck was flexed. After shaving, we disinfected and draped the operation field as usual. A 8cm midline scalp incision was made from 2cm above the inion. The neck muscle was detached as well as periosteum. Two burholes were created on both side of the position where transverse sinus was presumed. Then, a suboccipital-occipital craniotomy was done by saw. The dura was opened in U-shape with sinus as base and dura flap was tented. The arachnoid membrane was opened for CSF drainage and cerebellum became slack. We performed midline corticotomy by enlarging the slit at the superior part of vermis. Central debulking of the tumor was done followed by circumferential dissection of the tumor. Some specimen was sent for fronzen section. Vessels supplying the tumor from caudal and ventral aspect were coagulated and transected. Minor injury to left transverse sinus was noted and bleeding stopped by Gelfoam packing. After meticulous hemostasis, the tumor bed was covered with Surgicel. Dura was closed with 5-0 prolene continuous suture and covered by DuraForm. The bone flap was fixed back with mini-plates. Neck muscle and periosteum were approximated. Wound was closed in layers with 3-0 Vircyl and 4-0 Nylon. Operators VS 楊士弘 Assistants R4 游健生 相關圖片 張怡蓁 (F,2011/09/23,5m23d) 手術日期 2011/11/04 手術主治醫師 楊士弘 手術區域 兒醫 067房 02號 診斷 Ebstein anomaly 器械術式 Ommaya reservoir implantation 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3E 紀錄醫師 游健生, 時間資訊 00:01 臨時手術NPO 00:01 開始NPO 08:00 通知急診手術 15:00 報到 15:00 進入手術室 15:05 麻醉開始 15:15 誘導結束 15:40 抗生素給藥 15:58 手術開始 16:55 麻醉結束 16:55 手術結束 17:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 歐氏貯囊置放手術 1 1 R 麻醉 Peripheral arterial line inserti 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 套用罐頭: Implanataion of Ommaya reservoir 開立醫師: 楊士弘 開立時間: 2011/11/04 17:19 Pre-operative Diagnosis Intraventricular hemorrhage with hydrocephalus Post-operative Diagnosis Intraventricular hemorrhage with hydrocephalus Operative Method Implanataion of Ommaya reservoir Specimen Count And Types 3 pieces About size:小 Source:CSF About size:小 Source:CSF About size:小 Source:CSF Pathology Nil Operative Findings Light yellowish red CSF was noted after ventricular tapping. After aspiration of 20 ml CSF, the anterior fontanell became slack. Operative Procedures 1. ETGA, supine. 2. Right frontal scalp incision. 3. Removal of skull bone and opening dura mater around the right edge of anterior fontanell. 4. Ventricular tapping. 5. Insertion of Ommaya reservoir, with 3.5 cm long ventricular catheter into the right frontal horn. 6. Wound closure. Operators 楊士弘 Assistants 游健生 Indication Of Emergent Operation Venticulomegaly, IICP 相關圖片 記錄__ 手術科部: 套用罐頭: Implanataion of Ommaya reservoir 開立醫師: 游健生 開立時間: 2011/11/07 08:19 Pre-operative Diagnosis Intraventricular hemorrhage with hydrocephalus Post-operative Diagnosis Intraventricular hemorrhage with hydrocephalus Operative Method Implanataion of Ommaya reservoir Specimen Count And Types 3 pieces About size:小 Source:CSF About size:小 Source:CSF About size:小 Source:CSF Pathology Nil Operative Findings Light yellowish red CSF was noted after ventricular tapping. After aspiration of 20 ml CSF, the anterior fontanell became slack. Operative Procedures 1. ETGA, supine. 2. Right frontal scalp incision. 3. Removal of skull bone and opening dura mater around the right edge of anterior fontanell. 4. Ventricular tapping. 5. Insertion of Ommaya reservoir, with 3.5 cm long ventricular catheter into the right frontal horn. 6. Wound closure. Operators 楊士弘 Assistants 游健生 Indication Of Emergent Operation Venticulomegaly, IICP 相關圖片 陳乙彥 (M,1941/05/10,70y10m) 手術日期 2011/11/04 手術主治醫師 陳炯年 手術區域 東址 007房 02號 診斷 Inguinal hernia 器械術式 Repair of inguinal hernia (Left) 手術類別 預定手術 手術部位 腹 傷口分類 清潔 麻醉方式 脊髓麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 黃凱傑, 時間資訊 13:08 進入手術室 13:15 麻醉開始 13:25 誘導結束 13:45 手術開始 14:40 手術結束 14:40 麻醉結束 14:45 進入恢復室 14:45 送出病患 17:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 鼠蹊疝氣修補術-無腸切除 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Spinal anesthesia 1 0 摘要__ 手術科部: 外科部 套用罐頭: Hernia 開立醫師: 黃凱傑 開立時間: 2011/11/04 14:38 Pre-operative Diagnosis Left inguinal hernia, indirect type Post-operative Diagnosis Left inguinal hernia, indirect type Operative Method Herniorrhaphy and high ligation Specimen Count And Types 1 piece About size:2x1cm Source:hernia sac Pathology pending Operative Findings left side indirect type inguinal hernia, no content in herniac sac Operative Procedures 1. Under endotracheal general anesthesia with the patient in supine position, prepping with Povidone iodine and draping was performed in the usual sterile fashion. 2. An transverse incision along skin crease was made in the left side inguinal area. Incision was deepened through layers. The scarpa fascia was opened. The external oblique fascia was opened from external ring. 3. Spermatic cord was looped. Dissection was performed on the antero-medialaspect of the spermatic cord. An indirect herniac sac was noted and mobilized. The sac was opened and extended into distal and proximal ends, the latter was then high-ligated. The mesh was applied. Adequate hemostasis was obtained. 4. Closure was proceeded with interrupted catgut on the scarpa fasciaand the skin was closed subcuticularly. Operators 陳炯年 Assistants 黃凱傑 李國豪 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Hernia 開立醫師: 黃凱傑 開立時間: 2011/11/07 09:49 Pre-operative Diagnosis Left inguinal hernia, indirect type Post-operative Diagnosis Left inguinal hernia, indirect type Operative Method Herniorrhaphy and high ligation Specimen Count And Types 1 piece About size:2x1cm Source:hernia sac Pathology pending Operative Findings left side indirect type inguinal hernia, no content in herniac sac Operative Procedures 1. Under endotracheal general anesthesia with the patient in supine position, prepping with Povidone iodine and draping was performed in the usual sterile fashion. 2. An transverse incision along skin crease was made in the left side inguinal area. Incision was deepened through layers. The scarpa fascia was opened. The external oblique fascia was opened from external ring. 3. Spermatic cord was looped. Dissection was performed on the antero-medialaspect of the spermatic cord. An indirect herniac sac was noted and mobilized. The sac was opened and extended into distal and proximal ends, the latter was then high-ligated. The mesh was applied. Adequate hemostasis was obtained. 4. Closure was proceeded with interrupted catgut on the scarpa fasciaand the skin was closed subcuticularly. Operators 陳炯年 Assistants 黃凱傑 李國豪 相關圖片 吳新興 (M,1937/04/15,74y10m) 手術日期 2011/11/04 手術主治醫師 張金池 手術區域 東址 001房 02號 診斷 Predominant disturbance of consciousness 器械術式 Tracheostomy 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 蕭柏妮 ASA 3 紀錄醫師 郝政鴻, 時間資訊 00:00 開始NPO 00:00 臨時手術NPO 11:53 通知急診手術 11:25 報到 11:25 進入手術室 11:25 麻醉開始 11:32 誘導結束 11:42 手術開始 11:47 麻醉結束 11:47 手術結束 11:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 氣管切開術 1 0 記錄__ 手術科部: 外科部 套用罐頭: Tracheostomy via punture 開立醫師: 郝政鴻 開立時間: 2011/11/04 11:57 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy via punture Specimen Count And Types nil Pathology nil Operative Findings Fr . 8 low pressure cuffed tube inserted via punture method smoothly, checked by bronchoscopy. Operative Procedures 1. ETGA, supine 2. Skin disinfection and draping 3. longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage 4. Needle punture to trachea, checked by bronchoscopy 4. Needle punture to trachea 5. Insert guide wire and dilator 6. Insert tracheostomy with dilator 7. Fixatation of tracheostomy Operators VS張金池 Assistants R4郝政鴻 Ri張佑謙 Indication Of Emergent Operation Prolong intubation 黃雅慧 (F,1977/10/06,34y5m) 手術日期 2011/11/05 手術主治醫師 蔡瑞章 手術區域 東址 003房 02號 診斷 Subdural hemorrhage or effusion 器械術式 Right frontal burr hole for epidural collection evacuation 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 石博元 ASA 2 紀錄醫師 蔡宗良, 時間資訊 00:00 臨時手術NPO 11:25 進入手術室 11:30 麻醉開始 11:35 誘導結束 11:50 抗生素給藥 12:05 手術開始 13:20 手術結束 13:20 麻醉結束 13:30 送出病患 13:35 進入恢復室 15:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦脊髓液分流管重置 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Revision of VP shunt, change of reservoir fro... 開立醫師: 蔡宗良 開立時間: 2011/11/05 13:31 Pre-operative Diagnosis Overshunting Post-operative Diagnosis Overshunting Operative Method Revision of VP shunt, change of reservoir from 10mmH2O to 13mmH2O Specimen Count And Types nil Pathology None Operative Findings 1. Epidural fluid collections, clear 2. S/P cranioplasty with artificial skull plate Operative Procedures 1. ETGA, supine, head rotated to the left 2. Routine disinfection and preparation 3. Wound incision as previous wound as depicted 4. Change the reservoir from 10mmH2O to 13mmH2O Codman Hamkim Precision Fixed Pressure Valve 5. A burr hole was made on the artificial skull plate and a 7mm CWV drain was placed 6. Wound was closed in layers Operators Ｐ　蔡瑞章 Assistants Ｒ６　蔡宗良 Ｒ６　蔡宗良 pgy 施培艾 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Revision of VP shunt, change of reservoir fro... 開立醫師: 張哲瑋 開立時間: 2011/11/05 13:44 Pre-operative Diagnosis Overshunting Post-operative Diagnosis Overshunting Operative Method Revision of VP shunt, change of reservoir from 10mmH2O to 13mmH2O Specimen Count And Types nil Pathology None Operative Findings 1. Epidural fluid collections, clear 2. S/P cranioplasty with artificial skull plate Operative Procedures 1. ETGA, supine, head rotated to the left 2. Routine disinfection and preparation 3. Wound incision as previous wound as depicted 4. Change the reservoir from 10mmH2O to 13mmH2O Codman Hamkim Precision Fixed Pressure Valve 5. A burr hole was made on the artificial skull plate and a 7mm CWV drain was placed 6. Wound was closed in layers Operators Ｐ　蔡瑞章 Assistants Ｒ６　蔡宗良 pgy 施培艾 相關圖片 郭冠宏 (M,1977/11/08,34y4m) 手術日期 2011/11/05 手術主治醫師 蔡瑞章 手術區域 東址 003房 03號 診斷 Hydrocephalus 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 石博元 ASA 2 紀錄醫師 蔡宗良, 時間資訊 00:00 臨時手術NPO 13:45 進入手術室 13:50 麻醉開始 13:55 誘導結束 13:56 抗生素給藥 14:40 手術開始 16:45 手術結束 16:45 麻醉結束 16:55 送出病患 17:00 進入恢復室 18:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 腦室腹腔分流手術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 蔡瑞章 開立時間: 2011/11/05 16:49 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method V-P Shunt, Fraziers point, Medium pressure non-programmable reservoir, left-sided Specimen Count And Types 1 piece About size:小 Source:csf Pathology None Operative Findings ICP approximately 4-5 cm H2O Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: supine with head rotated (tilted) to right (left). 3.Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 5 cm curvilinear. 5.After the scalp flap had been lifted and reflected anteriorly, a burr hole was made and the dura was tented by 2 stitches. 6.The dura was opened by a nib incision. Left lateral ventricle was tapped by a ventricular needle, then a 11 cm segment of the ventricular catheter was introduced into the ventricle. 7. A nib incision was made at LUQ of the abdomen , then a trocar was pushed into peritoneal cavity. Subsequently, distal 30 cm segment of the peritoneal catheter (medium pressure) was introduced into the peritoneal cavity through the outer tube of the trochar. The proximal end of this catheter was passed through subcutaneous tunnel at forechest, neck, rt retroauricular area and connected the reservoir. The shunt system was checked to make sure its function was working. 8. The reservoir was fixed to pericranium by 3 stitches. 9. Scalp closure: hemostasis was done with monopolar coagulator touching on the sucker tip. Galea suture was performed by continuous suture with 3/0. Dexon and skin by continuous suture with 3/0 nylon. 10.Course of the surgery: smooth. Operators 蔡瑞章 Assistants 蔡宗良 張哲瑋 施培艾 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 張哲瑋 開立時間: 2011/11/05 17:08 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method V-P Shunt, Fraziers point, Medium pressure non-programmable reservoir, left-sided Specimen Count And Types 1 piece About size:小 Source:csf Pathology None Operative Findings ICP approximately 4-5 cm H2O Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: supine with head rotated (tilted) to right (left). 3.Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 5 cm curvilinear. 5.After the scalp flap had been lifted and reflected anteriorly, a burr hole was made and the dura was tented by 2 stitches. 6.The dura was opened by a nib incision. Left lateral ventricle was tapped by a ventricular needle, then a 11 cm segment of the ventricular catheter was introduced into the ventricle. 7. A nib incision was made at LUQ of the abdomen , then a trocar was pushed into peritoneal cavity. Subsequently, distal 30 cm segment of the peritoneal catheter (medium pressure) was introduced into the peritoneal cavity through the outer tube of the trochar. The proximal end of this catheter was passed through subcutaneous tunnel at forechest, neck, rt retroauricular area and connected the reservoir. The shunt system was checked to make sure its function was working. 8. The reservoir was fixed to pericranium by 3 stitches. 9. Scalp closure: hemostasis was done with monopolar coagulator touching on the sucker tip. Galea suture was performed by continuous suture with 3/0. Dexon and skin by continuous suture with 3/0 nylon. 10.Course of the surgery: smooth. Operators 蔡瑞章 Assistants 蔡宗良 張哲瑋 施培艾 相關圖片 陳榮鋒 (M,1955/08/05,56y7m) 手術日期 2011/11/05 手術主治醫師 蔡瑞章 手術區域 東址 003房 01號 診斷 Herniation of intervertebral disc without myelopathy, lumbar 器械術式 L3-4 microdiskectomy, right 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 石博元 ASA 2 紀錄醫師 蔡宗良, 時間資訊 00:00 臨時手術NPO 08:09 進入手術室 08:15 麻醉開始 08:25 誘導結束 08:41 抗生素給藥 09:09 手術開始 10:55 手術結束 10:55 麻醉結束 10:58 送出病患 11:00 進入恢復室 12:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-腰椎 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 外科部 套用罐頭: Microsurgical diskectomy 開立醫師: 葉玫娟 開立時間: 2011/11/05 10:58 Pre-operative Diagnosis Lumbar herniated intervertebral disk, right L3-4 Post-operative Diagnosis Ditto Operative Method Microsurgical diskectomy Specimen Count And Types nil Pathology Nil Operative Findings The right L3-4 disc was noted to bulged out posteriorly, causing compression of the right L4 nerve root. The right L4 root became slack after decompression. Operative Procedures 1. ETGA, prone. 2. Low back midline incision, L3-4. 3. Dissection and retraction of right paraspinal muscles off spinous process, lamina. 4. Laminotomy of lower right L3 under microscopy. 5. Opening of annulus with knife incision. 6. Removal of nucleus propulsus with disk forceps, currets. 7. Hemostasis. 8. Irrigation of epidural space with Rinderon solution. 9. Wound closure in layers Operators 蔡瑞章, 楊士弘 Assistants 蔡宗良 徐禮文 (M,1944/12/26,67y2m) 手術日期 2011/11/05 手術主治醫師 蔡翊新 手術區域 東址 002房 01號 診斷 Brain abscess 器械術式 Right frontal brain abscess drainage and removal of subdural catheter 手術類別 緊急手術 手術部位 頭、頸 傷口分類 污染 麻醉方式 全身麻醉 麻醉主治醫師 石博元 ASA 3E 紀錄醫師 張書豪, 時間資訊 00:10 臨時手術NPO 00:10 開始NPO 00:11 通知急診手術 09:10 報到 09:15 進入手術室 09:35 麻醉開始 09:55 誘導結束 10:15 抗生素給藥 10:22 手術開始 13:00 抗生素給藥 14:40 麻醉結束 14:40 手術結束 14:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 手術 腦瘤切除-手術時間在4小時以內 1 1 R 手術 慢性硬腦膜下血腫清除術 1 2 R 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT 開立醫師: 蔡翊新 開立時間: 2011/11/05 14:10 Pre-operative Diagnosis Right frontal brain abscess, retained subdural catheter and frontoparietal chronic SDH. Post-operative Diagnosis Right frontal brain abscess, retained subdural catheter and frontoparietal chronic SDH. Operative Method Right frontotemporoparietal craniotomy for abscess excision, removal of subdural catheter and evacuation of chronic SDH. Specimen Count And Types 3 culture swabs, sent for bacterial culture; 1 piece of brain abscess together with subdural catheter; 1 piece of outer membrane of chronic SDH. Pathology Pending. Operative Findings Retained subdural catheter at right frontal area with thick granulation tissue wrapping it. A 2.5 x 2.5 x 2.5 cm brain abscess with thick capsule and whitish pus content was excised from right frontal lobe, just distal to the tip of the subdural catheter. Outer membrane of chronic SDH was noted at right frontoparietal region, with motor oil-colored fluid in the subdural space. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: Question mark-shaped, right frontotemporoparietal. Raney clips were applied to the scalp edge for temporary hemostasis. 5. Craniotomy window: 8 x 8 cm, right frontoparietal, created by making 3 burr holes (two as previous ones) then cut by power saw. 6. Dural tenting: by 2/0 silk, 2 cm in interval, distributed along the edge of skull window. 7. Dural incision: U-shaped, along the edge of skull window, reflected to midline. 8. Lobectomy: cerebral cortical incision was made at right inferior frontal lobe by Greenwood bipolar forceps. The procedure was then carried out deep into white mater until the abscess was exposed. The abscess was resected by bipolar forceps along its junction with normal white mater as en-block of 2.5 x 2.5 x 2.5 cm in size. The bleeding during the dissection was stopped by bipolar coagulator or by packing with conttonoid patties. 9. The chronic SDH was evacuated. The outer membrane was excised. 10.Hemostasis: The hemostasis during the resection of the tumor was obtained satisfactorily by bipolar coagulator and suction on the patties packing on the bleeders. The bleeding from artery was stopped by bipolar coagulator. The blood oozing point from several locations on the bare surface after abscess excision were packed with Surgicel for complete hemostasis. Finally, the cavity created after abscess excision was irrigated with NS several times and it was perfectly watery clear before the dural closure. 11.Dural closure: interruped 2/0 silk sutures for key stitches, then continuous suture with 4/0 Prolene to obtain water-tight closure. A piece of periosteum, 6 x 2 cm was used for a perfect dura repair. 12.Closure of skull window: the skull plate was placed back to craniotomy window and fixed by 3 miniplates and 6 screws. The dura was tented to the center of the skull plate by 3 2/0 stitches. The covering muscle was closed by interrupted 1/0 silk stitches. 13.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 14.Drain: one, epidural, CWV. 15.Blood transfusion: nil. Blood loss: 350 ml. 16.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R4游健生R1張書豪 Indication Of Emergent Operation brain abscess with conscious disturbance and frequent seizure. 相關圖片 王秋英 (M,1983/06/29,28y8m) 手術日期 2011/11/05 手術主治醫師 蔡翊新 手術區域 東址 019房 02號 診斷 Major trauma rated 16 or above on the severity scale ( Injury severity score >=16 ) 器械術式 Removal of subdural hematoma, right craniectomy 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 石博元 ASA 4E 紀錄醫師 游健生, 時間資訊 20:13 通知急診手術 21:01 進入手術室 21:05 麻醉開始 21:25 誘導結束 21:32 手術開始 21:35 抗生素給藥 22:45 開始輸血 23:50 麻醉結束 00:00 送出病患 23:50 手術結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 手術 腦內血腫清除術 1 1 R 手術 顱內壓視置入 1 2 R 記錄__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 蔡翊新 開立時間: 2011/11/05 23:27 Pre-operative Diagnosis Head injury with right temporal base skull fracture, right frontotemporoparietal acute SDH, right frontal and temporal contusional ICH and brain swelling. Post-operative Diagnosis Head injury with right temporal base skull fracture, right frontotemporoparietal acute SDH, right frontal and temporal contusional ICH and brain swelling. Operative Method Right frontotemporoparietal craniectomy for removal of SDH and ICH, duroplasty, and intraparenchymal ICP monitoring. Excision of right temporalis muscle. Specimen Count And Types nil Pathology Nil. Operative Findings Scalp contusion at left occipital and bilateral temporal regions. The right temporal muscle was swollen. Initial ICP after first burr hole creation was 36 mmHg. Right temporal skull base fracture with active epidural bleeding was encountered after craniectomy. The dura was tense upon craniectomy. Subdural blood clots, about 1.5 cm in thickness, at right F-T-P area and contusional ICHs at right frontal and right temporal lobes were evacuated. Active bleeding from several cortical veins were coagulated. The ICP after duroplasty was 12 mmHg. When skin closure was nearly completed, the ICP climbed to 35 mmHg. We opened the wound to check bleeding which was not found. Only progressive brain swelling was noted, suspected due to impaired venous drainage. ICP after operation was 31 mmHg. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: right F-T-P, trauma flap. 5. A burr hole was made at right frontal area and the dura was incised for evacuating part of the subdural hematoma, therefore the IICP could be relieved earlier. 6. Craniectomy window: 15 x 12 cm, right F-T-P, created by making 5 burr holes then cut by power saw. 7. Dural tenting: by 2/0 silk, 2 cm in interval, distributed along the edge of skull window. 8. Dural incision: curvilinear along the edge of skull window. 9. The subdural clot and contusional ICHs were removed by sucker. A Camino ICP monitor was inserted to right frontal lobe. 10.Hemosatasis: the bleeders was stopped by Bovie and oozing surface was covered with gelfoam. 11.Dural closure: was closed with a piece of dural graft taking from temporalis fascia (crescent shape 12 cm long, 1.5 cm wide) along the 3/4 length of the dural incision in order to create an additional space for the swollen brain. The remaining 1/4 was covered with DuroGen. 12.The skull plate was removed and put to bone bank for preservation. 13.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 14.Drain: two epidural CWV drains. 15.Blood transfusion: PRBC 2U. Blood loss: 900 ml. Operators VS蔡翊新 Assistants R6蔡宗良R4游健生 Indication Of Emergent Operation Coma, anisocoric pupil, CT: uncal herniation with brainstem compression. 相關圖片 黃文寶 (M,1955/06/06,56y9m) 手術日期 2011/11/06 手術主治醫師 王國川 手術區域 東址 019房 01號 診斷 Intracerebral hemorrhage 器械術式 Crainotomy Brain Tumor excision and ICH removal 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 石博元 ASA 4E 紀錄醫師 游健生, 時間資訊 16:09 開始NPO 00:08 通知急診手術 01:30 報到 01:30 進入手術室 01:32 麻醉開始 01:45 誘導結束 02:18 抗生素給藥 02:25 手術開始 05:30 抗生素給藥 05:55 麻醉結束 05:55 手術結束 06:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4~8小時 1 1 R 手術 腦瘤切除-手術時間在4~8小時 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Right frontal craniotomy for tumor excision 開立醫師: 游健生 開立時間: 2011/11/06 08:03 Pre-operative Diagnosis Multiple intracerebral hemorrhage, suspect metastatic tumor bleeding Post-operative Diagnosis Multiple metastatic tumor with bleeding Operative Method Right frontal craniotomy for tumor excision Specimen Count And Types 2 pieces About size:5*3*1 cm Source:brain tumor with peripheral hematoma from right frontal lobe About size:3*2*2 cm Source:brain tumor with peripheral hematoma from right high frontal gyrus Pathology pending Operative Findings One 5*3*1 cm tumor with peripheral hematoma was noted at right frontal lobe. It was about 1cm beneath right middle gyrus cortex. Some mucoid material was seen inside the tumor. It was moderately vascularized with soft consistence. Another 3*2*2cm tumor with peripheral hematoma was noted at the surface of right superior frontal gyrus. It was moderately vascularized with soft consistence. Both tumor were dissected away from gliotic brain parenchyma by hematoma. Only some aspects were connected to brain parenchyma. Operative Procedures Under ETGA, patient was in supine position with head rotated to left 15 degrees. After shaving, we disinfected and draped the operation field as usual. A bi-coronal scalp incision was made followed by scalp flap elevation and reflection. The temporalis muscle was transected and reflected after part of fascia was harvested. Three burholes were created with one at Keyhole. A right frontal craniotomy was done. After dura tenting, dura was opened in U-shape with anterior craniotomy border as base. A 3cm corticotomy was made at middle gyrus of right frontal lobe. The intracerebral hematoma at right frontal base was encountered. After removal of some ICH, a tumor was noted inside hematoma which connected to brain parenchyma. We dissected the tumor along the plan between gliosis. After removal of the tumor and ICH, the cavity was covered by Surgicel. Another tumor was seen at the surface of superior frontal gyrus. It was dissected along the plan between gliosis. Hematoma was also seen. After removal of the tumor and ICH, the cavity was covered by Surgicel. Dura was repaired with fascia previous harvested and 3-0 prolene continuous suture. After 4 central tenting, bone flap was fixed by with mini-plates. Temporalis muscle was approximated. Wound was closed in layers with 2-0 Vircyl and 3- Nylon after a subgaleal CWV drain placement. Operators VS 王國川 Assistants R4 游健生 R1 張哲瑋 Indication Of Emergent Operation intracranial hypertension and pending uncal herniation 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Right frontal craniotomy for tumor excision 開立醫師: 游健生 開立時間: 2011/11/06 08:04 Pre-operative Diagnosis Multiple intracerebral hemorrhage, suspect metastatic tumor bleeding Post-operative Diagnosis Multiple metastatic tumor with bleeding Operative Method Right frontal craniotomy for tumor excision Specimen Count And Types 2 pieces About size:5*3*1 cm Source:brain tumor with peripheral hematoma from right frontal lobe About size:3*2*2 cm Source:brain tumor with peripheral hematoma from right high frontal gyrus Pathology pending Operative Findings One 5*3*1 cm tumor with peripheral hematoma was noted at right frontal lobe. It was about 1cm beneath right middle gyrus cortex. Some mucoid material was seen inside the tumor. It was moderately vascularized with soft consistence. Another 3*2*2cm tumor with peripheral hematoma was noted at the surface of right superior frontal gyrus. It was moderately vascularized with soft consistence. Both tumor were dissected away from gliotic brain parenchyma by hematoma. Only some aspects were connected to brain parenchyma. Operative Procedures Under ETGA, patient was in supine position with head rotated to left 15 degrees. After shaving, we disinfected and draped the operation field as usual. A bi-coronal scalp incision was made followed by scalp flap elevation and reflection. The temporalis muscle was transected and reflected after part of fascia was harvested. Three burholes were created with one at Keyhole. A right frontal craniotomy was done. After dura tenting, dura was opened in U-shape with anterior craniotomy border as base. A 3cm corticotomy was made at middle gyrus of right frontal lobe. The intracerebral hematoma at right frontal base was encountered. After removal of some ICH, a tumor was noted inside hematoma which connected to brain parenchyma. We dissected the tumor along the plan between gliosis. After removal of the tumor and ICH, the cavity was covered by Surgicel. Another tumor was seen at the surface of superior frontal gyrus. It was dissected along the plan between gliosis. Hematoma was also seen. After removal of the tumor and ICH, the cavity was covered by Surgicel. Dura was repaired with fascia previous harvested and 3-0 prolene continuous suture. After 4 central tenting, bone flap was fixed by with mini-plates. Temporalis muscle was approximated. Wound was closed in layers with 2-0 Vircyl and 3- Nylon after a subgaleal CWV drain placement. Operators VS 王國川 Assistants R4 游健生 R1 張哲瑋 Indication Of Emergent Operation intracranial hypertension and pending uncal herniation 相關圖片 王秋英 (M,1983/06/29,28y8m) 手術日期 2011/11/06 手術主治醫師 蔡翊新 手術區域 東址 027房 02號 診斷 Major trauma rated 16 or above on the severity scale ( Injury severity score >=16 ) 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 石博元 ASA 4E 紀錄醫師 蔡宗良, 時間資訊 00:50 進入手術室 00:50 報到 00:56 通知急診手術 01:00 麻醉開始 01:05 誘導結束 01:20 抗生素給藥 01:25 手術開始 01:45 開始輸血 03:10 麻醉結束 03:10 手術結束 03:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 硬腦膜外血腫清除術 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 蔡翊新 開立時間: 2011/11/06 02:52 Pre-operative Diagnosis Left temporal skull fracture with epidural hemorrhage. IICP. Post-operative Diagnosis Left temporal skull fracture with epidural hemorrhage. IICP. Operative Method Left frontotemporal craniotomy for removal of EDH. Specimen Count And Types nil Pathology Nil. Operative Findings The ICP monitor lost its reading during this operation. Linear skull fracture at left temporal bone was noted. Thick epidural hematoma, 12 x 10 cm in area and 2.5 cm in thickness, was noted at left frontotemporal area. Bleeding from epidural space was stopped by Gelfoam packing and during tenting. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 4 cm at anterior-lower temporal area, the skin edge was clipped by Raney clips for temporary hemostasis. The temporalis muscles was incised down to the tempoal squama which was exposed then by applying a self retaining retractor on the muscle. 5. A burr hole was made for evacuating part of the epidural hematoma, therefore the IICP could be relieved earlier. 6. The incision was extended to a temporal horseshoe, and the temporalis muscle was detached from temporal squama by rasp subsequently. 7. Craniotomy window: 10 x 8 cm, left frontotemporal, created by making 3 burr holes then cut by power saw. 8. Dural tenting: by 2/0 silk, 1.5 cm in interval, distributed along the edge of skull window. 9. The epidural clot was removed by sucker. 10.Hemosatasis: the bleeders was stopped by Bovie and epidural bleeding was packed with gelfoam. 11.The skull plate was placed back and fixed by 3 miniplates and 6 screws. 12.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 13.Drain: one, epidural, CWV. 14.Blood transfusion: PRBC 6U, FFP 6U. Blood loss: 1000 ml. 15.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R6蔡宗良 Indication Of Emergent Operation IICP, anisocoric pupil, CT: massive EDH 相關圖片 黃鴻明 (M,1973/10/23,38y4m) 手術日期 2011/11/07 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Anomalies of cerebrovascular system 器械術式 Pontine cavernoma excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:30 麻醉開始 09:00 誘導結束 09:40 抗生素給藥 09:43 手術開始 12:40 抗生素給藥 16:05 手術結束 16:05 麻醉結束 16:10 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 7 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 放置肺動脈導管術 1 0 麻醉 Cardiac out-put 1 0 麻醉 Swan-gang catheterization 1 0 麻醉 T.E.E 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 顱底瘤手術 1 1 摘要__ 手術科部: 外科部 套用罐頭: Supracerebellar infratentorial approach for e... 開立醫師: 鍾文桂 開立時間: 2011/11/07 17:00 Pre-operative Diagnosis Midbrain-pontine cavernous malformation with hemorrhage status post subtemporal approach for cavernoma excision status post telovelar approach for cavernoma excision with right hemaparesis and dysphagia. Post-operative Diagnosis Midbrain-pontine cavernous malformation with hemorrhage status post subtemporal approach for cavernoma excision status post telovelar approach for cavernoma excision with right hemaparesis and dysphagia. Operative Method Supracerebellar infratentorial approach for excision of cavernous malformation. Specimen Count And Types 1 piece About size:1x1x1 Source:Brain stem cavernoma Pathology Pendng. Operative Findings The patient was in sitting position. Further craniotomy for exposing the transverse sinus was done for better approach of supracerebellar infratentorial space. Several ( 5-6) grape-like cavernous malformation was noted after dissection along the yellowish hemosiderin plane. After cavernoma excision, the medbrain was transected and the basilar artery was exposed. The CN IV, SCA, and PCA were identified. Intraoperative SSEP and MEP had no significant change comparing to pre-operative status. Severe scar formation was noted over posterior part of midbrain. Operative Procedures Under ETGA, the patient was placed in sitting position and the head was fixed by Mayfield head holder and the neck was flexed. After shaving, disinfection, and draping, the previous operative wound was incised and dissected. Due to some bone resorption, the dura mater and the surrounding soft tissue was dissected seperately in meticulous fashion. Fuerther craniotomy was done for better exposure of infratentorial supracerebellar space. Durotomy was done based on transverse sinus. Dissection of arachnoid plane was done until reaching the tentorium incisura and exposing the midbrain. A 0.2 cm corticotomy was obtained by bipolar electrocautery. Meticulous dissection was obtained to excise the cavernoma. The dura mater was closed in watertight fashion. The skull bones were placed above the gelfoam. The wound was closed in layers with one submuscular CWV drain. Operators Prof. 杜永光 Assistants R6 鍾文桂 R3 曾偉倫 Ri 陳天華 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Supracerebellar infratentorial approach for e... 開立醫師: 曾偉倫 開立時間: 2011/11/07 17:06 Pre-operative Diagnosis Midbrain-pontine cavernous malformation with hemorrhage status post subtemporal approach for cavernoma excision status post telovelar approach for cavernoma excision with right hemaparesis and dysphagia. Post-operative Diagnosis Midbrain-pontine cavernous malformation with hemorrhage status post subtemporal approach for cavernoma excision status post telovelar approach for cavernoma excision with right hemaparesis and dysphagia. Operative Method Supracerebellar infratentorial approach for excision of cavernous malformation. Specimen Count And Types 1 piece About size:1x1x1 Source:Brain stem cavernoma Pathology Pendng. Operative Findings The patient was in sitting position. Further craniotomy for exposing the transverse sinus was done for better approach of supracerebellar infratentorial space. Several ( 5-6) grape-like cavernous malformation was noted after dissection along the yellowish hemosiderin plane. After cavernoma excision, the medbrain was transected and the basilar artery was exposed. The CN IV, SCA, and PCA were identified. Intraoperative SSEP and MEP had no significant change comparing to pre-operative status. Severe scar formation was noted over posterior part of midbrain. Operative Procedures Under ETGA, the patient was placed in sitting position and the head was fixed by Mayfield head holder and the neck was flexed. After shaving, disinfection, and draping, the previous operative wound was incised and dissected. Due to some bone resorption, the dura mater and the surrounding soft tissue was dissected seperately in meticulous fashion. Fuerther craniotomy was done for better exposure of infratentorial supracerebellar space. Durotomy was done based on transverse sinus. Dissection of arachnoid plane was done until reaching the tentorium incisura and exposing the midbrain. A 0.2 cm corticotomy was obtained by bipolar electrocautery. Meticulous dissection was obtained to excise the cavernoma. The dura mater was closed in watertight fashion. The skull bones were placed above the gelfoam. The wound was closed in layers with one submuscular CWV drain. Operators Prof. 杜永光 Assistants R6 鍾文桂 R3 曾偉倫 Ri 陳天華 相關圖片 黃鴻明 (M,1973/10/23,38y4m) 手術日期 2011/11/07 手術主治醫師 杜永光 手術區域 東址 002房 04號 診斷 Anomalies of cerebrovascular system 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 4E 時間資訊 00:00 開始NPO 00:00 臨時手術NPO 21:57 通知急診手術 22:58 進入手術室 22:58 報到 23:00 麻醉開始 23:10 誘導結束 23:36 手術開始 00:20 麻醉結束 00:20 手術結束 00:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室體外引流 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: External ventricular drainage via right Koche... 開立醫師: 李振豪 開立時間: 2011/11/08 01:18 Pre-operative Diagnosis Tension pneumoventricle Post-operative Diagnosis Tension pneumoventricle Operative Method External ventricular drainage via right Kocher"s approach Specimen Count And Types 1 piece About size:5ml Source:CSF Pathology Nil Operative Findings Bilateral dilated pupil(7mm/7mm) with sluggish light reflex was noted before the operation. The dura was not tense after burrhole creation. But after puncture of right lateral ventricle, much air gushed out. Deair was performed directly with normal saline. The ventricular catheter was placed at 6.5cm in depth from brain surface. The CSF was relative clear in character and sampled for routine, BCS, and bacterial culture. After whole procedure, the right side pupil size returned to 4mm but the left side still 7mm in diameter. The left side pneumoventricle will be drained at ICU with head turned to left. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position. The scalp was shaved, scrubbed, and disinfected as usual. Right frontal linear scalp incision was made followed by one burr hole creation. Two central tenting was done. Cruciform durotomy was performed and the arachnoid membrane was opened. Ventriculostomy was conducted with puncture needle and deair was done. The ventricular catheter was placed into right lateral ventricle and fixed at 6.5cm from in depth. The catheter was externalized. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. The ventricular catheter was connected to external ventricular drainage system. The patient stood whole procedure well. Operators Prof.杜永光 Assistants R5李振豪, PGY R5李振豪, PGY邱鈺涵 Indication Of Emergent Operation tension pneumoventricle with conscious disturbance and bilateral full dilated pupil 相關圖片 謝智安 (M,1974/11/27,37y3m) 手術日期 2011/11/07 手術主治醫師 李崇維 手術區域 東址 000房 號 診斷 Arteriovenous malformation, brain 器械術式 AVM, left occipital lobe, For TAE 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 3 時間資訊 08:25 麻醉開始 08:50 誘導結束 12:10 麻醉結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 魏宣章 (M,1944/01/08,68y2m) 手術日期 2011/11/07 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Brain Tumor 器械術式 Left cerebellar metastatic tumor excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 4 紀錄醫師 蔡宗良, 時間資訊 00:00 臨時手術NPO 07:35 報到 08:10 進入手術室 08:15 麻醉開始 08:40 誘導結束 08:50 抗生素給藥 08:55 手術開始 11:45 麻醉結束 11:45 手術結束 11:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除-手術時間在4小時以內 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Suboccipital craniotomy for brain tumor excision 開立醫師: 蔡宗良 開立時間: 2011/11/07 11:58 Pre-operative Diagnosis Cerebellar tumor, hemisphere, suspect colorectal adenocarcinoma metastasis, left-sided Post-operative Diagnosis Cerebellar tumor, hemisphere, suspect colorectal adenocarcinoma metastasis, left-sided Operative Method Suboccipital craniotomy for brain tumor excision Specimen Count And Types 1 piece About size:小 Source:cerebellum Pathology Report pending Operative Findings Tumor was yellowish in color, rounded and well-dermacated, hard in consistency, low in vasculature. Operative Procedures 1. ETGA, Mayfield skull fixation 2. Prone position with neck hyperflexion and elevation 3. Routine preparation and drapping 4. Midline wound incision from inion to C-2 spinous process 5. Craniotomy of left-sided suboccipital skull 6. U-shaped durotomy based on transverse sinus 7. Ultrasonography for confirmation of trajectory 8. Microscope was brought into the operation field 9. Corticotomy approximately 1.5 cm 10. Tumor was breached and removed totally 11. Hemostasis with bipolar cautery and Surgicel packing 12. Dura closure with 4-0 prolene and Gelfoam covering 13. Hemostasis and wound was closed in layers Operators VS VS曾漢民 Assistants R R6 蔡宗良 r1張哲瑋 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Suboccipital craniotomy for brain tumor excision 開立醫師: 蔡宗良 開立時間: 2011/11/07 12:04 Pre-operative Diagnosis Cerebellar tumor, hemisphere, suspect colorectal adenocarcinoma metastasis, left-sided Post-operative Diagnosis Cerebellar tumor, hemisphere, suspect colorectal adenocarcinoma metastasis, left-sided Operative Method Suboccipital craniotomy for brain tumor excision Specimen Count And Types 1 piece About size:小 Source:cerebellum Pathology Report pending Operative Findings Tumor was yellowish in color, rounded and well-dermacated, hard in consistency, low in vasculature. Operative Procedures 1. ETGA, Mayfield skull fixation 2. Prone position with neck hyperflexion and elevation 3. Routine preparation and drapping 4. Midline wound incision from inion to C-2 spinous process 5. Craniotomy of left-sided suboccipital skull 6. U-shaped durotomy based on transverse sinus 7. Ultrasonography for confirmation of trajectory 8. Microscope was brought into the operation field 9. Corticotomy approximately 1.5 cm 10. Tumor was breached and removed totally 11. Hemostasis with bipolar cautery and Surgicel packing 12. Dura closure with 4-0 prolene and Gelfoam covering 13. Hemostasis and wound was closed in layers Operators VS曾漢民 Assistants R6 蔡宗良 r1張哲瑋 相關圖片 莊瑞明 (M,1950/10/15,61y4m) 手術日期 2011/11/07 手術主治醫師 蔡瑞章 手術區域 東址 002房 01號 診斷 Subdural hemorrhage or effusion 器械術式 Bilateral burr hole drainage for cSDH drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3E 紀錄醫師 施培艾, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 02:00 通知急診手術 08:35 報到 08:55 進入手術室 09:05 麻醉開始 09:15 誘導結束 09:48 抗生素給藥 10:12 手術開始 11:45 麻醉結束 11:45 手術結束 11:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 慢性硬腦膜下血腫清除術 1 1 B 摘要__ 手術科部: 外科部 套用罐頭: Bilateral frontal burr hole for chronic subdu... 開立醫師: 王奐之 開立時間: 2011/11/07 12:11 Pre-operative Diagnosis Bilateral chronic subdural hematoma Post-operative Diagnosis Bilateral chronic subdural hematoma Operative Method Bilateral frontal burr hole for chronic subdural hematoma evacuation Specimen Count And Types Nil Pathology Nil Operative Findings Motor-oil like hematoma gushed out after incision of outer membrane of the chronic subdural hematoma. Rupture of a bone emissary vein was encountered on drilling of right side burr hole, resulted in significant blood loss in a short period (~300ml), and the bleeding ceased after application of bone wax. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position. After shaving, scrubbing, disinfection & draping in sterile fashion, linear incisions were made at bilateral frontal area. After creation of burr holes, tenting stitches were applied. Small cruciate durotomies were performed at each burr hole, followed by incision of the outer membrane. Small rubber tubes were inserted into the subdural space, and the hematoma was evacuated and the space was irrigated with normal saline. After hematoma evacuation, the rubber tubes were set and secured to function as subdural drains. After wound closure in layers, the operation ended after deairing. Operators Prof. 蔡瑞章 Assistants R4 王奐之, R0 施培艾 Indication Of Emergent Operation IICP 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Bilateral frontal burr hole for chronic subdu... 開立醫師: 王奐之 開立時間: 2011/11/07 12:11 Pre-operative Diagnosis Bilateral chronic subdural hematoma Post-operative Diagnosis Bilateral chronic subdural hematoma Operative Method Bilateral frontal burr hole for chronic subdural hematoma evacuation Specimen Count And Types Nil Pathology Nil Operative Findings Motor-oil like hematoma gushed out after incision of outer membrane of the chronic subdural hematoma. Rupture of a bone emissary vein was encountered on drilling of right side burr hole, resulted in significant blood loss in a short period (~300ml), and the bleeding ceased after application of bone wax. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position. After shaving, scrubbing, disinfection & draping in sterile fashion, linear incisions were made at bilateral frontal area. After creation of burr holes, tenting stitches were applied. Small cruciate durotomies were performed at each burr hole, followed by incision of the outer membrane. Small rubber tubes were inserted into the subdural space, and the hematoma was evacuated and the space was irrigated with normal saline. After hematoma evacuation, the rubber tubes were set and secured to function as subdural drains. After wound closure in layers, the operation ended after deairing. Operators Prof. 蔡瑞章 Assistants R4 王奐之, R0 施培艾 Indication Of Emergent Operation IICP 相關圖片 蔡足味 (F,1968/03/13,44y0m) 手術日期 2011/11/07 手術主治醫師 陳晉興 手術區域 東址 000房 號 診斷 Neck mass 器械術式 Right tumor excision + chest wall resection (clavicle) 手術類別 預定手術 手術部位 胸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 高明蔚, 時間資訊 00:17 臨時手術NPO 11:15 報到 11:55 進入手術室 12:00 麻醉開始 12:35 誘導結束 13:00 抗生素給藥 13:11 手術開始 16:00 抗生素給藥 17:40 麻醉結束 17:40 手術結束 17:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 惡性腫瘤胸壁切除 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Chest wall resection for tumor excision, right 開立醫師: 高明蔚 開立時間: 2011/11/07 16:55 Pre-operative Diagnosis Right thoracic inlet tumor, favor malignant peripheral nerve sheath tumor (MPNST), s/p partial excision Post-operative Diagnosis Right thoracic inlet tumor, favor malignant peripheral nerve sheath tumor (MPNST), s/p partial excision Operative Method Chest wall resection for tumor excision, right Specimen Count And Types Source:Right thoracic inlet tumor Pathology Pending Operative Findings Severe fibrotic change was noted over right subclavicular area. Some ill-defined whitish firm soft tissue tumor was noted over right subclavicular area, with adhesion with adjacent vessels and poorly determined from the brachial plexus. The cephalic vein was once transeceted and repaired; fially ligated for tumor exicions. Right subclavian vein and artery were well defined by the cardiovascular surgeon and preserved. The right clavicle was transeced for better operation field and internally fixed with miniplates. Operative Procedures ETGA, supine, skin disinfection and draping as usual. Linear skin incision from clavicular head to infraclavicular area. Free the clavicle and transet it with the saw. Dissect the soft tissue along the fibrotic layers. Transect the cephalic vein and repair. Consult CV surgeon, debulk the tumor after identify the subclavian artery and vein. Check bleeding, hemostasis, saline irrigation, set CWV x1 and fix the clavicle with miniplates. Close the wounds. Operators 陳晉興,戴浩志,吳毅暉 Assistants CR蔡東明,R4高明蔚,Ri張佑謙 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Chest wall resection for tumor excision, right 開立醫師: 高明蔚 開立時間: 2011/11/07 16:55 Pre-operative Diagnosis Right thoracic inlet tumor, favor malignant peripheral nerve sheath tumor (MPNST), s/p partial excision Post-operative Diagnosis Right thoracic inlet tumor, favor malignant peripheral nerve sheath tumor (MPNST), s/p partial excision Operative Method Chest wall resection for tumor excision, right Specimen Count And Types Source:Right thoracic inlet tumor Pathology Pending Operative Findings Severe fibrotic change was noted over right subclavicular area. Some ill-defined whitish firm soft tissue tumor was noted over right subclavicular area, with adhesion with adjacent vessels and poorly determined from the brachial plexus. The cephalic vein was once transeceted and repaired; fially ligated for tumor exicions. Right subclavian vein and artery were well defined by the cardiovascular surgeon and preserved. The right clavicle was transeced for better operation field and internally fixed with miniplates. Operative Procedures ETGA, supine, skin disinfection and draping as usual. Linear skin incision from clavicular head to infraclavicular area. Free the clavicle and transet it with the saw. Dissect the soft tissue along the fibrotic layers. Transect the cephalic vein and repair. Consult CV surgeon, debulk the tumor after identify the subclavian artery and vein. Check bleeding, hemostasis, saline irrigation, set CWV x1 and fix the clavicle with miniplates. Close the wounds. Operators 陳晉興,戴浩志,吳毅暉 Assistants CR蔡東明,R4高明蔚,Ri張佑謙 R4莊民楷,R5陳建璋,R3陳志軒 相關圖片 陳鄭幸連 (F,1945/04/12,66y11m) 手術日期 2011/11/07 手術主治醫師 陳敞牧 手術區域 東址 005房 04號 診斷 Malignant neoplasm of ethmoidal sinus 器械術式 Tracheostomy + Ommaya 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3E 紀錄醫師 郝政鴻, 時間資訊 00:19 臨時手術NPO 00:19 開始NPO 12:18 通知急診手術 16:10 報到 16:10 進入手術室 16:12 麻醉開始 16:15 誘導結束 16:35 手術開始 17:25 17:40 麻醉結束 17:40 17:40 手術結束 17:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 歐氏貯囊置放手術 1 1 R 手術 氣管切開術 1 0 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Tracheostomy via punture 開立醫師: 郝政鴻 開立時間: 2011/11/07 16:47 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy via punture Specimen Count And Types nil Pathology nil Operative Findings Fr . 7 low pressure cuffed tube inserted via punture method smoothly, checked by bronchoscopy. Operative Procedures 1. ETGA, supine 2. Skin disinfection and draping 3. longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage 4. Needle punture to trachea, checked by bronchoscopy 5. Insert guide wire and dilator 6. Insert tracheostomy with dilator 7. Fixatation of tracheostomy Operators VS張金池 Assistants R4郝政鴻 R0石恭蒨 Indication Of Emergent Operation Porlong intubation 相關圖片 摘要__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 曾峰毅 開立時間: 2011/11/07 17:57 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ommaya insertion via right Kocher point Specimen Count And Types Nil Pathology Nil Operative Findings Xanthcrhomia CSF gushed out while ventriculostomy. Operative Procedures Under undotracheal general anaesthesia, we put the patient in supine position. We made one trasverse skin incision at right frontal area, and inserted Ommaya catheter via previous ventriculostomy. The wound was closed in layers. Operators VS 陳敞牧 Assistants R5 曾峰毅 Indication Of Emergent Operation Acute hydrocephalus 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 曾峰毅 開立時間: 2011/11/07 17:58 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ommaya insertion via right Kocher point Specimen Count And Types Nil Pathology Nil Operative Findings Xanthcrhomia CSF gushed out while ventriculostomy. Operative Procedures Under undotracheal general anaesthesia, we put the patient in supine position. We made one trasverse skin incision at right frontal area, and inserted Ommaya catheter via previous ventriculostomy. The wound was closed in layers. Operators VS 陳敞牧 Assistants R5 曾峰毅 Indication Of Emergent Operation Acute hydrocephalus 相關圖片 陳天輝 (M,1960/01/03,52y2m) 手術日期 2011/11/07 手術主治醫師 蕭輔仁 手術區域 東址 005房 02號 診斷 Hydrocephalus 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3 紀錄醫師 張哲瑋, 時間資訊 00:00 臨時手術NPO 12:28 進入手術室 12:28 報到 12:35 麻醉開始 12:40 誘導結束 12:45 抗生素給藥 13:13 手術開始 13:55 手術結束 13:55 麻醉結束 14:05 送出病患 14:08 進入恢復室 15:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt via right Kocher point 開立醫師: 曾峰毅 開立時間: 2011/11/07 13:49 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunt via right Kocher point Specimen Count And Types CSF was sent for routine, culture and BCS. Pathology Nil Operative Findings Clear colorless CSF gushed out while ventriculostomy. Opening pressure was about 15 cm H20. Codman, programmable Hakim valve, was used for shunt. Shunt pressure was pre-set at 120 mm H20. Operative Procedures With endotracheal geneeral anaesthesia, the patient was put in supine position with head rotated to right. We made one transverse skin incision at left frontal area, and drilled one burr hole. Durotomy was done. We made another transeverse skin incision at left upper abdomen, and performed mini-laparotomy. We created subcutaneous tunnel to connected two wound. Peritoneal catheter was pulled through the subcutaneous tunnel. Ventriculostomy was performed once, and ventricular cathter was inserted. We connected the catheter with the reservoir, and checked the shunt function. The wounds were closed in layers. Operators VS 蕭輔仁 Assistants R5 曾峰毅 R4 王奐之 R1 張哲瑋 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt via right Kocher point 開立醫師: 張哲瑋 開立時間: 2011/11/07 14:06 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunt via right Kocher point Specimen Count And Types CSF was sent for routine, culture and BCS. Pathology Nil Operative Findings Clear colorless CSF gushed out while ventriculostomy. Opening pressure was about 15 cm H20. Codman, programmable Hakim valve, was used for shunt. Shunt pressure was pre-set at 120 mm H20. Operative Procedures With endotracheal geneeral anaesthesia, the patient was put in supine position with head rotated to right. We made one transverse skin incision at left frontal area, and drilled one burr hole. Durotomy was done. We made another transeverse skin incision at left upper abdomen, and performed mini-laparotomy. We created subcutaneous tunnel to connected two wound. Peritoneal catheter was pulled through the subcutaneous tunnel. Ventriculostomy was performed once, and ventricular cathter was inserted. We connected the catheter with the reservoir, and checked the shunt function. The wounds were closed in layers. Operators VS 蕭輔仁 Assistants R5 曾峰毅 R4 王奐之 R1 張哲瑋 相關圖片 鄭徹文 (M,1971/03/27,40y11m) 手術日期 2011/11/07 手術主治醫師 蔡翊新 手術區域 東址 001房 07號 診斷 Cerebrovascular accident 器械術式 Craniotomy for ICH evacuation 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 4E 紀錄醫師 王奐之, 時間資訊 13:00 開始NPO 20:56 通知急診手術 21:23 進入手術室 21:25 麻醉開始 21:45 誘導結束 22:00 抗生素給藥 22:20 手術開始 02:25 手術結束 02:25 麻醉結束 02:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 1 R 手術 顱內壓視置入 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: CVA 開立醫師: 蔡翊新 開立時間: 2011/11/08 02:13 Pre-operative Diagnosis Right putaminal ICH with IVH. Post-operative Diagnosis Right putaminal ICH with IVH. Operative Method Right frontotemporal craniotomy for ICH evacuation and left Kocher EVD for ICP monitoring. Specimen Count And Types nil Pathology Nil. Operative Findings The CSF gushed out upon ventricular puncture. Initial pressure was estimated more than 25 cmH2O. The brain was slightly bulging out upon dural incision, possibly due to partial relief of pressure from EVD. About 60 ml ICH was noted at right putamen, with several active bleeders from right MCA branches and perforators. The brain became slack, 1 cm away from dura, after hematoma evacuation. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. An EVD was inserted to left frontal horn via a burr hole made at left Kocher point. 5. Incision: right frontotemporal, curvilinear. The skin edge was clipped by Raney clips for temporary hemostasis. After scalp had been lifted, the temporalis muscle was incised and detached from temporalsquama and reflected to lower temporal side. 6. Craniotomy: A 6 x 5 cm craniotomy was made at right frontotemporal area by making 2 burr holes. 7. Dural tenting: by 2/0 silk, 1.5-cm in interval, distributed along the edge of skull window. 8. Dural incision: 3/4 circle along the craniotomy margin. 9. A 2 cm cortical incision was made at anterior part of the inferior frontal gyrus, the subcortex and white mater was splitted by brain retractor and sucker until the intracerebral hematoma was exposed. The hematoma was sucked out carefully. Those tough clot was removed by forceps. The cavity was irrigated with NS and the blood oozing was stopped by Surgicel packing. Before closure of the dura, the hematoma caivty was clean and the brain once bulging was very slack. 10.Dural closure:interrupted 2/0 silk sutures for key stitches, then continous sutures with 4/0 Prolene and a piece of fascia graft to obtain water-tight closure. 11.The craniotomy bone was contaminated, so bone cement was used to make an artificial bone plate and fixed back by 3 26# wires. 12.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 13.Drain: an EVD. 14.Blood transfusion: nil. Blood loss: 250 ml. 15.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5李振豪R4王奐之 Indication Of Emergent Operation IICP, left hemiplegia, drowsiness 相關圖片 潘盛松 (M,1968/01/15,44y1m) 手術日期 2011/11/07 手術主治醫師 蔡翊新 手術區域 東址 003房 02號 診斷 Intracerebral hemorrhage 器械術式 Brain tumor Crainotomy for ICH removal, right 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3E 紀錄醫師 邱鈺涵, 時間資訊 12:30 臨時手術NPO 12:30 開始NPO 16:24 通知急診手術 17:05 報到 17:05 進入手術室 17:10 麻醉開始 17:40 誘導結束 17:50 抗生素給藥 18:15 手術開始 20:50 抗生素給藥 22:15 麻醉結束 22:15 手術結束 22:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦內血腫清除術 1 1 R 手術 顱內壓視置入 1 2 R 記錄__ 手術科部: 外科部 套用罐頭: CVA 開立醫師: 蔡翊新 開立時間: 2011/11/07 21:44 Pre-operative Diagnosis Right putaminal ICH. Post-operative Diagnosis Right putaminal ICH. Operative Method Right frontotemporal craniotomy for ICH evacuation and subdural ICP monitoring. Specimen Count And Types nil Pathology Nil. Operative Findings The dura was tense after craniotomy. The brain bulged out after dural opening. Some SAH was noted along both side of right Sylvian fissure. There was a 40 ml ICH at right putamen, larger than the size measured on CT scan. The brain remained bulging after ICH evacuation. ICP after duroplasty was 8 mmHg and after cranioplasty was 10 mmHg. ICP after skin closure was 8 mmHg. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: right frontotemporal, curvilinear. The skin edge was clipped by Raney clips for temporary hemostasis. After scalp had been lifted, the temporalis muscle was incised and detached from temporalsquama and reflected to lower temporal side. 5. Craniotomy: A 6 x 5 cm craniotomy was made at right frontotemporal area over-ridding the Sylvian fissure with its center 5 cm above extenal ear canal. 6. Dural tenting: by 2/0 silk, 2 cm in interval, distributed along the edge of skull window. 7. Dural incision: cruciate. 8. The right Sylvian fissure was opened to expose right insular lobe, which was incised to enter white mater. The white mater was splitted by brain retractor and sucker until the intracerebral hematoma was exposed. The hematoma was sucked out carefully. Those tough clot was removed by forceps. The cavity was irrigated with NS and the blood oozing was stopped by Surgicel packing. Before closure of the dura, the hematoma caivty was clean, but the brain remained bulging. 9. Dural closure: interrupted 2/0 silk sutures for key stitches. A piece of 5 x 5 cm Duroform was used for duroplasty. 10.The craniotomy bone was placed back and fixed by 3 miniplates and 6 screws. 11.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 12.Drain: one epidural CWV. 13.Blood transfusion: nil. Blood loss: 200 ml. 14.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5李振豪R0邱鈺涵 Indication Of Emergent Operation IICP 相關圖片 胡照雄 (M,1955/02/11,57y1m) 手術日期 2011/11/08 手術主治醫師 李章銘 手術區域 東址 005房 04號 診斷 Esophageal cancer 器械術式 Port-A catheter implatation 手術類別 緊急手術 手術部位 胸 傷口分類 清潔污染 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 高明蔚, 時間資訊 09:52 通知急診手術 19:30 進入手術室 19:40 抗生素給藥 19:44 麻醉開始 19:45 誘導結束 19:47 麻醉結束 19:48 手術開始 21:05 手術結束 21:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 皮下肌肉或深部異物取出術 1 1 R 手術 皮下腫瘤摘除術小於2CM 1 4 L 手術 皮下腫瘤摘除術小於2CM 1 2 R 記錄__ 手術科部: 外科部 套用罐頭: Port-A removal 開立醫師: 高明蔚 開立時間: 2011/11/08 21:09 Pre-operative Diagnosis Port-A inefction; left chest wall subcutaneous tumor; right flank subcutaneous tumor Post-operative Diagnosis Port-A inefction; left chest wall subcutaneous tumor; right flank subcutaneous tumor Operative Method Port-A removal Tumor excision Specimen Count And Types Source:left chest wall subcutaneous tumor, right flank subcutaneous tumor Pathology Pending Operative Findings Port-A port and catheter moved smoothly and completely. One about 0.8cm in diameter ill-defined subcutaneous tumor with feeding vessel in right flank One about 1cm in diameter ill-defined subcutaneous tumor in left chest wall Operative Procedures LA, supine, skin disinfection and draping. Remove port-A, tumor excision. Close the wounds. Operators 李章銘 Assistants R4高明蔚 Indication Of Emergent Operation Inefction 邱福興 (M,1944/04/16,67y10m) 手術日期 2011/11/08 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Back pain 器械術式 L3-4 laminectomy + posterolateral fusion 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 蔡宗良, 時間資訊 00:00 臨時手術NPO 07:35 報到 08:01 進入手術室 08:07 麻醉開始 08:15 誘導結束 08:43 抗生素給藥 09:02 手術開始 11:00 開始輸血 11:30 手術結束 11:30 麻醉結束 11:40 送出病患 11:45 進入恢復室 12:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 手術 椎弓切除術(減壓)-超過二節 1 1 手術 脊椎融合術-後融合,無固定物 1 2 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 蔡宗良 開立時間: 2011/11/08 11:40 Pre-operative Diagnosis Lumbar spinal stenosis, L3-4, L4-5 Post-operative Diagnosis Lumbar spinal stenosis, L3-4, L4-5 Operative Method Lumbar Laminectomy, L3-4, L4-5 Specimen Count And Types nil Pathology None Operative Findings Hypertrophic ligmentum flavum and facet hypertrophy, causing spinal canal stenosis Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: prone. 3. Skin preparation as routine 4. Linear skin incision from L3 to L5 5. Subperiosteal dissection from L3 to L5 6. Laminectomy with rongeur and Kerrions punch 7. Gelfoam hemostasis 8. Autologous bone chips with artifical bone (Sinbone HT) were placed at the facets after decortication 9. Wound closed in layers after placing Hemovac Operators VS曾勝弘 Assistants R6 蔡宗良 R0 施培艾 相關圖片 摘要__ 手術科部: 外科部 套用罐頭: L2-3-4-5 Laminectomy, L2 lower half and L5 up... 開立醫師: 蔡宗良 開立時間: 2011/11/20 10:29 Pre-operative Diagnosis Lumbar spinal stenosis, L2-3-4-5 Post-operative Diagnosis Lumbar spinal stenosis, L2-3-4-5 Operative Method L2-3-4-5 Laminectomy, L2 lower half and L5 upper half Bone fusion, bilateral, L2-3-4-5 Specimen Count And Types nil Pathology None Operative Findings Hypertrophic ligmentum flavum and facet hypertrophy, causing spinal canal stenosis Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: prone. 3. Skin preparation as routine 4. Linear skin incision from L3 to L5 5. Subperiosteal dissection from L3 to L5 6. Laminectomy with rongeur and Kerrions punch 7. Gelfoam hemostasis 8. Autologous bone chips with artifical bone (Sinbone HT) were placed at the facets after decortication 9. Wound closed in layers after placing Hemovac Operators VS曾勝弘 Assistants R6 蔡宗良 R0 施培艾 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: L2-3-4-5 Laminectomy, L2 lower half and L5 up... 開立醫師: 蔡宗良 開立時間: 2011/11/20 10:29 Pre-operative Diagnosis Lumbar spinal stenosis, L2-3-4-5 Post-operative Diagnosis Lumbar spinal stenosis, L2-3-4-5 Operative Method L2-3-4-5 Laminectomy, L2 lower half and L5 upper half Bone fusion, bilateral, L2-3-4-5 Specimen Count And Types nil Pathology None Operative Findings Hypertrophic ligmentum flavum and facet hypertrophy, causing spinal canal stenosis Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: prone. 3. Skin preparation as routine 4. Linear skin incision from L3 to L5 5. Subperiosteal dissection from L3 to L5 6. Laminectomy with rongeur and Kerrions punch 7. Gelfoam hemostasis 8. Autologous bone chips with artifical bone (Sinbone HT) were placed at the facets after decortication 9. Wound closed in layers after placing Hemovac Operators VS曾勝弘 Assistants R6 蔡宗良 R0 施培艾 相關圖片 張庭瑋 (F,1989/07/04,22y8m) 手術日期 2011/11/08 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Epilepsy 器械術式 Vagus nerve stimulation implantation 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 石博元 ASA 3 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:05 進入手術室 08:10 麻醉開始 08:15 誘導結束 08:50 抗生素給藥 09:07 手術開始 11:50 抗生素給藥 13:05 手術結束 13:05 麻醉結束 13:28 送出病患 13:30 進入恢復室 15:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 L 手術 神經分離術–肩,臀關節以上,包括臂神經叢,坐骨神經 1 2 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: Vagus nerve stimulation implantation, left 開立醫師: 游健生 開立時間: 2011/11/08 13:59 Pre-operative Diagnosis Refractory epilepsy Post-operative Diagnosis Refractory epilepsy Operative Method Vagus nerve stimulation implantation, left Specimen Count And Types nil Pathology Nil Operative Findings Vagus nerve was identified between carotid artery and internal jugular vein. About 4cm of the nerve was freed for electrodes of Cyberonic vagus nerve stimulation anchoring. The generator of VNS was implanted at subcutaneous layer of left chest wall below clavicle. The electrical resistance was 1725 Ohms. Operative Procedures Under ETGA, patient was in supine position. After disinfection and draping, we made a 5cm transverse neck incision on left side. The platysma muscle was transected as well as the superficial cervical fascia. We dissected along avascular plan to expose carotid sheath. Vagus nerve was identified by meticulous dissection after carotid sheath was opened. A 4cm segment of vagus nerve was freed. A transverse skin incision was made at left chest wall just below clavicle. A subcutaneous pocket was created for the generator of VNS. The electrodes of Cyberonic vagus nerve stimulation were passed from here to neck wound via subcutaneous tunnel. Then, they were anchored to vagus nerve and the wire was fixed according to manufacturer"s recommendation. After the wire was connected to generator. They were placed into the subcutaneous pocket. After hemostasis, wounds were closed in layers. Operators VS 郭夢菲 Assistants R4 游健生 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Vagus nerve stimulation implantation, left 開立醫師: 郭夢菲 開立時間: 2011/11/09 12:31 Pre-operative Diagnosis Refractory epilepsy Post-operative Diagnosis Refractory epilepsy Operative Method Vagus nerve stimulation implantation after neurolysis of left vagus nerve (generator model 103, electrode model 303) Specimen Count And Types nil Pathology Nil Operative Findings Vagus nerve was identified between carotid artery and internal jugular vein. It was located deep in between the artery and vein. Another nerve parallel to the left vagus nerve could be identified in a more superficial layer. About 2.5cm of the vagus nerve was freed for electrodes of Cyberonic vagus nerve stimulation anchoring. The generator of VNS was implanted at subcutaneous layer of left chest wall just in front of left anterior axillary line. The electrical resistance was 1725 Ohms. Operative Procedures Under ETGA, patient was in supine position. After disinfection and draping, we made a 5cm transverse neck incision on left side. Under microscopic view, the platysma muscle was transected as well as the superficial cervical fascia. We dissected along avascular plan medial to the left sternoclaidomastoid muscle to expose carotid sheath. Vagus nerve was identified by meticulous dissection after carotid sheath was opened. A 2.5cm segment of vagus nerve was freed. A transverse skin incision was made at left chest wall just below clavicle. A subcutaneous pocket was created for the generator of VNS. The electrodes of Cyberonic vagus nerve stimulation were passed from here to neck wound via subcutaneous tunnel. Then, they were anchored to vagus nerve and the wire was fixed according to manufacturer"s recommendation. After the wire was connected to generator. They were placed into the subcutaneous pocket. After hemostasis, wounds were closed in layers. Operators VS 郭夢菲 Assistants R4 游健生 相關圖片 陳晶華 (M,1928/09/20,83y5m) 手術日期 2011/11/08 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Lumbar spondylosis 器械術式 L4-5 TPS + L3-4, L5-S1 sublaminar decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 07:26 報到 08:03 進入手術室 08:05 麻醉開始 08:20 誘導結束 08:40 抗生素給藥 09:03 手術開始 11:10 手術結束 11:10 麻醉結束 11:20 送出病患 11:20 進入恢復室 13:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 B 手術 椎間盤切除術-腰椎 1 2 B 手術 椎弓切除術(減壓)-二節以內 1 4 B 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: 1. L4/5 transforaminal lumbar interbody fusion 開立醫師: 李振豪 開立時間: 2011/11/08 11:24 Pre-operative Diagnosis 1. L4 on L5 spondylolisthesis, 2. L3-4, L5-S1 lumbar stenosis Post-operative Diagnosis 1. L4 on L5 spondylolisthesis, 2. L3-4, L5-S1 lumbar stenosis Operative Method 1. L4/5 transforaminal lumbar interbody fusion 2. Right L3/4 and left L5/S1 laminotomy for sublaminar decompression Specimen Count And Types nil Pathology Nil Operative Findings L4 on L5 spondylolisthesis with hypertrophic facet and ligmentum flavum was noted. The marginal spur and hypertrophic ligment also noted over right L3/4 and left L5/S1 level which cause lumbar stenosis. After decompression, the thecal sac expanded well without evident CSF leakage or incidental durotomy. Four 6.2 x 45mm transpedicular screws and two 5cm rods were implanted at L4 and L5 level for posterior instrumentation. One #11 PEEK banana cage was inserted for transforaminal lumbar interbody fusion. The patient stood whole procedure well. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position. L4 and L5 pedicles level were localized by portable C-arm X-ray. Midline skin incision was made and the subcutaneous soft tissue was devided. The paravertebral muscle was detached to expose the L3 to S1 laminae and facet joints. L4 and L5 transpedicular screws were implanted under C-arm guided. Right L3/4 and left L5/S1 laminotomy was conducted for sublaminar decompression. L4/5 laminectomy and left facetectomy was performed followed by L4/5 diskectomy. One #11 PEEK cage was inserted for transforaminal lumbar interbody fusion. Hemostasis was achieved with bipolar electrocautery, Surgicel, and Gelfoam packing. One 1/8 Hemovac was placed. The wound was irrigated with Gentamicin solution. The wound was then closed in layers with 1-0, 2-0 vicryl and 3-0 Nylon. Operators VS賴達明 Assistants R5李振豪, R1李嘉哲 相關圖片 王林富珠 (F,1945/04/22,66y10m) 手術日期 2011/11/08 手術主治醫師 賴達明 手術區域 東址 003房 號 診斷 Lumbar Spondylosis 器械術式 L3-5 sublaminar decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 11:35 進入手術室 11:40 麻醉開始 11:50 誘導結束 12:25 抗生素給藥 12:27 手術開始 14:10 手術結束 14:10 麻醉結束 14:20 送出病患 14:22 進入恢復室 17:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 椎弓切除術(減壓)-二節以內 1 1 記錄__ 手術科部: 外科部 套用罐頭: L3-L5 sublaminar decompression 開立醫師: 李振豪 開立時間: 2011/11/08 14:27 Pre-operative Diagnosis Lumbar stenosis, L3-L5 Post-operative Diagnosis Lumbar stenosis, L3-L5 Operative Method L3-L5 sublaminar decompression Specimen Count And Types nil Pathology Nil Operative Findings Degenerative and mild scoliotic change over L3 to L5 level was noted. The ligmentum flavum was hypertrophic which cause remarkable compression of thecal sac and nerve root. After decompression and foraminotomy, the thecal sac and the roots expanded well. No incidental durotomy or CSF leakage were noted after whole procedure. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position. L3/4 and L4/5 interlaminar space was localized by portable C-arm X-ray. the skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made and the subcutaneous soft tissue was devided. The spinous process was splitted by oscillating saw. the spinous process was fractured after splitting and the laminae was exposed. L3/4 and L4/5 laminotomy was conducted and sublaminar decompression was performed with curette and Kerrison punches. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. The wound was then closed in layers with 1-0, 2-0 Vicryl and 4-0 Dexon. Operators VS賴達明 Assistants R5李振豪, Ri 相關圖片 謝海兵 (M,1944/12/30,67y2m) 手術日期 2011/11/08 手術主治醫師 賴達明 手術區域 東址 003房 03號 診斷 Lumbar Spondylosis 器械術式 L4-5 TPS 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 14:03 報到 14:30 進入手術室 14:35 麻醉開始 15:00 抗生素給藥 15:20 手術開始 15:45 誘導結束 17:50 手術結束 17:50 麻醉結束 18:00 抗生素給藥 18:00 送出病患 18:01 進入恢復室 19:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎間盤切除術-腰椎 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 記錄__ 手術科部: 外科部 套用罐頭: L4/5 transforaminal lumbar interbody fusion 開立醫師: 李振豪 開立時間: 2011/11/08 17:45 Pre-operative Diagnosis L4 on L5 spondylolisthesis with lumbar stenosis Post-operative Diagnosis L4 on L5 spondylolisthesis with lumbar stenosis Operative Method L4/5 transforaminal lumbar interbody fusion Specimen Count And Types nil Pathology Nil Operative Findings Degenerative change and spondylolisthesis was noted over L4/5 level. The joint and ligmentum flavum was hypertrophic with thecal sac and roots compression. After decompression, the thecal sac and the root expanded well. No incidental durotomy or CSF leakage was noted after whole procedure. Four 6.2 x 45mm transpedicular screws and two 5cm rods were implanted at L4 and L5 level for posterior instrumentation. One #11 PEEK banana cage was used for transforaminal lumbar interbody fusion. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position. The L4 and L5 pedicle level were localized by portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made and the subcutaneous soft tissue was devided. The paravertebral muscle groups were detached. L4 and L5 transpedicular screws were implanted under C-arm guided. L4/5 laminectomy and left facetectomy was performed for decompression. L4/5 diskectomy was conducted followed by transforaminal lumbar interbody fusion with one #11 PEEK banana cage. After set up of posterior instrumentation, hemostasis was achieved with bipolar electrocautery and Gelfoam packing. The wound was irrigated with Gentamicin solution and closed in layers with 1-0, 2-0 Vicryl and 3-0 Nylon. Operators VS賴達明 Assistants R5李振豪, R1李嘉哲 相關圖片 柯蕭娟玉 (F,1953/12/15,58y2m) 手術日期 2011/11/08 手術主治醫師 賴達明 手術區域 東址 005房 02號 診斷 Pain in thoracic spine 器械術式 T2-3 laminectomy for meningioma excision 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 蔡宗良, 時間資訊 00:00 臨時手術NPO 11:25 報到 12:00 進入手術室 12:05 麻醉開始 12:25 誘導結束 12:29 手術開始 12:32 抗生素給藥 15:05 麻醉結束 15:05 手術結束 15:18 送出病患 15:25 進入恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 手術 良性脊髓腫瘤切除術 1 1 摘要__ 手術科部: 外科部 套用罐頭: T1-3 laminectomy for Simpsons grade II excisi... 開立醫師: 蔡宗良 開立時間: 2011/11/08 15:17 Pre-operative Diagnosis Intradural extramedullary tumor, T2 Post-operative Diagnosis Intradural extramedullary tumor, suspect meningioma, T2 Operative Method T1-3 laminectomy for Simpsons grade II excision of T2 meningioma Specimen Count And Types 1 piece About size:小 Source:intradural extramedullary tumor Pathology Report pending Operative Findings Tumor was based at the right-sided foraminal area displacing spinal cord towards the left. Tumor was greyish in color, rounded and very well demarcated, fragile, and moderately vascular. Operative Procedures 1. ETGA, Mayfield fixation, prone positioning 2. Confimation of T2 spinous process with C-arm 3. Routine preparation and drapping 4. Midline incision from T1 To T3, followed by subperiosteal dissection and laminectomy 5. Dura was opened and tented 6. Tumor was removed by bipolar cautery, currette, and tumor forceps 7. Dura where tumor was based was electrocauterized by bipolar cautery 8. Dura was closed with 5-0 Prolene 9. Wound was closed in layers after placing Operators VS 賴達明 Assistants R6 蔡宗良, R0 施培艾 連莊繡鑾 (F,1932/01/14,80y2m) 手術日期 2011/11/08 手術主治醫師 賴達明 手術區域 東址 005房 03號 診斷 Spinal Stenosis 器械術式 L4-5 TPS 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 蔡宗良, 時間資訊 15:18 報到 15:34 進入手術室 15:40 麻醉開始 15:50 誘導結束 15:56 抗生素給藥 16:28 手術開始 18:35 手術結束 18:35 麻醉結束 18:45 抗生素給藥 18:45 送出病患 18:48 進入恢復室 19:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎弓切除術(減壓)-二節以內 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 摘要__ 手術科部: 外科部 套用罐頭: Transforaminal lumbar interbody fusion, L4-5 開立醫師: 蔡宗良 開立時間: 2011/11/08 18:53 Pre-operative Diagnosis Lumbar spinal stenosis, L4-5 Herniated lumbar disc, far-lateral, L4-5, right-sided Post-operative Diagnosis Lumbar spinal stenosis, L4-5 Herniated lumbar disc, far-lateral, L4-5, right-sided Operative Method Transforaminal lumbar interbody fusion, L4-5 Posterior instrumentation, transpedicular screws with rod fixation, L4, L5, bilateral Laminectomy, L5 Specimen Count And Types nil Pathology None Operative Findings Facet hypertrophy, ligmentum flavum hypertrophy, herniated lumbar disc at farlateral, right-sided, L4-5 Operative Procedures 1. ETGA, prone 2. Fluroscopic confirmation of L4-5 3. Routine preparation 4. Midline incision from L3 to S1, followed by subperiosteal dissection 5. Transpedicular screw insertion to L4 and L5, bilateral 6. Laminectomy of L5 7. Transforaminal approach for cage insertion with autologous bone graft impacted into L4-5 disc space, with fluoroscopic confirmation 8. Rod fixation 9. Hemovac placement and wound was closed in layers Operators VS VS 賴達明 Assistants R6 蔡宗良 記錄__ 手術科部: 外科部 套用罐頭: Transforaminal lumbar interbody fusion, L4-5 開立醫師: 蔡宗良 開立時間: 2011/11/25 09:16 Pre-operative Diagnosis Lumbar spinal stenosis, L4-5 Herniated lumbar disc, far-lateral, L4-5, right-sided Post-operative Diagnosis Lumbar spinal stenosis, L4-5 Herniated lumbar disc, far-lateral, L4-5, right-sided Operative Method Transforaminal lumbar interbody fusion, L4-5 Posterior instrumentation, transpedicular screws with rod fixation, L4, L5, bilateral Laminectomy, L5 Specimen Count And Types nil Pathology None Operative Findings Facet hypertrophy, ligmentum flavum hypertrophy, herniated lumbar disc at farlateral, right-sided, L4-5 Operative Procedures 1. ETGA, prone 2. Fluroscopic confirmation of L4-5 3. Routine preparation 4. Midline incision from L3 to S1, followed by subperiosteal dissection 5. Transpedicular screw insertion to L4 and L5, bilateral 6. Laminectomy of L5 7. Transforaminal approach for cage insertion with autologous bone graft impacted into L4-5 disc space, with fluoroscopic confirmation 8. Rod fixation 9. Hemovac placement and wound was closed in layers Operators VS 賴達明 Assistants R6 蔡宗良 陳鎔宏 (M,1983/08/31,28y6m) 手術日期 2011/11/08 手術主治醫師 蕭輔仁 手術區域 西址 039房 01號 診斷 Scalp tumor 器械術式 Scalp tumor 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 09:00 報到 09:00 進入手術室 09:28 麻醉開始 09:29 誘導結束 09:30 手術開始 10:03 麻醉結束 10:03 手術結束 10:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 頭皮腫瘤 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Scalp tumor excision 開立醫師: 曾峰毅 開立時間: 2011/11/08 10:18 Pre-operative Diagnosis Right occipital scalp tumor Post-operative Diagnosis Right occipital scalp tumor Operative Method Scalp tumor excision Specimen Count And Types One cystic tumor was sent for pathology. Pathology Pending Operative Findings One subgaleal cystic tumor, about 4x3x3 cm, containing pus-like material, was noted at right occipital area. Operative Procedures The patient was put in prone position. After scalp shaved, disinfected, and then draped, we made one longitudinal scalp inciaion at right occipital area. Tumor was dissected along the border, and was removed totally. The wound was irrigated with saline, and was closed in layers. Operators VS 蕭輔仁 Assistants R5 曾峰毅 Ri 廖君樺 相關圖片 李白菊 (F,1958/03/10,54y0m) 手術日期 2011/11/08 手術主治醫師 王國川 手術區域 西址 039房 02號 診斷 Carpal tunnel syndrome 器械術式 Decompression of mediun nerve 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 10:35 進入手術室 10:53 麻醉開始 10:54 誘導結束 10:55 手術開始 11:20 手術結束 11:20 麻醉結束 11:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 正中神經或尺神經腕部減壓術–單側 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: 其他 開立醫師: 曾峰毅 開立時間: 2011/11/08 11:31 Pre-operative Diagnosis Carpal tunnel syndrome, left Post-operative Diagnosis Carpal tunnel syndrome, left Operative Method Median nerve decompression, left Specimen Count And Types Nil Pathology Nil Operative Findings Hypertrophic transverse carpal ligament compromised left median nerve tightly. The nerve was decompressed well after the surgery. Operative Procedures The patient was put in supine position. We made one curvilinear skin incision at left wrist and dissected along the ulnar side of flexor carpi radialis. Transverse carpal ligement was transected to release median nerve. The wound was closed in layers. Operators VS 王國川 Assistants R5 曾峰毅 Ri 廖君樺 相關圖片 蔡豐舟 (M,1935/11/22,76y3m) 手術日期 2011/11/09 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Carotid stenosis 器械術式 Left carotid endarterectomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 07:37 報到 08:08 進入手術室 08:18 麻醉開始 08:45 誘導結束 09:00 抗生素給藥 09:27 手術開始 11:33 麻醉結束 11:33 手術結束 11:44 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 動脈內膜切除術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Carotid endarterectomy, left 開立醫師: 曾偉倫 開立時間: 2011/11/09 12:16 Pre-operative Diagnosis Left proximal internal carotid artery stenosis Post-operative Diagnosis Left proximal internal carotid artery stenosis Operative Method Carotid endarterectomy, left Specimen Count And Types nil Pathology Nil. Operative Findings 70-80% stenosis over the left proximal ICA was found in the pre-operative angiography. Yellow-whitish athrosclerotic plaque was found over left common carotid artery with extsnion to internal and external carotid artery. The ischemic time was 24mins 52 secs. The SSEP and MEP showed no change during the procedure. The recurrent laryngel nerve was divided and well preserved. Operative Procedures Under ETGA, we placed the patient over supine position with his face tile to right. His neck was extended and we made a horizontal linear skin incision below the left mandible about 3cm. The wound was opened in layers and the platysma was divided. The wound was opened in layers alone the anterior surface of sternal-cleiomastoid muscle. The carotid sheath was seperated from internal jugular vein and the sheath was opened with knife and scissors. The carotid artery was exposed after meticulus dissection and the carotid sheath was opened with scissors. The soft tissue around the carotid artery was divided and we looped the CCA, ICA and ECA. The ICA was elevated with gauze packing. We opened the adventisia of ICA with knife. The athrosclerotic plaque was divided from the adventisia with dissector and knife. The CCA clamping was done followed by ICA clamping. The athrosclerotic plaque was resected with disseector, scissors and knife. After resecting the plaque, we closed the adventisia with 4-0 Prolene. The CCA clamp was opened. De-air was done before opening the ICA clamp. The wound was closed in layers with 4-0 vicryl sub-cutaneously. Operators Prof. 杜永光 Assistants R6 鍾文桂 R3 曾偉倫 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Carotid endarterectomy, left 開立醫師: 曾偉倫 開立時間: 2011/11/09 12:16 Pre-operative Diagnosis Left proximal internal carotid artery stenosis Post-operative Diagnosis Left proximal internal carotid artery stenosis Operative Method Carotid endarterectomy, left Specimen Count And Types nil Pathology Nil. Operative Findings 70-80% stenosis over the left proximal ICA was found in the pre-operative angiography. Yellow-whitish athrosclerotic plaque was found over left common carotid artery with extsnion to internal and external carotid artery. The ischemic time was 24mins 52 secs. The SSEP and MEP showed no change during the procedure. The recurrent laryngel nerve was divided and well preserved. Operative Procedures Under ETGA, we placed the patient over supine position with his face tile to right. His neck was extended and we made a horizontal linear skin incision below the left mandible about 3cm. The wound was opened in layers and the platysma was divided. The wound was opened in layers alone the anterior surface of sternal-cleiomastoid muscle. The carotid sheath was seperated from internal jugular vein and the sheath was opened with knife and scissors. The carotid artery was exposed after meticulus dissection and the carotid sheath was opened with scissors. The soft tissue around the carotid artery was divided and we looped the CCA, ICA and ECA. The ICA was elevated with gauze packing. We opened the adventisia of ICA with knife. The athrosclerotic plaque was divided from the adventisia with dissector and knife. The CCA clamping was done followed by ICA clamping. The athrosclerotic plaque was resected with disseector, scissors and knife. After resecting the plaque, we closed the adventisia with 4-0 Prolene. The CCA clamp was opened. De-air was done before opening the ICA clamp. The wound was closed in layers with 4-0 vicryl sub-cutaneously. Operators Prof. 杜永光 Assistants R6 鍾文桂 R3 曾偉倫 相關圖片 樂敏婉 (F,1958/03/28,53y11m) 手術日期 2011/11/09 手術主治醫師 杜永光 手術區域 東址 003房 02號 診斷 Lumbar spondylosis 器械術式 T8-9 laminectomy for decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 2 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 12:05 進入手術室 12:15 麻醉開始 12:30 誘導結束 12:40 抗生素給藥 13:05 手術開始 15:45 手術結束 15:45 麻醉結束 15:50 抗生素給藥 16:00 送出病患 16:07 進入恢復室 17:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 椎弓切除術(減壓)-二節以內 1 1 記錄__ 手術科部: 外科部 套用罐頭: T8 laminectomy 開立醫師: 曾偉倫 開立時間: 2011/11/09 16:21 Pre-operative Diagnosis T-spine stenosis, T8 with myelopathy Post-operative Diagnosis T-spine stenosis, T8 with myelopathy Operative Method T8 laminectomy Specimen Count And Types nil Pathology Nil Operative Findings Hypertrophic ligmentum flavum over T8-9-10 level. A large osteophyte was found below the left side of T8 lamina which compressed the cord severly. Previous laminectomy has been done over T9-10 with post operative change. The cord became loose after the laminectomy. There was no SSEP change during the operation but the MEP was not done. Left leg weakness was noted after she got awake, thus Megadose steroid was given. Operative Procedures Under ETGA, we placed the patient over prone position. The T8 level was located with C-arm. Horizontal linear skin incision was done and the wound was opened in layers. The para-spinal muscle was divided and the T8 spinus process and lamina was exposed with Dissector, electrocautery, Rasper, and scissors. Laminectomy was performed over the T8 level with Rongour, Kerrison punch after removing the spinous process on T8-9. The hypertrophic ligmentum flavum was also resected. The osteophyte below the left T8 lamina was removed with kerrison punch. We covered the spinal cored dura with Gelfoam and complete hemostasis was achived. We closed the wound in layers with 2-0 Vicryl and 3-0 Nylon. Operators Prof. 杜永光 Assistants R6 鍾文桂 R3 曾偉倫 相關圖片 畢台興 (M,1959/02/07,53y1m) 手術日期 2011/11/09 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Malignant neoplasm of cerebrum, except lobes and ventricles 器械術式 Right frontal GBM excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 2 紀錄醫師 張哲瑋, 時間資訊 00:00 臨時手術NPO 11:50 報到 12:43 進入手術室 12:45 麻醉開始 13:00 誘導結束 13:00 抗生素給藥 13:02 手術開始 16:00 抗生素給藥 16:10 麻醉結束 16:10 手術結束 16:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT 開立醫師: 曾峰毅 開立時間: 2011/11/09 16:27 Pre-operative Diagnosis Glioblastoma at right frontal area, status post craniotomy for tumor excision, status post CCRT, recurrence Post-operative Diagnosis Glioblastoma at right frontal area, status post craniotomy for tumor excision, status post CCRT, recurrence Operative Method Right frontal craniotomy for tumor excision Specimen Count And Types One tumor was sent for pathology. Pathology Frozen section: high grade glioma with focal necrosis Operative Findings Hypervascular, 3x3x3 cm soft, fragile, greyish tumor was noted at posterior portion, and beneath the posterior edge of previous craniotomy window. Sonography showed isoechogenecity, and thus the tumor can not be delineated well under sonography. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to left. We shaved, scrubbed, disinfected, and then draped the patient. We made scalp incision along previous right frontal curvilinear skin incision, and another excision for extended craniotomy. We removed mini-plates and screws to remove the craniotomy graft, and extended the craniotomy window posteriorly. WE made durotomy, and performed sonography to located the tumor. We sent sepcimens for frozen section, and performed gross total tumor excision. Hemostasis was performed. Duroplasty was performed with water-tight suture. Bone graft was fixed back with mini-plates. The wound was closed in layers. Operators VS 曾漢民 Assistants R5 曾峰毅 R1 張哲瑋 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT 開立醫師: 張哲瑋 開立時間: 2011/11/09 16:31 Pre-operative Diagnosis Glioblastoma at right frontal area, status post craniotomy for tumor excision, status post CCRT, recurrence Post-operative Diagnosis Glioblastoma at right frontal area, status post craniotomy for tumor excision, status post CCRT, recurrence Operative Method Right frontal craniotomy for tumor excision Specimen Count And Types One tumor was sent for pathology. Pathology Frozen section: high grade glioma with focal necrosis Operative Findings Hypervascular, 3x3x3 cm soft, fragile, greyish tumor was noted at posterior portion, and beneath the posterior edge of previous craniotomy window. Sonography showed isoechogenecity, and thus the tumor can not be delineated well under sonography. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to left. We shaved, scrubbed, disinfected, and then draped the patient. We made scalp incision along previous right frontal curvilinear skin incision, and another excision for extended craniotomy. We removed mini-plates and screws to remove the craniotomy graft, and extended the craniotomy window posteriorly. WE made durotomy, and performed sonography to located the tumor. We sent sepcimens for frozen section, and performed gross total tumor excision. Hemostasis was performed. Duroplasty was performed with water-tight suture. Bone graft was fixed back with mini-plates. The wound was closed in layers. Operators VS 曾漢民 Assistants R5 曾峰毅 R1 張哲瑋 相關圖片 李福銘 (M,1944/10/11,67y5m) 手術日期 2011/11/09 手術主治醫師 曾漢民 手術區域 東址 005房 03號 診斷 Pituitary tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 2 紀錄醫師 張哲瑋, 時間資訊 00:00 臨時手術NPO 16:30 進入手術室 16:35 麻醉開始 16:55 誘導結束 16:55 抗生素給藥 17:24 手術開始 18:35 手術結束 18:35 麻醉結束 19:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經由蝶竇之腦下垂體瘤切除 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: Hypophysectomy---Transphenoid 開立醫師: 曾峰毅 開立時間: 2011/11/09 18:38 Pre-operative Diagnosis Pituitary tumor Post-operative Diagnosis Pituitary tumor Operative Method Trans-sphenoidal adenomectomy, failed Specimen Count And Types Nil Pathology Nil Operative Findings Hypoplastic sphenoid sinus, and thinned frontal base was noted from the images. After vomer was knocked down, no obvious sphenoidal sinus was noted, and frontal base dura exposure was suspected. Venous bleeding was encountered. Blood loss was about 600 ml. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with neck extended. We scrubbed, disinfected, and then draped the patient as usual. We made one mucosa incision at medial side of the left nostril. We knocked out the vomer. Hemostasis was performed, and bilateral nostrils were packed. Operators VS 曾漢民 Assistants R5 曾峰毅 R1 張哲瑋 記錄__ 手術科部: 外科部 套用罐頭: Hypophysectomy---Transphenoid 開立醫師: 張哲瑋 開立時間: 2011/11/09 19:07 Pre-operative Diagnosis Pituitary tumor Post-operative Diagnosis Pituitary tumor Operative Method Trans-sphenoidal adenomectomy, failed Specimen Count And Types Nil Pathology Nil Operative Findings Hypoplastic sphenoid sinus, and thinned frontal base was noted from the images. After vomer was knocked down, no obvious sphenoidal sinus was noted, and frontal base dura exposure was suspected. Venous bleeding was encountered. Blood loss was about 600 ml. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with neck extended. We scrubbed, disinfected, and then draped the patient as usual. We made one mucosa incision at medial side of the left nostril. We knocked out the vomer. Hemostasis was performed, and bilateral nostrils were packed. Operators VS 曾漢民 Assistants R5 曾峰毅 R1 張哲瑋 陳正雄 (M,1943/11/26,68y3m) 手術日期 2011/11/09 手術主治醫師 王碩盟 手術區域 東址 008房 01號 診斷 Urinary retention 器械術式 Cystoscopy 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 靜脈麻醉 麻醉主治醫師 林佩玲 ASA 3 紀錄醫師 陳柏誠, 時間資訊 07:50 報到 08:07 進入手術室 08:16 麻醉開始 08:18 誘導結束 08:25 手術開始 08:55 手術結束 08:55 麻醉結束 09:00 送出病患 09:05 進入恢復室 11:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 膀胱造口術 1 1 手術 膀胱鏡檢查 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 記錄__ 手術科部: 泌尿部 套用罐頭: cystostomy, trocar 開立醫師: 陳柏誠 開立時間: 2011/11/09 09:10 Pre-operative Diagnosis Neurogenic bladder, enlarged prostate Post-operative Diagnosis Neurogenic bladder, enlarged prostate, bladder stone Operative Method Trocar cystostomy Trocar cystostomy cystoscopy Specimen Count And Types nil Pathology nil Operative Findings 1.bilateral kissing prostate, easily bleeding with some engorged vessels near bladder neck 2.some small bladder stones in bladder 3.bladder trabeculation Operative Procedures Under satisfactory anesthesia with the patient in lithotomy position, prepping and drapping was performed in the usual sterile fashion. A Fr 21 Olympus cystoscope was introduced into the bladder cavity under direct vision. Careful inspectionrevealed bilateral ureteral orifice was normal. After hydrodistention of bladder was done, trocar cystostomy was performed under optic guidance. A Fr 16 catheter was inserted. 3 way 22 Fr. Foley was inserted. Patient tolerated the procedure very well and was sent to recovery room in satisfactory condition. Operators 王碩盟, Assistants 陳柏誠, 伍嘉偉, 陳美枝 (F,1972/12/30,39y2m) 手術日期 2011/11/09 手術主治醫師 賴達明 手術區域 東址 003房 03號 診斷 HIVD 器械術式 L5-S1 microdiskectomy 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 2 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 15:28 報到 16:18 進入手術室 16:30 麻醉開始 16:40 誘導結束 16:50 抗生素給藥 16:50 手術開始 19:33 手術結束 19:33 麻醉結束 19:40 送出病患 19:42 進入恢復室 21:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 椎間盤切除術-腰椎 1 1 記錄__ 手術科部: 外科部 套用罐頭: Microsurgical diskectomy, L5-S1 開立醫師: 曾偉倫 開立時間: 2011/11/09 19:43 Pre-operative Diagnosis Herniated intervetebral disc, L5-S1 level Post-operative Diagnosis Herniated intervetebral disc, L5-S1 level Operative Method Microsurgical diskectomy, L5-S1 Specimen Count And Types nil Pathology Nil. Operative Findings A ruptured disk fragment over right side of the thecal sac which compressed the L5 root. The annulus fibrosis was opened with knife and part of the disc was removed. The root became loose after the disc fragment removed. Operative Procedures Under ETGA, we placed the patient on prone position. The L5-S1 level was located with C-arm and the skin was marked. A linear sin incision wa made and the wound was opened in lyers. The right side of paraspinal muscle was disseced with Rasper, electrocautery and scissors. The Tayler hook was applied after the left side laminar and facet joint was exposed. After opening the interlaminar ligament, hemilaminectomy of L5 and S1 was done for wider operation field. The fragmented disc was found and removed. Part of the disc was removed after we opened the annulus fibrosis with curette. Operators VS 賴達明 Assistants R6 鍾文桂 R3 曾偉倫 相關圖片 游象成 (M,1949/03/01,63y0m) 手術日期 2011/11/09 手術主治醫師 賴達明 手術區域 東址 005房 01號 診斷 Cervical spondylosis 器械術式 C3-4, 5-6 cervical diskectomy 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 2 紀錄醫師 張哲瑋, 時間資訊 00:00 臨時手術NPO 08:13 進入手術室 08:17 麻醉開始 08:30 誘導結束 08:56 抗生素給藥 09:00 手術開始 11:58 手術結束 11:58 麻醉結束 12:16 送出病患 12:18 進入恢復室 13:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-頸椎 1 1 手術 椎間盤切除術-頸椎 1 2 手術 脊椎融合術-前融合,有固定物)≦四節 1 4 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 摘要__ 手術科部: 外科部 套用罐頭: Anterior Discectomy and Fusion, Cervical Spine 開立醫師: 曾峰毅 開立時間: 2011/11/09 12:09 Pre-operative Diagnosis HIVD, C3/4 and C5/6 Post-operative Diagnosis HIVD, C3/4 and C5/6 Operative Method Anterior cervical diskectomy at C3/4 and C5/6, anterior arthroplasty at C3/4, and anteior cervical fusion with PEEK cage and artificial bone graft at C5/6 Specimen Count And Types Nil Pathology Nil Operative Findings Denerated cervical disc at C3/4 and C5/6 compromised thecal sac and neural foramen tightly. Neural structures were decompressed well after the surgery. Synthes cervical articial disc was placed at C3/4, and PEEK cage with articial bone graft was used for fusion at C5/6 Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position. The neck was scrubbed, disinfected, and then draped. We made one transverse skin incision at right aspect of the neck, and dissected the medial side of the platysma to the pre-vertebral space. After C-arm localization, we made C3/4 diskectomy and implanted artificial disc. We made antoher C5/6 diskectomy, and fusion was performed with PEEK cage and artificial bone graft. The wound was closed in layers. Operators VS 賴達民 Assistants R5 曾峰毅 R1 張哲瑋 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Anterior Discectomy and Fusion, Cervical Spine 開立醫師: 張哲瑋 開立時間: 2011/11/09 12:23 Pre-operative Diagnosis HIVD, C3/4 and C5/6 Post-operative Diagnosis HIVD, C3/4 and C5/6 Operative Method Anterior cervical diskectomy at C3/4 and C5/6, anterior arthroplasty at C3/4, and anteior cervical fusion with PEEK cage and artificial bone graft at C5/6 Specimen Count And Types Nil Pathology Nil Operative Findings Denerated cervical disc at C3/4 and C5/6 compromised thecal sac and neural foramen tightly. Neural structures were decompressed well after the surgery. Synthes cervical articial disc was placed at C3/4, and PEEK cage with articial bone graft was used for fusion at C5/6 Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position. The neck was scrubbed, disinfected, and then draped. We made one transverse skin incision at right aspect of the neck, and dissected the medial side of the platysma to the pre-vertebral space. After C-arm localization, we made C3/4 diskectomy and implanted artificial disc. We made antoher C5/6 diskectomy, and fusion was performed with PEEK cage and artificial bone graft. The wound was closed in layers. Operators VS 賴達民 Assistants R5 曾峰毅 R1 張哲瑋 相關圖片 李賢塗 (M,1948/03/10,64y0m) 手術日期 2011/11/09 手術主治醫師 陳敞牧 手術區域 東址 003房 04號 診斷 Neutropenic fever 器械術式 T-spine laminectomy for decompression 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 4E 紀錄醫師 李振豪, 時間資訊 16:00 臨時手術NPO 16:00 開始NPO 20:23 通知急診手術 21:50 進入手術室 22:00 開始輸血 22:00 麻醉開始 22:30 誘導結束 22:39 抗生素給藥 23:01 手術開始 01:10 手術結束 01:10 麻醉結束 01:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 椎弓切除術(減壓)-超過二節 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 記錄__ 手術科部: 內科部 套用罐頭: T8-10 laminectomy for abscess drainage 開立醫師: 李振豪 開立時間: 2011/11/10 01:36 Pre-operative Diagnosis T8-10 epidural abscess with osteomyelitis Post-operative Diagnosis T8-10 epidural abscess with osteomyelitis Operative Method T8-10 laminectomy for abscess drainage Specimen Count And Types 1 piece About size:culture swab x III Source:epidural abscess Pathology Nil Operative Findings Frank pus gushed out during laminectomy with foul smell. The epidural space was adhered with adjacent bony structure with some infectious granulation tissue. After T8 to T10 laminectomy, the infectious granulation tissue and abscess were all removed. Three culture swab was sampled and sent for bacterial, fungal, and mycobacterial culture. No incidental durotomy or active CSF leakage was noted during whole procedure. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position. T8 to T11 pedicle level was localized by portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made from T8 to T11 level. The subcutaneous soft tissue was devided and the paravertebral muscle group were detached. T8 to T10 laminectomy was performed with Ronguer, Kerrison punches, and curette. The epidural abscess and infectious granulation tissue was removed and three culture swab was sampled. Hemostasis was achieved with bipolar electrocautery and bonewax. The wound was irrigated with Gentamicin and Vancomycin solution. One epidural CWV drain was placed. The wound was then closed in layers with 1-0, 2-0 Vicryl and 3-0 Nylon. Operators VS陳敞牧 Assistants R5李振豪, PGY連子賢 Indication Of Emergent Operation Epidural abscess with paraplegia and sepsis 鄭春為 (M,1939/04/12,72y11m) 手術日期 2011/11/09 手術主治醫師 陳敞牧 手術區域 東址 002房 02號 診斷 Lumbar spine fracture 器械術式 Spinal fusion posterior 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 08:49 通知急診手術 09:48 報到 10:10 進入手術室 10:25 麻醉開始 10:50 抗生素給藥 10:50 誘導結束 11:10 手術開始 13:50 抗生素給藥 15:40 手術結束 15:40 麻醉結束 15:49 送出病患 15:50 進入恢復室 17:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術(減壓)-超過二節 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 記錄__ 手術科部: 外科部 套用罐頭: T11, T12, L2, and L3 transpedicular screws fo... 開立醫師: 李振豪 開立時間: 2011/11/09 16:12 Pre-operative Diagnosis L1 compression fracture with cauda equina syndrome Post-operative Diagnosis L1 compression fracture with cauda equina syndrome Operative Method T11, T12, L2, and L3 transpedicular screws for posterior instrumentation + T12 to L2 laminectomy for decompression Specimen Count And Types nil Pathology Nil Operative Findings Severe osteoporosis was noted during the operation. Scoliosis and rotated deformity of the spine was noted by portable C-arm X-ray. The cortex of vertebra was thin and the cancellous bone within the vertebral body was nearly vanished. During probing right L2 pedicle with pedicle finder, the pedicle fracture with suspect CSF leakage. The fracture site was packing with Gelfoam to avoid abrasion of the nerve root. Under C-arm guided, total eight transpedicular screws were implanted into T11, T12, L2, and L3(T-spine: 5.5 x 40mm, L-spine: 6.2 x 45mm). Two 17cm rods and one cross-link were applied for posterior instrumentation. T12 to L2 laminectomy was performed for posterior decompression. The thecal sac expanded well after decompression. We tried to approach L1 compression but failed to reduction the bony fragment. No active CSF leakage was found after we perform laminectomy. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position. T11 to L3 pedicle level was localized by portable C-arm. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made and the subcutaneous soft tissue was devided. The paravertebral muscle groups were detached. T11, T12, L2, and L3 transpedicular screws were implanted under C-arm guided. T12 to L2 laminectomy was conducted for posterior decompression. Anterior decomression was tried by failed due to difficult approach. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. The rods were applied for set up of posterior instrumentation. One epidural CWV drain was placed. The wound was then closed in layers with 1-0, 2-0 Vicryl and 3-0 Nylon. Operators VS陳敞牧 Assistants R5李振豪, R1張書豪 Indication Of Emergent Operation Cauda equina syndrome 林燕玉 (F,1960/05/17,51y9m) 手術日期 2011/11/09 手術主治醫師 王國川 手術區域 東址 022房 06號 診斷 Subarachnoid hemorrhage 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 蔡宗良, 時間資訊 00:00 臨時手術NPO 15:30 報到 15:45 進入手術室 15:50 麻醉開始 15:55 誘導結束 16:20 抗生素給藥 16:23 手術開始 17:10 手術結束 17:10 麻醉結束 17:20 送出病患 17:21 進入恢復室 18:21 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Ventriculo-peritoneal shunt, via left-sided K... 開立醫師: 蔡宗良 開立時間: 2011/11/09 17:17 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculo-peritoneal shunt, via left-sided Kochers point Specimen Count And Types nil Pathology Nil Operative Findings ICP: moderate Operative Procedures 1. ETGA, supine, head rotated towards the right 2. Routine preparation 3. Scalp incision at the left-sided Kochers point 4. Mini-laparotomy was performed 5. Codman fixed pressure 10 mmH2O was installed 6. Wound was closed in layers Operators VS 王國川 Assistants R6 蔡宗良 黃碧玉 (F,1945/12/12,66y3m) 手術日期 2011/11/09 手術主治醫師 蔡清霖 手術區域 東址 021房 02號 診斷 Fracture, humerus 器械術式 ORIF - Lockingplate (Hand) 手術類別 臨時手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3 紀錄醫師 范垂嘉, 時間資訊 10:55 進入手術室 11:00 麻醉開始 11:10 誘導結束 11:17 抗生素給藥 11:30 手術開始 12:35 抗生素給藥 13:25 手術結束 13:25 麻醉結束 13:30 送出病患 13:35 進入恢復室 15:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 開放性或閉鎖性肱骨粗隆或骨幹或踝部骨折,開放性復位術 1 1 L 手術 石膏副木固定－長臂 1 0 L 摘要__ 手術科部: 骨科部 套用罐頭: ORIF with Zimmer ULS (Dual compression plate,... 開立醫師: 范垂嘉 開立時間: 2011/11/09 13:37 Pre-operative Diagnosis Left humerus distal shaft fracture Post-operative Diagnosis Left humerus distal shaft fracture Operative Method ORIF with Zimmer ULS (Dual compression plate, 7 screws) and interfragmentary screws x3 Specimen Count And Types nil Pathology nil Operative Findings 1.Left humerus distal shaft fracture, with a large butterfly fragment 2.The radial nerve was grossly intact 3.The radial nerve was placed between the most and second proximal screws Operative Procedures 1.GA, right decubitus 2.Prep and drape the left upper limb 3.Posterior longitudinal incision, triceps splitting to the humerus 4.Identify and protect and radial nerve 5.Open reduction and internal fixation with interfragmentary screws x3 and clamps 6.Internal fixation with Zimmer ULS (Dual compression plate, 7 screws) 7.Irrigate and close the wound in layers 8.Apply long-arm splint Operators 蔡清霖 Assistants 陳彥宇,范垂嘉,許寬宏 記錄__ 手術科部: 骨科部 套用罐頭: ORIF with Zimmer ULS (Dual compression plate,... 開立醫師: 范垂嘉 開立時間: 2011/11/09 13:37 Pre-operative Diagnosis Left humerus distal shaft fracture Post-operative Diagnosis Left humerus distal shaft fracture Operative Method ORIF with Zimmer ULS (Dual compression plate, 7 screws) and interfragmentary screws x3 Specimen Count And Types nil Pathology nil Operative Findings 1.Left humerus distal shaft fracture, with a large butterfly fragment 2.The radial nerve was grossly intact 3.The radial nerve was placed between the most and second proximal screws Operative Procedures 1.GA, right decubitus 2.Prep and drape the left upper limb 3.Posterior longitudinal incision, triceps splitting to the humerus 4.Identify and protect and radial nerve 5.Open reduction and internal fixation with interfragmentary screws x3 and clamps 6.Internal fixation with Zimmer ULS (Dual compression plate, 7 screws) 7.Irrigate and close the wound in layers 8.Apply long-arm splint Operators 蔡清霖 Assistants 陳彥宇,范垂嘉,許寬宏 王國榮 (M,1950/11/24,61y3m) 手術日期 2011/11/09 手術主治醫師 洪學義 手術區域 東址 001房 05號 診斷 Cellulitis 器械術式 Finger,Toe amputation 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 2E 紀錄醫師 趙崧筌, 時間資訊 14:00 臨時手術NPO 14:00 開始NPO 16:10 通知急診手術 21:50 麻醉開始 21:57 進入手術室 22:00 誘導結束 22:10 手術開始 22:43 麻醉結束 22:43 手術結束 22:50 送出病患 22:50 進入恢復室 23:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 四肢切斷術-指、趾 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Toe amputation 開立醫師: 趙崧筌 開立時間: 2011/11/09 23:01 Pre-operative Diagnosis Left 4th and 5th toe wet gangrene Post-operative Diagnosis Left 4th and 5th toe wet gangrene Operative Method Toe amputation Specimen Count And Types 1 piece About size: Source:left 4th and 5th gangrenous toe Pathology Pending Operative Findings The left 4th and 5th gangrenous toe were amputated at metatarsal head and the 3th toe fibular side skin was also found unhealthy. The wound was left open after toes amputation. Operative Procedures ETGA, supine, disinfected and prepped Performed toe amputation Covered the exposed bone by sorrunding soft tissue Applied wet dressing and elastic bandage Operators 洪學義 Assistants 趙崧筌 Indication Of Emergent Operation Left 4th and 5th toe wet gangrene 記錄__ 手術科部: 外科部 套用罐頭: Toe amputation 開立醫師: 趙崧筌 開立時間: 2011/11/09 23:01 Pre-operative Diagnosis Left 4th and 5th toe wet gangrene Post-operative Diagnosis Left 4th and 5th toe wet gangrene Operative Method Toe amputation Specimen Count And Types 1 piece About size: Source:left 4th and 5th gangrenous toe Pathology Pending Operative Findings The left 4th and 5th gangrenous toe were amputated at metatarsal head and the 3th toe fibular side skin was also found unhealthy. The wound was left open after toes amputation. Operative Procedures ETGA, supine, disinfected and prepped Performed toe amputation Covered the exposed bone by sorrunding soft tissue Applied wet dressing and elastic bandage Operators 洪學義 Assistants 趙崧筌 Indication Of Emergent Operation Left 4th and 5th toe wet gangrene 陳姿佑 (F,2007/05/07,4y10m) 手術日期 2011/11/10 手術主治醫師 張重義 手術區域 兒醫 067房 03號 診斷 Complex congenital heart disease 器械術式 TCPC,JATENE,TAPVR,NORWOOD 請排二位刷手 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 4 紀錄醫師 黃世銘, 時間資訊 11:25 報到 11:50 進入手術室 11:55 麻醉開始 12:35 誘導結束 12:40 抗生素給藥 13:00 手術開始 15:40 抗生素給藥 18:30 開始輸血 20:20 麻醉結束 20:20 手術結束 20:32 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 9 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 T.E.E 1 0 麻醉 動脈血液檢查全套 4 0 麻醉 Hemoglobin (Hb) 4 0 麻醉 測血糖 4 0 麻醉 Ca (Calcium) 4 0 麻醉 Na (Sodium) 4 0 麻醉 K (Potassium) 4 0 麻醉 Blood gas analysis 4 0 手術 心房–肺動脈迴路成形術 1 1 手術 人工 A.S.D 血流進口阻斷法 1 2 手術 體外心肺循環 1 1 記錄__ 手術科部: 外科部 套用罐頭: TCPC with 4.5mm fenestration 開立醫師: 黃世銘 開立時間: 2011/11/25 15:58 Pre-operative Diagnosis RAI, DORV, TAPVR s/p Bilateral BDG creation Post-operative Diagnosis Ditto Operative Method TCPC with 4.5mm fenestration Specimen Count And Types nil Pathology Nil Operative Findings 1. Severe pericardial adhesion 2. Pre-OP PAP=9mmHg, SpO2 90%(FiO2 21%); Post-OP PAP=18mmHg, SpO2 99%(FiO2 60%) 3. TCPC: 18mm GoreTex graft with 4.5mm fenestration 4. Surgical membrane coverage heart Operative Procedures 1. Under ETGA with supine position 2. Disinfected and well drapped 3. Resternotomy 4. Cannulate via AoAo/RA->SVC/IVC. On CPB. Cooling to 28 degree Celsius 5. AXC and antegrade cardioplegia infusion. Cardiac arrest 6. TCPC creation with 18mm GoreTex graft and 4.5mm fenestration creation 7. Rewarm. Deair. Weaning off CPB 8. Hemostasis and set 4 chest tubes 9. Wound closure in layer Operators VS張重義 Assistants F徐綱宏, R3黃世銘 相關圖片 蔡聿澤 (M,2007/05/01,4y10m) 手術日期 2011/11/10 手術主治醫師 郭夢菲 手術區域 兒醫 066房 03號 診斷 Unspecified cause of encephalitis 器械術式 Brain tumor Crainotomy(Others) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 2E 紀錄醫師 游健生, 時間資訊 00:05 臨時手術NPO 00:05 開始NPO 08:00 通知急診手術 15:55 報到 16:00 進入手術室 16:05 麻醉開始 16:50 誘導結束 17:00 抗生素給藥 17:25 手術開始 19:25 麻醉結束 19:25 手術結束 19:29 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 腦瘤切除-手術時間在4小時以內 1 1 R 摘要__ 手術科部: 套用罐頭: Right temporal craniotomy for tumor excision 開立醫師: 游健生 開立時間: 2011/11/10 20:16 Pre-operative Diagnosis Multiple brain tumors Post-operative Diagnosis Multiple brain tumors Operative Method Right temporal craniotomy for tumor excision Specimen Count And Types 2 pieces About size:a few small pieces Source:tumor at sulcus between sup. and middle temporal gyrus About size:a few small pieces Source:tumor at sup. temporal gyrus Pathology Pending Frozen section: inflammatory changes with calcification Operative Findings Severe brain swelling was noted. There was a hypervascularized region at superior and middle temporal gyrus. The region was ill-defined and soft with a few whitish plaque scattered near the sulcus. Some tissue were sent for bacterial, fungus, and TB culture. Operative Procedures Under ETGA, patient was in supine position with head rotated to left. After shaving, we disinfected and draped the operation field as usual. A 5cm linear scalp incision was made 1cm anterior to tragus. The temporalis muscle was splitted vertically and retracted. A 4cm craniotomy was created after a burhole. After dura tenting along craniotomy border, the dura was opened. Mannitol and hyperventilation were used to make brain slack. The hypervascularized region was identified and excised with tumor forcep and bipolar. After hemostasis, the rough surface was covered with Gelfoam. Due to bulging brain, the dura was closed loosely with a DuraForm placed underneath. After central tenting, bone flap was fixed back with wires. Temporalis muscle was approximated. Wound was closed in layers with 3-0 Vircyl and 4-0 Nylon. Operators VS 郭夢菲 Assistants R4 游健生 Indication Of Emergent Operation multiple brain tumor with brain swelling and cons. changes 相關圖片 記錄__ 手術科部: 套用罐頭: Right temporal craniotomy for tumor excision 開立醫師: 郭夢菲 開立時間: 2011/11/11 09:19 Pre-operative Diagnosis Multiple brain lesions, suspect inflammation, infection or tumors Post-operative Diagnosis Multiple brain lesions, suspect inflammation or infection Operative Method Right temporal craniotomy for tumor excision Specimen Count And Types 2 pieces About size:a few small pieces Source:tumor at sulcus between sup. and middle temporal gyrus About size:a few small pieces Source:tumor at sup. temporal gyrus Pathology Pending Frozen section: suspect inflammatory changes with calcification Operative Findings Severe brain swelling was noted but the brain was still soft. the cortical surface was diffusely hyperemic. We chose the hypervascular sulcus between the right superior and middle temporal gyri for tissue prooving. The region was ill-defined and soft with a few whitish plaque on the surface. We also took another surface tissue from the right superior temproal gyrus for pathology. The brain tissue was also sent for bacterial, fungus, and TB cultures. Operative Procedures Under ETGA, patient was in supine position with head rotated to left. After shaving, we disinfected and draped the operation field as usual. A 5cm linear scalp incision was made 1cm anterior to tragus. The temporalis muscle was splitted vertically and retracted. A 4cm craniotomy was created after a burrhole. After dura tenting along craniotomy border, the dura was opened. Mannitol and hyperventilation were used to make brain slack. The hypervascularized region was identified and excised with tumor forcep and bipolar. After hemostasis, the rough surface was covered with Gelfoam. Due to bulging brain, the dura was closed with a DuraForm placed underneath. After central tenting, bone flap was fixed back with 3 wires. Temporalis muscle was approximated. Wound was closed in layers with 3-0 Vircyl and 4-0 Nylon. Operators VS 郭夢菲 Assistants R4 游健生 Indication Of Emergent Operation multiple brain tumor with brain swelling and cons. changes 相關圖片 陳許白棗 (F,1935/02/02,77y1m) 手術日期 2011/11/10 手術主治醫師 陳敞牧 手術區域 東址 003房 03號 診斷 Spinal stenosis, lumbar 器械術式 L3-5 sublaminar decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 施培艾, 時間資訊 00:00 臨時手術NPO 12:07 進入手術室 12:10 麻醉開始 12:20 誘導結束 12:30 抗生素給藥 13:30 手術開始 15:30 抗生素給藥 16:40 手術結束 16:40 麻醉結束 16:45 送出病患 16:50 進入恢復室 18:01 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 椎弓切除術(減壓)-超過二節 1 1 摘要__ 手術科部: 外科部 套用罐頭: L3/4 & L4/5 laminotomy for sublaminar decompr... 開立醫師: 王奐之 開立時間: 2011/11/10 16:59 Pre-operative Diagnosis L3-5 spinal stenosis Post-operative Diagnosis L3-5 spinal stenosis Operative Method L3/4 & L4/5 laminotomy for sublaminar decompression Specimen Count And Types Nil Pathology Nil Operative Findings Very thick ligamentum flavum was noted, which compressed the thecal sac tightly. The dura became very thin, a small unintentional durotomy was encountered at L3/4 level without obvious CSF leakage. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position. After localization of L3/4 & L4/5 level with C-arm, the back was scrubbed, disinfected & draped in sterile fashion, a midline linear incision was made at lower back. The incision was deepened through fascial layer, the left side paraspinal muscles were detached until the lamina was exposed. Taylor retractor was then applied, and the L3/4 interlaminary space was identified. Small laminotomies were done on lower L3 & upper L4 lamina, and the ligamentum flavum was removed in pieces with Kerrison punch under microscopic view. The same procedure was repeated at L4/5 level. After Gelfoam packing and hemostasis, the wound was closed in layers. Operators VS 陳敞牧 Assistants R4 王奐之, R0 施培艾 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: L3/4 & L4/5 laminotomy for sublaminar decompr... 開立醫師: 王奐之 開立時間: 2011/11/10 17:00 Pre-operative Diagnosis L3-5 spinal stenosis Post-operative Diagnosis L3-5 spinal stenosis Operative Method L3/4 & L4/5 laminotomy for sublaminar decompression Specimen Count And Types Nil Pathology Nil Operative Findings Very thick ligamentum flavum was noted, which compressed the thecal sac tightly. The dura became very thin, a small unintentional durotomy was encountered at L3/4 level without obvious CSF leakage. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position. After localization of L3/4 & L4/5 level with C-arm, the back was scrubbed, disinfected & draped in sterile fashion, a midline linear incision was made at lower back. The incision was deepened through fascial layer, the left side paraspinal muscles were detached until the lamina was exposed. Taylor retractor was then applied, and the L3/4 interlaminary space was identified. Small laminotomies were done on lower L3 & upper L4 lamina, and the ligamentum flavum was removed in pieces with Kerrison punch under microscopic view. The same procedure was repeated at L4/5 level. After Gelfoam packing and hemostasis, the wound was closed in layers. Operators VS 陳敞牧 Assistants R4 王奐之, R0 施培艾 相關圖片 詹素珠 (F,1949/06/17,62y8m) 手術日期 2011/11/10 手術主治醫師 蕭輔仁 手術區域 東址 003房 04號 診斷 Low back pain 器械術式 Radiofrequency coagulation(P-G 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 17:20 進入手術室 17:35 麻醉開始 17:36 誘導結束 17:37 手術開始 18:12 手術結束 18:22 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 高頻熱凝療法 1 1 B 摘要__ 手術科部: 外科部 套用罐頭: Pulsed radiofrequency stimulation on bilatera... 開立醫師: 王奐之 開立時間: 2011/11/10 18:16 Pre-operative Diagnosis Low back pain Post-operative Diagnosis Low back pain Operative Method Pulsed radiofrequency stimulation on bilateral L2 dorsal root ganglion Specimen Count And Types Nil Pathology Nil Operative Findings 1. Bilateral L2 dorsal root was identified by portable C-arm X-ray and sensory/motor stimulation test. No acute complication was noted after the procedure. 2. Temperature setting: 42 degrees Celsius, time: 180sec for 2 cycles (each side). Operative Procedures The patient was put in prone position. The location of L2 was identified by portable C-arm X-ray. The skin was disinfected and draped as usual. Local anesthesia was performed with 1% Xylocaine 10ml. Bilateral L2 dorsal root radiofrequency stimulation was performed under portable C-arm guidance. The patient stood whole procedure well. Operators VS 蕭輔仁 Assistants R4 王奐之 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Pulsed radiofrequency stimulation on bilatera... 開立醫師: 王奐之 開立時間: 2011/11/10 18:16 Pre-operative Diagnosis Low back pain Post-operative Diagnosis Low back pain Operative Method Pulsed radiofrequency stimulation on bilateral L2 dorsal root ganglion Specimen Count And Types Nil Pathology Nil Operative Findings 1. Bilateral L2 dorsal root was identified by portable C-arm X-ray and sensory/motor stimulation test. No acute complication was noted after the procedure. 2. Temperature setting: 42 degrees Celsius, time: 180sec for 2 cycles (each side). Operative Procedures The patient was put in prone position. The location of L2 was identified by portable C-arm X-ray. The skin was disinfected and draped as usual. Local anesthesia was performed with 1% Xylocaine 10ml. Bilateral L2 dorsal root radiofrequency stimulation was performed under portable C-arm guidance. The patient stood whole procedure well. Operators VS 蕭輔仁 Assistants R4 王奐之 相關圖片 黃敏銘 (M,1936/05/09,75y10m) 手術日期 2011/11/10 手術主治醫師 王國川 手術區域 東址 003房 號 診斷 Subdural hemorrhage (SDH) 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 施培艾, 時間資訊 00:00 臨時手術NPO 08:07 進入手術室 08:10 麻醉開始 08:15 誘導結束 08:54 抗生素給藥 09:10 手術開始 10:00 手術結束 10:00 麻醉結束 10:07 送出病患 10:10 進入恢復室 11:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室腹腔分流手術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt via left Kocher po... 開立醫師: 王奐之 開立時間: 2011/11/10 10:12 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunt via left Kocher point (Codman programmable reservoir) Specimen Count And Types Nil Pathology Nil Operative Findings Clear CSF was noted upon ventriculostomy. Opening pressure about 10~15 cmH2O. A Codman programmable reservoir was used, preset to 120 mmH2O. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to right. After shaving, scrubbing, disinfection & draping in sterile fashion, a linear incision was made at left frontal area. Another linear incision was made at left upper quadrant of abdomen, followed by mini-laparotomy. A burr hole was created at left Kocher point. A subcutaneous tunnel was then created from the abdominal wound to the left frontal wound, followed by passage of peritoneal catheter. After 2 tenting stitches, a small cruciate durotomy was performed. The shunt and reservoir was assembled and inserted after ventriculostomy. After hemostasis, the wounds were closed in layers. Operators VS 王國川 Assistants R4 王奐之, R0 施培艾 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt via left Kocher po... 開立醫師: 王奐之 開立時間: 2011/11/10 10:12 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunt via left Kocher point (Codman programmable reservoir) Specimen Count And Types Nil Pathology Nil Operative Findings Clear CSF was noted upon ventriculostomy. Opening pressure about 10~15 cmH2O. A Codman programmable reservoir was used, preset to 120 mmH2O. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to right. After shaving, scrubbing, disinfection & draping in sterile fashion, a linear incision was made at left frontal area. Another linear incision was made at left upper quadrant of abdomen, followed by mini-laparotomy. A burr hole was created at left Kocher point. A subcutaneous tunnel was then created from the abdominal wound to the left frontal wound, followed by passage of peritoneal catheter. After 2 tenting stitches, a small cruciate durotomy was performed. The shunt and reservoir was assembled and inserted after ventriculostomy. After hemostasis, the wounds were closed in layers. Operators VS 王國川 Assistants R4 王奐之, R0 施培艾 相關圖片 周美俐 (F,1951/12/10,60y3m) 手術日期 2011/11/10 手術主治醫師 王國川 手術區域 東址 002房 07號 診斷 Brain metastasis 器械術式 Cerebellar tumor excision, left 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林峰盛 ASA 3E 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 17:27 通知急診手術 18:38 進入手術室 18:40 麻醉開始 18:55 誘導結束 19:08 抗生素給藥 19:15 手術開始 22:00 手術結束 22:00 麻醉結束 22:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除-手術時間在4小時以內 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Left sub-occipital craniectomy with cerebella... 開立醫師: 曾峰毅 開立時間: 2011/11/10 22:17 Pre-operative Diagnosis Left cerebellar tumor, suspect metastatic breast cancer Post-operative Diagnosis Left cerebellar tumor, suspect metastatic breast cancer Operative Method Left sub-occipital craniectomy with cerebellar tumor excision Specimen Count And Types 1 piece About size:0.5x0.5x0.5 cm Source:Left cerebellar tumor Pathology Pending Operative Findings One cystic tumor, with soft, fragile and hypervascular portion was noted at left cerebellar hemisphere. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position with head fixed by Mayfield head calmp. The scalp was shaved, scrubbed, disinfected, and then draped as usual. We made one hocky-stick shape scalp incision at right occipital area and drilled three burr holes. Right suboccipital carniotomy was made. Occipital sinus was transected and ligated. Durotomy was made. We made one corticotomy at right cerebellar hemisphere, and tumor was removed totally. After hemostasis, dura was closed in water-tight fahsion. Bone graft was fixed back with wires. The wound was closed in layers after subgaleal CWV. Operators VS 王國川 Assistants R5 曾峰毅 R3 曾偉倫 Indication Of Emergent Operation Brainstem compression 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Left sub-occipital craniectomy with cerebella... 開立醫師: 曾偉倫 開立時間: 2011/11/10 23:06 Pre-operative Diagnosis Left cerebellar tumor, suspect metastatic breast cancer Post-operative Diagnosis Left cerebellar tumor, suspect metastatic breast cancer Operative Method Left sub-occipital craniectomy with cerebellar tumor excision Specimen Count And Types 1 piece About size:0.5x0.5x0.5 cm Source:Left cerebellar tumor Pathology Pending Operative Findings One cystic tumor, with soft, fragile and hypervascular portion was noted at left cerebellar hemisphere. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position with head fixed by Mayfield head calmp. The scalp was shaved, scrubbed, disinfected, and then draped as usual. We made one hocky-stick shape scalp incision at right occipital area and drilled three burr holes. Right suboccipital carniotomy was made. Occipital sinus was transected and ligated. Durotomy was made. We made one corticotomy at right cerebellar hemisphere, and tumor was removed totally. After hemostasis, dura was closed in water-tight fahsion. Bone graft was fixed back with wires. The wound was closed in layers after subgaleal CWV. Operators VS 王國川 Assistants R5 曾峰毅 R3 曾偉倫 Indication Of Emergent Operation 相關圖片 潘莉莉 (F,1954/02/13,58y1m) 手術日期 2011/11/11 手術主治醫師 王國川 手術區域 東址 002房 08號 診斷 Glioblastoma multiforma 器械術式 Right craniotomy for frontal brain tumor excision 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林峰盛 ASA 3E 紀錄醫師 曾偉倫, 時間資訊 12:00 臨時手術NPO 12:00 開始NPO 22:26 通知急診手術 00:18 進入手術室 00:25 麻醉開始 00:35 誘導結束 01:00 抗生素給藥 01:08 手術開始 02:48 開始輸血 04:00 抗生素給藥 04:50 手術結束 04:50 麻醉結束 04:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4~8小時 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Right pterional approach for tumor excision 開立醫師: 曾峰毅 開立時間: 2011/11/11 05:05 Pre-operative Diagnosis Right frontal brain tumor, suspect high grade glioma Post-operative Diagnosis Right frontal brain tumor, suspect high grade glioma Operative Method Right pterional approach for tumor excision Specimen Count And Types 1 piece About size:3x2x2 cm Source:Right frontal brain tumor, suspect high grade glioma Pathology Pending Operative Findings One hypervascular, yellowish, elastic tumor was noted at right frontal lobe, with extention to right anterior temporal lobe, and with feeders from right middle cerebral artery. Right middle cerebral artery, especially the frontal branch was encased by the tumor. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to left, and fixed with Mayfield head clamp. We shaved, scrubbed, disinfected, and then draped the scalp. We made one curvilinear skin incision at right frontal area, and dissected scalp falp with facial nerve preservation. Temporalis muscle was detached from the skull. Craniotomy was made after four burr holes. Durotomy was done in U-shape. We made one 3x3 corticotomy winodw at right inferior frontal gyrus, and tumor excision was done in piecemeal. Hemostasis was performed. Dukroplasty was done in water-tight suture. Bone graft was fixed back with mini-plates. The wound was closed in layers after one subgaleal CWV. Operators VS 王國川 Assistants R5 曾峰毅 R3 曾偉倫 Indication Of Emergent Operation Uncal herniation 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Right pterional approach for tumor excision 開立醫師: 曾偉倫 開立時間: 2011/11/11 05:07 Pre-operative Diagnosis Right frontal brain tumor, suspect high grade glioma Post-operative Diagnosis Right frontal brain tumor, suspect high grade glioma Operative Method Right pterional approach for tumor excision Specimen Count And Types 1 piece About size:3x2x2 cm Source:Right frontal brain tumor, suspect high grade glioma Pathology Pending Operative Findings One hypervascular, yellowish, elastic tumor was noted at right frontal lobe, with extention to right anterior temporal lobe, and with feeders from right middle cerebral artery. Right middle cerebral artery, especially the frontal branch was encased by the tumor. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to left, and fixed with Mayfield head clamp. We shaved, scrubbed, disinfected, and then draped the scalp. We made one curvilinear skin incision at right frontal area, and dissected scalp falp with facial nerve preservation. Temporalis muscle was detached from the skull. Craniotomy was made after four burr holes. Durotomy was done in U-shape. We made one 3x3 corticotomy winodw at right inferior frontal gyrus, and tumor excision was done in piecemeal. Hemostasis was performed. Dukroplasty was done in water-tight suture. Bone graft was fixed back with mini-plates. The wound was closed in layers after one subgaleal CWV. Operators VS 王國川 Assistants R5 曾峰毅 R3 曾偉倫 Indication Of Emergent Operation Uncal herniation 相關圖片 陳韋廷 (M,1986/02/14,26y1m) 手術日期 2011/11/10 手術主治醫師 蔡翊新 手術區域 東址 005房 02號 診斷 Injury (severity score >=16) 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 張書豪, 時間資訊 00:00 臨時手術NPO 13:50 報到 15:04 進入手術室 15:10 麻醉開始 15:15 誘導結束 15:30 抗生素給藥 15:45 手術開始 17:55 手術結束 17:55 麻醉結束 18:05 送出病患 18:10 進入恢復室 19:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 頭顱成形術 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Cranioplasty 開立醫師: 蔡翊新 開立時間: 2011/11/10 17:18 Pre-operative Diagnosis Left frontotemporoparietal skull defect. Post-operative Diagnosis Left frontotemporoparietal skull defect. Operative Method Cranioplasty with autologous bone graft. Specimen Count And Types nil Pathology Nil. Operative Findings A 15 x 13 cm skull defect at left F-T-P area. The temporalis muscle had been excised during previous operation and the muscle bulk was replaced with a piece of bone cement. The dura was slightly bulging after anesthesia. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with a sterilized adhesive plastic sheet. 4. Incision: along the previous operation scar at left frontotemporoparietal region, Raney clips were applied to the scalp edge for temporary hemostasis. 5. The left F-T-P scalp was dissected away from the underlying dura. 6. The bleeders on the dissected surfaces were coagulated with Bovie painstakingly. 7. The edge of the skull defect was exposed. 8. The original skull plate preserved at bone bank was soaked in Vancomycin solution and placed back to the skull window then fixed by 3 miniplates, 6 screws and 5 dural tentings at the center of the skull plate. 9. Bone cement paste was used to replace the excised temporalis muscle bulk. 10.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by interrupted suture with 3/0 nylon. 11.Drain: two epidural CWV drains. 12.Blood transfusion: nil. Blood loss: 200 ml. 13.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R6蔡宗良R1張書豪 相關圖片 賴建春 (M,1959/02/05,53y1m) 手術日期 2011/11/10 手術主治醫師 蔡翊新 手術區域 東址 003房 02號 診斷 Tardy ulnar palsy 器械術式 Neurolysis of the right ulnar neuve 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 施培艾, 時間資訊 00:00 臨時手術NPO 10:14 進入手術室 10:15 麻醉開始 10:20 誘導結束 10:35 抗生素給藥 10:50 手術開始 11:55 手術結束 11:55 麻醉結束 12:00 送出病患 12:01 進入恢復室 13:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 神經分離術-上臂.前臂.大腿.小腿處之神經 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Neurolysis and transposition of right ulnar n... 開立醫師: 王奐之 開立時間: 2011/11/10 12:08 Pre-operative Diagnosis Tardy ulnar palsy, right Post-operative Diagnosis Tardy ulnar palsy, right Operative Method Neurolysis and transposition of right ulnar nerve (at cubital tunnel) Specimen Count And Types Nil Pathology Nil Operative Findings A restricting band over the right ulnar nerve at right cubital tunnel was noted, compressing the right ulnar nerve. After transposition, the nerve became tension-free. Operative Procedures After laryngeal mask general anesthesia, the patient was placed in right semi-decubitus position, and his right arm was stretched out with elbow flexed. After disinfection & draping in sterile fashion, a linear incision was made between the medial epicondyle and olecranon, and extended to both ends (total length about 10cm). After dissection through the fascia, careful dissection was performed to expose the ulnar nerve. After releasing the overlying restricting band, mobilization of the ulnar nerve, and creation of a epi-fascial plane medial to the medial epicondyle, the ulnar nerve was transposed to the epi-fascial pocket. After hemostasis, the wound was closed in layers. Operators VS 蔡翊新, VS 王國川 Assistants R4 王奐之, R0 施培艾 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Neurolysis and transposition of right ulnar n... 開立醫師: 王奐之 開立時間: 2011/11/10 12:08 Pre-operative Diagnosis Tardy ulnar palsy, right Post-operative Diagnosis Tardy ulnar palsy, right Operative Method Neurolysis and transposition of right ulnar nerve (at cubital tunnel) Specimen Count And Types Nil Pathology Nil Operative Findings A restricting band over the right ulnar nerve at right cubital tunnel was noted, compressing the right ulnar nerve. After transposition, the nerve became tension-free. Operative Procedures After laryngeal mask general anesthesia, the patient was placed in right semi-decubitus position, and his right arm was stretched out with elbow flexed. After disinfection & draping in sterile fashion, a linear incision was made between the medial epicondyle and olecranon, and extended to both ends (total length about 10cm). After dissection through the fascia, careful dissection was performed to expose the ulnar nerve. After releasing the overlying restricting band, mobilization of the ulnar nerve, and creation of a epi-fascial plane medial to the medial epicondyle, the ulnar nerve was transposed to the epi-fascial pocket. After hemostasis, the wound was closed in layers. Operators VS 蔡翊新, VS 王國川 Assistants R4 王奐之, R0 施培艾 相關圖片 何秀娥 (F,1946/01/25,66y1m) 手術日期 2011/11/10 手術主治醫師 蔡翊新 手術區域 東址 005房 01號 診斷 Traumatic subarachnoid hemorrhage 器械術式 Craniotomy for left P-com aneurysm clipping 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 張書豪, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:05 進入手術室 08:13 麻醉開始 08:17 誘導結束 08:20 抗生素給藥 08:30 手術開始 11:20 抗生素給藥 11:52 開始輸血 14:20 抗生素給藥 14:35 麻醉結束 14:35 手術結束 14:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 開顱術摘除血管病變 - 腦血管瘤 有病徵的 1 1 L 手術 顱內壓視置入 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: Aneurysm-frontotemporal approach 開立醫師: 蔡翊新 開立時間: 2011/11/10 13:55 Pre-operative Diagnosis Left posterior communicating artery aneurysm. Post-operative Diagnosis Left posterior communicating artery aneurysm. Operative Method Left pterional craniotomy for aneurysm clipping and left Kocher EVD for ICP monitoring. Specimen Count And Types 3 tubes of CSF, sent for routine, BCS, and bacterial culture. Pathology nil. Operative Findings The CSF was clean and initial pressure was 15 cmH2O. Several draining veins leading from the Sylvian veins to the dura. There was a saccular aneurysm arising from the junction of left ICA and left posterior communicating artery, pointing laterally, with a wide base about 8 mm in width. The height of the dome was about 6 mm, with a daugher blister aneurysm. The aneurysm adhered tightly to the oculomotor nerve and the dura. The aneurysm was clipped by a 9-mm, curved Sugita clip. A suspected residual neck at posterior aspect of ICA-p-com junction could not be clipped properly, so we left it there. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right for 40 degree and slightly extended then fixed by Mayfield skull clamp. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergentfollowed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: left frontotemporal, curvilinear. The skin edge was clipped by Raney clips for temporary hemostasis. After scalp had been lifted, the temporalis muscle was incised and detached from temporal squama and reflected to lower temporal side. 5. A burr hole was made at left Kocher point for EVD insertion as an ICP monitor. 6. Craniotomy window: 10 x 8 cm, left frontotemporal, created by making 4 burr holes then cut by power saw. The lower temporalbone and pterionic ridge (esp. the inner table) were cut by rongeur as low as possible for easy approach to the anterior clinoid. 6. Dural tention: by 2/0 silk, 2 cm in interval, distributed along the edge of skull window. 7. Dural incision: curvilinear, over-riding Sylvian fissure and reflected to frontotemporal base. 8. Under operating microscope, the Sylvian fissure was opened, the suprasellar cistern was opened, meanwhile, the patinet's blood pressure was brought down to 90 mmHg. The left optic nerve and ICA came into view. The arachnoid trabeculi and the adhesion bands were cleaned out to expose the neck of the aneurysm which located just beneath the edge of tentorial hiatus. Premature rupture with minor bleeding from the daughter aneurysm was encountered and the aneurysm neck was partially clipped temporarily by a straight Sugita clip. The neck of the aneurysm was mobilized gently by a Gage 16 sucker and a fine tip bipolar forceps until it was entirely free from left oculomotor nerve and dura. 9. A 9-mm curved Sugita clip was applied to the neck of the aneurysm. 10.After successful clipping of the aneurysm, the patient's BP was brought back to normal, and the exposed field was irrigated with N.S. to make sure no any bleeding. 11.The brain retractors were removed. The dura was closed water-tight by running suture with 4/0 Prolene. 12.Closure of skull window: the skull plate was placed back to craniotomy window and fixed by 3 miniplates and 6 screws. The dura was tented to the center of the skull plate by 5 2/0 stitches. The covering muscle was closed by interrupted stitches with 1/ 0 silk. 13.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 14.Drain: one, epidural, CWV. 15.Blood transfusion: PRBC 2U. Blood loss: 700 ml. 16.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R6蔡宗良R1張書豪 相關圖片 賴保昌 (M,1929/03/25,82y11m) 手術日期 2011/11/11 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Meningioma 器械術式 Right frontal falx meningioma excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 張哲瑋, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:08 進入手術室 08:15 麻醉開始 09:05 誘導結束 09:06 抗生素給藥 09:10 手術開始 11:40 開始輸血 12:06 抗生素給藥 14:40 麻醉結束 14:40 手術結束 14:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除-手術時間在4~8小時 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT 開立醫師: 曾峰毅 開立時間: 2011/11/11 14:35 Pre-operative Diagnosis Right frontal falx meningioma Post-operative Diagnosis Right frontal falx meningioma Operative Method Right frontal craniotomy for tumor excision Specimen Count And Types Several fragments of one tumor was sent for pathology. Pathology Pending Operative Findings One hypervascular, grayish to pinkish, dura-based, elastic to firm, well defined, extra-axial tumor was noted arising from right side of frontal flax, encasing right ACA partially. ACA was transected during tumor removal, and was repaired in end to end anastomosis. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head fixed by Mayfield head clamp. After scalp shaved, scrubbed, disinfected, and then draped, we made one bicoronal scalp incision and drilled three burr holes. One 8x8 cm craniotomy window was made, and dura was tented along the craniiotomy edge. C-shape durotomy was done, and tumor base was cauterized for hemostasis. Tumor was removed in piecemeal, and right ACA was transected during the tumor removal. ACA was repaired in end to end anastomosis and hemostasis with Floseal. Dura was closed in water-tight fashion, and bone graft was fixed back with mini-plates. The wound was closed in layers after one subgaleal CWV. Operators VS 曾漢民 Assistants R5 曾峰毅 R1 張哲瑋 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT 開立醫師: 張哲瑋 開立時間: 2011/11/11 14:52 Pre-operative Diagnosis Right frontal falx meningioma Post-operative Diagnosis Right frontal falx meningioma Operative Method Right frontal craniotomy for tumor excision Specimen Count And Types Several fragments of one tumor was sent for pathology. Pathology Pending Operative Findings One hypervascular, grayish to pinkish, dura-based, elastic to firm, well defined, extra-axial tumor was noted arising from right side of frontal flax, encasing right ACA partially. ACA was transected during tumor removal, and was repaired in end to end anastomosis. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head fixed by Mayfield head clamp. After scalp shaved, scrubbed, disinfected, and then draped, we made one bicoronal scalp incision and drilled three burr holes. One 8x8 cm craniotomy window was made, and dura was tented along the craniiotomy edge. C-shape durotomy was done, and tumor base was cauterized for hemostasis. Tumor was removed in piecemeal, and right ACA was transected during the tumor removal. ACA was repaired in end to end anastomosis and hemostasis with Floseal. Dura was closed in water-tight fashion, and bone graft was fixed back with mini-plates. The wound was closed in layers after one subgaleal CWV. Operators VS 曾漢民 Assistants R5 曾峰毅 R1 張哲瑋 相關圖片 楊丕吉 (M,1974/12/22,37y2m) 手術日期 2011/11/11 手術主治醫師 曾漢民 手術區域 東址 003房 01號 診斷 Glioma, brain 器械術式 Left frontal glioma excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 08:45 進入手術室 09:00 麻醉開始 09:20 抗生素給藥 09:35 誘導結束 09:40 手術開始 12:20 抗生素給藥 15:20 抗生素給藥 16:35 手術結束 16:35 麻醉結束 16:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4~8小時 1 1 L 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 7 0 手術 立體定位術-切片 1 2 摘要__ 手術科部: 外科部 套用罐頭: Left frontal craniotomy for total tumor excis... 開立醫師: 鍾文桂 開立時間: 2011/11/11 17:15 Pre-operative Diagnosis Left frontal diffuse grade II astrocytoma, recurrent. Post-operative Diagnosis Left frontal diffuse grade II astrocytoma, recurrent. Operative Method Left frontal craniotomy for total tumor excision under navigation guidance. Specimen Count And Types 1 piece About size:1x1x1 cm Source:Left frontal tumor, suspect glioma Pathology Pending Operative Findings Under SonoWand Invite guidance, the tumor was excised. The tumor which locates at cingulate gyrus and corpus callosum was left alone. The left frontal horn of lateral ventricle was entered during tumor excision. The tumor was pinkish-gray in moderate vascularity. The dura tear was repaired by Cook artificial dura. Operative Procedures Under ETGA, the patient was placed in supine position and the head was fixed by Mayfield. After shaving, disinfection, and draping, the previous curvilinear scalp wound was incised. The scalp was dissected. The previous craniotomy skull plate was dissected from the surrounding scar tissue by using high speed craniotome. The tumor was localized by SonoWand Invite. The tumor was excised in piecemeal fashion. After well hemostasis, the dura mater was closed in watertigh fasion. The craniotomy plate was fixed by miniplates and screws. The wound was closed in layers with no drains in situ. Operators VS 曾漢民 Assistants R6 鍾文桂 R3 曾偉倫 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Left frontal craniotomy for total tumor excis... 開立醫師: 曾偉倫 開立時間: 2011/11/11 17:16 Pre-operative Diagnosis Left frontal diffuse grade II astrocytoma, recurrent. Post-operative Diagnosis Left frontal diffuse grade II astrocytoma, recurrent. Operative Method Left frontal craniotomy for total tumor excision under navigation guidance. Specimen Count And Types 1 piece About size:1x1x1 cm Source:Left frontal tumor, suspect glioma Pathology Pending Operative Findings Under SonoWand Invite guidance, the tumor was excised. The tumor which locates at cingulate gyrus and corpus callosum was left alone. The left frontal horn of lateral ventricle was entered during tumor excision. The tumor was pinkish-gray in moderate vascularity. The dura tear was repaired by Cook artificial dura. Operative Procedures Under ETGA, the patient was placed in supine position and the head was fixed by Mayfield. After shaving, disinfection, and draping, the previous curvilinear scalp wound was incised. The scalp was dissected. The previous craniotomy skull plate was dissected from the surrounding scar tissue by using high speed craniotome. The tumor was localized by SonoWand Invite. The tumor was excised in piecemeal fashion. After well hemostasis, the dura mater was closed in watertigh fasion. The craniotomy plate was fixed by miniplates and screws. The wound was closed in layers with no drains in situ. Operators VS 曾漢民 Assistants R6 鍾文桂 R3 曾偉倫 相關圖片 洪志融 (M,1981/10/27,30y4m) 手術日期 2011/11/11 手術主治醫師 蔡瑞章 手術區域 東址 019房 03號 診斷 Subdural hemorrhage or effusion 器械術式 left subdural effusion drainage, burhole via EVD 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2E 紀錄醫師 游健生, 時間資訊 10:00 臨時手術NPO 10:00 開始NPO 18:45 通知急診手術 19:15 報到 19:20 進入手術室 19:30 麻醉開始 19:35 誘導結束 20:17 抗生素給藥 20:26 手術開始 21:15 手術結束 21:15 麻醉結束 21:25 送出病患 21:28 進入恢復室 22:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Left frontal burhole drainage of SDE 開立醫師: 游健生 開立時間: 2011/11/11 21:37 Pre-operative Diagnosis Left subdural effusion Post-operative Diagnosis Left subdural effusion Operative Method Left frontal burhole drainage of SDE Specimen Count And Types 1 piece About size:8cc x 3tubes Source:subdural fluid Pathology Nil Operative Findings Yellow-redish clear subdural fluid ejected out after durotomy. No outer membrane was seen. An EVD was inserted into left frontal subdural space (5cm in length). Operative Procedures Under ETGA, patient was in supine position with head rotated to right. After shaving, we disinfected and draped the operation field as usual. A verticle scalp incision was made at left frontal region near superior temporal line. The scalp was retracted and muscle transected. A burhole was made followed by dura tenting. After coagulation, cruciate durotomy was made. An EVD was inserted into subdural space and irrigated gently. The EVD was fixed and burhole covered with Gelfoam. After hemostasis, wound was closed in layers. Operators P 蔡瑞章 Assistants R6 鍾文桂 R4 游健生 Indication Of Emergent Operation Massive subdural effusion with midbrain compression and intracranial hypertension 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Left frontal burhole drainage of SDE 開立醫師: 游健生 開立時間: 2011/11/11 21:38 Pre-operative Diagnosis Left subdural effusion Post-operative Diagnosis Left subdural effusion Operative Method Left frontal burhole drainage of SDE Specimen Count And Types 1 piece About size:8cc x 3tubes Source:subdural fluid Pathology Nil Operative Findings Yellow-redish clear subdural fluid ejected out after durotomy. No outer membrane was seen. An EVD was inserted into left frontal subdural space (5cm in length). Operative Procedures Under ETGA, patient was in supine position with head rotated to right. After shaving, we disinfected and draped the operation field as usual. A verticle scalp incision was made at left frontal region near superior temporal line. The scalp was retracted and muscle transected. A burhole was made followed by dura tenting. After coagulation, cruciate durotomy was made. An EVD was inserted into subdural space and irrigated gently. The EVD was fixed and burhole covered with Gelfoam. After hemostasis, wound was closed in layers. Operators P 蔡瑞章 Assistants R6 鍾文桂 R4 游健生 Indication Of Emergent Operation Massive subdural effusion with midbrain compression and intracranial hypertension 相關圖片 黃勝熒 (M,1953/11/12,58y4m) 手術日期 2011/11/11 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Spondylosis with myelopathy, lumbar 器械術式 L4-5 Dynasis 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 07:35 報到 08:05 進入手術室 08:15 麻醉開始 08:30 誘導結束 09:14 手術開始 09:35 抗生素給藥 13:15 手術結束 13:15 麻醉結束 13:30 送出病患 13:36 進入恢復室 14:36 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎弓切除術(減壓)-二節以內 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 記錄__ 手術科部: 外科部 套用罐頭: 1. L4/5 Dynesys implantation, 2. Right L4/5 l... 開立醫師: 李振豪 開立時間: 2011/11/11 13:43 Pre-operative Diagnosis 1. L4 on L5 spondylolisthesis, grade I, 2. Right L4/5 synovial cyst Post-operative Diagnosis 1. L4 on L5 spondylolisthesis, grade I, 2. Right L4/5 synovial cyst Operative Method 1. L4/5 Dynesys implantation, 2. Right L4/5 laminotomy for synovial cyst excision Specimen Count And Types nil Pathology Nil Operative Findings Two 6.4 x 50mm(right side) and two 6.4 x 45mm(left side) screws were implanted for Dynesys. Right side spacer was 22mm and left side spacer was 20mm in length. The cords were inserted and the Dynesys was set up. L4/5 right laminotomy was conducted and the synovial cyst and ligmentum flavum was removed for decompression. The thecal sac and root decompressed well after whole procedure. No obvious CSF leakage noted during whole procedure. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position. L4 and L5 pedicle level were localized by portable C-arm. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made from L3 to S1 level. The subcutaneous soft tissue was devided until the fascia was encountered. Dissection was performed along the fascia. Right side longitudinal fascia incision was made at 3cm lateral to midline. The muscle was splitted by finger to identify the L4 and L5 transverse process. After the entry point was localized, the Dynesys was implanted under C-arm guided. The spacer and cord was set up. The same procedure was performed at left side. The wound was irrigated with Gentamicin solution. Hemostasis was achieved and the fascia was closed with 2-0 Vicryl. L4/5 right paraspinal muscle groups were detached and retracted by modefied Tayler retractor. L4/5 laminotomy was performed and the ligmentum flavum was removed. The synovial cyst was removed for decompression. Hemostasis was achieved with Gelfoam packing. The wound was irrigated with Gentamicin solution. Two subcutaneous 1/8 Hemovac was placed. The wound was then closed in layers with 1-0, 2-0 Vicryl and 3-0 Nylon. Operators VS賴達明 Assistants R5李振豪, R1李嘉哲 相關圖片 廖添財 (M,1955/07/15,56y7m) 手術日期 2011/11/11 手術主治醫師 賴達明 手術區域 東址 019房 02號 診斷 Cervical Spondylosis 器械術式 C4/5, C5/6 anterior cervical diskectomy + plating 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 13:55 進入手術室 14:00 麻醉開始 14:15 誘導結束 14:20 抗生素給藥 14:45 手術開始 17:20 抗生素給藥 18:15 手術結束 18:15 麻醉結束 18:27 送出病患 18:30 進入恢復室 19:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-頸椎 1 1 R 手術 椎間盤切除術-頸椎 1 2 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 記錄__ 手術科部: 外科部 套用罐頭: Anterior cervical diskectomy and foraminotomy... 開立醫師: 李振豪 開立時間: 2011/11/11 18:47 Pre-operative Diagnosis C4/5, C5/6 hierniated disc with cervical myelopathy Post-operative Diagnosis C4/5, C5/6 hierniated disc with cervical myelopathy Operative Method Anterior cervical diskectomy and foraminotomy + anterior fusion with PEEK cage Specimen Count And Types nil Pathology Nil Operative Findings The C4/5 intervertebral disc was relative health in character which bulging out with thecal sac compression. The posterior marginal spur, herniated disc, and posterior longitudinal ligment were removed for decompression and the thecal sac expanded well. One #8 PEEK cage was inserted for anterior fusion. The C5/6 intervertebral disc was degenerative with both anterior and posterior marginal spur formation. Ruptured disc with caudal migration was noted and removed by curette. Mild calcification of the posterior longitudinal ligment was found during resection of the posterior longitudinal ligment. The thecal sac also expanded well after decompression. One #7 PEEK cage was used at C5/6 disc space for anterior fusion. No incidental durotomy or CSF leakage was noted during whole procedure. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position. The shoulder was elevated with neck extension. The skin was scrubbed, disinfected, and draped as usual. Transverse skin incision was made at right middle neck and the subcutaneous soft tissue was devided. The platysma muscle was transected. The fascia was opened longitudinally and dissection was performed along the plan between carotid sheath and thyroid gland. The prevertebral fascia was approached after retraction of the thyroid gland, trachea, and esophagus. The prevertebral fascia was opened and the disc was identified. C4/5, C5/6 disc level was localized by portable C-arm X-ray. C4/5 microdiskectomy was performed with curette, kerrison, alligator and Midas high-speed air-drived drills. The epidural space beneath the C4 and C5 vertebral body was checked by curette. One #8 PEEK cage was inserted for anterior fusion. C5/6 microdiskectomy was conducted as C4/5 microdiskectomy and one #7 PEEK cage was used for fusion. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. The One MiniHemovac was placed. The wound was then closed in layers with 3-0 Vicryl and 4-0 dexon. Operators VS賴達明 Assistants R5李振豪, R1李嘉哲 相關圖片 黃菊妹 (F,1940/01/03,72y2m) 手術日期 2011/11/11 手術主治醫師 賴達明 手術區域 東址 001房 02號 診斷 Herniated intervertebral disc (HIVD) 器械術式 L4/5 microdiskectomy, right 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 2 紀錄醫師 張書豪, 時間資訊 00:00 臨時手術NPO 13:00 進入手術室 13:05 麻醉開始 13:10 誘導結束 13:40 抗生素給藥 13:42 手術開始 14:45 手術結束 14:45 麻醉結束 14:55 送出病患 15:03 進入恢復室 16:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 椎間盤切除術-腰椎 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Lumbar 4-5 micro-discectomy 開立醫師: 張書豪 開立時間: 2011/11/11 15:03 Pre-operative Diagnosis L4-L5 herniated intervertebral disc with right L5 radiculopathy Post-operative Diagnosis L4-L5 herniated intervertebral disc with right L5 radiculopathy Operative Method Lumbar 4-5 micro-discectomy Specimen Count And Types nil Pathology nil Operative Findings 1.Protrusion of L4-L5 disc 2.Impinge of right L5 root Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: semiprone. 3. Skin preparation: the back was shaved and scrubbed with povidone-iodine detergent then painted with povidone-iodine tincture and followed by sterilized adhesive plastic sheet covering. 4.A spinal needle was inserted between spinous processes of L4-L5 and a portable X-ray film was taken to locate the correct interspace. 5.Incision: 3-cm, between L4-L5-spinous processes,off-midiline at the L4-L5 margin of spinous processes. The subcutaneous layer and lumbdorsal fascia were incised then. 6.The aponeurosis of the latissimus dorsi and ileocostalis lumborum muscles at spinous processes of L4-L5 was incised, the muscles were detached from the interspinous ligament. The multifidus muscles were detached subperiosteally from L4-L5 laminae by a rasp. 7.The paravertebral muscles were retracted by a modified narrow Taylor retractor which was retained constantly by a rubbersling to the side rail of the operating table. 8.Under an operating microscope, the ligamentum flavum was cleaned and incised longitudinally at the lateral part with a No. 11 blade. The lateral portion of this ligament was removed with a small angle Kerrison rongeur, the lateral portion of the laminae and the medial border of the facets were removed too until the margin of the facets and a corridor to the disc that ran lateral to the root was reached. 9. The epidural fat was left undisturbed andpreserved. 10.The compressed L5 root and veins overlying the protruded disc were gently pushed away by placing 2 small cottonoid patties, one above and one below the disc at the floor of the epidural canal. 11.The compressed root was gently pushed further away temporarily by sucker tip in order to expose the herniated disc more clearly. The posterior longitudinal ligament and annulus were incised around the protruded disc with a No. 15 blade. The degenerated disc was removed with microdisc forcepsuntil a substantial amount of the nucleus had been loosened with a cone curette and removed. 12.Close the wound in layers. Operators VS賴達明 Assistants R6蔡宗良 R1張書豪 相關圖片 洪志融 (M,1981/10/27,30y4m) 手術日期 2011/11/12 手術主治醫師 蔡瑞章 手術區域 東址 005房 04號 診斷 Subdural hemorrhage or effusion 器械術式 Exchange of subdural drain 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 3E 紀錄醫師 王奐之, 時間資訊 12:00 臨時手術NPO 12:00 開始NPO 19:44 通知急診手術 21:10 報到 21:16 進入手術室 21:20 麻醉開始 21:25 誘導結束 21:35 抗生素給藥 21:57 手術開始 22:42 手術結束 22:42 麻醉結束 23:00 送出病患 23:05 進入恢復室 00:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 慢性硬腦膜下血腫清除術 1 2 L 摘要__ 手術科部: 外科部 套用罐頭: Subdural hematoma evacuation and revision of ... 開立醫師: 王奐之 開立時間: 2011/11/12 23:15 Pre-operative Diagnosis Left side subdural effusion, status post subdural drain insertion, with post-operative subdural hematoma accumulation and subdural drain dysfunction Post-operative Diagnosis Left side subdural effusion, status post subdural drain insertion, with post-operative subdural hematoma accumulation and subdural drain dysfunction Operative Method Subdural hematoma evacuation and revision of subdural drain Specimen Count And Types Nil Pathology Nil Operative Findings Blood clots in tubular shape was removed from the durotomy after identification of the left side burr hole, and effusion gushed out after removal of the blood clots. A new BMI EVD catheter was inserted into the subdural space to function as subdural drain. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position. After removal of previous subdural drain, the scalp was scrubbed, disinfected and draped in sterile fashion. The wound was opened after removal of stitches, followed by evacuation of blood clots & meticulous hemostasis. After insertion of a new subdural drain, Gelfoam was packed into the burr hole to prevent influx of subgaleal blood. The wound was then closed in layers, followed by deairing. Operators P 蔡瑞章 Assistants R4 王奐之 Indication Of Emergent Operation IICP 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Subdural hematoma evacuation and revision of ... 開立醫師: 王奐之 開立時間: 2011/11/12 23:15 Pre-operative Diagnosis Left side subdural effusion, status post subdural drain insertion, with post-operative subdural hematoma accumulation and subdural drain dysfunction Post-operative Diagnosis Left side subdural effusion, status post subdural drain insertion, with post-operative subdural hematoma accumulation and subdural drain dysfunction Operative Method Subdural hematoma evacuation and revision of subdural drain Specimen Count And Types Nil Pathology Nil Operative Findings Blood clots in tubular shape was removed from the durotomy after identification of the left side burr hole, and effusion gushed out after removal of the blood clots. A new BMI EVD catheter was inserted into the subdural space to function as subdural drain. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position. After removal of previous subdural drain, the scalp was scrubbed, disinfected and draped in sterile fashion. The wound was opened after removal of stitches, followed by evacuation of blood clots & meticulous hemostasis. After insertion of a new subdural drain, Gelfoam was packed into the burr hole to prevent influx of subgaleal blood. The wound was then closed in layers, followed by deairing. Operators P 蔡瑞章 Assistants R4 王奐之 Indication Of Emergent Operation IICP 相關圖片 吳正義 (M,1939/12/10,72y3m) 手術日期 2011/11/12 手術主治醫師 曾勝弘 手術區域 東址 003房 02號 診斷 Brain cancer 器械術式 Right parietal metastatic tumor excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 3 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 12:25 報到 13:08 進入手術室 13:10 麻醉開始 13:50 誘導結束 14:05 抗生素給藥 14:20 手術開始 16:38 麻醉結束 16:38 手術結束 16:43 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Right parietal craniotomy for tumor excision 開立醫師: 李振豪 開立時間: 2011/11/12 17:20 Pre-operative Diagnosis Multiple brain metastasis Post-operative Diagnosis Multiple brain metastasis Operative Method Right parietal craniotomy for tumor excision Specimen Count And Types 1 piece About size:Multiple small pieces Source:Right parietal tumor Pathology Pending Operative Findings The tumor was located at posteromedial margin of the craniotomy window. The tumor was 2.3 x 2.3 x 2.1cm in size, gray-reddish in color, hypervascularized, ill-demarcated, and soft in character. The tumor was located just beneath motor cortex but extension into motor cortex at subcortical area. The cystic part near the tumor was filled with xanthochromic fluid. The cystic wall was thick and adhered to adjacent brain parenchyma tightly. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with right shoulder elevation. The head was rotated to left. The scalp was shaved, scrubbed, and disinfected as usual. Right parietal scalp incision was made along operative scar. The scalp flap was elevated. The skull plate was removed. Intra-operative sonography was used for localization of the tumor. C-shape durotomy was conducted with adhesionlysis. Tumor excision was performed with bipolar electrocautery, tumor forceps, dissection, and suction. Hemostasis was achieved with bipolar electrocautery and Surgicel lining. Dura was closed with 4-0 Prolene. The skull plate was fixed back with miniplates, screws, and one central tenting. One subgaleal CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and Appose staples. Operators VS曾勝弘 Assistants R5李振豪, R1張書豪 相關圖片 呂元中 (M,1972/02/17,40y0m) 手術日期 2011/11/12 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Parkinsonism (F02.3) 器械術式 Implantation of deep brain stimulation 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 面罩麻醉 麻醉主治醫師 劉治民 ASA 1 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 07:42 報到 08:08 進入手術室 08:25 麻醉開始 08:35 誘導結束 09:04 開始輸血 09:25 抗生素給藥 09:31 手術開始 12:25 抗生素給藥 15:15 手術結束 15:15 麻醉結束 15:20 送出病患 15:25 抗生素給藥 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Semi-opened mask inhalation anes 1 0 麻醉 Semi-opened INHALATION GENERAL A 4 0 麻醉 SENI-OPENED INHALATION GENERAL A 6 0 麻醉 Peripheral arterial line inserti 1 0 手術 立體定位術-功能性失調 1 1 R 手術 深部腦核電生理定位 1 0 手術 立體定位術-功能性失調 1 2 L 記錄__ 手術科部: 神經部 套用罐頭: Implantation of deep brain stimulator wire at... 開立醫師: 鍾文桂 開立時間: 2011/11/12 16:08 Pre-operative Diagnosis Parkisons disease. Post-operative Diagnosis Parkisons disease. Operative Method Implantation of deep brain stimulator wire at bilateral subthalamic nuclei. Specimen Count And Types nil Pathology Nil. Operative Findings The planned tract at left side was used with no change. The tract at right side was used 2mm anterior to the planned tract. Operative Procedures Under IV general anesthesia, the patient was put in supine position. The scalp was shaved, scrubbed and antiseptic with alcohol B-I. Registered the preset localization point to navigator. Bicoronal scalp incision was made with burr hole made at entery point of left frontal region as navigator guided. The DBS wire port was set up and localization of subthalamus nucleus with microelectrode assistance. Inserted the DBS wire and fixed with the port. Waked the patient from the anesthesia and started stimulation from low voltage. Checked the clinical responses while using different voltage for stimulation. Performed the same procedure at right side. After hemostasis, we closed the wound in layers. Operators 曾勝弘 Assistants 鍾文桂 相關圖片 菊池巖 (M,1960/03/11,52y0m) 手術日期 2011/11/12 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Intervertebral disc disorder with myelopathy, cervical 器械術式 C6-7 artificial disc + C5-6 foraminotomy 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 3 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 08:00 進入手術室 08:05 麻醉開始 08:10 誘導結束 08:30 抗生素給藥 09:02 手術開始 11:30 抗生素給藥 12:45 手術結束 12:45 麻醉結束 12:55 送出病患 12:56 進入恢復室 14:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 手術 椎間盤切除術-頸椎 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: 1. C6/7 anterior cervical diskectomy, right f... 開立醫師: 李振豪 開立時間: 2011/11/12 13:26 Pre-operative Diagnosis 1. C6/7 herniated intervertebral disc with radiculopathy 2. C5/6 herniated intervertebral disc s/p microdiskectomy, with re-stenosis of right neural foramen and radiculopathy Post-operative Diagnosis 1. C6/7 herniated intervertebral disc with radiculopathy 2. C5/6 herniated intervertebral disc s/p microdiskectomy, with re-stenosis of right neural foramen and radiculopathy Operative Method 1. C6/7 anterior cervical diskectomy, right foraminotomy, and anterior fusion with PEEK cage. 2. C5/6 right anterior foraminotomy for decompression Specimen Count And Types nil Pathology Nil Operative Findings The C6/7 was fused spontaneously. Even after anterior cervical diskectomy and right side foraminotomy, the C6/7 joint still can not be mobilized. One #9 PEEK cage was implanted into C6/7 disc space for anterior cervical fusion. C5/6 right anterior foraminotomy was performed with Midas air-drived drills under C-arm guided. The root and thecal sac expanded well after decompression. No acute complication was noted during whole procedure. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with shoulder elevation and neck extension. The skin was scrubbed, disinfected, and draped as usual. Transverse skin incision was made at right lower neck along operative scar. The subcutaneous soft tissue and platysma muscle was devided. The fascia was opened and the prevertebral fascia was approached along the plan between thyroid gland and carotid sheath. The longus collis muscle was detached. The C6/7 disc level was localized by intra-operative C-arm X-ray. C6/7 microdiskectomy and right foraminotomy for decompression was conducted. The C6/7 was fused spontaneously. So we did not use artificial disc for this patient. One #9 PEEK cage was implanted for anterior spinal fusion. Right side C5/6 anterior foraminotomy was performed for decompression. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. One MiniHemovac was placed. The wound was then closed in layers with 3-0 Vicryl and 4-0 Dexon. Operators VS賴達明 Assistants R5李振豪, R1張書豪 相關圖片 葉文章 (M,1940/02/11,72y1m) 手術日期 2011/11/12 手術主治醫師 陳敞牧 手術區域 東址 003房 03號 診斷 Multiple myeloma 器械術式 Spinal fusion posterior 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 4E 紀錄醫師 李振豪, 時間資訊 00:00 開始NPO 09:54 通知急診手術 18:35 報到 18:39 進入手術室 18:45 麻醉開始 19:50 誘導結束 20:00 開始輸血 20:20 手術開始 21:00 抗生素給藥 23:10 麻醉結束 23:10 手術結束 23:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 惡性脊髓腫瘤切除術 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 2 記錄__ 手術科部: 外科部 套用罐頭: 1. T7, T8 partial tumor excision for decompre... 開立醫師: 李振豪 開立時間: 2011/11/13 00:17 Pre-operative Diagnosis T7, T8 spinal tumor with myelopathy Post-operative Diagnosis T7, T8 spinal tumor with myelopathy Operative Method 1. T7, T8 partial tumor excision for decompression 2. T6, T9 transpedicular screws for posterior fixation 3. Right T7 and bilateral T8 rhizotomy Specimen Count And Types 1 piece About size:Multiple pieces Source:T8 spinal tumor Pathology Pending Operative Findings Four 5.5 x 40mm transpedicular screws, two 11cm rods, and one cross link were implanted at T6 and T9 level for posterior fixation. The tumor was mainly located at right side T7 pedicle and bilateral T8 pedicle with epidural extension and thecal sac compression. The T8 vertebral body and bilateral paraspinal area are also invaded. After T7 and T8 laminectomy, bilateral T8 and right side T7 facetectomy was performed and tumor excision was conducted along the pedicle. The tumor was gray-reddish, hypervascularized, elastic, and ill-demarcated with adjacent soft tissue(except thecal sac). The right T7 and bilateral T8 roots were encased by the tumor and adhered tightly. Bilateral T8 and right T7 rhizotomy was done for suspect radiculopathy related upper abdominal pain. Rapid blood loss was encountered during tumor excision and total blood loss was around 1800ml. After partial tumor excision, the thecal sac was expanded well and no incidental durotomy or CSf leakage was noted. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position. The T6 to T9 pedicle level was localized by C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made from T6 to T9 level. The subcutaneous soft tissue was devided. The paravertebral muscle group were detached. T6 and T9 transpedicular screws were implanted under C-arm guided. T7 and T8 laminectomy for partial tumor excision and decompression was conducted with Ronguer, Kerrison punches, and curette. Two rods and one cross-link were applied for posterior fixation. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. One 1/8 Hemovac was placed. The wound was irrigated with Gentamicin solution and closed in layers with 1-0, 2-0 Vicryl and 3-0 Nylon. Operators VS陳敞牧 Assistants R5李振豪, R1劉明侑 Indication Of Emergent Operation Spinal tumor was progressive paraplegia 陳福壽 (M,1953/04/25,58y10m) 手術日期 2011/11/12 手術主治醫師 蔡翊新 手術區域 東址 005房 02號 診斷 Cerebrovascular accident 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 4E 紀錄醫師 王奐之, 時間資訊 15:32 開始NPO 15:32 通知急診手術 16:10 進入手術室 16:15 麻醉開始 16:35 誘導結束 16:57 抗生素給藥 17:09 手術開始 17:45 手術結束 17:45 麻醉結束 17:52 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱內壓視置入 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 蔡翊新 開立時間: 2011/11/12 17:40 Pre-operative Diagnosis Diffuse SAH with acute hydrocephalus, suspected aneurysm rupture. Post-operative Diagnosis Diffuse SAH with acute hydrocephalus, suspected aneurysm rupture. Operative Method Left Kocher point EVD for ICP monitoring. Specimen Count And Types 3 tubes of CSF, sent for routine, BCS and bacterial culture. Pathology Nil. Operative Findings CSF: sanguinous, initial pressure: 5 cmH2O. Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: supine with head rotated to right. 3.Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 5 cm linear, left frontal, corresponded to the location of right occipital horn. Raney clips were applied to the scalp edge for temporary hemostasis. 5.A burr hole was made at left Kocher point and the dura was tented by 2 stitches. 6.The dura was opened by a nib incision. Left lateral ventricle was tapped by a ventricular needle, then a 6.5 cm segment of the EVD was introduced into the ventricle. Then it was connected to a reservoir bag. 7. Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 8. Course of the surgery: smooth. Operators VS蔡翊新 Assistants R4王奐之 Indication Of Emergent Operation diffuse SAH with acute hydrocephalus, coma, seizure 相關圖片 郭志偉 (M,1978/06/06,33y9m) 手術日期 2011/11/13 手術主治醫師 蔡翊新 手術區域 東址 005房 05號 診斷 Fracture of base of skull, closed with subarachnoid, subdural, and extradural hemorrhage, with brief (less than one hour) loss of consciousness 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 5E 紀錄醫師 劉明侑, 時間資訊 02:43 開始NPO 02:43 通知急診手術 03:00 報到 03:10 進入手術室 03:20 麻醉開始 03:30 誘導結束 03:35 抗生素給藥 03:40 手術開始 04:10 開始輸血 06:30 麻醉結束 06:30 手術結束 06:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 硬腦膜外血腫清除術 1 1 R 手術 顱內壓視置入 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 臉部創傷小於5CM縫合 1 0 R 記錄__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 蔡翊新 開立時間: 2011/11/13 05:10 Pre-operative Diagnosis Right temporal skull base fracture with massive right temporal epidural hematoma. 1.Right temporal skull base fracture with massive right temporal epidural hematoma. 2.Right upper eyelid laceration. Post-operative Diagnosis Right temporal skull base fracture with massive right frontotemporal epidural hematoma due to middle meningeal artery rupture. 1.Right temporal skull base fracture with massive right frontotemporal epidural hematoma due to middle meningeal artery rupture. 2.Right upper eyelid laceration. Operative Method Right frontotemporal craniotomy for removal of epidural hematoma and ICP monitoring. 1.Right frontotemporal craniotomy for removal of epidural hematoma and ICP monitoring. 2.Suture of right upper eyelid laceration. Specimen Count And Types nil Pathology Nil. Operative Findings Epidural hematoma gushed out upon first burr hole creation, followed by continuous arterial bleeding. There was an EDH, 3 cm in maximal thickness, at right frontotemporal area, more extensive than that shown by CT scan. Active bleeding from a ruptured hole of middle meningeal artery (MMA) was noted. A linear skull fracture was noted at medial aspect of right temporal base, adjacent to the sphenoid ridge, with active oozing. After evacuation of the EDH, the dura became very slack. ICP after skin closure was 2 mmHg. Reference of ICP monitor: 464. 1.Epidural hematoma gushed out upon first burr hole creation, followed by continuous arterial bleeding. There was an EDH, 3 cm in maximal thickness, at right frontotemporal area, more extensive than that shown by CT scan. Active bleeding from a ruptured hole of middle meningeal artery (MMA) was noted. A linear skull fracture was noted at medial aspect of right temporal base, adjacent to the sphenoid ridge, with active oozing. After evacuation of the EDH, the dura became very slack. ICP after skin closure was 2 mmHg. Reference of ICP monitor: 464. 2.A 3 cm laceration at lateral aspect of right upper eyelid. 2.A 3 cm whole-layer laceration at lateral aspect of right upper eyelid. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: right frontotemporal area, the skin edge was clipped by Raney clips for temporary hemostasis. The temporalis muscles was incised down to the tempoal squama. 5. A burr hole was made at temporal bone just above zygomatic arch for evacuating part of the epidural hematoma, therefore the IICP could be relieved earlier. 6. Craniotomy window: 8 x 6 cm, right frontotemporal, created by making 2 burr holes (the other at keyhole) then cut by power saw. 7. Dural tenting: by 2/0 silk, 1.5-cm in interval, distributed along the edge of skull window. 8. The epidural clot was removed by sucker. 9. Hemosatasis: The middle meningeal artery was coagulated by bipolar coagulator. The bleeding from fracture site and foramen spinosum was stopped with bone wax. The epidural bleeding was stopped by Surgicel and Gelfoam packing. 10.The dura was opened with a nib incision to instill normal saline for better expansion and to insert subdural Codman ICP monitor. 11.The skull plate was fixed back by 3 miniplates and 6 screws. Several central tentings with 2/0 silk were applied. 12.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 13.Drain: one, epidural, CWV. 14.Blood transfusion: PRBC 2U. Blood loss: 1300 ml. 14.Blood transfusion: PRBC 2U. Blood loss: 1400 ml. 14.Blood transfusion: PRBC 2U. Blood loss: 1400 ml. 15.Suture of right upper eyelid laceration with 6-0 Nylon was performed. 15.Suture of right upper eyelid laceration with 4-0 Vicryl and 5-0 Nylon was performed. 15.Course of the surgery: smooth. 16.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5李振豪R4王奐之 R5李振豪R4王奐之R0劉家侑 Indication Of Emergent Operation expanding EDH, right pupil dilatation. 相關圖片 林幸信 (M,1940/02/17,72y0m) 手術日期 2011/11/14 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Cerebral hemorrhage 器械術式 Left frontal base dural AVF excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:10 麻醉開始 08:35 誘導結束 08:40 抗生素給藥 09:25 手術開始 11:40 抗生素給藥 13:05 手術結束 13:05 麻醉結束 13:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 開顱術摘除血管病變-動靜脈畸型小型表淺 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Left frontal craniotomy for arteriovenous fis... 開立醫師: 鍾文桂 開立時間: 2011/11/14 13:22 Pre-operative Diagnosis Left frontal dural arteriovenous fistula Post-operative Diagnosis Left frontal dural arteriovenous fistula Operative Method Left frontal craniotomy for arteriovenous fistula excision Specimen Count And Types 1 piece About size:3x0.5x0.5 cm Source:Veins within arteriovenous fistula Pathology Engourged vein. Operative Findings Left frontal craniotomy, frontal sinus was entered. Feeder: anterior ethmoidal artery( engorged). with multiple cortical venous drainage( tortous engorged veins. Liquified dark brown hematoma at left frontal lobe( evacuated). Dura mater was reparied primarily in water-tight fashion. Operative Procedures Under ETGA, we placed the patient over supine position. After shaving, his head was fixed with Mayfield clamp with mild extension of his head. We scrubbed, disinfected and drappes as usual and a bicrownal skin incision was made. The wound was opened in layers and the bilateral supra-orbital nerve were preserved. The scalp flap was elevated and the left frontal craniotomy was made after three burr-holes. A curvilinear durotomy was made after dural tenting and the left frontal base was dissected meticulously. The engorged veins of dural arteriovenous fistula was encountered and the feeding arteries were identified. The feeding arteries from ethmoidal artery were cauterized and divided. The engorged veins was resected with bipolar forceps, scissors and dissectors. The old hematoma within left frontal lobe was found and removed with suction. The left olfactory nerve was visualized and well preserved. After complete hemostasis, the durotomy was closed with 3-0 Prolene. The pericranium was sutured with the dura for covering the frontal sinus. The skull flap was fixed with miniplates and screws, and the central tenting was made. After placeing a CWV drain, the wound was closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators Prof. 杜永光 Assistants VS 蕭輔仁 R6 鍾文桂 R3 曾偉倫 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Left frontal craniotomy for arteriovenous fis... 開立醫師: 曾偉倫 開立時間: 2011/11/14 13:26 Pre-operative Diagnosis Left frontal dural arteriovenous fistula Post-operative Diagnosis Left frontal dural arteriovenous fistula Operative Method Left frontal craniotomy for arteriovenous fistula excision Specimen Count And Types 1 piece About size:3x0.5x0.5 cm Source:Veins within arteriovenous fistula Pathology Engourged vein. Operative Findings Left frontal craniotomy, frontal sinus was entered. Feeder: anterior ethmoidal artery( engorged). with multiple cortical venous drainage( tortous engorged veins. Liquified dark brown hematoma at left frontal lobe( evacuated). Dura mater was reparied primarily in water-tight fashion. Operative Procedures Under ETGA, we placed the patient over supine position. After shaving, his head was fixed with Mayfield clamp with mild extension of his head. We scrubbed, disinfected and drappes as usual and a bicrownal skin incision was made. The wound was opened in layers and the bilateral supra-orbital nerve were preserved. The scalp flap was elevated and the left frontal craniotomy was made after three burr-holes. A curvilinear durotomy was made after dural tenting and the left frontal base was dissected meticulously. The engorged veins of dural arteriovenous fistula was encountered and the feeding arteries were identified. The feeding arteries from ethmoidal artery were cauterized and divided. The engorged veins was resected with bipolar forceps, scissors and dissectors. The old hematoma within left frontal lobe was found and removed with suction. The left olfactory nerve was visualized and well preserved. After complete hemostasis, the durotomy was closed with 3-0 Prolene. The pericranium was sutured with the dura for covering the frontal sinus. The skull flap was fixed with miniplates and screws, and the central tenting was made. After placeing a CWV drain, the wound was closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators Prof. 杜永光 Assistants VS 蕭輔仁 R6 鍾文桂 R3 曾偉倫 相關圖片 陳昌成 (M,1982/10/04,29y5m) 手術日期 2011/11/14 手術主治醫師 杜永光 手術區域 東址 005房 02號 診斷 Epidermoid cyst 器械術式 Right pre-sigmoid approach for epidermoid cyst excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 11:40 報到 12:34 進入手術室 12:40 麻醉開始 13:05 誘導結束 13:10 抗生素給藥 13:11 手術開始 16:10 抗生素給藥 19:10 抗生素給藥 21:10 麻醉結束 21:10 手術結束 21:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 9 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 顱底瘤手術 1 1 摘要__ 手術科部: 外科部 套用罐頭: Right far-lateral approach for tumor excision 開立醫師: 鍾文桂 開立時間: 2011/11/14 20:54 Pre-operative Diagnosis Prepontine tumor, suspect epidermoid cyst Post-operative Diagnosis Prepontine tumor, epidermoid cyst Operative Method Right far-lateral approach for tumor excision Specimen Count And Types 1 piece About size:3x2x2 cm Source:Pre-pontine tumor, suspect epidermoid cyst Pathology Pending Operative Findings 1. The tumor is soft, waxy, pearl-like, hypovascularized and 5x3x3 cm in size. It surrounds the adjacent strucure such as nerves and vessels. The tumor is loosely attached to the surrounding structures. 2. The PICA, bilateral VA, low cranial nerve, CV VII + VIII complex, and ipsilateral and contralateral CN VI were identified durng the dissection and were well preserved. 3. Intra-operative right ear BAEP became irregular after the craniotomy was made. The right side MEP of upper and lower limbs vanished abruptly after retraction the cerebellum for a period of time (~ 1hr). The cerebellar was released from retraction after the changing of MEP. The BAEP and MEP were not recovered after the operation. 4. Most of the tumor were resected. Operative Procedures Under ETGA, we placed the patient on supine position and his right shoulder was elevated. After fixing his head with Mayfield clamp, his face was tilt to left with neck mild flexion. A reverse-U shape skin insion was made over right sub-occipital area. The wound was opened in layers and the sub-occipital triangle was reached after dissecting the muscles. The C1 lamina was found and the occipital-atlantal ligament was identified. The venous plexus above the right vetebral artery was reached after dissecting the sofetissue. A small bleeder from the vetebral artery was packed with Gelfoam. Right sub-occiptal craniotomy was made after making a burr-hole. A curivilinear durotomy was created and the arachnoid membrane was opened for CSF drainage. The dura was opened after the brain was sunked and the PICA and low cranial nerve were seen. Pearl-like tumor was found and tumor resection was performed with dissector, tumor forceps, and suction. The CN VII + VIII complex was found and the contralateral VA and basilar artery were also found. The tumor between nerves and vessels was dissected meticulously. The low cranial nerve, CV VII + VIII complex were identified durng the dissection and were well preserved. Operators Prof. 杜永光 Assistants R6 鍾文桂 R3 曾偉倫 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Right far-lateral approach for tumor excision 開立醫師: 曾偉倫 開立時間: 2011/11/14 21:12 Pre-operative Diagnosis Prepontine tumor, suspect epidermoid cyst Post-operative Diagnosis Prepontine tumor, epidermoid cyst Operative Method Right far-lateral approach for tumor excision Specimen Count And Types 1 piece About size:3x2x2 cm Source:Pre-pontine tumor, suspect epidermoid cyst Pathology Pending Operative Findings 1. The tumor is soft, waxy, pearl-like, hypovascularized and 5x3x3 cm in size. It surrounds the adjacent strucure such as nerves and vessels. The tumor is loosely attached to the surrounding structures. 2. The PICA, bilateral VA, low cranial nerve, CV VII + VIII complex, and ipsilateral and contralateral CN VI were identified durng the dissection and were well preserved. 3. Intra-operative right ear BAEP became irregular after the craniotomy was made. The right side MEP of upper and lower limbs vanished abruptly after retraction the cerebellum for a period of time (~ 1hr). The cerebellar was released from retraction after the changing of MEP. The BAEP and MEP were not recovered after the operation. 3. Intra-operative right ear BAEP became irregular after the craniotomy was made. The left side MEP of upper and lower limbs vanished abruptly after retraction the cerebellum for a period of time (~ 1hr). The cerebellar was released from retraction after the changing of MEP. The BAEP and MEP were not recovered after the operation. 4. Most of the tumor were resected. Operative Procedures Under ETGA, we placed the patient on supine position and his right shoulder was elevated. After fixing his head with Mayfield clamp, his face was tilt to left with neck mild flexion. A reverse-U shape skin insion was made over right sub-occipital area. The wound was opened in layers and the sub-occipital triangle was reached after dissecting the muscles. The C1 lamina was found and the occipital-atlantal ligament was identified. The venous plexus above the right vetebral artery was reached after dissecting the sofetissue. A small bleeder from the vetebral artery was packed with Gelfoam. Right sub-occiptal craniotomy was made after making a burr-hole. A curivilinear durotomy was created and the arachnoid membrane was opened for CSF drainage. The dura was opened after the brain was sunked and the PICA and low cranial nerve were seen. Pearl-like tumor was found and tumor resection was performed with dissector, tumor forceps, and suction. The CN VII + VIII complex was found and the contralateral VA and basilar artery were also found. The tumor between nerves and vessels was dissected meticulously. The low cranial nerve, CV VII + VIII complex were identified durng the dissection and were well preserved. After complete hemostasis, the dura was closed with 3-0 prolene. The wound was closed in layers with 2-0Vicryl and 3-0 Nylon after a CWV drain placement. Operators Prof. 杜永光 Assistants R6 鍾文桂 R3 曾偉倫 相關圖片 謝智安 (M,1974/11/27,37y3m) 手術日期 2011/11/14 手術主治醫師 李崇維 手術區域 東址 000房 號 診斷 Arteriovenous malformation, brain 器械術式 TAE for AVM 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 2 時間資訊 00:00 臨時手術NPO 08:35 麻醉開始 09:05 誘導結束 14:05 麻醉結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 王駱美菊 (F,1949/11/19,62y3m) 手術日期 2011/11/14 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Brain metastasis 器械術式 Craniotomy for left cerebellar hemangioblastoma excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3 紀錄醫師 蔡宗良, 時間資訊 00:00 臨時手術NPO 07:35 報到 08:05 進入手術室 08:15 麻醉開始 08:45 誘導結束 08:46 抗生素給藥 09:00 手術開始 11:46 抗生素給藥 12:00 麻醉結束 12:00 手術結束 12:10 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除-手術時間在4小時以內 1 1 B 摘要__ 手術科部: 外科部 套用罐頭: Bicoronal bifrontal craniotomy for tumor excision 開立醫師: 蔡宗良 開立時間: 2011/11/14 12:26 Pre-operative Diagnosis Metastatic brain tumor, frontal lobe, bilateral Post-operative Diagnosis Metastatic brain tumor, suspect radionecrosis, frontal lobe, bilateral Operative Method Bicoronal bifrontal craniotomy for tumor excision Specimen Count And Types 2 pieces About size:小 Source:LEFT: left-sided brain tumor, suspect radionecrosis, partial lobectomy About size:小 Source:RIGHT: right-sided tumor exicision Pathology Report pending Operative Findings 1. Adhesion at subarachnoid space, suspect cancerous meningitis 2. Bilateral tumor was mixed with hard and fragile in consistency, pale yellowish in color, moderately dermacated, and surounded by cystic structures. Left-sided tumor has dural based characteristics, probably arise from dural metastasis with brain parenchymal invasion. 3. Sudden brain swelling occurred during left-sided frontal base tumor excision, thus partial lobectomy was performed. Ultrasonography did not reveal any intraparenchymal hematoma but hyperechoic lesion over circle of Willis Operative Procedures 1. ETGA, supine, Mayfield skull fixation, flexion 20 degrees 2. Bicoronal scalp incision on previous wound 3. Previous scull plate was removed 4. Extended craniotomy was performed to the left side 5. Right-sided U-shaped durotomy basing on superior sagittal sinus 6. 5-0 prolene for dural closure after tumor removal 7. Left-sided U-shaped durotomy basing on superior sagittal sinus 8. After tumor removal, dura was covered by Dura-Form 9. Skull plate was fixed back to the craniotomy window 8. Wound was closed in layers 10. Wound was closed in layers Operators VS 曾漢民 Assistants R6 蔡宗良, R1 張哲瑋 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Bicoronal bifrontal craniotomy for tumor excision 開立醫師: 張哲瑋 開立時間: 2011/11/14 12:32 Pre-operative Diagnosis Metastatic brain tumor, frontal lobe, bilateral Post-operative Diagnosis Metastatic brain tumor, suspect radionecrosis, frontal lobe, bilateral Operative Method Bicoronal bifrontal craniotomy for tumor excision Specimen Count And Types 2 pieces About size:小 Source:LEFT: left-sided brain tumor, suspect radionecrosis, partial lobectomy About size:小 Source:RIGHT: right-sided tumor exicision Pathology Report pending Operative Findings 1. Adhesion at subarachnoid space, suspect cancerous meningitis 2. Bilateral tumor was mixed with hard and fragile in consistency, pale yellowish in color, moderately dermacated, and surounded by cystic structures. Left-sided tumor has dural based characteristics, probably arise from dural metastasis with brain parenchymal invasion. 3. Sudden brain swelling occurred during left-sided frontal base tumor excision, thus partial lobectomy was performed. Ultrasonography did not reveal any intraparenchymal hematoma but hyperechoic lesion over circle of Willis Operative Procedures 1. ETGA, supine, Mayfield skull fixation, flexion 20 degrees 2. Bicoronal scalp incision on previous wound 3. Previous scull plate was removed 4. Extended craniotomy was performed to the left side 5. Right-sided U-shaped durotomy basing on superior sagittal sinus 6. 5-0 prolene for dural closure after tumor removal 7. Left-sided U-shaped durotomy basing on superior sagittal sinus 8. After tumor removal, dura was covered by Dura-Form 9. Skull plate was fixed back to the craniotomy window 10. Wound was closed in layers Operators VS 曾漢民 Assistants R6 蔡宗良, R1 張哲瑋 相關圖片 盧秀山 (F,1965/06/27,46y8m) 手術日期 2011/11/14 手術主治醫師 蔡翊新 手術區域 東址 005房 02號 診斷 Scalp Laceration wound 器械術式 craniotomy for EDH removal, cerebellum, right 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 4E 紀錄醫師 楊博智, 時間資訊 00:24 通知急診手術 00:36 報到 00:36 進入手術室 00:45 麻醉開始 00:55 誘導結束 01:15 抗生素給藥 01:25 手術開始 01:45 開始輸血 04:10 04:15 抗生素給藥 07:30 麻醉結束 07:30 手術結束 07:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 硬腦膜外血腫清除術 1 1 R 手術 顱內壓視置入 1 2 R 摘要__ 手術科部: 外科部 套用罐頭: Right occipito-suboccipital craniotomy for ep... 開立醫師: 游健生 開立時間: 2011/11/14 03:20 Pre-operative Diagnosis Right occipito-suboccipital epidural hematoma Post-operative Diagnosis 1. Right occipito-suboccipital epidural hematoma 2. Open fracture of skull Operative Method Right occipito-suboccipital craniotomy for epidural hematoma evacuation and ICP monitoring Specimen Count And Types nil Pathology Nil Operative Findings There was a whole-layer scalp laceration at right occipital region. Beneath that, there was a vertical linear fracture extending from occipital to suboccipital region. A large epidural hematoma was noted at right occipito-suboccipital region. The maximal thickness was about 4cm. The transverse sinus was intact. There was no subdural hematoma. Codman ICP monitor reference: 499. Estimated blood loss: 800ml Operative Procedures Under ETGA, patient was in prone position with head fixed by Mayfield headclamp. After shaving, we disinfected and draped the operation field as usual. A hockey-stick incision was made on right occipito-suboccipital region including the laceration wound at occiput. The skin flap was elevated to gatheter with neck muscle after muscle detachment along midline. After creation of 4 burholes, a 6x8cm craniotomy was done. Dura tenting along craniotomy window was done and the epidural hematoma was removed. We made a small durotomy at right occipital region and placed an ICP probe at subdural space. An epidural CWV was set followed by central tenting. Bone flap was fixed back with 3 mini-plates. Neck muscle was approximated and wound was closed in layers with 3-0 Vircyl and 4-0 Nylon. Operators VS 蔡翊新 Assistants R5 曾峰毅 Indication Of Emergent Operation epidural hematoma with pending brainstem compression 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Right occipito-suboccipital craniotomy for ep... 開立醫師: 游健生 開立時間: 2011/11/14 03:29 Pre-operative Diagnosis Right occipital skull fracture with epidural hematoma Post-operative Diagnosis Right occipital open skull fracture, grade II, with epidural hematoma Operative Method Right occipito-suboccipital craniotomy for epidural hematoma evacuation and ICP monitoring Specimen Count And Types nil Pathology Nil Operative Findings There was a whole-layer scalp laceration at right occipital region. Beneath that, there was a vertical linear fracture extending from occipital to suboccipital region. A large epidural hematoma was noted at right occipito-suboccipital region. The maximal thickness was about 4cm. The transverse sinus was intact. There was no subdural hematoma. ICP after skin closure was 2 mmHg. Codman ICP monitor reference: 499. Estimated blood loss: 800ml Operative Procedures Under ETGA, patient was in prone position with head fixed by Mayfield headclamp. After shaving, we disinfected and draped the operation field as usual. A hockey-stick incision was made on right occipito-suboccipital region including the laceration wound at occiput. The skin flap was elevated to gatheter with neck muscle after muscle detachment along midline. After creation of 5 burr holes, a 6x8cm craniotomy was done. Epidural hematoma was removed by currettes and sucker. Dura tenting along craniotomy window was done. We made a small durotomy at right occipital region and placed an Codman ICP probe at subdural space. An epidural CWV was set followed by central tenting. Bone flap was fixed back with 3 mini-plates. Neck muscle was approximated and wound was closed in layers with 3-0 Vircyl and 4-0 Nylon. Operators VS 蔡翊新 Assistants R5 曾峰毅 Indication Of Emergent Operation epidural hematoma with impending brainstem compression 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Exploratory laparotomy and remove foreign body 開立醫師: 楊博智 開立時間: 2011/11/14 15:03 Pre-operative Diagnosis Foreign body in stomach Post-operative Diagnosis Foreign body in stomach Operative Method Exploratory laparotomy and remove foreign body Specimen Count And Types nil Pathology nil Operative Findings 1. There are 44 needles in the fundus of stomach 2. No ascites or stomach perforation noted 3. There is not needle in the stomach on the last Xray film Operative Procedures 1. ETGA, supine 2. Skin disinfection, draped 3. Midline laparotomy 4. Lineal incision on the antrum 5. Remove the needles 6. Check the abdomen plain film 7. Close the gastric incision wound by layers 8. Insert one R/D on left subhepatic area 9. Close the wound in layers Operators VS蔡翊新 Assistants R5洪浩雲 R3楊博智 Ri蘇騰威 Indication Of Emergent Operation prevent perforation 相關圖片 周清榮 (M,1950/02/03,62y1m) 手術日期 2011/11/14 手術主治醫師 蔡翊新 手術區域 東址 002房 03號 診斷 Subarachnoid hemorrhage 器械術式 Craniotomy(Aneurysms) , right pterion, A-com 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 4E 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 12:34 通知急診手術 13:20 進入手術室 13:20 報到 13:25 麻醉開始 13:35 誘導結束 13:40 抗生素給藥 13:40 手術開始 16:40 抗生素給藥 19:40 抗生素給藥 22:05 麻醉結束 22:05 手術結束 22:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 9 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 開顱術摘除血管病變 - 腦血管瘤 有病徵的 1 1 R 手術 顱內壓視置入 1 2 R 記錄__ 手術科部: 外科部 套用罐頭: Aneurysm-frontotemporal approach 開立醫師: 蔡翊新 開立時間: 2011/11/14 21:26 Pre-operative Diagnosis Anterior communicating artery aneurysm rupture with subarachnoid hemorrhage, intraventricular hemorrhage and acute hydrocephalus. Post-operative Diagnosis Anterior communicating artery aneurysm rupture with subarachnoid hemorrhage, intraventricular hemorrhage and acute hydrocephalus. Operative Method Right pterional craniotomy for aneurysm clipping and right Kocher EVD for ICP monitoring. Specimen Count And Types 3 tubes of CSF, sent for routine, BCS and bacterial culture Pathology Nil. Operative Findings CSF: bloody, initial pressure: 10 cmH2O. There were dense fibrin and blood clots in the subarachnoid space around right Sylvian fissure and prechiasmatic cistern. The A1 segment of right ACA was elongated. An atresic left ACA was noted. There was a saccular aneurysm arising from A-com complex, pointing upward. The neck of aneurysm was about 6 mm in width. It was clipped by a 10-mm 135-degree angled Sugita aneurysm clip. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left for 45 degrees and slightly extended then fixed by Mayfield skull clamp. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: right frontotemporal, curvilinear. The skin edge was clipped by Raney clips for temporary hemostasis. After scalp had been lifted, the temporalis muscle was incised and detached from temporal squama and reflected to lower temporal side. 5. Craniotomy window: 10 x6 cm, right frontotemporal, created by making 3 burr holes then cut by power saw. The lower temporal bone and pterionic ridge (esp. the inner table) were cut by rongeur as low as possible for easy approach to the anterior clinoid. 6. Dural tention: by 2/0 silk, 1.5 cm in interval, distributed along the edge of skull window. 7. Dural incision: curvilinear, over-ridding Sylvian fissure and reflected to frontotemporal base. 8. Ventricular tapping via a burr hole at right Kocher point and drainage of CSF was made to slacken down the brain for easy approach to anterior clinoid without undue traction on the brain. 9. Under operating microscope, the suprasellar cistern was opened. The right optic nerve and ICA came into view. The right rectal gyrus was excised. The arachnoid trabeculi and the fibrin (or blood clot) were cleaned out to expose the neck of the aneurysm. The neck of the aneurysm was mobilized gently by a Gage 18 sucker and a microdissector. 10.A 10-mm, 135-degree angled Sugita clip was applied to the neck of the aneurysm. 11.After successful clipping of the aneurysm, the exposed field was irrigated with N.S. to make sure no any bleeding. 12.The brain retractors were removed. The dura was closed water-tight by running suture with 4/0 Prolene. 13.Closure of skull window: the skull plate was placed back to craniotomy window and fixed by 3 miniplates and 6 screws. The dura was tented to the center of the skull plate by several 2/0 stitches. The covering muscle was closed by interrupted stitches with 1/ 0 silk. 14.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 15.Drain: one, epidural, CWV. 16.Blood transfusion: nil. Blood loss: 200 ml. 17.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5李振豪R4游健生R0施培艾 Indication Of Emergent Operation progressive conscious deterioration after SAH. 相關圖片 蔡岱玲 (F,1953/09/12,58y6m) 手術日期 2011/11/15 手術主治醫師 蔡瑞章 手術區域 東址 002房 03號 診斷 Subdural hemorrhage, traumatic 器械術式 Removal of chronic subdural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 08:21 通知急診手術 11:40 報到 11:57 進入手術室 12:00 麻醉開始 12:05 誘導結束 12:18 抗生素給藥 12:56 手術開始 15:18 抗生素給藥 16:10 麻醉結束 16:10 手術結束 16:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 記錄__ 手術科部: 外科部 套用罐頭: Right frontal craniotomy for hematoma evacuation. 開立醫師: 鍾文桂 開立時間: 2011/11/15 16:32 Pre-operative Diagnosis Right frontal-parietal subacute subdural hemorrhage. Post-operative Diagnosis Right frontal-parietal subacute subdural hemorrhage. Operative Method Right frontal craniotomy for hematoma evacuation. Specimen Count And Types nil Pathology Nil. Operative Findings 1. Dark red brown liquified hematoma with small blood clots. 2. Some organized hematoma was noted at frontal area. 3. Inner and outer membranes were noted. The outer membrane just below the durotomy was excised. The inner membrane was incised in cruciate pattern for better brain expansion. The arachnoid membrane was kept intact. Operative Procedures Under ETGA, the patient was placed in supine position and the head was tilted to the left side. After shaving, disinfection, and draping, a linear scalp incision was made. After creating one 5 cm craniotomy with high speed drill, the dura mater was incised. The outer membrane was excised. The hematoma was evacuated by suction and rubber drain. After well hemostasis, the dura mater was closed in watertight fashion and augmented with Cook artificial dura mater. The craniotomy plate was fixed by miniplates and screws. The wound was closed in layers with one subdural rubber drain in situ. Operators 蔡瑞章 Assistants 鍾文桂 Indication Of Emergent Operation Acute left hemiparesis. 相關圖片 張光澤 (M,1949/01/13,63y2m) 手術日期 2011/11/15 手術主治醫師 曾勝弘 手術區域 東址 005房 02號 診斷 Lumbar spondylosis 器械術式 Repair of lumbar CSF leakage 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 蔡宗良, 時間資訊 00:00 臨時手術NPO 10:40 進入手術室 10:45 麻醉開始 10:50 誘導結束 10:50 抗生素給藥 11:12 手術開始 12:05 手術結束 12:05 麻醉結束 12:15 送出病患 12:18 進入恢復室 13:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 軟組織良性腫瘤切除術,大或深 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: CSF leak repair 開立醫師: 蔡宗良 開立時間: 2011/11/15 12:30 Pre-operative Diagnosis CSF leak Post-operative Diagnosis CSF leak Operative Method CSF leak repair Specimen Count And Types 1 piece About size:小 Source:deep wound Pathology none Operative Findings 1. Multiple suture loosening over the fascial layer 2. Serosanginous fluid collections above and below the fascial layers 3. Clear CSF oozing from left-sided lateral recess area at L4 level, which was covered by Gelfoam and covered by Tissucol Duo. Operative Procedures 1. ETGA prone 2. Wound opening and suture removal 3. Retractor apply, leakage searching, closure and repair of leakage 4. Gentamicin saline irrigation 5. Wound closed in layers Operators P 曾勝弘 Assistants R6 蔡宗良 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: CSF leak repair 開立醫師: 蔡宗良 開立時間: 2011/11/25 09:11 Pre-operative Diagnosis CSF leak Post-operative Diagnosis CSF leak Operative Method CSF leak repair Specimen Count And Types 1 piece About size:小 Source:deep wound Pathology none Operative Findings 1. Multiple suture loosening over the fascial layer 2. Serosanginous fluid collections above and below the fascial layers 3. Clear CSF oozing from left-sided lateral recess area at L4 level, which was covered by Gelfoam and covered by Tissucol Duo. Operative Procedures 1. ETGA prone 2. Wound opening and suture removal 3. Retractor apply, leakage searching, closure and repair of leakage 4. Gentamicin saline irrigation 5. Wound closed in layers Operators P 曾勝弘 Assistants R6 蔡宗良 相關圖片 呂元中 (M,1972/02/17,40y0m) 手術日期 2011/11/15 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Parkinsonism (F02.3) 器械術式 IPG implantation 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 張書豪, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:09 進入手術室 08:12 麻醉開始 08:17 誘導結束 08:30 抗生素給藥 08:57 手術開始 10:15 手術結束 10:15 麻醉結束 10:25 送出病患 10:27 進入恢復室 11:27 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: IPG implantation 開立醫師: 蔡宗良 開立時間: 2011/11/15 10:29 Pre-operative Diagnosis Parkinsonism s/p DBS implantation Post-operative Diagnosis Parkinsonism s/p DBS implantation and battery connection and implantation Operative Method IPG implantation Specimen Count And Types nil Pathology None Operative Findings Device was checked and confirmed Operative Procedures 1. ETGA supine, head rotated to the right 2. Scalp incision and DBS wire retrieval 3. Subcutanoeous pocked made at right subclavicular area 4. Wire were fixed to the battery 5. Device confirmation 6. Wound closure Operators VS 曾勝弘 Assistants R6 蔡宗良 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: IPG implantation 開立醫師: 張書豪 開立時間: 2011/11/18 11:42 Pre-operative Diagnosis Parkinsonism s/p DBS implantation Post-operative Diagnosis Parkinsonism s/p DBS implantation and battery connection and implantation Operative Method IPG implantation Specimen Count And Types nil Pathology None Operative Findings Device was checked and confirmed Operative Procedures 1. ETGA supine, head rotated to the right 2. Scalp incision and DBS wire retrieval 3. Subcutanoeous pocked made at right subclavicular area 4. Wire were fixed to the battery 5. Device confirmation 6. Wound closure Operators VS 曾勝弘 Assistants R6 蔡宗良 相關圖片 廖文豪 (M,1982/01/05,30y2m) 手術日期 2011/11/15 手術主治醫師 曾勝弘 手術區域 東址 005房 03號 診斷 Neurofibromatosis type 2 器械術式 craniotomy for left sphenoid ridge menngioma excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 張書豪, 時間資訊 00:00 臨時手術NPO 11:55 報到 12:40 進入手術室 12:45 麻醉開始 13:15 誘導結束 13:18 手術開始 13:20 抗生素給藥 15:55 開始輸血 16:20 抗生素給藥 18:55 麻醉結束 18:55 手術結束 19:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 手術 顱底瘤手術 1 1 摘要__ 手術科部: 外科部 套用罐頭: Pterional craniotomy for simpsons grade III r... 開立醫師: 張書豪 開立時間: 2011/11/17 16:42 Pre-operative Diagnosis Extra-axial tumor, sphenoid wing, inner-third, left-sided Post-operative Diagnosis Extra-axial tumor, suspect meningioma,sphenoid wing, inner-third, left-sided Operative Method Pterional craniotomy for simpsons grade III removal of meningioma Specimen Count And Types Pathology Report pending Operative Findings 1. A 5 cm diameter tumor, arising from inner third sphenoid wing, with adhesion to chiasmic cistern and lateral side of cavernous sinus. Tumor displaced ACA and MCA towards posteromedial side. Tumor was greyish in color, firm and elastic in consistency, rounded and very well demarcated and vascularity was high. Part of the tumor attached to the chiasmatic cistern was left in purpose to avoid injury to optic chiasm and sella structures. Operative Procedures 1. ETGA supine, Mayfield skull fixation, head rotated 60 degrees to the right. 2. Routine preparation 3. Curved scalp incision 4. Pterional craniotomy 5. U-shaped durotomy based on sphenoid ridge 6. Brain retraction and removal of brain tumor with bipolar cautery, suction, and tumor forceps 7. Dura was closed by 4-0 Prolene 8. Skull plate fixation by mini-plates 9. CWV placement at subgaleal space 10. Wound was closed in layers. Operators V Assistants 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Pterional craniotomy for simpsons grade III r... 開立醫師: 張書豪 開立時間: 2011/11/17 18:33 Pre-operative Diagnosis Extra-axial tumor, sphenoid wing, inner-third, left-sided Post-operative Diagnosis Extra-axial tumor, suspect meningioma,sphenoid wing, inner-third, left-sided Operative Method Pterional craniotomy for simpsons grade III removal of meningioma Specimen Count And Types Extra-axial tumor, sphenoid wing, inner-third, left-sided Pathology Report pending Operative Findings 1. A 5 cm diameter tumor, arising from inner third sphenoid wing, with adhesion to chiasmic cistern and lateral side of cavernous sinus. Tumor displaced ACA and MCA towards posteromedial side. Tumor was greyish in color, firm and elastic in consistency, rounded and very well demarcated and vascularity was high. Part of the tumor attached to the chiasmatic cistern was left in purpose to avoid injury to optic chiasm and sella structures. Operative Procedures 1. ETGA supine, Mayfield skull fixation, head rotated 60 degrees to the right. 2. Routine preparation 3. Curved scalp incision 4. Pterional craniotomy 5. U-shaped durotomy based on sphenoid ridge 6. Brain retraction and removal of brain tumor with bipolar cautery, suction, and tumor forceps 7. Dura was closed by 4-0 Prolene 8. Skull plate fixation by mini-plates 9. CWV placement at subgaleal space 10. Wound was closed in layers. Operators V VS曾勝弘 Assistants R6蔡宗良 R1張書豪 相關圖片 趙妍凱 (F,2011/08/16,7m1d) 手術日期 2011/11/15 手術主治醫師 郭夢菲 手術區域 東址 000房 號 診斷 Hydrocephalus 器械術式 V-P shunt 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3E 紀錄醫師 游健生, 時間資訊 11:00 臨時手術NPO 11:00 開始NPO 20:23 通知急診手術 21:13 進入手術室 21:15 麻醉開始 21:35 誘導結束 21:45 抗生素給藥 21:50 手術開始 22:20 手術結束 22:20 麻醉結束 22:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱內壓視置入 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 套用罐頭: EVD insertion as ICP monitor, right 開立醫師: 游健生 開立時間: 2011/11/15 22:53 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method EVD insertion as ICP monitor, right Specimen Count And Types 1 piece About size:25cc Source:CSF Pathology nil Operative Findings Tense bulging anterior and posterior fontanelle were noted before surgery. Turbid xanthochromic to yellow-red CSF ejected out after ventriculostomy. Some was sent for biochem, AFP, beta-HCG, culture, routine, and cytology. The ventricle catheter was 5.5cm in length. After surgery, the fontanelle became softer. Operative Procedures Under ETGA, patient was in supine position. After shaving, we disinfected and draped the operation field as usual. A transverse scalp incision was made at right frontal region near anterior border of anterior fontanelle. The periesteium was exposed and transected. The dura was exposed and opened in cruciate fashion. After bipolar coagulation, ventriculostomy was performed followed by EVD insertion. The EVD was fixed and CSF sample was collected. After hemostasis, wound was closed in layers with 4-0 Vicryl and 5-0 Nylon. Operators VS 郭夢菲 Assistants R4 游健生 Indication Of Emergent Operation Severe intracranial hypertension 相關圖片 記錄__ 手術科部: 套用罐頭: EVD insertion as ICP monitor, right 開立醫師: 郭夢菲 開立時間: 2011/11/16 11:38 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method EVD insertion as ICP monitor, right Specimen Count And Types 1 piece About size:25cc Source:CSF Pathology nil Operative Findings Very tense bulging anterior and posterior fontanelle were noted before surgery. Turbid, serosanguinous CSF ejected out after ventriculostomy. The ICP was more than 40 cm H2O. The CSF was sent for biochem, AFP, beta-HCG, culture, routine, and cytology. The ventricle catheter was 5.5cm in length. After surgery, the fontanelle became softer. Operative Procedures Under ETGA, patient was in supine position. After shaving, we disinfected and draped the operation field as usual. A transverse scalp incision was made at right frontal region near anterior border of anterior fontanelle. The periesteium was exposed and transected. The dura was exposed and opened in cruciate fashion. After bipolar coagulation, ventriculostomy was performed followed by EVD insertion. The EVD was fixed and CSF sample was collected. After hemostasis, wound was closed in layers with 4-0 Vicryl and 5-0 Nylon. Operators VS 郭夢菲 Assistants R4 游健生 Indication Of Emergent Operation Severe intracranial hypertension 相關圖片 李東南 (M,1944/02/16,68y0m) 手術日期 2011/11/15 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Lumbar stenosis 器械術式 L3/4 TLIF, left 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:15 麻醉開始 08:20 誘導結束 08:26 抗生素給藥 08:54 手術開始 11:45 抗生素給藥 12:35 手術結束 12:35 麻醉結束 12:45 送出病患 12:48 進入恢復室 14:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎間盤切除術-腰椎 1 2 記錄__ 手術科部: 外科部 套用罐頭: L3/4 transforaminal lumbar interbody fusion w... 開立醫師: 李振豪 開立時間: 2011/11/15 12:41 Pre-operative Diagnosis L3/4 spondylolisthesis with lumbar stenosis Post-operative Diagnosis L3/4 spondylolisthesis with lumbar stenosis Operative Method L3/4 transforaminal lumbar interbody fusion with PEEK banana cage Specimen Count And Types nil Pathology Nil Operative Findings Remarkable scar formation over bilateral paraspinal area was noted due to previous surgery. The scar extended into laminotomy and adhered to the thecal sac tightly. The plane was dissected with curette. The left epidural mass which cause thecal sac and root compression was granulation tissue. The disc was degenerative in character. After decompression, the thecal sac and root expanded well. No incidental durotomy or CSF leakage was noted. Total four 6.2 x 45mm transpedicular screws, two 5cm rods, and one #11 PEEK banana cage was implanted for transforaminal lumbar interbody fusion. Operative Procedures Under endotacheal general anesthesia, the patient was put in prone position. L3 and L4 pedicle level was localized by portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made and the subcutaneous soft tissue was devided. The paravertebral muscle groups were detached. L3 and L4 transpedicular screws were implanted under C-arm guided. L3/4 laminectomy and left facetectomy was conducted for decompression. After lumbar diskectomy, transforaminal lumbar interbody fusion with PEEK banana cage filled with autologous bone graft was performed. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. The wound was irrigated with Gentamicin solutions. One epidural 1/8 Hemovac was placed. The wound was then closed in layers with 1-0, 2-0 Vicryl and 3-0 Nylon. Operators VS賴達明 Assistants R5李振豪, R1李嘉哲, Ri陳天華 相關圖片 王至正 (F,1970/01/30,42y1m) 手術日期 2011/11/15 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 HIVD 器械術式 L4/5 microdiskectomy 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 13:05 進入手術室 13:07 麻醉開始 13:15 誘導結束 13:40 抗生素給藥 13:45 手術開始 15:10 手術結束 15:10 麻醉結束 15:13 送出病患 15:15 進入恢復室 16:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 椎間盤切除術-腰椎 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: L4/5 microdiskectomy, right 開立醫師: 李振豪 開立時間: 2011/11/15 15:22 Pre-operative Diagnosis L4/5 ruptured intervertebral disc, right Post-operative Diagnosis L4/5 ruptured intervertebral disc, right Operative Method L4/5 microdiskectomy, right Specimen Count And Types nil Pathology Nil Operative Findings Ruptured disc with severe compression of thecal sac and right L5 root was noted. Hyper-remic change of the right L5 root was noted. After removal of the ruptured disc, the thecal sac and the root decompressed well. The central bulging disc was also removed. The disc was healthy incharacter. No incidental durotomy or CSF leakage was noted during whole procedure. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position. The L4/5 disc level was localized by portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made and the subcutaneous soft tissue was devided. Right side paraspinal muscle groups were detached. L4/5 right side laminotomy was conducted and the ligmentum flavum was removed. The thecal sac and the root was retracted and the ruptured disc was identified. The ruptured disc was evacuated and the central bulging disc was removed with curette, alligator, and disc clamp. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Under endotracheal general anesthesia, the patient was put in prone position. The L4/5 disc level was localized by portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made and the subcutaneous soft tissue was devided. Right side paraspinal muscle groups were detached. L4/5 right side laminotomy was conducted and the ligmentum flavum was removed. The thecal sac and the root was retracted and the ruptured disc was identified. The ruptured disc was evacuated and the central bulging disc was removed with curette, alligator, and disc clamp. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. The wound was then closed in layers with 2-0 Vicryl and 4-0 Dexon. Operators VS賴達明 Assistants R5李振豪, R1李嘉哲 相關圖片 吳玲芬 (F,1960/02/05,52y1m) 手術日期 2011/11/15 手術主治醫師 賴達明 手術區域 東址 003房 03號 診斷 Chronic cough 器械術式 L4/5 TLIF, right 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 14:40 報到 15:26 進入手術室 15:35 麻醉開始 15:40 誘導結束 15:50 抗生素給藥 16:07 手術開始 18:50 抗生素給藥 19:10 手術結束 19:10 麻醉結束 19:20 送出病患 19:25 進入恢復室 20:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎間盤切除術-腰椎 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 記錄__ 手術科部: 外科部 套用罐頭: L4/5 transforaminal lumbar interbody fusion w... 開立醫師: 李振豪 開立時間: 2011/11/15 19:36 Pre-operative Diagnosis L4/5 spondylolisthesis with lumbar stenosis Post-operative Diagnosis L4/5 spondylolisthesis with lumbar stenosis Operative Method L4/5 transforaminal lumbar interbody fusion with PEEK banana cage Specimen Count And Types nil Pathology Nil Operative Findings Degeneration, pseudoarthrotic change, and unstable spine was noted on L4/5 facet joint. After decompression, the thecal sac and root expanded well. No obvious CSF leakage was noted during whole procedure. Four 6.2 x 40mm transpedicular screws, two 5cm rods, and one #11 PEEK banana cage were used for transforaminal lumbar interbody fusion. Operative Procedures Under endotracehal general anesthesia, the patient was put in prone position. The L4 and L5 pedicle was localized by portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made from L4 to L5 and the subcutaneous soft tissue was devided. The paravertebral muscle groups were detached. L4 and L5 transpedicular screws were implanted under C-arm X-ray guided. L4/5 laminectomy and right side facetectomy was conducted for decompression. The L4/5 diskectomy was performed followed by transforaminal lumbar interbody fusion with PEEK banana cage filled with autologous bone graft. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. One 1/8 hemovac was placed and the wound was irrigated with Gentamicin solution. The wound was then closed in layers with 1-0, 2-0 Vicryl and 3-0 Nylon. Operators VS賴達明 Assistants R5李振豪, R1李嘉哲 相關圖片 陸宜蓁 (F,1959/12/29,52y2m) 手術日期 2011/11/15 手術主治醫師 陳敞牧 手術區域 西址 039房 01號 診斷 Carpal tunnel syndrome 器械術式 Neurolysis of the uluar neuve 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 08:47 報到 09:04 進入手術室 09:12 麻醉開始 09:18 手術開始 10:00 麻醉結束 10:00 手術結束 10:10 送出病患 記錄__ 手術科部: 外科部 套用罐頭: Neurolysis. 開立醫師: 鍾文桂 開立時間: 2011/11/15 10:26 Pre-operative Diagnosis Carpal tunnel syndrome,right. Post-operative Diagnosis Carpal tunnel syndrome,right. Operative Method Neurolysis. Specimen Count And Types 1 piece About size: Source: Pathology Nil. Operative Findings The medium nerve was compressed tightly by the hypertrophic transverse carpal ligament, with erythematous change. Operative Procedures 1. Skin prepare, Local anesthesia. 2. Skin incision 3. Neurolysis 4. hemostasis 5. wound closure in layers Operators 陳敞牧 Assistants 鍾文桂 相關圖片 林微恩 (F,2010/09/01,1y6m) 手術日期 2011/11/15 手術主治醫師 楊士弘 手術區域 兒醫 067房 01號 診斷 Tethered cord syndrome 器械術式 cord untethering 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 石博元 ASA 3 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 08:00 進入手術室 08:10 麻醉開始 09:10 誘導結束 09:10 抗生素給藥 09:52 手術開始 12:15 手術結束 12:15 麻醉結束 12:25 送出病患 12:30 進入恢復室 13:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 手術 良性脊髓腫瘤切除術 1 1 麻醉 Peripheral arterial line inserti 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: L4 laminoplasty for terminal filum lipoma exc... 開立醫師: 游健生 開立時間: 2011/11/15 13:01 Pre-operative Diagnosis Tethered cord with terminal filum lipoma Post-operative Diagnosis Tethered cord with terminal filum lipoma Operative Method L4 laminoplasty for terminal filum lipoma excision and cord untethering Specimen Count And Types 1 piece About size:2mm Source:terminal filum lipoma Pathology Pending Operative Findings A cutaneous sinus was noted at sacral area. A slim tumor, which was adipose-tissue-like, was noted at terminal filum. Terminal filum was confirmed by intra-operative nerve stimulation (both sensory and motor). Operative Procedures Under ETGA, patient was in prone position. After disinfection and draping, we disinfected and draped the operation field as usual. A transverse skin incision was made level of spinous process(L4) below the one marked by paperclip. The spinous process was exposed by detactment of paraspinal muscle. The laminae was cut bilaterally by Kerrison and rotated to right side after cutting the interspinous ligament. The thecal sac was exposed after removal of epidural fat. It was opened at midline and tented. The arachnoid membrane was opened and we searched for terminal filum lipoma. The terminal filum was tested by intra-operative nerve stimulation (both sensory and motor). Then, the lipoma was excised together with a segment of terminal filum. Dura was closed with 5-0 prolene in water-tight fashion and covered with DuraForm. The laminae was fixed back with 4 silk sutures. After hemostasis and irrigation, wound was closed in layers with 3-0 Vicryl and 5-0 Nylon. Operators VS 楊士弘 Assistants R4 游健生 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: L4 laminoplasty for terminal filum lipoma exc... 開立醫師: 游健生 開立時間: 2011/11/15 13:02 Pre-operative Diagnosis Tethered cord with terminal filum lipoma Post-operative Diagnosis Tethered cord with terminal filum lipoma Operative Method L4 laminoplasty for terminal filum lipoma excision and cord untethering Specimen Count And Types 1 piece About size:2mm Source:terminal filum lipoma Pathology Pending Operative Findings A cutaneous sinus was noted at sacral area. A slim tumor, which was adipose-tissue-like, was noted at terminal filum. Terminal filum was confirmed by intra-operative nerve stimulation (both sensory and motor). Operative Procedures Under ETGA, patient was in prone position. After disinfection and draping, we disinfected and draped the operation field as usual. A transverse skin incision was made level of spinous process(L4) below the one marked by paperclip. The spinous process was exposed by detactment of paraspinal muscle. The laminae was cut bilaterally by Kerrison and rotated to right side after cutting the interspinous ligament. The thecal sac was exposed after removal of epidural fat. It was opened at midline and tented. The arachnoid membrane was opened and we searched for terminal filum lipoma. The terminal filum was tested by intra-operative nerve stimulation (both sensory and motor). Then, the lipoma was excised together with a segment of terminal filum. Dura was closed with 5-0 prolene in water-tight fashion and covered with DuraForm. The laminae was fixed back with 4 silk sutures. After hemostasis and irrigation, wound was closed in layers with 3-0 Vicryl and 5-0 Nylon. Operators VS 楊士弘 Assistants R4 游健生 相關圖片 許俊義 (M,1979/08/20,32y6m) 手術日期 2011/11/15 手術主治醫師 王國川 手術區域 東址 002房 04號 診斷 Intracranial hemorrhage 器械術式 Left decompressive craniectomy + ICP monitoring 手術類別 緊急手術 手術部位 頭、頸 傷口分類 髒 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 5E 紀錄醫師 曾偉倫, 時間資訊 18:18 通知急診手術 18:18 臨時手術NPO 18:18 開始NPO 18:50 進入手術室 18:52 麻醉開始 19:00 開始輸血 19:05 誘導結束 19:15 抗生素給藥 19:20 手術開始 21:05 手術結束 21:05 麻醉結束 21:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 硬腦膜外血腫清除術 1 1 L 手術 顱內壓視置入 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: 1. Craniotomy for epidural hematoma removal 開立醫師: 蔡宗良 開立時間: 2011/11/15 21:28 Pre-operative Diagnosis Epidural hematoma, fronto-temporo-parietal, left-sided Contusional brain hemorrhage Post-operative Diagnosis Epidural hematoma, fronto-temporo-parietal, left-sided Contusional brain hemorrhage Operative Method 1. Craniotomy for epidural hematoma removal 2. Intraparenchymal intracranial pressure monitoring Specimen Count And Types nil Pathology none Operative Findings 1. Skull fracture 2. Epidural hematoma 3. Intraparenchymal hemorrhage with subdural hematoma were present, as seen after durotomy 4. ICP was 6 mmHg upon insertion Operative Procedures 1. Tracheostomy-GA, supine, head rotated towards the right 2. Opening the laceration wound plus 1 cm wound incision 3. Craniotomy 4. Removal of EDH 5. Durotomy 6. ICP monitor insertion, intraparenchymal 7. Wound irrigation with gentamicin saline 8. Skull plate was fixed back to the craniotomy window 9. Wound was closed in layers after placing one CWV drain Operators Assistants Indication Of Emergent Operation increased intracranial pressure 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: 1. Craniotomy for epidural hematoma removal 開立醫師: 曾偉倫 開立時間: 2011/11/15 21:40 Pre-operative Diagnosis Epidural hematoma, fronto-temporo-parietal, left-sided Contusional brain hemorrhage Post-operative Diagnosis Epidural hematoma, fronto-temporo-parietal, left-sided Contusional brain hemorrhage Operative Method 1. Craniotomy for epidural hematoma removal 2. Intraparenchymal intracranial pressure monitoring Specimen Count And Types nil Pathology none Operative Findings 1. Skull fracture 2. Epidural hematoma 3. Intraparenchymal hemorrhage with subdural hematoma were present, as seen after durotomy 4. ICP was 6 mmHg upon insertion Operative Procedures 1. Tracheostomy-GA, supine, head rotated towards the right 2. Opening the laceration wound plus 1 cm wound incision 3. Craniotomy 4. Removal of EDH 5. Durotomy 6. ICP monitor insertion, intraparenchymal 7. Wound irrigation with gentamicin saline 8. Skull plate was fixed back to the craniotomy window 9. Wound was closed in layers after placing one CWV drain Operators VS 王國川 Assistants R6 蔡宗良 R3 曾偉倫 Indication Of Emergent Operation increased intracranial pressure 相關圖片 陳深淵 (M,1953/01/25,59y1m) 手術日期 2011/11/16 手術主治醫師 林文瑛 手術區域 西址 034房 05號 診斷 Brain metastasis 器械術式 Insertion of hichman or port a 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 林文瑛 ASA 3 時間資訊 11:35 報到 12:05 進入手術室 12:07 麻醉開始 12:10 誘導結束 12:10 抗生素給藥 12:18 手術開始 12:35 手術結束 12:35 麻醉結束 12:40 送出病患 12:46 進入恢復室 14:45 離開恢復室 記錄__ 手術科部: 麻醉部 套用罐頭: Port-A implantation, subclavian 開立醫師: 林文瑛 開立時間: 2011/11/16 12:35 Pre-operative Diagnosis Lung cancer Post-operative Diagnosis lung cancer Operative Method Port-A implantation, echo-guided Specimen Count And Types nil Pathology Nil Operative Findings 1.Site: right subclavian vein, with echo-guided procedure 2.Patent flow after implantation 3.Others: nil Operative Procedures 1.The patient was set on supine position and bilateral subclavian veins were checked by echo. 2.After IVGA and local anesthesia applied, transverse skin incision for 3cm was made at pre-cordial area. 3.Undermine the skin at the layer between subcutaneous tissue and deep fascia in lateral direction. 4.An IV catheter was inserted via the subclavian incision and negatively aspirated until venous blood attainable. 5.J-wire was inserted smoothly in rostral direction. A subclavian catheter with dilator was inserted through the J-wire, and the dilator was then removed. 6.The catheter of Port-A was threaded into the subclavian vein until mark 22 cm. The catheter was adapted into the port and locked with restrictor.The Port was inserted into the pouch of pre-cordial incision. 7.Skin was closed layer by layer. Both catheter and port were perfused with heparin solution after implantation. Operators 林文瑛, Assistants 陳盈曦, 潘孟臣 (M,1952/08/01,59y7m) 手術日期 2011/11/16 手術主治醫師 蔡瑞章 手術區域 東址 005房 02號 診斷 Malignant neoplasm of trachea 器械術式 Left cerebellar metastatic tumor excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 蔡宗良, 時間資訊 00:00 臨時手術NPO 12:45 進入手術室 12:50 麻醉開始 13:15 誘導結束 13:15 抗生素給藥 13:24 手術開始 16:15 抗生素給藥 16:35 手術結束 16:35 麻醉結束 16:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: Suboccipital craniotomy for tumor removal 開立醫師: 蔡宗良 開立時間: 2011/11/16 17:00 Pre-operative Diagnosis Cerebellar metastatic lung adenocarcinoma, recurrence, left-sided Post-operative Diagnosis Cerebellar metastatic lung adenocarcinoma, recurrence, left-sided Operative Method Suboccipital craniotomy for tumor removal Specimen Count And Types 1 piece About size:小 Source:cerebellar tumor, with dura Pathology Report pending Operative Findings 1. Tumor was just below the dura 2. Tumor was greyish in color, fragile and easily suckable, margin was not very well dermacated. Operative Procedures 1. ETGA, Mayfield head fixation, prone positioning 2. Routine preparation 3. Wound incision over previous scar 4. Exposure of the previous craniotomy skull plate and removed by air-saw 5. Dura over the tumor was removed, together with the tumor 6. Dura was closed by artificial dura and 4-0 prolene in water tight fashion 7. Skull plate was fixed back to craniotomy window 8. Gentamicin saline irrigation 9. Wound was closed in layers Operators Prof蔡瑞章 Assistants R6蔡宗良 R1張哲瑋 相關圖片 李怡瑱 (F,1969/10/16,42y4m) 手術日期 2011/11/16 手術主治醫師 林文瑛 手術區域 西址 034房 07號 診斷 Lymphoma 器械術式 Port-A Implatation /WOR 手術類別 臨時手術 手術部位 胸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 林文瑛 ASA 3 紀錄醫師 陳盈曦, 時間資訊 13:23 進入手術室 13:25 麻醉開始 13:27 誘導結束 13:28 抗生素給藥 13:31 手術開始 13:55 手術結束 13:55 麻醉結束 14:00 送出病患 14:10 進入恢復室 15:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 port–A導管植入術–治療性導管植入術 1 0 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 記錄__ 手術科部: 麻醉部 套用罐頭: Port-A implantation, subclavian 開立醫師: 陳盈曦 開立時間: 2011/11/16 13:59 Pre-operative Diagnosis Lymphoma Post-operative Diagnosis Ditto Operative Method Port-A implantation, echo-guided Specimen Count And Types Pathology Nil Operative Findings 1.Site: right subclavian vein, with echo-guided procedure 2.Patent flow after implantation 3.Others: nil Operative Procedures 1.The patient was set on supine position and bilateral subclavian veins were checked by echo. 2.After IVGA and local anesthesia applied, transverse skin incision for 3cm was made at pre-cordial area. 3.Undermine the skin at the layer between subcutaneous tissue and deep fascia in lateral direction. 4.An IV catheter was inserted via the subclavian incision and negatively aspirated until venous blood attainable. 5.J-wire was inserted smoothly in rostral direction. A subclavian catheter with dilator was inserted through the J-wire, and the dilator was then removed. 6.The catheter of Port-A was threaded into the subclavian vein until mark 21 cm. The catheter was adapted into the port and locked with restrictor.The Port was inserted into the pouch of pre-cordial incision. 7.Skin was closed layer by layer. Both catheter and port were perfused with heparin solution after implantation. Operators 林文瑛 Assistants 范秀華 (F,1961/10/10,50y5m) 手術日期 2011/11/16 手術主治醫師 蔡瑞章 手術區域 東址 005房 01號 診斷 Secondary malignant neoplasm of brain and spinal cord 器械術式 Craniotomy for left parietal metastatic tumor excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 蔡宗良, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:10 進入手術室 08:20 麻醉開始 08:35 抗生素給藥 08:40 誘導結束 08:50 手術開始 11:35 抗生素給藥 12:10 麻醉結束 12:10 手術結束 12:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: 1. Parietal craniotomy for brain tumor excisi... 開立醫師: 張哲瑋 開立時間: 2011/11/16 12:30 Pre-operative Diagnosis Metastastic brain tumor, pathology unknown, left-sided parietal lobe Post-operative Diagnosis Metastastic brain tumor, pathology unknown, left-sided parietal lobe Operative Method 1. Parietal craniotomy for brain tumor excision, left-sided 2. Intraoperative central sulcus mapping Specimen Count And Types 1 piece About size:小 Source:brain parenchyma Pathology Report pending Operative Findings 1. Intraoperative mapping confirmed the tumor was in the 2 sulcus away from central sulcus 2. Tumor was yellowish in color, fragile in consistency, well-dermacated, and low in vascularity. Operative Procedures 1. ETGA, supine, Mayfield skull fixation, head rotated 90 degrees towards the right with left shoulder elevated 2. Routine preparation and drapping 3. U-shaped scalp incision and cranitomy as depicted 4. Dura was reflected basing on superior sagittal sinus 5. Tumor was removed gross totally 6. Hemostasis 5. Skull plate fixed back to the craniotomy window with 26 gauze wire 6. Wound was closed in layers Operators Prof 蔡瑞章 Assistants R6 蔡宗良 R1張哲瑋 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: 1. Parietal craniotomy for brain tumor excisi... 開立醫師: 蔡宗良 開立時間: 2011/11/16 12:36 Pre-operative Diagnosis Metastastic brain tumor, pathology unknown, left-sided parietal lobe Post-operative Diagnosis Metastastic brain tumor, pathology unknown, left-sided parietal lobe Operative Method 1. Parietal craniotomy for brain tumor excision, left-sided 2. Intraoperative central sulcus mapping Specimen Count And Types 1 piece About size:小 Source:brain parenchyma Pathology Report pending Operative Findings 1. Intraoperative mapping confirmed the tumor was in the 2 sulcus away from central sulcus 2. Tumor was yellowish in color, fragile in consistency, well-dermacated, and low in vascularity. Operative Procedures 1. ETGA, supine, Mayfield skull fixation, head rotated 90 degrees towards the right with left shoulder elevated 2. Routine preparation and drapping 3. U-shaped scalp incision and cranitomy as depicted 4. Dura was reflected basing on superior sagittal sinus 5. Tumor was removed gross totally 6. Hemostasis 5. Skull plate fixed back to the craniotomy window with 26 gauze wire 6. Wound was closed in layers Operators Prof 蔡瑞章 Assistants R6 蔡宗良 R1張哲瑋 相關圖片 李馥均 (F,2009/05/10,2y10m) 手術日期 2011/11/16 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Benign neoplasm of bones of skull and face 器械術式 Excision of right skull tumor 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 2 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:00 進入手術室 08:05 麻醉開始 08:15 誘導結束 08:40 抗生素給藥 08:59 手術開始 10:00 手術結束 10:00 麻醉結束 10:15 送出病患 10:15 進入恢復室 11:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 顱骨切除術,包括異物移除或壓或經切斷 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Right frontal craniectomy for total skull bon... 開立醫師: 游健生 開立時間: 2011/11/16 10:40 Pre-operative Diagnosis Right frontal bone tumor Post-operative Diagnosis Right frontal bone tumor, favor histiocytosis X Operative Method Right frontal craniectomy for total skull bone tumor excision Specimen Count And Types 1 piece About size:2x2x1 cm Source:skull bone tumor Pathology Pending Operative Findings An expansile bone tumor, 2 x2 x1 cm, was noted at right frontal bone. It arose from bone marrow and eroded both inner and outer cortex to egg-shell thin. There was a small defect on both cortex. After removal of outer cortex, the tumor was seen. It was well-demarcated, soft, whitish, and easily dissected away from surrounding bone by currette. Grossly, there was no dura involvement after tumor and inner cortex removal. Operative Procedures Under ETGA, patient was in supine position with head rotated to left. After shaving, we disinfected and draped the operation field as usual. A curvilinear scalp incision was made over the tumor site. The temporalis muscle was splitted along its fiber and retracted laterally. The cranium was exposed. The outer cortex was removed by Kerrison punch starting from a small defect. The tumor was easily dissected away from surrounding bone by currette. The inner cortex was removed in the same way as the outer cortex. The dura was coagulated to stop bleeding. After 2 dura tenting, temporalis muscle was approximated. Wound was closed in layers with 3-0 Vicryl and 4-0 Nylon. Operators VS 郭夢菲 Assistants R4 游健生 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Right frontal craniectomy for total skull bon... 開立醫師: 郭夢菲 開立時間: 2011/11/16 11:44 Pre-operative Diagnosis Bone tumor, Right frontal (pterional) region Post-operative Diagnosis Bone tumor, Right frontal (pterional) region, suspect histiocytosis X Operative Method Right frontal craniectomy for total skull bone tumor excision Specimen Count And Types 1 piece About size:2x2x1 cm Source:skull bone tumor Pathology Pending Operative Findings An expansile bone tumor, 2 x2 x1 cm, was noted at right frontal (pterional) bone. It arose from bone marrow and expnaded both the inner and outer table of the skull into egg-shell thin. There was a small defect on both sides of the skull tables. The dura was intact. After removal of outer table of the skull, the tumor was seen. It was well-demarcated, elastic firm, whitish, and easily dissected away from the surrounding bone. Grossly, there was no dura involvement after tumor and inner table of the skull was removed. Operative Procedures Under ETGA, patient was in supine position with head rotated to left. After shaving, we disinfected and draped the operation field as usual. A curvilinear scalp incision was made over the tumor site. The temporalis muscle was splitted along its fiber and retracted laterally. The cranium was exposed. The outer cortex was removed by Kerrison punch starting from a small defect. The tumor was easily dissected away from surrounding bone and was totally excised as an intact piece. The inner table of the skull was removed in the same way as the outer table for a radical resection. The dura was coagulated to stop bleeding. After 2 dura tenting, temporalis muscle was approximated. Wound was closed in layers with 3-0 Vicryl and 4-0 Nylon. Operators VS 郭夢菲 Assistants R4 游健生 相關圖片 莊朝宗 (M,1938/09/22,73y5m) 手術日期 2011/11/16 手術主治醫師 賴達明 手術區域 東址 000房 號 診斷 Cerebrovascular Diseases 器械術式 Programmable valve revision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 鍾文桂, 曾偉倫, 時間資訊 00:00 臨時手術NPO 11:51 進入手術室 12:00 麻醉開始 12:10 誘導結束 12:25 抗生素給藥 12:40 手術開始 13:25 手術結束 13:25 麻醉結束 13:50 送出病患 13:52 進入恢復室 14:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦脊髓液分流管重置 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Revision of programmable valve. 開立醫師: 鍾文桂 開立時間: 2011/11/16 13:25 Pre-operative Diagnosis Hydrocephalus status post VP shunt with valve dysfunction. Post-operative Diagnosis Hydrocephalus status post VP shunt with valve dysfunction. Operative Method Revision of programmable valve. Specimen Count And Types nil Pathology Nil. Operative Findings No obvious blood clot or debris was noted in the programmable valve. The peritoneal and ventricular catheters were checked for their patency. 3 cc CSF were collected for routine, culture and BCS. The removed programmable valve is functioning ok under magnetic programmer. Operative Procedures Under ETGA, the patient was placed in supine position and the head was tilted to the right side. After shaving, disinfeciton, and draping, two linear horizontal incisions were made above and below the programmable valve. The programmable valve was resected and replaced with a new valve. The new valves patency was checked. The wound was closed in layers. Operators VS 賴達明 Assistants R6 鍾文桂 R3 曾偉倫 Ri 陳天華 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Revision of programmable valve. 開立醫師: 曾偉倫 開立時間: 2011/11/16 19:46 Pre-operative Diagnosis Hydrocephalus status post VP shunt with valve dysfunction. Post-operative Diagnosis Hydrocephalus status post VP shunt with valve dysfunction. Operative Method Revision of programmable valve. Specimen Count And Types nil Pathology Nil. Operative Findings No obvious blood clot or debris was noted in the programmable valve. The peritoneal and ventricular catheters were checked for their patency. 3 cc CSF were collected for routine, culture and BCS. The removed programmable valve is functioning ok under magnetic programmer. Operative Procedures Under ETGA, the patient was placed in supine position and the head was tilted to the right side. After shaving, disinfeciton, and draping, two linear horizontal incisions were made above and below the programmable valve. The programmable valve was resected and replaced with a new valve. The new valves patency was checked. The wound was closed in layers. Operators VS 賴達明 Assistants R6 鍾文桂 R3 曾偉倫 Ri 陳天華 相關圖片 楊末 (F,1945/07/23,66y7m) 手術日期 2011/11/16 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Meningioma 器械術式 Meningioma excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 2 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 08:07 進入手術室 08:15 麻醉開始 08:50 誘導結束 09:10 抗生素給藥 09:30 手術開始 11:20 手術結束 11:20 麻醉結束 11:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Right frontal craniotomy for tumor Simpron gr... 開立醫師: 曾偉倫 開立時間: 2011/11/16 11:39 Pre-operative Diagnosis Right frontal brain tumor, suspect convexity meningioma Post-operative Diagnosis Right frontal brain tumor, suspect convexity meningioma Operative Method Right frontal craniotomy for tumor Simpron grade II tumor excision Specimen Count And Types 1 piece About size:1x1x1 cm Source:Right frontal brain tumor Pathology Pending Operative Findings The tumor was greyish, soft, hypervascularized and 1.5x1.5x1 cm in size. The arachnoid plan between tumor and normal tissue was clear. Some feeding artertery was connected between the dura and tumor. Dural thickening was found above the tumor and the thickened dura was resected. Operative Procedures Under ETGA, we placed the patient on supine position with her face tile to left. After we shaved, scrubbed, disinfected and drapped, A curvilinear skin incision was made over right frontal area. The wound was opened in layers and the scalp flap was elevated. After making 3 burr-hols, right frontal craniotomy was done. A curvilinear durotomy was made. The feeders from the dura was divided with bipolar electrocautery and scissors. The tumor excision was made meticulously and complete hemostasis was done. The dura which attatched to the tumor was resected. The dural defect was repaired with fascia and dural tenting was made. The durotomy was closed with 3-0 Prolene. The bone flap was fixed with mini-plate and screw. The wound was closed with 0-0 Vicryl and 3-0 Nylon. Operators VS 賴達明 Assistants R6 鍾文桂 R3 曾偉倫 Ri 陳天華 相關圖片 汪林美月 (F,1950/12/14,61y3m) 手術日期 2011/11/16 手術主治醫師 賴達明 手術區域 東址 003房 03號 診斷 Spondylolisthesis 器械術式 L2/3 TLIF 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 2 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 14:04 進入手術室 14:15 麻醉開始 14:25 誘導結束 14:50 抗生素給藥 15:00 手術開始 17:25 開始輸血 17:55 手術結束 17:55 麻醉結束 18:10 送出病患 18:12 進入恢復室 22:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-腰椎 1 2 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: 1.Transforaminal lumbar interbody fusion and ... 開立醫師: 鍾文桂 開立時間: 2011/11/16 17:47 Pre-operative Diagnosis L2-3 spondylolisthesis. Post-operative Diagnosis L2-3 spondylolisthesis. Operative Method 1.Transforaminal lumbar interbody fusion and fixation, L2/3. 2.L2-3 diskectomy Specimen Count And Types nil Pathology Nil. Operative Findings Hypertrophic ligamentum flavum. Intact dura mater. PEEK banana cage 11mm with autologous bone graft( from right side). 6.2x40mm transpedical screws, rods: 5cm. Blood loss: 650ml. Operative Procedures Under ETGA, the patient was placed in prone position. After C-arm localization, the previous operative wound was incised and the paraspinal muscle was dissection. The transpedicle screws were implanted at L2 and L3 levels bilaterally. The PEEK cage was implanted after diskectomy, right side approach. The internal fixation apparatus was set up. The wound was closed in layers with one submuscular 1/8 hemovac. Operators VS 賴達明 Assistants R6 鍾文桂 R3 曾偉倫 Ri 陳天華 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: 1.Transforaminal lumbar interbody fusion and ... 開立醫師: 曾偉倫 開立時間: 2011/11/16 18:08 Pre-operative Diagnosis L2-3 spondylolisthesis. Post-operative Diagnosis L2-3 spondylolisthesis. Operative Method 1.Transforaminal lumbar interbody fusion and fixation, L2/3. 2.L2-3 diskectomy Specimen Count And Types nil Pathology Nil. Operative Findings Hypertrophic ligamentum flavum. Intact dura mater. PEEK banana cage 11mm with autologous bone graft( from right side). 6.2x40mm transpedical screws, rods: 5cm. Blood loss: 650ml. Operative Procedures Under ETGA, the patient was placed in prone position. After C-arm localization, the previous operative wound was incised and the paraspinal muscle was dissection. The transpedicle screws were implanted at L2 and L3 levels bilaterally. The PEEK cage was implanted after diskectomy, right side approach. The internal fixation apparatus was set up. The wound was closed in layers with one submuscular 1/8 hemovac. Operators VS 賴達明 Assistants R6 鍾文桂 R3 曾偉倫 Ri 陳天華 相關圖片 賴禹鈞 (M,1996/09/24,15y5m) 手術日期 2011/11/16 手術主治醫師 洪學義 手術區域 西址 038房 02號 診斷 Major trauma rated 16 or above on the severity scale ( Injury severity score >=16 ) 器械術式 removal arch bar 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 陳建璋, 時間資訊 09:20 進入手術室 09:30 麻醉開始 09:35 手術開始 09:50 手術結束 09:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 拆齒弓副木 1 0 摘要__ 手術科部: 復健部 套用罐頭: removal of IMF 開立醫師: 陳建璋 開立時間: 2011/11/16 09:54 Pre-operative Diagnosis upper palate fracture s/p close reduction and IMF Post-operative Diagnosis upper palate fracture s/p close reduction and IMF Operative Method removal of IMF Specimen Count And Types nil Pathology nil Operative Findings No mal-occlusion was noted. The dental arch was in neutral position Operative Procedures Under nerve block, the patient was put in the supine position. We remove the arch bars and the occlusal plate. Operators 洪學義 Assistants 陳建璋 記錄__ 手術科部: 復健部 套用罐頭: removal of IMF 開立醫師: 陳建璋 開立時間: 2011/11/16 09:54 Pre-operative Diagnosis upper palate fracture s/p close reduction and IMF Post-operative Diagnosis upper palate fracture s/p close reduction and IMF Operative Method removal of IMF Specimen Count And Types nil Pathology nil Operative Findings No mal-occlusion was noted. The dental arch was in neutral position Operative Procedures Under nerve block, the patient was put in the supine position. We remove the arch bars and the occlusal plate. Operators 洪學義 Assistants 陳建璋 李黃來馨 (F,1927/02/11,85y1m) 手術日期 2011/11/16 手術主治醫師 蔡翊新 手術區域 東址 002房 06號 診斷 Patients requiring long-term use of a respirator due to respiratory failure use respirator 6 hours per day continue 30 days 器械術式 Crainotomy for left cSDH 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 4E 紀錄醫師 蔡宗良, 時間資訊 20:00 開始NPO 00:53 通知急診手術 01:35 進入手術室 01:40 麻醉開始 02:10 誘導結束 02:33 手術開始 02:33 抗生素給藥 05:00 手術結束 05:00 麻醉結束 05:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Left frontotemporal craniotomy for removal of... 開立醫師: 蔡宗良 開立時間: 2011/11/16 05:08 Pre-operative Diagnosis Left frontotemporoparietal chronic SDH. Post-operative Diagnosis Left frontotemporoparietal chronic SDH. Operative Method Left frontotemporal craniotomy for removal of chronic SDH. Specimen Count And Types nil Pathology Nil. Operative Findings Dark reddish liquified blood gushed out upon opening the dura and the thick outer member. There were fibrin septations causing compartmentation of subdural space. The brain remained slack after removal of SDH. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: curvilinear at left frontotemporal area. Raney clips were applied to the scalp edge for temporary hemostasis. 5. Craniotomy: 8 x 7 cm at left frontotemporal area, by making 3 burr holes. 6. Dural tenting: by 2/0 silk at 2 cm interval, distributed along the edge of the trephine. 7. Dural incision: 3/4 circle along the craniotomy margin. 8. The outer membrane of the hematoma was coagulated by Bovie along the edge of dural incision, then excised. 9. The liquified old blood and clot in the subdural space was evacuated by sucker. 10.Dural closure: interruped 2/0 silk sutures for key stitches, then continuous sutures with 4/0 Prolene to obtain water-tight closure. A piece of COOK Biodesign dura graft was used for duroplasty. 11.Closure of skull window: the bone graft was fixed back by 3 miniplates and 6 screws. 12.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous sutures with 2/0 Vicryl and skin by continuouss suture with 3/0 nylon. 13.Drain: one, subdural, rubber drain. 14.Blood transfusion: nil. Blood loss: 50 ml. 15.Course of the surgery: smooth. Operators VS 蔡翊新 Assistants R6 蔡宗良 Indication Of Emergent Operation increased intracranial pressure 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Left frontotemporal craniotomy for removal of... 開立醫師: 蔡宗良 開立時間: 2011/11/16 05:13 Pre-operative Diagnosis Left frontotemporoparietal chronic SDH. Post-operative Diagnosis Left frontotemporoparietal chronic SDH. Operative Method Left frontotemporal craniotomy for removal of chronic SDH. Specimen Count And Types nil Pathology Nil. Operative Findings Dark reddish liquified blood gushed out upon opening the dura and the thick outer member. There were fibrin septations causing compartmentation of subdural space. The brain remained slack after removal of SDH. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: curvilinear at left frontotemporal area. Raney clips were applied to the scalp edge for temporary hemostasis. 5. Craniotomy: 8 x 7 cm at left frontotemporal area, by making 3 burr holes. 6. Dural tenting: by 2/0 silk at 2 cm interval, distributed along the edge of the trephine. 7. Dural incision: 3/4 circle along the craniotomy margin. 8. The outer membrane of the hematoma was coagulated by Bovie along the edge of dural incision, then excised. 9. The liquified old blood and clot in the subdural space was evacuated by sucker. 10.Dural closure: interruped 2/0 silk sutures for key stitches, then continuous sutures with 4/0 Prolene to obtain water-tight closure. A piece of COOK Biodesign dura graft was used for duroplasty. 11.Closure of skull window: the bone graft was fixed back by 3 miniplates and 6 screws. 12.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous sutures with 2/0 Vicryl and skin by continuouss suture with 3/0 nylon. 13.Drain: one, subdural, rubber drain. 14.Blood transfusion: nil. Blood loss: 50 ml. 15.Course of the surgery: smooth. Operators VS 蔡翊新 Assistants R6 蔡宗良 Indication Of Emergent Operation increased intracranial pressure 相關圖片 黃碧玉 (F,1945/12/12,66y3m) 手術日期 2011/11/16 手術主治醫師 蔡清霖 手術區域 東址 021房 01號 診斷 Fracture, humerus 器械術式 Left humerus revision ORIF 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3 紀錄醫師 范垂嘉, 時間資訊 07:40 報到 08:05 進入手術室 08:10 麻醉開始 08:20 誘導結束 08:30 抗生素給藥 08:55 手術開始 09:45 開始輸血 11:00 手術結束 11:00 麻醉結束 11:05 送出病患 11:15 進入恢復室 12:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 開放性或閉鎖性肱骨粗隆或骨幹或踝部骨折,開放性復位術 1 2 L 手術 石膏副木固定－長臂 1 0 L 摘要__ 手術科部: 骨科部 套用罐頭: Revision ORIF with orthogonal plating, two in... 開立醫師: 范垂嘉 開立時間: 2011/11/16 11:24 Pre-operative Diagnosis Left distal humeral shaft fracture, s/p ORIF, loss of reduction Post-operative Diagnosis Left distal humeral shaft fracture, s/p ORIF, loss of reduction Operative Method Revision ORIF with orthogonal plating, two interfragmentary screws and wires (#16 x2) -posterolateral: Zimmer ULS (Dual compression plate, 7 screws) -medial: 3.5mm DCP (6 screws) Specimen Count And Types Fracture site swab for bacterial culture Pathology nil Operative Findings 1.Left humerus distal shaft fracture, s/p ORIF, with loss of reduction, the lateral butterfly fragment was comminuted and the distal screws was dislodged 2.The distal most interfragmentary screw was loose and removed with the others preserved 3.Granulation tissue formation around the fracture site 4.The radial nerve was grossly intact and placed between the most and second proximal screws Operative Procedures 1.GA, right decubitus 2.Prep and drape the left upper limb 3.Open the previous wound, split the triceps to expose the humerus 4.Identify and protect and radial nerve 5.Remove the loose screws 6.Open reduction and internal fixation with medial 3.5mm DCP (6H6S) 7.Remove the locking plate, contour it with bender 8.Fixation with the locking plate (7 screws) 9.Reduce the comminuted butterfly fragment, fixation with #16 wires x2 10.Fill the bony defect with Sinbone 11.Irrigate and close the wound in layers 12.Apply long-arm splint Operators 蔡清霖 Assistants 陳彥宇,范垂嘉,吳俊毅 記錄__ 手術科部: 骨科部 套用罐頭: Revision ORIF with orthogonal plating, two in... 開立醫師: 范垂嘉 開立時間: 2011/11/16 11:24 Pre-operative Diagnosis Left distal humeral shaft fracture, s/p ORIF, loss of reduction Post-operative Diagnosis Left distal humeral shaft fracture, s/p ORIF, loss of reduction Operative Method Revision ORIF with orthogonal plating, two interfragmentary screws and wires (#16 x2) -posterolateral: Zimmer ULS (Dual compression plate, 7 screws) -medial: 3.5mm DCP (6 screws) Specimen Count And Types Fracture site swab for bacterial culture Pathology nil Operative Findings 1.Left humerus distal shaft fracture, s/p ORIF, with loss of reduction, the lateral butterfly fragment was comminuted and the distal screws was dislodged 2.The distal most interfragmentary screw was loose and removed with the others preserved 3.Granulation tissue formation around the fracture site 4.The radial nerve was grossly intact and placed between the most and second proximal screws Operative Procedures 1.GA, right decubitus 2.Prep and drape the left upper limb 3.Open the previous wound, split the triceps to expose the humerus 4.Identify and protect and radial nerve 5.Remove the loose screws 6.Open reduction and internal fixation with medial 3.5mm DCP (6H6S) 7.Remove the locking plate, contour it with bender 8.Fixation with the locking plate (7 screws) 9.Reduce the comminuted butterfly fragment, fixation with #16 wires x2 10.Fill the bony defect with Sinbone 11.Irrigate and close the wound in layers 12.Apply long-arm splint Operators 蔡清霖 Assistants 陳彥宇,范垂嘉,吳俊毅 王國榮 (M,1950/11/24,61y3m) 手術日期 2011/11/16 手術主治醫師 洪學義 手術區域 西址 031房 01號 診斷 Cellulitis 器械術式 S.T.S.G.<10 BSA 手術類別 預定手術 手術部位 四肢 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 陳志軒, 時間資訊 07:53 進入手術室 08:00 麻醉開始 08:05 誘導結束 08:32 手術開始 09:10 手術結束 09:10 麻醉結束 09:13 送出病患 09:15 進入恢復室 10:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 多層皮膚移植-小於10BSA 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: DM foot-debridement and STSG 開立醫師: 陳志軒 開立時間: 2011/11/16 09:10 Pre-operative Diagnosis Chronic wound of left foot Post-operative Diagnosis Chronic wound of left foot Operative Method Debridement and STSG Specimen Count And Types nil Pathology Nil Operative Findings One 5x5 cm chronic wound at right 4th and 5th toe amputation site without tendon or bone exposure and covered by STSG. Operative Procedures Under general anesthesia, patient lied at supine position. We excised the devitalized tissue. We harvested the 8/1000-inch in thickness STSG from left thigh with air-drive Zimmer dermatome. We applied the STSG on the skin defect. We applied short leg splint for immobilization. Operators VS洪學義 Assistants R5陳建璋 R3陳志軒 Ri林勝彥 相關圖片 賴朝慶 (M,1933/03/11,79y0m) 手術日期 2011/11/17 手術主治醫師 侯育致 手術區域 東址 010房 03號 診斷 Cataract 器械術式 Phaco+PCIOL 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 10:06 進入手術室 10:20 手術開始 10:35 手術結束 10:40 送出病患 記錄__ 手術科部: 眼科部 套用罐頭: Phaco-Superior (侯育致) 開立醫師: 許雅睿 開立時間: 2011/11/17 10:36 Pre-operative Diagnosis Cataract (od) Post-operative Diagnosis Cataract (od) Operative Method Phacoemulsification and PCIOL implantation (od) Specimen Count And Types nil Pathology Nil Operative Findings Cataract (od) Operative Procedures 1. Under topical anesthesia. 2. Disinfection, irrigation and draping. 3. Application of an eyelid speculum. 4. Made a clear corneal incision and penetrate into AC with 2.5mm trapezoid knife at 10 oclock position. 5. Inject Healon into the anterior chamber. 6. Continuous circular capsulorrhexis was done with bent needle and capsular forceps. 7. Made a sideport at 2 oclock position with the MVR blade. 8. Hydrodissection and hydrodelineation were done with BSS. 9. Phacoemulsification of the nucleus by standard divide-and-conquer technique. 10. Aspiration of the residual cortical material with I/A tube. 11. Foldable PCIOL was implanted into the bag after injection of Viscoat. 12. The residual Healon was washed out by I/A device. 13. Inject BSS into AC and check leakage 14. Stromal hydration of the wound with BSS 16. Topical irrigation of Rinderon and Gentamycin. 17. Maxitrol patching. Operators 侯育致, Assistants R4謝旻瑾,R2許雅睿 洪茂坤 (M,1948/02/10,64y1m) 手術日期 2011/11/17 手術主治醫師 陳敞牧 手術區域 東址 001房 02號 診斷 Malignant neoplasm of liver, not specified as primary or secondary 器械術式 T4 and T8 tumor resection with TPS fusion T3-T5, T7-T9 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 李振豪, 時間資訊 21:00 開始NPO 00:35 通知急診手術 11:25 報到 11:43 進入手術室 11:45 麻醉開始 12:10 誘導結束 12:15 抗生素給藥 12:16 手術開始 13:50 開始輸血 16:13 抗生素給藥 17:40 麻醉結束 17:40 手術結束 17:55 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 2 手術 惡性脊髓腫瘤切除術 1 1 記錄__ 手術科部: 外科部 套用罐頭: 1. T4 and T8 laminectomy for decompression an... 開立醫師: 李振豪 開立時間: 2011/11/17 18:52 Pre-operative Diagnosis T4 and T8 metastatic spinal tumor with myelopathy Post-operative Diagnosis T4 and T8 metastatic spinal tumor with myelopathy Operative Method 1. T4 and T8 laminectomy for decompression and tumor excision 2. Bilateral T4 and T8 rhizotomy 3. T3, T5, T7, and T9 transpedicular screws for posterior fixation Specimen Count And Types 1 piece About size:Multiple pieces Source:T spine tumor Pathology Pending Operative Findings Tumor was mainly located within the T4 and T8 vertebra with destructive and expansile change which cause severe thecal sac compression. The tumor was soft to elastic, fragile, extreme hypervascularized with easily touch bleeding, and green-yellowish in color. The tumor was extended from bilateral T4 laminae, transverse process, pedicle, into the vertebral body. The thecal sac expanded well after decompression and tumor excision. No incidental durotomy was noted during whole procedure. Bilateral T4 and T8 rhizotomy was performed during tumor excision. Posterior instrumentation was set up with two 4.5 x 30mm screws(T3), two 5.0 x 30mm screws(T5), four 5.5 x 35mm screws(T7, T9), two 8cm rods(T3-5), two 9cm rods(T7-9), and one cross-link. Total blood loss: 4500ml. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position with head fixed with Mayfield skull clamp. T4 to T9 pedicle level were localized by portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made from T3 to T9. The subcutaneous soft tissue was devided and the paraspinal muscle groups were detached. T3, T5, T7, and T9 transpedicular screws were implanted under C-arm guided. T8 laminectomy for decompression and epidural tumor excision was performed. T4 laminectomy and bilateral facetectomy, pediculectomy were conducted for tumor excision. Bilateral T4 and T8 rhizotomy also done during tumor excision. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. Two epidural 1/8 Hemovac was placed. The transpedicular screws, rods, and cross-link were set up for posterior fixation. The wound was irrigated with Gentamicin solution and closed in layers with 1-0, 2-0 Vicryl and Appose staples. Operators VS陳敞牧 Assistants R5李振豪, R4游健生 Indication Of Emergent Operation Progressive paraplegia due to metastatic spinal tumor 施玲芬 (F,1950/07/06,61y8m) 手術日期 2011/11/17 手術主治醫師 陳敞牧 手術區域 東址 005房 01號 診斷 Brain tumor 器械術式 Right petroclival meningioma excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 蔡宗良, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:10 進入手術室 08:15 麻醉開始 08:30 抗生素給藥 08:45 誘導結束 08:55 手術開始 11:30 抗生素給藥 13:48 麻醉結束 13:48 手術結束 14:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 手術 顱底瘤手術 1 1 R 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Suboccipital craniotomy retrosigmoid approach... 開立醫師: 蔡宗良 開立時間: 2011/11/17 14:23 Pre-operative Diagnosis Petroclival meningioma, right-sided Post-operative Diagnosis Petroclival meningioma, right-sided Operative Method Suboccipital craniotomy retrosigmoid approach for Simpons grade II excision Specimen Count And Types 1 piece About size:小 Source:intracranial Pathology Report pending Operative Findings 1. Tumor was greyish in color, fragile, and vascularity was moderate. Tumor attachment was at the posterior petrous bone. Seventh-eight complex was displaced caudally and superior petrosal vein and superior cerebellar artery were displaced to the cephalad. Tentorium can be seen. 2. Transient right-sided signal decrease of SSEP during tumor removal but recovered fully afterwards. Operative Procedures 1. ETGA, Mayfield skull fixation, 3/4 prone positioning towards the left 2. Routine preparation 3. S-shaped skin incision, followed by suboccipital craniotomy 4. K-shaped durotomy 5. Retraction of cerebellum for opening of cisterna magna 6. Tumor removal with bipolar cautery, tumor forceps, and suction 7. Dura closure with fascia graft by 4-0 prolene 8. Skull plate was fixed back to the craniotomy window 9. Saline irrigation 10. Wound was closed in layers Operators VS 陳敞牧 Assistants R6 蔡宗良, R1 張書豪 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Suboccipital craniotomy retrosigmoid approach... 開立醫師: 蔡宗良 開立時間: 2011/11/29 11:10 Pre-operative Diagnosis Petroclival meningioma, right-sided Post-operative Diagnosis Petroclival meningioma, right-sided Operative Method Suboccipital craniotomy retrosigmoid approach for Simpons grade II excision Specimen Count And Types 1 piece About size:小 Source:intracranial Pathology Report pending Operative Findings 1. Tumor was greyish in color, fragile, and vascularity was moderate. Tumor attachment was at the posterior petrous bone. Seventh-eight complex was displaced caudally and superior petrosal vein and superior cerebellar artery were displaced to the cephalad. Tentorium can be seen. 2. Transient right-sided signal decrease of SSEP during tumor removal but recovered fully afterwards. Operative Procedures 1. ETGA, Mayfield skull fixation, 3/4 prone positioning towards the left 2. Routine preparation 3. S-shaped skin incision, followed by suboccipital craniotomy 4. K-shaped durotomy 5. Retraction of cerebellum for opening of cisterna magna 6. Tumor removal with bipolar cautery, tumor forceps, and suction 7. Dura closure with fascia graft by 4-0 prolene 8. Skull plate was fixed back to the craniotomy window 9. Saline irrigation 10. Wound was closed in layers Operators VS 陳敞牧 Assistants R6 蔡宗良, R1 張書豪 相關圖片 陳乙彥 (M,1941/05/10,70y10m) 手術日期 2011/11/17 手術主治醫師 婁培人 手術區域 東址 025房 05號 診斷 Inguinal hernia 器械術式 Parotidectomy, R 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 陳姵妤, 時間資訊 13:55 進入手術室 14:00 麻醉開始 14:05 誘導結束 14:15 手術開始 15:25 手術結束 15:25 麻醉結束 15:35 送出病患 15:38 進入恢復室 17:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 耳下腺腫瘤切除術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 耳鼻喉部 套用罐頭: Excision of parotid tumor, right 開立醫師: 陳姵妤 開立時間: 2011/11/17 17:12 Pre-operative Diagnosis Parotid tumor, right Post-operative Diagnosis Parotid tumor, right, operated Operative Method Excision of parotid tumor, right Specimen Count And Types 1 piece About size:1.5*1.5cm Source:right parotid tumor Pathology pending Operative Findings A 1*1 cm tumor was seen at the superficial lobe of right parotid gland. Operative Procedures The 1. The patient was in supine position with head turned to the right side. 2. General anesthesia was set up via endotracheal tube 3. The operative field was disinfected and draped as usual. 4. Pre-auricular incision with cervical extension was made. 5. The skin flap was elevated toward the zygomatic arch superiorly, the masseter muscle anteriorly, and the tragus posteriorly. 6. The superficial musculoaponeurotic system(SMAS) was separated to expose the parotid gland beneath. 7. A 1*1*1 cm tumor was seen at superficial lobe of right parotid tail, just beneath the greater auricular nerve. 8. The tumor was removed along its capsule. 11.After hemostasis, the wound was closed in two-layers fashion with a mini-hemovac in place. 12.The operation was finished and the patient stood the whole course well. Operators P 婁培人 Assistants R4李建賢, R2陳姵妤 葉王玉真 (F,1948/01/20,64y1m) 手術日期 2011/11/17 手術主治醫師 蕭輔仁 手術區域 東址 005房 03號 診斷 Low back pain 器械術式 Radiofrequency coagulation(P-G 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 15:30 報到 16:33 進入手術室 16:56 麻醉開始 16:57 麻醉結束 16:57 誘導結束 16:59 手術開始 17:20 手術結束 17:28 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 高頻熱凝療法 1 1 B 摘要__ 手術科部: 外科部 套用罐頭: L2 dorsal root ganglion radiofrequency ablation 開立醫師: 張書豪 開立時間: 2011/11/17 17:47 Pre-operative Diagnosis Low back pain Post-operative Diagnosis Low back pain Operative Method L2 dorsal root ganglion radiofrequency ablation Specimen Count And Types nil Pathology None Operative Findings Right level was confirmed fluoroscopically. Stimulation test: positive Operative Procedures After prone postioning and confimation of trajectory to bilateral L2 DRG, the insertion site was routinely prepped and drapped. Pulsed RF for 3 minutes for 2 cycles were performed bilaterally. Operators VS 蕭輔仁 Assistants R6 蔡宗良, R1 張書豪 記錄__ 手術科部: 外科部 套用罐頭: L2 dorsal root ganglion radiofrequency ablation 開立醫師: 張書豪 開立時間: 2011/11/17 18:17 Pre-operative Diagnosis Low back pain Post-operative Diagnosis Low back pain Operative Method L2 dorsal root ganglion radiofrequency ablation Specimen Count And Types nil Pathology None Operative Findings Right level was confirmed fluoroscopically. Stimulation test: positive Operative Procedures After prone postioning and confimation of trajectory to bilateral L2 DRG, the insertion site was routinely prepped and drapped. Pulsed RF for 3 minutes for 2 cycles were performed bilaterally. Operators VS 蕭輔仁 Assistants R6 蔡宗良, R1 張書豪 陳武進 (M,1981/06/18,30y8m) 手術日期 2011/11/17 手術主治醫師 蕭輔仁 手術區域 東址 005房 04號 診斷 Low back pain 器械術式 Radiofrequency coagulation(P-G 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 17:35 進入手術室 17:55 手術開始 18:27 手術結束 18:32 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 高頻熱凝療法 1 1 B 摘要__ 手術科部: 外科部 套用罐頭: L2 dorsal root ganglion radiofrequency ablation 開立醫師: 張書豪 開立時間: 2011/11/17 18:13 Pre-operative Diagnosis Low back pain Post-operative Diagnosis Low back pain Operative Method L2 dorsal root ganglion radiofrequency ablation Specimen Count And Types nil Pathology nil Operative Findings Right level was confirmed fluoroscopically. Stimulation test: positive Operative Procedures After prone postioning and confimation of trajectory to bilateral L2 DRG, the insertion site was routinely prepped and drapped. Pulsed RF for 3 minutes for 2 cycles were performed bilaterally. Operators VS 蕭輔仁 Assistants R6 蔡宗良, R1 張書豪 記錄__ 手術科部: 外科部 套用罐頭: L2 dorsal root ganglion radiofrequency ablation 開立醫師: 張書豪 開立時間: 2011/11/17 18:14 Pre-operative Diagnosis Low back pain Post-operative Diagnosis Low back pain Operative Method L2 dorsal root ganglion radiofrequency ablation Specimen Count And Types nil Pathology nil Operative Findings Right level was confirmed fluoroscopically. Stimulation test: positive Operative Procedures After prone postioning and confimation of trajectory to bilateral L2 DRG, the insertion site was routinely prepped and drapped. Pulsed RF for 3 minutes for 2 cycles were performed bilaterally. Operators VS 蕭輔仁 Assistants R6 蔡宗良, R1 張書豪 王興華 (M,1929/11/04,82y4m) 手術日期 2011/11/17 手術主治醫師 王國川 手術區域 東址 003房 03號 診斷 Subdural hemorrhage, traumatic 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 施培艾, 時間資訊 00:00 臨時手術NPO 13:45 進入手術室 13:50 麻醉開始 13:55 誘導結束 13:56 抗生素給藥 14:23 手術開始 15:16 手術結束 15:16 麻醉結束 15:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt insertion via righ... 開立醫師: 王奐之 開立時間: 2011/11/17 15:23 Pre-operative Diagnosis Post-traumatic hydrocephalus Post-operative Diagnosis Post-traumatic hydrocephalus Operative Method Ventriculoperitoneal shunt insertion via right Kocher point Specimen Count And Types nil Pathology Nil Operative Findings Clear CSF was noted upon ventriculostomy, opening pressure about 10~15 cmH2O. A programmable Codman reservoir was used, preset to 120 mmH2O. The ventricular catheter was connected to the subduroperitoneal shunt via an Y-connector at right clavicular area. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After shaving, scrubbing, disinfection & draping in sterile fashion, a linear incision was made at right frontal area. Another linear incision was made at right clavicle, and the previously implanted subduroperitoneal shunt was exposed. After creation of the subcutaneous tunnel, the peritoneal catheter was passed through. After assembly of the shunt components, a small cruciate durotomy was performed after 2 tenting stitch. Ventriculostomy was performed, followed by insertion of the ventricular catheter. After hemostasis, the wounds were closed in layers. Operators VS 王國川 Assistants R4 王奐之, R0 施培艾 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt insertion via righ... 開立醫師: 王奐之 開立時間: 2011/11/17 15:23 Pre-operative Diagnosis Post-traumatic hydrocephalus Post-operative Diagnosis Post-traumatic hydrocephalus Operative Method Ventriculoperitoneal shunt insertion via right Kocher point Specimen Count And Types nil Pathology Nil Operative Findings Clear CSF was noted upon ventriculostomy, opening pressure about 10~15 cmH2O. A programmable Codman reservoir was used, preset to 120 mmH2O. The ventricular catheter was connected to the subduroperitoneal shunt via an Y-connector at right clavicular area. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After shaving, scrubbing, disinfection & draping in sterile fashion, a linear incision was made at right frontal area. Another linear incision was made at right clavicle, and the previously implanted subduroperitoneal shunt was exposed. After creation of the subcutaneous tunnel, the peritoneal catheter was passed through. After assembly of the shunt components, a small cruciate durotomy was performed after 2 tenting stitch. Ventriculostomy was performed, followed by insertion of the ventricular catheter. After hemostasis, the wounds were closed in layers. Operators VS 王國川 Assistants R4 王奐之, R0 施培艾 相關圖片 吳麗玉 (F,1960/08/15,51y6m) 手術日期 2011/11/17 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Brain tumor 器械術式 Right frontal convexity meningioma excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 施培艾, 時間資訊 00:00 臨時手術NPO 08:02 進入手術室 08:10 麻醉開始 08:45 誘導結束 08:55 抗生素給藥 09:15 手術開始 11:00 手術結束 11:00 麻醉結束 11:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Right frontal craniotomy for Simpson grade I ... 開立醫師: 王奐之 開立時間: 2011/11/17 11:18 Pre-operative Diagnosis Right frontal convexity meningioma Post-operative Diagnosis Right frontal convexity meningioma Operative Method Right frontal craniotomy for Simpson grade I tumor resection Specimen Count And Types 1 piece About size:3*3*3cm Source:right frontal tumor Pathology Pending Operative Findings A white-yellowish dural based tumor was noted at right frontal convexity, measuring about 3*3*3cm, with approximity to the superior sagittal sinus. The tumor was removed en bloc, and the overlying attached dura was also resected. The involved skull was drilled with MIDAS air drill. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After shaving, scrubbing, disinfection & draping in sterile fashion, an U-shaped incision was made at right frontal area. The skin flap was reflected inferiorly, and 4 burr holes were drilled, followed by craniotomy. A square-shaped durotomy was performed, and the meningioma was dissected along its natural plane. The tumor and the dura was removed en bloc, and the medial portion of dura was resected more. After meticulous hemostasis, the tumor bed was packed with Surgicel. The dura was closed with periosteal graft in water-tight fashion with 4-0 Prolene continuous sutures. After drilling of the involved bone graft, the bone graft was fixed back with mini-plates. A subgaleal CWV drain was set, and the wound was closed in layers. Operators VS 王國川 Assistants R4 王奐之, R0 施培艾 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Right frontal craniotomy for Simpson grade I ... 開立醫師: 王奐之 開立時間: 2011/11/17 11:18 Pre-operative Diagnosis Right frontal convexity meningioma Post-operative Diagnosis Right frontal convexity meningioma Operative Method Right frontal craniotomy for Simpson grade I tumor resection Specimen Count And Types 1 piece About size:3*3*3cm Source:right frontal tumor Pathology Pending Operative Findings A white-yellowish dural based tumor was noted at right frontal convexity, measuring about 3*3*3cm, with approximity to the superior sagittal sinus. The tumor was removed en bloc, and the overlying attached dura was also resected. The involved skull was drilled with MIDAS air drill. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After shaving, scrubbing, disinfection & draping in sterile fashion, an U-shaped incision was made at right frontal area. The skin flap was reflected inferiorly, and 4 burr holes were drilled, followed by craniotomy. A square-shaped durotomy was performed, and the meningioma was dissected along its natural plane. The tumor and the dura was removed en bloc, and the medial portion of dura was resected more. After meticulous hemostasis, the tumor bed was packed with Surgicel. The dura was closed with periosteal graft in water-tight fashion with 4-0 Prolene continuous sutures. After drilling of the involved bone graft, the bone graft was fixed back with mini-plates. A subgaleal CWV drain was set, and the wound was closed in layers. Operators VS 王國川 Assistants R4 王奐之, R0 施培艾 相關圖片 陳叡鋐 (M,1985/08/05,26y7m) 手術日期 2011/11/17 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 Hydrocephalus 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 施培艾, 時間資訊 00:00 臨時手術NPO 11:21 進入手術室 11:25 麻醉開始 11:35 誘導結束 11:40 抗生素給藥 12:05 手術開始 13:08 手術結束 13:08 麻醉結束 13:17 送出病患 13:19 進入恢復室 14:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt insertion via left... 開立醫師: 王奐之 開立時間: 2011/11/17 13:10 Pre-operative Diagnosis Post-traumatic hydrocephalus Post-operative Diagnosis Post-traumatic hydrocephalus Operative Method Ventriculoperitoneal shunt insertion via left Kocher point (Codman programmable shunt) Specimen Count And Types 1 piece About size:3ml Source:CSF Pathology Nil Operative Findings Clear CSF was noted upon ventriculostomy, opening pressure about 10-15 cmH2O. A Codman programmable shunt was inserted, preset to 120 mmH2O. Thick granulation tissue was noted at burr hole, and easy oozing was encountered throughout the operation. Estimated blood loss: 200ml. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to right. After shaving, scrubbing, disinfection & draping in sterile fashion, a curved incision was made at left frontal area (extension of previous scar). Another linear incision was made at left upper quadrant of abdomen, followed by mini-laparotomy. After creation of the subcutaneous tunnel, the peritoneal catheter was passed through. After assembly of the shunt components, a small cruciate durotomy was performed after 1 tenting stitch. Ventriculostomy was performed, followed by insertion of the ventricular catheter. After hemostasis, the wounds were closed in layers. Operators VS 王國川 Assistants R4 王奐之, R0 施培艾 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt insertion via left... 開立醫師: 王奐之 開立時間: 2011/11/17 13:10 Pre-operative Diagnosis Post-traumatic hydrocephalus Post-operative Diagnosis Post-traumatic hydrocephalus Operative Method Ventriculoperitoneal shunt insertion via left Kocher point (Codman programmable shunt) Specimen Count And Types 1 piece About size:3ml Source:CSF Pathology Nil Operative Findings Clear CSF was noted upon ventriculostomy, opening pressure about 10-15 cmH2O. A Codman programmable shunt was inserted, preset to 120 mmH2O. Thick granulation tissue was noted at burr hole, and easy oozing was encountered throughout the operation. Estimated blood loss: 200ml. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to right. After shaving, scrubbing, disinfection & draping in sterile fashion, a curved incision was made at left frontal area (extension of previous scar). Another linear incision was made at left upper quadrant of abdomen, followed by mini-laparotomy. After creation of the subcutaneous tunnel, the peritoneal catheter was passed through. After assembly of the shunt components, a small cruciate durotomy was performed after 1 tenting stitch. Ventriculostomy was performed, followed by insertion of the ventricular catheter. After hemostasis, the wounds were closed in layers. Operators VS 王國川 Assistants R4 王奐之, R0 施培艾 相關圖片 張仁龍 (M,1922/04/03,89y11m) 手術日期 2011/11/17 手術主治醫師 王國川 手術區域 東址 005房 02號 診斷 Syncope and collapse 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 張書豪, 時間資訊 00:00 臨時手術NPO 14:35 進入手術室 14:40 麻醉開始 14:45 誘導結束 15:10 抗生素給藥 15:19 手術開始 16:00 手術結束 16:00 麻醉結束 16:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室腹腔分流手術 1 1 摘要__ 手術科部: 內科部 套用罐頭: Ventriculoperitoneal shunt, Medtronics, mediu... 開立醫師: 蔡宗良 開立時間: 2011/11/17 16:02 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunt, Medtronics, medium pressure, via Kocher point, right-sided Specimen Count And Types 1 piece About size:CSF x 3 Source:CSF x 3 Pathology None Operative Findings 1. ICP: low 2. Chronic subdural hematoma over right-sided convexity, presence of inner and outer membrane Operative Procedures 1. ETGA, supine, head rotated to the left 2. Routine preparation 3. Curvilinear incision over right Kocher point, followed by burr hole creation, tenting, and durotomy 4. Minilaparotomy, followed by connection of VP shunt 5. Test to confirm the function. 6. CSF collected for laboratory investigation 7. Wound closed in layers Operators VS VS王國川 Assistants R6 R6蔡宗良 R1張書豪 相關圖片 記錄__ 手術科部: 內科部 套用罐頭: Ventriculoperitoneal shunt, Medtronics, mediu... 開立醫師: 蔡宗良 開立時間: 2011/11/17 16:04 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunt, Medtronics, medium pressure, via Kocher point, right-sided Specimen Count And Types 1 piece About size:CSF x 3 Source:CSF x 3 Pathology None Operative Findings 1. ICP: low 2. Chronic subdural hematoma over right-sided convexity, presence of inner and outer membrane Operative Procedures 1. ETGA, supine, head rotated to the left 2. Routine preparation 3. Curvilinear incision over right Kocher point, followed by burr hole creation, tenting, and durotomy 4. Minilaparotomy, followed by connection of VP shunt 5. Test to confirm the function. 6. CSF collected for laboratory investigation 7. Wound closed in layers Operators VS 王國川 Assistants R6蔡宗良 R1張書豪 相關圖片 楊育欣 (M,1973/12/21,38y2m) 手術日期 2011/11/17 手術主治醫師 蔡翊新 手術區域 東址 002房 05號 診斷 Intracerebral hemorrhage 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 4E 紀錄醫師 連子賢, 時間資訊 21:34 開始NPO 21:34 通知急診手術 22:15 進入手術室 22:20 麻醉開始 22:25 誘導結束 22:50 抗生素給藥 23:00 手術開始 23:40 手術結束 23:40 麻醉結束 23:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 手術 顱內壓視置入 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 蔡翊新 開立時間: 2011/11/17 23:50 Pre-operative Diagnosis Thalamic hemorrhage with intraventricular hemorrhage Post-operative Diagnosis Thalamic hemorrhage with intraventricular hemorrhage Operative Method Ventriculostomy via right-sided Kocher point Specimen Count And Types 1 piece About size: Source: Pathology none Operative Findings 1. intracranial pressure approximately 15 cmH2O Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: supine with neutral position 3.Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 5 cm linear, right occipital, corresponded to the location of right occipital horn. Raney clips were applied to the scalp edge for temporary hemostasis. 5.After the scalp flap had been lifted and reflected anteriorly, a burr hole was made and the dura was tented by 1 stitche. 6.The dura was opened by a nib incision. Rt lateral ventricle was tapped by a ventricular needle, then a 6.5 cm segment of the ventricular catheter was introduced into the ventricle. 7. One mL of urokinase, followed by 5 mL of saline was injected into the ventricle at 11:30PM 8. Wound was closed in layres 9. Course of the surgery: smooth. Operators VS 蔡翊新 Assistants R6 蔡宗良 Indication Of Emergent Operation increased intracranial pressure 相關圖片 葉金惠 (F,1950/02/01,62y1m) 手術日期 2011/11/18 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Glioblastoma multiforma 器械術式 telovelar approach for midbrain tumor biopsy. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 08:07 進入手術室 08:13 麻醉開始 08:50 誘導結束 09:30 抗生素給藥 09:45 手術開始 12:30 抗生素給藥 15:10 手術結束 15:10 麻醉結束 15:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 手術 腦瘤切除-手術時間在4~8小時 1 1 摘要__ 手術科部: 外科部 套用罐頭: Telovelar approach for tumor biopsy 開立醫師: 曾偉倫 開立時間: 2011/11/18 15:08 Pre-operative Diagnosis Mid-brain tumor, suspect glioma Post-operative Diagnosis Mid-brain tumor, suspect glioma Operative Method Telovelar approach for tumor biopsy Specimen Count And Types 1 piece About size:0.5x0.5x0.5 cm Source:Brain stem tumor Pathology Pending Operative Findings The tumor is whit-greyish, soft, hyperveasularized, locate posterior to the facial coliculus and the border between tumor and normal tissue was clear. The opening pressure of CSF was not high. The CSF was clear. The SSEP and MEP remain the same during the operation. Operative Procedures Under ETGA, we places the patient on prone position. After we shaved, scrubbed, disinfected and drapped, a liner skin incision was made over the mid-line from inion to C2 spinous process. The wound was opened in layers and the muscles was divided. A facia flap was preserved. The craniotomy was made after 5 burr holes. A reverse-U shape durotomy was made and the arachnoid membrane of cisterna magnum was opened. The CSF was drained and the cerebellum sunked. The tela-choroida and inferior medullary velum was dissected. The fourth ventricle was opened and the tumor was reached. Tumor biopsy was made with bipolar forceps, tumor forceps and scissors. After complete hemostasis, the dura was close in water-tight fashion with 3-0 Prolene and fascia flap. The skull flap was fixed with mini-plate and screw. The wound was closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators Prof. 杜永光 Assistants R6 鍾文桂 R3 曾偉倫 Ri 陳秋吟 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Telovelar approach for tumor biopsy 開立醫師: 曾偉倫 開立時間: 2011/11/18 15:41 Pre-operative Diagnosis Mid-brain tumor, suspect glioma Post-operative Diagnosis Mid-brain tumor, suspect glioma Operative Method Telovelar approach for tumor biopsy Specimen Count And Types 1 piece About size:0.5x0.5x0.5 cm Source:Brain stem tumor Pathology Pending Operative Findings The tumor is whit-greyish, soft, hyperveasularized, locate posterior to the facial coliculus and the border between tumor and normal tissue was clear. The opening pressure of CSF was not high. The CSF was clear. The SSEP and MEP remain the same during the operation. Operative Procedures Under ETGA, we places the patient on prone position. After we shaved, scrubbed, disinfected and drapped, a liner skin incision was made over the mid-line from inion to C2 spinous process. The wound was opened in layers and the muscles was divided. A facia flap was preserved. The craniotomy was made after 5 burr holes. A reverse-U shape durotomy was made and the arachnoid membrane of cisterna magnum was opened. The CSF was drained and the cerebellum sunked. The tela-choroida and inferior medullary velum was dissected. The fourth ventricle was opened and the tumor was reached. Tumor biopsy was made with bipolar forceps, tumor forceps and scissors. After complete hemostasis, the dura was close in water-tight fashion with 3-0 Prolene and fascia flap. The skull flap was fixed with mini-plate and screw. The wound was closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators Prof. 杜永光 Assistants R6 鍾文桂 R3 曾偉倫 Ri 陳秋吟 相關圖片 林貴惠 (F,1949/02/06,63y1m) 手術日期 2011/11/18 手術主治醫師 杜永光 手術區域 東址 003房 02號 診斷 Glioblastoma multiforma 器械術式 Left frontal metastatic tumor excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 15:35 進入手術室 15:45 麻醉開始 16:00 誘導結束 16:20 抗生素給藥 16:30 手術開始 19:20 抗生素給藥 19:35 手術結束 19:35 麻醉結束 19:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 手術 腦瘤切除-手術時間在4小時以內 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Left forntal craniotomy for tumor resection 開立醫師: 曾偉倫 開立時間: 2011/11/18 20:21 Pre-operative Diagnosis Left frontal brain tumor, suspect metastasis Post-operative Diagnosis Left frontal brain tumor, suspect metastasis or high grade glioma Operative Method Left forntal craniotomy for tumor resection Specimen Count And Types 2 pieces About size:0.5x0.5x0.5 cm Source:Superficial part of the tumor About size:0.5x0.5x0.5 cm Source:Deeper part of the tumor Pathology Pending Operative Findings A 2.0x1.0x1.0 cm greyish, hypervascularized, soft tumor was found within the frontal lobe. The border between the tumor and normal brain is clear. Total tumor excision was done. Blood loss: 100ml Operative Procedures Under ETGA, we placed the patient over supine position with her face tilt to right. After we shaved, scrubbed, disinfected and drapped, a U-shape skin incision was made over her left frontal area. The wound was opened in layers and the scalp flap was elevated. Craniotomy was made after making two burr holes. Intra-operative echo was used for defining the tumor location. The curvilinear durotmy was made and tumor resection was performed with bipolar corceps, tumor forceps, and suction. The tumor was removed totally and the bleeders were checked after then. After complete hemostasis, the dura was closed with pericranium flap under water-tight 3-0 Prolene suture. The skull flap was fixed with mini-plate and screws. The wound was closed in layers with 2-0 Vicryl and 3-0 Nylon after placing a CWV drain. Operators Prof. 杜永光 Assistants R6 鍾文桂 R3 曾偉倫 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Left forntal craniotomy for tumor resection 開立醫師: 曾偉倫 開立時間: 2011/11/18 20:22 Pre-operative Diagnosis Left frontal brain tumor, suspect metastasis Post-operative Diagnosis Left frontal brain tumor, suspect metastasis or high grade glioma Operative Method Left forntal craniotomy for tumor resection Specimen Count And Types 2 pieces About size:0.5x0.5x0.5 cm Source:Superficial part of the tumor About size:0.5x0.5x0.5 cm Source:Deeper part of the tumor Pathology Pending Operative Findings A 2.0x1.0x1.0 cm greyish, hypervascularized, soft tumor was found within the frontal lobe. The border between the tumor and normal brain is clear. Total tumor excision was done. Blood loss: 100ml Operative Procedures Under ETGA, we placed the patient over supine position with her face tilt to right. After we shaved, scrubbed, disinfected and drapped, a U-shape skin incision was made over her left frontal area. The wound was opened in layers and the scalp flap was elevated. Craniotomy was made after making two burr holes. Intra-operative echo was used for defining the tumor location. The curvilinear durotmy was made and tumor resection was performed with bipolar corceps, tumor forceps, and suction. The tumor was removed totally and the bleeders were checked after then. After complete hemostasis, the dura was closed with pericranium flap under water-tight 3-0 Prolene suture. The skull flap was fixed with mini-plate and screws and the central tenting was made. The wound was closed in layers with 2-0 Vicryl and 3-0 Nylon after placing a CWV drain. Operators Prof. 杜永光 Assistants R6 鍾文桂 R3 曾偉倫 相關圖片 黃堅維 (M,1959/12/01,52y3m) 手術日期 2011/11/18 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Parkinson''s disease 器械術式 C5/6 anterior cervical diskectomy 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 蔡宗良, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:15 麻醉開始 08:40 誘導結束 08:45 抗生素給藥 09:07 手術開始 11:21 手術結束 11:21 麻醉結束 11:25 送出病患 11:30 進入恢復室 12:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-頸椎 1 1 手術 椎融合術-前融合,無固定物(≦四節) 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Anterior cervical discectomy with fusion (cage) 開立醫師: 蔡宗良 開立時間: 2011/11/18 11:34 Pre-operative Diagnosis Herniated cervical disc, C5-6 Post-operative Diagnosis Herniated cervical disc, C5-6 Operative Method Anterior cervical discectomy with fusion (cage) Specimen Count And Types nil Pathology None Operative Findings 1. Redundant PLL 2. Fragments of degenerated nucleus pulposus heriated into the OLL Operative Procedures 1. ETGA, supine, head mildly extended 2. Routine preparation 3. Linear wound incision 4. Open platysma, SCM-streps muscle layer, confirmation of CCA 5. Blunt disection of prevertebral fascia 6. Fluoroscopic confirmation of correct level - C5-6 7. Detach longus colli with auto-retractor application and Caspar screws 8. Discectomy and open PLL 9. Six-mm height A-spine cage was impacted into the disc space 10. After meticulous hemostasis, the wound was closed in layers Operators 曾勝弘 Assistants R6蔡宗良 R1張哲瑋 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Anterior cervical discectomy with fusion (cage) 開立醫師: 張哲瑋 開立時間: 2011/11/18 11:38 Pre-operative Diagnosis Herniated cervical disc, C5-6 Post-operative Diagnosis Herniated cervical disc, C5-6 Operative Method Anterior cervical discectomy with fusion (cage) Specimen Count And Types nil Pathology None Operative Findings 1. Redundant PLL 2. Fragments of degenerated nucleus pulposus heriated into the OLL Operative Procedures 1. ETGA, supine, head mildly extended 2. Routine preparation 3. Linear wound incision 4. Open platysma, SCM-streps muscle layer, confirmation of CCA 5. Blunt disection of prevertebral fascia 6. Fluoroscopic confirmation of correct level - C5-6 7. Detach longus colli with auto-retractor application and Caspar screws 8. Discectomy and open PLL 9. Six-mm height A-spine cage was impacted into the disc space 10. After meticulous hemostasis, the wound was closed in layers Operators 曾勝弘 Assistants R6蔡宗良 R1張哲瑋 相關圖片 曾煥哲 (M,1950/02/03,62y1m) 手術日期 2011/11/18 手術主治醫師 賴達明 手術區域 東址 005房 02號 診斷 Abdominal pain 器械術式 L4-5 sublaminar decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 蔡宗良, 時間資訊 00:00 臨時手術NPO 11:00 報到 11:55 進入手術室 12:00 麻醉開始 12:20 誘導結束 12:40 抗生素給藥 12:52 手術開始 13:30 手術結束 13:30 麻醉結束 13:35 送出病患 13:38 進入恢復室 14:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術(減壓)-二節以內 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Sublaminar decompression, L4-5 開立醫師: 張哲瑋 開立時間: 2011/11/18 13:41 Pre-operative Diagnosis Lateral recess stenosis, L4-5 Post-operative Diagnosis Lateral recess stenosis, L4-5 Operative Method Sublaminar decompression, L4-5 Specimen Count And Types nil Pathology None Operative Findings Hypertrophic ligmentum flavum at L4-5 bilateral lateral recess Operative Procedures 1. ETGA, prone, fluoroscopic confirmation at L4-5 2. Routine preparation 3. Midline linear wound incision 4. Subperiosteal dissection 5. Rougeour removal of interspinous ligament 6. Laminotomy and facet undercut with removal of ligmentum flavum until bilateral L5 root were visible 7. Gentamicin saline irrigation and hemostasis 8. Wound was closed in layers Operators 賴達明 Assistants R6蔡宗良 R1張哲瑋 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Sublaminar decompression, L4-5 開立醫師: 張哲瑋 開立時間: 2011/11/18 13:42 Pre-operative Diagnosis Lateral recess stenosis, L4-5 Post-operative Diagnosis Lateral recess stenosis, L4-5 Operative Method Sublaminar decompression, L4-5 Specimen Count And Types nil Pathology None Operative Findings Hypertrophic ligmentum flavum at L4-5 bilateral lateral recess Operative Procedures 1. ETGA, prone, fluoroscopic confirmation at L4-5 2. Routine preparation 3. Midline linear wound incision 4. Subperiosteal dissection 5. Rougeour removal of interspinous ligament 6. Laminotomy and facet undercut with removal of ligmentum flavum until bilateral L5 root were visible 7. Gentamicin saline irrigation and hemostasis 8. Wound was closed in layers Operators 賴達明 Assistants R6蔡宗良 R1張哲瑋 相關圖片 王妙玲 (F,1957/12/15,54y2m) 手術日期 2011/11/18 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Lumbar Spondylosis 器械術式 L4/5, L5/S1 TLIF 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:10 麻醉開始 08:15 誘導結束 08:30 抗生素給藥 09:00 手術開始 12:00 抗生素給藥 13:40 手術結束 13:40 麻醉結束 13:45 送出病患 13:50 進入恢復室 15:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎間盤切除術-腰椎 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: L4/5, L5/S1 transforaminal lumbar interbody f... 開立醫師: 李振豪 開立時間: 2011/11/18 13:52 Pre-operative Diagnosis L4/5, L5/S1 spondylolisthesis with lumbar stenosis Post-operative Diagnosis L4/5, L5/S1 spondylolisthesis with lumbar stenosis Operative Method L4/5, L5/S1 transforaminal lumbar interbody fusion with PEEK banana cage Specimen Count And Types nil Pathology Nil Operative Findings The L4/5, L5/S1 joint was unstable with hypertrophic appearance. Narrowing of L4/5, L5/S1 disc space also found with bulging, dehydrated and necrotic disc. The ligmentum flavum over L4/5 was thick with thecal sac compression. After laminotomy and right facetectomy for decompression, the thecal sac expanded well. Five 6.2 x 40mm transpedicular screws, one 6.2 x 35mm transpedicular screws(right S1), and two 8cm rods were used for posterior instrumentation. Two #9 PEEK banana cage was implanted for transforaminal lumbar interbody fusion. No incidental durotomy or CSF leakage was noted duriong whole procedure. Total blood loss: 500ml. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position. L4, L5, and S1 pedicles were localized by portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made from L4 to S2 level. The subcutaneous soft tissue was devided and the paraspinal muscle groups were detached. The L4, L5, and S1 transpedicular screws were implanted under C-arm guided. L4/5, L5/S1 laminotomy and right side facetectomy was conducted for decompression and lumbar diskectomy, Two #9 PEEK banana cage filled with autologous bone graft was implanted for transforaminal lumbar interbody fusion. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. One 1/8 Hemovac was placed. The wound was then closed in layers with 1-0, 2-0 Vicryl and 3-0 Nylon. Operators VS賴達明 Assistants R5李振豪, R1李嘉哲 相關圖片 姜世生 (M,1963/05/20,48y9m) 手術日期 2011/11/18 手術主治醫師 賴達明 手術區域 東址 019房 02號 診斷 Cervical Spondylosis 器械術式 C5/6 anterior cervical diskectomy 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 14:00 麻醉開始 14:10 誘導結束 14:20 抗生素給藥 14:35 手術開始 14:57 進入手術室 17:10 手術結束 17:10 麻醉結束 17:20 送出病患 17:22 進入恢復室 19:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 椎間盤切除術-頸椎 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: C5/6 anterior cervical diskectomy, foraminoto... 開立醫師: 李振豪 開立時間: 2011/11/18 17:31 Pre-operative Diagnosis C5/6 herniated intervertebral disc with myelopathy and radiculopathy Post-operative Diagnosis C5/6 herniated intervertebral disc with myelopathy and radiculopathy Operative Method C5/6 anterior cervical diskectomy, foraminotomy, and fusion with PEEK cage Specimen Count And Types nil Pathology Nil Operative Findings Marginal spur formation was noted at C5/6 disc level. The disc was mild degenerative. The disc was herniated posteriorly, especially right side with thecal sac compression. The posterior longitudinal ligment was not calcified. After microdiskectomy and bilateral foraminotomy, the thecal sac expanded well. No incidental durotomy or CSF leakage was noted during whole procedure. The patient stood whole procedure well. Marginal spur formation was noted at C5/6 disc level. The disc was mild degenerative. The disc was herniated posteriorly, especially right side with thecal sac compression. The posterior longitudinal ligment was not calcified. After microdiskectomy and bilateral foraminotomy, the thecal sac expanded well. One #8 PEEK cage filled with artificial bone graft was used for anterior fusion. No incidental durotomy or CSF leakage was noted during whole procedure. The patient stood whole procedure well. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with neck extension. The skin was scrubbed, disinfected, and draped as usual. Transverse skin incision was made over right middle neck. The subcutaneous soft tissue and platysma muscle was devided. Dissection was performed along the plane between thyroid gland and carotid sheath. Prevertebral fascia was exposed and C5/6 disc level was localized by portable C-arm X-ray. After opening of prevertebral fascia and detachment of longus collis muscle, microdiskectomy was performed with curette, alligator, kerrison punches, and Midas air-drived drills. The posterior longitudinal ligment also transected after diskectomy. One #8 PEEK cage filled with artificial bone graft was implanted for anterior fusion. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. One Minihemovac was placed. The wound was then closed in layers with 3-0 Vicryl and 4-0 Dexon. Operators VS賴達明 Assistants R5李振豪, R1李嘉哲 相關圖片 張奕鴻 (M,1957/05/15,54y9m) 手術日期 2011/11/18 手術主治醫師 賴達明 手術區域 東址 017房 02號 診斷 Ulnar palsy 器械術式 Neurolysis for left tardy ulnar palsy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 2 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 14:25 報到 14:50 進入手術室 14:55 麻醉開始 15:00 誘導結束 15:25 抗生素給藥 15:35 手術開始 16:50 手術結束 16:50 麻醉結束 16:55 送出病患 16:56 進入恢復室 18:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 神經分離術-上臂.前臂.大腿.小腿處之神經 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Left ulnar nerve decompression 開立醫師: 游健生 開立時間: 2011/11/18 17:01 Pre-operative Diagnosis Left ulnar nerve palsy Post-operative Diagnosis Left ulnar nerve palsy Operative Method Left ulnar nerve decompression Specimen Count And Types nil Pathology Nil Operative Findings The ulnar nerve was compressed by fibrous band, especially at cubital tunnel. It was free from compression after surgery. Operative Procedures Under ETGA, patient was in supine position with left arm extended outward. His elbow was flexed and laterally rotated. After disinfection and draping, a curvilinear skin incision was made over left cubital tunnel along ulnar nerve tract. After dissection, the ulnar nerve was identified at cubital tunnel. The fibrous band compressing the nerve was cut opened. We checked full decompression of the nerve 4cm distal and 4cm proximal the the cubital tunnel. After hemostasis and N/S irrigation, we closed the wound with 3-0 Vicryl and 4-0 Nylon. Operators VS 賴達明 Assistants R4 游健生 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Left ulnar nerve decompression 開立醫師: 游健生 開立時間: 2011/11/18 17:02 Pre-operative Diagnosis Left ulnar nerve palsy Post-operative Diagnosis Left ulnar nerve palsy Operative Method Left ulnar nerve decompression Specimen Count And Types nil Pathology Nil Operative Findings The ulnar nerve was compressed by fibrous band, especially at cubital tunnel. It was free from compression after surgery. Operative Procedures Under ETGA, patient was in supine position with left arm extended outward. His elbow was flexed and laterally rotated. After disinfection and draping, a curvilinear skin incision was made over left cubital tunnel along ulnar nerve tract. After dissection, the ulnar nerve was identified at cubital tunnel. The fibrous band compressing the nerve was cut opened. We checked full decompression of the nerve 4cm distal and 4cm proximal the the cubital tunnel. After hemostasis and N/S irrigation, we closed the wound with 3-0 Vicryl and 4-0 Nylon. Operators VS 賴達明 Assistants R4 游健生 相關圖片 徐正發 (M,1956/05/24,55y9m) 手術日期 2011/11/18 手術主治醫師 楊士弘 手術區域 東址 005房 03號 診斷 Herniation of intervertebral disc with myelopathy, cervical (HIVD) 器械術式 C3-5 anterior cervical diskectomy + plating 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 張哲瑋, 時間資訊 00:00 臨時手術NPO 13:30 報到 13:47 進入手術室 13:55 麻醉開始 14:10 誘導結束 14:20 抗生素給藥 14:26 手術開始 16:30 手術結束 16:30 麻醉結束 16:38 送出病患 16:40 進入恢復室 17:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-頸椎 1 1 手術 椎融合術-前融合,無固定物(≦四節) 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: Anterior cervical discectomy with fusion (cag... 開立醫師: 蔡宗良 開立時間: 2011/11/18 16:50 Pre-operative Diagnosis 1. Ossification of posterior longitudinal ligament 2. Herniated cervical disc, C3-4, with myelopathy Post-operative Diagnosis 1. Ossification of posterior longitudinal ligament 2. Herniated cervical disc, C3-4, with myelopathy Operative Method Anterior cervical discectomy with fusion (cage), C3-4 Specimen Count And Types nil Pathology none Operative Findings 1. Ossification of posterior longitudinal ligament with minor ossification of underlying dura. 2. Herniated cervical disc fragments over PLL Operative Procedures 1. ETGA, supine, head mildly extended 2. Routine preparation 3. Linear wound incision 4. Open platysma, SCM-streps muscle layer, confirmation of CCA 5. Blunt disection of prevertebral fascia 6. Fluoroscopic confirmation of correct level - C3-4 7. Detach longus colli with auto-retractor application and Caspar screws 8. Discectomy and open PLL 9. Six-mm height cage was impacted into the disc space 10. After meticulous hemostasis, the wound was closed in layers Operators 楊士弘 Assistants R6蔡宗良 R1張哲瑋 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Anterior cervical discectomy with fusion (cag... 開立醫師: 蔡宗良 開立時間: 2011/11/18 16:50 Pre-operative Diagnosis 1. Ossification of posterior longitudinal ligament 2. Herniated cervical disc, C3-4, with myelopathy Post-operative Diagnosis 1. Ossification of posterior longitudinal ligament 2. Herniated cervical disc, C3-4, with myelopathy Operative Method Anterior cervical discectomy with fusion (cage), C3-4 Specimen Count And Types nil Pathology none Operative Findings 1. Ossification of posterior longitudinal ligament with minor ossification of underlying dura. 2. Herniated cervical disc fragments over PLL Operative Procedures 1. ETGA, supine, head mildly extended 2. Routine preparation 3. Linear wound incision 4. Open platysma, SCM-streps muscle layer, confirmation of CCA 5. Blunt disection of prevertebral fascia 6. Fluoroscopic confirmation of correct level - C3-4 7. Detach longus colli with auto-retractor application and Caspar screws 8. Discectomy and open PLL 9. Six-mm height cage was impacted into the disc space 10. After meticulous hemostasis, the wound was closed in layers Operators 楊士弘 Assistants R6蔡宗良 R1張哲瑋 相關圖片 周昶佑 (M,1975/12/02,36y3m) 手術日期 2011/11/18 手術主治醫師 王國川 手術區域 東址 001房 04號 診斷 Brain metastasis 器械術式 Crainotomy Brain Tumor(P-LIN) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3E 紀錄醫師 王奐之, 時間資訊 18:00 開始NPO 18:00 臨時手術NPO 09:04 通知急診手術 12:13 報到 12:35 進入手術室 12:40 麻醉開始 13:10 誘導結束 13:16 抗生素給藥 13:17 手術開始 14:30 開始輸血 15:50 麻醉結束 15:50 手術結束 16:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Left temporo-parieto-occipital craniotomy for... 開立醫師: 王奐之 開立時間: 2011/11/18 16:31 Pre-operative Diagnosis Left temporo-parieto-occipital intracerebral hemorrhage, suspected bleeding from metastatic tumor Post-operative Diagnosis Left temporo-parieto-occipital intracerebral hemorrhage, suspected bleeding from metastatic tumor Operative Method Left temporo-parieto-occipital craniotomy for tumor removal & hematoma evacuation Specimen Count And Types 1 piece About size:pieces Source:left temporo-parietal tumor & hematoma Pathology Pending Operative Findings The tumorous portion of brain bulged out after durotomy. A soft, fragile tumor with grey-purplish color was noted at left temporo-parieto-occipital area, posterior to the Wernicke area. Significant amount of hematoma was noted within the tumor. The tumor & hematoma measures about 8*6*5 cm in size. Estimiated blood loss: 200ml. Operative Procedures After endotracheal general anesthesia, the patient was placed in right semi-decubitus position, with head fixed in Mayfield skull clamp. After shaving, scrubbing, disinfection & draping in sterile fashion, an U-shaped incision was made at left temporo-parieto-occipital area. The skin flap was reflected inferiorly, the temporalis muscle and the periosteum were also reflected down. After creation of 4 burr holes, a square-shaped craniotomy was performed. An U-shaped durotomy was performed (with base at inferior edge) after dural tenting. The tumor & hematoma were then removed in pieces with tumor forceps & sucker. The tumor bed was packed with Surgicel after meticulous hemostasis. After filling the space with normal saline, the dura was closed in water-tight fashion with a piece of periosteal graft. The bone flap was fixed back with mini-plates after central tenting. The wound was closed in alyers after setting up 1 subgaleal CWV drain. Operators VS 王國川 Assistants R4 王奐之, Ri Indication Of Emergent Operation IICP 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Left temporo-parieto-occipital craniotomy for... 開立醫師: 王奐之 開立時間: 2011/11/18 16:31 Pre-operative Diagnosis Left temporo-parieto-occipital intracerebral hemorrhage, suspected bleeding from metastatic tumor Post-operative Diagnosis Left temporo-parieto-occipital intracerebral hemorrhage, suspected bleeding from metastatic tumor Operative Method Left temporo-parieto-occipital craniotomy for tumor removal & hematoma evacuation Specimen Count And Types 1 piece About size:pieces Source:left temporo-parietal tumor & hematoma Pathology Pending Operative Findings The tumorous portion of brain bulged out after durotomy. A soft, fragile tumor with grey-purplish color was noted at left temporo-parieto-occipital area, posterior to the Wernicke area. Significant amount of hematoma was noted within the tumor. The tumor & hematoma measures about 8*6*5 cm in size. Estimiated blood loss: 200ml. Operative Procedures After endotracheal general anesthesia, the patient was placed in right semi-decubitus position, with head fixed in Mayfield skull clamp. After shaving, scrubbing, disinfection & draping in sterile fashion, an U-shaped incision was made at left temporo-parieto-occipital area. The skin flap was reflected inferiorly, the temporalis muscle and the periosteum were also reflected down. After creation of 4 burr holes, a square-shaped craniotomy was performed. An U-shaped durotomy was performed (with base at inferior edge) after dural tenting. The tumor & hematoma were then removed in pieces with tumor forceps & sucker. The tumor bed was packed with Surgicel after meticulous hemostasis. After filling the space with normal saline, the dura was closed in water-tight fashion with a piece of periosteal graft. The bone flap was fixed back with mini-plates after central tenting. The wound was closed in alyers after setting up 1 subgaleal CWV drain. Operators VS 王國川 Assistants R4 王奐之, Ri Indication Of Emergent Operation IICP 相關圖片 黃雅慧 (F,1977/10/06,34y5m) 手術日期 2011/11/19 手術主治醫師 蔡瑞章 手術區域 東址 003房 01號 診斷 Subdural hemorrhage or effusion 器械術式 Shunt revision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 2 時間資訊 00:00 臨時手術NPO 07:34 報到 08:01 進入手術室 08:10 麻醉開始 08:15 誘導結束 08:55 抗生素給藥 09:33 手術開始 11:49 11:55 抗生素給藥 12:15 麻醉結束 12:15 手術結束 12:25 送出病患 12:30 進入恢復室 13:03 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 摘要__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt, Kocher point, lef... 開立醫師: 蔡宗良 開立時間: 2011/11/19 13:23 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunt, Kocher point, left-sided Specimen Count And Types CSF x 3 Pathology None Operative Findings 1. Multiple scalp eruptions with hyperemia 2. Ventriculostomy succeeded in single attempt 3. ICP: medium Operative Procedures 1. ETGA supine, head rotated to the right 2. Routine preparation 3. Curvilinear scalp incision with burr hole creation and ventriculostomy (6.5 cm) 4. Mini-laparotomy with peritoneal catherter 30 cm insertion 5. Connection of shunt with reservoir, initial pressure set at 11cmH2O 6. CSF was collected for laboratory investigation 7. Confirmation of shunt function 8. Wound was closed in layers Operators PROF 蔡瑞章 Assistants R6 蔡宗良, R1 張哲瑋 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt, Kocher point, lef... 開立醫師: 蔡宗良 開立時間: 2011/11/29 11:00 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunt, Kocher point, left-sided Specimen Count And Types CSF x 3 Pathology None Operative Findings 1. Multiple scalp eruptions with hyperemia 2. Ventriculostomy succeeded in single attempt 3. ICP: medium Operative Procedures 1. ETGA supine, head rotated to the right 2. Routine preparation 3. Curvilinear scalp incision with burr hole creation and ventriculostomy (6.5 cm) 4. Mini-laparotomy with peritoneal catherter 30 cm insertion 5. Connection of shunt with reservoir, initial pressure set at 11cmH2O 6. CSF was collected for laboratory investigation 7. Confirmation of shunt function 8. Wound was closed in layers Operators PROF 蔡瑞章 Assistants R6 蔡宗良, R1 張哲瑋 相關圖片 洪志融 (M,1981/10/27,30y4m) 手術日期 2011/11/19 手術主治醫師 蔡瑞章 手術區域 東址 005房 01號 診斷 Subdural hemorrhage or effusion 器械術式 Removal of chronic subdural 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 07:35 報到 08:08 進入手術室 08:10 麻醉開始 08:20 誘導結束 09:00 抗生素給藥 09:31 手術開始 12:00 抗生素給藥 13:50 麻醉結束 13:50 手術結束 14:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 手術 急性硬腦膜下血腫清除術 1 2 L 麻醉 Peripheral arterial line inserti 1 0 記錄__ 手術科部: 外科部 套用罐頭: 1. Evacuation of acute subdural hematoma and ... 開立醫師: 鍾文桂 開立時間: 2011/11/19 15:01 Pre-operative Diagnosis Head injury with subdural effusion s/p drainage, with acute subdural hemorrhage and pneumocranium. Post-operative Diagnosis Head injury with subdural effusion s/p drainage, with acute subdural hemorrhage and pneumocranium. Operative Method 1. Evacuation of acute subdural hematoma and air, left frontal frontal- temporal-parital. Specimen Count And Types 1 piece About size:2cc Source:cortical vessels. Pathology Nil. Operative Findings 1. Much more organized hematoma at subdural space than shown in CT scan. 2. Some fibrotic arachnoid septae were noted over left parietal and temporal areas. A thin whitish " outer membrane" was noted and collected. 3. Some oozing was noted near midline. Flooseal was used for hemostasis. Operative Procedures Under ETGa, the patient was placed in supine position and the head was tilted to the right side. After shaving, disinfection, and draping, a curvilinear incision was made at left temporal-frontal area. After dissection, a 10 cm craniotomy was obtained. After durotomy, the hematoma was evacuated. With well hemostasis, the dura mater was closed in water-tight fashion. The craniotomy plate was fixed by plates and screws. The wound was closed in layers with one subgaleal CWV drain. Operators 蔡瑞章 Assistants 鍾文桂 相關圖片 周文凱 (M,1981/02/14,31y1m) 手術日期 2011/11/19 手術主治醫師 楊士弘 手術區域 東址 003房 02號 診斷 Cervical spondylosis 器械術式 C3/6 laminectomy +/- lateral mass screws fixation 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 2 紀錄醫師 蔡宗良, 時間資訊 00:00 臨時手術NPO 12:12 報到 12:42 進入手術室 12:55 麻醉開始 13:15 誘導結束 13:30 抗生素給藥 13:35 手術開始 16:30 抗生素給藥 19:36 抗生素給藥 20:30 手術結束 20:30 麻醉結束 20:45 送出病患 21:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎弓切除術(減壓)-超過二節 1 2 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 7 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 摘要__ 手術科部: 外科部 套用罐頭: 1. Posterolateral fusion, C2-3-4-5-6 開立醫師: 蔡宗良 開立時間: 2011/11/19 21:04 Pre-operative Diagnosis Cervical spinal stenosis C2-3-4-5-6 Post-operative Diagnosis Cervical spinal stenosis C2-3-4-5-6 Operative Method 1. Posterolateral fusion, C2-3-4-5-6 2. Laminectomy C3-4-5, hemilaminectomy C2 (lower half) and C6 upper half Specimen Count And Types Nil Pathology None Operative Findings Severe spinal canal stenosis C2-3-4-5-6 Operative Procedures 1. ETGA, Mayfield skull fixation, prone positioning 2. Routine preparation, disinfection and drapping 3. Midline skin incision from C2 to C7, followed by subperiosteal dissection and exposure. 4. Lateral mass screw fixation over bilateral lateral mass of C2, C4, C5 and C6, with fluoroscopic confirmation 5. Laminectomy of C3-4-5, hemilaminectomy C2 (lower half) and C6 upper half were performed by rongeour, 1-mm and 2-mm Kerisons punch 6. Bilateral rod fixation and two cross-link fixation were performed. 7. Autologous bone graft and artificial bone OsteoSet (TM) were placed lateral to the rods after decortication performed using high-speed pneumatic burr 7. Placement of 7-mm CWV after copious saline irrigation 8. Wound was closed in layers Operators 楊士弘 Assistants R6蔡宗良 R1張哲瑋 記錄__ 手術科部: 外科部 套用罐頭: 1. Posterolateral fusion, C2-3-4-5-6 開立醫師: 蔡宗良 開立時間: 2011/11/19 21:05 Pre-operative Diagnosis Cervical spinal stenosis C2-3-4-5-6 Post-operative Diagnosis Cervical spinal stenosis C2-3-4-5-6 Operative Method 1. Posterolateral fusion, C2-3-4-5-6 2. Laminectomy C3-4-5, hemilaminectomy C2 (lower half) and C6 upper half Specimen Count And Types Nil Pathology None Operative Findings Severe spinal canal stenosis C2-3-4-5-6 Operative Procedures 1. ETGA, Mayfield skull fixation, prone positioning 2. Routine preparation, disinfection and drapping 3. Midline skin incision from C2 to C7, followed by subperiosteal dissection and exposure. 4. Lateral mass screw fixation over bilateral lateral mass of C2, C4, C5 and C6, with fluoroscopic confirmation 5. Laminectomy of C3-4-5, hemilaminectomy C2 (lower half) and C6 upper half were performed by rongeour, 1-mm and 2-mm Kerisons punch 6. Bilateral rod fixation and two cross-link fixation were performed. 7. Autologous bone graft and artificial bone OsteoSet (TM) were placed lateral to the rods after decortication performed using high-speed pneumatic burr 7. Placement of 7-mm CWV after copious saline irrigation 8. Wound was closed in layers Operators 楊士弘 Assistants R6蔡宗良 R1張哲瑋 摘要__ 手術科部: 外科部 套用罐頭: 1. Posterior instrumented fusion of cervical ... 開立醫師: 楊士弘 開立時間: 2011/11/20 12:47 Pre-operative Diagnosis Cervical spondylotic stenosis C2-3-4-5-6 Post-operative Diagnosis Cervical spiondylotic stenosis C2-3-4-5-6 Operative Method 1. Posterior instrumented fusion of cervical spine, C2-6 2. Laminectomy C3-4-5, hemilaminectomy C2 (lower half) and C6 (upper half) Specimen Count And Types Nil Pathology None Operative Findings The lamina were flat and hypertrophic and ligamentum was thick, causing severe compression of the thecal sac. The thecal reexpanded well after decompression. Polyaxial screws (3.5 mm in diameter) were inserted into the C2 pedicles and C4-6 lateral masses: C2 screws = 30 mm long C4 screws: right = 14 mm, left = 16 mm C5 screws: right = 16 mm, left = 18 mm C6 screws: 18 mm Two rods were used for bridging the screws, and two cross links were placed to bridge the rods. Operative Procedures 1. ETGA, Mayfield skull fixation, prone positioning 2. Routine preparation, disinfection and drapping 3. Midline skin incision from C2 to C7, followed by subperiosteal dissection and exposure. 4. Lateral mass screw fixation over bilateral lateral mass of C2, C4, C5 and C6, with fluoroscopic confirmation 5. Laminectomy of C3-4-5, hemilaminectomy C2 (lower half) and C6 upper half were performed by rongeour, 1-mm and 2-mm Kerisons punch 6. Bilateral rods fixation and two cross-links fixation were performed. 7. Autologous bone graft and artificial bone OsteoSet (TM) were placed lateral to the rods after decortication of C2-6 lateral masses performed using high-speed pneumatic burr 7. Placement of 7-mm CWV after copious saline irrigation 8. Wound was closed in layers Operators 楊士弘 Assistants 蔡宗良, 張哲瑋 記錄__ 手術科部: 外科部 套用罐頭: 1. Posterior instrumented fusion of cervical ... 開立醫師: 蔡宗良 開立時間: 2011/11/29 11:11 Pre-operative Diagnosis Cervical spondylotic stenosis C2-3-4-5-6 Post-operative Diagnosis Cervical spiondylotic stenosis C2-3-4-5-6 Operative Method 1. Posterior instrumented fusion of cervical spine, C2-6 2. Laminectomy C3-4-5, hemilaminectomy C2 (lower half) and C6 (upper half) Specimen Count And Types Nil Pathology None Operative Findings The lamina were flat and hypertrophic and ligamentum was thick, causing severe compression of the thecal sac. The thecal reexpanded well after decompression. Polyaxial screws (3.5 mm in diameter) were inserted into the C2 pedicles and C4-6 lateral masses: C2 screws = 30 mm long C4 screws: right = 14 mm, left = 16 mm C5 screws: right = 16 mm, left = 18 mm C6 screws: 18 mm Two rods were used for bridging the screws, and two cross links were placed to bridge the rods. Operative Procedures 1. ETGA, Mayfield skull fixation, prone positioning 2. Routine preparation, disinfection and drapping 3. Midline skin incision from C2 to C7, followed by subperiosteal dissection and exposure. 4. Lateral mass screw fixation over bilateral lateral mass of C2, C4, C5 and C6, with fluoroscopic confirmation 5. Laminectomy of C3-4-5, hemilaminectomy C2 (lower half) and C6 upper half were performed by rongeour, 1-mm and 2-mm Kerisons punch 6. Bilateral rods fixation and two cross-links fixation were performed. 7. Autologous bone graft and artificial bone OsteoSet (TM) were placed lateral to the rods after decortication of C2-6 lateral masses performed using high-speed pneumatic burr 7. Placement of 7-mm CWV after copious saline irrigation 8. Wound was closed in layers Operators 楊士弘 Assistants 蔡宗良, 張哲瑋 蘇黃雪蓮 (F,1931/08/14,80y7m) 手術日期 2011/11/19 手術主治醫師 楊長豪 手術區域 東址 011房 02號 診斷 Cataract 器械術式 Phaco+PCIOL 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 09:08 進入手術室 09:20 手術開始 09:35 手術結束 09:38 送出病患 記錄__ 手術科部: 眼科部 套用罐頭: ECCE + PCIOL implantation (OS) 開立醫師: 鄭琪睿 開立時間: 2011/11/19 09:33 Pre-operative Diagnosis Senile cataract (OS) Post-operative Diagnosis Senile cataract (OS) Operative Method ECCE + PCIOL implantation (OS) Specimen Count And Types Nil Pathology Nil Operative Findings Nuclear sclerosis (OS) Operative Procedures 1. Under retrobulbar anesthesia 2. Disinfection, irrigation and draping. 3. Apply an eyelid speculum. 4. Bridle suture over SRM. 5. Superior 150-degree peritomy and hemostasis with cautery. 6. 1st and 2nd planes of limbal incision witha No. 64 blade. 7. Penetrate into the anterior chamber inject Helon into the anterior chamber. 8. Anterior capsulotomy with can-opening technique. 9. Extend limbal wound with scissors. 10. Two 10-0 Nylon preplace limbal sutures were made. 11. Hydrodissection with BSS solution. 12. Deliver the nucleus. 13. Tighten the preplaced suture. 14. Irrigation and aspiration of cortical material with Simcoe I/A cannula. 15. PCIOL was implanted. 16. Close limbal wound with 10-0 Nylon. 17. Wash out residual Healon with Simcoe I/A cannula. 18. Inject Miostat into AC. 19. Subconjunctival injection of Gentamicin and Rinderon. 20. Maxitrol patching. Operators VS 楊長豪, Assistants R5 黃宇軒, R3 鄭琪睿 曾燕明 (M,1956/04/08,55y11m) 手術日期 2011/11/20 手術主治醫師 蔡瑞章 手術區域 東址 027房 01號 診斷 Subdural hemorrhage following injury, with no loss of consciousness 器械術式 Right side burr hole or trephination for chronic SDH evacuation 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3E 紀錄醫師 曾偉倫, 時間資訊 00:55 進入恢復室 02:10 離開恢復室 12:00 開始NPO 14:49 通知急診手術 22:40 進入手術室 22:45 麻醉開始 22:55 抗生素給藥 23:35 手術開始 23:55 誘導結束 00:35 手術結束 00:35 麻醉結束 00:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 手術 慢性硬腦膜下血腫清除術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Right Burr hole for hematoma evacuation 開立醫師: 曾偉倫 開立時間: 2011/11/21 00:58 Pre-operative Diagnosis Right frontotemporoparietal subdural hemorrhage Post-operative Diagnosis Right frontotemporoparietal subdural hemorrhage Operative Method Right Burr hole for hematoma evacuation Specimen Count And Types nil Pathology Nil Operative Findings 1. Much motor-oil like old hematoma gushed out after the urotomy was made. 2. Some blood clot was found while we drained the hematoma Operative Procedures Under ETGA, we placed the patient on supine position with his face tilt to left. After we shaved, scrubbed, disinfected and drapped, a curvilinear skin incision was made over his frontal area. The wound was opened and a burr-hole was made. After dural tenting, the durotomy was done with knife and bipolar forceps. The old hematoma was drained out. De-air was done after we fixed the drain. The wound was closed in layers. Operators Prof. 蔡瑞章 Assistants R6 鍾文桂 R3 曾偉倫 Indication Of Emergent Operation 相關圖片 李阿娥 (F,1938/09/19,73y5m) 手術日期 2011/11/20 手術主治醫師 蔡翊新 手術區域 東址 019房 01號 診斷 Subarachnoid hemorrhage 器械術式 Craniotomy for aneurysm clipping 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3E 紀錄醫師 王志仁, 時間資訊 09:00 開始NPO 15:55 通知急診手術 17:05 進入手術室 17:10 麻醉開始 17:30 誘導結束 17:40 抗生素給藥 17:40 手術開始 19:20 開始輸血 20:40 抗生素給藥 22:50 手術結束 22:50 麻醉結束 23:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 開顱術摘除血管病變 - 腦血管瘤 有病徵的 1 1 R 手術 顱內壓視置入 1 2 R 摘要__ 手術科部: 外科部 套用罐頭: Aneurysm-frontotemporal approach 開立醫師: 蔡翊新 開立時間: 2011/11/20 22:25 Pre-operative Diagnosis Right posterior communicating artery aneurysm rupture with diffuse SAH. Post-operative Diagnosis Right posterior communicating artery aneurysm rupture with diffuse SAH. Operative Method Right pterional craniotomy for aneurysm clipping and right Kocher EVD for ICP monitoring. Specimen Count And Types 3 tubes of CSF, sent for routine, BCS and bacterial culture. Pathology Nil. Operative Findings CSF: sanguinous, initial pressure: 10 cmH2O. There was diffuse SAH at right Sylvian fissure and suprachiasmatic cistern. A saccular aneurysm arose from the junction of right ICA and p-com artery, pointing laterally, with the neck about 6 mm in width. The dome was adhered tightly to right temporal lobe. There was two small perforators arising from the neck of the aneurysm. The aneurysm was clipped by a 10-mm, straight Sugita clip and a 4-mm, curve Sugita clip was used to obliterate the residual neck. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with the head rotated to left for 40 degrees and slightly extended then fixed by Mayfield skull clamp. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: right frontotemporal, curvilinear. The skin edge was clipped by Raney clips for temporary hemostasis. After scalp had been lifted, the temporalis muscle was incised and detached from temporal squama and reflected to lower temporal side. 5. A burr hole was made at right Kocher point for EVD insertion for CSF drainage and as an ICP monitor. 6. Craniotomy window: 10 x 8 cm, right frontotemporal, created by making 3 burr holes then cut by power saw. The lower temporal bone and pterionic ridge (esp. the inner table) were cut by rongeur as low as possible for easy approach to the anterior clinoid. 7. Dural tention: by 2/0 silk, 2 cm in interval, distributed along the edge of skull window. 8. Dural incision: V shape, over-ridding Sylvian fissure and reflected to frontotemporal base. 9. Under operating microscope, the suprasellar cistern was opened, meanwhile, the patinet's blood pressure was brought down to 90 mmHg. The right optic nerve and ICA came into view. The arachnoid trabeculi and the fibrin (or blood clot) were cleaned out to expose the neck of the aneurysm which located just beneath the edge of tentorial hiatus. The neck of the aneurysm was mobilized gently by a Gage 16 sucker and a fine tip bipolar forceps until it was entirely free. 10.A 10-mm, straight Sugita clip was applied to the neck of the aneurysm, sparing the p-com artery and the two perforators arising from the neck. The residual neck adjacent to ICA was clipped by a 4-mm curved Sugita clip. 11.After successful clipping of the aneurysm, the patient's BP was brought back to normal, and the exposed field was irrigated with N.S. to make sure no any bleeding. 12.The brain retractors were removed. The dura was closed water-tight by running suture with 4/0 Prolene. 13.Closure of skull window: the skull plate was placed back to craniotomy window and fixed by 3 miniplates and 6 screws. The dura was tented to the center of the skull plate by 2 2/0 stitches. The covering muscle was closed by interrupted stitches with 1/ 0 silk. 14.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 15.Drain: one, epidural, CWV. 16.Blood transfusion: PRBC 4U. Blood loss: 800 ml. 17.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R6鍾文桂R0王志仁 Indication Of Emergent Operation aneurysm rupture, to prevent rebleeding. 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Aneurysm-frontotemporal approach 開立醫師: 蔡翊新 開立時間: 2011/11/20 22:25 Pre-operative Diagnosis Right posterior communicating artery aneurysm rupture with diffuse SAH. Post-operative Diagnosis Right posterior communicating artery aneurysm rupture with diffuse SAH. Operative Method Right pterional craniotomy for aneurysm clipping and right Kocher EVD for ICP monitoring. Specimen Count And Types 3 tubes of CSF, sent for routine, BCS and bacterial culture. Pathology Nil. Operative Findings CSF: sanguinous, initial pressure: 10 cmH2O. There was diffuse SAH at right Sylvian fissure and suprachiasmatic cistern. A saccular aneurysm arose from the junction of right ICA and p-com artery, pointing laterally, with the neck about 6 mm in width. The dome was adhered tightly to right temporal lobe. There was two small perforators arising from the neck of the aneurysm. The aneurysm was clipped by a 10-mm, straight Sugita clip and a 4-mm, curve Sugita clip was used to obliterate the residual neck. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with the head rotated to left for 40 degrees and slightly extended then fixed by Mayfield skull clamp. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: right frontotemporal, curvilinear. The skin edge was clipped by Raney clips for temporary hemostasis. After scalp had been lifted, the temporalis muscle was incised and detached from temporal squama and reflected to lower temporal side. 5. A burr hole was made at right Kocher point for EVD insertion for CSF drainage and as an ICP monitor. 6. Craniotomy window: 10 x 8 cm, right frontotemporal, created by making 3 burr holes then cut by power saw. The lower temporal bone and pterionic ridge (esp. the inner table) were cut by rongeur as low as possible for easy approach to the anterior clinoid. 7. Dural tention: by 2/0 silk, 2 cm in interval, distributed along the edge of skull window. 8. Dural incision: V shape, over-ridding Sylvian fissure and reflected to frontotemporal base. 9. Under operating microscope, the suprasellar cistern was opened, meanwhile, the patinet's blood pressure was brought down to 90 mmHg. The right optic nerve and ICA came into view. The arachnoid trabeculi and the fibrin (or blood clot) were cleaned out to expose the neck of the aneurysm which located just beneath the edge of tentorial hiatus. The neck of the aneurysm was mobilized gently by a Gage 16 sucker and a fine tip bipolar forceps until it was entirely free. 10.A 10-mm, straight Sugita clip was applied to the neck of the aneurysm, sparing the p-com artery and the two perforators arising from the neck. The residual neck adjacent to ICA was clipped by a 4-mm curved Sugita clip. 11.After successful clipping of the aneurysm, the patient's BP was brought back to normal, and the exposed field was irrigated with N.S. to make sure no any bleeding. 12.The brain retractors were removed. The dura was closed water-tight by running suture with 4/0 Prolene. 13.Closure of skull window: the skull plate was placed back to craniotomy window and fixed by 3 miniplates and 6 screws. The dura was tented to the center of the skull plate by 2 2/0 stitches. The covering muscle was closed by interrupted stitches with 1/ 0 silk. 14.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 15.Drain: one, epidural, CWV. 16.Blood transfusion: PRBC 4U. Blood loss: 800 ml. 17.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R6鍾文桂R0王志仁 Indication Of Emergent Operation aneurysm rupture, to prevent rebleeding. 相關圖片 沈源杏 (M,1948/03/20,63y11m) 手術日期 2011/11/21 手術主治醫師 杜永光 手術區域 東址 005房 02號 診斷 Glioblastoma multiforma 器械術式 Left mesial frontal brain abscess drainage 手術類別 預定手術 手術部位 頭、頸 傷口分類 髒 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 4 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 12:25 進入手術室 12:35 麻醉開始 12:45 誘導結束 12:54 手術開始 16:40 手術結束 16:40 麻醉結束 16:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Left fronto-parietal craniotomy for abscess d... 開立醫師: 李振豪 開立時間: 2011/11/21 18:05 Pre-operative Diagnosis Left frontal glioblastoma, status post craniotomy for subtotal tumor excision, complicated with brain abscess formation Post-operative Diagnosis Left frontal glioblastoma, status post craniotomy for subtotal tumor excision, complicated with brain abscess formation Operative Method Left fronto-parietal craniotomy for abscess drainage Specimen Count And Types 2 pieces About size:few pieces Source:left frontal abscess About size:3 culture swab Source:left frontal abscess Pathology Pending Operative Findings Subgaleal abscess was encountered after scalp incision was three culture swab was obtained. The capsule of the abscess was curetted and irrigated with Gentamicin solution. After durotomy, the brain bulging out. Abscess was noted at posterior mesial frontal area. The corticotomy was extended from posterior to anterior for abscess drainage. The most part of the abscess was well liquefication. Some are still in late cerebritis and early abscess stage. The abscess was connected to left lateral ventricle after abscess drainage. External ventricular drainage was placed into left lateral ventricle under direct vision. After abscess drainage, the brain became much slack. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with right shoulder elevation and head rotated to left. The head was fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. The scalp incision was made along operative scar and retracted to exposure craniotomy window. The miniplates, screws, and skull plate was removed. The durotomy was opened. Interhemispheric approach was used for abscess drainage. During abscess drainage, left lateral ventricle was entered. The external ventricular drainage was placed into left lateral ventricle. Hemostasis was achieved with bipolar electrocautery. The dura was closed with 4-0 prolene. One epidural CWV drain was placed. The skull plate was fixed back with miniplates, screws, and one central tenting. One subgaleal CWV drain was placed. Externalization of EVD was performed. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators Prof.杜永光 Assistants R5李振豪, R1張哲瑋 相關圖片 陳岳宏 (M,1974/09/10,37y6m) 手術日期 2011/11/21 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Pituitary tumor 器械術式 Trans-nasal trans-sphenoidal adenomectomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 08:03 進入手術室 08:20 麻醉開始 08:50 誘導結束 09:10 抗生素給藥 09:33 手術開始 11:30 手術結束 11:30 麻醉結束 11:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 經由蝶竇之腦下垂體瘤切除 1 1 摘要__ 手術科部: 外科部 套用罐頭: Trans-nasal trans-sphenoidal adenomectomy 開立醫師: 曾偉倫 開立時間: 2011/11/21 11:41 Pre-operative Diagnosis Pituitary microadenoma, suspect prolactinoma Post-operative Diagnosis Pituitary microadenoma, suspect prolactinoma Operative Method Trans-nasal trans-sphenoidal adenomectomy Specimen Count And Types 1 piece About size:0.5x0.5x0.5 cm Source:Pituitary tumor, prolactinoma Pathology Pending Operative Findings 1. A pituitary tumor 0.7x0.6x0.5 cm in size, locate at left posterior area to the normal pituitary gland. The tumor puched the gland upward. 2. Intra-operative C-arm was used for localizing the sella area. Clivus area was entered incidentally. 3. The tumor was geryish, soft to elastic, hypervascularized ~ 0.5x0.5x0.5 cm insize. The normal pituitary gland was well preserved. 4. No CSF leak was noted during the operation. 5. Blood loss: 1000ml Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head tilted 30 degree to left and mild neck extension. The face and left lower abdomen were prepared with povidone-iodine alcohol tincture, and the mucosa of oral and nasal cavity with aqueous povidone- iodine tincture. The operative field were covered by a sterilized adhesive plastic sheet and draped as usual. The nasal submucosa at septum was infiltrated with 1:1000 epinephrine + Xylocaine solution. A 2cm mucosa incision was made at right side nasal septum and the mucosa was dissected away from the septum and vomer bone. The nasal septum was fractured to left side along the junction between cartilage and vomer bone. The left side mucosa covered the vomer bone was dissected away. A Hardys nasal speculum was applied to displace the nasal mucosa laterally and keep the nasal cavity open constantly for the exposure of the vomer bone and the anterior wall of the sphenoid sinus. Clivus area was entered incidentally. The sella area was located with intra-operative C-arm. The floor of sphenoid sinus was opened with Nomi and the sinus mucosa was removed. The sellar floor was identified and opened with Nomi and Kerrison punches. The dura was coagulated with bipolar forceps and then opened in cruciate fashion. The soft tumor parenchyma was removed by ring curette, tumor forceps, and alligator. The normal gland was noted superoposterior to the tumor. Diaphragm sellae was seen after tumor excision. CSF leakage was noted and the sellar region was sealed with Gelfoam, Surgicel, and Tissucol Duo. The sphenoid sinus also packing with Gelfoam, Surgicel, and Tissucol Duo. The bony fragment was placed back for skull base and vomer bone reconstruction. The nasal mucosa and nasal septum were pushed back to neutral position. Merocel soaked with Better-iodine ointment was placed into bilateral nasal cavity for nasal packing. Operators Prof. 杜永光 Assistants R6 鍾文桂 R3 曾偉倫 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Trans-nasal trans-sphenoidal adenomectomy 開立醫師: 曾偉倫 開立時間: 2011/11/21 11:47 Pre-operative Diagnosis Pituitary microadenoma, suspect prolactinoma Post-operative Diagnosis Pituitary microadenoma, suspect prolactinoma Operative Method Trans-nasal trans-sphenoidal adenomectomy Specimen Count And Types 1 piece About size:0.5x0.5x0.5 cm Source:Pituitary tumor, prolactinoma Pathology Pending Operative Findings 1. A pituitary tumor 0.7x0.6x0.5 cm in size, locate at left posterior area to the normal pituitary gland. The tumor puched the gland upward. 2. Intra-operative C-arm was used for localizing the sella area. Clivus area was entered incidentally. 3. The tumor was greyish, hard, hypervascularized ~ 0.5x0.5x0.5 cm insize. The normal pituitary gland was well preserved. 4. No CSF leak was noted during the operation. 5. Blood loss: 1000ml Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head tilted 30 degree to left and mild neck extension. The face and left lower abdomen were prepared with povidone-iodine alcohol tincture, and the mucosa of oral and nasal cavity with aqueous povidone- iodine tincture. The operative field were covered by a sterilized adhesive plastic sheet and draped as usual. The nasal submucosa at septum was infiltrated with 1:1000 epinephrine + Xylocaine solution. A 2cm mucosa incision was made at right side nasal septum and the mucosa was dissected away from the septum and vomer bone. The nasal septum was fractured to left side along the junction between cartilage and vomer bone. The left side mucosa covered the vomer bone was dissected away. A Hardys nasal speculum was applied to displace the nasal mucosa laterally and keep the nasal cavity open constantly for the exposure of the vomer bone and the anterior wall of the sphenoid sinus. Clivus area was entered incidentally. The sella area was located with intra-operative C-arm. The floor of sphenoid sinus was opened with Nomi and the sinus mucosa was removed. The sellar floor was identified and opened with Nomi and Kerrison punches. The dura was coagulated with bipolar forceps and then opened in cruciate fashion. The soft tumor parenchyma was removed by ring curette, tumor forceps, and alligator. The normal gland was noted superoposterior to the tumor. Diaphragm sellae was seen after tumor excision. CSF leakage was noted and the sellar region was sealed with Gelfoam, Surgicel, and Tissucol Duo. The sphenoid sinus also packing with Gelfoam, Surgicel, and Tissucol Duo. The bony fragment was placed back for skull base and vomer bone reconstruction. The nasal mucosa and nasal septum were pushed back to neutral position. Merocel soaked with Better-iodine ointment was placed into bilateral nasal cavity for nasal packing. Clivus area was entered incidentally. The sella area was located with intra-operative C-arm. The floor of sphenoid sinus was opened with Nomi and the sinus mucosa was removed. The sellar floor was identified and opened with Nomi and Kerrison punches. The dura was coagulated with bipolar forceps and then opened in cruciate fashion. The soft tumor parenchyma was removed by ring curette, tumor forceps, and alligator. The normal gland was noted superoposterior to the tumor. The nasal mucosa and nasal septum were pushed back to neutral position. Merocel soaked with Better-iodine ointment was placed into bilateral nasal cavity for nasal packing. Operators Prof. 杜永光 Assistants R6 鍾文桂 R3 曾偉倫 相關圖片 黃吳寶蓮 (F,1950/02/02,62y1m) 手術日期 2011/11/21 手術主治醫師 杜永光 手術區域 東址 003房 02號 診斷 Meningioma 器械術式 Left pterional approach for planum sphenoidale meningioma excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 12:10 進入手術室 12:15 麻醉開始 12:45 誘導結束 12:49 抗生素給藥 12:50 手術開始 15:50 抗生素給藥 17:45 開始輸血 18:50 手術結束 18:50 麻醉結束 19:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 顱底瘤手術 1 1 摘要__ 手術科部: 外科部 套用罐頭: Left pterional approach for Simpson grade III... 開立醫師: 曾偉倫 開立時間: 2011/11/21 19:08 Pre-operative Diagnosis Left clinoidal meningioma Post-operative Diagnosis Left clinoidal meningioma Operative Method Left pterional approach for Simpson grade III tumor excision Specimen Count And Types 1 piece About size:1.5x1x1 cm Source:Left clinoidal meningioma Pathology Pending Operative Findings 1. The tumor was elastic to hard, hypervascularized, 1.5x1.5x1 cm in size which attached to the left internal carotid artery and optic nerve. The left optic nerve was compressed and it was damaged. The tumor around the ICA was leaved in situ. 2. The left eye VEP was poor and the right eye VEP was normal during the whole operation. 3. The left P-com artery, basilar artery, CN III, pituitary stalk were identified and well preserved during the operation. Operative Procedures Under ETGA, we placed the patient on supine position. After shaving, we fixed her head with Mayfield clamp and make her neck extended with her face tilt to right. We scrubbed, disinfected and drapped, and the skin incision was made over the previous incision. The wound was open in layers and the scalp and temporalis muscle flap were elevated. The previous craniofix were removed and the craniotomy was done. The sphenoid ridge was resected with air-drived drill and the anterior clinoid process was also removed. The curivilinear durotomy was made after the optic nerve was mobilized. Adhesionlysis was performed with bipolar forceps and scissors. Tumor resection was performed with CUSA, Bipolar forceps, dissector and scissors. The durotomy was repaired with Dural-foam and Gelfoam. Complete hemostasis was achived and the skull flap was fixed with mini-plarte and screw. The craniofix plates were placed back and dural tenting was made. A CWV drain was inserted and the wound was closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators Prof. 杜永光 Assistants R6 鍾文桂 R3 曾偉倫 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Left pterional approach for Simpson grade III... 開立醫師: 曾偉倫 開立時間: 2011/11/21 19:30 Pre-operative Diagnosis Left clinoidal meningioma Post-operative Diagnosis Left clinoidal meningioma Operative Method Left pterional approach for Simpson grade III tumor excision Specimen Count And Types 1 piece About size:1.5x1x1 cm Source:Left clinoidal meningioma Pathology Pending Operative Findings 1. The tumor was elastic to hard, hypervascularized, 1.5x1.5x1 cm in size which attached to the left internal carotid artery and optic nerve. The left optic nerve was compressed and it was damaged. The tumor around the ICA was leaved in situ. 2. The left eye VEP was poor and the right eye VEP was normal during the whole operation. 3. The left P-com artery, basilar artery, CN III, pituitary stalk were identified and well preserved during the operation. Operative Procedures Under ETGA, we placed the patient on supine position. After shaving, we fixed her head with Mayfield clamp and make her neck extended with her face tilt to right. We scrubbed, disinfected and drapped, and the skin incision was made over the previous incision. The wound was open in layers and the scalp and temporalis muscle flap were elevated. The previous craniofix were removed and the craniotomy was done. The sphenoid ridge was resected with air-drived drill and the anterior clinoid process was also removed. The curivilinear durotomy was made after the optic nerve was mobilized. Adhesionlysis was performed with bipolar forceps and scissors. Tumor resection was performed with CUSA, Bipolar forceps, dissector and scissors. The durotomy was repaired with Dural-foam and Gelfoam. Complete hemostasis was achived and the skull flap was fixed with mini-plarte and screw. The craniofix plates were placed back and dural tenting was made. A CWV drain was inserted and the wound was closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators Prof. 杜永光 Assistants R6 鍾文桂 R3 曾偉倫 相關圖片 張秋月 (F,1949/11/26,62y3m) 手術日期 2011/11/21 手術主治醫師 賴達明 手術區域 東址 005房 01號 診斷 Thoracic spondylosis 器械術式 T6 meningioma excision 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 07:30 報到 08:02 進入手術室 08:10 麻醉開始 08:30 抗生素給藥 08:40 誘導結束 09:23 手術開始 11:30 抗生素給藥 11:40 手術結束 11:40 麻醉結束 12:02 送出病患 12:05 進入恢復室 13:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 良性脊髓腫瘤切除術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 記錄__ 手術科部: 外科部 套用罐頭: T6 and partial T7 laminectomy for total tumor... 開立醫師: 李振豪 開立時間: 2011/11/21 11:57 Pre-operative Diagnosis T6 intradural-extramedullary tumor, suspect meningioma Post-operative Diagnosis T6 intradural-extramedullary tumor, favor meningioma Operative Method T6 and partial T7 laminectomy for total tumor excision Specimen Count And Types 1 piece About size:Multiple pieces Source:T6 intraspinal tumor Pathology Pending Operative Findings Before the operation, the lower limbs MEP and right lower limb SSEP were absent. Only left lower limb SSEP was detectable. The tumor was well-defined, soft, 1.3 x 1.2 x 2cm in size, hypervascularized, and yellow-reddish in color. The dural attachment was mainly at left side dura with feeding artery arising from it. Half layer of the dura was left with the tumor for total tumor excision. The spinal cord was pushed to right side with paper-thin appearance. The spinal cord and the roots were all protected well during the operation. The left side dentate ligment was transected due to adhered to the tumor. After total tumor excision, the spinal cord expanded a little. The dural attachment was coagulated with bipolar electrocautery. After tumor excision and dural closure, bilateral lower limbs MEP became detactable with good waveform. However, right lower limb SSEP was still poor. Total blood loss: 100ml. Before the operation, the lower limbs MEP and right lower limb SSEP were absent. Only left lower limb SSEP was detectable. The tumor was well-defined, soft, 1.3 x 1.2 x 2cm in size, hypervascularized, and yellow-reddish in color. The dural attachment was mainly at left posterolateral side dura with feeding artery arising from it. Half layer of the dura was left with the tumor for total tumor excision. The spinal cord was pushed to right side with paper-thin appearance. The spinal cord and the roots were all protected well during the operation. The left side dentate ligment was transected due to adhered to the tumor. After total tumor excision, the spinal cord expanded a little. The dural attachment was coagulated with bipolar electrocautery. After tumor excision and dural closure, bilateral lower limbs MEP became detactable with good waveform. However, right lower limb SSEP was still poor. Total blood loss: 100ml. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position. The T6 level was localized by portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made and the subcutaneous soft tissue was devided. The paraspinal muscle groups were detached. T6 and partial T7 laminectomy was conducted with Ronguer and Kerrison punches. Midline durotomy was performed and the tumor was identified. Dissection was performed between the tumor and dura. Part of the dura was kept with the tumor for total tumor excision. After free the tumor from the dura attachment, the arachnoid membrane was opened for further dissection. Central debulking was conducted with bipolar electrocautery and tumor forceps. The tumor was seperated from the spinal cord with arachnoid membrane. Dentate ligment was transected due to adhered to the tumor. After total removal of the tumor, the dural attachment was coagulated with bipolar electrocautery. Hemostasis was achieved. The dura was closed with 5-0 prolene. One epidural CWV drain was placed. The wound was then closed in layers with 1-0, 2-0 Vicryl and 3-0 Nylon. Operators VS賴達明 Assistants R5李振豪, R1張哲瑋 相關圖片 陳周月雲 (F,1947/09/01,64y6m) 手術日期 2011/11/22 手術主治醫師 蔡瑞章 手術區域 東址 002房 01號 診斷 Subdural hemorrhage or effusion 器械術式 Removal of chronic subdural 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 07:47 通知急診手術 09:05 進入手術室 09:08 麻醉開始 09:15 誘導結束 09:20 抗生素給藥 09:55 手術開始 10:40 麻醉結束 10:40 手術結束 10:47 送出病患 10:50 進入恢復室 11:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 頭顱穿洞術(止血引流、穿刺檢查) 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Burr hole for drainage of subdural effision, ... 開立醫師: 鍾文桂 開立時間: 2011/11/22 10:59 Pre-operative Diagnosis Bilateral subdural effusion or chronic subdural hemorrhage. Post-operative Diagnosis Bilateral subdural effusion. Operative Method Burr hole for drainage of subdural effision, right. Specimen Count And Types 1 piece About size:5cc Source:subdural effusion, for BCS, routine, culture and cytology. Pathology Nil. Operative Findings Clear yellowish fluid drained out from burr hole. Low pressure. Medtronic EVD in 5 cm depth was inserted into subdural space. Operative Procedures Under ETGA, the patient was placed in supine positon and the head in midline. After shaving, disinfection, and draping, a 3 cm linear scalp incision was made at right frontal area. After creating a burr hole and cruciate durotomy, the EVD was inserted into subdural space. The wound was closed in layers after well hemostasis. The subdural EVD was connected with close drainage system. Operators 蔡瑞章 Assistants 鍾文桂 Indication Of Emergent Operation Drowsy consciousness for 2 weeks. 相關圖片 曾昱瑋 (M,2011/03/28,11m22d) 手術日期 2011/11/22 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Spina bifida 器械術式 Cord untethering 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 石博元 ASA 2 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 08:07 進入手術室 08:10 麻醉開始 09:30 抗生素給藥 09:48 手術開始 10:10 誘導結束 12:30 抗生素給藥 18:20 手術結束 18:20 麻醉結束 18:38 送出病患 18:40 進入恢復室 20:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 良性脊髓腫瘤切除術 1 1 手術 椎弓切除術(減壓)-超過二節 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 12 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: 1. Subcutaneous lipoma excision 2. L3-5 lami... 開立醫師: 游健生 開立時間: 2011/11/22 19:48 Pre-operative Diagnosis Lipomyelomeningocele Post-operative Diagnosis Lipomyelomeningocele Operative Method 1. Subcutaneous lipoma excision 2. L3-5 laminoplasty for intramedullary lipoma excision and partial cord untethering Specimen Count And Types 1 piece About size:2x2x2cm Source:lipoma Pathology Pending Operative Findings An umbilicus-like lesion was noted in the middle of bulging mass(lipoma) at back. There was a deep skin sinus just below the mass. The lipoma was at subcutaneous layer and extended deep to spinal canal via lamina defect at sacral region. There were no lamina at sacral spine leaving the spinal canal wide open. The lipoma then blended with thecal sac and spinal cord to become intramedullary lipoma. It extended to the anterolateral aspect of spinal cord on both side. Thus, untethering can only be done at posterolateral and dorsal aspect. A few nerve were identified and confirmed by nerve stilmulation during cord untethering. They were right L5, S1 root and nerves controlling sphincter and were all preserved. The baseline of SSEP waveform was poor and remained unchanged during the surgery. The right side MEP waveform was better than left side before and during the surgery. After surgery, the left side MEP waveform improved. Operative Procedures Under ETGA, patient was in prone position. After disinfection and draping, an elliptical skin incision was made at back over the lipoma. We dissected around the lipoma and reached the muscle fascia of back. We exposed the superior border of the fascia defect where lipoma extended into spinal canal. Then, the paraspinal muscles from L3 to L5 were detached and lamina were exposed. L3-L5 lamina were cut on both side and flipped upward to expose the thecal sac. The thecal sac was opened at midline and spinal cord was seen. We debulked the lipoma with SSEP/MEP monitoring to avoid functional neural tissue damage. A plan between caudal aspect of spinal cord and thecal sac was found on right side. Then, we untethered the cord starting from there and extended to contralateral side. Meanwhile, a few nerve were identified and confirmed by nerve stilmulation. They were all preserved. Due to the lipoma infiltrated to the anterolateral aspect of spinal cord, no clear surgical plan could be found and we stopped untethering. The caudal part of spinal cord together with residual intramedullary lipoma was put into thecal sac. The sac was then closed with 5-0 prolene and covered by DuraGen. After hemostasis, L3-L5 lamina were fixed back with silk sutures. Paraspinal muscles were approximated followed by CWV drain placement. The skin sinus was excised by extending the wound. Finally, wound was closed in layers with 3-0 Vicryl and 4-0 Nylon. Operators VS 郭夢菲 Assistants R4 游健生 Ri 謝文統 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: 1. L2-4 laminoplasty for intramedullary lipom... 開立醫師: 郭夢菲 開立時間: 2011/11/23 09:24 Pre-operative Diagnosis Lipomyelomeningocele, lumbosacral region Post-operative Diagnosis Lipomyelomeningocele, lumbosacral region Operative Method 1. L2-4 laminoplasty for intramedullary lipoma excision and partial cord untethering 2. subcutaneous lipoma excision Specimen Count And Types 1 piece About size:2x2x2cm Source:lipoma Pathology Pending Operative Findings An umbilicus-like lesion was noted in the middle of bulging mass(subcutaneous part of the lipoma) at lower back. The subcutaneous part of the lipoma was about 6x6 cm in diameter. There was a deep skin sinus just at the lower margin of the mass. The lipoma was at subcutaneous layer and extended deep to spinal canal via a large laminal defect at L5 and sacral region. There were no lamina at sacral spine leaving the spinal canal wide open. The lipoma then blended with thecal sac and spinal cord to become intramedullary lipoma. It extended to the anterolateral aspect of spinal cord on both side and infiltrated between the two layers of dura to the anterolateral sides. Thus, untethering can only be done at posterolateral, dorsal, and caudal aspects. A few nerves were identified and confirmed by nerve stilmulation during cord untethering. They were right L5, S1 root and nerves controlling the sphincter and were all preserved. The nerves controlloing the sphincter were located at the very end of the abnormal placode, that was close to the end the the cul-de-sac of the thecal sac. The baseline of SSEP waveform was poor and remained unchanged during the surgery. The right side MEP waveform was better than left side before and during the surgery. After surgery, the left side MEP waveform improved. Operative Procedures Under ETGA, patient was in prone position. After disinfection and draping, an elliptical skin incision was made at back over the lipoma. We dissected around the lipoma and reached the muscle fascia of back. We exposed the superior border of the fascia defect where lipoma extended into spinal canal. Then, the paraspinal muscles from L2 to L4 were detached and lamina were exposed. L2-L4 lamina were cut on both side and flipped upward to expose the thecal sac. Under microscope, the thecal sac was opened at midline and spinal cord was seen. We debulked the lipoma with SSEP/MEP monitoring to avoid functional neural tissue damage. A plan between caudal aspect of spinal cord and thecal sac was found on right side. Then, we untethered the cord starting from there and extended to contralateral side. Meanwhile, a few nerves were identified and confirmed by nerve stilmulation. They were all preserved. Due to the lipoma infiltrated to the anterolateral aspect of spinal cord, no clear surgical plan could be found and we stopped untethering. The caudal part of spinal cord together with residual intramedullary lipoma was removed as much as possible by CUSA till it could be placed inside the spinal canal. We further dissected the herniated fascial tissue on both side of the LMMC, then it was used as a dural graft for tight closure with 5-0 prolene and covered by DuraGen. After hemostasis, L2-L4 lamina were fixed back with silk sutures. Paraspinal muscles were approximated followed by CWV drain placement. The skin sinus was excised by extending the wound. Finally, wound was closed in layers with 3-0 Vicryl and 4-0 Nylon. Operators VS 郭夢菲 Assistants R4 游健生 Ri 謝文統 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: 1. Subcutaneous lipoma excision 2. L3-5 lami... 開立醫師: 郭夢菲 開立時間: 2011/11/28 12:04 Pre-operative Diagnosis Lipomyelomeningocele, lumbosacral region Post-operative Diagnosis Lipomyelomeningocele, lumbosacral region Operative Method 1. Subcutaneous lipoma excision 2. L3-5 laminoplasty for intramedullary lipoma excision and partial cord untethering Specimen Count And Types 1 piece About size:2x2x2cm Source:lipoma Pathology Pending Operative Findings An umbilicus-like lesion was noted in the middle of bulging mass(lipoma) at back. There was a deep skin sinus just below the mass. The lipoma was at subcutaneous layer and extended deep to spinal canal via lamina defect at sacral region. There were no lamina at sacral spine leaving the spinal canal wide open. The lipoma then blended with thecal sac and spinal cord to become intramedullary lipoma. It extended to the anterolateral aspect of spinal cord on both side. Thus, untethering can only be done at posterolateral and dorsal aspect. A few nerve were identified and confirmed by nerve stilmulation during cord untethering. They were right L5, S1 root and nerves controlling sphincter and were all preserved. The baseline of SSEP waveform was poor and remained unchanged during the surgery. The right side MEP waveform was better than left side before and during the surgery. After surgery, the left side MEP waveform improved. Operative Procedures Under ETGA, patient was in prone position. After disinfection and draping, an elliptical skin incision was made at back over the lipoma. We dissected around the lipoma and reached the muscle fascia of back. We exposed the superior border of the fascia defect where lipoma extended into spinal canal. Then, the paraspinal muscles from L3 to L5 were detached and lamina were exposed. L3-L5 lamina were cut on both side and flipped upward to expose the thecal sac. The thecal sac was opened at midline and spinal cord was seen. We debulked the lipoma with SSEP/MEP monitoring to avoid functional neural tissue damage. A plan between caudal aspect of spinal cord and thecal sac was found on right side. Then, we untethered the cord starting from there and extended to contralateral side. Meanwhile, a few nerve were identified and confirmed by nerve stilmulation. They were all preserved. Due to the lipoma infiltrated to the anterolateral aspect of spinal cord, no clear surgical plan could be found and we stopped untethering. The caudal part of spinal cord together with residual intramedullary lipoma was put into thecal sac. The sac was then closed with 5-0 prolene and covered by DuraGen. After hemostasis, L3-L5 lamina were fixed back with silk sutures. Paraspinal muscles were approximated followed by CWV drain placement. The skin sinus was excised by extending the wound. Finally, wound was closed in layers with 3-0 Vicryl and 4-0 Nylon. Operators VS 郭夢菲 Assistants R4 游健生 Ri 謝文統 相關圖片 陳文達 (M,1972/06/05,39y9m) 手術日期 2011/11/22 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Neoplasm of uncertain behavior of brain and spinal cord 器械術式 Right intraventricular tumor excision + revision of Ommaya reservoir 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 08:10 進入手術室 08:20 麻醉開始 08:40 誘導結束 09:15 抗生素給藥 09:19 手術開始 11:20 手術結束 11:20 麻醉結束 11:25 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 立體定位術-抽吸 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Endoscopic fenestration of right thalamic cys... 開立醫師: 李振豪 開立時間: 2011/11/22 11:53 Pre-operative Diagnosis Right thalamic cyst Post-operative Diagnosis Right thalamic cyst Operative Method Endoscopic fenestration of right thalamic cyst via right Kocher"s approach Specimen Count And Types 1 piece About size:6ml Source:CSF Pathology Nil Operative Findings Under neurosurgical endoscope, the right lateral ventricle was examed. The choroid plexus, occipital horn, foramen of Monro, and right thalamic cyst was identified. The CSF was xanthochromic with some debrid. 6ml CSF was sampled after ventriculostomy. Fenestration of right thalamic cyst was conducted with bipolar electrocautery, scissor, and #6 Fogarty biliary balloon probe. The ventricular catheter was placed into the thelemic cyst under endoscopic view and fixed at 7cm from brain surface. The patient stood well during whole procedure. No obvious active bleeding was noted after removal of the trocar sheath. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position. The scalp was shaved, scrubbed, and disinfected as usual. Linear scalp incision was made at right frontal area followed by one burr hole creation over right Kocher"s point. Two dural tenting was done. Cruciform durotomy was made and the arachnoid membrane was opened. Puncture of right lateral ventricle was conducted with endoscopic trocar. The endoscope was introduced and the right lateral ventricle was examed. 30 degree angled endoscope was used and cyst within right thalamus was identified. Fenestration of the cyst was performed with bipolar electrocautery, scissor, and #6 Fogarty biliary balloon probe. Metronic ventricular catheter was placed into the cyst under endoscopic view and externalization was done. The endoscope and the trocar sheath was removed. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS賴達明 Assistants R5李振豪, R1李嘉哲 相關圖片 黃燦雄 (M,1944/03/25,67y11m) 手術日期 2011/11/22 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Hypertrophy (benign) of prostate 器械術式 Syringo-pleural shunt(middle C-spine) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 11:57 進入手術室 12:05 麻醉開始 12:25 誘導結束 13:00 抗生素給藥 13:08 手術開始 16:00 抗生素給藥 16:05 手術結束 16:05 麻醉結束 16:18 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: Syringo-pleural shunt implantation 開立醫師: 李振豪 開立時間: 2011/11/22 16:54 Pre-operative Diagnosis Syringomyelia Post-operative Diagnosis Syringomyelia Operative Method Syringo-pleural shunt implantation Specimen Count And Types nil Pathology Nil Operative Findings CSF gushed out after opening of arachnoid membrane. The spinal cord became slack initially but expanded again soon. Bilateral dorsal root entry zone was identified for localization of the midline. The midline was rotated toward left side. After myelotomy, dilated central canal was encountered and CSF gushed out again. Under the consideration of possible adhesion of right pleural cavity, the distal catheter was inserted into left side pleural cavity with puncture method. The course of the operation: smooth. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made from T1 to T2 level and the subcutaneous soft tissue was devided. The paraspinal muscle groups were detached. T1 laminectomy and partial T2 laminectomy was conducted. Midline durotomy was performed and the arachnoid membrane was opened. Bilateral dorsal root entry zone was identified for localization of the midline. Midline myelotomy was performed with #59 blade and dilated central canal was encountered. Under endotracheal general anesthesia, the patient was put in prone position. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made from T2 to T3 level and the subcutaneous soft tissue was devided. The paraspinal muscle groups were detached. T2 laminectomy and partial T3 laminectomy was conducted. Midline durotomy was performed and the arachnoid membrane was opened. Bilateral dorsal root entry zone was identified for localization of the midline. Midline myelotomy was performed with #59 blade and dilated central canal was encountered. Two small skin incision was made left upper back(medial to scapula) and subcutaneous tunnel was created. The proximal part of the T-tube was tailed and inserted into the central cana. The T-tube was passed through the subcutaneous tunnel. Puncture of left pleural cavity was conducted and the distal part of the shunt was inserted into the pleural cavity smoothly. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. The dura was closed with 5-0 Prolene. The wound was irrigated with Gentamicin solution. The wound was then closed in layers with 1-0, 2-0 Vicryl and 3-0 Nylon. Two small skin incision was made left upper back(medial to scapula) and subcutaneous tunnel was created. The proximal part of the T-tube was tailed and inserted into the central cana. The T-tube was passed through the subcutaneous tunnel. Puncture of left pleural cavity was conducted and the distal part of the shunt was inserted into the pleural cavity smoothly. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. The dura was closed with 5-0 Prolene. The wound was irrigated with Gentamicin solution. The wound was then closed in layers with 1-0, 2-0 Vicryl and 3-0 Nylon. Operators VS賴達明 Assistants R5李振豪, R1李嘉哲 相關圖片 陳黃花茶 (F,1940/01/02,72y2m) 手術日期 2011/11/22 手術主治醫師 賴達明 手術區域 東址 005房 01號 診斷 Cervical spondylosis 器械術式 C4/5 anterior cervical diskectomy + plating 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 蔡宗良, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:10 麻醉開始 08:15 誘導結束 08:25 抗生素給藥 08:56 手術開始 11:25 抗生素給藥 12:00 手術結束 12:00 麻醉結束 12:10 送出病患 12:14 進入恢復室 13:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-頸椎 1 1 L 手術 椎融合術-前融合,無固定物(≦四節) 1 2 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 摘要__ 手術科部: 外科部 套用罐頭: 1. Anterior cervical discectomy with fusion, ... 開立醫師: 張書豪 開立時間: 2011/11/22 12:14 Pre-operative Diagnosis Herniated cervical disc, C4-5, C5-6 Post-operative Diagnosis Herniated cervical disc, C4-5, C5-6 Operative Method 1. Anterior cervical discectomy with fusion, C4-5 (cage) 2. Foraminotomy, C5-6 Specimen Count And Types nil Pathology none Operative Findings 1. Herniated disc at C4-5 and C5-6 2. Redundant PLL Operative Procedures 1. ETGA, supine, head extension 2. Routine preparation 3. Linear wound incision 4. Open SCM and streps muscle 5. Palpation of CCA and blunt dissection into prevertebral fascia 6. Detach longus colli and fixation of auto-retractor 7. Confirmation of level at C4-5, followed by discectomy 8. Open PLL 9. Six-mm Cage impacted into C4-5 disc space 10. Miniforaminotomy performed to left-sided C5-6 11. Meticulous hemostasis 12. Wound closed in layers after mini-Vac placement Operators 賴達明 Assistants R6蔡宗良 PGYR1張書豪 記錄__ 手術科部: 外科部 套用罐頭: 1. Anterior cervical discectomy with fusion, ... 開立醫師: 張書豪 開立時間: 2011/11/22 12:14 Pre-operative Diagnosis Herniated cervical disc, C4-5, C5-6 Post-operative Diagnosis Herniated cervical disc, C4-5, C5-6 Operative Method 1. Anterior cervical discectomy with fusion, C4-5 (cage) 2. Foraminotomy, C5-6 Specimen Count And Types nil Pathology none Operative Findings 1. Herniated disc at C4-5 and C5-6 2. Redundant PLL Operative Procedures 1. ETGA, supine, head extension 2. Routine preparation 3. Linear wound incision 4. Open SCM and streps muscle 5. Palpation of CCA and blunt dissection into prevertebral fascia 6. Detach longus colli and fixation of auto-retractor 7. Confirmation of level at C4-5, followed by discectomy 8. Open PLL 9. Six-mm Cage impacted into C4-5 disc space 10. Miniforaminotomy performed to left-sided C5-6 11. Meticulous hemostasis 12. Wound closed in layers after mini-Vac placement Operators 賴達明 Assistants R6蔡宗良 PGYR1張書豪 郭昆華 (M,1952/11/02,59y4m) 手術日期 2011/11/22 手術主治醫師 賴達明 手術區域 東址 005房 02號 診斷 Lumbar Spondylosis 器械術式 L4-S1 sublaminar decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 蔡宗良, 時間資訊 00:00 臨時手術NPO 12:02 報到 12:30 進入手術室 12:35 麻醉開始 12:40 誘導結束 13:00 抗生素給藥 13:12 手術開始 14:55 手術結束 14:55 麻醉結束 15:00 送出病患 15:05 進入恢復室 16:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 椎弓切除術(減壓)-二節以內 1 1 摘要__ 手術科部: 外科部 套用罐頭: L5 laminectomy, L4 lower half laminectomy 開立醫師: 蔡宗良 開立時間: 2011/11/22 15:08 Pre-operative Diagnosis Lumbar spinal stenosis, L4-5 Post-operative Diagnosis Lumbar spinal stenosis, L4-5 Operative Method L5 laminectomy, L4 lower half laminectomy Specimen Count And Types nil Pathology none Operative Findings Hypertrophy of ligmentum flavum at L4-5 Operative Procedures 1. ETGA, prone positioning, fluoroscopic confirmation of L4-5 2. Routine preparation 3. Midline incision from L4 to L5, followed by subperiosteal dissection 4. Laminectomy by bone cut, rongeur, Kerrions punch. Facets undercut and were preserved 5. Lateral recess of bilateral L4-5 were cleared with root clearly visible 6. Gentamicin saline irrigation 7. Wound closed in layers Operators 賴達明 Assistants R6蔡宗良 R1張書豪 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: L5 laminectomy, L4 lower half laminectomy 開立醫師: 張書豪 開立時間: 2011/11/22 15:10 Pre-operative Diagnosis Lumbar spinal stenosis, L4-5 Post-operative Diagnosis Lumbar spinal stenosis, L4-5 Operative Method L5 laminectomy, L4 lower half laminectomy Specimen Count And Types nil Pathology none Operative Findings Hypertrophy of ligmentum flavum at L4-5 Operative Procedures 1. ETGA, prone positioning, fluoroscopic confirmation of L4-5 2. Routine preparation 3. Midline incision from L4 to L5, followed by subperiosteal dissection 4. Laminectomy by bone cut, rongeur, Kerrions punch. Facets undercut and were preserved 5. Lateral recess of bilateral L4-5 were cleared with root clearly visible 6. Gentamicin saline irrigation 7. Wound closed in layers Operators 賴達明 Assistants R6蔡宗良 R1張書豪 相關圖片 陳鍾票 (F,1940/01/28,72y1m) 手術日期 2011/11/22 手術主治醫師 楊士弘 手術區域 東址 005房 03號 診斷 Brain tumor 器械術式 Left interhemispheric transcallosal approach for intraventricular tumor excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 蔡宗良, 時間資訊 00:00 臨時手術NPO 15:00 報到 15:21 進入手術室 15:25 麻醉開始 15:50 抗生素給藥 16:00 誘導結束 16:02 手術開始 20:10 抗生素給藥 21:53 麻醉結束 21:53 手術結束 22:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 顱內壓視置入 1 2 手術 腦瘤切除-手術時間在4~8小時 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Anterior transcallosal approach for grossly t... 開立醫師: 楊士弘 開立時間: 2011/11/22 22:40 Pre-operative Diagnosis Brain tumor, intraventricular Post-operative Diagnosis Brain tumor, intraventricular Operative Method Anterior transcallosal approach for grossly total tumor excision Specimen Count And Types 4 pieces About size:小 Source:tumor About size:小 Source:CSF About size:小 Source:CSF About size:小 Source:CSF Pathology pending Operative Findings Clear colorless CSF was seen upon ventricular tapping. The pressure was not high (around 8 cm H2O). The corpus callosum was thin. A greyish white, soft fragile, moderately vascularized tumor was seen after entry into the left lateral ventricle. The tumor originated from the bottom of left frontal horn. There was no well defined plane between the tumor and brain parenchyma. The tumor also attached to the septum pellucidum and entered the 3rd ventricle through the left foramen of Monro. Operative Procedures 1. ETGA, supine, head flexed and fixed with Mayfield skull clamp. 2. Bicoronal scalp incision. 3. Left frontal craniotomy, across midline, 6 cm x 6 cm. 4. U-shaped dural incision based on superior sagittal sinus. 5. Insertion of a ventricular catheter into left fronal horn. 6. Beginning of microscopic surgery. 7. Lateral retraction of left frontal lobe away from falx. 8. Longitudinal incision of corpus callosum, 2 cm long. 9. Lateral retraction of corpus callosum. 10. Central debulking then piecemeal removal tumor with suction tubes and bipolar cautery. 11. Meticulous hemostasis. 12. Dural closure with 4-0 prolene and a Durafoam graft. 13. One epidural CWV drain. 14. Replacement of skull flap and fixation with miniplates and screws. 15. Connection of ventricular catheter with external drainage set. 16. Scalp wound closure in layers. Operators 楊士弘 Assistants 蔡宗良, 張書豪 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Anterior transcallosal approach for grossly t... 開立醫師: 蔡宗良 開立時間: 2011/11/29 11:13 Pre-operative Diagnosis Brain tumor, intraventricular Post-operative Diagnosis Brain tumor, intraventricular Operative Method Anterior transcallosal approach for grossly total tumor excision Specimen Count And Types 4 pieces About size:小 Source:tumor About size:小 Source:CSF About size:小 Source:CSF About size:小 Source:CSF Pathology pending Operative Findings Clear colorless CSF was seen upon ventricular tapping. The pressure was not high (around 8 cm H2O). The corpus callosum was thin. A greyish white, soft fragile, moderately vascularized tumor was seen after entry into the left lateral ventricle. The tumor originated from the bottom of left frontal horn. There was no well defined plane between the tumor and brain parenchyma. The tumor also attached to the septum pellucidum and entered the 3rd ventricle through the left foramen of Monro. Operative Procedures 1. ETGA, supine, head flexed and fixed with Mayfield skull clamp. 2. Bicoronal scalp incision. 3. Left frontal craniotomy, across midline, 6 cm x 6 cm. 4. U-shaped dural incision based on superior sagittal sinus. 5. Insertion of a ventricular catheter into left fronal horn. 6. Beginning of microscopic surgery. 7. Lateral retraction of left frontal lobe away from falx. 8. Longitudinal incision of corpus callosum, 2 cm long. 9. Lateral retraction of corpus callosum. 10. Central debulking then piecemeal removal tumor with suction tubes and bipolar cautery. 11. Meticulous hemostasis. 12. Dural closure with 4-0 prolene and a Durafoam graft. 13. One epidural CWV drain. 14. Replacement of skull flap and fixation with miniplates and screws. 15. Connection of ventricular catheter with external drainage set. 16. Scalp wound closure in layers. Operators 楊士弘 Assistants 蔡宗良, 張書豪 相關圖片 鄭皇 (M,1932/09/12,79y6m) 手術日期 2011/11/22 手術主治醫師 王國川 手術區域 東址 002房 04號 診斷 Major trauma rated 16 or above on the severity scale ( Injury severity score >=16 ) 器械術式 Craniotomy for subacute SDH removal 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 鍾文桂, 時間資訊 14:31 開始NPO 14:31 臨時手術NPO 14:31 通知急診手術 16:15 報到 16:20 進入手術室 16:30 麻醉開始 16:55 誘導結束 17:05 抗生素給藥 17:20 手術開始 19:10 麻醉結束 19:10 手術結束 19:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 急性硬腦膜下血腫清除術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Right frontal-temporal craniotomy for evacuat... 開立醫師: 鍾文桂 開立時間: 2011/11/22 19:44 Pre-operative Diagnosis Subacute subdural hemorrhage, right frontal-temporal-paritel. Post-operative Diagnosis Subacute subdural hemorrhage, right frontal-temporal-paritel. Operative Method Right frontal-temporal craniotomy for evacuation of subacute subdural hemorrhage. Specimen Count And Types nil Pathology Nil. Operative Findings 1. Mixture of motor-oil like liquified hematoma and organized hematoma at right frontal-temporal-parietal areas. The amount of the hematoma is about 150cc. 2. Poor brain expansion after hematoma evacuation. Operative Procedures Under ETGA, the patient was placed in supine position and the head tilted to the left side. After shaving, disinfection, and draping, the scalp incision was made anterior to the V-P shunt. After dissection, a 10 cm craniotomy plate was obtained. After a curvilinear durotomy, the hematoma was evacuated. After normal saline irrigation, the dura mater was closed in water-tight fashion and repaired with autologous temporalis fascia. After fixation of the bone plate and placement of one subgaleal drain, the wound was closed in layers. Operators 王國川 Assistants 鍾文桂 Indication Of Emergent Operation Acute GCS deterioration. 相關圖片 邱明碩 (M,1925/01/02,87y2m) 手術日期 2011/11/23 手術主治醫師 蔡瑞章 手術區域 東址 005房 03號 診斷 Subdural hemorrhage 器械術式 Burr hole for right chronic SDH removal 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3E 紀錄醫師 李振豪, 時間資訊 06:00 開始NPO 13:52 通知急診手術 15:13 進入手術室 15:15 麻醉開始 15:25 誘導結束 15:30 抗生素給藥 15:49 手術開始 16:55 麻醉結束 16:55 手術結束 17:00 送出病患 17:01 進入恢復室 18:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 手術 頭顱穿洞術(止血引流、穿刺檢查) 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Right frontal burr hole for drainage of chron... 開立醫師: 李振豪 開立時間: 2011/11/23 17:20 Pre-operative Diagnosis Right fronto-temporo-parietal chronic subdural hematoma Post-operative Diagnosis Right fronto-temporo-parietal chronic subdural hematoma Operative Method Right frontal burr hole for drainage of chronic subdural hematoma Specimen Count And Types nil Pathology Nil Operative Findings The motor-oil like chronic subdural hematoma gushed out after opening of the outer membrane. The inner membrane and the brain surface also identified after hematoma evacuation. Some subacute hematoma was coating at inner membrane and evacuated with suction and normal saline irrigation. The brain remain slack after drainage. The patient stood whole procedure well. Total blood loss: minimal. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head rotated to left. The scalp was shaved, scrubbed, and disinfected as usual. Linear scalp incision was made at right frontal area followed by one burr hole creation. Two dural tenting was done. Cruciform durotomy was created and the outer membrne was identified. The outer membrane was coagulated and opened for drainage of subdural hematoma. The edge of the outer membrane was further coagulated to avoid further bleeding. Rubber drain was inserted for irrigation of the subdural space. Some subacute hematoma was noted and evacuated directly with suction. Total 1000ml normal saline was used for subdural irrigation. The rubber drain was then placed into subdural space toward anterior frontal area. Externalization was done. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Deair was achieved after wound closure and the drain was connected to close drainage system. Operators Prof.蔡瑞章 Assistants R5李振豪, R1張哲瑋 Indication Of Emergent Operation right side chronic subdural hematoma with mass effect and impending herniation 相關圖片 黃睿恩 (M,2005/03/07,7y0m) 手術日期 2011/11/23 手術主治醫師 曾勝弘 手術區域 兒醫 061房 01號 診斷 Aromatic L-amino acid decarboxylase deficiency 器械術式 Stereotaxic procedure for function(child) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 蔡奉芳 ASA 4 紀錄醫師 蔡宗良, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:05 進入手術室 08:15 麻醉開始 09:00 誘導結束 09:25 抗生素給藥 09:36 手術開始 12:25 抗生素給藥 15:25 抗生素給藥 18:10 麻醉結束 18:10 手術結束 18:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 立體定位術-功能性失調 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 12 0 手術 立體定位術-功能性失調 1 2 L 記錄__ 手術科部: 套用罐頭: Craniostomy for stereotactic gene therapy, bi... 開立醫師: 蔡宗良 開立時間: 2011/11/23 18:42 Pre-operative Diagnosis Aromatic L-amino acid decarboxylase deficiency Post-operative Diagnosis Aromatic L-amino acid decarboxylase deficiency Operative Method Craniostomy for stereotactic gene therapy, bilateral Specimen Count And Types None Pathology None Operative Findings 1. Moderate bleeding tendency over scalp 2. Tense dura, vascularity was moderate 3. Vector: Adenovirus associated virus 2, carrying genetic elements for AADC 4. Final follow-up brain CT confirmed the absence of any hemorrhagic or mass effect lesions. Operative Procedures 1. General anesthesia, via tracheostomy 2. Routine disinfection with neuronavigation marker fixation on the skull 3. Send patient to radiology department for brain CT 4. Return to OR and continue with navigation planning, targeted at bilateral putamen with two target at each side. 5. Linear wound incision over planned site of entrance 6. Craniostomy, bilateral 7. Tenting, durotomy, followed by installation of stereotactic devices under neuronavigation guidance. 8. Eight micro liter of the genetic elements (AADC) were injected at each time, totally 320 micro liter. 9. Craniostomy was covered by Gelfoam and TissuCol-Duo (fibrin sealant) to prevent CSF leakage. 10. Wound was closed in layers. 11. Patient was sent to radiology department again to follow-up brain CT Operators Professor 曾勝弘 Assistants R6 蔡宗良 相關圖片 張簡妤真 (F,2011/09/09,6m7d) 手術日期 2011/11/23 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Myelomeningocele 器械術式 Cord untethering 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 蔡奉芳 ASA 3 紀錄醫師 郭夢菲, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:08 進入手術室 08:20 麻醉開始 09:00 誘導結束 09:40 抗生素給藥 10:11 手術開始 12:45 抗生素給藥 13:10 開始輸血 15:40 抗生素給藥 15:50 手術結束 15:50 麻醉結束 15:55 送出病患 15:55 進入恢復室 17:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 7 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 脊椎內脊髓內腫瘤切除術 1 1 手術 椎弓整形術 1 2 摘要__ 手術科部: 外科部 套用罐頭: 1. T10 laminoplasty for intraspinal lipoma ex... 開立醫師: 游健生 開立時間: 2011/11/24 10:18 Pre-operative Diagnosis lipomyelocystocele Post-operative Diagnosis lipomyelocystocele Operative Method 1. T10 laminoplasty for intraspinal lipoma excision and cord untethering 2. Excision of subcutaneous lipoma Specimen Count And Types multiple pieces, Source: lipoma Pathology pending Operative Findings A large lipoma was seen at subcutaneous layer. It extended to spinal canal and infiltrated with spinal cord. At the attachment point, the cord splitted in half and then fused again at more caudal aspect. The spitted cord gave out nerves to supply ipslateral motor and sensation. Those nerves were stretched tightly before untethering and became relax after lysis. A bone chip was seen on the left side at T11 level which could be the malformed hemi-laminae. It was removed during surgery. Operative Procedures Under ETGA, patient was in prone position. After disinfection and draping, we made an elliptical incision over the back lipoma. After circumferential dissection, we reached the fascia of back muscle and exposed the defect. We detached paraspinal muscle and exposed T10 lamina. The both side lamina was cut and flipped upward. The thecal sac was opened at midline and cord was exposed. As we debulked the lipoma, we tried to identify junction of lipoma and dura by dissection. Eventually, the cord with lipoma was detached from dura. Some nerves were seen adherent to dura and lysised for untethering. Only small lipoma was left in situ at dorsal aspect of cord. After hemostasis, thecal sac was closed by 5-0 prolene. Lamina was fixed back with silk sutures. Paraspinal muscle was approximated. Wound closed in layers with a subcutaneous CWV drain placed. Operators VS 郭夢菲 Assistants R4游健生 Ri謝文統 相關圖片 摘要__ 手術科部: 外科部 套用罐頭: 1. T10 laminoplasty for intraspinal lipoma ex... 開立醫師: 郭夢菲 開立時間: 2011/11/24 12:12 Pre-operative Diagnosis lipomyelocystocele and split cord malformation Post-operative Diagnosis lipomyelocystocele and split cord malformation Operative Method 1. T10 laminoplasty for intraspinal lipoma excision and cord untethering 2. Excision of subcutaneous lipoma 3. revision of skin dimple over lower sacral region Specimen Count And Types multiple pieces, Source: lipoma Pathology pending Operative Findings A large lipoma was seen at subcutaneous layer. It occupied the whole lower back. There is a small skin dimple wlith scanty hairs. The lipoma extended to spinal canal and pushed the left part of laminae widely opened. The right side laminae was gone due to the deformity. The lipoma extended into the herniated myelomeningocele and attached at the dorsal side of the abnormal placode. At the attachment point, the cord splitted in half and then fused again at more caudal aspect. The spitted cord gave out nerves to supply ipslateral motor and sensation. Those nerves were stretched tightly and tethered to the dorsal side of the spinal canal. After further untethering, they became relax and returned to their original ventral position. The deformed hemilamina on the left side at T11-12 levels were removed. Operative Procedures Under ETGA, patient was in prone position. After disinfection and draping, we made an elliptical incision over the back lipoma. After circumferential dissection, we reached the fascia of back muscle and exposed the defect. We detached paraspinal muscle and exposed T10 lamina. The both side lamina was cut and flipped upward. The thecal sac was opened at midline and cord was exposed. Under microscope, as we debulked the lipoma, we tried to identify junction of lipoma and dura by dissection. Eventually, the cord with lipoma was detached from dura. Some nerves were seen adherent to dura and lysised for untethering. Only small lipoma was left in situ at dorsal aspect of cord. After hemostasis, thecal sac was closed by 5-0 prolene, then covered with a piece of DuroGen. The T10 lamina was fixed back with silk sutures. Paraspinal muscle was approximated. Wound closed in layers with a subcutaneous CWV drain placed. Operators VS 郭夢菲 Assistants R4游健生 Ri謝文統 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: 1. T10 laminoplasty for intraspinal lipoma ex... 開立醫師: 郭夢菲 開立時間: 2011/11/28 12:08 Pre-operative Diagnosis lipomyelocystocele and split cord malformation, thoracolumbar region Post-operative Diagnosis lipomyelocystocele and split cord malformation, thoracolumbar region Operative Method 1. T10 laminoplasty for intraspinal lipoma excision and cord untethering 2. Excision of subcutaneous lipoma 3. revision of skin dimple over lower sacral region Specimen Count And Types multiple pieces, Source: lipoma Pathology pending Operative Findings A large lipoma was seen at subcutaneous layer. It occupied the whole lower back. There is a small skin dimple wlith scanty hairs. The lipoma extended to the herniated dural sac and pushed the left part of deformed laminae widely opened. The deformed hemilamina on the left side at T11-12 levels were removed. The right side laminae was gone due to the deformity. The lipoma extended into the herniated myelomeningocele and attached at the dorsal side of the splitted abnormal placode. At the attachment point, the cord splitted into two parts and then fused again at more caudal aspect. The spitted cord gave out nerves to supply ipslateral motor and sensation. Those nerves were stretched tightly and tethered to the dorsal side of the spinal canal. After further untethering, they became relax and returned to their original ventral position. Operative Procedures Under ETGA, patient was in prone position. After disinfection and draping, we made an elliptical incision over the back lipoma. After circumferential dissection, we reached the fascia of back muscle and exposed the defect. We detached paraspinal muscle and exposed T10 lamina. The both side lamina was cut and flipped upward. The thecal sac was opened at midline and cord was exposed. Under microscope, as we debulked the lipoma, we tried to identify junction of lipoma and dura by dissection. Eventually, the cord with lipoma was detached from dura. Some nerves were seen adherent to dura and lysised for complete untethering. Only small lipoma was left in situ at dorsal aspect of cord. After hemostasis, thecal sac was closed by 5-0 prolene, then covered with a piece of DuroGen. The T10 lamina was fixed back with silk sutures. Paraspinal muscle was approximated. Wound closed in layers with a subcutaneous CWV drain placed. Operators VS 郭夢菲 Assistants R4游健生 Ri謝文統 相關圖片 朱芷緹 (F,2007/08/02,4y7m) 手術日期 2011/11/23 手術主治醫師 郭夢菲 手術區域 兒醫 067房 02號 診斷 Scalp mass 器械術式 suboccipital craniectomy for epidural abscess and scalp abscess excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 髒 麻醉方式 全身麻醉 麻醉主治醫師 蔡奉芳 ASA 3 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 15:52 報到 16:05 進入手術室 16:15 麻醉開始 16:50 誘導結束 17:00 抗生素給藥 17:45 手術開始 20:05 麻醉結束 20:05 手術結束 20:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除-手術時間在4小時以內 1 1 摘要__ 手術科部: 外科部 套用罐頭: 1. Suboccipital craniectomy for excision of i... 開立醫師: 游健生 開立時間: 2011/11/23 21:23 Pre-operative Diagnosis Infected dermal sinus tract with scalp abscess Post-operative Diagnosis Infected dermal sinus tract with scalp abscess Operative Method 1. Suboccipital craniectomy for excision of infected dermal sinus tract 2. Excision of scalp abscess Specimen Count And Types 2 pieces About size:0.5 x 4x 1cm Source:scalp abscess About size:0.5 x 1x 0.5cm Source:dermal sinus tract(epidural part) Pathology pending Operative Findings A bulging tense mass was noted at midline of suboccipital scalp. Pus was drained after puncture of the mass. An opening of the dermal sinus tract (a tiny black dot) was noted about 2cm above the abscess at midline. The dermal sinus tract extended through subcutaneous tissue and occipital bone to epidural space. It was encapsulated with rubber-like fibrotic tissue. The content included some mucoid or sebaceous tissue and hair. Some fibrotic tissue was left in situ at caudal aspect. The dura remained intact. The scalp abscess was below and contact with the dermal sinus tract. It was restricted above occipital bone. Operative Procedures Under ETGA, patient was in prone position with neck mildly flexed. After shaving, we disinfected and draped the operation field as usual. An elliptical scalp incision centered at bulging scalp abscess was made including the opening of dermal sinus. We dissected the abscess and dermal sinus tract circumferentially till we reached the occipital bone with neck muscle detachment. Swab cultures were done for the pus. The dermal sinus tract was transected at the level of occipital bone where it extended into epidural space. The subcutaneous part was excised together with scalp abscess. We performed a verticle rectangular suboccipital craniectomy by air-drill and Kerrison. Under microscope, the epidural part of dermal sinus tract was completely removed after circumferential dissection. Swab culture for the dermal sinus tract was done. Some fibrotic tissue was left in situ at caudal aspect of epidural space. The dura remained intact. After hemostasis, thorough N/S and Gentamycin solution irrigation of the operation field was done. Neck muscle was approximated with interrupted silk sutures. Wound was closed in layers with 3-0 Vicryl and 3-0 Nylon. Operators VS 郭夢菲 Assistants R4 游健生 Ri 謝文統 相關圖片 摘要__ 手術科部: 外科部 套用罐頭: 1. Suboccipital craniectomy for excision of i... 開立醫師: 郭夢菲 開立時間: 2011/11/24 12:15 Pre-operative Diagnosis recurrent scal abscess due to infected dermal sinus tract (from epidural space to the subcutaneous space), occipital region Post-operative Diagnosis Infected dermal sinus tract with scalp abscess Operative Method 1. Suboccipital craniectomy for excision of infected dermal sinus tract 2. Excision of scalp abscess Specimen Count And Types 2 pieces About size:0.5 x 4x 1cm Source:scalp abscess About size:0.5 x 1x 0.5cm Source:dermal sinus tract(epidural part) Pathology pending Operative Findings A bulging tense mass was noted at midline of suboccipital scalp. Pus was drained after puncture of the mass. An opening of the dermal sinus tract (a tiny black dot) was noted about 2cm above the abscess at midline. The dermal sinus tract extended through subcutaneous tissue and occipital bone to epidural space. It was encapsulated with rubber-like fibrotic tissue. The content included some mucoid or sebaceous tissue and hair. Some fibrotic tissue was left in situ at caudal aspect. The dura remained intact. The scalp abscess was below and contact with the dermal sinus tract. It was restricted above occipital bone. Operative Procedures Under ETGA, patient was in prone position with neck mildly flexed. After shaving, we disinfected and draped the operation field as usual. An elliptical scalp incision centered at bulging scalp abscess was made including the opening of dermal sinus. We dissected the abscess and dermal sinus tract circumferentially till we reached the occipital bone with neck muscle detachment. Swab cultures were done for the pus. The dermal sinus tract was transected at the level of occipital bone where it extended into epidural space. The subcutaneous part was excised together with scalp abscess. We performed a verticle rectangular suboccipital craniectomy by air-drill and Kerrison. Under microscope, the epidural part of dermal sinus tract was completely removed after circumferential dissection. Swab culture for the dermal sinus tract was done. Some fibrotic tissue was left in situ at caudal aspect of epidural space. The dura remained intact. After hemostasis, thorough N/S and Gentamycin solution irrigation of the operation field was done. Neck muscle was approximated with interrupted silk sutures. Wound was closed in layers with 3-0 Vicryl and 3-0 Nylon. Operators VS 郭夢菲 Assistants R4 游健生 Ri 謝文統 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: 1. Suboccipital craniectomy for excision of i... 開立醫師: 郭夢菲 開立時間: 2011/11/24 15:01 Pre-operative Diagnosis recurrent scalp abscess due to infected dermal sinus tract (from epidural space to the subcutaneous space), occipital region Post-operative Diagnosis recurrent scalp abscess due to infected dermal sinus tract (from epidural space to the subcutaneous space), occipital region Operative Method 1. Suboccipital craniectomy for excision of extradural infected dermal sinus tract 2. Excision of scalp abscess Specimen Count And Types 2 pieces About size:0.5 x 4x 1cm Source:scalp abscess About size:0.5 x 1x 0.5cm Source:dermal sinus tract(epidural part) Pathology pending Operative Findings 1. A bulging tense mass measuring about 1.5X1.5 cm in diameter was noted at midline of suboccipital scalp. Pus came out from the left margin suring dissection. It extended upward to three bony defects above it and entered the bony defect to communicate with its extradural part. 2. An small opening of the dermal sinus tract (a tiny black dot on the skin was noted about 2cm above the abscess at midline. Its loation was compatible with the bony defects. 3. The dermal sinus tract extended through subcutaneous tissue and occipital bone to epidural space. It was encapsulated with rubber-like fibrotic tissue. The content included some mucoid or sebaceous tissue and hairs. The surrounding reactive fibrotic meningeal thickening caudal to the lower end of the dermal sinus tract was left in situ at caudal aspect. The dura remained intact. The scalp abscess was below and contact with the dermal sinus tract. It was restricted above occipital bone. Operative Procedures Under ETGA, patient was in prone position with neck mildly flexed. After shaving, we disinfected and draped the operation field as usual. An elliptical scalp incision centered at bulging scalp abscess was made including the opening of dermal sinus. We dissected the abscess and dermal sinus tract circumferentially till we reached the occipital bony defects. Swab cultures were done for the pus (bacteria, fungus, and TB). The dermal sinus tract was transected at the level of occipital bone where it extended into epidural space. The subcutaneous part was excised together with scalp abscess. We irrigated the space with gentamicin solution. We performed a verticle rectangular suboccipital craniectomy by air-drill and Kerrison. Under microscope, the epidural part of dermal sinus tract was completely removed after circumferential dissection. Swab culture for the dermal sinus tract was done. The thickened meningeal reactive tissue was left in situ at caudal aspect of dermal sinus. The dura remained intact. After hemostasis, thorough N/S and Gentamycin solution irrigation of the operation field was done. Neck muscle was approximated with interrupted silk sutures. Wound was closed in layers with 3-0 Vicryl and 3-0 Nylon. Operators VS 郭夢菲 Assistants R4 游健生 Ri 謝文統 相關圖片 周正義 (M,1942/04/01,69y11m) 手術日期 2011/11/23 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Cervical Spondylosis 器械術式 C4/5, 5/6 anterior cervical diskectomy + plating 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 2 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:10 麻醉開始 08:40 誘導結束 09:10 抗生素給藥 09:33 手術開始 12:10 抗生素給藥 13:37 手術結束 13:37 麻醉結束 13:44 送出病患 13:46 進入恢復室 14:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-頸椎 1 1 手術 脊椎融合術-前融合,有固定物)≦四節 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Anterior cervical diskectomy with cage and pl... 開立醫師: 鍾文桂 開立時間: 2011/11/23 13:40 Pre-operative Diagnosis Cervical stenosis with spondylolisthesis and herniated disk, C4-5, C5-6 Post-operative Diagnosis Cervical stenosis with spondylolisthesis and herniated disk, C4-5, C5-6 Operative Method Anterior cervical diskectomy with cage and plate fusion, C4-5, C5-6 Specimen Count And Types nil Pathology Nil Operative Findings 1. Narrowed disk space between, C4-5 and C5-6 with hypertrophic posterior longitudinal ligament. 2. Spondylolisthesis over C4-5 and C5-6; ruptured disc at C5/6 level. 2. Spondylolisthesis over C4-5 and C5-6; ruptured disc at C5/6 level. Ruptured disk was found and removed. 3. The thecal sac became loose after the procedure 4. The MEP and SSEP were stationary during the whole procedure 5. A 6mm cervical cage (Synthesis) placed over C5-6 level and a 6mm cage was placed at C4-5 level. 6. Trachea was deviated to right side after intubation Operative Procedures Under ETGA, we placed the patient on supine position with his neck extended. After we scrubbed, disinfected and drapped, a horizontal linear skin incision was made alone the skin crese of right neck. The wound was opened in layers and the platysma was divided. The muscle over the neck was dissected and the pre-vetebral space was reached. The C5-6 disc space was marked with The trachea and esophagus were retracted to left side and the Korros retractor was applied for wound exposure. Under ETGA, we placed the patient on supine position with his neck extended. After we scrubbed, disinfected and drapped, a horizontal linear skin incision was made alone the skin crese of right neck. The wound was opened in layers and the platysma was divided. The muscle over the neck was dissected and the pre-vetebral space was reached. The C5-6 disc space was marked with The trachea and esophagus were retracted to left side and the Korros retractor was applied for wound exposure. Diskectomy over C4-5 and C5-6 was performed with curette, aligator and disk-clamp. The osteophyte was removed with air-drived drill and the OPLL and ruptured disk were removed. Operators VS 賴達明 Assistants R6 鍾文桂 R3 曾偉倫 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Anterior cervical diskectomy with cage and pl... 開立醫師: 曾偉倫 開立時間: 2011/11/23 13:49 Pre-operative Diagnosis Cervical stenosis with spondylolisthesis and herniated disk, C4-5, C5-6 Post-operative Diagnosis Cervical stenosis with spondylolisthesis and herniated disk, C4-5, C5-6 Operative Method Anterior cervical diskectomy with cage and plate fusion, C4-5, C5-6 Specimen Count And Types nil Pathology Nil Operative Findings 1. Narrowed disk space between, C4-5 and C5-6 with hypertrophic posterior longitudinal ligament. 2. Spondylolisthesis over C4-5 and C5-6; ruptured disc at C5/6 level. Ruptured disk was found and removed. 3. The thecal sac became loose after the procedure 4. The MEP and SSEP were stationary during the whole procedure 5. A 6mm cervical cage (Synthesis) placed over C5-6 level and a 6mm cage was placed at C4-5 level. 6. Trachea was deviated to right side after intubation Operative Procedures Under ETGA, we placed the patient on supine position with his neck extended. After we scrubbed, disinfected and drapped, a horizontal linear skin incision was made alone the skin crese of right neck. The wound was opened in layers and the platysma was divided. The muscle over the neck was dissected and the pre-vetebral space was reached. The C5-6 disc space was marked with The trachea and esophagus were retracted to left side and the Korros retractor was applied for wound exposure. Diskectomy over C4-5 and C5-6 was performed with curette, aligator and disk-clamp. The osteophyte was removed with air-drived drill and the OPLL and ruptured disk were removed. Two 6mm cage was placed over the disk cavity of C4-5 and C5-6. The cage was checked with C-arm. After complete hemostasis, a mini-hemovac was placed. The wound was closed in layers with 3-0 and 4-0 Vicryl. Operators VS 賴達明 Assistants R6 鍾文桂 R3 曾偉倫 相關圖片 陳黃琰玲 (F,1947/10/16,64y4m) 手術日期 2011/11/23 手術主治醫師 賴達明 手術區域 東址 002房 02號 診斷 Lumbar Spondylosis 器械術式 L4/5 TLIF 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 2 紀錄醫師 曾偉倫, 鍾文桂, 時間資訊 00:00 臨時手術NPO 13:35 報到 14:00 進入手術室 14:10 麻醉開始 14:30 誘導結束 14:35 抗生素給藥 15:00 手術開始 17:30 手術結束 17:30 麻醉結束 17:40 送出病患 17:45 進入恢復室 18:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎間盤切除術-腰椎 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: 1.Laminectomy and transforaminal lumbar inter... 開立醫師: 鍾文桂 開立時間: 2011/11/23 17:27 Pre-operative Diagnosis Lumbar spine, L4-5 spondylolisthesis with herniated disc Post-operative Diagnosis Lumbar spine, L4-5 spondylolisthesis with herniated disc Operative Method 1.Laminectomy and transforaminal lumbar interbody fusion and trans-pedicle screw fixation, L4-5. 2. L4/5 discectomy. Specimen Count And Types nil Pathology Nil. Operative Findings 1. L4-5 spondyloisthesis with heniated disk causing stenosis of the spinal canal. Intact dura mater after decompression, resection of L5 superior facet. 2. A Synthesis PEEK banana cage was placed over L4-5 disc space,9mm Operative Procedures Under ETGA, we placed the paeitent on prone position. The L4-5 level was located with C-arm. After we scrubbed, disinfected and drapped, a linear skin incision was made. the wound was opened in layers. After detaching the paraspinal muscle, the transpedicle screws were implanted. Then, L4 laminectomy was obtained. After decompression, L4/5 discectomy was done and the PEEK cage was implanted. The rods were set on the TPS. The wound was closed in layers with one submuscular drain in situ. Operators VS 賴達明 Assistants R6 鍾文桂 R3 曾偉倫 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: 1.Laminectomy and transforaminal lumbar inter... 開立醫師: 曾偉倫 開立時間: 2011/11/23 17:44 Pre-operative Diagnosis Lumbar spine, L4-5 spondylolisthesis with herniated disc Post-operative Diagnosis Lumbar spine, L4-5 spondylolisthesis with herniated disc Operative Method 1.Laminectomy and transforaminal lumbar interbody fusion and trans-pedicle screw fixation, L4-5. 2. L4/5 discectomy. Specimen Count And Types nil Pathology Nil. Operative Findings 1. L4-5 spondyloisthesis with heniated disk causing stenosis of the spinal canal. Intact dura mater after decompression, resection of L5 superior facet. 2. A Synthesis PEEK banana cage was placed over L4-5 disc space,9mm 2. A Synthesis PEEK banana cage was placed over L4-5 disc space,9mm 3. TPS x4 and 5cm Rod x 2 for fixation Operative Procedures Under ETGA, we placed the paeitent on prone position. The L4-5 level was located with C-arm. After we scrubbed, disinfected and drapped, a linear skin incision was made. the wound was opened in layers. After detaching the paraspinal muscle, the transpedicle screws were implanted. Then, L4 laminectomy was obtained. After decompression, L4/5 discectomy was done and the PEEK cage was implanted. The rods were set on the TPS. The wound was closed in layers with one submuscular drain in situ. Operators VS 賴達明 Assistants R6 鍾文桂 R3 曾偉倫 相關圖片 黃陳阿典 (F,1925/07/02,86y8m) 手術日期 2011/11/23 手術主治醫師 賴達明 手術區域 東址 005房 01號 診斷 Lumbar myelopathy 器械術式 L2/3 sublaminar decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 張哲瑋, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:10 麻醉開始 08:30 誘導結束 08:30 抗生素給藥 08:50 手術開始 10:05 手術結束 10:05 麻醉結束 10:15 送出病患 10:20 進入恢復室 11:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 手術 椎弓切除術(減壓)-二節以內 1 1 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 曾峰毅 開立時間: 2011/11/23 10:01 Pre-operative Diagnosis Status post spinal fusion surgery at L4/5, adjacent level degeneration at L2/3 Post-operative Diagnosis Status post spinal fusion surgery at L4/5, adjacent level degeneration at L2/3 Operative Method L2 laminectomy for decompression Specimen Count And Types Nil Pathology Nil Operative Findings Hypertrophic ligamentum flvaum compromised thecal sac and bilateral lateral recess at L2/3 tightly. Neural structures were decompressed well after the surgery. Operative Procedures With endotracheal tracheal general anaesthesiat, the patient was put in prone position. After back scrubbed, disinfected, and then draped, we made one midline skin incision at L2/3 level and dissected paraspinous muscle. L2 laminectomy was performed, and hypertrophic ligamentum flavum was removed. The wound was closed in layers after hemostasis. Operators VS 賴達明 Assistants R5 曾峰毅 R1 張哲瑋 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 張哲瑋 開立時間: 2011/11/23 10:23 Pre-operative Diagnosis Status post spinal fusion surgery at L4/5, adjacent level degeneration at L2/3 Post-operative Diagnosis Status post spinal fusion surgery at L4/5, adjacent level degeneration at L2/3 Operative Method L2 laminectomy for decompression Specimen Count And Types Nil Pathology Nil Operative Findings Hypertrophic ligamentum flvaum compromised thecal sac and bilateral lateral recess at L2/3 tightly. Neural structures were decompressed well after the surgery. Operative Procedures With endotracheal tracheal general anaesthesiat, the patient was put in prone position. After back scrubbed, disinfected, and then draped, we made one midline skin incision at L2/3 level and dissected paraspinous muscle. L2 laminectomy was performed, and hypertrophic ligamentum flavum was removed. The wound was closed in layers after hemostasis. Operators VS 賴達明 Assistants R5 曾峰毅 R1 張哲瑋 相關圖片 韓光明 (M,1943/12/21,68y2m) 手術日期 2011/11/23 手術主治醫師 賴達明 手術區域 東址 005房 02號 診斷 Lumbar myelopathy 器械術式 L3/4 microdiskectomy, right 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 張哲瑋, 時間資訊 00:00 臨時手術NPO 10:30 進入手術室 10:40 麻醉開始 10:50 誘導結束 11:00 抗生素給藥 11:23 手術開始 13:20 開始輸血 14:20 手術結束 14:20 麻醉結束 14:33 送出病患 14:38 進入恢復室 16:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 椎間盤切除術-腰椎 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: HIVD 開立醫師: 曾峰毅 開立時間: 2011/11/23 14:19 Pre-operative Diagnosis Lumbar HIVD, L3/4 Post-operative Diagnosis Lumbar HIVD, L3/4 Operative Method Microdiskectomy L3/4 Specimen Count And Types Nil Pathology Nil Operative Findings Ruptured disc from L3/4 compromised left L4 root tightly. Neural structure was decompressed after sequestrectomy. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. We made one midlins skin incision at L3/4 level, and dissected left paraspinous muscle to expose L3/4 interlaminar space. L3/4 laminotomy was performed, and ruptured disc was done. After sequestrectomy, the wound was closed in layers. Operators VS 賴達明 Assistants R5 曾峰毅 R1 張哲瑋 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: HIVD 開立醫師: 張得一 開立時間: 2011/11/23 14:36 Pre-operative Diagnosis Lumbar HIVD, L3/4 Post-operative Diagnosis Lumbar HIVD, L3/4 Operative Method Microdiskectomy L3/4 Specimen Count And Types Nil Pathology Nil Operative Findings Ruptured disc from L3/4 compromised left L4 root tightly. Neural structure was decompressed after sequestrectomy. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. We made one midlins skin incision at L3/4 level, and dissected left paraspinous muscle to expose L3/4 interlaminar space. L3/4 laminotomy was performed, and ruptured disc was done. After sequestrectomy, the wound was closed in layers. Operators VS 賴達明 Assistants R5 曾峰毅 R1 張哲瑋 相關圖片 林嘉誠 (M,1998/10/05,13y5m) 手術日期 2011/11/23 手術主治醫師 許文明 手術區域 兒醫 065房 04號 診斷 Mediastinum, malignant 器械術式 Port-A catheter implatation 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 蕭柏妮 ASA 3 紀錄醫師 林昊諭, 時間資訊 14:45 報到 15:40 進入手術室 15:45 麻醉開始 15:50 誘導結束 16:00 抗生素給藥 16:07 手術開始 17:04 18:02 手術結束 18:02 麻醉結束 18:10 進入恢復室 18:10 送出病患 19:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 內頸靜脈切開,永久導管放置術 1 1 L 摘要__ 手術科部: 套用罐頭: Port-A insertion (left subclavian vein) 開立醫師: 林昊諭 開立時間: 2011/11/23 16:57 Pre-operative Diagnosis Thymic carcinoma with metastasis Post-operative Diagnosis Thymic carcinoma with metastasis Operative Method Port-A insertion (left subclavian vein) Specimen Count And Types nil Pathology nil Operative Findings intra-operative portable X-ray showed Port-A catheter tip in correct venous branch to SVC. Operative Procedures 1. Under GA with the patient in supine position, prepped and draping were performed in the usual sterile method. 2. An incision was made in left side subclavical area. After identification of the left subclavian vein, Port-A catheter was inserted. Adequate hemostasis was obtained. Then the wound was closed in layers. Operators 許文明 Assistants F2林昊諭 記錄__ 手術科部: 套用罐頭: Port-A insertion (left subclavian vein) 開立醫師: 林昊諭 開立時間: 2011/11/23 16:57 Pre-operative Diagnosis Thymic carcinoma with metastasis Post-operative Diagnosis Thymic carcinoma with metastasis Operative Method Port-A insertion (left subclavian vein) Specimen Count And Types nil Pathology nil Operative Findings intra-operative portable X-ray showed Port-A catheter tip in correct venous branch to SVC. Operative Procedures 1. Under GA with the patient in supine position, prepped and draping were performed in the usual sterile method. 2. An incision was made in left side subclavical area. After identification of the left subclavian vein, Port-A catheter was inserted. Adequate hemostasis was obtained. Then the wound was closed in layers. 2. An incision was made in left side subclavical area. After identification of the left subclavian vein, Port-A catheter was inserted by puncture method. Adequate hemostasis was obtained. Then the wound was closed in layers. Operators 許文明 Assistants F2林昊諭 廖雪 (F,1951/01/02,61y2m) 手術日期 2011/11/23 手術主治醫師 楊榮森 手術區域 東址 020房 02號 診斷 Multiple bone metastasis 器械術式 R proxiaml femur tumor curettage+CHS 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 2 紀錄醫師 葉炳君, 時間資訊 10:22 報到 10:40 進入手術室 10:50 麻醉開始 10:55 誘導結束 11:00 抗生素給藥 11:17 手術開始 11:30 開始輸血 12:45 手術結束 12:45 麻醉結束 12:50 送出病患 12:53 進入恢復室 13:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 股骨頸骨折開放性復位術 1 2 R 手術 惡性骨瘤廣泛切除(一次) 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 骨科部 套用罐頭: Other 開立醫師: 葉炳君 開立時間: 2011/11/23 12:41 Pre-operative Diagnosis Subtrochanteric fracture of right femur, pathological Post-operative Diagnosis Subtrochanteric fracture of right femur, pathological Operative Method 1. Bone tumor curretage 2. Open reduction and internal fixation with dynamic hip screw(135 degree, 5H5S) Specimen Count And Types 1 piece About size:NUMEROUS PIECES Source:subtrochanteric area of right femur Pathology Pending Operative Findings 1. Subtrochanteric fracture of right femur 2. Soft and fragile materials surrounded the fracture site of right femur with extension to periosteum Operative Procedures 1. Under anesthesia, the patient was positioned in supine. 2. Skin disinfection and drapping as usual 3. Longitudinal skin incision at right lateral thigh, followed by lateral approach. 4. Excised the tumor surrounding the fracture site and intramedullary canal with Rongeur and currete. 5. Reduced the fragments and performed internal fixation with DHS under C-arm intensification. 6. Filled the bone defect on the subtrochanteric area of right femur with vancomycin-impregnated bone cement. 7. 95% alcohol and N/S irrigation and inserted an 1/8# H-V drain tube. 8. Repaired the detached vastus lateralis and closed the wound in layers Operators 楊榮森, Assistants 葉炳君, 陳明峰, 記錄__ 手術科部: 骨科部 套用罐頭: Other 開立醫師: 葉炳君 開立時間: 2011/11/23 12:41 Pre-operative Diagnosis Subtrochanteric fracture of right femur, pathological Post-operative Diagnosis Subtrochanteric fracture of right femur, pathological Operative Method 1. Bone tumor curretage 2. Open reduction and internal fixation with dynamic hip screw(135 degree, 5H5S) Specimen Count And Types 1 piece About size:NUMEROUS PIECES Source:subtrochanteric area of right femur Pathology Pending Operative Findings 1. Subtrochanteric fracture of right femur 2. Soft and fragile materials surrounded the fracture site of right femur with extension to periosteum Operative Procedures 1. Under anesthesia, the patient was positioned in supine. 2. Skin disinfection and drapping as usual 3. Longitudinal skin incision at right lateral thigh, followed by lateral approach. 4. Excised the tumor surrounding the fracture site and intramedullary canal with Rongeur and currete. 5. Reduced the fragments and performed internal fixation with DHS under C-arm intensification. 6. Filled the bone defect on the subtrochanteric area of right femur with vancomycin-impregnated bone cement. 7. 95% alcohol and N/S irrigation and inserted an 1/8# H-V drain tube. 8. Repaired the detached vastus lateralis and closed the wound in layers Operators 楊榮森, Assistants 葉炳君, 陳明峰, 蔡崇凱 (M,1932/11/12,79y4m) 手術日期 2011/11/23 手術主治醫師 余宏政 手術區域 西址 039房 05號 診斷 Malignant neoplasm of bladder, part unspecified 器械術式 Fiberocystoscopy /WOR 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 無麻醉 麻醉主治醫師 ASA 1 時間資訊 14:12 進入手術室 14:20 手術開始 14:23 手術結束 14:25 送出病患 方伯為 (M,2010/05/19,1y9m) 手術日期 2011/11/23 手術主治醫師 賴鴻緒 手術區域 兒醫 062房 01號 診斷 Inguinal hernia 器械術式 Repair of inguinal hernia with 手術類別 預定手術 手術部位 腹 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 蕭柏妮 ASA 2 紀錄醫師 李柏穎, 時間資訊 07:35 報到 08:06 進入手術室 08:10 麻醉開始 08:15 誘導結束 08:30 手術開始 09:20 手術結束 09:20 麻醉結束 09:30 送出病患 09:35 進入恢復室 10:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 鼠蹊疝氣修補術-無腸切除 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Hernia 開立醫師: 李柏穎 開立時間: 2011/11/23 09:26 Pre-operative Diagnosis Right side indirect type inguinal hernia Post-operative Diagnosis Right side indirect type inguinal hernia Operative Method Herniorrhaphy and high ligation Specimen Count And Types 1 piece About size:3x0.5x0.5 Source:right hernia sac Pathology pending Operative Findings Right side indirect type inguinal hernia, no content in herniac sac Operative Procedures 1. Under endotracheal general anesthesia with the patient in supine position, prepping with Povidone iodine and draping was performed in the usual sterile fashion. 2. An transverse incision along skin crease was made in the right side inguinal area. Incision was deepened through layers. The scarpa fascia was opened. The external oblique fascia was opened from external ring. 3. Spermatic cord was looped. Dissection was performed on the antero-medialaspect of the spermatic cord. An indirect herniac sac was noted and mobilized. The sac was opened and extended into distal and proximal ends, the latter was then high-ligated. Adequate hemostasis was obtained. 4. Closure was proceeded with interrupted catgut on the scarpa fascia and the skin was closed subcuticularly. Operators 賴鴻緒 Assistants 林文熙 柯柏瑞 李柏穎 吳柳樺 王新潔 (F,1972/06/20,39y8m) 手術日期 2011/11/24 手術主治醫師 曾勝弘 手術區域 東址 005房 02號 診斷 Parkinsonism (F02.3) 器械術式 IPG exposure, for capsulectomy and wound closure 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 蔡宗良, 時間資訊 00:00 臨時手術NPO 10:35 報到 10:58 進入手術室 11:00 麻醉開始 11:05 誘導結束 11:08 抗生素給藥 11:29 手術開始 12:02 手術結束 12:02 麻醉結束 12:10 送出病患 12:15 進入恢復室 14:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 深部傷口處理縫合擴創-中 1 0 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Debridement with primary closure 開立醫師: 張書豪 開立時間: 2011/11/24 12:17 Pre-operative Diagnosis IPG exposure Post-operative Diagnosis IPG exposure Operative Method Debridement with primary closure Specimen Count And Types Culture x 1, pathology x 1 Pathology Tissue scar Operative Findings 1. 2 x 1 cm area exposure of IPG 2. Wound was dry and no sign of active infection. Operative Procedures 1. ETGA, supine 2. Routine disinfection and drapping 3. Wound incision over the site of exposure 4. Debridement of the scar, with copious gentamicin saline irrigation 5. Scar was trimmed 6. 2-0 Vircyl and 4-0 Nylon interrupted closure Operators 曾勝弘 Assistants R6蔡宗良 R1張書豪 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Debridement with primary closure 開立醫師: 張書豪 開立時間: 2011/11/24 12:18 Pre-operative Diagnosis IPG exposure Post-operative Diagnosis IPG exposure Operative Method Debridement with primary closure Specimen Count And Types Culture x 1, pathology x 1 Pathology Tissue scar Operative Findings 1. 2 x 1 cm area exposure of IPG 2. Wound was dry and no sign of active infection. Operative Procedures 1. ETGA, supine 2. Routine disinfection and drapping 3. Wound incision over the site of exposure 4. Debridement of the scar, with copious gentamicin saline irrigation 5. Scar was trimmed 6. 2-0 Vircyl and 4-0 Nylon interrupted closure Operators 曾勝弘 Assistants R6蔡宗良 R1張書豪 相關圖片 趙妍凱 (F,2011/08/16,7m1d) 手術日期 2011/11/24 手術主治醫師 郭夢菲 手術區域 兒醫 065房 02號 診斷 Hydrocephalus 器械術式 right VP shunt implantation 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 3 紀錄醫師 游健生, 時間資訊 02:00 臨時手術NPO 02:00 開始NPO 08:00 通知急診手術 10:40 報到 10:50 進入手術室 11:05 麻醉開始 12:15 誘導結束 12:50 抗生素給藥 12:57 手術開始 14:25 麻醉結束 14:25 手術結束 14:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 摘要__ 手術科部: 套用罐頭: Ventriculo-peritoneal shunt implantation, lef... 開立醫師: 游健生 開立時間: 2011/11/24 15:00 Pre-operative Diagnosis Hydrocephalus after intraventricle hemorrhage Post-operative Diagnosis Hydrocephalus after intraventricle hemorrhage Operative Method Ventriculo-peritoneal shunt implantation, left frontal horn Specimen Count And Types 2 pieces About size:6cc Source:CSF About size:3cm Source:EVD tip Pathology Nil Operative Findings Clear xanthochromic CSF gashed out from EVD exit wound after EVD removal. The wound was sutured to seal off CSF leak. EVD tip was sent for culture. The ventricle catheter was 6.2cm in length. The peritoneal catheter was 35cm in length. A Medtronic burhole-type fixed pressure (medium) VP shunt valve was used. Some CSF was sent for routine, biochem, and culture. Operative Procedures Under ETGA, patient was in supine position. After disinfection, EVD was removed followed by EVD exit wound suture. Her head was rotated to right with left shoulder and trunk elevated by towel roll. After disinfection and draping, a semi-cirular scalp incision, 5cm in diameter, was made at left side of anterior border of anterior fontanelle. The scalp flap was elevated and the bone margin was exposed. A small durotomy was made after removal of some bone at margin. After coagulation, ventriculostomy was done. The ventricle catheter was inserted into left frontal horn. A transverse abdominal incision was made at LUQ next to umbilicus. After dissection, the peritonium was opened. The perionteal catheter was inserted into the peritoneal space. Its proximal end was passed to the scalp wound via a subcutaneous tract with a relay point at neck. The VP shunt was assembled. After hemostasis, wounds were closed in layers with Vicryl and Nylon. Operators VS 郭夢菲 Assistants R4 游健生 Indication Of Emergent Operation intracranial hypertension 相關圖片 記錄__ 手術科部: 套用罐頭: Ventriculo-peritoneal shunt implantation, lef... 開立醫師: 郭夢菲 開立時間: 2011/11/28 12:34 Pre-operative Diagnosis Hydrocephalus after intraventricular hemorrhage Post-operative Diagnosis Hydrocephalus after intraventricular hemorrhage Operative Method 1. VP shunt, left Kocher point, metronic medium pressure, 6.2 cm in ventricle and 35 cm in peritoneal cavity 2. removal of right side EVD Specimen Count And Types 2 pieces About size:6cc Source:CSF About size:3cm Source:EVD tip Pathology Nil Operative Findings Clear xanthochromic CSF gashed out from EVD exit wound after EVD removal. The wound was sutured to seal off CSF leak. EVD tip was sent for culture. The ventricle catheter was 6.2cm in length. The peritoneal catheter was 35cm in length. A Medtronic burhole-type fixed pressure (medium) VP shunt valve was used. Some CSF was sent for routine, biochem, and culture. Operative Procedures Under ETGA, patient was in supine position. After disinfection, EVD was removed followed by EVD exit wound suture. Her head was rotated to right with left shoulder and trunk elevated by towel roll. After disinfection and draping, a semi-cirular scalp incision, 5cm in diameter, was made at left side of anterior border of anterior fontanelle. The scalp flap was elevated and the bone margin was exposed. A small durotomy was made after removal of some bone at margin. After coagulation, ventriculostomy was done. The ventricle catheter was inserted into left frontal horn. A transverse abdominal incision was made at LUQ next to umbilicus. After dissection, the peritonium was opened. The perionteal catheter was inserted into the peritoneal space. Its proximal end was passed to the scalp wound via a subcutaneous tract with a relay point at neck. The VP shunt was assembled. After hemostasis, wounds were closed in layers with Vicryl and Nylon. Operators VS 郭夢菲 Assistants R4 游健生 Indication Of Emergent Operation intracranial hypertension 相關圖片 賴若心 (F,2011/06/05,9m13d) 手術日期 2011/11/24 手術主治醫師 郭夢菲 手術區域 兒醫 065房 03號 診斷 Hydrocephalus 器械術式 right VP shunt implantation 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 3 紀錄醫師 游健生, 時間資訊 06:00 開始NPO 06:00 臨時手術NPO 08:00 通知急診手術 14:38 報到 14:50 進入手術室 14:55 麻醉開始 15:05 誘導結束 15:25 抗生素給藥 15:48 手術開始 16:58 手術結束 16:58 麻醉結束 17:10 送出病患 17:10 進入恢復室 18:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室腹腔分流手術 1 1 R 摘要__ 手術科部: 套用罐頭: Ventriculo-peritoneal shunt, right frontal 開立醫師: 游健生 開立時間: 2011/11/24 17:23 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculo-peritoneal shunt, right frontal Specimen Count And Types 1 piece About size:10cc Source:CSF Pathology Nil Operative Findings Clear CSF gashed out after ventriculostomy. The opening pressure was >15cmH2O. The ventricle catheter was 6.5cm in lenght while the peritoneal catheter was 35cm. A Medtronic burhole-type fixed pressure (medium) VP shunt valve was used. CSF was sent for routine, biochem, and culture. Operative Procedures Under ETGA, patient was in supine position with head rotated to left. Right shoulder and trunk were elevated by towel roll. After shaving, we disinfected and draped the operation field as usual. A semi-cirular scalp incision, 5cm in diameter, was made at right side of anterior border of anterior fontanelle. The scalp flap was elevated and the bone margin was exposed. A small durotomy was made after removal of some bone at margin. After coagulation, ventriculostomy was done. The ventricle catheter was inserted into right frontal horn. A transverse abdominal incision was made at RUQ next to umbilicus. After dissection, the peritonium was opened. The perionteal catheter was inserted into the peritoneal space. Its proximal end was passed to the scalp wound via a subcutaneous tract with a relay point at parietal region. The VP shunt was assembled. After hemostasis, wounds were closed in layers with Vicryl and Nylon. Operators VS 郭夢菲 Assistants R4 游健生 Indication Of Emergent Operation intracranial hypertension 相關圖片 記錄__ 手術科部: 套用罐頭: Ventriculo-peritoneal shunt, right frontal 開立醫師: 郭夢菲 開立時間: 2011/11/28 12:30 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculo-peritoneal shunt, right frontal Specimen Count And Types 1 piece About size:10cc Source:CSF Pathology Nil Operative Findings Clear CSF gashed out after ventriculostomy. The opening pressure was >15cmH2O. The ventricle catheter was 6.5cm in lenght while the peritoneal catheter was 35cm. A Medtronic burhole-type fixed pressure (medium) VP shunt valve was used. CSF was sent for routine, biochem, and culture. Operative Procedures Under ETGA, patient was in supine position with head rotated to left. Right shoulder and trunk were elevated by towel roll. After shaving, we disinfected and draped the operation field as usual. A semi-cirular scalp incision, 5cm in diameter, was made at right side of anterior border of anterior fontanelle. The scalp flap was elevated and the bone margin was exposed. A small durotomy was made after removal of some bone at margin. After coagulation, ventriculostomy was done. The ventricle catheter was inserted into right frontal horn. A transverse abdominal incision was made at RUQ next to umbilicus. After dissection, the peritonium was opened. The perionteal catheter was inserted into the peritoneal space. Its proximal end was passed to the scalp wound via a subcutaneous tract with a relay point at parietal region. The VP shunt was assembled. After hemostasis, wounds were closed in layers with Vicryl and Nylon. Operators VS 郭夢菲 Assistants R4 游健生 Indication Of Emergent Operation intracranial hypertension 相關圖片 黃沛晴 (F,1976/05/03,35y10m) 手術日期 2011/11/24 手術主治醫師 楊士弘 手術區域 東址 005房 01號 診斷 Lumbar spondylosis 器械術式 L4/5 microdiskectomy, left 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 蔡宗良, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:05 進入手術室 08:10 麻醉開始 08:15 誘導結束 08:45 抗生素給藥 09:00 手術開始 10:30 手術結束 10:30 麻醉結束 10:38 送出病患 10:40 進入恢復室 11:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-腰椎 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 外科部 套用罐頭: Microdiscectomy, L4-5, via L4 laminotomy 開立醫師: 張書豪 開立時間: 2011/11/24 10:46 Pre-operative Diagnosis Herniated lumbar disc, L4-5, left-sided Post-operative Diagnosis Herniated lumbar disc, L4-5, left-sided Operative Method Microdiscectomy, L4-5, via L4 laminotomy Specimen Count And Types nil Pathology None Operative Findings Herniated lumbar disc, L4-5, left-sided, with left L4-5 facet joint hypertrophy and left L5 nerve root compression Operative Procedures 1. ETGA, prone positioningh 2. Fluoroscopic confirmation of L4-5 disc space 3. Routine preparation and disinfection 4. Linear wound inicision, followed by subperiosteal dissection 5. Microscope is brought into operation field. Midas 4-mm burr for laminotomy 6. Remove ligmentum flavum 7. Root retraction for disectomy 8. Rinderon soaked Gel-foam placed at the L5 root 9. Wound was closed in layers Operators 楊士弘 Assistants R6蔡宗良 PGYR1張書豪 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Microdiscectomy, L4-5, via L4 laminotomy 開立醫師: 張書豪 開立時間: 2011/11/24 10:46 Pre-operative Diagnosis Herniated lumbar disc, L4-5, left-sided Post-operative Diagnosis Herniated lumbar disc, L4-5, left-sided Operative Method Microdiscectomy, L4-5, via L4 laminotomy Specimen Count And Types nil Pathology None Operative Findings Herniated lumbar disc, L4-5, left-sided, with left L4-5 facet joint hypertrophy and left L5 nerve root compression Operative Procedures 1. ETGA, prone positioningh 2. Fluoroscopic confirmation of L4-5 disc space 3. Routine preparation and disinfection 4. Linear wound inicision, followed by subperiosteal dissection 5. Microscope is brought into operation field. Midas 4-mm burr for laminotomy 6. Remove ligmentum flavum 7. Root retraction for disectomy 8. Rinderon soaked Gel-foam placed at the L5 root 9. Wound was closed in layers Operators 楊士弘 Assistants R6蔡宗良 PGYR1張書豪 相關圖片 周林秀畏 (F,1943/08/24,68y6m) 手術日期 2011/11/24 手術主治醫師 蕭輔仁 手術區域 東址 005房 03號 診斷 Non-Hodgkin's lymphoma 器械術式 Left fronto-temporal tumor stereotaxic biopsy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 蔡宗良, 時間資訊 00:00 臨時手術NPO 12:28 報到 12:41 進入手術室 12:46 麻醉開始 12:50 誘導結束 13:10 抗生素給藥 13:23 手術開始 17:40 麻醉結束 17:40 手術結束 17:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 立體定位術-切片 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 摘要__ 手術科部: 外科部 套用罐頭: Stereotactic frameless (neuronavigation) brai... 開立醫師: 蔡宗良 開立時間: 2011/11/24 18:01 Pre-operative Diagnosis Brain tumor, parietal lobe Post-operative Diagnosis Brain tumor, parietal lobe Operative Method Stereotactic frameless (neuronavigation) brain biopsy Specimen Count And Types 1 piece About size:小 Source:Brain tumor Pathology Report pending Operative Findings Frozen section: lesioned specimen has been biopsied Operative Procedures 1. ETGA, Mayfield skull fixation, supine, head rotated to the right 2. Neuronavigation setup 3. Target, entry point and trajectory determination 4. Routine preparation and disinfection 5. Burr hole with tenting and durotomy 6. Biopsy needle directed according to navigation, specimen obtained and sent for frozen section confirmation 7. Wound was closed in layers Operators 蕭輔仁 Assistants R6蔡宗良 R1張書豪 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Stereotactic frameless (neuronavigation) brai... 開立醫師: 蔡宗良 開立時間: 2011/11/24 18:01 Pre-operative Diagnosis Brain tumor, parietal lobe Post-operative Diagnosis Brain tumor, parietal lobe Operative Method Stereotactic frameless (neuronavigation) brain biopsy Specimen Count And Types 1 piece About size:小 Source:Brain tumor Pathology Report pending Operative Findings Frozen section: lesioned specimen has been biopsied Operative Procedures 1. ETGA, Mayfield skull fixation, supine, head rotated to the right 2. Neuronavigation setup 3. Target, entry point and trajectory determination 4. Routine preparation and disinfection 5. Burr hole with tenting and durotomy 6. Biopsy needle directed according to navigation, specimen obtained and sent for frozen section confirmation 7. Wound was closed in layers Operators 蕭輔仁 Assistants R6蔡宗良 R1張書豪 相關圖片 郭葉麗華 (F,1955/07/12,56y8m) 手術日期 2011/11/24 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Bone cancer 器械術式 Left parietal brain metastasis excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 施培艾, 時間資訊 00:00 臨時手術NPO 08:09 進入手術室 08:20 麻醉開始 08:50 誘導結束 09:03 抗生素給藥 09:33 手術開始 11:50 手術結束 11:50 麻醉結束 12:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除-手術時間在4小時以內 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Left parietal craniectomy & tumor resection, ... 開立醫師: 王奐之 開立時間: 2011/11/24 12:25 Pre-operative Diagnosis Left parietal tumor, suspected rhabdomyosarcoma Post-operative Diagnosis Left parietal tumor, suspected rhabdomyosarcoma Operative Method Left parietal craniectomy & tumor resection, duroplasty & cranioplasty with titanium mesh Specimen Count And Types 2 pieces About size:4*3*3cm Source:left parietal tumor About size:5*4*1cm Source:left parietal skull Pathology Pending Operative Findings Suspected pericranium involvement was noted, and was removed along with the bone. The tumor was multi-lobulated, yellowish and stony-hard in consistency, measuring about 4*3*3cm in size, attached to the dura tightly and rich in blood supply. The vein of Trolard was not exposed during the operation. A small portion close to the midline was not removed and was electrocauterized. A titanium mesh trimmed for appropriate size was used for cranioplasty. Diffuse oozing of the scalp was encountered when closing the wound. Operative Procedures After endotracheal general anethesia, the patient was placed in right decubitus position with head fixed in Mayfield skull clamp. After shaving, scrubbing, disinfection & draping in sterile fashion, an U-shaped incision as made at left parietal area. After drilling of 5 burr holes, a rectangular craniectomy was performed. A round durotomy was performed over the tumor location, followed by dissection of the plane between the tumor and normal brain. The majority of tumor was removed en bloc, with the small portion left at posterior midline and electrocauterized. The dura was closed with Surgisis artificial dura in water-tight fashion. The bone defect was reconstructed with titanium mesh, and the wound was closed in layers after setting up one subgaleal CWV drain. Operators VS 王國川 Assistants R4 王奐之, R0 施培艾 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Left parietal craniectomy & tumor resection, ... 開立醫師: 王奐之 開立時間: 2011/11/24 12:25 Pre-operative Diagnosis Left parietal tumor, suspected rhabdomyosarcoma Post-operative Diagnosis Left parietal tumor, suspected rhabdomyosarcoma Operative Method Left parietal craniectomy & tumor resection, duroplasty & cranioplasty with titanium mesh Specimen Count And Types 2 pieces About size:4*3*3cm Source:left parietal tumor About size:5*4*1cm Source:left parietal skull Pathology Pending Operative Findings Suspected pericranium involvement was noted, and was removed along with the bone. The tumor was multi-lobulated, yellowish and stony-hard in consistency, measuring about 4*3*3cm in size, attached to the dura tightly and rich in blood supply. The vein of Trolard was not exposed during the operation. A small portion close to the midline was not removed and was electrocauterized. A titanium mesh trimmed for appropriate size was used for cranioplasty. Diffuse oozing of the scalp was encountered when closing the wound. Operative Procedures After endotracheal general anethesia, the patient was placed in right decubitus position with head fixed in Mayfield skull clamp. After shaving, scrubbing, disinfection & draping in sterile fashion, an U-shaped incision as made at left parietal area. After drilling of 5 burr holes, a rectangular craniectomy was performed. A round durotomy was performed over the tumor location, followed by dissection of the plane between the tumor and normal brain. The majority of tumor was removed en bloc, with the small portion left at posterior midline and electrocauterized. The dura was closed with Surgisis artificial dura in water-tight fashion. The bone defect was reconstructed with titanium mesh, and the wound was closed in layers after setting up one subgaleal CWV drain. Operators VS 王國川 Assistants R4 王奐之, R0 施培艾 相關圖片 黃金坤 (M,1937/03/04,75y0m) 手術日期 2011/11/24 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 Lumbar spondylosis 器械術式 L2/3, L3/4, L4/5 laminectomy for decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 施培艾, 時間資訊 00:00 臨時手術NPO 12:38 進入手術室 12:43 麻醉開始 12:59 抗生素給藥 13:10 誘導結束 13:40 手術開始 14:50 開始輸血 16:00 抗生素給藥 16:45 手術結束 16:45 麻醉結束 16:55 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 椎弓切除術(減壓)-超過二節 1 1 摘要__ 手術科部: 外科部 套用罐頭: L2-5 decompressive laminectomy 開立醫師: 王奐之 開立時間: 2011/11/24 19:04 Pre-operative Diagnosis Lumbar spinal stenosis, L2-5 Post-operative Diagnosis Lumbar spinal stenosis, L2-5 Operative Method L2-5 decompressive laminectomy Specimen Count And Types Nil Pathology Nil Operative Findings Prominent facet joints were noted. Hard bone consistency and thick lamina was observed, along with hypertrophic ligamentum flavum. Part of the ligamentum flavum became stony-hard at right L3/4 & left L2/3 level. The most stenotic part being the L3/4 level, and was fully decompressed after lower L2 to upper L5 laminectomy and removal of ligamentum flavum. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position. The L2/3 & L4/5 level was localized with C-arm. After scrubbing, disinfection & draping in sterile fashion, a midline linear incision was made. The incision was deepened through fascial layer, the paraspinal muscles were detached from the spinous process & lamina. The spinous processes were removed with rongeur, as well as part of the laminae. Laminectomy was then performed with Kerrison punch under microscopic view. After achieving full decompression, hemostasis was achieved and the dural surface was packed with a piece of gelfoam. The wound was then closed in layers after setting up 1 hemovac drain. Operators VS 王國川 Assistants R4 王奐之, R0 施培艾 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: L2-5 decompressive laminectomy 開立醫師: 王奐之 開立時間: 2011/11/24 19:04 Pre-operative Diagnosis Lumbar spinal stenosis, L2-5 Post-operative Diagnosis Lumbar spinal stenosis, L2-5 Operative Method L2-5 decompressive laminectomy Specimen Count And Types Nil Pathology Nil Operative Findings Prominent facet joints were noted. Hard bone consistency and thick lamina was observed, along with hypertrophic ligamentum flavum. Part of the ligamentum flavum became stony-hard at right L3/4 & left L2/3 level. The most stenotic part being the L3/4 level, and was fully decompressed after lower L2 to upper L5 laminectomy and removal of ligamentum flavum. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position. The L2/3 & L4/5 level was localized with C-arm. After scrubbing, disinfection & draping in sterile fashion, a midline linear incision was made. The incision was deepened through fascial layer, the paraspinal muscles were detached from the spinous process & lamina. The spinous processes were removed with rongeur, as well as part of the laminae. Laminectomy was then performed with Kerrison punch under microscopic view. After achieving full decompression, hemostasis was achieved and the dural surface was packed with a piece of gelfoam. The wound was then closed in layers after setting up 1 hemovac drain. Operators VS 王國川 Assistants R4 王奐之, R0 施培艾 相關圖片 邵坤成 (M,1951/09/16,60y5m) 手術日期 2011/11/24 手術主治醫師 蔡翊新 手術區域 東址 016房 02號 診斷 Shock 器械術式 Debridment-- >10cm 手術類別 緊急手術 手術部位 四肢 傷口分類 髒 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 趙崧筌, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 08:00 通知急診手術 11:39 進入手術室 11:45 麻醉開始 11:55 誘導結束 12:18 手術開始 12:35 開始輸血 13:15 麻醉結束 16:40 手術結束 16:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 區域筋膜切除術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Regional fasciectomy 開立醫師: 趙崧筌 開立時間: 2011/11/24 14:00 Pre-operative Diagnosis Abscess formation at left calf and knee joint Post-operative Diagnosis Septic arthritis of left knee with abscess formation at left calf Operative Method Regional fasciectomy Specimen Count And Types 1 piece About size:piecemeal Source:necrotic fascia Pathology Pending Operative Findings Chalk-like material and 150ml pus were drained from the left knee joint via upper and lateral incision and the orthopediologist suggested further arthrotomy if needed. The other two S incisions were made at left medial calf to drain the pus accumulation (about 100ml) between soleus and gastrocnemius muscle and the muscular texture was unhealthy. His perioperative vitals were stable and estimated blood loss was around 20ml although component therapy was still given. Operative Procedures ETGA, supine, disinfected and prepped Made incisions to drain the accumulated pus Obtained pus culture and pathological specimen Irrigated the wounds with 10000ml warm saline Applied Bosmin wet gauze packing Operators 郭源松 Assistants 趙崧筌 吳建暉 Indication Of Emergent Operation suspected necrotizing fasciitis and pyomyositis 林品臻 (F,2011/02/26,1y0m) 手術日期 2011/11/25 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Prematurity 器械術式 Crainotomy for 3rd ventricle Tumor excision 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 石博元 ASA 3E 紀錄醫師 蔡宗良, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 07:00 通知急診手術 11:02 進入手術室 11:10 麻醉開始 12:30 誘導結束 12:45 抗生素給藥 13:17 手術開始 15:45 抗生素給藥 16:00 開始輸血 18:45 抗生素給藥 20:45 麻醉結束 20:45 手術結束 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4~8小時 1 1 R 手術 顱內壓視置入 1 2 R 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 11 0 摘要__ 手術科部: 套用罐頭: Right frontal craniotomy with transcortical a... 開立醫師: 蔡宗良 開立時間: 2011/11/25 21:49 Pre-operative Diagnosis Intraventricular tumor, suspect choroid plexus papilloma Post-operative Diagnosis Intraventricular tumor, choroid plexus papilloma Operative Method Right frontal craniotomy with transcortical approach for tumor removal Specimen Count And Types CSF x 4 Pathology Report pending Operative Findings 1. Fontanelle was tense and sized 4 x 3 cm with premature closure of coronal and sagittal sutures. Skull plate was egg-shell thin. 2. CSF appears to be clear colorless. Ventricle was severely enlarged. Tumor was pinkish to reddish in color, cauliflower in surface appearance, highly vascular, and well-dermarcated. Tumor situated in 3rd ventricle with extension into bilateral lateral ventricle through foramen of Monro. Right-sided foramen of Monro was enlarged by the tumor. Part of the column of fornix was injured during the process of removal. Right-sided caudate vein, together with thalamostriate vein converges to become internal cerebral vein was clearly visible after tumor was totally removed. Operative Procedures Under general anesthesia, patient was put in supine position with head in neutral position under donut head-rest. After routine disinfection and preparation, linear wound incision was employed as depicted. A 4 x 5 craniotomy was performed by high-speed burr. Tenting was performed every 1.5 cm in interval. Ventriculostomy was performed approximately 5 away from midline. CSF was drained to slightly slacken the brain. An X-shaped durotomy was performed. Microscope was brought into the surgical field. A 2 x 2 cm corticotomy was enlarged through the ventriculostomy tract. Tumor was circumferencially coagulated by bipolar cautery and performed circumferentially. Tumor encroached into the 3rd ventricle and left-sided lateral ventricle was pulled to visibility and coagulated by bipolar cautery before removal. After meticulous hemostasis, EVD was placed to the 3rd ventricle. Corticotomy was covered by artificial dura. Dura was closed by 4-0 prolene. Skull plate was fixed back to craniotomy window by 2-0 silk suture. Dura was centrally tented. After fixation of EVD, the scalp was closed in layers. Operators 郭夢菲 Assistants 蔡宗良 Indication Of Emergent Operation Increased intracranial pressure 相關圖片 記錄__ 手術科部: 套用罐頭: Right frontal craniotomy with transcortical a... 開立醫師: 郭夢菲 開立時間: 2011/11/28 12:42 Pre-operative Diagnosis Third intraventricular tumor with both lateral ventricle extension, choroid plexus papilloma Post-operative Diagnosis Third intraventricular tumor with both lateral ventricle extension, choroid plexus papilloma Operative Method 1. bicoronal incision, right frontal craniotomy with transcortical approach for total tumor removal 2. EVD for ICP monitoring Specimen Count And Types CSF x 4 Pathology Report pending Operative Findings 1. Fontanelle was tense and sized 4 x 3 cm with coronal and sagittal sutures widely separated. Skull plate was egg-shell thin. 2. CSF appears to be clear colorless. Ventricle was severely enlarged. Tumor was pinkish to reddish in color, cauliflower in surface appearance, highly vascular, and well-dermarcated. It was about 4.5X4.5 cm in diameter. Tumor situated in 3rd ventricle with extension into bilateral lateral ventricle through foramen of Monro, which were markedly widened. The column of fornix was very thin. Right-sided caudate vein, together with thalamostriate vein converges to become internal cerebral vein was clearly visible after tumor was totally removed. 3. The feeders came from the medial posterior choroid arteries, and was coagulated smoothly after much of the tumor was removed. Operative Procedures Under general anesthesia, patient was put in supine position with head in neutral position under donut head-rest. After routine disinfection and preparation, linear wound incision was employed as depicted. A 4 x 5 craniotomy was performed by high-speed burr. Tenting was performed every 1.0 cm in interval. Ventriculostomy was performed approximately 4 cm away from midline. CSF was drained to slightly slacken the brain. An X-shaped durotomy was performed. Microscope was brought into the surgical field. A 2 x 2 cm corticotomy was enlarged through the ventriculostomy tract. Tumor was circumferencially coagulated by bipolar cautery and performed circumferentially. Tumor encroached into the 3rd ventricle and left-sided lateral ventricle was pulled to visibility and coagulated by bipolar cautery before removal. After meticulous hemostasis, EVD was placed to the 3rd ventricle for 7 to 8 cm in depth. Corticotomy was covered by artificial dura, durogen to prevent CSF leakage into the subdural space. Dura was closed by 4-0 prolene. Skull plate was fixed back to craniotomy window by 2-0 silk suture. Dura was centrally tented. After fixation of EVD, the scalp was closed in layers. Operators 郭夢菲 Assistants 蔡宗良 Indication Of Emergent Operation Increased intracranial pressure 相關圖片 林李阿娥 (F,1943/11/01,68y4m) 手術日期 2011/11/25 手術主治醫師 賴達明 手術區域 東址 005房 01號 診斷 Lumbar Spondylosis 器械術式 T12 corpectomy + fusion with body cage and Z-plate --> Removal of T10, T11, and L1 TPS 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 張哲瑋, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:05 進入手術室 08:10 麻醉開始 08:55 誘導結束 08:55 抗生素給藥 09:29 手術開始 11:55 抗生素給藥 12:12 12:50 麻醉結束 12:50 12:50 手術結束 13:00 送出病患 16:45 進入恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-前融合,有固定物)≦四節 1 1 手術 骨內固定物拔除術-脊椎 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Anterior T12 corpectomy, anterior fusion with... 開立醫師: 曾峰毅 開立時間: 2011/11/25 13:12 Pre-operative Diagnosis Compression fracture, T12, status post posterior fixaiton at T10-11 and L1, complicated with L1 instrumentation pulled out Post-operative Diagnosis Compression fracture, T12, status post posterior fixaiton at T10-11 and L1, complicated with L1 instrumentation pulled out Operative Method Anterior T12 corpectomy, anterior fusion with mesh cage and autologous bone graft, anterior fixation with Z-plate, removal of posterior instrumentation of T10, T11, and L1 Specimen Count And Types Nil Pathology Nil Operative Findings T12 vertebral body was resected. Medtronic titanium mesh cage with autologous bone graft was used for fusion. Medtronic Z-plate was used for anterior fixaiton, and screws was inserted into T11 and L1. Pleural cavity was not opened. Previous instrumentation at L1 was loosened. Operative Procedures With endotracheal general anaesthesia, the patient was put in right decubitus position. After skin scrubbed, disinfected, and then draped, we made one oblique skin incision at left subcotal area. We dissected to expose left T11 rib, and transected it. We dissected along retroplerual space to T12 vertebral body exposed. We peformed T12 corpectomy with osteotome, and removed T11/12 and T12/L1 intervertebral disc. Titanium mesh cage with auologous bone graft was implanted. Anterior fixation with Z-plate was done at T11 and L1. The wound was closed in layers after one submuscular CWV. We change the patients position to prone positin. We scrubbed, disinfected, and then draped the patients back as usual. One midline skin incision was made along previous operation wound. Paraspinous muscle was dissected to expose previous instrumentation. The screws, rods, cross-link were all removed. The wound was closed in layersf after one submuscular CWV. Operators VS 賴達明 Assistants R5 曾峰毅 R1 張哲瑋 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Anterior T12 corpectomy, anterior fusion with... 開立醫師: 曾峰毅 開立時間: 2011/11/25 13:17 Pre-operative Diagnosis Compression fracture, T12, status post posterior fixaiton at T10-11 and L1, complicated with L1 instrumentation pulled out Post-operative Diagnosis Compression fracture, T12, status post posterior fixaiton at T10-11 and L1, complicated with L1 instrumentation pulled out Operative Method Anterior T12 corpectomy, anterior fusion with mesh cage and autologous bone graft, anterior fixation with Z-plate, removal of posterior instrumentation of T10, T11, and L1 Specimen Count And Types Nil Pathology Nil Operative Findings T12 vertebral body was resected. Medtronic titanium mesh cage with autologous bone graft was used for fusion. Medtronic Z-plate was used for anterior fixaiton, and screws was inserted into T11 and L1. Pleural cavity was not opened. Previous instrumentation at L1 was loosened. Operative Procedures With endotracheal general anaesthesia, the patient was put in right decubitus position. After skin scrubbed, disinfected, and then draped, we made one oblique skin incision at left subcotal area. We dissected to expose left T11 rib, and transected it. We dissected along retroplerual space to T12 vertebral body exposed. We peformed T12 corpectomy with osteotome, and removed T11/12 and T12/L1 intervertebral disc. Titanium mesh cage with auologous bone graft was implanted. Anterior fixation with Z-plate was done at T11 and L1. The wound was closed in layers after one submuscular CWV. We change the patients position to prone positin. We scrubbed, disinfected, and then draped the patients back as usual. One midline skin incision was made along previous operation wound. Paraspinous muscle was dissected to expose previous instrumentation. The screws, rods, cross-link were all removed. The wound was closed in layersf after one submuscular CWV. Operators VS 賴達明 Assistants R5 曾峰毅 R1 張哲瑋 相關圖片 顏楊鈴 (F,1943/09/25,68y5m) 手術日期 2011/11/25 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Secondary cancer of brain and spinal cord 器械術式 Left frontal brain metastatic tumor excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 08:06 進入手術室 08:14 麻醉開始 08:33 誘導結束 09:00 抗生素給藥 09:15 手術開始 11:50 手術結束 11:50 麻醉結束 12:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除-手術時間在4小時以內 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Left frontal craniotomy for total tumor excision. 開立醫師: 鍾文桂 開立時間: 2011/11/25 11:45 Pre-operative Diagnosis Left frontal brain tumor, suspect brain metastasis. Post-operative Diagnosis Left frontal brain tumor, suspect brain metastasis. Operative Method Left frontal craniotomy for total tumor excision. Specimen Count And Types 1 piece About size:2cm Source:left frontal brain tumor. Pathology Pending. Operative Findings Under ultrasonography guidance, the tumor was resected in en bloc fashion. The tumor is red-grayish in moderate vascularity. Operative Procedures Under ETGA, the patient was placed in supine position and the head was tilted to the right side. After shaving, disinfection, and draping, a curvilinear scalp incision was made. After dissection, a 6cm craniotomy plate was obtained by using high speed drill. The dura mater was incised in U shape. The tumor was identified by ultrasonography. The tumor was resected and dissected from the surrounding brian parenchyma. After well hemostasis, the craniotomy plate was fixed by miniplates and screws. The wound was closed in layers. Operators 賴達明 Assistants R6鍾文桂 R3曾偉倫. 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Left frontal craniotomy for total tumor excision. 開立醫師: 曾偉倫 開立時間: 2011/12/06 08:56 Pre-operative Diagnosis Left frontal brain tumor, suspect brain metastasis. Post-operative Diagnosis Left frontal brain tumor, suspect brain metastasis. Operative Method Left frontal craniotomy for total tumor excision. Specimen Count And Types 1 piece About size:2cm Source:left frontal brain tumor. Pathology Pending. Operative Findings Under ultrasonography guidance, the tumor was resected in en bloc fashion. The tumor is red-grayish in moderate vascularity. Operative Procedures Under ETGA, the patient was placed in supine position and the head was tilted to the right side. After shaving, disinfection, and draping, a curvilinear scalp incision was made. After dissection, a 6cm craniotomy plate was obtained by using high speed drill. The dura mater was incised in U shape. The tumor was identified by ultrasonography. The tumor was resected and dissected from the surrounding brian parenchyma. After well hemostasis, the craniotomy plate was fixed by miniplates and screws. The wound was closed in layers. Operators 賴達明 Assistants R6鍾文桂 R3曾偉倫. 相關圖片 黃冠寧 (M,1987/01/18,25y1m) 手術日期 2011/11/25 手術主治醫師 賴達明 手術區域 東址 005房 02號 診斷 Lumbar Spondylosis 器械術式 L4/5, L5/S1 microdiskectomy 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 1 紀錄醫師 張哲瑋, 時間資訊 00:00 臨時手術NPO 12:43 報到 13:25 進入手術室 13:30 麻醉開始 13:40 誘導結束 13:45 抗生素給藥 14:08 手術開始 16:15 手術結束 16:15 麻醉結束 16:40 送出病患 16:45 進入恢復室 17:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 椎間盤切除術-腰椎 1 1 L 手術 椎間盤切除術-腰椎 1 2 L 摘要__ 手術科部: 外科部 套用罐頭: HIVD 開立醫師: 曾峰毅 開立時間: 2011/11/25 16:08 Pre-operative Diagnosis HIVD, L4/5 and L5/S1 Post-operative Diagnosis HIVD, L4/5 and L5/S1 Operative Method Microdiksectomy L4/5 and L5/S1 Specimen Count And Types Nil Pathology nil Operative Findings Ruptured intervertebral disc material of L4/5 and L5/S1 compromised left L5 and S1 root tightly. Neural structure was decompressed well after the surgery. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After C-arm localization, we made one midline skin incision and dissected left paraspinous muslce to expose interlaminar space of L4/5 and L5/S1. We performed left L5/S1 laminotomy, and performed diskectomy at L5/S1. We performed left L4/5 laminotomy, and then diskecotmy of L4/5. We closed the wound in layers. Operators 賴達明 Assistants R5 曾峰毅 R1 張哲瑋 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: HIVD 開立醫師: 張哲瑋 開立時間: 2011/11/25 16:43 Pre-operative Diagnosis HIVD, L4/5 and L5/S1 Post-operative Diagnosis HIVD, L4/5 and L5/S1 Operative Method Microdiksectomy L4/5 and L5/S1 Specimen Count And Types Nil Pathology nil Operative Findings Ruptured intervertebral disc material of L4/5 and L5/S1 compromised left L5 and S1 root tightly. Neural structure was decompressed well after the surgery. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After C-arm localization, we made one midline skin incision and dissected left paraspinous muslce to expose interlaminar space of L4/5 and L5/S1. We performed left L5/S1 laminotomy, and performed diskectomy at L5/S1. We performed left L4/5 laminotomy, and then diskecotmy of L4/5. We closed the wound in layers. Operators 賴達明 Assistants R5 曾峰毅 R1 張哲瑋 相關圖片 張琪 (M,1961/11/08,50y4m) 手術日期 2011/11/25 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Spinal tumor 器械術式 C7 intramedullary tumor excision 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 3 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 08:07 進入手術室 08:15 麻醉開始 08:30 誘導結束 08:45 抗生素給藥 09:27 手術開始 12:13 抗生素給藥 15:10 手術結束 15:10 麻醉結束 15:20 送出病患 15:25 進入恢復室 16:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 Peripheral arterial line inserti 1 0 手術 脊椎內脊髓內腫瘤切除術 1 1 記錄__ 手術科部: 外科部 套用罐頭: C6(partial), C7, T1, and T1(partial) laminect... 開立醫師: 李振豪 開立時間: 2011/11/25 15:44 Pre-operative Diagnosis C7 intramedullary tumor, suspect ependymoma or glioma Post-operative Diagnosis C7 intramedullary tumor, favor glioma Operative Method C6(partial), C7, T1, and T1(partial) laminectomy for intramedullary tumor excision Specimen Count And Types 1 piece About size:Multiple small pieces Source:C7 Intramedullary tumor Pathology Frozen section: high grade glioma Operative Findings Before the operation, lower limbs MEP was all absent. Poor left lower limb SSEP also found. The MEP and SSEP over bilateral upper limbs were good. The tumor was hyperechogenicity with ill-defined border under intra-operative sonography before dural opening. The tumor was gray-reddish, hypervascularized, soft, and ill-defined with left side of spinal cord. The right side border of the tumor was relative clear. Frozen section was sent and glioma was favored first time. We sent more specimen for second time frozen section and high grade glioma was favored because necrosis was yielded. Debulking and subtotal excision of the tumor was conducted since glioma was favored. Transient left lower limb SSEP change was noted during manipulation and returned to baseline soon. Floseal was applied after tumor excision. The lower limbs MEP still absent after whole procedure. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position with head fixed with Mayfield skull clamp. The C7 and T1 level were localized by portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made from C6 to T2 level. The subcutaneous soft tissue was devided. The paraspinal muscle groups were detached. Partial C6, T2, and total C7, T1 laminectomy was performed. Intra-operative sonography was used for confirmed the location of the tumor. Midline durotomy was conducted and dura was tenting to keep opening of durotomy. Midline myelotomy was performed and the tumor was encountered. The tumor was debulking by CUSA and dissected along the border for tumor excision. After subtotal tumor excision, hemostasis was achieved with Floseal and bipolar electrocautery. The dura was closed with 5-0 Prolene. One epidural CWV drain was placed. The wound was irrigated with Gentamicin solution. The wound was then closed in layers with 1-0, 2-0 Vicryl and 3-0 Nylon. Operators VS賴達明 Assistants R5李振豪, R1李嘉哲 相關圖片 翁添贊 (M,1944/02/26,68y0m) 手術日期 2011/11/25 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Lumbar spondylosis 器械術式 C3-6 laminoplasty 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 3 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 12:26 進入手術室 12:37 麻醉開始 12:45 誘導結束 12:50 抗生素給藥 12:58 手術開始 15:50 抗生素給藥 16:33 手術結束 16:33 麻醉結束 16:56 送出病患 17:00 進入恢復室 18:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓整形術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Laminoplasty, C3-6. 開立醫師: 鍾文桂 開立時間: 2011/11/25 16:23 Pre-operative Diagnosis Spinal stenosis,C3-6. Post-operative Diagnosis Spinal stenosis,C3-6. Operative Method Laminoplasty, C3-6. Specimen Count And Types nil Pathology nil. Operative Findings Hypertrophic ligamentum flavum. A small dura tear at right C5 level. Open door method, right side. Operative Procedures Operators 賴達明 Assistants 鍾文桂 曾偉倫 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Laminoplasty, C3-6. 開立醫師: 曾偉倫 開立時間: 2011/11/25 16:52 Pre-operative Diagnosis Spinal stenosis,C3-6. Post-operative Diagnosis Spinal stenosis,C3-6. Operative Method Laminoplasty, C3-6. Specimen Count And Types nil Pathology nil. Operative Findings Hypertrophic ligamentum flavum. A small dura tear at right C5 level. Open door method, right side. Operative Procedures Under ETGA, we placed the patient on prone position after we fixed his head with Mayfield clamp. After we shaved, scrubbed, disinfected and drapped, a linear skin incision was made from C2-C7 level above the mid-line. The wound was opened in layers and the para-spinal muscle was resected. C3-C6 laminoplasty was done smoothly. A incidental durotomy was made over right C5 level and we packed the durotomy with Gelfoam. A CWV drain was placed after complete hemostasis. The wound was closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS 賴達明 Assistants R6 鍾文桂 R3 曾偉倫 相關圖片 李玉敏 (F,1941/09/12,70y6m) 手術日期 2011/11/25 手術主治醫師 賴達明 手術區域 東址 019房 02號 診斷 Spinal stenosis, lumbar 器械術式 L3-5 sublaminar decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 3 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 14:50 報到 15:50 進入手術室 15:55 麻醉開始 16:10 誘導結束 16:20 抗生素給藥 16:33 手術開始 17:55 手術結束 17:55 麻醉結束 18:04 送出病患 18:08 進入恢復室 19:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術(減壓)-二節以內 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 記錄__ 手術科部: 外科部 套用罐頭: L3/4, L4/5 sublaminar decompression 開立醫師: 李振豪 開立時間: 2011/11/25 18:15 Pre-operative Diagnosis L3-5 lumbar stenosis Post-operative Diagnosis L3-5 lumbar stenosis Operative Method L3/4, L4/5 sublaminar decompression Specimen Count And Types nil Pathology Nil Operative Findings Hypertrophic ligmentum flavum and marginal spur formation with thecal sac and neural foramen compression was noted. After sublaminar decompression and bilateral foraminotomy, the thecal sac expanded well. Part of dura tear(not whole layer) was noted over right L4/5 level and packing with Gelfoam. No obvious CSF leakage was noted during whole procedure. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position. The L4/5 level was localized by portable C-arm. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made and the subcutaneous soft tissue was devided. The L3 and L4 spinous processes were splitted by oscillating saw. The spinous process was fractured. L3/4 and L4/5 laminotomy followed by sublaminar decompression was performed with Rongeur, Kerrison punches, and curette. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. The wound was then closed in layers with 1-0, 2-0 Vicryl and 3-0 Nylon. Operators VS賴達明 Assistants R5李振豪, R1李嘉哲 李雲田 (M,1925/08/21,86y6m) 手術日期 2011/11/26 手術主治醫師 王國川 手術區域 東址 026房 01號 診斷 Subarachnoid hemorrhage 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 王永彬 ASA 4E 紀錄醫師 曾偉倫, 游皓鈞, 時間資訊 18:00 臨時手術NPO 18:00 開始NPO 20:30 通知急診手術 02:15 進入手術室 02:20 麻醉開始 02:26 誘導結束 03:10 手術開始 04:10 手術結束 04:10 麻醉結束 04:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 硬腦膜外血腫清除術 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Epidural hematoma removal 開立醫師: 曾偉倫 開立時間: 2011/11/26 04:20 Pre-operative Diagnosis Acute subdural hematoma, right, status post craniectomy, complicated with acute epidural hematoma Post-operative Diagnosis Acute subdural hematoma, right, status post craniectomy, complicated with acute epidural hematoma Operative Method Epidural hematoma removal Specimen Count And Types Nil Pathology Nil Operative Findings Epidural hematoma, about 2-3 cm thick, was noted at right side. Oozing from subgaleal space was noted. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position. After scalp shaved, scrubbed, disinfected, and draped, we made skin incision along previous operation wound. We removed epidural hematoma, and opened subdural space to re-insert ICP monitor. After hemostasis, we placed another epidural CWV. The wound was closed in layers. Operators VS 王國川 Assistants R5 曾峰毅 R3 曾偉倫 R2 游皓鈞 Indication Of Emergent Operation 相關圖片 摘要__ 手術科部: 外科部 套用罐頭: Epidural hematoma removal 開立醫師: 曾偉倫 開立時間: 2011/11/26 04:21 Pre-operative Diagnosis Acute subdural hematoma, right, status post craniectomy, complicated with acute epidural hematoma Post-operative Diagnosis Acute subdural hematoma, right, status post craniectomy, complicated with acute epidural hematoma Operative Method Epidural hematoma removal Specimen Count And Types Nil Pathology Nil Operative Findings Epidural hematoma, about 2-3 cm thick, was noted at right side. Oozing from subgaleal space was noted. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position. After scalp shaved, scrubbed, disinfected, and draped, we made skin incision along previous operation wound. We removed epidural hematoma, and opened subdural space to re-insert ICP monitor. After hemostasis, we placed another epidural CWV. The wound was closed in layers. Operators VS 王國川 Assistants R5 曾峰毅 R3 曾偉倫 R2 游皓鈞 Indication Of Emergent Operation IICP 相關圖片 李雲田 (M,1925/08/21,86y6m) 手術日期 2011/11/25 手術主治醫師 王國川 手術區域 東址 002房 01號 診斷 Subarachnoid hemorrhage 器械術式 Craniotomy for right acute SDH removal 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 4E 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 01:25 通知急診手術 01:45 進入手術室 01:50 麻醉開始 02:15 誘導結束 02:33 抗生素給藥 02:45 手術開始 03:15 開始輸血 05:45 手術結束 05:45 麻醉結束 05:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 急性硬腦膜下血腫清除術 1 1 R 手術 顱內壓視置入 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Decompressive craniectomy for evacuation of a... 開立醫師: 王奐之 開立時間: 2011/11/25 06:10 Pre-operative Diagnosis Head injury with acute subdural hemorrhage, right frontal-temporal-parietal Post-operative Diagnosis Head injury with acute subdural hemorrhage, right frontal-temporal-parietal, contusional ICH and linear skull fracture Operative Method Decompressive craniectomy for evacuation of acute subdural hemorrhage, duroplasty & insertion of ICP monitor Specimen Count And Types nil Pathology Nil Operative Findings 1. A laceration wound at right occiput. 2. Severe adhesion of dura mater to skull bone; dura repair with Surgisis artificial dura mater. 3. Contused brain at temporal and frontal regions. Oozing from bridging veins and cortical surface. 4. ICP after wound closure: -2mmHg. Fair brain pulsation after SDH evacuation. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After shaving, scrubbing, disinfection & draping in sterile fashion, a question-mark incision was made at right frontotemporoparietal area. After reflecting the skin flap anteroinferiorly, 5 burr holes were made, followed by craniectomy. After removal of the bone flap, durotomy was performed along the lacerating dura. The subdural hematoma was evacuated, and the contused bleeders were hemostasized. After achieving hemostasis, contusional surfaces were packed with Surgicel. The dura was closed with Surgisis artificial dura with 4-0 Prolene continuous sutures. After insertion of a subdural ICP monitor & setting up one subgaleal CWV drain, the wound was closed in layers. Operators VS 王國川 Assistants R6 鍾文桂, R4 王奐之 Indication Of Emergent Operation IICP 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Decompressive craniectomy for evacuation of a... 開立醫師: 王奐之 開立時間: 2011/11/25 06:11 Pre-operative Diagnosis Head injury with acute subdural hemorrhage, right frontal-temporal-parietal Post-operative Diagnosis Head injury with acute subdural hemorrhage, right frontal-temporal-parietal, contusional ICH and linear skull fracture Operative Method Decompressive craniectomy for evacuation of acute subdural hemorrhage, duroplasty & insertion of ICP monitor Specimen Count And Types nil Pathology Nil Operative Findings 1. A laceration wound at right occiput. 2. Severe adhesion of dura mater to skull bone; dura repair with Surgisis artificial dura mater. 3. Contused brain at temporal and frontal regions. Oozing from bridging veins and cortical surface. 4. ICP after wound closure: -2mmHg. Fair brain pulsation after SDH evacuation. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After shaving, scrubbing, disinfection & draping in sterile fashion, a question-mark incision was made at right frontotemporoparietal area. After reflecting the skin flap anteroinferiorly, 5 burr holes were made, followed by craniectomy. After removal of the bone flap, durotomy was performed along the lacerating dura. The subdural hematoma was evacuated, and the contused bleeders were hemostasized. After achieving hemostasis, contusional surfaces were packed with Surgicel. The dura was closed with Surgisis artificial dura with 4-0 Prolene continuous sutures. After insertion of a subdural ICP monitor & setting up one subgaleal CWV drain, the wound was closed in layers. Operators VS 王國川 Assistants R6 鍾文桂, R4 王奐之 Indication Of Emergent Operation IICP 相關圖片 邱廖芙蓉 (F,1934/08/01,77y7m) 手術日期 2011/11/26 手術主治醫師 王國川 手術區域 東址 001房 01號 診斷 Subarachnoid hemorrhage 器械術式 V-P shunt, left 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 王永彬 ASA 4E 紀錄醫師 游皓鈞, 曾偉倫, 時間資訊 12:00 臨時手術NPO 12:00 開始NPO 17:01 通知急診手術 05:28 進入手術室 06:15 麻醉開始 06:25 誘導結束 06:40 手術開始 07:48 手術結束 07:48 麻醉結束 07:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦室腹腔分流手術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 曾峰毅 開立時間: 2011/11/26 07:32 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunt via left Kocher Specimen Count And Types Nil Pathology Nil Operative Findings Codman, programmable Hakim valve, set at 120 mmH20, was used for shunt system. Opening pressure was about 15 cm H20. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to right. We made one transverse skin incision at left frontal area, and drilled one burr hole. Durotomy was done, but arachnoid villi was encountered. We drilled another burr hole 1-cm anterior to our first burr hole. We created durotomy, and performed ventriculostomy. We made another left upper abdomen transverse skin incision, and performed mini-laparotomy. We inserted peritoneal cathter, and pulled out the catheter through subcutaneous tunnel to left occpital area. We inserted ventricular catheter, and connected the shunt together. We checked the shunt function, and closed the wound in layers. Operators VS 王國川 Assistants R5 曾峰毅 R3 曾偉倫 R1 游皓均 Indication Of Emergent Operation IICP 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 曾偉倫 開立時間: 2011/11/26 07:59 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunt via left Kocher Specimen Count And Types Nil Pathology Nil Operative Findings Codman, programmable Hakim valve, set at 120 mmH20, was used for shunt system. Opening pressure was about 15 cm H20. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to right. We made one transverse skin incision at left frontal area, and drilled one burr hole. Durotomy was done, but arachnoid villi was encountered. We drilled another burr hole 1-cm anterior to our first burr hole. We created durotomy, and performed ventriculostomy. We made another left upper abdomen transverse skin incision, and performed mini-laparotomy. We inserted peritoneal cathter, and pulled out the catheter through subcutaneous tunnel to left occpital area. We inserted ventricular catheter, and connected the shunt together. We checked the shunt function, and closed the wound in layers. Operators VS 王國川 Assistants R5 曾峰毅 R3 曾偉倫 R1 游皓均 Indication Of Emergent Operation IICP 相關圖片 胡照雄 (M,1955/02/11,57y1m) 手術日期 2011/11/26 手術主治醫師 李章銘 手術區域 東址 018房 03號 診斷 Esophageal cancer 器械術式 Port-A catheter implatation 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 郝政鴻, 時間資訊 12:45 進入手術室 12:50 抗生素給藥 13:00 麻醉開始 13:01 誘導結束 13:01 麻醉結束 13:02 手術開始 13:30 手術結束 13:32 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 port–A導管植入術–治療性導管植入術 1 0 L 記錄__ 手術科部: 外科部 套用罐頭: Port-A 開立醫師: 郝政鴻 開立時間: 2011/11/26 13:34 Pre-operative Diagnosis Esophageal cancer Post-operative Diagnosis Esophageal cancer Operative Method Port-A insertion Specimen Count And Types nil Pathology nil Operative Findings The port-A catheter was inserted to left subclavian via puncture method, checked by portable CXR Operative Procedures 1. LA, supine 2. Skin disinfection and draping as usual 3. Insert Port-A via puncture method 4. Checked by portable CXR, close wound in layers Operators VS李章銘 Assistants R4郝政鴻 陳素貞 (F,1955/08/01,56y7m) 手術日期 2011/11/27 手術主治醫師 蔡瑞章 手術區域 東址 002房 01號 診斷 Fever 器械術式 right EVD 手術類別 緊急手術 手術部位 頭、頸 傷口分類 污染 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 3E 紀錄醫師 游健生, 時間資訊 17:00 臨時手術NPO 17:00 開始NPO 20:12 通知急診手術 03:20 進入手術室 03:35 麻醉開始 03:45 誘導結束 04:00 抗生素給藥 04:30 手術開始 05:20 手術結束 05:20 麻醉結束 05:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 歐氏貯囊置放手術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 創傷醫學部 套用罐頭: Ommaya implantation via right Kocher point 開立醫師: 游健生 開立時間: 2011/11/27 05:37 Pre-operative Diagnosis 1. Right isolated ventricle with hydrocephalus 2. Suspect ventriculitis Post-operative Diagnosis 1. Right isolated ventricle with hydrocephalus 2. Suspect ventriculitis Operative Method Ommaya implantation via right Kocher point Specimen Count And Types 1 piece About size:6cc Source:CSF Pathology Nil Operative Findings Light yellowish with little debris CSF gashed out after ventriculostomy. The opening pressure was about 25cmH2O. The ventricle catheter was about 6.5cm in length. CSF was sent for biochem, routine, culture, indian ink, Crytococcal antigen, TB culture and PCR. Total 25cc CSF was drained during the surgery. Operative Procedures Under ETGA, patient was in supine position. After shaving, we disinfected and draped the operation field as usual. A Curvilinear scalp incision was made at Right Kocher region. The scalp flap was elevated and a burhole was done. After cruciated durotomy, a ventriculostomy was performed followed by Ommaya implantation. After hemostasis, wound was closed in layers with 3-0 Vicryl and 4-0 Nylon. Operators P 蔡瑞章 Assistants R6 鍾文桂 R4 游健生 Indication Of Emergent Operation Progressive deterioration of consciousness 相關圖片 記錄__ 手術科部: 創傷醫學部 套用罐頭: Ommaya implantation via right Kocher point 開立醫師: 游健生 開立時間: 2011/11/27 05:38 Pre-operative Diagnosis 1. Right isolated ventricle with hydrocephalus 2. Suspect ventriculitis Post-operative Diagnosis 1. Right isolated ventricle with hydrocephalus 2. Suspect ventriculitis Operative Method Ommaya implantation via right Kocher point Specimen Count And Types 1 piece About size:6cc Source:CSF Pathology Nil Operative Findings Light yellowish with little debris CSF gashed out after ventriculostomy. The opening pressure was about 25cmH2O. The ventricle catheter was about 6.5cm in length. CSF was sent for biochem, routine, culture, indian ink, Crytococcal antigen, TB culture and PCR. Total 25cc CSF was drained during the surgery. Operative Procedures Under ETGA, patient was in supine position. After shaving, we disinfected and draped the operation field as usual. A Curvilinear scalp incision was made at Right Kocher region. The scalp flap was elevated and a burhole was done. After cruciated durotomy, a ventriculostomy was performed followed by Ommaya implantation. After hemostasis, wound was closed in layers with 3-0 Vicryl and 4-0 Nylon. Operators P 蔡瑞章 Assistants R6 鍾文桂 R4 游健生 Indication Of Emergent Operation Progressive deterioration of consciousness 相關圖片 劉聯坤 (M,1925/01/19,87y1m) 手術日期 2011/11/26 手術主治醫師 陳敞牧 手術區域 東址 003房 01號 診斷 Fracture, cervical – spine 器械術式 Anterior cervical discectomy, C3/4, and fusion with cage 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 4 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 08:10 進入手術室 08:35 麻醉開始 08:50 誘導結束 08:50 抗生素給藥 09:23 手術開始 12:15 手術結束 12:15 麻醉結束 12:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-頸椎 1 1 手術 椎融合術-前融合,無固定物(≦四節) 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: C3/4 anterior cervical diskectomy and fusion ... 開立醫師: 游健生 開立時間: 2011/11/27 02:26 Pre-operative Diagnosis C3/4 subluxation with cord compression Post-operative Diagnosis C3/4 subluxation with cord compression Operative Method C3/4 anterior cervical diskectomy and fusion with cage Specimen Count And Types nil Pathology Nil Operative Findings C3/4 subluxation resulted in C3 inferoposterior margin compressing the thecal sac tightly. Disrupted disc, anterior, and posterior longitudinal ligament were seen. After diskectomy and drilling of the C3 inferoposterior margin, the thecal sac was free from compression. A 7# cage (A-spine) was inserted into C3/4 intervertebral disc space. Operative Procedures Under ETGA, patient was in supine position with neck mildly extended. We located the C3/4 intervertebral disc space with C-arm. After disinfection and draping, a transverse neck incision was made about 4cm in length. The platysmus was transected and undermined. The anterior cervical fascia was opened obliquely along anterior border of SCM. We dissected along avascular plane and reached prevertebral space. We located C3/4 disc with C-arm. The anterior longitudinal ligament was opened and longus colli were detached. Under microscope, disckectomy was done after retraction of trachea/esophagus medially and carotid artery/IVJ laterally. The C3 inferoposterior margin was trimmed by air-drill for full decompression of thecal sac. Considerable epidural bleeding was noted after decompression and stopped by Gelfoam packing. A 7# cage was inserted into C3/4 disc space and position was confirmed by C-arm. After hemostasis and N/S irrigation, a CWV was placed. Wound was closed in layers. Operators VS 陳敝牧 Assistants R4 游健生 R1 李嘉哲 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: C3/4 anterior cervical diskectomy and fusion ... 開立醫師: 游健生 開立時間: 2011/11/27 02:27 Pre-operative Diagnosis C3/4 subluxation with cord compression Post-operative Diagnosis C3/4 subluxation with cord compression Operative Method C3/4 anterior cervical diskectomy and fusion with cage Specimen Count And Types nil Pathology Nil Operative Findings C3/4 subluxation resulted in C3 inferoposterior margin compressing the thecal sac tightly. Disrupted disc, anterior, and posterior longitudinal ligament were seen. After diskectomy and drilling of the C3 inferoposterior margin, the thecal sac was free from compression. A 7# cage (A-spine) was inserted into C3/4 intervertebral disc space. Operative Procedures Under ETGA, patient was in supine position with neck mildly extended. We located the C3/4 intervertebral disc space with C-arm. After disinfection and draping, a transverse neck incision was made about 4cm in length. The platysmus was transected and undermined. The anterior cervical fascia was opened obliquely along anterior border of SCM. We dissected along avascular plane and reached prevertebral space. We located C3/4 disc with C-arm. The anterior longitudinal ligament was opened and longus colli were detached. Under microscope, disckectomy was done after retraction of trachea/esophagus medially and carotid artery/IVJ laterally. The C3 inferoposterior margin was trimmed by air-drill for full decompression of thecal sac. Considerable epidural bleeding was noted after decompression and stopped by Gelfoam packing. A 7# cage was inserted into C3/4 disc space and position was confirmed by C-arm. After hemostasis and N/S irrigation, a CWV was placed. Wound was closed in layers. Operators VS 陳敝牧 Assistants R4 游健生 R1 李嘉哲 相關圖片 王光添 (M,1947/12/20,64y2m) 手術日期 2011/11/26 手術主治醫師 王國川 手術區域 東址 003房 03號 診斷 Subarachnoid hemorrhage 器械術式 Craniotomy(Aneurysms) P-DUH 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 4E 紀錄醫師 鍾文桂, 時間資訊 12:00 臨時手術NPO 12:00 開始NPO 18:50 通知急診手術 19:20 進入手術室 19:30 麻醉開始 19:50 抗生素給藥 19:50 誘導結束 19:52 手術開始 22:50 抗生素給藥 01:35 手術結束 01:35 麻醉結束 01:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱內壓視置入 1 2 手術 開顱術摘除血管病變 - 腦血管瘤 有病徵的 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: 1. Right pterional approach for aneurysm clip... 開立醫師: 鍾文桂 開立時間: 2011/11/27 02:33 Pre-operative Diagnosis Ruptured dorsal internal carotid artery aneurysm with diffuse subarachnoid hemorrhage. Post-operative Diagnosis Ruptured dorsal internal carotid artery aneurysm with diffuse subarachnoid hemorrhage. Operative Method 1. Right pterional approach for aneurysm clipping and repair of internal carotid artery. 2. Ventriculosotmy for ICP monitoring and CSF drainage. Specimen Count And Types 1 piece About size:3cc Source:CSF. Pathology Nil. Operative Findings 1. A blister like wide-base aneurysm about 3 mm in size arising from dorsal aspect of internal carotid artery( just distal to anterior clinoid process.)The dome of the aneurysm adhered to the frontal lobe. Some part of the frontal lobe was sucted out for better exposure. The anterior clinoidectomy was obtained intradurally. 2. The aneurysm was initially cliped with a ENT forceps shaped Sugita aneurysm clip. However, during dural closuer, the aneurysm was transected by the clip and caused much hemorrhage. We applied tempoary clips to the distal and proximal ICA and repaired the ICA primarily with 8-0 prolene. And further aneurysm wrapping was done with fascia and TissuColDuo. A small part of the optic nerve was injured during repair. Operative Procedures Under ETGA, the patient was placed in supine position and the head was fixed by Maydfield and tilted to the left. After shaving, disinfection, and draping, a ventriculostomy was performed. Further craniotomy was obtained in right frontal-temporal regions. After a cruciate durotomy, the frontal lobe was retracted. The sylvian fissure was opened. The aneurysm was cliped with well preparation. Due to intraoperative transection of the aneurysm, the ICA was repaired primarily. With well hemostasis, the wound was closed in layers with one subgaleal drain in situ. Operators 王國川 Assistants 鍾文桂 Indication Of Emergent Operation Ａneurysm ruptured. 相關圖片 鄒湘齡 (F,1970/02/13,42y1m) 手術日期 2011/11/28 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Meningioma 器械術式 Left frontal parasagittal meningioma excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 08:10 進入手術室 08:15 麻醉開始 08:35 抗生素給藥 08:50 誘導結束 09:00 手術開始 11:30 抗生素給藥 13:30 手術結束 13:30 麻醉結束 13:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4~8小時 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Left frontal craniotomy for Simpson grade II ... 開立醫師: 鍾文桂 開立時間: 2011/11/28 14:16 Pre-operative Diagnosis Left frontal parasagital meningioma. Post-operative Diagnosis Left frontal parasagital meningioma. Operative Method Left frontal craniotomy for Simpson grade II tumor excision. Specimen Count And Types 1 piece About size:10cc Source:meningioma Pathology Pending. Operative Findings A well delineated yellowish-red, elastic tumor at left frontal parasagital area. The tumor has a 1 cm attachment to the parasagital area. The drainage vein located near midline. The arterial supply is from ACA. Very thick skull bone( 3 cm) Operative Procedures Under ETGA,the patient was placed in supine position and the head was fixed by mayfield. After shaving, disinfection, and draping, a curvilinear scalp incision was made. After dissection, a 10 cm craniotomy was obtained. The tumor was excised in piecemeal fashion after durotomy and meticulous dissection of the dura mater and cortical veins. After well hemostasis, the dura mater was closed in watertight fashion. After fixation of the craniotomy plate, the wound was closed layers. Operators 曾漢民 Assistants 鍾文桂 張哲瑋 相關圖片 王玉燕 (F,1952/01/03,60y2m) 手術日期 2011/11/28 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Pituitary tumor 器械術式 Trans-nasal trans-sphenoidal adenomectomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 14:00 進入手術室 14:05 麻醉開始 14:35 誘導結束 14:50 抗生素給藥 14:55 手術開始 16:20 開始輸血 16:43 手術結束 16:43 麻醉結束 16:55 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 經由蝶竇之腦下垂體瘤切除 1 1 摘要__ 手術科部: 外科部 套用罐頭: Translabila pituitary adenomectomy. 開立醫師: 鍾文桂 開立時間: 2011/11/28 17:11 Pre-operative Diagnosis Pituitary macroadenoma. Post-operative Diagnosis Pituitary macroadenoma. Operative Method Translabila pituitary adenomectomy. Specimen Count And Types 1 piece About size:3cc Source:pituitary adenoma. Pathology Pending. Operative Findings Postoperative change of nasal mucosa. Adenoma at sphenoid sinus. Soft, fragile, grey-pinkish. Drop down of arachnoid right after removal. Operative Procedures Under ETGA, the patient was placed in supine position and the head was rest on headrest. After disinfection, the nasal mucosa and upper labial mucosa was injected with lidocaine solution. The labial mucosa was incised. The nasal septum and vomer bone was resected until reaching the sphnoid sinus. After coagulation of the dura mater, the tumor was removed by suction, ring currete and tumor forceps. After well hemostasis, the labial mucosa was removed primarily. Operators 曾漢民 Assistants 鍾文桂 相關圖片 陳佛賜 (M,1932/12/19,79y2m) 手術日期 2011/11/28 手術主治醫師 蔡瑞章 手術區域 東址 001房 05號 診斷 Subdural hemorrhage 器械術式 burhole drainage of cSDH, right 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 石博元 ASA 4E 紀錄醫師 李振豪, 時間資訊 10:00 臨時手術NPO 10:00 開始NPO 14:23 通知急診手術 16:55 進入手術室 17:00 麻醉開始 17:10 誘導結束 17:30 抗生素給藥 17:48 手術開始 18:45 麻醉結束 18:45 手術結束 19:05 送出病患 19:07 進入恢復室 20:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 頭顱穿洞術(止血引流、穿刺檢查) 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: right frontal burr hole for drainage of chron... 開立醫師: 李振豪 開立時間: 2011/11/28 18:57 Pre-operative Diagnosis Chronic subdural hematoma, right fronto-temporo-parietal Post-operative Diagnosis Chronic subdural hematoma, right fronto-temporo-parietal Operative Method right frontal burr hole for drainage of chronic subdural hematoma Specimen Count And Types nil Pathology Nil Operative Findings Motor-oil like chronic subdural hematoma gushed out after opening of outer membrane. Total about 150ml chronic subdural hematoma was evacuated. Inner membrane was noted after hematoma evacuation. The subdural space was irrigated with 1000ml normal saline solution. The brain remain slack at the end of the procedure. One episode of hypotension occurred during hematoma evacuation and returned to baseline blood pressure soon. The patient stood whole procedure well. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head rotated to left. The scalp was shaved, scrubbed, and disinfected as usual. Linear scalp incision was made at right fronto-temporal area followed by one burr hole creation. Two dural tenting was done. Cruciform durotomy was conducted and coagulated with bipolar electrocautery. The outer membrane was coagulated and opened for drainage of chronic subdural hematoma. The edge of the outer membrane was coagulated again to avoid further bleeding. After evacuation of the chronic subdural hematoma, the subdural space was irrigated with 1000ml normal saline. One subdural rubber drain was placed. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Deair was achieved later after wound closure. Operators Prof.蔡瑞章 Assistants R5李振豪, R1李嘉哲 Indication Of Emergent Operation Uncal herniation with progressive hemiparesis 相關圖片 李秀珠 (F,1952/08/15,59y6m) 手術日期 2011/11/28 手術主治醫師 陳敞牧 手術區域 東址 003房 02號 診斷 Bone metastasis 器械術式 T6, T7, T9 TPS + T8 tumor excision 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3 紀錄醫師 蔡宗良, 曾偉倫, 時間資訊 00:00 臨時手術NPO 16:22 進入手術室 16:30 麻醉開始 17:00 誘導結束 17:00 抗生素給藥 17:20 手術開始 19:50 手術結束 19:50 麻醉結束 20:10 送出病患 20:11 進入恢復室 21:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 手術 惡性脊髓腫瘤切除術 1 1 手術 脊椎融合術-後融合,有固定物(<=六節) 1 2 記錄__ 手術科部: 外科部 套用罐頭: T7, T9 Trans-pedicle screw fixation + Laminec... 開立醫師: 曾偉倫 開立時間: 2011/11/28 20:13 Pre-operative Diagnosis 1. Left breast cancer, with spine metastasis, T5-7, status post lower T5-T7 laminectomy 2. Pathological compression fracture with central stenosis and cord compression at T8 Post-operative Diagnosis 1. Left breast cancer, with spine metastasis, T5-7, status post lower T5-T7 laminectomy 2. Pathological compression fracture with central stenosis and cord compression at T8 Operative Method T7, T9 Trans-pedicle screw fixation + Laminectomy T8 + T8 left rhizotomy with tumor excision Specimen Count And Types 1 piece About size:2x2x2 cm Source:Spine metastatic tumor Pathology Pending Operative Findings Tumor located in the body of T8 was greyish, high vascularity and fragile. Operative Procedures Under ETGA, we placed the patient on prone position. The T8 level was located with intra-operative C-arm. After we scrubbed, disinfected and drapped, a linear skin incision was made and the wound was opened in layers. The para-spinal muscle was divided and bilateral T7 and T9 transpedicular screw (4.5mm x 30 mm) were inserted. T8 laminectomy was done. Left sided T8 lamina was removed extensively towards the interbody space. T8 left-sided nerve root was transected after ligation. The metastic tumor resection was performed. Bilateral rod fixation to the TPS screw with cross-linkage was performed. After copious gentamicin saline irriagtion and meticulous hemostasis, the wound was closed in layers after placing an epidural HemoVac. Operators VS 陳敞牧 Assistants R6 蔡宗良 R3 曾偉倫 相關圖片 郭明裕 (M,1960/09/11,51y6m) 手術日期 2011/11/29 手術主治醫師 楊士弘 手術區域 東址 001房 07號 診斷 Cervical myelopathy 器械術式 C5/6, C6/7 anterior discectomy & cage insertion 手術類別 緊急手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 石博元 ASA 4E 紀錄醫師 曾峰毅, 時間資訊 09:00 臨時手術NPO 09:00 開始NPO 20:50 通知急診手術 23:19 進入手術室 23:25 麻醉開始 23:45 誘導結束 23:50 抗生素給藥 00:05 手術開始 02:20 麻醉結束 02:20 手術結束 02:25 送出病患 02:30 進入恢復室 03:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-頸椎 1 1 手術 脊椎融合術-前融合,有固定物)≦四節 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 摘要__ 手術科部: 外科部 套用罐頭: Anterior cervical diskectomy and fusion with ... 開立醫師: 曾峰毅 開立時間: 2011/11/29 02:27 Pre-operative Diagnosis Ruptured disc, C5/6 and C6/7, with acute spinal cord compression Post-operative Diagnosis Ruptured disc at C6/7 and spondylosis at C5/6, with acute spinal cord compression Operative Method Anterior cervical diskectomy and fusion with PEEK cage and artificial bone graft at C5/6 and C6/7 Specimen Count And Types Nil Pathology Nil Operative Findings Ruptured and sequestrated disc material compromised thecal sac tightly at C6/7. Posterior margical spur formation was noted at C5/6 with spinal canal stenosis and neural foramne stenosis. Neural structures were decompressed well after the surgery. Operative Procedures With endotracheal general anaesthesia, the patient was put in suipne position with neck extended. We made one transverse skin incision at right aspect of the neck, and dissected along the medial border of platysma until prevertebral space. After C-arm localization, we made anterior diskectomy of C5/6 and anterior fusion with PEEK cage and artificial bone graft. We made anterior diskectomy of C6/7 and anterior fusion with PEEK cage and artificial bone graft. The wound was closed in layers after one mini-hemovac placed. Operators VS 楊士弘 Assistants R5 曾峰毅 Indication Of Emergent Operation 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Anterior cervical diskectomy and fusion with ... 開立醫師: 曾峰毅 開立時間: 2011/11/29 02:29 Pre-operative Diagnosis Ruptured disc, C5/6 and C6/7, with acute spinal cord compression Post-operative Diagnosis Ruptured disc at C6/7 and spondylosis at C5/6, with acute spinal cord compression Operative Method Anterior cervical diskectomy and fusion with PEEK cage and artificial bone graft at C5/6 and C6/7 Specimen Count And Types Nil Pathology Nil Operative Findings Ruptured and sequestrated disc material compromised thecal sac tightly at C6/7. Posterior margical spur formation was noted at C5/6 with spinal canal stenosis and neural foramne stenosis. Neural structures were decompressed well after the surgery. Operative Procedures With endotracheal general anaesthesia, the patient was put in suipne position with neck extended. We made one transverse skin incision at right aspect of the neck, and dissected along the medial border of platysma until prevertebral space. After C-arm localization, we made anterior diskectomy of C5/6 and anterior fusion with PEEK cage and artificial bone graft. We made anterior diskectomy of C6/7 and anterior fusion with PEEK cage and artificial bone graft. The wound was closed in layers after one mini-hemovac placed. Operators VS 楊士弘 Assistants R5 曾峰毅 Indication Of Emergent Operation Acute cord compression 相關圖片 蔡鈴鈺 (F,1952/05/28,59y9m) 手術日期 2011/11/28 手術主治醫師 王國川 手術區域 東址 005房 03號 診斷 Low back pain 器械術式 L4/5 microdiskectomy 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 16:30 報到 17:23 進入手術室 17:25 麻醉開始 17:30 誘導結束 17:47 抗生素給藥 18:11 手術開始 19:55 手術結束 19:55 麻醉結束 20:10 送出病患 20:15 進入恢復室 21:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-腰椎 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 記錄__ 手術科部: 外科部 套用罐頭: Microscopic diskectomy, L4/5, left side approach. 開立醫師: 鍾文桂 開立時間: 2011/11/28 20:23 Pre-operative Diagnosis Herniated intervertebral disc, L4/5. Post-operative Diagnosis Herniated intervertebral disc, L4/5. Operative Method Microscopic diskectomy, L4/5, left side approach. Specimen Count And Types nil Pathology Nil. Operative Findings 1. A large ruptured disc at L4/5, left. slack root after diskectomy. Operative Procedures Under ETGA, the patient was placed in prone position. After intraoperative localization of L4/5 level, a 3 cm midline incision was made. Left paraspinal muscle was dissected. The L4 and L5 laminotomy were done. After retraction of the L5 root, the L4/5 disc was removed in piecemeal fashion. After well hemostasis, the wound was closed in layers. Operators 王國川 Assistants 鍾文桂 相關圖片 陳周月雲 (F,1947/09/01,64y6m) 手術日期 2011/11/29 手術主治醫師 蔡瑞章 手術區域 東址 002房 03號 診斷 Subdural hemorrhage or effusion 器械術式 Implantation of subduro-peritoneal shunt 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 曾偉倫, 時間資訊 04:00 臨時手術NPO 04:00 開始NPO 11:04 通知急診手術 13:08 進入手術室 13:15 麻醉開始 13:20 誘導結束 13:48 抗生素給藥 14:00 手術開始 14:38 麻醉結束 14:38 手術結束 14:43 送出病患 14:45 進入恢復室 15:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Leftg subdural peritoneal shunt 開立醫師: 曾偉倫 開立時間: 2011/11/29 14:51 Pre-operative Diagnosis Bilateral subdural effusion Post-operative Diagnosis Bilateral subdural effusion Operative Method Leftg subdural peritoneal shunt Specimen Count And Types nil Pathology Nil. Operative Findings 1. A 10mm-H2O Codman Hakim valve was placed 2. The shunt work well after placing the tube into subdural space 3. The subdural tube was 5cm, and the peritonium tube was 30cm. Operative Procedures Under ETGA, we placed the patient on supine position with her face tilt to left. A linear skin incision was made over left frontal area. The burr-hole was made with air-drived drill and dural tenting was made. The dura was opened after bipolar electrocalterized. A horizontal skin inciison was made over left abdominal area and the wound was opened in layers. The peritonium was opened. The bu-cutaneous tunnel was made and the drainage tube was placed. A 10mm-H2O resovior was placed and the shunt was placed from dub-dural space via sub-cutaneous route to peritoneal cavity. The wound was closed in layers after complete hemostasis. Operators Prof. 蔡瑞章 Assistants VS 王國川 R3 曾偉倫 R1 施培艾 Indication Of Emergent Operation 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Leftg subdural peritoneal shunt 開立醫師: 曾偉倫 開立時間: 2011/11/29 14:51 Pre-operative Diagnosis Bilateral subdural effusion Post-operative Diagnosis Bilateral subdural effusion Operative Method Leftg subdural peritoneal shunt Specimen Count And Types nil Pathology Nil. Operative Findings 1. A 10mm-H2O Codman Hakim valve was placed 2. The shunt work well after placing the tube into subdural space 3. The subdural catheter was 5cm, and the peritonium catheter was 30cm. Operative Procedures Under ETGA, we placed the patient on supine position with her face tilt to left. A linear skin incision was made over left frontal area. The burr-hole was made with air-drived drill and dural tenting was made. The dura was opened after bipolar electrocalterized. A horizontal skin inciison was made over left abdominal area and the wound was opened in layers. The peritonium was opened. The bu-cutaneous tunnel was made and the drainage tube was placed. A 10mm-H2O resovior was placed and the shunt was placed from dub-dural space via sub-cutaneous route to peritoneal cavity. The wound was closed in layers after complete hemostasis. Operators Prof. 蔡瑞章 Assistants VS 王國川 R3 曾偉倫 R1 施培艾 Indication Of Emergent Operation IICP 相關圖片 陳素真 (F,1958/02/20,54y0m) 手術日期 2011/11/29 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Lumbar spondylosis 器械術式 L4/5 TLIF 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 張書豪, 時間資訊 00:00 臨時手術NPO 07:38 報到 08:03 進入手術室 08:13 麻醉開始 08:20 誘導結束 08:40 抗生素給藥 08:55 手術開始 11:00 手術結束 11:00 麻醉結束 11:05 送出病患 11:08 進入恢復室 13:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎間盤切除術-腰椎 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 曾峰毅 開立時間: 2011/11/29 11:07 Pre-operative Diagnosis Spondylolisthesis, L4/5, grade I Post-operative Diagnosis Spondylolisthesis, L4/5, grade I Operative Method Transforaminal lumbar interbody fusion at L4/5 with PEEK cage and autologous bone graft, posterior fixation with transpedicular screws at L4 and L5 Specimen Count And Types 1 piece About size: Source: Pathology Nil Operative Findings Hypertrophic ligamentum flavum compromised thecal sat and bilatearl roots of L4 and L5 tightly. Neural structurew were decompressed well after the surgery. Synthes transpedicular screws, 6.2 x 45 mm, were used for posterior fixation at L4 and L5. Synthes PEEK cage with autologus bone graft was used for TLIF. Spondylolisthesis was reduced after cage insertion. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After back scrubbed, disinfected, and then draped, we made one midline skin incision and dissected paraspinous muscle to expose bilateral laminae from L3 to L5. Posterior instrumentation was performed with transpedicular screws into bilateral pedicles of L4 and L5. Posterior decompression was done with L4 laminectomy, and transformainal lumbar interbody fusion with done via right L4/5 neural foramen with PEEK cage and autologous bone graft. Posterior fixaiton was achieved with two 5-cm rods. The wound was irrigated with saline and gentamycin. After two submuscular hemovac set, the wound was closed in layers. Operators VS 曾勝泓 Assistants R5 曾峰毅 R1 張書豪 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 張書豪 開立時間: 2011/11/29 11:09 Pre-operative Diagnosis Spondylolisthesis, L4/5, grade I Post-operative Diagnosis Spondylolisthesis, L4/5, grade I Operative Method Transforaminal lumbar interbody fusion at L4/5 with PEEK cage and autologous bone graft, posterior fixation with transpedicular screws at L4 and L5 Specimen Count And Types 1 piece About size: Source: Pathology Nil Operative Findings Hypertrophic ligamentum flavum compromised thecal sat and bilatearl roots of L4 and L5 tightly. Neural structurew were decompressed well after the surgery. Synthes transpedicular screws, 6.2 x 45 mm, were used for posterior fixation at L4 and L5. Synthes PEEK cage with autologus bone graft was used for TLIF. Spondylolisthesis was reduced after cage insertion. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After back scrubbed, disinfected, and then draped, we made one midline skin incision and dissected paraspinous muscle to expose bilateral laminae from L3 to L5. Posterior instrumentation was performed with transpedicular screws into bilateral pedicles of L4 and L5. Posterior decompression was done with L4 laminectomy, and transformainal lumbar interbody fusion with done via right L4/5 neural foramen with PEEK cage and autologous bone graft. Posterior fixaiton was achieved with two 5-cm rods. The wound was irrigated with saline and gentamycin. After two submuscular hemovac set, the wound was closed in layers. Operators VS 曾勝泓 Assistants R5 曾峰毅 R1 張書豪 相關圖片 趙伯諺 (M,1988/02/25,24y0m) 手術日期 2011/11/29 手術主治醫師 曾勝弘 手術區域 東址 005房 02號 診斷 Lymphoma 器械術式 Left frontal tumor open biopsy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 蔡宗良, 時間資訊 00:00 臨時手術NPO 11:45 進入手術室 11:55 麻醉開始 12:20 誘導結束 12:30 手術開始 15:25 手術結束 15:25 麻醉結束 15:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for frontal lobe partial lobectomy 開立醫師: 張書豪 開立時間: 2011/11/29 15:53 Pre-operative Diagnosis Brain tumor, pathology unknown, frontal base, left-sided Post-operative Diagnosis Brain tumor, suspect perivascular lymphoma, frontal base, left-sided Operative Method Craniotomy for frontal lobe partial lobectomy Specimen Count And Types 1 piece About size:小 Source:Brain, frotal lobe Pathology Frozen section found atypical lymphoid cells at the perivascular tissue Operative Findings Tense dura with diffuse vasodilatation of brain surface vessels No visible brain parenchymal hemorrhage after systolic blood pressure was risen to 150 mmHg Moderate brain edema upon dura closure Operative Procedures 1. ETGA, supine, Mayfield fixation 2. Routine preparation 3. Curvilinear scalp incision, followed by frontal craniotomy 4. Tenting and X-shaped dura incision 5. Frontal lobe was reseted 3 x 3 cm in area with 3-cm deep 6. Frozen section was sent 7. After hemostasis, the dura was closed by 4-0 Prolene and pericranium 8. Skull plate was fixed back to the craniotomy window with mini-plate 9. The wound was closed in layers Operators 曾勝弘 Assistants R6蔡宗良 R1張書豪 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Craniotomy for frontal lobe partial lobectomy 開立醫師: 張書豪 開立時間: 2011/11/29 15:53 Pre-operative Diagnosis Brain tumor, pathology unknown, frontal base, left-sided Post-operative Diagnosis Brain tumor, suspect perivascular lymphoma, frontal base, left-sided Operative Method Craniotomy for frontal lobe partial lobectomy Specimen Count And Types 1 piece About size:小 Source:Brain, frotal lobe Pathology Frozen section found atypical lymphoid cells at the perivascular tissue Operative Findings Tense dura with diffuse vasodilatation of brain surface vessels No visible brain parenchymal hemorrhage after systolic blood pressure was risen to 150 mmHg Moderate brain edema upon dura closure Operative Procedures 1. ETGA, supine, Mayfield fixation 2. Routine preparation 3. Curvilinear scalp incision, followed by frontal craniotomy 4. Tenting and X-shaped dura incision 5. Frontal lobe was reseted 3 x 3 cm in area with 3-cm deep 6. Frozen section was sent 7. After hemostasis, the dura was closed by 4-0 Prolene and pericranium 8. Skull plate was fixed back to the craniotomy window with mini-plate 9. The wound was closed in layers Operators 曾勝弘 Assistants R6蔡宗良 R1張書豪 相關圖片 吳怡萱 (F,2011/05/22,9m27d) 手術日期 2011/11/29 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Other allied disorders of spine 器械術式 Cord untethering -KUO 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 石博元 ASA 3 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:05 進入手術室 08:25 麻醉開始 08:55 誘導結束 09:20 抗生素給藥 09:55 手術開始 12:20 抗生素給藥 15:20 抗生素給藥 16:02 手術結束 16:02 麻醉結束 16:30 送出病患 16:30 進入恢復室 17:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 良性脊髓腫瘤切除術 1 1 手術 椎弓整形術 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 7 0 摘要__ 手術科部: 外科部 套用罐頭: T3-L5 laminoplasty for T4-L4 intramedullary l... 開立醫師: 游健生 開立時間: 2011/11/29 17:27 Pre-operative Diagnosis T4-L4 intramedullary lipoma Post-operative Diagnosis T4-L4 intramedullary lipoma Operative Method T3-L5 laminoplasty for T4-L4 intramedullary lipoma excision Specimen Count And Types 1 piece About size:6x2cm Source:intraspinal lipoma Pathology Pending Operative Findings Pre-operative SSEP and MEP waveform were not detectable. The thecal sac was bulging from T8 to L1 and became paper-thin because of the large intramedullary lipoma inside. The lamina over this segment was thinner and wider than the other segment. The lipoma was encapsulated by a whitish fibrotic capsule which adhered to the dura tightly. It was on the dorsal aspect of the cord (T4-L4) and occupied most of the spinal canal. The plane between lipoma and spinal cord was unclear probably because it infiltrated into the cord. Operative Procedures Under ETGA, patient was in prone position. After marking T1 and L5 level, we disinfected and draped the operation field as usual. A lazy-S back incision was made from T3 to L5 followed by dissection. The paraspinal muscle was detached to expose T3-L5 lamina. The lamina were cut opened by Kerrison and flipped upward en bloc. Under microscope, the thecal sac was opened at midline from L5 level. The lipoma was seen on the dorsal aspect of cord. After the capsule was opened, tumor was debulked first on the dorsal side then further removed on both side with CUSA. The fibrotic capsule and some residual lipoma were left in situ because infiltrated into spinal cord. The capsule was closed with continuous 5-0 prolene suture. The thecal sac was closed in the same way followed by coverage by DuraGen. Lamina were fixed back with silk sutures. Paraspinal muscle was approximated. After hemostasis and irrigation, wound was closed in layers with 3-0 Vicryl and 4-0 Nylon. Operators VS 郭夢菲 Assistants R4 游健生 Ri 陳昱傑 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: T3-L5 laminoplasty for T4-L4 intramedullary l... 開立醫師: 郭夢菲 開立時間: 2011/11/30 17:10 Pre-operative Diagnosis T4-L4 intramedullary lipoma Post-operative Diagnosis T4-L4 intramedullary lipoma Operative Method T3-L5 laminoplasty for T4-L4 intramedullary lipoma excision Specimen Count And Types 1 piece About size:6x2cm Source:intraspinal lipoma Pathology Pending Operative Findings Pre-operative SSEP and MEP waveform were not detectable, so intraoperative monitoring was abandoned. Scoliotic change of the whole spine. The thecal sac was bulging from T8 to L1 and became paper-thin because of the large intramedullary lipoma inside. The lamina over this segment was thinner and wider than the other segment. The lipoma was encapsulated by a whitish fibrotic capsule which adhered to the dura, but could be separated from the dura. The lipoma on the dorsal aspect of the cord (T4-L4), occupying most of the spinal canal and extended into the bilateral intervertebral foramen and part of the ventral lateral spinal canal. The plane between lipoma and spinal cord was unclear, this part was left in situ. Operative Procedures Under ETGA, patient was in prone position. After marking T1 and L5 level, we disinfected and draped the operation field as usual. A lazy-S back incision was made from T3 to L5 due to preoperative scoliotic change of spine followed by dissection. The paraspinal muscle was detached to expose T3-L5 lamina. The laminae were cut opened by Kerrison and flipped upward en bloc. Under microscope, the thecal sac was opened at midline from L5 level. The lipoma was seen on the dorsal aspect of cord. After the capsule was opened, tumor was debulked first on the dorsal side then further removed on both side with CUSA. The fibrotic capsule and some residual lipoma just dorsal to the spinal cord were left in situ because of the absence of plane between the lipoma and cord. The capsule of the lipoma was closed with continuous 5-0 prolene suture. The thecal sac was closed in the same way followed by coverage by DuraGen. Lamina were fixed back with silk sutures at each level. Paraspinal muscle was approximated. After hemostasis and irrigation, wound was closed in layers with 3-0 Vicryl and 4-0 Nylon. Operators VS 郭夢菲 Assistants R4 游健生 Ri 陳昱傑 相關圖片 蘇嘉貞 (F,1948/12/12,63y3m) 手術日期 2011/11/29 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Cervical Spondylosis 器械術式 C3-6 laminoplasty 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:10 麻醉開始 08:15 誘導結束 08:25 抗生素給藥 09:03 手術開始 11:45 手術結束 11:45 麻醉結束 11:51 送出病患 11:55 進入恢復室 14:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓整形術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 記錄__ 手術科部: 外科部 套用罐頭: C3-7 laminoplasty, open-door method 開立醫師: 李振豪 開立時間: 2011/11/29 11:33 Pre-operative Diagnosis Ossification of posterior longitudinal ligment with cervical stenosis Post-operative Diagnosis Ossification of posterior longitudinal ligment with cervical stenosis Operative Method C3-7 laminoplasty, open-door method Specimen Count And Types nil Pathology Nil Operative Findings Open-door laminoplasty was performed with miniplates(five pieces) and screws(5mm x 5, 7mm x 5). The thecal sac expanded well after laminoplasty. Incidental durotomy was noted during grooving of the laminae. CSF leakage was noted. The durotomy was covered with Gelfoam. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position with head fixed with mayfield skull clamp. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made from inion to C7 level. The subcutaneous soft tissue was devided and the paravertebral muscle groups were detached. Grooving of bilateral laminae from C3 to C7 was conducted with Midas high speed air-drived drills. Laminoplasty was performed with miniplates and screws(opening: left side). Hemostasis was achieved with bipolar electrocautery. The incidental durotomy was covered with Gelfoam. One CWV drain was placed. The wound was then closed in layers with 1-0, 2-0 vicryl and 3-0 Nylon. Operators VS賴達明 Assistants R5李振豪, R1李嘉哲 相關圖片 曾富美 (F,1944/06/29,67y8m) 手術日期 2011/11/29 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Lumbar spondylosis 器械術式 L4-S1 TPS, redo 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 12:02 進入手術室 12:12 麻醉開始 12:20 誘導結束 12:25 抗生素給藥 12:48 手術開始 15:25 抗生素給藥 16:50 手術結束 16:50 麻醉結束 17:00 送出病患 17:01 進入恢復室 18:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎間盤切除術-腰椎 1 2 記錄__ 手術科部: 外科部 套用罐頭: 1. L4/5 transforaminal lumbar interbody fusio... 開立醫師: 李振豪 開立時間: 2011/11/29 17:24 Pre-operative Diagnosis L4/5, L5/S1 spondylolisthesis with lumbar stenosis, status post Wallis interspinous device implantation, status post sublaminar decompression Post-operative Diagnosis L4/5, L5/S1 spondylolisthesis with lumbar stenosis, status post Wallis interspinous device implantation, status post sublaminar decompression Operative Method 1. L4/5 transforaminal lumbar interbody fusion with PEEK cage 2. L4/S1 transpedicular screws for posterior fixation 3. L4/5, L5/S1 laminotomy for decompression 4. L4-S1 posterolateral fusion with autologous bone graft Specimen Count And Types nil Pathology Nil Operative Findings The Wallis interspinous device was placed at L4/5 level and removed. Scar formation with remarkable adhesion was noted due to previous operation. The facet joint was hypertrophic with marginal spur formation. During laminotomy and dissection along the dura and scar tissue, mild CSF leakage was noted from left side L5/S1 level. Previous incidental durotomy related CSF leakage was favored. After decompression, the thecal sac expanded well. No more CSf leakage was noted after Gelfoam packing. Osteoporotic change of vertebral body was noted during posterior instrumentation. Total four transpedicular screws(6.2 x 40mm x III(bilateral L4, left side S1), 6.2 x 45mm x I(right side S1)) and two 7cm rods were used for posterior instrumentation. L4/5 transforaminal lumbar interbody fusion was conducted with one 13mm PEEK banana cage filled with autologous bone. Posterolateral fusion with autologous bone was also used, especially for L5/S1 level. Total blood loss: 400ml. The patient stood whole procedure well. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made along operative scar. The subcutaneous soft tissue was devided. The paravertebral muscle groups were detached and the Wallis interspinous device was identified and removed. L4 and S1 transpedicular screws were implanted under C-arm guided. L4/5, L5/S1 laminotomy and L4/5 right facetectomy was performed and scar tissue was removed for decompression. L4/5 diskectomy was conducted and one #13 banana PEEK cage was implanted for transforaminal lumbar interbody fusion. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. Two 7cm rods were applied for posterior fixation. Posterolateral fusion with autologous bone graft also done, especially at L5/S1 level. One 1/8 Hemovac was placed. The wound was irrigated with Gentamicin solution and closed in layers with 1-0, 2-0 Vicryl and 3-0 Nylon. Operators VS 賴達明 Assistants R5李振豪, R1李嘉哲 相關圖片 黃惠萱 (F,1958/03/01,54y0m) 手術日期 2011/11/29 手術主治醫師 楊士弘 手術區域 東址 002房 02號 診斷 Cervical intervertebral disc disorder with myelopathy 器械術式 C6/7 anterior discectomy & cage insertion 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2E 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 08:03 通知急診手術 08:55 進入手術室 09:00 麻醉開始 09:05 誘導結束 09:20 抗生素給藥 09:49 手術開始 12:30 抗生素給藥 12:35 手術結束 12:35 麻醉結束 12:45 送出病患 12:50 進入恢復室 14:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-頸椎 1 1 R 手術 椎融合術-前融合,無固定物(≦四節) 1 2 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 摘要__ 手術科部: 外科部 套用罐頭: Diskectomy and interbody fusion, C6/7. 開立醫師: 鍾文桂 開立時間: 2011/11/29 09:53 Pre-operative Diagnosis C6/7 herniated intervertebral disc. Post-operative Diagnosis C6/7 herniated intervertebral disc. Operative Method Diskectomy and interbody fusion, C6/7. Specimen Count And Types nil Pathology Nil. Operative Findings C5/6 HIVD s/p C5/6 diskectomy and interbody fusion-> wound incised along the previous operative wound. The C6-7 disc was mildly dehydrated and degenerated. It bulged posteriorly. There were also posterior marginal spur and thick ligamentum flavm over the right side. The thecal sac and nerve root reexpanded well after decompression. Interbody fusion: PEEK cage: 6mm. Operative Procedures Under ETGA, the patient was placed in supine position and the neck was extended. After disinfection and draping, a linear skin incision was made along the previous operative wound. After dissection along the anterior border of the sternocledomastoid muscle, the prevertebral space was reached. C6/7 level was checked by using intraoperative fluoroscopy. The retraction system was set. C6/7 diskectomy was performed. The PEEK cage was implanted. The wound was closed in layers with one prevertebral mini-hemovac. Operators 楊士弘 Assistants 鍾文桂 施培艾 Indication Of Emergent Operation Acte severe radiculopathy. 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Diskectomy and interbody fusion, C6/7. 開立醫師: 鍾文桂 開立時間: 2011/12/09 22:45 Pre-operative Diagnosis C6/7 herniated intervertebral disc. Post-operative Diagnosis C6/7 herniated intervertebral disc. Operative Method Diskectomy and interbody fusion, C6/7. Specimen Count And Types nil Pathology Nil. Operative Findings The C6-7 disc was mildly dehydrated and degenerated. It bulged posteriorly. There were also posterior marginal spur and thick ligamentum flavm over the right side. The thecal sac and nerve root reexpanded well after decompression. Interbody fusion: PEEK cage: 6mm. Operative Procedures Under ETGA, the patient was placed in supine position and the neck was extended. After disinfection and draping, a linear skin incision was made along the previous operative wound. After dissection along the anterior border of the sternocledomastoid muscle, the prevertebral space was reached. C6/7 level was checked by using intraoperative fluoroscopy. The retraction system was set. C6/7 diskectomy was performed. The PEEK cage was implanted. The wound was closed in layers with one prevertebral mini-hemovac. Operators 楊士弘 Assistants 鍾文桂 施培艾 Indication Of Emergent Operation Acte severe radiculopathy. 相關圖片 潘萱 (M,1982/02/17,30y0m) 手術日期 2011/11/29 手術主治醫師 蕭輔仁 手術區域 西址 039房 01號 診斷 Neuropathy 器械術式 Neurolysis of the uluar neuve 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 08:25 報到 08:50 進入手術室 09:23 麻醉開始 09:25 手術開始 10:20 麻醉結束 10:20 手術結束 10:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 神經分離術-上臂.前臂.大腿.小腿處之神經 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Ulnar nerve decompression 開立醫師: 蔡宗良 開立時間: 2011/11/29 10:29 Pre-operative Diagnosis Tardy ulnar palsy, left-sided Post-operative Diagnosis Tardy ulnar palsy, left-sided Operative Method Ulnar nerve decompression Specimen Count And Types nil Pathology None Operative Findings Dense tissue fiber compression of ulnar nerve Operative Procedures 1. Routihe disinfection and preparation 2. Linear wound incision 3. Decompression of ulnar nerve 4. Wound closure with vicryl and nylon Operators VS 蕭輔仁 Assistants R6 蔡宗良 相關圖片 蔡吳阿秀 (F,1935/03/17,76y11m) 手術日期 2011/11/30 手術主治醫師 賴達明 手術區域 東址 005房 02號 診斷 Wound infection postoperative 器械術式 lumbar wound debridement 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3E 紀錄醫師 蔡宗良, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 07:31 通知急診手術 13:25 進入手術室 13:35 麻醉開始 13:45 誘導結束 14:00 手術開始 14:30 麻醉結束 14:30 手術結束 14:42 送出病患 14:45 進入恢復室 16:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 深部傷口處理縫合擴創-小 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Debridement 開立醫師: 張哲瑋 開立時間: 2011/11/30 14:46 Pre-operative Diagnosis Postoperative lumbar wound infection Post-operative Diagnosis Postoperative lumbar wound infection Operative Method Debridement Specimen Count And Types 1 piece About size:culture swab Source:wound Pathology None Operative Findings Lower 4 cm wound dehiscence with necrotic wound and pus coating. Inner lumen extended 2 cm cephalad. Operative Procedures 1. ETGA, prone positioning 2. Routine preparation and disinfection 3. Linear wound incision over 2 cm cephalad from the site of dehiscence. 4. Necrotic wound was trimmed by blade 5. Other necrotic tissue was debrided using currette 6. One liter of gentamicin saline irrigation 7. Wound closed by antibiotic coated Vicryl and 4-0 Nylon Operators 賴達明 Assistants R6蔡宗良 R1張哲瑋 Indication Of Emergent Operation wound infection 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Debridement 開立醫師: 張哲瑋 開立時間: 2011/11/30 14:47 Pre-operative Diagnosis Postoperative lumbar wound infection Post-operative Diagnosis Postoperative lumbar wound infection Operative Method Debridement Specimen Count And Types 1 piece About size:culture swab Source:wound Pathology None Operative Findings Lower 4 cm wound dehiscence with necrotic wound and pus coating. Inner lumen extended 2 cm cephalad. Operative Procedures 1. ETGA, prone positioning 2. Routine preparation and disinfection 3. Linear wound incision over 2 cm cephalad from the site of dehiscence. 4. Necrotic wound was trimmed by blade 5. Other necrotic tissue was debrided using currette 6. One liter of gentamicin saline irrigation 7. Wound closed by antibiotic coated Vicryl and 4-0 Nylon Operators 賴達明 Assistants R6蔡宗良 R1張哲瑋 Indication Of Emergent Operation wound infection 相關圖片 葛瓦琪 (F,1945/02/20,67y0m) 手術日期 2011/11/30 手術主治醫師 王國川 手術區域 東址 005房 01號 診斷 Brain tumors, malignant 器械術式 Left temporal metastatic tumor excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 蔡宗良, 時間資訊 00:00 臨時手術NPO 07:48 報到 08:08 進入手術室 08:25 麻醉開始 08:55 誘導結束 09:00 抗生素給藥 09:05 手術開始 12:00 抗生素給藥 12:45 麻醉結束 12:45 手術結束 12:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 手術 腦瘤切除-手術時間在4小時以內 1 1 R 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: 1. Suboccipital craniotomy for cerebellar tum... 開立醫師: 蔡宗良 開立時間: 2011/11/30 13:09 Pre-operative Diagnosis Metastatic brain tumor, cerebellum and parietal lobe, right-sided Post-operative Diagnosis Metastatic brain tumor, cerebellum and parietal lobe, right-sided Operative Method 1. Suboccipital craniotomy for cerebellar tumor removal, right-sided 2. Parietal craniotomy for parietal lobe tumor removal, right-sided Specimen Count And Types 1 piece About size:小 Source:brain Pathology Report pending Operative Findings Metastatic tumor at both sites were identical in characteristics, which are fragile, greyish in color, well-dermarcated, with few vascularity. Dura was tense and tumor squeezed out of the durotomy window in process of tumor removal of cerebellar tumor. Falx was visible upon removal of parietal lobe tumor. Operative Procedures 1. ETGA, Mayfield skull fixation, prone positioning, head hyperflexion 2. Routine preparation and disinfection 3. J-shaped scalp incision including the parietal lobe tumor and midline for cerebellar tumor 4. Suboccipital craniotomy with burr holes and connected with pneumatic saw 5. Tentings were performed, followed by X-shaped durotomy 6. Tumor removal with bipolar cautery, tumor forceps, followed by meticulous hemostasis and Surgicel coverage. 7. Dura was closed by 4-0 Prolene. 8. Craniotomy of parietal lobe tumor with burr holes and connected with pneumatic saw 9. U-shaped durotomy basing on the superior sagittal sinus 10. Tumor removal with bipolar cautery, tumor forceps, followed by meticulous hemostasis and Surgicel coverage 11. Dura was closed by 4-0 prolene 12. Both skull plate were fixed back to cranitomy window 13. Wound was closed in layers Operators 王國川 Assistants R6蔡宗良 R1張哲瑋 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: 1. Suboccipital craniotomy for cerebellar tum... 開立醫師: 蔡宗良 開立時間: 2011/11/30 13:09 Pre-operative Diagnosis Metastatic brain tumor, cerebellum and parietal lobe, right-sided Post-operative Diagnosis Metastatic brain tumor, cerebellum and parietal lobe, right-sided Operative Method 1. Suboccipital craniotomy for cerebellar tumor removal, right-sided 2. Parietal craniotomy for parietal lobe tumor removal, right-sided Specimen Count And Types 1 piece About size:小 Source:brain Pathology Report pending Operative Findings Metastatic tumor at both sites were identical in characteristics, which are fragile, greyish in color, well-dermarcated, with few vascularity. Dura was tense and tumor squeezed out of the durotomy window in process of tumor removal of cerebellar tumor. Falx was visible upon removal of parietal lobe tumor. Operative Procedures 1. ETGA, Mayfield skull fixation, prone positioning, head hyperflexion 2. Routine preparation and disinfection 3. J-shaped scalp incision including the parietal lobe tumor and midline for cerebellar tumor 4. Suboccipital craniotomy with burr holes and connected with pneumatic saw 5. Tentings were performed, followed by X-shaped durotomy 6. Tumor removal with bipolar cautery, tumor forceps, followed by meticulous hemostasis and Surgicel coverage. 7. Dura was closed by 4-0 Prolene. 8. Craniotomy of parietal lobe tumor with burr holes and connected with pneumatic saw 9. U-shaped durotomy basing on the superior sagittal sinus 10. Tumor removal with bipolar cautery, tumor forceps, followed by meticulous hemostasis and Surgicel coverage 11. Dura was closed by 4-0 prolene 12. Both skull plate were fixed back to cranitomy window 13. Wound was closed in layers Operators 王國川 Assistants R6蔡宗良 R1張哲瑋 相關圖片 胡進福 (M,1945/12/26,66y2m) 手術日期 2011/12/02 手術主治醫師 蕭輔仁 手術區域 東址 002房 06號 診斷 Spine bone metastasis 器械術式 Spinal fusion posterior 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3E 紀錄醫師 蔡宗良, 時間資訊 18:00 臨時手術NPO 18:00 開始NPO 19:58 通知急診手術 01:11 進入手術室 01:11 報到 01:15 麻醉開始 01:40 誘導結束 02:00 抗生素給藥 02:20 手術開始 05:00 抗生素給藥 05:50 開始輸血 07:15 手術結束 07:15 麻醉結束 07:27 送出病患 07:30 進入恢復室 08:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 惡性脊髓腫瘤切除術 1 1 記錄__ 手術科部: 內科部 套用罐頭: 1. Posterior fixation, transpedicular screws,... 開立醫師: 蔡宗良 開立時間: 2011/12/02 07:44 Pre-operative Diagnosis Suspect Tuberculosis related epidural spinal cord compression, T4 Post-operative Diagnosis Suspect Tuberculosis related epidural spinal cord compression, T4 Operative Method 1. Posterior fixation, transpedicular screws, cross-link, and rods 2. Posterior decompression, L3, L4, and L5 3. Partial corpectomy Specimen Count And Types 1 piece About size:小 Source:epidural mass Pathology Report pending Operative Findings Yellowish elastic mass, avascular, over T4 vertebra, resembling caseous necrosis Operative Procedures 1. ETGA, prone positioning 2. Routine preparation 3. Midline skin incision from T1 to T8, followed by subperiosteal dissection 4. Transpedicular screw fixation with 5.0 x 30 mm for bilateral T2 and T3 pedicles, and 5.0 x 35 mm for bilateral T5 and T6 pedicles. 5. Laminectomy from T3 to T5 with bilateral transversectomy of T4 with partial corpectomy to obtained lesioned tissue, which were sent separately. 6. Fixation of bilateral rods with one cross link. 7. Gentamicin saline irrigation 8. Hemomvac placement 9. Wound was closed in layers Operators VS 蕭輔仁 Assistants R6 蔡宗良 Indication Of Emergent Operation 相關圖片 高良信 (M,1945/05/10,66y10m) 手術日期 2011/12/01 手術主治醫師 張宏江 手術區域 東址 006房 02號 診斷 Compression fracture, pathological, spontaneous 器械術式 TRUS-Biobsy + Tx 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 4 紀錄醫師 蔡博超, 廖先啟, 時間資訊 15:25 進入手術室 15:28 麻醉開始 15:35 誘導結束 15:47 手術開始 16:10 手術結束 16:15 16:20 麻醉結束 16:20 16:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 前列腺切片-控取式 1 1 手術 氣管切開術 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 廖先啟 開立時間: 2011/12/01 15:57 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types Nil Pathology None Operative Findings Fr. 8 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators VS張金池 Assistants R4廖先啟，R4郝政鴻 摘要__ 手術科部: 泌尿部 套用罐頭: TRUS-P-biopsy 開立醫師: 蔡博超 開立時間: 2011/12/01 16:33 Pre-operative Diagnosis Elevated PSA, suspected prostate cancer Post-operative Diagnosis Elevated PSA, suspected prostate cancer Operative Method TRUSP biopsy Specimen Count And Types 6 bottles with every one 2 pieces About size: 1.2*0.2 cm chips Source: prostate Pathology pending Operative Findings 1.systematic 12 cores TRUSP biopsy was performed (Rt lat*2, Rt med*2, Rt apex*2, Lt apex*2, Lt med*2, Lt lat*2) 2.prostate size: 2.9cm x 4.7cm x 4.8cm= 34.6mL 3.DRE: no hard nodule Operative Procedures Under satisfactory anesthesia with the patient in Lithotomy position, prepping and draping was performed in the usual sterile fashion. TRUSP was performed and echo-guided prostate biopsies were performed smoothly with Biopty gun. The coresof tissue specimen were obtained. The biosy area was compressed for several minutes to ensure adequate hemostasis. The patient tolerated the operation well and was sent to the floor in satisfactory condition. Operators 張宏江, Assistants 蔡博超, 蘇彥榮, 記錄__ 手術科部: 泌尿部 套用罐頭: TRUS-P-biopsy 開立醫師: 蔡博超 開立時間: 2011/12/01 16:33 Pre-operative Diagnosis Elevated PSA, suspected prostate cancer Post-operative Diagnosis Elevated PSA, suspected prostate cancer Operative Method TRUSP biopsy Specimen Count And Types 6 bottles with every one 2 pieces About size: 1.2*0.2 cm chips Source: prostate Pathology pending Operative Findings 1.systematic 12 cores TRUSP biopsy was performed (Rt lat*2, Rt med*2, Rt apex*2, Lt apex*2, Lt med*2, Lt lat*2) 2.prostate size: 2.9cm x 4.7cm x 4.8cm= 34.6mL 3.DRE: no hard nodule Operative Procedures Under satisfactory anesthesia with the patient in Lithotomy position, prepping and draping was performed in the usual sterile fashion. TRUSP was performed and echo-guided prostate biopsies were performed smoothly with Biopty gun. The coresof tissue specimen were obtained. The biosy area was compressed for several minutes to ensure adequate hemostasis. The patient tolerated the operation well and was sent to the floor in satisfactory condition. Operators 張宏江, Assistants 蔡博超, 蘇彥榮, 楊育欣 (M,1973/12/21,38y2m) 手術日期 2011/12/01 手術主治醫師 李崇維 手術區域 東址 000房 號 診斷 Intracerebral hemorrhage 器械術式 NEURO T.A.E 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 3 時間資訊 23:55 臨時手術NPO 08:45 麻醉開始 08:50 誘導結束 09:45 麻醉結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 陳吳翠 (F,1935/01/12,77y2m) 手術日期 2011/12/01 手術主治醫師 蔡翊新 手術區域 東址 003房 01號 診斷 Subarachnoid hemorrhage 器械術式 Left P-com aneurysm clipping 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 翁上硯, 時間資訊 00:00 臨時手術NPO 08:16 進入手術室 08:20 麻醉開始 08:30 誘導結束 08:55 手術開始 11:42 抗生素給藥 13:35 手術結束 13:35 麻醉結束 13:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 手術 開顱術摘除血管病變 - 腦血管瘤 有病徵的 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Left pterional craniotomy for aneurysm clipping 開立醫師: 蔡翊新 開立時間: 2011/12/01 13:10 Pre-operative Diagnosis Left P-com aneurysm with rupture Post-operative Diagnosis Left P-com aneurysm with rupture Operative Method Left pterional craniotomy for aneurysm clipping Specimen Count And Types nil Pathology nil Operative Findings There was fibrin adhesion at prechiasmatic cistern and around left ICA and p-com artery. One sacular aneurym arising from the junction of left p-com artery and left ICA, with a wide base, 3 mm in width, and short height, 2.5 mm. The dome of the aneurysm pointed posterolaterally and adhered tightly to left temporal lobe, not to the oculomotor nerve. The aneurysm was clipped with one bayonet-shaped, laterally curved, 6-mm Sugita clip. The p-com artery was small in size. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right for 40 degrees and slightly extended then fixed by Mayfield skull clamp. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: left frontotemporal, curvilinear. The skin edge was clipped by Raney clips for temporary hemostasis. After scalp had been lifted, the temporalis muscle was incised and detached from temporal squama and reflected to lower temporal side. 5. Craniotomy window: 8 x 6 cm, left frontotemporal, created by making 3 burr holes then cut by power saw. The lower temporal bone and pterionic ridge (esp. the inner table) were cut by rongeur and high speed air drill as low as possible for easy approach to the anterior clinoid. 6. Dural tention: by 2/0 silk, 1.5 cm in interval, distributed along the edge of skull window. 7. Dural incision: V shape, over-ridding Sylvian fissure and reflected to frontotemporal base. 8. Under operating microscope, the suprasellar cistern was opened. The left optic nerve and ICA came into view. The arachnoid trabeculi and the fibrin were cleaned out to expose the neck of the aneurysm which located just beneath the edge of tentorial hiatus. The neck of the aneurysm was mobilized gently by a Gage 16 sucker and a fine tip bipolar forceps until it was entirely free. 9. A bayonet-shaped, laterally curved, 6-mm Sugita clip Sugita clip was applied to the neck of the aneurysm. 10.The brain retractors were removed. The dura was closed water-tight by 2 2/0 silk for key stitches followed by running suture with 4/0 Vicryl. 11.Closure of skull window: the skull plate was placed back to craniotomy window and fixed by 3 miniplates and 6 screws. The dura was tented to the center of the skull plate by a 2/0 stitch. The covering muscle was closed by interrupted stitches with 1/ 0 silk. 12.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 1/0 Vicryl and skin by continuous suture with 3/0 nylon. 13.Drain: one, epidural, CWV. 14.Blood transfusion: nil. Blood loss: 250 ml. 15.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R6蔡宗良R0翁上硯 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Left pterional craniotomy for aneurysm clipping 開立醫師: 蔡翊新 開立時間: 2011/12/01 13:11 Pre-operative Diagnosis Left P-com aneurysm with rupture Post-operative Diagnosis Left P-com aneurysm with rupture Operative Method Left pterional craniotomy for aneurysm clipping Specimen Count And Types nil Pathology nil Operative Findings There was fibrin adhesion at prechiasmatic cistern and around left ICA and p-com artery. One sacular aneurym arising from the junction of left p-com artery and left ICA, with a wide base, 3 mm in width, and short height, 2.5 mm. The dome of the aneurysm pointed posterolaterally and adhered tightly to left temporal lobe, not to the oculomotor nerve. The aneurysm was clipped with one bayonet-shaped, laterally curved, 6-mm Sugita clip. The p-com artery was small in size. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right for 40 degrees and slightly extended then fixed by Mayfield skull clamp. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: left frontotemporal, curvilinear. The skin edge was clipped by Raney clips for temporary hemostasis. After scalp had been lifted, the temporalis muscle was incised and detached from temporal squama and reflected to lower temporal side. 5. Craniotomy window: 8 x 6 cm, left frontotemporal, created by making 3 burr holes then cut by power saw. The lower temporal bone and pterionic ridge (esp. the inner table) were cut by rongeur and high speed air drill as low as possible for easy approach to the anterior clinoid. 6. Dural tention: by 2/0 silk, 1.5 cm in interval, distributed along the edge of skull window. 7. Dural incision: V shape, over-ridding Sylvian fissure and reflected to frontotemporal base. 8. Under operating microscope, the suprasellar cistern was opened. The left optic nerve and ICA came into view. The arachnoid trabeculi and the fibrin were cleaned out to expose the neck of the aneurysm which located just beneath the edge of tentorial hiatus. The neck of the aneurysm was mobilized gently by a Gage 16 sucker and a fine tip bipolar forceps until it was entirely free. 9. A bayonet-shaped, laterally curved, 6-mm Sugita clip Sugita clip was applied to the neck of the aneurysm. 10.The brain retractors were removed. The dura was closed water-tight by 2 2/0 silk for key stitches followed by running suture with 4/0 Vicryl. 11.Closure of skull window: the skull plate was placed back to craniotomy window and fixed by 3 miniplates and 6 screws. The dura was tented to the center of the skull plate by a 2/0 stitch. The covering muscle was closed by interrupted stitches with 1/ 0 silk. 12.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 1/0 Vicryl and skin by continuous suture with 3/0 nylon. 13.Drain: one, epidural, CWV. 14.Blood transfusion: nil. Blood loss: 250 ml. 15.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R6蔡宗良R0翁上硯 相關圖片 林純瑛 (F,1962/10/17,49y4m) 手術日期 2011/12/01 手術主治醫師 婁培人 手術區域 西址 033房 02號 診斷 Nasopharyngeal cancer 器械術式 Gromment placement (ntuh made) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 09:27 進入手術室 09:30 麻醉開始 09:32 手術開始 09:32 誘導結束 09:33 報到 09:50 麻醉結束 10:05 手術結束 10:08 送出病患 記錄__ 手術科部: 耳鼻喉部 套用罐頭: Grommet tube insertion, bilateral 開立醫師: 齊凡翔 開立時間: 2011/12/01 10:08 Pre-operative Diagnosis otitis media of effusion, bilateral Post-operative Diagnosis otitis media of effusion, bilateral, operated Operative Method Grommet tube insertion, bilateral Specimen Count And Types nil Pathology nil Operative Findings Bilateral MEE(+) with glue-like discharge. Operative Procedures 1.The patient was put in supine position. 2.After local anestehsia of external auditory canal, the face was disinfected and draped as usual. 3.Her head was turned to the left side. 4.Radial incision was made over the anterio-inferior quadrant of the right eardrum and middle ear effusion was sucked out. 5.Then one 1.27mm Grommet tube was inserted smoothly. 6.The head was then turned to the right side. The procedure was done similar to the right. Middle ear fluid was aspirated. 7.The patient tolerated the whole procedure well. Operators 婁培人, Assistants 齊凡翔, 林彥翰, 胡照雄 (M,1955/02/11,57y1m) 手術日期 2011/12/02 手術主治醫師 李章銘 手術區域 東址 019房 02號 診斷 Esophageal cancer 器械術式 Stent insertion 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 3E 紀錄醫師 鄒冠全, 時間資訊 12:13 通知急診手術 00:00 開始NPO 00:00 臨時手術NPO 11:25 報到 12:08 進入手術室 12:10 麻醉開始 12:15 誘導結束 12:25 抗生素給藥 12:40 手術開始 13:30 手術結束 13:30 麻醉結束 13:35 送出病患 13:40 進入恢復室 14:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 食道內腔置管術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Esophageal stent insertion and balloon dilatation 開立醫師: 鄒冠全 開立時間: 2011/12/02 13:33 Pre-operative Diagnosis Esophageal cancer, advance Post-operative Diagnosis Esophageal cancer, advance Operative Method Esophageal stent insertion and balloon dilatation Specimen Count And Types nil Pathology nil Operative Findings Severe stenosis at 27-30cm below incisor, s/p dilatation and stent insertion(Nifi stent 12cm) Operative Procedures 1. ETGA, left decubitus 2. PES examination, balloon dilatation 3. Insert stent via guide wire Operators 李章銘 Assistants R4鄒冠全, Ri陳秀婷 Indication Of Emergent Operation Esophageal cancer 丁培勳 (M,1943/10/10,68y5m) 手術日期 2011/12/02 手術主治醫師 詹志洋 手術區域 東址 001房 02號 診斷 Mitral valve insufficiency and aortic valve stenosis 器械術式 AVF PTA or reanastomosis 手術類別 臨時手術 手術部位 四肢 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 莊民楷, 時間資訊 10:30 報到 10:40 進入手術室 10:50 抗生素給藥 11:00 麻醉開始 11:02 誘導結束 11:05 手術開始 12:40 麻醉結束 12:40 手術結束 12:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 血管整形術 1 0 L 記錄__ 手術科部: 外科部 套用罐頭: PTA 開立醫師: 莊民楷 開立時間: 2011/12/02 13:00 Pre-operative Diagnosis ESRD, with left forearm radiocephalic AVF dysfunction Post-operative Diagnosis ESRD, with left forearm radiocephalic AVF dysfunction Operative Method PTA Specimen Count And Types nil Pathology Nil Operative Findings 1. one thombus load over distal puncture site with total obstruction(2cm upstream to AVF anastomosis); another segmental stenosis of cephalic vein over proximal puncture site(12cm upstream to AVF anastomosis) 2. mild stenosis of AVF anastomosis 3. postoperative drainage vein run-off improved(mainly drained into basilic vein, small caliber of upper arm cephalic vein was found) Operative Procedures 1. LA, supine 2. Disinfection and drapping 3. Left distal radial artery puncture, wiring to left cephalic vein 4. Insert 5Fr sheath, perform angiography 5. PTA with 5mm balloon dilatation to drainage vein, and 4mm ballon dilatation to AVF anastomosis 6. Recheck angiography 7. Hemostasis by compression Operators VS 詹志洋 Assistants R4 莊民楷, R4 陳政維 林嘉誠 (M,1998/10/05,13y5m) 手術日期 2011/12/03 手術主治醫師 楊士弘 手術區域 兒醫 067房 01號 診斷 Mediastinum, malignant 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 石博元 ASA 3E 紀錄醫師 陸惠宗, 時間資訊 17:57 通知急診手術 18:46 進入手術室 18:50 麻醉開始 19:20 誘導結束 19:42 手術開始 20:25 開始輸血 21:55 手術結束 21:55 麻醉結束 22:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 急性硬腦膜下血腫清除術 1 1 R 手術 顱內壓視置入 1 2 R 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 套用罐頭: 1. Right fronto-temporo-parietal craniotomy f... 開立醫師: 李振豪 開立時間: 2011/12/03 23:13 Pre-operative Diagnosis Right fronto-temporo-parietal acute subdural hematoma Post-operative Diagnosis Right fronto-temporo-parietal acute subdural hematoma Operative Method 1. Right fronto-temporo-parietal craniotomy for hematoma evacuation 2. ICP monitor implantation Specimen Count And Types 1 piece About size:1x3cm Source:dura Pathology Pending Operative Findings Bleeding tendancy was noted with diffuse oozing and mild improve after platelet transfusion. The dura was tense before dura opening. The subdural hematoma gushed out during dura tenting. The dura became much slack after partial evacuation of the subdural hematoma. After durotomy, the hematoma was evacuated and the subdural was irrigated with normal saline solution. Gelfoam was placed at subdural space near midline, anterior frontal area, and around sylvian fissure. After hematoma evacuation, the brain expanded rapidly with mild hard by palpation but not bulging out during dura closure. No active bleeding was found at subdural space. 1x3cm dura was sampled and sent for pathology. The dura was thick(1~2mm) with one thin layer of yellowish subdural membrane formation. Leptomeningeal seeding or reaction to hematoma was suspected. Duroplasty with COOK was performed to avoid CSF leakage. The ICP after duroplasty was 2mmHg and 3mmHg after wound closure. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head rotated to left. The scalp was shaved, scrubbed, and disinfected as usual. Question mark scalp incision was made at right fronto-temporo-parietal area and the scalp flap was elevated. Four burrholes were made and one 12x10cm craniotomy window was made. Dura tenting was performed with 2-0 silk interrupted suture. C-shape durotomy was conducted and the subdural hematoma was evacuated. The subdural space was irrigated with normal saline solution. Gelfoam was placed into subdural space near superior sagittal sinus, anterior frontal area, and around sylvian fissure. One 1x3cm dura was harvested for pathology and duroplasty was performed with COOK artificial dura and 4-0 prolene. One subdural ICP monitor and one epidural CWV drain was placed. The skull plate was fixed back with miniplates, screws, and two central tenting. One subgaleal CWV drain was placed. The wound was then closed in layers with 1-0, 2-0 Vicryl and Appose staples. Operators VS楊士弘 Assistants R5李振豪, R1陸惠宗 Indication Of Emergent Operation Conscious disturbance with right pupil dilatation 相關圖片 邵坤成 (M,1951/09/16,60y5m) 手術日期 2011/12/03 手術主治醫師 王廷明 手術區域 東址 001房 04號 診斷 Shock 器械術式 Arthroscopic debridement 手術類別 緊急手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林峰盛 ASA 3E 紀錄醫師 吳俊毅, 時間資訊 00:00 開始NPO 00:00 臨時手術NPO 14:47 通知急診手術 20:45 進入手術室 20:45 報到 20:50 麻醉開始 20:55 誘導結束 21:10 手術開始 22:30 麻醉結束 22:30 手術結束 22:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 關節鏡手術-關節鏡下關節面磨平成形術,打洞,游離體或骨軟骨碎片取出手術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: arthroscopic debridement 開立醫師: 吳俊毅 開立時間: 2011/12/03 22:24 Pre-operative Diagnosis left septic knee with necrotizing fasciitis s/p debridement and fasiotomy Post-operative Diagnosis left septic knee with necrotizing fasciitis s/p debridement and fasiotomy Operative Method arthroscopic debridement Specimen Count And Types nil Pathology nil Operative Findings 1.pus formation at left knee joint 2.cartilage defect at lateral condyle and patella 3.severe synovitis Operative Procedures 1.ETGA, supine 2.disinfection and draping 3.desanguination, on tourniquet 4.skin incision, set anteromedial and anterolateral portals 5.perform irrigation and debridement with shaver 6.set 1/4 hemovac x 1 7.close wound in layers Operators 王廷明 Assistants 陳勇璋,江毅彥 陳勇璋,何京澤 Indication Of Emergent Operation septic knee 屈聖安 (M,1959/07/23,52y7m) 手術日期 2011/12/05 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Meningioma 器械術式 Meningioma 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 1 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 08:37 進入手術室 08:40 麻醉開始 09:00 抗生素給藥 09:05 誘導結束 09:07 手術開始 10:55 手術結束 11:02 麻醉結束 11:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 記錄__ 手術科部: 外科部 套用罐頭: Left fronto-parietal craniotomy for Simpson g... 開立醫師: 李振豪 開立時間: 2011/12/05 11:15 Pre-operative Diagnosis Left high frontal convexity meningioma Post-operative Diagnosis Left high frontal convexity meningioma Operative Method Left fronto-parietal craniotomy for Simpson grade I tumor excision Specimen Count And Types 1 piece About size:2x2x2 Source:left frontal convexity meningioma Pathology Pending Operative Findings The tumor was 2x2x2cm in size, white-yellowish in color, firm, well-demarcated, and hypervascularized(from dura). Two large cortical veins near the tumor was preserved well during whole procedure. No hyperostosis or brain parenchyma invasion was noted. The dura tail was not significant and the adjacent dura was checked with ring curette. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. Linear scalp incision was made at left fronto-parietal area and one 3x3cm galea aponeurotica was harvested for duroplasty. Two burrholes were created followed by one 4x4cm craniotomy window. Dural tenting was done. The durotomy was made along the margin of the tumor for Simpson I tumor excision. The tumor was dissected away from the arachnoid plan and brain parenchyma. Hemostasis was achieved with Surgicel lining. Duroplasty was conducted with galea aponeurotica and 4-0 Prolene. The skull plate was fixed back with miniplates, screws, and one central tenting. The wound was then closed in layers with 2-0 Vicryl and Appose staples. Operators VS曾漢民 Assistants R5李振豪, PGY劉明侑 相關圖片 林惠禎 (F,1966/09/23,45y5m) 手術日期 2011/12/05 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Brain tumor 器械術式 Cerebellum hemangioblastoma excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 10:55 報到 11:22 進入手術室 11:35 麻醉開始 11:48 抗生素給藥 12:20 誘導結束 12:25 手術開始 13:50 開始輸血 14:48 抗生素給藥 16:15 麻醉結束 16:15 手術結束 16:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: Left suboccipital craniotomy for total tumor ... 開立醫師: 李振豪 開立時間: 2011/12/05 17:21 Pre-operative Diagnosis 1.Left cerebellar hemangioblastoma, 2. Von-Hippel-Lindau disease Post-operative Diagnosis 1.Left cerebellar hemangioblastoma, 2. Von-Hippel-Lindau disease Operative Method Left suboccipital craniotomy for total tumor excision Specimen Count And Types 1 piece About size:3x2x2cm Source:Left cerebellar tumor Pathology Pending Operative Findings The dura was tense after craniotomy. The posterior fossa was still crowded after release CSF from cisterna magna. Tonsillar herniation was noted. Intra-operative sonography was checked for localization of the tumor. The mural nodule was hyperechogenecity and located at anteroinferior part of the cyst. Trans-cortical approach was used and the cystic component was drained for decompression first. The content of the cyst was xanthochromic to mild strawberry in color. The tumor and the cystic wall were both hypervascularized and easily touch bleeding. The tumor was 3x1.5x3.3cm in size, soft to elastic, relative ill-demarcated, and located at left cerebellum. Numerous small feeding artery was noted during tumor excision. After tumor excision, the cerebellum became slack. The fourth ventricle was opened during tumor excision. The left side SSEP was poor before the operation. During tumor excision, absent bilateral lower limbs MEP occurred and did not return to baseline even after closure of dura. The SSEP was not change during whole procedure. Lab error was favored. Total blood loss: 150ml. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position with head fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. Hokeystick scalp incision was made over left occipital area and the scalp flap was elevated. The occipital, foramen magnum, and posterior arch of C1 ring was exposed. Suboccipital craniotomy was conducted with four burrholes creation. The foramen magnum also opened for decompression. Intra-operative sonography was checked for localization of the tumor. Curvilinear durotomy was performed. CSF was released from cisterna magna. Trans-cortical approach was used for tumor excision. The cystic part was opened first for decompression and the mural nodule was encountered soon. Tumor excision(including cystic wall) was performed with bipolar electrocautery, suction, and tumor forceps. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. The fourth ventricle was opening during tumor excision. The dura was closed with 4-0 Prolene. Dural tentnig was performed due to slack cerebellum after tumor excision. The skull plate was fixed back with miniplates, screws, and one central tenting. Subgaleal CWV drain was placed. The wound was then closed in layers with 2-0 silk, 2-0 Vicryl, and Appose staples. Operators VS曾漢民 Assistants R5李振豪, PGY劉明侑 相關圖片 唐美蓉 (F,1951/01/01,61y2m) 手術日期 2011/12/05 手術主治醫師 戴浩志 手術區域 東址 009房 03號 診斷 Parkinsonism (F02.3) 器械術式 Debridment-- >10cm 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3 紀錄醫師 李維棠, 時間資訊 10:13 進入手術室 10:18 麻醉開始 10:25 誘導結束 10:47 手術開始 12:25 手術結束 12:25 麻醉結束 12:30 送出病患 12:32 進入恢復室 14:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 深部傷口處理縫合擴創-大 1 0 L 記錄__ 手術科部: 外科部 套用罐頭: Debridement 開立醫師: 李維棠 開立時間: 2011/12/05 12:41 Pre-operative Diagnosis Left neck poor healing wounds Post-operative Diagnosis Deep brain stimulation device related left neck chronic wound with abscess accumulation Operative Method Debridement Specimen Count And Types nil Pathology Nil Operative Findings Left neck three poor healing wounds with wire exposure was noted after fragile granulation curetted. Abscess accumulation was also noted over left lower neck. Granulation tissues was noted around the deep brain stimulation wire. Operative Procedures Under ETGA, the patient was put in supine position. Local anathesia was performed. A linar incision was made from left frontal area to left lower neck. The skin and the fascia was seperated. Debridement was performed. After hemostasis and normal saline irrigation, the wound was closed with 2-0 and 3-0 Nylon. Under ETGA, the patient was put in supine position. Local anathesia was performed. A linar incision was made from left frontal area to left lower neck. The skin and the fascia was seperated. Debridement was performed and two CWV drainage tubes were inserted. After hemostasis and normal saline irrigation, the wound was closed with 2-0 and 3-0 Nylon. Operators VS戴浩志 Assistants R5游彥辰 R3李維棠 Ri陳怡君 洪茄倚 (F,2005/11/13,6y4m) 手術日期 2011/12/05 手術主治醫師 廖漢文 手術區域 東址 000房 號 診斷 Moyamoya disease 器械術式 diagnostic angiography 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 2 時間資訊 08:50 麻醉開始 09:10 誘導結束 09:50 麻醉結束 10:10 進入恢復室 11:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 胡彩樺 (F,1966/09/05,45y6m) 手術日期 2011/12/05 手術主治醫師 陳敞牧 手術區域 東址 003房 01號 診斷 Insomnia, nonorganic 器械術式 C5/6 anterior cervical diskectomy 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 07:30 報到 08:05 進入手術室 08:10 麻醉開始 08:20 誘導結束 08:50 抗生素給藥 09:03 手術開始 11:08 手術結束 11:08 麻醉結束 11:18 送出病患 11:20 進入恢復室 12:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-頸椎 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 手術 椎融合術-前融合,無固定物(≦四節) 1 2 記錄__ 手術科部: 外科部 套用罐頭: Anterior diskectomy and fusion with cage 開立醫師: 蔡宗良 開立時間: 2011/12/05 11:14 Pre-operative Diagnosis C5-6 herniated intervertebral disc Post-operative Diagnosis C5-6 herniated intervertebral disc Operative Method Anterior diskectomy and fusion with cage Specimen Count And Types nil Pathology nil Operative Findings The disc was dehydrated and the intervetebral disc space was narrow. One 7mm of cage was inserted. The SSEP remained unchanged. Operative Procedures Under ETGA, the patient was placed in supine position and the neck was extended. After disinfection and draping, a linear skin incision was made along skin crest. After dissection along the anterior border of the sternocledomastoid muscle, the prevertebral space was reached. C6/7 level was checked by using intraoperative fluoroscopy. The retraction system was set. C6/7 diskectomy was performed. The PEEK cage was implanted. The wound was closed in layers with one prevertebral mini-hemovac. Operators 陳敞牧 Assistants 蔡宗良 陳國瑋 相關圖片 王淑貞 (F,1964/04/29,47y10m) 手術日期 2011/12/05 手術主治醫師 陳敞牧 手術區域 東址 003房 02號 診斷 Carpal tunnel syndrome 器械術式 Neurolysis of left tardy ulnar palsy 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 面罩麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 11:20 報到 11:32 進入手術室 11:35 麻醉開始 11:40 抗生素給藥 11:40 誘導結束 11:54 手術開始 12:35 手術結束 12:35 麻醉結束 12:43 送出病患 12:45 進入恢復室 13:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 神經分離術-手.足之經 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Semi-opened mask inhalation anes 1 0 記錄__ 手術科部: 外科部 套用罐頭: Neurolysis, left 開立醫師: 陳國瑋 開立時間: 2011/12/05 12:56 Pre-operative Diagnosis Tardy ulnar palsy, left Post-operative Diagnosis Tardy ulnar palsy, left Operative Method Neurolysis, left Specimen Count And Types nil Pathology nil Operative Findings Much fibrotic tissue compressing the ulnar nerve tightly, and the nerve became injected. The nerve was decompressed well after neurolysis. Operative Procedures Under IVG, the patient was put in supine position. The left forearm was disinfected and drapped in sterile fasion. One skin incision was made between olecrenon and medial epicondyle. The nuerolysis of the fibrose tissue was done around ulnar nerve. The wound was then closed in layers. Compressive gauze was applied. Operators 陳敞牧 Assistants 蔡宗良 陳國瑋 相關圖片 吳偉民 (M,1976/12/17,35y2m) 手術日期 2011/12/05 手術主治醫師 楊士弘 手術區域 東址 003房 03號 診斷 Cervical spondylosis 器械術式 C5/6 anterior cervical diskectomy 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 13:05 進入手術室 13:10 麻醉開始 13:20 誘導結束 13:25 抗生素給藥 13:45 手術開始 16:11 手術結束 16:11 麻醉結束 16:17 送出病患 16:21 進入恢復室 18:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-頸椎 1 1 R 手術 椎融合術-前融合,無固定物(≦四節) 1 2 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: Anterior cervical diskectomy + interbody PEEK... 開立醫師: 楊士弘 開立時間: 2011/12/05 16:12 Pre-operative Diagnosis Cervical herniated intervertebral disc, C5-6 Post-operative Diagnosis Cervical herniated intervertebral disc, C5-6 Operative Method Anterior cervical diskectomy + interbody PEEK cage fusion Specimen Count And Types nil Pathology Nil Operative Findings The C5-6 disk space was very narrow. Prominent anterior and posterior marginal spurs were also noted. The disk protruded posteriorly and indented the thickened PLL against the thecal sac. The thecal sac reexpanded well after decompression. A 5 mm high PEEK cage (A-spine system) was inserted into the C5-6 disk space. Operative Procedures 1. ETGA, supine, neck extended. 2. Right anterior neck incision down to the subplatysmal muscle plane. 3. Dissection along medial SCM to reach the prevertebral space. 4. Localization of C5-6 level with C-arm. 5. Beginning of the following procedures with microscope. 6. Diskectomy with knife, currets, and disk forceps. 7. Removal of posterior marginal spurs with high speed air drill. 8. Excision of bulging disc and PLL with curret, and kerrison punches. 9. Insertion of a PEEK interbody cage. 10. Verification of the cage position by C-arm. 11. Wound closure in layers. Operators 楊士弘 Assistants 蔡宗良,陳國瑋 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Anterior cervical diskectomy + interbody PEEK... 開立醫師: 陳國瑋 開立時間: 2011/12/05 16:25 Pre-operative Diagnosis Cervical herniated intervertebral disc, C5-6 Post-operative Diagnosis Cervical herniated intervertebral disc, C5-6 Operative Method Anterior cervical diskectomy + interbody PEEK cage fusion Specimen Count And Types nil Pathology Nil Operative Findings The C5-6 disk space was very narrow. Prominent anterior and posterior marginal spurs were also noted. The disk protruded posteriorly and indented the thickened PLL against the thecal sac. The thecal sac reexpanded well after decompression. A 5 mm high PEEK cage (A-spine system) was inserted into the C5-6 disk space. Operative Procedures 1. ETGA, supine, neck extended. 2. Right anterior neck incision down to the subplatysmal muscle plane. 3. Dissection along medial SCM to reach the prevertebral space. 4. Localization of C5-6 level with C-arm. 5. Beginning of the following procedures with microscope. 6. Diskectomy with knife, currets, and disk forceps. 7. Removal of posterior marginal spurs with high speed air drill. 8. Excision of bulging disc and PLL with curret, and kerrison punches. 9. Insertion of a PEEK interbody cage. 10. Verification of the cage position by C-arm. 11. Wound closure in layers. Operators 楊士弘 Assistants 蔡宗良,陳國瑋 相關圖片 胡添枝 (M,1962/11/13,49y4m) 手術日期 2011/12/05 手術主治醫師 王國川 手術區域 東址 002房 04號 診斷 Subarachnoid hemorrhage 器械術式 kidney dornor, corneal dornor 手術類別 緊急手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 5E 紀錄醫師 高姿芸, 周博敏, 時間資訊 20:01 通知急診手術 21:00 進入手術室 21:13 麻醉開始 21:20 誘導結束 21:41 手術開始 23:35 麻醉結束 02:00 手術結束 02:23 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 屍體捐腎切除術 1 1 手術 鞏膜切除術 2 1 B 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 記錄__ 手術科部: 眼科部 套用罐頭: Sclerectomy (ou) 開立醫師: 高姿芸 開立時間: 2011/12/06 01:03 Pre-operative Diagnosis For donation, ou Post-operative Diagnosis For donation, ou Operative Method Sclerectomy (ou) Specimen Count And Types Pathology Operative Findings Operative Procedures 1.Disinfection and draping as usual 2.Application of an eyelid speculum on os 3.Application of an eyelid speculum 4.360-degree peritomy 5.dissect the sclera area 6.Sclerectomy 7.Tarsorrhaphy with 6-0 nylon 8.Repeat above procedures on os Operators 胡芳蓉, Assistants 高姿芸, 蘇乾嘉, Indication Of Emergent Operation donation 記錄__ 手術科部: 泌尿部 套用罐頭: donor nephrectomy, cadaveric 開立醫師: 周博敏 開立時間: 2011/12/06 03:00 Pre-operative Diagnosis for donation, kidneys Post-operative Diagnosis for donation, kidneys Operative Method donor nephrectomy, cadaveric Specimen Count And Types nil Pathology nil Operative Findings clamping time: 22:35 Operative Procedures 1. ETGA, supine, disinfection 2. midline laparotomy 3. take down colon, expose retroperitoneal space, dissect ureter 4. mobilize kidneys 5. ligate SMA, loop descending aorta, canulization 6. incise IVC 7. Irrigation with preservation fluid, cooling with ice 8. harvest kidneys 9. close wound in layers Operators 王碩盟, Assistants 周博敏, Indication Of Emergent Operation organ donation 吳順吉 (M,2009/11/02,2y4m) 手術日期 2011/12/06 手術主治醫師 黃書健 手術區域 兒醫 068房 01號 診斷 Tetralogy of fallot 器械術式 Total correction 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 石博元 ASA 3 紀錄醫師 黃世銘, 時間資訊 07:58 報到 08:08 進入手術室 08:25 麻醉開始 09:30 誘導結束 10:09 手術開始 10:35 抗生素給藥 11:38 抗生素給藥 12:38 開始輸血 13:20 麻醉結束 13:20 手術結束 13:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 存開性動脈導管手術 1 2 手術 體外心肺循環 1 1 手術 四合群症之修補(T.F) 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 T.E.E 1 0 麻醉 動脈血液檢查全套 4 0 麻醉 Hemoglobin (Hb) 4 0 麻醉 測血糖 4 0 麻醉 Ca (Calcium) 4 0 麻醉 Na (Sodium) 4 0 麻醉 K (Potassium) 4 0 麻醉 Blood gas analysis 4 0 記錄__ 手術科部: 套用罐頭: VSD repair, infundibilectomy, RVOT-PA transan... 開立醫師: 黃世銘 開立時間: 2012/01/18 13:30 Pre-operative Diagnosis TOF s/p right mBT shunt, s/p left mBT shunt Post-operative Diagnosis Ditto Operative Method VSD repair, infundibilectomy, RVOT-PA transannular patch with monocuspid valve, and left mBT shunt division Specimen Count And Types nil Pathology Nil Operative Findings 1. Situs solitus, Levocardia, Left arch 2. VSD: perimembranous trabecular type, 1.5cm in diameter -> Dacron patch repair 3. Aorta overrinding, hypertrophic infundibular muscle, narrow pulmonary annulus when systolic phase 4. Left mBT shunt: patent->Division 5. After resect infundibular muscle and pulmonary annulus, Hegar 18# could pass. After patch repair, pressure gradient about 11mmHg 6. Surgical membrane cover heart(+) Operative Procedures 1. Under ETGA with supine position 2. Disinfected and well drapped 3. Re-sternotomy 4. Cannulate via AsAo/RAAIVC. On CPB. Cooling to 28 degree Celsius 5. AXC and antegrade cardioplegia infusion, Venting via IAS. 6. Divide left mBT shunt. RVOT incision. Resect hypertrophic infundibular muscle and septal band 7. Dacron patch repair VSD with pledgette Prolene 5-0 x 10. 8. Extend RVOT incision to MPA 9. Create monocuspid valve(by bovine pericardium) On bovine pericardium patch, then attach to RVOt-MPA incision 10. Rewarm. Deair. Wean off CPB 11. Repair IAS and RA 12. Hemosasis. Set 4 chest tubes 13. Wound closure in layers Operators VS 黃書健 Assistants R5黃俊銘, R3黃世銘 洪茄倚 (F,2005/11/13,6y4m) 手術日期 2011/12/06 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Moyamoya disease 器械術式 EDAS for moyamoya disease 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 石博元 ASA 3 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:04 進入手術室 08:35 麻醉開始 09:00 誘導結束 09:23 抗生素給藥 09:38 手術開始 12:30 抗生素給藥 13:05 麻醉結束 13:05 手術結束 13:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 顱內外血管吻合術 1 1 L 手術 朴卜勒氏血流測定（週邊血管） 1 0 摘要__ 手術科部: 外科部 套用罐頭: Left side encephaloduroarteriosynangiosis (in... 開立醫師: 王奐之 開立時間: 2011/12/06 13:25 Pre-operative Diagnosis Moyamoya disease Post-operative Diagnosis Moyamoya disease Operative Method Left side encephaloduroarteriosynangiosis (indirect EC-IC bypass) from posterior branch of STA to MCA territory Specimen Count And Types Nil Pathology Nil Operative Findings Numerous small collateral vessel were noted at brain surface. The posterior branch of left STA was used, with about 6cm of mobilized segment; the surrounding galeal tissue were left with STA (about 1cm in width). Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to right. After tracing and marking of the superficial temporal artery (STA) with Duplex, the scalp was scrubbed, disinfected, and draped in sterile fashion. Under microscopic view, a small reversed hockey stick incision was made at left temporal area, followed by dissection of galea and careful preservation of STA. One segment of STA along with surrounding galeal tissue were mobilized and gently retracted to the side. After a linear incision over the temporalis muscle, an ovoid craniotomy was then done with its long axis along the STA course. A linear durotomy was made, followed by opening of the arachnoid membrane covering the surface artery. 4 anchoring sutures were applied to the proximal & distal end of STA to the dural edges, and one more stitch was applied at the middle segment to fix the STA graft to the exposed pia. The dura was then approximated with 4-0 Prolene continuous sutures. a piece of DuroForm was used to covered the dural surface to prevent CSF leakage. The bone flap edge was rongeured off to allow patent entry & exit points of STA. After central tenting, the bone flap was fixed back with 3 wires. The wound was then closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之, Ri 陳昱傑 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Left side encephaloduroarteriosynangiosis (in... 開立醫師: 王奐之 開立時間: 2011/12/06 13:25 Pre-operative Diagnosis Moyamoya disease Post-operative Diagnosis Moyamoya disease Operative Method Left side encephaloduroarteriosynangiosis (indirect EC-IC bypass) from posterior branch of STA to MCA territory Specimen Count And Types Nil Pathology Nil Operative Findings Numerous small collateral vessel were noted at brain surface. The posterior branch of left STA was used, with about 6cm of mobilized segment; the surrounding galeal tissue were left with STA (about 1cm in width). Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to right. After tracing and marking of the superficial temporal artery (STA) with Duplex, the scalp was scrubbed, disinfected, and draped in sterile fashion. Under microscopic view, a small reversed hockey stick incision was made at left temporal area, followed by dissection of galea and careful preservation of STA. One segment of STA along with surrounding galeal tissue were mobilized and gently retracted to the side. After a linear incision over the temporalis muscle, an ovoid craniotomy was then done with its long axis along the STA course. A linear durotomy was made, followed by opening of the arachnoid membrane covering the surface artery. 4 anchoring sutures were applied to the proximal & distal end of STA to the dural edges, and one more stitch was applied at the middle segment to fix the STA graft to the exposed pia. The dura was then approximated with 4-0 Prolene continuous sutures. a piece of DuroForm was used to covered the dural surface to prevent CSF leakage. The bone flap edge was rongeured off to allow patent entry & exit points of STA. After central tenting, the bone flap was fixed back with 3 wires. The wound was then closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之, Ri 陳昱傑 相關圖片 摘要__ 手術科部: 外科部 套用罐頭: Left side encephaloduroarteriosynangiosis (in... 開立醫師: 王奐之 開立時間: 2011/12/06 15:40 Pre-operative Diagnosis Moyamoya disease Post-operative Diagnosis Moyamoya disease Operative Method Left side encephaloduroarteriosynangiosis (indirect EC-IC bypass) from posterior branch of STA to MCA territory Specimen Count And Types Nil Pathology Nil Operative Findings Numerous small collateral vessel were noted at brain surface. The posterior branch of left STA was used, with about 6cm of mobilized segment; the surrounding galeal tissue were left with STA (about 1cm in width). Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to right. After tracing and marking of the superficial temporal artery (STA) with Duplex, the scalp was scrubbed, disinfected, and draped in sterile fashion. Under microscopic view, a small reversed hockey stick incision was made at left temporal area, followed by dissection of galea and careful preservation of STA. One segment of STA along with surrounding galeal tissue were mobilized and gently retracted to the side. After a linear incision over the temporalis muscle, an ovoid craniotomy was then done with its long axis along the STA course. A linear durotomy was made, followed by opening of the arachnoid membrane covering the surface artery. 4 anchoring sutures were applied to the proximal & distal end of STA to the dural edges, and one more stitch was applied at the middle segment to fix the STA graft to the exposed pia. The dura was then approximated with 4-0 Prolene continuous sutures. A piece of DuroGene was used to covered the dural surface to prevent CSF leakage. The bone flap edge was rongeured off to allow patent entry & exit points of STA. After central tenting, the bone flap was fixed back with 3 wires. The wound was then closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之, Ri 陳昱傑 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Left side encephaloduroarteriosynangiosis (in... 開立醫師: 王奐之 開立時間: 2011/12/06 15:40 Pre-operative Diagnosis Moyamoya disease Post-operative Diagnosis Moyamoya disease Operative Method Left side encephaloduroarteriosynangiosis (indirect EC-IC bypass) from posterior branch of STA to MCA territory Specimen Count And Types Nil Pathology Nil Operative Findings Numerous small collateral vessel were noted at brain surface. The posterior branch of left STA was used, with about 6cm of mobilized segment; the surrounding galeal tissue were left with STA (about 1cm in width). Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to right. After tracing and marking of the superficial temporal artery (STA) with Duplex, the scalp was scrubbed, disinfected, and draped in sterile fashion. Under microscopic view, a small reversed hockey stick incision was made at left temporal area, followed by dissection of galea and careful preservation of STA. One segment of STA along with surrounding galeal tissue were mobilized and gently retracted to the side. After a linear incision over the temporalis muscle, an ovoid craniotomy was then done with its long axis along the STA course. A linear durotomy was made, followed by opening of the arachnoid membrane covering the surface artery. 4 anchoring sutures were applied to the proximal & distal end of STA to the dural edges, and one more stitch was applied at the middle segment to fix the STA graft to the exposed pia. The dura was then approximated with 4-0 Prolene continuous sutures. A piece of DuroGene was used to covered the dural surface to prevent CSF leakage. The bone flap edge was rongeured off to allow patent entry & exit points of STA. After central tenting, the bone flap was fixed back with 3 wires. The wound was then closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之, Ri 陳昱傑 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Left side encephaloduroarteriosynangiosis (in... 開立醫師: 郭夢菲 開立時間: 2011/12/07 08:42 Pre-operative Diagnosis Moyamoya disease, bilateral Post-operative Diagnosis Moyamoya disease, bilateral Operative Method Left side encephaloduroarteriosynangiosis (indirect EC-IC bypass) from posterior branch of STA to MCA territory Specimen Count And Types Nil Pathology Nil Operative Findings Numerous small collateral vessel were noted at brain surface and dura. The posterior branch of left STA was used, with about 6cm of mobilized segment; the surrounding galeal tissue were left with STA (about 1cm in width). The left middle meningeal artery was preserved since the angiography showed the most anterior branch of it supplied a small region of the frontal lobe. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to right. After tracing and marking of the superficial temporal artery (STA) with Duplex, the scalp was scrubbed, disinfected, and draped in sterile fashion. Under microscopic view, a small reversed hockey stick incision was made at left temporal area, followed by dissection of galea and careful preservation of STA. One segment of STA along with surrounding galeal tissue were mobilized and gently retracted to the side. After a linear incision over the temporalis muscle, an ovoid craniotomy was then done with its long axis along the STA course. A linear durotomy was made, followed by opening of the arachnoid membrane covering the surface artery. 4 anchoring sutures were applied to the proximal & distal end of STA to the dural edges, and one more stitch was applied at the middle segment to fix the STA graft to the exposed pia. The dura was then approximated with 4-0 Prolene continuous sutures. a piece of DuroForm was used to covered the dural surface to prevent CSF leakage. The bone flap edge was rongeured off to allow patent entry & exit points of STA. After central tenting, the bone flap was fixed back with 3 wires. The wound was then closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之, Ri 陳昱傑 相關圖片 林呂守 (F,1940/07/15,71y7m) 手術日期 2011/12/06 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Lumbar stenosis 器械術式 S3 chordoma excision + reconstruction 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 官振翔, 蔡宗良, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:05 進入手術室 08:10 麻醉開始 08:22 抗生素給藥 08:45 誘導結束 09:29 手術開始 11:20 開始輸血 11:22 抗生素給藥 11:43 13:50 麻醉結束 13:50 手術結束 13:50 14:01 送出病患 14:05 進入恢復室 15:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 肌移位術 1 1 R 手術 惡性脊髓腫瘤切除術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 肌移位術 1 2 L 摘要__ 手術科部: 外科部 套用罐頭: Bilateral gluteal rotation muscle flap coverage 開立醫師: 官振翔 開立時間: 2011/12/06 14:07 Pre-operative Diagnosis Spine cordoma s/p wide excision Post-operative Diagnosis Spine cordoma s/p wide excision Operative Method Bilateral gluteal rotation muscle flap coverage Specimen Count And Types Nil Pathology Nil Operative Findings 1. spine cordoma s/p wide excision and removal of sacrum bone 2. ELevate bilateral lateral-based gluteal maximus muscle flap and rotation downward Operative Procedures Take over from neurosurgeon. Antiseptics applied and draped as usual. Normal saline irrigation.Elevate lateral based bilateral gluteal muscle flap. Muscle approximation medially with 2-0 monocryl. Wound closure with 3 CWV drains. Operators AP 戴浩志 Assistants R6 官振翔, R1李嘉哲 Ri 李書霖 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Bilateral gluteal rotation muscle flap coverage 開立醫師: 官振翔 開立時間: 2011/12/06 14:07 Pre-operative Diagnosis Spine cordoma s/p wide excision Post-operative Diagnosis Spine cordoma s/p wide excision Operative Method Bilateral gluteal rotation muscle flap coverage Specimen Count And Types Nil Pathology Nil Operative Findings 1. spine cordoma s/p wide excision and removal of sacrum bone 2. ELevate bilateral lateral-based gluteal maximus muscle flap and rotation downward Operative Procedures Take over from neurosurgeon. Antiseptics applied and draped as usual. Normal saline irrigation.Elevate lateral based bilateral gluteal muscle flap. Muscle approximation medially with 2-0 monocryl. Wound closure with 3 CWV drains. Operators AP 戴浩志 Assistants R6 官振翔, R1李嘉哲 Ri 李書霖 相關圖片 摘要__ 手術科部: 外科部 套用罐頭: Excision of chordoma 開立醫師: 連子賢 開立時間: 2011/12/06 17:46 Pre-operative Diagnosis Chordoma, sacrum Post-operative Diagnosis Chordoma, sacrum Operative Method Excision of chordoma Specimen Count And Types 1 piece About size:小 Source:Tumor Pathology Report pending Operative Findings 1. Tumor measuring in 5-cm in diameter was cystic and well-dermacated. Rostral and caudal bony sacrum was partially eroded by the tumor. The cystic content was greyish in color, fragile and avascular. There were only mild adhesion over the retroperitoneal fat. The retroperitoneal fat was kept intact. Operative Procedures 1. ETGA, prone positioning 2. Routine preparation and disinfection 3. Inverted U-shaped incision as depicted. Operators Assistants 相關圖片 摘要__ 手術科部: 外科部 套用罐頭: Excision of chordoma 開立醫師: 蔡宗良 開立時間: 2011/12/06 17:53 Pre-operative Diagnosis Chordoma, sacrum Post-operative Diagnosis Chordoma, sacrum Operative Method Excision of chordoma Specimen Count And Types 1 piece About size:小 Source:Tumor Pathology Report pending Operative Findings Tumor measuring in 5-cm in diameter was cystic and well-dermacated. Rostral and caudal bony sacrum was partially eroded by the tumor. The cystic content was greyish in color, fragile and avascular. There were only mild adhesion over the retroperitoneal fat. The retroperitoneal fat was kept intact. The tumor including cyst, together with parts of the eroded sacrum were removed totally. Operative Procedures 1. ETGA, prone positioning 2. Routine preparation and disinfection 3. Inverted U-shaped incision as depicted 4. Subcutaneous dissection until the caudal end of the tumor has been reached, then dissection proceeded laterally to include the tumor and parts of the eroded sacrum 5. Dissection of the tumor away from the retroperitoneal fat 6. Gentamicin saline irrigation 7. Cover the retroperitoneal fat with DURAFORM 8. Simple nylon sutures and coverage with OP site before removal of all the drapes 9. Take over by plastic surgeons for gluteus muscle recontruction Operators VS 賴達明 Assistants R6 蔡宗良 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Excision of chordoma 開立醫師: 蔡宗良 開立時間: 2011/12/06 17:53 Pre-operative Diagnosis Chordoma, sacrum Post-operative Diagnosis Chordoma, sacrum Operative Method Excision of chordoma Specimen Count And Types 1 piece About size:小 Source:Tumor Pathology Report pending Operative Findings Tumor measuring in 5-cm in diameter was cystic and well-dermacated. Rostral and caudal bony sacrum was partially eroded by the tumor. The cystic content was greyish in color, fragile and avascular. There were only mild adhesion over the retroperitoneal fat. The retroperitoneal fat was kept intact. The tumor including cyst, together with parts of the eroded sacrum were removed totally. Operative Procedures 1. ETGA, prone positioning 2. Routine preparation and disinfection 3. Inverted U-shaped incision as depicted 4. Subcutaneous dissection until the caudal end of the tumor has been reached, then dissection proceeded laterally to include the tumor and parts of the eroded sacrum 5. Dissection of the tumor away from the retroperitoneal fat 6. Gentamicin saline irrigation 7. Cover the retroperitoneal fat with DURAFORM 8. Simple nylon sutures and coverage with OP site before removal of all the drapes 9. Take over by plastic surgeons for gluteus muscle recontruction Operators VS 賴達明 Assistants R6 蔡宗良 相關圖片 吳佳富 (M,1942/06/03,69y9m) 手術日期 2011/12/06 手術主治醫師 賴達明 手術區域 東址 019房 04號 診斷 Hematuria 器械術式 L5-S1 microdiskectomy 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾峰毅, 時間資訊 00:00 臨時手術NPO 13:00 進入手術室 13:05 麻醉開始 13:15 誘導結束 13:30 抗生素給藥 14:11 手術開始 15:40 手術結束 15:40 麻醉結束 15:45 送出病患 15:50 進入恢復室 17:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-腰椎 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 外科部 套用罐頭: HIVD 開立醫師: 曾峰毅 開立時間: 2011/12/06 15:46 Pre-operative Diagnosis Ruptured disc, L5/S1 Post-operative Diagnosis Ruptured disc, L5/S1 Operative Method Left L5/S1 laminotomy for microdiskectomy Specimen Count And Types Nil Pathology Nil Operative Findings Sequestrated disc was noted from L5/S1 space compromising left S1 root tightly. Neural structures were decompressed well after diskectomy. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After C-arm localization, we scrubbed, disinfected, and then draped the patient's back. We made one midline skin incision, and dissected left paraspinous muscle to expose left L5/S1 interlaminar space. L5/S1 laminotomy was done, and diskectomy was performed. The wound was closed in layers. Operators VS 賴達明 Assistants R5 曾峰毅 Ri 葉師帆 R5 曾峰毅 Ri 葉詩帆 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: HIVD 開立醫師: 曾峰毅 開立時間: 2011/12/10 14:56 Pre-operative Diagnosis Ruptured disc, L5/S1 Post-operative Diagnosis Ruptured disc, L5/S1 Operative Method Left L5/S1 laminotomy for microdiskectomy Specimen Count And Types Nil Pathology Nil Operative Findings Sequestrated disc was noted from L5/S1 space compromising left S1 root tightly. Neural structures were decompressed well after diskectomy. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After C-arm localization, we scrubbed, disinfected, and then draped the patient's back. We made one midline skin incision, and dissected left paraspinous muscle to expose left L5/S1 interlaminar space. L5/S1 laminotomy was done, and diskectomy was performed. The wound was closed in layers. Operators VS 賴達明 Assistants R5 曾峰毅 Ri 葉詩帆 相關圖片 廖玉池 (M,1935/06/25,76y8m) 手術日期 2011/12/06 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 HIVD 器械術式 C4/5 anterior cervical diskectomy 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 蔡宗良, 時間資訊 00:00 臨時手術NPO 14:11 進入手術室 14:20 麻醉開始 14:30 誘導結束 14:35 抗生素給藥 14:52 手術開始 16:50 手術結束 16:50 麻醉結束 16:55 送出病患 16:56 進入恢復室 17:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 椎間盤切除術-頸椎 1 1 手術 脊椎融合術-前融合,有固定物)≦四節 1 2 摘要__ 手術科部: 外科部 套用罐頭: Anterior cervical discectomy, with fusion (ca... 開立醫師: 蔡宗良 開立時間: 2011/12/06 18:11 Pre-operative Diagnosis Herniated cervical disc, C4-5 Post-operative Diagnosis Herniated cervical disc, C4-5 Operative Method Anterior cervical discectomy, with fusion (cage), C4-5 Specimen Count And Types nil Pathology none Operative Findings Herniated C4-5 disc with redundant PLL Operative Procedures 1. ETGA, supine 2. Routine preparation 3. Linear wound incision, open platysma and SCM-streps muscle fasia 4. Reach prevertebral fascia 5. Confirm C4-5 level by fluoroscopy 6. Discectomy with opening of PLL under operating microscope 7. Six-mm height cage was impacted into the disc space 8. Wound was closed in layers after placing a miniVac. Operators VS 賴達明 Assistants R6 蔡宗良 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Anterior cervical discectomy, with fusion (ca... 開立醫師: 蔡宗良 開立時間: 2011/12/06 18:18 Pre-operative Diagnosis Herniated cervical disc, C4-5 Post-operative Diagnosis Herniated cervical disc, C4-5 Operative Method Anterior cervical discectomy, with fusion (cage), C4-5 Specimen Count And Types nil Pathology none Operative Findings Herniated C4-5 disc with redundant PLL Operative Procedures 1. ETGA, supine 2. Routine preparation 3. Linear wound incision, open platysma and SCM-streps muscle fasia 4. Reach prevertebral fascia 5. Confirm C4-5 level by fluoroscopy 6. Discectomy with opening of PLL under operating microscope 7. Six-mm height cage was impacted into the disc space 8. Wound was closed in layers after placing a miniVac. Operators VS 賴達明 Assistants R6 蔡宗良 相關圖片 呂欣怡 (F,1951/10/20,60y4m) 手術日期 2011/12/06 手術主治醫師 賴達明 手術區域 東址 005房 01號 診斷 Spondylolisthesis 器械術式 Diskectomy lumbar，Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:00 進入手術室 08:10 麻醉開始 08:25 誘導結束 08:35 抗生素給藥 09:12 手術開始 11:35 抗生素給藥 12:25 手術結束 12:25 麻醉結束 12:30 送出病患 12:35 進入恢復室 14:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎間盤切除術-腰椎 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: L4-5 sublaminal decompression, L4-5 discectom... 開立醫師: 林哲光 開立時間: 2011/12/06 12:50 Pre-operative Diagnosis L4-5 central canal stenosis with spondylolisthesis Post-operative Diagnosis L4-5 central canal stenosis with spondylolisthesis Operative Method L4-5 sublaminal decompression, L4-5 discectomy and posterior fusion with TPS and rods Specimen Count And Types nil Pathology Nil Operative Findings Hypertrophic change of bilateral facet joints and ligamentum flavum was noted with direct compressing the dura sac tightly. The dura sac seemed re-expanded well after decompression. 11mm cage was inserted at L4/5 disc level. 6.5x40mmx4 were inserted at bilateral L4 and L5 pedicles. 5cm rods were applied for posterior fusion. Operative Procedures Under ETGA and prone position, skin disinfected and drapped were performed as usual. Midline skin incsiion was made and paraspinal muscles were detached. Bilateral L4, L5 facet joints were well exposed under C-arm localization. TPS were then applied. L4-5 sublaminal decompression was done after partial laminotomy was done. Right L5 root was well-exposed and L4-5 disectomy was then performed. The cage was then inserted and rods were applied for posterior fusion. The wound was then closed in layers after hemostasis and epidural drain insertion. Operators 賴達明 Assistants 林哲光, 翁上硯 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: L4-5 sublaminal decompression, L4-5 discectom... 開立醫師: 林哲光 開立時間: 2011/12/06 12:50 Pre-operative Diagnosis L4-5 central canal stenosis with spondylolisthesis Post-operative Diagnosis L4-5 central canal stenosis with spondylolisthesis Operative Method L4-5 sublaminal decompression, L4-5 discectomy and posterior fusion with TPS and rods Specimen Count And Types nil Pathology Nil Operative Findings Hypertrophic change of bilateral facet joints and ligamentum flavum was noted with direct compressing the dura sac tightly. The dura sac seemed re-expanded well after decompression. 11mm cage was inserted at L4/5 disc level. 6.5x40mmx4 were inserted at bilateral L4 and L5 pedicles. 5cm rods were applied for posterior fusion. Operative Procedures Under ETGA and prone position, skin disinfected and drapped were performed as usual. Midline skin incsiion was made and paraspinal muscles were detached. Bilateral L4, L5 facet joints were well exposed under C-arm localization. TPS were then applied. L4-5 sublaminal decompression was done after partial laminotomy was done. Right L5 root was well-exposed and L4-5 disectomy was then performed. The cage was then inserted and rods were applied for posterior fusion. The wound was then closed in layers after hemostasis and epidural drain insertion. Operators 賴達明 Assistants 林哲光, 翁上硯 相關圖片 陳鄭幸連 (F,1945/04/12,66y11m) 手術日期 2011/12/06 手術主治醫師 陳敞牧 手術區域 東址 019房 05號 診斷 Malignant neoplasm of ethmoidal sinus 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾峰毅, 時間資訊 00:00 臨時手術NPO 15:45 報到 16:10 進入手術室 16:15 麻醉開始 16:30 誘導結束 16:35 抗生素給藥 17:00 手術開始 17:45 麻醉結束 17:45 手術結束 17:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 曾峰毅 開立時間: 2011/12/06 17:50 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunt via right Kocher Specimen Count And Types Nil Pathology Nil Operative Findings Medtronic, fixed-pressure valve, was used for VPS. Xanthochromic CSF gused out while previously implanted Ommaya removed. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to left. We scrubbed, disinfected, and then draped the patient. We made one transverse skin incision along previous bicoronal skin incision, and removed previously implanted Ommaya. We made one transverse skin incision at right upper abdomen, and performed mini-laparotomy. We created subcutaneous tunnel, and passed the shunt catheter through the tunnel. We connected the shunt and checked the function. We inserted the peritoneal and ventricular catheter. The wound was closed in layers. Operators VS 陳敞牧 Assistants R5 曾峰毅 Ri 葉詩帆 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 曾峰毅 開立時間: 2011/12/10 14:57 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunt via right Kocher Specimen Count And Types Nil Pathology Nil Operative Findings Medtronic, fixed-pressure valve, was used for VPS. Xanthochromic CSF gused out while previously implanted Ommaya removed. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to left. We scrubbed, disinfected, and then draped the patient. We made one transverse skin incision along previous bicoronal skin incision, and removed previously implanted Ommaya. We made one transverse skin incision at right upper abdomen, and performed mini-laparotomy. We created subcutaneous tunnel, and passed the shunt catheter through the tunnel. We connected the shunt and checked the function. We inserted the peritoneal and ventricular catheter. The wound was closed in layers. Operators VS 陳敞牧 Assistants R5 曾峰毅 Ri 葉詩帆 相關圖片 廖林寶幼 (F,1927/05/24,84y9m) 手術日期 2011/12/06 手術主治醫師 陳敞牧 手術區域 東址 005房 02號 診斷 Spondylosis with myelopathy, cervical 器械術式 C4-6 laminoplasty 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 12:23 報到 12:49 進入手術室 12:50 麻醉開始 13:05 誘導結束 13:10 抗生素給藥 13:11 手術開始 16:10 抗生素給藥 16:30 手術結束 16:30 麻醉結束 16:35 送出病患 16:40 進入恢復室 19:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓整形術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 摘要__ 手術科部: 外科部 套用罐頭: C4-6 laminoplasty and C3 sublaminal decompression 開立醫師: 林哲光 開立時間: 2011/12/06 16:58 Pre-operative Diagnosis C3-6 central canal stenosis Post-operative Diagnosis C3-6 central canal stenosis Operative Method C4-6 laminoplasty and C3 sublaminal decompression Specimen Count And Types nil Pathology Nil Operative Findings Severe osteoporosis was noted with easily active bleeding from bone defect. Hypertrophic change of ligamentum flavum was noted with direct compressing the cord tightly. The dura seemed re-expanded well after decompression. Intraoperative blood was about 1100ml. Operative Procedures Under ETGA and prone position with head fixed with Mayfield head clamp, skin disinfected and drapped were performed as usual. Midline skin incision was made and C2 spinous process was identified. C4-6 paraspinal muscles were detached and lateral mass were exposed. C4-6 laminoplasty via open-door method with left side as axis and the lamina was fixed with miniplates after spinous process was cut shorter. C3 sublaminal decompression was also done. The wound was then closed in layers after hemostasis and epidural drain insertion. Operators 陳敞牧 Assistants 林哲光, 翁上硯 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: C4-6 laminoplasty and C3 sublaminal decompression 開立醫師: 林哲光 開立時間: 2011/12/06 16:58 Pre-operative Diagnosis C3-6 central canal stenosis Post-operative Diagnosis C3-6 central canal stenosis Operative Method C4-6 laminoplasty and C3 sublaminal decompression Specimen Count And Types nil Pathology Nil Operative Findings Severe osteoporosis was noted with easily active bleeding from bone defect. Hypertrophic change of ligamentum flavum was noted with direct compressing the cord tightly. The dura seemed re-expanded well after decompression. Intraoperative blood was about 1100ml. Operative Procedures Under ETGA and prone position with head fixed with Mayfield head clamp, skin disinfected and drapped were performed as usual. Midline skin incision was made and C2 spinous process was identified. C4-6 paraspinal muscles were detached and lateral mass were exposed. C4-6 laminoplasty via open-door method with left side as axis and the lamina was fixed with miniplates after spinous process was cut shorter. C3 sublaminal decompression was also done. The wound was then closed in layers after hemostasis and epidural drain insertion. Operators 陳敞牧 Assistants 林哲光, 翁上硯 相關圖片 黃神添 (M,1938/08/29,73y6m) 手術日期 2011/12/06 手術主治醫師 陳敞牧 手術區域 西址 039房 01號 診斷 Malignant neoplasm of bones of skull and face,except mandible 器械術式 Excision of neuroma 手術類別 預定手術 手術部位 腹 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 09:00 報到 09:02 進入手術室 09:19 麻醉開始 09:20 誘導結束 09:22 手術開始 10:18 手術結束 10:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 臉部以外皮膚及皮下腫瘤摘除術 4公分至10公分 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Total excision of subcutaneous tumor. 開立醫師: 鍾文桂 開立時間: 2011/12/06 10:50 Pre-operative Diagnosis Subcutaneous tumor, right lower qudrant of abdomen. Post-operative Diagnosis Subcutaneous tumor, right lower qudrant of abdomen. Operative Method Total excision of subcutaneous tumor. Specimen Count And Types 1 piece About size:5 cm Source:subcutaneous tumor. Pathology Nil. Operative Findings A firm elastic well delineated subcutaneous tumor at right lower qudrant of abdomen. Surrounding fibrosis is noted. Low vascularity. Operative Procedures Under local anesthesia, the patient was placed in lateral decubitus position. After disinfection and draping, a linear skin incision was made. Tumor was dissected along its plane. After well hemostasis, the wound was closed in layers. Operators 陳敞牧 Assistants 鍾文桂 相關圖片 周林秀畏 (F,1943/08/24,68y6m) 手術日期 2011/12/06 手術主治醫師 吳毅暉 手術區域 東址 023房 03號 診斷 Non-Hodgkin's lymphoma 器械術式 Port-A Implatation /WOR 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 莊民楷, 時間資訊 15:00 報到 15:14 進入手術室 15:21 抗生素給藥 15:55 麻醉開始 15:56 麻醉結束 15:57 手術開始 16:25 手術結束 16:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 內頸靜脈切開,永久導管放置術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Port-A implantation, RIJV 開立醫師: 莊民楷 開立時間: 2011/12/06 16:28 Pre-operative Diagnosis CNS lymphoma Post-operative Diagnosis CNS lymphoma Operative Method Port-A implantation, RIJV Specimen Count And Types nil Pathology Nil Operative Findings 1. blood return smooth after port-A implantation Operative Procedures 1. LA, supine 2. Disinfection and drapping 3. Right internal jugular vein puncture 4. Right upper chest wall linear skin incision, 3cm 5. Create subcutaneous pouch, fix port-A 6. Insert port-A catheter through guidewire and sheath 7. Close the wound in layer Operators VS 吳毅暉 Assistants R4 莊民楷 廖雪 (F,1951/01/02,61y2m) 手術日期 2011/12/06 手術主治醫師 蕭輔仁 手術區域 東址 001房 03號 診斷 Spinal cord metastasis 器械術式 Spinal fusion posterior with TPS and tumor resection 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 09:17 通知急診手術 15:07 報到 15:30 進入手術室 15:35 麻醉開始 15:55 誘導結束 16:50 麻醉結束 16:51 送出病患 16:55 進入恢復室 18:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 葛瓦琪 (F,1945/02/20,67y0m) 手術日期 2011/12/07 手術主治醫師 王國川 手術區域 東址 003房 04號 診斷 Brain tumors, malignant 器械術式 Crainotomy for left temporal tumor excision 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林峰盛 ASA 3E 紀錄醫師 曾偉倫, 時間資訊 17:14 開始NPO 17:14 臨時手術NPO 17:14 通知急診手術 00:05 進入手術室 00:10 麻醉開始 00:30 抗生素給藥 00:30 誘導結束 00:55 手術開始 03:08 手術結束 03:15 送出病患 08:03 麻醉結束 23:40 報到 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 8 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除-手術時間在4小時以內 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Left temporal craniotomy for tumor excision 開立醫師: 曾偉倫 開立時間: 2011/12/07 03:26 Pre-operative Diagnosis Left temporal tumor, suspect metastasis Post-operative Diagnosis Left temporal tumor, suspect metastasis Operative Method Left temporal craniotomy for tumor excision Specimen Count And Types 1 piece About size:4x4x4 cm Source:Left temporal tumor, suspect metastasis Pathology Pending Operative Findings Tumor located at the left-sided temporal base with greyish in color, fragile, moderately demarcated, and moderate in vascularity. Operative Procedures Under ETGA, we placed the patient on supine position with her face tilt to right. After routine disinfection and drapping, a curvilinear wound was used, followed by a 4 x 4 cm diameter craniotomy. Tenting was performed at 1 cm interval. U-shaped durotomy was performed, basing on the temporal base. Tumor was removed by bipolar cautery, suction, and tumor forceps. After meticulous hemostasis, dura was closed by 4-0 Prolene. Two stitches of central tenting were performed. Skull plate was fixed back to craniotomy window by mini-plates. CWV drain was placed at the subgaleal space. The wound was closed in layers. Operators VS 王國川 Assistants R6 蔡宗良 R3 曾偉倫 Indication Of Emergent Operation IICP 相關圖片 高鍾琦 (M,1925/09/09,86y6m) 手術日期 2011/12/06 手術主治醫師 王國川 手術區域 東址 002房 03號 診斷 Subdural hemorrhage, traumatic 器械術式 Right craniectomy for SDH evacuation + ICP monitoring 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 4E 紀錄醫師 李振豪, 時間資訊 12:23 通知急診手術 12:23 臨時手術NPO 12:23 開始NPO 13:05 進入手術室 13:10 麻醉開始 13:30 抗生素給藥 13:47 開始輸血 13:47 手術開始 14:35 誘導結束 16:25 手術結束 16:25 麻醉結束 16:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 急性硬腦膜下血腫清除術 1 1 R 手術 顱內壓視置入 1 2 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 李振豪 開立時間: 2011/12/06 17:05 Pre-operative Diagnosis Traumatic acute subdural hematoma, right fronto-temporo-parietal Post-operative Diagnosis Traumatic acute subdural hematoma, right fronto-temporo-parietal Operative Method Right fronto-temporo-parietal craniotomy for subdural hematoma evacuation + ICP monitoring Specimen Count And Types nil Pathology Nil Operative Findings The dura was adhered to the skull bone tightly and part of dura laceration was noted during craniotomy. The subdural hematoma was about 1.5cm in thickness and the brain parenchyma was mild hard by palpation. One cortical artery near fronto-parietal junction with vascular wall injury and surrounded by firm hematoma was noted. The cortical artery may responsed to the acute subdural hematoma. The fascia of temporalis muscle was harvested for duroplasty. Before dura closure, the brain parenchyma became much soft but still mild firm by palpation. No further swelling of the brain was noted and we decided to place the skull bone back. The ICP after wound closure was around 1~2mmHg. Total 9U FFP was transfused during operation. Total blood loss: 250ml. The dura was adhered to the skull bone tightly and part of dura laceration was noted during craniotomy. The subdural hematoma was about 1.5cm in thickness and the brain parenchyma was mild hard by palpation. One cortical artery near fronto-parietal junction with vascular wall injury and surrounded by firm hematoma was noted. The cortical artery may responsed to the acute subdural hematoma. Subarachnoid hemorrhage also noted after removal of subdural hematoma. The fascia of temporalis muscle was harvested for duroplasty. Before dura closure, the brain parenchyma became much soft but still mild firm by palpation. No further swelling of the brain was noted and we decided to place the skull bone back. The ICP after wound closure was around 1~2mmHg. Total 9U FFP was transfused during operation. Total blood loss: 250ml. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with right should elevation and head rotated to left. The scalp was shaved, scrubbed, and disinfected as usual. Traumatic flap scalp incision was made over right fronto-temporo-parietal area and the scalp flap was elevated. Five burrholes were created followed by one 13x12 cm craniotomy window. Dural tenting was done. C-shape durotomy was conducted and subdural hematoma was evacuated with suction. One active bleeder from parenchyma was noted and coagulated by bipolar electrocautery. Hemostasis was achieved with bipolar electrocautery and Surgicel lining. The fascia of temporalis muscle was harvested and duroplasty was performed with 4-0 Prolene. The ICP monitor was inserted into subdural space. The skull plate was fixed back with miniplates, screws, and six central tenting. One subgaleal CWV drain was placed. The temporalis muscle was fixed back to the skull plate and the wound was closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS王國川 Assistants R5李振豪, Ri施顯學 Indication Of Emergent Operation Traumatic subdural hematoma with rapid deterioration of consciousness 相關圖片 彭俊傑 (M,1988/10/07,23y5m) 手術日期 2011/12/06 手術主治醫師 林晉 手術區域 東址 027房 03號 診斷 Brain abscess 器械術式 ORIF Interlocking Nail-Femoral 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉漢平 ASA 3 紀錄醫師 羅婉育, 時間資訊 14:25 進入手術室 14:30 麻醉開始 14:35 誘導結束 15:31 手術開始 16:17 開始輸血 17:00 抗生素給藥 18:35 手術結束 18:40 麻醉結束 18:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 股骨幹骨折開放性復位術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 摘要__ 手術科部: 外科部 套用罐頭: ORIF with DSN (2 proximal screws and 2 distal... 開立醫師: 羅婉育 開立時間: 2011/12/06 18:50 Pre-operative Diagnosis right femoral shaft comminuted fracture Post-operative Diagnosis right femoral shaft comminuted fracture Operative Method ORIF with DSN (2 proximal screws and 2 distal screws), open nailing Specimen Count And Types nil Pathology nil Operative Findings right femoral shaft comminuted fracture with angulation, with massive callous formation, and granulation tissue. ORIF with DSN (2 proximal screws and 2 distal screws) Operative Procedures 1.ETGA, left decubitus position 2.skin disinfection and draping 3.skin incision and approach to fracture site via lateral approach 4.remove callous and granulation tissue around fracture site 5.ORIF with ILN with 2 proximal screws and 2 distal screws with reverse nailing method 6.Autografting 7.normal saline irrigation 8.close wound in layers after 1/4 hemovac insertion Operators 林晉, Assistants 吳欣翰, 羅婉育, 陳勇璋, 記錄__ 手術科部: 外科部 套用罐頭: ORIF with DSN (2 proximal screws and 2 distal... 開立醫師: 羅婉育 開立時間: 2011/12/06 18:51 Pre-operative Diagnosis right femoral shaft comminuted fracture Post-operative Diagnosis right femoral shaft comminuted fracture Operative Method ORIF with DSN (2 proximal screws and 2 distal screws), open nailing Specimen Count And Types nil Pathology nil Operative Findings right femoral shaft comminuted fracture with angulation, with massive callous formation, and granulation tissue. ORIF with DSN (2 proximal screws and 2 distal screws) Operative Procedures 1.ETGA, left decubitus position 2.skin disinfection and draping 3.skin incision and approach to fracture site via lateral approach 4.remove callous and granulation tissue around fracture site 5.ORIF with ILN with 2 proximal screws and 2 distal screws with reverse nailing method 6.Autografting 7.normal saline irrigation 8.close wound in layers after 1/4 hemovac insertion Operators 林晉, Assistants 吳欣翰, 羅婉育, 陳勇璋, 張貴美 (F,1953/06/16,58y8m) 手術日期 2011/12/06 手術主治醫師 謝敦理 手術區域 西址 033房 05號 診斷 Otitis media with effusion 器械術式 Gromment placement (ntuh made) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 11:30 進入手術室 11:35 麻醉開始 11:37 手術開始 12:00 手術結束 12:00 麻醉結束 12:05 送出病患 記錄__ 手術科部: 耳鼻喉部 套用罐頭: 1. Grommet tube removal 2.Grommet tube insertion 開立醫師: 曾文萱 開立時間: 2011/12/06 12:00 Pre-operative Diagnosis otitis media, left, status post Grommet insertion Post-operative Diagnosis otitis media, left, status post Grommet insertion Operative Method 1. Grommet tube removal 2.Grommet tube insertion Specimen Count And Types nil Pathology Nil Operative Findings 1.Obstructed Grommet tube in left ear, removed 2. Grommet tube inserted to left ear 3. Granulation tissue at left middle ear cavity Operative Procedures 1.The patient was put in supine position. 2.After local anestehsia of external auditory canal, the face was disinfected and draped as usual. 3.Her head was turned to the right side. 4.Obstructed Grommet tube was noted and removed 5.THen radial insertion was made. Then one 1.27mm Grommet tube was inserted smoothly. 6.The patient tolerated the whole procedure well. Operators VS謝敦理, Assistants R2曾文萱, R4林彥翰, 郭水秀 (F,1948/07/20,63y7m) 手術日期 2011/12/07 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Facial spasm 器械術式 Microvascular decompression 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:10 麻醉開始 08:50 誘導結束 08:50 抗生素給藥 09:00 手術開始 10:50 開始輸血 11:50 抗生素給藥 13:45 手術結束 13:45 麻醉結束 13:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦微血管減壓術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: Microvascular decompression, left side 開立醫師: 曾峰毅 開立時間: 2011/12/07 13:33 Pre-operative Diagnosis Hemifacial spasm, left Post-operative Diagnosis Hemifacial spasm, left Operative Method Microvascular decompression, left side Specimen Count And Types nil Pathology nil Operative Findings Two sinus tear was noted during bone window creation and stopped with Gelfoam compression. The tortrous AICA compressing the CN VII VIII complex tightly from the amterior side. The offending vessel was separted from the CN VII VIII complex with teflon cotton. Operative Procedures After ETGA, the patient was in supine position with left shoulder elevated, and head turned to right. The skin was shaved, disinfected and drapped as usual. One curvilinear skin incision was made retro-auricular, and one piece of fascia was harvested for dura repair. Asterion was identified and the craniotomy was made. Sinus bleeding was encountered at two sites and stopped with Gelfoam packing. The dura was incised and reflected anteriorly. CSF was drained at cisterna meganum. CN VII VIII, CN V and CN VI were identified and decompression with Teflon was done. Duroplasty was performed with autologous fascia graft and water-tight suture. Bone graft was fixed back with mini-plates. The wound was closed in layers after one subgaleal CWV set. Operators Porf. 杜永光 Assistants R5 曾峰毅 R3 陳國瑋 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Microvascular decompression, left side 開立醫師: 陳國瑋 開立時間: 2011/12/07 14:00 Pre-operative Diagnosis Hemifacial spasm, left Post-operative Diagnosis Hemifacial spasm, left Operative Method Microvascular decompression, left side Specimen Count And Types nil Pathology nil Operative Findings Two sinus tear was noted during bone window creation and stopped with Gelfoam compression. The tortrous AICA compressing the CN VII VIII complex tightly from the anterior side. The offending vessel was separted from the CN VII VIII complex with teflon cotton. The BAEP remained unchanged during the whole procedure Operative Procedures After ETGA, the patient was in supine position with left shoulder elevated, and head turned to right. The skin was shaved, disinfected and drapped as usual. One curvilinear skin incision was made retro-auricular, and one piece of fascia was harvested for dura repair. Asterion was identified and the craniotomy was made. Sinus bleeding was encountered at two sites and stopped with Gelfoam packing. The dura was incised and reflected anteriorly. CSF was drained at cisterna meganum. CN VII VIII, CN V and CN VI were identified and decompression with Teflon was done. Duroplasty was performed with autologous fascia graft and water-tight suture. Bone graft was fixed back with mini-plates. The wound was closed in layers after one subgaleal CWV set. Operators Prof. 杜永光 Assistants R5 曾峰毅 R3 陳國瑋 Ri 施顯學 相關圖片 李世華 (M,1962/04/21,49y10m) 手術日期 2011/12/07 手術主治醫師 杜永光 手術區域 東址 003房 02號 診斷 Brain Tumor 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 14:07 進入手術室 14:10 麻醉開始 14:25 誘導結束 14:35 抗生素給藥 14:51 手術開始 17:35 抗生素給藥 18:40 手術結束 18:40 麻醉結束 18:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for tumor excision, Simpson grade III 開立醫師: 曾峰毅 開立時間: 2011/12/07 18:27 Pre-operative Diagnosis Left convexitiy meningioma Post-operative Diagnosis Left convexitiy atypuical meningioma Operative Method Craniotomy for tumor excision, Simpson grade III Specimen Count And Types 1 piece About size:fragments Source:brain tumor Pathology Frozen section showed meningioma, suspected atypical meningioma Operative Findings One 4x6x3.5 cm dura-based tumor was noted at left frontal area. Neurophysiology mapping showed the tumor located just above the motor cortex. The tumor invaded through dura and the underlying skull. The arachnoid plane was obscured, and pia was invased by the tumor. Some tumor tightly adhering to brain was remained in situ. Operative Procedures Under ETGA, the patient was put in supine position with head turned to right. The skin was shaved, scrubbed and disinfected drapped as ususal. One linear skin incision was made from pre-aurigular to midline. The scalp was retracted aside. One oval craniotomy, 8cm in diameter was made and then extended posteriorly. Tumor invading through dura was noticed and one piece of tumor was sent for frozen section. The dura was incised circumferentially. The tumor was dissected along the obscured arachnoid plane. The tumor was removed in en bloc. Duroplasty was performed with artificial dura graft, and cranioplasty was done with titanium mesh with screws. After one subgaleal CWV set, the wound was closed in layers. Operators Prof. 杜永光 Assistants R5 曾峰毅 R3 陳國瑋 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Craniotomy for tumor excision, Simpson grade III 開立醫師: 陳國瑋 開立時間: 2011/12/09 20:33 Pre-operative Diagnosis Left convexitiy meningioma Post-operative Diagnosis Left convexitiy atypuical meningioma Operative Method Craniotomy for tumor excision, Simpson grade III Specimen Count And Types 1 piece About size:fragments Source:brain tumor Pathology Frozen section showed meningioma, suspected atypical meningioma Operative Findings One 4x6x3.5 cm dura-based tumor was noted at left frontal area. Neurophysiology mapping showed the tumor located just above the motor cortex. The tumor invaded through dura and the underlying skull. The arachnoid plane was obscured, and pia was invased by the tumor. Some tumor tightly adhering to brain was remained in situ. Operative Procedures Under ETGA, the patient was put in supine position with head turned to right. The skin was shaved, scrubbed and disinfected drapped as ususal. One linear skin incision was made from pre-aurigular to midline. The scalp was retracted aside. One oval craniotomy, 8cm in diameter was made and then extended posteriorly. Tumor invading through dura was noticed and one piece of tumor was sent for frozen section. The dura was incised circumferentially. The tumor was dissected along the obscured arachnoid plane. The tumor was removed in en bloc. Duroplasty was performed with artificial dura graft, and cranioplasty was done with titanium mesh with screws. After one subgaleal CWV set, the wound was closed in layers. Operators Prof. 杜永光 Assistants R5 曾峰毅 R3 陳國瑋 相關圖片 曾隆建 (M,1960/10/17,51y4m) 手術日期 2011/12/07 手術主治醫師 杜永光 手術區域 東址 005房 01號 診斷 Ossification of posterior longitudinal ligament, cervical (OPLL) 器械術式 Laminectomy C-Spinal(Posterier，Lamino plasty 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 07:41 報到 08:08 進入手術室 08:15 麻醉開始 09:00 誘導結束 09:05 抗生素給藥 09:05 手術開始 12:07 手術結束 12:07 麻醉結束 12:33 送出病患 12:37 進入恢復室 13:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓整形術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: C3-5 laminoplasty, left side open-door method 開立醫師: 李振豪 開立時間: 2011/12/07 12:38 Pre-operative Diagnosis C3-4 ossification of posterior longitudinal ligment with cervical myelopathy Post-operative Diagnosis C3-4 ossification of posterior longitudinal ligment with cervical myelopathy Operative Method C3-5 laminoplasty, left side open-door method Specimen Count And Types nil Pathology Nil Operative Findings Decrease motility of his neck was noted which may caused by ankylosing spondylitis. The left side SSEP was flatened with prolonged latency before the operation. No obvious SSEP change during whole procedure. Left side open-door method laminoplasty was performed with three 5-holes miniplates, three 5mm screws, and three 7mm screws. C2/3 ligmentum flavum also removed for decompression. The thecal sac expanded well after laminoplasty. No incidental durotomy or CSF leakage was noted. The patient stood whole procedure well. Total blood loss: 150ml. Blood transfusion: nil. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position with head fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. Midline skin incision was made from suboccipital area to C5 level. The subcutaneous soft tissue was devided. The nuchal muscle and paraspinal muscle groups were detached to expose lower C2 to upper C6. C3-5 spinous processes were cut at it"s base. Grooving of C3-5 bilateral laminae was performed with Midas high speed air-drived drills. Left side open-door method laminoplasty was conducted with miniplates and screws. C2/3 ligmentum flavum also removed for decompression. Hemostasis was achieved with bipolar electrocautery. One epidural CWV drain was placed. The wound was irrigated with Gentamicin solution. The wound was then closed in layers with 1-0, 2-0 Vicryl and 3-0 Nylon. Operators Prof.杜永光 Assistants R5李振豪, PGY劉明侑 相關圖片 郭禮儀 (M,1971/05/12,40y10m) 手術日期 2011/12/07 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 13:15 報到 13:23 進入手術室 13:35 麻醉開始 14:00 誘導結束 14:00 抗生素給藥 14:12 手術開始 17:00 抗生素給藥 17:30 麻醉結束 17:30 手術結束 17:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Left temporal craniectomy for total tumor exc... 開立醫師: 李振豪 開立時間: 2011/12/07 18:40 Pre-operative Diagnosis Left temporal bone tumor, suspect epidermoid cyst Post-operative Diagnosis Left temporal bone epidermoid cyst Operative Method Left temporal craniectomy for total tumor excision + cranioplasty with titanium mesh Specimen Count And Types 1 piece About size:6x4x4.7cm Source:Left temporal bone epidermoid cyst Pathology Pending Operative Findings The skull bone was eroded with expansile change. The epidermoid cyst was well-capsulated, 6x4x4.7cm in size, white-yellowish in color, and filled with keratin-rich content. No hair or adipose tissue was noted within the tumor. The blood supply of the tumor was mainly from galeal. The dura was invaded by the tumor and contacted with temporal lobe directly. After total tumor removal, one 3x2cm dura defect was noted. Dura was repaired with one 4x3cm periosteum and the skull plate was reconstructed with titanium mesh. The brain expanded well after tumor excision except most lowest part of temporal lobe. The patient stood whole procedure well. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with left shoulder elevation. The head was turned to right and fixed with Mayfield skull clamp. Portable C-arm X-ray was used for localization of the tumor. The scalp was shaved, scrubbed, and disinfected as usual. Reverse U scalp incision was made and the scalp flap was elevated. The tumor was noted during subperiosteal dissection. Four burrholes were created followed bye one 7x5cm craniectomy window. The tumor was mainly located at epidural space and dissected away from the dura with dissector. The tumor invaded into the dura and contact with brain parenchyma at the lowest part. One 3x2cm dural defect was noted after total removal of the tumor. Hemostasis was achieved with bipolar electrocautery, Surgicel lining, and Gelfoam packing. The wound was irrigated with Gentamicin solution. Periosteum was harvested for duroplasty. Titanium mesh was used for cranioplasty and fixed with five screws. One subgaleal CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and Appose staples. Operators VS曾漢民 Assistants R5李振豪, PGY劉明侑 相關圖片 陳思穎 (F,2003/09/04,8y6m) 手術日期 2011/12/07 手術主治醫師 彭信逢 手術區域 東址 000房 號 診斷 Aromatic L-amino acid decarboxylase deficiency 器械術式 Other RAD exam/intervention 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 蔡奉芳 ASA 4 時間資訊 15:10 通知急診手術 00:00 開始NPO 11:10 麻醉開始 11:15 誘導結束 12:20 麻醉結束 12:25 進入恢復室 13:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 高若涵 (F,2005/12/06,6y3m) 手術日期 2011/12/07 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Arachnoid cyst 器械術式 Laminectomy for L-S spine arachnoid cyst removal 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 2 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:10 進入手術室 08:20 麻醉開始 08:30 誘導結束 09:00 抗生素給藥 09:16 手術開始 11:15 手術結束 11:15 麻醉結束 11:45 送出病患 11:45 進入恢復室 12:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓整形術 1 2 手術 良性脊髓腫瘤切除術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 摘要__ 手術科部: 外科部 套用罐頭: L2 laminoplasty for cyst removal 開立醫師: 王奐之 開立時間: 2011/12/07 11:26 Pre-operative Diagnosis L1-3 arachnoid cyst Post-operative Diagnosis L1-3 arachnoid cyst Operative Method L2 laminoplasty for cyst removal Specimen Count And Types 1 piece About size:2*2*2cm Source:arachnoid cyst Pathology Pending Operative Findings A arachnoid cyst locating underneath the arachnoid membrane with clear margin was noted at L1-3 level, containing clear CSF content; removal of the cyst was en bloc without rupture of the cyst. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position. Localization of L2 spinous process was done according to pre-operative lumbosacral spine X-ray. After scrubbing, disinfection & draping in sterile fashion, a midline linear incision was made at L1-L3 level. The incision was deepened through fascial layer, the paraspinal muscles were detached from the spinous process & lamina. L2 spinous process & lamina was removed en bloc after drilling of bilateral lamina. After hemostasis of the dural surface, a linear durotomy was performed. The cyst was then removed using a single grasp. The dura was closed in water-tight fashion with 4-0 prolene continuous sutures. The bone flap was fixed back with 4 silk sutures & 2 two-hole mini-plates. The wound was then closed in layers. After endotracheal general anesthesia, the patient was placed in prone position. Localization of L2 spinous process was done according to pre-operative lumbosacral spine X-ray. After scrubbing, disinfection & draping in sterile fashion, a midline linear incision was made at L1-L3 level. The incision was deepened through fascial layer, the paraspinal muscles were detached from the spinous process & lamina. L2 spinous process & lamina was removed en bloc after drilling of bilateral lamina. After hemostasis of the dural surface, a linear durotomy was performed under microscopic view. The cyst was then removed using a single grasp. The dura was closed in water-tight fashion with 4-0 prolene continuous sutures. The bone flap was fixed back with 4 silk sutures & 2 two-hole mini-plates. The wound was then closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之, Ri 陳昱傑 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: L2 laminoplasty for cyst removal 開立醫師: 王奐之 開立時間: 2011/12/07 11:26 Pre-operative Diagnosis L1-3 arachnoid cyst Post-operative Diagnosis L1-3 arachnoid cyst Operative Method L2 laminoplasty for cyst removal Specimen Count And Types 1 piece About size:2*2*2cm Source:arachnoid cyst Pathology Pending Operative Findings A arachnoid cyst locating underneath the arachnoid membrane with clear margin was noted at L1-3 level, containing clear CSF content; removal of the cyst was en bloc without rupture of the cyst. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position. Localization of L2 spinous process was done according to pre-operative lumbosacral spine X-ray. After scrubbing, disinfection & draping in sterile fashion, a midline linear incision was made at L1-L3 level. The incision was deepened through fascial layer, the paraspinal muscles were detached from the spinous process & lamina. L2 spinous process & lamina was removed en bloc after drilling of bilateral lamina. After hemostasis of the dural surface, a linear durotomy was performed under microscopic view. The cyst was then removed using a single grasp. The dura was closed in water-tight fashion with 4-0 prolene continuous sutures. The bone flap was fixed back with 4 silk sutures & 2 two-hole mini-plates. The wound was then closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之, Ri 陳昱傑 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: L2 laminoplasty for cyst total removal 開立醫師: 郭夢菲 開立時間: 2011/12/07 12:31 Pre-operative Diagnosis L1-3 intradural extramedullary arachnoid cyst Post-operative Diagnosis L1-3 intradural extramedullary arachnoid cyst Operative Method L2 laminoplasty for cyst total removal Specimen Count And Types 1 piece About size:2*2*2cm Source:arachnoid cyst Pathology Pending Operative Findings A well encapsulated arachnoid cyst locating underneath the arachnoid membrane with clear margin was noted at L1-3 level, containing clear CSF content; removal of the cyst was en bloc without rupture of the cyst. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position. Localization of L2 spinous process was done according to pre-operative lumbosacral spine X-ray. After scrubbing, disinfection & draping in sterile fashion, a midline linear incision was made at L1-L3 level. The incision was deepened through fascial layer, the paraspinal muscles were detached from the spinous process & lamina. L2 spinous process & lamina was removed en bloc after drilling of bilateral lamina. After hemostasis of the dural surface, a linear durotomy was performed under microscopic view. The cyst was then delivered and removed using a single grasp. The dura was closed in water-tight fashion with 4-0 prolene continuous sutures. The bone flap was fixed back with 4 silk sutures & 2 two-hole mini-plates and screws. The wound was then closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之, Ri 陳昱傑 相關圖片 蕭永昌 (M,1935/11/26,76y3m) 手術日期 2011/12/07 手術主治醫師 賴達明 手術區域 東址 002房 02號 診斷 Hypertension 器械術式 Left craniotomy for hematoma evacuation 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3E 紀錄醫師 林哲光, 時間資訊 11:33 開始NPO 11:33 通知急診手術 11:55 進入手術室 11:56 麻醉開始 12:20 誘導結束 12:40 抗生素給藥 12:55 手術開始 14:25 手術結束 14:25 麻醉結束 14:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦內血腫清除術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Left parietal craniotomy for hematoma evacuation 開立醫師: 林哲光 開立時間: 2011/12/07 15:40 Pre-operative Diagnosis Left parietal lobar hemorrhage Post-operative Diagnosis Left parietal lobar hemorrhage Operative Method Left parietal craniotomy for hematoma evacuation Specimen Count And Types 1 piece About size:around 2x2 cm Source:hematoma Pathology Pending Operative Findings About 60ml intraparenchymal hematoma was noted at left parietal lobe. No obvious vascular abnormality nor active bleeder was noted. The hematoma was mixed with blood clot and some bloody contents. The brain parenchyma seemed slack after hematoma removal. Operative Procedures Under ETGA and supine position with head rotated to right side, skin disinfected and drapped were performed as usual. A reverse U-shape skin incision was made at left parietal area and 4 burr holes were created. Craniotomy was then done and the dura was then opened after dural tenting as midline as base. Corticotomy was done at left high parietal lobe and hematoma evacuation was done. The rough surface was covered with surgecells. The skull bone was put back and fixed with miniplates. The wound was then closed in layers after hemostasis and a subglaeal drain insertion. Operators 賴達明 Assistants 林哲光 Indication Of Emergent Operation Acute onset of right hemiparesis and aphasia, with large amount of ICH around 60ml 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Left parietal craniotomy for hematoma evacuation 開立醫師: 林哲光 開立時間: 2011/12/07 15:40 Pre-operative Diagnosis Left parietal lobar hemorrhage Post-operative Diagnosis Left parietal lobar hemorrhage Operative Method Left parietal craniotomy for hematoma evacuation Specimen Count And Types 1 piece About size:around 2x2 cm Source:hematoma Pathology Pending Operative Findings About 60ml intraparenchymal hematoma was noted at left parietal lobe. No obvious vascular abnormality nor active bleeder was noted. The hematoma was mixed with blood clot and some bloody contents. The brain parenchyma seemed slack after hematoma removal. Operative Procedures Under ETGA and supine position with head rotated to right side, skin disinfected and drapped were performed as usual. A reverse U-shape skin incision was made at left parietal area and 4 burr holes were created. Craniotomy was then done and the dura was then opened after dural tenting as midline as base. Corticotomy was done at left high parietal lobe and hematoma evacuation was done. The rough surface was covered with surgecells. The skull bone was put back and fixed with miniplates. The wound was then closed in layers after hemostasis and a subglaeal drain insertion. Operators 賴達明 Assistants 林哲光 Indication Of Emergent Operation Acute onset of right hemiparesis and aphasia, with large amount of ICH around 60ml 相關圖片 烏家萍 (F,1952/08/26,59y6m) 手術日期 2011/12/07 手術主治醫師 林文瑛 手術區域 西址 036房 06號 診斷 Malignant neoplasm of female breast, unspecified 器械術式 Port-A Implatation, revision 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 林文瑛 ASA 1 紀錄醫師 林月女, 時間資訊 11:50 報到 12:50 麻醉開始 12:50 進入手術室 12:55 誘導結束 13:00 抗生素給藥 13:05 手術開始 13:25 手術結束 13:25 麻醉結束 13:30 送出病患 13:35 進入恢復室 15:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 手術 內頸靜脈切開,永久導管放置術 1 1 R 記錄__ 手術科部: 麻醉部 套用罐頭: Port-A removal and implantation, internal jugular 開立醫師: 林文瑛 開立時間: 2011/12/07 13:31 Pre-operative Diagnosis Malignant neoplasm of female breast, unspecified Post-operative Diagnosis Malignant neoplasm of female breast, unspecified Operative Method Removal and implantation of Port-A, echo-guided Specimen Count And Types nil Pathology Nil Operative Findings 1.Site: right internal jugular vein, with cut down & echo-guided procedure 2.Patent flow after implantation 3.Others: Operative Procedures 1.The patient was set on supine position and bilateral internal jugular veins were checked by echo. 2.After IVGA and local anesthesia applied, skin incision was made along the previous incision site. 3.Uncovered the Port-A, and then removed it. 4.Wash the pouch with normal saline. 5.Direct cut down method was performed to identify internal jugular vein. An IV catheter was inserted via the neck wound and negatively aspirated until venous blood attainable. 6.J-wire was inserted smoothly in rostral direction. An internal jugular catheter with dilator was inserted through the J-wire, and the dilator was then removed. 7.The catheter for Port-A was threaded into the internal vein catheter until mark 24 cm. Skin tunnelbetween neck and pre-cordial incision was made by the blunt dissection with Kelly clamp. The catheter was then threaded and adapted into the port and locked with restrictor. The port was inserted into the pouch of pre-cordial incision.8.Skin was closed layer by layer. Both catheter and the port were perfused with heparin solution after implantation. Operators 林文瑛, Assistants 林健華, 華靜芬 (F,1969/01/27,43y1m) 手術日期 2011/12/07 手術主治醫師 吳毅暉 手術區域 東址 018房 02號 診斷 Malignant neoplasm of trachea 器械術式 Port-A Implatation /WOR 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 莊民楷, 時間資訊 11:30 進入手術室 11:35 麻醉開始 11:40 誘導結束 11:40 抗生素給藥 11:45 手術開始 12:15 手術結束 12:15 麻醉結束 12:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 內頸靜脈切開,永久導管放置術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Port-A implantation, RIJV 開立醫師: 莊民楷 開立時間: 2011/12/07 12:20 Pre-operative Diagnosis Lung cancer Post-operative Diagnosis Lung cancer Operative Method Port-A implantation, RIJV Specimen Count And Types nil Pathology Nil Operative Findings 1. blood return smooth after port-A implantation Operative Procedures 1. LA, supine 2. Disinfection and drapping 3. Right internal jugular vein puncture 4. Right upper chest wall linear skin incision, 3cm 5. Create subcutaneous pouch, fix port-A 6. Insert port-A catheter through guidewire and sheath 7. Close the wound in layer Operators VS 吳毅暉 Assistants R4 莊民楷 向儀鳳 (F,1957/03/15,54y11m) 手術日期 2011/12/08 手術主治醫師 陳沛裕 手術區域 東址 021房 04號 診斷 Calcaneal fracture 器械術式 O.R.I.F-wire，K-pin (Hand)，ORIF - Small ""A-O"" plate 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 脊髓麻醉 麻醉主治醫師 林珍榮 ASA 3 紀錄醫師 黃鼎鈞, 時間資訊 13:26 進入手術室 13:30 麻醉開始 13:45 誘導結束 13:45 抗生素給藥 14:00 手術開始 14:50 手術結束 14:50 麻醉結束 14:55 送出病患 14:55 進入恢復室 16:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Spinal anesthesia 1 0 手術 腕、跗、掌、蹠骨骨折開放性復位術 1 1 R 摘要__ 手術科部: 骨科部 套用罐頭: ORIF with Wright locking plate 開立醫師: 黃鼎鈞 開立時間: 2011/12/08 13:33 Pre-operative Diagnosis Right calcaneal fracture Post-operative Diagnosis Right calcaneal fracture Operative Method ORIF with Wright locking plate Specimen Count And Types nil Pathology nil Operative Findings Right calcaneal fracture Operative Procedures 1. Anesthesia, right decubitus. 2. Skin disinfection and draping. 3. Inflate pneumatic touniqeut. 4. Skin incision by lateral approach. 5. Reduction then internal fixation with Wright locking plate. 6. Irrigation then closure Operators 陳沛裕, Assistants 黃鼎鈞, 何京澤, 游淑娟, 記錄__ 手術科部: 骨科部 套用罐頭: ORIF with Wright locking plate 開立醫師: 黃鼎鈞 開立時間: 2011/12/08 13:33 Pre-operative Diagnosis Right calcaneal fracture Post-operative Diagnosis Right calcaneal fracture Operative Method ORIF with Wright locking plate Specimen Count And Types nil Pathology nil Operative Findings Right calcaneal fracture Operative Procedures 1. Anesthesia, right decubitus. 2. Skin disinfection and draping. 3. Inflate pneumatic touniqeut. 4. Skin incision by lateral approach. 5. Reduction then internal fixation with Wright locking plate. 6. Irrigation then closure Operators 陳沛裕, Assistants 黃鼎鈞, 何京澤, 游淑娟, 曾昱瑋 (M,2011/03/28,11m22d) 手術日期 2011/12/08 手術主治醫師 郭夢菲 手術區域 兒醫 067房 02號 診斷 Syringomyelia and syringobulbia 器械術式 Wound treatment-- <5cm 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 2E 紀錄醫師 陳國瑋, 時間資訊 12:30 臨時手術NPO 12:30 開始NPO 13:18 通知急診手術 18:37 報到 18:45 進入手術室 18:55 麻醉開始 19:05 誘導結束 19:10 抗生素給藥 19:20 手術開始 19:50 手術結束 19:50 麻醉結束 19:55 送出病患 20:00 進入恢復室 21:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 深部傷口處理縫合擴創-小 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Wound debridement 開立醫師: 陳國瑋 開立時間: 2011/12/08 19:54 Pre-operative Diagnosis Wound dehiscence Post-operative Diagnosis Wound dehiscence Operative Method Wound debridement Specimen Count And Types 1 piece About size:fragments Source:wound tissue Pathology nil Operative Findings The muscle fascia was intact and no CSF leakage was noted. The muscle fascia was intact and no CSF leakage was noted. No pus was noted. The muscle fascia was intact and no CSF leakage was noted. No pus was noted. The wound ruptured at the lowest end of the previous wound for about 0.5 to 1 cm in length. no pus, no erythematous change, but some granulation tissue at the margin of it. Operative Procedures Under ETGA, the patient was put in prone position. The skin was scrubbed, disinfected, and drapped as usual. The elipticus skin incision was made around the wound and then scrubbed with curretage. The skin was then closed in layers. Under ETGA, the patient was put in prone position. The skin was scrubbed, disinfected, and drapped as usual. The elipticus skin incision was made around the wound and sent for culture. the subcutaneous tissue was scrubbed with curretage. The skin was then closed in layers in interrupted sutures.. Operators VS 郭夢菲 Assistants R3 陳國瑋 Indication Of Emergent Operation Suspected CSF leakage 相關圖片 林品臻 (F,2011/02/26,1y0m) 手術日期 2011/12/08 手術主治醫師 郭夢菲 手術區域 兒醫 066房 01號 診斷 Prematurity 器械術式 S-P shunt 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 石博元 ASA 2E 紀錄醫師 王奐之, 時間資訊 18:05 通知急診手術 00:00 開始NPO 00:00 臨時手術NPO 09:42 進入手術室 09:45 麻醉開始 09:50 誘導結束 10:23 手術開始 11:20 手術結束 11:30 送出病患 11:30 麻醉結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室腹腔分流手術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Subduroperitoneal shunt insertion, right side 開立醫師: 郭夢菲 開立時間: 2011/12/08 11:36 Pre-operative Diagnosis 3rd ventricle choroid plexus papilloma with severe hydrocephalus, status post craniotomy for total tumor resection, with bilateral subdural effusion Post-operative Diagnosis 3rd ventricle choroid plexus papilloma with severe hydrocephalus, status post craniotomy for total tumor resection, with bilateral subdural effusion Operative Method Subduroperitoneal shunt insertion, right side Specimen Count And Types Nil Pathology Nil Operative Findings 1. The CSF was yellowish and clsear. Some subgaleal effusion was noted at previous craniotomy site due to moderated increased intracranila pressure. 2. Codman 10m H2O fixed pressure setting flat-bottom type reservoir was used. The subdural catheter was 4.2 cm in length. The peritoneal catheter was about 30 cm in length. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After shaving, scrubbing, disinfection & draping in sterile fashion, a linear incision was made at right frontotemporal area. Another linear incision was made at right upper quadrant of abdomen, followed by mini-laparotomy. After creating a subcutaneous tunnel from the abdominal wound to the right frontal wound, the peritoneal catheter was passed through. A burr hole was created, followed by a small durotomy and dural tenting for two stitches. The reservoir and the subdural catheter was assembled, and the subdural catheter tip was inserted into the subdural space through the small durotomy. After confirmation of smooth flow and hemostasis, the wounds were closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之 Indication Of Emergent Operation 相關圖片 王益宏 (M,1941/04/08,70y11m) 手術日期 2011/12/08 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Lumbar Spondylosis 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 07:35 報到 08:02 進入手術室 08:15 麻醉開始 08:20 誘導結束 08:33 抗生素給藥 09:20 手術開始 11:15 手術結束 11:15 麻醉結束 11:25 送出病患 11:28 進入恢復室 12:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 椎弓切除術(減壓)-二節以內 1 1 摘要__ 手術科部: 外科部 套用罐頭: Sublaminal decompression at L4-5, L5-S1 and L... 開立醫師: 林哲光 開立時間: 2011/12/09 07:21 Pre-operative Diagnosis L4-5 ruptured disc, L4-5, L5-S1 central canal stenosis Post-operative Diagnosis L4-5 ruptured disc, L4-5, L5-S1 central canal stenosis Operative Method Sublaminal decompression at L4-5, L5-S1 and L4-5 discectomy, Chimney approach Specimen Count And Types nil Pathology Nil Operative Findings Hypertrophic change of ligamentum flavum was noted at L4-5 and L5-S1 level with direct compressing the dura sac tightly. A ruptured disc was noted at left L4-5 disc level and the dura sac seemed bulging posteriorly. The dura sac seemed re-expanded well after sublaminal decompression was done. Hyperemic change of right L5 root and left S1 root was noted. Operative Procedures Under ETGA and prone position, skin disinfected and drapped were performed as usual. Midline skin incision was made at L4-5, L5-S1 level after C-arm localization at interspinous space area. Interspinous process splitting was done with saw and fracutred to expose the base of spinous process. Laminotomy was done at L4, L5 lamina and sublaminal decompression was done. L4-5 disc was exposed from left side and ruptured disc was removed after incise the dura ring. Hemostasis with Gelfoam packing was done and the wound was then closed in layers. Operators 賴達明 Assistants 林哲光, 連子賢 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Sublaminal decompression at L4-5, L5-S1 and L... 開立醫師: 林哲光 開立時間: 2011/12/09 07:21 Pre-operative Diagnosis L4-5 ruptured disc, L4-5, L5-S1 central canal stenosis Post-operative Diagnosis L4-5 ruptured disc, L4-5, L5-S1 central canal stenosis Operative Method Sublaminal decompression at L4-5, L5-S1 and L4-5 discectomy, Chimney approach Specimen Count And Types nil Pathology Nil Operative Findings Hypertrophic change of ligamentum flavum was noted at L4-5 and L5-S1 level with direct compressing the dura sac tightly. A ruptured disc was noted at left L4-5 disc level and the dura sac seemed bulging posteriorly. The dura sac seemed re-expanded well after sublaminal decompression was done. Hyperemic change of right L5 root and left S1 root was noted. Operative Procedures Under ETGA and prone position, skin disinfected and drapped were performed as usual. Midline skin incision was made at L4-5, L5-S1 level after C-arm localization at interspinous space area. Interspinous process splitting was done with saw and fracutred to expose the base of spinous process. Laminotomy was done at L4, L5 lamina and sublaminal decompression was done. L4-5 disc was exposed from left side and ruptured disc was removed after incise the dura ring. Hemostasis with Gelfoam packing was done and the wound was then closed in layers. Operators 賴達明 Assistants 林哲光, 連子賢 相關圖片 劉聯坤 (M,1925/01/19,87y1m) 手術日期 2011/12/08 手術主治醫師 張金池 手術區域 東址 001房 01號 診斷 Fracture, cervical – spine 器械術式 Tracheostomy 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3E 紀錄醫師 郝政鴻, 羅偉誠, 時間資訊 00:00 開始NPO 00:00 臨時手術NPO 06:00 通知急診手術 08:22 進入手術室 08:22 報到 08:23 麻醉開始 08:26 誘導結束 08:41 手術開始 09:01 麻醉結束 09:01 手術結束 09:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 氣管切開術 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Tracheostomy via punture 開立醫師: 羅偉誠 開立時間: 2011/12/08 09:12 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy via punture Specimen Count And Types nil Pathology nil Operative Findings Fr . 7 low pressure cuffed tube inserted via punture method smoothly Operative Procedures 1. ETGA, supine 2. Skin disinfection and draping 3. longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage 4. Needle punture to trachea, checked by bronchoscopy 4. Needle punture to trachea 5. Insert guide wire and dilator 6. Insert tracheostomy with dilator 7. Fixatation of tracheostomy Operators V張金池 Assistants R4郝政鴻, R2羅偉誠 Indication Of Emergent Operation respiratory failure 李朝枝 (M,1940/04/15,71y10m) 手術日期 2011/12/08 手術主治醫師 陳敞牧 手術區域 東址 003房 04號 診斷 Spine bone metastasis 器械術式 Laminectomy for decompression T spine 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 蕭柏妮 ASA 3E 紀錄醫師 游淨惠, 時間資訊 07:00 臨時手術NPO 07:00 開始NPO 19:56 進入手術室 20:05 麻醉開始 20:20 誘導結束 20:40 抗生素給藥 20:49 手術開始 21:18 開始輸血 22:40 麻醉結束 22:40 手術結束 22:50 送出病患 22:55 進入恢復室 01:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 Blood gas analysis 1 0 手術 惡性脊髓腫瘤切除術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 椎弓切除術(減壓)-超過二節 1 2 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 曾峰毅 開立時間: 2011/12/08 22:43 Pre-operative Diagnosis Prostate cacner, with multiple spinal metastasis, and cord compression at T1 and T3/4 Post-operative Diagnosis Prostate cacner, with multiple spinal metastasis, and cord compression at T1 and T3/4 Operative Method T1-4 lamienctomy for epidural tumor removal Specimen Count And Types Several fragments of epidural tumor were sent for pathology. Pathology Pending Operative Findings Hypervascular, soft, pinkish tumor was noted involvied laminaes and epidural space, especially near left T1/2 neural foramen, and encasing T3-4 thecal sac. Thecal sac expanded well after the surgery. Blood loss was about 1200 ml. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After back scrubbed, disinfected, and then draped, we made one midline skin incision at upper back and dissected paraspinous muscle to expose bilateral laminae from T1-4. T1-4 laminectomy was performed, and epidural tumor was removed. The wound was irrigated with gentamycin-saline. The wound was closed in layers after one submuscular CWV placed. Operators VS 陳敞牧 Assistants R5 曾峰毅 R1 游淨惠 Indication Of Emergent Operation Acute spinal cord compression 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 曾峰毅 開立時間: 2011/12/10 14:58 Pre-operative Diagnosis Prostate cacner, with multiple spinal metastasis, and cord compression at T1 and T3/4 Post-operative Diagnosis Prostate cacner, with multiple spinal metastasis, and cord compression at T1 and T3/4 Operative Method T1-4 lamienctomy for epidural tumor removal Specimen Count And Types Several fragments of epidural tumor were sent for pathology. Pathology Pending Operative Findings Hypervascular, soft, pinkish tumor was noted involvied laminaes and epidural space, especially near left T1/2 neural foramen, and encasing T3-4 thecal sac. Thecal sac expanded well after the surgery. Blood loss was about 1200 ml. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After back scrubbed, disinfected, and then draped, we made one midline skin incision at upper back and dissected paraspinous muscle to expose bilateral laminae from T1-4. T1-4 laminectomy was performed, and epidural tumor was removed. The wound was irrigated with gentamycin-saline. The wound was closed in layers after one submuscular CWV placed. Operators VS 陳敞牧 Assistants R5 曾峰毅 R1 游淨惠 Indication Of Emergent Operation Acute spinal cord compression 相關圖片 張詠潔 (F,2000/10/02,11y5m) 手術日期 2011/12/08 手術主治醫師 楊士弘 手術區域 東址 005房 02號 診斷 Malignant neoplasm of cerebrum, except lobes and ventricles 器械術式 Brain tumor Crainotomy(Others) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 10:17 報到 10:47 進入手術室 10:50 麻醉開始 11:15 誘導結束 11:18 抗生素給藥 11:22 手術開始 13:30 開始輸血 14:18 抗生素給藥 17:18 抗生素給藥 20:25 麻醉結束 20:25 手術結束 20:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱內壓視置入 1 2 R 手術 腦瘤切除-手術時間在8小時以上 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 11 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Interhemispheric trans-callosal approach for ... 開立醫師: 林哲光 開立時間: 2011/12/08 21:49 Pre-operative Diagnosis Right thalamic tumor, suspected glioma Post-operative Diagnosis Right thalamic tumor, glioma Operative Method Interhemispheric trans-callosal approach for right thalamic tumor subtotal excision Right frontal EVD insertion as ICP monitor Specimen Count And Types 1 piece About size:2x2x2 cm Source:Right thalamic tumor, suspect glioma Pathology Frozen section: at least grade II glioma Operative Findings A fragile, not well-defined greyish-yellowish mass lesion was noted at lateral to left internal cerebral vein at thalamus level, and the tumor was removed as extensively as possible. Some greyish soft mass was noted along the bilateral foramen Monro into the 3rd ventricle and one blood clot inside the tumor was also noted. The tumor lateral to right choroid plexus was left untouched and part of the posterior part near the midbrain was left untouched due to easily touch bleeding. Postoperative left pupil larger than right side was noted (5mm, 3mm). Operative Procedures Under ETGA, we placed the patient on supine posiiton with her neck mild extended. Her head was fixed with Mayfield clamp. After shaving, disinfected and drapped, a bicoronal skin inciosn was made and the wound was opened in layers. A 6x5 cm craniotomy was made after 5 burr holes were made. The dural tenting was made. The durotomy was made along the right side of craniotomy window as U-sahped with SSS as base. EVD was inserted into the right ventricle along the imaginary line at right Kocher point. CSF drainage was done and the arachnoid membrane was excised along the falx and the dura near the SSS. Brain retractor was set at right frontal lobe to expose pericallosal artery and the corpus callosum was lying beneath the artery. Incision was made at corpus callosum and was widely opened. Right lateral ventricle wall was opened and right thalamus with choroid plexus lying over was noted. Two internal cerebral veins were identified and tumor excision was done at lateral side of left internal cerebral vein, which was contrast enhanced tumor noted at MRI study, and it was sent for frozen pathology. Further tumor excisoin was done along the foramen Monro and septum pellucidum was opened and tumor inside the left foramen Monro was also excised. Roof of 3rd ventricle was opened and tumor excision was done as extensively as possible. Some tumor part extending into right thalamus and tumor excision was done medial to right choroid plexus. Posterior part below the internal cerebral vein was easily touch bleeding and after removal of part of the tumor, hemostasis with Surgecell covering was done. The EVD was reinserted into the right lateral ventricle into the foramen Monro under microscopy and fixed on the skin. The skull bone was put back and fixed with miniplates after dura was closed with Prolene in water-tie method. The wound was then closed in layers after epdiural drain insertion. Operators VS 楊士弘 Assistants R5 林哲光 R3 曾偉倫 R1 連子賢 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Interhemispheric trans-callosal approach for ... 開立醫師: 林哲光 開立時間: 2011/12/08 21:50 Pre-operative Diagnosis Right thalamic tumor, suspected glioma Post-operative Diagnosis Right thalamic tumor, glioma Operative Method Interhemispheric trans-callosal approach for right thalamic tumor subtotal excision Right frontal EVD insertion as ICP monitor Specimen Count And Types 1 piece About size:2x2x2 cm Source:Right thalamic tumor, suspect glioma Pathology Frozen section: at least grade II glioma Operative Findings A fragile, not well-defined greyish-yellowish mass lesion was noted at lateral to left internal cerebral vein at thalamus level, and the tumor was removed as extensively as possible. Some greyish soft mass was noted along the bilateral foramen Monro into the 3rd ventricle and one blood clot inside the tumor was also noted. The tumor lateral to right choroid plexus was left untouched and part of the posterior part near the midbrain was left untouched due to easily touch bleeding. Postoperative left pupil larger than right side was noted (5mm, 3mm). Operative Procedures Under ETGA, we placed the patient on supine posiiton with her neck mild extended. Her head was fixed with Mayfield clamp. After shaving, disinfected and drapped, a bicoronal skin inciosn was made and the wound was opened in layers. A 6x5 cm craniotomy was made after 5 burr holes were made. The dural tenting was made. The durotomy was made along the right side of craniotomy window as U-sahped with SSS as base. EVD was inserted into the right ventricle along the imaginary line at right Kocher point. CSF drainage was done and the arachnoid membrane was excised along the falx and the dura near the SSS. Brain retractor was set at right frontal lobe to expose pericallosal artery and the corpus callosum was lying beneath the artery. Incision was made at corpus callosum and was widely opened. Right lateral ventricle wall was opened and right thalamus with choroid plexus lying over was noted. Two internal cerebral veins were identified and tumor excision was done at lateral side of left internal cerebral vein, which was contrast enhanced tumor noted at MRI study, and it was sent for frozen pathology. Further tumor excisoin was done along the foramen Monro and septum pellucidum was opened and tumor inside the left foramen Monro was also excised. Roof of 3rd ventricle was opened and tumor excision was done as extensively as possible. Some tumor part extending into right thalamus and tumor excision was done medial to right choroid plexus. Posterior part below the internal cerebral vein was easily touch bleeding and after removal of part of the tumor, hemostasis with Surgecell covering was done. The EVD was reinserted into the right lateral ventricle into the foramen Monro under microscopy and fixed on the skin. The skull bone was put back and fixed with miniplates after dura was closed with Prolene in water-tie method. The wound was then closed in layers after epdiural drain insertion. Operators VS 楊士弘 Assistants R5 林哲光 R3 曾偉倫 R1 連子賢 相關圖片 高王秀枝 (F,1943/08/11,68y7m) 手術日期 2011/12/08 手術主治醫師 蔡翊新 手術區域 東址 005房 01號 診斷 Obstructive hydrocephalus 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 翁上硯, 曾偉倫, 時間資訊 00:00 臨時手術NPO 07:55 報到 08:01 進入手術室 08:05 麻醉開始 08:15 誘導結束 08:50 抗生素給藥 09:12 手術開始 10:10 手術結束 10:20 麻醉結束 10:20 送出病患 10:31 進入恢復室 11:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室腹腔分流手術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 蔡翊新 開立時間: 2011/12/08 10:19 Pre-operative Diagnosis Midbrain ICH with IVH, s/p EVD. Hydrocephalus. Post-operative Diagnosis Midbrain ICH with IVH, s/p EVD. Hydrocephalus. Operative Method V-P Shunt, Codman programmable, via right Kocher point. Specimen Count And Types 3 tubes of CSF, sent for routine, BCS and bacterial culture Pathology Nil. Operative Findings Previous burr hole at right Kocher point and previous EVD tract were still patent. CSF: clean, initial pressure about 8 cmH2O. The ventricular catheter was 6.5 cm in depth and the peritoneal catheter 25 cm in depth. The pressure setting of programmable valve was 120 mmH2O. Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: supine with head rotated to left. 3.Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 5 cm linear, right frontal, corresponded to the location of right frontal horn. Raney clips were applied to the scalp edge for temporary hemostasis. 5.After the scalp flap had been lifted and reflected anteriorly, the burr hole was enlarged. 6.The pia was opened by a nib incision. A 6.5 cm segment of the ventricular catheter was introduced into the ventricle. The outer end of the catheter was connected to a Codman programmable reservoir. 7. A minilaparotomy was made at RUQ of the abdomen, then a trocar was pushed into peritoneal cavity. Subsequently, distal 25 cm segment of the peritoneal catheter was introduced into the peritoneal cavity through the outer tube of the trochar. The proximal end of this catheter was passed through subcutaneous tunnel at right forechest, neck, right retroauricular area and connected the reservoir. The shunt system was checked to make sure its function was working. 8. The ventricular catheter was fixed to pericranium by 1 stitch. 9. Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by interrupted suture with 3/0 nylon. 10.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R3曾偉倫R0翁上硯Ri葉詩帆 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 蔡翊新 開立時間: 2011/12/08 10:19 Pre-operative Diagnosis Midbrain ICH with IVH, s/p EVD. Hydrocephalus. Post-operative Diagnosis Midbrain ICH with IVH, s/p EVD. Hydrocephalus. Operative Method V-P Shunt, Codman programmable, via right Kocher point. Specimen Count And Types 3 tubes of CSF, sent for routine, BCS and bacterial culture Pathology Nil. Operative Findings Previous burr hole at right Kocher point and previous EVD tract were still patent. CSF: clean, initial pressure about 8 cmH2O. The ventricular catheter was 6.5 cm in depth and the peritoneal catheter 25 cm in depth. The pressure setting of programmable valve was 120 mmH2O. Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: supine with head rotated to left. 3.Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 5 cm linear, right frontal, corresponded to the location of right frontal horn. Raney clips were applied to the scalp edge for temporary hemostasis. 5.After the scalp flap had been lifted and reflected anteriorly, the burr hole was enlarged. 6.The pia was opened by a nib incision. A 6.5 cm segment of the ventricular catheter was introduced into the ventricle. The outer end of the catheter was connected to a Codman programmable reservoir. 7. A minilaparotomy was made at RUQ of the abdomen, then a trocar was pushed into peritoneal cavity. Subsequently, distal 25 cm segment of the peritoneal catheter was introduced into the peritoneal cavity through the outer tube of the trochar. The proximal end of this catheter was passed through subcutaneous tunnel at right forechest, neck, right retroauricular area and connected the reservoir. The shunt system was checked to make sure its function was working. 8. The ventricular catheter was fixed to pericranium by 1 stitch. 9. Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by interrupted suture with 3/0 nylon. 10.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R3曾偉倫R0翁上硯Ri葉詩帆 相關圖片 林茂守 (M,1927/02/02,85y1m) 手術日期 2011/12/09 手術主治醫師 杜永光 手術區域 東址 001房 05號 診斷 Malignant neoplasm of cerebrum, except lobes and ventricles 器械術式 Burr hole (trephination) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 蕭柏妮 ASA 3E 紀錄醫師 陳國瑋, 時間資訊 01:11 開始NPO 01:11 臨時手術NPO 01:11 通知急診手術 01:40 進入手術室 01:45 麻醉開始 01:55 誘導結束 02:40 手術開始 03:20 手術結束 03:20 麻醉結束 03:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: Chronic Subdural Hematoma 開立醫師: 曾峰毅 開立時間: 2011/12/09 03:04 Pre-operative Diagnosis Left subdural effusion Post-operative Diagnosis Left subdural effusion Operative Method Left frontal burr hole for subdural drainage Specimen Count And Types Nil Pathology Nil Operative Findings Colorless, clear, fluid gushed out while durotomy. Opening pressure was around 10-15 cm H20. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to right. The scalp was shaved, scurbbed, disinfected, and then draped as usual. We made one 3-cm skin incision along previous operation wound. We drilled one burr hole, and created durotomy. We inserted one catheter into subdural space, and closed the wound in layers. Operators Prof. 杜永光 Assistants R5 曾峰毅 R3 陳國瑋 Indication Of Emergent Operation IICP 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Chronic Subdural Hematoma 開立醫師: 陳國瑋 開立時間: 2011/12/09 20:33 Pre-operative Diagnosis Left subdural effusion Post-operative Diagnosis Left subdural effusion Operative Method Left frontal burr hole for subdural drainage Specimen Count And Types Nil Pathology Nil Operative Findings Colorless, clear, fluid gushed out while durotomy. Opening pressure was around 10-15 cm H20. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to right. The scalp was shaved, scurbbed, disinfected, and then draped as usual. We made one 3-cm skin incision along previous operation wound. We drilled one burr hole, and created durotomy. We inserted one catheter into subdural space, and closed the wound in layers. Operators Prof. 杜永光 Assistants R5 曾峰毅 R3 陳國瑋 Indication Of Emergent Operation IICP 相關圖片 黃寶珍 (F,1959/06/17,52y8m) 手術日期 2011/12/09 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Acoustic neuroma 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 07:38 報到 08:05 進入手術室 08:10 麻醉開始 08:50 誘導結束 09:00 抗生素給藥 09:10 手術開始 12:00 抗生素給藥 14:30 麻醉結束 14:30 手術結束 14:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Left retrosigmoid approach for tumor excision 開立醫師: 曾峰毅 開立時間: 2011/12/09 14:20 Pre-operative Diagnosis Left vestibular schwannoma Post-operative Diagnosis Left vestibular schwannoma Operative Method Left retrosigmoid approach for tumor excision Specimen Count And Types 1 piece About size:fragments Source:brain tumor Pathology pending Operative Findings One soft, hypervasculized tumor arising from left superior vestibular nerve was noted. It was about 1.2 cm and extending into internal acoustic meatus. Most of the tumor resided in the meatus and was removed with neuron hook and CUSA. During the tumor removal, the left BAEP became flattened. Left facial nerve, inferior vestibular and cochlear nerve were well preserved. Operative Procedures After ETGA, the patient was in supine position with left shoulder elevated, and head turned to right. The skin was shaved, disinfected and drapped as usual. One curvilinear skin incision was made retro-auricular, and one piece of fascia was harvested for dura repair. Asterion was identified and the craniotomy was made. The dura was incised into Ommega shape and reflected. CSF was drained at cisterna meganum. CN VII VIII complex along with tumor was noted. The internal acoustic meatus was drilled open and tumor resection was done with CUSA. The was performed with autologous fascia graft and water-tight suture. Bone graft was fixed back with mini-plates. The wound was closed in layers. Operators Prof. 杜永光 Assistants CR 曾峰毅 R3 陳國瑋 相關圖片 江俊昇 (M,1964/10/10,47y5m) 手術日期 2011/12/09 手術主治醫師 杜永光 手術區域 東址 003房 02號 診斷 Malignant neoplasm of frontal lobe 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 15:00 進入手術室 15:10 麻醉開始 15:35 誘導結束 15:39 手術開始 15:40 抗生素給藥 18:50 手術結束 18:50 麻醉結束 19:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除-手術時間在4小時以內 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT 開立醫師: 曾峰毅 開立時間: 2011/12/09 18:51 Pre-operative Diagnosis Left frontal oligodendroglioma, grade II, status post excision, recurrent Post-operative Diagnosis Left frontal oligodendroglioma, grade II, status post excision, recurrent Operative Method Left frontal craniotomy for tumor excision Specimen Count And Types One brain tumor, about 5.5x5x5 cm, was sent for pathology. Pathology Pending Operative Findings One heterogenous, moderately-vascularized, soft to elastic, yellowish to whitish tumor was noted at left superior frontal lobe, just medial to falx, and in front of lateral ventricle. Left lateral ventricle frontal horn was opened, ans was sealed with Gelfoam packing. Left ACA and its braches were well preserved. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to right and fixed by Mayfield head clamp. The scalp was shaved, scrubbed, disinfected, and then draped, we made skin incision along previous operation wound. We created craniotomy along previous craniotomy window, and made one U-shape durotomy. Tumor excision was performed in en bloc fashion wiht bipolar coagulation, suction, and CUSA, and the tumor bed was paved with Surgicels for hemostasis. Duroplasty was performed with water-tight fashion and artificial dura. Bone graft was fixed back with mini-plates. The wound was closed in layers after one subgaleal CWV placed. Operators Prof. 杜永光 Assistants R5 曾峰毅 R3 陳國瑋 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT 開立醫師: 陳國瑋 開立時間: 2011/12/09 20:27 Pre-operative Diagnosis Left frontal oligodendroglioma, grade II, status post excision, recurrent Post-operative Diagnosis Left frontal oligodendroglioma, grade II, status post excision, recurrent Operative Method Left frontal craniotomy for tumor excision Specimen Count And Types One brain tumor, about 5.5x5x5 cm, was sent for pathology. Pathology Pending Operative Findings One heterogenous, moderately-vascularized, soft to elastic, yellowish to whitish tumor was noted at left superior frontal lobe, just medial to falx, and in front of lateral ventricle. Left lateral ventricle frontal horn was opened, ans was sealed with Gelfoam packing. Left ACA and its braches were well preserved. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to right and fixed by Mayfield head clamp. The scalp was shaved, scrubbed, disinfected, and then draped, we made skin incision along previous operation wound. We created craniotomy along previous craniotomy window, and made one U-shape durotomy. Tumor excision was performed in en bloc fashion wiht bipolar coagulation, suction, and CUSA, and the tumor bed was paved with Surgicels for hemostasis. Duroplasty was performed with water-tight fashion and artificial dura. Bone graft was fixed back with mini-plates. The wound was closed in layers after one subgaleal CWV placed. Operators Prof. 杜永光 Assistants R5 曾峰毅 R3 陳國瑋 相關圖片 王慧珍 (F,1961/10/08,50y5m) 手術日期 2011/12/09 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 1 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:10 進入手術室 08:20 麻醉開始 08:30 誘導結束 08:31 手術開始 09:20 抗生素給藥 11:35 抗生素給藥 12:30 麻醉結束 12:30 手術結束 12:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 記錄__ 手術科部: 外科部 套用罐頭: Left lateral suboccipital craniotomy for near... 開立醫師: 李振豪 開立時間: 2011/12/09 13:08 Pre-operative Diagnosis Left posterior fossa tentorial meningioma Post-operative Diagnosis Left posterior fossa tentorial meningioma Operative Method Left lateral suboccipital craniotomy for near total tumor excision Specimen Count And Types 1 piece About size:Multiple pieces Source:Left posterior fossa tumor Pathology Pending Operative Findings The tumor was 4.5 x 4.6 x 4.5cm in size, red-yellowish in color, well-capsulated, hypovascularized(s/p TAE), and elastic to firm with central necrosis(s/p TAE). The attachment of the tumor was mainly along the transverse sinus and torcular hemophili. One 2x2cm dura defect due to tumor infiltration was noted with significant hyperostosis. Nearly total removal of the tumor was performed except the tumor within the wall of transverse and torcular hemophili. The arachnoid membrane was intact after tumor excision. The cerebellum was slack with good pulsation. No significant SSEP change was noted during whole procedure. The hyperostosis also drilled with high-speed air-drived drills. The dura defect was repaired with COOK artificial dura. The patient stood whole procedure well. Total blood loss: 200ml. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position with head fixed Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. Hokeystick scalp incision was made and the scalp flap was elevated. Five burrholes were created followed one 8x5cm craniotomy window. The foramen magnum was opened for decompression also. Dural tenting was done. Dural incision was made along the margin of the tumor. The attachment of the tumor(along the transverse sinus and torcular hemophili) was detached for devascularization. Central debulking was performed. The tumor was then dissected along the capsule for near total tumor excision. The tumor tight adhered to the sinus and torcular hemophili was coagulated with bipolar electrocautery. The bleeding from sinus was packing with Gelfoam and Surgicel. Hemostasis was achieved with bipolar electrocautery and Surgicel lining. Duroplasty was conducted with COOK artificial dura. Dural tenting was conducted again due to loose epidural space after tumor excision. The skull plate was fixed back with miniplates and one central tenting. One subgaleal CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and Appose staples. Operators VS曾漢民 Assistants R5李振豪, PGY劉明侑 相關圖片 王韻淳 (F,1989/01/18,23y1m) 手術日期 2011/12/09 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Oligodendroglioma, brain 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 1 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 13:20 進入手術室 13:25 麻醉開始 14:00 誘導結束 14:10 抗生素給藥 14:20 手術開始 17:40 手術結束 17:40 麻醉結束 17:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除-手術時間在4小時以內 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Right frontal craniotomy for tumor excision 開立醫師: 李振豪 開立時間: 2011/12/09 18:35 Pre-operative Diagnosis Right cingulate gyrus high grade glioma Post-operative Diagnosis Right cingulate gyrus high grade glioma Operative Method Right frontal craniotomy for tumor excision Specimen Count And Types 1 piece About size:Multiple pieces Source:right mesial frontal tumor Pathology Frozen section: favor WHO grade III glioma Operative Findings The tumor was hypervascularized, 4x4x8.5cm in size, gray-reddish in color, gelatinous in character, and ill-defined in border. The feeding artery was mainly from anterior cerebral artery. The main branches of right side ACA was noted after tumor excision. The main branches were preserved well during the operation. The high grade part of the tumor was located posteroinferior part of the tumor. Frozen section yielded anaplastic astrocytoma. Intra-operative sonography and navigation was used for tumor excision. The SSEP and MEP also applied for monitoring and the EP was stationary during whole operation. Intra-operative sonography and navigation was used for total tumor excision. The tumor was hypervascularized, 4x4x8.5cm in size, gray-reddish in color, gelatinous in character, and ill-defined in border. The feeding artery was mainly from anterior cerebral artery. The main branches of right side ACA was noted after tumor excision. The main branches were preserved well during the operation. The high grade part of the tumor was located posteroinferior part of the tumor. Frozen section yielded anaplastic astrocytoma. Intra-operative sonography and navigation was used for total tumor excision. Right lateral ventricle was entered during tumor excision and packing with Gelfoam and Surgicel. Two large cortical vein surrounding the corticotomy was preserved well. The SSEP and MEP also applied for monitoring and the EP was stationary during whole operation. The tumor was hypervascularized, 4x4x8.5cm in size, gray-reddish in color, gelatinous in character, and ill-defined in border. Calcification was noted in the anterior part of the tumor. The feeding artery was mainly from anterior cerebral artery. The main branches of right side ACA was noted after tumor excision. The main branches were preserved well during the operation. The high grade part of the tumor was located posteroinferior part of the tumor. Frozen section yielded anaplastic astrocytoma. Intra-operative sonography and navigation was used for total tumor excision. Right lateral ventricle was entered during tumor excision and packing with Gelfoam and Surgicel. Two large cortical vein surrounding the corticotomy was preserved well. The SSEP and MEP also applied for monitoring and the EP was stationary during whole operation. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head fixed with Mayfield skull clamp. Framless navigation was registrated. The scalp was shaved, scrubbed, and disinfected as usual. V-shape scalp incision was made over right frontal area and the scalp flap was elevated. Five burrholes were created followed by one 6x6cm craniotomy window. Dural tenting was done. Intra-operative sonography was checked for localization of the tumor. C-shape durotomy was conducted based with superior sagittal sinus. One 1x2cm corticotomy was made and the tumor excision was performed with bipolar electrocautery, suction, and tumor forceps. Frozen section was sent and the result showed WHO grade III glioma. After tumor excision, hemostasis was achieved with bipolar electrocautery and Surgicel lining. The opening of right lateral ventricle was packing with Gelfoam and Surgicel. Duroplasty with periosteum and 4-0 Prolene was done. The skull plate was fixed back with miniplates, screws, and two central tenting. One subgaleal CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and Appose staples. Operators VS曾漢民 Assistants R5李振豪, PGY劉明侑 相關圖片 羅奕鈞 (M,2000/05/03,11y10m) 手術日期 2011/12/09 手術主治醫師 郭夢菲 手術區域 兒醫 063房 06號 診斷 Abdominal pain 器械術式 V-P shunt revision 手術類別 緊急手術 手術部位 腹 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 2E 紀錄醫師 王奐之, 時間資訊 10:20 臨時手術NPO 10:20 開始NPO 10:58 通知急診手術 20:20 進入手術室 20:25 麻醉開始 20:30 誘導結束 21:09 手術開始 22:00 手術結束 22:00 麻醉結束 22:20 送出病患 22:20 進入恢復室 23:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦脊髓液分流管重置 1 1 B 摘要__ 手術科部: 套用罐頭: Ventriculoperitoneal shunt revision (relocati... 開立醫師: 王奐之 開立時間: 2011/12/09 22:26 Pre-operative Diagnosis Ventriculoperitoneal shunt infection with intra-abdominal abscess formation Post-operative Diagnosis Ventriculoperitoneal shunt infection with intra-abdominal abscess formation Operative Method Ventriculoperitoneal shunt revision (relocation of peritoneal shunt) Specimen Count And Types 1 piece About size:old peritoneal catheter Source:50cm long Pathology Nil Operative Findings Fibrotic tissue formed around the old catheter tightly. Some turbid debris was noted at the tip of old peritoneal catheter, no obvious fluid gushed out after removal of the old peritoneal catheter. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position. After scrubbing, disinfection & draping in sterile fashion, a linear incision was made at left upper quadrant of abdomen and followed by a mini-laparotomy. A new peritoneal catheter tip was inserted into the peritoneal catheter. Another small linear incision was made at right clavicle, and the old shunt was mobilized. A subcutaneous tunnel was created from the left abdominal wound to the right clavicular wound, followed by passage of the peritoneal catheter. The new catheter was connected to the old shunt at right clavicular area after transection and discarding the distal end of the old catheter. The 2 wounds were closed in layers after hemostasis. A 3rd wound was made at right upper quadrant of abdomen, followed by mobilization of the old catheter. The catheter was removed en bloc smoothly and the wound was closed. Operators AP 郭夢菲 Assistants R4 王奐之 Indication Of Emergent Operation intra-abdominal infection 相關圖片 記錄__ 手術科部: 套用罐頭: Ventriculoperitoneal shunt revision (relocati... 開立醫師: 王奐之 開立時間: 2011/12/09 22:26 Pre-operative Diagnosis Ventriculoperitoneal shunt infection with intra-abdominal abscess formation Post-operative Diagnosis Ventriculoperitoneal shunt infection with intra-abdominal abscess formation Operative Method Ventriculoperitoneal shunt revision (relocation of peritoneal shunt) Specimen Count And Types 1 piece About size:old peritoneal catheter Source:50cm long Pathology Nil Operative Findings Fibrotic tissue formed around the old catheter tightly. Some turbid debris was noted at the tip of old peritoneal catheter, no obvious fluid gushed out after removal of the old peritoneal catheter. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position. After scrubbing, disinfection & draping in sterile fashion, a linear incision was made at left upper quadrant of abdomen and followed by a mini-laparotomy. A new peritoneal catheter tip was inserted into the peritoneal catheter. Another small linear incision was made at right clavicle, and the old shunt was mobilized. A subcutaneous tunnel was created from the left abdominal wound to the right clavicular wound, followed by passage of the peritoneal catheter. The new catheter was connected to the old shunt at right clavicular area after transection and discarding the distal end of the old catheter. The 2 wounds were closed in layers after hemostasis. A 3rd wound was made at right upper quadrant of abdomen, followed by mobilization of the old catheter. The catheter was removed en bloc smoothly and the wound was closed. Operators AP 郭夢菲 Assistants R4 王奐之 Indication Of Emergent Operation intra-abdominal infection 相關圖片 劉玉秀 (F,1935/09/07,76y6m) 手術日期 2011/12/09 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 HIVD 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 3 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:07 進入手術室 08:15 麻醉開始 08:20 誘導結束 08:25 抗生素給藥 09:13 手術開始 11:05 手術結束 11:05 麻醉結束 11:15 送出病患 11:16 進入恢復室 12:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-腰椎 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 記錄__ 手術科部: 外科部 套用罐頭: Microsurgical diskectomy, L4/5. 開立醫師: 鍾文桂 開立時間: 2011/12/09 11:25 Pre-operative Diagnosis Herniated intervertebral disc, L4/5. Post-operative Diagnosis Herniated intervertebral disc, L4/5. Operative Method Microsurgical diskectomy, L4/5. Specimen Count And Types nil Pathology Nil. Operative Findings Ruptured disc at right lateral aspect of the disc. Part of the facet jount was removed for disc removal. A small epidural vessel. + epidural bleeding, sealed with gelfoam. Operative Procedures Under ETGA, the patient was placed in prone position. After localization of L4/5 level, the operative field was disinfected and draped. A linear skin incision was made. The lower forder of L4 and upper border of L5 laminae were removed. The ligamentum flavum was removed. Then, diskectomy was performed. After well hemostasis, the wound was closed in layers. Operators 賴達明 Assistants 鍾文桂 李嘉誠 相關圖片 NGUYENTHI BANH (F,1950/05/20,61y9m) 手術日期 2011/12/09 手術主治醫師 賴達明 手術區域 東址 018房 02號 診斷 Spinal tumor 器械術式 Intraspinal intramedullary tum 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 3 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 10:35 進入手術室 10:40 麻醉開始 11:20 誘導結束 12:20 抗生素給藥 12:30 手術開始 14:30 手術結束 14:30 麻醉結束 14:47 送出病患 14:50 進入恢復室 17:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 良性脊髓腫瘤切除術 1 1 摘要__ 手術科部: 外科部 套用罐頭: T6-8 laminectomy with tumor excison, partial ... 開立醫師: 林哲光 開立時間: 2011/12/09 15:08 Pre-operative Diagnosis T6-8 epidural mass, suspected cavernous hemangioma Post-operative Diagnosis T6-8 epidural mass, suspected cavernous hemangioma Operative Method T6-8 laminectomy with tumor excison, partial removal Specimen Count And Types 1 piece About size: Source:tumor Pathology Pending Operative Findings Hyperemic change of the paraspinal muscles with some large bore vessel bleeding was noted during the paraspinal muscles detachment. T6-8 reddish, well-defined, epidural mass with hypervascularity, easily touch bleeding and tightly compressing the dura sac. The tumor was extended to left T6 pedicle to the body and left 7th rib was also involved. The dura sac seemed-re-expanded well after tumor removal and laminectomy. The epidural part at T6-8 level was removed as extensively as possible but left 7th rib was left untouched due to easily touch bleeding. Operative Procedures Under ETGA and prone position, skin disinfected and drapped were perofmred as usual. Midline skin incision was made under C-arm localization for T6 transverse process. The paraspinal muscles were detached and T6-8 lamina were well exposed. T6-T8 laminectomy was then performed and epidural tumor was removed. Hemostasis with Gelfoam packing was then done and the wound was then closed in layers after a epidural drain was inserted. Operators 賴達明 Assistants 林哲光 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: T6-8 laminectomy with tumor excison, partial ... 開立醫師: 林哲光 開立時間: 2011/12/09 15:08 Pre-operative Diagnosis T6-8 epidural mass, suspected cavernous hemangioma Post-operative Diagnosis T6-8 epidural mass, suspected cavernous hemangioma Operative Method T6-8 laminectomy with tumor excison, partial removal Specimen Count And Types 1 piece About size: Source:tumor Pathology Pending Operative Findings Hyperemic change of the paraspinal muscles with some large bore vessel bleeding was noted during the paraspinal muscles detachment. T6-8 reddish, well-defined, epidural mass with hypervascularity, easily touch bleeding and tightly compressing the dura sac. The tumor was extended to left T6 pedicle to the body and left 7th rib was also involved. The dura sac seemed-re-expanded well after tumor removal and laminectomy. The epidural part at T6-8 level was removed as extensively as possible but left 7th rib was left untouched due to easily touch bleeding. Operative Procedures Under ETGA and prone position, skin disinfected and drapped were perofmred as usual. Midline skin incision was made under C-arm localization for T6 transverse process. The paraspinal muscles were detached and T6-8 lamina were well exposed. T6-T8 laminectomy was then performed and epidural tumor was removed. Hemostasis with Gelfoam packing was then done and the wound was then closed in layers after a epidural drain was inserted. Operators 賴達明 Assistants 林哲光 相關圖片 洪素蘭 (F,1947/02/20,65y0m) 手術日期 2011/12/09 手術主治醫師 賴達明 手術區域 東址 019房 02號 診斷 Lumbar Spondylosis 器械術式 Laminectomy for decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 2 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 11:03 報到 11:25 進入手術室 11:30 麻醉開始 11:40 誘導結束 12:30 抗生素給藥 12:41 手術開始 14:12 手術結束 14:42 麻醉結束 14:51 送出病患 14:55 進入恢復室 16:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 手術 椎弓切除術(減壓)-二節以內 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 記錄__ 手術科部: 外科部 套用罐頭: Sublaminar decompression, L4/5. 開立醫師: 鍾文桂 開立時間: 2011/12/09 15:03 Pre-operative Diagnosis Lumbar stenosis, L4/5. Post-operative Diagnosis Lumbar stenosis, L4/5. Operative Method Sublaminar decompression, L4/5. Specimen Count And Types nil Pathology Nil. Operative Findings Unstable facet joints, L4/5. Hypertrophic ligamentum flavum.It was removed from left to right side. Intact dura mater after decompression. Operative Procedures Under ETGA, the patient was placed in prone position. After localization, disinfection and draping were done. After linear skin incision, the paraspinal muscle was dissected. Lower border of L4 and upper border of L5 laminae were resected along with L4 spinous process. Ligamentum flavum was removed for decompression. After well hemostasis, the wound was closed in layers. Operators 賴達明 Assistants 鍾文桂 李嘉哲 相關圖片 裴年楨 (M,1966/08/26,45y6m) 手術日期 2011/12/09 手術主治醫師 賴達明 手術區域 東址 019房 03號 診斷 Lumbar Spondylosis 器械術式 Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 2 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 15:10 進入手術室 15:15 麻醉開始 15:20 誘導結束 15:50 抗生素給藥 16:06 手術開始 17:30 手術結束 17:30 麻醉結束 17:37 送出病患 17:40 進入恢復室 18:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-腰椎 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 記錄__ 手術科部: 外科部 套用罐頭: MIcrosurgical diskectomy, L5/S1. 開立醫師: 鍾文桂 開立時間: 2011/12/09 17:55 Pre-operative Diagnosis Herniated intervertebral disc, L5/S1. Post-operative Diagnosis Herniated intervertebral disc, L5/S1. Operative Method MIcrosurgical diskectomy, L5/S1. Specimen Count And Types nil Pathology Nil Operative Findings Approach through left side. A central bulging disc, intact annulus. Intact thecal sac and root. Operative Procedures Under ETGA, the patient was placed in prone position. After localization of L5/S1 level, disinfection and draping were done. A linear skin incision was made. Paraspinal dissection was obtained. After laminotomy of L5 level, the hypertrophic ligamentum flavum was resected. The underlying bulging disc was removed. After well hemostasis, the wound was closed in layers. Operators 賴達明 Assistants 鍾文桂 李嘉哲 相關圖片 周清榮 (M,1950/02/03,62y1m) 手術日期 2011/12/09 手術主治醫師 蔡翊新 手術區域 東址 023房 04號 診斷 Subarachnoid hemorrhage 器械術式 V-P shunt 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3E 紀錄醫師 王奐之, 時間資訊 12:48 開始NPO 12:48 臨時手術NPO 12:48 通知急診手術 15:00 進入手術室 15:10 麻醉開始 15:15 抗生素給藥 15:20 誘導結束 15:44 手術開始 16:40 手術結束 16:40 麻醉結束 16:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 蔡翊新 開立時間: 2011/12/09 16:32 Pre-operative Diagnosis A-com artery aneurysm rupture with IVH s/p Clipping and EVD. Hydrocephalus. Post-operative Diagnosis A-com artery aneurysm rupture with IVH s/p Clipping and EVD. Hydrocephalus. Operative Method V-P Shunt, Metronic, via right Kocher point. Specimen Count And Types 3 tubes of CSF, sent for routine, BCS and bacterial culture Pathology Nil. Operative Findings Previous burr hole at right Kocher point. CSF was sanguinous and initial pressure was more than 15 cmH2O. Ventricular catheter was 6.5 cm in depth and the reservoir was medium-pressure. Peritoneal catheter was 25 cm in depth. Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: supine with head rotated to left. 3.Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 5 cm curvilinear, right frontal along previous wound, corresponded to the location of right frontal horn. Raney clips were applied to the scalp edge for temporary hemostasis. 5.After the scalp flap had been lifted and reflected anteriorly, right lateral ventricle was tapped by a ventricular needle, then a 6.5 cm segment of the ventricular catheter was introduced into the ventricle. The outer end of the catheter was connected to a medium-pressure Pudenz reservoir. 6. A minilaparotomy was made at RUQ of the abdomen , then a trocar was pushed into peritoneal cavity. Subsequently, distal 25 cm segment of the peritoneal catheter (low pressure) was introduced into the peritoneal cavity through the outer tube of the trochar. The proximal end of this catheter was passed through subcutaneous tunnel at forechest, neck, right retroauricular area and connected the reservoir. The shunt system was checked to make sure its function was working. 7. The reservoir was fixed to pericranium by 3 stitches. 8. Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 9. Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5林哲光 R4王奐之 Ri施顯學 Indication Of Emergent Operation Hydrocephalus with IICP and conscious disturbance 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 蔡翊新 開立時間: 2011/12/09 16:33 Pre-operative Diagnosis A-com artery aneurysm rupture with IVH s/p Clipping and EVD. Hydrocephalus. Post-operative Diagnosis A-com artery aneurysm rupture with IVH s/p Clipping and EVD. Hydrocephalus. Operative Method V-P Shunt, Metronic, via right Kocher point. Specimen Count And Types 3 tubes of CSF, sent for routine, BCS and bacterial culture Pathology Nil. Operative Findings Previous burr hole at right Kocher point. CSF was sanguinous and initial pressure was more than 15 cmH2O. Ventricular catheter was 6.5 cm in depth and the reservoir was medium-pressure. Peritoneal catheter was 25 cm in depth. Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: supine with head rotated to left. 3.Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 5 cm curvilinear, right frontal along previous wound, corresponded to the location of right frontal horn. Raney clips were applied to the scalp edge for temporary hemostasis. 5.After the scalp flap had been lifted and reflected anteriorly, right lateral ventricle was tapped by a ventricular needle, then a 6.5 cm segment of the ventricular catheter was introduced into the ventricle. The outer end of the catheter was connected to a medium-pressure Pudenz reservoir. 6. A minilaparotomy was made at RUQ of the abdomen , then a trocar was pushed into peritoneal cavity. Subsequently, distal 25 cm segment of the peritoneal catheter (low pressure) was introduced into the peritoneal cavity through the outer tube of the trochar. The proximal end of this catheter was passed through subcutaneous tunnel at forechest, neck, right retroauricular area and connected the reservoir. The shunt system was checked to make sure its function was working. 7. The reservoir was fixed to pericranium by 3 stitches. 8. Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 9. Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5林哲光 R4王奐之 Ri施顯學 Indication Of Emergent Operation Hydrocephalus with IICP and conscious disturbance 相關圖片 胡照雄 (M,1955/02/11,57y1m) 手術日期 2011/12/10 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Esophageal cancer 器械術式 Brain tumor Crainotomy(TZENG)，Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 蕭柏妮 ASA 3 紀錄醫師 李嘉哲, 時間資訊 00:00 臨時手術NPO 08:10 進入手術室 08:25 麻醉開始 08:40 誘導結束 08:42 抗生素給藥 08:50 手術開始 10:55 手術結束 11:05 麻醉結束 11:05 送出病患 11:06 進入恢復室 12:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除-手術時間在4小時以內 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT 開立醫師: 曾峰毅 開立時間: 2011/12/10 11:02 Pre-operative Diagnosis Esophageal cancer, with left frontal skull metastasis with epidural extension Post-operative Diagnosis Esophageal cancer, with left frontal skull metastasis with epidural extension Operative Method Left frontal craniectomy for skull tumor excision Specimen Count And Types Skull and epidural tumor was sent for pathology. Pathology Pending Operative Findings Greyish, hypervascular tumor involving left frontal sukll with epidural extension. Feeders was noted from left middle meningeal artery and left superficial temporal artery. Greyish, hypervascular tumor involving left frontal sukll with epidural extension. Feeders was noted from left middle meningeal artery and left superficial temporal artery. Codman titanium mesh was used for cranioplasty Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to right. We shaved, scrubbed, disinfected, and then draped the scalp, and made one curvilinear skin incision at left frontal area. Feeder from superficial temporal artery was identified and ligated. We drilled five burr holes, and made craniectomy. Dura was tented along the craniectomy window. Feeder from middle meningeal artery was cauterized. Epidural tumor was removed. Cranioplasty was performed with artificial titanium mesh and screws. The wound was closed in layers. Operators VS 曾漢民 Assistants R5 曾峰毅 R1 李嘉哲 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Craniotomy for ICT 開立醫師: 曾峰毅 開立時間: 2011/12/10 14:53 Pre-operative Diagnosis Esophageal cancer, with left frontal skull metastasis with epidural extension Post-operative Diagnosis Esophageal cancer, with left frontal skull metastasis with epidural extension Operative Method Left frontal craniectomy for skull tumor excision Specimen Count And Types Skull and epidural tumor was sent for pathology. Pathology Pending Operative Findings Greyish, hypervascular tumor involving left frontal sukll with epidural extension. Feeders was noted from left middle meningeal artery and left superficial temporal artery. Codman titanium mesh was used for cranioplasty Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to right. We shaved, scrubbed, disinfected, and then draped the scalp, and made one curvilinear skin incision at left frontal area. Feeder from superficial temporal artery was identified and ligated. We drilled five burr holes, and made craniectomy. Dura was tented along the craniectomy window. Feeder from middle meningeal artery was cauterized. Epidural tumor was removed. Cranioplasty was performed with artificial titanium mesh and screws. The wound was closed in layers. Operators VS 曾漢民 Assistants R5 曾峰毅 R1 李嘉哲 相關圖片 謝智安 (M,1974/11/27,37y3m) 手術日期 2011/12/12 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Arteriovenous malformation, brain 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 07:55 報到 08:05 進入手術室 08:15 麻醉開始 08:45 誘導結束 09:00 抗生素給藥 09:03 手術開始 11:27 開始輸血 12:00 抗生素給藥 15:00 抗生素給藥 18:00 手術結束 18:00 抗生素給藥 18:00 麻醉結束 18:10 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 開顱術摘除血管病變- 動靜脈畸型大型 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 12 0 摘要__ 手術科部: 外科部 套用罐頭: Occipital craniotomy for AVM excision 開立醫師: 鍾文桂 開立時間: 2011/12/12 18:52 Pre-operative Diagnosis Left occipital arteriovenous malformation, Spetzler-Martin grade 4 Post-operative Diagnosis Left occipital arteriovenous malformation, Spetzler-Martin grade 4 Operative Method Occipital craniotomy for AVM excision Specimen Count And Types one piece 6cm, AVM Pathology pending Operative Findings Tortuous and dilated drainage veins distributed at the surface of left occipital lobe and drained into superior sagital sinus and left transverse sinus. Some AVM vessels adhered to the dura mater severely. It took some time to seperate the dura from the AVM. Multiple feeders from PCA and MCA were noted. The larger ones were embolized by TAE and the smaller ones were electrocoagulated by bipolar cautery. One small drainage vein was noted at superior aspect of the AVM. It was coagulated first. Then, the second large drainage vein to the superior sagital sinus was cliped temporarily by temporay clip to see if the AVM engorged. As no significant engorgement was noted, it was electrocoagulated later. The largest drainage vein into the transverse sinus was the final electrocoagulated one. Two large venous aneurysms were electrocoagulated. Easy oozing scalp. Operative Procedures After ETGA the patients head was fixed with Mayfield clamp, and then turned into prone position. The skin was shaved, scrubbed, disinfected and drapped as usual. One U shape skin incision was made across midline. The skin was reflected and one 10*8cm craniotomy window was made to exposed the transverse sinus and superior sagital sinus. After a L - shape durotomy 1 cm away from superior sagital sinus and transverse sinus, the AVM was seperate from the dura mater meticulously. The AVM nidus was dissected from the surrounding brain parenchyma. The feeders were electrocoagulated. The drainage veins were electrocoagulated and resected. Finally, the AVM was resected in en bloc fashion. The dura mater was closed in watertight fashion. The dural defect was repaired by fascia graft. The craniotomy bone plate was closed by miniplates and screws. The wound was closed in layers with one subgaleal CWV drain in situ. Operators Prof. 杜永光 Assistants R6 鍾文桂 R3 陳國瑋 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Occipital craniotomy for AVM excision 開立醫師: 陳國瑋 開立時間: 2011/12/12 19:37 Pre-operative Diagnosis Left occipital arteriovenous malformation, Spetzler-Martin grade 4 Post-operative Diagnosis Left occipital arteriovenous malformation, Spetzler-Martin grade 4 Operative Method Occipital craniotomy for AVM excision Specimen Count And Types one piece 6cm, AVM Pathology pending Operative Findings Tortuous and dilated drainage veins distributed at the surface of left occipital lobe and drained into superior sagital sinus and left transverse sinus. Some AVM vessels adhered to the dura mater severely. It took some time to seperate the dura from the AVM. Multiple feeders from PCA and MCA were noted. The larger ones were embolized by TAE and the smaller ones were electrocoagulated by bipolar cautery. One small drainage vein was noted at superior aspect of the AVM. It was coagulated first. Then, the second large drainage vein to the superior sagital sinus was cliped temporarily by temporay clip to see if the AVM engorged. As no significant engorgement was noted, it was electrocoagulated later. The largest drainage vein into the transverse sinus was the final electrocoagulated one. Two large venous aneurysms were electrocoagulated. Easy oozing scalp. Operative Procedures After ETGA the patients head was fixed with Mayfield clamp, and then turned into prone position. The skin was shaved, scrubbed, disinfected and drapped as usual. One U shape skin incision was made across midline. The skin was reflected and one 10*8cm craniotomy window was made to exposed the transverse sinus and superior sagital sinus. After a L - shape durotomy 1 cm away from superior sagital sinus and transverse sinus, the AVM was seperate from the dura mater meticulously. The AVM nidus was dissected from the surrounding brain parenchyma. The feeders were electrocoagulated. The drainage veins were electrocoagulated and resected. Finally, the AVM was resected in en bloc fashion. The dura mater was closed in watertight fashion. The dural defect was repaired by fascia graft. The craniotomy bone plate was closed by miniplates and screws. The wound was closed in layers with one subgaleal CWV drain in situ. Operators Prof. 杜永光 Assistants R6 鍾文桂 R3 陳國瑋 相關圖片 鍾定楷 (M,1967/07/10,44y8m) 手術日期 2011/12/12 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Oligodendroglioma, brain 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:15 麻醉開始 08:35 誘導結束 08:55 抗生素給藥 09:34 手術開始 10:58 開始輸血 11:55 抗生素給藥 12:30 手術結束 12:30 麻醉結束 12:35 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦瘤切除-手術時間在4小時以內 1 1 R 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Right parieto-occipital craniotomy for total ... 開立醫師: 李振豪 開立時間: 2011/12/12 13:01 Pre-operative Diagnosis Right mesial parietal tumor, suspect meningioma or high grade glioma Post-operative Diagnosis Right parietal falx meningioma Operative Method Right parieto-occipital craniotomy for total tumor excision Specimen Count And Types 1 piece About size:Multiple small pieces Source:Right mesial parietal tumor Pathology Frozen section: suspect variation of meningioma or dural metastasis Operative Findings The brain bulging out after durotomy and became mild slack after drainage of cystic component. The cystic component was filled with xanthochromic fluid. The tumor was adhered tightly to the dura with ill-defined margin with brain parenchyma. The tumor was 3.8 x 4.7 x 5.5cm in size, hypervascularized, soft to elastic, and red-yellowish. The frozen section did not favor intra-axial lesion since no evident neuron or glial cell noted. The tumor may originated from meninx(a variation type of meningioma) or dural metastasis. Numerous small fedding artery from falx was noted. One major vessel coursed through the tumor and coagulated during tumor excision. After total removal of the tumor, the brain became slack. The lateral ventricle was not entered during whole procedure. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position with head fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. One reverse U scalp incision was made at right parieto-occipital area and the scalp flap was elevated. Five burrholes were created followed by one 8x6cm craniotomy window. Intra-operative sonography was checked for localization of the tumor. The craniotomy window was extended toward the parietal area 1cm more for better exposure. Dural tenting was done. C-shape durotomy was conducted. The tumor was identified and the cystic component was drained for decompression. Some tumor was sampled for frozen section. Tumor was then detched from dura for devascularization. The tumor was then removed with bipolar electrocautery, suction, and tumor forceps. Hemostasis was achieved with bipolar electrocautery, Surgicel linig, and Gelfoam packing. The dura was closed with 4-0 Prolene. The skull plate was fixed back with miniplates, screws, and one central tenting. One subgaleal CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and Appose staples. Operators VS曾漢民 Assistants R5李振豪, PGY劉明侑 相關圖片 張家玲 (F,1958/08/05,53y7m) 手術日期 2011/12/12 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 12:58 進入手術室 13:05 麻醉開始 13:40 誘導結束 13:45 抗生素給藥 13:56 手術開始 16:25 手術結束 16:25 麻醉結束 16:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 R 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 記錄__ 手術科部: 外科部 套用罐頭: Right subfrontal approach for tumor excision 開立醫師: 李振豪 開立時間: 2011/12/12 17:01 Pre-operative Diagnosis Right tuberculum sellar meningioma Post-operative Diagnosis Right tuberculum sellar meningioma Operative Method Right subfrontal approach for tumor excision Specimen Count And Types 1 piece About size:Multiple pieces Source:Right tuberculum sellar meningioma Pathology Pending Operative Findings The tumor attachment was at anterior frontal base(including anterior clinoidal process, right tuberculum sella, and optic canal) with numerous small feeding artery from dura. The tumor was pinkish, elastic, well-capsulated, 2.5 x 2.5 x 1.5cm, and hypervascularized. The right optic nerve was pushed upward and anteriorly. The pituitary stalk and left side optic nerve also compressed by the tumor. The internal carotid artery was located at posterolateral side of the tumor and not encased. The intracranial part of the tumor was removed totally and the dura was coagulated. Bilateral optic nerve, pituitary stalk, and ICA were all visualized and preserved well during whole procedure. The arachnoid membrane covered the frontal base and pituitary stalk also intact. The patient stood whole procedure well. Total blood loss: 200ml Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. Bicoronal scalp incision was made along operative scar. The scalp flap was elevated and the craniotomy window was identified. Two craniofix was removed and the skull plate was removed. C-shape durotomy was conducted based with anterior frontal base. The frontal lobe was retracted and the tumor was encountered soon. Devascularization was performed along the skull base. The tumor was then dissected along the arachnoid plan. The intracranial part was all removed but the tumor extended into the optic canal. Left side optic nerve was decompressed well and the pituitary stalk was left intact which covered with a layer of arachnoid membrane. Hemostasis was achieved with bipolar electrocautery and Surgicel lining. Duroplasty was done with COOK artificial dura and 4-0 prolene. The skull plate was fixed back with miniplates, screws, and one central tenting. The wound was then closed in layers with 2-0 Vicryl and Appose staples. Operators VS曾漢民 Assistants R5李振豪, PGY劉明侑 相關圖片 李麗美 (F,1965/02/04,47y1m) 手術日期 2011/12/12 手術主治醫師 曾漢民 手術區域 東址 002房 05號 診斷 Spine tumor 器械術式 Benign intraspinal tumor, exci 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 15:30 進入手術室 15:35 麻醉開始 15:45 誘導結束 15:50 抗生素給藥 16:22 手術開始 18:45 手術結束 18:45 麻醉結束 18:50 抗生素給藥 18:50 送出病患 18:55 進入恢復室 20:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 良性脊髓腫瘤切除術 1 1 摘要__ 手術科部: 外科部 套用罐頭: T12 laminoplasty with intraspinal tumor exicision 開立醫師: 林哲光 開立時間: 2011/12/12 18:46 Pre-operative Diagnosis T12 intradural extramedullary tumor, suspected neuroma Post-operative Diagnosis T12 intradural extramedullary tumor, suspected neuroma Operative Method T12 laminoplasty with intraspinal tumor exicision Specimen Count And Types 1 piece About size:2.1 cm sized Source:intraspinal tumor Pathology Pending Operative Findings Mild posterior bluging of dura was noted after T12 lamina was removed. About 2.1cm sized, well-demarcated, yellowish, soft-elastic intradual extramedullary mass lesion was noted, more on left side, after dura opened with tightly adherent to the fasculi but no obvious extradural invasion was noted. Total tumor removal was done and the roolet was left intact after excision. Operative Procedures Under ETGA and prone position, skin disinfected and drapped were performed as usual. Midline skin incision was made at T11-L1 level. Paraspinal muscles were detached and bilateral T12 lamina were drilled off by high speed air-drill. T12 dura was well-exposed after ligamentum flavum was removed and the dura was opened in linear incision. The dura edge was tenting by silk. Tumor excision was done by dissection from the adhesion from the nerve fasculi. The dura was then closed in water tie method. The T12 bone graft was put back and fixed with miniplates. The wound was then closed in layers after one epidural CWV drain was inserted. Operators 曾漢民 Assistants 林哲光, 李振豪 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: T12 laminoplasty with intraspinal tumor exicision 開立醫師: 林哲光 開立時間: 2011/12/12 18:46 Pre-operative Diagnosis T12 intradural extramedullary tumor, suspected neuroma Post-operative Diagnosis T12 intradural extramedullary tumor, suspected neuroma Operative Method T12 laminoplasty with intraspinal tumor exicision Specimen Count And Types 1 piece About size:2.1 cm sized Source:intraspinal tumor Pathology Pending Operative Findings Mild posterior bluging of dura was noted after T12 lamina was removed. About 2.1cm sized, well-demarcated, yellowish, soft-elastic intradual extramedullary mass lesion was noted, more on left side, after dura opened with tightly adherent to the fasculi but no obvious extradural invasion was noted. Total tumor removal was done and the roolet was left intact after excision. Operative Procedures Under ETGA and prone position, skin disinfected and drapped were performed as usual. Midline skin incision was made at T11-L1 level. Paraspinal muscles were detached and bilateral T12 lamina were drilled off by high speed air-drill. T12 dura was well-exposed after ligamentum flavum was removed and the dura was opened in linear incision. The dura edge was tenting by silk. Tumor excision was done by dissection from the adhesion from the nerve fasculi. The dura was then closed in water tie method. The T12 bone graft was put back and fixed with miniplates. The wound was then closed in layers after one epidural CWV drain was inserted. Operators 曾漢民 Assistants 林哲光, 李振豪 相關圖片 趙伯諺 (M,1988/02/25,24y0m) 手術日期 2011/12/12 手術主治醫師 張金池 手術區域 東址 002房 01號 診斷 Lymphoma 器械術式 Tracheostomy 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3E 紀錄醫師 廖先啟, 羅偉誠, 時間資訊 00:02 臨時手術NPO 00:02 開始NPO 06:00 通知急診手術 08:24 進入手術室 08:25 麻醉開始 08:27 誘導結束 08:48 手術開始 08:55 手術結束 08:55 麻醉結束 09:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 氣管切開術 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 羅偉誠 開立時間: 2011/12/12 09:09 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types nil Pathology None Operative Findings Fr . 8 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding Operators V張金池 Assistants R4廖先啟, R2羅偉誠 Indication Of Emergent Operation Respiratory failure 高信謙 (M,1955/03/15,56y11m) 手術日期 2011/12/12 手術主治醫師 楊宗霖 手術區域 西址 037房 03號 診斷 Malignant neoplasm of brain 器械術式 Endoscopic functional sinus surgery, bilateral 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 2 紀錄醫師 周承翰, 時間資訊 12:38 進入手術室 12:45 麻醉開始 12:52 誘導結束 13:00 抗生素給藥 13:10 手術開始 17:05 手術結束 17:05 麻醉結束 17:15 開始輸血 17:20 送出病患 17:20 進入恢復室 18:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 多竇副鼻竇手術 1 1 B 手術 多竇副鼻竇手術 1 1 B 記錄__ 手術科部: 耳鼻喉部 套用罐頭: Functional endoscopic sinus surgery 開立醫師: 周承翰 開立時間: 2011/12/12 20:05 Pre-operative Diagnosis Chronic paranasal sinusitis Post-operative Diagnosis Chronic paranasal sinusitis, operated Operative Method Functional endoscopic sinus surgery (bilateral) Specimen Count And Types 2 pieces About size:2mmx2mm fragments Source:right sinonasal tissue About size:2mmx2mm fragments Source:left sinonasal tissue Pathology pending Operative Findings Right Inf:OK( ),edematous( ),polypoid( ),polyp( ),mucopus( ),fungus( ),N/A( ) AEth:OK( ),edematous( ),polypoid( ),polyp( ),mucopus( ),fungus( ),N/A( ) PEth:OK( ),edematous( ),polypoid( ),polyp( ),mucopus( ),fungus( ),N/A( ) Max:OK( ),edematous( ),polypoid( ),polyp( ),mucopus( ),fungus( ),N/A( ) Fron:OK( ),edematous( ),polypoid( ),polyp( ),mucopus( ),fungus( ),N/A( ) Sph:OK( ),edematous( ),polypoid( ),polyp( ),mucopus( ),fungus( ),N/A( ) Left Inf:OK( ),edematous( ),polypoid( ),polyp( ),mucopus( ),fungus( ),N/A( ) AEth:OK( ),edematous( ),polypoid( ),polyp( ),mucopus( ),fungus( ),N/A( ) PEth:OK( ),edematous( ),polypoid( ),polyp( ),mucopus( ),fungus( ),N/A( ) Max:OK( ),edematous( ),polypoid( ),polyp( ),mucopus( ),fungus( ),N/A( ) Fron:OK( ),edematous( ),polypoid( ),polyp( ),mucopus( ),fungus( ),N/A( ) Sph:OK( ),edematous( ),polypoid( ),polyp( ),mucopus( ),fungus( ),N/A( ) Operative Procedures (1) Infundibulotomy: R( )L( ) (2) Opening/trimming of - Ethmoid bulla........R( )L( ) - Anterior ethmoid.....R( )L( ) - Agger nasi...........R( )L( ) - Frontal recess.......R( )L( ) - Middle turbinate.... R( )L( ) (3) Opening/trimming of - Ground lamella.......R( )L( ) - Posterior ethmoid....R( )L( ) - Sphenoid sinus.......R( )L( ) (4) Widening of - Maxillary ostium.....R( )L( ) - Aspiration...........R( )L( ) - Irrigation...........R( )L( ) (5) Packing with - Merocel..............R( )L( ) - Fingerstall..........R( )L( ) Operators ASP楊宗霖 Assistants R4周承翰 王美玲 (F,1955/12/22,56y2m) 手術日期 2011/12/13 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Spinal stenosis 器械術式 Lamino plasty 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:10 麻醉開始 08:15 誘導結束 08:30 抗生素給藥 08:33 手術開始 11:05 開始輸血 11:30 抗生素給藥 11:55 手術結束 11:55 麻醉結束 12:05 送出病患 12:06 進入恢復室 14:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 手術 椎弓整形術 1 1 摘要__ 手術科部: 外科部 套用罐頭: Cervical laminoplasty with open-book method, C3-7 開立醫師: 林哲光 開立時間: 2011/12/13 12:32 Pre-operative Diagnosis Cervical stenosis Post-operative Diagnosis Cervical stenosis Operative Method Cervical laminoplasty with open-book method, C3-7 Specimen Count And Types nil Pathology Nil Operative Findings Hypertrophic change of ligamentum was noted at C3-7 level after lamina was opened. The dura sac seemed decompressed well after laminoplasty was done. Operative Procedures Under ETGA and prone position with head fixed with Mayfield head clamp, skin disinfected and drapped were performed as usual. Midline skin incision was made and paraspinal muscles were detached and spinous process from C2 to T1 were exposed. The spinous process were drilled off from C3-T1 level. Bilateral lamina of C3-C7 were drilled and opened in open-book method via greenstick fracture. A tunnel was created at each bone graft from the spinous process and at the bilateral lamina at C3-C7 level. The bone graft was then set on the each lamina and fixed with wire. The wound was then closed in layers after Gelfoam packing and one paraspinal CWV drain insertion. Operators 曾勝弘 Assistants 林哲光 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Cervical laminoplasty with open-book method, C3-7 開立醫師: 林哲光 開立時間: 2011/12/13 12:32 Pre-operative Diagnosis Cervical stenosis Post-operative Diagnosis Cervical stenosis Operative Method Cervical laminoplasty with open-book method, C3-7 Specimen Count And Types nil Pathology Nil Operative Findings Hypertrophic change of ligamentum was noted at C3-7 level after lamina was opened. The dura sac seemed decompressed well after laminoplasty was done. Operative Procedures Under ETGA and prone position with head fixed with Mayfield head clamp, skin disinfected and drapped were performed as usual. Midline skin incision was made and paraspinal muscles were detached and spinous process from C2 to T1 were exposed. The spinous process were drilled off from C3-T1 level. Bilateral lamina of C3-C7 were drilled and opened in open-book method via greenstick fracture. A tunnel was created at each bone graft from the spinous process and at the bilateral lamina at C3-C7 level. The bone graft was then set on the each lamina and fixed with wire. The wound was then closed in layers after Gelfoam packing and one paraspinal CWV drain insertion. Operators 曾勝弘 Assistants 林哲光 相關圖片 游沛純 (F,2010/05/24,1y9m) 手術日期 2011/12/13 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Apert syndrome 器械術式 Cranioplasty - FO advancement 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 石博元 ASA 3 紀錄醫師 游彥辰, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:08 進入手術室 08:10 麻醉開始 08:45 抗生素給藥 09:20 開始輸血 09:25 誘導結束 10:15 手術開始 11:45 抗生素給藥 14:45 抗生素給藥 17:45 抗生素給藥 20:45 抗生素給藥 21:20 麻醉結束 21:20 手術結束 21:25 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱顏合併手術 1 1 B 手術 顏面骨移植術(先天畸形或外傷腫瘍摘除) 1 2 B 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 18 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 4 0 麻醉 Hemoglobin (Hb) 4 0 麻醉 測血糖 4 0 麻醉 Ca (Calcium) 4 0 麻醉 Na (Sodium) 4 0 麻醉 K (Potassium) 4 0 麻醉 Blood gas analysis 4 0 手術 顱骨切除術,包括異物移除或壓或經切斷 1 1 B 手術 頭顱成形術 1 2 記錄__ 手術科部: 外科部 套用罐頭: Cranioplasty with fronto-orbital advancement 開立醫師: 游彥辰 開立時間: 2011/12/13 21:49 Pre-operative Diagnosis Apert syndrome with craniosynostosis, status post frontal and bilateral parietal craniectomy and expansive reconstructive cranioplasty, status post bilateral parietal-temporal and occipital craniectomy with expansive reconstructive cranioplasty and barrel-stave osteotomy Post-operative Diagnosis Apert syndrome with craniosynostosis, status post frontal and bilateral parietal craniectomy and expansive reconstructive cranioplasty, status post bilateral parietal-temporal and occipital craniectomy with expansive reconstructive cranioplasty and barrel-stave osteotomy Operative Method Cranioplasty with fronto-orbital advancement 1. Neurosurgical part: Craniectomy and cranioplasty of the frontal, perietal bones, and supraorbital bar. 2. plastic surgery part: Craniofacial correction with fronto-orbital advancement, anterior calvarial reconstruction, and scar trimming Specimen Count And Types Nil Pathology Nil Operative Findings 1. A small dural defect with CSF leakage was noted at right high frontal area while removing the bone flap, and repaired with 4-0 Prolene and augmented with DuraGen. 1. Marked adhesion between the skull, periosteum, and dura due to previous surgery. that a small dural defect with CSF leakage was noted at left high frontal area while removing the bone flap. It was repaired with 4-0 Prolene and augmented with DuraGen. 2. The head shape was abnormal due to her Apert syndrome. The head was tower in shape, and her sphenoid ridge was narrow. There was temporal bossing and the temporal was fossa was abnormally increased in the verticel dimension. 3.The olfactory grrove was steep down. 4. There were many bony defect between the skull plates due to previous surgery. 2. Severe adhesion between dura, periosteum and the bone. 3. Status post cranioplasty with several skull bone defect was found. The fronto-orbital bone was flat and was advanced to for reconstruction. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position. After scrubbing, disinfection & draping in sterile fashion (with face exposed), a curvilinear bicoronal incision was made at fronto-parietal junction along the previous wound scar. The scar was trimmed off. Subgaleal dissection to free the scalp flap was performed, the scalp was then reflected towards the face. The periosteum was dissected off the skull bone and dural surface in between the bony gaps. Bilateral frontal craniectomy was performed, and another band of frontal bone at the supra-orbital region was removed by reciprocal saw along with the superior orbital rims with air-drill (the supraorbital bar). The supraorbital bar was then advanced forward about 2cm and then fixed to midface at mideline (naso-frontal junction), bilateral temporal area and bilateral fronto-zygomatic junctions with absorbable plates. The other bone grafts (from frontal and parietal bones) were re-shaped and placed at the frontal and parietal area with fixation to surrouding skull bone with absorbable plate and 4-0 Vicryl. Bilateral temporal muscles were sutured to the temporal area. After hemostasis and N/S irrigation, one CWV drainage tube was inserted. The periosteum was then covered back to the bone and bone gap. The scalp wound was then closed in layers. Operators AP 郭夢菲, VS 謝孟祥 Assistants R5 游彥辰, R4 王奐之, R4 趙崧荃, R3 李維棠, Int李念霖 徐美玲 (F,1960/09/01,51y6m) 手術日期 2011/12/13 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Neurilemmoma 器械術式 Benign intraspinal tumor, exci 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 李嘉哲, 時間資訊 00:00 臨時手術NPO 07:55 進入手術室 08:05 麻醉開始 08:10 抗生素給藥 08:15 誘導結束 08:51 手術開始 11:10 抗生素給藥 13:10 手術結束 13:10 麻醉結束 13:20 送出病患 13:25 進入恢復室 14:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 手術 良性脊髓腫瘤切除術 1 1 摘要__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 曾峰毅 開立時間: 2011/12/13 13:07 Pre-operative Diagnosis Intraspinal tumor, T12 to L2 Post-operative Diagnosis Intraspinal intradural extramedullar tumor, from T12 to L2, arising from left L1 root, suspected schwannoma Operative Method T12 to L2 laminoplasty for intradural tumor excision Specimen Count And Types Several fragments of one tumor was sent for pathology. Pathology Pending Operative Findings One hypervascular, capsulated, yellowish intradural extramedullary tumor was noted from T12 to L2, arising from left L1 root. Turmo expanded intraspnial canal, invading dura at doral side, causing dura defect at bialteral L1/2 neural foramen and dorsal duat at L1/2. There was no SSEP or MEP change during the operation. One hypervascular, capsulated, yellowish intradural extramedullary tumor was noted from T12 to L2, arising from left L1 root. Turmo expanded intraspnial canal, invading dura at doral side, causing dura defect at bialteral L1/2 neural foramen and dorsal duat at L1/2, and extended to epidural space through the dura defect. There was no SSEP or MEP change during the operation. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After C-arm localization, we scrubbed, disinfected, and then draped the patient. We made one midline skin incision, and dissected paraspinous muscle to expose bilateral laminae from T11 to L3. Laminotomy was performed with air-drill from T12 to L2. Durotomy was performed. Tumor excision was performed in piecemeal with dissector, CUSA, and tumor forceps. Duroplasty was performed with water-tight fashion and artificial dura. Bone graft was fixed back with mini-plates. The wound was closed in layers after one submuscular CWV. Operators VS 賴達明 Assistants R5 曾峰毅 R1 李嘉哲 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Lumbar Laminectomy (and/or Posterior Fusion) 開立醫師: 李嘉哲 開立時間: 2011/12/14 10:03 Pre-operative Diagnosis Intraspinal tumor, T12 to L2 Post-operative Diagnosis Intraspinal intradural extramedullar tumor, from T12 to L2, arising from left L1 root, suspected schwannoma Operative Method T12 to L2 laminoplasty for intradural tumor excision Specimen Count And Types Several fragments of one tumor was sent for pathology. Pathology Pending Operative Findings One hypervascular, capsulated, yellowish intradural extramedullary tumor was noted from T12 to L2, arising from left L1 root. Turmo expanded intraspnial canal, invading dura at doral side, causing dura defect at bialteral L1/2 neural foramen and dorsal duat at L1/2, and extended to epidural space through the dura defect. There was no SSEP or MEP change during the operation. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position. After C-arm localization, we scrubbed, disinfected, and then draped the patient. We made one midline skin incision, and dissected paraspinous muscle to expose bilateral laminae from T11 to L3. Laminotomy was performed with air-drill from T12 to L2. Durotomy was performed. Tumor excision was performed in piecemeal with dissector, CUSA, and tumor forceps. Duroplasty was performed with water-tight fashion and artificial dura. Bone graft was fixed back with mini-plates. The wound was closed in layers after one submuscular CWV. Operators VS 賴達明 Assistants R5 曾峰毅 R1 李嘉哲 相關圖片 王旺 (M,1929/04/02,82y11m) 手術日期 2011/12/13 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Radiculopathy 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李嘉哲, 時間資訊 00:00 臨時手術NPO 13:40 進入手術室 13:45 麻醉開始 13:55 誘導結束 14:05 抗生素給藥 14:09 手術開始 16:30 手術結束 16:30 麻醉結束 16:35 送出病患 16:40 進入恢復室 18:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 手術 椎弓切除術(減壓)-超過二節 1 1 摘要__ 手術科部: 外科部 套用罐頭: Laminoplasty 開立醫師: 曾峰毅 開立時間: 2011/12/13 16:12 Pre-operative Diagnosis Cervical stenosis, C5-7 Post-operative Diagnosis Cervical stenosis, C5-7 Operative Method Laminectomy, C5 to upper C7 Specimen Count And Types nil Pathology Nil Operative Findings Hypertrophic ligamentum flavum compromised the thecal sac and bilateral neural foramens of C6/7 tightly. The neural structures were decompressed well after the surgery. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position with head fixed by Mayfield head clamp. We shaved, scrubbed, disinfected the neck, and made one midline skin incision. We dissected bilateral paraspinous muscle to expose laminae from C5-7. C5 to upper C7 laminectomy was performed with rongeur and Karrison. After placing one submuscular CWV, the wound was closed in layers. Operators VS 賴達明 Assistants R5 曾峰毅 R1 李嘉哲 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Laminoplasty 開立醫師: 李嘉哲 開立時間: 2011/12/14 10:58 Pre-operative Diagnosis Cervical stenosis, C5-7 Post-operative Diagnosis Cervical stenosis, C5-7 Operative Method Laminectomy, C5 to upper C7 Specimen Count And Types nil Pathology Nil Operative Findings Hypertrophic ligamentum flavum compromised the thecal sac and bilateral neural foramens of C6/7 tightly. The neural structures were decompressed well after the surgery. Operative Procedures With endotracheal general anaesthesia, the patient was put in prone position with head fixed by Mayfield head clamp. We shaved, scrubbed, disinfected the neck, and made one midline skin incision. We dissected bilateral paraspinous muscle to expose laminae from C5-7. C5 to upper C7 laminectomy was performed with rongeur and Karrison. After placing one submuscular CWV, the wound was closed in layers. Operators VS 賴達明 Assistants R5 曾峰毅 R1 李嘉哲 相關圖片 陳朝明 (M,1956/04/30,55y10m) 手術日期 2011/12/13 手術主治醫師 賴達明 手術區域 東址 005房 02號 診斷 Lumbar spondylosis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 12:24 進入手術室 12:25 麻醉開始 12:30 誘導結束 12:40 抗生素給藥 13:33 手術開始 16:10 手術結束 16:10 麻醉結束 16:15 送出病患 16:20 進入恢復室 17:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎間盤切除術-腰椎 1 2 摘要__ 手術科部: 外科部 套用罐頭: L4 laminectomy and sublaminal decompression; ... 開立醫師: 林哲光 開立時間: 2011/12/13 16:32 Pre-operative Diagnosis L4-5 spondylolisthesis Post-operative Diagnosis L4-5 spondylolisthesis Operative Method L4 laminectomy and sublaminal decompression; L4-5 discectomy and posterior fusion with cage and TPS Specimen Count And Types nil Pathology Nil Operative Findings Hypertrophic change of bilateral facet joints and ligamentum flavum was noted. The dura sac seemed reexpanded well after decompression. Four TPS 45mmx6.5mm and two 5cm rods were applied for posterior fusion. 11mm cage was inserted. Operative Procedures Under ETGA and prone position, skin disinfected and drapped were performed as usaul. Midline skin incision was made after C-arm localization for L4 and L5 transverse process. Paraspinal muscles were detached and TPS were applied and checked with C-arm. Right L4 laminotomy for sublaminal decompression was done and L4/5 discectomy was done. The cage was then inserted. Lateral fusion was done and Gelfoam packing was done. The wound was then closed in layers after a epidural H/V insertion. Operators 賴達明 Assistants 林哲光 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: L4 laminectomy and sublaminal decompression; ... 開立醫師: 林哲光 開立時間: 2011/12/13 16:32 Pre-operative Diagnosis L4-5 spondylolisthesis Post-operative Diagnosis L4-5 spondylolisthesis Operative Method L4 laminectomy and sublaminal decompression; L4-5 discectomy and posterior fusion with cage and TPS Specimen Count And Types nil Pathology Nil Operative Findings Hypertrophic change of bilateral facet joints and ligamentum flavum was noted. The dura sac seemed reexpanded well after decompression. Four TPS 45mmx6.5mm and two 5cm rods were applied for posterior fusion. 11mm cage was inserted. Operative Procedures Under ETGA and prone position, skin disinfected and drapped were performed as usaul. Midline skin incision was made after C-arm localization for L4 and L5 transverse process. Paraspinal muscles were detached and TPS were applied and checked with C-arm. Right L4 laminotomy for sublaminal decompression was done and L4/5 discectomy was done. The cage was then inserted. Lateral fusion was done and Gelfoam packing was done. The wound was then closed in layers after a epidural H/V insertion. Operators 賴達明 Assistants 林哲光 相關圖片 史志明 (F,1948/11/19,63y3m) 手術日期 2011/12/13 手術主治醫師 賴達明 手術區域 東址 005房 03號 診斷 Cervical Spondylosis 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 15:52 報到 16:32 進入手術室 16:38 麻醉開始 16:45 誘導結束 16:55 抗生素給藥 17:17 手術開始 21:15 手術結束 21:15 麻醉結束 21:25 送出病患 21:28 進入恢復室 23:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-頸椎 1 1 手術 脊椎融合術-前融合,有固定物)≦四節 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: C6-7 discectomy, removal of PLL and anterior ... 開立醫師: 林哲光 開立時間: 2011/12/13 21:46 Pre-operative Diagnosis C6-7 ruptured disc Post-operative Diagnosis C6-7 HIVD and OPLL Operative Method C6-7 discectomy, removal of PLL and anterior fusion with cage Specimen Count And Types nil Pathology Nil Operative Findings Decreased height of C6-7 intervertebral space was noted. Ruptured disc with posterior bulging and compressing the spinal cord tightly. Ossification of PLL and dura was noted and dura tear with CSF leakage was noted after PLL removal. Durafoam for dura repair and reinforcement with Tissu-cul-do was done and no obvious CSF leakage was noted after cage insertion. 7mm cage was inserted into C6-7 level. Operative Procedures Under ETGA and supine position with head mild extended, skin disinfected and drapped were performed as usual. Transverse skin incision was made at cricoid cartilage level. The plane medial to SCM was opened and the plane between carotid artery and esophagus was then dissected. The prevertebral fascia was opened and C6-7 level was localized by C-arm. Retractor was set fo expose C6-7 disc level well. C6-7 discectomy was then performed and removal of PLL was done. Uncinate process were opened with high speed drill. Dura repair with Durafoam and reinforcement with Tissu-cul-do was done. Cage was then inserted. The wound was then closed in layers after a mini-H/V was set at prevertebral area. Operators 賴達明 Assistants 林哲光 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: C6-7 discectomy, removal of PLL and anterior ... 開立醫師: 林哲光 開立時間: 2011/12/13 21:46 Pre-operative Diagnosis C6-7 ruptured disc Post-operative Diagnosis C6-7 HIVD and OPLL Operative Method C6-7 discectomy, removal of PLL and anterior fusion with cage Specimen Count And Types nil Pathology Nil Operative Findings Decreased height of C6-7 intervertebral space was noted. Ruptured disc with posterior bulging and compressing the spinal cord tightly. Ossification of PLL and dura was noted and dura tear with CSF leakage was noted after PLL removal. Durafoam for dura repair and reinforcement with Tissu-cul-do was done and no obvious CSF leakage was noted after cage insertion. 7mm cage was inserted into C6-7 level. Operative Procedures Under ETGA and supine position with head mild extended, skin disinfected and drapped were performed as usual. Transverse skin incision was made at cricoid cartilage level. The plane medial to SCM was opened and the plane between carotid artery and esophagus was then dissected. The prevertebral fascia was opened and C6-7 level was localized by C-arm. Retractor was set fo expose C6-7 disc level well. C6-7 discectomy was then performed and removal of PLL was done. Uncinate process were opened with high speed drill. Dura repair with Durafoam and reinforcement with Tissu-cul-do was done. Cage was then inserted. The wound was then closed in layers after a mini-H/V was set at prevertebral area. Operators 賴達明 Assistants 林哲光 相關圖片 林文雄 (M,1940/03/17,71y11m) 手術日期 2011/12/13 手術主治醫師 賴達明 手術區域 西址 039房 01號 診斷 Carpal tunnel syndrome 器械術式 Neurolysis of the uluar neuve 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 09:10 報到 10:00 進入手術室 10:12 麻醉開始 10:13 誘導結束 10:15 手術開始 11:00 麻醉結束 11:00 手術結束 11:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 正中神經或尺神經腕部減壓術–單側 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Neurolyssi for median nerve decompression, ri... 開立醫師: 曾偉倫 開立時間: 2011/12/13 11:10 Pre-operative Diagnosis Carpal tunnel syndrome, right hand Post-operative Diagnosis Carpal tunnel syndrome, right hand Operative Method Neurolyssi for median nerve decompression, right hand Specimen Count And Types nil Pathology Nil. Operative Findings 1. The median nerver was compressed with flexor retinaculum and transverse carpal ligament 2. The median nerve was fully released after the procedure 3. The finger movement was well after the operation Operative Procedures 1.The right hand and forearm were sterilized with povidone-iodine tincture, then covered with stockinet. 2.Anesthesia: Regional block with 15 ml 1% Xylocaine solution was infused through cephalic vein catheter at wrist area. 3. Incision: linear skin incison from vertical palmar crease to transverse wrist crease. 4.The palmaris longus tendon was identified, then the plamar aponeurosis was cut longitidinally along the ulnar side of the palmaris longus tendon. 5. The median nerve was identified beneath the palmars longus tendon. Under direct vision, the transverse carpal ligament was divided until no more pressure on the median nerve could be palpated. 6. The skin was closed by interrupted suture with 4/0 nylon. 7. The hand and wrist were draped with fluffy dressing and elastic bandage. Operators VS 賴達明 Assistants R5 李振豪 R3 曾偉倫 相關圖片 鄭春為 (M,1939/04/12,72y11m) 手術日期 2011/12/13 手術主治醫師 林峰盛 手術區域 西址 035房 12號 診斷 Lumbar spine fracture 器械術式 Nerve block / PC 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 神經阻斷 麻醉主治醫師 林峰盛 ASA 3 紀錄醫師 林健華, 時間資訊 17:50 進入手術室 17:52 麻醉開始 17:55 誘導結束 18:00 手術開始 18:15 手術結束 18:15 麻醉結束 18:20 送出病患 18:25 進入恢復室 19:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 手術 傳導麻醉－神經叢阻斷術 1 0 R 記錄__ 手術科部: 麻醉部 套用罐頭: Pulsed RF 開立醫師: 林健華 開立時間: 2011/12/13 18:20 Pre-operative Diagnosis right thigh pain , susp. Radiculopathy, r/o spinal cord injury Post-operative Diagnosis right thigh pain , susp. Radiculopathy, r/o spinal cord Operative Method root block Specimen Count And Types nil Pathology Nil Operative Findings Operative Procedures 1. LA with liodocaine 2. pt in prone position 3. Under fluoroscopic-guidance, insert 23 G Spinal meedle into right L2 neuroforamen 4. daignostic block with 0.25% Marcaine 6 ml Operators 林峰盛, Assistants 林健華, 李忠錦 (M,1946/02/06,66y1m) 手術日期 2011/12/13 手術主治醫師 楊士弘 手術區域 東址 001房 02號 診斷 Spinal metastasis 器械術式 Malignant intraspinal tumor, e，Spinal fusion posterior 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 09:56 報到 10:12 進入手術室 10:20 麻醉開始 10:40 誘導結束 11:05 抗生素給藥 11:25 手術開始 12:50 開始輸血 14:25 手術結束 14:25 麻醉結束 14:35 送出病患 14:40 進入恢復室 15:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 惡性脊髓腫瘤切除術 1 1 手術 脊椎融合術-後融合,有固定物(<=六節) 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 內科部 套用罐頭: 1. T12 laminectomy and left pediculectomy for... 開立醫師: 楊士弘 開立時間: 2011/12/13 14:47 Pre-operative Diagnosis Metastatic T12 vertebral and epidural tumor with spinal cord compression Post-operative Diagnosis Metastatic T12 vertebral and epidural tumor with spinal cord compression Operative Method 1. T12 laminectomy and left pediculectomy for tumor excision 2. Posterior fixation with transpedicle screws and rods from T11 to L1, and posterior fusion Specimen Count And Types 1 piece About size:小 Source:T12 vertebral epidural tumor Pathology pending Operative Findings The left T12 pedicle was softened and filled with greyish red, hypervascular tumor, which extended to the posterior epidural space and compressed the thecal sac and left T12 root. The thecal sac and roots were free from compression after decompression. Operative Procedures 1. ETGA, prone. 2. Midline skin incision over back, from T11 to L1. 3. Dissection of paravertebral muscles off spinous processes and lamina. 4. T12 laminectomy and left pediculectomy. 5. Dissection and excision of epidural tumor from the surface of thecal sac and left T12 root. 6. Insertion of 5 pedicule screws, 40 mm x 6.0 mm, into bilateral T11 and L1, and right T12. 7. Two rods, 9 cm each, for briding the screws on each side. 8. One cross-link to bridge the rods. 9. Two HV drains. 10. Wound closure in layers. Operators 楊士弘 Assistants 鍾文桂,曾偉倫 Indication Of Emergent Operation 相關圖片 記錄__ 手術科部: 內科部 套用罐頭: 1. T12 laminectomy and left pediculectomy for... 開立醫師: 曾偉倫 開立時間: 2011/12/13 14:55 Pre-operative Diagnosis Metastatic T12 vertebral and epidural tumor with spinal cord compression Post-operative Diagnosis Metastatic T12 vertebral and epidural tumor with spinal cord compression Operative Method 1. T12 laminectomy and left pediculectomy for tumor excision 2. Posterior fixation with transpedicle screws and rods from T11 to L1, and posterior fusion Specimen Count And Types 1 piece About size:小 Source:T12 vertebral epidural tumor Pathology pending Operative Findings The left T12 pedicle was softened and filled with greyish red, hypervascular tumor, which extended to the posterior epidural space and compressed the thecal sac and left T12 root. The thecal sac and roots were free from compression after decompression. Operative Procedures 1. ETGA, prone. 2. Midline skin incision over back, from T11 to L1. 3. Dissection of paravertebral muscles off spinous processes and lamina. 4. T12 laminectomy and left pediculectomy. 5. Dissection and excision of epidural tumor from the surface of thecal sac and left T12 root. 6. Insertion of 5 pedicule screws, 40 mm x 6.0 mm, into bilateral T11 and L1, and right T12. 7. Two rods, 9 cm each, for briding the screws on each side. 8. One cross-link to bridge the rods. 9. Two HV drains. 10. Wound closure in layers. Operators 楊士弘 Assistants 鍾文桂,曾偉倫 Indication Of Emergent Operation Leg weakness with cord compression 相關圖片 徐銘夆 (M,1982/12/05,29y3m) 手術日期 2011/12/13 手術主治醫師 林峰盛 手術區域 西址 035房 10號 診斷 Failed back syndrome 器械術式 Nerve block / PC 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 林峰盛 ASA 1 時間資訊 16:15 進入手術室 16:25 麻醉開始 16:28 誘導結束 16:30 手術開始 17:15 手術結束 17:15 麻醉結束 17:20 送出病患 17:25 進入恢復室 18:48 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 高頻熱凝療法 1 1 R 記錄__ 手術科部: 麻醉部 套用罐頭: Pulsed RF 開立醫師: 林健華 開立時間: 2011/12/13 17:16 Pre-operative Diagnosis Failed back syndrome Post-operative Diagnosis Failed back syndrome Operative Method Pulsed RF Specimen Count And Types nil Pathology Nil Operative Findings Operative Procedures 1. IV sedation with midazolam and LA with 1% xylocaine 2. pt in prone position 3. Under fluoroscopic-guidance, insert 22 G SMK RF meedle into neuroforamen 4. Neurostimulation with 50 HZ and 2 Hz 0.1-0.5 mV current with positive result 60-80V 2 Hz, 20 ms, 120sec *2 pulsed RF was delivered to right L2 & L5, RF lesion to right medial branch of L2, 3, 4, 5 send pt to POR Operators 林峰盛, Assistants 林健華, 卓麗珍 (F,1961/11/27,50y3m) 手術日期 2011/12/14 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Aneurysm 器械術式 Craniotomy(Aneurysms) P-DUH 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 08:03 進入手術室 08:10 麻醉開始 08:30 誘導結束 08:40 抗生素給藥 08:45 手術開始 11:08 開始輸血 11:40 抗生素給藥 13:35 手術結束 13:35 麻醉結束 13:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 開顱術摘除血管病變 - 腦血管瘤 無病徵的 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Aneurysm-frontotemporal approach 開立醫師: 曾峰毅 開立時間: 2011/12/14 13:15 Pre-operative Diagnosis Anterior communicating artery aneurysm, status post coiling, recurrent Post-operative Diagnosis Anterior communicating artery aneurysm, status post coiling, recurrent Operative Method Left pterional approach for aneurysm clip Specimen Count And Types Nil Pathology Nil Operative Findings There is dominant left A1 and hypoplastic right A1. Aneurysm arised from the junction of left A1 and anterior communicating artery, pointing superiorly and posteriorly. Previous inserted coil was noted penetrating through the aneurysm dome. The aneurysm was clipped by one side-curved Sugita clip. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to right and fixed with Mayfield head clamp. We shaved, scrubbed, disinfected, and then draped the scalp as usual. We made one curvilinear skin incision at right frontotemporal area. Temporalis muscle was detached, and three burr holes were drilled. One 4x6 cm craniotomy was performed. Durotomy was done in curvilinear shape. CSF was drained from pre-chiasmatic citern to make brain slack. We traced left optic nerve to identify the aneurysm, and dissected the aneurysm neck. Aneurysm was clipped under temporary proximal control. Duroplasty was performed in water-tight suture. Bone graft was fixed back with mini-plates. The wound was closed in layers. Operators Prof. 杜永光 Assistants R5 曾峰毅 R3 陳國瑋 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Aneurysm-frontotemporal approach 開立醫師: 陳國瑋 開立時間: 2011/12/14 13:56 Pre-operative Diagnosis Anterior communicating artery aneurysm, status post coiling, recurrent Post-operative Diagnosis Anterior communicating artery aneurysm, status post coiling, recurrent Operative Method Left pterional approach for aneurysm clip Specimen Count And Types Nil Pathology Nil Operative Findings There is dominant left A1 and hypoplastic right A1. Aneurysm arised from the junction of left A1 and anterior communicating artery, pointing superiorly and posteriorly. Previous inserted coil was noted penetrating through the aneurysm dome. The aneurysm was clipped by one side-curved Sugita clip. The SSEP remained unchanged through the whole procedure. First temporary clamp of left A1: 2 minutes 09 seconds, reperfusion 6 minutes, second temporary clamp 4 minutes 10 seconds, reperfusion 4 mininutes 10seconds, third clamp 3minutes 4seconds. Operative Procedures With endotracheal general anaesthesia, the patient was put in supine position with head rotated to right for 45 degrees and fixed with Mayfield head clamp. We shaved, scrubbed, disinfected, and then draped the scalp as usual. We made one curvilinear skin incision at right frontotemporal area. Temporalis muscle was detached, and three burr holes were drilled. One 4x6 cm craniotomy was performed. Durotomy was done in curvilinear shape. CSF was drained from pre-chiasmatic citern to make brain slack. We traced left optic nerve to identify the aneurysm, and dissected the aneurysm neck. Aneurysm was clipped under temporary proximal control. Duroplasty was performed in water-tight suture. Bone graft was fixed back with mini-plates. The wound was closed in layers. Operators Prof. 杜永光 Assistants R5 曾峰毅 R3 陳國瑋 相關圖片 王燕珍 (F,1954/08/26,57y6m) 手術日期 2011/12/14 手術主治醫師 杜永光 手術區域 東址 005房 01號 診斷 Pituitary Tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:05 進入手術室 08:10 麻醉開始 08:20 誘導結束 09:05 抗生素給藥 09:15 手術開始 12:05 抗生素給藥 12:35 麻醉結束 12:35 手術結束 12:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 經由蝶竇之腦下垂體瘤切除 1 1 記錄__ 手術科部: 外科部 套用罐頭: Endoscopic trans-nasal trans-sphenoidal adeno... 開立醫師: 李振豪 開立時間: 2011/12/14 13:27 Pre-operative Diagnosis Pituitary macroadenoma Post-operative Diagnosis Pituitary macroadenoma Operative Method Endoscopic trans-nasal trans-sphenoidal adenomectomy Specimen Count And Types 1 piece About size:Multiple pieces Source:Pituitary tumor Pathology pending Operative Findings The sellar floor was eroded by the tumor and easily opened by dissector. The tumor was 2.0 x 2.6 x 1.8 cm in size, red-whitish in color, soft to elastic, well-capsulated, and hypervascularized in character. After central debulking of the tumor, the tumor was dissected and removed along the capsule. The arachnoid pouch was noted without significant defect but the CSF leakage occurred. The sellar area was checked with 30 degree endoscope. The sellar area was then packing with Gelfoam, Surgicel, and sealed with Tissucol Duo to avoid further CSF leakage. Lumbar drain also placed at the end of the operation. The patient stood whole procedure well. The sellar floor was eroded by the tumor and easily opened by dissector. The tumor was 2.0 x 2.6 x 1.8 cm in size, red-whitish in color, soft to elastic, well-capsulated, and hypervascularized in character. After central debulking of the tumor, the tumor was dissected and removed along the capsule. The arachnoid pouch was noted without obvious defect but the CSF leakage occurred. A thin layer of reddish soft tissue was found at posterior part of the cavity which normal gland was favored. The sellar area was checked with 30 degree endoscope. The sellar area was then packing with Gelfoam, Surgicel, and sealed with Tissucol Duo to avoid further CSF leakage. Lumbar drain also placed at the end of the operation. The patient stood whole procedure well. No VEP change was noted during whole procedure. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position. Bilateral nasal cavity was packing with Xylocaine + Bosmine solution soaked gauze for 10 minutes. The skin, nasal cavity, and oral cavity was disinfected and draped as usual. Under operative endoscope, bilateral middle turbinate was fractured and pushed laterally. The nasal mucosa below the ostium was coagulated and opened. The vomer bone and floor of sphenois sinus were drilled with Midas high speed air-drived drill. The sphenoid sinus was opened and the mucosa was removed. The floor of sellar turcica was opened with Kerrison punches and dissector. The dura was coagulated with bipolar electrocautery and cruciform durotomy was conducted. The tumor bulging out immediately after durotomy. The tumor was removed with ring curette, suction, tumor forceps, and alligator. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. The sellar turcica was packing with Gelfoam, Surgicel, and sealed with Tissucol Duo to avoid further CSF leakage. Bilateral middle turbinate was pushed back to its neutral position. Bilateral nasal cavities were tightly packed with two segment of rubber glove finger filled with gauze strips each side which had been soaked with better-iodine ointment. Lumbar drain was placed also for treatment of CSF leakage. Operators Prof.杜永光, VS楊士弘 Assistants R5李振豪, PGY劉明侑 相關圖片 黃能忠 (M,1954/09/12,57y6m) 手術日期 2011/12/14 手術主治醫師 李章銘 手術區域 東址 019房 01號 診斷 Esophageal cancer 器械術式 Ivor-LewisVATS Esophagectomy+Total ScopyGastrectube reconstruction 手術類別 預定手術 手術部位 胸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 3 紀錄醫師 郝政鴻, 廖先啟, 時間資訊 08:05 進入手術室 08:10 麻醉開始 08:45 誘導結束 09:05 抗生素給藥 09:30 手術開始 12:05 抗生素給藥 14:14 15:05 抗生素給藥 18:05 抗生素給藥 19:35 麻醉結束 19:35 手術結束 19:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 術後止痛 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 15 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 食道再造術–以胃管重建 1 2 R 手術 胸腔鏡食道切除術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: 1. Video assisted thorcoscopic transthoracic ... 開立醫師: 廖先啟 開立時間: 2011/12/14 20:23 Pre-operative Diagnosis Esophageal cancer, SCC, middle third, s/p CCRT Post-operative Diagnosis Esophageal cancer, SCC, middle third, s/p CCRT Operative Method 1. Video assisted thorcoscopic transthoracic subtotal esophagectomy and total laparoscopic gastric tube reconstruction. (Ivor-Lewis) 2. Laparoscopic jejunostomy. Specimen Count And Types 7 piece Source: esophagus and lymph nodes Pathology Pending Operative Findings 1. Tumor located at middle 1/3 of the esophagus, with mild mucosa thickening. 2. Two previous clips localization was found. 3. Frozen: margin without malignancy involved 4. Botox injecton over pylorus area. 5. Mild adhesion over abdominal cavity. Operative Procedures 1. ETGA, supine with lithotomy position. 2. Skin disinfection then drapped as sterile. Left side chest tube 24# insertion. 3. Four abdominal working ports setting as usual. 4. Mobilization of gastric tube by Ligasure. 5. Open the E-G junction area and crus muscle. 6. Esopagectomy at stomach body site 7. Suture connection of the gastric tube to esophagus stump. 8. Inserted the gastric tube into thoracic cavity via hitus 9. Create left jejunostomy via puncture method, 10.Set two rubber drains: left subphrenic area and right hepatic area. 11.Close wound in layers then start thoracic stage 12.Left decubitus position, skin disinfection then drapped. 13.Four VATS working ports setting as usual. 14.Divid axygus vein with endo-GIA stapler. Mobilize the esophagus till azygus vein level. 15.Gr.106, 107 LNs dissection. 16.VATS esopagectomy, above tumor 5cm. 17.VATS end-to-side gastroesophagectomy via CEEA staple(OraVil 25mm) 17.VATS end-to-side gastroesophagectomy via CEEA staple(OraVil 21mm) 18.BI irrigation and warm normal saline 3000 ml irrigation. 21.Set one 28# chest tube, close wound in layers. Operators VS李章銘 Assistants R4廖先啟，R4郝政鴻，Ri陳秀婷 陳思穎 (F,2003/09/04,8y6m) 手術日期 2011/12/14 手術主治醫師 曾勝弘 手術區域 兒醫 061房 01號 診斷 Aromatic L-amino acid decarboxylase deficiency 器械術式 AADC deficiency gene therapy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 4 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:08 進入手術室 08:18 麻醉開始 09:15 誘導結束 09:35 抗生素給藥 09:40 手術開始 12:35 抗生素給藥 12:45 16:00 抗生素給藥 18:10 麻醉結束 18:10 18:10 手術結束 18:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 12 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 立體定位術-功能性失調 1 1 L 手術 立體定位術-功能性失調 1 1 R 摘要__ 手術科部: 套用罐頭: Stereotactic viral vectors delivery to bilate... 開立醫師: 鍾文桂 開立時間: 2011/12/14 18:45 Pre-operative Diagnosis Aromatic L-amino acid decarboxylase deficiency Post-operative Diagnosis Aromatic L-amino acid decarboxylase deficiency Operative Method Stereotactic viral vectors delivery to bilateral putamen (for gene therapy) Specimen Count And Types nil Pathology Nil Operative Findings Adeno-associated virus was used as vector to deliver the AADC gene, 80 microliters/each were infused to 4 pre-planned spots (at anterior & posterior putamen). Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position. Total of 8 fiducials were implanted over the scalp and skull. Follow-up CT for stereotasis was done. Back to OR, her head was fixed in Mayfield skull clamp. After scrubbing, disinfection & draping with large Op Site, bilateral frontal entry points were marked with K-pin under navigation. A bicoronal incision was made across the 2 entry points, followed by creation of 2 burr holes around the entry points. After tenting stitches, small durotomies were done, and Tissucol Duo were applied to the pial surface for hemostasis. After setting up of the navigation system, puncture needle was inserted to the desired depth according to the calculation from CT images. Viral vectors were then infused via the puncture needle. The wound was then closed in layers. Operators 曾勝弘 Assistants R6 鍾文桂. 相關圖片 記錄__ 手術科部: 套用罐頭: Stereotactic viral vectors delivery to bilate... 開立醫師: 鍾文桂 開立時間: 2011/12/14 18:47 Pre-operative Diagnosis Aromatic L-amino acid decarboxylase deficiency Post-operative Diagnosis Aromatic L-amino acid decarboxylase deficiency Operative Method Stereotactic viral vectors delivery to bilateral putamen (for gene therapy) Specimen Count And Types nil Pathology Nil Operative Findings Adeno-associated virus was used as vector to deliver the AADC gene, 80 microliters/each were infused to 4 pre-planned spots (at anterior & posterior putamen). Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position. Total of 8 fiducials were implanted over the scalp and skull. Follow-up CT for stereotasis was done. Back to OR, her head was fixed in Mayfield skull clamp. After scrubbing, disinfection & draping with large Op Site, bilateral frontal entry points were marked with K-pin under navigation. A bicoronal incision was made across the 2 entry points, followed by creation of 2 burr holes around the entry points. After tenting stitches, small durotomies were done, and Tissucol Duo were applied to the pial surface for hemostasis. After setting up of the navigation system, puncture needle was inserted to the desired depth according to the calculation from CT images. Viral vectors were then infused via the puncture needle. The wound was then closed in layers. Operators 曾勝弘 Assistants R6 鍾文桂. 相關圖片 李語萱 (F,2009/02/02,3y1m) 手術日期 2011/12/14 手術主治醫師 周獻堂 手術區域 東址 000房 號 診斷 Malignant neoplasm of spinal cord 器械術式 Other RAD exam/intervention 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 蔡奉芳 ASA 1 時間資訊 00:00 臨時手術NPO 08:40 麻醉開始 08:45 誘導結束 09:37 進入恢復室 09:40 麻醉結束 10:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 張簡妤真 (F,2011/09/09,6m7d) 手術日期 2011/12/14 手術主治醫師 郭夢菲 手術區域 兒醫 067房 03號 診斷 Myelomeningocele 器械術式 Debridement 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林峰盛 ASA 2E 紀錄醫師 王奐之, 時間資訊 11:00 開始NPO 11:00 臨時手術NPO 13:51 通知急診手術 17:10 報到 17:28 進入手術室 17:30 麻醉開始 17:40 誘導結束 17:57 抗生素給藥 18:05 手術開始 18:25 手術結束 18:25 麻醉結束 18:40 送出病患 18:40 進入恢復室 19:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 深部傷口處理縫合擴創-小 1 0 摘要__ 手術科部: 外科部 套用罐頭: Debridement & primary closure 開立醫師: 王奐之 開立時間: 2011/12/14 18:35 Pre-operative Diagnosis Poor wound healing Post-operative Diagnosis Poor wound healing Operative Method Debridement & primary closure Specimen Count And Types 1 piece About size:3*1*0.5cm Source:debrided tissue Pathology Nil Operative Findings Poorly healed wound was noted along previous surgical scar, with granulation tissue formation and non-epithelization. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position. After scrubbing, disinfection & draping in sterile fashion, a fusiform incision was made around the wound. The skin was removed along with the soft tissue underneath. The subcutaneous layer was undermined for tension release, and the wound was closed with 3-0 Vicryl continuous suture & 3-0 Nylon interrupted sutures. Operators AP 郭夢菲 Assistants R4 王奐之 Indication Of Emergent Operation Poor wound healing with suspected wound infection 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Debridement & primary closure 開立醫師: 王奐之 開立時間: 2011/12/14 18:35 Pre-operative Diagnosis Poor wound healing Post-operative Diagnosis Poor wound healing Operative Method Debridement & primary closure Specimen Count And Types 1 piece About size:3*1*0.5cm Source:debrided tissue Pathology Nil Operative Findings Poorly healed wound was noted along previous surgical scar, with granulation tissue formation and non-epithelization. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position. After scrubbing, disinfection & draping in sterile fashion, a fusiform incision was made around the wound. The skin was removed along with the soft tissue underneath. The subcutaneous layer was undermined for tension release, and the wound was closed with 3-0 Vicryl continuous suture & 3-0 Nylon interrupted sutures. Operators AP 郭夢菲 Assistants R4 王奐之 Indication Of Emergent Operation Poor wound healing with suspected wound infection 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Debridement & primary closure 開立醫師: 郭夢菲 開立時間: 2011/12/15 10:41 Pre-operative Diagnosis Poor wound healing Post-operative Diagnosis Poor wound healing Operative Method Debridement & primary closure Specimen Count And Types 1 piece About size:3*1*0.5cm Source:debrided tissue Pathology Nil Operative Findings Poorly healed wound was noted along the upper part of previous surgical scar, with granulation tissue formation and non-epithelization on the epidermal layer. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position. After scrubbing, disinfection & draping in sterile fashion, a fusiform incision was made around the wound. The skin was removed along with the soft tissue underneath. The subcutaneous layer was undermined for tension release, and the wound was closed with 3-0 Vicryl continuous suture & 3-0 Nylon interrupted sutures. Operators AP 郭夢菲 Assistants R4 王奐之 Indication Of Emergent Operation 相關圖片 施彩羚 (F,2011/12/01,3m14d) 手術日期 2011/12/14 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Myelomeningocele 器械術式 Excision & repair of myelomeningocele 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 2 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:08 進入手術室 08:20 麻醉開始 09:00 抗生素給藥 09:10 誘導結束 09:40 手術開始 11:55 麻醉結束 11:55 手術結束 12:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 脊椎內脊髓內腫瘤切除術 1 1 手術 腦膜或脊突出修補術 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: Reduction of nerve tissue, resection of cyst ... 開立醫師: 王奐之 開立時間: 2011/12/14 12:35 Pre-operative Diagnosis Lipomyelocystocele Post-operative Diagnosis Lipomyelocystocele Operative Method Lipomyelocystocele resection & repair Specimen Count And Types 1 piece About size:3*3*0.2cm Source:lipomyelocystocele wall Pathology Pending Operative Findings Intact skin was noted overlying the cystocele. Nerve tissue & fat tissue were contained in the cystocele, but seated in separated pouches with slight rotating fashion (nerve on the right and fat on the left). Estimated blood loss: minimal. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position. After scrubbing, disinfection & draping in sterile fashion, a midline linear incision was made over the mass. The skin was then undermined to expose the outermost layer of the surrounding soft tissue. Operating microscope was then brought into the surgical field, and careful dissection around the cystocele was carried out. After dissection of the cystocele to the orifice, the cyst wall was cut open for CSF release. The nerve tissue was reduced back into the thecal sac, and the redundant cyst wall was resected. After closure of the cyst wall for dural repair with Prolene sutures in water tight fashion, the wound was closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Reduction of nerve tissue, resection of cyst ... 開立醫師: 王奐之 開立時間: 2011/12/14 12:35 Pre-operative Diagnosis Lipomyelocystocele Post-operative Diagnosis Lipomyelocystocele Operative Method Lipomyelocystocele resection & repair Specimen Count And Types 1 piece About size:3*3*0.2cm Source:lipomyelocystocele wall Pathology Pending Operative Findings Intact skin was noted overlying the cystocele. Nerve tissue & fat tissue were contained in the cystocele, but seated in separated pouches with slight rotating fashion (nerve on the right and fat on the left). Estimated blood loss: minimal. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position. After scrubbing, disinfection & draping in sterile fashion, a midline linear incision was made over the mass. The skin was then undermined to expose the outermost layer of the surrounding soft tissue. Operating microscope was then brought into the surgical field, and careful dissection around the cystocele was carried out. After dissection of the cystocele to the orifice, the cyst wall was cut open for CSF release. The nerve tissue was reduced back into the thecal sac, and the redundant cyst wall was resected. After closure of the cyst wall for dural repair with Prolene sutures in water tight fashion, the wound was closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Lipomyelocystocele resection (untethering), e... 開立醫師: 郭夢菲 開立時間: 2011/12/15 10:51 Pre-operative Diagnosis Lipomyelocystocele, L5-S1 Post-operative Diagnosis Lipomyelocystocele, L5-S1 Operative Method Lipomyelocystocele resection (untethering), excision & dural repair Specimen Count And Types 1 piece About size:3*3*0.2cm Source:lipomyelocystocele wall Pathology Pending Operative Findings 1. the laminae was open at L5 level and below. 2. Intact skin was noted overlying the cystocele, which was larger than 5 cm in diameter. 3. Nerve tissue & fat tissue were contained in the cystocele and attached to the herniated meningeal wall, but seated in separated pouches with slight rotating fashion (fat on the right and nerve on the left). 4. Estimated blood loss: minimal. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position. After scrubbing, disinfection & draping in sterile fashion, a midline linear incision was made over the mass. The skin was then undermined to expose the outermost layer of the surrounding soft tissue. Operating microscope was then brought into the surgical field, and careful dissection around the cystocele was carried out. After dissection of the cystocele to the orifice at the L5-S1 level, the cyst wall was cut open for CSF release and the identification of nervous structure. The nerve tissue was detethered from the meningeal wall. The lipomatous tissue was identified and divided from the right meningeal wall, too. The residual fat and the untethered nerves was further untethered fromthe open fascia and dura. The nervous tissue wasthen reduced back into the thecal sac freely, and the redundant cyst wall was resected. After closure of the cyst wall for dural repair with 5-0 Prolene sutures in water tight fashion, the wound was closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之 相關圖片 史志明 (F,1948/11/19,63y3m) 手術日期 2011/12/14 手術主治醫師 賴達明 手術區域 東址 003房 05號 診斷 Cervical Spondylosis 器械術式 Spinal fusion posterior 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 3E 紀錄醫師 李振豪, 時間資訊 10:00 臨時手術NPO 10:00 開始NPO 20:15 報到 20:25 進入手術室 20:30 麻醉開始 20:50 誘導結束 21:00 抗生素給藥 21:34 手術開始 23:55 麻醉結束 00:01 送出病患 00:05 進入恢復室 01:20 離開恢復室 23:55 手術結束 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術(減壓)-二節以內 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 記錄__ 手術科部: 外科部 套用罐頭: C6 and C7 laminectomy for posterior decompression 開立醫師: 李振豪 開立時間: 2011/12/15 00:12 Pre-operative Diagnosis C6/7 herniated intervertebral disc and ossification of posterior longitudinal ligment, status post anterior cervical diskectomy and fusion Post-operative Diagnosis C6/7 herniated intervertebral disc and ossification of posterior longitudinal ligment, status post anterior cervical diskectomy and fusion Operative Method C6 and C7 laminectomy for posterior decompression Specimen Count And Types nil Pathology Nil Operative Findings C6 and C7 laminectomy was conducted smoothly with Midas high speed air-drived drill and curette. The thecal sac expanded well after laminectomy. No incidental durotomy or CSF leakage occurred. The C5 and T1 spinous process was fixed with one Ticron suture to avoid further kyphotic change. Total blood loss: 100ml. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position with head fixed with Mayfield skull clamp. C6/7 level was localized by portable C-arm X-ray. The scalp was shaved, scrubbed, and disinfected as usual. Midline skin incision was made and the subcutaneous soft tissue was devided. The nuchal and paravertebral muscle groups were detached to expose C6 and C7 laminae. Bilateral grooving of C6 and C7 laminae was conducted with Midas high speed air-drived drills and fractured for laminectomy. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. The C5 and T1 spinous process was fixed with one #5 Ticron. One epidural CWV drain was placed. Gentamicin solution was used for wound irrigation. The wound was then closed in layers with 1-0, 2-0 Vicryl and 3-0 Nylon. Operators VS賴達明 Assistants R5李振豪, PGY Indication Of Emergent Operation Acute deterioration of left lower limb muscle power(4 -> 1) 相關圖片 陳柏亨 (M,1954/05/08,57y10m) 手術日期 2011/12/14 手術主治醫師 賴達明 手術區域 東址 002房 01號 診斷 Intracerebral hemorrhage 器械術式 Removal of ICH 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3E 紀錄醫師 林哲光, 時間資訊 04:38 通知急診手術 05:25 進入手術室 05:30 麻醉開始 05:40 誘導結束 06:10 抗生素給藥 06:20 手術開始 09:10 抗生素給藥 10:35 手術結束 10:35 麻醉結束 10:40 送出病患 20:00 開始NPO 20:00 臨時手術NPO 醫令資訊 類別 名稱 量 刀 側 手術 腦內血腫清除術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Left parietal craniotomy for hematoma evacuation 開立醫師: 林哲光 開立時間: 2011/12/14 11:59 Pre-operative Diagnosis Left parietal lobar hemorrhage Post-operative Diagnosis Left parietal lobar hemorrhage Operative Method Left parietal craniotomy for hematoma evacuation Specimen Count And Types 1 piece About size: Source:hematoma Pathology Pending Operative Findings About 30ml intraparenchymal blood clot was noted with ruptured to brain suface after dura was opened. No obvious active bleeder was noted during the operation. The brain seemed slack after hematoma evacuation. Postoperative subdural ICP was less than 1 mmHg. Operative Procedures Under ETGA and supine position with head rotated to right side, skin disinfected and drapped were performed as usual. A reverse U-shaped skin incision was made at left parietal area. Left parietal craniotomy was done after four burr holes were created. Hematoma evacuation was done from the inferior border of left parietal lobe which hematoma was out of the brain surface. The rough surface was covered with Surgecells. The dura was then closed in water-tie method. The skull bone was put back and fixed with miniplates. The wound was then closed in layers after epidural CWV drain insertion. Operators 賴達明 Assistants 林哲光 Indication Of Emergent Operation Acute conscious change with aphasia 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Left parietal craniotomy for hematoma evacuation 開立醫師: 林哲光 開立時間: 2011/12/14 11:59 Pre-operative Diagnosis Left parietal lobar hemorrhage Post-operative Diagnosis Left parietal lobar hemorrhage Operative Method Left parietal craniotomy for hematoma evacuation Specimen Count And Types 1 piece About size: Source:hematoma Pathology Pending Operative Findings About 30ml intraparenchymal blood clot was noted with ruptured to brain suface after dura was opened. No obvious active bleeder was noted during the operation. The brain seemed slack after hematoma evacuation. Postoperative subdural ICP was less than 1 mmHg. Operative Procedures Under ETGA and supine position with head rotated to right side, skin disinfected and drapped were performed as usual. A reverse U-shaped skin incision was made at left parietal area. Left parietal craniotomy was done after four burr holes were created. Hematoma evacuation was done from the inferior border of left parietal lobe which hematoma was out of the brain surface. The rough surface was covered with Surgecells. The dura was then closed in water-tie method. The skull bone was put back and fixed with miniplates. The wound was then closed in layers after epidural CWV drain insertion. Operators 賴達明 Assistants 林哲光 Indication Of Emergent Operation Acute conscious change with aphasia 相關圖片 鄭阿守 (M,1928/08/07,83y7m) 手術日期 2011/12/14 手術主治醫師 賴達明 手術區域 東址 005房 02號 診斷 Communicating hydrocephalus 器械術式 S-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 12:35 報到 13:15 進入手術室 13:20 麻醉開始 13:30 誘導結束 13:50 抗生素給藥 14:15 手術開始 15:30 手術結束 15:30 麻醉結束 15:45 送出病患 15:47 進入恢復室 17:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室腹腔分流手術 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Subduro-peritoneal shunt implantation, left side 開立醫師: 李振豪 開立時間: 2011/12/14 15:59 Pre-operative Diagnosis Bilateral subdural collection Post-operative Diagnosis Bilateral subdural effusion Operative Method Subduro-peritoneal shunt implantation, left side Specimen Count And Types 1 piece About size:15ml Source:subdural effusion Pathology Nil Operative Findings The subdural effusion was light yellow-brownish in color with mild increase cellularity. Previous subdural hemorrahge was favored. The pressure is not high after durotomy. Total 15ml subdural effusion was sampled for routine, biochemistry, and bacterial culture. 1cmH2O Codman fixed pressure reservoir was used for subduro-peritoneal shunt. The subdural catheter and peritoneal catheter was 3cm and 25cm in length respectively. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head rotated to right and left shoulder elevation. The scalp was shaved, scrubbed, and disinfected as usual. Linear scalp incision was made at left temporal area followed by one burrhole creation. Two dural tenting was done. A small durotomy was performed with knife and subdural effusion was confirmed. the durotomy was covered with cotton to avoid air trapping. A transverse skin incision was made at LUQ of the abdomen and the subcutaneous soft tissue was devided. Minilaparotomy was conducted and the peritoneal cavity was entered. The subcutaneous tunnel was created from LUQ of the abdomen, left forechest, left neck, left retroauricular area, to left temporal area. The other 1cm skin incision was made at left temporal area. The peritoneal catheter was passed through the subcutaneous tunnel. The subdural catheter was passed through the subgaleal space and connected to the peritoneal catheter with one 1cmH2O Codman fixed pressure reservoir. The subdural catheter was introduced into the left side subdural space. The function of the S-P shunt was checked and 15ml subdural effusion was collected for routine, BCS, and bacterial culture. Hemostasis was achieved and the peritoneal catheter was placed into peritoneal cavity under direct vision. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS賴達明 Assistants R5李振豪, PGY劉明侑 相關圖片 范石文卿 (F,1935/04/11,76y11m) 手術日期 2011/12/14 手術主治醫師 蔡清霖 手術區域 東址 020房 04號 診斷 Knee OA 器械術式 TKR, R 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 脊髓麻醉 麻醉主治醫師 韓吟宜 ASA 2 紀錄醫師 吳欣翰, 時間資訊 14:25 開始輸血 14:28 報到 14:50 進入手術室 14:55 麻醉開始 15:13 抗生素給藥 15:15 誘導結束 15:35 手術開始 17:05 手術結束 17:05 麻醉結束 17:10 送出病患 17:12 進入恢復室 18:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Spinal anesthesia 1 0 手術 膝關節全置換術 1 1 R 摘要__ 手術科部: 骨科部 套用罐頭: Total knee arthroplasty, right 開立醫師: 吳欣翰 開立時間: 2011/12/14 16:57 Pre-operative Diagnosis Osteoarthritis, right knee Post-operative Diagnosis Osteoarthritis, right knee Operative Method Total knee arthroplasty, right Specimen Count And Types nil Pathology Nil Operative Findings 1. Cartilage wearing and subcondral bone exposure 2. Osteophyte formation 3. Varus deformity Operative Procedures Under spinal anesthesia, the patient was postioned in supine. The operation field was disinfected and draped as usual. After inflating air tourniquet with 350 mmHg in pressure, skin was incised along midline of knee, and exposusre of the knee jointwas done with lateral approach. Bony preparation of femur, tibia, and patella were performed with ""United"" jigs subsequently. Total knee prosthesis was applied with cement, Tibia: _2_, Femur: _2__, Patella: _22__mm, Insert: _9__mm. Thenair tourniquet was deflated, and hemostasis was done. After cleaning surgical wound with normal saline irrigation, the wound was finally closed in layers. Operators 蔡清霖, Assistants 吳欣翰, 黃志逢, 張允亮, 陳勇璋, 記錄__ 手術科部: 骨科部 套用罐頭: Total knee arthroplasty, right 開立醫師: 吳欣翰 開立時間: 2011/12/14 16:57 Pre-operative Diagnosis Osteoarthritis, right knee Post-operative Diagnosis Osteoarthritis, right knee Operative Method Total knee arthroplasty, right Specimen Count And Types nil Pathology Nil Operative Findings 1. Cartilage wearing and subcondral bone exposure 2. Osteophyte formation 3. Varus deformity Operative Procedures Under spinal anesthesia, the patient was postioned in supine. The operation field was disinfected and draped as usual. After inflating air tourniquet with 350 mmHg in pressure, skin was incised along midline of knee, and exposusre of the knee jointwas done with lateral approach. Bony preparation of femur, tibia, and patella were performed with ""United"" jigs subsequently. Total knee prosthesis was applied with cement, Tibia: _2_, Femur: _2__, Patella: _22__mm, Insert: _9__mm. Thenair tourniquet was deflated, and hemostasis was done. After cleaning surgical wound with normal saline irrigation, the wound was finally closed in layers. Operators 蔡清霖, Assistants 吳欣翰, 黃志逢, 張允亮, 陳勇璋, 潘坤福 (M,1944/02/15,68y0m) 手術日期 2011/12/14 手術主治醫師 王碩盟 手術區域 東址 008房 02號 診斷 Ureteral stricture 器械術式 U.R.S.-S.M. 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 靜脈麻醉 麻醉主治醫師 林佩玲 ASA 3 紀錄醫師 張奕凱, 時間資訊 09:15 報到 09:20 進入手術室 09:25 麻醉開始 09:30 誘導結束 09:35 抗生素給藥 09:44 手術開始 09:57 手術結束 09:57 麻醉結束 10:02 送出病患 10:03 進入恢復室 11:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 手術 雙丁輸尿管導管置入術 1 0 R 記錄__ 手術科部: 泌尿部 套用罐頭: DBJ stent insertion 開立醫師: 張奕凱 開立時間: 2011/12/14 10:04 Pre-operative Diagnosis right ureteral stricture post DBJ Post-operative Diagnosis right ureteral stricture post DBJ replacement Operative Method URS and DBJ insertion Specimen Count And Types nil Pathology nil Operative Findings right middle and upper ureteral stricture, r/o external compression Operative Procedures Under satisfactory anesthesia with the patient in lithotomy position, prepping and drapping was performed in the usual sterile fashion. A Fr 21 Olympus cystoscope was introduced into the bladder cavity under direct vision. Careful inspection was done and 7-22 optima DBJ was inserted under URS inspection. 22 Fr 3way Foley, balloon: 10 ml Patient tolerated the procedure very well and was sent to recovery room in satisfactory condition. Operators 王碩盟, Assistants 張奕凱, 吳維哲, 潘以宏 (M,1922/09/24,89y5m) 手術日期 2011/12/14 手術主治醫師 張金池 手術區域 東址 013房 02號 診斷 Subdural hemorrhage following injury without mention of open intracranial wound, with loss of consciousness of unspecified duration 器械術式 Tracheostomy 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 3E 紀錄醫師 游皓鈞, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 06:00 通知急診手術 10:39 進入手術室 10:43 麻醉開始 10:48 誘導結束 10:51 手術開始 11:10 手術結束 11:10 麻醉結束 11:12 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 氣管切開術 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 內科部 套用罐頭: Tracheostomy 開立醫師: 游皓鈞 開立時間: 2011/12/14 11:16 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types nil Pathology None Operative Findings Internal diameter 8 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators VS張金池 Assistants R4高明蔚, R2游皓鈞 Indication Of Emergent Operation respiratory failure 黃兆仁 (M,1951/03/07,61y0m) 手術日期 2011/12/15 手術主治醫師 曾漢民 手術區域 東址 002房 05號 診斷 Predominant disturbance of consciousness 器械術式 Removal of epidural hematoma 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 曾偉倫, 時間資訊 07:00 臨時手術NPO 07:00 開始NPO 12:46 通知急診手術 14:50 進入手術室 15:00 麻醉開始 15:15 誘導結束 15:23 開始輸血 16:24 手術開始 18:00 手術結束 18:00 麻醉結束 18:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 慢性硬腦膜下血腫清除術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: Triphination for hematoma evacuation and drai... 開立醫師: 曾偉倫 開立時間: 2011/12/15 18:37 Pre-operative Diagnosis Chronic subdural hematoma, left Post-operative Diagnosis Chronic subdural hematoma, left Operative Method Triphination for hematoma evacuation and drainage, left Specimen Count And Types nil Pathology Nil. Operative Findings 1. The outer membrane was found during the procedure, but there was no obvious inner membrane 2. The opening pressure after the outer membrane opened was high 3. Some clear dark yellowish fluid was drained initially and some motor-oil like hematoma was drained after irrigation 4. The brain re-expanded well after the hematoma was drained Operative Procedures Under ETGA, we placed the patient on supine position with his face tile to left. After we shaved, disinfected and drapped, an S shape skin incision was made over the left temporal area. The wound was opened in layers. Triphination was done after 2 burr holes. The durotomy was performed and the outermembrane was opened meticulously. The chronic subdural hematoma was drained and a rubber-drain was placed. The durotomy was closed with 3-0 Prolene and the skull flap was fixed with mini-plate. The wound was closed in alyers after the drain was fixed. Operators VS 曾漢民 Assistants R5 林哲光 R3 曾偉倫 Indication Of Emergent Operation IICP, conscious disturbance 相關圖片 吳艷香 (F,1932/07/13,79y8m) 手術日期 2011/12/15 手術主治醫師 陳敞牧 手術區域 東址 003房 03號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(Others) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 11:30 報到 11:55 進入手術室 12:00 麻醉開始 12:32 誘導結束 12:40 抗生素給藥 13:02 手術開始 15:40 麻醉結束 15:40 手術結束 15:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Left frontal craniotomy for tumor excision an... 開立醫師: 林哲光 開立時間: 2011/12/15 15:18 Pre-operative Diagnosis Left frontal convexity meningioma status post radiosurgery with peri-focal post-irradiation necrosis Post-operative Diagnosis Left frontal convexity meningioma status post radiosurgery with peri-focal post-irradiation necrosis Operative Method Left frontal craniotomy for tumor excision and excision of peritumor gliosis Specimen Count And Types 1 piece About size:3x2x2 cm Source:Left frontal tumor with peri-focal post-irradiation necrosis Pathology Pending Operative Findings One 2.2cm sized elastic-firm, whitish, well-demarcated mass lesion was noted at left frontal lobe with intact arachnoid border and tightly adherent to the dura. Thickness of the covered dura and surrounding arachonid membrane was also noted. Brain parenchyma surrounding to the mass lesion was yellowish and firm in consistency, radiation induced gliosis was impressed. Part of the gliosis was removed about 1cm around the tumor. Operative Procedures Under ETGA, we placed the patient on supine position with her face tile to right. After we shaved, scrubbed, disinfected and drape, a bicrownal skin incision was made. The muscle flap was deflected. Left frontal craniotomy was then done after four burr holes were created. The dura was then opened in C-shaped with SSS as base after dural tenting. Tumor removal was done with dissection along the arachnoid plane. The pia was then opened along the tumor and part of the gliosis part was removed. Duroplasty with Cook Surgisis dura graft was done after hemostasis with Surgecell. The skull bone was then put back and fixed with miniplates. The wound was then closed in layers after a subgaleal drain insertion. Operators VS 陳敞牧 Assistants R5 林哲光, R4 王奐之, R3 曾偉倫 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Left frontal craniotomy for tumor excision an... 開立醫師: 林哲光 開立時間: 2011/12/15 15:18 Pre-operative Diagnosis Left frontal convexity meningioma status post radiosurgery with peri-focal post-irradiation necrosis Post-operative Diagnosis Left frontal convexity meningioma status post radiosurgery with peri-focal post-irradiation necrosis Operative Method Left frontal craniotomy for tumor excision and excision of peritumor gliosis Specimen Count And Types 1 piece About size:3x2x2 cm Source:Left frontal tumor with peri-focal post-irradiation necrosis Pathology Pending Operative Findings One 2.2cm sized elastic-firm, whitish, well-demarcated mass lesion was noted at left frontal lobe with intact arachnoid border and tightly adherent to the dura. Thickness of the covered dura and surrounding arachonid membrane was also noted. Brain parenchyma surrounding to the mass lesion was yellowish and firm in consistency, radiation induced gliosis was impressed. Part of the gliosis was removed about 1cm around the tumor. Operative Procedures Under ETGA, we placed the patient on supine position with her face tile to right. After we shaved, scrubbed, disinfected and drape, a bicrownal skin incision was made. The muscle flap was deflected. Left frontal craniotomy was then done after four burr holes were created. The dura was then opened in C-shaped with SSS as base after dural tenting. Tumor removal was done with dissection along the arachnoid plane. The pia was then opened along the tumor and part of the gliosis part was removed. Duroplasty with Cook Surgisis dura graft was done after hemostasis with Surgecell. The skull bone was then put back and fixed with miniplates. The wound was then closed in layers after a subgaleal drain insertion. Operators VS 陳敞牧 Assistants R5 林哲光, R4 王奐之, R3 曾偉倫 相關圖片 方阿運 (M,1932/10/02,79y5m) 手術日期 2011/12/15 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 Subdural hemorrhage 器械術式 removal VP shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 10:30 進入手術室 10:35 麻醉開始 10:40 誘導結束 11:00 手術開始 11:28 手術結束 11:28 麻醉結束 11:33 送出病患 11:37 進入恢復室 13:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 肌肉或深部組織腫瘤切除術及異物取出術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Removal of ventriculo- and subdural- peritone... 開立醫師: 曾偉倫 開立時間: 2011/12/15 11:41 Pre-operative Diagnosis Ventriculo- and subdural- peritoneal shunt infection Post-operative Diagnosis Ventriculo- and subdural- peritoneal shunt infection Operative Method Removal of ventriculo- and subdural- peritoneal shunt Specimen Count And Types nil Pathology Nil Operative Findings 1. Clear CSF was drained from the ventricular catheter 2. Previous CSF culture showed Streptococcus epidermidis (MRSE) 3. Some pus-like, fibrinous substance within the resovoir of the SP shunt Operative Procedures Under ETGA, we place the patient over supine position with his head tilt to left. After we shaved, scrubbed, disinfected, and drapped, three skin incisions were made over the burrhole of VP shunt, above the resovoirs and previous abdominal operation wound. The shunts were removed smoothly. The wound was closed in layers after complete hemostasis. Operators VS 王國川 Assistants R3 曾偉倫 Ri 相關圖片 傅南榮 (M,1940/03/27,71y11m) 手術日期 2011/12/15 手術主治醫師 黃正賢 手術區域 東址 010房 06號 診斷 Cataract 器械術式 Phaco+PCIOL 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 12:50 報到 12:50 進入手術室 12:55 麻醉開始 12:56 麻醉結束 13:10 手術開始 13:50 手術結束 14:00 送出病患 記錄__ 手術科部: 眼科部 套用罐頭: Phaco-Superior (黃正賢) 開立醫師: 鄭琪睿 開立時間: 2011/12/15 13:50 Pre-operative Diagnosis Cataract (OD) Post-operative Diagnosis Cataract (od) Operative Method Phacoemulsification and PCIOL implantation (OD) Specimen Count And Types nil Pathology Nil Operative Findings Cataract (OD) Operative Procedures 1. Under RBGB 2. Disinfection, irrigation and draping. 3. Application of an eyelid speculum. 4. Made a clear corneal incision and penetrate into AC with 2.5mm trapezoid knife at 11 oclock position. 5. Inject Viscoat into the anterior chamber. 6. Continuous circular capsulorrhexis was done with bent needle and capsular forceps. 7. Made a sideport at 3 oclock position with the MVR blade. 8. Hydrodissection and hydrodelineation were done with BSS. 9. Phacoemulsificationof the nucleus by standard divide-and-conquer technique. 10. Aspiration of the residual cortical material with I/A tube. 11. Foldable PCIOL was implanted into the bag after injection of Viscoat. 12. The residual Viscoat was washed out bySimcoe I/A cannula. 13. Inject BSS into AC and check leakage 14. Suture the wound by 10-0 Nylon 16. Subconjunctival injection of Rinderon and Gentamycin. 17. Latycin patching. Operators 黃正賢, Assistants 鄭琪睿, 黃宇軒, 王淑珍 (F,1963/12/04,48y3m) 手術日期 2011/12/15 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 07:48 報到 08:05 進入手術室 08:10 麻醉開始 08:20 誘導結束 08:33 抗生素給藥 09:09 手術開始 10:00 手術結束 10:00 麻醉結束 10:03 送出病患 10:05 進入恢復室 11:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 頭顱成形術 1 1 R 手術 頭皮腫瘤 1 2 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Scalp tumor excision and skull tumor resectio... 開立醫師: 曾偉倫 開立時間: 2011/12/15 10:09 Pre-operative Diagnosis Left frontal tumor, suspect osteoma Post-operative Diagnosis Left frontal tumors, lipoma and osteoma Operative Method Scalp tumor excision and skull tumor resection with cranioplasty Specimen Count And Types 1 piece About size:1x1x1 Source:Skull tumor, suspect osteoma Pathology Pending Operative Findings 1. A 1x1x0.5 cm elastic, yellowish lipoma was found over left frontal area 2. A 0.5x0.5x0.5 cm hard, whitish osteoma over the middle frontal area Operative Procedures Under ETGA, we placed the patient on supine position with her face tilt to left. After we shaved, disinfected and drapped, a bi-crownal skin incision was made and the scalp flap was elevated. The lipoma was resected first and the osteoma was removed with air-drived drill. Cranioplasty was performed with bone-cement. After complete hemostasis, the wound was closed in layers. Operators VS 王國川 Assistants R3 曾偉倫 Ri 相關圖片 彭俊傑 (M,1988/10/07,23y5m) 手術日期 2011/12/15 手術主治醫師 蔡翊新 手術區域 東址 005房 01號 診斷 Brain abscess 器械術式 Brain tumor Crainotomy(Others) 手術類別 預定手術 手術部位 頭、頸 傷口分類 髒 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 連子賢, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:10 麻醉開始 08:30 誘導結束 09:11 手術開始 13:00 抗生素給藥 13:15 手術結束 13:15 麻醉結束 13:25 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除-手術時間在4~8小時 1 1 手術 顱內壓視置入 1 2 摘要__ 手術科部: 外科部 套用罐頭: Right frontotemporparietal craniectomy for br... 開立醫師: 蔡翊新 開立時間: 2011/12/15 13:48 Pre-operative Diagnosis Right frontal brain abscess. Post-operative Diagnosis Right frontal brain abscess, epidural/subdural abscess, and dural defect. Operative Method Right frontotemporparietal craniectomy for brain abscess excision. Left Kocher EVD for ICP monitoring. Specimen Count And Types 3 tubes of CSF, sent for routine, BCS and culture; two culture swab of pus; many pieces of debrided tissue collected in a jar. Pathology Pending. Operative Findings 1. CSF: clean, pressure: 8 cmH2O. EVD was 6.5 cm in depth into left frontal horn. 2. Pus and granulation tissue at right frontal area, beneath the poorly healed scalp wound, epidural space, subdural space, communicating via a 6 x 3 cm dural defect. A 10 x 6 x 5 cm brain abscess with whitish pus content and surrounding granulation tissue (capsule) was removed from right frontal lobe. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. A linear scalp incision and a burr hole were made at left frontal area. EVD was inserted via left Kocher point as an ICP monitor. 5. Incision: right frontotemporoparietal, along previous wound. Raney clips were applied to the scalp edge for temporary hemostasis. 6. The pus was removed by sucker. The granulation tissue (capsule) of the brain abscess was excised. 7. Hemostasis: The hemostasis was obtained satisfactorily by bipolar coagulator. Finally, the cavity created after lobectomy was irrigated with NS and Gentamicin solution several times and it was perfectly watery clear before the dural closure. 8. Dural closure: A piece of Biodesign dural graft (4 x 7 cm ) was used for a perfect dura repair. 9. Scalp closure: hemostasis was done with bipolar coagulator. The granulation tissue on the scalp wound was curretted off. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by interrupted suture with 3/0 nylon. 10.Drain: two epidural CWV drains. One ventricular, which was connected to the ICP monitor. 11.Blood transfusion: nil. Blood loss: 100 ml. 12.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5林哲光R0連子賢M6駱耀璋 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Right frontotemporparietal craniectomy for br... 開立醫師: 蔡翊新 開立時間: 2011/12/15 13:48 Pre-operative Diagnosis Right frontal brain abscess. Post-operative Diagnosis Right frontal brain abscess, epidural/subdural abscess, and dural defect. Operative Method Right frontotemporparietal craniectomy for brain abscess excision. Left Kocher EVD for ICP monitoring. Specimen Count And Types 3 tubes of CSF, sent for routine, BCS and culture; two culture swab of pus; many pieces of debrided tissue collected in a jar. Pathology Pending. Operative Findings 1. CSF: clean, pressure: 8 cmH2O. EVD was 6.5 cm in depth into left frontal horn. 2. Pus and granulation tissue at right frontal area, beneath the poorly healed scalp wound, epidural space, subdural space, communicating via a 6 x 3 cm dural defect. A 10 x 6 x 5 cm brain abscess with whitish pus content and surrounding granulation tissue (capsule) was removed from right frontal lobe. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. A linear scalp incision and a burr hole were made at left frontal area. EVD was inserted via left Kocher point as an ICP monitor. 5. Incision: right frontotemporoparietal, along previous wound. Raney clips were applied to the scalp edge for temporary hemostasis. 6. The pus was removed by sucker. The granulation tissue (capsule) of the brain abscess was excised. 7. Hemostasis: The hemostasis was obtained satisfactorily by bipolar coagulator. Finally, the cavity created after lobectomy was irrigated with NS and Gentamicin solution several times and it was perfectly watery clear before the dural closure. 8. Dural closure: A piece of Biodesign dural graft (4 x 7 cm ) was used for a perfect dura repair. 9. Scalp closure: hemostasis was done with bipolar coagulator. The granulation tissue on the scalp wound was curretted off. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by interrupted suture with 3/0 nylon. 10.Drain: two epidural CWV drains. One ventricular, which was connected to the ICP monitor. 11.Blood transfusion: nil. Blood loss: 100 ml. 12.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R5林哲光R0連子賢M6駱耀璋 相關圖片 林茂守 (M,1927/02/02,85y1m) 手術日期 2011/12/16 手術主治醫師 杜永光 手術區域 東址 019房 04號 診斷 Malignant neoplasm of cerebrum, except lobes and ventricles 器械術式 Left F-P craniotomy for hematoma removal 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2E 紀錄醫師 鍾文桂, 時間資訊 14:25 臨時手術NPO 14:25 開始NPO 14:26 通知急診手術 16:16 進入手術室 16:18 麻醉開始 16:25 誘導結束 17:00 抗生素給藥 17:00 手術開始 19:05 手術結束 19:05 麻醉結束 19:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 急性硬腦膜下血腫清除術 1 2 L 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 摘要__ 手術科部: 外科部 套用罐頭: Craniotomy for evacuation of acute subdural h... 開立醫師: 鍾文桂 開立時間: 2011/12/16 19:21 Pre-operative Diagnosis Left frontal-parietal-temporal acute subdural hemorrhage. Post-operative Diagnosis Left frontal-parietal-temporal acute subdural hemorrhage. Operative Method Craniotomy for evacuation of acute subdural hemorrhage. Specimen Count And Types nil Pathology Nil. Operative Findings Organized, elastic hematoma at subdural space. thickness about 1-2 cm. Poor brain expansion and pulsation after hematoma evacuation. Operative Procedures Under ETGA, the patient was placed in supine position. The head was tilted to the right side. After disinfection and draping, a linear scalp incision was made. After dissection, a 4 cm craniotomy was made. After durotomy, the acute SDH was evacuated. The dura mater was closed in watertight fashion. After fixation of the craniotomy plate with miniplate and screws, the wound was closed in layers. Operators 杜永光 Assistants R6 鍾文桂 Indication Of Emergent Operation Acute conscious deterioration after subdural drain removal. 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Craniotomy for evacuation of acute subdural h... 開立醫師: 鍾文桂 開立時間: 2011/12/16 19:22 Pre-operative Diagnosis Left frontal-parietal-temporal acute subdural hemorrhage. Post-operative Diagnosis Left frontal-parietal-temporal acute subdural hemorrhage. Operative Method Craniotomy for evacuation of acute subdural hemorrhage. Specimen Count And Types nil Pathology Nil. Operative Findings Organized, elastic hematoma at subdural space. thickness about 1-2 cm. Poor brain expansion and pulsation after hematoma evacuation. Operative Procedures Under ETGA, the patient was placed in supine position. The head was tilted to the right side. After disinfection and draping, a linear scalp incision was made. After dissection, a 4 cm craniotomy was made. After durotomy, the acute SDH was evacuated. The dura mater was closed in watertight fashion. After fixation of the craniotomy plate with miniplate and screws, the wound was closed in layers. Operators 杜永光 Assistants R6 鍾文桂 Indication Of Emergent Operation Acute conscious deterioration after subdural drain removal. 相關圖片 謝美雪 (F,1947/09/02,64y6m) 手術日期 2011/12/16 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 07:43 報到 08:07 進入手術室 08:15 麻醉開始 08:40 抗生素給藥 08:40 誘導結束 08:51 手術開始 11:40 抗生素給藥 13:30 開始輸血 14:40 抗生素給藥 17:40 抗生素給藥 17:50 抗生素給藥 19:15 麻醉結束 19:15 手術結束 19:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 14 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 3 0 麻醉 動脈血液檢查全套 3 0 麻醉 Hemoglobin (Hb) 3 0 麻醉 測血糖 3 0 麻醉 Ca (Calcium) 3 0 麻醉 Na (Sodium) 3 0 麻醉 K (Potassium) 3 0 麻醉 Blood gas analysis 3 0 摘要__ 手術科部: 外科部 套用罐頭: Frontotemporal craniotmy, trans-sylvian fissu... 開立醫師: 陳國瑋 開立時間: 2011/12/16 19:34 Pre-operative Diagnosis Right cavernous sinus meningioma Post-operative Diagnosis Right cavernous sinus meningioma Operative Method Frontotemporal craniotmy, trans-sylvian fissure approach for tumor excision, Simpson grade III Specimen Count And Types 1 piece About size:fragments Source:brain tumor Pathology pending Operative Findings The tumor was soft at the suprasellar region, hard and firm at the posterior fossa. The right oculomotor nerve, right trochlear nerve, right ICA, P-com, anterior choroidal, right PCA and SCA were encased by the tumor, and was perserved well after the surgery. The oculomotor nerve was pushed anteriorly and the optic chiasm was pushed upward. During tumor excision along the tentorium, the SSEP deminished and the left foot SSEP recovered but deminished again when dealing with with tumor adhearing to the brainstem. The part adhearing to the brainstem was remained in situ due to severe adhesion. Operative Procedures After ETGA, the patient was put in supine position with head fixed with Mayfield clamp. The head was turned 45 degrees to left and extended 15 degrees. Skin was preped and draped as usual. One curvelinear skin incision was made. The skin was reflected downward along with the Yasagil fat pad. The temporalis muscle was retracted posteriorly. Three burr holes were made and the frontotemporal craniotomy was made. The sphenoid ridge and the anterior clinoid process was drilled extradurally. The the roof of the right optic canal was opened. The dura was incised transverse. The sylvian fissure was opened. Tumor excision was done and the encased ICA, P-com, and anterior choroidal arteries were dissected meticulously. Excision was done along the tentorium to the posterior fossa. A small piece of tumor was left on the brainstem due to severe adhesion. Dura was closed in water-tight fashion, and bone graft was fixed back with mini-plates. We placed one subgaleal CWV, and the wound was closed in layers. Operators Prof. 杜永光 Assistants R5曾峰毅 R3陳國瑋 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Frontotemporal craniotmy, trans-sylvian fissu... 開立醫師: 陳國瑋 開立時間: 2011/12/19 00:53 Pre-operative Diagnosis Right cavernous sinus meningioma Post-operative Diagnosis Right cavernous sinus meningioma Operative Method Frontotemporal craniotmy, trans-sylvian fissure approach for tumor excision, Simpson grade III Specimen Count And Types 1 piece About size:fragments Source:brain tumor Pathology pending Operative Findings The tumor was soft at the suprasellar region, hard and firm at the posterior fossa. The right oculomotor nerve, right trochlear nerve, right ICA, P-com, anterior choroidal, right PCA and SCA were encased by the tumor, and was perserved well after the surgery. The oculomotor nerve was pushed anteriorly and the optic chiasm was pushed upward. During tumor excision along the tentorium, the SSEP deminished and the left foot SSEP recovered but deminished again when dealing with with tumor adhearing to the brainstem. The part adhearing to the brainstem was remained in situ due to severe adhesion. Operative Procedures After ETGA, the patient was put in supine position with head fixed with Mayfield clamp. The head was turned 45 degrees to left and extended 15 degrees. Skin was preped and draped as usual. One curvelinear skin incision was made. The skin was reflected downward along with the Yasagil fat pad. The temporalis muscle was retracted posteriorly. Three burr holes were made and the frontotemporal craniotomy was made. The sphenoid ridge and the anterior clinoid process was drilled extradurally. The the roof of the right optic canal was opened. The dura was incised transverse. The sylvian fissure was opened. Tumor excision was done and the encased ICA, P-com, and anterior choroidal arteries were dissected meticulously. Excision was done along the tentorium to the posterior fossa. A small piece of tumor was left on the brainstem due to severe adhesion. Dura was closed in water-tight fashion, and bone graft was fixed back with mini-plates. We placed one subgaleal CWV, and the wound was closed in layers. Operators Prof. 杜永光 Assistants R5曾峰毅 R3陳國瑋 相關圖片 許文婷 (F,1972/10/26,39y4m) 手術日期 2011/12/16 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Malignant neoplasm of brain, unspecified 器械術式 Brain tumor Crainotomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 08:35 報到 08:47 進入手術室 08:48 麻醉開始 08:55 誘導結束 09:03 手術開始 09:10 抗生素給藥 12:05 麻醉結束 12:05 手術結束 12:10 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 手術 腦瘤切除-手術時間在4小時以內 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Right frontal craniotomy for partial tumor ex... 開立醫師: 李振豪 開立時間: 2011/12/16 12:30 Pre-operative Diagnosis Right frontal oligodendroglioma, WHO grade II, suspect malignant transformation Post-operative Diagnosis Right frontal oligodendroglioma, WHO grade II, suspect malignant transformation Operative Method Right frontal craniotomy for partial tumor excision Specimen Count And Types 1 piece About size:Multiple pieces Source:Right frontal glioma Pathology Pending Operative Findings Intra-operative navigation was used for localization of the tumor. Motor cortex mapping also applied after durotomy. The tumor was mainly located at pre-motor cortex but motor cortex also involved. Partial tumor excision was performed via previous corticotomy. The tumor was normovascularized, gray-whitish, ill-demarcated, with significant calcification. The specimen was sampled for further pathology exam. One cortical vein at anterior margin of durotomy was injured and coagulated because hemostasis was hard to achieve by Gelfoam packing. The brain was not swelling during whole procedure. Intra-operative navigation was used for localization of the tumor. Motor cortex mapping also applied after durotomy. The precentral gyrus was posterior to the durotomy. The tumor was mainly located at pre-motor cortex but motor cortex also involved. Partial tumor excision was performed via previous corticotomy. The tumor was normovascularized, gray-whitish, ill-demarcated, with significant calcification. The specimen was sampled for further pathology exam. One cortical vein at anterior margin of durotomy was injured and coagulated because hemostasis was hard to achieve by Gelfoam packing. The brain was not swelling during whole procedure. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head fixed with Mayfield skull clamp. Navigation was registrated as usual. The scalp was then shaved, scrubbed, and disinfected. The scalp incision was made along operative scar and the scalp flap was elevated. Miniplates and screws were removed and the skull plate was removed. C-shape durotomy was conducted based with superior sagittal sinus. Intra-operative navigation was used for localization of the tumor. Partial tumor excision for pathology was performed with bipolar electrocautery and tumor forceps. Hemostasis was achieved with bipolar electrocautery and Surgicel lining. Duroplasty was conducted with one piece of periosteum and 4-0 prolene. The skull plate was fixed back with miniplates, screws, and one central tenting. One subgaleal CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and Appose staples. Operators VS曾漢民 Assistants R5李振豪, PGY劉明侑 相關圖片 李凱翰 (M,1989/12/31,22y2m) 手術日期 2011/12/16 手術主治醫師 曾漢民 手術區域 東址 005房 03號 診斷 Brain cancer 器械術式 Ommaya reservoir implantation 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 15:57 進入手術室 16:00 麻醉開始 16:05 誘導結束 16:05 抗生素給藥 16:14 手術開始 18:35 手術結束 18:35 麻醉結束 18:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 歐氏貯囊置放手術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 記錄__ 手術科部: 外科部 套用罐頭: Ommaya reservoir implantation for drainage of... 開立醫師: 李振豪 開立時間: 2011/12/16 19:09 Pre-operative Diagnosis Right fronto-parietal glioblastoma, status post tumor excision and Gliadel Wafer implantation, with recurrence Post-operative Diagnosis Right fronto-parietal glioblastoma, status post tumor excision and Gliadel Wafer implantation, with recurrence Operative Method Ommaya reservoir implantation for drainage of cystic component Specimen Count And Types 1 piece About size:10ml Source:Cystic component of right fronto-parietal glioblastoma Pathology Nil Operative Findings Intra-operative sonography was checked for localization of the cystic component which was mainly located at posteromedial part of the craniotomy window. Direct puncture of the cystic component was conducted and xanthochromic fluid gushed out. Total 10ml fluid was sampled for study(routine, total protein, glucose, cytology, and bacterial culture). Ommaya reservoir was placed into the cystic component for further drainage. The ventricular catheter was 4.5cm in length. The function of the Ommaya reservoir was checked after fixation. No obvious bleeding was noted during check the function of the reservoir. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. The scalp incision was made along operative scar. The scalp flap was elevated. The wires were cut off and the skull plate was removed. Intra-operative sonography was checked for localization of the cystic component of the tumor. A small durotomy was made and the cystic component was punctured with puncture needle. Nelaton was inserted via the tract and total 10ml fluid was sampled for study. One burrhole was created at the skull plate and the skull plate was fixed back with eight wires. The Ommaya reservoir was then implanted via the tract for drainage of the cystic component. The function of the Ommaya reservoir was checked and it was fixed with four stitches. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. The wound was then closed in layers with 2-0 Vicryl and Appose staples. Operators VS曾漢民 Assistants R5李振豪, PGY劉明侑 相關圖片 習煥忠 (M,1972/09/26,39y5m) 手術日期 2011/12/16 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Glioma 器械術式 Stereotaxic procedure for biop 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 12:30 進入手術室 12:45 麻醉開始 13:00 誘導結束 13:00 抗生素給藥 13:02 手術開始 15:35 手術結束 15:35 麻醉結束 15:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 手術 腦瘤切除-手術時間在4小時以內 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Right parietal craniotomy for stereotactic tu... 開立醫師: 李振豪 開立時間: 2011/12/16 16:09 Pre-operative Diagnosis Right parietal oligoastrocytoma, status post stereotactic tumor excision, with tumor recurrence Post-operative Diagnosis Right parietal oligoastrocytoma, status post stereotactic tumor excision, with tumor recurrence Operative Method Right parietal craniotomy for stereotactic tumor excision Specimen Count And Types 1 piece About size:Multiple pieces Source:Right parietal glioma Pathology Pending Operative Findings The skull plate was partially absorbed and the wires were loosening. One cortical vein goes through the durotomy and injuried during adhesionlysis. Hemostasis was achieved with Gelfoam and Surgicel packing. The tumor was localized by intra-operative navigation. The tumor was whitish, normovascularized, well-demarcated, 1.7 x 1.4 x 1.5cm in size, and soft in character. The margin between the tumor and sensory cortex was not clear. The adjacent brain parenchyma was mild yellowish which hemosiderin due to previous surgery was favored. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head fixed with Mayfield skull clamp. Navigation was registrated as usual. The scalp was shaved, scrubbed, and disinfected as usual. Reverse U scalp incision was made and the scalp flap was elevated. The wires and the skull plate were removed. Intra-operative navigation was used for localization of the tumor. Linear durotomy was done and the tumor was encountered. The tumor was removed by tumor forcep, bipolar electrocautery, and suction. Hemostasis was achieved with bipolar electrocautery and Surgicel lining. Duroplasty was conducted with one piece of periosteum and 4-0 prolene. The skull plate was fixed back with miniplates, screws, and two central tenting. The wound was then closed in layers with 2-0 Vicryl and Appose staples. Operators VS曾漢民 Assistants R5李振豪, PGY劉明侑 相關圖片 曾添萬 (M,1956/04/26,55y10m) 手術日期 2011/12/16 手術主治醫師 賴達明 手術區域 東址 001房 01號 診斷 Cervical Spondylosis 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 2 紀錄醫師 蔡宗良, 時間資訊 00:00 臨時手術NPO 07:47 報到 08:05 進入手術室 08:27 麻醉開始 08:35 誘導結束 08:45 抗生素給藥 09:09 手術開始 11:25 手術結束 11:25 麻醉結束 11:35 送出病患 11:40 進入恢復室 12:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-頸椎 1 1 手術 椎融合術-前融合,無固定物(≦四節) 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Anterior cervical discectomy with fusion (cag... 開立醫師: 蔡宗良 開立時間: 2011/12/16 11:52 Pre-operative Diagnosis Herniated cervical disc, C5-6 Post-operative Diagnosis Herniated cervical disc, C5-6 Operative Method Anterior cervical discectomy with fusion (cage), C5-6 Specimen Count And Types nil Pathology none Operative Findings 1. Herniated cervical disc, at C5-6 2. Redundant PLL with fragments of nucleus pulposus Operative Procedures 1. ETGA, supine, neck extension 2. Routine preparation 3. Linear wound incision 4. Open SCM and streps and proceeded into prevertebral fascia 5. Fluroscopic confirmation of C5-6, followed by microscdiscectomy 6. Six-mm cage impacted into the C5-6 disc space 7. Placing mini-Vac 8. Wound closed in layers after meticulous hemostasis Operators vs賴達明 Assistants R6蔡宗良 PGYR1張書豪 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Anterior cervical discectomy with fusion (cag... 開立醫師: 蔡宗良 開立時間: 2011/12/16 11:52 Pre-operative Diagnosis Herniated cervical disc, C5-6 Post-operative Diagnosis Herniated cervical disc, C5-6 Operative Method Anterior cervical discectomy with fusion (cage), C5-6 Specimen Count And Types nil Pathology none Operative Findings 1. Herniated cervical disc, at C5-6 2. Redundant PLL with fragments of nucleus pulposus Operative Procedures 1. ETGA, supine, neck extension 2. Routine preparation 3. Linear wound incision 4. Open SCM and streps and proceeded into prevertebral fascia 5. Fluroscopic confirmation of C5-6, followed by microscdiscectomy 6. Six-mm cage impacted into the C5-6 disc space 7. Placing mini-Vac 8. Wound closed in layers after meticulous hemostasis Operators vs賴達明 Assistants R6蔡宗良 PGYR1張書豪 相關圖片 鄭素琴 (F,1942/08/11,69y7m) 手術日期 2011/12/16 手術主治醫師 賴達明 手術區域 東址 001房 02號 診斷 Lumbar spondylosis 器械術式 Laminectomy for decompressionSpinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 3 紀錄醫師 蔡宗良, 時間資訊 00:00 臨時手術NPO 11:38 報到 11:50 進入手術室 11:53 麻醉開始 12:00 誘導結束 12:22 抗生素給藥 12:37 手術開始 15:22 抗生素給藥 16:20 手術結束 16:20 麻醉結束 16:30 送出病患 16:32 進入恢復室 18:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎弓切除術(減壓)-二節以內 1 2 記錄__ 手術科部: 外科部 套用罐頭: 1. Transforaminal lumbar interbody fusion, L3-4 開立醫師: 張書豪 開立時間: 2011/12/16 16:37 Pre-operative Diagnosis 1. Spondylolisthesis, L3-4, grade I 2. Lumbar spinal stenosis, L2-3, L3-4, L4-5 Post-operative Diagnosis 1. Spondylolisthesis, L3-4, grade I 2. Lumbar spinal stenosis, L2-3, L3-4, L4-5 Operative Method 1. Transforaminal lumbar interbody fusion, L3-4 2. Laminectomy, lower L2, L3, L4, and upper L5 Specimen Count And Types nil Pathology None Operative Findings Severe lumbar spinal stenosis at L2-3, L3-4, L4-5 Operative Procedures 1. ETGA, prone positioning 2. Fluroscopic confirmation of L3-4 3. Linear wound incision, followed by subperiosteal dissection 4. Transpedicular screw fixation to L3 and L4 bilaterally, with 6.2 x 40 mm screws 5. Laminectomy was performed L3, L4, with lower half of L2 and upper half of L5 6. Rod fixation bilaterally 7. Hemovac placement 8. Wound was closed in layers after gentamicin saline irrigation and meticulous hemostasis Operators VS賴達明 Assistants R6蔡宗良 R1張書豪 相關圖片 張秀珠 (F,1951/02/24,61y0m) 手術日期 2011/12/16 手術主治醫師 賴達明 手術區域 東址 001房 03號 診斷 Lumbar stenosis 器械術式 Laminectomy for decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 3 紀錄醫師 蔡宗良, 時間資訊 00:00 臨時手術NPO 16:20 報到 16:45 進入手術室 16:50 麻醉開始 17:00 誘導結束 17:07 抗生素給藥 17:26 手術開始 19:25 手術結束 19:25 麻醉結束 19:35 送出病患 19:35 進入恢復室 20:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術(減壓)-二節以內 1 1 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 外科部 套用罐頭: Sublaminar decompression, L4-5 開立醫師: 蔡宗良 開立時間: 2011/12/16 19:39 Pre-operative Diagnosis Lumbar spinal stenosis, L4-5 Post-operative Diagnosis Lumbar spinal stenosis, L4-5 Operative Method Sublaminar decompression, L4-5 Specimen Count And Types nil Pathology None Operative Findings Hypertrophy of ligmentum flavum at L4-5 and bilateral lateral recess Operative Procedures 1. ETGA, prone positioning 2. Fluroroscpic confirmation 3. Routine preparation 4. Linear wound incision, followed by subperiosteal dissection 5. Fluroscopic confirmation again 6. Laminotomy bilateral, followed by removal of ligmentum flavum and decompression of bilateral lateral recess 7. Gentamicin saline irrigation 8. Wound was closed in layers Operators VS 賴達明 Assistants R6 蔡宗良 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Sublaminar decompression, L4-5 開立醫師: 蔡宗良 開立時間: 2011/12/16 19:39 Pre-operative Diagnosis Lumbar spinal stenosis, L4-5 Post-operative Diagnosis Lumbar spinal stenosis, L4-5 Operative Method Sublaminar decompression, L4-5 Specimen Count And Types nil Pathology None Operative Findings Hypertrophy of ligmentum flavum at L4-5 and bilateral lateral recess Operative Procedures 1. ETGA, prone positioning 2. Fluroroscpic confirmation 3. Routine preparation 4. Linear wound incision, followed by subperiosteal dissection 5. Fluroscopic confirmation again 6. Laminotomy bilateral, followed by removal of ligmentum flavum and decompression of bilateral lateral recess 7. Gentamicin saline irrigation 8. Wound was closed in layers Operators VS 賴達明 Assistants R6 蔡宗良 相關圖片 王慶泉 (M,1935/11/05,76y4m) 手術日期 2011/12/16 手術主治醫師 陳忠信 手術區域 東址 015房 04號 診斷 Benign prostatic hypertrophy 器械術式 Herniorrhaphy 手術類別 預定手術 手術部位 腹 傷口分類 清潔 麻醉方式 脊髓麻醉 麻醉主治醫師 黃慧薰 ASA 3 紀錄醫師 葉亭均, 時間資訊 17:49 進入手術室 18:00 麻醉開始 18:10 誘導結束 18:10 抗生素給藥 18:18 手術開始 19:15 手術結束 19:15 麻醉結束 19:25 送出病患 19:25 進入恢復室 20:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Spinal anesthesia 1 0 手術 鼠蹊疝氣修補術-無腸切除 1 1 R 記錄__ 手術科部: 泌尿部 套用罐頭: herniorrhaphy, inguinal 開立醫師: 葉亭均 開立時間: 2011/12/16 19:29 Pre-operative Diagnosis Right side inguinal hernia Post-operative Diagnosis Right side inguinal hernia, indirect type Operative Method Right herniorrhaphy and posterior repair with Mesh Specimen Count And Types 1 piece About size:2x3x2 cm*3 Source:hernia sac Pathology pending Operative Findings 1. Sac from internal inguinal ring, indirect sac 2. Posterior wall weakness. Operative Procedures 1. Under satisfactory spinal anesthesia with the patient in supine position. 2. Prepping and draping was performed in the usual sterile fashion. 3. An inguinal oblique incision was made in the right inguinal area. 4. The wound was deepened through layers into inguinal canal. 5. The spermatic cord was mobilized, and an indirect sac was noted. 6. The hernia sac was isolated from spermatic cord. 7. Ligation and transection of the hernia sac near the the internal inguinal ring was performed. 8. Posterior wall repair with interrupted 1-O surgelon was performed to approximate the conjoin ligment, transverse abdominal fascia and the shelfing portion of the inguinal ligament with Mesh. 9. After adequate hemostasis was obtained, the wound was closed in layers with 1-O chromic on the external oblique fascia and 2-O Vicryl on the Scarpa's fascia. Skin was closed with interrupted 3-O nylon mattress stitches. 10. The patient tolerated the procedure very well, and was sent to the recovery room insatisfactory condition. The sponge count was correct and blood loss was minimal. Operators 陳忠信, Assistants 楊智凱, 葉亭均, 徐榮意 (M,1939/01/28,73y1m) 手術日期 2011/12/16 手術主治醫師 郭順文 手術區域 西址 034房 02號 診斷 Respiratory failure 器械術式 Tracheostoma revision+ bronchoscopy check, 備頭燈 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 蔡奉芳 ASA 3 紀錄醫師 游皓鈞, 時間資訊 09:00 進入手術室 09:05 麻醉開始 09:10 誘導結束 09:18 手術開始 09:40 手術結束 09:40 麻醉結束 09:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 氣管切開術 1 0 手術 支氣管鏡檢查 1 0 記錄__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 游皓鈞 開立時間: 2011/12/16 10:06 Pre-operative Diagnosis Respiratory failure status post tracheostomy, complicated with tube dislocation and granulation tissue formation Post-operative Diagnosis Respiratory failure status post tracheostomy, complicated with tube dislocation and granulation tissue formation Operative Method Tracheostomy revision and bronchoscopy examination Specimen Count And Types 1 piece About size:1*1 cm Source:neck granulation tissue Pathology None Operative Findings Internal diameter 7 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures 1. ETGA, supine position with neck extension 2. Disinfection and drapped in a sterile way 3. Remove the granulation tissue in the tracheostoma 4. Idetified the tracheal ring and opened it atound the 2nd cartilage of trachea 5. Insertion the tracheostomy tube 6. Confirm the position by bronchoscopy 7. Fix the tracheostomy tube Operators VS郭順文 Assistants R4鄒冠全, R2游皓鈞 陳樹松 (M,1942/12/07,69y3m) 手術日期 2011/12/17 手術主治醫師 曾漢民 手術區域 東址 027房 01號 診斷 Subdural hemorrhage 器械術式 Removal of chronic subdural hematoma, Left 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3E 紀錄醫師 曾偉倫, 時間資訊 08:00 開始NPO 15:05 通知急診手術 19:50 進入手術室 19:55 麻醉開始 20:00 誘導結束 20:10 抗生素給藥 20:42 手術開始 21:25 手術結束 21:25 麻醉結束 21:35 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 慢性硬腦膜下血腫清除術 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Burr hole drainage of cSDH, left 開立醫師: 曾偉倫 開立時間: 2011/12/17 21:33 Pre-operative Diagnosis Left chronic subdural hematoma Post-operative Diagnosis Left chronic subdural hematoma Operative Method Burr hole drainage of cSDH, left Specimen Count And Types nil Pathology nil Operative Findings 1. Some clear yellowish fluid drained after the outer membrane was opened. The opening presure was not high. 2. Some motor-oild like subdural hematoma was drained initially 3. The brain not well expanded after the hematoma was removed Operative Procedures under ETGA, we placed the patient on supine position with his head tile to right. After we shaved, scrubbed, disinfected and drapped, a linear skin incision was made over his left frontal area. The burr hole was made with air-drived drill. After the dural tenting, the dura was cauterized with bipolar forceps and durotomy was made. A rubber drain was inserted for draining the hematoma and saline irrigation was performed for clearing the hematoma. The drain was fixed. De-air was done and the wound was closed in layers. Operators VS 曾漢民 Assistants R5 林哲光 R3 曾偉倫 Indication Of Emergent Operation IICP, mid-line shift 相關圖片 黃清記 (M,1955/10/18,56y4m) 手術日期 2011/12/17 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 07:36 報到 08:00 進入手術室 08:10 麻醉開始 08:30 誘導結束 08:50 抗生素給藥 09:00 手術開始 11:50 抗生素給藥 12:35 麻醉結束 12:35 手術結束 12:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除-手術時間在4小時以內 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Right parieto-occipital craniotomy for tumor ... 開立醫師: 李振豪 開立時間: 2011/12/17 13:09 Pre-operative Diagnosis Right parietal and occipital tumor, favor metastasis Post-operative Diagnosis Right parietal and occipital tumor, favor metastasis Operative Method Right parieto-occipital craniotomy for tumor excision Specimen Count And Types 2 pieces About size:Multiple pieces Source:Right occipital tumor About size:Multiple pieces Source:Right parietal tumor Pathology Pending Operative Findings The tumor was 4.6 x 3.7 x 3.8cm(occipital tumor) and 2.5 x 2.4 x 2.1cm (parietal tumor)in size, green-yellowish in color, ill-demarcated in most part of the tumor, normo- to hypervascularized(especially parietal tumor), and soft in character. Necrotic change was noted within the occipital tumor. Metastatic lesion was favored according to gross pathology. The brain bulging out after durotomy and became mild slack after tumor excision. One large cortical vein cross the durotomy was preserved well during whole procedure. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position with head fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. Reverse V scalp incision was made at right occipito-parietal area and the scalp flap was elevated. Five burrholes were created followed by one 12 x 9cm craniotomy window. Dural tenting was done. Intra-operative sonography was used for localization of the tumor. One 1x3cm corticotomy was made at right occipital lobe and and the tumor was encountered about 1cm in depth from brain surface. Central debulking of the tumor was conducted first and the tumor was excised with suction, tumor forceps, and bipolar electrocautery. The other 1x1cm corticotomy was performed at right posterior parietal area and the tumor was identified about 1.5cm in depth from brain surface. The tumor was excised with suction, tumor forceps, and bipolar electrocautery. After total removal of the tumor, hemostasis was achieved with bipolar electrocautery and Surgicel lining. Dura was closed with 4-0 Prolene. The skull plate was fixed back with miniplates, screws, and two central tenting. One subgaleal CWV drain was placed. The wound was then closed in layers with 2-0 Vicryl and Appose staples. Operators VS曾漢民 Assistants R5李振豪, R1李嘉哲 相關圖片 丁培勳 (M,1943/10/10,68y5m) 手術日期 2011/12/17 手術主治醫師 楊士弘 手術區域 東址 003房 01號 診斷 Mitral valve insufficiency and aortic valve stenosis 器械術式 Diskectomy lumbar，Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 4 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 07:40 報到 07:58 進入手術室 08:15 麻醉開始 09:00 誘導結束 09:10 抗生素給藥 09:20 手術開始 10:50 12:10 抗生素給藥 15:10 抗生素給藥 16:08 麻醉結束 16:08 手術結束 16:23 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 骨或軟骨移植術 1 3 手術 椎間盤切除術-腰椎 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 8 0 記錄__ 手術科部: 外科部 套用罐頭: Harvest of bone graft from left iliac crest; ... 開立醫師: 林哲光 開立時間: 2011/12/17 17:27 Pre-operative Diagnosis L5/S1 ruptured disc, spondylodiskitis Post-operative Diagnosis L5/S1 ruptured disc, spondylodiskitis Operative Method Harvest of bone graft from left iliac crest; L5 laminectomy with sublaminal decompression; L5/S1 discectomy, posterior fusion with autologus bone, TPS and rods Specimen Count And Types 1 piece About size: Source:L5/S1 ruptured disc Pathology Pending Operative Findings Flatten bilateral facet joints was noted at L5 level. Hypertrohpic change of ligamentum flavum was noted. Some dark-yellowish coating at epidural area of dura sac was noted, suspected previous infection-related. Ruptured disc covered with soft tissue was noted at L5 level with compressing the dura sac to posterior side. The dura sac seemed re-expanded well after discectomy and laminectomy. TPS, 6.5mmx45mm x2 were inserted at biateral L5 pedicles; TPS 6.5x40mm x2 were inserted at S1 level. Rod 5cm x2 were applied for posterior fusion. Operative Procedures Under ETGA and supine position, skin disinfected and drapped were performed as usual. Transverse skin incision was made at left iliac crest. The bone graft, about 4x2cm, were harvested by osteotome. Then we put the patient in prone position, skin was disinfected and drapped. Midline skin incison was made at L4-S2 level. The paraspinal muscles were detached. TPS were applied at L5 and S1 pedicles under C-arm localization. L5 laminectomy was then perfomred. L5/S1 discectomy was then done. The autologus bone graft was inserted into L5/S1 disc space for posterior fusion. Hemostasis with Gelfoam was then done. Rods were then applied. THe wound was then closed in layers after epidural H/V insertion. Operators 楊士弘 Assistants 林哲光 相關圖片 摘要__ 手術科部: 外科部 套用罐頭: Harvest of bone graft from left iliac crest; ... 開立醫師: 林哲光 開立時間: 2011/12/17 17:28 Pre-operative Diagnosis L5/S1 ruptured disc, spondylodikitis Post-operative Diagnosis L5/S1 ruptured disc, spondylodikitis Operative Method Harvest of bone graft from left iliac crest; L5 laminectomy with sublaminal decompression; L5/S1 discectomy, posterior fusion with autologus bone, TPS and rods Specimen Count And Types 1 piece About size: Source:L5/S1 ruptured disc Pathology Pending Operative Findings Flatten bilateral facet joints was noted at L5 level. Hypertrohpic change of ligamentum flavum was noted. Some dark-yellowish coating at epidural area of dura sac was noted, suspected previous infection-related. Ruptured disc covered with soft tissue was noted at L5 level with compressing the dura sac to posterior side. The dura sac seemed re-expanded well after discectomy and laminectomy. TPS, 6.5mmx45mm x2 were inserted at biateral L5 pedicles; TPS 6.5x40mm x2 were inserted at S1 level. Rod 5cm x2 were applied for posterior fusion. Operative Procedures Under ETGA and supine position, skin disinfected and drapped were performed as usual. Transverse skin incision was made at left iliac crest. The bone graft, about 4x2cm, were harvested by osteotome. Then we put the patient in prone position, skin was disinfected and drapped. Midline skin incison was made at L4-S2 level. The paraspinal muscles were detached. TPS were applied at L5 and S1 pedicles under C-arm localization. L5 laminectomy was then perfomred. L5/S1 discectomy was then done. The autologus bone graft was inserted into L5/S1 disc space for posterior fusion. Hemostasis with Gelfoam was then done. Rods were then applied. THe wound was then closed in layers after epidural H/V insertion. Operators 楊士弘 Assistants 林哲光 相關圖片 高鍾琦 (M,1925/09/09,86y6m) 手術日期 2011/12/17 手術主治醫師 郭順文 手術區域 東址 002房 02號 診斷 Subdural hemorrhage, traumatic 器械術式 Tracheostomy 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3E 紀錄醫師 廖先啟, 時間資訊 00:00 開始NPO 00:00 臨時手術NPO 00:00 通知急診手術 09:40 報到 09:42 進入手術室 09:50 麻醉開始 09:55 抗生素給藥 09:55 誘導結束 10:00 手術開始 10:06 麻醉結束 10:06 手術結束 10:10 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 氣管切開術 1 0 記錄__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 廖先啟 開立時間: 2011/12/17 10:16 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types nil Pathology None Operative Findings Fr. 8 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators VS郭順文 Assistants R4廖先啟，R1陸惠宗 Indication Of Emergent Operation Respiratory failure 張育銘 (M,1969/08/31,42y6m) 手術日期 2011/12/18 手術主治醫師 蔡翊新 手術區域 東址 025房 02號 診斷 Brain abscess 器械術式 Removal of epidural abscess 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3E 紀錄醫師 林玫君, 陳國瑋, 時間資訊 06:00 臨時手術NPO 06:00 開始NPO 09:40 通知急診手術 14:25 進入手術室 14:35 麻醉開始 14:45 誘導結束 15:33 手術開始 17:00 抗生素給藥 19:16 20:00 麻醉結束 22:30 手術結束 22:38 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 手術 多竇副鼻竇手術 1 1 L 手術 硬腦膜外血腫清除術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 蔡翊新 開立時間: 2011/12/18 18:27 Pre-operative Diagnosis Left frontal epidural abscess, extended from frontal sinusitis. Post-operative Diagnosis Left frontal epidural abscess, extended from frontal sinusitis. Operative Method Left frontotemporal craniotomy for removal of epidural abscess. Specimen Count And Types Debrided granulation tissues in one jar; two culture swabs for bacterial culture and smear. Pathology Pending. Operative Findings Subgaleal swelling was noted at left frontal region along previous wound. Frank pus gushed out from subgaleal space upon wound opening. Previous left frontotemporal craniotomy fixed by miniplates and screws, sized 12 x 8 cm. Pus and granulation tissue were noted at epidural space. A bony defect communicated frontal sinus and epidural space and a piece of bone wax was removed from the frontal sinus. Pus culture and smear were obtained. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: bicoronal along previous wound, the skin edge was clipped by Raney clips for temporary hemostasis. The temporalis muscles was incised down to the temporal squama which was exposed then by applying a self retaining retractor on the muscle. 5. Craniotomy window: 12 x 8 cm, left frontotemporal. 6. The epidural abscess and granulation tissue were removed by sucker and currettes. Pus culture and smear were obtained. The bony defect leading from epidural space to the frontal sinus was sealed by a piece of fascial graft. 7. Hemosatasis: the bleeders was stopped by Bovie. The operative field was irrigated with large amount of normal saline and Gentamicin solution. 8. The skull plate was fixed back by miniplates and screws. Several central tentings were placed. 9. Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 10.Drain: two, epidural, CWV. 11.Blood transfusion: nil. Blood loss: 400 ml. 12.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R6蔡宗良R3陳國瑋 Indication Of Emergent Operation CNS infection 記錄__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 蔡翊新 開立時間: 2011/12/18 18:27 Pre-operative Diagnosis Left frontal epidural abscess, extended from frontal sinusitis. Post-operative Diagnosis Left frontal epidural abscess, extended from frontal sinusitis. Operative Method Left frontotemporal craniotomy for removal of epidural abscess. Specimen Count And Types Debrided granulation tissues in one jar; two culture swabs for bacterial culture and smear. Pathology Pending. Operative Findings Subgaleal swelling was noted at left frontal region along previous wound. Frank pus gushed out from subgaleal space upon wound opening. Previous left frontotemporal craniotomy fixed by miniplates and screws, sized 12 x 8 cm. Pus and granulation tissue were noted at epidural space. A bony defect communicated frontal sinus and epidural space and a piece of bone wax was removed from the frontal sinus. Pus culture and smear were obtained. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: bicoronal along previous wound, the skin edge was clipped by Raney clips for temporary hemostasis. The temporalis muscles was incised down to the temporal squama which was exposed then by applying a self retaining retractor on the muscle. 5. Craniotomy window: 12 x 8 cm, left frontotemporal. 6. The epidural abscess and granulation tissue were removed by sucker and currettes. Pus culture and smear were obtained. The bony defect leading from epidural space to the frontal sinus was sealed by a piece of fascial graft. 7. Hemosatasis: the bleeders was stopped by Bovie. The operative field was irrigated with large amount of normal saline and Gentamicin solution. 8. The skull plate was fixed back by miniplates and screws. Several central tentings were placed. 9. Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 10.Drain: two, epidural, CWV. 11.Blood transfusion: nil. Blood loss: 400 ml. 12.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R6蔡宗良R3陳國瑋 Indication Of Emergent Operation CNS infection 摘要__ 手術科部: 耳鼻喉部 套用罐頭: Endoscopic sinus surgery, left 開立醫師: 林玫君 開立時間: 2011/12/18 18:45 Pre-operative Diagnosis Acute paranasal sinusitis with epidural abscess Post-operative Diagnosis Acute paranasal sinusitis with epidural abscess, operated Operative Method Endoscopic sinus surgery, left Specimen Count And Types 1 piece About size:0.2x0.2cm Source:left nose Pathology pending Operative Findings Left infun.: mucopus A.Eth.: mucopus P.Eth: mucopus Maxi.: mucopus Fron.: mucopus Sph.: not checked septal deviation to right bony variation of uncinate process :R( )L( ) enlarged ethmoid bulla :R( )L( ) prominent agger nasi :R( )L( ) concha bullosa :R( )L( ) others : Operative Procedures (1) Infundibulotomy :R( )L(V) (2) Opening/trimming of ethmoid bulla :R( )L(V) anterior ethmoid :R( )L(V) agger nasi :R( )L(V) frontal recess :R( )L(V) middle turbinate :R( )L(V) (3) Opening/trimming of ground lamella :R( )L(V) posterior ethmoid :R( )L(V) sphenoid sinus :R( )L( ) (4) Widening of maxillary ostium :R( )L(V) aspiration :R( )L(V) irrigation :R( )L(V) (5) Packing with Nasopore x 1 Operators AsP吳振吉, Assistants R4許軍偉, R3林玫君, Indication Of Emergent Operation Acute paranasal sinusitis with epidural abscess 記錄__ 手術科部: 外科部 套用罐頭: Endoscopic sinus surgery, left 開立醫師: 林玫君 開立時間: 2011/12/18 21:40 Pre-operative Diagnosis Acute paranasal sinusitis with epidural abscess Acute paranasal sinusitis with epidural abscess, left Post-operative Diagnosis Acute paranasal sinusitis with epidural abscess, operated Acute paranasal sinusitis with epidural abscess, left, operated Operative Method Endoscopic sinus surgery, left Specimen Count And Types 1 piece About size:0.2x0.2cm Source:left nose Pathology pending Operative Findings Left infun.: mucopus A.Eth.: mucopus P.Eth: edematous Maxi.: mucopus Fron.: edematous Sph.: not checked septal deviation to right Operative Procedures (1) Infundibulotomy :R( )L(V) (2) Opening/trimming of ethmoid bulla :R( )L(V) anterior ethmoid :R( )L(V) agger nasi :R( )L(V) frontal recess :R( )L(V) middle turbinate :R( )L(V) (3) Opening/trimming of ground lamella :R( )L(V) posterior ethmoid :R( )L(V) sphenoid sinus :R( )L( ) (4) Widening of maxillary ostium :R( )L(V) aspiration :R( )L(V) irrigation :R( )L(V) (5) Packing with Nasopore x 1 Operators AsP吳振吉, Assistants R4許軍偉, R3林玫君, Indication Of Emergent Operation Acute paranasal sinusitis with epidural abscess, left 陳文英 (F,1953/10/30,58y4m) 手術日期 2011/12/19 手術主治醫師 杜永光 手術區域 東址 001房 03號 診斷 Meningioma 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 蔡宗良, 時間資訊 00:00 臨時手術NPO 15:13 進入手術室 15:21 麻醉開始 15:23 誘導結束 15:50 抗生素給藥 16:14 手術開始 17:49 手術結束 17:49 麻醉結束 18:10 送出病患 18:12 進入恢復室 19:12 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 腦室腹腔分流手術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt, via right-sided K... 開立醫師: 陳國瑋 開立時間: 2011/12/19 18:02 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunt, via right-sided Kocher point Specimen Count And Types 1 piece About size:CSF x 3 Source: Pathology none Operative Findings ICP: moderate The intracranial pressure was not high and the V-P shunt function was good after implantation. The CSF was clear and transparent and was sent for routine study. Operative Procedures 1. General anesthesia via tracheostomy 2. Fixation by Nylon of tracheostomy 3. Routine preparation and disinfection 4. Incision over previous scar at Kocher point 5. Burr hole creation 6. Mini-laparotomy 7. Tunneling of the catheters 8. Medium pressure Medtronics reservoir was used and function was confirmed by testing 9. Ventriculostomy with ventricular end measuring 7 cm in length 10. 30cm of peritoneal catherter was placed towards the Douglas pouch 11. Wound was closed in layers Operators 杜永光 Assistants 蔡宗良 陳國瑋 相關圖片 余春生 (M,1964/02/06,48y1m) 手術日期 2011/12/19 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:05 進入手術室 08:10 麻醉開始 08:35 誘導結束 08:40 抗生素給藥 09:00 手術開始 11:40 抗生素給藥 12:35 手術結束 12:35 麻醉結束 12:38 送出病患 14:06 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除-手術時間在4小時以內 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Right retrosigmoid approach for partial tumor... 開立醫師: 李振豪 開立時間: 2011/12/19 13:05 Pre-operative Diagnosis Right petrous tip meningioma, status post partial tumor excision x II Post-operative Diagnosis Right petrous tip meningioma, status post partial tumor excision x II Operative Method Right retrosigmoid approach for partial tumor excision Specimen Count And Types 1 piece About size:Multiple pieces Source:Right petrous tip meningioma Pathology Pending Operative Findings Severe adhesion and encephalomalacia of right cerebellum were noted after durotomy. After adhesiolysis, the tumor was encountered near the right petrous tip. The tumor was elastic to firm, hypervascularized, and red-yellowish in color. The tumor was adhered to the adjacnet cranial nerve tightly and dissection was difficult to achieve. The margin between lower part of the tumor and brainstem was relative clear and partial tumor excision was performed. A large artery(right AICA?) was encased within the tumor and again, difficult to seperate from the tumor due to adhesion. Under the consideration of functional preservation, the operation was aborded. No obvious EP change was noted during whole procedure. Operative Procedures Under endotracheal general anesthesia, the patient was put in 3/4 prone position with head fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. Retroauricular linear scalp incision was made along operative scar. The subcutaneous soft tissue was devided and the skull plate was exposed. The wires were cut off and the skull plate was removed. Craniotomy window was extended toward posteroinferiorly for better exposure. C-shape durotomy was conducted based with sigmoid sinus. Adhesiolysis was conducted carefully and the tumor was encountered near petrous tip. Central debulking was conducted with bipolar electrocautery and microscissor. Dissection between cranial nerve and the tumor was tried but gave up due to severe adhesion. Under the consideration of the functional preservation, the operation was aborded. Hemostasis was achieved with bipolar electrocautery and Surgicel lining. Duroplasty was done with autologous fascia graft and 4-0 prolene. The skull plate was fixed back with four #26 wires. The wound was then closed in layers. Operators VS曾漢民 Assistants R5李振豪, PGY劉明侑 相關圖片 吳培澤 (M,1972/11/02,39y4m) 手術日期 2011/12/19 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Brain Tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 11:35 報到 12:55 進入手術室 13:00 麻醉開始 13:10 誘導結束 13:15 抗生素給藥 13:55 手術開始 16:00 麻醉結束 16:00 手術結束 16:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 經由蝶竇之腦下垂體瘤切除 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Hypophysectomy---Transphenoid 開立醫師: 李振豪 開立時間: 2011/12/19 16:40 Pre-operative Diagnosis Growth hormone-secreting pituitary adenoma Post-operative Diagnosis Growth hormone-secreting pituitary tumor Operative Method Trans-nasal, trans-sphenoidal adenomectomy Specimen Count And Types 1 piece About size:Multiple small pieces Source:Pituitary tumor Pathology Pending Operative Findings The tumor was 1x1x0.65cm in size, hypervascularized, whitish, well-demarcated, and soft to elastic in character. Massive bleeding was encountered during tumor excision and total blood loss was 650ml. the bleeder was from dura and tumor itself. The tumor was mainly located at inferior part of the sellar region and mild CSF leakage was noted after tumor excision. Reddish normal gland was found at the upper part of the sellar region and preserved well. Tissucol Duo was applied for CSF leakage. Lumbar drain also inserted at the end of the surgery. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position. The face and, nasal cavity, and oral cavity was disinfected as usual. The ostium of sphenoid sinus was identified. The right side nasal mucosa of the septum was infiltrated with Xylocaine solution. One 2.5cm linear vertical mucosa incision was made at right side septum and the submucosal dissection was conducted till the ostium of the sphenoid sinus was identified. The nasal septum was fractured and the left side mucosa was dissected also to expose left side ostium of sphenoid sinus. A Hardy"s nasal speculum was applied to displace the nasal mucosa laterally and keep the nasal cavity open constantly for the exposure of the vomer bone and the anterior wall of the sphenoid sinus. The floor of sphenoid sinus was opened with osteotome then widened by Kerrison punches. The mucosa of sphenoid sinus was removed. The sellar floor was identified and opened with osteotome. The dura was coagulated and cruciform durotomy was made. The tumor was encountered and tumor excision was performed by ring curette, suction, and alligator. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. Tissucol Duo was applied to avoid further CSF leakage. The sellar floor and Vomer bone was placed back for reconstruction of skull base. The nasal mucosa and the middle turbinate was pushed back to it"s neutral position. Right side nasal cavity was packed with a segment of glove filled with one gauze strips which had been soaked with Better-iodine ointment. Lumbar drain was placed via L4/5 interspinous space with midline approach. The depth was fixed at 20cm with one stat suture. The function was checked and total 5ml CSF was sampled for routine, biochemistry, and bacterial culture. Operators VS曾漢民 Assistants R5李振豪, PGY劉明侑 相關圖片 許金發 (M,1952/03/03,60y0m) 手術日期 2011/12/19 手術主治醫師 蔡翊新 手術區域 東址 003房 01號 診斷 Cerebral aneurysm 器械術式 Craniotomy(Aneurysms) P-DUH EC-IC by-pass， 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:10 麻醉開始 08:40 誘導結束 08:42 手術開始 09:00 抗生素給藥 12:00 抗生素給藥 15:00 抗生素給藥 17:35 手術結束 17:35 麻醉結束 17:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 11 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 開顱術摘除血管病變 - 腦血管瘤 有病徵的 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Left frontotemporal craniotomy for aneurysm c... 開立醫師: 蔡翊新 開立時間: 2011/12/19 18:15 Pre-operative Diagnosis Left MCA bifurcation large aneurysm. Post-operative Diagnosis Left MCA bifurcation large aneurysm. Operative Method Left frontotemporal craniotomy for aneurysm clipping-reconstruction. Specimen Count And Types nil Pathology Nil. Operative Findings Superficial temporal artery was harvested for possible EC-IC bypass. There was a saccular aneurysm at left MCA bifurcation, size 1.3 cm, with 4 distal branches arising from the dome. Two separate branches arose adjacent to proximal MCA, one led to temporal lobe and the other kept going as M2 segment. Two branches arose from the top of the dome as a very short common trunk and one went to temporal lobe and the other to frontal lobe. A tiny branch arose from the back of the dome and led to temporal lobe. The aneurysm was clipped with 7 clips parallel to each other, 6 of which were straight with length of blades 7, 10, 12, 15, 18, 18 mm, and the last one was a 10-mm bayonet shaped Sugita clip. The flow to the 2 branches arising from the dome was reconstructed with aneurysm wall, coming from proximal MCA. ICG injection showed patent flows to all the branches. The STA was not used for bypass at last. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with left back elevated and head rotated to right for 40 degree and slightly extended then fixed by Mayfield skull clamp. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: left frontotemporal, curvilinear. The superficial temporal artery was isolated together with its perivascular soft tissue cuff. The skin edge was clipped by Raney clips for temporary hemostasis. After scalp had been lifted, the temporalis muscle was incised and detached from temporal squama and reflected to lower temporal side. 5. Craniotomy window: 12 x 8 cm, left frontotemporal, created by making 3 burr holes then cut by power saw. The lower temporalbone and pterionic ridge (esp. the inner table) were cut by rongeur and high speed air drill as low as possible for easy approach to the anterior clinoid. 6. Dural tention: by 2/0 silk, 2-cm in interval, distributed along the edge of skull window. 7. Dural incision: V shape, over-ridding Sylvian fissure and reflected to frontotemporal base. 8. Under operating microscope, the Sylvian fissure was opened, then the frontal and temporal opercula were retracted by self-retaining retractor in an opposite direction to expose the M-2 segment of left MCA. When the dissection was carried out more proximally, the aneurysm soon came into view. Temporary clips were applied to proximal MCA and all the branches. The neck of the aneurysm was mobilized gently by a Gage 18 sucker and microdissectors until it was entirely free. 9. Seven Sugita clips were applied to the neck of the aneurysm, parallel to each other, and the flow to distal branches was reconstructed by the residual aneurysm wall. ICG was injected to evaluate the patency of the flows. 10.After successful clipping of the aneurysm, the exposed field was irrigated with N.S. to make sure no any bleeding. 11.The brain retractors were removed. The dura was closed water-tight by running suture with 4/0 Prolene. 12.Closure of skull window: the skull plate was placed back to craniotomy window and fixed by 3 miniplates and 6 screws. The dura was tented to the center of the skull plate by 2 2/0 stitches. The covering muscle was closed by interrupted stitches with 1/ 0 silk. 13.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 14.Drain: one, epidural, CWV. 15.Blood transfusion: nil. Blood loss: 350 ml. 16.Course of the surgery: smooth. Operators P杜永光VS蔡翊新 Assistants R6鍾文桂R3陳國瑋 相關圖片 陳炳坤 (M,1935/02/03,77y1m) 手術日期 2011/12/20 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Hydrocephalus 器械術式 V-P shunt (Vetnricle-pleura cavity) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:08 進入手術室 08:10 麻醉開始 08:15 誘導結束 08:30 抗生素給藥 09:10 手術開始 10:08 手術結束 10:08 麻醉結束 10:16 送出病患 10:20 進入恢復室 11:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Left Kocher point Medtronic V-P (pleural cavi... 開立醫師: 林哲光 開立時間: 2011/12/20 10:37 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Left Kocher point Medtronic V-P (pleural cavity) shunt insertion, medium pressure Specimen Count And Types 1 piece About size: Source:CSF for routine, BCS, culture Pathology Nil Operative Findings Opening pressure was around 10cmH2O after ventricular puncture. CSF seemed clear and transparent. Medium valve was inserted. Ventricular catheter was around 6.5cm long and catheter to pleural cavity was around 10cm long. Operative Procedures Under ETGA and supine position with head mild rotated to right side, skin disinfected and drapped were performed as usual. Curvilinear skin incision was made at left Kocher point. A burr hole was then created. The dura was then opened after dural tenting. Ventricular catheter was then inserted with ventricular puncture via the imaginary line composed with two planes pointing to targus and medial canthus. Subcutaneous tunneling was then created through left chest to left posterior auricle and pleural catheter was put through the subcutaneous tunneling and then inserted into the pleural cavity with puncture method after transverse skin incison at left 5-6th ICS. The wound was then closed in layers after ventricular catheter was connected to pleural catheter with valve and function was checked intact. Operators 曾勝弘 Assistants 林哲光 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Left Kocher point Medtronic V-P (pleural cavi... 開立醫師: 林哲光 開立時間: 2011/12/20 10:37 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Left Kocher point Medtronic V-P (pleural cavity) shunt insertion, medium pressure Specimen Count And Types 1 piece About size: Source:CSF for routine, BCS, culture Pathology Nil Operative Findings Opening pressure was around 10cmH2O after ventricular puncture. CSF seemed clear and transparent. Medium valve was inserted. Ventricular catheter was around 6.5cm long and catheter to pleural cavity was around 10cm long. Operative Procedures Under ETGA and supine position with head mild rotated to right side, skin disinfected and drapped were performed as usual. Curvilinear skin incision was made at left Kocher point. A burr hole was then created. The dura was then opened after dural tenting. Ventricular catheter was then inserted with ventricular puncture via the imaginary line composed with two planes pointing to targus and medial canthus. Subcutaneous tunneling was then created through left chest to left posterior auricle and pleural catheter was put through the subcutaneous tunneling and then inserted into the pleural cavity with puncture method after transverse skin incison at left 5-6th ICS. The wound was then closed in layers after ventricular catheter was connected to pleural catheter with valve and function was checked intact. Operators 曾勝弘 Assistants 林哲光 相關圖片 吳錦國 (M,1958/03/31,53y11m) 手術日期 2011/12/20 手術主治醫師 曾勝弘 手術區域 東址 005房 02號 診斷 Parkinsonism 器械術式 IPG change (電池更換) 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 10:12 報到 10:30 進入手術室 10:35 麻醉開始 10:40 誘導結束 10:45 抗生素給藥 10:58 手術開始 11:32 手術結束 11:32 麻醉結束 11:45 送出病患 11:53 進入恢復室 13:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦脊髓液分流管重置 1 1 L 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 摘要__ 手術科部: 外科部 套用罐頭: Change of implanted pulse generator at left p... 開立醫師: 林哲光 開立時間: 2011/12/20 11:38 Pre-operative Diagnosis Parkinson disease Post-operative Diagnosis Parkinson disease Operative Method Change of implanted pulse generator at left prechest area Specimen Count And Types nil Pathology Nil Operative Findings IPG was at well position of prechest area with adhesion to surrounding soft tissue. The function of newly inserted IPG was checked after the wound closure. Operative Procedures Under ETGA and supine position, skin disinfected and drapped were performed as usual. Skin incision along the previous operative wound was done and subcutaneous pocket was opened after checking the eletrical line position. IPG was then removed and new one was inserted and fixed on the subcutaneous area. The wound was then closed in layers after hemostasis. Operators 曾勝弘 Assistants 林哲光 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Change of implanted pulse generator at left p... 開立醫師: 林哲光 開立時間: 2011/12/20 11:38 Pre-operative Diagnosis Parkinson disease Post-operative Diagnosis Parkinson disease Operative Method Change of implanted pulse generator at left prechest area Specimen Count And Types nil Pathology Nil Operative Findings IPG was at well position of prechest area with adhesion to surrounding soft tissue. The function of newly inserted IPG was checked after the wound closure. Operative Procedures Under ETGA and supine position, skin disinfected and drapped were performed as usual. Skin incision along the previous operative wound was done and subcutaneous pocket was opened after checking the eletrical line position. IPG was then removed and new one was inserted and fixed on the subcutaneous area. The wound was then closed in layers after hemostasis. Operators 曾勝弘 Assistants 林哲光 相關圖片 王進庭 (M,1956/03/12,56y0m) 手術日期 2011/12/20 手術主治醫師 曾勝弘 手術區域 東址 005房 03號 診斷 HIVD 器械術式 Laminectomy for decompression，Diskectomy lumbar 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 11:30 報到 11:57 進入手術室 12:00 麻醉開始 12:15 誘導結束 12:40 抗生素給藥 13:06 手術開始 15:40 抗生素給藥 16:20 手術結束 16:20 麻醉結束 16:35 送出病患 16:40 進入恢復室 17:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術(減壓)-超過二節 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 脊椎融合術-後融合,無固定物 1 2 摘要__ 手術科部: 外科部 套用罐頭: L3-5 laminectomy and sublaminal decompression... 開立醫師: 林哲光 開立時間: 2011/12/20 16:52 Pre-operative Diagnosis L3-S1 spinal canal stenosis Post-operative Diagnosis L3-S1 spinal canal stenosis Operative Method L3-5 laminectomy and sublaminal decompression from L3-S1; Posterolateral fusion with autologus bone and Simbone Specimen Count And Types nil Pathology Nil Operative Findings Hypertrophic change of ligamentum flavum and bilateral facet joints were noted with direct compressing dura sac tigthly. The dura sac seemed re-expanded well after decompression was done. Intraoperative dura tear was noted but ceased after Gelfoam packing. Operative Procedures Under ETGA and prone position, skin disinfected and drapped were performed as usual. Midline skin incision was made at L2-S1 level. The paraspinal muscles were detached and bilateral facet joints were exposed well. L3-L5 laminectomy was then done until bilateral axilla of L3-S1 roots were exposed well and decompressed. Hemostasis with Gelfoam packing was done. Bone graft was packed at bilateral facet joints and transverse process after decortication. The wound was then closed in layers after a epidural H/V drain was inserted. Operators 曾勝弘 Assistants 林哲光 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: L3-5 laminectomy and sublaminal decompression... 開立醫師: 林哲光 開立時間: 2011/12/20 16:52 Pre-operative Diagnosis L3-S1 spinal canal stenosis Post-operative Diagnosis L3-S1 spinal canal stenosis Operative Method L3-5 laminectomy and sublaminal decompression from L3-S1; Posterolateral fusion with autologus bone and Simbone Specimen Count And Types nil Pathology Nil Operative Findings Hypertrophic change of ligamentum flavum and bilateral facet joints were noted with direct compressing dura sac tigthly. The dura sac seemed re-expanded well after decompression was done. Intraoperative dura tear was noted but ceased after Gelfoam packing. Operative Procedures Under ETGA and prone position, skin disinfected and drapped were performed as usual. Midline skin incision was made at L2-S1 level. The paraspinal muscles were detached and bilateral facet joints were exposed well. L3-L5 laminectomy was then done until bilateral axilla of L3-S1 roots were exposed well and decompressed. Hemostasis with Gelfoam packing was done. Bone graft was packed at bilateral facet joints and transverse process after decortication. The wound was then closed in layers after a epidural H/V drain was inserted. Operators 曾勝弘 Assistants 林哲光 相關圖片 沈昀蓁 (F,2011/03/25,11m25d) 手術日期 2011/12/20 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Anomalies of spine 器械術式 Cord untethering -KUO 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 石博元 ASA 2 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:00 進入手術室 08:15 麻醉開始 08:25 誘導結束 08:50 抗生素給藥 09:02 手術開始 14:36 手術結束 14:36 麻醉結束 14:55 進入恢復室 14:58 送出病患 15:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦膜或脊髓膜突出修補術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 摘要__ 手術科部: 外科部 套用罐頭: L3-5 laminoplasty for intradural lipoma remov... 開立醫師: 王奐之 開立時間: 2011/12/20 14:55 Pre-operative Diagnosis Intradural lipoma with tethered cord Post-operative Diagnosis Intradural lipoma with tethered cord Operative Method L3-5 laminoplasty for intradural lipoma removal & cord untethering Specimen Count And Types 2 pieces About size:pieces Source:lipoma About size:3*0.5*0.2cm Source:skin Pathology Pending Operative Findings A small skin flap containing the hemangioma and the skin dimpling was trimmed off. The lipoma located at intradural space, extending to inter-dural space and adhered tightly with surrounding dura at the dorsal & dorsolateral aspects. Two large nerve roots at left dorsal side were transected extradurally, while the ventral roots were all preserved. Several small dural defects were noted after dural closure, and was repaired & augmented with DuraGen & Tissucol Duo. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position. After scrubbing, disinfection & draping in sterile fashion, a midline linear incision was made at lower lumbar area. The incision was deepened through fascial layer, and the paraspinal muscles were dissected off the spinous process & lamina. The L3-5 lamina was cut off with scissors & Kerrison punch, and the operating microscope was brought into the surgical field. The dura was opened in longitudinal linear fashion, and the lipoma was debulked with CUSA. Dissection along the plane between the lipoma, dura and nerve tissue was carried out. Untether was performed through adhesiolysis of the nerve tissue. After meticulous hemostasis, the inner layer of dura was closed with 7-0 Prolene, and the outer layer of dura was closed with 5-0 Prolene. The bone was fixed back with silk sutures, and the wound was closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之, Ri 黃柔維 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: L3-5 laminoplasty for intradural lipoma remov... 開立醫師: 王奐之 開立時間: 2011/12/20 14:55 Pre-operative Diagnosis Intradural lipoma with tethered cord Post-operative Diagnosis Intradural lipoma with tethered cord Operative Method L3-5 laminoplasty for intradural lipoma removal & cord untethering Specimen Count And Types 2 pieces About size:pieces Source:lipoma About size:3*0.5*0.2cm Source:skin Pathology Pending Operative Findings A small skin flap containing the hemangioma and the skin dimpling was trimmed off. The lipoma located at intradural space, extending to inter-dural space and adhered tightly with surrounding dura at the dorsal & dorsolateral aspects. Two large nerve roots at left dorsal side were transected extradurally, while the ventral roots were all preserved. Several small dural defects were noted after dural closure, and was repaired & augmented with DuraGen & Tissucol Duo. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position. After scrubbing, disinfection & draping in sterile fashion, a midline linear incision was made at lower lumbar area. The incision was deepened through fascial layer, and the paraspinal muscles were dissected off the spinous process & lamina. The L3-5 lamina was cut off with scissors & Kerrison punch, and the operating microscope was brought into the surgical field. The dura was opened in longitudinal linear fashion, and the lipoma was debulked with CUSA. Dissection along the plane between the lipoma, dura and nerve tissue was carried out. Untether was performed through adhesiolysis of the nerve tissue. After meticulous hemostasis, the inner layer of dura was closed with 7-0 Prolene, and the outer layer of dura was closed with 5-0 Prolene. The bone was fixed back with silk sutures, and the wound was closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之, Ri 黃柔維 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: 1. L3-5 laminoplasty for intradural lipoma re... 開立醫師: 郭夢菲 開立時間: 2011/12/20 16:30 Pre-operative Diagnosis Intradural lipoma with tethered cord Post-operative Diagnosis Intradural lipoma with tethered cord Operative Method 1. L3-5 laminoplasty for intradural lipoma removal & complete cord untethering. 2. Excision of the skin hemangioma and dimple Specimen Count And Types 2 pieces About size:pieces Source:lipoma About size:3*0.5*0.2cm Source:skin Pathology Pending Operative Findings An elliptical skin flap containing the hemangioma (lower lumbar) and the skin dimpling (sacral region) was trimmed off. The lipoma was located at the dura and intradural space with infiltration to extending into the inter-dural space, especially the left side to the lateral part. It adhered tightly with surrounding dura at the dorsal & dorsolateral aspects. Two large aberrant nerve roots at left dorsal side of lower lumbar regin were transected extradurally to achieve complete untethering. The ventral roots were all preserved. Two small dural defects were noted after dural closure. The dura was too thin to be repaired again, so DuraGen then Tissucol Duo were used to repair these defects. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position. After scrubbing, disinfection & draping in sterile fashion, a midline elliptical incision was made at lower lumbar and sacral area. The incision was deepened through fascial layer, and the paraspinal muscles were dissected off the spinous process & lamina. The L3-5 lamina was cut off with scissors & Kerrison punch in a piece, and the operating microscope was brought into the surgical field. The dura was opened in longitudinal linear fashion at the upper operative field, and the lipoma was debulked with CUSA. Dissection along the plane between the lipoma, dura and nerve tissue was carried out. Complete untether was performed through adhesiolysis of the nerve tissue. After meticulous hemostasis, the placode was resonctructed into tube shpae with 7-0 prolene, then the dura was primaril closed with 5-0 Prolene. The dural defects, which were too thin to be repaired were covered with Tissucol Duo then DuroGen to prevent CSF leakage. The wound was then closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之, Ri 黃柔維 相關圖片 張莊月里 (F,1949/09/02,62y6m) 手術日期 2011/12/20 手術主治醫師 賴達明 手術區域 東址 016房 02號 診斷 Subarachnoid hemorrhage 器械術式 Craniotomy(Aneurysms) P-DUH 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 翁上硯, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 06:00 通知急診手術 09:55 進入手術室 10:10 麻醉開始 10:15 誘導結束 10:20 抗生素給藥 10:30 手術開始 13:20 抗生素給藥 15:50 手術結束 15:50 麻醉結束 16:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 開顱術摘除血管病變 - 腦血管瘤 有病徵的 1 1 L 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 摘要__ 手術科部: 外科部 套用罐頭: Left frontal craniotomy for aneurysm clipping. 開立醫師: 鍾文桂 開立時間: 2011/12/20 16:08 Pre-operative Diagnosis Anterior comminicating artery aneurysm, ruptured. Post-operative Diagnosis Anterior comminicating artery aneurysm, ruptured. Operative Method Left frontal craniotomy for aneurysm clipping. Specimen Count And Types nil Pathology Nil. Operative Findings Severe adhesion of the dura mater to the skull bone-> severe dura tear during craniotomy-> repaired with DuraGen and pericranium. Moderate brain swelling. Bilateral A1 and A2, recurrent artery of Herbner were exposed for aneurysm clipping. An angled straight Sugita clip was applied to the aneurysm. Left A1 proximal control: 3min 58secs. Operative Procedures Under ETGA, the patient was placed in supine position. The head was fixed by Mayfield and tilted to the right. After shaving, disinfection, and draping, a curvilinear scalp incision was made. After dissection, a 10 cm craniotomy was obtained. After retraction of the frontal lobe and dissection of the sylvian fissure, the optic nerve and internal carotid artery were exposed. Further arachnoid lysis and suction of the rectus gyrus for exposing the bilateral A1 and A2 were achieved. A right angled straight Sugita aneurysm clip was applied. The aneurysm dome was electrocoagulated. With well hemostasis, the dura mater was repaired with DuraGen and pericranium in watertight fashion. The craniotomy plate was fixed by miniplates and screws. The wound was closed in layers with one subgaleal CWV drain. Operators 賴達明 Assistants R6 鍾文桂 PGY1 翁上硯 Indication Of Emergent Operation Acute subarachnoid hemorrhage, aneurysm rupture. 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Left frontal craniotomy for aneurysm clipping. 開立醫師: 鍾文桂 開立時間: 2011/12/20 16:31 Pre-operative Diagnosis Anterior comminicating artery aneurysm, ruptured. Post-operative Diagnosis Anterior comminicating artery aneurysm, ruptured. Operative Method Left frontal craniotomy for aneurysm clipping. Specimen Count And Types nil Pathology Nil. Operative Findings Severe adhesion of the dura mater to the skull bone-> severe dura tear during craniotomy-> repaired with DuraGen and pericranium. Moderate brain swelling. Bilateral A1 and A2, recurrent artery of Herbner were exposed for aneurysm clipping. An angled straight Sugita clip was applied to the aneurysm. Left A1 proximal control: 3min 58secs. Transient SSEP change of right lower extrimity, recovered after removal of temporary clip. Operative Procedures Under ETGA, the patient was placed in supine position. The head was fixed by Mayfield and tilted to the right. After shaving, disinfection, and draping, a curvilinear scalp incision was made. After dissection, a 10 cm craniotomy was obtained. After retraction of the frontal lobe and dissection of the sylvian fissure, the optic nerve and internal carotid artery were exposed. Further arachnoid lysis and suction of the rectus gyrus for exposing the bilateral A1 and A2 were achieved. A right angled straight Sugita aneurysm clip was applied. The aneurysm dome was electrocoagulated. With well hemostasis, the dura mater was repaired with DuraGen and pericranium in watertight fashion. The craniotomy plate was fixed by miniplates and screws. The wound was closed in layers with one subgaleal CWV drain. Operators 賴達明 Assistants R6 鍾文桂 PGY1 翁上硯 Indication Of Emergent Operation Acute subarachnoid hemorrhage, aneurysm rupture. 相關圖片 張家駿 (M,1930/02/27,82y0m) 手術日期 2011/12/20 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Lumbar stenosis 器械術式 L3/4, L4/5 sublaminal decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 蔡宗良, 時間資訊 00:00 臨時手術NPO 08:03 進入手術室 08:08 誘導結束 08:08 麻醉開始 09:00 抗生素給藥 09:01 手術開始 10:45 手術結束 10:45 麻醉結束 11:19 送出病患 11:25 進入恢復室 13:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術(減壓)-二節以內 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 外科部 套用罐頭: Laminectomy, L4 and lower half of L3 開立醫師: 蔡宗良 開立時間: 2011/12/20 11:01 Pre-operative Diagnosis Lumbar spinal stenosis, L4-5 Post-operative Diagnosis Lumbar spinal stenosis, L4-5 Operative Method Laminectomy, L4 and lower half of L3 Specimen Count And Types nil Pathology None Operative Findings Lumbar spinal stenosis, L4-5 with hypertrophy of ligmentum flavum Operative Procedures 1. ETGA, magnets over pacemakers, prone postioning 2. Routine preparation with fluroscopic confirmation of L4 3. Linear skin incision over previous wound 4. Subperiosteal dissection 5. Under microscope, laminectomy of L4 and lower half of L3 were performed 6. Gentamicin saline irrigation 7. The wound was closed in layers Operators VS 賴達明 Assistants R6 蔡宗良, R1 張書豪 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Laminectomy, L4 and lower half of L3 開立醫師: 蔡宗良 開立時間: 2011/12/20 11:01 Pre-operative Diagnosis Lumbar spinal stenosis, L4-5 Post-operative Diagnosis Lumbar spinal stenosis, L4-5 Operative Method Laminectomy, L4 and lower half of L3 Specimen Count And Types nil Pathology None Operative Findings Lumbar spinal stenosis, L4-5 with hypertrophy of ligmentum flavum Operative Procedures 1. ETGA, magnets over pacemakers, prone postioning 2. Routine preparation with fluroscopic confirmation of L4 3. Linear skin incision over previous wound 4. Subperiosteal dissection 5. Under microscope, laminectomy of L4 and lower half of L3 were performed 6. Gentamicin saline irrigation 7. The wound was closed in layers Operators VS 賴達明 Assistants R6 蔡宗良, R1 張書豪 相關圖片 羅李鳳蘭 (F,1939/01/22,73y1m) 手術日期 2011/12/20 手術主治醫師 賴達明 手術區域 東址 009房 02號 診斷 Spinal stenosis 器械術式 L2/3 sublaminal decompression 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 10:20 麻醉開始 10:40 進入手術室 10:55 誘導結束 11:10 抗生素給藥 11:25 手術開始 13:30 手術結束 13:30 麻醉結束 13:40 送出病患 13:43 進入恢復室 14:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 椎弓切除術(減壓)-二節以內 1 1 記錄__ 手術科部: 外科部 套用罐頭: L2/3, L3/4(left side) sublaminar decompression 開立醫師: 李振豪 開立時間: 2011/12/20 13:26 Pre-operative Diagnosis L2/3, L3/4 lumbar stenosis Post-operative Diagnosis L2/3, L3/4 lumbar stenosis Operative Method L2/3, L3/4(left side) sublaminar decompression Specimen Count And Types nil Pathology Nil Operative Findings Severe stenosis of L2/3 and L3/4 level was noted due to hypertrophic ligmentum flavum and herniated intervertebral disc. After sublaminar decompression, the thecal sac expanded well. Bilateral L2/3 and left side L3/4 foraminotomy also done for neural foramen stenosis. No incidental durotomy or CSF leakage was noted during whole procedure. The patient stood whole procedure well. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position. The L2-4 level were localized by portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made along operative scar. The subcutaneous soft tissue was devided. The L2 and L3 spinous process were splitted by osteotome and fracture to expose L2 and L3 laminae. L2/3 laminotomy was performed with Ronguer and Kerrison punches. The ligmentum flavum was removed followed by bilateral foraminotomy. Left side L3/4 laminotomy was conducted in the same way followed by sublaminar decompression and foraminotomy. After well decompression, hemostasis was achieved with bipolar electrocautery and Gelfoam packing. The wound was irrigated with normal saline solution and closed in layers with 1-0, 2-0 Vicryl, and 3-0 Nylon. Operators VS賴達明 Assistants R5李振豪, R2陳以幸 相關圖片 曾芳嬿 (F,1973/12/16,38y2m) 手術日期 2011/12/20 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Herniated intervertebral disc (HIVD) 器械術式 C5/6 ACDF 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 蔡宗良, 時間資訊 00:00 臨時手術NPO 10:35 報到 11:30 進入手術室 11:35 麻醉開始 11:45 誘導結束 11:50 抗生素給藥 12:13 手術開始 14:30 手術結束 14:30 麻醉結束 14:47 送出病患 14:50 進入恢復室 15:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 椎間盤切除術-頸椎 1 1 手術 椎融合術-前融合,無固定物(≦四節) 1 2 摘要__ 手術科部: 外科部 套用罐頭: Anterior cervical discectomy with fusion, C5-6 開立醫師: 蔡宗良 開立時間: 2011/12/20 14:38 Pre-operative Diagnosis Herniated cervical disc, C5-6 Post-operative Diagnosis Herniated cervical disc, C5-6 Operative Method Anterior cervical discectomy with fusion, C5-6 Specimen Count And Types nil Pathology None Operative Findings Herniated nucleus pulposus squeezed through PLL Operative Procedures 1. ETGA, supine positioning, with head extension 2. Routine preparation 3. Skin incision over skin crease 4. Open platysma and SCM-streps muscle 5. Dissect to reach prevertebral fascia 6. Confirmation of C5-6 level 7. Koros installation 8. Discectomy under microscope and open PLL 9. A six-mm height cage was impacted to the disc space 10. After meticulous hemostasis, the wound was closed in layers Operators VS 賴達明 Assistants R6 蔡宗良, R1 張書豪 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Anterior cervical discectomy with fusion, C5-6 開立醫師: 蔡宗良 開立時間: 2011/12/20 14:49 Pre-operative Diagnosis Herniated cervical disc, C5-6 Post-operative Diagnosis Herniated cervical disc, C5-6 Operative Method Anterior cervical discectomy with fusion, C5-6 Specimen Count And Types nil Pathology None Operative Findings Herniated nucleus pulposus squeezed through PLL Operative Procedures 1. ETGA, supine positioning, with head extension 2. Routine preparation 3. Skin incision over skin crease 4. Open platysma and SCM-streps muscle 5. Dissect to reach prevertebral fascia 6. Confirmation of C5-6 level 7. Koros installation 8. Discectomy under microscope and open PLL 9. A six-mm height cage was impacted to the disc space 10. After meticulous hemostasis, the wound was closed in layers Operators VS 賴達明 Assistants R6 蔡宗良, R1 張書豪 相關圖片 李家龍 (M,1995/12/28,16y2m) 手術日期 2011/12/20 手術主治醫師 楊士弘 手術區域 兒醫 062房 05號 診斷 Malignant neoplasm of other parts of brain 器械術式 Trans-sphenoidal pituitary adenomectomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 石博元 ASA 2 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 12:55 報到 13:10 進入手術室 13:15 麻醉開始 13:40 誘導結束 14:37 手術開始 16:45 麻醉結束 16:45 手術結束 17:02 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經由蝶竇之腦下垂體瘤切除 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 手術 鼻中膈鼻道成形術-雙側 1 2 摘要__ 手術科部: 套用罐頭: Endoscopic transnasal trans-sphenoidal pituit... 開立醫師: 王奐之 開立時間: 2011/12/20 17:17 Pre-operative Diagnosis Pituitary tumor, suspected germ cell tumor Post-operative Diagnosis Pituitary tumor, suspected germ cell tumor Operative Method Endoscopic transnasal trans-sphenoidal pituitary tumor removal & partial hypophysectomy Specimen Count And Types 1 piece About size:pieces Source:pituitary tumor Pathology Pending. Frozen section reported germ cell tumor. Operative Findings Greyish elastic tumor was noted at right side of the sella, posteroinferior to the normal gland. Some other suspicious tissue at sella was also removed. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position. After scrubbing, disinfection & draping in sterile fashion, endoscope was introduced into the nasal cavity. After retracting bilateral middle nasal concha laterally, the mucosa at anterior sphenoid was splitted. The anterior wall of sphenoid sinus was then fractured open along with the vomer bone. After entering the sphenoid sinus, the middle septum was removed, exposing the sellar floor. The sellar floor was opened with osteotome. After hemostasis, a cruciate durotomy was performed with scissors. The suspected tumor tissue was removed with alligator clamp. After tumor removal, the tumor bed was packed with Gelfoam, and the bone chips were placed back. The mucosa was relocated and bilateral middle nasal concha were reduced to their original position. After placement of Marocels into bilateral nostrils, the operation ended. Operators VS 楊士弘 Assistants R4 王奐之, R3 曾偉倫, Ri 黃柔維 相關圖片 記錄__ 手術科部: 套用罐頭: Endoscopic transnasal trans-sphenoidal pituit... 開立醫師: 王奐之 開立時間: 2011/12/20 17:17 Pre-operative Diagnosis Pituitary tumor, suspected germ cell tumor Post-operative Diagnosis Pituitary tumor, suspected germ cell tumor Operative Method Endoscopic transnasal trans-sphenoidal pituitary tumor removal & partial hypophysectomy Specimen Count And Types 1 piece About size:pieces Source:pituitary tumor Pathology Pending. Frozen section reported germ cell tumor. Operative Findings Greyish elastic tumor was noted at right side of the sella, posteroinferior to the normal gland. Some other suspicious tissue at sella was also removed. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position. After scrubbing, disinfection & draping in sterile fashion, endoscope was introduced into the nasal cavity. After retracting bilateral middle nasal concha laterally, the mucosa at anterior sphenoid was splitted. The anterior wall of sphenoid sinus was then fractured open along with the vomer bone. After entering the sphenoid sinus, the middle septum was removed, exposing the sellar floor. The sellar floor was opened with osteotome. After hemostasis, a cruciate durotomy was performed with scissors. The suspected tumor tissue was removed with alligator clamp. After tumor removal, the tumor bed was packed with Gelfoam, and the bone chips were placed back. The mucosa was relocated and bilateral middle nasal concha were reduced to their original position. After placement of Marocels into bilateral nostrils, the operation ended. Operators VS 楊士弘 Assistants R4 王奐之, R3 曾偉倫, Ri 黃柔維 相關圖片 摘要__ 手術科部: 套用罐頭: Endoscopic transnasal transeptal trans-spheno... 開立醫師: 楊士弘 開立時間: 2011/12/21 12:14 Pre-operative Diagnosis Pituitary tumor, suspected germ cell tumor Post-operative Diagnosis Pituitary tumor, suspected germ cell tumor Operative Method Endoscopic transnasal transeptal trans-sphenoidal pituitary tumor removal & partial hypophysectomy Specimen Count And Types 1 piece About size:pieces Source:pituitary tumor Pathology Pending. Frozen section reported germ cell tumor. Operative Findings Greyish elastic tumor was noted at right side of the sella, posteroinferior to the normal gland. Some other suspicious tissue at sella was also removed. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position. After scrubbing, disinfection & draping in sterile fashion, a curved incision was made at the right septal mucosa, which was dissected and detached from the septal cartilage and bone. The same procedure was done at the left side. Then a nasal speculum was inserted to retract the bilateral septal mucosa laterally. The endoscope was introduced into the nasal cavity. The anterior wall of sphenoid sinus was opened with an osteotome. After entering the sphenoid sinus, the middle septum was removed, exposing the sellar floor. The sellar floor was opened with an osteotome and Kerrison punches. After hemostasis, a cruciate durotomy was performed with scissors. The suspected tumor tissue was removed with a ring curret and alligator clamps. After tumor removal, the tumor bed was packed with Gelfoam, and the bone chips were placed back. The mucosa was relocated and bilateral middle nasal concha were reduced to their original position. After placement of Merocels into bilateral nostrils, the operation ended. Operators VS 楊士弘 Assistants R4 王奐之, R3 曾偉倫, Ri 黃柔維 相關圖片 記錄__ 手術科部: 套用罐頭: Endoscopic transnasal transeptal trans-spheno... 開立醫師: 王奐之 開立時間: 2011/12/21 17:25 Pre-operative Diagnosis Pituitary tumor, suspected germ cell tumor Post-operative Diagnosis Pituitary tumor, suspected germ cell tumor Operative Method Endoscopic transnasal transeptal trans-sphenoidal pituitary tumor removal & partial hypophysectomy Specimen Count And Types 1 piece About size:pieces Source:pituitary tumor Pathology Pending. Frozen section reported germ cell tumor. Operative Findings Greyish elastic tumor was noted at right side of the sella, posteroinferior to the normal gland. Some other suspicious tissue at sella was also removed. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position. After scrubbing, disinfection & draping in sterile fashion, a curved incision was made at the right septal mucosa, which was dissected and detached from the septal cartilage and bone. The same procedure was done at the left side. Then a nasal speculum was inserted to retract the bilateral septal mucosa laterally. The endoscope was introduced into the nasal cavity. The anterior wall of sphenoid sinus was opened with an osteotome. After entering the sphenoid sinus, the middle septum was removed, exposing the sellar floor. The sellar floor was opened with an osteotome and Kerrison punches. After hemostasis, a cruciate durotomy was performed with scissors. The suspected tumor tissue was removed with a ring curret and alligator clamps. After tumor removal, the tumor bed was packed with Gelfoam, and the bone chips were placed back. The mucosa was relocated and bilateral middle nasal concha were reduced to their original position. After placement of Merocels into bilateral nostrils, the operation ended. Operators VS 楊士弘 Assistants R4 王奐之, R3 曾偉倫, Ri 黃柔維 相關圖片 陳榮貴 (M,1964/08/25,47y6m) 手術日期 2011/12/20 手術主治醫師 蕭輔仁 手術區域 東址 003房 03號 診斷 Spinal metastasis 器械術式 T10-T11 laminectomy+ TPS fixation T8-T9-T12-L1 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2E 紀錄醫師 蔡宗良, 時間資訊 09:00 開始NPO 10:45 通知急診手術 14:50 報到 15:15 進入手術室 15:20 麻醉開始 15:30 誘導結束 15:50 抗生素給藥 16:15 手術開始 18:50 抗生素給藥 19:50 開始輸血 21:00 麻醉結束 21:00 手術結束 21:10 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 惡性脊髓腫瘤切除術 1 1 手術 脊椎融合術-後融合,有固定物(<=六節) 1 2 摘要__ 手術科部: 外科部 套用罐頭: 1. Posterior decompression, laminectomy of T9... 開立醫師: 王奐之 開立時間: 2011/12/20 21:32 Pre-operative Diagnosis Metastatic epidural spinal cord compression, T10, T11 Post-operative Diagnosis Metastatic epidural spinal cord compression, T10, T11 Operative Method 1. Posterior decompression, laminectomy of T9, T10, T11, T12 2. Posterior instrumentation, transpedicular screws of bilateral T8, T9, T12, L1 with bilateral rod and cross-link fixation Specimen Count And Types 1 piece About size:小 Source:Epidural mass Pathology Report pending Operative Findings Greyish, fragile, avascular epidural mass at bilateral T10 and T11, compressing the thecal sac Operative Procedures 1. ETGA, prone positioning 2. Confirmation of intended intrumentation levels 3. Routine preparation 4. Mildine incision, followed by subperiosteal dissection 5. Transpedicular screw fixation with 6.0 x 40 for T12 and L1 and 5.5 x 40 for T8 and T9 6. Laminectomy of T9, T10, T11, T12 follows. 7. Debulking of the epidural mass 8. Hemovac placement after copious gentamicin saline irrigation 9. Wound was closed in layers Operators VS 蕭輔仁 Assistants R6 蔡宗良, R1 張書豪 Indication Of Emergent Operation Spinal cord compression 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: 1. Posterior decompression, laminectomy of T9... 開立醫師: 王奐之 開立時間: 2011/12/20 21:32 Pre-operative Diagnosis Metastatic epidural spinal cord compression, T10, T11 Post-operative Diagnosis Metastatic epidural spinal cord compression, T10, T11 Operative Method 1. Posterior decompression, laminectomy of T9, T10, T11, T12 2. Posterior instrumentation, transpedicular screws of bilateral T8, T9, T12, L1 with bilateral rod and cross-link fixation Specimen Count And Types 1 piece About size:小 Source:Epidural mass Pathology Report pending Operative Findings Greyish, fragile, avascular epidural mass at bilateral T10 and T11, compressing the thecal sac Operative Procedures 1. ETGA, prone positioning 2. Confirmation of intended intrumentation levels 3. Routine preparation 4. Mildine incision, followed by subperiosteal dissection 5. Transpedicular screw fixation with 6.0 x 40 for T12 and L1 and 5.5 x 40 for T8 and T9 6. Laminectomy of T9, T10, T11, T12 follows. 7. Debulking of the epidural mass 8. Hemovac placement after copious gentamicin saline irrigation 9. Wound was closed in layers Operators VS 蕭輔仁 Assistants R6 蔡宗良, R1 張書豪 Indication Of Emergent Operation Spinal cord compression 相關圖片 莊瑞發 (M,1953/08/01,58y7m) 手術日期 2011/12/21 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Lung cancer 器械術式 Port-A catheter Implatation 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 12:50 進入手術室 13:01 報到 13:03 抗生素給藥 13:27 麻醉開始 13:28 麻醉結束 13:28 誘導結束 13:29 手術開始 14:40 手術結束 14:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 port–A導管植入術–治療性導管植入術 1 0 L 記錄__ 手術科部: 外科部 套用罐頭: Port-A puncture 開立醫師: 李振豪 開立時間: 2011/12/21 14:47 Pre-operative Diagnosis Lung cancer Post-operative Diagnosis Lung cancer Operative Method Port-A implantation via percutaneous puncture Specimen Count And Types nil Pathology nil Operative Findings 1. Port-A catheter was inserted into SVC via left subclavicular vein 2. Post-operative portable X-ray showed Port-A catheter tip in correct venous branch to SVC. 3. Port-A catheter: Celsite(ST305) 6.5Fr, catheter length: 19cm Operative Procedures The patient was put in supine position. The skin was disinfected and draped as usual. Transverse skin incision was made over left upper forechest with 3cm in length. The subcutaneous soft tissue was devided. Percutaneous puncture of left subclavicular vein was conducted then Port-A catheter was inserted. The location of the catheter tip was checked by portable X-ray. A subcutaneous packet was made and the Port-A was implanted. Hemostasis was achieved. The wound was then closed in layers with 3-0 Vicryl and 4-0 Nylon. Operators VS曾漢民 Assistants R5 李振豪, PGY劉明侑 相關圖片 方韓寶 (F,1940/05/04,71y10m) 手術日期 2011/12/21 手術主治醫師 曾漢民 手術區域 東址 005房 03號 診斷 Glioma, brain 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 14:20 報到 14:55 進入手術室 15:00 麻醉開始 15:15 誘導結束 15:15 抗生素給藥 15:17 手術開始 18:15 抗生素給藥 21:30 麻醉結束 21:30 手術結束 21:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除-手術時間在4~8小時 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Left parieto-occipital craniotomy for near to... 開立醫師: 李振豪 開立時間: 2011/12/21 22:41 Pre-operative Diagnosis Left parietal high grade glioma Post-operative Diagnosis Left parietal high grade glioma Operative Method Left parieto-occipital craniotomy for near total tumor excision Specimen Count And Types 1 piece About size:Multiple pieces Source:Left parietal tumor Pathology Pending Operative Findings Intra-operative sonography was used for localization of the tumor before durotomy. The tumor was hypervascularized, gelatinous, gray and yellowish, soft but fragile in central part, and 5.7 x 2.9 x 2.7cm in size. The left lateral ventricle was entered during tumor excision and sealed with Gelfoam and Surgicel. Due to easily touch bleeding, Flowseal was used for hemostasis. Dura was closed after 30 minutes observation. The tumor extended to corpus callosum was not excised. Before the operation, poor left lower limb SSEP was noted and no significant change during the operation. However, flatening of left upper limb SSEP noticed during tumor excision. The left upper limb SSEP was still detectable but did not return to baseline at the end of the operation. Intra-operative sonography was used for localization of the tumor before durotomy. The tumor was hypervascularized, gelatinous, gray and yellowish, soft but fragile in central part, and 5.7 x 2.9 x 2.7cm in size. The left lateral ventricle was entered during tumor excision and sealed with Gelfoam and Surgicel. Due to easily touch bleeding, Flowseal was used for hemostasis. Dura was closed after 30 minutes observation. The tumor extended to corpus callosum was not excised. Before the operation, poor right lower limb SSEP was noted and no significant change during the operation. However, flatening of right upper limb SSEP noticed during tumor excision. The right upper limb SSEP was still detectable but did not return to baseline at the end of the operation. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position with head fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. Reverse U scalp incision was made at left parieto-occipital area and the scalp flap was elevated. Five burrholes were created followed by one 9 x 6cm craniotomy window. Dural tenting was done. Bleeding from superior sagittal sinus was packing with Gelfoam and Surgicel. Intra-operative sonography was used for localization of the tumor. C-shape durotomy was made based with superior sagittal sinus. One 2x2.5cm corticotomy was made and tumor was encountered about 0.3cm from brain surface. Tumor excision was performed with bipolar electrocautery, suction, and tumor forceps. Hemostasis was achieved with bipolar electrocautery, Floseal, and Surgicel lining. The opening of left lateral ventricle was sealed with Gelfoam and Surgicel. Duroplasty was conducted with autologous fascia graft and 4-0 prolene. The skull plate was fixed back with miniplates, screws, and two central tenting. One subgaleal CWV drain was placed. the wound was then closed in layers with 2-0 Vicryl and Appose staples. Operators VS曾漢民 Assistants R5李振豪, PGY劉明侑 相關圖片 柳雅心 (F,2003/02/20,9y0m) 手術日期 2011/12/21 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Anomalies of spinal cord 器械術式 Excision of filum terminale lipoma 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 2 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:06 進入手術室 08:15 麻醉開始 08:20 誘導結束 08:25 抗生素給藥 09:07 手術開始 10:50 手術結束 10:50 麻醉結束 11:05 送出病患 11:10 進入恢復室 13:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 脊椎內脊髓內腫瘤切除術 1 1 摘要__ 手術科部: 外科部 套用罐頭: Resection of filum terminale 開立醫師: 王奐之 開立時間: 2011/12/21 11:02 Pre-operative Diagnosis Filum terminale lipoma Post-operative Diagnosis Filum terminale lipoma Operative Method Resection of filum terminale Specimen Count And Types 1 piece About size:0.5*0.2*0.2cm Source:filum terminale Pathology Pending Operative Findings A segment of filum terminale was resected and sent for pathology. No obvious intradural adhesion of the nerve tissue was noted. Easy oozing from the soft tissue & bony edge was encountered. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position. After scrubbing, disinfection & draping in sterile fashion, a midline linear incision was made at L3-4 level. The incision was further deepened through fascial layer, and the paraspinal muscles were detached from the spinous process & lamina. After adequate exposuse of L3-4 lamina and interlaminary space, the L3 spinous process was reflected superiorly, and the L3-4 space was widened with Kerrison punch. Operating microscope was then brought into the surgical field, a linear durotomy was performed under microscopic view. After some CSF release, the filum terminale was identified, and transected for a segment after bipolar electrocauterization. After meticulous hemostasis, the dura was closed with 5-0 Prolene. The spinous process was fixed back and the wound was closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Resection of filum terminale 開立醫師: 王奐之 開立時間: 2011/12/21 11:02 Pre-operative Diagnosis Filum terminale lipoma Post-operative Diagnosis Filum terminale lipoma Operative Method Resection of filum terminale Specimen Count And Types 1 piece About size:0.5*0.2*0.2cm Source:filum terminale Pathology Pending Operative Findings A segment of filum terminale was resected and sent for pathology. No obvious intradural adhesion of the nerve tissue was noted. Easy oozing from the soft tissue & bony edge was encountered. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position. After scrubbing, disinfection & draping in sterile fashion, a midline linear incision was made at L3-4 level. The incision was further deepened through fascial layer, and the paraspinal muscles were detached from the spinous process & lamina. After adequate exposuse of L3-4 lamina and interlaminary space, the L3 spinous process was reflected superiorly, and the L3-4 space was widened with Kerrison punch. Operating microscope was then brought into the surgical field, a linear durotomy was performed under microscopic view. After some CSF release, the filum terminale was identified, and transected for a segment after bipolar electrocauterization. After meticulous hemostasis, the dura was closed with 5-0 Prolene. The spinous process was fixed back and the wound was closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Resection of filum terminale 開立醫師: 郭夢菲 開立時間: 2011/12/21 12:16 Pre-operative Diagnosis Filum terminale lipoma Post-operative Diagnosis Filum terminale lipoma Operative Method Resection of filum terminale Specimen Count And Types 1 piece About size:0.5*0.2*0.2cm Source:filum terminale Pathology Pending Operative Findings 1. The filum terminale was 1 mm in diameter, not thick and not very tight. 2.A segment of filum terminale was resected and sent for pathology. No obvious intradural adhesion of the nerve tissue was noted. Easy oozing from the soft tissue & bony edge was encountered. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position. After scrubbing, disinfection & draping in sterile fashion, a midline linear incision was made at L3-4 level. The incision was further deepened through fascial layer, and the paraspinal muscles were detached from the spinous process & lamina. After adequate exposuse of L3-4 lamina and interlaminary space, the L3 spinous process was reflected superiorly, and the L3-4 space was widened with Kerrison punch (partial laminectomy of lower L3 and upper L4). Operating microscope was then brought into the surgical field, a linear durotomy was performed under microscopic view. After some CSF release, the filum terminale was identified, and transected for a segment after bipolar electrocauterization. After meticulous hemostasis, the dura was closed with 5-0 Prolene. The spinous process was fixed back and the wound was closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之 相關圖片 黃華雄 (M,1955/03/26,56y11m) 手術日期 2011/12/21 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Cervical Spondylosis 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 2 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 08:08 進入手術室 08:15 麻醉開始 08:35 誘導結束 09:00 抗生素給藥 09:20 手術開始 12:42 手術結束 12:42 麻醉結束 12:50 送出病患 12:51 進入恢復室 14:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 椎間盤切除術-頸椎 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: C3-4 anterior diskectomy and fusion with cage 開立醫師: 陳國瑋 開立時間: 2011/12/21 11:04 Pre-operative Diagnosis HIVD C3-4 Post-operative Diagnosis HIVD C3-4 Operative Method C3-4 anterior diskectomy and fusion with cage Specimen Count And Types nil Pathology nil Operative Findings Operative Procedures Under ETGA and supine position with head mild extended, skin disinfected and drapped were performed as usual. Transverse skin incision was made at cricoid cartilage level. The plane medial to SCM was opened and the plane between carotid artery and esophagus was then dissected. The prevertebral fascia was opened and C3-4 level was localized by C-arm. Retractor was set fo expose C3-4 disc level well. C3-4 discectomy was then performed. Uncinate process were opened with high speed drill. Cage was then inserted. The wound was then closed in layers after a mini-H/V was set at prevertebral area. Operators 賴達明 Assistants 鍾文桂 陳國瑋 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: C3-4 anterior diskectomy and fusion with cage 開立醫師: 鍾文桂 開立時間: 2011/12/21 12:40 Pre-operative Diagnosis HIVD C3-4 Post-operative Diagnosis HIVD C3-4 Operative Method C3-4 anterior diskectomy and fusion with cage Specimen Count And Types nil Pathology nil Operative Findings Presence of spur formation, and bulging disc. 7mm PEEK cage with allograft bone material for spinal fusion. Intact dura mater. No SSEP change intraoperatively. Operative Procedures Under ETGA and supine position with head mild extended, skin disinfected and drapped were performed as usual. Transverse skin incision was made at cricoid cartilage level. The plane medial to SCM was opened and the plane between carotid artery and esophagus was then dissected. The prevertebral fascia was opened and C3-4 level was localized by C-arm. Retractor was set fo expose C3-4 disc level well. C3-4 discectomy was then performed. Uncinate process were opened with high speed drill. Cage was then inserted. The wound was then closed in layers after a mini-H/V was set at prevertebral area. Operators 賴達明 Assistants 鍾文桂 陳國瑋 相關圖片 李靜雄 (M,1943/01/20,69y1m) 手術日期 2011/12/21 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Spinal stenosis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 2 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 12:30 報到 13:10 進入手術室 13:15 麻醉開始 13:35 誘導結束 13:50 抗生素給藥 14:07 手術開始 16:50 抗生素給藥 18:25 手術結束 18:25 麻醉結束 18:32 送出病患 18:35 進入恢復室 20:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 椎間盤切除術-腰椎 1 2 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 記錄__ 手術科部: 外科部 套用罐頭: Transformanial lumbar interbodt fusion and fi... 開立醫師: 鍾文桂 開立時間: 2011/12/21 18:46 Pre-operative Diagnosis L4/5 spondylolisthesis. Post-operative Diagnosis L4/5 spondylolisthesis. Operative Method Transformanial lumbar interbodt fusion and fixation, L4/5. Diskectomy,L4/5 and laminectomy, L4. Specimen Count And Types nil Pathology Nil. Operative Findings Hypertrophic ligamentum flavum. Slack L5 root,right after decompression. bananna PEEK cage: 11mm, Synthes titanium TPS: 6.2*45mm, rods: 5cm. Intact dura mater Operative Procedures 1. ETGA, prone positioning 2. Fluroscopic confirmation of L4-5 3. Linear wound incision, followed by subperiosteal dissection 4. Transpedicular screw fixation to L4 and L5 bilaterally, with 6.2 x 45 mm screws 5. Laminectomy was performed L4, right foraminotomy, interbody cage insertion 6. Rod fixation bilaterally 7. Hemovac placement 8. Wound was closed in layers after gentamicin saline irrigation and meticulous hemostasis Operators 賴達明 Assistants 鍾文桂 陳國瑋 相關圖片 陳巧萱 (F,1936/11/08,75y4m) 手術日期 2011/12/21 手術主治醫師 賴達明 手術區域 東址 005房 01號 診斷 Lumbar spondylosis with myelopathy 器械術式 Diskectomy lumbar，Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 07:53 報到 08:00 進入手術室 08:05 麻醉開始 08:15 誘導結束 08:37 抗生素給藥 09:05 手術開始 11:37 抗生素給藥 12:00 開始輸血 12:25 手術結束 12:25 麻醉結束 12:35 送出病患 12:36 進入恢復室 15:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎間盤切除術-腰椎 1 2 記錄__ 手術科部: 外科部 套用罐頭: 1. L3-5 transpedicular screws for posterior f... 開立醫師: 李振豪 開立時間: 2011/12/21 12:50 Pre-operative Diagnosis L3-5 spondylolisthesis with lumbar stenosis Post-operative Diagnosis L3-5 spondylolisthesis with lumbar stenosis Operative Method 1. L3-5 transpedicular screws for posterior fixation 2. L3/4 sublaminar decompression 3. L4/5 transforaminal lumbar interbody fusion with PEEK cage 4. L3-5 posterolateral fusion with autologous bone graft and Sinbone Specimen Count And Types nil Pathology Nil Operative Findings L3 on L4 and L4 on L5 grade I spondylolisthesis with unstable spine was noted with hypertrophic facet joints, hypertrophic ligmentum flavum, and marginal spur formation which cause severe stenosis of L3 to L5 level, especially L4/5 level. The ligmentum flavum at L4/5 level adhered to the thecal sac and incidental durotomy with about 1.5cm in length was noted during posterior decompression. The nerve roots were pushed back to the thecal sac with Gelfoam and primary closure of the dura with 5-0 prolene was achieved. Remarkable degenerative change of L4/5 intervertebral disc also noted during diskectomy and one #11 PEEK banana cage filled with autologous bone graft was used for interbody fusion. After decompression, the thecal sac expanded well. L3-5 foraminotomy also done. Four 6.2 x 40mm transpedicular screws and two 7cm rods were used for posterior instrumentation(L3 and L5). L3 to L5 posterolateral fusion was conducted with autologous bone graft mixed with Sinbone artificial bone graft after posterior instrumentation. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position. The L3 and L5 pedicle were localized by portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made from L3 to L5 level. The subcutaneou soft tissue was devided and the paravertebral muscle groups were detached. L3 and L5 transpedicular screws were inserted under fluoroscopy guided. L3/4 laminotomy for sublaminar decompression was conducted for decompression. L4/5 laminotomy and left side facetectomy was performed also for TLIF. Incidental durotomy was noted during resection of ligmantum flavum and dura was repaired with 5-0 prolene directly. After L4/5 left side facetectomy, L4/5 lumbar diskectomy was done and one #11 PEEK banana cage filled with autologous bone graft was inserted for interbody fusion. Rods were applied for posterior fixation. L3-5 posterolateral fusion with autologous bone graft mixed with Sinbone artificial bone graft was done. One epidural CWV drain was placed. The wound was irrigated with Gentamicin solution. The wound was then closed in layers with 1-0, 2-0 Vicryl and 3-0 Nylon. Operators VS賴達明 Assistants R5李振豪, PGY劉明侑 相關圖片 黃哲男 (M,1945/02/25,67y0m) 手術日期 2011/12/21 手術主治醫師 楊士弘 手術區域 東址 020房 03號 診斷 Herniated intervertebral disc (HIVD) 器械術式 Radiofrequency coagulation 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 蔡宗良, 時間資訊 15:55 進入手術室 16:00 麻醉開始 16:05 誘導結束 16:10 手術開始 16:25 手術結束 16:25 麻醉結束 16:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 高頻熱凝療法 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: L4 root rinderon injection, right-sided 開立醫師: 蔡宗良 開立時間: 2011/12/21 16:48 Pre-operative Diagnosis L4 radiculopathy, right-sided Post-operative Diagnosis L4 radiculopathy, right-sided Operative Method L4 root rinderon injection, right-sided Specimen Count And Types nil Pathology None Operative Findings Urograffin did not enter the thecal sac Operative Procedures 1. Prone positioning 2. Routine preparation and drapping 3. Confirmation of L4 by K-pin under fluroscopy 4. Local anesthesia with 1% lidocaine 5. Insertion of 19G spinal needle reaching L4 root under L4 pedicle into the neuroforamen 6. Injection of urograffin 7. Injection of 2 ampoules of Rinderon 8. Wound was covered with dry gauze Operators VS 楊士弘 Assistants R6 蔡宗良 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: L4 root rinderon injection, right-sided 開立醫師: 蔡宗良 開立時間: 2011/12/21 16:48 Pre-operative Diagnosis L4 radiculopathy, right-sided Post-operative Diagnosis L4 radiculopathy, right-sided Operative Method L4 root rinderon injection, right-sided Specimen Count And Types nil Pathology None Operative Findings Urograffin did not enter the thecal sac Operative Procedures 1. Prone positioning 2. Routine preparation and drapping 3. Confirmation of L4 by K-pin under fluroscopy 4. Local anesthesia with 1% lidocaine 5. Insertion of 19G spinal needle reaching L4 root under L4 pedicle into the neuroforamen 6. Injection of urograffin 7. Injection of 2 ampoules of Rinderon 8. Wound was covered with dry gauze Operators VS 楊士弘 Assistants R6 蔡宗良 相關圖片 摘要__ 手術科部: 外科部 套用罐頭: Transforaminal steroid injection, L4 nerve ro... 開立醫師: 楊士弘 開立時間: 2011/12/22 10:00 Pre-operative Diagnosis L4 radiculopathy, right-sided Post-operative Diagnosis L4 radiculopathy, right-sided Operative Method Transforaminal steroid injection, L4 nerve root, right-sided Specimen Count And Types nil Pathology None Operative Findings Contrast medium did not enter the thecal sac or blood vessels Operative Procedures 1. Prone positioning 2. Routine preparation and drapping 3. Confirmation of L4 by K-pin under fluroscopy 4. Local anesthesia with 1% lidocaine 5. Insertion of 23 G spinal needle to reach right L4 root under L4 pedicle into the neuroforamen 6. Injection of Omnipaque, 1 c.c., under real time C-arm fluoroscopy 7. Injection of 2 ampoules of Rinderon (2.5 mg, 0.5 c.c./amp) and 1% lidocaine (0.5 c.c.) 8. Wound was covered with dry gauze Operators VS 楊士弘 Assistants R6 蔡宗良 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Transforaminal steroid injection, L4 nerve ro... 開立醫師: 蔡宗良 開立時間: 2011/12/22 15:53 Pre-operative Diagnosis L4 radiculopathy, right-sided Post-operative Diagnosis L4 radiculopathy, right-sided Operative Method Transforaminal steroid injection, L4 nerve root, right-sided Specimen Count And Types nil Pathology None Operative Findings Contrast medium did not enter the thecal sac or blood vessels Operative Procedures 1. Prone positioning 2. Routine preparation and drapping 3. Confirmation of L4 by K-pin under fluroscopy 4. Local anesthesia with 1% lidocaine 5. Insertion of 23 G spinal needle to reach right L4 root under L4 pedicle into the neuroforamen 6. Injection of Omnipaque, 1 c.c., under real time C-arm fluoroscopy 7. Injection of 2 ampoules of Rinderon (2.5 mg, 0.5 c.c./amp) and 1% lidocaine (0.5 c.c.) 8. Wound was covered with dry gauze Operators VS 楊士弘 Assistants R6 蔡宗良 相關圖片 高于祥 (M,2011/11/15,4m0d) 手術日期 2011/12/21 手術主治醫師 楊士弘 手術區域 兒醫 067房 02號 診斷 Fever 器械術式 Evacuation of subgaleal hematoma & debridement 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 11:35 進入手術室 11:40 麻醉開始 12:20 誘導結束 12:50 手術開始 12:58 抗生素給藥 13:20 手術結束 13:20 麻醉結束 13:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 深部傷口處理縫合擴創-中 1 0 R 摘要__ 手術科部: 套用罐頭: Hematoma evacuation, debridement and primary ... 開立醫師: 王奐之 開立時間: 2011/12/21 13:24 Pre-operative Diagnosis Right frontoparietal subgaleal hematoma & cephalohematoma, infected Post-operative Diagnosis Right frontoparietal cephalohematoma, infected Operative Method Hematoma evacuation, debridement and primary closure Specimen Count And Types Nil Pathology Nil Operative Findings Yellowish pus accumulated underneath the periosteum, mixed with old hematoma. Calcified periosteum was noted. No obvious subgaleal hematoma. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After scrubbing, disinfection & draping in sterile fashion, a curvilinear incision was made at right frontoparietal area. The incision was carefully deepened until entering the pus cavity. After removal of the pus and vigorous irrigation with normal saline, a CWV drain was inserted into the cavity. The calcified periosteum was approximated, and the wound was closed in layers. Operators VS 楊士弘 Assistants R4 王奐之 相關圖片 記錄__ 手術科部: 套用罐頭: Hematoma evacuation, debridement and primary ... 開立醫師: 王奐之 開立時間: 2011/12/21 13:24 Pre-operative Diagnosis Right frontoparietal subgaleal hematoma & cephalohematoma, infected Post-operative Diagnosis Right frontoparietal cephalohematoma, infected Operative Method Hematoma evacuation, debridement and primary closure Specimen Count And Types Nil Pathology Nil Operative Findings Yellowish pus accumulated underneath the periosteum, mixed with old hematoma. Calcified periosteum was noted. No obvious subgaleal hematoma. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After scrubbing, disinfection & draping in sterile fashion, a curvilinear incision was made at right frontoparietal area. The incision was carefully deepened until entering the pus cavity. After removal of the pus and vigorous irrigation with normal saline, a CWV drain was inserted into the cavity. The calcified periosteum was approximated, and the wound was closed in layers. Operators VS 楊士弘 Assistants R4 王奐之 相關圖片 張雅嵐 (F,1982/12/29,29y2m) 手術日期 2011/12/22 手術主治醫師 李苑如 手術區域 東址 008房 08號 診斷 Ureteral stone 器械術式 U.R.S.-S.M. 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 靜脈麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 陳柏誠, 時間資訊 12:55 報到 13:15 進入手術室 13:20 麻醉開始 13:25 誘導結束 13:30 抗生素給藥 13:33 手術開始 13:46 手術結束 13:46 麻醉結束 14:15 送出病患 14:20 進入恢復室 14:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 輸尿管鏡取石術或碎石術–併用雷射治療方式 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 記錄__ 手術科部: 泌尿部 套用罐頭: URS-SM 開立醫師: 陳柏誠 開立時間: 2011/12/22 13:42 Pre-operative Diagnosis left ureteral stone with hydronephrosis Post-operative Diagnosis left ureteral stone with hydronephrosis Operative Method URS-SM Specimen Count And Types nil Pathology Operative Findings A yellowish stone obstructed at left lower ureter with hydronephrosis was crushed by Holmium Laser Operative Procedures Under satisfactory anesthesia with the patient in the lithotomy position, skin preparation was performed. A cystoscope was inserted into the bladder and a guidewire was then introduced into the ureteral orifice. A 6 Fr. ureteroscope was introduced into the ureter. A yellowish stones was noted at left ureter and crushed by Holmium Laser A Fr.6-24cm DBJ catheter was inserted. A 16 Fr. Foley catheter was placed in the urinary bladder. The patient tolerated the operation well and was sent to the recovery room in stable condition. Operators 李苑如, Assistants 陳柏誠, 曾任偉, 潘君婷 (F,1972/06/19,39y8m) 手術日期 2011/12/22 手術主治醫師 陳敞牧 手術區域 東址 002房 02號 診斷 Compression fracture 器械術式 Spinal fusion posterior 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2E 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 07:30 通知急診手術 09:40 報到 09:50 進入手術室 10:00 麻醉開始 10:20 誘導結束 10:45 抗生素給藥 10:52 手術開始 12:25 開始輸血 13:29 手術結束 13:29 麻醉結束 13:40 送出病患 13:43 進入恢復室 15:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 惡性脊髓腫瘤切除術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 2 記錄__ 手術科部: 外科部 套用罐頭: 1. T8 and partial T7 laminectomy for tumor ex... 開立醫師: 李振豪 開立時間: 2011/12/22 14:03 Pre-operative Diagnosis T8 metastatic tumor with spinal cord compression Post-operative Diagnosis T8 metastatic tumor with spinal cord compression Operative Method 1. T8 and partial T7 laminectomy for tumor excision 2. Bilateral T8 rhizotomy 3. T7 and T9 transpedicular screws for posterior fixation Specimen Count And Types 1 piece About size:Multiple pieces Source:T8 spinal tumor Pathology Pending Operative Findings The tumor was hypervascularized and red-whitish in color which mainly within T8 with bony destruction and thecal sac compression. Bilateral T8 roots also encased by the tumor. Circumferential decompression of T8 level was achieved and the thecal sac expanded well. Bilateral T8 rhizotomy was done for back pain control. Posterior fixation was performed with four 5.5 x 40mm transpedicular screws, one 8cm and one 9cm rod, and one cross-link. No incidental durotomy or CSF leakage was found during whole procedure. Total blood loss: 1100ml. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position. T7 to T9 level were localized by portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made and the subcutaneous soft tissue was devided. The paravertebral muscle groups were detached to expose T7 to T9 laminae. T7 and T9 transpedicular screws were inserted under fluoroscope guided. T8 and partial T7 laminectomy was conducted for tumor excision. Bilateral T8 pediculectomy also performed for excision the tumor anterior to spinal cord. After circumferential decompression of spinal cord, hemostasis was achieved with bipolar electrocautery and gelfoam packing. Bilateral T8 rhizotomy was done with Hemoclip. Two rods and one cross-link were applied for posterior fixation. One epilaminal Hemovac was placed. The wound was then closed in layers with 1-0, 2-0 vicryl and 3-0 Nylon. Operators VS陳敞牧 Assistants R5李振豪, PGY連子賢 Indication Of Emergent Operation Urinary and stool incontinence 相關圖片 胡進福 (M,1945/12/26,66y2m) 手術日期 2011/12/22 手術主治醫師 詹志洋 手術區域 東址 016房 01號 診斷 Spine bone metastasis 器械術式 Port-A catheter implatation 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 莊民楷, 時間資訊 08:10 進入手術室 08:45 麻醉開始 08:48 誘導結束 08:50 手術開始 09:00 抗生素給藥 09:15 手術結束 09:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 內頸靜脈切開,永久導管放置術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Port-A implantation, RIJV 開立醫師: 莊民楷 開立時間: 2011/12/22 09:17 Pre-operative Diagnosis Spine metastatic carcinoma Post-operative Diagnosis Spine metastatic carcinoma Operative Method Port-A implantation, RIJV Specimen Count And Types nil Pathology Nil Operative Findings 1. blood return smooth after port-A implantation Operative Procedures 1. LA, supine 2. Disinfection and drapping 3. Right internal jugular vein puncture 4. Right upper chest wall linear skin incision, 3cm 5. Create subcutaneous pouch, fix port-A 6. Insert port-A catheter through guidewire and sheath 7. Close the wound in layer Operators VS 詹志洋 Assistants R4 莊民楷 陳振文 (M,1983/09/29,28y5m) 手術日期 2011/12/22 手術主治醫師 蕭輔仁 手術區域 東址 003房 04號 診斷 Low back pain 器械術式 Radiofrequency coagulation(P-G 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 16:20 進入手術室 16:25 手術開始 17:23 手術結束 17:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 高頻熱凝療法 1 1 B 記錄__ 手術科部: 外科部 套用罐頭: Bilateral L2 dorsal root ganglion radiofreque... 開立醫師: 陳國瑋 開立時間: 2011/12/22 17:49 Pre-operative Diagnosis Low back pain Post-operative Diagnosis Low back pain Operative Method Bilateral L2 dorsal root ganglion radiofrequency ablation Specimen Count And Types nil Pathology nil Operative Findings The ablation needle was introduced to the bilateral upper outer fourth quadrent of neuroforamen. The ablation temprature was set at 42 Celsius degrees and 180 seconds per cycle for two cycles. Operative Procedures 1. Prone 2. Skin disinfected and draped 3. C-arm localization of T2 pedicles 4. Local anesthesia 5. Introduce the ablation needle to the left L2-3 neuroforamen and begin radiofrequency ablation 6. Repeat the same procedure to the right side Operators 蕭輔仁 Assistants 陳國瑋 Ri 相關圖片 張蓬玉 (M,1951/01/03,61y2m) 手術日期 2011/12/22 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Spondylosis,cervical 器械術式 Lamino plasty 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:20 麻醉開始 08:30 誘導結束 08:40 抗生素給藥 08:43 手術開始 11:05 手術結束 11:05 麻醉結束 11:16 送出病患 11:17 進入恢復室 12:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓切除術(減壓)-二節以內 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 記錄__ 手術科部: 外科部 套用罐頭: Leminectomy C4-5 + Hemilamonectomy C6 開立醫師: 曾偉倫 開立時間: 2011/12/22 11:24 Pre-operative Diagnosis Cervical stenossi status post disectomy and fixation, C3-6 Post-operative Diagnosis Cervical stenossi status post disectomy and fixation, C3-6 Operative Method Leminectomy C4-5 + Hemilamonectomy C6 Specimen Count And Types nil Pathology Nil Operative Findings 1. OPLL over C3-6 level with canal stenosis, especially over C4-5 level with myelopathy 2. The thecal sac expanded well after laminectomy 3. No SSEP or MEP change during the operation Operative Procedures Under ETGA, we fixed his head with Mayfield clamp. We placed him on prone position and shaving was performed. We scrubbed, disinfected, drapped and a mid-line linear skin incision was done from C2 to C6 level. The soft tissue and paraspinal muscle was dissected. Leminectomy C4-5 + Hemilamonectomy C6 were perfomred with air-drived drill. After complete hemostasis, a CWV was placed. The wound was closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS 王國川 Assistants R3 曾偉倫 Ri 相關圖片 高良信 (M,1945/05/10,66y10m) 手術日期 2011/12/22 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 Compression fracture, pathological, spontaneous 器械術式 Laminectomy for decompression，Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 11:48 進入手術室 11:50 麻醉開始 12:05 誘導結束 12:35 手術開始 14:05 開始輸血 15:10 手術結束 15:10 麻醉結束 15:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 手術 椎弓切除術(減壓)-二節以內 1 2 手術 椎間盤切除術-腰椎 1 1 記錄__ 手術科部: 外科部 套用罐頭: L4 laminectomy with partial diskectomy L4-5 a... 開立醫師: 曾偉倫 開立時間: 2011/12/22 15:38 Pre-operative Diagnosis L4 compression fracture, suspect pathologicle fracture Post-operative Diagnosis L4 compression fracture, suspect pathologicle fracture Operative Method L4 laminectomy with partial diskectomy L4-5 and corpectomy L4 Specimen Count And Types 3 pieces About size:2x1x1 cm Source:1.Lamina About size:1x1x1 cm Source:2.facet About size:1x1x1 cm Source:3.body Pathology Pending Operative Findings 1. The lamina of L4 became soft and osteopenic and the biopsy was done. 2. Some greyish tumor like lesion was collected from L4-5 disk and L4 body 3. The thecal sac expanded well after the laminectomy Operative Procedures Under ETGA, we placed the patient on prone position. The L4-5 level was located with intra-operative C-arm. After we scrubbed, disinfected and drapped, a linear skin incision was made over L4-5 level. The soft tissue and paraspinal muscles were resected and the L4 spinous process and lamina was exposed. L4 laminectomy was done with Rongour and Kerrison punch, part of the L4 lamina and right L4-5 facet joint were send for pathology. After we release the thecal sac, corpectomy for tissue bipsy was done with curret. After complete hemostasis, a hemovac drain was placed and the wound was closed in alyers with 2-0 Vicryl and 3-0 Nylon. Operators VS 王國川 Assistants R3 曾偉倫 Ri 相關圖片 黃啟瑞 (M,1972/03/29,39y11m) 手術日期 2011/12/22 手術主治醫師 蔡翊新 手術區域 東址 005房 01號 診斷 Injury (severity score >=16) 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 翁上硯, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:10 麻醉開始 08:15 誘導結束 08:20 抗生素給藥 08:33 報到 09:05 手術開始 11:20 抗生素給藥 11:35 手術結束 11:35 麻醉結束 11:45 送出病患 11:46 進入恢復室 12:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 手術 頭顱成形術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Cranioplasty 開立醫師: 蔡翊新 開立時間: 2011/12/22 10:59 Pre-operative Diagnosis Right frontotemporoparietal skull defect. Post-operative Diagnosis Right frontotemporoparietal skull defect. Operative Method Cranioplasty with autologous bone graft. Specimen Count And Types nil Pathology Nil. Operative Findings A skull defect, 14 x 12 cm, at right frontotemporoparietal region. The dura was slightly bulging, but the bone graft could still be placed back. The right temporalis muslce had been excised during previous craniectomy and its bulk was replaced with a piece of bone cement. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation:shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with a sterilized adhesive plastic sheet. 4. Incision: along the previous operation scar at right frontotemporoparietal area, Raney clips were applied to the scalp edge for temporary hemostasis. 5. The right frontotemporoparietal scalp was dissected away from the underlying dura. 6. The bleeders on the dissected surfaces were coagulated with Bovie painstakingly. 7. The edge of the skull defect was exposed. 8. The original skull plate preserved at bone back was soaked with Vancomycin solution and placed back to the skull window then fixed by 3 miniplates and 6 screws, with several dural tentings at the center of the skull plate. 9. Bone cement paste was applied to the outer surface of the temporal bone to replace the bulk of excised temporalis muscle. 10.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by interrupted suture with 3/0 nylon. 11.Drain: two epidural CWV drains. 12.Blood transfusion: nil. Blood loss: 450 ml. 13.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R6蔡宗良R0翁上硯 相關圖片 廖接宇 (M,1959/03/25,52y11m) 手術日期 2011/12/23 手術主治醫師 蔡翊新 手術區域 東址 002房 05號 診斷 Major trauma rated 16 or above on the severity scale ( Injury severity score >=16 ) 器械術式 ICP monitoring 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 石博元 ASA 3E 紀錄醫師 陳國瑋, 時間資訊 07:20 臨時手術NPO 07:20 開始NPO 23:21 通知急診手術 00:25 進入手術室 00:27 麻醉開始 00:45 誘導結束 01:15 手術開始 02:10 手術結束 02:10 麻醉結束 02:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱內壓視置入 1 1 L 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 蔡翊新 開立時間: 2011/12/23 02:10 Pre-operative Diagnosis Head injury with right temporal skull fracture and left frontotemporal acute SDH and contusion. Post-operative Diagnosis Head injury with right temporal skull fracture and left frontotemporal acute SDH and contusion. Operative Method Left frontal burr hole for ICP monitoring. Specimen Count And Types nil Pathology Nil. Operative Findings Subdural hematoma and effusion were noted upon burr hole creation and dural opening. The brain was not bulging out. ICP was 12 mmHg. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 5 cm at left frontal area, the skin edge was clipped by Raney clips for temporary hemostasis. 5. A burr hole was made at left Kocher point. A Camino ICP monitor was inserted to subdural space at left frontotemporal region. 6. Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 7. Blood transfusion: nil. Blood loss: minimal. 8. Course of the surgery: smooth. Operators VS蔡翊新 Assistants R3陳國瑋 Indication Of Emergent Operation Head injury with comatous consciousness and dilated pupils. 相關圖片 林佑樺 (F,1949/04/23,62y10m) 手術日期 2011/12/22 手術主治醫師 蔡翊新 手術區域 東址 005房 05號 診斷 Intracerebral hemorrhage 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 翁上硯, 時間資訊 00:00 臨時手術NPO 11:18 報到 11:57 進入手術室 12:00 麻醉開始 12:10 誘導結束 12:15 抗生素給藥 12:43 手術開始 13:48 手術結束 13:48 麻醉結束 14:05 送出病患 14:10 進入恢復室 15:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室腹腔分流手術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 蔡翊新 開立時間: 2011/12/22 13:50 Pre-operative Diagnosis Left basal ganglia ICH with IVH. Hydrocephalus. Post-operative Diagnosis Left basal ganglia ICH with IVH. Hydrocephalus. Operative Method Right Kocher point VP shunt, Codman programmable. Specimen Count And Types 3 tubes of CSF, sent for routine, BCS and bacterial culture. Pathology Nil. Operative Findings CSF: clear, pressure: 10 cmH2O. Ventricular catheter: 6.2 cm in depth. Pressure setting: 120 mmH2O. Peritoneal catheter: 25 cm in depth. Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: supine with head rotated to left. 3.Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 6 cm linear, right frontal, along previous wound, corresponded to the location of right frontal horn. Raney clips were applied to the scalp edge for temporary hemostasis. 5.After the scalp flap had been lifted and reflected anteriorly, a burr hole was made and the dura was tented by 2 stitches. 6.The dura was opened by a nib incision. Right lateral ventricle was tapped by a ventricular needle, then a 6.2 cm segment of the ventricular catheter was introduced into the ventricle. The outer end of the catheter was connected to a Codman programmable reservoir. 7. A minilaparotomy was made at RUQ of the abdomen, then a trocar was pushed into peritoneal cavity. Subsequently, distal 25 cm segment of the peritoneal catheter was introduced into the peritoneal cavity through the outer tube of the trochar. The proximal end of this catheter was passed through subcutaneous tunnel at forechest, neck, right retroauricular area and connected the reservoir. The shunt system was checked to make sure its function was working. 8. The reservoir was fixed to pericranium by 1 stitch. 9. Scalp closure: hemostasis was done with polar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 10.Blood transfusion: nil. Blood loss: minimal. 11.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R6蔡宗良R0翁上硯 相關圖片 林育慶 (M,1976/04/24,35y10m) 手術日期 2011/12/23 手術主治醫師 謝榮賢 手術區域 東址 023房 05號 診斷 Finger Injury 器械術式 1.proximal phulanx corrrctive osteotomy 2.PIP joint flexion contructure release 3.EDC tendon repair 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 陸惠宗, 時間資訊 14:15 報到 15:36 進入手術室 15:45 麻醉開始 15:50 誘導結束 15:50 抗生素給藥 16:18 手術開始 17:55 手術結束 17:55 麻醉結束 18:05 送出病患 18:10 進入恢復室 19:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 矯正切骨術–其他部位骨盆除外 1 1 R 手術 肌腱黏連分離術 1 2 R 記錄__ 手術科部: 骨科部 套用罐頭: 1. Tenolysis of the extensor tendon at index ... 開立醫師: 陸惠宗 開立時間: 2011/12/23 18:06 Pre-operative Diagnosis Right index finger MP joint Post-operative Diagnosis Ditto Operative Method 1. Tenolysis of the extensor tendon at index finger 2. Corrective osteotomy of the right 2nd proximal phalange Specimen Count And Types nil Pathology nil Operative Findings 1. Severe adhesion of extensor tendon at index finger 2. Malunion at previous operation site in the right index finger, apex volar angulation Operative Procedures 1. ETGA, supine position with right hand stretched out. 2. Tourniquet was set 250mmHg on right arm. 3. Incise along the 2nd MP joint. 4. Adheolysis and tenolysis around the 2nd MP joint region. 5. Osteotomy was made to the right 2nd proximal phalange. 6. The cutting edge was shaped with saw. 7. Mini-Plate and one 1.9mm and three 1.7mm screw were used to fix the osteotomy site. 8. Tourniquet was set off. 9. Normal saline irrgation was done. 10. Meticulous hemostasis was performed. 11. The wound was closed with 4-0 Monocryl and 5-0 Nylon in layers. Operators VS謝榮賢 Assistants R4趙崧筌, R1陸惠宗 相關圖片 余萬年 (M,1946/05/17,65y9m) 手術日期 2011/12/23 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Acromegaly 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 07:43 報到 08:05 進入手術室 08:10 麻醉開始 08:25 誘導結束 09:24 手術開始 10:13 麻醉結束 10:13 手術結束 10:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經由蝶竇之腦下垂體瘤切除 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 記錄__ 手術科部: 外科部 套用罐頭: Trans-nasal trans-sphenoidal adenomectomy 開立醫師: 李振豪 開立時間: 2011/12/23 10:35 Pre-operative Diagnosis Growth hormone-secreting pituitary adenoma Post-operative Diagnosis Growth hormone-secreting pituitary adenoma Operative Method Trans-nasal trans-sphenoidal adenomectomy Specimen Count And Types 1 piece About size:Multiple small pieces Source:Pituitary tumor Pathology Pending Operative Findings The tumor was 8.4 x 5.5 x 8.6mm in size, hypovascularized, whitish, well-demarcated, and soft in character. The tumor was mainly located at left inferior part of the sellar region. After total removal of the tumor, red-yellowish normal gland was found at the upper part of the sellar region and preserved well. No CSF leakage noted during whole procedure. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position. The face and, nasal cavity, and oral cavity was disinfected as usual. The ostium of sphenoid sinus was identified. The right side nasal mucosa of the septum was infiltrated with Xylocaine solution. One 2.5cm linear vertical mucosa incision was made at right side septum and the submucosal dissection was conducted till the ostium of the sphenoid sinus was identified. The nasal septum was fractured and the left side mucosa was dissected also to expose left side ostium of sphenoid sinus. A Hardy"s nasal speculum was applied to displace the nasal mucosa laterally and keep the nasal cavity open constantly for the exposure of the vomer bone and the anterior wall of the sphenoid sinus. The floor of sphenoid sinus was opened with osteotome then widened by Kerrison punches. The mucosa of sphenoid sinus was removed. The sellar floor was identified and opened with osteotome. The dura was coagulated and cruciform durotomy was made. The tumor was encountered and tumor excision was performed by dissector, ring curette, suction, and alligator. Hemostasis was achieved with Gelfoam packing. The sellar floor and Vomer bone was placed back for reconstruction of skull base. The nasal mucosa and the middle turbinate was pushed back to it"s neutral position. Right side nasal cavity was packed with a segment of glove filled with one gauze strips which had been soaked with Better-iodine ointment. Operators VS曾漢民 Assistants R5李振豪 相關圖片 吳裕華 (F,1946/01/22,66y1m) 手術日期 2011/12/23 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 10:20 報到 10:40 進入手術室 10:45 麻醉開始 11:10 抗生素給藥 11:10 誘導結束 11:30 手術開始 13:32 開始輸血 14:10 抗生素給藥 15:25 麻醉結束 15:25 手術結束 15:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 顱底瘤手術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Right orbitozygomatic approach for Simpson gr... 開立醫師: 李振豪 開立時間: 2011/12/23 16:01 Pre-operative Diagnosis Right sphenoid ridge meningioma Post-operative Diagnosis Right sphenoid ridge meningioma Operative Method Right orbitozygomatic approach for Simpson grade II tumor excision Specimen Count And Types 1 piece About size:Multiple pieces Source:Right temporal meningioma Pathology Frozen section: WHO grade I meningioma Operative Findings The tumor was 5.6 x 4.2 x 4.9cm in size, hypervascularized, gray-reddish in color, soft, and well-demarcated. The attachment of the tumor was mainly at right temporal base and sphenoid ridge with numerous feeding artery. Frozen section was sent and WHO grade I meningioma was favored. The cavernous sinus was kept intact after tumor excision. The most of the arachnoid membrane was also preserved. The optic nerve and major cerebral vessel were not exposed. The brain became very slack after removal of the tumor. One 1.5 x 1.5cm dural defect was noted after tumor excision. A 4x2cm pedicle flap of temporalis muscle was reflected into the skull base for repair of the dura defect. Tissucol Duo was applied both inside and outside of the dura for augmentation. Total blood loss: 1000ml. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with right shoulder elevation. The head was turned to left and fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. A curvilinear scalp incision was made at right fronto-temporal area and the scalp flap was elevated with facial nerve preservation. The temporalis muslce was detached from skull bone and reflected to inferoposteriorly. Four burrholes were created and orbitozygomatic craniotomy was made. The sphenoid ridge and lower part of temporal bone was removed by ronguer. Dural tenting was done. C-shape durotomy was made based with right fronto-temporal base. Devascularization was achieved by detaching the tumor from temporal base. Debulking was performed with bipolar electrocautery, suction, tumor forceps, and scissor. The tumor was then dissected along the arachnoid plan. After total removal of the tumor, hemostasis was achieved with bipolar electrocautery and Surgicel lining. Part of right temporalis muscle was used as pedicle flap and reflected into temporal base for repair of dural defect. Tissucol Duo was applied inside and outside of the dura to avoid CSF leakage. The dura was closed with 4-0 prolene and COOK artificial dura. The right temporal base was packing with Gelfoam. The skull plate was fixed back with miniplates, screws, and two central tenting. The tmeporalis muscle was fixed back to its neutral position. The wound was then closed in layers with 2-0 Vicryl and Appose staples. Operators VS曾漢民 Assistants R5李振豪, Ri黃子晏 相關圖片 林宛琦 (F,1987/11/06,24y4m) 手術日期 2011/12/23 手術主治醫師 曾漢民 手術區域 東址 005房 03號 診斷 Spinal cord cancer 器械術式 Benign intraspinal tumor, exci 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 15:53 進入手術室 16:00 麻醉開始 16:06 抗生素給藥 16:10 誘導結束 16:52 手術開始 19:06 抗生素給藥 19:30 手術結束 19:35 麻醉結束 19:45 送出病患 19:45 進入恢復室 醫令資訊 類別 名稱 量 刀 側 手術 良性脊髓腫瘤切除術 1 1 手術 椎弓整形術 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 記錄__ 手術科部: 外科部 套用罐頭: T12-L2 laminoplasty for intraspinal tumor exc... 開立醫師: 李振豪 開立時間: 2011/12/23 20:17 Pre-operative Diagnosis 1. T12-L1 intraspinal meningioma, 2. Multiple intraspinal neuroma, 3. Neurofibromatosis, type II Post-operative Diagnosis 1. T12-L1 intraspinal meningioma, 2. Multiple intraspinal neuroma, 3. Neurofibromatosis, type II Operative Method T12-L2 laminoplasty for intraspinal tumor excision Specimen Count And Types 2 pieces About size:2.6 x 1.3 x 1.7cm Source:T12-L1 intraspinal meningioma About size:Multiple pieces Source:L1~L2 multiple intraspinal neuroma Pathology Pending Operative Findings T12-L1 maningioma was 2.6 x 1.3 x 1.7 cm in size, soft, normovascularized, well-demarcated, and pinkish in color. The dura attachment was at left posterolateral side of thecal sac. The spinal cord and nerve roots were pushed to right anterolateral part tightly and decompressed well after tumor excision. Numerous intraspinal neuroma was noted within the operative field. The largest one was 1.1 x 1.3 x 1.1cm in size. Total six neuroma was removed. However, there was still numerous tiny neuroma which hard to excise without root damage. So we left the tumor in situ under the consideration of functional preserve. Besides, one 5mm in diameter tumor was adhered to right posterior part of T12 spinal cord. We tried to remove the tumor but right lower limb SSEP was absent transiently. Dissection of the tumor was withheld. The SSEP recovered soon. Left side(both upper and lower limbs) SSEP was poor before the operation and no significant change found at the end of the operation. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position. T12 to L2 level were localized by portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made from T12 to L2 level. The subcutaneous soft tissue was devided and the paraspinal muscle groups were detached. T12 to L2 laminectomy was conducted with Midas high-speed drills. Linear durotomy was made and tenting with adjacent soft tissue. T12-L1 meningioma was identified. The tumor was detached from the dura with dissector first for devascularization. Then the tumor was removed totally along the arachnoid plan. The dura attachment of the meningioma was coagulated with bipolar electrocautery. The arachnoid membrane was opened and total six intraspinal neuroma was removed with microdissector and microscissor. There are still a lot of tiny neuroma but dissection was difficult to achieve with good anatomical preservation of nerve root. Furthermore, right lower limb SSEP was transient absent during dissection of a neuroma which adhered to the right posterior part of the spinal cord at T12 level. So we left the rest of tiny neuroma in situ. Hemostasis was achieved with direct compression and bipolar electrocautery. Dura was closed with 5-0 prolene. Laminoplasty with miniplates and screws was done. One epilaminal CWV drain was placed. The wound was closed in layers with 1-0, 2-0 vicryl and Appose staples. Operators VS曾漢民 Assistants R5李振豪 相關圖片 桑劉秀鳳 (F,1951/12/18,60y2m) 手術日期 2011/12/23 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Chronic conjunctivitis 器械術式 Benign intraspinal tumor, exci 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳國瑋, 鍾文桂, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:10 麻醉開始 08:25 誘導結束 08:30 抗生素給藥 08:47 手術開始 11:30 抗生素給藥 14:27 手術結束 14:27 麻醉結束 14:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 脊椎內脊髓內腫瘤切除術 1 1 手術 椎弓整形術 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: C4-5 laminoplasty for total tumor excision. 開立醫師: 鍾文桂 開立時間: 2011/12/23 14:13 Pre-operative Diagnosis Intramedullary tumor suspected hemangioblastoma Post-operative Diagnosis Intramedullary tumor suspected hemangioblastoma Operative Method C4-5 laminoplasty for total tumor excision. Specimen Count And Types 1 piece About size:1.3cm Source:intramedullary spinal tumor Pathology pending Operative Findings A well delineated reddish hypervascularized mass at C4/5 level. Intraoperative SSEP has no change. Moderate cord swelling even after tumor resection. We gave him megadose steroid as prophylactics. The cord was kept intact during tumor resection. A small drainage vein was noted at the inferior border of the tumor. It was electrocoagulated. The dura mater was closed in watertight fashion. Laminoplasty was achieved with mini plates and screws. Operative Procedures Under ETGA, the patient was put in supine position and the head was fixed with Mayfield clamp. She was then turned into prone position. The skin was disinfected and draped as usual. One linear skin incision was made. Paraspinal dissection was obtained. Under ETGA, the patient was put in supine position and the head was fixed with Mayfield clamp. She was then turned into prone position. The skin was disinfected and draped as usual. One linear skin incision was made. Paraspinal dissection was obtained. Then, C4/5 laminectomy was done. After linear durotomy, the tumor was noted and resected meticulously in en bloc fashion. After ensuring complete tumor resection, the dura mater was closed in watertoght fashion. The laminae were fixed by miniplates and screws. The paraspinal muscle was re-approximated. The wound was closed in layers with one submuscular CWV drain. Operators 賴達明 賴達明 Assistants 鍾文桂 陳國瑋 鍾文桂 陳國瑋 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: C4-5 laminoplasty for total tumor excision. 開立醫師: 陳國瑋 開立時間: 2011/12/23 14:51 Pre-operative Diagnosis Intramedullary tumor suspected hemangioblastoma Post-operative Diagnosis Intramedullary tumor suspected hemangioblastoma Operative Method C4-5 laminoplasty for total tumor excision. Specimen Count And Types 1 piece About size:1.3cm Source:intramedullary spinal tumor Pathology pending Operative Findings A well delineated reddish hypervascularized mass at C4/5 level. Intraoperative SSEP has no change. Moderate cord swelling even after tumor resection. We gave him megadose steroid as prophylactics. The cord was kept intact during tumor resection. A small drainage vein was noted at the inferior border of the tumor. It was electrocoagulated. The dura mater was closed in watertight fashion. Laminoplasty was achieved with mini plates and screws. Operative Procedures Under ETGA, the patient was put in supine position and the head was fixed with Mayfield clamp. She was then turned into prone position. The skin was disinfected and draped as usual. One linear skin incision was made. Paraspinal dissection was obtained. Then, C4/5 laminectomy was done. After linear durotomy, the tumor was noted and resected meticulously in en bloc fashion. After ensuring complete tumor resection, the dura mater was closed in watertoght fashion. The laminae were fixed by miniplates and screws. The paraspinal muscle was re-approximated. The wound was closed in layers with one submuscular CWV drain. Operators 賴達明 Assistants 鍾文桂 陳國瑋 相關圖片 辛宗翰 (M,1965/11/23,46y3m) 手術日期 2011/12/23 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Herniation of intervertebral disc with myelopathy, cervical 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 1 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 14:50 進入手術室 14:55 麻醉開始 15:00 誘導結束 15:10 抗生素給藥 15:39 手術開始 17:20 手術結束 17:20 麻醉結束 17:30 送出病患 17:35 進入恢復室 19:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-頸椎 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 外科部 套用罐頭: Anterior diskectomy and fusion with body cage 開立醫師: 陳國瑋 開立時間: 2011/12/23 16:48 Pre-operative Diagnosis C5-6 HIVD Post-operative Diagnosis C5-6 HIVD Operative Method Anterior diskectomy and fusion with body cage Specimen Count And Types nil Pathology nil Operative Findings Presence of spur formation, and bulging disc. 7mm PEEK cage with allograft bone material for spinal fusion. Intact dura mater Operative Procedures Under ETGA and supine position with head mild extended, skin disinfected and drapped were performed as usual. Transverse skin incision was made at cricoid cartilage level. The plane medial to SCM was opened and the plane between carotid artery and esophagus was then dissected. The prevertebral fascia was opened and C5-6 level was localized by C-arm. Retractor was set fo expose C5-6 disc level well. C35-6 discectomy was then performed. Uncinate process were opened with high speed drill. Cage was then inserted. The wound was then closed in layers after a mini-H/V was set at prevertebral area. Operators 賴達明 Assistants 鍾文桂 陳國瑋 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Anterior diskectomy and fusion with body cage 開立醫師: 蕭智陽 開立時間: 2011/12/23 17:34 Pre-operative Diagnosis C5-6 HIVD Post-operative Diagnosis C5-6 HIVD Operative Method Anterior diskectomy and fusion with body cage Specimen Count And Types nil Pathology nil Operative Findings Presence of spur formation, and bulging disc. 7mm PEEK cage with allograft bone material for spinal fusion. Intact dura mater Operative Procedures Under ETGA and supine position with head mild extended, skin disinfected and drapped were performed as usual. Transverse skin incision was made at cricoid cartilage level. The plane medial to SCM was opened and the plane between carotid artery and esophagus was then dissected. The prevertebral fascia was opened and C5-6 level was localized by C-arm. Retractor was set fo expose C5-6 disc level well. C35-6 discectomy was then performed. Uncinate process were opened with high speed drill. Cage was then inserted. The wound was then closed in layers after a mini-H/V was set at prevertebral area. Operators 賴達明 Assistants 鍾文桂 陳國瑋 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Anterior diskectomy and fusion with body cage 開立醫師: 陳國瑋 開立時間: 2011/12/23 20:48 Pre-operative Diagnosis C5-6 HIVD Post-operative Diagnosis C5-6 HIVD Operative Method Anterior diskectomy and fusion with PEEK cage Specimen Count And Types nil Pathology nil Operative Findings Presence of spur formation, and bulging disc. 7mm PEEK cage with allograft bone material for spinal fusion. Intact dura mater Operative Procedures Under ETGA and supine position with head mild extended, skin disinfected and drapped were performed as usual. Transverse skin incision was made at cricoid cartilage level. The plane medial to SCM was opened and the plane between carotid artery and esophagus was then dissected. The prevertebral fascia was opened and C5-6 level was localized by C-arm. Retractor was set fo expose C5-6 disc level well. C5-6 discectomy was then performed. Uncinate process were opened with high speed drill. Cage was then inserted. The wound was then closed in layers after a mini-H/V was set at prevertebral area. Operators 賴達明 Assistants 鍾文桂 陳國瑋 相關圖片 苗華南 (M,1940/04/30,71y10m) 手術日期 2011/12/23 手術主治醫師 賴達明 手術區域 東址 019房 02號 診斷 Herniated intervertebral disc (HIVD) 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 2 紀錄醫師 蔡宗良, 時間資訊 00:00 臨時手術NPO 12:40 進入手術室 12:50 麻醉開始 13:00 誘導結束 13:15 抗生素給藥 13:27 手術開始 16:12 手術結束 16:12 麻醉結束 16:25 進入恢復室 18:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-頸椎 1 1 手術 椎融合術-前融合,無固定物(≦四節) 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 記錄__ 手術科部: 外科部 套用罐頭: Anterior cervical discectomy with fusion, C4-... 開立醫師: 蔡宗良 開立時間: 2011/12/23 16:19 Pre-operative Diagnosis Herniated cervical discs, C4-5, C5-6 Post-operative Diagnosis Herniated cervical discs, C4-5, C5-6 Operative Method Anterior cervical discectomy with fusion, C4-5, C5-6 Specimen Count And Types nil Pathology None Operative Findings Partial ossification of posterior longitudinal ligament to the left-sided C5-6, with severe compression of thecal sac Operative Procedures 1. ETGA, supine, neck extension 2. Routine preparation 3. Linear wound incision, open platysma, SCM-streps, and prevertebral fascia 4. Confirmation of level with fluoroscope 5. Discectomy of C5-6, then C4-5 under microscope 6. Six-mm cage was impacted into C4-5 and C5-6 7. Wound was closed in layers after meticulous hemostasis and minivac placement. Operators VS賴達明 Assistants R6蔡宗良 R1張書豪 相關圖片 劉文隆 (M,1954/12/05,57y3m) 手術日期 2011/12/23 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Cervical spondylosis 器械術式 Diskectomy cervical(Anterier) 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 2 紀錄醫師 蔡宗良, 時間資訊 00:00 臨時手術NPO 07:30 報到 08:05 進入手術室 08:10 麻醉開始 08:25 誘導結束 08:40 抗生素給藥 09:05 手術開始 11:40 抗生素給藥 12:15 手術結束 12:15 麻醉結束 12:20 送出病患 12:30 進入恢復室 13:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 手術 椎間盤切除術-頸椎 1 1 手術 椎融合術-前融合,無固定物(≦四節) 1 2 摘要__ 手術科部: 外科部 套用罐頭: Anterior cervical discectomy with fusion, C4-... 開立醫師: 蔡宗良 開立時間: 2011/12/23 12:34 Pre-operative Diagnosis Herniated cervical disc, C4-5, and C5-6 Post-operative Diagnosis Herniated cervical disc, C4-5, and C5-6 Ossification of posterior longitudinal ligament, C4-5 Operative Method Anterior cervical discectomy with fusion, C4-5 and C5-6 Specimen Count And Types nil Pathology none Operative Findings Ossification of posterior longitudinal ligament at level C4-5 Operative Procedures 1. ETGA, supine, neck extension 2. Routine preparation 3. Linear wound incision 4. Open platysma, SCM-streps, prevertebral fascia 5. Confirm level by fluoroscopy 6. Discectomy under microscope, first C5-6, then C4-5 7. Cage sized 6-mm in height was impacted into C5-6 and 5-mm to C4-5 respectively 8. After meticulous hemostasis, the wound was closed in layers Operators VS 賴達明 Assistants R6 蔡宗良, R1 張書豪 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Anterior cervical discectomy with fusion, C4-... 開立醫師: 蔡宗良 開立時間: 2011/12/23 12:34 Pre-operative Diagnosis Herniated cervical disc, C4-5, and C5-6 Post-operative Diagnosis Herniated cervical disc, C4-5, and C5-6 Ossification of posterior longitudinal ligament, C4-5 Operative Method Anterior cervical discectomy with fusion, C4-5 and C5-6 Specimen Count And Types nil Pathology none Operative Findings Ossification of posterior longitudinal ligament at level C4-5 Operative Procedures 1. ETGA, supine, neck extension 2. Routine preparation 3. Linear wound incision 4. Open platysma, SCM-streps, prevertebral fascia 5. Confirm level by fluoroscopy 6. Discectomy under microscope, first C5-6, then C4-5 7. Cage sized 6-mm in height was impacted into C5-6 and 5-mm to C4-5 respectively 8. After meticulous hemostasis, the wound was closed in layers Operators VS 賴達明 Assistants R6 蔡宗良, R1 張書豪 相關圖片 陳國財 (M,1945/04/07,66y11m) 手術日期 2011/12/23 手術主治醫師 袁瑞晃 手術區域 東址 013房 02號 診斷 Ventral hernia 器械術式 Repair of inguinal hernia 手術類別 預定手術 手術部位 腹 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 3 紀錄醫師 洪浩雲, 時間資訊 12:50 報到 13:00 進入手術室 13:05 麻醉開始 13:10 誘導結束 13:25 抗生素給藥 13:32 手術開始 15:55 手術結束 15:55 麻醉結束 16:00 送出病患 16:05 進入恢復室 17:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腹壁疝氣修補術-無腸切除 1 1 手術 鼠蹊疝氣修補術-無腸切除 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 記錄__ 手術科部: 外科部 套用罐頭: 1. Left inguinal herniorrhaphy by Bassini met... 開立醫師: 洪浩雲 開立時間: 2011/12/23 16:20 Pre-operative Diagnosis 1. Ventral hernia 2. Left inguinal hernia Post-operative Diagnosis Ditto Operative Method 1. Left inguinal herniorrhaphy by Bassini method and high ligation 2. Ventral hernia repair Specimen Count And Types 1 piece About size:3cm Source:hernia sac Pathology Sac Operative Findings 1. Left side indirect type inguinal hernia, no content in herniac sac 2. A 2cm fascia defect was noted at previous drain site, bowel adhesion was noted Operative Procedures 1. Under endotracheal general anesthesia with the patient in supine position, prepping with Povidone iodine and draping was performed in the usual sterile fashion. 2. An transverse incision along skin crease was made in the left side inguinal area. Incision was deepened through layers. The scarpa fascia was opened. The external oblique fascia was opened from external ring. 3. Spermatic cord was looped. Dissection was performed on the antero-medialaspect of the spermatic cord. An indirect herniac sac was noted and mobilized. The sac was opened and extended into distal and proximal ends, the latter was then high-ligated. Then we performed Bassini repair. Adequate hemostasis was obtained. 4. Closure was proceeded with interrupted catgut on the scarpa fascia and the skin was closed subcuticularly. 5. An incision was done at left abdomen on the previous OP drain site. 6. Subcutaneous dissection was done and the bowel wasss mobilized from the fascia defect. The fascia defect was repaired by interrupted suture. 7. The wound was closed by layers. Operators VS 袁瑞晃, VS 楊卿堯 Assistants R5 洪浩雲, PGY 王志仁 相關圖片 陳艷莉 (F,1956/10/13,55y5m) 手術日期 2011/12/24 手術主治醫師 詹志洋 手術區域 東址 016房 05號 診斷 Endometrial cancer 器械術式 Port-A Removal 手術類別 臨時手術 手術部位 胸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 莊民楷, 時間資訊 12:35 進入手術室 12:40 抗生素給藥 12:48 麻醉開始 12:49 誘導結束 12:50 手術開始 13:05 手術結束 13:10 送出病患 13:10 麻醉結束 醫令資訊 類別 名稱 量 刀 側 手術 皮下肌肉或深部異物取出術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Port-A removal 開立醫師: 莊民楷 開立時間: 2011/12/24 13:09 Pre-operative Diagnosis 1) Endometrial cancer, 2) port-A dysfunction Post-operative Diagnosis 1) Endometrial cancer, 2) port-A dysfunction Operative Method Port-A removal Specimen Count And Types nil Pathology Nil Operative Findings 1. port-A removed intactly, no obvious abnormal finding of port-A device Operative Procedures 1. LA, supine 2. Disinfection and drapping 3. Skin incision along previous scar 4. Dissect to expose port-A, then remove it 5. Hemostasis, saline irrigation 6. Close the wound in layers Operators VS 詹志洋 Assistants R4 莊民楷 原銘傑 (M,1958/09/15,53y5m) 手術日期 2011/12/24 手術主治醫師 賴達明 手術區域 東址 003房 02號 診斷 Subarachnoid hemorrhage 器械術式 Craniotomy(Aneurysms) P-DUH 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3E 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 11:29 通知急診手術 13:36 進入手術室 13:55 麻醉開始 14:00 誘導結束 14:25 抗生素給藥 14:30 手術開始 17:00 開始輸血 17:40 抗生素給藥 21:10 手術結束 21:10 麻醉結束 21:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 開顱術摘除血管病變 - 腦血管瘤 有病徵的 1 1 L 手術 顱內壓視置入 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 7 0 記錄__ 手術科部: 外科部 套用罐頭: Pterional approach for aneurysm clipping and ... 開立醫師: 鍾文桂 開立時間: 2011/12/25 03:47 Pre-operative Diagnosis Left internal carotid artery dorsal aneurysm, ruptured. Post-operative Diagnosis Left internal carotid artery dorsal aneurysm, ruptured. Operative Method Pterional approach for aneurysm clipping and wrapping. External ventricular drainage for ICP monitoring and CSF drainage. Specimen Count And Types nil Pathology Nil. Operative Findings Well pneumonized sphenoid sinus. The left anterior clinoid process is pneumonized. The anterior clinoid process was removed. The sphenoid sinus mucosal wall was kept intact during drilling. EVD was inserted into left frontal horn. depth: 7cm. CSF: clear, colorless, high pressure. No intraoperative aneurysm rupture. Thick SAH in sylvian fissure. An angled clip and an ENT shaped clip were used for aneurysm clipping. The brain was slack intraoperatively. Temporary clipping was applied for aneurysm clipping. Ischemic time: 7min. Post-op pupil: 3/3. Operative Procedures Under ETGA, the patient was placed in supine position and the head was tilted to the right side. After shaving, disinfection, and draping, a curvilinear scalp incision was made. After dissection of scalp and temporalis muscle,a burr hole for EVD insertion was done. EVD was inserted.Later, a 10 cm craniotomy was obtained. The anterior clinoid process was drilled out. After durotomy, the slyvian fissure was opened. After exposing the aneurysm, the clips were applied. Pericranium fascia was wraped around the aneurysm. After well hemostasis, the dura mater was closed in watertight fashion. The cranitomy skull plate was fixed by miniplates and screws. The wound was closed in layers with one subgaleal drain. Operators 賴達明 Assistants 鍾文桂 Indication Of Emergent Operation Aneurysm rupture. 相關圖片 許林寶珠 (F,1934/05/24,77y9m) 手術日期 2011/12/24 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Spinal stenosis, lumbar 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 賴達明, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:03 進入手術室 08:15 麻醉開始 08:25 誘導結束 08:35 抗生素給藥 09:02 手術開始 11:37 抗生素給藥 11:48 開始輸血 13:05 手術結束 13:05 麻醉結束 13:12 送出病患 13:15 進入恢復室 16:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎間盤切除術-腰椎 1 2 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 摘要__ 手術科部: 外科部 套用罐頭: 1. Transforaminal lumbar interbody fusion and... 開立醫師: 鍾文桂 開立時間: 2011/12/24 13:31 Pre-operative Diagnosis Lumbar spondylolisthesis, L4/5. Lumbar stenosis, L3/4. Post-operative Diagnosis Lumbar spondylolisthesis, L4/5. Lumbar stenosis, L3/4. Operative Method 1. Transforaminal lumbar interbody fusion and internal fixation with transpedicle screws, L4/5. 2. Discectomy, L4/5 and L3 laminectomy. 4. Posterolateral fusion, L3-5. Specimen Count And Types nil Pathology Nil Operative Findings Severe stenosis with hypertrophic ligamentum flavum. Presence of scoliosis and compressed L4 vertebra. TPS:4 6.2*40mm screws, 2 5cm rods, and Synthes 11mm Travios cage. Blood loss: 1300cc. A small incidental durotomy at right L5 level. Operative Procedures Under ETGA, the patient was placed in prone position. After localization of L4/5 level with intraoperative fluoroscopy, the skin was disinfected and draped. A linear vertical skin incision was made followed by paraspinal dissection. The TPS was implanted under the guidance of intraoperative fluoroscopy. L4 laminectomy and right L4/5 facetectomy were done. After L4/5 discectomy, the PEEK cage was implanted. The rods were set. Later, L3 laminectomy was achieved. Autologous bone graft was used for posterolateral fusion. The wound was closed in layers with one submuscular 1/8 hemovac drain. Operators 賴達明 Assistants 鍾文桂 劉明侑 相關圖片 周文凱 (M,1981/02/14,31y1m) 手術日期 2011/12/24 手術主治醫師 張金池 手術區域 東址 002房 01號 診斷 Cervical spondylosis 器械術式 Tracheostomy 手術類別 緊急手術 手術部位 頭、頸 傷口分類 污染 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3E 紀錄醫師 廖先啟, 時間資訊 00:27 臨時手術NPO 00:27 開始NPO 07:27 通知急診手術 07:55 進入手術室 08:15 麻醉開始 08:20 誘導結束 08:23 手術開始 08:32 手術結束 08:32 麻醉結束 08:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 氣管切開術 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 廖先啟 開立時間: 2011/12/24 08:40 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types Nil Pathology None Operative Findings Fr. 8 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators VS張金池 Assistants R4廖先啟，R0邱鈺涵 Indication Of Emergent Operation Respiratory failure 簡謝烏定 (F,1931/05/26,80y9m) 手術日期 2011/12/24 手術主治醫師 王國川 手術區域 東址 005房 01號 診斷 Hydrocephalus 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3 紀錄醫師 蔡宗良, 時間資訊 00:00 臨時手術NPO 07:34 報到 07:55 進入手術室 08:05 麻醉開始 08:10 誘導結束 08:15 抗生素給藥 09:00 手術開始 09:45 手術結束 09:45 麻醉結束 09:55 送出病患 10:00 進入恢復室 12:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室腹腔分流手術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunting, via right-side... 開立醫師: 蔡宗良 開立時間: 2011/12/24 10:04 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunting, via right-sided Kochers point, programmable reservoir Specimen Count And Types nil Pathology none Operative Findings 1. ECP approx. 5 cmH20 2. CSF: clear, colorless Operative Procedures 1. ETGA, supine 2. Head rotated towards the left 3. Routine preparation 4. Linear scalp incision over Kochers point and linear incision over abdomen 5. Craniostomy and tenting of the dura 6. Minilaparotomy reaching the peritoneal cavity 7. Catheter was connected together 8. Ventriculostomy of Kochers point and insert the 5 cm ventricular catheter into the ventricles 9. CSF were collected for laboratory check 10. Wound was closed in layers Operators VS 王國川 Assistants R6 蔡宗良 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunting, via right-side... 開立醫師: 蔡宗良 開立時間: 2011/12/24 10:04 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunting, via right-sided Kochers point, programmable reservoir Specimen Count And Types nil Pathology none Operative Findings 1. ECP approx. 5 cmH20 2. CSF: clear, colorless Operative Procedures 1. ETGA, supine 2. Head rotated towards the left 3. Routine preparation 4. Linear scalp incision over Kochers point and linear incision over abdomen 5. Craniostomy and tenting of the dura 6. Minilaparotomy reaching the peritoneal cavity 7. Catheter was connected together 8. Ventriculostomy of Kochers point and insert the 5 cm ventricular catheter into the ventricles 9. CSF were collected for laboratory check 10. Wound was closed in layers Operators VS 王國川 Assistants R6 蔡宗良 相關圖片 鐘採卿 (F,1956/01/18,56y1m) 手術日期 2011/12/25 手術主治醫師 曾漢民 手術區域 東址 002房 01號 診斷 Glioblastoma multiforma 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3E 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 01:18 通知急診手術 08:40 進入手術室 08:50 麻醉開始 09:10 抗生素給藥 09:10 誘導結束 09:20 手術開始 12:50 手術結束 12:50 麻醉結束 13:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 記錄__ 手術科部: 外科部 套用罐頭: Right fronto-temporo-parietal craniotomy for ... 開立醫師: 李振豪 開立時間: 2011/12/25 13:25 Pre-operative Diagnosis Right temporal tumor, favor high grade glioma Post-operative Diagnosis Right temporal tumor, favor high grade glioma Operative Method Right fronto-temporo-parietal craniotomy for total tumor excision Specimen Count And Types 1 piece About size:Multiple pieces Source:Right temporal tumor Pathology Pending Operative Findings Intra-operative sonography was used after craniotomy for localization of the tumor. The tumor was 4.4 x 4.4 x 4cm in size, gray-reddish, hypervascularized, gelatinous to elastic in character, and ill-demarcated which located at right superior and middle temporal gyrus. The vein of Labbe and transverse sinus were preserved during the operation. The right lateral ventricle was not opened during whole procedure. Active oozing from vein of Labbe was noted after tumor excision and hemostasis was achieved with Surgicel and Gelfoam packing. The brain became slack after total removal of the tumor. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with right shoulder elevation. The head was fixed with Mayfield skull clamp and turned to left. The scalp was shaved, scrubbed, and disinfected as usual. Reverse U scalp incision was made at right fronto-temporal area and the scalp flap was elevated with temporalis muscle. Five burrholes were created followed by one 6x5cm craniotomy window. Dural tenting was done. Intra-operative sonography was used for localization of the tumor. C-shape durotomy was made based with right temporal base. One 3x3cm corticotomy was conducted and tumor excision was performed with bipolar electrocautery, suction, and tumor forceps. Hemostasis was achieved with bipolar electrocautery and Surgicel lining. The fascia of temporalis muscle was harvested and duroplasty was done with 4-0 prolene. The skull plate was fixed back with miniplates, screws, and two central tenting. The wound was then closed in layers with 2-0 Vicryl and Appose staples. Operators VS曾漢民 Assistants R5李振豪, PGY劉明侑 Indication Of Emergent Operation Rapid neurological deterioration due to right temporal brain tumor 相關圖片 簡進和 (M,1960/03/01,52y0m) 手術日期 2011/12/26 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Glioblastoma multiforma 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 08:03 進入手術室 08:10 麻醉開始 08:30 抗生素給藥 08:35 誘導結束 08:46 手術開始 11:30 抗生素給藥 14:55 手術結束 14:55 麻醉結束 15:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除-手術時間在4~8小時 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Left occitital craniotomy for tumor excision 開立醫師: 鍾文桂 開立時間: 2011/12/26 15:12 Pre-operative Diagnosis Left parietal-occipital tumor, suspect high grade glioma Post-operative Diagnosis Left parietal-occipital tumor, suspect high grade glioma Operative Method Left occitital craniotomy for tumor excision Specimen Count And Types 1 piece About size:3x3x2 cm Source:Left parietal-occipital tumor Pathology Frozen section:High grade glioma Operative Findings Transulcus approach. Elastic, hard, yellowish-red tumor in very high vascularity. The occipital horn of lateral ventricle was entered. CUSA was used for tumor excision. We used ultrasound for tumor localization. Mild brain swelling after dural closure. No intraoperative SSEP or MEP change. Operative Procedures Under ETGA, we placed the patient on prone position after we fixed his head with Mayfield clamp. After we shaved, scrubbed, disinfected and drapped, a reverse U-shape skin incision was made over left occipital area. The scalp flap was elevated after leyer by layer dissection and the craniotomy was made after 4 burr holes. Dural tenting around the craniotomy was made. The tumor locaion was identified with intra-operative echo and the U shape durotomy was done. A 1.5x1cm corticotomy was made and the tumor resection was performed with bipolar forceps, micro-scissors, tumor forceps and CUSA. The frozen section showed: Under ETGA, we placed the patient on prone position after we fixed his head with Mayfield clamp. After we shaved, scrubbed, disinfected and drapped, a reverse U-shape skin incision was made over left occipital area. The scalp flap was elevated after leyer by layer dissection and the craniotomy was made after 4 burr holes. Dural tenting around the craniotomy was made. The tumor locaion was identified with intra-operative echo and the U shape durotomy was done. A 1.5x1cm corticotomy was made and the tumor resection was performed with bipolar forceps, micro-scissors, tumor forceps and CUSA. The frozen section showed high grade glioma. Due to the easy oozing operative field, H2O2 brain cotton was used for hemostasis intermittently. After total tumor excision, well hemostasis was achieved with bipolar coagulation. The brain surface was covered with surgicel. The dura mater was closed in water-tight fashion. The skull bone was fixed by mini plates and screws. The wound was closed in layers with one subgaleal CWV drain. Operators Prof. 杜永光 Assistants R6 鍾文桂 R3 曾偉倫 陳國瑋 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Left occitital craniotomy for tumor excision 開立醫師: 陳國瑋 開立時間: 2011/12/26 15:41 Pre-operative Diagnosis Left parietal-occipital tumor, suspect high grade glioma Post-operative Diagnosis Left parietal-occipital tumor, suspect high grade glioma Operative Method Left occitital craniotomy for tumor excision Specimen Count And Types 1 piece About size:3x3x2 cm Source:Left parietal-occipital tumor Pathology Frozen section:High grade glioma Operative Findings Transulcus approach. Elastic, hard, yellowish-red tumor in very high vascularity. The occipital horn of lateral ventricle was entered. CUSA was used for tumor excision. We used ultrasound for tumor localization. Mild brain swelling after dural closure. No intraoperative SSEP or MEP change. Operative Procedures Under ETGA, we placed the patient on prone position after we fixed his head with Mayfield clamp. After we shaved, scrubbed, disinfected and drapped, a reverse U-shape skin incision was made over left occipital area. The scalp flap was elevated after leyer by layer dissection and the craniotomy was made after 4 burr holes. Dural tenting around the craniotomy was made. The tumor locaion was identified with intra-operative echo and the U shape durotomy was done. A 1.5x1cm corticotomy was made and the tumor resection was performed with bipolar forceps, micro-scissors, tumor forceps and CUSA. The frozen section showed high grade glioma. Due to the easy oozing operative field, H2O2 brain cotton was used for hemostasis intermittently. After total tumor excision, well hemostasis was achieved with bipolar coagulation. The brain surface was covered with surgicel. The dura mater was closed in water-tight fashion. The skull bone was fixed by mini plates and screws. The wound was closed in layers with one subgaleal CWV drain. Operators Prof. 杜永光 Assistants R6 鍾文桂 R3 曾偉倫 陳國瑋 相關圖片 陳永和 (M,1958/09/12,53y6m) 手術日期 2011/12/26 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Pituitary tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 08:01 進入手術室 08:05 麻醉開始 08:15 誘導結束 09:00 抗生素給藥 09:10 手術開始 10:25 手術結束 10:25 麻醉結束 10:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 經由蝶竇之腦下垂體瘤切除 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Trans-nasal, trans-sphenoidal adenomectomy 開立醫師: 李振豪 開立時間: 2011/12/26 11:01 Pre-operative Diagnosis Pituitary macroadenoma with apoplexy Post-operative Diagnosis Pituitary macroadenoma with apoplexy Operative Method Trans-nasal, trans-sphenoidal adenomectomy Specimen Count And Types 1 piece About size:Multiple pieces Source:Pituitary tumor Pathology Pending Operative Findings The nasal mucosa was easily touch bleeding. The sellar floor was eroded by the tumor totally. Apoplexy of the tumor was noted and motor oil-like fluid gushed out after durotomy. Some blood clot also noted within the sellar region and removed. The tumor was 3 x 2.4 x 3cm in size, hypervascularized, red-yellowish, well-demarcated, and soft in character. After removal of the tumor, reddish normal gland was found at the left upper part of the sellar region. The arachnoid pouch was intact without evident CSF leakage. The VEP was stationary during whole procedure. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position. The face and, nasal cavity, and oral cavity was disinfected as usual. The ostium of sphenoid sinus was identified. The right side nasal mucosa of the septum was infiltrated with Xylocaine solution. One 2.5cm linear vertical mucosa incision was made at right side septum and the submucosal dissection was conducted till the ostium of the sphenoid sinus was identified. The nasal septum was fractured and the left side mucosa was dissected also to expose left side ostium of sphenoid sinus. A Hardy"s nasal speculum was applied to displace the nasal mucosa laterally and keep the nasal cavity open constantly for the exposure of the vomer bone and the anterior wall of the sphenoid sinus. The floor of sphenoid sinus was opened with osteotome then widened by Kerrison punches. The mucosa of sphenoid sinus was removed. The sellar floor was eroded by the tumor totally. The dura was coagulated and cruciform durotomy was made. Motor oil-like fluid gushed out after durotomy and the tumor was decompressed rapidly. After evacuation of hematoma, the tumor was identified and removed by suction, tumor forceps, ring curette, and alligator. Hemostasis was achieved with Gelfoam packing. The sellar floor and Vomer bone was placed back for reconstruction of skull base. The nasal mucosa and the middle turbinate was pushed back to it"s neutral position. Bilateral nasal cavities were packed with segments of glove filled with one gauze strips which had been soaked with Better-iodine ointment(two on right side and one on left side). Operators VS曾漢民 Assistants R5李振豪, PGY劉明侑 相關圖片 石聰富 (M,1955/01/04,57y2m) 手術日期 2011/12/26 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Brain metastasis 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 11:40 進入手術室 11:45 麻醉開始 12:10 誘導結束 12:30 抗生素給藥 12:39 手術開始 15:30 抗生素給藥 15:45 手術結束 15:45 麻醉結束 15:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Left fronto-parietal craniotomy, trans-sulcus... 開立醫師: 李振豪 開立時間: 2011/12/26 16:33 Pre-operative Diagnosis Left thalamic tumor, suspect metastasis Post-operative Diagnosis Left thalamic metastatic carcinoma Operative Method Left fronto-parietal craniotomy, trans-sulcus, trans-ventricular approach for left thalamic tumor excision + external ventricular drainage Specimen Count And Types 1 piece About size:Multiple pieces Source:Left thalamic tumor Pathology Frozen section: metastatic carcinoma Operative Findings The tumor was 2.8 x 3.3 x 3.5cm in size, well-demarcated with firm fibrotic capsule, gray-reddish in color, hypervascularized, and elastic in central part. Tumor bleeding with gliosis and hemosiderin deposition around the tumor also noted. The tumor was mainly located at posterior part of the left thalamus. Dissection was conducted along the gliotic plan and hematoma. Total tumor excision was achieved. The SSEP was stationary during whole procedure. But decrease right lower limb MEP amplitude noted after total removal of the tumor. The waveform did not return to baseline after wound closure. Frozen section was sent and metastatic carcinoma was favored. Brain mapping was made after durotomy. The motor cortex was about 2cm posterior to durotomy window. The tumor was 2.8 x 3.3 x 3.5cm in size, well-demarcated with firm fibrotic capsule, gray-reddish in color, hypervascularized, and elastic in central part. Tumor bleeding with gliosis and hemosiderin deposition around the tumor also noted. The tumor was mainly located at posterior part of the left thalamus. Dissection was conducted along the gliotic plan and hematoma. Total tumor excision was achieved. The SSEP was stationary during whole procedure. But decrease right lower limb MEP amplitude noted after total removal of the tumor. The waveform did not return to baseline after wound closure. Frozen section was sent and metastatic carcinoma was favored. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with neck flexion and head fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. Left fronto-parietal U-shape scalp incision was made and the scalp flap was elevated. Three burrholes were created followed by one 6x6cm craniotomy window. Dural tenting was done. Intra-operative sonography was used for localization of the tumor and left lateral ventricle. Trans-sulcus, trans-ventricular approach for left thalamic tumor excision was conducted with bipolar electrocautery, surction, and tumor forceps. The frozen section was sent during the operation and metastatic carcinoma was favored. After total removal of the tumor, hemostasis was achieved with bipolar electrocautery and Surgicel lining. External ventricular drainage was placed into left lateral ventricle under direct vision. Externalization was done. Dura was closed with 4-0 prolene. The skull plate was fixed back with miniplates, screws, and two central tenting. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS曾漢民 Assistants R5李振豪, PGY劉明侑 相關圖片 梁政翎 (F,2002/09/17,9y5m) 手術日期 2011/12/26 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Soft tissue tumor 器械術式 Ommaya reservoir implantation 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃啟祥 ASA 3E 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 08:00 通知急診手術 09:45 報到 09:45 進入手術室 09:48 麻醉開始 09:50 誘導結束 10:25 手術開始 11:00 抗生素給藥 11:05 麻醉結束 11:05 手術結束 11:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 歐氏貯囊置放手術 1 1 R 摘要__ 手術科部: 套用罐頭: Ommaya reservoir implantation via right Koche... 開立醫師: 王奐之 開立時間: 2011/12/26 11:27 Pre-operative Diagnosis Hydrocephalus, suspected cancerous meninigitis Post-operative Diagnosis Hydrocephalus, suspected cancerous meninigitis Operative Method Ommaya reservoir implantation via right Kocher point Specimen Count And Types 1 piece About size:about 10ml Source:CSF Pathology Nil Operative Findings Clear CSF was noted, about 10ml of CSF was drained and sent for analysis & cultures. Opening pressure was above 20 cmH2O upon ventriculostomy. Ventricular catheter length: 6.5cm. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position. After scrubbing, disinfection & draping in sterile fashion, a curved incision was made at right frontal area. After reflecting the periosteum, a burr hole was made at right Kocher point. Two dural tenting stitches were applied, followed by a small cruciate durotomy. After meticulous hemostasis of the dura and cortical surface, ventricular puncture was performed. After collection of the CSF specimen via a 6-Fr Nelaton tube, and the Ommaya reservoir was inserted after assembly of the reservoir and catheter. The reservoir was secured with silk sutures to the periosteum, and the wound was closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之 Indication Of Emergent Operation IICP 相關圖片 記錄__ 手術科部: 套用罐頭: Ommaya reservoir implantation via right Koche... 開立醫師: 王奐之 開立時間: 2011/12/26 11:27 Pre-operative Diagnosis Hydrocephalus, suspected cancerous meninigitis Post-operative Diagnosis Hydrocephalus, suspected cancerous meninigitis Operative Method Ommaya reservoir implantation via right Kocher point Specimen Count And Types 1 piece About size:about 10ml Source:CSF Pathology Nil Operative Findings Clear CSF was noted, about 10ml of CSF was drained and sent for analysis & cultures. Opening pressure was above 20 cmH2O upon ventriculostomy. Ventricular catheter length: 6.5cm. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position. After scrubbing, disinfection & draping in sterile fashion, a curved incision was made at right frontal area. After reflecting the periosteum, a burr hole was made at right Kocher point. Two dural tenting stitches were applied, followed by a small cruciate durotomy. After meticulous hemostasis of the dura and cortical surface, ventricular puncture was performed. After collection of the CSF specimen via a 6-Fr Nelaton tube, and the Ommaya reservoir was inserted after assembly of the reservoir and catheter. The reservoir was secured with silk sutures to the periosteum, and the wound was closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之 Indication Of Emergent Operation IICP 相關圖片 記錄__ 手術科部: 套用罐頭: Ommaya reservoir implantation via right Koche... 開立醫師: 郭夢菲 開立時間: 2011/12/26 12:22 Pre-operative Diagnosis Hydrocephalus, suspected communicating type due to meninigeal sarcomatosis Post-operative Diagnosis Hydrocephalus, suspected communicating type due to meninigeal sarcomatosis Operative Method Ommaya reservoir implantation via right Kocher point Specimen Count And Types 1 piece About size:about 10ml Source:CSF Pathology Nil Operative Findings Clear CSF was noted, about 10ml of CSF was drained and sent for analysis & cultures. Opening pressure was far above 20 cmH2O upon ventriculostomy. Ventricular catheter length: 6.5cm. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position. After scrubbing, disinfection & draping in sterile fashion, a curved incision was made at right frontal area. After reflecting the periosteum, a burr hole was made at right Kocher point. Two dural tenting stitches were applied, followed by a small cruciate durotomy. After meticulous hemostasis of the dura and cortical surface, ventricular puncture was performed. After collection of the CSF specimen via a 6-Fr Nelaton tube, and the Ommaya reservoir was inserted after assembly of the reservoir and catheter. The reservoir was secured with silk sutures to the periosteum, and the wound was closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之 Indication Of Emergent Operation 相關圖片 沈常山 (M,1925/01/13,87y2m) 手術日期 2011/12/26 手術主治醫師 李伯皇 手術區域 東址 013房 01號 診斷 Gastric cancer 器械術式 Subtotal gastrectomy 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 4 紀錄醫師 曾任偉, 時間資訊 07:30 報到 08:06 進入手術室 08:13 麻醉開始 08:30 抗生素給藥 08:35 誘導結束 08:45 手術開始 09:14 11:50 抗生素給藥 14:45 麻醉結束 14:45 手術結束 14:55 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 手術 膀胱鏡檢查 1 0 L 手術 次全胃切除及淋巴清除及腸胃重建 1 1 L 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 泌尿部 套用罐頭: cystoscopy（biopsy ) 開立醫師: 周淇業 開立時間: 2011/12/26 09:09 Pre-operative Diagnosis Bladder neck contracture Post-operative Diagnosis Bladder neck contracture Operative Method cystoscopy Specimen Count And Types nil Pathology nil Operative Findings Bladder neck contracture was noted Operative Procedures Under satisfactory anesthesia with the patient in lithotomy position, prepping and drapping was performed in the usual sterile fashion. A Fr 21 Olympus cystoscope was introduced into the bladder cavity under direct vision. A Foley catheter was placed smoothly. Operators 陳忠信, Assistants 曾任偉, 相關圖片 摘要__ 手術科部: 外科部 套用罐頭: Radical subtotal gastrectomy with B-II recons... 開立醫師: 張政傑 開立時間: 2011/12/26 15:11 Pre-operative Diagnosis Gastric cancer , antrum Post-operative Diagnosis Gastric cancer , antrum Operative Method Radical subtotal gastrectomy with B-II reconstruction Specimen Count And Types 1 piece About size:25*10*3cm Source:Partial body and antrum of stomach Pathology pending Operative Findings 1. One 3*2cm ulcerative mass located at antrum over the posterior surface near lesser curvature side. 2. The distal margin was at the pyloric ring. 3. Associated LNs were identified Operative Procedures 1. ETGA , supine position 2. Midline laparotomy and performed bursectomy 3. Divide the pyloric ring and transect the stomach over pyloric area. Oversewed the duodenal stump by silk. 4. LNs dissection including group 7 ,8 , 1 , 3 , 4 , 5 , 6 5. Transect the body of stomach and performed antecolic B-II gastrojejunostomy , about 30cm from Triez ligment 6. Place the NG tube into A-loop of jejunum 7. N/S irrigation and place two rubber drains into left subphrnic space 8. Close the wound in layers Operators 李伯皇 Assistants 張政傑 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Radical subtotal gastrectomy with B-II recons... 開立醫師: 張政傑 開立時間: 2011/12/26 15:12 Pre-operative Diagnosis Gastric cancer , antrum Post-operative Diagnosis Gastric cancer , antrum Operative Method Radical subtotal gastrectomy with B-II reconstruction Specimen Count And Types 1 piece About size:25*10*3cm Source:Partial body and antrum of stomach Pathology pending Operative Findings 1. One 3*2cm ulcerative mass located at antrum over the posterior surface near lesser curvature side. 2. The distal margin was at the pyloric ring. 3. Associated LNs were identified Operative Procedures 1. ETGA , supine position 2. Midline laparotomy and performed bursectomy 3. Divide the pyloric ring and transect the stomach over pyloric area. Oversewed the duodenal stump by silk. 4. LNs dissection including group 7 ,8 , 1 , 3 , 4 , 5 , 6 5. Transect the body of stomach and performed antecolic B-II gastrojejunostomy , about 30cm from Triez ligment 6. Place the NG tube into A-loop of jejunum 7. N/S irrigation and place two rubber drains into left subphrnic space 8. Close the wound in layers Operators 李伯皇 Assistants 張政傑 相關圖片 李偉烈 (M,1947/12/10,64y3m) 手術日期 2011/12/26 手術主治醫師 王國川 手術區域 東址 002房 01號 診斷 Injury (severity score >=16) 器械術式 Burr hole (trephination) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭淳心 ASA 3E 紀錄醫師 陳國瑋, 時間資訊 18:00 臨時手術NPO 18:00 開始NPO 03:05 通知急診手術 04:15 進入手術室 04:20 麻醉開始 04:30 抗生素給藥 04:30 誘導結束 05:05 手術開始 06:00 麻醉結束 06:00 手術結束 06:10 送出病患 06:15 進入恢復室 07:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 慢性硬腦膜下血腫清除術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Burr hole hematoma evaculation 開立醫師: 陳國瑋 開立時間: 2011/12/26 06:08 Pre-operative Diagnosis Left subacute subdural hematoma Post-operative Diagnosis Left subacute subdural hematoma Operative Method Burr hole hematoma evaculation Specimen Count And Types nil Pathology nil Operative Findings Dark dubdural hematoma gush out upon cutting the outer membrane. One subdural EVD was inserted for drainage Dark subdural hematoma gush out upon cutting the outer membrane. One subdural EVD was inserted for drainage Operative Procedures Supine position Skin disinfected and draped Skin incision Burr hole creation Dura tenting Cruciate durotomy Hematoma drainage Insert the sundural EVD, de-air Close wound in layers Operators 王國川 Assistants 陳國瑋 劉明侑 Indication Of Emergent Operation IICP, midline shift 相關圖片 江李梅鳳 (F,1942/11/04,69y4m) 手術日期 2011/12/26 手術主治醫師 謝孟祥 手術區域 東址 009房 04號 診斷 Acute myeloid leukemia 器械術式 Incisional biopsy 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 徐展陽, 時間資訊 15:47 進入手術室 15:53 手術開始 16:45 手術結束 16:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 癌前病變軟組織切片 1 0 L 記錄__ 手術科部: 內科部 套用罐頭: Incisional biopsy 開立醫師: 徐展陽 開立時間: 2011/12/26 16:47 Pre-operative Diagnosis Left elbow subcutaneous tumor Post-operative Diagnosis Left elbow subcutaneous tumor Operative Method Incisional biopsy Specimen Count And Types 1 piece About size:1x1cm Source:Left elbow region Pathology Pending Operative Findings There was one solid subtuaneous tumor at left elbow region. The tumor was fragile, grey, adn easily bleeding. Incisional biopsy was performed. Operative Procedures The patient was placed in supine position. Anti-septic preparation was performed. Local anesthesia was injected. Linease incision was made. Dissection was performed to explore the tumor. Incisional biopsy was then done. After hemostasis and N/S irrigation, one mini-H/V drainage tube was inserted. the wound was then closed inlayers. Operators VS謝孟祥 Assistants R5游彥辰, R2徐展陽 呂金彥 (M,1943/11/16,68y3m) 手術日期 2011/12/28 手術主治醫師 曾漢民 手術區域 東址 018房 03號 診斷 Head Injury 器械術式 Burr hole (trephination) 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3E 紀錄醫師 林哲光, 時間資訊 13:00 開始NPO 22:07 通知急診手術 00:00 進入手術室 00:10 麻醉開始 00:15 誘導結束 00:24 抗生素給藥 01:00 手術開始 02:05 麻醉結束 02:05 手術結束 02:15 送出病患 02:25 進入恢復室 03:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 慢性硬腦膜下血腫清除術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Left frontal burr hole drainage for chronic s... 開立醫師: 林哲光 開立時間: 2011/12/28 02:32 Pre-operative Diagnosis Left chronic subdural hematoma Post-operative Diagnosis Left chronic subdural hematoma Operative Method Left frontal burr hole drainage for chronic subdural hematoma Specimen Count And Types 1 piece About size: Source:Subdural hematoma for routine, culture, BCS and cytology Pathology Nil Operative Findings Gush of darkish, motor-oil like fluid contents were noted after dura opening. Outer and inner membrane formation at subdural cavity was also noted. The brain seemed not well re-expanded after hematoma removal. Operative Procedures Under ETGA and supine position, skin disinfected and drapped were performed as usual. A linear skin incision was made at left frontal area. THe burr hole was then created with high speed drill. The dura was then opened and outer membrane was opened and cauterized with bipolar around the burr hole. Subdural drainage for hematoma was then done and N/S irrigation was then performed. The subdural drain was then inserted and fixed through the subcutaneous tunneling. The wound was then closed in layers after Gelfoam packing at burr hole and deair was done. Operators 曾漢民 Assistants 林哲光 Indication Of Emergent Operation Right side weakness with unsteady gait; slurred speech; progressive in one day 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Left frontal burr hole drainage for chronic s... 開立醫師: 林哲光 開立時間: 2011/12/28 02:33 Pre-operative Diagnosis Left chronic subdural hematoma Post-operative Diagnosis Left chronic subdural hematoma Operative Method Left frontal burr hole drainage for chronic subdural hematoma Specimen Count And Types 1 piece About size: Source:Subdural hematoma for routine, culture, BCS and cytology Pathology Nil Operative Findings Gush of darkish, motor-oil like fluid contents were noted after dura opening. Outer and inner membrane formation at subdural cavity was also noted. The brain seemed not well re-expanded after hematoma removal. Operative Procedures Under ETGA and supine position, skin disinfected and drapped were performed as usual. A linear skin incision was made at left frontal area. THe burr hole was then created with high speed drill. The dura was then opened and outer membrane was opened and cauterized with bipolar around the burr hole. Subdural drainage for hematoma was then done and N/S irrigation was then performed. The subdural drain was then inserted and fixed through the subcutaneous tunneling. The wound was then closed in layers after Gelfoam packing at burr hole and deair was done. Operators 曾漢民 Assistants 林哲光 Indication Of Emergent Operation Right side weakness with unsteady gait; slurred speech; progressive in one day 相關圖片 張婷詒 (F,2008/01/05,4y2m) 手術日期 2011/12/27 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Anomalies of spinal cord 器械術式 Cord untethering -KUO 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 石博元 ASA 2 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:10 麻醉開始 08:40 誘導結束 09:15 抗生素給藥 09:42 手術開始 11:40 手術結束 11:40 麻醉結束 11:50 送出病患 11:50 進入恢復室 12:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 良性脊髓腫瘤切除術 1 1 摘要__ 手術科部: 外科部 套用罐頭: Cord untethering 開立醫師: 王奐之 開立時間: 2011/12/27 12:05 Pre-operative Diagnosis Tethered cord syndrome due to myelomeningocele and filum terminale lipoma, status post repair of myelomeningocele and excision of filum terminale lipoma, with cord retethering Post-operative Diagnosis Tethered cord syndrome due to myelomeningocele and filum terminale lipoma, status post repair of myelomeningocele and excision of filum terminale lipoma, with cord retethering Operative Method Cord untethering Specimen Count And Types Nil Pathology Nil Operative Findings Moderate fibrosis of the previous incision site and thickening of the dura were observed. Intradural adhesion was found at the dorsal and lateral aspects of the spinal cord. The lumbosacral nerve roots were noted to exit the neural foramina in a upward direction, indicating the low-set of spinal cord. The 6-0 Prolene knots were invaginated into itself to prevent future adhesion. The end of spinal cord was found to have going upward for about 1cm after untethering. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position. After scrubbing, disinfection & draping in sterile fashion, a midline linear incision was made at lumbosacral area along the previous surgical scar. The incision was deepened until the dura was identified under microscopic view. A midline linear durotomy was performed, adhesiolysis around the spinal cord and nerve roots were performed until loosening of the spinal cord was observed. After meticulous hemostasis, the dura was closed in water-tight fashion with 4-0 Prolene continuous sutures. After placement of 1 piece of Gelfoam in epidural region, the wound was closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Cord untethering 開立醫師: 王奐之 開立時間: 2011/12/27 12:06 Pre-operative Diagnosis Tethered cord syndrome due to myelomeningocele and filum terminale lipoma, status post repair of myelomeningocele and excision of filum terminale lipoma, with cord retethering Post-operative Diagnosis Tethered cord syndrome due to myelomeningocele and filum terminale lipoma, status post repair of myelomeningocele and excision of filum terminale lipoma, with cord retethering Operative Method Cord untethering Specimen Count And Types Nil Pathology Nil Operative Findings Moderate fibrosis of the previous incision site and thickening of the dura were observed. Intradural adhesion was found at the dorsal and lateral aspects of the spinal cord. The lumbosacral nerve roots were noted to exit the neural foramina in a upward direction, indicating the low-set of spinal cord. The 6-0 Prolene knots were invaginated into itself to prevent future adhesion. The end of spinal cord was found to have going upward for about 1cm after untethering. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position. After scrubbing, disinfection & draping in sterile fashion, a midline linear incision was made at lumbosacral area along the previous surgical scar. The incision was deepened until the dura was identified under microscopic view. A midline linear durotomy was performed, adhesiolysis around the spinal cord and nerve roots were performed until loosening of the spinal cord was observed. After meticulous hemostasis, the dura was closed in water-tight fashion with 4-0 Prolene continuous sutures. After placement of 1 piece of Gelfoam in epidural region, the wound was closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Cord untethering 開立醫師: 郭夢菲 開立時間: 2011/12/27 13:25 Pre-operative Diagnosis Tethered cord syndrome due to myelomeningocele and filum terminale lipoma, status post repair of myelomeningocele and excision of filum terminale lipoma, with cord retethering Post-operative Diagnosis Tethered cord syndrome due to myelomeningocele and filum terminale lipoma, status post repair of myelomeningocele and excision of filum terminale lipoma, with cord retethering Operative Method Cord untethering Specimen Count And Types Nil Pathology Nil Operative Findings Moderate fibrosis of the previous incision site and thickening of the dura were observed. Intradural adhesion was found at the dorsal and lateral aspects of the spinal cord. The lumbosacral nerve roots were noted to exit the neural foramina in a upward direction, indicating the low-set of spinal cord. Moderate fibrosis of the previous incision site and thickening of the dura were observed. Intradural adhesion was found at the dorsal and lateral aspects of the spinal cord. The lumbosacral nerve roots were noted to exit the neural foramina in a upward direction, indicating the low-set of spinal cord. The placode was tightly tethered by the fibrotic tissue surrounding it. The untethering effect was good. The placode was rotated clockwisely from the caudal view, that mede the right sacral nerve exit at the ventral part of the thecal sac. The 6-0 Prolene knots (used to reconstruct the placode) were invaginated into itself to prevent future adhesion. The end of spinal cord was found to have going upward for about 1cm after untethering. Operative Procedures After endotracheal general anesthesia, the patient was placed in prone position. After scrubbing, disinfection & draping in sterile fashion, a midline linear incision was made at lumbosacral area along the previous surgical scar. The incision was deepened until the dura was identified under microscopic view. We incised the wound at its upper part to exposed the relatively normal dura and fibrous lamina, which was then removed with 2 mm Kerrison punches. A midline linear durotomy was performed, adhesiolysis around the spinal cord and nerve roots were performed from the left side. The dissection was done along the duroneural junction to the cul-de-sac of thecal sac. The dissection was then done to the right side until complete loosening of the spinal cord was achieved. After meticulous hemostasis, The bivalved placode was reconstructed with 6-0 prolene, then the dura was closed in water-tight fashion with 5-0 Prolene continuous sutures. After placement of 1 piece of Gelfoam in epidural region, the wound was closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之 相關圖片 陳李菊 (F,1938/12/15,73y2m) 手術日期 2011/12/27 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Malignant neoplasm of thyroid gland 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 蔡宗良, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:01 進入手術室 08:15 麻醉開始 08:30 誘導結束 08:50 抗生素給藥 09:10 手術開始 11:50 抗生素給藥 12:10 手術結束 12:10 麻醉結束 12:20 送出病患 12:23 進入恢復室 13:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎弓切除術(減壓)-二節以內 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: Posterior decompression, laminectomy of L4 開立醫師: 張書豪 開立時間: 2011/12/27 12:26 Pre-operative Diagnosis Spondylolisthesis, L4-5, grade I Lumbar spinal stenosis, L4-5 Post-operative Diagnosis Spondylolisthesis, L4-5, grade I Lumbar spinal stenosis, L4-5 Operative Method Posterior decompression, laminectomy of L4 Posterior instrumentation, transpedicular screws, L4 and L5, bilateral, with rod fixation Transforaminal lumbar interbody fusion, L4-5 Specimen Count And Types nil Pathology None Operative Findings 1. Hypertrophy of ligmentum flavum of L4-5 2. Spondylolisthesis, grade I, L4-5 3. Screws: 6.2 x 45 for right-sided L4, others: 6.2 x 40 4. Cage height: 13 mm Operative Procedures 1. ETGA, prone positioning, confirmation of level using fluroscope 2. Routine preparation 3. Linear wound incision from L3 to S1, followed by subperiosteal dissection 4. Transpedicular screw fixation with fluoroscopic confirmation 5. Laminectomy of L4 6. Total facetectomy of right-sided L4-5, followed by discectomy, end-plate preparation and cage fixation, with fluoroscopic confirmation 7. Wound irrigation by gentamicin saline 8. Wound was closed in layers after placing HemoVac Operators VS賴達明 Assistants R6蔡宗良 R1張書豪 相關圖片 林清吉 (M,1961/12/27,50y2m) 手術日期 2011/12/27 手術主治醫師 賴達明 手術區域 東址 001房 02號 診斷 Chronic osteomyelitis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 蔡宗良, 時間資訊 00:00 臨時手術NPO 11:10 報到 11:30 進入手術室 11:35 麻醉開始 11:50 誘導結束 12:27 抗生素給藥 12:44 手術開始 14:50 手術結束 14:50 麻醉結束 15:05 送出病患 15:06 進入恢復室 16:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 骨內固定物拔除術-脊椎 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: Removal of implant, spine 開立醫師: 周博敏 開立時間: 2011/12/27 15:06 Pre-operative Diagnosis s/p T5- T9 posterior instrumentation, transpedicular screw with rod fixation Post-operative Diagnosis s/p removal of previous instruments Operative Method Removal of implant, spine Specimen Count And Types nil Pathology None Operative Findings Monoaxial transpedicular screws at T5 and T7, bilateral, with rod fiation Good fusion, especially to the left-sided TPS-rod, with presence of cortical bone encasing the rods and screws Operative Procedures 1. ETGA, prone postitioning 2. Routine preparation 3. Wound incision over previous wound 4. Dissection of the instruments and removal of all of them 5. Hemovac placement 6. Gentamicin saline irrigation 7. Wound was closed in layers Operators VS 賴達明 Assistants R6 蔡宗良, R1 張書豪, Intern 陳怡君 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Removal of implant, spine 開立醫師: 周博敏 開立時間: 2011/12/27 15:06 Pre-operative Diagnosis s/p T5- T9 posterior instrumentation, transpedicular screw with rod fixation Post-operative Diagnosis s/p removal of previous instruments Operative Method Removal of implant, spine Specimen Count And Types nil Pathology None Operative Findings Monoaxial transpedicular screws at T5 and T7, bilateral, with rod fiation Good fusion, especially to the left-sided TPS-rod, with presence of cortical bone encasing the rods and screws Operative Procedures 1. ETGA, prone postitioning 2. Routine preparation 3. Wound incision over previous wound 4. Dissection of the instruments and removal of all of them 5. Hemovac placement 6. Gentamicin saline irrigation 7. Wound was closed in layers Operators VS 賴達明 Assistants R6 蔡宗良, R1 張書豪, Intern 陳怡君 相關圖片 侯秀溱 (F,1949/12/13,62y3m) 手術日期 2011/12/27 手術主治醫師 陳敞牧 手術區域 東址 005房 01號 診斷 Brain tumor 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:00 進入手術室 08:10 麻醉開始 08:45 誘導結束 09:00 抗生素給藥 09:05 手術開始 12:00 抗生素給藥 14:55 麻醉結束 14:55 手術結束 15:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 6 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 顱底瘤手術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Right retrosigmoid approach for partial tumor... 開立醫師: 林哲光 開立時間: 2011/12/27 15:57 Pre-operative Diagnosis Right cerebellopontine angle tumor Post-operative Diagnosis Right cerebellopontine angle tumor Operative Method Right retrosigmoid approach for partial tumor excision Specimen Count And Types 1 piece About size: Source:Tumor Pathology Pending Operative Findings One 3cm sized, well-defined, yellowish, soft-elastic mass lesion was noted at right C-P angle with solid and cystic component. The cystic part was localized at the tip of tumor at cerebellum. Right CN 7-8 complex was tightly compressed by the tumor to the medial side. The tumor was removed at the superior part near the tentorium and inferior part near the low cranial nerves. The tumor protruding into the cerebellum part was removed as extensively as possible. The rest of the tumor near CN7-8 complex and inside the IAC complex was left untouched. Facial nerve stimulation was done initially at the tumor surface and no identified facial nerve overlying the tumor. The low cranial nerves were identified and left intact during the dissection of the plane between the inferior part of the tumor. Operative Procedures Under ETGA and 3/4 prone position, skin disinfected and drapped were performed as usual. A curvilinear skin incision was made at right posterior auricle area inside the hairline. A fascia flap was excised initially. Two burr holes were created at T-S junction and one near the foramen magnum. Craniotomy was then performed. The dura was then opened as "K" shape. CSF drainage was then done by opening the cistern magnum. The retractor was then applied to cerebellum to expose the tumor well. Central debulking was then performed and partial tumor removal was then done after the tumor margin was free from the cerebellum and brainstem at inferior, superior and lateral part. Hemostasis with Surgecells packing was then done. Duroplasty with autologus fascia was done after deair and the bone graft was put back and fixed with miniplates. The wound was then closed in layers after a subgaleal CWV drain insertion. Operators 陳敞牧 Assistants 林哲光 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Right retrosigmoid approach for partial tumor... 開立醫師: 林哲光 開立時間: 2011/12/27 15:57 Pre-operative Diagnosis Right cerebellopontine angle tumor Post-operative Diagnosis Right cerebellopontine angle tumor Operative Method Right retrosigmoid approach for partial tumor excision Specimen Count And Types 1 piece About size: Source:Tumor Pathology Pending Operative Findings One 3cm sized, well-defined, yellowish, soft-elastic mass lesion was noted at right C-P angle with solid and cystic component. The cystic part was localized at the tip of tumor at cerebellum. Right CN 7-8 complex was tightly compressed by the tumor to the medial side. The tumor was removed at the superior part near the tentorium and inferior part near the low cranial nerves. The tumor protruding into the cerebellum part was removed as extensively as possible. The rest of the tumor near CN7-8 complex and inside the IAC complex was left untouched. Facial nerve stimulation was done initially at the tumor surface and no identified facial nerve overlying the tumor. The low cranial nerves were identified and left intact during the dissection of the plane between the inferior part of the tumor. Operative Procedures Under ETGA and 3/4 prone position, skin disinfected and drapped were performed as usual. A curvilinear skin incision was made at right posterior auricle area inside the hairline. A fascia flap was excised initially. Two burr holes were created at T-S junction and one near the foramen magnum. Craniotomy was then performed. The dura was then opened as "K" shape. CSF drainage was then done by opening the cistern magnum. The retractor was then applied to cerebellum to expose the tumor well. Central debulking was then performed and partial tumor removal was then done after the tumor margin was free from the cerebellum and brainstem at inferior, superior and lateral part. Hemostasis with Surgecells packing was then done. Duroplasty with autologus fascia was done after deair and the bone graft was put back and fixed with miniplates. The wound was then closed in layers after a subgaleal CWV drain insertion. Operators 陳敞牧 Assistants 林哲光 相關圖片 林崇德 (M,2011/07/16,8m2d) 手術日期 2011/12/27 手術主治醫師 邱英世 手術區域 兒醫 068房 01號 診斷 Interruption of aortic arch 器械術式 Repair CoA + Sano shunt enlargement 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 石博元 ASA 3 紀錄醫師 陳政維, 時間資訊 08:00 報到 08:00 進入手術室 08:20 麻醉開始 09:10 誘導結束 09:45 抗生素給藥 10:15 手術開始 12:45 抗生素給藥 13:10 開始輸血 14:20 麻醉結束 14:20 手術結束 14:26 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 四合群症之繞道手術 1 1 手術 主動脈之修補 1 2 手術 體外心肺循環 1 1 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 記錄__ 手術科部: 外科部 套用罐頭: Residual CoA revision and Sano shunt revision 開立醫師: 陳政維 開立時間: 2011/12/27 14:44 Pre-operative Diagnosis IAA, type A, VSD, s/p Norwood stage I + Sano shunt with CoA Post-operative Diagnosis Ditto Operative Method Residual CoA revision and Sano shunt revision Aortoplasty and RV-PA shunt revision Specimen Count And Types Nil Pathology Nil Operative Findings 1.Situs solitus, d-loop, levocardia, left side arch 2.Pre-OP PG between upper and lower limbs:30mmHg 3.Coarctation site: proximal DsAo: 2mm(luminal diameter), previous anastomosis site of DsAo and arch 4.Post-OP PG: around 10mmHg 5.Post-OP Goretex membrane wrap the AsAo and RV-PA shnut and cover the mediastinum space 6. Operative Procedures 1.ETGA, supine position, skin disinfection and well draped 2.Resternotomy and adhesionlysis 3.Cannulation: A4mm Goretex graft-->IA, V:RAA, on CPB and cooling to 18C, transect previous RV-PA shunt and venting(PV and PA) 4.AXC and antegrade cardioplegia infusion 5.DHCA with selective cerebral perfusion 6.Aortoplasty with bovine pericardium 7.Rewarm, recreate RV-PA shunt with 6mm Goretex graft, wean off CPB 8.Hemostasis and set four chest tubes 9.Close the wound in layers Operators P邱英世 VS黃書健 Assistants R5周恒文 R4陳政維 張寶瑜 (F,1962/05/12,49y10m) 手術日期 2011/12/27 手術主治醫師 蕭輔仁 手術區域 西址 039房 01號 診斷 Carpal tunnel syndrome 器械術式 Decompression of mediun nerve 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 09:15 進入手術室 09:35 麻醉開始 09:38 手術開始 10:10 手術結束 10:15 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 正中神經或尺神經腕部減壓術–單側 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Carpal Tunnel Syndrome 開立醫師: 蕭輔仁 開立時間: 2011/12/27 10:28 Pre-operative Diagnosis Carpal tunnel syndrome, right Post-operative Diagnosis Carpal tunnel syndrome, right Operative Method Decompression of right median nerve Specimen Count And Types nil Pathology Nil Operative Findings Hypertrophic and calcified transverse carpal ligment was noted. The right median nerve was decompressed well after transection of the transverse carpal ligment. The nerve was preserved well during the operation. Operative Procedures The hand and forearm were sterilized with povidone-iodine tincture, then covered with stockinet. Local anesthesia with 1% Xylocaine 10ml was applied. One linear skin incision was made with 1.5cm in length. The subcutaneous soft tissue was devided and the transverse carpal ligment was identified. The transverse carpal ligment was transected with knife and scissor. Hemostasis was achieved. The wound was closed in layers with 3-0 Vicryl and 4-0 Nylon. Operators VS蕭輔仁 Assistants R5李振豪 范國淡 (M,1945/04/15,66y10m) 手術日期 2011/12/27 手術主治醫師 蔡翊新 手術區域 東址 026房 01號 診斷 Subdural hemorrhage, traumatic 器械術式 Triphination for acute SDH evacuation and ICP monitoring, Right 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 4E 紀錄醫師 施培艾, 時間資訊 09:00 臨時手術NPO 09:00 開始NPO 01:56 通知急診手術 02:45 進入手術室 02:50 麻醉開始 03:00 誘導結束 03:30 手術開始 04:10 開始輸血 05:00 抗生素給藥 06:30 手術結束 06:30 麻醉結束 07:00 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦內血腫清除術 1 1 R 手術 顱內壓視置入 1 2 R 記錄__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 蔡翊新 開立時間: 2011/12/27 06:20 Pre-operative Diagnosis Right frontotemporoparietal acute SDH, right temporal contusional ICH, and brain swelling. Post-operative Diagnosis Right temporal skull fracture with right frontotemporoparietal acute SDH, right temporal contusional ICH, and brain swelling. Operative Method Right frontotemporoparietal craniectomy for removal of right temporal ICH and right F-T-P acute SDH, duroplasty with Duroform and right temporal intraparenchymal ICP monitoring. Specimen Count And Types nil Pathology Nil. Operative Findings Linear skull fracture at right temporal bone led posteriorly from temporal squama along upper border of petous bone to occipital area. Initial ICP after first burr hole creation was 40 mmHg. The dura adhered to the bone tightly and broke easily as a whole piece while craniectomy was performed. There was massive SDH, 2.5 cm in thickness, at right F-T-P area. Contusional ICH at right temporal lobe, about 20 ml in amount. Bleeding tendency was encountered during hematoma evacuation. The dural defect was as large as the craniectomy window and it was covered with Duroform. The ICP after scalp closure was 15 mmHg. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 4 cm at anterior-lower temporal area, the skin edge was clipped by Raney clips for temporary hemostasis. The temporalis muscles was incised down to the tempoal squama which was exposed then by applying a self retaining retractor on the muscle. 5. A burr hole was made and the dura was incised for evacuating part of the subdural hematoma, therefore the IICP could be relieved earlier. 6. The incision was extended to a temporal horseshoe, and the temporalis muscle was detached from temporal squama by rasp subsequently. 7. Craniotomy window: 14 x 12 cm, right frontotemporoparietal, created by making 5 burr holes then cut by power saw. 8. The dura was removed with the bone plate due to tight adhesion. 9. The subdural clot and contusional ICH were removed by sucker. 10.Hemosatasis: the bleeders was stopped by Bovie and oozing surface was covered with Surgicel. 11.Dural closure: was closed with two pieces of Duroform, 12 x 10 cm and 7.5 x 2.5 cm, in order to create an additional space for the swollen brain. 12.The skull plate was removed and stored at bone bank for preservation. 13.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 13.Drain: two epidural CWV drains. 14.Blood transfusion: PRBC 4U, FFP 6U, Platelet 12U. Blood loss: 1600 ml. 15.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R6蔡宗良R0施培艾 Indication Of Emergent Operation Massive SDH with midline shift and brainstem compression, IICP 相關圖片 張杰瑞 (M,1979/03/28,32y11m) 手術日期 2011/12/28 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Acoustic tumor 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 2 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 08:08 進入手術室 08:20 麻醉開始 08:45 誘導結束 09:00 抗生素給藥 09:02 手術開始 11:50 開始輸血 12:00 抗生素給藥 15:00 抗生素給藥 18:00 手術結束 18:00 抗生素給藥 18:00 麻醉結束 18:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 11 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 顱底瘤手術 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Left retrosigmoid approach for tumor excision 開立醫師: 陳國瑋 開立時間: 2011/12/28 18:30 Pre-operative Diagnosis Left vestibular schwannnoma Post-operative Diagnosis Left vestibular schwannnoma Operative Method Left retrosigmoid approach for tumor excision Specimen Count And Types 1 piece About size:fratments Source:brain tumor Pathology pending Operative Findings One soft, hypervasculized tumor arising from left superior vestibular nerve was noted. It was about 2 cm and extending into internal acoustic meatus. There was cystic part compressing the facial nerve and pushed it anterior-inferiorly. The tumor adhered to the facial and cochlear nerve tightly. We spent much time on seperating the nerves and the tumor. The meatus was drilled open( 1 cm in dpeth) and the tumor inside was removed with neuron hook and CUSA. The left BAEP was flattened from the beginning of the surgery. Facial nerve stimulation was used to identify the CN VII. The inferior vestibular was transected. The facial nerve and choclear nerve were preserved well. Operative Procedures After ETGA, the patient was in supine position with left shoulder elevated, and head turned to right. The skin was shaved, disinfected and drapped as usual. One curvilinear skin incision was made retro-auricular, and one piece of fascia was harvested for dura repair. Asterion was identified and the craniotomy was made. The dura was incised into Ommega shape and reflected. CSF was drained at cisterna meganum. CN VII VIII complex along with tumor was noted. The internal acoustic meatus was drilled open and tumor resection was done with CUSA. The cystic part of tumor compressed the CN VII tightly and was removed meticulously. The opening of the IAC was sealed with autologous fascia and Tissucol Duo. Duroplasty was performed with autologous fascia graft and water-tight suture. Bone graft was fixed back with mini-plates. The wound was closed in layers. Operators Prof. 杜永光 Assistants 鍾文桂 陳國瑋 相關圖片 詹喻媗 (F,2005/01/12,7y2m) 手術日期 2011/12/28 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Hydrocephalus 器械術式 Revision of CSF shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 2 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:10 麻醉開始 08:15 誘導結束 08:30 抗生素給藥 09:13 手術開始 10:25 手術結束 10:25 麻醉結束 10:30 送出病患 10:30 進入恢復室 11:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦脊髓液分流管重置 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 摘要__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt revision, right si... 開立醫師: 王奐之 開立時間: 2011/12/28 10:45 Pre-operative Diagnosis Hydrocephalus, status post ventriculoperitoneal shunt insertion, right side, status post elongation of peritoneal catheter, with suspected slit ventricle syndrome Post-operative Diagnosis Hydrocephalus, status post ventriculoperitoneal shunt insertion, right side, status post elongation of peritoneal catheter, with suspected slit ventricle syndrome Operative Method Ventriculoperitoneal shunt revision, right side, with addition of a Codman programmable reservoir Specimen Count And Types 1 piece About size:10cm (*2) Source:peritoneal catheter tips Pathology Nil Operative Findings After removal of the catheter from the burr hole reservoir, CSF flows out freely. Mild to moderate adhesion was noted around previous operation site (at right frontal area & right upper quadrant of abdomen), along with fibrosis of the epidermal layer. Smooth CSF flow was confirmed after connection of the programmable reservoir and new catheter. The Codman programmable reservoir was preset to 110 mmH2O. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position. After scrubbing, disinfection & draping in sterile fashion, a curvilinear incision was made along previous scar at right frontal area. Dissection was made to carefully expose the catheter (to the connection site to the burr hole reservoir). Another linear incision was made at right upper quadrant of abdomen along previous scar, dissection was also made to expose the peritoneal catheter & the straight connector. A third small incision was made at right retroauricular region, a retroauricuular subcutaneous tunnel was then made with blunt dissection, long enough for passage of the programmable reservoir. The original catheter in between the connection site to the burr hole reservoir and the abdominal straight connector was replaced with a new segment of catheter and the programmable reservoir. After hemostasis, the wounds were closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之, Ri 黃柔維 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt revision, right si... 開立醫師: 王奐之 開立時間: 2011/12/28 10:45 Pre-operative Diagnosis Hydrocephalus, status post ventriculoperitoneal shunt insertion, right side, status post elongation of peritoneal catheter, with suspected slit ventricle syndrome Post-operative Diagnosis Hydrocephalus, status post ventriculoperitoneal shunt insertion, right side, status post elongation of peritoneal catheter, with suspected slit ventricle syndrome Operative Method Ventriculoperitoneal shunt revision, right side, with addition of a Codman programmable reservoir Specimen Count And Types 1 piece About size:10cm (*2) Source:peritoneal catheter tips Pathology Nil Operative Findings After removal of the catheter from the burr hole reservoir, CSF flows out freely. Mild to moderate adhesion was noted around previous operation site (at right frontal area & right upper quadrant of abdomen), along with fibrosis of the epidermal layer. Smooth CSF flow was confirmed after connection of the programmable reservoir and new catheter. The Codman programmable reservoir was preset to 110 mmH2O. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position. After scrubbing, disinfection & draping in sterile fashion, a curvilinear incision was made along previous scar at right frontal area. Dissection was made to carefully expose the catheter (to the connection site to the burr hole reservoir). Another linear incision was made at right upper quadrant of abdomen along previous scar, dissection was also made to expose the peritoneal catheter & the straight connector. A third small incision was made at right retroauricular region, a retroauricuular subcutaneous tunnel was then made with blunt dissection, long enough for passage of the programmable reservoir. The original catheter in between the connection site to the burr hole reservoir and the abdominal straight connector was replaced with a new segment of catheter and the programmable reservoir. After hemostasis, the wounds were closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之, Ri 黃柔維 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt revision, right si... 開立醫師: 郭夢菲 開立時間: 2011/12/28 11:13 Pre-operative Diagnosis Hydrocephalus, status post ventriculoperitoneal shunt insertion, right side, status post elongation of peritoneal catheter, with slit ventricle formation Post-operative Diagnosis Hydrocephalus, status post ventriculoperitoneal shunt insertion, right side, status post elongation of peritoneal catheter, with slit ventricle formation Operative Method Ventriculoperitoneal shunt revision, right side, with addition of a Codman programmable reservoir and replacement of a new catheter of the distal subcutaneous one Specimen Count And Types 1 piece About size:10cm (*2) Source:peritoneal catheter tips Pathology Nil Operative Findings After disconnection of the catheter from the previous burr-hole typed reservoir, CSF flew out freely. Mild to moderate adhesion was noted around previous operation site (at right frontal area & right upper quadrant of abdomen), along with fibrosis of the epidermal layer. Smooth CSF flow was confirmed after connection of the programmable reservoir and new catheter. The Codman programmable reservoir was preset to 110 mmH2O. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position. After scrubbing, disinfection & draping in sterile fashion, a curvilinear incision was made along previous scar at right frontal area. Dissection was made to carefully expose the connection site between the distal catheter and the burr-hole typed reservoir. Another linear incision was made at right upper quadrant of abdomen along previous scar, dissection was also made to expose the peritoneal catheter & the straight connector. A third small incision was made at right retroauricular region, a retroauricular subcutaneous tunnel was then made with blunt dissection, long enough for passage of the programmable reservoir. The original catheter in between the connection site to the burr hole reservoir and the abdominal straight connector was replaced with a new segment of catheter and the programmable reservoir. After hemostasis, the wounds were closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之, Ri 黃柔維 相關圖片 張怡蓁 (F,2011/09/23,5m23d) 手術日期 2011/12/28 手術主治醫師 楊士弘 手術區域 兒醫 067房 02號 診斷 Ebstein anomaly 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 10:54 進入手術室 11:00 麻醉開始 11:10 誘導結束 11:15 抗生素給藥 11:46 手術開始 12:45 手術結束 12:45 麻醉結束 12:58 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 套用罐頭: Ventriculoperitoneal shunt insertion, right s... 開立醫師: 王奐之 開立時間: 2011/12/28 13:21 Pre-operative Diagnosis Post-hemorrhagic hydrocephalus, status post Ommaya reservoir implantation via right Kocher point Post-operative Diagnosis Post-hemorrhagic hydrocephalus, status post Ommaya reservoir implantation via right Kocher point Operative Method Ventriculoperitoneal shunt insertion, right side, with Codman programmable reservoir Specimen Count And Types Nil Pathology Nil Operative Findings Codman programmable reservoir was used (no pre-chamber), pressure preset to 100 mmH2O. Smooth CSF flow was confirmed after ventricular catheter insertion. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After shaving, scrubbing, disinfection & draping in sterile fashion, a linear incision was made along previous wound at right frontal area. After dissection out the Ommaya reservoir, a mini-laparotomy was performed at right upper quadrant of abdomen. A subcutaneous tunnel was created from the abdominal wound to the right frontal area, through a small third wound at right retroauricular region. The peritoneal catheter was passed through first, followed by assembly of the programmable reservoir and the catheters. The Ommaya reservoir was then carefully pulled out, followed by insertion of the new ventricular catheter. After confirmation of smooth CSF flow, the peritoneal catheter was inserted into the peritoneal cavity. The wounds were closed in layers after hemostasis. Operators VS 楊士弘 Assistants R4 王奐之, Ri 黃柔維 相關圖片 記錄__ 手術科部: 套用罐頭: Ventriculoperitoneal shunt insertion via righ... 開立醫師: 王奐之 開立時間: 2011/12/28 16:12 Pre-operative Diagnosis Post-hemorrhagic hydrocephalus, status post Ommaya reservoir implantation via right Kocher point Post-operative Diagnosis Post-hemorrhagic hydrocephalus, status post Ommaya reservoir implantation via right Kocher point Operative Method Ventriculoperitoneal shunt insertion via right Kocher point with Codman programmable reservoir Specimen Count And Types Nil Pathology Nil Operative Findings Codman programmable reservoir was used (no pre-chamber), pressure preset to 100 mmH2O. Smooth CSF flow was confirmed after ventricular catheter insertion. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After shaving, scrubbing, disinfection & draping in sterile fashion, a linear incision was made along previous wound at right frontal area. After dissection out the Ommaya reservoir, a mini-laparotomy was performed at right upper quadrant of abdomen. A subcutaneous tunnel was created from the abdominal wound to the right frontal area, through a small third wound at right retroauricular region. The peritoneal catheter was passed through first, followed by assembly of the programmable reservoir and the catheters. The Ommaya reservoir was then carefully pulled out, followed by insertion of the new ventricular catheter. After confirmation of smooth CSF flow, the peritoneal catheter was inserted into the peritoneal cavity. The wounds were closed in layers after hemostasis. Operators VS 楊士弘 Assistants R4 王奐之, Ri 黃柔維 相關圖片 葉佐詮 (M,2002/08/31,9y6m) 手術日期 2011/12/29 手術主治醫師 楊士弘 手術區域 兒醫 063房 號 診斷 Spinal cord injury 器械術式 Laminectomy for decompression 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3E 紀錄醫師 李振豪, 時間資訊 21:09 臨時手術NPO 21:09 開始NPO 22:09 通知急診手術 23:51 進入手術室 23:55 麻醉開始 00:20 抗生素給藥 00:25 誘導結束 01:00 手術開始 02:10 開始輸血 02:28 手術結束 02:28 麻醉結束 02:35 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 脊椎腔內動靜脈畸型切除術-二節以內 1 1 記錄__ 手術科部: 套用罐頭: T2-3 laminectomy for hematoma removal and lam... 開立醫師: 楊士弘 開立時間: 2011/12/29 02:56 Pre-operative Diagnosis Posterior T2-3 spinal epidural lesion; thoracic cord lesion Post-operative Diagnosis Spinal epidural hematoma, T2-3, r/o vascular lesion related Operative Method T2-3 laminectomy for hematoma removal and laminoplasty Specimen Count And Types 1 piece About size:小 Source:epidural lesion, r/o hematoma 3 swab culture tubes Pathology pending Operative Findings An encapsulated hematoma, 3 cm x 2 cm x 1 cm, was found over the posterior epidural space at lower T1 to upper T4 level. Profuse oozing was noted from the left lateral epidural space after hematoma removal. The bleeding was stopped after packing with Surgicel strips. Operative Procedures 1. ETGA, prone, head fixed with skull clamp. 2. C-arm localization of T2-3 level. 3. Midline incision from T1-4. 4. Dissection of paraspinal muscles off spinous processes and lamina. 5. Laminectomy of T2, T3 with Kerrison punches and osteotome. 6. Removal of epidural hematoma. 7. Hemostasis with Surgicel strips packing in the epidural space. 8. Fixation of T2,3 lamina back with miniplates and screws. 9. One epilaminal CWV drain. 10. Wound closure in layers. Operators 楊士弘 Assistants 李振豪 Indication Of Emergent Operation epidural lesion with acute paraplegia 相關圖片 許武助 (M,1939/09/28,72y5m) 手術日期 2011/12/28 手術主治醫師 林明中 手術區域 西址 039房 14號 診斷 Hematuria 器械術式 Fiberocystoscopy /WOR 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 15:19 報到 15:43 進入手術室 15:45 麻醉開始 15:47 手術開始 15:50 手術結束 15:52 送出病患 周仲煜 (M,1939/08/30,72y6m) 手術日期 2011/12/28 手術主治醫師 王國川 手術區域 東址 005房 02號 診斷 Cerebral hemorrhage 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 14:00 報到 14:58 進入手術室 15:05 麻醉開始 15:15 誘導結束 15:30 抗生素給藥 15:40 手術開始 16:27 手術結束 16:27 麻醉結束 16:35 送出病患 16:40 進入恢復室 17:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 神經部 套用罐頭: Left Kocher point Codman programmable V-P shu... 開立醫師: 林哲光 開立時間: 2011/12/28 16:49 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Left Kocher point Codman programmable V-P shunt insertion Specimen Count And Types nil Pathology Nil Operative Findings The brain parenchyma seemed slack after dura opening. CSF seemed clear and transparent when ventricular puncture. Opening pressure was low. Valve was set 12cmH2O. Ventricular catheter was 7cm long and abdominal catheter was more than 10cm long. Operative Procedures Under ETGA and supine position with head rotated to right side, skin disinfected and drapped were perofrmed as usual. Transverse skin incision was made at left Kocher point. A burr hole was created and dura was opened after dural tenting. Transverse skin incision was made at left abdomen and minilarparotomy was done. Subcutaneous tunneling was then made through left abdomen, left chest, left neck to left posterior auricle. The ventricular catheter was then connected to abdominal catheter with valve through subcutaneous tunneling. Ventricular catheter was then introduced into the lateral horn via ventricular puncture along the trajectory composed of two planes pointing to targus and medial cathus. The abdominal catheter was then introduced into the peritoneal cavity. THe wound was then closed in layers after function of V-P was checked and hemostasis was done with Gelfoam packing at burr hole. Operators 王國川 Assistants 林哲光, 連子賢 相關圖片 記錄__ 手術科部: 神經部 套用罐頭: Left Kocher point Codman programmable V-P shu... 開立醫師: 林哲光 開立時間: 2011/12/28 16:49 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Left Kocher point Codman programmable V-P shunt insertion Specimen Count And Types nil Pathology Nil Operative Findings The brain parenchyma seemed slack after dura opening. CSF seemed clear and transparent when ventricular puncture. Opening pressure was low. Valve was set 12cmH2O. Ventricular catheter was 7cm long and abdominal catheter was more than 10cm long. Operative Procedures Under ETGA and supine position with head rotated to right side, skin disinfected and drapped were perofrmed as usual. Transverse skin incision was made at left Kocher point. A burr hole was created and dura was opened after dural tenting. Transverse skin incision was made at left abdomen and minilarparotomy was done. Subcutaneous tunneling was then made through left abdomen, left chest, left neck to left posterior auricle. The ventricular catheter was then connected to abdominal catheter with valve through subcutaneous tunneling. Ventricular catheter was then introduced into the lateral horn via ventricular puncture along the trajectory composed of two planes pointing to targus and medial cathus. The abdominal catheter was then introduced into the peritoneal cavity. THe wound was then closed in layers after function of V-P was checked and hemostasis was done with Gelfoam packing at burr hole. Operators 王國川 Assistants 林哲光, 連子賢 相關圖片 王桂雲 (F,1954/09/17,57y5m) 手術日期 2011/12/28 手術主治醫師 蔡翊新 手術區域 東址 005房 01號 診斷 Lumbar spondylosis with myelopathy 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 2 紀錄醫師 連子賢, 時間資訊 00:00 臨時手術NPO 07:48 報到 08:08 進入手術室 08:15 麻醉開始 08:25 誘導結束 09:05 手術開始 09:38 開始輸血 14:08 進入恢復室 14:35 手術結束 14:35 麻醉結束 14:45 送出病患 16:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 椎弓切除術(減壓)-超過二節 1 2 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 記錄__ 手術科部: 外科部 套用罐頭: L2-5 laminectomy, posterolateral fusion with ... 開立醫師: 林哲光 開立時間: 2011/12/28 15:08 Pre-operative Diagnosis L3-4 spondylolisthesis, grade I; L2-5 spinal canal stenosis Post-operative Diagnosis L3-4 spondylolisthesis, grade I; L2-5 spinal canal stenosis Operative Method L2-5 laminectomy, posterolateral fusion with autologus bone graft and Simbone; L3-4 discectomy and L3-4 posteior fusion with TPS and rods Specimen Count And Types nil Pathology Nil Operative Findings Depressed height of vertebral body was noted at L5 level. Severe hypertrophic change of bilateral facet joints and ligamentum flavum were noted at L2-L5 level. Depressed L3 lamina was noted. The dura sac seemed re-expanded well after laminectomy was done. L3-4 intervertebral disc ruptured was noted during discectomy. Intraoperative dura tear at L3 level was noted and the dura repair was done with 10-0 Prolene and packed with Gelfoam. No obvious osteoporosis was noted during the operation. TPS 6.5x40mm x2 and rods 5cm x2 were applied at L3 and L4 level for posterior fusion. Operative Procedures Under ETGA and prone position, skin disinfected and drapped were performed as usual. Midline skin incision was made from L2-S1 level. The paraspinal muscles were detached. TPS was then applied at L3, L4 pedicles under C-arm localization. L2-L5 laminectomy was then performed. Subalminal decompression was reinforced at L3, L4 level. L3/4 discectomy was done. Dura repair was done with 10-0 Prolene. Hemostasis was then done wiht Gelfoam packing. Rods were then applied for posterior fusion. Posterior lateral fusion with autologus bone and Simbone was then performed after decortication was done at L2-L5 level. The wound was then closed in layers after a epidural H/V was inserted. Operators 蔡翊新 Assistants 林哲光, 連子賢 相關圖片 摘要__ 手術科部: 外科部 套用罐頭: L2-5 laminectomy, posterolateral fusion with ... 開立醫師: 林哲光 開立時間: 2011/12/28 15:09 Pre-operative Diagnosis L3-4 spondylolisthesis, grade I; L2-5 spinal canal stenosis Post-operative Diagnosis L3-4 spondylolisthesis, grade I; L2-5 spinal canal stenosis Operative Method L2-5 laminectomy, posterolateral fusion with autologus bone graft and Simbone; L3-4 discectomy and L3-4 posteior fusion with TPS and rods Specimen Count And Types nil Pathology Nil Operative Findings Depressed height of vertebral body was noted at L5 level. Severe hypertrophic change of bilateral facet joints and ligamentum flavum were noted at L2-L5 level. Depressed L3 lamina was noted. The dura sac seemed re-expanded well after laminectomy was done. L3-4 intervertebral disc ruptured was noted during discectomy. Intraoperative dura tear at L3 level was noted and the dura repair was done with 10-0 Prolene and packed with Gelfoam. No obvious osteoporosis was noted during the operation. TPS 6.5x40mm x2 and rods 5cm x2 were applied at L3 and L4 level for posterior fusion. Operative Procedures Under ETGA and prone position, skin disinfected and drapped were performed as usual. Midline skin incision was made from L2-S1 level. The paraspinal muscles were detached. TPS was then applied at L3, L4 pedicles under C-arm localization. L2-L5 laminectomy was then performed. Subalminal decompression was reinforced at L3, L4 level. L3/4 discectomy was done. Dura repair was done with 10-0 Prolene. Hemostasis was then done wiht Gelfoam packing. Rods were then applied for posterior fusion. Posterior lateral fusion with autologus bone and Simbone was then performed after decortication was done at L2-L5 level. The wound was then closed in layers after a epidural H/V was inserted. Operators 蔡翊新 Assistants 林哲光, 連子賢 相關圖片 潘坤福 (M,1944/02/15,68y0m) 手術日期 2011/12/28 手術主治醫師 王碩盟 手術區域 東址 002房 04號 診斷 Hydronephrosis 器械術式 Double-J ureteral stent insert 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 靜脈麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 黃冠棠, 時間資訊 12:30 報到 12:35 進入手術室 12:40 麻醉開始 12:45 誘導結束 12:48 手術開始 12:50 手術結束 12:54 麻醉結束 12:55 送出病患 13:00 進入恢復室 14:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 手術 前列腺切片-控取式 1 1 摘要__ 手術科部: 泌尿部 套用罐頭: TRUS-P-biopsy 開立醫師: 黃冠棠 開立時間: 2011/12/28 13:01 Pre-operative Diagnosis r/o prostate cancer Post-operative Diagnosis r/o prostate cancer Operative Method TRUSP biopsy Specimen Count And Types 1 piece About size:0.1*1.2cm, 12 cores Source:prostate Pathology pending Operative Findings 1.systematic 12 cores TRUSP biopsy was performed (Rt lat*3, Rt med*3, Lt med*3, Lt lat*3) 2.prostate size: 3.71cm x 2.69cm x 5.71cm= 26.7mL 3.DRE: hard nodule at bilateral lobe, suspected T2c lesion Operative Procedures Under satisfactory anesthesia with the patient in right flank position, prepping and draping was performed in the usual sterile fashion. TRUSP was performed and echo-guided prostate biopsies were performed smoothly with Biopty gun. The 12 cores of tissue specimen were obtained. The biosy area was compressed for several minutes to ensure adequate hemostasis. The patient tolerated the operation well and was sent to the floor in satisfactory condition. Operators 王碩盟, Assistants 黃冠棠, 記錄__ 手術科部: 泌尿部 套用罐頭: TRUS-P-biopsy 開立醫師: 黃冠棠 開立時間: 2011/12/28 13:01 Pre-operative Diagnosis r/o prostate cancer Post-operative Diagnosis r/o prostate cancer Operative Method TRUSP biopsy Specimen Count And Types 1 piece About size:0.1*1.2cm, 12 cores Source:prostate Pathology pending Operative Findings 1.systematic 12 cores TRUSP biopsy was performed (Rt lat*3, Rt med*3, Lt med*3, Lt lat*3) 2.prostate size: 3.71cm x 2.69cm x 5.71cm= 26.7mL 3.DRE: hard nodule at bilateral lobe, suspected T2c lesion Operative Procedures Under satisfactory anesthesia with the patient in right flank position, prepping and draping was performed in the usual sterile fashion. TRUSP was performed and echo-guided prostate biopsies were performed smoothly with Biopty gun. The 12 cores of tissue specimen were obtained. The biosy area was compressed for several minutes to ensure adequate hemostasis. The patient tolerated the operation well and was sent to the floor in satisfactory condition. Operators 王碩盟, Assistants 黃冠棠, 吳瑞琴 (F,1965/12/02,46y3m) 手術日期 2011/12/29 手術主治醫師 曾漢民 手術區域 東址 003房 03號 診斷 Malignant neoplasm of female breast, nipple and areola 器械術式 Ommaya implantation 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 16:17 進入手術室 16:21 麻醉開始 16:25 誘導結束 17:00 抗生素給藥 17:05 手術開始 17:52 手術結束 17:52 麻醉結束 18:00 送出病患 18:03 進入恢復室 19:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室體外引流 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 腫瘤醫學部 套用罐頭: Ommaya resovior implantation via right Kocher... 開立醫師: 曾偉倫 開立時間: 2011/12/29 17:43 Pre-operative Diagnosis Breast cancer brain metastasis with cancerous meningitis Post-operative Diagnosis Breast cancer brain metastasis with cancerous meningitis Operative Method Ommaya resovior implantation via right Kocher point Specimen Count And Types nil Pathology Nil. Operative Findings 1. The opening pressure was high 2. The CSF from the ventricle was clear 3. The ventricular catheter: 6cm Operative Procedures Under ETGa, we placed the patient on supine position with her head tilt to left. After we shaved, scrubbed, disinfected and drapped, a U shape skin incision was made. The wound was opened in layers and the burr-hole was made with air-drived drill. the dural tenting was done and the dura was opened with bipolar forceps and knife. The ventricular needle was inserted and the Ommaya resovoir was placed. The wound was closed in layers. Operators VS 曾漢民 Assistants R3 曾偉倫 Ri 林書平 相關圖片 鄭羽翔 (M,2001/06/06,10y9m) 手術日期 2011/12/29 手術主治醫師 王廷明 手術區域 東址 020房 02號 診斷 Cerebral palsy 器械術式 Bil hamstring release + rectus transfer 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 2 紀錄醫師 賴昆鴻, 時間資訊 10:15 報到 11:03 進入手術室 11:10 麻醉開始 11:15 誘導結束 11:20 抗生素給藥 11:33 手術開始 13:15 手術結束 13:15 麻醉結束 13:20 送出病患 13:25 進入恢復室 14:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 肌腱轉移或移位 2 1 B 手術 肌腱切開或筋膜切開 2 2 B 手術 石膏固定－長腿 1 0 B 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 骨科部 套用罐頭: 1. Both rectus femoris tendon transfer 開立醫師: 賴昆鴻 開立時間: 2011/12/29 13:29 Pre-operative Diagnosis Cerebral palsy with spastic diplegia Post-operative Diagnosis Cerebral palsy with spastic diplegia Operative Method 1. Both rectus femoris tendon transfer 2. Both hamstring release Specimen Count And Types nil Pathology nil Operative Findings 1. Both knee extension leg with limited range of motion in flexion 2. Both hamstring tightness Operative Procedures 1. ETGA, supine position 2. Skin disinfection, draped, on rubber tourniquet 3. Incision over posterior thigh, dissect and identified the gracilis, semi-membranosous and semi-tendonosous, them performed tenotomy 4. Make another longitudinal incision over anterior knee, dissect and espose the quadriceps tendon 5. Harvest the rectous femoris tendon, perpared the tendon graft. Identified the satorious muscle, pass the tendon graft beneth the satorious, looped and repair with its prxomial part 6. Reapir the residual quadriceps 7. Irrigation, hemostasis, close in layers 8. Applied long leg cast 9. Repeated the same procedure over the other leg. Operators 王廷明, Assistants 賴昆鴻, 謝忠佑, 廖翊廷, 記錄__ 手術科部: 骨科部 套用罐頭: 1. Both rectus femoris tendon transfer 開立醫師: 賴昆鴻 開立時間: 2011/12/29 13:29 Pre-operative Diagnosis Cerebral palsy with spastic diplegia Post-operative Diagnosis Cerebral palsy with spastic diplegia Operative Method 1. Both rectus femoris tendon transfer 2. Both hamstring release Specimen Count And Types nil Pathology nil Operative Findings 1. Both knee extension leg with limited range of motion in flexion 2. Both hamstring tightness Operative Procedures 1. ETGA, supine position 2. Skin disinfection, draped, on rubber tourniquet 3. Incision over posterior thigh, dissect and identified the gracilis, semi-membranosous and semi-tendonosous, them performed tenotomy 4. Make another longitudinal incision over anterior knee, dissect and espose the quadriceps tendon 5. Harvest the rectous femoris tendon, perpared the tendon graft. Identified the satorious muscle, pass the tendon graft beneth the satorious, looped and repair with its prxomial part 6. Reapir the residual quadriceps 7. Irrigation, hemostasis, close in layers 8. Applied long leg cast 9. Repeated the same procedure over the other leg. Operators 王廷明, Assistants 賴昆鴻, 謝忠佑, 廖翊廷, 鄭春為 (M,1939/04/12,72y11m) 手術日期 2011/12/29 手術主治醫師 林峰盛 手術區域 西址 034房 05號 診斷 Lumbar spine fracture 器械術式 Nerve block / PC 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 林峰盛 ASA 3 紀錄醫師 林健華, 時間資訊 12:20 進入手術室 12:30 麻醉開始 12:32 誘導結束 12:40 手術開始 13:05 手術結束 13:05 麻醉結束 13:10 送出病患 13:15 進入恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 手術 高頻熱凝療法 1 1 R 記錄__ 手術科部: 麻醉部 套用罐頭: Pulsed RF 開立醫師: 林健華 開立時間: 2011/12/29 13:08 Pre-operative Diagnosis Radiculopathy Spinal stenosis Post-operative Diagnosis radiculopathy Spinal stenosis Operative Method Pulsed RF Specimen Count And Types nil Pathology Nil Operative Findings Operative Procedures 1. IV sedation with midazolam and LA with 1% xylocaine 2. pt in prone position 3. Under fluoroscopic-guidance, insert 22 G SMK RF meedle into right L2 neuroforamen 4. Neurostimulation with 50 HZ and 2 Hz 0.1-0.5 mV current with positive result 60-80V 2 Hz, 20 ms, 120sec *2 pulsed RF was delivered send pt to PRO Operators 林峰盛, Assistants 林健華, 柯春敏 (F,1958/03/19,53y11m) 手術日期 2011/12/29 手術主治醫師 陳敞牧 手術區域 東址 003房 02號 診斷 Spondylolisthesis, acquired 器械術式 L4/5 TLIF 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 09:55 報到 10:30 進入手術室 10:35 麻醉開始 10:45 誘導結束 11:00 抗生素給藥 11:18 手術開始 14:11 抗生素給藥 16:00 手術結束 16:00 麻醉結束 16:05 送出病患 16:10 進入恢復室 17:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎弓切除術(減壓)-二節以內 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 摘要__ 手術科部: 外科部 套用罐頭: L4 hemilaminectomy for decompression and Tran... 開立醫師: 曾偉倫 開立時間: 2011/12/29 10:10 Pre-operative Diagnosis 1. Spondylolisthesis, L4-5 with spinal stenosis Post-operative Diagnosis 1. Spondylolisthesis, L4-5 with spinal stenosis Operative Method L4 hemilaminectomy for decompression and Transforaminal Lumbar Interbody Fusion, L4-5 with TPS fixation Specimen Count And Types nil Pathology nil. Operative Findings Operative Procedures Under ETGA, we placed the patient on prone position. The L4-5 level was located with C-arm, and we scrubbed, disinfected and drapped as usual. A linear skin incision was made from L4 facet level to L5 facet level and the wound was closed in layers. The paraspinal muscle and soft tissue was detached. Operators VS 陳敞牧 Assistants R3 曾偉倫 Ri 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: L4 hemilaminectomy for decompression and Tran... 開立醫師: 陳柏誠 開立時間: 2011/12/29 16:17 Pre-operative Diagnosis 1. Spondylolisthesis, L4-5 with spinal stenosis Post-operative Diagnosis 1. Spondylolisthesis, L4-5 with spinal stenosis Operative Method L4 hemilaminectomy for decompression and Transforaminal Lumbar Interbody Fusion, L4-5 with TPS fixation Specimen Count And Types nil Pathology nil. Operative Findings 1. Grade II spondylolisthesis over L4-5 with severe core compression, more on left. Hypertrophic ligmentum flavum (+). Degenerative change over L4-5 facet joint with hypertrophy. 2. A-spine instrument with TPS: 6.5 mm x 55 mm x 4, ROD 5.0 (Left) and 6.0 cm (Right) Banana cage: 10mm x1 3. The thecal sac expanded well after the procedure 4. No CSF leak during the operation Operative Procedures Under ETGA, we placed the patient on prone position. The L4-5 level was located with C-arm, and we scrubbed, disinfected and drapped as usual. A linear skin incision was made from L4 facet level to L5 facet level and the wound was closed in layers. The paraspinal muscle and soft tissue was detached. After hemostasis, 4 TPS was placed over L4 and L5 pedicles and a 6.0cm rod was foxed over right side for reduction of the listhesis. Hemilaminectomy and left foraminotomy over L4 was done and the L4-5 disk was removed with curettes. A banana cage was placed and the left side rod was fixed. The TPS, RODs and cage place were checked with C-arm. After complete hemostasis, a hemovac drain was placed and the wound was closed in layers. Operators VS 陳敞牧 Assistants R3 曾偉倫 Ri 王書平 相關圖片 李明澤 (M,1989/09/02,22y6m) 手術日期 2011/12/29 手術主治醫師 蕭輔仁 手術區域 東址 002房 01號 診斷 Head injury, unspecified 器械術式 Spinal fusion posterior 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3E 紀錄醫師 李振豪, 時間資訊 22:00 臨時手術NPO 22:00 開始NPO 04:08 通知急診手術 04:43 進入手術室 04:45 麻醉開始 05:15 誘導結束 05:30 抗生素給藥 05:48 手術開始 06:43 開始輸血 10:00 抗生素給藥 11:00 12:25 12:44 13:00 抗生素給藥 14:20 麻醉結束 14:20 14:20 手術結束 14:30 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 11 0 手術 深部傷口處理縫合擴創-中 1 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 手術 椎弓切除術(減壓)-二節以內 1 2 手術 深部傷口處理縫合擴創-小 1 0 手術 眼瞼裂傷之修補 1 1 L 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 創傷醫學部 套用罐頭: 1. L1-L2 laminectomy for posterior decompression 開立醫師: 李振豪 開立時間: 2011/12/29 11:20 Pre-operative Diagnosis T9 to L3 vertebral fracture and L2 burst fracture with cauda equina syndrome Post-operative Diagnosis T9 to L3 vertebral fracture and L2 burst fracture with cauda equina syndrome Operative Method 1. L1-L2 laminectomy for posterior decompression 2. T12, L1, L3, and L4 transpedicular screws for posterior fixation. Specimen Count And Types nil Pathology Nil Operative Findings Hematoma was noted within paraspinal muscle especially T-L junction. T12 to L3 vertebral fracture was noted with destruction of right T12 to L2 facet joints. Transpedicular screws were implanted under fluoroscope guided(6.0 x 40mm at T12 and L1, 6.5 x 45mm at L3 and L4). L1 and L2 laminectomy was conducted for decompression along the fracture line of laminae. A large dural laceration was disclosed on right posterolateral side of L1-2 thecal sac and right L2 root. Herniation of cauda equina also found with two small roots transection. The margin of dura laceration was identified and dura was closed primary with 5-0 Prolene. Part of the burst fracture fragment was removed for decompression. The rest part of the burst fracture was pushed back with curette and anterior decompression. After circumferential decompression of the thecal sac, a piece of Duraform was applied over the dural laceration site. Two 18cm rods and one cross-link were set up for posterior fixation. Total blood loss was 3000ml. A 4cm scalp laceration was noted at right frontal scalp with large subgaleal hematoma formation. Part of the hematoma was evacuated from the wound for debridement. The wound was disinfected and closed with 3-0 prolene. Operative Procedures Under endotracheal general anesthesia, the patient was put in prone position. L2 level were localized by portable C-arm X-ray. The skin was scrubbed, disinfected, and draped as usual. Midline skin incision was made from T12 to L4. The subcutaneous soft tissue was devided and the paravertebral muscle groups were detached. T12, L1, L3, and L4 transpedicular screws were implanted under fluoroscope guided. L1 and L2 laminectomy was conducted for posterior decompression. A large dural laceration was noted at right posterolateral side of thecal sac. The cauda equina was pushed back to thecal sac and primary closure of the thecal sac with 5-0 prolene was achieved. The ventral part of the thecal sac was decompressed by curette and some bony fragment that compressed the thecal sac was removed. The thecal sac was covered with Duraform. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. Two epidural Hemovac was placed. Two rods and one cross-link was set up for posterior instrumentation. The wound was then closed in layers with 1-0, 2-0 Vicryl and Appose staples. The frontal scalp wound was disinfected with Aqua Better-iodine solution. The Debridement of the wound with primary closure with 3-0 Nylon was done. Operators VS蕭輔仁 Assistants R5李振豪, R2陳以幸 Indication Of Emergent Operation L2 burst fracture with cauda equina syndrome 記錄__ 手術科部: 眼科部 套用罐頭: eyelid tumor with hard palate 開立醫師: 高姿芸 開立時間: 2011/12/29 12:16 Pre-operative Diagnosis eyelid laceration(os ) Post-operative Diagnosis eyelid laceration(os ) Operative Method Suture of eyelid laceration (os ) Specimen Count And Types Pathology nil Operative Findings upper eyelid tissue loss Operative Procedures 1.Under general anesthesia 2.Disinfection and draping 3.suture the eyelid margin with 6-0 nylon with adaposition of gray line, meibomian gland and eyelash 4.suture the tarsus and internal laceration with 6-0 Vicryl 5. suture lower eyelid and nasal laceration with 6-0 nylon 6. Check fundus 7. Latycin pressure patching Operators 廖述朗, Assistants 高姿芸, 許詠瑞, Indication Of Emergent Operation eyelid laceration 記錄__ 手術科部: 外科部 套用罐頭: Wound debridement and repair 開立醫師: 趙崧筌 開立時間: 2011/12/29 14:41 Pre-operative Diagnosis Multiple facial lacerations and through-and-through laceration over upper lip, left side Post-operative Diagnosis Multiple facial lacerations and through-and-through laceration over upper lip, left side Operative Method Wound debridement and repair Specimen Count And Types nil Pathology Nil Operative Findings Multiple facial lacerations over bilaterl brows and upper eyelid were found with depth to muscle layer and they were repaired by layers. The through-and-through laceration over upper lip, left side was also repaired after debridement. Operative Procedures ETGA, supine, disinfected and prepped Debrided the wouhds and gave N/S irrigation Repaired them by layers Operators 鄭乃禎 Assistants 趙崧筌 Indication Of Emergent Operation L-spine injury 周張水 (F,1939/04/08,72y11m) 手術日期 2011/12/29 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Osteoporosis 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:25 麻醉開始 08:30 誘導結束 09:00 抗生素給藥 09:11 手術開始 09:55 手術結束 09:55 麻醉結束 10:15 送出病患 10:18 進入恢復室 11:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Ventricular-peritoneal shunt via right Kocher... 開立醫師: 曾偉倫 開立時間: 2011/12/29 09:59 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventricular-peritoneal shunt via right Kochers point Specimen Count And Types nil Pathology Nil Operative Findings 1. Some clear CSF was drained after the ventricular needle placed 2. Opening pressure: low 3. Valve: Medtronic Fixed-middle pressure valve 4. Ventricular catheter: 7cm , Peritoneal catheter: 25cm Operative Procedures Under ETGA, we placed the patient on supine position with hie face tile to left with right shoulder elevated. After we scrubbed, disinfected and drapped, a right frontal skin incision and RUQ skin incision was made. The burr-hole was made after the skin opened and the peritonial cavity was also opened after layer by layer dissection. the right lateral ventricle was reached with a ventricular puncture needle and the ventricular catheter was placed. The peritonium catheter was placed and connected to the ventricular catheter via a sub-cutaneous tunnel. the wound were closed in layers after complete hemostasis. Operators VS 王國川 Assistants R3 曾偉倫 R1 連子賢 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Ventricular-peritoneal shunt via right Kocher... 開立醫師: 曾偉倫 開立時間: 2011/12/29 10:00 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventricular-peritoneal shunt via right Kochers point Specimen Count And Types nil Pathology Nil Operative Findings 1. Some clear CSF was drained after the ventricular needle placed 2. Opening pressure: low 3. Valve: Medtronic Fixed-middle pressure valve 4. Ventricular catheter: 7cm , Peritoneal catheter: 25cm Operative Procedures Under ETGA, we placed the patient on supine position with hie face tile to left with right shoulder elevated. After we scrubbed, disinfected and drapped, a right frontal skin incision and RUQ skin incision was made. The burr-hole was made after the skin opened and the peritonial cavity was also opened after layer by layer dissection. the right lateral ventricle was reached with a ventricular puncture needle and the ventricular catheter was placed. The peritonium catheter was placed and connected to the ventricular catheter via a sub-cutaneous tunnel. the wound were closed in layers after complete hemostasis. Operators VS 王國川 Assistants R3 曾偉倫 R1 連子賢 相關圖片 余欽麟 (M,1948/03/07,64y0m) 手術日期 2011/12/29 手術主治醫師 蔡翊新 手術區域 東址 005房 01號 診斷 Patients requiring long-term use of a respirator due to respiratory failure use respirator 6 hours per day continue 30 days 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 07:55 報到 08:08 進入手術室 08:10 麻醉開始 08:13 誘導結束 08:40 抗生素給藥 09:18 手術開始 10:30 手術結束 10:30 麻醉結束 10:35 送出病患 10:43 進入恢復室 12:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 記錄__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 蔡翊新 開立時間: 2011/12/29 10:27 Pre-operative Diagnosis Hydrocephalus. Post-operative Diagnosis Hydrocephalus. Operative Method V-P Shunt, left Kocher. Specimen Count And Types 3 tubes of CSF, sent for routine, BCS and culture. Pathology Nil. Operative Findings CSF: clean, pressure: 3 cmH2O. Ventricular catheter: 6.5 cm in depth, Medium pressure. Peritoneal catheter: 25 cm in depth. Operative Procedures 1.Anesthesia: general via tracheostomy. 2.Position: supine with head rotated to right. The tracheostomy was sutured to the skin. 3.Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 5 cm curvilinear, left frontal, corresponded to the location of left frontal horn. Raney clips were applied to the scalp edge for temporary hemostasis. 5.After the scalp flap had been lifted and reflected anteriorly, a burr hole was made at left Kocher point and the dura was tented by stitch. 6.The dura was opened by a nib incision. Left lateral ventricle was tapped by a ventricular needle, then a 6.5 cm segment of the ventricular catheter was introduced into the ventricle. The outer end of the catheter was connected to a Pudenz reservoir. 7. A minilaparotomy was made at LUQ of the abdomen, then a trocar was pushed into peritoneal cavity. Subsequently, distal 25 cm segment of the peritoneal catheter (medium pressure) was introduced into the peritoneal cavity through the outer tube of the trochar. The proximal end of this catheter was passed through subcutaneous tunnel at left forechest, neck, rt retroauricular area and connected the reservoir. The shunt system was checked to make sure its function was working. 8. The reservoir was fixed to pericranium by 3 stitches. 9. Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 10.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R3陳國瑋Ri黃柔維 相關圖片 王秋英 (M,1983/06/29,28y8m) 手術日期 2011/12/29 手術主治醫師 蔡翊新 手術區域 東址 005房 02號 診斷 Major trauma rated 16 or above on the severity scale ( Injury severity score >=16 ) 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 10:18 報到 10:55 進入手術室 11:00 麻醉開始 11:07 誘導結束 11:35 抗生素給藥 11:50 手術開始 14:30 手術結束 14:30 麻醉結束 14:40 送出病患 14:41 進入恢復室 15:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 頭顱成形術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 記錄__ 手術科部: 外科部 套用罐頭: Cranioplasty 開立醫師: 蔡翊新 開立時間: 2011/12/29 13:37 Pre-operative Diagnosis Right frontotemporoparietal skull defect. Post-operative Diagnosis Right frontotemporoparietal skull defect. Operative Method Cranioplasty with autologous bone graft. Specimen Count And Types nil Pathology Nil. Operative Findings A 14 x 12 cm skull defect at right F-T-P area. The brain was slightly bulging after general anesthesia, but the bone plate could still be fixed back. The temporalis muscle was excised during previous craniectomy and its bulk was replaced by a piece of bone cement. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to left. 3. Skin preparation:shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with a sterilized adhesive plastic sheet. 4. Incision: along the previous operation scar at right F-T-P area, Raney clips were applied to the scalp edge for temporary hemostasis. 5. The right F-T-P scalp was dissected away from the underlying dura. 6. The bleeders on the dissected surfaces were coagulated with Bovie painstakingly. 7. The edge of the skull defect was exposed. 8. The original skull plate preserved at bone bank was soaked with Vancomycin solution and placed back to the skull window then fixed by 3 miniplates and 6 screws. Nine dura tentings were set at the center of the skull plate. 9. Bone cement paste was applied to the temporal area to replace the excised temporal muscle bulk. 10.Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by interrupted suture with 3/0 nylon. 11.Drain: two epidural CWV. 12.Blood transfusion: nil. Blood loss: 430 ml. 13.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R3陳國瑋Ri黃柔維 相關圖片 陳正偉 (M,1968/01/20,44y1m) 手術日期 2011/12/29 手術主治醫師 蔡翊新 手術區域 東址 005房 03號 診斷 Intracranial hemorrhage 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 13:28 報到 14:48 進入手術室 14:52 麻醉開始 15:00 誘導結束 15:15 抗生素給藥 15:34 手術開始 16:55 手術結束 16:55 麻醉結束 17:00 送出病患 17:05 進入恢復室 18:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腦室腹腔分流手術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 蔡翊新 開立時間: 2011/12/29 16:45 Pre-operative Diagnosis Head injury with left frontal ICH, IVH and hydrocephalus. Post-operative Diagnosis Head injury with left frontal ICH, IVH and hydrocephalus. Operative Method V-P Shunt, right Kocher, Codman programmable shunt. Specimen Count And Types 3 tubes of CSF, sent for routine, BCS, culture. Pathology Nil. Operative Findings CSF: xanthochromic, initial pressure: 10 cmH2O. Ventricular catheter: 6.5 cm in depth. Peritoneal catheter: 25 cm in depth. Setting of VP shunt threshold: 120 mmH2O. Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: supine with head rotated to left. 3.Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 5 cm linear, right frontal, corresponded to the location of right frontal horn. 5.After the scalp flap had been lifted and reflected anteriorly, a burr hole was made at right Kocher point and the dura was tented by 2 stitches. 6.The dura was opened by a nib incision. Right lateral ventricle was tapped by a ventricular needle, then a 6.5 cm segment of the ventricular catheter was introduced into the ventricle. The outer end of the catheter was connected to a Codman programmable shunt reservoir, with a right-angled splint at the edge of burr hole. 7. A minilaparotomy was made at RUQ of the abdomen, then a trocar was pushed into peritoneal cavity. Subsequently, distal 25 cm segment of the peritoneal catheter (open end) was introduced into the peritoneal cavity through the outer tube of the trochar. The proximal end of this catheter was passed through subcutaneous tunnel at forechest, neck, right retroauricular area and connected the reservoir. The shunt system was checked to make sure its function was working. 8. The right-angled splint was fixed to pericranium by 1 stitches. 9. Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 10.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R3陳國瑋Ri黃柔維 相關圖片 何素勉 (F,1956/11/16,55y3m) 手術日期 2011/12/30 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Meningioma 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 1 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:03 進入手術室 08:15 麻醉開始 09:00 誘導結束 09:00 抗生素給藥 09:40 手術開始 10:50 開始輸血 12:30 抗生素給藥 15:30 抗生素給藥 17:20 麻醉結束 17:20 手術結束 17:30 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 顱底瘤手術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 10 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: Right subfrontal approach for tumor excision,... 開立醫師: 鍾文桂 開立時間: 2011/12/30 17:55 Pre-operative Diagnosis Olfactory groove meningioma Post-operative Diagnosis Olfactory groove meningioma Operative Method Right subfrontal approach for tumor excision, Simpson grade I Specimen Count And Types 1 piece About size:fragments Source:brain tumor Pathology Pending Operative Findings The brain was mild buldging after craniotomy. One soft, extra-axial, hypervasculized tumor measureing 7*7*6 cm was noted with attachment to the frontal base. The frontal sinus was opend and packed with better-iodine soaked gelform. Bilateral ACA were push upward and backward by the tumor mass. Bilateral A1, A2, and A-com were identified. The optic chiasm was exposed. All the structures were preserved well. Feeders from ethmoid artery were noted and electrocoagulated. The crista galli and cribriform plate were drilled and covered with pericranium. Right frontopolar artery was sacrifisied during the procedure. Operative Procedures After ETGA, the patient was put in supine position with neck slightly extended. The head was fixed with Mayfield clamp. The skin was prepared, dis-infected and draped as usual. Bicoronal skin incision was made and the skin was reflected antiorly toward the upper border of orbit. Periostem was preserved. Four burr holes were made and one 8*6 cm craniotomy window was elevated. The dura tenting was done and the dura was inciced and reflected medially. The right fontal base was approached and tumor was identified. Devasculization was done along the tumor bed and then central debulking was done. The falx was cut open and tumor excision of the opposite site was done. Tumor excision was deep down to the olfactory groove and optic chiasm and bilateral A1, A2, and A-com were noted. Crista galli and cribiform plate were drilled open into ethomoid sinus and repaired with pericranium. Duroplasty was done with pericranium. Pericranium was sutured to the dura to seal the frontal sinus. The wound was closed in layers after setting on CWV drain. Operators Prof. 杜永光 Assistants 鍾文桂 陳國瑋 相關圖片 石海燕 (F,1959/11/28,52y3m) 手術日期 2011/12/30 手術主治醫師 曾漢民 手術區域 東址 005房 01號 診斷 Pituitary tumor 器械術式 T.S.H. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 08:10 進入手術室 08:15 麻醉開始 08:25 誘導結束 09:00 抗生素給藥 09:20 手術開始 11:00 手術結束 11:00 麻醉結束 11:05 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 經由蝶竇之腦下垂體瘤切除 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 記錄__ 手術科部: 外科部 套用罐頭: Trans-nasal, trans-sphenoidal adenomectomy 開立醫師: 李振豪 開立時間: 2011/12/30 11:19 Pre-operative Diagnosis Pituitary macroadenoma Post-operative Diagnosis Pituitary macroadenoma Operative Method Trans-nasal, trans-sphenoidal adenomectomy Specimen Count And Types 1 piece About size:Multiple pieces Source:pituitary tumor Pathology Pending Operative Findings The nasal mucosa was easily touch bleeding. The sellar floor was eroded by the tumor with small bony defect. The tumor was 3.2 x 2.2 x 2.1 cm in size, hypervascularized, whitish with some hemorrhage within the tumor, well-demarcated, and soft in character. Pseudocapsule formation was noted and dissection was tried along the capsule. Active bleeding from cavernous sinus and epidural space was encountered during dissection alongh the pseudocapsule. Hemostasis was achieved with Gelfoam packing. Normal gland was found at the posterior part of the sellar region. CSF leakage was noted during tumor excision and Tissucol Duo was applied. The VEP was not satisficated before the operation but stationary during whole procedure. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position. The face and, nasal cavity, and oral cavity was disinfected as usual. The ostium of sphenoid sinus was identified. The right side nasal mucosa of the septum was infiltrated with Xylocaine solution. One 2.5cm linear vertical mucosa incision was made at right side septum and the submucosal dissection was conducted till the ostium of the sphenoid sinus was identified. The nasal septum was fractured and the left side mucosa was dissected also to expose left side ostium of sphenoid sinus. A Hardy"s nasal speculum was applied to displace the nasal mucosa laterally and keep the nasal cavity open constantly for the exposure of the vomer bone and the anterior wall of the sphenoid sinus. The floor of sphenoid sinus was opened with osteotome then widened by Kerrison punches. The mucosa of sphenoid sinus was removed. The sellar floor was eroded by the tumor and removed by dissector and alligator. The dura was coagulated and cruciform durotomy was made. Tumor excision was performed with ring curette, suction, dissector, and alligator. Active bleeding from epidural space and cavernous sinus was encountered after tumor excision. Hemostasis was achieved with Gelfoam packing. Tissucol Duo was applied for CSF leakage. The sellar floor and Vomer bone was placed back for reconstruction of the skull base. The nasal mucosa and the middle turbinate was pushed back to it"s neutral position. Right nasal cavities were packed with a segments of glove filled with one gauze strips which had been soaked with Better-iodine ointment. Operators VS曾漢民 Assistants R5李振豪, PGY劉明侑 相關圖片 廖智祥 (M,1968/09/26,43y5m) 手術日期 2011/12/30 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Glioma, brain 器械術式 Brain tumor Crainotomy(TZENG) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 10:55 報到 11:23 進入手術室 11:26 麻醉開始 11:40 誘導結束 11:55 手術開始 12:20 抗生素給藥 15:05 麻醉結束 15:05 手術結束 15:10 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 腦瘤切除-手術時間在4小時以內 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Left fronto-parietal craniotomy for navigatio... 開立醫師: 李振豪 開立時間: 2011/12/30 15:43 Pre-operative Diagnosis Left frontal oligoastrocytoma, WHO grade II, status post tumor excision, with recurrence Post-operative Diagnosis Left frontal oligoastrocytoma, WHO grade II, status post tumor excision, with recurrence Operative Method Left fronto-parietal craniotomy for navigation-guided tumor excision Specimen Count And Types 2 pieces About size:Multiple pieces Source:Left frontal tumor, suspect high grade part About size:Multiple pieces Source:Left frontal tumor, suspect low grade part Pathology Pending Operative Findings The high grade part of the tumor was grayish in color, soft and fragile, mild hypervascularized, well-demarcated, which mainly located at anterior and mesial part of the tumor. Malignant transformation was favored according to gross pathology. The rest of the tumor was whitish, normovascularized, calcified, and ill-demarcated in character. The total size of the tumor was about 6.5 x 5.8 x 4.4cm. The left lateral ventricle was unroofing(about 4cm in length) after tumor excision. The tumor cross the midline through corpus callosum was excised as far as possible under navigation guided. The left lateral ventricle was covered with a large piece of Gelfoam and a layer of Surgicel. The motor strip was about 2cm posterior to craniotomy window according to intra-operative mapping. The SSEP and MEP were all stationary during whole procedure. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head fixed with Mayfield skull clamp. Registration of framless navigation was done. The scalp was shaved, scrubbed, and disinfected as usual. Bicoronal scalp incision was made along operative scar and the scalp flap was elevated both anteriorly and posteriorly. Previous craniotomy and miniplates/screws were identified. The miniplates, screws, and skull plate was removed. Intra-operative sonography was used for localization of the tumor. C-shape durotomy was made based with superior sagittal sinus. Under framless navigation and sonography guided, tumor excision was performed wit bipolar electrocautery, suction, and tumor forceps. Hemostasis was achieved with bipolar electrocautery and Surgicel lining. The left lateral ventricle was covered with a large piece of Gelfoam and a layer of Surgicel. Dura was closed with 4-0 prolene. The skull plate was fixed back with miniplates and screws. The wound was then closed in layers with 2-0 Vicryl and Appose staples. Operators VS曾漢民 Assistants R5李振豪, PGY劉明侑 相關圖片 鄭淑璧 (F,1952/07/05,59y8m) 手術日期 2011/12/30 手術主治醫師 黃俊升 手術區域 兒醫 069房 05號 診斷 Breast cancer, female 器械術式 Port-A catheter Implatation 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 吳健暉, 時間資訊 16:45 進入手術室 16:50 抗生素給藥 17:03 手術開始 18:00 手術結束 18:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 port–A導管植入術–治療性導管植入術 1 0 R 記錄__ 手術科部: 外科部 套用罐頭: Port-A implantation 開立醫師: 吳健暉 開立時間: 2011/12/30 22:11 Pre-operative Diagnosis 1.Right Breast cancer with metastasis 2.T3 extradural metastasis status post 1. T2~T4 laminectomy and T3 transpedicular corpectomy for tumor excision2. Bilateral T3 rhozitomy3. T1, T2, T5, and T6 transpedicular screws for posterior fixation4. T2~T4 anterior fusion with titanium mesh cage Post-operative Diagnosis 1.Right Breast cancer with metastasis 2.T3 extradural metastasis status post 1. T2~T4 laminectomy and T3 transpedicular corpectomy for tumor excision2. Bilateral T3 rhozitomy3. T1, T2, T5, and T6 transpedicular screws for posterior fixation4. T2~T4 anterior fusion with titanium mesh cage Operative Method Port-A implantation by surgical cut down Specimen Count And Types nil Pathology nil Operative Findings 1. Port-A catheter was inserted into SVC via right cephalic vein 2. Post-operative portable X-ray showed Port-A catheter tip in correct venous branch to SVC. Operative Procedures 1. Local anesthesia with the patient in supine position, prepped and draping were performed in the usual sterile method. 2. An incision was made in right side neck and subclavical area. After identification of the cephalic vein, Port-A catheter was inserted. 3. Adequate hemostasis was obtained. 4. Post-operative portable X-ray showed catheter tip in correct venous branchto SVC. Then the wound was closed in layers. Operators 黃俊升 Assistants 吳健暉 ri林信男 相關圖片 林尚安 (M,1956/12/17,55y2m) 手術日期 2011/12/30 手術主治醫師 賴達明 手術區域 東址 002房 04號 診斷 Spinal metastasis 器械術式 Malignant intraspinal tumor, e 手術類別 緊急手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3E 紀錄醫師 蔡宗良, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 12:30 報到 12:55 進入手術室 13:00 麻醉開始 13:20 誘導結束 13:50 抗生素給藥 14:00 手術開始 15:50 開始輸血 16:50 抗生素給藥 18:35 麻醉結束 18:35 手術結束 18:41 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 惡性脊髓腫瘤切除術 1 1 手術 脊椎融合術-前融合,有固定物)≦四節 1 2 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 摘要__ 手術科部: 外科部 套用罐頭: 1. Corpectomy of T1, partial corpectomy of T2 開立醫師: 蔡宗良 開立時間: 2011/12/30 19:48 Pre-operative Diagnosis Metastatic epidural spinal cord compression, T1, hepatocellular carcinoma Post-operative Diagnosis Metastatic epidural spinal cord compression, T1, hepatocellular carcinoma Operative Method 1. Corpectomy of T1, partial corpectomy of T2 2. Anterior fixation with structured methylmethaacrylate, T1 & T2; vertebral screws and plate from C7 to T3 Specimen Count And Types 1 piece About size:小 Source:Epidural space Pathology Report pending Operative Findings 1. Tumor invaded whole T1 and part of anterior cephalad T2. Involved vertebra was soft and fragile. Abundant tumor mass compressing 2. Tumor was greyish in color, highly vascular, fragile, and well dermacated Operative Procedures 1. ETGA, supine, head slight extension 2. Routine preparation 3. Skin incision as depictted 4. Dissect through the plane reaching prevertebral fascia 5. Set up autoretractor 6. Microscope brought into operating field 7. Corpectomy of T1 and partial T2 8. Bone cement shaping to fit the corpectomy window 9. Plate and screws fixation from C7 to T3 10. Gentamicin saline irrigation. Meticulous hemostasis 11. Wound was closed in layer after placing CWV drain Operators VS 賴達明 Assistants R6 蔡宗良, Intern 汪書平 Indication Of Emergent Operation 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: 1. Corpectomy of T1, partial corpectomy of T2 開立醫師: 蔡宗良 開立時間: 2011/12/30 19:48 Pre-operative Diagnosis Metastatic epidural spinal cord compression, T1, hepatocellular carcinoma Post-operative Diagnosis Metastatic epidural spinal cord compression, T1, hepatocellular carcinoma Operative Method 1. Corpectomy of T1, partial corpectomy of T2 2. Anterior fixation with structured methylmethaacrylate, T1 & T2; vertebral screws and plate from C7 to T3 Specimen Count And Types 1 piece About size:小 Source:Epidural space Pathology Report pending Operative Findings 1. Tumor invaded whole T1 and part of anterior cephalad T2. Involved vertebra was soft and fragile. Abundant tumor mass compressing 2. Tumor was greyish in color, highly vascular, fragile, and well dermacated Operative Procedures 1. ETGA, supine, head slight extension 2. Routine preparation 3. Skin incision as depictted 4. Dissect through the plane reaching prevertebral fascia 5. Set up autoretractor 6. Microscope brought into operating field 7. Corpectomy of T1 and partial T2 8. Bone cement shaping to fit the corpectomy window 9. Plate and screws fixation from C7 to T3 10. Gentamicin saline irrigation. Meticulous hemostasis 11. Wound was closed in layer after placing CWV drain Operators VS 賴達明 Assistants R6 蔡宗良, Intern 汪書平 Indication Of Emergent Operation spinal cord compression 相關圖片 王鄭貞蘭 (F,1936/11/30,75y3m) 手術日期 2011/12/30 手術主治醫師 賴達明 手術區域 東址 019房 01號 診斷 Spondylosis with myelopathy, cervical 器械術式 Spinal fusion anterior spinal 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 3 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:05 進入手術室 08:10 麻醉開始 08:25 誘導結束 08:55 抗生素給藥 09:00 手術開始 12:30 手術結束 12:30 麻醉結束 12:35 送出病患 12:37 進入恢復室 14:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎弓整形術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: C3-5 laminoplasty with open-door method and C... 開立醫師: 林哲光 開立時間: 2011/12/30 13:13 Pre-operative Diagnosis Cervical spinal canal stenosis Post-operative Diagnosis Cervical spinal canal stenosis Operative Method C3-5 laminoplasty with open-door method and C7 laminectomy with sublaminal decompression Specimen Count And Types nil Pathology Nil Operative Findings Hypertrohpic change of ligamentum flavum was noted at C3-5 and C7 level, more on C7 level. Dura sac seemed re-expanded well after laminectomy and sublaminal decompression. 5mm miniplate screw were used for fixation at C3 level and 7mm screws were used at C4 and C5 level. Operative Procedures Under ETGA and prone position with head fixed with Mayfield head clamp, skin disinfected and drapped were performed as usual. Midline skin incision was made from C2-T1 level. The paraspinal muscles were then detached until lamina of C3-C7 were well exposed. C7 laminectomy was then performed and sublaminal decompression was done. C3-5 laminoplasty with right side green-stick fracture and left side drilled off by high speed drill. Z-shaped miniplate for fixation was then doone. The wound was then closed in layers after hemostasis and a epidural CWV drain insertion. Operators 賴達明 Assistants 林哲光 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: C3-5 laminoplasty with open-door method and C... 開立醫師: 林哲光 開立時間: 2011/12/30 13:13 Pre-operative Diagnosis Cervical spinal canal stenosis Post-operative Diagnosis Cervical spinal canal stenosis Operative Method C3-5 laminoplasty with open-door method and C7 laminectomy with sublaminal decompression Specimen Count And Types nil Pathology Nil Operative Findings Hypertrohpic change of ligamentum flavum was noted at C3-5 and C7 level, more on C7 level. Dura sac seemed re-expanded well after laminectomy and sublaminal decompression. 5mm miniplate screw were used for fixation at C3 level and 7mm screws were used at C4 and C5 level. Operative Procedures Under ETGA and prone position with head fixed with Mayfield head clamp, skin disinfected and drapped were performed as usual. Midline skin incision was made from C2-T1 level. The paraspinal muscles were then detached until lamina of C3-C7 were well exposed. C7 laminectomy was then performed and sublaminal decompression was done. C3-5 laminoplasty with right side green-stick fracture and left side drilled off by high speed drill. Z-shaped miniplate for fixation was then doone. The wound was then closed in layers after hemostasis and a epidural CWV drain insertion. Operators 賴達明 Assistants 林哲光 相關圖片 李正星 (M,1947/08/09,64y7m) 手術日期 2011/12/30 手術主治醫師 賴達明 手術區域 東址 019房 02號 診斷 Spinal tumor 器械術式 Benign intraspinal tumor, exci 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 2 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 12:42 進入手術室 12:50 麻醉開始 13:10 誘導結束 13:40 抗生素給藥 13:50 手術開始 15:35 手術結束 15:35 麻醉結束 15:55 送出病患 15:56 進入恢復室 17:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 手術 良性脊髓腫瘤切除術 1 1 R 摘要__ 手術科部: 外科部 套用罐頭: Right L4 laminotomy for cyst removal 開立醫師: 林哲光 開立時間: 2011/12/30 15:47 Pre-operative Diagnosis Right L4-5 synovial cyst Post-operative Diagnosis Right L4-5 synovial cyst Operative Method Right L4 laminotomy for cyst removal Specimen Count And Types 1 piece About size: Source:Right synovial cyst Pathology Pending Operative Findings A bulging soft, yellowish cyst like lesion was noted at L4-5 level with bulging out of the interlaminal space and compressing the dura sac medially. The cyst in connected to the right L4-5 facet joint. Hypertrophic change of ligamentum flavum was also noted and dura sac seemed re-expanded well after removal of cyst and ligamentum flavum. Operative Procedures Under ETGA and prone position, skin disinfected and drapped were performed as usual. Midline skin incision was made at L4-5 level and the right paraspinal muscles were detached and L4-5 right facet joint was exposed. Lamiotomy at L4 was done and removal of ligamentum flavum was done. The cyst was also removed until the facet joint was epoxsed and the dura sac was well-exposed. The wound was then closed in layers after hemostasis. Operators 賴達明 Assistants 林哲光, 張書豪 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Right L4 laminotomy for cyst removal 開立醫師: 林哲光 開立時間: 2011/12/30 15:47 Pre-operative Diagnosis Right L4-5 synovial cyst Post-operative Diagnosis Right L4-5 synovial cyst Operative Method Right L4 laminotomy for cyst removal Specimen Count And Types 1 piece About size: Source:Right synovial cyst Pathology Pending Operative Findings A bulging soft, yellowish cyst like lesion was noted at L4-5 level with bulging out of the interlaminal space and compressing the dura sac medially. The cyst in connected to the right L4-5 facet joint. Hypertrophic change of ligamentum flavum was also noted and dura sac seemed re-expanded well after removal of cyst and ligamentum flavum. Operative Procedures Under ETGA and prone position, skin disinfected and drapped were performed as usual. Midline skin incision was made at L4-5 level and the right paraspinal muscles were detached and L4-5 right facet joint was exposed. Lamiotomy at L4 was done and removal of ligamentum flavum was done. The cyst was also removed until the facet joint was epoxsed and the dura sac was well-exposed. The wound was then closed in layers after hemostasis. Operators 賴達明 Assistants 林哲光, 張書豪 相關圖片 丁培勳 (M,1943/10/10,68y5m) 手術日期 2011/12/30 手術主治醫師 楊士弘 手術區域 東址 005房 03號 診斷 Mitral valve insufficiency and aortic valve stenosis 器械術式 Debridment-- >10cm 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 劉明侑, 時間資訊 00:00 臨時手術NPO 15:30 進入手術室 15:35 報到 15:37 麻醉開始 15:45 誘導結束 16:20 手術開始 16:56 手術結束 16:56 麻醉結束 17:00 送出病患 17:05 進入恢復室 18:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 深部傷口處理縫合擴創-中 1 0 摘要__ 手術科部: 外科部 套用罐頭: Debridement 開立醫師: 楊士弘 開立時間: 2011/12/30 16:54 Pre-operative Diagnosis Wound dishescence; L5-S1 spondylodiskitis s/p op. Post-operative Diagnosis Wound dishescence; L5-S1 spondylodiskitis s/p op. Operative Method Debridement Specimen Count And Types nil Pathology Nil Operative Findings A 15 cm long wound was seen in the low back. The lower 6 cm of wound was open, with fascia layer seen inside the wound. Operative Procedures 1. ETGA, prone. 2. Trimming of wound edges. 3. Curretage of wound bed. 4. Saline irrigation. 5. Wound closure in 2 layers: interrupted 2-0 Vicryl for subcutaneous layer, and interrupted 3-0 Nylon for skin. Operators 楊士弘 Assistants 李振豪, 劉義 李振豪, 劉明侑 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Debridement 開立醫師: 劉明侑 開立時間: 2012/01/05 11:58 Pre-operative Diagnosis Wound dishescence; L5-S1 spondylodiskitis s/p op. Post-operative Diagnosis Wound dishescence; L5-S1 spondylodiskitis s/p op. Operative Method Debridement Specimen Count And Types nil Pathology Nil Operative Findings A 15 cm long wound was seen in the low back. The lower 6 cm of wound was open, with fascia layer seen inside the wound. Operative Procedures 1. ETGA, prone. 2. Trimming of wound edges. 3. Curretage of wound bed. 4. Saline irrigation. 5. Wound closure in 2 layers: interrupted 2-0 Vicryl for subcutaneous layer, and interrupted 3-0 Nylon for skin. Operators 楊士弘 Assistants 李振豪, 劉明侑 相關圖片 曾嘉一 (M,1937/11/01,74y4m) 手術日期 2011/12/30 手術主治醫師 李柏居 手術區域 東址 006房 02號 診斷 Gall Stone 器械術式 Cholecystectomy 手術類別 預定手術 手術部位 腹 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 3 紀錄醫師 黃渝芸, 時間資訊 09:43 報到 10:50 麻醉開始 10:50 進入手術室 11:00 誘導結束 11:00 抗生素給藥 11:06 手術開始 12:30 手術結束 12:30 麻醉結束 12:37 送出病患 12:40 進入恢復室 15:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 膽囊切除術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 摘要__ 手術科部: 外科部 套用罐頭: Open Cholecystectomy 開立醫師: 楊惠馨 開立時間: 2011/12/30 12:48 Pre-operative Diagnosis Gall stone Post-operative Diagnosis Gall stone Operative Method Open Cholecystectomy Specimen Count And Types 1 piece About size:3*3*5cm Source:Gallbladder Pathology Gallbladder Operative Findings 1. Gallstone: one 3*3*5 hardness gall stone noted , 2. Gallbladder wall thickness: thin, all hardness in tensity 3. Adhesion: No 4. CBD no dilatation Operative Procedures 1. ETGA, patient in supine position 2. After the abdomen was opened through a right oblique subcostal incision, a self-retaining retractor of Kent type was used on the right side to retract the costal margin. 3. Adhesion between the undersurface of the gallbladder and adjacent structures was divided, and the hardness GB was noted. 4. The cystic duct, cystic artery, and CBD was ligated. 5. GB was removed 6. The abdomen was closed in layers after irrigation with copious warm normal saline solution and insertion of one rubber drain tube in right subhepatic space. Operators VS 李柏居 Assistants CR 楊惠馨, PGY 黃渝芸, Int 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Open Cholecystectomy 開立醫師: 許立民 開立時間: 2012/01/04 16:49 Pre-operative Diagnosis Gall stone Post-operative Diagnosis Gall stone Operative Method Open Cholecystectomy Specimen Count And Types 1 piece About size:3*3*5cm Source:Gallbladder Pathology Gallbladder Operative Findings 1. Gallstone: one 3*3*5 hardness gall stone noted , 2. Gallbladder wall thickness: thin, all hardness in tensity 3. Adhesion: No 4. CBD no dilatation Operative Procedures 1. ETGA, patient in supine position 2. After the abdomen was opened through a right oblique subcostal incision, a self-retaining retractor of Kent type was used on the right side to retract the costal margin. 3. Adhesion between the undersurface of the gallbladder and adjacent structures was divided, and the hardness GB was noted. 4. The cystic duct, cystic artery, and CBD was ligated. 5. GB was removed 6. The abdomen was closed in layers after irrigation with copious warm normal saline solution and insertion of one rubber drain tube in right subhepatic space. Operators VS 李柏居 Assistants CR 楊惠馨, PGY 黃渝芸, Int 相關圖片 潘以宏 (M,1922/09/24,89y5m) 手術日期 2011/12/30 手術主治醫師 郭順文 手術區域 西址 034房 02號 診斷 Subdural hemorrhage following injury without mention of open intracranial wound, with loss of consciousness of unspecified duration 器械術式 Tracheostomy 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 蔡奉芳 ASA 3 紀錄醫師 廖先啟, 羅偉誠, 時間資訊 00:00 臨時手術NPO 09:25 進入手術室 09:35 麻醉開始 09:40 誘導結束 09:45 手術開始 09:50 手術結束 09:50 麻醉結束 09:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 氣管切開術 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 羅偉誠 開立時間: 2011/12/30 10:10 Pre-operative Diagnosis Tracheostomy wound bleeding Post-operative Diagnosis Tracheostomy wound bleeding Operative Method Hemostasis Specimen Count And Types Nil Pathology None Operative Findings oozing over tracheostomy site, the hemostasis was done by electrocoagulation Operative Procedures Under tracheostomy tube GA, the patient was in supine position and the op field was disinfected by BI. The tracheostomy wound was checked and hemostatsis was done by electrocoagulation. Change new low pressure Fr 8 tube. Operators V郭順文 Assistants R4廖先啟, R2羅偉誠 胡照雄 (M,1955/02/11,57y1m) 手術日期 2011/12/31 手術主治醫師 李章銘 手術區域 東址 018房 02號 診斷 Esophageal cancer 器械術式 Gastrostomy 手術類別 預定手術 手術部位 腹 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 3 紀錄醫師 游皓鈞, 時間資訊 11:10 報到 11:25 進入手術室 11:30 麻醉開始 11:47 誘導結束 11:58 手術開始 13:03 麻醉結束 13:03 手術結束 13:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 胃造口術 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Laparotomy gastrostomy 開立醫師: 游皓鈞 開立時間: 2011/12/31 13:14 Pre-operative Diagnosis Esophageal cancer Post-operative Diagnosis Esophageal cancer Operative Method Laparotomy gastrostomy Specimen Count And Types nil Pathology nil Operative Findings Gastrostomy was inserted from left abdomen into stomach body. The test (water) was smooth. Operative Procedures After ETGA, the patient was put in supine position. The abdomen was disinfected and drapped in a sterile way. Midline laparotomy about 10 cm was done. After identifying the body of the stomach, purse strip suture was made by three 2-0 silk with increasing diameter. Then we inserted the gastrostomy tube from the left abdomen into the stomach via the purse strip and fixed it. Reenforcement of peritonization was done. After adequate hemostasis, the wound was closed in layers. Operators P李章銘 Assistants R4郝政鴻,R4廖先啟,R2游皓鈞 邱逢琪 (M,1950/08/20,61y6m) 手術日期 2011/12/31 手術主治醫師 蔡瑞章 手術區域 東址 005房 01號 診斷 Brain metastasis 器械術式 Brain tumor Crainotomy(P-DUH) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 08:00 進入手術室 08:10 麻醉開始 08:40 誘導結束 09:00 抗生素給藥 09:00 手術開始 11:50 手術結束 11:50 麻醉結束 11:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 外科部 套用罐頭: Left occipital craniotomy for total tumor rem... 開立醫師: 鍾文桂 開立時間: 2011/12/31 12:26 Pre-operative Diagnosis Left occipital metastatic tumor. Post-operative Diagnosis Left occipital metastatic tumor. Operative Method Left occipital craniotomy for total tumor removal. Specimen Count And Types 1 piece About size:3cc Source: left occipital tumor Pathology Pending. Operative Findings 1. A soft grayish-red tumor with yellowish serous cystic content at left occipital area. The tumor has high vascularity. Moderate brain swelling. 2. Pericranium fascia graft was used for dural repair. Operative Procedures Under ETGA, the patient was placed in prone position. The head was fixed by Mayfield head clamp. After shaving, disinfection, and draping, a reverse U scalp incision was made. A 5 cm craniotomy was obtained. After dural tenting and durotomy, the tumor was identified. The tumor was excised in piecemeal fashion. After well hemostasis, the dura was closed in watertight fashion and repaired with pericranium graft. After fixing the craniotomy plate with wires, the wound was closed in layers with one subgaleal CWV drain. Operators 蔡瑞章 王國川 Assistants 鍾文桂 翁上硯 相關圖片 王光添 (M,1947/12/20,64y2m) 手術日期 2011/12/31 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Subarachnoid hemorrhage 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 08:00 進入手術室 08:13 麻醉開始 08:20 誘導結束 09:00 抗生素給藥 09:06 手術開始 09:55 手術結束 09:55 麻醉結束 10:10 送出病患 10:15 進入恢復室 12:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Ventricular-peritoneal shunt via left Kochers... 開立醫師: 曾偉倫 開立時間: 2011/12/31 10:06 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventricular-peritoneal shunt via left Kochers point Specimen Count And Types nil Pathology Nil Operative Findings 1. Some clear CSF was drained after the ventricular needle placed 2. Opening pressure: low 3. Valve: Codman HAKIN Programmable valve with initial setting of 120 mm-H2O 4. Ventricular catheter: 7cm , Peritoneal catheter: 25cm Operative Procedures Under ETGA, we placed the patient on supine position with hie face tile to left with right shoulder elevated. After we scrubbed, disinfected and drapped, a right frontal skin incision and RUQ skin incision was made. The burr-hole was made after the skin opened and the peritonial cavity was also opened after layer by layer dissection. the right lateral ventricle was reached with a ventricular puncture needle and the ventricular catheter was placed. The peritonium catheter was placed and connected to the ventricular catheter. We closed the wound in layers after complete hemostasis. Operators VS 王國川 Assistants R3 曾偉倫 Ri 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Ventricular-peritoneal shunt via left Kochers... 開立醫師: 曾偉倫 開立時間: 2011/12/31 10:13 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventricular-peritoneal shunt via left Kochers point Specimen Count And Types nil Pathology Nil Operative Findings 1. Some clear CSF was drained after the ventricular needle placed 2. Opening pressure: low 3. Valve: Codman HAKIN Programmable valve with initial setting of 120 mm-H2O 4. Ventricular catheter: 7cm , Peritoneal catheter: 25cm Operative Procedures Under ETGA, we placed the patient on supine position with hie face tile to left with right shoulder elevated. After we scrubbed, disinfected and drapped, a right frontal skin incision and RUQ skin incision was made. The burr-hole was made after the skin opened and the peritonial cavity was also opened after layer by layer dissection. the right lateral ventricle was reached with a ventricular puncture needle and the ventricular catheter was placed. The peritonium catheter was placed and connected to the ventricular catheter. We closed the wound in layers after complete hemostasis. Operators VS 王國川 Assistants R3 曾偉倫 Ri 相關圖片 廖亞女 (F,1951/03/04,61y0m) 手術日期 2011/12/31 手術主治醫師 陳沛裕 手術區域 東址 001房 02號 診斷 Hip dislocation, closed 器械術式 Manipulation (Leg) 手術類別 緊急手術 手術部位 四肢 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 林佩玲 ASA 2E 紀錄醫師 張允亮, 時間資訊 05:30 臨時手術NPO 05:30 開始NPO 10:27 通知急診手術 12:10 進入手術室 12:20 麻醉開始 12:21 誘導結束 12:22 手術開始 12:25 麻醉結束 12:25 手術結束 12:30 送出病患 12:36 進入恢復室 14:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 手術 股關節脫位徒手復位術 1 1 R 記錄__ 手術科部: 骨科部 套用罐頭: Closed reduction 開立醫師: 張允亮 開立時間: 2011/12/31 12:34 Pre-operative Diagnosis Right THR dislocation Post-operative Diagnosis Right THR dislocation Operative Method Closed reduction Specimen Count And Types nil Pathology nil Operative Findings 1. Right THR posterior dislocation was noted with internal rotated right hip 2. Good alignment and ROM was achieved after reduction Operative Procedures 1. GA, supine 2. Closed reduction with 90-90 method 3. Check alignment under C-arm Operators 陳沛裕, Assistants 張允亮, 謝忠佑, Indication Of Emergent Operation acute dislocation 張雅嵐 (F,1982/12/29,29y2m) 手術日期 2012/01/02 手術主治醫師 李苑如 手術區域 西址 039房 12號 診斷 Calculus of ureter 器械術式 Removal of double-J 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 無麻醉 麻醉主治醫師 ASA 1 時間資訊 15:05 進入手術室 15:07 手術開始 15:08 手術結束 15:10 送出病患 李家龍 (M,1995/12/28,16y2m) 手術日期 2012/01/02 手術主治醫師 林文熙 手術區域 兒醫 062房 05號 診斷 Malignant neoplasm of other parts of brain 器械術式 Port-A catheter implatation 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 蔡奉芳 ASA 2 紀錄醫師 范姜鈞, 時間資訊 17:35 進入手術室 17:40 麻醉開始 17:45 誘導結束 17:50 抗生素給藥 17:57 手術開始 18:50 手術結束 18:50 麻醉結束 18:55 送出病患 19:00 進入恢復室 20:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 內頸靜脈切開,永久導管放置術 1 1 R 記錄__ 手術科部: 套用罐頭: Port-A insertion, right cephalic vein 開立醫師: 范姜鈞 開立時間: 2012/01/02 18:50 Pre-operative Diagnosis Pituitary tumor Post-operative Diagnosis Pituitary tumor Operative Method Port-A insertion, right cephalic vein Specimen Count And Types nil Pathology nil Operative Findings Post-operative portable X-ray showed Port-A catheter tip in correct venous branch to SVC. Operative Procedures 1. Under endotracheal general anesthesia with the patient in supine position, prepped and draping were performed in the usual sterile method. 2. An incision was made in right subclavical area. After identification of the cephalicvein, Port-A catheter was inserted. Adequate hemostasis was obtained. Then the wound was closed in layers. Post-operative portable X-ray showed catheter tip in correct venous branch to SVC. Then the wound was closed in layers Operators Vs 林文熙 Assistants F2 林昊諭 R1 范姜鈞 李偉烈 (M,1947/12/10,64y3m) 手術日期 2012/01/02 手術主治醫師 王國川 手術區域 東址 002房 02號 診斷 Injury (severity score >=16) 器械術式 Burr hole drainage of left cSDH 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3E 紀錄醫師 許皓淳, 時間資訊 23:37 通知急診手術 00:00 開始NPO 00:00 臨時手術NPO 11:05 報到 11:25 進入手術室 11:30 麻醉開始 11:40 誘導結束 12:10 抗生素給藥 12:25 手術開始 13:15 手術結束 13:15 麻醉結束 13:20 送出病患 13:26 進入恢復室 14:26 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 慢性硬腦膜下血腫清除術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Burr hole drainage of hematoma 開立醫師: 許皓淳 開立時間: 2012/01/02 14:05 Pre-operative Diagnosis Left chronic subdural hematoma Post-operative Diagnosis Left chronic subdural hematoma Operative Method Burr hole drainage of hematoma Specimen Count And Types nil Pathology nil Operative Findings Dark brown hematoma gushed out after durotomy. One subdural EVD was placed for drainage of hematoma. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head rotated to right. The scalp was shaved, scrubbed, disinfected and draped as usual. A 4cm linear scalp incision was made over left temporal area. Temporalis muscle was dissected and retracted. 1cm burr hole was created. Dural tenting was done. Cruciate durotomy was performed, and hematoma was drained out. One subdural EVD was placed, and de-air was done. The wound was closed in layers, with 2-0 Vicryl and 3-0 Nylon. Operators 王國川 Assistants R2許皓淳 Indication Of Emergent Operation right leg weakness progression 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Burr hole drainage of hematoma 開立醫師: 許皓淳 開立時間: 2012/01/06 07:10 Pre-operative Diagnosis Left chronic subdural hematoma Post-operative Diagnosis Left chronic subdural hematoma Operative Method Burr hole drainage of hematoma Specimen Count And Types nil Pathology nil Operative Findings Dark brown hematoma gushed out after durotomy. One subdural EVD was placed for drainage of hematoma. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with head rotated to right. The scalp was shaved, scrubbed, disinfected and draped as usual. A 4cm linear scalp incision was made over left temporal area. Temporalis muscle was dissected and retracted. 1cm burr hole was created. Dural tenting was done. Cruciate durotomy was performed, and hematoma was drained out. One subdural EVD was placed, and de-air was done. The wound was closed in layers, with 2-0 Vicryl and 3-0 Nylon. Operators 王國川 Assistants R2許皓淳 Indication Of Emergent Operation right leg weakness progression 相關圖片 王晨允 (F,2010/10/19,1y4m) 手術日期 2012/01/03 手術主治醫師 許巍鐘 手術區域 兒醫 062房 01號 診斷 Allergic rhinitis 器械術式 BRONCHOSCOPY-COMPLICATED 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 面罩麻醉 麻醉主治醫師 陳李魁 ASA 2 時間資訊 07:30 報到 08:20 進入手術室 08:30 麻醉開始 09:25 誘導結束 09:33 手術開始 09:42 手術結束 09:42 麻醉結束 10:00 送出病患 10:05 進入恢復室 11:35 離開恢復室 記錄__ 手術科部: 耳鼻喉部 套用罐頭: Flexible and rigid bronchoscope 開立醫師: 林奎佑 開立時間: 2012/01/03 09:58 Pre-operative Diagnosis Hoarseness Post-operative Diagnosis Bilateral vocal cord palsy, status post examination Operative Method Flexible and rigid bronchoscope Specimen Count And Types 2 pieces About size:< .1x0.1x0.1cm Source:inter-arytenoid tissue About size:<0.1x0.1x0.1cm Source:upper esophageal tissue Pathology 1. inter-arytenoid tissue, < 0.1x0.1x0.1cm, pending 2. upper esophageal tissue,< 0.1x0.1x0.1cm, pending Operative Findings Flexible bronchoscopy Nose:patent Choana:patent Pharynx: Nasopharynx:adenoid Tongue base:ok Vallecula:ok Hypopharynx:ok Larynx: Epiglottis:ok Aryepiglottic fold:ok Arytenoid cartilage:ok Accesory cartilage:ok True vocal fold: OK False vocal folds: OK Subglotttis: OK_ Trachea:tracheomalacia Carina:patent Right main bronchus:patent Left main bronchus:patent Rigid bronchoscopy Pharynx: Nasopharynx:adenoid Tongue base:ok Vallecula:ok Hypopharynx:ok Larynx: Epiglottis:ok Aryepiglottic fold:ok Arytenoid cartilage:ok Accesory cartilage:ok True vocal fold: OK False vocal folds: OK Subglotttis: OK Trachea:tracheomalacia Carina:patent Right main bronchus:patent Left main bronchus:patent Operative Procedures The patient was put in supine position with neck hyperextended. After IVF was setup, flexible bronchoscope was applied into the nostril. From the nasal cavity and nasopharynx till bilateral bronchi were examed. Adenoid vegetation and bilateral tonsillar hypertrophy were noted under the bronchoscopy. The pharynx, larynx, trachea, carina and bilateral bronchi were smooth and patent. Then, jet ventilation was used for impending airway obstruction. Rigid bronchoscopy was set and larynx, subglottis, trachea, carina, bilateral main bronchus, and right upper, middle, lower; left upper and lower bronchus were checked. Operators Asp 許巍鐘 Assistants R3林玫君 姜徐玉英 (F,1939/01/25,73y1m) 手術日期 2012/01/04 手術主治醫師 張道遠 手術區域 兒醫 065房 01號 診斷 Stress urinary incontinence 器械術式 T.V.T. 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 脊髓麻醉 麻醉主治醫師 林峰盛 ASA 2 紀錄醫師 陳瓏仁, 時間資訊 07:37 報到 08:07 進入手術室 08:15 麻醉開始 08:25 誘導結束 08:25 抗生素給藥 08:36 手術開始 09:10 手術結束 09:10 麻醉結束 09:13 送出病患 09:15 進入恢復室 10:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腹式會陰尿道懸吊術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Spinal anesthesia 1 0 記錄__ 手術科部: 婦產部 套用罐頭: Tension free vaginal tape suspension (TVT). 開立醫師: 陳瓏仁 開立時間: 2012/01/04 09:25 Pre-operative Diagnosis Stress urinary incontinence. Post-operative Diagnosis 1 Stress urinary incontinence. Stress urinary incontinence. 2. Cystocele, grade II. Operative Method Tension free vaginal tape suspension (TVT). Specimen Count And Types Nil Pathology Nil. Operative Findings 1. Cystocele: grade II. 1. One tension free vaginal tape suspension was inserted. 2. Estimated blood loss: 20 mL, Blood transfusion: nil, Complication: nil. Operative Procedures 1. Put the patient on lithotomy position. 2. Douching, urine catheterization, disinfecting with beta-iodine and skin draping as usual. 3. Inject dilute pitressin (1:50) into anterior vaginal submucosal and paravesicle space. 4. Make a vertical skin incision 1 cm below the urethral orifice. 5. Make a blind tunnel from the incision wound to reach retropubic space bilaterally. 6. Apple catheter guide foley to avoid injury of urethra. 7. Insert TVT into the blind tunnel to retropubic space bilaterally. 8. Make two small skin incisions of 0.5 cm on lower abdominal area. 9. Perform cystoscopy to check if any bladder injury. 9. Adjust the tension of the TVT according the urine leakage. 10. Remove the sheath of the TVT and cut the end of the TVT. 11. Repair the vaginal wall and lower abdominal wall. 12. Pack the vagina with one piece of gauze and insert Foley. Operators 張道遠 Assistants R3陳瓏仁, Ri林勝彥 相關圖片 郭詠婕 (F,2004/10/19,7y4m) 手術日期 2012/01/04 手術主治醫師 彭信逢 手術區域 東址 000房 號 診斷 器械術式 Other RAD exam/intervention 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 石博元 ASA 4 時間資訊 00:00 開始NPO 08:00 通知急診手術 09:15 麻醉開始 09:20 誘導結束 10:05 麻醉結束 吳翠英 (F,1955/07/22,56y7m) 手術日期 2012/01/04 手術主治醫師 楊榮森 手術區域 東址 020房 01號 診斷 Septic arthritis 器械術式 THR -United 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3 紀錄醫師 葉軒, 時間資訊 07:38 進入手術室 08:15 麻醉開始 08:20 誘導結束 08:51 手術開始 09:15 開始輸血 11:10 手術結束 11:10 麻醉結束 11:17 送出病患 11:23 進入恢復室 12:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 股關節全置換術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 摘要__ 手術科部: 骨科部 套用罐頭: Total hip replacement-Posterior 開立醫師: 葉軒 開立時間: 2012/01/04 10:48 Pre-operative Diagnosis Septic osteoarthritis of hip, right Post-operative Diagnosis Septic osteoarthritis of hip, right Operative Method Total hip arthroplasty with United prosthesis (shell 56mm; head mm, -3; femur stem mm ) Specimen Count And Types 3 sets of culture; 2 sets for pathology: No.1: osteonecrotic femoral head, No. 2: many pieces of small debris obtained from capsule and acetabular site Pathology nil Operative Findings 1. Poor acetabulum bone quality, suspected post infection related 2. CSevere osteonecrosis of right femoral head with cartilage wearing 3. No flank pus or turbid joint fluid observed 4. Severe constricure of right hip Operative Procedures 1. Under spinal anesthesia, the patient was placed in left decubitus position. 2. The skin was dis-infected and scrubbed with beta-iodine detergent and alcoholic solution. 3. Longitudinal skin incision according to previous operation scar and posterior approach were done to dissect the joint capsule. 4. Debridement was done with reamer and rongeur. The wound was irrigated with massive normal-saline. 5. The acetabulum rim was exposed and reamed size by size to fit the proper size of acetabular shield. Trans-acetabular screws x 4 were use to fix the shield. Insert was set to shield. 6. Then intra-medullar reaming of the femoral medullar canal with rigid reamer was done size by size. Enlarged the inlet of femoral bone canal by broach to fit the femoral stem. 7. The femoral stem prosthesis was set into femoral canal and head were put onto the stem. The femoral head component was reduced into acetabular prosthesis and the stability of new joint was checked. 8. Then the wound was irrigated with normal saline and hemostasis was performed carefully. 9. Finally, the wound was closed layer by layer after appling one 1/8 hemovac. Operators 楊榮森, Assistants 葉軒, 林家聖, 陳明峰, 廖伯峰 記錄__ 手術科部: 骨科部 套用罐頭: Total hip replacement-Posterior 開立醫師: 葉軒 開立時間: 2012/01/04 11:22 Pre-operative Diagnosis Septic osteoarthritis of hip, right Post-operative Diagnosis Septic osteoarthritis of hip, right Operative Method Total hip arthroplasty with United prosthesis (shell 56mm; head mm, -3; femur stem mm ) Specimen Count And Types 3 sets of culture; 2 sets for pathology: No.1: osteonecrotic femoral head, No. 2: many pieces of small debris obtained from capsule and acetabular site Pathology nil Operative Findings 1. Poor acetabulum bone quality, suspected post infection related 2. CSevere osteonecrosis of right femoral head with cartilage wearing 3. No flank pus or turbid joint fluid observed 4. Severe constricure of right hip Operative Procedures 1. Under spinal anesthesia, the patient was placed in left decubitus position. 2. The skin was dis-infected and scrubbed with beta-iodine detergent and alcoholic solution. 3. Longitudinal skin incision according to previous operation scar and posterior approach were done to dissect the joint capsule. 4. Debridement was done with reamer and rongeur. The wound was irrigated with massive normal-saline. 5. The acetabulum rim was exposed and reamed size by size to fit the proper size of acetabular shield. Trans-acetabular screws x 4 were use to fix the shield. Insert was set to shield. 6. Then intra-medullar reaming of the femoral medullar canal with rigid reamer was done size by size. Enlarged the inlet of femoral bone canal by broach to fit the femoral stem. 7. The femoral stem prosthesis was set into femoral canal and head were put onto the stem. The femoral head component was reduced into acetabular prosthesis and the stability of new joint was checked. 8. Then the wound was irrigated with normal saline and hemostasis was performed carefully. 9. Finally, the wound was closed layer by layer after appling one 1/8 hemovac. Operators 楊榮森, Assistants 葉軒, 林家聖, 陳明峰, 廖伯峰 陳艷莉 (F,1956/10/13,55y5m) 手術日期 2012/01/05 手術主治醫師 李苑如 手術區域 東址 008房 03號 診斷 Endometrial cancer 器械術式 Double-J ureteral stent insert 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 靜脈麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 周博敏, 時間資訊 08:57 報到 09:12 進入手術室 09:17 麻醉開始 09:25 誘導結束 09:27 手術開始 09:34 手術結束 09:34 麻醉結束 09:37 送出病患 09:38 進入恢復室 10:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 雙丁輸尿管導管置入術 1 0 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 記錄__ 手術科部: 泌尿部 套用罐頭: DBJ stent insertion 開立醫師: 周博敏 開立時間: 2012/01/05 09:37 Pre-operative Diagnosis left obstructive uropathy Post-operative Diagnosis left obstructive uropathy Operative Method cystoscopy and DBJ replacement Specimen Count And Types nil Pathology nil Operative Findings 7-24 DBJ Operative Procedures Under satisfactory anesthesia with the patient in lithotomy position, prepping and drapping was performed in the usual sterile fashion. A Fr 21 Olympus cystoscope was introduced into the bladder cavity under direct vision. Careful inspection was done andDBJ was replaced. Patient tolerated the procedure very well and was sent to recovery room in satisfactory condition. Operators 李苑如, Assistants 陳聖復,周博敏, 陳炳坤 (M,1935/02/03,77y1m) 手術日期 2012/01/05 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Chronic renal failure 器械術式 Bilateral burrhole drainage for subdural hematoma + V-P shunt revision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 08:10 進入手術室 08:15 麻醉開始 08:20 誘導結束 09:00 抗生素給藥 09:17 手術開始 10:30 開始輸血 11:30 手術結束 11:30 麻醉結束 11:35 送出病患 11:38 進入恢復室 14:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦脊髓液分流管重置 1 1 L 手術 慢性硬腦膜下血腫清除術 1 2 B 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Revision of ventriculopleural shunt and bilat... 開立醫師: 王奐之 開立時間: 2012/01/05 11:51 Pre-operative Diagnosis Hydrocephalus, status post ventriculopleural shunt, left side, with over-drainage and bilateral subdural effusion Post-operative Diagnosis Hydrocephalus, status post ventriculopleural shunt, left side, with over-drainage and bilateral subdural effusion Operative Method Revision of ventriculopleural shunt and bilateral frontal burr hole for subdural effusion drainage Specimen Count And Types Nil Pathology Nil Operative Findings Previous Medtronic burr-hole type reservoir and the catheter proximal to left retroauricular area were replaced with a Codman programmable reservoir and a new ventricular catheter. A new trajectory was adapted for the insertion of ventricular catheter, set 6.5cm intracranially. The reservoir was preset to 120 mmH2O. Xanthochromic subdural effusion gushed out after durotomies, and the bilateral subdural spaces were inter-connected. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned slightly to the right. Previous stitches were removed, the scalp was then shaved, scrubbed, disinfected & draped in sterile fashion. 2 new linear incision were made at retroauricular area, and the old catheter was exposed. A larger subcutaneous space was dissected for placement of the programmable reservoir. A curvilinear incision was made at left frontal area along previous wound, and the burr-hole type reservoir was mobilized. After replacing the old catheter with the new ventricular catheter and programmable reservoir, the old reservoir and ventricular catheter was removed, followed by ventricular puncture and insertion of the new one. After hemostasis, the wounds were closed in layers. Another linear incision was made at left frontal area (posterior to the shunt passage way), a burr hole was then created. After dural tenting, a small cruciate durotomy was performed. A small rubber drain was then inserted into the subdural space and pointed anteriorly. The same procedure was carried out at right frontal area. Two subdural rubber drains were secured, and the two wounds were closed in layers. The operation ended with deairing. Operators VS 曾勝弘 Assistants R4 王奐之, PGY 張簡晴瑩 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Revision of ventriculopleural shunt and bilat... 開立醫師: 王奐之 開立時間: 2012/01/05 11:51 Pre-operative Diagnosis Hydrocephalus, status post ventriculopleural shunt, left side, with over-drainage and bilateral subdural effusion Post-operative Diagnosis Hydrocephalus, status post ventriculopleural shunt, left side, with over-drainage and bilateral subdural effusion Operative Method Revision of ventriculopleural shunt and bilateral frontal burr hole for subdural effusion drainage Specimen Count And Types Nil Pathology Nil Operative Findings Previous Medtronic burr-hole type reservoir and the catheter proximal to left retroauricular area were replaced with a Codman programmable reservoir and a new ventricular catheter. A new trajectory was adapted for the insertion of ventricular catheter, set 6.5cm intracranially. The reservoir was preset to 120 mmH2O. Xanthochromic subdural effusion gushed out after durotomies, and the bilateral subdural spaces were inter-connected. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned slightly to the right. Previous stitches were removed, the scalp was then shaved, scrubbed, disinfected & draped in sterile fashion. 2 new linear incision were made at retroauricular area, and the old catheter was exposed. A larger subcutaneous space was dissected for placement of the programmable reservoir. A curvilinear incision was made at left frontal area along previous wound, and the burr-hole type reservoir was mobilized. After replacing the old catheter with the new ventricular catheter and programmable reservoir, the old reservoir and ventricular catheter was removed, followed by ventricular puncture and insertion of the new one. After hemostasis, the wounds were closed in layers. Another linear incision was made at left frontal area (posterior to the shunt passage way), a burr hole was then created. After dural tenting, a small cruciate durotomy was performed. A small rubber drain was then inserted into the subdural space and pointed anteriorly. The same procedure was carried out at right frontal area. Two subdural rubber drains were secured, and the two wounds were closed in layers. The operation ended with deairing. Operators VS 曾勝弘 Assistants R4 王奐之, PGY 張簡晴瑩 相關圖片 高良信 (M,1945/05/10,66y10m) 手術日期 2012/01/05 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Compression fracture, pathological, spontaneous 器械術式 L3-5 laminectomy 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 08:08 進入手術室 08:15 麻醉開始 08:30 誘導結束 08:40 抗生素給藥 09:28 手術開始 11:20 開始輸血 12:10 抗生素給藥 13:35 手術結束 13:35 麻醉結束 13:40 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 椎融合術-前融合,無固定物(≦四節) 1 1 手術 椎間盤切除術-腰椎 1 2 記錄__ 手術科部: 神經部 套用罐頭: Corpectomy, L3 and L4 and diskectomy, L2/3, L... 開立醫師: 鍾文桂 開立時間: 2012/01/05 14:29 Pre-operative Diagnosis Compression fracture, L3 and L4. Compression fracture,L4. Post-operative Diagnosis Compression fracture, L4. Operative Method Corpectomy, L3 and L4 and diskectomy, L2/3, L3/4, and L4/5 for interbody fusion with body cage. Corpectomy, L3(partial) and L4 and diskectomy, L3/4, and L4/5 for interbody fusion with body cage. Specimen Count And Types 1 piece About size:10 cc Source:vertebral body and disc. Pathology Pending. Operative Findings Eroded, compressed, and fragile L3 and L4 vertebral body. The intervertebral disc was edematous and fragile. Some necrotic tissue was noted at the intervertebral space. A-spine body cage was used for interbody fusion. The peritoneal cavity was reached during inital dissection. The peritoneum was sealed with slik primarily. Operative Procedures Under ETGA, the patient was placed in lateral decubitus position. After disinfection and draping, a linear skin incision was made 1 finger breath superior to iliac crest. After dissection, the L3/4 and L4/5 disc spaces were localized by intraoperative fluoroscopy.The vertebral bodies and discs were removed in piecemeal fashion. Later, the body cage was placed into the cavity. With well hemostasis, the wound was closed in layers. Operators 王國川 Assistants 鍾文桂 許皓純 鍾文桂 許皓淳 鄭國基 (M,1959/07/08,52y8m) 手術日期 2012/01/05 手術主治醫師 蔡翊新 手術區域 東址 000房 號 診斷 Bacterial meningitis 器械術式 Remove V-P shunt + Ommaya reservoir implantation 手術類別 預定手術 手術部位 頭、頸 傷口分類 污染 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 11:50 進入手術室 12:00 麻醉開始 12:10 誘導結束 12:51 手術開始 13:30 手術結束 13:30 麻醉結束 13:35 送出病患 13:38 進入恢復室 14:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 歐氏貯囊置放手術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Removal of VP shunt and left Kocher point Omm... 開立醫師: 王奐之 開立時間: 2012/01/05 13:41 Pre-operative Diagnosis Hydrocephalus s/p VP shunt, with shunt infection. Post-operative Diagnosis Hydrocephalus s/p VP shunt, with shunt infection. Operative Method Removal of VP shunt and left Kocher point Ommaya reservoir implantation Specimen Count And Types 3 tubes of CSF, sent for routine, BCS and bacterial culture. The ventricular and peritoneal catheter tips were sent for bacterial culture. Pathology Nil Operative Findings Programmable VP shunt with ventricular catheter inserted via left Kocher point and its reservoir at left parieto-occipital region. CSF was sanguinous. The ventricular catheter tip was partially obstructed by some debris. The catheter of Ommaya was 6.5 cm in depth. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position with head rotated to right. The scalp was shaved, scrubbed, antiseptic with alcohol B-I then draped. A curvilinear skin incision was made at left frontal region. Another small incision was made proximal to the reservoir. The peritoneal catheter was removed via the small incision after dividing the shunt. The ventricular catheter was removed via the larger wound and a ventricular catheter connected to the Ommaya reservoir was inserted via the tract. After checked the reservoir function, the wound was closed in layers. Operators VS蔡翊新 Assistants R4王奐之 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Removal of VP shunt and left Kocher point Omm... 開立醫師: 王奐之 開立時間: 2012/01/05 13:42 Pre-operative Diagnosis Hydrocephalus s/p VP shunt, with shunt infection. Post-operative Diagnosis Hydrocephalus s/p VP shunt, with shunt infection. Operative Method Removal of VP shunt and left Kocher point Ommaya reservoir implantation Specimen Count And Types 3 tubes of CSF, sent for routine, BCS and bacterial culture. The ventricular and peritoneal catheter tips were sent for bacterial culture. Pathology Nil Operative Findings Programmable VP shunt with ventricular catheter inserted via left Kocher point and its reservoir at left parieto-occipital region. CSF was sanguinous. The ventricular catheter tip was partially obstructed by some debris. The catheter of Ommaya was 6.5 cm in depth. Operative Procedures Under general anesthesia and intubation, the patient was put in supine position with head rotated to right. The scalp was shaved, scrubbed, antiseptic with alcohol B-I then draped. A curvilinear skin incision was made at left frontal region. Another small incision was made proximal to the reservoir. The peritoneal catheter was removed via the small incision after dividing the shunt. The ventricular catheter was removed via the larger wound and a ventricular catheter connected to the Ommaya reservoir was inserted via the tract. After checked the reservoir function, the wound was closed in layers. Operators VS蔡翊新 Assistants R4王奐之 相關圖片 鄭國基 (M,1959/07/08,52y8m) 手術日期 2012/01/05 手術主治醫師 蔡翊新 手術區域 東址 005房 04號 診斷 Bacterial meningitis 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 3E 紀錄醫師 王奐之, 時間資訊 17:32 通知急診手術 18:25 進入手術室 18:30 麻醉開始 18:50 誘導結束 19:03 手術開始 19:30 手術結束 19:30 麻醉結束 19:42 進入恢復室 19:45 送出病患 21:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室體外引流 1 2 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 C.V.P. catheter in ubation 1 0 摘要__ 手術科部: 外科部 套用罐頭: External ventricular drainage via left Kocher... 開立醫師: 王奐之 開立時間: 2012/01/05 19:40 Pre-operative Diagnosis Post-traumatic hydrocephalus, status post ventriculoperitoneal shunt insertion via left Kocher point, with shunt infection, status post shunt removal & Ommaya reservoir implantation, with post-op intraventricular hemorrhage & Ommaya dysfunction Post-operative Diagnosis Post-traumatic hydrocephalus, status post ventriculoperitoneal shunt insertion via left Kocher point (with Codman programmable reservoir), with shunt infection, status post shunt removal & Ommaya reservoir implantation, with post-op intraventricular hemorrhage & Ommaya dysfunction Operative Method External ventricular drainage via left Kocher point Ommaya resevoir removal & external ventricular drainage via left Kocher point Specimen Count And Types Nil Pathology Nil Operative Findings CSF gushed out after removal of Ommaya reservoir. The catheter tip was obstructed by visible blood clots. Opening pressure upon ventriculostomy was 10~15 cmH2O. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to right. After scrubbing, disinfection & draping in sterile fashion, a curvilinear incision along previous wound was performed. The Ommaya reservoir was then removed. Ventricular puncture was performed via a new trajectory, followed by EVD insertion. After externalization of EVD and securing the drain in place, the wound was closed in layers. Operators VS 蔡翊新 Assistants R4 王奐之 Indication Of Emergent Operation Acute hydrocephalus 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: External ventricular drainage via left Kocher... 開立醫師: 王奐之 開立時間: 2012/01/05 19:52 Pre-operative Diagnosis Post-traumatic hydrocephalus, status post ventriculoperitoneal shunt insertion via left Kocher point, with shunt infection, status post shunt removal & Ommaya reservoir implantation, with post-op intraventricular hemorrhage & Ommaya dysfunction Post-operative Diagnosis Post-traumatic hydrocephalus, status post ventriculoperitoneal shunt insertion via left Kocher point (with Codman programmable reservoir), with shunt infection, status post shunt removal & Ommaya reservoir implantation, with post-op intraventricular hemorrhage & Ommaya dysfunction Operative Method External ventricular drainage via left Kocher point Ommaya resevoir removal & external ventricular drainage via left Kocher point Specimen Count And Types Nil Pathology Nil Operative Findings CSF gushed out after removal of Ommaya reservoir. The catheter tip was obstructed by visible blood clots. Opening pressure upon ventriculostomy was 10~15 cmH2O. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to right. After scrubbing, disinfection & draping in sterile fashion, a curvilinear incision along previous wound was performed. The Ommaya reservoir was then removed. Ventricular puncture was performed via a new trajectory, followed by EVD insertion. After externalization of EVD and securing the drain in place, the wound was closed in layers. Operators VS 蔡翊新 Assistants R4 王奐之 Indication Of Emergent Operation 相關圖片 陳福川 (M,1976/08/28,35y6m) 手術日期 2012/01/06 手術主治醫師 曾漢民 手術區域 東址 005房 02號 診斷 Pituitary Tumor 器械術式 Craniopharyngioma excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 12:39 進入手術室 12:45 麻醉開始 13:00 抗生素給藥 13:05 誘導結束 13:13 手術開始 16:05 手術結束 16:05 抗生素給藥 16:05 麻醉結束 16:15 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦瘤切除-手術時間在4小時以內 1 1 記錄__ 手術科部: 外科部 套用罐頭: Transcortical approach for tumor removal. 開立醫師: 鍾文桂 開立時間: 2012/01/06 17:07 Pre-operative Diagnosis Craniopharyngioma, recurrent. Post-operative Diagnosis Craniopharyngioma, recurrent. Operative Method Transcortical approach for tumor removal. Specimen Count And Types 1 piece About size:3cc Source:craniopharyngioma. Pathology Pending. Operative Findings The tumor was 1.5 cm in diameter, elastic, hard and well delineated. Severe adhesion of the tumor with the surrounding structures was noted. The optic chiasm is just posterior to the mass. It is well perserved. The septal veins , thalamostriate vein and fornix were also preserved. The lateral ventricle and third ventricle were encountered. The previous corticotomy window and surgical route were used to access the tumor.The dural defect was repaired by Cook artificial dura. Operative Procedures Under ETGA, the patient was placed in supine position and the head was fixed by Mayfield and slightly flexed. After shaving, disinfection, and draping, the previous operative wound was incised and dissected. The wires for fixing the craniotomy bone plate were removed. The dura was opened. The previous corticotomy was entered. The tumor was just below the axis of the corticotomy and third ventricle. The tumor was removed in en bloc fashion after meticulous dissection of the tumor and the surrounding tissue. After well hemostasis, the dura mater was closed in water tight fashion. The craniotomy plate was fixed by miniplates and screws. The wound was closed in layers with one subgaleal CWV drain. Operators 曾漢民 Assistants 鍾文桂 洪士鈞 相關圖片 張莊月里 (F,1949/09/02,62y6m) 手術日期 2012/01/06 手術主治醫師 賴達明 手術區域 東址 019房 02號 診斷 Subarachnoid hemorrhage 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 3 紀錄醫師 許皓淳, 時間資訊 00:00 臨時手術NPO 17:33 進入手術室 17:37 麻醉開始 17:42 誘導結束 18:10 抗生素給藥 18:28 手術開始 19:30 手術結束 19:30 麻醉結束 19:40 送出病患 19:45 進入恢復室 20:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室腹腔分流手術 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt insertion via righ... 開立醫師: 王奐之 開立時間: 2012/01/06 19:38 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunt insertion via right Kocher point Specimen Count And Types Nil Pathology Nil Operative Findings Opening pressure about 10cmH2O upon ventriculostomy. Ventricular catheter length: 6.5cm, peritoneal catheter length: 30cm. A 100mmH20 fixed-pressure Codman reservoir was used. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After shaving, scrubbing, disinfection & draping in sterile fashion, a linear incision was made at right frontal area along part of the previous wound. A burr hole was created at right Kocher point. Another linear incision was made at right upper quadrant of abdomen, followed by mini-laparotomy. A subcutaneous tunnel was created from the abdominal wound to the right frontal wound, with another small wound in between. After assembly of the shunt catheter and reservoir, a small durotomy was performed, followed by ventricular puncture. The ventricular catheter was then inserted. After confirmation of smooth CSF flow, the peritoneal catheter was placed into the peritoneal cavity. The wounds were then closed in layers. Operators VS 賴達明 Assistants R4 王奐之, R2 許浩淳 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt insertion via righ... 開立醫師: 王奐之 開立時間: 2012/01/06 19:38 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunt insertion via right Kocher point Specimen Count And Types Nil Pathology Nil Operative Findings Opening pressure about 10cmH2O upon ventriculostomy. Ventricular catheter length: 6.5cm, peritoneal catheter length: 30cm. A 100mmH20 fixed-pressure Codman reservoir was used. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After shaving, scrubbing, disinfection & draping in sterile fashion, a linear incision was made at right frontal area along part of the previous wound. A burr hole was created at right Kocher point. Another linear incision was made at right upper quadrant of abdomen, followed by mini-laparotomy. A subcutaneous tunnel was created from the abdominal wound to the right frontal wound, with another small wound in between. After assembly of the shunt catheter and reservoir, a small durotomy was performed, followed by ventricular puncture. The ventricular catheter was then inserted. After confirmation of smooth CSF flow, the peritoneal catheter was placed into the peritoneal cavity. The wounds were then closed in layers. Operators VS 賴達明 Assistants R4 王奐之, R2 許浩淳 相關圖片 呂敏雲 (F,1941/01/07,71y2m) 手術日期 2012/01/07 手術主治醫師 陳坤源 手術區域 東址 012房 02號 診斷 Thyroid cancer 器械術式 Total thyroidectomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 2 紀錄醫師 劉昌杰, 時間資訊 09:23 報到 10:03 進入手術室 10:10 麻醉開始 10:15 抗生素給藥 10:17 誘導結束 10:27 手術開始 12:20 手術結束 12:20 麻醉結束 12:26 送出病患 12:28 進入恢復室 13:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 雙側甲狀腺全葉切除術 1 1 B 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Bilaterl total thyroidectomy 開立醫師: 劉昌杰 開立時間: 2012/01/07 12:32 Pre-operative Diagnosis 1. Right thyroid cancer ; 2. Left thyroid goiter Post-operative Diagnosis 1. Right thyroid cancer ; 2. Left thyroid goiter Operative Method Bilaterl total thyroidectomy Specimen Count And Types 2 pieces About size:3x3 cm Source:Right thyroid cancer About size:3x3 cm Source:Left thyroid goiter Pathology pending Operative Findings 1. Paratracheal lymph node involvement: negative 2. Upper mediastinal lymph node involvement: negative Operative Procedures 1. ETGA , put the patient in semi-Fowler position 2. Preparation of skin with betadine solution 3. Mark the location of the incision, two finger breadths above the sternal notch 4. Skin incision and formation of flaps 5. Opening of the deep fascia and elevation of the strap muscles 6. Exposure and mobilization of the gland then ligation of supplying vessel with silk and ligasure 7. Identified bilateral recurrent larygneal nerve 8. Resect the totalthyroid gland and establish good hemostasis 9. Place two surgicel for hemostasis 10. Close the wound in layers by 4-0 Vicryl, 5-0 Prolene Operators 陳坤源 Assistants R2 劉昌杰 Ri 呂昀珊 相關圖片 韓其芳 (M,1965/02/01,47y1m) 手術日期 2012/01/07 手術主治醫師 戴槐青 手術區域 東址 006房 05號 診斷 Malignant neoplasm of kidney, except pelvis 器械術式 U.R.S.-S.M. 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 靜脈麻醉 麻醉主治醫師 陳李魁 ASA 2 紀錄醫師 彭元宏, 時間資訊 11:55 報到 12:05 進入手術室 12:10 麻醉開始 12:14 抗生素給藥 12:15 誘導結束 12:25 手術開始 12:50 手術結束 12:50 麻醉結束 12:55 送出病患 12:57 進入恢復室 14:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 輸尿管鏡取石術或碎石術–併用超音波或電擊方式 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 記錄__ 手術科部: 泌尿部 套用罐頭: URS-SM 開立醫師: 彭元宏 開立時間: 2012/01/07 12:58 Pre-operative Diagnosis ureteral stone with hydronephrosis, left side Post-operative Diagnosis ureteral stone with hydronephrosis, left side Operative Method URS-SM, left side Specimen Count And Types nil Pathology nil Operative Findings A yellowish stone obstructed at left lower ureter with hydronephrosis was crushed by Holmium Laser(Energy:1.0J,Frequency:10 /s) Operative Procedures Under satisfactory anesthesia with the patient in the lithotomy position, skin preparation was performed. A cystoscope was inserted into the bladder and a guidewire was then introduced into the ureteral orifice. A 6 Fr. ureteroscope was introduced into the ureter. A yellowish stones was noted at left ureter and crushed by Holmium Laser(Energy:1.0J, Frequency:10 /s) A Fr.6-26cm DBJ catheter was inserted. A 16 Fr. Foley catheter was placed in the urinary bladder. The patient tolerated the operation well and was sent to the recovery room in stable condition. Operators 戴槐青, Assistants 彭元宏, 周淇業, 陳深淵 (M,1953/01/25,59y1m) 手術日期 2012/01/09 手術主治醫師 主治醫師 手術區域 西址 034房 03號 診斷 Lung cancer 器械術式 Remove ""Implant Port"" 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 石博元 ASA 3 紀錄醫師 林彥君, 時間資訊 00:00 臨時手術NPO 10:10 報到 10:30 進入手術室 10:33 麻醉開始 10:35 誘導結束 10:43 手術開始 11:05 手術結束 11:05 麻醉結束 11:10 送出病患 11:12 進入恢復室 13:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 手術 皮下肌肉或深部異物取出術 1 1 R 記錄__ 手術科部: 麻醉部 套用罐頭: Port-A remove, GA 開立醫師: 林彥君 開立時間: 2012/01/09 11:07 Pre-operative Diagnosis Lung cancer with brain metastasis Post-operative Diagnosis Ditto Operative Method Removal of Port-A Specimen Count And Types 1 piece About size: Source:PORT-A CATHETER Pathology Nil Operative Findings Tip culture x 1 Operative Procedures 1.Under IVGA and local anesthesia, skin incision was made along the previous incision site. 2.Uncovered the Port-A, and then removed it. 3.Wash the pouch with normal saline. 4.Subcutaneous and skin suture. Operators 石博元, Assistants 林彥君, 廖接宇 (M,1959/03/25,52y11m) 手術日期 2012/01/09 手術主治醫師 戴浩志 手術區域 東址 009房 04號 診斷 Major trauma rated 16 or above on the severity scale ( Injury severity score >=16 ) 器械術式 Reduction of mandible;simple 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 蕭柏妮 ASA 3 紀錄醫師 陳志軒, 時間資訊 00:00 臨時手術NPO 14:10 進入手術室 15:40 麻醉開始 15:50 誘導結束 16:00 抗生素給藥 16:05 手術開始 18:50 手術結束 18:50 麻醉結束 19:00 送出病患 19:05 進入恢復室 20:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 下顎骨骨折開放性復位(簡單) 1 1 R 手術 深部傷口處理縫合擴創-大 1 0 R 麻醉 兩動式支氣管內管插管術及支氣管鏡檢查 1 0 手術 顎間固定法 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 記錄__ 手術科部: 外科部 套用罐頭: 1. ORIF for mandible fracture 開立醫師: 陳志軒 開立時間: 2012/01/09 18:50 Pre-operative Diagnosis 1. Mandible fracture, right body 2. Right knee chronic wound Post-operative Diagnosis 1. Mandible fracture, right body 2. Right knee chronic wound Operative Method 1. ORIF for mandible fracture 2. Intermaxillary fixation 3. Debridement Specimen Count And Types Right knee wound culture x2 Pathology Nil Operative Findings 1. The fracture of right mandible body was found. And ORIF was done with miniplates. 2. After removal of appose over right knee, about 5ml in volume semi-gel like fluid was drained out. Fair graunnlation was found intra-knee wound. The wound was closed primarily. Operative Procedures Under general anesthesia, patient lied in supine. Disinfection and drapping were performed as usual. We made one incision along original intraoral wound and dissect to expose the fracture site. Then we performed reduction with internal fixation by 2 miniplates (4-hole-4-screw). We closed the wound in layers. And we performed intermaxillary fixation. We removed the appose over right knee. Then we excised the devitalized tissue and resected wound edge. One CWV was inserted into the wound. The wound was closed. Operators VS戴浩志 Assistants R5陳建璋 R3陳志軒 相關圖片 丁竺原 (F,1969/05/30,42y9m) 手術日期 2012/01/10 手術主治醫師 林晉 手術區域 東址 027房 01號 診斷 Fracture of surgical neck of humerus, closed 器械術式 ORIF _locked plate(Z) 手術類別 臨時手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉漢平 ASA 3 紀錄醫師 黃俊傑, 時間資訊 07:40 報到 08:05 進入手術室 08:30 麻醉開始 08:45 誘導結束 09:00 抗生素給藥 09:25 手術開始 10:55 手術結束 10:55 麻醉結束 11:00 送出病患 11:02 進入恢復室 12:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 開放性或閉鎖性肱骨粗隆或骨幹或踝部骨折,開放性復位術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 記錄__ 手術科部: 骨科部 套用罐頭: Open reduction for closed or open humeral fracture; tuberosity, shaft or coudyles 開立醫師: 黃俊傑 開立時間: 2012/01/10 11:08 Pre-operative Diagnosis Left proximal humerus fracture Post-operative Diagnosis Left proximal humerus fracture Operative Method ORIF with locking plate Specimen Count And Types nil Pathology nil Operative Findings simple oblique fracture Implants: Zimmer locking plate Operative Procedures 1.ETGA, semisitting ,prepped ,draping ,check reduction under fluoroscope 2.Linear incision over left shoulder, anterolateral approach, deltoid splitted 3.The fracture site was exposed and minimal dissected. 4.Apply Zimmer proximal humerus plate, fix the plate with K pin and check reduction under fluoroscopy 5.Insert conical screws for furthre reduction 6.Insert self tapping locking screws 7.Irrigation, close the wounds by layers. Operators 林晉, Assistants 黃俊傑, 曾渥然, 摘要__ 手術科部: 骨科部 套用罐頭: Open reduction for closed or open humeral fracture; tuberosity, shaft or coudyles 開立醫師: 黃俊傑 開立時間: 2012/01/10 11:08 Pre-operative Diagnosis Left proximal humerus fracture Post-operative Diagnosis Left proximal humerus fracture Operative Method ORIF with locking plate Specimen Count And Types nil Pathology nil Operative Findings simple oblique fracture Implants: Zimmer locking plate Operative Procedures 1.ETGA, semisitting ,prepped ,draping ,check reduction under fluoroscope 2.Linear incision over left shoulder, anterolateral approach, deltoid splitted 3.The fracture site was exposed and minimal dissected. 4.Apply Zimmer proximal humerus plate, fix the plate with K pin and check reduction under fluoroscopy 5.Insert conical screws for furthre reduction 6.Insert self tapping locking screws 7.Irrigation, close the wounds by layers. Operators 林晉, Assistants 黃俊傑, 曾渥然, 張智傑 (M,1979/10/14,32y5m) 手術日期 2012/01/10 手術主治醫師 蔡翊新 手術區域 東址 025房 03號 診斷 Hydrocephalus 器械術式 Revision of CSF shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 14:13 報到 14:33 進入手術室 14:37 麻醉開始 14:45 誘導結束 14:50 抗生素給藥 15:25 手術開始 16:20 手術結束 16:20 麻醉結束 16:25 送出病患 16:26 進入恢復室 17:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦脊髓液分流管重置 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 蔡翊新 開立時間: 2012/01/10 16:15 Pre-operative Diagnosis Hydrocephalus s/p VP shunt with slit ventricle. Post-operative Diagnosis Hydrocephalus s/p VP shunt with slit ventricle. Operative Method VP shunt revision with Codman programmable shunt. Specimen Count And Types VP shunt tip, sent for bacterial culture. Pathology Nil. Operative Findings Previous high-pressure Pudenz shunt valve at right Kocher point was removed. Codman programmable shunt, with threshold set at 200 mmH2O, replaced the valve, using previous peritoneal catheter. Operative Procedures 1.Anesthesia: endotracheal general. 2.Position: supine with head rotated to left. 3.Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 5 cm curvilinear, right frontal, corresponded to the location of right frontal horn. Raney clips were applied to the scalp edge for temporary hemostasis. 5.After the scalp flap had been lifted and reflected anteriorly, previous VP shunt was exposed. 6.Another skin incision, 2 cm, was made at right parietal region, along the path of peritoneal shunt. The peritoneal catheter was exposed and divided. The Codman programmable shunt was connected to the stump of peritoneal catheter distally and the ventricular catheter proximally via a subcutaneous tunnel over right parietal scalp. 7. Previous VP shunt valve was removed and the new ventricular catheter was inserted to right lateral ventricle via the old tract. The shunt system was checked to make sure its function was working. 8. The catheter was fixed to pericranium by 1 stitch. 9. Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 10.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R6鍾文桂 相關圖片 高崇武 (M,1941/02/24,71y0m) 手術日期 2012/01/11 手術主治醫師 王水深 手術區域 兒醫 068房 04號 診斷 Fever 器械術式 Permcath 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 莊民楷, 時間資訊 13:25 進入手術室 13:45 麻醉開始 13:48 誘導結束 13:50 手術開始 14:25 手術結束 14:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 內頸靜脈切開,永久導管放置術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Permcath implantation, RIJV 開立醫師: 莊民楷 開立時間: 2012/01/11 14:28 Pre-operative Diagnosis ESRD Post-operative Diagnosis ESRD Operative Method Permcath implantation, RIJV Specimen Count And Types nil Pathology Nil Operative Findings 1. blood draw smooth after permcath implantation Operative Procedures 1. LA, supine 2. Disinfection and drapping 3. Right internal jugular vein pucture, then permcath insertion via subcutaneous tract from right upper chest wall 4. Fix the permcath, hemostasis by compression Operators VS 王水深 Assistants R4 莊民楷 張貴美 (F,1953/06/16,58y8m) 手術日期 2012/01/11 手術主治醫師 謝敦理 手術區域 西址 033房 號 診斷 Otitis media with effusion 器械術式 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 無麻醉 麻醉主治醫師 ASA 1 時間資訊 16:33 進入手術室 16:35 手術開始 16:45 手術結束 16:50 送出病患 記錄__ 手術科部: 耳鼻喉部 套用罐頭: Grommet tube insertion, left 開立醫師: 陳姵妤 開立時間: 2012/01/11 16:46 Pre-operative Diagnosis Otitis media with effusion, left Post-operative Diagnosis Otitis media with effusion, left,operated Operative Method Grommet tube insertion, left Specimen Count And Types nil Pathology Nil Operative Findings 1. Left ear Grommet with crust, removed. 2. Left eardrum thickened with granulation. Operative Procedures 1.The patient was put in supine position. 2.The face was disinfected and draped as usual. 3.Her head was turned to the right side. 4.Crust and cerumen was removed under microscopy. 5.Grommet was removed smoothly. 6.The patient tolerated the whole procedure well. Operators VS 謝敦理 Assistants R4周承翰, R2陳姵妤 陳明四 (F,1959/08/10,52y7m) 手術日期 2012/01/11 手術主治醫師 嚴孟祿 手術區域 兒醫 063房 01號 診斷 Abdominal pain 器械術式 LSC RSO+D&C; 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 2 紀錄醫師 田怡文, 時間資訊 08:02 進入手術室 08:05 麻醉開始 08:10 誘導結束 08:20 抗生素給藥 08:40 手術開始 10:05 手術結束 10:05 麻醉結束 10:10 送出病患 10:15 進入恢復室 11:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腹腔鏡子宮附屬器部份或全部切除術 1 1 手術 診斷性子宮頸刮除術(非產科) 1 2 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 婦產部 套用罐頭: LSC BSO (single port) 開立醫師: 田怡文 開立時間: 2012/01/11 10:22 Pre-operative Diagnosis 1.Left ovarian cyst 2.Endometrial thickening Post-operative Diagnosis 1.Left ovarian cyst, hydrosalpinx 2.Endometrial thickening Operative Method Laparoscopic left salpingo-oophorectomy (two port) + diagnostic dilatation and curettage Specimen Count And Types 2 pieces About size:0.2x0.2x0.2cm Source:endometrial tissue About size:5x3x3cm Source:left adnexa Pathology Pending Operative Findings 1. Uterus: Avfl, grossly normal, sounding: 8 cm. 2. Scanty endometrial tissue was curetted out. 3. LAD: one 3x3x3 cm cystic lesion in the left ovary with pus-like content. Swelling and dilated fallopian tube. with adhesion with left pelvic wall, rectum and posterior uterine wall. 3. RAD: atrophic change. 4. CDS: no adhesion. 5. Estimated blood loss:minimal Blood transfusion:nil Complication:nil Operative Procedures 1. Put the patient on the lithotomy position. 2. Vaginal douching with beta-iodine. 3. Skin disinfection with beta-iodine and skin draping as usual 4. Sounding: Anteversion, 8 cm. 5. Cervical dilatation to Hegar No. 7. 6. Curette the uterine cavity. 7. Insert the Foley catheter and uterus elevator. 8. Make a 2cm skin incision at the umbilicus 9. open the abdominal wall layer by layer 10. Insert single port equipment and 1st(10mm), 2nd (5mm) and 3rd (5mm) trocar 11. Make pneumoperitoneum 12. Make skin incision at left lower abdominal wall and insert 4th(5mm) trocar 13. Isolate left infundibulo-pelvic ligament. 14. Electrocauterize and cut left infundibulo-pelvic ligament. 15. Electroacuterization and cut left ovarian ligament and oviduct 16. Remove the specimen from the abdominal wound. 17. Check bleeding and hemostasis with electrocoagulation. 18. Insert one CWV drain to cul-de-sac 19. Remove trocars and repair abdominal incision wound. Operators 嚴孟祿, Assistants 田怡文, 高良信 (M,1945/05/10,66y10m) 手術日期 2012/01/12 手術主治醫師 王國川 手術區域 東址 003房 02號 診斷 Compression fracture, pathological, spontaneous 器械術式 L1, 2, 5, S1 TPS 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 11:25 報到 11:34 進入手術室 11:40 麻醉開始 11:45 誘導結束 12:32 手術開始 12:50 開始輸血 15:10 麻醉結束 15:10 手術結束 15:19 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 脊椎融合術-後融合,有固定物(<=六節) 1 1 記錄__ 手術科部: 神經部 套用罐頭: L1-L2-L5-S1 posterolateral fusion and fixatio... 開立醫師: 鍾文桂 開立時間: 2012/01/12 15:41 Pre-operative Diagnosis L4 compression fracture status post L4 corpectomy and partial L3 corpectomy and implantation of body cage for fusion. Post-operative Diagnosis L4 compression fracture status post L4 corpectomy and partial L3 corpectomy and implantation of body cage for fusion status post L1-L2-L5-S1 posterolateral fusion and fixation with TPS. Operative Method L1-L2-L5-S1 posterolateral fusion and fixation with TPS. Specimen Count And Types nil Pathology Nil. Operative Findings Severe osteoporotic change of spine. A-spine instruments were used for fixation. Bone allogrfts were posterolateral fusion. Total bloos loss: 1000cc. Transfusion: PRBC 4U. The previous laminectomy site was kept intact( intact dura mater, some postoperative fibtrosis of the tissue was noted. The root was slack. Operative Procedures Under ETGA, the patient was placed in prone position. After disinfection and draping, a vertical incision was made. Paraspinal muscle was dissected. The TPS were implanted. Their positions were ensured by intraoperative fluoroscope. The rods and crosslinks were also set. After well hemostasis, the wound was closed in layers with two 1/8 hemovac drains. Operators 王國川 Assistants 鍾文桂 許皓淳 相關圖片 張育銘 (M,1969/08/31,42y6m) 手術日期 2012/01/12 手術主治醫師 蔡翊新 手術區域 東址 005房 01號 診斷 Brain abscess 器械術式 Left frontal epidural abscess evacuation + skull base reconstruction 手術類別 預定手術 手術部位 頭、頸 傷口分類 污染 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 張簡晴瑩, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:05 進入手術室 08:10 麻醉開始 08:40 誘導結束 08:42 抗生素給藥 08:58 手術開始 11:10 麻醉結束 11:10 手術結束 11:20 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 硬腦膜外血腫清除術 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 蔡翊新 開立時間: 2012/01/12 10:44 Pre-operative Diagnosis Left frontal epidural abscess, extended from frontal sinusitis. Post-operative Diagnosis Left frontal epidural organized hematoma, suspected communication between frontal sinus and epidural space. Operative Method Left frontotemporal craniotomy for removal of epidural abscess and repair of defect between frontal sinus and epidural space with Tissucol Duo. Specimen Count And Types Two culture swabs from epidural space, one for smear and one for bacterial culture. Pathology Nil. Operative Findings The dura adhered to the bone with granulation tissue. There was grey-reddish, fragile, cheese-like, material, suspected organized or infected hematoma at left frontal epidural space. The defect between frontal sinus and epidural space has been repaired during previous operation, but whether there was residual defect was not certain. So the whole area was sealed off with 1 c.c. Tissucol Duo. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: bicoronal along previous wound, the skin edge was clipped by Raney clips for temporary hemostasis. The temporalis muscles was incised down to the temporal squama which was exposed then by applying a self retaining retractor on the muscle. 5. Craniotomy window: 12 x 8 cm, left frontotemporal. 6. The epidural granulation tissue and organized hematoma were removed by sucker and currettes. Pus culture and smear were obtained. The defect leading from epidural space to the frontal sinus has been repaired with a fascial graft during previous operation. The area was sealed by 1 c.c. Tissucol Duo. 7. Hemostasis: the bleeders was stopped by Bovie. The operative field was irrigated with large amount of normal saline and Vancomycin solution. 8. The skull plate was fixed back by miniplates and screws. Several central tentings were placed. 9. Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 10.Drain: two, epidural, CWV. 11.Blood transfusion: nil. Blood loss: 350 ml. 12.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R4王奐之R0張簡晴瑩 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Head Injury 開立醫師: 蔡翊新 開立時間: 2012/01/12 10:44 Pre-operative Diagnosis Left frontal epidural abscess, extended from frontal sinusitis. Post-operative Diagnosis Left frontal epidural organized hematoma, suspected communication between frontal sinus and epidural space. Operative Method Left frontotemporal craniotomy for removal of epidural abscess and repair of defect between frontal sinus and epidural space with Tissucol Duo. Specimen Count And Types Two culture swabs from epidural space, one for smear and one for bacterial culture. Pathology Nil. Operative Findings The dura adhered to the bone with granulation tissue. There was grey-reddish, fragile, cheese-like, material, suspected organized or infected hematoma at left frontal epidural space. The defect between frontal sinus and epidural space has been repaired during previous operation, but whether there was residual defect was not certain. So the whole area was sealed off with 1 c.c. Tissucol Duo. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: bicoronal along previous wound, the skin edge was clipped by Raney clips for temporary hemostasis. The temporalis muscles was incised down to the temporal squama which was exposed then by applying a self retaining retractor on the muscle. 5. Craniotomy window: 12 x 8 cm, left frontotemporal. 6. The epidural granulation tissue and organized hematoma were removed by sucker and currettes. Pus culture and smear were obtained. The defect leading from epidural space to the frontal sinus has been repaired with a fascial graft during previous operation. The area was sealed by 1 c.c. Tissucol Duo. 7. Hemostasis: the bleeders was stopped by Bovie. The operative field was irrigated with large amount of normal saline and Vancomycin solution. 8. The skull plate was fixed back by miniplates and screws. Several central tentings were placed. 9. Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by continuous suture with 3/0 nylon. 10.Drain: two, epidural, CWV. 11.Blood transfusion: nil. Blood loss: 350 ml. 12.Course of the surgery: smooth. Operators VS蔡翊新 Assistants R4王奐之R0張簡晴瑩 相關圖片 謝美雪 (F,1947/09/02,64y6m) 手術日期 2012/01/16 手術主治醫師 黃書健 手術區域 心血管 053房 01號 診斷 Meningioma 器械術式 Pulmonary thromboendarterectomy 手術類別 緊急手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 4E 紀錄醫師 羅健洺, 時間資訊 12:08 開始NPO 12:08 臨時手術NPO 12:08 通知急診手術 13:03 報到 13:03 進入手術室 13:10 麻醉開始 13:25 誘導結束 13:30 抗生素給藥 13:46 手術開始 15:05 開始輸血 15:25 麻醉結束 15:25 手術結束 15:35 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 3 0 麻醉 動脈血液檢查全套 3 0 麻醉 Hemoglobin (Hb) 3 0 麻醉 測血糖 3 0 麻醉 Ca (Calcium) 3 0 麻醉 Na (Sodium) 3 0 麻醉 K (Potassium) 3 0 麻醉 Blood gas analysis 3 0 麻醉 T.E.E 1 0 手術 體外心肺循環 1 1 手術 肺動脈塞切除術 1 1 記錄__ 手術科部: 外科部 套用罐頭: Pulmonary thromboembolectomy 開立醫師: 羅健洺 開立時間: 2012/01/16 16:01 Pre-operative Diagnosis Acute pulmonary thromboembolism with RV failure Post-operative Diagnosis Acute pulmonary thromboembolism with RV failure Operative Method Pulmonary thromboembolectomy Specimen Count And Types intra-pulmonary artery thrombus Pathology pending Operative Findings 1. Distended RA and RV, poor RV contractility after sternotomy 2. Massive organized fresh mural thrombus was noted at the level of bilateral PAs to first branches 3. After thromboembolectomy, RV functiion was improved and not distended, CVP was decreased from 20mmHg to 9mmHg Operative Procedures ETGA, supine, skin sterization, drapping. Midline sternotomy. AsAO, RAA cannulation. On CPB with normathermia. MPA incisiion and RPA incision. Thromboembolectomy was performed. Close the PA incision with 5-0 prolene. Weaned off CPB. After hemostasis, set two chest tubes. Close wound in layers. Operators 黃書健 Assistants 羅健洺, Ri Indication Of Emergent Operation Acute pulmonary thromboembolism with RV failure 唐美蓉 (F,1951/01/01,61y2m) 手術日期 2012/01/16 手術主治醫師 戴浩志 手術區域 東址 009房 03號 診斷 Parkinsonism (F02.3) 器械術式 Local Flap 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 陳志軒, 時間資訊 10:05 進入手術室 10:10 麻醉開始 10:15 誘導結束 10:20 抗生素給藥 10:30 手術開始 11:19 手術結束 11:19 麻醉結束 11:30 送出病患 11:32 進入恢復室 13:05 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 移前皮瓣移植術 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Debridement and primary closure with advanced... 開立醫師: 陳志軒 開立時間: 2012/01/16 11:16 Pre-operative Diagnosis Left post-auricular wound infection with exposure deep brain stimulation wire Post-operative Diagnosis Left post-auricular wound infection with exposure deep brain stimulation wire Operative Method Debridement and primary closure with advanced flap Specimen Count And Types nil Pathology nil Operative Findings There was one segment of deep brain stimulation wire about 4cm in length. There was few necrotis tissue around the wire. The wire was embedded below the muscle layer. Operative Procedures Under general anesthesia, patient lied in right decubitus position. Disinfection and drapping were performed as usual. We excised the devitalized tissue and trimmed the wound edge. Irrigation with normal saline and hemostasis were performed. We performed undermining and inserted one CWV drain into the wound. The wound was closed in layers. Operators VS戴浩志 Assistants R5陳建璋 R3陳志軒 Ri許仁毓 相關圖片 鄭國基 (M,1959/07/08,52y8m) 手術日期 2012/01/16 手術主治醫師 蔡翊新 手術區域 東址 003房 02號 診斷 Bacterial meningitis 器械術式 EVD revision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3 紀錄醫師 曾偉倫, 時間資訊 11:13 報到 11:40 進入手術室 11:45 麻醉開始 11:55 誘導結束 12:00 抗生素給藥 12:26 手術開始 12:55 手術結束 12:55 麻醉結束 13:10 送出病患 13:15 進入恢復室 14:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室體外引流 1 2 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Revision of external ventricular drainage 開立醫師: 李振豪 開立時間: 2012/01/16 13:16 Pre-operative Diagnosis Ventriculitis with hydrocephalus Post-operative Diagnosis Ventriculitis with hydrocephalus Operative Method Revision of external ventricular drainage Specimen Count And Types 2 pieces About size:tip culture x 1 Source:old ventricular catheter About size:6ml Source:CSF for routine, bacterial culture, and biochemistry Pathology Nil Operative Findings The CSF was xanthochromic with increase in turbidity. The new ventricular catheter was inserted along the tract of old ventricular catheter and the function was good. The new ventricular catheter was fixed at 6.5cm in depth from burrhole. Total 6ml CSf was sampled for routine, biochemistry, and bacterial culture. The old ventricular catheter was sent for tip culture. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position. The stitches were removed. The scalp was shaved, scrubbed, and disinfected as usual. The scalp incision was made along previous operative wound. The burrhole and old ventricular catheter was identified. The old ventricular catheter was ligated and cut off. The old ventricular catheter was removed and new one was inserted. Externalization of the ventricular catheter was done and fixed at 6.5cm in depth from burrhole. Hemostasis was achieved with bipolar electrocautery and Gelfoam packing. The wound was then closed in layers with 2-0 Vicryl and 3-0 Nylon. The external ventricular drainage system was set up. The old ventricular catheter was removed and the wound was closed with one 2-0 silk. Operators VS蔡翊新 Assistants R5李振豪, R3曾偉倫 相關圖片 謝美雪 (F,1947/09/02,64y6m) 手術日期 2012/01/17 手術主治醫師 吳毅暉 手術區域 心血管 056房 01號 診斷 Meningioma 器械術式 IVC filter 手術類別 臨時手術 手術部位 腹 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 張得一, 時間資訊 23:35 臨時手術NPO 13:45 報到 13:45 進入手術室 13:46 麻醉開始 13:50 誘導結束 14:20 手術開始 14:40 麻醉結束 14:40 手術結束 14:50 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經皮穿腔靜脈過濾裝置置放術 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: IVC filter placement 開立醫師: 張得一 開立時間: 2012/01/17 15:16 Pre-operative Diagnosis Pulmonary embolism, with DVT Post-operative Diagnosis Ditto Operative Method IVC filter placement Specimen Count And Types nil Pathology Operative Findings Deployed below right renal vein about 2cm. Axis: good Operative Procedures ETGA, supine Right femoral vein puncture, insert a 5Fr. sheath Venography, identify renal veins Insert IVC filter device. Remove sheath Operators VS吳毅暉 Assistants R4張得一 黃琰宸 (M,1952/05/02,59y10m) 手術日期 2012/01/17 手術主治醫師 陳敞牧 手術區域 東址 001房 03號 診斷 Subdural hemorrhage 器械術式 Bilateral burrhole drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 鍾文桂, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 10:40 報到 11:20 進入手術室 11:20 麻醉開始 11:25 誘導結束 11:28 抗生素給藥 12:11 手術開始 13:00 手術結束 13:00 麻醉結束 13:20 送出病患 13:25 進入恢復室 15:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 慢性硬腦膜下血腫清除術 1 1 摘要__ 手術科部: 外科部 套用罐頭: Burr hole for checking subdural content, bila... 開立醫師: 鍾文桂 開立時間: 2012/01/17 13:31 Pre-operative Diagnosis Bilateral chronic subdural hemorrhage or effusion. Post-operative Diagnosis Brain atrophy. Operative Method Burr hole for checking subdural content, bilateral. Specimen Count And Types nil Pathology Nil. Operative Findings Thickened dura mater, bilateral. No subdural hematoma or effusion was noted after durotomy. A potential subdural space was noted. Poor brain expansion. Operative Procedures Under ETGA, the patient was placed in supine position and the head was in midline. After shaving, disinfection, and draping, the previous linear scalp wound was incised and dissected. The scar tissue was resected. The dura mater was exposed. A cruciate durotomy was made. The subdural space was exposed. Some normal saline was infused into the subdural space. The wound was closed in layers. Operators 陳敞牧 Assistants 鍾文桂 Indication Of Emergent Operation Unsteady gait, acute conscious deterioration. 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Burr hole for checking subdural content, bila... 開立醫師: 鍾文桂 開立時間: 2012/01/17 13:32 Pre-operative Diagnosis Bilateral chronic subdural hemorrhage or effusion. Post-operative Diagnosis Brain atrophy. Operative Method Burr hole for checking subdural content, bilateral. Specimen Count And Types nil Pathology Nil. Operative Findings Thickened dura mater, bilateral. No subdural hematoma or effusion was noted after durotomy. A potential subdural space was noted. Poor brain expansion. Operative Procedures Under ETGA, the patient was placed in supine position and the head was in midline. After shaving, disinfection, and draping, the previous linear scalp wound was incised and dissected. The scar tissue was resected. The dura mater was exposed. A cruciate durotomy was made. The subdural space was exposed. Some normal saline was infused into the subdural space. The wound was closed in layers. Operators 陳敞牧 Assistants 鍾文桂 Indication Of Emergent Operation Unsteady gait, acute conscious deterioration. 相關圖片 鄭進貴 (M,1951/10/03,60y5m) 手術日期 2012/01/17 手術主治醫師 李章銘 手術區域 東址 018房 01號 診斷 Esophageal cancer 器械術式 Laparoscope jejunostomy+Port-A catheter implatation 手術類別 預定手術 手術部位 腹 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 韓吟宜 ASA 3 紀錄醫師 鄒冠全, 時間資訊 08:04 進入手術室 08:15 麻醉開始 08:25 誘導結束 09:00 抗生素給藥 09:03 手術開始 09:38 10:55 手術結束 10:55 麻醉結束 11:00 送出病患 11:10 進入恢復室 12:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腹腔鏡空腸造廔術 1 1 手術 port–A導管植入術–治療性導管植入術 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 內科部 套用罐頭: Laparoscopic jejunostomy and port-A insertion 開立醫師: 鄒冠全 開立時間: 2012/01/17 11:07 Pre-operative Diagnosis Esophageal cancer, advance Post-operative Diagnosis Esophageal cancer, advance Operative Method Laparoscopic jejunostomy and port-A insertion Specimen Count And Types nil Pathology nil Operative Findings 1. The jejunostomy was inserted via puncture method, smoothly 2. The port-A was inserted to right subclavian vein via puncture method; checked with portable CXR Operative Procedures 1. ETGA, supine 2. port-A insertion via puncture method 3. checked with portable CXR 4. Laparoscopic jejunostomy via mini-laparotomy, pneumoperitonium, puncture method 5. Hemostasis, close wounds in layers Operators 李章銘 Assistants R4鄒冠全, Ri 楊婷儒 (F,1994/07/29,17y7m) 手術日期 2012/01/18 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Moyamoya disease 器械術式 left EDAS 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:10 麻醉開始 08:25 誘導結束 08:40 抗生素給藥 09:29 手術開始 11:40 抗生素給藥 14:40 手術結束 14:40 麻醉結束 14:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 5 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 顱內外血管吻合術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Encephalo-duro-arterio-synangiosis, left 開立醫師: 游健生 開立時間: 2012/01/18 15:20 Pre-operative Diagnosis Moyamoya disease, status post right side EDAS Post-operative Diagnosis Moyamoya disease, status post bilateral EDAS Operative Method Encephalo-duro-arterio-synangiosis, left Specimen Count And Types nil Pathology Nil Operative Findings A 12-cm long STA and its posterior branch were isolated for EDAS. It was placed over three M4 segments on frontal lobe surface. Operative Procedures Under ETGA, patient was in supine position with head rotated to right and left shoulder elevated. After shaving, we mapped the course of superficial temporal artery by Duplex. After disinfection and draping, we made a 7-shape scalp incision at left fronto-temporal region. Under microscope, the scalp flap was elevated without galea to preserve STA and its posterior branch. The STA and its branch with nearby galea were isolated from temporalis fascia. The temporalis muscle was splitted verticlely underneath STA and retracted. A burhole was created at squamous temporal bone and another one at frontal. An elliptical craniotomy was done by saw connecting these burholes followed by dura tenting along the craniotomy border. An H-shape durotomy was done. We opened the arachnoid membrane and identified a M4 segment just exit from Sylvian fissure. Another 2 M4 segment at frontal lobe surface were also identified. After removing the arachnoid membrane over these cortical arteries, the STA and its branch were put over them. The nearby galea were sutured to dura as anchor. The dura was closed with 4-0 prolene continuous suture loosely with two openings at both ends for STA entry and exit. After central tenting, dura was covered by DuraForm as on-lay graft. The bone flap was fixed back with 4 wires. The temporalis muscle was approximated. A subgaleal CWV was placed. Wound was closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS 郭夢菲 Assistants R4 游健生 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Encephalo-duro-arterio-synangiosis, left 開立醫師: 郭夢菲 開立時間: 2012/01/18 16:53 Pre-operative Diagnosis Moyamoya disease, status post right side EDAS Post-operative Diagnosis Moyamoya disease, status post bilateral EDAS Operative Method Indirect EC-IC bypass by Encephalo-duro-arterio-synangiosis, left Specimen Count And Types nil Pathology Nil Operative Findings A 12-cm long STA and its posterior branch were isolated for EDAS. It was placed over three M4 segments on left frontal lobe surface. Operative Procedures Under ETGA, patient was in supine position with head rotated to right and left shoulder elevated. After shaving, we mapped the course of superficial temporal artery by Duplex. After disinfection and draping, we made a 7-shape scalp incision at left fronto-temporal region. Under microscope, the scalp flap was elevated without galea to preserve STA and its posterior branch. The STA and its branch with nearby galea were isolated from temporalis fascia. The temporalis muscle was splitted verticaly underneath STA and retracted. A burhole was created at squamous temporal bone and another one at frontal. An elliptical craniotomy was done by saw connecting these burholes followed by dura tenting along the craniotomy border. An H-shape durotomy was done. We opened the arachnoid membrane and identified a M4 segment just exit from Sylvian fissure. Another 2 M4 segment at frontal lobe surface were also identified. After removing the arachnoid membrane over these cortical arteries, the STA and its branch were put over them. The nearby galea were sutured to the inner surface of the dura to extend the galeal flap as wide as possible. The flap was suture to the four corners of the dural defect as anchor. The dura was approximated with three silk stitches, and closed with 4-0 prolene continuous suture loosely with two openings at both ends for STA entry and exit. After central tenting, dura was covered by DuraForm as on-lay graft. The bone flap was fixed back with 4 wires. The temporalis muscle was approximated. A subgaleal CWV was placed. Wound was closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators VS 郭夢菲 Assistants R4 游健生 相關圖片 李玉仙 (F,1941/06/07,70y9m) 手術日期 2012/01/18 手術主治醫師 林峰盛 手術區域 西址 034房 08號 診斷 Failed back syndrome 器械術式 Nerve block / PC 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 林峰盛 ASA 3 時間資訊 20:10 進入手術室 20:13 麻醉開始 20:15 誘導結束 20:20 手術開始 20:42 手術結束 20:42 麻醉結束 20:45 送出病患 20:50 進入恢復室 22:00 離開恢復室 記錄__ 手術科部: 麻醉部 套用罐頭: Pulsed RF 開立醫師: 林彥君 開立時間: 2012/01/18 20:45 Pre-operative Diagnosis Failed back syndrome Post-operative Diagnosis Failed back syndrome Operative Method Pulsed RF Specimen Count And Types Pathology Nil Operative Findings Operative Procedures 1. IV sedation with midazolam and LA with 1% xylocaine 2. pt in prone position 3. Under fluoroscopic-guidance, insert 22 G SMK RF meedle into bilateral L2 neuroforamen 4. Neurostimulation with 50 HZ and 2 Hz 0.1-0.5 mV current with positive result 60-80V 2 Hz, 20 ms, 120sec *2 pulsed RF was delivered 5. 1% Xylocaine 3ml + Rideron 2.5mg were injected into bilateral epidural space, respectively send pt to PRO Operators 林峰盛, Assistants 林彥君, 賴仕懷 (M,1966/02/25,46y0m) 手術日期 2012/01/18 手術主治醫師 杜永光 手術區域 東址 003房 01號 診斷 Facial spasm 器械術式 Microvascular decompression for recurrent left hemifacial spasm 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 3 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:10 麻醉開始 08:45 誘導結束 08:53 抗生素給藥 09:22 手術開始 11:46 抗生素給藥 13:10 手術結束 13:10 麻醉結束 13:20 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 腦微血管減壓術 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: Microvascular decompression 開立醫師: 李振豪 開立時間: 2012/01/18 13:43 Pre-operative Diagnosis Left hemifacial spasm status post microvascular decompression with recurrence Post-operative Diagnosis Left hemifacial spasm status post microvascular decompression with recurrence Operative Method Microvascular decompression Specimen Count And Types nil Pathology Nil Operative Findings Incidental durotomy occurred during dissection along previous craniotomy and CSF was drained from the durotomy gradually. Severe adhesion was noted after durotomy expecially between cerebellum, dura and around the CN VII, VIII complex. The previous Teflon felt was pushed anteriorly and the facial nerve was compressed by the AICA loop tightly. The old Teflon felt was removed during dissection. New Teflon felt was placed between AICA loop and root exit zone. A small branch arising from AICA loop which course through CN VII, VIII complex was also found. A small piece of Teflon felt was placed between brainstem and the small branch for decompression. The BAEP was fluctuated during manipulation and returned to baseline after duroplasty. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position with left shoulder elevation and head rotated to right. The head was fixed with Mayfield skull clamp. The scalp was shaved, scrubbed, and disinfected as usual. Curvilinear scalp incision was made along operative scar. A 3x2cm fascia was harvested for duroplasty. The soft tissue and nuchal muscle was devided and previous craniotomy was exposed. The skull plate was removed. Pi shape durotomy was made and adhesionlysis was conducted. The CN VII, VIII complex, low cranial nerve, and trigeminal nerve were exposed. After careful dissection, the offending vessel and previous Teflon felt were identified. The Teflon felt was removed and dissection was conducted along the AICA loop. The AICA loop was pushed away from root exit zone and Teflon felt was placed between the AICA and root exit zone. Hemostasis was achieved with bipolar electrocautery and Surgicel lining. Duroplasty with autologous fascia graft and 4-0 prolene was done. The skull plate was placed back and the wound was closed in layers with 2-0 Vicryl and 3-0 Nylon. Operators Prof. 杜永光 Assistants R5 李振豪 R3 曾偉倫 相關圖片 李佳宜 (F,1997/11/23,14y3m) 手術日期 2012/01/19 手術主治醫師 黃世傑 手術區域 東址 020房 02號 診斷 Multiple epiphyseal dysplasia 器械術式 ROI, bil 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 3 紀錄醫師 吳俊毅, 時間資訊 00:00 臨時手術NPO 09:00 報到 09:20 進入手術室 09:28 麻醉開始 09:32 誘導結束 09:35 抗生素給藥 09:49 手術開始 10:55 手術結束 10:55 麻醉結束 11:05 送出病患 11:07 進入恢復室 12:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 骨內固定物拔除術-骨盆,髖骨,肱骨,股骨,尺骨,橈骨,脛骨 2 1 B 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 骨科部 套用罐頭: Removal of implants 開立醫師: 吳俊毅 開立時間: 2012/01/19 09:29 Pre-operative Diagnosis Bilateral coxa vara status post valgus osteotomy Post-operative Diagnosis Bilateral coxa vara status post valgus osteotomy Operative Method Removal of implants Specimen Count And Types nil Pathology nil Operative Findings Bone union Operative Procedures 1. ETGA. supine 2. Skin prepare, disinfection and drapped 3. Skin incision over previous op scar 4. Removed two cannualted scews at right hip 5. Removed osteotomy plate at left hip 6. NS irrigation and closed wound in layers Operators 王廷明, Assistants 吳俊毅, 廖翊廷, 記錄__ 手術科部: 骨科部 套用罐頭: Removal of implants 開立醫師: 潘梳婷 開立時間: 2012/01/19 10:58 Pre-operative Diagnosis Bilateral coxa vara status post valgus osteotomy Post-operative Diagnosis Bilateral coxa vara status post valgus osteotomy Operative Method Removal of implants Specimen Count And Types nil Pathology nil Operative Findings Bone union Operative Procedures 1. ETGA. supine 2. Skin prepare, disinfection and drapped 3. Skin incision over previous op scar 4. Removed two cannualted scews at right hip 5. Removed osteotomy plate at left hip 6. NS irrigation and closed wound in layers Operators 王廷明, Assistants 吳俊毅, 廖翊廷, 葉佐詮 (M,2002/08/31,9y6m) 手術日期 2012/01/19 手術主治醫師 許巍鐘 手術區域 兒醫 067房 03號 診斷 Spinal cord injury 器械術式 Tracheostomy 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 蕭柏妮 ASA 3 紀錄醫師 廖怡茹, 時間資訊 00:00 開始NPO 08:00 臨時手術NPO 11:05 進入手術室 11:08 麻醉開始 11:10 誘導結束 11:21 手術開始 11:28 報到 11:50 麻醉結束 11:50 手術結束 11:57 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 氣管永久造孔術 1 1 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 耳鼻喉部 套用罐頭: Permanant tracheastomy 開立醫師: 廖怡茹 開立時間: 2012/01/19 13:29 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure,operated Operative Method Permanant tracheastomy Specimen Count And Types nil Pathology nil Operative Findings 6.5 PDL shiley inserted and permanat tracheastomy was created Operative Procedures After general anesthesia was set up via endotracheal tube, the patient was in supine position with head hyperextended. The operative field was disinfected and draped as usual, 1: 100000 Bosmin was injected into the subcutaneous tissue and the pretracheal area layer by layer. A horizontal skin incision was made along the midline between cricoid and sternal notch. Subcutaneous fat was removed a little for well exposure of operative field. The fascia and strap muscles were separated layer by layer, after retracting the thyroid gland, the trachea was seen. The tracheal rings were cut a slit in a longitudinal fashion. The lateral aspects of the tracheal window were suture-tied with 4-0 Dexon to fix on the surroundingskin. Then one No.6.5 PDL shiley tracheostomy tube was inserted after removal of the endotracheal tube. The patient tolerated the procedure well. Operators Asp許巍鐘, Assistants R3廖怡茹, R4林其懋, Indication Of Emergent Operation Respiratory failure 蔡阿森 (M,1950/11/13,61y4m) 手術日期 2012/01/19 手術主治醫師 李苑如 手術區域 東址 008房 04號 診斷 Ureteral stone, right 器械術式 U.R.S.-S.M. + Meatotomy,URS 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 靜脈麻醉 麻醉主治醫師 葉惠敏 ASA 3 紀錄醫師 周博敏, 時間資訊 10:48 報到 11:13 進入手術室 11:15 麻醉開始 11:20 誘導結束 11:30 抗生素給藥 11:32 手術開始 12:05 手術結束 12:05 麻醉結束 12:10 送出病患 12:15 進入恢復室 13:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 輸尿管鏡取石術或碎石術–併用超音波或電擊方式 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 記錄__ 手術科部: 泌尿部 套用罐頭: URS-SM 開立醫師: 周博敏 開立時間: 2012/01/19 12:23 Pre-operative Diagnosis right ureteral stone with hydronephrosis Post-operative Diagnosis right ureteral stone with hydronephrosis Operative Method URS-SM Specimen Count And Types nil Pathology nil Operative Findings A yellowish stone obstructed at right middle ureter with hydronephrosis was crushed by Holmium Laser(Energy:1.2J,Frequency:12 /s) Operative Procedures Under satisfactory anesthesia with the patient in the lithotomy position, skin preparation was performed. A cystoscope was inserted into the bladder and a guidewire was then introduced into the ureteral orifice. A 6 Fr. ureteroscope was introduced into the ureter. A yellowish stones was noted at right ureter and crushed by Holmium Laser(Energy:1.2J, Frequency:12 /s) A Fr.7-24cm DBJ catheter was inserted. A 16 Fr. Foley catheter was placed in the urinary bladder. The patient tolerated the operation well and was sent to the recovery room in stable condition. Operators 李苑如, Assistants 陳聖復,周博敏, 黃琰宸 (M,1952/05/02,59y10m) 手術日期 2012/01/20 手術主治醫師 陳敞牧 手術區域 東址 019房 01號 診斷 Subdural hemorrhage 器械術式 Subduro-peritoneal shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 蕭柏妮 ASA 3 紀錄醫師 許皓淳, 時間資訊 00:00 臨時手術NPO 07:50 報到 08:05 進入手術室 08:20 麻醉開始 08:30 誘導結束 09:31 手術開始 10:37 手術結束 10:37 麻醉結束 10:43 送出病患 10:45 進入恢復室 12:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 頭顱穿洞術(止血引流、穿刺檢查) 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 摘要__ 手術科部: 外科部 套用罐頭: 1. Burr hole for subdural effusion evacuation... 開立醫師: 王奐之 開立時間: 2012/01/20 10:51 Pre-operative Diagnosis Bilateral chronic subdural hemorrhage or effusion Post-operative Diagnosis Minimal subdural effusion with thickened dura Operative Method 1. Burr hole for subdural effusion evacuation, right side 2. Dural biopsy Specimen Count And Types 1 piece About size:pieces Source:dura Pathology Pending Operative Findings Thickened dura mater was observed at right side, about 0.7~0.8cm in thcikness. Minimal amount of slight xanthochromic subdural effusion was noted with low pressure, which was evacuated. The brain surface was close to the dura with small subdural space. Two pieces of dura was harvested for pathologic examination. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After shaving, scrubbing, disinfection & draping in sterile fashion, a curved incision was made at right frontoparietal area. After careful dissection to expose the shunt catheter, a burr hole was created lateral to the shunt, followed by dural tenting. A cruciate durotomy was performed, and a piece of dura was harvested for pathologic examination. The minimal subdural effusion was evacuated, and the burr hole was packed with Gelfoam. The wound was then closed in layers after meticulous hemostasis. Operators VS 陳敞牧 Assistants R4 王奐之, R2 許皓淳 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: 1. Burr hole for subdural effusion evacuation... 開立醫師: 王奐之 開立時間: 2012/01/20 10:51 Pre-operative Diagnosis Bilateral chronic subdural hemorrhage or effusion Post-operative Diagnosis Minimal subdural effusion with thickened dura Operative Method 1. Burr hole for subdural effusion evacuation, right side 2. Dural biopsy Specimen Count And Types 1 piece About size:pieces Source:dura Pathology Pending Operative Findings Thickened dura mater was observed at right side, about 0.7~0.8cm in thcikness. Minimal amount of slight xanthochromic subdural effusion was noted with low pressure, which was evacuated. The brain surface was close to the dura with small subdural space. Two pieces of dura was harvested for pathologic examination. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position with head turned to left. After shaving, scrubbing, disinfection & draping in sterile fashion, a curved incision was made at right frontoparietal area. After careful dissection to expose the shunt catheter, a burr hole was created lateral to the shunt, followed by dural tenting. A cruciate durotomy was performed, and a piece of dura was harvested for pathologic examination. The minimal subdural effusion was evacuated, and the burr hole was packed with Gelfoam. The wound was then closed in layers after meticulous hemostasis. Operators VS 陳敞牧 Assistants R4 王奐之, R2 許皓淳 相關圖片 陳正培 (M,1979/07/30,32y7m) 手術日期 2012/01/20 手術主治醫師 梁金銅 手術區域 東址 016房 02號 診斷 Brain cancer 器械術式 Remove V-P shunt (laparoscopy) 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 葉育彰 ASA 2 紀錄醫師 劉昌杰, 時間資訊 09:55 報到 11:10 進入手術室 11:15 麻醉開始 11:20 誘導結束 11:32 抗生素給藥 11:55 手術開始 12:15 手術結束 12:15 麻醉結束 12:20 送出病患 13:00 進入恢復室 14:10 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 腹腔內異物卻除術 1 1 記錄__ 手術科部: 外科部 套用罐頭: Laparoscopic removal of V-P shunt 開立醫師: 劉昌杰 開立時間: 2012/01/20 12:29 Pre-operative Diagnosis V-P shunt dislocation Post-operative Diagnosis V-P shunt dislocation Operative Method Laparoscopic removal of V-P shunt Specimen Count And Types 1 piece About size:2x2cm Source:Mixed hemorrhoid Pathology nil Operative Findings Whole V-P shunt was inside pelvic space; no adhesion was noted Operative Procedures 1. ETGA, supine position 2. Disinfection, drapped 3. Make mini-laparotomy at umbilicus, 1cm in size 4. Identify V-P shunt by laparoscope 5. Make another working port at right lower abdomen, 1cm in size 6. Remove V-P shunt 7. Close wounds in layers Operators 梁金銅 Assistants R4 陳姿君 R2 劉昌杰 相關圖片 鄭國基 (M,1959/07/08,52y8m) 手術日期 2012/01/27 手術主治醫師 蔡翊新 手術區域 東址 003房 01號 診斷 Bacterial meningitis 器械術式 EVD revision(改long tract EVD) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 2 紀錄醫師 許皓淳, 時間資訊 00:00 臨時手術NPO 07:38 報到 07:55 進入手術室 08:10 麻醉開始 08:20 誘導結束 09:04 手術開始 10:12 手術結束 10:12 麻醉結束 10:22 送出病患 10:25 進入恢復室 11:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦室體外引流 1 2 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: V-P Shunt 開立醫師: 蔡翊新 開立時間: 2012/01/27 10:07 Pre-operative Diagnosis Hydrocephalus with VP shunt infection, s/p EVD. Post-operative Diagnosis Hydrocephalus with VP shunt infection, s/p EVD. Operative Method EVD revision with long-tract EVD, via left Kocher point. Specimen Count And Types nil Pathology Nil. Operative Findings CSF: mild sanguinous, pressure: 5 cmH2O. Ventricular catheter: 6.5 cm in depth. EVD exit site was located at left subclavian region. Operative Procedures 1. Anesthesia: endotracheal general. 2. Position: supine with head rotated to right. 3. Skin preparation: shaved and scrubbed with povidone-iodine detergent followed by painting with povidone-iodine alcohol tincture, then covered with sterilized adhesive plastic sheet. 4. Incision: 5 cm curvilinear, left frontal, corresponded to the location of left frontal horn. Raney clips were applied to the scalp edge for temporary hemostasis. 5. After the scalp flap had been lifted and reflected anteriorly, previous EVD was removed by amputation at wound edge. 6. A 6.5 cm segment of the ventricular catheter was introduced into the ventricle. 7. A nib incision was made at left subclavian region. The proximal end of peritoneal catheter was passed through subcutaneous tunnel at neck, left retroauricular area and connected the ventricular catheter via a straight connector. 8. Scalp closure: hemostasis was done with bipolar coagulator. Galea suture was performed by continuous suture with 2/0 Vicryl and skin by interrupted suture with 3/0 nylon. 9. Course of the surgery: smooth. Operators VS蔡翊新 Assistants R4王奐之R2許皓淳 相關圖片 賴月嬌 (F,1962/08/23,49y6m) 手術日期 2012/01/30 手術主治醫師 林昌平 手術區域 東址 010房 08號 診斷 Nodular lymphoma, unspecified site, extranodal solid organ sites 器械術式 P.P.V.- complicated 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 謝昀翰, 時間資訊 13:40 進入手術室 14:05 手術開始 14:30 手術結束 14:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 眼坦部玻璃體切除術-簡單 1 1 R 記錄__ 手術科部: 眼科部 套用罐頭: 23G PPV 開立醫師: 謝昀翰 開立時間: 2012/01/30 14:36 Pre-operative Diagnosis suspect Masquerate syndrome(od) Post-operative Diagnosis suspect Masquerate syndrome(od) Operative Method 23G PPV Specimen Count And Types 1 piece About size:2ml Source:vitreous Pathology nil Operative Findings great amount of cells in vitreous Operative Procedures 1. Under retrobulbar anesthesia 2. Disinfection and draping as usual, apply an eyelid speculum. 3. Insert 23G trocar 3. Three sclerotomy were made then apply light probe, microvit, and infusion line throughthe sclerotomy wounds. 4. Vitrectomy was performed with Microvit and save vitreous sample 5. Remove trocar and close sclertomy wound suturelessly 6. Subconjunctival injection of Cefa 7.Atropine and Latycinpatching. Operators 林昌平, Assistants R4謝旻瑾,R2謝昀翰 李紫汶 (F,1998/02/15,14y0m) 手術日期 2012/01/31 手術主治醫師 郭夢菲 手術區域 兒醫 067房 02號 診斷 Chiari malformation 器械術式 Syringo-pleural shunt 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 石博元 ASA 2 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 11:05 進入手術室 11:10 麻醉開始 11:20 誘導結束 12:30 抗生素給藥 12:51 手術開始 15:30 抗生素給藥 16:00 手術結束 16:00 麻醉結束 16:13 送出病患 16:25 進入恢復室 17:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 手術 良性脊髓腫瘤切除術 1 1 手術 椎弓整形術 1 2 摘要__ 手術科部: 外科部 套用罐頭: T4 laminoplasty for syringo-subarachnoid shun... 開立醫師: 游健生 開立時間: 2012/01/31 16:59 Pre-operative Diagnosis Syringomyelia, C1-T9 Post-operative Diagnosis Syringomyelia, C1-T9 Operative Method T4 laminoplasty for syringo-subarachnoid shunt placement Specimen Count And Types nil Pathology Nil Operative Findings After removal of T4 lamina, the thecal sac expanded well. We can see the syrinx via a transparent pia membrane on the left side of the spinal cord. A T-tube was inserted into the syrinx via an opening on that pia. The cranial tip was about 5cm and the rostral tip was about 2.5cm. The subarachnoid tip was about 1cm pointing rostrally. After the surgery, the thecal sac became slack. Operative Procedures Under ETGA, patient was in prone position. We marked the level of paper clip, which was at T6 level, by a shallow cut on skin. After disinfection and draping, a midline incision was made from T3 to T5. After detaching paraspinal muscles, T3-5 spinous process were exposed as well as T4 lamina. We removed the T4 lamina by drilling both side. Under microscope, the dura was opened at midline and tacked up by sutures. We examined the intrathecal pathology. The syrinx was seen via a transparent pia membrane on the left side of cord. Thus, we opened the membrane by micro-scissors and mini-knife. Much CSF gashed out after the opening and cord became slack. A T-tube was inserted into the syrinx via that opening with rostral tip (shorter one) inserted first. The subarachnoid space was identified by opening the arahnoid membrane. The arahnoid opening was sutured to dura in order to maintain its patency. The subarachnoid tip of T-tube was placed in the subarachnoid space via that opening pointing rostrally. The T-tube was anchored to arachnoid membrane. Dura was closed with 7-0 prolene in continuous suture. A Gelfoam was placed over the thecal sac. After hemostasis, T4 lamina were fixed back with mini-plates. The paraspinal muscles were approximated. Wound was closed in layers with 3-0 Vicryl and 4-0 Nylon. Operators VS 郭夢菲 Assistants R4 游健生 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: T4 laminoplasty for syringo-subarachnoid shun... 開立醫師: 郭夢菲 開立時間: 2012/02/01 10:11 Pre-operative Diagnosis Syringomyelia, C1-T10 Post-operative Diagnosis Syringomyelia, C1-T10 Operative Method T4 laminoplasty for syringo-subarachnoid shunt placement Specimen Count And Types nil Pathology Nil Operative Findings 1. After removal of T4 lamina, the thecal sac expanded markedly. We can see the syrinx via a transparent pia membrane on the left dorsal root entry zone of the spinal cord. 2. The subarachnoid space was adhered markedly and diffusely. 3. A T-tube was inserted into the syrinx via an opening on that pia. The cranial tip was about 5cm and the rostral tip was about 2.5cm. The subarachnoid tip was about 2.5cm pointing caudally. After the surgery, the thecal sac became slack. 4. during the whole course of surgery, the SSEP and MEP did not changed. Operative Procedures Under ETGA, patient was in prone position. We marked the level of paper clip, which was at T6 level, by a shallow cut on skin. After disinfection and draping, a midline incision was made from T3 to T5. After detaching paraspinal muscles, T3-5 spinous process were exposed as well as T4 lamina. We removed the T4 lamina by drilling both side. Under microscope, the dura was opened at midline and tacked up by sutures. We examined the intrathecal pathology. The syrinx was seen via a transparent pia membrane on the left side of cord. Thus, we opened the pia membrane by micro-scissors and mini-knife. Much CSF gashed out after the opening and cord became slack. A T-tube was inserted into the syrinx via that opening with caudaone (shorter one) then rostral tip (longer one) inserted. The subarachnoid space was identified by opening the arahnoid membrane. The arahnoid opening was sutured to dura with 7-0 prolene in order to maintain its patency. The subarachnoid tip of T-tube was placed in the subarachnoid space via that opening pointing caudally for about 2.5 cm. The T-tube was anchored to arachnoid membrane. Dura was closed with 7-0 prolene in continuous suture. A Gelfoam was placed over the thecal sac. After hemostasis, T4 lamina were fixed back with 2 sets of mini-plates. The paraspinal muscles were approximated. Wound was closed in layers with 3-0 Vicryl and 4-0 Nylon. Operators VS 郭夢菲 Assistants R4 游健生 相關圖片 葉佐詮 (M,2002/08/31,9y6m) 手術日期 2012/01/31 手術主治醫師 許巍鐘 手術區域 兒醫 062房 02號 診斷 Spinal cord injury 器械術式 BRONCHOSCOPY-COMPLICATED 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 陳李魁 ASA 3 紀錄醫師 齊凡翔, 時間資訊 08:50 進入手術室 08:55 麻醉開始 08:56 誘導結束 08:57 手術開始 09:07 手術結束 09:07 麻醉結束 09:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 管、支 管、細支 管異物除去術- 管鏡 1 1 手術 換氣切管 1 0 手術 支氣管鏡檢查 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 套用罐頭: Flexible bronchoscope + rigid bronchoscope + ... 開立醫師: 齊凡翔 開立時間: 2012/01/31 09:45 Pre-operative Diagnosis respiratory failure, status post tracheostomy Post-operative Diagnosis respiratory failure, status post tracheostomy, operated Operative Method Flexible bronchoscope + rigid bronchoscope + change tracheostomy tube Specimen Count And Types nil Pathology nil Operative Findings Nose: patent; Choana: patent Pharynx:normal Nasopharynx: Adenoid Tongue base: patent Vallecula: patent Hypopharynx: patent Larynx: Epiglottis: intact Aryepiglottic fold: grossly no lesion Arytenoid cartilage: grossly no lesion Accesory cartilage: grossly no lesion True vocal fold: grossly no lesion False vocal folds: grossly no lesion Subglotttis: erosion, posterior wall Trachea: tracheostomy tube(+) Carina: patent Right main bronchus: patent Left main bronchus: patent Operative Procedures The patient was put in supine position. After ETGA was setup, flexible bronchoscope was applied into the nostril. From the nasal cavity and nasopharynx till bilateral bronchi were examed. Subglotttis erosion, posterior wall, was noted under the bronchoscopy. The pharynx, larynx, trachea, carina and bilateral bronchi were smooth and patent. Then, rigid bronchoscopy was applied. Jet ventilation was used via rigid bronchoscopy. Rigid bronchoscopy was set and larynx, subglottis, trachea, carina, bilateral main bronchus were checked, and operative findings are complatibel with flexible bronchoscopic examination. Removed tracheostomy stoma stitch. We change tracheostomy to 6.5 shiley PDL. The patient was well tolerated to the procedure. Operators Asp許巍鐘, Assistants 齊凡翔, 廖怡茹, 徐鵬鎮 (M,2003/07/05,8y8m) 手術日期 2012/02/02 手術主治醫師 廖漢文 手術區域 東址 000房 號 診斷 Moyamoya disease 器械術式 Common Carotid Angiography 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 3 時間資訊 00:00 臨時手術NPO 08:30 麻醉開始 08:50 誘導結束 09:43 麻醉結束 10:08 進入恢復室 11:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 巫德福 (M,1950/11/09,61y4m) 手術日期 2012/02/02 手術主治醫師 張志豪 手術區域 西址 036房 03號 診斷 Carpal tunnel syndrome 器械術式 Right carpal tunnel and Guyon canal neurolysis 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林峰盛 ASA 3 紀錄醫師 葉炳君, 時間資訊 10:57 進入手術室 11:07 麻醉開始 11:20 誘導結束 11:25 抗生素給藥 11:50 手術開始 12:30 手術結束 12:30 麻醉結束 12:35 送出病患 12:40 進入恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 神經分離術-手.足之經 1 1 R 摘要__ 手術科部: 骨科部 套用罐頭: Other 開立醫師: 葉炳君 開立時間: 2012/02/02 12:40 Pre-operative Diagnosis Carpal tunnel syndrome, right wrist Post-operative Diagnosis Carpal tunnel syndrome, right wrist Operative Method Carpal tunnel release, right wrist Tophi excision Specimen Count And Types nil Pathology nil Operative Findings Much tophi formation deposition on radioscapholunate and long scapho-lunate ligament and surrounding tendon sheaths Operative Procedures LMAGA, supine ositioned Skin disinfection and drapping as usual, followed by exsangunation and pneumatic tourniqueting with 250 mmHg Zigzag skin incision on volar wrist and identified median nerve Performed carpal tunnel release and tophi excision N/S irrigation and hemostasis Wound closure in layers Operators 張志豪, Assistants 葉炳君, 記錄__ 手術科部: 骨科部 套用罐頭: Other 開立醫師: 葉炳君 開立時間: 2012/02/02 12:40 Pre-operative Diagnosis Carpal tunnel syndrome, right wrist Post-operative Diagnosis Carpal tunnel syndrome, right wrist Operative Method Carpal tunnel release, right wrist Tophi excision Specimen Count And Types nil Pathology nil Operative Findings Much tophi formation deposition on radioscapholunate and long scapho-lunate ligament and surrounding tendon sheaths Operative Procedures LMAGA, supine ositioned Skin disinfection and drapping as usual, followed by exsangunation and pneumatic tourniqueting with 250 mmHg Zigzag skin incision on volar wrist and identified median nerve Performed carpal tunnel release and tophi excision N/S irrigation and hemostasis Wound closure in layers Operators 張志豪, Assistants 葉炳君, 張秀霞 (F,1967/08/28,44y6m) 手術日期 2012/02/02 手術主治醫師 王國川 手術區域 東址 003房 01號 診斷 Brain cancer 器械術式 Bifrontal GBM excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 08:07 進入手術室 08:10 麻醉開始 08:47 誘導結束 08:55 抗生素給藥 09:19 手術開始 11:55 抗生素給藥 12:57 手術結束 12:57 麻醉結束 13:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 B 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: Bilateral frontal craniotomy for tumor resection 開立醫師: 曾偉倫 開立時間: 2012/02/02 13:27 Pre-operative Diagnosis Bifrontal glioblastoma multiforme status post right frontal craniotomy for tumor excision Post-operative Diagnosis Bifrontal glioblastoma multiforme status post right frontal craniotomy for tumor excision Operative Method Bilateral frontal craniotomy for tumor resection Specimen Count And Types 1 piece About size:2x2x2 cm Source:Frontal GBM Pathology Pending Operative Findings 1. The tumor over left was white-reddish, soft, hypervascularized ~ 1.5x1.5 cm in size which located anterily to the left lateral ventricle 2. The brain tissue over right frontl area was yellowish, elastic with gliotic change. The tumor located anterior-inferily to the right lateral ventricle and it extend to the front of third ventricle. The tumor was grey-yellowish, hypervascularized, soft to elastic ~ 2.0x2.0x.2.0 cm in size. Fibrotic change was found within the tumor. 3.The bilateral ventricles and third ventricle were opened during the operation. The EVD was placed into the right lateral ventricle. Operative Procedures Under ETGA, we placed the patient on supine position with her neck mild extended after clamping with the Mayfield clamp. After we shaved, disinfected and drapped, a bicrownal skin incision was made on the previous skin incision with extension to right pre-auricular area. The skin flap was elevated after dissection. The previous right frontal craniotomy was removed and the left frontal craniotomy was done after 2 burr-holes. Left frontal durotomy was done and the brain tumor was located by intra-operative echo. The tumor was resected by bipolar forceps, tumor forceps and suction. The left lateral ventricle was reached after the tumor removed. The dura was closed with 3-0 Prolene after complete hemostasis. Right frontal durotomy was done and the tumor resection was performed via previous operation tract. The right lateral ventricle was reached and the third ventricle was opened after the tumor resection. An EVD was placed into the left lateral ventricle. After the bleeders checked, the durotomy was closeed with autologus fascia flap. The bone graft was placed back and fixed with mini-plate and screws. The wound was closed in layers after we placed a CWV drain. Operators VS 王國川 Assistants R3 曾偉倫 R2 俞錫全 相關圖片 王余賢英 (F,1949/05/02,62y10m) 手術日期 2012/02/03 手術主治醫師 賴達明 手術區域 東址 019房 02號 診斷 Ischemic stroke 器械術式 Cranioplasty 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 蕭柏妮 ASA 3 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 13:20 報到 14:00 進入手術室 14:10 麻醉開始 14:45 誘導結束 15:10 抗生素給藥 15:30 手術開始 18:10 抗生素給藥 18:57 手術結束 18:57 麻醉結束 19:12 送出病患 19:15 進入恢復室 22:20 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 2 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 頭顱成形術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Cranioplasty with autologus bone graft and fi... 開立醫師: 林哲光 開立時間: 2012/02/03 21:28 Pre-operative Diagnosis Right F-T-P skull bone defect Post-operative Diagnosis Right F-T-P skull bone defect Operative Method Cranioplasty with autologus bone graft and fixed with miniplates Specimen Count And Types nil Pathology Nil Operative Findings Two seperate skull bone was noted and was fixed together with miniplates. The previous skull bone defect became smaller than the bone graft due to newly developed bony formation around the edge. No residual temporalis muscle was identfied during the cranioplasty. Operative Procedures Under ETGA and supine position with head rotated to left side, skin disinfected and drapped were performed as usual. SKin incision was made along the previous operative wound. The plane between the galea and dura was dissected meticulously. Two pieces of skull bone graft was fixed together with miniplates. The edge of skull bone was then drilled off to fit the craniectomy window. The skull bone was then put back and fixed with miniplates. The wound was then closed in layers after two subgaleal drain insertion. Operators 賴達明 Assistants 林哲光, 王馨佩 相關圖片 摘要__ 手術科部: 外科部 套用罐頭: Cranioplasty with autologus bone graft and fi... 開立醫師: 林哲光 開立時間: 2012/02/03 21:28 Pre-operative Diagnosis Right F-T-P skull bone defect Post-operative Diagnosis Right F-T-P skull bone defect Operative Method Cranioplasty with autologus bone graft and fixed with miniplates Specimen Count And Types nil Pathology Nil Operative Findings Two seperate skull bone was noted and was fixed together with miniplates. The previous skull bone defect became smaller than the bone graft due to newly developed bony formation around the edge. No residual temporalis muscle was identfied during the cranioplasty. Operative Procedures Under ETGA and supine position with head rotated to left side, skin disinfected and drapped were performed as usual. SKin incision was made along the previous operative wound. The plane between the galea and dura was dissected meticulously. Two pieces of skull bone graft was fixed together with miniplates. The edge of skull bone was then drilled off to fit the craniectomy window. The skull bone was then put back and fixed with miniplates. The wound was then closed in layers after two subgaleal drain insertion. Operators 賴達明 Assistants 林哲光, 王馨佩 相關圖片 吳佳富 (M,1942/06/03,69y9m) 手術日期 2012/02/03 手術主治醫師 余宏政 手術區域 西址 039房 01號 診斷 Hematuria 器械術式 Fiberocystoscopy /WOR 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 09:23 進入手術室 09:25 麻醉開始 09:28 手術開始 09:30 手術結束 09:31 送出病患 唐美蓉 (F,1951/01/01,61y2m) 手術日期 2012/02/06 手術主治醫師 戴浩志 手術區域 東址 009房 05號 診斷 Parkinsonism (F02.3) 器械術式 Debridment-- >10cm 手術類別 預定手術 手術部位 胸 傷口分類 清潔污染 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 柯人玄, 時間資訊 17:08 進入手術室 17:16 手術開始 17:45 手術結束 17:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 深部傷口處理縫合擴創-大 1 0 L 記錄__ 手術科部: 外科部 套用罐頭: Debridement 開立醫師: 柯人玄 開立時間: 2012/02/07 01:52 Pre-operative Diagnosis Parkinsonism s/p deep brain stimulator insertion with wound poor healing with wire exposure s/p primary closure and debridement with anterior chest poor wound healing Post-operative Diagnosis Parkinsonism s/p deep brain stimulator insertion with wound poor healing with wire exposure s/p primary closure and debridement with anterior chest poor wound healing Operative Method Debridement Specimen Count And Types nil Pathology Nil Operative Findings Poor wound healing noted over left anterior chest, covered by necrotic granulation tissue. Necrotic granulation tissure was removed and wound was irrigated by N/S. The wound was connected to a subcutaneous pockect located at left anterior chest near the nipple, another incision was made and necrotic tissue was removed. Operative Procedures Under local anesthesia, patient was placed in supine position. We disinfected and drapped as usual. Poor wound healing noted over left anterior chest, covered by necrotic granulation tissue. Linear incision was made along the poor healed wound. Necrotic granulation tissure was removed and wound was irrigated by N/S. The wound was connected to a subcutaneous pockect located at left anterior chest about 5 cm belowe the wound. Another incision was made and necrotic tissue was removed. One CWV drain was placed and after hemostasis and irrigation with NS, the wound was closed in layeres. Operators VS 戴浩志 Assistants R5 游彥辰 李文金 (M,1954/10/31,57y4m) 手術日期 2012/02/07 手術主治醫師 曾勝弘 手術區域 西址 037房 01號 診斷 Tardy ulnar palsy 器械術式 Neurolysis of the uluar neuve 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 09:40 報到 10:30 進入手術室 10:55 麻醉開始 10:57 手術開始 12:25 麻醉結束 12:25 手術結束 12:45 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 神經分離術-上臂.前臂.大腿.小腿處之神經 1 1 L 手術 正中神經或尺神經腕部減壓術–單側 1 2 L 記錄__ 手術科部: 外科部 套用罐頭: Carpal tunnel release and ulnar neurolysis 開立醫師: 周聖哲 開立時間: 2012/02/07 12:37 Pre-operative Diagnosis Carpal tunnel syndrome and tardy ulnar nerve palsy, left Post-operative Diagnosis Carpal tunnel syndrome and tardy ulnar nerve palsy, left Operative Method Carpal tunnel release and ulnar neurolysis Specimen Count And Types nil Pathology Nil Operative Findings 1. Hypertrophic flexor retinaculum, the median nerve was released after the decompression 2. The ulnar nerve was compressed tightly at 2cm below the ulnar nerve, the ulnar nerve was released after decompression. Operative Procedures 1. Supine position, local anesthesia 2. Skin incision of left palm 3. Dissect to exposed the flexor retinaculum and transect it carefully 4. Hemostasis and close the wound in layers 5. Skin incision of left elbow 6. Dissect to exposed the ulnar nerve 7. Perform neurolyisis of the ulnar nerve about 5cm above and below the ulnar groove respectively 8. Hemostasis and close the wound in layers Operators VS曾勝弘 Assistants R2周聖哲 廖溱家 (F,2008/12/29,3y2m) 手術日期 2012/02/08 手術主治醫師 曾勝弘 手術區域 兒醫 061房 01號 診斷 Aromatic L-amino acid decarboxylase deficiency 器械術式 CSF leakage repair 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林子富 ASA 3 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 12:40 報到 12:55 進入手術室 13:00 麻醉開始 13:25 誘導結束 13:30 抗生素給藥 13:30 手術開始 14:05 手術結束 14:05 麻醉結束 14:20 送出病患 14:25 進入恢復室 15:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 頭皮腫瘤 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 套用罐頭: Repair of CSF leakage 開立醫師: 李振豪 開立時間: 2012/02/08 14:40 Pre-operative Diagnosis CSF leakage with subgaleal effusion Post-operative Diagnosis CSF leakage with subgaleal effusion Operative Method Repair of CSF leakage Specimen Count And Types nil Pathology Nil Operative Findings Clear subgaleal effusion was noted with pseudocapsule formation. After removal of the pseudocapsule and the scar tissue, the leakage site was identified(anterior part of the burrhole). Tissucol Duo and Surgicel was applied for repair of CSF leakage. No acute complication was noted during whole procedure. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position. The scalp was shaved, scrubbed, and disinfected as usual. Linear scalp incision was made over right frontal area along operative scar. The subgaleal effusion was drained and the scar tissue was excised. The leakage site was identified and Tissucol Duo and Surgicel was applied for repair of CSF leakage. Hemostasis was achieved with bipolar electrocautery. The wound was closed wit 4-0 Nylon. Operators VS曾勝弘 Assistants R5李振豪 相關圖片 李子良 (M,1966/07/04,45y8m) 手術日期 2012/02/09 手術主治醫師 杜永光 手術區域 東址 001房 02號 診斷 Meningioma 器械術式 EVD for pneumocephalus 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3E 紀錄醫師 周聖哲, 時間資訊 00:00 臨時手術NPO 00:00 開始NPO 07:08 通知急診手術 09:25 報到 09:58 進入手術室 10:00 麻醉開始 10:10 誘導結束 10:36 抗生素給藥 10:40 手術開始 11:20 手術結束 11:20 麻醉結束 11:28 送出病患 11:35 進入恢復室 12:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腦脊髓液分流管重置 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: Air irrigation 開立醫師: 李振豪 開立時間: 2012/02/09 11:41 Pre-operative Diagnosis Pneumocephalus with ventriculomegaly Post-operative Diagnosis Pneumocephalus with ventriculomegaly Operative Method Air irrigation Specimen Count And Types nil Pathology None Operative Findings Saline filled up the right-sided ventricle after 50 mL of saline irrigation. Operative Procedures After endotracheal intubation general anesthesia, the head with the back was elevated to approximately 40 degreess and rotated 20 degrees to the left. Routine disinfection and preparation were performed. Linear incision was made on the previous scar. The burr hole was enlarged. Warm saline irrigation was performed to irrigate the air. After the saline has filled up the spaces, the ventricular end of the VP shunt was placed back to the right ventricle. The wound was closed in layers. Operators Professor 杜永光 Assistants R6 蔡宗良, R2 周聖哲 Indication Of Emergent Operation 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Air irrigation 開立醫師: 李振豪 開立時間: 2012/02/09 11:42 Pre-operative Diagnosis Pneumocephalus with ventriculomegaly Post-operative Diagnosis Pneumocephalus with ventriculomegaly Operative Method Air irrigation Specimen Count And Types nil Pathology None Operative Findings Saline filled up the right-sided ventricle after 50 mL of saline irrigation. Operative Procedures After endotracheal intubation general anesthesia, the head with the back was elevated to approximately 40 degreess and rotated 20 degrees to the left. Routine disinfection and preparation were performed. Linear incision was made on the previous scar. The burr hole was enlarged. Warm saline irrigation was performed to irrigate the air. After the saline has filled up the spaces, the ventricular end of the VP shunt was placed back to the right ventricle. The wound was closed in layers. Operators Professor 杜永光 Assistants R6 蔡宗良, R2 周聖哲 Indication Of Emergent Operation increased intracranial pressure 相關圖片 陳臣堪 (M,1934/09/03,77y6m) 手術日期 2012/02/09 手術主治醫師 李苑如 手術區域 東址 008房 07號 診斷 Benign prostatic hypertrophy 器械術式 U.R.S.-S.M. + Meatotomy,URS 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 面罩麻醉 麻醉主治醫師 葉惠敏 ASA 3 紀錄醫師 楊智凱, 時間資訊 16:18 報到 16:48 進入手術室 16:53 麻醉開始 16:58 誘導結束 17:16 手術開始 18:00 手術結束 18:00 麻醉結束 18:02 送出病患 18:05 進入恢復室 19:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 膀胱鏡檢查 1 0 手術 皮下穿刺腎造廔術（單側） 1 0 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 Semi-opened mask inhalation anes 1 0 摘要__ 手術科部: 泌尿部 套用罐頭: cystoscopy（biopsy ) 開立醫師: 楊智凱 開立時間: 2012/02/09 18:13 Pre-operative Diagnosis Left ureteral stone with hydronephrosis Post-operative Diagnosis Left ureteral stone with hydronephrosis Operative Method cystoscopy, left pigtail PCN Specimen Count And Types nil Pathology pending Operative Findings left ureteral orifice was invisible, Dilated renal pelvis and collecting system, left side Operative Procedures Under satisfactory anesthesia with the patient in lithotomy position, prepping and drapping was performed in the usual sterile fashion. A Fr 21 Olympus cystoscope was introduced into the bladder cavity under direct vision. Careful inspection revealed left ureteral orifice was invisible. The patient was placed in right flank position. Prepping and draping were performed in the usual sterile method. Dilated renal collecting system was identified. Adequate puncture path was chosen. The puncture needle was introduced into the collecting system under ultrasonographic guidance. The guide-wire was inserted into left renal pelvis under sono-guidedance. The tract was dilated with dilators, and the pigtail catheter was introduced into the renal pelvis smoothly through the guidewire. The guidewire was removed. After the fluid was drained out, the tube was fixed on the skin. Patient tolerated the procedure very well and was sent to recovery room in satisfactory condition. Operators 李苑如, Assistants 楊智凱, 伍嘉偉, 記錄__ 手術科部: 泌尿部 套用罐頭: cystoscopy（biopsy ) 開立醫師: 楊智凱 開立時間: 2012/02/09 18:13 Pre-operative Diagnosis Left ureteral stone with hydronephrosis Post-operative Diagnosis Left ureteral stone with hydronephrosis Operative Method cystoscopy, left pigtail PCN Specimen Count And Types nil Pathology pending Operative Findings left ureteral orifice was invisible, Dilated renal pelvis and collecting system, left side Operative Procedures Under satisfactory anesthesia with the patient in lithotomy position, prepping and drapping was performed in the usual sterile fashion. A Fr 21 Olympus cystoscope was introduced into the bladder cavity under direct vision. Careful inspection revealed left ureteral orifice was invisible. The patient was placed in right flank position. Prepping and draping were performed in the usual sterile method. Dilated renal collecting system was identified. Adequate puncture path was chosen. The puncture needle was introduced into the collecting system under ultrasonographic guidance. The guide-wire was inserted into left renal pelvis under sono-guidedance. The tract was dilated with dilators, and the pigtail catheter was introduced into the renal pelvis smoothly through the guidewire. The guidewire was removed. After the fluid was drained out, the tube was fixed on the skin. Patient tolerated the procedure very well and was sent to recovery room in satisfactory condition. Operators 李苑如, Assistants 楊智凱, 伍嘉偉, 李徐昭慧 (F,1947/12/01,64y3m) 手術日期 2012/02/10 手術主治醫師 陳偉勵 手術區域 東址 011房 04號 診斷 Cataract 器械術式 Phaco+PCIOL 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 12:15 進入手術室 12:55 手術開始 13:07 手術結束 13:10 送出病患 記錄__ 手術科部: 眼科部 套用罐頭: Phacoemulsification and PCIOL implantation(OS) 開立醫師: 麥珮怡 開立時間: 2012/02/10 13:06 Pre-operative Diagnosis Cataract (OD) Post-operative Diagnosis Cataract (OD) Operative Method Phacoemulsification and PCIOL implantation(OS) Phacoemulsification and PCIOL implantation(Od) Specimen Count And Types nil Pathology Nil Operative Findings Cataract (OD) Operative Procedures 1. Under peribulbar anesthesia 2. Disinfection, irrigation and draping. 3. Application of an eyelid speculum. 4. Made a clear corneal incision and penetrate into AC with 2.5mm cresent knife at 9 oclock position . 5. Inject Healon into the anterior chamber. 6. Continuous circular capsulorrhexis was done with capsular forceps. 7. Made a sideport at 10 oclock position with the MVR blade. 8. Hydrodissection and hydrodelineation were done with BSS. 9. Phacoemulsification of the nucleus by standard divide-and-conquer technique. 10. Aspiration of the residual cortical material with I/A cannula. 11. One-piece PCIOL was implanted into the bag after injection of Healon. 12. The residual Healon was washed out by I/A cannula. 13. Inject BSS into AC and check leakage. 14. Subconjunctival injection of Rinderon and Gentamicin. 15. Maxitrol patching. Operators 陳偉勵, Assistants 麥珮怡, 吳瑋萍 (F,1979/11/08,32y4m) 手術日期 2012/02/13 手術主治醫師 林昌平 手術區域 西址 032房 05號 診斷 Acute lymphoid leukemia 器械術式 IVI-Ganciclovir 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 鄭至豪, 時間資訊 14:37 報到 14:45 進入手術室 14:46 麻醉開始 14:50 手術開始 14:55 麻醉結束 14:55 手術結束 15:00 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 玻璃體空氣液體交換術 1 1 B 記錄__ 手術科部: 眼科部 套用罐頭: IVIA 開立醫師: 林昌平 開立時間: 2012/02/13 14:56 Pre-operative Diagnosis Post-operative Diagnosis Ditto Operative Method Intravitreal Injection Of Cymevene(OU) Specimen Count And Types nil Pathology nil Operative Findings nil Operative Procedures 1.Under topical anesthesia. 2.Disinfection and draping as usual. 3.Apply an eyelid speculum. 4.Intravitreal injection of Cymevene 0.05ml 5.Check leakage 6.Iop measurement by digit 7.Check bare VA>ND100cm Operators 林昌平, Assistants 鄭至豪, 黃靖安 (M,1979/05/17,32y9m) 手術日期 2012/02/14 手術主治醫師 林文瑛 手術區域 西址 037房 03號 診斷 Glioma, brain 器械術式 Insertion of hichman or port a 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 林文瑛 ASA 3 紀錄醫師 林昱廷, 時間資訊 00:00 臨時手術NPO 08:45 麻醉開始 08:47 誘導結束 10:48 進入手術室 10:59 手術開始 11:10 手術結束 11:10 麻醉結束 11:15 送出病患 11:16 進入恢復室 12:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 IV or IM anesthesia 1 0 手術 port–A導管植入術–治療性導管植入術 1 0 R 記錄__ 手術科部: 麻醉部 套用罐頭: Port-A implantation, subclavian 開立醫師: 林昱廷 開立時間: 2012/02/14 11:10 Pre-operative Diagnosis brain tumor Post-operative Diagnosis Ditto Operative Method Port-A implantation, echo-guided Specimen Count And Types nil Pathology Nil Operative Findings 1.Site: right subclavian vein, with echo-guided procedure 2.Patent flow after implantation 3.Others: nil Operative Procedures 1.The patient was set on supine position and bilateral subclavian veins were checked by echo. 2.After IVGA and local anesthesia applied, transverse skin incision for 3cm was made at pre-cordial area. 3.Undermine the skin at the layer between subcutaneous tissue and deep fascia in lateral direction. 4.An IV catheter was inserted via the subclavian incision and negatively aspirated until venous blood attainable. 5.J-wire was inserted smoothly in rostral direction. A subclavian catheter with dilator was inserted through the J-wire, and the dilator was then removed. 6.The catheter of Port-A was threaded into the subclavian vein until mark 22 cm. The catheter was adapted into the port and locked with restrictor.The Port was inserted into the pouch of pre-cordial incision. 7.Skin was closed layer by layer. Both catheter and port were perfused with heparin solution after implantation. Operators 林文瑛, Assistants 林昱廷, 陳炳坤 (M,1935/02/03,77y1m) 手術日期 2012/02/14 手術主治醫師 曾勝弘 手術區域 東址 005房 01號 診斷 Chronic renal failure 器械術式 removal of pleural catheter of V-P shunt 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 3 紀錄醫師 李振豪, 時間資訊 00:00 臨時手術NPO 08:15 進入手術室 08:20 麻醉開始 08:25 誘導結束 08:53 手術開始 09:25 麻醉結束 09:25 手術結束 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 皮下腫瘤摘除術小於2CM 1 1 L 記錄__ 手術科部: 外科部 套用罐頭: 1. Removal of pleural catheter of CSF shunt 開立醫師: 李振豪 開立時間: 2012/02/14 10:02 Pre-operative Diagnosis Persistent left pleural effusion Post-operative Diagnosis Persistent left pleural effusion Operative Method 1. Removal of pleural catheter of CSF shunt 2. Left tubal thoracostomy with 16 Fr. pigtail catheter Specimen Count And Types 2 pieces About size:5ml Source:Left pleural effusion About size:tip culture Source:pleural catheter of CSF shunt Pathology Nil Operative Findings The CSF was clear in character and the shunt was patent by manual compression of reservoir. The pleural catheter was transected after ligation the shunt with two stat suture. The pleural catheter was sent for bacterial culture. Left tubal thoracostomy was conducted with 16 Fr. pigtail catheter under sonography guided. The pleural effusion was serosanguineous in character and sent for pleural effusion study. Operative Procedures Under endotracheal general anesthesia, the patient was put in supine position. The skin was scrubbed, disinfedcted, and draped as usual. A 1cm transverse skin incision was made over left subclavicular area and the subcutaneous soft tissue was dissected. The pleural catheter was identified and ligated with two 3-0 silk suture. The pleural catheter was transected and sent for bacterial culture. The wound was closed with 3-0 Nylon. The patient was put in semi-sitting position. Under sonography guided, left pleural effusion was localized. The skin was disinfected and draped. One step 16 Fr. pigtail catheter was applied for tubal thoracostomy. One stat suture with 3-0 Nylon was used for wound closure. Operators VS曾勝弘 Assistants R5李振豪, R2俞錫全 相關圖片 徐鵬鎮 (M,2003/07/05,8y8m) 手術日期 2012/02/14 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Moyamoya disease 器械術式 Multiple burr holes (for moyamoya) 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 王奐之, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:00 進入手術室 08:10 麻醉開始 08:50 誘導結束 09:10 抗生素給藥 09:20 手術開始 11:30 開始輸血 12:10 抗生素給藥 13:40 麻醉結束 13:40 手術結束 13:50 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 顱內外血管吻合術 1 1 摘要__ 手術科部: 外科部 套用罐頭: Indirect EC-IC bypass (multiple burr hole pro... 開立醫師: 王奐之 開立時間: 2012/02/14 14:17 Pre-operative Diagnosis Moyamoya disease, status post right side encephaloduromyosynangiosis (EDMS), status post left side encephaloduroarteriosynangiosis (EDAS) Post-operative Diagnosis Moyamoya disease, status post right side encephaloduromyosynangiosis (EDMS), status post left side encephaloduroarteriosynangiosis (EDAS) Operative Method Indirect EC-IC bypass (multiple burr hole procedure) at bilateral frontal area Specimen Count And Types Nil Pathology Nil Operative Findings Moderate adhesion at subdural space was noted (more severe over right side), resulted in easy oozing when dissecting the arachnoid membrane. The brain was slack, easy epidural bleeding was continuous encountered, causing extra efforts in achieving hemostasis. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position. After shaving, scrubbing, disinfection & draping in sterile fashion, a curvilinear bicoronal scalp incision was made. Raney clips were applied to the skin edge for hemostasis. Six V-shaped incision over the pericranium was created, with 3 over each side in symmetric fashion, followed by creation of 6 burr holes. After dural tenting, a triangular durotomy was created, followed by opening of the arachnoid membrane. After meticulous hemostasis, the pericranium was stuffed into the burr hole to allow direct contact with the exposed brain parenchyma and vessels. An anchoring suture was applied to the pericranium. The same procedure was repeated at other five burr holes. The wound was then closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之, Ri 劉傑翹 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Indirect EC-IC bypass (multiple burr hole pro... 開立醫師: 王奐之 開立時間: 2012/02/14 14:17 Pre-operative Diagnosis Moyamoya disease, status post right side encephaloduromyosynangiosis (EDMS), status post left side encephaloduroarteriosynangiosis (EDAS) Post-operative Diagnosis Moyamoya disease, status post right side encephaloduromyosynangiosis (EDMS), status post left side encephaloduroarteriosynangiosis (EDAS) Operative Method Indirect EC-IC bypass (multiple burr hole procedure) at bilateral frontal area Specimen Count And Types Nil Pathology Nil Operative Findings Moderate adhesion at subdural space was noted (more severe over right side), resulted in easy oozing when dissecting the arachnoid membrane. The brain was slack, easy epidural bleeding was continuous encountered, causing extra efforts in achieving hemostasis. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position. After shaving, scrubbing, disinfection & draping in sterile fashion, a curvilinear bicoronal scalp incision was made. Raney clips were applied to the skin edge for hemostasis. Six V-shaped incision over the pericranium was created, with 3 over each side in symmetric fashion, followed by creation of 6 burr holes. After dural tenting, a triangular durotomy was created, followed by opening of the arachnoid membrane. After meticulous hemostasis, the pericranium was stuffed into the burr hole to allow direct contact with the exposed brain parenchyma and vessels. An anchoring suture was applied to the pericranium. The same procedure was repeated at other five burr holes. The wound was then closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之, Ri 劉傑翹 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Indirect EC-IC bypass (multiple burr hole pro... 開立醫師: 郭夢菲 開立時間: 2012/02/14 14:59 Pre-operative Diagnosis Moyamoya disease, status post right side encephaloduromyosynangiosis (EDMS), status post left side encephaloduroarteriosynangiosis (EDAS) Post-operative Diagnosis Moyamoya disease, status post right side encephaloduromyosynangiosis (EDMS), status post left side encephaloduroarteriosynangiosis (EDAS) Operative Method Indirect EC-IC bypass (multiple burr hole procedure) at bilateral frontal area Specimen Count And Types Nil Pathology Nil Operative Findings Marked adhesion at the dura, outer and inner membrane due to previous subdural hematoma was noted at right side. Moderate adhesion at subdural space was also noted at left side. The adhesion resulted in easy oozing when dissecting the arachnoid membrane. The brain was slack, easy epidural bleeding was continuous encountered, causing extra efforts in achieving hemostasis. Operative Procedures After endotracheal general anesthesia, the patient was placed in supine position. After shaving, scrubbing, disinfection & draping in sterile fashion, a curvilinear bicoronal scalp incision was made. Raney clips were applied to the skin edge for hemostasis. Six V-shaped incision over the pericranium based laterrally were created, with 3 over each side in symmetric fashion, followed by creation of 6 burr holes. After dural tenting, a triangular durotomy was created under microscopic view, followed by opening of the arachnoid membrane. After meticulous hemostasis, the pericranium was stuffed into the burr hole to allow direct contact with the exposed brain parenchyma and vessels. An anchoring suture was applied to the pericranium. The same procedure was repeated at other five burr holes. The wound was then closed in layers. Operators AP 郭夢菲 Assistants R4 王奐之, Ri 劉傑翹 相關圖片 陳清文 (M,1950/08/23,61y6m) 手術日期 2012/02/14 手術主治醫師 蔡瑞章 手術區域 東址 001房 04號 診斷 Other cellulitis and abscess, face 器械術式 VP shunt removal 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 4E 紀錄醫師 蔡宗良, 時間資訊 00:00 開始NPO 07:20 通知急診手術 09:00 臨時手術NPO 14:20 報到 15:30 進入手術室 15:35 麻醉開始 15:40 誘導結束 16:15 抗生素給藥 16:23 手術開始 17:00 抗生素給藥 17:15 手術結束 17:15 麻醉結束 17:25 送出病患 17:27 進入恢復室 18:55 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 軟組織良性腫瘤切除術,大或深 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 外科部 套用罐頭: Wound debridement with removal of remnants of... 開立醫師: 李振豪 開立時間: 2012/02/14 17:39 Pre-operative Diagnosis Wound infection with remnants of cystoperitoneal shunt underneath Post-operative Diagnosis Wound infection with remnants of cystoperitoneal cystoperitoneal shunt underneath Operative Method Wound debridement with removal of remnants of cystoperitoneal shunt Specimen Count And Types 1 piece About size:小 Source:SWAB X 2, TIP CULTURE X 1 Pathology None Operative Findings Ventricular end of the cystoperitoneal shunt was retrieved meausuring about 18 cm in length with pus coating and a broken suture at the end. Operative Procedures 1. ETGA, supine, head rotated towards the left 2. Routine preparation 3. Linear skin incision over previous wound 4. Debridement with currette and saline irrigation 5. Removal of the foreign body 6. 7-mm CWV drain placed at the dead-space 7. Wound was closed by single layer of 4-0 Nylon Operators VS 蔡瑞章 Assistants R6 蔡宗良 Indication Of Emergent Operation Local wound infection 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Wound debridement with removal of remnants of... 開立醫師: 李振豪 開立時間: 2012/02/14 17:39 Pre-operative Diagnosis Wound infection with remnants of cystoperitoneal shunt underneath Post-operative Diagnosis Wound infection with remnants of cystoperitoneal cystoperitoneal shunt underneath Operative Method Wound debridement with removal of remnants of cystoperitoneal shunt Specimen Count And Types 1 piece About size:小 Source:SWAB X 2, TIP CULTURE X 1 Pathology None Operative Findings Ventricular end of the cystoperitoneal shunt was retrieved meausuring about 18 cm in length with pus coating and a broken suture at the end. Operative Procedures 1. ETGA, supine, head rotated towards the left 2. Routine preparation 3. Linear skin incision over previous wound 4. Debridement with currette and saline irrigation 5. Removal of the foreign body 6. 7-mm CWV drain placed at the dead-space 7. Wound was closed by single layer of 4-0 Nylon Operators VS 蔡瑞章 Assistants R6 蔡宗良 Indication Of Emergent Operation Local wound infection 相關圖片 蔡阿森 (M,1950/11/13,61y4m) 手術日期 2012/02/15 手術主治醫師 李苑如 手術區域 西址 039房 07號 診斷 Hydronephrosis 器械術式 Removal of double-J 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 14:45 進入手術室 14:48 麻醉開始 14:50 手術開始 14:52 手術結束 14:52 麻醉結束 14:54 送出病患 吳瑋萍 (F,1979/11/08,32y4m) 手術日期 2012/02/16 手術主治醫師 林昌平 手術區域 西址 031房 14號 診斷 Acute lymphoid leukemia 器械術式 IVI 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 謝旻瑾, 時間資訊 15:42 進入手術室 15:44 麻醉開始 15:46 手術開始 15:46 誘導結束 15:50 手術結束 15:50 麻醉結束 15:52 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 玻璃體空氣液體交換術 1 2 B 記錄__ 手術科部: 眼科部 套用罐頭: IVIA 開立醫師: 林昌平 開立時間: 2012/02/16 15:54 Pre-operative Diagnosis Post-operative Diagnosis Ditto Operative Method Intravitreal Injection Of Cymevene(OU) Specimen Count And Types nil Pathology nil Operative Findings nil Operative Procedures 1.Under topical anesthesia. 2.Disinfection and draping as usual. 3.Apply an eyelid speculum. 4.Intravitreal injection of Cymevene 0.05ml 5.Check leakage 6.Iop measurement by digit 7.Check bare VA>ND100cm Operators 林昌平, Assistants 謝旻瑾, 陳天佑 (M,1997/09/18,14y5m) 手術日期 2012/02/16 手術主治醫師 楊士弘 手術區域 東址 005房 01號 診斷 Spine tumor 器械術式 C4, C5 ACDF 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 李宗勳 ASA 2 紀錄醫師 范齡勻, 時間資訊 00:00 臨時手術NPO 07:45 報到 08:05 進入手術室 08:20 麻醉開始 08:30 誘導結束 08:45 抗生素給藥 09:16 手術開始 11:45 抗生素給藥 13:00 手術結束 13:00 麻醉結束 13:12 送出病患 13:15 進入恢復室 14:25 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 椎間盤切除術-頸椎 1 1 手術 脊椎融合術-前融合,有固定物)≦四節 1 2 記錄__ 手術科部: 外科部 套用罐頭: (1) Anterior cervical diskectomy, C3-4, and C3-5 開立醫師: 李振豪 開立時間: 2012/02/16 13:07 Pre-operative Diagnosis (1) Swan neck deformity, cervical spine (2) Cervical spinal cord tumor s/p tumor excision and C3-6 laminoplasty Post-operative Diagnosis (1) Swan neck deformity, cervical spine (2) Cervical spinal cord tumor s/p tumor excision and C3-6 laminoplasty Operative Method (1) Anterior cervical diskectomy, C3-4, and C3-5 (2) Interbody cage fusion, C3-4 and C4-5, with cervical locking plate and screws fixation from C3-5 Specimen Count And Types Nil Pathology Nil Operative Findings Mild kyphotic deformity over C3-5 was noted by C-arm fluoroscopy before operation. The C3-4 and C4-5 disks were elastic and well hydrated. Two 8 mm high PEEK cages filled with autologous cancellous bone graft were impacted into the diskectomy space. One 34 mm long Synthese cervical plate and four 14 mm long screws were used to fixate the C3-4-5. Porper position of the cage and plate/screws were verified by the C-arm fluoroscopy. The kyphotic deformity was further reduced after internal fixation. The SSEP was poor before the operation and no obvious change during whole procedure. Operative Procedures 1. ETGA, supine, neck extended. 2. Transverse skin incision over right anterior neck. 3. Dissection along right SCM muscle to each the prevertebral space. 4. C-arm localization of C4-5 disk space. 5. Anterior cervical diskectomy, C3-4, and C4-5, by knife, currets, disk forceps, under microscope. 6. Harvest of cancellous bone graft from right anterior iliac crest, to fill the center of PEEK cage for fusion. 7. Insertion of interbody PEEK cages into C3-4, C4-5 interspace. 8. Cervical plate and screws fixation from C3-5. 9. One CWV drain. 10. Wound closure in layers. Operators VS楊士弘 Assistants R5李振豪,PGY范齡勻 相關圖片 白彩雪 (F,1939/01/30,73y1m) 手術日期 2012/02/16 手術主治醫師 洪立維 手術區域 東址 022房 03號 診斷 Fracture, femoral neck 器械術式 Hemi..Bipolar /Versys 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉治民 ASA 3 紀錄醫師 傅紹懷, 時間資訊 13:15 報到 13:20 進入手術室 13:30 麻醉開始 13:40 誘導結束 13:40 抗生素給藥 13:50 手術開始 15:00 手術結束 15:00 麻醉結束 15:09 送出病患 15:11 進入恢復室 16:11 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 部份關節置換術併整形術–只置換髖臼或股骨或半股關節或半肩關節 1 1 R 摘要__ 手術科部: 骨科部 套用罐頭: bipolar hemiarthroplasty with Zimmer bipolar ... 開立醫師: 傅紹懷 開立時間: 2012/02/16 14:58 Pre-operative Diagnosis right femoral neck fracture, Garden type 4. Post-operative Diagnosis right femoral neck fracture, Garden type 4. Operative Method bipolar hemiarthroplasty with Zimmer bipolar prosthesis (shell 42mm, head 22+0mm, liner 22mm, and stem #12 ), right Specimen Count And Types nil Pathology nil Operative Findings right femoral neck fracture, displaced. Operative Procedures 1. Anesthesia induction, left decubitus position. 2. Skin disinfection and draped. 3. Longitudinal skin incision then posterior approach of hip. 4. Remove femoral head then prepare the femur with reamer and broach. 5. Insert Zimmer bipolar prosthesis. 6. Irrigate the wound and repair the capsule and short rotators. 7. Close the wound in layers after leave one 1/8 hemovac. Operators 洪立維, Assistants 傅紹懷, 黃偉程, 許寬宏, 記錄__ 手術科部: 骨科部 套用罐頭: bipolar hemiarthroplasty with Zimmer bipolar ... 開立醫師: 傅紹懷 開立時間: 2012/02/16 14:58 Pre-operative Diagnosis right femoral neck fracture, Garden type 4. Post-operative Diagnosis right femoral neck fracture, Garden type 4. Operative Method bipolar hemiarthroplasty with Zimmer bipolar prosthesis (shell 42mm, head 22+0mm, liner 22mm, and stem #12 ), right Specimen Count And Types nil Pathology nil Operative Findings right femoral neck fracture, displaced. Operative Procedures 1. Anesthesia induction, left decubitus position. 2. Skin disinfection and draped. 3. Longitudinal skin incision then posterior approach of hip. 4. Remove femoral head then prepare the femur with reamer and broach. 5. Insert Zimmer bipolar prosthesis. 6. Irrigate the wound and repair the capsule and short rotators. 7. Close the wound in layers after leave one 1/8 hemovac. Operators 洪立維, Assistants 傅紹懷, 黃偉程, 許寬宏, 邱逢琪 (M,1950/08/20,61y6m) 手術日期 2012/02/18 手術主治醫師 蔡瑞章 手術區域 東址 002房 02號 診斷 Brain abscess 器械術式 External ventricular drainage 手術類別 緊急手術 手術部位 頭、頸 傷口分類 污染 麻醉方式 全身麻醉 麻醉主治醫師 林峰盛 ASA 4E 紀錄醫師 蔡宗良, 時間資訊 00:00 開始NPO 09:06 通知急診手術 10:05 報到 10:30 進入手術室 10:35 麻醉開始 10:45 誘導結束 11:08 手術開始 13:00 抗生素給藥 14:00 麻醉結束 14:00 手術結束 14:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 腦瘤切除-手術時間在4小時以內 1 1 L 手術 顱內壓視置入 1 2 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 摘要__ 手術科部: 外科部 套用罐頭: 1. Cranitomy for brain abscess removal 開立醫師: 蔡宗良 開立時間: 2012/02/18 14:58 Pre-operative Diagnosis Brain abscess, parietal lobe, with ventriculitis Post-operative Diagnosis Brain abscess, parietal lobe, with ventriculitis Operative Method 1. Cranitomy for brain abscess removal 2. Ventriculostomy for intracranial pressure monitoring Specimen Count And Types 2 pieces About size:小 Source:brain tissue, R/O tumor About size:小 Source:CSF x 3 Pathology Report pending Operative Findings 1. Skin was well healed 2. Pus coating over the pericranium. 1-cm thick pus coating at the epidural space. The dura was severely adhere to the pus and thus removed. 3. The abscess was yellowish and fragile with no obvious wall 4. CSF: turbid with whitish precipitates Operative Procedures 1. ETGA, Mayfield fixation, prone positioning 2. Routine preparation 3. Wound incision over previous wound 4. Remove central tentings, and wire 5. Skull plate and dura removed 6. Abscess removal with hemostasis 7. Ventriulostomy with 9 cm insertion towards the frontal horn 8. Copious saline irrigation 9. Duraplasty with 4-0 Prolene on the fascia harvested from the pericranium 10. Fixation of EVD 11. Skull plate fixed back to craniotomy window 12. Wound was closed 2-0 Vicryl+ and 3-0 interrupted sutures after placing CWV drain Operators VS 蔡瑞章 Assistants R6 蔡宗良 Indication Of Emergent Operation 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: 1. Cranitomy for brain abscess removal 開立醫師: 蔡宗良 開立時間: 2012/02/18 14:58 Pre-operative Diagnosis Brain abscess, parietal lobe, with ventriculitis Post-operative Diagnosis Brain abscess, parietal lobe, with ventriculitis Operative Method 1. Cranitomy for brain abscess removal 2. Ventriculostomy for intracranial pressure monitoring Specimen Count And Types 2 pieces About size:小 Source:brain tissue, R/O tumor About size:小 Source:CSF x 3 Pathology Report pending Operative Findings 1. Skin was well healed 2. Pus coating over the pericranium. 1-cm thick pus coating at the epidural space. The dura was severely adhere to the pus and thus removed. 3. The abscess was yellowish and fragile with no obvious wall 4. CSF: turbid with whitish precipitates Operative Procedures 1. ETGA, Mayfield fixation, prone positioning 2. Routine preparation 3. Wound incision over previous wound 4. Remove central tentings, and wire 5. Skull plate and dura removed 6. Abscess removal with hemostasis 7. Ventriulostomy with 9 cm insertion towards the frontal horn 8. Copious saline irrigation 9. Duraplasty with 4-0 Prolene on the fascia harvested from the pericranium 10. Fixation of EVD 11. Skull plate fixed back to craniotomy window 12. Wound was closed 2-0 Vicryl+ and 3-0 interrupted sutures after placing CWV drain Operators VS 蔡瑞章 Assistants R6 蔡宗良 Indication Of Emergent Operation increased intracranial pressure 相關圖片 吳瑋萍 (F,1979/11/08,32y4m) 手術日期 2012/02/20 手術主治醫師 林昌平 手術區域 西址 033房 04號 診斷 Acute lymphoid leukemia 器械術式 IVI 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 鄭至豪, 時間資訊 13:45 進入手術室 13:48 麻醉開始 13:50 手術開始 13:53 手術結束 13:56 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 玻璃體空氣液體交換術 1 2 B 記錄__ 手術科部: 眼科部 套用罐頭: IVIA 開立醫師: 鄭至豪 開立時間: 2012/02/20 13:57 Pre-operative Diagnosis ALL Post-operative Diagnosis Ditto Operative Method Intravitreal Injection Of Cymevene(OU) Specimen Count And Types Pathology nil Operative Findings nil Operative Procedures 1.Under topical anesthesia. 2.Disinfection and draping as usual. 3.Apply an eyelid speculum. 4.Intravitreal injection of Cymevene 0.05ml 5.Check leakage 6.Iop measurement by digit 7.Check bare VA>ND100cm Operators 林昌平, Assistants 鄭至豪, 許瓊花 (F,1945/11/02,66y4m) 手術日期 2012/02/20 手術主治醫師 侯君翰 手術區域 東址 001房 02號 診斷 Contusion, thigh 器械術式 Right bipolar hemiarthroplasty 手術類別 緊急手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉漢平 ASA 3 紀錄醫師 黃俊傑, 時間資訊 00:00 開始NPO 00:00 臨時手術NPO 08:00 通知急診手術 10:47 報到 11:20 進入手術室 11:22 麻醉開始 11:27 誘導結束 11:50 抗生素給藥 11:58 手術開始 12:40 開始輸血 13:25 手術結束 13:25 麻醉結束 13:35 送出病患 13:35 進入恢復室 14:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 部份關節置換術併整形術–只置換髖臼或股骨或半股關節或半肩關節 1 1 R 記錄__ 手術科部: 骨科部 套用罐頭: Bipolar hemiarthroplasty 開立醫師: 黃俊傑 開立時間: 2012/02/20 13:13 Pre-operative Diagnosis right femoral neck fracture, Garden type 4. Post-operative Diagnosis right femoral neck fracture, Garden type 4. Operative Method bipolar hemiarthroplasty with Zimmer bipolar prosthesis (cap 44mm, head 28mm, liner, and stem proximal #12 distal 12mm) Specimen Count And Types nil Pathology nil Operative Findings right femoral neck fracture, displaced. Operative Procedures 1. Anesthesia induction, right decubitus position. 2. Skin disinfection and draped. 3. Longitudinal skin incision then posterior approach of hip. 4. Remove femoral head then prepare the femur with reamer and broach. 5. Insert Zimmer Hip System bipolar prosthesis. 6. Irrigate the wound and repair the capsule and short rotators. 7. Close the wound in layers. Operators 侯君翰, Assistants 張允亮, 黃俊傑, Indication Of Emergent Operation nil 張秀英 (F,1970/10/19,41y4m) 手術日期 2012/02/21 手術主治醫師 林文瑛 手術區域 西址 035房 03號 診斷 Malignant neoplasm of trachea 器械術式 Insertion of hichman or port a 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 林文瑛 ASA 3 時間資訊 10:35 進入手術室 10:37 麻醉開始 10:40 誘導結束 10:42 抗生素給藥 10:45 手術開始 11:00 手術結束 11:00 麻醉結束 11:05 送出病患 11:10 進入恢復室 13:35 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 port–A導管植入術–治療性導管植入術 1 0 R 記錄__ 手術科部: 麻醉部 套用罐頭: Port-A implantation, subclavian 開立醫師: 林昱廷 開立時間: 2012/02/21 11:02 Pre-operative Diagnosis lung cancer Post-operative Diagnosis Ditto Operative Method Port-A implantation, echo-guided Specimen Count And Types nil Pathology Nil Operative Findings 1.Site: right subclavian vein, with echo-guided procedure 2.Patent flow after implantation 3.Others: nil Operative Procedures 1.The patient was set on supine position and bilateral subclavian veins were checked by echo. 2.After IVGA and local anesthesia applied, transverse skin incision for 3cm was made at pre-cordial area. 3.Undermine the skin at the layer between subcutaneous tissue and deep fascia in lateral direction. 4.An IV catheter was inserted via the subclavian incision and negatively aspirated until venous blood attainable. 5.J-wire was inserted smoothly in rostral direction. A subclavian catheter with dilator was inserted through the J-wire, and the dilator was then removed. 6.The catheter of Port-A was threaded into the subclavian vein until mark 20 cm. The catheter was adapted into the port and locked with restrictor.The Port was inserted into the pouch of pre-cordial incision. 7.Skin was closed layer by layer. Both catheter and port were perfused with heparin solution after implantation. Operators 林文瑛, Assistants 林昱廷, 許美柑 (F,1951/04/22,60y10m) 手術日期 2012/02/22 手術主治醫師 林文瑛 手術區域 西址 034房 04號 診斷 Lung cancer 器械術式 Remove ""Implant Port"" 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 林文瑛 ASA 3 時間資訊 10:00 報到 11:40 進入手術室 11:45 麻醉開始 11:48 抗生素給藥 11:50 誘導結束 11:57 手術開始 12:30 手術結束 12:30 麻醉結束 12:40 送出病患 12:50 進入恢復室 14:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 皮下肌肉或深部異物取出術 1 1 R 記錄__ 手術科部: 麻醉部 套用罐頭: Port-A remove, GA 開立醫師: 林昱廷 開立時間: 2012/02/22 12:36 Pre-operative Diagnosis LUNG CANCER Post-operative Diagnosis Ditto Operative Method Removal of Port-A Specimen Count And Types nil Pathology Nil Operative Findings Operative Procedures 1.Under IVGA and local anesthesia, skin incision was made along the previous incision site. 2.Uncovered the Port-A, and then removed it. 3.Wash the pouch with normal saline. 4.Subcutaneous and skin suture. Operators 林文瑛, Assistants 林昱廷, 高崇武 (M,1941/02/24,71y0m) 手術日期 2012/02/22 手術主治醫師 郭源松 手術區域 東址 009房 02號 診斷 Fever 器械術式 Debridment 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 3 紀錄醫師 李維棠, 時間資訊 11:55 進入手術室 12:00 麻醉開始 12:05 誘導結束 12:16 手術開始 12:50 手術結束 12:50 麻醉結束 12:55 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 深部傷口處理縫合擴創-大 1 0 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Pressure sore- debridement 開立醫師: 李維棠 開立時間: 2012/02/22 13:11 Pre-operative Diagnosis Sacral pressure sore, Gr II Post-operative Diagnosis Sacral pressure sore, Gr II Operative Method Debridement Specimen Count And Types nil Pathology Nil Operative Findings Multiple Gr II sacral pressure sore with debris noted over sacral area Operative Procedures Under general anesthesia, he lied at right decubitus position. We disinfected and drapped as usual. Debridement was performed and copious normal saline irrigation. After hemostasis, the wound Bosmin gauze wet dressing. Operators VS郭源松 Assistants R3李維棠 Ri蔡欣熹 陳貴昌 (M,1979/08/08,32y7m) 手術日期 2012/02/22 手術主治醫師 曾漢民 手術區域 東址 017房 01號 診斷 Meningioma 器械術式 cranioplasty of left skull bone defect 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 詹偉弘 ASA 2 紀錄醫師 林哲光, 時間資訊 00:00 臨時手術NPO 08:05 進入手術室 08:15 麻醉開始 08:20 誘導結束 08:45 抗生素給藥 09:07 手術開始 11:44 手術結束 11:44 麻醉結束 11:48 送出病患 11:50 進入恢復室 12:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 頭顱成形術 1 1 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 摘要__ 手術科部: 外科部 套用罐頭: Cranioplasty with artificial titanium mesh (B... 開立醫師: 林哲光 開立時間: 2012/02/22 12:08 Pre-operative Diagnosis Left F-T skull bone defect Post-operative Diagnosis Left F-T skull bone defect Operative Method Cranioplasty with artificial titanium mesh (B-Braun) Specimen Count And Types nil Pathology Nil Operative Findings Left F-T skull bone defect was noted and around 9x6 cm sized titanium mesh was shaped as curve and covered at the bony defect and fixed with screws. Operative Procedures Under ETGA and supine position with head rotated to right side, skin disinfected and drapped were performed as usual. Skin incision was made at previous operative wound and the skin flap was deflected to expose the bone edge well. The Titanium mesh was covered at skull bone defect and fixed with screws after multiple central tenting. The wound was then closed in layers after hemostasis and a subgaleal drain insertion. Operators 曾漢民 Assistants 林哲光, 俞錫全 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Cranioplasty with artificial titanium mesh (B... 開立醫師: 林哲光 開立時間: 2012/02/22 12:08 Pre-operative Diagnosis Left F-T skull bone defect Post-operative Diagnosis Left F-T skull bone defect Operative Method Cranioplasty with artificial titanium mesh (B-Braun) Specimen Count And Types nil Pathology Nil Operative Findings Left F-T skull bone defect was noted and around 9x6 cm sized titanium mesh was shaped as curve and covered at the bony defect and fixed with screws. Operative Procedures Under ETGA and supine position with head rotated to right side, skin disinfected and drapped were performed as usual. Skin incision was made at previous operative wound and the skin flap was deflected to expose the bone edge well. The Titanium mesh was covered at skull bone defect and fixed with screws after multiple central tenting. The wound was then closed in layers after hemostasis and a subgaleal drain insertion. Operators 曾漢民 Assistants 林哲光, 俞錫全 相關圖片 黃燦金 (M,1956/02/10,56y1m) 手術日期 2012/02/22 手術主治醫師 林志峰 手術區域 東址 025房 04號 診斷 Oropharyngeal tumor 器械術式 LMS excision 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 詹光政 ASA 2 紀錄醫師 齊凡翔, 時間資訊 13:08 報到 13:20 進入手術室 13:23 麻醉開始 13:26 誘導結束 13:30 手術開始 14:10 手術結束 14:10 麻醉結束 14:17 送出病患 14:20 進入恢復室 15:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 複雜性喉直達鏡並做聲帶式或會厭軟骨腫瘤切除或剝去 1 1 記錄__ 手術科部: 耳鼻喉部 套用罐頭: Laryngomicrosurgery excision of epiglottic tumor 開立醫師: 齊凡翔 開立時間: 2012/02/22 14:28 Pre-operative Diagnosis epiglottic tumor Post-operative Diagnosis epiglottic tumor,operated Operative Method Laryngomicrosurgery excision of epiglottic tumor Specimen Count And Types nil Pathology Pending Operative Findings huge epiglottic tumor status post laryngomicrosurgery Operative Procedures 1.The patient was in supine position. 2.ETGA was performed. 3.Lindholm laryngoscope was applied to expose the laryngeal structure along the trachea tube, and the huge epiglottic tumor was visible. The lewys appartus was attached to support the laryngoscope. 4.Operating microscopy was put into position and biopsy of laryngomicrosurgery excision of epiglottic tumor was performed. 5.Bleeding was little,bosmin-soaked cotton balls was used for hemostasis. 6.2% Xylocaine spray into vocal cord and vallecula toprevent laryngospasm. 6.Removed the laryngoscope smoothly. 7.The patient tolerated the whole procedure well. Operators vs林志峰, Assistants R2齊凡翔, R4周承翰, 賴月嬌 (F,1962/08/23,49y6m) 手術日期 2012/02/23 手術主治醫師 林昌平 手術區域 西址 031房 15號 診斷 Nodular lymphoma, unspecified site, extranodal solid organ sites 器械術式 IVI 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 16:28 進入手術室 16:30 麻醉開始 16:32 手術開始 16:35 手術結束 16:37 送出病患 16:37 麻醉結束 記錄__ 手術科部: 眼科部 套用罐頭: IVIA 開立醫師: 林昌平 開立時間: 2012/02/23 16:39 Pre-operative Diagnosis macular edema Post-operative Diagnosis Ditto Operative Method Intravitreal Injection Of MTX(OU) Specimen Count And Types nil Pathology nil Operative Findings nil Operative Procedures 1.Under topical anesthesia. 2.Disinfection and draping as usual. 3.Apply an eyelid speculum. 4.Intravitreal injection of MTX 0.05ml 5.Check leakage 6.Iop measurement by digit 7.Check bare VA>ND100cm Operators 林昌平, Assistants 許詠瑞, 范秀華 (F,1961/10/10,50y5m) 手術日期 2012/02/23 手術主治醫師 陳晉興 手術區域 東址 017房 02號 診斷 Malignant neoplasm of trachea 器械術式 VATS RLL lobectomy 手術類別 預定手術 手術部位 胸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 鄭雅蓉 ASA 3 紀錄醫師 高明蔚, 時間資訊 09:50 報到 10:30 進入手術室 10:35 麻醉開始 11:35 抗生素給藥 11:40 誘導結束 12:00 手術開始 15:00 抗生素給藥 16:05 麻醉結束 16:05 手術結束 16:35 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 根除性淋巴切除術(肺葉切除或全肺切除時) 1 2 手術 胸腔鏡肺葉切除術 1 1 R 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 記錄__ 手術科部: 外科部 套用罐頭: VATS right lower lobectomy and lymph node dis... 開立醫師: 高明蔚 開立時間: 2012/02/23 16:22 Pre-operative Diagnosis Right lower lobe adenocarcinoma, with bain metastasis, s/p craniotomy tumor excision, under traget therapy Post-operative Diagnosis Right lower lobe adenocarcinoma, with bain metastasis, s/p craniotomy tumor excision, under traget therapy Operative Method VATS right lower lobectomy and lymph node dissection Specimen Count And Types 4 pieces: RLL, Gr.3/4, 7, 11 LNs Pathology Pending Operative Findings Severe adhesion was noted over whole right pleural cavity. One about 2.5cm irregular firm mass was noted over RLL, B6 segment. Enlarged pretracheal and subcarinal LNs were also noted. Operative Procedures ETGA blocker, left lateral decubitus, skin disinfection and draping as usual. VATS setting. Adhesiolysis. Open fissure and pleura. Divide fissure. Divide PA branches -> PV -> bronchus. Saline irrigation, hemostasis, set Fr.28 chest tube and close the wounds. Operators 陳晉興, 徐紹勛 Assistants R4高明蔚, Ri陳子堯 王思茹 (F,1980/05/16,31y9m) 手術日期 2012/02/23 手術主治醫師 楊政憲 手術區域 產房 090房 02號 診斷 Uterine myoma 器械術式 Hysteroscopic Dr-Yang 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 面罩麻醉 麻醉主治醫師 蔡奉芳 ASA 2 時間資訊 08:00 報到 09:00 進入手術室 09:05 麻醉開始 09:10 誘導結束 09:15 抗生素給藥 09:20 手術開始 10:10 手術結束 10:10 麻醉結束 10:15 送出病患 10:20 進入恢復室 13:00 離開恢復室 記錄__ 手術科部: 婦產部 套用罐頭: Hysteroscopic myomectomy. 開立醫師: 陳瓏仁 開立時間: 2012/02/23 10:23 Pre-operative Diagnosis Submucosal myoma. Post-operative Diagnosis Submucosal myoma. Operative Method Hysteroscopic myomectomy. Specimen Count And Types 1 piece, about size: 1.5*1.5 cm, 10 g, source: uterine myoma. Pathology Pending. Operative Findings 1. Several submucosal myoma, occupying the uterine cavity. 2. Bilateral ostium: seemed patent. 3. Usage of dextrose water: 2600 ml. 4. Estimated blood loss: 20 ml; Blood Transfusion: nil; Complication: nil. Operative Procedures 1. Put the patient on lithotomy position. 2. Skin disinfection and skin draping as usual. 3. Vaginal douching. 4. Insert hysteroscope. 5. Exam the whole uterine cavity and identify the myomata. 6. Resection of the myomata by electrocauterization. 7. Check bleeding and hemostasis. 8. Insert one piece of vaginal gauze. Operators 楊政憲 Assistants R4烏恩慈 吳瑋萍 (F,1979/11/08,32y4m) 手術日期 2012/02/23 手術主治醫師 林昌平 手術區域 西址 031房 09號 診斷 Acute lymphoid leukemia 器械術式 IVI 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 許詠瑞, 時間資訊 15:11 進入手術室 15:12 麻醉開始 15:13 手術開始 15:15 手術結束 15:17 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 玻璃體空氣液體交換術 1 2 B 記錄__ 手術科部: 眼科部 套用罐頭: IVIA 開立醫師: 許詠瑞 開立時間: 2012/02/23 15:20 Pre-operative Diagnosis CMV(OU) Post-operative Diagnosis Ditto Operative Method Intravitreal Injection Of Cymevene(OU)) Specimen Count And Types nil Pathology nil Operative Findings nil Operative Procedures 1.Under topical anesthesia. 2.Disinfection and draping as usual. 3.Apply an eyelid speculum. 4.Intravitreal injection of Cymevene 0.05ml 5.Check leakage 6.Iop measurement by digit 7.Check bare VA>ND100cm Operators 林昌平, Assistants 許詠瑞, 廖接宇 (M,1959/03/25,52y11m) 手術日期 2012/02/23 手術主治醫師 戴浩志 手術區域 西址 030房 06號 診斷 Maxilla fracture 器械術式 Excision of subcutaneous tumor 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 15:15 進入手術室 15:20 麻醉開始 15:23 手術開始 15:35 手術結束 15:35 麻醉結束 15:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 骨外固定器取除術 1 0 記錄__ 手術科部: 外科部 套用罐頭: REmove arch bars 開立醫師: 阮廷倫 開立時間: 2012/02/23 15:39 Pre-operative Diagnosis Mandible fracture, s/p ORIF + IMF Post-operative Diagnosis Mandible fracture, s/p ORIF + IMF Operative Method REmove arch bars Specimen Count And Types Nil Pathology Nil Operative Findings s/p arch bars insertion Operative Procedures The patient was put in supine position. After skin disinfection and draped, nerve block was given. The arch bars were removed. Operators VS戴浩志 Assistants R6阮廷倫 韓其芳 (M,1965/02/01,47y1m) 手術日期 2012/02/24 手術主治醫師 戴槐青 手術區域 西址 039房 08號 診斷 Malignant neoplasm of kidney, except pelvis 器械術式 Removal of double-J 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 10:00 報到 10:33 進入手術室 10:35 麻醉開始 10:38 手術開始 10:41 手術結束 10:43 送出病患 陳洪絹 (F,1941/02/10,71y1m) 手術日期 2012/02/25 手術主治醫師 陳晉興 手術區域 心血管 052房 03號 診斷 Lung cancer 器械術式 Port-A catheter implatation 手術類別 預定手術 手術部位 胸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 吳健暉, 時間資訊 13:05 進入手術室 13:19 麻醉開始 13:21 手術開始 13:21 誘導結束 13:58 手術結束 13:58 麻醉結束 14:05 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 皮下肌肉或深部異物取出術 1 1 R 記錄__ 手術科部: 外科部 套用罐頭: Removal of port-A 開立醫師: 吳健暉 開立時間: 2012/02/25 14:02 Pre-operative Diagnosis lung cancer s/p port-A insertion Post-operative Diagnosis lung cancer s/p removal of port-A Operative Method Port-A catheter Removal Specimen Count And Types nil Pathology Nil Operative Findings The catheter was removed totally and the course was smooth Operative Procedures 1. Local anesthesia, supine position. 2. Skin disinfection. 3. An incision was made over previous scar. 4. Dissect the port-A catheter and port from fascia with eletrocautery knife. 5. Remove port-A set. A suture with 3-0 Dexon was doneto seal the catheter tunnel. 6. Hemostasis. 7. Close wounds in layers with 3-0 Dexon, 4-0 Dexon. Operators 陳晉興 Assistants 吳健暉 相關圖片 陳清文 (M,1950/08/23,61y6m) 手術日期 2012/02/25 手術主治醫師 蔡瑞章 手術區域 東址 005房 01號 診斷 Other cellulitis and abscess, face 器械術式 Debridment-- 5-10cm 手術類別 預定手術 手術部位 胸 傷口分類 污染 麻醉方式 全身麻醉 麻醉主治醫師 林文瑛 ASA 3 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 08:55 報到 09:05 進入手術室 09:10 麻醉開始 09:30 誘導結束 10:04 手術開始 11:20 麻醉結束 11:20 手術結束 11:35 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 Lactic Acid (lactate) 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 手術 深部傷口處理縫合擴創-中 1 0 記錄__ 手術科部: 外科部 套用罐頭: Debridement and residual shunt tube removal 開立醫師: 陳國瑋 開立時間: 2012/02/25 11:27 Pre-operative Diagnosis VP shunt infection Post-operative Diagnosis VP shunt infection Operative Method Debridement and residual shunt tube removal Specimen Count And Types 2 pieces About size:7cm Source:shunt peritoneal tip About size:pus Source:right anterior chest wall pus discharge Pathology Nil Operative Findings One chamber at right anterior chest wall was noted and filled with pus. The cathter from the chamber to the intraperitoneal portion was removed. Operative Procedures After ETGA, the patient was put in supine position. The skin was prepared as ususal. One transvers skin incision at previous wound of the abdomen was made. The intraperitoneal catheter was removed and debridement was done. Another transverse skin incision of the right anterior chest wall was done and the chamber was removed. Culture was sent. The wound was then closed in layers. Operators Prof. 蔡瑞章 Assistants 鍾文桂 陳國瑋 相關圖片 賴月嬌 (F,1962/08/23,49y6m) 手術日期 2012/02/27 手術主治醫師 林昌平 手術區域 西址 032房 03號 診斷 Nodular lymphoma, unspecified site, extranodal solid organ sites 器械術式 IVI 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 14:13 進入手術室 14:13 麻醉開始 14:15 誘導結束 14:20 手術開始 14:24 手術結束 14:25 送出病患 記錄__ 手術科部: 眼科部 套用罐頭: IVIA 開立醫師: 林昌平 開立時間: 2012/02/27 14:19 Pre-operative Diagnosis Lyphoma Post-operative Diagnosis Ditto Operative Method Intravitreal Injection Of MTX(OU) Specimen Count And Types nil Pathology nil Operative Findings nil Operative Procedures 1.Under topical anesthesia. 2.Disinfection and draping as usual. 3.Apply an eyelid speculum. 4.Intravitreal injection of MTX 0.05ml 5.Check leakage 6.Iop measurement by digit 7.Check bare VA>ND100cm Operators 林昌平, Assistants 鄭至豪, 馬景鵬 (M,1958/12/13,53y3m) 手術日期 2012/02/27 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Lumbar Spondylosis 器械術式 L4-5 microdiscectomy 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3 紀錄醫師 陳國瑋, 時間資訊 00:00 臨時手術NPO 07:58 進入手術室 08:15 麻醉開始 08:35 誘導結束 09:00 抗生素給藥 09:09 手術開始 11:55 手術結束 11:55 麻醉結束 12:00 抗生素給藥 12:05 送出病患 12:13 進入恢復室 13:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 椎間盤切除術-腰椎 1 1 R 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 摘要__ 手術科部: 外科部 套用罐頭: L4/5 microdiskectomy and L5/S1 epidural hemat... 開立醫師: 陳國瑋 開立時間: 2012/02/27 11:50 Pre-operative Diagnosis L4/5 L5/S1 HIVD Post-operative Diagnosis L4/5 herniated intervertebral disc, L5/S1 epidural hematoma 1.L4/5 herniated intervertebral disc. 2.L5/S1 epidural hematoma Operative Method L4/5 microdiskectomy and L5/S1 epidural hematoma evacuation, right side approach. Specimen Count And Types nil Pathology nil Operative Findings 1. Unstable L4/5 facet joint, right before decompression. 2. Stenosis over L4/5 level with severe adhesion of epidural scar tissue to dura mater. Intact dura mater during decompression. The L4/5 disc was removed for decompression. 3. Epidural hematoma was noted after laminotomy. The S1 root was slack after decompression. 3. Coflex was kept intact during decompression. Operative Procedures Under ETGA the patient was placed in prone position. After disinfection and draping, the previous operative wound was incised and dissected. The L4 laminotomy was achieved and L4/5 diskectomy was performed. Later, L5 laminotomy was obtained. dark liquified hematoma drained out in the epidural space. After further decompression by removal of hypertrophic ligamentum flavum, the wound was closed in layers. Operators 賴達明 Assistants 鍾文桂 陳國瑋 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: L4/5 microdiskectomy and L5/S1 epidural hemat... 開立醫師: 陳國瑋 開立時間: 2012/02/27 12:13 Pre-operative Diagnosis L4/5 L5/S1 HIVD Post-operative Diagnosis 1.L4/5 herniated intervertebral disc. 2.L5/S1 epidural hematoma Operative Method L4/5 microdiskectomy and L5/S1 epidural hematoma evacuation, right side approach. Specimen Count And Types nil Pathology nil Operative Findings 1. Unstable L4/5 facet joint, right before decompression. 2. Stenosis over L4/5 level with severe adhesion of epidural scar tissue to dura mater. Intact dura mater during decompression. The L4/5 disc was removed for decompression. 3. Epidural hematoma was noted after laminotomy. The S1 root was slack after decompression. 3. Coflex was kept intact during decompression. Operative Procedures Under ETGA the patient was placed in prone position. After disinfection and draping, the previous operative wound was incised and dissected. The L4 laminotomy was achieved and L4/5 diskectomy was performed. Later, L5 laminotomy was obtained. dark liquified hematoma drained out in the epidural space. After further decompression by removal of hypertrophic ligamentum flavum, the wound was closed in layers. Operators 賴達明 Assistants 鍾文桂 陳國瑋 相關圖片 吳瑋萍 (F,1979/11/08,32y4m) 手術日期 2012/02/27 手術主治醫師 林昌平 手術區域 西址 032房 15號 診斷 Acute lymphoid leukemia 器械術式 IVI 手術類別 臨時手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 鄭至豪, 時間資訊 16:00 報到 16:23 進入手術室 16:25 麻醉開始 16:27 手術開始 16:36 麻醉結束 16:36 手術結束 16:40 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 玻璃體空氣液體交換術 1 2 B 記錄__ 手術科部: 眼科部 套用罐頭: IVIA 開立醫師: 林昌平 開立時間: 2012/02/27 16:32 Pre-operative Diagnosis CMV Post-operative Diagnosis Ditto Operative Method Intravitreal Injection Of Cymevene(OU) Specimen Count And Types nil Pathology nil Operative Findings nil Operative Procedures 1.Under topical anesthesia. 2.Disinfection and draping as usual. 3.Apply an eyelid speculum. 4.Intravitreal injection of Cymevene 0.05ml 5.Check leakage 6.Iop measurement by digit 7.Check bare VA>ND100cm Operators 林昌平, Assistants 鄭至豪, 陳怡理 (F,2000/08/27,11y6m) 手術日期 2012/02/29 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Brain tumors, malignant 器械術式 Endoscopic left frontal cyst fenestration 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 曾偉倫, 時間資訊 00:00 臨時手術NPO 07:46 報到 08:03 進入手術室 08:10 麻醉開始 08:20 誘導結束 08:30 抗生素給藥 09:10 手術開始 10:35 麻醉結束 10:35 手術結束 10:45 送出病患 醫令資訊 類別 名稱 量 刀 側 麻醉 Peripheral arterial line inserti 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 腦組織活體切片 1 1 手術 顱內壓視置入 1 2 手術 腦內視鏡 1 0 記錄__ 手術科部: 外科部 套用罐頭: Endoscopic left frontal cyst fenestration via... 開立醫師: 曾偉倫 開立時間: 2012/02/29 11:17 Pre-operative Diagnosis 1. A cyst-like lesion in the left lateral ventricle 1. Left optic pathway hypothalamic diffuse astrocytoma(WHO grade II) with cystic degeneration and protrusion into left frontal horn 2. Left optic pathway diffuse astrocytoma(World Health Organization grade II) Post-operative Diagnosis 1. A cyst-like lesion in the left lateral ventricle 1. Left optic pathway hypothalamic diffuse astrocytoma(WHO grade II) with cystic degeneration and protrusion into left frontal horn 2. Left optic pathway diffuse astrocytoma(World Health Organization grade II) Operative Method Endoscopic left frontal cyst fenestration via left Kochers burr-hole + EVD insertion Endoscopic left frontal cyst fenestration via left Kochers burr-hole + EVD insertion for ICP monitoring Specimen Count And Types nil Pathology Nil. Operative Findings 1. A 4x3x3 cm cystic lesion with thin wall. Clear watery fluid was found within the cyst. Three fenestrations were made and the cyst collapsed after fenestration 1. A 4x3x3 cm cystic lesion with thin wall on the medial and thicker on the outer walls. Clear watery fluid was found within the cyst. Three fenestrations were made and the cyst collapsed after fenestration. 2. The left lateral ventricle was entered and the thalamostriate vein, foramen Monro and choroid plexus were identified. Some hemosiderin deposition over the medial side of the lateral ventricle. 2. The left lateral ventricle was entered and the thalamostriate vein, foramen Monro and choroid plexus were identified. Diffuse hemosiderin deposition over the lateral ventricular walls and the tumor under due to previous hemorrhage was noted. 3. The ventriclar catheter is 5.5 cm Operative Procedures Under ETGA, we placed the patient on supine position with her face tilt to right. We scrubbed, disinfected and drapped as usual and a linear skin incision was made abover the left kochers point. The wound was opened in layers and a burr-hole was made with air-drived drill. The bleeders were stopped by the bipolar forceps and the durotomy was made. A ventricular puncture needle was used for ventriculostomy via left Kochers point. The endoscope was placed through the previous puncture tract and the left lateral ventricle was entered. The fenestration was made with unipolar cauterization and Fogarty catheter. An EVD was placed through the tract and the wound was closed in layers. Under ETGA, we placed the patient on supine position in neutral position. We scrubbed, disinfected and drapped as usual and a linear skin incision was made abover the left kochers point. The wound was opened in layers and a burr-hole was made with air-drived drill. The bleeders were stopped by the bipolar forceps and the durotomy was made. A ventricular puncture needle was used for ventriculostomy via left Kochers point. The endoscope was placed through the previous puncture tract and the left lateral ventricle was entered. The fenestration was made with unipolar cauterization and then 3-Fr. Fogarty catheter. An EVD was placed through the tract and the wound was closed in layers after degassing. Operators VS 郭夢菲 Assistants R3 曾偉倫 Ri 賴彥玲 相關圖片 吳順吉 (M,2009/11/02,2y4m) 手術日期 2012/02/29 手術主治醫師 許文明 手術區域 兒醫 062房 04號 診斷 Tetralogy of Fallot (TOF) 器械術式 stoma closure 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 林子富 ASA 3 紀錄醫師 游皓鈞, 時間資訊 13:10 報到 13:15 進入手術室 13:25 麻醉開始 14:45 誘導結束 15:00 抗生素給藥 15:03 手術開始 17:05 麻醉結束 17:05 手術結束 17:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 經由剖腹術行小腸或結腸造廔管關閉及吻合 1 1 L 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 3 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 1 0 麻醉 Hemoglobin (Hb) 1 0 麻醉 測血糖 1 0 麻醉 Ca (Calcium) 1 0 麻醉 Na (Sodium) 1 0 麻醉 K (Potassium) 1 0 麻醉 Blood gas analysis 1 0 記錄__ 手術科部: 套用罐頭: Closurse of D-colostomy with end-to-end anast... 開立醫師: 游皓鈞 開立時間: 2012/02/29 17:15 Pre-operative Diagnosis Imperforate anus status post D-colostomy Post-operative Diagnosis Imperforate anus status post D-colostomy Operative Method Closurse of D-colostomy with end-to-end anastomosis Specimen Count And Types 1 piece About size:3*3 cm Source:D-colon stoma Pathology pending Operative Findings 1. One stoma was located at LLQ abdomen, proximal end was at distal descending colon, distal end was at proximal sigmoid colon. 2. One small bowel was adhesive to the stoma and was divided without injury. Operative Procedures 1. ETGA, supine position 2. Disinfection of abdomen and drapping 3. Suture ligation of opening of colostomy 4. Fusiform incision made along the stoma 5. Divided the stoma from the abdominal wall to mobilize the stoma 6. Transected the stoma 7. Performed end-to-end anastomosis of colon 8. Checked bleeding 9. Closed the wound in layers Operators VS許文明 Assistants F2柯柏瑞, R2游皓鈞 周美俐 (F,1951/12/10,60y3m) 手術日期 2012/02/29 手術主治醫師 楊榮森 手術區域 東址 020房 02號 診斷 Breast cancer, female 器械術式 ORIF - Large A-O plate, tumor curretage 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 2 紀錄醫師 黃志逢, 時間資訊 09:15 報到 09:20 進入手術室 09:25 麻醉開始 09:30 誘導結束 09:31 抗生素給藥 09:51 手術開始 10:55 手術結束 10:55 麻醉結束 11:00 送出病患 11:05 進入恢復室 12:15 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 惡性骨瘤廣泛切除(一次) 1 1 L 手術 開放性或閉鎖性肱骨粗隆或骨幹或踝部骨折,開放性復位術 1 2 L 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 摘要__ 手術科部: 骨科部 套用罐頭: Benign bone tumor, curettage and bone graft 開立醫師: 黃志逢 開立時間: 2012/02/29 10:46 Pre-operative Diagnosis left proximal humerus impending pathologic fracture Post-operative Diagnosis left proximal humerus impending pathologic fracture post tumor curettage and ORIF with clover leaf plate and screws*7 with cement. Operative Method tumor curettage and ORIF with clover leaf plate and screws*7 with cement. Specimen Count And Types 1 piece About size:few debris Source:left proximal humerus Pathology pending Operative Findings many fragile yellowish tumor tissue was removed Operative Procedures 1.under anesthesia,patient was put in semi-sitting position 2.Skin prepare and drap as routine 3.Set arm board,lateral approach around 10cm 4.deepen to lesion site,preserve axillary nerve3 5.Intralesional injected alcohol 35ml;tumor curettage and ORIF with clover leaf plate and screws*7 with cement were done step by step 6.Irrigation,hemostasis and close wound by layers 7.Fix one h/v,applied sling Operators 楊榮森, Assistants 黃志逢, 林家聖, 黃哲南, 記錄__ 手術科部: 骨科部 套用罐頭: Benign bone tumor, curettage and bone graft 開立醫師: 黃志逢 開立時間: 2012/02/29 10:48 Pre-operative Diagnosis left proximal humerus impending pathologic fracture Post-operative Diagnosis left proximal humerus impending pathologic fracture post tumor curettage and ORIF with clover leaf plate and screws*7 with cement. Operative Method tumor curettage and ORIF with clover leaf plate and screws*7 with cement. Specimen Count And Types 1 piece About size:few debris Source:left proximal humerus Pathology pending Operative Findings many fragile yellowish tumor tissue was removed Operative Procedures 1.under anesthesia,patient was put in semi-sitting position 2.Skin prepare and drap as routine 3.Set arm board,lateral approach around 10cm 4.deepen to lesion site,preserve axillary nerve3 5.Intralesional injected alcohol 35ml;tumor curettage and ORIF with clover leaf plate and screws*7 with cement were done step by step 6.Irrigation,hemostasis and close wound by layers 7.Fix one h/v,applied sling Operators 楊榮森, Assistants 黃志逢, 林家聖, 黃哲南, 賴月嬌 (F,1962/08/23,49y6m) 手術日期 2012/03/01 手術主治醫師 林昌平 手術區域 西址 031房 16號 診斷 Nodular lymphoma, unspecified site, extranodal solid organ sites 器械術式 IVI 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 15:54 進入手術室 15:55 麻醉開始 15:56 手術開始 16:00 手術結束 16:02 送出病患 記錄__ 手術科部: 眼科部 套用罐頭: IVIA 開立醫師: 林昌平 開立時間: 2012/03/01 15:58 Pre-operative Diagnosis macular edema Post-operative Diagnosis Ditto Operative Method Intravitreal Injection Of MTX(OU) Specimen Count And Types nil Pathology nil Operative Findings nil Operative Procedures 1.Under topical anesthesia. 2.Disinfection and draping as usual. 3.Apply an eyelid speculum. 4.Intravitreal injection of MTX 0.05ml 5.Check leakage 6.Iop measurement by digit 7.Check bare VA>ND100cm Operators 林昌平, Assistants 謝旻瑾, 吳瑋萍 (F,1979/11/08,32y4m) 手術日期 2012/03/01 手術主治醫師 林昌平 手術區域 西址 031房 14號 診斷 Acute lymphoid leukemia 器械術式 IVI 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 謝旻瑾, 時間資訊 15:26 進入手術室 15:27 麻醉開始 15:28 手術開始 15:32 手術結束 15:32 麻醉結束 15:34 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 玻璃體空氣液體交換術 1 2 B 記錄__ 手術科部: 眼科部 套用罐頭: IVIA 開立醫師: 林昌平 開立時間: 2012/03/01 15:34 Pre-operative Diagnosis CMV(OU) Post-operative Diagnosis Ditto Operative Method Intravitreal Injection Of Cymevene(OU) Specimen Count And Types nil Pathology nil Operative Findings nil Operative Procedures 1.Under topical anesthesia. 2.Disinfection and draping as usual. 3.Apply an eyelid speculum. 4.Intravitreal injection of Cymevene 0.05ml 5.Check leakage 6.Iop measurement by digit 7.Check bare VA>ND100cm Operators 林昌平, Assistants 謝旻瑾, 陳王勉 (F,1939/04/12,72y11m) 手術日期 2012/03/02 手術主治醫師 何子昌 手術區域 東址 010房 01號 診斷 Cataract 器械術式 Phaco+PCIOL 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 08:23 進入手術室 08:50 手術開始 09:05 手術結束 09:10 送出病患 記錄__ 手術科部: 眼科部 套用罐頭: Phaco-Superior (何子昌) 開立醫師: 高姿芸 開立時間: 2012/03/02 09:07 Pre-operative Diagnosis Cataract (od ) Post-operative Diagnosis Cataract (od ) Operative Method Phacoemulsification and PCIOL implantation (od ) Specimen Count And Types Pathology Nil Operative Findings Cataract (od ) Operative Procedures 1. Under peribulbar anesthesia 2. Disinfection, irrigation and draping 3. Application of eyelid speculum 4. Made a sideport at 3 oclock position with the MVR blade 5. Inject Viscoat into the anterior chamber 6. Made a clear corneal incision and penetrate into AC with 2.5mm trapezoid knife at 11 oclock position 7. Continuous circular capsulorrhexis was done with bent needle and capsular forceps 8. Hydrodissection and hydrodelineation were done with BSS 9. Phacoemulsification of the nucleus by standard divide-and-conquer technique 10. Aspiration of the residual cortical material with I/A tube 11. Foldable PCIOL was implanted into the bag after injection of Healon 12. The residual Healon was washed outbySimcoe I/A cannula 13. Inject BSS into AC and check leakage, and inject Miostat to AC to constrict the pupil 14. Stromal hydration of the wound with BSS 16. Subconjunctival injection of Rinderon and Gentamycin 17. Lactycin patching Operators 何子昌, Assistants 高姿芸, 吳郁芊, 劉維哲 (M,2010/09/02,1y6m) 手術日期 2012/03/02 手術主治醫師 郭夢菲 手術區域 兒醫 069房 02號 診斷 Obstructive hydrocephalus 器械術式 Revision of CSF shunt, left 手術類別 緊急手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 蔡奉芳 ASA 3E 紀錄醫師 游健生, 時間資訊 03:00 臨時手術NPO 03:00 開始NPO 08:33 通知急診手術 09:45 進入手術室 09:50 麻醉開始 10:00 誘導結束 10:20 抗生素給藥 10:44 手術開始 11:27 麻醉結束 11:27 手術結束 11:37 送出病患 11:40 進入恢復室 12:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 Peripheral arterial line inserti 1 0 手術 腦脊髓液分流管重置 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Add on programmable VP shunt valve, left 開立醫師: 游健生 開立時間: 2012/03/02 12:01 Pre-operative Diagnosis Slit ventricle syndrome Post-operative Diagnosis Slit ventricle syndrome Operative Method Add on programmable VP shunt valve, left Specimen Count And Types nil Pathology Nil Operative Findings Clear CSF was drained after cutting the peritoneal catheter at proximal end. A pro-GAV programmable shunt valve was added distal to medium pressure VP shunt valve. The pressure was set at 12cmH2O. Operative Procedures Under ETGA, patient was in supine position with head rotated to right. After shaving, we disinfected and draped the operation field as usual. A curved scalp incision was made along previous operation wound scar at left Kocher region. We elevated the scalp flap and exposed the VP shunt valve and proximal end of peritoneal catheter. We cut the proximal end and connected it to pro-GAV programable shunt valve. Then, the shunt valve was connected to previous VP shunt valve. After hemostasis, wound was closed in layers with 4-0 Vicryl and 4-0 Nylon. Operators VS 郭夢菲 Assistants R4 游健生 Ri 賴彥伶 Indication Of Emergent Operation suspect intracranial hypotension 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Add on programmable VP shunt valve, left 開立醫師: 郭夢菲 開立時間: 2012/03/02 14:45 Pre-operative Diagnosis Slit ventricle syndrome Post-operative Diagnosis Slit ventricle syndrome Operative Method VP shunt revision by add-on a programmable valve, left Specimen Count And Types nil Pathology Nil Operative Findings Clear CSF was drained after cutting the peritoneal catheter at proximal end. A B. Braun pro-GAV programmable shunt valve was added distal to the Metronic medium pressure valve. The pressure was set at 12cmH2O. Operative Procedures Under ETGA, patient was in supine position with head rotated to right. After shaving, we disinfected and draped the operation field as usual. A curved scalp incision was made along previous operation wound scar at left Kocher region. We elevated the scalp flap and exposed the VP shunt valve and proximal end of peritoneal catheter. We cut the proximal end and connected it to pro-GAV programable shunt valve. Then, the shunt valve was connected to previous VP shunt valve. After hemostasis, wound was closed in layers with 4-0 Vicryl and 4-0 Nylon. Operators VS 郭夢菲 Assistants R4 游健生 Ri 賴彥伶 Indication Of Emergent Operation suspect intracranial hypotension suspect slit ventricle syndrome causing repeated vomiting 相關圖片 邱美嬌 (F,1961/02/21,51y0m) 手術日期 2012/03/05 手術主治醫師 童寶玲 手術區域 兒醫 063房 01號 診斷 Uterine myoma 器械術式 LSC LSO(SILS) 手術類別 預定手術 手術部位 腹 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 蔡奉芳 ASA 3 紀錄醫師 吳晉睿, 時間資訊 07:22 報到 08:03 進入手術室 08:15 麻醉開始 08:20 誘導結束 08:30 抗生素給藥 08:35 手術開始 09:45 手術結束 09:45 麻醉結束 09:50 送出病患 10:00 進入恢復室 11:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 腹腔鏡子宮附屬器部份或全部切除術 1 1 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 婦產部 套用罐頭: LSC BSO (single port) 開立醫師: 吳晉睿 開立時間: 2012/03/05 09:58 Pre-operative Diagnosis Left ovarian tumor Post-operative Diagnosis Left ovarian tumor Operative Method Laparoscopic left salpingo-oophorectomy (SILS) Specimen Count And Types 1 piece About size:10*10 Source:Ovarian cyst Pathology Pending Operative Findings 1. Uterus: Avfl, grossly normal. 2. LAD: one 10*8*8 cm cystic lesion in the left ovary with mucinous fluid content. 3. RAD: grossly normal. 4. CDS: no adhesion. 5. Estimated blood loss: 20 ml. Blood transfusion: nil Complication: nil Operative Procedures 1. Put the patient on the lithotomy position. 2. Vaginal douching with beta-iodine. 3. Skin disinfection with beta-iodine and skin draping as usual, then insert the Foley catheter and uterus elevator. 4. Make a 2cm skin incision at the umbilicus 5. open the abdominal wall layer by layer 6. Insert single port equipment and 1st(10mm), 2nd (5mm) and 3rd (5mm) trocar 7. make pneumoperitoneum 8. Isolate bilateral infundibulo-pelvic ligament. 9. Electrocauterize and cut left infundibulo-pelvic ligament. 10. Electroacuterization and cut left ovarian ligaments and oviducts 11. Remove the specimen from the abdominal wound. 12. Check bleeding and hemostasis with electrocoagulation. 13. Remove trocars and repair abdominal incision wound. Operators 童寶玲, Assistants 劉惠珊, 相關圖片 謝美雪 (F,1947/09/02,64y6m) 手術日期 2012/03/05 手術主治醫師 杜永光 手術區域 東址 007房 02號 診斷 Meningioma 器械術式 V-P shunt 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3 紀錄醫師 游健生, 時間資訊 00:00 臨時手術NPO 11:00 報到 11:58 進入手術室 12:00 麻醉開始 12:10 誘導結束 12:45 抗生素給藥 13:32 手術開始 14:55 手術結束 14:55 麻醉結束 15:05 送出病患 15:10 進入恢復室 16:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 2 0 手術 腦室腹腔分流手術 1 1 L 摘要__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt, left Kocher, medi... 開立醫師: 游健生 開立時間: 2012/03/05 15:20 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunt, left Kocher, medium pressure Specimen Count And Types 1 piece About size:3cc Source:CSF Pathology Nil Operative Findings Clear CSF gushed out after ventriculostomy. The opening pressure was about 10cmH2O. The ventricle catheter was 7cm in length and peritoneal catheter was about 25cm. A Medtronic medium-pressure shunt valve was used. Operative Procedures Under ETGA, patient was in supine position with head rotated to right and left shoulder elevated. After shaving, we disinfected and draped the operation field as usual. A curved scalp incision was made at left Kocher region. After elevated the scalp flap, a burhole was made followed by dura tenting. A cruciated durotomy was made followed by coagulation. We made a ventriculostomy and inserted a ventricle catheter. A LUQ abdominal incision was made followed by dissection. After opening the peritoneum, a peritoneal catheter was inserted into peritoneal cavity. Its proximal end was passed upward to left parietal region via a subcutaneous tract. A stab wound was created as re-lay point. The VP shunt was assembled to Medtronic medium pressure shunt valve. After hemostasis, wounds were closed in layers. Operators Prof. 杜永光 Assistants R6鍾文桂 R4游健生 PGY白晏瑋 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Ventriculoperitoneal shunt, left Kocher, medi... 開立醫師: 游健生 開立時間: 2012/03/05 15:30 Pre-operative Diagnosis Hydrocephalus Post-operative Diagnosis Hydrocephalus Operative Method Ventriculoperitoneal shunt, left Kocher, medium pressure Specimen Count And Types 1 piece About size:3cc Source:CSF Pathology Nil Operative Findings Clear CSF gushed out after ventriculostomy. The opening pressure was about 10cmH2O. The ventricle catheter was 7cm in length and peritoneal catheter was about 25cm. A Medtronic medium-pressure shunt valve was used. Operative Procedures Under ETGA, patient was in supine position with head rotated to right and left shoulder elevated. After shaving, we disinfected and draped the operation field as usual. A curved scalp incision was made at left Kocher region. After elevated the scalp flap, a burhole was made followed by dura tenting. A cruciated durotomy was made followed by coagulation. We made a ventriculostomy and inserted a ventricle catheter. A LUQ abdominal incision was made followed by dissection. After opening the peritoneum, a peritoneal catheter was inserted into peritoneal cavity. Its proximal end was passed upward to left parietal region via a subcutaneous tract. A stab wound was created as re-lay point. The VP shunt was assembled to Medtronic medium pressure shunt valve. After hemostasis, wounds were closed in layers. Operators Prof. 杜永光 Assistants R6鍾文桂 R4游健生 PGY白晏瑋 相關圖片 賴月嬌 (F,1962/08/23,49y6m) 手術日期 2012/03/05 手術主治醫師 林昌平 手術區域 西址 031房 09號 診斷 Nodular lymphoma, unspecified site, extranodal solid organ sites 器械術式 IVI 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 14:20 進入手術室 14:22 麻醉開始 14:24 手術開始 14:26 手術結束 14:26 麻醉結束 14:28 送出病患 記錄__ 手術科部: 眼科部 套用罐頭: IVIA 開立醫師: 林昌平 開立時間: 2012/03/05 14:27 Pre-operative Diagnosis Lymphoma(OU) Post-operative Diagnosis Ditto Operative Method Intravitreal Injection Of MTX(OU) Specimen Count And Types nil Pathology nil Operative Findings nil Operative Procedures 1.Under topical anesthesia. 2.Disinfection and draping as usual. 3.Apply an eyelid speculum. 4.Intravitreal injection of MTX 0.05ml 5.Check leakage 6.Iop measurement by digit 7.Check bare VA>ND100cm Operators 林昌平, Assistants 蘇乾嘉, 洪茄倚 (F,2005/11/13,6y4m) 手術日期 2012/03/05 手術主治醫師 李崇維 手術區域 東址 000房 號 診斷 Moyamoya disease 器械術式 Common Carotid Angiography 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃慧薰 ASA 3 時間資訊 09:05 麻醉開始 09:15 誘導結束 09:55 麻醉結束 12:00 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 吳瑋萍 (F,1979/11/08,32y4m) 手術日期 2012/03/05 手術主治醫師 林昌平 手術區域 西址 031房 08號 診斷 Acute lymphoid leukemia 器械術式 IVI 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 蘇乾嘉, 時間資訊 14:00 進入手術室 14:02 麻醉開始 14:04 手術開始 14:08 手術結束 14:08 麻醉結束 14:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 玻璃體空氣液體交換術 1 2 B 記錄__ 手術科部: 眼科部 套用罐頭: IVIA 開立醫師: 林昌平 開立時間: 2012/03/05 14:13 Pre-operative Diagnosis ALL Post-operative Diagnosis Ditto Operative Method Intravitreal Injection Of Cymevene(OU) Specimen Count And Types nil Pathology nil Operative Findings nil Operative Procedures 1.Under topical anesthesia. 2.Disinfection and draping as usual. 3.Apply an eyelid speculum. 4.Intravitreal injection of Cymevene 0.05ml 5.Check leakage 6.Iop measurement by digit 7.Check bare VA>ND100cm Operators 林昌平, Assistants 蘇乾嘉, 洪茄倚 (F,2005/11/13,6y4m) 手術日期 2012/03/06 手術主治醫師 郭夢菲 手術區域 兒醫 067房 01號 診斷 Moyamoya disease 器械術式 EDAS, right 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 黃信豪 ASA 3 紀錄醫師 游健生, 時間資訊 10:25 進入恢復室 00:00 臨時手術NPO 07:59 報到 08:03 進入手術室 08:10 麻醉開始 08:40 誘導結束 09:00 抗生素給藥 09:36 手術開始 12:00 抗生素給藥 13:40 麻醉結束 13:40 手術結束 13:47 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 朴卜勒氏血流測定（週邊血管） 1 0 手術 顱內外血管吻合術 1 1 R 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 3 0 摘要__ 手術科部: 外科部 套用罐頭: Right fronto-temporal craniotomy for encephal... 開立醫師: 游健生 開立時間: 2012/03/06 14:31 Pre-operative Diagnosis Moyamoya disease, status post left EDAS Post-operative Diagnosis Moyamoya disease, status post left EDAS, status post right EDAS Operative Method Right fronto-temporal craniotomy for encephalo-duro-arteriosynangiosis Specimen Count And Types nil Pathology Nil Operative Findings An 8cm superficial temporal artery with surrounding soft tissue was isolated and put over the cortical artery at frontal lobe. Operative Procedures Under ETGA, patient was in supine position with head rotated to left. After shaving, we mapped the superficial temporal artery by Doppler at scalp. After disinfection and draping, we made a 7-shape scalp incision at fronto-temporal region. Under microscope, the scalp flap was elevated without galea to expose STA. Then, the STA was isolated with surround soft tissue from galea sacrificing the anterior branch. The temporalis muscle was splitted in half and dissected away from skull subperiosteally. After a burhole at frontal and temporal bone, an elliptical craniotomy was done. Dura tenting along craniotomy window was performed followed by an H-saphe durotomy. We identified a cortical artery at frontal lobe and opened the arachnoid membrane over it. Then, the STA graft was anchored to dura so that it can lay over the cortical artery with good contact. An DuraForm was put underneath the dura as on-lay graft. The dura was closed with 4-0 Prolene by continous suture leaving a space for STA graft to enter and exit the subdural space. After central tenting, bone flap was fixed back with micro-plates. The temporalis muscle was approximated. Wound was closed in layers with Vicryl and Nylon. dura tenting along craniotomy windowdura tenting along craniotomy window Operators VS 郭夢菲 Assistants R4 游健生 Ri 賴彥伶 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: Right fronto-temporal craniotomy for encephal... 開立醫師: 郭夢菲 開立時間: 2012/03/06 15:32 Pre-operative Diagnosis Moyamoya disease, status post left EDAS Post-operative Diagnosis Moyamoya disease, status post left EDAS, status post right EDAS Operative Method Right fronto-temporal craniotomy for indirect EC-IC bypass (encephalo-duro-arteriosynangiosis) Specimen Count And Types nil Pathology Nil Operative Findings An 8cm superficial temporal artery with surrounding soft tissue was put over the cortical artery at frontal lobe. The cortical branch was well exposed along its way and had a good contact with the STA flap There were profound menigeal collateral branches Operative Procedures Under ETGA, patient was in supine position with head rotated to left. After shaving, we mapped the superficial temporal artery by Doppler at scalp. After disinfection and draping, we made a long Hockey stick-shape scalp incision at fronto-temporal region. Under microscope, the scalp flap was elevated without galea to expose STA. Then, the STA was isolated with surround soft tissue from galea sacrificing the anterior branch. The temporalis muscle was splitted in half and dissected away from skull subperiosteally. After a burhole at frontal and temporal bone, an elliptical craniotomy was done. Dura tenting along craniotomy window was performed followed by an H-shape durotomy. We identified a cortical artery at frontal lobe and opened the arachnoid membrane over it. Then, the STA graft was anchored to dura at its posterior side for two stitches, so that it can lay over the cortical artery with good contact. An DuraGen was put underneath the dura as on-lay graft. The dura was closed with 4-0 Prolene by continous suture leaving a space for STA graft to enter and exit the subdural space. After central tenting, bone flap was fixed back with micro-plates. The temporalis muscle was approximated. Wound was closed in layers with Vicryl and Nylon. Operators VS 郭夢菲 Assistants R4 游健生 Ri 賴彥伶 相關圖片 耿杰 (M,1976/09/04,35y6m) 手術日期 2012/03/06 手術主治醫師 林峰盛 手術區域 西址 035房 04號 診斷 Postlaminectomy syndrome, lumbar region 器械術式 Nerve block / PC 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 靜脈麻醉 麻醉主治醫師 林文瑛 ASA 2 時間資訊 13:45 進入手術室 13:50 麻醉開始 14:00 手術開始 14:00 誘導結束 14:15 手術結束 14:15 麻醉結束 14:20 送出病患 14:30 進入恢復室 15:30 離開恢復室 醫令資訊 類別 名稱 量 刀 側 手術 末稍神經阻斷術 1 0 L 手術 末稍神經阻斷術 1 0 L 記錄__ 手術科部: 麻醉部 套用罐頭: RF lesioning 開立醫師: 林怡萱 開立時間: 2012/03/06 14:18 Pre-operative Diagnosis low back pain lumbar spondylosis Post-operative Diagnosis low back pain lumbar spondylosis Operative Method RF lesioning Specimen Count And Types Pathology Nil Operative Findings Operative Procedures 1.LA with 1%xylocaine. 2.patient in prone position 3. Under fluoroscopic-guidance, LEFT L3-4 facet block with 0.5% Marcaine 1ml+ rinderon 2.5 mg per joint Operators 林文瑛, Assistants 林怡萱, 郭環 (F,1946/12/16,65y2m) 手術日期 2012/03/06 手術主治醫師 周介仁 手術區域 東址 011房 02號 診斷 Cataract 器械術式 Phaco+PCIOL 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 09:35 進入手術室 10:00 手術開始 10:30 手術結束 10:35 送出病患 記錄__ 手術科部: 眼科部 套用罐頭: Phaco-Temporal (周介仁) 開立醫師: 許詠瑞 開立時間: 2012/03/06 10:24 Pre-operative Diagnosis Cataract (os) Post-operative Diagnosis Cataract (os) Operative Method Phacoemulsification and PCIOL implantation (os) Specimen Count And Types nil Pathology Nil Operative Findings Cataract (os) Operative Procedures 1. Under peribulbar anesthesia 2. Disinfection, irrigation and draping. 3. Application of an eyelid speculum. 4. Made a clear corneal incision and penetrate into AC with 2.5mm cresent knife at 3 oclock position . 5. Inject Viscoat into the anterior chamber. 6. Continuous circular capsulorrhexis was done with capsular forceps. 7. Made a sideport at 5 oclock position with the MVR blade. 8. Hydrodissection and hydrodelineation were done with BSS. 9. Phacoemulsification of the nucleus by standard divide-and-conquer technique. 10. Aspiration of the residual cortical material with I/A cannula. 11. One-piece PCIOL was implanted into the bag after injection of Viscoat. 12. The residual Viscoat was washedout by Simcoe I/A cannula. 13. Inject BSS into AC and check leakage. 14. Subconjunctival injection of Rinderon and Gentamicin. 15. Maxitrol patching Operators 周介仁, Assistants 許詠瑞, 陳林瑞月 (F,1936/09/01,75y6m) 手術日期 2012/03/07 手術主治醫師 張道遠 手術區域 兒醫 063房 03號 診斷 Stress urinary incontinence 器械術式 Cystoplasty+Anterior-Posterior colporrhaphy 手術類別 預定手術 手術部位 腹 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 林子富 ASA 3 紀錄醫師 陳瓏仁, 時間資訊 11:18 報到 11:33 進入手術室 11:35 麻醉開始 11:40 誘導結束 11:50 抗生素給藥 11:57 手術開始 13:30 手術結束 13:30 麻醉結束 13:35 進入恢復室 13:35 送出病患 14:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 膀胱成形術或膀胱尿道成形術 1 1 手術 前後側陰道縫合術 1 2 記錄__ 手術科部: 婦產部 套用罐頭: Trans-vaginal pelvic floor repair with mesh i... 開立醫師: 陳瓏仁 開立時間: 2012/03/07 16:07 Pre-operative Diagnosis 1. Cystocole, grade II. 2. Rectocele, grade II. Post-operative Diagnosis 1. Cystocole, grade II. 2. Rectocele, grade II. Operative Method Trans-vaginal pelvic floor repair with mesh insertion, anterior and posterior colporraphy, and perineorrhaphy. Specimen Count And Types 1 piece, about size: 3*2*1 cm, source: anterior and posterior vaginal walls. Pathology Pending. Operative Findings 1. Cystocele, grade II. 2. Rectocele, grade II. 3. Estimated blood loss: 200 mL, Blood transfusion: nil, Complication: nil. Operative Procedures 1. Put the patient on lithotomy position. 2. Vaginal douching and skin disinfection. 3. Submucosal injection of diluted Pitressin (1:100) into anterior vaginal wall. 4. Make incision on the anterior vaginal mucosa. 5. Dissect the vesico-vaginal space and identify bilateral white line. 6. Push the bladder upward. 7. Insert Foley catheter. 8. Suspend the vaginal stump to bilateral white line, with mesh insertion. 9. Remove partial anterior vaginal mucosa. 10. Repair the anterior vaginal wall with 1-0 Vicryl continuously. 11. Inject diluted Pitressin (1:100) into posterior vaginal wall. 12. Make posterior vaginal incision and dissect the utero-rectal space. 13. Make transverse incision of perineal region. 14. Remove partial posterior vaginal mucosa. 15. Suture the incision wound as episiotomy wound with 3-0 Vicryl. 16. Insert one vaginal gauze. Operators 張道遠 Assistants R3陳瓏仁, Ri郭曉佩 相關圖片 賴月嬌 (F,1962/08/23,49y6m) 手術日期 2012/03/08 手術主治醫師 林昌平 手術區域 西址 031房 19號 診斷 Nodular lymphoma, unspecified site, extranodal solid organ sites 器械術式 IVI 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 時間資訊 16:16 進入手術室 16:17 麻醉開始 16:18 手術開始 16:20 手術結束 16:20 麻醉結束 16:25 送出病患 記錄__ 手術科部: 眼科部 套用罐頭: IVIA 開立醫師: 林昌平 開立時間: 2012/03/08 16:23 Pre-operative Diagnosis Lymphoma Post-operative Diagnosis Ditto Operative Method Intravitreal Injection Of MTX(OU) Specimen Count And Types nil Pathology nil Operative Findings nil Operative Procedures 1.Under topical anesthesia. 2.Disinfection and draping as usual. 3.Apply an eyelid speculum. 4.Intravitreal injection of MTX 0.05ml 5.Check leakage 6.Iop measurement by digit 7.Check bare VA>ND100cm Operators 林昌平, Assistants 謝旻瑾, 吳瑋萍 (F,1979/11/08,32y4m) 手術日期 2012/03/08 手術主治醫師 林昌平 手術區域 西址 031房 15號 診斷 Acute lymphoid leukemia 器械術式 IVI 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 謝旻瑾, 時間資訊 15:40 進入手術室 15:41 麻醉開始 15:43 手術開始 15:45 手術結束 15:47 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 玻璃體空氣液體交換術 1 2 L 記錄__ 手術科部: 眼科部 套用罐頭: IVIA 開立醫師: 林昌平 開立時間: 2012/03/08 15:48 Pre-operative Diagnosis ALL Post-operative Diagnosis Ditto Operative Method Intravitreal Injection Of Cymevene(OS) Specimen Count And Types nil Pathology nil Operative Findings nil Operative Procedures 1.Under topical anesthesia. 2.Disinfection and draping as usual. 3.Apply an eyelid speculum. 4.Intravitreal injection of Cymevene 0.05ml 5.Check leakage 6.Iop measurement by digit 7.Check bare VA>ND100cm Operators 林昌平, Assistants 謝旻瑾, 黃靖安 (M,1979/05/17,32y9m) 手術日期 2012/03/09 手術主治醫師 張金池 手術區域 西址 034房 04號 診斷 Malignant neoplasm of cerebrum, except lobes and ventricles 器械術式 Tracheostomy 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔污染 麻醉方式 全身麻醉 麻醉主治醫師 洪明輝 ASA 3 紀錄醫師 施廷翰, 時間資訊 00:00 臨時手術NPO 09:37 報到 09:38 進入手術室 09:40 麻醉開始 09:42 誘導結束 09:50 抗生素給藥 09:52 手術開始 10:05 麻醉結束 10:05 手術結束 10:10 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 氣管切開術 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 記錄__ 手術科部: 外科部 套用罐頭: Tracheostomy 開立醫師: 施廷翰 開立時間: 2012/03/09 10:13 Pre-operative Diagnosis Respiratory failure Post-operative Diagnosis Respiratory failure Operative Method Tracheostomy Specimen Count And Types nil Pathology None Operative Findings Fr. 8 low pressure cuffed tube inserted via 2nd cartilage of trachea smoothly. Operative Procedures After endotracheal tube general anesthesia, supine position is made with shoulder elevation. Local anesthesia is injected with xylocain to the subcutaneous layer. A longitudinal incision approximately 2cm is made 2 finger wide below the thyroid cartilage. It carried through the skin, subcutaneous tissue, and plastysma muscle. The strap muscles are split longitudinally and the pre-tracheal fascia is identified. The thyoid isthmus is also divided. Tracheotomy is made at the level of 2nd ring of cartilage. Following suction of the tracheal secretions, a low pressure cuffed tracheotomy tube is inserted with an inner cannula in place. Once the tube is passed into the trachea, the inner cannula is removed and the tubeis fixed in place by tying umbilical tape around the neck and attaching it on either side of the tracheotomy tube. Check bleeding and close the wound with 3-0 nylon. Operators 張金池 Assistants 郝政鴻 陳心言 蘇靖淳 (F,1998/03/15,13y11m) 手術日期 2012/03/09 手術主治醫師 郭耿南 手術區域 東址 022房 01號 診斷 Chromosomal anomalies 器械術式 Bil PB release, calcaneal lengthening, TN fusion 手術類別 預定手術 手術部位 四肢 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 劉漢平 ASA 3 紀錄醫師 張之嚴, 時間資訊 08:00 進入手術室 08:05 麻醉開始 08:10 誘導結束 08:15 抗生素給藥 08:50 手術開始 12:25 手術結束 12:25 麻醉結束 12:30 送出病患 12:40 進入恢復室 13:45 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 手術 骨內翻外翻 2 1 B 手術 肌腱切開或筋膜切開 2 2 B 手術 肌腱放長術 2 4 B 手術 石膏固定－短腿 2 0 B 摘要__ 手術科部: 骨科部 套用罐頭: Bilateral 開立醫師: 張之嚴 開立時間: 2012/03/09 13:02 Pre-operative Diagnosis Talipes equinovarus, bilateral feet Post-operative Diagnosis Talipes equinovarus, bilateral feet, status post Bilateral Vulpius procedure, peroneus brevis release, calcaneal lengthening, and Talonavicular joint fixation Operative Method Bilateral 1. Vulpius procedure 2. Peroneus brevis release 3. Calcaneal lengthening 4. Talonavicular joint fixation Specimen Count And Types nil Pathology nil Operative Findings Bilateral Achellis tendons tightening. Bilateral pronated feet deformity. Operative Procedures 1. General anesthesia, supine. Disinfection, draping, on tourniquet. 2. Perform Vulpius procedure over posterior aspect of lower calf to release the gastrocnemius muscle tendon. 3. Perform peroneus brevis release over lateral aspect of lower calf. 4. Perform calcaneal lengthening over lateral aspect of heel: calcaneal open-wedge osteotomy with allograft. Fixation with 40mm cannulated screw*1. 5. Perform talonavicular joint fixation over medial aspect of foot: Reduction of the joint and fixation with staple*1. 6. Normal saline irrigation. Close the wound in layers. 7. Repeat above procedures over contralateral side. 8. On short leg cast, bilateral. Operators 郭耿南, 吳冠 Assistants 黃哲南, 張之嚴 記錄__ 手術科部: 骨科部 套用罐頭: Bilateral 開立醫師: 張之嚴 開立時間: 2012/03/09 13:02 Pre-operative Diagnosis Talipes equinovarus, bilateral feet Post-operative Diagnosis Talipes equinovarus, bilateral feet, status post Bilateral Vulpius procedure, peroneus brevis release, calcaneal lengthening, and Talonavicular joint fixation Operative Method Bilateral 1. Vulpius procedure 2. Peroneus brevis release 3. Calcaneal lengthening 4. Talonavicular joint fixation Specimen Count And Types nil Pathology nil Operative Findings Bilateral Achellis tendons tightening. Bilateral pronated feet deformity. Operative Procedures 1. General anesthesia, supine. Disinfection, draping, on tourniquet. 2. Perform Vulpius procedure over posterior aspect of lower calf to release the gastrocnemius muscle tendon. 3. Perform peroneus brevis release over lateral aspect of lower calf. 4. Perform calcaneal lengthening over lateral aspect of heel: calcaneal open-wedge osteotomy with allograft. Fixation with 40mm cannulated screw*1. 5. Perform talonavicular joint fixation over medial aspect of foot: Reduction of the joint and fixation with staple*1. 6. Normal saline irrigation. Close the wound in layers. 7. Repeat above procedures over contralateral side. 8. On short leg cast, bilateral. Operators 郭耿南, 吳冠 Assistants 黃哲南, 張之嚴 林尚安 (M,1956/12/17,55y2m) 手術日期 2012/03/12 手術主治醫師 賴達明 手術區域 東址 003房 01號 診斷 Spinal cord metastasis 器械術式 Spinal fusion posterior 手術類別 預定手術 手術部位 脊椎 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 林佩玲 ASA 3 紀錄醫師 蔡宗良, 時間資訊 00:00 臨時手術NPO 07:40 報到 08:00 進入手術室 08:10 麻醉開始 08:30 誘導結束 08:50 手術開始 09:00 抗生素給藥 12:00 抗生素給藥 14:15 手術結束 14:15 麻醉結束 14:25 送出病患 14:30 進入恢復室 15:40 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 4 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 4 0 麻醉 Peripheral arterial line inserti 1 0 麻醉 C.V.P. catheter in ubation 1 0 麻醉 Lactic Acid (lactate) 2 0 麻醉 動脈血液檢查全套 2 0 麻醉 Hemoglobin (Hb) 2 0 麻醉 測血糖 2 0 麻醉 Ca (Calcium) 2 0 麻醉 Na (Sodium) 2 0 麻醉 K (Potassium) 2 0 麻醉 Blood gas analysis 2 0 手術 惡性脊髓腫瘤切除術 1 1 手術 脊椎融合術-後融合,有固定物(<=六節) 1 2 摘要__ 手術科部: 外科部 套用罐頭: 1. Laminectomy for epidural tumor removal, C7... 開立醫師: 蔡宗良 開立時間: 2012/03/12 14:55 Pre-operative Diagnosis Metastatic epidural spinal cord compression, T1 Post-operative Diagnosis Metastatic epidural spinal cord compression, T1 Operative Method 1. Laminectomy for epidural tumor removal, C7, T2, T3 2. Posterior instrumentation, TPS, LMS, rod, cross linkage at C6, C7, T2, T3 Specimen Count And Types 1 piece About size:小 Source:epidural tumor Pathology Report pending Operative Findings 1. Greyish, fragile, hypervascular tumor at dorsal epidural space at T1, and T3 2. Lateral mass screw at bilateral C6 with 14mm to the right and 16 mm to the left 3. Transpedicular screw for C7 with 24mm to the right and 30mm to the left 4. Transpedicular screw for T2 and T3 are 4.0 x 30 mm bilaterally 5. Transitional rod with thin segment at the cervical spine and thick segment at the thoracic spine Operative Procedures 1. ETGA, Mayfield fixation, and prone positioning 2. Routine preparation 3. Linear wound incision from C5 to T3, followed by subperiosteal dissection 4. Posterior instrumentation with lateral mass, transpedicular screws 5. Laminectomy from C7 to T2 6. Removal of epidural tumor 7. Rod modeling and fixation 8. Cross-linkage fixation 9. HV placement bilaterally 10. Hemostasis and gentamicin saline irrigation 11. Wound was closed in layers. Operators VS 賴達明 Assistants R6 蔡宗良 相關圖片 記錄__ 手術科部: 外科部 套用罐頭: 1. Laminectomy for epidural tumor removal, C7... 開立醫師: 蔡宗良 開立時間: 2012/03/12 14:56 Pre-operative Diagnosis Metastatic epidural spinal cord compression, T1 Post-operative Diagnosis Metastatic epidural spinal cord compression, T1 Operative Method 1. Laminectomy for epidural tumor removal, C7, T2, T3 2. Posterior instrumentation, TPS, LMS, rod, cross linkage at C6, C7, T2, T3 Specimen Count And Types 1 piece About size:小 Source:epidural tumor Pathology Report pending Operative Findings 1. Greyish, fragile, hypervascular tumor at dorsal epidural space at T1, and T3 2. Lateral mass screw at bilateral C6 with 14mm to the right and 16 mm to the left 3. Transpedicular screw for C7 with 24mm to the right and 30mm to the left 4. Transpedicular screw for T2 and T3 are 4.0 x 30 mm bilaterally 5. Transitional rod with thin segment at the cervical spine and thick segment at the thoracic spine Operative Procedures 1. ETGA, Mayfield fixation, and prone positioning 2. Routine preparation 3. Linear wound incision from C5 to T3, followed by subperiosteal dissection 4. Posterior instrumentation with lateral mass, transpedicular screws 5. Laminectomy from C7 to T2 6. Removal of epidural tumor 7. Rod modeling and fixation 8. Cross-linkage fixation 9. HV placement bilaterally 10. Hemostasis and gentamicin saline irrigation 11. Wound was closed in layers. Operators VS 賴達明 Assistants R6 蔡宗良 相關圖片 吳瑋萍 (F,1979/11/08,32y4m) 手術日期 2012/03/12 手術主治醫師 林昌平 手術區域 西址 034房 05號 診斷 Acute lymphoid leukemia 器械術式 IVI-Cymevene 手術類別 預定手術 手術部位 頭、頸 傷口分類 清潔 麻醉方式 局部麻醉 麻醉主治醫師 ASA 1 紀錄醫師 蘇乾嘉, 時間資訊 15:11 報到 15:11 進入手術室 15:12 麻醉開始 15:13 麻醉結束 15:15 手術開始 15:20 手術結束 15:21 送出病患 醫令資訊 類別 名稱 量 刀 側 手術 玻璃體空氣液體交換術 1 1 B 記錄__ 手術科部: 眼科部 套用罐頭: IVIA 開立醫師: 林昌平 開立時間: 2012/03/12 15:17 Pre-operative Diagnosis ALL Post-operative Diagnosis Ditto Operative Method Intravitreal Injection Of ACymevene(OU) Specimen Count And Types nil Pathology nil Operative Findings nil Operative Procedures 1.Under topical anesthesia. 2.Disinfection and draping as usual. 3.Apply an eyelid speculum. 4.Intravitreal injection of Cymevene 0.05ml 5.Check leakage 6.Iop measurement by digit 7.Check bare VA>ND100cm Operators 林昌平, Assistants 蘇乾嘉, 林秉毅 (M,1987/07/27,24y7m) 手術日期 2012/03/12 手術主治醫師 戴槐青 手術區域 東址 015房 02號 診斷 Hernia 器械術式 Herniorrhaphy 手術類別 預定手術 手術部位 腹 傷口分類 清潔 麻醉方式 全身麻醉 麻醉主治醫師 葉惠敏 ASA 2 紀錄醫師 張奕凱, 時間資訊 10:15 報到 10:27 進入手術室 10:30 麻醉開始 10:40 誘導結束 10:45 抗生素給藥 10:53 手術開始 12:45 手術結束 12:45 麻醉結束 12:50 送出病患 12:53 進入恢復室 14:50 離開恢復室 醫令資訊 類別 名稱 量 刀 側 麻醉 POST-ANESTHESIA RECOVERY CARE 1 0 麻醉 PRE-ANESTHESIA EVALUATION 1 0 麻醉 SEMI-CLOSED INTRATRACHEAL INTUBA 1 0 麻醉 G-anesthesia (2-4 hours,each 30 1 0 手術 鼠蹊疝氣修補術-無腸切除 1 1 R 摘要__ 手術科部: 泌尿部 套用罐頭: herniorrhaphy, inguinal 開立醫師: 張奕凱 開立時間: 2012/03/12 12:53 Pre-operative Diagnosis right side inguinal hernia Post-operative Diagnosis right side inguinal hernia Operative Method right herniorrhpahy with MESH Specimen Count And Types 1 piece About size:4*6 cm Source:hernia sac Pathology pending Operative Findings 1. Sac from internal inguinal ring, indirect sac Operative Procedures 1. Under satisfactory spinal anesthesia with the patient in supine position. 2. Prepping and draping was performed in the usual sterile fashion. 3. An inguinal oblique incision was made in the left inguinal area. 4. The wound was deepened through layers into inguinal canal. 5. The spermatic cord was mobilized, and an indirect sac was noted. 6. The hernia sac was isolated from spermatic cord. 7. Ligation and transection of the hernia sac near the the internal inguinal ring was performed. 8. Posterior wall repair with interrupted 1-O nylon was performed to approximate the conjoin ligment, transverse abdominal fascia and the shelfing portion of the inguinal ligament. ( Bassini's method or Mesh). 9. After adequate hemostasis was obtained, the wound was closed in layers with 3-O silk on the external oblique fascia and 3-O chromic on the Scarpa's fascia. Skin was closed with interrupted 3-O nylon mattress stitches. 10. The patient tolerated the procedure very well, and was sent to the recovery room insatisfactory condition. The sponge count was correct and blood loss was minimal. Operators 戴槐青, Assistants 張奕凱, Int 鄭勝允 記錄__ 手術科部: 泌尿部 套用罐頭: herniorrhaphy, inguinal 開立醫師: 張奕凱 開立時間: 2012/03/12 12:53 Pre-operative Diagnosis right side inguinal hernia Post-operative Diagnosis right side inguinal hernia Operative Method right herniorrhpahy with MESH Specimen Count And Types 1 piece About size:4*6 cm Source:hernia sac Pathology pending Operative Findings 1. Sac from internal inguinal ring, indirect sac Operative Procedures 1. Under satisfactory spinal anesthesia with the patient in supine position. 2. Prepping and draping was performed in the usual sterile fashion. 3. An inguinal oblique incision was made in the left inguinal area. 4. The wound was deepened through layers into inguinal canal. 5. The spermatic cord was mobilized, and an indirect sac was noted. 6. The hernia sac was isolated from spermatic cord. 7. Ligation and transection of the hernia sac near the the internal inguinal ring was performed. 8. Posterior wall repair with interrupted 1-O nylon was performed to approximate the conjoin ligment, transverse abdominal fascia and the shelfing portion of the inguinal ligament. ( Mesh). 9. After adequate hemostasis was obtained, the wound was closed in layers with 3-O silk on the external oblique fascia and 3-O chromic on the Scarpa''s fascia. Skin was closed with interrupted 3-O nylon mattress stitches. 10. The patient tolerated the procedure very well, and was sent to the recovery room insatisfactory condition. The sponge count was correct and blood loss was minimal. Operators 戴槐青, Assistants 張奕凱, Int 鄭勝允